| ABDOM/PELV WITHOUT & W/C CT |
74178 |
$ 240.00 |
$ 450.00 |
$ 124.54 |
| ABDOMEN CT |
74150 |
$ 225.00 |
$ 260.00 |
$ 44.25 |
| ABDOMEN (ABD) XR |
74018 |
$ 19.92 |
$ 52.45 |
$ 6.40 |
| ABDOMEN ANTEPOST. AND OBLIQ XR |
74019 |
$ 38.46 |
$ 73.66 |
$ 9.21 |
| ABDOMEN COMP.(2 VIEWS) XR |
74021 |
$ 29.22 |
$ 73.66 |
$ 10.12 |
| ABDOMEN W/CONTRAST CT |
74160 |
$ 240.00 |
$ 260.00 |
$ 82.42 |
| ABDOMEN WITHOUT AND W/C CT |
74170 |
$ 240.00 |
$ 260.00 |
$ 94.96 |
| ABDOMINAL COMPLETE US |
76700 |
$ 80.00 |
$ 90.00 |
$ 35.00 |
| ABDOMINO/PELVICO CT |
74176 |
$ 225.00 |
$ 450.00 |
$ 55.56 |
| ABDOMINO/PELVICO W CONTRAST CT |
74177 |
$ 240.00 |
$ 450.00 |
$ 108.57 |
| Abortion Procedures |
59812 |
$ 5,000.00 |
$ 1,595.00 |
$ 450.00 |
| ACETAMINOPHEN |
80329 |
$ 70.00 |
$ 50.00 |
0 |
| ALBUMIN URINE; MICROALBUMIN QN |
82043 |
$ 13.00 |
$ 70.00 |
$ 5.00 |
| ALBUMIN; SERUM |
82040 |
$ 19.00 |
$ 8.00 |
$ 1.40 |
| AMMONIA |
82140 |
$ 32.00 |
$ 40.00 |
$ 12.59 |
| AMYLASE |
82150 |
$ 36.00 |
$ 14.00 |
$ 5.60 |
| ANGIO CHEST W/O AND W/C CT |
71275 |
$ 225.00 |
$ 400.00 |
$ 89.25 |
| ANGIO NECK W/O AND W/C CT |
70498 |
$ 225.00 |
$ 400.00 |
$ 91.00 |
| ANKLE COMP. XR RT |
73610 |
$ 34.02 |
$ 52.45 |
$ 10.85 |
| ANKLE XR RT |
73600 |
$ 24.42 |
$ 52.45 |
$ 9.00 |
| ANTIBODY; MYCOPLASMA |
86738 |
$ 84.00 |
$ 67.86 |
$ 11.44 |
| ANTIGEN; INFLUENZA A VIRUS |
87276 |
$ 24.00 |
$ 60.00 |
$ 10.38 |
| ANTIGEN; INFLUENZA B VIRUS |
87275 |
$ 24.00 |
$ 60.00 |
$ 10.36 |
| ANTIMICROBIAL AGENT (MIC) |
87186 |
$ 19.00 |
$ 50.00 |
$ 3.00 |
| Appendectomy Laparoscopic |
44970 |
$ 5,004.00 |
$ 1,595.00 |
$ 475.00 |
| ARM (HUMERUS) LEFT XR |
73060 |
$ 29.22 |
$ 52.45 |
$ 9.26 |
| Arthroscopy, knee, surgical |
29881 |
$ 1.00 |
$ 1,595.00 |
$ 475.00 |
| Arthroscopy, shoulder, surgical |
29826 |
$ 1.00 |
$ 1,595.00 |
$ 475.00 |
| Arthrotom wrist jnt w jnt expl |
25101 |
$ 1,947.83 |
$ 1,549.24 |
$ 470.56 |
| BASIC METABOLIC PANEL CTOTAL |
80048 |
$ 70.60 |
$ 40.00 |
$ 7.31 |
| BETA SUB UNIT (PREGNA) QL HCG |
84703 |
$ 18.00 |
$ 25.00 |
$ 6.50 |
| BETA SUB UNIT (PREGNA) QN HCG |
84702 |
$ 50.00 |
$ 60.00 |
$ 13.01 |
| BILATERAL MAMMOGRAPH DIGITAL |
77066 |
$ 104.39 |
$ 143.37 |
$ 28.77 |
| BILIRUBIN; DIRECT |
82248 |
$ 47.00 |
$ 12.00 |
$ 4.33 |
| BILIRUBIN; DIRECT |
82248 |
$ 47.00 |
$ 12.00 |
$ 4.33 |
| BILIRUBIN; TOTAL |
82247 |
$ 24.00 |
$ 24.00 |
$ 4.33 |
| Biopsy of prostate gland |
55700 |
|
|
|
| BLEEDING TIME |
85002 |
$ 23.00 |
$ 12.00 |
$ 2.00 |
| BLOOD OCCULT,QUAL,FECES,1-3 |
82270 |
$ 15.50 |
$ 24.00 |
$ 3.00 |
| BLOOD TYPING; ABO |
86900 |
$ 30.80 |
$ 28.75 |
$ 2.58 |
| BLOOD TYPING; RH (D) |
86901 |
$ 10.00 |
$ 23.00 |
$ 2.58 |
| Bonegraft any donor area sm |
20900 |
$ 2,115.17 |
$ 1,300.00 |
$ 450.00 |
| BRAIN CT |
70450 |
$ 225.00 |
$ 260.00 |
$ 36.12 |
| BRAIN W/CONTRAST CT |
70460 |
$ 240.00 |
$ 260.00 |
$ 51.85 |
| BRAIN WITHOUT AND W/C CT |
70470 |
$ 240.00 |
$ 260.00 |
$ 63.16 |
| BREAST COMPL.SONOMAMOGRA US LT |
76641 |
$ 75.00 |
$ 83.00 |
$ 17.50 |
| BREAST LIMITED SONOMAMOG US |
76642 |
$ 60.00 |
$ 70.00 |
$ 13.00 |
| BUN (UREA NITROGEN) SERUM |
84520 |
$ 21.40 |
$ 10.00 |
$ 3.42 |
| CALCIUM;TOTAL |
82310 |
$ 25.00 |
$ 10.00 |
$ 4.46 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities |
216 |
|
|
|
| Carpal Tunnel Release |
64721 |
$ 2,210.70 |
$ 1,300.00 |
$ 450.29 |
| CBC |
85025 |
$ 25.00 |
$ 11.02 |
$ 6.40 |
| CEA (CARCINOEMBRYONIC ANTIGEN |
82378 |
$ 87.00 |
$ 62.00 |
$ 16.39 |
| Cervical Cone Biopsy |
57522 |
$ 1,923.81 |
$ 806.00 |
$ 475.00 |
| CERVICAL SP. COMP. XR |
72052 |
$ 43.68 |
$ 73.66 |
$ 18.63 |
| Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). |
473 |
|
|
|
| CERVICAL SPINE AP & LAT XR |
72040 |
$ 24.42 |
$ 52.45 |
$ 8.50 |
| CERVICAL SPINE CT |
72125 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| CERVICAL SPINE W/CONTRAST CT |
72126 |
$ 240.00 |
$ 260.00 |
$ 82.95 |
| CERVICAL WITHOUT & WITH CON CT |
72127 |
$ 240.00 |
$ 260.00 |
$ 102.56 |
| Cesarean Delivery Procedures |
59510 |
$ 2,267.50 |
|
|
| CHEST CT |
71250 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| CHEST PA & LAT XR |
71046 |
$ 29.22 |
$ 52.45 |
$ 7.60 |
| CHEST PA XR |
71045 |
$ 21.18 |
$ 52.45 |
$ 6.13 |
| CHEST W/CONTRAST CT |
71260 |
$ 240.00 |
$ 260.00 |
$ 82.42 |
| CHEST, THORAX WITHOUT & W/C CT |
71270 |
$ 240.00 |
$ 260.00 |
$ 89.25 |
| CHLORIDE; URINE |
82436 |
$ 18.00 |
$ 11.00 |
$ 3.00 |
| Cholecystectomy Laparoscopic |
47562 |
$ 1.00 |
$ 2,587.57 |
$ 475.00 |
| CHOLESTER SERUM OR WHLE BLD T |
82465 |
$ 21.00 |
$ 10.00 |
$ 3.76 |
| Circumcision |
54160 |
$ 1,752.04 |
$ 974.21 |
$ 250.00 |
| Cleaning and Debridement (C&D) |
11042 |
$ 1,538.00 |
$ 806.00 |
$ 475.00 |
| Clos tx bimaleol ankle fra fix |
27814 |
$ 4,138.37 |
$ 3,213.65 |
$ 475.00 |
| CLOSTRIDIUM-TOXIN-DIFFICILE |
87230 |
$ 19.00 |
$ 67.00 |
$ 8.34 |
| COLD AGGLUTININ; SCREEN |
86156 |
$ 15.00 |
$ 57.50 |
$ 4.80 |
| COLD AGGLUTININ; TITER |
86157 |
$ 18.00 |
$ 92.00 |
$ 4.80 |
| Colonoscopy |
45378 |
$ 250.00 |
$ 452.56 |
$ 111.00 |
| Colonoscopy w/biopsy |
45380 |
$ 250.00 |
$ 567.55 |
$ 111.00 |
| Complete blood count, automated |
85027 |
|
|
|
| COMPREHENSIVE METABOLIC PANEL |
80053 |
$ 80.00 |
$ 55.00 |
$ 9.13 |
| COOMBS TEST DIRECT |
86880 |
$ 30.00 |
$ 30.00 |
$ 4.20 |
| COOMBS TEST INDIRECT QL |
86885 |
$ 44.00 |
$ 20.00 |
$ 4.95 |
| CPK TOTAL (CREATINE KINASE) |
82550 |
$ 37.00 |
$ 20.00 |
$ 5.63 |
| C-REACTIVE PROTEIN |
86140 |
$ 27.00 |
$ 15.00 |
$ 3.00 |
| CREATINI OTH SOURCE 24 HR URI |
82570 |
$ 12.00 |
$ 12.00 |
$ 3.80 |
| CREATININE CLEARANCE |
82575 |
$ 40.00 |
$ 20.00 |
$ 8.17 |
| CREATININE;BLOOD |
82565 |
$ 23.50 |
$ 10.00 |
$ 4.43 |
| CULTURE ANAEROBIC ISOLATE |
87076 |
$ 39.10 |
$ 50.00 |
$ 5.00 |
| CULTURE ANY OTHER SOURCE |
87070 |
$ 39.10 |
$ 30.00 |
$ 7.45 |
| CULTURE BLOOD AEROBIC |
87040 |
$ 39.10 |
$ 35.00 |
$ 8.92 |
| CULTURE FECES |
87045 |
$ 39.10 |
$ 28.00 |
$ 8.16 |
| CULTURE PRESUMP SCREENING ONL |
87081 |
$ 39.10 |
$ 30.00 |
$ 5.73 |
| CULTURE URINE |
87086 |
$ 39.10 |
$ 32.00 |
$ 3.00 |
| CYANOCOBALAMIN (VITAMIN B-12) |
82607 |
$ 48.00 |
$ 45.00 |
$ 13.03 |
| Cystolitholapaxy |
52318 |
$ 2,463.97 |
$ 1,453.36 |
$ 475.00 |
| De Quervains Disease,incision |
25000 |
$ 1,535.96 |
$ 1,453.36 |
$ 475.00 |
| Debridement |
11043 |
$ 1,860.00 |
$ 806.00 |
$ 475.00 |
| Delivery Procedures After Previous Cesarean Delivery |
59610 |
$ 1,410.24 |
|
|
| DENSITOMETRIA OSEA PROD. XR |
77080 |
$ 55.00 |
$ 73.66 |
$ 15.27 |
| Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope |
43235 |
|
|
|
| DIGOXIN (LANOXIN) TOTAL |
80162 |
$ 54.60 |
$ 35.00 |
$ 11.47 |
| DIHYDROXYVITAMIN D,1,25 |
82652 |
$ 376.00 |
$ 195.00 |
$ 33.27 |
| Dilatation & Curettage |
58120 |
$ 1,829.00 |
$ 1,203.63 |
$ 475.00 |
| DRUG PANEL 10 URINE/BLOOD TOXI |
80305 |
$ 130.00 |
$ 19.00 |
$ 19.00 |
| EAR,ORBIT,SELLA T W/O & W/C CT |
70482 |
$ 240.00 |
$ 260.00 |
$ 110.00 |
| EKG |
93000 |
$ 35.34 |
$ 32.00 |
$ 30.00 |
| EKG PRODUCCION |
93005 |
$ 58.90 |
$ 100.00 |
$ 6.00 |
| ELBOW AP & LAT. XR RT |
73070 |
$ 22.14 |
$ 52.45 |
$ 9.26 |
| ELECTROLYTE PANEL |
80051 |
$ 55.00 |
$ 25.00 |
$ 6.06 |
| Encounter for sterilization |
58600 |
$ 2,000.00 |
$ 1,595.00 |
$ 475.00 |
| ENDOVAGINAL NO OBST. US |
76830 |
$ 90.00 |
$ 110.00 |
$ 20.00 |
| ENDOVAGINAL OBSTETRIC US |
76817 |
$ 90.00 |
$ 110.00 |
$ 19.50 |
| Exc tumor soft tiss neck/thorax subfascial<5cm |
21556 |
$ 1,465.00 |
$ 1,453.36 |
$ 475.00 |
| Exc. of Multip Subcutan Lesion |
38760 |
$ 4,534.22 |
$ 806.00 |
$ 475.00 |
| Excision Procedures on the Breast |
19120 |
$ 1.00 |
$ 914.62 |
$ 475.00 |
| FACE, MAXILLA WITHOUT & W/C CT |
70488 |
$ 240.00 |
$ 260.00 |
$ 69.87 |
| FACIAL BONE XR |
70140 |
$ 21.54 |
$ 52.45 |
$ 9.26 |
| Family psychotherapy, including patient, 50 min |
90847 |
|
|
|
| Family psychotherapy, not including patient, 50 min |
90846 |
|
|
|
| FECAL LEUKOCYTES QUAN OE SEMI |
89055 |
$ 12.10 |
$ 10.00 |
$ 3.69 |
| FEMUR AP & LAT XR RT |
73552 |
$ 29.22 |
$ 52.45 |
$ 10.50 |
| FERRITIN |
82728 |
$ 30.00 |
$ 40.00 |
$ 11.78 |
| FIBRIN DEGRADATION PROD DIMER |
85378 |
$ 16.00 |
$ 48.00 |
$ 6.80 |
| FIBRIN(OGEN) QUANTITATIVE |
85370 |
$ 25.00 |
$ 34.00 |
$ 9.81 |
| FINGERS XR RT |
73140 |
$ 19.92 |
$ 52.45 |
$ 6.50 |
| Fistula gastrocutanea |
46270 |
$ 2,164.00 |
$ 806.00 |
$ 475.00 |
| FOOT COMP.(AP-LAT-OBLQ) XR RT |
73630 |
$ 33.36 |
$ 52.45 |
$ 9.97 |
| FOOT XR RT |
73620 |
$ 24.42 |
$ 52.45 |
$ 8.92 |
| FOREARM LEFT XR |
73090 |
$ 29.22 |
$ 52.45 |
$ 8.38 |
| GASES BLOOD, ANY COMBIN OF PH |
82803 |
$ 94.20 |
$ 78.00 |
$ 18.25 |
| Gastroscopy |
43239 |
$ 240.00 |
$ 452.56 |
$ 111.00 |
| GENTAMICIN |
80170 |
$ 36.00 |
$ 60.00 |
$ 2.00 |
| GLUCOSE;QUAN,BLOOD(EXCEPT RE |
82947 |
$ 19.00 |
$ 8.00 |
$ 3.40 |
| Group psychotherapy |
90853 |
|
|
|
| HAND MINIMUM OF 3 VIEWS LT XR |
73130 |
$ 33.84 |
$ 52.45 |
$ 10.68 |
| HAND XR RT |
73120 |
$ 24.42 |
$ 73.66 |
$ 8.56 |
| HEMATOCRITO |
85014 |
$ 8.50 |
$ 6.55 |
$ 2.05 |
| HEMOGLOBIN |
85018 |
$ 8.50 |
$ 6.55 |
$ 1.78 |
| HEMOGLOBIN; GLYCOSYLATED |
83036 |
$ 20.80 |
$ 30.00 |
$ 8.39 |
| HEPATIC FUNCTION PANEL(LIVERP |
80076 |
$ 54.60 |
$ 35.00 |
$ 7.06 |
| HEPATITIS B SURF AG (HBS AG) |
87340 |
$ 23.00 |
$ 33.00 |
$ 8.93 |
| HEPATITIS B SURFACE AB (HBSAB) |
86706 |
$ 39.00 |
$ 37.00 |
$ 9.28 |
| HEPATITIS PANEL ACUTE |
80074 |
$ 190.00 |
$ 80.00 |
$ 41.17 |
| Herniorrhaphy Incisional |
49566 |
$ 2,656.00 |
$ 1,200.00 |
$ 475.00 |
| Herniorrhaphy Inguinal |
49505 |
$ 2,164.00 |
$ 1,689.56 |
$ 475.00 |
| Herniorrhaphy Inguinal |
49505 |
$ 1.00 |
$ 1,689.56 |
$ 475.00 |
| Herniorrhaphy Inguinal |
49507 |
$ 2,312.00 |
$ 1,689.56 |
$ 475.00 |
| Herniorrhaphy Umbilical |
49585 |
$ 2,707.82 |
$ 1,200.00 |
$ 475.00 |
| Herniorrhaphy Umbilical |
49587 |
$ 2,759.00 |
$ 1,200.00 |
$ 475.00 |
| HERPES SIMP 1,2 VIRUS PCR |
87529 |
$ 135.00 |
$ 195.00 |
$ 30.33 |
| HIP UNIL W/PELVIS 2-3V LEFT XR |
73502 |
$ 29.22 |
$ 52.45 |
$ 13.00 |
| HIP WITH PELVIS 1 VIEW XR RT |
73501 |
$ 24.42 |
$ 52.45 |
$ 7.00 |
| HIPS BILAT. 2 VIEW W PELVIS XR |
73521 |
$ 38.92 |
$ 73.66 |
$ 13.00 |
| HIV1 ANTG W HIV1 HIV2 AB SING |
87389 |
$ 102.36 |
$ 33.00 |
$ 20.81 |
| Hysterectomy |
58670 |
$ 3,600.00 |
$ 1,595.00 |
$ 475.00 |
| Hysteroscopy |
58558 |
$ 2,050.00 |
$ 1,201.00 |
$ 475.00 |
| Incision and Drainage (I/D) |
10060 |
$ 5,171.08 |
$ 806.00 |
$ 66.80 |
| INFLUENZA |
87804 |
$ 70.00 |
$ 52.00 |
$ 14.83 |
| Initial new patient preventive medicine evaluation (18-39 years) |
99385 |
|
|
|
| Initial new patient preventive medicine evaluation (40-64 years) |
99386 |
|
|
|
| Injection of substance into spinal canal of lower back or sacrum using imaging guidance |
62322 |
|
|
|
| Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance |
64483 |
|
|
|
| Insertion of catheter into left heart for diagnosis |
93452 |
|
|
|
| IRON |
83540 |
$ 23.50 |
$ 14.00 |
$ 5.59 |
| IRON BINDING CAPACITY (TIBC) |
83550 |
$ 31.60 |
$ 17.00 |
$ 7.55 |
| K.U.B. XR |
74018 |
$ 19.92 |
$ 52.45 |
$ 6.00 |
| KETONE BODY QUAL (ACETONE) |
82009 |
$ 14.00 |
$ 6.40 |
$ 1.00 |
| KNEE 1 OR 2 VIEW LEFT XR |
73560 |
$ 24.42 |
$ 52.45 |
$ 9.00 |
| KNEE 3 VIEW XR RT |
73562 |
$ 33.84 |
$ 52.45 |
$ 10.24 |
| KNEE COMP. 4 VIEW LEFT XR |
73564 |
$ 29.22 |
$ 73.66 |
$ 12.50 |
| L.S.S. COMPLETE OBLIGUES XR |
72110 |
$ 48.18 |
$ 73.66 |
$ 16.16 |
| LACTATE (LACTIC ACID) |
83605 |
$ 70.00 |
$ 49.00 |
$ 9.23 |
| Laparoscopic Procedures on the Abdomen, Peritoneum, and Omentum |
49320 |
$ 4,269.00 |
$ 2,587.57 |
$ 475.00 |
| Laparoscopy, surgical |
58661 |
$ 5,000.00 |
$ 1,595.00 |
$ 475.00 |
| Laparoscopy, surgical |
58662 |
$ 4,158.00 |
$ 1,595.00 |
$ 475.00 |
| LDH (LACTATE DEHYDRIGENAS) |
83615 |
$ 30.00 |
$ 10.00 |
$ 5.22 |
| LIPASE |
83690 |
$ 25.00 |
$ 15.00 |
$ 5.96 |
| LIPID PANEL |
80061 |
$ 45.00 |
$ 45.00 |
$ 11.57 |
| LOWER EXTREMITY CT LT |
73700 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| LOWER EXTREMITY W/C CT RT |
73701 |
$ 240.00 |
$ 260.00 |
$ 67.53 |
| LUMBAR SPINE CT |
72131 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| LUMBAR SPINE WITH CONTRAST CT |
72132 |
$ 240.00 |
$ 260.00 |
$ 82.77 |
| LUMBO SACRAL SPINE XR |
72100 |
$ 33.72 |
$ 73.66 |
$ 11.50 |
| MAGNESIUM |
83735 |
$ 18.70 |
$ 15.00 |
$ 5.79 |
| MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT. W/O MCC |
470 |
$ 9,920.37 |
|
|
| Mastectomy Parcial |
19301 |
$ 3,833.78 |
$ 806.00 |
$ 475.00 |
| MAXILLOFACIAL W/CONTRAST CT |
70487 |
$ 240.00 |
$ 260.00 |
$ 55.21 |
| MB FRACTION ONLY |
82553 |
$ 36.40 |
$ 40.00 |
$ 9.98 |
| Missed abortion |
59820 |
$ 2,227.00 |
$ 1,595.00 |
$ 475.00 |
| MRA-BRAIN W/O AND W/C |
70546 |
$ 700.00 |
$ 500.00 |
$ 223.32 |
| MRA-HEAD WITHOUT CONT |
70544 |
$ 600.00 |
$ 500.00 |
$ 134.44 |
| MRCP MAG RES CHOLANG PANCREAT |
74181 |
$ 555.00 |
$ 500.00 |
$ 128.61 |
| MRI LOW EX.OTH THA JOIN WO RT |
73718 |
$ 555.00 |
$ 500.00 |
$ 134.44 |
| MRI LOWER EXT.ANY JOINT W/C RT |
73722 |
$ 630.00 |
$ 500.00 |
$ 148.40 |
| MRI UPP EXT.OTH.THAN J. W/O LT |
73218 |
$ 555.00 |
$ 500.00 |
$ 134.44 |
| MRI-ABDOMEN W CONTRAST |
74182 |
$ 630.00 |
$ 500.00 |
$ 181.62 |
| MRI-ABDOMEN W/O AND W/C |
74183 |
$ 630.00 |
$ 500.00 |
$ 194.34 |
| MRI-ANY JT UPPER EXT. W/C RT |
73222 |
$ 630.00 |
$ 500.00 |
$ 146.63 |
| MRI-BRAIN |
70551 |
$ 555.00 |
$ 500.00 |
$ 77.12 |
| MRI-BRAIN W/O AND W/C |
70553 |
$ 630.00 |
$ 500.00 |
$ 129.67 |
| MRI-BRAIN WITH CONTRAST |
70552 |
$ 630.00 |
$ 500.00 |
$ 113.77 |
| MRI-CERVICAL SPINE |
72141 |
$ 555.00 |
$ 500.00 |
$ 73.76 |
| MRI-CERVICAL SPINE W CONTRAST |
72142 |
$ 630.00 |
$ 500.00 |
$ 116.06 |
| MRI-CERVICAL W/O AND W/C |
72156 |
$ 630.00 |
$ 500.00 |
$ 130.55 |
| MRI-FACIAL/ORBITS/NECK WITH C |
70542 |
$ 630.00 |
$ 500.00 |
$ 156.02 |
| MRI-LOWER EXTREMITY LT |
73721 |
$ 555.00 |
$ 500.00 |
$ 83.02 |
| MRI-LOWER EXTREMITY RT |
73721 |
$ 555.00 |
$ 500.00 |
$ 83.02 |
| MRI-LUMBAR SPINE |
72148 |
$ 555.00 |
$ 500.00 |
$ 73.23 |
| MRI-LUMBAR SPINE W CONTRAST |
72149 |
$ 630.00 |
$ 500.00 |
$ 114.12 |
| MRI-LUMBAR W/O AND W/C |
72158 |
$ 630.00 |
$ 500.00 |
$ 130.20 |
| MRI-PELVIS |
72195 |
$ 555.00 |
$ 500.00 |
$ 134.44 |
| MRI-PELVIS W CONTRAST |
72196 |
$ 630.00 |
$ 500.00 |
$ 160.42 |
| MRI-PELVIS W/O AND W/C |
72197 |
$ 630.00 |
$ 500.00 |
$ 193.98 |
| MRI-THORACIC SPINE |
72146 |
$ 555.00 |
$ 500.00 |
$ 73.76 |
| MRI-THORACIC SPINE W CONTRAST |
72147 |
$ 630.00 |
$ 500.00 |
$ 114.65 |
| MRI-UPPER EXTR. ANY JOINT RT |
73221 |
$ 555.00 |
$ 500.00 |
$ 82.84 |
| NASAL BONES XR |
70160 |
$ 29.22 |
$ 52.45 |
$ 9.26 |
| NATRIURETIC PEPTIDE (BNP) |
83880 |
$ 265.80 |
$ 90.00 |
$ 29.33 |
| NECK CT |
70490 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| NECK SOFT TISSUE (C.S.) XR |
70360 |
$ 19.92 |
$ 52.45 |
$ 6.83 |
| NECK W/CONTRAST CT |
70491 |
$ 240.00 |
$ 260.00 |
$ 82.07 |
| NECK WITHOUT AND W/C CT |
70492 |
$ 240.00 |
$ 260.00 |
$ 101.50 |
| New patient office of other outpatient visit, typically 45 min |
99204 |
|
|
|
| New patient office of other outpatient visit, typically 60 min |
99205 |
|
|
|
| New patient office or other outpatient visit, typically 30 min |
99203 |
|
|
|
| NON STRESS TEST |
59025 |
$ 45.00 |
$ 55.00 |
$ 18.00 |
| NUCL AG AB,SSA, SSB,SM, RNP |
86235 |
$ 104.00 |
$ 80.00 |
$ 8.00 |
| OBSTETRIC <= 14WEEK FETUS US |
76801 |
$ 48.00 |
$ 80.00 |
$ 19.50 |
| OBSTETRIC >= 14WEEK FETUS US |
76805 |
$ 55.00 |
$ 94.97 |
$ 17.50 |
| OBSTETRIC LIMITED |
76815 |
$ 48.00 |
$ 80.00 |
$ 21.00 |
| OBSTETRIC PANEL |
80055 |
$ 60.00 |
$ 80.00 |
$ 40.00 |
| OBSTETRIC<=14WK FETUS=GEST US |
76802 |
$ 20.00 |
$ 80.00 |
$ 10.00 |
| OBSTETRIC>=14WK FETUS+GEST US |
76810 |
$ 20.00 |
$ 80.00 |
$ 10.00 |
| Open tx carpal scahoid ext fix |
25628 |
$ 2,643.27 |
$ 1,549.24 |
$ 475.00 |
| Open tx metacarpal frac ex fix |
26615 |
$ 1,767.10 |
$ 1,300.00 |
$ 475.00 |
| Open tx proximal hum int fix |
23615 |
$ 2,538.83 |
$ 6,183.29 |
$ 475.00 |
| Opn tx dist radi intr-art fra3 |
25609 |
$ 3,785.26 |
$ 3,213.65 |
$ 450.00 |
| ORBIT, EAR, MASTOIDS W/C CT |
70481 |
$ 240.00 |
$ 260.00 |
$ 89.25 |
| ORBIT,EAR,MASTOIDS CT LT |
70480 |
$ 225.00 |
$ 260.00 |
$ 53.55 |
| OS-CALCIS (TALON) XR RT |
73650 |
$ 24.42 |
$ 52.45 |
$ 9.27 |
| OVA AND PARASITES |
87177 |
$ 18.70 |
$ 10.99 |
$ 3.50 |
| PARANASAL SINUS,WATER VIEW XR |
70220 |
$ 38.52 |
$ 52.45 |
$ 12.09 |
| Partial Bilatera Salpingectomy |
58700 |
$ 2,433.00 |
$ 1,595.00 |
$ 475.00 |
| Patient office consultation, typically 40 min |
99243 |
|
|
|
| Patient office consultation, typically 60 min |
99244 |
|
|
|
| PEG Tube Replacement |
43246 |
$ 2,550.00 |
$ 806.00 |
$ 111.00 |
| PELVIC CT |
72192 |
$ 225.00 |
$ 260.00 |
$ 44.96 |
| PELVIC W/CONTRAST CT |
72193 |
$ 240.00 |
$ 260.00 |
$ 82.95 |
| PELVICO COMPLETE US |
76856 |
$ 55.00 |
$ 78.30 |
$ 20.00 |
| PELVICO LIMITED US |
76857 |
$ 45.00 |
$ 73.66 |
$ 10.00 |
| PELVIS "AP" XR |
72170 |
$ 19.92 |
$ 73.66 |
$ 7.80 |
| PELVIS COMP. XR |
72190 |
$ 29.22 |
$ 73.66 |
$ 12.68 |
| PELVIS WITHOUT AND W/C CT |
72194 |
$ 240.00 |
$ 260.00 |
$ 98.68 |
| PHENYLALANINE (PKU), BLOOD |
84030 |
$ 105.00 |
$ 130.00 |
$ 5.24 |
| PHENYTOIN; TOTAL |
80185 |
$ 29.00 |
$ 45.00 |
$ 11.45 |
| PHERIFERAL SMEAR |
85008 |
$ 8.25 |
$ 17.00 |
$ 2.97 |
| PHOSPHORUS INOGANIC |
84100 |
$ 18.70 |
$ 10.00 |
$ 4.10 |
| Physical therapy, therapeutic exercise |
97110 |
|
|
|
| Post Repair Vaginal |
57250 |
$ 2,758.00 |
$ 1,453.36 |
$ 475.00 |
| POTASSIUM; SERUM |
84132 |
$ 18.00 |
$ 10.00 |
$ 3.98 |
| PROLACTIN |
84146 |
$ 79.00 |
$ 40.00 |
$ 16.74 |
| PROSTAT SPECIF ANTIG TOT(PSA |
84153 |
$ 40.00 |
$ 58.00 |
$ 15.90 |
| PROSTATICO (TRANSRECTAL) US |
76872 |
$ 90.00 |
$ 113.13 |
$ 30.12 |
| PROTEIN TOTAL URINE |
84156 |
$ 10.00 |
$ 40.07 |
$ 3.17 |
| Psychotherapy, 30 min |
90832 |
|
|
|
| Psychotherapy, 45 min |
90834 |
|
|
|
| Psychotherapy, 60 min |
90837 |
|
|
|
| PT (PROTHROMBIN TIME) |
85610 |
$ 25.85 |
$ 12.00 |
$ 3.40 |
| PTT (THROMBOPLASTIN TIME) |
85730 |
$ 25.85 |
$ 14.00 |
$ 5.19 |
| Removal of cataract with insertion of lens |
66984 |
|
|
|
| Removal of Central Venous Acce |
36590 |
$ 2,397.00 |
$ 806.00 |
$ 475.00 |
| Removal of polyps or growths of large bowel using an endoscope |
45385 |
|
|
|
| Removal of recurring cataract in lens capsule using laser |
66821 |
|
|
|
| Removal of tonsils and adenoid glands patient younger than age 12 |
42820 |
|
|
|
| Remove pelvis hip f body |
27086 |
$ 1,434.59 |
$ 1,300.00 |
$ 475.00 |
| RENAL FUNCTION PANEL |
80069 |
$ 150.00 |
$ 70.00 |
$ 7.50 |
| RENAL-KIDNEY/BLADDER US LT |
76770 |
$ 48.00 |
$ 80.00 |
$ 28.00 |
| Reverse Total Shoulder Arthrop |
23472 |
$ 6,621.60 |
$ 1,300.00 |
$ 475.00 |
| RIB UNILATERAL LEFT XR |
71100 |
$ 30.84 |
$ 52.45 |
$ 10.50 |
| RIBS BILATERAL XR |
71110 |
$ 43.32 |
$ 73.66 |
$ 11.56 |
| SACRUM COCCYX XR |
72220 |
$ 29.22 |
$ 52.45 |
$ 9.26 |
| SCREENING MAMMOGRA DIGITAL LT |
77067 |
$ 105.18 |
$ 118.89 |
$ 14.92 |
| SCROTUM (TESTICULO) US |
76870 |
$ 48.00 |
$ 74.93 |
$ 17.57 |
| SEDIMENTATION RATE (SED RATE) |
85651 |
$ 19.00 |
$ 8.00 |
$ 3.07 |
| SGOT (TRANSF ASPARTATE AMINO) |
84450 |
$ 30.00 |
$ 10.00 |
$ 4.47 |
| SGPT (TRANSFERASE ALANINE AMI |
84460 |
$ 30.00 |
$ 10.00 |
$ 4.58 |
| SHOULDER 1 VIEW XR RT |
73020 |
$ 24.42 |
$ 52.45 |
$ 6.50 |
| SHOULDER 2 O MAS VISTAS LT XR |
73030 |
$ 34.02 |
$ 52.45 |
$ 9.44 |
| Sigmoidoscopy |
45330 |
$ 1,140.54 |
$ 806.00 |
$ 475.00 |
| SINUSES CT |
70486 |
$ 225.00 |
$ 260.00 |
$ 47.96 |
| SKULL COMP. XR |
70260 |
$ 43.32 |
$ 73.66 |
$ 13.68 |
| Sleep study |
95810 |
|
|
|
| SODIUM; URINE |
84300 |
$ 16.10 |
$ 8.00 |
$ 4.10 |
| Spinal fusion except cervical without major comorbid conditions or complications (MCC) |
460 |
|
|
|
| Surgical removal of prostate and surrounding lymph nodes using an endoscope |
55866 |
|
|
|
| SYPHILIS TEST; QUAL. (VDRL) |
86592 |
$ 15.50 |
$ 12.00 |
$ 3.69 |
| TEMPOROMANDIBULAR BILA. XR |
70330 |
$ 46.86 |
$ 312.50 |
$ 12.68 |
| Tenolysi ext tendon dors hand |
26445 |
$ 1,573.49 |
$ 1,411.69 |
$ 470.56 |
| Tenolysis flexor tendon |
26442 |
$ 2,054.05 |
$ 1,300.00 |
$ 394.22 |
| THEOPHYLINE (AMINOPHYLLINE) |
80198 |
$ 45.00 |
$ 40.00 |
$ 12.22 |
| THORACIC SPINE CT |
72128 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| THORACIC SPINE W/CONTRAST CT |
72129 |
$ 240.00 |
$ 260.00 |
$ 83.12 |
| THORACIC SPINE XR |
72070 |
$ 29.22 |
$ 73.66 |
$ 9.50 |
| THORACO-LUMBER SPINE XR |
72080 |
$ 38.52 |
$ 52.45 |
$ 9.26 |
| THOR-LUMB,SKULL,CERV &SACR 2,3 |
72082 |
$ 57.00 |
$ 73.66 |
$ 10.00 |
| THYROXINE FREE (T4 FREE) |
84439 |
$ 35.00 |
$ 30.00 |
$ 7.79 |
| TIBIA & FIBULA (LEG) LT XR |
73590 |
$ 24.42 |
$ 52.45 |
$ 9.00 |
| TIROIDE (NECK) US |
76536 |
$ 48.00 |
$ 91.35 |
$ 21.00 |
| TOES XR RT |
73660 |
$ 19.92 |
$ 52.45 |
$ 6.83 |
| Total Vaginal Hysterectomy |
58150 |
$ 3,138.31 |
$ 872.37 |
$ 475.00 |
| TRIGLYCERIDES |
84478 |
$ 18.70 |
$ 15.00 |
$ 4.96 |
| TROPONIN QUAN. |
84484 |
$ 110.00 |
$ 65.00 |
$ 8.73 |
| TSH (THYROID STIMULATING HORM |
84443 |
$ 55.00 |
$ 50.00 |
$ 14.53 |
| Ultrasound examination of lower large bowel using an endoscope |
45391 |
|
|
|
| UNILATERAL MAMMOGR DIGITAL LT |
77065 |
$ 80.20 |
$ 112.45 |
$ 21.06 |
| UPPER EXTREMITY CT RT |
73200 |
$ 225.00 |
$ 260.00 |
$ 55.38 |
| Uretherotomy |
52276 |
$ 1,416.17 |
$ 974.21 |
$ 475.00 |
| URIC ACID BLOOD |
84550 |
$ 20.00 |
$ 10.00 |
$ 3.91 |
| URINALIS AUTOMAT W/O MICROSC |
81003 |
$ 4.00 |
$ 8.00 |
$ 1.00 |
| URINALYSIS AUTOMATED W MICROSC |
81001 |
$ 15.00 |
$ 8.00 |
$ 2.74 |
| UTERINE AND ADNEXA PROCEDURES FOR NON-MALINGANC W/O CC MCC |
743 |
$ 6,765.79 |
|
|
| Vaginal Delivery, Antepartum and Postpartum Care Procedures |
59400 |
$ 1,999.93 |
|
|
| VANCOMYCIN |
80202 |
$ 44.00 |
$ 74.00 |
$ 11.70 |
| Venus Port |
36561 |
$ 1,981.87 |
$ 806.00 |
$ 475.00 |
| VESICULA(GALLBLADDER) US |
76705 |
$ 48.00 |
$ 80.00 |
$ 17.50 |
| WATER VIEW XR |
70210 |
$ 19.92 |
$ 52.45 |
$ 7.86 |
| Wide local excision (ginecolog |
11420 |
$ 1,290.00 |
$ 1,595.00 |
$ 475.00 |
| WRIST COMP. XR RT |
73110 |
$ 29.22 |
$ 52.45 |
$ 12.00 |
| WRIST XR RT |
73100 |
$ 24.42 |
$ 52.45 |
$ 9.00 |