These standard charges are billed to your health insurance … · 2020. 9. 29. · 444 disorders of...

CPT Description Total

ANESTHESIA INITIAL 15 MIN 389$

ANESTHESIA EA ADDL MINUTE 21$

RECOVERY INITIAL 15MIN 159$

RECOVERY EA ADDL MINUTE 12$

OR ACUITY LEVEL 1 BASE 30MIN 1,639$



OR ACUITY LEVEL 4 BASE 30 MIN 4,692$

OR ACUITY LEVEL 5 BASE 30 MIN 5,016$

OR ACUITY ADD'L 15 MIN 432$

OXYGEN PER HOUR 17$

LABOR ROOM 3,000$

DELIVERY VAGINAL/RECOVERY 3,000$

LABOR CARE LEVEL 1 PER HR 160$

LABOR CARE LEVEL 2 PER HR 230$

These standard charges are billed to your health insurance company or to you for the

services provided at our hospital. The actual charges will depend on variety of factors

such as length of time spent in surgery or recovery, the number of days spent in the

hospital, specific equipment, supplies and medication required, additional tests ordered

by your physician, and/or any unusual special care or unexpected conditions or

complications. These charges do not represent your out-of-pocket costs and it does not

include physician charges which will be billed to you separately by the physician. If

you have health insurance, your out of pocket cost will depend on your individual

coverage benefits and usually include deductible, copay, and/or co-insurance. You

should contact your health insurance representative for your specific out of pocket

costs. If you do not have health insurance, please contact our Patient Financial Service

representative at (808) 932-1446 or (808) 932-1453 to determine if you qualify for the

various financial assistance programs available.

ECD ICF PRIVATE 1,500$

ECD SNF PRIVATE 2,500$

MED-ROOM & BOARD/PVT 3,000$

SURG-ROOM & BOARD/PVT 3,000$

MONITORING CARE-MED/ACUTE 4,500$

MONITORING CARE-SUR/ACUTE 4,500$

SHORT STAY OVERFLOW 4,500$

PCU OVERFLOW 4,500$

PCU MED ROOM & BOARD PVT 5,000$

OB-ROOM & BOARD/PVT 3,000$

MONITORING CARE - OB 4,500$

PSYCH-ROOM & BOARD/PVT 4,000$

MONITORING CARE - PSYCH 4,500$

MED ICF WL RM/BD ECD 1,000$

MED ICF WL RM/BD 1,000$

SURG ICF WL RM/BD 1,000$

ECD ICF SEMI PRIVATE 1,000$

MED SNF WL RM/BD ECD 2,000$

MED SNF WL RM/BD 2,000$

SURG SNF WL RM/BD 2,000$

ECD SNF SEMI PRIVATE 2,000$

MED-ROOM & BOARD/SEMI ECD 2,500$

MED-ROOM & BOARD/SEMI 2,500$

SURG-ROOM & BOARD/SEMI 2,500$

MED/SURG IN OB SEMI RM/BD 2,500$

SURG STEPDOWN CARDIAC SEMI 2,500$

PCU MED ROOM & BOARD SEMI 4,500$

OB-ROOM & BOARD/SEMI 2,500$

PED-ROOM & BOARD SEMI 2,500$

PEDS IN OB SEMI RM/BD 2,500$

PSYCH ICF WL RM/BD 1,000$

PSYCH SNF WL RM/BD 2,000$

PSYCH-ROOM & BOARD/SEMI 3,500$

ECD ICF ROOM & BOARD 1,000$

ECD SNF ROOM & BOARD 2,000$

MEDICAL ACUTE ISOLATION 4,500$

MEDICAL ACUTE ISOLATION ECD 4,500$

SURGICAL ACUTE ISOLATION 4,500$

ECD ISOLATION ICF 4,500$

PCU MED ACUTE ISOLATION 4,500$

STEPDOWN PCU ISOLATIO 4,500$

NURSERY LEVEL 1 1,500$

NURSERY LEVEL 2 2,000$

CCU OVERFLOW 4,500$

ICU MONITORING CARE ACUTE 4,500$

ICU/CCU ROOM & BOARD 5,000$

SECONDARY ICU 4,500$

PCU SECONDARY ICU 4,500$

PCU MONITORING CARE ACUTE 4,500$

STEPDOWN PCU SEMI PRI 4,500$

STEPDOWN PCU PRIVATE 5,000$

0042T CT PERFUSION W/CONTRAST CBF 1,554$

0099U RESPIRATORY PATHOGEN PNL 3,237$

0201T PERQ SACRAL AUGMY BILAT INJ 23,424$

10005 P-FNA W/US GUIDANCE 2,389$

10006 P-FNA W/US GDN ADDL LESION 711$

10009 P-FNA W/CT GUIDANCE 2,389$

10021 FNA BIOPSY 1ST LES W/O IMG GDN 1,251$

10060 P-INC/DRAIN SKIN ABSCESS 684$

10061 I&D ABSCESS COMPLEX 1,251$

10080 I&D PILONIDAL CYST SIMPLE 2,389$

10120 INC & FB REM SUBQ SIMPLE 1,251$

10140 I&D HEMATOMA 5,375$

10160 P-PUNC ASP ABSCESS CYST 1,251$

11042 DEBRID SKN/SUB TISS 1ST 20SQCM 1,251$

11104 BX SKIN PUNCH LESION SNGL 684$

11730 AVUL NAIL PLATE SIMPLE 684$

12001 SMPL RPR S/N/A/GENT </=2.5CM 684$

12002 SMPL RPR S/N/A/GENT 2.6-7.5CM 684$

12004 SMPL RPR S/N/A/GENT 7.6-12.5CM 684$

12005 SMPL RPR S/N/A/GENT 12.6-20CM 1,251$

12006 SMPL RPR S/N/A/GENT 20.1-30CM 1,251$

12007 SMPL RPR SUPFC S/N/AX/G/T >30 684$

12011 SMPL RPR FACE </= 2.5CM 684$

12013 SMPL LAC FACE 2.6-5 CM 684$

12014 SMPL LAC FACE 5.1-7.5CM 684$

12015 SMPL LAC FACE 7.6-12.5CM 684$

12031 INTMD RPR S/A/T/EXT 2.5 CM/< 1,251$

12032 INTMD RPR S/A/T/EXT 2.6-7.5 1,251$

12034 INTMD RPR S/TR/EXT 7.6-12.5 1,251$

12035 INTMD RPR S/A/T/EXT 12.6-20 1,251$

12041 INTMD RPR N-HF/GENIT 2.5 CM/< 1,251$

12042 INTMD RPR N-HF/GENIT 2.6-7.5/< 1,251$

12044 INTMD RPR N-HF/GENIT7.6-12.5 1,946$

12051 INTERMED LAC FACE <2.5 CM 1,251$

12052 INTERMED LAC FACE 2.6-5CM 1,251$

13121 CMPLX RPR S/A/L 2.6-7.5 1,946$

13122 CMP RPR S/A/LG EA ADDL 5CM 509$

13131 CMPLX RPR F/N/G/H/F 1.1-2.5CM 1,251$

13132 CMPLX RPR F/N/G/H/F 2.6-7.5 1,946$

16020 DRESS/DEBRID P-THICK BURN S 684$

19000 P-PUNCT ASP CYST BREAST 2,389$

19020 MASTOTOMY W/EXPL/DRG ABSC DP 5,375$

19083 US BX BREAST PERC 1ST LESION 5,375$

20220 SC-BX BONE TROC/NDL SUP 5,375$

20225 P-BX BONE TROCAR/NDL DEEP 5,375$

20225 SC-BX BONE TROC/NDL DEEP 5,375$

20552 INJ MUSC TRIGGER POINT 1 OR 2 1,025$

20604 ASP/INJ BURSA SM JOINT 1,025$

20605 ASP/INJ INT JNT/BURSA W/O US 1,025$

20606 ASP/INJ BURSA MED JOINT 2,448$

20610 ASP/INJ MAJOR JNT/BURSA W/O US 1,025$

20611 ASP/INJ MAJOR JOINT/BURSA W/US 1,025$

21480 CLTX TMJ DISLOC INIT/SUBSQ 844$

21501 P-DRAIN NECK/CHEST LESION 9,080$

21550 CT BIOPSY OF NECK/CHEST 5,375$

21550 P-BIOPSY OF NECK/CHEST 5,375$

22510 PERQ CERVICOTHORACIC INJECT 10,719$

22511 PERQ LUMBOSACRAL INJECTION 10,719$

23350 P-INJ SHOULDER ARTHRO 319$

23575 CLTX SCAP FX W/MANJ W/WO SK TR 5,307$

23650 CLTX SHLD DISL W/MANIP WO ANES 844$

23655 CLTX SHLD DISL W/MANIP W/ANES 5,307$

23665 CLTX HUM DISLOC SHLDR W/MAN 5,307$

24505 CLTX HUMERAL SHFT FX W/MANIP 5,307$

24600 CLTX ELBOW DISLOC W/O ANES 844$

24605 CLTX ELBOW DISLOC W/ANES 5,307$

24640 CLTX RAD HEAD DISLOC W/MANIP 844$

25565 CLTX RAD&ULN SHAFT FX W/MANIP 5,307$

25600 CLTX DIST RADIAL FX W/O MANIP 844$

25605 CLTX DIST RADIAL FX W/MANIP 5,307$

25660 CLTX WRIST DISL 1/> W/MANIP 844$

26010 ABSCESS DRAINAGE FINGER SIMPLE 684$

26605 CLTX METACARP FX SGL W/MANIP 844$

26700 CLTX MCP FINGER SGL W/O ANES 844$

26725 CLTX PROX/MID PX/F/T W/MANIP 844$

26742 CLSD TX FX FINGER W/MAN EA 5,307$

26770 CLTX IPHAL JT W/MANIP W/O ANES 844$

26785 OPEN TX FINGER DISLOCATION SGL 10,719$

26951 AMPUTATION OF FINGER/THUMB 10,719$

26989 HAND/FINGER SURGERY 844$

26990 P-INC DRAIN ABSC HEMATOMA 10,719$

27041 BX PELVIS SOFT TISSUE DEEP 5,375$

27041 SC-BX BONE TROC/NDL DEEP 5,375$

27250 CLSD TXMT DIS HIP TRAUMATIC 844$

27252 TXMT DIS HIP W/ANES 5,307$

27265 CLSD TXMT DIS HIP W/O ANES 844$

27562 CLTX PATELLAR DISLOC W/ANES 844$

27752 CLTX FX TIBIA W/MANIP 5,307$

27788 CLTX DIST FIB FX W/MANIP 844$

27818 CLTX TRIMALLEOLAR ANK W/MANIP 5,307$

27825 FX CLSD TX DISTAL TIBIA W/MANI 5,307$

28192 RMVL FB FOOT DP 5,375$

28495 FX CLOSED GREAT TOE W/MAN 844$

28515 FX CLOSED TOE W/MANIP 844$

29105 APPLY SPLINT LONG ARM 524$

29125 APPLY SPLINT SHORT ARM STATIC 427$

29126 APPLY SPLINT SHORT ARM DYNAMIC 427$

29130 APPL SPLNT FINGER STATIC 215$

29505 APPLY SPLINT LONG LEG 524$

29515 APPLY SPLINT SHORT LEG 524$

30000 DRN ABS/HEMATMA NASAL INTERNAL 797$

30901 NASAL HEMMOR/ANT PACK SIM 427$

30903 NASAL HEMORR/ANT PK COMPL 427$

31500 EMERGENCY INTUBATION 797$

31575 LARYNGOSCOPY FLEXIBLE DX 613$

32405 SC-BX LUNG/MEDIA PERCUT N 5,375$

32550 P-TUNNEL PLEURALCATH CUFF 12,175$

32551 TUBE THORACOSTOMY W/SEAL 6,387$

32552 CATH PLEURAL REMOVAL 2,456$

32554 ASPIRATE PLEURA W/O IMAGING 2,469$

32555 ASPIRATE PLEURA W/ IMAGING 2,469$

32557 INSERT CATH PLEURA W/IMAGE 6,387$

33016 PERICARDIOCENTES INITIAL 6,387$

33016 P-PERICARDIOCENTESIS INIT 6,387$

33206 INS / REPL PACER SYS ATRL 40,144$

33207 INS / REPL PACER SYS VENT 40,144$

33208 INS / REPL PACER SYS DUAL 40,144$

33210 INSRT/RMV TEMP TRANS PACEMAKER 29,923$

33215 P-REPOS PACING-DEFIB LEAD 10,852$

33216 INSERT 1 ELECTRODE PM-DEFIB 29,923$

33225 INSERT LV LEAD NEW PLACEMENT 38,350$

33227 REMV&REPLC PM GEN SNGL 29,923$

33228 REMV&REPLC PM GEN DUAL LEAD 40,144$

33229 REMV&REPLC PM GEN MULT LEADS 71,710$

33233 REMOVE PACER GENERATOR 29,923$

33241 REMOVE ICD GENERATOR 11,685$

33249 INS / REPL DEFIB SYS W/LEAD 126,410$

33262 REMV&REPLC CVD GEN SNGL LEAD 88,938$

33263 REMV&REPL CVD GEN DUAL LEAD 88,938$

33264 REMV&REPLC CVD GEN MULT LEAD 126,410$

33274 TCAT INSJ/RPL PERM LDLS PM 62,417$

33285 INSERT SUBQ CARDIAC RHYT MONIT 29,923$

33286 RMVAL SUBQ CARDIACRHYT MONITOR 2,389$

33967 IAB CATH INSERT PERC 1,384$

36002 P-INJ TX PSEUDOAN THROMBN 2,469$

36140 P-INTR NDL EXTREMITY 842$

36200 P-INTR CATH AORTA 890$

36223 PLACE CATH CARTOID/INOM I-ART 17,997$

36226 PLACE CATH VERTEBRAL ART 17,997$

36245 P-S-CATH AB/LWR EX 1ST RT 1,016$

36246 P-S-CATH AB/LWR EX 2ND RT 1,143$

36247 P-S-CATH AB/LWR EX 3RD RT 1,269$

36248 P-S-CATH ABD/LWR EXT ADD RT 851$

36251 ANGIO RENAL ART S-CATH 1ST LT 10,852$

36252 ANGIO RENAL ART S-CATH 1ST BIL 10,852$

36430 BLOOD TRANSFUSION 1,519$

36430 HMC BLOOD TRANSFUSION 1,519$

36510 CATHERIZATION UMB VEIN NEWBRN 299$

36556 INSERT NON TUNNEL CV CATH >=5Y 6,387$

36558 INSERT CV CATH WO PORT>=5Y 10,852$

36561 INSERT CV CATH W/ PORT>=5Y 10,852$

36561 INSERT TUN CV CATH>=5YRS 10,852$

36573 INSERT MIDLINE WO PORT >=5YRS 6,387$

36573 INSERT PICC WO PORT >=5YRS 6,387$

36578 REPLACE TUNNEL CV AC 10,852$

36580 RPL NON-TUNNLD CVC W/O PO 6,387$

36581 REPLACEMNT OF TUNNELED CA 10,852$

36589 REMOVE TUNNEL CV DEV 2,469$

36590 P-CENTRAL VENOUS CATH REM 2,469$

36591 BLOOD DRAW FROM IMPL PORT 427$

36593 DECLOT VASCULAR DEVICE 1,212$

36596 P-REM OF INTRACATH OBSTR 6,387$

36597 P-REP CVP CATH FLOURO 6,387$

36598 INJ W/FLUORO EVAL CV DEC 719$

36600 ABG PUNCTURE 427$

36901 INTRO CATH DIAL CIRC DX 6,387$

36902 INTRO CATH DIAL CIRC W/ANGIO 19,398$

36903 INTRO CATH DIAL CIRC W/TCAT 38,799$

36905 THRMBC/NFS DIAL CIRC W/ANGIO 38,799$

36906 THRMBC/NFS DIAL CIRC W/TCAT 62,417$

36907 BALO ANGIOP DIAL SEG W/IMG 18,738$

37184 ART MECH THROMBECT INITIAL VES 38,799$

37187 VEN MECH THROMBECT W/FLUORO 19,398$

37191 INS ENDOVAS VENA CAVA FILTR 17,997$

37197 REMOVE INTRVAS FOREIGN BODY 10,852$

37211 THROMBOLYTIC ART THERAPY 17,997$

37221 REVASC ILIAC TLASTENT INIT 38,799$

37224 REVAS FEM/POPL TLA UNILATERAL 19,398$

37226 REVAS FEM/POPL TLASTENT 38,799$

37227 REVAS FEM/POP TLAATHERSTNT 62,417$

37228 REVASC TIB/PER TLA INITIAL UNI 38,799$

37229 REVASC TIB/PER TLAATHER INIT 62,417$

37236 OPEN/PERQ PLC STENT ART 1ST 38,799$

37237 OPEN/PERQ PLC STENT ART EA AD 16,596$

37241 VASC EMBOLIZE/OCCLUDE VENOUS 38,799$

37244 VASC EMBOLIZE/OCCLUDE BLEED 38,799$

38220 BONE MARROW ASPIRATION 5,375$

38221 BONE MARROW BIOPSY 5,375$

38222 BONE MARROW ASPIRATE BIOPSY 9,080$

38505 P-BX LYMPH NODE NDL SUP 5,375$

40652 RPR LIP FULL THCK<1/2 VERT HGT 1,730$

41800 DRAINAGE DENTO ABSC/CYST/HMTMA 427$

42400 BIOPSY OF A SALIVARY GLAND 2,389$

42700 I&D ABSCESS PERITONSILLAR 797$

43752 NASAL/OROGASTRIC W/TUBE PLMT 1,424$

43762 RPL GASTR TUBE WO IMG/END GUID 920$

46040 I&D PERIRECTAL ABSCESS 3,932$

46040 P-I&D ISCHIO/PERIREC ABSC 3,932$

46050 I&D PERIANAL ABSCESS 2,991$

46083 INC THROMB HEMMORRHOID EX 920$

47000 P-BX LIVER PERC NDL 5,375$

47000 SC-BX LIVER PERCUT NDL 5,375$

47001 SC-BX LIVER NDL 1,744$

47490 P-PERC CHOLECYSTOST W/IMG S&I 12,175$

47531 INJ FOR CHOLANGIOGRAM EXIS ACC 12,175$

47531 INJECTION FOR CHOLANGIOGRAM 12,175$

47533 PLMT BILIARY DRAIN CATH EXT 12,175$

47534 PLMT BILIARYDRAIN CATH INT-EXT 12,175$

47536 EXCHANGE BILIARY DRAIN CATH 12,175$

47537 RMVL BILIARY DRAIN CATH 3,077$

47538 PERQ PLMT BILE DUCT STENT EXIS 18,928$

47540 PERQ PL BILE DUCT STENT NEW W 18,928$

48102 SC-BX PANCREAS PERCUT NDL 5,375$

49082 ABD PARACENTESIS 3,077$

49083 ABD PARACENTESIS W/IMAGING 3,077$

49180 P-BX ABD/RETRO MASS PERC NDL 5,375$

49180 SC-BX ABD/RETRO PERCUT ND 5,375$

49405 CT IMAGE CATH FLUID COLXN VISC 5,375$

49406 CT IMAGE CATH FLUID PERI/RETRO 5,375$

49423 P-EXCH PREV ABS DRAIN 6,098$

49424 P-CNTR INJ CATH ASSES ABS 409$

49440 P-PERC PLACE GAS TUBE 6,098$

49441 P-DUODEN JEJUNTUBE INSERT 6,098$

49450 P-REPL GASTRO TUBE 3,077$

49451 P-REPL DUODEN JEJUNO TUBE 3,077$

49452 REPLACE G-J TUBE PERC W GUIDE 3,077$

49465 FLUORO EVAL COLON TUBE CON INJ 913$

50200 SC-BX RENAL RECUT TROC/ND 5,375$

50432 PLMT NEPHROSTOMY CATHETER 6,937$

50435 CONVERT NEPHROSTOMY CATH EXIST 6,937$

50435 EXCHANGE NEPHROSTOMY CATH 5,527$

50693 PLMT URETERAL STENT PRQ EXIST 11,820$

50695 PLMT URETERAL STENT PRQ NEW W 11,820$

51600 P-INJ CYSTOGRAM/VCU 593$

51702 INST INDWELL TEMP BLADDER CATH 427$

51702 INST INDWELL TEMP CATH BLADDER 427$

51705 CYSTOSTOMY TUBE CHG SIMPLE 920$

51720 TRMT OF BLADDER LESION 920$

54150 CIRCUMCISION CLAMP OTH DV 6,937$

54160 CIRCUMCISION NEONATE <=28 DAYS 2,179$

55100 DRAIN SCROTAL WALL ABSC 5,375$

56405 I&D VULVA/ PERINEAL ABSCESS 1,060$

56420 I&D BARTHOLINS 650$

59025 NON-STRESSTEST 650$

59412 EXTERNAL CEPHALIC VERSION 9,782$

59414 DELIVERY OF PLACENTA 9,782$

60100 P-BX THYROD PERC CORE NDL 2,389$

62326 LABOR EPIDURAL PLACEMENT 3,180$

62328 DX LMBR SPI PNXR W/FLUOR/CT 2,448$

62328 LUMBAR PUNCTURE DIAGNOSTIC 2,448$

62329 LUMBAR PUNCT/ P-RX 2,448$

62329 THER SPI PNXR CSF FLUOR/CT 2,448$

64400 NJX AA&/STRD TRIGEMINAL NRV 1,025$

64405 NJX AA&/STRD GR OCPL NRV 1,025$

64450 NJX AA&/STRD OTHER PN/BRANCH 2,448$

65205 RMVL FB EYE CONJUNCTIVA SIMPLE 427$

65222 RMVL FB EYE CORNEAL W/SLIT 427$

69000 I&D ABSCESS EAR 2,389$

69200 RMVL FB EXT AUD CANAL W/O ANES 427$

69209 RMVL EARWAX IRRIG/LVG UNI 215$

69210 RMVL EARWAX UNI 215$

70030 EYE FOREIGN BODY 313$

70100 MANDIBLE <4V 313$

70110 MANDIBLE COMP MIN 4V 439$

70140 FACIAL BONES <3V 313$

70150 FACIAL BONES COMP MIN 3V 439$

70160 NASAL BONES COMP MIN 3V 313$

70200 ORBITS COMP MIN 4V 439$

70210 SINUS SERIES <3V 313$

70220 SINUS SERIES COMP MIN 3V 313$

70250 SKULL SERIES <4V 439$

70260 SKULL SERIES COMP MIN 4V 439$

70330 TMJ OPEN & CLSD BILATERAL 313$

70360 NECK SOFT TISSUE 313$

70450 CT HEAD W/O CONTRAST 439$

70460 CT HEAD W/CONTRAST 714$

70470 CT HEAD W/WO CONTRAST 714$

70480 CT ORB/SEL POS W/O CONT 439$

70481 CT ORB/SEL POS W/CONT 714$

70482 CT ORB/SEL POS W/WO CONT 714$

70486 CT MAX-FAC W/O CONTRAST 439$

70487 CT MAX-FAC W/CONTRAST 714$

70490 CT NECK W/O CONTRAST 439$

70491 CT NECK W/CONTRAST 714$

70492 CT NECK W/WO CONTRAST 714$

70496 CTA HEAD W/WO CONTRAST 714$

70498 CTA NECK W/WO CONTRAST 714$

70543 MRI ORB/FAC/NCK W/WO CONT 1,495$

70544 MRA HEAD W/O CONTRAST 913$

70547 MRA NECK W/O CONTRAST 913$

70549 MRA NECK W/WO CONTRAST 1,495$

70551 MRI BRAIN W/O CONTRAST 913$

70552 MRI BRAIN W/CONTRAST 1,495$

70553 MRI BRAIN W/WO CONTRAST 1,495$

71045 CHEST 1V 313$

71046 CHEST 2V 313$

71047 X-RAY EXAM CHEST 3 VIEWS 313$

71048 CHEST COMP MIN 4V 439$

71100 RIBS UNI 2V LT 313$

71100 RIBS UNI 2V RT 313$

71101 RIBS MIN 3V W/CXR LT 439$

71101 RIBS MIN 3V W/CXR RT 439$

71110 RIBS BILATERAL 3V 439$

71111 RIBS BIL W/CXR MIN 4V 439$

71120 STERNUM MIN 2V 313$

71250 CT THORAX W/O CONTRAST 439$

71260 CT THORAX W/CONTRAST 714$

71270 CT THORAX W/WO CONTRAST 714$

71275 CTA CHEST W/WO CONTRAST 714$

71550 MRI CHEST W/O CONTRAST 913$

71552 MRI CHEST W/WO CONTRAST 1,495$

71555 MRA CHEST W/CONTRAST 1,495$

72020 SPINE SINGLE VIEW 313$

72040 C-SPINE 2V/3V 313$

72050 C-SPINE MIN 4/5VWS 439$

72052 C-SPINE COMP W/OBL 6/> VWS 439$

72070 T-SPINE 2V 439$

72072 T-SPINE 3V 439$

72080 THORACOLUMBAR SPINE 2V 313$

72081 X-RAY EXAM ENTIRE SPI 1 VW 313$

72082 X-RAY EXAM ENTIRE SPI 2/3 VW 439$

72100 L-S SPINE 2V/3V 439$

72110 L-S SPINE MIN 4V 439$

72114 L-S SPINE COMP BENDING MIN 6VW 439$

72120 L-S SP BEND ONLY 2-3V 439$

72125 CT C-SPINE W/O CONTRAST 439$

72126 CT C-SPINE W/CONTRAST 1,495$

72128 CT T-SPINE W/O CONTRAST 439$

72129 CT T-SPINE W/CONTRAST 714$

72130 CT T-SPINE W/WO CONTRAST 714$

72131 CT L-SPINE W/O CONTRAST 439$

72132 CT L-SPINE W/CONTRAST 1,495$

72133 CT L-SPINE W/WO CONTRAST 714$

72141 MRI C-SPINE W/O CONTRAST 913$

72142 MRI C-SPINE W/CONTRAST 1,495$

72146 MRI T-SPINE W/O CONTRAST 913$

72147 MRI T-SPINE W/CONTRAST 1,495$

72148 MRI L-SPINE W/O CONTRAST 913$

72149 MRI L-SPINE W/CONTRAST 1,495$

72156 MRI C-SPINE W/WO CONTRAST 1,495$

72157 MRI T-SPINE W/WO CONTRAST 1,495$

72158 MRI L-SPINE W/WO CONTRAST 1,495$

72170 PELVIS 1V/2V 439$

72190 PELVIS COMP MIN 3V 439$

72192 CT PELVIS W/O CONTRAST 439$

72193 CT PELVIS W/CONTRAST 714$

72195 MRI PELVIS W/O CONTRAST 913$

72195 MRI SACRUM W/O CONTRAST 913$

72197 MRI PELVIS W/WO CONTRAST 1,495$

72197 MRI SACRUM W/WO CONTRAST 1,495$

72198 MRA PELVIS W/WO CONTRAST 1,495$

72220 SACRUM & COCCYX MIN 2V 313$

72270 MYELOGRAPHY ENTIRE SPINE S&I 2,666$

73000 CLAVICLE COMP LT 313$

73000 CLAVICLE COMP RT 313$

73010 SCAPULA COMP LT 439$

73010 SCAPULA COMP RT 439$

73020 SHOULDER 1V LT 313$

73020 SHOULDER 1V RT 313$

73030 SHOULDER MIN 2V LT 313$

73030 SHOULDER MIN 2V RT 313$

73040 SHOULDER ARTHROGRAM LT S&I 1,495$

73050 A-C JOINTS BILATERAL 313$

73060 HUMERUS MIN 2V LT 313$

73060 HUMERUS MIN 2V RT 313$

73070 ELBOW 2V LT 313$

73070 ELBOW 2V RT 313$

73080 ELBOW COMP MIN 3V LT 313$

73080 ELBOW COMP MIN 3V RT 313$

73090 FOREARM 2V LT 313$

73090 FOREARM 2V RT 313$

73092 UP EXT INF MIN 2V LT 439$

73092 UP EXT INF MIN 2V RT 439$

73100 WRIST 2V LT 313$

73100 WRIST 2V RT 313$

73110 WRIST COMP MIN 3V LT 313$

73110 WRIST COMP MIN 3V RT 313$

73120 HAND 2V LT 439$

73120 HAND 2V RT 439$

73130 HAND MIN 3V LT 313$

73130 HAND MIN 3V RT 313$

73140 FINGER(S) MIN 2V LT 313$

73140 FINGER(S) MIN 2V RT 313$

73200 CT UPPER EXT W/O CONT LT 439$

73200 CT UPPER EXT W/O CONT RT 439$

73201 CT UPPER EXT W/CONT LT 1,495$

73201 CT UPPER EXT W/CONT RT 1,495$

73206 CTA UPPER EXT LT W/WO CONTRAST 714$

73206 CTA UPPER EXT RT W/WO CONTRAST 714$

73218 MRI UPPER EXT W/O CONT LT 913$

73218 MRI UPPER EXT W/O CONT RT 913$

73220 MRI UPPER EXT W/WO CNT LT 1,495$

73220 MRI UPPER EXT W/WO CNT RT 1,495$

73221 MRI JNT UP EXT WO CONT LT 913$

73221 MRI JNT UP EXT WO CONT RT 913$

73223 MRI JNT UP EXT W/WO CNT L 1,495$

73223 MRI JNT UP EXT W/WO CNT R 1,495$

73501 X-RAY EXAM HIP UNI 1 VIEW LT 313$

73501 X-RAY EXAM HIP UNI 1 VIEW RT 313$

73502 X-RAY EXAM HIP UNI 2-3VIEWS LT 313$

73502 X-RAY EXAM HIP UNI 2-3VIEWS RT 313$

73521 X-RAY EXAM HIPS BI 2 VIEWS 439$

73551 X-RAY EXAM OF FEMUR 1 LT 313$

73551 X-RAY EXAM OF FEMUR 1 RT 313$

73552 X-RAY EXAM OF FEMUR 2/> LT 313$

73552 X-RAY EXAM OF FEMUR 2/> RT 313$

73560 KNEE 1V/2V LT 313$

73560 KNEE 1V/2V RT 313$

73562 KNEE W/OBL 3V LT 313$

73562 KNEE W/OBL 3V RT 313$

73564 KNEE COMP 4V+ LT 439$

73564 KNEE COMP 4V+ RT 439$

73590 TIB/FIB 2V LT 313$

73590 TIB/FIB 2V RT 313$

73592 LOW EXT INF MIN 2V LT 313$

73592 LOW EXT INF MIN 2V RT 313$

73600 ANKLE 2V LT 313$

73600 ANKLE 2V RT 313$

73610 ANKLE COMP MIN 3V LT 313$

73610 ANKLE COMP MIN 3V RT 313$

73620 FOOT 2V LT 313$

73620 FOOT 2V RT 313$

73630 FOOT COMP MIN 3V LT 313$

73630 FOOT COMP MIN 3V RT 313$

73650 HEEL MIN 2V LT 313$

73650 HEEL MIN 2V RT 313$

73660 TOE(S) MIN 2V LT 313$

73660 TOE(S) MIN 2V RT 313$

73700 CT LWR EXT W/O CONT BILAT 439$

73700 CT LWR EXT W/O CONT LT 439$

73700 CT LWR EXT W/O CONT RT 439$

73701 CT LWR EXT W/CONT BILAT 714$

73701 CT LWR EXT W/CONT LT 714$

73701 CT LWR EXT W/CONT RT 714$

73706 CTA LWR EXT BIL W/WO CONTRAST 714$

73706 CTA LWR EXT LT W/WO CONTRAST 714$

73706 CTA LWR EXT RT W/WO CONTRAST 714$

73718 MRI LWR EXT WO CONT LT 913$

73718 MRI LWR EXT WO CONT RT 913$

73720 MRI LWR EXT W/WO CONT LT 1,495$

73720 MRI LWR EXT W/WO CONT RT 1,495$

73721 MRI JNT LWR EXT WO CNT LT 913$

73721 MRI JNT LWR EXT WO CNT RT 913$

73723 MRI JNT LWR EXT W/WO LT 1,495$

73723 MRI JNT LWR EXT W/WO RT 1,495$

74018 ABDOMEN AP VIEW 313$

74019 X-RAY EXAM ABDOMEN 2 VIEWS 439$

74021 X-RAY EXAM ABDOMEN 3+ VIEWS 439$

74022 X-RAY EXAM COMPLETE ABDOMEN 439$

74150 CT ABD W/O CONTRAST 439$

74160 CT ABD W/CONTRAST 714$

74170 CT ABD W/WO CONTRAST 714$

74174 CT ANGIO ABD&PELVIS W/O&W/DYE 1,495$

74175 CTA ABDOMEN W/WO CONTRAST 714$

74176 CT ABD & PELVIS W/OUT CONTRAST 913$

74177 CT ABD & PELVIS WITH CONTRAST 1,495$

74178 CT ABD & PELVIS W/OUT W/CONTR 1,495$

74181 MRI ABD W/O CONTRAST 913$

74183 MRI ABD W/WO CONTRAST 1,495$

74185 MRA ABD W/WO CONTRAST 1,511$

74220 X-RAY XM ESOPHAGUS 1CNTRST 714$

74221 X-RAY XM ESOPHAGUS 2CNTRST 714$

74230 X-RAY XM SWLNG FUNCJ C+ 714$

74240 EC X-RAY XM UPR GI TRC 1CNTRST 714$

74246 EC X-RAY XM UPR GI TRC 2CNTRST 714$

74248 EC X-RAY SM INT F-THRU STD 614$

74250 X-RAY XM SM INT 1CNTRST STD 714$

74270 X-RAY XM COLON 1CNTRST STD 714$

74280 X-RAY XM COLON 2CNTRST STD 714$

74300 CHOLANGIOGRAM INTRAOP S&I 588$

74330 ERCP BILIARY & PANCREATIC S&I 980$

74340 XRAY GUIDE FOR GI TUBE S&I 460$

74420 RETROGRADE PYELOGRAM 1,495$

74430 CYSTOGRAM MIN 3V S&I 1,495$

74450 URETHROCYSTOGRAM RETRO S&I 913$

74455 URETHROCYTOGRAM VOIDING S&I 913$

75561 CARD MRI M/F CNTRST 1,495$

75571 CT HRT W/O QUANT EVAL CAL 313$

75574 CT ANGIO HRT W/3D IMAGE 714$

75625 AORTO ABD BY SERIAL S&I 10,852$

75635 CTA AORTA W/RO W/WO CONTRAST 714$

75705 ANGIO SPINAL SELECT S&I 17,997$

75710 ANGIO EXTREMITY LT S&I 10,852$

75710 ANGIO EXTREMITY RT S&I 10,852$

75716 ANGIO EXTREMITY BIL S&I 10,852$

75726 ANGIO VISCERAL SEL/SUPRA 17,997$

75820 VENOGRAM EXT UNI LT S&I 2,469$

75820 VENOGRAM EXT UNI RT S&I 2,469$

75822 VENOGRAM EXT BIL S&I 6,387$

75901 GUIDE FOR MECH REMOVAL S&I 534$

75984 CATH CHANGE W/CONTRAST S&I 588$

75989 CT PERC DRAINAGE ABSCESS S&I 1,069$

75989 PERC DRAIN ABSCESS W/ CATH PLC 1,069$

76000 FLUOROSCOPY UP TO 1 HR 913$

76000 MINI MOBILE FLUORO 913$

76010 BABYGRAM NOSE-RECT 1FILM 313$

76080 FISTULAGRAM S&I 1,886$

76098 BREAST TISSUE SPEC 1,886$

76376 3D RENDERING W/O POSTPROC 571$

76377 3D RENDERING W/POSTPROC 480$

76390 MRI SPECTROSCOPY 2,305$

76506 US HEAD REAL TIME W/IMAGE 439$

76536 US HD/NCK SFT TISSUE W/IM 439$

76604 US CHEST REAL TIME W/IMAG 439$

76641 US BREAST COMPLETE LT 439$

76641 US BREAST COMPLETE RT 439$

76642 US BREAST LIMITED LT 313$

76642 US BREAST LIMITED RT 313$

76700 US ABDOMEN COMPLETE 439$

76705 US ABDOMEN LIMITED 439$

76706 US ABDL AORTA SCREEN AAA 439$

76770 EC US RETROPERITONEAL CMP 439$

76775 US RETROPERITONEAL LTD 439$

76776 US TRANSPL KIDNEY W/DOPPL 439$

76800 US SPINAL CANAL 439$

76801 US OB <14 WKS SNGL FETUS 439$

76802 US OB <14 WKS EA ADDL FET 344$

76805 US OB COMP 1ST GEST 439$

76815 US OB LIMITED 439$

76816 US OB F/U OR REPEAT 439$

76816 US OB REPEAT ADDL FETUS 439$

76817 US TRANSVAG PREG UTERUS 439$

76818 FETAL BIO W/NON STRESS 439$

76819 FETAL BIO W/O NON STRESS 439$

76830 US TRANSVAGINAL 439$

76856 US PELVIS COMPLETE NON OB 439$

76857 US PELVIS LIMITED 439$

76870 US TESTICLES 439$

76882 US EXTR NON-VASC LTD SPECIF LT 439$

76882 US EXTR NON-VASC LTD SPECIF RT 439$

76885 US INFANT HIPS 313$

76937 US GUIDE VASC ACCESS 445$

76942 US NDL PLCMNT GUIDANCE S&I 435$

76981 US ELASTOGRAPHY PARENCHYMA 439$

76982 US ELASTOGRAPHY 1ST LESION 439$

76983 US ELASTOGRAPHY EA ADDL LESION 494$

76998 US GUIDE INTRAOPERATIVE 549$

77001 FLUORO GUIDE VASC ACCESS S&I 381$

77002 FLUORO LOC NDL BX/ASP 488$

77012 CT NEEDLE BIOPSY GUIDANCE S&I 1,294$

77014 CT PLCMT RAD FIELD GUIDE 600$

77073 BONE LENGTH STUDIES 439$

77075 BONE SURVEY COMPLETE 439$

77076 BONE SURVEY INFANT 439$

77280 THER RAD SET FIELD SIMP 496$

77285 THER RAD SET FIELD INTER 1,312$

77290 THER SIM FIELD SET CMPLX 1,312$

77295 THER RAD SIM AID FLD 3D 4,876$

77300 RX BASIC RAD DOSIM CALC 496$

77301 IMRT PLAN 4,876$

77306 TELETHX ISODOSE PLAN SIMPLE 1,312$

77307 TELETHX ISODOSE PLAN CPLX 1,312$

77321 SP TELETHER PORT PLAN PAR 1,312$

77331 SPECIAL DOSIMETRY 496$

77332 TX DEV DSGN/FAB SIMPLE 496$

77333 TX DEV DSGN/FAB INT 496$

77334 TX DEV DSGN/FAB COMPLEX 1,312$

77336 CONT RAD PHYSICS CONSULT 496$

77338 MLC IMRT TRMT DEVICE 1,312$

77370 SPC MED RAD PHYSICS CONS 496$

77385 INTSTY MODUL RAD TX DLVR SMPL 2,110$

77386 INTSTY MODUL RAD TX DLVR CPLX 2,110$

77387 GUIDANCE FOR DLVRY RAD TX 290$

77402 RAD TX DEL>=1 MEV SIMP 480$

77412 RAD TX DEL >=1 MEV COMPLEX 926$

77417 THERA RAD PORT FILM(S) 247$

77470 SPECIAL TREATMENT PROC 2,110$

78013 THYROID IMAGING W/BLD FLOW 1,441$

78014 THYROID IMAGING W/BLD FLOW QT 1,441$

78018 THYROID CA METS WHOLE BDY 1,848$

78070 PARATHYROID SCAN 1,441$

78071 PARATHYROID PLANAR W/SPECT 1,441$

78195 LYMPHATICS & LYMPH SCAN 1,848$

78202 LIVER SCAN W/VASC FLOW 4,982$

78206 LIVER SPECT W/VASC FLOW 1,491$

78215 LIVER/SPLEEN STATIC 1,441$

78226 HEPATOBILIARY SYS IMAGE 1,441$

78227 HEPATOBIL SYS IMAGE W/PHARM 1,848$

78264 GASTRIC EMPTYING STUDY 1,441$

78278 GI ACUTE BLOOD LOSS STDY 1,441$

78290 BOWEL SCAN 1,441$

78300 BONE/JNT SCAN LIMITED 1,441$

78305 BONE/JNT SCAN MX AREAS 1,441$

78306 BONE/JNT SCAN WHOLE BODY 1,441$

78315 BONE/JNT SCAN 3 PHASE 1,441$

78452 MYOCARDIAL PERF SPECT MULT 4,982$

78453 MYOCARDIAL PERF PLANAR SGL 4,982$

78472 CARDIAC BLOOD POOL SGL 1,441$

78580 LUNG PERF PARTICULATE 1,441$

78582 LUNG VENTILAT&PERFUS IMAGING 1,848$

78701 RENAL SCAN STATIC W/FLOW 1,441$

78707 RENAL FLOW & FUNC SGL 1,848$

78708 RENAL FLOW&FUNC SGL W/RX 1,848$

78709 RENAL FLOW & FUNC MULT 1,848$

78800 RP LOCLZJ TUM 1 AREA 1 D IMG 1,441$

78802 RP LOCLZJ TUM WHBDY 1+D IMG 4,982$

78803 RP LOCLZJ TUM SPECT 1 AREA 4,982$

78804 RP LOCLZJ TUM WHBDY 2+D IMG 4,982$

78805 ABSCESS SCAN LTD 1,430$

78806 ABSCESS SCAN WHOLE BODY 1,430$

78808 IV INJ RADIOPHAR DRUG DX STUDY 1,441$

79005 NUCLEAR RX ORAL ADMIN 930$

80048 BASIC METABOLIC PANEL 71$

80051 ELECTROLYTE PANEL 59$

80053 COMP METABOLIC PANEL 89$

80061 LIPID PANEL(CARDIAC RISK) 112$

80069 RENAL FUNCTION PANEL 73$

80074 ACUTE HEPATITIS PANEL 400$

80076 HEPATIC FUNCTION PANEL 69$

80156 CARBAMAZEPINE TOTAL 122$

80158 CYCLOSPORINE 151$

80162 DIGOXIN 111$

80164 VALPROIC ACID 114$

80170 GENTAMICIN PEAK 137$

80170 GENTAMICIN RANDOM 137$

80170 GENTAMICIN TROUGH 137$

80171 GABAPENTIN SO (GAB) 182$

80175 LAMOTRIGINE SO (LAMOT) 111$

80177 KEPPRA/LEVETRACETAM (WKEPPA) 111$

80178 LITHIUM 55$

80183 OXCARBAZEPINE MET OB 111$

80184 PHENOBARBITAL 128$

80185 PHENYTOIN/DILANTIN TOTAL 111$

80197 TACROLIMUS FK506 115$

80198 THEOPHYLLINE 119$

80200 TOBRAMYCIN RANDOM 135$

80200 TOBRAMYCIN TROUGH 135$

80202 VANCOMYCIN PEAK 114$

80202 VANCOMYCIN RANDOM 114$

80202 VANCOMYCIN TROUGH 114$

80299 METHOTREXATE 156$

80299 QUANTITATION DRUG NOS SO 156$

80307 ACETAMINOPHEN/TYLENOL 521$

80307 ALCOHOL BLOOD 521$

80307 DRUG SCREEN URINE-8 521$

80307 MECONIUM DRUG SCREEN SO 521$

80307 PCP/PHENCYCLIDIN SCRN UR QL 521$

80307 SALICYLATES BLOOD 521$

80320 METHANOL SO 960$

80326 AMPHET MECO QUANT SO 960$

80346 BENZODIAZEPINES MECO QUANT SO 960$

80349 CANNABINOIDS CONF UR EA 960$

80358 METHADONE MECO QUANT SO 960$

80361 OPIATES MECO QUANT SO 960$

80361 OPIATES UR QT EA 960$

80373 TRAMADOL QUANT SO 960$

80377 HYPOGLYCEMIA PANEL SO 192$

81001 UA COMPLETE AUTO W/MICRO 27$

81001 UA REFLEX C&S 27$

81002 KETONES UR 29$

81003 UA PH ONLY AUTO W/O MICRO 19$

81003 UA QUAL AUTO W/O MICRO 19$

81015 UA MICRO ONLY 26$

81015 UA MICRO REFLEX CULT 26$

81163 BRCA1 FULL GENE SEQ SO 7,853$

81206 BCR-ABL1 P210 SO 1,376$

81207 BCR-ABL1 P190 SO 1,215$

81210 BRAF GENE ANALYSIS SO 1,472$

81219 CALR MUTATION ANALYSIS SO 1,134$

81220 CYSTIC FIBROSIS MUT ANA SO 4,670$

81229 MICROARRAY ANA SNP SO 9,732$

81235 EGFR GENE COM VARIANTS SO 2,723$

81240 PROTHOMB F2 GENE MUT (PTGENM) 551$

81241 FACTOR V LEIDEN (FVLEI) 616$

81256 HEMOCHROMATOSIS MUT PCR SO 548$

81261 IGH GENE REARRANGE AMP METH SO 1,661$

81264 IKG GENE REARRANGEMENT SO 1,449$

81270 JAK2 V617F MUT QUAL SO 769$

81270 JAK2 V617F MUTATION SO 769$

81301 MICROSATELLITE INST ANALY 2,924$

81305 MYD88 MUT ANALYSIS SO 1,472$

81340 TRB GENE REARRANGE AMP SO 1,753$

81342 TRG GENE REARRANGEMENT SO 1,691$

81402 MPL COMMON VARIANTS SO 1,261$

81403 JAK2 EKON 12 & 13 1,554$

81403 JAK2 EXON 12 MUT ANA SO 1,554$

81403 JAK2 EXONS 12-15 SO 1,554$

81450 HEMATOLYMPH NEO 5-50 G SO 6,372$

81479 B CELL GENE REARRANGE SO 514$

81479 NTRK NGS FUSION PRO SO 1,065$

82010 BETA HYDROXYBUTYRATE (BHOB) 69$

82024 ACTH SO 324$

82040 ALBUMIN SERUM 42$

82042 ALBUMIN URINE/OTHER 65$

82043 MICROALBUMIN UR RANDOM QT 48$

82088 ALDOSTERONE SERUM SO 342$

82103 ALPHA 1 ANTITRYPSIN TOT SO 113$

82105 ALPHA FETOPROTEIN SERUM 141$

82140 AMMONIA 122$

82150 AMYLASE BLOOD 54$

82150 AMYLASE BODY FLUID 54$

82164 ANGIOTENSIN I CON ENZ SO 122$

82175 ARSENIC BLOOD SO 159$

82232 BETA2 MICROGLOB SERUM SO 136$

82239 BILE ACIDS TOTAL SO 144$

82247 BILIRUBIN TOTAL 42$

82248 BILIRUBIN DIRECT 42$

82271 BLOOD OCCULT GASTRIC 45$

82274 OCCULT BLD FECES ICT VIAL 134$

82274 OCCULT BLOOD ICT 134$

82306 VITAMIN D 25-HYDRYOXY SO 248$

82308 CALCITONIN SO 225$

82310 CALCIUM TOTAL 43$

82330 CALCIUM IONIZED 115$

82340 CALCIUM UR QN TIMED SPEC 51$

82365 CALCULUS INFRAR SPECT SO 108$

82374 CARBON DIOXIDE 41$

82375 CARBOXYHEMOGLOBIN QT (COHGB) 103$

82378 CARCINOEMBRYONIC AG 159$

82384 CATECHOLAMIN FR PLASMA SO 212$

82390 CERULOPLASMIN KSO 90$

82436 CHLORIDE UR RANDOM 48$

82438 CHLORIDES CSF 42$

82465 CHOLESTEROL TOTAL 36$

82525 COPPER SERUM SO 104$

82533 CORTISOL TOTAL 30 MIN 137$

82533 CORTISOL TOTAL 60 MIN 137$

82533 CORTISOL TOTAL BASELINE 137$

82533 CORTISOL TOTAL RANDOM 137$

82533 CORTISOL TOTAL SALIVA SO 137$

82542 PTH RELATED POLYPEPTID QT SO 154$

82550 CPK TOTAL 55$

82552 CPK ISOENZYMES SO 112$

82553 CKMB 97$

82565 CREATININE BLOOD 43$

82570 CREATININE BODY FLUID 43$

82570 CREATININE UR 24HR 43$

82570 CREATININE UR RANDOM 43$

82575 CREATININE CLEARANCE 79$

82595 CRYOGLOBULIN QT/SEMIQT SO 54$

82607 VITAMIN B12 127$

82652 VITAMIN D 1 25-DIHYDRO SO 323$

82668 ERYTHROPOIETIN SO 158$

82693 ETHYLENE GLYCOL SO 125$

82705 FECAL FAT QUAL SO 43$

82728 FERRITIN 114$

82731 FETAL FIBRONECTIN SEMIQT 540$

82746 FOLIC ACID SERUM 123$

82784 IGG SYNTH INDEX CF/SER EA SO 78$

82784 IMMUNOGLOBULIN IGA SO 78$

82784 IMMUNOGLOBULIN IGG SO 78$

82784 IMMUNOGLOBULIN IGM SO 78$

82785 IMMUNOGLOBULIN E SO 138$

82800 PH BLOOD 92$

82800 PH WHOLE BLOOD 92$

82805 BLOOD GAS CORD ART BLD WO2 661$

82805 BLOOD GAS CORD VENOUS WO2 661$

82805 BLOOD GAS VENOUS W/O2 SAT 661$

82805 BLOOD GAS W/O2 SAT DIRECT 661$

82810 O2 SATURATION PANEL (AO2SAT) 82$

82941 GASTRIN SO 148$

82945 GLUCOSE BODY FLUID 33$

82945 GLUCOSE CSF 33$

82947 GLUCOSE BLOOD QT 33$

82977 GGT 60$

83001 FSH 156$

83002 LH 155$

83003 GROWTH HORMONE HUMAN SO 140$

83010 HAPTOGLOBIN QT 106$

83020 HEMOGLOBIN ELECTROPHOR 108$

83030 FETAL SCREEN 90$

83033 APT TEST FOR FETAL HGB 67$

83036 HEMOGLOBIN A1C 81$

83036 HEMOGLOBIN A1C SO 81$

83050 METHEMOGLOBIN QUANT 69$

83090 HOMOCYSTINE 150$

83497 5-HIAA URINE 24-HR SO 108$

83516 ACETYLCHOLINE REC MOD AB SO 97$

83516 F ACTIN IGG AB QT/SEMIQT SO 97$

83516 GLIADIN AB QT SO 97$

83516 GLOMERULAR BASE MEM AB SO 97$

83516 IMMUNOASSAY ANAL MULT SO 97$

83516 MITOCHONDRIAL AB QL/SEMIQT SO 97$

83516 MYELOPEROXIDASE AB (MPOAB) 97$

83516 PROTEIN-3 AB (PR3AB) IA 97$

83516 RIBOSOMAL PROTEIN AB IA SO 97$

83516 TISSUE TGLUTAMINASE IGA S 97$

83516 TISSUE TGLUTAMINASE IGG SO 97$

83519 ACETYLCHOLINE RECEPTOR SO QT 154$

83520 ELASTASE PANCREATIC SO (PELA) 145$

83520 IMMUNOASSAY QUANT NOS SO 145$

83520 TSH RECEPTOR AB QT SO 145$

83525 INSULIN TOTAL 96$

83540 IRON BLOOD 54$

83550 IRON BINDING CAPACITY 73$

83605 LACTIC ACID 97$

83615 LDH 51$

83615 LDH BODY FLUID 51$

83655 LEAD URINE SO 102$

83655 LEAD WHOLE BLOOD 102$

83690 LIPASE 58$

83718 CHOLESTEROL HDL 69$

83721 LDL DIRECT MEASUREMENT SO 88$

83735 MAGNESIUM 56$

83789 MASS SPEC QUANT EA SO 202$

83825 MERCURY BLOOD QT SO 136$

83835 METANEPHRINE UR 24H QN SO 142$

83835 METANEPHRINE UR QN SO 142$

83873 MYELIN BASIC PROTEIN SO 144$

83874 MYOGLOBIN 108$

83874 MYOGLOBIN UR QN SO 108$

83880 NATRIURETIC PEPTIDE 329$

83883 EC KAPPA LT CHAIN QUANT SO 114$

83883 EC LAMBDA LT CHAIN QUANT SO 114$

83883 KAPPA LT CHAIN QT EA 114$

83883 LAMBDA LT CHAIN QT EA 114$

83883 NEPHELOMETRY EA NES SO 114$

83916 OLIGOCLONAL BANDS SO 230$

83921 METHYLAMALONIC ACID SO 178$

83930 OSMOLALITY BLOOD 55$

83935 OSMOLALITY URINE 57$

83970 PTH INTACT 346$

83986 PH BODY FLUID EXCEPT BLD 30$

83986 PH FECES SO 30$

84075 PHOSPHATASE ALKALINE 43$

84080 ALK PHOS FRACTIONATION 124$

84100 PHOSPHORUS BLOOD 40$

84105 PHOSPHORUS URINE 48$

84110 PORPHOBILINOGEN UR QN SO 71$

84112 PAMG 1 823$

84120 PORPHYRINS UR FRAC SO 123$

84132 POTASSIUM SERUM 40$

84133 POTASSIUM UR RANDOM 40$

84134 PREALBUMIN 122$

84145 PROCALCITONIN 228$

84146 PROLACTIN 163$

84153 PSA TOTAL 154$

84154 PSA FREE SO 154$

84155 PROTEIN TOTAL BLOOD 31$

84156 PROTEIN TOTAL URINE 31$

84156 PROTEIN URINE RANDOM 31$

84157 PROTEIN TOT OTHER SOURCE 34$

84157 PROTEIN TOTAL CSF 34$

84165 PROTEIN ELECTROPH SERUM 90$

84165 PROTEIN ELP REFLEX IFE 90$

84166 PROTEIN ELECTROPH CSF 150$

84166 PROTEIN ELECTROPH UR 150$

84202 EC ZINC PROTOPORPHYRIN SO 120$

84207 VITAMIN B6 SO 236$

84244 RENIN SO 184$

84295 SODIUM SERUM 40$

84300 SODIUM UR RANDOM 42$

84305 SOMATOMEDIN C SO 178$

84315 SPECIFIC GRAVITY 28$

84403 TESTOSTERONE TOTAL SO 217$

84425 THIAMINE/VITAMIN B1 SO 178$

84432 THYROGLOBULIN SO 135$

84436 T4 TOTAL 58$

84439 T4 FREE 76$

84443 TSH 141$

84443 TSH REFLEX FT4 141$

84445 THYROID STIM IMMUNOGLO SO 427$

84446 VITAMIN E SO 119$

84450 SGOT 43$

84460 SGPT 44$

84478 TRIGLYCERIDES SO 48$

84479 T3 UPTAKE 54$

84480 T3 TOTAL 119$

84481 T3 FREE 142$

84484 TROPONIN I QUANT 105$

84520 BLOOD UREA NITROGEN/BUN 33$

84540 UREA NITROGEN UR RANDOM 33$

84540 UREA NITROGEN URINE 33$

84550 URIC ACID BLOOD 38$

84560 URIC ACID BODY FLUID 43$

84560 URIC ACID URINE 43$

84586 VASOACTIVE INTEST POLY SO 296$

84590 VITAMIN A RETINOL SO 97$

84630 ZINC SO 96$

84681 C PEPTIDE 175$

84702 HCG QUANT 126$

84703 HCG QUAL SERUM 63$

84703 HCG QUAL URINE 63$

84704 BETA HCG QUANT 128$

85004 BLOOD COUNT AUTO DIFF 54$

85007 MANUAL DIFF 32$

85014 HEMATOCRIT 20$

85018 HEMOGLOBIN 20$

85025 CBC W/AUTO DIFF&PLATELET 65$

85027 CBC W/O DIFF INC PLATELET 54$

85045 RETICULOCYTE COUNT AUTO 33$

85048 EOSINOPHIL COUNT 21$

85048 WBC 21$

85049 PLATELET COUNT AUTO 38$

85240 FACTOR VIII ONE STAGE 150$

85246 VON WILLEBRAND AG SO 192$

85247 VON WILLBRAND MULTIMET SO 192$

85250 FACTOR IX ACTIVITY SO 151$

85300 ANTITHROMBIN III FUNCTION 99$

85301 ANTITHROMBIN III AG 91$

85302 PROTEIN C AG SO 101$

85303 PROTEIN C ACTIVITY 116$

85305 PROTEIN S TOTAL 97$

85306 PROTEIN S FREE 129$

85347 COAGULATION TIME ACTIVAT 36$

85362 FIBRIN DEGRAD SEMI QN 58$

85379 D-DIMER QUANT 85$

85384 FIBRINOGEN ACTIVITY 82$

85397 ADAMTS-13 ACTIVITY SO 259$

85460 KLEIHAUER-BETKE 65$

85525 HEPARIN NEURALIZATION SO 99$

85540 LEUKOCYTE ALK PHOS SO 72$

85576 PLT AGGREGATE COLL/ADP EA 209$

85576 PLT AGGREGATE COLL/EPI EA 209$

85598 HEXAGONAL PHOS NEUTRAL SO 151$

85610 PROTHROMBIN TIME (PT) 36$

85610 PROTHROMBIN TIME SO 36$

85613 DILUTE RUSSEL VIPER VEN SO 80$

85635 REPTILASE TEST SO (CRTBO) 83$

85651 ESR 36$

85660 SICKLE CELL SCREEN 46$

85670 THROMBIN TIME SO 48$

85670 THROMBIN TIME SO (CTTBO) 48$

85730 PTT 50$

85730 PTT SO 50$

85732 PTT MIXING STUDIES SO 54$

85810 VISCOSITY SERUM/PLASMA SO 98$

86003 ALLERGEN QT EA SO 44$

86022 PLATELET ANTIBODIES 154$

86023 PlT IMMUNOGLOB IGG SO 105$

86038 ANA AB 101$

86039 ANA TITER 94$

86060 ASO TITER 61$

86063 ASO SCREEN 48$

86140 C-REACTIVE PROTEIN 43$

86146 BETA 2 GLYCOPROTEIN AB EA SO 214$

86146 BETA 2 GLYCOPROTEN AB IGA EA 214$

86146 BETA 2 GLYCOPROTEN AB IGG EA 214$

86146 BETA 2 GLYCOPROTEN AB IGM EA 214$

86147 CARDIOLIPIN AB IGA SO 214$

86147 CARDIOLIPIN AB IGG SO 214$

86147 CARDIOLIPIN AB IGM SO 214$

86148 PHOSPHATIDYLSERINE AB IGG SO 135$

86160 COMPLEMENT C3 101$

86160 COMPLEMENT C4 101$

86160 COMPLEMENT CIQ SO 101$

86162 COMPLEMENT TOTAL CH50 SO 170$

86200 CCP ANTIBODY 109$

86225 DNA AB DS 115$

86235 ENA EA AB 150$

86235 JO-1 AB SO 150$

86235 SJOGRENS AB EA 150$

86255 FLUOR AB SCRN EA AB SO 101$

86255 NMDA RECPT AB IGG 101$

86255 NMO/AQP4 AB SCRN SO 101$

86256 ENDOMYSIAL AB TITER SO 101$

86256 NMDA RECEPT AB IGG TITER 101$

86256 SMOOTH MUSC AB TITER SO EA 101$

86300 CA 15-3 QT 175$

86300 CA 27.29 QT SO 175$

86301 CA 19-9 QT 175$

86304 CA 125 175$

86308 MONO TEST SCREEN 43$

86317 PNUEMOCOCCAL AB PNL SO 126$

86327 COMPLEMENT C3 NEPHRITIC 251$

86331 IMMUNO GEL DIFUSION SO 101$

86332 IMMUNE COMPLEX CIQ SO 204$

86332 IMMUNE COMPLEX RAJI CL SO 204$

86334 IMMUNOFIXATION ELP SERUM 187$

86335 IMMUNOFIXATION/IFE URINE 246$

86337 INSULIN AB SO 180$

86355 B CELLS TOTAL COUNT 317$

86357 NATURAL KILLER CELLS TL CNT 317$

86359 T CELLS TOTAL COUNT 317$

86360 T CELLS ABS CD4 CD8 INC RATIO 394$

86361 T CELLS ABSOLUTE CD4 225$

86376 LIVER-KIDNEY MICROS AB SO 122$

86376 MICROSOMAL/THYROID AB 122$

86403 CRYPTOCOCCUS AG CSF EA 97$

86431 RA QUANT 48$

86480 QUANTIFERON TB GOLD TUBE 520$

86592 RPR QUAL 36$

86592 VDRL QUAL CSF SO 36$

86592 VDRL QUAL SERUM SO 36$

86593 VDRL TITER SO 37$

86606 ASPERGILLUS AB SO 126$

86611 CAT SCRATCH FEVER AB SO 85$

86618 LYME DIS AB SO 143$

86635 COCCIDIOIDES AB BY CF 96$

86635 COCCIDIOIDES AB SO 96$

86663 EBV EARLY AG AB IGG SO 110$

86664 EBV NUC AG AB (ECBNA) 128$

86665 EBV VCA AB IGG (CEBVG) 152$

86665 EBV VCA AB IGM (CEBVM) 152$

86677 H PYLORI AB 141$

86682 HELMINTH AB NOS SO 109$

86701 EC HIV 1 AB SO 75$

86702 EC HIV-2 AB SO 113$

86704 HEP B CORE AB TOTAL 101$

86705 HEP B CORE AB IGM 99$

86706 HEP B SURF AB 90$

86707 HEP BE AB SO 97$

86708 HEP A AB TOTAL SO 104$

86709 HEP A AB IGM 94$

86735 MUMPS AB IGG SO 109$

86735 MUMPS AB IGM SO 109$

86735 MUMPS ANTIBODY 109$

86738 MYCOPLASMA AB IGM SO 111$

86738 MYCOPLASMA AB SO 111$

86747 PARVOVIRUS B19 IGG SO 126$

86747 PARVOVIRUS B19 IGM SO 126$

86762 RUBELLA AB 121$

86762 RUBELLA AB IGG 121$

86765 RUBEOLA AB IGG 108$

86765 RUBEOLA AB IGM SO 108$

86774 TETANUS AB SO 124$

86777 TOXOPLASMA AB IGG 121$

86778 TOXOPLASMA AB IGM 121$

86790 HERPES VIRUS-6 IGG SO 108$

86790 VIRAL AB NOS SO 108$

86800 THYROGLOBULIN AB SO 133$

86803 HEP C AB 120$

86812 HLA-B27 AG 217$

86850 AB SCREEN RBC EA TECH 482$

86860 AB ELUTION EA 1,399$

86860 AB ELUTION SO EA 1,399$

86870 AB ID RBC EA PNL 2,763$

86870 AB ID RBC EA PNL SO 2,763$

86880 COOMBS DIRECT 326$

86880 COOMBS DIRECT SO 326$

86900 BLD TYPING ABO 1,063$

86900 BLD TYPING ABO SO 1,063$

86901 BLD TYPING RH(D) 326$

86901 BLD TYPING RH(D) SO 326$

86902 BLD TYPG DONOR BLD REAGT EA AG 2,763$

86905 RBC AG ID EA 2,763$

86905 RBC AG ID EA SO 2,763$

86906 RH PHENOTYPING COMPL SO 326$

86920 COMPATIB IMMED SPIN EA 1,399$

86922 COMPATIB AHG 1,399$

86978 RBC ABSORPTION EA (ALLO/AUTO) 326$

87015 CONCENTRATION INF AGNT 56$

87040 CULT BLOOD 87$

87040 CULT BLOOD #2 87$

87045 CULT STOOL 79$

87046 CULT STOOL ADD PATH EA 79$

87070 CULT ALL OTHER ISOL 72$

87070 CULT BRONCHIAL 72$

87070 CULT CATH TIP 72$

87070 CULT CSF 72$

87070 CULT FLUID 72$

87070 CULT GENITAL 72$

87070 CULT RESPIRATORY 72$

87070 CULT SPUTUM 72$

87070 CULT THROAT 72$

87070 CULT WOUND 72$

87075 CULT ANAEROBIC 79$

87076 CULT ANAEROBIC ID EA 68$

87076 CULTURE ANAEROBIC ID #2 68$

87076 CULTURE ANAEROBIC ID #3 68$

87077 CULT AEROBIC ID EA 68$

87077 CULTURE AEROBIC ID #4 68$

87077 CULTURE AEROBIC ID ORG #2 68$

87077 CULTURE AEROBIC ID ORG #3 68$

87077 H PYLORI UREASE 68$

87081 CULT BORDETELLA SCREEN 56$

87081 CULT GC SCREEN 56$

87081 CULT GRP B STREP SCREEN 56$

87081 CULT LEGIONELLA SCREEN SO 56$

87081 CULT METH RESI STAPH SCRN 56$

87081 CULT STREP SCREEN 56$

87086 CULT URINE 68$

87088 CULT URINE ID 68$

87101 CULT FUNG SKIN/HAIR/NAILS 65$

87102 CULT FUNGUS/YEAST OTHER 71$

87103 CULT FUNGUS BLOOD 172$

87106 CULT FUNGUS ID YEAST EA 87$

87107 CULT FUNGUS ID MOLD SO 87$

87116 CULT AFB BLOOD SO 91$

87116 CULT AFB NON-BLOOD SO 91$

87118 CULT MYCOBACT DEF ID EA 123$

87118 CULT MYCOBACTER DEF ID SO 123$

87149 AFB ID BY DIRECT PROBE SO 168$

87153 AFB ID BY SEQ ETHAM RES SO 968$

87153 AFB ID BY SEQ SO 968$

87158 AFB ID MALDI TOF SO 65$

87169 MACROSCOPIC EXAM PARASITE 36$

87177 O & P SMEAR CONC ID 75$

87181 SUSCEPTIBILITY PER AGENT 40$

87184 SENSITIVITY DISK <= 12A 63$

87185 SENSITIVITY PER ENZYME 40$

87186 AFB SUSC MIC SO 73$

87186 SENSITIVITY MIC PER PLATE 73$

87186 SENSITIVITY MIC PER PLATE SO 73$

87186 SUSCEPTIBILITY MIC MOLD SO 73$

87188 AFB SUSC MACRO BROTH SO 56$

87205 EOSINOPHILS URINE 36$

87205 GRAM STAIN 36$

87205 WRIGHTS STAIN WBC(STOOL) W/INT 36$

87206 AFB SMEAR 45$

87207 MALARIA SMEAR W/INTERP 50$

87207 MICROSPORIDIA SPORE DET W/INT 50$

87209 SMEAR COMPLEX W/INTERP O&P 151$

87210 KOH PREP OTHER 49$

87210 WET MOUNT 49$

87220 KOH SKIN/HAIR/NAILS 36$

87252 CULTURE HERPES SO 219$

87253 VIRAL ID TISS CULT ADD SO 169$

87278 LEGIONELLA PNEUMO DFA 131$

87305 ASPERGILLUS AG SO 101$

87324 C DIFFICILE TOXINS A & B 101$

87329 GIARDIA ANTIGEN EIA 101$

87338 H PYLORI AG STOOL 121$

87340 HEP B SURF AG 87$

87350 HEP BE AG SO 97$

87389 HIV 1/2 AG AB W/RFX W/BLOT 202$

87389 HIV-1 AG W/HIV 1/2 ABS 202$

87420 RSV AG EIA QL/SEMIQT 117$

87425 ROTAVIRUS AG 101$

87449 AG DETECT NOS MX 101$

87449 C DIFFICILE GDH AG 101$

87449 FUNGITELL R (1-3) 101$

87449 LEGIONELLA PNEUMO AG EA 101$

87480 CANDIDA DNA DIR PROBE 168$

87486 CHLAMYDIA PNEUMO AMP PRB 294$

87491 CHLAMYDIA AMP PROBE 294$

87493 C DIFFICILE BY PCR (CDPCR) 313$

87496 CMV AMP PROBE SO 294$

87496 CMV AMPLIFIED PROBE 294$

87496 CMV QUAL PCR SALIVA SO 294$

87497 CYTOMEGALOVIRUS QUANT SO 359$

87498 ENTEROVIRUS PCR CSF 294$

87498 ENTEROVIRUS PCR PLASMA SO 294$

87502 INFLUENZA A&B RT AMP PROBE 804$

87510 GARDNER VAG DNA DIR PROBE 168$

87517 HEP B VIRUS QUANT SO (HBVDNA) 359$

87522 HEP C QUANT SO 359$

87529 EC HSV 1 AMP PROBE CSF/SWAB 294$

87529 EC HSV 2 AMP PROB CSF/SWAB 294$

87529 HSV 1 2 BLD/OTHER FLUID SO 294$

87529 HSV SUBTYPE BLD/OTHER SO 294$

87532 HSV 6 AMP PROBE 294$

87535 HIV-1 AMP PROBE SO 294$

87536 HIV-1 QUANT SO 714$

87556 M TB AMP PROBE 350$

87581 MYCOPLASMA PNEUMO AMP PRB 294$

87591 GC AMP PROBE 294$

87633 RESP VIRUS 12-25 TARGETS 3,497$

87634 RSVP AM PROBE 589$

87635 SARS-COV2 BY RT PCR SO 260$

87635 SARS-COV-2 COVID19 AMP PR 260$

87635 SARS-COV2 COVID19 AP PAN 260$

87635 SARS-COV2 RT PCR SO DLS 260$

87653 STREP GRP B AMP PROBE 294$

87660 TRICHOMONAS VAG DIRECT 168$

87798 B PERTUSSIS AMP PROBE DNA EA 294$

87798 BORDETELLA PERTUSS AMP PRB 294$

87798 EBV PCR SO 294$

87798 INF AG AMP PROBE EACH 294$

87798 M TB AMP PROBE RESIST EA SO 294$

87798 NORVOVIRUS GRP 1 PCR SO 294$

87799 BK VIRUS DNA QNT PCR EA SO 359$

87804 EC INFLU AG DIR OPTIC OBS ADD 139$

87804 EC INFLU AG W/DIRCT OPTIC OBS 139$

87806 HIV AG WITH HIV 1&2 ABS 275$

87880 STREP A SCREEN DIRECT OBS 139$

87899 CAMPY ANTIGEN DIRECT 135$

87899 SHIGA TOXIN 1 135$

87899 SHIGA TOXIN 2 135$

87899 STREP PNEUMO AG 135$

87900 INF AG DRUG SUSC PHENOT 1,094$

87901 HIV-1 GENOTYPING SO 2,160$

87902 HEPATITIS C VIRUS SO 2,160$

88104 CYTOPATH WASH BR NON-GYN INTP 326$

88108 CYTO CONC SMR & INTERP 326$

88172 EVAL OF FNA FIRST EPISODE 1,399$

88173 FNA INTERP & REPT 482$

88177 EVAL OF FNA EA ADD EPISODE 47$

88184 FLOWCYTOMETRY FIRST MARKR 2,763$

88185 FLOWCYTOMETY EA ADD MARKR 316$

88233 TISSUE CULT SKIN/OTHER SO 1,181$

88237 TISSUE CULT BONE MARRO SO 1,206$

88261 CHROMO ANAL 5C/1K SO 2,218$

88262 CHROMO ANAL 15-20C/2K SO 1,053$

88264 CHROMOSOME ANALY 20-25 SO 1,213$

88271 MOL CYTO DNA PROBE 180$

88275 MOL CYTO INTERPHASE 180$

88280 CHROMO ANAL ADD KARY SO 281$

88285 CHROMO ANAL ADD CELL SO 226$

88300 SURG PATH 1 GROSS ONLY 224$

88302 SURG PATH 2 G&M 224$

88304 SURG PATH 3 G&M 482$

88305 SURG PATH 4 G&M 482$

88307 SURG PATH 5 G&M 2,763$

88309 SURG PATH 6 G&M 6,124$

88311 DECALCIFICATION 54$

88312 SPECIAL STAIN GRP 1 INT/RPT EA 482$

88313 SPECIAL STAIN GRP 2 INT/RPT EA 326$

88319 HISTOCHEM TO ID ENZYME EA 6,124$

88323 CONSULT/RPT ON REF MAT 482$

88331 CONSULT W/ FROZEN SECTION SGL 1,399$

88332 CONSULT ADDL TISS BLK W/FROZEN 156$

88333 CONSULT CYTOPATH INITIAL 6,124$

88334 CONSULT CYTOPATH ADDL 156$

88341 IMMUNOHISTOCHEM EA ADD 445$

88342 IMMUNOCYTOCHEM 445$

88344 IMMUNOHISTOCHEM EA MULT 445$

88346 IMMUNOFLUOR DIRECT 2,763$

88348 ELECTRON MICROSCOPY SO 6,124$

88350 IMMUNOFLUOR AB STAIN ADD 570$

88360 MORPH ANALYSIS SO 1,399$

88361 MORPH ANALYSIS TUMOR 2,673$

88364 IN SITU HYBRID EA ADD 751$

88365 TISSUE INSITU HYBRIDIZATI EA 1,399$

88366 IN SITU HYBRID EA MULTIPLEX 2,763$

88368 MORPH ANAL IN SITU MAN SO 2,763$

88369 MORPH ANA IN SITU ADD 643$

88374 MORPH INSITU QN W/CAT MULTI EA 1,399$

88377 MORPH ANA MANUAL MULT EA 1,399$

88381 MICRODISSECTION MANUAL 1,393$

89051 CELL CNT BODY FL W/DIFF 47$

89051 CELL CNT CSF W/DIFF 47$

89060 CRYSTAL ID BODY FL 61$

90384 RH IG FULL DOSE IM 406$

90471 ADMIN VACCINE/IMMUN OTHER SGL 237$

90472 ADMIN EA ADDL VACCINE 108$

90935 HEMODIALYSIS 2,506$

90935 KIDNEY HEMODIALYSIS ACUTE 2,506$

92507 SPEECH TRMT INDIVIDUAL 288$

92522 EVAL SPEECH SOUND PRODUCTION 381$

92523 EVAL SPEECH SOUND W/LANG COMP 708$

92524 BEHAVIORAL QUALIT ANALYS VOICE 326$

92526 SWALLOWING TRMT FOR FEED 323$

92587 NURSERY TEOAE SCREENING 991$

92597 EVAL&/FITG VOICE PROSTC DEVICE 265$

92605 EVAL NON SPEECH DEV 1 HR 246$

92608 EVAL SP DVC ADDL 30 MIN 191$

92609 TRMT SPEECH DVC PROG/MOD 400$

92610 SWALLOWING EVALUATION 263$

92611 SWALLOW EVAL FLUORO 337$

92612 ENDOSCOPY SWALLOW FEES VID 245$

92613 ENDOSCOPY SWALLOW FEES I&R 91$

92920 ANGIOPLASTY SINGLE VESSEL 19,398$

92921 ANGIOPLASTY ADDL BRANCH 14,611$

92937 PCI BYPASS ANY METHOD 38,799$

92941 PCI ACUTE MI SNGL VESSEL 30,196$

92950 CPR 991$

92950 CPR CODE BLUE 991$

92960 CARDIOVERSION ELECTIVE EXT 2,101$

92973 CORONARY THROMBECTOMY MECH 10,571$

92978 IVUS IMAGING INITIAL VESSEL 3,218$

92979 IVUS IMAGING ADDL VESSEL 1,779$

93005 EKG 12LEAD TRACE ONLY INT 215$

93005 EKG12LEAD TRACE ONLY INIT 215$

93005 EKG12LEAD TRACEONLY SUBSQ 215$

93017 STRESS TST W/EKG TRACING 991$

93288 PM DEVICE EVAL IN PERSON 142$

93289 ICD DEVICE INTERROGATE 142$

93303 ECHO CONGENITAL ANOM COMP 2D 1,886$

93304 F-UP/LIMITED TTHRC ECHO 1,876$

93306 ECHOT-THOR2DCOMPW/DOPPLER 2,666$

93306 TTE 2D COMP W/ DOPPCF W/CONT 2,666$

93308 ECHO T-THORACIC 2D LMTD 913$

93312 ECHO TRANSESOPHAGEAL 1,886$

93320 ECHO DOPPLER COMPLETE 572$

93351 ECHO T-THORACIC STRESS COMP 1,876$

93356 MYOCRD STRAIN IMG SPCKL TRCK 4,423$

93451 RIGHT HEART CATH 11,160$

93452 LT HRT CATH W/VENTRCLGRPHY 11,160$

93454 CORONARY ART ANGIO S&I 11,160$

93455 CORONARY ART/GRFT ANGIO S&I 11,160$

93456 RT HRT CORONARY ARTERY ANGIO 11,160$

93458 LT HRT ARTERY/VENTRICLE ANGIO 11,160$

93459 LT HRT ART/GRFT ANGIO 11,160$

93460 CORONARY ART ANG RHC/LHC VENT 11,160$

93503 INSRT/PLCMNT FLO-DIR CATH 6,387$

93567 INJECT SUPRVLV AORTOGRAPHY 221$

93571 INTRVASC BLDFLW VELOC INT 2,681$

93572 INTRVASC BLDFLW VELOC ADD 1,423$

93641 INTRA-OP ICD CHECK 2,185$

93797 CARDIAC REHAB W/O MONITORING 431$

93798 CARDIAC REHAB W/MONITORING 431$

93880 EXTRACRAN ART DUPLEX COMP BIL 913$

93882 EXTRACRAN ART DUPLEX UNI/LTD 439$

93922 BIL ART STUDY EXT 1-2 LVL 427$

93925 ART SCN LWR EXT CMP BIL 913$

93926 ART SCN LWR EXT LMTD LT 439$

93926 ART SCN LWR EXT LMTD RT 439$

93930 ART SCN UPPER EXT CMP BIL 913$

93931 ART SCN UPPER EXT LMTD LT 439$

93931 ART SCN UPPER EXT LMTD RT 439$

93970 DUPLEX SCN EXT VEINS BIL CMPL 913$

93971 DPLX SCN EXT VEINS UNI LTD LT 439$

93971 DPLX SCN EXT VEINS UNI LTD RT 439$

93976 EC USART/VEIN/ABD/PEL/SCR/LTD 439$

93979 US DUPLEX AO/IVC LTD 439$

93985 DUP-SCAN HEMO COMPL BI STD 913$

93986 DUP-SCAN HEMO COMPL UNI STD LT 439$

93990 DOPPLER FLOW TESTING 439$

94002 VENT MGMT INIT DAY-IP/OBS 1,819$

94003 VENT MGMT SUBQ DAY-IP/OBS 1,819$

94004 VENT MGMT PER DAY-SNF 620$

94060 BRONCHOSPSM PRE/POST EVAL 991$

94375 FLOW VOLUME LOOP 991$

94640 RESPIRATORY TRMT INITIAL 720$

94640 RESPIRATORY TRMT SUBQ 720$

94644 CBT 1ST HOUR 427$

94645 CBT EACH ADDL HOUR 313$

94660 CPAP/BIPAP MNGT INIT/SUBQ 720$

94664 DEMO/EVAL INH DEVICE/DAY 720$

94668 CHEST WALL MANIP SUBSEQ 427$

94726 PLETHYSMOGRAPHY DET LUNG VOL 991$

94727 PULM FUNCTION TEST BY GAS 542$

94729 C02/MEMBANE DIFFUSE CAPACITY 277$

94760 PULSE OXIMETRY SGL 79$

94761 PULSE OXIMETRY MULTIPLE 201$

95812 EEG MONITORING UP TO 1 HR 991$

95813 EEG EXTND MNTR 61-119 MIN 991$

95816 EEG AWAKE AND DROWSY 991$

95819 EEG AWAKE AND ASLEEP 991$

95822 EEG COMA OR SLEEP ONLY 991$

95992 CANALITH REPOSITIONING PER DAY 135$

96105 ASSESSMENT OF APHASIA PER HR 373$

96125 COGNITIVE TEST PERHR BY HC PRO 398$

96360 IV HYDRATION 31 MIN TO 1HR 719$

96361 IV HYDRATION EA ADDL HR 149$

96365 IV INFUSION INITIAL TO 1 HR 719$

96366 IV INFUSION EA ADDL HR 149$

96367 IV INF ADDL SEQUNT 1ST HR 237$

96368 IV INFUSION CONCURRENT 161$

96372 INJ SUBQ OR IM 237$

96374 INJ IV PUSH INITIAL DRUG 719$

96374 IV PUSH BUBBLE STUDY 719$

96375 IV PUSH EA ADDL SEQ NEW DRUG 149$

96376 IV PUSH EA ADDL SAME DRUG 223$

96377 ON BODY INJ SUBQ PEGFILGRASTIM 149$

96401 CHEMO ADM SUBQ/IM NON-HRM 237$

96402 CHEMO ADM SUBQ/IM HORMONL 237$

96409 CHEMO ADMIN IV PUSH INIT 719$

96411 CHEMO ADM IV PUSH EA ADDL 237$

96413 CHEMO ADMIN INIT IV INF 1HR 1,212$

96415 CHEMO ADM IV INF ADDL HR 237$

96415 CHEMO ADM IV INF ADD'L HR 237$

96416 CHEMO IV INF > 8 HRS 1,212$

96417 CHEMO ADM IV INF ADDL SEQ 237$

96450 CHEMO ADMIN SPINAL PUNC 1,212$

96523 IRRIG DRUG DELIVERY 215$

96523 IRRIG DRUG DELIVERY DEVICE 215$

97014 ELEC STIM 1/>OTHER THAN WOUND 51$

97028 ULTRAVIOLET THERAPY 30$

97035 ULTRASOUND EACH 15 MIN 53$

97035 ULTRASOUND THERAPY 15 MIN EA 53$

97110 THERAP PROC EA 15 MIN 112$

97110 THERAPEUTIC EX EA 15 MIN 112$

97112 NEURO RE-EDUC EA 15 MIN 130$

97116 GAIT TRAIN EACH 15 MIN 111$

97129 COG SKILL DEV INITIAL 15 MIN 84$

97130 COG SKILL DEV ADDL 15 MIN 81$

97140 MANUAL THERAPY EA 15 MIN 103$

97161 PT EVAL LOW COMPLEX 20 MIN 315$

97162 PT EVAL MOD COMPLEX 30 MIN 315$

97163 PT EVAL HIGH COMPLEX 45 MIN 315$

97165 OT EVAL LOW COMPLEX 30 MIN 336$

97166 OT EVAL MOD COMPLEX 45 MIN 334$

97167 OT EVAL HIGH COMPLEX 60 MIN 334$

97530 THERAPEUTIC ACT EA 15 MIN 147$

97535 ADL TRAINING EA 15 MIN 126$

97605 VAC THERAPY <=50 SQ CM 684$

97606 VAC THERAPY > 50 SQ CM 1,251$

97608 DISP WOUNDVAC NPWT>50 SQ CM 1,950$

97760 ORTHOTIC FIT/TRAIN 15 MIN 185$

97763 CHK ORTH/PROSTH EA 15 MIN 199$

99152 AG MODSED SAME MD>=5YR 1ST 15M 185$

99152 CC MODSED SAME MD>=5YR 1ST 15M 185$

99152 CT MODSED SAME MD>=5YR 1ST 15M 185$

99152 ER MODSED SAME MD>=5YR 1ST 15M 185$

99152 US MODSED SAME MD>=5YR 1ST 15M 185$

99153 AG MODSED SAMD MD EA 15M ADDL 59$

99153 CC MODSED SAMD MD EA 15M ADDL 59$

99153 CT MODSED SAMD MD EA 15M ADDL 59$

99153 US MODSED SAMD MD EA 15M ADDL 59$

99195 PHLEBOTOMY 427$

99211 CHEMO EST VISIT LEVEL 1 243$

99211 L&D OP VISIT EP LEVEL 1 243$

99211 OP VISIT EP MINOR 5MIN SUTURE 454$

99211 RAD EST VISIT LEVEL 1 243$

99211 REMOVAL OF PICC LINE 243$

99211 TREATMENT ROOM BASIC 454$



99212 TREATMENT ROOM LIMITED 454$



99213 TREATMENT ROOM INTERMED 454$



99219 ER OBS PER DAY MOD 184$

99219 SURGICAL OBS PER DAY MOD 184$

99281 ER FAC VISIT LVL 1 273$



99284 ER FAC VISIT LVL 4 1,378$

99285 ER FAC VISIT LVL 5 1,976$

99291 ER CRIT CARE 30-74MIN 2,610$

A4338 CATH LATEX URO 0165SI16 54$

A4338 CATH PED LATEX URO 0165SI10 54$

A4371 OST POWDER STOMAHESIVE 20$

A4377 OST PCH UROST 1.75 11$

A4377 OST PCH UROST 2.25 11$

A4388 OST PCH DRN 1PC HOLISTER 9$

A4398 OST PCH DRN HOLISTER 2.25 6$

A4407 OST WFR HOLISTER 2.25 9$

A4428 OST PCH 1 PC UROST HOLIST 17$

A4649 GUIDEWIRE THREADED #292.69 538$

A4649 HUMERALSTEM COMP MICRO 55X10MM 5,000$

A4649 RETR SELF RETAIN DISP 279$

A5063 OST PCH OE COLOST 4 FL 141$

A9517 RX TX 131 I CAP PER MCI 70$

B4087 FD TUBE GASTRO 20F 131$

B4087 FD TUBE GASTRO 24F 141$

B4087 G- TUBE STD 12FR X 40 94$

B4087 G- TUBE STD 16FR X 40 94$

B4088 FD TUBE LOW PROFILE 20F 384$

C1713 ANCHOR DBL LOAD 4.75 SWVLLOCK 1,488$

C1713 BLD TI SPIRAL RETGRDFEM 90MM 2,111$

C1713 CABLE ORTHO #2232-04-18 2,100$

C1713 CABLE ORTHO #2232-05-18 1,715$

C1713 CEMENT ORTHO#B000-0240 542$

C1713 CEMENTORTHO#6191-1-010 325$

C1713 CMC MINI TIGHTROPE #AR-8919DS 2,685$

C1713 DBX DEMINERALIZED BONE 10CC 2,760$

C1713 FIXATION KIT ACL/PCL RPR 1,800$

C1713 GI ANCHOR SET 12 FR MIC 709$

C1713 GI ANCHOR SET 14 FR MIC 709$

C1713 GI ANCHOR SET COPE 268$

C1713 HERNIA REP 5MM ABSORBATACK FIX 2,338$

C1713 KIT OSTEOSET BEAD 2,030$

C1713 KWIRE .035X6" 126$

C1713 KWIRE .035X6" DBL TROCAR 147$

C1713 KWIRE .045 X 6 DBL TROCAR 130$

C1713 KWIRE .045" DIAMOND TIP 1 END 87$

C1713 KWIRE .045X6" 126$

C1713 KWIRE .062 X 7.25" 126$

C1713 KWIRE .062X6" DBL TROCAR 147$

C1713 KWIRE 0.7X80MM 90$

C1713 KWIRE 0.8X120MM 90$

C1713 KWIRE 0.9 100MM 120$

C1713 KWIRE 1.1 100MM 90$

C1713 KWIRE 1.6 150MM 120$

C1713 KWIRE 3.2X450MM STERILE 698$

C1713 KWIRE TROCAR ORTHO#292.50 72$

C1713 KWIRE TROCAR POINT 0.6X70MM 83$

C1713 KWIRETROCARORTHO#49011215 90$



C1713 KWIRETROCARPTORTHO#292.16 79$

C1713 MENISCAL CINCH II 1,383$

C1713 NAIL GAMMA3 10X170MM 125ANG 4,730$



C1713 NAIL GAMMA3 11X380MM LT 125ANG 6,402$

C1713 NAIL TI DISTALFEMORAL 12X240MM 4,396$

C1713 NAIL TIBIAL 10/330 3,635$

C1713 NAIL TIBIAL TI CANN 10X300MM 3,635$

C1713 NAIL TICANN RETANTFEM 13X360MM 3,970$


C1713 NAILLONG GAMMA3 360MM LT125ANG 6,402$

C1713 OSTEOVATION EX 5CC INJ FORMULA 105$

C1713 PALACOS LV+G 00-119-140-01 1,920$

C1713 PALACOS R+G 00-1113-140-01 1,033$

C1713 PIN 4.5 POSITIONING #298.803S 815$

C1713 PIN STEINMAN 2.4MM 120$

C1713 PIN STEINMAN 3.2MM STYLE 5 108$

C1713 PIN STEINMAN 4.0MM 227$

C1713 PIN STEINMANN 3.2MM ACCESS THD 431$

C1713 PIN THRD STEINMAN #6 3.6X229MM 713$

C1713 PINFLUTEDORTHO#7650-2038A 1,731$

C1713 PLATE 3H LAT FIBULA FX RIGHT 2,884$

C1713 PLATE 4.5 6HOLE 170MM 3,479$

C1713 PLATE CPR MINI SCORPION 2,190$

C1713 PLATE H 3.5MM 30MM 2,667$

C1713 PLATE HANDLOC 2.3/1.5 4X2H 3D 2,335$

C1713 PLATE HANDLOC 2.3MM 7H NRRW T 2,335$

C1713 PLATE LAPIDUS 3.5MM 3,031$

C1713 PLATE M STD STRAIGHT 2.3MM 16H 1,277$

C1713 PLATE M VHLP 2.3X1.5 5H LT MC5 2,335$

C1713 PLATE MICALCANEAL 3.5MM65MM LT 2,884$

C1713 PLATE PROX RADIUS LARGE 2,660$

C1713 PLATE RADIAL COLUMN PIN 3HOLE 1,785$

C1713 PLATE SHLDR GLENOID UNIV SM 3,430$

C1713 PLATE STEP 2.7MM 2MM 2,667$

C1713 PLATE SUBCONDYLAR 2.7MM 10HOLE 2,597$

C1713 PLATE T 6H NRW STD M 2.3X1.0MM 1,475$

C1713 PLATE T COMPRESS 2.7MM 7HOLE 2,163$

C1713 PLATE VLRFIX ANG LT 3HOLE 7PEG 1,950$

C1713 PLATE VLRFIX ANG LT 5HOLE 7PEG 2,340$

C1713 PLATE VLRFIX ANG RT 3HOLE 7PEG 2,040$

C1713 PLATE VOLAR BRG LT 3HOLE 7PEG 2,160$

C1713 PLATE VOLAR BRG LT 5HOLE 7PEG 2,370$

C1713 PLATE VOLAR BRG RT 3HOLE 7PEG 2,160$

C1713 PLATE VOLAR BRG RT 5HOLE 7PEG 2,370$

C1713 PLATE1/3ORTHO#4935-06-03 488$

C1713 PLATE1/3TUBCOLORTH#241.36 435$

C1713 PLATE1/3TUBORTHO#241.351 743$




C1713 PLATE2.7/3.5MM VALCP02.117.203 2,749$

C1713 PLATE6HOL4.5ORTHO#222.656 5,042$

C1713 PLATEBASE GLENOID 28MM REUNION 4,400$

C1713 PLATEL-BUTTRSSORTH#240.54 1,506$

C1713 PLATELC-DCP3.5ORTH#223.56 1,369$

C1713 PLATELCP3.5ORTHO#223.591 1,454$

C1713 PLATELCP3.5ORTHO#241.901 3,409$

C1713 PLATES 3.5MM LCP 4H 109MM LT 3,221$

C1713 PLATES 3.5MM LCP 4H 111MM RT 2,163$

C1713 PLATES 3.5MM LCP 7H 98MM 1,328$

C1713 PLATES2.7MM VA LCP LT MED 64MM 2,296$

C1713 ROD ANKLE EXFIX C-FBR11X360MM 1,085$

C1713 SCREWS LEVEL 1 84$






C1713 SCREWS LEVEL 7 1,196$

C1713 SCREWS LEVEL 8 1,317$

C1713 SUTURE ANCH CORKSCRW 5.5X14.7 1,243$

C1713 SUTURE ANCH INTERNALBRACE 2,150$

C1713 SUTURE ANCH OSTEORAPTOR 2.9MM 1,148$

C1713 SUTURE ANCH SPEEDBRIDGE 4.75 3,480$

C1713 SUTURE FIBERTAK 1.3MM AR3602-2 1,295$

C1713 SUTURE FIBERTAK DBL #AR-3632 1,295$

C1713 SUTURETAK SM JOINT 3.0 BIOCOMP 1,138$

C1713 SYNDESMOSIS TIGHTROPE XP STAIN 2,990$

C1713 TIBIAL TS UNIVBPLATE TRIATH #8 3,344$

C1713 TIGHTROPE ACL RT W/DPLYG SUTR 1,295$

C1713 WASHER 3.5/4.0MM 294$

C1713 WASHER MEDIAL MALLEOLAR SLED 619$

C1713 WASHERFORSCRWORTHO#219.99 166$

C1713 WASHERFORSCRWORTHO#619904 233$

C1724 CATH CORONARY 1.25MM CLASCROWN 7,590$

C1724 CATH DIAMONDBACK 1.25MM 6,790$

C1724 CATH DIAMONDBACK 1.5MM 6,790$

C1725 BALLOON 2.25X20MM 506$

C1725 BALLOON 2.5X20MM 506$







C1725 BALLOON COYOTE 2.5X100X150 963$

C1725 BALLOON COYOTE 2.5X220X150 1,068$


C1725 BALLOON COYOTE 2X100X150 963$

C1725 BALLOON COYOTE 2X220X150 1,068$







C1725 BALLOON EMERGE 12X1.50MM 544$













C1725 BALLOON F/G EMERGE 12X1.20MM 544$


C1725 BALLOON F/G EMERGE 2.0X12MM 544$
















C1725 BALLOON MUSTANG 4X200X135 619$




C1725 BALLOON NC EMERGE 2.50X20MM 544$



C1725 BALLOON PTA/NC 10 X 4 X 75 798$

C1725 BALLOON PTA/NC 12 X 4 X 120 1,540$

C1725 BALLOON PTA/NC 14 X 4 X 80 1,797$




C1725 BALLOON STERLING 4.0X220X150 875$







C1725 BALLOON STERLING 6X20X135 875$

C1725 BLN PTA 4MM 2CM 80CM 619$

C1725 BLN CUT VASCU 2.5MM/4CM/140 1,950$

C1725 BLN FG STERLING MR 4X40X135 875$








C1725 BLN-RIVAL 6MM X 80 X 80 619$

C1725 CATH 1.2MMx6MM MINI TREK 506$



C1725 CATH 1.5MMx6MM NC TREK OTW 506$

C1725 CATH 1.5MMx6MM NC TREK RX 506$

C1725 CATH 2.0MMX12MM 506$







C1725 CATH 2.5MMX15MM MINI TREK 506$


C1725 CATH 2.5MMX20MM MINI TREK 506$




C1725 CATH 2MMx12MM MINI TREK 506$

C1725 CATH 2MMx12MM NC TREK RX 506$




C1725 CATH 3.0MMX12MM NC TREK 506$








C1725 CATH 3MMX20MM MINI TREK 506$









C1725 CATH BALLOON PTA/SC 8X8X75 619$

C1725 CATH CONQUEST BALLOON 10X4 928$

C1725 CATH CONQUEST BALLOON 8X4 928$

C1725 CATH PTA DORADO 5MMX2CMX 80CM 784$

C1725 CATH PTA ULTV 18/ 2MM 12CM 130 963$

C1725 CATH PTA ULTV 18/ 2MM 8CM 130 963$

C1725 CATH STERLING BALLOON5X220X150 1,068$

C1725 CATH STERLING BALLOON6X150X150 945$

C1725 CATH SYM BLN 2.5MMX4CMX90CM 1,098$

C1726 BALLOONDILCATHENDO#4594 898$

C1726 BALLOONDILCATHENDO#4596 898$

C1726 BALLOONDILWRGUIDENDO#5847 801$



C1726 CATH BLN 18-20MM COL240CM 801$

C1726 CATH UROMAX ULTRA 12FRX4CM 829$

C1729 CATH ABSCESSION DRAINAGE 360$

C1729 CATH DRAIN APD 10 FR 400$



C1729 CATH DRAIN APD MINIPIGTAIL 8FR 298$

C1729 CATH DRAIN BILIARY 8FR COOK 397$

C1729 CATH DRAIN MALECOT 10F 132$








C1729 CATH DRAINAGE FIRM 10FR 182$

C1729 CATH DRAINAGE REG 12FR 188$



C1729 CATH MINI PIGTAIL 8FRX12CM 240$

C1729 CATH PNEUMO PIGTAIL/VALVE 296$

C1729 CATH THORACIC PVC RT 28F 61$

C1729 CATH THORACIC PVC RT 32F 102$

C1729 CHEST DRAIN SET 170$

C1729 CHEST TUBE THALQUIK 10F 615$



C1729 DRN CATH TROCAR/THORC 24F 94$



C1729 DRN CHST CATH THALQK 28F 632$

C1729 KIT 8.3FR PERICARDIAL PIGTAIL 786$

C1729 TUBE NJ 12FRX60INCH 191$

C1750 CATH ASH SPLIT VAS#ASPC4016-3 1,292$

C1750 CATH DIALYSIS LONG#8888145063P 1,470$

C1750 CATH DIALYSIS PERM 14.5FR 1,470$

C1750 CATHDIALYSSGEN#8888413823 1,356$

C1750 CATHDIALYSVAS#8888145063 1,870$

C1750 CATHETER DIALYSIS LONG TERM 1,470$

C1750 CATHETER VAS#8888414011 1,680$

C1751 4 FRSL PWRPICC CATH 805$

C1751 5 FRDL PWRPICC CATH 825$

C1751 5 FRTL PWRPICC CATH 950$

C1751 CATH ART 18G X 6 KIT 169$

C1751 CATH INF CRAGG M/C 20CM 431$

C1751 CATH INF CRAGG M/C 5CM 431$

C1751 CATH INF PROSTREAM 12CM 863$

C1751 CATH MAHURKAR 11.5F 509$

C1751 CATH MULTI LUMEN 20CM 396$

C1751 CATH OMNI FLUSH 5F 65CM 98$

C1751 CATH PIGTAIL UHF 5F 70CM 146$

C1751 CATH STRAIGHT PIGTAIL 89$

C1751 PICC PWR INJ/2 LUMEN 411$

C1752 CATH 135CM TP SPINAL MICRO 2,010$

C1752 CATH HEMODIALYSIS DBL 12F 342$

C1752 CATH INF MICRO RENEGADE 2,076$

C1752 CATH MAHURKAR 11.5FR 551$

C1753 CATH ACIST KODAMA IVUS 2,475$

C1757 ANGIOJET ZELANTE DVT 5,850$

C1757 BLN FOGARTY OTW 411$

C1757 CATH ANJIOJET DISTA 4,000$

C1757 CATH EMBLOCTMY 2FR VAS#A4F01 420$



C1757 CATH THROM/EMBO ANJIOJET AVX 2,061$

C1757 CATH THROM/EMBO ANJIOJET OMNI 3,380$

C1757 CATHETER ASPIRATION 1,710$

C1757 CATHFOGARTY OCCK 3F 40CM 387$

C1757 THROMBOLYTIC CATH DEVICE 1,153$

C1758 CATH URETERAL C1 TIP 65CM 396$

C1758 CATHDUALURO#M0064051000 271$

C1758 CATHURTRAL6FRURO #400-116 71$

C1760 ANGIOSEAL 6FR 844$

C1760 CLOSER - PLUG MYNX 5R 896$

C1760 CLOSER - PLUG MYNX 6/7FR 896$

C1760 CLOSER - SUTR 6FR/ PERC 844$

C1764 BIOMONITOR III 11,700$

C1764 INSERTABLE LOOP RECORDER 10,590$

C1768 GRAFT COLLAGEN VASC 6MMX39CM 2,480$

C1768 GRAFT COLLAGEN VASC 6MMX40CM 2,560$

C1768 GRAFTLNTRNGVASC#IRS47045L 1,947$

C1768 GRAFTPROPATENVAS#H470045A 2,532$

C1768 GRAFTSTNDRDWALLVAS#S0701 668$

C1769 ADVANTAGE GLIDEWIRE 260 675$

C1769 BLUE RHINO PERC INTRODUC 6.0MM 1,449$

C1769 BLUE RHINO PERC INTRODUC 8.0MM 1,209$

C1769 CATH MICRO ACIST NAVVUS FFR 2,100$

C1769 CATHETER GUIDE EXT 6FR 2,085$

C1769 DILATOR URETHRAL URO #G14185 831$

C1769 DRILL BIT 2.8MM QC 248MM 712$

C1769 GLIDEWIRE J 3CMX260CM 263$

C1769 GLIDEWIRE STIFF 180CMX.035 277$

C1769 GLIDEWIRE STRAIGHT .035 189$

C1769 GLW ANGLED 035 X 150CM 158$

C1769 GLW ANGLED 035 X 180CM 145$

C1769 GLW ANGLED 035 X 260CM 176$

C1769 GLW SM VSL 018/150/3 225$

C1769 GLW XSTIFF 035 X 260 277$

C1769 GUIDE MINI 1.8MM 150$

C1769 GUIDEWIRE .062" TROCAR TIP 129$

C1769 GUIDEWIRE 2.0MM 204$

C1769 GUIDEWIRE 2.8MM/300MM #292.68 221$

C1769 GUIDEWIRE DREAM .035X260CM 639$

C1769 GUIDEWIRE PICC 2$

C1769 GUIDEWIRE PTFE COATED 035X150C 71$

C1769 GUIDEWIRE SPRING AW0422 72$

C1769 GUIDEWIRE SPRING AW1472 91$

C1769 GUIDEWIRE STND SHAFT 0.35X150 183$

C1769 GUIDEWIREJAGWIREENDO#5658 639$

C1769 GUIDEWIREJAGWIREENDO#5660 419$

C1769 GUIDEWIREORTHO#702462 286$

C1769 GUIDEWRDRLLTPORTH#310.423 312$

C1769 GUIDEWRHYDRAJAGENDO #5600 639$

C1769 GUIDEWRSNSRANGURO#670-312 220$

C1769 GUIDEWRSNSRSTRURO#670-308 211$

C1769 GUIDEWRZBRASTRURO #00711059 413$

C1769 GUIDEWRZBRASTRURO#670-112 376$

C1769 GW .035X150 SNSR ANG TIP 3CM 203$

C1769 GW 2.5x23 MINI VIS RX BARE MTL 2,250$

C1769 GW 2x12 MINI VIS RX BARE MTL 2,250$





C1769 GW 3.5x15MM VISION RX BARE MTL 2,250$

C1769 GW 3.5x23MM VISION RX BARE MTL 2,250$

C1769 GW 3MM J-TIP 035X145 CM 99$

C1769 GW 3MM J-TIP 035X260 CM 152$

C1769 GW 3x18MM VISION RX BARE METAL 2,250$

C1769 GW 4.5x13MM ULT RX BARE METAL 2,250$






C1769 GW 5x13MM ULTRA RX BARE METAL 2,250$

C1769 GW 5x28MM ULTRA RX BARE METAL 2,250$

C1769 GW AMPLATZ 035 X 145CM 122$

C1769 GW AMPLATZ 035 X 80CM 135$

C1769 GW AMPLATZ XSTF 035X260CM 122$

C1769 GW APP CTO 14X300/ 18G 608$

C1769 GW ASAHI 300CM JTIP 360$

C1769 GW ASAHI 300CM STRAIGHT TIP 360$

C1769 GW BALANCE 190CM MIDDLEWEIGHT 360$

C1769 GW BALL TIP 3X1000MM 1,288$

C1769 GW BENTSON 035 X 145 CM 98$

C1769 GW BENTSON 035 X 200 CM 122$

C1769 GW BENTSON 035 X 260 CM 122$

C1769 GW BENTSON 035 X 80CM 117$

C1769 GW BMW UNIVERSAL II 300CM 360$

C1769 GW CHOICE PT FLOPPY 300$

C1769 GW COONS .035 X 145 161$

C1769 GW DOC WIRE EXTENSION 360$

C1769 GW FATHOM - 16 320$

C1769 GW FIXED CORE 035 180CM 3MM 55$

C1769 GW GRANDSLAM 180CMX.014 506$

C1769 GW GS WORKHORSE 014 X 300 658$

C1769 GW J 260CM 3MM 114$

C1769 GW LUNDERQUIST 035 X 260 334$

C1769 GW MBROS-3 HSL 014 X 300 839$

C1769 GW MICRO TAPER - 16 348$

C1769 GW PILOT 150 300CM 360$

C1769 GW PLATINUM 018X3X180 209$

C1769 GW PLATINUM 018x3x260 241$

C1769 GW ROSEN 035 X 180 CM 89$

C1769 GW RUNTHROUGH 516$

C1769 GW SNR EN SYS 6F 12-20X120 609$

C1769 GW VIPERWIRE ADVANCE CORONARY 2,925$

C1769 GW VSI .025x150CM 112$

C1769 GW WHISPER MS 300CM 360$

C1769 GW WIGGLE .014 MICROGLIDE COAT 360$

C1769 GW X190CM HT BMW UNIVERSAL II 360$

C1769 GW X190CM HT IRONMAN .014x3CM 360$

C1769 GW X190CM HT PILOT 150 3CM 360$

C1769 GW X190CM HT WHISPER ES 3CM 360$

C1769 GW X190CM HT WHISPER LS 3CM 360$

C1769 GW X190CM HT WHISPER MS 3CM 360$

C1769 GW X300CM HT IRONMAN .014x3CM 360$

C1769 GWIRE2.8X450MM THRD TRCR POINT 458$

C1769 HT PILOT 50 .014 3CM GUIDEWIRE 360$

C1769 KIT G BUTTON W/GW 18FR 877$

C1769 NDL MICROPUNC STIFF 4FR 259$

C1769 NDL MICROPUNC STIFF 5FR 237$

C1769 NDL MICROPUNCTURE 4 FR 154$

C1769 PACK HIP DISPOSABLE 988$

C1769 SNR GOOSENECK 15M 120CM 631$

C1769 SNR GOOSENECK 25M 120CM 630$

C1769 SPHINCTEROTOMEENDO#8304 1,410$

C1769 V-14 CONTROL GUIDEWIRE.014X300 656$

C1769 WIRE FILTER 2.25X3.5MM 2,990$

C1769 WIRE FIXED CORE SWAN 99$

C1769 WIRE PILOT REUNION NITINOL 150$

C1769 WIRE VIPER .014X335CM 360$

C1771 SLING TVT OBTURATOR SYSTEM 3,121$

C1771 SOLYX SLING LOT #19357689 3,801$

C1776 ACETABULAR TRITANIUM 52MM 3,244$

C1776 ACETABULAR TRITANIUM 54MM 3,244$

C1776 ADAPTOR COMP STANDARD TAPER 563$

C1776 ATTUNE CR CEMT FEM #6 RIGHT 5,000$

C1776 ATTUNE CR CEMT FEM #7 LEFT 5,000$

C1776 ATTUNE CR FB INSERT #6 10MM 3,000$

C1776 ATTUNE CR FB INSERT #7 8MM 3,000$

C1776 ATTUNE FB CEMT TIB BASE #5 3,400$

C1776 ATTUNE FB CEMT TIB BASE #7 3,400$

C1776 ATTUNE MEDIAL DOME PAT 35MM 1,650$

C1776 ATTUNE MEDIAL DOME PAT 41MM 1,650$

C1776 ATTUNE PIN PACK 875$

C1776 BEARING R LG 3MM #159582 2,400$

C1776 CEMENTED STEM 12X50MM 2,184$

C1776 C-TAPERBIOLOX ADAP SLV19-0325T 768$

C1776 CUP SUTURE UNIV REVERS 36 NEUT 3,570$

C1776 CUP TRITANIUM HEMICLUSTER 50MM 3,244$

C1776 FEMORAL CR COMP BEADWPA 6 LT 5,947$

C1776 FEMORAL CR COMP BEADWPA 6 RT 5,947$

C1776 FEMORAL CR COMP CMENT 4 RT 4,325$

C1776 FEMORAL PS COMP CMENT 2 LT 4,325$


C1776 FEMORAL PS COMP CMENT 3 RT 4,325$








C1776 FEMORALHEAD V40 LFIT -3.0x26MM 1,990$

C1776 FEMORALHEAD V40 LFIT 4.0x26MM 1,990$

C1776 FEMORL HD CTAPER DELTA 36MM +0 2,703$

C1776 FEMORL HD V40DELTA 36MM +5 2,703$

C1776 FEMORL HD V40DELTA 36MM 0 2,703$

C1776 FEMORL HD V40DELTA 36MM -2.5 2,703$

C1776 FEMORL HD V40DELTA 36MM -5 2,703$

C1776 FEMORLHD CTAPERDELTA 36MM +2.5 2,703$

C1776 FEMORLHD UNIV BIOLOXDELTA 36MM 2,703$

C1776 FEMUR SPHERE GMK CMENT LT 3+ 4,000$

C1776 FEMUR SPHERE GMK CMENT LT 4+ 4,000$

C1776 FEMUR SPHERE GMK CMENT LT 6 4,000$

C1776 FEMUR SPHERE GMK CMENT RT 6+ 4,000$

C1776 GLEN POST MODHYBRID REGENEREX 1,050$

C1776 GLENOID PEGGED SZ44 TSA-X3 4,721$

C1776 GLENOID PEGGED SZ52 TSA-X3 4,721$

C1776 GLENOID SZ 48 4,721$

C1776 GLENOIDBASE MOD HYBRID MED 4MM 3,000$

C1776 GLENOSPHERE CONC32X6MM REUNION 4,000$

C1776 GLENOSPHERE CONC36X2MM REUNION 4,000$

C1776 GLENOSPHERE ECCEN36X2MM REUNI 4,000$

C1776 HIP ACCOLADE II SZ 1 127 DEGRE 5,839$












C1776 HIP STEM OMNIFIT EON 127 #7 3,127$

C1776 HIP STEM SECURFIT MAX 127 #11 5,839$

C1776 HIP STEM SECURFIT MAX 127 #8 5,839$

C1776 HUMERAL CUP REUNION RSA 32X4MM 4,000$

C1776 HUMERAL CUP REUNION RSA 36X4MM 4,000$

C1776 HUMERAL HEAD REUNION TSA SGL56 4,067$

C1776 HUMERAL HEAD SGL RAD 48X18MM 4,067$

C1776 HUMERAL INSERT S/36+3 36CUP 2,030$

C1776 HUMERAL STEM MODULAR 14X133MM 9,010$

C1776 HUMERAL STEM REUNION TSA MOD12 9,010$

C1776 HUMERAL STEM UNIV REVERS SZ 7 4,970$

C1776 HUMERALHEAD REUN SR STD44X16MM 4,067$

C1776 HUMERALHEAD VERSADIAL 42X21X43 2,200$

C1776 HUMERALINSRT REUNIONRSA 32X4MM 3,200$



C1776 HUMERALSTEM REUNIONRFX 8X118MM 9,010$

C1776 HUMERALSTEM REUNIONTSA10X123MM 9,010$



C1776 HUMERLSTEM REUNI PFIT 11X123MM 9,010$

C1776 KIT BIOPREP BONE PREP SYS 408$

C1776 KIT SCP FOOTANKENDDEL 15GAX3CC 5,700$

C1776 LINER TRIDENT 0DEG 36MM 50,52 2,703$



C1776 MENISC BEAR OXPKS SM LT THK 9 2,400$


C1776 NAIL GAMMA3 11X170MM LT 125ANG 6,402$

C1776 NAIL GAMMA3 11X360MM RT 125ANG 6,402$


C1776 NAILTICANN TFNA 10RX340MM 130D 5,665$

C1776 NAILTICANN TFNA 10X170MM 130D 4,045$


C1776 NAILTICANN TFNA 12LX360MM 130D 5,665$

C1776 NAILTICANN TFNA 12LX400MM 130D 5,665$




C1776 PATELLA ASYM TRIATH A32X10MM 2,341$

C1776 PATELLA ASYM TRIATH A35X10MM 2,341$

C1776 PATELLA ASYM TRIATH X3 2,341$

C1776 PATELLA RESURFACING SZ2 1,575$



C1776 PERSONA 12MMRT FEM10-12 TIB GH 2,400$

C1776 PERSONA PK FEM CMP LM SZ6 4,410$

C1776 PERSONA PK TIB CMP LM SZH 2,940$

C1776 PERSONA PK VEB LM SZH 9MM 2,520$

C1776 PIN STEINMAN #6 4.8X229MM 120$

C1776 PLATE FUSION CUP 7H 14MM 2,180$

C1776 PLATE M VHLP 2.3X1.5MM 16H STR 2,335$

C1776 PLATES 3.5MM LCP 2H 86MM LT 2,073$

C1776 PROSTC-TAPERORTHO#06-2600 1,990$

C1776 PROSTHESISORTH#5551-G-299 2,341$

C1776 PROSTUNIVORTHO#UH1-45-26 2,433$

C1776 PROSTUNIVORTHO#UH1-46-26 2,433$

C1776 SHELL METAL BIPOLAR 47MM OD 1,225$

C1776 SHELL TRI II ACETAB CLUSTR 48 3,244$






C1776 SHELL TRIDENT PSL HA ACETAB 52 2,703$

C1776 SLED MEDIAL MALLEOLAR 35MM 2,265$

C1776 TIBIAL BASEPLATE TRIATH 6 3,244$

C1776 TIBIAL BEARING RT MED 5MM 2,400$

C1776 TIBIAL BEARING RT SM 4MM 2,400$

C1776 TIBIAL CR INSERTX3 #4 4.9MM 2,703$

C1776 TIBIAL CR INSERTX3 #6 13MM 2,703$

C1776 TIBIAL CS INSERTX3 #3 9MM 2,703$




C1776 TIBIAL OX COMP LT MEDIAL AA 2,400$

C1776 TIBIAL OX COMP RT MEDIAL A 2,400$

C1776 TIBIAL PS INSERTX3 E #5 9MM 2,703$

C1776 TIBIAL PS INSERTX3 #2 11MM 2,703$

















C1776 TIBIAL TRAY GMK CMENT LT 5 3,600$

C1776 TIBIAL TRIATHAUGMENT #5LT 10MM 2,195$

C1776 TIBIAL TS UNIVBPLATE TRIATH #2 3,344$

C1776 TIBIALSPHEREGMKCR INS 10MMS3L 2,400$


C1776 TIBIALSPHEREGMKCR INS 10MMS4R 2,400$


C1776 TIBIALSPHEREGMKCR INS 10MMS5R 2,400$

C1776 TRAY TIB FIXED GMK CMENT T3i4L 3,600$

C1776 TRAY TIBIAL FIXED GMK CMENT 3L 3,600$

C1776 TRAY TIBIAL FIXED GMK CMENT 4R 3,600$

C1776 TRAY TIBIAL FIXED GMK CMENT 5R 3,600$

C1776 VERSYS DISTAL CENTR 10MM 200$

C1781 GRAFT MESH CARRIER 179$

C1781 MESH NONABSORB PROLENE 10X15CM 1,893$

C1781 MESH PARIETEX #PCO15X 2,695$

C1781 MESH PARIETEX GEN #PCO2520 3,346$

C1781 MESH PARIETEX GEN#TEM1208GL 1,470$

C1781 MESH PARIETEX GEN#TEM1208GR 1,379$

C1781 MESH XIS+ LTWT BIOLOGIC 5X8CM 2,760$

C1781 MESHHERNIAPRLENEGEN#PHSE 1,526$

C1781 MESHHERPRLENELGGEN#PHSL 1,687$

C1781 MESHHERPRLENEMEDGEN#PHSM 1,526$

C1781 PLUGPERFIXLGGEN #0112970 956$

C1781 PLUGPERFIXMEDGEN #0112960 945$

C1781 PLUGPERFIXSMGEN #0112950 936$

C1785 PACEMAKER ACCOLADE MRI DR 13,440$

C1785 PACEMAKER DUAL ABBOTTPM2240 9,200$

C1786 MESH PARIETEX PCOX 1,643$

C1786 MICRA TRANSCATH PACING KIT 21,500$

C1788 PORT POWER 8.0FR SPD#1808000 1,218$

C1788 PORT POWER 8.0FR SPD#1808560 1,218$

C1788 PORT PWR MRI 1,559$

C1874 STENT COV 5.0MMX15MM 6,000$

C1874 STENT XIENCE 4.0MMX38 2,590$

C1874 STNT 2.25x12 RX XIENCE SIERRA 2,590$

C1874 STNT 2.25X12MM SYNERGY 2,300$

















































C1874 STNT 3X12 RX XIENCE SIERRA 2,590$






C1874 STNT 3x8 RX XIENCE SIERRA 2,590$














C1874 STNT- VIABAHN 7MM X 50MM 5,540$

C1874 STNT- VIABAHN 8MM X 50MM 5,540$

C1875 STENT EXPRESS 7X40X75 2,700$



C1875 STENT INNOVA 6X150X130 2,900$



C1876 LIFE STENT 5MMX100MMX130CM 3,600$

C1876 STENT ELUVIA 6X100X130 5,190$






C1876 STENT VIABAHN 6MM X 25CM 13,110$

C1876 STENT WALLFLEXDUODENAL 22X90MM 4,928$

C1876 STENTWALLFLEXENDO#1693 5,160$

C1876 STENTWALLFLEXENDO#7064 3,357$

C1876 STNT LIFE NC 6MM 120MM 130 4,900$

C1876 STNT LIVE 8MM 40MM /130 3,600$

C1876 STNT PREMOUNT 5MM 19MM 2,725$

C1876 STNT PREMOUNT 7MMX27MM 2,700$

C1876 STNT SELF-XP NC/NC 6MM 200MM 5,500$




C1876 STNT SELF-XPAND 10MM 80MM 3,600$



C1876 STNT SELF-XPAND 8MM 60-80 3,600$

C1876 STNT STAR 10MM 40MM /80 2,175$

C1880 FLTR IVC BARD /FEM 3,466$

C1883 LEAD TEMP PACING 5F 353$

C1884 EMBOLIC PROTECTION DEVICE 2,790$

C1887 CATH 6 FR FEMORAL LT 4 FR4 238$

C1887 CATH 6 FR FEMORAL RT 4 FR4 238$

C1887 CATH 6FR DIAGNOSTIC TIG 220$

C1887 CATH AMPLATZ LT 6FR .75 240$

C1887 CATH BYPASS IMA 6FR 230$

C1887 CATH BYPASS LT 6FR 230$

C1887 CATH GLIDE ANGLED 5F 100 158$

C1887 CATH GLIDE ANGLED 5F 65CM 158$

C1887 CATH GUIDE 3.5 XB SIDEHOLES 230$

C1887 CATH GUIDE 4.0 XB 230$

C1887 CATH GUIDE 5FR EBU 3.75 240$

C1887 CATH GUIDE 6FR XB LAD 230$

C1887 CATH GUIDE 6FR XB3.5 100CM 230$

C1887 CATH GUIDE AMPLATZ LT (AL1) 89$

C1887 CATH GUIDE AMPLATZ LT 2(AL2) 89$

C1887 CATH GUIDE CXI CRSSR 2.6F X150 716$

C1887 CATH GUIDE ENDO#OA-G21739 332$

C1887 CATH GUIDE FEM LT 4.5(FL4.5) 89$

C1887 CATH GUIDE FEMORAL LT (FL6) 89$

C1887 CATH GUIDE FEMORAL LT 4(FL4) 89$

C1887 CATH GUIDE FEMORAL LT 5(FL5) 89$

C1887 CATH GUIDE FEMORAL RT 4(FR4) 89$

C1887 CATH GUIDE FEMORAL RT 5 (FR5) 89$

C1887 CATH GUIDE H-1 5F 100CM 98$

C1887 CATH GUIDE INTERNAL MAMMARY 89$

C1887 CATH GUIDE LT 6FR AMPLATZ 1.0 230$

C1887 CATH GUIDE LT 6FR AMPLATZ 3.0 230$

C1887 CATH GUIDE LT 6FR EBU 3.0 230$





C1887 CATH GUIDE LT 6FR JL 3.5 230$



C1887 CATH GUIDE LT 6FR LT 2.0 230$

C1887 CATH GUIDE RT 6FR 3DRC 230$

C1887 CATH GUIDE RT 6FR AMPLATZ 230$

C1887 CATH GUIDE RT 6FR JR 3.5 230$

C1887 CATH GUIDE RT 6FR JR 4.0 230$

C1887 CATH GUIDE RT 6FR RBU 4.0 230$

C1887 CATH JUDKINS RT 5FR JR 4.0 72$

C1887 CATH KUMPE 5F 40CM 110$

C1887 CATH KUMPE 5F 65CM 110$

C1887 CATH MACH 1 LIMA 6FR 295$

C1887 CATH MULTIPURPOSE 6FR 1 230$

C1887 CATH MULTIPURPOSE 6FR 2 230$

C1887 CATH MULTIPURPOSE A1(MPA) 89$

C1887 CATH RIM 5F 65 CM 98$

C1887 CATH RUNWAY 6FR AR1 242$

C1887 CATH RUNWAY 6FR JR4 242$

C1887 CATH RUNWAY 6FR WRP 242$

C1887 CATH SIM-1 5F 100CM 98$

C1887 CATH SIM-1 5F 65CM 98$

C1887 CATH SIM-2 5F 100CM 98$

C1887 CATH SIZING PIG 5FR X 100 469$

C1887 CATH WILLIAMS RT CURVE (WR) 89$

C1887 CATHETER 4FR CXI .035X90CM 731$

C1887 CATHETER 4FR IM 275$

C1887 CATHETER 4FR JL4 89$

C1887 CATHETER 4FR JL4.5 89$

C1887 CATHETER 4FR JR4 275$

C1887 CATHETER 4FR MPA2 89$

C1887 CATHETER 6FRX125CM JR4 567$

C1887 CATHETER AR 1 MOD 87$

C1887 CATHETER AR 2 MOD 87$

C1887 CATHETER BARBEAU GUIDING 5FR 420$

C1887 CATHETER BARBEAU GUIDING 6FR 420$

C1887 CATHETER CXI 2.3FRX150CM 731$

C1887 CATHETER GUIDE 6FR JL4.5 230$

C1887 CATHETER LANGSTON 6FR 600$

C1887 CATHETER MICRO 2.4FR 4,800$

C1887 CATHETER MPA 2 87$

C1887 CATHETER PIGTAIL 4FR 89$

C1887 CATHETER RADIAL 3.5FR JACKEY 220$

C1887 CATHETER RADIAL 4FR SARAH 220$

C1887 CATHETER RADIAL 4FR TIG 220$

C1887 CATHETER RUBICON 35 SUPPORT 544$

C1887 CATHFEMORAL LT 3.5(FL3.5) 89$

C1887 CATHGUIDE6FR SHRTAMPLATZ LT1.0 230$

C1887 CATHGUIDE6FR SHRTAMPLATZ LT3.0 230$

C1887 CATHLT CORONARYBYPAS(LCB) 89$

C1887 CATHRT CORONARYBYPAS(RCB) 89$

C1887 CATHWILLIAMS RT CURVE(WR) 64$

C1887 GUIDING CATH C-1 5F 80CM 98$

C1887 GUIDING CATH C-2 5F 80CM 98$

C1892 KIT PERCUT SHEATH 8.5F 220$

C1892 SAFESHEATH II SS6 236$

C1892 SAFESHEATH II SS8 236$

C1892 SHEATH INTRACARDIAC FIXD CURVE 1,449$

C1892 SHEATH PEELAWAY 7FR 208$

C1893 INTRODUC SHEATH 46CM 412$

C1894 CATH GLIDE SHEATH 6X25 240$

C1894 CATH SLENDER GLIDE SHEATH 6X10 360$

C1894 CATH SLENDER GLIDE SHEATH 6X16 280$

C1894 INTRODUCER SAFE SHEATH 9F 208$

C1894 SET INTRO CATH COAXIAL 5FR 125$

C1894 SHEATH - VISCERAL INTRO 328$

C1894 SHEATH 5FR X 11 187$

C1894 SHEATH 6F X 10CM 138$


C1894 SHEATH 6FR X 11 154$

C1894 SHEATH 6FR X 25CM 130$


C1894 SHEATH 7FR X 25CM 130$


C1894 SHEATH ANSEL 5F X 45CM 310$




C1894 SHEATH BRITETIP 4F X 11CM 148$

C1894 SHEATH BRITETIP 5F X 11CM 144$

C1894 SHEATH BRITETIP 8FRF X 23CM 604$

C1894 SHEATH CKFLO 5F X 30CM 221$



C1894 SHEATH COOK 6FRX55CM 320$

C1894 SHEATH DRYSEAL FLEX 20FRX33CM 1,950$

C1894 SHEATH INTRODUCER MICRA 1,800$

C1894 SHEATH PEEL NONGUID6X15.5 89$

C1894 SHEATH PEELNONGUID14X15.5 145$

C1894 SHEATH SHUTTLE 6F X 90 546$

C1894 SHEATH TERUMO 6FRX45CM 536$



C1894 VARI-PASS 10/12FRX54CM SHEATH 384$

C1898 LEADMRI PACE ACT INGEVITY 52CM 1,875$

C1898 LEADMRI PACE ACT INGEVITY 59CM 1,875$

C2617 STENT KIT IRIS URETERAL LIGHTD 1,270$

C2617 STENT SET URETERAL 7FR 22CM 473$

C2617 STENT URO #133622 #G15144 473$

C2617 STENT URO #133628 #G15147 473$

C2617 STENTBILENDO#CHBSO-10-5 284$

C2617 STENTBILENDO#CHBSO-10-7 240$

C2617 STENTBLKSILCONEURO#G15145 473$

C2617 STENTBLKSILCONEURO#G15146 473$

C2617 STENTPLRSURO#M0061552300 558$





C2621 PACEMAKER OTH THAN SINGLE/DUAL 16,778$

C2623 CATHTER 10MM LUTONIX DCB 3,900$

C2625 STENT PROPEL MINI MONET FUROAT 2,835$

C2625 STENT PROPEL MOMET FUROATE 2,835$

C2625 STNT URETL 8 X 20 FLEX 581$

C2625 STNT URETL 8 X 22 FLEX 581$

C2625 STNT URETL 8.5 X 20 AMPZ 567$

C2625 STNT URETL 8.5 X 22 AMPZ 567$

C2627 CATH SUPRAPUBIC MALECOT 14F 230$

C2627 CATH SUPRAPUBIC MALECOT 16F 230$

C2627 CATH SUPRAPUBIC SET W MACLOC 344$

C2627 SET INTRO 1STEP SUPRAPUB 14FR 304$

C2631 CAPIOSLIM SUTURE CAPTURING DEV 1,883$

C8924 TTE 2D FU/LTD W/CONT 1,495$

C8925 TTE 2D PLCMT INT RPT W/CONT 2,666$

C8930 STRESS TTE W/ECG W/CONT 2,666$

C9359 KIT OSTEOVATION 6CC B TCP 3,570$

C9363 INTEGRA MESH BL WND 25.80SQ CM 7,000$

C9600 STENT BARE METAL SINGLE VESSEL 38,799$

C9600 STENT DRUG ELUTING SNGL VESSEL 38,799$

C9601 STENT BARE METAL ADDL BRANCH 30,196$

C9601 STENT DRUG ELUTING ADDL BRANCH 30,196$

C9602 ATHERECTOMY+STENT DE SNGL VSL 62,417$

C9604 PCI BYPASS + STENT DE 38,799$

C9606 PCI ACUTEMI+STENT DE SNGL VSL 30,196$

C9607 PCI OF CTO + STENT DE 62,417$

G0008 ADMIN INFLUENZA VACCINE 149$

G0009 ADMIN PPV VACCINE 149$

G0010 ADMIN HEPATITIS B VACCINE 149$

G0103 PSA TOTAL CA MCR SCREEN 162$

G0127 TRIM DYSTROPHIC NAILS 215$

G0297 CT LOW DOSE LUNG CA SCREEN 313$

G0378 ER OBSERVATION PER HOUR 116$

G0390 FULL TRAUMA RESP W/CRIT CARE 3,490$

G0390 MODERATE TRAUMA RESP TEAM ACTV 3,490$

G0422 INTENSE CARD REHAB W/EX/SESS 431$

G0423 INTENSE CARD REHAB WO EX/SESS 431$

G0480 AMPHETAMINES CONFIRMATION 960$

G0480 BUPRENORPHINE QUANT SO 960$

G0480 MARIJUANA CONF MEC SO 960$

G0498 CHEMO EXTEND IV INFUS W/PUMP 1,212$

J2785 LEXISCAN 0.4MG/5ML SYRING 379$

J2805 SINCALIDE 5MCG INJ 134$

J3240 THYROGEN 2 VIALS 5,730$

J7030 IVS 0.45%NACL 1L 11$

J7030 IVS 0.9%NACL 1L 8$

J7040 IVS 0.45%NACL 500ML 7$

J7040 IVS 0.9%NACL 500ML 10$

J7042 IVS D5/0.2%NACL 1L 14$

J7042 IVS D5/0.45%NACL 1L 11$

J7042 IVS D5/0.45%NACL 500ML 11$

J7042 IVS D5/0.9%NACL 1L 11$

J7042 IVS D5/0.9%NACL 500ML 11$

J7050 IVS 0.9%NACL 250ML 9$

J7060 IVS D5W 250ML 10$

J7060 IVS D5W 500ML 11$

J7070 IVS D10W 1L 16$

J7070 IVS D5W 1L 12$

J7120 IVS LR 1L 10$

J7121 IVS D5/LR 1L 12$

J7121 IVS D5/LR 500ML 13$

L0120 COLLAR CERV UNIV SOFT 18$

L0150 COLLAR XTRICATION ADULT 39$

L0150 COLLAR XTRICATION PEDS 39$

L0172 ASPEN PD5 COLLAR CHILD REG 137$

L0172 VISTA COLLAR ADULT 218$

L0625 BINDER ABD 4 PANEL 45"-62" 38$

L0625 BINDER ABD 4 PANEL 62"-74" 62$

L0625 BINDER ADB UNIV ADL 34$

L0634 SUPPORT L/S 13 XL 48$

L1830 IMMOB KNEE UNIV 16IN W/FA 87$




L1830 KNEE IMMOBILIZER TROM COOL 373$

L3265 CAST SANDAL LG 29$

L3265 CAST SANDAL MD 29$

L3265 CAST SANDAL SM 29$

L3650 BRACE CLAVICLE ADL L W/FA 27$

L3650 IMMOB SHLDR UNIV PED W/FA 41$

L3650 SLING & SWATHE LG W/FA 52$

L3650 SLING & SWATHE MD W/FA 52$

L3650 SLING & SWATHE SM W/FA 52$

L3650 SLING & SWATHE XL W/FA 56$

L3670 BRACE ARM MED AIRCAST 176$

L3670 SLING ATLAS MINOR UNIVERSAL 149$

L3670 SLINGSHOT 3 LARGE 207$

L3670 SLINGSHOT 3 MEDIUM 207$

L3670 ULTRASLING III AB SM 11-0450-2 285$

L3670 ULTRASLING III MD 11-0449-3 247$

L3908 SPLINT FOREARM UNV L W/FA 36$

L3908 SPLINT FOREARM UNV R W/FA 36$

L3908 SPLINT WRIST UNIV L W/FA 35$

L3908 SPLINT WRIST UNIV R W/FA 36$

L4350 ANKLE STIRRUP PREFAB W/FA 111$

L4360 BRACE FOAM WALKER L W/FA 221$

L4360 BRACE FOAM WALKER M W/FA 221$

L4360 WALK BOOT CAM STAT S W/FA 356$

L4398 FOOT MULTIPOD SYS MD W/FA 169$

L5785 8MM CARBON FIBER ROD 200MM EXT 727$

L6624 SUPPORT THUMB LT LG W/FIT 90$

L6624 SUPPORT THUMB LT MD W/FIT 90$

L6624 SUPPORT THUMB RT LG W/FIT 615$

L6624 SUPPORT THUMB RT MD W/FIT 90$

L8501 TRACH VLV SPEAK DUAL TP 268$

L8699 GLENOSPHERE 36+4 LAT 4,200$

P9012 CRYO EA UNIT (MULTI/POOLED) 492$

P9012 CRYOPRECIPITATE EA UNIT 492$

P9016 RBC LEUKOPOOR EA UNIT 1,836$

P9035 PLATELETPHERSIS LEUKOREDU 4,871$

P9037 PLATELET PHER LEUKORD IRR 6,187$

P9040 RBC LEUKO REDUC IRRAD EA 2,562$

P9059 FFP 8-24 HRS EA UNIT 740$

Q3014 TELEHEALTH FACILITY FEE 77$

Q4107 GRAFTJACKET 5X5CM STANDARD 5,517$

Q9957 DEFINITY INJ PERFULTREN PER ML 428$

V2632 IOL POSTERIOR LENS PRELOADED 563$

V2787 ALCON IOL LENS SN6AT4 20.5 1,733$

V2787 TORIC LENSES SN6AT3 ASTIGMATI 1,733$

Updated 9/14/2020

These standard charges are billed to your health insurance … · 2020. 9. 29. · 444 disorders of...

Documents

Transcript of These standard charges are billed to your health insurance … · 2020. 9. 29. · 444 disorders of...