Description Price CPT CodeANES FOR DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPHY 1701.00 1916NERVE BLOCK-OTHER THAN PRONE POSITION PF 0.00 1991NERVE BLOCK PRONE-PF 0.00 1992FINE NEEDLE ASP W/O IMAGING 235.20 10021FINE NEEDLE ASP W/O IMAGING PRO FEE 152.30 10021LUNG BX FINE NDL ASP 1217.00 10022FN ASPIR W/GUIDANCE 1217.50 10022ER I&D ABCESS SIMPLE 44.20 10060EP I&D ABCESS SIMPLE 209.20 10060OHC I&D ABSCESS SMPL 240.00 10060I&D ABSCESS SINGLE 184.60 10060ER I&D ABCESS MULTI 67.20 10061EP I&D ABCESS MULTI 442.90 10061I&D ABSCESS CMP MLTP 335.50 10061ER I&D CYST SIMPLE 177.00 10080EP I & D CYST SIMPLE 341.80 10080ER INC RM FORGN BDY 136.00 10120EP INC REM FORGN BDY 356.50 10120INC & REMOVAL OF FOREIGN BODY; SUBQ TISSUES; SIMPLE PF 365.60 10120INC REM FOREIGN BODY 309.60 10120EP I&R FB SUBQ COMPL 546.90 10121ER I&D HEMATOMA/SERO 100.00 10140EP I&D HEMATOMA/SERO 271.30 10140ER ASPIR ABCESS/HEMA 70.20 10160EP ASPIR ABCESS/HEMA 233.90 10160EP I&D COMP POST WND 537.80 10180EP DEBRID EXT ECZEMA 117.20 11000DEBRIDEMENT INCL REMOVAL OF FOREIGN MATERIAL; SKIN AND SUB 1158.00 11010ER DEBRID SUBQ TS 20 91.40 11042EP DEBRID SKIN SUBQ 210.20 11042DEBRID SUBCU 20SQCM< 249.00 11042DEBRID SKIN SUBQ PF 127.30 11042DEB MUSC/FAS </=20CM 445.70 11043DEBRID TISS MUSCL PF 874.10 11043DEB BONE </=20CM2 581.70 11044DEBRID SUBQ EA +20CM 72.00 11045DEBRID MSCL FAS+20CM 85.20 11046EP BX SKIN SUBQ SIMP 158.60 11100BX SUBQ MUC MEM SNGL 150.90 11100ER REM SKIN TAG <=15 184.10 11200EP REM SKIN TAG <=15 178.30 11200ER EXC BENIGN LESION 114.70 11400EP EXC BENIGN LESION 286.10 11400ER EXC BEN LES .6/1 99.90 11401EP EXC BEN LES .6/1 342.80 11401EXCISION, BENIGN LESION INCL MARGINS, EXCEPT SKIN TAG 2.1-3.0CM 673.90 11403

ER EXC BENIGN LESION OVER 4CM 797.00 11406EP EXC BENIGN LESION OVER 4CM 199.50 11406EXC BENG LESION .5CM OR LESS 199.80 11420EXC BENG LESION .6 TO 1CM 229.30 11421EXC MALIGNANT LESION 1.1/2CM 520.90 11602DEBRID NAIL 1 TO 5 51.80 11720DEBRID NAIL 6 OR MOR 78.50 11721ER AVULS NAIL PLT SN 110.80 11730EP AVULS NAIL PLATE 224.00 11730AVULSION OF NAIL PLATE PF 339.70 11730OHC REMVL NAIL PLATE 240.00 11730EP AVULS NAIL ADD'L 107.40 11732ER EVAC SUBUNGAL HEM 44.60 11740EP EVAC SUBUNGAL HEM 83.50 11740ER EXCI NAIL & MATRI 118.30 11750EP EXCI NAIL PAR COM 392.40 11750EP EXCIS NAIL/AMPUTA 591.60 11752REPAIR OF NAIL BED 362.30 11760REPAIR OF NAIL BED PF 220.50 11760ER EXC SKIN NAIL FLD 136.40 11765EP EXC SKIN NAIL FLD 299.00 11765INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT PF 453.60 11981ER WND REPAIR 2.5CM< 142.80 12001ER CLS TX TOE DISLOCATION W/ANES 420.00 12001EP WND REPAIR 2.5CM< 370.90 12001OHC SIMPLE SUTURE2.5 245.50 12001ER WND REPAIR2.6/7.5 136.20 12002EP WND REPAIR2.6/7.5 414.40 12002OHC SIMPLE SUTURE2.6 354.80 12002ER WND REPAI7.6/12.5 158.40 12004EP WND REPAI7.6/12.5 510.50 12004OHC SIMPLE SUTURE 7.6-12.5CM 378.00 12004ER WND REPA12.6/20.0 170.20 12005EP WND REPA12.6/20.0 612.30 12005ER WND REP 20.1/30.0 268.30 12006EP WND REPA20.1/30.0 790.90 12006ER WND REPAIR >30CM 206.40 12007EP WND REPAIR >30CM 822.40 12007ER WND REPAIR 2.5CM< 138.30 12011EP WND REPAIR 2.5CM< 338.00 12011ER WND REPAIR2.6/5.0 163.00 12013EP WND REPAIR2.6/5.0 455.50 12013ER WND REPAIR5.1/7.5 183.10 12014EP WND REPAIR5.1/7.5 554.30 12014ER WND REPR 7.6/12.5 201.90 12015EP WND REPR 7.6/12.5 514.00 12015ER WND REPAIR 12.6-20CM 415.80 12016

EP WND REPAR 12.6-20 899.70 12016ER SPRFCL WND SMPCLO 200.70 12020EP SPRFCL WND SMPCLO 568.80 12020EP SPRFCL WND W/PACK 364.20 12021ER LAYER CLOS 2.5CM< 182.80 12031EP LAYER CLOS 2.5CM< 443.10 12031ER LAYER CLOS2.6/7.5 299.70 12032EP LAYER CLOS2.6/7.5 438.70 12032ER LAYER CLS7.6/12.5 254.00 12034EP LAYER CLS7.6/12.5 670.60 12034ER LAYER CL12.6/20.0 797.70 12035EP LAYER CL12.6/20.0 747.70 12035ER LAYER CL 20.1/30 311.20 12036EP LAYER CL20.1/30.0 882.30 12036ER LAYER CLOS 2.5CM< 219.30 12041EP LAYER CLOS 2.5CM< 487.00 12041ER LAYER CLOS2.6/7.5 228.30 12042EP LAYER CLOS2.6/7.5 542.00 12042ER LAYER CLO7.6/12.5 314.00 12044EP LAYER CLO7.6/12.5 674.40 12044ER LAYER CL12.6/20.0 355.20 12045EP LAYER CL12.6/20.0 803.40 12045ER LAYER CLOS 2.5CM< 187.00 12051EP LAYER CLOS 2.5CM< 481.60 12051ER LAYER CLOS2.6/5.0 225.60 12052EP LAYER CLOS2.6/5.0 577.30 12052ER LAYER CLOS5.1/7.5 795.00 12053EP LAYER CLOS5.1/7.5 672.70 12053EP LAYER CLO7.6/12.5 791.80 12054ER COMPLEX REPAIR TRUNK 2.6-7.5CM 809.30 13101EP COMPLEX REPAIR TRUNK 2.6-7.5CM 405.00 13101ER REP COMPLEX SCALP 245.70 13120EP REP COMPLEX SCALP 647.00 13120ER REP COM 2.6/7.5CM 858.90 13121EP REP COMP 2.6/7.5C 1086.90 13121COMPLX SUTURE REPAIR 432.50 13122ER REPAIR COMPLEX 573.30 13131EP REPAIR COMPLEX 394.00 13131ER WND REPAIR COMPLEX 1013.30 13132EP WND REPAIR COMPLX 1303.10 13132REPAIR, COMPLEX 2.6CM TO 7.5CM 1825.30 13132REPAIR COMPLEX FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, 554.70 13133SURG PREP 100SQCM 619.40 15002SURG PREP ADDL100CM2 182.80 15003TISSUE SKIN 25 SQ CM 600.50 15271APLI SKIN SBS 25C PF 762.00 15271TISSUE SKIN ADDL 25S 86.10 15272

APLIGRAF ADDL 25 PF 84.10 15272EP DRSNG CHANGE/ANES 223.30 15852EP BURN TXR INITIAL 156.10 16000ER DRSG/DEBR PT BURN 72.80 16020EP DRSNG/DEBRIDEMENT 144.70 16020DRSG/DEBRID BURN <5% 157.50 16020EP DRSG/DEBRID 5-10% 191.80 16025DEBRID BURN 5 TO 10% 282.00 16025EP BURN TREATMENT 239.00 16030DEBRID BURN >10% 332.70 16030ER DESTRC BENIGN LES 109.20 17110EP DESTRC BENIGN LES 272.90 17110ER CHEM CAUT GR TISS 105.60 17250EP CHEM CAUT GR TISS 138.40 17250CHEM CAUTERIZ TISSUE 127.50 17250BREAST CYST ASPIRAT 931.10 19000PUNC ASP CYST BRS EA 101.90 19001PERC VAC ASSISTED BX 3319.10 19081BIOPSY BREAST 1ST LS 798.80 19081BIOPSY BREAST EA ADD 562.50 19082BREAST CORE BX W/O G 1080.70 19100PL BREAST WIRE 1 LES 373.80 19281PL BREAST WIRE AD LS 92.40 19282EP EXP WND NECK 1493.30 20100EP EXP WND AB/FLNK 597.60 20102ER WND EXP EXTREMITY 1121.60 20103EP WND EXP EXTREMITY 920.00 20103BIOPSY MUSCLE PERC 284.00 20206BIOPSY MUSCLE PRC PF 808.00 20206INJ SINUS TRACT 423.20 20501INJ SINUS TRACT PF 241.00 20501EP REMOV FB MSCL TND 479.70 20520FOREIGN BODY REMOVAL 245.00 20520SNGL TNDN SH LIG INJ 32.80 20550INJ SINGLE TENDON PF 188.10 20550SNGL TNDN ORIG I INJ 35.00 20551ER INJ TRGR PT MSCLE 47.80 20552INJ KNLG TRIG PT PRO 57.50 20552EP INJ ERGR PT MSCLE 181.20 20552TRIGGER INJ 1 2 MUSC 33.80 20552INJ TRIG PT 1-2 PF 144.30 20552TRIGGER INJ 3 MUSCLE 40.40 20553INJ TRIG PT 3> PF 186.20 20553EP ARTHRO/ASPIR/INJ 130.20 20600ARTHROCENTESIS SMALL JOINT W/O US 116.10 20600ARTHROCENTESIS SMALL JOINT W/O US PF 36.50 20600ARTHO INJ ASP SM JT 23.50 20600

ARTHROC ASP/INJ SM J 192.40 20600ARTHROC ASP/IJ SJ PF 140.70 20600SMALL JOINT INJECTION 34.70 20600ER ARTHRO ASPIR JNT 37.50 20605EP ARTHRO ASPIR JNT 131.40 20605ARTHORCENTESIS INTERMEDIATE JOINT W/O US 120.50 20605ARTHROCENTESIS INTERMEDIATE JOINT W/O US PF 38.50 20605ARTHO INJ ASP MED JT 24.00 20605ARTHR ASP INT JT PF 190.60 20605ARTHRO INTMED JT/BRS 289.30 20605INTERMEDIATE JOINT INJECTION 37.30 20605ER ARTHR MAJOR JOINT 66.70 20610EP ARTHR ASP MAJ JNT 140.50 20610ARTHROCENTESIS MAJOR JOINT W/O US 148.90 20610ARTHROCENTESIS MAJOR JOINT W/O US PF 40.70 20610ARTHR ASPIR MJ JT PF 225.10 20610ARTHROC ASP/INJ MJ 146.00 20610ARTHROC ASP/IJ MJ PF 245.40 20610LARGE JOINT INJECTION 40.20 20610ARTHROCENTESIS, ASPIRATION AND/OR INJECTION MAJOR JT OR BUR 195.30 20611REMOVAL OF IMPLANT DEEP 1574.70 20680APPLI OF A UNIPLANE, UNILATERAL, EXTERNAL FIXATION SYSTEM PF 1924.70 20690EP CLSD FX NASAL MAN 142.10 21310EP CLSD FX NASAL STB 409.00 21315ER CLSD DISLO TMPMAN 169.20 21480EP CLSD DISLO TMPMAN 159.80 21480EP CLSD FX VERTEBRAE 573.40 22305ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOU 1961.40 23130INJ SHLDR ARTHROGRAM 682.00 23350INJ ARTHROG SHLDR PF 258.30 23350REPAIR RUPTURED MUSCULOTENDINOUS CUFF CHRONIC 4469.10 23412ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER PF 8000.10 23472EP CLS FX CLAV W/O M 563.90 23500CLS TX OF CLAVICULAR FX W/O MANIPULATION 696.20 23500CLS TX OF CLAVICULAR FRACTURE W/O MANIPULATION PROF 562.40 23500EP CLS FX CLAV MANIP 949.10 23505EP CLS FX SCAP W/O M 597.10 23570EP CLS FX PROX HUMER 846.10 23600CLS TX OF PROXIMAL HUMERAL FX; W/O MANIP 642.60 23600CLS TX OF PROXIMAL HUMERAL FX; W/O MANIP PF 963.90 23600CLS TX OF GREATER HUMERAL TUBEROSITY FX; W/O MANIPULATION 498.80 23620CLS TX OF GREATER HUMERAL TUBEROSITY FX; W/O MANIPULATION P 787.50 23620ER CLS DISLOC SHOULD 812.10 23650EP CLS DISLOC SHOULD 909.40 23650ER CLS DISL SHLDR MN 254.90 23655EP CLS DISL SHLDR MN 1020.20 23655ER CLS DLC SHDLR FX 96.30 23665

EP CLS DLC SHDLR FX 1294.90 23665MANIPULATION UNDER ANES, SHOULDER JT, INCL APPL OF FIXATION A 1025.00 23700OHC NEEDLE ASPIRATN 775.00 23931EP REMOV FB UPP ARM 449.80 24200INJ PRO ELBOW ARTHR 796.40 24220TENODESIS OF BICEPS TENDON AT ELBOW PF 1960.40 24340ER CLS FX HUMERALW/O 94.20 24500EP CLS FX HUMERALW/O 846.10 24500CLS TX OF HUMERAL SHAFT FX; W/O MANIP 168.00 24500CLS TX OF HUMERAL SHAFT FX; W/O MANIPULATION 1023.80 24500EP CLS FX HUMER MANI 1470.90 24505CLS TX SUPRACONDYLAR/TRANSCONDYLAR HUMERAL FX 1088.00 24530CLS TX SUPRACONDYLAR/TRANSCONDYLAR HUMERAL FX PF 100.80 24530CLS TX HUMERAL EPICONDYLAR FX W/O MANIP 907.60 24560CLS TX HUMERAL EPICONDYLAR FX W/O MANIP PF 105.40 24560ER CLS ELBOW DISLOCA 90.10 24600EP CLS ELBOW DISLOCA 1056.60 24600ER DISLOC ELBOW ANES 101.00 24605EP DISLOC ELBOW ANES 1388.50 24605TX OF CLS ELBOW DISLOCATION; REQUIRING ANES PF 1506.80 24605ER CLS TX RADL HDW/M 107.50 24640EP CLS RADIAL SUBLUX 325.20 24640EP CLS FX RAD HEADWO 564.70 24650CLS TX OF RADIAL HEAD/NECK FX W/O MANIP 753.20 24650CLS TX OF RADIAL HEAD/NECK FX W/O MANIP PF 58.50 24650ER TREAT RADIUS FX W/MANIPULATION 1241.50 24655EP TREAT RADIUS FX W/MANIPULATION 113.70 24655EP CLS FX ULNAR PROX 690.20 24670CLS TX ULNAR FX PROXIMAL END W/O MANIP 825.70 24670CLS TX ULNAR FX PROXIMAL END W/O MANIP PF 78.20 24670I&D, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA PF 1659.00 25028ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OF TRIA 1962.50 25107EXCISION OF GANGLION, WRIST; PRIMARY PF 2050.00 25111INJ PRO WRIST ARTH 819.50 25246ER REPAIR TENDON/MUS 114.70 25260EP REPAIR TENDON/MUS 1937.80 25260ARTHROPLASTY INTERPOSITION INTERCARPAL OR CARPOMETACARPA 4471.60 25447EP CLS FX RADIAL SHF 609.30 25500CLS TX RADIAL SHAFT FX W/O MANIP 784.70 25500CLS TX RADIAL SHAFT FX W/O MANIP PF 74.10 25500ER CLS TX RD SH FX W 1495.50 25505EP CLS FX ULNAR W/O 552.70 25530CLS TX ULNAR SHAFT FX W/O MANIP 743.20 25530CLS TX ULNAR SHAFT FX W/O MANIP PF 68.80 25530EP CLS FX RAD SHF MA 684.90 25560CLS TX RADIAL & ULNAR SHAFT FX W/O MANIP 790.90 25560CLS TX RADIAL & ULNAR SHAFT FX W/O MANIP PF 84.50 25560

ER CLS TX ULN FX W/M 1545.20 25565EP CLS FX DISTAL RAD 667.60 25600CLS TX DISTAL RADIAL FX W/O MANIP 972.90 25600CLS TX DISTAL RADIAL FX W/O MANIP PF 49.00 25600ER CL FX DST RAD MNP 153.60 25605EP CL FX DST RAD MNP 1600.40 25605CLS TX OF DISTAL RADIAL FX W/MANIPULATION 1239.00 25605CLS TX OF DISTAL RADIAL FX W/MANIPULATION PF 1612.80 25605EP CLS FX CARPAL SCA 644.90 25622CLS TX CARPAL SCAPHOIS FX W/O MANIP 873.60 25622CLS TX CARPAL SCAPHOIS FX W/O MANIP PF 75.10 25622EP CL FX CRPL W/O MN 690.90 25630CLS TX OF ULNAR SYLOID FX 168.00 25650CLS TX OF ULNAR SYLOID FX PF 938.70 25650ER DRNG FINGER ABSCE 336.70 26010EP DRNG FINGER ABSCE 370.30 26010I&D DRAINAGE OF FINGER ABSCESS, COMPLICATED 582.80 26011DRAINAGE OF FINGER ABSCESS, COMPLICATED PF 648.90 26011TENDON SHEATH INCISION PF 1389.20 26055FASCIECTOMY PARTIAL PALMAR W/RELEASE OF SINGLE DIGIT 4360.20 26123EXC LESION TENDON SHEATH/JT HAND/FINGER PF 1743.70 26160EXCISION OF CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROX 260.20 26210EP REPAIR FINGER TENDON 1706.30 26418EP CLS FX METACARPAL 505.70 26600CLS TX METACARPAL FX W/O MANIP 866.40 26600CLS TX METACARPAL FX W/O MANIP PF 46.90 26600ER CLS FX MTCRPL W/M 126.10 26605EP CLS FX MTCRPL W/M 764.20 26605CLS TX METACARPAL FX W/MANIP 919.50 26605CLS TX METACARPAL FX W/MANIP PF 89.80 26605EP CLS FX MTCRPL W/M 1089.40 26607OPEN TX OF METACARPAL FX, SINGLE INCLUDES INTERNAL FIXATION P 2923.20 26615EP CLS DISLOC THUMB 941.90 26641EP CLS FX/DSL THUMB 1103.80 26645ER CLS TX META DISLC 87.20 26700EP CLS TX META DISLC 872.90 26700ER CL DSLC MTCP ANES 101.00 26705EP CL DSLC MTCP ANES 992.90 26705EP CLS FX PHALNG W/O 378.50 26720CLS TX PHALANGEAL SHAFT FX W/O MANIP 573.80 26720CLS TX PHALANGEAL SHAFT FX W/O MANIP PF 37.50 26720ER CLS FX PHALNG W/M 97.70 26725EP CLS FX PHALNG W/M 875.80 26725PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAF 2449.30 26727OPEN TX OF PHALANGEAL SHAFT FX, PROXIMAL OR MIDDLE PHALANX 3019.20 26735ER CLS FX ARTCLR W/M 96.30 26742EP CLS FX ARTCLR W/M 909.90 26742

EP CLS FX DSTL PHLNG 439.30 26750CLS TX DISTAL PHALANGEAL FRACTURE FINGER/THUMB W/O MANIPU 382.20 26750CLS TX DISTAL PHALANGEAL FRACTURE FINGER/THUMB W/O MANIPU 483.00 26750ER CLS FX FINGER MAN 138.50 26755EP CLS FX FINGER MAN 842.80 26755ER CLS DISL INTRP JT 66.80 26770EP CLS DISL INTRP JT 712.70 26770ER CL DSL INTRP ANES 118.40 26775EP CL DSL INTRP ANES 916.20 26775ARTHROTOMY, HIP W/DRAINAGE OF INFECTION PF 2190.30 27030REMOVAL OF HIP PROSTHESIS COMPLICATED PF 8524.50 27091INJ PRO HIP ARTHR WO 960.80 27093ARTHROPLASTY, TOTAL HIP ARTHROPLASTY WITH OR W/O AUTOGRAF 7714.40 27130EP CLS FX COCCYGEAL 476.20 27200OPEN TX FEMORAL FX, PROXIMAL END, NECK, INTERNAL FIXATION OR 6370.20 27236TX OF FEMORAL FRACTURE; W/IMPLANT 6559.40 27244TX OF FEMORAL FX; WITH INTRAMEDULLARY IMPLANT W/W/O INTER 6534.80 27245ER CLS TX HIP DISLC 130.90 27250EP CLS TX HIP DISLC 523.60 27250EP CLS PT HIP DS W/A 1889.90 27266ARTHROTOMY W/SYNOVECTOMY, KNEE PF 3977.70 27335INJ PRO KNEE ARTHRO 682.00 27369INJ ARTHROG KNEE PF 258.80 27369ANTERIOR TIBIAL TUBERCLEPLASTY PF 4340.30 27418RECONSTRUCTION OF DISLOCATING PATELLA PF 2394.00 27420ARTHROPLASTY KNEE MEDIAL AND LATERAL 8140.30 27447REVISION TOTAL KNEE ARTHROPLASTY PF 7504.10 27486OPEN TX FEMORAL FX, DISTAL END, MEDIAL OR LATERAL CONDYLE PF 3232.80 27514EP CLS FX PATEL W/O 750.80 27520OPEN TX OF TIBIAL FX, BICONDYLAR PF 6031.00 27536ER CLS TX KNEE DL WO 109.20 27550EP CLS TX KNEE DL WO 1693.70 27550ER CLS DSL KNEE W/AN 109.20 27552EP CLS DSL KNEE W/AN 1767.40 27552ER CLS DISL PATELLAR 108.40 27560EP CLS DISL PATELLAR 901.40 27560ER DISLOC PATEL ANES 1530.90 27562EP DISLOC PATEL ANES 1408.80 27562INJ PRO ANKLE ARTH 805.60 27648REPAIR RUPTURED ACHILLES TENDON 3514.60 27650EP CLS FX TIBIAL SHF 940.10 27750CLS TX TIBIAL SHAFT FX W/O MANIP 1001.40 27750CLS TX TIBIAL SHAFT FX W/O MANIP PF 79.30 27750EP CLS FX TIB SHF MA 1582.40 27752EP CLS FX MED MALLEO 761.70 27760CLS TX MEDIAL MALLEOLUS FX W/O MANIP 956.30 27760CLS TX MEDIAL MALLEOLUS FX W/O MANIP PF 81.40 27760

EP CL FX MD MAL W/MN 1255.60 27762OPEN TX MEDIAL MALLEOLUS FRACTURE 3226.50 27766EP CLS FX PROX FIBUL 670.30 27780CLS TX PROXIMAL FIBULA/SHAFT FX 874.30 27780CLS TX PROXIMAL FIBULA/SHAFT FX PF 76.10 27780OPEN TX OF PROXIMAL FIBULA OR SHAFT FX PF 2283.80 27784EP CLS FX DIST FIBUL 728.20 27786CLS TX DISTAL FIBULAR FX 896.50 27786CLS TX DISTAL FIBULAR FX PF 83.50 27786OPEN TX OF DISTAL FIBULAR FX, INCLUDES INTERNAL FIXATION PF 2606.20 27792EP CLS FX BIMAL ANKL 868.20 27808CLS TX BIMALLEOLAR ANKLE FX W/O MANIP 944.60 27808CLS TX BIMALLEOLAR ANKLE FX W/O MANIP PF 94.90 27808ER CLS TX BIM ANK WM 142.00 27810EP CLS TX BIM ANK WM 2086.20 27810OPEN TX BIMALLEOLAR ANKLE FX PF 4095.60 27814ER TX ANKLE FRAC W/M 126.80 27818EP TRTMNT ANKLE FRAC 1100.40 27818CLS TX FX WEIGHT BEARING PORTION DISTAL TIBIA 958.10 27824CLS TX FX WEIGHT BEARING PORTION DISTAL TIBIA PF 32.40 27824ER CLS TX FX DIS TIB 147.40 27825EP TREAT DSTAL JOINT 1435.40 27829OPEN TX OF DISTAL TIBOFIBULAR JOINT DISRUPTION PF 3597.30 27829EP CLS TX ANKLE DISLOC W/O ANES 1184.40 27840EP ANKLE DISLOC W/AN 1625.60 27842ER REMV FB FOOT SUBQ 314.30 28190EP REMOV FB FOOT SUB 489.30 28190EP REMV FB FOOT DEEP 1108.00 28192TENOTOMY TOE SINGLE 522.50 28232RELEASE OF TOE JOINT 803.30 28272CLS TX CALCANEAL FX 713.00 28400CLS TX CALCANEAL FX PF 59.40 28400EP CLS FX TALUS W/O 630.60 28430CLS TX TALUS FX 658.20 28430CLS TX TALUS FX PF 83.50 28430CLOSED TX OF TALUS FRACTURE; W/MANIPULATION PF 120.20 28435EP FX TARSL BONE W/O 576.50 28450TX TARSAL BONE FX 598.20 28450TX TARSAL BONE FX PF 64.70 28450EP FX TRSL BONE W/MP 858.40 28455EP CLS FX METTRSLW/O 551.10 28470CLS TX METATARSAL FX 636.10 28470CLS TX METATARSAL FX PF 44.80 28470ER CLOSED FX META W/MANIP 711.90 28475EP CLS FX META W/MNP 732.80 28475EP CLS FX TOE W/O MN 307.00 28490CLS TX OF FX GREAT TOE; W/O MANIP 262.50 28490

CLS TX OF FX GREAT TOE; W/O MANIP PF 393.80 28490EP CL FX TOE W/MANIP 390.70 28495EP CLS FX PHLNX W/OM 307.00 28510FRACTURE OF PHALANX OTHER THAN GREAT TOE W/O MANIP 371.70 28510FRACTURE OF PHALANX OTHER THAN GREAT TOE W/O MANIP PF 20.00 28510ER CL FX PHLNX W MNP 45.50 28515EP CL FX PHLNX W MNP 344.90 28515EP CLS DSLC METSPHLN 400.30 28630ER CLS TX JT D W/O A 83.30 28660EP CLS TX JT D W/O A 332.30 28660EP CLS TX TOE DISLOCATION W/ANES 70.40 28665EP APL CAST SHLD-HND 187.20 29065APPL CAST SHOULDER TO HAND 215.40 29065APPL CAST SHOULDER TO HAND PF 81.40 29065EP APL CAST ELB-FNGR 161.30 29075APPL SHORT ARM CAST 196.00 29075APPL SHORT ARM CAST PF 71.90 29075EP APL CAST HND-FORA 173.50 29085ER APL LONGARM SPLNT 80.70 29105EP APL LONGARM SPLNT 167.40 29105APPLY LONG ARM SPLINT 168.00 29105APPLY LONG ARM SPLINT PF 157.50 29105ER APL SHORTARM SPLN 74.90 29125EP APL SHORTARM SPLN 104.80 29125APPL SHORT ARM SPLIN 124.70 29125APPL SHORT ARM SPLINT PF 73.10 29125ER APL FNGR SPLNT ST 32.70 29130EP APL FNGR SPLNT ST 90.40 29130EP STRAPPING THORAX 117.70 29200EP STRAPPING SHOULDE 137.20 29240EP STRAPPING ELB-WRS 100.20 29260ER STRAPPING OF HAND/FINGER 66.20 29280EP STRAPPING HND-FNG 93.50 29280STRAPPING; HAND OR FINGER 63.00 29280STRAPPING; HAND OR FINGER PF 31.50 29280EP APL CAST LONG LEG 292.10 29345APPL OF LONG LEG CAST 371.70 29345APPL OF LONG LEG CAST PF 100.80 29345EP APL CAST SHRT LEG 183.50 29405APPL SHORT LEG CAST 188.70 29405APPL SHORT LEG CAST PF 62.60 29405APPL TOTAL CONT LEG 206.40 29445ER APL LONG LEG SPLN 91.40 29505EP APL LONG LEG SPLN 245.70 29505APPL LONG LEG SPLINT 248.10 29505ER APPL SHORT LEG SP 76.00 29515EP APL SHRT LEG SPLN 153.50 29515

APPL OF SHORT LEG SPLINT 168.00 29515APPL LOWER LEG SPLINT PF 157.50 29515EP STRAPPING HIP 108.20 29520EP STRAPPING KNEE 119.00 29530EP STRAPPING ANKLE 95.70 29540EP STRAPPING TOE 90.10 29550EP STRAPPING UNNA BT 111.40 29580UNNA BOOT 95.00 29580APL COMPRESS SYS LEG 192.20 29581EP REMOV GNTLT/CAST 111.80 29700REMOVAL UNNA BOOT 112.40 29700EP REMOV ARM/LEG CST 147.10 29705EP WINDOWING OF CAST 141.50 29730ARTHROSCOPY SHOULDER PF 5566.50 29806ARTHROSCOPY SHOULDER REPAIR OF SLAP LESION PF 5430.10 29807ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE 1873.20 29821ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE W/LATERAL REL 2678.60 29873ARTHROSCOPY KNEE SYNOVECTOMY MAJOR PF 3467.40 29876ARTHROSCOPY, KNEE, SURGICAL DEBRIDEMENT/SHAVING OF ARTICUL 3230.90 29877ARTHROSCOPY KNEE W/MENISCECTOMY MEDIAL OR LATERAL 2893.50 29881HEALTH/BLOOD SCRNG 26.00 29999EMP HEP B IMMUNE GLB 492.00 29999MRO BACKUP 25.00 29999VARICELLA INJ OCH 110.00 29999PNEUMOCOCCAL INJ OCH 80.00 29999MENINGITIS INJ OCH 120.00 29999PREPLACEMENT TYPE A 0.00 29999FRA CERTIFICATION 0.00 29999TRANSFER A 0.00 29999BASIC PHYSICAL EXAM 0.00 29999DOT/CDL RECERT FMCSA 0.00 29999DOT/CDL RECERT 0.00 29999PREPLACEMNT NONAGRMN 0.00 29999FURLOUGH<1YR(NONFED) 0.00 29999DOT/CDL NEW CT FMCSA 0.00 29999DOT/CDL NEW CERT 0.00 29999PRE-PLCMNT SAFETY SS 0.00 29999POST OFFER W/SPIRO 0.00 29999PHA 0.00 29999PHA W/FOCUSED EXAM 0.00 29999PHYSICAL EXAM MALE 0.00 29999OHC MRO REVIEW 20.00 29999OHC NO CHARGE VISIT 0.00 29999OHC LATEX SCREENING 8.00 29999RESP QUESTION REVIEW 11.00 29999NAL EXECUTIVE PHYS 656.00 29999ER REMOV FB INTRANAS 326.00 30300

EP REMOV FB INTRANAS 405.80 30300ER ANT NASAL CTRY/PK 127.60 30901EP ANT NASAL CTRY/PK 217.80 30901ER NASAL CTRY PK CMP 283.80 30903EP NASAL CTRY PK CMP 276.90 30903ER POS NASAL CTRY/PK 347.70 30905EP POS NASAL CTRY/PK 308.20 30905ER INTUBATION/ENDOTR 163.70 31500EP INTUBATION/ENDOTR 422.30 31500EP LARYNGOSCOPY INDI 120.60 31505EP LRNGOSCOPY FB REM 438.60 31511EP LRNGSCP FLEX FB R 633.40 31577EP TRACHEOSTOMY TRAN 1032.60 31603CATHETER ASPIRATION 160.70 31720LUNG BX PLAC NDL 292.70 32405ER TUBE THORACOSTOMY 57.30 32551EP TUBE THORACOSTOMY 866.90 32551THOR ASP PIR W/IMAG 2447.00 32555ER PERICARDIOCENTESI 114.70 33010EP PERICARDIOCENTESI 503.90 33010EP INTRACATH NDL VEI 36.30 36000EP VENIPUNCTURE VEIN 35.10 36406EP VENI >3YR PHD SKL 36.30 36410VENIPUNCTURE 18.20 36415SPECIAL VENIPUNC.FEE 95.80 36415VENIPUNCTURE/OHS 13.00 36415VENIPUNCTURE/BLD DRW 0.00 36415EP VENI UNDER AGE 1 207.90 36420BLOOD TRANSFUSION 161.60 36430TRANSFUSION CL/4 HRS 192.00 36430BLOOD TRANSFUS 1 BAG 155.40 36430BLOOD TRANSFUS 2 BAG 233.10 36430BLOOD TRANSFUS 3 BAG 310.80 36430BLOOD TRANSFUS 1 BAG 155.40 36430BLOOD TRANSFUS 2 BAG 233.10 36430BLOOD TRANSFUS 3 BAG 310.80 36430INSERT CENT VEN CATH 703.10 36556EP CNTR VEN CAT >2YR 277.90 36558EP CNTR VEN CAT >2YR 351.60 36558EP CENT VEN CAT 5+YR 634.90 36558INSERT PICC >5 YR 480.40 36569PICC WO SUB PRT PMP 729.20 36569EP INS PICC/PRT 5+YR 951.90 36571PICC LINE W/FLOURO 277.20 36573BLOOD COLL PORT/CL 104.50 36591BLOOD COLL IV/PICC 139.10 36592DECLOTTING OF A LINE 217.80 36593

CONTR INJ EVL EX CVC 548.60 36598EP ART PUNC BLOOD 71.70 36600ARTERIAL PUNCTURE 57.50 36600ABG COLLECTION SPEC 31.60 36600LIGATION ARTERY EXT 114.70 37618LIGATION ARTY EXT PF 1405.20 37618ID OF SENTINEL NODE 169.10 38792EP REM EMBED FB MOUT 332.40 40804EP LAC REPAIR MOUTH 519.90 40830EP LAC REP TONG <2.5 375.70 41250EP LAC REPAIR TONGUE 525.40 41251ER LAC REPR TNG >2.6 245.10 41252EP LAC REPR TNG >2.6 962.90 41252ER DRNG ABSC DENT ST 250.80 41800EP DRNG ABSC DENT ST 313.60 41800EP DRAIN ABS PALATE 278.90 42000EP REMOV FB PHARYNX 403.00 42809EP ESOPHAGOSCPY W FB 643.40 43215ER GASTR INTUB/ASPIR 259.10 43753EP GASTR INTUB/ASPIR 94.10 43753EP CHG GASTROSTOMY 295.30 43760ER REPL GASTRONOMY TUBE 543.90 43762EP REPL GASTRONOMY TUBE 126.00 43762ER I&D ABCESS PERIRE 298.10 46040EP I&D ABCESS PERIRE 1052.90 46040ER I&D ABCESS PERIANA 315.00 46050EP I&D ABCES PERIANA 275.80 46050ER INC EXT HEMORRHOI 163.80 46083EP INC EXT HEMORRHOI 394.20 46083EP ANOSCOPY BRSH/WSH 93.20 46600LIVER BX 967.10 47000LIVER BX 1080.70 47000PANCREAS BX 967.10 48102PANCREAS BX 1080.70 48102ER ABD PARACENTESIS 216.40 49082EP ABD PARACENTESIS 279.70 49082ER PARACENTESIS W/IM 475.40 49083EP PARACENTESIS W/IM 331.00 49083PARACENTESIS W/IMAG 1185.50 49083ABD RETRO BX 1143.50 49180ABD RETRO BX 1080.70 49180PERC IMG DRAN VISCER 583.80 49405PERC IMG GU DRN RETR 583.80 49406PERC IG DRN RETR V/R 583.80 49407FLUO EX G COLON TUBE 659.90 49465RENAL BIOPSY PERC TR 2900.60 50200RENAL CYST 967.10 50390

US ASP RENAL CYST 1080.70 50390INJ PRO CYSTO/VCUG 461.00 51600ER IRRIG BLDR SIMPLE 161.70 51700EP IRRIG BLDR SIMPLE 154.10 51700ER INST TMP BLDR CTH 219.30 51702EP INSERT INDWE CATH 160.40 51702INSERT TEMP BLADDER CATH 219.30 51702INSERT TEMP BLADDER CATH 219.30 51702EP INST TMP BLD CT C 368.00 51703ER MEASUREMENT OF POST-VOIDING RESIDUAL URINE BY US 47.30 51798ER INST TMP BLD CT C 213.00 55100ER DRAIN SCROTAL ABS 162.60 55100EP DRAIN SCROTAL ABS 537.30 55100PROSTATE BX 931.10 55700ER I&D VULVA PER ABS 10.90 56405EP I&D VULVA PER ABS 442.40 56405ER I&D BARTHOLIN ABS 80.20 56420EP I&D BARTHOLIN ABS 380.70 56420EP BX ENDOMETRIAL 145.80 58100ER REM OF IUD 71.00 58301EP REM OF IUD 303.60 58301HYSTEROSALP CNTR INJ 442.10 58340EP VAGINAL DELIVERY 2959.20 59409THYROID BX 931.10 60100ASP/INJ THYROID CYST 931.10 60300ER LUMBAR PUNCT DIAG 290.90 62270SPINAL TAP ROOM CHRG 311.60 62270EP SPINAL PUNCT LUMB 425.50 62270SPINAL PUNCTURE LMBR 569.60 62270INJ CERVICAL/THOR W/IMAGING 401.10 62321INJ INTERLAMINAR 202.70 62322INJ LUMBAR/SPINE W/IMAGING 417.40 62323ER INJ ANS AG TRG NV 143.20 64400EP INJ ANES AG TR NV 294.80 64400ER INJ ANES FACL NRV 145.30 64402EP FACIAL NERVE BLCK 430.70 64402ER NERVE BLOCK OCCIPITAL 202.90 64405EP NERVE BLOCK OCCIPITAL 72.40 64405INJ CERVICAL PLEXUS 288.80 64413INJ BRACHIAL PLEXUS 358.80 64415INJ BRACHL PLEX CONT 391.20 64416AXILLARY NERVE INJ 174.70 64417INJ SUPRASCAPULA NRV 207.90 64418INTERCOSTAL NERVE SG 320.90 64420INJ INTERCOSTAL ML 175.90 64421ILIOINGNL NRV INJ PF 412.70 64425INJ SCIATIC NERVE SG 346.20 64445

INJ SCIATIC NERVE CO 384.30 64446INJ FEMORAL NERVE SG 531.70 64447INJ FEMORAL NRV CONT 392.20 64448INJ PERIPH NERVE 363.90 64450ER OTH PERIPHRL NRVE 122.90 64450EP OTH PERIPHRL NRVE 199.80 64450OHC DIGITAL BLOCK 200.00 64455TAP BLOCK UNILAT 183.30 64486TAP BLOCK BIL 483.90 64488TAP BLOCK CONTIN BIL 372.10 64489INJ SPHEN GANGLIO PF 371.20 64505CHEMODENERVATION OF MUSCLE; BILATERAL PF 69.70 64615CARPAL TUNNEL 3248.80 64721ER REMOV FB EXT EYE 125.10 65205EP REMOV FB EXT EYE 137.80 65205ER REM FB CONJ EMBED 41.30 65210EP REM FB CONJ EMBED 156.10 65210ER REM FB CORNEA W/O 40.30 65220EP REM FB CORNEA W/O 126.00 65220IRIDOTOMY/IRIDECTOMY 2315.30 66761YAG UNILATERAL 1736.70 66821EP DRNG EYELID ABSCS 437.90 67700EP REM FB EYELID EMB 243.90 67938ER DRNG ABCESS EXEAR 153.30 69000EP DRNG ABCESS EXEAR 258.30 69000ER REM FB EX AUD CAN 196.00 69200EP REM FB EX AUD CAN 157.90 69200ER REMOVE IMPACTED EAR WAX UNI 27.30 69209EP REMOVE IMPACTED EAR WAX UNI 14.70 69209ER REM IMPACT CERUME 50.00 69210EP REM IMPACT CERUME 104.70 69210OHC REM CERUMEN IMPA 125.00 69210ORBITS FOR F.B./MRI 303.50 70030MANDIBLE PARTIAL <4V 70.90 70100MANDIBLE COMPLETE 584.60 70110MASTOIDS <3V 74.30 70120MASTOIDS COMPLETE 723.70 70130FACIAL BONES PARTIAL 57.00 70140FACIAL BONES MIN 3 V 743.10 70150NASAL BONES MIN 3 V 497.20 70160ORBITS MIN 4 VIEW 619.20 70200SINUSES PARTIAL 62.50 70210SINUSES MIN 3 VIEW 543.60 70220SELLA TURCICA 59.30 70240SKULL LESS THAN 4 V 434.70 70250SKULL MIN 4 VIEW 674.60 70260TEMP MAND UNILATERAL 236.00 70328

TEMP MAND BILATERAL 524.50 70330MRI TMPOMANDIB JOINT 2122.10 70336SOFT TISSUE NECK 329.20 70360COMPLETE SPEECH EVAL 142.80 70371SALIVARY GLAND 470.70 70380CT HEAD W/O 2184.00 70450CT HEAD WITH 2663.90 70460CT HEAD W W/O 3233.00 70470CT ORB PF IAC W/O 2389.80 70480CT ORB PR IAC W 2781.50 70481CT ORB PR IAC W W/O 2915.90 70482CT MAXIL W/O DENTAL 458.90 70486CT MAX-FACIAL W/O 2316.30 70486CT MAX FACIAL W 2744.70 70487CT MAX FACIAL W/W/O 2904.30 70488CT ST NECK W/O 2389.80 70490CT ST NECK W 2781.50 70491CT ST NECK W W/O 2915.90 70492CTA HEAD W/W/O 2407.70 70496CTA NECK W/W/O 2407.70 70498MRI ORB FAC NCK W/O 2122.10 70540MRI ORB FAC NCK CONT 2587.20 70542MRI ORB/NECK W/W/O 2776.20 70543MRI MRA HEAD W/O 2587.20 70544MRA HEAD W CONTRAST 2201.90 70545MRI MRA HEAD W/W/O 3053.40 70546MRI MRA NECK W/O 2587.20 70547MRA NECK W CONTRAST 2201.90 70548MRI MRA NECK W/W/O 3053.40 70549MRI BRAIN W/BRN STEM 2122.10 70551MRI BRAIN W/CONTRAST 2587.20 70552MRI BRAIN W & W/O CN 3053.40 70553CHEST PA/OHS 72.75 71010CHEST PA & LATER OHS 40.00 71010CHEST PA 1 VIEW 331.30 71045CHEST PA & LAT 405.30 71046CHEST 2V W/FLUORO 131.00 71046CHEST 3V FRT LAT LOR 578.60 71047CHEST 2V FRT/LAT OBL 515.00 71047CHEST 4 VIEW 678.80 71048CHEST CMP 4V W FLURO 912.70 71048RIBS 2 VIEW UNILATER 647.60 71100RIBS UNI MIN 3V CXR1 585.60 71101RIBS 3 VIEW BILATERA 496.40 71110RIBS BIL MIN 4V CXR1 750.80 71111STERNUM MIN 2 VIEW 457.50 71120STERNOCLAVICUL JT 3V 578.60 71130

CT CHEST W/O 2260.70 71250CT CHEST W 2038.10 71260CT CHEST W W/O 2642.90 71270CTA CHEST W/W/O 3233.00 71275MRI CHEST W/O 2122.10 71550MRI CHEST W CONTRAST 2587.20 71551MRI CHEST W W/O CNTR 3053.40 71552MRA CHEST W/W/O 3053.40 71555SPINE SINGLE VIEW 352.30 72020CERVICAL 2-3 VIEWS 584.60 72040CERVICAL MIN 4 VIEW 894.90 72050CERV COMP W FL/EXT 907.20 72052SPINE THORACIC 2V 403.70 72070T SPINE W SWIMMERS 647.60 72072T SPINE 4V 651.00 72074THORACOLUMBAR AP/LAT 465.20 72080SCOLIOSIS 1V 557.00 72081SCOLIOSIS 2-3V 590.10 72082SCOLIOSIS 4-5V 622.40 72083SCOLIOSIS 6V 644.20 72084L SPINE 2-3 VIEWS 743.10 72100LSPINE OHS 109.00 72100L SPINE MIN 4V 990.90 72110LSPINE MIN 4V OHS 318.50 72110LSPINE W BEND MIN 6V 949.70 72114LSPINE BENDING ONLY 765.50 72120CT C SPINE W/O 2772.00 72125CT C SPINE W 3230.90 72126CT C SPINE W W/O 3880.80 72127CT T SPINE W/O 2772.00 72128CT T SPINE W 3230.90 72129CT T SPINE W/W/O 3880.80 72130CT L-SPINE W/O 2772.00 72131CT L-SPINE W 3230.90 72132CT L-SPINE W W/0 3880.80 72133MRI CERVICAL SPINE 2122.10 72141MRI CRV SPNE CONTRAS 2587.20 72142MRI THORAC SPINE W/O 2122.10 72146MRI THORC SPN CNTRST 2587.20 72147MRI LUMBAR SPINE W/O 2122.10 72148MRI LMBR SPN CONTRAS 2845.50 72149MRI CERV SPN W & W/O 3053.40 72156MRI THRC SPN W & W/O 3053.40 72157MRI LMBR SPN W & W/O 3310.70 72158MRA SPIN CANAL W/O C 1829.10 72159MRA SPIN CANAL CONTR 2201.90 72159PELVIS (1 VIEW) 467.00 72170

PELVIS MIN 3 VIEW 510.60 72190CTA PELVIS W/W/O 2738.40 72191CT PELVIS W/O 2226.00 72192CT PELVIS W 2536.80 72193CT PELVIS W W/O 3233.00 72194MRI PELVIS W/O CNTRS 2122.10 72195MRI PELVIS W CONTRAS 2587.20 72196MRI PELVIS W/W/O 3053.40 72197MRA PELVIS W CONTRAS 2201.90 72198MRA PELVIS W/O CONTR 1829.10 72198SI JOINTS <3V 58.30 72200SI JOINTS MIN 3 VIEW 531.00 72202SACR & COCCYX MIN 2V 448.60 72220CLAVICLE 2 VIEW 419.50 73000SCAPULA MIN 2 VIEW 419.50 73010SHOULDER 1 VIEW 333.10 73020SHOULDER MIN 2 VIEW 543.60 73030ARTHROGRAM SHOULDER 1086.80 73040AC JOINTS COMP 526.30 73050HUMERUS MIN 2 VIEW 515.00 73060ELBOW 2V 312.40 73070ELBOW MIN 3 VIEW 419.50 73080ARTHROGRAM ELBOW 668.30 73085FOREARM 2V 464.60 73090UP EXT INFANT 2 VIEW 341.80 73092WRIST 2V 351.00 73100WRIST MIN 3 VIEW 413.20 73110ARTHROGRAM WRIST 505.80 73115HAND 2V 407.90 73120HAND MIN 3 VIEW 543.60 73130FINGER MIN 2 VIEW 362.30 73140CT UP EXT W/O 2373.00 73200CT UP EXT W 2810.90 73201CT UP EXT W/W/O 3363.20 73202CTA UPP EXT W/W/O 2427.60 73206MRI UPPER EXTREM W/O 2122.10 73218MRI UPP EXT W/CONTR 2587.20 73219MRI UPP EXT W/W/O 3053.40 73220MRI UP EXT JNT W/O 2122.10 73221MRI JNT UPP EXT W CN 2587.20 73222MRI JNT UPP EXT W/WO 3053.40 73223MRA UPPER EXT W/W/O 2262.80 73225HIP UNI W/PELVIS 1V 245.70 73501HIP UNI W/PELV 2-3V 409.50 73502HIP UNI W/PLV MIN 4V 507.70 73503HIPS BIL W/PELVIS 2V 517.70 73521HIP BIL W/PELV 2V PR 130.50 73521

HIP BIL W/PELVIS 3-4 545.00 73522HIP BIL W/PLV MIN 5V 572.30 73523ARTHROGRAM HIP 718.20 73525FEMUR 1V 398.50 73551FEMUR 2V 442.30 73552KNEE 1 OR 2 VIEWS 419.50 73560KNEE 3 VIEW 464.60 73562KNEE 4 VIEW 521.10 73564KNEES BIL STAND AP 331.30 73565ARTHROGRAM KNEE 1011.20 73580TIBIA FIBULA 2V 497.20 73590LOW EXT INFANT 2V 395.90 73592ANKLE 2V 386.70 73600ANKLE MIN 3 VIEW 490.60 73610ARTHROGRAM ANKLE 668.30 73615FOOT 2V 419.50 73620FOOT MIN 3 VIEW 543.60 73630HEEL MIN 2 VIEW 419.50 73650TOE MIN 2 VIEW 291.60 73660CT LOW EXT W/O 2373.00 73700CT LOW EXT W 2810.90 73701CT LOW EXT W/W/O 3363.20 73702CTA LOW EXT W/W/O 2427.60 73706MRI LOWER EXTREM W/O 2122.10 73718MRI LOW EXT W/CONTR 2587.20 73719MRI LOW EXT W/W/O 3053.40 73720MRI LOW EXT JNT W/O 2122.10 73721MRI JNT LOW EXT W CN 2587.20 73722MRI JNT LOW EXT W/WO 3053.40 73723MRA LOWER EXT W/CONT 2262.80 73725ABDOMEN 1 VIEW 543.60 74018ABD FLAT/UPR/DECUB 574.60 74019ABD 3-4 VIEW 609.00 74021ACUTE ABD SERIE COMP 722.70 74022CT ABDOMEN W/O 2196.60 74150CT ABDOMEN W 2588.30 74160CT ABDOMEN W W/O 3233.00 74170CTA ABD PELVIS W/W/O 3810.50 74174CTA ABD W/W/O 3233.00 74175CT ABD PELVIS W/O 3077.60 74176CT ABD PELVIS W 3565.80 74177CT ABD PELVIS W/W/O 4499.30 74178MRI ABDOMEN W/O CNTR 2122.10 74181MRI ABDOMEN W/CONTRA 2587.20 74182MRI ABDOMEN W/W/O 3053.40 74183MRA ABDOMEN WITH CNT 2587.20 74185MRA ABDOMEN W/O CNTR 2122.10 74185

MRA ABDOMEN W/W/O 3053.40 74185ESOPHAGUS 653.40 74220SWALLOW FUNCT CINERA 301.40 74230UPPER GI W/O KUB 1000.10 74240UPPER GI W KUB 1067.90 74241UPPER GI W SM BOWEL 1557.20 74245UPPER GI W AIR 1209.30 74246UPPER GI AIR W KUB 1234.30 74247UPPER GI AIR/SM BWEL 1672.10 74249SMALL BOWEL SERIES 771.50 74250CT COLONOGRAPHY W/0 3982.70 74261CT COLONOGRPHY W/W/O 4461.50 74262CT COLONOGRAPHY SCRN 6286.40 74263COLON (BE) 1189.40 74270COLON W/AIR CONTRAST 1279.40 74280ENEMA RED INTUSSUSCE 818.00 74283INTER OP CHOL 735.00 74300IV PYELOGRAM 990.90 74410IV PYELOGRAM W/TOMO 1979.50 74415RETROGRADE UROGRAPHY 557.60 74420CYSTOGRAM 747.10 74430URETHROGRAM VOIDING 813.50 74455HYSTEROSALPINGOGRAM 163.80 74740CT CORONARY CALCIUM SCORE 75.00 75571CTA AORTA/RUNOFF 5847.50 75635FLUOROSCOPY > 1 HR 589.10 76000FISTULA STUDY 735.00 76080XRAY MAMMO SURG SPEC 155.10 76098CT MR US 3D RECON 990.20 76376CT LTD STUDY FU 1784.00 76380US THYROID NECK 1112.50 76536US CHEST PL EFF 1017.50 76604US BREAST EACH BRST 311.90 76641US BREAST LTD EACH 236.00 76642US ABDOMEN COMP 1361.10 76700US GALLBLADDER 1166.80 76705US LIVER DUCTS 1166.80 76705US SPLEEN 1166.80 76705US PANCREAS 1166.80 76705US RT UPPER QUAD 1166.80 76705ULTRASOUND AAA SCREN 474.60 76706US RETR/REN/AO CMP 1184.70 76770US RETRO/REN/AO/LTD 1085.70 76775US SPINE 243.20 76800US FETAL 1ST TRIMEST 1023.20 76801US FETAL 1ST TRI ADD 438.60 76802US FETAL >14 WEEKS 1023.20 76805

US FETAL >14WK ADD'L 474.10 76810US FETAL LTD 733.20 76815US FETAL FU 936.30 76816US TRANSVAG FETAL 1023.20 76817US BPP W/NST 204.80 76818US BPP W/O NST 150.60 76819US TRANSVAG PELVIS 946.60 76830US SONOHYSTEROGRAPHY 940.50 76831US PELVIS 1106.40 76856US PELVIS FU 776.50 76857US PELVIS LTD 74.00 76857US SCROTUM 1062.30 76870US EXT NON VAS COMP 373.30 76881US EXT NON VAS LTD 84.80 76882US INFANT HIPS DYN 1041.60 76885US INFANT HIPS STATC 183.50 76886US GUID VASCULAR ACS 121.50 76937US GUIDANCE 161.50 76942US GUID NEEDLE PLACE 1006.20 76942FLUORO GUIDE CVC 453.60 77001FL GUID NEEDLE PLACE 824.00 77002FLUORO GUID LMBR PUN 260.90 77003CT GUID NEEDLE PLACE 1097.30 77012MAMMOGRAM EMPLOYEE 0.00 77057MAMMOGRAM UNILAT 167.00 77065MAMMOGRAM DIAG BILAT 269.90 77066MAMMOGRAM SCRN BILAT 203.70 77067MAMMO GRANT 80.00 77067STRESS VIEWS ANY JNT 629.70 77071BONE AGE STUDY 415.80 77072BONE LENGTH STUDY 471.50 77073BONE SURVEY LIMIT 785.10 77074BONE SURVEY 645.80 77075BONE SURVEY INFANT 540.50 77076CT BONE MINERAL DENS 577.50 77078CT BONE MINERAL DENS EMPLOYEE 0.00 77078THRYOID IMG W/UPTAKE 973.40 78014PARATHYROID IMAGING 779.40 78070PARATHYROID IMG SPEC 713.00 78071SPLEEN IMAGING 1002.20 78185SENTINEL NODE IMAG 1254.80 78195LIVER IMAG SPECT 2064.00 78205LIVER\SPLEEN STATIC 1444.80 78215NM LIVER/SPLN VSC FL 1719.90 78216HEPATOBIL W/O CCK 1375.00 78226HEPATOBIL W CCK 2065.60 78227GASTRIC EMPTY STUDY 1855.10 78264

GASTRIC EMP W/SMBOWL 1095.90 78265ACUTE GI BLEED IMAG 2064.00 78278NUCLEAR SCAN OUTSIDE 0.00 78278INTESTIN IMAG MECKEL 1370.50 78290BONE JNT IMAG LTD 1318.30 78300BONE JNT IMAG MULTIP 1914.90 78305BONE JNT IMAG WH BDY 2191.90 78306BONE JNT IMAG 3 PHAS 2031.50 78315BONE JOINT IMAG SPEC 2426.80 78320HT MUSCLE IMAG SP SN 3346.90 78451HT MUSCLE IMAG SP ML 3877.90 78452CARD BLD POOL EF MUG 2246.20 78472PUL PERF IMAG PARTIC 1461.90 78580PUL VENT&PERF IMAGNG 2028.30 78582BRAIN IMAG STAT <4V 1212.80 78600BRAIN IMG ST/FLW <4V 1439.30 78601BRAIN IMAGING SPECT 888.30 78607KIDNEY IMG W FUNCTIO 2022.00 78707KIDNEY IMG FLW PHARM 2174.80 78708TESTICULAR IMG FLOW 1699.40 78761RADIONUC LOC ABSCESS 1787.90 78805RADIONUC LOC ABS WB 2818.50 78806RADIONUC LOC ABS SPT 2871.80 78807BASIC METABOLIC PANE 131.40 80048GENERAL HEALTH PANEL 217.20 80050ELECTROLYTES 255.00 80051COMP METABOLIC PANEL 189.40 80053COMP METABOLIC PANEL - VET 12.00 80053COMP METABOLIC PANEL - WELLNESS 4.70 80053LIPID PANEL 198.60 80061RENAL FUNCTION PANEL 157.50 80069HEPATITIS COMPREHENS 1004.90 80074HEPATITIS PANEL 412.00 80074LIVER FUNCTION PANEL 138.70 80076AMIKACIN 124.60 80150CARBAMAZIPINE TOTAL 226.80 80156CARBAMAZEPINE FREE 192.00 80157CYCLOSPORINE, SPECIF 208.30 80158CLOZAPINE (CLOZARIL) 439.30 80159DIGOXIN 154.70 80162VALPROIC ACID 183.10 80164VALPROIC ACID FREE 259.40 80165ETHOSUXIMIDE (ZARONT 200.80 80168GENTAMICIN TROUGH 184.20 80170GENTAMICIN PEAK 184.20 80170HALOPERIDOL LEVEL 129.40 80173LAMOTRIGINE(LAMICTAL 110.30 80175

LIDOCAINE, SERUM 133.40 80176LITHIUM, SERUM 84.50 80178MYCOPHENOLIC ACID 326.00 80180OXCARBAZEPINE 33.80 80183PHENOBARBITAL 226.50 80184PHENYTOIN (DILANTIN) 213.00 80185PHENYTOIN (DIL) FREE 235.40 80186PRIMIDONE--PHENOBARB 108.60 80188PROCAINAMIDE N-ACETY 244.40 80192QUINIDINE SERUM 224.70 80194RAPAMUNE(SIROLIMUS) 262.40 80195TACROLIMUS(PROGRAF) 149.10 80197THEOPHYLLINE, SERUM 171.30 80198TOBRAMYCIN LEVEL 511.80 80200TOPAMAX (TOPIRMATE) 316.40 80201VANCOMYCIN-PEAK 196.70 80202VANCOMYCIN-TROUGH 196.70 80202GABAPENTIN/NEURONTIN 113.80 80299LAMOTRIGINE LEVEL 86.30 80299METHOTREXATE LEVEL 91.40 80299ZONISAMIDE ZONEGRAN 380.60 80299OHS DRUG COL.HANDFEE 23.00 80300DRUGS OF ABUSE 5 PAN 90.60 80305DRUG SCRN BUS DRIVER 105.10 80305DRUG SCRN NO CONTRAC 89.10 80305DRUG SCRN (5) OHS 58.30 80305DRUG SCREEN (10) OHS 58.30 80305OHS 5 PANEL IN-HOUSE 51.60 80305EMPLOYEE DRUG SCREEN 82.80 80305DRUG SCREEN URINE RE 271.20 80305SINGL DRUG CLAS SCRN 36.10 80305OHS 6 PANEL IN HOUSE 34.00 80305OHS DRUG PANEL 11 PM 110.00 80305DRUG SCREEN 11 INHSE 37.00 80305BATH SALTS 75.00 80305BATH SALTS CONFIRM 50.00 80305DRUG COMPRE TOXASSUR 163.80 80307DRUG OF ABUSE SCREEN 161.70 80307DRUG PROFILE BLOOD 376.70 80307DRUG SCN FEDERAL DOT 98.30 80307DRUG SCREEN SERUM & 219.00 80307LYSERGIC ACID-URINE 421.10 80307FENTANYL/NORFENTANYL 126.60 80307GAMA HYDROXYBUTY ACI 605.00 80307NICOTINE METABOLITE (CONTININE) SCREEN ONLY 125.10 80307DRUG SCRN 9 W/REFLEX CONFIRMATION 273.00 80307CANNABINOIDS, SYNTHETIC, K2 SCREEN 105.00 80307

TRAMADOL, URINE SCRN, QUAL 121.80 80307GABAPENTIN, URINE, QUAL 372.80 80307DRUG SCRN COMP,SERUM 659.10 80307DRUG SCREEN 10, WHOLE BLOOD W/REFLEX TO CONFIRM 462.00 80307ALCOHOL (ETHANOL) 167.50 80320NICOTINE URINE LEVEL 63.60 80323NICOTINE BLOOD LEVEL 326.30 80323AMPHETAMINE CONFIRMATION, URINE 48.30 80324DIHYDROTESTOSTERONE 478.80 80327ACETAMINOPHEN 289.80 80329SALICYLATE SERUM 139.20 80329IBUPROFEN LEVEL 442.50 80329NORTRIPTYLINE LEVEL 129.00 80335NORDOXEPIN, SERUM 156.10 80335AMITRIPTYLINE LEVEL 129.00 80335DOXEPIN 132.70 80335IMIPRAMINE 147.30 80335NORDOXEPIN URINE 132.70 80335DESIPRAMINE 165.70 80335TRICYCLIC ANTIDEPRESSANTS CONFIRMATION, URINE 251.00 80337BUPROBION(WELLBUTRIN 530.40 80338METHSUXIMIDE LEVEL 127.50 80339CLOBAZAM 331.80 80339RUFINAMIDE (BANIEL) 283.50 80339CHLORPROMAZINE(THORA 157.80 80342QUETIAPINE(SEROQUEL) 260.60 80342BARBITURATE CONFIRMATION, URINE 48.30 80345LORAZEPAM (ATIVAN) 294.80 80346CHLORDIAZEPOXIDE-SER 165.70 80346CLONAZEPAM LEVEL 165.70 80346BENZODIAZEPINE CONFIRMATION, URINE 48.30 80346CANNABINOID CONFIRMATION, URINE 48.30 80349COCAINE METABOLITES CONFIRMATION, URINE 48.30 80353METHADONE CONFIRMATION, URINE 48.30 80358AMPHETAMINE, METHAMPHETAMINE MDMA, MDA 119.70 80359HYDROCODONE, QUANT. 320.10 80361OPIATES CONFIRMATION, URINE 48.30 80361MEPERIDINE/NORMEPERI 441.70 80362OXYCODONE CONFIRMATION, URINE 52.50 80365PROPOXYPHENE CONFIRMATION, URINE 52.50 80367DEXAMETHASONE 216.20 80375DRUG CONFIRM EACH 57.30 80375DRUG CONF(GS/MS)BLD 206.40 80375METOPROLOL(LOPRESSR) 299.30 80375WARFARIN LEVEL 62.30 80375DURG 10 PANEL INHOUSE 28.00 80375HAIR DRUG SCREEN 44.00 80377

HAIR SHIPMENT 10.50 80377PATH CONSULT LIMITED 10.90 80500PATH CONSULT COMPLEX 10.90 80502URINALYSIS, EMPL COM 0.00 81001URINALYSIS 49.50 81001UA OHS 11.00 81001URINE DIPSTICK 22.60 81002SPECIF GRAVITY URINE 26.70 81003URINALYSIS W/O MICRO 17.50 81003UA STICK OHS 10.00 81003INDICAN, URINE 126.00 81005PREGNANCY TEST URINE 83.60 81025URINE PREGNANCY 46.90 81025VOLUME MEASURE TIMED 29.50 81050BRCA 1/2 COMPREHENSIVE 5065.20 81162BCR-AB1 KINASE MUTAT 661.50 81170BCR/ABL1 ANALY MAJOR 491.40 81206BCR/ABL1 ANA MINR BP 928.20 81207BRAF GENE ANALYSIS 1575.00 81210CALR MUTATION ANAYSI 1081.10 81219CLOPIDOGREL CYP2C19 GENOTYPE 525.00 81225FACTOR II DNA ANALYS 276.30 81240FACTOR V(LEIDEN)MUTA 270.10 81241FRAGILE X SYND PCR 518.90 81243HEREDIT HEMOCH MUTAT 256.40 81256IGVH SOMATIC HYPERMUTATION 1963.50 81263JAK2V617F MUTAT QUAL 436.80 81270JAK2 GENE ANAYLSIS 873.60 81270JAK2(V617F) MUTATION 873.60 81270JAK2 MUTATION ANALYSIS W/REFLEX TO CALR AND MPL 840.00 81270KRAS GENE ANALYSIS 1417.50 81275METH(MTHFR) REDA DNA 215.00 81291ALPHA-A-TRYP DEF DNA 588.00 81332HLA-B27 ANTIGEN 283.00 81374HLA DR 1/3/4/5, DQ INTERMEDIATE RESOLUTION 1071.00 81375HLA II TYPE 1 ANTIGN 1071.80 81377HLA TYPING 657.50 81379HLA II TYPE 1 ALLELE 1071.80 81383PAI-1 GENE 4G/5G POL 764.40 81400MPL MUTATION ANAYLSI 1179.40 81402JAK2 EXON 12 MUTATN 945.00 81403BETA-THALASSEMIA: HBB 771.80 81404PRENATAL TEST (INFORMA SEQ) W/X,Y ANALYSIS 1879.50 81420ALPHA-FETOPROTEIN (AFP) TETRA PROFILE 96.60 81511ACETONE URINE 21.20 82010ACETONE SERUM QUANT 54.10 82010B-HYDROXYBUTYRATE 293.60 82010

ACYL CARNITINE 439.70 82017ACTH, PLASMA EXTRACT 441.50 82024ADRENOCORTICOTROPIC HORMONE (ACTH) EIGHT SPECIMENS 302.40 82024ALBUMIN SERUM 56.40 82040ALBUMIN, URINE QUANT 42.10 82042ALBUMIN BODY FLUID 62.50 82042MICROALBUMIN,24HR UR 93.20 82043MICROALBUMIN RANDOM 87.50 82043BREATH ALCOHOL TEST 29.00 82075NONDOT BAT TESTING 0.00 82075ALDOLASE 104.00 82085ALDOSTERONE URINE 284.10 82088ALDOSTERONE 423.70 82088FECAL ALPH-1-ANTITRY 361.60 82103ALPHA-1-ANTITRY TOTL 106.70 82103ALPHA-1-ANTITRY PHEN 144.70 82104ALPHAFETOPORTN-MATER 38.50 82105ALPHA FETOPROT TUMER 233.20 82105AMINO ACID-SCN-URINE 131.40 82128PHENYLALANINE QUANT 222.20 82131AMINO ACID QUANT URN 289.70 82131AMINOLEVUL ACID DELT 137.60 82135AMINO ACID SCR SERUM 122.50 82139AMMONIA, BLOOD 209.00 82140AMMONIA 24HR URINE 82.70 82140AMYLASE URINE 120.90 82150AMYLASE BODY FLUID 130.00 82150AMYLASE, SERUM 130.00 82150AMYLASE ISOENZYMES 183.40 82150ANDROSTENEDIONE 339.50 82157ANGIOT-1-CONV ENZYN 93.20 82164LIPOPROTEIN (A1) 99.40 82172APOLIPOPROTEIN B 33.80 82172ARSENIC URINE 314.50 82175ARSENIC HAIR 271.20 82175ARSENIC, BLOOD, QUAN 153.50 82175VITAMIN C, SERUM 79.80 82180BETA-2-MICROGLOBULIN 110.40 82232BILIRUBIN TOTAL 97.10 82247BILIRUBIN DIRECT 83.60 82248FECALOCULT SCN 3SPEC 98.00 82270FECAL OCCULT BLOOD 27.90 82270GASTROCCULT 29.20 82271FECAL OCULT BLD 1SPE 92.00 82272FECAL IMMUNO OCCULT 60.00 82274CADMIUM 96.60 82300CADMIUM, URINE 131.30 82300

VITAMIN-D-25-HYDROXY 244.70 82306CALCITONIN 259.50 82308CALCIUM, SERUM 71.10 82310CALCIUM URINE RANDOM 55.20 82310CALCIUM, IONIZED 229.40 82330CALCIUM 24 HR URINE 83.60 82340CALCULI QUANT ANALYS 177.50 82360URINE CALCULI ANALYS 138.60 82360CARBO DEFIC TRANSFER 503.90 82373CO2 66.20 82374CARBOXYHEMOGLOBIN 122.70 82375CARBOXYHEMOGLOBIN 43.10 82375CARCINO-EMBRYONIC AG 291.60 82378CARNITINE 262.40 82379CAROTENE 91.40 82380CATECHOLAMIN,FRAC,PL 274.30 82383CATECHOLAMIN,FRAC,UR 294.80 82384CATECHOLAMINES FRACTIONATED PLASMA 58.00 82384CATECHOLAMINES, FRACTIONATED RANDOM URINE 63.00 82384CERULOPLASMIN SERUM 135.60 82390ANTI-MULLERIAN HORMO 222.80 82397PTH RELATED PEPTIDE 148.50 82397DIGITOXIN REFERRED 167.60 82397ANTI-ADALIMUMAB ANTIBODY 867.30 82397CHLORIDE, SERUM 62.50 82435CHLORIDE 24HR URINE 67.00 82436CHLORIDE URIN RANDOM 49.90 82436CHLORIDE CSF 52.50 82438CHOLESTEROL SERUM 78.00 82465CHOLINESTERASE PLASMA/SERUM 129.00 82480CHOLINESTERASE RBC 172.30 82482CHROMIUM 132.30 82495CITRATE, URINE 188.80 82507DEOXYPYRIDINOLINE 192.00 82523N-TELOPEPTIDE(NTX) 483.20 82523C-TELOPEPTIDE 417.20 82523COPPER SERUM 253.60 82525COPPER, 24 HR URINE 235.80 82525CORTISOL, URINE FREE 514.90 82530CORTISOL, FREE BY LC/MS 315.00 82530CORTISOL TOTAL SINGL 233.70 82533CORTISOL, ACTH STIMULATION 336.00 82533CORTISOL (DEXAMETHASONE SUPPRESSION) 168.00 82533CORTISOL, EIGHT SPECIMENS 100.80 82533BENZTROPINE LEVEL 371.10 82542RISPERDAL LEVEL 448.10 82542FLECAINIDE LEVEL 101.10 82542

IONAMIN(PHENTERMINE) 318.50 82542OLANZAPINE (ZYPREXA) 260.60 82542ITRACONAZOLE 274.80 82542LEVETIRACETAM(KEPPA) 235.20 82542ACETAZOLAMIDE 263.30 82542TRAZODONE (DESYREL) 417.20 82542CARBAMAZ-10,11-EPOX1 277.90 82542FELBAMATE LEVEL 106.40 82542LEVODOPA LEVEL 569.50 82542PROZAC(FLUOXETIN/NOR 198.00 82542CLOMIPRAMINE & NORCL 114.30 82542RISPERIDONE LEVEL 462.60 82542CAFFEINE SERUM 355.60 82542TIAGABINE (GABITRIL) 251.70 82542BILE ACID FRACT&TOT 360.70 82542THIOPURINE METHYLTRN 739.60 82542LACOSAMIDE (VIMPAT) 523.70 82542ZIPRASIDONE(ZELDOX) 347.60 82542VORICONAZOLE LEVEL 909.10 82542METHYLPHENIDATE 252.40 82542COENZYME Q10 TOTAL 65.90 82542CPK 77.40 82550CPK ISOENSYMES 125.00 82552CPK-MB 258.60 82553CREATININE SERUM 110.10 82565CREATININE 24HR URIN 116.40 82570CREATIN URINE RANDOM 116.40 82570CREATININE BOD FLUID 102.60 82570CREATININE CLEARANCE 214.20 82575CRYOGLOBULINS, QUAL 62.00 82595CYANIDE BLOOD 174.70 82600VITAMIN B-12 162.00 82607VIT B12 BIND CAPACI 183.00 82608CYSTATIN C 283.50 82610DEHYDROEPIANDRO. SUL 263.60 82627DIBUCAINE NUMBER 134.80 82638CALCITROL(1,25 DI-OH 328.20 82652PANCREAT ELAST FECAL 535.10 82656ERYTHROPOIETIN 389.80 82668ESTRADIOL, SERUM 369.20 82670ESTROGEN, TOTAL 124.60 82672ESTRIOL,UNCONJUGATED 75.80 82677ESTRONE 222.80 82679ETHYLENE GLYCOL 449.30 82693FECAL FAT 156.20 82705FECAL FAT QUANTITATI 40.20 82710FATTY ACIDS(NONESTER 97.80 82725

FERRITIN 157.20 82728FLUORIDE, URINE 227.30 82735FOLATE, SERUM 151.40 82746FOLATE, RBC 181.80 82747FRUCTOSE, SEMEN 668.90 82757IMMUNOGLOB A,D,G,M 194.30 82784IGG, SERUM 76.50 82784IGM, SERUM 66.40 82784IGA, TOTAL QUANTITAT 76.50 82784IGE, SERUM 195.10 82785IGG SUBCLASSES 561.40 82787IMMUNOGLOBULIN G, IGG, SUBCLASS 4 30.50 82787VENOUS BLOOD GASES 146.80 82803BLOOD GASES ARTERIAL 153.70 82803GASTRIN 153.70 82941GLUCAGON 159.00 82943GLUCOSE 24 HR URINE 104.80 82945GLUCOSE CSF 84.50 82945GLUCOSE BODY FLUID 15.20 82945GLUCOSE, SERUM QUANT 97.10 82947GLUCOSE, BLOOD, REAGENT STRIP CLINIC 23.80 82948GLUCOSE POST DOSE 108.40 82950GLUCOSE TOLER 2 HOUR 124.70 82951GLUCOSE TOLER 3 HOUR 233.30 82951GLUCOSE TOLER 4 HOUR 276.90 82951GLUCOSE TOLER 5 HOUR 313.10 82951GLUCOSE TOLER 6 HOUR 384.80 82951GLUCOSE TOLER 1 HOUR 106.90 82951GLUCOSE TOL ADD SPEC 39.40 82952GLUCOSE-6-PHOS-DEHYD 118.10 82955GLUCOSE FSA 42.60 82962GLUCOSE, WHOLE BLOOD 37.40 82962BLOOD GLUCOSE 9.50 82962GGTP, SERUM 125.70 82977PROTEIN BOUND GLUCOS 123.70 82985FRUCTOSAMINE 138.70 82985FOLLICLE STIM HORMON 255.50 83001LUTEINIZING HORMONE 254.40 83002GROWTH HORMONE 206.90 83003HAPTOGLOBIN 158.10 83010HEAVY METAL SCREEN 200.00 83015COBALT PLASMA 131.40 83018BISMUTH 153.50 83018HEMOGLOBIN A2, BLOOD 198.80 83021HEMOGL FRACTIONATION 129.00 83021GLYCOHEM AGB A1C 41.00 83036HEMOGLOBIN A1C CLINIC 56.70 83037

METHEMOGLOBIN-QUANT. 81.70 83050HEMOGLOBIN FREE PLASMA 28.40 83051HEMOSIDERIN URINE 211.90 83070TAY-SACHS B-HEXOSAMI 173.10 83080HISTAMINE LEVEL 309.20 83088HOMOCYSTINE SERUM 187.30 8309017 HYDROXYCORTICOSTE 121.70 834915 HYDROXYINDOLACETIC 120.40 8349717 HYDROXYPROGESTERO 424.00 83498HYDROXYPROL,FRE,URIN 219.90 83500HYDROXYPROL,TOT,URIN 281.30 83505GLIADIN ANTIBODY IGG 50.30 83516ANTIPARIETAL CELL 56.30 83516GLIADIN ANTIBODY IGA 104.90 83516GLIADIN ANTIBODY IGM 104.90 83516ANTI-GLIADIN,IGG,IGA 283.00 83516GLOM BASE MEMBR ANTI 216.00 83516MITOCHONDRIAL ANTIBO 119.70 83516ANTI-SMOOTH MUSCLE 188.10 83516TISSUE TRANSGLUTAMINASE, IGA 309.00 83516BULLOUS PEMPHIGOID 180 AND 230 466.20 83516ACETYLCHOLINE REC AB 423.30 83519PANCREATIC POLYPEPTI 235.80 83519GLUTAMIC ACID DECARB 520.70 83519ANTI-MUSCULAR RECEPT 1266.50 83519ACETYLCHOLINE RECEPTOR MODULATING 168.00 83519ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODIES 67.20 83519TSH RECEPTOR ANTIBOD 166.30 83520ANTIPROTEINASE 3 98.90 83520ANTIMYELOPEROXIDASE 98.90 83520TRYPTASE 183.50 835202-HYDROXYESTRONE 301.20 8352016ALPHA-HYDROXYESTRO 301.20 83520ALPHA SUBUNIT 191.80 83520THYROTROPIN RECEP AB 100.50 83520ANTI-OMPC IGA ELISA 139.20 83520ANTI-CBIR1 ELISA 139.20 83520IBD SPECIFIC PANCA 139.20 83520NEUROMYELITIS OPTICA 1363.10 83520ANTIMYELIN ANTIBODY 459.80 83520TISSUE TRANSGLUTAMINASE, IGG 321.90 83520INHIBIN B 346.50 83520INSULIN, SERUM 152.90 83525IRON, SERUM 79.40 83540TIBC TOTAL IRON BIND 99.60 8355017 KETOSTEROIDS 24 H 183.80 83586LACTATE, BLOOD 171.60 83605

LDH, SERUM 83.60 83615LDH, BODY FLUID 86.70 83615LDH ISOENZYMES 177.00 83625LACTOFERRIN FECAL 397.30 83630FECAL WBC LACTOFERIN 64.40 83630FECAL WBC LACTOFERRIN QUANTITATIVE 277.20 83631LEAD BLOOD 99.20 83655LEAD URINE 108.40 83655LIPASE, SERUM 57.20 83690LIPOPROTEIN(A) 90.20 83695LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 85.10 83698LIPOPROTEIN FRACTION 293.30 83701NMR LIPOPROTEINS 153.80 83704HDL HIGH DENSITY LIP 127.10 83718VERY LOW DENSITY LIP 164.30 83719LDL LOW DENSITY LIPO 178.60 83721MAGNESIUM, URINE 46.50 83735MAGNESIUM, RBC 209.00 83735MAGNESIUM, SERUM 73.70 83735MANGANESE LEVEL 134.50 83785IODINE SERUM 133.20 83789MERCURY,BLOOD,QUANT 179.20 83825MERCURY,24HR,UR,QUAN 134.50 83825METANEPHRINES PLASMA 654.00 83835METANEPHRINES 24H UR 238.50 83835MYELIN BASIC PRO CSF 76.90 83873MYOGLOBIN, URINE 106.90 83874MYOGLOBIN, SERUM 100.00 83874BRAIN NATRIU PEPTIDE 332.90 83880KAPPA/LAMBA CHN SERA 87.60 83883KAPP/LAMBA FREE LIGHT CHAIN PLUS RATIO, QUANT, URINE 63.00 83883OLIGOCLONAL BAND CSF 89.90 83916ORGANIC ACID QUALIT 365.10 83919METHYLMALONIC ACID 257.90 83921STYRENE METABOLITE 210.00 83921ETHYL BENZENE METABOLITE 160.10 83921OSMOLALITY, SERUM 76.80 83930OSMOLALITY, URINE 76.80 83935OSTEOCALCIN 219.00 83937OXALATE URINE 123.30 83945DES GAMMA CARBOXY PT 424.00 83951PARA-THYROID HORMONE 355.60 83970PH BODY FLUID 56.50 83986PH FECAL 31.60 83986PHENCYCLIDINE (PCP) CONFIRMATION, URINE 48.30 83992CALPROTECTIN 576.00 83993PKU NEWBORN SCREEN 219.30 84030

ACID PHOSPHATASE 150.50 84060ALKALINE PHOSPHATASE 90.70 84075ALK.PHOS.ISOENZY. 247.20 84080ALKALINE PHOSPHATASE BONE-SPECIFIC (BAP) 107.40 84080PHOSPHOROUS 95.70 84100PHOSPHATE URINE 41.00 84105PORPHOLINOGEN,QUANT 141.80 84110PORYPHRINS URINE QUA 215.10 84120POTASSIUM SERUM 89.50 84132POTASSIUM 24HR URINE 75.50 84133POTASSIUM RANDOM URINE 18.90 84133PREALBUMIN 182.50 84134PREGNENOLONE 155.90 84140PROGESTERONE SERUM 230.50 84144PROCALCITONIN 104.00 84145PROLACTIN, SERUM 276.30 84146PSA ULTRA SENSITIVE 155.60 84153PSA SERUM TOTAL 216.00 84153PROSTAT SPEC AG FREE 294.60 84154TOTAL PROTEIN 57.50 84155TOTAL PROT RAND URIN 85.50 84156TOTAL PROT 24 HR URN 65.30 84156TOTAL PROTEIN CSF 71.70 84157PROTEIN ELECTROPHORE 119.70 84165URINE PROT. ELECTROP 131.40 84166URINE PROTEIN ELECTROPH, RANDOM 42.50 84166PROTEIN ELECTROPHORESIS, CSF 84.00 84166RBC PROTOPORPHYRIN 116.70 84202ZINC PROTOPORPHYRIN 114.30 84202PROINSULIN 220.40 84206VITAMIN B-6 558.60 84207PYRUVATE 186.30 84210ESTROGEN RECEPTOR 643.90 84233PROGESTERONE RECEPTO 643.90 84234TRANSFERRIN RECEPTOR 164.60 84238RENIN, PLASMA 249.60 84244VITAMIN B-2 679.50 84252SELENIUM 165.00 84255SEROTONIN, SERUM 147.90 84260SEX HORMON BIND GLOB 154.70 84270SODIUM SERUM 77.90 84295SODIUM URINE 24 HR 101.50 84300SODIUM URINE RANDOM 101.50 84300INSULIN GROWTH FACTO 417.90 84305BROMIDES; BLOOD 225.00 84311PORPHYRINS, SERUM 163.80 84311PHOSPHOLIPIDS 65.50 84311

FECAL REDUCING SUBST 67.70 84377REDUCING SUBS.-STOOL 55.40 84377SULFATE QUANT URINE 186.30 84392TESTOSTERONE-FREE 291.90 84402TESTOSTERONE, TOTAL 388.10 84403VITAMIN B1 (THIAMINE 251.40 84425THIOCYANATE, SERUM 205.80 84430THYROBLOBULIN 179.00 84432T4 THYROXIN 110.10 84436FREE T4 BY DIALYSIS 729.50 84439FREE THYROXINE 142.10 84439THYROXINE-BDG GLOBUL 112.00 84442THYROID STIM HORMON 155.20 84443THYROID STIM IMM TSI 594.50 84445VITAMIN E 124.30 84446TRANSCORTIN (CBG) 94.10 84449AST/SGOT SERUM 83.60 84450ALT/SGPT SERUM 77.90 84460TRANSFERRIN 139.40 84466TRIGLYCERIDES 123.00 84478TRIGLYCER BODY FLUID 114.30 84478T3 UPTAKE, SERUM 110.10 84479T-3,TOTAL,TRIIODOTHR 84.60 84480T3, FREE 172.40 84481T3 REVERSE 96.80 84482TROPONIN-T QUANT 150.50 84484BLOOD UREA NITROGEN 83.60 84520URINE UREA NITROGEN 93.20 84540URIC ACID SERUM 61.00 84550URIC ACID 24 HOUR UR 73.00 84560UROBILINOGEN, QUAL. 150.50 84578VMA URINE RANDOM 50.20 84585VMA, URINE 24 HOUR 170.50 84585VASOACTIV INTES POLY 304.70 84586ARGININE VASOPRESSIN 688.30 84588ANTIDIURETIC HORMONE 366.90 84588VITAMIN A (RETINOL) 141.40 84590VITAMIN B3 (NIACIN & METABOLITE) 781.20 84591VITAMIN K1 579.40 84597URINE PHENOL 296.40 84600ALCOHOL (METHANOL) 141.80 84600ALCOHOL (ISOPROPYL) 153.00 84600XYLENE LEVEL 250.60 84600TOLUENE METABOLITE 160.10 84600XYLOSE ABSORP, URINE 228.90 84620XYLOSE ABSORP, BLOOD 114.30 84620ZINC, SERUM 125.30 84630

ZINC, URINE 29.00 84630ZINC, RBC'S 194.30 84630C-PEPTIDE 102.90 84681B-HCG, QUANT. SERUM 211.50 84702HUMAN CHORIONIC GONA 37.30 84702BETA-HCG AT LABCORP 140.30 84702HCG LOW, TURMOR MARK 227.20 84702PREGNANCY TEST SERUM 83.90 84703FECAL OSMOLALITY 47.30 84999BLEEDING TIME 107.20 85002WBC MICRO DIFFERENTI 48.80 85004DIFFERENTIAL 48.40 85007EOSINOPHIL COUNT 46.20 85008HEMATOCRIT 48.40 85014HEMOGLOBIN 36.30 85018HEMOGLOBIN 17.90 85018HEMOGLOBIN 27.90 85018CBC W/AUTO DIFF. 79.40 85025HEMOGRAM AUTOMATED 59.80 85027RETICULOCYTE COUNT 89.50 85045WHITE BLOOD CELL CT 36.30 85048PLATELET COUNT 60.30 85049FACTOR II 237.20 85210FACTOR VII 237.20 85230FACTOR VIII (AHG) 409.20 85240FACT VIII VONW ACTIV 287.50 85245FACTOR VIII VW ANTIG 287.50 85246VONWILLEB FACT MULTI 458.60 85247FACTOR IX 548.50 85250FACTOR X 237.20 85260FACTOR XI ACTIVITY 259.10 85270FACTOR XII ACTIVITY 259.10 85280FACTOR XIII FIBRIN STABILIZING SCREEN 164.30 85291PREKALLIKREIN ASSAY 360.40 85292KININOGEN ASSAY 360.40 85293ANTITHROMBIN III ACT 159.50 85300ANTITHROM III ANTIGE 148.20 85301PROTEIN C ANTIGEN 777.40 85302PROTEIN C, ACTIVITY 145.10 85303PROTEIN S ANTIGEN, TOTAL 799.10 85305PROTEIN S, ACTIVITY, FREE 161.20 85306ACT.PROTEIN C RESIST 180.90 85307FDP BY D-DIMER QUANT 214.20 85379FIBRINOGEN LEVEL 209.30 85384FIBRINOGEN ANTIGEN 168.00 85385ADAMTS 13 ACTIVITY 352.80 85397PLASMINOG ACT INHIBR 331.00 85415

HEPARIN ANTI-XA 248.00 85520L.A.P. SCORE 248.60 85540LYSOZYME(MURAMIDASE) 153.00 85549RBC OSMOTIC FRAG. 176.20 85555PLATELET PHOSPHOLIPID NEUTRALIZATION 226.80 85597HEXAG PHASE PHOSPHOL 155.30 85598PROTHROMBIN TIME(PT) 68.00 85610MIXING CORRECT STUDY 104.20 85611LUPUS ANTICOAG.EVAL 186.40 85613DIL RUSSELL VIPER VE 114.90 85613SED RATE RBC AUTOMAT 47.40 85652SICKLE CELL SCREEN 132.70 85660HEMOGLOBIN SOLUBILIT 72.50 85660THROMBIN TIME 90.30 85670PTT 95.70 85730MIXING SUBSTITUTION FRACTIONS 157.50 85732VISCOSITY, SERUM 93.50 85810FEBRILE ANTIGENS 66.00 86000TULAREMIA AGGLUTINAT 121.80 86000ALLERGEN, IGE, CLAM 13.00 86003LATEX SPECIFIC IGE 38.10 86003RAST 6 ALLERGENS 1134.40 86003ALLERGEN PANEL, HAZELNUT, IGE 52.50 86003ALLERGEN, IGE, A. ALTERNATA 12.60 86003ALLERGEN, IGE, WHITE ASH 12.60 86003ALLERGEN, IGE, A. FUMIGATUS 12.60 86003ALLERGEN, IGE, BERMUDA GRASS 12.60 86003ALLERGEN, IGE, CAT DANDER 12.60 86003ALLERGEN, IGE, MTN. CEDAR 12.60 86003ALLERGEN, IGE, C. HERBARUM 12.60 86003ALLERGEN, IGE, GERMAN COCKROACH 12.60 86003ALLERGEN, IGE, COTTONWOOD 12.60 86003ALLERGEN, IGE, D. FARINAE 12.60 86003ALLERGEN, IGE, D. PTERONYSSINUS 12.60 86003ALLERGEN, IGE, DOG DANDER 12.60 86003ALLERGEN, IGE, AMERICAN ELM 12.60 86003ALLERGEN, IGE, MAPLE LEAF SYCAMORE 12.60 86003ALLERGEN, IGE, MAPLE/BOX ELDER 12.60 86003ALLERGEN, IGE, MOUSE URINE 12.60 86003ALLERGEN, IGE, WHITE OAK 12.60 86003ALLERGEN, IGE, PECAN, HICKORY 12.60 86003ALLERGEN, IGE, P. CHRYSOGENUM 12.60 86003ALLERGEN, IGE, PIG WEED 12.60 86003ALLERGEN, IGE, SHORT RAGWEED 12.60 86003ALLERGEN, IGE, ROUGH MARSHELDER 12.60 86003ALLERGEN, IGE, RUSSIAN THISTLE 12.60 86003ALLERGEN, IGE, TIMOTHY GRASS 12.60 86003

ALLERGEN, IGE, WALNUT 12.60 86003ALLERGEN, IGE, WHITE MULBERRY 12.60 86003ALLERGEN, IGE, EGG WHITE 13.70 86003ALLERGEN, IGE, MILK 13.70 86003ALLERGEN, IGE, WHEAT 13.70 86003ALLERGEN, IGE, SOYBEAN 13.70 86003ALLERGEN, IGE, CORN 13.70 86003ALLERGEN, IGE, CODFISH 13.70 86003ALLERGEN, IGE, SHRIMP 13.70 86003ALLERGEN, IGE, SCALLOP 13.70 86003ALLERGEN, IGE, SESAME SEED 13.70 86003ALLERGEN IGE PEANUT 13.70 86003MYELOPEROXIDASE ANTI 216.50 86021HEPARIN INDU PLT ABS 346.80 86022PLATELET ANTIBODIES 166.00 86022ANA DIRECT 146.80 86038STREPTOZYME 120.90 86060ANTI-STREPTOLYSIN O 113.20 86060C-REACTIVE PROTEIN 77.90 86140HSCRP HIGH SENSITIVE 286.40 86141B-2 GLYCOPROTEIN IGA 112.50 86146B-2 BLYCOPROTEIN IGG 112.50 86146B-2 GLYCOPROTEIN IGM 112.50 86146ANTI-CARDIOLIPIN,COM 78.40 86147ANTIPHOSPHATIDYISERI 231.70 86148COLD AGGLUTININS SCR 149.00 86156COMPLEMENT (C3) 97.50 86160COMPLEMENT (C4) 222.40 86160COMPLEMENT C1Q QUANT 61.50 86160C1 ESTER INHIB FUNCT 224.70 86161COMPLEMENT-TOT-CH50 223.50 86162ANTI CYCLIC CIT PEPT 81.50 86200CYCLIC CITRU PEPTIDE 81.50 86200ANTI-DNASE 151.10 86215DNA ANTIBODIES,NATIV 142.90 86225ANTI-DNA DOUBLE STRD 206.20 86225ANTI DNA SINGLE STRD 94.80 86226CENTROMERE ANTIBODY 105.00 86235SJOGREN'S ANTI-SS-B 87.80 86235SJOGREN'S ANTI-SS-A 87.80 86235ANTI-JO-1 144.40 86235ANTIEXTRACTABLE NUCL 165.70 86235ANTI-SCLERODERMA 81.80 86235ANTIHISTONE 89.50 86235ANTICHROMATIN ANTIBO 87.80 86235RNP ANTIBODIES 86.10 86235SM (SMITH) ANTIBODY 86.10 86235

ANTIENDOMYSIAL, IGA 532.80 86255ANTISKIN AUTOANTIBOD 178.10 86255RETICULIN ANTI IGG 203.50 86255RETICULIN ANTI IGA 129.00 86255ANTIMUSCLE ANTIBODIES, QUANT. 125.60 86255INSU GRO FAC IGFBP-3 82.80 86256NEUTROPHIL CYTOPL AB 571.10 86256ANTINEUTROPHIL CYTOP 107.50 86256ANTI-HU (ANNA1) 294.80 86256CA 15-3 237.50 86300CA 27-29 408.20 86300CA 19-9 394.40 86301CA-125 SERUM 237.50 86304INFECT. MONO. QUANT. 114.30 86308HETEROPH ANTI TITER 81.70 86308INFECTOUS MONO 89.50 86308CA 72-4 251.90 86316CHROMOGRANIN A 397.50 86316PNEUMOCOCAL ANTIBODY 299.30 86317HEPATITIS B SURFACE ANTIBODY, QUANTITATIVE 36.80 86317STREP PNEUMONIAE IGG ANTIBODY SEROTYPES 47.30 86317IMMUNOELECTROPHORESI 238.10 86320TEICHOIC ACID ANTIBO 263.30 86329ANTI-PIGEON SERUM IG 53.60 86331IMMUNE COMPLEXES, C, Q BINDING 27.30 86332IMMUNOFIX ELECTROPHO 110.30 86334LIGHT CHAIN TYPING 227.20 86335IMMUNOFIX/ELECT URIN 231.70 86335IMMUNOFIXATION, CSF 75.60 86335INHIBIN A ULTRASENS 593.40 86336INSULIN ANTIBODIES 881.20 86337INTRINSIC FACT ANTIB 73.40 86340ZINC TRANSPORT ANTIB 666.10 86341ISLET CELL ANTIBODY 73.50 86341LYMPHOCYTE ACTIVATN 728.40 86353B LYMPHOCYTE COUNT 532.90 86355MONONUCL CEL ANTIGEN 56.40 86356LYMPH SUBSET 5PNL 114.00 86356NATURAL KILLER CELL 645.30 86357T LYMPHOCYTE COUNT 493.00 86359LYMPHOCYT SUBSET III 396.20 86360CD4 CD8 COUNT & RATO 201.20 86360ANTITHYROID PEROXIDA 112.70 86376RHEUMATOID FACTOR 77.90 86431T B QUANTIFERON 450.90 86480TB TEST 24.00 86580R.P.R., QUALITATIVE 71.70 86592

RPR EMPLOYEE PHYSICA 0.00 86592R.P.R., QUANTITATIVE 60.30 86593VDRL SERUM 48.00 86593ANTI-ACTIMOMYCES IGG 30.30 86602ADENOVIRUS ANTIBODY 104.70 86603ANTI-ASPERGILLUS IMM 89.30 86606ANTI-MICROPOLYSPORA 38.30 86609BARTNELLA AB(CAT SC) 56.30 86611BLASTOMYCES ANTI,IMM 95.20 86612B PERTUSIS IGA QUANT 91.60 86615BORDETELLA ANTIBODY 165.70 86615B PERTUS IGG/M QUANT 125.60 86615LYME WESTER BLOT IGM 54.60 86617LYME WESTER BLOT IGG 52.50 86617LYME DISEASE ANTIBOD 286.30 86618BRUCELLA ANTIBODY 98.40 86622CANDIDA ALBICANS AB 172.70 86628CHLAMYDIA ANTIBO IGG 86.90 86631CHLAMYDIA ANTI-IGM 141.80 86631CHLAMYDIA PNEUMONIAE, IGG, IGM, IGA 651.00 86631COCCIDIODES ANTI,IMM 105.50 86635Q FEVER ANTIBODIES 111.60 86638CYTOMEGALOVIRUS IGG 226.60 86644CYTOMEGALOVIRUS IGM 224.90 86645DIPHTHERIA ANTITOX 276.20 86648CALIF ENCEPHALITIS 216.00 86651EASTERN ENCEPHALITIS 183.30 86652ST LOUIS ENCEPHALITI 216.00 86653WESTERN ENCEPHALITIS 183.30 86654POLIOVIRUS ANTI-123 273.70 86658ECHOVIRUS ANTIBODY 214.00 86658COXSACKIE VIRUS ANTI 531.30 86658E-B VIRUS ERLY AG-AB 196.60 86663EBV NUCLEAR ANTI-IGG 52.70 86664E-B VIRUS CAPSID,IGG 184.80 86665E-B VIRUS CAPSID,IGM 120.10 86665EBV COMP PANEL 336.70 86665SACCH CEREVISIAE IGA 139.20 86671SACCH CEREVISIAE IGG 139.20 86671ANTI-AUREOBASIDIUM 36.40 86671INFLAM BOWEL DIS(IBD 667.30 86671H. PYLORI ANTI-IGM 100.90 86677H. PYLORI ANTI-IGG 100.90 86677H. PYLORI ANTI-IGA 100.90 86677HELICOBAC, PYLORI BX 135.00 86677ANTI-HELICOBAC PYLOR 114.70 86677ANTI-HELICOBACT-QUAN 131.40 86677

STRONGYLOIDEA, IGG, QUALITATIVE, EIA 189.00 86682ANTI H INFLUENZAE B 391.50 86684HIV CONFIRMATION TES 193.80 86689HEPATITIS D ANTIBODY 540.50 86692HERPES SIMPLEX IGG 152.50 86694HERPE SIMPLEX AB-IGM 176.20 86694HSV TYPE I SPEC IGG 91.00 86695HERPES SIMPLEX TYPE2 161.90 86696HSV TYPE II SPEC IGG 160.30 86696HSV TYPE 2 IGM 199.50 86696HISTOPLASMA ANTIBODY 548.30 86698HISTOPLASMA AB IMMUN 67.30 86698HIV-1 RAPID SCREEN 88.50 86701HEPAT. B CORE-AB-TOT 83.60 86704HEPATI B CORE AB IGM 235.60 86705HEP B SURF ANTIBODY 136.20 86706POST EXP HEP B SF AB 0.00 86706HEP B SURF ANTI 28.00 86706HEPATITIS BE ANTIBDY 121.70 86707HEPATITIS A ANTI TOT 149.00 86708HEPATITIS A AB-IGM 127.30 86709INFLUENZA AB. A+B 247.70 86710ANTI PARAINFLUENZA 327.70 86710LEGIONELLA ANTIBODY 227.50 86713LEPTOSPIRA AGGLUTIN 114.30 86720MUMPS ANTIBODIES,IGG 89.60 86735MUMPS ANTIBODIES IGM 90.40 86735MYCOPLASMA PNEUMONIAE ANTIBODY, IGG 119.70 86738MYCOPLASMA PNEUMONIAE ANTIBODY, IGM 23.10 86738PARVOVIRUS B19 ANBDY 236.80 86747RESP SYN VIRUS-AB 88.80 86756RICKETTSIA ANTIBODY 205.10 86757RUBELLA 113.20 86762RUBELLA EMPLOYEE PHY 0.00 86762RUBELLA AB TITER 113.70 86762RUBEOLA ANTIBODY 271.40 86765TETANUS ANTITOXIN 315.60 86774TOXOPLASMA GONDI IGG 139.10 86777TOXOPLASMA GONDI IGM 139.10 86778ANTI TREP. PALLIDUM 139.10 86780FTA-ABS,T.PALLIDUM 138.60 86780VARICELLA-ZOSTER IGG 228.50 86787VARICELLA-ZOSTER IGM 153.10 86787OHC VARICELLA TITER 75.00 86787WEST NILE VIRUS IGM 120.10 86788WEST NILE VIRUS, IGG 191.00 86789HERPES VIRUS 6 AB-PN 636.60 86790

RABIES ANTIBODY 274.20 86790HEPATITIS E IGM 98.50 86790HEPATITIS E IGG 98.50 86790HTLV-1/2 QUAL 62.10 86790YERSINIA ANTIBODY 230.00 86793ANTITHYROGLOBULIN AB 99.90 86800THYROGLOBULIN ANTIBODY AND THYROGLOBULIN BY IMA OR LS/MS 207.90 86800HEPATITIS C AB RIBA 335.10 86803POST EXPO HEP C AB 0.00 86803HEPATITIS C ANTIBODY 136.60 86803HLA CLASS I AND II ANTIBODY SCREEN 367.50 86828ANTI-PROTHROM IGG 194.60 86849ANTI-PROTHROM IGM 196.60 86849EOSINOPHIL CATIONIC PROTEIN 151.20 86849ANTIBODY SCREEN 181.30 86850ANTIBODY SCRN RBC AR 117.00 86850ANTIBODY ELUTION ECH 163.80 86860ANTIBODY IDENTIFICAT 326.30 86870SERUM ANTIBODY IDENT 147.10 86870DIRECT ANTIGLOB TEST 53.40 86880ANTIHUMAN GLOB TEST 77.30 86885ABO CELL TYPE 73.40 86900RH BLOOD TYPING 71.90 86901ANTIGEN SCREEND UNIT 91.10 86902RBC ANTIGEN(S) 69.90 86905M RED BLOOD CELL ANTIGEN TYPING 84.00 86905COMPATIBIL BY I.S.T. 273.40 86920COMPATIB BY INCUBATI 180.60 86921COMPATIBILITY BY AHG 320.40 86922FFP THAWING EA UNIT 83.60 86927ISOHEMAGGLUTININ 38.10 86940RBC ABSORPTION PREAT 142.00 86978CYCLOSPORA STAIN SMEAR STOOL 46.20 87015CULTURE BLOOD 180.20 87040CULTURE STOOL 42.10 87045CULTURE STOOL YERSIN 42.10 87046CULTURE STOOL CAMPY 42.10 87046CULTURE THROAT ALL P 149.00 87070CULTURE SPINAL FLUID 96.20 87070CULTURE BONE 95.20 87070CULT BORDETELLA PERT 151.90 87070CULTURE E-COLI 0157 126.80 87070CULTURE SPUTUM 154.70 87070ENVIROMENTAL CULTURE 100.90 87070CULTURE EAR 149.00 87070ENVIRONMENTAL SURVEY 0.00 87070CULTURE EYE 149.00 87070

CULTURE BODY FLUID 145.80 87070CULTURE GENITAL 149.00 87070CULTURE WOUND 227.70 87070CULTURE ANAEROBIC 250.10 87075AEROBIC DEFINITIV ID 36.00 87077CULTURE FOR GC 155.20 87081MRSA CULTURE SCREEN 45.60 87081GROUP B STEPTOCOCCUS COLONIZATION DETECTION CULTURE 81.90 87081CULTURE URINE 114.00 87086URINE PRESUMP ISOLAT 36.20 87088CULTURE FUNGAL 129.90 87101YEAST CULTURE 82.10 87102ID, YEAST 48.80 87106CULTURE MYCOPLASMA 268.10 87109CULTURE CHLAMYDIA 417.00 87110CULTURE TB-AFB ISOLA 207.10 87116PARASITE DIRECT EXAM 27.30 87169OVA AND PARASITES 149.00 87177SENSITIVITY, MIC 118.80 87186STAIN GRAM STAIN 49.10 87205WRIGHTS STAIN 47.00 87205EOSINOPHIL URINE 45.80 87205FECAL SMEAR, STAIN F 26.60 87205ACID FAST STAIN 101.50 87206CYCLOSPORA SMEAR 46.20 87206MALARIAL PARASITE SM 131.10 87207O&P DIRECT SMEAR 118.10 87207CRYPTOSPORIDIA SMEAR 43.50 87207MALARIAL PARASITE SM 50.40 87207TRICHROME STAIN O&P 80.30 87209FUNGAL KOH PREP 54.30 87210WET PREP SCREEN 53.80 87210INDIA INK PREP 60.90 87210CULTURE VIRAL 541.20 87252VIRUS ISO SHELL VIAL 405.30 87254HERPES VIRAL CULT. 209.00 87255CRYPTOSPORIDIUM, DIRECT EIA 164.90 87328GIARDIA ANTIGEN EIA 122.30 87329H PYLORI STL ANTIGEN 205.80 87338HELIC PYLORI ANTIGEN 117.60 87339POST EXP HEP B SF AG 0.00 87340HEPATITIS B SURF ANG 92.60 87340HEPATITIS BE ANTIGEN 130.00 87350HEPATITIS D ANTIGEN 422.60 87380HISTOPLAS ANTIGE EIA 256.70 87385HISTOPLAS ANTIGEN SE 233.70 87385HISTOPLASMA GALACTOMANNAN ANTIGEN, URINE 291.90 87385

HIV-1 ANTIBODY 134.30 87389ROTAVIRUS AG, STOOL 78.10 87425LEGIONELLA ANTGN URN 428.80 87449BACT MENING ANTIGENS 147.10 87449BLASTOMYC ANTIGE EIA 375.70 87449LYME DISEASE, BORRELIA BURGDORFERI, REAL-TIME PCR 325.50 87476C PRARPSILOSIS NAA 331.70 87481C GLABRATA NAA 221.10 87481C ALBICANS NAA 221.10 87481C TROPICALIS NAA 331.70 87481C LUSITANIAE NAA 331.70 87481C KRUSEI NAA 331.70 87481CHLAMYD PNEUM AMPLIF 323.40 87486CHLAMYDIA DIRECT PRB 113.20 87490CHLAMYDIA TRACH PCR 195.30 87491CLOSTRIDIUM DIFF.TOX 383.40 87493C DIFF DNA AMPLIFIED 195.30 87493CYTOME CMV PCR QUANT 714.00 87497ENTEROVIRUS PCR 366.10 87498GI PATHOGENS PANEL 655.20 87507HEPAT B DNA QUAL PCR 524.10 87516HEPAT B DNA QUNT PCR 881.50 87517HEPATITIS C RNA PCR 571.10 87521HEPAT C HCV RNA QUAN 283.90 87522HERPES SIMPLEX VIRUS (HSV) TYPES 1&2, NAA 325.50 87529HERPES SIMPLEX VIRUS (HSV) TYPES 1/2, DNA PCR 346.50 87529HIV-1 RNA QUALITATIVE, SERUM/PLASMA 70.70 87535HTLV-I VIRUS, PCR 333.20 87536HIV-1 RNA QUANT PCRW 534.20 87536HTLV-II VIRUS, PCR 293.20 87536HIV-2 ANTIBODY PCR 274.20 87538MYCOPLAS PNEUMON PCR 297.00 87581N GONORHOEAE D PROBE 113.20 87590N GONORRHEAE DNA LCR 197.20 87591N GONORHOE AMP URINE 195.30 87591RESP VIRUS PANEL PCR 672.00 87633STREP A DNA AMPLIFIE 212.00 87651TRICHOMONA VAGIN PCR 298.30 87661JC VIRUS DNA, PCR 749.10 87798PLASMODIUM SPEC PCR 239.70 87798NOROVIUS PCR 703.90 87798HEPATITIS D RNA PCR 1128.10 87798TROPHERYMA WHIPPEL11 575.00 87798HISTOPLASMA PCR AG 475.10 87798EHRLICHIA ABS,IGG&M 551.60 87798MEGASPHAERA 1 196.60 87798BVAB 2 196.60 87798

ATOPOBIUM VAGINAE 196.60 87798CHIKUNGUNYA VIRUS 873.60 87798B PERTUSIS DNA (PCR) 297.00 87798VARICELLA ZOSTER (VZV), DNA PCR 273.00 87798EPSTEIN-BARR V PCR 534.50 87799BK VIRUS QUANT DNA 1201.70 87799INFLUENZA A/B DIRECT 121.70 87804RAPID INFLUENZA 76.80 87804R.S.V. DIRECT ANTIGN 121.70 87807INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIR 47.30 87808STREP GRP A ANTIGEN 111.80 87880S PNEUMONIAE ANTIGEN 472.50 87899CYPTOCOCCUS ANTIGEN 83.10 87899HEPATITIS C GENOTYPE 868.00 87902INFECTIOUS AGENT ENZYMATIC ACTIVITY OTHER THAN VIRUS 47.30 87905PROCESSING AUTOPSY G 52.50 88000PROCESSING AUTOPSY L 131.10 88036TISSUE AUTOPSY N-COM 275.90 88045PROCESSING AUTOPSY T 209.30 88099TISSUE AUTOPSY COMPL 313.20 88099BRONCHIAL WASHING TC 96.20 88104C.S.F. WASHINGS TC 96.20 88104FLUIDS (NON-GYN) TC 96.20 88104G.I. WASHINGS TC 96.20 88104SPUTUM CYTOLOGY TC 96.20 88104URINE, CYTOLOGY 96.20 88104CYTO - CELL BLOCK 150.50 88108THIN PREP NON-GYN 160.50 88112CYTOLOGY MISCELLANEOUS FLUID 279.30 88112CYTOLOGY ABDOMINAL FLUID 174.30 88112CYTOLOGY, PLEURAL FLUID 279.30 88112CYTO, PAP SMEAR PROC 7.20 88150CYTO (PAP SMEAR) GYN 54.30 88150CYTOLOGY - NON-GYNE 69.10 88160FINE NEEDLE EVALUATE 122.30 88172FINE NEEDLE ASPIRATI 274.70 88173DNA HISTOGRAM 699.10 88182FLOW CYTOMETRY MARKR 139.10 88184EA ADDL FLOW MARKER 65.40 88185FLOW CYTOMETRY INTERP. 2-8 MARKERS 183.60 88187FLOW CYTO >16 INTER 366.90 88189NON NEOPLAST TIS CUL 455.90 88230CHROMOSOME ANALYSIS 693.70 88262KARYOTYPE CHROM BAND 487.70 88262BCR-AB1 ONCOLOGY, FISH 661.50 88271CHRONIC LYMPH LEUKEMIA BY FISH 737.10 88271MYELODYSPLASTIC CYNDROME 491.40 88271

MOLECULAR CYTOGENETICS DNA PROBE 122.90 88271FISH INTER ANALYSIS 100-300 CEKKS 336.00 88275MYELODYSPLASTIC SYNDROME (MDS) 546.00 88275CYTOGEN MOLECUL RPRT 82.80 88291TISSUE PROCESSING GR 54.30 88300SURG.PATH. LEVEL I 83.90 88300SURG.PATH. LEVEL II 162.90 88302TISSUE PROCESSING I. 142.90 88302TISSUE PROCESSING, D 45.90 88302SURG.PATH. LEVEL III 179.30 88304CELL BLOCK TECHNICAL 240.80 88305BONE MARROW REPORT O 388.70 88305PATH NEEDLE ASPIRATN 202.80 88305CELL BLOCK -F.N. ASP 77.50 88305BONE CORE 132.70 88305CELL BLOCK--BONE MRW 77.50 88305SURG.PATH. LEVEL IV 258.80 88305SURG.PATH. LEVEL V 516.50 88307CONSULTING PATHOLOGI 471.10 88309SURG.PATH. LEVEL VI 701.50 88309DECALCIFICATION 70.40 88311STAIN - GROUP I 282.70 88312STAIN TRICHROME 52.50 88313STAIN - GROUP II 85.20 88313CONSULT TO OR (REPOR 120.10 88329FROZN SECTN 1ST BLCK 156.70 88331ADD'L FROZEN SECTION 156.70 88332IMMUNO EACH ADDL STN 478.30 88341IMMUNOHISTOCHAM ADT 178.20 88341MUSCLE BIOPSY IMMUNO 915.30 88342IMMUNOHISTOCHEM EA 237.60 88342IMMUNOFLOR EA AB 254.10 88346IFA PERINUCLEAR PATT 400.10 88346DNASE SENSITIVITY 400.10 88346MUSCLE BIOPSY, ELECT 837.00 88348MORPHOMET IHC QUANT 273.00 88360MORPHOMETRIC ANALYSI 332.30 88361EACH ADD'L SINGLE PROBE STAIN PROCEDURE 256.20 88364IN SITU HYBRIDIZATION (FISH) 378.00 88365HER 2 MORPHOMETRIC SINGLE PROBE 604.80 88368MORPHOMETRIC MULTIPLEX PROBE 840.00 88377CSF/FLUIDS CELL CNT 303.80 89050CSF DIFF COUNT 108.40 89051CRYSTAL ID BODY FLUI 103.10 89060FAT STAIN FECES,URIN 26.60 89125FECAL FIBERS 36.60 89160NASAL SMEAR FOR EOSI 58.10 89190

SPUTUM COLLECT AEORO 60.00 89220SEMEN ANALYSIS FERTI 210.90 89320SEMEN ANALYSIS POST 60.30 89321SPERM ANTIBODIES 784.70 89325HEP B IMM. GLOB 1CC 95.45 90371HYPERAB 1UNIT 90375IMMUNI ADMIN 1 VACCI 54.40 90471ADMIN IMMUNZ VACCINE 79.20 90471ADMIN IMMUNIZ 1 VACC 76.10 90471IMMUNIZATION ADMIN 1 50.90 90471IMMUNIZATION ADMIN 1 17.00 90471HEPATITIS B VAC 59.00 90471HEPATITIS A INJECT 78.00 90471TB TEST VOLUNTEER 0.00 90471HEPATITIS B INJ EMP 0.00 90471TB TEST EMP 0.00 90471TB SKIN TEST W/READ 0.00 90471ADMIN IMMUNIZ 1 VACC 76.10 90471IMMUNIZ ADM EA ADDL 26.30 90472HEPATITIS A 0.00 90632TWINRIX INJECTION 95.00 90636TWIN RIX 0.00 90636FLU SHOT 0.00 90658RABAVERT(RABIES VAC) 90675INFLUENZA VACCINE 90686TYPHOID INJ OHS 89.00 90690TYPHOID 0.00 90691MMR VAC 70.00 90707MMR VACCINE 0.00 90707POLIOVIRUS VAC (IPV) 37.00 90713POLIO 0.00 90713TETANUS/DIPTH INJ 31.00 90714EMP TD INJ 18.00 90714TETANUS-DIPTH. INJ 62.40 90714TDAP 7YRS> VAC 58.00 90715EMPLOYEE TDAP 33.00 90715TDAP INJ 0.00 90715ADACEL (TDAP) 90715VARICELLA VACCINE 0.00 90716PNEUMOCOCCAL VACCINE 0.00 90732MENINGITIS VACCINE 0.00 90734IXIARO JAPANESE ENCEPHALITIS VACCINE 495.00 90738IXIARO JE VAX 0.5ML 620.00 90738HEPATITIS B 0.00 90746HEPATITIS B PED DOSE 0.00 90746HEP-B VAC ADULT 90746PSYCH DIAGNOSTIC EVAL 382.70 90791

PSYCH DIAGNOSTIC EVAL PRO FEE 42.50 90791EVALUATION ASSESSMNT 326.60 90791PSYCH DIAG EVAL W/MED SRVCS 428.40 90792PSYCH DIAG EVAL W/MED SRVCS PRO FEE 47.30 90792PSYTX PT & FAMILY 30MIN 184.30 90832PSYTX PT & FAMILY 30 MIN PRO FEE 20.50 90832INDIV THERAPY 20-30M 88.20 90832PSYTX PT & FAMILY 45 MIN 249.90 90834PSYTX PT & FAMILY 45 MIN PRO FEE 27.30 90834INDIV THERAPY 45-50M 165.90 90834PSYTX PT & FAMILY 60 MIN 371.70 90837PSYTX PT & FAMILY 60 MIN PRO FEE 41.00 90837INDIV THERAPY 75-80M 336.00 90837PSYCHOANALYSIS 269.30 90845PSYCHOANALYSIS PRO FEE 29.90 90845FAMILY THRPY W/O PT 165.90 90846FAMILY THRPY W/PT 165.90 90847GROUP THERAPY 1 HOUR 228.90 90853VISION SCREEN 0.00 92499AUDIOMETRY PURE TONE 15.00 92552AUDIOGRAM 0.00 92552ER CARDIOPULM RESUSC 381.90 92950EP CARDIOPULM RESUSC 768.10 92950CODE BLUE MED SURG/SCU 64.50 92950TEMP TRANSCUT PACING 50.20 92953CARDIOVERSION EXTERN 273.00 92960EP CPR EXTERNAL 373.10 92971EP THROMBOLYS COR IV 991.10 92977EKG 12 LEAD 0.00 93000ELECTROCARDIOGRAM 205.50 93005EKG FOR HOLTER 0.00 93005EKG / OHS 39.75 93005EKG PRO FEE 77.70 93010STRESS TEST SUPERVISION PF 249.90 93016STRESS TEST NONREHAB 1815.20 93017STRESS TEST INTERPRETATION PF 147.80 93018HOLTER MONITOR 430.50 93225HOLTER MON SCANNING 646.00 93226HOLTER MONITOR PRO 253.80 93227ECHO COMPLETE 1357.90 93306ECHO 2D 584.30 93307ECHO 2D LTD 445.70 93308TEE 2D PROBE IMG INR 875.70 93312ECHO DOP C/PW 444.40 93320ECHO DOP C/PW LTD 350.20 93321ECHO VELOCITY COLOR 317.60 93325STRESS ECHO 617.40 93350

STRESS TTE COMPLETE 2736.60 93351PHASE 2 EXERCISE W/O ECG MONITORING 49.40 93797PHASE 2 EXERCISE 89.30 93798PHASE 2 EX INITIAL 152.30 93798DUP EXTC ART BIL COM 899.30 93880DUP EXTC ART UNI LIM 430.00 93882ARTL U OR L EXT-LMTD 281.90 93922ART U OR L EXT COMP 484.80 93923ABI/ABI W STRESS 448.90 93924DUP ART LE BIL COMP 899.30 93925DUP ART LE UNI LIMIT 510.30 93926DUP ART UE BIL COMP 851.30 93930DUP ART UE UNI LIMIT 520.30 93931DUPLX VEN UE/LE BIL 868.90 93970DUP VEN UE/LE UNI LM 545.50 93971DUPLX ABD/PEL ORG CP 836.60 93975US SCROT W COLORCOMP 1541.40 93975DUPLX ABD/PEL ORG LT 526.10 93976DUPLX VASC COMPLETE 554.90 93978DUPLX VASC LIMITED 369.10 93979VENT MGMT FIRST DAY 615.50 94002VENT MGMT SUBSEQ DAY 259.00 94003SPIROMETRY 0.00 94010INCENT SPIROM PERDAY 0.00 94010PFS SPIROMETRY BASIC 269.60 94010OHC PFT 33.00 94060PFT COMPLETE 337.50 94060PULMON FUNC SCRN PF 80.00 94060MVV 62.60 94200FLO-VOL LOOP 62.60 94375NONPRES INHL ACUTE A 85.20 94640AEROSOL RX INITIAL 77.50 94640PEAK FLOW W AEROSOL 77.60 94640ASTHMA ACTION PLAN 53.60 94640CONTIN AEROSOL INITIAL FIRST HOUR 50.40 94644CONTIN AEROSOL SUBS EACH ADDL HOUR 29.60 94645CPAP/BIPAP 318.60 94660EDUCATION INHAL NEBU 50.70 94664FLUTTER INSTR INITIAL PER DAY 229.10 94664METERED DOSE INHALOR - MDI 229.10 94664CHEST PHYSIO INITIAL 293.00 94667CHEST PHYSIO SUBSEQU 41.40 94668MECHANICAL CHEST WALL OSCILLATION 94.50 94669PFT GAS DILUTION 300.30 94727DIFFUSING CAPACITY 245.70 94729PULSE OXIMETRY 33.20 94760PULSE OX MULTIPLE 92.10 94761

PULSE OX OVERNIGHT 74.60 94762CAPNOGRAPHY 35.50 94770RESPIRATORY FIT TEST 42.00 94799FIT TEST EVALUATION 11.00 94799RESP FIT TEST EMP 0.00 94799RESPIRATOR FIT QUANT 0.00 94799NITRIC OXIDE EXPIRED GAS MEASURE 59.90 95012GLUCOSE MONITRG-CONT 400.00 95250MSLT OR MWT 873.60 95805SLEEP STUDY UNATTEND 321.80 95806REGULAR SLEEP STUDY 1583.40 95810SPLIT NIGHT SLP STDY 1692.60 95811NASAL CPAP TITRATION 1692.60 95811NASAL BIPAP TITRATIO 1692.60 95811EEG RT 319.70 95816EEG PRO RT 142.50 95816PARASPINAL W/1 EXTR. 272.70 95860PARASPINAL W/2 EXTR. 174.30 95861EMG W/NERVE COND STUDY 115.80 95885EMG NERVE CONDUCTION COMPLETE 5 OR MORE 147.00 95886NERVE CONDUCTION 5-6 316.80 95909NERVE CONDUCTION 7-8 STUDIES 341.30 95910NERVE CONDUCTION 9-10 STUDIES 425.30 95911NERVE CONDUCTION 11-12 STUDIES 300.80 95912SOMATOSENSORY UPP EX 130.50 95925SOMATOSENSORY LOW EX 130.50 95926NM JXN TEST EA NERVE 73.20 95937ELECTRICAL STIMUL 73.20 95937BRIEF EMOT/BEHAV ASMT PF 15.80 96127PATIENT FOCUSED HEALTH RISK ASMT PF 15.80 96160CAREGIVER HEALTH RISK ASSESSMENT 9.50 96161IV HYDRATION 31-60 44.50 96360IV HYDRATION INITIAL 31M-60M 208.50 96360IV HYDRATION 31-60MN 170.60 96360IV HYDRATION 31-60MN 170.60 96360IV HYDRATION ADDL HR 43.70 96361IV HYDRATION ADDL HR 62.70 96361IV HYDRATION ADDL HR 45.20 96361IV HYDRATION ADDL HR 45.20 96361IV INFUSION INIT 1HR 207.70 96365IV INFUSION 1ST HOUR 208.50 96365IV INFUSION INIT HR 219.70 96365IV INFUSION INIT HR 219.70 96365IV INFUSION ADD'L HR 69.20 96366MED INFUSION ADDL HR 62.70 96366IV INFUSION ADDL HR 64.60 96366IV INFUSION ADDL HR 64.60 96366

IV INFUSION SEQ NEW 93.90 96367MED INFUSION ADDL 110.00 96367IV INFUS SEQ NEW DRU 93.90 96367IV INFUS SEQ NEW DRU 93.90 96367IV INFUSION CONCURRE 54.60 96368MED INFUSION CONCURR 60.10 96368IV INFUSION CONCURRE 55.70 96368IV INFUSION CONCURRE 55.70 96368INJECT ANTIBIOTIC IM 50.60 96372INJECTION SUBQ/IM 46.70 96372INJECT IM NON ANTIBI 21.30 96372INJECTION SUBQ IM 76.10 96372INJECTION SUBQ/IM 84.00 96372INJECTION SUBQ IM 50.90 96372INJECTION SUBQ IM PF 17.00 96372INJECTION SUBQ/IM 79.20 96372INJECTION SUBQ IM 76.10 96372INJ THER PROPH DIAG 32.60 96372IV PUSH INITIAL 191.10 96374IV PUSH INITIAL 142.50 96374IV PUSH INITIAL 167.80 96374IV PUSH INITIAL 167.80 96374IV PUSH SEQUENT NEW 63.30 96375IV PUSH ADD'L DRUG 58.40 96375IV PUSH SEQ NEW DRUG 65.70 96375IV PUSH SEQ NEW DRUG 65.70 96375IV PUSH SEQUENT SAME 39.30 96376IV PUSH AD'L SAME DR 30.00 96376IV PUSH SEQ SAME DRU 39.90 96376IV PUSH SEQ SAME DRU 39.90 96376CHEMO SUBQ/IM NONHOR 235.40 96401CHEMO SUBQ/IM HORMON 108.60 96402CHEMO IV PUSH 386.90 96409CHEMO IV PUSH ADD'L 202.40 96411CHEMO INFUSION/1 HR 417.30 96413CHEMO INF EA ADDL HR 125.20 96415CHEMO IV INF PROLONG 416.40 96416CHEMO IV INF SEQ 1HR 215.40 96417PORTABLE PUMP MTCE 361.50 96521FLUSHES VAD 100.70 96523MLS LASER 25.00 97026MLS LASER 25.00 97026STEP DOWN PROGRAM 40.00 97026MANUAL THERAPY 92.40 97140MOMENTUM PROGRAM 30.00 97530MOMENTUM PROGRAM (3 SESSION SPECIAL) 45.00 97530MOMENTUM PROGRAM (10 SESSIONS) 250.00 97530

MOMENTUM PARTNER SESSION 20.00 97530MOMENTUM PARTNER SESSION (10 SESSIONS) 175.00 97530ER DEBRID SKIN 79.50 97597EP DEBRIDE SEL SKIN 142.40 97597DEBRID 1ST </=20CM2 118.10 97597REM DEV TS WND<20 PF 133.50 97597DEBRID SLCT ADL20CM2 59.00 97598WOUND THERAPY NEG PR 20.90 97605NEG PRES WD THPY>50C 38.30 97606WND THERAPY NEG PRESSURE DISP EQUIP. <50C 79.50 97607WND THERAPY NEG PRESSURE DISP EQUIP >50C 86.10 97608COLL/HNDLG URINE SPC 0.00 99000NONDOT COC UDS COLL 0.00 99000SPECIAL SHIPPING PER 68.00 99001SPECIMEN HANDLING 23.00 99001PRE OP GLOBAL PF 0.00 99002POST OP F/U VISIT GLOBAL PF 0.00 99024POST OP F/U VISIT PF 0.00 99024EP MOD SEC EACH ADDL 52.40 99150MODERATE SEDATION INITIAL 15 MINS OF INTRASERVICE TIME 5YR> 113.40 99152EP MODERATE SEDATION >5YR 110.30 99156COLOR VISION-14 PLAT 0.00 99172EP IPECAC INDUC EMES 190.10 99175PHLEBOTOMY THERAPEUT 229.70 99195PHLEBOTOMY THERAPEUT 294.80 99195NEW PATIENT LEVEL 1 39.30 99201NEW PT INIT EXAM 10 104.50 99201OFFICE VISIT FOCUS NEW PT 85.40 99201OFFICE VISIT FOCUS NEW PT PF 55.30 99201OHC PHYSICAL RE EVAL 30.00 99201OHC OFFICE NEW 10MN 89.00 99201CLINIC OFFICE NEW 10 89.00 99201NEW PATIENT SIMPLE 83.70 99201NEW PT VISIT LEVEL 1 65.80 99201NEW PT INIT EXAM 20 104.50 99202OFFICE VISIT LOW CMP NEW PT 160.30 99202OFFICE VISIT LOW COMP NEW PT PF 75.20 99202OHC PHYSICAL SIMPLE 42.00 99202OHC OFFICE NEW 20MN 123.30 99202CLINIC OFFICE NEW 20 123.30 99202NEW PT VISIT 20MN PF 119.70 99202NEW PATIENT LIMITED 20MN 158.20 99202NEW PT VISIT LEVEL 2 136.50 99202OFFICE VISIT COMPLEX NEW PT 241.90 99203OFFICE VISIT COMPLEX NEW PT PF 94.00 99203OHC OFFICE NEW 30MN 170.90 99203CLINIC OFFICE NEW 30 170.90 99203

NEW PATIENT LOW 30MN 242.90 99203NEW PT VISIT LEVEL 3 203.90 99203OFFICE VISIT MR COMP NEW PT 409.00 99204OFFICE VISIT MR COMP NEW PT PF 103.30 99204OHC PHYSICAL COMPLEX 65.00 99204OHC OFFICE NEW 45MN 250.00 99204CLINIC OFFICE NEW 45 250.00 99204NEW PT VISIT 45MN PF 275.50 99204NEW PATIENT MOD 45MN 409.70 99204NEW PT VISIT LEVEL 4 261.00 99204NEW PT INIT EXAM 60 104.50 99205OHC OFFICE NEW 60MN 295.00 99205CLINIC OFFICE NEW 60 295.00 99205NEW PT VISIT 60MN PF 399.00 99205NEW PATIENT COMP 60MN 532.80 99205NEW PT VISIT LEVEL 5 343.10 99205OFFICE VISIT MINIMAL 42.20 99211NURSING ASSESS/EDUCA 37.30 99211OFFICE/OP VISIT EST 64.10 99211OHC OFFICE EST 5MN 37.60 99211CLINIC OFFICE EST 5 37.60 99211PFT EVALUATION 60.10 99211EST PATIENT SIMPLE 28.90 99211EST PT VISIT LEVEL 1 39.50 99211OFFICE VISIT STRAIGHT FORWARD 89.00 99212OTHER CLINIC 86.30 99212OFFICE VISIT FOCUS EST 80.90 99212OFFICE VISIT FOCUS EST PF 57.30 99212OHC OFFICE EST 10MN 79.10 99212CLINIC OFFICE EST 10 79.10 99212EST PATIENT LIMITED 10MN 79.30 99212EST PT VISIT LEVEL 2 80.20 99212OFFICE VISIT LOW 121.40 99213OFFICE VISIT COMPLEX EST 161.50 99213OFFICE VISIT COMPLEX EST PF 67.70 99213OHC OFFICE EST 15MN 108.00 99213CLINIC OFFICE EST 15 108.00 99213EST PATIENT LOW 15MN 160.30 99213EST PT VISIT LEVEL 3 98.80 99213EST PT 15MIN EXP PF 113.60 99213OFFICE VISIT MODERATE 174.40 99214RETURN EXTEND PRO 25 96.60 99214OFFICE VISIT MR COMPLEX 248.70 99214OFFICE VISIT MR COMPLEX PF 87.60 99214OHC OFFICE EST 25MN 155.00 99214CLINIC OFFICE EST 25 155.00 99214EST PT VISIT 25MN PF 219.30 99214

EST PATIENT MOD 25MN 245.90 99214EST PT VISIT LEVEL 4 160.40 99214OFFICE VISIT HIGH 252.80 99215RET PT COMPLEX EXAM 226.80 99215OHC OFFICE EST 40MN 224.80 99215CLINIC OFFICE EST 40 244.80 99215EST PATIENT COMP 40MN 348.30 99215EST PT VISIT LEVEL 5 235.20 99215OBS DISCHARGE 191.80 99217OBSERV INITIAL DETAI 167.10 99218OBSERV INIT COMP MOD 236.90 99219OBSERV INIT CMP HIGH 511.10 99220INITIAL IP H&P LOW 207.30 99221HOSP ADMIT FOCUSED 242.60 99221INITIAL IP H&P MODER 283.70 99222INITIAL IP H&P HIGH 606.30 99223SUBSEQ PROBLEM LOW OBS 126.60 99224PAIN F/U OBS 126.60 99224OBS VISIT MODER 81.70 99225OBS VISIT HIGH 152.80 99226SUBSEQ PROBLEM LOW (FOCUSED) 109.30 99231SUBSEQ PROBLEM MOD (EXPANDED) 148.30 99232CONSULT SUBSEQUENT CARE 171.80 99232SUBSEQ PROBLEM HIGH (DETAILED) 209.90 99233OBS/IP ADM DSCH LOW 313.50 99234OBS/IP ADM DSCH MOD 412.10 99235OBS/IP ADM DSCH HIGH 549.00 99236DISCHARGE DAY 30 MINUTES OR LESS 188.20 99238DISCHARGE DAY >30MIN IP 338.60 99239CONSULT NEW/EST 15 156.70 99241OFFICE CONSULTATION 177.10 99241OP CONSULT LEVEL 1 156.70 99241CONSULT NEW/EST 30 156.70 99242O/P CONSULTATION 229.40 99242OHC PHYS CMPLX W CC 90.00 99242OHC VISIT COORD CARE 204.00 99242OP CONSULT LEVEL 2 156.70 99242CONSULT NEW/EST 40 156.70 99243OP CONSULT LEVEL 3 156.70 99243CONSULT NEW/EST 60 226.80 99244OP CONSULT LEVEL 4 226.80 99244CONSULT NEW/EST 80 226.80 99245OP CONSULT LEVEL 5 226.80 99245INIT IP CONSULT 20 57.20 99251IP CONSULT 20MNS 330.00 99251INIT IP CONSULT 40 102.40 99252INIT IP CONSULT 55 125.20 99253

INPATIENT CONSULT; 55 MINS PF 321.80 99253INIT IP CONSULT 80 147.30 99254INIT IP CONSULT 110 170.40 99255CRITICAL CARE 30-74M 697.10 99291ER CRIT CARE ADDL 30 360.70 99292CRITICAL CARE ADL 30 347.40 99292INIT FACILITY CARE 182.00 99304NURSING FACILITY VIS 0.00 99307PHYSICIAN SVC IP 1HR 239.60 99356SMOKING/TOBACCO USE CESSATION COUNSELING VISIT 3-10MN 39.40 99406ALCOHOL AND/OR SUBSTANCE ABUSE STRUCTURED SCREENING; 15 TO 15.80 99408CATH PLACEMENT GROSH 3126.50 00532,QZANESTH CAT/MRI SCAN 569.00 01922,QZBURN EXC DEBRID <4% 130.60 01951,QZINJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE QUI 1050.00 0232TI&D ABSCESS SIMPL PF 308.60 10060,26I&D ABCS CMP MLTP PF 449.90 10061,26I&D HEMATOMA 394.00 10140,26DEBRIDEMENT BONE PF 845.90 11044,26DEBD SK SBQ AD 20 PF 54.00 11045,26BIOPSY SKIN SNGLE PF 145.80 11100,26SHVG LESN .6/1 CM PF 203.10 11306,26EXC BENIGN LESION .5 306.20 11400,26EXC BENIGN LES3-4 PF 550.00 11404,26EXC BENIGN L >4.0 PF 815.70 11406,26EXC BENG LES .5CM PF 292.60 11420,26EXC LES .6/1.0CM PF 394.90 11421,26EXC LES 1.1/2.0CM PF 484.90 11422,26EXC LES 2.1/3.0CM PF 547.60 11423,26EXC MALIGNANT LESION 1.1/2CM PF 471.50 11602,26DEBRIDEMENT NAIL PF 52.50 11720,26DEBRID NAIL>5 PF 242.40 11721,26EXCISION OF NAIL 646.00 11750,26INJ INTRALESION<8 PF 118.90 11900,26WND REPAR 2.6 7.5 PF 665.90 12032,26WND REP 2.6CM/7.5CM 665.90 12042,26SKIN TISSUE REARG PF 1531.10 14040,26DRSG/DEBD BURN <5%PF 224.90 16020,26CHEM CAUT GRN TIS PF 89.50 17250,26PUNC ASP CY BR EA PF 78.80 19001,26BIOPSY BREST 1 LS PF 377.70 19081,26BIOPSY BREAST ADL PF 262.00 19082,26PL BREST WIRE 1LS PF 163.80 19281,26PL BREST WIRE ADL PF 78.80 19282,26INJ CARPAL TUNNEL PF 269.70 20526,26INJ SNGL TENDON PF 188.10 20550,26ARTHR ASPIR SM JT PF 185.60 20600,26

ARTHR INTMD JT/BR PF 198.70 20605,26INJ ARTHROG ELBOW PF 332.10 24220,26INJ ARTHROG WRIST PF 364.60 25246,26INJ ARTHROG HIP PF 371.20 27093,26SI JOINT INJ PRO FEE BILATERAL 763.60 27096,50,QZSI JOINT INJ PF 381.80 27096,QZI&D LEG OR ANKLE 1441.40 27603,26INJ ARTHROG ANKLE PF 255.40 27648,26REV LOWER LEG TENDON 606.90 27685,26OPN TX DST FB FRC PF 2354.20 27792,26FASCIOTOMY FT TOE PF 1214.90 28008,26REM NEUROMA FT PF 1310.50 28080,26EXC LESION TNDN FOOT 1244.90 28090,26EXC BONE CYST/TUMOR 1551.50 28104,26PART REM METATARS PF 1157.80 28110,26METATARSAL PR REM PF 543.60 28110,26OSTECTOMY 1ST META 1618.40 28111,26OSECTOMY METATARS PF 1274.70 28112,26OSTECTOMY COMP EXC 5 2068.30 28113,26OSTECTOMY ALL META 4084.10 28114,26REMOVAL HEEL SPUR PF 1451.60 28119,26PRTL EXC MET BONE PF 2022.00 28122,26REMOV FOOT BONE PF 2022.00 28122,26PRTL EXC PHALANX PF 1439.30 28124,26HEMIPHALANG JNT EXC 1303.90 28160,26REM FB FOOT DEEP PF 1303.30 28192,26REM FB FOOT SUBQ PF 1624.00 28193,26TENOTOMY TOE SNG TND 1328.90 28232,26TENOTOMY TOE SNG PF 1343.50 28232,26RELEASE OF TOE JOINT PF 425.30 28272,26REPAIR HAMMERTOE PF 1274.70 28285,26OSTECTOMY PARTIAL 1447.00 28288,26HALLUX RIGID CORR PF 2180.10 28289,26HALLUX VALGUS CORR 1634.20 28290,26PHALANX OSTEO DBL PF 2771.90 28299,26OSTEOTOMY N1 META PF 1381.40 28308,26OSTEOTOMY MULTPL PF 3284.20 28309,26SESAMOIDECTOM TOE PF 1307.60 28315,26TX METATARSAL FX PF 1041.00 28485,26AMPUTATION TOE PF 1603.50 28810,26AMPUTATION OF TOE 1358.90 28820,26APPL TL CT LEG CST P 384.50 29445,26STRAP ANKLE/FOOT PF 86.50 29540,26INTUBATION ENDO EMR 446.90 31500,QZLARYNGOSCOPY DIR OR 1103.60 31515,QZLARYNGOSCOPY FLEX OR 864.90 31575,QZLUNG BX PLAC NDL PRO 401.40 32405,26

THOR ASP PIR W/IM PF 430.20 32555,26IV START 141.50 36000,QZVENIP (IV) > 3YR 175.20 36410,QZCENT VEN CATH>5Y NON 600.80 36556,QZCENT VENOUS CATH5+YR 1099.40 36558,QZINS PICC AGE 5+ PF 364.60 36569,26REPAIR TNLD CV CATH 571.50 36576,QZREPLACE TNLD CV CATH 911.60 36578,QZRPLC PICC CATH W/O P 362.00 36584,QZREPLC PIC CATH W/PRT 2619.80 36585,QZDECLOT VASCULAR DEVC 95.00 36593,QZREPOS VENOUS CATH 189.60 36597,QZCNT INJ EV EX CVC PF 203.20 36598,26BLOOD GAS-ARTERIAL S 416.60 36600,QZARTERIAL CATH PERCUT 815.20 36620,QZPLACEMENT INTRAOSSEO 1031.70 36680,QZID SENTINEL NODE PF 239.10 38792,26DIL ESOPHAGUS BOUGIE 376.20 43450,QZLIVER BX PRO 890.10 47000,26PARACENTESIS PF 460.20 49083,26ABD RETRO BX CT PF 634.50 49180,26PERC IMG GD VISCR PF 264.30 49405,26PERC IMG GD RETRO PF 264.30 49406,26PERC IG DR RT V/R PF 264.30 49407,26FL EX G COLON TUB PF 117.90 49465,26RENAL BIOP PR T/N PF 812.40 50200,26PROSTATE BX PRO FEE 337.90 55700,26SALINE INJ HYSTER PF 357.80 58340,26SPINAL TAP PRO FEE 311.60 62270,26SPINAL PNCTR LUMB PF 488.80 62270,26SPINAL TAP/CRNA 503.20 62270,QZEPIDURAL BLOOD PATCH 406.40 62273,QZINJ CT EPIDURL-TX PF 619.00 62310,QZINJ L/S EPIDRL-TX PF 473.20 62311,QZINJ INDWLG CATH L/S 1374.80 62324,QZINJ ANES GR OCC NRV 309.40 64405,QZILIOINGNL NRV INJ PF BILATERAL 825.30 64425,50,QZINJ LUMBAR PLEXUS 282.90 64449,QZOTH PERIPHERAL BL PF 266.50 64450,26INJ TF EPI CT 1 LEV 648.60 64479,QZINJ TF EPI LS 1LV PF 651.90 64483,QZINJ PARAV NERVE ADDL 259.90 64484,QZINJ ANES LMBR ADL PF 429.00 64484,QZINJ CRV/THR FACET PF BILATERAL 875.30 64490,50,QZINJ CRV/THR FACET PF 437.60 64490,QZINJ CERV/THOR SEC LV BILATERAL 510.70 64491,50,QZINJ CERV/THOR SEC LV 255.40 64491,QZ

INJ CRV/THR 3RD LV P BILATERAL 520.80 64492,50,QZINJ CRV/THR 3RD LV P 260.40 64492,QZINJ L/S FACET PF BILATERAL 709.00 64493,50,QZINJ L/S FACET PF 354.50 64493,QZINJ L/S 2ND FACET PF BILATERAL 458.20 64494,50,QZINJ L/S 2ND FACET PF 229.10 64494,QZINJ LUMBAR/SC 3RD LV PF BILATERAL 467.00 64495,50,QZINJ LMBR/SC 3RD LV P 233.50 64495,QZINJ SPENOPAL GANGLN 264.10 64505,QZLUMBAR/THORACIC SYMPATHECTOMY 302.40 64520,QZDESTRUCTION BY NEUROLYTIC AGENT; INTERCOSTAL NERVE 91.90 64620,QZDESTRUCT OF CERV/THORACIC FACET FIRST LEVEL BILATERAL 1134.00 64633,50,QZDESTRUCT OF CERV/THORACIC FACET FIRST LEVEL 567.00 64633,QZDESTR OF CERV/THORACIC FACET (ADD ON LEVEL) BILATERAL 705.60 64634,50,QZDESTR OF CERV/THORACIC FACET (ADD ON LEVEL) 352.80 64634,QZDES PV FAC NV LS BILATERAL PF 1320.30 64635,50,QZDES PV FAC NV LS PF 660.10 64635,QZDESTRUCT NRV ADDL BILATERAL PF 412.70 64636,50,QZDESTRUCT NRV ADDL PF 206.30 64636,QZINJECTION OTHER PERIPHERAL NERVE BILATERAL 225.20 64640,50,QZINJECTION OTHER PERIPHERAL NERVE 112.60 64640,QZORBITS F.B./MRI PRO 98.20 70030,26ORBITS F.B./MRI BIL 607.20 70030,50ORBITS FB/MRI BIL PF 196.60 70030,50MANDIBLE PRTL <4V PF 30.20 70100,26MANDIBLE COMPLETE PF 98.40 70110,26MASTOIDS <3V PF 30.20 70120,26MASTOIDS COMPLETE PF 158.80 70130,26MASTOIDS COMPLETE BL 1447.40 70130,50MASTOID COMPLT BI PF 317.90 70130,50FACIAL BONES PRTL PF 34.40 70140,26FACIAL BNS MIN 3 PRO 114.70 70150,26NASAL BNS MIN 3 PRO 72.20 70160,26ORBITS MIN 4 PRO 109.70 70200,26SINUSES PARTIAL PF 28.90 70210,26SINUSES MIN 3 PRO 128.60 70220,26SELLA TURCICA PF 33.90 70240,26SKULL LESS 4 PRO 86.60 70250,26SKULL MIN 4 PRO 130.50 70260,26TEMP MANDIBLR UNI PF 76.90 70328,26TEMP MAND BILAT PRO 144.40 70330,26MRI TMPOMANDB JT PRO 586.20 70336,26SOFT TISSUE NECK PRO 80.60 70360,26COMPL SPEECH EVAL PF 138.60 70371,26CT HEAD W/O PRO 387.70 70450,26CT HEAD WITH PRO 416.90 70460,26CT HEAD W W/O PRO 542.10 70470,26

CT ORB PF IAC WO PRO 373.80 70480,26CT ORB PR IAC W PRO 455.70 70481,26CT ORB PR IAC WWO PR 590.60 70482,26CT MAXIL WO DENTL PF 136.50 70486,26CT MAX-FACIAL WO PRO 417.60 70486,26CT MAX-FACIAL W PRO 440.00 70487,26CT MAX FAC W W/O PRO 574.40 70488,26CT ST NECK W/O PRO 485.40 70490,26CT ST NECK W PRO 473.80 70491,26CT ST NECK W W/O PRO 590.60 70492,26CTA HEAD W/W/O PF 386.40 70496,26CTA NECK W/W/O PRO 625.50 70498,26MRI ORB FC NCK WO PR 723.70 70540,26MRI ORB FC NC CN PRO 407.90 70542,26MRI ORB/NCK W/W/O PR 593.00 70543,26MRI MRA HEAD W/O PRO 457.30 70544,26MRA HEAD W CONT PRO 425.30 70545,26MRI MRA HEAD WWO PRO 627.40 70546,26MRI MRA NECK W/O PRO 359.10 70547,26MRI MRA NECK WWO PRO 627.40 70549,26MRI BRAIN W/BR ST PR 632.10 70551,26MRI BRAIN W/CONT PRO 782.50 70552,26MRI BRAIN W/W/O PRO 942.90 70553,26CHEST 2V FR/LT OB PF 63.30 71022,26CHEST 2V W/FLUORO PF 65.60 71023,26CHEST DECUB PRO 60.60 71035,26CHEST PA 1 VIEW PRO 70.40 71045,26CHEST PA & LAT PRO 89.30 71046,26CHEST 3V W AP LRD PRO 120.50 71047,26CHEST 4 VIEW PRO 147.50 71048,26RIBS 2V UNIL PRO 100.30 71100,26RIBS UNI MN 3V C PRO 116.80 71101,26RIBS 3V BIL PRO 111.80 71110,26RIBS BIL MN 4V CX PR 147.50 71111,26STERNUM MIN 2V PRO 89.30 71120,26STERNOCLAV JT 3V PRO 71.10 71130,26CT CHEST W/O PRO 456.20 71250,26CT CHEST W PRO 419.20 71260,26CT CHEST W W/O PRO 511.10 71270,26CTA CHEST W/W/O PF 651.00 71275,26MRI CHEST W/O PRO 311.30 71550,26MRI CHEST W/CONT PRO 453.60 71551,26MRI CHEST W W/O PRO 592.50 71552,26MRA CHEST W/W/O PF 383.80 71555,26SPINE SINGLE VW PRO 74.80 72020,26CERVICAL 2-3 VW PRO 97.10 72040,26CERVICAL MIN 4V PRO 132.80 72050,26

CERV COMP W FL/EX PR 159.10 72052,26SPINE THORACIC 2V PR 93.20 72070,26T SPINE W/SWIMMER PR 109.20 72072,26T SPINE 4V PF 47.30 72074,26THORACOLUMBR AP/L PR 92.70 72080,26SCOLIOSIS 1V PF 118.90 72081,26SCOLIOSIS 2-3V PF 130.50 72082,26SCOLIOSIS 4-5V PF 146.20 72083,26SCOLIOSIS 6V PF 162.80 72084,26L SPINE 2-3 V PRO 94.80 72100,26L SPINE MIN 4V PRO 139.10 72110,26SPINE LUMBSC BNDG PR 159.10 72114,26SPINE LUM BND 4V PRO 127.30 72120,26CT C SPINE W/O PRO 485.40 72125,26CT C SPINE W PRO 499.50 72126,26CT C SPINE W W/O PRO 588.50 72127,26CT T SPINE W/O PRO 470.90 72128,26CT T SPINE W PRO 197.70 72129,26CT T SPINE W/W/O PF 277.50 72130,26CT L-SPINE W/O PRO 485.40 72131,26CT L-SPINE W PRO 257.50 72132,26CT L-SPINE W W/O PRO 295.60 72133,26MRI CERV SPINE PRO 643.90 72141,26MRI CRV SPNE CON PRO 742.40 72142,26MRI THORACIC SPN PRO 621.10 72146,26MRI THORC SPN CNT PR 636.30 72147,26MRI LUMBAR SPINE PRO 875.40 72148,26MRI LMBR SPN CNT PRO 698.80 72149,26MRI C-SPINE W W/O PR 761.30 72156,26MRI THRC SP W W/O PR 959.70 72157,26MRI LMBR SP W W/O PR 909.80 72158,26PELVIS 1V PRO 80.90 72170,26PELVIS MIN 3V PRO 102.60 72190,26CT PELVIS W/O PRO 459.90 72192,26CT PELVIS W PRO 496.70 72193,26CT PELVIS W W/O PRO 537.10 72194,26MRI PELVIS W/O PRO 434.20 72195,26MRI PELVIS W/W/O 593.00 72197,26MRA PELVIS W/O CT PF 432.90 72198,26SI JOINTS <3V PF 28.90 72200,26SI JOINTS MN 3V PRO 109.20 72202,26SACR&COCCYX MN 2V PR 85.10 72220,26CT EPIDUROGRAPHY PF 214.50 72275,26CLAVICLE 2V PRO 86.10 73000,26CLAVICLE COMP/BIL 839.20 73000,50CLAVICLE COMP/BIL PF 171.90 73000,50SCAPULA MIN 2V PRO 90.60 73010,26

SCAPULA MIN 2V/BIL 839.20 73010,50SCAPULA MIN 2V/BI PF 181.40 73010,50SHOULDER 1V PRO 68.00 73020,26SHOULDER 1V/BIL 666.20 73020,50SHOULDER 1V/BIL PF 136.00 73020,50SHOULDER MN 2V PRO 98.20 73030,26SHOULDER 2V/BIL 1086.80 73030,50SHOULDER 2V/BIL PF 196.60 73030,50ARTHROGRAM SLDR PRO 233.40 73040,26AC JOINTS COMP PRO 89.30 73050,26HUMERUS MIN 2V PRO 81.60 73060,26HUMERUS MIN 2V/BIL 1030.30 73060,50HUMERUS MIN 2V/BI PF 163.30 73060,50ELBOW 2V PRO 64.30 73070,26ELBOW 2V/BIL 624.20 73070,50ELBOW 2V/BIL PF 128.90 73070,50ELBOW MIN 3V PRO 81.60 73080,26ELBOW MIN 3 VIEW/BIL 839.20 73080,50ELBOW MIN 3V/BIL PRO 163.30 73080,50ARTHROGRAM ELBOW PF 115.80 73085,26ARTHROGR ELB/BIL 1336.40 73085,50ARTHROGR ELB/BIL PF 231.50 73085,50FOREARM 2V PRO 65.40 73090,26FOREARM 2V/BIL 929.50 73090,50FOREARM 2V/BIL PF 130.50 73090,50UP EXT INFANT 2V PRO 68.00 73092,26UP EXT INF 2V/BIL 683.60 73092,50UP EXT INF 2V/BIL PF 136.00 73092,50WRIST 2V PRO 58.50 73100,26WRIST 2V/BIL 702.20 73100,50WRIST 2V/BIL PF 116.80 73100,50WRIST MIN 3V PRO 71.10 73110,26WRIST MIN 3V/BIL 825.80 73110,50WRIST MIN 3V/BIL PF 142.50 73110,50ATHROGR WRST/BIL 1011.70 73115,50HAND 2V PRO 67.70 73120,26HAND 2V/BIL 815.30 73120,50HAND 2V/BIL PF 135.50 73120,50HAND MIN 3V PRO 79.00 73130,26HAND MIN 3V/BIL 1086.80 73130,50HAND MIN 3V/BIL PF 157.80 73130,50FINGER MIN 2V PRO 55.70 73140,26FINGER MIN 2V/BIL 724.50 73140,50FINGER MIN 2V/BIL PF 111.30 73140,50CT UP EXT W/O PRO 383.80 73200,26CT UP EXT WO/BIL 4746.00 73200,50CT UP EXT WO/BIL PF 767.60 73200,50

CT UP EXT W PF 257.50 73201,26CT UP EXT W/BIL 5621.70 73201,50CT UP EXT W/BIL PF 514.80 73201,50CT UP EXT W W/O PF 380.60 73202,26CT UP EXT W/WO/BIL 6726.30 73202,50CT UP EXT W/WO/BI PF 761.30 73202,50CTA UPP EXT W/W/O PF 403.70 73206,26MRI UP EXT W/O PRO 369.10 73218,26MRI UP EXT WO/BIL 4243.10 73218,50MRI UP EXT WO/BIL PF 738.20 73218,50MRI UP EXT W/CNTR PF 395.10 73219,26MRI UP EXT W/CON BIL 5174.40 73219,50MRI UP EXT W BIL PF 790.10 73219,50MRI UPP EXT W/W/O PF 540.50 73220,26MRI UP EXT W/WO/BIL 6106.80 73220,50MRI UP EXT WWO/BI PF 1081.00 73220,50MRI UP EXT JT W/O PR 604.30 73221,26MRI UP EXT JNT WO/BI 4243.10 73221,50MRI UP EX JT WO/B PF 1208.30 73221,50MRI UP EXT JT W PRO 407.90 73222,26MRI JNT UP EXT W/C B 5174.40 73222,50MRI JNT UP EX W B PF 815.90 73222,50MRI JNT UP EX WWO PF 515.00 73223,26MRI JNT UP EXT WWO B 6106.80 73223,50MRI JT U/EX WWO B PF 1030.30 73223,50HIP UNI W/PELV 1V PR 62.50 73501,26HIP UNI W/PLV 2-3V P 85.10 73502,26HIP UNI W/PL MN4V PF 100.50 73503,26HIP BIL W/PL 3-4V PF 141.50 73522,26HIP BIL W/PLV 5V PF 152.30 73523,26ARTHROGRAM HIP PF 195.60 73525,26FEMUR 1V PF 68.00 73551,26FEMUR 1V BIL 797.20 73551,50FEMUR 1V BIL PF 136.00 73551,50FEMUR 2V PRO 79.00 73552,26FEMUR 2V/BIL 884.60 73552,50FEMUR 2V/BIL PRO 157.80 73552,50KNEE 1 OR 2VIEW PRO 72.20 73560,26KNEE 2V/BIL 839.20 73560,50KNEE 2V/BIL PF 144.10 73560,50KNEE 3V PRO 84.50 73562,26KNEE 3V/BIL 929.50 73562,50KNEE 3V/BIL 169.30 73562,50KNEE 4V PRO 95.60 73564,26KNEE 4V/BIL 1042.40 73564,50KNEE 4V/BIL PF 191.10 73564,50KNEE BIL STD AP PRO 104.50 73565,26

ARTHROGRAM KNEE PF 94.20 73580,26TIBIA FIBULA 2V PRO 79.00 73590,26TIBIA FIBULA 2V/BIL 994.40 73590,50TIBIA FIBLA 2V/BI PF 157.80 73590,50LOW EXT INFANT 2V PF 46.20 73592,26LOW EXT INF 2V/BIL 791.70 73592,50LOW EXT INF 2V/BI PF 92.40 73592,50ANKLE 2V PRO 66.70 73600,26ANKLE 2V/BIL 773.10 73600,50ANKLE 2V/BIL PF 133.40 73600,50ANKLE MIN 3V PRO 71.10 73610,26ANKLE MIN 3V/BIL 981.00 73610,50ANKLE MIN 3V/BIL PF 142.50 73610,50FOOT 2V PRO 79.00 73620,26FOOT 2V/BIL 839.20 73620,50FOOT 2V/BIL PF 157.80 73620,50FOOT MIN 3V PRO 76.90 73630,26FOOT MIN 3V/BIL 1086.80 73630,50FOOT MIN 3V/BIL PF 154.10 73630,50HEEL MIN 2V PRO 67.70 73650,26HEEL MIN 2V/BIL 839.20 73650,50HEEL MIN 2V/BIL PF 135.50 73650,50TOE MIN 2V PRO 58.80 73660,26CT LOW EXT W/O PRO 446.00 73700,26CT LOW EXT WO/BIL 4746.00 73700,50CT LOW EXT WO/BI PF 892.20 73700,50CT LOW EXT W PRO 382.20 73701,26CT LOW EXT W/BIL 5621.70 73701,50CT LOW EXT W/BIL PF 764.40 73701,50CT LOW EXT W/W/O PRO 431.30 73702,26CT LOW EXT W/WO/BIL 6726.30 73702,50CT LOW EXT WWO/BI PF 862.60 73702,50CTA LOW EXT W/W/O PF 455.70 73706,26CTA LOW EXT W/WO/BIL 4855.20 73706,50CTA LW EXT WWO/BI PF 911.40 73706,50MRI LOW EXT W/O PRO 369.10 73718,26MRI LOW EXT WO BIL 4243.10 73718,50MRI LOW EXT WO/BI PF 738.20 73718,50MRI LOW EXT W/ PRO 407.90 73719,26MRI LOW EXT W/CON BI 5174.40 73719,50MRI LOW EXT W BIL PF 815.90 73719,50MRI LOW EXT WWO PRO 655.70 73720,26MRI LOW EXT W/WO BIL 6106.80 73720,50MRI LOW EXT WWO B PF 1311.50 73720,50MRI LOW EXT JT WO PR 604.30 73721,26MRI LOW EXT JNT WO B 4243.10 73721,50MRI LW EX JT WO B PF 1208.30 73721,50

MRI JNT LOW EXT W PF 343.40 73722,26MRI JNT LE W/CON BIL 5174.40 73722,50MRI JNT LE W BIL PF 687.00 73722,50MRI JT LW EXT WWO PR 593.00 73723,26MRI JNT LE W/WO BIL 6106.80 73723,50MRI JNT LE WWO BI PF 1186.00 73723,50MRA LOWER EXT W/O PR 595.40 73725,26ABD/KUB AP BIL 1086.80 74000,50ABD/KUB AP BIL PF 159.90 74000,50ABDOMEN 1 VIEW PRO 80.10 74018,26ABD FL/UP/DECUB PRO 107.90 74019,26ABD 3-4 VIEW PRO FEE 99.80 74021,26ACUTE ABD COMP PRO 149.60 74022,26CT ABDOMEN W/O PRO 446.80 74150,26CT ABDOMEN W PRO 532.60 74160,26CT ABDOMEN W W/O PRO 634.50 74170,26CTA ABD PLV W/W/O PF 709.80 74174,26CTA ABD W/W/O PRO 432.10 74175,26CT ABD PELVIS W/O PF 630.30 74176,26CT ABD PELVIS W PF 619.50 74177,26CT ABD PEL W/W/O PF 780.90 74178,26MRI ABDOMEN W/O PRO 653.40 74181,26MRI ABDOMEN W/W/O PR 643.90 74183,26MRA ABDOMEN W/ PRO 789.60 74185,26ESOPHAGUS PRO 177.50 74220,26SWALLOW FNCT CNRA PR 210.80 74230,26UPPER GI W/O KUB PRO 232.10 74240,26UPPER GI W KUB PRO 238.90 74241,26UPPER GI W/SM BWL PR 301.10 74245,26UPPER GI W AIR PRO 270.60 74246,26UPR GI AIR W KUB PRO 282.20 74247,26UPR GI AIR/SM BWL PR 390.10 74249,26SMALL BOWEL SER PRO 193.50 74250,26CT COLONOGRPHY WO PF 524.20 74261,26CT COLONGRPHY WWO PF 546.00 74262,26CT COLONOGRPHY SC PF 511.10 74263,26COLON (BE) PRO 294.00 74270,26COLON W/AIR CONT PRO 357.00 74280,26INTER OP CHOLANGI PR 148.10 74300,26IV PYELOGRAM PRO 200.30 74410,26IV PYELOGRM W/TOM PR 200.30 74415,26CYSTOGRAM PRO 132.30 74430,26URETHROGRAM VDG PRO 136.80 74455,26HYSTEROSALPINGOGRAM PF 59.90 74740,26CT CORONARY CALCIUM SCORE PF 87.00 75571,26CTA AORTA/RUNOFF PF 733.40 75635,26SHUNTOGRAM PRO 137.30 75809,26

VEIN ARM/LEG UNIL PF 217.10 75820,26VEIN ARM/LEG BIL PF 325.80 75822,26VENOGRAPHY CAVAL PF 436.00 75827,26FLUOROSCOPY <1HR PRO 148.10 76000,26FLUORO UP TO 1 HOUR 395.60 76000,59FISTULA STUDY PF 118.10 76080,26XRY MAMMO SURG SP PR 104.50 76098,26TOMOGRAM (6CUTS) PF 119.20 76100,26CT/MR/US 3D RECO PRO 92.40 76376,26US THYROID NECK PRO 249.90 76536,26US CHEST PL EFF PRO 286.70 76604,26US BREAST EA BRST PF 169.60 76641,26US BREAST LTD EA PF 158.00 76642,26US ABDOMEN COMP PRO 336.00 76700,26US RT UPPER QUAD PRO 252.00 76705,26ULTRASOUND AAA SC PF 327.60 76706,26US RETRO/REN/AO/C PR 300.60 76770,26US RETR/REN/AO/LT PR 230.00 76775,26US SPINE PRO 193.40 76800,26US FETAL 1ST TRI PRO 260.90 76801,26US FETAL 1 TRI AD PR 232.10 76802,26US FETAL >14 WKS PRO 293.20 76805,26US FETAL>14WK ADL PR 375.60 76810,26US FETAL LTD PRO 237.00 76815,26US FETAL FU PRO 232.10 76816,26US TRANSVAG FETAL PR 260.90 76817,26US BPP W/NST PRO 173.30 76818,26US BPP W/O NST PF 126.00 76819,26US TRNSVAL PELVIS PR 313.20 76830,26SONOHYSTEROGRAPHY PF 367.20 76831,26US PELVIS PRO 290.90 76856,26US PELVIS LTD PRO 82.20 76857,26US SCROTUM PRO 277.20 76870,26US EXT NON VAS CM PF 82.20 76881,26US EXT NON VAS LTD P 57.80 76882,26US INFANT HIPS DYNPF 349.40 76885,26US INFANT HIPS ST PF 67.70 76886,26US VASCULAR ACCESS 111.50 76937,26,QZUS GUID CYST ASP PRO 405.80 76942,26FLUORO GUIDE CVC PF 428.10 77001,26FL GUID NEEDLE PL PF 115.20 77002,26FLUORO GUID INJ PF 148.50 77002,26,QZFLOURO GUID LMBR PF 256.20 77003,26FLOURO GUID SPINE PF 146.60 77003,26,QZCT GUID NDL PLC PF 246.80 77012,26CAD DIAG MAMMO PF 31.00 77051,26CAD SCREEN MAMMO PF 31.00 77052,26

MAMMOGRAM UNILAT PRO 161.40 77065,26MAMMOGRAM BILAT PRO 196.90 77066,26MAMMOGRAM SCREEN PRO 125.00 77067,26MAMMO SCREEN UNILAT 136.50 77067,52BONE AGE STUDY PF 71.10 77072,26BONE LENGTH STUDY PF 96.60 77073,26BONE SURVEY LMTD PF 97.70 77074,26BONE SURVEY COMP PRO 233.90 77075,26BONE SURVY INFANT PF 140.70 77076,26CT BONE MIN DENS PF 151.20 77078,26CT BONE MIN DENS EMPLOYEE PF 0.00 77078,26DEXA (BONE DEN) PRO 151.20 77080,26THYROID UPTK S M PF 59.10 78012,26THYROID IMAG FLOW PF 111.30 78013,26THYROID IMG UPTK PF 162.00 78014,26PARATHYROID IMAG PF 196.40 78070,26PARATHY IMG SPECT PF 132.00 78071,26SENTINEL NODE IMG PF 254.10 78195,26LIVER/SPLEEN SCN PRO 292.70 78215,26HEPATOBIL W/O CCK PF 168.80 78226,26HEPATOBIL W CCK PF 244.10 78227,26GASTRIC EMPTYG ST PF 327.10 78264,26GASTRIC EMP W/SB PF 158.60 78265,26ACUTE GI BLD IMG PRO 353.90 78278,26INTESTIN IMG MCKL PF 192.40 78290,26BONE JNT IMG LTD PRO 236.00 78300,26BONE JNT IMG MLT PRO 306.10 78305,26BONE JT IMG WH BD PR 337.60 78306,26BONE JT IMG 3 PH PRO 333.10 78315,26BONE JOINT SPEC PRO 415.00 78320,26MYO PRF IMG SP RT PF 694.80 78451,26MYO PERF IMG MULT PF 893.60 78452,26CARD BLD PL EF MG PR 446.80 78472,26PUL PERF IMAG PAR PF 181.10 78580,26PUL VENT&PERF IMG PF 236.30 78582,26BRAIN IMAG SPECT PRO 189.00 78607,26KIDNEY IMG W FUNC PF 272.00 78707,26KIDNEY IMG FL PHM PF 336.00 78708,26TESTICULR IMG FLW PF 209.70 78761,26RADNUC LOC TUMOR PRO 316.80 78800,26RADNUC LOC TMR SP PF 252.80 78803,26RADNUC LOCAL ABS PRO 341.00 78805,26RADIONC LC ABS WB PF 257.50 78806,26GLUCOSE FSA APPV MON 42.60 82962,QWHEMOGLOBIN A1C 82.10 83036,QWRAPID STREP 20.80 87880,QWSPEECH LANGUAGE RX 316.80 92507,GN

EVAL SPEECH FLUENCY 182.70 92521,GNEVAL SPEECH SND PROD 148.80 92522,GNEVAL SPEECH SND LANG 308.40 92523,GNBEHAV QUAL VOIC REAS 155.70 92524,GNTREATMNT OF SWALLOWI 292.20 92526,GNEVAL SPEECH DEV 1HR 434.20 92607,GNEVAL SPEECH DEV ADDL 179.30 92608,GNSPCHGEN DEV PROG/USE 335.70 92609,GNTRAIN SPEECH DEVICE 376.20 92609,GNEVAL OF SWALLOWING 391.70 92610,GNEVAL MOD BARIUM SWAL 372.20 92611,GNPHASE 3 EXERCISE 6.00 93797,GYPULMONARY REHAB PHASE 3 EXERCISE 6.00 93797,GYDUPLX EXTC ART B PRO 425.00 93880,26DUPLX EXT ART U PRO 208.70 93882,26ARTL U L EXT LMT PRO 284.60 93922,26ARTL U OR LE EXT PRO 267.20 93923,26ABI/ABI W STRESS PF 81.90 93924,26DUPLX ART LE BIL PRO 401.40 93925,26DUPLX ART UE BIL PRO 367.50 93930,26DUPLX VEN UELE B PRO 388.00 93970,26DUPLX VEN UELE UN PR 241.50 93971,26DUPLX ABD/PEL OR PRO 394.80 93975,26DUPLX ABD/PEL O PRO 234.40 93976,26VENT INIT MGT 1STDAY 1064.50 94002,QZAEROSOL RX SUBSEQUE 76.50 94640,76CONT GLUCOSE MNTG PF 150.00 95251,26MSLT OR MWT PF 198.70 95805,26SLEEP STUDY UNATT PF 198.20 95806,26REG SLEEP STUDY PF 602.70 95810,26SPLIT NIGHT SLEEP PF 629.00 95811,26NASAL CPAP TITRA PF 629.00 95811,26NASAL BIPAP TITRA PF 629.00 95811,26PARASPINAL W/1 PRO 198.70 95860,25PARASPINAL W/2 PRO 437.30 95861,26NERVE CONDUCTION 1-2 211.30 95907,25NERVE CONDUCTION 3-4 239.90 95908,25SOMATOSENSORY UE PF 104.50 95925,25SOMATOSENSORY LE PF 104.50 95926,25NEUROMU JUNC TEST PF 130.50 95937,25ELECTRICAL STIMUL PF 130.50 95937,25RFL/MTNCE IMPLT PUMP 245.10 95991,QZASSESMENT OF APHASIA 529.50 96105,GNDEVELOPMENTAL TSTING 396.70 96111,GPMMSE MEMORY CHECK 90.80 96116,26NEUROBEHAVIORAL EXAM 529.50 96116,GNSTAND COGN PERF HR 384.30 96125,GN

STND COGN PERF P/HR 183.50 96125,GNTRACTION MECHANICAL 201.80 97012,GPVASOPNEUMATIC DEVICE THERAPY 170.50 97016,GPPARAFFIN 151.60 97018,GOPARAFFIN 150.90 97018,GPFLUIDOTHERAPY 237.60 97022,GOFLUIDOTHERAPY 236.80 97022,GPDIATHERMY 201.80 97024,GPELECTR ATND STM/15MN 163.30 97032,GOE STIM ATND EA 15MIN 162.60 97032,GPIONTOPHORESIS/15 MIN 253.80 97033,GOIONTOPHORESIS/15 MIN 252.80 97033,GPCONTRAST BATH 15 MIN 176.00 97034,GOULTRASOUND 15 MIN 202.50 97035,GOULTRASOUND 15 MIN 201.80 97035,GPTHERA EXERCISE/15MN 229.40 97110,GOTHERAPEUT EXRC/15MIN 228.60 97110,GPNEUROMUSC REED 15MIN 206.90 97112,GONEUROMUSC REEDU 15MN 206.00 97112,GPAQUATIC THERAPY 15MN 232.80 97113,GPGAIT TRAINING/15 MIN 185.20 97116,GPMANUAL THERAPY/15 MIN 228.60 97140,GOMANUAL THERAPY-LYMPHEDEMA 15MN 228.60 97140,GPMANUAL THERAPY/15 MN 228.60 97140,GPMANUAL THERAPY-LYMPHEDEMA 15 MN 256.60 97140,GPTHERAPUTIC PROC GRP 134.20 97150,GPEVAL LOW COMPLEXITY 20 MN 500.00 97161,GPEVAL MODERATE COMPLEXITY 30 MN 625.00 97162,GPEVAL HIGH COMPLEXITY 45 MN 750.00 97163,GPEVALUATION RE-EVAL 259.70 97164,GPOT EVAL LOW COMPLEXITY 500.00 97165,GOOT EVAL MODERATE COMPLEXITY 625.00 97166,GOOT EVAL HIGH COMPLEXITY 750.00 97167,GOOCCUP THER REEVAL 260.60 97168,GOTHERAPEUT ACTIV 15MN 194.40 97530,GOTHERAPEUT ACTV/15MIN 214.70 97530,GPSENS INTEGR PER 15MN 181.40 97533,GOSENS INTEGR PER 15MN 180.80 97533,GPHOME PROGRAM/15 MIN 192.40 97535,GOSELF CARE/HOME 15MIN 190.50 97535,GOSELF CARE/HOME MGT15 189.60 97535,GPCOM WORK TRAIN/15MIN 178.10 97537,GOCOM WORK TRAIN/15MIN 177.50 97537,GPWHEELCHAIR MGT 15MIN 184.50 97542,GOWHEELCHAIR MGT 15MIN 183.60 97542,GPWORK CONDITION 2 HRS 895.20 97545,GOWORK CONDITION 2 HRS 891.90 97545,GP

WORK CONDITION ADDL HR 199.00 97546,GOWORK COND ECH ADL HR 330.20 97546,GPDEBRID SKIN FULL PF 99.40 97597,26REM DV TX WND A20 PF 108.00 97598,26ST PERFORM TEST/15MN 159.10 97750,GNOT PERFORM TEST/15MN 209.30 97750,GOPT PERFORM TEST/15MN 208.40 97750,GPORTH MGMT TRAINING, INITIAL 15MIN 229.40 97760,GOORTHO MGMT TRAINING, INITIAL 15MN 228.60 97760,GPPROSTHETIC FIT 15MIN 210.20 97761,GOPROST TRAINING, INITIAL 15MIN 220.50 97761,GPORTHO PROSTHETIC USE EACH 15 MIN 181.40 97763,GOORTHO/PROS MGMT TRAIN, SUBS 15 MIN 148.10 97763,GPPOST OP F/U VISIT PF 0.00 99024,25ANES FOR PT EXT AGE 0.00 99100,QZANES COMP BY HYPOTEN 0.00 99135,QZANES FOR EMERGENCY 0.00 99140,QZNEW PT INIT 10 PF 78.20 99201,25NEW PATIENT SIMPLE 10 PRO FEE 80.40 99201,25NEW PT LEVEL 1 PF 56.60 99201,25NEW PT VISIT 10MN PF 57.50 99201,26NEW PATIENT LEVEL 2 48.10 99202,25NEW PT INIT 20 PF 163.30 99202,25NEW PATIENT LIMITED 20MN PRO FEE 152.70 99202,25NEW PT EXPANDED PF 130.10 99202,25NEW PATIENT LEVEL 3 63.30 99203,25NEW PT INIT 30 PF 273.80 99203,25NEW PT VISIT 30MN PF 183.50 99203,25NEW PATIENT LOW 30MN PRO FEE 233.50 99203,25NEW PT DETAILED PF 186.80 99203,25NEW PATIENT LEVEL 4 72.00 99204,25NEW PT INIT 45 PF 405.30 99204,25NEW PATIENT MODERATE 45MN PRO FEE 395.10 99204,25NEW PATIENT LEVEL 5 78.60 99205,25NEW PT INIT 60 PF 554.90 99205,25NEW PATIENT COMP 60MN PRO FEE 513.80 99205,25EST PATIENT LEVEL 1 26.30 99211,25RET PT INIT EXAM 5PF 63.30 99211,25EST PT VISIT 5MN PF 33.50 99211,25EST PATIENT SIMPLE PRO FEE 28.00 99211,25EST PT LEVEL 1 PF 23.10 99211,25EST PATIENT LEVEL 2 37.20 99212,25RE PT INIT EX PRO 10 172.70 99212,25EST PT VISIT 10MN PF 61.10 99212,25EST PATIENT LIMITED 10MN PRO FEE 76.50 99212,25EST PT 10MIN PF 67.00 99212,25EST PATIENT LEVEL 3 41.50 99213,25

RETURN INTERM PRO 15 69.30 99213,25EST PT VISIT 15MN PF 81.60 99213,25EST PATIENT LOW 15MN PRO FEE 155.10 99213,25EST PATIENT LEVEL 4 56.80 99214,25EST PATIENT MODERATE 25 PRO FEE 238.10 99214,25EST PT 25 MIN EXP PF 229.30 99214,26EST PATIENT LEVEL 5 72.00 99215,25COMPLEX RETURN PRO 107.10 99215,25EST PT VISIT 40MN PF 266.00 99215,25EST PATIENT COMP 40MN PRO FEE 337.20 99215,25EST PT 40MIN CMP PF 290.40 99215,26FOLLOW UP VISIT-PAIN 128.80 99231,QZSUBS HOSP CARE 25MNS 234.80 99232,QZSUBS HOSP CARE 35MNS 339.60 99233,QZOP CONSULT LEVEL 1 PRO FEE 259.40 99241,25CONSUL NEW/EST PRO15 259.40 99241,26CONSULT 15 MIN PF 80.30 99241,26OP CONSULT LEVEL 2 PRO FEE 450.20 99242,25CONSUL NEW/EST PRO30 450.20 99242,26CONSULT 30 MIN PF 160.90 99242,26OP CONSULT LEVEL 3 PRO FEE 592.20 99243,25CONSUL NEW/EST PRO40 592.20 99243,26CONSULT 40 MIN PF 216.50 99243,26OP CONSULT LEVEL 4 PRO FEE 709.80 99244,25CONSUL NEW/EST PRO60 709.80 99244,26OP CONSULT LEVEL 5 PRO FEE 946.10 99245,25CONSUL NEW/EST PRO80 946.10 99245,26IP CONSULT LEVEL 1 PRO FEE 330.00 99251,25INIT IP CONSUL PRO20 330.00 99251,26IP CONSULT LEVEL 2 PRO FEE 529.70 99252,25INIT IP CONSUL PRO40 529.70 99252,26IP CONSULT LEVEL 3 PRO FEE 588.80 99253,25INIT IP CONSUL PRO55 588.80 99253,26IP CONSULT LEVEL 4 PRO FEE 814.80 99254,25INIT IP CONSUL PRO80 814.80 99254,26IP CONSULT LEVEL 5 PRO FEE 1105.10 99255,25INIT IP CONSU PRO110 1105.10 99255,26ER LEVEL 1 94.50 99281,25ER PHYS LEVEL 1 156.90 99281,25ER LEVEL 2 180.30 99282,25ER PHYS LEVEL 2 231.70 99282,25ER LEVEL 3 463.90 99283,25ER PHYS LEVEL 3 425.40 99283,25ER LEVEL 4 654.70 99284,25ER PHYS LEVEL 4 619.70 99284,25ER LEVEL 5 775.60 99285,25ER PHYS LEVEL 5 1007.50 99285,25

ER CRIT CARE 30-74MN 1555.30 99291,25EP CC 30-74MIN 1873.80 99291,25EP CRTCL CARE ADD30 538.80 99292,25PROLONGED SERVICE 1ST HOUR PRO FEE 282.30 99354,25PROLONGED SERVICE ADD'L 30MN PRO FEE 274.60 99355,25EXTENDED SERVICE 1ST HOUR PRO FEE 352.30 99358,25EXTENDED SERVICE ADD'L 30MN PRO FEE 169.30 99359,25CARDIOLYTE ISOTOPE 923.00 A9500TC 99M MDP 194.80 A9503TL-201 THALLOUS CHL 189.80 A9505TC99M PERT ISOTOPE 192.70 A9512I 123 CAPSULE 302.10 A9516CERETEC ISOTOPE 2708.70 A9521NEOTEC-TC 2630.50 A9536TC 99M MEMBRO CHOLTE 267.50 A9537TC 99M PYP ISOTOPE 276.90 A9538TC-99M PENTETATE DX 347.30 A9539TC 99 PENTETATE 25MI 192.70 A9539TC 99M MAA 190.80 A9540TC99M SULF COLL ISOT 207.10 A9541SULPHUR COLLOID FLTR 311.10 A9541TAGGED RED BLOOD CEL 199.50 A9560MAG 3 ISOTOPE 275.90 A9562TC 99M DTPA AERO 190.80 A9567TECENTRIQ 10MG 140.00 C9483RADICAVA 30 MG/100 ML BAG 1 mg, 100 mL C9493ADMIN INFLUENZA VACC 30.00 G0008ADMIN INFLUENZA VACC 31.50 G0008ADMIN PNEUMONIA VACC 32.80 G0009ADMIN PNEUMONIA VACC 30.00 G0009PNEUMOVAX G0009ADMIN PNEUMONIA VACC 31.50 G0009PSA SCREENING 228.30 G0103COLON CA-SCR BAR ENE 666.80 G0106COLON CA-SC BR EN PF 185.60 G0106,26COLON CA-SC BR EN HR 666.80 G0120COLON CA-SC BE HR PF 185.60 G0120,26ER WND CLS DERMABOND 195.30 G0168DERMABOND SKIN ADHES G0168MAMMO GRANT PRO FEE 40.00 G0202MAMMOGRAM EMPLOYEE PRO 0.00 G0202,26INDIVIDUAL EDUCATION 15MN 27.00 G0237INDIVIDUAL EXERCISE 15MN 30.00 G0238GROUP EXERCISE 33.00 G0239ELECTRICAL STIM UNAT 136.30 G0283,GOELECTRICAL STIM UNAT 137.10 G0283,GPCT LOW DOSE LUNG SCR 79.00 G0297

CT LOW DOSE LUNG PF 20.00 G0297FECAL OCCULT SCN IMM 71.10 G0328OBSERV REG 1ST HOUR 282.00 G0378OBSERV REG 2-24 HOUR 26.30 G0378OBSERV REG ADD'L HRS 26.30 G0378OBSERV SCU 1ST HOUR 429.50 G0378OBSERV SCU 2-24 HOUR 44.10 G0378OBSERV SCU ADD'L HRS 47.30 G0378DIRECT ADMIT OBSERV 105.00 G0379OBSERVATION MEDICAID 0.00 G0379DIRECT ADMIT OBSERV 105.00 G0379PULMONARY REHAB W/EXERCISE 84.00 G0424RET PT INIT EXAM 10 168.50 G0463RETURN INTERM EXAM15 153.00 G0463RETURN EXTEND EXAM25 243.90 G0463NEW PT INIT EXAM 30 112.40 G0463NEW PT INIT EXAM 45 101.60 G0463RET PT INIT EXAM 5 63.30 G0463EST PT VISIT 5 MIN 37.20 G0463EST PT VISIT 10 MIN 46.60 G0463EST PT VISIT 15 MIN 48.00 G0463EST PT VISIT 25MN 79.80 G0463EST PT VISIT 40MN 113.00 G0463NEW PT VISIT 10 MIN 43.40 G0463NEW PT VISIT 20 MIN 73.20 G0463NEW PT VISIT 30 MIN 119.70 G0463NEW PT VISIT 45MN 132.00 G0463NEW PT VISIT 60MN 159.60 G0463HEPATITIS C ANTIBODY SCREENING 136.60 G0472DRUG SELECT TOXASSUR 136.50 G0479DRUG DEFINITIVE 8-14 136.50 G0481DRUG DEFINITIVE 22 163.80 G0483COGNITIVE TX PER 15MN 93.50 G0515,GNCOGNITIVE TX PER 15 MN 75.00 G0515,GOMOBILITY CURRENT 0.01 G8978,CH,GOMOBILITY CURRENT 0.01 G8978,CH,GPMOBILITY CURRENT 0.01 G8978,CI,GOMOBILITY CURRENT 0.01 G8978,CI,GPMOBILITY CURRENT 0.01 G8978,CJ,GOMOBILITY CURRENT 0.01 G8978,CJ,GPMOBILITY CURRENT 0.01 G8978,CK,GOMOBILITY CURRENT 0.01 G8978,CK,GPMOBILITY CURRENT 0.01 G8978,CL,GOMOBILITY CURRENT 0.01 G8978,CL,GPMOBILITY CURRENT 0.01 G8978,CM,GOMOBILITY CURRENT 0.01 G8978,CM,GPMOBILITY CURRENT 0.01 G8978,CN,GO

MOBILITY CURRENT 0.01 G8978,CN,GPMOBILITY GOAL 0.01 G8979,CH,GOMOBILITY GOAL 0.01 G8979,CH,GPMOBILTIY GOAL 0.01 G8979,CI,GOMOBILITY GOAL 0.01 G8979,CI,GPMOBILITY GOAL 0.01 G8979,CJ,GOMOBILITY GOAL 0.01 G8979,CJ,GPMOBILITY GOAL 0.01 G8979,CK,GOMOBILITY GOAL 0.01 G8979,CK,GPMOBILITY GOAL 0.01 G8979,CL,GOMOBILITY GOAL 0.01 G8979,CL,GPMOBILITY GOAL 0.01 G8979,CM,GOMOBILITY GOAL 0.01 G8979,CM,GPMOBILITY GOAL 0.01 G8979,CN,GOMOBILITY GOAL 0.01 G8979,CN,GPMOBILITY D/C 0.01 G8980,CH,GOMOBILITY D/C 0.01 G8980,CH,GPMOBILITY D/C 0.01 G8980,CI,GOMOBILITY D/C 0.01 G8980,CI,GPMOBILITY D/C 0.01 G8980,CJ,GOMOBILITY D/C 0.01 G8980,CJ,GPMOBILITY D/C 0.01 G8980,CK,GOMOBILITY D/C 0.01 G8980,CK,GPMOBILITY D/C 0.01 G8980,CL,GOMOBILITY D/C 0.01 G8980,CL,GPMOBILITY D/C 0.01 G8980,CM,GOMOBILITY D/C 0.01 G8980,CM,GPMOBILITY D/C 0.01 G8980,CN,GOMOBILITY D/C 0.01 G8980,CN,GPBODY POS CURRENT 0.01 G8981,CH,GOBODY POS CURRENT 0.01 G8981,CH,GPBODY POS CURENT 0.01 G8981,CI,GOBODY POS CURRENT 0.01 G8981,CI,GPBODY POS CURRENT 0.01 G8981,CJ,GOBODY POS CURRENT 0.01 G8981,CJ,GPBODY POS CURRENT 0.01 G8981,CK,GOBODY POS CURRENT 0.01 G8981,CK,GPBODY POS CURRENT 0.01 G8981,CL,GOBODY POS CURRENT 0.01 G8981,CL,GPBODY POS CURRENT 0.01 G8981,CM,GOBODY POS CURRENT 0.01 G8981,CM,GPBODY POS CURRENT 0.01 G8981,CN,GOBODY POS CURRENT 0.01 G8981,CN,GPBODY POS GOAL 0.01 G8982,CH,GOBODY POS GOAL 0.01 G8982,CH,GPBODY POS GOAL 0.01 G8982,CI,GOBODY POS GOAL 0.01 G8982,CI,GP

BODY POS GOAL 0.01 G8982,CJ,GOBODY POS GOAL 0.01 G8982,CJ,GPBODY POS GOAL 0.01 G8982,CK,GOBODY POS GOAL 0.01 G8982,CK,GPBODY POS GOAL 0.01 G8982,CL,GOBODY POS GOAL 0.01 G8982,CL,GPBODY POS GOAL 0.01 G8982,CM,GOBODY POS GOAL 0.01 G8982,CM,GPBODY POS GOAL 0.01 G8982,CN,GOBODY POS GOAL 0.01 G8982,CN,GPBODY POS D/C 0.01 G8983,CH,GOBODY POS D/C 0.01 G8983,CH,GPBODY POS D/C 0.01 G8983,CI,GOBODY POS D/C 0.01 G8983,CI,GPBODY POS D/C 0.01 G8983,CJ,GOBODY POS D/C 0.01 G8983,CJ,GPBODY POS D/C 0.01 G8983,CK,GOBODY POS D/C 0.01 G8983,CK,GPBODY POS D/C 0.01 G8983,CL,GOBODY POS D/C 0.01 G8983,CL,GPBODY POS D/C 0.01 G8983,CM,GOBODY POS D/C 0.01 G8983,CM,GPBODY POS D/C 0.01 G8983,CN,GOBODY POS D/C 0.01 G8983,CN,GPCARRY CURRENT 0.01 G8984,CH,GOCARRY CURRENT 0.01 G8984,CH,GPCARRY CURRENT 0.01 G8984,CI,GOCARRY CURRENT 0.01 G8984,CI,GPCARRY CURRENT 0.01 G8984,CJ,GOCARRY CURRENT 0.01 G8984,CJ,GPCARRY CURRENT 0.01 G8984,CK,GOCARRY CURRENT 0.01 G8984,CK,GPCARRY CURRENT 0.01 G8984,CL,GOCARRY CURRENT 0.01 G8984,CL,GPCARRY CURRENT 0.01 G8984,CM,GOCARRY CURRENT 0.01 G8984,CM,GPCARRY CURRENT 0.01 G8984,CN,GOCARRY CURRENT 0.01 G8984,CN,GPCARRY GOAL 0.01 G8985,CH,GOCARRY GOAL 0.01 G8985,CH,GPCARRY GOAL 0.01 G8985,CI,GOCARRY GOAL 0.01 G8985,CI,GPCARRY GOAL 0.01 G8985,CJ,GOCARRY GOAL 0.01 G8985,CJ,GPCARRY GOAL 0.01 G8985,CK,GOCARRY GOAL 0.01 G8985,CK,GPCARRY GOAL 0.01 G8985,CL,GO

CARRY GOAL 0.01 G8985,CL,GPCARRY GOAL 0.01 G8985,CM,GOCARRY GOAL 0.01 G8985,CM,GPCARRY GOAL 0.01 G8985,CN,GOCARRY GOAL 0.01 G8985,CN,GPCARRY D/C 0.01 G8986,CH,GOCARRY D/C 0.01 G8986,CH,GPCARRY D/C 0.01 G8986,CI,GOCARRY D/C 0.01 G8986,CI,GPCARRY D/C 0.01 G8986,CJ,GOCARRY D/C 0.01 G8986,CJ,GPCARRY D/C 0.01 G8986,CK,GOCARRY D/C 0.01 G8986,CK,GPCARRY D/C 0.01 G8986,CL,GOCARRY D/C 0.01 G8986,CL,GPCARRY D/C 0.01 G8986,CM,GOCARRY D/C 0.01 G8986,CM,GPCARRY D/C 0.01 G8986,CN,GOCARRY D/C 0.01 G8986,CN,GPSELF CARE CURRENT 0.01 G8987,CH,GOSELF CARE CURRENT 0.01 G8987,CH,GPSELF CARE CURRENT 0.01 G8987,CI,GOSELF CARE CURRENT 0.01 G8987,CI,GPSELF CARE CURRENT 0.01 G8987,CJ,GOSELF CARE CURRENT 0.01 G8987,CJ,GPSELF CARE CURRENT 0.01 G8987,CK,GOSELF CARE CURRENT 0.01 G8987,CK,GPSELF CARE CURRENT 0.01 G8987,CL,GOSELF CARE CURRENT 0.01 G8987,CL,GPSELF CARE CURRENT 0.01 G8987,CM,GOSELF CARE CURRENT 0.01 G8987,CM,GPSELF CARE CURRENT 0.01 G8987,CN,GOSELF CARE CURRENT 0.01 G8987,CN,GPSELF CARE GOAL 0.01 G8988,CH,GOSELF CARE GOAL 0.01 G8988,CH,GPSELF CARE GOAL 0.01 G8988,CI,GOSELF CARE GOAL 0.01 G8988,CI,GPSELF CARE GOAL 0.01 G8988,CJ,GOSELF CARE GOAL 0.01 G8988,CJ,GPSELF CARE GOAL 0.01 G8988,CK,GOSELF CARE GOAL 0.01 G8988,CK,GPSELF CARE GOAL 0.01 G8988,CL,GOSELF CARE GOAL 0.01 G8988,CL,GPSELF CARE GOAL 0.01 G8988,CM,GOSELF CARE GOAL 0.01 G8988,CM,GPSELF CARE GOAL 0.01 G8988,CN,GOSELF CARE GOAL 0.01 G8988,CN,GP

SELF CARE D/C 0.01 G8989,CH,GOSELF CARE D/C 0.01 G8989,CH,GPSELF CARE D/C 0.01 G8989,CI,GOSELF CARE D/C 0.01 G8989,CI,GPSELF CARE D/C 0.01 G8989,CJ,GOSELF CARE D/C 0.01 G8989,CJ,GPSELF CARE D/C 0.01 G8989,CK,GOSELF CARE D/C 0.01 G8989,CK,GPSELF CARE D/C 0.01 G8989,CL,GOSELF CARE D/C 0.01 G8989,CL,GPSELF CARE D/C 0.01 G8989,CM,GOSELF CARE D/C 0.01 G8989,CM,GPSELF CARE D/C 0.01 G8989,CN,GOSELF CARE D/C 0.01 G8989,CN,GPOTHER PT/OT CURRENT 0.01 G8990,CH,GOOTHER PT/OT CURRENT 0.01 G8990,CH,GPOTHER PT/OT CURRENT 0.01 G8990,CI,GOOTHER PT/OT CURRENT 0.01 G8990,CI,GPOTHER PT/OT CURRENT 0.01 G8990,CJ,GOOTHER PT/OT CURRENT 0.01 G8990,CJ,GPOTHER PT/OT CURRENT 0.01 G8990,CK,GOOTHER PT/OT CURRENT 0.01 G8990,CK,GPOTHER PT/OT CURRENT 0.01 G8990,CL,GOOTHER PT/OT CURRENT 0.01 G8990,CL,GPOTHER PT/OT CURRENT 0.01 G8990,CM,GOOTHER PT/OT CURRENT 0.01 G8990,CM,GPOTHER PT/OT CURRENT 0.01 G8990,CN,GOOTHER PT/OT CURRENT 0.01 G8990,CN,GPOTHER PT/OT GOAL 0.01 G8991,CH,GOOTHER PT/OT GOAL 0.01 G8991,CH,GPOTHER PT/OT GOAL 0.01 G8991,CI,GOOTHER PT/OT GOAL 0.01 G8991,CI,GPOTHER PT/OT GOAL 0.01 G8991,CJ,GOOTHER PT/OT GOAL 0.01 G8991,CJ,GPOTHER PT/OT GOAL 0.01 G8991,CK,GOOTHER PT/OT GOAL 0.01 G8991,CK,GPOTHER PT/OT GOAL 0.01 G8991,CL,GOOTHER PT/OT GOAL 0.01 G8991,CL,GPOTHER PT/OT GOAL 0.01 G8991,CM,GOOTHER PT/OT GOAL 0.01 G8991,CM,GPOTHER PT/OT GOAL 0.01 G8991,CN,GOOTHER PT/OT GOAL 0.01 G8991,CN,GPOTHER PT/OT D/C 0.01 G8992,CH,GOOTHER PT/OT D/C 0.01 G8992,CH,GPOTHER PT/OT D/C 0.01 G8992,CI,GOOTHER PT/OT D/C 0.01 G8992,CI,GOOTHER PT/OT D/C 0.01 G8992,CI,GP

OTHER PT/OT D/C 0.01 G8992,CJ,GPOTHER PT/OT D/C 0.01 G8992,CK,GOOTHER PT/OT D/C 0.01 G8992,CK,GPOTHER PT/OT D/C 0.01 G8992,CL,GOOTHER PT/OT D/C 0.01 G8992,CL,GPOTHER PT/OT D/C 0.01 G8992,CM,GOOTHER PT/OT D/C 0.01 G8992,CM,GPOTHER PT/OT D/C 0.01 G8992,CN,GOOTHER PT/OT D/C 0.01 G8992,CN,GPSUB PT/OT CURRENT 0.01 G8993,CH,GOSUB PT/OT CURRENT 0.01 G8993,CH,GPSUB PT/OT CURRENT 0.01 G8993,CI,GOSUB PT/OT CURRENT 0.01 G8993,CI,GPSUB PT/OT CURRENT 0.01 G8993,CJ,GOSUB PT/OT CURRENT 0.01 G8993,CJ,GPSUB PT/OT CURRENT 0.01 G8993,CK,GOSUB PT/OT CURRENT 0.01 G8993,CK,GPSUB PT/OT CURRENT 0.01 G8993,CL,GOSUB PT/OT CURRENT 0.01 G8993,CL,GPSUB PT/OT CURRENT 0.01 G8993,CM,GOSUB PT/OT CURRENT 0.01 G8993,CM,GPSUB PT/OT CURRENT 0.01 G8993,CN,GOSUB PT/OT CURRENT 0.01 G8993,CN,GPSUB PT/OT GOAL 0.01 G8994,CH,GOSUB PT/OT GOAL 0.01 G8994,CH,GPSUB PT/OT GOAL 0.01 G8994,CI,GOSUB PT/OT GOAL 0.01 G8994,CI,GPSUB PT/OT GOAL 0.01 G8994,CJ,GOSUB PT/OT GOAL 0.01 G8994,CJ,GPSUB PT/OT GOAL 0.01 G8994,CK,GOSUB PT/OT GOAL 0.01 G8994,CK,GPSUB PT/OT GOAL 0.01 G8994,CL,GOSUB PT/OT GOAL 0.01 G8994,CL,GPSUB PT/OT GOAL 0.01 G8994,CM,GOSUB PT/OT GOAL 0.01 G8994,CM,GPSUB PT/OT GOAL 0.01 G8994,CN,GOSUB PT/OT GOAL 0.01 G8994,CN,GPSUB PT/OT D/C 0.01 G8995,CH,GOSUB PT/OT D/C 0.01 G8995,CH,GPSUB PT/OT D/C 0.01 G8995,CI,GOSUB PT/OT D/C 0.01 G8995,CI,GPSUB PT/OT D/C 0.01 G8995,CJ,GOSUB PT/OT D/C 0.01 G8995,CJ,GPSUB PT/OT D/C 0.01 G8995,CK,GOSUB PT/OT D/C 0.01 G8995,CK,GPSUB PT/OT D/C 0.01 G8995,CL,GOSUB PT/OT D/C 0.01 G8995,CL,GP

SUB PT/OT D/C 0.01 G8995,CM,GOSUB PT/OT D/C 0.01 G8995,CM,GPSUB PT/OT D/C 0.01 G8995,CN,GOSUB PT/OT D/C 0.01 G8995,CN,GPSWALLOW CURRENT 0.01 G8996,CH,GNSWALLOW CURRENT 0.01 G8996,CI,GNSWALLOW CURRENT 0.01 G8996,CJ,GNSWALLOW CURRENT 0.01 G8996,CK,GNSWALLOW CURRENT 0.01 G8996,CL,GNSWALLOW CURRENT 0.01 G8996,CM,GNSWALLOW CURRENT 0.01 G8996,CN,GNSWALLOW GOAL 0.01 G8997,CH,GNSWALLOW GOAL 0.01 G8997,CI,GNSWALLOW GOAL 0.01 G8997,CJ,GNSWALLOW GOAL 0.01 G8997,CK,GNSWALLOW GOAL 0.01 G8997,CL,GNSWALLOW GOAL 0.01 G8997,CM,GNSWALLOW GOAL 0.01 G8997,CN,GNSWALLOW D/C 0.01 G8998,CH,GNSWALLOW D/C 0.01 G8998,CI,GNSWALLOW D/C 0.01 G8998,CJ,GNSWALLOW D/C 0.01 G8998,CK,GNSWALLOW D/C 0.01 G8998,CL,GNSWALLOW D/C 0.01 G8998,CM,GNSWALLOW D/C 0.01 G8998,CN,GNMOTOR SPEECH CURRENT 0.01 G8999,CH,GNMOTOR SPEECH CURRENT 0.01 G8999,CI,GNMOTOR SPEECH CURRENT 0.01 G8999,CJ,GNMOTOR SPEECH CURRENT 0.01 G8999,CK,GNMOTOR SPEECH CURRENT 0.01 G8999,CL,GNMOTOR SPEECH CURRENT 0.01 G8999,CM,GNMOTOR SPEECH CURRENT 0.01 G8999,CN,GNMOTOR SPEECH D/C 0.01 G9158,CH,GNMOTOR SPEECH D/C 0.01 G9158,CI,GNMOTOR SPEECH D/C 0.01 G9158,CJ,GNMOTOR SPEECH D/C 0.01 G9158,CK,GNMOTOR SPEECH D/C 0.01 G9158,CL,GNMOTOR SPEECH D/C 0.01 G9158,CM,GNMOTOR SPEECH D/C 0.01 G9158,CN,GNLANG COMP CURRENT 0.01 G9159,CH,GNLANG COMP CURRENT 0.01 G9159,CI,GNLANG COMP CURRENT 0.01 G9159,CJ,GNLANG COMP CURRENT 0.01 G9159,CK,GNLANG COMP CURRENT 0.01 G9159,CL,GNLANG COMP CURRENT 0.01 G9159,CM,GNLANG COMP CURRENT 0.01 G9159,CN,GNLANG COMP GOAL 0.01 G9160,CH,GN

LANG COMP GOAL 0.01 G9160,CI,GNLANG COMP GOAL 0.01 G9160,CJ,GNLANG COMP GOAL 0.01 G9160,CK,GNLANG COMP GOAL 0.01 G9160,CL,GNLANG COMP GOAL 0.01 G9160,CM,GNLANG COMP GOAL 0.01 G9160,CN,GNLANG COMP D/C 0.01 G9161,CH,GNLANG COMP D/C 0.01 G9161,CI,GNLANG COMP D/C 0.01 G9161,CJ,GNLANG COMP D/C 0.01 G9161,CK,GNLANG COMP D/C 0.01 G9161,CL,GNLANG COMP D/C 0.01 G9161,CM,GNLANG COMP D/C 0.01 G9161,CN,GNLANG EXPRESS CURRENT 0.01 G9162,CH,GNLANG EXPRESS CURRENT 0.01 G9162,CI,GNLANG EXPRESS CURRENT 0.01 G9162,CJ,GNLANG EXPRESS CURRENT 0.01 G9162,CK,GNLANG EXPRESS CURRENT 0.01 G9162,CL,GNLANG EXPRESS CURRENT 0.01 G9162,CM,GNLANG EXPRESS CURRENT 0.01 G9162,CN,GNLANG EXPRESS GOAL 0.01 G9163,CH,GNLANG EXPRESS GOAL 0.01 G9163,CI,GNLANG EXPRESS GOAL 0.01 G9163,CJ,GNLANG EXPRESS GOAL 0.01 G9163,CK,GNLANG EXPRESS GOAL 0.01 G9163,CL,GNLANG EXPRESS GOAL 0.01 G9163,CM,GNLANG EXPRESS GOAL 0.01 G9163,CN,GNLANG EXPRESS D/C 0.01 G9164,CH,GNLANG EXPRESS D/C 0.01 G9164,CI,GNLANG EXPRESS D/C 0.01 G9164,CJ,GNLANG EXPRESS D/C 0.01 G9164,CK,GNLANG EXPRESS D/C 0.01 G9164,CL,GNLANG EXPRESS D/C 0.01 G9164,CM,GNLANG EXPRESS D/C 0.01 G9164,CN,GNATTEN CURRENT 0.01 G9165,CH,GNATTEN CURRENT 0.01 G9165,CI,GNATTEN CURRENT 0.01 G9165,CJ,GNATTEN CURRENT 0.01 G9165,CK,GNATTEN CURRENT 0.01 G9165,CL,GNATTEN CURRENT 0.01 G9165,CM,GNATTEN CURRENT 0.01 G9165,CN,GNATTEN GOAL 0.01 G9166,CH,GNATTEN GOAL 0.01 G9166,CI,GNATTEN GOAL 0.01 G9166,CJ,GNATTEN GOAL 0.01 G9166,CK,GNATTEN GOAL 0.01 G9166,CL,GNATTEN GOAL 0.01 G9166,CM,GN

ATTEN GOAL 0.01 G9166,CN,GNATTEN D/C 0.01 G9167,CH,GNATTEN D/C 0.01 G9167,CI,GNATTEN D/C 0.01 G9167,CJ,GNATTEN D/C 0.01 G9167,CK,GNATTEN D/C 0.01 G9167,CL,GNATTEN D/C 0.01 G9167,CM,GNATTEN D/C 0.01 G9167,CN,GNMEMORY CURRENT 0.01 G9168,CH,GNMEMORY CURRENT 0.01 G9168,CI,GNMEMORY CURRENT 0.01 G9168,CJ,GNMEMORY CURRENT 0.01 G9168,CK,GNMEMORY CURRENT 0.01 G9168,CL,GNMEMORY CURRENT 0.01 G9168,CM,GNMEMORY CURRENT 0.01 G9168,CN,GNMEMORY GOAL 0.01 G9169,CH,GNMEMORY GOAL 0.01 G9169,CI,GNMEMORY GOAL 0.01 G9169,CJ,GNMEMORY GOAL 0.01 G9169,CK,GNMEMORY GOAL 0.01 G9169,CL,GNMEMORY GOAL 0.01 G9169,CM,GNMEMORY GOAL 0.01 G9169,CN,GNMEMORY D/C 0.01 G9170,CH,GNMEMORY D/C 0.01 G9170,CI,GNMEMORY D/C 0.01 G9170,CJ,GNMEMORY D/C 0.01 G9170,CK,GNMEMORY D/C 0.01 G9170,CL,GNMEMORY D/C 0.01 G9170,CM,GNMEMORY D/C 0.01 G9170,CN,GNVOICE CURRENT 0.01 G9171,CH,GNVOICE CURRENT 0.01 G9171,CI,GNVOICE CURRENT 0.01 G9171,CJ,GNVOICE CURRENT 0.01 G9171,CK,GNVOICE CURRENT 0.01 G9171,CL,GNVOICE CURRENT 0.01 G9171,CM,GNVOICE CURRENT 0.01 G9171,CN,GNVOICE GOAL 0.01 G9172,CH,GNVOICE GOAL 0.01 G9172,CI,GNVOICE GOAL 0.01 G9172,CJ,GNVOICE GOAL 0.01 G9172,CK,GNVOICE GOAL 0.01 G9172,CL,GNVOICE GOAL 0.01 G9172,CM,GNVOICE GOAL 0.01 G9172,CN,GNVOICE D/C 0.01 G9173,CH,GNVOICE D/C 0.01 G9173,CI,GNVOICE D/C 0.01 G9173,CJ,GNVOICE D/C 0.01 G9173,CK,GN

VOICE D/C 0.01 G9173,CL,GNVOICE D/C 0.01 G9173,CM,GNVOICE D/C 0.01 G9173,CN,GNSPEECH LANG CURRENT 0.01 G9174,CH,GNSPEECH LANG GOAL 0.01 G9174,CH,GNSPEECH LANG CURRENT 0.01 G9174,CI,GNSPEECH LANG CURRENT 0.01 G9174,CJ,GNSPEECH LANG CURRENT 0.01 G9174,CK,GNSPEECH LANG CURRENT 0.01 G9174,CL,GNSPEECH LANG CURRENT 0.01 G9174,CM,GNSPEECH LANG CURRENT 0.01 G9174,CN,GNSPEECH LANG GOAL 0.01 G9175,CI,GNSPEECH LANG GOAL 0.01 G9175,CJ,GNSPEECH LANG GOAL 0.01 G9175,CK,GNSPEECH LANG GOAL 0.01 G9175,CL,GNSPEECH LANG GOAL 0.01 G9175,CM,GNSPEECH LANG GOAL 0.01 G9175,CN,GNSPEECH LANG D/C 0.01 G9176,CH,GNSPEECH LANG D/C 0.01 G9176,CI,GNSPEECH LANG D/C 0.01 G9176,CJ,GNSPEECH LANG D/C 0.01 G9176,CK,GNSPEECH LANG D/C 0.01 G9176,CL,GNSPEECH LANG D/C 0.01 G9176,CM,GNSPEECH LANG D/C 0.01 G9176,CN,GNMOTOR SPEECH GOAL 0.01 G9186,CH,GNMOTOR SPEECH GOAL 0.01 G9186,CI,GNMOTOR SPEECH GOAL 0.01 G9186,CJ,GNMOTOR SPEECH GOAL 0.01 G9186,CK,GNMOTOR SPEECH GOAL 0.01 G9186,CL,GNMOTOR SPEECH GOAL 0.01 G9186,CM,GNMOTOR SPEECH GOAL 0.01 G9186,CN,GNORENCIA 10MG IV J0129OFIRMEV 1000/100MLIV J0131ACETADOTE 100 MG IV 5.70 J0132ACETADOTE 200 MG/ML VIAL 100 mcg, 30 mL J0132ZOVIRAX INJ 500MG J0133ADENOCARD IV 1MG GEN J0153PROLASTIN 10MG/ML IV 5.60 J0256PROLASTIN C 1,000 MG/20 ML VL 10 mg, 1 each J0256AMINOPHYLLIN IV500MG J0280CORDARONE IV 30MG(G) J0282AMPICILLIN IV 1GM J0290AMPICILLIN IV 500MG J0290UNASYN IV 3GM (GEN) J0295UNASYN IV 1.5GM (GN) J0295SUCCINYLCHOLINE INJ J0330HYDRALAZINE IV 20MG J0360

ZITHROMAX IV (GEN) J0456ATROPINE 0.01MG/ML J0461ATROPINE .01MG/1ML J0461BENLYSTA 10MG/ML IV J0490DICYCLOMINE IM 10MG J0500BICILLIN LA 100000MU J0561BICILLIN LA 100000MU J0561BOTOX 200 UNIT VIAL 1 unit, 1 each J0585CALC GLUC INJ 1GM J0610LEUCOVORIN 50MG IV J0640KEFZOL-G IV 500MG J0690KEFZOL-G IV 1GM J0690cefTAZidime 2 GM VIAL 500 mcg, 1 each J0690CEFEPIME 2G J0692MEFOXIN IV 1GM (GEN) J0694cefOXitin 1 GM PIGGYBACK BAG 1 g, 1 each J0694ROCEPHIN INJ 250MG G J0696ROCEPHIN INJ 250MG G J0696ROCEPHIN INJ 250 (G) J0696ROCEPHIN INJ 250MG (G) J0696CELESTONE 3MG J0702FORTAZ INJ 500MG J0713CEFTAZIDIME 500 MG J0713CIPRO IV 200MG (GEN) J0744CIPRO 200MG IV (GEN) J0744ACTHREL 100 MCG VIAL 1 mcg, 1 each J0795CORTROSYN 0.25MG J0834DALVANCE 5MG J0875CUBICIN 1 IV (G) J0878CUBICIN 1 IV (G) J0878ARANESP 1 MCG J0881ARANESP 1 MCG 340B J0881EPOGEN 1000 UNITS J0885PROLIA 1MG INJ J0897XGEVA 1MG SQ J0897PROLIA 1 MG INJ J0897DEPO-MEDROL 40MG 1 G J1030TESTOSTERONE CYP200M J1071DEXAMETH 1MG/ML 1ML J1100DEXAMETHASONE 1MG/ML J1100LANOXIN IV 0.5MG (G) J1160DIGIFAB 40MG IV J1162DILANTIN IV50MG/ML G 8.45 J1165HYDROMORPHONE 2MG IV J1170HYDROMORPHONE 10MG/ML J1170Dilaudid 0.5 MG/0.5 ML SYRINGE 0.5 mcg, 0.5 mL J1170HYDROmorphone 1 MG/ML CARPUJCT 1 mg, 1 mL J1170

BENADRYL IV 50MG (G) J1200DRAMAMINE 50MG/ML(G) J1240DOBUTAMINE IV 250MG J1250DOPAMINE 400MG/250ML J1265DORIBAX 10MG IV 2.10 J1267INTEGRILIN 5MG/ML J1327INTEGRILIN 20MG J1327INVANZ 500MG J1335INVANZ 500 MG J1335INJECTAFER 750MG/15ML J1439INJECTAFER 750MG/15ML J1439NEUPOGEN INJ 300MCG J1442NEUPOGEN INJ 480MCG J1442NEUPOGEN INJ 480MCG J1442EMEND 1MG IV J1453PRIVIGEN 10% VIAL 500 mcg, 400 mL J1459GAMMA GLOBULIN 500MG J1569FLEBOGAMMA 500MG IV 78.00 J1572GENTAMYCIN 80MG J1580ISO gentamicin 120 MG/100 ML 80 mcg, 100 mL J1580SIMPONI ARIA 1MG IV J1602SIMPONI ARIA 1MG IV J1602GLUCAGON 1MG VIAL J1610GRANISETRON HCL 1MG J1626HALDOL INJ 5MG (GEN) J1630HEPARIN 10U/ML J1642HEPARIN 10U/ML-5ML J1642HEPARIN 25,000 UNITS J1644HEPARIN SOD 5000U J1644HEPARIN SOD 1000U J1644LOVENOX 10MG J1650LOVENOX 10MG J1650LOVENOX 10MG J1650LOVENOX 10MG J1650LOVENOX 10MG SC J1650LOVENOX 10MG J1650LOVENOX 10MG J1650A-HYDROCORT IV 100MG J1720SOLU-CORTEF 100MG IV J1720REMICADE 10MG J1745INFED 50GM/ML J1750VENOFER 1MG J1756VENOFER 1MG J1756INDERAL INJ 1ML (GEN J1800CRESEMBA 372 MG VIAL 1 mg, 1 each J1833TORADOL INJ 60MG (G) J1885KETOROLAC 15MG IV J1885

LASIX IV 20MG (GEN) J1940LASIX IV 20MG (GEN) J1940LUPRON DEPOT 3.75MG J1950LUPRON DEPOT 3.75MG J1950KEPPRA 10MG/ML IV J1953LEVAQUIN 250MG INJ J1956LEVAQUIN 250MG INJ J1956LEVAQUIN 250MG INJ J1956LIDOCAINE 2% 10MG J2001ATIVAN IV 2MG/ML (G) J2060MANNITOL 25% 50ML J2150DEMEROL INJ 100MG 16.15 J2175DEMEROL INJ 25MG J2175DEMEROL INJ 50MG J2175MEROPENEM 1OOMG IV J2185MEROPENEM 100MG J2185MYCAMINE 100MG J2248VERSED 1MG/ML (GEN) J2250VERSED IV 1MG (GEN) J2250MILRINONE 5MG 16.00 J2260MORPHINE SO4 IM 4MG J2270morphine 0.5 MG/ML VIAL 5 mcg, 10 mL J2270DURAMORPH 10 MG/10 ML AMPUL 10 mcg, 10 mL J2270AVELOX 100MG IV J2280NARCAN 1ML (GEN) J2310NALOXONE 1MG/ML J2310OCREVUS 300 MG/10 ML VIAL 1 mg, 10 mL J2350OCREVUS 300 MG/10 ML VIAL 1 MG, 10 ML J2350SANDOSTATIN LAR 25MC J2353SANDOSTATIN LAR 1MG J2353XOLAIR 5MG J2357XOLAIR 5MG J2357NORFLEX INJ 60MG(GEN J2360NEO-SYN INJ 1% (GEN) J2370ZOFRAN INJ 1MG (GEN) J2405AREDIA 30MG INJ J2430ALOXI 0.25MG/5ML J2469ALOXI 0.25MG/5ML J2469NEULASTA KIT 6MG J2505NEULASTA 6MG SYRINGE J2505UDENYCA 6 MG/0.6 ML SYRINGE 6 mg, 0.6 mL J2505PENTOBARB. IM 50MG 52.00 J2515ZOSYN IV 3.375GM J2543ZOSYN 4.5GM J2543ZOSYN 2.25GM J2543PHENERGAN INJ25MG(G) J2550PITOCIN INJ 1ML (GN) J2590

NEOSTIGMINE 1MG J2710REGLAN INJ 10MG (G) J2765LEXISCAN 0.4MG/5ML J2785LEXISCAN 0.4MG/5ML J2785RHOGAM IMMUNE GLOBUL J2790NAROPIN 0.5%-PER 1MG J2795NAROPIN 0.2% PER 1MG J2795FERRLECIT 12.5MG AMP J2916SOLU MEDROL 40 MG. J2920A-METHOPRED 125MG J2930SOLU MEDROL 125 MG. 72.30 J2930A-METHOPRED 125MG J2930SOLU MEDROL 500MG J2930CATHFLO 1MG/ML J2997ACTIVASE 100MG J2997CATHFLO 1MG/ML J2997FENTANYL TUBEX J3010FENTANYL 1ML J3010IMITREX INJ 6MG (GN) J3030TNKASE 1MG J3101BRETHINE INJ 1MG (G) J3105THYROGEN 1.1 MG VIAL 0.9 mcg, 1 each J3240TOBRAMYCIN 80MG J3260TOBRAMYCIN 1.2GM J3260ACTEMRA 1MG/ML IV J3262DEMADEX 10MG/ML I.V. 13.70 J3265KENALOG-G 10MG IM J3301VALIUM INJ 10MG (GN) J3360VANCOMYCIN IV 500MG J3370VANCOMYCN 500MG(1GM) J3370ENTYVIO 300 MG VIAL 1 mg, 1 each J3380THIAMINE HCL INJ. 1 J3411PYRIDOXINE INJ 100MG 14.40 J3415AQUA MEPH 1MG OB (G) J3430AQUA MEPHYTON 1MG(G) J3430MAGNESIUM SULFAT 500 J3475ZOMETA 1MG IV J3489ZOMETA 1MG IV J3489RECLAST 1MG IV J3489PRECEDEX 200MCG/50ML J3490KCENTRA 1 UNIT J3490CINVANTI 130 MG/18 ML VIAL 130 mcg, 18 mL J3490EVENITY 210 MG DOSE-2 SYRINGES 1 ea, 1.17 mL J3490PERJETA 420MG IV J3590EUFLEXXA 20 MG/2 ML SYRINGE 1 ea, 2 mL J7323GEL-ONE 30 MG/3 ML SYRINGE 30 mcg, 3 mL J7326MEDROL MEDULES 4MG G J7509

MUCOSIL 20% 1ML (GN) J7608CYTOXIN TAB 25MG (G) 8.25 J8530ADRIAMYCIN IV 10MG G J9000BCG TICE STRAIN VAC 476.20 J9031TREANDA 1MG/ML IV J9033BENDEKA 100 MG/4 ML VIAL 1 mg, 4 mL J9034AVASTIN 10MG/ML J9035BLEOMYCIN 15UNITS J9040VELCADE 0.1MG IV J9041ADCETRIS 1MG J9042JEVTANA 60 MG/1.5 ML KIT 1 mg, 1.5 mL J9043PARAPLATIN IV 50MG G J9045KYPROLIS 1MG IV J9047PLATINOL 10MG J9060CYTOXIN IV 100MG (G) J9070CYTARABINE 100MG/5ML VIAL J9100DACARBAZINE 100MG IV J9130TAXOTERE 1MG J9171IMFINZI 500 MG/10 ML VIAL 10 mcg, 10 mL J9173VEPESID IV 10MG J9181FLUDARA IV 50MG J9185FLUOROURACIL 500MG J9190GEMZAR 200MG J9201GEMZAR 200 MG J9201ZOLADEX 3.6MG SYRINGE J9202ONIVYDE 1MG J9205CAMPTOSAR 20 MG J9206INTRON-A 1MIL U 52.05 J9214LUPRON DEPOT INJ 7.5 J9217ELIGARD 7.5MG J9217ELIGARD 7.5MG J9217LUPRON DEPOT-4 MONTH KIT 7.5 mcg, 1 each J9217LUPRON DEPOT 45 MG 6MO KIT 7.5 mcg, 1 each J9217ELOXATIN 0.5MG J9263ABRAXANE 1MG IV J9264TAXOL INJ 1MG J9267KEYTRUDA 1MG J9271OPDIVO 1MG J9299GAZYVA 10 MG VL J9301ALIMTA 10MG IV J9305RITUXAN 100MG J9312TOPOTECAN HCL .1MG J9351HERCEPTIN 10MG IV J9355VINBLASTINE 1MG 44.50 J9360VINBLASTINE 1MG/ML J9360VINCRISTINE IV 1MG J9370NAVELBINE 10MG/ML 100.35 J9390

FASLODEX 25MG J9395ELBOW ORTHOSIS W/O J 811.90 L3702ELB/WR/HAND ORTH RGD 1323.50 L3763WR/HND/FG ORTH W/JT 851.30 L3806WRIST HAND FNGR ORTH 368.10 L3807WRST HAND FNGR OR RG 526.20 L3808WR/HAND ORTHO W/O JT 748.30 L3906HAND/FG ORTHO W/O JT 399.30 L3913FINGER ORTHO W/O JNT 314.30 L3933TRINITY ELITE MEDIUM 4736.30 L8699TRINITY ELITE LARGE 8504.20 L8699CRYOPRECIPITATED AHF 134.60 P9012RBC LEUKO REDUCED 448.10 P9016PLASMA FRESH FROZEN 121.20 P9017PLATLET PHERESIS 955.40 P9035CATH FOR URINE SPEC 6.50 P9612CATH FOR URINE SPEC 6.50 P9612CEREBYX 50MG PE/ML G Q2009DOXIL 10MG IV Q2049TELEHEALTH FACILITY FEE 79.80 Q3014APLIGRAF EA SQ CM 172.20 Q4101EPI FIX GS-5180 18MM 520.00 Q4131EPI FIX 14MM GS-5140 780.00 Q4131EPI FIX 2X4CM GS5240 292.50 Q4131EPI FIX MESH 4X4.5CM 181.25 Q4131EPI FIX MESH 3.5X3.5 215.70 Q4131INFLECTRA 100MG VIAL Q5103RETACRIT 10,000 UNIT/ML VIAL 1000 unit, 1 mL Q5106MVASI 400 MG/16 ML VIAL 10 mcg, 16 mL Q5107DEFINITY CONTRAST 262.00 Q9957ISOSULFAN BLUE 1%INJ Q9968METHYLENE BLUE IV 1% Q9968