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Jerold Phelps Community Hospital Standard Charges Listing – September 2023
Download as Spreadsheet| Description | Price |
|---|---|
| IMM ADMIN PFIZER BIVALENT 30 MCG/.3ML AGE 12+ (ADDITIONAL DOSE) | $0.00 |
| INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $329.19 |
| INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $342.70 |
| INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE | $593.75 |
| INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE | $686.72 |
| INCISION & DRAINAGE PILONIDAL CYST SIMPLE | $524.06 |
| INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $457.93 |
| INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $483.35 |
| INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL | $1,047.19 |
| I&D HEMATOMA SEROMA/FLUID COLLECTION | $565.46 |
| PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST | $369.15 |
| PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST | $414.35 |
| DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF | $139.27 |
| DBRDMT FX&/DISLC SUBQ T/M/F BONE | $1,889.28 |
| DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< | $134.67 |
| DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< | $278.47 |
| DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< | $759.58 |
| PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 | $80.85 |
| TANGENTIAL BIOPSY SKIN SINGLE LESION | $335.51 |
| TANGENTIAL BIOPSY SKIN SINGLE LESION | $137.20 |
| TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION | $181.07 |
| TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION | $78.66 |
| PUNCH BIOPSY SKIN SINGLE LESION | $422.11 |
| PUNCH BIOPSY SKIN SINGLE LESION | $171.81 |
| PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION | $207.69 |
| PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION | $93.27 |
| INCISIONAL BIOPSY SKIN SINGLE LESION | $511.29 |
| INCISIONAL BIOPSY SKIN SINGLE LESION | $209.07 |
| INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION | $245.01 |
| INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION | $111.84 |
| REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $212.52 |
| REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $261.57 |
| SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< | $223.68 |
| SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< | $125.81 |
| SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM | $383.41 |
| SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM | $442.75 |
| SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM | $442.75 |
| SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM | $387.67 |
| SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< | $200.56 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< | $329.19 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM | $457.93 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM | $465.18 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM | $561.89 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM | $597.08 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM | $659.64 |
| EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM | $659.64 |
| EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM | $789.94 |
| EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< | $289.46 |
| EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< | $285.20 |
| EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM | $480.24 |
| EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM | $537.40 |
| EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< | $447.35 |
| EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< | $588.23 |
| EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM | $635.78 |
| EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/< | $632.73 |
| EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM | $696.79 |
| EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM | $801.78 |
| EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM | $987.28 |
| TRIMMING NONDYSTROPHIC NAILS ANY NUMBER | $73.43 |
| DEBRIDEMENT NAIL ANY METHOD 1-5 | $64.52 |
| DEBRIDEMENT NAIL ANY METHOD 6/> | $159.51 |
| AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $234.89 |
| AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $234.89 |
| EVACUATION SUBUNGUAL HEMATOMA | $107.99 |
| EVACUATION SUBUNGUAL HEMATOMA | $107.99 |
| EXCISION NAIL MATRIX PERMANENT REMOVAL | $499.68 |
| EXCISION NAIL MATRIX PERMANENT REMOVAL | $598.35 |
| REPAIR NAIL BED | $435.45 |
| WEDGE EXCISION SKIN NAIL FOLD | $214.13 |
| INSERTION DRUG DELIVERY IMPLANT | $338.56 |
| REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT | $230.69 |
| RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT | $449.19 |
| HC SEMI-PRIVATE ROOM DAILY SWING | |
| HC SEMI-PRIVATE ROOM DAILY SKILLED NURSING | |
| SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $519.11 |
| SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $519.11 |
| SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $626.87 |
| SIMPLE RSCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM | $776.48 |
| SMPL RSCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM | $819.78 |
| SMPL RSCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM | $855.54 |
| SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $520.61 |
| SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $626.87 |
| SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM | $580.46 |
| SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM | $734.51 |
| SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM | $682.12 |
| SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM | $949.96 |
| REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $567.07 |
| REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM | $730.08 |
| REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM | $822.71 |
| REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM | $1,041.61 |
| REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM | $965.31 |
| REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< | $628.25 |
| REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM | $746.47 |
| REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM | $831.85 |
| REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< | $746.47 |
| REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM | $700.12 |
| REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM | $824.26 |
| REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM | $1,314.85 |
| HC DAILY ROOM RATE SEMI PRIVATE ACUITY LVL 1 | |
| HC DAILY ROOM RATE SEMI PRIVATE ACUITY LVL 2 | |
| REPAIR COMPLEX TRUNK 2.6-7.5 CM | $874.69 |
| REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM | $1,147.24 |
| REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< | $510.03 |
| REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM | $873.66 |
| REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM | $1,355.28 |
| REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< | $442.92 |
| REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM | $1,099.46 |
| ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM | $2,331.74 |
| FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/< | $2,758.39 |
| APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25 | $258.41 |
| INITIAL TX 1ST DEGREE BURN LOCAL TX | $239.43 |
| DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL | $320.28 |
| DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM | $605.94 |
| DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE | $559.25 |
| DESTRUCTION PREMALIGNANT LESION 1ST | $173.77 |
| DESTRUCTION PREMALIGNANT LESION 2-14 EA | $40.48 |
| DESTRUCTION BENIGN LESIONS UP TO 14 | $194.70 |
| DESTRUCTION BENIGN LESIONS UP TO 14 | $393.88 |
| DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/< | $304.29 |
| HC ROOM RATE SNF BED HOLD/LOA | |
| HC ROOM RATE SWB BED HOLD/LOA | |
| EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK | $1,737.13 |
| EXPLORATION PENETRATING WOUND SPX EXTREMITY | $1,256.89 |
| INJECTION THERAPEUTIC CARPAL TUNNEL | $176.64 |
| INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $333.73 |
| INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $333.73 |
| INJECTION SINGLE TENDON ORIGIN/INSERTION | $334.02 |
| INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $333.73 |
| INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $333.73 |
| INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES | $333.73 |
| INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES | $226.49 |
| ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $212.52 |
| ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $248.46 |
| ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $220.00 |
| ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $282.90 |
| ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $260.36 |
| ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $260.36 |
| ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US | $234.89 |
| ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ | $195.62 |
| CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION | $709.09 |
| CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ | $109.14 |
| CLSD TX CLAVICULAR FRACTURE W/MANIPULATION | $1,439.23 |
| CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION | $1,296.68 |
| CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ | $1,727.65 |
| CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES | $954.39 |
| CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES | $1,543.76 |
| CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ | $1,348.66 |
| CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ | $1,771.29 |
| INCISION&DRAINAGE UPPER ARM/ELBOW BURSA | $549.93 |
| EXCISION OLECRANON BURSA | $1,213.94 |
| CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION | $1,075.54 |
| CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ | $1,695.10 |
| CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ | $1,937.06 |
| TREATMENT CLOSED ELBOW DISLOCATION W/O ANES | $1,379.20 |
| CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ | $444.25 |
| UNLISTED PROCEDURE HUMERUS/ELBOW | $452.70 |
| EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST | $1,408.52 |
| CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION | $1,806.88 |
| CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ | $1,405.88 |
| CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ | $1,074.10 |
| CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF | $1,959.43 |
| CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ | $1,620.81 |
| CLOSED TREATMENT ULNAR STYLOID FRACTURE | $1,067.89 |
| DRAINAGE FINGER ABSCESS SIMPLE | $510.03 |
| DRAINAGE FINGER ABSCESS COMPLICATED | $577.19 |
| HC IV INFUSION, HYDRATION, 31-60 MIN | $1,687.28 |
| HC IV INFUSION, HYDRATION, 31-60 MIN | $1,687.28 |
| HC IV INFUSION, HYDRATION, EA ADD HOUR | $869.06 |
| HC IV INFUSION, HYDRATION, EA ADD HOUR | $869.06 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR | $779.36 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR | $779.36 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR | $572.99 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR | $572.99 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR | $182.62 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR | $182.62 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION | $316.83 |
| HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION | $316.83 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT | $291.75 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT | $291.76 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG | $362.25 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG | $362.25 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG | $281.41 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG | $281.41 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG | $259.04 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG | $259.04 |
| HC BEBTELOVIMAB INJECTION | $403.08 |
| REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH | $1,794.81 |
| CLTX METACARPAL FX W/O MANIPULATION EACH BONE | $951.97 |
| CLTX METACARPAL FX W/MANIPULATION EACH BONE | $1,268.51 |
| CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ | $1,241.31 |
| CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA | $571.44 |
| CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA | $1,268.51 |
| CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ | $1,627.14 |
| CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA | $1,171.28 |
| CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA | $931.96 |
| OPEN TX DISTAL PHALANGEAL FRACTURE EACH | $1,440.61 |
| CLTX IPHAL JT DISLC W/MANJ W/O ANES | $915.52 |
| AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR | $2,307.71 |
| HC BANDAGE- ACE ELASTIC 4" | $43.59 |
| HC BANDAGE- ACE ELASTIC 3" | $31.51 |
| HC BANDAGE- ACE ELASTIC 6" | $31.51 |
| HC DERMABOND | $66.59 |
| HC RIB BELT UNIVERSAL | $32.03 |
| HC DRESS-TRANSPARENT 2X3 | $27.03 |
| HC DRESS-NONADHERING 3"X3" | $10.52 |
| HC DRESS-NONADHEARING 3"X8" | $16.56 |
| HC OCULAR IRRIG LENS MORGAN | $234.89 |
| HC BLANKET-BAIR HUGGER | $46.69 |
| HC RIB BELT UNISEX L | $46.69 |
| HC TEGADERM 3.5 X 4.5 | $25.42 |
| HC CATH-FOLEY SILICONE COUDE TIP 14FR | $97.41 |
| CLTX POST HIP ARTHRP DISLC W/O ANES | $1,427.38 |
| HC DRESS-HYDROCOLLOID 3X3 | $48.07 |
| HC DRESS-HYDROCOLLOID 4X4 | $25.42 |
| HC PACKING- IODOFORM 1/4" | $64.56 |
| HC BANDAGE-CONFORM 4" PER YARD | $13.57 |
| HC BANDAGE-CONFORM 3" PER YARD | $13.57 |
| HC BANDAGE-CONFORM 2" PER YARD | $13.57 |
| I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION | $1,738.69 |
| REMOVAL FOREIGN BODY DEEP THIGH/KNEE | $1,325.84 |
| HC SHLDER SLING OR VEST ADBUCT RESTRAIN W/WO SWATHE CTRL | $25.65 |
| HC TUBE-TRACH PEDIACTRIC 3.0 | $181.13 |
| HC COLLAR-CERVICAL SOFT | $47.15 |
| HC COLLAR-HARD ADULT | $128.80 |
| HC COLLAR-HARD INFANT/PEDI | $140.30 |
| HC CERV COLLAR SUPP ADJ CERV BA | $50.60 |
| HC KNEE ORTHO PRE FAB OTS W JOINTS | $329.71 |
| HC KO IMMOB CANVAS LONG PREFAB OFFSHELF | $329.71 |
| HC SANDAL-CAST | $128.80 |
| HC SHOULDER ORTHOSIS LARGE | $80.85 |
| HC SHOULDER ORTHOSIS CHILD | $23.98 |
| HC SPLINT-CLAVICLE | $37.32 |
| HC SPLINT-COLLES | $128.80 |
| HC BRACE-WRIST UNIV | $131.79 |
| HC SPLINT-ANKLE STIRRUP | $259.04 |
| HC NON-PNEUM WALK BOOT PRE OTS | $166.52 |
| CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ | $1,901.87 |
| CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA | $1,202.61 |
| UNLISTED PROCEDURE FEMUR/KNEE | $465.98 |
| CLTX TIBIAL SHAFT FX W/O MANIPULATION | $1,199.68 |
| CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ | $2,291.26 |
| CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION | $1,076.98 |
| CLTX PROX FIBULA/SHFT FX W/MANJ | $1,311.00 |
| CLTX DSTL FIBULAR FX LAT MALLS W/MANJ | $1,872.72 |
| CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ | $1,324.69 |
| CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION | $2,209.15 |
| CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ | $1,771.29 |
| CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA | $1,272.48 |
| REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS | $408.14 |
| CLOSED TX CALCANEAL FRACTURE W/MANIPULATION | $1,217.28 |
| CLOSED TX TALUS FRACTURE W/MANIPULATION | $879.41 |
| CLTX METAR FX W/MANJ | $700.35 |
| OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES | $1,376.55 |
| CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ | $517.67 |
| CLTX METATARSOPHLNGL JT DISLC W/O ANES | $418.89 |
| CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES | $457.24 |
| AMPUTATION TOE INTERPHALANGEAL JOINT | $2,173.39 |
| APPLICATION CAST ELBOW FINGER SHORT ARM | $308.32 |
| APPLICATION LONG ARM SPLINT SHOULDER HAND | $254.38 |
| APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC | $217.12 |
| APPLICATION SHORT ARM SPLINT DYNAMIC | $315.79 |
| APPLICATION FINGER SPLINT STATIC | $143.75 |
| HC CRUTCH UNDERARM PAIR | $238.05 |
| APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $281.41 |
| APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES | $324.70 |
| APPLICATION SHORT LEG SPLINT CALF FOOT | $209.30 |
| APPLICATION SHORT LEG SPLINT CALF FOOT | $210.97 |
| UNLISTED PROCEDURE CASTING/STRAPPING | $239.43 |
| HC MINIDOKA HEALTH FAIR PROFILE | $0.00 |
| HC KIT DRAW FROM EMPLOYEE | $0.00 |
| HC CHP BLOOD DRAW | $40.60 |
| HC KIT DRAW FROM PATIENT | $71.01 |
| HC DOT DRUG TESTING - DATCO | $104.20 |
| HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE | $50.95 |
| HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE | $50.95 |
| HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS | $48.07 |
| HC ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD | $112.36 |
| HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION | $218.62 |
| HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN | $251.16 |
| HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS | $2,182.70 |
| HC AQUAPORIN-4 ANTB CBA | $36.69 |
| HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS | $33.12 |
| HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH | $77.74 |
| HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN | $30.94 |
| HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - DIRECT ANTIGLOBULIN TEST | $22.08 |
| HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER | $17.25 |
| HC BLOOD TYPING SEROLOGIC ABO | $95.57 |
| HC BLOOD TYPING SEROLOGIC RH (D) | $146.91 |
| HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN | $118.34 |
| HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT - BLOOD TYPING, PAT | $118.34 |
| HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH - BLOOD TYPING, RBC | $12.82 |
| HC CROSSMATCH IMMEDIATE SPIN TECHNIQUE | $643.25 |
| HC COMPATIBILITY TEST ANTIGLOB TECH | $452.07 |
| HC COMPATIBILITY TEST ANTIGLOB TECH | $0.00 |
| HC COMPATIBILITY TEST ANTIGLOB TECH | $393.10 |
| HC HIV-1 ANTIGENS W/HIV 1 & 2 ANTIBODY | $98.90 |
| HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF | $22.71 |
| HC LEUKOCYTE COUNT,FECAL - FECAL LEUKOCYTES | $17.54 |
| HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL | $29.44 |
| HC SEMEN ANALYSIS POST VASECTOMY | $49.68 |
| HC LAB HANDLING CHARGE | $46.69 |
| HC RAY'S MARKET DRUG SCREEN | $50.80 |
| HC BASIC METABOLIC PANEL CALCIUM TOTAL | $239.43 |
| HC ELECTROLYTE PANEL | $169.28 |
| HC METABOLIC PANEL,COMPREHENSIVE | $284.28 |
| HC OBSTETRIC PANEL | $477.37 |
| HC LIPID PANEL - BUNDLED CHARGE | $309.75 |
| HC RENAL FUNCTION PANEL - BUNDLED CHARGE | $285.83 |
| HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE | $194.81 |
| HC HEPATIC FUNCTION PANEL | $202.06 |
| HC OBSTESTRIC PANEL | $307.63 |
| HC DRUG ASSAY - ACETAMINOPHEN | $53.59 |
| HC DRUG ASSAY - ADALIMUMAB | $116.38 |
| HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL | $59.92 |
| HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE | $74.18 |
| HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN | $324.70 |
| HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID TOTAL | $55.66 |
| HC ASSAY EVEROLIMUS | $56.47 |
| HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH | $67.39 |
| HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK | $67.39 |
| HC DRUG SCREEN QUANT LAMOTRIGINE | $54.40 |
| HC ASSAY OF LEVETIRACETAM | $63.14 |
| HC ASSAY OF LITHIUM - LITHIUM | $27.20 |
| HC ASSAY OF SALICYLATE | $53.59 |
| HC DRUG SCREEN QUANTITATIVE MYCOPHENOLATE MYCOPHENOLIC ACID | $74.18 |
| HC DRUG SCREEN QUANTITATIVE OXCARBAZEPINE | $54.51 |
| HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL | $50.95 |
| HC ASSAY OF PHENYTOIN, TOTAL - PHENYTOIN TOTAL | $324.70 |
| HC ASSAY OF SIROLIMUS - SIROLIMUS/RAPAMUNE | $56.47 |
| HC ASSAY OF TACROLIMUS - TACROLIMUS | $56.47 |
| HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH | $100.28 |
| HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH | $48.40 |
| HC ASSAY OF VANCOMYCIN | $100.28 |
| HC ASSAY OF ZONISAMIDE | $54.51 |
| HC ASSAY OF METHOTREXATE | $110.92 |
| HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED | $62.10 |
| HC DRUG TEST PRSMV DIR OPT OBS - TOXICOLOGY SCREEN URINE | $36.23 |
| HC DRUG TEST PRSMV DIR OPT OBS - TOXICOLOGY SCREEN URINE | $31.50 |
| HC DRUG TEST PRSMV CHEM ANLYZR - AMPHETAMINE | $495.19 |
| HC DRUG SCREEN | $350.06 |
| HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD | $263.47 |
| HC DRUG TEST PRSMV CHEM ANLYZR - SALYCILATES | $299.17 |
| HC DRUG SCREEN PRESUMPTIVE OPT INST | $101.78 |
| HC DRUG SCREEN/MULTI DRG CLS | $350.06 |
| HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL | $33.06 |
| HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL | $28.75 |
| HC ALKALOIDS NOT OTHERWISE SPECIFIED | $38.99 |
| HC ANTIEPILEPTICS, NOT OTHERWISE SPECIFIED; 1-3 | $16.56 |
| HC KETONE BODIES SERUM QUALITATIVE | $18.17 |
| HC ASSAY OF ACTH - ACTH | $158.82 |
| HC ASSAY OF SERUM ALBUMIN - ALBUMIN | $113.85 |
| HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE | $23.81 |
| HC MICROALBUMIN, QUANTITATIVE URINE | $23.81 |
| HC ASSAY OF ALDOLASE - ALDOLASE | $39.91 |
| HC ASSAY OF ALDOSTERONE - ALDOSTERONE | $167.50 |
| HC ALPHA-1-ANTITRYPSIN, TOTAL - ALPHA-1-ANTITRYPSIN, STOOL | $54.86 |
| HC ALPHA-1-ANTITRYPSIN, PHENOTYPE | $59.46 |
| HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL | $69.00 |
| HC ALPHA-FETOPROTEIN, SERUM | $69.00 |
| HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT | $194.47 |
| HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE | $69.35 |
| HC ASSAY OF AMMONIA - AMMONIA | $272.38 |
| HC ASSAY OF AMYLASE - AMYLASE | $236.56 |
| HC ASSAY OF ANDROSTENEDIONE - ANDROSTENEDIONE | $133.69 |
| HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME | $60.03 |
| HC ASSAY OF APOLIPOPROTEIN - LIPOPROTEIN A (LPA) | $70.15 |
| HC ASSAY OF ARSENIC | $78.03 |
| HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN | $66.47 |
| HC BILE ACIDS, TOTAL - BILE ACIDS, TOTAL | $70.38 |
| HC BILIRUBIN TOTAL - BILIRUBIN TOTAL AND DIRECT | $112.36 |
| HC BILIRUBIN TOTAL - BILIRUBIN TOTAL | $112.36 |
| HC BILIRUBIN DIRECT - BILIRUBIN DIRECT | $115.23 |
| HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD | $104.77 |
| HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD | $104.77 |
| HC BLOOD OCCULT,BY PEROXID,FECES - OCCULT BLD | $49.68 |
| HC BLOOD OCCULT FECAL IMMUNOASSAY | $75.79 |
| HC ASSAY OF CADMIUM - CADMIUM 24 HR URINE | $95.16 |
| HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25 | $121.61 |
| HC ASSAY OF CALCITONIN - CALCITONIN | $110.17 |
| HC ASSAY OF CALCIUM, TOTAL - CALCIUM | $86.88 |
| HC ASSAY OF CALCIUM, IONIZED - CALCIUM IONIZED | $56.18 |
| HC ASSAY OF CALCIUM IN URINE - CALCIUM TIMED URINE | $24.84 |
| HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS | $53.02 |
| HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL | $20.07 |
| HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN | $50.60 |
| HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN) | $77.91 |
| HC ASSAY OF CAROTENE - CAROTENE, SERUM | $27.83 |
| HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED | $103.79 |
| HC ASSAY OF CERULOPLASMIN - CERULOPLASMIN | $44.16 |
| HC CHEMILUMINESCENT ASSAY | $58.08 |
| HC ASSAY OF BLOOD CHLORIDE - CHLORIDE | $18.92 |
| HC ASSAY OF URINE CHLORIDE | $20.70 |
| HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL | $59.92 |
| HC ASSAY OF CHROMIUM - CHROMIUM LEVEL | $83.38 |
| HC ASSAY OF CITRATE - CITRATE 24 HOUR URINE | $14.95 |
| HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, URINE | $76.82 |
| HC ASSAY OF COPPER - COPPER, SERUM | $50.95 |
| HC CORTISOL, FREE - CORTISOL 24HR URINARY FREE | $68.71 |
| HC TOTAL CORTISOL - CORTISOL | $66.93 |
| HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC | $86.02 |
| HC ASSAY OF CK (CPK) - CK | $191.65 |
| HC ASSAY OF CK (CPK) ISOENZYMES | $204.99 |
| HC CREATINE, MB FRACTION - CKMB | $47.50 |
| HC ASSAY OF CREATININE - CREATININE SERUM | $125.70 |
| HC ASSAY OF CREATININE - CREATININE FLUID | $125.70 |
| HC ASSAY OF URINE CREATININE - CREATININE RANDOM URINE | $23.69 |
| HC ASSAY OF URINE CREATININE | $23.69 |
| HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR | $38.87 |
| HC ASSAY OF CRYOFIBRINOGEN - CRYOFIBRINOGEN | $47.15 |
| HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN | $26.57 |
| HC VITAMIN B-12 - VITAMIN B12 | $62.22 |
| HC ASSAY OF CYSTATIN C | $61.64 |
| HC DEHYDROEPIANDROSTERONE - DHEA | $103.85 |
| HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE | $91.43 |
| HC DEOXYCORTISOL - 11-DEOXYCORTISOL | $88.44 |
| HC ASSAY OF DIHYDROTESTOSTERONE | $92.86 |
| HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1 | $158.24 |
| HC PANCREATIC ELASTASE, FECAL, QUAL/SEMI-QUANT - PANCREATIC ELASTASE | $47.50 |
| HC ENZYME ACTIVITY NONRADIOACTIVE SUBSTRATE | $63.71 |
| HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN | $77.22 |
| HC ASSAY OF ESTRADIOL - ESTRADIOL | $114.77 |
| HC ASSAY OF ESTROGENS - ESTROGENS, FRACTIONATED | $102.41 |
| HC ASSAY OF ESTROGEN - ESTROGENS, TOTAL | $89.13 |
| HC ASSAY OF ESTRIOL | $76.71 |
| HC ASSAY OF ESTRONE - ESTRONE | $102.58 |
| HC FATS/LIPIDS, FECES, QUALITATIVE - FECAL FAT QUALITATIVE | $20.93 |
| HC ASSAY OF BLOOD FATTY ACIDS - FATTY ACIDS, FREE | $59.57 |
| HC ASSAY OF FERRITIN - FERRITIN | $56.01 |
| HC BLOOD FOLIC ACID SERUM - FOLATE | $60.38 |
| HC ASSAY OF FOLIC ACID, RBC - FOLATE RBC | $190.67 |
| HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG | $38.30 |
| HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM | $38.30 |
| HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA | $38.30 |
| HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE | $67.62 |
| HC IMMUNOGLOBULIN SUBCLASSES IGG 1, 2, 3 OR 4 | $25.53 |
| HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL | $875.09 |
| HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS | $875.09 |
| HC ASSAY OF GASTRIN - GASTRIN | $72.45 |
| HC HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE SYNOVIAL FLUID | $16.22 |
| HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING | $82.34 |
| HC GLUCOSE, BLOOD BY REAGENT STRIP | $33.12 |
| HC GLUCOSE, BLOOD BY REAGENT STRIP | $33.12 |
| HC GLUCOSE TEST - GTT 1 HOUR | $86.88 |
| HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR | $314.18 |
| HC GTT-ADDED SAMPLES - GTT 3 HOUR | $23.23 |
| HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE | $39.73 |
| HC ASSAY OF GGT - GAMMA GT | $29.61 |
| HC GLYCATED PROTEIN - POCT FRUCTOSAMINE | $61.99 |
| HC GLYCATED PROTEIN - ALBUMIN, GLYCATED | $61.99 |
| HC GLYCATED PROTEIN - ALPHA-1-ACID GLYCOPROTEIN | $61.99 |
| HC GLYCATED PROTEIN - FRUCTOSAMINE | $61.99 |
| HC GONADOTROPIN (FSH) - FSH | $76.36 |
| HC GONADOTROPIN (LH) - LUTEINIZING HORMONE | $76.13 |
| HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE | $52.90 |
| HC ASSAY OF HAPTOGLOBIN, QUANT - HAPTOGLOBIN | $51.69 |
| HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST | $276.81 |
| HC QUANTITATIVE SCREEN, METALS - COBALT | $116.90 |
| HC HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS | $36.97 |
| HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBINOPATHY EVAL | $74.29 |
| HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C | $234.89 |
| HC ASSAY OF HISTAMINE - HISTAMINE | $122.48 |
| HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE TOTAL | $69.35 |
| HC ASSAY OF 5-HIAA - 5 HIAA QUANT,24HR URINE | $53.02 |
| HC ASSAY OF PROGESTERONE 17-D - 17-HYDROXYPROGESTERONE | $86.14 |
| HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAMINASE, IGA | $47.50 |
| HC IMMUNOASSAY NONANTIBODY - TISSUE TRANSGLUTAMINASE, IGG | $47.50 |
| HC IMMUNOASSAY NONANTIBODY - CELIAC DIAGNOSTIC PANEL | $47.50 |
| HC IMMUNOASSAY NONANTIBODY - GLIADIN ANTIBODY IGG IGA | $47.50 |
| HC RIA NONANTIBODY | $63.88 |
| HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS - ANTI-MULLERIAN HORMONE | $57.50 |
| HC ASSAY OF INSULIN,TOTAL - INSULIN, FASTING | $46.98 |
| HC ASSAY OF IRON - IRON | $26.68 |
| HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL | $36.00 |
| HC IRON BINDING TEST - IRON + TRANSFERRIN + TIBC | $36.00 |
| HC ASSAY OF LACTIC ACID - LACTATE | $261.91 |
| HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE | $30.02 |
| HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS | $52.67 |
| HC ASSAY LACTOFERRIN FECAL QUANTITATIVE | $62.33 |
| HC ASSAY OF LEAD - LEAD BLOOD | $49.80 |
| HC ASSAY OF LIPASE - LIPASE | $169.28 |
| HC ASSAY OF LIPOPROTEIN (A) | $53.25 |
| HC ASSAY LIPOPROTEIN PLA2 - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 | $154.91 |
| HC LIPOPROTEIN BLOOD, HIGH RES FRACTION/ QUANT - LIPOPROTEIN SUBCLASS | $112.70 |
| HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR | $129.61 |
| HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST - HDL CHOLESTEROL | $33.75 |
| HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST - LDL CHOLESTEROL DIRECT | $227.47 |
| HC ASSAY OF MAGNESIUM - MAGNESIUM | $161.69 |
| HC ASSAY OF MAGNESIUM - MAGNESIUM URINE | $14.95 |
| HC ASSAY OF MAGNESIUM - MAGNESIUM RBC | $161.69 |
| HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE | $80.33 |
| HC ASSAY OF MERCURY - MERCURY 24 HOUR URINE | $66.82 |
| HC ASSAY OF MERCURY - HEAVY METALS, BLOOD | $66.82 |
| HC ASSAY OF MERCURY - MERCURY, BLOOD | $66.82 |
| HC ASSAY OF METANEPHRINES | $69.63 |
| HC ASSAY SYNOVIAL FLUID MUCIN - MUCIN CLOT TEST | $24.15 |
| HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF | $70.78 |
| HC ASSAY OF MYOGLOBIN - MYOGLOBIN SERUM | $40.94 |
| HC ASSAY MYELOPEROXIDASE | $161.23 |
| HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP) | $830.24 |
| HC NEPHELOMETRY, NOT SPECIFIED - KAPPA / LAMBDA LIGHT CHAINS, URINE | $55.89 |
| HC OLIGOCLONAL IMMUNOGLOBULIN - OLIGOCLONAL BANDING | $91.20 |
| HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM | $70.38 |
| HC ASSAY OF BLOOD OSMOLALITY - OSMOLALITY | $27.20 |
| HC ASSAY OF URINE OSMOLALITY - OSMOLALITY URINE | $28.06 |
| HC ASSAY OF PARATHORMONE - PTH INTACT | $169.68 |
| HC ASSAY OF PARATHORMONE - PTH INTACT | $147.55 |
| HC ASSAY OF PARATHORMONE | $169.68 |
| HC ASSAY OF PARATHORMONE | $169.68 |
| HC PH BODY FLUID NOS - PH BODY FLUID | $14.72 |
| HC ASSAY OF CALPROTECTIN FECAL | $80.04 |
| HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE | $106.26 |
| HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS | $118.34 |
| HC ASSAY OF PHOSPHORUS INORGANIC URINE | $21.33 |
| HC ASSAY OF PORPHOBILINOGEN URINE | $34.79 |
| HC PORPHYRINS URINE QUANTITATIVE/FRACTIONATED | $60.49 |
| HC ASSAY OF SERUM POTASSIUM - POTASSIUM | $118.34 |
| HC ASSAY OF URINE POTASSIUM - POTASSIUM BODY FLUID | $17.77 |
| HC ASSAY OF URINE POTASSIUM - POTASSIUM DIALYSATE | $17.77 |
| HC ASSAY OF URINE POTASSIUM - POTASSIUM RANDOM URINE | $17.77 |
| HC ASSAY OF URINE POTASSIUM - POTASSIUM,TIMED URINE | $17.77 |
| HC ASSAY OF URINE POTASSIUM - POTASSIUM 24 HOUR URINE | $17.77 |
| HC ASSAY OF PREALBUMIN - PREALBUMIN | $60.03 |
| HC ASSAY OF PREGNENOLONE - PREGNENOLONE | $84.99 |
| HC ASSAY OF 17-HYDROXYPREGNENOLONE - 17-HYDROXYPREGNENOLONE | $93.73 |
| HC ASSAY OF PROGESTERONE - PROGESTERONE | $85.79 |
| HC ASSAY OF PROCALCITOUIN | $110.17 |
| HC ASSAY OF PROLACTIN - PROLACTIN | $79.64 |
| HC ASSAY OF PROSTAGLANDIN - PROSTAGLANDIN E2, PLASMA | $139.84 |
| HC ASSAY OF PROSTAGLANDIN - PROSTAGLANDIN E2, URINE | $139.84 |
| HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA | $291.76 |
| HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA TOTAL AND FREE | $291.76 |
| HC PSA FREE | $75.61 |
| HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL | $18.80 |
| HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN 24 HOUR URINE | $15.12 |
| HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN / CREATININE RATIO, U | $15.12 |
| HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF | $15.12 |
| HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN BODY FLUID | $15.12 |
| HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - POCT PROTEIN | $15.12 |
| HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM | $44.16 |
| HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE | $73.31 |
| HC PROTEIN, WESTERN BLOT TEST | $70.04 |
| HC HC PROTEIN, WESTERN BLOT TEST, W BAND ID OTH FLUID | $88.21 |
| HC ASSAY OF VITAMIN B-6 - VITAMIN B6 | $115.46 |
| HC ASSAY, NON-ENDOCRINE RECEPTOR - ACETYLCHOLINE RECEPTOR, BINDING | $105.17 |
| HC ASSAY, NON-ENDOCRINE RECEPTOR - ACETYLCHOLINE RECEPTOR, BLOCKING | $105.17 |
| HC ASSAY, NON-ENDOCRINE RECEPTOR - ACETYLCHOLINE RECEPTOR, MODULATING | $105.17 |
| HC ASSAY OF RENIN - RENIN DIRECT ASSAY | $90.33 |
| HC ASSAY OF SELENIUM - SELENIUM SERUM | $104.94 |
| HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN | $89.24 |
| HC ASSAY OF SERUM SODIUM - SODIUM | $110.86 |
| HC ASSAY OF URINE SODIUM - SODIUM 24 HOUR URINE | $20.07 |
| HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR | $87.40 |
| HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR | $87.40 |
| HC SUGARS SINGLE QUALITATIVE | $22.71 |
| HC SUGARS SINGLE QUANTITATIVE, EACH SPECIMEN - 1,5-ANHYDROGLUCITOL | $36.57 |
| HC ASSAY OF URINE SULFATE - SULFATE, URINE | $19.55 |
| HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE | $104.71 |
| HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE | $106.09 |
| HC ASSAY OF VITAMIN B-1 - VITAMIN B1 | $87.29 |
| HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN | $66.07 |
| HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE) | $28.29 |
| HC ASSAY OF FREE THYROXINE - T4 FREE | $234.89 |
| HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE | $411.47 |
| HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM | $208.96 |
| HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL) | $58.31 |
| HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT) | $50.95 |
| HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT) | $56.93 |
| HC ASSAY OF TRANSFERRIN - TRANSFERRIN | $52.56 |
| HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES | $79.47 |
| HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE | $26.57 |
| HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE) | $58.31 |
| HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE | $69.63 |
| HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE | $64.86 |
| HC ASSAY OF TROPONIN, QUANT - TROPONIN I | $466.84 |
| HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN | $106.26 |
| HC ASSAY URINE UREA-N - UREA NITROGEN, URINE | $19.55 |
| HC ASSAY OF URIC ACID, BLOOD - URIC ACID | $18.63 |
| HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE - URIC ACID, URINE, 24 HOUR | $19.55 |
| HC ASSAY OF URINE VMA - VMA, URINE | $63.65 |
| HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE | $139.50 |
| HC ASSAY OF VITAMIN A - VITAMIN A | $47.73 |
| HC ASSAY OF NOS VITAMIN | $56.81 |
| HC ASSAY OF VITAMIN K - VITAMIN K | $56.47 |
| HC ASSAY OF ZINC - ZINC | $46.81 |
| HC ASSAY OF C-PEPTIDE - C-PEPTIDE | $85.62 |
| HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD | $69.23 |
| HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE | $184.17 |
| HC TRICHOMONAS VAGINALIS DNA AMP PROB | $135.99 |
| HC PSA SCREENING | $291.76 |
| HC DRUG TEST DEF 1-7 CLASSES | $380.88 |
| HC DRUG TEST DEF 22+ CLASSES | $821.85 |
| HC ALLERGEN SPEC IGG QUANT,EACH | $26.11 |
| HC ALLERGEN SPEC IGE | $21.45 |
| HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY | $61.87 |
| HC PLATELET ANTIBODIES - PLATELET ANTIBODIES, INDIRECT | $55.43 |
| HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES) | $49.80 |
| HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER | $45.89 |
| HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER | $30.02 |
| HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN | $26.45 |
| HC C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP | $317.23 |
| HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS | $104.65 |
| HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY | $104.65 |
| HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES | $66.07 |
| HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER | $29.21 |
| HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT | $71.13 |
| HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT | $49.34 |
| HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL | $83.49 |
| HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY | $53.25 |
| HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED | $56.47 |
| HC DNA ANTIBODY, SINGLE STRAND - DNA ANTIBODY, SINGLE STRAND | $49.80 |
| HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB | $73.72 |
| HC FLUORESCENT ANTIBODY SCREEN | $49.68 |
| HC FLUORESCENT ANTIBODY; TITER - EHRLICA CANIS AB | $49.68 |
| HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3 | $85.62 |
| HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29 | $85.62 |
| HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9 | $85.62 |
| HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125 | $85.62 |
| HC HUMAN EPIDIDYMIS PROTEIN 4 HE4 /SO | $85.62 |
| HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN | $127.42 |
| HC IMMUNOASSAY FOR TUMOR QUANTITATIVE ANTIGEN | $85.62 |
| HC IMMUNOASSAY,INFECT AGENT,QUANT - RUBELLA ANTIBODY IGG | $61.99 |
| HC IMMUNOASSAY,INFECT AGENT,QUANT - STREP PNEUMONIAE ANTIBODY SEROTYPES | $61.64 |
| HC IMMUNOASSAY,INFECT AGENT,QUANT - HERPES CULTURE | $61.99 |
| HC IMMUNOASSAY,INFECT AGENT,QUAL - POCT H. PYLORI ANTIBODIES | $61.99 |
| HC IMMUNOELECTROPHORESIS SERUM | $99.65 |
| HC IMMUNODIFFUSION NES | $57.73 |
| HC IMMUNODIFFUSION OUCHTERLONY - HYPER PNEUMO EXTENDED PANEL | $37.95 |
| HC IMMUNODIFFUSION OUCHTERLONY - HYPER PNEUMO SEROLOGY | $37.95 |
| HC IMMUNOFIXATION ELECTROPHORESIS SERUM | $92.00 |
| HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE | $120.64 |
| HC INSULIN ANTIBODIES - INSULIN ANTIBODY | $64.69 |
| HC INTRINSIC FACTOR ANTIBODY - INTRINSIC FACTOR BLOCKING ANTIBODY | $61.99 |
| HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB | $81.31 |
| HC B CELLS, TOTAL COUNT - B CELLS, TOTAL COUNT | $113.85 |
| HC MONONUCLEAR CELL ANITGEN NOS | $76.99 |
| HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT | $155.02 |
| HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT | $119.60 |
| HC T CELL ABSOLUTE COUNT/RATIO - T-HELPER CELLS CD4/CD8 % | $148.93 |
| HC T CELL ABSOLUTE COUNT - T-HELPER CELLS (CD4) COUNT | $110.06 |
| HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY | $59.80 |
| HC MITOCHONDRIAL ANTIBODY EACH | $73.14 |
| HC NEUTRALIZATION TEST, VIRAL - RABIES ANTIBODY TITER | $69.52 |
| HC PARTICLE AGGLUTINATION SCREEN | $38.41 |
| HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN | $17.65 |
| HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR | $23.35 |
| HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST | $254.73 |
| HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST | $221.50 |
| HC TUBERCULOSIS INTRADERMAL TEST | $123.17 |
| HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP | $17.54 |
| HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL | $12.94 |
| HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS | $55.66 |
| HC BACTERIUM, ANTIBODY | $47.61 |
| HC BARTONELLA, ANTIBODY - BARTONELLA AB PANEL | $41.92 |
| HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES | $47.78 |
| HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY | $41.92 |
| HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT | $63.65 |
| HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES | $70.04 |
| HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY | $49.34 |
| HC CHLAMYDIA, ANTIBODY - CHLAMYDIA ANTIBODIES | $48.65 |
| HC CHLAMYDIA, IGM, ANTIBODY - CHLAMYDIA ANTIBODY, IGM | $25.53 |
| HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES | $42.67 |
| HC Q FEVER ANTIBODY - COXIELLA BRUNETII Q FEVER ANTIBODY | $50.60 |
| HC CRYPTOCOCCUS ANTIBODY - CRYPTOCOCCUS ANTIBODY | $53.25 |
| HC CMV ANTIBODY - CYTOMEGALOVIRUS IGG | $59.11 |
| HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM | $69.23 |
| HC ENTEROVIRUS ANTIBODY - COXSACKIE AB | $53.48 |
| HC EPSTEIN-BARR ANTIBODY - EPSTEIN-BARR VIRUS EARLY | $39.62 |
| HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB | $62.91 |
| HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGA | $74.58 |
| HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL | $41.92 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, ALTERNARIA TENUIS IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, AUREOBASIDIUM PUL IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, CANDIDA ALBICANS IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, CLADOSPORIUM IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, FUSARIUM PRO/MON IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, HEL SET ROS/HAL IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, MUCOR RACEMOSUS IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, PENICILLIUM CH/NO IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, PHOMA BETAE IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, RHIZOPUS NIGRICAN IGG | $50.37 |
| HC FUNGUS NES ANTIBODY - ALLERGEN, FUNGI & MOLDS, TRICHOPHYTON RUB IGG | $50.37 |
| HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA | $50.37 |
| HC FUNGUS, ANTIBODY - SPOROTHRIX ANTIBODY | $50.37 |
| HC SHIGELLA - INFLAMMATORY BOWEL DISEASE PANEL | $50.37 |
| HC GIARDIA LAMBLIA - GIARDIA LAMBLIA ANTIBODY, IFA | $60.49 |
| HC HELICOBACTER PYLORI - HELICOBACTER PYLORI IGA | $59.69 |
| HC HELMINTH, ANTIBODY - CYSTICERCOSIS ANTIBODY, IGG | $39.27 |
| HC HELMINTH, ANTIBODY - ECHINOCOCCUS ANTIBODY, IGG | $39.27 |
| HC HELMINTH, ANTIBODY - FILARIASIS ANTIBODIES, IGG4 | $39.27 |
| HC HELMINTH, ANTIBODY - SCHISTOSOMA ANTIBODY, IGG | $39.27 |
| HC HELMINTH, ANTIBODY - TOXACARA ANTIBODY | $39.27 |
| HC HEPATITIS, DELTA AGENT - HEPATITIS DELTA VIRUS | $70.50 |
| HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC ANTIBODY | $59.11 |
| HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY | $54.22 |
| HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY | $79.58 |
| HC HISTOPLASMA - HISTOPLASMA ANTIBODIES | $46.23 |
| HC HIV-1/HIV-2, SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN | $56.29 |
| HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL | $49.68 |
| HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM | $48.42 |
| HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY | $44.16 |
| HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY | $47.61 |
| HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL | $50.83 |
| HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM | $46.35 |
| HC LEISHMANIA - LEISHMANIA ANTIBODY | $58.31 |
| HC MUMPS - MUMPS IGG ANTIBODY | $53.59 |
| HC MUMPS - MUMPS IGM ANTIBODY | $53.59 |
| HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG | $54.40 |
| HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGG | $50.83 |
| HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGM | $50.83 |
| HC PROTOZOA, NOT ELSEWHERE - TRYPANOSOMA CRUZI ANTIBODY, IGG | $50.83 |
| HC PROTOZOA, NOT ELSEWHERE - TRYPANOSOMA CRUZI ANTIBODY, IGM | $50.83 |
| HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY | $79.93 |
| HC RICKETTSIA - RICKETTSIA TYPHI (TYPHUS FEVER) ANTIBODY | $79.93 |
| HC RUBELLA - RUBELLA ANTIBODY, IGM | $59.11 |
| HC RUBEOLA - RUBEOLA ANTIBODY | $52.96 |
| HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM | $107.87 |
| HC TETANUS - TETANUS TOXOID, IGG | $61.76 |
| HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY | $59.11 |
| HC TOXOPLASMA - TOXOPLASMA GONDII ANTIBODY, IGA | $59.11 |
| HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM | $59.23 |
| HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY | $40.02 |
| HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG | $52.96 |
| HC VIRUS ANTIBODIES NES | $52.96 |
| HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB | $65.44 |
| HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY | $58.59 |
| HC HEP C AB TEST, CONFIRM - HEPATITIS C VIRUS, RIBA | $63.65 |
| HC HLA TYPING, A,B,OR C /SINGLE - HLA-B27 ANTIGEN | $106.09 |
| REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE | $466.84 |
| HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL | $154.27 |
| HC HEMATOCRIT - HEMATOCRIT | $88.44 |
| HC HEMOGLOBIN - HEMOGLOBIN | $100.40 |
| HC COMPLETE CBC & AUTO DIFF WBC | $217.12 |
| HC COMPLETE CBC - CBC | $172.21 |
| HC RED BLOOD CELL (RBC) COUNT - RED BLOOD CELL COUNT | $12.42 |
| HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES | $245.41 |
| HC PLATELET COUNT - PLATELET COUNT | $260.36 |
| HC BLOOD SMEAR INTERPRETATION - LAB BLOOD SMEAR INTERPRETATION | $85.16 |
| HC CLOT FACTOR VIII AHG 1 STAGE - VON WILLEBRAND PANEL | $73.54 |
| HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR | $94.30 |
| HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN | $94.30 |
| HC CLOTTING FACTR VIII VW MULTIMETRIC | $94.30 |
| HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY | $88.32 |
| HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN PANEL | $48.65 |
| HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG | $44.45 |
| HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL | $64.52 |
| HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY | $56.93 |
| HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY | $63.02 |
| HC FACTOR INHIBITOR TEST - BETHESDA INHIBITOR | $40.83 |
| HC FIBRIN DEGRAD PRODUCTS, AGGLUTINATION - FIBRIN SPLIT PRODUCTS | $29.33 |
| HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE | $408.48 |
| HC FIBRINOGEN, ANTIGEN - FIBRINOGEN ANTIGEN | $48.19 |
| HC HEPARIN ASSAY - HEPARIN LEVEL | $46.35 |
| HC WBC ALKALINE PHOSPHATASE - LEUKOCYTE ALKALINE PHOSPHATASE | $35.42 |
| HC MURAMIDASE - LYSOZYME, SERUM | $56.58 |
| HC MURAMIDASE - LYSOZYME, URINE | $56.58 |
| HC PROTHROMBIN TIME - PROTIME-INR | $229.02 |
| HC PROTHROMBIN TIME - PROTHROMBIN MIXING STUDY | $229.02 |
| HC PROTHROMBIN TIME - PROTIME-INR, FINGERSTICK | $229.02 |
| HC PROTHROMBIN TIME - ADDITIONAL CHARGE | $229.02 |
| HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME) | $39.39 |
| HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED | $97.41 |
| HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN | $22.71 |
| HC THROMBOPLAS TIME PARTIAL (APTT) - PLASMA/WHOLE BLOOD | $260.36 |
| HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM | $48.07 |
| HC SEMEN COUNT NOT BILLABLE | $0.00 |
| HC SPECIMEN CONCENTRATION - CRYPTOSPORIDIUM OR INFECTIOUS AGENT | $27.49 |
| HC BLOOD CULTURE FOR BACTERIA | $42.44 |
| HC CULTURE AEROBIC BACTERIA FECES | $38.87 |
| HC HC STOOL CULTURE, ADDL PATHOGENS | $38.87 |
| HC CULTURE BACTERIA EXCPT URINE BLOOD/STOOL AEROBIC ISOL | $35.42 |
| HC CULTURE BACTERIA ANAEROBIC EXCEPT BLOOD | $38.99 |
| HC ORGANISM IDENTIFIED ANAEROBIC | $38.87 |
| HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - POCT H. PYLORI | $38.87 |
| HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - ORGANISM ID CULTURE | $38.87 |
| HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - PERFORM ID V/M | $38.87 |
| HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - PERFORM ID R/M | $38.87 |
| HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - PERFORM ID V/M/R | $38.87 |
| HC BACTERIA CULTURE SCREEN | $27.31 |
| HC URINE CULTURE QUANTITATIVE COLONY COUNT | $33.24 |
| HC URINE BACTERIA CULTURE | $38.87 |
| HC CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS | $31.63 |
| HC FUNGUS ISOLATION CULTURE | $34.56 |
| HC BLOOD FUNGUS CULTURE | $68.08 |
| HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD | $42.44 |
| HC MYCOPLASMA CULTURE - MYCOPLASMA / UREAPLASMA CULTURE | $48.88 |
| HC CHLAMYDIA CULTURE ANY SOURCE | $80.56 |
| HC MICOBACTERIA CULTURE TB/AFB | $44.45 |
| HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM | $23.00 |
| HC CULTURE TYPING GLC/HPLC | $51.52 |
| HC CULTURE TYPE IMMUN NOT FLUORES | $24.90 |
| HC MACROSCOPIC EXAM, PARASITE - PARASITE IDENTIFICATION | $17.54 |
| HC PINWORM EXAM - PINWORM PREP | $17.54 |
| HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION | $36.57 |
| HC MICROBE SUSCEPTIBLE DIFFUSE | $19.55 |
| HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTBILITY DISK | $28.29 |
| HC MICROBE SUSCEPTIBLE ENZYME /SO | $22.83 |
| HC ANTIBIOTIC SENS,MIC,EACH - SUSCEPTIBILITY | $41.52 |
| HC SMEAR GRAM STAIN | $17.54 |
| HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN | $22.08 |
| HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR | $24.61 |
| HC SMEAR COMPLEX STAIN OVA PARASITES | $73.83 |
| HC SMEAR,STAIN,WET MNT,INTERP - WET PREP GENITAL | $69.00 |
| HC TISSUE EXAM BY KOH - KOH PREP | $56.93 |
| HC ASSAY, TOXIN OR ANTITOXIN - CLOSTRIDIUM DIFFICILE TOXINS TISSUE CULT | $81.08 |
| HC VIRUS TISSUE CULTURE BY INOCULATION | $107.18 |
| HC VIRUS INOCULATION SHELL VIAL STAIN | $80.44 |
| HC VIRUS ID,NON-IMMUNOLOGIC METHOD - HSV CULTURE | $139.15 |
| HC CRYPTOSPORIDIUM AG IF | $49.34 |
| HC VARICELLA AG, DFA - VARICELLA ZOSTER DFA | $49.34 |
| HC AG DETECTION NOS, IMMUNOFLUORESCENT OR FLUORSCENCE | $53.59 |
| HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT | $44.45 |
| HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA) | $49.34 |
| HC IAAD IA GIARDIA STOOL - OVA AND PARASITE SCREEN | $49.34 |
| HC IAAD IA GIARDIA - GIARDIA LAMBLIA ANTIGEN | $49.34 |
| HC ENTAMOEB HIST GRP AG IA | $49.34 |
| HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL | $59.11 |
| HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN | $42.44 |
| HC IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN | $47.38 |
| HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE | $44.45 |
| HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN, SERUM | $44.45 |
| HC INFLUENZA A&B AG,EIA | $49.34 |
| HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN, EIA | $49.34 |
| HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM | $49.34 |
| HC BARTONELLA, DNA, AMP PROBE - BARTONELLA, DNA, AMP PROBE | $144.21 |
| HC CANDIDA, DNA, DIR PROBE - CANDIDA DNA PROBE | $82.46 |
| HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR | $144.21 |
| HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP | $144.21 |
| HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR | $144.21 |
| HC C DIFF AMPLIFIED PROBE | $144.21 |
| HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR | $176.01 |
| HC INFLUENZA DNA AMP PROBE | $318.90 |
| HC GARDNER VAG DNA DIR PROBE - GARDNERELLA VAGINALIS DNA PROBE, DIRECT | $82.46 |
| HC GARDNER VAG DNA QUANT - GARDNERELLA VAGINALIS DNA PROBE, QUANT | $171.58 |
| HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR | $176.01 |
| HC IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR - HEPATITIS C GENO | $144.21 |
| HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR | $176.01 |
| HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION | $176.01 |
| HC HSV, DNA, AMP PROBE - HSV PCR | $144.21 |
| HC HSV, DNA, QUANT - HSV DNA, QUANTITATIVE | $151.00 |
| HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR | $349.72 |
| HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED | $144.21 |
| HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA GENITALIUM | $105.97 |
| HC M.PNEUMON, DNA, AMP PROBE - MYCOPLASMA PNEUMONIAE PCR | $105.97 |
| HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR | $144.21 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, AMP | $144.20 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK PCR | $144.20 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, AMP/DIRECT/PCR | $144.21 |
| HC IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY | $144.21 |
| HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET | $1,092.00 |
| HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 RT PCR | $161.00 |
| HC MRSA, DNA, AMP PROBE - MR STAPH DNA PROBE, AMPLIFIED | $144.21 |
| HC STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION | $129.84 |
| HC TRICHOMONAS VAGIN, DIR PROBE - TRICHOMONAS VAGINALIS DNA PROBE | $82.46 |
| HC INFECTIOUS DETECT AGENT NOS, DNA, AMP | $144.21 |
| HC INFECTIOUS DETECT AGENT NOS, DNA, AMP - RSV BY PCR | $144.21 |
| HC DETECT AGENT NOS, DNA, QUANT | $176.01 |
| HC DETECT AGENT, MULT ORGS, DNA, AMP | $259.67 |
| HC DETECT AGENT, MULT ORGS, DNA, AMP LYME WEST BLOT /SO | $288.48 |
| HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA | $119.72 |
| HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN | $220.00 |
| HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN | $139.27 |
| HC GENOTYPE ANALYSIS HEPATITIS C LIPA | $1,057.89 |
| HC HEP B GENOTYPE DNA | $1,057.89 |
| HC URINALYSIS, NONAUTO, W/SCOPE | $82.34 |
| HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC | $178.19 |
| HC URINALYSIS NONAUTO W/O SCOPE | $36.00 |
| HC URINALYSIS NONAUTO W/O SCOPE | $36.00 |
| HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY | $152.78 |
| HC URINALYSIS, MICROSCOPIC ONLY | $56.93 |
| HC URINE PREGNANCY TEST - PREGNANCY URINE | $125.70 |
| HC URINE PREGNANCY TEST - PREGNANCY URINE | $100.40 |
| HC ASSAY OF OXALATE - OXALATE URINE | $14.95 |
| CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE | $344.02 |
| CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE | $344.02 |
| CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX | $499.68 |
| CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST | $325.05 |
| CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST | $325.05 |
| HC KIT - URINE COLLECTION | $71.01 |
| HC BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS | $7,497.77 |
| HC BCR/ABL1 GENE MAJOR BREAKPOINT | $519.69 |
| HC BCR/ABL1 GENE MINOR BREAKPOINT | $459.08 |
| HC CFTR GENE ANALYSIS COMMON VARIANTS | $1,852.54 |
| HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT | $268.53 |
| HC JAK2 GENE ANAL - JAK 2 MUTATION | $384.62 |
| HC MTHFR METHYLENETRAHYDROFOLATE GENE ANAL - METHYLENETRAHYDROFOLATE | $217.47 |
| HC SNRPN/UBE3A METHYLATION GENE ANALYSIS S/O | $170.03 |
| HC TPMT GENE ANALYSIS COM VARIANTS | $554.13 |
| HC HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH | $298.94 |
| HC HLA ONE CLASS II LOCUS LOW RESOLUTION ASSESSMENT | $502.21 |
| HC HLA ONE CLASS II LOCUS HIGH RESOLUTION ASSESSMENT | $508.19 |
| HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - HUNTINGTON'S | $455.40 |
| HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - FSHD1 SOUTHERN BLOT TEST | $871.24 |
| HC ONCO OVARIAN BIOCHEM ASSAY 2 PROTEIN | $866.99 |
| HC LIVER FIBROSIS PANEL | $240.35 |
| HC QUEST MISC LIVER FIBROSIS TEST | $0.00 |
| HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II | $105.92 |
| HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III | $148.81 |
| HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V | $717.03 |
| HC CYTOPATH FL NONGYN SMEARS - LAB CYTOPATH FLUIDS,SMEAR,INTERP | $105.92 |
| HC CYTOPATH CELL ENHANCE TECH - LAB CYTOPATH, CELL ENHANCE TECH | $93.61 |
| HC CYTOPATH C/V THIN LAYER - LAB CYTOPATH CERV/VAG THIN LAYER | $83.26 |
| HC CYTOPATH C/V AUTO FLUID REDO - LAB CYTOPAT,CER/VAG,THIN LAYER,INTER | $108.91 |
| HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LAB FLOWCYTOMETRY/TECH CMP | $47.90 |
| HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP | $12.42 |
| HC FLOWCYTOMETRY INTERPRETATION 16 OR MORE MARKERS | $296.01 |
| HC MOLECULAR CYTOGENETICS DNA PROBE EACH | $64.69 |
| HC MOLECULAR CYTOGENETICS 25-99 CELLS S/O | $127.94 |
| HC CYSTIC FIBROSIS SCREEN | $149.73 |
| HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I | $58.19 |
| HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV | $148.81 |
| HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI | $1,800.44 |
| INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE | $535.73 |
| LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX | $147.95 |
| LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN | $687.70 |
| HC POST PROCEDURE PLACEMENT XRAY | $0.00 |
| HC X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS LEFT | $206.89 |
| HC X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS RIGHT | $206.89 |
| HC X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS BILATERAL | $413.60 |
| HC X-RAY FACIAL BONES <3 VW - XR FACIAL BONES 1-2 VIEWS | $206.89 |
| HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS | $395.26 |
| HC X-RAY NASAL BONES - XR NASAL BONES | $206.89 |
| HC X-RAY ORBITS - XR ORBITS COMPLETE 4+ VIEWS | $395.26 |
| HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS | $206.89 |
| HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS | $206.89 |
| HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS | $395.26 |
| HC X-RAY SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS | $395.26 |
| HC X-RAY TMJ BILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED BIL | $206.89 |
| HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE | $206.89 |
| HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS LEFT | $206.89 |
| HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS RIGHT | $206.89 |
| HC X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL | $395.26 |
| HC X-RAY STERNUM 2+ VW - XR STERNUM 2+ VIEWS | $206.89 |
| HC X-RAY SPINE ONE VIEW - XR SPINE | $206.89 |
| HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS | $206.89 |
| HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS | $395.26 |
| HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS | $395.26 |
| HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS | $395.26 |
| HC X-RAY THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS | $395.26 |
| HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS | $206.89 |
| HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW - XR ENTIRE SPINE 1 V | $206.89 |
| HC RADEX X-RAY EXAM ENTIRE SPI 4/5 VW - XR ENTIRE SPINE 4 OR 5 VW | $319.70 |
| HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS | $395.26 |
| HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS | $395.26 |
| HC X-RAY LUMBAR SPINE 6+ VW - XR LUMBAR SPINE 6+ VWS INCLUDING BENDING | $395.26 |
| HC X-RAY LUMBAR SPINE FLEX/EXTEN - XR LUMBAR SPINE 4+ VIEWS W/ FLEX EXT | $381.05 |
| HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS | $395.26 |
| HC X-RAY SACROILIAC JTS <3 VW - XR SACROILIAC JOINTS 1-2 VIEWS | $395.26 |
| HC X-RAY SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS | $395.26 |
| HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS | $206.89 |
| HC X-RAY CLAVICLE - XR CLAVICLE LEFT | $206.89 |
| HC X-RAY CLAVICLE - XR CLAVICLE RIGHT | $206.89 |
| HC X-RAY SCAPULA - XR SCAPULA LEFT | $395.26 |
| HC X-RAY SCAPULA - XR SCAPULA RIGHT | $395.26 |
| HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW LEFT | $206.89 |
| HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW RIGHT | $206.89 |
| HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS BILATERAL | $413.60 |
| HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS LEFT | $206.89 |
| HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS RIGHT | $206.89 |
| HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL | $206.89 |
| HC X-RAY HUMERUS - XR HUMERUS LEFT | $206.89 |
| HC X-RAY HUMERUS - XR HUMERUS RIGHT | $206.89 |
| HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS BILATERAL | $413.60 |
| HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS LEFT | $206.89 |
| HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS RIGHT | $206.89 |
| HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS BILATERAL | $413.60 |
| HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS LEFT | $206.89 |
| HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS RIGHT | $206.89 |
| HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS LEFT | $206.89 |
| HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS RIGHT | $206.89 |
| HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS BILATERAL | $413.60 |
| HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT LEFT | $395.26 |
| HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT RIGHT | $395.26 |
| HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS LEFT | $206.89 |
| HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS RIGHT | $206.89 |
| HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL | $413.60 |
| HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS LEFT | $206.89 |
| HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS RIGHT | $206.89 |
| HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL | $413.60 |
| HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS LEFT | $395.26 |
| HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS RIGHT | $395.26 |
| HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS BILATERAL | $790.45 |
| HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS LEFT | $206.89 |
| HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS RIGHT | $206.89 |
| HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS BILATERAL | $413.60 |
| HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS RIGHT | $206.89 |
| HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS LEFT | $206.89 |
| HC X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW LEFT | $206.89 |
| HC X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW RIGHT | $206.89 |
| HC X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW LEFT | $206.89 |
| HC X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW RIGHT | $206.89 |
| HC X-RAY EXAM HIPS BI 2 VWS - XR HIPS BILAT 2 VW W/ OR W/O PELVIS | $395.26 |
| HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS | $395.26 |
| HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW LT | $206.89 |
| HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW RT | $206.89 |
| HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS LEFT | $206.89 |
| HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS RIGHT | $206.89 |
| HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS BILAT | $413.60 |
| HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS LEFT | $206.89 |
| HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS RIGHT | $206.89 |
| HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS BILATERAL | $413.60 |
| HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS LEFT | $395.26 |
| HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS RIGHT | $395.26 |
| HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS BILATERAL | $790.34 |
| HC X-RAY KNEE BILAT STANDING - XR KNEES ANTEROPOSTERIOR STANDING BILAT | $206.89 |
| HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS LEFT | $206.89 |
| HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS RIGHT | $206.89 |
| HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS BILATERAL | $413.60 |
| HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT LEFT | $206.89 |
| HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT RIGHT | $206.89 |
| HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS LEFT | $206.89 |
| HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS RIGHT | $206.89 |
| HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS BILATERAL | $413.60 |
| HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS LEFT | $206.89 |
| HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS RIGHT | $206.89 |
| HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS BILATERAL | $413.60 |
| HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS LEFT | $206.89 |
| HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS RIGHT | $206.89 |
| HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS BILATERAL | $413.60 |
| HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS LEFT | $206.89 |
| HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS RIGHT | $206.89 |
| HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL | $413.60 |
| HC X-RAY HEEL - XR CALCANEUS 2 VIEWS LEFT | $206.89 |
| HC X-RAY HEEL - XR CALCANEUS 2 VIEWS RIGHT | $206.89 |
| HC X-RAY HEEL - XR CALCANEUS 2 VIEWS BILATERAL | $413.60 |
| HC X-RAY TOE(S) - XR TOES 2+ VIEWS LEFT | $206.89 |
| HC X-RAY TOE(S) - XR TOES 2+ VIEWS RIGHT | $206.89 |
| HC X-RAY TOE(S) - XR TOES 2+ VIEWS BILATERAL | $413.60 |
| HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW | $206.89 |
| HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW | $395.26 |
| HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS | $395.26 |
| HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW | $395.26 |
| HC X-RAY NOSE-RECTUM CHILD F.B. - XR NOSE TO RECTUM FOREIGN BODY PEDS | $206.89 |
| HC X-RAYS FOR BONE AGE - XR BONE AGE EXTENDED | $395.26 |
| HC X-RAYS, BONE SURVEY COMPLETE - XR BONE SURVEY COMPLETE | $395.26 |
| HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW | $206.89 |
| HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS | $206.89 |
| HC RADIOLOGIC EXAM CHEST 3 VIEWS - XR CHEST 3 VIEWS | $206.89 |
| HC RADIOLOGIC EXAM CHEST 4+ VIEWS - XR CHEST 4+ VIEWS | $395.26 |
| HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS LT W/ CHEST ANTEROPOSTERIOR | $395.26 |
| HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS RT W/ CHEST ANTEROPOSTERIOR | $395.26 |
| HC X-RAY RIBS, CHEST 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR | $395.26 |
| TUBE THORACOSTOMY INCLUDES WATER SEAL | $839.27 |
| THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING | $891.60 |
| THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $386.11 |
| HC CT CHEST LOW DOSE LUNG CANCER SCREENING | $599.15 |
| HC CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP | $599.15 |
| HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDANCE FOR NEEDLE PLACEMENT | $0.00 |
| HC CT BONE DENSITY PERIPHERAL | $599.15 |
| HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST | $1,078.36 |
| HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST | $2,051.31 |
| HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST | $2,051.31 |
| HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT ORBITS/SELLA WO IV CONT | $1,078.36 |
| HC CT ORBIT/EAR/FOSSA/ WITH CONTRAST | $2,051.31 |
| HC CT SCAN SKULL COMBO - CT ORBITS/SELLA W AND WO IV CONTRAST | $2,051.31 |
| HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST | $1,078.36 |
| HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT | $1,078.36 |
| HC CT SCAN,MAXILLOFACIAL W/O CONTRAST | $1,078.36 |
| HC CT SCAN, FACE/JAW CONTRAST - CT SINUS W CONTRAST | $2,051.31 |
| HC CT SCAN, FACE/JAW CONTRAST - CT SINUS FACIAL BONES W CONTRAST | $2,051.31 |
| HC CT SCAN, FACE/JAW CONTRAST | $2,051.31 |
| HC CT SCANS FACE/JAW COMBO - CT SINUS W WO CONTRAST | $2,051.31 |
| HC CT SCANS FACE/JAW COMBO - CT SINUS FACIAL BONES W WO CONTRAST | $2,051.31 |
| HC CT SCANS FACE/JAW W WO CONTRAST | $2,051.31 |
| HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST - CT SOFT TISSUE NECK WO CONT | $1,078.36 |
| HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST | $2,051.31 |
| HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST | $2,051.31 |
| HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST | $2,051.31 |
| HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST | $2,051.31 |
| HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT HEAD | $0.00 |
| HC CT SCAN,THORAX,W/O CONTRAST - CT CHEST WO CONTRAST | $1,078.36 |
| HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST | $2,051.31 |
| HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST | $2,051.31 |
| HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT | $2,051.31 |
| HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST | $1,078.36 |
| HC CT SCAN CERV SPINE CONTRAST - CT CERVICAL SPINE W CONTRAST | $2,157.80 |
| HC CT SCAN CERV SP COMBO - CT CERVICAL SPINE W WO CONTRAST | $3,489.10 |
| HC CT SCAN,THORACIC SPINE,W/O CONTRAST - CT THORACIC SPINE WO CONTRAST | $1,078.36 |
| HC CT SCAN DORSAL SP CONTRAST - CT THORACIC SPINE W CONTRAST | $2,051.31 |
| HC CT SCAN DORSAL SP COMBO - CT THORACIC SPINE W WO CONTRAST | $2,051.31 |
| HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST | $1,078.36 |
| HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST | $2,051.31 |
| HC CT SCAN LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST | $3,489.10 |
| HC CT SCAN,PELVIS,W/O CONTRAST - CT PELVIS WO CONTRAST | $1,078.36 |
| HC CT SCAN OF PELVIS CONTRAST - CT PELVIS W CONTRAST | $2,051.31 |
| HC CT SCAN OF PELVIS COMBO - CT PELVIS W WO CONTRAST | $2,051.31 |
| HC CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT LEFT WO IV CONTRAST | $1,078.36 |
| HC CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT RIGHT WO IV CONTRAST | $1,078.36 |
| HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY LEFT W IV CONTRAST | $2,051.31 |
| HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY RIGHT W IV CONTRAST | $2,051.31 |
| HC CT SCAN OF ARM COMBO - CT UPPER EXTREMITY LEFT W AND WO IV CONTRAST | $2,051.31 |
| HC CT SCAN OF ARM COMBO - CT UPPER EXTREMITY RIGHT W AND WO IV CONTRAST | $2,051.31 |
| HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP LEFT WO IV CONTRAST | $1,078.36 |
| HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT WO IV CONTRAST | $1,078.36 |
| HC CT SCAN OF LEG CONTRAST - CT LOWER EXTREMITY W IV CONTRAST | $2,051.31 |
| HC CT SCAN OF LEG COMBO - CT LOWER EXTREMITY RIGHT W AND WO IV CONTRAST | $2,051.31 |
| HC CT SCAN OF LEG COMBO - CT LOWER EXTREMITY LEFT W AND WO IV CONTRAST | $2,051.31 |
| HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST | $1,078.36 |
| HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST | $2,051.31 |
| HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST | $2,051.31 |
| HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST | $2,051.31 |
| HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST | $2,396.31 |
| HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST | $2,051.31 |
| HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST | $3,489.10 |
| HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST | $599.15 |
| HC CT ANGIO ABDOMINAL ARTERIES - CT ANGIO AORTA & BILAT ILIOFEMORAL RUN | $2,051.31 |
| HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT BODY | $0.00 |
| HC CTRL NOSEBLEED,ANTER,SIMPLE | $344.02 |
| HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM | $665.85 |
| HC PLACE NEEDLE IN VEIN | $263.47 |
| HC INSERT TUNNELED CV CATH W/O PORT OR PUMP | $8,620.75 |
| HC INJECT NERV BLCK,INTERCOSTAL,ONE | $1,981.80 |
| HC DRAINAGE OF EYELID ABSCESS | $901.37 |
| VNPNXR 3 YEARS/> PHYS/QHP SKILL | $28.46 |
| INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y | $295.61 |
| INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> | $897.46 |
| INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> | $957.72 |
| INSERTION PICC W/O IMG GDN 5 YR/> | $294.86 |
| ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ | $196.08 |
| PLACEMENT NEEDLE INTRAOSSEOUS INFUSION | $558.10 |
| HC MOD SED SAME PHYS <5 YRS | $230.40 |
| HC MOD SED SAME PHYS <5 YRS | $230.40 |
| HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS | $279.62 |
| HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS | $191.65 |
| HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS | $191.65 |
| HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS | $96.60 |
| HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS | $96.60 |
| HC MOD SED PHYS/QHP INITIAL 15 MINS 5/> YRS | $241.50 |
| HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS | $193.20 |
| HC INVESTIGATION OF TRANSFSION REACTION /SO | $409.52 |
| HC RBC LEUKOCYTES REDUCED | $685.06 |
| HC PLATELETS, EACH UNIT | $193.00 |
| HC PLATELETS, PHERESIS, EA UNIT | $1,655.89 |
| HC RBC LEUKOREDUCED IRRADIATED | $1,061.05 |
| HC BLOOD TRANSFUSION SERVICE | $2,702.73 |
| HC BLOOD TRANSFUSION SERVICE | $2,702.73 |
| HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS LT | $0.01 |
| HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS RT | $0.01 |
| HC DX MAMMO INCL CAD UNI - MAMMO ADDITIONAL VIEWS RIGHT | $382.05 |
| HC US, HEAD/NECK TISSUES,REAL TIME - US THYROID | $319.70 |
| HC US, HEAD/NECK TISSUES,REAL TIME - US HEAD NECK SOFT TISSUE | $319.70 |
| HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE | $319.70 |
| HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED | $319.70 |
| HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING | $319.70 |
| HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE | $319.70 |
| HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST | $319.70 |
| HC OB US < 14 WKS ADDL FETUS - US OB < 14 WEEKS EACH ADDITIONAL GEST | $0.01 |
| HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST | $319.70 |
| HC OB US >/= 14 WKS ADDL FETUS - US OB 14+ WEEKS EACH ADDITIONAL GEST | $0.01 |
| HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST | $675.63 |
| HC OB US DETAILED ADDL FETUS - US OB DETAIL FETAL ANAT EA ADDL GEST | $0.01 |
| HC US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON | $319.70 |
| HC NUCHAL TRANSL MULT FETUS | $0.01 |
| HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES | $319.70 |
| HC OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH | $319.70 |
| HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL | $319.70 |
| HC FETAL BIOPHYS PROF,W/O NST | $319.70 |
| HC DOPPLER FETAL UMBILICAL ARTERY - US UMBILICAL ARTERY DOPPLER | $319.70 |
| HC DOPPLER FETAL UMBILICAL ARTERY | $319.70 |
| HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL | $319.70 |
| HC ECHOGRAPHY,TRANSVAGINAL | $319.70 |
| HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS | $319.70 |
| HC SONO PELVIS LIMITED - US PELVIS LIMITED | $319.70 |
| HC ECHO,SCROTUM & CONTENTS - US SCROTUM | $319.70 |
| HC US EXT NON-VASC LIMITED, REALTIME W/ IMG | $319.70 |
| HC US LMTD JT/NONVASC XTR STRUX - US KNEE RIGHT LIMITED | $319.70 |
| HC US LMTD JT/NONVASC XTR STRUX - US WRIST LEFT LIMITED | $319.70 |
| HC US LMTD JT/NONVASC XTR STRUX - US WRIST RIGHT LIMITED | $319.70 |
| HC US EXT NON-VASC LIMITED, REALTIME W/ IMG | $319.70 |
| HC US AXILLA | $319.70 |
| HC EXTREMITY STUDY - US LOWER EXTREMITY VEINS BILATERAL | $675.63 |
| HC EXTREMITY STUDY - US UPPER EXTREMITY VEINS BILATERAL | $675.63 |
| HC EXTREMITY STUDY - LT US VEINS UNILATERAL | $319.70 |
| HC EXTREMITY STUDY - RT US VEINS UNILATERAL | $319.70 |
| HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED | $319.70 |
| HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS BILAT | $0.01 |
| HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS LEFT | $0.01 |
| HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS RIGHT | $0.01 |
| HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL | $443.67 |
| DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL | $516.24 |
| CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL | $824.78 |
| INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE | $650.00 |
| HC RT HEART/LUNG RESUSCITATION (CPR) | $1,084.45 |
| HC RT CPAP NON-EMERGENT | $619.10 |
| RLAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG | $1,166.68 |
| RLAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX | $1,146.32 |
| HC INHALATION TREATMENT | $435.45 |
| HC INHALATION TREATMENT | $435.45 |
| HC INHALATION TREATMENT SUBSEQUENT (EA) | $73.43 |
| DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS | $667.29 |
| UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES | $603.75 |
| DRAINAGE ABSCESS PALATE UVULA | $342.36 |
| HC PT ELECTRICAL STIMULATION | $110.86 |
| HC PT ULTRASOUND THERAPY | $59.92 |
| HC PT THERAPEUTIC EXERCISES | $124.26 |
| HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN | $124.26 |
| HC PT GAIT TRAINING THERAPY | $109.42 |
| HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN | $105.34 |
| HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $86.88 |
| HC PT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES | $86.88 |
| HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS | $314.70 |
| HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS | $384.62 |
| HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS | $489.33 |
| HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS | $195.73 |
| HC MOBILITY CURRENT STATUS | $0.00 |
| I&D ABSCESS PERITONSILLAR | $652.28 |
| REMOVAL FOREIGN BODY PHARYNX | $418.14 |
| CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE | $949.96 |
| UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS | $326.26 |
| GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE | $439.88 |
| PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC | $133.17 |
| HC SLP SPEECH/HEARING THERAPY, INDIVIDUAL | $299.17 |
| HC SLP ORAL FUNCTION THERAPY | $324.70 |
| HC SLP THER SRVC(S),NON-SPEECH GEN DEV, W/PROG | $269.33 |
| HC SLP THER SRVC, SPEECH GEN DEV USE, W/PROG | $418.89 |
| HC SLP STANDARDIZED COGNITIVE PERFORMANCE TESTING | $444.25 |
| HC SP COGNITIVE FUNCT THER INTERV, INITIAL 15 MIN | $66.70 |
| HC SLP COGNITIVE FUNCT THER INTERV, EA ADDL 15 MIN | $66.70 |
| HC COGNITIVE SKILLS DEVELOPMENT | $100.40 |
| HC SLP EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION | $733.01 |
| HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE | $339.60 |
| HC SLP EVAL VOICE PROSTH DEVICE | $272.38 |
| HC EVAL,NON-SPEECH GEN AUG/ALT COMMUN DEV | $336.66 |
| HC SLP EVAL,SPEECH-GEN AUG/ALT COMM DEV,1ST HR | $478.75 |
| HC SLP EVAL,SPEECH-GEN AUG/ALT COMM DEV,ADDL 30 | $197.57 |
| HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION | $276.81 |
| HC SLP EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN | $122.76 |
| HC PRO ED PLACEHOLDER | $757.74 |
| HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB | $468.40 |
| HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB | $468.40 |
| HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY | $1,471.83 |
| HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY | $1,471.83 |
| HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY | $2,752.07 |
| HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY | $2,752.07 |
| HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY | $4,005.57 |
| HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY | $4,005.57 |
| HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC | $7,252.71 |
| HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC | $7,252.71 |
| HC ED NURSE ONLY - NO CHG | $0.00 |
| HC ED NURSE ONLY - NO CHG | $0.00 |
| I&D PERIANAL ABSCESS SUPERFICIAL | $626.87 |
| INCISION THROMBOSED HEMORRHOID EXTERNAL | $626.23 |
| INCISION THROMBOSED HEMORRHOID EXTERNAL | $381.80 |
| HC VITAL CAPACITY TEST - PR VITAL CAPACITY TEST | $143.75 |
| HC VITAL CAPACITY TEST - PR VITAL CAPACITY TEST | $143.75 |
| HC NONINVASV OXYGEN SATUR;SINGLE | $71.93 |
| HC NONINVASV OXYGEN SATUR;SINGLE | $71.93 |
| ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD | $297.91 |
| ANOSCOPY W/RMVL FOREIGN BODY | $293.60 |
| HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL | $1,002.11 |
| HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL | $1,002.11 |
| HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX | $675.74 |
| HC VASC DUPLEX EXTREM VENOUS,BILAT | $675.63 |
| HC DUPLEX EXTREM VENOUS,UNI OR LTD | $319.70 |
| HC DUPLEX ABD/PEL VASC STUDY,LIMITD | $319.70 |
| ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE | $516.24 |
| ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE | $375.42 |
| ASPIRATION BLADDER NEEDLE | $134.21 |
| INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE | $224.48 |
| INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE | $224.48 |
| CHANGE CYSTOSTOMY TUBE SIMPLE | $186.07 |
| HC EXC SKIN BENIG <5MM REMAINDR BODY | $289.46 |
| HC REMOVE DRUG IMPLANT DEVICE | $230.69 |
| HC REMOVE W REINSERT DRUG IMPLANT | $449.19 |
| HC REMV IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $49.68 |
| DSTRJ LESION PENIS SIMPLE CRYOSURGERY | $440.80 |
| DRAINAGE SCROTAL WALL ABSCESS | $488.75 |
| I&D VULVA/PERINEAL ABSCESS | $471.27 |
| I&D OF BARTHOLINS GLAND ABSCESS | $347.19 |
| COLPORRHAPHY SUTURE INJURY VAGINA | $1,094.34 |
| COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA | $626.87 |
| COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE | $896.20 |
| ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX | $592.54 |
| INSERTION INTRAUTERINE DEVICE IUD | $253.00 |
| REMOVAL INTRAUTERINE DEVICE IUD | $519.11 |
| REMOVAL INTRAUTERINE DEVICE IUD | $221.95 |
| VAGINAL DELIVERY ONLY | $4,923.96 |
| DELIVERY PLACENTA SEPARATE PROCEDURE | $304.29 |
| DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $1,000.79 |
| INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH | $273.87 |
| INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $242.48 |
| INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL | $196.59 |
| INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH | $369.50 |
| CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | $430.10 |
| REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL | $149.62 |
| REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL | $309.75 |
| RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR | $335.11 |
| RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP | $360.58 |
| RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP | $207.00 |
| BLEPHAROTOMY DRAINAGE ABSCESS EYELID | $394.11 |
| HC CRITICAL CARE, E/M 30-74 MINUTES | $12,562.49 |
| HC CRITICAL CARE, ADDL 30 MIN | $1,081.58 |
| DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE | $713.52 |
| DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE | $713.52 |
| DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS | $785.51 |
| RMVL FB XTRNL AUDITORY CANAL W/O ANES | $354.20 |
| RMVL FB XTRNL AUDITORY CANAL W/O ANES | $414.35 |
| REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $49.68 |
| REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $49.68 |
| REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $163.19 |
| REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $163.19 |
| HC APPLY LONG LEG SPLINT | $740.49 |
| RADIOLOGIC EXAMINATION MANDIBLE PRTL <4 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION MANDIBLE PRTL <4 VIEWS | $62.33 |
| RADEX FACIAL BONES < 3 VIEWS | $40.02 |
| RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS | $45.54 |
| RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS | $40.02 |
| RADEX ORBITS COMPLETE MINIMUM 4 VIEWS | $49.16 |
| RADEX SINUSES PARANASAL <3 VIEWS | $40.02 |
| RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS | $43.13 |
| RADIOLOGIC EXAMINATION SKULL 4< VIEWS | $43.13 |
| RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS | $60.03 |
| RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT | $42.03 |
| RADIOLOGIC EXAMINATION NECK SOFT TISSUE | $40.02 |
| CT HEAD/BRAIN W/O CONTRAST MATERIAL | $370.88 |
| CT HEAD/BRAIN W/CONTRAST MATERIAL | $521.18 |
| CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL | $618.13 |
| CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL | $748.08 |
| CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL | $884.35 |
| CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR | $963.59 |
| CT MAXILLOFACIAL W/O CONTRAST MATERIAL | $447.01 |
| CT MAXILLOFACIAL W/CONTRAST MATERIAL | $538.89 |
| CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL | $656.19 |
| CT SOFT TISSUE NECK W/O CONTRAST MATERIAL | $621.29 |
| CT SOFT TISSUE NECK W/CONTRAST MATERIAL | $757.62 |
| CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL | $890.73 |
| CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST | $941.45 |
| CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST | $938.29 |
| RADIOLOGIC EXAM CHEST SINGLE VIEW | $40.02 |
| RADIOLOGIC EXAM CHEST 2 VIEWS | $40.02 |
| RADIOLOGIC EXAM CHEST 2 VIEWS | $40.02 |
| RADIOLOGIC EXAM CHEST 3 VIEWS | $47.96 |
| RADIOLOGIC EXAM CHEST 4+ VIEWS | $55.20 |
| RADEX RIBS UNILATERAL 2 VIEWS | $40.02 |
| RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS | $46.69 |
| RADEX RIBS BILATERAL 3 VIEWS | $50.37 |
| RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS | $56.29 |
| RADEX STERNUM MINIMUM 2 VIEWS | $40.02 |
| DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST | $580.06 |
| CT THORAX DX | $738.59 |
| DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+ | $884.35 |
| COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- | $811.44 |
| CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST | $963.59 |
| RADEX SPINE 1 VIEW SPECIFY LEVEL | $40.02 |
| RADEX SPINE CERVICAL 2 OR 3 VIEWS | $40.02 |
| RADEX SPINE CERVICAL 4 OR 5 VIEWS | $53.99 |
| RADEX SPINE CERVICAL 6 OR MORE VIEWS | $62.33 |
| HC OBSTETRICAL CARE,VAG DELIV ONLY | $1,241.31 |
| RADEX SPINE THORACIC 2 VIEWS | $40.02 |
| RADEX SPINE THORACIC 3 VIEWS | $40.02 |
| RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS | $40.02 |
| RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW | $45.54 |
| RADEX SPINE LUMBOSACRAL 2/3 VIEWS | $40.02 |
| RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $53.99 |
| RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 | $56.29 |
| RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS | $137.89 |
| CT CERVICAL SPINE W/O CONTRAST MATERIAL | $592.77 |
| CT CERVICAL SPINE W/CONTRAST MATERIAL | $732.38 |
| CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL | $865.38 |
| CT THORACIC SPINE W/O CONTRAST MATERIAL | $580.06 |
| CT THORACIC SPINE W/CONTRAST MATERIAL | $738.59 |
| CT THORACIC SPINE W/O & W/CONTRAST MATERIAL | $871.70 |
| CT LUMBAR SPINE W/O CONTRAST MATERIAL | $576.96 |
| CT LUMBAR SPINE W/CONTRAST MATERIAL | $732.21 |
| CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL | $865.38 |
| RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS | $40.02 |
| CT PELVIS W/O CONTRAST MATERIAL | $469.14 |
| CT PELVIS W/CONTRAST MATERIAL | $725.88 |
| CT PELVIS W/O & W/CONTRAST MATERIAL | $833.64 |
| RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS | $40.02 |
| RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS | $40.02 |
| RADEX SACRUM & COCCYX MINIMUM 2 VIEWS | $40.02 |
| HC DELIVER PLACENTA | $7,917.98 |
| RADEX CLAVICLE COMPLETE | $40.02 |
| RADEX SCAPULA COMPLETE | $40.02 |
| RADEX SHOULDER 1 VIEW | $40.02 |
| RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | $40.02 |
| RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | $64.75 |
| RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ | $40.02 |
| RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ | $64.75 |
| RADEX HUMERUS MINIMUM 2 VIEWS | $40.02 |
| RADEX ELBOW 2 VIEWS | $40.02 |
| RADEX ELBOW 2 VIEWS | $55.20 |
| RADEX ELBOW COMPLETE MINIMUM 3 VIEWS | $40.02 |
| RADEX ELBOW COMPLETE MINIMUM 3 VIEWS | $60.03 |
| RADEX FOREARM 2 VIEWS | $40.02 |
| RADEX FOREARM 2 VIEWS | $57.62 |
| RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS | $40.02 |
| HC ELECTROCARDIOGRAM, TRACING | $832.03 |
| HC ELECTROCARDIOGRAM, TRACING | $832.03 |
| HC ECG-1-3 LEAD TRACING ONLY | $116.90 |
| HC ECG-1-3 LEAD TRACING ONLY | $116.90 |
| RADEX WRIST 2 VIEWS | $40.02 |
| RADEX WRIST 2 VIEWS | $60.03 |
| RADEX WRIST COMPLETE MINIMUM 3 VIEWS | $40.02 |
| RADEX WRIST COMPLETE MINIMUM 3 VIEWS | $60.03 |
| RADEX HAND 2 VIEWS | $40.02 |
| RADEX HAND 2 VIEWS | $57.62 |
| RADEX HAND MINIMUM 3 VIEWS | $40.02 |
| RADEX HAND MINIMUM 3 VIEWS | $60.03 |
| RADEX FINGR MINIMUM 2 VIEWS | $40.02 |
| CT UPPER EXTREMITY W/O CONTRAST MATERIAL | $576.96 |
| CT UPPER EXTREMITY W/CONTRAST MATERIAL | $713.23 |
| CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL | $890.73 |
| RADEX HIP UNILATERAL WITH PELVIS 1 VIEW | $40.02 |
| RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS | $40.02 |
| RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS | $79.93 |
| RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS | $40.02 |
| RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS | $51.58 |
| RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS | $115.00 |
| RADIOLOGIC EXAMINATION KNEE 3 VIEWS | $129.49 |
| RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS | $40.02 |
| RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS | $79.93 |
| RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST | $79.93 |
| RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS | $115.00 |
| RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION ANKLE 2 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION ANKLE 2 VIEWS | $79.93 |
| RADEX ANKLE COMPLETE MINIMUM 3 VIEWS | $40.02 |
| RADEX ANKLE COMPLETE MINIMUM 3 VIEWS | $119.83 |
| RADIOLOGIC EXAMINATION FOOT 2 VIEWS | $40.02 |
| RADIOLOGIC EXAMINATION FOOT 2 VIEWS | $105.57 |
| RADEX FOOT COMPLETE MINIMUM 3 VIEWS | $40.02 |
| RADEX FOOT COMPLETE MINIMUM 3 VIEWS | $115.00 |
| RADEX CALCANEUS MINIMUM 2 VIEWS | $40.02 |
| RADEX CALCANEUS MINIMUM 2 VIEWS | $110.29 |
| RADEX TOE MINIMUM 2 VIEWS | $40.02 |
| RADEX TOE MINIMUM 2 VIEWS | $79.93 |
| CT LOWER EXTREMITY W/O CONTRAST MATERIAL | $580.69 |
| CT LOWER EXTREMITY W/CONTRAST MATERIAL | $725.88 |
| CT LOWER EXTREMITY W/O & W/CONTRAST MATRL | $878.03 |
| RADIOLOGIC EXAM ABDOMEN 1 VIEW | $40.02 |
| RADIOLOGIC EXAM ABDOMEN 2 VIEWS | $40.02 |
| RADIOLOGIC EXAM ABDOMEN 3+ VIEWS | $35.31 |
| RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES | $55.20 |
| CT ABDOMEN W/O CONTRAST MATERIAL | $481.85 |
| CT ABDOMEN W/CONTRAST MATERIAL | $741.75 |
| CT ABDOMEN W/O & W/CONTRAST MATERIAL | $843.18 |
| CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG | $1,248.90 |
| CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL | $646.65 |
| CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $998.49 |
| CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE | $1,134.82 |
| HC GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC | $1,492.82 |
| HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS | $2,096.85 |
| CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM | $323.38 |
| CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP | $1,226.71 |
| RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD | $40.02 |
| HC INCISION DRAIN SKIN ABSCESS SIMPLE | $436.08 |
| HC INCISION DRAIN SKIN ABSCESS SIMPLE | $487.77 |
| HC DRAIN SKIN ABSCESS COMPLIC | $611.92 |
| HC DRAIN PILONIDAL CYST SIMPL | $908.27 |
| HC REMOVE FOREIGN BODY SIMPLE | $634.23 |
| HC REMOVE FOREIGN BODY COMPLIC | $2,295.98 |
| HC DRAINAGE OF HEMATOMA/FLUID | $1,955.00 |
| HC PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST | $240.93 |
| HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA | $613.30 |
| HC DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE | $3,121.68 |
| HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM | $1,012.69 |
| HC TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION | $587.19 |
| HC TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EA ADDL | $311.54 |
| HC PUNCH BIOPSY SKIN SINGLE LESION | $587.19 |
| HC PUNCH BIOPSY SKIN LESION EACH ADDITIONAL | $311.54 |
| HC INCISIONAL BIOPSY SKIN SINGLE LESION | $1,045.12 |
| HC INCISIONAL BIOPSY SKIN SINGLE LESION | $553.84 |
| HC REMOVAL OF SKIN TAGS, UP TO 15 | $411.01 |
| HC SHAVE SKIN LESION <0.5 CM TRUNK,ARM,LEG | $408.25 |
| HC EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG | $1,435.14 |
| HC EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG | $4,246.84 |
| HC EXC SKIN BENIG <5MM REMAINDR BODY | $1,118.26 |
| HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY | $3,662.41 |
| HC REMOVAL OF NAIL PLATE | $412.51 |
| HC DRAIN BLOOD FROM UNDER NAIL | $217.12 |
| HC REMOVAL OF NAIL BED | $852.50 |
| HC RECONSTRUC OF NAIL BED | $1,498.57 |
| HC RESUPERF WND BODY <2.5CM | $1,104.00 |
| HC RESUP NPTERF WND BODY 2.6-7.5 CM | $1,223.72 |
| HC RESUPERF WND BODY 7.6-12.5 CM | $665.85 |
| HC RESUPERF WND BODY 12.6-20 CM | $1,121.83 |
| HC RESUPERF WND BODY 20.1-30 CM | $1,006.48 |
| HC RESUPERF WND FACE <2.5 CM | $789.94 |
| HC RESUPERF WND FACE 2.6-5 CM | $448.85 |
| HC RESUPERF WND FACE 5.1-7.5 CM | $436.94 |
| HC RESUPERF WND FACE 7.6-12.5 CM | $665.85 |
| HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM | $783.84 |
| HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM | $783.84 |
| HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM | $782.46 |
| HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM | $732.49 |
| HC LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM | $1,606.95 |
| HC LAYR CLOS WND TRUNK,ARM,LEG >30.0 CM | $1,606.95 |
| HC LAYR CLOS WND REST BODY <2.5 CM | $665.85 |
| HC LAYR CLOS WND REST BODY 2.6-7.5 CM | $768.43 |
| HC LAYR CLOS WND FACE,FACIAL <2.5 CM | $665.85 |
| HC LAYR CLOS WND FACE,FACIAL 2.5-5 CM | $665.85 |
| HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM | $803.97 |
| HC LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM | $513.36 |
| HC REPAIR COMPLEX WND TRUNK 2.6-7.5 CM | $1,624.89 |
| HC RECMPL WND SCALP,EXTR 2.6-7.5 CM | $1,171.28 |
| HC REP,SKIN,SCALP/EXTREM+5 CM/< | $1,149.08 |
| HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM | $826.79 |
| HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM | $752.33 |
| HC REPAIR COMPLEX FAC,HAND,GN EA ADD <5CM | $752.33 |
| HC FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/< | $4,906.71 |
| HC APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25 | $4,930.05 |
| HC INITIAL RX BURN(S) 1ST DEGREE | $554.30 |
| HC DRESS/DEBRID SMALL BURN NO ANES | $439.88 |
| HC DRESS/DEBRID MED BURN NO ANESTH | $306.71 |
| HC DRESS/DEBRID LARGE BURN NO ANESTH | $826.79 |
| HC DESTRUCTION BENIGN LESIONS UP TO 14 | $535.21 |
| HC EXPL PENETRATING WOUND ABD/BACK | $4,989.05 |
| HC EXPLORE PENETRATING WOUND,EXTREMITY | $1,506.90 |
| HC INJECT TENDON SHEATH/LIGAMENT | $757.74 |
| HC INJECT TRIGGER POINT, 1 OR 2 | $837.72 |
| HC INJECT TRIGGER POINTS, > 3 | $778.72 |
| HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US | $781.54 |
| HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US | $788.27 |
| HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US | $833.18 |
| HC CLOSED TX NOSE FRACTURE, W/O STABILIZATION | $2,746.20 |
| HC REDUCE TEMPOROMANDIBL DISLOC | $749.63 |
| HC CLOSED TX CLAVICLE FX,MANIPULATN | $836.05 |
| HC CLOSED TX SCAPULA FX,MANIPULATN | $4,369.20 |
| HC CLOSED TX PROX HUMERUS FX,MANIP | $4,089.40 |
| HC CLOSED TX SHLDR DISLOCATION | $1,299.90 |
| HC CLOSED TX SHLDR DISLOC,ANESTHESIA | $3,464.20 |
| HC CLOSED TX SHLDR DISLOC,GR TUB FX | $3,241.39 |
| HC CLOSED TX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ | $3,831.69 |
| HC I&D ARM/ELBOW INFECT BURSA | $4,486.38 |
| HC EXCISION OLECRANON BURSA | $8,729.19 |
| HC CLOSED TX HUM SUPRACONDYLR FX,MANIPU | $4,089.40 |
| HC CLOSED TX HUMER CONDYLR FX,MANIP | $795.92 |
| HC CLOSED TX ELBOW DISLOCATION | $621.92 |
| HC CLOSED TX RADIAL HEAD DISLOC,CHILD | $860.09 |
| HC UNLISTED PROCEDURE HUMERUS/ELBOW | $718.98 |
| HC REMOVE FOREARM/WRIST FOREIGN BODY | $4,044.44 |
| HC CLOSED TX RAD/ULNA SHAFT FX,MANIP | $1,853.17 |
| HC CLOSED TX DIST RAD/ULNA FX | $731.63 |
| HC CLOSED TX DIST RAD/ULNA FX,MANIPUL | $673.10 |
| HC CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ | $3,240.36 |
| HC CLOSED TX ULNA STYLOID FX | $698.40 |
| HC DRAIN FINGER ABSCESS,SIMPLE | $968.88 |
| HC DRAIN FINGER ABSCESS,COMPLICATED | $4,485.92 |
| HC REPAIR EXTEN TENDON,DORSUM FINGR,EA | $3,589.67 |
| HC CLOSED TX METACARPAL FX | $748.19 |
| HC CLOSED TX METACARPAL FX,MANIP | $803.97 |
| HC TREAT THUMB FX/DISLOC,MANIP | $4,293.87 |
| HC CLOSE TX PROX/MID FING SHFT FX,MANIP | $1,299.90 |
| HC CLOSE TX FINGR ARTICULAR FX,MANIP | $553.61 |
| HC CLOSE TX DIST FINGR FX,MANIPULATN | $683.45 |
| HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH | $4,461.89 |
| HC CLOSED TX IP JT DISLOCATION | $852.50 |
| HC AMPUTATION FINGER/THUMB | $2,696.64 |
| HC CLOSED TX POST HIP ARTHRPLAS DISLOC | $699.03 |
| HC I&D DEEP ABSC BURSA THIGH/KNEE | $7,914.42 |
| HC REMOV FB DEEP THIGH/KNEE | $7,350.23 |
| HC CLOSED TX TIB PLAT FX+MANIP | $8,676.18 |
| HC CLOSED TX KNEECAP DISLOCATN | $684.71 |
| HC CLOSED TX TIBIA SHAFT FX,MANIPULATN | $554.42 |
| HC CLOSED TX PROX FIBULA SHAFT FX W MANIJ PRO FE | $4,294.33 |
| HC CLOSED TX DIST FIBULA FX,MANIP | $715.19 |
| HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP | $4,202.10 |
| HC CLOSED TX TRIMALLEOLAR FX,MANIP | $554.42 |
| HC CLOSED TX WEIGHT BEAR DIST TIB,MANIP | $3,831.69 |
| HC CLOSED TX ANKLE DISLOCATN | $715.19 |
| HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS | $1,875.31 |
| HC CLOSED TX HEEL FX | $715.19 |
| HC CLOSED TX TALUS FX,MANIPULATN | $3,240.36 |
| HC CLOSED TX METATARSAL FX W/MANI | $621.92 |
| HC OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES | $3,247.14 |
| HC CLOSED TX TOE FX,MANIPULATN | $852.50 |
| HC CLOSED TX MT-PHAL TOE DISLOCATION | $795.92 |
| HC CLOSED TX I-P JT,TOE DISLOCATION | $796.84 |
| HC APPLY LONG ARM SPLINT | $365.13 |
| HC APPLY FOREARM SPLINT,STATIC | $487.77 |
| HC APPLY FINGER SPLINT,STATIC | $239.43 |
| HC APPLICATION LONG LEG SPLINT | $750.50 |
| HC APPLY LOWER LEG SPLINT | $487.77 |
| HC STRAPPING UNNA BOOT | $414.00 |
| HC REMOVE NASAL FOREIGN BODY | $349.66 |
| HC CTRL NOSEBLEED,ANTER,SIMPLE | $344.02 |
| HC CTRL NOSEBLEED,ANTER,COMPLEX | $483.35 |
| HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT | $331.09 |
| HC INSERT EMERGENCY ENDOTRACH AIRWAY | $2,800.14 |
| HC LARYNGOSCOPY,INDIRECT,DX | $495.08 |
| HC LARYNGOSCOPY,DIRECT,DIAGNOSTIC | $3,381.46 |
| HC TUBE THORACOSTOMY INCLUDES WATER SEAL | $1,209.34 |
| HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING | $1,232.28 |
| HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING | $2,116.52 |
| HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,630.87 |
| HC INTRAVENOUS START/SAL LOC | $263.47 |
| HC INSERT NON-TUNNEL CV CATH < 5 Y/O | $4,011.66 |
| HC INSERT NON-TUNNEL CV CATH | $3,344.55 |
| HC INSERT PICC W/O SUB-Q PORT | $2,616.08 |
| HC INSERT NEEDLE,INTRAOSSEOUS INFUSN | $1,253.50 |
| HC DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL | $852.50 |
| HC CLOSER MOUTH LACERATION >2.5CM OR COMPLEX | $1,544.80 |
| HC REPAIR TONGUE LACER,<2.6 CM | $318.78 |
| HC REPAIR TONGUE LACER,2.6 CM+/COMPLX | $2,407.07 |
| HC DRAINAGE OF GUM LESION | $783.84 |
| HC DENTAL SURGERY PROCEDURE | $638.83 |
| HC DRAINAGE ABSCESS PALATE, UVULA | $646.65 |
| HC INC/DRAIN PERITONSIL ABSCESS | $561.09 |
| HC REMOVE PHARYNX FOREIGN BODY | $1,098.37 |
| HC CONTROL THROAT BLEED,SIMPLE | $595.47 |
| HC THROAT SURGERY PROCEDURE UNSPEC | $1,045.12 |
| HC RPLC GASTRO TUBE NO REV/GUID | $770.85 |
| HC I&D PERIANAL ABSCESS,SUPERFICIAL | $1,205.72 |
| HC INCISE EXTERNAL HEMORRHOID | $720.02 |
| HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD | $349.03 |
| HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE | $2,533.45 |
| HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE | $2,111.06 |
| HC ASPIRATION BLADDER NEEDLE | $1,882.44 |
| HC INSERT,NON-INDWELLING BLADDER CATHETER | $378.93 |
| HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE | $836.05 |
| HC INSERT,TEMP INDWELLING BLAD CATH,COMP | $281.64 |
| HC CHANGE OF BLADDER TUBE,SIMPLE | $559.25 |
| HC DRAINAGE SCROTAL WALL ABSCESS | $4,128.50 |
| HC I&D OF VULVA/PERINEUM ABSCESS | $527.16 |
| HC I&D BARTHOLIN GLAND ABSCESS | $523.54 |
| HC COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB | $6,049.35 |
| HC REMOVE INTRAUTERINE DEVICE | $858.42 |
| HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC | $1,646.69 |
| HC INJECT NERV BLCK,TRIGEMINAL | $788.27 |
| HC INJECT NERV BLCK,GREAT OCCIPTL | $793.50 |
| HC INJECT NERV BLCK,OTHR PERIPH NERV | $778.72 |
| HC REMV F.B.,EYE,SUPERF CONJUNC | $349.66 |
| HC REMV F.B.,EYE,CORNEA,NO SLIT | $715.07 |
| HC REMV F.B.,EYE,CORNEA,SLIT LAMP | $921.38 |
| HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE | $798.33 |
| HC DRAIN EXT AUDITORY CANAL ABSCESS | $798.33 |
| HC REMV EXT CANAL FOREIGN BODY | $282.38 |
| HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $204.99 |
| HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $149.73 |
| HC UNLISTED PROCEDURE EXTERNAL EAR | $621.00 |
| HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT | $277.84 |
| HC DEBRIDEMENT OPEN WOUND 20 SQ CM< | $1,295.42 |
| HC NEGATIVE PRESSURE WOUND THERAPY DME | $554.13 |
| HC NEGATIVE PRESSURE WOUND THERAPY DME | $554.13 |
| HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM | $1,013.15 |
| HC NEG PRESSURE WOUND THERAPY NON DME | $1,043.28 |
| HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP | $444.59 |
| HC OFFICE OUTPATIENT VISIT EST 10-19 MINUTES | $322.06 |
| HC OFFICE OUTPATIENT VISIT EST 20-29 MINUTES | $307.86 |
| HC OFFICE OUTPATIENT VISIT EST 30-39 MINUTES | $275.08 |
| HC HOSPITAL OBSERVATION HOURLY PER HR | $247.94 |
| 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION | $76.13 |
| CT LIMITED/LOCALIZED FOLLOW UP STUDY | $469.14 |
| US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM | $335.23 |
| US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $350.75 |
| US ABDOMINAL REAL TIME W/IMAGE LIMITED | $262.20 |
| US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA | $319.70 |
| US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE | $325.45 |
| US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT | $350.18 |
| US PREG UTERUS 14 WK TRANSABDL EACH GESTATION | $180.55 |
| US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $402.50 |
| US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO | $261.63 |
| US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | $516.35 |
| US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT | $575.00 |
| US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION | $350.75 |
| US PREGNANT UTERUS LIMITED 1/> FETUSES | $242.65 |
| US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS | $327.18 |
| US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $249.55 |
| FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING | $248.40 |
| DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY | $134.55 |
| US TRANSVAGINAL | $358.80 |
| US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE | $317.40 |
| US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U | $141.45 |
| US SCROTUM & CONTENTS | $325.45 |
| US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG | $166.18 |
| CT GUIDANCE NEEDLE PLACEMENT | $399.45 |
| DIGITAL BREAST TOMOSYNTHESIS UNILATERAL | $155.25 |
| SCREENING DIGITAL BREAST TOMOSYNTHESIS BI | $155.25 |
| DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $146.51 |
| SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $155.54 |
| BONE AGE STUDIES | $40.02 |
| RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL | $92.35 |
| CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE | $364.55 |
| HC PIFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, 1ST DOSE | $77.05 |
| HC PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, 2ND DOSE | $77.05 |
| HC PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, 3RD DOSE | $77.05 |
| HC PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, BOOSTER | $77.05 |
| HC MODERNA COVID-19 VACCINE, 100MCG/0.5ML, ADMINISTRATION - 1ST DOSE | $77.05 |
| HC MODERNA COVID-19 VACCINE, 100MCG/0.5ML, ADMINISTRATION - 2ND DOSE | $77.05 |
| HC MODERNA COVID-19 VACCINE, 50MCG/0.25ML, ADMINISTRATION – BOOSTER DOSE | $77.05 |
| HC PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, 1ST DOSE | $77.05 |
| HC PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, 2ND DOSE | $77.05 |
| HC PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, 3RD DOSE | $77.05 |
| HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID | $119.72 |
| HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | $119.72 |
| HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID CHILDREN | $33.01 |
| HC IMMUNIZ,ADMIN,EACH ADDL | $45.77 |
| HC IMMUNIZ,ADMIN,EACH ADDL | $76.99 |
| HC TELEHEALTH ORIGIN SITE FAC FEE | $63.42 |
| URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $36.00 |
| URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS | $125.29 |
| GLUCOSE BLOOD REAGENT STRIP | $33.12 |
| SKIN TEST TUBERCULOSIS INTRADERMAL | $123.17 |
| HC PSYCHIATRIC DIAGNOSTIC EVALUATION | $511.75 |
| HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $575.00 |
| HC PSYCHOTHERAPY W/PATIENT 60 MINUTES | $433.55 |
| HC PSYCHOTHERAPY FOR CRISIS INIT 60 MINS | $415.15 |
| HC PSYCHOANALYSIS | $279.45 |
| IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE | $141.16 |
| IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE | $29.93 |
| IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE | $50.03 |
| IM ADM INTRANSL/ORAL 1 VACCINE | $48.76 |
| IM ADM INTRANSL/ORAL EA VACCINE | $36.80 |
| MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM | $0.00 |
| HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE | $0.00 |
| 9VHPV VACC 2/3 DOSE SCHED IM USE | $0.00 |
| IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | $103.50 |
| PCV13 VACCINE FOR INTRAMUSCULAR USE | $0.00 |
| LAIV4 VACCINE FOR INTRANASAL USE | $0.00 |
| PCV20 VACCINE FOR INTRAMUSCULAR USE | $441.60 |
| RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE | $0.00 |
| IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE | $0.00 |
| AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE | $207.00 |
| DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE | $0.00 |
| DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM | $0.00 |
| DT VACCINE YOUNGER THAN 7 YRS FOR IM USE | $0.00 |
| MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ | $235.75 |
| MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ | $0.00 |
| POLIOVIRUS VACCINE INACTIVATED SUBQ/IM | $97.75 |
| TDAP VACCINE 7 YRS/> IM | $187.45 |
| TDAP VACCINE 7 YRS/> IM | $0.00 |
| VAR VACCINE LIVE FOR SUBCUTANEOUS USE | $303.60 |
| VAR VACCINE LIVE FOR SUBCUTANEOUS USE | $0.00 |
| DTAP-HEPB-IPV VACCINE INTRAMUSCULAR | $194.35 |
| DTAP-HEPB-IPV VACCINE INTRAMUSCULAR | $0.00 |
| ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE | $44.28 |
| HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM | $129.00 |
| HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM | $0.00 |
| HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE | $274.51 |
| HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX | $269.10 |
| PSYCHIATRIC DIAGNOSTIC EVALUATION | $511.75 |
| PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $575.00 |
| PSYCHOTHERAPY W/PATIENT 30 MINUTES | $224.25 |
| PSYCHOTHERAPY W/PATIENT 45 MINUTES | $295.55 |
| PSYCHOTHERAPY W/PATIENT 60 MINUTES | $433.55 |
| PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES | $415.15 |
| PSYCHOANALYSIS | $279.45 |
| PFIZER (COVID-19) SARSCOV2 VACCINE BIVALENT 30 MCG/0.3 ML IM USE | $0.00 |
| HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | $373.75 |
| HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES | $402.50 |
| HC PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES | $431.25 |
| HC GROUP PSYCHOTHERAPY | $339.25 |
| HC FAMILY PSYCHOTHERAPY,NO PT | $431.25 |
| HC FAMILY PSYCHOTHERAPY W PHYS | $431.25 |
| HC DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM | $68.43 |
| HC BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT | $14.95 |
| HC PT HEAL FCUS RISK ASSES SCOR/DOC EA INST | $8.05 |
| HC PROV FOCUS HLTH RISK ASSES S/D PER INSTR | $8.05 |
| HC BEHAVIOR COUNSEL OBESITY EA 15 MIN | $67.85 |
| HC DUPLEX EXTREM VENOUS,BILAT - LOWER EXTREMITY DVT | $675.63 |
| HC DUPLEX EXTREM VENOUS,UNI OR LTD | $319.70 |
| HC DUPLEX ABD/PEL VASC STUDY,LIMITD | $319.70 |
| SCREENING TEST PURE TONE AIR ONLY | $50.95 |
| PURE TONE AUDIOMETRY AIR ONLY | $98.90 |
| TYMPANOMETRY | $77.91 |
| CARDIOPULMONARY RESUSCITATION | $785.34 |
| CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $598.35 |
| ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY | $83.95 |
| DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $527.00 |
| DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $357.08 |
| DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RORGN LMT | $472.65 |
| HC MEDICAL NUTRITION THERAPY REAS SAME YR INDIV EA 15 MN | $81.65 |
| HC MEDICAL NUTRITION THERAPY REAS SAM YR GROUP EA 30 MIN | $44.85 |
| AIRWAY INHALATION TREATMENT | $297.91 |
| DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM | $68.43 |
| DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM | $68.43 |
| BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT | $14.95 |
| PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM | $8.05 |
| CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM | $8.05 |
| THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM | $82.34 |
| HC PRO X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS | $40.02 |
| HC PRO X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS BILATERAL | $62.33 |
| HC PRO X-RAY FACIAL BONES <3 VW - XR FACIAL BONES 1-2 VIEWS | $40.02 |
| HC PRO X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS | $45.54 |
| HC PRO X-RAY NASAL BONES - XR NASAL BONES | $40.02 |
| HC PRO X-RAY ORBITS - XR ORBITS COMPLETE 4+ VIEWS | $49.16 |
| HC PRO X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS | $40.02 |
| HC PRO X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS | $43.13 |
| HC PRO X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS | $43.13 |
| HC PRO X-RAY SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS | $60.03 |
| HC PRO X-RAY TMJ BILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED BIL | $42.03 |
| HC PRO X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE | $40.02 |
| HC PRO CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST | $370.88 |
| HC PRO CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST | $521.18 |
| HC PRO CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST | $618.13 |
| HC PRO CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT ORBITS/SELLA WO IV CONT | $748.08 |
| HC PRO CT ORBIT/EAR/FOSSA/ WITH CONTRAST | $884.35 |
| HC PRO CT SCAN SKULL COMBO - CT ORBITS/SELLA W AND WO IV CONTRAST | $963.59 |
| HC PRO CT SCAN,MAXILLOFACIAL W/O CONTRAST | $447.01 |
| HC PRO CT SCAN, FACE/JAW CONTRAST | $538.89 |
| HC PRO CT SCANS FACE/JAW W WO CONTRAST | $656.19 |
| HC PRO CT SCAN,SOFT TISSUE NECK,W/O CONTRAST - CT SOFT TISSUE NECK WO CONT | $621.29 |
| HC PRO CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST | $757.62 |
| HC PRO CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST | $890.73 |
| HC PRO CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST | $941.45 |
| HC PRO CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST | $938.29 |
| HC PRO RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW | $40.02 |
| HC PRO RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS | $40.02 |
| HC PRO RADIOLOGIC EXAM CHEST 3 VIEWS - XR CHEST 3 VIEWS | $47.96 |
| HC PRO RADIOLOGIC EXAM CHEST 4+ VIEWS - XR CHEST 4+ VIEWS | $55.20 |
| HC PRO X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS | $40.02 |
| HC PRO X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS LT W/ CHEST ANTEROPOSTERIOR | $46.69 |
| HC PRO X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS RT W/ CHEST ANTEROPOSTERIOR | $46.69 |
| HC PRO X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL | $50.37 |
| HC PRO X-RAY RIBS, CHEST 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR | $56.29 |
| HC PRO X-RAY STERNUM 2+ VW - XR STERNUM 2+ VIEWS | $40.02 |
| HC PRO CT SCAN,THORAX,W/O CONTRAST - CT CHEST WO CONTRAST | $580.06 |
| HC PRO CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST | $738.59 |
| HC PRO CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST | $884.35 |
| HC PRO CT CHEST LOW DOSE LUNG CANCER SCREENING | $811.44 |
| HC PRO CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT | $963.59 |
| HC PRO X-RAY SPINE ONE VIEW - XR SPINE | $40.02 |
| HC PRO RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS | $40.02 |
| HC PRO RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS | $53.99 |
| HC PRO RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS | $62.33 |
| HC PRO X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS | $40.02 |
| HC PRO X-RAY THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS | $40.02 |
| HC PRO RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS | $40.02 |
| HC PRO RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW - XR ENTIRE SPINE 1 V | $45.54 |
| HC PRO X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS | $40.02 |
| HC PRO X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS | $53.99 |
| HC PRO X-RAY LUMBAR SPINE 6+ VW - XR LUMBAR SPINE 6+ VWS INCLUDING BENDING | $56.29 |
| HC PRO X-RAY LUMBAR SPINE FLEX/EXTEN - XR LUMBAR SPINE 4+ VIEWS W/ FLEX EXT | $137.89 |
| HC PRO CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST | $592.77 |
| HC PRO CT SCAN CERV SPINE CONTRAST - CT CERVICAL SPINE W CONTRAST | $732.38 |
| HC PRO CT SCAN CERV SP COMBO - CT CERVICAL SPINE W WO CONTRAST | $865.38 |
| HC PRO CT SCAN,THORACIC SPINE,W/O CONTRAST - CT THORACIC SPINE WO CONTRAST | $580.06 |
| HC PRO CT SCAN DORSAL SP CONTRAST - CT THORACIC SPINE W CONTRAST | $738.59 |
| HC PRO CT SCAN DORSAL SP COMBO - CT THORACIC SPINE W WO CONTRAST | $871.70 |
| HC PRO CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST | $576.96 |
| HC PRO CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST | $732.21 |
| HC PRO CT SCAN LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST | $865.38 |
| HC PRO X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS | $40.02 |
| HC PRO CT SCAN,PELVIS,W/O CONTRAST - CT PELVIS WO CONTRAST | $469.14 |
| HC PRO CT SCAN OF PELVIS CONTRAST - CT PELVIS W CONTRAST | $725.88 |
| HC PRO CT SCAN OF PELVIS COMBO - CT PELVIS W WO CONTRAST | $833.64 |
| HC PRO X-RAY SACROILIAC JTS <3 VW - XR SACROILIAC JOINTS 1-2 VIEWS | $40.02 |
| HC PRO X-RAY SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS | $40.02 |
| HC PRO X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS | $40.02 |
| HC PRO X-RAY CLAVICLE - XR CLAVICLE LEFT | $40.02 |
| HC PRO X-RAY CLAVICLE - XR CLAVICLE RIGHT | $40.02 |
| HC PRO X-RAY SCAPULA - XR SCAPULA LEFT | $40.02 |
| HC PRO X-RAY SCAPULA - XR SCAPULA RIGHT | $40.02 |
| HC PRO X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW LEFT | $40.02 |
| HC PRO X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW RIGHT | $40.02 |
| HC PRO X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS | $40.02 |
| HC PRO X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS | $64.75 |
| HC PRO X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS LEFT | $40.02 |
| HC PRO X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL | $40.02 |
| HC PRO X-RAY HUMERUS - XR HUMERUS LEFT | $40.02 |
| HC PRO X-RAY HUMERUS - XR HUMERUS RIGHT | $40.02 |
| HC PRO X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS BILATERAL | $55.20 |
| HC PRO X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS LEFT | $40.02 |
| HC PRO X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS | $60.03 |
| HC PRO X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS LEFT | $40.02 |
| HC PRO X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS LEFT | $40.02 |
| HC PRO X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS BILATERAL | $57.62 |
| HC PRO X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT LEFT | $40.02 |
| HC PRO X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT RIGHT | $40.02 |
| HC PRO X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS | $40.02 |
| HC PRO X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL | $60.03 |
| HC PRO X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS | $40.02 |
| HC PRO X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL | $60.03 |
| HC PRO X-RAY HAND 2 VW - XR HAND 1-2 VIEWS | $40.02 |
| HC PRO X-RAY HAND 2 VW - XR HAND 1-2 VIEWS | $57.62 |
| HC PRO X-RAY HAND 2 VW - XR HAND 1-2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY HAND 2 VW - XR HAND 1-2 VIEWS BILATERAL | $57.62 |
| HC PRO X-RAY HAND 3+ VW - XR HAND 3+ VIEWS | $40.02 |
| HC PRO X-RAY HAND 3+ VW - XR HAND 3+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY HAND 3+ VW - XR HAND 3+ VIEWS BILATERAL | $60.03 |
| HC PRO X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS | $40.02 |
| HC PRO X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS LEFT | $40.02 |
| HC PRO CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT WO IV CONTRAST | $576.96 |
| HC PRO CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY W IV CONTRAST | $713.23 |
| HC PRO CT SCAN OF ARM COMBO - CT UPPER EXTREMITY W AND WO IV CONTRAST | $890.73 |
| HC PRO X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW | $40.02 |
| HC PRO X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW RIGHT | $40.02 |
| HC PRO X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW | $40.02 |
| HC PRO X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW RIGHT | $40.02 |
| HC PRO X-RAY EXAM HIPS BI 2 VWS - XR HIPS BILAT 2 VW W/ OR W/O PELVIS | $79.93 |
| HC PRO X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS | $51.58 |
| HC PRO RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW | $40.02 |
| HC PRO RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW RT | $40.02 |
| HC PRO X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS LEFT | $40.02 |
| HC PRO X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS BILAT | $115.00 |
| HC PRO X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS | $40.02 |
| HC PRO X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS BILATERAL | $129.49 |
| HC PRO X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS | $40.02 |
| HC PRO X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS BILATERAL | $79.93 |
| HC PRO X-RAY KNEE BILAT STANDING - XR KNEES ANTEROPOSTERIOR STANDING BILAT | $79.93 |
| HC PRO X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS LEFT | $40.02 |
| HC PRO X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS BILATERAL | $115.00 |
| HC PRO X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT LEFT | $40.02 |
| HC PRO X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT RIGHT | $40.02 |
| HC PRO X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS | $40.02 |
| HC PRO X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS BILATERAL | $79.93 |
| HC PRO X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS | $40.02 |
| HC PRO X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS BILATERAL | $119.83 |
| HC PRO X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS | $40.02 |
| HC PRO X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS BILATERAL | $105.57 |
| HC PRO X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS | $40.02 |
| HC PRO X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL | $115.00 |
| HC PRO X-RAY HEEL - XR CALCANEUS 2 VIEWS LEFT | $40.02 |
| HC PRO X-RAY HEEL - XR CALCANEUS 2 VIEWS RIGHT | $40.02 |
| HC PRO X-RAY HEEL - XR CALCANEUS 2 VIEWS BILATERAL | $110.29 |
| HC PRO X-RAY TOE(S) - XR TOES 2+ VIEWS LEFT | $40.02 |
| HC PRO X-RAY TOE(S) - XR TOES 2+ VIEWS RIGHT | $40.02 |
| HC PRO X-RAY TOE(S) - XR TOES 2+ VIEWS BILATERAL | $79.93 |
| HC PRO CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT WO IV CONTRAST | $580.69 |
| HC PRO CT SCAN OF LEG CONTRAST - CT LOWER EXTREMITY W IV CONTRAST | $725.88 |
| HC PRO CT SCAN OF LEG COMBO - CT LOWER EXTREMITY W AND WO IV CONTRAST | $878.03 |
| HC PRO RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW | $40.02 |
| HC PRO RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW | $40.02 |
| HC PRO RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS | $46.81 |
| HC PRO X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW | $55.20 |
| HC PRO CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST | $481.85 |
| HC PRO CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST | $741.75 |
| HC PRO CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST | $843.18 |
| HC PRO CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST | $1,248.90 |
| HC PRO CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST | $646.65 |
| HC PRO CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST | $998.49 |
| HC PRO CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST | $1,134.82 |
| HC PRO CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST | $323.38 |
| HC PRO CT ANGIO ABDOMINAL ARTERIES - CT ANGIO AORTA & BILAT ILIOFEMORAL RUN | $1,226.71 |
| HC PRO X-RAY NOSE-RECTUM CHILD F.B. - XR NOSE TO RECTUM FOREIGN BODY PEDS | $40.02 |
| HC PRO 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT | $76.13 |
| HC PRO CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP | $469.14 |
| HC PRO US, HEAD/NECK TISSUES,REAL TIME - US HEAD NECK SOFT TISSUE | $350.75 |
| HC PRO US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN | $350.75 |
| HC PRO US, ABDOMEN LIMITED - US ABDOMEN LIMITED | $262.20 |
| HC PRO US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING | $319.70 |
| HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE | $325.45 |
| HC PRO OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST | $350.18 |
| HC PRO OB US < 14 WKS ADDL FETUS - US OB < 14 WEEKS EACH ADDITIONAL GEST | $180.55 |
| HC PRO OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST | $402.50 |
| HC PRO OB US >/= 14 WKS ADDL FETUS - US OB 14+ WEEKS EACH ADDITIONAL GEST | $261.63 |
| HC PRO OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST | $516.35 |
| HC PRO OB US DETAILED ADDL FETUS - US OB DETAIL FETAL ANAT EA ADDL GEST | $575.00 |
| HC PRO US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON | $350.75 |
| HC PRO OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES | $242.65 |
| HC PRO OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH | $327.18 |
| HC PRO TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL | $277.15 |
| HC FETAL BIOPHYS PROFIL W/O NST | $248.40 |
| HC DOPPLER FETAL UMBILICAL ARTERY | $134.55 |
| HC ECHOGRAPHY,TRANSVAGINAL | $358.80 |
| HC US EXAM PELVIC COMPLETE | $317.40 |
| HC PRO SONO PELVIS LIMITED - US PELVIS LIMITED | $141.45 |
| HC ECHO,SCROTUM & CONTENTS - US SCROTUM | $325.45 |
| HC PRO CT GUIDANCE NEEDLE PLACEMENT - CT GUIDANCE FOR NEEDLE PLACEMENT | $399.45 |
| HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS BILAT | $155.25 |
| HC PRO SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL | $155.54 |
| HC PRO X-RAYS FOR BONE AGE - XR BONE AGE EXTENDED | $40.02 |
| HC PRO X-RAYS, BONE SURVEY COMPLETE - XR BONE SURVEY COMPLETE | $92.35 |
| HC PRO CT BONE DENSITY PERIPHERAL | $364.55 |
| HC DUPLEX EXTREM VENOUS,UNI OR LTD | $357.08 |
| DEBRIDEMENT OPEN WOUND 20 SQ CM/< | $166.18 |
| MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI | $94.30 |
| MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M | $80.50 |
| MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI | $44.85 |
| HC PRO HEART/LUNG RESUSCITATION (CPR) | $785.34 |
| HC PRO EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB | $206.54 |
| HC PRO EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB | $89.82 |
| HC PRO EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY | $279.74 |
| HC PRO EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY | $418.89 |
| HC PRO EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY | $626.87 |
| HC PRO EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC | $933.46 |
| HC PRO PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS | $582.02 |
| HC PRO INCISION DRAIN SKIN ABSCESS SIMPLE | $342.70 |
| HC PRO INCISION DRAIN SKIN ABSCESS COMPLEX | $686.72 |
| HC PRO INCISION DRAIN PILONIDAL CYST SIMPLE | $524.06 |
| HC PRO REMOVE FOREIGN BODY SIMPLE | $483.35 |
| HC PRO REMOVE FOREIGN BODY COMPLEX | $1,047.19 |
| HC PRO INCISION DRAINAGE OF HEMATOMA/FLUID | $565.46 |
| HC PRO PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST | $414.35 |
| HC PRO DEBRIDEMENT INFECTED SKIN UP TO 10% BSA | $139.27 |
| HC PRO DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE | $1,889.28 |
| HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM | $278.47 |
| HC PRO TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION | $137.20 |
| HC PRO TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EA ADDL | $78.66 |
| HC PRO PUNCH BIOPSY SKIN SINGLE LESION | $171.81 |
| HC PRO PUNCH BIOPSY SKIN LESION EACH ADDITIONAL | $93.27 |
| HC PRO INCISIONAL BIOPSY SKIN SINGLE LESION | $209.07 |
| HC PRO REMOVAL OF SKIN TAGS, UP TO 15 | $261.57 |
| HC PRO SHAVE SKIN LESION <0.5 CM TRUNK,ARM,LEG | $125.81 |
| HC PRO EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG | $561.89 |
| HC PRO EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG | $659.64 |
| HC PRO EXC SKIN BENIG <5MM REMAINDR BODY | $285.20 |
| HC PRO EXC SKIN BENIG 2.1-3 CM REMAINDR BODY | $537.40 |
| HC PRO AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE | $234.89 |
| HC PRO EVACUATION SUBUNGUAL HEMATOMA | $107.99 |
| HC PRO EXCISION NAIL MATRIX PRT/CMPL PERMANENT REMOVAL | $598.35 |
| HC PRO REPAIR OF NAIL BED | $435.45 |
| HC PRO REPAIR SUPERFICAL WND BODY <2.5CM | $519.11 |
| HC PRO REPAIR SUPERFICAL WND BODY 2.6-7.5 CM | $626.87 |
| HC PRO REPAIR SUPERFICIAL WOUND BODY 7.6-12.5 CM | $776.48 |
| HC PRO REPAIR SUPERFICIAL WOUND BODY 12.6-20 CM | $819.78 |
| HC PRO REPAIR SUPERFICAL WOUND BODY 20.1-30 CM | $855.54 |
| HC PRO REPAIR SUPERFICIAL WND FACE <2.5CM | $626.87 |
| HC PRO REPAIR SUPERFICIAL WND FACE 2.6-5 CM | $734.51 |
| HC PRO REPAIR SUPERFICIAL WND FACE 5.1-7.5 CM | $682.12 |
| HC PRO REPAIR SUPERFICIAL WND FACE 7.6-12.5 CM | $949.96 |
| HC PRO LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM | $567.07 |
| HC PRO LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM | $730.08 |
| HC PRO LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM | $822.71 |
| HC PRO LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM | $1,041.61 |
| HC PRO LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM | $965.31 |
| HC PRO LAYR CLOS WND REST BODY <2.5 CM | $628.25 |
| HC PRO LAYR CLOS WND REST BODY 2.6-7.5 CM | $746.47 |
| HC PRO LAYR CLOS WND REST BODY 7.6-12.5 CM | $831.85 |
| HC PRO LAYR CLOS WND FACE,FACIAL <2.5 CM | $746.47 |
| HC PRO LAYR CLOS WND FACE,FACIAL 2.6-5 CM | $700.12 |
| HC PRO LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM | $824.26 |
| HC PRO LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM | $1,314.85 |
| HC PRO REPAIR COMPLEX WND TRUNK 2.6-7.5 CM | $874.69 |
| HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY 2.6-7.5 CM | $1,147.24 |
| HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY EA ADDL <5 CM | $510.03 |
| HC PRO REPAIR COMPLEX WND HEAD,FAC,HAND 1.1-2.5 CM | $873.66 |
| HC PRO REPAIR COMPLEX WND HEAD,FAC,HAND 2.6-7.5 CM | $1,355.28 |
| HC PRO REPAIR COMPLEX FAC,HAND,GN EA ADD <5CM | $442.92 |
| HC PRO REPAIR COMPLEX WND LID,NOS,EAR 1.1-2.5 CM | $1,099.46 |
| HC PRO INITIAL TX BURN(S) 1ST DEGREE LOCAL TX | $239.43 |
| HC PRO DRESS/DEBRID SMALL BURN NO ANES | $320.28 |
| HC PRO DRESS/DEBRID MED BURN NO ANES | $605.94 |
| HC PRO DRESS/DEBRID LARGE BURN NO ANES | $559.25 |
| HC PRO DESTRUCTION BENIGN LESIONS UP TO 14 | $393.88 |
| HC PRO EXPL PENETRATING WOUND ABD/BACK | $1,737.13 |
| HC PRO EXPLORE PENETRATING WOUND,EXTREMITY | $1,256.89 |
| HC PRO INJECTION THERAPEUTIC CARPAL TUNNEL | $176.64 |
| HC PRO INJECT TENDON SHEATH/LIGAMENT | $333.73 |
| HC PRO INJECT TRIGGER POINT, 1 OR 2 | $333.73 |
| HC PRO INJECT TRIGGER POINTS, > 3 | $226.49 |
| HC PRO ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $248.46 |
| HC PRO ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US | $282.90 |
| HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US | $260.36 |
| HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US | $234.89 |
| HC PRO CLOSED TX NOSE FRACTURE, W/O STABILIZATION | $709.09 |
| HC PRO CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ | $109.14 |
| HC PRO CLOSED TX CLAVICLE FX W/MANIPULATION | $1,439.23 |
| HC PRO CLOSED TX SCAPULA FX W/MANIPULATION | $1,296.68 |
| HC PRO CLOSED TX PROX HUMERUS FX W/ MANIPULATION | $1,727.65 |
| HC PRO CLOSED TX SHLDR DISLOCATION W/O ANES | $954.39 |
| HC PRO CLOSED TX SHLDR DISLOLOCATION W/MANIPULATION ANES | $1,543.76 |
| HC PRO CLOSED TX SHLDR DISLOC W FX GR HUMERAL TUBEROSITY W MANIP | $1,348.66 |
| HC PRO CLOSED TX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ | $1,771.29 |
| HC PRO I&D ARM/ELBOW INFECT BURSA | $549.93 |
| HC PRO EXCISION OLECRANON BURSA | $1,213.94 |
| HC PRO CLOSED TX HUMERUS SHAFT FX W/O MANIPULATION | $1,075.54 |
| HC PRO CLOSED TX HUM SUPRACONDYLR FX W/ MANIPULATION | $1,695.10 |
| HC PRO CLOSED TX HUMERAL CONDYLAR FX W/ MANIPULATION | $1,937.06 |
| HC PRO CLOSED TX ELBOW DISLOCATION W/O ANES | $1,379.20 |
| HC PRO CLOSED TX RADIAL HEAD SUBLUXATION W/ MANIPULATION CHILD | $444.25 |
| HC PRO UNLISTED PROCEDURE HUMERUS/ELBOW | $452.70 |
| HC PRO REMOVE FOREARM/WRIST FOREIGN BODY | $1,408.52 |
| HC PRO CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION | $1,806.88 |
| HC PRO CLOSED TX RADIAL & ULNAR SHAFT FRACTURES W/MANIPULATION | $1,405.88 |
| HC PRO CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION | $1,074.10 |
| HC PRO CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION | $1,959.43 |
| HC PRO CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ | $1,620.81 |
| HC PRO CLOSED TX ULNAR STYLOID FRACTURE | $1,067.89 |
| HC PRO DRAIN FINGER ABSCESS SIMPLE | $510.03 |
| HC PRO DRAINAGE OF FINGER ABSCESS COMPLICATED | $577.19 |
| HC PRO REPAIR EXTEN TENDON,DORSUM FINGR,EA | $1,794.81 |
| HC PRO CLOSED TX METACARPAL FX WO MANIP | $951.97 |
| HC PRO CLOSED TX METACARPAL FX,MANIP | $1,268.51 |
| HC PRO TREAT THUMB FX/DISLOC,MANIP | $1,241.31 |
| HC PRO CLOSED TX PROX/MID FING SHFT FX | $571.44 |
| HC PRO CLOSED TX PROX/MID FING SHFT FX,MANIP | $1,268.51 |
| HC PRO CLOSE TX FINGR ARTICULAR FX,MANIP | $1,627.14 |
| HC PRO CLOSE TX DIST FINGER FX W/O MANIP | $1,171.28 |
| HC PRO CLOSE TX DIST FINGR FX,MANIPULATN | $931.96 |
| HC PRO OPEN TX DISTAL PHALANGEAL FRACTURE EACH | $1,440.61 |
| HC PRO CLOSED TX IP JT DISLOCATION | $915.52 |
| HC PRO AMPUTATION FINGER/THUMB | $2,307.71 |
| HC PRO CLOSED TX POST HIP ARTHRPLAS DISLOCATION W/O ANESTH | $1,427.38 |
| HC PRO I&D DEEP ABSC BURSA THIGH/KNEE PRO FEE | $1,738.69 |
| HC PRO REMOVAL FB DEEP THIGH/KNEE | $1,325.84 |
| HC PRO CLOSED TX TIBIAL FX W/WO MANI SKEL TRAC PR FE | $1,901.87 |
| HC PRO CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA | $1,202.61 |
| HC PRO LEG SURGERY PROCEDURE PRO FEE | $465.98 |
| HC PRO CLOSED TX TIBIA SHAFT FX W/O MANIP | $1,199.68 |
| HC PRO CLOSED TX TIBIA SHAFT FX,MANIPULATN | $2,291.26 |
| HC PRO CLOSED TX MED MALLEOLUS FX W/O MANIP | $1,076.98 |
| HC PRO CLOSED TX PROX FIBULA SHAFT FX W MANIJ | $1,311.00 |
| HC PRO CLOSED TX DSTL FIBULAR FX LAT MALLS W/MANJ | $1,872.72 |
| HC PRO CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP | $1,324.69 |
| HC PRO CLOSED TX TRIMALLEOLAR FX,MANIP | $2,209.15 |
| HC PRO TREAT LOWER LEG FRACTURE | $1,771.29 |
| HC PRO CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA | $1,272.48 |
| HC PRO REMOVAL FOOT FOREIGN BODY,SUBCUTANEOUS | $408.14 |
| HC PRO CLOSED TX HEEL FRACTURE PRO FEE | $1,217.28 |
| HC PRO CLOSED TX TALUS FX,MANIPULATN | $879.41 |
| HC PRO CLOSED TX METATARSAL FX W/MANI PRO FEE | $700.35 |
| HC PRO OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES | $1,376.55 |
| HC PRO CLOSED TX TOE FX,MANIPULATION | $517.67 |
| HC PRO CLOSED RX MT-PHAL TOE DISLOCATION | $418.89 |
| HC PRO CLOSED TX INTERPHALANGEAL JOINT DISLOCATION W/O ANES | $457.24 |
| HC PRO AMPUTATION TOE INTERPHALANGEAL JOINT | $2,173.39 |
| HC PRO APPLY LONG ARM SPLINT | $254.38 |
| HC PRO APPLY FOREARM SPLINT,STATIC | $217.12 |
| HC PRO APPL SPLINT SHT ARM DYNAM | $315.79 |
| HC PRO APPLY FINGER SPLINT,STATIC | $143.75 |
| HC PRO APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $281.41 |
| HC PRO APPLICATION LONG LEG SPLINT | $324.70 |
| HC PRO APPLY LOWER LEG SPLINT | $210.97 |
| HC PRO REMOVE NASAL FOREIGN BODY | $466.84 |
| HC PRO CTRL NOSEBLEED,ANTER,SIMPLE | $344.02 |
| HC PRO CTRL NOSEBLEED,ANTER,COMPLEX | $499.68 |
| HC PRO CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT | $325.05 |
| HC PRO INSERT EMERGENCY ENDOTRACH AIRWAY | $535.73 |
| HC PRO LARYNGOSCOPY INDIRECT DIAGN SPX PRO FEE | $147.95 |
| HC PRO LARYNGOSCOPY,DIRECT,DIAGNOSTIC | $687.70 |
| HC PRO TUBE THORACOSTOMY INCLUDES WATER SEAL | $839.27 |
| HC PRO THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING | $891.60 |
| HC PRO THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $386.11 |
| HC PRO VNPNXR 3 YEARS/> PHYS/QHP SKILL | $28.46 |
| HC PRO INSERT NON-TUNNEL CV CATH < 5 Y/O | $295.61 |
| HC PRO INSERT NON-TUNNEL CV CATH >5 Y/O | $897.46 |
| HC PRO INSERT TUNNELED CV CATH W/O PORT OR PUMP | $957.72 |
| HC PRO INSERT PICC W/O SUB-Q PORT W/O IMAGE GUIDE >5 Y/O | $294.86 |
| HC PRO INSERT CATH ARTERIAL PERCUTANEOUS | $196.08 |
| HC PRO INSERT NEEDLE,INTRAOSSEOUS INFUSN | $558.10 |
| HC PRO DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPLE | $516.24 |
| HC PRO CLOSER MOUTH LACERATION >2.5CM OR COMPLEX | $824.78 |
| HC PRO I&D MOUTH INTRA,SUBMANDIBULAR | $650.00 |
| HC PRO REPAIR TONGUE LACERATION <2.5CM | $1,166.68 |
| HC PRO REPAIR TONGUE LACER,2.6 CM+/COMPLX | $1,146.32 |
| HC PRO DRAINAGE OF GUM LESION | $667.29 |
| HC PRO UNLISTED PROC DENTOALVEOLAR STRUCTURES | $603.75 |
| HC PRO DRAINAGE ABSCESS PALATE, UVULA | $342.36 |
| HC PRO I&D ABCESS PERITONSILLAR | $652.28 |
| HC PRO REMOVE PHARYNX FOREIGN BODY | $418.14 |
| HC PRO CONTROL THROAT BLEED,SIMPLE | $949.96 |
| HC PRO THROAT SURGERY PROCEDURE UNSPEC PRO FEE | $326.26 |
| HC PRO GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC | $439.88 |
| HC PRO RPLC GASTRO TUBE NO REV/GUID PRO FEE | $133.17 |
| HC PRO I&D PERIANAL ABSCESS,SUPERFICIAL | $626.87 |
| HC PRO INCISE THROMBOSED HEMORRHOID EXT | $381.80 |
| HC PRO ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD | $119.60 |
| HC PRO ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS | $293.60 |
| HC PRO ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE | $516.24 |
| HC PRO ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE | $375.42 |
| HC PRO ASPIRATION BLADDER NEEDLE | $134.21 |
| HC PRO INSERT,TEMP INDWELLING BLAD CATH,SIMPLE | $224.48 |
| HC PRO CHANGE OF BLADDER TUBE,SIMPLE | $186.07 |
| HC PRO DRAINAGE SCROTAL WALL ABSCESS | $488.75 |
| HC PRO I&D VULVA/PERINEAL ABSCESS | $471.27 |
| HC PRO I&D BARTHOLIN GLAND ABSCESS | $347.19 |
| HC PRO COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB | $1,094.34 |
| HC PRO REMOVE INTRAUTERINE DEVICE | $221.95 |
| HC PRO OBSTETRICAL CARE,VAG DELIV ONLY | $4,923.96 |
| HC PRO DELIVER PLACENTA | $304.29 |
| HC PRO SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC | $1,000.79 |
| HC PRO INJECT NERV BLCK,TRIGEMINAL | $273.87 |
| HC PRO INJECT NERV BLCK,FACIAL NERV | $694.08 |
| HC PRO INJECT NERV BLCK,GREAT OCCIPTL | $242.48 |
| HC PRO INJECT NERV BLCK,INTERCOSTAL,ONE | $196.59 |
| HC PRO INJECT NERV BLCK,OTHR PERIPH NERV | $369.50 |
| HC PRO CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | $430.10 |
| HC PRO REMV F.B.,EYE,SUPERF CONJUNC | $309.75 |
| HC PRO REMOVAL FB EXT EYE CONJUCTIVAL EMBEDDED | $335.11 |
| HC PRO REMOVAL FB CORNEAL W/O SLIT LAMP | $360.58 |
| HC PRO REMOVE FB EYE CORNEA W SLIT LAMP | $207.00 |
| HC PRO DRAINAGE OF EYELID ABSCESS | $394.11 |
| HC PRO DRAIN EXT EAR ABSC/BLOOD,SIMPLE | $713.52 |
| HC PRO DRAIN EXT AUDITORY CANAL ABSCESS | $785.51 |
| HC PRO REMV FB EXT AUDITORY CANAL W/O ANESTH | $414.35 |
| HC PRO REMV IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $49.68 |
| HC PRO REMV IMPACTED CERUMEN INSTRUMENTATION UNILAT/BILAT | $163.19 |
| HC PRO CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL | $598.35 |
| HC PRO ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY | $83.95 |
| HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX | $572.70 |
| HC VASC DUPLEX EXTREM VENOUS,BILAT | $563.50 |
| HC DUPLEX ABD/PEL VASC STUDY,LIMITD | $472.65 |
| HC PRO DEBRIDEMENT OPEN WOUND 20 SQ CM< | $166.18 |
| HC PRO OFFICE OUTPATIENT NEW 15-29 MINUTES | $245.18 |
| HC PRO OFFICE OUTPATIENT NEW 30-44 MINUTES | $319.13 |
| HC PRO OFFICE OUTPATIENT NEW 45-59 MINUTES | $455.92 |
| HC PRO OFFICE OUTPATIENT NEW 60-74 MINUTES | $615.48 |
| HC OFFICE OUTPATIENT VISIT EST 10-19 MINUTES | $133.98 |
| HC OFFICE OUTPATIENT VISIT EST 20-29 MINUTES | $172.44 |
| HC OFFICE OUTPATIENT VISIT EST 30-39 MINUTES | $249.44 |
| HC OFFICE OUTPATIENT VISIT EST 40-54 MINUTES | $398.94 |
| HC PRO OBSERVATION CARE DISCHARGE MANAGEMENT | $203.61 |
| HC PRO OBSERVATION CARE DISCHARGE MANAGEMENT | $203.61 |
| HC PRO INITIAL OBSERVATION CARE/DAY 30 MINUTES | $254.38 |
| HC PRO INITIAL OBSERVATION CARE/DAY 50 MINUTES | $345.69 |
| HC PRO INITIAL OBSERVATION CARE/DAY 70 MINUTES | $432.40 |
| HC PRO INITIAL HOSPITAL CARE 30 MINUTES | $315.79 |
| HC PRO INITIAL HOSPITAL CARE 50 MINUTES | $424.93 |
| HC PRO INITIAL HOSPITAL CARE 70 MINUTES | $522.10 |
| HC PRO SBSQ OBSERVATION CARE/DAY 15 MINUTES | $139.27 |
| HC PRO SBSQ OBSERVATION CARE/DAY 25 MINUTES | $212.52 |
| HC PRO SBSQ OBSERVATION CARE/DAY 35 MINUTES | $314.18 |
| HC PRO SBSQ HOSPITAL CARE/DAY 15 MINUTES | $158.82 |
| HC PRO SBSQ HOSPITAL CARE/DAY 25 MINUTES | $225.98 |
| HC PRO SBSQ HOSPITAL CARE/DAY 35 MINUTES | $306.71 |
| HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES | $445.86 |
| HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES | $605.94 |
| HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES | $679.08 |
| HC PRO HOSPITAL DISCHARGE DAY,<30 MIN | $267.95 |
| HC PRO HOSPITAL DISCHARGE DAY,>30 MIN | $335.11 |
| HC PRO CRITICAL CARE, E/M 30-74 MINUTES | $930.47 |
| HC PRO CRITICAL CARE, ADDL 30 MIN | $465.18 |
| HC PRO ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY | $83.95 |
| HC PRO TEAM CONFERENCE FACE-TO-FACE NON PHYS | $136.97 |
| POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX | $0.00 |
| MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS | $230.40 |
| MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS | $191.65 |
| MOD SED SAME PHYS/QHP EACH ADDL 15 MINS | $96.60 |
| PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $115.23 |
| OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES | $257.49 |
| OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES | $335.11 |
| OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES | $478.75 |
| OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES | $646.30 |
| OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP | $98.90 |
| OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN | $140.70 |
| OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN | $181.07 |
| OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN | $261.91 |
| OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN | $418.89 |
| OBSERVATION CARE DISCHARGE MANAGEMENT | $203.61 |
| INITIAL OBSERVATION CARE/DAY 30 MINUTES | $254.38 |
| INITIAL OBSERVATION CARE/DAY 50 MINUTES | $345.69 |
| INITIAL OBSERVATION CARE/DAY 70 MINUTES | $432.40 |
| 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES | $315.65 |
| 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES | $315.79 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | $424.93 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | $424.93 |
| 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES | $613.10 |
| 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES | $522.10 |
| SBSQ OBSERVATION CARE/DAY 15 MINUTES | $139.27 |
| SBSQ OBSERVATION CARE/DAY 25 MINUTES | $212.52 |
| SBSQ OBSERVATION CARE/DAY 35 MINUTES | $314.18 |
| SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES | $158.82 |
| SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES | $158.82 |
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | $225.98 |
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | $225.98 |
| SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES | $292.10 |
| SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES | $306.71 |
| HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN | $445.86 |
| HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN | $445.86 |
| HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN | $605.94 |
| HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN | $605.94 |
| HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN | $679.08 |
| HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN | $679.08 |
| HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/< | $267.95 |
| HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/< | $267.95 |
| HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN | $335.11 |
| HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN | $335.11 |
| EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP | $206.54 |
| EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM | $279.74 |
| EMERGENCY DEPARTMENT VISIT LOW MDM | $418.89 |
| EMERGENCY DEPARTMENT VISIT MODERATE MDM | $626.87 |
| EMERGENCY DEPARTMENT VISIT HIGH MDM | $933.46 |
| PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS | $582.02 |
| CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN | $930.47 |
| CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN | $930.47 |
| CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN | $465.18 |
| CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN | $465.18 |
| INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN | $185.50 |
| INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES | $260.36 |
| INITIAL NURSING FACILITY CARE HI MDM 45 MINUTES | $315.79 |
| SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES | $103.39 |
| SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES | $140.70 |
| SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES | $204.99 |
| SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES | $278.47 |
| NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME | $193.09 |
| NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME | $240.93 |
| E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN | $204.99 |
| HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES | $206.54 |
| HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES | $297.91 |
| HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES | $489.21 |
| HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES | $683.68 |
| HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES | $830.24 |
| HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES | $164.57 |
| HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES | $251.39 |
| HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES | $385.94 |
| HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES | $535.73 |
| INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR | $390.20 |
| INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS | $312.80 |
| INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS | $383.07 |
| INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR | $420.44 |
| INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $483.35 |
| INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $547.63 |
| INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> | $534.06 |
| PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y | $210.97 |
| PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS | $261.91 |
| PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS | $275.31 |
| PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS | $297.91 |
| PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS | $400.89 |
| PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS | $454.83 |
| PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER | $498.35 |
| PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES | $95.80 |
| ADVANCE CARE PLANNING FIRST 30 MINS | $281.52 |
| ADVANCE CARE PLANNING EA ADDL 30 MINS | $245.99 |
| ADMIN PNEUMOCOCCAL VACCINE | $44.28 |
| COMM SVCS BY RHC/FQHC 5 MIN | $295.49 |
| MNT SUBS TX FOR CHANGE DX | $81.65 |
| GROUP MNT 2 OR MORE 30 MINS | $44.85 |
| INITIAL PREVENTIVE EXAM | $615.02 |
| PPPS, INITIAL VISIT | $498.35 |
| PPPS, SUBSEQ VISIT | $525.67 |
| BEHAVIOR COUNSEL OBESITY 15M | $67.85 |
| DIS SITE TELE SVCS RHC/FQHC | $256.11 |
| SCRN ND POS ND PROV OF REC | $82.80 |
| SCRNING PERF AND NEGATIVE | $82.80 |
| METHYLPREDNISOLONE 40 MG INJ | $30.00 |
| KETOROLAC TROMETHAMINE INJ | $22.00 |
| TRIAMCINOLONE ACET INJ NOS | $294.40 |
| CERV COLLAR SUPP ADJ CERV BA | $50.60 |
| CLINIC SERVICE | $0.01 |
| NO CHARGE VISIT | $0.00 |
| NURSE ONLY VISIT | $0.00 |
| NURSE ONLY VISIT | $0.00 |
| IMMUNIZATION ONLY VISIT | $0.00 |
| PROCEDURE ONLY VISIT | $0.00 |
| ABBREVIATED SPORTS PHYSICAL (SELF-PAY) | $22.00 |
| SUTURE REMOVAL | $0.00 |
| DMV EXAM - SHORT | $63.42 |
| DMV EXAM - LONG | $181.13 |
| EMPLOYEE PHYSICAL | $181.07 |
| PRE-EMPLOYMENT PHYSICAL | $190.21 |