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 |