| C1886 | 5 FR VTK 125cm | 157 | ||
|---|---|---|---|---|
| C5271KX | APLY SKIN SUB 1ST 25 SQ CM LEGS MEDICARE | 1,192 | ||
| C5272KX | APLY SKIN SUB ADL 25 SQ CM LEGS MEDICARE | 1,192 | ||
| C5273KX | APLY SKIN SUB 1ST 100 SQ CM LEGS MEDICAR | 1,192 | ||
| C5274KX | APLY SKIN SUB EA ADL 100 SQ CM LEGS MC | 1,192 | ||
| C5275KX | APLY SKIN SUB 1ST 25 SQ CM FEET MEDICARE | 1,192 | ||
| C5276KX | APLY SKIN ADDL 25 SQ CM FEET | 1,192 | ||
| C5277KX | APLY SKIN SUB 1ST 100 SQ CM FEET MEDICAR | 1,192 | ||
| C5278KX | APLY SKIN SUB EA ADL 100 SQ CM FEET MC | 1,192 | ||
| C8900 | MRA ABDOMEN W/CONTRAST | 2,139 | ||
| C8901 | MRA ABDOMEN W/O CONTRAST | 1,880 | ||
| C8902 | MRA ABDOMEN W & W/O CONTRAST | 2,552 | ||
| C8906 | MRI BREAST - BILAT W / CONTRAST | 2,139 | ||
| C8907 | MRI BREAST - BILAT W/O CONTRAST | 1,880 | ||
| C8908 | MRI BREAST - BILAT W & W/O CONTRA | 2,552 | ||
| C8909 | MRA CHEST W / CONTRAST | 2,139 | ||
| C8910 | MRA CHEST W/O CONTRAST | 1,880 | ||
| C8911 | MRA CHEST W & W/O CONTRAST | 2,552 | ||
| C891250 | MRA LOWER EXTREMITY W/CONTRAST -BILATERA | 2,139 | ||
| C8912LT | MRA LOWER EXTREMITY W/CONTRAST LEFT | 2,139 | ||
| C8912RT | MRA LOWER EXTREMITY W/CONTRAST -RIGHT | 2,139 | ||
| C891350 | MRA LOWER EXT W/O CONTRAST -BILATERAL | 1,880 | ||
| C8913LT | MRA LOWER EXTREMITY W/O CONTRAST LEFT | 1,880 | ||
| C8913RT | MRA LOWER EXT W/O CONTRAST -RIGHT | 1,880 | ||
| C891450 | MRA LOWER EXT W/WO CONTRAST -BILATERAL | 2,552 | ||
| C8914LT | MRA LOWER EXT W & W/O CONTRAST-LEFT | 2,552 | ||
| C8914RT | MRA LOWER EXT W/WO CONTRAST -RIGHT | 2,552 | ||
| C8957 | IV INFUSION >8HRS, REQ PUMP | 173 | ||
| C9467 | RITUXAN HYCELA | 1,475 | ||
| C9477 | ABD US W/CONTRAST | 394 | ||
| C9492 | INJECTION, DURVALUMAB, 10MG | 106 | ||
| C9600 | SP CORONARY DRG-ELDG STNT,SGLE VS | 22,832 | ||
| C9601 | SP CORONARY DRG-ELD SNT,EA ADD VS | 6,221 | ||
| C9602 | SP ATREC DES SGL VES | 27,368 | ||
| C9603 | SP ATREC DES EACH ADD VES | 12,785 | ||
| C9604 | SP DES SGL IN GRAFT W ATREC | 14,246 | ||
| C9605 | SP DES EACH ADDL IN GRAFT W/ATREC | 12,785 | ||
| C9606 | SP DES SGL VES STEM W/PTCT&ATREC | 28,896 | ||
| C9607 | SP CTO DES SLG VES W/WO ATREC | 27,368 | ||
| C9608 | SP CTO DES EA ADDL VES W/ATREC | 12,785 | ||
| G0008 | ADMIN OF INFLUENZA VIRUS VACCINE | 75 | ||
| G0009 | ADMIN OF PNEUMONIA VACCINE | 75 | ||
| G0103 | PSA SCREENING | 77 | ||
| G0108 | DIAB MGMT, IND RN/RD,MC/BCBS 30MN | 113 | ||
| G0109 | TP2 DIB SLF MGT TRG MC/BCBS GR 30 | 42 | ||
| G0123 | CYTO SCREENING BY CYTOTECH | 38 | ||
| G0143 | CYTO SCREENING - MANUAL SCREENING | 38 | ||
| G0144 | CYTO SCREENING AUTOMATED/MANUAL RESCREEN | 38 | ||
| G0145 | CYTO SCREENING AUTOMATED | 38 | ||
| G0147 | CYTO SMEARS AUTOMATED | 38 | ||
| G0148 | CYTO SMEARS AUTO/W/MANUAL RESCREEN | 38 | ||
| G0202 | MG MAMMO SCREENING DIGITAL | 239 | ||
| G0257 | HEMODIALYSIS - OUTPATIENT | 1,486 | ||
| G0260 | CT Z INJECTION S-I JOINT | 899 | ||
| G0269 | INSERTION OF CLOSURE DEVICE | 134 | ||
| G0270 | MED NUTRITION THER, SEC REFERRAL NEW DX | 150 | ||
| G0271 | MNT, NEW DX, GROUP 2 OR MORE 30 MIN | 239 | ||
| G0277 | HYPERBARIC OXYGEN THERAPY(30 INCR | 656 | ||
| G0279 | MG MAMMO 3D DIAG DIGITAL | 102 | ||
| G0281 | ELECTRICAL STIM. UN.(PRES ULCER) | 74 | ||
| G0282 | ELECTRICAL STIM, UN (OTHER WOUND) | 74 | ||
| G0283 | ELECT. STIM. - UNATTENDED - G0283 | 74 | ||
| G0297 | CT LOW DOSE LUNG CA SCREENING | 57 | ||
| G0365 | VESSEL MAPPING HEMO ACCESS | 1,319 | ||
| G0378 | 2N OBSERVATION | 22 | ||
| G0379 | DIRECT REFERRAL FOR HOSP OBV CARE | 22 | ||
| G0380 | FAST TRACK -- LEVEL 1 | 147 | ||
| G0381 | FAST TRACK -- LEVEL 2 | 114 | ||
| G0382 | FAST TRACK -- LEVEL 3 | 197 | ||
| G0383 | FAST TRACK -- LEVEL 4 | 425 | ||
| G0384 | FAST TRACK -- LEVEL 5 | 626 | ||
| G0390 | TRAUMA RESPONSE TEAM | 1,794 | ||
| G0438 | ANNUAL WELLNESS VISIT, W/ PPS, INITIAL | 515 | ||
| G0439 | ANNUAL WELLNESS VISIT, W/ PPS , SUB | 344 | ||
| G0480 | USDTL CORD DRUG SC CONFIRM | 223 | ||
| G0482 | Tramadol Screen W/Rfl to Confirmation, U | 268 | ||
| G0500 | MODERATE SEDATION | 40 | ||
| G0515 | OT - DEVELOP OF COGNITIVE SKILLS | 132 | ||
| P3000 | CYTO SCREENING BY TECH | 38 | ||
| P9012 | APHERESIS CRYO - 1 | 2 | ||
| P9016 | RBC LEUKOCYTES REDUCED | 517 | ||
| P9017 | APHERESIS FF PLASMA - 2 | 2 | ||
| P9021 | RED BLOOD CELLS - CHRG ONLY | 340 | ||
| P9022 | WASHED RED BLOOD CELL - CHRG | 111 | ||
| P9034 | APHERESIS PLATELET-2 | 2 | ||
| P9036 | IRR PLAP - CHRG ONLY | 1,629 | ||
| P9037 | PLATE PHERES LEUKOREDU IRRAD | 2,702 | ||
| P9039 | RBC FRO DEGLYCEROLIZE - CHRG | 708 | ||
| P9040 | RBC LEUKOREDUCED IRRADIATED | 641 | ||
| P9052 | PLAP HLA MATCHED - CHRG O | 1,566 | ||
| P9059 | FP 24 | 192 | ||
| P9612 | URINE SPECIMEN COLLECTION ONLY | 71 | ||
| S0028 | INJECTION, FAMOTIDINE 20MG | 2 | ||
| S0073 | AZTREONAM, 500MG | 57 | ||
| S9443 | LACTATION CLASS | 140 | ||
| S9445 | RETURN LACTATION VISIT | 94 | ||
| cpt4_ext_id | CPT Description | Charge Amount | ||
| 10022 | ACT Z-ABSC DRNG,RETROPERITONEA | 1,192 | ||
| 10060 | I&D SIMPLE | 339 | ||
| 10061 | I&D COMPLEX | 618 | ||
| 10160 | AUS PUNCTURE DRAINAGE OF LESION | 618 | ||
| 11042 | DEB SUBCUT TISS 1ST 20SQCM | 799 | ||
| 11043 | DEB MUSCLE/FASCIA 1ST 20SQCM | 1,236 | ||
| 11044 | DEB BONE 1ST 20 SQ CM | 2,809 | ||
| 11045 | DEBRID SUBQ EACH ADDL 20 SQ CM | 631 | ||
| 11046 | DEB MUSCLE/FASICA ADDL SQCM | 527 | ||
| 11047 | DEBRID BONE EA ADDL 20 SQ CM | 1,654 | ||
| 11055 | BENIGN LESION PARING | 394 | ||
| 11056 | BENIGN LESION PARING (2-4) | 157 | ||
| 11057 | BENIGN LESION PARING (4+) | 618 | ||
| 11100 | BIOPSY COLLECTION | 1,236 | ||
| 11101 | BIOPSY OF BREAST EA ADDT'L | 386 | ||
| 11719 | TRIMMING OF NONDYSTROPHIC NAILS(A | 192 | ||
| 11720 | DEBRIDE NAIL 1-5 | 83 | ||
| 11721 | DEBRIDE NAIL >5 | 83 | ||
| 11730 | AVULSION OF NAIL PLATE (PT, COMPL | 245 | ||
| 11732 | AVULSION OF EACH ADDL NAIL PLATE | 167 | ||
| 11750 | EXCISION OF NAIL - PART/COMPLETE | 432 | ||
| 12007 | LACER-SMP-SCALP/TRK/HND > 30CM | 405 | ||
| 12018 | RPR F/E/E/N/L/N > 30.0CM | 435 | ||
| 13122 | REPAIR COMPLEX SCALP/ARM/LEG EA ADL 5CM< | 715 | ||
| 15004 | SITE PREP 100SQ CM (TRUNK/ARM/LEG | 1,115 | ||
| 15110 | EPIDRM AUTOGRFT TRNK/ARM/LEG | 6,260 | ||
| 15115 | EPIDRM A-GRFT FACE/NCK/HF/G | 3,797 | ||
| 15271 | ALLOGENIC GRAFT (1ST 25 SQCM) T/A/L | 2,135 | ||
| 15272 | ALLOGENIC GRAFT (ADDT'L 25 SQCM) T/A/L | 1,686 | ||
| 15273 | XENO SKIN SUB 1ST 100 SQCM (T/A/L) | 2,135 | ||
| 15274 | XENO SKIN SUB (T/A/L) EACH ADD 100SQCM | 1,686 | ||
| 15275 | ALLOGENIC SKIN SUB (F/NK/HF/G) | 2,135 | ||
| 15276 | ALLOGENIC SKIN SUB (F/NK/HF/G) ADD'L | 1,686 | ||
| 15277 | XENO SUB 1ST 100 SQCM (F/NK/HF,G) | 2,135 | ||
| 15278 | XENO SUB EACH ADDL 100 SQCM (F/NK/HF,G) | 1,686 | ||
| 15786 | CALLUS ABRASION (SINGLE) | 245 | ||
| 15787 | CALLUS ABRASION (ADD ON) | 245 | ||
| 16020 | WOUND DEBRIDEMENT (SMALL BURN) | 234 | ||
| 16025 | WOUND DEBRIDEMENT (MED BURN) | 277 | ||
| 16030 | WOUND DEBRIDEMENT (LARGE BURN) | 323 | ||
| 17250 | CAUTERY OF WOUND (CHEMICAL) | 245 | ||
| 17999 | UNSPECIFIED DEBRIDEMENT FULL THICK BURNS | 448 | ||
| 19000 | DRAINAGE OF BREAST LESION | 939 | ||
| 19001 | AUS BREAST PUNCT/ASP CYST EA ADD | 69 | ||
| 19081 | MM BREAST 1ST BX PERCUT W/VACUUM | 1,562 | ||
| 19083 | AUS Breast biopsy, perc 1st lesion w/US | 3,821 | ||
| 19084 | AUS Breast biopsy, perc addl lesion w/US | 1,134 | ||
| 19085 | BREAST BIOPSY PERC 1ST LESION MRI | 2,328 | ||
| 19086 | BREAST BIOPSY PERC ADDL LESION MRI | 1,134 | ||
| 19281 | BREAST LOCAL DEVICE-1ST LESION-MAMMO GUI | 286 | ||
| 19282 | LOCAL DEVICE-ADDT'L LESION-MAMMO GUIDE | 286 | ||
| 19283 | LOCAL DEVICE-1ST LESION-STEREOTATIC | 286 | ||
| 19284 | LOCAL DEVICE-ADDT'L LESION-STEREOTATIC | 286 | ||
| 19285 | LOCAL DEVICE-1ST LESION-ULTRASOUND | 286 | ||
| 19286 | LOCAL DEVICE-ADDT'L LESION-ULTRASOUND | 286 | ||
| 19287 | LOCAL DEVICE-1ST LESION MRI RESONANCE | 286 | ||
| 19288 | LOCAL DEVICE-ADDT'L LESION MRI RESONANCE | 286 | ||
| 19499 | BREAST SURG PROC | 3,371 | ||
| 20206 | ACT Z-BIOPSY MUSCLE | 1,834 | ||
| 20225 | SP BIOPSY BONE DEEP | 649 | ||
| 20605 | ARTHOCENTESIS (WRIST, ELBOW, ANKLE) | 685 | ||
| 20610 | ARTHOCENTESIS (KNEE, HIP, SHOULDER) | 685 | ||
| 22513 | KYPHOPLASTY THORACIC | 12,880 | ||
| 22514 | KYPHOPLASTY LUMBAR | 17,534 | ||
| 22515 | KYPHOPLASTY EA ADDL VERT BODY | 17,534 | ||
| 23350 | ARTHOGRAM SHOULDER PR CODE | 159 | ||
| 24220 | ARTHOGRAM ELBOW PR CODE | 140 | ||
| 25246 | ARTHOGRAM WRIST PR CODE | 123 | ||
| 27093 | ARTHROGRAM HIP PR CODE | 156 | ||
| 27370 | ARTHOGRAM KNEE PR CODE | 142 | ||
| 27648 | ARTHOGRAM ANKLE PR CODE | 140 | ||
| 28190 | REMOVAL OF FOREIGN BODY FROM FOOT | 138 | ||
| 29105 | APPLICATION OF LONG ARM SPLINT | 185 | ||
| 29125 | APPL. OF SHORT ARM SPLINT-STATIC | 185 | ||
| 29126 | APPL. OF SHORT ARM SPLINT-DYNAMIC | 185 | ||
| 29130 | APPL. OF FINGER SPLINT-STATIC | 185 | ||
| 29131 | APPL. OF FINGER SPLINT-DYNAMIC | 185 | ||
| 29240 | SHOULDER TAPING | 185 | ||
| 29280 | HAND/FINGER TAPING | 185 | ||
| 29405 | SHORT LEG CAST | 540 | ||
| 29445 | TOTAL CONTACT CASTING | 629 | ||
| 31500 | INSERT EMERGENCY AIRWAY | 465 | ||
| 31502 | ARTIFICIAL AIRWAY CHANGE | 508 | ||
| 31720 | NASOTRACHEAL SUCTIONING | 155 | ||
| 32405 | ACT Z-BIOPSY, LUNG/MEDISTNM | 1,834 | ||
| 32554 | REMOVAL OF FLUID FROM CHEST CAVITY | 202 | ||
| 32555 | X-THORACENTESIS,ASPIRATION PUNCT | 1,344 | ||
| 32560 | CT Z CHEMICAL PLEURODESIS | 1,015 | ||
| 33282 | SP LOOP RECORDER | 3,767 | ||
| 33284 | REMOVE PAT-ACTIVE HT RECORD | 3,334 | ||
| 33967 | SP INTRAAORTIC BALLOON INSERT | 1,584 | ||
| 36000 | IV START W/O INFUSION/INJ | 36 | ||
| 36005 | VENOGRAM EXT UNI PR CODE | 245 | ||
| 36010 | CATHETER PLACEMENT IN VEIN | 611 | ||
| 36011 | VENOUS 1ST ORDER PR CODE | 1,153 | ||
| 36012 | VENOUS 2ND ORDR/MORE PR CODE | 279 | ||
| 36013 | ART HEART OR PULMNRY PR CODE | 613 | ||
| 36014 | PULMONARY ARTERIOGRAMS THRU RT | 770 | ||
| 36140 | NON-SELCT ART EXTR UNI PRCD | 602 | ||
| 36160 | NON-SELCT AORTA(TRNS LUMBR) | 1,002 | ||
| 36200 | NON-SELCT AROTA (FEM/AX) PR CD | 1,377 | ||
| 36215 | ART 1ST ORDR THOR/BRACH PRCD | 602 | ||
| 36216 | ART 2ND ORDR THOR/BRACH PRCD | 639 | ||
| 36217 | ART 3RD ORDR THOR/BRACH PRCD | 894 | ||
| 36218 | ART ADD 2ND,3RD THOR/BRACH PR | 358 | ||
| 36221 | SP ARCH | 2,809 | ||
| 36222 | SP CAROTID COM CERV UNI | 3,496 | ||
| 36223 | SP CAROTID COM CEREB BIL | 4,949 | ||
| 36224 | SP INT CAROTID UNILATE W CEREB | 5,285 | ||
| 36225 | UNILATERAL VERTEBRAL ANGIOGRAM | 1,783 | ||
| 36226 | VERTEBRAL,CERVICAL,2ND SIDE | 1,783 | ||
| 36227 | SP EXTRENAL CAROTID UNILATERAL | 4,470 | ||
| 36245 | ART 1ST ORDR ABD/PEL/EXTR PRCD | 770 | ||
| 36246 | ART 2ND ORDR ABD/PEL/EXTR PRCD | 399 | ||
| 36247 | ART 3RD ORDR ABD/PDL/EX PRCD | 1,279 | ||
| 36248 | ART ADD 2ND,3RD ABD/PEL/EX PRC | 358 | ||
| 36251 | ADD L 2ND ORDER 4RD ORDERB | 3,220 | ||
| 36252 | SP RENAL, BILATERAL | 6,080 | ||
| 36299 | FL VASCULAR INJECTION | 99 | ||
| 36415 | VENIPUNCTURE | 25 | ||
| 36416 | CAPILLARY BLOOD DRAW | 10 | ||
| 36430 | BLOOD PROD ADMIN 1 UNIT | 416 | ||
| 36466 | SCLEROTHERAPY MULT VEINS SAME LEG | 4,157 | ||
| 36473 | ENDOVENOUS MCHNCHEM 1ST VEIN | 7,954 | ||
| 36474 | ENDOVENOUS MCHNCHEM ADD-ON | 2,809 | ||
| 36475 | US ENDOVENOUS ABLATION THERAPY | 7,208 | ||
| 36481 | PORTAL VENOGRAM PR CODE | 1,030 | ||
| 36500 | X-VENOUS ORGAN BLOOD SAMPLING(REN | 533 | ||
| 36558 | SP PERMACATH MODERATE SEDATION | 5,596 | ||
| 36568 | INSERTION OF PICC <5 YRS OLD | 986 | ||
| 36569 | SP PICC LINE INSERTION PR CODE | 398 | ||
| 36584 | REPLACEMENT OF PICC THRU VENOU | 843 | ||
| 36590 | REMOVAL OF PICC | 1,417 | ||
| 36591 | COLL BLOOD IMPLANTABLE VENOUS DEV | 23 | ||
| 36592 | PICC ACCESS | 25 | ||
| 36593 | DECLOTTING ACCESS DEVICE | 450 | ||
| 36595 | PR-REMOVE CV DEVICE FB/SEP ACCESS | 1,469 | ||
| 36596 | PR-REMOVE CV CATH FB/THRU CV LUME | 1,469 | ||
| 36598 | FL CONTRAST INJ/EVAL CV ACCESS | 850 | ||
| 36600 | ARTERIAL PUNCTURE | 152 | ||
| 36620 | ARTERIAL LINE START | 342 | ||
| 36680 | INSERT NDLE INTRAOSSEOUS INF | 141 | ||
| 36901 | AV FISTULOGRAM | 1,146 | ||
| 36902 | AV FISTULOGRAM W/BALLOON | 6,756 | ||
| 36903 | AV FISTULOGRAM W/STENT | 13,653 | ||
| 36904 | AV FISTULOGRAM W/MECHINICAL THROM | 6,756 | ||
| 36905 | ANGIOPLASTY | 13,653 | ||
| 36906 | ANGIOPLASTY W/ STENT | 20,694 | ||
| 36907 | ANGIOPLASTY W/CENTRAL BALLOON | 5,668 | ||
| 36908 | ANGIOPLASTY W/CENTRAL STENTS | 5,955 | ||
| 36909 | VASCULAR EMBOLIZATION OR OCCLUSION | 2,805 | ||
| 37184 | SP PTPT (PERIPHERAL THROMBECOMY) | 4,383 | ||
| 37185 | SP PTPT EACH ADDITIONAL VESSEL | 1,543 | ||
| 37186 | SP PTPT EACH ADDITIONAL VESSEL | 1,543 | ||
| 37187 | SP-PERIPH VEN THROMBECTOMY | 1,543 | ||
| 37191 | SP VENACAVA FILTER INSERTION | 4,155 | ||
| 37193 | VENACAVA FILTER REMOVAL | 6,503 | ||
| 37195 | THROMBOLYTIC AGENT ADMINISTRATION | 744 | ||
| 37197 | SP FB RETREVAL PLUS PR CODE | 6,503 | ||
| 37200 | BIOPSY TRANSCATH PR CD 37200 | 449 | ||
| 37211 | TPA 1ST DAY | 4,383 | ||
| 37212 | 1ST VENOUS THOMBO | 9,422 | ||
| 37213 | SP SUBUS ART/VEN THROMBO | 3,490 | ||
| 37214 | SP LAS DAY ART/VEN REMOVAL | 2,984 | ||
| 37215 | CERVICL CAROTID STENT W/FILTER-PR | 1,092 | ||
| 37216 | CERVCL CAROTD STENT W/O FILTER-PR | 1,092 | ||
| 37217 | SP STENT COMMON CAROTID/INNOMINATE ARTE | 5,299 | ||
| 37220 | SP ILIAC PTA | 6,714 | ||
| 37221 | SP ILIAC STENT | 17,978 | ||
| 37222 | SP ILIAC PTA ADD VES | 6,714 | ||
| 37223 | SP ILIAC STENT ADD VES | 13,760 | ||
| 37224 | SP FEM/POP PTA | 5,238 | ||
| 37225 | SP FEM/POP ARTHERECTOMY | 23,267 | ||
| 37226 | SP FEM/POP STENT | 24,439 | ||
| 37227 | SP FEM/POP ARTHER STENT | 28,871 | ||
| 37228 | SP TIB/PERO PTA | 14,098 | ||
| 37229 | SP TIB/PERO ARTHERECTOMY | 28,090 | ||
| 37230 | SP TIB/PERO STENT | 28,090 | ||
| 37231 | SP TIB/PERO ARTHER STENT | 28,090 | ||
| 37232 | SP TIB/PERO PTA ADD VES | 5,817 | ||
| 37233 | SP TIB/PERO ARTHER ADD VES | 7,160 | ||
| 37234 | SP TIB/PERO STENT ADD VES | 12,863 | ||
| 37235 | SP TIB/PERO ARTHER STENT ADD VES | 14,206 | ||
| 37236 | VENOUS STENT PLACEMENT | 11,468 | ||
| 37237 | W-STENT/NON-CORONARY EA ADDITIONA | 6,192 | ||
| 37238 | SP VEIN STENT | 16,578 | ||
| 37242 | EMBOLIATION PR CODE 37204 | 2,805 | ||
| 37246 | TRLML BAL ANGIOP 1ST ARTERY | 7,123 | ||
| 37247 | TRLML BAL ANGIOP ADDT'L ARTERY | 2,104 | ||
| 37248 | TRLML BAL ANGIOP 1ST VEIN | 5,668 | ||
| 37249 | TRLML BAL ANGIOP ADDT'L VEIN | 5,668 | ||
| 37252 | SP IVUS (NON-CORONARY VESSEL) | 6,563 | ||
| 37253 | SP IVUS (NON-C0R E/ ADD VESSEL) | 1,043 | ||
| 42550 | SIALOGRAM PR CODE | 123 | ||
| 43752 | NG TUBE PR CODE | 502 | ||
| 47000 | NEEDLE BIOPSY OF LIVER | 1,834 | ||
| 47531 | CHOLANGIOGRM,T TUBE/TRHPC PR CD | 147 | ||
| 47532 | SP CHOLANGIOGRAM-PERCUTANEOUS | 1,646 | ||
| 47534 | SP BILIARY DRAIN INT/EXT | 631 | ||
| 47536 | SP BILIARY DRAIN CHANGE | 712 | ||
| 47544 | SP BIL STONE REMOV PST-OP | 1,621 | ||
| 47555 | BILIARY DILTN W/O STNT PR CODE | 893 | ||
| 47556 | BILIARY DILATN W/STNT PR CODE | 1,617 | ||
| 48102 | ACT Z-BIOPSY, PANCREAS | 1,834 | ||
| 49083 | ABD PARACENTESIS W/IMAGING | 1,344 | ||
| 49405 | ACT Z-ABSCESS DRAINAGE LIVER | 1,349 | ||
| 49406 | PERITONEAL DRAINAGE | 697 | ||
| 49418 | INSERT TUN IP CATH PERC | 6,659 | ||
| 49427 | ABDOMINAL SHUNT/INJ | 465 | ||
| 49450 | FL GASTRIC TUBE PLCMNT PR CD | 172 | ||
| 50200 | AUS RENAL BX PERCUTANEOUS-PR | 1,092 | ||
| 50384 | REMOVE URETER STENT PERCUT | 2,172 | ||
| 50389 | REMOVAL OF NEPHROSTOMY TUBE | 1,852 | ||
| 50395 | NEPHROSTOMY PR CODE | 607 | ||
| 50432 | FL RENAL PELVIS DRNG/INJ | 3,790 | ||
| 50435 | FL NEPHROSTOMY TUBE CHANGE-LEFT | 1,017 | ||
| 50693 | SP URETERAL CAT/STENT PERCUTANEOU | 701 | ||
| 51600 | CYSTOURETHROGRAM,VOID PR CODE | 203 | ||
| 51701 | INSERTION OF STRAIGHT CATH | 135 | ||
| 51702 | INSERTION OF FOLEY CATH SIMPLE | 135 | ||
| 51703 | INSERTION OF CATH COMPLES | 243 | ||
| 56820 | COLPOSCOPY OF THE VULVA | 251 | ||
| 58340 | HYSTEROSALPLINGRAM PR CODE | 108 | ||
| 59000 | AMNIOCENTESIS TESTING | 274 | ||
| 59020 | STRESS TEST PER 1/4 HR | 110 | ||
| 59025 | FETAL NON-STRESS TEST | 212 | ||
| 59050 | INTERNAL FETAL MONITORING-EA 1/4 | 22 | ||
| 60300 | AUS THYROID CYST ASPRAT/INJ-PR | 86 | ||
| 62270 | LUMBAR PUNCTURE | 543 | ||
| 62368 | ANALYZE OF PROGM IMPLANT | 1,590 | ||
| 62370 | ANL SP INF PMP W/MDREPRG & FIL | 1,590 | ||
| 63650 | SPINAL CORD STIMULATOR IMPLANTATION | 10,891 | ||
| 68850 | DACRYOCYSTOGRAM INJECTION PC | 105 | ||
| 69209 | REMOVAL IMPACTED CERUMEN w/IRRIGATION | 32 | ||
| 69210 | CERUMEN REMOV REQUIRED INSTRU UNILATERAL | 156 | ||
| 70030 | XR ORBITS FOR FB 70030 | 341 | ||
| 70110 | MANDIBLE 4 VIEWS | 349 | ||
| 70130 | MASTOIDS 7 VIEWS | 272 | ||
| 70140 | XR FACIAL BONE(LESS THAN 3 VW) | 192 | ||
| 70150 | FACIAL BONES 4 VIEWS | 396 | ||
| 70160 | NASAL BONES 3 VIEWS | 262 | ||
| 70170 | FL NASOLACRIMAL DUCT S&I 70170 | 1,054 | ||
| 70190 | OPTIC FORAMINA 2 VIEWS | 192 | ||
| 70200 | ORBITS 4 VIEWS | 341 | ||
| 70210 | XR SINUSES (LESS THAN 3 VIEWS) | 192 | ||
| 70220 | XR SINUSES PARANASAL SINUSES 3 | 290 | ||
| 70240 | XR SELLATURCICA 3 VIEWS | 234 | ||
| 70250 | XR SKULL AP AND LATERAL | 234 | ||
| 70260 | SKULL PA BOTH LATERALS & AP TOWNE | 431 | ||
| 70330 | XR TEMPOROMANDIBULAR JOINTS BI | 290 | ||
| 70336 | MRI TM JOINT | 1,495 | ||
| 70355 | XR ORTHOPANTOGRAM | 155 | ||
| 70360 | XR NECK SOFT TISSUE | 192 | ||
| 70390 | FL SIALOGRAM 70390 | 929 | ||
| 70450 | CT OF HEAD UNENHANCED | 2,079 | ||
| 70460 | CT OF HEAD ENHANCED(20 SLICES) | 1,689 | ||
| 70470 | CT OF HEAD UNENHANCED & ENHANCED | 2,166 | ||
| 70480 | CT ORBITS, SELLA, IAC W/O CON | 1,074 | ||
| 70481 | CT ORBIT,SELLA,MIDDLE/INNER EAR E | 1,185 | ||
| 70482 | CT ORBIT,SELLA,MIDDLE/INNER EAR W | 1,689 | ||
| 70486 | CT MAXILLOFAC AREA W/O CONTRAS | 1,074 | ||
| 70487 | CT MAXILLOFAC AREA W/CONTRAST | 1,185 | ||
| 70488 | CT CT MAXILLOFC AREA WO/W CONT | 1,689 | ||
| 70490 | CT SOFT TISSUE NECK & UNENHANCED | 1,074 | ||
| 70491 | CT SOFT TISSUE NECK W/CONT | 1,185 | ||
| 70492 | CT SFT TISSUE NECT WO/W CONT | 1,689 | ||
| 70496 | CTA HEAD W/WO (W/RECON) | 1,561 | ||
| 70498 | CTA NECK W/WO (W/RECON) | 1,561 | ||
| 70540 | MRI ORBIT, FACE, NECK W/O CONTRST | 1,495 | ||
| 70542 | MRI ORBIT, FACE NECK W/CONTRAST | 2,443 | ||
| 70543 | MRI ORBIT,FACE,NECK W/WO CONTRAST | 1,789 | ||
| 70544 | MRA HEAD W/O CONTRAST 70544 | 2,406 | ||
| 70547 | MRA NECK W/O CONTRAST 70547 | 2,406 | ||
| 70548 | MRA NECK W/CONTRAST | 2,365 | ||
| 70549 | MRA NECK WITH & W/O CONTRAST | 2,552 | ||
| 70551 | NATIVE AMER STRONG HEART/STROKE | 951 | ||
| 70552 | MRI BRAIN WITH CONTRAST | 2,445 | ||
| 70553 | MRI BRAIN W/O CONT THEN W/CONT | 3,242 | ||
| 71045 | XR CHEST AP (1 VIEW) | 191 | ||
| 71046 | XR CHEST PA & LAT (2 VIEWS) | 292 | ||
| 71047 | XR CHEST W/APICAL LORIDOTIC (3 VIEWS) | 328 | ||
| 71048 | XR CHEST W/OBLIQUES (4+ VIEWS) | 376 | ||
| 71101 | XR RIBS UNILAT W/PA CHEST LT | 302 | ||
| 71110 | XR RIBS BILATERAL | 405 | ||
| 71111 | XR RIBS BILAT W/PA CHEST | 302 | ||
| 71120 | XR STERNUM 2 VIEWS | 196 | ||
| 71250 | CT THORAX W/O CONTRAST (GRP 2) | 315 | ||
| 71260 | CT THORAX W/CONTRAST PE | 1,504 | ||
| 71270 | CT THORAX WO/W CONTRAST | 2,165 | ||
| 71275 | CTA CHEST W/WO (W/RECON) | 1,561 | ||
| 71550 | MRI CHES W/O CONTRAST | 1,495 | ||
| 71551 | MRI CHEST W/CONTRAST | 1,789 | ||
| 71552 | MRI CHEST W/WO CONTRAST | 2,445 | ||
| 72020 | XR SPINE SINGLE VIEW SPEC LEV | 192 | ||
| 72040 | XR SPINE CERVICAL 3 VIEW | 290 | ||
| 72050 | XR SPINE CERVICAL 5 VIEWS | 520 | ||
| 72052 | XR SPINE, CERVICAL W/FLEX & EX | 498 | ||
| 72070 | XR SPINE, THORACIC 2 VIEW | 258 | ||
| 72072 | XR SPINE THORACIC 3 VIEWS | 302 | ||
| 72080 | XR SPINE-THORACOLUMBAR | 213 | ||
| 72081 | XR SCOLIOSIS 1V | 181 | ||
| 72100 | XR SPINE LUMBAR 3 VIEW | 329 | ||
| 72110 | XR SPINE LUMBAR 5 VIEWS | 520 | ||
| 72114 | XR SPINE LUMBAR SRS & BENDING | 690 | ||
| 72120 | XR SPINE-LUMBAR, BENDING ONLY(3V) | 302 | ||
| 72125 | CT CERVICAL SPINE WO CONT | 1,402 | ||
| 72126 | CT CERVICAL SPINE W/CONT | 1,503 | ||
| 72127 | CT CERVICAL SPINE WO/W CONT | 2,166 | ||
| 72128 | CT THORACIC SPINE W/O CONT | 1,402 | ||
| 72129 | CT THORACIC SPINE W/CONT | 1,504 | ||
| 72130 | CT THORACIC SPINE WO/W CONT | 2,166 | ||
| 72131 | CT LUMBAR SPINE W/OUT CONTRAST | 1,402 | ||
| 72132 | CT LUMBAR SPINE W/CONTRAST | 1,503 | ||
| 72133 | CT LUMBAR SPINE WO/W CONTRAST | 2,166 | ||
| 72141 | MRI CERVICAL W/OUT CONTRAST | 2,443 | ||
| 72142 | MRI CERVICAL WITH CONTRAST | 2,445 | ||
| 72146 | MRI THORACIC W/OUT CONTRAST | 2,443 | ||
| 72147 | MRI THORACIC WITH CONTRAST | 2,445 | ||
| 72148 | MRI LUMBAR W/OUT CONTRASTING | 2,443 | ||
| 72149 | MRI LUMBAR WITH CONTRAST | 2,445 | ||
| 72156 | MRI CERVICAL W/O CONT THEN W/C | 3,242 | ||
| 72157 | MRI THORACIC W/O CON THEN W/CO | 3,242 | ||
| 72158 | MRI LUMBAR W/O CON THEN W/CON | 3,242 | ||
| 72170 | XR PELVIS (AP) | 192 | ||
| 72190 | XR PELVIS, (MIN 3 VIEWS) | 329 | ||
| 72192 | CT PELVIS W/OUT CONTRAST | 1,075 | ||
| 72193 | CT PELVIS WITH CONTRAST | 1,185 | ||
| 72194 | CT PELVIS WO/W CONTRAST | 1,714 | ||
| 72195 | MRI PELVIS | 1,495 | ||
| 72196 | MRI PELVIS W/ CONTRAST | 2,443 | ||
| 72197 | MRI PELVIS W/O & W/CONTRAST | 2,443 | ||
| 72198 | MRA PELVIS W OR W/O CONTRAST | 2,697 | ||
| 72202 | XR SACROILIAC JOINTS 3V | 214 | ||
| 72220 | XR SACRUN AND/OR COCCYX | 192 | ||
| 73040 | FL ARTHROGRAM SHOULDER 73040 LT | 1,125 | ||
| 73050 | XR AC JOINTS | 214 | ||
| 73092 | XR EXTREMITY INFANT, UPPER LT | 302 | ||
| 73120 | XR HAND BILATERAL AP/PA HANDS LT | 192 | ||
| 73140 | XR FINGER LT | 192 | ||
| 73206 | CTA UPPER EXTREMITY W/WO (W/RECON | 1,472 | ||
| 73221 | MRI ANY JOINT UPPER EXT W/O CONTR | 2,443 | ||
| 73501 | XR HIP 1 VIEW | 181 | ||
| 73502 | XR HIP/PELVIS 2-3 VIEWS | 181 | ||
| 73503 | XR HIP/PELVIS 4 VIEWS MIN | 301 | ||
| 73521 | XR HIP/PELVIS BILAT 2V | 253 | ||
| 73522 | XR HIP/PELVIS BILAT 3-4 V | 301 | ||
| 73523 | XR HIP/PELVIS BILAT 5 VIEWS MIN | 572 | ||
| 73525 | FL ARTHOGRAM, HIP LT | 969 | ||
| 73551 | XR FEMUR 1 VIEW | 181 | ||
| 73565 | XR KNEES STANDING AP ONLY | 286 | ||
| 74010 | XR ABD AP W/OBLIQUE &/OR CONED VI | 192 | ||
| 74018 | XR FETAL AGE 1 VIEW | 228 | ||
| 74021 | XR ABDOMEN COMPLETE (3 VIEWS) | 328 | ||
| 74022 | XR ABDOMINAL SERIES | 440 | ||
| 74150 | CT ABDOMEN W/OUT CONTRAST | 1,075 | ||
| 74160 | CT ABDOMEN WITH CONTRAST | 1,689 | ||
| 74170 | CT ABDOMEN WO/W CONTRAST | 2,166 | ||
| 74174 | CTA ABD/PEL (W/WO)-W/RECON | 1,472 | ||
| 74175 | CTA ABDOMEN W/WO (W/RECON) | 1,561 | ||
| 74176 | CT ABD/PELVIS W/O CONTRAST | 2,149 | ||
| 74177 | CT ABD/PELVIS W/CONTRAST | 2,875 | ||
| 74178 | CT ABD/PELVIS W + W/O CONTRAST | 3,880 | ||
| 74181 | STRONG HEART STUDY ABDOMEN | 997 | ||
| 74182 | MRI ABDOMEN W/CONTRAST | 2,443 | ||
| 74183 | MRI ABDOMEN W/O & W/CONTRAST | 3,242 | ||
| 74220 | FL ESOPHAGRAM 74220 | 468 | ||
| 74230 | FL DYNAMIC PHARYNGEAL EVAL | 665 | ||
| 74235 | FL ESOPHAGUS FB REMOVAL 74235 | 869 | ||
| 74241 | UGI W/KUB | 502 | ||
| 74245 | XR UGI & SMALL BOWEL | 656 | ||
| 74247 | FL UGI/AIR CONTRAST 74247 | 514 | ||
| 74249 | FL UGI/AIR & SMALL BOWEL 74249 | 690 | ||
| 74250 | FL SMALL BOWEL SERIES 74250 | 424 | ||
| 74270 | FL BARIUM ENEMA 74270 | 580 | ||
| 74280 | FL BARIUM ENEMA W/AIR CNTRST74280 | 787 | ||
| 74300 | FL CHOLANGIOGRAM OPERATIVE 74300 | 468 | ||
| 74328 | FL ERC/BILIARY ONLY 74328 | 819 | ||
| 74329 | FL ERCP / PANCREAS ONLY 74329 | 819 | ||
| 74330 | FL ERCP PANCR & BIL | 1,490 | ||
| 74340 | FL GASTRO TUBE PLCMNT 74340 | 433 | ||
| 74360 | FL TRACHAEL DILATION | 893 | ||
| 74363 | SP BILIARY DILATION | 1,802 | ||
| 74410 | FL IVP, BOLUS 74410 | 854 | ||
| 74415 | FL IVP W/TOMOGRAMS 74415 | 854 | ||
| 74420 | FL PYELOGRAM RETROGRADE 74420 | 854 | ||
| 74425 | SP FL NEPHROSTOGRAM LOOPOGRAM | 420 | ||
| 74430 | FL CYSTOGRAM 74430 | 854 | ||
| 74450 | FL CYSTOURETHROGRM,RETROGRD 74450 | 777 | ||
| 74455 | FL CYSTOURETHROGRM, VOIDING 74455 | 854 | ||
| 74485 | NEPHROSTOMY TUBE GUIDANCE | 2,439 | ||
| 74710 | XR PELVIMETRY | 302 | ||
| 74740 | FL HYSTEROSAL GRAM 74740 | 929 | ||
| 75571 | CT CALCIUM SCORING | 53 | ||
| 75574 | CTA CORO MORPHO W/CALIUM SCORE | 1,098 | ||
| 75600 | THORACIC AORTOGRAM | 379 | ||
| 75605 | SP THORACIC | 4,738 | ||
| 75625 | FL TRIPLE AAA REPAIR | 8,539 | ||
| 75630 | ABDOMINAL AORTOGRAM W/BILATERAL RUNOFFS | 2,809 | ||
| 75635 | CTA ABD AORTA/ILIO-FEM W/CONTRST | 1,561 | ||
| 75705 | SP SPINAL, SELECTIVE | 711 | ||
| 75710 | ANGIOGRAPHY EXP UNILATERAL TC | 2,809 | ||
| 75716 | SP EXTRMTY BILAT LOWER | 5,731 | ||
| 75726 | VISCERAL - 1ST VESSEL ONLY | 2,550 | ||
| 75733 | SP ADRENAL, BILATERAL | 3,716 | ||
| 75736 | SP PELVIC, EACH VESSEL | 3,679 | ||
| 75741 | SP PULMONARY ARTERY | 7,102 | ||
| 75743 | SP PULMONARY, BILATERAL | 4,730 | ||
| 75746 | PULMONARY,NON-SELECTIVE | 993 | ||
| 75774 | SP ANGIOGRAPHY, SEL, EA ADDL VESS | 747 | ||
| 75809 | XR NONVASCULAR SHUNT | 284 | ||
| 75820 | VENOGRAM,EXTMITY UNILATERAL | 472 | ||
| 75822 | FL VENOGRAM, EXTRMTY BILAT 75822 | 2,448 | ||
| 75825 | SP VENCAVAGRAM, INFERIOR | 4,505 | ||
| 75827 | SP VENACAVAGRAM, SUPERIOR | 4,505 | ||
| 75887 | SP PORTAL VENOGRAM | 3,088 | ||
| 75893 | RENINS | 667 | ||
| 75894 | EMBOLIZATION-CRANIAL | 7,981 | ||
| 75898 | ANGIO THRU EXISTING CATHERTER | 1,095 | ||
| 75901 | SP CATH STRIPPING | 866 | ||
| 75902 | SP REMOVE CV CATH FB/THRU CV LUME | 588 | ||
| 75970 | SP BIOPSY - TRANSCATHETER | 2,630 | ||
| 75984 | SP BILIARY DRNG CATH CHANGE | 898 | ||
| 75989 | US GUIDANCE-PERCUTANEOUS DRAINAGE | 313 | ||
| 76000 | SP FL UP TO 1 HOUR | 434 | ||
| 76010 | XR PED BODY GRM FOR FB | 534 | ||
| 76080 | FL FIST/SINUS TRACT STUDY 76080 | 1,054 | ||
| 76100 | LAMINOGRAMS MULTIPLE VIEWS | 565 | ||
| 76377 | CT 3D RENDERING W/INTERP &REPORT | 361 | ||
| 76380 | CT LIMITED PEDIATRIC SINUS | 475 | ||
| 76390 | MRI SPECTROSCOPY | 894 | ||
| 76506 | US NEONATAL HEAD | 410 | ||
| 76536 | US SOFT TISSUE,HEAD & NECK 76536 | 417 | ||
| 76604 | US CHEST | 492 | ||
| 76641 | ULTRASOUND BREAST COMPLETE | 313 | ||
| 76700 | US ABDOMINAL COMPLETE 76700 | 823 | ||
| 76705 | US GB,SINGLE ORGAN,QUADRANT,FOLLO | 602 | ||
| 76770 | US RENAL/BILAT | 634 | ||
| 76775 | US ABDOMEN SONO,RENAL UNILAT | 330 | ||
| 76800 | US SPINAL CANAL & CONTENTS | 370 | ||
| 76801 | US OB 1ST TRIMESTER (<14 WEEKS) | 321 | ||
| 76802 | US GPO&G 1ST TRI <14WKS EACH ADDL | 104 | ||
| 76805 | US PAHP - OB SINGLE FETUS | 175 | ||
| 76810 | US GPO&G - OB MULTIGESTATION | 204 | ||
| 76815 | US GPO&G - OB LIMITED | 518 | ||
| 76816 | US GPO & G FOLLOW-UP | 518 | ||
| 76817 | US OB TRANSVAGINAL | 518 | ||
| 76819 | US FETAL BIOPHYSICAL EACH ADDL | 518 | ||
| 76820 | US FETAL UMBILICIAL ARTERY DOPPLE | 207 | ||
| 76830 | US TRANSVAGINAL ULTRASOUND 76830 | 674 | ||
| 76856 | US PELVIC SONOGRAM 76856 | 553 | ||
| 76857 | US PELVIC LIMITED/BLADDER | 150 | ||
| 76870 | US SCROTUM & CONTENTS 76870 | 448 | ||
| 76881 | US NON-VASC EXT COMPLETE -LEFT | 322 | ||
| 76882 | US NON-VASC EXT LIMITED -LEFT | 207 | ||
| 76930 | US GUIDANCE PERICARDIOCENTESIS RS&I | - | ||
| 76936 | US GUID.REPAIR ART PSEUD ANUSM/AV | 603 | ||
| 76937 | US ASSESSMENT OF SITE/VISUAL AIDE | 201 | ||
| 76942 | US GUIDANCE NEEDLE (BS, INJ, ASP) | 202 | ||
| 76946 | US GUIDANCE-AMNIOCENTESIS 76946 | 732 | ||
| 76999 | US UNSPECIFIED PROCEDURE | 202 | ||
| 77001 | FL GUIDE CV ACCESS DEVICE PLACE | 678 | ||
| 77002 | SP FL NEEDLE GUIDANCE BX/ASP/INJ | 631 | ||
| 77003 | PLCMT OF FL GUIDE/SPINAL NEEDLE | 540 | ||
| 77011 | CT GUIDANCE STEREOTACTIC LOCAL | 1,714 | ||
| 77012 | CT NEEDLE GUIDANCE BX/ASPIRTN/INJ | 1,458 | ||
| 77014 | COMPUTED TOMOGRAPHY GUID PLACEMNT | 390 | ||
| 77021 | MRI BREAST GUID NDL PLCMNT | 1,534 | ||
| 77063 | MG MAMMO SCREENING 3D | 156 | ||
| 77065 | MAMMO DIAG UNILAT(CONVERTED FROM SCREEN) | 506 | ||
| 77066 | DX MAMMO INCL CAD BILATERIAL | 239 | ||
| 77067 | SCREENING MAMMO INCL CAD BILATERAL | 281 | ||
| 77072 | XR BONE AGE STUDY | 192 | ||
| 77073 | XR BONE LENGTH STUDY | 410 | ||
| 77074 | XR BONE SURVEY,LIMITED 76061 | 402 | ||
| 77075 | XR BONE SURVEY (ADULT) | 588 | ||
| 77076 | XR BONE SURVEY (INFANT) | 413 | ||
| 77077 | XR JOINT SURVEY/1 VIEW(2+ JOINTS) | 211 | ||
| 77080 | DEXA-CCMH | 299 | ||
| 77084 | MRI BONE MARROW BLOOD SUPPLY | 1,130 | ||
| 77280 | SIMULATION - SIMPLE | 879 | ||
| 77285 | SIMULATION - INTERMEDIATE | 1,383 | ||
| 77290 | SIMULATION - COMPLEX | 1,658 | ||
| 77295 | 3D TREATMENT COMP DOSIMETRY | 1,633 | ||
| 77300 | DOSIMETRY CALC / MANUAL-BASIC | 232 | ||
| 77301 | IMRT TX. PLANNING | 6,556 | ||
| 77306 | DOSIMETRY CALC / SIMPLE | 394 | ||
| 77307 | DOSIMETRY CALC / INTERMEDIATE | 302 | ||
| 77316 | BRACHYTX ISODOSE PLAN SIMPLE | 617 | ||
| 77317 | BRACHYTX ISODOSE INTERMED | 805 | ||
| 77318 | BRACHYTX ISODOSE COMPLEX | 1,164 | ||
| 77321 | SPEC TELETHERAPY-(ELECTRON)-PLAN | 317 | ||
| 77331 | SPECIAL DOSIMETRY | 225 | ||
| 77332 | TREATMENT DEVICE - SIMPLE | 273 | ||
| 77333 | TREATMENT DEVICE - INTERMEDIATE | 183 | ||
| 77334 | TREATMENT DEVICE - COMPLEX | 508 | ||
| 77336 | CONT RAD PHYSICS CON | 245 | ||
| 77338 | MULTI-LEAF COLLIMATOR DEVICE | 1,719 | ||
| 77370 | SPECIAL PHYSICS CONSULT | 376 | ||
| 77385 | INTENSITY MOD TREATMENT DELIVERY-SIMPLE | 1,514 | ||
| 77386 | INTENSITY MOD TREATMENT DELIVERY-COMPLEX | 2,020 | ||
| 77387 | X-RAY GUIDANCE | 251 | ||
| 77402 | DAILY TX MANAGEMENT SIMPLE | 458 | ||
| 77407 | DAILY TX MANAGEMENT INTERMEDIATE | 833 | ||
| 77412 | DAILY TX MANAGEMENT COMPLEX | 791 | ||
| 77417 | PORTAL FILM | 34 | ||
| 77470 | SPECIAL TX PROC (BRACHY, CC) | 533 | ||
| 77761 | APPLY INTRCAV RADIATE SIMPLE | 1,289 | ||
| 77762 | INTRCAV RADIATE INTERM | 1,727 | ||
| 77763 | INTRCAV RADIAT COMPLEX | 2,453 | ||
| 77770 | HDR RDNCL NTRSTL/ICAV BRCHTX | 1,042 | ||
| 77771 | HDR RDNCL NTRSTL/ICAV BRCHTX 2-12 CHAN | 1,942 | ||
| 77772 | HDR RDNCL NTRSTL/ICAV BRCHTX OVER 12 CHA | 2,961 | ||
| 77790 | RADIATION HANDLING | 46 | ||
| 78014 | NM THYROID UPTAKE & SCAN MULT | 1,043 | ||
| 78018 | THYROID MET IMAGING WHOLE BODY | 1,490 | ||
| 78070 | NM SCAN,PARATHYROID | 1,114 | ||
| 78140 | NM LABELED RBC STUDY 78140 | 2,735 | ||
| 78195 | NM LOCALIZATION-TUMOR/MULTI AREAS | 2,277 | ||
| 78215 | NM LIVER/SPLEEN-STATIC ONLY | 1,503 | ||
| 78227 | NM HEPATOBILIARY/PIPIDA SCAN | 1,296 | ||
| 78262 | NM GASTROESOPHAGEAL REFLUX 78262 | 866 | ||
| 78264 | NM GASTRIC EMPTYING STUDY | 1,304 | ||
| 78278 | NM GI BLEED NUCLEAR | 942 | ||
| 78290 | NM MECKELS SCAN | 1,309 | ||
| 78300 | NM BONE IMAGING/LIMITED AREA | 770 | ||
| 78306 | NM BONE IMAGING/STATIC TOT BOD | 1,565 | ||
| 78315 | NM BONE IMAGING/THREE PHAS STU | 1,721 | ||
| 78320 | NM BONE IMAGING LMTED, SPECT | 1,481 | ||
| 78451 | SPECT MULTI STUDY LTD | 2,171 | ||
| 78452 | NM DUAL ST/LEXISCAN/ADENO/DOBU | 4,720 | ||
| 78466 | NM MYOCARDIAL INFARCT SCAN | 1,139 | ||
| 78472 | NM TECH99 ENVG/BLOOD POOL/MULT | 1,948 | ||
| 78580 | NM LUNG SCAN PERFUSION | 1,296 | ||
| 78582 | NM LUNG PERFUSION W/VENT 78588 | 2,592 | ||
| 78606 | NM BRAIN IMGAING W VASCULAR FLOW | 1,329 | ||
| 78630 | NM CISTERNAGRAM | 1,206 | ||
| 78645 | NM SHUNT EVALUATION | 1,024 | ||
| 78650 | NM CSF LEAKAGE | 994 | ||
| 78707 | NM RENAL W/FLOW & FUNCTION | 1,088 | ||
| 78709 | NM RENAL IMG,FLOW/FUN-MULT-W/PHAR | 424 | ||
| 78740 | NM NUCLEAR CYSTOGRAM | 507 | ||
| 78800 | R.L.OF TUMOR,LIMITED AREA | 1,684 | ||
| 78802 | NM LOCALIZATION-TUMOR/WHOLE BODY | 2,560 | ||
| 78805 | NM LOCALIZATN-INFLAMATORY/LIMITED | 1,190 | ||
| 78806 | NM ABSCESS WHOLE BODY | 2,549 | ||
| 78815 | PET IMAGING W/CT SKULL-MID THIGH | 6,032 | ||
| 78816 | PET IMAGING W/CT WHOLE BODY | 6,405 | ||
| 79005 | NM RADIOPHARMACEUTICAL THER-ORAL | 2,162 | ||
| 79101 | NUCLEAR RX IV ADMINISTRATION | 493 | ||
| 80047 | BMP (POC) | 45 | ||
| 80048 | BASIC META PANEL WITH TOTAL CA++ | 59 | ||
| 80050 | GENERAL HEALTH PANEL | 185 | ||
| 80051 | ELECTROLYTES, SERUM | 55 | ||
| 80053 | COMPREHENSIVE METABOLIC PANEL* | 77 | ||
| 80055 | PRENATAL PROFILE II | 206 | ||
| 80061 | LIPID PROFILE * | 95 | ||
| 80069 | RENAL FUNCTION PANEL | 57 | ||
| 80074 | HEPATITIS PANEL MASTER (ACUTE) | 181 | ||
| 80076 | HEPATIC FUNCTIOIN PANEL* | 59 | ||
| 80100 | LEGAL URINE DRUG TEST (SENDOUT) | 104 | ||
| 80101 | DRUG SCREEN - EACH CLASS 80101 | 31 | ||
| 80156 | TEGRETOL (CARBAMAZEPINE) | 92 | ||
| 80158 | Cyclosporine A, FPIA (B) | 420 | ||
| 80162 | DIGOXIN | 86 | ||
| 80164 | VALPROIC ACID | 104 | ||
| 80170 | GENTAMICIN, PEAK | 56 | ||
| 80176 | LIDOCAINE | 79 | ||
| 80177 | Levetiracetam | 61 | ||
| 80178 | LITHIUM | 48 | ||
| 80180 | Mycophenolic Acid | 410 | ||
| 80183 | 10-Hydroxycarbazepine | 61 | ||
| 80184 | PHENOBARBITOL LEVEL | 86 | ||
| 80185 | DILANTIN | 92 | ||
| 80192 | PROCAINAMIDE/NAPA | 86 | ||
| 80197 | Tacrolimus, Highly Sensitive, LC/MS/MS | 572 | ||
| 80198 | THEOPHYLLINE | 84 | ||
| 80200 | TOBRAMYCIN,PEAK | 168 | ||
| 80202 | VANCOMYCIN, PEAK | 74 | ||
| 80299 | Methotrexate | 21 | ||
| 80305 | Drug Abuse Panel 10 | 386 | ||
| 80306 | Urine Drug Screen | 435 | ||
| 80320 | ALCOHOL (ETHANOL) | 79 | ||
| 80323 | Nicotine and Cotinine, LC/MS/MS, Serum | 270 | ||
| 80329 | SALICYLATE | 63 | ||
| 80336 | Tricyclic Antidepressant Panel (3) | 270 | ||
| 80373 | Tramadol and Metabolite, Quantitative, U | 270 | ||
| 80375 | Thiopurine Metabolites | 270 | ||
| 81002 | SPECIFIC GRAVITY | 23 | ||
| 81003 | URINALYSIS | 12 | ||
| 81015 | URINALYSIS - MICROSCOPIC ONLY | 21 | ||
| 81050 | VOL MEAS TIME COLL, EA - CHRG ONL | 26 | ||
| 81220 | Cystic Fibrosis Screen | 271 | ||
| 81240 | Prothrombin (Factor II) 20210G>A Mutatio | 24 | ||
| 81241 | Factor V (Leiden) Mutation Analysis | 281 | ||
| 81256 | Hereditary Hemochromatosis DNA Mutation | 301 | ||
| 81257 | Alpha Globin Common Mutation Analysis | 853 | ||
| 81291 | Methylenetetrahydrofolate Reductase (MTH | 201 | ||
| 81510 | Triple Screen | 62 | ||
| 82010 | KETONE BODIES SERUM | 59 | ||
| 82024 | ACTH, Plasma | 188 | ||
| 82040 | ALBUMIN, SERUM | 32 | ||
| 82042 | IgG Synthesis Rate/Index, CSF | 20 | ||
| 82043 | MICROALBUMIN URINE | 57 | ||
| 82085 | Aldolase | 43 | ||
| 82088 | Aldosterone, LC/MS/MS | 178 | ||
| 82103 | Alpha-1-Antitrypsin QN | 63 | ||
| 82105 | Alpha Fetoprotein, Tumor Marker | 126 | ||
| 82140 | AMMONIA | 92 | ||
| 82150 | AMYLASE, URINE RANDOM | 81 | ||
| 82157 | Androstenedione, LC/MS/MS | 143 | ||
| 82164 | Angiotensin Converting Enzyme (ACE) | 86 | ||
| 82172 | Liver Fibrosis, FibroTest ActiTest Panel | 72 | ||
| 82175 | Heavy Metals Panel, Blood | 79 | ||
| 82180 | Vitamin C, LC/MS/MS | 94 | ||
| 82232 | Beta 2 Microglobulin, Serum | 86 | ||
| 82247 | Liver Fibrosis, FibroTest ActiTest Panel | 22 | ||
| 82248 | BILIRUBIN, DIRECT | 35 | ||
| 82270 | OCCULT BLOOD, FECES (SCREENING) | 26 | ||
| 82271 | OCCULT BLOOD, GASTRIC | 29 | ||
| 82272 | BLOOD,OCCULT,BY PEROXIDASE ACT | 20 | ||
| 82274 | OCCULT BLOOD FECES ICT (DIAG) | 82 | ||
| 82306 | VITD, 25-HYDROXY (CALCIFEROL) | 86 | ||
| 82308 | Calcitonin | 344 | ||
| 82310 | Urine Calcium, Random (W/O Creatinine) | 22 | ||
| 82330 | IONIZED CALCIUM (POC) | 76 | ||
| 82340 | CALCIUM, 24HR URINE | 40 | ||
| 82365 | Stone Analysis | 62 | ||
| 82374 | CARBON DIOXIDE, SERUM | 31 | ||
| 82375 | ABG - COHB | 93 | ||
| 82378 | CEA | 115 | ||
| 82384 | Catecholamines 24Hr Urine | 166 | ||
| 82390 | Ceruloplasmin | 61 | ||
| 82397 | ANTI MULLERIAN HORMONE-FEMALE | 44 | ||
| 82435 | CHLORIDE (WB) | 23 | ||
| 82436 | CHLORIDE, 24HR URINE | 53 | ||
| 82438 | CHLORIDE, CSF | 57 | ||
| 82465 | CHOLESTEROL, TOTAL | 32 | ||
| 82482 | Cholinesterase, RBC | 41 | ||
| 82495 | Chromium, Serum | 94 | ||
| 82525 | Copper | 61 | ||
| 82530 | Cortisol, Free 24H Urine LC/MS/MS | 156 | ||
| 82533 | CORTISOL, SERUM | 95 | ||
| 82542 | Bile Acids, Fractionated and Total | 83 | ||
| 82550 | Creatine Kinase Isoenzyme Panel | 56 | ||
| 82552 | Creatine Kinase Isoenzyme Panel | 56 | ||
| 82553 | CKMB | 38 | ||
| 82565 | Creatinine POC | 26 | ||
| 82570 | CREATININE, OTHER SOURCE | 36 | ||
| 82575 | CREATININE CLEARANCE 12 HOUR | 64 | ||
| 82595 | Cryoglobulin, QL Analysis | 34 | ||
| 82607 | B-12, SERUM | 63 | ||
| 82610 | Cystatin C | 76 | ||
| 82626 | DHEA, LC/MS/MS | 133 | ||
| 82627 | DHEA Sulfate | 101 | ||
| 82652 | Vitamin D, 1,25 Dihydroxy LC/MS/MS | 188 | ||
| 82668 | Erythropoietin | 126 | ||
| 82670 | Estradiol | 141 | ||
| 82671 | Estrogens, Fractionated, LC/MS/MS | 370 | ||
| 82677 | Triple Screen | 68 | ||
| 82693 | Ethylene Glycol, Blood | 275 | ||
| 82728 | FERRITIN | 72 | ||
| 82731 | FETAL FIBRONECTIN | 479 | ||
| 82746 | FOLATE | 55 | ||
| 82747 | Folate, RBC | 80 | ||
| 82784 | Immunoglobulin G | 41 | ||
| 82785 | Respiratory Allergy Profile Region X | 59 | ||
| 82800 | PH PLEURAL FLUID | 36 | ||
| 82803 | BLOOD GAS (POC) | 105 | ||
| 82805 | O2 SATURATION DIRECT MEASUREMENT | 62 | ||
| 82941 | Gastrin | 101 | ||
| 82945 | GLUCOSE, BODY FLUID | 31 | ||
| 82947 | GLUCOSE (WB) | 22 | ||
| 82950 | GLUCOSE 2 HR PP | 31 | ||
| 82951 | LACTOSE TOLERANCE | 106 | ||
| 82952 | GLUCOSE TOLERANCE, EA ADDITION | 41 | ||
| 82955 | Glucose-6-Phosphate Dehydrogenase, Quan | 86 | ||
| 82962 | FINGER STICK BLOOD SUGAR | 14 | ||
| 82977 | Liver Fibrosis, FibroTest ActiTest Panel | 34 | ||
| 83001 | FOLLICLE STIMULATING HORMONE | 88 | ||
| 83002 | LUTEINIZING HORMONE (LH) | 212 | ||
| 83003 | Growth Hormone (GH) | 86 | ||
| 83010 | Haptoglobin | 72 | ||
| 83018 | Cobalt, Serum/Plasma | 101 | ||
| 83021 | Hemoglobinopathy Evaluation | 111 | ||
| 83033 | FETAL SCREEN - CHRG ONLY | 87 | ||
| 83036 | HEMOGLOBIN A1C | 65 | ||
| 83070 | Hemosiderin Stain, Urine | 49 | ||
| 83090 | Homocysteine | 39 | ||
| 83497 | 5 HIAA, 24Hr Urine | 180 | ||
| 83498 | 17 Hydroxyprogesterone, LC/MS/MS | 107 | ||
| 83516 | IMMUNOASSAY, MULTISTEP | 44 | ||
| 83519 | Acetylcholine Receptor Blocking Ab | 71 | ||
| 83520 | PAN ANCA Plus with Reflex | 31 | ||
| 83525 | Insulin | 86 | ||
| 83540 | IRON | 35 | ||
| 83550 | IRON BINDING CAPACITY | 90 | ||
| 83605 | LACTATE (POC) | 59 | ||
| 83615 | LDH, BODY FLUID | 35 | ||
| 83625 | Lactate Dehydrogenase Isoenzyme Panel | 59 | ||
| 83630 | FECAL LEUKOCYTE, LEUKOFERRIN, QUA | 59 | ||
| 83655 | Lead, Blood | 51 | ||
| 83663 | FETAL LUNG MATURITY | 324 | ||
| 83690 | LIPASE | 45 | ||
| 83695 | Lipoprotein (a) | 71 | ||
| 83698 | LP-PLA2 | 126 | ||
| 83718 | HDL | 51 | ||
| 83721 | LDL DIRECT | 33 | ||
| 83735 | MAGNESIUM | 55 | ||
| 83825 | Heavy Metals Panel, Blood | 112 | ||
| 83835 | Metanephrines, Fract. LC/MS/MS, 24Hr U | 67 | ||
| 83873 | Myelin Basic Protein | 126 | ||
| 83874 | Myoglobin, Serum | 39 | ||
| 83880 | PROBNP | 110 | ||
| 83883 | Kappa/Lambda Light Chains Free with Rati | 79 | ||
| 83916 | Oligoclonal Bands, CSF | 343 | ||
| 83921 | Methylmalonic Acid | 87 | ||
| 83930 | OSMOLALITY, SERUM | 101 | ||
| 83935 | OSMOLALITY, URINE | 59 | ||
| 83970 | PTH, INTACT | 123 | ||
| 83986 | NITROZINE PH (BODY FLUID) | 29 | ||
| 83993 | Calprotectin, Stool | 91 | ||
| 84066 | PROSTATIC ACID PHOSPHOROUS | 71 | ||
| 84075 | ALKALINE PHOSPHATASE | 34 | ||
| 84100 | PHOSPHOROUS, SERUM | 34 | ||
| 84110 | Porphobilinogen, QN, Random Urine | 51 | ||
| 84112 | AMNISURE | 218 | ||
| 84132 | POTASSIUM (POC) | 22 | ||
| 84133 | POTASSIUM, URINE 24 HR | 34 | ||
| 84134 | PREALBUMIN | 63 | ||
| 84144 | Progesterone | 86 | ||
| 84145 | PROCALCITONIN | 83 | ||
| 84146 | PROLACTIN | 99 | ||
| 84153 | PSA (Free and Total) | 102 | ||
| 84154 | PSA FREE CHRG 84154 | 95 | ||
| 84155 | PROTEIN, TOTAL | 62 | ||
| 84156 | PROTEIN URINE | 32 | ||
| 84157 | PROTEIN TOTAL OTHER 84157 | 20 | ||
| 84165 | Protein, Total and Protein Electrophores | 99 | ||
| 84166 | PRO.ELETRO. OTHER 84166 | 49 | ||
| 84202 | Erythrocyte Protoporphyrin (EP) | 54 | ||
| 84207 | Vitamin B6 | 114 | ||
| 84244 | Plasma Renin Activity, LC/MS/MS | 123 | ||
| 84260 | Serotonin, Blood | 180 | ||
| 84295 | SODIUM (POC) | 26 | ||
| 84300 | SODIUM, URINE RANDOM | 32 | ||
| 84305 | IGF I, LC/MS | 217 | ||
| 84311 | Phospholipids | 197 | ||
| 84376 | Reducing Substances, Feces | 26 | ||
| 84402 | Testosterone, Free, LC/MS/MS | 60 | ||
| 84403 | TESTOSTERONE, TOTAL | 115 | ||
| 84425 | Vitamin B1 (Thiamine), Blood, LC/MS/MS | 117 | ||
| 84432 | QN Thyroglobulin W/O TGAB | 79 | ||
| 84436 | T-4 THYROXINE | 51 | ||
| 84439 | FREE T4 (THYROXINE) | 45 | ||
| 84443 | THYROID STIM. HORMONE | 102 | ||
| 84445 | TSI (Thyroid Stimulating Immunoglobulin) | 115 | ||
| 84446 | Vitamin E (Tocopherol) | 71 | ||
| 84450 | AST (SGOT) | 34 | ||
| 84460 | Liver Fibrosis, FibroTest ActiTest Panel | 25 | ||
| 84466 | Transferrin | 57 | ||
| 84478 | TRIGLYCERIDES | 53 | ||
| 84479 | T3 Uptake | 59 | ||
| 84480 | TOTAL T3 | 51 | ||
| 84481 | Free T3 | 92 | ||
| 84482 | T3 Reverse, LC/MS/MS | 73 | ||
| 84484 | ISTAT TROPONIN | 52 | ||
| 84520 | BUN (WB) | 22 | ||
| 84540 | Urine Urea Nitrogen, Random | 26 | ||
| 84545 | UREA CLEARENCE | 19 | ||
| 84550 | URIC ACID, SERUM | 42 | ||
| 84560 | URIC ACID, URINE | 34 | ||
| 84585 | VMA, 24Hr Urine Without Creatinine | 126 | ||
| 84588 | Arginine Vasopressin (AVP Antidiuretic H | 178 | ||
| 84630 | Zinc, Plasma | 65 | ||
| 84681 | C-Peptide | 79 | ||
| 84702 | BETA HCG QUANTITATIVE | 57 | ||
| 84703 | URINE PREGNANCY TEST | 53 | ||
| 85002 | BLEEDING TIME | 39 | ||
| 85007 | MANUAL DIFFERENTIAL | 218 | ||
| 85008 | NUCLEATED RBC COUNT IN CORD BLOOD | 59 | ||
| 85014 | H&H (POC) | 14 | ||
| 85018 | HEMOGLOBIN | 28 | ||
| 85025 | COMPLETE BLOOD COUNT | 75 | ||
| 85027 | CBC W/OUT DIFF | 48 | ||
| 85041 | Hemoglobinopathy Evaluation | 17 | ||
| 85045 | RETIC COUNT ON LINE | 33 | ||
| 85048 | E0S COUNT | 33 | ||
| 85049 | PLATELET COUNT | 31 | ||
| 85060 | PERIPHERAL SMEAR BY PATHOLOGIST | 59 | ||
| 85097 | REFERRAL BONE MARROW PREP,STAIN | 68 | ||
| 85220 | Coag Factor V Activity | 82 | ||
| 85240 | Factor VIII Activity, Clotting | 166 | ||
| 85245 | Ristocetin Cofactor | 113 | ||
| 85246 | Von Willebrand Factor Antigen | 131 | ||
| 85250 | Coag Factor IX Activity | 166 | ||
| 85260 | Coag Factor X Activity | 72 | ||
| 85301 | Antithrombin III Antigen | 48 | ||
| 85303 | Protein C, Activity | 224 | ||
| 85306 | Protein S, Activity | 159 | ||
| 85347 | ACTIVATED COAGULATION TIME | 99 | ||
| 85362 | Fibrinogen Degradation Products (FDP), S | 31 | ||
| 85379 | D-DIMER | 104 | ||
| 85384 | FIBRINOGEN | 48 | ||
| 85460 | FETALDEX* | 213 | ||
| 85520 | Heparin, Low Molecular Weight Xa | 61 | ||
| 85576 | PLAVIX ASSAY | 53 | ||
| 85597 | Lupus Anticoagulant Evaluation with Refl | 76 | ||
| 85598 | Hexagonal Phase Confirm | 254 | ||
| 85610 | PROTHROMBIN TIME | 26 | ||
| 85611 | MIX PT | 31 | ||
| 85613 | Lupus Anticoagulant Evaluation with Refl | 38 | ||
| 85652 | SED RATE | 33 | ||
| 85660 | DONOR SICKLE SCREEN CHRG ONLY | 19 | ||
| 85670 | THROMBIN TIME | 61 | ||
| 85730 | Lupus Anticoagulant Evaluation with Refl | 25 | ||
| 85732 | Lupus Anticoagulant Evaluation with Refl | 30 | ||
| 86001 | Asp. FumIgatus IgG* | 25 | ||
| 86003 | Respiratory Allergy Profile Region X | 35 | ||
| 86021 | PAN ANCA Plus with Reflex | 129 | ||
| 86022 | Heparin Induced Platelet Ab | 115 | ||
| 86023 | Platelet Ab, Direct, Flow Cytometry | 115 | ||
| 86038 | CENTROMERE B AUTOANTIBODIES | 48 | ||
| 86039 | ANA ANTINUCLEAR TITER - MISC CHRG | 61 | ||
| 86060 | ASO STREPTOZYME TITER - CHRG ONLY | 45 | ||
| 86077 | DIFFICULT CROSSMATCH INVESTIGATIO | 178 | ||
| 86078 | INVESTIGATION OF TRANSFUSION RX | 146 | ||
| 86079 | AUTHORIZATION OF NONSTANDARD B.B. | 3 | ||
| 86140 | CRP (INFLAMMATION)* | 57 | ||
| 86141 | C-REACTIVE PROTEIN (CARDIAC RISK) | 63 | ||
| 86146 | Beta 2 Glycoprotein I Ab (IgG,IgA,IgM) | 117 | ||
| 86147 | Cardiolipin Ab (IgA,IgG,IgM) | 280 | ||
| 86148 | Antiphospholipid Ab Panel | 74 | ||
| 86160 | Complement Component C3C | 43 | ||
| 86162 | Complement, Total (CH50) | 121 | ||
| 86200 | Cyclic Citrullinated Peptide (CCP) Ab (I | 213 | ||
| 86226 | ssDNA IgG Ab | 112 | ||
| 86235 | DNA-DS ABS | 31 | ||
| 86255 | Endomysial Antibody Screen (IgA) | 41 | ||
| 86256 | Endomysial Antibody Titer | 29 | ||
| 86300 | CA 27.29 | 77 | ||
| 86301 | CA-19-9 | 86 | ||
| 86304 | CA-125* | 86 | ||
| 86305 | HE4, Ovarian Cancer Monitoring | 624 | ||
| 86308 | MOND SPOT | 35 | ||
| 86316 | Chromogranin A, ECL | 105 | ||
| 86317 | Hepatitis B Surface Ab Immunity, QN | 126 | ||
| 86332 | Immune Complex Detection By C1Q Binding | 140 | ||
| 86334 | Immunofixation, Serum | 112 | ||
| 86335 | Immunofixation, Urine | 180 | ||
| 86337 | Insulin Autoantibody | 86 | ||
| 86340 | Intrinsic Factor Blocking Ab | 141 | ||
| 86341 | IA-2 Ab | 81 | ||
| 86360 | Lymphocyte Subset Panel 4 | 187 | ||
| 86376 | Thyroid Peroxidase Antibodies | 34 | ||
| 86382 | Rabies Vaccine Response End Point Titer | 78 | ||
| 86403 | Streptozyme Screen with Reflex to Titer | 47 | ||
| 86406 | Streptozyme Titer | 49 | ||
| 86430 | RA LATEX | 36 | ||
| 86431 | RA LATEX TITER - MISC CHRG | 42 | ||
| 86480 | Quantiferon TB Gold, (Draw Site Incubate | 297 | ||
| 86580 | TUBERCULIN SKIN TEST | 23 | ||
| 86592 | VDRL, CSF | 54 | ||
| 86593 | RPR QUANTITATIVE | 42 | ||
| 86606 | ASPERGILLUS AB 86606 | 80 | ||
| 86612 | Fungal Panel 2, ID and CF | 79 | ||
| 86617 | Lyme Disease Antibodies (IgG,IgM), Immun | 30 | ||
| 86618 | LYME DISEASE SCREEN | 36 | ||
| 86635 | Fungal Panel 2, ID and CF | 79 | ||
| 86644 | Torch IgG Panel | 49 | ||
| 86645 | Cytomegalovirus (CMV) IgG + IgM Ab | 61 | ||
| 86648 | Diphtheria and Tetanus Antitoxoid | 78 | ||
| 86658 | Coxsackie B (1-6) Antibodies, Serum | 60 | ||
| 86664 | Epstein Barr Virus Ab Panel | 226 | ||
| 86665 | Epstein Barr Virus Ab Panel | 226 | ||
| 86666 | Anaplas Phagocytophilum & Ehrlich Chaffe | 35 | ||
| 86682 | Cysticercus IgG Ab, WB (Serum) | 60 | ||
| 86689 | HIV AB WB 86689 | 101 | ||
| 86694 | Torch IgM Panel | 67 | ||
| 86695 | HERPES SIMPLEX AB I (IGM) | 71 | ||
| 86696 | HERPES SIMPLEX TYPE 2 86696 | 101 | ||
| 86698 | Histoplasma Ab, CF | 68 | ||
| 86703 | RAPID HIV SCREEN | 26 | ||
| 86704 | TOTAL HEPATITIS B CORE ANTIBODY | 150 | ||
| 86705 | HEP B CORE (IGM) | 85 | ||
| 86706 | HEP B SURFACE ANTIBODY (EMPLOYEE) | 121 | ||
| 86709 | HEPATITIS A ANTIBODY IGM | 90 | ||
| 86713 | LEGIONELLA AB 86713 | 9 | ||
| 86735 | MUMPS AB 86735 | 71 | ||
| 86738 | MYCOPLASMA AB 86738 | 100 | ||
| 86747 | Parvovirus B19 Antibodies (IgG, IgM) | 60 | ||
| 86757 | RMSF IgG Titer | 79 | ||
| 86762 | RUBELLA IGG ANTIBODIES | 42 | ||
| 86765 | MEASLES IGG ANTIBODY | 42 | ||
| 86774 | Diphtheria and Tetanus Antitoxoid | 78 | ||
| 86777 | Toxoplasma IgG Ab By EIA | 129 | ||
| 86778 | Toxoplasma Ab (IgG,IgM) | 129 | ||
| 86780 | FTA-ABS | 281 | ||
| 86787 | VARICELLA-ZOSTER IGG ANTIBODIES | 45 | ||
| 86800 | Thyroid Peroxidase and Thyroglobulin Ant | 61 | ||
| 86803 | HEP C AB (EMPLOYEE) | 150 | ||
| 86812 | HLA-B27 Antigen | 86 | ||
| 86850 | ANTIBODY SCREEN* | 79 | ||
| 86860 | ANTIBODY ELUTION | 14 | ||
| 86870 | ANTIBODY ID | 112 | ||
| 86880 | DIRECT COOMBS* | 374 | ||
| 86885 | ANTIBODY SCREEN | 79 | ||
| 86886 | ANTIBODY TITER | 54 | ||
| 86900 | ABO TYPE - CHRG ONLY - CHRG ONLY | 47 | ||
| 86901 | RH (D) | 71 | ||
| 86902 | ANTIGEN TYPING EACH AG TESTED | 124 | ||
| 86905 | RBC ANTIGEN TYPE DIRECT | 163 | ||
| 86920 | IMMEDIATE SPIN TECHNIQUE | 26 | ||
| 86921 | INCUBATION TECHNIQUE | 26 | ||
| 86922 | ANTIGLOBULIN TECHNIQUE | 26 | ||
| 86923 | CROSSMATCH ELECTRONIC | 160 | ||
| 86931 | FREEZING AND DEGLYCER - CHRG | 183 | ||
| 86940 | FREE ANTI A OR ANTI B - CHRG | 54 | ||
| 86945 | IRRADIATION PROCEDURE | 125 | ||
| 86965 | POOLING COMPONENETS - CHRG | 40 | ||
| 86971 | ENZYME PRETREATMENT RBC MISC CHG | 188 | ||
| 86975 | ANTIBODY ABSORPTION - CHRG ONLY | 80 | ||
| 86985 | ALIQUOTING BLOOD | 22 | ||
| 87040 | CULTURE, BLOOD X1 ADULT | 63 | ||
| 87045 | CULTURE STOOL | 68 | ||
| 87046 | STOOL ADDITIONAL ID - CHG ONLY | 45 | ||
| 87070 | ENVIRONMENTAL CULTURE | 18 | ||
| 87075 | CULTURE WOUND ANAEROBIC | 72 | ||
| 87076 | ANAEROBIC ID - CHRG ONLY | 82 | ||
| 87077 | ENVIRO ID MISC CHRG | 21 | ||
| 87081 | CULTURE FOR PERTUSSIS | 55 | ||
| 87086 | CULTURE URINE | 61 | ||
| 87102 | CULTURE YEAST | 55 | ||
| 87103 | CULTURE BLOOD FUNGUS | 134 | ||
| 87106 | YEAST ADDITIONAL ID - CHG ONLY | 90 | ||
| 87107 | CULTURE DEFINITIVE ID MOLD | 72 | ||
| 87116 | AFB CULTURE AND STAIN | 96 | ||
| 87147 | SEROLOGIC MTHD, AGGLUTINATION GRP | 22 | ||
| 87149 | ORGANISM ID BY NA PROBE | 98 | ||
| 87164 | DARKFIELD EXAM | 102 | ||
| 87168 | LICE AND SCABIES EXAM | 38 | ||
| 87172 | PINWORM EXAM | 32 | ||
| 87177 | OVA AND PARASITE EXAM | 105 | ||
| 87181 | D-Test (charge only) | 14 | ||
| 87185 | CARBAPENEMASE BY HODGE TEST | 6 | ||
| 87186 | SENSITIVITY - MICRO CHRG ONLY | 40 | ||
| 87205 | GRAM STAIN | 34 | ||
| 87206 | AFB STAIN | 63 | ||
| 87207 | MALARIA SMEAR | 51 | ||
| 87210 | WETPREP | 33 | ||
| 87220 | KOH PREP | 35 | ||
| 87252 | Culture, Cytomegalovirus, Rapid and Conv | 125 | ||
| 87254 | Culture, Cytomegalovirus, Rapid and Conv | 90 | ||
| 87255 | Herpes Simplex Virus Culture W/Rfl to Ty | 105 | ||
| 87301 | CAMPY BY EIA QUAL | 51 | ||
| 87328 | CRYPTO ID (EIA) - CHRG ONLY | 58 | ||
| 87329 | GIARDIA ID (EIA) - CHRG ONLY | 54 | ||
| 87338 | H.PYLORI ANTIGEN | 310 | ||
| 87340 | HEPATITIS B SURFACE ANTIGEN | 68 | ||
| 87385 | Histoplasma Galactomannan Antigen, Urine | 56 | ||
| 87389 | HIV 1/2 ANTIBODY | 86 | ||
| 87400 | INFLUENZA TYPE B ANTIGEN | 82 | ||
| 87425 | ROTAVIRUS ANTIGEN TEST | 72 | ||
| 87427 | SHIGA-LIKE TOXIN - MISC CHG | 51 | ||
| 87449 | *RAPID HIV - CHRG ONLY | 26 | ||
| 87480 | VAGINITIS (CANDIDA SP) | 91 | ||
| 87491 | CHLAMYDIA AMPLIFIED DNA | 125 | ||
| 87493 | C DIFFICILE DNA BY PCR | 85 | ||
| 87496 | Cytomegalovirus DNA, QL RT PCR | 162 | ||
| 87497 | Cytomegalovirus DNA, QN RT PCR | 197 | ||
| 87498 | Enterovirus RNA, QL RT PCR | 162 | ||
| 87502 | INFLUENZA TYPE A ANTIGEN | 186 | ||
| 87510 | VAGINITIS (GARDNERELLA VAGINALIS) | 91 | ||
| 87517 | HBV DNA,QN,PCR,Plasma *Transplant Pt ONL | 174 | ||
| 87522 | HCV RNA, QN RT PCR | 419 | ||
| 87530 | HSV, Type 1 and 2 DNA, QN RT PCR | 171 | ||
| 87535 | HIV 1 RNA, QL TMA | 162 | ||
| 87536 | HIV 1 RNA, QN RT PCR | 440 | ||
| 87538 | HIV 2 DNA/RNA QL RT PCR | 162 | ||
| 87591 | GONORRHEA AMPLIFIED DNA | 125 | ||
| 87631 | FLUA&B/RSV BY PCR | 276 | ||
| 87640 | MSSA BY PCR | 112 | ||
| 87641 | MRSA BY PCR | 77 | ||
| 87651 | STREP GP A | 127 | ||
| 87653 | STREP B DNA AMPLIFICATION | 114 | ||
| 87660 | VAGINITIS (TRICH. VAGINALIS) | 97 | ||
| 87798 | RESPIRATORY SYNCYTIAL VIRUS | 151 | ||
| 87799 | JC Polyoma Virus DNA, QN RT PCR, Plasma | 197 | ||
| 87899 | N. MENN C & W135 | 56 | ||
| 87902 | Hepatitis C Viral RNA Genotype, LIPA | 699 | ||
| 88184 | FLOW MYELOID PANEL ITEM 1 (5493) | 83 | ||
| 88185 | FLOW MYELOID PANEL ITEM 2 (5493) | 19 | ||
| 88230 | Chromosome Analysis, Blood | 640 | ||
| 88237 | CYTOGENETICS-TISSUE CULT | 231 | ||
| 88262 | Chromosome Analysis, Blood | 687 | ||
| 88264 | CYTOGENETICS-CHROMOSOME ANAL. | 229 | ||
| 88280 | CYTOGENETICS-ASSL KARYOTYPES,EA | 99 | ||
| 88313 | BONE MARROW IRON STAIN | 63 | ||
| 88329 | PATHOLOGY CONSULTATION DURING SUR | 66 | ||
| 88334 | TOUCH PREP EA ADD - CHRG ONLY | 61 | ||
| 89051 | CELL COUNT, BODY FLUID | 36 | ||
| 89055 | FECAL LEUKOCYTES | 34 | ||
| 89060 | JOINT FLUID CRYSTALS | 34 | ||
| 89220 | SPUTUM INDUCTION | 174 | ||
| 89230 | SWEAT ANALYSIS | 104 | ||
| 89320 | SEMEN ANALYSIS | 115 | ||
| 89321 | SEMEN ANALYSIS POST VASECTOMY | 64 | ||
| 90389 | TETANUS IG IM | 281 | ||
| 90471 | VACCINATION INCLUDING TETANUS | 63 | ||
| 90472 | EACH ADDITIONAL VACCINATION | 63 | ||
| 90653 | IIV FLU VACCINE OVER 65 | 126 | ||
| 90686 | IIV4 VACC NO PRSV 0.5ML IM | 112 | ||
| 90688 | FLUZONE | 61 | ||
| 90732 | PNEUMNOCCAL VACCINE | 137 | ||
| 90733 | MENINGOCCAL VACCINE | 184 | ||
| 90945 | CAPD - W/SINGLE PHYSICAN EVAL | 971 | ||
| 90947 | CAPD - W/REPEATED PHYSICAN EVAL | 1,030 | ||
| 91034 | 24HR REFLUX | 968 | ||
| 91110 | GI TRACT CAPSULE ENDOSCOPY | 455 | ||
| 91112 | GI WIRELESS CAPSULE MEASURE | 398 | ||
| 92242 | FLUORESCEIN ICG ANGIOGRAPHY | 787 | ||
| 92507 | MODIFICATION PROSTHESIS - PER OCC | 211 | ||
| 92508 | GROUP SPEECH/LANG/TX | 105 | ||
| 92521 | FLUENCY EVAL | 262 | ||
| 92522 | SPEECH EVAL | 215 | ||
| 92523 | SPEECH/LANGUAGE EVAL | 444 | ||
| 92524 | VOICE EVAL | 215 | ||
| 92526 | TX OF SWALLOWING DYSFUNCTION | 346 | ||
| 92551 | HEARING SCREENING NEWBORN | 174 | ||
| 92597 | PROSTHESIS AUGMENTATIVE EVAL INIT | 181 | ||
| 92605 | EVAL OF NONSPEECH GEN AUG DEVICE | 320 | ||
| 92606 | SPEECH THERAPY/MOD COMM BOARD IT | 280 | ||
| 92607 | EVAL SPEECH GEN AUG DEVICE | 383 | ||
| 92608 | EACH ADDITIONAL 30 MIN | 190 | ||
| 92609 | SPEECH THER/PROG OF GEN DEVICE | 250 | ||
| 92610 | DYSPHAGIA/BEDSIDE EVAL - PER OCC | 304 | ||
| 92611 | MODIFIED BARIUM SWALLOW | 517 | ||
| 92920 | PERCUTANEOUS TRANSLUMINAL COR ANG | 13,484 | ||
| 92921 | PTCA EA ADD VESSEL | 4,087 | ||
| 92924 | SP PTCA ATHERECTOMY 92995 | 13,123 | ||
| 92925 | SP PTCA ATHRECTMY EA ADDTL 92996 | 6,565 | ||
| 92928 | SP CORONARY STENT, SINGLE VESSEL | 14,246 | ||
| 92929 | SP CORONARY STENT, EA ADDTNL VESL | 6,221 | ||
| 92933 | SP BMS W ATREC SGL VES | 27,368 | ||
| 92934 | SP BMS W ATREC EACH ADDL VES | 28,896 | ||
| 92937 | SP BMS GRAFT ATREC SGL VES | 27,368 | ||
| 92938 | SP BMS GRAFT ATREC EAC ADDL | 12,785 | ||
| 92941 | SP BMS W ATREC EACH ADDL VES | 12,785 | ||
| 92943 | SP CTO BMS SGL VES W/WO ATREC | 27,368 | ||
| 92944 | SP CTO BMS EA ADDL W/ATREC | 12,785 | ||
| 92950 | CPR | 139 | ||
| 92953 | EXTERNAL PACEMAKER | 268 | ||
| 92960 | ELECTIVE CARDIOVERSION | 304 | ||
| 92973 | CORO MECHANICAL THORMBECT | 1,543 | ||
| 92974 | SP RAD DELIVERY CATHETER PLACMENT | 8,812 | ||
| 92977 | THROMBOLYSIS,CORONARY BY IV INFUS | 547 | ||
| 92978 | SP IVUS (CORONARY VESSEL) | 4,233 | ||
| 92979 | SP IVUS (CORONARY E/ ADD VESSEL) | 1,043 | ||
| 92986 | PERCUTANEOUS BALLOON VALVULOPASTY | 7,675 | ||
| 93005 | STANDARD 12 LEAD-NO PC | 185 | ||
| 93010 | STANDARD 12 LEAD | 29 | ||
| 93017 | STRESS EKG-TECHNICAL | 402 | ||
| 93225 | HOLTER MONITOR HOOKUP | 213 | ||
| 93226 | SCANNING 24 HR RECORDING | 213 | ||
