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| CPT Code | Description | Charge Amount |
| 0202U | COVID-19 BioFire Respiratory Panel 2.1 (RP2.1) Testing | $2,550.77 |
| 10060 | INCISION/DRAINAGE ABSCESS | $1,662.80 |
| 10061 | INS/DRAIN ABSCESS COMPL | $2,634.00 |
| 10080 | INCISION & DRAINAGE PILONIDAL CYST SIMPLE | $2,042.91 |
| 10081 | I&D PILONIDAL CST COMP | $6,514.99 |
| 10120 | I & RMVL SUB-CUT SIMPLE | $2,763.00 |
| 10121 | I & RMVL FB, SUB-CUT,COMP | $13,253.00 |
| 10140 | I&D HEMATOMA SEROMA/FLUID COLLECTION | $16,139.30 |
| 10160 | PUNCTURE ASP OF ABSCESS | $1,565.00 |
| 10180 | Incision and drainage, complex, postoperative wound infecti… | $13,429.00 |
| 11010 | DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS | $9,150.60 |
| 11042 | DBRD SKN SUBQ TISSUE | $5,214.02 |
| 11043 | DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< | $6,821.00 |
| 11045 | DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM | $1,943.00 |
| 11200 | RMVL SKIN TAGS | $2,138.17 |
| 11730 | AVULSION/1-NAIL PLATE | $1,701.14 |
| 11732 | AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL | $528.00 |
| 11740 | EVAC SUBUNGUAL HEMATOMA | $760.00 |
| 11750 | EXC NAIL PART/COMP | $6,767.00 |
| 11760 | REPAIR NAIL BED | $8,549.00 |
| 12001 | LACERATION REPAIR | $1,143.98 |
| 12002 | REPAIR LAC SCALP 2.6-7.5 | $1,150.81 |
| 12004 | REPAIR LAC SCALP 7.6-12.5 | $1,170.04 |
| 12005 | REPAIR LAC,SCALP 12.6-20C | $1,176.00 |
| 12006 | SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM | $1,946.00 |
| 12007 | SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM | $2,540.00 |
| 12011 | REPAIR LAC FACE LESS THAN 2.5 CM | $1,119.40 |
| 12013 | REPAIR LAC FACE 2.6-5.0CM | $1,151.40 |
| 12014 | REPAIR LAC FACE 5.1-7.5CM | $1,558.00 |
| 12015 | SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM | $1,638.00 |
| 12020 | TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE | $3,785.00 |
| 12031 | LYR CLSR S/A/T/E 2.5CM | $1,915.00 |
| 12032 | REPAIR-INT SCALP 2.6-7.5 | $2,273.00 |
| 12034 | INTERM RPR SCLP/TRNK/EXTR | $3,165.00 |
| 12035 | REPAIR INTERM S/A/T/E 12. | $3,932.00 |
| 12041 | LAYER CLSR NECK/HAND 2.6 | $1,456.64 |
| 12042 | REPAIR LAC HAND/FOOT 2.6- | $1,546.44 |
| 12044 | LYR CLSR N/H/F/ETRNL GENT | $2,725.00 |
| 12051 | LAYER CLSR OF WND NCK/HND | $1,868.08 |
| 12052 | LYR CLSR WOUND 2.6-5.0FAC | $1,915.00 |
| 12053 | LYR CLSR F/E/E/N/L/M&/MUC | $2,188.00 |
| 12054 | REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM | $2,621.00 |
| 13101 | REPAIR COMPLEX TRUNK 2.6-7.5 CM | $11,504.00 |
| 13121 | RPR CMPX SCALP ARM2.6-7.5 | $4,622.00 |
| 13122 | CMPLX RPR ADD 5 CM OR LES | $1,846.73 |
| 13131 | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM | $2,831.00 |
| 13132 | RPR CMPX FOREHEAD/CHECK/C | $3,937.00 |
| 13133 | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< | $3,256.41 |
| 13151 | CMPX RPR EYE NOSE 1.1-2.5 | $4,087.00 |
| 13152 | RPR CPLX E/N/E/L 2.6-7.5 | $4,967.00 |
| 16000 | BURN, INITIAL TREATMENT | $1,631.80 |
| 16020 | BURN, DRESSING/DBRDMNT-SM | $1,510.00 |
| 16030 | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE | $3,353.15 |
| 17250 | UMBILICAL CAUTERIZATION | $1,454.69 |
| 19020 | MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP | $15,871.14 |
| 20103 | EXPLORATION PENETRATING WOUND SPX EXTREMITY | $9,778.00 |
| 20520 | REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE | $6,102.00 |
| 20525 | RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP | $14,267.00 |
| 20552 | TRIGGER POINT INJ 1-2 MUS | $7,891.00 |
| 20605 | ARTHROCENTESIS, MED JOINT | $4,695.00 |
| 20610 | ARTHROCENTESIS, LG JOINT | $5,568.00 |
| 20611 | Arthrocentesis, aspiration and/or injection, major joint or… | $3,964.00 |
| 21320 | CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION | $10,273.00 |
| 21480 | CLDS TX TEMP DISLOCATION | $1,842.00 |
| 21485 | CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ | $11,643.00 |
| 23600 | CLTX PROX HUMRL FX WO MAN | $2,165.12 |
| 23605 | CLTX PRX HMRL FX MNPJ+-TRACT | $6,012.00 |
| 23650 | SHOULDER DISLOCATION TRMT | $1,815.67 |
| 23655 | CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES | $8,747.56 |
| 23665 | CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ | $3,471.00 |
| 23931 | INCISION&DRAINAGE UPPER ARM/ELBOW BURSA | $7,329.00 |
| 24505 | CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ | $5,048.00 |
| 24535 | CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ | $8,585.00 |
| 24565 | CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ | $7,263.00 |
| 24600 | CLSD TX ELBOW DISLOCAT | $1,342.06 |
| 24605 | Treatment of closed elbow dislocation; requiring anesthesia | $7,607.77 |
| 24620 | CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ | $5,184.95 |
| 24640 | RADIAL HEAD SUBLUX. CHILD | $1,247.63 |
| 24650 | CLTX RDL HEAD FX WO MANP | $2,565.91 |
| 24655 | CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION | $6,529.00 |
| 24675 | CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ | $7,129.00 |
| 25505 | CLSD TX RAD SHAFT W/MANIP | $5,809.00 |
| 25520 | CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT | $7,090.00 |
| 25535 | CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION | $6,488.00 |
| 25565 | CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ | $3,153.55 |
| 25600 | CLSD TX DISTAL RAD FX WO | $4,425.76 |
| 25605 | CLSD TX DISTAL RAD FX | $2,551.27 |
| 25607 | OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP | $25,284.00 |
| 25652 | OPEN TREATMENT ULNAR STYLOID FRACTURE | $18,687.50 |
| 25675 | CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ | $3,542.20 |
| 26010 | I & D FINGER ABSCESS,SIMP | $1,022.78 |
| 26011 | DRAINAGE FINGER ABSCESS COMPLICATED | $7,507.16 |
| 26600 | CLSD TX METACARPAL FX | $1,843.74 |
| 26605 | CLSD TX MEDICARPAL FX | $2,841.00 |
| 26700 | CLS TX MCP DISLOCATION | $1,990.00 |
| 26725 | CLTX PHLNGL FX PROX/MIDDL | $2,191.26 |
| 26735 | OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA | $25,284.00 |
| 26742 | CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ | $6,712.00 |
| 26746 | OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA | $16,463.00 |
| 26750 | CLS TX FX FINGER/THUMB | $1,552.20 |
| 26755 | CLTX DSTL PHLNGL FX FNGR/ | $2,085.52 |
| 26765 | OPEN TX DISTAL PHALANGEAL FRACTURE EACH | $13,312.00 |
| 26770 | TREAT FINGER DISLOC FINGE | $1,535.83 |
| 26775 | Closed treatment of interphalangeal joint dislocation, sing… | $3,665.00 |
| 27550 | CLOSED TX KNEE DISLOCATION W/O ANESTHESIA | $2,303.00 |
| 27560 | CLTX PATELLAR DISLC W/O A | $1,917.56 |
| 27750 | Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation | $4,062.50 |
| 27752 | CLTX TIBL SFT FX W/MANP | $8,065.00 |
| 27762 | CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ | $7,043.00 |
| 27788 | CLTX DSTL FIBULAR FX LAT MALLS W/MANJ | $3,198.93 |
| 27792 | Open treatment of distal fibular fracture (lateral malleolu… | $25,063.00 |
| 27810 | CLTX BIMAL ANKLE FX W/POT | $4,919.00 |
| 27818 | CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION | $3,435.14 |
| 27840 | CLOSED TX ANKLE DISLOCATI | $3,642.60 |
| 27842 | CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ | $15,556.02 |
| 28190 | RMVL FB BODY FOOT SUBQ | $6,856.00 |
| 28192 | RMVL FB FOOT DEEP | $16,549.65 |
| 28495 | CLTX FX GRT TOE PHLX/PHLG W/MANJ | $2,652.67 |
| 28515 | FX CARE PHALANX NOT GREAT | $2,356.00 |
| 28660 | CLSD TX PIP JNT DISLOCATI | $1,636.18 |
| 29105 | LONG ARM SPLINT | $829.00 |
| 29125 | SHORT ARM SPLINT | $753.22 |
| 29126 | SHORT ARM SPLINT DYNAMIC | $1,071.00 |
| 29130 | APPLICATION FINGER SPLINT | $625.00 |
| 29240 | STRPG SHO | $797.00 |
| 29280 | STRAPPING HAND/FINGER | $646.00 |
| 29505 | LONG LEG SPLINT | $1,099.00 |
| 29515 | SHORT LEG SPLINT | $1,026.37 |
| 29530 | STRAPPING KNEE | $805.00 |
| 29550 | STRAPPING TOES | $836.00 |
| 30300 | RMVL FOREIGN BODY NASAL | $685.91 |
| 30901 | NASAL PACKING | $1,023.89 |
| 30903 | CTRL NSL HEMRRG ANT CPLX | $3,209.00 |
| 30905 | CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST | $1,370.00 |
| 30906 | CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ | $1,791.00 |
| 31500 | INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE | $1,213.09 |
| 31502 | TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT | $1,942.00 |
| 32550 | INSERTION INDWELLING TUNNELED PLEURAL CATHETER | $20,534.31 |
| 32551 | TUBE THORACOSTOMY INCLUDES WATER SEAL | $3,465.00 |
| 32556 | PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING | $8,060.39 |
| 36000 | INTRODUCTION OF NEEDLE/IN | $350.26 |
| 36005 | NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH | $4,393.00 |
| 36410 | VENIPUNCTURE, 3 YRS OR OLDER | $765.01 |
| 36415 | VENIPUNCTURE | $74.85 |
| 36416 | COLL CAPILLARY BLG SPEC | $82.50 |
| 36556 | Insertion of non-tunneled centrally inserted central venous… | $6,684.99 |
| 36558 | INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR | $13,386.49 |
| 36569 | INSERTION PICC W/O IMG GDN 5 YR/> | $8,161.08 |
| 36589 | RMVL TUN CVC W/O SUBQ PORT/PMP | $7,102.88 |
| 36591 | COLLECT BLOOD FROM IMPLAN | $735.89 |
| 36592 | COLLECT BLOOD FROM CATHETER VENOUS NOS | $702.84 |
| 36680 | PLACEMENT NEEDLE INTRAOSSEOUS INFUSION | $1,091.83 |
| 40650 | RPR LIP FULL THICKNESS | $5,063.00 |
| 40800 | DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL | $3,008.19 |
| 41250 | RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG | $1,653.69 |
| 41800 | DRNG ABSC DENTOALVEOLAR S | $1,558.00 |
| 42700 | I&D ABSC PRITONSILLAR | $2,929.00 |
| 43752 | NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE | $2,787.02 |
| 43753 | GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING … | $976.00 |
| 45915 | RMVL FECAL IMPACTION/FB SPX UNDER ANES | $9,348.00 |
| 46040 | I&D ISCHIOR/PRIRC ABSC SP | $12,172.00 |
| 46050 | INC/DRAIN PERIANAL ABS SU | $5,126.00 |
| 46083 | INCISION THROM HEMORRHOID | $1,571.00 |
| 49083 | ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE | $6,502.68 |
| 49505 | RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $25,524.60 |
| 51700 | BLDR IRR SMPL LVG&/INSTLJ | $1,902.92 |
| 51701 | INSR NONDWELLING BLDR CAT | $680.91 |
| 51702 | INSERTION BLADDER CATH | $664.00 |
| 51703 | INSERT BLADDER CATH COMPL | $844.76 |
| 54220 | IRRIGATION CORPORA CAVERNOSA PRIAPISM | $2,403.92 |
| 54235 | NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT | $1,419.87 |
| 54437 | REPAIR OF TRAUMATIC CORPOREAL TEAR(S) | $25,072.78 |
| 54450 | FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING | $4,025.00 |
| 55100 | DRAINAGE SCROTAL WALL ABSCESS | $6,504.55 |
| 56405 | INC/DRAIN VULVA/PERINEAL | $2,036.47 |
| 56420 | I & D BARTHOLIN ABSCESS | $1,694.00 |
| 57410 | PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL | $13,698.75 |
| 58301 | REMOVAL INTRAUTERINE DEVICE IUD | $14,504.00 |
| 59025 | FTL NON-STRS TST | $1,670.13 |
| 62270 | SPINAL PUNCTURE,LUMBAR | $3,147.32 |
| 62272 | THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF | $3,759.11 |
| 64400 | NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH | $2,474.37 |
| 64405 | INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $4,308.53 |
| 64450 | INJ ANESTHETIC AGENT | $2,131.06 |
| 65205 | REMOVAL FB EYE-SUPERFCL | $1,275.00 |
| 65210 | RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR | $2,119.65 |
| 65220 | RMVL FB EYE W/O SLIT LAMP | $1,561.00 |
| 65222 | RMVL FB EYE | $1,681.00 |
| 67700 | I&D ABSCESS EYELID | $1,658.00 |
| 69000 | Drainage external ear | $3,343.00 |
| 69200 | RMVL FOREIGN BODY EAR | $826.00 |
| 69205 | RMVL FB XTRNL AUD CANAL A | $9,924.00 |
| 69209 | REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL | $766.00 |
| 69210 | RMVL IMPACTED CERUMEN | $671.70 |
| 70100 | XRAY MANDIBLE LESS THAN 4 VIEWS | $1,716.86 |
| 70110 | XRAY MANDIBLE MIN 4 VIEWS | $1,709.01 |
| 70130 | RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE | $1,335.29 |
| 70140 | XRAY FACIAL BONES LESS THAN 3 VIEW | $1,838.76 |
| 70150 | XRAY FACIAL BONES GREATER THAN 3 VIEW | $1,699.89 |
| 70160 | Radiologic examination, nasal bones, complete, minimum of 3… | $1,286.15 |
| 70200 | RAD EXAM ORBIT COMP. | $2,352.18 |
| 70210 | RADEX SINUSES PARANASAL <3 VIEWS | $1,100.47 |
| 70220 | RAD EXAM SINUS COMPLETE | $1,324.00 |
| 70250 | SKULL LESS THAN 4 VIEWS | $1,542.89 |
| 70260 | RAD EXAM SKULL COMPLETE | $1,988.00 |
| 70330 | RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT | $1,415.89 |
| 70360 | RAD EXAM NECK,SOFT TISSUE | $986.98 |
| 70450 | COMPUTED TOMOGRAPHY HD/BR | $6,000.35 |
| 70460 | TOMOGRAPHY HEAD/BRAIN WIT | $6,473.78 |
| 70470 | COMPUTED TOMOGRAPHY HEAD/ | $7,290.89 |
| 70480 | CT ORBIT SELLA/POST FOSSA | $5,449.04 |
| 70481 | CT ORBIT SELLA/POST FOSSA | $6,918.53 |
| 70482 | CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR | $8,800.75 |
| 70486 | CT MAXLFCL AREA C-MATRL | $6,491.00 |
| 70487 | CT MAXLFCL AREA C+ MATRL | $8,034.29 |
| 70488 | CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL | $7,129.51 |
| 70490 | CT NECK WO CONTRAST | $5,581.92 |
| 70491 | CT SOFT TISS NCK C+MATRL | $6,970.56 |
| 70492 | CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL | $6,402.00 |
| 70496 | CTA HEAD C-/C+ | $6,569.35 |
| 70498 | CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST | $6,650.72 |
| 71045 | Radiologic examination, chest ; single view | $1,119.00 |
| 71046 | CHEST XRAY 2 VIEWS | $1,410.15 |
| 71047 | Radiologic examination, chest ; 3 views | $1,428.00 |
| 71100 | RIBS UNILATERAL 2 VIEWS | $1,689.49 |
| 71101 | RIB UNILATERAL W CHEST | $1,643.78 |
| 71110 | RIBS BILATERAL 3 VIEWS | $2,887.49 |
| 71111 | RIBS BILATERAL W/CHEST | $3,412.26 |
| 71120 | Radiologic examination; sternum, minimum of 2 views | $1,314.73 |
| 71250 | CT CHEST W/O CONTRAST | $5,793.47 |
| 71260 | CT THORAX W/CONTRAST | $7,325.61 |
| 71270 | CT THORAX WO CONTRAST | $8,569.40 |
| 71275 | CT ANGIOGRAPHY | $7,192.43 |
| 72020 | Radiologic examination, spine, single view, specify level | $714.00 |
| 72040 | SPINE, CERVICAL 2/3 VIEWS | $1,387.03 |
| 72050 | SPINE, CERVICAL MIN 4VIEW | $2,298.95 |
| 72052 | SPINE CERV. COMP FLEX/EXT | $2,879.53 |
| 72070 | SPINE THORACIC 2 VIEWS | $1,864.83 |
| 72072 | SPINE THORACIC 3 VIEWS | $2,042.75 |
| 72074 | RAD EXAN SPINE THROAC 4 V | $1,605.93 |
| 72080 | RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS | $1,490.51 |
| 72082 | RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW | $2,390.99 |
| 72100 | SPINE LUMBO. MIN 4 VIEWS | $1,655.93 |
| 72110 | LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS | $2,484.48 |
| 72125 | COMPUTED TOMOGRAPHY CERVI | $5,904.47 |
| 72126 | CT CRV SPI C+MATRL | $7,249.92 |
| 72127 | CT CRV SPI C-/C+ | $8,780.00 |
| 72128 | CT THRC SPI C-MATRL | $7,830.72 |
| 72129 | CT THRC SPI C+ MATRL | $7,320.41 |
| 72131 | CT L SPINE WO CONTRST | $7,131.83 |
| 72132 | CT LMBR SPI C+ MATRL | $7,215.83 |
| 72133 | CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL | $7,493.00 |
| 72170 | RAD EXAM PELVIS 1/2 VEIW | $1,155.29 |
| 72190 | RADEX PELVIS COMPL MIN 3 | $1,417.68 |
| 72192 | CT PELVIS WO CONTRAST | $6,238.31 |
| 72193 | TOMOGRAPHY PELVIS WCONTRS | $7,003.32 |
| 72220 | XRAY COCCYX/SACRUM | $1,341.14 |
| 73000 | XRAY CLAVICLE 2 VIEWS | $1,342.35 |
| 73010 | SCAPULA COMPLETE | $1,508.15 |
| 73020 | RADEX SHO 1 VIEW | $1,044.62 |
| 73030 | SHOULDR COMPLETE 2 VIEWS | $1,605.00 |
| 73060 | XRAY HUMERUS MIN 2 VIEWS | $1,305.02 |
| 73070 | XRAY ELBOW 2 VIEWS | $1,451.65 |
| 73080 | XRAY ELBOW GREATER THAN 3 VIEWS-COMP | $1,505.02 |
| 73090 | XRAY FOREARM AP & LAT | $1,232.77 |
| 73092 | Radiologic examination; upper extremity, infant, minimum of… | $997.00 |
| 73100 | XRAY WRIST AP & LAT VIEW | $1,236.77 |
| 73110 | XRAY WRIST/COMP MIN 3 VIE | $1,514.00 |
| 73120 | XRAY HAND AP & LAT | $1,236.00 |
| 73130 | XRAY HAND MIN 3 VIEWS | $1,421.75 |
| 73140 | XRAY FINGER MIN 2 VIEWS | $1,096.72 |
| 73200 | CT UPPR EXTR WO CNTRS | $6,051.50 |
| 73201 | CT UPPER EXTREMITY W/CONTRAST MATERIAL | $6,125.59 |
| 73202 | CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL | $8,139.25 |
| 73501 | RADEX HIP UNILATERAL WITH PELVIS 1 VIEW | $899.68 |
| 73502 | RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN P… | $1,331.50 |
| 73503 | RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS | $3,029.65 |
| 73521 | Radiologic examination, hips, bilateral, with pelvis when p… | $2,996.00 |
| 73522 | RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS | $2,699.97 |
| 73523 | Radiologic examination, hips, bilateral, with pelvis when p… | $3,139.00 |
| 73551 | RADIOLOGIC EXAMINATION FEMUR 1 VIEW | $1,650.00 |
| 73552 | FEMUR; MIN 2 VIEWS | $1,720.31 |
| 73560 | XRAY KNEE, SUNRISE VIEW | $1,151.00 |
| 73562 | XRAY KNEE MIN 3 VIEWS | $1,668.26 |
| 73564 | RAD EXAM KNEE 4 OR MORE | $2,035.51 |
| 73590 | XRAY TIBIA/FIBULA AP/LAT | $1,407.38 |
| 73592 | RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS | $1,182.06 |
| 73600 | XRAY ANKLE 2 VIEWS | $1,177.62 |
| 73610 | XRAY ANKLE 3 VIEWS/COMPLE | $1,412.56 |
| 73620 | XRAY FOOT MIN 2 VIEWS | $1,321.00 |
| 73630 | XRAY FOOT MIN 3 VIEWS | $1,883.00 |
| 73650 | RAD EXAN HEEL MIN 2 VIEWS | $1,057.85 |
| 73660 | XRAY TOES, MIN 2 VIEWS | $1,088.51 |
| 73700 | CT LWR EXTR WO CONTRAST | $5,608.28 |
| 73701 | CT LWR EXT W CONT | $7,054.52 |
| 73702 | CT LXTR C-/C+ | $7,201.81 |
| 73706 | CT ANGIOGRAPHY LOWER EXTREMITY | $13,771.00 |
| 74018 | Radiologic examination, abdomen; 1 view | $1,063.05 |
| 74019 | Radiologic examination, abdomen; 2 views | $1,484.30 |
| 74021 | Radiologic examination, abdomen; 3 or more views | $1,639.76 |
| 74022 | RAD EXAM COMPLETE ABD | $1,705.16 |
| 74150 | COMPUTED TOMOGRAPHY ABD | $7,791.41 |
| 74160 | TOMOGRAPHY ABD W/CONTRAST | $8,410.50 |
| 74170 | TOMOGRAPHY ABD W/OCONTRAS | $9,068.43 |
| 74174 | CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG | $15,775.03 |
| 74175 | CT ANGIO ABDOMEN W/CONTRA | $9,171.00 |
| 74176 | COMP TOMOG AB/PEL W/O CON | $9,914.62 |
| 74177 | COMP TOMO AB/PELV W/OCONT | $10,986.69 |
| 74178 | CT ABD & PELVIS 1 PLUS SECTION/REGNS | $13,343.04 |
| 74220 | RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY | $2,001.14 |
| 74240 | RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB | $3,088.48 |
| 74246 | Radiologic examination, gastrointestinal tract, upper, air … | $2,527.30 |
| 74250 | RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES | $2,411.38 |
| 74328 | ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I | $2,853.66 |
| 74330 | CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I | $5,004.85 |
| 74340 | INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I | $2,242.00 |
| 75574 | CT CORONARY | $6,053.46 |
| 75635 | CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP | $7,566.54 |
| 76010 | RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD | $979.00 |
| 76376 | 3D RNDR I&R CT MRI US/OTH | $1,871.83 |
| 76536 | ULTRASOUND, SOFT TISSUES OF HEAD AND NECK | $2,623.06 |
| 76604 | US CHEST REAL TIME W/IMAGE DOCUMENTATION | $1,716.51 |
| 76641 | US BREAST UNI REAL TIME WITH IMAGE COMPLETE | $2,739.00 |
| 76642 | US BREAST UNI REAL TIME WITH IMAGE LIMITED | $2,766.31 |
| 76700 | US ABDOMINAL R-T W/IMAGE | $3,749.11 |
| 76705 | US ABDOMINAL | $2,913.68 |
| 76770 | US RETROPERITONEAL R-T W/ | $3,104.40 |
| 76775 | US RPR B-SCAN&/R-T IMG LMTD | $2,902.50 |
| 76801 | ULTRASOUND 14 WK TABDL 1/1ST GESTATION | $2,905.05 |
| 76802 | US PREG UTERUS 14 WK TRANSABDL EACH GESTATION | $1,469.12 |
| 76805 | US PG UTER F&MAT AFTER 1S | $3,004.33 |
| 76810 | US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO | $2,164.13 |
| 76815 | ULTRASND PG UTER | $2,534.91 |
| 76816 | US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS | $2,425.15 |
| 76817 | UT PG UTER R-T IMG TRVG | $2,833.44 |
| 76830 | TRANSVAGINAL ULTRASOUND | $2,491.27 |
| 76856 | US PELVIC NONOB REAL-TIME | $3,110.49 |
| 76857 | PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 | $2,144.27 |
| 76870 | US SCROTUM&CNTS | $2,692.89 |
| 76881 | US EXTREMITY NON-VASC REAL-TIME IMG COMPL | $2,977.21 |
| 76882 | ULTRASOUND, EXTREMITY, NON VASCULAR | $2,783.68 |
| 76937 | Us guide vascular access | $2,026.00 |
| 76942 | ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND I… | $3,311.72 |
| 78315 | B1&/JT IMG 3 PHASE STD | $5,640.00 |
| 80047 | BASIC METABOLIC PANEL CALCIUM IONIZED | $417.90 |
| 80048 | METABOLIC PANEL BASIC | $839.17 |
| 80051 | ELECTROLYTE PANEL | $781.42 |
| 80053 | METABOLIC COMPRE PANEL | $1,187.55 |
| 80061 | LIPID PROFILE III | $798.10 |
| 80074 | HEPATITIS PANEL | $1,262.45 |
| 80076 | HEPATIC FUNCTION PANEL | $792.48 |
| 80143 | Acetaminophen | $616.04 |
| 80175 | DRUG SCREEN QUANTITATIVE LAMOTRIGINE | $116.22 |
| 80177 | DRUG SCREEN QUANTITATIVE LEVETIRACETAM | $351.00 |
| 80178 | LITHIUM | $330.30 |
| 80197 | TACROLIMUS | $754.71 |
| 80202 | VANCOMYCIN PEAK | $408.10 |
| 80305 | DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUM… | $728.58 |
| 80307 | DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS | $935.00 |
| 80320 | DRUG SCREEN | $526.91 |
| 80329 | DRUG SCREEN | $356.69 |
| 80349 | DRUG SCREENING CANNABINOIDS NATURAL | $853.71 |
| 80353 | DRUG SCREENING COCAINE | $853.71 |
| 80361 | DRUG SCREENING OPIATES 1 OR MORE | $853.71 |
| 81001 | U/A DIP STICK | $485.32 |
| 81003 | U/A W/O MICRO DIPSTICK | $255.32 |
| 81005 | Urinalysis; qualitative or semiquantitative, except immunoa… | $65.67 |
| 81025 | PREG.TST URINE VISUAL | $491.11 |
| 81240 | F2 GENE ANALYSIS 20210G >A VARIANT | $786.05 |
| 82010 | KETONE BODIES SERUM QUANTITATIVE | $288.04 |
| 82040 | ALBUMIN; SERUM | $201.28 |
| 82075 | ALCOHOL BREATH TEST | $262.92 |
| 82140 | Ammonia | $365.00 |
| 82150 | AMYLASE | $523.51 |
| 82247 | BILIRUBIN TOTAL | $256.60 |
| 82248 | BILIRUBIN DIRECT | $306.65 |
| 82270 | OCCULT BLOOD | $240.31 |
| 82271 | BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES | $148.87 |
| 82272 | BLD OCLT PEROXIDASE ACTV | $114.93 |
| 82310 | CALCIUM | $212.00 |
| 82330 | CALCIUM IONIZED | $339.21 |
| 82374 | CARBON DIOXIDE BICARBONATE | $199.00 |
| 82375 | Under Chemistry Procedures | $455.11 |
| 82435 | CHLORIDE BLD | $168.82 |
| 82465 | CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | $175.12 |
| 82533 | CORTISOL TOTAL | $454.90 |
| 82550 | CREATINE CK-TOTAL | $343.57 |
| 82553 | CREATINE CKMB | $541.53 |
| 82565 | CREATININE | $314.93 |
| 82607 | VITAMIN B-12 | $268.08 |
| 82728 | ASSAY OF FERRITIN | $555.00 |
| 82746 | ASSAY OF FOLIC ACID SERUM | $294.42 |
| 82747 | ASSAY OF FOLIC ACID RBC | $470.56 |
| 82784 | IGC IMMUNOGLOBULIN | $433.13 |
| 82785 | GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE | $262.68 |
| 82800 | GASES BLD PH ONLY | $163.18 |
| 82803 | BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 | $659.49 |
| 82805 | Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (… | $824.41 |
| 82945 | GLUCOSE BODY FLUID OTHER THAN BLOOD | $311.95 |
| 82947 | GLUCOSE | $284.83 |
| 82948 | GLUCOSE BLOOD REAGET STR | $203.32 |
| 82977 | GLUTAMYLTRANSFERASE-GTT | $216.42 |
| 83036 | HEMOGLOBIN GLYCOSYLATED A1C | $291.00 |
| 83050 | Under Chemistry Procedures | $550.24 |
| 83520 | IMMUNOASSAY ANALYTE QUANTITIATIVE NOS | $461.34 |
| 83525 | ASSAY OF INSULIN TOTAL | $360.19 |
| 83540 | IRON-TOTAL | $241.98 |
| 83550 | IRON BINDING CAPACITY | $356.00 |
| 83605 | ASSAY OF LACTATE | $259.81 |
| 83615 | Lactate dehydrogenase (LD), (LDH); | $293.00 |
| 83690 | LIPASE | $469.00 |
| 83735 | MAGNESIUM | $340.00 |
| 83874 | MYOGLOBIN | $309.47 |
| 83880 | B-TYPE NATRIURETIC | $542.32 |
| 83992 | ASSAY OF PHENCYCLIDINE | $459.69 |
| 84075 | ALK PHOS/PROFILE OR PANEL | $270.00 |
| 84100 | ASSAY OF PHOSPHORUS INORGANIC | $239.00 |
| 84132 | POTASSIUM SERUM PLASMA/WHOLE BLOOD | $298.00 |
| 84153 | Prostate specific antigen (PSA); total | $368.00 |
| 84155 | PROTEIN,TOTAL,EXCEPT REFR | $223.80 |
| 84157 | PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC | $256.54 |
| 84165 | PROTEIN ELECTROPHORESIS | $468.95 |
| 84295 | SODIUM; SERUM | $153.00 |
| 84403 | Testosterone; total | $560.52 |
| 84436 | THYRIXINE TOTAL | $278.07 |
| 84439 | THYROXINE-FREE | $389.05 |
| 84443 | Thyroid stimulating hormone (TSH) | $440.69 |
| 84450 | Transferase; aspartate amino (AST) (SGOT) | $343.09 |
| 84460 | ALT-TRANSFERASE;ALANINE | $355.77 |
| 84478 | ASSAY OF TRIGLYCERIDES | $287.37 |
| 84479 | THYROID HORMONE | $541.28 |
| 84480 | T3 TOTAL | $482.60 |
| 84481 | ASSAY OF TRIIODOTHYRONINE T3 FREE | $618.77 |
| 84484 | TROPONIN I | $583.78 |
| 84520 | Urea nitrogen; quantitative | $233.22 |
| 84550 | URIC ACID | $343.51 |
| 84560 | URIC ACID OTH SRC | $248.16 |
| 84702 | HCG QUANTATIVE | $554.98 |
| 84703 | PREGNANCY TEST BLOOD | $527.57 |
| 85014 | HEMATOCRIT | $121.51 |
| 85018 | HEMOGLOBIN | $116.93 |
| 85025 | Blood count; complete (CBC) | $361.01 |
| 85027 | CBC W/O DIFF | $258.71 |
| 85044 | RETICULOCYTE COUNT | $71.64 |
| 85347 | COAGJ TM ACTIVATED | $326.63 |
| 85379 | D-DIMER | $593.59 |
| 85384 | FIBRINOGEN ACTIVITY | $412.13 |
| 85397 | Coagulation and fibrinolysis, functional activity, not othe… | $777.10 |
| 85610 | PROTHROMBIN TIME | $306.02 |
| 85651 | SEDIMENTATION RATE NONAUT | $202.85 |
| 85652 | SED RATE ERYTHROCYTE NON | $215.19 |
| 85730 | THROMBOPLASTIN TIME PART | $317.85 |
| 86038 | ANTINUCLEAR AB | $410.17 |
| 86039 | ANTINUCLEAR AB TITER | $616.32 |
| 86060 | ANTISTREPTOLYSIN O TITER | $373.13 |
| 86140 | C REACTIVE PROTEIN | $259.98 |
| 86235 | EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD | $472.85 |
| 86256 | SMOOTH MUSCLE AB TITER | $568.46 |
| 86308 | MONO,HETEROPHILE ANTIBODI | $342.87 |
| 86328 | COVID-19 RAPID ANTIBODY TEST SINGLE METHOD | $100.00 |
| 86360 | T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO | $1,301.46 |
| 86376 | Microsomal antibodies (eg, thyroid or liver-kidney), each | $325.78 |
| 86403 | MONO SPOT | $362.35 |
| 86430 | RHEUMATOID FACTOR | $157.87 |
| 86431 | RHEUMATOID FACTOR QUANTITATIVE | $376.55 |
| 86592 | Syphilis test, non-treponemal antibody; qualitative (eg, VD… | $290.05 |
| 86593 | Syphilis test, non-treponemal antibody; quantitative | $276.11 |
| 86617 | Antibody; Borrelia burgdorferi (Lyme disease) confirmatory … | $546.00 |
| 86631 | ANTB CHLAMYDIA | $183.00 |
| 86644 | ANTIBODY CYTOMEGALOVIRUS CMV | $501.81 |
| 86645 | ANTIBODY CYTOMEGALOVIRUS CMV IGM | $613.92 |
| 86664 | EPSTEIN-BARR VIRUS EBNA | $350.11 |
| 86677 | ANTIBODY HELICOBACTER PYLORI | $387.83 |
| 86689 | ANTB HTLV/HIV ANTB CONFIRMATION TST | $593.00 |
| 86695 | Antibody; herpes simplex, type 1 | $347.98 |
| 86696 | Antibody; herpes simplex, type 2 | $408.32 |
| 86701 | HIV SERUM | $767.00 |
| 86704 | HEPATITIS B CORE ANTIBODY HBCAB TOTAL | $529.00 |
| 86705 | HEPATITIS B CORE IGM | $306.46 |
| 86706 | HEPATITIS B SURF ANTIBODY HBSAB | $447.00 |
| 86708 | HEPATITIS A ANTIBODY HAAB | $312.00 |
| 86709 | HEPATITIS ANTIBODY HAAB IGM ANTIBODY | $323.87 |
| 86757 | ANTIBODY RICKETTSIA | $288.05 |
| 86769 | COVID-19 RAPID ANTIBODY TEST MULTIPLE STEP METHOD | $100.00 |
| 86780 | TP-Under Qualitative or Semi quantitative Immunologists- | $187.31 |
| 86803 | HEPATITIS C ANTIBODY | $439.00 |
| 86850 | ANTB SCR RBC EA SERUM TQ | $315.78 |
| 86900 | Blood typing, serologic; ABO | $310.13 |
| 86901 | RH FACTOR-BLOOD | $236.89 |
| 87015 | CONCENTRATION INFECTIOUS AGENTS | $162.82 |
| 87040 | BLOOD CULTURE | $631.00 |
| 87045 | CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL | $570.47 |
| 87046 | Culture, bacterial; stool, aerobic, additional pathogens, i… | $377.36 |
| 87070 | CULTURE BODY FLUID | $467.00 |
| 87075 | CULTURE ANAEROBIC | $701.00 |
| 87076 | CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL | $393.03 |
| 87077 | CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL | $326.00 |
| 87081 | CULTURE, BACTERIAL-SCREEN | $357.89 |
| 87086 | URINE CULTURE | $449.32 |
| 87088 | CULTURE BCT ISOL&PRSMPTV | $505.99 |
| 87106 | CUL FNGI DEFINITIVE ID EA ORGANISM YEAST | $302.06 |
| 87110 | CHLAMYDIA CULTURE | $562.00 |
| 87140 | Culture, typing; immunofluorescent method, each antiserum | $194.00 |
| 87177 | Ova and parasites, direct smears, concentration and identif… | $498.48 |
| 87186 | Susceptibility studies, antimicrobial agent | $307.46 |
| 87205 | SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL | $282.00 |
| 87207 | SMR PRIM SRC SPEC STAIN | $310.44 |
| 87209 | SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS | $468.89 |
| 87210 | WET SMEAR | $263.25 |
| 87252 | VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT | $359.53 |
| 87255 | Herpes Simplex Virus Culture with Reflex Typing | $689.85 |
| 87324 | IAAD IA CLOSTRIDIUM DIFFICILE TOXIN | $274.91 |
| 87338 | IAAD IA HPYLORI STOOL | $302.04 |
| 87340 | IAAD IA HEPATITIS B SURFACE ANTIGEN | $451.00 |
| 87341 | IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION | $476.27 |
| 87389 | infection agent etc | $279.65 |
| 87400 | INFLUENZA A&B | $405.86 |
| 87420 | IAAD IA RESPIRATORY SYNCTIAL VIRUS | $522.54 |
| 87425 | IAAD IA ROTAVIRUS | $491.75 |
| 87426 | COVID-19 RAPID ANTIGEN TESTING | $446.62 |
| 87430 | INF AGT IMMUNO STREP A | $221.00 |
| 87486 | IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ | $285.00 |
| 87491 | IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $477.19 |
| 87493 | INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE | $556.31 |
| 87506 | IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 | $1,498.51 |
| 87507 | IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 | $3,160.95 |
| 87522 | Infectious agent detection by nucleic acid (DNA or RNA); he… | $1,416.35 |
| 87529 | IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ | $1,150.41 |
| 87581 | IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ | $1,665.64 |
| 87591 | IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $447.57 |
| 87633 | IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET | $3,757.00 |
| 87635 | Infectious agent detection by nucleic acid (DNA or RNA); se… | $275.00 |
| 87660 | IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ | $471.63 |
| 87661 | IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $486.92 |
| 87798 | IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM | $672.62 |
| 87804 | INFLUENZA IMMUNOASSAY OPT | $378.23 |
| 87807 | INF AGT DET IMNAS OPT RSV | $348.97 |
| 87880 | RAPID STREP-BETA STREP | $335.45 |
| 88305 | PATH SURG LEVEL IV | $1,222.55 |
| 89050 | CELL COUNT MISCELLANEOUS BODY FLUIDS | $445.15 |
| 89051 | CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT | $527.00 |
| 89055 | LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE | $295.32 |
| 89060 | CRYSTAL INDENTIFICATION | $267.06 |
| 90471 | IMMUN ADM 1 VAC | $356.68 |
| 90472 | IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE | $154.56 |
| 90714 | TETANUS DIPHTHERIA TOXOID | $638.00 |
| 90715 | TDAP VACCINE | $547.02 |
| 92950 | Cardiopulmonary resuscitation (eg, in cardiac arrest) | $2,738.00 |
| 92960 | CARDIOVERSION ELECTIVE ARRHYT XTRNL | $4,586.90 |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; trac… | $1,011.32 |
| 93017 | CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $4,759.05 |
| 93041 | RHYTHEM ECG 1-3 LDS | $503.64 |
| 93303 | COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY | $6,128.85 |
| 93306 | ECHO TEST | $7,760.32 |
| 93307 | ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP | $5,627.00 |
| 93308 | ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD | $2,277.11 |
| 93320 | DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY | $2,469.25 |
| 93325 | DOP ECHOCARD COLOR FLOW VELOCITY MAPPING | $1,508.77 |
| 93351 | ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG | $8,973.75 |
| 93880 | DUP-SCAN XTRC ART COMPL B | $3,894.94 |
| 93882 | DUP-SCAN XTRC ART UNI/LMTD STD | $2,806.00 |
| 93922 | NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $6,328.44 |
| 93925 | DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $3,347.82 |
| 93926 | DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD | $2,425.62 |
| 93930 | DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY | $3,525.00 |
| 93931 | DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD | $2,203.43 |
| 93970 | DUP-SCAN XTR VEINS COMPL | $4,238.00 |
| 93971 | DPLX SCN EXTRM VEINS | $2,961.51 |
| 93975 | DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, P… | $4,816.86 |
| 93976 | DUPLEX SCAN- LIMITED | $2,686.00 |
| 94010 | SPIROMETRY W/RECORD | $1,742.74 |
| 94150 | Vital capacity test | $1,031.74 |
| 94640 | NEBULIZER TREATMENT | $762.00 |
| 94644 | INHALATION TREATMENT – CONTINUOUS 1ST HR | $757.25 |
| 94660 | CPAP VENTILATION CPAP INITIATION&MGMT | $1,855.11 |
| 94664 | DEMO&/EVAL OF PT UTILIZ | $351.62 |
| 94760 | EAR OR PULSE OXIMETRY | $249.04 |
| 94761 | N-INVAS EAR/PLS OXIMTRY F | $501.00 |
| 94762 | NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR | $1,171.95 |
| 96360 | IV INFUS INIT 31 MIN 1 HR | $1,464.84 |
| 96361 | IV INFUS HYDR EA ADD’T HR | $597.33 |
| 96365 | IV INFUSION THERAPY/PROPH | $1,467.74 |
| 96366 | IV INFUS THER PROPH/DX EA | $688.00 |
| 96367 | IV NFS THER PROPH/DX ADDL | $1,486.18 |
| 96368 | IV NFS TX PROPHYLAXIS/DX | $1,128.35 |
| 96372 | THERAPEUTIC PROPHYLACTIC/ | $583.04 |
| 96374 | THER PROPH/DX NJX IV PUSH | $753.31 |
| 96375 | THER PROPH/DX NJX EA SEQL | $621.20 |
| 96376 | SUB INFU EA ADD IV PUSH | $471.15 |
| 97116 | THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR | $330.24 |
| 97140 | MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES | $450.45 |
| 97166 | OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS | $1,062.60 |
| 97597 | DEBRIDEMENT OPEN WOUND 20 SQ CM/< | $1,053.00 |
| 99000 | SPECIMEN HANDLING | $53.00 |
| 99001 | COC COLLECITON ONLY | $142.88 |
| 99070 | SUPPLIES&MATERIALS ABOVE or BEYOND PROV BY PHYS or QHP | $117.03 |
| 99151 | MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS | $1,099.00 |
| 99152 | MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS | $2,852.00 |
| 99153 | Moderate sedation services provided by the same physician o… | $286.59 |
| 99156 | MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS | $756.60 |
| 99157 | MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS | $186.00 |
| 99173 | SCREENING TEST OF VISION | $761.53 |
| 99281 | E/M VISIT LEVEL 1 TECH COMP | $1,000.00 |
| 99282 | E/M VISIT LEVEL 2 TECH COMP | $1,965.24 |
| 99283 | E/M VISIT LEVEL 3 TECH COMP | $3,485.69 |
| 99284 | E/M VISIT LEVEL 4 TECH COMP | $5,681.64 |
| 99285 | E/M VISIT LEVEL 5 TECH COMP | $7,635.21 |
| 99291 | CRITICAL CARE 30-74 MIN | $10,658.97 |
| 99292 | CRITICAL CARE ADD 30 MIN | $2,865.36 |
| G0378 | HOSPITAL OBSERVATION SERVICES PER HOUR | $2,500.00 |
| J0131 | INJECTION, ACETAMINOPHEN, 10 MG | $48.13 |
| J0153 | ADENOSINE INJ 1MG | $50.30 |
| J0171 | ADRENALIN EPINEPHRINE INJECT | $50.30 |
| J0282 | INJ AMIODARONE HYDROCHLOR | $32.59 |
| J0290 | AMPICILLIN 500 MG INJ | $79.00 |
| J0295 | INJ AMPCLLN SODIUM/SULBA | $64.62 |
| J0330 | SUCCINYLCHOLINE CHLO 20MG | $121.80 |
| J0360 | HYDRALAZINE HCL INJ UP TO 20MG | $162.55 |
| J0456 | INJ AZITHROMYCIN 500MG | $106.99 |
| J0461 | INJ ATROPINE SULFATE 0.01 | $22.13 |
| J0500 | DICYCLOMINE HCL 20MG | $557.51 |
| J0515 | Injection, benztropine mesylate, per 1 mg | $390.46 |
| J0561 | INJECTION PENICILLIN G BENZATHINE 100,000 UNITS | $215.93 |
| J0595 | STADOL | $65.00 |
| J0690 | KEFZOL 1 GR VIAL | $34.00 |
| J0692 | INJ CEFEPIME HCI 500MG | $62.78 |
| J0696 | ROCEPHIN 250 MG | $49.21 |
| J0735 | CLONIDINE 1MG | $177.31 |
| J0744 | CIPRO 200MG | $85.77 |
| J0780 | COMPAZINE 10 MG | $156.16 |
| J1030 | DEPO MEDROL 40 MG/ML | $68.63 |
| J1040 | METHYLPREDNISOLONE 80MG | $119.76 |
| J1100 | DECADRON 4 MG VIAL | $21.98 |
| J1110 | dihydroergotamine mesylate | $1,259.92 |
| J1165 | DILANTIN 100 MG VIAL | $20.45 |
| J1170 | DILAUDID 4 MG | $61.48 |
| J1200 | BENADRYL 50MG | $40.82 |
| J1335 | ERTAPENEM INJECTION | $605.36 |
| J1580 | GARAMYCIN,GENTAMICIN 80MG | $61.96 |
| J1610 | GLUCOGAN 1 MG VIAL | $1,555.50 |
| J1630 | HALOPERIDOL INJECTION | $63.94 |
| J1642 | HEPARIN SODIUM PER 10 UNI | $12.11 |
| J1644 | INJ HEPARIN SOD PER 1000 | $78.18 |
| J1650 | ENOXAPARIN SODIUM 10MG | $159.24 |
| J1670 | TETANUS INJECTION | $4,732.95 |
| J1815 | INJ INSULIN PER 5 UNITS | $23.74 |
| J1885 | TORADOL INJ 15 MG | $45.64 |
| J1940 | LASIX 40 MG IV VIAL | $46.86 |
| J1956 | LEVOFLOXACIN 250 MG | $78.35 |
| J2001 | LIDOCAINE HCI 10MG | $19.77 |
| J2060 | ATIVAN 2ML SYRUP | $51.89 |
| J2150 | MANNITOL INJECTION | $45.38 |
| J2175 | DEMEROL 50 MG SYRINGE | $59.82 |
| J2250 | MIDAZOLAM HCI PER 1 MG | $19.19 |
| J2270 | INJ MORPHINE SULFATE 10 M | $46.30 |
| J2274 | INJ MORPHINE PF EPID ITHC | $80.50 |
| J2300 | NUBAIN 10MG AMP | $102.25 |
| J2310 | INJ NALOXONE HCL 1MG | $210.81 |
| J2360 | ORPHENADRINE CITRATE 60MG | $140.03 |
| J2370 | NEO-SYNEPHRINE UP TO 1 ML | $96.16 |
| J2405 | ONDANSETRON HCI, PER MG | $18.94 |
| J2543 | ZOSYN – PIPERACILLIN/TAZOBACTAM | $75.76 |
| J2550 | PHENERGAN 50 MG | $49.68 |
| J2704 | INJ, PROPOFOL, 10 MG | $25.40 |
| J2765 | METOCLOPRAMIDE HCL 10MG | $34.76 |
| J2770 | Quinupristin/dalfopristin | $1,656.91 |
| J2790 | RHOGAM INJECTION | $339.05 |
| J2800 | METHOCARBAMOL INJECTION | $344.59 |
| J2920 | SOLU-MEDROL 40MG | $122.10 |
| J2930 | SOLU-MEDROL 125 MG | $110.69 |
| J3010 | INJ FENTANYL CITRATE .1MG | $22.78 |
| J3030 | IMITREX 6MG VIAL | $167.37 |
| J3105 | INJECTION, TREBUTALINE SULFATE, UP TO 1 MG | $72.76 |
| J3230 | THOROZINE 50 MG | $347.06 |
| J3360 | VALIUM INJ 5 MG | $157.22 |
| J3370 | VANCOMYCIN HCI INJ 500MG | $198.77 |
| J3410 | VISTERIL INJ 50 MG | $74.46 |
| J3411 | INJ THIAMINE 100 MG | $89.60 |
| J3430 | INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG | $101.43 |
| J3475 | MAGNESIUM SULFATE 2CC AMP | $50.15 |
| J3480 | POTASSIUM CHLORIDE 2 MG | $35.12 |
| J3486 | GEODON – ZIPRASIDONE MESYLATE 10MG | $272.18 |
| J3490 | UNCLASSIFIED DRUGS | $458.39 |
| J7030 | INFUS NORM SALINE 1000CC | $104.54 |
| J7040 | INFUS NORM SALINE 500ML | $92.06 |
| J7042 | 5% DEXTROSE | $74.31 |
| J7050 | INFS NORM SALINE 250CC | $97.51 |
| J7060 | INFUSION D5W 250ML | $93.48 |
| J7070 | INFUSION D5W 1000ML | $62.50 |
| J7120 | RINGER’S LACTATE INFUS | $188.27 |
| J7121 | 5% DEXTROSE IN LAC RINGERS | $242.92 |
| J7510 | PREDNISOLONE ORAL 5 MG | $7.72 |
| J7512 | PREDNISONE 5 MG | $6.62 |
| J7607 | LEVALBUTEROL COMP CON | $27.71 |
| J7613 | ALBUT INHAL NON-CP 1MG | $36.89 |
| J7614 | ALBUTEROL ALL FOMULATIONS | $27.52 |
| J7620 | ALBUTEROL 2.5 MG ATROVENT | $36.89 |
| J7644 | IPRATROPIUM BROMIDE INHAL | $53.75 |
| J7699 | NOC DRUGS INHAL SOL ADMIN | $38.19 |
| J8499 | NONCHEMOTHERAPEUTIC ORAL | $73.09 |
| J8540 | DEXAMETHASONE, ORAL .25MG | $14.82 |
| L0120 | CERVICAL FLEX NONADJ COLL | $244.41 |
| L0150 | CERV SEMI-RIG ADJ MOLDED CHN | $368.00 |
| L0464 | TLSO 4MOD SACRO-SCAP PRE | $9,421.00 |
| L1600 | Hip orthosis (HO), abduction control of hip joints, flexible, Frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | $234.82 |
| L1830 | KNEE IMMOBOLIZER | $224.00 |
| L3260 | SURGICAL BOOT/SHOE | $228.41 |
| L3620 | Transfer of an orthosis from one shoe to another, solid stirrup, existing | $359.00 |
| L3650 | SO FIGURE EIGHT ABDUCTION | $654.91 |
| L3660 | SO 8 AB RSTR CAN/WEB PRE OTS | $686.43 |
| L3908 | WRIST EXTN CONTROL COCKUP | $228.41 |
| L3913 | Hand-finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | $733.00 |
| L4350 | AIR SPLINT | $888.41 |
| L8501 | Tracheostomy speaking valve | $762.17 |
| M0243 | Intravenous infusion, casirivimab and imdevimab, includes i… | $1,200.00 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes… | $1,200.00 |
| Q9966 | LOCM 200-299MG ML IODINE, 1ML | $12.63 |
| Q9967 | LOW OSMOLAR CNTRS MAT | $13.00 |
| S0028 | INJECT FAMOTIDINE 20 MG | $62.06 |
| S0119 | ZOFRAN, 4MG, ORAL | $161.73 |
| S0164 | PROTONIX PANTROPRAZOLE 40MG | $256.01 |
| S5000 | PRESCRIPTION DRUG GENERIC | $14.15 |
| S5001 | PRESCRIPTION DRUG BAND NM | $17.93 |
| S8451 | SPLINT WRIST OR ANKLE | $169.68 |
| U0002 | SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple ty… | $150.00 |
Looking for an emergency care near you? At Frontline ER Richmond and Houston we are beyond urgent care and proud to offer 24 hour emergency care for the entire Richmond, Southwest Houston and Mission Bend community. Our emergency room in 77407 is equipped with state-of-the-art medical equipment, allowing us to diagnose with a higher efficiency along with providing immediate and effective emergency care in Richmond and Houston for a range of illnesses, injuries and traumatic events. At Frontline emergency care in Richmond, our board-certified emergency doctors near you have over 100 years of combined experience with providing emergency care and are dedicated to helping the Richmond, Southwest Houston and Mission Bend community in their time of need.
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