A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.  This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.

  • These charges are rarely the price that patients pay. The Fee Schedule lists the dollar amount set for each service prior to insurance contract/benefit plan discounts or self-pay discounts being applied, so the price patients pay tends to be less than the standard charge.
  • Hospital charges differ from patient to patient for the same service depending upon variations in treatment.
  • Patients who are eligible for financial assistance also receive additional discounts.
Code Mod Description  Current Charge
10060 G INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE  $      591.50
10061 G INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE  $      979.89
10120 G INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE  $      704.37
11042 G DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<  $  1,250.00
11055 G PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1  $      165.00
11056 G PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4  $      231.04
11200 G REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15  $      455.00
11201 G REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10  $      133.16
11301 G SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM  $      359.00
11400 G EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<  $      374.00
11401 G EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM  $      723.00
11402 G EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM  $      767.00
11403 G EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM  $      867.00
11420 G EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<  $      690.00
11421 G EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM  $      842.00
11422 G EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM  $      885.00
11423 G EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM  $  1,015.00
11424 G EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM  $  1,019.00
11426 G EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM  $  1,574.00
11441 G EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM  $      857.00
11442 G EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM  $      960.00
11444 G EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM  $  1,245.81
11446 G EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM  $  2,414.69
11601 G EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM  $  1,001.00
11602 G EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM  $      649.00
11603 G EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM  $      770.00
11646 G EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM  $  2,364.38
11719 G TRIMMING NONDYSTROPHIC NAILS ANY NUMBER  $        81.00
11720 G DEBRIDEMENT NAIL ANY METHOD 1-5  $      148.80
11730 G AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1  $      695.00
11732 G AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL  $      790.13
11765 G WEDGE EXCISION SKIN NAIL FOLD  $      494.30
11976 G REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES  $      850.00
11981 G INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT  $      750.00
11982 G REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT  $      850.00
11983 G RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT  $  1,329.00
12001 G SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<  $      624.00
12002 G SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM  $      685.00
12004 G SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM  $      815.00
12005 G SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM  $  1,251.73
12011 G SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<  $      783.00
12013 G SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM  $      868.00
12014 G SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM  $  1,118.57
12031 G REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<  $      605.00
12032 G REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM  $      746.44
12034 G REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM  $      880.00
12035 G REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM  $  1,793.26
12051 G REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<  $  1,500.00
12052 G REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM  $  1,417.00
12053 G REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM  $  1,192.00
17000 G DESTRUCTION PREMALIGNANT LESION 1ST  $      165.54
17003 G DESTRUCTION PREMALIGNANT LESION 2-14 EA  $        17.00
19000 G PUNCTURE ASPIRATION CYST BREAST  $      609.00
20550 G INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS  $      335.00
20552 G INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES  $      400.00
20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES  $      520.00
20600 G ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US  $      355.00
20605 G ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US  $      375.00
20610 G ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US  $      405.00
24071 G EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>  $  2,949.87
26641 G CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ  $  2,318.98
29065 G APPLICATION CAST SHOULDER HAND LONG ARM  $      549.00
29075 G APPLICATION CAST ELBOW FINGER SHORT ARM  $      495.00
29085 G APPLICATION CAST HAND & LOWER FOREARM GAUNTLET  $      520.00
29086 G APPLICATION CAST FINGER  $      453.56
29105 G APPLICATION LONG ARM SPLINT SHOULDER HAND  $      501.00
29125 G APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC  $      367.00
29130 G APPLICATION FINGER SPLINT STATIC  $      203.48
29345 G APPLICATION LONG LEG CAST THIGH-TOE  $      778.00
29405 G APPLICATION SHORT LEG CAST BELOW KNEE-TOE  $      450.00
29505 G APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES  $      475.00
29515 G APPLICATION SHORT LEG SPLINT CALF FOOT  $      409.00
29705 G REMOVAL/BIVALVING FULL ARM/FULL LEG CAST  $      439.92
30901 G CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE  $      600.00
36410 G VNPNXR 3 YEARS/> PHYS/QHP SKILL  $        95.22
36415 G COLLECTION VENOUS BLOOD VENIPUNCTURE  $        43.00
40810 G EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR  $  1,115.16
46083 G INCISION THROMBOSED HEMORRHOID EXTERNAL  $      978.74
46600 G ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD  $      300.00
51701 G INSJ NON-NDWELLG BLADDER CATHETER  $      396.75
51702 G INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE  $      520.00
54056 G DSTRJ LESION PENIS SIMPLE CRYOSURGERY  $      618.00
54065 G DSTRJ LESION PENIS EXTENSIVE  $  1,101.20
57061 G DESTRUCTION VAGINAL LESIONS SIMPLE  $      854.47
57065 G DESTRUCTION VAGINAL LESIONS EXTENSIVE  $  1,771.02
57160 G FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI  $      450.00
58100 G ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX  $      650.00
58300 G INSERTION INTRAUTERINE DEVICE IUD  $      717.00
58301 G REMOVAL INTRAUTERINE DEVICE IUD  $      550.00
59430 G POSTPARTUM CARE ONLY SEPARATE PROCEDURE  $      923.00
62270 G DIAGNOSTIC LUMBAR SPINAL PUNCTURE  $  1,250.00
64400 G INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH  $  1,200.00
64405 G INJECTION AA&/STRD GREATER OCCIPITAL NERVE  $  3,140.00
64615 G CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE  $  2,155.00
69210 G REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT  $      266.00
70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS  $      345.59
70190 G RADEX OPTIC FORAMINA  $      255.74
70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE  $      217.72
71045 G RADIOLOGIC EXAM CHEST SINGLE VIEW  $      166.00
71046 G RADIOLOGIC EXAM CHEST 2 VIEWS  $      210.00
71047 G RADIOLOGIC EXAM CHEST 3 VIEWS  $      407.79
71048 G RADIOLOGIC EXAM CHEST 4+ VIEWS  $      438.90
71100 G RADEX RIBS UNILATERAL 2 VIEWS  $      228.00
71101 G RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS  $      261.00
72040 G RADEX SPINE CERVICAL 2 OR 3 VIEWS  $      283.00
72072 G RADEX SPINE THORACIC 3 VIEWS  $      277.00
72074 G RADEX SPINE THORACIC MINIMUM 4 VIEWS  $      302.00
72100 G RADEX SPINE LUMBOSACRAL 2/3 VIEWS  $      245.00
72170 G RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS  $      210.00
73030 G RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS  $      280.00
73060 G RADEX HUMERUS MINIMUM 2 VIEWS  $      260.00
73070 G RADEX ELBOW 2 VIEWS  $      200.00
73090 G RADEX FOREARM 2 VIEWS  $      203.00
73100 G RADEX WRIST 2 VIEWS  $      195.00
73110 G RADEX WRIST COMPLETE MINIMUM 3 VIEWS  $      216.00
73130 G RADEX HAND MINIMUM 3 VIEWS  $      214.00
73140 G RADEX FINGR MINIMUM 2 VIEWS  $      158.00
73501 G RADEX HIP UNILATERAL WITH PELVIS 1 VIEW  $      205.00
73560 G RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS  $      215.00
73562 G RADIOLOGIC EXAMINATION KNEE 3 VIEWS  $      231.00
73590 G RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS  $      210.00
73600 G RADIOLOGIC EXAMINATION ANKLE 2 VIEWS  $      220.00
73610 G RADEX ANKLE COMPLETE MINIMUM 3 VIEWS  $      215.00
73620 G RADIOLOGIC EXAMINATION FOOT 2 VIEWS  $      200.00
73630 G RADEX FOOT COMPLETE MINIMUM 3 VIEWS  $      225.00
73650 G RADEX CALCANEUS MINIMUM 2 VIEWS  $      185.00
73660 G RADEX TOE MINIMUM 2 VIEWS  $      186.00
74018 G RADIOLOGIC EXAM ABDOMEN 1 VIEW  $      204.00
74019 G RADIOLOGIC EXAM ABDOMEN 2 VIEWS  $      252.00
74021 G RADIOLOGIC EXAM ABDOMEN 3+ VIEWS  $      265.00
78451 G MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS  $  2,246.32
80048 G BASIC METABOLIC PANEL CALCIUM TOTAL  $        70.48
80051 G ELECTROLYTE PANEL  $        23.78
80053 G COMPREHENSIVE METABOLIC PANEL  $        75.00
80061 G LIPID PANEL  $      121.00
80069 G RENAL FUNCTION PANEL  $        76.35
80074 G ACUTE HEPATITIS PANEL  $      377.17
80076 G HEPATIC FUNCTION PANEL  $        67.51
80156 G DRUG ASSAY CARBAMAZEPINE TOTAL  $      121.57
80162 G DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL  $        93.00
80164 G DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL  $      120.50
80175 G DRUG SCREEN QUANTITATIVE LAMOTRIGINE  $      160.00
80178 G DRUG SCREEN QUANTITATIVE LITHIUM  $        72.34
80201 G DRUG SCREEN QUANTITATIVE TOPIRAMATE  $      173.11
80202 G DRUG SCREEN QUANTITATIVE VANCOMYCIN  $      111.00
80299 G QUANTITATION DRUG NOT ELSEWHERE SPECIFIED  $      181.56
80307 G DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE  $      200.00
80323 G ALKALOIDS NOT OTHERWISE SPECIFIED  $      202.67
80327 G DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2  $      204.78
81001 G URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY  $        42.00
81002 G URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP  $        35.00
81015 G URINALYSIS MICROSCOPIC ONLY  $        20.00
81025 G URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS  $        70.00
81243 G FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES  $      500.00
81256 G HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS  $      534.31
81327 G SEPT9 GENE PROMOTER METHYLATION ANALYSIS  $      445.44
81374 G HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH  $      225.00
82024 G ADRENOCORTICOTROPIC HORMONE ACTH  $      215.33
82040 G ALBUMIN SERUM PLASMA/WHOLE BLOOD  $          6.97
82043 G URINE ALBUMIN QUANTITATIVE  $        81.00
82075 G ASSAY OF ALCOHOL (ETHANOL) BREATH  $        50.00
82085 G ASSAY OF ALDOLASE  $        76.50
82103 G ALPHA-1-ANTITRYPSIN TOTAL  $        88.79
82105 G ALPHA-FETOPROTEIN SERUM  $        99.00
82140 G ASSAY OF AMMONIA  $      129.00
82150 G ASSAY OF AMYLASE  $        53.17
82154 G ANDROSTANEDIOL GLUCURONIDE  $      346.22
82157 G ANDROSTENEDIONE  $      222.73
82172 G APOLIPOPROTEIN EACH  $        80.50
82175 G ASSAY OF ARSENIC  $      182.23
82247 G BILIRUBIN TOTAL  $          3.60
82270 G BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER  $        40.00
82274 G BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3  $        95.00
82300 G CADMIUM  $      154.11
82306 G 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED  $      241.84
82310 G CALCIUM TOTAL  $          5.44
82330 G CALCIUM IONIZED  $        96.00
82340 G CALCIUM URINE QUANTITATIVE TIMED SPECIMEN  $        41.00
82365 G CALCULUS INFRARED SPECTROSCOPY  $      137.22
82378 G CARCINOEMBRYONIC ANTIGEN CEA  $      106.92
82397 G CHEMILUMINESCENT ASSAY  $      182.81
82465 G CHOLESTEROL SERUM/WHOLE BLOOD TOTAL  $        38.56
82507 G ASSAY OF CITRATE  $      139.62
82530 G CORTISOL FREE  $      140.04
82533 G CORTISOL TOTAL  $      100.76
82540 G ASSAY OF CREATINE  $        76.00
82542 G COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC  $      142.85
82550 G CREATINE KINASE TOTAL  $        57.37
82565 G CREATININE BLOOD  $        19.00
82570 G CREATININE OTHER SOURCE  $        64.50
82575 G CREATININE CLEARANCE  $      103.44
82595 G CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE  $        90.78
82607 G CYANOCOBALAMIN VITAMIN B-12  $      106.00
82626 G DEHYDROEPIANDROSTERONE  $      295.84
82627 G DEHYDROEPIANDROSTERONE-SULFATE  $      213.72
82652 G 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED  $      297.50
82664 G ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED  $      236.44
82670 G ASSAY OF TOTAL ESTRADIOL  $      218.00
82672 G ASSAY OF ESTROGENS TOTAL  $      193.48
82705 G FAT/LIPIDS FECES QUALITATIVE  $        99.00
82728 G ASSAY OF FERRITIN  $        94.75
82746 G ASSAY OF FOLIC ACID SERUM  $        97.00
82747 G ASSAY OF FOLIC ACID RBC  $      166.48
82784 G ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH  $        69.75
82785 G ASSAY OF GAMMAGLOBULIN IGE  $      112.50
82947 G GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP  $          7.82
82948 G GLUCOSE BLOOD REAGENT STRIP  $        25.00
82950 G GLUCOSE POST GLUCOSE DOSE  $        40.00
82951 G GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS  $      128.00
82977 G ASSAY OF GLUTAMYLTRASE GAMMA  $        50.62
83001 G GONADOTROPIN FOLLICLE STIMULATING HORMONE  $      134.98
83002 G GONADOTROPIN LUTEINIZING HORMONE  $      136.03
83010 G ASSAY OF HAPTOGLOBIN QUANTITATIVE  $      103.79
83013 G HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE  $      375.00
83036 G HEMOGLOBIN GLYCOSYLATED A1C  $        83.00
83090 G ASSAY OF HOMOCYSTEINE  $      186.00
83516 G IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP  $      169.29
83518 G IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP  $        34.54
83519 G IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY  $      259.92
83520 G IMMUNOASSAY ANALYTE QUANTITATIVE NOS  $      198.00
83525 G ASSAY OF INSULIN TOTAL  $        75.00
83527 G ASSAY OF INSULIN FREE  $      158.33
83540 G ASSAY OF IRON  $        41.00
83550 G IRON BINDING CAPACITY  $        50.62
83615 G LACTATE DEHYDROGENASE LDH  $        40.57
83655 G ASSAY OF LEAD  $        60.00
83690 G ASSAY OF LIPASE  $        65.24
83695 G LIPOPROTEIN (A)  $      155.00
83701 G LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS  $      282.89
83721 G LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL  $        94.50
83735 G ASSAY OF MAGNESIUM  $        55.12
83825 G ASSAY OF MERCURY QUANTITATIVE  $      155.23
83872 G MUCIN SYNOVIAL FLUID ROPES TEST  $        65.44
83880 G NATRIURETIC PEPTIDE  $      234.00
83883 G ASSAY OF NEPHELOMETRY EACH ANALYTE NES  $      295.00
83921 G ORGANIC ACID 1 QUANTITATIVE  $      269.96
83930 G ASSAY OF OSMOLALITY BLOOD  $        68.08
83935 G ASSAY OF OSMOLALITY URINE  $        69.57
83945 G ASSAY OF OXALATE  $        65.70
83970 G ASSAY OF PARATHORMONE  $      167.58
83986 G PH BODY FLUID NOT ELSEWHERE SPECIFIED  $        33.00
84075 G ASSAY OF PHOSPHATASE ALKALINE  $          3.60
84100 G ASSAY OF PHOSPHORUS INORGANIC  $        40.13
84105 G ASSAY OF PHOSPHORUS INORGANIC URINE  $        28.97
84133 G POTASSIUM URINE  $        43.50
84134 G PREALBUMIN  $      119.24
84144 G ASSAY OF PROGESTERONE  $      138.00
84145 G PROCALCITONIN (PCT)  $      181.56
84146 G ASSAY OF PROLACTIN  $      144.89
84153 G ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL  $      135.00
84155 G PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD  $          4.77
84156 G PROTEIN TOTAL XCPT REFRACTOMETRY URINE  $        48.07
84207 G ASSAY OF PYRIDOXAL PHOSPHATE  $      251.97
84300 G ASSAY OF URINE SODIUM  $        37.93
84305 G ASSAY OF SOMATOMEDIN  $      317.00
84376 G SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC  $        90.78
84392 G ASSAY OF SULFATE URINE  $        27.00
84402 G ASSAY OF TESTOSTERONE FREE  $      197.00
84403 G ASSAY OF TESTOSTERONE TOTAL  $      190.00
84425 G ASSAY OF THIAMINE-VITAMIN B-1  $      179.55
84436 G ASSAY OF THYROXINE TOTAL  $        60.67
84439 G ASSAY OF FREE THYROXINE  $      104.67
84443 G ASSAY OF THYROID STIMULATING HORMONE TSH  $      105.00
84450 G TRANSFERASE ASPARTATE AMINO AST SGOT  $          6.97
84460 G TRANSFERASE ALANINE AMINO ALT SGPT  $        19.00
84466 G ASSAY OF L7383TRANSFERRIN  $        94.29
84478 G ASSAY OF TRIGLYCERIDES  $        42.74
84479 G THYROID HORM UPTK/THYROID HORMONE BINDING RATIO  $        60.66
84480 G ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3  $      121.34
84481 G ASSAY OF TRIIODOTHYRONINE T3 FREE  $      234.00
84484 G ASSAY OF TROPONIN QUANTITATIVE  $      122.08
84520 G ASSAY OF UREA NITROGEN QUANTITATIVE  $          5.74
84550 G ASSAY OF BLOOD/URIC ACID  $        40.13
84560 G ASSAY OF URIC ACID OTHER SOURCE  $        41.00
84600 G ASSAY OF VOLATILES  $      107.67
84630 G ASSAY OF ZINC  $      101.00
84681 G ASSAY OF C-PEPTIDE  $      130.00
84702 G GONADOTROPIN CHORIONIC QUANTITATIVE  $      146.43
84703 G GONADOTROPIN CHORIONIC QUALITATIVE  $      110.00
85014 G BLOOD COUNT HEMATOCRIT  $        36.62
85018 G BLOOD COUNT HEMOGLOBIN  $        50.00
85025 G BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC  $        49.00
85045 G BLOOD COUNT RETICULOCYTE AUTOMATED  $        45.58
85246 G CLOTTING FACTOR VIII VW FACTOR ANTIGEN  $      316.67
85384 G FIBRINOGEN ACTIVITY  $        90.00
85610 G PROTHROMBIN TIME  $        43.00
85651 G SEDIMENTATION RATE RBC NON-AUTOMATED  $        35.00
85652 G SEDIMENTATION RATE RBC AUTOMATED  $        38.50
85730 G THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD  $        44.00
86003 G ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH  $        39.62
86038 G ANTINUCLEAR ANTIBODIES ANA  $        86.86
86060 G ANTISTREPTOLYSIN O TITER  $        57.37
86140 G C-REACTIVE PROTEIN  $        75.37
86141 G C-REACTIVE PROTEIN HIGH SENSITIVITY  $        92.00
86146 G BETA 2 GLYCOPROTEIN I ANTIBODY EACH  $      164.79
86147 G CARDIOLIPIN ANTIBODY EACH IG CLASS  $      110.00
86200 G CYCLIC CITRULLINATED PEPTIDE ANTIBODY  $      137.24
86225 G DNA ANTIBODY NATIVE/DOUBLE STRANDED  $      126.00
86235 G EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD  $      125.56
86304 G IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125  $      175.00
86308 G HETEROPHILE ANTIBODIES SCREEN  $        64.00
86317 G IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS  $      127.00
86336 G INHIBIN A  $        92.94
86341 G ISLET CELL ANTIBODY  $      217.27
86376 G MICROSOMAL ANTIBODIES EACH  $      101.00
86382 G NEUTRALIZATION TEST VIRAL  $      204.78
86403 G PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY  $        50.67
86431 G RHEUMATOID FACTOR QUANTITATIVE  $        58.49
86480 G TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON  $      232.00
86580 G SKIN TEST TUBERCULOSIS INTRADERMAL  $        49.00
86592 G SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL  $        44.00
86611 G ANTIBODY BARTONELLA  $        97.11
86615 G ANTIBODY BORDETELLA  $      158.33
86617 G ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST  $      112.49
86618 G ANTIBODY BORRELIA BURGDORFERI LYME DISEASE  $      178.85
86631 G ANTIBODY CHLAMYDIA  $      105.56
86632 G ANTIBODY CHLAMYDIA IGM  $      124.56
86641 G ANTIBODY CRYPTOCOCCUS  $      152.00
86644 ANTIBODY CYTOMEGALOVIRUS CMV  $      112.49
86664 G ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA  $      112.09
86665 G ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA  $      132.96
86677 G ANTIBODY HELICOBACTER PYLORI  $      153.00
86689 G ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST  $      242.78
86695 G ANTIBODY HERPES SMPLX TYPE 1  $      109.00
86696 G ANTIBODY HERPES SMPLX TYPE 2  $      145.17
86701 G ANTIBODY HIV-1  $      157.67
86703 G ANTIBODY HIV-1&HIV-2 SINGLE RESULT  $      180.50
86705 G HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY  $        97.00
86706 G HEPATITIS B SURF ANTIBODY HBSAB  $        89.50
86708 G HEPATITIS A ANTIBODY HAAB  $      110.24
86709 G HEPATITIS ANTIBODY HAAB IGM ANTIBODY  $        96.48
86735 G ANTIBODY MUMPS  $      132.74
86747 G ANTIBODY PARVOVIRUS  $      113.00
86762 G ANTIBODY RUBELLA  $        84.33
86765 G ANTIBODY RUBEOLA  $      136.10
86777 G ANTIBODY TOXOPLASMA  $      110.76
86787 G ANTIBODY VARICELLA-ZOSTER  $      148.48
86800 G THYROGLOBULIN ANTIBODY  $      115.86
86803 G HEPATITIS C ANTIBODY  $      108.25
86812 G HLA TYPING A/B/C SINGLE ANTIGEN  $      187.86
86850 G ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE  $        52.87
86900 G BLOOD TYPING SEROLOGIC ABO  $        45.00
86910 G BLOOD TYPING PATERNITY PR INDIV ABO RH&MN  $      209.00
87040 G CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES  $        81.13
87045 G CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL  $        76.67
87070 G CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL  $      104.89
87073 G CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL  $        69.67
87075 G CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID  $      119.50
87076 G CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL  $        50.62
87077 G CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL  $        32.62
87081 G CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ  $        95.90
87086 G CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE  $        72.00
87088 G CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE  $        36.00
87101 G CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL  $      103.00
87102 G CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD  $        99.08
87172 G PINWORM EXAMINATION  $        59.11
87177 G OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID  $        58.86
87181 G SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ  $        44.33
87205 G SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL  $        51.99
87206 G SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT  $        83.50
87209 G SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS  $      118.90
87210 G SMR PRIM SRC WET MOUNT NFCT AGT  $        61.00
87220 G TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT  $        72.00
87254 G VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA  $      129.92
87255 G VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC  $      153.00
87280 G IAADI RESPIRATORY SYNCTIAL VIRUS  $        73.89
87299 G IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM  $      135.11
87324 G IAAD IA CLOSTRIDIUM DIFFICILE TOXIN  $      132.98
87327 G IAAD IA CRYPTOCOCCUS NEOFORMANS  $      101.33
87329 G IAAD IA GIARDIA  $        93.36
87338 G IAAD IA HPYLORI STOOL  $      221.00
87340 G IAAD IA HEPATITIS B SURFACE ANTIGEN  $        84.36
87389 G IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE  $      168.00
87390 G IAAD IA HIV-1  $      166.78
87430 G IAAD IA STREPTOCOCCUS GROUP A  $        70.00
87480 G IADNA CANDIDA SPECIES DIRECT PROBE TQ  $      126.00
87491 G IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ  $      220.00
87502 G INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES  $      350.00
87517 G IADNA HEPATITIS B VIRUS QUANTIFICATION  $      653.00
87522 G IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION  $      571.43
87591 G IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ  $      220.00
87624 G IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES  $      190.70
87635 G IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ  $      130.00
87641 G IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ  $      220.00
87661 G IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH  $      173.23
87798 G IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM  $      113.62
87799 G IADNA NOS QUANTIFICATION EACH ORGANISM  $      507.25
87801 G IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ  $      210.02
87804 G IAADIADOO INFLUENZA  $      105.00
87808 G IAADIADOO TRICHOMONAS VAGINALIS  $        52.05
87810 G IAADIADOO CHLAMYDIA TRACHOMATIS  $        80.22
87880 G IAADIADOO STREPTOCOCCUS GROUP A  $      105.00
87902 G NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS  $      769.40
87905 G INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS  $        80.00
88104 G CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ  $      392.67
88108 G CYTP CONCENTRATION SMEARS & INTERPRETATION  $      373.00
88112 G CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V  $      169.00
88142 G CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN  $        87.73
88160 G CYTP SMRS ANY OTH SRC SCR&INTERPJ  $      309.00
88174 G CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS  $      192.11
88175 G CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS  $      109.66
88300 G LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY  $      107.00
88302 G LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM  $      307.00
88305 G LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM  $      459.00
88307 G LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM  $  1,125.00
90471 G IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE  $        59.00
90472 G IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE  $        31.00
90473 G IM ADM INTRANSL/ORAL 1 VACCINE  $        51.00
90474 G IM ADM INTRANSL/ORAL EA VACCINE  $        31.00
90632 G HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE  $      177.00
90633 G HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE  $        67.00
90636 G HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM  $      205.00
90649 G 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE  $      325.00
90658 G IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE  $        36.00
90660 G LAIV3 VACCINE LIVE FOR INTRANASAL USE  $      108.70
90670 G PCV13 VACCINE FOR INTRAMUSCULAR USE  $      241.00
90674 G CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE  $        45.00
90675 G RABIES VACCINE INTRAMUSCULAR  $      390.00
90680 RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE  $      176.00
90686 G IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE  $        35.00
90691 G TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM  $      150.00
90700 G DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM  $        60.00
90707 G MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ  $      111.00
90713 G POLIOVIRUS VACCINE INACTIVATED SUBQ/IM  $        72.00
90714 G TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE  $        51.00
90715 G TDAP VACCINE 7 YRS/> IM  $        83.00
90716 G VAR VACCINE LIVE FOR SUBCUTANEOUS USE  $      196.00
90717 G YELLOW FEVER VACCINE LIVE SUBQ  $      180.00
90723 G DTAP-HEPB-IPV VACCINE INTRAMUSCULAR  $      120.00
90732 G PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE  $      150.00
90734 G MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE  $      238.00
90736 G ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE  $      585.07
90738 G JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM  $      390.00
90739 G HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE  $      170.00
90740 G HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM  $      792.88
90744 G HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM  $        80.00
90746 G HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE  $      223.00
90750 G HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX  $      250.00
90785 G PSYCHOTHERAPY COMPLEX INTERACTIVE  $        90.00
90791 G PSYCHIATRIC DIAGNOSTIC EVALUATION  $      380.00
90832 G PSYCHOTHERAPY W/PATIENT 30 MINUTES  $      196.00
90834 G PSYCHOTHERAPY W/PATIENT 45 MINUTES  $      248.00
90837 G PSYCHOTHERAPY W/PATIENT 60 MINUTES  $      240.00
90839 G PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES  $      450.00
90840 G PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES  $      250.00
90846 G FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS  $      250.00
90847 G FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS  $      283.00
90853 G GROUP PSYCHOTHERAPY  $      175.00
92283 G COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV  $      179.04
92551 G SCREENING TEST PURE TONE AIR ONLY  $        70.00
92558 G EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS  $        39.00
92567 G TYMPANOMETRY  $      134.00
93000 G ECG ROUTINE ECG W/LEAST 12 LDS W/I&R  $      163.00
93005 G ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R  $      142.00
93010 G ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY  $        74.00
93015 G CV STRS TST XERS&/OR RX CONT ECG W/SI&R  $      794.00
93320 G DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY  $      895.00
93350 G ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST  $  1,336.38
93922 G NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL  $      879.00
94010 G SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ  $      210.00
94150 G VITAL CAPACITY TOTAL SEPARATE PROCEDURE  $        95.91
94640 G PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT  $      140.00
94664 G DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP  $      102.00
94760 G NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER  $        80.00
95115 G PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX  $        30.00
95117 G PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS  $        40.00
95120 G PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX  $        88.75
95806 G SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT  $  1,800.00
96372 G THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM  $      101.50
97110 G THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES  $      102.00
97161 G PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS  $      250.00
97162 G PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS  $      252.00
97163 G PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS  $      275.00
97164 G PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS  $      172.00
97530 G THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN  $        90.00
97597 G DEBRIDEMENT OPEN WOUND 20 SQ CM/<  $      441.00
97598 G DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM  $      193.00
97803 G MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M  $      100.00
98966 G NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN  $        55.90
98967 G NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN  $        92.20
98968 G NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN  $      137.16
99000 G HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB  $        40.00
99050 G SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS  $      342.99
99172 G VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM  $        95.91
99173 G SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT  $        28.00
99202 G OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES  $      237.00
99203 G OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES  $      349.00
99204 G OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES  $      585.00
99205 G OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES  $      765.00
99211 G OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S)  $      106.00
99212 G OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN  $      159.00
99213 G OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN  $      236.40
99214 G OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN  $      351.00
99215 G OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN  $      522.00
99347 G HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES  $      265.00
99381 G INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR  $      340.00
99382 G INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS  $      339.00
99383 G INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS  $      341.00
99384 G INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR  $      395.00
99385 G INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS  $      455.00
99386 G INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS  $      510.00
99387 G INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>  $      592.00
99391 G PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y  $      285.00
99392 G PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS  $      250.00
99393 G PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS  $      250.00
99394 G PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS  $      330.00
99395 G PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS  $      395.00
99396 G PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS  $      430.00
99397 G PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER  $      450.00
99441 G PHYS/QHP TELEPHONE EVALUATION 5-10 MIN  $      109.19
99442 G PHYS/QHP TELEPHONE EVALUATION 11-20 MIN  $      219.39
99443 G PHYS/QHP TELEPHONE EVALUATION 21-30 MIN  $      325.54
99450 G BASIC LIFE AND/OR DISABILITY EXAMINATION  $      218.05
A4352 G COUDE TIP URINARY CATHETER  $        11.40
A4353 G INTERMITTENT URINARY CATH  $        14.25
A4358 G URINARY LEG OR ABDOMEN BAG  $        20.52
A4550 G SURGICAL TRAYS  $      100.00
A4565 G SLINGS  $        30.01
A4566 G SHOULD SLING/VEST/ABRESTRAIN  $        40.00
A4570 G SPLINT  $        59.99
A4614 G HAND-HELD PEFR METER  $      103.01
A5112 G URINARY LEG BAG  $        91.35
A6448 G LT COMPRES BAND <3/YD”  $        10.00
A6449 G LT COMPRES BAND >=3 <5″/YD”  $          2.80
A6450 G LT COMPRES BAND >=5/YD”  $          6.09
A6453 G SELF-ADHER BAND W <3/YD”  $          1.73
A6530 G COMPRESSION STOCKING BK18-30  $      113.99
A9999 G DME SUPPLY OR ACCESSORY, NOS  $               –
E0100 NU CANE ADJUST/FIXED WITH TIP  $        61.12
E0114 NU CRUTCH UNDERARM PAIR NO WOOD  $      101.93
E0143 NU WALKER FOLDING WHEELED W/O S  $      192.93
E0570 NU NEBULIZER WITH COMPRESSION  $      305.60
G0008 ADMIN INFLUENZA VIRUS VAC  $        64.00
G0009 G ADMIN PNEUMOCOCCAL VACCINE  $        64.99
G0010 G ADMIN HEPATITIS B VACCINE  $        70.02
G0101 G CA SCREEN;PELVIC/BREAST EXAM  $      135.00
G0402 G INITIAL PREVENTIVE EXAM  $      444.08
G0438 G PPPS, INITIAL VISIT  $      507.92
G0439 G PPPS, SUBSEQ VISIT  $      340.00
G0466 G FQHC VISIT NEW PATIENT  $      265.05
G0467 G FQHC VISIT ESTAB PT  $      221.00
G0468 G FQHC VISIT IPPE OR AWV  $      283.92
G0469 G FQHC VISIT MH NEW PT  $      268.05
G0470 G FQHC VISIT MH ESTAB PT  $      249.99
H0001 G ALCOHOL AND/OR DRUG ASSESS  $      184.20
H0004 G ALCOHOL AND/OR DRUG SERVICES  $        50.00
H0005 G ALCOHOL AND/OR DRUG SERVICES  $      144.00
J0456 G AZITHROMYCIN  $      119.99
J0558 G PENG BENZATHINE/PROCAINE INJ  $        25.00
J0561 G PENICILLIN G BENZATHINE INJ  $        40.00
J0599 G INJ., HAEGARDA 10 UNITS  $          9.59
J0696 G CEFTRIAXONE SODIUM INJECTION  $        39.95
J1030 G METHYLPREDNISOLONE 40 MG INJ  $        27.00
J1040 G METHYLPREDNISOLONE 80 MG INJ  $        40.00
J1050 G MEDROXYPROGESTERONE ACETATE  $          1.60
J1071 G INJ TESTOSTERONE CYPIONATE  $          0.20
J1200 G DIPHENHYDRAMINE HCL INJECTIO  $        10.00
J1885 G KETOROLAC TROMETHAMINE INJ  $        20.00
J2550 G PROMETHAZINE HCL INJECTION  $        25.00
J3301 G TRIAMCINOLONE ACET INJ NOS  $        15.00
J3420 G VITAMIN B12 INJECTION  $        19.99
J7307 G ETONOGESTREL IMPLANT SYSTEM  $  1,870.00
J7325 G SYNVISC OR SYNVISC-ONE  $        38.00
J7509 G METHYLPREDNISOLONE ORAL  $        27.02
L0120 G CERV FLEX N/ADJ FOAM PRE OTS  $        52.98
L0625 G LO FLEX L1-BELOW L5 PRE OTS  $        99.98
L1830 G KO IMMOB CANVAS LONG PRE OTS  $      149.00
L1902 G AFO ANKLE GAUNTLET PRE OTS  $      150.00
L1906 G AFO MULTILIG ANK SUP PRE OTS  $      236.70
L1930 G AFO PLASTIC  $      387.93
L3040 G FT ARCH SUPRT PREMOLD LONGIT  $        96.98
L3260 G AMBULATORY SURGICAL BOOT EAC  $        60.02
L3660 G SO 8 AB RSTR CAN/WEB PRE OTS  $      124.98
L3702 G EO W/O JOINTS CF  $      543.97
L3762 G EO RIGID W/O JOINTS PRE OTS  $      180.00
L3809 G WHFO W/O JOINTS PRE OTS  $      330.02
L3908 G WHO COCK-UP NONMOLDE PRE OTS  $      106.35
L4350 G ANKLE CONTROL ORTHO PRE OTS  $      149.96
L4386 G NON-PNEUM WALK BOOT PRE CST  $      350.00
Q0091 G OBTAINING SCREEN PAP SMEAR  $      129.98
Q2037 G FLUVIRIN VACC, 3 YRS & >, IM  $        50.01
Q2038 G FLUZONE VACC, 3 YRS & >, IM  $        57.99
Q4006 G CAST SUP LONG ARM ADULT FBRG  $      100.01
Q4014 G CAST SUP GAUNTLET FIBERGLASS  $        96.00
S0630 G REMOVAL OF SUTURES  $      170.00
S8100 G SPACER WITHOUT MASK  $        59.99
S9982 G MED RECORD COPY PER PAGE  $          0.80
T1016 G CASE MANAGEMENT  $        56.53
U0003 G SARS-COV-2 COVID-19 AMP PRB HTT  $      200.08