Billing Services/Fees


Monongahela Valley Hospital's view of Federal Price Transparency Requirements
December, 2018

In 2018, the Centers for Medicare and Medicaid Services (CMS) established a requirement that, effective January 1, 2019; hospitals must make available a list of our current standard charges via the Internet in a machine readable format at least annually. A "machine readable format" is a format that can be easily integrated into a computer system or statistical program (e.g., XML, CSV). This could be in the form of the chargemaster (a standard format used by all hospitals) itself or another form of the hospital's choice, as long as the information is in machine readable format. The agency had not previously required standard hospital charges to be available in a machine readable format, nor had it required that the list be posted on a public-facing website. Instead, hospitals could meet prior guidance by providing charges upon request.

Monongahela Valley Hospital promotes price transparency and applauds Medicare's intent to promote pricing transparency. Monongahela Valley complies with the Medicare requirements and therefore you can access a list of standard charges with a brief description by clicking Billing Services/Fees. Although we understand CMS' intent to promote price transparency and we have provided the required list of charges online, we do not feel providing the list of our charges will provide meaningful information to our community as most payments by insurers and patients are not based on the actual charge but instead on contracted rates or adjusted charges. We are still providing a payment estimation tool on our website that may help you better understand your payment responsibility for our most common procedures and tests. Hospital payments are very complex and we are attempting to provide information that you find useful. In our opinion, providing a list of charges as required by CMS is missing the mark which creates more confusion for our patients.

Download Fees (CSV file)

Diagnostic Related Grouping Charges (CSV file)

Fees

  • Laboratory

    Service Code Description Price
    01020015 ACETONE $40.00
    01020023 AMINO ACID $62.00
    01020049 D XYLOSE TOLERANCE $60.00
    01020056 SALICYLATES $240.00
    01020064 CAROTENE $25.00
    01020080 HEPATITIS B ANTIGEN $40.00
    01020098 GLYCOHEMOGLOBIN $47.00
    01020106 FERRITIN $40.00
    01020114 ENOLASE $40.00
    01020122 ZARONTIN/ETHOSUXIMIDE $60.00
    01020148 GLUCOSE TOLERANCE 3 SPEC $63.00
    01020155 GLUCOSE TEST FASTING $20.00
    01020163 BUN $20.00
    01020171 CREATININE $24.80
    01020189 CALCIUM $25.00
    01020197 PHOSPHORUS $15.00
    01020205 URIC ACID $22.00
    01020213 SODIUM (NA) $24.00
    01020221 POTASSIUM (K) $23.00
    01020239 CHLORIDE (CL) $23.00
    01020247 CARBON DIOXIDE (CO2) $24.00
    01020254 CHOLESTEROL $21.00
    01020262 TOTAL PROTEIN $18.00
    01020270 ALBUMIN $24.00
    01020304 ACID PHOSPHATASE $30.00
    01020312 ALKALINE PHOSPHATASE $25.50
    01020320 AMYLASE $31.30
    01020338 CPK, TOTAL $31.40
    01020346 LACTATE DEHYDROGENASE $17.00
    01020353 LIPASE $26.00
    01020361 SGOT $25.00
    01020379 SGPT $25.60
    01020387 BILIRUBIN TOTAL $30.00
    01020395 SERUM IRON $20.00
    01020403 TIBC $32.00
    01020429 AMMONIA $45.00
    01020437 CREATININE CLEARANCE $30.00
    01020445 MAGNESIUM $20.00
    01020478 LIPOPROTEIN FRACTIONS $80.00
    01020486 COMPREHENSIVE METABOLIC PANEL $50.90
    01020494 TRIGLYCERIDES $27.70
    01020536 ELECTROLYTES $33.80
    01020544 BILIRUBIN DIRECT $20.00
    01020569 LITHIUM, SERUM $31.90
    01020593 GLUCOSE TOLERANCE 2 HR $62.00
    01020601 HEPATITIS B ANTIBODY $54.00
    01020619 QUANT IMMUNOGLOBULINS EA $35.00
    01020635 LDH ISOENZYMES $36.00
    01020643 CK MB FRACTION $27.90
    01020650 PROSTATIC ACID PHOSPHATAS $40.00
    01020684 ELECTROPHORESIS PROTEIN TC $40.00
    01020718 IMMUNO FIXATION SERUM $80.00
    01020726 CYSTINE $60.00
    01020734 VITAMIN A $32.50
    01020775 AMYLASE 2HR URINE $31.30
    01020783 AMYLASE 24 HR URINE $31.30
    01020791 CREATININE; NOT BLOOD $25.00
    01020809 CALCIUM URINE $20.00
    01020817 PHOSPHORUS URINE $25.00
    01020825 SODIUM NA URINE $20.00
    01020833 POTASSIUM URINE $20.00
    01020841 CHLORIDE CL URINE $25.00
    01020858 UREA NITROGEN URINE $20.00
    01020866 URIC ACID; OTHER SOURCE $11.50
    01020908 GLUCOSE 2HRPP $22.90
    01020916 GESTATIONAL DIAB SER BS $22.90
    01020924 OSMOLALITY;URINE $20.00
    01020932 BODY FLUID GLUCOSE $30.00
    01020940 BODY FLUID PROTEIN $17.70
    01020957 CHLORIDE BODY FLUIDS $30.00
    01020965 LDH BODY FLUIDS $17.00
    01020973 AMYLASE BODY FLUIDS $31.30
    01020981 PH BODY FLUIDS $17.30
    01020999 BLOOD DRAW $10.00
    01021013 PROTEIN ELECTROPHOREIS URINE $70.00
    01021021 SODIUM URINE SPOT $20.00
    01021039 POTASSIUM URINE SPOT $20.00
    01021047 CHLORIDE URINE SPOT $25.00
    01021088 BASIC METABOLIC PANEL $40.80
    01021120 CITRATE URINE $100.00
    01021153 MAGNESIUM 24HR URINE $20.00
    01021179 T3 T UPTAKE $25.00
    01021187 T4 TOTAL THYROXINE $20.00
    01021203 CSF PROTEIN ELECTRO $70.00
    01021211 BILIRUBIN TOTAL NEONATAL $30.00
    01021229 BILIRUBIN DIR NEONATAL $20.00
    01021237 IMMUNOGLOBULINS CSF EA $35.00
    01021245 MYOGLOBIN $36.00
    01021252 TOBRAMYCIN TROUGH $73.00
    01021260 GENTAMICIN TROUGH $62.00
    01021278 VAMCOMYCIN TROUGH $40.00
    01021286 GENTAMICIN RANDOM $62.00
    01021294 TOBRAMYCIN RANDOM $73.00
    01021302 VANCOMYCIN RANDOM $40.00
    01021310 CORTISOL PM $60.00
    01021328 AB; RUBELLA $40.00
    01021336 CSF CL CHLORIDE $30.00
    01021344 CSF GLUCOSE $30.00
    01021351 CSF PROTEIN $20.00
    01021401 JOINT FL PROTEIN $20.00
    01021419 BODY FLUID TOTAL BILIRUBIN $30.00
    01021427 BODY FLUID CREATININE $15.00
    01021435 BODY FLUID POTASSIUM $20.00
    01021443 BODY FLUID SODIUM $20.00
    01021492 INSULIN ANTIBODIES $50.00
    01021500 BUN - ARTERIAL $20.00
    01021518 BUN PERIPHEAL $20.00
    01021526 BUN VEINOUS $20.00
    01021542 HOMOCYSTEINE $67.00
    01021559 T3 TOTAL $45.00
    01021567 PROTEIN URINE SPOT $15.00
    01021575 BETA HCG SUBUNIT $50.00
    01021583 PREGNANCY TEST SERUM $20.00
    01021591 GLCS TLRNC GSTTN 3 SPEC $50.00
    01021609 VOLUME & PERIOD $20.00
    01021617 ACTH STIM PANEL $175.00
    01021625 BASELINE ACTH CORTISOL $52.00
    01021633 IMMUNO TUMR ANTI QUA CA, 27-29 $87.00
    01021641 HEPATITIS C RIBA $65.00
    01021658 TROPONIN I $33.00
    01021666 TSH $58.00
    01021674 FOLATE LEVEL $52.00
    01021682 CEA $66.00
    01021690 VITAMIN B-12 $44.00
    01021732 HEPATITIS C-RNA,PCR QUANT $191.00
    01021740 FREE PSA $86.00
    01021757 TACROLIMUS, FK506 $60.00
    01021765 TOLERANCE EA ADD'L SPEC $15.00
    01021773 ANTI THY PEROXIDASE ABY $40.00
    01021781 GLUTATHIONE $30.00
    01021799 GLUTATHION REDUCTASE $40.00
    01021823 PROGESTERONE RECEPTOR EA AB ST $650.00
    01021831 HEPATITIS A IGM AB $55.00
    01021849 CHOLINESTERASE;SERUM $35.00
    01021880 HEMA-STIX URINE $15.00
    01021906 AB;HIV-1 AND HIV-2,AGL ASSAY $62.00
    01021914 UREA NITROGEN CLEAR 24HR URINE $25.00
    01021922 MICRO ALBUMIN SPOT URINE $23.00
    01021930 RENAL FUNCTION PANEL $43.00
    01021948 RUSSEL VIPER VENOM TIME $40.00
    01021963 CARDIO-C-REACTIVE PROTEIN $40.00
    01021971 DRUG SCREEN NON TLC DEVICES $250.00
    01021989 OPIATES QUALITATIVE $152.30
    01021997 OXYCODONE (QD) $225.00
    01022003 METHADONE QUANTITATIVE (QD) $225.00
    01022011 COCAINE SCREEN $236.00
    01022029 COCAINE QUANTITATIVE (QD) $225.00
    01022037 METHADONE SCREEN $236.00
    01022045 BENZODIAZAPINES SCREEN $236.00
    01022052 BENZODIAZAPINES QUANT (QD) $225.00
    01022060 NICKEL $90.00
    01022078 T CELL ANTIGEN RECEPTOR, BETA $890.00
    01022086 T CELL ANTIGEN RECEPTOR, GAMMA $870.00
    01022094 EPSTEIN BARR-VIRAL CAPSID $55.00
    01022185 LACTOFERRIN FECAL (QUANT) $115.00
    01022193 BUPRENORPHINE CONF $236.00
    01022201 H PYLORI (C-13) BREATH TEST $215.00
    01022219 H PYLORI DRUG ADMIN/SPEC COLL $32.50
    01022227 UNLISTED MOLECULAR PATHOLOGY $545.00
    01022235 CHROM ANALY; 20-25 CELLS $540.00
    01022243 CALR GENE COM VARIANTS $650.00
    01022251 DEOXYCORTISOL 11 $75.00
    01022268 ONCOPROTEIN DCP $300.00
    01022276 THC QUANTITATIVE CONFIRMATION $225.00
    01023597 HSV ANTIGEN DETECTION, DFA $45.00
    01023605 DIRUETICS SCREEN, URINE $250.00
    01023613 LEFLUNOMIDE METABOLITE $385.00
    01023621 MOPATH PROCEDURE LEVEL 1 $450.00
    01023639 HLA I TYPING 1 ALLELE HR $430.00
    01023647 HEP C SCREEN HIGH RISK $180.80
    01023654 SEPT 9 METHYLATION ANALYSIS $669.10
    01023662 HLA II TYPING 1 LOCUS LR $420.00
    01023671 PROCALCITONIN (PCT) $300.00
    01023688 ASSAY LIPOPROTEIN PLA2 $175.00
    01023696 UGT1A1 GENE POLYMORPHISM $456.40
    01023704 OXYCODONE SCREEN W CONFIRMATIO $240.00
    01023712 DRUG TOX MONITORING 6 $240.00
    01023720 BLASTOMYCES ANTIBODY $65.00
    01023738 OSTEOCALCIN $150.00
    01023753 CELIAC GENETICS $690.20
    01023761 AB; HIV-1 $42.80
    01023779 ANTIBODY; HIV-2 ELISA W/REFLEX $45.00
    01023795 LEVETIRACETAM $225.00
    01023803 LAMOTRIGINE $225.00
    01023811 ZONISAMIDE $225.00
    01023829 OXCARBAZEPINE $225.00
    01023837 GABAPENTIN $225.00
    01023860 BARBITURATES NES (QD) $225.00
    01023878 MOPATH PROCEDURE LEVEL 4 $941.00
    01023886 BCR/ABL1 GENE MAJOR BP $700.00
    01023894 BCR/ABL1 GENE MINOR BP $610.00
    01023902 JAK 2 GENE $380.00
    01023910 F5 GENE $773.70
    01023928 MOPATH PROC LEVEL 2 (2-10 SNP) $669.10
    01023936 MOPATH PROC LEVEL 3 (>10SNPS) $888.70
    01023944 HFE GENE $583.70
    01023951 CFTR GENE COM VARIANTS $1,254.60
    01023969 F2 GENE $180.90
    01023977 MTHFR GENE $232.20
    01023985 GENERAL HEALTH PANEL $80.00
    01023993 FLUORIDE $100.00
    01024017 ASO; TITER $30.00
    01024025 DRUG SCREEN MULTIPLE CLASS-URI $250.00
    01024033 HOMOVANILLIC ACID $46.70
    01024041 CYANIDE, BLOOD $95.00
    01024058 FREE INSULIN $58.00
    01024066 AB; HELMINTH NES $65.00
    01024074 MONONUCLEAR CELL ANTIGEN $115.00
    01024082 PROSTAGLANDIN EACH $85.00
    01024090 VERY LONG FATTY ACID CHAINS $80.00
    01024108 ANTIPROTHROMBIN AB EA IG CL $20.00
    01024116 PAPPA SERUM $40.00
    01024124 GCMS SING NONDRUG QNT NES SS M $95.00
    01024132 ASSAY RIBOFLAVIN VITAMIN B-2 $96.00
    01024140 AB; HEPATITIS D $55.00
    01024157 GCMS SING NONDRUG QUL NES SS M $95.00
    01024165 LUTEINIZING RELEASING FACTOR $83.00
    01024173 CHLORIDE; OTHER $30.00
    01024181 MICROSOMAL AB EACH $40.00
    01024199 ENZYME ACTIVITY BC; NOT RA $95.00
    01024207 FRUCTOSE SEMEN $95.00
    01024215 LIPOPROTEIN BLD BY NMR $130.00
    01024223 AB; CAMPYLOBACTER $70.00
    01024231 QUANT SERUM ACETONES/KETONES $39.40
    01024249 AB ID; PLATELET IG ASSAY $35.00
    01024256 SUGARS; SINGLE QUAL EA SPECIME $30.00
    01024264 LEUCINE AMINOPEPTIDASE $50.00
    01024272 GCMS MULT NONDRUG QNT NES SS M $95.00
    01024280 SUGARS; SINGLE QUAN EA SPECIME $50.00
    01024298 VITAMIN K $73.00
    01024306 ANDROSTANEDIOL GLUCURONIDE $140.00
    01024314 FAT/LIPIDS FECES; QUAL $15.00
    01024322 CHEMILUMINESCENT ASSAY $60.00
    01024330 DRUG SCREEN COLLECT,NOT BLOOD $21.00
    01024348 COMPLETE URINE DRUG SCR-CLIENT $51.00
    01024355 CYSTATIN C $80.00
    01024363 AMPHETAMINE/METHAM QUANT (QD) $30.00
    01024371 VITAMIN, NOS $75.00
    01024389 ASSAY, NONENDOCRINE RECEPTOR $155.00
    01024397 LHR TEST $55.00
    01024405 DESOXYCORTICOSTERONE 11 $140.00
    01024413 PROINSULIN $80.00
    01024421 AMINO ACIDS, 6/> QUAN EA $72.00
    01024439 QUAL ORGANIC ACIDS EA SPECIM $86.00
    01024462 CPK, ISOENZYMES $43.00
    01024470 CARNITINE, QUAN EA $85.00
    01024488 HALOPERIDOL ASSAY $40.00
    01024496 AB; CANDIDA $65.00
    01024504 PA; SCREEN, EA AB $40.00
    01024512 QUANTIT ORGANIC ACIDS, EA SPEC $88.00
    01024520 NICOTINE (QD) $248.70
    01024538 ALPHA-1-ANTITRYPSIN; PHENOTYPE $45.00
    01024546 PROTEIN WESTERN BLOT $91.00
    01024553 AB; PROTOZOA, NES $55.00
    01024561 AB; ERLICHIA $60.00
    01024579 PROTOPORPHYRIN, RBC; QUANTITAT $62.00
    01024587 TB TEST, CELL IMMUN MEASURE $260.00
    01024595 AB; HSV, NON-SPECIFIC $55.00
    01024603 IMMUNODIFFUSION; NES $63.00
    01024611 PROTEIN WB; IM ID FOR BANDS $96.00
    01024629 ASSAY CALPROTECTIN FECAL $80.00
    01024637 ACUTE HEPATITIS PANEL $207.00
    01024645 ASSAY OF LIPOPROTEIN(A) $60.00
    01024652 DELTA ALA $50.00
    01024660 C CHROMATOGR, QUAN ,ANALYT NES $95.00
    01024678 DNA, AB $60.00
    01024686 FLUORESCENT AB; TITER, EA AB $30.00
    01024694 EPIDERMAL GROWTH FACTOR RECEPT $155.00
    01024702 ONCOPROTEIN, HER-2/NEU $471.60
    01024710 AB ID; LEUKOCYTE AB $36.30
    01024728 AB; HBEAB $58.00
    01024751 ALLERG SP IGG,QUAN OR SEMIQUAN $45.90
    01024769 LACTOFERRIN, FECAL (QUAL) $85.90
    01024777 AB; BARTONELLA $55.00
    01024785 AB; VIRUS,NES $65.00
    01024793 COMPLEMENT; AG, EA $33.50
    01024801 OCCULT BLD FHG, QUAL,1-3 $76.70
    01024819 DIHYDROMORPHINONE,QUAN (QD) $152.30
    01024835 MANGANESE $59.30
    01024843 STONE; IR SPECTROSCOPY $50.00
    01024850 URINE SULFATE $20.00
    01024868 IA NOT INFECT AGENT AB;MULTIST $55.60
    01024892 ASSAY OF BLOOD LIPOPROTEIN $46.00
    01024900 ETHYLENE GLYCOL $60.00
    01024918 AB;ASPERGILLUS $66.00
    01024926 T3;REVERSE $95.00
    01024934 ISLET CELL AB $95.00
    01024942 C CHROMOTOGR,QUAN;MULTI ANALY $95.00
    01024967 IA;OTHER TUMOR AG QUAN,EA $85.00
    01024975 SODIUM, OTHER SOURCE $25.00
    01024983 SPECTROPHOTOMETRY,ANALYTE NES $30.00
    01024991 ESTRONE $120.20
    01025006 COOMBS TEST, INDIRECT, TITER $320.00
    01025014 AB; HISTOPLASMA $40.00
    01025022 AB; COXIELLA BRUNETII $65.00
    01025030 AB BRUCELLA $30.00
    01025048 IA INFECTIOUS AGENT AB QUAN $55.00
    01025055 PARAINFLUENZA AG BY DFA $73.00
    01025063 HEP-B DNA QUAN $200.00
    01025071 FLUORESCENT AB; SCRN, EA AB $34.00
    01025089 DESIPRAMINE (QD) $71.10
    01025097 TOPIRAMATE(TOPAMAX) $60.00
    01025105 VASOPRESSIN $165.00
    01025113 IMMUNFIX E-PHORSIS/URINE/CSF $125.00
    01025121 PREGNENOLONE $105.00
    01025139 QUANTITATIVE ANALYSIS RIA/RPIA $70.00
    01025147 GLUCAGON $73.00
    01025154 HEPATITIS B CORE TOTAL $50.00
    01025162 DIHYDROTESTOSTERONE (QD) $182.90
    01025170 IA NOT INFECT AGENT; NOS $67.40
    01025188 VIRAL NEUTRALIZATION $90.00
    01025196 HYPOGLYCEMIC PANEL $250.00
    01025204 BUPRENORPHINE BY GCMS QUAL QD $240.00
    01025212 ANTI-PHOSPHATIDYLSERINE AB $145.00
    01025220 BETA 2 GLYCOPROTEIN 1 AB EA $150.00
    01025238 AB ID; PLATELET AB $44.30
    01025246 STREP PNEUMO URINE Ag $40.00
    01025253 QUAN MASS SPECTROMETRY $73.00
    01025279 LYMPHOCYTE SUBSET PANEL 5 CD4 $200.00
    01025287 IgA $58.00
    01025295 ASCA IgG $58.00
    01025303 HYDROXYPREGNENOLONE-17 $110.00
    01025311 INHIBIN B $67.40
    01025329 COLLAGEN CROSS LINKS $91.00
    01025337 SINGLE STRANDED DNA $48.00
    01025360 NEPHELOMETRY, EA ANALYTE, NES $40.00
    01025378 ESTROGENS; TOTAL $105.00
    01025386 SELENIUM $120.00
    01025394 PANCREATIC ELASTASE, FEC $145.00
    01025402 THERAPEUTIC DRUG QUANT, NES $50.00
    01025410 ASCORBIC ACID, BLOOD (VIT C) $45.00
    01025428 ANGIOTENSIN II $87.00
    01025501 CMV ANTIGENEMIA $200.00
    01025519 FETAL LUNG MATURITY $167.00
    01025527 CHROMATOGRAPHY A2,S,C $95.00
    01025535 ALBUMIN; OTHER SOURCE $30.40
    01025550 CYCLIC CITRULLINE PEP IGG $67.40
    01025568 CELL FLOW CYTOMETRY, EA ADD $45.00
    01025576 FLOW CYTOMETRY, INTERP 16 & > $290.00
    01025592 B CELL TOTAL COUNT $160.00
    01025600 NATURAL KILLER CELLS $160.00
    01025618 ANTI-XA, HEPARIN $31.60
    01025634 COUNT 15-20 CELLS 2KARYOTYPE $525.00
    01025642 ADDITIONAL KAROTYPE $140.00
    01025659 ADD HIGH RESOLUTION STUDY $150.00
    01025667 PLASMINOGEN $25.00
    01025675 VAP CHOLESTEROL $105.00
    01025709 BNP-B TYPE NATRIURETIC PEPTIDE $163.50
    01025717 GLIADIN AB 59 $67.40
    01025725 GLIADIN AB $67.40
    01025733 ANTI GLUTAMATE DECARBOXYLASE $70.00
    01025741 TRANSGLUTAMINASE TISSUE $55.60
    01025758 CLOZAPINE/CLOZARIL $171.60
    01025766 HCV RNA GENOTYPING $1,090.00
    01025774 INHIBIN A $221.60
    01025816 PSA DIAGNOSTIC $54.00
    01025857 APOLIPOPROTEIN A-1 $60.00
    01025865 APOLIPROTEIN B $60.00
    01025873 LIPOPROTEIN (A) $60.00
    01025964 CARBAMAZEPINE FREE $37.00
    01025972 HCV RNA PCR QUAL $175.00
    01025998 FRUCTOSAMINE $72.60
    01026087 C1 ESTERASE INHIBITOR TOTAL $33.50
    01026202 ANTIRIBOSOMAL-P-PROTEIN ANTI $60.00
    01026210 ANTI SKELETAL-STRIATIONAL ABY $34.00
    01026228 ACETYLCHOLINE RECP MODUL ABY $160.00
    01026244 IMMUNOGLOB IGA SUB CLASS $35.00
    01026293 VARICELLA ZOSTER 1GM $50.00
    01026319 PREALBUMIN $45.00
    01026335 FREE DILANTIN $55.00
    01026350 PTH RELATED PROTEIN $70.00
    01026368 AMIODARONE $95.00
    01026376 H BACTER PYLORI SCRN $25.00
    01026384 THYROID STIMULATING IMMUNO $215.00
    01026491 CHLORPHENIRAMINE $95.00
    01026509 LEGIONELLA ANTIGEN URINE $50.00
    01026517 PARVO VIRUS B19 $55.00
    01026525 ANTI ACETYLCHOLINE RECEPTOR AB $160.00
    01026533 HYDROXYPROGESTERONE-17 $115.00
    01026558 MATERNAL MSHCG $50.00
    01026566 METHYL ALCOHOL, BLOOD $93.00
    01026582 ANTI HISTONE ABY $67.40
    01026590 IMMUNE COMPLEX C1 Q QUANT $100.00
    01026616 TETANIS ABY $45.00
    01026640 LORAZEPAM-ATIVAN (QD) $225.00
    01026657 FACTOR IX $65.00
    01026707 AB;HAEMOPHILUS INFLUENZA $70.00
    01026715 DT TITER $70.00
    01026756 SUPPLEMENTAL NEWBORN SCREENING $62.00
    01026772 HEPATITIS C AB SCRN $60.00
    01026780 AB ID; LEUKOCYTE AB $36.30
    01026798 AB; BORDETELLA $40.00
    01026806 CELL FLOW CYTOMETRY $650.00
    01026822 RUBEOLA MEASLES IGG $35.00
    01026863 ANTICENTROMERE ANTIBODY $34.00
    01026871 ANTI-SCL-70 (SCLERODERMA ABY) $55.00
    01026889 OLIGOCLONAL BANDS-SPINAL FLUID $110.00
    01026921 ANTISPERM ANTIBODIES $30.00
    01026947 INTRINSIC FACTOR $73.00
    01026954 HPV HIGH RISK TYPES $348.20
    01026962 CLOMIPRAMINIE N $95.00
    01027085 CHROMIUM $48.90
    01027093 ANDROSTENEDIONE $130.00
    01027143 ALBUMIN-MICRO 24' HR URINE $27.90
    01027150 PROTEIN C ACTIVITY $60.00
    01027168 PERTUSSIS CULTURE $25.00
    01027218 PROTEIN S TOTAL $32.50
    01027291 IGG 1 2 3 or 4 EACH $125.00
    01027309 PNEUMOCOCCAL ABY $65.00
    01027317 SEX HORMONE BINDING GLOBULIN $80.00
    01027333 C2 COMPLEMENT $33.50
    01027366 LYMPHOCYTE CHORIOMENINGITIS AB $40.00
    01027390 ANTICARDIOLIPIN ANTIBODY PANEL $95.00
    01027408 VASOACTIVE INTEST POLYPEPTIDE $180.00
    01027432 CYTOMEGALOVIRUS CULTURE $110.00
    01027507 RSV DIRECT ANTIGEN $60.00
    01027515 VITAMIN B12 UNSAT BIND $55.00
    01027580 RISTOCETIN FACTOR $125.00
    01027598 VON WILLEBRANDS ANTIGEN $95.00
    01027630 SOMATOMEDIN C $66.00
    01027663 HISTAMINE LEVEL $150.00
    01027721 VITAMIN E $50.00
    01027739 BETA 2 MICROGLOBULIN $57.00
    01027747 DESYREL/TRAZODONE $95.00
    01027762 PORPHOBILINOGEN $25.00
    01027788 LIBRIUM (QD) $225.00
    01027796 HYDROXYPROLINE URINE TOTAL $125.00
    01027804 HYDROXYPROLINE $90.00
    01027812 CORTISOL FREE 24HR URINE $50.00
    01027820 FLECAINIDE - TAMBOCAR $67.40
    01027846 CLONOPIN $95.00
    01027960 ANTI-PARIETAL CELL ABY $34.00
    01027978 MYELIN BASIC PROTEIN,CSF $85.00
    01027986 IMMUN COMPLEX ASSAY EACH $100.00
    01028018 ALUMINUM (BLOOD) $100.00
    01028026 DHEA-S $90.00
    01028042 METHYLMALONIC ACID $60.00
    01028083 C-PEPTIDE $80.00
    01028117 AMYLASE ISOENZYME $165.00
    01028158 PTH INTACT $170.00
    01028166 CREATININE URINE SPOT $25.00
    01028174 HEPATIC FUNCTION PANEL $32.00
    01028208 CYCLOSPORIN LC/MS/MS $65.00
    01028232 TRIPLE SCREEN MATERNAL AFPM $50.00
    01028240 PSA SCREEN $100.80
    01028257 HDL CHOLESTEROL $39.50
    01028315 CADMUIM $70.00
    01028323 DIBUCAINE NUMBER $55.00
    01028331 CA-15-3 $87.00
    01028364 ERYTHROPOIETIN $60.00
    01028398 CA-125 $90.00
    01028406 CA-19-9 $90.00
    01028414 THYROGLOBULIN $50.00
    01028430 ANTI GBM ANTIBODY $67.40
    01028455 VITAMIN B6 $125.00
    01028471 IMMUNOGLOBULIN - IGE $62.00
    01028505 ALDOLASE $40.00
    01028513 RENIN $84.00
    01028539 CATECHOLAMINES FRACTION URINE $100.00
    01028547 ESTRIOL (UE3) $90.00
    01028554 G-6-PD $35.00
    01028570 ALDOSTERONE $170.00
    01028588 VMA - 24 HR URINE $58.00
    01028596 CERULOPLASMIN $42.00
    01028604 SEROTONIN (5HIAA) - URINE $45.00
    01028620 THYROGLOBULIN AB $44.00
    01028638 ANTI NUCLEAR ANTIBODIES $34.00
    01028653 FECAL FAT-72HR $55.00
    01028679 ACTH-ADRENOCORTICOTROPIN $165.00
    01028687 BLOOD ALCOHOL $93.00
    01028695 DIGOXIN $40.00
    01028703 FSH $89.50
    01028711 LH $89.20
    01028729 HAPTOGLOBIN $35.00
    01028737 LEAD $58.40
    01028745 HEAVY METAL QUANT EACH $125.00
    01028778 CORTISOL AM $60.00
    01028802 PHENOBARBITAL $32.00
    01028810 LACTIC ACID $52.00
    01028828 ACETAMINOPHEN $240.00
    01028844 DEPAKENE/VALPROIC ACID $50.00
    01028851 AMNIOTIC FLUID-LS RATIO $108.00
    01028885 MYSOLINE-PRIMIDONE $60.00
    01028893 GAMMA GLUTAMYL TRNSTPTDSE $34.70
    01028901 METANEPHRINES $55.00
    01028927 DILANTIN LEVEL $40.00
    01028950 HYDROXYCORTICOSTEROIDS-17 $55.00
    01028968 INSULIN LEVEL $32.00
    01028984 GASTRIN AFTER SECRETIN STIM $84.00
    01028992 OSMOLALITY BLOOD $25.00
    01029016 ALPHA 1 ANTITRYPSIN TOTAL $50.00
    01029032 QUINIDINE $41.00
    01029040 PROLACTIN $70.00
    01029057 TUMOR MARKER-ALPHA FETOPROTEIN $50.00
    01029065 ANTI MITOCHONDRIAL ABY/EA $34.00
    01029073 C3 COMPLEMENT $33.50
    01029081 TRANSFERRIN $50.00
    01029099 TEGRETOL-CARBAMAZEPINE $55.00
    01029107 THEOPHYLLINE $54.00
    01029123 HEPATITIS A TOTAL $60.00
    01029131 PROGESTERONE $90.00
    01029149 LIPID PROF-LDL,HDL,CHOL,TRG $64.50
    01029156 COMPLEMENT TOTAL CH50 $90.00
    01029164 PROCAINAMIDE/PRONESTYL-NAPA $50.00
    01029180 TESTOSTERONE $110.00
    01029198 COPPER $45.00
    01029206 CRYOGLOBULIN $20.00
    01029214 TOBRAMYCIN PEAK $73.00
    01029230 CATECHOLAMINE-FRAC PLASMA $100.00
    01029255 HEMOGLOBIN,PLASMA $17.70
    01029289 CALCIUM IONIZED $65.90
    01029297 GENTAMICIN PEAK $62.00
    01029305 ENA, ANY METHOD $55.00
    01029313 C4 COMPLEMENT $33.50
    01029339 GROWTH HORMONE HUMAN $60.00
    01029347 ESTRADIOL $115.00
    01029354 ELAVIL (QD) $71.10
    01029362 CRYOFIBRINOGIN $45.00
    01029370 HLA-B27 $100.00
    01029396 MYOGLOBIN URINE $36.00
    01029420 SSA/SSB-SJOGRENS ANTIBODY $55.00
    01029479 SPECIFIC GRAVITY $10.00
    01029487 CALCITONIN $110.00
    01029529 ARSENIC $70.00
    01029537 MERCURY $60.00
    01029552 ACE-ANGIOTEN CONVERT ENZYME $56.00
    01029586 OXALATES $40.00
    01029594 TOFRANIL (QD) $71.10
    01029602 TESTOSTERONE FREE $105.00
    01029610 25 HYDROXY VIT D $125.00
    01029628 DIHYDROXY VIT D-1,25 $160.00
    01029636 THYROID BINDING GLOBULIN $45.00
    01029644 FREE T3 $60.00
    01029651 FREE T4 $34.00
    01029669 AMIKACIN LEVEL $75.00
    01029677 AVENTYL/NORTRIPTYLINE (QD) $71.10
    01029693 HISTAMINE URINE $150.00
    01029701 HISTAMINE,BLOOD $150.00
    01029719 ALK PHOS ISO ENZ $45.00
    01029735 RAJI CELL ASSAY $100.00
    01029743 HEPATITIS B CORE IgM $60.00
    01029768 DHEA $105.00
    01029792 ALLERGY TESTING (EACH) $28.00
    01029826 SEROTONIN BLOOD $130.00
    01029867 VANCOMYCIN PEAK $40.00
    01029891 ZINC $45.00
    01029941 FOLATE,RBC $60.00
    01029958 C1 ESTERASE INHIBITOR FCTNL $50.00
    01029966 COMPLEMENT C1Q $33.50
    01029974 CHOLINESTERASE RBC $30.00
    01029990 VITAMIN B1 $115.00
    01030014 PEANUT COMPONENT PANEL IMMUNO $30.00
    01030022 VORICONAZOLE $385.00
    01030031 SYNTHETIC STIMULANTS PANEL $128.00
    01040047 PROTIME $19.00
    01040062 PART.THROMBOPLASTIN TIME $20.00
    01040070 FIBRINOGEN $35.00
    01040112 FIBRIN DEGRADATION PRODUCTS $20.00
    01040138 THROMBIN TIME $25.00
    01040161 FDP D-DIMER $30.00
    01040187 FACTOR VIII, C $66.00
    01040195 VON W F8 RISTOCETIN COFACTOR $125.00
    01040211 VON W F8 MULTIMETRIC $115.00
    01040229 SUBSTITUTION,PLASMA FRAC EA $35.00
    01040237 PLATELET, AGGREGATION EA $105.00
    01040244 CLOTTING FUNCT ACTIVITY $171.60
    01040245 CLOTTING FUNCT ACTIVITY $171.60
    01040252 CLOTTING; FACTOR V $73.00
    01040260 FACTOR INHIBITOR TEST $31.00
    01040278 PT SUBSTITUTION PLASMA FRACTIO $25.00
    01049949 CLOTTING; FACTOR XIII FS $39.40
    01049956 PLATELET NEUTRALIZATION $100.00
    01049964 THROMBOPLASTIN INHIBITION, TIS $40.00
    01049972 REPTILASE TEST $25.00
    01049980 ANTI THROMIN III $28.60
    01049998 ANTI FACTOR VIII $66.00
    01050012 BODY FLUID CELL COUNT $20.00
    01050020 CBC AUTOMATED $37.50
    01050038 HEMOGLOBIN $15.00
    01050046 HEMATOCRIT $15.00
    01050053 WBC $10.00
    01050061 RBC $10.00
    01050087 RETICULOCYTE COUNT $15.00
    01050095 PLATELET $40.00
    01050103 SED RATE $17.00
    01050129 SICKLE CELL SCREENING $20.00
    01050145 BONE MARROW STAINING & PREP $145.00
    01050160 L A P STAIN $45.00
    01050178 DIFFERENTIAL MANUAL $10.00
    01050194 EOSINOPHIL COUNT $10.00
    01050202 HAMS TEST $50.00
    01050210 HEMOSIDERIN, QUAL URINE $20.00
    01050236 SUCROSE HEMOLYSIS $53.00
    01050244 TRAP STAIN TC $145.00
    01050285 CSF CELL COUNT $20.00
    01050293 JOINT FL CELL COUNT $20.00
    01050350 CBC $20.00
    01050376 T CELLS TOTAL COUNT $175.00
    01050384 T CELLS T4 T8 INCLUDES RATIO $215.00
    01050418 H-PTT $20.00
    01050426 TISSUE CULTURE;BM, BLD CELLS $575.00
    01050434 SPUN HEMATOCRIT $15.00
    01050442 OSMOTIC FRAGILITY RBC; INCUBAT $69.00
    01059773 MURAMIDASE $70.00
    01059781 PLASMINOGEN ACTIVATOR $70.00
    01059799 CLOTTING FACTOR XII ACTIVITY $62.00
    01059807 CLOTTING FACTOR XI ACTIVITY $60.00
    01059815 CLOTTING FACTOR VII ACTIVITY $73.00
    01059823 CLOTTING FACTOR II PROTHROMBIN $31.30
    01059831 PLATELET NEUTRALIZATION $165.90
    01059849 PLATELET COUNT FROM BLUE TOP $40.00
    01059856 BRONCHOALVEOLAR LAVAGE CELL CT $20.00
    01059864 CLOSURE TIME COLLAGEN ADP $84.50
    01059872 CLOSURE TIME COLLAGEN EPI $105.00
    01059880 GROUP II STAIN $145.00
    01059914 KETOSTIX KETONE $15.00
    01059922 PROTEIN S ACTIVITY $70.00
    01059930 FACTOR X $62.00
    01059948 APC RESISTANCE $60.00
    01059971 VISCOSITY $63.00
    01059997 CLOTTING INHIBITOR; PROTEIN C $124.60
    01060029 TISSUE CULTURE NON NEOPLASTIC $480.00
    01080019 PROTEIN 24 HR URNRY QUNTV $15.00
    01080027 URINE HCG $32.00
    01080043 URINALYSIS $15.00
    01080084 URINE MICRO $20.00
    01080092 EOSINOPHIL-URINE $20.00
    01080118 URINE AUTO W/O MICRO $15.00
    01080126 ED URINE HCG $35.00
    01080134 AUTOM URINE DIP W MICRO $10.00
    01089994 PORPHYRINS,URINE $35.50
    01090001 AQP4 NMO-IgG AUTOANTIBODY TEST $1,120.00
    02010304 GROUP STAIN I $20.00
    02010312 GROUP STAIN II $145.00
    02010460 WASHINGS $170.00
    02010478 BRUSH $170.00
    02010486 FINE NEEDLE $170.00
    02010494 NON GYNE BODY FLUID $170.00
    02010502 PAP SMEAR SCREEN $70.00
    02010510 PARACENTESIS $170.00
    02010528 PNEUMOCYSTIS CARINII $145.00
    02010536 CSF CYTOLOGY $170.00
    02010544 SPUTUM CYTOLOGY $170.00
    02010551 THOROCENTESIS $170.00
    02010569 URINE CYTOLOGY $170.00
    02010593 BRONCHOALAR LAVAGE $170.00
    02010627 CYTO LIQUID SCREEN $90.00
    02010635 CYTO LIQUID BASE DIAGNOSTIC $90.00
    02010643 HPV REFLEX $348.20
    02010650 TZANK SMEAR $20.00
    02010668 PAP SMEAR DIAGNOSTIC $52.00
    02010676 CP SMR OTHR SCRN & INT $37.00
    02010684 QUAN RHEUM FACTOR $25.00
    02010692 VDRL, RPR, STS; QUAN $25.00
    02010700 ANTINUCLEAR AB (ANA); TITER $50.00
    02010718 MCG; IP SITU, 100-300 CELLS $210.00
    02010726 TISSUE CULTURE;LYMPHOCYTE $480.00
    02010734 CHROM ANALY;15-20 CELLS $525.00
    02010742 CHROM ANALY;ADDTL HI RESOLN $150.00
    02010759 FLOW CYTOMETRY INTERP,2-8 MARK $221.90
    02010767 CCP ANTIBODY $97.40
    02010775 CHROM ANALY; ADDTL CELL COUNTS $88.00
    02010783 CHROM ANALY; 5 CELLS $800.00
    02010791 TISSUE CULTURE; OTHER TISSUE $650.00
    02010809 FLOW CYTOMETRY INTERP 9-15 MAR $136.60
    02010817 CHROM ANALY; 45 CELLS $730.00
    02010825 TL PAP W AUTO SCRN & MANUAL RS $110.00
    02010833 CYTOLOGY QUICK STAIN $369.00
    02010841 CYTOPATH,CONCENTRATION TECHNIQ $57.00
    03010014 SURG PATH GROSS (LEVEL I) $90.00
    03010022 SURG PATH MULTI/F/SEC $30.00
    03010030 SURG PATH FROZEN TC $310.00
    03010048 SURG PATH GROSS/MICRO LEVEL II $80.00
    03010055 SUR PATH GROSS/MICRO LEVEL III $145.00
    03010063 SURG PATH GROSS/MICRO LEVEL V $650.00
    03010089 SURG PATH GROSS/MICRO LEVEL VI $1,380.00
    03010097 ELECTRON MICROSCOPY TC $1,390.00
    03010105 IF; EA AB; DIRECT $650.00
    03010113 IMMUNOHISTOCHEM FIRST AB STAIN $650.00
    03010121 CG, MCG; INT & REP $30.00
    03010139 MCG; IP SITU, 100-300 CELLS $210.00
    03010147 MCG; SITU HYBRID, 10-30 CELLS $130.00
    03010154 KI67 SCORE $375.00
    03010303 GROUP STAIN I TC $145.00
    03010311 GROUP STAIN II TC $145.00
    03010329 CALCULUS; QUAL ANAL $60.00
    03010337 DECALCIFICATION PROCEDURE BONE $50.00
    03010345 HER-2/NEU IMMUNOHISTO EA AB ST $650.00
    03010352 TOUCH PREP $1,375.00
    03010360 INSITU HYBRIDIZATION,MANUEL $650.00
    03010378 MOLECULAR CYTO DNA PROBE EA $60.00
    03010386 PREP SLIDE REFERRED MATERIAL $320.00
    03010394 INTERPHASE IN SITU HYBRIDIZATI $150.00
    03010402 UNLISTED SURGICAL PATH PROCEDU $238.70
    03010410 TOUCH PREP,ADDITIONAL SITE $51.00
    03010428 CONSULTATION RPT-REFERRED SPEC $130.00
    03010436 FISH MORPHOMET INSIT HYBR AUTO $650.00
    03010444 COMPUTER MORPHO ANALY EA AB ST $650.00
    03010451 CP SMR,OTHR,PREP,SCRN,INT $95.00
    03010469 FISH INSITU HYBRID,EA PROB STN $320.00
    03010485 REF CONSULT, PREP ELSEWHERE $105.00
    03010493 CYTP URNE 3-5 PROBES EA SPEC $660.00
    03010519 PROSTATE BIOPSY ANY METHOD $700.00
    03010543 KI-67 PROTEIN EACH AB STAIN $650.00
    03010550 SURG PATH GROSS/MICRO LEVEL IV $145.00
    03010568 IMMUNOHISTO ABY EA ADDL SLIDE $105.00
    03010576 INSITU HYBRIDIZATION (FISH) $585.00
    03010584 HISTOCHEMICAL STAINS ADD-ON $590.00
    03010592 ENZYME HISTOCHEMISTRY $1,390.00
    03010600 IMMUNOHISTO ANTIBODY SLIDE $650.00
    03010618 FISH PROBE, MNL TECH $385.00
    03019999 ESTROGEN RECEPTOR EACH AB STAI $650.00
    03020005 MUSCLE BIOPSY TC ONLY $145.00
    03020013 CML PANEL (FISH) $650.00
    03020021 IMMUNOFLUOR ANTB ADDL STAIN $275.00
    03020039 CYTP URINE 3-5 PROBES CMPTR $725.00
    04010013 SMEAR $20.00
    04010039 SENSITIVITY - DISK PER PLATE $20.00
    04010047 AFB SMEAR $20.00
    04010054 AFB (SMR/CLT) $45.00
    04010062 KOH PREP $20.00
    04010070 FUNGUS CULTURE $25.00
    04010088 URINE CULTURE $30.00
    04010096 G.C. CULTURE $25.00
    04010120 GENITAL CULTURE $25.00
    04010138 RESP CULTURE $25.00
    04010146 STOOL CULTURE $35.00
    04010153 CULT BACT; ANY SRC NO BLD ANAE $35.00
    04010161 MALARIA $20.00
    04010187 NIH SWAB (PINWORMS) $20.00
    04010195 OVA AND PARASITES $35.00
    04010203 OCCULT BLOOD-GUIAC $13.80
    04010229 BLOOD CULTURE $37.00
    04010245 BACTERIAL TYPING $30.00
    04010294 SEMEN SCREENING $58.10
    04010302 CRYSTALS $20.00
    04010310 CULTURE WOUND $25.00
    04010336 STOOL FOR WBC $20.00
    04010344 HIV $73.00
    04010351 ROTAVIRUS $50.00
    04010369 TOXO ANTIBODY $45.00
    04010377 RUBEOLA MEASLES IGG OR IGM $35.00
    04010385 CSF CULTURE SPINAL FLUID $25.00
    04010443 LYME DIS ABY SCREEN $82.10
    04010450 CULTURE-NOSE $25.00
    04010468 CULTURE-THROAT $25.00
    04010476 CULTURE-BRON WASHING $25.00
    04010500 CULTURE-EYE $25.00
    04010518 CULTURE-EAR $25.00
    04010526 CULTURE-IV CATH TIP $25.00
    04010534 CULTURE-TISSUE BX $25.00
    04010542 CULTURE-PERITONEAL FLD/ABD CAV $25.00
    04010559 CULTURE-GALLBLADDER/BILE $25.00
    04010567 CULTURE-JOINT FLUID $25.00
    04010575 CULTURE-PLEURAL FLUID $25.00
    04010583 CULTURE-PERICARDIAL FLUID $25.00
    04010609 CULTURE NASAL SINUS $25.00
    04010617 CULTURE-M.R.S.A $25.00
    04010625 COLD AGGLUTININ-TITER $35.00
    04010641 NOCARDIA SMEAR $20.00
    04010658 PERI FLD BLD CULT $25.00
    04010666 AB; HELICOBACTER PYLORI $45.00
    04010674 HERPES SIMPLEX II IGG $80.00
    04010682 CULTURE SURGICAL SITE $25.00
    04010690 CULTURE DECUBITUS $25.00
    04010708 CULTURE ABSCESS $25.00
    04010716 GRAM SMEAR $20.00
    04010724 CULTURE BLOOD AFB $45.00
    04010732 CULTURE BLOOD FUNGUS $40.00
    04010773 FUNGUS ID, MOLD $30.00
    04010781 CULTURE VRE $25.00
    04010807 TICK I.D. $20.00
    04010823 CULTURE FUNGUS ID $55.00
    04010831 CULTURE ID URINE $39.00
    04010849 CYCLOSPORA CYAETINESUS $40.00
    04010856 GASTRO CULT $37.90
    04010864 CULTURE ID $38.90
    04010872 SENSITIVITY MIC $25.00
    04010922 CHLAMYDIA BY DNA/PCR $142.00
    04010930 G.C. BY DNA/PCR $143.00
    04010948 TOXOPLASMA $45.00
    04010963 CHLAMYDIA IGM $55.00
    04010971 LYMES IGG,IGM WESTERN BLOT CON $81.00
    04010989 HSV TYPING STAIN $15.00
    04010997 CMV-IGM $55.00
    04011003 HIV-1 RNA BY PCR $375.00
    04011011 HERPES SMPLX VIRUS BY PCR,CSF $170.00
    04011037 CULTURE ID-59 $38.90
    04011045 CULTURE ID ANAEROBIC-59 $50.00
    04011052 CULTURE ID URINE 91 $38.90
    04011060 STOOL AND PATHOGENS-91 $26.00
    04011078 CHLAMYDIA T, DIR NA PROBE $105.00
    04011086 NEISSERIA, DIR NA PROBE $95.00
    04011094 MACROSCOPIC EXAM, ARTHROPOD $20.00
    04011102 GENOTYPE,DNA,HIV REVERSE T $1,262.40
    04011110 PHENOTYPE, DNA HIV W/CULTURE $2,110.00
    04011128 PHENOTYPE, DNA HIV W/CLT ADD $197.60
    04011136 TRICHOMONAS VAGINALIS AMPLIF $238.60
    04011144 CRYPTOCOCCAL ANTIGEN SERUM $31.00
    04011151 CRYPTOCOCCAL ANTIGEN FOR CSF $31.00
    04011169 REFLEX CRYPTOCOCCAL ANTIGEN $55.00
    04011177 BACT CULT QUAN AEROBIC $80.00
    04011185 BACT CULT QUAN ANAEROBIC $96.00
    04011193 HIV-1 PROBE REVERSE TRNSCRPT J $145.00
    04011243 RESP VIRUS 3-5 TARGETS $617.70
    04011250 GROUP B STREP BY PCR $274.10
    04011268 HERPES SIMPLEX/VARICELLA ZOSTE $70.00
    04011276 PARASITE IDENTIFICATION, WORM $20.00
    04019311 HIV-1 INTEGRASE GENOTYPE $785.00
    04019329 PHENOTYPE INFECT AGENT DRUG $550.00
    04019337 URINE BACTERIA CULTURE $30.00
    04019345 HIV-1 AG W/HIV-1 & HIV-2 AB $78.50
    04019352 DNA/RNA/;MULTI ORG-AMP PR $338.10
    04019360 GARDNERELLA DIR NA PROBE $88.00
    04019378 CANDIDA NA DIRECT PROBE $90.00
    04019386 TRICHOMONAS VAGIN DIR PROBE $80.00
    04019394 HEP-B AMPLIF NA PROBE $150.00
    04019402 ASPERGILLUS AG EIA $110.00
    04019410 AGENT NOS ASSAY W/OPTIC $62.70
    04019428 GENET VIRUS ISOLATE HSV $145.00
    04019436 BARTONELLA AMPLIF NAP $145.00
    04019444 C DIFF AMPLIFIED PROBE $258.60
    04019451 INFLUENZA DNA AMP PROBE $409.80
    04019469 HIV-1 AG, EA $87.00
    04019477 CYTOMEGALOV, AMPLIF NA PROBE $175.00
    04019493 HPYLORI, STOOL, EIA $69.30
    04019501 MR-STAPH, DNA, AMP PROBE $145.00
    04019519 HISTOPLASMA CAPSUL AG, EIA $60.00
    04019527 FUNGUS CULTURE, DEF ID, MOLD $30.00
    04019535 MYCOBACTERIA, DIR NA PROBE $88.00
    04019543 SENSITIVITY-MYCOBACT, EA AGNT $30.00
    04019550 RSV AG BY IF $60.00
    04019568 HEPATITIS BE AG, EIA $55.00
    04019576 CONCENTRATION FOR INFECT AGNT $40.00
    04019584 SHIGA-LIKE TOXIN AG,EIA $85.90
    04019592 CRYPTOSPOR AG BY IFA $50.00
    04019600 LYMES,AMPLIFIED NA PROBE $145.00
    04019618 MYCOBACTERIA T, DIR NA PROBE $85.00
    04019626 MYCOBACTERIA A, DIR NA PROBE $85.00
    04019634 BC-AEROBIC-ADDTL ID $38.90
    04019642 ENTEROVIRUS,DNA, AMP PROBE $221.90
    04019659 NA QUAN NOS AGENT $195.00
    04019675 AMPLIF NA PROBE NOS AGENT $165.00
    04019683 SENSITIVITY-MACROBROTH,EA AGNT $25.00
    04019691 SENSITIVITY-MACROBROTH,EA AGNT $25.00
    04019709 HEPATITIS B SURFACE, AG, EIA $35.00
    04019717 MYCOBACTERIA T, AMPLIF NA PROB $145.00
    04019725 TRICHOMONAS RAPID TEST $59.70
    04019733 MRSA ALL ADMISSIONS $23.00
    04019741 AB; HTLV OR HIV WB $71.00
    04019758 HOMOGENIZ TISSUE FOR CULTURE $35.00
    04019766 HERPES SIMPLEX II IGM $80.00
    04019774 HERPES SIMPLEX I IGM $50.00
    04019782 WEST NILE VIRUS IGM $75.00
    04019790 WEST NILE VIRUS IGG $350.00
    04019808 VAG PERI RECTAL CULT GRP B STR $25.00
    04019824 CHLAMYDIA/GC DNA $170.00
    04019832 INFECT AGNT DIRECT INFLUENZA $31.00
    04019840 STREPT SCREEN GPA $64.50
    04019857 MYCOPLASMA CULTURE RESPIRATORY $55.00
    04019865 CULTURE ID ANAEROBIC $55.00
    04019873 BETA LACTAMASE $15.00
    04019899 GIARDIA ANTIGEN $40.00
    04019923 WATER ANALYSIS(BACTERIAL)(CASH $28.80
    04019931 VDRL CSF $15.00
    04019949 MYCOPLASMA CULTURE UROGENITAL $55.00
    04019956 BACT MENG EA ANTIBODY $40.00
    04019964 HERPES VIRUS CULTURE $145.00
    04019980 STOOL ADD PATHOGENS $26.00
    04019998 CLOSTRIOIUM DIFF TOXIN $50.00
    04020012 MONO TEST $25.00
    04020020 C REACTIVE PROTEIN $22.00
    04020038 RHEUMATOID FACTOR (RF) $25.00
    04020053 SEROLOGY (RPR) $15.00
    04020079 ASO BLOOD $25.00
    04020087 STAPH A DNA AMP PROBE $170.00
    04020095 HERPES S AMPLIF NA PROBE $170.00
    04028932 TREPONEMA PALLIDUM $63.80
    04028940 IA BY EIA MULTI STEP $57.80
    04028965 COXSACKIE VIRUS ""A"" $50.00
    04028973 COXSACKIE VIRUS ""B"" $50.00
    04028981 ECHOVIRUS $50.00
    04028999 POLIOVIRUS $50.00
    04029005 EBNA (NUCLEAR AG) $45.00
    04029013 EARLY ANTIGEN-EBV $37.00
    04029021 GC ANTIBODY $65.00
    04029039 CHLAMYDIA CULTURE $80.00
    04029047 MYCOPLASMA IGG/IGM $37.00
    04029096 ANTI DNA ANTIBODY $40.00
    04029112 COCCIDIOIDES ABY $50.00
    04029120 CRYPTOCOCCAL ABY $66.00
    04029138 CYTOMEGALOVIRUS $45.00
    04029146 HERPES SIMPLEX I IGG $50.00
    04029153 VARICELLA ZOSTER $50.00
    04029161 LEPTOSPIRA ANTI $60.00
    04029179 MUMPS ANTIBODY $47.00
    04029195 CHLAMYDIA ANTIBODIES $30.00
    04029203 ROCKY MOUNT SPOT $80.00
    04029211 CULTURE VIRAL $110.00
    04029229 SUDAN IV FAT SC $15.00
    04029237 COXSACKIE B GROUP $50.00
    04029245 INFLUENZA VIRUS EA $60.00
    04029252 LEGIONELLA ANTI $55.00
    04029278 ADENOVIRUS ANTI $40.00
    04029328 LEGIONELLA CULTURE $25.00
    04029336 TRICHINELLA ABY $55.00
    04029351 MYCOBACTERIA ID $58.00
    04029377 IADNA-DNA/RNA PROBE TQ 6-11 $920.00
    05010012 OBSTETRICAL PANEL $123.00
    05010053 COOMBS DIRECT BROAD $170.00
    05010061 ANTIBODY SCREEN $145.00
    05010087 THERAPEUTIC PHLEBOTOMY $272.10
    05010103 PROC FEE RED CELL $1,250.00
    05010111 DEGLYCEROLIZED RBC $862.80
    05010129 PROC FEE WHOLE BLOOD $1,053.50
    05010137 PROC FEE FF PLSMA $304.50
    05010145 PROC FEE PLT CONC $239.00
    05010152 PROC FEE CRYOPREC $261.40
    05010244 ANTIBODY TITRATION EA $320.00
    05010293 RBC AB ELUATE $320.00
    05010301 MINI ANTIBODY INDENTIFICA $648.90
    05010319 FETAL SCREEN $35.00
    05010327 FETAL MATERNAL RBC RATIO $35.00
    05010343 POOLING PLATELETS $320.00
    05010376 ANTIBODY IDENTIFICATION $648.90
    05010384 ABO TYPE $206.00
    05010418 ANTIBODY IDENT (SPECIAL) $383.00
    05010426 AUTOABSORPTION (PER SERUM) $56.00
    05010442 TRANS REACTION EVAL $310.00
    05010525 PROC FEE SD PLT $1,254.60
    05010657 PROC FEE AUTO RBC $784.10
    05010665 PROC FEE HLA PLT $1,599.50
    05010699 BASIC EVALUATION-ARC $648.90
    05010731 PR FEE DDNR RBC $784.10
    05010749 DIRECTED DONOR SURCHARGE $450.00
    05010772 HLA TYPING-ARC (ABC) $245.00
    05010798 CMV SCREEN $45.00
    05010806 HLA ABY SCR-ARC $200.00
    05010822 CROSSMATCH BY ARC $320.00
    05010830 ANTI NEUTRALIZA $320.00
    05010848 NEUTRAL/TITER $320.00
    05010921 PROC FEE AUTO WBL $312.00
    05010939 IRRADIATION FEE $95.00
    05010947 POOLING CRYO $320.00
    05010962 SURCHARGE FEE-ARC $150.00
    05011051 ZZAP RBC TREATMENT $85.00
    05011069 COOMBS DIRECT IGG $170.00
    05011077 COOMBS DIRECT C3 $170.00
    05011085 AG SCREEN-PT SERUM $85.00
    05011093 SUPP. ID CHARGE-ARC $648.90
    05011101 PROC FEE LEUK RDUCED RBC $1,062.50
    05011127 HLA DR - ARC $275.00
    05011283 IRRD DIR DONOR LR RBC $801.10
    05011291 PROC FEE CRYOSUPR $127.10
    05011309 PROC FEE JB PLSMA $227.60
    05011333 INCUBATION $320.00
    05011382 RHO IMMUNE GLOBULIN 300 UG MGR $472.00
    05011390 COOMBS DIRECT $170.00
    05011408 CROSSMATCH $320.00
    05011416 ABO TYPE FORWARD $206.00
    05011432 THAW FRZN RBC $650.00
    05011440 PROC FEE AUTO D RBC $1,173.50
    05011457 RH TYPE $85.00
    05011465 ANTIGLOBULIN-PHASE $320.00
    05011481 RBC ABY SCR EACH SER TECH ARC $145.00
    05011499 RBC ABY ELUTION EA ELUTION ARC $320.00
    05011507 RBC ABY ID EA PANEL/SER TECH $648.90
    05011515 AGT DIRECT ANTISERUM ARC $170.00
    05011523 AGT INDIRECT TITER EA ANTISER $310.00
    05011531 ABO BLOOD TYPING ARC $206.00
    05011549 BLOOD TYPING RH(D) ARC $85.00
    05011556 RBC AG OTHER THAN ABO/RH (D) $369.00
    05011564 RBC AG OTHER THAN ABO/RH(D)ARC $369.00
    05011572 PHENOTYPING COMPLETE ARC $85.00
    05011580 COMP TEST EA UNIT AGT TECH ARC $320.00
    05011598 PRETREAT RBC ABY ID INCUB CHEM $85.00
    05011606 INCUBATION W/ENZYMES ARC $369.00
    05011614 BY DENSITY GRADIENT SEP ARC $320.00
    05011622 INCUBATION W/INHIBITORS ARC $320.00
    05011630 DIFF RBC ABSORB/EACH ARC $35.00
    05011648 AUTO SURCHARGE $450.00
    05011663 PROC FEE LP SD PLT $1,582.40
    05011689 PROC FEE SD PLT LREDUCED IRR $1,726.40
    05011697 PROC FEE LEUKOREDUC IRR RBC $1,273.00
    05011705 PROC FEE PLATELET IRRADIATED $335.00
    05011713 PROC FEE PLT RDM LKREDUCED IRR $325.00
    05011721 PROC FEE PLT RANDOM LEUKOREDUC $252.00
    05011739 WHOLE BLD/RBCS LEUKO RDUC CMV $1,186.10
    05011747 PLATLTS PHERES LEUKO RDUC CMV $3,079.00
    05011754 SD,PLT,LR,CMVN $2,959.10
    05011762 RBC, LEUKO RDUC CMVN, IRR $1,397.30
    05011770 FRESH FRZN PLAS BETWN 8-24HR C $284.70
    05011796 SICKLING OF RBC, REDUCTION $20.00
    05011804 *CRYOPRECIPITATE 5 UNIT BAG $1,075.90
    05011812 PROC FEE IRR RBC $1,713.80
    05011820 HLA MATCHING SURCHARGE $340.00
    05011838 AG TEST DONOR BLOOD/EA AG $369.00
    05011846 LICENSED RBC PANEL $941.00
    05011853 TRANSFUSION, BLOOD OR BLD COMP $710.00
    05011861 OBSTETRIC PANEL W HIV $424.00
    05011879 FETOMATERNAL BLD FLOW CYTOMETR $30.00
    05030010 IAT COMPLETE SERVICE $961.00
    05030028 IAT (CANCEL WITHOUT SET-UP) $961.00
  • Cardiology/Sleep Studies

    Service Code Description Price
    10010015 HOLTER MONITOR TC $507.50
    10010031 ELECTROCARDIOGRAM TC $170.00
    11010030 EEG; SLEEP ONLY $680.00
    11010063 EEG CEREBRAL DEATH EVAU ONLY $1,230.00
    11010113 EEG AWAKE AND DROWSY $675.00
    11010121 EEG AWAKE & DROWSY W PORTABLE $675.00
    11010147 EEG AWAKE AND ASLEEP $675.00
    12010021 ECHO REAL-TI M-MD $1,300.00
    12010260 TEE TRANSESOPHAGEAL ECHO $2,200.00
    12010278 DOBUTAMINE STRESS TEST $680.00
    12010328 NUCLEAR EXERCISE STRESS TEST $680.00
    12010377 STRESS TTE W CONTINUOUS ECT $1,300.00
    12010385 ADMIN ECG CONTRAST AGENT $60.00
    12010427 LEXISCAN STRESS TEST $680.00
    12010435 TREADMILL $680.00
    12010443 TTE W OR WO FOL WCON DOPPLER $2,130.00
    12010451 MOD SEDATION INITIAL 15 MIN $203.00
    12010468 MOD SEDATION EA ADDL 15 MIN $203.00
    12010476 TEE W/ CARDIOVERSION $2,200.00
    14010268 ECHO FOLLOW UP $480.00
  • X-Ray/Nuclear Medicine/Special Procedures

    Service Code Description Price
    20010021 MANDIBLE (ROUTINE) $226.00
    20010047 FACIAL BONES (ROUTINE) $226.00
    20010054 NASAL BONES $126.00
    20010070 SINUSES $126.00
    20010088 SKULL (ROUTINE) $226.00
    20010112 TMJ BILAT $126.00
    20010153 SKULL (2 VIEWS PARTIAL) $226.00
    20010161 MANDIBLE (PARTIAL EXAM) $126.00
    20010187 FACIAL BONES (PARTIAL EXAM) $126.00
    20010195 PANELIPSE $126.00
    20010203 ORBITS $226.00
    20010211 SKULL(2 VIEW)EYE FOREIGN BODY $126.00
    20010237 SINUSES PARANASAL < 3 VIEWS $126.00
    20010245 TMJ JOINT-UNILATERAL-RT $126.00
    20010252 TMJ JOINT-UNILATERAL-LT $126.00
    20020103 RIBS (BILATERAL) $226.00
    20020178 RIBS(UNILATERAL)LT $126.00
    20020186 RIBS(UNILATERAL)RT $126.00
    20020228 RIBS, BILATERAL W 1V CHEST $226.00
    20020236 RIBS UNI RT W/PA CHEST $226.00
    20020244 RIBS UNI LT W/PA CHEST $226.00
    20020301 CHEST, 1 VIEW $126.00
    20020319 CHEST, 2 VIEWS $126.00
    20020327 CHEST, 3 VIEWS $135.00
    20020335 CHEST, 4 OR MORE VIEWS $255.00
    20030052 ABDOMEN SERIES W 1V CHEST $226.00
    20030086 ABDOMEN, 1 VIEW $136.00
    20030094 ABDOMEN, 2 VIEWS $240.00
    20030102 ABDOMEN, 3 OR MORE VIEWS $265.00
    20040044 IVP (NO TOMO) $452.00
    20040051 RETGOGRADE PYELOGRAM $1,080.00
    20040069 URETHRO-VOIDING $1,080.00
    20040093 CYSTOGRAM $452.00
    20040150 IVP INFUSION & TOMOGRAMS $452.00
    20040184 URETHRO-RETRO $460.00
    20050027 BARIUM SWALLOW/ESOPHAGUS $449.00
    20050035 SMALL BOWEL $226.00
    20050043 UPPER GI $449.00
    20050050 BARIUM ENEMA $449.00
    20050068 BARIUM ENEMA/AIR CONTRAST $449.00
    20050092 UPPER GI/AIR CONTRAST $449.00
    20050126 RHB SWALLOWING STUDY $226.00
    20050134 UPPER GI W/SM BOWEL $452.00
    20050159 CHOLANGIOGRAM OPERATIVE $100.00
    20050167 CHOLANGIOGRAM ADD FILM/OR $90.00
    20050183 GI WITH BARIUM SWALLOW $449.00
    20050209 BARIUM ENEMA GASTROGRAPHIN $449.00
    20060026 BONE AGE $226.00
    20060034 BONE LENGTH $300.00
    20060042 SKELETAL SURVEY $324.80
    20060059 SCANOGRAM/VISIONAIRE $300.00
    20070017 ACROMIOCLAVICULAR JOINTS $150.00
    20070025 STERNOCLAVICULAR JOINTS $170.00
    20070314 ELBOW (ROUTINE)LT $126.00
    20070322 ELBOW(ROUTINE)RT $126.00
    20070330 CLAVICLE LT $126.00
    20070348 CLAVICLE RT $126.00
    20070355 SCAPULA LT $226.00
    20070363 SCAPULA RT $226.00
    20070371 SHOULDER 2 VIEW LT $126.00
    20070389 SHOULDER 2 VIEW RT $126.00
    20070397 HUMERUS LT $126.00
    20070405 HUMERUS RT $126.00
    20070413 ELBOW(RECHECK)LT $126.00
    20070421 ELBOW(RECHECK)RT $126.00
    20070439 FOREARM LT $126.00
    20070447 FOREARM RT $126.00
    20070454 WRIST(ROUTINE)LT $126.00
    20070462 WRIST(ROUTINE)RT $126.00
    20070470 HAND LT $126.00
    20070488 HAND RT $126.00
    20070496 WRIST(RECHECK)LT $126.00
    20070504 WRIST(RECHECK)RT $126.00
    20070512 UPPER EXTREMITY INFANT LT $226.00
    20070520 UPPER EXTREMITY INFANT RT $226.00
    20070678 CLAVICLE(RECHECK)LT $126.00
    20070686 CLAVICLE(RECHECK)RT $126.00
    20070694 SHOULDER(RECHECK 2V)LT $126.00
    20070702 SHOULDER(RECHECK 2V)RT $126.00
    20070710 HUMERUS(RECHECK)LT $126.00
    20070728 HUMERUS(RECHECK)RT $126.00
    20070736 FOREARM(RECHECK)LT $126.00
    20070744 FOREARM(RECHECK)RT $126.00
    20070751 HAND(RECHECK)LT $226.00
    20070769 HAND(RECHECK)RT $226.00
    20070777 ELBOW(2VIEW)LT $126.00
    20070785 ELBOW(2VIEW)RT $126.00
    20070793 WRIST(2VIEW)LT $126.00
    20070801 WRIST(2VIEW)RT $126.00
    20070819 THUMB LT $126.00
    20070827 FINGER 2ND LT $126.00
    20070835 FINGER 3RD LT $126.00
    20070843 FINGER 4TH LT $126.00
    20070850 FINGER 5TH LT $126.00
    20070868 THUMB RT $126.00
    20070876 FINGER 2ND RT $126.00
    20070884 FINGER 3RD RT $126.00
    20070892 FINGER 4TH RT $126.00
    20070900 FINGER 5TH RT $126.00
    20070918 THUMB RECHECK LT $126.00
    20070926 FINGER 2ND RECHECK LT $126.00
    20070934 FINGER 3RD RECHECK LT $126.00
    20070942 FINGER 4TH RECHECK LT $126.00
    20070959 FINGER 5TH RECHECK LT $126.00
    20070967 THUMB RECHECK RT $126.00
    20070975 FINGER 2ND RECHECK RT $126.00
    20070983 FINGER 3RD RECHECK RT $126.00
    20070991 FINGER 4TH RECHECK RT $126.00
    20071007 FINGER 5TH RECHECK RT $126.00
    20071114 HAND RT (2 VIEW) $226.00
    20071122 HAND LT (2 VIEW) $226.00
    20071130 SHOULDER 1 VIEW LT $126.00
    20071148 SHOULDER 1 VIEW RT $126.00
    20080149 KNEES, WEIGHT BEARING $126.00
    20080297 ANKLE(ROUTINE) 4 VIEW LT $126.00
    20080305 ANKLE(ROUTINE) 4 VIEW RT $126.00
    20080339 OS CALCIS/HEEL LT $126.00
    20080347 OS CALCIS/HEEL RT $126.00
    20080370 KNEE(2VIEW)LT $126.00
    20080388 KNEE(2VIEW)RT $126.00
    20080396 ANKLE 2 VIEW LT $126.00
    20080404 ANKLE 2 VIEW RT $126.00
    20080412 FOOT LT $126.00
    20080420 FOOT RT $126.00
    20080438 LOWER LEG LT $126.00
    20080446 LOWER LEG RT $126.00
    20080453 KNEE 4 OR MORE VIEWS LT $226.00
    20080461 KNEE 4 OR MORE VIEWS RT $226.00
    20080479 KNEE/OBL/PAT/EREC LT $226.00
    20080487 KNEE/OBL/PAT/EREC RT $226.00
    20080495 LOWER EXTREMITY INFANT LT $126.00
    20080503 LOWER EXTREMITY INFANT RT $126.00
    20080677 FOOT(RECHECK)LT $126.00
    20080685 FOOT(RECHECK)RT $126.00
    20080693 LOWER LEG(RECHECK)LT $126.00
    20080701 LOWER LEG(RECHECK)RT $126.00
    20080719 ANKLE(2 VIEW)RECHECK LT $126.00
    20080727 ANKLE(2 VIEW)RECHECK RT $126.00
    20080735 KNEE(2 VIEW)RECHECK LT $126.00
    20080743 KNEE(2 VIEW)RECHECK RT $126.00
    20080750 TOE 1ST LT $126.00
    20080768 TOE 2ND LT $126.00
    20080776 TOE 3RD LT $126.00
    20080784 TOE 4TH LT $126.00
    20080792 TOE 5TH LT $126.00
    20080800 TOE 1ST RT $126.00
    20080818 TOE 2ND RT $126.00
    20080826 TOE 3RD RT $126.00
    20080834 TOE 4TH RT $126.00
    20080842 TOE 5TH RT $126.00
    20080859 TOE 1ST RECHECK LT $126.00
    20080867 TOE 2ND RECHECK LT $126.00
    20080875 TOE 3RD RECHECK LT $126.00
    20080883 TOE 4TH RECHECK LT $126.00
    20080891 TOE 5TH RECHECK LT $126.00
    20080909 TOE 1ST RECHECK RT $126.00
    20080917 TOE 2ND RECHECK RT $126.00
    20080925 TOE 3RD RECHECK RT $126.00
    20080933 TOE 4TH RECHECK RT $126.00
    20080941 TOE 5TH RECHECK RT $126.00
    20081055 FOOT RT (2 VIEW) $126.00
    20081063 FOOT LT (2 VIEW) $126.00
    20081113 KNEE 3 VIEWS LT $126.00
    20081121 KNEE 3 VIEWS RT $126.00
    20081139 HIP UNI 1 VIEW RT $126.00
    20081147 HIP UNI 1 VIEW LT $126.00
    20081154 HIP UNI 2-3 VIEWS RT $126.00
    20081162 HIP UNI 2-3 VIEWS LT $126.00
    20081170 HIPS BI 2 VIEWS $255.00
    20081188 HIPS BI 3-4 VIEWS $250.00
    20081196 FEMUR 2+ VIEWS RT $126.00
    20081204 FEMUR 2+ VIEWS LT $126.00
    20090015 TOMOGRAMS $226.00
    20090049 FLUOROSCOPY < 1 HOUR $455.00
    20090056 C-ARM < 1 HOUR $455.00
    20090072 MYELOGRAM CERVICAL W PUNC $1,900.00
    20090130 MYELOGRAM 2 OR MORE REGIONS $2,100.00
    20090171 SIALOGRAM $500.00
    20090189 FISTULA/SIN TRCT $1,080.00
    20090379 CERVICAL PUNCTURE-MYELO $1,700.00
    20090387 FLOURO GUIDIANCE $263.90
    20090403 SIALOGRAM INJ PRO $185.00
    20090411 FISTULA INJ PRO $255.00
    20090437 URETHROCYSTOGRAM INJ PRO $900.00
    20090445 VOIDING CYSTO INJ PRO $1,000.00
    20090452 LUMBAR PUNC DX $1,700.00
    20090502 ARTHROGRAM KNEE LT $1,000.00
    20090510 ARTHROGRAM KNEE RT $1,000.00
    20090528 ARTHROGRAM SHOULDER LT $1,000.00
    20090536 ARTHROGRAM SHOULDER RT $1,000.00
    20090569 ARTHROGRAM WRIST LT $900.00
    20090577 ARTHROGRAM WRIST RT $900.00
    20090585 ARTHROGRAM HIP LT $1,000.00
    20090593 ARTHROGRAM HIP RT $1,000.00
    20090601 ARTHROGRAM ANKLE LT $1,000.00
    20090619 ARTHROGRAM ANKLE RT $1,000.00
    20090627 ARTHROGRAM ELBOW LT $1,000.00
    20090635 ARTHROGRAM ELBOW RT $1,000.00
    20090643 TMJ ARTHROGRAM LT $460.00
    20090650 TMJ ARTHROGRAM RT $460.00
    20090668 BONE DENSITY $360.40
    20090676 ARTH INJ PRO ANKLE LT $1,525.00
    20090684 ARTH INJ PRO ANKLE RT $1,525.00
    20090692 ARTH INJ PRO ELBOW LT $1,525.00
    20090700 ARTH INJ PRO ELBOW RT $1,525.00
    20090718 ARTH INJ PRO HIP LT $500.00
    20090726 ARTH INJ PRO HIP RT $500.00
    20090734 ARTH INJ PRO KNEE LT $155.00
    20090742 ARTH INJ PRO KNEE RT $155.00
    20090759 ARTH INJ PRO SHOULDER LT $225.00
    20090767 ARTH INJ PRO SHOULDER RT $225.00
    20090775 ARTH INJ PRO TMJ LT $225.00
    20090783 ARTH INJ PRO TMJ RT $225.00
    20090791 ARTH INJ PRO WRIST LT $220.00
    20090809 ARTH INJ PRO WRIST RT $220.00
    20090882 INJECTION PROC, THER MAJ JOINT $650.00
    20090890 WRIST DEXA LEFT $170.00
    20090908 WRIST DEXA RIGHT $170.00
    20090924 VERTEBRAL ASSESSMENT $200.00
    20090932 CHEMO, CNS (INTRATHECAL) $350.00
    20090940 C ARM > 1 HOUR $300.00
    20090973 EPIDUROGRAM $190.00
    20090981 DRAIN/INJECT SM JNT/BURSA $490.00
    20090999 DRAIN/INJ INTERM JNT/BURSA $490.00
    20091005 FLUOROGUIDE FOR SPINE INJECT $175.00
    20091021 MYELOGRAM - CERVICAL $2,354.80
    20091039 MYELOGRAM - THORACIC $2,354.80
    20091047 MYELOGRAM - LUMBAR $2,354.80
    20091054 MYELOGRAM - 2 OR MORE REGIONS $2,679.60
    20091062 T-TUBE INJ PROC INCL RADIOLOGY $5,730.00
    20099065 STEROTACTIC NEEDLE SYS W/CLIP $954.10
    20099073 SITZMARK CAPSULE $81.20
    20099081 NOSE TO RECTUM FOR FB CHILD $350.00
    20099099 FLUORO EXAM OF G/COLON TUBE $525.00
    20100012 ERCP $340.00
    20110060 SPECIMEN RADIOGRAPHY $900.00
    20110219 HYSTEROSALPINGOGRAPHY INJ PRO $380.00
    20110300 DUCTOGRAM SINGLE LT $460.00
    20110318 DUCTOGRAM SINGLE RT $460.00
    20110326 DUCTOGRAM MULTIPLE LT $538.00
    20110334 DUCTOGRAM MULTIPLE RT $538.00
    20110375 DUCTOGRAM INJ PROC LT $230.00
    20110383 DUCTOGRAM INJ PROC RT $230.00
    20110664 HYSTERSALPINGOGRAM $630.00
    20110730 SURGICAL SPECIMEN XR $900.00
    20110763 MAMMO DX BILATERAL $446.20
    20110771 MAMMO SCREEN BILATERAL $446.20
    20110789 MAMMO DX UNILATERAL RT $316.20
    20110797 MAMMO DX UNILATERAL LT $316.20
    20110813 MAMMO SCREEN TO DX-BILATERAL $446.20
    20110821 MAMMO SCREEN TO DX-UNILAT LT $316.20
    20110839 MAMMO SCREEN TO DX-UNILAT RT $316.20
    20110870 MAMMO GUIDE NEEDLE LOC INIT RT $900.00
    20110888 MAMMO GUIDE NEEDLE LOC INIT LT $900.00
    20110896 MAMMO GUIDE NEEDLE LOC ADDL RT $310.00
    20110904 MAMMO GUIDE NEEDLE LOC ADDL LT $310.00
    20110912 BREAST STRTC BX INIT LESION RT $2,250.00
    20110920 BREAST STRTC BX INIT LESION LT $2,250.00
    20110938 BREAST STRTC BX ADDL LESION RT $650.00
    20110946 BREAST STRTC BX ADDL LESION LT $650.00
    20110987 BREAST TOMOSYNTHESIS UNI RT $300.00
    20110995 BREAST TOMOSYNTHESIS UNI LT $300.00
    20111001 BREAST TOMOSYNTHESIS BI DIAGNO $250.00
    20111019 BREAST TOMOSYNTHESIS BI SCREEN $200.00
    20111035 MAMMO SCREEN WALKIN $446.20
    20111068 WALK IN SCREENING TOMO $200.00
    20111076 MAMMO POSTPROCEDURAL RT $240.00
    20111084 MAMMO POSTPROCEDURAL LT $240.00
    20111092 MAMMO POSTPROCEDURAL BILATERAL $400.00
    20111101 MAMMO SCREENING NO RX $370.00
    20111126 MAMMO SCREEN UNILATERAL RT $316.20
    20111134 MAMMO SCREEN UNILATERAL LT $316.20
    20111142 MAMMO SCREEN UNI RT WALKIN $316.20
    20111159 MAMMO SCREEN UNI LT WALKIN $316.20
    20111167 WALKIN SCREEN TOMO UNILATERAL $200.00
    20120010 CERVICAL SPINE 4-5 VIEWS $226.00
    20120028 CERVICAL SPINE 2-3 VIEWS $190.00
    20120036 CERVICAL SPINE 6+ VIEWS $226.00
    20120044 THORACIC SPINE $226.00
    20120051 LUMBAR (ROUTINE) $226.00
    20120069 PELVIS $226.00
    20120077 SACROILIAC JOINTS $226.00
    20120085 SACRUM/COCCYX $126.00
    20120093 LUMBAR (AP/LAT) $226.00
    20120119 NECK SOFT TISSUE $126.00
    20120135 LUMBAR FLEX/EXT $226.00
    20120143 LUMBAR WITH FLEX/EXT $226.00
    20120150 SPINE (1 VIEW) $126.00
    20120168 THORACIC SP - 2 VIEW $226.00
    20120184 INJ PARAVERT F JNT L/S 1 LEV $1,600.00
    20120200 CERVICAL FLEX EXT $190.00
    20120226 PELVIS MINIMUM 3 VIEWS $226.00
    20120267 SACROILIAC JOINTS < THAN 3 V $226.00
    20120283 ENTIRE SPINE 1 VIEW $135.00
    20120291 ENTIRE SPINE 2-3 VIEWS $226.00
    20120309 ENTIRE SPINE 4-5 VIEWS $452.00
    20120317 ENTIRE SPINE 6+ VIEWS $452.00
    20120325 LUMBAR WITH LATERAL BENDING $226.00
    20120333 LUMBAR W/ BEND RT TO LT 2VWS $226.00
    20130100 ANGIO, EXTREMITY,BILAT $4,850.00
    20130225 IO,VISCERAL,SEL/SUPSEL,W OR WO $8,400.00
    20130456 AORTA ABDOMINAL $4,850.00
    20130480 NOGRAPHY,CAVAL SUPERIOR(SVC) $1,600.00
    20130514 EMBOL $3,250.00
    20131009 CHANGE PERC TUBE $235.00
    20131033 DILATION NEPH TRACT $3,290.00
    20131091 CT MOD SEDATION EA ADDL 15 MIN $203.00
    20131272 NEPHROSTOGRAM RT $900.00
    20131843 AORTA THORACIC $8,400.00
    20131850 I V C $4,850.00
    20131868 FOLLOW-UP ANGIOGRAPHY $1,469.00
    20131876 ABD AOR-W RUNOFF $4,850.00
    20132056 FIRST ORDER ABD $1,525.00
    20132064 SECOND ORDER ABD $2,010.00
    20132072 THIRD ORDER ABD $2,240.00
    20132080 ADDITIONAL 2-3 ABD $400.00
    20132122 VEIN 1ST ORDER $3,000.00
    20132130 2ND ORDER VEIN $2,950.00
    20132148 RETROGRADE BRACHIAL $1,525.00
    20132155 EXTREMITY ARTERY $1,525.00
    20132171 CATH INTRO AORTA $1,525.00
    20132197 CATH SUPER/INFER VENA CAVA $2,960.00
    20132254 NEPH TRACT INJ PRO $4,150.00
    20132387 ADRENAL UNI ARTERY $4,850.00
    20132395 ADRENAL BI ARTERY $4,850.00
    20132403 PELVIC ARTERY $4,950.00
    20132411 PULMONARY BILAT $4,850.00
    20132445 NON DEF VESSEL $1,100.00
    20132452 EXTREM BI VEIN $2,000.00
    20132478 RENAL BI VEIN $4,850.00
    20132494 ADRENAL VEIN BI $4,950.00
    20132619 BIL DIL W STENT $7,400.00
    20132627 BIL DIL W/O STENT $4,000.00
    20132635 BILIARY DILATION $575.00
    20132882 REPOSITION CENTRAL LINE $1,900.00
    20133005 CHANGE GASTROSTOMY TUBE $1,000.00
    20133013 REPOSIT GI FEEDING TUBE DUOD $1,400.00
    20133088 PERICARDIOCENTESIS INITIAL $2,000.00
    20133096 PERICARDIOCENTSIS SUBSEQUENT $2,000.00
    20133138 HEPATIC W/O HEMODYNAMIC EVAL $4,850.00
    20133161 EXTREMITY UNI ARTY LT $4,850.00
    20133179 EXTREMITY UNI ARTY RT $4,850.00
    20133187 PULMONARY UNI LT $4,850.00
    20133195 PULMONARY UNI RT $4,850.00
    20133245 EXTREM UNI VEIN LT $1,250.00
    20133252 EXTREM UNI VEIN RT $1,250.00
    20133286 RENAL UNI VEIN LT $4,850.00
    20133294 RENAL UNI VEIN RT $4,850.00
    20133567 LOOPOGRAM $1,000.00
    20133575 LOOPOGRAM S&I $630.00
    20133674 NEPHOSTOGRAM LT $630.00
    20133690 EMBOLIZATION,CEREBRAL ANEURYSM $5,582.50
    20133989 DIALYSIS ACCESS DECLOTT W/BALL $6,850.00
    20133997 TUBE ABSCESSOGRAM $385.00
    20134003 S&I TUBE ABSCESSOGRAM $630.00
    20134029 DECLOT BY THROMBOLYTIC AGENT $915.40
    20134086 VENOGRAM INJ UNI LT $160.00
    20134094 VENOGRAM INJ UNI RT $160.00
    20134102 PULMONARY SECOND ORDER LT $900.00
    20134110 PULMONARY SECOND ORDER RT $900.00
    20134128 PULMONARY 3RD ORDER LT $900.00
    20134136 PULMONARY 3RD ORDER RT $900.00
    20134144 BRACEPH 1ST ORD LT $2,150.00
    20134151 BRACEPH 1ST ORD RT $2,150.00
    20134169 BRACEPH 2ND ORD LT $2,600.00
    20134177 BRACEPH 2ND ORD RT $2,600.00
    20134185 BRACEPH 3RD ORD LT $2,600.00
    20134193 BRACEPH 3RD ORD RT $2,600.00
    20134201 BRACHIO 2-3 ADD LT $350.00
    20134219 BRACHIO 2-3 ADD RT $350.00
    20134227 FIRST ORDER ABD LT $1,400.00
    20134235 FIRST ORDER ABD RT $1,400.00
    20134243 SECOND ORDER ABD LT $1,850.00
    20134250 SECOND ORDER ABD RT $1,850.00
    20134268 THIRD ORDER ABD LT $1,950.00
    20134276 THIRD ORDER ABD RT $1,950.00
    20134284 ADDITIONAL 2-3 ABD LT $350.00
    20134292 ADDITIONAL 2-3 ABD RT $350.00
    20134557 ABSCESS DRAIN CHANGE $2,800.00
    20134748 DISKOGRAPHY, CERV THOR S&I $4,850.00
    20134755 DISKOGRAPHY, CER THOR $526.00
    20134763 DISKOGRAPHY, LUMBAR S&I $4,850.00
    20134771 DISKOGRAPHY LUMBAR $1,875.00
    20134789 REPEAT DISKOGRAPHY CRV THRS S& $4,850.00
    20134847 INSERT NG TUBE $700.00
    20134862 INSERTION TUNNELED CATHETER $4,900.00
    20134870 INSERT TUNNELED CATH 2 SEPARAT $5,887.00
    20134888 INSERT PIC $2,000.00
    20134904 REPLACE CENTRAL CATHETER $3,552.50
    20134912 REPLACE TUNNELED CATH $4,900.00
    20134920 REPLACE PICC $2,000.00
    20134938 REMOVE TUNNEL CATH $960.00
    20134946 FLOURO GUIDANCE-VENOUS ACCESS $329.90
    20134953 CAROTID STENTING W/DISTAL PROT $13,195.00
    20134987 DRAIN GALLBLADDER $4,000.00
    20135001 ILIAC REVASC LT $10,000.00
    20135018 ILIAC REVASC W/STENT LT $19,270.00
    20135026 ILIAC REVASC ADD-ON LT $8,932.00
    20135034 ILIAC REVASC W/STENT ADD-ON LT $8,932.00
    20135042 FEM/POPL REVAS W/TLA LT $12,180.00
    20135059 FEM/POPL REVASC W/STENT LT $26,390.00
    20135067 TIB/PER REVASC W/TLA LT $18,000.00
    20135075 TIB/PER REVASC W/STENT LT $27,500.00
    20135083 TIB/PER REVASC ADD-ON LT $9,135.00
    20135091 REVSC OPN/PRQ TIB/PERO STENT L $12,180.00
    20135109 INJ CENTRAL VENOUS ACC DEVICE $710.50
    20135117 INS NON-TUNNEL CV CATH 5 YRS/> $1,650.00
    20135125 INS ENDOVAS VENA CAVA FILTR $7,205.00
    20135133 REDO ENDOVAS VENA CAVA FLTR $7,105.00
    20135141 REM ENDOVAS VENA CAVA FILTER $7,105.00
    20135158 INS CATH REN ARET 1ST UNILAT $5,227.30
    20135166 INS CATH REN ART 2ND + ULILAT $5,300.00
    20135174 INS CATH REN ART 1ST BILAT $5,227.30
    20135182 INS CATH REN ART 2ND + BILAT $5,227.30
    20135190 PLACE CATH THORACIC AORTA $5,481.00
    20135242 PLACE CATH XTRNL CAROTID RT $2,918.20
    20135257 PLACE CATH XTRNL CAROTID LT $2,918.20
    20135265 PLACE CATH INTRACRANIAL ART RT $2,918.20
    20135273 PLACE CATH INTRACRANIAL ART LT $2,918.20
    20135281 THROMBOLYTIC ART THERAPY $6,850.00
    20135299 THROMBOLYTIC VENOUS THERAPY $1,700.00
    20135307 THROMBLYTIC ART/VEN THERAPY $4,050.00
    20135315 CESSJ THERAPY CATH REMOVAL $4,050.00
    20135323 REMOVE INTRVAS FOREIGN BODY $5,650.00
    20135349 ART OCCLUSIVE DEVICE PLCMT $1,132.00
    20135356 ILIAC REVASC RT $10,000.00
    20135364 ILIAC REVASC W/STENT RT $18,750.00
    20135372 ILIAC REVASC ADD-ON RT $8,932.00
    20135380 ILIAC REVASC W/STENT ADD-ON RT $8,932.00
    20135398 FEM/POPL REVAS W/TLA RT $12,180.00
    20135406 FEM/POPL REVASC W/STENT RT $26,390.00
    20135414 TIB/PER REVASC W/TLA RT $18,000.00
    20135422 TIB/PER REVASC W/STENT RT $27,500.00
    20135431 TIB/PER REVASC ADD-ON RT $9,135.00
    20135448 REVSC OPN/PRQ TIB/PERO STENT R $12,180.00
    20135455 FEM/POPL REVAS W/ATHER $30,450.00
    20135463 VASC EMBOLIZ/OCCLUSION VEIN RT $17,000.00
    20135471 VASC EMBOLIZ/OCCLUSION VEIN LT $17,000.00
    20135489 VASC EMBOLIZ/OCCLUDE ARTERY RT $17,000.00
    20135497 VASC EMBOLIZ/OCCLUDE ARTERY LT $17,000.00
    20135505 VASC EMBOL/OCC TUMOR/INFARC RT $17,000.00
    20135513 VASC EMBOL/OCC TUMOR/INFARC LT $17,000.00
    20135521 VASC EMBOL/OCCLU HEMORRHAGE RT $17,000.00
    20135539 VASC EMBOL/OCCLU HEMORRHAGE LT $17,000.00
    20135547 VASC STENT INITIAL ARTERY RT $17,000.00
    20135554 VASC STENT INITIAL ARTERY LT $17,000.00
    20135562 VASCULAR STENT ADD ARTERY RT $8,932.00
    20135570 VASCULAR STENT ADD ARTERY LT $8,932.00
    20135588 VASCULAR STENT INITIAL VEIN RT $17,000.00
    20135596 VASCULAR STENT INITIAL VEIN LT $17,000.00
    20135604 VASCULAR STENT ADD VEIN RT $8,932.00
    20135612 VASCULAR STENT ADD VEIN LT $8,932.00
    20135620 US GUIDE VASCULAR ACCESS $93.00
    20135638 FEM/POPL REVASC STNT & ATHER $28,500.00
    20135646 TRANSCATH STENT CCA W/O EPS RT $11,672.50
    20135653 TRANSCATH STENT CCA W/O EPS LT $11,672.50
    20135661 PRIM ART MECH THROMBECTOMY $15,935.50
    20135679 PRIM ART M-THROMBECT ADD-ON $5,176.50
    20135687 SEC ART M-THROMBECT ADD-ON $10,759.00
    20135695 INJ CHOLANGIOGRAM EXIST ACCESS $5,100.00
    20135703 INJ CHOLANGIOGRAM NEW ACCESS $4,000.00
    20135711 PLMT BILIARY DRN CATH INT&EXT $4,000.00
    20135729 PLMT BILIARY DRN CATH EXTERNAL $6,000.00
    20135737 CONV BIL DR CATH EXT TO INT&EX $6,000.00
    20135745 EXCHANGE BILIARY DRAIN CATH $4,000.00
    20135752 REMOVAL BILIARY DRAIN CATH $1,700.00
    20135760 PRQ PLMT BILE DUCT STENT EXIST $7,400.00
    20135778 PRQ PLMT BILE DUCT STENT NEW A $7,400.00
    20135786 PRQ PLMT BILE DUCT STNT&CATH N $7,400.00
    20135794 INJ NEPHGRM&URETRGRM EXIST RT $1,600.00
    20135802 INJ NEPHGRM&URETRGRM EXIST LT $1,600.00
    20135810 INJ NEPHGRMS&URETRGRM NEW RT $1,600.00
    20135828 INJ NEPHGRM&URETRGRM NEW LT $1,600.00
    20135836 PLMT NEPHROSTOMY CATHETER RT $2,800.00
    20135844 PLMT NEPHROSTOMY CATHETER LT $2,800.00
    20135851 PLMT NEPHROURETERAL CATH NEW R $2,800.00
    20135869 PLMT NEPHROURETERAL CATH NEW L $2,800.00
    20135877 CONVERT NEPHROS CATH RT $1,700.00
    20135885 CONVERT NEPHROS CATH LT $1,700.00
    20135896 EXCHANGE NEPHROS CATH RT $1,700.00
    20135901 EXCHANGE NEPHROS CATH LT $1,700.00
    20135919 PLMT URETERAL STENT RT $4,500.00
    20135927 PLMT URETERAL STENT LT $4,500.00
    20135935 PLMT URET STNT W/O CATH NEW RT $4,500.00
    20135943 PLMT URET STNT W/O CATH NEW LT $4,500.00
    20135950 PLMT URET STNT W/CATH NEW RT $4,500.00
    20135968 PLMT URET STNT W/CATH NEW LT $4,500.00
    20135976 IVUS NONCORONARY EA ADD VESSEL $2,500.00
    20135984 IVUS NONCORONARY INITIAL VESSE $2,000.00
    20135992 TIB/PER REVAS W/ATHER $48,000.00
    20136008 ANGIO DIALYSIS CIRCUIT $1,365.00
    20136016 PTA DIALYSIS CIRCUIT $9,250.00
    20136024 STENT DIALYSIS CIRCUIT $18,000.00
    20136032 THROMBECTOMY DIALYSIS CIRCUIT $9,500.00
    20136041 THROMBECTOMY & PTA DIALYS CIRC $17,500.00
    20136057 THROMBCTMY & STNT DIALYSIS CIR $27,000.00
    20136065 PTA CENTRAL DIALYSIS SEGMENT $1,100.00
    20136073 STENT CENTRAL DIALYSIS SEGMENT $2,300.00
    20136081 EMBOL/OCCLUS DIALYSIS CIRCUIT $1,700.00
    20136099 PTA INITAL ARTERY $9,500.00
    20136107 PTA EACH ADDL ARTERY $600.00
    20136115 PTA INITIAL VEIN $9,500.00
    20136123 PTA EACH ADDL VEIN $600.00
    20136131 SP MOD SEDATION INITIAL 15 MIN $203.00
    20136149 SP MOD SEDATION EA ADDL 15 MIN $203.00
    20136156 PLACE CATH CAROTID/INOM ART RT $5,481.00
    20136164 PLACE CATH CAROTID/INOM ART LT $5,481.00
    20136172 PLACE CATH CAROTID/INOM ART RT $6,850.00
    20136181 PLACE CATH CAROTID/INOM ART LT $6,850.00
    20136198 PLACE CATH CAROTD ART RT $6,850.00
    20136206 PLACE CATH CAROTD ART LT $6,850.00
    20136214 PLACE CATH SUBCLAVIAN ART RT $4,850.00
    20136222 PLACE CATH SUBCLAVIAN ART LT $4,850.00
    20136231 PLACE CATH VERTEBRAL ART RT $8,678.30
    20136248 PLACE CATH VERTEBRAL ART LT $8,678.30
    20140091 VESSEL DILATOR $253.80
    20140463 IVC FILTER $5,075.00
    20140471 BALLOON INTRA AORTIC $1,624.00
    20140497 HYSTEROSALPINGOGRAPHY CATH $116.80
    20140505 ULTRA-THIN BALLOON $999.80
    20140521 SYMMETRY BALLOON $1,152.10
    20140539 BALLOON, XXL $1,243.40
    20140547 BLUE MAX BALLOON $1,202.80
    20140554 BALLOON, OCCLUSION $588.70
    20140562 ENCORE INFLATION DEVICE $329.90
    20140570 AMPLATZ SNARE $659.80
    20140612 URETERAL STENT $614.10
    20140620 NEPHRO-URETERAL STENT $304.50
    20140638 DRAINAGE CATH, APDL FLEXIMA $355.30
    20140646 MEWISSEN CATHETER $71.10
    20140661 TRACKER CATHETER $172.60
    20140679 GUIDE CATHETER-VISTABRITE $532.90
    20140703 PLATINUM PLUS GUIDEWIRE $279.20
    20140711 KATZEN GUIDEWIRE $172.60
    20140729 WHOLEY GUIDEWIRE $203.00
    20140737 TAD GUIDEWIRE $269.00
    20140745 TRACKER GUIDEWIRE $121.80
    20140786 COPE ACCESS SET $203.00
    20140794 GLIDEWIRE $96.50
    20140802 BALLOON DILIATION $984.60
    20140851 STENT, SELF EXPANDING SMART $5,481.00
    20140877 STENT,BILIARY,TRANSHEPATIC BIL $2,131.50
    20140935 STENT, BILIARY PALMAZ CORDIS $6,597.50
    20140943 PERCLOSE/ANGIOSEAL CLOSURE DEV $1,218.00
    20140984 FLEXMA BILIARY DRAIN $380.70
    20141057 WALLSTENT, RP TRACH $5,481.00
    20141073 COOK PIC $355.30
    20141107 CORONARY WIRE $1,979.30
    20141115 CORONARY GUIDECATH $1,319.50
    20141123 CORONARY/CAROTID BALLOON $1,705.20
    20141131 STENT NON-COA/NON-COV W/DEL $6,090.00
    20141149 FILTER WIRE $7,612.50
    20141156 CUTTING BALLOON $3,552.50
    20141164 ACCULINK/PRECISE STENT $9,947.00
    20141172 SYVEK/STASYS (PATCH) $243.60
    20141180 THROMBECT/EMBOLECTOMY CATH $2,476.60
    20141198 GUIDEWIRE (VIPER) $771.40
    20141206 ATHRECTOMY CATHETER $13,195.00
    20141214 VIPER SLIDE LUBRICANT $324.80
    20141222 DRUG ELUTING STENT VIABAHN $13,174.70
    20141230 STENT COATED/COV W/DEL SYS ICA $11,266.50
    20141248 CATHETER SUPPORT 0.018 $3,146.50
    20141255 CATH, TRANSLUMIN, DRUG-COAT $13,500.00
    20150116 PERC INSERT IN-AORTIC BALLOON $660.00
    20150124 INTRAVENT PACER $8,300.00
    20150132 INTRAAORTIC BALLOON $2,207.70
    20150272 SEL RT VENT OR RT ATRIAL ANGIO $913.50
    20150439 ACT (ACTIVATED CLOTTING TIME) $25.00
    20150462 DRUG ELUDING STENT $5,176.50
    20150471 LFT HRT ARTERY/VENTRICLE ANGIO $6,500.00
    20150488 LFT HRT ART/GRFT ANGIO $6,500.00
    20150496 INJECT SUPRVLV AORTOGRAPHY $786.70
    20150504 RT&LT HRT ART/VENTRICLE ANGIO $6,500.00
    20150512 RT&LT HRT ART/VENTRICLE ANGIO $6,500.00
    20150521 RIGHT HEART CATH $6,500.00
    20150538 CORONARY ARTERY ANGIO S&I $6,500.00
    20150546 CORONARY ART/GRFT ANGIO S&I $6,500.00
    20150553 INJECT PULM ART HRT CATH $862.80
    20150561 RENAL ANGIO CARDIAC CATH $532.90
    20150579 ILIAC ART ANGIO CARDIAC CATH $507.50
    20150587 PRQ CARD STENT W/ANGIO 1 VSL $17,000.00
    20150595 PRQ CARD REVASC MI 1 VSL $17,000.00
    20150603 PRQ CARD REVASC CHRONIC 1VSL $17,000.00
    20150611 PRQ CARD STENT W/ANGIO ADDL $13,195.00
    20150629 PRQ CARD REVASC CHRONIC ADDL $13,195.00
    20150637 PRQ CARDIAC ANGIOPLAST 1 ART $9,566.40
    20150645 PRQ CARDIAC ANGIO ADDL ART $9,566.40
    20150652 PRQ REVASC BYP GRAFT 1 VSL $17,000.00
    20150661 PRQ REVASC BYP GRAFT ADDL $13,195.00
    20150686 IV US CORONARY V; INITIAL $260.00
    20150694 IV US CORONARY V; EA ADDTL $243.60
    20150702 IV DOPPLER (FFR); INIT VESSEL $300.00
    20150710 IV DOPPLER (FFR); EA ADD VESSL $270.00
    20150728 IV US CATHETER $3,045.00
    20150736 FFR WIRE $2,821.70
    20150744 R HRT CORONARY ARTERY ANGIO $6,500.00
    20150751 C MOD SEDATION INIT 15 MIN $203.00
    20150769 C MOD SEDATION EA ADDL 15 MIN $203.00
    21010392 GATED BLOOD POOL FOR RT VEJ(AD $185.00
    21010418 HELICOBACTER PYLORI TEST $225.00
    21010426 H PYLORI BREATH TEST $45.00
    21020045 BLOOD FLOW STUDY TC $600.00
    21020128 THYROID SCAN TC $1,080.00
    21020433 ABSCESS WHOLE BODY LOC. $2,100.00
    21020573 RENAL SPECT 78710 $790.00
    21020599 BONE SPECT 78320 $700.00
    21020607 TUMOR SPECT 78803 $790.00
    21020649 CARD AV INF SPECT 78469 $890.00
    21020672 SPECT MYOCARD SINGL $2,100.00
    21020763 CARDIAC REST QUAN $1,318.00
    21020771 CARDIAC R/S QUAN $2,400.00
    21020862 ABSCESS SPECT $1,065.80
    21020896 GALLIUM SCAN W/TUMOR $2,100.00
    21020904 MECKLES DIVERT SC $600.00
    21020912 CARD GATED BLD PL SINGLE $600.00
    21020920 CARD SCAN AVID IN $600.00
    21020938 PERFUSION LUNG SC $600.00
    21020946 LIVER/SPLEEN SCAN $600.00
    21020961 BONE SCAN-PARTIAL $600.00
    21020979 HEPATOBILIARY SCAN $710.50
    21020987 CISTENOGRAPHY $790.00
    21020995 GI BLEEDING STUDY $600.00
    21021001 AEROSOL VENTILATION LUNG IMAGI $600.00
    21021019 THYROID CA SCAN $810.00
    21021027 RENAL SCAN W/FLOW GFR $790.00
    21021043 LIVER SPECT $700.00
    21021050 SPECT MYOCARD MULTI $2,025.00
    21021076 LYMPHOSCINTIGRAPHY $900.00
    21021084 LEVEEN SHUNT $600.00
    21021092 RENAL BASELINE $790.00
    21021118 BODY ABSCESS LIMITED $2,400.00
    21021126 VENT/PERFUSION LUNG SCAN $1,283.00
    21021142 HEMANGIOMA STUDY $900.00
    21021159 SALIVARY GLAND-SERIAL IMAGES $600.00
    21021167 SALIVARY GLAND-FUNCTION $600.00
    21021175 BONE MARROW-LIMITED AREA $600.00
    21021183 BONE MARROW-MULTIPLE AREAS $600.00
    21021191 RENAL W/ PHARM $790.00
    21021209 SENTINEL NODE INJECTION $850.00
    21021217 CARD GATED BLD PL MULTIPLE $820.00
    21021233 BONE SCAN WHOLE BODY $600.00
    21021241 TRIPHASIC BONE SCAN $600.00
    21030093 ADMIN. OF I-131, HYPERTHYROID $450.00
    21030101 I-131 CAP, DIAG PER MCI $270.00
    21030119 ADMIN OF I 131, THYROID METS $450.00
    21030127 SUBSEQ.TX,I-131 THROID CA $450.00
    21030150 HYPER THYROID TREATMENT $450.00
    21030184 I-123 THYROID SCAN $1,080.00
    21030192 ADMIN OF STRONTIUM $450.00
    21030200 ADMIN OF QUADRAMET TX $450.00
    21040142 I-123 THYROID IMAGING W/UP MUL $600.00
    21040167 I-123 THYROID UPTAKE ONLY,MULT $1,055.00
    21040183 TUMOR LOCAL/ONCOSCINCT $890.00
    21040209 TUMOR LOCAL SCAN/OCTREOTIDE $2,100.00
    21040217 TUMOR LOC WHOLE BODY NEO TECT $890.00
    21040225 MIBG SCAN $2,400.00
    21040233 NM GASTRIC EMPTYING STUDY $600.00
    21040241 PARATHYRD PLANAR W/WO SUBTRJ $710.00
    21040266 PARATHYROID PLANAR NO SPECT $600.00
    21050018 TC 99M DTPA $258.90
    21050026 TECHNETIUM $180.00
    21050034 TC 99 MEDRONATE UP TO 30 MCI $157.40
    21050042 TC 04-TAG RBC $304.50
    21050059 TC 99M PYP $401.00
    21050067 GALLIUM 67 PER MCI $796.80
    21050083 I-123 CAP $532.90
    21050091 TC 99M SULFER COLLOID $153.30
    21050109 THALLOUS CHLORIDE 201 P MCI $203.00
    21050117 TC 99 ALBUMIN AGGR PER VIAL $395.90
    21050133 CYANOCOBALAMIN COBALT CO 57 $289.30
    21050166 INDIUM 111 OXINE 0.5 MCI $1,216.90
    21050182 STRONTIUM 89 TX $6,090.00
    21050190 SATUMOMAB PENTETIDE PER DOSE $3,933.10
    21050216 IN 111 OCTREOSCAN $6,318.40
    21050224 CARDIOLITE $350.00
    21050240 TC 99M CERETEC $3,679.40
    21050257 TC 99M HMPAO WBC $3,679.40
    21050265 TC 99M MYOVIEW $285.00
    21050273 TC 99M NEUROLITE $812.00
    21050281 COLD PYP $304.50
    21050307 COLLOIDAL P-32 PER MCI $1,650.00
    21050323 INDIUM IN 111 CAPROMAB PENDETI $8,120.00
    21050331 99M TC GLUCOHEPTONATE $37.60
    21050349 TC-MAG3 $723.00
    21050372 NEO TECT $1,218.00
    21050380 I-131CAP WHOLE BODY CAPSOL $609.00
    21050398 I-131 CAP, DIAG PER MCI $82.00
    21050422 SINCALIDE (KINEVAC) INJ $275.00
    21050430 IODINE I-131 IODIDE CAP DX $270.00
    21050448 INPT STAY RADIOLABELED ITEM $1.60
    21050455 SM 153 LEXIDRONAM UP TO 150 MC $20,500.00
    21050463 I-123 IOBEGUANE UP TO 15MCI $13,195.00
    21050471 TC99M SUCCIMER < 10 MCI $2,030.00
    21050489 TC99M MEBROFENIN=< 15 MCI $152.30
    21050497 LYMPHOSEEK $1,449.50
    21050505 AXUMIN F18 10 MCI $16,380.00
    21050588 PERC CORON THROMBECTOMY $8,120.00
    21060017 LUNG-VENT KIT $142.10
    21070107 FDG-PER DOSE (4-4OMCI/ML) $558.30
    21070388 CARDIAC PET METABOL EVAL $4,567.50
  • Pet Scans

    Service Code Description Price
    21070404 PET W/CT SKULL-THIGH(INITIAL) $5,582.50
    21070412 PET W/CT FULL BODY(INITIAL) $7,105.00
    21070453 PET W/CT, SKULL-THIGH(RESTAGE) $5,582.50
    21070479 PET W/CT, FULL BODY (RESTAGE) $7,105.00
    21070498 PET SCAN, INCOMPLETE $4,060.00
    21070545 BRAIN PET; METABOLIC EVAL $3,030.00
    21070552 SODIUM FLUORIDE F-18 =< 30 MCI $1,300.00
    21070561 PET SKELETAL (INITIAL) $7,105.00
    21070578 PET SKELETAL (RESTAGE) $7,105.00
  • Ultrasound

    Service Code Description Price
    22010011 US THYROID/NECK $280.00
    22010037 US LIVER TC $280.00
    22010045 US GALLBLADDER TC $280.00
    22010060 US PANCREAS TC $280.00
    22010078 US KIDNEYS/BLADDER $280.00
    22010110 US ABD AO $280.00
    22010128 US PREG > 14 WKS $280.00
    22010144 US PELVIS TC $280.00
    22010185 US ABD COMP $286.00
    22010201 US SCROTUM TC $280.00
    22010235 US ABD LMTD $280.00
    22010243 US GUIDANCE $400.00
    22010433 US SPLEEN $280.00
    22010441 US TRANSVAGINAL $280.00
    22010466 US FETAL BPP W/O STRESS TEST $280.00
    22010474 US CHEST $226.00
    22010482 US PORT KIDNEY $280.00
    22010524 US PARACENTESIS $2,588.30
    22010532 US PREG MULT > 14 WKS $550.00
    22010565 US PREG LIMITED $280.00
    22010631 US PROSTATE TRANSRECTAL $280.00
    22010649 US ABDOMINAL DUPLEX $634.40
    22010680 US PSEUDOANEURYSM $650.00
    22010714 US PREG REPEAT $226.00
    22010722 US PROSTATE BX $3,290.00
    22010748 US RLQ $280.00
    22010789 US GB LIMITED PORT $280.00
    22010797 US ABDOMEN PORTABLE $286.00
    22010805 US PANCREAS PORT $280.00
    22010813 US LIVER PORT $280.00
    22010821 US ABD AORTA PORT $280.00
    22010839 US RUQ PORT $280.00
    22010847 US RUQ $280.00
    22010854 US KIDNEYS & AORTA $280.00
    22010870 US LIVER BIOPSY $1,800.00
    22010912 US THORACENTESIS LT $975.00
    22010920 US THORACENTESIS RT $975.00
    22010938 US REANL CYST ASP LT $1,750.00
    22010946 US REANL CYST ASP RT $1,750.00
    22010979 US EXTREMITIES LT $226.00
    22010987 US EXTREMITIES RT $226.00
    22010995 US BX RENAL LT $2,550.00
    22011001 US BX RENAL RT $2,550.00
    22011019 US BX THYROID LT $1,050.00
    22011027 US BX THYROID RT $1,050.00
    22011035 US BREAST ASP ADD LT $130.00
    22011043 US BREAST ASP ADD RT $130.00
    22011118 USDRAIN/INJ MAJOR JNT/BURSA LT $410.00
    22011126 USDRAIN/INJ MAJOR JNT/BURSA RT $410.00
    22011134 US BREAST CYST ASP - LT $960.00
    22011142 US BREAT CYST ASP - RT $960.00
    22011159 US KIDNEY LT $280.00
    22011167 US KIDNEY RT $280.00
    22011209 US KIDNEY TRANS LT $456.80
    22011217 US KIDNEY TRANS RT $456.80
    22011225 US BLADDER PVR $250.00
    22011274 US BX/REMOVAL LYMPH NODES $1,850.00
    22011282 US KIDNEYS $280.00
    22011290 US BLADDER $226.00
    22011308 US PREG < 14 WKS $285.00
    22011316 US PREG MULT < 14 WKS $200.00
    22011324 US PREG TV < 14 WKS $300.00
    22011357 US PREG REPEAT EA ADD FETUS $226.00
    22011365 US RENAL ARTERY DOPPLER $426.30
    22011373 US RENAL VEIN DOPPLER $426.30
    22011399 US (ABI) ART BILAT LOW LTD $253.80
    22011407 US ART BILAT LOW-COMPLETE $329.90
    22011415 US ART UNI LOW-COMPLETE $253.80
    22011423 US ART BIL UPP COMPLETE $329.90
    22011431 US ART DUPLEX LOW UNI $294.40
    22011449 US ART DUPLEX UPP UNI $304.50
    22011456 US CAROTID ART DUPLEX $492.30
    22011464 EXERCISE DOPPLER-LOWER EXT $355.30
    22011472 VENOUS DUPLEX LOWER EXT BILAT $487.20
    22011480 VENOUS DUPLEX LOWER EXT-UNI $324.80
    22011498 VENOUS DUPLEX UPPER EXT-BILAT $487.20
    22011506 VENOUS DUPLEX UPPER EXT-UNI $324.80
    22011514 VENOUS MAPPING UNILATERAL $77.00
    22011530 US PUNCT ASP - ABSC HEMAT CYST $520.00
    22011555 US BX OF SALIVARY GLAND RT $1,750.00
    22011563 US DRAINAGE CATH UNDER RX $385.00
    22011589 US BX SALIVARY GLAND LT $1,750.00
    22011597 US DUPLEX BILAT UPPER ARTERIAL $456.80
    22011605 US DUPLEX BILAT LOWER ARTERIAL $460.00
    22011613 DUPLEX HEMODIALYSIS ACCESS $380.60
    22011621 US GUIDANCE INTRAOPERATIVE $538.00
    22011639 US NUCHAL TRANSLUCENCY $335.00
    22011647 US NUCHAL TRANSLUCENCY MULTIPL $187.80
    22011654 US BX SOFT TISSUE NECK/THORAX $1,850.00
    22011696 US LUNG BX RT $1,850.00
    22011704 US LUNG BX LT $1,850.00
    22011712 US SPINE CANAL AND CONTENTS $250.00
    22011720 US I-CAROTID DUP LMTD $406.00
    22011738 US DUPLEX A,IVC,IL/BPG;COMPL $456.80
    22011746 US AAA SCREEN $265.00
    22011787 US MUSCLE BX; PERC NDL $1,850.00
    22011795 US FINE NEEDLE ASPIRATION $1,050.00
    22011803 US KIDNEYS/BLADDER 2 $280.00
    22011829 US ART LTD LOW $253.80
    22011837 US ART UNI UPPER COMPLETE $253.80
    22011845 US ART BILAT LOW w/MOD $329.90
    22011852 US ART LTD LOW, w UPPER CMPLT $253.80
    22011861 US ART LTD BILAT LOW w/MOD $253.80
    22011878 US ART CMPLT UNI LOW, W/MOD $253.80
    22011944 US BX TESTIS, NEEDLE $2,650.00
    22011951 US BONE BX TR/NDL;SUPERF $1,850.00
    22011977 VESSEL MAP HEMODIALYSIS ACCESS $812.00
    22011985 US BREAST NEEDLE LOC INIT LT $955.00
    22011993 US BREAST NEEDLE LOC INIT RT $955.00
    22012009 US BREAST CLIP INITIAL LT $955.00
    22012017 US BREAST CLIP INITIAL RT $955.00
    22012025 US BREAST NEEDLE LOC ADDL LT $406.00
    22012033 US BREAST NEEDLE LOC ADDL RT $406.00
    22012041 US BREAST CLIP ADDL LT $406.00
    22012058 US BREAST CLIP ADDL RT $406.00
    22012066 US BREAST BX INITIAL LESION LT $1,800.00
    22012074 US BREAST BX INITIAL LESION RT $1,800.00
    22012082 US BREAST BX ADDL LESION LT $735.90
    22012090 US BREAST BX ADDL LESION RT $735.90
    22012108 US DRAIN PERI/RETRO ABSCESS $2,550.00
    22012165 US INJ PERC EXTR ANEURYSM $1,200.00
    22012173 US DRN/INJ MAJOR JNT/BURSA W/L $410.00
    22012181 USDRN/INJ MAJOR JNT/BURSA W/R $410.00
    22012199 US LONG HEAD OF BICEPS INJ RT $410.00
    22012207 US LONG OF HEAD BICEPS INJ LT $410.00
    22012215 US INS MARK THOR FOR RDT PERQ $3,950.00
    22012314 US MAMMOSITE CATHETER PLACE $14,500.00
    22012331 US SOFT TISSUE LOC, INITIAL $1,200.00
    22012348 US SOFT TISSUE LOC, EA ADDL $640.00
    22012355 US MOD SEDATION INITIAL 15 MIN $203.00
    22012363 US MOD SEDATION EA ADDL 15 MIN $203.00
    22012371 US BONE DENSITY-BMD $226.00
    22012389 US OPTHALMIC $280.00
    22012397 US BX PANCREAS, PERCUTANEOUS $2,700.00
    22012405 US PARACENTESIS W ALBUMIN $2,588.30
    22050017 US BREAST CORE BX NEEDLE $30.50
    22050025 US PROSTATE CORE BX NEEDLE $45.70
    22050033 PRECUT BIOPSY TRAY $50.80
    22050041 THORA/PARACENTESIS TRAY $81.20
    22050066 ENDOCAVITY NEEDLE GUIDE KIT $66.00
    22050074 H/S CATHETER SET $66.00
    22050082 BREAST MARKING SYSTEM-SUPPLY $40.60
    22050090 US BPP-MULT GEST $280.00
    22050124 TISSUE MARKER $335.00
    22050132 INTRODUCER LOCALIZATION SET $761.30
    22050141 USDRAIN/INJ INTERM JNT/BURSALT $1,100.00
    22050157 USDRAIN/INJ INTERM JNT/BURSTRT $1,110.00
    22050165 US AXILLA RT $226.00
    22050173 US AXILLA LT $226.00
    22050181 US BREAST COMPLETE RT $226.00
    22050199 US BREAST COMPLETE LT $226.00
    22050207 US BREAST LIMITED RT $180.00
    22050215 US BREAST LIMITED LT $180.00
    22050223 MAMMOSITE CATHETER $9,600.00
    22050231 US DRAIN SOFT TISS FLUID COLL $1,250.00
    22050249 US THORACENTESIS W/CATH PLC LT $2,300.00
    22050256 US THORACENTESIS W/CATH PLC RT $2,300.00
    22050264 LIMITED DUPLEX AO IVC ILIAC $200.00
    22050272 US VENOUS BILATERAL LIMITED $324.80
  • Cat Scans

    Service Code Description Price
    23010010 CT HEAD W/CONTRAST $964.30
    23010028 CT HEAD WO/CONTRAST $791.70
    23010036 CT HEAD W/WO CONTRAST $1,167.30
    23010044 CT SOFT TISS NECK;W/O CONTRST $791.70
    23010051 CT SOFT TISSUE NECK;W/CONTRAST $964.30
    23010069 CT SFT TISS NCK; W/O&W/CONTRST $1,167.30
    23010242 CT ORBIT,SELLA WO/CONTRAST $862.80
    23010259 CT ORBIT,SELLA W/CONTRAST $964.30
    23010267 CT ORBIT,SELLA W/WO CONTRAST $1,167.30
    23010275 CT PF,MID IN EAR WO/CONTRAST $862.80
    23010283 CT PF,MID IN EAR W/CONTRAST $964.30
    23010291 CT PF,MID IN EAR W/WO CONTRAST $1,167.30
    23010309 CT MAXILLOFACIAL WO/CONTRAST $791.70
    23010317 CT MAXILLOFACIAL W/CONTRAST $964.30
    23010325 CT MAXILLOFACIAL W/WO CONTRAST $1,167.30
    23010366 CT DORSAL SPINE WO/CONTRAST $791.70
    23010374 CT DORSAL SPINE W/CONTRAST $964.30
    23010382 CT DORSAL SPINE W/WO CONTRAST $1,167.30
    23010481 CT COR/SAG/RECON $725.80
    23010507 CT ABD W/ CONTRAST $1,218.00
    23010531 CT ABD W/O CONTRAST $964.30
    23010564 CT ABD W/WO CONTRAST $1,421.00
    23010614 CT CHEST W/ CONTRAST $964.30
    23010671 CT CHEST W/WO CONTRAST $1,167.30
    23010705 CT PELVIS W/ CONTRAST $964.30
    23010739 CT PELVIS W/O CONTRAST $791.70
    23010762 CT PELVIS W/WO CONTRAST $1,167.30
    23010796 CT CERV SPINE W/ CONTRAST $964.30
    23010820 CT CERV SPINE W/O CONTRAST $791.70
    23010853 CT CERV SPINE W/WO CONTRAST $1,167.30
    23010887 CT LUMB SPINE W/ CONTRAST $964.30
    23010911 CT LUMB SPINE W/O CONTRAST $791.70
    23010945 CT LUMB SPINE W/WO CONTRAST $1,167.30
    23010978 CT GUID NEEDLE PLACEMENT $1,289.10
    23010986 CT BX-ABD/RETRO $1,850.00
    23010994 CT BX PANCREAS, PERCUTANEOUS $2,700.00
    23011000 CT BX LUNG $1,850.00
    23011018 CT BX-BONE DEEP $2,550.00
    23011026 CT BX-BONE SUPER $1,850.00
    23011034 CT BX LIVER $1,850.00
    23011042 CT BX-MUSCLE $1,850.00
    23011067 CT BIOPSY-RENAL $2,550.00
    23011125 CT RETROPERITONEAL $2,842.00
    23011141 CT PERIRENAL/RENAL $3,145.00
    23011174 CT UPPER EXT W/CONTRAST RT $964.30
    23011182 CT UPPER EXT W/WO CONTRAST LT $1,167.30
    23011190 CT UPPER EXT W/WO CONTRAST RT $1,167.30
    23011208 CT LOWER EXT WO/CONTRAST LT $862.80
    23011216 CT LOWER EXT WO/CONTRAST RT $862.80
    23011224 CT LOWER EXT W/CONTRAST LT $1,015.00
    23011232 CT LOWER EXT W/CONTRAST RT $1,015.00
    23011240 CT LOWER EXT W/WO CONTRAST LT $1,202.80
    23011257 CT LOWER EXT W/WO CONTRAST RT $1,202.80
    23011307 CT GUIDED NERVE BLOCK-LUMBAR $1,350.00
    23011331 CT GUIDANCE FOR DRAINAGE $639.50
    23011349 CTA NECK W/WO CONTRAST $1,167.30
    23011356 CT THORACENTESIS RT $975.00
    23011364 CT THORA W/TUBE THERAPUTIC RT $975.00
    23011372 CT CHEST TUBE/PNEUMO RT $975.00
    23011380 CT ABSCESS DRAIN/PLEURAL RT $975.00
    23011455 CT PARACENTESIS $2,588.30
    23011471 CT ABSCESS DRAIN TUBE CHANGE $2,650.00
    23011505 CT THORACENTESIS LT $975.00
    23011513 CT THORA W/TUBE THERAPUTIC LT $975.00
    23011521 CT CHEST TUBE/PNEUMO LT $975.00
    23011539 CT ABSCESS DRAIN PLEURAL LT $975.00
    23011562 CT INJ SI JNT;ANES&/TX AGT&ART $1,811.80
    23011570 CT BX SOFT TISSUE NECK OR THOR $1,850.00
    23011588 CTA UP EXT W/WO CONTRAST LT $1,167.30
    23011596 CTA LW EXT W/WO CONTRAST RT $1,355.10
    23011604 CTA UP EXT W/WO CONTRAST RT $1,167.30
    23011612 CTA ABD W/WO CONTRAST $1,522.50
    23011620 CTA LW EXT W/WO CONTRAST LT $1,355.10
    23011638 CTA PELVIS W/WO CONTRAST $1,167.30
    23011646 CTA CHEST W/WO CONTRAST $964.30
    23011653 CTA HEAD W/WO CONTRAST $1,167.30
    23011661 CT THORAX W/O CONTRAST $791.70
    23011687 CT STERNUM(THORAX)WO CONTRAST $791.70
    23011695 CT HEART WO DYE; QUAL CALC $253.80
    23011703 CT HEART W/WO DYE FUNCT $964.30
    23011711 CCTA W/WO DYE $1,431.20
    23011752 CCTA W/WO DISEASE STRXR $1,334.80
    23011976 CTA WITH RUNOFFS $1,953.90
    23011984 CT DRAIN/INJ MAJOR JNT/BURSA $410.00
    23011992 CT FINE NEEDLE ASPIRATION W/GU $1,050.00
    23020019 CT CORE NEEDLE BIOPSY KIT $152.30
    23020027 CT INJECTOR SYRINGES $30.50
    23020035 CT ACUPLACE STEREOTACTIC GUIDE $76.20
    23020423 CT 3D RENDER W/O POSTPROCESS $340.10
    23020464 CT ABD & PELVIS WO CONTRAST $1,532.00
    23020472 CT ABD & PELVIS W CONTRAST $2,257.00
    23020481 CT ABD & PELVIS W & WO CONTRAS $2,628.00
    23020498 CT PELVIS WO & ABD W CONTST $2,650.00
    23020506 CT PELVIS WO & ABD W&WO CONTST $2,650.00
    23020514 CT PELVIS W & ABD WO CONTRAST $2,650.00
    23020522 CT PELVIS W & ABD W&WO CONTRAS $2,628.00
    23020531 CT PELVIS W&W/O & ABD WO CONTR $2,650.00
    23020548 CT PELVIS W&W/O & ABD W CONTRA $2,650.00
    23020779 CT ANGIO ABD&PELV W/O&W/DYE $2,233.00
    23020787 CT HEAD/STROKE W/O CONTRAST $791.70
    23020795 CTA STROKE HEAD W/WO CONTRAST $1,167.30
    23020803 CTA STROKE NECK W/WO CONTRAST $1,167.30
    23020837 CT THORAX WO CONTRAST $791.70
    23020845 CT DRAIN VISCERAL RT $2,000.00
    23020852 CT DRAIN VISCERAL LT $2,000.00
    23020860 CT DRAIN PERI/RETRO RT $2,450.00
    23020878 CT DRAIN PERI/RETRO LT $2,450.00
    23020886 CT SIJ INJ ARTHGRM/ANESTH/STE $1,015.00
    23020894 CT ENTEROGRAPHY $2,270.00
    23020902 CT UPPER EXT WO/CONTRAST LT $791.70
    23020910 CT UPPER EXT WO/CONTRAST RT $791.70
    23020928 CT CHEST W/O CONTRAST $791.70
    23020936 CT UPPER EXT W/CONTRAST LT $964.30
    23020944 CT INS MARK THOR FOR RDT PERQ $3,950.00
    23021033 CT LUNG CA SCREENING LOW DOSE $275.00
    23021091 CT MOD SEDATION EA ADDL 15 MIN $203.00
    23021108 PNEUMOTHORAX CATHETER SET $469.32
    23021116 CT MOD SEDATION INITIAL 15 MIN $203.00
    23021124 CT INS MARK ABD FOR RDT PERQ $2,350.00
    23021132 MARKERS, FIDUCIAL FOR RDT $1,500.00
    23021181 CT STERNUM W/ CONTRAST $964.30
    23021215 CT LUNG CA LOW DOSE FOLLOWUP $600.00
  • Portable X-Rays

    Service Code Description Price
    24000036 PORTABLE ABD SERIES W 1V CHEST $226.00
    24000044 PORTABLE ANKLE(ROUTINE)4V LT $126.00
    24000051 PORTABLE ANKLE 2V RECHECK LT $126.00
    24000069 PORTABLE ANKLE 2 VIEW LT $126.00
    24000077 PORTABLE ANKLE(ROUTINE)4V RT $126.00
    24000085 PORTABLE ANKLE(2V)RECHECK RT $126.00
    24000093 PORTABLE ANKLE 2 VIEW RT $126.00
    24000168 PORTABLE CLAVICLE LT $126.00
    24000176 PORTABLE CLAVICLE RT $126.00
    24000184 PORTABLE ELBOW(ROUTINE) LT $126.00
    24000192 PORTABLE ELBOW(2VIEW)LT $126.00
    24000200 PORTABLE ELBOW(RECHECK) LT $126.00
    24000218 PORTABLE ELBOW (ROUTINE) RT $126.00
    24000226 PORTABLE ELBOW (2 VIEW) RT $126.00
    24000234 PORTABLE ELBOW(RECHECK) RT $126.00
    24000242 PORTABLE THUMB LT $126.00
    24000259 PORTABLE THUMB RT $126.00
    24000267 PORTABLE FINGER 2ND LT $126.00
    24000275 PORTABLE FINGER 2ND RECHECK LT $126.00
    24000283 PORTABLE FINGER 2ND RT $126.00
    24000291 PORTABLE FINGER 2ND RECHECK RT $126.00
    24000309 PORTABLE FINGER 3RD LT $126.00
    24000317 PORTABLE FINGER 3RD RECHECK LT $126.00
    24000325 PORTABLE FINGER 3RD RT $126.00
    24000333 PORTABLE FINGER 3RD RECHECK RT $126.00
    24000341 PORTABLE FINGER 4TH LT $126.00
    24000358 PORTABLE FINGER 4TH RECHECK LT $126.00
    24000366 PORTABLE FINGER 4TH RT $126.00
    24000374 PORTABLE FINGER 4TH RECHECK RT $126.00
    24000382 PORTABLE FINGER 5TH LT $126.00
    24000390 PORTABLE FINGER 5TH RT $126.00
    24000408 PORTABLE FINGER 5TH RECHECK RT $126.00
    24000416 PORTABLE FACIAL BONES(PARTIAL $126.00
    24000465 PORTABLE FOOT LT-3 VIEW $126.00
    24000473 PORTABLE FOOT LT (2 VIEW) $126.00
    24000481 PORTABLE FOOT(RECHECK) LT-2 V $126.00
    24000499 PORTABLE FOOT RT-3 VIEW $126.00
    24000507 PORTABLE FOOT RT (2 VIEW) $126.00
    24000515 PORTABLE FOOT(RECK) RT-2V $126.00
    24000523 PORTABLE FOREARM LT $126.00
    24000531 PORTABLE FOREARM(RECHECK) LT $120.00
    24000549 PORTABLE FOREARM RT $126.00
    24000556 PORTABLE FOREARM(RECHECK) RT $126.00
    24000564 PORTABLE HAND LT-3 VIEW $126.00
    24000572 PORTABLE HAND LT (2 VIEW) $226.00
    24000580 PORTABLE HAND(RECK) LT-2 VIEW $226.00
    24000598 PORTABLE HAND RT $126.00
    24000606 PORTABLE HAND RT (2 VIEW) $226.00
    24000614 PORTABLE HAND(RECK) RT-2 VIEW $226.00
    24000622 PORTABLE OS CALCIS/HEEL LT $126.00
    24000630 PORTABLE OS CALCIS/HEEL RT $126.00
    24000705 PORTABLE HUMERUS LT $126.00
    24000713 PORTABLE HUMERUS(RECHECK) LT $126.00
    24000721 PORTABLE HUMERUS RT $126.00
    24000739 PORTABLE HUMERUS(RECHECK) RT $126.00
    24000747 PORTABLE KNEE 4 OR MORE VWS LT $226.00
    24000754 PORTABLE KNEE(2VIEW) LT $126.00
    24000770 PORTABLE KNEE(2 V)RECHECK LT $126.00
    24000788 PORT KNEE 4 OR MORE VWS RT $226.00
    24000796 PORTABLE KNEE(2 VIEW) RT $126.00
    24000812 PORTABLE KNEE(2VIEW)RECHECK RT $126.00
    24000820 PORTABLE LOWER EXT INFANT LT $126.00
    24000838 PORTABLE LOWER EXT INFANT RT $126.00
    24000846 PORTABLE LOWER LEG LT $126.00
    24000853 PORTABLE LOWER LEG(RECHECK)LT $126.00
    24000861 PORTABLE LOWER LEG RT $126.00
    24000879 PORTABLE LOWER LEG(RECHECK)RT $126.00
    24000887 PORTABLE LUMBAR (AP/LAT) $226.00
    24000895 PORTABLE NASAL BONES $126.00
    24000903 PORTABLE NECK SOFT TISSUE $126.00
    24000911 PORTABLE PELVIS $226.00
    24000945 PORT RIBS(UNILATERAL) LT $126.00
    24000952 PORTABLE RIBS(UNILATERAL)RT $126.00
    24000960 PORTABLE RIBS (BILATERAL) $226.00
    24000978 PORTABLE SCAPULA LEFT $226.00
    24000986 PORTABLE SCAPULA RT $226.00
    24000994 PORTABLE SHOULDER 2 VIEW LT $126.00
    24001000 PORT SHOULDER(RECHECK 2V)LT $126.00
    24001018 PORTABLE SHOULDER 2 VIEW RT $126.00
    24001026 PORT SHOULDER(RECHECK 2V)RT $126.00
    24001034 PORTABLE SKULL 2 VIEWS PARTIAL $226.00
    24001042 PORTABLE SPINE 1 VIEW $126.00
    24001059 PORTABLE TOE 1ST LT $126.00
    24001067 PORTABLE TOE 1ST RECHECK LT $126.00
    24001075 PORTABLE TOE 1ST RT $126.00
    24001083 PORTABLE TOE 1ST RECHECK RT $126.00
    24001091 PORTABLE TOE 2ND LT $126.00
    24001109 PORTABLE CERVICAL (AP/LAT) $190.00
    24001117 PORTABLE TOE 2ND RECHECK LT $126.00
    24001125 PORTABLE TOE 2ND RT $126.00
    24001133 PORTABLE TOE 2ND RECHECK RT $126.00
    24001141 PORTABLE TOE 3RD LT $126.00
    24001158 PORTABLE TOE 3RD RECHECK LT $126.00
    24001166 PORTABLE TOE 3RD RT $126.00
    24001174 PORTABLE TOE 3RD RECHECK RT $126.00
    24001182 PORTABLE TOE 4TH LT $126.00
    24001190 PORTABLE TOE 4TH RECHECK LT $126.00
    24001208 PORTABLE TOE 4TH RT $126.00
    24001216 PORTABLE TOE 4TH RECHECK RT $126.00
    24001224 PORTABLE TOE 5TH LT $126.00
    24001232 PORTABLE TOE 5TH RECHECK LT $126.00
    24001240 PORTABLE TOE 5TH RT $126.00
    24001257 PORTABLE TOE 5TH RECHECK RT $126.00
    24001265 PORTABLE THORACIC SPINE $226.00
    24001273 PORTABLE THORACIC SP 2 VIEW $226.00
    24001281 PORTABLE UPPER EXT INFANT LT $226.00
    24001299 PORTABLE UPPER EXT INFANT RT $226.00
    24001307 PORTABLE WRIST ROUTINE LT-4V $126.00
    24001315 PORTABLE WRIST 2 VIEW LT $126.00
    24001323 PORTABLE WRIST RECHECK LT-2V $126.00
    24001331 PORTABLE WRIST ROUTINE RT-4V $126.00
    24001349 PORTABLE WRIST 2 VIEW RT $126.00
    24001356 PORTABLE WRIST RECHECK RT-2V $126.00
    24001364 PORTABLE THUMB RECHECK RT $126.00
    24001372 PORTABLE THUMB RECHECK LT $126.00
    24001380 PORTABLE FINGER 5TH RECHECK LT $126.00
    24001398 OR PORT ANKLE 2 VIEWS LT $126.00
    24001406 OR PORT ANKLE 2 VIEWS RT $120.00
    24001422 OR PORT CLAVICLE LT $126.00
    24001430 OR PORT CLAVICLE RT $126.00
    24001448 OR PORT ELBOW(2VIEW)LT $126.00
    24001455 OR PORT ELBOW (2 VIEW) RT $126.00
    24001463 OR PORT FINGER LT 1 $126.00
    24001471 OR PORT FINGER RT 1 $126.00
    24001489 OR PORT FINGER 2ND LT $126.00
    24001497 OR PORT FINGER RT 2 $126.00
    24001505 OR PORT FINGER 3RD LT $126.00
    24001513 OR PORT FINGER 3RD RT $126.00
    24001521 OR PORT FINGER LT 4 $126.00
    24001539 OR PORT FINGER RT 4 $126.00
    24001547 OR PORT FINGER 5TH LT $126.00
    24001554 OR PORT FINGER 5TH RT $126.00
    24001588 OR PORT FOOT LT (2 VIEW) $126.00
    24001596 OR PORT FOOT RT (2 VIEW) $126.00
    24001604 OR PORT FORARM LT $126.00
    24001612 OR PORT FOREARM RT $126.00
    24001620 OR PORT HAND LT (2 VIEW) $226.00
    24001638 OR PORT HAND RT (2 VIEW) $226.00
    24001646 OR PORT OS CALCIS/HEEL LT $126.00
    24001653 OR PORT OS CALCIS/HEEL RT $126.00
    24001661 OR PORT HUMERUS LT $126.00
    24001679 OR PORT HUMERUS RT $126.00
    24001687 OR PORT KNEE(2VIEW) LT $126.00
    24001695 OR PORT KNEE(2 VIEW) RT $126.00
    24001703 OR PORT LOWER LEG LT $126.00
    24001711 OR PORT LOWER LEG RT $126.00
    24001729 OR PORT LUMBAR (AP/LAT) $226.00
    24001737 OR PORT PELVIS $226.00
    24001745 OR PORT SCAPULA LEFT $226.00
    24001752 OR PORT SCAPULA RT $226.00
    24001760 OR PORT SHOULDER 2 VIEW LT $126.00
    24001778 OR PORT SHOULDER 2 VIEW RT $126.00
    24001786 OR PORT TOE 1ST LT $126.00
    24001802 OR PORT TOE 2ND LT $126.00
    24001810 OR PORT CERVICAL (AP/LAT) $190.00
    24001820 OR PORT TOE 2ND LT $126.00
    24001828 OR PORT TOE 2ND RT $126.00
    24001836 OR PORT TOE 3RD LT $126.00
    24001844 OR PORT TOE 3RD RT $126.00
    24001851 OR PORT TOE 4TH LT $126.00
    24001869 OR PORT TOE 4TH RT $126.00
    24001877 OR PORT TOE 5TH LT $126.00
    24001893 OR PORT THORACIC SP 2 VIEW $226.00
    24001919 OR PORT WRIST 2 VIEW RT $126.00
    24001943 OR PORT SPINE 1 VIEW $126.00
    24001976 PORTABLE XRAY SHOULDER RT, 1V $126.00
    24001984 PORTABLE XRAY SHOULDER LT 1 V $126.00
    24001992 OR ERCP $340.00
    24002016 OR SHOULDER 1V,LT $126.00
    24002024 OR SHOULDER 1V,RT $126.00
    24002040 OR PORT WRIST 2 VIEW LT $126.00
    24002057 OR PORT TOE 1ST RT $126.00
    24002065 OR PORT TOE 5TH RT $126.00
    24002073 OR PORT NECK SOFT TISSUE $126.00
    24002081 PORTABLE HIP UNI 1 VIEW RT $126.00
    24002099 PORTABLE HIP UNI 1 VIEW LT $126.00
    24002107 OR PORT HIP UNI 1 VIEW LT $126.00
    24002115 OR PORT HIP UNI 1 VIEW RT $126.00
    24002123 PORTABLE HIP UNI 2-3 VIEWS RT $126.00
    24002131 PORTABLE HIP UNI 2-3 VIEWS LT $126.00
    24002149 OR PORT HIP UNI 2-3 VIEWS RT $126.00
    24002156 OR PORT HIP UNI 2-3 VIEWS LT $126.00
    24002164 PORTABLE HIPS BI 2 VIEWS $255.00
    24002172 OR PORT HIPS BI 2 VIEWS $255.00
    24002180 PORTABLE HIPS 3-4 VIEWS $250.00
    24002198 OR PORT HIPS 3-4 VIEWS $250.00
    24002206 PORTABLE FEMUR 1 VIEW RT $126.00
    24002214 PORTABLE FEMUR 1 VIEW LT $126.00
    24002222 OR PORT FEMUR 1 VIEW RT $126.00
    24002230 OR PORT FEMUR 1 VIEW LT $126.00
    24002248 PORTABLE FEMUR 2+ VIEWS RT $126.00
    24002255 PORTABLE FEMUR 2+ VIEWS LT $126.00
    24002263 OR PORT FEMUR 2+ VIEWS RT $126.00
    24002271 OR PORT FEMUR 2+ VIEWS LT $126.00
    24002289 PORTABLE CHEST, 1 VIEW $126.00
    24002297 PORTABLE CHEST, 2 VIEWS $126.00
    24002305 PORTABLE CHEST, 3 VIEWS $260.00
    24002313 PORTABLE CHEST, 4 OR MORE VIEW $255.00
    24002321 OR PORT CHEST, 1 VIEW $126.00
    24002339 OR PORT CHEST, 2 VIEWS $126.00
    24002347 OR PORT CHEST, 3 VIEWS $135.00
    24002354 OR PORT CHEST, 4 OR MORE VIEWS $255.00
    24002362 PORTABLE ABDOMEN, 1 VIEW $150.00
    24002371 PORTABLE ABDOMEN, 2 VIEWS $275.00
    24002388 PORTABLE ABDOMEN,3 OR MORE VWS $265.00
    24002396 OR PORT ABDOMEN, 1 VIEW $150.00
    24002404 OR PORT ABDOMEN, 2 VIEWS $275.00
    24002412 OR PORT ABDOMEN,3 OR MORE VWS $265.00
  • Radiation Therapy

    Service Code Description Price
    27010073 CENTRAL AXIS DEPTH $310.00
    27010172 SPECIAL DOSIMETRY $310.00
    27010180 SIMPLE BLOCK $310.00
    27010198 COMPLEX IRR BLOCK $800.00
    27010297 SIMPLE RADIOELEMT $1,300.00
    27010321 RADIOISOTOPE HANDLING $170.00
    27010347 INFUSION RADIOISO $675.00
    27010354 INTER INTRACAVITA $1,300.00
    27010362 COMPLEX INTRACAVI $1,775.00
    27010388 COMPLEX INTERSTIT $1,775.00
    27010453 SP TX MANAGEMENT $1,300.00
    27010461 TELETHER PORT PLN $800.00
    27010495 PHYSIC CONSULT $310.00
    27010503 SP PHYSIC CONSULT $310.00
    27010529 SMPLE RAD SIM AFS $370.00
    27010545 COMPLEX RADSIM $1,150.00
    27010644 SIMPLE RAD TREAT DEL >= 1 MEV $430.00
    27010669 COMP RAD TREAT DEL >= 1 MEV $560.00
    27010693 THER RAD PORT IMAGES $40.00
    27010750 ADMIN OF RADIOPHARM. THERAPY $590.00
    27010768 3D RADIOTHERAPY PLAN INCL D-V $3,000.00
    27010818 CT SIM $980.00
    27010834 IMRT PLANNING $4,000.00
    27010859 ULTRASONIC GUIDANCE FOR XRT $842.50
    27010867 MLC DESIGN FOR IMRT, PER PLAN $1,436.30
    27010875 HDR BRACHYTX 1 CHANNEL $1,775.00
    27010883 HDR BRACHYTX 2-12 CHANNEL $3,714.90
    27010891 BRACHTX NON-STR HDR IR-192 $800.00
    27010909 UNLISTED PROCEDURE $310.00
    27010917 CENTRL AXIS DEPTH-76 MODIFIER $310.00
    27010925 HDR BRACHYTX 2-12 CHNL 76 MOD $3,714.90
    27010933 SMPLE RAD SIM AFS 76 MODIFIER $370.00
    27010941 SRS LINEAR BASED 1 SESSION-CRA $18,710.00
    27010958 SBRT DELIVERY PER FRACTION-BOD $13,068.20
    27010966 INTRAFRACTION TRACK MOTION,EA $842.50
    27010974 STEREOSCOPIC X-RAY GUIDANCE $842.50
    27010982 SBRT MANAGEMENT $4,136.20
    27011030 INSERT VAG BRACHYTX DEVICE $1,320.00
    27011055 RESPIRATORY MOTION MGMT STIMUL $1,600.00
    27011113 INSERT UTERI TANDEM/OVOIDS $5,620.00
    27011139 INTER BRACH ISO INCL CALC $1,218.00
    27011147 SIMPLE BRACHY ISO INCL CALC $1,200.00
    27011154 COMPLX BRACHY ISO INCL CALC $1,471.80
    27011162 COMPLEX ISODOSE INCL CALC $1,065.80
    27011170 SIMPLE ISODSE PLN INCL CALC $862.80
    27011188 SIMPLE IMRT DELIVERY $1,903.20
    27011196 COMPLEX IMRT DELIVERY $2,182.30
    27011212 BRACHY GUIDING TUBE (RING) $1,120.00
    27011220 BRACHY NEEDLE $125.00
    27011238 COMP RAD TREAT DEL 76 MOD $560.00
    27011246 IGRT 59 MODIFIER $842.50
    27011253 DIRECT LARYNGOSCOPY $3,275.00
    27011261 INDIRECT LARYNGOSCOPY $390.00
    27011279 LARYNGOSCOPY FLEX; DIAGNOSTIC $390.00
    27011295 GOLD FIDUCIAL MARKER $320.00
    27020395 NEW PT LIMITED OFFICE SVC $285.00
    27020403 O/P OFF VISIT NEW PT DETAILED $293.00
    27020411 O/P OFF VISIT NEW PT MOD COMP $308.00
    27020429 O/P OFF VISIT EST PT EXPANDED $285.00
    27020437 O/P OFF VISIT PT MOD COMPLX $293.00
    27020445 O/P OFF VISIT EST PT COMPLX $308.00
    27020585 EST PT DETAILED OFFICE SVC $268.00
    27020601 NEW PT EXPANDED OFFICE SVC $268.00
    27020619 NEW PT HIGHLYCOMPLEX OFFICE S $338.00
    27020627 EST PT LIMITED OFFICE SVC $285.00
    27020817 HDR SKIN SURFACE LESION < 2CM $800.00
    27020825 HDR SKIN SURFACE LESION >2CM $800.00
  • Vaccinations/Contrast Materials

    Service Code Description Price
    31004989 PNEUMOVAX VACCINE $235.20
    31004997 TETANUS IMMUNE GLOBULIN INJ $1,385.20
    31005002 RABIES IMMUNE GLOBULIN(RIG)2ML $1,923.50
    31005010 IMOVAX RABIES VACCINE 2.5IU $1,547.04
    31005044 DIPTHERIA/TETANUS PEDIATRIC $181.10
    31005069 HEP-B-GAMMAGEE INJ 5ML $3,699.60
    31005077 MENOMUNE A/C/Y/W-135 $593.00
    31005085 ENGERIX-B 10MCG/0.5ML $235.30
    31005093 INFLUENZA VACCINE-PF SYRINGE $45.70
    31005101 DIPHTH,PERTUSS,ADELL TETANUS $153.20
    31005119 VARICELLA VACCINE(VARIVAX)1350 $479.60
    31005127 HEPATITIS A VACCINE (VAQTA) $382.20
    31005135 OMNISCAN 20ML VIAL-RADIOLGY $188.70
    31005151 OMNISCAN 15 ML VIAL-Radiology $196.40
    31005168 OMNIPAQUE 350MG/100ML RADIOLOG $491.73
    31005176 OMNIPAQUE 350, 500ML RADIOLGY $1,264.50
    31005184 VAQTA 25 UNITS/0.5 ML VIAL $157.60
    31005192 I-MAGNEVIST(BAYER) 5ML VIAL469 $107.70
    31005200 I-MAGNEVIST(BAYER)15ML VIAL 46 $265.00
    31005218 I-MAGNEVIST(BAYER)20ML PRE FIL $349.10
    31005226 I-ULTRAVIST(BAYER)300MG/ML 50M $123.00
    31005234 I-ULTRAVIST(BAYER)300MG/ML 100 $245.70
    31005242 I-ULTRAVIST(BAYER)300MG/ML 150 $368.40
    31005259 BOOSTRIX PFS TIP LOK 0.5ML $192.80
    31005267 TENIVAC TETANUS DIP. TOXOID $107.70
    31005275 BOOSTRIX VACCINE VIAL 0.5ML $188.20
    31005283 FLUVIRIN VACCINE PFS 45MCG/.5M $52.30
    31005291 FLUARIX VACCINE 0.5ML SYRINGE $52.30
    31005309 APLISOL PPD (TB) INJ $32.00
    31005317 INFLUENZA VACCINE-VIAL $45.70
    31005325 PREVNAR 13 PFS 0.5 ML $678.70
    31005333 DEXAMETHASONE 10MG ADMIX BAG $22.90
    31005341 NORMAL SALINE 50ML BAG $12.54
    31005366 MULTIHANCE INJ 529MG 15ML $414.70
    31005374 EOVIST INJ 10ML $665.10
    31005382 LEVOPHED SDV 1MG/ML 4ML $53.80
    31005391 DEXTROSE 5% WATER 250ML $25.60
    31005408 MENVEO VACCINE A-C-Y 135 DIP V $268.00
    31005416 BEXSERO PFS 1 IU 0.5ML $392.00
    31005424 FLUZONE HIGH DOSE SYRINGE 0.5M $150.08
    31005441 FLUARIX QUADRIVALENT 0.5ML SYR $80.72
    31005473 RABAVERT RABIES VACCINE VIAL $1,385.52
    31005481 DOTAREM VIAL 15ML-RADIOLOGY $362.16
    31005499 OMNIPAQUE 300, 100 ML-RADIOLOG $471.38
    31005507 VISIPAQUE 320, 50 ML-RADIOLOGY $68.52
    31005515 VISIPAQUE 320MG/ML, 100ML-RADI $600.00
    31005523 SODIUM CHLORIDE 0.9% 10ML-RADI $4.00
    31005531 OMNIPAQUE 350 MG/ML,150ML-RADI $725.00
    31005549 OMNIPAQUE 240 MG/ML, 50ML-RADI $200.00
    31005556 OMNIPAQUE 300, 50-RADIOLOGY $440.00
    31005564 FLUAD TRIVALENT VACCINE $157.40
    31005572 FLULAVAL QUADRIVALENT VACCINE $80.12
    31005581 GADAVIST 7.5 ML--RADIOLOGY $298.80
    31005606 XYLOCAINE 1% 20 ML VIAL $48.00
    31005614 0.9% SODIUM CHLORIDE 250ML BAG $21.00
    31005648 NAROPIN 0.5% 5MG/ML 30ML $271.00
    31005655 DURAMORPH AMP 1MG/ML 10 ML $83.00
    35010016 RECOVERY ROOM $558.90
    35010024 BLOOD DRAW FROM VAD $201.00
    35010032 INJECTION, SQ, IM $138.70
    35010040 IV THERAPY 1ST HOUR $427.50
    35010057 IV THERAPY EA ADD HOUR $226.30
    35010065 IV MEDICATION PUSH $360.00
    35010073 INSERTION FOLEY CATH-STRAIGHT $201.00
    35010081 INSERT FOLEY CATH-INDWELLING $201.00
    35010099 CPR $465.00
    36010031 RECOVERY ROOM PER HOUR $710.50
    36010049 FETAL MONITOR NON STRESS $305.00
    36010106 CIRCUMCISION $3,290.00
  • Observation Services

    Service Code Description Price
    39010400 OBSERVATION CARE - LOW $80.10
    39010418 OBSERVATION CARE - MODERATE $89.40
    39010426 OBSERVATION CARE - HIGH $98.50
    39010434 EXTENDED RECOVERY ROOM $42.60
    39010459 OBSERVATION COND CODE 44 $98.50
    39010483 THERAPEUTIC PLASMA EXCHANGE $2,250.00
    39010640 THER/PROPH/DIAG INJ SC/IM $138.70
    39010657 THER/PROPH/DIAG INJ IV PUSH $360.00
    39010665 TX/PRO/DX INJ NEW DRUG ADD ON $151.20
    39010673 THER/PROPH/DIAG IV INF INIT $427.50
    39010681 THER/PROPH/DIAG IV INF ADD ON $226.30
    39010699 HYDRATION IV INFUSION INIT $360.00
    39010707 HYDRATION IV INFUSION ADD ON $83.40
    39010715 TX/PROPH/DG ADDL SEQ IV INF $128.40
    39010723 TX/PROPH/DG ADDL CONCURRENT IV $82.30
    39010731 TX/PRO/DX INJ SAME DRUG ADON $162.40
    39010749 TRANSFUSION, BLOOD OR BLD COMP $650.00
    39010756 PROCEDURE-SIMPLE, OBSERVATION $672.00
    39010764 PROCEDURE-INTERIM, OBSERVATION $1,142.50
    39010772 THER/PROPH/DIAG IV INF INIT=<1 $427.50
    39400031 LEVEL 1 NEW PATIENT $243.00
    39400049 LEVEL 1 NEW PT W/PROCEDURE $243.00
    39400056 LEVEL II NEW PATIENT $268.00
    39400064 LEVEL II NEW PT W/PROCEDURE $268.00
    39400072 LEVEL III NEW PATIENT $293.00
    39400080 LEVEL III NEW PT W/PROCEDURE $293.00
    39400106 LEVEL IV NEW PATIENT $308.00
    39400114 LEVEL IV NEW PT W/PROCEDURE $308.00
    39400122 LEVEL V NEW PATIENT $338.00
    39400130 LEVEL V NEW PT W/PROCEDURE $338.00
    39400148 LEVEL I ESTABLISHED PATIENT $218.00
    39400155 LEVEL I EST PT W/PROCEDURE $218.00
    39400171 LEVEL II ESTABLISHED PATIENT $243.00
    39400189 LEVEL II EST PT W/PROCEDURE $243.00
    39400197 LEVEL III ESTABLISHED PATIENT $268.00
    39400205 LEVEL III EST PT W/PROCEDURE $268.00
    39400213 LEVEL IV ESTABLISHED PATIENT $293.00
    39400221 LEVEL IV EST PT W/PROCEDURE $293.00
    39400247 LEVEL V ESTABLISHED PATIENT $308.00
    39400254 LEVEL V EST PT W/PROCEDURE $308.00
    39400262 IV THERAPY NON CHEMO 1ST HOUR $427.50
    39400270 IV THERAPY NON CHEMO EA ADD HR $226.30
    39400288 BLOOD DRAW FROM VAD $201.00
    39400296 BLOOD TRANSFUSION $650.00
    39400312 NON CHEMO INJ; SQ, IM $138.70
    39400320 NON CHEMO IV PUSH $360.00
    39400346 PARACENTESIS $1,852.00
    39400387 THERAPEUTIC PHLEBOTOMY W/ORW/O $272.10
    39400395 THORACENTESIS $1,200.00
    39400411 INJECTION IM FLU;NO MD;NO E&M $69.80
    39400429 INJ IM PNEUMONIA;NO MD;NO E&M $69.80
    39400437 INJ IM HEPATITIS B;NO MD $107.00
    39400445 INSERT PICC LINE $2,000.00
    39400452 REPAIR PICC LINE $1,550.00
    39400460 REPLACE PICC LINE; SAME SITE $2,000.00
    39400486 THER/PROPH/DIAG INJ ADD-ON $151.20
    39400494 HYDRATION IV INF,INITIAL $360.00
    39400502 HYDRATION IV INF, ADD-ON $83.40
    39400510 IRRIG DRUG DELIVERY DEVICE $138.80
    39400528 COLLECT BLOOD FROM PICC $201.00
    39400536 DECLOT VASCULAR DEVICE $915.40
  • Operating Room/Supplies

    Service Code Description Price
    40010167 OP SURGICAL ROOM $462.90
    40010316 SDS-RECOVERY ROOM PER HOUR $69.90
    40010357 ECT $1,800.60
    40010373 CONSCIOUS SEDATION IV,IM,INHAL $201.20
    40010456 OR SET UP CHARGE $1,200.00
    40010464 OR EACH 15 MIN LEVEL 1 $600.00
    40010472 OR EACH 15 MIN LEVEL 2 $850.00
    40010480 OR EACH 15 MIN LEVEL 3 $1,250.00
    40010498 OR EACH 15 MIN LEVEL 4 $1,600.00
    40020026 AMB PH GASTRIC MONITORING $832.00
    40020042 ESOPHAGEAL MOTILITY $832.00
    40020059 LES IDENTIFICATION $113.30
    40030025 CASSETTES DRAPE SMALL $17.30
    40030080 ACUCISE PROCEDURAL PACK $7,060.10
    40030116 SCREW - CLASS 2 $274.10
    40030124 SCREW, CANCELLOUS $274.10
    40030215 PLATE - CLASS 1 $522.40
    40030223 NARROW COMP PL 6-7 HOLE $590.90
    40030397 SM FRAG PL 2.7MM 5 HOLE $274.10
    40030405 SM FRAG PL 2.7MM 7 HOLE $274.10
    40030587 FIXATION STAPLER $89.40
    40030637 STEINMAN PINS/K-WIRES $274.10
    40030736 BONE CEMENT $342.90
    40030744 DISP BOWL AND SPATULA $26.50
    40030785 RUSH PINS LARGE $274.10
    40030991 SCREW, CORTICAL TITANIUM $274.10
    40031072 CANNULA, ARTHROSCOPE $109.90
    40031098 SAW BLADE, DISPOSABLE-CLS 1 $152.30
    40031148 ARTHROSCOPE FILTER $245.90
    40031502 ARTHROSCOPE BLADE $194.40
    40031577 CANCELLOUS BONE/CHIPS 30 CC $2,284.90
    40031643 FIXATOR, EXTERNAL SET $6,302.80
    40031692 KNEE, TOTAL $11,000.00
    40031718 ARTHROFLOW SYSTEM $218.40
    40031726 K.I.S.S. KNEE POSTIONER $194.40
    40031791 PLC75 LINEAR CUTTER $1,269.50
    40031809 CR 75 CARTRIDGE $636.70
    40031841 SCREW - CLASS 6 $868.40
    40031858 SCREW - CLASS 8 $1,142.50
    40031866 PLUG BONE CEMENT $332.70
    40031882 DRILL & PIN SET $502.80
    40031916 JACOB CHUCK 3.2MM DRILL BT $284.70
    40031924 DRILL BIT, CANULATED-CLS 2 $1,713.80
    40031965 STERNAL SAW BLADE $211.60
    40031973 PODIATRY DRILL BITS $85.90
    40031981 SAW BLADES, PODIATRY $245.90
    40032005 CABLES, ORTHOPEDIC $1,685.20
    40032120 SHOULDER SUSPENSION KIT $443.80
    40032153 ANCHOR-ARTHROSCOPIC $1,938.40
    40032161 DISP ARTHROSCOPIC DRAPE PACK $131.60
    40032294 ARTHRAX ARTHRO-WAND $331.50
    40032328 HOOK BLADE $834.70
    40032344 ELECTRODE, MITEK $1,005.50
    40032377 HIP PREP KIT $1,139.30
    40032393 STERILE TOURNIQUET $45.90
    40032419 OSI SHOULDER KIT $228.60
    40032484 SYNTHESIS ORIF HIP $3,574.70
    40032518 DON JOY KNEE IMMOBILIZER $376.00
    40032526 MITEK CANNULA W OBTURATOR $52.80
    40032542 HIP, BI-POLAR $9,700.00
    40032559 ORTHOPEDIC HOOD $129.30
    40032575 SURGICAL FIBRILLAR $283.50
    40032583 GPS SYSTEM/FLOSEAL $1,713.80
    40032591 KYPHOPLASTY CEMENT KIT $946.10
    40032609 KYPHOPLASTY KIT $17,935.70
    40032617 KYPHON BONE BIOPSY DEVICE $685.60
    40032625 SCREW - CLASS 4 $579.50
    40032633 PLATE, LOCKING $732.70
    40032666 NEEDLE, JAM SHIDI $97.40
    40032674 KYPHOPAK 2ND FX KIT $11,424.10
    40032682 USS SURGICAL ANCHOR SYSTEM $1,160.90
    40032690 SCREWS, OSTEOMED/NEURO $595.30
    40032708 US SURGICAL ANCHORS $1,160.90
    40032716 ACL RECONSTRUCTION KIT $3,400.00
    40032724 CROSS PIN KIT $1,233.30
    40032757 BUTTON, FIXATION $274.10
    40032765 BUTTON, ENDO $1,171.30
    40032773 AQUAMANTYS BIPOLAR DEVICE $2,170.70
    40032781 EXPRESS SEW $525.70
    40032799 BOLT, LOCKING-TROCHANTERIC $612.10
    40032807 TROCHANTERIC NAIL $5,735.00
    40032815 HELICAL BLADE (TROCH NAIL SYS) $2,570.60
    40032823 SCREW - CLASS 5 $742.70
    40032831 SCREW - CLASS 7 $936.90
    40032849 PLATE - CLASS 3 $777.00
    40032856 PLATE - CLASS 7 $2,256.50
    40032864 PLATE - CLASS 6 $1,339.20
    40032872 PLATE - CLASS 5 $1,182.60
    40032880 SCREW, SHAFT $274.10
    40032898 WASHER, ORTHOPEDIC $274.10
    40032906 HIP, BIRMINGHAM $24,700.00
    40032914 HIP, UNIPOLAR $8,900.00
    40032922 HIP, OXINIUM $14,700.00
    40032930 HIP, CERAMIC $18,400.00
    40032948 KNEE, HI-FLEX $12,100.00
    40032955 KNEE, UNI $15,536.80
    40032963 KNEE, JOURNEY $16,793.30
    40032971 KNEE, OXINIUM $12,600.00
    40032989 SHOULDER, TOTAL $23,990.40
    40032997 SHOULDER, PARTIAL $13,600.00
    40033003 FIBERWIRE/ORTHO CORD $274.10
    40033011 DURASEALENT-CLS 1 $856.90
    40033029 DURASEALENT-CLS 2 $4,312.00
    40033060 BONE FILLER/PUTTY(ALLOMATRIX)1 $2,284.90
    40033078 BONE FILLER/PUTTY(ALLOMATRIX)2 $3,455.90
    40033086 BONE FILLER/PUTTY(ALLOMATRIX)3 $4,055.60
    40033094 BONE FILLER/PUTTY CLS 4 $4,352.70
    40033102 BONE FILLER/PUTTY(ALLOMATRIX)5 $6,254.80
    40033110 BONE CEMENT W/ANTIBIOTIC $1,531.10
    40033128 TENDON, TIBIAL ANTERIOR $15,556.00
    40033151 DRILL BIT, CANULATED-CLS 1 $600.10
    40033169 PODIATRY BURR $280.10
    40033177 DRILL BIT/TAP-CLS 1 $2,330.70
    40033185 DRILL BIT/TAP-CLS 2 $457.20
    40033193 GUIDEWIRE-TROCH NAIL SYS $400.10
    40033201 GUIDE/GLIDE WIRE-CLS 2 $314.40
    40033219 KYPHON INFLATION SYRINGE $548.60
    40033227 KYPHON DIRECTIONAL BALLOON $5,483.70
    40033235 ABLATOR, LIGHTWAVE $388.70
    40033243 SUTURE PASSER $217.30
    40033250 SUTURE RETRIEVER $466.90
    40033268 MENISCAL APPLIER $548.60
    40033276 FAST FIX DELIVERY SYSTEM $1,336.80
    40033284 FAST FIX KNOW PUSHER $479.90
    40033292 RESERVOIR (OMMAYA) $782.70
    40033300 LAPROSCOPIC GEL PORT $2,422.00
    40033326 BONE FILLER/PUTTY(ALLOMATRIX)6 $1,142.50
    40033334 PELVIC SLING-CLS1 $4,991.20
    40033342 PELVIC SLING-CLS 2 $6,876.70
    40033359 TOE IMPLANT $3,655.80
    40033368 HIP, METAL ON METAL $29,702.30
    40033376 SHOULDER, REVERSE $46,152.80
    40033392 KNEE, HI-FLEX $17,364.50
    40033409 HIP, CERAMIC ON CERAMIC $24,675.80
    40033417 PLATE - CLASS 12 $7,425.70
    40033425 SCREW - CLASS 10 $1,769.20
    40033433 RADIAL HEAD OR STEM (ELBOW) $9,538.60
    40033441 CAPSTONE CAGE $16,038.10
    40033459 SCREW - CLASS 13 $4,569.80
    40033467 ROD, LUMBAR $600.00
    40033475 PLATE - CLASS 13 $8,873.10
    40033482 FEMORAL SHAFT $8,134.20
    40033490 PLATE, DISTAL RADIUS $7,711.30
    40033491 PELVIC SLING-CLS 3 $9,316.70
    40033508 CATHETER, SINUS BALLOON $3,936.20
    40033516 GUIDE WIRE, SINUE ILLUMINATED $2,153.70
    40033524 CATHETER, FRONTAL SINUS GUIDE $1,860.90
    40033532 CATHETER HANDLE, SINUE GUIDE $277.10
    40033541 BALLOON INFLATION DEVICE,SINUS $376.40
    40033557 THD HEMORRHOID DEVICE $1,986.40
    40033565 ULTRASONIC GUIDANCE FOR OR $400.00
    40033573 TENEX DISPOSABLE PACK $2,943.50
    40033581 TOTAL HIP PACK KIT $1,672.80
    40033599 TOTAL KNEE PACK KIT $1,463.70
    40033607 WC SPEC ORD/IMPLANTS CAT 1 $1,000.00
    40033615 WC SPEC ORD/IMPLANTS CAT 2 $2,000.00
    40033623 WC SPEC ORD/IMPLANTS CAT 3 $3,000.00
    40033631 WC SPEC ORD/IMPLANTS CAT 4 $4,000.00
    40033649 WC SPEC ORD/IMPLANTS CAT 5 $5,000.00
    40033656 WC SPEC ORD/IMPLANTS CAT 6 $10,000.00
    40033664 WC SPEC ORD/IMPLANTS CAT 7 $15,000.00
    40033672 WC SPEC ORD/IMPLANTS CAT 8 $20,000.00
    40033681 WC SPEC ORD/IMPLANTS CAT 9 $25,000.00
    40033698 WC SPEC ORD/IMPLANTS CAT 10 $30,000.00
    40033706 WC SPEC ORD/IMPLANTS CAT 11 $40,000.00
    40033714 WC SPEC ORD/IMPLANTS CAT 12 $50,000.00
    40033722 WC SPEC ORD/IMPLANTS CAT 13 $60,000.00
    40033731 WC SPEC ORD/IMPLANTS CAT 14 $75,000.00
    40033748 WC SPEC ORD/IMPLANTS CAT 15 $99,000.00
    40033763 GRAFTJACKET 4X7CM $9,938.90
    40033771 CAM WALKING BOOT $696.00
    40033789 CANCELLOUS BONE/CHIPS 15CC $948.00
    40033797 PLATE - CLASS 2 $650.00
    40033805 PLATE - CLASS 4 $975.00
    40033813 PLATE - CLASS 8 $3,500.00
    40033821 PLATE - CLASS 9 $4,500.00
    40033839 PLATE - CLASS 10 $5,500.00
    40033847 PLATE - CLASS 11 $6,500.00
    40033854 PLATE - CLASS 14 $10,000.00
    40033862 PLATE - CLASS 15 $11,000.00
    40033871 SCREW - CLASS 1 $153.50
    40033888 SCREW - CLASS 3 $425.00
    40033896 SCREW - CLASS 9 $1,450.00
    40033904 SCREW - CLASS 11 $2,500.00
    40033912 SCREW - CLASS 12 $3,500.00
    40033921 SCREW - CLASS 14 $5,500.00
    40033938 SCREW - CLASS 15 $6,500.00
    40033946 BIOVANCE 4X4 CM $8,700.00
    40033953 INTERFYL 100 MG $5,500.00
    40033961 INTERFYL FLOWABLE 1.5ML SYRING $9,200.00
    40033979 KNOTLESS ROPE SYNDESMOSIS $3,520.00
    40033987 FOOT & ANKLE KIT SCP $13,180.00
    40033995 REAMER - CLASS 1 $650.00
    40034001 REAMER - CLASS 2 $850.00
    40034019 REAMER - CLASS 3 $1,050.00
    40034027 FLIPCUTTER $1,300.00
    40034035 INTERNAL BRACING LIGAMENT SYST $4,148.00
    40034043 SYNDESMOSIS REPAIR IMPLANT $3,520.00
    40034051 PERITONEAL DIALYSIS CATHETER $1,900.00
    40034068 TROCAR STYLETTE $1,900.00
    40034076 STRAIGHTENING STYLETTE $260.00
    40034084 TITANIUM ADAPTOR $500.00
    40034092 EVARREST SEALANT PATCH $3,600.00
    40034101 REVERSE TOTAL SHOULDER $33,000.00
    40034118 SERENGETI MI RS DBL DIAMOND $960.00
    40034126 PERC LAMINECTOMY ONE LEVEL KIT $8,620.00
    40034134 PERFECT SCALPEL $1,576.00
    40034142 SYNDESMOSIS IMPLANT SYSTEM $9,400.00
    40034159 ARTIFICIAL DISC $16,020.00
    40034167 CRYONEVROLYSIS DEVICE CODE $1,600.00
    40034175 CRYONEVROLYSIS BLOCK RT $2,000.00
    40034183 CRYONEVROLYSIS BLOCK LT $2,000.00
    40034217 IVAS KIT $4,050.00
    40034225 10 GAUGE DRILL $240.00
    40034233 10 GAUGE FILLER $220.00
    40034241 10 GAUGE BIOPSY $280.00
    40034258 AUTOPLEX w/HV CEMENT $3,048.00
    40040040 BSS 250CC $442.40
    40040156 EYE CAUTERY $37.90
    40040263 EYE SHEILD PLASTIC $15.10
    40040438 NASAL SPLINT-DENVER $188.70
    40040560 MYOCURE PHACO KERATOME BLADE $72.20
    40040693 ALCON VITRECTOMY HANDPIECE $380.60
    40040735 LENS, INTRAOCCULAR $772.50
    40040743 EYE PIK PAK - M $985.00
    40040750 EYE PIK PAK - G $626.30
    40040776 ARTHROCARE COBLATOR II WAND $868.40
    40040784 LENS, ANTERIOR CHAMBER $685.60
    40040792 EYE OCUTOME PROBE $754.20
    40040800 EYE ABS HANDPIECE $182.90
    40040818 EYE STABILIZER RING $914.20
    40040826 EAR BURR $627.30
    40040834 MYRINGOTOMY TUBE-JAHN $548.60
    40040842 NASAL SEPTAL BUTTON $508.60
    40040859 IMPLANT SYNTHETIC VOCAL CORD $1,202.80
    40040867 NEEDLE BIOFORM RIGIN INJECTION $280.10
    40040875 RADIESSE VOICE GEL $1,254.60
    40040883 RADIUS VOICE $1,254.60
    40040891 RIGID INJ NEEDLE (VOCAL INJ) $280.10
    40050106 SAUVAGE FABRIC $964.30
    40050130 CAROTID SHUNT $263.00
    40050148 EMBOLECTOMY CATHETER $507.50
    40050213 INTRODUCER $274.40
    40050395 PERITONEAL ACSS CATH EXTERNAL $731.30
    40050528 HIP, TOTAL $12,900.00
    40050627 MIXING CHAMBER $228.60
    40050635 CEMENT MIXER W/NOZZLE (HIP) $457.20
    40050759 DIALYSIS CATHETER $565.70
    40050866 ELECTRODE,LOOP -CLS 1 $360.20
    40050874 HEMASHIELD GRAFTS-CLASS 1 $2,451.80
    40050999 MEADOX TEFLON FELT $154.40
    40051039 VALVULOTOME $2,284.90
    40051047 MEDOX CARDIOVASC PATCH $1,400.00
    40051054 SELDINGER ENTRY NEEDLE #44-163 $12.80
    40051062 PINNACLE INTRODUCER SHEATH $37.90
    40051278 PACEMAKER LEAD-ATRIAL $3,139.50
    40051286 PACEMAKER LEAD-VENTRICULAR $3,139.50
    40051302 TESIO CATH GUIDEWIRE $135.00
    40051310 STAPLER, HAND PIECE $426.30
    40051328 US SURG GIA RELOAD $1,543.60
    40051450 BARD OPTI-FLO CUFFED CATHETER $1,312.80
    40051468 BOSTON SCIENTIFIC TORQUE DEVIC $40.20
    40051492 BARD IMPRA GRAFT F7007TW $3,227.50
    40051500 BARD IMPRA GRAFT F7006TW $3,227.50
    40051518 BARD IMPRA GRAFT F8006TW $3,913.00
    40051526 BARD IMPRA GRAFT F4006TW $2,227.90
    40051534 BARD IMPRA GRAFT F70T7-4 $3,570.20
    40051542 BARD IMPRA GRAFT CF5006 $2,342.20
    40051559 BARD IMPRA GRAFT 70S07TW $2,741.90
    40051575 BARD IMPRA GRAFT 40S06TW $1,713.80
    40051583 BARD IMPRA GRAFT 40S06 $1,485.30
    40051591 BARD IMPRA GRAFT DF7006SC $9,596.30
    40051609 BARD IMPRA GRAFT 70S08 $2,256.50
    40051617 HEMI GLIDE CATH, BARD $1,607.60
    40051625 VASCULAR PATCH $1,015.00
    40051633 BARD GRAFT DFM7006SC $9,515.20
    40051690 HEMASHIELD GRAFTS-CLASS 2 $1,800.60
    40051708 BARD GRAFT 70S06TWC $2,570.60
    40051716 BARD GRAFT 70S08TWC $2,570.60
    40051724 BARD GRAFT 80S06TW $2,570.60
    40051732 BARD GRAFT 80S06C $2,627.60
    40051740 BARD GRAFT F7006TW $3,084.70
    40051757 BARD GRAFT 80S10TW $3,084.70
    40051765 BARD GRAFT F70T74TSC $3,570.20
    40051781 BARD GRAFT F8010C $3,655.80
    40051799 BARD GRAFT 10002-5050-001 $4,798.20
    40051807 BARD GRAFT F8008TWSC $7,104.00
    40051815 BARD GRAFT DFM8006SC $9,596.30
    40051823 AORTIC PUNCH $137.40
    40051831 IVC RETRIEVAL SET $1,308.30
    40051849 INTRODUCER-ENDO AAA $559.90
    40051856 PACEMAKER, DUAL CHAMBER RR $14,851.20
    40051864 PACEMAKER, SINGLE CHAMBER RR $13,023.50
    40051872 BARD GRAFT 70S10TW $2,570.60
    40051880 CAROTID SHUNT $1,239.80
    40051898 NEUROSTIMULATOR GENERATOR BLAD $45,604.50
    40051906 NEUROSTIMULATOR LEAD $13,891.70
    40051914 PT PROGRAMMER (NEUROSTIM)BLADD $5,437.90
    40051922 LEAD INTRODUCER KIT $1,279.80
    40051930 NEUROSTIMULATOR ANTENNA $365.60
    40051948 LEAD, NEUROSTIM TEST KIT $8,225.40
    40051963 NEUROSTIMULATOR,GENERATOR(NON $44,276.20
    40051971 NEUROSTIMULATOR LEAD $13,487.10
    40051989 NEUROSTIM LEAD INTRODUCE BLADD $1,242.40
    40051997 NEUROSTIMULATOR PROGRAMING $5,279.50
    40052003 NEUOSTIMULATOR ANTENNA $355.00
    40052011 ARTEGRAFT $4,800.00
    40052029 DEFIBRILLATOR, SINGLE CHAMBER $39,200.00
    40052037 DEFIBRILLATOR, DUAL CHAMBER $44,000.00
    40052045 DEFIBRILLATOR, CRT/BIV $52,000.00
    40052052 LEAD,DEFIBRILLATOR,SINGLE COIL $12,000.00
    40052061 LEAD,DEFIBRILLATOR,DUAL COIL $12,000.00
    40052078 HEMASHIELD GRAFTS-CLASS 3 $3,400.00
    40052086 PACEMAKER, BIVENTRICULAR $28,000.00
    40060089 STAPLER, LDS $668.50
    40060147 STAPLER, E E A $1,510.90
    40060253 STAPLER, RELOAD RU 30, 60, 90 $173.80
    40060261 LINEAR STAPLES RL 30 $1,452.20
    40060279 LINEAR STAPLES RL 60 $1,486.50
    40060287 STAPLER, RELOAD LN 30, 60, 90 $457.20
    40060295 STAPLER, ROTICULATOR 45-60 $1,096.90
    40060303 PURSE STRING INST. $354.30
    40060329 SURGINEEDLE 120MM AUTO-SUTURE $71.10
    40060337 SURGINEEDLE 150MM AUTO SUTURE $71.10
    40060345 SURGIPORT 5MM to 8MM $108.90
    40060352 SURGIPORT 11 to 12 MM $328.40
    40060360 ENDO CLIP AUTO SUTURE $547.10
    40060378 5.5MM SURG CONVERT $71.10
    40060410 LAP CHOLI KIT $1,482.50
    40060444 ETHICON 20MM LIGACLIP/EA $273.30
    40060451 VESSEL SEALER $3,015.20
    40060469 ETHICON STAPLER ""G"" EZ45G $3,858.20
    40060477 STAPLER, RELOAD $565.70
    40060485 HERNIA TACKER $2,741.90
    40070054 CODMAN BIPOLAR CORDS $28.80
    40070062 EVOKED POTENTIALS; UPPER EXT $1,600.00
    40070070 DRILL BITS, NEURO-CLASS 1 $363.60
    40070088 CASPAR DISTRACTION PINS $185.40
    40070096 BLACK MAX SPEED DRILL BITS $167.00
    40070195 SPINAL NEUROSTIMULATOR-BACK $70,238.00
    40070203 EXT KIT, SPINAL STIMULAT-BACK $5,237.40
    40070211 PT PROGRAMMER SPINAL STIM-BACK $4,039.70
    40070229 DRILL BITS, NEURO-CLASS 2 $1,025.00
    40080046 STOCKINETTE 6 $18.50
    40080061 BILE BAG 19 OZ $18.50
    40080095 NEEDLE, TRU-CUT BIOPSY $76.80
    40080103 DERMATONE CUTTING BLADE $49.40
    40080129 CYTOLOGY BRUSH $491.30
    40080145 T TUBES $31.10
    40080178 STAPLER, SKIN $127.40
    40080194 SURGICLIP $258.40
    40080251 DISPOSABLE BOVIE PAD $12.80
    40080269 DISPOSABLE VEIN STRIPPER $8.40
    40080277 DIS.DERMATONE CUTTING HEA $40.20
    40080293 ENT-NERVE STIMULATOR $182.90
    40080384 CATHETER, URETERAL $228.60
    40080392 URETERAL CATH CONNECTOR $16.30
    40080418 TRAVENOL GLYCINE $121.80
    40080475 MOSS TUBE PLAIN $37.90
    40080566 CHOLANGIOCATH $263.00
    40080624 DISP DERAMTOME BLADE $137.40
    40080715 GAUEER PONSKI SET $628.50
    40080749 MARLEX MESH $1,071.80
    40080764 LITHOTRIPSY PROBE $685.60
    40080954 PULSAVAC SUCTION LAVAGE $189.90
    40080996 DERMATOME BLADE $125.80
    40081010 SCLERO THERAPY NEEDLE $178.50
    40081085 URETERAL J STENT $307.60
    40081184 STAPLER, GIA 60/80 $502.80
    40081192 STAPLER, RELOAD GIA 60/80 $371.50
    40081242 TRANSMISSION TUBE $171.60
    40081366 BARD TEF GUIDEWIRE $199.10
    40081382 BARD BALLOON CATH $781.70
    40081390 BALLOON INFLAT DEVICE $1,008.90
    40081416 URETERO FORCEPS-3 WIRE $513.10
    40081440 GIA REFILL $430.90
    40081457 DRILL BIT/TWIST DRILL-CLS 2 $284.70
    40081523 BILIARY STENT KIT $1,833.70
    40081556 FLAT DRAIN $128.10
    40081606 MYRINGOTOMY TUBE $114.30
    40081630 AUTO PROSTATE BX SYSTEM $171.60
    40081663 VITAL VUE SUCTIONS $369.10
    40081671 SNARES, DISP POLYPECTOMY $114.30
    40081739 MALECOT NEPHROS SET $613.70
    40081747 GUIDE/GLIDE WIRE-CLS 1 $160.10
    40081762 BX FCPS (MICROVASIVE DISP $258.40
    40081788 URETERAL BASKET $914.20
    40081804 URETERAL STONE DISPLACE CATH $152.20
    40081812 LOOPOSTOMY 4"" GENTLE TOUCH $152.20
    40081820 LOOPOSTOMY 2 3/4 GENTLE TOUC $124.70
    40081846 FEMORAL IRR & SUCTION TIP SETS $39.10
    40081903 SEMIPULSE IRRIGATOR KIT $146.40
    40081911 STENT, URETERAL CLS 1 $628.50
    40081952 US SURG 5MM SURGICLIP SLEEVE $369.10
    40081960 SUCTION IRRIGATOR KIT-LAP CHOL $180.00
    40081978 URISTIL SUPRAPUBIC TUBE $209.20
    40082059 MEDITECH-EMPLATZ GUIDEWIRES $213.90
    40082067 IVC FILTER $4,569.80
    40082075 ENDOPATH BLUNT TIP TROCAR $486.80
    40082091 MICRO DUAL LUMEN STONE DIS $191.10
    40082109 INFUSAPORT $2,524.90
    40082117 ELECTRODE, LLETZ $91.60
    40082133 DISTRACTION/SKULL PINS $396.60
    40082158 LAP AM CATH CHOLANGIO CATH $547.40
    40082182 TUOHY-BORST/SIDE PORT $67.50
    40082190 ERCP CATHETER $263.00
    40082224 KNIFE COLD DISPOSABLE $874.20
    40082240 APDYNE PHENOL APP KIT $79.00
    40082265 ETHICON ENDOLOOP #EL10G $66.50
    40082281 MESH, HERNIA - CLASS 1 $499.60
    40082299 ELECTROSURG PROBE W NEEDLE TIP $409.20
    40082307 ENDOSHEARS $342.90
    40082315 ETHICON CUTTER REFILLS #ERU35 $400.10
    40082323 ETHICON LINEAR CUTTER #ELC35 $870.70
    40082331 THORACIC PORT 20MM $558.30
    40082356 BARD MARLEX MESH PERFIX PLUG $685.60
    40082364 THORACIC PORT 15MM $558.30
    40082398 IRRIGATION TUBING $211.60
    40082414 MUSCLE BX CLAMP $297.20
    40082448 INTRA NASAL SPLINT $125.80
    40082455 BERKELEY DC & E SYSTEM $137.40
    40082471 ETHICON ROTATING HEAD STAPLER $791.90
    40082513 MONITORING PROBE DISP $185.40
    40082521 PEG SUPPORT TRAY $93.90
    40082547 UTERINE MANIPULATOR $251.50
    40082554 BALLOON KIT,DILATATION-CLASS 1 $1,142.50
    40082562 ENDOCATCH $371.50
    40082596 SUTURE DEVICE $2,040.00
    40082604 ENDOSTITCH, SUTURE $182.90
    40082638 BABCOCK (GRASPER) $942.70
    40082646 LIVER RETRACTOR, US SURGICAL $514.30
    40082695 NASAL TAMPON $57.30
    40082737 PUMP SYRINGE $211.60
    40082760 SW100 ETHICON SUTURE ASSIST $370.50
    40082778 SW110 REFILLS $58.50
    40082794 MICROVASIVE GAUGE $137.40
    40082802 DILATOR, ESOPHOGEAL $1,051.20
    40082828 MICROVASIVE URETERAL DILATORS $293.90
    40082836 PERI-STRIPS/SEAMGUARD $790.40
    40082851 LIS QUICK LOAD SUTURE $69.90
    40082869 FALOPE RINGS, ACMI $228.60
    40082901 TRANSVAGINAL ANCHOR SYSTEM $4,682.80
    40082935 OLYMPUS INSUFLATION TUBING $33.30
    40082984 TUBING, IRRIGATION ENT $122.10
    40082992 DOLPHIN TUBING SET $217.30
    40083016 NASAL DEBRIEDER $1,170.90
    40083065 DERMABOND $335.00
    40083073 URODYNAMICS CABLES $171.60
    40083107 GASTROSTOMY FEEDING TUBE $161.30
    40083115 ESOPHAGEAL BAND LIGATOR $1,415.70
    40083123 RETRIEVAL DEVICE $434.30
    40083230 SPOT ENDOSCOPIC MARKER CHEKMED $99.60
    40083248 TRIPOLAR FORCEPS $1,240.80
    40083263 ABLATION SYSTEM $4,546.80
    40083271 MICROVASIVE COAXIAL INTRODUCER $187.60
    40083289 MESH, VENTRALEX #10010301 SM $1,885.10
    40083297 MESH, VENTRALEX #0010302 MED $2,253.00
    40083305 CYTOLOGY BRUSH $524.60
    40083313 JAG WIRE $799.90
    40083321 TRAPEZOID BASKETS $1,317.30
    40083339 BILIARY STENT $485.80
    40083347 BILIARY LOCKING DEVICE $45.90
    40083354 RX CHOLANGIOGRAM KIT $1,268.20
    40083362 EXTRACTOR BALLOON $734.70
    40083370 DILITATION BALLOON $1,219.20
    40083388 AUTOTOME/JAGTOME/DREAMTOME $1,656.70
    40083396 BREEZE RX $353.30
    40083404 ENDOCLOSE $242.40
    40083412 DAVOL, 20 Q RING,IMPLANT CART $1,876.10
    40083420 CYSTOGRAM TUBING/CYSTOGRAFFIN $59.70
    40083479 ARGON TRIPLE OPTION HANDPIECE $217.30
    40083495 ESSURE MICRO-INSERT SPRINGS(2) $6,443.30
    40083503 ESSURE DISPOSABLE CATHETER (2) $708.50
    40083511 MISC FEEDING TUBE $100.80
    40083537 NON-VASC BALLOON DILATN CATH $1,064.90
    40083552 APC PROBE $975.80
    40083560 LIGASURE $1,942.30
    40083586 MESH, HERNIA - CLASS 2 $685.60
    40083594 MESH, HERNIA - CLASS 3 $914.20
    40083602 MESH, HERNIA - CLASS 4 $2,142.20
    40083610 MESH, HERNIA - CLASS 5 $3,427.30
    40083628 MESH, HERNIA - CLASS 6 $4,398.40
    40083636 MESH, HERNIA - CLASS 7 $8,197.00
    40083644 MESH, VENTRALEX #10010303 LG $2,342.20
    40083651 HERNIA, KUGEL MODIFIED PATCH $1,005.50
    40083677 RESOLUTION CLIPS $876.00
    40083685 ERCP CANNULA (STD OR TAPER) $260.70
    40083693 WALL STENT $9,596.30
    40083719 SAW BLADE, DISPOSABLE-CLS 2 $160.10
    40083727 SAW BLADE, DISPOSABLE-CLS 3 $325.90
    40083735 DRILL BIT/TWIST DRILL-CLS1 $171.60
    40083750 STAPLER,RELOAD VASC.-CLASS 1 $1,199.80
    40083768 CATHETER, BILIARY $497.20
    40083776 ANAL FISTULA PLUG $3,884.30
    40083784 MAMMOSITE CED CATHETER $1,120.00
    40083792 CATHETER, BALLOON TISS DISECTR $1,051.20
    40083800 J TUBE $491.30
    40083818 FALOPE RING BAND KITS $856.90
    40083826 RETRACTOR/STAY $205.80
    40083834 PH PROBE $457.20
    40083842 VESSEL SEALER $845.50
    40083859 T-ROM KNEE BRACE $1,700.00
    40083867 PERM CONTRACEPTIVE DEVICE EA $3,806.30
    40083875 PERM CONTRACEPTIVE INSERT KIT $344.60
    40083883 BRACHYMESH W/I-125 SEEDS $12,921.80
    40083891 MAMMOSITE MULTI LUMEN APPLICAT $9,600.00
    40083909 A-CELL,MM0060,60MG MICROMATRIX $941.00
    40083917 A-CELL,MM0100,100MG MICROMATRI $1,568.20
    40083925 A-CELL,MM0200,200MG MICROMATRI $3,136.40
    40083933 A-CELL,MM0500,500MG MICROMATRI $7,840.90
    40083941 A-CELL,SMRS0204,2X4CM SURGICAL $705.80
    40083958 A-CELL,PSMX0505,5X5CM PLASTIC $3,136.40
    40083966 A-CELL,PSMX0412,4X12CM PLASTIC $6,021.80
    40083974 A-CELL,PSMX0615,6X15CM,PLASTIC $11,290.90
    40083982 A-CELL,PSMX0710,7X10CM,PLASTIC $8,781.80
    40083990 A-CELL,PSMX0816,8X16CM,PLASTIC $16,058.20
    40084006 A-CELL,PSMX1015,10X15CM,PLASTI $18,818.10
    40084014 HDR LUNG THERAPY CATH (ELEKTA) $1,979.30
    40084022 HDR LUMEN CATH GUIDEWIRE(ELEKT $441.60
    40084031 MESHED BIL WND MAT PER SQ, 25 $9,189.90
    40084048 MESHED BIL WND MAT PER SQ,125 $15,328.60
    40084055 A-CELL,MM1000,1000MG MICROMAT $9,865.80
    40084063 ANTERIOR REPAIR MESH $7,917.00
    40084071 FLOWABLE WOUND MATRIX,FWD301,3 $14,210.00
    40084089 MESHED BILAYER WOUND MATRIX,MW $9,189.90
    40084097 SYNTHETIC IMPLNT URINARY 1ML $1,522.50
    40084147 COAPTITE INJ IMPLANT 1ML $1,492.10
    40084154 SIDEKICK NEEDLE 14.6" 21GA $182.70
    40084162 WC SPEC ORD/SURG SUPPLY CAT 1 $500.00
    40084171 WC SPEC ORD/SURG SUPPLY CAT 2 $1,000.00
    40084188 WC SPEC ORD/SURG SUPPLY CAT 3 $1,500.00
    40084196 WC SPEC ORD/SURG SUPPLY CAT 4 $2,000.00
    40084204 WC SPEC ORD/SURG SUPPLY CAT 5 $2,500.00
    40084212 WC SPEC ORD/SURG SUPPLY CAT 6 $3,000.00
    40084221 WC SPEC ORD/SURG SUPPLY CAT 7 $3,500.00
    40084238 WC SPEC ORD/SURG SUPPLY CAT 8 $4,000.00
    40084246 WC SPEC ORD/SURG SUPPLY CAT 9 $4,500.00
    40084253 WC SPEC ORD/SURG SUPPLY CAT 10 $5,000.00
    40084261 WC SPEC ORD/SURG SUPPLY CAT 11 $5,500.00
    40084279 WC SPEC ORD/SURG SUPPLY CAT 12 $6,000.00
    40084287 WC SPEC ORD/SURG SUPPLY CAT 13 $6,500.00
    40084295 WC SPEC ORD/SURG SUPPLY CAT 14 $7,000.00
    40084303 WC SPEC ORD/SURG SUPPLY CAT 15 $7,500.00
    40084311 WC SPEC ORD/SURG SUPPLY CAT 16 $8,000.00
    40084329 WC SPEC ORD/SURG SUPPLY CAT 17 $9,000.00
    40084337 WC SPEC ORD/SURG SUPPLY CAT 18 $10,000.00
    40084345 WC SPEC ORD/SURG SUPPLY CAT 19 $12,500.00
    40084352 WC SPEC ORD/SURG SUPPLY CAT 20 $15,000.00
    40084360 THERASKIN 5.1 X 7.6 CM $5,100.00
    40084378 VPAD CONNECTOR CABLE-NAVBRONCH $935.00
    40084386 VPAD PATIENT TRACKER-NAVBRONCH $1,360.00
    40084394 GUIDEWIRE,1.0MM,950MM-NAVBRONC $765.00
    40084402 BRUSH-NAVBRONCH $2,040.00
    40084411 FORCEPS,SERRATED CUP-NAVBRONCH $2,040.00
    40084428 NEEDLE,HISTO,19GA-NAVBRONCH $2,040.00
    40084436 NEEDLE,CYTO,21GA-NAVBRONCH $2,040.00
    40084444 NEEDLE,NITINOL,22GA-NAVBRONCH $3,060.00
    40084451 CATH,PERIPH,3.8MM,2.5MM-NAVBRO $2,890.00
    40084469 SPINPERC KIT-NAVBRONCH $1,360.00
    40084477 LAP BAND $15,100.00
    40084485 LAP BAND ACCESS PORT $3,000.00
    40084493 TRACH TUBE, HYPERFLEX $760.00
    40084501 RPEZ APPLIER--LAP BAND $800.00
    40084519 CALIBRATION TUBE--LAP BAND $500.00
    40084527 BALLOON KIT,DILATATION-CLASS 2 $1,625.00
    40084535 STAPLER,RELOAD VASC.-CLASS 2 $1,800.00
    40084543 WC SPEC ORD/SURG SUPPLY CAT 21 $17,500.00
    40084551 WC SPEC ORD/SURG SUPPLY CAT 22 $20,000.00
    40084576 BIOZORB PLACEMENT PROCEDURE $2,500.00
    40084584 BIOZORB MARKER FOR RDT $4,000.00
    40090029 AAA INTRODUCER SHEATH $103.00
    40090037 AAA (2)SELDINGER ENTRY NEEDLES $50.50
    40090045 AAA(1)NAMIC PROCTECTION STATIO $53.90
    40090052 AAA2ROYAL FLUSH ANGIO CATH CS $1,224.90
    40090060 AAA2 TSCMG-35-260-LES3 STIFF G $689.00
    40090078 AAA2DAIG RT GUIDEWIRES/1TORCON $96.50
    40090086 AAA ANGIOGRAPHIC CATH VAN 4 $121.80
    40090094 BALLOON CATHETER, CODA $1,704.60
    40090102 MAIN BODY GRAPH $35,169.30
    40090110 ILIAC ENDOGRAPHS,EA $12,832.70
    40090128 A-CELL PFM0912 MESH $7,892.70
    40090136 MEDTRONIC MAGNIFUSE $9,450.00
    40090144 AVITUS 5 MM HARVESTER $6,300.00
    40090151 AVITUS PILOT HOLE CREATOR $1,237.00
    40100182 C O R E - ORGAN DONATION $3,882.00
    40200024 MICRON FIBER WO/HAND PIECE $1,354.10
    40200032 MICRON FIBER W/HAND PIECE $1,549.20
    40200040 GAS FLUID CARTRIDGE $508.60
    40300014 UNILATERAL LITHOTRIPSY $12,597.70
    40300022 BILATERAL LITHOTRIPSY $16,727.20
    40300030 ELECTRODE,LOOP -CLS 2 $628.50
    40300048 ELECTRODE, LOOP -CLS 3 $971.20
    40300055 BIOPSY FORCEP (CYSTO) $1,508.10
    40300063 STENT, URETERAL CLS 2 $1,462.50
    40300071 STENT, URETERAL CLS 3 $422.90
  • MRI/MRA

    Service Code Description Price
    42501031 MRI ORBIT FACE NECK $1,522.50
    42501049 MRI BRAIN $1,522.50
    42501056 MRI CHEST $1,522.50
    42501064 MRI CERVICAL SPINE W/O CONT $1,522.50
    42501072 MRI THORACIC SPINE W/O $1,522.50
    42501080 MRI LUMBAR SPINE W/O CONT $1,522.50
    42501155 MRI ABDOMEN $1,814.00
    42501189 MRI LUMBAR SPINE W/ CONT $2,131.50
    42501197 MRI BRAIN W/CONTRAST $2,131.50
    42501205 MRI CERV SPINE W/CONTRAST $2,131.50
    42501213 MRI THORACIC SPINE W/C $2,131.50
    42501221 MRI LUMBAR W/WO $2,740.50
    42501239 MRI THOR W/WO $2,740.50
    42501247 MRI CERV W/WO $2,740.50
    42501254 MRI BRAIN W/WO $2,740.50
    42501288 MRI ABD W/WO CONTRAST $3,095.80
    42501361 MRA PELVIS WITH CONSTRAST $1,928.50
    42501601 MRI TMJ $1,644.30
    42501619 MRI ORBIT FACE NECK W/CONTRAST $2,131.50
    42501627 MRI ORBIT FACE NECK W/&W/O $2,740.50
    42501643 MRI CHEST W/CONTRAST $3,781.50
    42501650 MRI CHEST W/&W/O CONTRAST $2,740.50
    42501668 MRI PELVIS W/O CONTRAST $1,522.50
    42501676 MRI PELVIS W/CONTRAST $2,131.50
    42501684 MRI PELVIS W AND W/O CONTRAST $2,740.50
    42501692 MRI ABDOMEN W/CONTRAST $1,674.80
    42501700 MRA HEAD W/O $1,522.50
    42501734 MRA NECK W/O $1,522.50
    42501742 MRA NECK W/ $2,131.50
    42501759 MRA NECK W/ AND W/O $2,740.50
    42501767 MRI UPPER EXTREMITY LT W/O $1,522.50
    42501775 MRI UPPER EXTREMITY LT W/ $2,131.50
    42501783 MRI UPPER EXTREMITY RT W/O $1,522.50
    42501791 MRI UPPER EXTREMITY RT W/ $2,131.50
    42501809 MRI LOWER EXTREMITY LT W/O $1,395.70
    42501817 MRI LOWER EXTREMITY LT W/ $1,674.80
    42501825 MRI LOWER EXTREMITY RT W/O $1,395.70
    42501833 MRI LOWER EXTREMITY RT W/ $1,674.80
    42501841 MRI JOINT UPPER EXT LT WITH $2,233.00
    42501858 MRI JOINT UPPER EXT LT W/&W/O $2,842.00
    42501866 MRI JOINT UPPER EXT RT W/ $2,233.00
    42501874 MRI JOINT UPPER EXT RT W/&W/O $2,842.00
    42501890 MRI JOINT LOWER EXT LT W/&W/O $2,390.40
    42501908 MRI JOINT LOWER EXT RT WITH $1,903.20
    42501916 MRI JOINT LOWER EXT RT W/&W/O $2,390.40
    42501940 MRI LOWER EXTREMITY LT W/& W/O $2,500.00
    42501957 MRI LOWER EXTREMITY RT W/& W/O $2,500.00
    42502005 MRA ABD W/CONTRAST $1,801.70
    42502013 MRA ABD W/O CONTRAST $1,801.70
    42502021 MRA ABD W & W/O CONTRAST $1,801.70
    42502047 MRI BREAST W/O (UNI) LT $2,867.50
    42502054 MRI BREAST W & W/O (UNI) LT $2,867.50
    42502070 MRI BREAST W/O (BI) $1,700.00
    42502088 MRI BREAST W & W/O (BI) $2,867.50
    42502096 MRA CHEST W CONTRAST $1,522.50
    42502104 MRA CHEST W/O $1,522.50
    42502112 MRA CHEST W & W/O $1,522.50
    42502146 MRA LOWER EXT W & W/O LT $2,390.40
    42502161 MRI BREAST W/O (UNI) RT $2,867.50
    42502179 MRI BREAST W & W/O (UNI) RT $2,867.50
    42502203 MRA LOWER EXT W & W/O RT $2,390.40
    42502216 MRA, SPINE W/WO CONTR $2,740.50
    42502229 MRA PELVIS W/O CONTRAST $1,015.00
    42502237 MRA PELVIS W/WO CONTRAST $1,015.00
    42502245 MRI MRCP $1,814.00
    42502278 MRA W/O&W/DYE UPPER EXTR RT $2,892.80
    42502286 MRA W/O&W/DYE UPPER EXTR LT $2,892.80
    42502328 MR TISSUE MARKER $335.00
    42502336 MR ATEC HANDPIECE $1,960.00
    42502344 MR ATEC CANISTER $21.70
    42502369 MRI BREAST W/O (UNI) RT, LTD $1,015.00
    42502377 MRI BREAST W/O (UNI) LT, LTD $1,060.00
    42502393 MRI, IAC ONLY, W & W/O $2,740.50
    42502401 MRI BRAIN & PITUITARY W & W/O $2,740.50
    42502419 MRI PITUITARY ONLY, W & W/O $2,740.50
    42502435 MR GRID IMMOBILIZER PLATE $81.20
    42502450 MRI BRAIN/IAC W/O CONT $1,522.50
    42502468 MRI BRAIN & PITUITARY W/O $1,522.50
    42502476 *MRI CAD BREAST $76.20
    42502526 MRI 18G LOC NDL $345.10
    42502534 MRA LOWER EXTREMITIES, NO CONT $1,015.00
    42502542 MRI BREAST BX INITIAL RT $2,650.00
    42502559 MRI BREAST BX INITIAL LT $2,650.00
    42502567 MRI BREAST BX ADDL RT $1,725.50
    42502575 MRI BREAST BX ADDL LT $1,725.50
    42502583 MRI NEEDLE LOC INITIAL RT $1,150.00
    42502591 MRI NEEDLE LOC INITIAL LT $1,150.00
    42502609 MRI NEEDLE LOC ADDL RT $761.30
    42502617 MRI NEEDLE LOC ADDL LT $761.30
    42502625 GADOBUTROL INJ 7.5ML-IRG $162.40
    42502633 GADOBUTROL INJ 10ML-IRG $213.20
    42502641 MR LOCALIZING OBTURATOR $304.50
    42502658 MR NEEDLE BLOCK/GUIDE $50.80
    42502666 MR INTRODUCER STYLET $192.90
    42502674 MR INTRODUCER SHEATH $192.90
    42502682 MRI JOINT LOWER EXT LT W/O $1,649.40
    42502690 MRI JOINT UPPER EXT RT W/O $1,649.40
    42502708 MRI JOINT LOWER EXT RT W/O $1,649.40
    42502716 MRI JOINT UPPER EXT LT W/O $1,649.40
    42502724 MRI UPPER EXTREMITY LT W/& W/O $2,537.50
    42502732 MRI UPPER EXTREMITY RT W/& W/O $2,537.50
    42502740 MRI BRAIN/IAC W & W/O CONT $2,740.50
    42502757 MRI JOINT LOWER EXT LT WITH $1,903.20
    42502765 MRV OF BRAIN W/O $1,522.50
    44130011 PHASE III C.R. MONTH $70.00
    44130029 CARD RHB W/ECG MONITOR/PHASEII $228.00
    44130037 PHASE III C.R. 2 WEEKS $35.00
    44130045 THERAPEUTIC PROCEDURE GROUP $110.00
    44130094 CARD REHAB MTN EVAL $85.90
    44130102 NON COPD REHAB $107.60
    44130110 PULMONARY REHAB MAINTENANCE $70.00
    44510014 MULTIPLE SLEEP LATENCY $1,765.00
    44510022 SLEEP STAGING 4 OR > $1,765.00
    44510030 SLEEP STAGING 4OR> W/CPAP/BPAP $1,873.60
    44510048 NO SHOW SLEEP LAB $66.50
    44510055 SLEEP STUDY; UNATTENDED $628.50
    44900017 DBE IND PER 30 MIN $109.90
    44900025 DBE GROUP PER 30 MIN $93.90
    44900041 OP MNT INITIAL CONSULT EA 15MI $110.00
    44900058 OP MNT F/U CONSULT EA 15 MIN $110.00
    44900066 OP MNT GROUP PER 30 MIN $110.00
    44900141 FIRST DIABETES PREVENTION CLAS $63.00
    44900157 FOURTH DPP CLASS $125.00
    44900173 TWO CORE MAIN 7-9 MONTHS $37.50
    44900181 TWO CORE MAIN 10-12 MONTHS $37.50
    44900191 TWO CORE MAIN 7-9 MONTHS $150.00
    44900207 TWO CORE MAIN 10-12 MONTHS $150.00
    44900215 MDPP 5% WT LOSS DURING 1-12 MO $400.00
    44900223 MDPP 9% WT LOSS 1-24 MONTHS $62.50
    44900231 TWO ONGOING MAIN 13-15 MONTHS $125.00
    44900249 TWO ONGOING MAIN 16-18 MONTHS $125.00
    44900256 TWO ONGOING MAIN 19-21 MONTHS $125.00
    44900264 TWO ONGOING MAIN 22-24 MONTHS $125.00
    44900281 NINE TOTAL CORE SESSIONS MDPP $225.00
  • Occupational Therapy

    Service Code Description Price
    46200069 ORTHOTIC MGMT/TRAIN,INIT EA 15 $148.70
    46200093 OT REEVALUATION INITIAL VISIT $110.00
    46200101 THER ACTIVITIES-EA15 MIN $69.40
    46200119 SELF CARE/HOME TRAIN EA 15 MIN $67.90
    46200127 COMMUNITY/WORK TRAIN EA 15 MIN $67.60
    46200135 DEVELOP COGNITIVE SKL/EA 15MIN $67.60
    46200143 MASSAGE 1 OR > AREAS EA 15 MIN $62.60
    46200150 WC MGT EA 15 MIN $67.60
    46200168 ORTHOTIC RECHECK EST PT EA 15 $87.00
    46200201 OT EVAL,LOW COMPLEXITY,~30MIN $175.00
    46200218 OT EVAL,MOD COMPLEXITY,~45MIN $200.00
    46200226 OT EVAL,HIGH COMPLEXITY,~60MIN $225.00
    46200234 ORTH/PROS TRAIN,SUBS,EA 15MIN $87.00
    46300018 REACHER $53.90
    46300026 DRESSING STICK $6.90
    46300034 BUTTON HOOK $31.10
    46300042 STOCKING (SOCK AID) $24.20
    46300059 SHOEHORN-18" $12.80
    46300067 SHOEHORN-24" $12.80
    46300075 ELASTIC SHOELACE $8.40
    46300133 LONG HANDLED BATH BRUSH $6.90
    46300174 DENTURE BRUSH $24.20
    46300208 DYCEM MATTING $8.40
    46300257 FOAM 3"" $5.90
    46300307 CUTTING BOARD $56.30
    46300331 WEIGHTED UTENSIL $10.40
    46300356 PLATE GUARD $13.80
    46300398 ISOTONER GLOVE EACH $9.40
    46300406 ELASTIC WRIST SPLINT $73.30
    46300414 SHOE BUTTONS $12.80
    46300422 HAND GRIPPER $15.10
    46300448 COBAN WRAP 1 INCH $4.90
    46300455 STAND MAGNIFIER MIRROR $22.00
    46300463 TOILET AID $104.20
    46300471 LEG LIFTER $11.70
    46300489 FOOT DROP SPLINT $190.00
    46300497 FUNC POSITION HAND SPLINT $31.10
    46300505 WALKER SPLINT $52.80
    46300513 STATIC ANKLE FOOT ORTHOSIS $425.00
    46300539 WALKER BAG (SMALL) $59.70
    46300554 WALKER BASKET $85.90
    46300562 ROCKER T KNIFE $66.50
    46300570 BUILT UP KNIFE $43.70
    46300588 BUILT UP SPOON $43.70
    46300596 BUILT UP FORK $43.70
    46400206 THERABAND 3 FT PIECE $3.50
    46400214 THERAPUTTY 2OZ $4.90
    46400222 HAND HELPER $6.90
    46400271 ELECTRICAL STIM - UNATTENDED $71.70
    46400289 HOT PACKS $60.00
  • Respiratory Services

    Service Code Description Price
    50010057 VENTILATOR; INITIAL $820.00
    50010065 CAR/PUL RESUSC $436.70
    50010107 CHEST PHYSIOTHERAPY; INITIAL $170.00
    50010131 DAILY OXYGEN INPATIENT UNIT $263.00
    50010149 DAILY AEROSOL INPATIENT UNIT $590.90
    50010156 PENTAMIDINE TREATMENT $280.00
    50010172 CPAP CONTINOUS DAILY $315.00
    50010180 BIPAP CONTINOUS $302.00
    50010214 EBT - BREATH ALCOHOL $55.00
    50010263 VENTILATOR; SUBSEQUENT $820.00
    50010289 CHEST PHYSIOTHERAPY;SUBSEQUENT $110.00
    50010362 INHALATION TX 1ST HR $170.00
    50010388 ARTERIAL PUNCTURE (BLOOD GAS) $170.00
    50010438 SVN & OR MDI INITIAL TX $280.00
    50010446 SVN & OR MDI SUBSEQ TX $280.00
    50010453 SVN & OR MDI INSTRUCTION, DAY $280.00
    50010487 MECH CHESTWALL OSCILLATION EA $280.00
    50020023 DISP FACE MASK $24.20
    50020031 VENTI-MASK $13.80
    50020072 AEROSOL SET UP $24.20
    50020080 NASAL CANNULA $25.30
    50020098 CORRUGATED TUBING $23.80
    50020106 DISP NEBULIZER/HUMIDIFIER $27.70
    50020122 SPIROMETER INCENTATIVE $58.50
    50020130 C P A P SET UP $50.50
    50020155 HAND HELD NEBULIZER $28.80
    50020171 VENTILATOR SET UP $32.20
    50020197 SUCTION CATH-24 HR $65.40
    50020213 AMBU BAGS DISPOSABLE $82.50
    50020247 CARE CUBE 12X12 $49.40
    50020254 CARE CUBE 24X24 $52.80
    50020262 PASSY MUIR VALVE $60.70
    50020270 PULM FUNC FILTER $29.90
    50020288 AEROSOL FACE TENT/EA $33.30
    50020296 PENTAMIDINE NEBULIZER $63.10
    50020304 HME/FILTER UNIT $36.80
    50020312 BIPAP SET-UP $93.90
    50020346 RESP CARE KIT $80.10
    50020353 PEAK FLOW METER $65.00
    50020361 RESP CARE KIT $80.10
    50030014 FRC-STEADY STATE=HEL $240.00
    50030022 SINGLE-BREATH CO DIFFUS $179.60
    50030097 CARBON MONOXIDE LEVEL $155.50
    50030105 SPIROMETRY $304.50
    50030113 PULSE OXIMETRY - SINGLE $31.10
    50030121 BRONCHOSPASM PRE/POST DILATOR $400.00
    50030154 CONTINOUS PULSE OXIMETRY $240.00
    50030188 PULSE OXIMETRY;MULTIPLE $48.20
    50030196 METHEMOGLOBIN $15.00
    50030204 BLOOD GAS ANALYSIS $84.00
    50030212 ARTERIAL BLOOD GAS POTASSIUM $15.00
    50030220 ARTERIAL BLOOD GAS SODIUM $20.00
    50030238 ARTERIAL BLOOD GAS CHLORIDE $15.00
    50030246 ARTERIAL BLOOD GAS GLUCOSE $20.00
    50030253 ARTERIAL BLOOD GAS LACTATE $56.00
    50030261 VENOUS BLOOD GAS POTASSIUM $15.00
    50030279 VENOUS BLOOD GAS SODIUM $20.00
    50030287 VENOUS BLOOD GAS CHLORIDE $15.00
    50030295 VENOUS BLOOD GAS GLUCOSE $20.00
    50030303 VENOUS BLOOD GAS LACTATE $56.00
    50030311 VENOUS BLOOD GAS ANALYSIS $95.00
    50030329 NOCTURNAL PULSE OXIMETRY $240.00
    50040021 MUCOMYST 10% ML $24.40
    50040062 VAPONEFRIN $5.70
    50040096 ATROVENT .5MG $6.86
    50040112 PENTAMIDINE 300MG $513.52
    50040138 XOPENEX 0.63MG $9.14
    50040146 XOPENEX 1.25MG $17.13
    50040153 DUONEB INHAL SOL $39.98
    50040161 SPIRIVA HANDIHALER(TIOTROPIUM) $63.00
    50040179 PROVENTIL SOLN .083% 3ML $7.76
  • Physical Therapy Services/Equipment

    Service Code Description Price
    60010055 HOT PACKS $60.00
    60010089 WHIRLPOOL $72.20
    60010105 PARAFFIN BATH $42.60
    60010113 ELECTRICAL STIM - UNATTENDED $71.70
    60010162 GAIT TRAINING PER EA 15MIN $60.70
    60010287 ULTRA SOUND - EACH 15 MIN $75.60
    60010360 THERAPEUTIC PROCEDURE EA 15MIN $62.00
    60010444 NEUROMUSCULAR RE-EDUC EA 15MIN $79.00
    60010477 MASSAGE PER 15 MIN $62.60
    60010527 THERABAND EXERCISOR 3 FT $3.50
    60010675 CPM PER DAY RENTAL $88.80
    60010709 DEBRIDEMENT PART THICK <20 CM $410.00
    60010717 CPM-SHOULDER PER DAY $141.90
    60010725 IONTOPHORESIS EACH 15 MIN $72.20
    60010733 PT REEVAL $110.00
    60010741 ELECTRICAL STIMULATION EA 15 $75.60
    60010766 JOINT MOBILIZATION EA 15 MIN $74.50
    60010774 ORTHOTIC MGMT/TRN,INIT EA 15MI $148.70
    60010782 PROSTH MGMT/TRAIN,INIT EA 15MI $75.20
    60010790 WHEELCHAIR MANAGEMENT EA 15 $67.60
    60010824 MANUEL TECHNIQUES EA 15 MIN $74.50
    60010832 THERAPEUTIC ACTIV PER 15 MI $69.40
    60010840 ORTHOTIC MGMT/TRN,INIT EA 15MI $148.70
    60010857 SKIN THERAPY $68.80
    60010873 PT ADL SELF CARE TR EA 15 MIN $67.90
    60010899 THERAPEUTIC REHAB GROUP $130.80
    60011087 SLCTV WND DEBRIDEM ADDL 20CM $332.50
    60011103 LOW FREQ NONTHERMAL US PT $270.00
    60011119 PT EVAL,LOW COMPLEXITY,~20MIN $200.00
    60011127 PT EVAL,MOD COMPLEXITY,~30MIN $225.00
    60011135 PT EVAL,HIGH COMPLEXITY,~45MIN $250.00
    60011145 ORTH/PROS TRAIN,SUBS,EA 15MIN $87.00
    60020146 PHILADELPHIA COLLAR $242.00
    60020351 HAND EXERCISER $58.50
    60020369 THERAPLAST $9.40
    60020526 AFO PLASTIC $730.00
    60020534 EMPI ELECTRODES $6.90
    60020542 PHYSIOTH NEO SLEEVE $26.50
    60020559 ABDOMINAL BINDER $59.70
    60020575 HEEL WEDGE HEALING SHOE $43.70
    60020591 CAM WALKING BOOT $268.70
    60020609 AIR CAST ANKLE BRACE $700.00
    60020617 WARM-N-FORM BACK SUPPORT W/INS $603.60
    60020674 SEMIRIG 2PC THERMOPL CERV COLL $848.00
    60020682 TLSO TRIPANEL CNTRL W HYPEREXT $1,248.00
    60020690 CUSTOM TLSO 2PC PL SHELL W LIN $5,818.00
    60020716 LSO POST RIGID PANEL $365.40
    60020724 LSO S/C SHELL/PANEL PREFAB $3,230.50
    60020732 PREFAB POSTOP HO $3,543.00
    60020740 KO ADJ JNT POS RIGID SUPP $1,700.00
    60020757 CUSTOM PLASTIC AFO SOLID ANKLE $1,825.00
    60020765 CUSTOM PLASTIC AFO W ANKLE JNT $2,196.00
    60020773 UE FX ORTHOSIS HUMER $967.00
    60020781 HEEL CUP $45.70
    60020799 KNEE PLUS COOL BRACE $2,270.00
    60020807 LEG LENGTH DISCREPANCY PAD $190.00
  • Speech Therapy Services

    Service Code Description Price
    61010021 SPEECH TREATMENT 15 MIN $150.00
    61010039 SPEECH TREATMENT 30 MIN $200.00
    61010047 SPEECH TREATMENT 45 MIN $250.00
    61010054 SPEECH TREATMENT 60 MIN $300.00
    61010062 HEARING SCREENING $51.60
    61010070 EVALUATION SWALLOWING $345.10
    61010088 TREATMENT SWALLOWING 1-15 MIN $332.90
    61010096 TREATMENT SWALLOWING 16-30 MIN $332.90
    61010104 TREATMENT SWALLOWING 31-45 MIN $360.70
    61010112 TREATMENT SWALLOWING 46-60 MIN $438.30
    61010203 MODIFIED BARIUM SWALLOW EVAL $438.30
    61010500 EVAL SPEECH FLUENCY $243.60
    61010518 EVAL SPEECH SOUND PRODUCTION $233.50
    61010526 EVAL SPEECH SND PROD W/COMPRES $366.00
    61010534 BEHAV/QUANT ANALYSIS VOICE/RES $233.50
  • Occupational Health Services

    Service Code Description Price
    63000012 COMPLETE PHYSICAL EXAM $62.00
    63000020 NEW PATIENT LEVEL 1 $71.00
    63000038 NEW PATIENT LEVEL 2 $97.00
    63000046 NEW PATIENT LEVEL 3 $125.00
    63000053 NEW PATIENT LEVEL 4 $186.00
    63000061 NEW PATIENT LEVEL 5 $232.00
    63000079 ESTABLISHED PATIENT LEVEL 1 $37.00
    63000087 ESTABLISHED PATIENT LEVEL 2 $63.00
    63000095 ESTABLISHED PATIENT LEVEL 3 $85.00
    63000103 ESTABLISHED PATIENT LEVEL 4 $120.00
    63000111 ESTABLISHED PATIENT LEVEL 5 $180.00
    63000129 CONSULTATION LEVEL 1 $120.00
    63000137 CONSULTATION LEVEL 2 $159.00
    63000145 CONSULTATION LEVEL 3 $192.00
    63000152 CONSULTATION LEVEL 4 $285.00
    63000160 CONSULTATION LEVEL 5 $338.00
    63000178 INDEPENDENT MEDICAL EXAM $1,998.00
    63000186 INDEPEND MED EXAM ADD 15 MIN $500.00
    63000194 DEPOSITION $1,887.00
    63000202 DEPOSITION ADD 15 MIN SUB 1HR $473.00
    63000228 RETURN TO WORK EVALUATION $106.00
    63000236 EXTENDED (RETURN TO WORK EVAL) $125.00
    63000244 CHART REVIEW & SUMMARY $338.00
    63000251 CHART REVIEW & SUMMARY EXTEND $464.00
    63000269 RESP QUESTIONNAIRE REVIEW $27.00
    63000277 DOT PHYSICAL EXAM + EXTRAS $89.00
    63000285 SCHOOL BUS PHYSICAL EXAM + EXT $89.00
    63000293 DRIVERS LICENSE PHYSICAL EXAM $40.00
    63000301 RESPIRATORY PHYSICAL EXAM $52.00
    63000327 NEW PATIENT;LEVEL 1 W/PROC $71.00
    63000335 NEW PT;LEVEL 2 W/PROC $97.00
    63000343 NEW PT;LEVEL 3 W/PROC $125.00
    63000350 NEW PT;LEVEL 4 W/PROC $186.00
    63000368 NEW PT;LEVEL 5 W/PROC $232.00
    63000376 EST PT;LEVEL 1 W/PROC $37.00
    63000384 EST PT LEVEL 2 W/PROC $63.00
    63000392 EST PT; LEVEL 3 W/PROC $85.00
    63000400 EST PT;LEVEL 4 W/PROC $120.00
    63000418 EST PT;LEVEL 5 W/PROC $180.00
    63000426 ONLINE CONSULT-BRIEF <5 MINUTE $17.00
    63000434 ONLINE CONSULT-INTERMEDIATE $32.00
    63000442 ONLINE CONSULT-EXTENDED >10MIN $65.00
    63000459 MEDICAL CONFERENCE < 30 MINUTE $65.00
    63000467 REVIEW TB QUESTIONNAIRE $14.00
    63000475 CASE MANAGER CONSULT $76.00
    63000483 B&W PHYSICAL EXAM $95.00
    63000491 COLLATE & MAIL DATA $12.00
    63000509 RESP CLEARANCE FORM $8.00
    63000517 INGRAM BARGE PE $95.00
    63000525 CFH 15 MIN ASSESS $20.00
    63000533 DOT PE FOLLOW-UP $45.00
    63000541 MSHA SMPLE PE $52.00
    63000558 MSHA MED SURV $61.00
    63000566 MSHA EXTENSIVE $106.00
    63000574 MSHA EXTENSIVE 2 VISITS $125.00
    63000582 MSHA CDL $89.00
    63000590 RECTAL EXAM $10.00
    63000608 HERR'S DOT W/ORTHO $140.00
    63000616 A-M REVIEW $50.00
    63000624 CHS PHYSICAL EXAMINATION $45.00
    63000632 CHS DOT COMM.DRIVER EXAM $89.00
    63000641 CHS HISTORY REVIEW W/O EXAM $10.00
    63000657 CHS VITALS ONLY $5.00
    63000665 CHS BREAST EXAMINATION $10.00
    63000673 CHS TRAVEL CONSULTATION $25.00
    63000699 CHS FOCUSED EXAM W/REP 10 MIN $50.00
    63000707 CHS FOCUSED EXAM W/REP 20 MIN $80.00
    63000715 CHS FOCUSED EXAM W/REP 30 MIN $110.00
    63000723 CHS FOCUSED EXAM W/REP 40 MIN $160.00
    63000731 CHS FOCUSED EXAM W/REP 50 MIN $200.00
    63010045 DR. FINGER ABSCESS SIMPLE $152.00
    63010052 PUNC. ASP. HEMATOMA/ABSCESS $138.00
    63010060 SPIROMETRY $41.00
    63010078 AUDIOGRAM $27.00
    63010086 STOOL GUAIAC TEST/HEMOCULT $20.00
    63010094 I & R FB SIMPLE $146.00
    63010102 REMVL FB EXT EYE CONJUNCTIVAL $104.00
    63010110 REM FB EXTERNAL AUD CANAL $104.00
    63010136 SHORT ARM SPLINT STATIC $97.00
    63010144 FABRICATE THUMB SPICA SPLINT $163.00
    63010151 FINGER SPLINT STATIC $85.00
    63010169 SIMPLE REPAIR WOUND 2.5CC/LESS $236.00
    63010177 RESPIRATORY FIT TEST $21.00
    63010185 TRNK,SCLP,NECK,EXT 2.6-7.5CM $219.00
    63010219 INITIAL HISTORY & PHYSICAL IP $167.00
    63010268 I & D ABSCESS SIMPLE $138.00
    63010276 EVAC. SUBUNGUAL HEMATOMA $92.00
    63010284 SECOND MEDICAL OPINION $551.00
    63010292 BLOOD PRESSURE CHECK $18.00
    63010318 SCLP,ARMS,LEGS 2.6-7.5 CM $533.00
    63010334 SPECIAL FORMS/REPORTS $25.00
    63010342 PFT INTERPRETATION $36.00
    63010359 AUDIO INTERPRETATION $18.00
    63010367 TRNK,SCLP,NECK,EXT 2.6-7.5 CM $272.00
    63010375 CARD REPLACEMENT $9.00
    63010383 DIRECTOR FOR AED EST CLIENT $298.00
    63010391 FINGER STRAPPING $71.00
    63010409 WRIST STRAPPING $157.00
    63010417 ANKLE STRAPPING $157.00
    63010425 FOOT STRAPPING $157.00
    63010433 HAND STRAPPING $157.00
    63010441 STRAPPING TOE $157.00
    63010458 I & D; COMPLICATED $246.00
    63010466 I & R FB;COMPLICATED $326.00
    63010474 I & D HEMATOMA $159.00
    63010508 DEBRID;SKIN/SUBCUTANEOUS $186.00
    63010573 AVULSION NAIL PLATE;ONE $120.00
    63010581 EX. NAIL/NAIL MATRIX $405.00
    63010599 RPR. NAILBED $180.00
    63010607 TRNK,SCLP,NK,EXT.;2.5CM OR < $164.00
    63010615 TRNK,SCLP,NK,EXT;7.6-12.5CM $305.00
    63010623 TRNK,SCLP,NK,EXT;12.6-20.0CM $393.00
    63010631 FACE,EAR,EYELID,NOSE; 2.5CM < $180.00
    63010649 FACE,EAR,EYELID,NOSE;2.6-5.0CM $252.00
    63010656 FACE,EAR,EYELID,NOSE;5.1-7.5CM $285.00
    63010664 FACE,EAR,EYELID,NOSE;7.6-12.5C $393.00
    63010672 TX. WOUND DEHISCENCE;SIMPLE $359.00
    63010680 TX;COMPLICATED $427.00
    63010698 TRNK,SCLP,NK,EXT.;2.5CM OR < $204.00
    63010706 TRNK,SCLP,NECK,EXT 7.6-12.5CM $387.00
    63010714 TRNK,SCLP,NECK,EXT 12.6-20.0CM $473.00
    63010722 NK,HANDS,FT; 2.5CM OR LESS $211.00
    63010730 NK,HANDS,FT; 2.6 - 7.5CM $299.00
    63010748 NK,HANDS,FT; 7.6 - 12.5CM $393.00
    63010755 NK,HANDS,FT; 12.5 - 20.0 CM $473.00
    63010763 FACE,EAR,EYELID,NOSE; 2.5CM < $252.00
    63010771 FACE,EAR,EYELID,NOSE;2.6-5.0CM $332.00
    63010789 FACE,EAR,EYELID,NOSE;5.1-7.5CM $379.00
    63010797 FACE,EAR,EYELID,NOSE;7.6-12.5C $533.00
    63010805 TRUNK; 1.1 - 2.5CM $326.00
    63010821 SCLP, ARMS/LEGS; 1.1 - 2.5 CM $346.00
    63010839 FACE,HANDS/FEET; 1.1 - 2.5CM $447.00
    63010847 FACE,HANDS/FEET; 2.6 - 7.5CM $707.00
    63010854 EYELID,NOSE,EAR; 1.0CM OR < $439.00
    63010862 EYELID,NOSE,EAR; 1.1 - 2.5 CM $614.00
    63010870 EYELID,NOSE,EAR;2.6 - 7.5CM $1,022.00
    63010888 TX WOUND DEHISCENCE; EXT $1,129.00
    63010896 INITIAL TREATMENT 1ST DEGREE $104.00
    63010904 DRSG/DBRD;INITIAL/SUB;SMALL $97.00
    63010912 DRSG/DBRD;MEDIUM $204.00
    63010920 DRSG/DBRD;LARGE $232.00
    63010938 EXCHAROTOMY; INITIAL $572.00
    63010946 ESCHAROTOMY;EA ADDITIONAL $104.00
    63011043 CL TX SCAPULAR FX; W/O MANI $346.00
    63011050 DR FINGER ABSCESS;FELON $278.00
    63011233 REMOVE FB FOOT,SUBC $186.00
    63011373 REM FB EXT EYE;EMBEDDED NON-PE $120.00
    63011381 REM FB;EXT EYE;CORNEAL,W/O SLI $104.00
    63011423 DEBRIDEMENT;SELECTIVE;EACH $138.00
    63011431 DEBRID;NON-SELECTIVE;EACH $138.00
    63011449 KNEE STRAPPING $157.00
    63011472 TYMPANIC MEMBRANE CHECK BILAT $15.00
    63011480 PE W/EXPANDED ORTHO $64.00
    63011498 DEBRIDEMENT; 20 CM OR < $92.00
    63011506 DEBRIDEMENT > 20 CM $138.00
    63011514 PE MD REVIEW $31.00
    63011522 INCENTIVE SPIROMETER TX $24.00
    63011531 CHS SPIROMETRY (PFT) 3 TRACING $41.00
    63020010 EVIDENTIAL BREATH ALCOHOL TEST $27.00
    63020028 CONFIRMATORY BREATH ALCOHOL $45.00
    63020036 URINE DRUG SCREEN COLLECT ONLY $21.00
    63020044 COMPLETE URINE DRUG SCREEN $51.00
    63020051 HAIR DRUG SCREEN COLLECT ONLY $34.00
    63020077 MRO FUNCTION (DOT DS) $47.00
    63020085 TOXOLOGICAL REVIEW(NON-DOT DS) $51.00
    63020101 ADD/DELETE RANDOM DRUG SCREEN $8.00
    63020119 CONSORTIUM/DRUG SCREEN START U $13.00
    63020127 REVIEW URINE DRUG SCREEN POLIC $167.00
    63020135 CREATE URINE DRUG SCREEN POLIC $332.00
    63020143 6-MONOACETYLMORPHINE LEVEL $127.00
    63020150 AMPHETAMINE ISOMERIZATION TEST $62.00
    63020168 SPECIMEN REANALYSIS,EA METABOL $159.00
    63020176 AFTER HRS SERVICE/TRAVEL $93.00
    63020184 OFFICE STAFF TESTIMONY/PER HR $82.00
    63020192 DRUG TEST REVIEW/SIGN OFF $17.00
    63020200 CHF DRUG SCREEN $23.00
    63020234 5 PANEL HAIR DRUG SCREEN $62.00
    63020242 EXPANDED OPIATES UDS $68.00
    63020283 UDS QUANTITATIVE OPIATE LEVEL $96.00
    63020291 SIGN OFF ON NEGATIVE DRUG TEST $9.00
    63020309 URINE ALCOHOL SCREEN $24.00
    63020317 RAPID URINE DRUG SCREEN $31.00
    63020325 HAIR DRUG SCREEN W/EXP OPIATES $64.00
    63030019 INJ. TENDON SHEATH/TRIGGER $97.00
    63030035 ARTHROCENTESIS-INTERMED JO $104.00
    63030076 DEPO MEDDROL INTRA MUSCULAR $52.00
    63030092 LIDOCAINE INJ 2% PER CC $8.00
    63030126 INJ;TENDON ORIGIN/INSERTION $104.00
    63030134 INJ;SINGLE/MULTIPLE 1-2 MUSCLE $104.00
    63030159 IV INF UNDER DIR SUP PHY 1 HR $80.00
    63030167 IM/SQ INJECTION $18.00
    63030175 CELESTONE 6MG $39.00
    63040018 VACCINE ADMINISTRATION $17.00
    63040026 DIPTHERIA/TETANUS VACCINE $27.00
    63040034 HEPATITIS A VACCINE $71.00
    63040042 HEPATITIS B VACCINE $60.00
    63040059 INFLUENZA VACCINE $28.00
    63040075 VARICELLA-ZOSTER VACCINE $180.00
    63040109 HEPATITIS B IMMUNE GLOBULIN $85.00
    63040125 ADMIN HEPATITIS VACCINE $13.00
    63040174 PNEUMOCOCCAL VACCINE $40.00
    63040182 TDAP (ADACEL) VACCINE $76.00
    63040191 CHS HEPATITIS B VACCINE & ADMI $60.00
    63040208 CHS HEPATITIS A VACCINE & ADMI $71.00
    63040216 CHS TETANUS-DIPHTHERIA VAC. & $27.00
    63040224 CHS TDAP VACCINE & ADMIN $76.00
    63040232 CHS INFLUENZA VACCINE & ADMIN $23.00
    63050017 PHYSCN VENIPUNCTURE NONROUTINE $31.00
    63050025 VENIPUNCTURE $13.00
    63050033 LEAD/ZPP $54.00
    63050041 URINE HEAVY METAL SCREEN $101.00
    63050058 ZINC BLOOD $41.00
    63050074 OH CBC WITH DIFF $15.00
    63050082 HEPATITIS C ANTIBODY $30.00
    63050090 HEPATITIS B SURFACE ANTI TITER $30.00
    63050108 ANABOLIC STEROIDS $188.00
    63050116 HIV $122.00
    63050124 LYMES TITER $170.00
    63050132 NASAL PHARYNX CULTURE $115.00
    63050165 VARICELLA ANTIBODY TITRE $94.00
    63050173 LDL CHOLESTEROL LEVEL $41.00
    63050181 BLOOD ARSENIC LEVEL $81.00
    63050199 BLOOD KIT W/BLOOD DRAW $20.00
    63050207 BLOOD ALCOHOL $99.00
    63050215 HEALTH FAIR SCREENING $40.00
    63050223 OH COMP METAB PANEL $26.00
    63050231 OH LIPID PANEL $27.00
    63050249 OH PSA $36.00
    63050256 OH CRP $24.00
    63050264 CREATININE; NOT BLOOD $15.50
    63050272 CADMIUM $31.00
    63050280 BETA-2 MICROGLOBULIN $15.50
    63050298 B&W LEAD/ZPP 22996 $28.40
    63050306 B&W SERIUM CADMIUM 56093P $26.40
    63050314 B&W SERUM MERCURY 56853P $30.40
    63050322 B&W SERUM ARSENIC 55830P $36.20
    63050330 URINE CYTO $100.00
    63050348 URINALYSIS R & M $16.00
    63050355 HEMOGLOBIN A1C $26.00
    63050363 URINE NICOTINE $20.00
    63050371 HEMOCCULT $10.00
    63050389 CLOSETMAID DRUG SCRN COLLECT $12.00
    63050397 CHS BLOOD DRAW $10.00
    63050405 CHS FINGER STICK FOR BLOOD SUG $5.00
    63050413 CHS ROUTINE U/A COLLECT $16.00
    63050421 CHS REGULATED DRUG SCRN COLLEC $21.00
    63050439 CHS NON-REG DRUG SCRN COLLECT $21.00
    63050447 CHS DIRECT OBSERVATION DRG SCR $12.00
    63050454 CHS HAIR DRUG SCRN COLLECT $34.00
    63050462 CHS RAPID DRG SCRN QUAL $31.00
    63050471 CHS BREATH ALCOHOL TEST $27.00
    63050488 CHS URINE DIPSTICK (NOT DOT) $16.00
    63050496 CHS HCG ONE STEP PREG TEST $5.00
    63050504 CHS RECTAL EXAM W/ OCCULT BLOO $18.00
    63050512 CHS PPD/TB ADMIN & READ $21.00
    63050521 CHS DNA BUCCAL SWAB COLLECT $15.00
    63060024 URINE DIP $16.00
    63060032 PPD PLANT & READ $21.00
    63060040 AUDIOSCOPE SCREENING TEST $13.00
    63060057 VISION TEST (TITMUS) $31.00
    63060065 VISION TEST (SNELLEN CHART) $10.00
    63060073 COLOR VISION (ISHIHARA BOOK) $11.00
    63060081 WORK PERFORM EVAL < 30 MIN $123.00
    63060099 FUNCTIONAL CAPACITY SCREEN $125.00
    63060107 FCE EXPANDED $150.00
    63060115 TELEPHONE CONSULTATION,SIMPLE $33.00
    63060123 TELEPHONE CONSULTATION,INTERME $48.00
    63060149 WORK PERFORM EVAL > THAN 30MIN $143.00
    63060156 CHEST XRAY 1 VIEW $59.00
    63060164 CHEST XRAY 2 VIEWS $62.00
    63060172 L-S SPINE 3 VIEWS $62.00
    63060180 B-READ CXR $70.00
    63060198 RIGGING FCE $175.00
    63060206 DYNEGY PWS $40.00
    63060214 CHS AUDIOGRAM PURE TONE $27.00
    63060222 CHS BODY MEASUREMENTS $5.00
    63060231 CHS VISUAL ACUITY W/O PHYSICAL $10.00
    63060248 CHS VISION-COLOR,TITMUS/SIMILA $5.00
    63060255 CHS COLOR VISION ISHIHARA 14+ $11.00
    63060263 CHS DEPTH PERCEPTION $10.00
    63060271 CHS PERIPHERAL VISUAL FIELDS $5.00
    63060289 CHS CHEST XRAY SINGL VIEW FRON $59.00
    63060297 CHS CHEST XRAY 2 VIEW FRONT/LA $62.00
    63060305 CHS CHEST XRAY COPY/MAIL FEE $10.00
    63060313 CHS BRIEF FIT TEST/EVAL <20MIN $50.00
    63060321 CHS PERFORM FIT TEST (PA003C) $50.00
    63060339 CHS PERFORM FIT TEST (PA003AM) $50.00
    63060347 CHS PERFORM FIT TEST (PA003I) $50.00
    63060354 CHS FITNESS TEST UP TO 45 MIN $50.00
    63060362 CHS FLEXIBILITY ASSESSMENT $50.00
    63060371 CHS FITNESS TEST-SEAFARERS $50.00
    63060388 ORBIT XRAY FOREIGN BODY $74.00
    63070015 FINGER SPLINT $66.00
    63070023 WRIST SPLINT $97.00
    63070031 ANKLE SPLINT $62.00
    63070049 ACE WRAP-2" $13.00
    63070056 ACE WRAP-3" $14.00
    63070064 ACE WRAP-6" $19.00
    63070072 CRUTCHES (PAIR) $115.00
    63070098 ARM SLING $18.00
    63070106 SHORT;DYNAMIC $113.00
    63070114 FINGER;DYNAMIC $159.00
    63070122 LONG LEG SPLINT $125.00
    63070130 SHORT LEG SPLINT $113.00
    63070148 LONG ARM SPLINT $125.00
    63070155 MEDTOX $13.00
    63070163 MULTIPURPOSE TRAY $39.00
    63070171 TRAY, SUTURE REMOVAL $14.00
    63070189 PETROLEUM GAUZE 3X9 $9.00
    63070197 XEROFORM GAUZE 5X9 $9.00
    63070205 STAPLE REMOVER PSX $29.00
    63070213 ETHICON PROXIMATE PLUS STAPLER $88.00
    63070221 SMALL DRESSING $6.00
    63070239 AIR CAST ANKLE BRACE $269.00
    63080014 EKG W/O INTERPRETATION $47.00
    63080048 EKG PROFESSIONAL $20.00
    63080055 PLAIN TREADMILL STRESS TEST $180.00
    63080063 PROF PLAIN TREADMILL STRESS TE $19.00
    63080071 CHS RESTING EKG 12 LEAD W/INTE $47.00
    63090039 IBUPROFEN 800MG 30TAB $22.00
    63090047 METHYLPREDNISOLONE 4MG 21 DOSE $22.00
    63090070 SILVER SULFADIAZINE CREAM 50G $52.00
    63090104 KENALOG 40IM $31.00
    63100010 NON-CLIENT COMP URINE DRUG $88.00
    63100028 NON-CLIENT PPD TEST $35.00
  • Chemotherapy Services

    Service Code Description Price
    69510147 CHEMO IV PUSH SNGL DRUG $360.00
    69510154 CHEMO INFUSION TECH 1 HR $559.00
    69510220 NON-CHEMO ADMIN 1ST HOUR $427.50
    69510253 NON-CHEMO/ADMIN EA ADD HOUR $226.30
    69510261 CHEMO OTHER THAN INF >1HR $238.00
    69510311 INFLUENZA VACCINE W/O MD VISIT $69.80
    69510352 MEDICATION INJECTION SQ OR IM $138.70
    69510428 INTRAVESICAL OR BLADDER INSTA $620.00
    69510469 RN EST PT PROBLEM-5 MIN $218.00
    69510485 RN EST PT PROB W PROC-5 MIN $218.00
    69510493 MEDICATION INJECTION (IV PUSH) $360.00
    69510519 PARACENTESIS $1,852.00
    69510535 TRANSFUSIONS(ALL BLOOD/BLOOD $666.00
    69510550 SUBARACHNOID OR INTRAVEN CHEMO $360.00
    69510576 RN EST PT COMPREHENSIVE-25 MIN $300.70
    69510616 LEVEL V NEW PT W/PROC-60 MIN $338.00
    69510626 RN EST PT EXPANDED PROB-10 MIN $246.90
    69510642 RN VISIT-EST PT COMPLEX-40 MIN $328.20
    69510659 RN EST PT DETAIL W PROC-15 MIN $266.40
    69510667 CHEMO INFUSION EA ADD 1 HR $249.70
    69510675 BONE MARROW ASPIRATION $2,700.00
    69510683 BONE MARROW BIOPSY $2,550.00
    69510725 LEVEL 1 NEW PATIENT-10 MIN $243.00
    69510733 LEVEL 1 NEW PT W/PROC-10 MIN $243.00
    69510741 LEVEL II NEW PATIENT-20 MIN $268.00
    69510758 LEVEL II NEW PT W/PROC-20 MIN $268.00
    69510766 LEVEL III NEW PATIENT-30 MIN $293.00
    69510774 LEVEL III NEW PT W/PROC-30 MIN $293.00
    69510782 LEVEL IV NEW PATIENT-45 MIN $304.10
    69510808 LEVEL V NEW PATIENT-60 MIN $335.00
    69510824 LEVEL II EST PT W/PROC-10 MIN $246.90
    69510832 LEVEL IV EST PT W/PROC-25 MIN $300.70
    69510840 LEVEL V EST PT W/PROC-40 MIN $328.20
    69510857 BLOOD DRAW FROM VAD $201.00
    69510865 THORACENTESIS $1,200.00
    69510907 INJ IM PNEUMONIA;NO MD;NO E&M $69.80
    69510923 INSERT PICC LINE $2,000.00
    69510931 REPAIR PICC LINE $1,550.00
    69510949 REPLACE PICC LINE; SAME SITE $2,000.00
    69510964 BONE ASPIRATE & BIOPSY $2,635.00
    69510972 CHEMO-HORMONAL INJ SQ/IM $215.00
    69510980 HYDRATION IV INF, INITIAL $360.00
    69510998 HYDRATE IV INF, ADD-ON $83.40
    69511004 THER/PROPH/DIAG INJ ADD-ON $151.20
    69511012 CHEMO IV;EA ADDL SEQ INF UP1HR $221.90
    69511020 CHEMO IV PUSH, ADDL DRUG $249.70
    69511038 THERAPEUTIC PHLEBOTOMY W/ORW/O $272.10
    69511046 IRRIG DRUG DELIVERY DEVICE $138.80
    69511053 RN VISIT-EST PT MODERATE-15 MN $268.00
    69511061 RN NEW PT LEVEL IV W/PRO-45 MN $308.00
    69511079 CHEMO CNS (INTRATHECAL) W LP $627.30
    69511087 APPLICATION ON BODY INJECTOR $80.00
    69511095 REFILL/MAINT PUMP/RESVR SYST $450.00
    69530012 DECLOT VASCULAR DEVICE $915.40
    69530021 TX/PROPH/DG ADDL CONCURRENT IV $82.30
    69530038 IV TX ADD SEQ NON CHEMO INF $128.40
    69530046 TX/PROPH/DG ADDL SEQ IV INF =< $128.40
    69530053 TX/PRO/DX INJ SAME DRUG ADDON $162.40
    69530061 CHEMO PROLONG 8+ HRS INFUSE W/ $581.50
    69530079 PROLONGED IV INF REQ PUMP >8 H $592.30
    69530087 COLLECT BLOOD FROM PICC $201.00
    69530095 SKIN TEST; TB ID (PPD SKIN) $35.00
    69530103 SKIN TEST; CANDIDA $65.00
  • Medical Supplies

    Service Code Description Price
    70020037 COLOSTOMY IRRIGATION $119.20
    70020334 SQUIBB IRRIGATOR $119.20
    70020433 OSTOMY POUCHES 1 3/4"" $41.40
    70020458 OSTOMY POUCHES 2 3/4"" $32.20
    70020466 OSTOMY POUCHES 4"" $36.80
    70020532 UROSTOMY POUCH 1 3/4"" $29.90
    70020623 OSTOMY IRRIGATION SLEEVE $24.20
    70030010 SOD CHL.IRRIG.SOLN 1000ML $37.90
    70030036 SOD CHL.IRRIG.SOLN 3000ML $42.60
    70030069 WATER FOR IRRIG 1000ML $23.10
    70030101 LR IRRIG SOLN 3000 ML $39.10
    70030192 4.25 DIALYSATE W/2.5 CALCIUM $19.70
    70030200 2.5 DIALYSATE W/2.5 CALCIUM $19.70
    70030242 DEXTROSE 1.5%/LO CALCIUM 2000 $17.30
    70030325 DELFLEX 1.5 5000ML LO-CAL $28.80
    70030333 DELFLEX 2.5 5000ML LO-CAL $12.80
    70030341 DELFLEX 4.25 5000ML LO-CAL $12.80
    70030374 DELFLEX 1.5 2000ML LO-CAL W/D $28.80
    70030382 DELFLEX 2.5 2000ML LO-CAL W/D $28.80
    70030390 DELFLEX 4.25 2000ML LO-CAL W/ $28.80
    70040084 STERILE TAPE PATCH 4 X 7 $3.50
    70040092 WOUND DRAIN BAG 10 1/2 CM $68.80
    70040100 DUODERM-4 X 4 $25.30
    70040241 HYDROSORB DRESSING $27.70
    70040290 V.A.C. LG DRESSING $70.00
    70040324 DRESSING VAC SILVER MEDIUM $70.00
    70050018 ARM SLING $39.10
    70050026 CERVICAL COLLAR SM $138.50
    70050059 SHOULDER IMMOBILIZER $328.20
    70050083 ANKLE SPLINT $70.00
    70050091 COCK UP SPLINT $303.00
    70050109 KNEE IMMOBILIZER $228.60
    70050125 CANE $74.50
    70050133 CRUTCHES, PAIR $284.00
    70050257 SLING & SWATHE $249.30
    70050265 WRIST & FOREARM SPLINT $244.90
    70050299 LONG LEG CUTTER CAST $275.60
    70050307 LONG ARM CUTTER CAST $193.30
    70050315 SHORT LEG CUTTER CAST $209.20
    70050323 SHORT ARM CUTTER CAST $177.30
    70050364 ADJUSTABLE CANE $141.00
    70050380 HAND SPLINT $134.00
    70050398 PADDED HAND SPLINT $108.90
    70050455 FINGER SPLINT $115.00
    70050463 WRIST AND HAND CAST $115.80
    70050513 CLAVICLE STRAP OR SUPPORT $240.00
    70050570 POSTERIOR LEG (PLASTER) $159.00
    70050596 FOOT CRADLE BOOT $373.30
    70050604 WOODEN SURGICAL SHOE $373.30
    70050620 MED ABD PILLOW DISP $92.80
    70050638 SM ABD PILLOW DISP $91.60
    70050745 SHOULDER IMMOBIL MED $430.50
    70050752 SHOULDER IMMOBIL LG $430.50
    70050836 LUMBAR SAC BELT MED-LG $461.80
    70050919 CAST BOOT OT MED $148.70
    70050927 CAST BOOT OT LG $148.70
    70050935 CAST BOOT OT XLG $129.30
    70050943 CAST BOOT CT SM $132.60
    70050950 CAST BOOT CT MED $152.20
    70050968 CAST BOOT CT LG $152.20
    70050976 CAST BOOT CT XLG $152.20
    70051271 CAST BOOT SM O.T $129.30
    70051289 CAST BOOT XSM C.T $119.20
    70051297 PELVIC TX LARGE $332.70
    70051305 CRUTCH CHILD EACH $59.70
    70051313 CRUTCHES MED ADULT EACH $59.70
    70051321 CRUTCH YOUTH EACH $175.00
    70051354 TUBEGAUZE 01 $16.30
    70051362 TUBEGAUZE 1 $16.30
    70051388 BELT SACRAL PELVIC SM-MED $384.00
    70051404 SURGICAL SHOE $373.30
    70051420 KNEE IMMOBULIZER PO/6"" XXL $340.70
    70051792 COLLAR CERVICAL XLGE $68.80
    70051842 BRACE ANKLE GEL-AIRLINER $220.00
    70060033 ARM BOARDS $40.60
    70060058 AVETINE $339.90
    70060124 BREAST PUMP $55.90
    70060215 HYPOTHER UNIT $187.80
    70060223 ZIMMERO POSEY WRISTLETS $20.80
    70060249 ENEMA KIT $12.80
    70060355 DEFIB PADS $26.50
    70060405 ELECTRODES $10.40
    70060470 PLEUROVAC $155.50
    70060488 ATHLETIC SUPPORTER $87.00
    70060520 SEXUAL ASSULT EVIDENCE KIT $201.20
    70060546 BILE BAG 9 OZ $31.10
    70060637 SURGICAL HEMOSTASIS 1/2X2 $121.80
    70060645 SURGICAL HEMOSTASIS 2 X 3 $60.70
    70060652 SURGICEL $339.90
    70060686 DISP HYPOTHERMIA BLANKET $137.40
    70060694 VAGINAL SPECULUM DISP $13.80
    70060769 UMBILICAL VESSEL CATHETER $20.80
    70060835 HEEL FREE $355.30
    70060959 SUPPORTER MED (REG BAND) $36.80
    70060967 SUPPORTER LG (REG BAND) $28.80
    70061296 DRESSING AQUACEL 6X6 $35.70
    70061312 LYMPHEDEMA PUMP $24.20
    70061346 ISO-FLEX MATTRESS $36.80
    70061353 MATTRESS CFT STAGE I & II $19.70
    70061361 MATTRESS APM OVERLAY $19.70
    70061379 MATTRESS TURN Q $39.10
    70061387 MATTRESS PLEXUS 2500 $29.90
    70061429 MULTIPURPOSE TRAY $36.80
    70061452 NEEDLE HUBER 20G X 3/4"" $42.60
    70061478 DRESSING AQUACEL AG 4X4.7 $75.60
    70061486 LOW BED PACKAGE #1 $91.60
    70061494 MATTRESS ALTERNATING PRESSURE $32.20
    70061502 NEEDLE HUBER PORT ACCESS TRAY $42.60
    70061528 TEK FLUID MATTRESS $77.90
    70061551 LOW BED PACKAGE #2 $103.00
    70061585 LOW BED PACKAGE #3 $149.90
    70061593 SELECT AIR LOSS MATTRESS $85.90
    70061601 LOW BED PACKAGE #4 $93.90
    70061619 IMMERSE AIR MATTRESS $120.00
    70061627 HERCULES BED $520.00
    70070057 GUAZE IODOFORM $47.10
    70070065 KERLIX $11.70
    70070115 TAPE $13.80
    70070123 MICROFOAM TAPE $27.70
    70070156 BANDAGE KLING 3 INCH $8.40
    70070164 BANDAGE KLING 4 INCH $10.40
    70070198 ACE BANDAGE 6""&UP WIDE $15.10
    70070214 TRANSPARENT DRESSING 4X5 $22.00
    70070248 ADD'L 4"" ACE BANDAGE $13.80
    70070313 PLAIN GUAZE PACKING 1"" $119.20
    70070347 TUBE GUAZE $15.10
    70070396 EXT PACEMAKER W/PADS $1,243.40
    70070446 STERI STRIP 1/2"" $26.50
    70070560 AIRSTRIP DRESSING 4.75 X 3.25 $11.70
    70070586 COBAN 6"" $24.20
    70070685 DRESSING SETOPRESS 4" $53.90
    70070727 AQUACEL SILVER 3.5 X 12 INCHES $155.64
    70070735 AQUACEL SILVER 3.5 X 4 INCHES $91.80
    70070743 AQUACEL SILVER 3.5 X 6 INCHES $139.68
    70070751 AQUACEL SILVER 3.5 X 10 INCHES $139.68
    70070768 MEPILEX BORDER AG 4X8 INCH $80.90
    70070776 MEPILEX BORDER AG 4X12 INCH $116.60
    70080015 URETHRAL CATHETER $24.20
    70080031 TUBES FEEDING $10.40
    70080056 MID STREAM URINE COLLECTR $16.30
    70080064 CATHETER TRAY $56.30
    70080080 MONTGOMERY STRAP $10.40
    70080106 FOLEY 5CC BAG $35.70
    70080114 FOLEY 30CC BAG $31.10
    70080122 MALE EXTERIOR CATHETER-TEXAS $9.40
    70080288 VASELINE GUAZE 1/2X72 $24.20
    70080296 XEROFORM 1X8 $11.70
    70080304 XEROFORM 5X9 $11.70
    70080338 SUCTION CATH PLASTIC $12.00
    70080346 URINE STRAINER $10.40
    70080403 BARDEX 3WAY FOLEY $58.50
    70080411 URINE DRAINAGE BAG $47.10
    70080429 CATHETER THORACIC 34 36 $116.80
    70080460 LUKIPORE BLOOD FILTER $57.30
    70080486 TRACHESTOMY TUBE W CUFF $203.60
    70080627 TRACH TUBE $366.30
    70080650 UROGATE CYSTOSCOPY SET $33.30
    70080676 TRACH PLUG $40.20
    70080684 IV TUBING SET-REGULAR $27.90
    70080700 VESSEL TIP 3.5 CM $42.60
    70080767 ROBINSON CATHETER $19.70
    70080791 IV PUMP EXTENSION SET $26.50
    70080809 AIRWAY TUBE $5.90
    70080833 URETHRAL TRAY W/OCTH $20.80
    70080908 FENESTRATED TRACH TUBE $219.60
    70080932 G.P. BIOPSY KIT $168.20
    70080981 FEMORAL ARTERY KIT 18GA $221.80
    70080999 CATHETER TRIPLE LUMEN EDWARDS $259.70
    70081005 JELCO CATH KIT $13.80
    70081013 CATHETER DOUBLE LUMEN EDWARDS $260.70
    70081054 CATHETER SET TROCAR $173.80
    70081062 TUBE TRACH SIZE 6 $239.00
    70081104 ENG TUBE-4 LUMEN $2,125.30
    70081138 SWAN-GANZ V.I.P. CATHETER-7.5 $285.80
    70081146 HEMAQUET INTRODUCER KIT,9FR $141.90
    70081153 PRESSURE EXTENSION SET $23.10
    70081161 YELLOW CAPS (MALELEUR LOCK),#3 $12.80
    70081179 SINGLE STOPCOCK (3 WAY) $72.20
    70081187 DOUBLE STOPCOCK (3 WAY) $104.20
    70081195 COOK NEEDLE 1 1/2 OR 3 INCH $11.70
    70081229 RAD ART CATH SET-20 GA $195.60
    70081278 COOK GUIDEWIRE .038CM $96.50
    70081302 RAE ENDO TUBE $66.50
    70081328 AXILLARY BLOCK KIT $17.30
    70081344 SADDLE BLOCK TRAY $104.20
    70081369 TWIN SITE EXTENSION $8.40
    70081427 SINGLE TRANSDUCER $135.00
    70081435 DOUBLE TRANSDUCER $226.50
    70081443 TRIPLE TRANSDUCER $346.40
    70081609 SUCTION CATH 14FR $9.40
    70081617 SUCTION CATH COUDE 14FR $9.40
    70081674 INNER CANNULAS 10 $24.20
    70081682 TUBE TRACH SIZE 8 $227.60
    70081690 SHILEY DCT 10 $197.90
    70081740 DERMICLEAR TAPE 2"" $9.40
    70081765 DERMILITE TAPE 1"" $9.40
    70081773 DERMILITE TAPE 2"" $9.40
    70081799 TRACH TUBE O (SS) $204.70
    70081807 TRACH TUBE 1 (SS) $204.70
    70081815 TRACH TUBE 2 (SS) $204.70
    70081823 TRACH TUBE 4 (SS) $184.20
    70081849 TRACH TUBE 5 (SS) $184.20
    70081856 TRACH TUBE 6 (SS) $234.50
    70081864 TRACH TUBE 7 (SS) $204.70
    70081872 TRACH TUBE 8 (SS) $204.70
    70081880 TRACH TUBE 9 (SS) $204.70
    70081898 TRACH TUBE 10 (SS) $184.20
    70081906 TRACH PLUG 4 1/4"" $44.80
    70081914 TRACH PLUG 4 1/2"" $44.80
    70081922 TRACH PLUG 4 3/4"" $44.80
    70081930 TRACH PLUG 4 FC $44.80
    70081948 TRACH PLUG 5 FC $40.20
    70081955 TRACH PLUG 6 1/4"" $44.80
    70081963 TRACH PLUG 6 1/2"" $44.80
    70081971 TRACH PLUG 6 3/4"" $44.80
    70081989 TRACH PLUG 6 FC $51.60
    70081997 TRACH PLUG 8 FC $44.80
    70082003 TRACH PLUG 10 FC $44.80
    70082011 SHILEY FENESTRATED 8 $243.00
    70082029 SHILEY PEDIATRIC 1 $794.30
    70082037 SHILEY PEDIATRIC 2 $794.30
    70082045 SHILEY PEDIATRIC 3 $794.30
    70082060 FOLEY CATH 3 WAY 20FR 5CC $75.60
    70082078 FOLEY CATH 3WAY 22FR 5CC $85.90
    70082086 FOLEY CATH 3WAY 24FR 5CC $75.60
    70082094 FOLEY CATH 3WAY 30CC 18FR $75.60
    70082102 FOLEY CATH 3WAY 30CC 20FR $67.60
    70082110 FOLEY CATH 3WAY 30CC 22FR $67.60
    70082128 FOLEY CATH 3WAY 30CC 24FR $67.60
    70082151 AIRWAY 60MM $5.90
    70082169 AIRWAY 70MM $4.90
    70082201 SHILEY CANNULA 4 $191.10
    70082219 SHILEY TRACH 4DCT $197.90
    70082243 SUCTION CATH 14FR $9.40
    70082250 FOLEY CATH 2WAY 10FR 3CC $33.30
    70082268 FOLEY CATH 2 WAY 12FR 5CC $33.30
    70082276 FOLEY CATH 2 WAY 14FR 5CC $33.30
    70082292 FOLEY CATH 2WAY 18FR 5CC $33.30
    70082326 FOLEY CATH 2 WAY 5CC 24FR $33.30
    70082334 FOLEY CATH 2WAY 5CC 26FR $33.30
    70082342 FOLEY CATH 2WAY 5CC 28FR $33.30
    70082359 FOLEY CATH 2WAY 3CC 8FR $33.30
    70082375 FOLEY CATH 2WAY 30CC 20FR $33.30
    70082383 FOLEY CATH 2WAY 30CC 22FR $33.30
    70082391 FOLEY CATH 2 WAY 30CC 24FR $33.30
    70082409 FOLEY CATH 2 WAY 30CC 28FR $33.30
    70082417 FOLEY CATH 2 WAY 30CC 30FR $56.30
    70082433 URETHRAL CATH 16FR $19.70
    70082441 URETHRAL CATH 18FR $19.70
    70082458 URETHRAL CATH 20FR $19.70
    70082615 URETHRAL CATH 14FR COUDE $19.70
    70082649 CATH FOLEY 26FR 30CC 2 WAY $37.90
    70082656 SUCTION CATH 8FR $9.40
    70082680 CATHETER 5FR SPIRAL FILIFORM $267.60
    70082698 CATH 6FR SPIRAL FILIFORM $233.30
    70082706 CATHETER 3FR OLIVE TIP FILIFO $233.30
    70082714 CATHETER 4FR OLIVE TIP FILIFO $209.20
    70082722 CATH 5FR OLIVE TIP FILIFORM $209.20
    70082730 CATH 6FR OLIVE TIP FILIFORM $209.20
    70082748 CATH 8FR PHILLIPS FOLLOWER $209.20
    70082755 CATH 10FR PHILLIPS FOLLOWER $267.60
    70082763 CATH 12FR PHILLIPS FOLLOWER $267.60
    70082771 CATH 14FR PHILLIPS FOLLOWER $209.20
    70082789 CATH 16FR PHILLIPS FOLLOWER $209.20
    70082797 CATH 18FR PHILLIPS FOLLOWER $209.20
    70082805 CATH 20FR PHILLIPS FOLLOWER $209.20
    70082813 CATH 24FR PHILLIPS FOLLOWER $209.20
    70082821 CATH URETHRAL 10FR COUDE $16.30
    70082839 CATH URETHRAL 12FR COUDE $19.70
    70082847 CATH URETHRAL 16FR COUDE $19.70
    70082854 CATH URETHRAL 18FR COUDE $17.30
    70082862 CATH URETHRAL 20FR COUDE $17.30
    70082870 CATH URETHRAL 22FR COUDE $16.30
    70082888 CATH URETHRAL 24FR COUDE $17.30
    70082904 THORACIC CATHETER 32FR $121.80
    70082920 FOLEY CATHETER 16FR 5CC 3 WA $83.60
    70082938 FOLEY CATHETER 24FR 5CC 3 WAY $74.50
    70082946 FOLEY CATHETER 26FR 5CC 3 WAY $83.60
    70082953 FOLEY CATHETER 16FR 30CC 2 WA $37.90
    70082961 FOLEY CATHETER 20FR 30CC 2 WA $37.90
    70082979 FOLEY CATHETER 28FR 30CC 2 WA $37.90
    70082987 FOLEY CATHETER 30FR 30CC 2 WA $37.90
    70082995 FOLEY CATHETER 12FR COUDE $74.50
    70083001 FOLEY CATHETER 22FR COUDE $71.10
    70083035 FOLEY CATH 3WAY 30CC 16FR $83.60
    70083043 FOLEY CATH 5CC 2WAY 26FR $37.90
    70083068 CATHETER FOLEY IOFR COUDE I2W $65.40
    70083084 CATH FOLEY COUDE 20FR 2 WAY 5 $74.50
    70083092 CATH FOLEY COUDE 24FR 2 WAY 5 $74.50
    70083100 CATH FOLEY COUDE 26FR 2 WAY 5 $65.40
    70083118 CATH FOLEY COUDE 28FR 5CC 2WA $65.40
    70083126 CATH FOLEY 28FR 5CC 2 WAY $37.90
    70083134 CATH FOLEY 10FR 30CC 2 WAY $37.90
    70083142 CATH FOLEY 12FR 30CC 2 WAY $37.90
    70083159 CATH FOLEY 14FR 30CC 2 WAY $37.90
    70083167 CATH FOLEY 10FR 5CC 3 WAY $83.60
    70083175 CATH FOLEY 12FR 5CC 3 WAY $83.60
    70083183 CATH FOLEY 14FR 5CC 3 WAY $83.60
    70083191 CATH FOLEY 18FR 5CC 3 WAY $83.60
    70083209 CATH FOLEY 28FR 5CC 3 WAY $83.60
    70083217 CATH FOLEY 10FR 30CC 3 WAY $83.60
    70083225 CATH FOLEY 12FR 30CC 3 WAY $83.60
    70083233 CATH FOLEY 14FR 30CC 3 WAY $83.60
    70083241 CATH FOLEY 26FR 30CC 3 WAY $83.60
    70083266 CATH FOLEY 14FR COUDE 2-W $74.50
    70083274 TRACH SHILEY #6 CUFFLESS $233.00
    70083340 TRACH TUBE-8 FR CUFFLESS $265.30
    70083357 LARYNGECTOMY TUBE, # 8 $265.30
    70083365 LARYNGECTOMY TUBE. # 10 $265.30
    70083373 LARYNGECTOMY TUBE-6FR $265.30
    70083381 LARYNGECTOMY TUBE-8FR $265.30
    70083399 LARYNGECTOMY TUBE-10FR $265.30
    70083407 HEYMAN FOLLOWER-10F $157.90
    70083415 HEYMAN FOLLOWER-12FR $157.90
    70083423 HEYMAN FOLLOWER-14FR $157.90
    70083431 HEYMAN FOLLOWER-16FR $157.90
    70083449 HEYMAN FOLLOWER-18FR $157.90
    70083456 HEYMAN FOLLOWER-20 FR $157.90
    70083464 HEYMAN FOLLOWER-22 FR $157.90
    70083472 HEYMAN FOLLOWER-24FR $157.90
    70083480 CUFFLESS TRACH TUBE-4FR SHILEY $258.60
    70083522 URETHRAL CATH 22FR $17.30
    70083571 DRAINAGE SET FOR CYCLER $77.90
    70083589 SET DISCONNECT FOR UV FLASH $40.20
    70083613 VAGINAL DILATORS X-SMALL $39.10
    70083621 VAGINAL DILATOR SMALL $39.10
    70083639 VAGINAL DILATOR MEDIUM $47.10
    70083647 VAGINAL DILATOR LARGE $56.30
    70083654 CATH FOLEY 16FR COUDE 30CC 2W $71.10
    70083662 CATH FOLEY 18FR COUDE 30CC 2W $71.10
    70083670 CATH FOLEY 20FR COUDE 30CC 2W $71.10
    70083688 CATH FOLEY 30FR COUDE 30CC 2W $71.10
    70083712 GROSHONG CATH CONNECTOR $52.80
    70083738 MINICAP W/PVP SOLUTION $20.80
    70083753 TROCAR CATH 24 FR $45.90
    70083761 TROCAR CATH 28 FR $45.90
    70083837 COOK GUIDEWIRE .35CM $96.50
    70083845 CATH FOLEY COUDE 16FR 2WAY $99.50
    70083860 CATHETER TRAY TEMP DUAL LUMEN $446.90
    70083928 THYMAPAD EPAD $11.70
    70083951 HOT/ICE HIP PAD $124.70
    70083969 CATHETER COUNCIL 16FR $91.60
    70083977 CATHETER COUNCIL 18FR $91.60
    70083985 CATHETER COUNCIL 20FR $91.60
    70083993 CATHETER COUNCIL 22FR $91.60
    70084033 TRACH TUBE 8 SCT $192.20
    70084041 TRACH TUBE 9 SCT $192.20
    70084058 URETHRAL GUIDEWIRE $169.30
    70084074 FOLEY CATH 18FR 2WAY 30CC $37.90
    70084116 AIRWAY NASOPHARYNGEAL 34FR $20.80
    70084124 AIRWAY NASOPHARYNGEAL 36FR $20.80
    70084157 CATHETER TRIPLE LUMEN HEMODIAL $448.10
    70084199 CATH FOLEY 14FR 30CC 2WAY COU $66.50
    70084207 CATHETER CLEARVUE PICC 4 FR $249.70
    70084223 CATHETER RADIAL ARTERY $57.30
    70084249 CATHETER HEMODIALYSIS CURVED $301.90
    70084256 CATHETER GROSHONG DBL.LUMEN 5F $337.20
    70084272 TUBE PEDIATRIC 8 FR FEEDING $40.20
    70084389 TUBE TRACH SHILEY 10 SCT $191.10
    70084413 CATHETER SINGLE LUMEN 3 FR $128.10
    70084454 CATHETER GROSH MIDLINE 4FR 18G $157.90
    70084462 CATHETER DUAL LUMEN 4.5FR $274.40
    70084496 TUBE SHILEY 0 PT $191.10
    70084561 DELCLAMP $3.50
    70084595 MARKER RECTAL $28.80
    70084603 MARKER VAGINAL $28.80
    70084611 CATHETER PICC SINGLE LUMEN 3F $332.70
    70084629 HYPAFIX TAPE $9.40
    70084686 URETHRAL CATHETER 12FR $6.00
    70084694 CATHETER FOLEY 24FR COUDE 30C $71.10
    70084710 FOLEY CATH 12FR 5CC LATEX FRE $71.10
    70084801 CATHETER DOUBLE LUMEN LF $81.30
    70084827 TUBE SHILEY #8 DCFN $191.10
    70084835 OSTOMY BELT SMALL $33.30
    70084843 OSTOMY BELT MEDIUM $33.30
    70084850 OSTOMY BELT LARGE $33.30
    70084876 V.A.C. UNIT $152.20
    70084884 GASTROSTOMY TUBE 20 FR $191.10
    70084900 HYPAFIX 6X10 TAPE $47.10
    70085030 TUBE TRACH SHILEY 8 X LONG $380.60
    70085048 INNER CANNULA 8 X LONG $137.10
    70085055 CATHETER QUAD LUMEN EDWARDS $298.50
    70085097 SAFELOCK 4""ADAPTER DIALYSIS $49.40
    70085105 DRAIN SET 4-LEAD $27.00
    70085113 ECOSET 4-LEAD $26.50
    70085121 FLEXI-SEAL FECAL COLLECTOR KIT $1,236.80
    70085188 NEWTON CYCLER SET W/2 PIN CONN $27.00
    70085196 IV TUBING SET-NON PVC $83.40
    70085204 CATHETER POWER PICC SOLO $860.80
    70085212 POWERGLIDE KIT 22 GAUGE $384.00
    70085220 POWERGLIDE NEEDLE 22 GAUGE $220.00
    70085238 POWERGLIDE KIT 20 GAUGE $340.00
    70085246 POWERGLIDE NEEDLE 20 GAUGE $192.00
    70085253 POWERGLIDE NEEDLE 18 GAUGE $220.00
    70085261 POWERGLIDE KIT 18 GAUGE $384.00
    70085279 POWERGLIDE BASIC KIT 10CM $220.00
    70090063 PARACERVICAL PUDENTAL TRAY $74.50
    70090105 TRAY LUMBAR PUNCTURE $91.60
    70090170 DISP DOUCHE TRAY $19.70
    70090204 SYRINGE MAGNIFIER $43.70
    70090212 DISP URETHER CATH TRAY $36.80
    70090329 SUTURE TRAY $102.00
    70090337 NASAL TRAY $72.20
    70090345 VAGINAL TRAY $72.20
    70090386 PED. LUMBAR PUCTURE TRAY $82.50
    70090402 OBESE BED PER DAY $398.90
    70090410 CVP LINE DRESSING TRAY $72.20
    70090436 UROLOGY TRAY $144.20
    70090444 ENT TRAY $140.70
    70090501 BASIC BIOPSY TRAY $82.50
    70090535 PERICARDIALCENTESIS SET $342.90
    70090543 THORACENTESIS SUPPLY KIT $182.90
    70110010 EYE PAD $6.90
    70110028 STER SODIUM CHL IRRIG SOL (P) $53.90
    70110036 ACE BANDAGE 4"" $13.80
    70110044 XEROFORM DRESSING 5X9 $13.80
    70110051 XEROFORM DRESSING 1X8 $11.70
    75010017 DEXTROSE 5% IN WATER 100ML $17.90
    75010025 DEXTROSE 5% IN WATER 250 ML $17.90
    75010033 DEXTROSE 5% IN WATER 500ML $17.90
    75010041 DEXTROSE 5% IN WATER 1000ML $17.90
    75010058 DEXTROSE 5% IN 1/4SALINE 500ML $12.80
    75010066 DEXTROSE 5% IN 1/4SALINE1000ML $12.80
    75010074 DEXTROSE 5% IN 1/3SALINE 500ML $12.80
    75010082 DEXTROSE 5% IN 1/2SALINE 500ML $12.80
    75010090 DEXTROSE 5% IN 1/2SALINE1000ML $12.80
    75010108 DEXTROSE 5% IN SALINE 500ML $12.80
    75010116 DEXTROSE 5% IN SALINE 1000ML $12.80
    75010124 DEXTROSE 5% IN RINGERS 500ML $16.20
    75010132 DEXTROSE 5% IN RINGERS 1000ML $16.20
    75010140 DEXTROSE 5% IN LACT RING 500ML $16.20
    75010157 DEXTROSE 5% IN LACT RING1000ML $16.20
    75010165 DEXTROSE 10% IN WATER 500ML $17.90
    75010173 DEXTROSE 10% IN WATER 1000ML $17.90
    75010181 DEXTROSE 10% IN SALINE 1000ML $12.80
    75010199 DEXTROSE 50% IN WATER 500ML $17.90
    75010207 LACTATED RINGERS 250ML $16.20
    75010215 LACTATED RINGERS 500ML $16.20
    75010223 LACTATED RINGERS 1000ML $12.80
    75010231 RINGERS INJECTION 500ML $16.20
    75010249 RINGERS INJECTION 1000ML $16.20
    75010256 NORMAL SALINE 250ML $12.80
    75010264 NORMAL SALINE 500ML $12.80
    75010272 NORMAL SALINE 1000ML $12.80
    75010280 SODIUM CHLORIDE SOLN 5% 500ML $12.80
    75010322 MANNITOL SOLN 5% 1000ML $127.10
    75010330 MANNITOL SOLN 10% 1000ML $146.40
    75010348 INVERT SUGAR 10% 1000ML $36.80
    75010355 NORMOSOL M IN D5W 500ML $74.50
    75010363 NORMOSOL M IN D5W 1000ML $82.50
    75010371 NORMOSOL R 500ML $52.80
    75010389 NORMOSOL R 1000ML $72.20
    75010397 NORMOSOL R IN D5W 1000ML $82.50
    75010405 LMD 10% IN DEXTROSE 5% 500ML $252.80
    75010413 LMD 10% IN SALINE 500ML $252.80
    75010421 DEXTRAN 6% IN DEXTROSE 5%500ML $308.50
    75010439 DEXTRAN 6% IN SALINE 500ML $308.50
    75010447 SALINE SOLN 0.45% 1000ML $48.20
    75010454 SODIUM LACTATE SOLN 1/6M 500ML $36.80
    75010462 SODIUM LACTATE SOLN 1/6M1000ML $48.20
    75010470 MANNITOL SOLN 20% 500ML $146.40
    75010488 AMINOSYN M 3.5% 1000ML $202.50
    75010512 ALCOHOL 5% IN D5W 1000ML $31.10
    75010587 NORMAL SALINE 100ML $10.00
    75010595 SALINE SOLUTION 0.45% 500ML $42.60
    75010637 THEOPHYLLINE 400MG D5W 500 $49.40
    75020024 NITROGLYCERIN ADM SET $71.10
    75020032 FAT EMULSION ADM SET $62.00
    75020040 NONVENT VOL TUB W FILTER $63.10
    75020065 NONVENTED TUBING W FILTER $62.00
    75020073 NONVENTED ANESTHESIA SET $16.30
    75020099 VENTED VOL TUBE WO FILTER $97.40
    75020115 VENTED PRI SET W/O FILTER $10.40
    75020123 SOLUSETS $32.20
    75020131 BLOOD Y SET $6.90
    75020149 JELCO NEEDLE $12.80
    75020164 VENOSET $18.50
    75020172 N-V SEC MICRO DRIP SET $36.80
    75020180 MIRO PUMP W/FILTER SET $60.70
    75020198 Y-BLOOD BUMP SET $47.10
    75020206 HEMA MICROAGGREGATE $29.90
    75020222 INFUSAID NEEDLE $15.10
    75020248 MIRCO NITROGLYCERIN SET $62.00
    75020263 ANGLED INFUSAID NEEDLE $24.20
    75020289 LEUKOCYTE FILTR $143.00
    75020313 TPN ADMIN SET $9.40
    75020321 VENTED ADAPTER $8.40
    75020339 VENTED SECONDARY SET 1059 $6.90
    75020347 NON-VENTED SECONDARY SET 1058 $6.90
    75020354 VENTED NITROGLYCERINE SET $29.90
    75020370 SET SECONDARY PUMP $10.40
    75020438 BLOOD WARMING SET $33.30
    75020446 PRIMARY SET W/FILTER $45.90
    75020461 PLATELET REMOVAL FILTER $338.40
    75020503 IV CAD PLUS PUMP (1-31 DAYS) $562.30
    75030056 RECERTIFICATION,IV ANTIBIOTIC $225.30
    75040014 JELCO NEEDLE $12.80
  • Emergency Room

    Service Code Description Price
    80010382 EMERGENCY ROOM LEVEL 1 $224.90
    80010390 EMERGENCY ROOM LEVEL 2 $376.40
    80010408 EMERGENCY ROOM LEVEL 3 $627.30
    80010416 EMERGENCY ROOM LEVEL 4 $1,261.30
    80010424 EMERGENCY ROOM LEVEL 5 $1,318.60
    80010481 ED CRITICAL CARE UP TO 74MIN $1,663.80
    80010499 ED CRITICAL CARE EA ADD 30MIN $575.00
    80010531 IMMUNIZATION ADM;ONE $107.00
    80010564 TELEHEALTH FACILITY FEE $143.00
    80010598 THER/PROPH/DIAG INJ SC/M $138.70
    80010606 IMMUNE ADMIN PEDIATRIC $40.00
    80010689 DERMABOND $137.10
    80010697 NG TUBE $45.90
    80010705 RAPID RHINO $119.20
    80010812 ADMIN FLU VIRUS VACCINE $69.80
    80010820 ADMIN HEPATITIS B VACCINE $80.00
    80010838 ADMIN PNEUMONIA VACCINE $69.80
    80010846 ER ULTRASOUND LINE PLACEMENT $400.00
    80010861 PLACE NEEDLE INTRAOSSEOUS INFU $820.00
    80010879 INTRAOSSEOUS INF SYSTEM $418.20
    80010895 ADMIN OF PREVNAR $69.80
    80010903 THER/PROPH/DIAG IV INF INIT=<1 $427.50
    80010911 PROCEDURE-SIMPLE $700.00
    80010929 PROCEDURE-COMPLEX $2,000.00
    80010937 PROCEDURE-INTERIM $1,400.00
    80010945 ADM INJ $107.00
    80011571 SPICA SPLINT $540.00
    80030034 ZMI EXT CARD PACE W/PADS $773.70
    80030059 ZMI PACER PADS $213.90
    80051048 CAUTERY KNIVES-DISPOSABLE $29.90
    80051097 SHORT ARM SPLINT $201.00
    80051105 ANKLE STRAPPING $251.00
    80051113 SHORT LEG SPLINT $251.00
    80051154 STRAPPING SHOULDER $187.00
    80051188 AIRCAST FOAM WALKER $696.00
    80051196 ARTHROCENTESIS-INTERMEDIATE JO $1,325.60
    80051204 CARDIOVERSION/DEFIBRILLATION $963.00
    80051212 CHEST TUBE INSERTION $1,590.80
    80051220 THORACENTESIS $1,369.00
    80051238 SPLINT OCL ARM $381.90
    80051246 ARTERIAL/VENOUS LINE INSERTION $828.40
    80051253 CENTRAL LINE INSTERTION $1,193.60
    80051261 THER/PROPH/DIAG INJ SC/IM $138.70
    80051279 THER/PROPH/DIAG INJ IV PUSH $360.00
    80051287 TX/PRO/DX INJ NEW DRUG ADDON $151.20
    80051295 THER/PROPH/DIAG IV INF INIT $427.50
    80051303 THER/PROPH/DIAG IV INF, ADD ON $124.70
    80051311 HYDRATION IV INFUSION INIT $360.00
    80051329 HYDRATION IV INFUSION ADD ON $83.40
    80051337 TX/PROPH/DG ADDL SEQ IV INF $128.40
    80051345 TX/PROPH/DG ADDL CONCURRENT IV $82.30
    80051352 TX/PRO/DX INJ SAME DRUG ADON $162.40
    80051361 HYDRATION IV INFUSION, INIT $360.00
    80051378 PORT FLUSH $138.80
    80051436 MOD SEDATION INITIAL 15 MIN $203.00
    80051444 MOD SEDATION EA ADDL 15 MIN $203.00
    81000259 OP MNT INITIAL CONSULT EA 15MI $110.00
    81000267 OP MNT F/U CONSULT EA 15 MIN $110.00
    81000275 OP MNT GROUP PER 30 MIN $110.00
    81000283 MNT EA 15 M AFTER 2ND REFRL $53.90
    81000291 MNT GRP/30M AFTER 2ND RFERL $53.90
    81000309 V-U-H NUTRITIONAL COUNSELING $45.90
    81000317 CHOOSE TO LOSE $143.00
    81000358 BARIATRIC FOLLOWUP 30 MIN $51.00
  • Wound Care

    Service Code Description Price
    82000050 MINOR/SELF-LIMITED VST <10 MIN $243.00
    82000068 STRAIGHT FORWARD <20 MINUTES $268.00
    82000076 LOW <30 MINUTES $293.00
    82000084 MODERATE <45 MINUTES $308.00
    82000092 HIGH >45 MINUTES $338.00
    82000100 EST PT NURSE VISIT 10 MINUTES $218.00
    82000118 EST PT STRAIGHT FORWARD <10MIN $243.00
    82000134 EST PT MODERATE < 25 MINUTES $293.00
    82000142 EST PT HIGH > 40 MINUTES $308.00
    82000167 PRC/INTR MINOR/SELF LIMIT<10 $243.00
    82000175 PRC/INTR STRAIGHT FORWARD <20 $268.00
    82000191 PROC/INTER MODERATE < 45 MIN $308.00
    82000209 PROC/INTER HIGH > 45 MIN $338.00
    82000217 EST PT PRO/INTR NURSE VST 10 $218.00
    82000233 EST PT PRO/INTR LOW <15 MIN $268.00
    82000241 EST PT PRO/INTR MODERATE <25 $293.00
    82000258 EST PT PRO/INTR HIGH > 40 MIN $308.00
    82000324 DESTRUCTION BENIG LESION/WART $350.00
    82000332 DESTRUCT BENIGN LESION/WARTS $130.00
    82000340 PARING/CUTTING CORN/CALLOUS 1 $350.00
    82000357 PARING/CUTTING CORN/CALLOUS2-4 $350.00
    82000365 PARING/CUTTING CORN/CALLOUS >5 $410.00
    82000373 ARTRL VASCULAR EX ANKLE $253.80
    82000381 REPAIR WOUND SIMPLE <2.5CM $370.00
    82000431 DEBRIDEMENT;SKIN AND SUBQ $1,325.00
    82000449 DEBRIDEMENT;SKIN AND MUSCLE $1,325.00
    82000456 DEBRIDEMENT;NAIL 1-5 $175.00
    82000464 DEBRIDEMENT; NAIL >6 $225.00
    82000472 AVULSION NAIL PLATE,PART/COMP $350.00
    82000480 REMOVAL FOREIGN BODY FOOT;SUBQ $1,750.00
    82000498 BX SKIN &/SUBQ TISSUE;1 LESION $615.00
    82000506 TRIMMING NON-DYSTROPHIC NAILS $110.00
    82000522 I & D OF ABSCESS $370.00
    82000530 EXC BENIGN LESION .5CM $2,700.00
    82000548 EXC BENIGN LESION .6CM $1,750.00
    82000555 EXC BENIGN LESION 1.1-2CM $2,700.00
    82000563 EXC BENIGN LESION 2.1 - 3 CM $2,700.00
    82000571 EXC BENIGN LESION 3.1CM - 4CM $2,550.00
    82000589 EXC BENIGN LESION OVER 4CM $4,600.00
    82000605 WOUND CLOSURE W/ TISSUE ADHES $223.10
    82000613 INIT PHYS E&M DIABETIC PT W/LO $223.10
    82000621 F/U EVAL DIABETIC PT W/LOPS $223.10
    82000639 ROUTINE FT CARE PHYS DIAB PT W $350.00
    82000647 I & D OF BONE INFECTION $5,160.00
    82000654 DEBRIDEMENT; SKIN TO BONE $2,635.00
    82000662 I&D; COMPLEX $615.00
    82000670 PUNC ABCESS/CYST $615.00
    82000688 I&D; POST OP WOUND $4,600.00
    82000746 INJ TRIGGER POINT, 1/2 MUSCL $490.00
    82000761 BIOPSY OF SKIN;EA ADD LESION $375.00
    82000779 FLEXOR TENOTOMY, SINGLE TOE $2,650.00
    82000787 AQUACEL AG 4X4 DRESSING $22.00
    82000795 CURASOL HYDROGEL 4X4 DRESSING $23.10
    82000803 FIBRACOL PLUS 4X4 WOUND DRESS $34.50
    82000860 I&D HEMATOMA,SUBUNGUAL RT HALL $2,700.00
    82000878 REMOVAL FB,SUBQ TISSUE, SIMPLE $615.00
    82000886 INJECTION TENDON OR LIGAMENT $490.00
    82000902 TX TARSAL BONE FX,W/O MANIP RT $660.00
    82000910 TX TARSAL BONE FX,WO MANIP LT $660.00
    82000928 CL TX METARSAL FX;WO MANIP RT $660.00
    82000936 CL METARSAL FX; WO MANIP LT $660.00
    82000969 TRIM DYSTROPHIC NAIL, ANY # $110.00
    82000977 PRISMA WOUND DRESSING $61.00
    82000985 DEEP DISSECT FOOT INF;SGL BURS $4,877.00
    82001009 APLIGRAF 44 SQ CM $5,257.70
    82001017 ALGINATE(MAXORB)DRESS 19 SQ CM $49.00
    82001025 WOUND PREP,CH/INF,TRK/ARM/LG $3,100.00
    82001033 WOUND PREP, CH/INF ADDL 100CM $1,575.00
    82001041 WOUND PREP CH/INF, F/N/HF/G $1,480.00
    82001058 WOUND PREP, F/N/HF/G, ADDL CM $1,130.00
    82001082 NWS DEBRIDEM WO A/SESSION PT $350.00
    82001090 WND CARE UNATT ELECTR STIM PT $71.70
    82001108 NON WND ELECT STIM PT $71.70
    82001132 NWS DEBRIDEM WO/SESSION RN $350.00
    82001165 LESSOR TOE,CLOSED TX W/O MANIP $425.00
    82001173 PT-MANUAL THERAPY EA 15 MIN $74.50
    82001181 PT ADL SELF CARE TR EA 15 MIN $67.90
    82001199 PT MODALITY VASOPNEUMATIC DEVI $88.80
    82001207 PT THERAP EXERCISE ROM EA 15 M $62.00
    82001215 PT MASSAGE THERAPY EA 15 MIN $62.60
    82001264 LEVEL IV SKIN REPAIR $5,300.00
    82001280 ORTHOTIC MGMT/TRN,INIT EA 15MI $148.70
    82001298 SKIN THERAPY $68.80
    82001330 3M COBAN COMFORT LAYER $20.30
    82001348 WET-TO-MOIST DRESSINGS, RN $350.00
    82001355 SLCTV WND DEBRIDEM 20 CM OR < $410.00
    82001363 SLCTV WND DEBRIDEM ADD 20 CM/< $332.50
    82001371 DERMAGRAFT SKIN SUB, PER SQ CM $5,075.00
    82001389 VOLUMETRIC MEASUREMENT, EA 15M $111.00
    82001397 TENOTOMY, SQ, TOE; SINGLE $2,650.00
    82001405 SLCTV WND DEBRIDEM 20 CM OR < $410.00
    82001413 SLCTV WND DEBRIDEM ADDL 20CM/< $332.50
    82001421 CHEM CAUT GRANULATION TISS $330.00
    82001439 DEB SUBQ TISSUE ADD-ON=<20SQ $549.00
    82001447 DEB MUSC/FASCIA ADD-ON=<20SQ $653.50
    82001454 DEB BONE ADD-ON=<20 SQ CM $1,646.70
    82001462 UNNA BOOT APPLICATION, LT $268.00
    82001470 UNNA BOOT APPLICATION, RT $268.00
    82001488 SKIN SUB GRAFT TRNK/ARM/LEG $3,856.00
    82001496 SKIN SUB GRAFT T/A/L ADD-ON $794.60
    82001504 SKIN SUB GRFT T/ARM/LG> 100CM $5,300.00
    82001512 SKN SUB GRFT T/A/L > 100CM ADD $1,076.90
    82001520 SKIN SUB GRAFT FACE/NK/HF/G $3,100.00
    82001538 SKIN SUB GRAFT F/N/HF/G ADDL $794.60
    82001546 SKN SUB GRFT F/N/HF/G > 100CM $3,100.00
    82001553 SKN SUB GRFT F/N/HF/G> 100CM A $1,076.90
    82001561 THERASKIN 5.1 x 7.6 CM $5,100.00
    82001595 APPLY RIGID TOTAL CONTACT LEG $522.80
    82001603 CAST SUP SHRT LEG ADULT FIBERG $161.60
    82001711 NEG PRE WOUND <=50 SQ CM $610.00
    82001728 NEG PRES WOUND >50 SQ CM $610.00
    82001736 EPIFIX 2 x 3 (6CM) $4,576.00
    82001744 EPIFIX 4 X 4 (16CM) $12,204.00
    82001751 EPIFIX 7 X 7 (49 SQ CM) $37,376.00
    82001769 GRAFIX PRIM 5 X 5 CM $10,759.00
    82001777 GRAFIX CORE 5 X 5 CM $10,759.00
    82001785 GRAFIX CORE 2 X 3 $4,466.00
    82001793 OASIS TRI-LAYER MATRIX 35 SQ C $1,451.50
    82001801 LC SKIN SUB GRAFT TRNK/ARM/LEG $1,076.90
    82001819 LC SKIN SUB GRAFT T/A/L ADD-ON $794.60
    82001827 LC SKIN SUB GRFT T/ARM/LG>100C $3,850.00
    82001835 LC SKN SUB GRFT T/A/L>100CM AD $1,076.90
    82001843 LC SKIN SUB GRAFT FACE/NK/HF/G $1,076.90
    82001850 LC SKIN SUB GRAFT F/N/HF/G ADD $794.60
    82001868 LC SKIN SUB GRFT F/N/HF/G>100C $2,550.00
    82001876 LC SKN SUB GRFT F/N/HF/G>100CM $1,076.90
    82001884 TX WOUND DEHISCENCE; SIMPLE $1,674.80
    82001892 THERASKIN 2.5 X 5.1 $3,900.00
    82001900 3M COBAN COMPRESSION LAYER $147.20
    82001934 EST PT PRO/INTR STRGHT FOR <10 $243.00
    82001942 PROC/INTER LOW <30MIN $293.00
    82001959 EST PT LOW <15 MINUTES $268.00
    82001967 GRAFIX PRIME 2 X 3 $4,466.00
    82001975 GRAFIX PRIME 3X4 CM $5,481.00
    82001983 APPLY MULTLAY COMPRS LWR LEG R $583.70
    82001991 APPLY MULTLAY COMP LWR LEG LT $583.70
    82002064 DRESS/DEBRID P-THICK BURN S $350.00
    82002072 DRESS/DEBRID P-THICK BURN M $410.00
    82002081 DRESS/DEBRID P-THICK BURN L $1,000.00
    82002098 LOW FREQ NONTHERMAL US $350.00
    82002106 EPIFIX 14MM DISK $1,252.00
    82002114 EPIFIX 18MM DISK $2,976.00
    82002122 EPIFIX 2CM X 2 CM $4,256.00
    82002130 EPIFIX 2CM X 4CM $5,400.00
    82002148 EPIFIX 3CM X 4CM $9,516.00
    82002155 EPIFIX 5CM X 6CM $22,884.00
    82002163 EPIFIX MESH 3.5CM X 3.5CM $4,976.00
    82002171 EPIFIX MESH 4CM X 4.5CM $5,576.00
    82002189 PRIMATRIX, MESHED 2:1, 3X3 CM $3,220.00
    82002197 PRIMATRIX, SOLID 4X4 CM $5,000.00
    82002205 PRIMATRIX, FENESTRATED, 4X4 $5,000.00
    82002213 PRIMATRIX, MESHED 2:1, 4X4CM $5,500.00
    82002221 PRIMATRIX, MESHED 2:1, 5X5 CM $7,980.00
    82002239 PRIMATRIX, SOLID, 6X6 CM $9,996.00
    82002247 PRIMATRIX, FENESTRATED, 6X6 CM $9,996.00
    82002254 PRIMATRIX, MESHED 2:1, 6X6 CM $10,995.60
    82002262 PRIMATRIX AG, SOLID, 4X4 CM $5,750.00
    82002271 PRIMATRIX AG,FENESTRATED,4X4CM $5,750.00
    82002288 PRIMATRIX AG,MESHED 2:1,4X4CM $5,750.00
    82002296 PRIMATRIX AG, SOLID, 6X6 CM $11,495.40
    82002304 PRIMATRIX AG,FENESTRATED,6X6CM $11,495.40
    82002312 HYALOMATRIX 2.5 X 2.5 CM $700.00
    82002321 HYALOMATRIX 5 X 5 CM $1,100.00
    82002338 HYALOMATRIX 10 X 10 CM $3,900.00
    82002346 HYALOMATRIX 10 X 20 CM $7,100.00
    82002361 PURAPLY 2 X 4 CM $3,296.00
    82002379 PURAPLY 5 X 5 CM $10,300.00
    82002387 PURAPLY 6 X 9 CM $22,248.00
    82002395 PURAPLY AM 2 X 2 CM $2,368.00
    82002403 PURAPLY AM 2 X 4 CM $3,584.00
    82002411 PURAPLY AM 5 X 5 CM $11,200.00
    82002429 PURAPLY AM 6 X 9 CM $24,192.00
    82002437 FAST CAST KIT $469.00
    82002445 CAM BOOT $266.00
    82002452 TWO PRESS 2 COMPRESSION LAYER $264.96
    82002461 TWO PRESS 2 COMFORT LAYER $47.32
    82002494 HYDROFERA BLUE FOAM 2X2 $30.00
    82002502 HYDROFERA BLUE FOAM 4X4 $30.00
    82002511 HYDROFERA BLUE READY TRANS 4X5 $60.00
    82200007 EXTREMITY STUDY $329.90
    82200015 HYPERBARIC O2 PER 30 MIN $600.10
    82200023 GLUCOSE; BLD BYMONITOR DEVICE $15.50
    82200031 REPEAT GLUCOSE; BLD BY MONITOR $15.00
    82200056 EST PT NURSE VISIT 10 MIN $218.00
    82200064 EST PT STRAIGHTFORWARD <10MIN $243.00
    82200072 EST PT LOW <15 MIN $268.00
    82200081 EST PT MODERATE <25 MIN $293.00
    82200098 EST PT HIGH >40 MIN $308.00
    82200106 NEW PT LOW <30 MINUTES $293.00
  • Dialysis

    Service Code Description & Price
    90010018 HEMO-DIALYSIS
    $940.00
    90010026 UNSCHG/EMRG DIALYS OUTPATIENT
    $940.00
  • Room Charges

    Service Code Description Price
    98010010 ROOM CHARGE 5E $1,000.00
    98010051 ROOM CHARGE 5E $1,000.00
    98010069 VIP BED 5E $1,100.00
    98020050 ROOM CHARGE 5 $1,000.00
    98020092 REHAB $925.00
    98030018 ROOM CHARGE 6E $1,000.00
    98030042 ROOM CHARGE 6E $1,000.00
    98030059 VIP BED 6E $1,100.00
    98040017 ROOM CHARGE 6W $1,000.00
    98040041 ROOM CHARGE 6W $1,000.00
    98040058 VIP BED 6W $1,100.00
    98060015 ROOM CHARGE 7E $1,000.00
    98060049 ROOM CHARGE 7E $1,000.00
    98060056 VIP BED 7E $1,100.00
    98070014 ROOM CHARGE 7W $1,000.00
    98070048 ROOM CHARGE 7W $1,000.00
    98070055 CRIB BED 7W $600.00
    98070063 VIP BED 7W $1,100.00
    98120025 ROOM CHARGE 4W $1,000.00
    98130016 ROOM CHARGE 4 PCU $1,800.00
    98160013 PSYCH BED 2W $975.00
    98200017 ICU BED $1,900.00
    98200033 M/S ICU $1,000.00
    98210016 CCU BED $1,900.00
    98210032 M/S CCU $1,000.00
    98220015 PRIVATE PCU $1,800.00
    98220072 PRIVATE BED PCU $1,800.00
    98220098 M/S PCU $1,000.00