hospital_name,last_updated_on,version,location_name,hospital_address,license_number|TX,type_2_npi,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,,,,,,,,,,,, Neighbors Regional Hospital Amarillo North,2/9/2026,3.0.0,Neighbors Regional Hospital Amarillo North,"2101 Coulter St S, Amarillo, TX 79106",100600,1386325801,TRUE,"Darleen Callahan, Vice President of Revenue Cycle",,,,,,,,,,,, description,code|1,code|1|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|Region_Health_Insurance|HMO|negotiated_dollar,standard_charge|Region_Health_Insurance|HMO|negotiated_percentage,standard_charge|Region_Health_Insurance|HMO|negotiated_algorithm,median_amount|Region_Health_Insurance|HMO,10th_percentile|Region_Health_Insurance|HMO,90th_percentile|Region_Health_Insurance|HMO,count|Region_Health_Insurance|HMO,standard_charge|Region_Health_Insurance|HMO|methodology,additional_payer_notes|Region_Health_Insurance|HMO,standard_charge|min,standard_charge|max,additional_generic_notes "Injection, testosterone cypionate, 1 mg",J1071,HCPCS,,Both,,,0.56,,,,,,,,,,,,,"Neighbors Regional Hospital Amarillo North does not have a universal discounted cash price. Only select Evaluation & Management (E/M) codes have specified discounted cash rates, which vary by E/M code tier. For all other descriptions, patients without insurance or who are self-pay are charged the standard gross amount. Please contact billing for specific quotes." "Injection, folic acid, 0.1 mg",J1808,HCPCS,,Both,,,0.88,,,,,,,,,,,,, Famotidine Injection 0.25 mg,J1308,HCPCS,,Both,,,1,,,,,,,,,,,,, "Injection, casirivimab and imdevimab, 1200 mg",Q0244,HCPCS,,Both,,,1,,,,,,,,,,,,, "Injection, casirivimab and imdevimab, 2400 mg",Q0243,HCPCS,,Both,,,1,,,,,,,,,,,,, "Injection, sotrovimab, 500 mg",Q0247,HCPCS,,Both,,,1,,,,,,,,,,,,, Polytrim 10mu-0.1% eye drop,J3490,HCPCS,,Both,,,1.19,,,,,,,,,,,,, ROPIVACAINE 5MG/ML 30ML INJ,J2795,HCPCS,,Both,0.001,GM,1.24,,,,,,,,,,,,, AZATHIOPRINE 50MG TAB,J7500,HCPCS,,Both,0.05,GM,1.55,,,,,,,,,,,,, Folic Acid 1MG Oral Tablet,A9150,HCPCS,,Both,,,2,,,,,,,,,,,,, DEXAMETHASONE 0.25 MG TAB,J8540,HCPCS,,Both,0.00025,GM,2.23,,,,,,,,,,,,, "LOCM 300-399MG/ML IODINE,1ML",Q9967,HCPCS,,Both,,,2.48,,,,,,,,,,,,, "Oral magnetic resonance contrast agent, per 100 ml",Q9954,HCPCS,,Both,,,2.48,,,,,,,,,,,,, MEDROXYPROGESTERONE ACETATE,J1050,HCPCS,,Both,0.001,GM,2.71,,,,,,,,,,,,, METHOTREXATE 25MG/ML 4ML INJ,J9250,HCPCS,,Both,0.005,GM,3.19,,,,,,,,,,,,, Flexeril Cyclobenzaprine 5 mg,J8499,HCPCS,,Both,,,3.23,,,,,,,,,,,,, "HOCM <=149 mg/ml iodine, 1ml",Q9958,HCPCS,,Both,,,3.24,,,,,,,,,,,,, IRON SUCROSE 20MG/ML 5ML,J1756,HCPCS,,Both,0.001,GM,3.4,,,,,,,,,,,,, Hydroxyzine 25 mg,S5001,HCPCS,,Both,,,3.45,,,,,,,,,,,,, ITRACONAZOLE 200MG IV KIT,J1835,HCPCS,,Both,0.05,GM,3.5,,,,,,,,,,,,, TRIAMCINOLONE 20MG/ML 1ML INJ,J3302,HCPCS,,Both,0.005,GM,3.5,,,,,,,,,,,,, Acetylcysteine 200MG/ML INJ/ORAL SOLUTION,J3490,HCPCS,,Both,,,4.6,,,,,,,,,,,,, CALCITRIOL 1MCG/ML 1ML,J0636,HCPCS,,Both,1,GM,4.64,,,,,,,,,,,,, ACETAMINOPHEN 120 MG SUPP,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Acetaminophen 160 mg/5mL Strength Liquid,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, ACETAMINOPHEN 325 MG SUPP,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Acetaminophen 325 mg tab,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Acetaminophen 500 mg tab,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Acetaminophen Susp 80MG PED,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Acetylcysteine 100MG/ML INJ/ORAL SOLUTION,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, "ADHESIVE BANDAGE, FIRST-AID",A6413,HCPCS,,Both,,,5,,,,,,,,,,,,, AFRIN 0.05% (Oxymetazoline HCL) Nasal Spray,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, ALCOHOL WIPES PER BOX,A4245,HCPCS,,Both,,,5,,,,,,,,,,,,, ALLU_MAG HYDROX 30 ML LIQD,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Amlodipine Besylate(NORASAC) 5 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, AMMONIA AROMATIC ASPIROL 1 EA INHA,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Amoxicillin 200mg/5mL Oral Suspension 100mL,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, AMOXICILLIN 400MG SUS 100ML,G9315,HCPCS,,Both,,,5,,,,,,,,,,,,, Amoxicillin 400mg/5mL Oral Suspension 100mL,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Antiseptic Benzoin Tincture 3m Steri-Strip Topical Liq0.667mL Ampule,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, ATENOLOL 50 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Augementin 875 mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, "BACITRACIN, OINT 500U/GM",J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, BISACODYL 10 MG SUPP,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, BLOOD GLUCOSE/REAGENT STRIPS,A4253,HCPCS,,Both,,,5,,,,,,,,,,,,, Calcium Carbonate-Mylanta 500mg ,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, CAPSAICIN CREAM 0.1%,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, CARBAMAZEPINE 100 MG CHEW,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Cetirizine 10mg PO (ZYRTEC) ,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Ciprofloxacin HCl 500 mg Tablet(CIPRO),J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Clindamycin 300 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Clindamycin HCl 150 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, CLONIDINE 0.1 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Debrox 0.5oz Otic Drops 6.5% Strength Carbamide Peroxide,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, DIPHENHYDRAMINE 12.5MG/5ML 12.5 MG ELIX,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, DIPHENHYDRAMINE HCI 50mg,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Diphenhydramine HCl 12.5mg Elixir 5mL,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, "DIPHENHYDRAMINE HCL, 25MG CAP",A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Diphenoxylate-atropine (Lomotil) PO 2.5-0.025Mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Docusate Sodium - COLACE 100mg TABLET,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Eliquis 2.5mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, ENALAPRIL 5 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Flexeril Cyclobenzarprine 5 mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, FLUORISTRIPS 1 APP STRP,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Furosemide 40 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, "GLUCOSE FAST ACT, TAB 4GM",A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Glucotrol 10mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, GLYCERIN INFANT 1 SUP SUPP 1 Gram,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Hydrocodone Bitartrate/Acetaminophen 7.5mg-325mg/15mL Solution,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, IBUPROFEN (PED) 10MG,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, IBUPROFEN 100MG/5ML 100 MG SUSP,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Ibuprofen 200 mg Tablet,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Ibuprofen 800mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, "Injection, diltiazem HCl, 0.5mg",J1163,HCPCS,,Both,,,5,,,,,,,,,,,,, Iron 65mg Strength Tablet,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, KEFLEX(Cephalexin) 250 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, KEFLEX(Cephalexin) 500 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, KEPPRA 500 MG CAPSULES,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Lancet device each,A4258,HCPCS,,Both,,,5,,,,,,,,,,,,, Lansoprazole 30 mg Capsule - PREVACID,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, LEVOFLOXACIN 500 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Lidocaine 1% Muscosal Solution ,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Linzess 145 Mcg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Lomotil(Diphenoxylate HCl)/Atropine Sulfate 2.5mg-0.025mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Loratadine-Claritin 10MG TABLET,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Lorazepam(Ativan) 1 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, LUBRICANT PER OUNCE,A4402,HCPCS,,Both,,,5,,,,,,,,,,,,, MAALOX Antacid 200mg/ 5 mL Strength Liquid,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, MAALOX Antacid Max 800mg/800mg/80mg Strength Liquid,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Magnesium Citrate 240ML,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, MELATONIN 10MG TAB,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Milk of Magnesia Oral Suspension 30 mL ,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Naproxen sodium 220 mg,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, NEOSYNEPHRINE NASAL SPRAY,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Oral prescrip drug non chemo,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Oxycodone HCl / Acetaminophen 5 mg - 325 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Oxycodone HCl 20 mg Tablet ,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, OXYMETAZOLINE 0.05% 1 EA SOLN,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, PHENOBARBITAL (CIV) 100MG TABLETS,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Polyethylene glycol 17gm,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Potassium Chloride 10 mEq Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, POTASSIUM CHLORIDE 20MEQ ER 1 TAB,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Prilosec(Omeprazole) 20MG CAPSULE,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Probiotic Cap 250mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Promethazine HCl 25 mg oral,Q0170,HCPCS,,Both,,,5,,,,,,,,,,,,, Protonix (Pantoprazole Sodium) 40 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Pyridium (Phenazopyridine HCl) 100 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Pyridium (Phenazopyridine HCl) 95mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Robatussin Liquid(GUAIFENESIN) PO 200mg-10mg/5 mL,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, ROBAXIN-Methocarbamol 500 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, SELF-ADHER BAND >=5/YD,A6455,HCPCS,,Both,,,5,,,,,,,,,,,,, "SENNA LAX, SENNOSIDES TAB 8.6MG",A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Silver Nitrate 75%-25% 70 mg Applicator,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Simethicone 180 mg,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, Simethicone 180mg PO,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Simethicone 80 mg tab chewable,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Simethicone Mag-Al 30ML PO,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, Sodium Chloride Supplement 1 Gram Strength Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, SUDAFED 30MG TABLET,A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, SURGICAL MASK,A4928,HCPCS,,Both,,,5,,,,,,,,,,,,, TESSALON PERLES(Benzonatate) 100MG CAPSULE,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, TESSALON PERLES(Benzonatate) 200MG CAPSULE,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Tramadol HCl 50 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Tranexamic Acid 100mg Injection,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, "TRIPLE ANTIBIOTIC,OINT 0.9gram Individual Packet",A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, URINE REAGENT STRIPS/TABLETS,A4250,HCPCS,,Both,,,5,,,,,,,,,,,,, Valtrex 100 Mg,J8499,HCPCS,,Both,,,5,,,,,,,,,,,,, Verapamil HCl 2.5 mg / 1 mL Inj,J3490,HCPCS,,Both,,,5,,,,,,,,,,,,, "Vitamin B12 1,000 mcg Strength Tablet",A9150,HCPCS,,Both,,,5,,,,,,,,,,,,, IV TUBING SECONDARY,A4223,HCPCS,,Both,,,5.63,,,,,,,,,,,,, 5% DEXTROSE & 0.45% SODIUM CHLORIDE 500 ML INJECTI,J7042,HCPCS,,Both,500,ML,5.81,,,,,,,,,,,,, 5% DEXTROSE & 0.45% SODIUM CHLORIDE 500 ML INJECTI,J7042,HCPCS,,Both,,,6.09,,,,,,,,,,,,, Levofloxacin 750 mg Tablet ,J8499,HCPCS,,Both,,,6.09,,,,,,,,,,,,, GRANISETRON 1MG/ML INJ,J1626,HCPCS,,Both,0.0001,GM,6.28,,,,,,,,,,,,, Robatussin Liquid(GUAIFENESIN) PO 100mg-10mg/5 mL,A9150,HCPCS,,Both,,,6.41,,,,,,,,,,,,, Caffeine citrate injection,J0706,HCPCS,,Both,0.005,GM,6.46,,,,,,,,,,,,, NEOSTIGMINE 1:2000 10ML INJ,J2710,HCPCS,,Both,0.0005,GM,6.67,,,,,,,,,,,,, Oxaliplatin,J9263,HCPCS,,Both,0.0005,GM,6.69,,,,,,,,,,,,, IBUPROFEN 600MG TABLET,J8499,HCPCS,,Both,,,7,,,,,,,,,,,,, IV START KIT,A4223,HCPCS,,Both,,,7,,,,,,,,,,,,, Macrobid 25 mg,J8499,HCPCS,,Both,,,7.5,,,,,,,,,,,,, DAPTOMYCIN 500MG INJ,J0878,HCPCS,,Both,0.001,GM,7.55,,,,,,,,,,,,, IMODIUM/LOPERAMIDE 2MG PO,A9150,HCPCS,,Both,,,7.88,,,,,,,,,,,,, ASPIRIN 81MG CHEWABLE,A9150,HCPCS,,Both,,,8,,,,,,,,,,,,, STERILE WATER 10 ML SOLN,J3490,HCPCS,,Both,,,8.05,,,,,,,,,,,,, Verapamil HCl 40 mg Tablet ,J8499,HCPCS,,Both,,,8.22,,,,,,,,,,,,, MORPHINE SULFATE INJECTION UP TO 10MG,J2270,HCPCS,,Both,0.01,GM,8.33,,,,,,,,,,,,, MEROPENEM 1GM INJ,J2185,HCPCS,,Both,0.1,GM,8.8,,,,,,,,,,,,, ETOPOSIDE 100MG/ML 5ML,J9181,HCPCS,,Both,0.01,GM,8.93,,,,,,,,,,,,, LASIX - FUROSEMIDE INJECTION 1MG,J1938,HCPCS,,Both,,,9.73,,,,,,,,,,,,, CIPRODEX DROPS,J3490,HCPCS,,Both,,,9.75,,,,,,,,,,,,, TRANEXAMI ACID 1000 MG,S5000,HCPCS,,Both,,,9.75,,,,,,,,,,,,, 1 CC STERILE SYRINGE&NEEDLE,A4206,HCPCS,,Both,,,10,,,,,,,,,,,,, Amiodarone 200mg tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Amlodipine Besylate-Valsartan 5mg-320mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, ASPIRIN 325MG ED TABLET,A9150,HCPCS,,Both,,,10,,,,,,,,,,,,, BACTRIM 400-80 MG TABLET,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, BACTRIM DS 800/160 TABLET,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Carbamazepine 100 mg Chewable Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, CARBAMIDE/DEBROX EAR DROPS,J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Cyclopentolate-Cyclogyl 1% Eye Drop,J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Dexamethasone 4mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Dicyclomine HCl 10mg CAP,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Direct Questions per set old fee eff until 4/3/24,S9981,HCPCS,,Both,,,10,,,,,,,,,,,,, FAMOTIDINE 20 MG TABS,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, FLEET ENEMA,J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Fluorescein Sodium 1 mg Strip,J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Glimepiride 2 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Hyoscyamine Sulfate-LEVESIN 0.125 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, "Injection, methylprednisolone acetate, 1 mg",J1010,HCPCS,,Both,,,10,,,,,,,,,,,,, Levothyroxine Sodium 25mcg Tablet ,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Lisinopril 10 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, ORASOL 20% Strength Benzocaine Oral Gel 0.75 Gram ,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Pedia-Lax Suppository 1Gram Strength Glycerin,J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Phenytoin Sodium 100 mg Capsule,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, "Polymyxin B Sulfate Trimethoprim 10,000/mL- 0.1 Eye Drops",J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Potassium Bicarbonate 25mEq Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Potassium Chloride 25mEq Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Tylenol with Codenine 300 Mg,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, TYLENOL/Codeine 120 mg-2 mg Strength Solution 5 mL(LIQUID),J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, Versed 3 mg Intranasal ,J3490,HCPCS,,Both,,,10,,,,,,,,,,,,, Zanaflex(Tizanidine HCl) 4 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,,,,, DIPYRIDAMOLE 5MG/ML 10ML,J1245,HCPCS,,Both,0.01,GM,10.3,,,,,,,,,,,,, Romiplostim 500mcg Injection 1mL,J2802,HCPCS,,Both,,,10.54,,,,,,,,,,,,, ANIDULAFUNGIN 50MG INJ,J0348,HCPCS,,Both,0.001,GM,10.59,,,,,,,,,,,,, PROTAMINE 250MG/25ML INJ,J2720,HCPCS,,Both,0.01,GM,10.76,,,,,,,,,,,,, TESTOSTERON PROP 100MG/ML 10ML,J3150,HCPCS,,Both,0.1,GM,10.85,,,,,,,,,,,,, RACEMIC EPINEPHRINE 2.25% 1 APP NEBU,J3490,HCPCS,,Both,,,11.03,,,,,,,,,,,,, PREDNISONE IMMEDIATE OR DELAYED RELEASE ORAL 1MG,J7512,HCPCS,,Both,0.001,GM,11.04,,,,,,,,,,,,, CYCLOSPORINE 25MG CAP,J7515,HCPCS,,Both,0.025,GM,11.06,,,,,,,,,,,,, ET TUBE,A9999,HCPCS,,Both,,,11.5,,,,,,,,,,,,, PROTECTIVE IV CATHETER,A4223,HCPCS,,Both,,,11.85,,,,,,,,,,,,, RACONIC (Bronchodilator Nephron) 2.25% Strength Inhalation Solution 0.5 mL,J3490,HCPCS,,Both,,,11.89,,,,,,,,,,,,, SODIUM BORATE 120 GTT SOLN (eye wash),J3490,HCPCS,,Both,,,11.97,,,,,,,,,,,,, PREDNISOLONE ORAL PER 5 MG,J7510,HCPCS,,Both,0.005,GM,12,,,,,,,,,,,,, CYTARABINE 100MG INJ,J9100,HCPCS,,Both,0.1,GM,12.06,,,,,,,,,,,,, CYCLOPHOSPHAMIDE 50MG TAB,J8530,HCPCS,,Both,0.025,GM,12.19,,,,,,,,,,,,, BUPRENORPHINE 0.3MG/ML,J0592,HCPCS,,Both,0.0001,GM,12.37,,,,,,,,,,,,, MYCOPHENOLATE MOFET 250MG CAP,J7517,HCPCS,,Both,0.25,GM,12.95,,,,,,,,,,,,, METRONIDAZOLE IN 0.9% SODIUM CHLORIDE 500 MG INJ,J3490,HCPCS,,Both,,,13.16,,,,,,,,,,,,, AMIKACIN 500MG/2ML 2ML,J0278,HCPCS,,Both,0.1,GM,13.44,,,,,,,,,,,,, METHOTREXATE 2.5MG TAB,J8610,HCPCS,,Both,0.0025,GM,13.53,,,,,,,,,,,,, ELA-MAX 5% 5 GM KIT,J3490,HCPCS,,Both,,,14,,,,,,,,,,,,, 5% DEXTROSE & 0.9% SODIUM CHLORIDE 1000 ML INJECT,J7042,HCPCS,,Both,,,14.35,,,,,,,,,,,,, Promethazine 25mg Or 1 Tablet,J8499,HCPCS,,Both,,,14.5,,,,,,,,,,,,, "Inj, epirubicin hcl, 2 mg",J9178,HCPCS,,Both,0.002,GM,14.75,,,,,,,,,,,,, AMINOPHYLLINE 250MG/10ML 10ML,J0280,HCPCS,,Both,0.25,GM,14.85,,,,,,,,,,,,, 2 CC STERILE SYRINGE&NEEDLE,A4207,HCPCS,,Both,,,15,,,,,,,,,,,,, Acetaminophen Codeine 120mg/12mg Strength Solution 5mL,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, ALPRAZOLAM (CIV) 0.25 MG TABS (Xanax),J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, ALPRAZOLAM CIV 1 MG TABS (Xanax),J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Amoxicillin 500mg Capsule,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Amoxicillin-Clavulanate 875mg-125mg Tablet ,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Azithromycin 250 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, BACTRIM(Sulfamethoxazole/Trimethoprim)200-40mg/5 mL Suspension,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Carvedilol (Coreg) 12.5mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Clopidogrel Bisulfate 75 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Coumadin® Warfarin Sodium 5 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Cyclobenzaprine (FLEXRIL) HCl 10 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, DEPAKOTE(Divalproex Sodium) 250 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Diazepam 5 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Dicyclomine HCl 20 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Eliquis Apixaban 5mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Eszopiclone 3 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, FIORICET (BUTALBITAL 50MG-CAFFEINE 40MG-TYLENOL-325MG) PO,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Gentamicin Sulfate 0.3% Ophthalmic Solution 5mL,J3490,HCPCS,,Both,,,15,,,,,,,,,,,,, Hydralazine HCl 25 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, HYDROCODONE APAP 10/325 MG TABLET,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, HYDROCODONE APAP 5/325 MG TABLET,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, HYDROCODONE/APAP 7.5/325 MG TABLET,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Hydrocortisone/AceticAcid1%-2%Otic Drops10mL,J3490,HCPCS,,Both,,,15,,,,,,,,,,,,, Levothyroxine Sodium 50 mcg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, LIBRIUM 50MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Librium Chlordiazepoxide 25mg CAP,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, MACROBID 100MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, MECLIZINE 25 MG TABS,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Metformin HCl 500 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Methocarbamol 750 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, METOCLOPRAMIDE 10MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Metoprolol Tartrate 25 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Metronidazole - FLAGYL 250 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, NON CORING NEEDLE OR STYLET,A4212,HCPCS,,Both,,,15,,,,,,,,,,,,, NONNEEDLE INJECTION DEVICE,A4210,HCPCS,,Both,,,15,,,,,,,,,,,,, PHENERGAN 25MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Propranolol 20 mg,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Spironolactone 25mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, SUPP FOR SELF-ADM INJECTIONS,A4211,HCPCS,,Both,,,15,,,,,,,,,,,,, TOBRADEX OPHTHALMIC,J3490,HCPCS,,Both,,,15,,,,,,,,,,,,, Torsemide 20 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, Vancomycin HCl 125 mg Capsule,J8499,HCPCS,,Both,,,15,,,,,,,,,,,,, "Injection, acetaminophen, not otherwise specified, 10 mg",J0131,HCPCS,,Both,0.01,GM,15.23,,,,,,,,,,,,, Lidocaine 2% Viscous SOL 10ML,J3490,HCPCS,,Both,,,17.06,,,,,,,,,,,,, LIDOCAINE JELLY 2% 30 APP GEL,J3490,HCPCS,,Both,,,17.5,,,,,,,,,,,,, LET Gel Topical Anesthetic 1 oz,J3490,HCPCS,,Both,,,18,,,,,,,,,,,,, HYDROCORTISONE SODIUM PHOSPHATE UP TO 50 MG INJECTION,J1710,HCPCS,,Both,,,18.22,,,,,,,,,,,,, IV TUBING PRIMARY,A4223,HCPCS,,Both,,,18.55,,,,,,,,,,,,, PAPAVERINE 30MG/ML 10ML,J2440,HCPCS,,Both,0.06,GM,18.6,,,,,,,,,,,,, CATHETER KIT - FEMAL 8 FR,A9270,HCPCS,,Both,,,18.62,,,,,,,,,,,,, Inj progesterone per 50 MG,J2675,HCPCS,,Both,0.05,GM,18.64,,,,,,,,,,,,, BUTTERFLY VACUTAINER,A4215,HCPCS,,Both,,,18.66,,,,,,,,,,,,, IV LOOP CONNECTOR,A4223,HCPCS,,Both,,,18.9,,,,,,,,,,,,, Albuterol COomp Con,J7610,HCPCS,,Both,,,19,,,,,,,,,,,,, URINE STRAINER,A9270,HCPCS,,Both,,,19,,,,,,,,,,,,, "Sodium Bicarbonate, Preservative Free 8.4%, 1 mEq / mL Injection 50 mL",J3490,HCPCS,,Both,,,19.11,,,,,,,,,,,,, PROCHLORPERAZINE 5MG/ML 10 MG INJECTION,Q0165,HCPCS,,Both,,,19.18,,,,,,,,,,,,, MOD COMPRES BAND W>=3 <5 YD (Ace),A6451,HCPCS,,Both,,,19.74,,,,,,,,,,,,, MOD COMPRES BAND W>=3 <5 /YD (Ace X2),A6451,HCPCS,,Both,,,19.74,,,,,,,,,,,,, BACTROBAN(Mupirocin) 2% Ointment,J3490,HCPCS,,Both,,,19.8,,,,,,,,,,,,, "METOPROLOL TARTRATE, 1MG/ML 5ML/VL",J3490,HCPCS,,Both,,,19.95,,,,,,,,,,,,, ABSORPT DRG <=16 SQ IN W/O B,A6251,HCPCS,,Both,,,20,,,,,,,,,,,,, Acetaminophen Codeine 300mg-30mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Amoxicillin Potassium Clavulanate-AUGMENTIN 200mg-28.5mg 5mL Suspension,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Atorvastatin Calcium 10 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Atorvastatin Calcium-LIPITOR 40mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, BASIC SUPPORT ROUTINE SUPPLS,A0382,HCPCS,,Both,,,20,,,,,,,,,,,,, Capsaicin 8% Gel,J3490,HCPCS,,Both,,,20,,,,,,,,,,,,, Celecoxib 100mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Colcrys® Colchicine 0.6 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Compazine(Prochlorperazine Maleate) 10 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Digoxin 0.125 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Escitalopram Oxalate 10 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Gabapentin 100mg CAP PO,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Glyburide 5mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Haloperidol 5mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Hydroxyzine Pamoate 25 mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, "Injection, vancomycin HCl, 10 mg",J3373,HCPCS,,Both,,,20,,,,,,,,,,,,, Kayexalate(Sodium Polystyrene Sulfonate) 15 Gram / 60 mL Suspension,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Librium (Chlordiazepoxide) HCl 5 mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, LYRICA - Pregabalin 75mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Memantine HCl 5 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Metronidazole - FLAGYL 500 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Olmesartan Medoxomil-Hydrochlorothiazide 40mg-25mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Procardia Nifedipine 10mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Sucralfate(CARAFATE) 1Gram Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Terazosin HCl 5 mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Valsartan 160 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, Venlafaxine HCl 75 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, XARELTO-Rivaroxaban 2.5 MG TABLET,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, ZOLPIDEM TARTRATE-AMBIEN 5MG TABLET,J8499,HCPCS,,Both,,,20,,,,,,,,,,,,, TACROLIMUS 1MG CAP,J7507,HCPCS,,Both,0.001,GM,20.18,,,,,,,,,,,,, PARICALCITOL 5MCG INJ,J2501,HCPCS,,Both,0.000001,GM,20.24,,,,,,,,,,,,, Amiodarone 30mg INJECTION,J0282,HCPCS,,Both,0.03,GM,20.35,,,,,,,,,,,,, AMIODARONE 500 ML IV SOLUTION,J0282,HCPCS,,Both,0.03,GM,20.35,,,,,,,,,,,,, CODEINE PHOSPHATE 60MG INJ,J0745,HCPCS,,Both,0.03,GM,20.46,,,,,,,,,,,,, VINBLASTINE 1MG INJ,J9360,HCPCS,,Both,0.001,GM,20.73,,,,,,,,,,,,, DRESSING TEGADERM 4x4 3/4 X3,A6259,HCPCS,,Both,,,21,,,,,,,,,,,,, Fosaprepitant injection,J1453,HCPCS,,Both,0.001,GM,21.46,,,,,,,,,,,,, Levoleucovorin injection,J0641,HCPCS,,Both,0.0005,GM,21.8,,,,,,,,,,,,, Butorphanol tartrate 1 mg,J0595,HCPCS,,Both,0.001,GM,21.81,,,,,,,,,,,,, "Inj, nitroglycerin, 5 mg",J2305,HCPCS,,Both,0.005,GM,22,,,,,,,,,,,,, Lidocaine 4% 50ml topical ,J3490,HCPCS,,Both,,,22,,,,,,,,,,,,, Lidocaine HCL Mucous Membrane,J3490,HCPCS,,Both,,,22,,,,,,,,,,,,, TIGECYCLINE 50MG INJ,J3243,HCPCS,,Both,0.001,GM,22.13,,,,,,,,,,,,, BUPIVICAINE (MARCAINE) 0.5% 10 ML INJECTION,J3490,HCPCS,,Both,,,22.47,,,,,,,,,,,,, Irrigation tray,A4320,HCPCS,,Both,,,23,,,,,,,,,,,,, Vecuronium Bromide 1 mg / mL Injection,J3490,HCPCS,,Both,,,23.1,,,,,,,,,,,,, Fluorescein Eye Drop,J3490,HCPCS,,Both,,,23.28,,,,,,,,,,,,, NICOTINE PATCH,S4990,HCPCS,,Both,,,23.42,,,,,,,,,,,,, ENALAPRILAT 1.25MG/ML 2.5 MG INJECTION,J3490,HCPCS,,Both,,,23.8,,,,,,,,,,,,, ONDANSETRON ODT 1 MG TBDP,Q0162,HCPCS,,Both,,,23.96,,,,,,,,,,,,, IV TUBING PUMP,A4223,HCPCS,,Both,,,24.22,,,,,,,,,,,,, DIAL A FLOW,A4223,HCPCS,,Both,,,24.64,,,,,,,,,,,,, FLUOROURACIL 50MG/ML 10ML,J9190,HCPCS,,Both,0.5,GM,24.94,,,,,,,,,,,,, Acyclovir 400mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, Hydrochlorothiazide 12.5 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, Levetiracetam 500 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, NEOMYCIN HYDROCORTISONE OTIC DROPS,J3490,HCPCS,,Both,,,25,,,,,,,,,,,,, Norflex Orphenadrine Citrate 100mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, Olanzapine - Zyprexa 2.5 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, Questionnaire -(per set of 10) EFF AS OF 4/4/24,S9981,HCPCS,,Both,,,25,,,,,,,,,,,,, Quetiapine Fumarate -Seroquel- 25 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, Ropinirole HCl 0.25mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,,,,, "Spirometer, nonelectronic,includes all accessories",A9284,HCPCS,,Both,,,25,,,,,,,,,,,,, STERILE GAUZE>16 <= 48 SQ IN,A6403,HCPCS,,Both,,,25,,,,,,,,,,,,, Timolol Maleate 0.5% Solution 5mL,J3490,HCPCS,,Both,,,25,,,,,,,,,,,,, NOREPINEPHRINE 1MG/ML INJECTION,J3490,HCPCS,,Both,,,25.55,,,,,,,,,,,,, Inj ceftazidime per 500 mg,J0713,HCPCS,,Both,0.5,GM,25.76,,,,,,,,,,,,, DIPHENHYDRAMINE HCL INJECTIO,J1200,HCPCS,,Both,0.05,GM,25.8,,,,,,,,,,,,, REMOVAL OF SUTURES,S0630,HCPCS,,Both,,,26,,,,,,,,,,,,, PROPARACAINE HYDROCHLORIDE 5 mg/mL Ophthalmic Solution,J3490,HCPCS,,Both,,,26.04,,,,,,,,,,,,, Rocuronium Bromide 10 mg / mL Injection,J3490,HCPCS,,Both,,,26.19,,,,,,,,,,,,, Cisplatin 10 MG injection,J9060,HCPCS,,Both,0.01,GM,26.39,,,,,,,,,,,,, DROPERIDOL 2.5MG/ML 1ML INJ,J1790,HCPCS,,Both,0.005,GM,26.77,,,,,,,,,,,,, CLINDAMYCIN 600mg/4ml inj,J3490,HCPCS,,Both,,,27.3,,,,,,,,,,,,, OXACILLIN 1GM INJ,J2700,HCPCS,,Both,0.25,GM,27.41,,,,,,,,,,,,, Topotecan injection,J9351,HCPCS,,Both,0.0001,GM,27.45,,,,,,,,,,,,, DEXAMETHASONE SODIUM PHOS 1MG INJ,J1100,HCPCS,,Both,0.001,GM,28.15,,,,,,,,,,,,, ONDANSETRON HCL INJECTION,J2405,HCPCS,,Both,0.001,GM,28.15,,,,,,,,,,,,, FOSPHEYTOIN INJ 50 MG,Q2009,HCPCS,,Both,,,28.49,,,,,,,,,,,,, LABETALOL 5MG/ 20ML INJECTION,J3490,HCPCS,,Both,,,28.63,,,,,,,,,,,,, MOD COMPRES BAND W>=3 <5 /YD (Ace X3),A6451,HCPCS,,Both,,,29.61,,,,,,,,,,,,, CLINDAMYCIN 150MG/ML 300 MG INJECTION,J3490,HCPCS,,Both,,,29.68,,,,,,,,,,,,, Fentanyl intranasal 100mg,J3490,HCPCS,,Both,,,29.95,,,,,,,,,,,,, ABSORPT DRG >16 <=48 W/O BDR,A6252,HCPCS,,Both,,,30,,,,,,,,,,,,, Azithromycin 500mg Tablet,J8499,HCPCS,,Both,,,30,,,,,,,,,,,,, CONTACT LAYER > 48 SQ IN,A6208,HCPCS,,Both,,,30,,,,,,,,,,,,, DISK/FOAM PAD +OR- ADHESIVE,A5126,HCPCS,,Both,,,30,,,,,,,,,,,,, FOAM DRSG <=16 SQ IN W/O BDR,A6209,HCPCS,,Both,,,30,,,,,,,,,,,,, GRAD COMP NON-ELASTIC BK,A6545,HCPCS,,Both,,,30,,,,,,,,,,,,, HYDROGEL DRSG GEL FILLER,A6248,HCPCS,,Both,,,30,,,,,,,,,,,,, "Inj, naloxone HCl, not otherwise specified, 0.01mg",J2312,HCPCS,,Both,,,30,,,,,,,,,,,,, "Injection, metoprolol tartrate, 1 mg",J0616,HCPCS,,Both,,,30,,,,,,,,,,,,, Lidocaine 2% with Epinephrine,J3490,HCPCS,,Both,,,30,,,,,,,,,,,,, Ofloxacin 0.3% Ophthalmic Drops 5 mL,J3490,HCPCS,,Both,,,30,,,,,,,,,,,,, PROMETHAZINE HCL 12.5MG ORAL,Q0169,HCPCS,,Both,,,30,,,,,,,,,,,,, SURGICL DRESS HOLD NON-REUSE,A4461,HCPCS,,Both,,,30,,,,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 2in),Q4050,HCPCS,,Both,,,30.63,,,,,,,,,,,,, Methotrexate sodium inj,J9260,HCPCS,,Both,0.05,GM,31.23,,,,,,,,,,,,, IV TUBING BURETROL,A4223,HCPCS,,Both,,,31.24,,,,,,,,,,,,, "High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml",Q9960,HCPCS,,Both,,,31.25,,,,,,,,,,,,, "LOCM 200-299MG/ML IODINE,1ML",Q9966,HCPCS,,Both,,,31.25,,,,,,,,,,,,, DEXAMETHASONE 8MG/ML 1ML,J1094,HCPCS,,Both,0.001,GM,31.93,,,,,,,,,,,,, DIPHENHYDRAMINE HCI 50mg,Q0163,HCPCS,,Both,,,31.93,,,,,,,,,,,,, HYDROXYZINE HCL INJECTION 25 Mg,J3410,HCPCS,,Both,0.025,GM,31.93,,,,,,,,,,,,, CERVICAL COLLAR,L0180,HCPCS,,Both,,,32.2,,,,,,,,,,,,, "propranolol HCl, up to 1 mg Injection",J1800,HCPCS,,Both,0.001,GM,32.23,,,,,,,,,,,,, MILRINONE 1MG/ML 20ML,J2260,HCPCS,,Both,0.005,GM,32.28,,,,,,,,,,,,, OCTREOTIDE INJ 25 MCG,J2354,HCPCS,,Both,0.000025,GM,32.57,,,,,,,,,,,,, Xofluza,J8499,HCPCS,,Both,,,32.65,,,,,,,,,,,,, APROTININ 10MU/ML 200ML INJ,J0365,HCPCS,,Both,10000,UN,33.07,,,,,,,,,,,,, TAMSULOSIN HCI/FLOMAX CAP 0.4MG,J8499,HCPCS,,Both,,,33.89,,,,,,,,,,,,, Erythromycin Eye Ointment 1 Application,J3490,HCPCS,,Both,,,34.23,,,,,,,,,,,,, BILLING RECORDS EFF 4/4/24,S9981,HCPCS,,Both,,,35,,,,,,,,,,,,, IBUPROFEN INJECTION,J1741,HCPCS,,Both,0.1,GM,35,,,,,,,,,,,,, INJ HEPARIN SODIUM PER 10 U,J1642,HCPCS,,Both,10,ML,35,,,,,,,,,,,,, DILTIAZEM 25MG/5ML 25 MG INJECTION,J3490,HCPCS,,Both,,,35.28,,,,,,,,,,,,, PO Capsule75 Mg Tamiflu,J8499,HCPCS,,Both,,,35.62,,,,,,,,,,,,, MESNA 1GM/10ML INJ,J9209,HCPCS,,Both,0.2,GM,35.69,,,,,,,,,,,,, "Injection, gamma globulin, intramuscular, 10 cc",J1550,HCPCS,,Both,10,ML,36,,,,,,,,,,,,, Marcaine(Bupivacaine HCl) 0.5% 50 ml,J3490,HCPCS,,Both,,,36,,,,,,,,,,,,, Triamcinolone hexacetonl inj,J3303,HCPCS,,Both,0.005,GM,36.2,,,,,,,,,,,,, Na ferric gluconate complex,J2916,HCPCS,,Both,0.0125,GM,36.3,,,,,,,,,,,,, Vasopressin 20 Unit / mL Injection 10 mL,J3490,HCPCS,,Both,,,36.4,,,,,,,,,,,,, Butorphanol Tartrate (Stadol) 2mg Inj,J0595,HCPCS,,Both,0.001,GM,36.75,,,,,,,,,,,,, DOXYCYCLINE 100MG TAB PO,J8499,HCPCS,,Both,,,37.2,,,,,,,,,,,,, REDUCING SUBSTANCE URINE,81005,CPT ,,Both,,,37.25,,,,,,,,,,,,, KEPPRA(LEVETIRACETAM) 500 MG INJECTION VIAL,J3490,HCPCS,,Both,,,37.8,,,,,,,,,,,,, MANNITOL 25% 50ML INJ,J2150,HCPCS,,Both,,,37.92,,,,,,,,,,,,, Bupivacaine 0.5 % 5MG,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, BUPIVICAINE 0.5%,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, Lidocaine / Prilocaine 2.5% - 2.5% Cream,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, Lidocaine 4% 50 ml,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, Metoprolol Tartrate (Lopressor) 1mg inj,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, Odansetron (Zofran) 2mg inj,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, Pantoprazole Sodium (Protonix) 40mg inj,J3490,HCPCS,,Both,,,38,,,,,,,,,,,,, Pantoprazole Sodium (Protonix) 40mg inj,J2470,HCPCS,,Both,,,38,,,,,,,,,,,,, PROTONIX - PANTROPRAZOLE 40MG INJ (MCR CARRIER),C9113,HCPCS,,Both,,,38,,,,,,,,,,,,, PROTONIX - PANTROPRAZOLE 40MG INJ (NON-MCR CARRIER),S0164,HCPCS,,Both,,,38,,,,,,,,,,,,, CARBOPLATIN 50MG INJ,J9045,HCPCS,,Both,0.05,GM,38.03,,,,,,,,,,,,, CIPROFLOXACIN HCI OPHTALMIC 0.3% 2.5mL (drops),J3490,HCPCS,,Both,,,38.06,,,,,,,,,,,,, HIGH COMPRES BAND W>=3 <5 YD (Ace X4),A6452,HCPCS,,Both,,,39.48,,,,,,,,,,,,, CYCLOSPORINE MICR 100MG CAP,J7502,HCPCS,,Both,0.1,GM,39.75,,,,,,,,,,,,, ABSORPT DRG > 48 SQ IN W/O B,A6253,HCPCS,,Both,,,40,,,,,,,,,,,,, ALGINATE DRESSING <=16 SQ IN,A6196,HCPCS,,Both,,,40,,,,,,,,,,,,, HYDROGEL DRESSING >48 SQ IN,A6233,HCPCS,,Both,,,40,,,,,,,,,,,,, HYDROGEL DRG >16<=48 IN W/B,A6246,HCPCS,,Both,,,40,,,,,,,,,,,,, STERILE GAUZE > 48 SQ IN,A6404,HCPCS,,Both,,,40,,,,,,,,,,,,, TRANSPARENT FILM <= 16 SQ IN,A6257,HCPCS,,Both,,,40,,,,,,,,,,,,, BIVALIRUDIN 1MG INJ,J0583,HCPCS,,Both,0.001,GM,40.13,,,,,,,,,,,,, "Inj, moxifloxacin 100 mg",J2280,HCPCS,,Both,0.1,GM,42.35,,,,,,,,,,,,, Oral prescrip drug non chemo,J8499,HCPCS,,Both,,,42.59,,,,,,,,,,,,, "Injection, lidocaine HCl for intravenous infusion 10 mg",J2001,HCPCS,,Both,0.01,GM,42.7,,,,,,,,,,,,, LIDOCAINE 2GM W/D5W 500ML INJECTION,J3490,HCPCS,,Both,,,42.7,,,,,,,,,,,,, "Injection, lidocaine HCl in 5% dextrose, 1 mg",J2002,HCPCS,,Both,,,43,,,,,,,,,,,,, SPECIFIC GRAVITY-OTHER,84315,CPT ,,Both,,,43.13,,,,,,,,,,,,, ACTIVATED CHARCOAL-25GM LIQD(actidose),A9150,HCPCS,,Both,,,43.4,,,,,,,,,,,,, DOXORUBICIN 10MG INJ,J9000,HCPCS,,Both,0.01,GM,43.41,,,,,,,,,,,,, "Trypanosoma cruzi Antibody, IgG (PROTOZOA)",86753,CPT ,,Both,,,44.88,,,,,,,,,,,,, Admin influenza virus vac,G0008,HCPCS,,Both,,,45,,,,,,,,,,,,, Admin pneumococcal vaccine,G0009,HCPCS,,Both,,,45,,,,,,,,,,,,, COMPRESSION STOCKING BK18-30,A6530,HCPCS,,Both,,,45,,,,,,,,,,,,, MEC RCRDS ADMIN FEE EFF 4/4/24,S9981,HCPCS,,Both,,,45,,,,,,,,,,,,, DARBEPOETIN ALFA 60MCG/ML,J0881,HCPCS,,Both,0.000001,GM,45.06,,,,,,,,,,,,, "Darbepoetin alfa, esrd use",J0882,HCPCS,,Both,0.000001,GM,45.06,,,,,,,,,,,,, PROTONIX 40MG INJECTION,J3490,HCPCS,,Both,,,45.75,,,,,,,,,,,,, METHYLERGONOVINE INJ Up To 0.2 Mg,J2210,HCPCS,,Both,0.0002,GM,46.27,,,,,,,,,,,,, Tocilizumab injection,J3262,HCPCS,,Both,0.001,GM,46.29,,,,,,,,,,,,, Degarelix injection,J9155,HCPCS,,Both,0.001,GM,46.46,,,,,,,,,,,,, NITROGLYCERIN 25MG/250ML 250 ML INJECTION,J3490,HCPCS,,Both,,,47.32,,,,,,,,,,,,, DOPAMINE INJECTION,J1265,HCPCS,,Both,0.04,GM,48,,,,,,,,,,,,, PROPOFOL 10MG/ML 20 MLEMUL,J3490,HCPCS,,Both,,,48.3,,,,,,,,,,,,, Fluconazole,J1450,HCPCS,,Both,0.2,GM,48.66,,,,,,,,,,,,, FONDAPARINUX 2.5MG/0.5ML INJ,J1652,HCPCS,,Both,0.0005,GM,48.9,,,,,,,,,,,,, Dacarbazine 100 mg inj,J9130,HCPCS,,Both,0.1,GM,49.81,,,,,,,,,,,,, LACTULOSE 10GM/15ML SOLUTION,J8499,HCPCS,,Both,,,49.84,,,,,,,,,,,,, ABSORPT DRG <=16 SQ IN W/BDR,A6254,HCPCS,,Both,,,50,,,,,,,,,,,,, Baclofen 10mg Tablet,J8499,HCPCS,,Both,,,50,,,,,,,,,,,,, COMPOSITE DRSG <= 16 SQ IN,A6203,HCPCS,,Both,,,50,,,,,,,,,,,,, CONFORM BAND S W <3/YD,A6445,HCPCS,,Both,,,50,,,,,,,,,,,,, Coupling gel or paste (20 ounces),A4559,HCPCS,,Both,,,50,,,,,,,,,,,,, GUAIFENESIN DM 10 ML ,J8499,HCPCS,,Both,,,50,,,,,,,,,,,,, Inj Methylprednisolone Sodium Succinate 5 mg,J2919,HCPCS,,Both,,,50,,,,,,,,,,,,, "Injection, acetylcysteine, 100 mg",J0132,HCPCS,,Both,,,50,,,,,,,,,,,,, "Injection, bupivicaine 0.5mg",J0665,HCPCS,,Both,0.0005,GM,50,,,,,,,,,,,,, "Injection, calcium chloride, 2 mg",J0618,HCPCS,,Both,,,50,,,,,,,,,,,,, "Injection, clindamycin phosphate, 300 mg",J0736,HCPCS,,Both,0.3,GM,50,,,,,,,,,,,,, "Injection, doxycycline hyclate, 1 mg",J1271,HCPCS,,Both,,,50,,,,,,,,,,,,, "Injection, metronidazole, 10 mg",J1836,HCPCS,,Both,0.01,GM,50,,,,,,,,,,,,, Narcan - Naloxone HCl 4mg Spray 0.1 mL,J3490,HCPCS,,Both,,,50,,,,,,,,,,,,, NON-STERILE GLOVES,A4927,HCPCS,,Both,,,50,,,,,,,,,,,,, POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX,99024,CPT ,,Both,,,50,,,,,,,,,,,,, Sertraline 100 mg tablet ,J8499,HCPCS,,Both,,,50,,,,,,,,,,,,, STERILE CEFUROXIME INJECTION,J0697,HCPCS,,Both,0.75,GM,50,,,,,,,,,,,,, "STERILE, GLOVES PER PAIR",A4930,HCPCS,,Both,,,50,,,,,,,,,,,,, TRANSPARENT FILM >16<=48 IN,A6258,HCPCS,,Both,,,50,,,,,,,,,,,,, ZINC PASTE BAND W >=3<5/YD,A6456,HCPCS,,Both,,,50,,,,,,,,,,,,, Rocuronium BR 10mg/ml,J3490,HCPCS,,Both,,,50.12,,,,,,,,,,,,, Alpha 1 proteinase inhibitor,J0256,HCPCS,,Both,0.01,GM,50.3,,,,,,,,,,,,, AURALGAN 15 GTT SOLN,J3490,HCPCS,,Both,,,50.33,,,,,,,,,,,,, PenG benzathine/procaine inj,J0558,HCPCS,,Both,100000,UN,50.55,,,,,,,,,,,,, METHEMOGLOBIN,83050,CPT ,,Both,,,50.63,,,,,,,,,,,,, TIMED VOLUME MEASUREMENT,81050,CPT ,,Both,,,51.5,,,,,,,,,,,,, Codeine Phosphate/Guaifenesin 10mg-100mg/5mL,J8499,HCPCS,,Both,,,52.5,,,,,,,,,,,,, Azithromycin 200 mg / 5 mL Suspension,J8499,HCPCS,,Both,,,52.64,,,,,,,,,,,,, "Injection, lidocaine HCl , 1 mg",J2003,HCPCS,,Both,,,53,,,,,,,,,,,,, "NITROGLYCERIN SUBLINGUAL, TAB 0.4MG ",J8499,HCPCS,,Both,,,54.09,,,,,,,,,,,,, PACLITAXEL 100MG/16.7ML INJ,J9265,HCPCS,,Both,0.03,GM,54.35,,,,,,,,,,,,, DOBUTAMINE INJECTION 250MG,J1250,HCPCS,,Both,0.25,GM,54.58,,,,,,,,,,,,, UNDERARM CRUTCH PAD,A4635,HCPCS,,Both,,,55,,,,,,,,,,,,, VORICONAZOLE 200MG/20ML INJ,J3465,HCPCS,,Both,0.01,GM,56.06,,,,,,,,,,,,, LEUCOVORIN CA 100MG INJ,J0640,HCPCS,,Both,0.05,GM,56.26,,,,,,,,,,,,, TERBUTALINE 1MG/ML 1ML INJ,J3105,HCPCS,,Both,0.001,GM,56.7,,,,,,,,,,,,, SODIUM POLYSTYRENE SULFONATE 15GM/60ML 15 GM SUSP,J8499,HCPCS,,Both,,,57.82,,,,,,,,,,,,, Docetaxel injection,J9171,HCPCS,,Both,0.001,GM,57.85,,,,,,,,,,,,, Garamycin gentamicin inj 80 MG,J1580,HCPCS,,Both,0.08,GM,58.64,,,,,,,,,,,,, PSYTX COMPLEX INTERACTIVE,90785,CPT ,,Both,,,59.63,,,,,,,,,,,,, Rhophylac injection,J2791,HCPCS,,Both,100,UN,59.73,,,,,,,,,,,,, AMPICILLIN 500 MG INJ,J0290,HCPCS,,Both,0.5,GM,60,,,,,,,,,,,,, HUMULIN R INSULIN INJECTION,J1815,HCPCS,,Both,5,UN,60,,,,,,,,,,,,, SHOE LIFTS ELEVATION HEEL /I,L3334,HCPCS,,Both,,,60,,,,,,,,,,,,, TRIAMCINOLONE ACET INJ (KENALOG 10MG),J3301,HCPCS,,Both,0.01,GM,60,,,,,,,,,,,,, TORSEMIDE 20MG/2ML INJ,J3265,HCPCS,,Both,0.01,GM,60.14,,,,,,,,,,,,, PHENYTOIN SODIUM INJECTION,J1165,HCPCS,,Both,0.05,GM,60.73,,,,,,,,,,,,, "PH ASSAY, BODY FLUID, NOS",83986,CPT ,,Both,,,61.5,,,,,,,,,,,,, "VITAMIN K1, AMP 1MG INJECTION",J3430,HCPCS,,Both,0.001,GM,62.12,,,,,,,,,,,,, "Injection, lidocaine HCl with epinephrine, 1 mg",J2004,HCPCS,,Both,,,63,,,,,,,,,,,,, PROTEIN RANDOM URINE,84156,CPT ,,Both,,,63,,,,,,,,,,,,, URINALYSIS GLASS TEST,81020,CPT ,,Both,,,63.38,,,,,,,,,,,,, Cefotaxime sodium injection,J0698,HCPCS,,Both,1,GM,64.32,,,,,,,,,,,,, DIMENHYDRINATE 50MG/ML 1ML INJ,J1240,HCPCS,,Both,0.05,GM,64.86,,,,,,,,,,,,, EPINEPHRINE 0.1MG/ML 10ML 3.5in,J0170,HCPCS,,Both,1,ML,64.96,,,,,,,,,,,,, "AMINES, VAGINAL FLUID, QUALITATIVE",82120,CPT ,,Both,,,65,,,,,,,,,,,,, Epinephrine 0.1 mg Injection,J0165,HCPCS,,Both,,,65,,,,,,,,,,,,, ANTIGEN TYPING W/AHG,86905,CPT ,,Both,,,65.63,,,,,,,,,,,,, Donnatal P Hyoscyamine-Atropine S Scopolamine Bromaide16.2mg Elixir 5 mL,J8499,HCPCS,,Both,,,66.36,,,,,,,,,,,,, EASY CAP END-TIDAL CO2 DETECTR,A9999,HCPCS,,Both,,,66.78,,,,,,,,,,,,, EASY CAP II CO2 DETECTOR,A9999,HCPCS,,Both,,,66.78,,,,,,,,,,,,, DEXTROSE 50% 50 ML SYRINGE,J3490,HCPCS,,Both,,,67.27,,,,,,,,,,,,, GLUCOSE TOL 4TH HR ONLY,82952,CPT ,,Both,,,67.38,,,,,,,,,,,,, TETRACAINE 0.5% EYE DROPS,J3490,HCPCS,,Both,,,67.75,,,,,,,,,,,,, BOTULINUM 100U INJ,J0585,HCPCS,,Both,1,UN,68.16,,,,,,,,,,,,, DOLASETRON 100MG/5ML INJ,J1260,HCPCS,,Both,0.01,GM,68.28,,,,,,,,,,,,, ATROPINE 1MG/10ML 1 MG SYRINGE,J0460,HCPCS,,Both,0.0003,GM,68.32,,,,,,,,,,,,, Arformoterol non-comp unit,J7605,HCPCS,,Both,0.000015,GM,69.38,,,,,,,,,,,,, ENOXAPARIN SODIUM (LOVENOX) - INJ 10MG,J1650,HCPCS,,Both,0.01,GM,70,,,,,,,,,,,,, Inj desmopressin acetate,J2597,HCPCS,,Both,0.000001,GM,70.35,,,,,,,,,,,,, PRIMAXIN 500MG INJ,J0743,HCPCS,,Both,0.25,GM,71.18,,,,,,,,,,,,, ACYCLOVIR 500MG INJ,J0133,HCPCS,,Both,0.005,GM,71.4,,,,,,,,,,,,, Azacitidine injection,J9025,HCPCS,,Both,0.001,GM,71.8,,,,,,,,,,,,, ASA/ANTIPLAT THER USED,G8598,HCPCS,,Both,,,72,,,,,,,,,,,,, ATROPINE SULFATE INJECTION,J0461,HCPCS,,Both,0.00001,GM,72,,,,,,,,,,,,, VINCRISTINE 1MG/ML 1ML,J9370,HCPCS,,Both,0.001,GM,72.09,,,,,,,,,,,,, RISPERIDONE 25MG INJ,J2794,HCPCS,,Both,0.0005,GM,72.21,,,,,,,,,,,,, Silvadene Cream 20gm,J3490,HCPCS,,Both,,,72.52,,,,,,,,,,,,, CATUERY HIGH TEMP FINE TEMP,A9999,HCPCS,,Both,,,73,,,,,,,,,,,,, SKIN STAPLER,A9999,HCPCS,,Both,,,73,,,,,,,,,,,,, COAGULATION TIME: ACTIV,85347,CPT ,,Both,,,73.13,,,,,,,,,,,,, PINWORM PREP,87172,CPT ,,Both,,,73.38,,,,,,,,,,,,, COAGULATION TIME,85345,CPT ,,Both,,,73.88,,,,,,,,,,,,, POTASSIUM RANDOM URINE,84133,CPT ,,Both,,,73.88,,,,,,,,,,,,, Inj nalbuphine hydrochloride 10 Mg,J2300,HCPCS,,Both,0.01,GM,74.6,,,,,,,,,,,,, ACETYLCYSTEINE SOLN 1gm,J7608,HCPCS,,Both,1,GM,75,,,,,,,,,,,,, Allopurinol 300 mg tablet ,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Amitriptyline HCL 25mg TABLET,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Buspirone HCl 30 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Diltiazem HCl 120 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Fluconazole 150 mg Tablet PO,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Gabapentin 300 mg PO,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, GI COCKTAIL,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Isosorbide Dinitrate 10 mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Lamotrigine 150mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Levothyroxine Sodium 112 mcg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Lisinopril 20 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Losartan Potassium 25 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Losartan Potassium 50 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Lovastatin 20 mg PO ,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Lurasidone(LATUDA) HCl 60 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Meloxicam 15mg tab,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Montelukast 10mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Nebivolol 10 mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Oxcarbazepine 600 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Radiology CD OLD FEE EFF UNTIL 4/3/24,S9981,HCPCS,,Both,,,75,,,,,,,,,,,,, RADIOLOGY FILMS ADMIN EFF 4/4/24,S9981,HCPCS,,Both,,,75,,,,,,,,,,,,, Risperidone 3 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Sertraline 100 mg tablet ,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, Simvastatin 20mg tablet ,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, "Tranexamic Acid 1,000 mg Injection/Solution 10mL",J3490,HCPCS,,Both,,,75,,,,,,,,,,,,, Trazodone HCl 150 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,,,,, "Vasopressin (antidiuretic hormone, ADH)",84588,CPT ,,Both,,,75,,,,,,,,,,,,, FLU VACCINE 3 YRS IM,90657,CPT ,,Both,,,75.28,,,,,,,,,,,,, Levetiracetam injection,J1953,HCPCS,,Both,0.01,GM,77,,,,,,,,,,,,, MULTI VITAMIN INJECTION,J3490,HCPCS,,Both,,,77,,,,,,,,,,,,, BLEEDING TIME,85002,CPT ,,Both,,,77.38,,,,,,,,,,,,, DRUG SCRN QUAN LEVETIRACETAM,80177,CPT ,,Both,,,77.45,,,,,,,,,,,,, "Injection, penicillin G benzathine, 100,000 units",J0561,HCPCS,,Both,100000,UN,78,,,,,,,,,,,,, LACERATION TRAY,A9999,HCPCS,,Both,,,78.54,,,,,,,,,,,,, Colon Cancer Screening,G0328,HCPCS,,Both,,,78.56,,,,,,,,,,,,, "MICROALBUMIN, URINE, SEMIQUANTITATIVE ASSAY",82044,CPT ,,Both,,,79,,,,,,,,,,,,, HYDROXYINDOLACETIC 5-HIAA,83497,CPT ,,Both,,,79.88,,,,,,,,,,,,, EOSINOPHILS NASAL SMEAR,89190,CPT ,,Both,,,81.63,,,,,,,,,,,,, E-TEST AMOXICIL CLAVULAN ACID,87181,CPT ,,Both,,,81.63,,,,,,,,,,,,, GLUCOSE 1HR PC/50G,82950,CPT ,,Both,,,81.63,,,,,,,,,,,,, UREA NITROGEN 24HR URINE,84540,CPT ,,Both,,,81.63,,,,,,,,,,,,, ALLERGY BERMUDA,86003,CPT ,,Both,,,82.13,,,,,,,,,,,,, SODIUM BICARBONATE 4.2% 0.5 MEQ,J3490,HCPCS,,Both,,,82.25,,,,,,,,,,,,, Hydrocortisone Topical Cream,A6250,HCPCS,,Both,,,82.66,,,,,,,,,,,,, ALS IV DRUG THERAPY SUPPLIES,A0394,HCPCS,,Both,,,83,,,,,,,,,,,,, ART OR VENOUS BLOOD TUBING,A4750,HCPCS,,Both,,,83,,,,,,,,,,,,, BETADINE/IODINE SWABS/WIPES,A4247,HCPCS,,Both,,,83,,,,,,,,,,,,, CONFORM BAND S W >=5/YD,A6447,HCPCS,,Both,,,83,,,,,,,,,,,,, DISPOSABLE UNDERPADS,A4554,HCPCS,,Both,,,83,,,,,,,,,,,,, GAUZE > 48 SQ IN W/BORDER,A6221,HCPCS,,Both,,,83,,,,,,,,,,,,, GAUZE >16<=48 NO W/SAL W/O B,A6223,HCPCS,,Both,,,83,,,,,,,,,,,,, GRAVLEE JET WASHER,A4470,HCPCS,,Both,,,83,,,,,,,,,,,,, HYDROCOLLD DRG >16<=48 W/BDR,A6238,HCPCS,,Both,,,83,,,,,,,,,,,,, HYDROCOLLD DRG >16<=48 W/O B,A6235,HCPCS,,Both,,,83,,,,,,,,,,,,, LUBE STERILE PACKET,A4332,HCPCS,,Both,,,83,,,,,,,,,,,,, OCCLUSIVE EYE PATCH,A6412,HCPCS,,Both,,,83,,,,,,,,,,,,, PADDING FOR COMPRSSN BDG,S8430,HCPCS,,Both,,,83,,,,,,,,,,,,, PD CATHETER ANCHOR BELT,A4653,HCPCS,,Both,,,83,,,,,,,,,,,,, TRACHEOSTOMY CARE KIT,A4629,HCPCS,,Both,,,83,,,,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 3in),Q4050,HCPCS,,Both,,,83.25,,,,,,,,,,,,, APREPITANT 80MG TAB,J8501,HCPCS,,Both,0.005,GM,83.6,,,,,,,,,,,,, TETRACAINE - PONTOCAINE 1% 2ML IMIIV,J3490,HCPCS,,Both,,,83.8,,,,,,,,,,,,, CRUTCH FOREARM PAIR,E0110,HCPCS,,Both,,,84,,,,,,,,,,,,, Etomidate 2 mg / mL Injection 10 mL,J3490,HCPCS,,Both,,,84,,,,,,,,,,,,, BILIRUBIN TRANSCUTANEOUS,88720,CPT ,,Both,,,86.25,,,,,,,,,,,,, CHLORIDE RANDOM URINE,82436,CPT ,,Both,,,86.38,,,,,,,,,,,,, FECAL FAT SCREEN,82705,CPT ,,Both,,,87.38,,,,,,,,,,,,, Abobotulinumtoxin A,J0586,HCPCS,,Both,5,UN,88.16,,,,,,,,,,,,, ALBUMIN FLUID,82042,CPT ,,Both,,,88.88,,,,,,,,,,,,, ANTIBODY TITER,86886,CPT ,,Both,,,88.88,,,,,,,,,,,,, PHOSPHORUS 24HR URINE,84105,CPT ,,Both,,,88.88,,,,,,,,,,,,, SEROL AGGLUT/ANTISERUM,87147,CPT ,,Both,,,88.88,,,,,,,,,,,,, Med record admin OLD FEE EFF UNTIL 4/3/24,S9981,HCPCS,,Both,,,89.24,,,,,,,,,,,,, HurriCaine® 20% Strength Benzocaine Unit Dose Spray 0.5 mL,J3490,HCPCS,,Both,,,89.61,,,,,,,,,,,,, IV TUBING EXTENSION SET,S1015,HCPCS,,Both,,,90,,,,,,,,,,,,, Testosterone enanthate inj,J3120,HCPCS,,Both,0.1,GM,90.05,,,,,,,,,,,,, LUMBAR PUNCTURE TRAY,A9999,HCPCS,,Both,,,90.75,,,,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 4in),Q4050,HCPCS,,Both,,,91.75,,,,,,,,,,,,, Gastrostomy/jejunostomy tube standard any material/type,B4087,HCPCS,,Both,,,92.33,,,,,,,,,,,,, AFB SMEAR ONLY,87206,CPT ,,Both,,,92.38,,,,,,,,,,,,, Gastrostomy/jejunostomy tube standard,B4089,HCPCS,,Both,,,93,,,,,,,,,,,,, INDWELLING CATHETER (COUDE CATH ALL),A4340,HCPCS,,Both,,,94,,,,,,,,,,,,, PKU BLOOD,84030,CPT ,,Both,,,94.5,,,,,,,,,,,,, RBC SICKLE CELL TEST,85660,CPT ,,Both,,,94.88,,,,,,,,,,,,, MICROALBUMIN URINE,82043,CPT ,,Both,,,95.75,,,,,,,,,,,,, KANAMYCIN 1GM/3ML 3ML INJ,J1840,HCPCS,,Both,0.5,GM,96.06,,,,,,,,,,,,, Injection adenosine 6 MG,J0150,HCPCS,,Both,0.006,GM,96.83,,,,,,,,,,,,, LINCOMYCIN 600MG/2ML 2ML,J2010,HCPCS,,Both,0.3,GM,97.08,,,,,,,,,,,,, DEFEROXAMINE 2GM INJ,J0895,HCPCS,,Both,0.5,GM,98.56,,,,,,,,,,,,, PENICILLIN G POT 10MMU,J2540,HCPCS,,Both,600000,UN,98.9,,,,,,,,,,,,, ABSORPT DRG >16<=48 IN W/BDR,A6255,HCPCS,,Both,,,99,,,,,,,,,,,,, CATH IMPL VASC ACCESS PORTAL,A4300,HCPCS,,Both,,,99,,,,,,,,,,,,, CATH W/DRAINAGE 2-WAY SILCNE,A4315,HCPCS,,Both,,,99,,,,,,,,,,,,, COUDE TIP URINARY CATHETER,A4352,HCPCS,,Both,,,99,,,,,,,,,,,,, FOAM DRG <=16 SQ IN W/BORDER,A6212,HCPCS,,Both,,,99,,,,,,,,,,,,, GAUZE <= 16 SQ IN W/BORDER,A6219,HCPCS,,Both,,,99,,,,,,,,,,,,, GAUZE <=16 IN NO W/SAL W/O B,A6222,HCPCS,,Both,,,99,,,,,,,,,,,,, GAUZE >16 <=48 SQ IN W/BORDR,A6220,HCPCS,,Both,,,99,,,,,,,,,,,,, HYDROCOLLD DRG > 48 IN W/BDR,A6239,HCPCS,,Both,,,99,,,,,,,,,,,,, LT COMPRES BAND >=5/YD,A6450,HCPCS,,Both,,,99,,,,,,,,,,,,, NON-ELASTIC EXTREMITY BINDER,A4465,HCPCS,,Both,,,99,,,,,,,,,,,,, NON-STERILE GAUZE > 48 SQ IN,A6218,HCPCS,,Both,,,99,,,,,,,,,,,,, "PACKING STRIPS, NON-IMPREG STERILE up to 2in in width, per linear yd",A6407,HCPCS,,Both,,,99,,,,,,,,,,,,, PAD BAND W>=3 <5/YD,A6441,HCPCS,,Both,,,99,,,,,,,,,,,,, PECTIN BASED OSTOMY PASTE,A4406,HCPCS,,Both,,,99,,,,,,,,,,,,, "PESSARY, NON RUBBER,ANY TYPE",A4562,HCPCS,,Both,,,99,,,,,,,,,,,,, SELF-ADHER BAND W>=3 <5/YD,A6454,HCPCS,,Both,,,99,,,,,,,,,,,,, "STERILE WATER/SALINE, 500 ML",A4217,HCPCS,,Both,,,99,,,,,,,,,,,,, SYRINGE W/NEEDLE INSULIN 3CC,A4232,HCPCS,,Both,,,99,,,,,,,,,,,,, TUBING (OXYGEN) PER FOOT,A4616,HCPCS,,Both,,,99,,,,,,,,,,,,, GEMCITABINE 1GM INJ,J9201,HCPCS,,Both,0.2,GM,99.51,,,,,,,,,,,,, COLCHICINE 0.5MG/ML 2ML INJ,J0760,HCPCS,,Both,0.001,GM,99.82,,,,,,,,,,,,, LACTULOSE 20GM/30ML SOLUTION,J8499,HCPCS,,Both,,,100,,,,,,,,,,,,, Spacer with or wo mask for use with metered dose inhaler,A4627,HCPCS,,Both,,,100,,,,,,,,,,,,, MUCIN SYNOVIAL FLUID,83872,CPT ,,Both,,,100.75,,,,,,,,,,,,, HOMOGENIZATION TISSUE CELL,87176,CPT ,,Both,,,101.13,,,,,,,,,,,,, Depo-estradiol cypionate inj,J1000,HCPCS,,Both,0.005,GM,101.29,,,,,,,,,,,,, CO2 Expired Gas Determination,94770,CPT ,,Both,,,101.75,,,,,,,,,,,,, TB INTRADERMAL TEST,86580,CPT ,,Both,,,101.88,,,,,,,,,,,,, CHEST TUBE,A7042,HCPCS,,Both,,,102.5,,,,,,,,,,,,, PYRIDOXINE 100MG/ML 1ML,J3415,HCPCS,,Both,0.1,GM,102.71,,,,,,,,,,,,, CARBON MONOXIDE TEST,82376,CPT ,,Both,,,103,,,,,,,,,,,,, CALCIUM 24HR URINE,82340,CPT ,,Both,,,103.63,,,,,,,,,,,,, COMPRESSION BANDAGE,S8431,HCPCS,,Both,,,105,,,,,,,,,,,,, "Flulaval vacc, 3 yrs & >, im",Q2036,HCPCS,,Both,,,107.23,,,,,,,,,,,,, AEROSOL MASK USED W NEBULIZE,A7015,HCPCS,,Both,,,108,,,,,,,,,,,,, CPAP FULL FACE MASK,A7030,HCPCS,,Both,,,108,,,,,,,,,,,,, METHYLPREDNISOLONE 20 MG INJ,J1020,HCPCS,,Both,0.02,GM,108,,,,,,,,,,,,, Estradiol valerate 10 MG inj,J1380,HCPCS,,Both,0.01,GM,108.61,,,,,,,,,,,,, "MONITOR CVP, VENOUS PRESSURE",93770,CPT ,,Both,,,108.81,,,,,,,,,,,,, MELPHALAN 2MG TAB,J8600,HCPCS,,Both,0.002,GM,109.18,,,,,,,,,,,,, RA LATEX QUAL,86430,CPT ,,Both,,,109.77,,,,,,,,,,,,, AMBU BAG EASY CAP,A9999,HCPCS,,Both,,,110,,,,,,,,,,,,, VINORELBINE 10MG/ML 5ML INJ,J9390,HCPCS,,Both,0.01,GM,110.13,,,,,,,,,,,,, CRYOGLOBULIN,82595,CPT ,,Both,,,111.13,,,,,,,,,,,,, "IRON STAIN, BONE MARROW",85536,CPT ,,Both,,,111.13,,,,,,,,,,,,, PTT FRACTIONATED,85732,CPT ,,Both,,,111.13,,,,,,,,,,,,, TIROFIBAN HCL 12.5MG/50ML,J3246,HCPCS,,Both,0.00025,GM,111.93,,,,,,,,,,,,, Ketamine HCl 50 mg IV/IM Injection,J3490,HCPCS,,Both,,,112.25,,,,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 5in),Q4050,HCPCS,,Both,,,112.5,,,,,,,,,,,,, FILTERED NEBULIZER ADMIN SET,A7006,HCPCS,,Both,,,112.8,,,,,,,,,,,,, LITHIUM,80178,CPT ,,Both,,,113.63,,,,,,,,,,,,, FETAL SCREEN ROSETTE,85461,CPT ,,Both,,,114,,,,,,,,,,,,, INJECTION KETOROLAC TROMETHAMINE PER 15MG,J1885,HCPCS,,Both,0.015,GM,114,,,,,,,,,,,,, "PATCH, LIDOCAINE/TETRACAINE",C9285,HCPCS,,Both,,,114.53,,,,,,,,,,,,, HYDROCORTISONE 100MG INJ,J1720,HCPCS,,Both,0.1,GM,116.97,,,,,,,,,,,,, FDP,85362,CPT ,,Both,,,118.38,,,,,,,,,,,,, I&D TRAY,A4550,HCPCS,,Both,,,118.86,,,,,,,,,,,,, Pelvic Tray,A4550,HCPCS,,Both,,,118.86,,,,,,,,,,,,, ALLERGY INJECTION,95115,CPT ,,Both,,,119,,,,,,,,,,,,, ALBUMIN 5% 250ML,P9041,HCPCS,,Both,,,119.32,,,,,,,,,,,,, Paclitaxel protein bound,J9264,HCPCS,,Both,0.001,GM,119.41,,,,,,,,,,,,, METHYLPREDNISOLONE 40 MG INJ,J1030,HCPCS,,Both,0.04,GM,120,,,,,,,,,,,,, ROCKY MTN SPOTTED FEVER,86000,CPT ,,Both,,,120,,,,,,,,,,,,, CAPECITABINE 500MG TAB,J8520,HCPCS,,Both,0.15,GM,121.09,,,,,,,,,,,,, ACETYLCHOLINESTERASE,82013,CPT ,,Both,,,121.38,,,,,,,,,,,,, KETAMINE 100MG/10ML 10MG/ML 1 EA SYRINGE,J3490,HCPCS,,Both,,,121.8,,,,,,,,,,,,, MICROSCOPIC EXAM OF URINE,81015,CPT ,,Both,,,124.12,,,,,,,,,,,,, RUSS VIPER VENOM TIME DIL,85613,CPT ,,Both,,,124.22,,,,,,,,,,,,, SUBPOENAS ADMIN FEE EFF AS OF 4/4/24,S9981,HCPCS,,Both,,,125,,,,,,,,,,,,, CAST SUPPLIES (PLASTER),A4580,HCPCS,,Both,,,127,,,,,,,,,,,,, COLLAGEN DRESSING <=16 SQ IN,A6021,HCPCS,,Both,,,127,,,,,,,,,,,,, CONDUCTIVE GEL OR PASTE,A4558,HCPCS,,Both,,,127,,,,,,,,,,,,, CONFORM BAND N/S W<3/YD,A6442,HCPCS,,Both,,,127,,,,,,,,,,,,, IRRIGATION SYRINGE,A4322,HCPCS,,Both,,,127,,,,,,,,,,,,, LT COMPRES BAND >=3 <5/YD,A6449,HCPCS,,Both,,,127,,,,,,,,,,,,, REUSABLE ENEMA BAG,A4458,HCPCS,,Both,,,127,,,,,,,,,,,,, CAD W/DR W/WO DIGIT DX MAMO,77051,CPT ,,Both,,,127.38,,,,,,,,,,,,, CAD W/DR W/WO DIGIT SCR MAMO,77052,CPT ,,Both,,,127.38,,,,,,,,,,,,, Testosterone enanthate inj,J3130,HCPCS,,Both,0.2,GM,127.48,,,,,,,,,,,,, INDWELLING CATHETER LATEX,A4338,HCPCS,,Both,,,128,,,,,,,,,,,,, LEUPROLIDE 30MG (4MOS),J9218,HCPCS,,Both,0.001,GM,128.13,,,,,,,,,,,,, Streptomycin injection,J3000,HCPCS,,Both,1,GM,128.5,,,,,,,,,,,,, TRIMETHOBENZAMIDE 100MG/ML 2ML,J3250,HCPCS,,Both,0.2,GM,129.43,,,,,,,,,,,,, CATH INDW FOLEY 3 WAY,A4346,HCPCS,,Both,,,130,,,,,,,,,,,,, PHENOBARBITAL (CIV) 20MG/5ML 20MG ELIX,J8499,HCPCS,,Both,,,131.68,,,,,,,,,,,,, PHENOBARBITAL 130MG/ML INJ,J2560,HCPCS,,Both,0.12,GM,131.68,,,,,,,,,,,,, "CHOLINESTERASE,RBC",82482,CPT ,,Both,,,132,,,,,,,,,,,,, TEMPORARY EXTERNAL PACING,92953,CPT ,,Both,,,132.5,,,,,,,,,,,,, CYANOCOBALAMIN 1000MG/ML 30ML,J3420,HCPCS,,Both,0.001,GM,132.75,,,,,,,,,,,,, KLEIHAUER-BETKE,85460,CPT ,,Both,,,133,,,,,,,,,,,,, Pamidronate disodium /30 MG,J2430,HCPCS,,Both,0.03,GM,133.96,,,,,,,,,,,,, CARDIOLIPIN ANTIBODY,86147,CPT ,,Both,,,134.88,,,,,,,,,,,,, FOAM DRG >16<=48 SQ IN W/BDR,A6213,HCPCS,,Both,,,135,,,,,,,,,,,,, UREA BREATH TEST C-14ACQ ANALY,78267,CPT ,,Both,,,135.13,,,,,,,,,,,,, OXYTOCIN 10U/ML 1ML INJ,J2590,HCPCS,,Both,10,UN,135.14,,,,,,,,,,,,, "CHOLINESTERASE,SERUM",82480,CPT ,,Both,,,135.38,,,,,,,,,,,,, CREATININE URINE RANDOM,82570,CPT ,,Both,,,136.11,,,,,,,,,,,,, "INJ, RIMABOTULINUMTOXINB",J0587,HCPCS,,Both,100,UN,136.11,,,,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA); Zika virus,87662,CPT ,,Both,,,136.12,,,,,,,,,,,,, ACTIVATED CHARCOAL/SORBITOL 240 ML LIQD,J3490,HCPCS,,Both,,,136.71,,,,,,,,,,,,, ALLERG SCR FOOD,86005,CPT ,,Both,,,137,,,,,,,,,,,,, SECURESEAL TOPICAL SKIN ADHESIVE,A9999,HCPCS,,Both,,,137,,,,,,,,,,,,, 20+ CC SYRINGE ONLY,A4213,HCPCS,,Both,,,138,,,,,,,,,,,,, ADENOSINE INJ 1MG,J0153,HCPCS,,Both,0.001,GM,138,,,,,,,,,,,,, ALCOHOL OR PEROXIDE PER PINT,A4244,HCPCS,,Both,,,138,,,,,,,,,,,,, AMIODARONE HCL (Nexterone),J0283,HCPCS,,Both,0.03,GM,138,,,,,,,,,,,,, ANTIEMETIC RECTAL/SUPP NOS,J8498,HCPCS,,Both,,,138,,,,,,,,,,,,, "AUTOMATIC BP MONITOR, DIAL",A4670,HCPCS,,Both,,,138,,,,,,,,,,,,, BATH/SHOWER CHAIR,E0240,HCPCS,,Both,,,138,,,,,,,,,,,,, BATTERY CHARGER,A4613,HCPCS,,Both,,,138,,,,,,,,,,,,, BETADINE/PHISOHEX SOLUTION,A4246,HCPCS,,Both,,,138,,,,,,,,,,,,, BLOOD COLLECTION TUBE/VACUUM,A4770,HCPCS,,Both,,,138,,,,,,,,,,,,, "Blood ketone test strips, per strip",A4252,HCPCS,,Both,,,138,,,,,,,,,,,,, CANNULA NASAL,A4615,HCPCS,,Both,,,138,,,,,,,,,,,,, CATH W/DRAINAGE 2-WAY LATEX,A4314,HCPCS,,Both,,,138,,,,,,,,,,,,, CATHETER W/BAG 3-WAY,A4313,HCPCS,,Both,,,138,,,,,,,,,,,,, CATHETER W/O BAG 2-WAY LATEX,A4311,HCPCS,,Both,,,138,,,,,,,,,,,,, CHLORHEXIDINE ANTISEPT 15mL Individual Packet 4% Strength,A4248,HCPCS,,Both,,,138,,,,,,,,,,,,, CLONIDINE HYDROCHLORIDE,J0735,HCPCS,,Both,0.001,GM,138,,,,,,,,,,,,, CONFORM BAND S W>=3 <5/YD,A6446,HCPCS,,Both,,,138,,,,,,,,,,,,, CROMOLYN SODIUM NONCOMP UNIT,J7631,HCPCS,,Both,0.01,GM,138,,,,,,,,,,,,, D5W INFUSION,J7070,HCPCS,,Both,1000,ML,138,,,,,,,,,,,,, DEXAMETHASONE COMP CON,J7637,HCPCS,,Both,1,GM,138,,,,,,,,,,,,, DEXAMETHASONE COMP UNIT,J7638,HCPCS,,Both,1,GM,138,,,,,,,,,,,,, DRUG SCREENING HEROIN METABOLITE,80356,CPT ,,Both,,,138,,,,,,,,,,,,, "ELECTRODES, PAIR",A4556,HCPCS,,Both,,,138,,,,,,,,,,,,, EXT LINE W EASY LOCK CONNECT,A4673,HCPCS,,Both,,,138,,,,,,,,,,,,, FACE TENT,A4619,HCPCS,,Both,,,138,,,,,,,,,,,,, FACTOR VIII RECOMBINANT NOS,J7192,HCPCS,,Both,1,UN,138,,,,,,,,,,,,, FEM URINARY COLLECT DEV CUP,A4327,HCPCS,,Both,,,138,,,,,,,,,,,,, FIVE PLUS CC STERILE SYRINGE&NEEDLE,A4209,HCPCS,,Both,,,138,,,,,,,,,,,,, FLUOCINOL ACET INTRAVIT IMP,J7313,HCPCS,,Both,0.00001,GM,138,,,,,,,,,,,,, GAUZE > 48 IN NO W/SAL W/O B,A6224,HCPCS,,Both,,,138,,,,,,,,,,,,, "Gauze nonimpregnated, sterile, pad size 16sq in or less, wo adhesive border",A6402,HCPCS,,Both,,,138,,,,,,,,,,,,, "GENVISC 850, INJ, 1MG",J7320,HCPCS,,Both,0.001,GM,138,,,,,,,,,,,,, HYDROGEL DSG<=16 SQ IN,A6231,HCPCS,,Both,,,138,,,,,,,,,,,,, HYPERTONIC SALINE SOL,J7131,HCPCS,,Both,1,ML,138,,,,,,,,,,,,, IMPREG GAUZE NO H20/SAL/YARD,A6266,HCPCS,,Both,,,138,,,,,,,,,,,,, INHALATION SOLUTION FOR DME,J7699,HCPCS,,Both,,,138,,,,,,,,,,,,, INJ MAGNESIUM SULFATE,J3475,HCPCS,,Both,0.5,GM,138,,,,,,,,,,,,, "INJ, PROPOFOL, 10 MG",J2704,HCPCS,,Both,0.01,GM,138,,,,,,,,,,,,, "Injection, calcium gluconate (fresenius kabi), per 10 mg",J0612,HCPCS,,Both,0.01,GM,138,,,,,,,,,,,,, INSERT TRAY W/O BAG/CATH,A4310,HCPCS,,Both,,,138,,,,,,,,,,,,, INSULIN FOR INSULIN PUMP USE,J1817,HCPCS,,Both,50,UN,138,,,,,,,,,,,,, INTERMITTENT URINARY CATH,A4353,HCPCS,,Both,,,138,,,,,,,,,,,,, IRINOTECAN INJECTION,J9206,HCPCS,,Both,0.02,GM,138,,,,,,,,,,,,, LT COMPRES BAND <3/YD,A6448,HCPCS,,Both,,,138,,,,,,,,,,,,, MEPERIDINE HYDROCHL /100 MG,J2175,HCPCS,,Both,0.1,GM,138,,,,,,,,,,,,, NON-STERILE GAUZE<=16 SQ IN,A6216,HCPCS,,Both,,,138,,,,,,,,,,,,, NON-STERILE GAUZE>16<=48 SQ,A6217,HCPCS,,Both,,,138,,,,,,,,,,,,, NON-WATERPROOF TAPE,A4450,HCPCS,,Both,,,138,,,,,,,,,,,,, OROPHARYNGEAL SUCTION CATH,A4628,HCPCS,,Both,,,138,,,,,,,,,,,,, OXYMORPHONE HCL INJECTION,J2410,HCPCS,,Both,0.001,GM,138,,,,,,,,,,,,, PALIFERMIN INJECTION,J2425,HCPCS,,Both,0.00005,GM,138,,,,,,,,,,,,, "PEGADEMASE BOVINE, 25 IU",J2504,HCPCS,,Both,25,UN,138,,,,,,,,,,,,, RANITIDINE HYDROCHLORIDE INJ,J2780,HCPCS,,Both,0.025,GM,138,,,,,,,,,,,,, REPLACEMENT BREASTPUMP CAP,A4283,HCPCS,,Both,,,138,,,,,,,,,,,,, REPLACEMENT BREASTPUMP TUBE,A4281,HCPCS,,Both,,,138,,,,,,,,,,,,, SELF-ADHER BAND W <3/YD,A6453,HCPCS,,Both,,,138,,,,,,,,,,,,, SKIN BARRIER LIQUID PER OZ,A4369,HCPCS,,Both,,,138,,,,,,,,,,,,, "SKIN BARRIER, WIPE OR SWAB",A5120,HCPCS,,Both,,,138,,,,,,,,,,,,, SKIN SEAL PROTECT MOISTURIZR,A6250,HCPCS,,Both,,,138,,,,,,,,,,,,, SPACER WITH MASK,S8101,HCPCS,,Both,,,138,,,,,,,,,,,,, SPACER WITHOUT MASK,S8100,HCPCS,,Both,,,138,,,,,,,,,,,,, STERILE NEEDLE,A4215,HCPCS,,Both,,,138,,,,,,,,,,,,, STERILE SALINE OR WATER,A4218,HCPCS,,Both,,,138,,,,,,,,,,,,, "STERILE WATER/SALINE, 10 ML",A4216,HCPCS,,Both,,,138,,,,,,,,,,,,, SUPPLY INSULIN INF CATH/WK,A4224,HCPCS,,Both,,,138,,,,,,,,,,,,, SYRINGE W/WO NEEDLE,A4657,HCPCS,,Both,,,138,,,,,,,,,,,,, Syringe with needle sterile 3cc ,A4208,HCPCS,,Both,,,138,,,,,,,,,,,,, TOBRAMYCIN NON-COMP UNIT,J7682,HCPCS,,Both,0.3,GM,138,,,,,,,,,,,,, URINARY LEG BAG,A5112,HCPCS,,Both,,,138,,,,,,,,,,,,, URINARY LEG OR ABDOMEN BAG,A4358,HCPCS,,Both,,,138,,,,,,,,,,,,, VARIABLE CONCENTRATION MASK,A4620,HCPCS,,Both,,,138,,,,,,,,,,,,, WATERPROOF TAPE,A4452,HCPCS,,Both,,,138,,,,,,,,,,,,, Activated charcoal 15 gm,J3490,HCPCS,,Both,,,140,,,,,,,,,,,,, "EPOETIN ALFA 20,000U/1ML",J0885,HCPCS,,Both,1000,UN,140.28,,,,,,,,,,,,, ADENOVIRUS ANTIBODY,86603,CPT ,,Both,,,140.5,,,,,,,,,,,,, ANTIBODY CRYPTOCOCCUS,86641,CPT ,,Both,,,140.5,,,,,,,,,,,,, BARTONELLA HENSALAE/QUINTANA,86611,CPT ,,Both,,,140.5,,,,,,,,,,,,, COXSACKIE A VIRAL TITER,86658,CPT ,,Both,,,140.5,,,,,,,,,,,,, FACTOR VIII RISTOCETIN COFACT,85245,CPT ,,Both,,,140.5,,,,,,,,,,,,, FACTOR VIII VW FACTOR ANTIGEN,85246,CPT ,,Both,,,140.5,,,,,,,,,,,,, VONWILLEBRAND FACT MULTIM ANAL,85247,CPT ,,Both,,,140.5,,,,,,,,,,,,, AMPHOTERICIN B 50MG INJ,J0285,HCPCS,,Both,0.05,GM,142.18,,,,,,,,,,,,, AMPHOTERICIN 5MG/ML 20ML INJ,J0287,HCPCS,,Both,0.01,GM,142.69,,,,,,,,,,,,, "Afluria vacc, 3 yrs & >, im",Q2035,HCPCS,,Both,,,144.28,,,,,,,,,,,,, "Injection, erythromycin lactobionate, per 500 mg",J1364,HCPCS,,Both,0.5,GM,144.45,,,,,,,,,,,,, PORPHOB. URINE(QUANT),84110,CPT ,,Both,,,145,,,,,,,,,,,,, "IMMUNOASSAY ANALYSIS, QUAL/SEMI-QUANT, SINGLE-STEP",83518,CPT ,,Both,,,145.63,,,,,,,,,,,,, WOUND CLEANSER ANY TYPE/SIZE,A6260,HCPCS,,Both,,,147.49,,,,,,,,,,,,, LEUKOCYTE ALKALINE PHOS.,85540,CPT ,,Both,,,147.88,,,,,,,,,,,,, SENSITIVITY MIC,87186,CPT ,,Both,,,148.5,,,,,,,,,,,,, RETICULOCYTE COUNT,85044,CPT ,,Both,,,148.71,,,,,,,,,,,,, RENAL FUNCTION PANEL,80069,CPT ,,Both,,,149.25,,,,,,,,,,,,, BLADDER IRRIGATION TUBING,A4355,HCPCS,,Both,,,150,,,,,,,,,,,,, BLD GASES O2 SAT ONLY,82810,CPT ,,Both,,,150,,,,,,,,,,,,, CATH INDW FOLEY 2 WAY SILICN,A4344,HCPCS,,Both,,,150,,,,,,,,,,,,, CONFORM BAND N/S W>=3<5/YD,A6443,HCPCS,,Both,,,150,,,,,,,,,,,,, DISPOSABLE CANISTER FOR PUMP,A7000,HCPCS,,Both,,,150,,,,,,,,,,,,, DISPOSABLE NEBULIZER SML VOL,A7004,HCPCS,,Both,,,150,,,,,,,,,,,,, FEM URINARY COLLECT POUCH,A4328,HCPCS,,Both,,,150,,,,,,,,,,,,, HOT/COLD H2OBOT/CAP/COL/WRAP,A9273,HCPCS,,Both,,,150,,,,,,,,,,,,, INJ POTASSIUM CHLORIDE,J3480,HCPCS,,Both,2,ME,150,,,,,,,,,,,,, "INJECTION, CLINDAMYCIN PHOSP",S0077,HCPCS,,Both,,,150,,,,,,,,,,,,, IODINE I-125 SODIUM IODIDE,A9527,HCPCS,,Both,,,150,,,,,,,,,,,,, Miscellaneous Medicine Services,99072,CPT ,,Both,,,150,,,,,,,,,,,,, NEBULIZER ADMINISTRATION SET,A7003,HCPCS,,Both,,,150,,,,,,,,,,,,, NONDISPOSABLE NEBULIZER SET,A7005,HCPCS,,Both,,,150,,,,,,,,,,,,, NONDISPOSABLE PUMP CANISTER,A7001,HCPCS,,Both,,,150,,,,,,,,,,,,, REACHING/GRABBING DEVICE,A9281,HCPCS,,Both,,,150,,,,,,,,,,,,, "REPL WATER CHAMBER, PAP DEV",A7046,HCPCS,,Both,,,150,,,,,,,,,,,,, REPLACEMENT FACEMASK INTERFA,A7031,HCPCS,,Both,,,150,,,,,,,,,,,,, RESP SUCTION ORAL INTERFACE,A7047,HCPCS,,Both,,,150,,,,,,,,,,,,, REUSABLE ORAL THERMOMETER,A4931,HCPCS,,Both,,,150,,,,,,,,,,,,, TUBING USED W SUCTION PUMP,A7002,HCPCS,,Both,,,150,,,,,,,,,,,,, TUBULAR DRESSING,A6457,HCPCS,,Both,,,150,,,,,,,,,,,,, WATER CIRC HEAT PAD W PUMP,E0217,HCPCS,,Both,,,150,,,,,,,,,,,,, ALKALINE PHOS ISOENZYME,84080,CPT ,,Both,,,150.25,,,,,,,,,,,,, ANGIOTENSION II,82163,CPT ,,Both,,,150.25,,,,,,,,,,,,, "Fluzone vacc, 3 yrs & >, im",Q2038,HCPCS,,Both,,,150.55,,,,,,,,,,,,, FLUMAZENIL 0.1MG/ML 1 MG INJECTION,J3490,HCPCS,,Both,,,151.2,,,,,,,,,,,,, HEMATOCRIT,85014,CPT ,,Both,,,151.48,,,,,,,,,,,,, HEMOGLOBIN (HGB),85018,CPT ,,Both,,,151.48,,,,,,,,,,,,, Inj iron dextran,J1750,HCPCS,,Both,0.05,GM,151.63,,,,,,,,,,,,, ANTIBODY ID,86870,CPT ,,Both,,,152.99,,,,,,,,,,,,, SURGICEL,A9999,HCPCS,,Both,,,153,,,,,,,,,,,,, RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,70100,CPT ,,Both,,,153.75,,,,,,,,,,,,, COLISTIMETHATE 150MG INJ,J0770,HCPCS,,Both,0.15,GM,154.45,,,,,,,,,,,,, DIAZEPAM (CIV) 5MG/ML 10 MG INJECTION,J3490,HCPCS,,Both,,,154.98,,,,,,,,,,,,, ED-IMMUNIZATION NASAL\ORAL 2or more,90474,CPT ,,Both,,,157.75,,,,,,,,,,,,, UNLISTED MISC PATH LAB,88399,CPT ,,Both,,,158.88,,,,,,,,,,,,, OSMOLALITY BLOOD,83930,CPT ,,Both,,,159.23,,,,,,,,,,,,, Synvisc or Synvisc-One,J7325,HCPCS,,Both,1,GM,160.38,,,,,,,,,,,,, Natalizumab injection,J2323,HCPCS,,Both,0.001,GM,161.23,,,,,,,,,,,,, "Injection, tenecteplase, 1 mg",J3101,HCPCS,,Both,0.001,GM,161.7,,,,,,,,,,,,, DALTEPARIN 2500 UNITS,J1645,HCPCS,,Both,2500,UN,162.35,,,,,,,,,,,,, CREATININE CLEARANCE,82575,CPT ,,Both,,,162.38,,,,,,,,,,,,, "LDL CHOLESTEROL, LIPOPROTEIN ASSAY",83721,CPT ,,Both,,,163.88,,,,,,,,,,,,, LEGIONELLA ANTIGEN SCRN,87450,CPT ,,Both,,,164.75,,,,,,,,,,,,, "ADHESIVE, LIQUID OR EQUAL",A4364,HCPCS,,Both,,,165.6,,,,,,,,,,,,, INJ MEPIVACAINE HCL/10 ML,J0670,HCPCS,,Both,10,ML,165.6,,,,,,,,,,,,, PROSTATIC ACID PHOSPHATAS,84066,CPT ,,Both,,,166,,,,,,,,,,,,, SIROLIMUS 1MG TAB,J7520,HCPCS,,Both,0.001,GM,166,,,,,,,,,,,,, MODERATE SEDATION BY DIFF. PHYS ADD ON (15 MIN.),99150,CPT ,,Both,,,166.13,,,,,,,,,,,,, SALICYLATE,80196,CPT ,,Both,,,166.59,,,,,,,,,,,,, "A1C HEMOGLOBIN, GLYCOSYLATED, HOME DEVICE",83037,CPT ,,Both,,,166.75,,,,,,,,,,,,, ALDOLASE,82085,CPT ,,Both,,,166.75,,,,,,,,,,,,, CASPOFUNGIN ACET 50MG 10ML INJ,J0637,HCPCS,,Both,0.005,GM,166.81,,,,,,,,,,,,, Cerebryx fosphenytoin 750 MG INJ,S0078,HCPCS,,Both,,,167.03,,,,,,,,,,,,, SEDIMENTATION RATE RBC AUTOMATED,85652,CPT ,,Both,,,168,,,,,,,,,,,,, PLATELET ANTIBODY PANEL,86022,CPT ,,Both,,,168.13,,,,,,,,,,,,, OSMOLALITY URINE,83935,CPT ,,Both,,,169.53,,,,,,,,,,,,, PREALBUMIN,84134,CPT ,,Both,,,170.74,,,,,,,,,,,,, APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS,97010,CPT ,,Both,,,171,,,,,,,,,,,,, RABIES ANTIBODY,86790,CPT ,,Both,,,171.25,,,,,,,,,,,,, Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen),82820,CPT ,,Both,,,171.63,,,,,,,,,,,,, MISC/EXPER NON-PRESCRIPT DRU,A9150,HCPCS,,Both,,,172.28,,,,,,,,,,,,, PROMETHAZINE HCL INJECTION,J2550,HCPCS,,Both,0.05,GM,173,,,,,,,,,,,,, FLU VACCINE NO PRESERV 3 & >,90656,CPT ,,Both,,,173.62,,,,,,,,,,,,, ONDANSETRON ORAL 4 MG,S0119,HCPCS,,Both,,,173.66,,,,,,,,,,,,, URINAL FEMALE JUG-TYPE,E0326,HCPCS,,Both,,,174,,,,,,,,,,,,, URINAL MALE JUG-TYPE,E0325,HCPCS,,Both,,,174,,,,,,,,,,,,, DENOSUMAB INJECTION,J0897,HCPCS,,Both,0.001,GM,176.91,,,,,,,,,,,,, SPLINT WRIST OR ANKLE,S8451,HCPCS,,Both,,,177,,,,,,,,,,,,, "Injection, levofloxacin, 250mg ",J1956,HCPCS,,Both,0.25,GM,177.87,,,,,,,,,,,,, CULTURE MYCOPLASMA,87109,CPT ,,Both,,,179.13,,,,,,,,,,,,, SHOULD SLING/VEST/ABRESTRAIN,A4566,HCPCS,,Both,,,179.26,,,,,,,,,,,,, CERV COL SR FOAM 2PC PRE OTS,L0172,HCPCS,,Both,,,180,,,,,,,,,,,,, DIGOXIN INJECTION,J1160,HCPCS,,Both,0.0005,GM,180,,,,,,,,,,,,, "Injection, phenylephrine hydrochloride, 20 micrograms",J2371,HCPCS,,Both,0.00002,GM,180,,,,,,,,,,,,, PHENYLEPHRINE HCL INJECTION,J2370,HCPCS,,Both,1,ML,180,,,,,,,,,,,,, HEP B CORE ANTIBODY TOTAL,86704,CPT ,,Both,,,181.25,,,,,,,,,,,,, PAP SMEAR DIAGNOSTIC,88150,CPT ,,Both,,,181.63,,,,,,,,,,,,, PAP SMEAR DIAGNOSTIC-BETHESDA,88164,CPT ,,Both,,,181.63,,,,,,,,,,,,, CHLORPROMAZINE HCL 50 MG INJECTION,J3230,HCPCS,,Both,0.05,GM,181.72,,,,,,,,,,,,, PATHOLOGY LEVEL I,88300,CPT ,,Both,,,182.75,,,,,,,,,,,,, DIAZEPAM INJECTION,J3360,HCPCS,,Both,0.005,GM,184,,,,,,,,,,,,, FOOT DROP SPLINT PRE OTS,L4398,HCPCS,,Both,,,184,,,,,,,,,,,,, CERULOPLASMIN,82390,CPT ,,Both,,,184.5,,,,,,,,,,,,, ALCOHOL BLOOD,82055,CPT ,,Both,,,185.63,,,,,,,,,,,,, ANTISTREPTOLYSIN O TITER,86060,CPT ,,Both,,,186,,,,,,,,,,,,, PENICILLIN G PRO 1.2MU/2ML 2ML,J2510,HCPCS,,Both,600000,UN,186.59,,,,,,,,,,,,, "Fluvirin vacc, 3 yrs & >, im",Q2037,HCPCS,,Both,,,187.03,,,,,,,,,,,,, OXYGEN PROBE USED W OXIMETER,A4606,HCPCS,,Both,,,189.15,,,,,,,,,,,,, CROSSMATCH 1 UNIT,86920,CPT ,,Both,,,189.88,,,,,,,,,,,,, HEP B CORE ANTIBODY IGM,86705,CPT ,,Both,,,190.1,,,,,,,,,,,,, Chorionic gonadotropin/1000u,J0725,HCPCS,,Both,1000,UN,192.54,,,,,,,,,,,,, "Gases, blood, pH only",82800,CPT ,,Both,,,193.47,,,,,,,,,,,,, CHLAMYDIA ANTIBODY,86631,CPT ,,Both,,,193.58,,,,,,,,,,,,, RH PHENOTYPING,86906,CPT ,,Both,,,194.25,,,,,,,,,,,,, Amphotericin b liposome inj,J0289,HCPCS,,Both,0.01,GM,194.68,,,,,,,,,,,,, KETONE SERUM,82009,CPT ,,Both,,,195.5,,,,,,,,,,,,, PHENOBARBITAL (LUMINAL),80184,CPT ,,Both,,,196.75,,,,,,,,,,,,, "Injection, furosemide (furoscix), 20 mg",J1941,HCPCS,,Both,0.02,GM,198,,,,,,,,,,,,, H. INFLU GP.B ANTIGEN EIA,86403,CPT ,,Both,,,198.21,,,,,,,,,,,,, MYELOPEROXIDASE (MPO) ANTIBODS,83516,CPT ,,Both,,,198.25,,,,,,,,,,,,, PROTEIN S TOTAL,85305,CPT ,,Both,,,199.38,,,,,,,,,,,,, NITROGLYCERIN 2% 1 IN OINT,J3490,HCPCS,,Both,,,199.64,,,,,,,,,,,,, "Infectious disease,bacterial vaginosis,quantitative RT amp of RNA markers ",81513,CPT ,,Both,,,200,,,,,,,,,,,,, Quantitative Of SARS-CoV2antibodies,86413,CPT ,,Both,,,200,,,,,,,,,,,,, EACH ADD'L HOUR CONTINUOUS INHALATION TX W/ AEROSOL MEDICATION,94645,CPT ,,Both,,,200.51,,,,,,,,,,,,, Alteplase recombinant Per 1 Mg,J2997,HCPCS,,Both,0.001,GM,202.8,,,,,,,,,,,,, ANTITHROMBIN III;ACTIVITY,85300,CPT ,,Both,,,203.63,,,,,,,,,,,,, ALBUMIN SERUM PLASMA/WHOLE BLOOD,82040,CPT ,,Both,,,204,,,,,,,,,,,,, DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE,80352,CPT ,,Both,,,204,,,,,,,,,,,,, "Levofloxacin/Dextrose 5%,750mg/150mL Injection",J3490,HCPCS,,Both,,,204.75,,,,,,,,,,,,, CALCIUM GLUCONATE INJECTION,J0610,HCPCS,,Both,10,ML,205.25,,,,,,,,,,,,, ADENOVIRUS ASSAY W/OPTIC,87809,CPT ,,Both,,,206.13,,,,,,,,,,,,, AG GIARDIC ANTIGEN EIA,87328,CPT ,,Both,,,206.13,,,,,,,,,,,,, AG N MEN B/E.COLI,87335,CPT ,,Both,,,206.13,,,,,,,,,,,,, AG N MEN C/W,87449,CPT ,,Both,,,206.13,,,,,,,,,,,,, CHLAMYDIA TRACHOMATIS,87810,CPT ,,Both,,,206.13,,,,,,,,,,,,, CYTOMEGALOVIRUS IMM EARLY AG,87299,CPT ,,Both,,,206.13,,,,,,,,,,,,, TRICHOMONAS ASSAY W/OPTIC,87808,CPT ,,Both,,,206.13,,,,,,,,,,,,, CANDIDA DNA AMP PROBE,87481,CPT ,,Both,,,206.19,,,,,,,,,,,,, C1 ESTERASE INHIBITOR,86160,CPT ,,Both,,,206.25,,,,,,,,,,,,, COMPLEMENT C4,86161,CPT ,,Both,,,206.25,,,,,,,,,,,,, PROTEIN C ANTIGEN,85302,CPT ,,Both,,,206.5,,,,,,,,,,,,, CHLOROPROCAINE HCL 2% 30ML,J2400,HCPCS,,Both,30,ML,206.61,,,,,,,,,,,,, HEP A ANTIBODY IGM,86709,CPT ,,Both,,,208,,,,,,,,,,,,, LEAD ASSAY,83655,CPT ,,Both,,,208,,,,,,,,,,,,, DNA ANTIBODY SINGLE,86226,CPT ,,Both,,,208.13,,,,,,,,,,,,, Scopolamine 1 mg / 3 Day Patch ,J3490,HCPCS,,Both,,,208.35,,,,,,,,,,,,, Bordetella pertussis/parapertussis,87265,CPT ,,Both,,,209,,,,,,,,,,,,, SUPP NON-INSULIN INF CATH/WK,A4221,HCPCS,,Both,,,209.82,,,,,,,,,,,,, DEPAKOTE(Divalproex Sodium) 500 mg Tablet,J8499,HCPCS,,Both,,,209.92,,,,,,,,,,,,, "INJECTION, BUPIVICAINE HYDRO",S0020,HCPCS,,Both,,,210,,,,,,,,,,,,, SIALIDASE ENZYME ASSAY,87905,CPT ,,Both,,,210,,,,,,,,,,,,, Water seal drain container,A7041,HCPCS,,Both,,,210,,,,,,,,,,,,, HEPATITIS B SURF ANTIGEN,87340,CPT ,,Both,,,210.5,,,,,,,,,,,,, CARBOXYHEMOGLOBIN,82375,CPT ,,Both,,,211.75,,,,,,,,,,,,, INDUCTION OF VOMITING,99175,CPT ,,Both,,,212.75,,,,,,,,,,,,, HEPATITIS A ANTIBODY IGG,86708,CPT ,,Both,,,212.88,,,,,,,,,,,,, COPPER,82525,CPT ,,Both,,,213.25,,,,,,,,,,,,, CULTURE FUNGUS (BLOOD),87103,CPT ,,Both,,,214.83,,,,,,,,,,,,, FLU VAC NO PRSV 3 VAL 6-35 M,90655,CPT ,,Both,,,215.53,,,,,,,,,,,,, HAPTOGLOBIN QUANT,83010,CPT ,,Both,,,216.13,,,,,,,,,,,,, COMPATIBILITY EA UNIT ELECTRON,86923,CPT ,,Both,,,216.38,,,,,,,,,,,,, "Injection, nicardipine, 0.1 mg, HCl 25mg/10mL ",J2404,HCPCS,,Both,,,216.64,,,,,,,,,,,,, RHYTHM ECG TRACING,93041,CPT ,,Both,,,216.92,,,,,,,,,,,,, SLINGS,A4565,HCPCS,,Both,,,216.92,,,,,,,,,,,,, CORD BLOOD STUDIES,86880,CPT ,,Both,,,218.73,,,,,,,,,,,,, LDH ISOENZYMES,83625,CPT ,,Both,,,220,,,,,,,,,,,,, GLUCOSE TOL 2HR,82951,CPT ,,Both,,,221.13,,,,,,,,,,,,, OXALATE 24 HR URINE,83945,CPT ,,Both,,,221.13,,,,,,,,,,,,, STONE ANALYSIS QUAN,82360,CPT ,,Both,,,221.13,,,,,,,,,,,,, "Sputum, obtaining specimen, aerosol induced technique (separate procedure)",89220,CPT ,,Both,,,221.25,,,,,,,,,,,,, CROSSMATCH AHG/UNIT,86922,CPT ,,Both,,,221.65,,,,,,,,,,,,, "IMMUNOASSAY INFECTIOUS ANTIGEN, QUAL/SEMI-QUANT, SINGLE",86318,CPT ,,Both,,,222.5,,,,,,,,,,,,, LUPUS ANTICOAGULANT S,85210,CPT ,,Both,,,223.13,,,,,,,,,,,,, D-DIMER,85378,CPT ,,Both,,,223.5,,,,,,,,,,,,, AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT ,,Both,,,224.5,,,,,,,,,,,,, FRESH FROZ PLASMA THAWING/UNIT,86927,CPT ,,Both,,,224.5,,,,,,,,,,,,, IRRADIATED BLOOD PRODUCT,86945,CPT ,,Both,,,224.5,,,,,,,,,,,,, MULTIPLE SCL PROFILE,86999,CPT ,,Both,,,224.5,,,,,,,,,,,,, CELIAC DISEASE ANTIBOD,83520,CPT ,,Both,,,225.5,,,,,,,,,,,,, ARGATROBAN 100MG/ML 2.5ML INJ,C9121,HCPCS,,Both,,,225.88,,,,,,,,,,,,, MANUAL CELL COUNT EACH,85032,CPT ,,Both,,,226.55,,,,,,,,,,,,, ROTAVIRUS,86759,CPT ,,Both,,,226.63,,,,,,,,,,,,, MYCOPLASMA PNEU IGG,86738,CPT ,,Both,,,227.5,,,,,,,,,,,,, FIBRINOGEN ACTIVITY,85384,CPT ,,Both,,,227.52,,,,,,,,,,,,, IGG SYNTHSIS & INDEX,86325,CPT ,,Both,,,227.64,,,,,,,,,,,,, Albuterol inh non-comp per 1mg or Levalbuterol per 0.50mg(MCR replace code for J7611 & J7612),Q4093,HCPCS,,Both,,,228,,,,,,,,,,,,, Albuterol inh non-comp u d per 1mg or Levalbuterol per 0.50mg(MCR replaced code for J7613 & J7614),Q4094,HCPCS,,Both,,,228,,,,,,,,,,,,, ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,,Both,0.0025,GM,228,,,,,,,,,,,,, ALBUTEROL NON-COMP CON,J7611,HCPCS,,Both,0.001,GM,228,,,,,,,,,,,,, ALBUTEROL NON-COMP UNIT,J7613,HCPCS,,Both,0.001,GM,228,,,,,,,,,,,,, BUDESONIDE NON-COMP UNIT,J7626,HCPCS,,Both,0.0005,GM,228,,,,,,,,,,,,, CEFAZOLIN SODIUM INJECTION,J0690,HCPCS,,Both,0.5,GM,228,,,,,,,,,,,,, CEFEPIME HCL FOR INJECTION 500MG,J0692,HCPCS,,Both,0.5,GM,228,,,,,,,,,,,,, CEFTRIAXONE SODIUM INJECTION,J0696,HCPCS,,Both,0.25,GM,228,,,,,,,,,,,,, Ciprofloxacin 200mg-100mL Intravenous Injection ,J0744,HCPCS,,Both,0.2,GM,228,,,,,,,,,,,,, FENTANYL CITRATE INJECITON 0.1MG,J3010,HCPCS,,Both,0.0001,GM,228,,,,,,,,,,,,, HYDRALAZINE HCL INJECTION,J0360,HCPCS,,Both,0.02,GM,228,,,,,,,,,,,,, HYDROMORPHONE 0.1mg,J1171,HCPCS,,Both,,,228,,,,,,,,,,,,, IN MORPHINE PRESERVATIV FREE,J2274,HCPCS,,Both,0.01,GM,228,,,,,,,,,,,,, INJ HEPARIN SODIUM PER 1000U,J1644,HCPCS,,Both,1000,ML,228,,,,,,,,,,,,, INJ METARAMINOL BITARTRATE,J0380,HCPCS,,Both,0.01,GM,228,,,,,,,,,,,,, INJ MIDAZOLAM HYDROCHLORIDE,J2250,HCPCS,,Both,0.001,GM,228,,,,,,,,,,,,, "Injection, azithromycin, 500 mg",J0456,HCPCS,,Both,0.5,GM,228,,,,,,,,,,,,, IPRATROPIUM BROMIDE COMP,J7645,HCPCS,,Both,1,GM,228,,,,,,,,,,,,, IPRATROPIUM BROMIDE NON-COMP,J7644,HCPCS,,Both,1,GM,228,,,,,,,,,,,,, LEVALBUTEROL COMP UNIT,J7615,HCPCS,,Both,0.0005,GM,228,,,,,,,,,,,,, Levalbuterol neb non-compounded concentrated form 0.5 milligram,J7612,HCPCS,,Both,0.0005,GM,228,,,,,,,,,,,,, LEVALBUTEROL NON-COMP UNIT,J7614,HCPCS,,Both,0.0005,GM,228,,,,,,,,,,,,, LORAZEPAM INJECTION,J2060,HCPCS,,Both,0.002,GM,228,,,,,,,,,,,,, METOCLOPRAMIDE HCL INJECTION,J2765,HCPCS,,Both,0.01,GM,228,,,,,,,,,,,,, ORPHENADRINE INJECTION,J2360,HCPCS,,Both,0.06,GM,228,,,,,,,,,,,,, PIPERACILLIN/TAZOBACTAM,J2543,HCPCS,,Both,1,GM,228,,,,,,,,,,,,, Prochlorperazine Edisylate up to 10 mg injection,J0780,HCPCS,,Both,0.01,GM,228,,,,,,,,,,,,, TETRACYCLIN INJECTION,J0120,HCPCS,,Both,0.25,GM,228,,,,,,,,,,,,, THIAMINE HCL 100 MG,J3411,HCPCS,,Both,0.1,GM,228,,,,,,,,,,,,, ZIPRASIDONE MESYLATE,J3486,HCPCS,,Both,0.01,GM,228,,,,,,,,,,,,, CRP ULTRASENSITIVE,86141,CPT ,,Both,,,229.72,,,,,,,,,,,,, IMMUNOELECTROPHORESIS,86320,CPT ,,Both,,,230.88,,,,,,,,,,,,, GLUTAMIC ACID DECARBOXYLASE,83519,CPT ,,Both,,,232.13,,,,,,,,,,,,, NORTRIPTYLINE,80182,CPT ,,Both,,,232.88,,,,,,,,,,,,, PARAINFLUENZA TYPE 1,86710,CPT ,,Both,,,232.88,,,,,,,,,,,,, WINRHO 5000U 2.5ML,J2792,HCPCS,,Both,100,UN,233.43,,,,,,,,,,,,, CSF ALBUMIN,83883,CPT ,,Both,,,233.63,,,,,,,,,,,,, CYSTATIN C,82610,CPT ,,Both,,,233.63,,,,,,,,,,,,, "DEMO AND/OR EVAL OF PT UTILIZATION OF AEROSOL, NEB, MDI, OR IPPB DEVICE",94664,CPT ,,Both,,,234,,,,,,,,,,,,, PROPOFOL 1OMG/ML 100 ML EMUL,J3490,HCPCS,,Both,,,234.64,,,,,,,,,,,,, PROCAINAMIDE HCL 100MG/ML 10ML,J2690,HCPCS,,Both,1,GM,235.76,,,,,,,,,,,,, DNA ANTIBODIES NATIVE,86225,CPT ,,Both,,,236,,,,,,,,,,,,, PROTEIN S ACTIVITY,85306,CPT ,,Both,,,237.13,,,,,,,,,,,,, FLUPHENAZINE DEC 25MG/ML 1ML,J2680,HCPCS,,Both,0.025,GM,237.44,,,,,,,,,,,,, PROTEIN C ACTIVITY,85303,CPT ,,Both,,,237.63,,,,,,,,,,,,, SURGICAL SPECIMEN X-RAY,76098,CPT ,,Both,,,238.5,,,,,,,,,,,,, ANTIBODY MYOCARDIAL TITER,86256,CPT ,,Both,,,239.38,,,,,,,,,,,,, "AZITHROMYCIN DIHYDRATE, ORAL",Q0144,HCPCS,,Both,,,239.46,,,,,,,,,,,,, VASOACT INTES PEPTIDE-VIP,84586,CPT ,,Both,,,239.75,,,,,,,,,,,,, ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY,93010,CPT ,,Both,,,240,,,,,,,,,,,,, SODIUM SERUM PLASMA OR WHOLE BLOOD,84295,CPT ,,Both,,,240,,,,,,,,,,,,, Palonosetron hcl,J2469,HCPCS,,Both,0.000025,GM,242.3,,,,,,,,,,,,, Inject for sacroiliac joint,G0259,HCPCS,,Both,,,243,,,,,,,,,,,,, PHENYTOIN (DILANTIN),80185,CPT ,,Both,,,243.1,,,,,,,,,,,,, HEPATITIS C ANTIBODY,86803,CPT ,,Both,,,245.25,,,,,,,,,,,,, "Albumin (human), 25%, 20 ml",P9046,HCPCS,,Both,,,246,,,,,,,,,,,,, UNLIS MISC,89240,CPT ,,Both,,,246,,,,,,,,,,,,, DRUG SCREEN BLOOD,80101,CPT ,,Both,,,246.45,,,,,,,,,,,,, IMMUNOFIXATION ELECTROPHO,86334,CPT ,,Both,,,247.25,,,,,,,,,,,,, TOXOPLASMA IGG,86777,CPT ,,Both,,,247.38,,,,,,,,,,,,, "Col chromotography qual/quan - Bile Acids, Fractionated and Total, Serum",82542,CPT ,,Both,,,247.7,,,,,,,,,,,,, ALPHA-1-ANTITRYPSIN;PHE,82104,CPT ,,Both,,,248.5,,,,,,,,,,,,, Presumptive Drug Screening,80306,CPT ,,Both,,,248.56,,,,,,,,,,,,, HEX PHOSPHOLIPID NEUTRALIZTION,85597,CPT ,,Both,,,249.38,,,,,,,,,,,,, ANGIOTENSIN CONV ENZYME,82164,CPT ,,Both,,,250.88,,,,,,,,,,,,, QUINIDINE LEVEL,80194,CPT ,,Both,,,250.88,,,,,,,,,,,,, BL DRAW <3 YRS OTHER VEIN,36406,CPT ,,Both,,,251,,,,,,,,,,,,, HGB ELECT,83020,CPT ,,Both,,,251.5,,,,,,,,,,,,, PLATELET FUNCTION ASSAY #2,85576,CPT ,,Both,,,251.5,,,,,,,,,,,,, PNEUMOCYSTIS PREP,87207,CPT ,,Both,,,251.5,,,,,,,,,,,,, PROTEIN PHORESIS SERUM,84165,CPT ,,Both,,,251.5,,,,,,,,,,,,, PROTEIN PHORESIS URINE,84166,CPT ,,Both,,,251.5,,,,,,,,,,,,, MOD/CON SED EA ADDL 15 MIN,99145,CPT ,,Both,,,251.61,,,,,,,,,,,,, LIDOCAINE,80176,CPT ,,Both,,,252.38,,,,,,,,,,,,, FOLATE SERUM,82746,CPT ,,Both,,,252.63,,,,,,,,,,,,, PORPHYRIN URINE QUANT,84120,CPT ,,Both,,,252.75,,,,,,,,,,,,, Interferon alfacon-1 inj,J9212,HCPCS,,Both,0.000001,GM,254.36,,,,,,,,,,,,, DECALCIFICATION PROCEDURE,88311,CPT ,,Both,,,255.75,,,,,,,,,,,,, FLU VACCINE 3 YRS & > IM,90658,CPT ,,Both,,,256.53,,,,,,,,,,,,, SUCCINYLCHOLINE 20MG/ML 200 MG SOLN,J0330,HCPCS,,Both,0.02,GM,256.82,,,,,,,,,,,,, INFLUENZA A&B ANTIGEN,87400,CPT ,,Both,,,258.55,,,,,,,,,,,,, Interferon alfa-2b inj,J9214,HCPCS,,Both,1000000,UN,258.69,,,,,,,,,,,,, P-ANCA (MYELOPEROXIDASE AB),86021,CPT ,,Both,,,258.75,,,,,,,,,,,,, AMIKACIN LEVEL,80150,CPT ,,Both,,,259,,,,,,,,,,,,, ANTIBODY INTRINSIC FACTOR,86340,CPT ,,Both,,,259,,,,,,,,,,,,, GLYCATED PROTEIN,82985,CPT ,,Both,,,260,,,,,,,,,,,,, BENZTROPINE 1MG/ML 2ML,J0515,HCPCS,,Both,0.001,GM,262.79,,,,,,,,,,,,, LEGIONELLA ANTIBODY,86713,CPT ,,Both,,,263,,,,,,,,,,,,, BLEOMYCIN 15U INJ,J9040,HCPCS,,Both,15,UN,263.05,,,,,,,,,,,,, "Injection, bendamustine hydrochloride 1mg",J9033,HCPCS,,Both,0.001,GM,263.25,,,,,,,,,,,,, CATHETERIZE FOR URINE SPEC,P9612,HCPCS,,Both,,,263.42,,,,,,,,,,,,, NORMAL SALINE SOLUTION INFUS,J7040,HCPCS,,Both,500,ML,265,,,,,,,,,,,,, DOXEPIN (SINEQUAN),80166,CPT ,,Both,,,266.25,,,,,,,,,,,,, HEPATITIS C RIBA,86804,CPT ,,Both,,,266.25,,,,,,,,,,,,, URINE VANILYMANDELIC ACID,84585,CPT ,,Both,,,266.25,,,,,,,,,,,,, WBC COUNT ONLY,85048,CPT ,,Both,,,267.75,,,,,,,,,,,,, DEBRIDE INFECTED SKIN EACH ADDL 10% BSA,11001,CPT ,,Both,,,268.38,,,,,,,,,,,,, "TUBING, Y BLOOD",70355,CPT ,,Both,,,268.38,,,,,,,,,,,,, WBC DIFF ONLY,85007,CPT ,,Both,,,268.81,,,,,,,,,,,,, DICYCLOMINE INJECTION,J0500,HCPCS,,Both,0.02,GM,271,,,,,,,,,,,,, "Lacosamide, VIMPAT Serum or Plasma",80235,CPT ,,Both,,,271,,,,,,,,,,,,, ASSAY TEST FOR BLOOD FECAL,82274,CPT ,,Both,,,273.25,,,,,,,,,,,,, "ANESTH, ABDOMINAL WALL SURG",700,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, ABDOMINAL WALL SURG",800,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, ANORECTAL SURGERY",902,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, BLADDER SURGERY",910,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, BLEPHAROPLASTY",103,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, CAT OR MRI SCAN",1922,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, CHEST PROCEDURE",520,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, CHEST SURGERY",540,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, CORRECT HEART RHYTHM",410,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, CS DELIVERY",1961,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, EAR EXAM",124,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, EAR SURGERY",120,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, EYE EXAM",148,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, FACE/SKULL BONE SURG",190,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, GENITALIA SURGERY",920,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, HEAD/NECK/PTRUNK",300,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, HIP JOINT PROCEDURE",1200,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, KNEE AREA PROCEDURE",1340,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, KNEE AREA PROCEDURE",1390,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, KNEE AREA SURGERY",1320,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, KNEE JOINT PROCEDURE",1380,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LOWER ARM CASTING",1860,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LOWER ARM PROCEDURE",1820,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LOWER ARM SURGERY",1810,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LOWER ARM SURGERY",1830,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LOWER LEG CASTING",1490,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LOWER LEG PROCEDURE",1462,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, LUMBAR PUNCTURE",635,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, NECK ORGAN, 1 & OVER",320,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, NOSE/SINUS SURGERY",160,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, PROCEDURE ON FEMUR",1220,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, PROCEDURE ON MOUTH",170,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, PROCEDURES ON EYE",140,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, REPAIR OF HERNIA",830,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, SHOULDER CASTING",1680,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, SHOULDER PROCEDURE",1620,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, SKIN, EXT/PER/ATRUNK",400,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, SPINE, CORD SURGERY",630,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, SURG ON VAG/URETHRAL",942,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, UPPER GI VISUALIZE",740,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, UPPR ARM PROCEDURE",1730,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, VAGINAL DELIVERY",1960,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, VAGINAL PROCEDURES",940,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH, VASCULAR ACCESS",532,CPT ,,Both,,,274,,,,,,,,,,,,, "ANESTH/ANALG, VAG DELIVERY",1967,CPT ,,Both,,,274,,,,,,,,,,,,, "NUCLEAR MATRIX PROTEIN 22 (NMP22), QUAL",86386,CPT ,,Both,,,274.38,,,,,,,,,,,,, Medical conference by physic,S0220,HCPCS,,Both,,,275,,,,,,,,,,,,, "Medical conference, 60 min",S0221,HCPCS,,Both,,,275,,,,,,,,,,,,, T-3 REVERSE,84482,CPT ,,Both,,,275.41,,,,,,,,,,,,, 12-LEAD ECG PERFORMED,3120F,CPT ,,Both,,,276,,,,,,,,,,,,, BED PAN STANDARD,E0275,HCPCS,,Both,,,276,,,,,,,,,,,,, "Drug confirmation, each procedure",80102,CPT ,,Both,,,276,,,,,,,,,,,,, DRUG SCREENING PROPOXYPHENE,80367,CPT ,,Both,,,276,,,,,,,,,,,,, GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,82947,CPT ,,Both,,,276,,,,,,,,,,,,, "HOCM 350-399MG/ML IODINE,1ML",Q9963,HCPCS,,Both,,,276,,,,,,,,,,,,, THYROGLOBULIN,84432,CPT ,,Both,,,276,,,,,,,,,,,,, TOBRAMYCIN PEAK,80200,CPT ,,Both,,,277,,,,,,,,,,,,, Zonisamide,80203,CPT ,,Both,,,277,,,,,,,,,,,,, BETA 2 MICROGLOBULIN,82232,CPT ,,Both,,,278,,,,,,,,,,,,, Telehealth facility fee,Q3014,HCPCS,,Both,,,280.24,,,,,,,,,,,,, VITAMIN B 12,82607,CPT ,,Both,,,280.5,,,,,,,,,,,,, METHADONE,83840,CPT ,,Both,,,280.63,,,,,,,,,,,,, CYTOPATHOLOGY FORENSIC,88125,CPT ,,Both,,,281.38,,,,,,,,,,,,, ANTIBODY SCREEN RBC,86850,CPT ,,Both,,,281.98,,,,,,,,,,,,, METHYLMALONIC ACID URINE QUANT,83921,CPT ,,Both,,,282.75,,,,,,,,,,,,, IMMUNOGLOBULIN E,82785,CPT ,,Both,,,283,,,,,,,,,,,,, GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE,82962,CPT ,,Both,,,283.05,,,,,,,,,,,,, "MICROFLUID ANALYSIS, TEARS",83861,CPT ,,Both,,,283.88,,,,,,,,,,,,, PRIMIDONE (MYSOLINE),80188,CPT ,,Both,,,285.13,,,,,,,,,,,,, GROWTH HORMONE (HGH),83003,CPT ,,Both,,,286.63,,,,,,,,,,,,, CORTISOL 24HR URINE,82530,CPT ,,Both,,,287.13,,,,,,,,,,,,, N-ACETYL PROCAINAMIDE,80192,CPT ,,Both,,,287.88,,,,,,,,,,,,, ABATACEPT INJECTION,J0129,HCPCS,,Both,0.01,GM,288.25,,,,,,,,,,,,, ALPHA-FETOPROTEIN SERUM,82105,CPT ,,Both,,,288.25,,,,,,,,,,,,, PENICILLIN G BENZATHINE 600000 U/ML 1 ML DISP SYRIN,J0530,HCPCS,,Both,600000,UN,290.99,,,,,,,,,,,,, ASSAY OF PHOSPHORUS INORGANIC,84100,CPT ,,Both,,,292,,,,,,,,,,,,, LYME DISEASE (BORRELIA BUGDORFERI) ANTIBODY,86618,CPT ,,Both,,,292.63,,,,,,,,,,,,, MODERATE SEDATION OTHER PHYS/QHP ADDITIONAL 15 MINUTES 5YRS AND OLDER,99157,CPT ,,Both,,,293.74,,,,,,,,,,,,, CATECHOLAMINES TOTAL URIN,82382,CPT ,,Both,,,295.5,,,,,,,,,,,,, MYELIN BASIC PROTEIN CSF,83873,CPT ,,Both,,,295.63,,,,,,,,,,,,, IMPRAMINE,80174,CPT ,,Both,,,295.75,,,,,,,,,,,,, NORMAL SALINE SOLUTION INFUS INFUS 1000CC,J7030,HCPCS,,Both,1000,ML,296,,,,,,,,,,,,, DRAW BLOOD OFF VENOUS DEVICE,36591,CPT ,,Both,,,298,,,,,,,,,,,,, BONE AGE STUDIES,77072,CPT ,,Both,,,298.25,,,,,,,,,,,,, SEROTONIN,84260,CPT ,,Both,,,298.88,,,,,,,,,,,,, HEPATITIS B SURF ANTIBODY,86706,CPT ,,Both,,,298.93,,,,,,,,,,,,, Inj cladribine per 1 MG,J9065,HCPCS,,Both,0.001,GM,299.93,,,,,,,,,,,,, 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.,U0001,HCPCS,,Both,,,300,,,,,,,,,,,,, 5% DEXTROSE IN LAC RINGERS,J7121,HCPCS,,Both,1000,ML,300,,,,,,,,,,,,, 5% DEXTROSE/WATER,J7060,HCPCS,,Both,500,ML,300,,,,,,,,,,,,, Antibody,86617,CPT ,,Both,,,300,,,,,,,,,,,,, ANTIBODY EPSTEIN BARR (EBNA),86664,CPT ,,Both,,,300,,,,,,,,,,,,, ANTIBODY VARICELLA-ZOSTER,86787,CPT ,,Both,,,300,,,,,,,,,,,,, ENTERAL NG TUBING W/O STYLET,B4082,HCPCS,,Both,,,300,,,,,,,,,,,,, IRON BINDING CAPACITY,83550,CPT ,,Both,,,300,,,,,,,,,,,,, NORMAL SALINE SOLUTION INFUS,J7050,HCPCS,,Both,250,ML,300,,,,,,,,,,,,, POTASSIUM SERUM PLASMA/WHOLE BLOOD,84132,CPT ,,Both,,,300,,,,,,,,,,,,, RINGERS LACTATE INFUSION,J7120,HCPCS,,Both,1000,ML,300,,,,,,,,,,,,, SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP,99070,CPT ,,Both,,,300,,,,,,,,,,,,, TRANSFERASE ALANINE AMINO ALT SGPT,84460,CPT ,,Both,,,300,,,,,,,,,,,,, URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP,81002,CPT ,,Both,,,300,,,,,,,,,,,,, TETANUS TOXOID ADSORBED 5 UNIT/ML 5 ML SOLN,J3490,HCPCS,,Both,,,301.98,,,,,,,,,,,,, Infuvite Adult Multivitamin Infusion Vitamin K 200mg-150mcg/10mL Injection 50 mL,J3490,HCPCS,,Both,,,302.27,,,,,,,,,,,,, Infuvite Pediatric Pediatric Multivitamin Infusion Vitamin K 400MG-200MCG/5mL Injection ,J3490,HCPCS,,Both,,,302.27,,,,,,,,,,,,, INTRO LONG FI TUBE (SPR PROC),44500,CPT ,,Both,,,302.63,,,,,,,,,,,,, HEP B VACC ADOL 2 DOSE IM,90743,CPT ,,Both,,,302.69,,,,,,,,,,,,, HEPATIT B VIR VACC 10MCG/.5ML,90744,CPT ,,Both,,,302.69,,,,,,,,,,,,, GASTRIN,82941,CPT ,,Both,,,303,,,,,,,,,,,,, HIV-1,87390,CPT ,,Both,,,303.13,,,,,,,,,,,,, ASSAY OF PHOSPHATASE ALKALINE,84075,CPT ,,Both,,,306,,,,,,,,,,,,, PROINSULIN,84206,CPT ,,Both,,,306.13,,,,,,,,,,,,, MITOMYCIN 5MG INJ,J9280,HCPCS,,Both,0.005,GM,306.69,,,,,,,,,,,,, RHEUMATOID FACTOR QUANTITATIVE,86431,CPT ,,Both,,,307,,,,,,,,,,,,, "FINGER SPLINT, STATIC",Q4049,HCPCS,,Both,,,307.15,,,,,,,,,,,,, FLU VACCINE 4 VALENT NASAL,90672,CPT ,,Both,,,307.44,,,,,,,,,,,,, FACTOR VII PROCONVERTIN,85230,CPT ,,Both,,,307.63,,,,,,,,,,,,, Group psychotherapy (other than of a multiple-family group),90853,CPT ,,Both,,,307.63,,,,,,,,,,,,, CYCLOSPORINE LEVEL,80158,CPT ,,Both,,,310.13,,,,,,,,,,,,, ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2,80335,CPT ,,Both,,,310.19,,,,,,,,,,,,, GABAPENTIN (NEURONTIN),82491,CPT ,,Both,,,310.25,,,,,,,,,,,,, HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT ,,Both,,,310.25,,,,,,,,,,,,, ANTIBODY AUTOABSORPTION,86978,CPT ,,Both,,,312.38,,,,,,,,,,,,, IRRIG DRUG DELIVERY DEVICE,96523,CPT ,,Both,,,315.13,,,,,,,,,,,,, RH IG MINIDOSE IM,90385,CPT ,,Both,,,316.01,,,,,,,,,,,,, PSA FREE,84154,CPT ,,Both,,,316.13,,,,,,,,,,,,, STATIC OR DYNAMI AFO PRE CST,L4396,HCPCS,,Both,,,318,,,,,,,,,,,,, LUTEINIZING HORMONE,83002,CPT ,,Both,,,318.52,,,,,,,,,,,,, WEST NILE VIRUS AB IGM,86788,CPT ,,Both,,,318.75,,,,,,,,,,,,, Omalizumab injection,J2357,HCPCS,,Both,0.005,GM,319,,,,,,,,,,,,, "DEBRIDEMENT OPEN WOUND, EACH ADD'L 20 SQ CM",97598,CPT ,,Both,,,319.25,,,,,,,,,,,,, FSH,83001,CPT ,,Both,,,319.25,,,,,,,,,,,,, FLU VACCINE NASAL,90660,CPT ,,Both,,,319.3,,,,,,,,,,,,, COLLAGEN CROSSLINKS,82523,CPT ,,Both,,,322,,,,,,,,,,,,, ANTIBODY EPSTEIN BARR VCA,86665,CPT ,,Both,,,322.12,,,,,,,,,,,,, COMPLEMENT TOTAL (CH 50),86162,CPT ,,Both,,,322.88,,,,,,,,,,,,, HEAVY METAL SCREEN,83015,CPT ,,Both,,,323.63,,,,,,,,,,,,, IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,90471,CPT ,,Both,,,324,,,,,,,,,,,,, IMMUNE ADMIN ORAL/NASAL,90473,CPT ,,Both,,,324,,,,,,,,,,,,, CEA,82378,CPT ,,Both,,,326,,,,,,,,,,,,, Knee orthosis(KO) elastic w joints prefabricated off-the-shelf,L1812,HCPCS,,Both,,,327,,,,,,,,,,,,, CARBAMAZEPINE (TEGRETOL),80156,CPT ,,Both,,,327.38,,,,,,,,,,,,, MORGAN LENS X2,V2797,HCPCS,,Both,,,327.6,,,,,,,,,,,,, "CHEST WALL MANIPULATION, INITIAL DEMO AND/OR EVAL",94667,CPT ,,Both,,,327.75,,,,,,,,,,,,, MAX VOLUNTARY VENT (MVV),94200,CPT ,,Both,,,327.75,,,,,,,,,,,,, Tdap Injection,J3490,HCPCS,,Both,,,328.2,,,,,,,,,,,,, HEMOGLOBIN GLYCOSYLATED A1C,83036,CPT ,,Both,,,330,,,,,,,,,,,,, PNEUMA/VAC WALK BOOT PRE OTS,L4361,HCPCS,,Both,,,330,,,,,,,,,,,,, PNEUMAT WALKING BOOT PRE CST,L4360,HCPCS,,Both,,,330,,,,,,,,,,,,, FENTANYL AND METABOLITE,83925,CPT ,,Both,,,334.25,,,,,,,,,,,,, VITAL CAPACITY,94150,CPT ,,Both,,,334.96,,,,,,,,,,,,, CHLORIDE BLD,82435,CPT ,,Both,,,335.46,,,,,,,,,,,,, BL DRAW <3 YRS SCALP VEIN,36405,CPT ,,Both,,,335.88,,,,,,,,,,,,, X-RAYS AT SURGERY ADD-ON,74301,CPT ,,Both,,,336,,,,,,,,,,,,, AMPICILLIN SODIUM PER 1.5 GM,J0295,HCPCS,,Both,1.5,GM,336.5,,,,,,,,,,,,, "IMMUNOASSAY TUMOR ANTIGEN, QUAL",86294,CPT ,,Both,,,337.13,,,,,,,,,,,,, NEONATAL PROCEDURE TRAY,A9900,HCPCS,,Both,,,337.25,,,,,,,,,,,,, STAPLE REMOVER KIT,A9900,HCPCS,,Both,,,337.25,,,,,,,,,,,,, Drug Screen Class A direct optical observation,80300,CPT ,,Both,,,341.83,,,,,,,,,,,,, Drug Screen Only - Non-DOT,80100,CPT ,,Both,,,341.83,,,,,,,,,,,,, ASSAY OF INSULIN TOTAL,83525,CPT ,,Both,,,342,,,,,,,,,,,,, DRUG SCREENING PREGABALIN,80366,CPT ,,Both,,,342,,,,,,,,,,,,, SECRETIN 16MCG INJ,J2850,HCPCS,,Both,0.000001,GM,343.68,,,,,,,,,,,,, CONCENTRATION INFECTIOUS AGENTS,87015,CPT ,,Both,,,344,,,,,,,,,,,,, CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE,87088,CPT ,,Both,,,344,,,,,,,,,,,,, CHLAMYDIA/GC DNA PROB,87797,CPT ,,Both,,,344.63,,,,,,,,,,,,, GONORRHEA BY DNA PROBE,87590,CPT ,,Both,,,344.63,,,,,,,,,,,,, COLLECT BLOOD FROM PICC,36592,CPT ,,Both,,,344.88,,,,,,,,,,,,, RESPIRATORY SYNCYTIAL VIRU,86756,CPT ,,Both,,,345,,,,,,,,,,,,, OLIGOCLONAL BANDS,83916,CPT ,,Both,,,345.5,,,,,,,,,,,,, SODIUM RANDOM URINE,84300,CPT ,,Both,,,345.75,,,,,,,,,,,,, PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,94640,CPT ,,Both,,,347,,,,,,,,,,,,, PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD,84155,CPT ,,Both,,,347,,,,,,,,,,,,, GARDNER VAG DNA QUANT,87512,CPT ,,Both,,,347.12,,,,,,,,,,,,, CYTOMEGALO IGG,86644,CPT ,,Both,,,347.38,,,,,,,,,,,,, ACETAMINOPHEN,82003,CPT ,,Both,,,347.75,,,,,,,,,,,,, PAP SMEAR THIN PREP DIAGNOSTIC,88142,CPT ,,Both,,,348.13,,,,,,,,,,,,, STREP GROUP A ANTIGEN,87430,CPT ,,Both,,,348.26,,,,,,,,,,,,, CHROMIUM,82495,CPT ,,Both,,,348.5,,,,,,,,,,,,, GASTROCULT (POC),82271,CPT ,,Both,,,348.74,,,,,,,,,,,,, CULTURE TB/AFB ISO ONLY,87116,CPT ,,Both,,,349.74,,,,,,,,,,,,, "Inj labetalol hcl hikma, 5mg",J1921,HCPCS,,Both,0.005,GM,350,,,,,,,,,,,,, "Injection, labetalol hydrochloride, 5 mg",J1920,HCPCS,,Both,0.005,GM,350,,,,,,,,,,,,, URINE SCREEN FOR BACTERIA,81007,CPT ,,Both,,,350,,,,,,,,,,,,, FACTOR VIII CLOT;ANTIGEN,85244,CPT ,,Both,,,350.75,,,,,,,,,,,,, EPTIFIBATIDE 0.75MG/ML 100ML,J1327,HCPCS,,Both,0.005,GM,350.95,,,,,,,,,,,,, "UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE, SC TICCUE",17999,CPT ,,Both,,,355,,,,,,,,,,,,, TRANSFERASE ASPARTATE AMINO AST SGOT,84450,CPT ,,Both,,,356,,,,,,,,,,,,, DOC (DEOXYCORT 11-),82634,CPT ,,Both,,,356.25,,,,,,,,,,,,, HIP 1V LT,73500,CPT ,,Both,,,357.13,,,,,,,,,,,,, SARGRAMOSTIM 500MCG INJ,J2820,HCPCS,,Both,0.00005,GM,357.4,,,,,,,,,,,,, C PEPTIDE,84681,CPT ,,Both,,,357.63,,,,,,,,,,,,, CA 27-29,86300,CPT ,,Both,,,357.63,,,,,,,,,,,,, CA-125,86304,CPT ,,Both,,,357.63,,,,,,,,,,,,, CA-19-9,86301,CPT ,,Both,,,357.63,,,,,,,,,,,,, CHROMOGRANIN A,86316,CPT ,,Both,,,357.63,,,,,,,,,,,,, ASSAY OF FOLIC ACID RBC,82747,CPT ,,Both,,,358,,,,,,,,,,,,, PROGESTERONE,84144,CPT ,,Both,,,358.5,,,,,,,,,,,,, LANREOTIDE INJECTION,J1930,HCPCS,,Both,0.001,GM,359,,,,,,,,,,,,, THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,85730,CPT ,,Both,,,359,,,,,,,,,,,,, THER/PROPH/DIAG INJ IA,96373,CPT ,,Both,,,359.54,,,,,,,,,,,,, "2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19)",U0002,HCPCS,,Both,,,360,,,,,,,,,,,,, ANTIBODY COCCIDIOIDES,86635,CPT ,,Both,,,360,,,,,,,,,,,,, ASSAY OF L7383TRANSFERRIN,84466,CPT ,,Both,,,360,,,,,,,,,,,,, CARBON DIOXIDE BICARBONATE,82374,CPT ,,Both,,,360,,,,,,,,,,,,, IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ,87581,CPT ,,Both,,,360,,,,,,,,,,,,, "Immunoassay for infectious agent antibody(ies), qualitative or semi-quantitative",86328,CPT ,,Both,,,360,,,,,,,,,,,,, "severe acute respiratory syndrome CoV eg SARSCoV,SARSCoV-2 COVID-19",87426,CPT ,,Both,,,360,,,,,,,,,,,,, INTRODUCTION NEEDLE/INTRACATHETER VEIN,36000,CPT ,,Both,,,364.4,,,,,,,,,,,,, EPSTEIN BARR (EA),86663,CPT ,,Both,,,365.17,,,,,,,,,,,,, INSULIN LK GRWTH FAC 1 (IGF-1),84305,CPT ,,Both,,,365.25,,,,,,,,,,,,, BILIRUBIN TOTAL,82247,CPT ,,Both,,,366,,,,,,,,,,,,, MOLECULAR CYTO DNA PROBE,88271,CPT ,,Both,,,368,,,,,,,,,,,,, CHLORAMPHENICOL 1GRAM INJ,J0720,HCPCS,,Both,1,GM,368.25,,,,,,,,,,,,, FEMUR MIN 2V RT,73550,CPT ,,Both,,,369.88,,,,,,,,,,,,, "INJECTION, METRONIDAZOLE",S0030,HCPCS,,Both,,,370.06,,,,,,,,,,,,, BL DRAW < 3 YRS FEM/JUGULAR,36400,CPT ,,Both,,,370.25,,,,,,,,,,,,, SO 8 ABD RESTRAINT PRE OTS,L3650,HCPCS,,Both,,,373.09,,,,,,,,,,,,, Gold sodium thiomaleate inj,J1600,HCPCS,,Both,0.05,GM,376.92,,,,,,,,,,,,, COLLECTION VENOUS BLOOD VENIPUNCTURE,36410,CPT ,,Both,,,378,,,,,,,,,,,,, HALOPERIDOL DECANOATE INJ,J1631,HCPCS,,Both,0.05,GM,378,,,,,,,,,,,,, RENIN,84244,CPT ,,Both,,,378,,,,,,,,,,,,, SUMATRIPTAN SUCCINATE / 6 MG,J3030,HCPCS,,Both,0.006,GM,378,,,,,,,,,,,,, HIB VACCINE PRP-T IM,90648,CPT ,,Both,,,378.05,,,,,,,,,,,,, KETONE BODIES SERUM QUANTITATIVE,82010,CPT ,,Both,,,382,,,,,,,,,,,,, SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL,86592,CPT ,,Both,,,384,,,,,,,,,,,,, CULTURE CHLAMYDIA,87110,CPT ,,Both,,,385.15,,,,,,,,,,,,, HYDROXYPREGNENOLONE-17,84143,CPT ,,Both,,,387.13,,,,,,,,,,,,, PATHOLOGY LEVEL II,88302,CPT ,,Both,,,387.5,,,,,,,,,,,,, IFOSFAMIDE INJECTION,J9208,HCPCS,,Both,1,GM,388.01,,,,,,,,,,,,, CHEST X-RAY STEREO FRONTAL,71015,CPT ,,Both,,,392,,,,,,,,,,,,, OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,98925,CPT ,,Both,,,392.38,,,,,,,,,,,,, NITROPRUSSIDE SODIUM 25MG/ML 1 ml vial,J3490,HCPCS,,Both,,,393.05,,,,,,,,,,,,, Octagam injection,J1568,HCPCS,,Both,0.5,GM,393.64,,,,,,,,,,,,, CYCLOSPORINE 250MG 5ML INJ,J7516,HCPCS,,Both,0.25,GM,394.28,,,,,,,,,,,,, DECLOT VASCULAR DEVICE,36593,CPT ,,Both,,,396,,,,,,,,,,,,, PENTAZOCINE 30MG/ML INJ,J3070,HCPCS,,Both,0.03,GM,396.81,,,,,,,,,,,,, CADMIUM,82300,CPT ,,Both,,,397.63,,,,,,,,,,,,, FLU VACC PRSV FREE INC ANTIG,90662,CPT ,,Both,,,397.79,,,,,,,,,,,,, Removal of impacted wax md,G0268,HCPCS,,Both,,,401.38,,,,,,,,,,,,, PENTOBARBITAL 50MG/ML 2ML INJ,J2515,HCPCS,,Both,100,ML,401.99,,,,,,,,,,,,, THYROID HORM UPTK/THYROID HORMONE BINDING RATIO,84479,CPT ,,Both,,,402,,,,,,,,,,,,, CYTO AND MOLEC CYTOGEN INT&REP,88291,CPT ,,Both,,,403.18,,,,,,,,,,,,, Robinul(Glycopyrrolate) 0.2 mg / mL Injection 1 mL ,J3490,HCPCS,,Both,,,404.03,,,,,,,,,,,,, ANTIBODY HERPES SMPLX TYPE 1,86695,CPT ,,Both,,,408,,,,,,,,,,,,, ASSAY OF TROPONIN QUALITATIVE,84512,CPT ,,Both,,,408,,,,,,,,,,,,, BLOOD COUNT COMPLETE AUTOMATED,85027,CPT ,,Both,,,408,,,,,,,,,,,,, "Cast supplies, long arm splint, adult (11 years +), fiberglass",Q4018,HCPCS,,Both,,,408,,,,,,,,,,,,, "Cast supplies, long arm splint, adult (11 years +), plaster",Q4017,HCPCS,,Both,,,408,,,,,,,,,,,,, CORTISOL TOTAL,82533,CPT ,,Both,,,408,,,,,,,,,,,,, IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ,87591,CPT ,,Both,,,408,,,,,,,,,,,,, NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,94761,CPT ,,Both,,,408,,,,,,,,,,,,, "PROBE/NEEDLE, CRYO",C2618,HCPCS,,Both,,,408,,,,,,,,,,,,, Removing sutures OR staples that do not require anesthesia,15853,CPT ,,Both,,,408,,,,,,,,,,,,, DEBRIDE NAIL 1-5,11720,CPT ,,Both,,,409,,,,,,,,,,,,, U/S AMNIOCENTESIS GUIDE,76946,CPT ,,Both,,,409.5,,,,,,,,,,,,, ANTINUCLEAR ANTIBODIES ANA,86038,CPT ,,Both,,,411,,,,,,,,,,,,, ANTIBODY ELUTION,86860,CPT ,,Both,,,411.53,,,,,,,,,,,,, SPLINT,A4570,HCPCS,,Both,,,413,,,,,,,,,,,,, US abdominal aorta real time w image doc. screening study abdominal aortic aneurysm AAA,76706,CPT ,,Both,,,414.04,,,,,,,,,,,,, ESTRIOL,82677,CPT ,,Both,,,415.63,,,,,,,,,,,,, TESTOSTERON ENANT 200MG/ML 1ML,J0900,HCPCS,,Both,1,ML,417,,,,,,,,,,,,, DIHYDROERGOTAMINE 1MG/ML,J1110,HCPCS,,Both,0.001,GM,418.36,,,,,,,,,,,,, AFO MULTILIG ANK SUP PRE OTS,L1906,HCPCS,,Both,,,420,,,,,,,,,,,,, CERVICAL COLLAR MOLDED TO PT,L0170,HCPCS,,Both,,,420,,,,,,,,,,,,, ELECTRONIC SPIROMETER,E0487,HCPCS,,Both,,,420,,,,,,,,,,,,, IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE,90472,CPT ,,Both,,,420,,,,,,,,,,,,, LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL,83718,CPT ,,Both,,,420,,,,,,,,,,,,, SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,87205,CPT ,,Both,,,420,,,,,,,,,,,,, X-RAY MEASUREMENT OF PELVIS,74710,CPT ,,Both,,,422.25,,,,,,,,,,,,, "ngestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing",95079,CPT ,,Both,,,426.1,,,,,,,,,,,,, BLOOD GASES W/O2 SATURATION,82805,CPT ,,Both,,,426.32,,,,,,,,,,,,, Multiple-family group psychotherapy,90849,CPT ,,Both,,,426.88,,,,,,,,,,,,, ESTRONE ASSAY,82679,CPT ,,Both,,,429,,,,,,,,,,,,, CATECHOLAMINES BLOOD,82383,CPT ,,Both,,,430.63,,,,,,,,,,,,, ASSAY OF UREA NITROGEN QUANTITATIVE,84520,CPT ,,Both,,,431,,,,,,,,,,,,, CHROM ANAL KARYOTYPE,88280,CPT ,,Both,,,431.25,,,,,,,,,,,,, MITOXANTRONE 2MG/ML 10ML,J9293,HCPCS,,Both,0.005,GM,432.74,,,,,,,,,,,,, DHEA,82626,CPT ,,Both,,,434.25,,,,,,,,,,,,, BLOOD TRANSFUSION SERVICE,36430,CPT ,,Both,,,434.38,,,,,,,,,,,,, Decitabine injection,J0894,HCPCS,,Both,0.001,GM,434.78,,,,,,,,,,,,, TESTOSTERONE FREE,84402,CPT ,,Both,,,437.5,,,,,,,,,,,,, ASSAY OF THYROXINE TOTAL,84436,CPT ,,Both,,,438,,,,,,,,,,,,, SELENIUM,84255,CPT ,,Both,,,438.75,,,,,,,,,,,,, Idarubicin hcl injection,J9211,HCPCS,,Both,0.005,GM,441.39,,,,,,,,,,,,, HLA B27,86812,CPT ,,Both,,,443.5,,,,,,,,,,,,, TESTOSTERONE TOTAL,84403,CPT ,,Both,,,443.63,,,,,,,,,,,,, ANTIBODY RETICULIN IGA,86255,CPT ,,Both,,,445.5,,,,,,,,,,,,, "Immune globulin, powder",J1566,HCPCS,,Both,0.5,GM,446.85,,,,,,,,,,,,, SACROILIAC JOINTS MIN 3V,72202,CPT ,,Both,,,447.38,,,,,,,,,,,,, CULTURE VIRUS,87252,CPT ,,Both,,,447.88,,,,,,,,,,,,, BILIRUBIN DIRECT,82248,CPT ,,Both,,,450,,,,,,,,,,,,, "Intravenous infusion, sotrovimab, includes infusion and post administration monitoring",M0247,HCPCS,,Both,,,450,,,,,,,,,,,,, HIP OPERATIVE PROC,73530,CPT ,,Both,,,451,,,,,,,,,,,,, HALOPERIDOL 5MG INJ,J1630,HCPCS,,Both,0.0001,GM,452.45,,,,,,,,,,,,, COLLECTION VENOUS BLOOD VENIPUNCTURE,36415,CPT ,,Both,,,456,,,,,,,,,,,,, HEAVYDUTY/WIDE COMMODE CHAIR,E0168,HCPCS,,Both,,,456,,,,,,,,,,,,, WOUND CLOSURE BY ADHESIVE,G0168,HCPCS,,Both,,,456,,,,,,,,,,,,, Inj IVIG privigen 500 mg,J1459,HCPCS,,Both,0.5,GM,456.46,,,,,,,,,,,,, NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,94760,CPT ,,Both,,,457,,,,,,,,,,,,, Initial Comp Preventative Med E&M Age 12-17,99384,CPT ,,Both,,,457.43,,,,,,,,,,,,, Initial Comp Preventative Med E&M Age 5-11,99383,CPT ,,Both,,,457.43,,,,,,,,,,,,, THEOPHYLLINE (AMNIOPHYLLIN,80198,CPT ,,Both,,,459.2,,,,,,,,,,,,, CALCITONIN,82308,CPT ,,Both,,,460.25,,,,,,,,,,,,, CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES,87040,CPT ,,Both,,,463,,,,,,,,,,,,, IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,87324,CPT ,,Both,,,463,,,,,,,,,,,,, MASTOIDS 1-2V,70120,CPT ,,Both,,,464.38,,,,,,,,,,,,, ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86689,CPT ,,Both,,,465,,,,,,,,,,,,, CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,87086,CPT ,,Both,,,465,,,,,,,,,,,,, HYDROXYPROGESTERONE 17-D,83498,CPT ,,Both,,,466.88,,,,,,,,,,,,, CREATINE KINASE TOTAL,82550,CPT ,,Both,,,468,,,,,,,,,,,,, CREATININE BLOOD,82565,CPT ,,Both,,,468,,,,,,,,,,,,, ORTHO SHOE ADD LEATHER INSOL,L3500,HCPCS,,Both,,,468,,,,,,,,,,,,, SPIROM SIMPL PFT VC,94010,CPT ,,Both,,,468.63,,,,,,,,,,,,, GLUCOSE BODY FLUID OTHER THAN BLOOD,82945,CPT ,,Both,,,474,,,,,,,,,,,,, Interferon alfa-n3 inj,J9215,HCPCS,,Both,250000,UN,476.16,,,,,,,,,,,,, HEP A VACC PED/ADOL 2 DOSE,90633,CPT ,,Both,,,476.32,,,,,,,,,,,,, CITRATE,82507,CPT ,,Both,,,477.75,,,,,,,,,,,,, ANTIBODY HERPES SMPLX TYPE 2,86696,CPT ,,Both,,,480,,,,,,,,,,,,, ANTIBODY RUBELLA,86762,CPT ,,Both,,,480,,,,,,,,,,,,, "Detection Test by nucliec acid for multiple organisms, direct probe(s) technique",87800,CPT ,,Both,,,480,,,,,,,,,,,,, DRUG SCREENING CANNABINOIDS NATURAL,80349,CPT ,,Both,,,480,,,,,,,,,,,,, IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ,87486,CPT ,,Both,,,480,,,,,,,,,,,,, IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,87651,CPT ,,Both,,,480,,,,,,,,,,,,, IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ,87653,CPT ,,Both,,,480,,,,,,,,,,,,, "Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",U0003,HCPCS,,Both,,,480,,,,,,,,,,,,, Sarscov & inf vir a&b ag ia,87428,CPT ,,Both,,,480,,,,,,,,,,,,, ESTRADIOL,82670,CPT ,,Both,,,480.13,,,,,,,,,,,,, "Injection anesthetic agent and/or steroid brachial plexus,incl imaging guidance",64415,CPT ,,Both,,,487.18,,,,,,,,,,,,, Gammagard liquid injection,J1569,HCPCS,,Both,0.5,GM,490.81,,,,,,,,,,,,, TETANUS VACCINE IM,90703,CPT ,,Both,,,491.06,,,,,,,,,,,,, MORGAN LENS,V2797,HCPCS,,Both,,,491.4,,,,,,,,,,,,, MORGAN LENS X3,V2797,HCPCS,,Both,,,491.4,,,,,,,,,,,,, DRUG TEST PRSMV QUAL DIR OPTICAL OBS PER DAY,80305,CPT ,,Both,,,493,,,,,,,,,,,,, GENTAMICIN LEVEL TROUGH,80170,CPT ,,Both,,,494.88,,,,,,,,,,,,, Cyclophosphamide 100 MG inj,J9070,HCPCS,,Both,0.1,GM,495.86,,,,,,,,,,,,, LINEZOLID 600MG/300ML,J2020,HCPCS,,Both,0.2,GM,496.38,,,,,,,,,,,,, CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT,89051,CPT ,,Both,,,497,,,,,,,,,,,,, VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC,87255,CPT ,,Both,,,497.73,,,,,,,,,,,,, SHOE LIFT ELEV HEEL/SOLE NEO,L3310,HCPCS,,Both,,,498,,,,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87636,CPT ,,Both,,,500,,,,,,,,,,,,, VEIN ACCESS CUTDOWN > 1 YR,36425,CPT ,,Both,,,501.38,,,,,,,,,,,,, Betamethasone acet&sod phosp,J0702,HCPCS,,Both,0.003,GM,502.43,,,,,,,,,,,,, ANTIBODY HIV-1,86701,CPT ,,Both,,,502.8,,,,,,,,,,,,, AFO POS SOLID ANK PLASTIC MO,L1960,HCPCS,,Both,,,504,,,,,,,,,,,,, CALCIUM IONIZED,82330,CPT ,,Both,,,504,,,,,,,,,,,,, CALCIUM TOTAL,82310,CPT ,,Both,,,504,,,,,,,,,,,,, C-REACTIVE PROTEIN,86140,CPT ,,Both,,,504,,,,,,,,,,,,, Penicillin g benzathine inj,J0540,HCPCS,,Both,1200000,UN,504.07,,,,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87661,CPT ,,Both,,,505.47,,,,,,,,,,,,, GAMUNEX-C/GAMMAKED,J1561,HCPCS,,Both,0.5,GM,505.85,,,,,,,,,,,,, Cefoxitin sodium injection 1GM,J0694,HCPCS,,Both,1,GM,506.1,,,,,,,,,,,,, Removal of sutures AND staples not requiring anesthesia,15854,CPT ,,Both,,,508,,,,,,,,,,,,, OXFORD W SUPINAT/PRONAT INF,L3201,HCPCS,,Both,,,510,,,,,,,,,,,,, SURGICAL BOOT EACH CHILD,L3209,HCPCS,,Both,,,510,,,,,,,,,,,,, URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY,81000,CPT ,,Both,,,510,,,,,,,,,,,,, CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL,87076,CPT ,,Both,,,516,,,,,,,,,,,,, CONTRAST X-RAY BLADDER,74430,CPT ,,Both,,,520.13,,,,,,,,,,,,, PROGRAF (TACROLIMUS) LEVEL,80197,CPT ,,Both,,,520.57,,,,,,,,,,,,, ANTINUCLEAR ANTIBODIES ANA TITER,86039,CPT ,,Both,,,521,,,,,,,,,,,,, HETEROPHILE ANTIBODIES SCREEN,86308,CPT ,,Both,,,524,,,,,,,,,,,,, PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC,84157,CPT ,,Both,,,524.1,,,,,,,,,,,,, TOBRAMYCIN SULFATE INJECTION,J3260,HCPCS,,Both,0.08,GM,528,,,,,,,,,,,,, METHYLDOPATE 500MG/10ML INJ,J0210,HCPCS,,Both,0.25,GM,530,,,,,,,,,,,,, Application of wound VAC dressing,97605,CPT ,,Both,,,531.63,,,,,,,,,,,,, HIP BI W/PELVIS,73520,CPT ,,Both,,,532.13,,,,,,,,,,,,, DEB MUSC/FASCIA 20 SQ CM/<,11043,CPT ,,Both,,,534.75,,,,,,,,,,,,, DEB SUBQ TISSUE EACH ADDITIONAL 20 SQ CM,11045,CPT ,,Both,,,534.75,,,,,,,,,,,,, ASSAY OF FREE THYROXINE,84439,CPT ,,Both,,,538,,,,,,,,,,,,, "MODERATE SEDATION BY DIFF. PHYS, 30 MIN, OVER 5Y",99149,CPT ,,Both,,,539.65,,,,,,,,,,,,, ASSAY OF PHENCYCLIDINE,83992,CPT ,,Both,,,540,,,,,,,,,,,,, ASSAY OF URIC ACID OTHER SOURCE,84560,CPT ,,Both,,,540,,,,,,,,,,,,, CHOLESTEROL SERUM/WHOLE BLOOD TOTAL,82465,CPT ,,Both,,,540,,,,,,,,,,,,, ELECTROLYTE PANEL,80051,CPT ,,Both,,,540,,,,,,,,,,,,, "Destruction Lesion,dentoalveolar Structure",41850,CPT ,,Both,,,542.5,,,,,,,,,,,,, URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY,81003,CPT ,,Both,,,545,,,,,,,,,,,,, PATIENT LIFT BATHROOM OR TOI,E0625,HCPCS,,Both,,,546,,,,,,,,,,,,, FROZEN SECTION ADDL TISSUE BLK,88332,CPT ,,Both,,,546.5,,,,,,,,,,,,, SPINE THORACOLUMBAR STAND,72069,CPT ,,Both,,,555.27,,,,,,,,,,,,, ASSAY OF LIPASE,83690,CPT ,,Both,,,556,,,,,,,,,,,,, PATHOLOGY LEVEL III,88304,CPT ,,Both,,,558.25,,,,,,,,,,,,, Initial Comp Preventative Med E&M Age 18-39 ,99385,CPT ,,Both,,,559.08,,,,,,,,,,,,, OMT 3-4 Body Regions,98926,CPT ,,Both,,,559.38,,,,,,,,,,,,, Bortezomib injection,J9041,HCPCS,,Both,0.0001,GM,561.18,,,,,,,,,,,,, DEBRIDE NAIL 6 OR MORE,11721,CPT ,,Both,,,562.75,,,,,,,,,,,,, EXTENDED STEEL SHANK,L2360,HCPCS,,Both,,,564,,,,,,,,,,,,, IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM,87798,CPT ,,Both,,,566.52,,,,,,,,,,,,, "Cast sup short leg splint, ped 0-10 years plaster",Q4047,HCPCS,,Both,,,568,,,,,,,,,,,,, CULTURE FUNGUS (OTHER),87102,CPT ,,Both,,,568.72,,,,,,,,,,,,, ADDITION OF WALKER TO CAST,29440,CPT ,,Both,,,570,,,,,,,,,,,,, ASSAY OF LACTATE,83605,CPT ,,Both,,,570,,,,,,,,,,,,, ASSAY OF TRIIODOTHYRONINE T3 FREE,84481,CPT ,,Both,,,570,,,,,,,,,,,,, IAAD IA RESPIRATORY SYNCTIAL VIRUS,87420,CPT ,,Both,,,570,,,,,,,,,,,,, X-RAY BILE DUCTS/PANCREAS,74300,CPT ,,Both,,,570.38,,,,,,,,,,,,, ASSAY OF AMYLASE,82150,CPT ,,Both,,,572,,,,,,,,,,,,, Interferon alfa-2a inj,J9213,HCPCS,,Both,3000000,UN,574.43,,,,,,,,,,,,, IAADIADOO INFLUENZA,87804,CPT ,,Both,,,575,,,,,,,,,,,,, ANKLE CONTROL ORTHO PRE OTS,L4350,HCPCS,,Both,,,575.49,,,,,,,,,,,,, Xray Hips Min 5 View,73523,CPT ,,Both,,,582.13,,,,,,,,,,,,, APPLICATION FINGER SPLINT STATIC,29130,CPT ,,Both,,,583,,,,,,,,,,,,, X-RAY EXAM OF PELVIS & HIPS,73540,CPT ,,Both,,,583,,,,,,,,,,,,, HEPATITIS C/RNA/PCR,87522,CPT ,,Both,,,583.8,,,,,,,,,,,,, "CONTINUOUS INHALATION TX W/ AEROSOL MEDICATION, FIRST HOUR",94644,CPT ,,Both,,,587.75,,,,,,,,,,,,, ERTAPENEM INJECTION 500MG,J1335,HCPCS,,Both,0.5,GM,595.36,,,,,,,,,,,,, "Albumin (human), 5%, 250 ml",P9045,HCPCS,,Both,,,596.6,,,,,,,,,,,,, CHROM ANALYSIS 25-99 CELLS,88274,CPT ,,Both,,,598.13,,,,,,,,,,,,, "2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies",U0004,HCPCS,,Both,,,600,,,,,,,,,,,,, ANTIBODY RUBEOLA,86765,CPT ,,Both,,,600,,,,,,,,,,,,, ASSAY OF ALCOHOL BREATH,82075,CPT ,,Both,,,600,,,,,,,,,,,,, ASSAY OF GLUTAMYLTRASE GAMMA,82977,CPT ,,Both,,,600,,,,,,,,,,,,, ASSAY OF MAGNESIUM,83735,CPT ,,Both,,,600,,,,,,,,,,,,, DRUG TEST DEF 8-14 CLASSES,G0481,HCPCS,,Both,,,600,,,,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87637,CPT ,,Both,,,600,,,,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2,87635,CPT ,,Both,,,600,,,,,,,,,,,,, "Injection(s), anesthetic agent(s) and/or steroid;",64451,CPT ,,Both,,,600,,,,,,,,,,,,, "INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP",36572,CPT ,,Both,,,600,,,,,,,,,,,,, LACTATE DEHYDROGENASE LDH,83615,CPT ,,Both,,,600,,,,,,,,,,,,, METHOCARBAMOL INJECTION,J2800,HCPCS,,Both,10,ML,602.9,,,,,,,,,,,,, HEPATITIS C PRR QUAL,87521,CPT ,,Both,,,603,,,,,,,,,,,,, CHEST 2V AND LORDOTIC,71021,CPT ,,Both,,,611.09,,,,,,,,,,,,, CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL,87070,CPT ,,Both,,,612,,,,,,,,,,,,, "GI PANEL-eg,Clostridium difficile,Ecoli,Salmonella,Shigella,norovirus,Giardia",87505,CPT ,,Both,,,613.81,,,,,,,,,,,,, Unlisted Vascular Surgery Procedure,37799,CPT ,,Both,,,614.13,,,,,,,,,,,,, WHEELCHAIR MGMT EA 15 MIN,97542,CPT ,,Both,,,615,,,,,,,,,,,,, "Albumin (human), 25%, 50ml",P9047,HCPCS,,Both,,,615.01,,,,,,,,,,,,, NON-PNEUM WALK BOOT PRE OTS,L4387,HCPCS,,Both,,,615.47,,,,,,,,,,,,, Ingestion challenge test seq/incremental ingestion of test items-initial 120min,95076,CPT ,,Both,,,615.8,,,,,,,,,,,,, Arsenic trioxide injection,J9017,HCPCS,,Both,0.001,GM,617.5,,,,,,,,,,,,, DRAINAGE CHEST PLEUR-EVAC,A7040,HCPCS,,Both,,,618.25,,,,,,,,,,,,, HEP A VACCINE ADULT IM,90632,CPT ,,Both,,,620.84,,,,,,,,,,,,, STRAPPING OF HIP,29520,CPT ,,Both,,,622.38,,,,,,,,,,,,, "BRONCHOSCOPY W/ FLUOROSCOPIC GUIDANCE, DIAGNOSTIC, W/ CELL WASHING",31720,CPT ,,Both,,,626.88,,,,,,,,,,,,, ACETYLCHOLINE RECEPTOR BINDING,84238,CPT ,,Both,,,628.38,,,,,,,,,,,,, DRUG SCREENING BENZODIAZEPINES 13 OR MORE,80347,CPT ,,Both,,,630,,,,,,,,,,,,, DRUG SCREENING BUPRENORPHINE,80348,CPT ,,Both,,,630,,,,,,,,,,,,, BONE DENSITY DEXA,77080,CPT ,,Both,,,630.63,,,,,,,,,,,,, "INSERTION CATHETER ARTERY FOR SAMPLING, MONITORING, OR TRANSFUSION, PERCUTANEOUS",36620,CPT ,,Both,,,635,,,,,,,,,,,,, KO IMMOBILIZER CANVAS LONGIT (Splint Knee 3 panel,L1830,HCPCS,,Both,,,635,,,,,,,,,,,,, WHO COCK-UP NONMOLDE PRE OTS,L3908,HCPCS,,Both,,,639.87,,,,,,,,,,,,, MOD/CON SED AGE 5+ 1ST 30M,99144,CPT ,,Both,,,645.5,,,,,,,,,,,,, EVACUATION SUBUNGUAL HEMATOMA,11740,CPT ,,Both,,,648,,,,,,,,,,,,, BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3,82803,CPT ,,Both,,,649,,,,,,,,,,,,, ANTIBODY TREPONEMA PALLIDUM,86780,CPT ,,Both,,,650,,,,,,,,,,,,, ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,84153,CPT ,,Both,,,650,,,,,,,,,,,,, MOD/CON SED <5YRS 1ST 30M,99143,CPT ,,Both,,,652.46,,,,,,,,,,,,, REVISE EYELASHES,67820,CPT ,,Both,,,654.63,,,,,,,,,,,,, VEIN ACCESS CUTDOWN < 1 YR,36420,CPT ,,Both,,,655.25,,,,,,,,,,,,, MAMMO GUIDE NEEDLE LOC BREAST,77032,CPT ,,Both,,,656.63,,,,,,,,,,,,, Cetuximab injection,J9055,HCPCS,,Both,0.01,GM,656.94,,,,,,,,,,,,, ASSAY OF FERRITIN,82728,CPT ,,Both,,,660,,,,,,,,,,,,, IAAD IA SHIGA-LIKE TOXIN,87427,CPT ,,Both,,,660,,,,,,,,,,,,, WALKER FOLDING WHEELED W/O S,E0143,HCPCS,,Both,,,660,,,,,,,,,,,,, Inj for sacroiliac jt anesth,G0260,HCPCS,,Both,,,661.38,,,,,,,,,,,,, ACTH,82024,CPT ,,Both,,,663.75,,,,,,,,,,,,, "C-ARM: FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR, OTHER THAN 71023 OR 71034",76000,CPT ,,Both,,,664.63,,,,,,,,,,,,, Alligator Forceps,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, Dental Box,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, I&D LOOPS,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, Katz Extractor,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, NoseBleed tray,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, Rapid Rhino,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, Rapid Rhino X 2,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, RHINO ROCKET,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, Vaginal Delivery Kit,A4649,HCPCS,,Both,,,665,,,,,,,,,,,,, AFO ANKLE GAUNTLET PRE OTS,L1902,HCPCS,,Both,,,666.28,,,,,,,,,,,,, Cast sup short leg splint plaster adult(11yrs+),Q4045,HCPCS,,Both,,,668,,,,,,,,,,,,, "Pathogen specific RNA, 3 targets (SARS, FLU A, FLUB B)",0240U,CPT ,,Both,,,670.52,,,,,,,,,,,,, X-RAY EXAM SCLOIOSIS ERECT,72090,CPT ,,Both,,,672.5,,,,,,,,,,,,, TRANSFUSN REACTION INVESTIGATN,86078,CPT ,,Both,,,674.38,,,,,,,,,,,,, APPLICATION OF UNNA BOOT,29580,CPT ,,Both,,,676.88,,,,,,,,,,,,, STRAPPING THORAX,29200,CPT ,,Both,,,677.88,,,,,,,,,,,,, CHOLANGIOGRAM T TUBE S&I,74305,CPT ,,Both,,,680.75,,,,,,,,,,,,, ANTIBODY HELICOBACTER PYLORI,86677,CPT ,,Both,,,684,,,,,,,,,,,,, ASSAY OF BLOOD/URIC ACID,84550,CPT ,,Both,,,684,,,,,,,,,,,,, ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3,84480,CPT ,,Both,,,684,,,,,,,,,,,,, BLOOD GLUCOSE MONITOR HOME,E0607,HCPCS,,Both,,,684,,,,,,,,,,,,, CAST SUP SHT ARM SPLINT FBRG,Q4022,HCPCS,,Both,,,684,,,,,,,,,,,,, CAST SUP SHT ARM SPLNT PED F,Q4024,HCPCS,,Both,,,684,,,,,,,,,,,,, CAST SUP SHT ARM SPLNT PED P,Q4023,HCPCS,,Both,,,684,,,,,,,,,,,,, COLLECTION CAPILLARY BLOOD SPECIMEN,36416,CPT ,,Both,,,684,,,,,,,,,,,,, CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,87077,CPT ,,Both,,,684,,,,,,,,,,,,, CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ,87081,CPT ,,Both,,,684,,,,,,,,,,,,, CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID,87075,CPT ,,Both,,,684,,,,,,,,,,,,, "Drug confirmation, each procedure",G6058,HCPCS,,Both,,,684,,,,,,,,,,,,, DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2,80329,CPT ,,Both,,,684,,,,,,,,,,,,, DRUG SCREEN QUANTITATIVE ALCOHOLS,80320,CPT ,,Both,,,684,,,,,,,,,,,,, DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS,80374,CPT ,,Both,,,684,,,,,,,,,,,,, DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2,80362,CPT ,,Both,,,684,,,,,,,,,,,,, DRUG SCREENING TRAMADOL,80373,CPT ,,Both,,,684,,,,,,,,,,,,, DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,,Both,,,684,,,,,,,,,,,,, EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD,86235,CPT ,,Both,,,684,,,,,,,,,,,,, GLUCOSE BLOOD REAGENT STRIP,82948,CPT ,,Both,,,684,,,,,,,,,,,,, "HOCM 300-349MG/ML IODINE,1ML",Q9962,HCPCS,,Both,,,684,,,,,,,,,,,,, HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE,83013,CPT ,,Both,,,684,,,,,,,,,,,,, LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE,89055,CPT ,,Both,,,684,,,,,,,,,,,,, NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,94762,CPT ,,Both,,,684,,,,,,,,,,,,, SEDIMENTATION RATE RBC NON-AUTOMATED,85651,CPT ,,Both,,,684,,,,,,,,,,,,, URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,81025,CPT ,,Both,,,684,,,,,,,,,,,,, MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS,99155,CPT ,,Both,,,687.47,,,,,,,,,,,,, MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS,99151,CPT ,,Both,,,687.47,,,,,,,,,,,,, REMOVE NAIL PLATE ADDITIONAL,11732,CPT ,,Both,,,689.04,,,,,,,,,,,,, ANTIBODY HIV-2,86702,CPT ,,Both,,,690,,,,,,,,,,,,, CUSTOM MOLD SHOE REMOV PROST,L3250,HCPCS,,Both,,,690,,,,,,,,,,,,, FOOT LAMIN/PREPREG COMPOSITE,L3031,HCPCS,,Both,,,690,,,,,,,,,,,,, MOLEC INTERPHASE INSITU,88275,CPT ,,Both,,,690,,,,,,,,,,,,, ORTHO SHOE ADD FULL SOLE,L3540,HCPCS,,Both,,,690,,,,,,,,,,,,, SO 8 AB RSTR CAN/WEB PRE OTS,L3660,HCPCS,,Both,,,690,,,,,,,,,,,,, URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY,81001,CPT ,,Both,,,690,,,,,,,,,,,,, Temsirolimus injection,J9330,HCPCS,,Both,0.001,GM,699.63,,,,,,,,,,,,, ALDOSTERONE,82088,CPT ,,Both,,,700.25,,,,,,,,,,,,, PARATHYROID HORMONE,83970,CPT ,,Both,,,709.25,,,,,,,,,,,,, CORONARY THROMBOLYSIS BY IV INFUSION,92977,CPT ,,Both,,,710.63,,,,,,,,,,,,, CRYOPRECIPITATE PROCESSING,P9012,HCPCS,,Both,,,712.38,,,,,,,,,,,,, IV INFUSION HYDRATION EACH ADDITIONAL HOUR,96361,CPT ,,Both,,,714,,,,,,,,,,,,, ANTIBODY MUMPS,86735,CPT ,,Both,,,720,,,,,,,,,,,,, CRUTCH UNDERARM EACH NO WOOD,E0116,HCPCS,,Both,,,720,,,,,,,,,,,,, IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE,87389,CPT ,,Both,,,720,,,,,,,,,,,,, IADNA NOS QUANTIFICATION EACH ORGANISM,87799,CPT ,,Both,,,720,,,,,,,,,,,,, PATHOLOGY CONSULT IN SURG,88329,CPT ,,Both,,,720.88,,,,,,,,,,,,, HEP B/HIB VACCINE IM,90748,CPT ,,Both,,,720.91,,,,,,,,,,,,, "AFO, WALK BOOT TYPE, CUS FAB",L4631,HCPCS,,Both,,,721.48,,,,,,,,,,,,, "PUSH TRANS, BLOOD 2 YRS OR UNDER",36440,CPT ,,Both,,,736.5,,,,,,,,,,,,, DEB BONE 20 SQ CM/<,11044,CPT ,,Both,,,737.75,,,,,,,,,,,,, PARING OR CUTTING OF LESION; 2-4 LESIONS,11056,CPT ,,Both,,,737.75,,,,,,,,,,,,, PEMETREXED 500MG INJ,J9305,HCPCS,,Both,0.01,GM,743.6,,,,,,,,,,,,, PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,36680,CPT ,,Both,,,746.13,,,,,,,,,,,,, HEP B VACC ADULT 3 DOSE IM,90746,CPT ,,Both,,,746.34,,,,,,,,,,,,, TETANUS IMMUNE GLOBULIN INJ,J1670,HCPCS,,Both,250,UN,753,,,,,,,,,,,,, NESIRITIDE 1.5MG 5ML INJ,J2325,HCPCS,,Both,0.0001,GM,753.19,,,,,,,,,,,,, PROLACTIN,84146,CPT ,,Both,,,754.31,,,,,,,,,,,,, DRUG SCREEN QUANT AMPHETAMINES 1 OR 2,80324,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING BARBITURATES,80345,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING BENZODIAZEPINES 1-12,80346,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6,80351,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING COCAINE,80353,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING METHADONE,80358,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING METHYLENEDIOXYAMPHETAMINES,80359,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING OPIATES 1 OR MORE,80361,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG SCREENING OXYCODONE,80365,CPT ,,Both,,,756,,,,,,,,,,,,, DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS,80307,CPT ,,Both,,,756,,,,,,,,,,,,, ECG ROUTINE ECG W/LEAST 12 LDS W/I&R,93000,CPT ,,Both,,,756,,,,,,,,,,,,, IAAD IA HPYLORI STOOL,87338,CPT ,,Both,,,756,,,,,,,,,,,,, IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,87491,CPT ,,Both,,,756,,,,,,,,,,,,, IADNA NEISSERIA GONORRHOEAE QUANTIFICATION,87592,CPT ,,Both,,,756,,,,,,,,,,,,, Mycoplasma genitalium,87563,CPT ,,Both,,,756,,,,,,,,,,,,, PNEUMOTHORAX TRAY,A4649,HCPCS,,Both,,,756,,,,,,,,,,,,, RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON,93042,CPT ,,Both,,,756,,,,,,,,,,,,, SYPHILIS TEST QUANTITATIVE,86593,CPT ,,Both,,,756,,,,,,,,,,,,, TDAP VACCINE 7 YRS/> IM,90715,CPT ,,Both,,,756,,,,,,,,,,,,, ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ,20612,CPT ,,Both,,,762.13,,,,,,,,,,,,, NICARDIPINE(Cardene) INJ 0.9% SODIUM CHORIDE 20MG/200ML ,J3490,HCPCS,,Both,,,763,,,,,,,,,,,,, "ABS, FISTULA, SINUS TRACT S&I",76080,CPT ,,Both,,,771.63,,,,,,,,,,,,, ASSAY OF THYROID STIMULATING HORMONE TSH,84443,CPT ,,Both,,,774,,,,,,,,,,,,, CERV FLEX N/ADJ FOAM PRE OTS,L0120,HCPCS,,Both,,,774,,,,,,,,,,,,, ASPIRATION OF BLADDER BY NEEDLE,51100,CPT ,,Both,,,775.25,,,,,,,,,,,,, AMBULATORY SURGICAL BOOT EAC,L3260,HCPCS,,Both,,,780,,,,,,,,,,,,, ASSAY OF ERYTHROPOIETIN,82668,CPT ,,Both,,,780,,,,,,,,,,,,, CREATINE KINASE MB FRACTION ONLY,82553,CPT ,,Both,,,780,,,,,,,,,,,,, CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,89060,CPT ,,Both,,,780,,,,,,,,,,,,, DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL,80162,CPT ,,Both,,,780,,,,,,,,,,,,, IAADIADOO NOT OTHERWISE SPECIFIED,87899,CPT ,,Both,,,780,,,,,,,,,,,,, IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ,87660,CPT ,,Both,,,780,,,,,,,,,,,,, LO FLEX L1-BELOW L5 PRE OTS,L0625,HCPCS,,Both,,,780,,,,,,,,,,,,, Measurement of alcohol level in specimen other than breath or urine,82077,CPT ,,Both,,,780,,,,,,,,,,,,, METANEPHRINES,83835,CPT ,,Both,,,780,,,,,,,,,,,,, MYOGLOBIN,83874,CPT ,,Both,,,780,,,,,,,,,,,,, SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD,87184,CPT ,,Both,,,780,,,,,,,,,,,,, THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR,97116,CPT ,,Both,,,780,,,,,,,,,,,,, PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,11055,CPT ,,Both,,,783,,,,,,,,,,,,, POS AIRWAY PRESSURE CPAP,94660,CPT ,,Both,,,801.75,,,,,,,,,,,,, BRONCH EVAL PRE/POST,94060,CPT ,,Both,,,805.5,,,,,,,,,,,,, APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,29581,CPT ,,Both,,,805.75,,,,,,,,,,,,, TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE,90714,CPT ,,Both,,,806,,,,,,,,,,,,, SO ACRO/CLAV CAN WEB PRE OTS,L3670,HCPCS,,Both,,,807,,,,,,,,,,,,, "ASPARAGINASE, NOS",J9020,HCPCS,,Both,10000,UN,807.06,,,,,,,,,,,,, UNLISTED US EXAM PROCEDURE,76999,CPT ,,Both,,,807.13,,,,,,,,,,,,, T CELL HELPER/SUPPRESSOR,86360,CPT ,,Both,,,807.38,,,,,,,,,,,,, Bevacizumab injection,J9035,HCPCS,,Both,0.01,GM,807.78,,,,,,,,,,,,, "Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use",90700,HCPCS,,Both,,,808,,,,,,,,,,,,, ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH,82784,CPT ,,Both,,,810,,,,,,,,,,,,, CERV SEMI-RIG ADJ MOLDED CHN,L0150,HCPCS,,Both,,,811.98,,,,,,,,,,,,, CAST SUP LNG ARM SPLNT PED F,Q4020,HCPCS,,Both,,,816,,,,,,,,,,,,, Cosyntropin cortrosyn inj,J0834,HCPCS,,Both,0.005,GM,818.05,,,,,,,,,,,,, PATH CONSULT OR EA ADD SITE,88334,CPT ,,Both,,,823.25,,,,,,,,,,,,, WINDOWING OF CAST,29730,CPT ,,Both,,,833.75,,,,,,,,,,,,, Floxuridine injection,J9200,HCPCS,,Both,0.5,GM,838.46,,,,,,,,,,,,, STRAPPING OF ELBOW OR WRIST,29260,CPT ,,Both,,,842.88,,,,,,,,,,,,, CHEST X-RAY AND FLUOROSCOPY,71023,CPT ,,Both,,,844.25,,,,,,,,,,,,, SPECIAL STAINS GROUP II,88313,CPT ,,Both,,,848,,,,,,,,,,,,, CYCLIC CITRULLINATED PEPTIDE ANTIBODY,86200,CPT ,,Both,,,850,,,,,,,,,,,,, EMERGENCY SERVICES BUNDLE FLAT RATE FRONTIER,99499,CPT ,,Both,,,850,,,,,,,,,,,,, HUMAN EPIDIDYMIS PROTEIN 4 (HE4),86305,CPT ,,Both,,,850,,,,,,,,,,,,, "Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each",87593,CPT ,,Both,,,850,,,,,,,,,,,,, MICROSOMAL ANTIBODIES EACH,86376,CPT ,,Both,,,850,,,,,,,,,,,,, THYROGLOBULIN ANTIBODY,86800,CPT ,,Both,,,850,,,,,,,,,,,,, REMOVAL OR BIVALVING OF CAST; FULL ARM OR FULL LEG,29705,CPT ,,Both,,,850.5,,,,,,,,,,,,, THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,96376,CPT ,,Both,,,853,,,,,,,,,,,,, APPLICATION FINGER SPLINT DYNAMIC,29131,CPT ,,Both,,,853.45,,,,,,,,,,,,, FORSKIN MANIPULATION INCLUDING LYSIS,54450,CPT ,,Both,,,856.5,,,,,,,,,,,,, ASSAY OF TRIGLYCERIDES,84478,CPT ,,Both,,,858,,,,,,,,,,,,, Ixabepilone injection,J9207,HCPCS,,Both,0.001,GM,858.06,,,,,,,,,,,,, CALCITONIN 200IU/ML 0.5ML,J0630,HCPCS,,Both,400,UN,863.1,,,,,,,,,,,,, INFLIXIMAB 100MG INJ,J1745,HCPCS,,Both,0.01,GM,874.48,,,,,,,,,,,,, PATHOLOGY LEVEL IV,88305,CPT ,,Both,,,879.38,,,,,,,,,,,,, CAST SUP SHT ARM SPLINT PLST,Q4021,HCPCS,,Both,,,882,,,,,,,,,,,,, CHOLECYSTO REPEAT EXAM,74291,CPT ,,Both,,,882,,,,,,,,,,,,, CAST SUP SHT ARM CAST FBRG,Q4010,HCPCS,,Both,,,884,,,,,,,,,,,,, HYOSCYAMINE 0.5MG/ML INJ,J1980,HCPCS,,Both,0.00025,GM,888.89,,,,,,,,,,,,, "Pathogen Specific RNA, 4 targets (SARS, Flu A, Flu B, RSV)",0241U,CPT ,,Both,,,894.02,,,,,,,,,,,,, "WOUND CARE, NON-SELECT DEBRIDEMENT W/O ANESTH",97602,CPT ,,Both,,,894.25,,,,,,,,,,,,, BONE SURVEY LIMITED,77074,CPT ,,Both,,,894.88,,,,,,,,,,,,, Insertion of Intrauterine Device (IUD),58300,CPT ,,Both,,,896.21,,,,,,,,,,,,, Echocardiography transthoracic RT w image2D incl M-mode recording if done,93308,CPT ,,Both,,,899.36,,,,,,,,,,,,, CHOLECYSTO ORAL CONTRAST,74290,CPT ,,Both,,,899.38,,,,,,,,,,,,, ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,36600,CPT ,,Both,,,900,,,,,,,,,,,,, PNEUMOCOCCAL VACCINE,90732,CPT ,,Both,,,904.4,,,,,,,,,,,,, INTRAOP EPICAR& ENDOCAR PACG& MAPG,93631,CPT ,,Both,,,912,,,,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74425,CPT ,,Both,,,915.38,,,,,,,,,,,,, ECHOGRAHY TRANSRECTAL,76872,CPT ,,Both,,,920.88,,,,,,,,,,,,, GANCICLOVIR 500MG INJ,J1570,HCPCS,,Both,0.5,GM,921.38,,,,,,,,,,,,, PLASMA POOL MLTI DNR TREAT FRZ,P9023,HCPCS,,Both,,,925.66,,,,,,,,,,,,, Family psychotherapy (without the patient present),90846,CPT ,,Both,,,927.88,,,,,,,,,,,,, MEASLES MUMPS RUBELLA VACCINE,90707,CPT ,,Both,,,928.3,,,,,,,,,,,,, PROTHROMBIN TIME,85610,CPT ,,Both,,,934,,,,,,,,,,,,, IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,96366,CPT ,,Both,,,937,,,,,,,,,,,,, "Capsaicin 8% patch, per sq cm",J7336,HCPCS,,Both,,,940.77,,,,,,,,,,,,, CHEMO ANTI-NEOPL SQ/IM,96401,CPT ,,Both,,,949.63,,,,,,,,,,,,, CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL,87045,CPT ,,Both,,,953,,,,,,,,,,,,, CRUTCH UNDERARM PAIR NO WOOD,E0114,HCPCS,,Both,,,955,,,,,,,,,,,,, CYTO NON GYN SMEAR INTERP,88104,CPT ,,Both,,,955.5,,,,,,,,,,,,, "Injection, therapeutic, carpal tunnel",20526,CPT ,,Both,,,956.88,,,,,,,,,,,,, APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,96377,CPT ,,Both,,,960,,,,,,,,,,,,, CAST SUP LNG ARM SPLNT PED P,Q4019,HCPCS,,Both,,,960,,,,,,,,,,,,, DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL,80164,CPT ,,Both,,,960,,,,,,,,,,,,, ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,93005,CPT ,,Both,,,960,,,,,,,,,,,,, IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,96368,CPT ,,Both,,,960,,,,,,,,,,,,, RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT,93040,CPT ,,Both,,,960,,,,,,,,,,,,, X-RAY FALLOPIAN TUBE,74742,CPT ,,Both,,,962.25,,,,,,,,,,,,, DENTAL SURGERY PROCEDURE,41899,CPT ,,Both,,,976.13,,,,,,,,,,,,, LIP SURGERY PROCEDURE,40799,CPT ,,Both,,,976.13,,,,,,,,,,,,, UNLISTED PROCEDURE EXTERNAL EAR,69399,CPT ,,Both,,,976.13,,,,,,,,,,,,, "Unlisted procedure, tongue,floor of mouth",41599,CPT ,,Both,,,976.13,,,,,,,,,,,,, "Unlisted Procedures pharynx,adenoids or tonsils",42999,CPT ,,Both,,,976.13,,,,,,,,,,,,, "Athrocentesis, Aspiration Or Injection W US",20606,CPT ,,Both,,,977.6,,,,,,,,,,,,, FITTING/INSERTION PESSARY OR INTRAVAGINAL SUPPORT DEVICE,57160,CPT ,,Both,,,978.13,,,,,,,,,,,,, TRASTUZUMAB 440MG KIT,J9355,HCPCS,,Both,0.01,GM,984,,,,,,,,,,,,, IBUTILIDE 0.1MG/ML 10ML INJ,J1742,HCPCS,,Both,0.001,GM,986.63,,,,,,,,,,,,, CYTP CONCENTRATION SMEARS & INTERPRETATION,88108,CPT ,,Both,,,989.25,,,,,,,,,,,,, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,Both,50,ML,991.5,,,,,,,,,,,,, HYSTEROSALPINGOGRAPHY S&I,74740,CPT ,,Both,,,993.38,,,,,,,,,,,,, X-RAY EXAM OF KIDNEY LESION,74470,CPT ,,Both,,,996.63,,,,,,,,,,,,, VARICELLA-ZOSTER IG IM,90396,CPT ,,Both,,,998.5,,,,,,,,,,,,, APPLY SHORT LEG CAST - WALKING OR AMBULATORY TYPE,29425,CPT ,,Both,,,1009,,,,,,,,,,,,, APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,29125,CPT ,,Both,,,1014,,,,,,,,,,,,, HISTO STAIN FROZEN SECT,88314,CPT ,,Both,,,1014.88,,,,,,,,,,,,, CAST SUP LNG ARM CAST PED F,Q4008,HCPCS,,Both,,,1016,,,,,,,,,,,,, APPLICATION SHORT LEG SPLINT CALF FOOT,29515,CPT ,,Both,,,1019,,,,,,,,,,,,, 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,82306,CPT ,,Both,,,1020,,,,,,,,,,,,, ANTIBODY RICKETTSIA,86757,CPT ,,Both,,,1020,,,,,,,,,,,,, Antibody; severe acute respiratory syndrome coronavirus 2,86769,CPT ,,Both,,,1020,,,,,,,,,,,,, ASSAY OF AMMONIA,82140,CPT ,,Both,,,1020,,,,,,,,,,,,, ASSAY OF IRON,83540,CPT ,,Both,,,1020,,,,,,,,,,,,, BLOOD COUNT PLATELET AUTOMATED,85049,CPT ,,Both,,,1020,,,,,,,,,,,,, BLOOD TYPING SEROLOGIC ABO,86900,CPT ,,Both,,,1020,,,,,,,,,,,,, BLOOD TYPING SEROLOGIC RH (D),86901,CPT ,,Both,,,1020,,,,,,,,,,,,, CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL,87071,CPT ,,Both,,,1020,,,,,,,,,,,,, CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL,87101,CPT ,,Both,,,1020,,,,,,,,,,,,, CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST,87106,CPT ,,Both,,,1020,,,,,,,,,,,,, GONADOTROPIN CHORIONIC QUALITATIVE,84703,CPT ,,Both,,,1020,,,,,,,,,,,,, HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB,99000,CPT ,,Both,,,1020,,,,,,,,,,,,, IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ,87529,CPT ,,Both,,,1020,,,,,,,,,,,,, INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE,87493,CPT ,,Both,,,1020,,,,,,,,,,,,, INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT ,,Both,,,1020,,,,,,,,,,,,, INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,20552,CPT ,,Both,,,1020,,,,,,,,,,,,, INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,20553,CPT ,,Both,,,1020,,,,,,,,,,,,, OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,23550,CPT ,,Both,,,1020,,,,,,,,,,,,, PROCALCITONIN (PCT),84145,CPT ,,Both,,,1020,,,,,,,,,,,,, QUANTITATION DRUG NOT ELSEWHERE SPECIFIED,80299,CPT ,,Both,,,1020,,,,,,,,,,,,, "Red blood count automated, with additional calculations",85046,CPT ,,Both,,,1020,,,,,,,,,,,,, SMR PRIM SRC WET MOUNT NFCT AGT,87210,CPT ,,Both,,,1020,,,,,,,,,,,,, THERAPEUTIC DRUG ASSAYS,80143,CPT ,,Both,,,1020,,,,,,,,,,,,, Therapeutic Drug Assays,80179,CPT ,,Both,,,1020,,,,,,,,,,,,, THROMBIN TIME PLASMA,85670,CPT ,,Both,,,1020,,,,,,,,,,,,, TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT,87220,CPT ,,Both,,,1020,,,,,,,,,,,,, SPINE COMP AP&LAT-ENTIRE,72010,CPT ,,Both,,,1022.75,,,,,,,,,,,,, MAMMOGRAM SCREENING,77057,CPT ,,Both,,,1023.13,,,,,,,,,,,,, UNLISTED PROCEDURE MALE GENITAL SYSTEM,55899,CPT ,,Both,,,1024.88,,,,,,,,,,,,, "UNLISTED PROCEDURE, URINARY SYSTEM",53899,CPT ,,Both,,,1024.88,,,,,,,,,,,,, REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,15850,CPT ,,Both,,,1026,,,,,,,,,,,,, "DILATE URETHRA STRICTURE BY SOUND OR URETHRAL DILATOR, MALE",53600,CPT ,,Both,,,1026.88,,,,,,,,,,,,, Injection Rho D immune globulin human full dose 300mcg - 1500 IU,J2790,HCPCS,,Both,0.0003,GM,1033.56,,,,,,,,,,,,, 3D ULTSND PRCSS IND WRKSTN,76377,CPT ,,Both,,,1036.13,,,,,,,,,,,,, Pentamidine non-comp unit,J2545,HCPCS,,Both,0.3,GM,1036.55,,,,,,,,,,,,, CELL COUNT MISCELLANEOUS BODY FLUIDS,89050,CPT ,,Both,,,1038,,,,,,,,,,,,, IAADIADOO STREPTOCOCCUS GROUP A,87880,CPT ,,Both,,,1038,,,,,,,,,,,,, SINCALIDE 5MCG INJ,J2805,HCPCS,,Both,0.000005,GM,1038.86,,,,,,,,,,,,, DESTRUCT PREMALG LESION,17000,CPT ,,Both,,,1043.25,,,,,,,,,,,,, FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE,85379,CPT ,,Both,,,1050,,,,,,,,,,,,, APPLY SHORT LEG CAST (BELOW ANKLE TO TOES),29405,CPT ,,Both,,,1051.25,,,,,,,,,,,,, FLUDARABINE PHOS 50MG INJ,J9185,HCPCS,,Both,0.05,GM,1052.11,,,,,,,,,,,,, ASSAY OF TROPONIN QUANTITATIVE,84484,CPT ,,Both,,,1055,,,,,,,,,,,,, NATRIURETIC PEPTIDE,83880,CPT ,,Both,,,1056,,,,,,,,,,,,, APPLICATION CAST FINGER,29086,CPT ,,Both,,,1062,,,,,,,,,,,,, Pilocarpine HCl(VUITY) 1.25% Solution 5 mL OPHTH DROPS,J3490,HCPCS,,Both,,,1069.85,,,,,,,,,,,,, USG PERICARDIOCENTESIS,76930,CPT ,,Both,,,1075.25,,,,,,,,,,,,, BONE MARROW INTER ONLY,85097,CPT ,,Both,,,1079.25,,,,,,,,,,,,, URETHROCYSTOGRAM VOIDING S&I,74455,CPT ,,Both,,,1087,,,,,,,,,,,,, "DIAGNOSTIC LARYNGOSCOPY, INDIRECT",31505,CPT ,,Both,,,1090.38,,,,,,,,,,,,, NEBULIZER WITH COMPRESSION,E0570,HCPCS,,Both,,,1092,,,,,,,,,,,,, SCHILLING TEST W/O INTR FACTOR,78270,CPT ,,Both,,,1099.38,,,,,,,,,,,,, PUNCTURE SHUNT TUBING FOR ASPIRATION/INJECTION,61070,CPT ,,Both,,,1099.63,,,,,,,,,,,,, CHEST X-RAY&FLUORO 4/> VIEWS,71034,CPT ,,Both,,,1100.13,,,,,,,,,,,,, "ESTROGEN ASSAY, ESTROGEN",84233,CPT ,,Both,,,1106.75,,,,,,,,,,,,, LD - FETAL FIBRONECTIN,82731,CPT ,,Both,,,1106.75,,,,,,,,,,,,, Hyalgan/supartz inj per dose,J7321,HCPCS,,Both,0.00001,GM,1110.65,,,,,,,,,,,,, Family psychotherapy (conjoint psychotherapy) (with patient present),90847,CPT ,,Both,,,1111.88,,,,,,,,,,,,, MAMMO EXTRA VIEW,77055,CPT ,,Both,,,1116.88,,,,,,,,,,,,, APPLICATION CAST ELBOW FINGER SHORT ARM,29075,CPT ,,Both,,,1118.38,,,,,,,,,,,,, DEB MUSC/FASCIA EACH ADDITIONAL 20 SQ CM,11046,CPT ,,Both,,,1119.5,,,,,,,,,,,,, REMOVAL OF SKIN TAGS YRS,99152,CPT ,,Both,,,1500,,,,,,,,,,,,, SBSQ HOSPITAL CARE/DAY 15 MINUTES,99231,CPT ,,Both,,,1500,,,,,,,,,,,,, SBSQ OBSERVATION CARE/DAY 15 MINUTES,99224,CPT ,,Both,,,1500,,,,,,,,,,,,, Treatment for dislocated shoulder,23660,CPT ,,Both,,,1500,,,,,,,,,,,,, DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,11042,CPT ,,Both,,,1502.88,,,,,,,,,,,,, "CLOSED TX INTERPHALANGEAL JOINT DISLO, W/O ANESTH",28660,CPT ,,Both,,,1505.63,,,,,,,,,,,,, Bcg live intravesical vac,J9031,HCPCS,,Both,0.001,GM,1511.43,,,,,,,,,,,,, BCG VACCINE INTRAVESICAL,90586,CPT ,,Both,,,1511.43,,,,,,,,,,,,, BCG VACCINE PERCUT,90585,CPT ,,Both,,,1511.43,,,,,,,,,,,,, BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC,85025,CPT ,,Both,,,1512,,,,,,,,,,,,, BLOOD COUNT RETICULOCYTE AUTOMATED,85045,CPT ,,Both,,,1512,,,,,,,,,,,,, BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER,82270,CPT ,,Both,,,1512,,,,,,,,,,,,, BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC,82272,CPT ,,Both,,,1512,,,,,,,,,,,,, CERV SR 2PC THOR EXT PRE OTS,L0174,HCPCS,,Both,,,1512,,,,,,,,,,,,, CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,CPT ,,Both,,,1512,,,,,,,,,,,,, INITIAL TX 1ST DEGREE BURN LOCAL TX,16000,CPT ,,Both,,,1512,,,,,,,,,,,,, "Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring",M0245,HCPCS,,Both,,,1512,,,,,,,,,,,,, "Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",M0239,HCPCS,,Both,,,1512,,,,,,,,,,,,, "Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",M0243,HCPCS,,Both,,,1512,,,,,,,,,,,,, IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,CPT ,,Both,,,1512,,,,,,,,,,,,, IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR,96365,CPT ,,Both,,,1512,,,,,,,,,,,,, LIPID PANEL,80061,CPT ,,Both,,,1512,,,,,,,,,,,,, REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,65205,CPT ,,Both,,,1512,,,,,,,,,,,,, REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,69210,CPT ,,Both,,,1512,,,,,,,,,,,,, RMVL FB XTRNL AUDITORY CANAL ANES,69205,CPT ,,Both,,,1512,,,,,,,,,,,,, RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,65222,CPT ,,Both,,,1512,,,,,,,,,,,,, THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,96372,CPT ,,Both,,,1512,,,,,,,,,,,,, FLUORO CENT VEN ACCESS DEV,77001,CPT ,,Both,,,1516.88,,,,,,,,,,,,, US EXTREMITY NON-VASC REAL-TIME IMG LMTD,76882,CPT ,,Both,,,1520.97,,,,,,,,,,,,, BLOCK INJ FEMORAL NERVE,64447,CPT ,,Both,,,1522.13,,,,,,,,,,,,, THROMBOLYTIC THERAPY STROKE,37195,CPT ,,Both,,,1522.72,,,,,,,,,,,,, FRENOTOMY,40806,CPT ,,Both,,,1525.13,,,,,,,,,,,,, WHFO W/O JOINTS PRE CST,L3807,HCPCS,,Both,,,1531.68,,,,,,,,,,,,, HEP A/HEP B VACC ADULT IM,90636,CPT ,,Both,,,1535.74,,,,,,,,,,,,, APPLY PATELLAR TENDON BEARING CAST,29435,CPT ,,Both,,,1542.63,,,,,,,,,,,,, EXC BEN LES SCALP OVER 4.0 CM,11426,CPT ,,Both,,,1543.75,,,,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,12013,CPT ,,Both,,,1543.75,,,,,,,,,,,,, BASIC METABOLIC PANEL CALCIUM IONIZED,80047,CPT ,,Both,,,1554,,,,,,,,,,,,, CMPLX RPR TRUNK ADDL 5CM/<,13102,CPT ,,Both,,,1555.63,,,,,,,,,,,,, OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES,99234,CPT ,,Both,,,1560,,,,,,,,,,,,, PSYCH DIAG EVAL W/MED SRVCS,90792,CPT ,,Both,,,1560.5,,,,,,,,,,,,, Block Inj-FACIAL NERVE,64402,CPT ,,Both,,,1561.63,,,,,,,,,,,,, DRAINAGE OF GLAND ABSCESS (BARTHOLIN'S GLAND),56420,CPT ,,Both,,,1564.38,,,,,,,,,,,,, "APPLIATION OF CAST, PLASTER Velpeau",29058,CPT ,,Both,,,1572.88,,,,,,,,,,,,, EXC H-F-NK-SP B9+MARG 0.5/<,11420,CPT ,,Both,,,1575.75,,,,,,,,,,,,, ANOGENITAL ABUSE EXAM CHILD,99170,CPT ,,Both,,,1577.88,,,,,,,,,,,,, U/S FETAL BIOPHYS PROF W/NST,76818,CPT ,,Both,,,1578.5,,,,,,,,,,,,, REMOVAL OR BIVALVING SHOULDER OR HIP SPICA CAST,29710,CPT ,,Both,,,1580.13,,,,,,,,,,,,, NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH,64400,CPT ,,Both,,,1585.4,,,,,,,,,,,,, S&I RAD GUID PERC DRN/CATH PLT,75989,CPT ,,Both,,,1586.75,,,,,,,,,,,,, APPLICATION OF CYLINDER CAST (THIGH TO ANKLE),29365,CPT ,,Both,,,1589.5,,,,,,,,,,,,, TRANSCATH INT IV STENT S&I,75960,CPT ,,Both,,,1589.88,,,,,,,,,,,,, ESTROGEN RECEPTOR,88360,CPT ,,Both,,,1595.63,,,,,,,,,,,,, "CLOSED TX FX PHALANX OR PHALANGESOTHER THAN GREAT TOE, W/O MANIP, EACH",28510,CPT ,,Both,,,1596.75,,,,,,,,,,,,, Replacement G-tube No Imaging,43762,CPT ,,Both,,,1599.36,,,,,,,,,,,,, ANGIO VIA EXIST CATH S&I,75898,CPT ,,Both,,,1600.13,,,,,,,,,,,,, DSTRJ NULYT OTH PRPH NRV/BRANCH,64640,CPT ,,Both,,,1600.65,,,,,,,,,,,,, VENO EXTREMITY UNI S&I,75820,CPT ,,Both,,,1611.25,,,,,,,,,,,,, IPILIMUMAB INJECTION,J9228,HCPCS,,Both,0.001,GM,1611.94,,,,,,,,,,,,, CT GUIDED NEEDLE BIOPSY,77012,CPT ,,Both,,,1612.63,,,,,,,,,,,,, 3N-HYSTROSONOGRAM,76831,CPT ,,Both,,,1615.88,,,,,,,,,,,,, INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,51703,CPT ,,Both,,,1619,,,,,,,,,,,,, PROCTOSIGMOIDOSCOPY DX,45300,CPT ,,Both,,,1621.88,,,,,,,,,,,,, RMVL FB XTRNL AUDITORY CANAL W/O ANES,69200,CPT ,,Both,,,1622.5,,,,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74420,CPT ,,Both,,,1622.75,,,,,,,,,,,,, "CLOSED TX METACARPAL FX, SINGLE W/O MANIP",26600,CPT ,,Both,,,1635.2,,,,,,,,,,,,, SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,12004,CPT ,,Both,,,1641.13,,,,,,,,,,,,, MYELOGRAM CERVICAL S&I,72240,CPT ,,Both,,,1645.63,,,,,,,,,,,,, BIOPSY OF CERVIX,57500,CPT ,,Both,,,1650.25,,,,,,,,,,,,, CONTRST X-RAY UPPR GI TRACT,74246,CPT ,,Both,,,1653.75,,,,,,,,,,,,, REMOVE EYELID LESION,67800,CPT ,,Both,,,1662.38,,,,,,,,,,,,, IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS,87631,CPT ,,Both,,,1662.99,,,,,,,,,,,,, PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,10160,CPT ,,Both,,,1664.5,,,,,,,,,,,,, UNLISTED HAND/FINGER SURGERY,26989,CPT ,,Both,,,1670.63,,,,,,,,,,,,, UNLISTED LEG/ANKLE SURGERY PROCEDURE,27899,CPT ,,Both,,,1670.63,,,,,,,,,,,,, UNLISTED UPPER ARM/ELBOW SURGERY,24999,CPT ,,Both,,,1670.63,,,,,,,,,,,,, Cautery of Cervix,57510,CPT ,,Both,,,1674.25,,,,,,,,,,,,, DESTROY VULVA LESIONS SIM,56501,CPT ,,Both,,,1674.63,,,,,,,,,,,,, PLATELET CONC L/R PROCESSING,P9031,HCPCS,,Both,,,1678.65,,,,,,,,,,,,, ARTHROGRAPHY KNEE S&I,73580,CPT ,,Both,,,1691.38,,,,,,,,,,,,, DIAZOXIDE 300MG/20ML INJ,J1730,HCPCS,,Both,0.3,GM,1698.96,,,,,,,,,,,,, "Octreotide injection, depot",J2353,HCPCS,,Both,0.001,GM,1701.73,,,,,,,,,,,,, CMPLX RPR S/A/L ADDL 5 CM/>,13122,CPT ,,Both,,,1704.38,,,,,,,,,,,,, HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN,99239,CPT ,,Both,,,1710,,,,,,,,,,,,, INITIAL HOSPITAL CARE/DAY 50 MINUTES,99222,CPT ,,Both,,,1710,,,,,,,,,,,,, INITIAL OBSERVATION CARE/DAY 50 MINUTES,99219,CPT ,,Both,,,1710,,,,,,,,,,,,, SBSQ HOSPITAL CARE/DAY 25 MINUTES,99232,CPT ,,Both,,,1710,,,,,,,,,,,,, SBSQ OBSERVATION CARE/DAY 25 MINUTES,99225,CPT ,,Both,,,1710,,,,,,,,,,,,, BLOCK INJ ILIOINGUINAL NERVE,64425,CPT ,,Both,,,1732.88,,,,,,,,,,,,, INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I,74340,CPT ,,Both,,,1733.75,,,,,,,,,,,,, Cabazitaxel injection,J9043,HCPCS,,Both,0.001,GM,1738.86,,,,,,,,,,,,, CHEMODENERV FACIAL NERVE,64612,CPT ,,Both,,,1740.13,,,,,,,,,,,,, BLOCK INJ SCIATIC NERVE,64445,CPT ,,Both,,,1741.88,,,,,,,,,,,,, APPLY RIGID LEG CAST,29445,CPT ,,Both,,,1744.38,,,,,,,,,,,,, CLOSED TX NOSE FX W/O MANJ,21310,CPT ,,Both,,,1745.5,,,,,,,,,,,,, Dexrazoxane HCl injection,J1190,HCPCS,,Both,0.25,GM,1745.64,,,,,,,,,,,,, GARDNER VAG DNA DIR PROBE,87510,CPT ,,Both,,,1750.95,,,,,,,,,,,,, BLOCK INJ PUDENDAL NERVE,64430,CPT ,,Both,,,1751.13,,,,,,,,,,,,, APPLICATION OF LONG LEG CAST,29345,CPT ,,Both,,,1755,,,,,,,,,,,,, Replacement Gtube Requiring Revision,43763,CPT ,,Both,,,1756.35,,,,,,,,,,,,, US Lower EXT L Venous And Arterial Duplex,93990,CPT ,,Both,,,1759.25,,,,,,,,,,,,, RADEX TOE MINIMUM 2 VIEWS,73660,CPT ,,Both,,,1760,,,,,,,,,,,,, VANCOMYCIN PEAK,80202,CPT ,,Both,,,1764.75,,,,,,,,,,,,, FINE NEEDLE ASPIRATION W IMAGING GUIDANCE ER,10022,CPT ,,Both,,,1767.5,,,,,,,,,,,,, Ustekinumab injection,J3357,HCPCS,,Both,0.001,GM,1777.08,,,,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74415,CPT ,,Both,,,1781.38,,,,,,,,,,,,, COMPREHENSIVE METABOLIC PANEL,80053,CPT ,,Both,,,1794,,,,,,,,,,,,, UNLISTED PROCEDURE NOSE,30999,CPT ,,Both,,,1800,,,,,,,,,,,,, X-RAY BILE STONE REMOVAL,74327,CPT ,,Both,,,1800.25,,,,,,,,,,,,, EXC FACE-MM B9+MARG 0.5 CM/<,11440,CPT ,,Both,,,1802.75,,,,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM,12014,CPT ,,Both,,,1802.75,,,,,,,,,,,,, NASOPHARYNGOSCOPY WITH ENDOSCOPE,92511,CPT ,,Both,,,1803.38,,,,,,,,,,,,, Vaginal Packing,57180,CPT ,,Both,,,1806.88,,,,,,,,,,,,, SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT,99173,CPT ,,Both,,,1812,,,,,,,,,,,,, PNEUMOCOCCAL VACC 13 VAL IM,90670,CPT ,,Both,,,1813.84,,,,,,,,,,,,, APPLICATION OF LONG LEG CAST - WALKER OR AMBULATORY TYPE,29355,CPT ,,Both,,,1823,,,,,,,,,,,,, RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,70130,CPT ,,Both,,,1824,,,,,,,,,,,,, TREAT STERNUM FRACTURE,21820,CPT ,,Both,,,1832,,,,,,,,,,,,, CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,24640,CPT ,,Both,,,1832.63,,,,,,,,,,,,, C-ARM OVER 1 HOUR,76001,CPT ,,Both,,,1839.38,,,,,,,,,,,,, APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,29450,CPT ,,Both,,,1839.75,,,,,,,,,,,,, MESH (IMPLANTABLE),C1781,HCPCS,,Both,,,1849,,,,,,,,,,,,, US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,76816,CPT ,,Both,,,1854,,,,,,,,,,,,, 3D ULTSND PRCSS NO IND WRKSTN,76376,CPT ,,Both,,,1855.01,,,,,,,,,,,,, ESTROGEN CONJ 25MG INJ,J1410,HCPCS,,Both,0.025,GM,1869.58,,,,,,,,,,,,, KO ELASTIC WITH JOINTS,L1810,HCPCS,,Both,,,1872,,,,,,,,,,,,, X-RAY GUIDE INTESTINAL TUBE,74355,CPT ,,Both,,,1874,,,,,,,,,,,,, DRESS/DEBRID P-THICK BURN MEDIUM,16025,CPT ,,Both,,,1875.75,,,,,,,,,,,,, "FNA EVALUATION, INTERP/REPORT",88173,CPT ,,Both,,,1881.75,,,,,,,,,,,,, PSYCH DIAGNOSTIC EVALUATION,90791,CPT ,,Both,,,1892.38,,,,,,,,,,,,, VENO CAVAL INF W/SERIAL S&I,75825,CPT ,,Both,,,1896.63,,,,,,,,,,,,, CLTX FX GRT TOE PHLX/PHLG W/O MANJ,28490,CPT ,,Both,,,1898.63,,,,,,,,,,,,, ANGIOPLASTY VENOUS S&I,75978,CPT ,,Both,,,1900.88,,,,,,,,,,,,, "DEBRIDEMENT, BONE; EACH ADDTL 20SQ CM OR PART OF",11047,CPT ,,Both,,,1910.5,,,,,,,,,,,,, EXC TR-EXT B9+MARG 0.6-1 CM,11401,CPT ,,Both,,,1910.5,,,,,,,,,,,,, ULS OBSTETRIC DETAILED EA ADDL,76812,CPT ,,Both,,,1916.63,,,,,,,,,,,,, ANGIOPLASTY PERIPH ART S&I,75962,CPT ,,Both,,,1917.88,,,,,,,,,,,,, FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,10021,CPT ,,Both,,,1926.75,,,,,,,,,,,,, Ibandronate sodium injection,J1740,HCPCS,,Both,0.001,GM,1940.6,,,,,,,,,,,,, US BREAST UNI REAL TIME WITH IMAGE LIMITED,76642,CPT ,,Both,,,1941.41,,,,,,,,,,,,, RABIES VACCINE ID,90676,CPT ,,Both,,,1945.5,,,,,,,,,,,,, DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,76827,CPT ,,Both,,,1948.41,,,,,,,,,,,,, INITIAL HOSPITAL CARE/DAY 70 MINUTES,99223,CPT ,,Both,,,1950,,,,,,,,,,,,, INITIAL OBSERVATION CARE/DAY 70 MINUTES,99220,CPT ,,Both,,,1950,,,,,,,,,,,,, SBSQ HOSPITAL CARE/DAY 35 MINUTES,99233,CPT ,,Both,,,1950,,,,,,,,,,,,, SBSQ OBSERVATION CARE/DAY 35 MINUTES,99226,CPT ,,Both,,,1950,,,,,,,,,,,,, INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,CPT ,,Both,,,1954.25,,,,,,,,,,,,, BARIUM ENEMA W/GAST,74270,CPT ,,Both,,,1956.38,,,,,,,,,,,,, ESOPHAGUS ENDOSCOPY WITH FB REMOVAL,43215,CPT ,,Both,,,1958.5,,,,,,,,,,,,, REMOVE ESOPHAGUS OBSTRUCTION,74235,CPT ,,Both,,,1960,,,,,,,,,,,,, AORTOGRAPHY THORACIC S&I,75605,CPT ,,Both,,,1965.25,,,,,,,,,,,,, AORTOGRAM ABDOMINAL S&I,75625,CPT ,,Both,,,1968.5,,,,,,,,,,,,, BIOPSY OF PALATE UVULA,42100,CPT ,,Both,,,1975.25,,,,,,,,,,,,, UPPER GI ENDOSCOPY WITH TUBE,43241,CPT ,,Both,,,1980.38,,,,,,,,,,,,, Dislocation reduction interphalangeal joint with anesthesia,28665,CPT ,,Both,,,1992.13,,,,,,,,,,,,, "BLOCK INJ INTERCOSTAL NERVE MULTIPLE, REGIONAL BLOCK",64421,CPT ,,Both,,,1992.63,,,,,,,,,,,,, CULT SKIN GRFT F/N/HFG ADD,15156,CPT ,,Both,,,1999.75,,,,,,,,,,,,, "TISSUE CULTURE,LYMPHOCYTE",88230,CPT ,,Both,,,2001.75,,,,,,,,,,,,, VENO EXTREMITY BI S&I,75822,CPT ,,Both,,,2003.38,,,,,,,,,,,,, Baclofen 10 MG injection,J0475,HCPCS,,Both,0.01,GM,2003.78,,,,,,,,,,,,, US POPLITEAL FOSSA,76880,CPT ,,Both,,,2009.44,,,,,,,,,,,,, "DILATION OF ESOPHAGUS, SINGLE/MULTI PASS",43450,CPT ,,Both,,,2016.63,,,,,,,,,,,,, BONE SURVEY INFANT,77076,CPT ,,Both,,,2019.18,,,,,,,,,,,,, CHEST 4 VIEWS,71030,CPT ,,Both,,,2019.18,,,,,,,,,,,,, CHEST X-RAY FRNT LAT OBLIQUE,71022,CPT ,,Both,,,2019.18,,,,,,,,,,,,, RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,73560,CPT ,,Both,,,2019.18,,,,,,,,,,,,, UPPER EXTREMITY INFANT,73092,CPT ,,Both,,,2019.18,,,,,,,,,,,,, VASCULAR STUDY,93976,CPT ,,Both,,,2021.65,,,,,,,,,,,,, CLOSED TX METATARSOPHALANGEAL JOINT W/O ANESTH,28630,CPT ,,Both,,,2025.88,,,,,,,,,,,,, X-RAY GUIDE GI DILATION,74360,CPT ,,Both,,,2038.63,,,,,,,,,,,,, STRAPPING KNEE,29530,CPT ,,Both,,,2040,,,,,,,,,,,,, LUMBAR PUNCTURE,62270,CPT ,,Both,,,2046.13,,,,,,,,,,,,, CHLOROTHIAZIDE 500MG INJ,J1205,HCPCS,,Both,0.5,GM,2049.76,,,,,,,,,,,,, "Radiologic examination, abdomen; 2 views",74019,CPT ,,Both,,,2058,,,,,,,,,,,,, ANGIO PUL UN SELECT S&I,75741,CPT ,,Both,,,2063.38,,,,,,,,,,,,, APPLY LONG LEG CAST BRACE,29358,CPT ,,Both,,,2069.75,,,,,,,,,,,,, RPR FE/E/EN/L/M 20.1-30.0 CM,12017,CPT ,,Both,,,2079.48,,,,,,,,,,,,, DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,93980,CPT ,,Both,,,2080,,,,,,,,,,,,, "CLOSED TX TALOTARSAL JOINT DISLO, W/O ANESTH",28570,CPT ,,Both,,,2085,,,,,,,,,,,,, "OPEN TX OF FX, PHALANX OR PHALANGES, OTHER THAN GREAT TOE,, INCLUDES INTERNAL FIXATION",28525,CPT ,,Both,,,2086,,,,,,,,,,,,, "CLOSED TX FX PHALANX OR PHALANGESOTHER THAN GREAT TOE, W/ MANIP, EACH",28515,CPT ,,Both,,,2086.63,,,,,,,,,,,,, CONTRST X-RAY UPPR GI TRACT,74249,CPT ,,Both,,,2088.75,,,,,,,,,,,,, RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,72170,CPT ,,Both,,,2111,,,,,,,,,,,,, EXC H-F-NK-SP B9+MARG 0.6-1,11421,CPT ,,Both,,,2121.25,,,,,,,,,,,,, SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,12005,CPT ,,Both,,,2121.25,,,,,,,,,,,,, EXC TR-EXT B9+MARG 1.1-2 CM,11402,CPT ,,Both,,,2122.63,,,,,,,,,,,,, "INTRAORAL I&D ABSCESS,CYST,HEMATOMA TONGUE OR FLOOR MOUTH, LINGUAL",41000,CPT ,,Both,,,2128.63,,,,,,,,,,,,, EXC TR-EXT B9+MARG 0.5 CM<,11400,CPT ,,Both,,,2131.63,,,,,,,,,,,,, WEDGE RESECTION TOENAIL,11765,CPT ,,Both,,,2131.63,,,,,,,,,,,,, BARIUM ENEMA/AIR CONTRAST,74280,CPT ,,Both,,,2135.88,,,,,,,,,,,,, HPV VACCINE 2 VALENT IM,90650,CPT ,,Both,,,2141.17,,,,,,,,,,,,, CHROM ANALYSIS 20-25 CELLS,88264,CPT ,,Both,,,2141.63,,,,,,,,,,,,, CHROM COUNT 15-20 CELLS,88262,CPT ,,Both,,,2141.63,,,,,,,,,,,,, "Radiologic examination, abdomen; 1 view",74018,CPT ,,Both,,,2142,,,,,,,,,,,,, "BIOPSY OF SKIN AND SUBCUTANEOUS TISSUE, EACH ADDL LESION",11101,CPT ,,Both,,,2152.75,,,,,,,,,,,,, EXC FACE-MM B9+MARG 0.6-1 CM,11441,CPT ,,Both,,,2152.75,,,,,,,,,,,,, Drainage of Abscess; intraoral,42310,CPT ,,Both,,,2153.63,,,,,,,,,,,,, X-RAY HIP UNILATERAL 2 VIEWS,73510,CPT ,,Both,,,2154,,,,,,,,,,,,, "AMINOLEVULAN, 354MG (1 UNIT=354MG)",J7308,HCPCS,,Both,0.354,GM,2157.5,,,,,,,,,,,,, UNLISTED PROCEDURE LARYNX,31599,CPT ,,Both,,,2160,,,,,,,,,,,,, ESOPHAGUS W/GASTROGRAFFIN,74220,CPT ,,Both,,,2160.91,,,,,,,,,,,,, "INJECT MEDICATION, ANTERIOR CHAMBER OF EYE",66030,CPT ,,Both,,,2162.63,,,,,,,,,,,,, TISSUE CULTURE BONE MARROW,88237,CPT ,,Both,,,2170.25,,,,,,,,,,,,, ECHOGRAP TRANS R PROS STUDY,76873,CPT ,,Both,,,2170.63,,,,,,,,,,,,, PLATELET RICH PLASMA PROCESS,P9020,HCPCS,,Both,,,2171.55,,,,,,,,,,,,, CLOSURE OF SPLIT WOUND,12021,CPT ,,Both,,,2177,,,,,,,,,,,,, CHEMODENERV NECK MUSCLE,64613,CPT ,,Both,,,2180.75,,,,,,,,,,,,, RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,70030,CPT ,,Both,,,2190,,,,,,,,,,,,, CONTROL OROPHARYNGEAL HEMORRHAGE,42960,CPT ,,Both,,,2195.5,,,,,,,,,,,,, KIDNEY W/FLOW&FUNCT W/ PHARM,78708,CPT ,,Both,,,2195.5,,,,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM,12015,CPT ,,Both,,,2198,,,,,,,,,,,,, "Platelets, irradiated",P9032,HCPCS,,Both,,,2198.21,,,,,,,,,,,,, Uper GI Endo with balloon dilation of esophagus,43249,CPT ,,Both,,,2201.88,,,,,,,,,,,,, Inj trimetrexate glucoronate,J3305,HCPCS,,Both,0.025,GM,2203.48,,,,,,,,,,,,, PERC VERTEBROPLSTY PER VRT S&I,72291,CPT ,,Both,,,2210.75,,,,,,,,,,,,, RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,72190,CPT ,,Both,,,2214,,,,,,,,,,,,, Orthovisc inj per dose,J7324,HCPCS,,Both,0.01,GM,2214.46,,,,,,,,,,,,, REPAIR OF TUNNELED OR NON-TUNNELED CV CATH,36575,CPT ,,Both,,,2214.5,,,,,,,,,,,,, TEMPORARY TRANSVENOUS PACEMAKER,33210,CPT ,,Both,,,2214.63,,,,,,,,,,,,, ANGIO PELVIC SEL/SUP SEL S&I,75736,CPT ,,Both,,,2217.25,,,,,,,,,,,,, OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES,99235,CPT ,,Both,,,2223.47,,,,,,,,,,,,, CLTX METATARSOPHLNGL JT DISLC REQ ANES,28635,CPT ,,Both,,,2227.13,,,,,,,,,,,,, "INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",62273,CPT ,,Both,,,2236.88,,,,,,,,,,,,, EXC H-F-NK-SP B9+MARG 1.1-2,11422,CPT ,,Both,,,2242,,,,,,,,,,,,, PARING OR CUTTING OF LESION; >4 LESIONS,11057,CPT ,,Both,,,2242,,,,,,,,,,,,, HPV VACCINE 4 VALENT IM,90649,CPT ,,Both,,,2246.73,,,,,,,,,,,,, ANGIOPLSTY RENAL/VISC ART S&I,75966,CPT ,,Both,,,2251.25,,,,,,,,,,,,, INT/EX BILIARY STENT/DRAIN S&I,75982,CPT ,,Both,,,2254.13,,,,,,,,,,,,, CMPLX RPR F/C/C/M/N/AX/G/H/F,13133,CPT ,,Both,,,2257.88,,,,,,,,,,,,, ABD PARACENTESIS,49082,CPT ,,Both,,,2262.75,,,,,,,,,,,,, REMOVE PHARYNX FOREIGN BODY,42809,CPT ,,Both,,,2263.5,,,,,,,,,,,,, WHFO W/O JOINTS PRE OTS,L3809,HCPCS,,Both,,,2268,,,,,,,,,,,,, "WHFO, RIGID W/O JOINTS",L3808,HCPCS,,Both,,,2268,,,,,,,,,,,,, WHO W/NONTORSION JNT(S) CF,L3905,HCPCS,,Both,,,2268,,,,,,,,,,,,, STERNOCLAVICULAR JOINTS MIN 3V,71130,CPT ,,Both,,,2269.69,,,,,,,,,,,,, RADEX FINGR MINIMUM 2 VIEWS,73140,CPT ,,Both,,,2274,,,,,,,,,,,,, RADEX RIBS UNILATERAL 2 VIEWS,71100,CPT ,,Both,,,2274,,,,,,,,,,,,, RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,74022,CPT ,,Both,,,2275,,,,,,,,,,,,, "CLOSED TX HIP DISLO, TRAUMATIC",27250,CPT ,,Both,,,2277.25,,,,,,,,,,,,, RADEX SHOULDER 1 VIEW,73020,CPT ,,Both,,,2279,,,,,,,,,,,,, Pralatrexate injection,J9307,HCPCS,,Both,0.001,GM,2282.64,,,,,,,,,,,,, ANGIO EXTREME UNI W/CONT S&I,75710,CPT ,,Both,,,2285.5,,,,,,,,,,,,, ANGIO VISCERAL S&I,75726,CPT ,,Both,,,2293,,,,,,,,,,,,, INCISE EXTERNAL HEMORRHOID,46083,CPT ,,Both,,,2293.13,,,,,,,,,,,,, TREAT TAIL BONE FRACTURE,27200,CPT ,,Both,,,2295.13,,,,,,,,,,,,, "TRACHEOSTOMY, CRICOTHYROID MEMBRANE",31605,CPT ,,Both,,,2299.13,,,,,,,,,,,,, ULTRSND PREGNANCY LMTD,76815,CPT ,,Both,,,2300,,,,,,,,,,,,, CLOSED TX FX GREAT TOE W/ MANIP,28495,CPT ,,Both,,,2303.75,,,,,,,,,,,,, SLITTING OF PREPUCE,54001,CPT ,,Both,,,2304.38,,,,,,,,,,,,, INCISION & DRAINAGE PILONIDAL CYST SIMPLE,10080,CPT ,,Both,,,2319.38,,,,,,,,,,,,, BONE IMAGING LIMITED AREA PRO,78300,CPT ,,Both,,,2322.25,,,,,,,,,,,,, MARSUPLIALIZATION OF BARTHOLIN'S GLAND CYST,56440,CPT ,,Both,,,2327.38,,,,,,,,,,,,, NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE,43752,CPT ,,Both,,,2332,,,,,,,,,,,,, AORTA ABD W/BI ILIOFEM S&I,75630,CPT ,,Both,,,2336.88,,,,,,,,,,,,, DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,16030,CPT ,,Both,,,2337.5,,,,,,,,,,,,, RBC DIRECTED PROCESSING,P9021,HCPCS,,Both,,,2344.07,,,,,,,,,,,,, VISUALIZATION OF WINDPIPE,31615,CPT ,,Both,,,2345.5,,,,,,,,,,,,, LOCAL INFLAMM PROCESS LMT AREA,78805,CPT ,,Both,,,2352.13,,,,,,,,,,,,, CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,26750,CPT ,,Both,,,2363.63,,,,,,,,,,,,, BRAIN IMAGING LIMITED STATIC,78600,CPT ,,Both,,,2365,,,,,,,,,,,,, "Radiologic examination, chest ; single view",71045,CPT ,,Both,,,2370,,,,,,,,,,,,, ULS OBSTETRIC DETAIL FIRST TRI,76811,CPT ,,Both,,,2377.25,,,,,,,,,,,,, RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,73552,CPT ,,Both,,,2382,,,,,,,,,,,,, "Upper Endoscopy with dilation (balloon,guide wire, bougie)",43245,CPT ,,Both,,,2383.25,,,,,,,,,,,,, UP GI ENDO W DILATION ESOPHAG,43248,CPT ,,Both,,,2384.88,,,,,,,,,,,,, REMOVAL OF HEMORRHOID CLOT,46320,CPT ,,Both,,,2385.9,,,,,,,,,,,,, "Radiologic examination, abdomen; 3 or more views",74021,CPT ,,Both,,,2389,,,,,,,,,,,,, RADEX FACIAL BONES < 3 VIEWS,70140,CPT ,,Both,,,2394,,,,,,,,,,,,, RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,70150,CPT ,,Both,,,2394,,,,,,,,,,,,, EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,99282,CPT ,,Both,,,2400,,,,,,,,,,,,, "CLOSED TX TARSOMETATARSAL JOINT DISLO, W/O ANESTH",28600,CPT ,,Both,,,2408.25,,,,,,,,,,,,, WHO W/O JOINTS CF,L3906,HCPCS,,Both,,,2420.5,,,,,,,,,,,,, GOSERELIN 3.6 MG SYRINGE,J9202,HCPCS,,Both,0.0036,GM,2427.4,,,,,,,,,,,,, QUINOPRISTIN/DALFOPRISTIN 10ML,J2770,HCPCS,,Both,0.5,GM,2429.04,,,,,,,,,,,,, TUMOR LOCAL LTD AREA,78800,CPT ,,Both,,,2445.63,,,,,,,,,,,,, Removal of indwelling tunneled pleural catheter with cuff,32552,CPT ,,Both,,,2450.5,,,,,,,,,,,,, CLOSED TX SPINE PROCESS FX,22305,CPT ,,Both,,,2451.38,,,,,,,,,,,,, CMPLX RPR E/N/E/L ADDL 5CM/<,13153,CPT ,,Both,,,2453.13,,,,,,,,,,,,, DRAIN EXTERNAL EAR ABSCESS OR HEMATOMA - SIMPLE,69000,CPT ,,Both,,,2460.13,,,,,,,,,,,,, I&D HEMATOMA SEROMA/FLUID COLLECTION,10140,CPT ,,Both,,,2473.24,,,,,,,,,,,,, EPISIOTOMY OR VAGINAL REPAIR,59300,CPT ,,Both,,,2477.25,,,,,,,,,,,,, "CLOSED TX TARSAL BONE DISLO, LTHER THAN TALOTARSAL, W/O ANESTH",28540,CPT ,,Both,,,2487.75,,,,,,,,,,,,, "ESCHAROTOMY, INITIAL INCISION",16035,CPT ,,Both,,,2491.38,,,,,,,,,,,,, TC DPT,90710,CPT ,,Both,,,2493.33,,,,,,,,,,,,, DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,93880,CPT ,,Both,,,2500,,,,,,,,,,,,, DRAINAGE OF TONSIL ABSCESS,42700,CPT ,,Both,,,2515.75,,,,,,,,,,,,, LIVER/SPLEEN SCAN STATIC ONLY,78215,CPT ,,Both,,,2517.88,,,,,,,,,,,,, INITIAL PREVENTIVE EXAM,G0402,HCPCS,,Both,,,2520,,,,,,,,,,,,, RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,76010,CPT ,,Both,,,2520,,,,,,,,,,,,, CLOSED TX ORBIT FX W/O MANIP,21400,CPT ,,Both,,,2526.63,,,,,,,,,,,,, INCISION OF EARDRUM,69420,CPT ,,Both,,,2529.38,,,,,,,,,,,,, IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM,54220,CPT ,,Both,,,2534,,,,,,,,,,,,, CYSTOSCOPY,52000,CPT ,,Both,,,2534.38,,,,,,,,,,,,, LEUPROLIDE 22.5MG KIT,J9217,HCPCS,,Both,0.0075,GM,2535.46,,,,,,,,,,,,, RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,70110,CPT ,,Both,,,2538,,,,,,,,,,,,, RADIOLOGIC EXAMINATION FOOT 2 VIEWS,73620,CPT ,,Both,,,2538,,,,,,,,,,,,, "LARYNGOSCOPY DIRECT, OPERATIVE, W/ FB REMOVAL",31530,CPT ,,Both,,,2539.58,,,,,,,,,,,,, UPPER GI ENDOSCOPY WITH REMOVAL OF FB,43247,CPT ,,Both,,,2540.88,,,,,,,,,,,,, EXC FACE-MM B9+MARG 2.1-3 CM,11443,CPT ,,Both,,,2541.75,,,,,,,,,,,,, RPR F/E/E/N/L/M >30.0 CM,12018,CPT ,,Both,,,2541.75,,,,,,,,,,,,, "CATH, INF, PER/CENT/MIDLINE",C1751,HCPCS,,Both,,,2544,,,,,,,,,,,,, BRAIN IMAGING COMPLETE STATIC 78605,78605,CPT ,,Both,,,2547.88,,,,,,,,,,,,, "CLOSED TX PHALANGEAL SHAFT FX, PROX OR MID PHALANX, FINGER OR THUMB W/O MANIP",26720,CPT ,,Both,,,2551,,,,,,,,,,,,, Synthetic implnt urinary 1ml,L8606,HCPCS,,Both,,,2558.37,,,,,,,,,,,,, SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,12006,CPT ,,Both,,,2563,,,,,,,,,,,,, U/S GUIDED REPAIR PSEUDO-ANEUR,76936,CPT ,,Both,,,2571.75,,,,,,,,,,,,, RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,73501,CPT ,,Both,,,2571.81,,,,,,,,,,,,, "AICD, SINGLE CHAMBER",C1722,HCPCS,,Both,,,2580,,,,,,,,,,,,, EXC BEN LES SCALP 2.1 TO 3.0 CM,11423,CPT ,,Both,,,2581.75,,,,,,,,,,,,, RADEX HAND 2 VIEWS,73120,CPT ,,Both,,,2584,,,,,,,,,,,,, REDUCTION OF RECTAL PROLAPSE,45900,CPT ,,Both,,,2589.5,,,,,,,,,,,,, D & C AFTER DELIVERY,59160,CPT ,,Both,,,2602.75,,,,,,,,,,,,, REMOVAL OF FOREIGN BODY FROM MUSCLE - SIMPLE WITH INCISION,20520,CPT ,,Both,,,2603.5,,,,,,,,,,,,, INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE,10061,CPT ,,Both,,,2605.13,,,,,,,,,,,,, ECHO GUIDE FOR BIOPSY,76942,CPT ,,Both,,,2612.5,,,,,,,,,,,,, INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION,20650,CPT ,,Both,,,2622,,,,,,,,,,,,, SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID,62272,CPT ,,Both,,,2626.5,,,,,,,,,,,,, RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,24200,CPT ,,Both,,,2632.75,,,,,,,,,,,,, RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,71101,CPT ,,Both,,,2634,,,,,,,,,,,,, KIDNEY SPECT,78710,CPT ,,Both,,,2634.13,,,,,,,,,,,,, CONSULT COMPREHENSIVE,88325,CPT ,,Both,,,2637,,,,,,,,,,,,, RASBURICASE 1.5MG INJ,J2783,HCPCS,,Both,0.0005,GM,2641.91,,,,,,,,,,,,, I&D OF SCROTUM,54700,CPT ,,Both,,,2660.63,,,,,,,,,,,,, "DRAINAGE OF ABSCESS OF PALATE, UVULA",42000,CPT ,,Both,,,2666,,,,,,,,,,,,, US GUIDE FOR VASCULAR ACCESS,76937,CPT ,,Both,,,2671.18,,,,,,,,,,,,, RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,CPT ,,Both,,,2700,,,,,,,,,,,,, CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,30903,CPT ,,Both,,,2707.13,,,,,,,,,,,,, LARYNGOSCOPY FOR ASPIRATION,31515,CPT ,,Both,,,2716,,,,,,,,,,,,, DRAINAGE OF SCROTUM ABSCESS,55100,CPT ,,Both,,,2720.25,,,,,,,,,,,,, RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,71020,CPT ,,Both,,,2724,,,,,,,,,,,,, RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,70260,CPT ,,Both,,,2724,,,,,,,,,,,,, RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,71010,CPT ,,Both,,,2724,,,,,,,,,,,,, RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,70250,CPT ,,Both,,,2724,,,,,,,,,,,,, US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,76857,CPT ,,Both,,,2724,,,,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC",31579,CPT ,,Both,,,2728.25,,,,,,,,,,,,, EXC FACE-MM B9+MARG 1.1-2 CM,11442,CPT ,,Both,,,2728.38,,,,,,,,,,,,, RPR FE/E/EN/L/M 12.6-20.0 CM,12016,CPT ,,Both,,,2728.38,,,,,,,,,,,,, LIVER SCAN (SPECT),78205,CPT ,,Both,,,2739.88,,,,,,,,,,,,, RABIES IG IM/SC,90375,CPT ,,Both,,,2747.69,,,,,,,,,,,,, TESTICULAR SCAN W/FLOW,78761,CPT ,,Both,,,2782.5,,,,,,,,,,,,, "REPLACEMENT, COMPLETE, OF A NON-TUNNELED CENTRALLY",36580,CPT ,,Both,,,2785.5,,,,,,,,,,,,, REMOVE FOREIGN BODY LARYNX,31511,CPT ,,Both,,,2787.25,,,,,,,,,,,,, TX TARSAL BONE FX (EXCEPT TALUS AND CALCANEUS) W/O MANIP,28450,CPT ,,Both,,,2795.75,,,,,,,,,,,,, DRAIN EXTERNAL EAR ABSCESS OR HEMATOMA - COMPLICATED,69005,CPT ,,Both,,,2800.63,,,,,,,,,,,,, "ESOPHAGUS ENDOSCOPY, DIAGNOSTIC",43200,CPT ,,Both,,,2805.25,,,,,,,,,,,,, TREAT CLAVICLE FRACTURE W/O MANIPULATION,23500,CPT ,,Both,,,2805.38,,,,,,,,,,,,, "DRAINAGE OF MOUTH LESION, SIMPLE",40800,CPT ,,Both,,,2810.13,,,,,,,,,,,,, EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,CPT ,,Both,,,2838.13,,,,,,,,,,,,, SHAVE SKIN LESION,11300,CPT ,,Both,,,2838.13,,,,,,,,,,,,, ASPIRATION OF BLADDER W/ SUPRAPUBIC CATH INSERTION,51102,CPT ,,Both,,,2849.13,,,,,,,,,,,,, CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,28470,CPT ,,Both,,,2854.38,,,,,,,,,,,,, US BREAST UNI REAL TIME WITH IMAGE COMPLETE,76641,CPT ,,Both,,,2865.56,,,,,,,,,,,,, US CHEST REAL TIME W/IMAGE DOCUMENTATION,76604,CPT ,,Both,,,2865.56,,,,,,,,,,,,, US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,76801,CPT ,,Both,,,2865.56,,,,,,,,,,,,, US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,76770,CPT ,,Both,,,2865.56,,,,,,,,,,,,, OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES,99236,CPT ,,Both,,,2866.72,,,,,,,,,,,,, CLOSED TX ACROMIOCLAVICULAR DISLOCATION; W/O MANIP,23540,CPT ,,Both,,,2869.38,,,,,,,,,,,,, "APPLICATION OF CAST, SHOULDER SPICA",29055,CPT ,,Both,,,2878.5,,,,,,,,,,,,, RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,40804,CPT ,,Both,,,2879.25,,,,,,,,,,,,, ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,93307,CPT ,,Both,,,2880,,,,,,,,,,,,, Prolonged IA Infusion>8hours requiring a pump,C8957,HCPCS,,Both,,,2881.25,,,,,,,,,,,,, IAADIADOO RESPIRATORY SYNCTIAL VIRUS,87807,CPT ,,Both,,,2895.6,,,,,,,,,,,,, "UNLISTED PROCEDURE, LACRIMAL SYSTEM",68899,CPT ,,Both,,,2897,,,,,,,,,,,,, RABIES VACCINE IM,90675,CPT ,,Both,,,2904.81,,,,,,,,,,,,, INSITU HYBRIDIZATION MANUAL,88368,CPT ,,Both,,,2908.75,,,,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC, WITH BIOPSY",31576,CPT ,,Both,,,2912.63,,,,,,,,,,,,, RPR S/N/AX/GEN/TRNK >30.0 CM,12007,CPT ,,Both,,,2915.13,,,,,,,,,,,,, NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,93922,CPT ,,Both,,,2921,,,,,,,,,,,,, "CLOSED TX ARTICULAR FX, W/O MANIP",26740,CPT ,,Both,,,2926.25,,,,,,,,,,,,, RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,72200,CPT ,,Both,,,2940,,,,,,,,,,,,, CLOSED TX STERNOCLAVICULAR DISLOCATION; W/O MANIP,23520,CPT ,,Both,,,2940.88,,,,,,,,,,,,, EXTRACRANIAL STUDY Uni,93882,CPT ,,Both,,,2956.56,,,,,,,,,,,,, RBC leukocytes reduced,P9016,HCPCS,,Both,,,2959.88,,,,,,,,,,,,, ACETAZOLAMIDE 500MG 1ML,J1120,HCPCS,,Both,0.5,GM,2960.06,,,,,,,,,,,,, CLOSED TX SCAPULAR FX W/O MANIPULATION,23570,CPT ,,Both,,,2962.38,,,,,,,,,,,,, KIDNEY W/FLOW&FUNCT W/O PHARM,78707,CPT ,,Both,,,2970.75,,,,,,,,,,,,, DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,93931,CPT ,,Both,,,2976,,,,,,,,,,,,, IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25,87507,CPT ,,Both,,,3001.53,,,,,,,,,,,,, REPAIR OF NAIL BED,11760,CPT ,,Both,,,3008.88,,,,,,,,,,,,, SHAVE SKIN LESION,11301,CPT ,,Both,,,3008.88,,,,,,,,,,,,, CYSTOSCOPY W/ FB REMOVAL,52310,CPT ,,Both,,,3011.38,,,,,,,,,,,,, INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>,36556,CPT ,,Both,,,3014.13,,,,,,,,,,,,, "(Radiologic examination, chest ; 4 or more",71048,CPT ,,Both,,,3024,,,,,,,,,,,,, BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,19100,CPT ,,Both,,,3024,,,,,,,,,,,,, CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS,33512,CPT ,,Both,,,3024,,,,,,,,,,,,, DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,93971,CPT ,,Both,,,3024,,,,,,,,,,,,, ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,74329,CPT ,,Both,,,3024,,,,,,,,,,,,, HOSPITAL OBSERVATION PER HR,G0378,HCPCS,,Both,,,3024,,,,,,,,,,,,, MYELOGRAPY 2/MORE REGIONS RS&I,72270,CPT ,,Both,,,3024,,,,,,,,,,,,, NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,93923,CPT ,,Both,,,3024,,,,,,,,,,,,, PERITONEOGRAM RS&I,74190,CPT ,,Both,,,3024,,,,,,,,,,,,, PUNCTURE ASPIRATION CYST BREAST,19000,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,74000,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,73050,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX CALCANEUS MINIMUM 2 VIEWS,73650,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX CHEST SPECIAL VIEWS,71035,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX CLAVICLE COMPLETE,73000,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX ELBOW 2 VIEWS,73070,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,73080,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,72082,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX FOREARM 2 VIEWS,73090,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB,74241,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB,74240,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES,74245,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX HAND MINIMUM 3 VIEWS,73130,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,73503,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,73521,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,73522,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX HUMERUS MINIMUM 2 VIEWS,73060,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,73592,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,70160,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,70200,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,71111,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX RIBS BILATERAL 3 VIEWS,71110,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,72220,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SCAPULA COMPLETE,73010,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SINUSES PARANASAL <3 VIEWS,70210,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,70220,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE,74251,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES,74250,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE 1 VIEW SPECIFY LEVEL,72020,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE CERVICAL 2 OR 3 VIEWS,72040,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,72114,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE THORACIC 2 VIEWS,72070,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE THORACIC 3 VIEWS,72072,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE THORACIC MINIMUM 4 VIEWS,72074,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,72080,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX STERNUM MINIMUM 2 VIEWS,71120,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,70330,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX WRIST 2 VIEWS,73100,CPT ,,Both,,,3024,,,,,,,,,,,,, RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,73564,CPT ,,Both,,,3024,,,,,,,,,,,,, RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,CPT ,,Both,,,3024,,,,,,,,,,,,, RADIOLOGIC EXAMINATION NECK SOFT TISSUE,70360,CPT ,,Both,,,3024,,,,,,,,,,,,, RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,73590,CPT ,,Both,,,3024,,,,,,,,,,,,, "Radiologic examination, chest ; 2 views",71046,CPT ,,Both,,,3024,,,,,,,,,,,,, "Radiologic examination, chest ; 3 views",71047,CPT ,,Both,,,3024,,,,,,,,,,,,, US EXTREMITY NON-VASC REAL-TIME IMG COMPL,76881,CPT ,,Both,,,3024,,,,,,,,,,,,, US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,76856,CPT ,,Both,,,3024,,,,,,,,,,,,, US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,76810,CPT ,,Both,,,3024,,,,,,,,,,,,, US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,76805,CPT ,,Both,,,3024,,,,,,,,,,,,, US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,76817,CPT ,,Both,,,3024,,,,,,,,,,,,, US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,76775,CPT ,,Both,,,3024,,,,,,,,,,,,, US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,76536,CPT ,,Both,,,3024,,,,,,,,,,,,, VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,74440,CPT ,,Both,,,3024,,,,,,,,,,,,, RADEX SPINE CERVICAL 4 OR 5 VIEWS,72050,CPT ,,Both,,,3025,,,,,,,,,,,,, RADEX SPINE CERVICAL 6 OR MORE VIEWS,72052,CPT ,,Both,,,3025,,,,,,,,,,,,, CARD BLOOD POOL IMG SNGL STUDY,78472,CPT ,,Both,,,3032.24,,,,,,,,,,,,, Cauterize inner nose/superficial - simple,30801,CPT ,,Both,,,3041.38,,,,,,,,,,,,, "DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH",30000,CPT ,,Both,,,3043.88,,,,,,,,,,,,, CLOSED TX TALUS FX W/O MANIP,28430,CPT ,,Both,,,3046,,,,,,,,,,,,, PROCTOSIGMOIDOSCOPY FB REMOVAL,45307,CPT ,,Both,,,3049.38,,,,,,,,,,,,, DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,93926,CPT ,,Both,,,3049.75,,,,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,12031,CPT ,,Both,,,3054.88,,,,,,,,,,,,, BONE IMAGING MULT AREAS,78305,CPT ,,Both,,,3055.5,,,,,,,,,,,,, REMOVAL OF SALIVARY STONE,42330,CPT ,,Both,,,3060.63,,,,,,,,,,,,, LUNG PERFUSION,78580,CPT ,,Both,,,3064.13,,,,,,,,,,,,, ANOSCOPY REMOVE FB,46608,CPT ,,Both,,,3072.5,,,,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, SUBLINGUAL, SUPERFICIAL",41005,CPT ,,Both,,,3075.25,,,,,,,,,,,,, WHOLE BLOOD PROCESSING,P9010,HCPCS,,Both,,,3080.94,,,,,,,,,,,,, "DRAIN EXTERNAL AUDITORY CANAL, ABSCESS",69020,CPT ,,Both,,,3083.13,,,,,,,,,,,,, I&D SHOULDER DEEP ABSCESS/HEMATOMA,23030,CPT ,,Both,,,3085.95,,,,,,,,,,,,, REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,30300,CPT ,,Both,,,3088,,,,,,,,,,,,, "DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM",30020,CPT ,,Both,,,3091.5,,,,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,12041,CPT ,,Both,,,3102,,,,,,,,,,,,, Canthotomy,67715,CPT ,,Both,,,3140,,,,,,,,,,,,, Ophthalmic Ultrasound;Diagnostic of Eye,76512,CPT ,,Both,,,3140.55,,,,,,,,,,,,, TUMOR LOCAL MULT AREAS,78801,CPT ,,Both,,,3140.63,,,,,,,,,,,,, HCV GENOTYPE,87902,CPT ,,Both,,,3149,,,,,,,,,,,,, INCISION OF PERIANAL ABSCESS,46050,CPT ,,Both,,,3150.32,,,,,,,,,,,,, "COMPLEX DRAINAGE WOUND, POST-OP WOUND INFECTION",10180,CPT ,,Both,,,3161.25,,,,,,,,,,,,, RADEX WRIST COMPLETE MINIMUM 3 VIEWS,73110,CPT ,,Both,,,3164,,,,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC, WITH REMOVAL OF FB",31577,CPT ,,Both,,,3166.75,,,,,,,,,,,,, INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,36569,CPT ,,Both,,,3169.88,,,,,,,,,,,,, REMOVE FB EYELID,67938,CPT ,,Both,,,3175.75,,,,,,,,,,,,, Etanercept injection,J1438,HCPCS,,Both,0.025,GM,3188.76,,,,,,,,,,,,, PROBE NASOLACRIMAL DUCT,68810,CPT ,,Both,,,3189.38,,,,,,,,,,,,, APPLICATION OF HIP SPICA CAST,29305,CPT ,,Both,,,3193.25,,,,,,,,,,,,, LYSIS OR EXCISION OF PENILE POST CIRCUM ADHESIONS,54162,CPT ,,Both,,,3203.38,,,,,,,,,,,,, US TRANSVAGINAL,76830,CPT ,,Both,,,3208,,,,,,,,,,,,, "REPAIR, LACERATION OF PALATE, UP TO 2 CM",42180,CPT ,,Both,,,3213.88,,,,,,,,,,,,, US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,76700,CPT ,,Both,,,3224,,,,,,,,,,,,, BONE IMAGING WHOLE BODY,78306,CPT ,,Both,,,3234.63,,,,,,,,,,,,, RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,CPT ,,Both,,,3235,,,,,,,,,,,,, CLOSED TX CALCANEAL FX W/O MANIP,28400,CPT ,,Both,,,3241.63,,,,,,,,,,,,, DX LARYNGOSCOPY EXCL NB,31525,CPT ,,Both,,,3256.38,,,,,,,,,,,,, RADEX SPINE LUMBOSACRAL 2/3 VIEWS,72100,CPT ,,Both,,,3258,,,,,,,,,,,,, CLOSED TX METATARSAL FX W/ MANIP,28475,CPT ,,Both,,,3260.38,,,,,,,,,,,,, "Removal of embedded foreign body from dentalalveolar structure, soft tissue",41805,CPT ,,Both,,,3275,,,,,,,,,,,,, DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,93930,CPT ,,Both,,,3280,,,,,,,,,,,,, CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,74330,CPT ,,Both,,,3286,,,,,,,,,,,,, PERITONEAL SHUNT PATENCY TEST,78291,CPT ,,Both,,,3298.25,,,,,,,,,,,,, RADIOLOGIC EXAMINATION KNEE 3 VIEWS,73562,CPT ,,Both,,,3300,,,,,,,,,,,,, REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,12051,CPT ,,Both,,,3314.5,,,,,,,,,,,,, INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y,36555,CPT ,,Both,,,3320.25,,,,,,,,,,,,, FLUID PRESSURE MUSCLE,20950,CPT ,,Both,,,3324.13,,,,,,,,,,,,, TX TARSAL BONE FX (EXCEPT TALUS AND CALCANEUS) W/ MANIP,28455,CPT ,,Both,,,3335.75,,,,,,,,,,,,, INSERTION OF CHEST TUBE,32551,CPT ,,Both,,,3345.87,,,,,,,,,,,,, REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,CPT ,,Both,,,3353,,,,,,,,,,,,, CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,24650,CPT ,,Both,,,3363.5,,,,,,,,,,,,, CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,30905,CPT ,,Both,,,3366.5,,,,,,,,,,,,, CLOSED TX ULNAR SHAFT FX W/O MANIP,25530,CPT ,,Both,,,3367.88,,,,,,,,,,,,, CARDIOVERSION ELECTRIC EXT,92960,CPT ,,Both,,,3368.78,,,,,,,,,,,,, CLOSED TX NOSE FX W/ STABLJ,21320,CPT ,,Both,,,3371.5,,,,,,,,,,,,, BIOPSY OF NECK/CHEST,21550,CPT ,,Both,,,3384,,,,,,,,,,,,, PARATHYROID SCAN,78070,CPT ,,Both,,,3387.88,,,,,,,,,,,,, "Cystoscopy, with calibration and /or dilation of urethral stricture or stenosis",52281,CPT ,,Both,,,3390.5,,,,,,,,,,,,, RBC irradiated,P9038,HCPCS,,Both,,,3405.51,,,,,,,,,,,,, ZOLEDRONIC ACID 4MG INJ,J3487,HCPCS,,Both,0.001,GM,3424.73,,,,,,,,,,,,, CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,99292,CPT ,,Both,,,3427.08,,,,,,,,,,,,, DRAINAGE FINGER ABSCESS SIMPLE,26010,CPT ,,Both,,,3434.63,,,,,,,,,,,,, DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,CPT ,,Both,,,3455,,,,,,,,,,,,, OPRELVEKIN 5MG INJ,J2355,HCPCS,,Both,0.005,GM,3457.45,,,,,,,,,,,,, CLOSED TX GREATER HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT ,,Both,,,3459.88,,,,,,,,,,,,, CLOSED TX RADIAL SHAFT FX W/O MANIP,25500,CPT ,,Both,,,3482.75,,,,,,,,,,,,, Injection of substance into lower spine canal using imaging guidance,62323,CPT ,,Both,,,3500,,,,,,,,,,,,, DRAINAGE OF PILONIDAL CYST - COMPLICATED/MULT,10081,CPT ,,Both,,,3503.75,,,,,,,,,,,,, LIGATION OF HEMORRHOID(S),46221,CPT ,,Both,,,3513.13,,,,,,,,,,,,, DRAINAGE OF EYELID ABSCESS,67700,CPT ,,Both,,,3516.38,,,,,,,,,,,,, APPLICATION OF HIP SPICA CAST - 1 1/2 OR BOTH LEGS,29325,CPT ,,Both,,,3528.75,,,,,,,,,,,,, INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL,10121,CPT ,,Both,,,3531.38,,,,,,,,,,,,, REPAIR MOUTH LACERATION 2.5 CM OR LESS,40830,CPT ,,Both,,,3540.5,,,,,,,,,,,,, CLTX IPHAL JT DISLC W/MANJ W/O ANES,26770,CPT ,,Both,,,3541,,,,,,,,,,,,, DRAINAGE OF RECTAL ABSCESS,45005,CPT ,,Both,,,3543,,,,,,,,,,,,, REMOVAL OF ANAL TAGS,46230,CPT ,,Both,,,3554.13,,,,,,,,,,,,, Repair of lac <2.5 cm to floor of mouth and/or tongue,41250,CPT ,,Both,,,3561.5,,,,,,,,,,,,, Destruction of lesion or scar vestibule mouth,40820,CPT ,,Both,,,3569,,,,,,,,,,,,, DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,93925,CPT ,,Both,,,3570,,,,,,,,,,,,, "EGD,Control of Bleeding,Any Method",43255,CPT ,,Both,,,3570,,,,,,,,,,,,, RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,72110,CPT ,,Both,,,3571,,,,,,,,,,,,, CLOSED TX RADIAL AND ULNAR SHAFT FX W/O MANIP,25560,CPT ,,Both,,,3575.38,,,,,,,,,,,,, "CYSTOSTOMY, CYSTOTOMY W/DRAINAGE",51040,CPT ,,Both,,,3586.63,,,,,,,,,,,,, CLOSURE OF SPLIT WOUND,12020,CPT ,,Both,,,3603.25,,,,,,,,,,,,, TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,11719,CPT ,,Both,,,3603.25,,,,,,,,,,,,, FILGRASTIM 300MCG/ML 1ML,J1440,HCPCS,,Both,1,ML,3608.64,,,,,,,,,,,,, MECKELS DIVERTICULUM SCAN,78290,CPT ,,Both,,,3617.88,,,,,,,,,,,,, CLSD TX POSTERIOR MALLEOLUS FX W/O MANIPULATION,27767,CPT ,,Both,,,3621.75,,,,,,,,,,,,, RECONSTRUCTION OF NAIL BED,11762,CPT ,,Both,,,3633.25,,,,,,,,,,,,, CSF SHUNT EVALUATION,78645,CPT ,,Both,,,3643.13,,,,,,,,,,,,, US SCROTUM & CONTENTS,76870,CPT ,,Both,,,3654,,,,,,,,,,,,, I&D DENTAL ABSCESS,41800,CPT ,,Both,,,3661.13,,,,,,,,,,,,, DRAINAGE LYMPH NODE ABSCESS,38300,CPT ,,Both,,,3662.25,,,,,,,,,,,,, "NASAL HEMORRHAGE CONTROL, POSTERIOR, SUBSEQUENT",30906,CPT ,,Both,,,3678,,,,,,,,,,,,, "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE, EPIDURAL , LUMBAR, SACRAL",62282,CPT ,,Both,,,3687.5,,,,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,12042,CPT ,,Both,,,3689.13,,,,,,,,,,,,, GASTRIC EMPTYING SCAN,78264,CPT ,,Both,,,3690.38,,,,,,,,,,,,, DRAINAGE OF ARM BURSA,23931,CPT ,,Both,,,3705.75,,,,,,,,,,,,, PATHOLOGY LEVEL V,88307,CPT ,,Both,,,3727.5,,,,,,,,,,,,, Gastrointestional Endoscopy Upper with Ligation,43244,CPT ,,Both,,,3727.75,,,,,,,,,,,,, AMIFOSTINE 500MG INJ,J0207,HCPCS,,Both,0.5,GM,3731.76,,,,,,,,,,,,, "CLOSED TX ULNAR FX, PROX, W/O MANIP",24670,CPT ,,Both,,,3737,,,,,,,,,,,,, NASAL ENDOSCOPY DX,31231,CPT ,,Both,,,3739.25,,,,,,,,,,,,, ETHANOLAMINE OLEATE 5% 2ML INJ,J1430,HCPCS,,Both,0.1,GM,3749.21,,,,,,,,,,,,, REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM,12052,CPT ,,Both,,,3757.25,,,,,,,,,,,,, RBC leukoreduced irradiated,P9040,HCPCS,,Both,,,3764.64,,,,,,,,,,,,, DRAIN PERC TRANS HEP S&I,75980,CPT ,,Both,,,3771.5,,,,,,,,,,,,, INSERT PICC CATH < 5 YR,36568,CPT ,,Both,,,3775.25,,,,,,,,,,,,, Removal of Tunneled Catheter w/ subcu port by Incision and Sutures,36590,CPT ,,Both,,,3790,,,,,,,,,,,,, EXCISION OF BARTHOLIN'S GLAND OR CYST,56740,CPT ,,Both,,,3792,,,,,,,,,,,,, GI BLEEDING SCAN ACUTE,78278,CPT ,,Both,,,3801.75,,,,,,,,,,,,, "Colporrhaphy, suture of injury of vagina",57200,CPT ,,Both,,,3811.75,,,,,,,,,,,,, DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,93975,CPT ,,Both,,,3815,,,,,,,,,,,,, INTERFERON BETA-1A 30MCG,Q3025,HCPCS,,Both,,,3839.26,,,,,,,,,,,,, BIOPSY ANORECTAL WALL ANAL APPROACH,45100,CPT ,,Both,,,3840.13,,,,,,,,,,,,, HEART/LUNG RESUSCITATION CPR,92950,CPT ,,Both,,,3857.75,,,,,,,,,,,,, CLOSED TX VERT FX W/O MANJ,22310,CPT ,,Both,,,3880.25,,,,,,,,,,,,, "CLOSED TX TIBIAL FX, PROX W/O MANIP",27530,CPT ,,Both,,,3885.63,,,,,,,,,,,,, "TX SPONTANEOUS HIP DISLO, W/O MANIP",27256,CPT ,,Both,,,3886.75,,,,,,,,,,,,, UPPR GI ENDOSCOPY DIAGNOSIS,43235,CPT ,,Both,,,3898.13,,,,,,,,,,,,, "CLOSED TX CARPAL BONE FX W/O MANIP, EACH BONE",25630,CPT ,,Both,,,3902.13,,,,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,12032,CPT ,,Both,,,3902.38,,,,,,,,,,,,, MYELOGRAM THORACIC S&I,72255,CPT ,,Both,,,3903.42,,,,,,,,,,,,, REP LAC 2.5 CM OR LESS POST THIRD OF TONGUE,41251,CPT ,,Both,,,3904.5,,,,,,,,,,,,, CLOSED TX NAVICULAR FX W/O MANIP,25622,CPT ,,Both,,,3911.25,,,,,,,,,,,,, DRILL SKULL FOR IMPLANTATION,61107,CPT ,,Both,,,3913.88,,,,,,,,,,,,, SIGMOIDOSCOPY W/FB REMOVAL,45332,CPT ,,Both,,,3920.38,,,,,,,,,,,,, BONE IMAGING 3 PHASE,78315,CPT ,,Both,,,3939.54,,,,,,,,,,,,, BONE IMAGING SPECT,78320,CPT ,,Both,,,3939.54,,,,,,,,,,,,, CLOSED TX PROX FIBULA OR SHAFT FX W/O MANIP,27780,CPT ,,Both,,,3949.5,,,,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,12034,CPT ,,Both,,,3993.5,,,,,,,,,,,,, CLOSED TX FX OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIB W/O MANIP,27824,CPT ,,Both,,,3995,,,,,,,,,,,,, EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE,43246,CPT ,,Both,,,4000,,,,,,,,,,,,, US ABDOMINAL REAL TIME W/IMAGE LIMITED,76705,CPT ,,Both,,,4003,,,,,,,,,,,,, REMOVE BY LIGAT INT HEM GRP,46945,CPT ,,Both,,,4020.88,,,,,,,,,,,,, "CLOSED TX DIST PHALANGEAL FX, W/ MANIP",26755,CPT ,,Both,,,4025.38,,,,,,,,,,,,, CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,23650,CPT ,,Both,,,4029.75,,,,,,,,,,,,, THYROID METASTASES W/BODY,78018,CPT ,,Both,,,4035.75,,,,,,,,,,,,, TREATMENT OF INCOMPLETE ABORTION,59812,CPT ,,Both,,,4066.38,,,,,,,,,,,,, "Bronchoscopy, including fluoro guidance; with brushing",31624,CPT ,,Both,,,4073.75,,,,,,,,,,,,, CLOSED TX DISTAL FIB FX (LATERAL MALLEOLUS) W/O MANIP,27786,CPT ,,Both,,,4077.5,,,,,,,,,,,,, ABD PARACENTESIS W/IMAGING,49083,CPT ,,Both,,,4078,,,,,,,,,,,,, DX BRONCHOSCOPE/WASH,31622,CPT ,,Both,,,4087.75,,,,,,,,,,,,, EXCISON OF NAIL AND ANIL MATRIX; WITH AMPUTATION OF TUFT OF DISTAL PHALANX,11752,CPT ,,Both,,,4088.63,,,,,,,,,,,,, TEMPORAL ARTERY PROCEDURE,37609,CPT ,,Both,,,4091.25,,,,,,,,,,,,, ESOPHAGOS W DIRECT SUBM INJECT,43201,CPT ,,Both,,,4091.38,,,,,,,,,,,,, "CLOSED TX TRIMALLEOLAR ANKLE FX, W/O MANIP",27816,CPT ,,Both,,,4094.75,,,,,,,,,,,,, CLOSED TX ULNAR STYLOID FX,25650,CPT ,,Both,,,4101.75,,,,,,,,,,,,, "CLOSED TX METACARPAL FX, SINGLE W/ MANIP",26605,CPT ,,Both,,,4119.5,,,,,,,,,,,,, "DRAINAGE OF MOUTH LESION, COMPLICATED",40801,CPT ,,Both,,,4129,,,,,,,,,,,,, "CLOSED TX HUMERAL EPICONDYLAR FX, MED OR LAT, W/O MANIP",24560,CPT ,,Both,,,4136.38,,,,,,,,,,,,, "CLOSED TX MEGACARPOPHALANGEAL DISLO, W/ MANIP",26700,CPT ,,Both,,,4140.13,,,,,,,,,,,,, BRONCHOSCOPY WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE,31645,CPT ,,Both,,,4146,,,,,,,,,,,,, "Repair of laceration of tongue, floor of mouth, over 2.6cm or complex",41252,CPT ,,Both,,,4156.25,,,,,,,,,,,,, CLOSED TX PATELLAR FX W/O MANIP,27520,CPT ,,Both,,,4161.13,,,,,,,,,,,,, TUMOR LOCAL WHOLE BODY,78802,CPT ,,Both,,,4167.88,,,,,,,,,,,,, REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL,57415,CPT ,,Both,,,4170.94,,,,,,,,,,,,, "REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX",42182,CPT ,,Both,,,4175.5,,,,,,,,,,,,, CLOSED TX PROX HUMERAL FX W/O MANIP,23600,CPT ,,Both,,,4199.75,,,,,,,,,,,,, "Hip dislocation reduction, with manip., with anesthesia",27257,CPT ,,Both,,,4201.88,,,,,,,,,,,,, "CLOSED TX CARPOMETACARPAL DISLO, W/ MANIP (OTHER THAN THUMB)",26670,CPT ,,Both,,,4211.88,,,,,,,,,,,,, CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,25600,CPT ,,Both,,,4218.13,,,,,,,,,,,,, Each additional digital nerve repair,64832,CPT ,,Both,,,4218.75,,,,,,,,,,,,, ARTHROGRAPHY SHOULDER S&I,73040,CPT ,,Both,,,4221.69,,,,,,,,,,,,, MRA ABD WO CONT,C8901,HCPCS,,Both,,,4231.13,,,,,,,,,,,,, MRA PELVIS W/O CONTRAST,C8919,HCPCS,,Both,,,4231.13,,,,,,,,,,,,, MRI BREAST BI WO CON,C8907,HCPCS,,Both,,,4231.13,,,,,,,,,,,,, Removal of fecal impaction or foreign body (separate procedure) under anesthesia,45915,CPT ,,Both,,,4261.88,,,,,,,,,,,,, LOCAL INFLAMM PROCESS WB,78806,CPT ,,Both,,,4274.38,,,,,,,,,,,,, CMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT ,,Both,,,4275.88,,,,,,,,,,,,, ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,74328,CPT ,,Both,,,4282,,,,,,,,,,,,, BRAIN SCAN W/FLOW COMPLET,78606,CPT ,,Both,,,4291.75,,,,,,,,,,,,, ENDOSCOPY NASAL/SINUS,31238,CPT ,,Both,,,4299.88,,,,,,,,,,,,, CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,26725,CPT ,,Both,,,4305.63,,,,,,,,,,,,, CLOSED TX MEDIAL MALLEOLUS FX W/O MANIP,27760,CPT ,,Both,,,4306.5,,,,,,,,,,,,, CSF LEAKAGE DETECT/LOCALIZE,78650,CPT ,,Both,,,4307.75,,,,,,,,,,,,, CLOSED TX BIMALLEOLAR ANKLE FX W/O MANIP,27808,CPT ,,Both,,,4311.25,,,,,,,,,,,,, WASHED RED BLOOD CELLS PROC,P9022,HCPCS,,Both,,,4341.09,,,,,,,,,,,,, SUTURE PHARYNX FOR WOUND OR INJURY,42900,CPT ,,Both,,,4343.75,,,,,,,,,,,,, LOCAL INFLAMM PROCESS SPECT,78807,CPT ,,Both,,,4351.75,,,,,,,,,,,,, BRONCHOSCOPY W/BIOPSY(S),31625,CPT ,,Both,,,4359,,,,,,,,,,,,, ENDOSCOPIC ERCP SURG,43260,CPT ,,Both,,,4373.5,,,,,,,,,,,,, "CLOSED TX HUMERAL CONDYLAR FX, MED OR LAT, W/O MANIP",24576,CPT ,,Both,,,4374.25,,,,,,,,,,,,, TUMOR LOCAL SPECT,78803,CPT ,,Both,,,4389.75,,,,,,,,,,,,, INTMD RPR FACE/MM 5.1-7.5 CM,12053,CPT ,,Both,,,4437.25,,,,,,,,,,,,, CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE WITHOUT MANIPULATION,27750,CPT ,,Both,,,4441.63,,,,,,,,,,,,, CLOSED TX ACROMIOCLAVICULAR DISLOCATION; W/ MANIP,23545,CPT ,,Both,,,4456,,,,,,,,,,,,, CISTERNOGRAPHY,78630,CPT ,,Both,,,4457.38,,,,,,,,,,,,, REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM,13120,CPT ,,Both,,,4480,,,,,,,,,,,,, REPAIR MOUTH LACERATION OVER 2.5 CM OR COMPLX,40831,CPT ,,Both,,,4480.75,,,,,,,,,,,,, TREAT CLAVICLE FRACTURE W/ MANIPULATION,23505,CPT ,,Both,,,4491.5,,,,,,,,,,,,, UPPER GI ENDOSCOPY BIOPSY,43239,CPT ,,Both,,,4494.5,,,,,,,,,,,,, BRONCHOSCOPY W/FB REMOVAL,31635,CPT ,,Both,,,4502.13,,,,,,,,,,,,, BRAIN SCAN TOMOGRAP SPECT,78607,CPT ,,Both,,,4535.13,,,,,,,,,,,,, Burr holes(s)Ventricular Cath or other Cerebral Monitoring device,61210,CPT ,,Both,,,4575.38,,,,,,,,,,,,, ACUTE VENOUS THROMB IMAG PEPTI,78456,CPT ,,Both,,,4577.63,,,,,,,,,,,,, DRAINAGE OF ARM LESION - DEEP ABSCESS/HEMATOMA,23930,CPT ,,Both,,,4577.88,,,,,,,,,,,,, TREAT HUMERAL SHAFT FX W/O MANIP,24500,CPT ,,Both,,,4582.38,,,,,,,,,,,,, CLOSED TX TALUS FX W/ MANIP,28435,CPT ,,Both,,,4611,,,,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,12044,CPT ,,Both,,,4611.38,,,,,,,,,,,,, Repair of Laceration of Vagina and/or Perineum(non ob),57210,CPT ,,Both,,,4656.88,,,,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, SUBMENTAL SPACE",41007,CPT ,,Both,,,4657.75,,,,,,,,,,,,, "CLOSED TX ARTICULAR FX, W/ MANIP",26742,CPT ,,Both,,,4671,,,,,,,,,,,,, CLOSED TX PATELLAR DISLO W/O ANESTH,27560,CPT ,,Both,,,4673.88,,,,,,,,,,,,, TX CLOSED ELBOW DISLOCATION W/O ANESTH,24600,CPT ,,Both,,,4675,,,,,,,,,,,,, "CLOSED TX CARPOMETACARPAL DISLO, THUMB, W/ MANIP",26641,CPT ,,Both,,,4688.38,,,,,,,,,,,,, INTMD RPR FACE/MM 7.6-12.5CM,12054,CPT ,,Both,,,4733.5,,,,,,,,,,,,, CLOSED TX ANKLE DISLO W/O ANESTH,27840,CPT ,,Both,,,4767.63,,,,,,,,,,,,, CMPLX RPR E/N/E/L 1.0 CM/<,13150,CPT ,,Both,,,4781.25,,,,,,,,,,,,, REPAIR FLEXOR TENDON LEG,27658,CPT ,,Both,,,4800.13,,,,,,,,,,,,, CLOSED TX STERNOCLAVICULAR DISLOCATION; W/ MANIP,23525,CPT ,,Both,,,4810.63,,,,,,,,,,,,, CLOSED TX CALCANEAL FX W/ MANIP,28405,CPT ,,Both,,,4846,,,,,,,,,,,,, CLOSED TX GREATER HUMERAL TUBEROSITY FX W/ MANIP,23625,CPT ,,Both,,,4848.25,,,,,,,,,,,,, CLOSED TX PROX TIBIOFIBULAR JOINT DISLO W/O ANESTH,27830,CPT ,,Both,,,4848.5,,,,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FX W/O MANIP,24530,CPT ,,Both,,,4858.5,,,,,,,,,,,,, MRI T-SPINE WO CONT,72146,CPT ,,Both,,,4859,,,,,,,,,,,,, CLOSED TX GREATER TROCHANTERIC FX,27246,CPT ,,Both,,,4870.88,,,,,,,,,,,,, Dislocation interphalangeal joint with manipulation with anesthesia,26775,CPT ,,Both,,,4914.63,,,,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, SUBMANDIBULAR SPACE",41008,CPT ,,Both,,,4921.63,,,,,,,,,,,,, CMPLX RPR F/C/C/M/N/AX/G/H/F,13131,CPT ,,Both,,,4926.63,,,,,,,,,,,,, "ARTHROTOMY, INTERPHALANGEAL JOINT, EACH",26080,CPT ,,Both,,,4934.63,,,,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,12035,CPT ,,Both,,,4970.13,,,,,,,,,,,,, PED CRITICAL CARE SUBSQ,99472,CPT ,,Both,,,4976.38,,,,,,,,,,,,, "REMOVAL OF IMPLANT, SUPERFICIAL",20670,CPT ,,Both,,,4989.63,,,,,,,,,,,,, ROOM AND BOARD INPATIENT,110,DRG,,Both,,,5000,,,,,,,,,,,,, REPAIR TESTIS INJURY,54670,CPT ,,Both,,,5009.63,,,,,,,,,,,,, EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,99283,CPT ,,Both,,,5040,,,,,,,,,,,,, DRAINAGE OF FINGER ABSCESS - COMPLICATED,26011,CPT ,,Both,,,5047.63,,,,,,,,,,,,, MRI ORB/FACE &/OR NECK WO CONT 70540,70540,CPT ,,Both,,,5055,,,,,,,,,,,,, MRI UP EXTREM WO CONT,73218,CPT ,,Both,,,5059.63,,,,,,,,,,,,, "CLOSED TX PROX TIBIOFIBULAR JOINT DISLO, W/O ANESTH",27831,CPT ,,Both,,,5063.13,,,,,,,,,,,,, CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,23655,CPT ,,Both,,,5077,,,,,,,,,,,,, CMPLX RPR TRUNK 2.6-7.5 CM,13101,CPT ,,Both,,,5080.38,,,,,,,,,,,,, CLOSED TX SCAPULAR FX W/ MANIPULATION,23575,CPT ,,Both,,,5094.13,,,,,,,,,,,,, CLOSED TX POST HIP ARTHROPLASTY DISLOCATION,27265,CPT ,,Both,,,5123.63,,,,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,12045,CPT ,,Both,,,5150.28,,,,,,,,,,,,, REVISION OF PENIS,54435,CPT ,,Both,,,5150.5,,,,,,,,,,,,, CHEST SURGERY PROCEDURE,32999,CPT ,,Both,,,5154.88,,,,,,,,,,,,, CLOSED TX RADIOCARPAL OR INTERCARPAL DISLO W/ MANIP,25660,CPT ,,Both,,,5204.75,,,,,,,,,,,,, REMV EMBEDDED FB MOUTH-COMPLIC,40805,CPT ,,Both,,,5208.25,,,,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, MASTICATOR SPACE",41009,CPT ,,Both,,,5223.63,,,,,,,,,,,,, DEBRIDE EAR,69145,CPT ,,Both,,,5263.38,,,,,,,,,,,,, Dislocation metacarpophalangeal W/ MANIPULATION each with anesthesia,26705,CPT ,,Both,,,5269.63,,,,,,,,,,,,, CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,42970,CPT ,,Both,,,5281.75,,,,,,,,,,,,, CLOSED TX SEPTAL&NOSE FX,21337,CPT ,,Both,,,5298,,,,,,,,,,,,, PERCUTANEOUS SKEL FIXATION OF DISTAL PHALANGEL FX,26756,CPT ,,Both,,,5308.25,,,,,,,,,,,,, CLOSED TX PROX FIBULA OR SHAFT FX W/ MANIP,27781,CPT ,,Both,,,5332.5,,,,,,,,,,,,, "TENOTOMY, OPEN TENDON FLEXOR",28234,CPT ,,Both,,,5355.38,,,,,,,,,,,,, CMPLX RPR E/N/E/L 1.1-2.5 CM,13151,CPT ,,Both,,,5381.75,,,,,,,,,,,,, EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,99284,CPT ,,Both,,,5400,,,,,,,,,,,,, CLOSED TX DISTAL FIB FX (LATERAL MALLEOLUS) W/ MANIP,27788,CPT ,,Both,,,5401.75,,,,,,,,,,,,, CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,23665,CPT ,,Both,,,5413.25,,,,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,12036,CPT ,,Both,,,5414.38,,,,,,,,,,,,, "CLOSED TX CARPOMETACARPAL FX DISLO, THUMB W/ MANIP (BENNETT FX)",26645,CPT ,,Both,,,5417.38,,,,,,,,,,,,, "HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROX END OF PHALANX",28160,CPT ,,Both,,,5466.13,,,,,,,,,,,,, REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM,13121,CPT ,,Both,,,5467.25,,,,,,,,,,,,, UNLISTED PROCEDURE RECTUM,45999,CPT ,,Both,,,5491.88,,,,,,,,,,,,, "UNLISTED PROCEDURE, ANUS",46999,CPT ,,Both,,,5491.88,,,,,,,,,,,,, MRI T-SPINE W/CONT,72147,CPT ,,Both,,,5511.63,,,,,,,,,,,,, "I&D INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL",46045,CPT ,,Both,,,5526.5,,,,,,,,,,,,, RED BLOOD CELLS DEGLYC PROCESS,P9039,HCPCS,,Both,,,5543.89,,,,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, HEAD W/O MANIP",27267,CPT ,,Both,,,5545.13,,,,,,,,,,,,, MRI UP EXTREM JT W/CONT,73222,CPT ,,Both,,,5545.13,,,,,,,,,,,,, "Amputation, metatarsal, with toe",28810,CPT ,,Both,,,5579.63,,,,,,,,,,,,, CLSD TX POSTERIOR MALLEOLUS FX W/ MANIPULATION,27768,CPT ,,Both,,,5589,,,,,,,,,,,,, CLOSED TX RADIAL HEAD OR NECK FX W/ MANIP,24655,CPT ,,Both,,,5597.13,,,,,,,,,,,,, RPR UMBIL HERN REDUC > 5 YR,49585,CPT ,,Both,,,5607.13,,,,,,,,,,,,, PATHOLOGY LEVEL VI,88309,CPT ,,Both,,,5633.88,,,,,,,,,,,,, "XR ABDOMEN, 2 OR MORE VIEWS",74010,CPT ,,Both,,,5636.56,,,,,,,,,,,,, X-RAY URETHRA/BLADDER,74450,CPT ,,Both,,,5636.56,,,,,,,,,,,,, CLOSED TX DISTAL RADIOULNAR DISLO W/ MANIP,25675,CPT ,,Both,,,5653,,,,,,,,,,,,, MRA ABD W/CONT,C8900,HCPCS,,Both,,,5682,,,,,,,,,,,,, MRA PELVIS W/CONTRAST,C8918,HCPCS,,Both,,,5682,,,,,,,,,,,,, FILGRASTIM 300MCG/ML 1.6ML,J1441,HCPCS,,Both,0.00048,GM,5731.34,,,,,,,,,,,,, MRA HEAD W/CONT,70545,CPT ,,Both,,,5749.5,,,,,,,,,,,,, "EXTRAORAL I&D OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH, SUBMANDIBULAR",41017,CPT ,,Both,,,5756,,,,,,,,,,,,, Dislocation carpometacarpal finger each with anesthesia,26675,CPT ,,Both,,,5769.38,,,,,,,,,,,,, "CLOSED TX METACARPAL FX, W/ MANIP, W/ EXT FIXATION",26607,CPT ,,Both,,,5771.88,,,,,,,,,,,,, "CLOSED TX CARPAL BONE FX W/ MANIP, EACH BONE",25635,CPT ,,Both,,,5787.5,,,,,,,,,,,,, ARTERIAL LINE PLACEMENT,36140,CPT ,,Both,,,5796.88,,,,,,,,,,,,, Repair of Lip full thickness Vermilion,40650,CPT ,,Both,,,5802,,,,,,,,,,,,, "CLOSED TX ULNAR FX, PROX LEG, OLECRANON OR CORONOID PROCESS, W/O MANIP",24675,CPT ,,Both,,,5817.25,,,,,,,,,,,,, MRI ORB/FACE/NECK W/CONT,70542,CPT ,,Both,,,5843.5,,,,,,,,,,,,, "CLOSED TX INTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEM FX W/O MANIP",27238,CPT ,,Both,,,5847.13,,,,,,,,,,,,, DRAINAGE OF THROAT ABSCESS,42720,CPT ,,Both,,,5863.13,,,,,,,,,,,,, MRI UP EXTREM W/CONT,73219,CPT ,,Both,,,5907.38,,,,,,,,,,,,, EXPLORE WOUND CHEST,20101,CPT ,,Both,,,5914,,,,,,,,,,,,, DRAIN NECK/CHEST LESION,21501,CPT ,,Both,,,5914.25,,,,,,,,,,,,, CLOSED TX PROX HUMERAL FX W/ MANIP,23605,CPT ,,Both,,,5922.5,,,,,,,,,,,,, PERCUTANEOUS SKELETAL FIXATION OF FINGER FX,26727,CPT ,,Both,,,5931.75,,,,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E >30.0 CM,12037,CPT ,,Both,,,5952.88,,,,,,,,,,,,, "CLOSED TX PELVIC RING FX, DISLO, DIASTASIS OR SUBLUXATION W/O MANIP",27193,CPT ,,Both,,,5956.5,,,,,,,,,,,,, TX CLOSED ELBOW DISLOCATION W/ ANESTH,24605,CPT ,,Both,,,5958.88,,,,,,,,,,,,, EXPLORATION OF TOE JOINT,28024,CPT ,,Both,,,5973.75,,,,,,,,,,,,, REMOVE EXT HEM GROUPS 2+,46250,CPT ,,Both,,,5976.63,,,,,,,,,,,,, CTA PELVIS W&W/O CONTRAST,72191,CPT ,,Both,,,5991.23,,,,,,,,,,,,, CTA LOWER EXTRM W&W/O CONTRAST,73706,CPT ,,Both,,,5991.93,,,,,,,,,,,,, MRI LOW EXTREM W/CONT,73719,CPT ,,Both,,,6005.38,,,,,,,,,,,,, CLOSED TX BIMALLEOLAR ANKLE FX W/ MANIP,27810,CPT ,,Both,,,6016,,,,,,,,,,,,, MRI L-SPINE W/CONT,72149,CPT ,,Both,,,6031.13,,,,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, NECK W/O MANIP",27230,CPT ,,Both,,,6034.38,,,,,,,,,,,,, PERC SKELETAL FIXATION METACARPAL FX EACH BONE,26608,CPT ,,Both,,,6037.38,,,,,,,,,,,,, CLOSED TX INTERCONDYLAR/TUBEROSITY KNEE FX,27538,CPT ,,Both,,,6041.63,,,,,,,,,,,,, MRA UP EXTREM W&WO CONT,73225,CPT ,,Both,,,6045.13,,,,,,,,,,,,, CT CERVICAL SPINE W/CONTRAST MATERIAL,72126,CPT ,,Both,,,6048,,,,,,,,,,,,, CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,70490,CPT ,,Both,,,6048,,,,,,,,,,,,, CT THORACIC SPINE W/CONTRAST MATERIAL,72129,CPT ,,Both,,,6048,,,,,,,,,,,,, INTMD RPR FACE/MM 12.6-20 CM,12055,CPT ,,Both,,,6048.5,,,,,,,,,,,,, OPEN TREATMENT OF NOSE FX,21325,CPT ,,Both,,,6066.63,,,,,,,,,,,,, "CLOSED TX TRANS-SCAPHOPERIULNAR FX DISLO, W/ MANIP",25680,CPT ,,Both,,,6067.5,,,,,,,,,,,,, CLOSED TX NAVICULAR FX W/ MANIP,25624,CPT ,,Both,,,6069.88,,,,,,,,,,,,, CMPLX RPR F/C/C/M/N/AX/G/H/F,13132,CPT ,,Both,,,6079.88,,,,,,,,,,,,, "RPR TENDON, EXTENSOR, FOOT W/O FREE GRAFT",28208,CPT ,,Both,,,6082.25,,,,,,,,,,,,, CLOSED TX MEDIAL MALLEOLUS FX W/ MANIP,27762,CPT ,,Both,,,6084.63,,,,,,,,,,,,, MRI CHEST WO CONT,71550,CPT ,,Both,,,6086.21,,,,,,,,,,,,, MRI IAC WO CONT 70551,70551,CPT ,,Both,,,6086.21,,,,,,,,,,,,, MRI LOW EXTREM JT WO CONT,73721,CPT ,,Both,,,6086.21,,,,,,,,,,,,, MRI UP EXTREM JT WO CONT,73221,CPT ,,Both,,,6086.21,,,,,,,,,,,,, EXC BACK LES SC < 3 CM,21930,CPT ,,Both,,,6087,,,,,,,,,,,,, CLOSED TX ORBIT FX W/ MANIP,21401,CPT ,,Both,,,6089,,,,,,,,,,,,, "CLOSED TX LUNATE DISLO, W/ MANIP",25690,CPT ,,Both,,,6089.5,,,,,,,,,,,,, REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,13152,CPT ,,Both,,,6109.38,,,,,,,,,,,,, "MASTOTOMY WITH EXP OR DRAINAGE OF ABSCESS, DEEP",19020,CPT ,,Both,,,6113,,,,,,,,,,,,, CLOSED TX PATELLA W/ ANESTH,27562,CPT ,,Both,,,6114.5,,,,,,,,,,,,, MRI IAC W/CONT 70552,70552,CPT ,,Both,,,6116.38,,,,,,,,,,,,, REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT ,,Both,,,6147,,,,,,,,,,,,, "RPR TENDON/MUSCLE FLEXOR,FOREARM,WRIST PRIM SGL EA",25270,CPT ,,Both,,,6188.25,,,,,,,,,,,,, MRA NECK W/CONT,70548,CPT ,,Both,,,6188.38,,,,,,,,,,,,, "CLOSED TX TRIMALLEOLAR ANKLE FX, W/ MANIP",27818,CPT ,,Both,,,6194.75,,,,,,,,,,,,, IMPORTED LIPODOX INJ,Q2049,HCPCS,,Both,,,6228.3,,,,,,,,,,,,, CLOSED TX ULNAR SHAFT FX W/ MANIP,25535,CPT ,,Both,,,6233.13,,,,,,,,,,,,, MRI C-SPINE W/CONT,72142,CPT ,,Both,,,6240.38,,,,,,,,,,,,, REMOVAL OF FOREIGN BODY FROM MUSCLE - DEEP OR COMPLICATED WITH INCISION,20525,CPT ,,Both,,,6240.52,,,,,,,,,,,,, CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,70488,CPT ,,Both,,,6249.52,,,,,,,,,,,,, CLOSED TX ANKLE DISLO W/ ANESTH,27842,CPT ,,Both,,,6285.38,,,,,,,,,,,,, "RPR TENDON, FLEXOR, FOOT W/O FREE GRAFT",28200,CPT ,,Both,,,6288.75,,,,,,,,,,,,, CLOSED TX DISTAL EXTENSOR TENDON INSERTION,26432,CPT ,,Both,,,6320.25,,,,,,,,,,,,, DEBRIDE SKIN AND SC TISSUE WITH OPEN FRACTURE,11010,CPT ,,Both,,,6344.88,,,,,,,,,,,,, CLOSED TX KNEE DISLO,27550,CPT ,,Both,,,6347.38,,,,,,,,,,,,, EXPLORE WOUND ABDOMEN,20102,CPT ,,Both,,,6351.5,,,,,,,,,,,,, "Open reduction, distal phalynx, with internal fixation",26765,CPT ,,Both,,,6351.63,,,,,,,,,,,,, MRA NECK WO CONT,70547,CPT ,,Both,,,6366.88,,,,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FX W/O MANIP,27501,CPT ,,Both,,,6368.63,,,,,,,,,,,,, TREAT HUMERAL SHAFT FX W/ MANIP,24505,CPT ,,Both,,,6381.38,,,,,,,,,,,,, MRA HEAD WO CONT,70544,CPT ,,Both,,,6382.63,,,,,,,,,,,,, CT LOWER EXT W/W/O CONT,73702,CPT ,,Both,,,6407.7,,,,,,,,,,,,, CLOSED TX RADIAL SHAFT FX W/ MANIP,25505,CPT ,,Both,,,6412,,,,,,,,,,,,, Repair of Lip full thickness up to half vertical height,40652,CPT ,,Both,,,6430.88,,,,,,,,,,,,, Change of Nephrostomy tube,50398,CPT ,,Both,,,6443.5,,,,,,,,,,,,, CLOSED TX DISTAL FEMORAL EPIPHYSEAL SEPARATION W/O MANIP,27516,CPT ,,Both,,,6461.25,,,,,,,,,,,,, CLOSED TX FEMORAL SHAFT FX W/O MANIP,27500,CPT ,,Both,,,6548.88,,,,,,,,,,,,, INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,36010,CPT ,,Both,,,6558,,,,,,,,,,,,, TREATMENT OF RIB FRACTURE(S) W/ EXTERNAL FIXATION,21810,CPT ,,Both,,,6613.88,,,,,,,,,,,,, MRI ABD W/CONT,74182,CPT ,,Both,,,6615.13,,,,,,,,,,,,, CLOSED TX RADIAL AND ULNAR SHAFT FX W/ MANIP,25565,CPT ,,Both,,,6645.28,,,,,,,,,,,,, MRI CHEST W/CONT,71551,CPT ,,Both,,,6649.25,,,,,,,,,,,,, CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,70492,CPT ,,Both,,,6650.4,,,,,,,,,,,,, CHANGE GASTROSTOMY TUBE,43760,CPT ,,Both,,,6658.5,,,,,,,,,,,,, MRI ABD WO CONT,74181,CPT ,,Both,,,6668.26,,,,,,,,,,,,, "CLOSED TX FEMORAL FX,M DISTAL, MED OR LATERAL CONDYLE W/O MANIP",27508,CPT ,,Both,,,6689.88,,,,,,,,,,,,, "Plt, aph/pher, l/r, cmv-neg",P9055,HCPCS,,Both,,,6698.64,,,,,,,,,,,,, TREAT HIP SOCKET FRACTURE W/O MANIP,27220,CPT ,,Both,,,6704.38,,,,,,,,,,,,, "EXTEN TENDON REPAIR, DISTAL",26433,CPT ,,Both,,,6713.88,,,,,,,,,,,,, "CLOSED TX HUMERAL EPICONDYLAR FX, MED OR LAT, W/ MANIP",24565,CPT ,,Both,,,6767.25,,,,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, HEAD W/ MANIP",27268,CPT ,,Both,,,6783.88,,,,,,,,,,,,, CT HEAD/BRAIN W/CONTRAST MATERIAL,70460,CPT ,,Both,,,6804,,,,,,,,,,,,, CT LIMITED/LOCALIZED FOLLOW UP STUDY,76380,CPT ,,Both,,,6804,,,,,,,,,,,,, CT LUMBAR SPINE W/CONTRAST MATERIAL,72132,CPT ,,Both,,,6804,,,,,,,,,,,,, CT LUMBAR SPINE W/O CONTRAST MATERIAL,72131,CPT ,,Both,,,6804,,,,,,,,,,,,, CT MAXILLOFACIAL W/CONTRAST MATERIAL,70487,CPT ,,Both,,,6804,,,,,,,,,,,,, CT MAXILLOFACIAL W/O CONTRAST MATERIAL,70486,CPT ,,Both,,,6804,,,,,,,,,,,,, CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,70481,CPT ,,Both,,,6804,,,,,,,,,,,,, CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,70482,CPT ,,Both,,,6804,,,,,,,,,,,,, CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,70480,CPT ,,Both,,,6804,,,,,,,,,,,,, CT PELVIS W/O CONTRAST MATERIAL,72192,CPT ,,Both,,,6804,,,,,,,,,,,,, CT SOFT TISSUE NECK W/CONTRAST MATERIAL,70491,CPT ,,Both,,,6804,,,,,,,,,,,,, CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,72130,CPT ,,Both,,,6804,,,,,,,,,,,,, CT THORACIC SPINE W/O CONTRAST MATERIAL,72128,CPT ,,Both,,,6804,,,,,,,,,,,,, CT THORAX W/CONTRAST MATERIAL,71260,CPT ,,Both,,,6804,,,,,,,,,,,,, CT THORAX W/O & W/CONTRAST MATERIAL,71270,CPT ,,Both,,,6804,,,,,,,,,,,,, CT THORAX W/O CONTRAST MATERIAL,71250,CPT ,,Both,,,6804,,,,,,,,,,,,, CT UPPER EXTREMITY W/CONTRAST MATERIAL,73201,CPT ,,Both,,,6804,,,,,,,,,,,,, CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,73202,CPT ,,Both,,,6804,,,,,,,,,,,,, CT UPPER EXTREMITY W/O CONTRAST MATERIAL,73200,CPT ,,Both,,,6804,,,,,,,,,,,,, CT PELVIS W/CONTRAST MATERIAL,72193,CPT ,,Both,,,6827,,,,,,,,,,,,, TX TIBIAL SHAFT FX W/ MANIP,27752,CPT ,,Both,,,6843.13,,,,,,,,,,,,, INTMD RPR N-HF/GENIT20.1-30,12046,CPT ,,Both,,,6862.5,,,,,,,,,,,,, "DEBRIDE, FB SKIN OPEN FX; MUSCLE",11011,CPT ,,Both,,,6868.13,,,,,,,,,,,,, MRA ABD W&WO CONT,C8902,HCPCS,,Both,,,6868.38,,,,,,,,,,,,, MRA LOW EXTREM W&WO,C8914,HCPCS,,Both,,,6868.38,,,,,,,,,,,,, MRA PELVIS W/WO CONTRAST,C8920,HCPCS,,Both,,,6868.38,,,,,,,,,,,,, MRI BREAST BI W&WO CONT,C8908,HCPCS,,Both,,,6868.38,,,,,,,,,,,,, I&D ISCHIORECTAL AND/OR PERIRECTAL ABSCESS,46040,CPT ,,Both,,,6871.38,,,,,,,,,,,,, TREAT LOWER LEG FRACTURE,27825,CPT ,,Both,,,6901.63,,,,,,,,,,,,, OPEN TX INTERPHALANGEAL JOINT DISLOCATION,26785,CPT ,,Both,,,6912.2,,,,,,,,,,,,, "I&D DEEP ABSCESS, BURSA, OR HEMATOMA, LEG OR ANKLE",27603,CPT ,,Both,,,6923.38,,,,,,,,,,,,, REMOVAL OF FOOT FOREIGN BODY - FOOT - COMPLICATED,28193,CPT ,,Both,,,6923.5,,,,,,,,,,,,, CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,72127,CPT ,,Both,,,6930,,,,,,,,,,,,, "CLOSED TX HUMERAL CONDYLAR FX, MED OR LAT, W/ MANIP",24577,CPT ,,Both,,,6962.63,,,,,,,,,,,,, "Platelets, pheresis",P9034,HCPCS,,Both,,,6965.24,,,,,,,,,,,,, "CLOSED TX SHOULDER DISLO, W/ SURGICAL OR ANAT NECK FX, W/ MANIP",23675,CPT ,,Both,,,6971.25,,,,,,,,,,,,, CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,25605,CPT ,,Both,,,6988.25,,,,,,,,,,,,, INTMD RPR FACE/MM 20.1-30.0,12056,CPT ,,Both,,,6994.75,,,,,,,,,,,,, CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,70496,CPT ,,Both,,,7000.13,,,,,,,,,,,,, "CLOSED TX MONTEGGIA FX DISLO AT ELBOW, W/ MANIP",24620,CPT ,,Both,,,7002.88,,,,,,,,,,,,, CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,70498,CPT ,,Both,,,7009.88,,,,,,,,,,,,, INTMD RPR FACE/MM >30.0 CM,12057,CPT ,,Both,,,7057.75,,,,,,,,,,,,, CONTRST X-RAY UPPR GI TRACT,74247,CPT ,,Both,,,7068.81,,,,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74400,CPT ,,Both,,,7068.81,,,,,,,,,,,,, CTA AORTA W/RUNOFFS W&W/O CONT,75635,CPT ,,Both,,,7068.81,,,,,,,,,,,,, "AMPUTATION, TOE, INTERPHALANGEAL JOINT",28825,CPT ,,Both,,,7077.5,,,,,,,,,,,,, TRACHEOTOMY TUBE CHANGE,31502,CPT ,,Both,,,7085.36,,,,,,,,,,,,, UROKINASE 250MU INJ,J3365,HCPCS,,Both,250000,UN,7094.82,,,,,,,,,,,,, CTA UPPER EXTRM W&W/O CONTRAST,73206,CPT ,,Both,,,7114.54,,,,,,,,,,,,, "ARTHRODESIS, METACARPOPHALANGEAL JOINT",26860,CPT ,,Both,,,7115.63,,,,,,,,,,,,, LEPIRUDIN 50MG 1ML INJ,J1945,HCPCS,,Both,0.05,GM,7131.75,,,,,,,,,,,,, "REPAIR EXTENSOR TENDON, HAND, W/O FREE GRAFT",26410,CPT ,,Both,,,7152.63,,,,,,,,,,,,, CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,74175,CPT ,,Both,,,7170,,,,,,,,,,,,, MRI ORB/FACE/NECK W&WO CONT,70543,CPT ,,Both,,,7173.88,,,,,,,,,,,,, CT ABDOMEN W/CONTRAST MATERIAL,74160,CPT ,,Both,,,7177,,,,,,,,,,,,, CT ABDOMEN W/O CONTRAST MATERIAL,74150,CPT ,,Both,,,7177,,,,,,,,,,,,, CLOSED TX RADIAL SHAFT FX/ W/ DISTAL RADIOULNAR DISLOCATION,25520,CPT ,,Both,,,7186.63,,,,,,,,,,,,, Debridement of skin: external genitalia and perineum,11004,CPT ,,Both,,,7187.38,,,,,,,,,,,,, REMOVAL ELBOX/UPPER ARM FOREIGN BODY - DEEP,24201,CPT ,,Both,,,7193,,,,,,,,,,,,, MYELOGRAM LUMBAR S&I,72265,CPT ,,Both,,,7196.31,,,,,,,,,,,,, RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,73565,CPT ,,Both,,,7196.31,,,,,,,,,,,,, OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,21490,CPT ,,Both,,,7200,,,,,,,,,,,,, ECHO TTE 2D CONTRAST W DOPP/CF,C8929,HCPCS,,Both,,,7229.5,,,,,,,,,,,,, CT ABDOMEN W/W/O CONT,74170,CPT ,,Both,,,7261.96,,,,,,,,,,,,, DERMABRASION OTHER THAN FACE,15782,CPT ,,Both,,,7287.5,,,,,,,,,,,,, Post arthroplasty hip dislocation reduction with anesthesia,27266,CPT ,,Both,,,7335.75,,,,,,,,,,,,, MRI PELVIS W&WO CONT,72197,CPT ,,Both,,,7340.5,,,,,,,,,,,,, TUMOR LOCAL WHOLE BODY>1DAY,78804,CPT ,,Both,,,7342.13,,,,,,,,,,,,, MECH REMOV TUNNELED CV CATH,36595,CPT ,,Both,,,7352.75,,,,,,,,,,,,, "REPAIR EXTENSOR TENDOR, W/O FREE GRAFT",26418,CPT ,,Both,,,7353.63,,,,,,,,,,,,, CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,72133,CPT ,,Both,,,7366.48,,,,,,,,,,,,, Repair of Lip full thickness over half vertical height,40654,CPT ,,Both,,,7412.63,,,,,,,,,,,,, CT HEAD/BRAIN W/O CONTRAST MATERIAL,70450,CPT ,,Both,,,7429,,,,,,,,,,,,, "AMPUTATION, TOE, METATARSOPHALANGEAL JOINT",28820,CPT ,,Both,,,7446.13,,,,,,,,,,,,, EXPLORE WOUND EXTREMITY,20103,CPT ,,Both,,,7495.5,,,,,,,,,,,,, CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,70470,CPT ,,Both,,,7507.13,,,,,,,,,,,,, CT PELVIS W/W/O CONTRAST,72194,CPT ,,Both,,,7507.13,,,,,,,,,,,,, INTMD RPR N-HF/GENIT >30.0CM,12047,CPT ,,Both,,,7525.13,,,,,,,,,,,,, EXPLORE WOUND NECK,20100,CPT ,,Both,,,7529,,,,,,,,,,,,, REPAIR OF KNEECAP TENDON,27380,CPT ,,Both,,,7532.5,,,,,,,,,,,,, OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA,26735,CPT ,,Both,,,7535.75,,,,,,,,,,,,, EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,99285,CPT ,,Both,,,7553.32,,,,,,,,,,,,, CLOSED TX MANDIBULAR OR MAX ALVEOLAR RIDGE FX,21440,CPT ,,Both,,,7607.13,,,,,,,,,,,,, CT LOWER EXTREMITY W/CONTRAST MATERIAL,73701,CPT ,,Both,,,7770,,,,,,,,,,,,, ESOPHAGUS UNLISTED PROCEDURE,43499,CPT ,,Both,,,7793.13,,,,,,,,,,,,, UNLISTED PROCEDURE STOMACH,43999,CPT ,,Both,,,7793.13,,,,,,,,,,,,, "CLOSED TX TIBIAL FX, PROX W/ MANIP",27532,CPT ,,Both,,,7800.88,,,,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FX W/ MANIP,24535,CPT ,,Both,,,7807.5,,,,,,,,,,,,, REMOVAL FOREIGN BODY DEEP THIGH/KNEE,27372,CPT ,,Both,,,7813.38,,,,,,,,,,,,, MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,73718,CPT ,,Both,,,7814,,,,,,,,,,,,, REPAIR EYELID WOUND,67935,CPT ,,Both,,,7817.88,,,,,,,,,,,,, "CLOSED TX KNEE DISLO, W/ ANESTHESIA",27552,CPT ,,Both,,,7922,,,,,,,,,,,,, REPAIR ING HERNIA REDUCE,49520,CPT ,,Both,,,7932.25,,,,,,,,,,,,, "RPR TENDON OR MUSCLE, EACH",25260,CPT ,,Both,,,7955.75,,,,,,,,,,,,, MRA NECK W&WO CONT,70549,CPT ,,Both,,,7970.5,,,,,,,,,,,,, MRA HEAD W&WO CONT,70546,CPT ,,Both,,,7974.38,,,,,,,,,,,,, EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,25248,CPT ,,Both,,,8000,,,,,,,,,,,,, CT CERVICAL SPINE W/O CONTRAST MATERIAL,72125,CPT ,,Both,,,8000.07,,,,,,,,,,,,, CT LOWER EXTREMITY W/O CONTRAST MATERIAL,73700,CPT ,,Both,,,8004,,,,,,,,,,,,, TREAT LOWER JAW FRACTURE W/O MANIPULATION,21450,CPT ,,Both,,,8047.5,,,,,,,,,,,,, MRI PELVIS WO CONT,72195,CPT ,,Both,,,8079.63,,,,,,,,,,,,, AMPUTATION OF FINGER/THUMB W/ LOCAL ADVANCEMENT FLAPS,26952,CPT ,,Both,,,8113.63,,,,,,,,,,,,, ABCIXIMAB 2MG/ML 5ML INJ,J0130,HCPCS,,Both,0.01,GM,8140.66,,,,,,,,,,,,, PLATELET APHER/PHER L/R PROC,P9035,HCPCS,,Both,,,8179.97,,,,,,,,,,,,, MRI CHEST W&WO CONT,71552,CPT ,,Both,,,8243.88,,,,,,,,,,,,, AMPUTATION OF FINGER/THUMB,26951,CPT ,,Both,,,8246.75,,,,,,,,,,,,, REPAIR HAND JOINT,26540,CPT ,,Both,,,8276.88,,,,,,,,,,,,, MRI L-SPINE WO CONT,72148,CPT ,,Both,,,8385.37,,,,,,,,,,,,, RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,74020,CPT ,,Both,,,8388.89,,,,,,,,,,,,, REPAIR ACHILLES TENDON,27650,CPT ,,Both,,,8439.75,,,,,,,,,,,,, RITUXIMAB 500MG INJ,J9310,HCPCS,,Both,0.1,GM,8483.78,,,,,,,,,,,,, IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,87633,CPT ,,Both,,,8575.8,,,,,,,,,,,,, "OPEN TX FX, GREAT TOE",28505,CPT ,,Both,,,8607.38,,,,,,,,,,,,, "I&D DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE",27301,CPT ,,Both,,,8607.75,,,,,,,,,,,,, CLOSED TX DISTAL FEMORAL EPIPHYSEAL SEPARATION W/ MANIP,27517,CPT ,,Both,,,8642.88,,,,,,,,,,,,, "Suture of digital nerve, hand or foot; one nerve",64831,CPT ,,Both,,,8653,,,,,,,,,,,,, "CLOSED TX FEMORAL FX, DISTAL END, MED OR LATERAL CONDYLE W/ MANIP",27510,CPT ,,Both,,,8659.25,,,,,,,,,,,,, REPLACE G/C TUBE PERC,49450,CPT ,,Both,,,8744.38,,,,,,,,,,,,, MRI C-SPINE WO CONT,72141,CPT ,,Both,,,8785.87,,,,,,,,,,,,, "CLOSED TX PELVIC RING FX, DISLO, DIASTASIS OR SUBLUXATION W/ MANIP",27194,CPT ,,Both,,,8927.75,,,,,,,,,,,,, "RPR/ADVNCE FLEXOR TENDN PRIMRY/SECONDRY W/O FREE GRFT, EA",26350,CPT ,,Both,,,9018.88,,,,,,,,,,,,, CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,99291,CPT ,,Both,,,9026,,,,,,,,,,,,, DEB SKIN BONE WITH OPEN FX,11012,CPT ,,Both,,,9066,,,,,,,,,,,,, MRI LOW EXTREM JT W/CONT,73722,CPT ,,Both,,,9074.6,,,,,,,,,,,,, MRI PELVIS W/CONT,72196,CPT ,,Both,,,9074.6,,,,,,,,,,,,, ELECTRON MICROSCOPY DIAGNOSTIC,88348,CPT ,,Both,,,9085.75,,,,,,,,,,,,, CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,21485,CPT ,,Both,,,9121.63,,,,,,,,,,,,, LEUPROLIDE 11.25MG DEPOT 3MO,J1950,HCPCS,,Both,0.00375,GM,9349,,,,,,,,,,,,, REPAIR ARM TENDON/MUSCLE,24341,CPT ,,Both,,,9473.25,,,,,,,,,,,,, "REPAIR BLOOD VESSEL, HAND OR FINGER",35207,CPT ,,Both,,,9526,,,,,,,,,,,,, REPLACE DUOD/JEJ TUBE PERC,49451,CPT ,,Both,,,9535.75,,,,,,,,,,,,, "Unlisted procedure, trachea, bronchi",31899,CPT ,,Both,,,9548.5,,,,,,,,,,,,, Repair Profundus tendon with intact Superficialis tendon,26370,CPT ,,Both,,,9559.88,,,,,,,,,,,,, "CLOSED TX HIP DISLO, TRAUMATIC W/ ANESTHESIA",27252,CPT ,,Both,,,9566.13,,,,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, NECK W/ MANIP",27232,CPT ,,Both,,,9581.5,,,,,,,,,,,,, CLOSED TX FEMORAL SHAFT FX W/ MANIP,27502,CPT ,,Both,,,9715.5,,,,,,,,,,,,, CULT SKIN GRAFT F/N/HF/G,15155,CPT ,,Both,,,9716.38,,,,,,,,,,,,, DEBRIDEMENT OF ABDOMINAL WALL,11005,CPT ,,Both,,,9731,,,,,,,,,,,,, TIS TRNFR F/C/C/M/N/A/G/H/F,14040,CPT ,,Both,,,9735.5,,,,,,,,,,,,, TREAT LOWER JAW FRACTURE W/ MANIPULATION,21451,CPT ,,Both,,,9887.5,,,,,,,,,,,,, OPEN CHEST HEART MASSAGE,32160,CPT ,,Both,,,10025.25,,,,,,,,,,,,, CLOSED TX NOSE FX W/O STABLJ,21315,CPT ,,Both,,,10027.31,,,,,,,,,,,,, "REPAIR BLOOD VESSEL LESION, UPPER EXTREMITY",35206,CPT ,,Both,,,10042.13,,,,,,,,,,,,, CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,71275,CPT ,,Both,,,10046,,,,,,,,,,,,, "Insertion of tunneled centrally inserted central venous catheter, < 5 YR",36557,CPT ,,Both,,,10073.88,,,,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FX W/ MANIP,27503,CPT ,,Both,,,10127.25,,,,,,,,,,,,, LATE CLOSURE OF WOUND,13160,CPT ,,Both,,,10218.13,,,,,,,,,,,,, PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR,24582,CPT ,,Both,,,10224.75,,,,,,,,,,,,, INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,36558,CPT ,,Both,,,10251.63,,,,,,,,,,,,, TREAT EYE SOCKET FRACTURE,21390,CPT ,,Both,,,10261.13,,,,,,,,,,,,, MRI ABD W&WO CONT,74183,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI C-SPINE W&WO CONT,72156,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI IAC W&WO CONT 70553,70553,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI LOW EXTREM JT W&WO CONT,73723,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI LOW EXTREM W&WO CONT,73720,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI T-SPINE W&WO CONT,72157,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI UP EXTREM JT W&WO CONT,73223,CPT ,,Both,,,10265.45,,,,,,,,,,,,, MRI UP EXTREM W&WO CONT,73220,CPT ,,Both,,,10265.45,,,,,,,,,,,,, CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,74174,CPT ,,Both,,,10368.99,,,,,,,,,,,,, VAGINAL DELIVERY,59409,CPT ,,Both,,,10383.5,,,,,,,,,,,,, INTERDENTAL FIXATION,21110,CPT ,,Both,,,10390.13,,,,,,,,,,,,, PED CRITICAL CARE INITIAL,99471,CPT ,,Both,,,10471.5,,,,,,,,,,,,, CLOSED TX PALATAL OR MAXILLARY FX,21421,CPT ,,Both,,,10474,,,,,,,,,,,,, REPAIR OF HAND OR FOOT NERVE,64836,CPT ,,Both,,,10491.75,,,,,,,,,,,,, CLOSED TX NOSE/JAW FX WITH FIXATION,21345,CPT ,,Both,,,10773.25,,,,,,,,,,,,, "REPAIR BLOOD VESSEL LESION, LOWER EXTREMITY",35226,CPT ,,Both,,,10836.38,,,,,,,,,,,,, Carmustine injection,J9050,HCPCS,,Both,0.1,GM,10886.59,,,,,,,,,,,,, CLOSED TX VERT FX W/MANJ,22315,CPT ,,Both,,,11190.25,,,,,,,,,,,,, Replacement of gastro-jejunostomy tube,49452,CPT ,,Both,,,11709.75,,,,,,,,,,,,, THORACOTOMY WITH OPEN INTRAPLEURAL PNEUMONOLYSIS,32124,CPT ,,Both,,,11807.63,,,,,,,,,,,,, TREAT LOWER JAW FRACTURE W/ WIRING,21453,CPT ,,Both,,,11929.13,,,,,,,,,,,,, "CLOSED TX INTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEM FX W/ MANIP",27240,CPT ,,Both,,,12104.25,,,,,,,,,,,,, TREAT HIP SOCKET FRACTURE W/ MANIP,27222,CPT ,,Both,,,12162.38,,,,,,,,,,,,, MRI L-SPINE W&WO CONT,72158,CPT ,,Both,,,12203.69,,,,,,,,,,,,, CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,74176,CPT ,,Both,,,12476,,,,,,,,,,,,, CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,74178,CPT ,,Both,,,12554.73,,,,,,,,,,,,, SKIN FULL GRAFT EEN & LIPS; 20 CM OR LESS,15260,CPT ,,Both,,,12925.5,,,,,,,,,,,,, RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,72120,CPT ,,Both,,,13053.45,,,,,,,,,,,,, INSERT PLEURAL CATH,32550,CPT ,,Both,,,13503.76,,,,,,,,,,,,, REPAIR FLEXOR TENDON W/O FREE GRAFT,26356,CPT ,,Both,,,13816.63,,,,,,,,,,,,, CT ABDOMEN & PELVIS W/CONTRAST MATERIAL,74177,CPT ,,Both,,,14400.8,,,,,,,,,,,,, DIGOXIN IMMUNE 38MG INJ,J1162,HCPCS,,Both,1,EA,15517.08,,,,,,,,,,,,, INSRT TUNNELED CV CATH W PORT,36561,CPT ,,Both,,,15667.13,,,,,,,,,,,,, Laparoscopy; revision of adjustable gastric device,43771,CPT ,,Both,,,15944,,,,,,,,,,,,, LONGITUDINAL GASTRECTOMY,43775,CPT ,,Both,,,15996.38,,,,,,,,,,,,, THORACOTOMY for trauma,32110,CPT ,,Both,,,18551.5,,,,,,,,,,,,, "CroFab Antivenin,Crotalidae Polyvalent Immune Fab 1GM Inj",J3490,HCPCS,,Both,,,18931.11,,,,,,,,,,,,, MUSCULOSKELETAL SURGERY - UNLISTED,20999,CPT ,,Both,,,19441.38,,,,,,,,,,,,, UNLISTED PROCEDURE ABDOMEN,49999,CPT ,,Both,,,23157.25,,,,,,,,,,,,, UNLISTED PROCEDURE INTESTINE,44799,CPT ,,Both,,,23157.25,,,,,,,,,,,,, RETEPLASE 10U,J2993,HCPCS,,Both,0.0181,GM,28773.83,,,,,,,,,,,,, PEGFILGRASTIM 6MG INJ,J2505,HCPCS,,Both,0.006,GM,39002.84,,,,,,,,,,,,, "TRACHEOSTOMY, EMERGENCY PROCEDURE",31603,CPT ,,Both,,,41201.03,,,,,,,,,,,,, SIPULEUCEL-T AUTO CD54+,Q2043,HCPCS,,Both,,,408874.7,,,,,,,,,,,,,