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Bill Item Long Desc Reference Number Clinic Price Hospital & Ancillary Services Outpatient Lab Price Physician Fees
Kirby-Bauer 87184 109 43
Minimum Inhibitory Concentration 87186 109 43
Gram negative identification (Vitek) 87077 102 41
Gram positive identification (Vitek) 87077 102 41
Anti-D 86901 38
Urine Dipstick POC 81000 40
Vision Testing 99173 0
Stool for Occult Blood POC 82274 66 66
Urine Dipstick POC 81002 42 42 42
URINE PREGNANCY TEST POC 81025 74 74
Report 75820 799
Report 75820 799
Prolonged Physician Service Outpatient with Direct Patient Contact First Hour - 99354 99354 257 388 294
Report 77012 469
Report 71046 68
Report 77002 169
Report 50605 5,255
Report 50605 5,255
Amylase Level 82150 82
After Hours Visit - 99050 99050 63 25 0
Antepartum Care 7 or More Visits - 59426 59426 2,813 2,814 1,712
Critical Care Services Evaluation and Treatment for Each Additional 30 Minutes - 99292 99292 583 673 468
Emergency Department Visit Level 1 - 99281 99281 103
Emergency Department Visit Level 2 - 99282 99282 201
Emergency Department Visit Level 3 - 99283 99283 315
Emergency Department Visit Level 4 - 99284 99284 587
Emergency Department Visit Level 5 - 99285 99285 872
Hospital Discharge Management 30 min or Less - 99238 99238 344 344 215
Hospital Discharge Management More Than 30 min - 99239 99239 511 512 320
Initial Hospital Care Level 1 - 99221 99221 483 483 323
Initial Hospital Care Level 2 - 99222 99222 651 651 439
Initial Hospital Care Level 3 - 99223 99223 964 964 649
Initial Inpatient Consultation Level 1 - 99251 99251 232 232 168
Initial Inpatient Consultation Level 2 - 99252 99252 355 355 252
Initial Inpatient Consultation Level 3 - 99253 99253 545 545 382
Initial Inpatient Consultation Level 4 - 99254 99254 791 792 553
Initial Inpatient Consultation Level 5 - 99255 99255 955 955 673
Initial Observation Care Level 1 - 99218 99218 474 475 323
Initial Observation Care Level 2 - 99219 99219 646 645 436
Initial Observation Care Level 3 - 99220 99220 882 883 598
*DNU Obs/ Same Day Inpatient Care Level 1 - 99234 99234 634 634 430
*DNU Observation/ Same Day Inpatient Care Level 2 - 99235 99235 804 804 545
*DNU Observation/ Same Day Inpatient Care Level 3 - 99236 99236 1,035 1,036 706
*DNU Observation Care Discharge 99217 346 346 215
Office Consultation Level 1 - 99241 99241 176 215 122
Office Consultation Level 2 - 99242 99242 308 381 236
Office Consultation Level 3 - 99243 99243 380 297
Office Consultation Level 4 - 99244 99244 526 660 442
Office/Outpatient Visit Level 1 Established - 99211 99211 75 93 41
Office/Outpatient Visit Level 1 New - 99201 99201 125 145 68
99213 Office/Outpatient Visit Level 3 Est (Ofc) 99213 218 246 131
Postpartum Care only - 59430 59430 894 1,156 678
Preventive Medicine 1-4 years Established - 99392 99392 258 316 187
Preventive Medicine 1-4 years New - 99382 99382 280 342 199
Preventive Medicine 12-17 years Established - 99394 99394 282 347 212
Preventive Medicine 12-17 years New - 99384 99384 330 408 250
Preventive Medicine 18-39 years New - 99385 99385 319 392 239
Preventive Medicine 40-64 years Established - 99396 99396 307 380 237
Preventive Medicine 40-64 years New - 99386 99386 371 462 291
Preventive Medicine 5-11 years New - 99383 99383 293 359 212
Preventive Medicine 65+ years Established - 99397 99397 297 392 250
Preventive Medicine 65+ years New - 99387 99387 403 531 344
Preventive Medicine < 1 year Established - 99391 99391 241 294 171
Preventive Medicine < 1 year New - 99381 99381 269 327 187
Prolonged Physician Service Inpatient with Direct Patient Contact Each Additional 30 Minutes - 99357 99357 436 422 272
Prolonged Physician Service Inpatient with Direct Patient Contact First Hour - 99356 99356 270 375 282
Prolonged Physician Service Without Direct Patient Contact First Hour - 99358 99358 531 532 353
Subsequent Hospital Care Level 1 - 99231 99231 186 186 127
99232 Subsequent Hospital Care Level 2 99232 342 342 233
Subsequent Hospital Care Level 3 - 99233 99233 496 496 336
Glucose Level 82947 49 20
Glucose Urine 82945 49
Glucose Cerebrospinal Fluid 82945 49
Blood Urea Nitrogen 84520 49 20
Creatinine Level 82565 64 25
Creatinine Level Urine 82570 65 26
Sodium Level 84295 61
Sodium Level 24 Hour Urine 84300 61
Potassium Level 84132 58
Potassium Level 24 Hour Urine 84133 54
Chloride Level 82435 58
Chloride Level 24 Hour Urine 82436 63
Carbon Dioxide Level 82374 62
ALT 84460 66
Aspartate Aminotransferase 84450 65
Albumin Level 82040 62
Alkaline Phosphatase 84075 65
Ammonia Level 82140 184
Bilirubin Direct 82248 63
Bilirubin Total 82247 63
Venous Blood Gas 82800 106
Calcium Level 24 Hour Urine 82340 65
Calcium Level 82310 65
Carbamazepine Level 80156 183
Cholesterol High Density Lipid 83718 103
Cholesterol Low Density Lipids 83721 120
Cholesterol Total 82465 55
Creatine Kinase 82550 82
C-Reactive Protein 86141 163
D-Dimer 85379 128
Digoxin Level 80162 167
Gamma Glutamyl Transferase 82977 90
Hemoglobin 85018 29 12
Hematocrit 85014 29 12
Hemoglobin A1c 83036 122 48
Lactic Acid 83605 134
Lactate Dehydrogenase 83615 76
Lipase Level 83690 87
Lithium Level 80178 83
Magnesium Level 83735 84 34
Mononucleosis Screen 86308 65
Prothrombin Time 85610 49 20
Partial Thromboplastin Time 85730 76
pH Body Fluid 83986 45
Phenobarbital Level 80184 144
Phosphorus Level 84100 60 24
Platelet Count 85049 57
Protein Level 24 Hour Urine 84156 46
Protein Cerebrospinal Fluid 84157 46
Protein Total 84155 46
Protein Level Urine 84156 46
Rubella 86762 168
Sedimentation Rate 85651 44 18
T3 Uptake 84479 82
Thyroid Stimulating Hormone 84443 211 84
Triglycerides 84478 72
Uric Acid 84550 57
Urinalysis 81003 41 12
Valproic Acid Level 80164 170
Vitamin B12 Level 82607 189
White Blood Count 85048 32
Eye Culture 87070 108 43
Genital Culture 87070 108 43
Beta Lactamase 87185 11
Oxidase 87184 87
Antigen Type 86902 48
Destruct, Vulva Lesion Simple Charge 56501 446 494
Destruct, Vulva Lesion Extensive Charge 56515 1,085 789
Biopsy Vulva/Perineum, One Charge 56605 317 255
Bartholin's Gland/Cyst Remove Charge 56440 873 486
Destruct Vagina Lesion Extensive Charge 57065 935 838
Fitting/Insert Pessary/Other Support Charge [RMC] 57160 273 201
Fitting Diaphragm/Cervical Cap Charge 57170 290 233
Colposcopy Entire Vagina w/Cervix Charge 57420 419 444
Colposcopy Cervix Upper Vag Charge 57452 368 283
57454 Colposcopy Cervix/Upper Vag w/Bx Cervix & Endo Charge 57454 533 456
Colposcopy Cervix/Upper Vag w/Bx Cervix Charge 57455 543 397
Colposcopy Cervix/Upper Vag w/Loop Bx Charge 57460 1,346 781
Biopsy, Single or Multiple, or Local Excision of Lesion 57500 457 365
Endocervical Curettage Charge 57505 345 340
Cryocautery Cervix Charge 57511 691 632
Cervix Conization, Remove Charge 57520 1,472 1,320
Cervix Conization w/Loop Elec, Remove Charge 57522 1,088 1,165
Dilation Cervix Canal Charge 57800 289 233
Biopsy Endometrial Charge 58100 393 310
IUD, Insert Charge 58300 346 259
REMOVE INTRAUTERINE DEVICE (IUD) 58301 332 290
Insert Cervical Dilator Charge 59200 346 219
Anoscopy Charge 46600 311 177
Hepatitis A Adult Vaccine 90632 159
Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge 90633 68 68
CL-FLU INJ 6-35 Mon 0.25 ml 90657 32 32
Flu Vaccine Split 3 yrs and above IM 90658 37 37
Flu Vaccine Live Intranasal POC 90660 38 38
Pneumococcal Conjugate Polyvalent Vaccine < 5yrs POC 90669 147 147
DTaP Diphtheria/Pertussis, acellular/Tetanus Vaccine Daptacel Under 7 yrs POC 90732 46 46
DT Diphtheria-Tetanus toxoids < 7 yrs POC 90733 39 39
MMR Measles/Mumps/Rubella Virus Vaccine POC 90744 93 93
IPV Inactivated Poliovirus Vaccine POC 87880 51 0
Varicella Virus Vaccine POC 6043378 138 138
Diphth/HepB/Pertussis,Acel/Polio/Tetanus Pediarix 6042271 142 142
Pneumococcal 23-Valent Adult Vaccine POC 6042180 110
Meningococcal Vaccine POC 6043907 188 188
Hepatitis B Vaccine, Pediatric 3 Dose Sched POC 6042412 64 0
EKG 12 Lead, Interp/Report Only Charge 6042396 76 135
Cervical/Vaginal CA Screen; Pelvic/Breast Exam Medicare Charge 6043410 183 134
Betamethasone Acetate/Betamethasone Sodium Injection 3 mg Charge 6042206 23 23
Depo-Provera Injection per 1 mg 6042255 255
Furosemide Injection up to 20 mg 6043899 14 14
Wet Mount POC 6042230 64
Strep A POC 6042024 42 40 40 42
Hemoglobin A1c POC 6043949 126
Community/Work Reintegration Charges 10060 121
Cognitive Skills Development Charges Initial 15 Minutes 10061 108
Therapeutic Activities Charges 10140 139
Therapeutic Exercise Charges 7528406 129
Ultrasound Charges 11401 51
Neuromuscular Reeducation Charges 11402 134
Massage Charge Units 11403 25
Manual Therapy Charge Units 11404 120
Iontophoresis Charges 11406 132
Attended E-Stim Charges 11420 56
ADL Training Charges 11421 139
Therapeutic Exercise Charges 11422 129
Ultrasound Charges 11423 51
Neuromuscular Reeducation Charges 11424 134
Wheelchair Management Charges 11426 123
Prosthetic Training Charges 11440 133
Orthotic Mgmt and Training Charges 11441 153
Therapeutic Activities Charge 11442 139
Gait Training Charges 11443 114
Massage Charge Units 90715 25
Manual Therapy Charge Units 17000 120
Iontophoresis Charges 20605 132
Attended E-Stim Charges 20610 76
E-Stim for Wound Other Charge 93306 63
Drain Skin Abscess, Simple/Single Charge 339 409
Drain Skin Abscess, Complex/Multiple Charge 11300 601 862
Drainage of Skin Lesion Charge 11301 464 569
Remove Lesion, Trunk/Arm/Leg <.5 cm Charge 11305 336 301
Remove Lesion, Trunk/Arm/Leg .6 to 1.0 cm Charge 11446 401 363
Remove Lesion, Trunk/Arm/Leg 1.1 to 2.0 cm Charge 11606 463 490
Remove Lesion, Trunk/Arm/Leg 2.1 to 3.0 cm Charge 11624 540 711
Remove Lesion, Trunk/Arm/Leg 3.1 to 4.0 cm Charge 11626 610 1,804
Remove Lesion, Trunk/Arm/Leg >4.0 cm Charge 11643 880 1,193
Remove Lesion, Scalp/Neck/Hand/Foot < .5 cm Charge 11644 351 402
Remove Lesion, Scalp/Neck/Hand/Foot .6 to 1.0 cm Charge 12001 437 531
Remove Lesion, Scalp/Neck/Hand/Foot 1.1 to 2.0 cm Charge 12002 484 654
Remove Lesion, Scalp/Neck/Hand/Foot 2.1 to 3.0 cm Charge 12004 567 694
Remove Lesion, Scalp/Neck/Hand/Foot 3.1 to 4.0 cm Charge 12005 634 993
Remove Lesion, Scalp/Neck/Hand/Foot >4.0 cm Charge 12011 884 1,330
Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge 12013 388 400
Remove Lesion, Face/Lid/Ear/Nose/Lip .6 to 1.0 cm Charge 12014 472 491
Remove Lesion, Face/Lid/Ear/Nose/Lip 1.1 to 2.0 cm Charge 85610 521 633
Remove Lesion, Face/Lid/Ear/Nose/Lip 2.1 to 3.0 cm Charge 11040 623 859
Tetanus Injection Charge 11042 61
Destruction Benign/Premalig Lesion Charge 11043 205 165
Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge 11044 209 180
20610 Arthrocentesis Major Joint, Shoulder, Hip, Knee Charge 29580 278 223
ECHO, Transthoracic, w/or w/o M Mode Recording w/o Doppler Charge 45300 871 304
Nerve Conduction Sensory Charge 11980 158
Shave (Epi)Dermal Lesion, Single, Trunk, Arms or Legs; Diam 0.5 cm > Charge 51795 221 161
Shave (Epi)Dermal Lesion, Single, Trunk, Arms or Legs; Diam 0.6 to 1.0 cm Charge 58340 286 213
Shave (Epi)Dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 0.5 cm > Charge 44950 204 179
Remove Other Benign Lesion w/Margins , Face/Ears/Eyelids/Nose/Lips; Diam 4.0+ cm Charge 19101 951 1,574
Remove Malig Lesion w/Margins, Trunk, Arms, or Legs; Diam 4.0+ cm Charge 58558 1,195 1,555
Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 3.1 to 4.0 cm Charge 59400 869 1,167
Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 4.0+ cm Charge 59409 962 1,431
Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 2.1 to 3.0 cm Charge 59410 820 926
Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 3.1 to 4.0 cm Charge 59610 1,111 1,383
Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm > Charge 59514 348 323
Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm to 7.5 cm Charge 59515 400 386
Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 7.6 cm to 12.5 cm Charge 59160 462 475
Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extrem 59150 768 602
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 59120 397 376
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.6 59812 432 424
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 5.1 59820 636 496
PT/INR POC 59821 24 24
Debride Skin/Partial Thickness Charge 58660 112 113
11042 DEB SUBQ TISSUE 20 SQ CM/< 58661 321 297
Debride Skin/Tissue/Muscle Charge 58662 843 753
Debride Skin/Tissue/Muscle/Bone Charge 58670 1,033 1,118
Stick Assay of Blood Glucose Charge 58120 42
Unna Boot (UNI) 58611 186 152
Proctosigmoidoscopy w/ or w/o Specimen Collection Charge 58605 488 264
Hormone Pellet Implant; Subcutaneous Charge 57410 355 272
Voiding Pressure Study Charge 57280 1,038 1,037
Catheterization/Introduction Saline for SIS or HSG Charge 57260 445 279
Appendectomy Charge 57250 3,127 1,783
Breast Biopsy Open Incision Charge 57135 1,632 1,069
Breast Aspiration, Puncture Charge 56810 387 212
Salpingectomy, Partial or Complete, Unilat or Bilat Charge 49320 3,739 2,179
Hysteroscopy Surgical w/ Endometrial Ablation Charge 49321 7,568 2,226
Hysteroscopy Surgical w/ Sampling Endometrium/Polypectomy Charge 49322 1,367 1,131
Routine OB Care, Antepartum/Vaginal Delivery/Postpartum Charge 44970 10,144 5,412
Vaginal Delivery Only (With Or Without Episiotomy And/Or Forceps); 10120 3,968 2,418
Delivery Vaginal-Only w/ Postpartum Care Charge 10121 5,065 3,031
Routine OB Care, Antepartum/Vaginal Delivery After Cesarean/Postpartum Charge 10160 10,678 5,700
Delivery Cesarean-Only Charge 10180 4,472 2,415
Delivery Cesarean-Only w/ Postpartum Care Charge 11000 6,157 3,613
Curettage Postpartum Charge 11200 984 843
Laparoscopic Treatment Ectopic Pregnancy; w/o Salp/Ooph Charge 11201 3,732 2,068
Surgical Treatment Ectopic Pregnancy; w/ Salp/Ooph Charge 11601 3,845 2,132
Treatment Incomplete Abortion, Surgical; Any Trimester Charge 11602 1,542 1,437
Treatment Missed Abortion, Surgical; First Trimester Charge 11603 1,836 1,729
Treatment Missed Abortion, Surgical; Second Trimester Charge 11604 1,850 1,734
Laparoscopy Surgical w/ Adhesiolysis Charge 11640 3,227 1,857
Laparoscopy Surgical w/ Removal Adnexal Structures Charge 11641 3,116 1,910
Laparoscopy Surgical w/ Fulguration/Excsicion Lesions Charge 11642 3,404 2,045
Laparoscopy Surgical w/ Fulguration Oviducts Charge 11730 1,741 994
Dilation & Curettage, Non-OB Charge 11740 1,234 1,050
Ligation/Transection Fallopian Tubes During Cesarean Delivery Charge 11760 367 243
Ligation/Transection Fallopian Tubes Postpartum Charge 11771 1,569 888
Pelvic Examination w/ Anesthesia Charge 12020 517 446
Colpopexy Abdominal Charge 12042 4,572 2,807
Combined Anteroposterior Colporrhaphy Charge 12044 3,983 2,389
Posterior Colporrhaphy; Repair Rectocele w/ or w/o Perineorrhaphy Charge 13120 3,234 1,935
Excision Vaginal Cyst/Tumor Charge 13121 918 831
Perineoplasty Non-OB Charge 13160 1,247 722
Laparoscopy Diagnostic Charge 16000 1,583 931
Laparoscopy Surgical w/ Biopsy Charge 19020 1,676 915
Laparoscopy Surgical w/ Aspiration Cavity/Cyst Charge 20103 1,795 1,011
Laparoscopy Surgical Appendectomy Charge 20206 2,924 1,590
Incision & Removal of Foreign Body, Subcutaneous Tissues; Simple Charge 20225 418 641
Incision & Removal of Foreign Body, Subcutaneous Tissues; Complicated Charge 20550 907 976
Puncture Aspirtn of Abscess, Hematoma, Bulla, or Cyst Charge 20552 390 416
I&D, Complex, Postoperative Wound Infectn Charge 20553 703 861
Debride of Extensive Eczematous or Infected Skin; Up to 10% of Body Surface Charge 20600 127 208
Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to & w/15 Lesions Charge 20612 252 207
Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; each Addtl Ten Lesions Charge 20670 89 80
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Less Charge 20680 520 493
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.6 to 1.0 cm Charge 21555 617 523
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 1.1 to 2.0 cm Charge 23075 662 633
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 2.1 to 3.0 cm Charge 23412 734 739
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 3.1 to 4.0 cm Charge 23500 827 1,007
Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0.5 cm or Less Charge 23600 535 554
Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0.6 to 1.0 cm Charge 23620 618 531
Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 1.1 to 2.0 cm Charge 23650 722 831
Avulsion of Nail Plate, Partial or Complete, Simple; Single Charge 23655 253 256
Evac of Subungual Hematoma Charge 24006 149 156
Repair of Nail Bed Charge 24500 635 648
11771 EXC PILONID CYST; EXTENS 24576 2,743 2,073
Treatment of Superficial Wound Dehiscence; Simple Closure Charge 24600 799 910
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 2.6 cm to 7.5 cm Charge 24640 786 806
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 7.6 cm to 12.5 cm Charge 24650 759 1,041
Repair Complex, Scalp, Arms, and/or Legs; 1.1 cm to 2.5 cm Charge 24670 979 919
Repair Complex, Scalp, Arms, and/or Legs; 2.6 cm to 7.5 cm Charge 25000 1,274 1,237
Secondary Closure of Surgical Wound or Dehiscence, Extensive or Complicated Charge 25530 1,736 2,044
Initial Trtmt, First Degree Burn, When No More Than Local Trtmt Is Required Charge 25560 182 222
Mastotomy w/Explore or Drainage of Abscess, Deep Charge 25565 2,261 1,477
Explore of Penetrating Wound; Extremity Charge 25622 2,793 1,688
20206 Biopsy, Muscle, Percutaneous Needle Charge 25650 868 297
Biopsy, Bone, Trocar, or Needle; Deep (eg, Vertebral Body, Femur) Charge 26010 517
Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar ""Fascia"") Charge 26140 210 210
20552 Inj(s); Single or Mult Trigger Point(S), One or Two Muscle(s) Charge 26410 196 222
20553 Inj(s); Single or Mult Trigger Point(S), Three or More Muscle(s) Charge 26418 248 209
Arthrocentesis, Aspirtn and/or Inj; Small Joint or Bursa (eg, Fingers, toes) Charge 26600 184 190
Aspirtn and/or Inj of Ganglion Cyst(s) Any Location Charge 26605 205 147
Removal of Implanter; Superficial, (eg, Buried Wire, Pin or Rod)Charge 26615 1,309 839
Removal of Implanter; Deep (eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod or Plate) Charge 26750 1,576 2,046
Excise Tumor, Soft Tissue of Neck or Thorax; Subcutaneous Charge 26765 1,398 1,481
Excise, Soft Tissue Tumor, Shoulder Area; Subcutaneous Charge 26770 2,253 1,579
Repair of Ruptured Musculotendinous Cuff (eg, Rotator Cuff) Open; Chronic Charge 27086 4,119 3,032
Closed Trtmt of Clavicular Fx; w/o Manipulation Charge 27096 888 1,061
Closed Trtmt of Clavicular Fx; w/Manipulation Charge 27125 1,679 1,587
Closed Trtmt of Scapular Fx; w/o Manipulation Charge 850 1,139
Closed Trtmt of Proximal Humeral (Surgical or Anatomical Neck) Fx; w/o Manipulation Charge 27230 1,260 1,384
Closed Trtmt of Greater Humeral Tuberosity Fx; w/o Manipulation Charge 27235 1,033 1,227
Closed Trtmt of Shoulder Dislocation, w/Manipulation; w/o Anesthesia Charge 27236 1,499 1,380
Closed Trtmt of Shoulder Dislocation, w/Manipulation; Requiring Anesthesia Charge 27265 1,929 1,276
Arthrotomy of The Elbow, w/Capsular Excise For Capsular ReleaseCharge 27301 1,639
Closed Trtmt of Humeral Shaft Fx; w/o Manipulation Charge 27385 1,420 1,116
Closed Trtmt of Humeral Epicondylar Fx, Medial or Lateral; w/o Manipulation Charge 27520 1,532 1,377
Closed Trtmt of Humeral Condylar Fx, Medial or Lateral; w/o Manipulation Charge 27600 1,625 1,462
Trtmt of Closed Elbow Dislocation; w/o Anesthesia Charge 27676 1,741 1,597
Closed Trtmt of Radial Head Subluxation In Child, Nursemaid Elbow, w/Manipulation Charge 27635 559 412
Closed Trtmt of Radial Head or Neck Fx; w/o Manipulation Charge 27750 1,015 1,137
Closed Trtmt of Ulnar Fx, Proximal End (Olecranon Process); w/o Manipulation Charge 28126 1,389 1,046
Open Trtmt of Ulnar Fx Proximal End (Olecranon Process), w/ or w/o Inter or Ext Fixation Charge 28190 3,155 1,997
Incision, Extensor Tendon Sheath, Wrist (eg, Dequervains Disease) Charge 28288 1,617 1,853
Excise of Ganglion, Wrist (Dorsal or Volar); Primary Charge 28400 1,540 1,595
Closed Trtmt of Radial Shaft Fx; w/o Manipulation Charge 28470 1,307 1,201
Closed Trtmt of Ulnar Shaft Fx; w/o Manipulation Charge 29065 979 1,136
Closed Trtmt of Radial & Ulnar Shaft Fxs; w/o Manipulation Charge 29075 1,327 1,203
Closed Trtmt of Radial & Ulnar Shaft Fxs; w/Manipulation Charge 29085 2,478 2,242
Closed Trtmt of Carpal Scaphoid (Navicular) Fx; w/o Manipulation Charge 29125 1,184 1,264
Closed Trtmt of Ulnar Styloid Fx Charge 29405 1,526 1,434
Drainage of Finger Abscess; Simple Charge 29515 911 659
Synovectomy, Proximal Interphalangeal Joint, w/Extensor Reconstr, each Interphalangeal Joint Charge 29881 1,066
Repair, Extensor Tendon, Hand, Primary or Secondary; w/o Free Graft, each Tendon Charge 33213 2,676 1,837
Repair, Extensor Tendon, Finger, Primary or Secondary; w/o Free Graft, each Tendon Charge 36556 2,735 1,775
Closed Trtmt of Metacarpal Fx, Single; w/o Manipulation, each Bone Charge 37799 1,106 1,276
Closed Trtmt of Metacarpal Fx, Single; w/Manipulation, each Bone Charge 38220 1,535 1,401
Open Trtmt of Metacarpal Fx, Single, w/ or w/o Inter or Ext Fixation, each Bone Charge 44204 2,775 3,004
Closed Trtmt of Distal Phalangeal Fx, Finger or Thumb; w/o Manipulation, each Charge 45100 678 880
Open Trtmt of Distal Phalangeal Fx, Finger or Thumb, w/ or w/o Inter or Ext Fixation, each Charge 46050 2,409 1,789
Closed Trtmt of Interphalangeal Joint Dislocation, Single, w/Manipulation; w/o Anesthesia Charge 46320 847 1,216
Removal of Foreign Body, Pelvis or Hip; Subcutaneous Tissue Charge 46945 264
Inj Procedure For Sacroiliac Joint, Arthrography and/or Anesthetic/Steroid Charge 47562 760 532
Hemiarthroplasty, Hip, Partial (eg, Femoral Stem Prosthesis, Bipolar Arthroplasty) Charge 49505 5,497 3,117
Closed Trtmt of Pelvic Ring Fx, Dislocation, Diastasis or Subluxation; w/o Manipulation Charge 50590 1,883
Closed Trtmt of Femoral Fx, Proximal End, Neck; w/o Manipulation Charge 54150 2,288 2,273
Percutaneous Skeletal Fixation of Femoral Fx, Proximal End, Neck Charge 56405 4,406 2,726
Open Trtmt of Femoral Fx, Proximal End, Neck, Inter Fixation or Prosthetic Replacement Charge 56420 5,803 2,964
Closed Trtmt of Post Hip Arthroplasty Dislocation; w/o Anesthesia Charge 59025 1,915 1,482
I&D, Deep Abscess, Bursa, or Hematoma, Thigh or Knee Region Charge 59510 3,229 2,418
Suture of Quadriceps or Hamstring Muscle Rupture; Primary Charge 64405 2,767 1,766
Closed Trtmt of Patellar Fx, w/o Manipulation Charge 64420 1,261 1,253
Closed Trtmt of Tibial Fx, Proximal (Plateau); w/o Manipulation Charge 64450 1,336 1,330
Open Trtmt of Tibial Fx, Proximal (Plateau); Unicondylar, w/ or w/o Inter or Ext Fixation Charge 64721 4,351 2,257
Decompression Fasciotomy, Leg; Anter and/or Lateral Compartments Only Charge 69090 1,974 1,966
Arthrotomy, w/Synovectomy, Ankle; Charge 1,468
Excise or Curettage of Bone Cyst or Benign Tumor, Tibia or Fibula; Charge 96402 2,828 1,732
Tenolysis, Flexor or Extensor Tendon, Leg and/or Ankle; Single, each Tendon Charge 99000 1,932
Closed Trtmt of Tibial Shaft Fx (With or w/o Fibular Fx); w/o Manipulation Charge 11975 1,472 1,383
Closed Trtmt of Medial Malleolus Fx; w/o Manipulation Charge 11976 1,457 1,145
Closed Trtmt of Proximal Fibula or Shaft Fx; w/o Manipulation Charge 19100 1,148 1,336
Closed Trtmt of Distal Fibular Fx (Lateral Malleolus); w/o Manipulation Charge 59618 1,194 1,259
Open Trtmt of Distal Fibular Fx (Lateral Malleolus), w/ or w/o Inter or Ext Fixation Charge 58925 3,152 2,442
Closed Trtmt of Bimalleolar Ankle Fx, (Including Potts); w/o Manipulation Charge 58740 1,293 1,267
Closed Trtmt of Trimalleolar Ankle Fx; w/o Manipulation Charge 58150 1,542 1,252
Closed Trtmt of Trimalleolar Ankle Fx; w/Manipulation Charge 58262 2,318 2,081
Amputation, Leg, Through Tibia & Fibula; Charge 58350 4,476 2,586
I&D Below Fascia, w/ or w/o Tendon Sheath Involvement, Foot; Single Bursal Space Charge 58600 733
Ostectomy, Calcaneus; Charge 58720 1,993
Resection, Partial or Complete, Phalangeal Base, each to e Charge 44180 499
Removal of Foreign Body, Foot; Subcutaneous Charge 11750 761 647
Ostectomy, Partial, Exostectomy or Condylectomy, Metatarsal Head, each Metatarsal Head Charge 0 2,078
Closed Trtmt of Calcaneal Fx; w/o Manipulation Charge 0 855 689
Closed Trtmt of Talus Fx; w/o Manipulation Charge 10080 1,134 1,009
Trtmt of Tarsal Bone Fx (Except Talus & Calcaneus); w/o Manipulation, each Charge 10081 1,037 926
Closed Trtmt of Metatarsal Fx; w/o Manipulation, each Charge 30300 794 861
Closed Trtmt of Fx, Phalanx or Phalanges, Other Than Great toe; w/o Manipulation, each Charge 69200 438 579
Open Trtmt of Tarsal Bone Dislocation, w/ or w/o Inter or Ext Fixation Charge 16020 3,231
Arthrodesis, Midtarsal or Tarsometatarsal, Single Joint Charge 17250 4,107 3,017
Amputation, toe; Metatarsophalangeal Joint Charge 2517197 1,298 1,916
Amputation, toe; Interphalangeal Joint 90648 1,799
Applic, Cast; Shoulder to Hand (Long Arm) Charge 90680 355 182
Applic, Cast; Elbow to Finger (Short Arm) Charge 90710 327 205
Applic, Cast; Hand & Lower Forearm (Gauntlet) Charge 90734 338 228
Applic of Short Arm Splint (Forearm to Hand); Static Charge 94640 235 189
Applic of Short Leg Cast (Below Knee to toes); Charge 51725 300 202
Applic of Short Leg Cast (Below Knee to toes); Walking or Ambulatory Type Charge 51702 319 274
Applic of Short Leg Splint (Calf to Foot) Charge 51772 249 240
Arthroscopy, Knee, Surgical; w/Meniscectomy (Medial or Lateral, w/Any Meniscal Shaving) Charge 57456 2,618 2,621
Insert or Replacement of Pacemaker Pulse Generator Only; Dual Chamber Charge 59000 888
Insert of Non-Tunneled Centrally Inserted Central Venous Catheter; Age 5 Yrs or Older Charge 59412 1,117 585
Unlisted Procedure, Vascular Surgery Charge 0 1,004
Bone Marrow; Aspirtn Only Charge 20551 458 299
Laparoscopy, Surgical; Colectomy, Partial, w/Anastomosis Charge 20526 7,509 4,446
Biopsy of Anorectal Wall, Anal Approach (eg, Congenital Megacolon) Charge 17110 1,530
Sigmoidoscopy, Flexible; w/Biopsy, Single or Mult Charge 17111 597 544
Colonoscopy, Flexible, Proximal to Splenic Flexure; w/Biopsy, Single or Mult Charge 1,668 1,153
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia 6123097 1,594 1,055
I&D of Ischiorectal and/or Perirectal AbscessCharge 6290128 1,883 1,939
I&D, Perianal Abscess, Superficial Charge 6290020 704 473
Incision of Thrombosed Hemorrhoid, Ext Charge 6290250 560 497
Papillectomy or Excise of Single Tag, AnusCharge 90655 658 575
Excise of Ext Hemorrhoid Tags and/or Mult Papillae Charge 90651 360
Hemorrhoidectomy, Inter & External, Complex or Extensive; Charge 2522007 2,307 1,499
Enucleation or Excise of Ext Thrombotic Hemorrhoid Charge 0 604 447
Ligation of Inter Hemorrhoids; Single Procedure Charge 2511075 1,485 1,094
Laparoscopy, Surgical; Cholecystectomy Charge 0 3,202 1,907
Repair Initial Inguinal Hernia, Age 5 Yrs or Over; Reducible Charge 2501001 2,530 1,914
Lithotripsy, Extracorporeal Shock Wave Charge 2511091 2,615 2,758
Complex Cystometrogram (eg, Calibrated Electronic Equipment) Charge 500205 1,045 371
Complex Uroflowmetry (eg, Calibrated Electronic Equipment) Charge 0 135 75
Measurement of Post-Voiding Residual Urine and/or Bladder Capacity By Ultrasound, Non-Imaging Charge 0 78 62
Cystourethroscopy Charge 0 713 678
Circumcision, Using Clamp or Other Device; Newborn Charge 53200 387 386
Excise of Hydrocele; Unilateral Charge 2514939 1,641 1,603
Vasectomy, Unilateral or Bilateral (Separate Procedure), w/Postoperative Semen Exam(s) Charge 2517445 1,326 791
I&D of Vulva or Perineal Abscess Charge 2517791 382 520
I&D of Bartholin's Gland Abscess Charge 2511281 399 437
Fetal Non-Stress Test Charge 3900100 175 135
Routine Obstetric Care w/Anterepartum Care, Cesarean Delivery, & Postpartum Care Charge 3113044 11,261 5,998
64405 Inj, Anesthetic Agent; Greater Occipital Nerve Charge 3113036 481 639
Inj, Anesthetic Agent; Intercostal Nerve, Single Charge 3113028 529 406
Inj, Anesthetic Agent; Other Peripheral Nerve or Branch Charge 3113077 339 633
Neuroplasty and/or Transposition; Median Nerve At Carpal Tunnel Charge 3113069 1,656 2,058
Ear Piercing Charge 3113051 45 0
Nerve Conduction, Amplitude & Latency/Velocity Study, each Nerve; Motor, w/o F-Wave Study Charge 3113416 173
Chemotherapy Admin, Subcutaneous or IM; Hormonal Anti-Neoplastic Charge 3113937 141 31
Handling and/or Conveyance of Specimen For Transfer From The Physician's Office to A Lab Charge 3113424 20 0
Medical Testimony Charge 3113218 458 0
Insertion, Implantable Contraceptive Capsules Charge 3400142 351 352
Removal, Implantable Contraceptive Capsules Charge 3400134 681 454
Breast Biopsy; Percutaneous, Needle Core (Not Using Imaging Guidance) Charge 3400126 543 339
Routine OB Care, Antepartum/Cesarean/Postpartum Care for Vaginal Deliv Attempt (after previou C-sect 3400771 11,411 6,085
Ovarian Cystectomy, Unilat or Bilat Charge 3400770 3,585 2,092
Oophorectomy, Partial or Total, Unilat or Bilat Charge 3400210 2,530 1,282
Lysis of Adhesions (Salpingolysis, Ovariolysis) Charge 3400308 4,242 2,508
Total abd. hysterectomy, w/ or w/o removal of tube(s) or ovary(s) Charge 3400290 4,882 2,913
Vag. hysterectomy, uterus 250 grams or less; w/removal of tube(s), &/or ovary(s) Charge 3400217 4,405 2,682
Chromotubation of oviduct, including materials Charge 3400209 460 377
Ligation or transection of fallopian tube(s), abd. or vag. approach, unilateral or bilateral Charge 3400274 1,732 994
Salpingo-oophorectomy, complete or partial, unilateral or bilateral Charge 3400266 3,547 2,046
Laparoscopy, Surgical, Enterolysis Charge 3400241 4,481 2,570
Excise of Nail & matrix, Part. or Complete, for Permanent Removal Charge 3400233 579 549
*DNU Intrauterine Copper Contraceptive Charge 3320088 578 578
LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG 3320047 980 980
I&D Pilonidal Cyst; Simple Charge 3321177 558 675
I&D Pilonidal cyst; complicated Charge 3321268 1,283 816
Removal Foreign Body, Intranasal; Office Type Procedure 3320328 797 506
Removal foreign body from external auditory canal; without general anesthesia Charge 3320260 395 228
Dressings and/or debridement of partial-thickness burns,initial or subsequent;(less than 5%) Charge 3321490 258 261
Chemical cauterization of granulation tissue (proud flesh, sinus or fistula) Charge 3321227 247 171
Blood, occult, by peroxidase activity, qualitative, feces, single specimen Charge 3321224 31
Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for IM Use POC 3320161 52 52
*DNU Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use POC Rota Teq 3320203 138 138
Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use POC 3321029 246 246
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for IM Use POC 3220004 174 0
Pressurized or nonpressurized inhalation treatment for acute airway obstruction Charge 3220020 67 0
Monospot POC 3221033 53 53
Simple cystometrogram (CMG) (eg, spinal manometer) Charge 3220449 660 287
Insert of non-indwelling bladder catheter; simple Charge 3221291 275 154
Urethral pressure profile studies (UPP) (urethral closure pressure profile), any technique Charge 3220327 661 661
Hysteroscopy, diagnostic (sp) Charge 3220473 1,278 740
Colposcopy of the Cervix incl. upper/adj. Vag.; w/Endocervical Curettage Charge 3220613 472 412
Removal w/Reinsertion, implantable contraceptive capsules Charge 3221009 581 582
Amniocentesis; diagnostic Charge 3221074 606 395
External cephalic version, with or without tocolysis Charge 3221017 502 287
Injection, Methylprednisolone sodium succinate, up to 40 mg Med Admin POC 3220431 48
Injection(s); single tendon origin/insertion Med Admin POC 3221090 218 205
Inj., Therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel Med Admin POC 3221109 317 284
Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 14 lesions Charge 3222158 293 234
Destruction (laser/electro/cryo/chemosurgery/curette), of warts; 15 or more lesions Charge 3222307 314 259
*DNU Zoster (shingles) vaccine, live, subcutaneous injection POC 3220301 298 0
Sensory Integration Charges 3220160 117
Standardized Aphasia Assessment Charge 3220202 401
Cognitive Skills Development Charges 3220426 108
Eval of Oral and Pharyngeal Swallowing Fx Chg 3220472 280
Influenza virus vaccine, splie virus, preservative free, for children 6-35 months of age, IM POC (in 3221041 37 37
Human Papilloma virus (HPV) Vaccine POC 3221058 309 309
Brain Natriuretic Peptide (BNP) 3221082 424
Injection, Ketorolac Tromethamine Charge, Per 15MG 3220431 8
Creatine Kinase-MB 3221090 145
Injection, Promethazine HCL, up to 50 mg Charge 3221108 22 22 22
Strep A Screen 3021040 151
Respiratory Syncytial Virus 3021065 151
Insert Foley Cath 3020695 289
J3301 Inj, Triamcinolone Acetonide, Per 10mg Charge 3024325 31 31
Vitamin B-12 Cyanocobalamin Inj, up to 1000 mcg 3024408 19 19 19
Injection, Ceftriaxone Sodium, Per 250 mg 3024390 38
Biopsy, Uretha Charge 3020209 755 994
COLLECTION: Capillary 3020224 27
COLLECTION: Venous Draw 3023640 27
Hematocrit 3020810 29
Hemoglobin 3020877 29
BD DEXA Axial Skeleton 3023723 357
CT Abdomen w/ + w/out contrast 3023061 2,705
CT Abdomen w/contrast 3020125 2,350
CT Abdomen w/out contrast 3022253 1,265
CT Head or Brain w/ + w/out contrast 3024374 1,800
CT Head or Brain w/contrast 3024366 1,485
CT Head or Brain w/out contrast 3020711 1,030
CT LE w/contrast Lt 3024382 2,360
CT LE w/contrast Rt 3020893 2,360
CT LE w/out contrast Lt 3023772 1,825
CT LE w/out contrast Rt 3023871 1,825
CT Maxillofacial w/contrast 3023863 1,560
CT Maxillofacial w/out contrast 3020935 1,355
CT Orbit/Sella/IAC etc. w/cont 3023889 2,905
CT Orbit/ Sella/IAC etc. w/out contrast 3024028 2,375
CT Pelvis w/ + w/o Cont 3024010 2,800
CT Pelvis w/contrast 3020596 2,360
CT Pelvis w/out contrast 3024036 1,285
CT Neck Soft Tissue w/ + w/o Cont 3020851 2,885
CT Neck Soft Tissue w/contrast 3023715 2,335
CT Neck Soft Tissue w/out contrast 3024200 1,810
CT Spine Cervical w/out contrast 3024192 1,845
CT Spine Lumbar w/out contrast 3020653 1,825
CT Spine Thoracic w/out contrast 3024184 1,835
CT UE w/ Cont Lt 3020042 2,310
CT UE w/ Cont Rt 3020141 2,310
CT UE w/out contrast Lt 3022634 1,820
CT UE w/out contrast Rt 3023111 1,820
MRI Brachial Plexus w/ + w/o Cont 3023350 4,099
MRA Head w/ Cont 3023343 3,420
MRA Neck w/o Cont 3023376 3,503
MRI Brain w/ + w/out contrast 3020539 3,184
MRI Brain w/ Cont 3020794 2,793
MRI Brain w/out contrast 3023657 1,888
MRI Chest w/ + w/out contrast 3023673 4,883
MRI Face Neck Orbit w/ + w/out contrast 3023665 4,028
MRI Face Neck Orbit w/ Cont 3020109 3,368
MRI Femur w/o Cont Lt 3020000 2,493
MRI Femur w/o Cont Rt 3020398 2,493
MRI Unlisted Procedure 3020471 0
MRI Pelvis w/ Cont 3020513 3,394
MRI Pelvis w/out contrast 3023426 3,169
MRI Spine Cervical w/ Cont 3020455 2,836
MRI Spine Cervical w/out contrast 3020349 1,805
MRI Spine Lumbar w/ Cont 3020323 2,788
MRI Spine Lumbar w/out contrast 3023822 1,788
MRI Spine Thoracic w/ Cont 3020919 2,810
MRI Spine Thoracic w/out contrast 3023806 1,805
NM Bone Ltd 3023814 1,742
NM Bone Whole Body 3321086 1,963
NM Bone 3 Phase Study 90470 3,474
NM Cardiac Blood Pool Gated Single 2515068 2,132
NM GI Blood Loss 2515035 3,510
NM Hepa Duct System 2515001 3,445
NM Kidney w/ Flow w/ Pharm 2525285 1,341
NM Myocard Perf Spect Mult Rest+Stress 2518500 1,872
NM Myocard Perf Spect Single Rest+Stress 99291 2,137
NM Pulm Perf 99395 2,366
NM Thyroid Only 99393 2,008
NM Thyroid Uptake Mult 2522821 819
US Abdomen Comp 2522820 596
US Abdomen Ltd 2522821 450
US Abdomen/Pelvic/Scrotal Art/Vein Ltd 2514731 893
US Carotid Duplex Bil 2510101 1,414
US Chest 2516165 439
US Head +Neck Soft Tissue 2514541 576
US LE Art Doppler Mult Level Bil 2516090 761
US LE Art Doppler Single Level Bil 2513035 839
US LE Art Duplex Bil 2516090 2,408
US LE Art Duplex Lt 2516090 931
US LE Art Duplex Rt 2518509 931
US LE Veins Duplex Bil 2518509 1,414
US LE Veins Duplex Lt 2518509 717
US LE Veins Duplex Rt 2518509 717
US Pregnant < 14 Weeks Ea Addl Gest 2512990 165
US Pregnant Transvaginal 2517841 425
US Unlisted Procedure 2523017 465
US Retroperitoneal Comp 2515043 552
US Scrotum +Contents 2515019 255
US Transvaginal 2515019 537
US UE Art Doppler Mult Level Bil 2514020 761
US UE Art Duplex Bil 2515233 1,849
US UE Art Duplex Lt 2513485 763
US UE Art Duplex Bil 2519029 763
US UE Veins Duplex Bil 90465 1,414
US UE Veins Duplex Lt 90466 717
US UE Veins Duplex Rt 90467 717
XR Abdomen 1 View 90473 213
XR Abdomen 2 Views 96374 351
XR Ankle Comp Min 3 Views Lt 20100 330
XR Ankle Comp Min 3 Views Rt 50100 330
XR Heel Min 2 Views Lt 10200 235
XR Heel Min 2 Views Rt 12031 235
XR Chest 1 View 12032 196
XR Chest 2 Views 12034 250
XR Clavicle Comp Lt 12036 282
XR Clavicle Comp Rt 12045 282
XR Elbow 2 Views Lt 12051 282
XR Elbow 2 Views Rt 12052 282
XR Facial Bones < 3 Views 13100 282
XR Facial Bones Comp Min 3 Views 13102 415
XR Fluoro Up to 1 Hour 13122 570
XR Foot 2 Views Lt 13131 266
XR Foot 2 Views Rt 13132 266
XR Foot Comp Min 3 Views Lt 13133 303
XR Foot Comp Min 3 Views Rt 25600 303
XR Forearm 2 Views Lt 25605 256
XR Forearm 2 Views Rt 110 256
XR Hand 2 Views Lt 120 261
XR Hand 2 Views Rt 130 261
XR Hand Min 3 Views Lt 164 320
XR Hand Min 3 Views Rt 202 320
XR Hip 1 View Lt 260 256
XR Hip 2-3 View Rt 270 256
XR Hip Comp Min 2 Views Lt 271 382
XR Hip Comp Min 2 Views Rt 272 382
XR Humerus Min 2 Views Lt 274 261
XR Humerus Min 2 Views Rt 290 261
XR Knee 3 Views Lt 300 363
XR Knee 3 Views Rt 301 363
XR Knee 1 or 2 Views Lt 302 264
XR Knee 1 or 2 Views Rt 320 264
XR Mandible Comp Min 4 Views 350 373
XR Nasal Bones Comp Min 3 Views 401 351
XR Neck Soft Tissue 402 287
XR Orbits Comp Min 4 Views Bil 403 622
XR Ribs 2 Views Lt 410 282
XR Ribs 2 Views Rt 420 282
XR Ribs 3 Views Bil 421 519
XR Sacrum +Coccyx Min 2 Views 430 282
XR Scapula Comp Lt 440 303
XR Scapula Comp Rt 444 303
XR Shoulder 1 View Lt 450 224
XR Shoulder 1 View Rt 519 224
XR Sinuses Paranasal Comp Min 3 Views 519 363
XR Skull < 4 Views 540 341
XR Spine Cerv 2 or 3 Views 610 320
XR Spine Lumbosacral 2 or 3 Views 618 329
XR Spine Lumbosacral Min 4 Views 730 484
XR Spine Thoracic 2 Views 760 293
XR Spine Thoracic 3 Views 761 346
XR Sternoclavicular Joint(s) Min 3 Views 771 363
XR Sternum Min 2 Views 914 282
XR Wrist Comp Min 3 Views Rt 921 331
XR Wrist Comp Min 3 Views Lt 940 331
XR Wrist 2 Views Rt 942 303
XR Wrist 2 Views Lt 969 303
NM Parathyroid 969 3,052
H1N1 Immunization Admin, Including Counseling When Performed (Charge) 972 40 40
Blood Culture 972 168
Throat Culture 981 108 43
Urine Culture 983 102 40
NT Pro-BNP 985 424
Renal Function Panel 250 109
Critical Care Services Evaluation and Treatment for First 30 - 74 Minutes 255 937 1,385 991
Preventive Medicine 18-39 years Established 370 287 354 218
Preventive Medicine 5-11 years Established 424 257 315 187
Influenza B 434 151
Influenza A 450 151
Influenza B 460 151
RHIG 740 404
RBC CPD AS1 500 LR Irr 450 727
RBC CPD 450 LR Irr 26720 669
PACKED CELLS LR 27560 524
Aph Plt ACDA LR 30903 1,198
Aph Plt ACDA LR 1 32551 1,315
Aph Plt ACDA LR 2 49080 1,198
Aph Plt ACDA LR 3 258 1,198
Aph Plt ACDA LR Irr 2514608 1,225
Aph Plt ACDA LR Irr 1 2517411 1,225
Aph Plt ACDA LR Irr 2 2517403 1,225
Aph Plt ACDA LR Irr 3 58550 1,225
Acetaminophen Level 1050266 34
Free T4 1050441 113
CSF Culture 1050107 108
Body Fluid Culture 1050018 108 43
Sputum Culture 1050133 108 43
Wound Culture 1050059 108 43
Gentamycin Level Peak 1050075 206
Gentamycin Level Trough 1050091 206
Phenytoin Level 2514442 167
Vancomycin Trough 1 3113896 170
IMM ADM < 8 1ST INJ NSG Charge 3113040 48 48
IMM ADM <8 EA ADD IN NSG Charge 3113030 29 29
IMM ADM <8 1ST ORL/N NSG Charge 3113025 37 37
IMM ADM >8 1ST ORL/N NSG Charge 3114069 61
IV Push Initial/ SIN Charge 3114026 214 30
ROOM/BED: Private 3113333 2,519
ROOM/BED: Swing 3113100 2,519
ROOM/BED: Telemetry 3113090 3,595
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 2.5 cm or Less 3113080 677 626
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 2.6 cm to 07.5 3100103 835 876
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 7.6 cm to 12.5 3113085 856 996
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 20.1 cm to 30. 3113101 2,011 1,351
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 12.6 cm to 20.0 cm Charge 3113059 1,913 1,305
Layer Closure of Wounds of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.5 cm or Less Charge 3113055 723 799
Layer Closure of Wounds of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.6 cm to 05.0 cm Charge 3100177 783 966
Repair Complex Trunk 01.1 to 02.5 cm Charge 3114059 845 976
Repair Complex Trunk Each Additional 5cm or Less Charge 3113226 346 362
Repair Complex, Scalp, Arms, and/or Leg Each Additional 5cm or Less Charge 3113622 359 417
Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet 01.1 to 02.5 cm Charge 3113572 1,038 982
Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet 02.6 to 07.5 cm Charge 3113655 1,419 1,500
Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet Each Additional 5cm or Less 3113648 532 541
Closed treatment of distal radial fracture (eg, Colles or Smith type) w/o manipualtion charge 3113697 1,186 1,212
Closed treatment of distal radial fracture (eg, Colles or Smith type) w/ manipulation charge 3113689 2,050 3,346
110 - ROOM-BOARD/PVT 3113671 0
120 - ROOM-BOARD/SEMI 3113663 0
130 - ROOM-BOARD/3&4BED 3113929 0
164 - R&B/STERILE 3113192 0
202 - ICU/MEDICAL 3021675 0
260 - IV THERAPY 3822848 0
270 - MED-SUR SUPPLIES 3822855 0
271 - NON-STER SUPPLY 3822863 0
272 - STERILE SUPPLY 3822665 0
274 - PROSTH/ORTH DEVICE 3822624 0
290 - MED EQUIP/DURAB 3822871 0
300 - LABORATORY 3821500 0
301 - LAB/CHEMISTRY 3400662 0
302 - LAB/IMMUNOLOGY 3400555 0
320 - DX X-RAY 3400530 0
350 - CT SCAN 3400812 0
401- DIAG MAMMOGRAPHY 3400589 0
402 - ULTRASOUND 3400571 0
403 - SCRN MAMMOGRAPHY 3400712 0
410 - RESPIRATORY SVC 3400720 0
420 - PHYSICAL THERAPY 3400605 0
421 - PHYS THERP/VISIT 3400767 0
430 - OCCUPATION THER 3400766 0
440- SPEECH PATHOL 3400464 0
444 - SPEECH PATH/EVAL 3400456 0
450 - EMERG ROOM 3400449 0
519 - OTHER CLINIC 3400522 0
519 - OTHER CLINIC PROFEE 3400514 0
540 - AMBULANCE 3400755 0
610 - MRI 3400183 0
618 - MRA 3400175 0
730 - EKG/ECG 3400809 0
760 - TREATMENT/OBSERVATION RM 3021164 0
761 - TREATMENT RM 3900101 0
771 - VACCINE ADMIN 3115006 0
914 - BH/INDIV RX 3114067 0
921 - PERI VASCUL LAB 3114068 0
940 - OTHER RX SVS 3100157 0
942 - EDUC/TRAINING 3113049 0
969 - OTHER PRO FEE TECH 8504282 0
969 - OTHER PRO FEE 3113952 0
972 - PRO FEE/RAD/DX TECH 3113408 0
972 - PRO FEE/RAD/DX 3821505 0
981 - PRO FEE/ER 3823022 0
983 - PRO FEE/CLINIC 3823020 0
985 - PRO FEE/EKG 3823028 0
250 - PHARMACY 3823024 0
255 - DRUGS/INCIDENT RAD 3400805 0
370 - ANESTHESIA 3400804 0
424 - PHYS THERP/EVAL 3400799 0
434 - OCCUP THERP/EVAL 3400798 0
450 - EMERG ROOM PROFEE 3400759 0
460 - PULMONARY FUNC 3400758 0
740 - EEG 3400751 0
450 - EMERG ROOM ER 3400750 0
Closed tx of phalangeal shaft fx, proximal or midlle phalanx, finger or thumb: without manipulation, 3400779 710 880
Closed tx of patellar dislocation; without anesthesia 3400778 1,722 1,592
Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method 3400731 663 412
Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed (separ 3400730 768 549
Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (dx or therapeutic): initial 3400724 404 404
258 - IV Solutions 3400801 0
Fecal Leukocytes 3400800 54
Sodium Level Urine 3221025 61
Potassium Level Urine 3221066 54
Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; 3221040 4,215 2,435
Cataract Extraction with Intraocular Lens Implantation 3220755 4,000
Esophagogastroduodenoscopy and Colonoscopy 8504294 2,606
Minor 3220006 0
Level 1 3220418 0
Level 2 3025215 0
OR LEVEL III FIRST 15 MIN 3024648 0
Level 4 3024085 0
OR LEVEL V FIRST 15 MIN 3024077 0
Antibody ID 3024242 256
CT 3D Reconstruction 3021750 266
CT Abdomen +Pelvis w/ + w/out contrast 3023699 3,555
CT Abdomen +Pelvis w/contrast 3023848 3,095
CT Abdomen +Pelvis w/out contrast 3023830 1,595
CT Angio Neck w/ Cont 3023277 2,880
CT Angio Pelvis 3023285 4,083
CT Biopsy 3024671 1,384
CT Chest +Abdomen +Pelvis w/ + w/o Cont 3025900 2,895
CT Abdomen +Pelvis w/ Cont 8504296 2,350
CT Chest +Abdomen +Pelvis w/o Cont 3025199 1,729
CT Fingers w/o Cont Rt 3023491 1,820
CT Chest w/o Cont 3021180 1,729
CT Chest w/ + w/out contrast 3023459 2,895
CT Chest +Abdomen w/ + w/o Cont 3024556 2,895
CT Chest +Abdomen w/o Cont 3024788 1,729
CT Heel w/ Cont Lt 3021461 2,360
CT Ltd or Localized Fol-Up 3025132 2,013
CT Maxillofacial w/ + w/o Cont 3021859 1,980
CT Orbit Sella etc. w/ + w/o Cont 3025074 3,215
CT Sinus or Facial w/ Cont 54700 1,355
CT Spine Cervical w/ + w/o Cont 54161 2,905
CT Spine Cervical w/ Cont 51720 2,355
CT Spine Lumbar w/ + w/o Cont 14001 2,900
CT Spine Lumbar w/ Cont 15839 2,350
CT Spine Thoracic w/ + w/o Cont 38525 2,920
CT Spine Thoracic w/ Cont 26735 2,365
CT UE w/ + w/o Cont Lt 28515 3,040
CT UE w/ + w/o Cont Rt 26160 3,040
MA Breast Tissue Specimen 11450 28
MA Addl Views BCCP Bil. 2518031 390
MA Addl Views BCCP Lt. 38221 228
MA Addl Views BCCP Rt. 2514400 305
MA Addl Views Bil. 2514434 390
MA Addl Views Rt. 3114018 305
MA Diag BCCP Rt. 3114070 305
MA Diag Ltd Marker Placement Rt. 10040 228
MRA Chest w/ + w/o Cont 45005 3,225
MRA Head w/ + w/o Cont 45388 5,344
MRA Head w/out contrast 45384 3,484
MRA LE w/o Cont Rt 54522 3,274
MRA Neck w/ + w/o Cont 55000 5,370
MRA Neck w/ Cont 60220 3,705
MRA Pelvis w/o Cont 60252 3,270
MRA Pelvis w/ + w/o Cont 90670 3,270
MRA Spinal Canal +Contents 87070 3,416
MRA UE w/o Cont Lt 93288 3,334
MRA UE w/o Cont Rt 99460 3,334
MRI Abdomen w/ + w/out contrast 99463 4,118
MRI Abdomen w/ Cont 58290 3,855
MRI Abdomen w/out contrast 58353 3,154
MRI Bone Marrow Blood Supply 58571 3,248
MRI Breast w/ + w/o Cont Bil 58615 3,617
MRI Fingers w/ Cont Lt 58679 3,371
MRI Chest w/ Cont 59151 3,885
MRI Chest w/o Cont 59300 3,578
MRI Toes w/ + w/o Cont Lt 0 3,306
MRI Face Neck Orbit w/o Cont 36589 3,049
MRI Foot w/ + w/o Cont Lt 82270 3,306
MRI Foot w/ + w/o Cont Rt 112 3,306
MRI Foot w/ Cont Lt 119 3,386
MRI Foot w/ Cont Rt 170 3,386
MRI Foot w/o Cont Lt 174 2,493
MRI Foot w/o Cont Rt 210 2,493
MRI Toes w/o Cont Lt 324 2,493
MRI Toes w/o Cont Rt 361 2,493
MRI Pelvis w/ + w/out contrast 371 4,106
MRI Spine Cervical w/ + w/out contrast 379 3,210
MRI Spine Lumbar w/ + w/o Cont 381 3,189
MRI Spine Thoracic w/ + w/o Cont 391 3,215
MRI TMJ 419 2,993
MRI UE Non Joint w/ + w/o Cont Lt 490 4,375
MRI UE Non Joint w/ + w/o Cont Rt 510 4,375
MRI UE Non Joint w/out contrast Lt 520 3,315
MRI UE Non Joint w/out contrast Rt 551 3,315
MRI Wrist w/ + w/o Cont Lt 561 3,780
MRI Wrist w/ + w/o Cont Rt 569 3,780
MRI Wrist w/ Cont Lt 571 3,109
MRI Wrist w/ Cont Rt 580 3,109
MRI Wrist w/o Cont Lt 611 2,027
MRI Wrist w/o Cont Rt 615 2,027
NM Bone Mult Areas 651 2,221
NM Bone Spect 655 2,081
NM Gastric Emptying Study 656 2,923
NM Kidney w/ Flow w/o Pharm 720 2,173
NM Liver Spect 770 1,042
NM Liver +Spleen Static Only 780 998
NM Lymphatics +Lymph Nodes 920 3,479
NM Myocard Perf w/ Ejection Fraction 960 249
NM Myocard Perf w/ Wall Motion 973 249
NM Myocard Perf Spect Mult 975 4,606
NM Pulm Perf w/ Vent 982 3,301
US Guide Amniocentesis 96372 703
US Hysterosonography 90471 590
US Liver Biopsy 90472 1,647
US Lymph Node Biopsy 96372 594
Report 0 356
US Thyroid Biopsy 0 477
US Echoencephalography 3220105 627
US Fetal Biophys Profile w/ Non-Stress 3400514 485
US Pregnant Fol-Up 3400506 516
US Hips Infant Dynamic 3400505 784
US Pregnant > 14 Weeks Ea Addl Gest 3823009 319
US Pelvic Non-OB Comp 3823018 547
US Pelvic Non-OB Ltd 7510065 165
US Pregnant Ltd 7509851 372
US Retroperitoneal Ltd 7509844 209
US Spinal Canal +Contents 7509836 586
XR Ankle 2 Views Lt 7509828 277
XR Ankle 2 Views Rt 7509810 277
XR Ankle Arthrography Lt 1,032
XR Ankle Arthrography Rt 11770 1,032
XR Elbow Arthrography Lt 11772 1,038
XR Elbow Arthrography Rt 15100 1,038
XR Knee Arthrography Lt 17999 1,288
XR Barium Enema w/ or w/o KUB 1,709
XR Barium Enema w/Double Contrast 19120 2,411
XR Bone Age Studies 19300 202
XR Bone Length Studies Scanograms 19301 320
XR Bone Survey Infant 19305 889
XR Chest 2 Views w/ Apical Lordotic 20102 299
XR Chest 2 Views w/ Fluoro 21930 85
XR Chest 2 Views w/ Obl 22900 373
XR Nose to Rectum FB 1 View Child 24530 250
XR Cholecystography Oral Cont 24538 485
XR Elbow Comp Min 3 Views Lt 25630 330
XR Elbow Comp Min 3 Views Rt 26725 330
XR Fingers Min 2 Views Lt 26740 320
XR Fingers Min 2 Views Rt 27130 320
XR Fistula or Sinus Tract Abscess Study 27244 425
XR Hand 2 Views Bil 27447 391
XR Hip Min 2 Views Bil w/ Pelvis 27759 567
XR Pelvis +Hip Infant Min 2 Views 27822 432
XR Hysterosalpingography 27827 831
XR Knee Comp Min 4 Views Lt 27829 415
XR Knee Comp Min 4 Views Rt 31645 415
XR Knee Standing AP Bil 36561 337
XR Mandible Partial < 4 Views 43239 351
XR Mastoids Comp Min 3 Views Bil 43245 831
XR Spine Myelography 2 or More Regions 43246 889
XR Spine Lumbosacral Myelography 43247 740
XR Urography Retrograde w/ or w/o KUB 43255 1,206
XR Ribs Min 3 Views Rt w/ AP Chest 43499 335
XR SI Joints 1 or 2 Views 43840 287
XR Salivary Gland Calculus Bil 44005 590
XR Spine Thoracic Standing (Scoliosis) 44120 303
XR Sella Turcica 44140 293
XR Sialography 44141 1,113
XR Sinuses Paranasal < 3 Views 44143 308
XR Skull Comp Min 4 Views 44145 410
XR Spine 1 View Cerv 44160 207
XR Spine Entire AP +Lateral 44227 693
XR Spine Cerv Comp w/ Obl +Flex +/or Ext 44310 498
XR Spine Lumbosacral Min 4 views 44320 676
XR Spine Thoracolumbar 2 Views 44602 320
XR TMJ Open +Closed Bil 44604 759
XR UGI w/o KUB 38500 757
XR UGI w/ Air Cont w/o KUB 45317 1,373
Aph RBC CP2D AS3 LR 45330 524
Cryo AHF 45335 803
hCG Quantitative 45381 189
PSA Screen 45382 231 92
PSA Diagnostic 45385 231
Alcohol Level 1 46020 201
CT Angio Pelvis w/ Cont 46221 2,360
CT Ankle w/ + w/o Cont Lt 46250 2,995
CT Ankle w/ + w/o Cont Rt 46255 2,995
CT Ankle w/ Cont Lt 46270 2,360
CT Ankle w/ Cont Rt 47563 2,360
CT Ankle w/o Cont Lt 47600 1,825
CT Ankle w/o Cont Rt 49000 1,825
CT Elbow w/o Cont Lt 49002 1,820
CT Elbow w/o Cont Rt 44960 1,820
CT Foot w/ + w/o Cont Lt 49255 2,995
CT Foot w/ + w/o Cont Rt 49520 2,995
CT Foot w/ Cont Lt 49521 2,360
CT Foot w/ Cont Rt 49550 2,360
CT Foot w/o Cont Lt 49566 1,825
CT Foot w/o Cont Rt 49568 1,825
CT Knee w/ + w/o Cont Lt 49570 2,995
CT Knee w/ + w/o Cont Rt 49572 2,995
CT Knee w/ Cont Lt 49585 2,360
CT Knee w/ Cont Rt 49587 2,360
CT Knee w/o Cont Lt 49590 1,825
CT Knee w/o Cont Rt 49651 1,825
CT Shoulder w/o Cont Lt 49653 1,820
CT Shoulder w/o Cont Rt 49900 1,820
CT Wrist w/o Cont Lt 51860 1,820
CT Wrist w/o Cont Rt 55450 1,820
MRI Cardiac Morph w/o Cont 57010 2,440
US Aorta Duplex IVC Iliac Ltd 57120 696
XR Hip Comp Min 2 Views Lt +Pelvis 57267 256
XR Cholangiography Intraoperative 57288 596
XR Optic Foramina Lt 57295 351
XR Optic Foramina Rt 51700 351
XR Pelvis Comp Min 3 Views 27767 399
XR SI Joints Min 3 Views 54450 346
XR Spine 1 View Lumbar 55100 207
XR Spine 1 View Thoracic 3823015 207
XR TMJ Open +Closed Lt 15002 320
XR TMJ Open +Closed Rt 1400200 320
CT Angio LE Bil 3113057 4,905
MRI Brachial Plexus w/ Cont Lt 2021347 3,371
Anaerobic Culture 2020125 119
Ear Culture 1015607 108 43
Group B Strep Culture 2514542 83
111 - MED-SUR-GY/PVT 90746 0
121 - MED-SUR-GY/2BED 90698 0
206 - POST ICU 6042065 0
259 - DRUGS/OTHER 6042057 0
275 - PACE MAKER 6042081 0
276 - INTROC LENS 6123089 0
278 - SUPPLY/IMPLANTS 6042123 0
279 - SUPPLY/OTHER 6042115 0
305 - LAB/HEMATOLOGY 6123139 0
306 - LAB/BACT-MICRO 6123147 0
307 - LAB/UROLOGY 6290250 0
309 - LAB/OTHER 6290086 0
310 - PATHOLOGY LAB 6290003 0
312 - PATHOL/HYSTOL 6290037 0
322 - DX X-RAY/ARTH 6290300 0
323 - DX X-RAY/ARTER 6123782 0
329 - DX X-RAY/OTHER 6043923 0
343 - Diagnostic radiopharmaceuticals 3100123 0
351 - CT SCAN/HEAD 3823012 0
352 - CT SCAN/BODY 3021675 0
360 - OR SERVICES 0 0
390 - BLOOD/STOR-PROC 53620 0
460 - PULMONARY FUNC 53600 0
480 - CARDIOLOGY 29700 0
481 - CARDIAC CATH LAB 28200 0
482 - STRESS TEST 29730 0
612 - MRI - SPINE 54163 0
636 - DRUGS/DETAIL CODE 24620 0
637 - DRUGS/SELF ADMIN 99464 0
710 - RECOVERY ROOM 27508 0
721 - LABOR 27752 0
730 - EKG/ECG 99202 0
731 - HOLTER MONT 99203 0
732 - TELEMETRY 99204 0
762 - OBSERVATION RM 99212 0
Add'l 30 Min Increments CC > 74 99214 778
US Guide Ndl Placement 99215 195
Report 6042438 130
.GTT Fasting Glucose 99245 95
Work Hardening Additional Hours Charge 6043485 194
US Hips Infant Static Ltd 6043477 544
ROOM/BED: Nursery 6044010 1,343
ROOM/BED: Obstetrics 6042099 2,182
Biopsy or excision of lymph node(s); open, deep cervical node(s) 6042099 2,501 2,040
Change of cystostomy tube; simple 23130 351 252
Initial hospital or birthing center care, per day, for E&M of normal newborn infant 23410 476 476 323
Subsequent hospital care, per day, for evaluation and management of normal newborn 23415 211 212 141
PET Ltd Area 23420 2,491
PET Whole Body 23430 3,267
CT Chest w/contrast 23470 2,350
MA Addl Views Lt. 23472 305
MA Diag BCCP Bil. 23515 390
MA Diag BCCP Lt. 23615 305
XR MRI Screen Waters View 23700 282
XR Spine Cerv Min 4 Views 24342 425
XR Toe(s) Min 2 Views Lt 24515 267
XR Toe(s) Min 2 Views Rt 25545 267
Report 25574 513
US Guide Abdomen Paracentesis 25575 1,545
Report 26608 1,030
US Guide Thoracentesis 27245 195
Report 27340 130
US Pregnant < 14 Weeks 1st Gest 27380 529
Iron Level 27445 82
Creatinine Level 24 Hour Urine 27506 62
Cord DAT 27524 68
zzCMP 3 27536 132 53
Removal of tunneled cntrl venous access device w/subcutaneous port/pump cntrl/peripheral insertion 27650 1,025 930
Ligation major artery (eg post-traumatic rupture) neck 27766 2,476 1,312
Stool Culture 27814 119 47
Environmental Culture 27826 183
GC Culture 27828 108
US Retroperitoneal Aorta Comp 28485 1,101
.GTT-1 Hr 29805 49
.GTT-2 Hr 29806 49
.GTT-3 Hr 29807 49
MRI Ankle w/o Cont Lt 29819 1,926
MRI Ankle w/o Cont Rt 29821 1,926
MRI Elbow w/o Cont Lt 29822 2,027
MRI Elbow w/o Cont Rt 29823 2,027
MRI Femur w/ + w/o Cont Lt 29824 3,306
MRI Femur w/ + w/o Cont Rt 29825 3,306
MRI Forearm w/ + w/o Cont Lt 29826 4,099
MRI Forearm w/ + w/o Cont Rt 29827 4,099
MRI Knee w/o Cont Lt 29850 1,926
MRI Knee w/o Cont Rt 29870 1,926
US Echo 2D Comp 29873 1,169
Report 29875 855 299
Tibia fracture, distal, wt bearing articular surface portion - closed treatment of w or wo anesthes 29876 1,503 1,462
Thoracentesis with insertion of tube, includes water seal eg, for pneumothorax , when performed (sep 29877 565 566
BD DEXA Appendicular Skeleton 29879 197
PET Whole Body w/ CT Scan 29880 4,042
CT Angio Abdomen Aorta +Iliofemoral 29882 4,966
CT Angio Head 29888 3,563
CT Toes w/ + w/o Cont Rt 25607 2,995
CT Guide Ndl Placement 25608 1,384
Report 25609 469
CT LE w/ + w/o Cont 6123097 2,995
CT LE w/ + w/o Cont Rt 6123329 2,995
MA Diag Ltd Marker Placement Lt. 6049003 228
MA Routine Screen BCCP Bil. 0 322
MA Routine Screen Implant Bil. 11004 322
MA Routine Screen Lt. 20240 322
MA Routine Screen Rt. 24000 322
MRI Ankle w/ + w/o Cont Lt 2513493 3,803
MRI Ankle w/ + w/o Cont Rt 26115 3,803
MRI Ankle w/ Cont Lt 27324 3,139
MRI Ankle w/ Cont Rt 28008 3,139
MRI Elbow w/ + w/o Cont Lt 28022 3,780
MRI Elbow w/ + w/o Cont Rt 28090 3,780
MRI Elbow w/ Cont Lt 64719 3,109
MRI Elbow w/ Cont Rt 69433 3,109
MRI Femur w/ Cont Lt 74420 3,386
MRI Femur w/ Cont Rt 2513154 3,386
MRI Forearm w/ Cont Lt 3100120 3,371
MRI Forearm w/ Cont Rt 3100121 3,371
MRI Forearm w/o Cont Lt 3100110 3,109
MRI Forearm w/o Cont Rt 3100111 3,109
MRI Knee w/ Cont Lt 3400688 3,139
MRI Knee w/ Cont Rt 3325105 3,139
US Abdomen/Pelvic/Scrotal Art/Vein Comp 3320286 1,630
US Carotid Duplex Lt 3320260 754
US Carotid Duplex Rt 93016 754
US Guide Vascular Access 3222257 139
Report 3020778 50
US Guide Intraoperative 3023681 597
US Transrectal 36415 434
XR Spine Puncture Lumbar Diag 85014 710
XR GI Tube Inj for Placement 3100150 1,204
XR Hip Arthrography Lt 3100151 1,081
XR Hip Arthrography Rt 3100140 1,081
XR Knee Arthrography Rt 3100141 1,288
XR Shoulder Arthrography Lt 3100130 1,081
XR Shoulder Arthrography Rt 3100131 1,081
XR Wrist Arthrography Lt 3100167 1,165
XR Wrist Arthrography Rt 3100166 1,165
XR Chest Comp Min 4 Views 3100169 382
XR Chest Comp Min 4 Views w/ Fluoro 3100168 905
XR Cholangiography Perc Transhepatic 3100124 990
XR Fluoro Guide CVA Placement 3100125 766
Report 3100114 65
XR Fluoro Guide Ndl Loc Spine 3100115 766
XR Spine Cerv Myelography 3100104 771
XR Small Bowel w/ Serial Films 3100105 1,191
XR Spine Lumbosacral Bending Only 3100165 420
XR Swallowing Funct w/ Video 3100164 1,511
XR Urethrocystography Retrograde 3100163 746
XR Urography Antegrade 3100162 666
XR Venography LE Bil 3100161 1,900
XR Venography LE Lt 3100160 1,198
XR Venography LE Rt 3100126 1,198
Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma) 3100127 1,038 763
Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days 3100116 773 774
Bladder instillation of anticarcinogenic agent (including retention time) 3100117 399 309
Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm 3100158 1,206
Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area 3100159 3,555
Biopsy or excision of lymph node(s); open, deep axillary node(s) 3100148 2,123 1,377
Open treatment of phalangeal shaft fracture, mid phalanx, finger/thumb, incl int. fixation 3100149 2,873 2,004
Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation,ea 3100138 779 688
Excision of lesion of tendon sheath or joint capsule (eg, cyst, ganglion), hand/finger 3100139 1,804 1,676
Excision of skin and subcutaneous tissue for hidradenitis, axillary,w simple or intermed repai 3100128 1,823 1,219
MRSA Screen Culture 3100129 108
Bone marrow; biopsy, needle or trocar 3100118 710 362
Reference ABO/Rh 3100119 38
Reference ABSC 3821665 192
CT Angio Abdomen w/ Cont 3821665 3,045
CT Angio Chest w/ Cont 3400764 2,940
10040 ACNE SURGERY 97605 184 425
Incision and drainage of submucosal abscess, rectum 97606 784
Colonoscopy, flexible, proximal to splenic flexure; w/ ablation of tumor, polyp,lesion not amenable 0 15,308 1,420
Colonoscopy, flexible, proximal to splenic flexure; w/ removal of tumor, polyp,lesion by hot biopsy 200 2,147 1,129
Orchiectomy, partial 22 2,875 1,724
Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication 253 409 414
Total thyroid lobectomy, unilateral; with or without isthmusectomy 254 1,537
Thyroidectomy, total or subtotal for malignancy; with limited neck dissection 273 3,023
Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure 321 802 755
Pneumococcal conjugate vaccine, 13 valent, for intramuscular use 340 449 449
Bronchial Wash Culture 341 108
Interrogation device evaluation (in person) with physician analysis, review and report, connection 342 135 150 70
Initial hospital or birthing center care, per day, for eval and mgmt of normal newborn infant 380 476 476 323
Initial hospital or birthing cntr care, per day, for eval and mgmt of normal newborn infant same day 382 568 568 358
Vaginal hysterectomy, for uterus greater than 250 g; 383 5,499 3,411
Endometrial ablation, thermal, without hysteroscopic guidance 384 4,780 1,046
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) 400 4,315 2,709
Occlusion of fallopian tube(s) by device (eg, band, clip,Falope ring) vaginal or suprapubic approach 412 1,189 663
Unlisted laparoscopy procedure, oviduct, ovary 422 885 0
Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy 431 3,637 2,037
Episiotomy or vaginal repair, by other than attending physician 432 930 720
Prednisolone oral per 5 mg 441 3
Removal of tunneled central venous catheter, without subcutaneous port or pump 442 641 590
Hemoccult POC 483 44 44
112 - OB/PVT 750 0
119 - OTHER/PVT 964 0
170 - NURSERY 986 0
174 - NURSERY/LEVEL IV 987 0
210 - CORONARY CARE 988 0
324 - DX X-RAY/CHEST 3221284 0
361 - OR/MINOR 51703 0
371 - ANESTHE/INCIDENT RAD 51784 0
379 - ANESTHE/OTHER 51797 0
381 - BLOOD/PKD RED 52001 0
391 - BLOOD/ADMIN 52204 0
419 - OTHER RESPIR SVS 52224 0
490 - AMBUL SURG 52234 0
510 - CLINIC 52235 0
520 - FREESTAND CLINIC 52240 0
551 - SKILLED NURS/VISIT 52276 0
561 - MED SOC SERVS/VISIT 52281 0
569 - MED SOC SERV/OTHER 52310 0
571 - AIDE/HOME HLTH/VISIT 52317 0
314 - Laboratory Biopsy 52332 0
611 - MRI - BRAIN 52351 0
615 - MRI-Head and neck 52342 0
651 - HOSPICE/RTN HOME 52353 0
655 - HOSPICE/IP RESPITE 52500 0
656 - HOSPICE/IP NON-RESPITE 52601 0
720 - DELIVEROOM/LABOR 52630 0
770 - PREVENT CARE SVS 52648 0
780 - TELEMEDICINE 54520 0
920 - OTHER DX SVS 54530 0
960 - PRO FEE 55700 0
973 - PRO FEE/RAD/RX 99225 0
975 - PRO FEE/OR 50385 0
982 - PRO FEE/OUTPT 20200 0
96372 Therapeutic, prophylactic, or diagnostic injection, SQ/IM (Ofc) 21012 77
Immunization Administration 1st vaccine 23120 73 73
Immun Admin each additional vaccine 23180 28
96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular 23930 77
Imitrex 6mg Injection 24516 168 168
Hydroxyzine HCl 25mg Injection 24575 22
US Breast Rt. 26055 413
MRI Breast w/ + w/o Cont Bil. 27310 4,759
MRI Breast w/ + w/o Cont Lt. 27347 4,819
MRI Breast w/ + w/o Cont Rt. 27415 4,819
MA Diag Bil. 27602 390
MA Routine Screen Bil. 27603 322
99291 - Critical Care 27823 2,592
99285 - Level 5 27870 2,108
99284 - Level 4 28289 1,436
99283 - Level 3 29871 765
99282 - Level 2 29874 523
99281 - Level 1 51040 261
Excision of nail partial or complete for perm. removal w/ amputation of tuft of distal phalanx 52005 1,034
11770 EXC PILOND CYST;SMPL 54001 1,324 893
11772 EXC PILOND CYT;COMPL 54100 3,323 2,427
Split-thickness autograft trunk arms legs first 100 sq cm or less 55060 4,115 3,452
Unlisted procedure skin mucous membrane and subcutaneous tissue 55520 187 821
Biopsy of breast percutaneous needle core using imaging guidance 57000 567 568
Excision of cyst fibroadenoma aberrant breast tissue duct lesion areolar lesion 1 or more 57130 1,699 1,999
Mastectomy for gynecomastia 57285 2,510 1,994
Mastectomy partial (eg lumpectomy tylectomy quadrantectomy segmentectomy) 57300 3,158 1,931
Mastectomy radical including pectoral muscles axillary lymph nodes 57720 2,938
Exploration of penetrating wound (separate procedure) abdomen/flank/back 58263 2,331 1,235
Excision tumor soft tissue of back or flank subcutaneous less than 3 cm 58356 1,554 1,702
Excision tumor soft tissue of abdominal wall subfascial (eg intramuscular) less than 5 cm 11045 2,738 1,574
Closed treatment of supracondylar humeral fracture w/wo intercondylar ext. without manipulation 15851 1,820 1,651
Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture 35201 3,599 1,644
Closed treatment of carpal bone fracture without manipulation each bone 35800 1,192 1,143
Closed treatment of phalangeal shaft fracture with manipulation w/wo skin or skeletal traction 36510 1,227 1,452
Closed treatment of articular fracture metacarpophalangeal or interphalangeal joint wo manip. Each 38100 1,100 1,035
Arthroplasty acetabular and proximal femoral prosthetic replacement w/wo autograft or allograft 43234 2,781 3,487
Treatment of intertrochanteric peritrochanteric femoral fracture with plate/screw type implant 43251 5,973 3,156
Arthroplasty knee condyle and plateau medial AND lateral compartments w/wo patella resurfacing 43631 3,199 3,514
Treatment of tibial shaft fracture by intramedullary implant w/wo interlocking screws 44800 4,838 2,575
Open treatment of trimalleolar ankle fracture includes internal fixation when performed 46604 4,152 2,413
Open treatment of fracture of weight bearing articular surface/portion of distal tibia of tibia only 47379 5,318 3,194
Open treatment of distal tibiofibular joint (syndesmosis) disruption when performed 49010 3,362 2,011
Bronchoscopy rigid or flex incl. fluoroscopic w/ therapeutic aspiration tracheobronchial initial 50220 1,219 725
Insertion of tunneled centrally inserted cntrl venous access device w/ sub port age 5 yr+ 60500 4,048 1,788
Upper GI endoscopy incl. esophagus stomach the duodenum/jejunum w/ biopsy single or multi 59612 1,171 924
Upper GI endoscopy incl esophagus stomach duodenum/ejunum w/dilation of gastric outlet for obstr 59855 2,636 997
Upper GI endoscopy incl esophagus stomach either duodenum and/or jejunum w/percutaneous gastro tube 59870 988 678
Upper GI endoscopy incl esophagus stomach either duodenum/ jejunum w/ remov of foreign body 99359 1,672 875
Upper GI endoscopy incl. esophagus stomach either duodenum and/or jejunum w/ cntrl of bleeding 99224 3,173 994
Gastrotomy with exploration or foreign body removal 99406 3,091 2,916
Gastrorrhaphy suture of perforated duodenal or gastric ulcer wound or injury 99441 6,625 3,842
Enterolysis (freeing of intestinal adhesion) (separate procedure) 99442 5,339 3,106
Enterectomy resection of small intestine single resection and anastomosis 99443 5,967 3,503
Colectomy partial with anastomosis 49441 6,542 3,801
Colectomy partial with skin level cecostomy or colostomy 2517569 8,909 5,033
Colectomy partial with end colostomy and closure of distal segment (Hartmann type procedure) 2510042 8,122 4,676
Colectomy partial with coloproctostomy (low pelvic anastomosis) 2599010 8,093 4,810
Colectomy partial with removal of terminal ileum with ileocolostomy 2599010 6,056 3,515
Laparoscopy surgical enterectomy resection of small intestine single resection and anastomosis 2599010 4,816
Ileostomy or jejunostomy non-tube 2599010 2,960
Colostomy or skin level cecostomy 3113804 3,350
Suture of sm. intestine for perforated ulcer diverticulum wound injury or rupture single perforation 3400739 6,889 4,160
Suture of lg. intestine for perforated ulcer diverticulum wound injury or rupture w/o colostomy 3400738 5,162 3,055
Biopsy or excision of lymph node(s) open superficial 3400727 1,059 1,235
Proctosigmoidoscopy rigid with control of bleeding (eg injection bipolar cautery laser) 3400726 875 548
Sigmoidoscopy flexible diagnostic with or without collection of specimen by brushing or washing 3400785 532 431
Sigmoidoscopy flexible with directed submucosal injection(s) any substance 3400784 1,115 616
Colonoscopy flexible proximal to splenic flexure w/ directed submucosal injection any substance 3400769 989 1,091
Colonoscopy flexible proximal to splenic flexure with control of bleeding 3400768 3,441 1,322
Colonoscopy flexible proximal splenic flexure w/ removal of tumor polyp lesion snare technique 3400735 1,847 1,258
Placement of seton 3400734 412
Hemorrhoidectomy internal by rubber band ligation(s) 3400723 887 731
Hemorrhoidectomy external 2 or more columns/groups 3400722 2,227 1,527
Hemorrhoidectomy internal and external single column/group 3400807 2,437 1,716
Surgical treatment of anal fistula (fistulectomy/fistulotomy) subcutaneous 3400806 2,446 1,898
Laparoscopy surgical cholecystectomy with cholangiography 3400757 3,478 1,930
Transrectal drainage of pelvic abscess 3400756 5,199 2,941
Exploratory laparotomy exploratory celiotomy with or without biopsy(s) 3400741 3,751 2,110
Reopening of recent laparotomy 3400740 5,095 2,967
Drainage of peritoneal abscess or localized peritonitis exclusive of appendiceal abscess open 3400789 7,757 4,489
Closure of enterovesical fistula with intestine and or bladder resection 3400788 4,603
Appendectomy for ruptured appendix with abscess or generalized peritonitis 3400773 4,260 2,440
Omentectomy epiploectomy resection of omentum 3400772 3,851 2,113
Repair recurrent inguinal hernia any age reducible 3221010 3,073 2,042
Repair recurrent inguinal hernia any age incarcerated or strangulated 3221011 3,486 1,944
Repair initial femoral hernia any age reducible 3625504 2,798 2,064
Repair recurrent incisional or ventral hernia incarcerated or strangulated 3025330 4,568 2,613
Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh 3020976 821
Repair epigastric hernia (eg preperitoneal fat) reducible (separate procedure) 3021420 2,023 1,355
Repair epigastric hernia (eg preperitoneal fat) incarcerated or strangulated 3021446 2,509 1,706
Repair umbilical hernia age 5 years or older reducible 3021347 2,161 1,451
Repair umbilical hernia age 5 years or older incarcerated or strangulated 3002578 2,308 1,739
Repair spigelian hernia 3021180 2,785 1,498
Laparoscopy surgical repair recurrent inguinal hernia 30233335 2,706 1,951
Laparoscopy surgical repair ventral umbilical hernia 30233334 4,517 2,878
Suture secondary of abdominal wall for evisceration or dehiscence 13101 3,962 2,088
Cystorrhaphy suture of bladder wound injury or rupture simple 3025000 3,624 2,030
Ligation (percutaneous) of vas deferens unilateral or bilateral (separate procedure) 3025158 1,765 1,270
Colpotomy with drainage of pelvic abscess 36582 2,080 1,151
Colpocleisis (Le Fort type) 49500 2,433 1,393
Insertion of mesh or other prosthesis for repair of pelvic floor defect each site vaginal approach 49565 1,230 821
Sling operation for stress incontinence (eg fascia or synthetic) 57421 3,438 2,041
Revision (including removal) of prosthetic vaginal graft vaginal approach 58671 2,286 1,315
Irrigation Bladder, Simple Technical Charge 43249 309 175
Acetabulum (hip socket) fracture(s) - closed treatment of; wo manipulation Charge 0 2,555 2,030
Malleolus fracture, posture - closed treatment of; without manipulation Charge 43250 1,342 1,351
Foreskin manipulation including lysis of preputial adhesions and stretching Charge 44626 234 242
Drainage of abscess, scrotal wall Charge 0 1,036 804
MA Diag Rt. 129 305
15002 Surgical prep/creation of recipient site by excision of open wounds, first 100sqcm (Surg) 311 1,354 1,102
General 359 0
CT Chest +Abdomen w/ Cont 2514434 2,350
TRAY EPIDURAL 2525026 180
MECONIUM ASPIRATOR 6123063 37
C-SECTION PACK 43235 524
Pooled Cryo AHF Thawed 49650 520
Hepatitis B immune globulin (HBIg), human, for intramuscular use 19303 207 207
*DNU DTaP-Hib-IPV Vaccine IM 3221090 139 139
Yes- PT Unattended Electrical Therapy Charge 3221109 62
Mechanical Traction Charge 0 62
Yes- PT Paraffin Bath Charge 3021149 42
Yes- OT Paraffin Bath Charge 42
Yes 0 162
Yes 0 289
Yes 0 327
Yes 0 201
Eval of Oral and Pharyngeal Swallowing Fx Chg 0 280
Yes- Treatment of Swallowing Dysfunction Charge 0 332
Yes 0 355
Tx of Speech/Lang/Voice/Comm/Auditory Chg 0 304
ST Fluoro Eval of Swallow Function Chg 0 334
Prosthetic Charge 0 133
Aquatic Therapy Charges 2091753 173
CT Fingers w/ + w/o Cont Rt 2516223 3,040
MA Diag Lt. 2514442 305
MA Breast Tissue Specimen. 2517379 28
Methotrexate sodium inj 2514418 8
Dilation of urethral stricture by passage of filiform and follower, male initial 425
Dilation of urethral stricture by passage of sound, male initial 2511141 287 237
Removal/revision of cast 3400702 302 163
Repair of foot tendon 3220087 2,387 1,904
Windowing of cast 3222208 162 217
Repair of circumcision 2093842 859 861
Treat elbow fracture 5002035 2,640 1,214
Attendance at delivery 2517528 252
Closed Treatment of proximal humerus w/manip Charge 2510010 2,524 2,010
Treatment of tibia fracture 2515514 2,577 2,305
Office/OP New Visit Level 2 99202 2514418 219 258 134
Office/OP New Visit Level 3 2514400 333 377 198
Office/OP New Visit Level 4 3222418 471 587 363
Office/OP Established Visit Level 2 99212 3114071 126 77
Office/OP Established Visit Level 4 99214 3100198 309 363 207
Office/OP Established Visit Level 5 99215 3100206 415 514 313
ADL Training Charge 3022772 139
Office/OP Consult Level 5 - 99245 3822764 641 804 547
CPM Daily Treatment Charge 3822764 179
CPM Initial Fit Charge 3221283 230
Compression Bandage Application Charge 3221284 969
Whirlpool Full Body Charge 3221283 93
Whirlpool Extremity Charge 3020265 93
Acromioplasty Or Acromionectomy, Partial, With Or Without Coracoacromial Ligament Release 2517528 2,943 2,215
Repair Of Ruptured Musculotendinous Cuff (Eg, Rotator Cuff) Open; Acute 7552042 3,974 2,430
Coracoacromial Ligament Release 2525004 3,370 1,553
Reconstruction Of Complete Shoulder (Rotator) Cuff Avulsion, Chronic (Includes Acromioplasty) 2525004 4,688 3,211
Tenodesis Of Long Tendon Of Biceps 2517569 3,603 2,279
Arthroplasty, Glenohumeral Joint; Hemiarthroplasty 2514580 5,823 3,011
Arthroplasty, Glenohumeral Joint; Total Shoulder (Glenoid And Proximal Humeral Replacement) 2510010 7,064 3,724
Open Treatment Of Clavicular Fracture, With Or Without Internal Or External Fixation 2514580 3,481 2,989
Open Treatment Of Greater Humeral Tuberosity Fracture, With Or Without Internal Or External Fixation 0 4,278 2,089
Manipulation Under Anesthesia, Shoulder Joint, Including Application Of Fixation Apparatus 21931 947 933
Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without Tendon Graft 23073 3,747 2,466
Open Treatment Of Humeral Shaft Fracture With Plate/Screws, With Or Without Cerclage 23076 4,240 2,321
Open Treatment Of Unla Shft Dxr W Int Fix 49656 3,006 1,833
Open Treatment Of Radius And Unla 58260 3,254 1,481
Open Treatment Of Radial & Ulnar Shaft Fractures, With Internal /External Fixation; Radius And Ulna 2524268 4,354 2,925
Percutaneous Skeletal Fixation Of Metacarpal Fracture, Each Bone 2522822 2,288 1,808
Treatment of Intertrochanteric,Pertrochanteric,Subtrochanteric Femoral Fract, w/ implant 12041 5,973 3,302
Excision, Prepatellar Bursa 3400733 1,790 1,752
Suture Of Infrapatellar Tendon; Primary 3400732 2,860 1,690
Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment 3400777 6,076 3,140
Open Treatment Of Femoral Shaft Fracture,w/ wo External Fix,w/ Insertion of Intramedullary Implant 3400776 6,487 3,465
Open Treatment Of Patellar Fracture, w/ Internal Fixation And/Or Partial Or Complete Patellectomy 3400729 3,637 2,060
Open Treatment Of Tibial Fracture, Proximal (Plateau); Bicondylar, With Or Without Internal Fixation 3400728 3,444
Repair, Primary, Open Or Percutaneous, Ruptured Achilles Tendon; 3400749 3,180 2,856
Open Treatment Of Medial Malleolus Fracture, With Or Without Internal Or External Fixation 3400748 2,941 2,277
Open Treatment Of Bimalleolar Ankle Fracture, With Or Without Internal Or External Fixation 3400781 3,731 2,170
Open Treatment Of Fracture Of Weight Bearing Articular Surface/Portion Of Distal Tibia 3400780 4,110 2,397
Treat Lower leg Fracture Tib and Fib 3220757 6,362 3,490
Open Treatment Of Metatarsal Fracture, With Or Without Internal Or External Fixation, Each 3220758 2,618 2,286
Arthroscopy, Shoulder, Diagnostic, With Or Without Synovial Biopsy (Separate Procedure) 3023525 2,280 1,526
Arthroscopy, Shoulder, Surgical; Capsulorrhaphy 3020307 5,145 4,290
Arthroscopy, Shoulder, Surgical; Repair Of Slap Lesion 3025041 5,019 4,174
Arthroscopy, Shoulder, Surgical; Synovectomy, Partial 97597 2,832 2,884
Arthroscopy, Shoulder, Surgical; Synovectomy, Complete 99205 2,822 2,720
Arthroscopy, Shoulder, Surgical; Debridement, Limited 2514566 2,741 1,927
Arthroscopy, Shoulder, Surgical; Debridement, Extensive 2513668 2,990 2,539
Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articular Surface 2515095 3,222 2,620
Arthroscopy, Shoulder, Surgical; With Lysis And Resection Of Adhesions, With Or Without Manipulation 2515080 2,789 2,081
Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial Acromioplasty 2514580 1,320 1,029
Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair 2514580 5,108 3,496
Arthroscopically Aided Treatment Of Intercondylar Spine(S) And/Or Tuberosity Fracture(S) Of The Knee 1050434 2,935 1,392
Arthroscopy, Knee, Diagnostic, With Or Without Synovial Biopsy (Separate Procedure) 90696 2,804 1,978
Arthroscopy, Knee, Surgical; With Lateral Release 99173 2,529 2,983
Arthroscopy, Knee, Surgical; Synovectomy, Limited (Eg Plica Or Shelf Resection) (Separate Procedure) 0 2,394 1,917
Arthroscopy, Knee, Surgical; Synovectomy, Major, Two Or More Compartments (Eg, Medial Or Lateral) 3100190 3,184 2,767
Arthroscopy, Knee, Surgical; Debridement/Shaving Of Articular Cartilage (Chondroplasty) 3222427 3,007 2,528
Arthroscopy, Knee, Surgical; Abrasion Arthroplasty Or Multiple Drilling Or Microfracture 3222423 3,205 2,675
Arthroscopy, Knee, Surgical; W/ Meniscectomy-Medial & Lateral, Any Meniscal Shaving 2515019 2,720 2,690
Arthroscopy, Knee, Surgical; With Meniscus Repair (Medial Or Lateral) 2513006 3,396 4,145
Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation Or Reconstruction 2513501 4,776 4,198
Treat fracture rad extra-articul 54840 3,547 2,931
Treat fracture rad intra-articul 3222410 3,980 3,313
Treat fracture radial 3+ frag 93308 5,062 3,520
Sensory Stimulation Charge 5125090 117
Yes 5001078 0
Yes- PT Apply Hot or Cold Pack Charge 5000229 0
H1N1 DRUG IM 5000237 36 36
11004 DEBR NECROTIZ ST- GENITALS & PERINEUM 5000401 1,817
Biopsy, Bone, Excisional; Superficial (Eg, Ilium, Sternum, Spinous Process) 5000419 741 610
Arthrotomy, Elbow, Incl Exploration, Drainage, Or Removal Of Foreign Body 5000328 2,305 1,023
Salicylate Level 3025205 34
Excision, tumor or vascular malformation, hand or finger; subcutaneous. 91271000 2,322 1,602
Biopsy, soft tissue of thigh or knee area; superficial 11982 1,922 1,393
Fasciotomy, foot and/or toe 15240 2,102 1,421
Arthrotomy, w exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint 24359 2,357 1,375
Excision of lesion of tendon or fibrous sheath or capsule (cyst or ganglion); foot. 26236 2,290 625
Neuroplasty and/or transposition; ulnar nerve at wrist 26990 1,931 1,392
Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia 27487 777 554
Urography, Retrograde, With Or Without Kub 27570 93
T4, Total 27599 86
CT Elbow w/ + w/o Cont Lt 27652 3,040
CT Elbow w/ + w/o Cont Rt 27698 3,040
CT Elbow w/ Cont Lt 36416 2,310
CT Elbow w/ Cont Rt 43200 2,310
MRA Abdomen w/ + w/o Cont 43215 3,281
NM Sentinel Node Inj Only 49905 1,542
NM Hepa Duct System w/ Pharm 57287 4,731
NM Hepa Duct System w/o Pharm 95860 3,445
Report 95861 74
US Pregnant Detailed Ea Addl Gest 0 821
XR Shoulder Comp Min 2 Views Lt 0 282
XR Shoulder Comp Min 2 Views Rt 0 282
Venipuncture 0 21 21
Hematocrit POC 12 12
CT Femur w/ + w/o Cont Lt 3222257 2,995
CT Femur w/ + w/o Cont Rt 2513006 2,995
CT Femur w/ Cont Lt 635 2,360
CT Femur w/ Cont Rt 155 2,360
CT Femur w/o Cont Lt 6123345 1,825
CT Femur w/o Cont Rt 45337 1,825
CT Forearm w/ Cont Lt 1016522 2,310
CT Forearm w/ Cont Rt 2514079 2,310
CT Forearm w/o Cont Lt 2000004 1,820
CT Forearm w/o Cont Rt 55110 1,820
CT Hand w/ + w/o Cont Lt 7552046 3,040
CT Hand w/ + w/o Cont Rt 7552028 3,040
CT Hand w/ Cont Lt 7552032 2,310
CT Hand w/ Cont Rt 7552066 2,310
CT Hand w/o Cont Lt 7552037 1,820
CT Hand w/o Cont Rt 7552036 1,820
CT Humerus w/ + w/o Cont Lt 7552033 3,040
CT Humerus w/ + w/o Cont Rt 54450 2,995
CT Humerus w/ Cont Lt 6043840 2,310
CT Humerus w/ Cont Rt 45378 2,310
CT Humerus w/o Cont Lt 0 1,820
CT Humerus w/o Cont Rt 140 1,820
CT Shoulder w/ + w/o Cont Lt 252 3,040
CT Shoulder w/ + w/o Cont Rt 456 3,040
CT Shoulder w/ Cont Lt 21 2,310
CT Shoulder w/ Cont Rt 521 2,310
CT Tibia/Fibula w/ + w/o Cont Lt 681 2,995
CT Tibia/Fibula w/ + w/o Cont Rt 943 2,995
CT Tibia/Fibula w/ Cont Lt 999 2,360
CT Tibia/Fibula w/ Cont Rt 6123758 2,360
CT Tibia/Fibula w/o Cont Lt 6043782 1,825
CT Tibia/Fibula w/o Cont Rt 5005145 1,825
CT Wrist w/ + w/o Cont Lt 6042130 3,040
CT Wrist w/ + w/o Cont Rt 6123006 3,040
CT Wrist w/ Cont Lt 5400101 2,310
CT Wrist w/ Cont Rt 6290018 2,310
MA Breast Ndl Loc Placement Lt. 3321230 1,056
MA Breast Ndl Loc Placement Rt. 6290037 1,056
MRA UE w/ Cont Rt 6290300 3,334
Negative pressure wound therapy (e.g., vacuum-assisted drainage collection)<50 sq cm 6290185 139 119
Negative pressure wound therapy (e.g., vacuum-assisted drainage collection)>50 sq cm 6290250 231 131
INJECTION, PROCHLORPERAZINE, UP TO 10 MG 2514580 6
200 - INTENSIVE CARE 2514580 0
022 - SNF PPS (RUG) 2514580 0
253 - DRUGS/TAKEHOME 2514580 0
254 - DRUGS/INCIDENT ODX 5002002 0
273 - TAKEHOME SUPPLY 2525019 0
321 - DX X-RAY/ANGIO 2525032 0
340 - NUCLEAR MEDICINE 2514400 0
341 - NUC MED/DX 27335 0
342 - NUC MED/RX 27664 0
380 - BLOOD 54162 0
382 - BLOOD/WHOLE 22903 0
383 - BLOOD/PLASMA 24071 0
384 - BLOOD/PLATELETS 32560 0
400 - IMAGE SERVICE 3400106 0
412 - INHALATION SVC 3101401 0
422 - PHYS THERP/HOUR 3113572 0
431 - OCCUP THERP/VISIT 3400647 0
432 - OCCUP THERP/HOUR 3400650 0
441 - SPEECH PATH/VISIT 3400597 0
442 - SPEECH/PATH/HOUR 3400654 0
483 - ECHOCARDIOLOGY 3400811 0
750 - GASTR-INTS SVS 3400810 0
964 - PRO FEE/ANES CRNA 3400813 0
986 - PRO FEE/EEG 3400613 0
987 - PRO FEE/HOS VIS 3400710 0
988 - PRO FEE/CONSULT 3021081 0
US Breast Biopsy Lt. 3020638 195
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Eg, Altered Anatomy, Fractured Cath 3024176 473 373
Electromyography Studies (Emg) Of Anal Or Urethral Sphincter, Other Than Needle, Any Technique 3024291 453 240
Voiding Pressure Studies(Vp);Intra-Abdominal Voiding Pressure (Ap) (Rectal,Gastric,Intraperitoneal) 3024283 486 194
Cystourethroscopy With Irrigation And Evacuation Of Multiple Obstructing Clots 3020281 1,262 1,236
Cystourethroscopy, With Biopsy 3020679 1,451 1,026
Cystourethroscopy, With Fulguration Or Treatment Of Minor (Less Than 0.5 Cm) Lesion(S) W/ Or W/o 3024275 2,548 1,868
Cystourethroscopy, With Fulguration And/Or Resection Of; Small Bladder Tumor(S) (0.5 To 2.0 Cm) 3023798 1,054 1,025
Cystourethroscopy, With Fulguration And/Or Resection Of; Medium Bladder Tumor(S) (2.0 To 5.0 Cm) 3023780 1,406 1,126
Cystourethroscopy, With Fulguration And/Or Resection Of; Large Bladder Tumor(S) 2517304 1,909 1,295
Cystourethroscopy With Direct Vision Internal Urethrotomy 5001094 1,289 1,049
Cystourethroscopy,w/ Calibration And/Or Dilation of Urethral Stricture or Stenosis,w/ w/o Meatotomy 6123071 963 1,004
Cystourethroscopy, With Removal Of Foreign Body, Calculus, Or Ureteral Stent From Urethra Or Bladder 3320322 875 979
Litholapaxy: Crushing Or Fragmentation Of Calculus, Removal Of Fragments Simple Or Small 3320323 2,380 1,693
Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (Eg, Gibbons Or Double-J Type) 3221283 1,488 1,133
Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; Diagnostic 3730102 1,474 1,069
Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Removal Or Manipulation Of Calculus 82962 1,507 984
Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Lithotripsy 3025660 1,909 1,262
Transurethral Resection Of Bladder Neck (Separate Procedure) 24341 2,368 1,386
Transurethral Electrosurgical Resection Prostate, Inc Control Of Postoperative Bleeding, Complete 2514418 4,111 2,568
Transurethral Resection; Of Regrowth Of Obstructive Tissue Longer Than One Year Postoperative 2514749 1,943 1,363
Contact Laser Vaporization W W/O Transurethral Resection Prostate,control Postoperative Bleeding 2525033 8,779 3,352
Orchiectomy, Simple, W/ W/O Testicular Prosthesis, Scrotal Or Inguinal Approach 11981 1,585 1,103
Orchiectomy, Radical, For Tumor; Inguinal Approach 31237 2,453 1,578
Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach 2525023 746 881
*DNU Subsequent observation care, per day 3025175 233
Change stent via transureth 2522896 5,162 1,069
Biopsy, Muscle; Superficial 93279 992 529
Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater 5401009 1,194 1,177
Claviculectomy; Partial 93281 2,819 1,862
Partial Excision (Craterization, Saucerization, Or Diaphysectomy) Bone (Eg, Osteomyelitis), Clavicle 93282 3,197 1,512
Incision And Drainage, Upper Arm Or Elbow Area; Deep Abscess Or Hematoma 93284 1,701 1,046
Treatment Of Humeral Shaft Fracture, With Insertion Of Intramedullary Implant 96110 4,158 2,084
Open Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral 0 3,545 1,634
Tendon Sheath Incision (Eg, For Trigger Finger) Proc Charge 0 2,099 1,641
Arthr, Knee, With Explor, Drainage, Or Rem FB (Eg, Infection) ASSIST 0 3,532 2,073
Excision Of Lesion Of Meniscus Or Capsule (Eg, Cyst, Ganglion), Knee 2513014 2,550 1,496
Osteochondral allograft, knee, open 3821665 6,667 3,366
Decompression Fasciotomy, Leg; Anterior And/Or Lateral, And Posterior Compartment(S) 3821665 2,373 1,315
Incision And Drainage, Leg Or Ankle; Deep Abscess Or Hematoma 2525022 2,541 1,819
Open Treatment Of Trimalleolar Ankle Fracture, Medial And/Or Lateral Malleolus 86580 4,707 2,911
Arthrodesis, Ankle, Open 3220753 2,117
Hallux Rigidus Correction W Cheilectomy, Debridement/Capsular Release, First Metatarsophalangeal Jnt 3220756 3,631 2,252
Arthroscopy, Knee, Surgical; For Infection, Lavage And Drainage 51785 2,490 1,591
Arthroscopy, Knee, Surgical; For Removal Of Loose Body Or Foreign Body 25606 2,599 1,875
Cystostomy, Cystotomy With Drainage 8096044 1,404 902
Cystourethroscopy, W Ureteral Catheterization, W Wo Irrigation, Instillation, Or Ureteropyelography 2518005 920 834
Slitting Of Prepuce, Dorsal Or Lateral (Separate Procedure); Except Newborn 3220118 674 673
Biopsy Of Penis (Separate Procedure) 3220124 603 613
55060 Repair Of Tunica Vaginalis Hydrocele (Bottle Type) 1017470 1,849 1,244
Excision Of Lesion Of Spermatic Cord (Separate Procedure) 7511550 1,219
Colpotomy; With Exploration 6042016 882 507
Excision Of Vaginal Septum 2513584 844 758
Paravaginal defectrepair (including repair of cystocele) 2514873 3,222 1,952
Closure Of Rectovaginal Fistula; Vaginal Or Transanal Approach 2523757 2,707 1,465
Trachelorrhaphy, Plastic Repair Of Uterine Cervix, Vaginal Approach 2515514 1,470 776
Vaginal Hysterectomy, Uterus 250 Grams Or Less; W/ Removal Of Tube(S), And/Or Ovary(S) 26011 4,726 2,899
Endometrial cryoablation with ultrasonic guidance, including endometrial curettage 26607 8,953 1,652
11403 Excision, benign lesion , except skin tag , trunk, arms or legs; 2.1 to 3.0 cm 57200 162 128
Removal Of Sutures Under Anesthesia (Other Than Local), Other Surgeon 90384 183 220
Repair Blood Vessel, Direct; Neck 36415 4,647 2,848
Exploration For Postoperative Hemorrhage, Thrombosis Or Infection; Neck 51701 3,508 2,019
Catheterization Of Umbilical Vein For Diagnosis Or Therapy, Newborn 99080 415 272
Splenectomy; Total (Separate Procedure) 0 2,685
Upper GI Endoscopy, Simple Primary Exam (Eg, With Small Diameter Flexible Endoscope) 0 779 779
Upper GI Endoscopy Including Esophagus, Stomach,Duodenum And/Or Jejunum; With Removal Of Tumor(S), 0 2,103 1,011
Gastrectomy, Partial, Distal; With Gastroduodenostomy 0 4,124
Excision Of Meckel'S Diverticulum (Diverticulectomy) Or Omphalomesenteric Duct 5099004 2,027
Anoscopy; With Dilation (Eg, Balloon, Guide Wire, Bougie) 5001045 141
Unlisted Laparoscopic Procedure, Liver 96372 2,140 3,628
Exploration, Retroperitoneal Area With Or Without Biopsy(S) (Separate Procedure) 1050265 4,554 2,703
Nephrectomy, Including Partial Ureterectomy, Any Open Approach Including Rib Resection; 1050430 5,088 3,143
Parathyroidectomy Or Exploration Of Parathyroid(S); 1050433 2,143
Vaginal Delivery Only, After Previous Cesarean Delivery (With Or Without Episiotomy And/Or Forceps); 1050441 2,708
Induced Abortion, By 1+ Vaginal Suppositories W W/O Cervical Dilation, Inc Hosp Admission & Visits 3320393 1,082
Uterine Evacuation And Curettage For Hydatidiform Mole 3220613 1,105
Prolonged Eval And Mgmt Service Before And/Or After Direct Patient Care; Each Additional 30 Minutes 2000315 255 256 168
Subsequent observation care, per day, for the evaluation and management of a patient,w/ 2 key 2514541 189 189 127
Smoking and tobacco-use cessation counseling visit 10 min 0 43 48
Phone E&M by Physician 5 to 10 minutes of medical discussion 0 51 47
Phone E&M by Physician 11 to 20 minutes of medical discussion 2514541 92 87
Phone E&M by Physician 21 to 31 minutes of medical discussion 1050442 122 119
Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance 2514566 1,178
Yes 2514566 50
No 1050431 98 39
Yes 1050323 41
UA w/Micro, Auto 1050434 41
No 1050448 41
No 1050439 41
CT Guide Drain 1050435 1,280
MRI Hand w/ + w/o Cont Lt 1050436 4,099
MRI Hand w/ + w/o Cont Rt 1050438 4,099
MRI Hand w/o Cont Lt 1050432 3,109
MRI Hand w/o Cont Rt 1050437 3,109
MRI Hip w/ + w/o Cont Lt 1050590 3,306
MRI Hip w/ + w/o Cont Rt 1050576 3,306
MRI Hip w/o Cont Lt 1016320 2,493
MRI Hip w/o Cont Rt 1050433 2,493
MRI Humerus w/ + w/o Cont Lt 1050450 4,099
MRI Humerus w/ + w/o Cont Rt 1050449 4,099
MRI Humerus w/o Cont Lt 1050281 3,109
MRI Humerus w/o Cont Rt 29581 3,109
MRI Knee w/ + w/o Cont Lt 29828 3,803
MRI Knee w/ + w/o Cont Rt 43236 3,803
MRI Shoulder w/ + w/o Cont Lt 43248 3,780
MRI Shoulder w/ + w/o Cont Rt 2517445 3,780
MRI Shoulder w/o Cont Lt 2021750 2,027
MRI Shoulder w/o Cont Rt 2513881 2,027
MRI Tibia/Fibula w/ + w/o Cont Lt 95971 3,306
MRI Tibia/Fibula w/ + w/o Cont Rt 97598 3,306
MRI Tibia/Fibula w/o Cont Lt 19302 2,493
MRI Tibia/Fibula w/o Cont Rt 21933 2,493
US Kidney Transplant Lt 24358 858
US Kidney Transplant Rt 0 858
XR AC Joints w/ or w/out Weights Bil 5382226 551
XR Bone Survey Comp 2525034 889
XR Bone Survey Ltd Mets 2525035 612
XR Cystography Min 3 Views 2525036 314
XR Urethrocystography Voiding 2525037 969
XR IVP 2525038 1,260
XR Pelvis 1 or 2 View 2525039 271
XR SB Series 2525020 1,191
XR Venography UE Lt 2525021 1,198
XR Venography UE Rt 92552 1,198
Repair, complex, trunk; 2.6-7.5 cm Technical Charge 27332 1,168 1,160
Arthrocentesis, aspiration and or injection; intermediate joint or bursa Technical Charge 43202 171
Arthrocentesis, aspiration and or injection; major joint or bursa Technical Charge 46257 211
Replace Porta-Cath Technical Charge 55150 4,819 1,423
Hernia Repair Inguinal Child Technical Charge 90460 1,915 983
Hernia Repair Ventral Incisional, recurrent Technical Charge 90461 3,738 2,081
Colposcopy of the entire vagina, with cervix if present; with biopsy(s) Technical Charge 2510010 578 598
Laparoscopy, surgical; with occlusion of oviducts by device Technical Charge 2514580 1,736 994
Upper GI endoscopy; w balloon dilation of esophagus less than 30 MM Technical Charge 2514580 4,850 1,244
Colorectal cancer screening; colonoscopy on indiv meeting criteria for high risk Technical Charge 2514580 911
Upper GI endoscopy w removal of tumor(s),polyp(s),/other lesion(s) by hot biopsy forceps Tech Chg 3221127 1,897 841
Closure of enterostomy, large or small intestine;w resection and colorectal anastomosis Tech Chg 3024622 7,826 4,696
Colorectal cancer screening; colonoscopy on indiv not meeting criteria for high risk Tech Chg 3024879 915
129 - ROOM-BOARD/SBI 3024812 0
311 - CYTOLOGY 3024895 0
359 - CT SCAN/OTHER 3024897 0
Bill Antibody Screen 3822772 192
Bill Immunohisto Ea Ab IHC 88342 3822772 343
Orthotic Mgmt and Training Charges 3022764 193
Esophagogastroduodenoscopy Charge 3823038 724 745
Hernia Repair Inguinal Charge 3823044 2,080 2,432
Mastectomy Charge 3400765 2,799
US LE Veins Duplex Lt 3400511 931
US LE Veins Duplex Rt 3400513 717
HyAlgan Injection 3400519 296 296
XR Esophagus 3400498 678
Orthovisc inj per dose 3321094 262
Cast Supplies, Long Arm Cast, Adult (11 Years +), Plaster 3321350 46 0
Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Plaster 3321169 20 0
Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Fiberglass 3320210 31 0
Cast Supplies, Short Arm Cast, Adult (11 Years +), Plaster 3321011 24 0
Cast Supplies, Short Arm Cast, Adult (11 Years +), Fiberglass 3115007 46 46
Cast Supplies, Short Arm Cast, Pediatric (0-10 Years), Plaster 3115002 19 0
Cast Supplies, Short Arm Cast, Pediatric (0-10 Years), Fiberglass 3115003 24 0
Cast Supplies, Short Leg Cast, Adult (11 Years +), Fiberglass 3115004 71 0
Cast Supplies, Short Leg Cast, Pediatric (0-10 Years), Fiberglass 3220750 46 0
Influenza A H1N1,admin w cou 3221283 36 36
ANASCOPE DISPOSABLE 3221101 5
Basic Metabolic Panel 3 3221069 106 42
REF Antibody ID 3023046 256
Carboxy Hgb 3023047 155
D Control 3024549 38
REPAIR OF NAIL BED Charge 1507504 635 648
Pregnancy Test Urine 101 80 32
MRI Brachial Plexus w/o Cont Lt 122 3,109
US Pregnant > 14 Weeks 1st Gest 123 663
US Pregnant Detailed 1st Gest 292 604
MASK OXYGEN PEDIATRIC 294 9
Oxygen Hours 311 25
ABO/Rh Interp 314 38
Crossmatch IS Interp 590 238
Crossmatch AHG Interp 524 192
Microalb/Creat Ratio 3021448 72
Rheumatoid Factor1 3020018 71
Anti-D 28810 38
Cord ABO/Rh Interp 2516165 38
Miscellaneous Charge 20974 1,169
CT Angio UE Bil 25660 4,514
CT Aspiration 25685 1,635
CT Cardiac Calcium Score 51727 85
MA Ductogram or Galactogram Mult Bil. 52282 177
MA Ductogram or Galactogram Single Lt. 52290 131
MA Ductogram or Galactogram Single Rt. 52320 131
US Breast Biopsy Rt. 52354 195
US Breast Biopsy Lt 54840 195
US Breast Biopsy Rt 64475 195
XR Chest 1 View Discount 64476 196
Computer XM Interp 64555 207
LARYNGOSCOPY (FLEXIBLE) Charge 64565 192
.GTT-4 Hr 76872 49
.GTT-5 Hr 76942 49
Complete Blood Count with Manual Diff 3100122 50
Computer XM OK 3100112 238
X-Match AHG Tube Interp 3100113 204
Compatible 3100102 238
Methotrexate Sodium 5 Mg 3100180 8
Excise Tumor Soft Tissue Back/ Flank >3 Cm 3100181 1,665 1,689
Exc Shoulder Tum Deep >5Cm 3100176 3,366 1,921
Exc Shoulder Area Les Sf <5Cm 3100179 2,611 1,791
Lap Inc Hernia Repair Recur 3100156 2,537
Vaginal Hysterectomy, for uterus 250g or less 3100146 3,947 2,381
Pinworm Prep 3100147 54
Reducing Substance 3100136 27
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 2.5 cm or Less Charge Tech Chg 3100137 686 700
MRI Hand w/ Cont Lt 3400714 3,371
MRI Hand w/ Cont Rt 3400713 3,371
MRI Hip w/ Cont Lt 3400763 3,386
MRI Hip w/ Cont Rt 3400762 3,386
MRI Humerus w/ Cont Lt 3400754 3,371
MRI Humerus w/ Cont Rt 3400747 3,371
MRI Shoulder w/ Cont Lt 3400746 3,109
MRI Shoulder w/ Cont Rt 3400808 3,109
MRI Tibia/Fibula w/ Cont Lt 3400803 3,386
MRI Tibia/Fibula w/ Cont Rt 3730101 3,386
US Extremity Nonvascular Ltd Lt 3222000 79
US Extremity Nonvascular Ltd Rt 3222059 79
XR Spine Thoracic Myelography 3730105 762
XR Ribs Min 4 Views Bil w/ PA Chest 3730104 687
XR Shuntogram Non-Vascular 3730106 1,122
Wound Debridement Less than 20 cm Tech Chg 3020208 191 123
Office/OP New Visit Level 5 99205 2517106 594 758 487
Plasma Thawed CPD 2512109 176
Legionella Pneumophila Antigen, Urine ARUP 2513972 107
HSV 2 Glycoprotein G Ab, IgG ARUP 2518123 93
HSV 1 Glycoprotein G Ab, IgG ARUP 2515722 93
Incompatible 55041 238
X-MATCH COMPUTER 1050579 238
Esophagogastroduodenoscopy with Biopsy 1050577 1,404
Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-I 1050575 138 138
Vision Acuity Screening 2514871 0 0
Non-Medicare Pap Collection 2513377 213 93
XR Facet Injection 2517569 429
US Echo Congenital Cardiac Anomaly Comp 2516140 1,318
US Echo Congenital Cardiac Anomaly Ltd 2516215 855
Blood Unit Culture 2516132 108
OxS 2517809 87
Acetone 2510002 103
Excision of Spermatocele 2515597 1,560 1,927
Echo 2D Ltd 2516181 153
Report 2516207 365 126
EKG RT Charge 2525004 269 1
Sputum Induction - RT Charge 2525004 214
Mini-Neb Initial 2525004 214
Mini-Neb Subsequent 2525004 148
PEP Therapy Initial 2525004 303
PEP Therapy Subsequent 2525004 333
Ventilator Services Initial 2514178 2,200
77002 XR Fluoro Guide Therapeutic Inj 2515746 766
XR Drain Abscess or Cyst 2523146 581
Remv Non-biodegradable Rx Del 2523153 765 488
Full Thick Gft Chin/ax/ft; 20 2516411 2,617 2,852
Tenotomy, elbow, Debride Bone/Tissue, open-ASSIST 2524367 3,183 2,519
Part Exc Bone; Dist Phalanx-fi 2523773 2,122 1,495
I&d Pelvis/hip Jt; Deep Absces 2513048 3,026 1,792
Revis Tot Knee Arthroplas; Fem 2515738 8,536 4,562
Manip Knee Jt Under Gen Anes 2517201 727 1,004
Unlisted Proc Femur/knee 2517202 1,369 0
Repr Prim Op Rupt Achilles; W/ 2516991 3,310 1,814
Repr Secnd Disrupt Lig Ank Col 2516215 3,098 1,869
Heel/finger Stick PKU 2513351 20 0
Esophagoscopy; Dx (separt Proc 2523856 535 641
Esophagoscopy; W/remov Fb 2514889 1,721 699
Omental Flap 2514418 1,726 1,100
Remov/revis Stress Incont Slin 2511513 3,271 1,876
Needle Emg; 1 Extrem W/wo Para 2514434 344 205
Needle Emg; 2 Extrem W/wo Para 2514426 510 396
Cast sup gauntlet plaster 2514020 37 0
Cast sup gauntlet fiberglass 2514400 45 0
Cast sup shrt leg plaster 2514400 53 0
Cast sup shrt leg ped plster 2514053 26 0
Influenza Virus Vaccine, IM, Fluzone 2517410 28 28
US Pregnant Detailed Ea Addl Gest 2513519 821
Oxacillin Screen 2517395 87
635 - DRUG/EPO>10,000 UNITS 2517223 0
155 - HOSPICE/WARD 2523153 0
Whirlpool Full Body Charge 30200 93
Sigmoidoscopy w/ Decompres of Volvulus 47480 288
PEG TUBE KIT 49560 714
Vancomycin Peak 1 2514079 170
AMNISURE ROM TEST 49507 325
Scrotal exploration CHARGE 1305014 1,884 1,064
INCISION AND DRAINAGE COMPLEX POST OP WOUND INFECTION CHARGE 1305006 1,177
MONITORING OF INTERSTITIAL FLUID PRESSURE IN DETECTION OF MUSCLE COMPARTMENT SYNDROME CHARGE 2514749 322
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION (THUMB) WITH MANIPULATION CHARGE 15821 1,396
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITH MANIPULATION CHARGE 15822 6,341
CLOSED TREATMENT OF ANKLE DISLOCATION REQUIRING ANESTHESIA CHARGE 19110 1,825
NASO OR ORO-GASTRIC TUBE PLACEMENT REQUIRING PHYSICIAN SKILL AND FLUOROSCOPIC GUIDANCE CHARGE 20690 81
INCISION OF THROMBOSED EXTERNAL HEMORRHOID CHARGE 20694 389
FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING CHARGE 21011 234 242
Biofeedback 21554 78
Colonoscopy Diag By Brush/Wash 22901 962
Foot examination 23550 0
140 - ROOM-BOARD/PVT/DLX 24495 0
252 - DRUGS/NONGENERIC 2517198 0
456 - URGENT CARE 2517197 0
21 - RURAL/CLINIC 2518568 0
521 - RURAL/CLINIC 2513534 0
681 - LEVEL 1 TRAUMA TEAM ACTIV 2517402 0
943 - CARDIAC REHAB 2517189 0
999 - PT CONVENCE/OTH 0
Yes- OT Unattended Electrical Therapy Charge 2514400 62
Work Reconditioning Initial Charge 24665 387
RT CO2 Monitor, Single Charge 3020018 87
Functional Capacity Eval Charge 2514749 65
Splint/Equipment Charge 2514749 153
RT Pulmonary Rehab Charge 1451021 248
Standardized Cognitive Eval Charge 2525495 472
NM Myocard Perf Spect Single 2501007 3,212
Yes 304
Yes 334
Speech Generating Device Eval 1st Hr Chg 2513451 278
Yes 2513453 280
Compatible 2517619 238
Incompatible 503147 238
Incompatible 2523237 238
Compatible 37609 238
Pulse Oximetry Single Determination 58180 19
Bill Decal Procedure 88311 64782 69
Bill FNA Rapid 88172 8096054 189
Bill ABO Typing 8096057 38
Arthrotomy, Knee, With Synovectomy; Anterior And Posterior Including Popliteal Area 8096049 3,683 1,131
Repair, Extensor Tendon, Leg; Primary, Without Graft, Each Tendon 8096048 1,749 1,175
Lysis Or Excision Of Penile Post-Circumcision Adhesions 8096018 784 785
Excise Tumor Subq Abd Wall >3cm 8096061 2,128 1,190
Excise Tumor Sub Q Upperarm/elbow >3 Cm 8096059 1,965 1,557
Installation Through Chest Tube Agent For Pleurode 8092814 1,165 434
CT 3D Reconstruction w/ Workstation 8092822 503
CT 3D Reconstruction w/o Workstation 8092830 503
CT Sinus or Facial w/o Cont 8092855 1,355
MRA Abdomen w/ Cont 7552069 3,281
MRA Abdomen w/o Cont 7552072 3,281
MRA Chest w/ Cont 7552048 3,225
MRA Chest w/o Cont 7552050 3,225
MRA LE w/ Cont Lt 7552068 3,274
MRA LE w/ Cont Rt 7552076 3,274
MRA LE w/o Cont Lt 7552074 3,274
MRA Pelvis w/ Cont 8096022 3,270
MRI Brachial Plexus w/o Cont Rt 2525534 3,109
XR Abdomen Comp +Chest 1 View 2515522 415
XR Femur 2 Views Lt 2515524 266
XR Femur 2 Views Rt 2517015 266
XR LE Infant Min 2 Views Lt 2517204 282
XR LE Infant Min 2 Views Rt 2513097 282
XR Ribs Min 3 Views Lt w/ AP Chest 2525066 335
XR Tibia +Fibula 2 Views Lt 2520024 261
XR Tibia +Fibula 2 Views Rt 2512371 261
XR UE Infant Min 2 Views Lt 2512388 282
XR UE Infant Min 2 Views Rt 2517993 282
Ferritin Level 2522791 110
POX, Multiple Determination Charge 2522595 57
Pre-Employment Post Offer Exam Charge 2518071 121
NM Urea Breath Test C-14 Acquisition 2516314 343
NM Urea Breath Test C-14 Analysis 2522494 212
US Breast Biopsy Bil. 2522502 293
US Pregnant > 14 Weeks 1st Gest WC 2519060 663
Blood Glucose POC 2519045 19 19
XR Hip Comp Min 2 Views Rt +Pelvis 2522767 256
Repair tendon/muscle upper arm or elbow, primary or secondary 2513121 2,672
Bill Rh(D) Type 2516249 38
DIRECT COOMBS (DAT) 2511224 68
Bill FNA Interp Report 88173 2517478 331
Insertion, Non-Biodegradable Drug Delivery Implant 2511169 673 401
Nasal/Sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (Separate Procedure) 2520005 1,231 803
Bill Frozen Section Addtl 88332 2522809 107
Injection Procedure For Sacroiliac Joint; Provision Of Anesthetic, Steroid And/Or Other Therapeutic 2513915 1,213
Urinalysis Dipstick 2521900 33
Programming device evaluation; single lead pacemaker 2517593 175 219 123
Programming device evaluation; dual lead pacemaker 2524052 282
Programming device evaluation; multiple lead pacemaker 2515720 241 168
Programming device eval; 1 lead implantable cardio-defib 2517676 221 153
Programming device eval; multiple lead cardio-defib 2517601 327 397 230
DEVELOPMENT TEST LIMIT 2517619 45 0
ALBUTEROL 1MG UD INH S 2514293 10
BUPIVACAINE 0.5% 2ML 2522692 33 33
XOPENEX 1.25MG/3ML INH 2521405 42
Pregnancy Test Serum 2517677 95
MA Breast Ndl Loc Placement Lt 2515080 1,056
MA Breast Ndl Loc Placement Rt 2515095 1,056
Bill Frozen Section First Spec 88331 2522254 266
TB Test POC 2522742 29 29
US Doppler Fetal Umbilical Art 2523823 145
US Doppler Fetal Mid Cerebral Art 2523781 370
EMG anal urethral 2523799 840 336
TREAT FRACTURE DISTAL RADIUS CHARGE 2518630 2,183
LARYNGOSCOPY (PRO FEE) 2515803 216
WBC w/ Auto Diff 2521157 82
US Breast BCCP Lt. 2514772 390
US Breast BCCP Rt. 2522234 390
SURGICEL 4X8 2501005 397
CLSD TX METACARPAL FX W/O MAN Charge 2522619 1,242
Checkout for Prosth/Orth Use Charges 2522479 193
Creatinine Clearance 2516447 69
Cord Blood Gases 2513728 244
HIV 1&2 Antibody 2521355 172 68
Rheumatoid Arthritis Titer 2517387 71
DRAIN FINGER ABSCESS, COMP 2513170 1,863 901
FRACTURE METACARPAL MANIP EXTERNAL FIXATION 2513170 2,187 922
REPAIR OF VAGINA 2517040 1,449 743
RHO D IMM GLOBULIN, 300 2513162 234 234
VENIPUNCTURE 2523740 21 21
CATHERIZATION NON INDWELLING 2517915 210 124
99080 ADDITIONAL SPECIAL REPORTS 2523013 592 237 0
CAST LONG ARM FIBERGLASS ADULT 2522379 53 0
SPLINT, PEDIATRIC FIBERGLASS 2522715 25 26
CAST, FIBERGLASS LONG LEG ADUL 2521207 94 0
CAST SUPP LONG LEG UP TOAGE 10 2518175 60 0
RT Spirometry with Graphic Record Charge 2522577 420
RT Peak Flow Procedure Charge 90003657 60
96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular 2039091 77
Cataract Extraction with Intraocular Lens Implantation 2522346 4,000
COLONOSCOPY 2515524 2,080
Esophagogastroduodenoscopy 2522435 1,404
Esophagogastroduodenoscopy and Colonoscopy 2517974 2,606
NM Pulm Vent 2525059 1,884
US UE Art Doppler Single Level Bil 2525013 839
26ML APPLICATOR 2% CHLORHEXIDINE 2525017 348
Aph RBC CP2D AS3 LR 1 2525018 524
APH RBC CP2D AS3 LR 2 2517812 524
METHOTREXATE 50MG 2525015 8
DRBC CPD AS1 500 LR 2525014 524
Esophagogastroduodenoscopy and Colonoscopy with Biopsy and Polypectomy 2525016 4,493
Plasma Thawed CP2D 2522353 176
Plasma Thawed CPDA1 2516397 176
Colonoscopy with Biopsy 2523708 2,080
Esophagogastroduodenoscopy with Balloon Dilatation 2523300 1,404
Esophagogastroduodenoscopy with Biopsy 2513730 1,404
Esophagogastroduodenoscopy with Hot Biopsy or Cautery 2512224 1,404
Esophagogastroduodenoscopy with Biopsy and Colonoscopy 2518069 2,606
Esophagogastroduodenoscopy and Colonoscopy with Biopsy 2513113 2,606
Esophagogastroduodenoscopy and Colonoscopy with Polypectomy 2517853 4,493
Esophagogastroduodenoscopy with Biopsy and Colonoscopy with Biopsy 2524367 2,606
Colonoscopy with Polypectomy 2518091 3,632
Colonoscopy with Biopsy and Polypectomy 2524391 3,632
Esophagogastroduodenoscopy with Biopsy and Dilation 124 1,404
Esophagogastroduodenoscopy with Polypectomy 2518060 1,404
Cataract Extraction with Toric Implantation 2525334 7,557
Esophagogastroduodenoscopy with Foreign Body Removal 2521058 1,404
Esophagogastroduodenoscopy with Polyp Ablation 2522460 4,493
Esophagogastroduodenoscopy with Snare Removal of Polyp 2514848 2,606
Implant Exchange 2522635 10,587
Multi-layer compression application 2523369 297 174
Arthroscopy, Shoulder, Surgical; Bicep 2518542 4,409 2,872
Esophagogastroduodenoscopy w/ Submucosal Injection 2511170 1,570 860
Esophagogastroduodenoscopy w/ Insertion guide wire 2519046 1,674 931
Venipuncture Charge Only 2516264 27
TRAY THORACENTESIS 2525457 294
Fibrinogen 2518189 107
ANALYZE NEUROSTIM, SIMPLE 2511158 175
REMOVE DEVITALIZE TISSUE MORE 20 SQ 2517628 117 88
Lumpectomy with Sentinel Node Biopsy 2511125 4,358 2,646
EXC SOFT TISSUE TUMOR 5CMS OR>BACK/ 2511128 3,581 2,159
TENOTOMY; DEBRID OPEN 2518058 2,518 2,109
Arthroscopy, Knee, Surgical, For Removal Of Loose Body, Foreign Body, Debridement/Shaving Of Articul 2512447 424 248
RT Methacholine Challenge Charge 2517011 690
Bill Surg Level I 88300 2517935 54
Bill Surg Level II 88302 2522593 148
Bill Surg Level III 88304 2518115 156
Bill Surg Level IV 88305 2518643 207
Bill Surg Level V 88307 2518643 398
Bill Surg Level VI 88309 2518643 543
Bill Surg Stains Micro Org 88312 2522866 352
Bill Surg Stains Non-Micro 88313 2518592 340
Hearing Screen POC 2517918 0 0 0
REMOVAL OF KNEE CARTILAGE (ARTHROSCOPY) 2511242 3,097 1,423
ESOPHAGOSCOPY WITH BIOPSY ONE OR MORE 2518557 1,467 665
HEMORRHOIDECTOMY W/FISSURECTOMY 2518524 2,041 969
RESECTION OF SCROTUM 2513279 2,389 1,369
90460 - IM ADMIN 1st Component with Counseling by Provider, Peds 2516363 61 14
90461 Immun Admin, Each Addtl Component, Peds 2518733 31 13
X-Match AHG Gel Interp 2523922 204
Compatible 2522874 238
Incompatible 2515670 238
Crossmatch 2520009 238
CT Renal Biopsy 2518138 2,477
IR Enteroclysis Tube Placement 2523567 1,315
IR Nephrostomy Dilation Rt 2522890 979
IR Renal Cyst Study Translumbar Lt 2513733 629
IR Ureteral Cath or Stent Perc Lt 2523195 8,758
IR Ureteral Cath or Stent Perc Rt 2523963 8,758
MA Ductogram or Galactogram Mult Lt. 2517856 177
MA Ductogram or Galactogram Mult Rt. 2524128 177
MA Ductogram or Galactogram Single Bil. 2520020 131
MA Stereotactic Loc Lt 2518256 686
MA Stereotactic Loc Rt 2511265 686
MRA UE w/ Cont Lt 2511240 3,334
MRI Breast w/o Cont Bil. 2513618 4,759
MRI Breast w/o Cont Lt. 2522668 4,819
MRI Breast w/o Cont Rt. 2511245 4,819
MRI Cardiac M+F w/ + w/o Cont 2517980 3,090
NM Adrenal 2522296 4,848
NM Cerebrospinal Fluid Cisternography 2522239 3,574
NM Intestine 2522288 3,493
NM Radiopharm Ther Interstitial Colloid 2524110 554
NM Thyroid Uptake Mult Determinations 2524011 819
PET Brain Metabolic Eval 2510156 2,397
PET Ltd Area w/ CT Scan 2501002 3,630
PET Skull Base to Midthigh 2522820 3,137
PET Skull Base to Midthigh w/ CT Scan 2522973 3,995
US Biopsy Fine Ndl Asp 2517986 491
US Breast Biopsy Bil 2525523 293
US Guide Pericardiocentesis 2525523 1,251
US Prostate Vol 2525523 642
XR Mastoids < 3 Views Lt 2525523 368
XR Mastoids < 3 Views Rt 2522056 368
XR Pharynx or Cerv Esophagus 2513535 883
Cardioversion External 24579 1,121
101 - ALL INCL R&B 90837 0
122 - OB/2BED 1000564 0
123 - PEDS/2BED 3114017 0
171 - NURSERY/LEVEL I 6043782 0
179 - NURSERY/OTHER 27355 0
251 - DRUGS/GENERIC 27784 0
291 - MED EQUIP/RENT 1451012 0
292 - MED EQUIP/NEW 42826 0
294 - MED EQUIP/SUPPLIES/DRUGS 0
311 - PATHOL/CYTOLOGY 28296 0
314 - PATHOL/BIOPSY 28309 0
470 - AUDIOLOGY 28705 0
522 - RURAL/HOME 29834 0
582 - VISIT/HOME HLTH/HOUR 2525538 0
590 - UNIT/HOME HEALTH 57283 0
722 - DELIVERY ROOM 57282 0
971 - PRO FEE/LAB 57268 0
524 - COVERED SNF VISIT 57240 0
684 - TRAUMA/LEVEL IV 57100 0
950 - OTHER THERAPEUTIC SERVICES 57061 0
948 - PULMONARY REHABILITATION 57023 0
264 - IV THER/SUPPLIES 56820 0
Bill Cytopath Cell Enhance 88112 44188 314
FETAL NON-STRESS TEST CHARGE 2516207 175 135
NM Thyroid Uptake Single Determination 46080 716
21931 EXC TUMOR SFT TIS BK/FLNK 3CM+ CHARGE 46750 1,665 1,689
30520 SEPTOPLASTY OR SUBMUC0US RESEC CHARGE 49084 1,908
54150 CIRCUM CLAMP OR DEVICE W BLOCK CHARGE 99468 262
62273 INJ EPIDURAL BLOOD OR CLOT PAT CHARGE 99480 1,090
99477 INIT DAY HOSP NEONATE CARE CHARGE 100220 1,178
59025 FETAL NONSTRESS TEST CHARGE 100221 223
59200 INSERT HYGROS CERVICAL DILATOR CHARGE 100222 109
Plt CPD 500 100223 1,198
ROOM/BED: Nursery Level 2 200350 1,875
ROOM/BED: Nursery Level 3 200355 2,563
OT Transfer Charges 100402 139
EKG w/ Interpretation and/or Report Charge 100215 39 39
PT Canalith Repositioning Charge 200060 149
880 - DIALYSIS/MISC 200410 0
Q0163 Benadryl 25mg Charge 100410 0
US Echo Exercise Stress 200396 1,472
Report 200461 1,163 399
US Echo TEE Comp w/ Spec +CF Doppler 200398 1,397
US Extremity Nonvascular Comp Lt 100253 613
US Extremity Nonvascular Comp Rt 100261 613
US Pelvis Transvaginal 100204 537
XR Fluoro Hip Joint Inj Asp Lt 100212 766
XR Fluoro Hip Joint Inj Asp Rt 100218 766
XR Fluoro Shoulder Joint Inj Asp Lt 100219 289
XR Fluoro Shoulder Joint Inj Asp Rt 100205 289
XR Urethrocystography Voiding 100207 969
NM Unlisted Procedure 100206 0
Amputation, metatarsal, with toe, single 100208 2,095 1,207
Aph RBC ACDA LR Irr 100213 669
Electrical bone stimulation; noninvasive 100214 306 245
Closed treatment,radiocarpal dislocation 200339 1,974 838
Open treatment, trans-scaphoperilunar fracture 200140 3,542 1,698
Complex cystometrogram; w/ urethral pressure profile studies 200141 1,069 520
Complex cystometrogram; with voiding pressure studies 200142 976 507
Simple uroflowmetry (UFR) 200143 73 40
Cystourethroscopy, fulguration trigone 200375 2,230 1,393
Cystourethroscopy, urethral stent insert 200255 1,640 1,075
Cystourethroscopy with ureteral meatotomy 200260 1,188 771
Cystourethroscopy, ureteral calculus removal 200062 1,203 789
Cystourethroscopy w/ manipulation w/o calculus removal 200453 2,370 1,336
Cystourethroscopy, w/ biopsy and/or fulguration of lesion 200404 2,032 1,346
Urinary system surgery, unlisted 200057 1,021 1,132
Removal of non-inflatable or inflatable penile prothesis 200107 2,568 1,494
Penis plastic surgery for injury 200115 3,581 0
Excision of spermatocele 200123 1,560 1,927
Inject/anesthesia, steroid facet nerve lumbar/sacral 1 level 200131 534 535
Inject, anesthesia, steroid facet nerve, lumbar/sacral, each additional 200103 221 222
Percutaneous implantation neurostimulator; peripheral 200105 1,008 13,169
Percutaneous implantation neurostimulator, neuromus 200110 925 647
Posterior tibial neurostimulation, percutaneous needle eledtrode, prog 200112 469 146
Ultrasound, transrectal 7510099 394 191
Ultrasonic guidance for needle placement 7510107 403 199
CT Fingers w/ + w/o Cont Lt 7510115 3,040
CT Fingers w/ Cont Lt 7510131 2,310
CT Fingers w/ Cont Rt 7510149 2,310
CT Fingers w/o Cont Lt 7510156 1,820
CT Heel w/ + w/o Cont Lt 7510164 2,995
CT Heel w/ + w/o Cont Rt 7510172 2,995
CT Heel w/ Cont Rt 7513614 2,360
CT Heel w/o Cont Lt 7514026 1,825
CT Heel w/o Cont Rt 7510214 1,825
CT Mandible Ltd Dental Plan 7510230 2,005
CT Toes w/ + w/o Cont Lt 7510248 2,995
CT Toes w/ Cont Lt 7510255 2,360
CT Toes w/ Cont Rt 7510271 2,360
CT Toes w/o Cont Lt 7510289 1,825
CT Toes w/o Cont Rt 7510594 1,825
MRI Brachial Plexus w/ + w/o Cont 7510305 4,099
MRI Brachial Plexus w/ Cont Rt 7510339 3,371
MRI Fingers w/ + w/o Cont Lt 7510347 4,099
MRI Fingers w/ + w/o Cont Rt 7510420 4,099
MRI Fingers w/ Cont Rt 7510438 3,371
MRI Fingers w/o Cont Lt 7510446 3,109
MRI Fingers w/o Cont Rt 7510453 3,109
MRI Toes w/ + w/o Cont Rt 7510487 3,306
MRI Toes w/ Cont Lt 7510495 3,386
MRI Toes w/ Cont Rt 7510511 3,386
US Pregnant < 14 Weeks 1st Gest WC 7510545 529
US Pregnant Fol-Up 1st Gest 7510552 516
US Pregnant Fol-Up Ea Addl Gest 7510560 516
US Pregnant Fol-Up WC 7510578 516
US Pregnant Ltd WC 7510651 372
US Pregnant Transvaginal WC 7510669 425
XR Chest 1 View Portable 7510750 196
Creat/Prot Ratio 7510768 46
Glucose, Body Fluid 7510891 49
Bleeding Time 7510909 57
Cell Count, Body Fluid 7510925 69
Fern Test 7510933 90
55041 EXCISION HYDROCELE BILATERAL CHARGE 7511105 1,437
Colonoscopy with Anoscopy and Hemorrhoid Banding 7511113 3,632
Colonoscopy with Polypectomy by Cold Snare 7513549 3,632
Colonoscopy with Polypectomy by Hot Snare 7511121 3,632
Arterial Blood Gas 3 7511238 244
Ionized Calcium Level 7511246 64
Hemogram 3 7511253 50 33
Lipid Panel 3 7511378 168 67
Electrolytes 3 7511386 88
Hepatic Panel 3 7511394 103 41
zzC Diff Ag/Toxin 7511618 151
Rotavirus 7511634 151
Semen Analysis Post Vas 7511667 151
Methemoglobin 7511118 92
Fetal Bleed Screen 7511766 98
.GTT-3 Hr 7511857 49
.GTT-3 Hr 7511865 49
.GTT-4 Hr 7511899 49
.GTT-3 Hr 7511949 49
.GTT-4 Hr 7511964 49
.GTT-5 Hr 7511972 49
Drugs of Abuse Panel 7511980 338
KOH Prep 1 7512012 54
Cell Count CSF 7512236 69
Manual Diff 7512244 43
Protein Body Fluid 7512293 46
Reticulocyte Count 1 7512301 50
Specific Gravity, Body Fluid 7512319 32
Calcium Level Urine 7512376 65
Wet Prep 3 7512384 54
Occult Blood Gastric Fluid 7512475 41
pH 7512483 45
Crystal Exam Body Fluid 7512491 90
Electrolytes-Rapid 7512509 88
Rapid Glucose 7512525 49 20
India Ink Prep 7512541 151
Capillary Blood Gas 1 7512608 244
Rh3 7512632 38
Troponin T 7512673 167
ABSC Tube3 7512707 192
Du 3 7512749 48
Gentamycin Level Random 1 7512798 206
Cord Blood Interp 7512806 38
ABO/Rh3 Interp 7551721 38
Theophylline 1 7512954 177
Urine Sodium 24 Hour 7512947 61
Urine Protein 24 Hour 7512964 46
Urine Amylase 24 Hour 7512962 82
White Blood Cell 7512970 32
Neut Man 7512015 43
ROOM/BED: Obstetrics Level 2 7512992 3,362
47480 Cholecysto-tmy/stmy w/calc rmvl 7513077 2,229
49560 Repr init incis/ventral hernia, reduc 7502010 3,591 2,006
Vancomycin Level 1 7513085 170
Repair inguinal hernia, incarcerated or strangled 7513119 2,845 1,826
CMH PACU Nursing Record 7513143 0
CMH PACU Area 7513150 0
DAT 3 7513218 68
Blepharoplasty, lower eyelid; with extensive herniated fat pad 7513226 2,896 2,604
Blepharoplasty, upper eyelid; with excessive skin weighting down lid 7513234 2,126 2,207
Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactifero 7513358 1,654
Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system 7513366 2,880 1,804
Removal, under anesthesia, of external fixation system 7527040 2,039 1,633
Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm 8000601 1,118 1,164
Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); >5.0cm 8000619 3,544 1,960
Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); 5 cm or greater 8000809 3,236 1,701
Open treatment of acromioclavicular dislocation, acute or chronic 8001203 2,703 2,071
Decompression fasciotomy, forearm, with brachial artery exploration 8001211 2,574 1,415
Hemosure Fecal 8001401 113
Guaiac Occult Blood 8001609 41
Urine Creatinine 12 Hour 8010006 65 26
Urine Creatinine 24 Hour 8013612 65 26
Urine Potassium 24 Hour 8014008 54
Occult Blood Screening1 8017308 40
19103 BIOPSY BREAST CHARGE 8017407 1,439 1,440
ABO 3 8017506 38
Treat Radius Fracture 8017605 3,149 2,019
CT Unlisted Procedure 8020013 0
IgG DAT 8020021 68
Cd3 DAT 8020047 68
64416 INJECT ANESTH AGNT BRACHIAL PX CHARGE 8020054 304
Bill Auto Absorption. 8020112 60
Rapid Strep w/ Reflex 8020138 151
T3 Uptake 8020310 82
Free Thyroxine Index 8020328 113
Iron Level 8020344 82
UIBC 8020351 103 110
Hepatitis B Surface Antigen 8020419 130 51
59070 AMNIOINFUSION CHARGE 8020427 999
CK, CKMB with Index 8020450 82
Rapid Point Ca+ 8020518 64
88720 BILIRUBIN TOTAL TRANSCUT CHARGE 8020526 67
Vitamin D, 25-Hydroxy 8020542 150
Ligation or biopsy,temporal artery 8031218 1,120 1,007
Partial hysterectomy 8031226 4,615 2,793
Excision of neuroma; hand or foot, except digital nerve 8060001 1,154
16025 BURN MEDIUM 1-2 DEGREE ED PRO FEE CHARGE 8060209 399
41250 LAC MOUTH <2.5 ED PRO FEE CHARGE 8006053 449
20552 INJECT SINGLE MULTI TRIGGER PT ED PRO FEE CHARGE 8006103 151
42000 DRAINAGE ABSCESS PLATE, UVULA ED PRO FEE CHARGE 8013109 293
13151 REP CMPLX LID/NOSE/LIP 1.1-2.5 ED PRO FEE CHARGE 8013158 1,363
54220 IRRIG COPORA CAVERNSA PRIAPISM ED PRO FEE CHARGE 8036506 555
24505 TRTMT HUMERAL SHAFT FX W/MANIP ED PRO FEE CHARGE 8046000 1,237
99281 LEVEL 1 ER PHYSICIAN ED PRO FEE CHARGE 8024627 103
99282 LEVEL 2 ER PHYSICIAN ED PRO FEE CHARGE 8055654 201
99283 LEVEL 3 ER PHYSICIAN ED PRO FEE CHARGE 8056009 315
99284 LEVEL 4 ER PHYSICIAN ED PRO FEE CHARGE 8056058 587
99285 LEVEL 5 ER PHYSICIAN ED PRO FEE CHARGE 8067253 872
16025 BURN MEDIUM 1-2 DEGREE ED CHARGE 8067428 725
41250 LAC MOUTH 2.5 OR LESS ED CHARGE 8067709 1,014
42000 DRAINAGE ABSCESS PALATE, UVULA ED CHARGE 8077010 677
20552 INJ SINGLE/MULT TRIGGER PTS ED CHARGE 8077526 249
13151 REP COMP LID/NOSE/LIP 1.1-2.5 ED CHARGE 8077880 892
23675 CLSD TRMT SHLDR DISLOC W/MANIP ED CHARGE 8078102 3,288
54220 IRRIG COPORA CAVERNSA PRIAPISM ED CHARGE 8078151 888
24505 TRTMT HUMERAL SHAFT FX W/MANIP ED CHARGE 8078169 2,951
67715 CANTHOTOMY SEPARATE PROC ED CHARGE 8078409 704
Hepatitis C Antibody 8086303 95
ANA ELISA Scrn Rflx IFA LLS 8028669 152
ANA IFA LLS 8091055 141
Comprehensive Food Profile LLS 8091253 0
Food Allergy Panel LLS 8095056 0
Alpha-1-Fetoprotein LLS 8095155 111
B Pertussis DNA by PCR LLS 8003001 158
BK Virus Quant by PCR LLS 8009057 512
Beta 2 Glycoprotein1 IgA Abs LLS 8015005 302
Beta 2 Glycoprotein1 IgG IgM Abs LLS 8015112 0
Body Fluid Albumin LLS 8016052 65
Body Fluid Amylase LLS 8020203 57
Body Fluid Glucose LLS 8064250 49
Body Fluid LDH LLS 8064896 76
Body Fluid Total Protein LLS 8008000 46
C Peptide LLS 8018009 261
C3 Complement LLS 8027000 151
C4 Complement LLS 8011053 151
CA27.29 Ag LLS 8036704 189
CA 125 LLS 8070250 246
CA 19-9 LLS 8083011 246
CEA LLS 8044500 238
Cardiolipin Ab- Quant LLS 8052206 78
Chlamydia Trachomatis swab by BD QX LLS 8090206 143 143
C. Difficile Toxin by PCR LLS 8092004 271
Cortisol LLS 8092103 124
Cyclic Citrullinated Peptide Abs LLS 8 163
DHEA Sulfate LLS 0 118
DNA Antibody Quant LLS 0 172
Erythropoietin Level LLS 0 236
Estradiol 17-Beta LLS 0 149
FSH LLS 19103 61
Folic Acid LLS 20930 185
Free and Total PSA LLS 21932 0
Free T3 22554 213
GC and Chlamydia swab by BD QX LLS 22585 0
Gliadin Peptide IgA IgG Abs LLS 22612 0
hCG Quant Tumor Antigen LLS 22614 101
Human Immunodeficiency Virus-1 RNA Quantitation LLS 22842 279
Haptoglobin LLS 22845 159
Helicobacter pylori IgG Ab LLS 22855 181
Hepatitis A IgM Ab LLS 23552 142
Hepatitis A Total Ab LLS 6042125 155
Hepatitis Acute Panel LLS 2525497 600
Hepatitis B Core Ab LLS 2521553 126
Hepatitis B Surface Ab LLS 23929 135
Hepatitis B Surface Ag LLS 24366 130 51
Hepatitis C Ab LLS 3324785 95
Hepatitis C Genotyping LLS 3324718 1,046
Hep C RNA Quant by PCR w/Reflex to Geno if Ind. LLS 3324726 426
Hepatitis Chronic Panel LLS 3324734 0
Herpes Simplex 1 Type Specific IgG Antibody LLS 3324721 166
Herpes Simplex 2 Type Specific IgG Antibody LLS 3324759 195
Homocysteine Quant LLS 3325004 174
Immunoglobulin A LLS 3324767 81
Immunoglobulin G LLS 3324780 81
Immunoglobulin IgE Total LLS 3324791 207
Immunoglobulin M LLS 3324809 81
Insulin Fasting Level LLS 3324817 88
Insulin Random Level LLS 3324783 88
Lead LLS 3324866 152
Luteinizing Hormone LLS 3324935 111
Lyme Screen IgG/IgM Abs LLS 3324916 214
Maternal Screen Quad Marker LLS 3324908 251
Measles-Rubeola Ab IgG LLS 3324882 162
Mumps Ab IgG LLS 3324930 149
Osmolality LLS 3324965 83
Parathyroid Intact Hormone LLS 3400106 200
Prealbumin LLS 25520 184
Progesterone LLS 27269 263
Protein Electrophoresis LLS 27333 135
Protein Electrophoresis w/Rflx LLS 27334 135
QuantiFeron Gold TB LLS 27350 296
T3 Total LLS 27430 179
Testosterone Free and Total LLS 2521959 210
Thyroid Antibody Group LLS 2525207 83
Thyroid Peroxidase Ab LLS 2524034 181
Tissue Transglutaminase IgA Ab LLS 2523039 86
Tissue Transglutaminase IgG Ab LLS 2525521 86
Transferrin Level LLS 2502014 161
Urine BK Virus Quant by PCR LLS 2518066 539
Varicella Zoster IgG Ab LLS 2517585 134
TUBE GASTROSTOMY 18FR 2525098 280
TRAY THORACENTESIS/PARACENTESIS 92567 336
Zinc LLS 2525222 143
.Antinuclear Antibody Titer LLS 8 141
.Hemoglobin Electrophoresis LLS 43220 61
.Hepatitis B Core IgM Ab LLS 27477 67
.IEP Group LLS 27556 281
.U CalciumTimed LLS 27756 19
.U Creatinine Timed LLS 59200 27
.U Magnesium Timed LLS 6042107 44
.U PELP Random LLS 6042132 158
.U Sodium Timed LLS 6123329 19
.U Urea Nitrogen Timed LLS 6123152 19
.U Uric Acid Timed LLS 6290185 19
Antithrombin Activity LLS 0 149
Factor V Leiden Detection LLS 2000314 433
Factor VIII C Activity LLS 9 185
Prothrombin Gene Mutation LLS 2042103 437
Prothrombin Time and INR LLS 1015078 49
Von Willebrand Factor LLS 1010151 289
Von Willebrand Factor Antigen LLS 7 289
HLA B27 Antigen Typing LLS 2000201 729
Kleihaur-Betke Stain LLS 2000034 98
Reticulocyte Count LLS 2005274 50
.Body Fluid Cell Count LLS 2006256 69
.Flow CD4 Panel LLS 2001278 228
124 - PSYCH ROOM CHARGE 2000321 0
.Flow Immune Panel 1 LLS 20000315 305
APC Resistance Profile LLS 2003502 77
Aldolase LLS 1015607 122
Aldosterone LLS 2000021 512
Alkaline Phosphatase Isos LLS 2000032 91
Alpha-1-Antitrypsin LLS 2000202 169
Beta-2-Microglobulin Serum LLS 2000203 204
Bile Acids Total LLS 2003503 215
CMV Cytomegalovirus Quant PCR LLS 2003505 539
CA 15-3 LLS 2003504 246
Ceruloplasmin LLS 2093528 135
Cytoplasmic Neutrophilic Ab LLS 1015805 55
DHEA Serum by TMS LLS 4000159 88
Epstein-Barr Virus Ab Panel LLS 4001751 0
Epstein-Barr Virus Quant PCR LLS 4001850 317
Estriol LLS 4001900 88
Estrogens Fractionated by TMS LLS 4001967 376
Estrone Level by TMS LLS 4002007 248
Fecal Calprotectin LLS 4002114 247
Hemochromatosis Mutation PCR LLS 4002205 554
IgG Subclasses 1-2-3-4 LLS 4002213 0
Insulin-Like Growth Factor LLS 4002221 183
Kappa/Lambda Free Quant LLS 4002239 140
Lipoprotein A LLS 4002247 163
Metanephrines Plasma Free Fractionated LLS 4002304 151
Misc Referral Frozen Test Request LLS 4002320 0
Misc Referral Room Temp Request LLS 4002353 0
Misc Referral Test Request LLS 4002437 0
Mitochondrial M2 Ab LLS 4002650 145
NMR LipoProfile LLS 4002668 294
Norovirus Group 1&2 by PCR LLS 4002700 233
Oxcarbazepine Metabolite LLS 4002809 124
Parathyroid Related Peptide Hormone LLS 4002866 137
Pregnenolone LLS 4003054 260
Prostatic Acid Phosphatase LLS 4003104 122
Protein S Functional/Activity LLS 4003302 146
RBC Magnesium LLS 4003351 84
Renin Activity LLS 4003401 244
Smooth Muscle Ab LLS 4003450 86
Streptolysin O Antibody LLS 4003468 91
Thyroglobulin w/Anti-Thyroglobulin LLS 4003500 35
Urine Catecholamines Free LLS 4003559 317
Urine Citric Acid LLS 4003609 126
24 Hr Urine Cortisol Free LLS 4003708 92
Urine Oxalate Total LLS 4005018 126
Vitamin A LLS 4005026 146
Vitamin B1 Plasma LLS 4005034 267
Vitamin B1 Whole Blood LLS 4005042 267
Vitamin D 1-25-Dihydroxy LLS 4005059 447
.Meconium Cannabinoid Confirmation LLS 4005067 226
.Meconium Opiates Confirmation LLS 4005075 228
Cyclosporine A Level LLS 4005109 227
FK506 Level LLS 4031766 172
Imipramine with Metabolite LLS 4055060 196
Lamotrigine Level LLS 4074903 227
Levetiracetam Level LLS 4077863 167
Meconium Drug Panel LLS 4077924 0
Methylmalonic Acid LLS 4077942 170
Topiramate Level LLS 4078209 150
Vitamin D 25 Hydroxy Level LLS 2026809 296
U Amphetamine/Methamph Confirmation LLS 2001437 101
.U Opiate ID Confirmation LLS 7 105
U THC20 Confirmation LLS 7 105
Culture AFB LLS 9 0
Culture Bacterial Organism ID LLS 2000040 0
Culture Fungus LLS 2032302 106
Culture Fungus ID Only LLS 2043234 0
Culture Herpes Simplex LLS 2000022 214
Giardia/Cryptosporidium Detection LLS 2020133 0
Helicobacter Pylori Stool Ag LLS 2000135 151
Influenza Rapid EIA w/Rflx LLS 2002156 151
Organism Referral for Susceptibilities LLS 2014318 109 43
Parasite Comprehensive Exam LLS 2000011 0
Protein C Activity LLS 1016530 174
Urovysion Fish Request LLS 2040297 0
961 - PRO FEE PSYCHIATRIC 2000002 0
Meconium Amphetamine Scn LLS 2000129 34
Meconium Cannabinoids Scn LLS 2000128 34
Meconium Cocaine/Metabol Scn LLS 2000127 34
Meconium Methadone Scn LLS 2000126 34
Meconium Methamphet Scn LLS 2000010 32
Meconium Opiate Scn LLS 2011884 34
PTT 1Hr 1:1 Mix LLS 2000035 37
PTT 1Hr Undiluted LLS 2045406 37
PTT Immed 1:1 Mix LLS 1010065 37
PTT Immed Undil LLS 1015987 37
U Alb/Creat Ratio LLS 1017470 0
U Albumin LLS 2016057 72
U Creatinine LLS 2021347 65 26
Open treatment of periarticular fracture and/or dislocation of the elbow 2039091 4,038 2,491
Psychotherapy, 60 minutes with patient and/or family member 2096109 451
Tourniquet O-Rings #61-7308-000-00 2000121 58
CT Angio Abdomen +Pelvis w/ + w/out contrast 2000122 3,925
Yes- PT Work Hardening Charge 2000124 371
Partial excision; bone, femur, proximal tibia and/or fibula 2000125 2,911 2,479
Excision, tumor, soft tissue of thigh or knee area, subfascial; 5 cm or greater 2021750 3,436 1,647
Revision of total knee arthroplasty, with or without allograft; 1 component 2000041 6,826 3,554
Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengthening 2005258 1,119
Repair, primary, disrupted ligament, ankle; collateral 1017157 2,306 2,115
Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed 1017165 3,456 1,627
Ostectomy, complete excision; fifth metatarsal head 1017314 2,379 1,578
Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) 1017322 1,913
00630 ANESTH LUMBAR REGION NOS Charge 2000175 21
00846 ANESTH RAD HYSTERECTOMY Charge 2000170 21
01951 ANESTH 2ND-3RD%BURN EXC Charge 2075111 21
Programming device eval; dual lead implantable cardio-defib 2075112 414 670 414
Tonsillectomy, primary or secondary; age 12 or over [MONR] 1001098 1,098
Correction, hallux valgus (bunion), with or without sesamoidectomy 1015045 1,573
Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy 2093867 1,933 2,495
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal 4003153 2,382
Arthrodesis; pantalar 2000004 2,938
Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint 2039091 2,353 1,633
Arthroscopy, ankle, surgical; with removal of loose body or foreign body 1001111 1,009
Triage only 1010683 130
Procalcitonin 1010684 84
57283 Colpopexy, uterosacral fixation 1010713 3,296 1,962
57282 Colpopexy,Extraperitoneal 1010689 2,396 1,341
57268 Repair enterocele vaginal approach 1010682 2,316 1,273
57240 Anterior collporrhaphy,repair cystocele 1010681 3,216 1,935
57100 Biopsy of vagina 1010688 340 324
57061 Destroy vaginal lesions,simple 1010828 373 471
57023 I&D vag hematoma non-ob 1001104 1,480 872
56820 Colposcopy of vulva 1001105 421 419
Laparoscopy, surgical, colostomy or skin level cecostomy 1001109 3,256
Fetal Bleed 1001112 98
Sphincterotomy, anal, division of sphincter (separate procedure) 1001110 1,195 1,044
Sphincteroplasty, anal, for incontinence or prolapse; adult 1010137 3,663 2,045
Peritoneal lavage, including imaging guidance, when performed 1010690 336
99468 INITIAL NEONATAL CRIT CARE Charge 1003000 3,106
99480 SUBSEQ INTENSIVE CARE/DAY Charge 1003001 403
ICU Blood Transfusion <2 Hours 1003002 689
ICU Blood Transfusion 2-4 Hours 1010118 932
ICU Blood Transfusion 4-6 Hours 1010853 1,175
ICU Blood Transfusion >6 Hours 2093884 1,419
IV Infusion Hydration 31 Min to 1 Hour 1015128 422
IV Infusion Hydration Additional Hour 1000144 121
ICU Infusion 1st Hour 2000267 433
ICU Infusion Each Additional Hour 2000108 129
IV Concurrent Infusion 2000219 130
Injection Muscular 2000218 0
ICU Injection Subsequent 2008502 118
IV Push Ther/DX/Intrv Single/Init Drug 2093743 332
Inj IV Push EA Add Sequential Drug 2008501 172
Inj IV Push EA Add Seq Same RX >30 Min 1010609 162
ICU Observation Care 1-8 Hours 1000083 105
ICU Observation Care 9+ Hours 1017546 105
ICU Tele Observation Care 1-8 Hours 1015193 105
ICU Tele Observation Care 9+ Hours 9 105
ICU Direct Admit Observ 1-8 Hours 2093619 105
ICU Direct Admit Observ 9+ Hours 1000161 105
ICU Tele Direct Admit Observ 1-8 Hours 2004004 105
ICU Tele Direct Admit Observ 9+ Hours 2004005 105
ICU MS Overflow Observation 1-8 Hours 2004006 105
ICU MS Overflow Observation 9+ Hours 2004007 105
ICU MS Overflow Direct Admit Obsv 1-8 HRS 1015458 105
ICU MS Overflow Direct Admit Obsv 9+ HRS 1015459 105
Blood transfusion X1 1015460 336
MS Blood Transfusion <2 Hours 1000292 689
MS Blood Transfusion 2-4 Hours 1000293 932
MS Blood Transfusion 4-6 Hours 1000280 1,175
MS Blood Transfusion >6 Hours 9 1,419
Vaccine Administration Single 90007609 65
MS Infusion Therapy 1st Hour 2087751 433
MS Infusion Each Additional Hour 2087741 129
IV Additional Sequential Infusion 2087740 281
MS Injection Subsequent 1000107 118
OP SURGERY CARE INTERMEDIATE 1000552 851
MS Observation Hourly 1015482 105
MS Observation Care 1-8 Hours 1000718 105
MS Observation Care 9+ Hours 90000687 105
MS Tele Observation 1-8 Hours 2011000 105
MS Tele Observation 9+ Hours 2011001 105
MS Direct Admit Observation 1-8 Hours 2000027 105
MS Direct Admit Observation 9+ Hours 2000026 105
MS Tele Direct Admit Observ 1-8 Hours 1001713 105
MS Tele Direct Admit Observ 9+ Hours 1010178 105
I&D Abscess Sgl Simp ED Charge 1010177 499
I&D Abscess Mult Or Comp ED Charge 1010171 626
I&D Pilon Cyst Simp ED Charge 1010172 404
Incis Remov Fb Subq Simp ED Charge 1010173 799
Incis Remov Fb Subq Comp ED Charge 1010174 812
I&D Hema Seroma Fluid ED Charge 1010175 3,331
Punct Aspir Abscess Hema Bulla ED Charge 1010176 348
Debridement Ecz Or Infect Sk Up To 10% ED Charge 2011506 511
Debrid Skin Sbq Tiss Musc Bo <= 20 Sq Cm ED Charge 2011507 1,045
Paring Cutting Ben Les 1 ED Charge 2011508 88
Avulsion Nail Plate Sgl Simp ED Charge 2011505 211
Evacuate Subungual Hematoma ED Charge 2001006 153
Exc Nail Matrix Permanent ED Charge 2041105 573
Rpr Nail Bed ED Charge 2000062 729
Rep Simp Sclp Trnk Xtrm <2.5 Cm ED Charge 2000067 342
Rep Simp Sclp Trnk Xtrm 2.6 7.5 Cm ED Charge 2095135 460
Rep Simp Sclp Trnk Xtrm 7.6 12.5 Cm ED Charge 2003499 588
Rep Simp Sclp Trnk Xtrm 12.6 20.0 Cm ED Charge 2000033 692
Rep Simp Face < 2.5 Cm ED Charge 1010294 504
Rep Simp Face 2.6 To 5.0 Cm ED Charge 1010359 506
Lyr Cls Sclp Trnk Axl Extr < 2.5 Cm ED Charge 1010360 565
Lyr Cls Sclp Trnk Axl Extr 2.6 7.5 Cm ED Charge 1010361 716
Lyr Cls Sclp Trnk Axl Extr 7.6 12.5 Cm ED Charge 4020981 1,929
Lyr Cls Sclp Trnk Axl Extr 12.6 20.0 Cm ED Charge 1001701 1,493
Lyr Cls Nck Hnd Ft Genit < 2.5 Cm ED Charge 1000733 559
Lyr Cls Nck Hnd Ft Genit 2.6 7.5 Cm ED Charge 1010014 687
Lyr Cls Nck Hnd Ft Genit 12.6 20.0 Cm ED Charge 1010015 949
Lyr Cls Face < 2.5 Cm ED Charge 1017413 673
Lyr Cls Face 2.6 5.0 Cm ED Charge 1000693 752
Lyr Cls Face 5.1 7.5 Cm ED Charge 1000698 984
Lyr Cls Face 7.6 12.5 Cm ED Charge 1017421 1,143
Rep Comp Scalp 2.6-7.5 Cm ED Charge 1016886 853
Rep Comp Scalp Ea Add 5 Cm ED Charge 1000971 315
Init Trt First Degree Burn ED Charge 1001658 100
Drss Dbrid Burn Prtl Thkns Sm ED Charge 1015748 288
Arthrocent Aspir Inj Int Jnt ED Charge 1010858 170
Arthrocent Aspir Inj Maj Jnt ED Charge 1010859 193
Cls Trt Nasal Bone Frac ED Charge 1010860 44
Cls Trt Nas Fx Wo Stab ED Charge 1010054 862
Cls Trt Gr Hum Fx W/Man ED Charge 1010861 1,407
Cls Trt Shoulder Disloc ED Charge 1015789 1,088
Cls Trt Shldr Disl W Man, Anes ED Charge 1000556 2,180
Cls Trt Shlr Disl W Fx W Man ED Charge 2000086 1,550
Cls Trt Elbow Disloc Wo Anes ED Charge 2010913 1,198
Cls Trt Elbow Fracture ED Charge 2010912 1,965
Cls Trt Radial Head Subl ED Charge 2010408 338
Cls Trt Rad & Ulna Shf W Man ED Charge 2010914 1,774
Cls Trt Ds Rd Fx Inc Uln St Wo Man ED Charge 2010916 1,412
Cls Trt Ds Rd Fx Inc Uln St W Man ED Charge 2010917 2,235
Cls Trt Phal Fx W Man ED Charge 2010919 1,206
Cls Trt Artic Fx W Man ED Charge 2010928 1,277
Cls Trt Inter Jnt Wo Ane ED Charge 2010930 954
Cls Trt Fmrl Fx Prxml, Neck W Manip ED Charge 2010931 2,343
Cls Trt Hip Artho Disloc ED Charge 2010932 1,684
Cls Trt Knee Disloc ED Charge 2010933 1,728
Cls Trt Patellar Disloc ED Charge 2010934 1,281
Cls Trt Of Tibia Frac ED Charge 2010935 1,856
Cls Trt Distl Fib Fx W Man ED Charge 2000012 1,583
Cls Trt Bimall Ank W Man ED Charge 1000051 1,594
Cls Trt Trimalle Wo Man ED Charge 1010004 1,202
Cls Trt Trimalle W Man ED Charge 1000325 1,568
Cls Trt Ankle Dislocation ED Charge 1000516 1,797
Cls Trt Jnt Disloc Metatars Wo Anes ED Charge 1001203 326
Cls Trt Intrphlgl Disloc ED Charge 1010153 706
Apply Long Arm Splint ED Charge 1017355 302
Apply Short Arm Splint Static ED Charge 1010116 371
Apply Finger Splint Static ED Charge 1010143 118
Apply Long Leg Splint ED Charge 1010141 317
Apply Short Leg Splint ED Charge 1000960 340
Remove Fb Intranasal ED Charge 1010142 589
Control Nasal Hemorr Ant Simp ED Charge 1000961 426
Control Nasal Hemorr Ant Comp ED Charge 2093749 484
Control Nasal Hemorr Post Init ED Charge 1016852 930
Intubation Endotracheal ED Charge 1015896 703
Remove Fb Larynx ED Charge 1000596 370
Tracheostomy Cricothyroid Memb ED Charge 1010692 590
Tube Thrcstmy Inc Watr Seal Sep ED Charge 1000662 1,435
Venipuncture Cutdown Gt 1 Yr ED Charge 1000661 91
Insert Non Tunnel Cv Cath 5+ ED Charge 1015904 900
Drain Abscess Vest Mouth Simp ED Charge 1000730 618
Drain Abscess Cyst Hema Dento ED Charge 1056063 701
Incis Abscess Peritonsillar ED Charge 1017496 837
Insrt Temp Indwl Blad Cath Sim ED Charge 1000984 201
Insert Temp Blad Cath Compl ED Charge 1015813 326
Change Cystostomy Tube Simple ED Charge 1010032 529
Preputial Stretching ED Charge 1000996 124
I&D Vulva Perineal Abs ED Charge 1001627 741
I&D Bart Gl& Abscess ED Charge 1010642 612
Colporrhaphy Suture Injury Vagina ED Charge 1010002 3,051
Removal Intrauterine Device ED Charge 1017264 239
Spinal Puncture Lumbar Diag ED Charge 1017272 679
Inj Lumbar Epidural Blood Ptch ED Charge 1000213 1,090
Inj Ansth Trigeminal Nerve ED Charge 1010008 420
Inj Ansth Oth Peripheral Nerve ED Charge 1016027 432
Remove Fb Corn Wo Slit ED Charge 1016035 342
Remove Fb Corn W Slit ED Charge 1010604 702
Drainage Ext Auditory Canal Ab ED Charge 1000965 598
Remove Fb Ear Wo Anes ED Charge 1010005 221
Remove Impacted Cerumen ED Charge 1010675 120
Cardiopulmonary Resuscitation ED Charge 1016051 1,108
Temp Transcutaneous Pacing ED Charge 1010600 21
Cardioversion External ED Charge 1010601 1,143
I&D Abscess Sgl Simp Pro ED Charge 1010602 523
I&D Abscess Mult Or Comp Pro ED Charge 1010603 1,150
I&D Pilon Cyst Simp Pro ED Charge 2039679 675
Incis Remov Fb Subq Simp Pro ED Charge 1001078 641
Incis Remov Fb Subq Comp Pro ED Charge 1001079 1,218
I&D Hema Seroma Fluid Pro ED Charge 1001080 776
Punct Aspir Abscess Hema Bulla Pro ED Charge 1001081 532
Debridement Ecz Or Infect Sk Up To 10% Pro ED Charge 1001082 208
Debrid Skin Sbq Tiss Musc Bo <= 20 Sq Cm Pro ED Charge 1001083 1,496
Paring Cutting Ben Les 1 Pro ED Charge 1000853 106
Avulsion Nail Plate Sgl Simp Pro ED Charge 1000821 327
Evacuate Subungual Hematoma Pro ED Charge 1000822 213
Exc Nail Matrix Permanent Pro ED Charge 1000823 743
Rpr Nail Bed Pro ED Charge 1000824 752
Rep Simp Sclp Trnk Xtrm <2.5 Cm Pro ED Charge 1000825 323
Rep Simp Sclp Trnk Xtrm 2.6 7.5 Cm Pro ED Charge 1000826 386
Rep Simp Sclp Trnk Xtrm 7.6 12.5 Cm Pro ED Charge 1000827 482
Rep Simp Sclp Trnk Xtrm 12.6 20.0 Cm Pro ED Charge 1000828 626
Rep Simp Face < 2.5 Cm Pro ED Charge 1000829 376
Rep Simp Face 2.6 To 5.0 Cm Pro ED Charge 1000834 424
Lyr Cls Sclp Trnk Axl Extr < 2.5 Cm Pro ED Charge 1000835 801
Lyr Cls Sclp Trnk Axl Extr 2.6 7.5 Cm Pro ED Charge 1000837 1,120
Lyr Cls Sclp Trnk Axl Extr 7.6 12.5 Cm Pro ED Charge 1000838 1,276
Lyr Cls Sclp Trnk Axl Extr 12.6 20.0 Cm Pro ED Charge 1000839 1,586
Lyr Cls Nck Hnd Ft Genit < 2.5 Cm Pro ED Charge 1000840 897
Lyr Cls Nck Hnd Ft Genit 2.6 7.5 Cm Pro ED Charge 1000841 1,032
Lyr Cls Nck Hnd Ft Genit 12.6 20.0 Cm Pro ED Charge 1000842 1,780
Lyr Cls Face < 2.5 Cm Pro ED Charge 1000843 1,024
Lyr Cls Face 2.6 5.0 Cm Pro ED Charge 1000844 1,237
Lyr Cls Face 5.1 7.5 Cm Pro ED Charge 1000845 1,438
Lyr Cls Face 7.6 12.5 Cm Pro ED Charge 1000846 1,470
Rep Comp Scalp 2.6-7.5 Cm Pro ED Charge 1000847 1,584
Rep Comp Scalp Ea Add 5 Cm Pro ED Charge 1000848 568
Init Trt First Degree Burn Pro ED Charge 1000849 302
Drss Dbrid Burn Prtl Thkns Sm Pro ED Charge 1000850 355
Arthrocent Aspir Inj Int Jnt Pro ED Charge 1000851 245
Arthrocent Aspir Inj Maj Jnt Pro ED Charge 1000852 304
Cls Trt Nasal Bone Frac Pro ED Charge 1001068 267
Cls Trt Nas Fx Wo Stab Pro ED Charge 1001069 996
Cls Trt Shoulder Disloc Pro ED Charge 1001070 1,881
Cls Trt Shldr Disl W Man, Anes Pro ED Charge 1001071 1,276
Cls Trt Elbow Disloc Wo Anes Pro ED Charge 1001072 2,177
Cls Trt Elbow Fracture Pro ED Charge 1001073 1,657
Cls Trt Radial Head Subl Pro ED Charge 1001074 562
Cls Trt Rad & Ulna Shf W Man Pro ED Charge 1001075 3,058
Cls Trt Ds Rd Fx Inc Uln St Wo Man Pro ED Charge 1001076 1,552
Cls Trt Ds Rd Fx Inc Uln St W Man Pro ED Charge 1001094 3,346
Cls Trt Phal Fx W Man Pro ED Charge 1001095 1,980
Cls Trt Artic Fx W Man Pro ED Charge 1010043 2,186
Cls Trt Inter Jnt Wo Ane Pro ED Charge 1010042 1,659
Cls Trt Fmrl Fx Prxml, Neck W Manip Pro ED Charge 1010041 2,689
Cls Trt Hip Artho Disloc Pro ED Charge 1010040 1,482
Cls Trt Knee Disloc Pro ED Charge 1000820 3,084
Cls Trt Patellar Disloc Pro ED Charge 1000854 2,171
Cls Trt Of Tibia Frac Pro ED Charge 1000855 2,950
Cls Trt Distl Fib Fx W Man Pro ED Charge 1000856 2,124
Cls Trt Bimall Ank W Man Pro ED Charge 1000857 2,763
Cls Trt Trimalle Wo Man Pro ED Charge 1000858 1,603
Cls Trt Trimalle W Man Pro ED Charge 1000859 2,838
Cls Trt Ankle Dislocation Pro ED Charge 1000860 1,311
Cls Trt Jnt Disloc Metatars Wo Anes Pro ED Charge 1000861 732
Cls Trt Intrphlgl Disloc Pro ED Charge 1000862 587
Apply Long Arm Splint Pro ED Charge 1000863 392
Apply Short Arm Splint Static Pro ED Charge 1000864 259
Apply Finger Splint Static Pro ED Charge 1000865 188
Apply Long Leg Splint Pro ED Charge 1000866 328
Apply Short Leg Splint Pro ED Charge 1000867 328
Remove Fb Intranasal Pro ED Charge 1000868 690
Control Nasal Hemorr Ant Simp Pro ED Charge 1000869 374
Control Nasal Hemorr Ant Comp Pro ED Charge 1000870 530
Control Nasal Hemorr Post Init Pro ED Charge 1000871 699
Intubation Endotracheal Pro ED Charge 1000872 688
Remove Fb Larynx Pro ED Charge 1000873 855
Tracheostomy Cricothyroid Memb Pro ED Charge 1000874 819
Tube Thrcstmy Inc Watr Seal Sep Pro ED Charge 1000875 697
Venipuncture Cutdown Gt 1 Yr Pro ED Charge 1000876 174
Insert Non Tunnel Cv Cath 5+ Pro ED Charge 1000877 798
Drain Abscess Vest Mouth Simp Pro ED Charge 1000878 883
Drain Abscess Cyst Hema Dento Pro ED Charge 1000879 989
Incis Abscess Peritonsillar Pro ED Charge 1000880 797
Gi Intbate, Aspir Wwo Lavage Md Pro ED Charge 1000881 103
Insrt Temp Indwl Blad Cath Sim Pro ED Charge 1000882 170
Insert Temp Blad Cath Compl Pro ED Charge 1000883 510
Change Cystostomy Tube Simple Pro ED Charge 1000884 344
Preputial Stretching Pro ED Charge 1000885 310
I&D Vulva Perineal Abs Pro ED Charge 1001084 708
I&D Bart Gl& Abscess Pro ED Charge 1001085 596
Colporrhaphy Suture Injury Vagina Pro ED Charge 1001086 1,014
Removal Intrauterine Device Pro ED Charge 1001087 372
Spinal Puncture Lumbar Diag Pro ED Charge 1001088 516
Inj Ansth Trigeminal Nerve Pro ED Charge 1001089 470
Inj Ansth Oth Peripheral Nerve Pro ED Charge 1001090 633
Remove Fb Corn Wo Slit Pro ED Charge 1001091 277
Remove Fb Corn W Slit Pro ED Charge 1001092 339
Drainage Ext Auditory Canal Ab Pro ED Charge 1001093 932
Remove Fb Ear Wo Anes Pro ED Charge 1000655 312
Remove Impacted Cerumen Pro ED Charge 1001028 136
Cardiopulmonary Resuscitation Pro ED Charge 1001029 1,228
Temp Transcutaneous Pacing Pro ED Charge 1001030 2
Cardioversion External Pro ED Charge 1001031 721
SCREW-2.7 X 22 LOCKING 614522 1001032 729
SYSTEM FIXATION SORBAFIX 30 FSTNRS 1001033 136
VI-DRAPE WOUND PROTECTOR 9 RING 1001034 143
VI-DRAPE WOUND PROTECTOR 11 RING 1001035 143
Methacholine Challenge PFT 1001036 137
D1206 Topical Flouride 1001037 33
Long leg cast, peds, plaster 1001038 31 0
Gauntlet cast, peds fiberglass 1001039 29 0
Colorectal CA screen; fecal-occult; immunoassay; 3 determ 1001040 36 0
Biopsy of breast, percut, imaging guidance 1001041 1,482 1,483
Allograft for spine surgery only; morselized 1001042 766 0
Excision, tumor, soft tissue, back/flank; subfascial; < 5 cm 1001043 3,212 1,901
Arthrodesis, anterior; cervical below C2 1001044 6,139 2,977
Arthrodesis, ant. technique;ea. add'l 1001045 1,617 929
Arthrodesis, posterior, single; lumbar 1001046 7,764 3,959
Arthrodesis,posterior,single, ea add'l 1001047 1,930 1,082
Posterior segmental instrumentation; 3-6 vertebral segments 1001048 3,760 2,113
Anterior instrumentation; 2 to 3 vertebral segments 1001049 3,604 2,009
Removal of anterior instrumentation 1001050 5,416 2,669
Treat AC dislocate c graft 1001051 3,163 1,484
PT Self Care, Home Management Charges 1001052 139
Bill Antibody ID Each 1001053 18
HS C-Reactive Protein 1001054 163
Unlisted procedure, shoulder 1001055 2,176 0
Arthroplasty, radial head; with implant 1001056 3,287 1,574
CMH RN TC LABELED REAGENTS NOS 1001057 260
CMH NM RN SESTAMIBI 1001058 486
CMH NM RN MYOVIEW TETROFSMIN 1001059 486
CMH RN MDP MEDRONATE TO 30 MCI 1001060 216
CMH RN THALLIUM T1-201 PER MILLICURIE 1001061 226
CMH NM RN DISOFENIN HEPATOLITE 1001062 182
CMH RN TC PERTECHNETATE P MCI 1001063 18
CMH NM RN I-123 CAPSULE P 100UCI 1001064 180
CMH NM RN I 131 CAPSULE PER MCI 1001065 67
CMH RN TC EXAMETAZIME PR DOSE 1001066 1,426
CMH NM RN MEBROFENIN CHOLETEC 1001067 40
CMH NM RN TC PENTETATE (DTPA) 1001019 150
CMH NM RN TC ALBUMIN MAA P MCI 1001020 40
CMH RN TC SULFUR COLLOID P MCI 1001021 271
CMH NM RN INDIUM III DTPA 1001022 1,262
CMH NM RN TC LABEL RBC P/MCI 1001023 15
CMH NM RN HDP EACH mci 1001024 17
CMH RN MAG 3 MERTIATIDE PMCI 1001025 65
CMH NM ADENOSINE 60mg 1001026 1,177
CMH SINCALIDE KINEVAC CCK 5MG 1000917 227
CMH CT 3D Recon w/ Workstation 1000918 503
Closed tx, radial shaft fx closed dislocation of distal rad 1000919 2,711 2,575
Open TX femoral fracture, proximal end, head, internal fixat 1000920 6,032 3,179
Arthrotomy, knee; medial AND lateral 1000921 2,830 1,270
Arthrotomy, knee; anterior OR posterior 1000922 3,301 1,546
Patellectomy or hemipatellectomy 1000923 3,143 1,692
Quadricepsplasty 1000924 3,570 1,709
ACTH Hormone LLS 1000925 486
Alkaline Phosphatase, Bone Sp LLS 1000926 237
Alpha Subunit LLS 1000927 177
Calcitonin LLS 1000928 85
Factor XI Activity LLS 1000929 44
Fructosamine LLS 1000930 189
Growth Hormone LLS 1000931 92
Prolactin LLS 1000932 61
Sex Hormone-Binding Globulin LLS 1000933 65
92567 TYMPANOMETRY 1000934 58
Gastrin LLS 1000935 51
BAG TISSUE RETRIEVAL 100 BX/5 1000936 1,223
UPPER GI ENDOSCOPY DIAGNOSTIC 1000937 5,115 1,133
Epiphyseal arrest; prox tibia and fibula 1000938 3,547 1,706
Open treat knee dislocat, int fix, no prim ligm rpr aug/rcnt 1000939 4,183 2,187
PERC SKELETAL FEXATION TIBIAL SHAFT FX - ASSIST 1000940 2,785 1,253
INSERT CERVICAL DILATOR CHARGE 1000941 219
PT Contrast Bath Charges 1000942 72
PT Physical Performance Test Charges 1000943 65
OT Contrast Bath Charges 1000944 72
OT Physical Performance Test Charges 1000945 65
Yes 1000946 278
Freetext Item 1000947 0
AIRWAY BERMAN 50MM INFANT 1000948 4
ALUMI HAND XL 1000949 209
ANKLE COLLAR 1000950 364
SHOULDER/ARTHRO PROC PACK 1000951 521
ARTHROSCOPY TUBE SET 1000952 455
AUTOTRANSFUSION BAG PLUEREVAC 1000953 197
CANISTER SET w/GEL NPWT 500CC 1000954 181
CANISTER WOUND VAC 500ML 1000955 315
CATH PCI INTRO KIT 1000956 234
CLAMP URINARY INCONTINENCE 1000957 158
COLLAR RIGID SML 1050936 134
COMBITUBE 37FR** DISC 08/20/14 1050937 377
COMBITUBE 41FR**DISC 08/20/14 1050938 364
CPR-D PADZ ZOLL 1050939 744
C-SECTION PACK 1050940 550
DRESS GELFOAM SIZE 100 LARGE 1050941 270
DRESS WOUND VAC WHITE FOAM SMALL 1050942 374
DRESSING SET MED BLACK NPWT 1050943 258
DRESSING SET SML BLACK NPWT 1050944 208
ELECTRODE ONE-STEP ZOLL 1050945 502
ELECTRODE PEDI PADZ ZOLL 1050946 365
ELECTRODE STAT PADZ ZOLL 1050947 245
EPISTAXIS CATH BIVONA 1050948 322
EYE PACK 1050949 1,031
D5LR 1000ML + 20 MEQ KCL 1050950 92
D5W 100ML PF 1050951 92
D5W 250ML 1050952 92
D5W 500ML 1050953 92
D5W 1000ML 1050954 92
D5 NS 1000ML 1050955 92
D5LR 1000ML 1050956 92
D5 1/2NS 500ML + 10MEQ KCL 1050957 92
D5 1/2NS 1000ML 1050958 92
D5 1/2NS 1000ML + 20MEQ KCL 1050959 92
D5 1/2NS 1000ML + 30MEQ KCL 1050970 92
D5 1/2NS 1000ML + 40MEQ KCL 1050971 92
D5 1/4NS 1000ML 1050972 92
D5 1/4NS 1000ML + 20MEQ KCL 1050974 92
D10W 500 MLS 1050975 92
D10W 500/1000MLS PF 1050976 108
LR 500ML 1010104 92
LR 1000ML 1010106 92