"NOTE: The following are Shirley Ryan AbilityLab's standard charges as of Jan. 1, 2020. These standard charges often do not reflect what a patient or their insurance company/payer may be required to pay. Contact Patient Financial Services at 312-238-6039 for more information." Description Price STRYKER T-PAD $143.00 "11-Deoxycortisol, Urine Random" "$1,098.00 " "12 Lead Ekg, Tracing Only" $507.00 "17 Hydroxycorticosteroids, Urine Timed" $751.00 "17 Hydroxyprogesterone, Serum" $356.00 "17 Ketosteroids, Urine Timed" $565.00 "17-Ketosteroids with Creatinine, Urine Random" $565.00 2D Gait Analysis Charge(95999) "$2,283.00 " "5' Nucleotidase, Serum" $556.00 5-HIAA-24 Hr Urine $205.00 "A4566 Shoulder sling or vest design, abduction res" $233.00 "A4595 FES Electrode, each" $39.00 "A6545 Gradient Compression Wrap, Non-Elastic, Belo" $176.00 ABO Rh Type $113.00 Above Knee Nylon Hose PR $85.00 Above Knee Suction Sheath $135.00 "Above knee, for proximal femoral focal deficiency," "$14,774.00 " "Above knee, molded socket, open end, SACH foot, en" "$11,074.00 " "Above knee, molded socket, single axis constant fr" "$11,263.00 " "Above knee, short prosthesis, no knee joint (""""stu" "$7,652.00 " "Above knee, short prosthesis, no knee joint (""""stu" "$8,942.00 " "Above knee, short prosthesis, no knee joint (""stub" "$8,942.00 " ACAPELLA DH GREEN VIBRATORY PEP W/MOUTHPIECE DEVIC $193.00 Acetabuloplasty (27120) "$4,628.00 " "Acetone, Serum" $56.00 Acetylcholine Receptor Binding Antibody $838.00 Acid Phosphatase $136.00 "Acid Phosphatase, Prostatic fraction" $136.00 ACNE SURGERY MILIA CYSTS (10040) $557.00 Acorn Nebulizer $186.00 Activated PTT/Partial Thromboplastin Time $116.00 Active Wound Care > 20 cm Units $180.00 Active Wound Care/20 cm or < Units $180.00 Acupuncture with E-Stim. Each additional 15 minute $67.00 Acupuncture with E-Stim. Initial 15 minutes Charge $113.00 Acupuncture without E-Stim each additional 15 minu $67.00 Acupuncture without E-Stim. Initial 15 minutes Cha $92.00 Acute Hepatitis Panel $720.00 Add Padding to Belt $121.00 "Addit to LE, BK/AK, custom fab or prefab, socket i" "$2,134.00 " "Addit to LE, BK/AK, custom fab socket insert for c" "$4,289.00 " "Addit to LE, BK/AK, custom fab socket insert for o" "$4,289.00 " "Addition to Halo Procedure, MRI Compatible System " "$2,605.00 " "Addition to LE pros, endo knee-shin sys, microproc" "$21,346.00 " "Addition to LE pros, endo knee-shin sys, microproc" "$44,712.00 " "Addition to LE pros, endo knee-shin sys, microproc" "$74,387.00 " "Addition to LE pros, endo knee-shin sys, powered &" "$37,412.00 " "Addition to LE, AK or knee disartic, acrylic socke" "$1,394.00 " "Addition to LE, AK or knee disartic, pelvic joint" $607.00 "Addition to LE, AK or knee disartic, Silesian band" $495.00 "Addition to LE, AK or knee disarticulation, pelvic" $287.00 "Addition to LE, AK, air cushion socket" "$1,817.00 " "Addition to LE, AK, flexible inner socket, externa" "$4,632.00 " "Addition to LE, AK, leather socket" "$1,690.00 " "Addition to LE, AK, pelvic control belt, light" $407.00 "Addition to LE, AK, pelvic control belt, padded an" $752.00 "Addition to LE, AK, pelvic control, sleeve suspens" $675.00 "Addition to LE, AK, wood socket" "$1,462.00 " "Addition to LE, BK flexible inner socket, external" "$3,175.00 " "Addition to LE, BK, acrylic socket" "$1,306.00 " "Addition to LE, BK, air cushion socket" "$1,539.00 " "Addition to LE, BK, back check (extension control)" $181.00 "Addition to LE, BK, cuff suspension" $317.00 "Addition to LE, BK, fork strap" $147.00 "Addition to LE, BK, joint covers, pair" $122.00 "Addition to LE, BK, knee joints, polycentric, pair" "$1,710.00 " "Addition to LE, BK, knee joints, single axis, pair" "$1,147.00 " "Addition to LE, BK, leather socket" "$1,606.00 " "Addition to LE, BK, molded distal cushion" $367.00 "Addition to LE, BK, molded supracondylar suspensio" $860.00 "Addition to LE, BK, removable medial brim" $894.00 "Addition to LE, BK, suction socket" "$2,577.00 " "Addition to LE, BK, suspension/sealing sleeve, w/ " $397.00 "Addition to LE, BK, thigh lacer, gluteal/ischial, " "$1,927.00 " "Addition to LE, BK, thigh lacer, non-molded" $964.00 "Addition to LE, BK, total contact" "$1,581.00 " "Addition to LE, BK, waist belt, padded and lined" $387.00 "Addition to LE, BK, waist belt, webbing" $190.00 "Addition to LE, BK, wood socket" "$2,775.00 " "Addition to LE, BK/AK suspension locking mechanism" "$2,125.00 " "Addition to LE, BK/AK, custom fab or prefab, socke" "$2,562.00 " "Addition to LE, endo sys, AK or knee disartic, 4-b" "$5,222.00 " "Addition to LE, endo sys, AK or knee disartic, 4-b" "$7,935.00 " "Addition to LE, endo sys, AK, hydracadence system" "$6,260.00 " "Addition to LE, endo sys, AK, universal multiplex " "$3,852.00 " "Addition to LE, endosys, AK or knee disartic, 4-ba" "$4,230.00 " "Addition to LE, hip disartic, flexible inner socke" "$6,207.00 " "Addition to LE, ischial containment/narrow M-L soc" "$7,985.00 " "Addition to LE, knee disartic, expandable wall soc" "$2,096.00 " "Addition to LE, knee disartic, leather socket" "$1,824.00 " "Addition to LE, quick change self aligning unit, A" "$1,394.00 " "Addition to LE, shoulder harness" $506.00 "Addition to LE, socket insert, AK (Kemblo, Pelite," "$1,949.00 " "Addition to LE, socket insert, AK, silicone gel or" "$1,847.00 " "Addition to LE, socket insert, AK, silicone gel or" "$2,562.00 " "Addition to LE, socket insert, BK (Kemblo, Pelite," $903.00 "Addition to LE, socket insert, BK, silicone gel or" "$1,620.00 " "Addition to LE, socket insert, knee disartic, sili" "$1,620.00 " "Addition to LE, socket insert, multidurometer, Sym" "$1,620.00 " "Addition to LE, socket insert, Symes, silicone gel" "$2,562.00 " "Addition to LE, socket insert, Synes" "$1,247.00 " "Addition to LE, suction suspension, AK or knee dis" "$1,381.00 " "Addition to LE, Symes type, """"PTB"""" brim socket de" "$1,118.00 " "Addition to LE, Symes type, expandable wall socket" "$1,406.00 " "Addition to LE, Symes type, medial opening socket" $795.00 "Addition to LE, Symes type, posterior opening (Can" "$1,042.00 " "Addition to LE, test socket, AK" "$1,274.00 " "Addition to LE, test socket, BK" "$1,229.00 " "Addition to LE, test socket, Hemipel" "$1,984.00 " "Addition to LE, test socket, Hip disartic" "$1,959.00 " "Addition to LE, test socket, Knee disartic" "$1,275.00 " "Addition to LE, test socket, Symes" "$1,384.00 " "Addition to LE, total contact, AK or knee disartic" "$1,545.00 " "Addition to LE,socket insert, knee disartic (Kembl" "$1,372.00 " "Addition to lower extremity, Long tongue stirrup" $654.00 "Addition to UE, External power, additional switch" "$1,275.00 " "Addition, endo knee-shin sys, 4-bar linkage or mul" "$12,084.00 " "Addition, endo knee-shin sys, hydraulic stance ext" "$3,331.00 " "Addition, endo knee-shin sys, polycentric, frictio" "$2,960.00 " "Addition, endo knee-shin sys, polycentric, hydraul" "$12,103.00 " "Addition, endo knee-shin sys, polycentric, mechani" "$2,697.00 " "Addition, endo knee-shin sys, single axis, fluid s" "$5,129.00 " "Addition, endo knee-shin sys, single axis, fluid s" "$9,132.00 " "Addition, endo knee-shin sys, single axis, frictio" "$1,880.00 " "Addition, endo knee-shin sys, single axis, hydraul" "$7,827.00 " "Addition, endo knee-shin sys, single axis, manual " "$1,813.00 " "Addition, endo knee-shin sys, single axis, manual " "$2,502.00 " "Addition, endo knee-shin sys, single axis, pneumat" "$4,978.00 " "Addition, endo knee-shin sys, single axis, pneumat" "$5,430.00 " "Addition, endo knee-shin sys, stance flexion featu" "$5,555.00 " "Addition, endo sys, AK or hip disartic, alignable " "$2,187.00 " "Addition, endo sys, AK or knee disartic or hip dis" "$1,034.00 " "Addition, endo sys, AK, flexible protective outer " "$7,304.00 " "Addition, endo sys, AK, ultra-light material (tita" "$3,204.00 " "Addition, endo sys, BK, alignable system" "$1,494.00 " "Addition, endo sys, BK, flexible protective outer " "$4,848.00 " "Addition, endo sys, high activity knee control fra" "$10,432.00 " "Addition, endo sys, hip disartic, flexible protect" "$7,236.00 " "Addition, endo sys, hip disartic, ultra-light mate" "$3,586.00 " "Addition, endo system, AK or hip disartic, knee ex" $528.00 "Addition, endo system, BK, ultra-light material (t" "$2,066.00 " "Addition, endo system, hip disartic, mechanical hi" $954.00 "Addition, exo knee-shin sys, polycentric mechanica" "$2,145.00 " "Addition, exo knee-shin sys, polycentric, friction" "$2,294.00 " "Addition, exo knee-shin sys, single axis, external" "$5,122.00 " "Addition, exo knee-shin sys, single axis, fluid sw" "$4,331.00 " "Addition, exo knee-shin sys, single axis, fluid sw" "$6,041.00 " "Addition, exo knee-shin sys, single axis, friction" "$1,066.00 " "Addition, exo knee-shin sys, single axis, manual l" $889.00 "Addition, exo knee-shin sys, single axis, manual l" "$1,494.00 " "Addition, exo knee-shin sys, single axis, pneumati" "$2,789.00 " "Addition, exo knee-shin sys, single axis, pneumati" "$3,305.00 " "Addition, exo knee-shin sys, single axis, variable" "$1,085.00 " "Addition, exo sys, BK, ultra-light material (tita" "$1,708.00 " "Addition, exo sys, AK, ultra-light material (titan" "$2,466.00 " "Addition, exo sys, hip disartic, ultra-light mater" "$3,309.00 " "Addition, Knee Joint, Cam Lock" $563.00 "Addition, Knee Joint, Disc/Dial Lock" $666.00 "Addition, Knee Joint, Drop Lock, Stance or Swing" $404.00 "Addition, Knee Joint, Lift Loop for Drop Lock Ring" $544.00 "Addition, Knee Joint, Ratchet" $666.00 "Addition, vacuum pump, residual limb volume manage" "$13,035.00 " "Addition, vacuum pump, residual limb volume manage" "$13,070.00 " "Addtion to LE prosthesis, user adj heel height" "$5,622.00 " Adductor Release Thumb "$2,160.00 " Adenovirus Antibody $178.00 ADHESIVE GEL PATCH $34.00 Adjustable Hip Block Hardware $296.00 Adrenocorticotropic Hormone (ACTH) $813.00 ADULT 24 HOUR ORAL SUCTION CLEANING KIT 6308 $45.00 ADULT RESUSCITATION BAG/MASK $40.00 ADV POST TIBIAL TENDON W EXC NAVICLR BONE (28238) "$20,688.00 " "ADV POST TIBIAL TENDON W EXC NAVICLR BONE,Bilatera" "$31,027.00 " Advanced Care Planning 30 min (99497) $350.00 "AE, ext power, molded inner socket, remov shell, i" "$30,221.00 " "AE, ext power, molded inner socket, remov shell, i" "$32,228.00 " "AE, molded double wall socket, internal locking el" "$10,065.00 " "AE, molded socket, endo sys, incl soft prosthetic " "$10,821.00 " AEL Abductor Hardware Lever Release $490.00 AEL Abductor Hardware Push-Button Release $490.00 AEL Abductor Pad $169.00 AEL Bracket Adapter $194.00 "AEL Contoured Arm Support, All Sizes, Each" $305.00 "AEL Dynaform Chest Harness, All Sizes" $192.00 AEL Fixed Mounting Hardware $128.00 AEL H and X Straps $224.00 AEL Lateral Trunk Support Pad $176.00 "AEL POSAlinc Arm Support Hardware, Each" $474.00 AEL Quick/Swing Away Trunk Support Hardware $316.00 AEL Tri-pad Headrest $750.00 "AEL Wrist Strap Padded, Each" $63.00 AEROCHAMBER MV (USE W/MANU VENT) $57.00 AEROCHAMBER PLUS (USE W/MOUTHPC) $43.00 AEROCHAMBER W/LARGE MASK $88.00 AEROCHAMBER W/MEDIUM MASK $85.00 AEROCHAMBER W/SMALL MASK $109.00 Aerosol Therapy $114.00 AEROTRACH PLUS (USE W/TRACH) $69.00 AERPGEN NEB AERO KIT $206.00 AF531 ORO-NASAL/LARGE $114.00 AF531 ORO-NASAL/MEDIUM $114.00 AF531 ORO-NASAL/SMALL $114.00 Affiliates 00003-0293-20 Kenalog 40mg $44.00 Affiliates 00023-1145-01 Botox/unit $14.00 Affiliates 00259-1610-01 Xeomin/unit $12.00 Affiliates 00409-1162-18- Bupivacaine 5mg/1ml- Sil $3.00 Affiliates 00409-1587-50 Marcaine .25% $8.00 Affiliates 45945-0157-02 Baclofen 10mg "$2,165.00 " Affiliates 58468-0090-03 Synvisc One 1mg $163.00 Affiliates On Site Technical Charge $247.00 AFO WALK BOOT TYPE CUS FAB "$5,692.00 " AK/FT POWER ASST INCL MOTORS (L5969) "$41,627.00 " Akin "$2,205.00 " Albumin Level $143.00 Albumin-Fluid $74.00 Aldolase $211.00 Aldosterone "$2,285.00 " "Aldosterone, random Urine" $689.00 "Aldosterone, Urine timed" "$1,197.00 " Alkaline Phosphatase $176.00 Alkaline Phosphatase-Bone Specific $219.00 Alkaline Phosphatase-Iso $252.00 Alkaline Phosphatase-Isoenzymes $488.00 All 4 compartments "$2,168.00 " "All endoskeletal LE prostheses, axial rotation uni" "$2,663.00 " "All endoskeletal LE prostheses, dynamic prosthetic" $703.00 "All exoskeletal lower extremity prostheses, axial " "$1,600.00 " "All LE prostheses, combination single axis and fle" "$1,435.00 " "All LE prostheses, energy storing foot (Seattle, C" "$1,874.00 " "All LE prostheses, Flex-Foot system" "$12,374.00 " "All LE prostheses, flexible keel foot, (SAFE, STEN" "$1,260.00 " "All LE prostheses, Flex-Walk system or equal" "$11,117.00 " "All LE prostheses, foot, multi-axial ankle/foot" $992.00 "All LE prostheses, multi-axial ankle/foot, dynamic" "$8,124.00 " "All LE prostheses, multi-axial rotation unit (""""MC" "$3,222.00 " "All LE prosthesis, ankle, multiaxial shock absorbi" "$9,107.00 " "All LE prosthesis, combination vertical shock and " "$6,508.00 " "All LE prosthesis, shank foot system with vertical" "$23,434.00 " "All lLE prostheses, foot, single axis ankle foot" $741.00 Allergen-Latex Enhanced IgE $114.00 "AllLE prostheses, foot, external keel, SACH foot" $692.00 Alpha 1 Antitrypsin Phenotype $188.00 Alpha 1 Antitrypsin Total $620.00 Alpha Fetoprotein $550.00 Alpha Fetoprotein Quad 4 "$1,042.00 " "Alpha Fetoprotein, Tumor Marker" $453.00 ALT/SGPT $186.00 "Aluminum Level, Serum" $335.00 "Aluminum Level, Urine Random" $469.00 "Aluminum Level, Urine timed" $469.00 Ambu Bag and Treatment $613.00 Amikacin-Peak $807.00 Amikacin-Random $807.00 Amikacin-Trough $807.00 "Amino Acid Profile, Quantitative" $914.00 "Aminolevulinic Acid, Urine" $697.00 Amiodarone & Metabolites (Desethylamiodarone) $77.00 Ammonia $110.00 AMPUT ANKLE TO TIB-FIB M W PL REP (27888) "$2,332.00 " AMPUTATE THIGH-FEMUR ANY LEVEL (27590) "$3,047.00 " AMPUTATELEG THRU TIBIA AND FIBULA (27880) "$3,337.00 " Amputation Metatarsal (Single) "$1,861.00 " Amputation Secondary Closure or Scar Revision "$2,090.00 " Amputation Secondary Closure or Scar Revision Bila "$3,133.00 " "Amputation Toe, Interphalangeal Joint" "$1,625.00 " "Amputation, finger or thumb , primary or secondary" "$2,567.00 " "Amputation, leg, through tibia and fibula; re-ampu" "$2,365.00 " "Amputation, Toe; Metatarsal Phalangeal Joint" "$1,841.00 " "Amylase Level, Random Urine" $221.00 "Amylase Level, Serum" $283.00 "Amylase, Fluid" $184.00 "Amylase, Timed Urine" $213.00 Anal SP inf pmp wt reprog/refill (62369) $775.00 Anal SP inf pmp wt reprog/refill RN(62369) $688.00 ANALYZE NEUROSTIM SIMPLE (95971) $636.00 "Analyze Neurostim, Complex, 1st hour" $923.00 Androstenedione $740.00 Angiotensin Converting Enzyme $304.00 Angiotensin Converting Enzyme-CSF $304.00 ANK-FOOT SYS DORS-PLANT FLEX "$45,546.00 " Ankle Contracture Splint $781.00 "Ankle foot orthosis, multiligamentous ankle suppor" $523.00 "Ankle Strap, Each" $121.00 "Ankle, Symes, metal frame, molded leather socket, " "$8,070.00 " "Ankle, Symes, molded socket, SACH foot" "$8,573.00 " "Ankle-Foot Orthosis, Ankle Gauntlet" $347.00 "Ankle-Foot Orthosis, Double Upright, Plantar Dorsi" "$2,167.00 " "Ankle-Foot Orthosis, Molded Ankle Gauntlet" "$2,094.00 " "Ankle-Foot Orthosis, Plastic or Other Material, w/" "$2,176.00 " "Ankle-Foot Orthosis, Plastic, Molded to Patient" "$2,259.00 " "Ankle-Foot Orthosis, Plastic, Posterior Solid Ankl" "$2,876.00 " "Ankle-Foot Orthosis, Plastic, Rigid Anterior Tibia" "$5,207.00 " "Ankle-Foot Orthosis, Plastic, w/ Ankle Joint, Mold" "$3,214.00 " "Ankle-Foot Orthosis, Posterior, Single Bar, Clasp " $624.00 "Ankle-Foot Orthosis, Prefabricated includes Fit an" "$1,170.00 " "Ankle-Foot Orthosis, Rigid Anterior Tibial Section" "$4,140.00 " "Ankle-Foot Orthosis, Rigid, Tibial Fracture Orthos" "$1,737.00 " "Ankle-Foot Orthosis, Single Upright w/ Static or A" "$1,907.00 " "Ankle-Foot Orthosis, Single Upright, Plantar/Dorsi" $890.00 "Ankle-Foot Orthosis, Soft, Tibial Fracture Orthosi" "$2,339.00 " "Ankle-Foot Orthosis, Spiral, Plastic or Other Mate" "$3,896.00 " "Ankle-Foot Orthosis, Spiral, Plastic, Custom Fabri" "$1,700.00 " "Ankle-Foot Orthosis, Spring Wire, Dorsiflexion Cal" $677.00 "Ankle-Foot Orthosis, Supramalleolar w/ Straps" "$2,611.00 " "Ankle-Foot Orthosis, Tibial Fracture Orthosis, Mol" "$2,540.00 " "Ankle-Foot Orthosis, Tibial Fracture Orthosis, Sem" "$1,398.00 " "Ankle-Foot Orthosis, Tibial Fracture Orthosis, The" "$1,743.00 " ANL SP infusion pmp wt/MD reprogram and refill (62 $901.00 Anodal Trypsin Assay- HAT $149.00 Anorectal manometry (90911) "$1,408.00 " Anti Neutrophil Cytoplasmic AB by IF $511.00 Anti OKT3 Ab Titers $761.00 Anti Streptolysin O AB $56.00 Anti Xa Assay - Atrixtra $168.00 Anti Xa Assay - Fragmin $168.00 Anti Xa Assay - Lovenox $168.00 Anti Xa Assay - Rivaroxaban $168.00 Anti Xa Assay - Unfractionated Heparin $168.00 Antibodies $110.00 Antibodies * $110.00 Antibody Elution $525.00 "Antibody Elution, referred" $347.00 Antibody Identification (blood bank) $465.00 Antibody Identification Interpretation $256.00 Antibody Screen $162.00 Antibody Screen (Blood Bank) $341.00 "Antibody Titration, indirect, each" $201.00 Anticardiolipin Antibody $278.00 Anticardiolipin Antibody "$1,168.00 " Anticentromere Antibodies $62.00 Antidiuretic Hormone $372.00 Anti-DNA Antibody $293.00 Anti-DNA Antibody $567.00 "Anti-Dnase B Antibodies, Streptococcal" $178.00 "Antigen Screen on Blood, Reagent Method" $159.00 Anti-Mitochondrial AB $269.00 ANTINUCLEAR AB (ANA) $75.00 Antinuclear Antibody $461.00 Anti-Parietal Cell AB $292.00 Anti-Smooth Muscle AB $283.00 Antithrombin III $399.00 Anti-Thrust Wedge Option $121.00 Anti-Thyroglobulin AB $203.00 Anti-Thyroglobulin AB $393.00 APATER FEEDING DUAL PORT $68.00 APC Resistance $271.00 Apolipoprotein (a) $205.00 Apolipoprotein B $205.00 Apolipoprotein E $205.00 Appl. of Rigid Total Contact Leg Cast/TCC (2944) $255.00 Application ex-fix "$1,984.00 " Apply Multlay Comprs LWR Leg (29581) $542.00 "Apply Multlay Comprs LWR Leg, Bilateral (29581)" "$1,085.00 " Apply Short Arm Splint; Dynamic (29126) $159.00 APTT-Activated PTT/Partial Thromboplastin Time $372.00 "AQUAGUARD ""7 X 7""" $51.00 "AQUAGUARD 12"" X 14""" $92.00 "AQUAGUARD 9"" X 9""" $65.00 AQUAGUARD BOOT $51.00 AQUAPHOR COMPOUNDING OINTMENT 14oz $66.00 Arginaid $1.00 Arhtroscopically aided treatment on intercondylar "$3,987.00 " "Arhtrotomy wrist, I&D" "$2,419.00 " "Arrest, epiphyseal, any method (eg, epiphysiodesis" "$18,144.00 " "Arrest, epiphysiodesis, open; distal fibula (27732" "$11,951.00 " Arsenic $945.00 "Arsenic Level, Urine timed" $279.00 "Arsenic, random Urine" $279.00 Arterial Blood Gas Collection $132.00 Arterial Blood Gas Lab Charge $176.00 Arthrocentesis Intermediate Joint - Bilateral Char "$1,430.00 " Arthrocentesis Intermediate Joint Charge (20605) $953.00 Arthrocentesis Major Joint Bilateral Charge (20610 "$1,480.00 " Arthrocentesis Major Joint Charge (20610) $983.00 Arthrocentesis Small Joint - Bilateral Charge (206 "$1,424.00 " Arthrocentesis Small Joint Charge (20600) $947.00 "ARTHROD GT IP JNT W EHL TRANSFER,Bilateral (28760-" "$2,314.00 " "Arthrodesis Great Toe, MP Joint" "$2,529.00 " "Arthrodesis Great Toe, MP Joint,Bilateral (28750-5" "$31,686.00 " Arthrodesis Interphalangeal Joint Great Toe "$1,442.00 " "Arthrodesis w/Tendon Lengthen and Advancement, Mid" "$2,993.00 " Arthrodesis with Bone Graft "$3,607.00 " Arthrodesis Wrist Complete "$3,156.00 " Arthrodesis Wrist w/Sliding Graft "$3,620.00 " "Arthrogram, hip" $331.00 Arthroscopically aided ACL "$4,192.00 " "Arthroscopy ankle, debridement" "$2,228.00 " "Arthroscopy ankle, OCD drilling" "$2,890.00 " "Arthroscopy knee, chondroplasty" "$2,557.00 " "Arthroscopy knee, chondroplasty microfracture" "$2,738.00 " "Arthroscopy knee, diagnostic" "$1,707.00 " "Arthroscopy knee, infection and drainage" "$2,155.00 " "Arthroscopy knee, lateral release" "$2,160.00 " "Arthroscopy knee, medial AND lateral meniscectomy" "$2,859.00 " "Arthroscopy knee, medial OR lateral meniscectomy" "$2,663.00 " "Arthroscopy knee, meniscus repair" "$2,881.00 " "Arthroscopy knee, OCD drilling" "$2,603.00 " "Arthroscopy knee, OCD internal fixation" "$3,072.00 " "Arthroscopy knee, plica" "$2,090.00 " "Arthroscopy knee, removal loose body" "$2,232.00 " Arthroscopy shoulder with debridement "$2,430.00 " Arthrotomy ankle "$2,743.00 " Arthrotomy Hip "$4,132.00 " Arthrotomy Intertarsal or Tarsometatarsal Joint "$1,419.00 " Arthrotomy Knee "$2,958.00 " Arthrotomy W/ OP Meniscus Repair (27403) "$2,248.00 " "Arthrotomy, elbow" "$1,955.00 " "Arthrotomy, glenohumeral joint" "$3,012.00 " "Arthrotomy, hip" "$3,998.00 " "Arthrotomy, posterior capsular release, ankle, wit" "$2,364.00 " "Arthrotomy, posterior capsular release, ankle, wit" "$4,727.00 " Artificial Airway $367.00 ARTIFICIAL TEARS EYE DROPS 15ML $27.00 "Aspiration (biopsy) deep (femur, vertebral body)" $503.00 Aspiration/injection bone cyst $647.00 Aspiration/Injection Ganglion Cyst Charge (20612) $970.00 Assay IgA/IgD/IgG/IgM Each $57.00 "Assay of PSA, free" $126.00 ASSAY PH BODY FLUID NOS $27.00 Assessment of aphasia $321.00 AST/SGOT $178.00 ATT E/N/E/L; D 10 SQ CM (14060) "$6,780.00 " ATT E/N/E/L; D 10.1-30 (14061) "$7,204.00 " ATT F/C/M/N/A/G/H/F; 10 SQ CM (14040) "$6,669.00 " ATT F/C/M/N/A/G/H/F; 10.1-30SQCM (14041) "$7,059.00 " ATT S/A/L; D 10 SQ CM/< (14020) "$6,501.00 " ATT S/A/L; D 10.1-30 SQ CM (14021) "$6,908.00 " ATT TRUNK; D 10 SQ CM/< (14000) "$6,323.00 " ATT TRUNK; D 10.1-30 SQ (14001) "$6,739.00 " "Automatic grasp feature, addition to upper-limb pr" "$13,318.00 " "AVOGEL 8"" X 8""" $147.00 AVOGEL 8IN X 8IN SINGLE $188.00 "Avulsion of nail plate, partial or complete, simpl" $740.00 Back Cover Only $486.00 Back Cushion Cover - Complex Upgrade Option $238.00 Back Hardware - Adjustable/Growth Option $725.00 BAG BREATHING TEST LUNG 1 LITER $4.00 BAG BREATHING ANESTHESIA TEST LUNG 3 LITER $6.00 BAG FEED GASTRIC GRAVITY 1000ML $13.00 BAG LEG 800ML $22.00 BAG NIGHT DRAINAGE $36.00 Band Applicator $128.00 BANDAGE COMPRILAN 10CM LYMPHEDEMA $68.00 BANDAGE COMPRILAN 12CM LYMPHEDEMA $82.00 BANDAGE COMPRILAN 6 CM LYMPHEDEMA $41.00 BANDAGE COMPRILAN 8 CM LYMPHEDEMA $67.00 BANDAGE ELASTINET SURGILAST SZ-1 $40.00 BANDAGE ELASTINET SURGILAST SZ-10 $164.00 BANDAGE ELASTINET SURGILAST SZ-2 $42.00 BANDAGE ELASTINET SURGILAST SZ-3 $51.00 BANDAGE ELASTINET SURGILAST SZ-4 $62.00 BANDAGE ELASTINET SURGILAST SZ-5 $67.00 BANDAGE ELASTINET SURGILAST SZ-6 $74.00 BANDAGE ELASTINET SURGILAST SZ-8 $127.00 BANDAGE ELASTINET SURGILAST SZ-9 $147.00 BANDAGE GAUZE KERLIX 4.5IN X 4YDS $6.00 Basement Membrane IgG Abs $321.00 Basic Chemistry Panel $784.00 "Basic Chemistry Panel, Calcium, total" $784.00 BATERIAL FILTER $4.00 "Battery Charger, six volt, Otto Bock or equal" $894.00 "Battery Charger, twelve volt, Utah or equal" "$1,764.00 " "be, ext power, self-susp inner socket, remov shell" "$20,219.00 " "BE, ext power, self-susp inner socket, remov shell" "$27,603.00 " "BE, molded socket (Muenster or Northwestern suspen" "$7,243.00 " "BE, molded socket (Muenster or Northwestern suspen" "$8,324.00 " "BE, molded socket, endo sys, incl soft prosthetic " "$8,513.00 " "BE, molded socket, flexible elbow hinges, triceps " "$7,867.00 " Behavioral and Qualitative Analysis of Voice and R $172.00 Below Knee Nylon Hose PR $52.00 "Below knee, molded socket shin, SACH foot (EXO)" "$8,531.00 " "Below knee, molded socket, shin, SACH foot, endosk" "$8,302.00 " "Below knee, plastic socket, joints and thigh lacer" "$11,930.00 " BELT OSTOMY $27.00 BENGAY CREAM 4oz $32.00 "Beta 2 Mircroglobulin, Serum" $205.00 Beta-2 GPI Antoantibodies $230.00 Beta-2-Transferrin "$1,082.00 " Biangular Back Option $144.00 "Bilirubin, Direct" $176.00 "Bilirubin, Fluid" $176.00 "Bilirubin, Total" $176.00 BINDER ABDOMINAL LF LG 10IN $99.00 BINDER ABDOMINAL LF LG 8IN $85.00 BINDER ABDOMINAL LF MED 10IN $99.00 BINDER ABDOMINAL LF MED 8IN $85.00 BINDER ABDOMINAL LF SM 8IN $85.00 BINDER ABDOMINAL LF XL 8IN $93.00 Biofeedback Training $68.00 "Biopsy, muscle deep" $610.00 BiPAP- Initial $519.00 BiPAP Initial Charge $833.00 BiPAP Subsequent Charge $675.00 "BK Virus Quant, Bld" "$1,235.00 " "BK Virus Quant, Urine" "$1,235.00 " Bladder Irrigation/Lavage/Instill Charge (51700) $194.00 "Blastomyces Antigen, Urine" $236.00 "Bld Glucose, Capillary" $116.00 BLISTEX LIP BALM .15oz $4.00 "Blood Gas, Adult ABG w Measured Sat" $360.00 "Blood Gas, Adult VBG w Measured Sat" $360.00 Blood Glucose POC $58.00 Blood Smear Path Consult without Review of Chart $149.00 Blood typing; ABO $26.00 "Blood, Split Unit, 175 cc" $749.00 "Blood, split unit, 175 mL" $356.00 B-Natiuretic Peptide $633.00 BOARD SLIDING AIDE ALL 24IN $300.00 BOARD SLIDING REG 1/2IN X 8IN X 24IN $179.00 Body Fluid Cell Count and Differential $300.00 Body Fluid pH $178.00 BONE BX TR/NDL; SUPERF (20220) "$2,780.00 " Bone Density DEXA App Skeleton Charge $159.00 Bone Density DEXA Axial Skeleton Charge $369.00 Bone Graft Ileum "$1,519.00 " BONE GRFT; MINOR/SM (20900) $644.00 Bonth Length Studies $225.00 "BOOT, Z-FLEX FLUIDIZED HEEL BOOTS" $169.00 BORDERED FOAM 6X8 $32.00 BORDERED FOAM DRESSING 4X4 $7.00 BORDERED FOAM DRESSING 6X6 $7.00 "BREATHABLE UNDERPAD PROT PLUS 23 X 36""" $21.00 Brief emotional/behavioral assessment (96127) $52.00 Bronchial Hygiene Evaluation Charge $116.00 Bronchospasm- Pre & Post BD (94060) $609.00 Brucella Abortus IgG Ab $118.00 "Brucella Abortus IgG,IgM,IgA Ab" $347.00 "BUN, Fluid" $126.00 "BUN, Serum" $126.00 BUTTON TRACH SZ-10CM X 27CM "$1,104.00 " BUTTON TRACH SZ-10CM X 40CM "$1,031.00 " BUTTON TRACH SZ-11CM X 27CM $519.00 BUTTON TRACH SZ-11CM X 40CM "$1,225.00 " BUTTON TRACH SZ-12CM X 27CM "$1,225.00 " BUTTON TRACH SZ-12CM X 40CM "$1,225.00 " BUTTON TRACH SZ-9CM X 27CM $744.00 BUTTON TRACH SZ-9CM X 40CM "$1,225.00 " BVI $130.00 C Difficile by PCR $399.00 C Difficile Culture & Toxin $262.00 C Difficile Toxin $150.00 C Reactive Protein $225.00 C1 Esterase Inhibitor $219.00 C3 $25.00 C3 $94.00 C3 * $94.00 C4 $25.00 C4 $94.00 C4 * $94.00 CA19-9 $273.00 CA27.29 $134.00 CADIOLIPIN AB EA IG CLASS $120.00 "Cadmium,random Urine with Creatinine Ratio" $418.00 Calcitonin Level $352.00 CALCIUM ALGINATE DRESSING 4X4 $10.00 CALCIUM ALGINATE DRESSING 4X8 $27.00 "CALCIUM ALGINATE DRESSING ROPE 12""" $37.00 Calcium Ionized $461.00 "Calcium, Urine Random" $153.00 "Calcium, Urine Timed" $188.00 Calcium/CA++ Level $240.00 Calculus Analysis $209.00 "Calf Sling, Vinyl" $244.00 "Calf Strap, 2 inch Webbing" $119.00 Canalith Repositioning Units $167.00 Cancer Antigen 125 $465.00 CANISTER SUCTION 1200ML $9.00 CANISTER SUCTION 2000ML $9.00 CAP DDCP 15MM W/DISP FEN CANULA $31.00 CAP SHILEY TRACHEOSTOMY WHITE FOR DECANNULATION 15 $31.00 Capsulotomy Hip w/Release Hip Flexor "$4,195.00 " Capsulotomy MP Joint 5th Toe Extensor Tendon (ea) "$1,443.00 " "Capsulotomy, Posterior Capsular Release, Knee" "$4,717.00 " "Capsulotomy, posterior capsular release, knee; Bil" "$4,780.00 " "Carbon Dioxide, Urine" $211.00 "Carbon Monoxide, quant." $77.00 Carcinoembryonic Antigen $751.00 Cardiolipin antibody $278.00 "CARE-E-VAC II W BATTERY, TABLE TOP PORTABLE" $21.00 C-Arm Exam $326.00 C-Arm Exam $628.00 C-Arm Exam $861.00 C-Arm Exam "$1,045.00 " C-Arm Exam "$1,138.00 " C-Arm Exam "$1,144.00 " C-Arm Exam "$1,170.00 " C-Arm Exam "$1,235.00 " C-Arm Exam "$1,601.00 " C-Arm Exam "$1,994.00 " C-Arm Exam "$2,224.00 " C-Arm Exam "$2,425.00 " C-Arm Exam "$2,628.00 " C-Arm Exam "$2,704.00 " C-Arm Exam "$2,751.00 " C-Arm Exam "$2,975.00 " C-Arm Exam "$3,006.00 " C-Arm Exam "$3,062.00 " C-Arm Exam "$3,210.00 " C-Arm Exam "$8,606.00 " Carotene Level $469.00 Casting/Strapping Procedure $413.00 "Catecholamines, Fractionated, Urine, Random" $474.00 "Catecholamines, Plasma, Fractionated" $534.00 "Catecholamines-Fractionated, Urine timed" $507.00 CATH KIT TOUCLS URET UNISX 10 FR INTERMIT $29.00 CATH KIT TOUCLS URET UNISX 12FR INTERMIT $28.00 CATH KIT TOUCLS URET UNISX 8 FR INTERMIT $26.00 "CATH STRAIGHT COUDE 12FR 16""" $5.00 "CATH STRAIGHT COUDE 14F 16""" $5.00 "CATH STRGHT COUDE 16FR 16""" $5.00 Cath-Complex Urethral Charge (51703) $479.00 CATHETER 100% SILICONE 24FR 5CC $59.00 CATHETER ALL PURPOSE URETHRAL STRAIGHT 14FR $7.00 CATHETER ALL PURPOSE URETHRAL STRAIGHT 16FR $5.00 CATHETER ALL PURPOSE URETHRAL STRAIGHT 18FR $5.00 CATHETER CLEAN ULTRA M/F 16IN 14FR $7.00 CATHETER COUDE TAPPERED TIP SELF 10FR $9.00 CATHETER COUDE TIP FUNNEL END SELF 14FR $7.00 CATHETER EXTERNAL INTERMEDIATE $7.00 CATHETER EXTERNAL LG $7.00 CATHETER EXTERNAL MED $7.00 CATHETER EXTERNAL SM $7.00 CATHETER EXTERNAL WIDE BAND L $7.00 CATHETER FOLEY 100% SILICONE 14FR 5CC-10CC $41.00 CATHETER FOLEY 100% SILICONE 16FR 5CC-10CC $35.00 CATHETER FOLEY 100% SILICONE 20FR 30CC $49.00 CATHETER FOLEY 16FR 5CC $51.00 CATHETER FOLEY COUDE TIP 16FR 5CC-10CC $36.00 CATHETER FOLEY SIL-CTD LTX 20FR 5CC-10CC $12.00 CATHETER FOLEY SILICONE 20FR 5CC $35.00 CATHETER FOLEY SILICONE COATED 16FR 5CC-10CC $6.00 CATHETER FOLEY SILICONE COATED 18FR 5CC-10CC $6.00 CATHETER FOLEY SILICONE ELASTOMER COATED 5CC-10CC $6.00 CATHETER SELF COUDE OLIVE TIP FUNNEL END 8FR $7.00 CATHETER SELF COUDE TAPERED TIP FUNNEL END 8FR $25.00 CATHETER SUCTION/VENT RED RUBBER 10-12FR $6.00 CATHETER SUCTION/VENT RED RUBBER 14-16FR $6.00 "CATHETER, CATH ADAPTER STERILE" $21.00 "CATHETER, CATH FOLEY 10FR 3CC SIL ELAST" $32.00 "CATHETER, CATH FOLEY 6FR 3CC SIL ELAST" $26.00 "CATHETER, CATH FOLEY 8FR 3CC SIL ELASTIC" $51.00 "CATHETER, CATH FOLEY COUDE 5CC 14FR BARD" $110.00 "CATHETER, CATH FOLEY SIL-CTD LATEX 22FR 5CC-10CC" $9.00 "CATHETER, CATH SUCTION RED RUBBER 8FR" $21.00 Cath-Simple Urethral Charge (51702) $129.00 CBC with Manual Differential $358.00 CBC with Platelets $97.00 CBC with Platelets $269.00 CBC-Compete Blood Count with Differential and Plat $314.00 CBC-Complete Blood Count without Platelets $103.00 CBC-Hemoglobin and Hematocrit Only $91.00 CD Treatment Speech Language Voice Communication A $122.00 CD3 $644.00 "CD3,4 Peripheral Blood" $492.00 CD34 $492.00 "Cell Count and Differential, CSF" $126.00 CEPACOL SORE THROAT LOZENGE $24.00 Ceruloplasmin $327.00 "Cervical Collar, Flexible, Thermoplastic, Molded t" $336.00 "Cervical Collar, Muti-Post, Occip/Mand Supports, A" "$2,093.00 " "Cervical Collar, Semi-Rigid, Adjustable Molded Chi" $497.00 "Cervical Collar, Semi-Rigid, Adjustable Plastic" $134.00 "Cervical Collar, Semi-Rigid, Wire-Frame" $725.00 "Cervical Halo Procedure, Incorporated Into Jacket " "$5,907.00 " "Cervical Halo Procedure, Incorporated Into Milwauk" "$7,109.00 " "Cervical Halo Procedure, Incorporated Into Plaster" "$4,647.00 " Cervical-Thoracic Discography (62291) $650.00 Cervical-Thoracic Transforaminal (64479) "$3,321.00 " Cervical-Thoracic Transforaminal-additional level "$2,025.00 " Cervical-Thoracic Transforaminal-additional level "$2,671.00 " Cervical-Thoracic Transforaminal-Bilateral (64479) "$4,945.00 " "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $84.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $116.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $185.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $195.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $221.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $250.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $343.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $365.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $387.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $419.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $468.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $501.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $503.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition" $706.00 "Cervical-Thoracic-Lumbar-Sacral Orthosis, Ant/Post" "$4,399.00 " "Cervical-Thoracic-Lumbar-Sacral Orthosis, Ant/Post" "$4,835.00 " "Cervical-Thoracic-Lumbar-Sacral Orthosis, Milwauke" "$4,479.00 " CH50 $753.00 Change of Windpipe Airway (31502) $711.00 "Charger, Hosmer" $159.00 CHEMODENER MUSCLE LARYNX EMG (64617) "$1,916.00 " "CHEMODENER MUSCLE LARYNX EMG,Bilateral (64617-50)" "$2,152.00 " CHEMODENERV 1 EXTREM 5/> MUS (64644) "$1,939.00 " CHEMODENERV 1 EXTREMITY 1-4 (64642) "$1,901.00 " CHEMODENERV EACH ADD'L EXTREM 5/> MUSCLES (64645) $304.00 CHEMODENERV EACH ADD'L EXTRM 1-4 MUSCLES (64643) $264.00 CHEMODENERV ECCRINE GLANDS OTHER AREAS (64653) $964.00 CHEMODENERV MUSC MIGRAINE (64615) "$1,186.00 " CHEMODENERV MUSC NECK DYSTON (64616) "$1,270.00 " "CHEMODENERV MUSC NECK DYSTON,Bilateral (64616-50)" "$1,906.00 " Chemodenerv Saliv Glands (64611) "$1,252.00 " CHEMODENERV TRUNK MUSC 1-5 (64646) "$1,934.00 " CHEMODENERV TRUNK MUSC 6/> (64647) "$1,998.00 " Chemodenervation-Face (64612) "$1,644.00 " "Chemotherapy, into CNS Charge-96450" "$1,443.00 " Chest Percussion- Subsequent $138.00 Chest Physical Therapy $105.00 Chest Physical Therapy Initial Charge $216.00 Chest Physical Therapy Subsequent Charge $178.00 Chest physical therapy-Initial $166.00 Chest physical therapy-Subsequent $138.00 Chest Wall Oscillation Therapy $166.00 Chest Wall Oscillation Therapy-Initial Charge $216.00 Chest Wall Oscillation Therapy-Subsequent Charge $178.00 Chiro E-Stim Attended Charge $179.00 Chiro E-Stim Unattended Charge $92.00 Chiro Manual Therapy Techniques Charge $134.00 Chiro Manual Treatment Extra Spinal 1 or more Regi $230.00 Chiro Manual Treatment Spinal 1-2 regions Charge $279.00 Chiro Manual Treatment Spinal 3-4 regions Charge $304.00 Chiro Manual Treatment Spinal 5 regions Charge $341.00 Chiro Massage Charge $93.00 Chiro Neuromuscular Re-education Charge $123.00 Chiro Patient Self/Home Care Charge $126.00 Chiro Therapeutic Exercise Charge $116.00 Chiro Therapeutic Fuctional Act Charge $134.00 Chiro Ultrasound Charge $92.00 Chlamydia by PCR $157.00 Chloride $72.00 "Chloride, Timed Urine" $211.00 "Chloride, Urine Random" $184.00 Cholesterol $128.00 Chronic Ventilator Support $216.00 "Citrate, Urine Timed" $269.00 CK/CPK $600.00 CKMB Fraction $58.00 CKMB Fraction $112.00 CL TX FEMUR FX OR EPIPHYS SEP (27510) "$3,738.00 " CL TX FEMUR FX OR EPIPHYS SEP;Bilateral (27510-50) "$5,392.00 " CL TX OF ACETABULUM X(S); WO MAN "$2,589.00 " CLAMP HICKMAN SOFT JAW EDS $136.00 CLAMP OSTOMY $12.00 CLEANSER HIBICLENS ANTIMICROBIAL 4-OZ $13.00 Closed Red. Clavicle w/Man $651.00 Closed Red. Clavicle w/o Man "$1,119.00 " Closed Red. Prox Humerus w.o Man $927.00 Closed treatment of Galeazzi fracture "$2,125.00 " Closed treatment of Monteggia fracture "$2,268.00 " Closed treatment of proximal humerus fracture with "$1,736.00 " "Closed treatment of radial neck fracture, with man" "$1,591.00 " Closed treatment proximal tib fracture with manipu "$2,398.00 " Closed TX Calcaneal FX w/o Man $909.00 Closed TX Carpal Bone w/o Man (ea) "$1,057.00 " Closed TX Dist. Femur Epiphyseal Sep. w/Man "$2,750.00 " Closed TX Dist. Femur Epiphyseal Sep. w/o Man "$1,875.00 " Closed TX Distal Radius w/Man "$2,290.00 " Closed TX Distal Radius w/o Man "$1,007.00 " Closed TX Femoral FX Prox/Neck w/Man "$3,254.00 " Closed TX Femoral FX Prox/Neck w/o Man "$1,890.00 " Closed TX Femoral Shaft FX w/Man "$3,318.00 " Closed TX Femoral Shaft Fx w/o Man "$1,952.00 " Closed TX FX Phalanx (Not Gerat Toe) w/o Man (ea) $457.00 Closed TX FX Phalanx (Not Great Toe) w/Man (ea) $571.00 Closed TX Humeral Condyle Med/Lat w/o Man "$1,160.00 " Closed TX Humerus Shaft FX w/o Man "$1,226.00 " Closed TX Intertrochanteric FX w/Man "$3,986.00 " Closed TX Intertrochanteric FX w/o Man "$1,854.00 " Closed TX Metacarpal FX w/o Man (ea) $939.00 Closed TX Metarpal FX w/Man (ea) "$1,144.00 " Closed TX Metatarsal FX w/ Man (ea) "$1,017.00 " Closed TX Metatarsal FX w/o Man (ea) $761.00 Closed TX Patellar Disl w/o Anesthesia "$1,227.00 " Closed TX Patellar FX w/o Man "$1,124.00 " Closed TX Phalanx Distal FX w/Man "$1,053.00 " Closed TX Phalanx Distal FX w/o man $663.00 Closed TX Phalanx Shaft FX w/Man "$1,203.00 " Closed TX Phalanx Shaft FX w/o Man $671.00 Closed TX Prox Fib or Shaft FX w/Man "$1,574.00 " Closed TX Prox Fib or Shaft FX w/o Man "$1,041.00 " Closed TX Radial & Ulnar Shaft w/ Man "$1,922.00 " Closed TX Radial & Ulnar Shaft w/o Man $903.00 Closed TX Radial Head/Neck FX w/o Man $888.00 Closed TX Radial Shaft w/ Man "$1,861.00 " Closed TX Radial Shaft w/o Man $916.00 Closed TX Supracondylar FX w/Man "$3,365.00 " Closed TX Supracondylar FX w/o Man "$2,031.00 " Closed TX Supracondylar Humeral FX w/ Man "$2,343.00 " Closed TX Supracondylar Humeral FX w/o Man "$1,329.00 " Closed TX Tib Shaft FX w/Man "$2,042.00 " Closed TX Tib Shaft FX w/o Man "$1,241.00 " Closed TX Tibial Fx Prox. w/o Man "$1,463.00 " Closed TX Trochanteric RX w/o Man "$1,586.00 " Closed TX Ulnar FX Prox w/o Man $997.00 Closed TX Ulnar Shaft w/ Man "$1,824.00 " CLOTH-BATHING MOIST $5.00 CLTX BIMALLEOLAR ANKLE FRACT W MNP (27810) "$1,182.00 " Clubfoot Cast (29450) $947.00 Clubfoot Cast Bilateral "$1,321.00 " CMV Culture Non-Blood $486.00 "CMV DNA Qualitative, Blood" $263.00 CO2/Bicarb $128.00 "Collar, Cervical Multiple" "$2,863.00 " "Collar, Cervical, SOMI" "$2,468.00 " "Collar, Cervical, w/ Thoracic Extensions" "$1,291.00 " "Collar, Molded to Model" "$3,732.00 " "Collar, Semi-Rigid 2-Piece" $655.00 COLLECTION: Venous Draw $26.00 Collection: Venous Draw $48.00 COLLECTOR MID STREAM $6.00 Combined Epiphy. Dis Femur Prox Tib "$3,280.00 " "Complement C3,C4" $182.00 Complement Functional Activity $176.00 "Complement, Antigen" $94.00 "Complement, Total (CH50, C3 & C4)" $753.00 COMPLEMENT; AG EA $68.00 Complex Cystometrogram (51726) "$1,537.00 " Complex Cystometrogram w/ VP & UP (51729) "$1,691.00 " Complex Cystometrogram w/ VP (51728) "$1,611.00 " Complex Uroflowmetry $667.00 Complicated (felon) $759.00 Comprehensive computer based motion analysis-1 Cha "$3,087.00 " Comprehensive computer based motion analysis-2 Cha "$4,627.00 " Comprehensive computer based motion analysis-3 Cha "$5,398.00 " Comprehensive computer based motion analysis-4 Cha "$5,783.00 " Comprehensive computer based motion analysis-5 Cha "$5,976.00 " "COMPREHENSIVE EYE EXAM & TREATMENT, ESTAB PT 1+ VI" $413.00 COMPREHENSIVE EYE EXAM. NEW PATIENT 1+ VISITS (920 $459.00 Comprehensive Metabolic Panel $747.00 "Compression Burn Mask, Custom Fabricated" "$2,825.00 " CONNECTOR VAC DRAIN Y-TYPE 10-PK $12.00 CONNECTOR W/GLOW RING CLAVE $25.00 CONTOUR DELUXE W/HEADGEAR M/L $59.00 CONTOUR DELUXE W/HEADGEAR/SMALL $59.00 "Coombs test, indirect, qual" $37.00 "Coombs, Direct" $248.00 "Coombs, Direct (only C3 or IgG)" $91.00 "Coombs, Indirect" $256.00 Copper Level $453.00 "Copper Level, Urine random" $432.00 "Copper Level, Urine Timed" $453.00 Coronary Risk/Lipid Panel $682.00 Correction cock-up toe "$1,328.00 " Correction hammertoe "$1,378.00 " "Cortisol, Free & Creatinine, Urine Timed" "$1,115.00 " Cortisol-Total $929.00 COUDE CATH TAPERED TIP STRL 14FR $6.00 "Coxsackie B Antibodies, Serum" $91.00 "Coxsackie B Antibodies, Serum" $176.00 "Coxsackievirus Antibodies, CSF" $176.00 CPAP Initial/Management (0-12 hours) $782.00 CPAP Initiation and Management Charge $675.00 CPAP Initiation and Management Pulmonary $519.00 CPAP/BiPAP Initial Charge $688.00 CPAP/BiPAP Subsequent Charge $688.00 C-Peptide $273.00 CPM-No Show/Cancellation $50 $50.00 CPR Charge $469.00 "Cranial Cervical Orthosis, Congenital Torticolous " "$6,491.00 " C-Reactive Protein-Hi Sensitivity $225.00 CREAM LANTISEPTIC THERAPEUTIC $29.00 CREAM TRIPLE CARE EPC 7.75-OZ TUBE $74.00 "Creatine with Creatinine, Urine Timed" $261.00 Creatinine $134.00 Creatinine Clearance $165.00 "Creatinine, Fluid" $165.00 "Creatinine, Urine Random" $165.00 CREATININE; NOT BLOOD $30.00 CREME SKIN CONDITIONING 4 OZ BTL $34.00 "Crossmatch for Transfusion (electronic, IS or IgG)" $190.00 Crucial $7.00 "Crutch, Axillary Extension" $451.00 Cryoglobulin Identification $252.00 Cryoglobulin Screen $252.00 Cryoprecipitate Charge $90.00 Cryptococcal Screen-Blood $64.00 Cryptococcal Screen-CSF $64.00 Cryptococcal Screen-Stool $64.00 Cryptospordium Exam - Stool $250.00 Cryptosporidium Exam - Other $205.00 "Crystal Identification, Fluid" $180.00 "Crystals Analysis, Fluid" $225.00 C-sp Disc. Add'l level x___ "$1,740.00 " CT Abdomen W/ Contrast "$3,640.00 " CT Abdomen W/&W/O Contrast "$4,198.00 " CT Abdomen W/O Contrast "$3,216.00 " CT Abdomen/Pelvis W/ Contrast "$7,543.00 " CT Abdomen/Pelvis W/&W/O Contrast "$8,684.00 " CT Abdomen/Pelvis W/O Contrast "$6,123.00 " CT Angiogram Abdomen W/&W/O Contrast "$5,039.00 " CT Angiography Abd/Pel W/&W/O Contrast "$5,592.00 " CT Angiography Chest "$4,351.00 " CT Angiography Chest PE-71275 "$1,080.00 " CT Angiography Head "$3,776.00 " CT Angiography Neck "$4,181.00 " CT C-Spine W/ Contrast "$3,924.00 " CT C-Spine W/&W/O Contrast "$3,401.00 " CT C-Spine W/O Contrast "$3,394.00 " CT Head/Brain W/ Contrast "$3,117.00 " CT Head/Brain W/&W/O Contrast "$4,475.00 " CT Head/Brain W/O Contrast "$2,909.00 " CT Lower Extremity W/ Contrast Bil "$3,531.00 " CT Lower Extremity W/ Contrast Lt "$3,531.00 " CT Lower Extremity W/ Contrast Rt "$3,531.00 " CT Lower Extremity W/&W/O Contrast Bil "$4,173.00 " CT Lower Extremity W/&W/O Contrast Lt "$4,173.00 " CT Lower Extremity W/&W/O Contrast Rt "$4,173.00 " CT Lower Extremity W/O Contrast Bil "$3,209.00 " CT Lower Extremity W/O Contrast Lt "$3,209.00 " CT Lower Extremity W/O Contrast Rt "$3,209.00 " CT L-Spine W/ Contrast "$4,351.00 " CT L-Spine W/&W/O Contrast "$3,401.00 " CT L-Spine W/O Contrast "$3,860.00 " CT Maxillofacial W/ Contrast "$3,401.00 " CT Maxillofacial W/&W/O Contrast "$3,401.00 " CT Maxillofacial W/O Contrast "$3,148.00 " CT Orbit/Ear/Fossa W/ Contrast "$3,401.00 " CT Orbit/Ear/Fossa W/&W/O Contrast "$3,401.00 " CT Orbit/Ear/Fossa W/O Contrast "$3,175.00 " CT Pelvis W/ Contrast "$3,898.00 " CT Pelvis W/&W/O Contrast "$4,158.00 " CT Pelvis W/O Contrast "$2,738.00 " CT Soft Tissue Neck W/ Contrast "$3,776.00 " CT Soft Tissue Neck W/&W/O Contrast "$3,401.00 " CT Soft Tissue Neck W/O Contrast "$3,011.00 " CT Thorax W/ Contrast "$3,898.00 " CT Thorax W/&W/O Contrast "$4,098.00 " CT Thorax W/O Con Lung CA Screen "$3,288.00 " CT Thorax W/O Con Lung CA Screen:Ep "$3,288.00 " CT Thorax W/O Contrast-71250 "$3,288.00 " CT T-Spine W/ Contrast "$4,273.00 " CT T-Spine W/&W/O Contrast "$3,401.00 " CT T-Spine W/O Contrast "$4,273.00 " CT Upper Extremity W/ Contrast Bil "$3,401.00 " CT Upper Extremity W/ Contrast Lt "$3,401.00 " CT Upper Extremity W/ Contrast Rt "$3,401.00 " CT Upper Extremity W/&W/O Contrast Bil "$3,401.00 " CT Upper Extremity W/&W/O Contrast Lt "$3,401.00 " CT Upper Extremity W/&W/O Contrast Rt "$3,401.00 " CT Upper Extremity W/O Contrast Bil "$3,097.00 " CT Upper Extremity W/O Contrast Lt "$3,097.00 " CT Upper Extremity W/O Contrast Rt "$3,097.00 " Cuboid Osteotomy with Autograft "$3,120.00 " "Cuboid Osteotomy with Autograft, Bilateral" "$30,331.00 " "CUFF, ADULT DISPOSABLE" $12.00 "CUFF, ADULT LONG, DISPOSABLE" $13.00 "CUFF, CHILD, DISPOSABLE, 2-TUBE LOCKING" $10.00 "CUFF, LARGE, ADULT, LONG, DISPOSABLE" $14.00 "CUFF, SMALL ADULT, DISPOSABLE, SOFT 2-TUBE" $12.00 "CUFF, SMALL CHILD DISPOSABLE SOFT 2-TUBE, LOCKING" $10.00 "CUFF,THIGH,DISPOSABLE" $20.00 Culture-AFB Culture (non-blood) $176.00 Culture-C. Difficile $276.00 Culture-C. Difficile Surveillance $298.00 Culture-Chlamydia $143.00 Culture-CSF Aerobic/Anaerobic Culture w/Gm Stain $673.00 Culture-CSF with Gram Stain $218.00 Culture-Eye $218.00 Culture-Eye with Gram Stain $244.00 Culture-Fluid & Anaerobic Culture with Gram Stain $321.00 Culture-Fluid & Anaerobic w/Gram Stain $422.00 Culture-Fluid with Gram Stain $273.00 Culture-Fungus Blood $176.00 Culture-Fungus CSF $176.00 Culture-Fungus with Smear $234.00 Culture-GC $99.00 Culture-Genital with Gram Stain $141.00 Culture-Group B Streptococcus $92.00 Culture-IV Cath Tip $389.00 Culture-Legionella $69.00 Culture-Mycobacteria Blood $130.00 Culture-Mycobacteria no Smear $176.00 Culture-Mycobacteria with AFB Smear $106.00 Culture-Nose $122.00 Culture-Other Aerobic/Anaerobic w/Gm Stain $354.00 Culture-Other Fungal w/Smear $341.00 Culture-Sputum Respiratory w/ Gm Stain $422.00 Culture-Stool $422.00 Culture-Surveillance $422.00 Culture-Throat $124.00 Culture-Tissue with Gram Stain $218.00 Culture-Urine $183.00 Culture-Virus $486.00 Culture-Wound Aerobic with Gram Stain $354.00 Culture-Wound Aerobic/Anaerobic w/Gm Stain $651.00 "Custom Contour (Foam In Place), Large" $360.00 "Custom Contour (Foam In Place), Medium" $311.00 "Custom Contour (Foam In Place), Small" $293.00 "Custom shaped protective cover, BK" "$5,180.00 " "Custom shaped protective cover, hip disartic" "$9,314.00 " "Custom shaped protective cover, knee disartic" "$6,932.00 " Cyanide $374.00 Cyclic Citrulinated Peptide $165.00 Cyclospora $106.00 Cyclosporine Level $534.00 Cylinder Cast (29365) "$1,253.00 " Cystatin C $294.00 Cystometrogram w/ UP "$1,621.00 " Cytology Fluid Specimen $287.00 Cytology-CSF $287.00 Cytology-CSF $556.00 "Cytomegalovirus Antibody(IgG & IgM), Serum" $360.00 "Cytomegalovirus by PCR, CSF Qualitative" $461.00 "Cytomegalovirus by PCR, Urine, Qualitative" $986.00 "Cytomegalovirus Viral Load PCR, blood" $755.00 "Cytopath, concentrate technique" $360.00 DANDRUFF SHAMPOO 7oz $22.00 D-Dimer $75.00 D-Dimer $339.00 DEB BONE 20 SQ CM/< (11044) "$4,053.00 " Deb Bone ADD-on =<20 Sq cm "$3,078.00 " DEB MUSC/FASCIA ADD-ON =<20 SQ CM "$1,057.00 " Deb skin bone at FX site "$3,422.00 " Deb Subq Tissue ADD-on=<20 Sq cm $973.00 DEBR EXZ/INF SKIN; 10% BS (11000) "$1,002.00 " DEBR NECROTIZ ST - GENITALS & PERINEUM (11004) "$1,606.00 " DEBR NECROTIZ STISS - ABD WALL (11005) "$2,211.00 " DEBR W OPEN FX; SKIN & SQ Charge (11010) "$2,825.00 " DEBRIDE INFECTED SKIN ADD-ON =<10% BS (11001) $353.00 Debride Nail 1-5 (11720) $302.00 "Debride Skin to Muscle, Open FX" "$2,713.00 " "Debridement-skin , sub q, muscle/fascia 20 Sq cm/<" "$2,057.00 " "Debridement-skin, 20 Sq cm/< (11042)" "$1,239.00 " Declot Vascular Device $662.00 Decompression fasciotomy forearm "$2,475.00 " DEEP DISSECT FOOT INF; MULTI AREAS (28003) "$6,023.00 " DEEP DISSECT FOOT INF; SGL BURSA SP (28002) "$8,345.00 " Deep I&D - UA/ELBOW (23930) "$7,188.00 " Deep Inc Foot w Op Bone Cortex "$9,786.00 " Dehydroepiandrosterone $643.00 DENTURE ADHESIVE 2.4oz $7.00 DENTURE CLEANSER TABLET $21.00 DEORDORANT BANISH OSTOMY BTL 1-1/4-OZ $66.00 Deoxypyridin $449.00 DESTR W NEUROLYTIC; INTERCOSTAL NRV (64620) "$7,199.00 " DESTROY C/TH FACET JNT ADDL (64634) "$1,108.00 " "DESTROY C/TH FACET JNT ADDL, Bilateral (64634-50)" "$1,658.00 " Destroy Cer/Thor Facet Joint (64633) "$3,049.00 " "DESTROY CERV/THOR FACET JNT, Bilateral (64633-50)" "$4,931.00 " "Destroy L/S Facet Joint B, ea add'l (64636-50)" "$3,866.00 " Destroy L/S Facet joint each add'l (64636) "$2,579.00 " "Destroy L/S facet joint, bilateral (64635-50)" "$7,176.00 " Destroy lumb/sac Facet Joint (64635) "$4,784.00 " "DESTROY NERVE FACE MUSCLE, BILATERAL (64612-50)" "$2,465.00 " DESTRUCT B9 LESION 1-14 (17110) $595.00 Dexa Exam $163.00 Dexa Exam $525.00 DHEA Sulfate $643.00 "Diabetic Only, Custom Molded Shoe" "$1,025.00 " "Diabetic Only, Not Otherwise Specified Shoe Modifi" $151.00 "Diabetics only, the off-the-shelf depth inlay to a" $344.00 Diabetisource AC $7.00 Diagnostic Anoscopy Charge-46600 $391.00 DIAPER BRIEF ADULT XXL $139.00 DIC Panel $469.00 Digoxin/Ditgitalis Level $463.00 "Dilantin/Phenytoin, Free" $587.00 Direct and Indirect Antiglobulin Test $106.00 DISPOSABLE GROUND AND DISK ELECTRODES NCV KIT $35.00 "DIVIDE PLANTAR FASCIA & MSCL,BILATERAL (28250-50)" "$12,970.00 " Division of Plantar Release "$1,758.00 " Division of SCM for torticollis "$1,603.00 " DNA $99.00 DNA * $99.00 DNA ** $99.00 DO NOT USE -5 $355.00 DO NOT USE -9 $66.00 DO NOT USE-2 $342.00 DO NOT USE-3 $648.00 Doctor service required to establish and document $25.00 Domicil/R-Home Visit est Pat $701.00 Domicil/R-Home visit est patient - detailed modera $514.00 Domicil/R-Home visit est patient - expanded proble $365.00 Domicil/R-Home visit est patient - problem focus/ $236.00 Domicil/R-Home visit New Pat / low complexity $336.00 Domicil/R-Home visit New Pat /moderate complexity $549.00 Domicil/R-Home visit New Pat comprehensive/high co $847.00 Domicil/R-Home visit New Pat comprehensive/moderat $719.00 Domicil/R-Home visit New Pat/problem focus $233.00 Drain Cerebrospinal Fluid "$1,811.00 " Drain Palmar Bursa; Complicated "$8,529.00 " DRAIN/INJ INTER JOINT/BURSA W/US (20606) "$1,006.00 " "DRAIN/INJ INTER JOINT/BURSA W/US,Bilateral (20606-" "$1,511.00 " DRAIN/INJ MAJOR JOINT/BURSA W/US (20611) "$1,040.00 " "DRAIN/INJ MAJOR JOINT/BURSA W/US, Bilateral (20611" "$1,562.00 " DRAIN/INJ SMALL JOINT/BURSA W/US (20604) $982.00 "DRAIN_INJ SMALL JOINT_BURSA W_US, Bilateral (20604" "$1,478.00 " Drainage of finger abscess $528.00 "Drainage of palmar bursa; single, bursa (26025)" "$7,152.00 " Drainage of Tendon Sheath "$1,744.00 " DRAINAGE SYSTEM AEROSOL BAG $4.00 DRESSING 15CM X 20 CM TEGADERM $13.00 DRESSING 20CM X 30CM TEGADERM $25.00 DRESSING 8IN X 9IN DUODERM $94.00 DRESSING BURN # 20301 ACTICOAT $316.00 DRESSING BURN 9IN X 15IN EXU-DRY $32.00 "DRESSING EXU-DRY 3"" X 4""" $7.00 DRESSING FOAM MEPILEX AG 4X4 $53.00 DRESSING FOAM MEPILEX AG 8X8 $192.00 DRESSING PROMOGRAN MATRIX 4.34SQ IN $42.00 DRESSING STERI STRIP 1/2IN X 4IN $6.00 DRESSING TRACHEOSTOMY 3.5INX 3.5IN ALLEVYN $29.00 "DRESSING TRAY, PEDIATRIC W SORBAVIEW SHIELD IV" $40.00 DRESSING XEROFORM 4IN X 3YDS $29.00 DXA BONE DENSITY STUDY (77085) $61.00 "D-Xylose, 1Hr Blood" $165.00 "D-Xylose, 2Hr Blood" $165.00 "D-Xylose, 5 Hr Urine" $569.00 Dynamic fine wire electromyography Charge (96003) "$1,006.00 " Dynamic plantar pressure meas during walk-1 Charge "$3,730.00 " Dynamic plantar pressure meas during walk-2 Charge "$5,273.00 " Dynamic plantar pressure meas during walk-3 Charge "$6,044.00 " Dynamic plantar pressure meas during walk-4 Charge "$6,428.00 " Dynamic plantar pressure meas during walk-5 Charge "$6,621.00 " "Dynamic surface electromyography, during walking o" "$1,006.00 " E. Histolytica Antibodies $163.00 "E0770 FES, Complete System, NOS" "$6,833.00 " each additional leg tendon (leg) $487.00 Each Add'l 15 min. MOD SED SAME PHYS/QHP (99153) $34.00 "EBV Qualitative by PCR, Blood" $449.00 Education Supplies $69.00 Education/Training $84.00 ELASTIC WRIST BRACE LARGE LEFT $69.00 ELASTIC WRIST BRACE LARGE RIGHT $69.00 Elbow Arthrogram inj $295.00 "Elbow Arthrogram inj, Bilateral" $588.00 "Elbow Block, Each" $191.00 "Elbow disartic, ext power, molded inner socket, re" "$26,109.00 " "Elbow disartic, ext power, molded inner socket, re" "$29,128.00 " "Elbow disartic, molded socket with expandable inte" "$10,786.00 " "Elbow disartic, molded socket, endo sys, incl soft" "$8,558.00 " "Elbow disartic, molded socket, outside locking hin" "$7,870.00 " "Elbow Orthosis, Double Upright w/ Forearm/Arm Cuff" "$2,885.00 " "Elbow Orthosis, Double Upright w/ Forearm/Arm Cuff" "$3,827.00 " "Elbow Orthosis, Double Upright w/ Forearm/Arm Cuff" "$4,537.00 " "Elbow Orthosis, Elastic w/ Metal Jts" $604.00 "Elbow Orthosis, Elastic, Custom Fabricated" "$1,220.00 " "Elbow Orthosis, Rigid w/o Joints, Prefabricated" $454.00 "Elbow-Wrist-Hand Orthosis, Nontorsion Joints, Cust" "$3,308.00 " "Elbow-Wrist-Hand Orthosis, Rigid, Custom Fabricate" "$3,159.00 " "Elbow-Wrist-Hand-Finger Orthosis, Nontorsion Joint" "$2,620.00 " "Elbow-Wrist-Hand-Finger Orthosis, Rigid Custom Fab" "$2,473.00 " Electrical Stimulation Guidance for Chemodenervati $413.00 ELECTRODE SILVER MACTROD $26.00 Electroejaculation Charge "$1,803.00 " Electrolyte Panel $474.00 "Electronic elbow, adolescent, Variety Village or e" "$15,850.00 " "Electronic elbow, adolescent, Variety Village or e" "$21,028.00 " "Electronic elbow, child, Variety Village or equal," "$28,024.00 " "Electronic elbow, child, Variety Village or equal," "$32,947.00 " "Electronic elbow, Hosmer or equal, switch controll" "$15,074.00 " "Electronic elbow, microproc sequential control of " "$97,525.00 " "Electronic elbow, microproc simultaneous control o" "$107,700.00 " "Electronic Greifer, Otto Bock or equal, myoelectro" "$11,579.00 " "Electronic hand, Otto Bock, Steeper or equal switc" "$11,834.00 " "Electronic hand, System Teknik, Variety Village or" "$17,550.00 " "Electronic hook, child, Michigan or equal, switch " "$4,024.00 " Electronic Wrist Rotator Any "$11,475.00 " EMG 1 Limb Charge (95860) "$1,116.00 " EMG 2 Limbs Charge (95861) "$1,479.00 " EMG 3 Limbs Charge (95863) "$1,701.00 " EMG 4 Limbs Charge (95864) "$1,863.00 " "EMG Anal/Urethr Sphinct, Not Needle (51784)" $749.00 "EMG Facial, Bilateral Charge (95868)" $706.00 "EMG Facial, Unilateral Charge (95867)" $612.00 EMG Guidance with Chemodenervation Charge (95874) $315.00 "EMG, Limited Charge (95870)" $393.00 EMST150 $177.00 ENCLOSURE BED $315.00 ENDO POLY HIP PNEU/HYD/ROT "$21,175.00 " "Endomysial Autoantibodies, IgG" $252.00 ENEMA MINERAL OIL 4.5-OZ $6.00 ENF ADJUST GTUBE 12FR $120.00 ENF EX SET BIFURCATED 8IN $12.00 ENF FARRELL BAG 500ML $47.00 ENF NG TUBE 10FR FEEDING $64.00 ENF NG TUBE 5FR FEEDING $38.00 ENF NG TUBE 6.5FR FEEDING $38.00 ENF NG TUBE 8FR FEEDING $38.00 ENFADJUST GTUBE 16FR $74.00 ENFADJUST GTUBE 18FR $72.00 Enfamil 20 kcal $14.00 Enfamil 24 kcal $14.00 ENFBRUSH 30 DAY $48.00 ENFMINIONE 12FR 1.5CM $485.00 ENFMINIONE 14FR 2.5CM $485.00 ENFMINIONE 14FR 2CM $485.00 ENFMINIONE 16FR 3CM $518.00 Entamoeba Histolytica Antigen $227.00 ENVELLA BED (HILL ROM) $578.00 "EO with Joint, Prefabricated Custom Fit" "$2,110.00 " "Eosinophil Count, Urine & Body Fluid" $103.00 Epiphyseal Arrest Distal Radius or Ulna "$2,398.00 " Epiphyseal Arrest Radius and Ulna "$2,560.00 " Epiphysiodesis Distal Femur "$2,620.00 " Epiphysiodesis Prox Tib/Fib "$3,918.00 " Epstein Barr Viral Antibody-IgM $63.00 "Epstein-Barr Quantitative, CSF" "$1,259.00 " "Epstein-Barr Quantitative, Serum" "$1,259.00 " Epstein-Barr Viral Antibody-IgG $122.00 Epstein-Barr Virus by PCR $277.00 Epstein-Barr Virus IgG $69.00 Epstein-Barr Virus IGM $69.00 Equipment BIPAP AVAPS $114.00 "Equipment Care-E-Vac II W Battery, Table Top,Porta" $21.00 Equipment-Bariatric Bed $648.00 Equipment-Bariatric Overylay Low Air Loss Mattress $355.00 Equipment-Clinitron Specialty Bed $578.00 Equipment-Cough Assist $49.00 Equipment-CPAP $7.00 Equipment-CPM Left Hand $154.00 Equipment-CPM Right Hand $154.00 Equipment-Crib $169.00 Equipment-Enclosure Canopy Posey 8050 $315.00 Equipment-Flexicare Specialty Bed (Hill Rom) $666.00 Equipment-Flowtron Excel Leg Pneumatic Compression $130.00 Equipment-Heat Therapy Pump $143.00 Equipment-Infusion Pump - LVP Module $51.00 Equipment-Infusion Pump-PCU $199.00 Equipment-Instavac II Aspirator Suction Machine (E $21.00 Equipment-IPV 1C PERCUSSIONATOR "$1,691.00 " Equipment-Kangaroo 324 Enteral Feeding Pump LP $158.00 Equipment-KCI Wound Vac $587.00 Equipment-Leg CPM (OrthoRehab) $216.00 Equipment-META NEB $25.00 Equipment-NPWT Wound Vac $230.00 Equipment-Overlay Low Air Loss Mattress $99.00 Equipment-Pulse Oximeter $12.00 Equipment-Ventilator LTV 1150 $143.00 Equipment-Ventilator LTV 950 $138.00 Equipment-Ventilator Trilogy $119.00 Erythropoietin Level $720.00 ESC I P ULCER W OSTECT & FLAP (15946) "$11,282.00 " Estradiol "$1,652.00 " Estriol $74.00 Estrogen-Total Serum $461.00 Estrone Level $143.00 Ethafoam Seat Wedge w/ Vinyl Cover $244.00 EUCERIN CREAM 4oz $37.00 Eval Use/Fitting Voice Prosthetic Units $104.00 Evaluation of Language Comprehension and Expressio $221.00 Evaluation of Speech Fluency Units $221.00 Evaluation of Speech Sound Production Units $221.00 Evaluation of Speech Sound Production w/ Evaluatio $221.00 Everolimus Level $161.00 EXC ABD LES SC 3 CM/> (22903) "$8,976.00 " EXC BC/B Tumor Clav/Scapula "$9,658.00 " "EXC BC/B Tumor Clav/Scapula, Bilateral" "$14,488.00 " EXC BEN LES T/A/L; > 4.0CM (11406) $925.00 EXC BEN LES T/A/L; 0.6-1.0CM (11401) $382.00 EXC BEN LES T/A/L; 2.1-3.0CM (11403) $542.00 EXC BEN LES T/A/L; 3.1-4.0CM (11404) $240.00 EXC BLES S/N/EX G; 0.5CM/< (11420) "$2,700.00 " EXC BLES S/N/EX G; 0.6-1.0CM (11421) "$2,891.00 " EXC BLES S/N/EX G; 1.1-2.0CM (11422) "$2,958.00 " EXC BLES S/N/EX G; 2.1-3.0CM (11423) "$5,408.00 " EXC BLES S/N/EX G; 3.1-4.0CM (11424) "$5,308.00 " Exc Bone BX;DEEP "$2,597.00 " EXC C P ULCER; W 1' SUTURE (15920) "$1,705.00 " EXC C P ULCER; W FLAP (15922) "$2,184.00 " EXC FACE-MM B9+MARG > 4 CM (11446) "$1,175.00 " EXC FACE-MM B9+MARG 0.5CM/< (11440) $361.00 EXC FACE-MM B9+MARG 0.6-1 CM (11441) $462.00 EXC FACE-MM B9+MARG 1.1-2 CM (11442) $516.00 EXC FACE-MM B9+MARG 2.1-3 CM (11443) $633.00 EXC FACE-MM B9+MARG 3.1-4 CM (11444) "$3,548.00 " EXC FOOT CYST/GANGLION (28090) "$8,286.00 " EXC H-F-NK-SP MAL+MARG 0.5 < (11620) "$3,166.00 " EXC HIDRAD AXIL; CPLX REP (11451) "$1,174.00 " EXC HIDRAD AXIL; CPLX REP; Bilateral (11451-50) "$1,761.00 " EXC LEG/ANKLE TUM < 3 CM (27618) "$6,425.00 " EXC S P ULCER PREP FOR FLAP (15936) "$2,507.00 " EXC S P ULCER W SKIN FLAP (15934) "$2,589.00 " EXC S/N/H/F/G MAL+MRG 1.1-2 (11622) "$3,342.00 " EXC SHOULDER LES SC 3 CM/> (23071) "$8,927.00 " EXC T P ULCER; W FLAP (15956) "$3,114.00 " EXC THIGH/KNEE LES SC < 3 CM (27327) "$5,143.00 " EXC THIGH/KNEE TUM DEEP <5CM (27328) "$7,866.00 " "EXC THIGH/KNEE TUM DEEP <5CM, Bilateral (27328-50)" "$11,799.00 " EXC TIB/FIB CYST/TUMOR W ALLOGRFT (27638) "$2,158.00 " EXC TNDN SHTH LES HND/FING (26160) $909.00 EXC TR-EXT B9+MARG 0.5CM/< (11400) $287.00 EXC TROCHANTERIC BURSA/CALCIFICAT (27062) "$1,259.00 " Exc. Benign Les T/A/L; 1-1-2.0 CM "$2,122.00 " EXCISE VAGINAL CYST OR TUMOR (57135) $606.00 Excision epiphyeal bar "$3,827.00 " Excision ganglion "$1,324.00 " Excision nail matrix-ingrown nail $699.00 Excision of Foot Lesion "$1,048.00 " Excision or curettage of bone cyst femur with allo "$3,076.00 " Excision or curettage of bone cyst of proximal hum "$2,696.00 " Excision or curettage of calcaneus cyst "$1,752.00 " Excision Osteochondroma Humerus "$2,429.00 " Excision Osteochondroma Metacarpal "$1,852.00 " Excision Osteochondroma Phalanx "$1,799.00 " Excision Osteochondroma Tib "$2,503.00 " Excision Tarsal Coalition "$2,265.00 " Excision/Curettage Bone Cyst Femur "$2,524.00 " Excision/Curettage Bone Cyst Metatarsal "$1,531.00 " Excision/Curettage Bone Cyst Phalanges Foot "$1,256.00 " Excision/Curretage Bone Cyst Radius/Ulna "$2,398.00 " EXCISION; ISCHIAL BURSA (27060) "$1,284.00 " Exercise Oximetry $308.00 Exhaled air analysis Charge-94690 $233.00 Exhaled air analysisO2 Charge-94680 $359.00 Exhaled air analysisO2/CO2 Charge-94681 $410.00 Expiratory Resistance Valve $294.00 EXPL P WND; EXTREM (20103) "$4,877.00 " EXPL/REM FB IPH Joint EA (26080) "$6,453.00 " Exploration of Foot Joint "$1,289.00 " EXTENSIVE MIDFOOT CAPSULOTOMY;Bilateral (28262-50) "$15,587.00 " Extractable nuclear antigen $13.00 Extractable nuclear antigen * $13.00 Extractable nuclear antigen ** $13.00 F5 Gene Analysis $587.00 Factor II Assay $277.00 Factor IX Assay $292.00 Factor V Assay $372.00 Factor VII Assay $372.00 Factor VIII Assay $372.00 Factor VIII Inhibitor $538.00 Factor X Assay $372.00 Factor XI Assay $372.00 Factor XII Assay $372.00 Factor XIII Assay $186.00 Family Psychotherapy with Patient $412.00 Family Psychotherapy Without Patient $383.00 Fasciotomy leg "$1,764.00 " Fast Charger "$1,508.00 " FB removal in sub q-complex "$5,541.00 " FB removal in sub q-simple "$1,258.00 " Fecal Fat Timed Collection $873.00 Fecal Leukocytes $64.00 Fecal Lytes/pH/Osmo Timed Collection $474.00 "FEED TUBE 10FR 36"" STYLETE ULTR" $121.00 "FEED_FLUSH SET 1000ML, E-PUMP" $27.00 Femoral Shortening "$4,998.00 " Ferritin $389.00 Fetal Hemoglobin $460.00 Fetal Hemoglobin $891.00 Fibersource HN $7.00 Fibrin Degradation Product $134.00 Fibrinogen $94.00 Fibrinogen $269.00 Fibrinogen Antigen $182.00 FILTER BACTERIAL $36.00 Fine Needle Aspiration without Imaging $278.00 "Finger Orthosis, Safety Pin, Spring Wire" $138.00 "Firbrin degradation products, quant." $60.00 Fit or Insert Pessary $792.00 Fixation of ankle joint (Ankle/Foot Manipulation G $749.00 FLEX SUPERSET W/MASK ELBOW $13.00 FLEXI SEAL SIGNAL FMS "$1,017.00 " FLEXI SEAL SIGNAL FMS COLLECT W/FILTER $225.00 FLEXION MITT ROYLAN BEIGE MED $61.00 Flexor Carpo Ulnaris Transfer "$3,761.00 " Flexor Origin Slide Forearm/Wrist "$3,325.00 " Flexor/Extensor Tendons "$2,560.00 " Flexor-Plasty Elbow "$2,319.00 " "Flow cytometry each cell surface, cytoplasmic or n" $138.00 Flow cytometry Interpretation 16 or more markers $565.00 "Flow Cytometry, CSF" "$1,247.00 " Fluid CEA $302.00 Fluid Cell Count and Diff $188.00 FLUIDIZED ANCILLARY PAD $164.00 Fluorescent AB; Titer Ea AB $68.00 Fluoro Guide Non-spine "$1,773.00 " Fluoro Guide Spinal Injection "$1,974.00 " Fluoroscopic Guidance- Needle Localization (77002) "$3,212.00 " Fluoroscopic Guidance- Spine (77003) "$3,212.00 " "Fluoroscopy (separate procedure), up to 1 hour phy" $30.00 Fluoxetine & Norfluoxetine $796.00 FO PIP/DIP W/O JOINT/SPRING $123.00 Foam Collar $122.00 Folate-Folic Acid Level $146.00 Folate-Folic Acid Level $283.00 Folate-RBC $236.00 Follicle Stimulating Hormone $929.00 Foot Drop Splint $358.00 "Foot Insert, Removable, Formed to Patient Foot" $353.00 "Foot Insert, Removable, Longitudinal Arch Support," $813.00 "Foot Insert, Removable, Longitudinal Support" $921.00 "Foot Insert, Removable, Plastizote Insert, Molded " $752.00 "Foot Insert, Removable, Pre-Molded, Longitudinal A" $218.00 "Foot Insert, Removable, Pre-Molded, Longitudinal/M" $310.00 "Foot Insert, Removable, Pre-Molded, Metatarsal Arc" $218.00 "Foot Insert, Removable, Silicone Gel, Molded to Pa" $485.00 "Foot Insert, Removable, Spenco, Molded to Patient" $613.00 "Foot Insert, Removable, UCB Type, Molded to Patien" "$1,458.00 " "Foot Orthosis, Abduction Rotation Bar, Incl Shoes" $199.00 "Foot Orthosis, Abduction Rotation Bar, w/out Shoes" $258.00 "Foot Orthosis, Arch Support, Longitudinal/Metatars" $93.00 "Foot Orthosis, Non-Removable, Longitudinal Arch Su" $146.00 "Foot Orthosis, Non-Removable, Metatarsal Support, " $146.00 "Foot Plate Padding, Each" $124.00 Forearm Flexor Lenghtening each tendon "$4,717.00 " Fork Holder $28.00 Free Light Chains $180.00 Fresh Frozen Plasma $418.00 Fresh Frozen Plasma Charge $199.00 FUNCTIONAL ELECTRIC STIM NOS (Bioness L300) "$10,942.00 " Fungus Stain/PAS $43.00 Fusion of Foot Bones "$2,638.00 " "G TUBE HOLDER 30"" - 45""" $58.00 "G TUBE HOLDER 45"" - 60""" $58.00 Gastric Fluid pH $263.00 Gastrin Level $608.00 Gastrocnemius Recession "$1,919.00 " "Gastrocnemius Recession, Bilateral" "$2,726.00 " Gastrografin 30ml $84.00 GC Culture $461.00 Gentamcin-Trough $354.00 Gentamicin-Peak $463.00 Gentamicin-Random $354.00 GGTP/GGT $217.00 "Giardia Antigen, Stool (Infectious Agent antigen D" $256.00 Gillette Seat "$5,309.00 " "Gliadin AB's IgG, IgA" $256.00 Glucagon Level $103.00 Glucerna- Chocolate $7.00 Glucerna- Vanilla $7.00 Glucose 6 PD $418.00 Glucose Level $128.00 "Glucose, Fluid" $136.00 "Glucose, post glucose dose, Including baseline" $196.00 "Glucose, Timed Urine" $54.00 "Glucose, Urine, Random" $54.00 Glucose-CSF $54.00 Glutamic Decarboxylast Abs $343.00 GM 1 Autoantibodies $132.00 GM 1 Autoantibodies $256.00 Goal Post Style Joystick $62.00 "Gonadotropin, chorionic" $97.00 Gonorrhoeae by PCR $461.00 Greater Occipital Nerve Injection Charge "$1,859.00 " Group Psychotherapy $146.00 Group Therapy Exercise 15 min $67.00 Growth Hormone Level $645.00 "H. Pylori Antigen, Stool" $393.00 Hallus-Valgus Night Dynamic Splint $202.00 Halo Replacement Liner/Interface "$1,000.00 " Hamstring Lengthening-Bilateral "$4,238.00 " Hamstring Lengthening-Unilateral "$2,718.00 " "hand Orthosis, Custom Fabricated" "$1,144.00 " "Hand Orthosis, Metacarpal Fx, Prefabricated" $213.00 "Hand restoration (incl cast/sahde/measure), replac" "$2,511.00 " "Hand restoration (incl cast/shade/measure), partia" "$4,731.00 " "Hand restoration (incl cast/shade/measure), partia" "$4,808.00 " "Hand restoration (incl cast/shade/measure), partia" "$4,860.00 " "Hand-Finger Orthosis, Composite Elastic" $187.00 "Hand-Finger Orthosis, Finger Extension w/ Clock Sp" $139.00 "Hand-Finger Orthosis, Flexion Glove w/ Elastic Fin" $212.00 "Hand-Finger Orthosis, Knuckle Bender" $203.00 "Hand-Finger Orthosis, Knuckle Bender w/ Outrigger" $250.00 "Hand-Finger Orthosis, Knuckle Bender, 2 Segment to" $240.00 "Hand-Finger Orthosis, Nontorsion Joints, Custom Fa" "$1,357.00 " "Hand-Finger Orthosis, Reverse Knuckle Bender" $199.00 "Hand-Finger Orthosis, Reverse Knuckle Bender, w/ O" $250.00 Haptoglobin $873.00 Hard Protet Helmet Prefabricated $824.00 HCG/Serum Pregnancy Test $385.00 HCV PCR Qualtitative $292.00 HCV PCR Quantitation Regular $906.00 "Headrest Padding w/ Cover, All Sizes" $245.00 "Heavy and Light Chain, IgA" $87.00 "Heavy and Light Chain, IgA" $168.00 "Heavy and Light Chain, IgG" $87.00 "Heavy and Light Chain, IgG" $168.00 "Heavy and Light Chain, IgM" $87.00 "Heavy Metal Screen, Urine, Random" "$1,880.00 " "Heavy Metals Screen, Urine timed" "$1,880.00 " "Heavy Metals Screen, Whole Blood" "$1,880.00 " "Heel, Counter, Plastic Reinforced" $61.00 "Heel, New Leather, Standard" $138.00 "Heel, New Rubber, Standard" $159.00 "Heel, Pad, Removable for Spur" $63.00 "Heel, Sach Cushion Type" $109.00 "Heel, Thomas Extended to Ball" $69.00 "Heel, Thomas w/ Wedge" $69.00 "Heinz Body Prep, Direct" $91.00 Helicobacter Pylori- IgG Elisa $364.00 "Helmet, Molded to Model" "$2,522.00 " "Helmet, Non-Molded" $670.00 "Hematocrit, Fluid" $58.00 Hematopathology Review $143.00 Hemiepiphysiodesis Distal Femur or Prox Tibia "$2,877.00 " Hemiepiphysiodesis Distal Femur or Prox Tibia Bila "$4,015.00 " Hemiepiphysiodesis Distal Tibia "$2,638.00 " "Hemipel, Canadian type; molded socket, endo system" "$13,382.00 " "Hemipelvectomy, Canadian type; molded socket, hip " "$14,474.00 " Hemochromatosis Panel $993.00 Hemodialysis Procedure Charge "$1,658.00 " Hemoglobin $30.00 Hemoglobin A2 Quantitation $581.00 Hemoglobin Electrophoresis $966.00 Hemoglobin Glycosated $263.00 "Hemoglobin, Urine" $17.00 Heparin Induced Antibody $523.00 "Hepatitis A Antibody, Total" $339.00 Hepatitis A IgM $339.00 Hepatitis B Core Antibody IgG + IgM $521.00 Hepatitis B Core Antibody IgM Acute Titer $513.00 Hepatitis B Core IgM $370.00 Hepatitis B Surface Antibody $267.00 "Hepatitis B Surface Antibody, Quant, End" $354.00 Hepatitis B Surface Antigen $273.00 "Hepatitis B Viral DNA, Qualitative" $596.00 Hepatitis B Virus Viral Load PCR $904.00 Hepatitis BE Antigen $35.00 Hepatitis BE Antigen/Antibody $246.00 Hepatitis C Antibody IgM + IgG $463.00 Hepatitis C Genotype "$3,375.00 " Hepatitis C Virus Antibodies (RIBA) & Bands $376.00 Hepatitis C Virus Qualitative RT-PCR $639.00 Hepatitis C Virus-Quantitative $906.00 Hepatitis D Virus Antibody Panel (IgG) $256.00 Hepatitis D Virus IgM $132.00 Herpes Culture $254.00 Herpes Simplex AB IgG $304.00 Herpes Simplex AB IgM $304.00 Herpes Simplex DFA $130.00 Herpes Simplex Virus 1&2 PCR $918.00 Herpes Simplex Virus PCR $918.00 Heterophile Screen $188.00 HFO NONTORSION JNTS PRE OTS (L3930) $357.00 "HFO Nontorsion Joint, Prefabricated" $386.00 HFO WITHOUT JOINTS PRE OTS (L3924) $376.00 HHTC Charge-Subsequent $105.00 HI STRNGTH LTWT FOOT INSERT EACH $238.00 High Density Lipoprotein $399.00 High Humidity Trach Collar Charge-Equipment $135.00 Hip Arthrogram (73525) $92.00 Hip Block Cover - Complex Upcharge $60.00 "Hip disart, Canadian type; molded socket, endo sys" "$16,215.00 " "Hip disartic, Canadian type; molded socket, hip jt" "$13,362.00 " "Hip disartic, tilt table type; molded socket, lock" "$14,886.00 " Hip Orthosis Bilateral Thighcuffs w/ Spreader Bar "$1,651.00 " "Hip Orthosis, Abduction Control" $467.00 "Hip Orthosis, Abduction Control, Custom Fabricated" "$5,159.00 " "Hip Orthosis, Abduction Control, Flexible, Frejka " $597.00 "Hip Orthosis, Abduction Control, Flexible, Pavlik " $348.00 "Hip Orthosis, Abduction Control, Post-op type" "$4,347.00 " "Hip Orthosis, Abduction Control, Semi-Flexible (Vo" $469.00 "Hip Orthosis, Abduction Control, Static, Adjustabl" $545.00 "Hip Orthosis, Abduction Control, Static, Pelvic Ba" "$2,196.00 " "Hip Orthosis, Adbuction Control, Flexible, Frejka " $254.00 "Hip Orthosis, Adduction Control" "$8,972.00 " "Hip Orthosis, Dynamic, Abduction/Pelvic/Adj Hip Co" "$5,285.00 " "Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Bil" $450.00 "Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Bil" "$2,262.00 " "Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Bil" "$2,522.00 " "Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Uni" $343.00 "Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Uni" $824.00 "Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Uni" "$2,306.00 " Histone Semi-Quantitative $244.00 "Histoplasma Antigen, Urine" $248.00 HIV Antigen/Antibody Combo $236.00 HIV P24 Antigen Test $505.00 HIV-1 Viral Load (Regular) "$1,119.00 " HIV-1 Viral Load (Ultra) "$1,119.00 " HIV-2 IgG with Confirmation $531.00 HLA B27 $372.00 Home Health Cert. Medicare Only Charge (G0180) $254.00 Home Health Re-certification Greater than 60 days $194.00 Homocysteine-Serum $221.00 Homocysteine-Urine $354.00 HOOK/HAND HVY DTY VOL CLOS "$6,288.00 " HOOK/HAND HVY DTY VOL OPEN "$5,784.00 " HOSE ANTIEMBOLISM THIGH SMALL SHORT $47.00 HOSE COMPRESSION LRG 15-20mmHg $109.00 HOSE COMPRESSION LRG 20-30mmHg $127.00 HOSE COMPRESSION LRG 30-40mmHg $127.00 HOSE COMPRESSION MED 15-20mmHg $109.00 HOSE COMPRESSION MED 20-30mmHg $127.00 HOSE COMPRESSION MED 30-40mmHg $127.00 HOSE COMPRESSION SML 15-20mmHg $109.00 HOSE COMPRESSION SML 20-30mmHg $127.00 HOSE COMPRESSION STOCKING JOBST 30-40MMhG SMALL $127.00 HOSE COMPRESSION XLG 15-20mmHg $109.00 HOSE COMPRESSION XLG 20-30mmHg $127.00 HOSE COMPRESSION XLG 30-40mmHg $127.00 "HOSE, ANTIEMB THIGH XL SHORT" $410.00 Hospital Discharge > 30 min Charge - 99239 $363.00 Hospital Discharge 30 min or less Charge - 99238 $287.00 "HTLV, IgG" $114.00 Human Anti-Mouse IgG Antibodies $256.00 HUMID - VENT MINI $9.00 HUMID - VENT 1 $5.00 HUMID - VENT 2 STRAIGHT $9.00 HUMID TRACH VENT $5.00 HUMIDIFIER CHAMBER $50.00 "HYDROFERA BLUE FOAM DRESSING 4"" X 4""" $5.00 HYDROGEL IMPREGNATEED GAUZE PAD 4X4 $26.00 HYDROGEL TUBE 3 OZ $27.00 Hypnotherapy $347.00 Hypobaric Sheath $145.00 Hypobaric Wool $192.00 I&D PELV/HIP JNT; INF BURSA (26991) "$1,453.00 " I&D PILONID CYS; SMPL (10080) $818.00 I&D PILONID CYST; CPLX (10081) "$3,572.00 " I.M.S.T. $88.00 IgE Level $62.00 "IgG/Albumin Index, CSF" $279.00 Iliac Osteotomy with Femoral Shortening "$6,259.00 " Iliac Osteotomy with Femoral Shortening and Open R "$6,940.00 " Iliac Osteotomy with Open Reduction "$5,941.00 " "Immediate postsurg/early fitting, """"AK"""" or knee d" "$1,306.00 " "Immediate postsurg/early fitting, app of initial r" "$1,053.00 " "Immediate postsurg/early fitting, app of initial r" "$3,384.00 " "Immediate postsurg/early fitting, app of initial r" "$3,809.00 " "Immediate postsurg/early fitting, app of initial r" "$4,027.00 " "Immediate postsurg/early fitting, app of initial r" "$4,814.00 " "Immediate postsurg/early fitting, app of initial r" "$5,096.00 " "Immediate postsurg/early fitting, app of nonweight" "$1,482.00 " "Immediate postsurg/early fitting, app of nonweight" "$1,508.00 " "Immediate postsurg/early fitting, app of rigid drs" "$1,239.00 " "Immediate postsurg/early fitting, each, addit cast" "$1,118.00 " Immunoassay Nonantibody (Histone) $79.00 Immunoassay Quant NOS NONAB $74.00 "Immunoassay, RIA, not elsewhere specified" $209.00 "Immunoassay,other analytes" $225.00 "immunofixation electrophoresis, other fluid requir" $354.00 "Immunofixation Electrophoresis, Timed Urine" $685.00 "Immunofixation Electrophoresis, Urine" $544.00 Immunofixation Profile $370.00 Immunoglobulins $845.00 "Immunoglobulins, Quantitative IgA, IgG, IgM" "$1,636.00 " IMPL OR REVISE EPID CATH FOR PAIN (62350) "$1,464.00 " IMPL/REPL PR PUMP FOR INFUSION (62362) "$1,421.00 " Implant Neuroelectrodes "$26,196.00 " INC DEEP W OP BONE CORTEX PELV (26992) "$3,195.00 " INC/REPL SPINE NSTIM PG/RCVR (63685) "$1,321.00 " INCENTIVE SPIROMETER $29.00 INCISE FOOT/TOE FASCIA (28008) "$1,028.00 " Incise Thigh Tendon and Fascia "$10,400.00 " "Incise Thigh Tendon and Fascia, Bilateral" "$15,597.00 " "Incision (eg, osteomyelitis or bone abscess), leg " "$2,555.00 " "Incision (eg, osteomyelitis or bone abscess), leg " "$3,669.00 " "Incision and drainage complex, post-op infection" "$6,354.00 " "Incision and Drainage of Abscess, complicated or m" "$1,207.00 " "Incision and Drainage of Abscess, single or simple" $912.00 "Incision and Drainage of Hematoma, Seroma or Fluid" "$4,931.00 " "Incision and Drainage, deep abscess, bursa or hema" "$14,255.00 " "Incision and Drainage, deep abscess, bursa, or hem" "$8,543.00 " "Incision and Drainage, leg or ankle; Infected burs" "$1,404.00 " "Incision and Drainage, leg or ankle; Infected burs" "$2,005.00 " "Incision and Drainage; Leg, Ankle, Deep Abscess, o" "$8,645.00 " Incision bone cortex (osteomyelitis) shoulder area "$2,902.00 " "Incision bone cortex, forearm/wrist" "$3,008.00 " Incision deep femur (osteomyelitis) "$2,672.00 " "Incision, bone cortex, hand or finger (eg. osteomy" "$2,155.00 " Incision/fixation of femur bilateral "$11,059.00 " Individual Education 15 min $82.00 Individual Therapy Exercise 15 min $95.00 Infant Above Elbow "$6,552.00 " INFANT RESPIRATORY CARE SYSTEM $208.00 INFANT RESUSCITATION BAG $36.00 Infectious agent antigen detection $82.00 "Infectious Agent Detection by Nucleic Acid,Amplifi" $92.00 "Influenza A + B IgG, IgA, & IgM Antibodies" $93.00 "Influenza A+B IgG, IgA & IgM Antibodies" $180.00 INFRARED THERAPY 1+ AREAS OT (97026) $17.00 INFRARED THERAPY 1+ AREAS PT (97026) $17.00 INFUSION PUMP MODULE -LVP $51.00 INFUSION PUMP- PCU $199.00 Initial Hospital Care Level 1 Charge - 99221 $419.00 Initial Hospital Care Level 2 Charge - 99222 $481.00 Initial Hospital Care Level 3 Charge - 99223 $586.00 Initial Inpatient Consultation Level 1Charge - 992 $419.00 Initial Inpatient Consultation Level 2 Charge- 992 $419.00 Initial Inpatient Consultation Level 3 Charge - 99 $481.00 Initial Inpatient Consultation Level 4 Charge - 99 $586.00 Initial Inpatient Consultation Level 5 Charge - 99 $586.00 "Initial, AK or knee disartic, ischial level socket" "$4,955.00 " "Initial, BK """"PTB"""" type socket, non-alignable sys" "$3,525.00 " "Inj Anesth; Intercost Nrv, Multi/Region" "$2,859.00 " "Inj Anesth; Intercost Nrv, Multi/Region, Bilateral" "$5,135.00 " INJ ANESTH; PUDENDAL NERVE (64430) "$3,145.00 " INJ ANESTH; SPHENOPALATINE GANGLION (64505) "$1,160.00 " INJ ANESTH; SUPRASCAPULAR NERVE (64418) "$1,773.00 " Inj Epidural Blood or Clot Patch "$1,627.00 " INJ NEUROLYTIC; EPIDURAL LUMB/CAUDAL (62282) "$7,790.00 " Inj Paravert F Jnt C/T One Level (64490) "$3,144.00 " Inj Paravert F Jnt C/T One Level-Bilateral (64490- "$6,285.00 " Inj Paravert F Jnt C/T Three Levels (64492) "$1,252.00 " Inj Paravert F Jnt C/T Three Levels-Bilateral (644 "$2,392.00 " Inj Paravert F Jnt C/T Two Levels (64491) "$1,192.00 " Inj Paravert F Jnt C/T Two Levels-Bilateral (64491 "$2,384.00 " Inj Paravert F Jnt L/S One Level (64493) "$3,092.00 " Inj Paravert F Jnt L/S One Level-Bilateral (64493- "$6,177.00 " Inj Paravert F Jnt L/S Three Levels (64495) "$1,166.00 " Inj Paravert F Jnt L/S Three Levels-Bilateral (644 "$2,330.00 " Inj Paravert F Jnt L/S Two Levels (64494) "$1,162.00 " Inj Paravert F Jnt L/S Two Levels-Bilateral (64494 "$2,325.00 " INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE(6444 $203.00 Injection intralesional; up to and incl. 7 lesions $112.00 Injection Tendon Origin/Insertion Charge (20551) "$1,070.00 " "Injection Tendon Sheath, Ligament Charge (20550)" "$1,070.00 " Injection Therapeutic Carpal Tunnel Charge (20526) "$1,137.00 " Injection Therapeutic Carpal Tunnel-Bilateral Char "$1,721.00 " Injection Trigger Point(s): 1 or 2 Muscle(s) Charg "$1,064.00 " Injection Trigger Point(s): 3 or more Muscle(s) Ch "$1,064.00 " Injection(s) Plantar digital nerve(s) (Morton's Ne $973.00 "Injection(s), platelet rich plasma, any site, incl" "$1,172.00 " "Injection, anesthetic agent; intercostal nerve, si" "$1,712.00 " "Injection, Anesthetic Agent; Lumbar or Thoracic (p" "$2,822.00 " "Injection, Anesthetic Agent; Stellate Ganglion" "$3,065.00 " "Injection, anesthetic agent; trigeminal nerve, any" $964.00 "Injection, intralesional; more than 7 lesions (119" $175.00 Inpatient Vocational Rehab Evaluation $173.00 INS PIC Age 5 yrs/> "$3,210.00 " Insall "$3,137.00 " Insert Non-Tunnel CV Cath age 5 Yr/> "$4,840.00 " "Insole, Leather" $57.00 "Insole, Rubber" $49.00 Inspiratory Muscle Trainer $91.00 Insulin Level $420.00 Intact Parathyroid Hormone $656.00 Intensive Aphasia Program $996.00 Intensive Aphasia Program Full Charge "$20,916.00 " Intensive Aphasia Program Half Day $498.00 "INTERCARPAL FUSION, WO BONE GRAFT (25820)" "$16,447.00 " Interleukin-6 $449.00 INTERMEDIATE EYE EXAM EST PT (92012) $352.00 "INTERMEDIATE NEW PATIENT, EYE EXAM PT (92002)" $339.00 "International Case Managment, per hour" $80.00 "Interscapular thoracic, molded socket, shoulder bu" "$11,794.00 " "Interscapular thoracic, passive restoration (compl" "$10,092.00 " "Interscapular-thoracic, ext power, molded inner so" "$44,436.00 " INTERVAL TIMER $85.00 INTMD WND REPAIR S/A/T/EXT (12035) "$1,788.00 " INTMD WND REPAIR S/A/T/EXT (12036) "$1,825.00 " "INTMD WND REPAIR S/A/T/EXT, 2.6-7.5 cm (12032)" $688.00 INTMD WND REPAIR S/TR/EXT 30.0+ CM (12037) "$1,203.00 " INTMD WND REPAIR S/TR/EXT 7.6-12.5 CM (12034) "$1,529.00 " Intra-abdominal Pressure Test (51797) $960.00 "Intrascapular thoracic, passive restoration (shoul" "$5,851.00 " "Intrerscapular-thoracic, ext power, molded inner s" "$40,311.00 " IONM REMOTE/>1 PT OR PER HR (95941) $122.00 IPPB $162.00 IPPB Charge $210.00 "IPV PULMONARY TUBING CIRCUIT, INDIVIDUAL" $281.00 Iron $130.00 Iron and Iron Binding Capacity $302.00 Iron and Iron Binding Capacity with Transferrin $381.00 Iron Binding Capacity $166.00 Iron Level $302.00 IRRIGATION SYSTEM VISI-FLOW $284.00 Isocal HN $3.00 Isosource $7.00 Isosource 1.5 $7.00 Isospora Exam $205.00 Itraconazole Level $796.00 "IV SAFETY START KIT W/GLOVE, MEDC" $9.00 IVAC PROBE RECTAL TEMP PLUS 2880A $27.00 Jo-1 Quantitative $244.00 Job Coaching Units $117.00 Job Placement - Individual $77.00 Job Placement Case Management Units $138.00 Job Placement Group Units $74.00 Job Placement Individual Units $77.00 Jones Procedure "$1,544.00 " KANGAROO E-PUMP ENTERNAL FEEDING PUMP $158.00 Kappa/Lambda Ratio $246.00 Kidney Chemistry Panel $699.00 Kindercal with Fiber $4.00 KIT BLOOD GAS W/SAFETY CATH 3CC $7.00 KIT CATHETER SUCTION W/NACL 10FR $6.00 KIT CATHETER SUCTION W/NACL 12FR $6.00 KIT CATHETER SUCTION W/NACL 14FR $6.00 KIT CATHETER SUCTION W/NACL 8FR $7.00 KIT CATHETER TOUCHLESS FOR INTERMITTENT UNISEX 14F $21.00 KIT IRRIGATION 60CC $9.00 KIT STAPLE REMOVER $6.00 KIT SUTURE REMOVER $5.00 KIT TRACHEOSTOMY CARE $7.00 Klonopin Level $796.00 "KNEE DISART, SACH FT, ENDO (L5312)" "$12,111.00 " "Knee disartic (or through knee), molded socket, ex" "$12,081.00 " "Knee disarticulation, molded socket, bent knee con" "$11,229.00 " "Knee Orthosis, Derotation, Medial/Lateral, Custom " "$1,947.00 " "Knee Orthosis, Double Upright, Medial/Lateral Rota" "$3,886.00 " "Knee Orthosis, Double Upright, Medial/Lateral/Rota" "$5,430.00 " "Knee Orthosis, Elastic w/ Condylar Pads and Joints" $660.00 "Knee Orthosis, Elastic w/ Conylar Pads" $210.00 "Knee Orthosis, Elastic w/ Joints" $476.00 "Knee Orthosis, Elastic w/ Stays" $293.00 "Knee Orthosis, Immobilizer, Canvas" $386.00 "Knee Orthosis, Positional Adjustable Knee Joints, " "$3,195.00 " "Knee Orthosis, Positional, Locking Knee Joint, Pre" "$1,365.00 " "Knee Orthosis, Rigid, Molded to Patient, w/o Knee " "$3,367.00 " "Knee Orthosis, Rigid, Prefabricated, w/o Knee Join" $297.00 "Knee Orthosis, Single Upright w/ Adjustable Joint," "$2,245.00 " "Knee Orthosis, Single Upright, Thigh/Calf Adjustab" "$7,066.00 " "Knee Orthosis, Supracondylar Model, Molded to Pati" "$5,784.00 " "Knee Orthosis, Swedish Style" "$1,321.00 " "Knee-Ankle-Foot Orthosis, Double Upright, Free Ank" "$2,394.00 " "Knee-Ankle-Foot Orthosis, Double Upright, Free Kne" "$5,113.00 " "Knee-Ankle-Foot Orthosis, Double Upright, Free Kne" "$8,601.00 " "Knee-Ankle-Foot Orthosis, Femoral Fx, Thermoplasti" "$2,819.00 " "Knee-Ankle-Foot Orthosis, Full Plastic, Static, Pr" $384.00 "Knee-Ankle-Foot Orthosis, Full Plastic, w/out Knee" "$2,825.00 " "Knee-Ankle-Foot Orthosis, Molded to Patient, Femor" "$3,315.00 " "Knee-Ankle-Foot Orthosis, Rigid, Femoral Fx" "$2,786.00 " "Knee-Ankle-Foot Orthosis, Semi-Rigid, Femoral Fx" "$2,546.00 " "Knee-Ankle-Foot Orthosis, Single or Double Upright" "$19,010.00 " "Knee-Ankle-Foot Orthosis, Single Upright, Free Ank" "$1,928.00 " "Knee-Ankle-Foot Orthosis, Single Upright, Free Kne" "$5,192.00 " "Knee-Ankle-Foot Orthosis, Single Upright, Full Pla" "$7,694.00 " "Knee-Ankle-Foot Orthosis, Soft, Femoral Fx" "$2,150.00 " KO ADJ JNT POS R SUP PRE OTS (L1833) "$2,958.00 " KO DBL UPRIGHT W/AIR PRE OTS (L1848) "$2,469.00 " KO ELASTIC W/JOINTS PRE OTS (L1812) $442.00 KOH Prep $61.00 KOH Prep $188.00 "K-Typing, Patient" $114.00 "K-Typing, Unit" $114.00 "L0450 Thoracic-Lumbar-Sacral Orthosis, Flexible, P" $754.00 "L0452 Thoracic-Lumbar-Sacral Orthosis, Flexible, C" "$1,574.00 " "L0490 Thoracic-Lumbar-Sacral Orthosis, 1-Piece Rig" $630.00 "L0633 Lumbar-Sacral Orthosis, Rigid Posterior Pane" "$1,329.00 " "L0635 LSO Sag Rigid Panel, Pre" "$2,223.00 " "L0636 LSO Sag Rigid Panel, Cust" "$3,015.00 " "L0639 Lumbar-Sacral Orthosis, Sac - T9, Prefabrica" "$2,881.00 " "L0640 Lumbar-Sacral Orthosis, sac - T9, Custom Fab" "$4,853.00 " L1005 Tension Scoliosis Orthosis with Pads "$3,937.00 " L1847 KO Adjustable with air Chambers "$2,667.00 " "L2034 Knee-Ankle-Foot Orthosis, Full Plastic, Sing" "$9,423.00 " "L2232 Rocker bottom, Cus Fab Only" $451.00 L2387 Polycentric Knee JT $887.00 L3252 Custom Plastazote Ea $179.00 L3254 Non Standard Size/Width Pr $220.00 L3255 Non Standard Size/Length Pr $192.00 L3257 Split Size Additional charge $255.00 "L3410 Metatarsal bar wedge, between sole" $423.00 L3480 Pad & Depression for Spur $287.00 "L3649 Orthopedic Shoe Addition/Modification, Velcr" $136.00 L3649a Rockport $274.00 "L3675 Shoulder orthosis (SO), vest type abduction " $729.00 L3761 Elbow orthosis with adjustable position lock "$1,720.00 " "L3913 HFO, w/o JTs, Custom Fab" "$1,144.00 " "L3933 FO, w/o JTs, Custom Fab" $899.00 "L3935 FO, Nontorsion JT, Custom Fab" $931.00 "L3967 SEWHO, Airplane Design, w/o JTs, Custom Fab" "$3,826.00 " "L3971 SEWHO, Shoulder cap design, Incl Nontorsion " "$3,919.00 " "L3973 SEWHO, Airplane design, Incl Nontorsion JTs/" "$4,127.00 " "L3975 SEWHO, Shoulder cap design, w/o JTs" "$3,498.00 " "L3976 SEWHFO, Airplane design, w/o JTs" "$3,498.00 " "L3977 SEWHFO, Shoulder cap design, Incl nontorsion" "$3,919.00 " "L3978 SEWHFO, Airplane design, Incl Nontorsion JTs" "$4,127.00 " "L4002 Replacement Strap, Any" $61.00 "L4045 Replace non-molded thigh lacer, for custom f" "$1,401.00 " L4205 Repair Labor 15 minutes $130.00 "L5580 Prep, AK or knee disartic, ischial level soc" "$8,794.00 " "L5703 Ankle, symes, molded to patient model w/o so" "$5,780.00 " "L5705 Custom shaped protective cover, AK" "$7,468.00 " "L5971 All lower extremity prosthesis,solid ankle c" $673.00 "L6130 BE, molded socket (Muenster or Northwestern " "$7,636.00 " "L6570 Shoulder disartic, molded socket, endo sys, " "$12,147.00 " "L6621 Upper extremity additions,flexion/extension " "$7,087.00 " "L6677 Upper extremity addition,harness,triple cont" $709.00 "L6714 Terminal device, hand, VC, pediatric" "$4,101.00 " L6880 ELEC HAND IND ART DIGITS "$72,824.00 " "L6883 Replacement socket,below elbow/wrist disarti" "$9,233.00 " "L6884 Replacement socket,above elbow/elbow disarti" "$6,227.00 " "L6885 Replacement socket,shoulder disarticulation/" "$9,676.00 " "L6895 UE Pros Addition, glove for terminal device," "$2,069.00 " "L7400 Addition to upper extremity prosthesis,below" $952.00 "L7401 Addition to upper extremity prosthesis,above" "$1,064.00 " "L7402 Addition to upper extremity prosthesis,shoul" "$1,147.00 " "L7403 Addition to upper extremity prosthesis,below" "$1,142.00 " "L7404 Addition to upper extremity prosthesis,above" "$1,722.00 " "L7405 Addition to upper extremity prosthesis,shoul" "$2,252.00 " "L7600 Prosthetic donning sleeve, any material, ea" $166.00 "L7700 Gasket or seal, for use with prosthetic sock" $377.00 "Labac Arm Support, All Sizes, Each" $390.00 LACRI-LUB S.O.P. OINTMENT 3.5gm $49.00 Lactate Dehydrogenase Isoenzymes (contains LDH) $157.00 "Lactate Dehydrogenase, Fluid" $157.00 Lactate Dehydrogenase/LDH $190.00 "Lactic Acid, Venous Specimen" $134.00 Lamictal Level $428.00 Lamotrigine Level $796.00 Laptray Edging $468.00 Laptray Padding $284.00 "Laptray Velcro Straps, Pair" $119.00 "Laptray, Custom" $599.00 Laryngoscopy Flex Fibroptic $176.00 Laryngoscopy Flex Fibroptic- Physician fee $413.00 Laryngoscopy Indirect Diagnostic (31505) $505.00 Lateral Contour Option $117.00 Lateral Hip Block w/ Cover $371.00 LDH Isoenzymes $77.00 Lead Level $660.00 LEG CPM MACHINE $216.00 "Legg Perthes Orthosis, Newington Type" "$4,378.00 " "Legg Perthes Orthosis, Patten Bottom Type" "$3,956.00 " "Legg Perthes Orthosis, Toronto Type" "$3,440.00 " "Legg Perthes Orthosis, Trilateral, Tachdijan Type" "$3,259.00 " "Legionella Antigen, Urine" $99.00 Legionella DFA Stain $179.00 "Legionella Pneumophila IgG & IgM Antibodies, Sero" $327.00 Leishmania Antibodies $159.00 Lengthen Flexor Tendon (ea) "$2,319.00 " "Lengthen, Extensor, Hand/Finger (ea) Tendon" "$2,486.00 " "Lengthening or Shortening of Tendon, leg or ankle;" "$1,919.00 " "Lengthening or Shortening of Tendon, leg or ankle;" "$2,784.00 " Levetiracetam Level $796.00 "Lewis Phenotyping, blood" $114.00 "Lift, Heel and Sole, Cork, Per Inch" $179.00 "Lift, Heel and Sole, Neoprene, Per Inch" $379.00 "Lift, Heel, Per Inch" $177.00 "Lift, Heel, Tapered to Metatarsal, Per Inch" $242.00 "Lift, Inside Shoe, Tapered, Per Inch" $343.00 "Lift, Metal Extension (Skate)" "$1,250.00 " Lipase $374.00 "Lipase, Fluid" $374.00 Lipoprotein (a) $256.00 Lipoprotein Electrophoresis $488.00 Lipoprotein Fractionation $120.00 "Lipoprotein, blood" $82.00 "Lithium ion battery, charger" "$1,564.00 " "Lithium ion battery, replacement" "$1,207.00 " Lithium Level $252.00 LITTLE SWIMMERS LARGE $4.00 LITTLE SWIMMERS MEDIUM $4.00 Liver Chemistry Panel $550.00 Liver-Kidney Microsome Autoantibodies $422.00 LNCS TFA - ADH SENSOR DISPOSABLE $96.00 LNGTHN.SHORTN MULTI LEG/ANKLE TENDONS EA BILATERAL "$18,896.00 " LO RIG POS PNL L1-L5 PRE OTS (L0641) $334.00 Long Arm Cast (29065) "$1,167.00 " Long Leg Cast "$1,312.00 " Long Leg Cast Bilateral "$1,966.00 " Long Leg Splint $193.00 Low Level IgM $163.00 Lower Extremity Addition Thigh/Weight Bearing Lace "$2,106.00 " "Lower Extremity Addition, Abduction Bar, Jointed, " $527.00 "Lower Extremity Addition, Abduction Bar, Straight" $536.00 "Lower Extremity Addition, Anterior Swing Band" $618.00 "Lower Extremity Addition, Dorsiflexion/Plantarflex" $293.00 "Lower Extremity Addition, Dorsiflexion/Plantarflex" $374.00 "Lower Extremity Addition, Extended Steel Shank" $240.00 "Lower Extremity Addition, Foot Plate, Stirrup Atta" "$1,906.00 " "Lower Extremity Addition, Lacer, Molded to Patient" "$1,706.00 " "Lower Extremity Addition, Limited Ankle Motion Joi" $234.00 "Lower Extremity Addition, Molded Inner Boot" "$2,620.00 " "Lower Extremity Addition, Non-Corrosive Finish Bar" $294.00 "Lower Extremity Addition, Non-Molded Lacer, Custom" $894.00 "Lower Extremity Addition, Offset Knee Joint" $475.00 "Lower Extremity Addition, Offset Knee Joint, Heavy" $677.00 "Lower Extremity Addition, Patten Bottom" $748.00 "Lower Extremity Addition, Pelvic Control Band/Belt" "$1,458.00 " "Lower Extremity Addition, Pelvic Control Hip Joint" "$1,161.00 " "Lower Extremity Addition, Pelvic Control Sling" "$2,015.00 " "Lower Extremity Addition, Pelvic Control, Band/Bel" $553.00 "Lower Extremity Addition, Pelvic Control, Hip Jt, " $509.00 "Lower Extremity Addition, Pelvic Control, Hip Jt, " $930.00 "Lower Extremity Addition, Pelvic Control, Hip Jt, " "$1,064.00 " "Lower Extremity Addition, Pelvic Control, Hip Jt, " "$1,095.00 " "Lower Extremity Addition, Pelvic Control, Hip Jt, " "$1,475.00 " "Lower Extremity Addition, Pelvic Control, Reciproc" "$7,268.00 " "Lower Extremity Addition, Pelvic Control, Reciproc" "$9,914.00 " "Lower Extremity Addition, Pelvic/Thoracic Control " $643.00 "Lower Extremity Addition, Pre-Tibial Shell, Molded" "$1,938.00 " "Lower Extremity Addition, PTB Socket, Molded to Pa" "$1,660.00 " "Lower Extremity Addition, Reinforced Solid Stirrup" $868.00 "Lower Extremity Addition, Round caliper, Plate Att" $440.00 "Lower Extremity Addition, Split Flat Caliper Stirr" $442.00 "Lower Extremity Addition, Straight Knee Joint, Hea" $682.00 "Lower Extremity Addition, Suspension Sleeve" $238.00 "Lower Extremity Addition, Thigh Weight Bearing Isc" "$1,526.00 " "Lower Extremity Addition, Thigh Weight Bearing Lac" $572.00 "Lower Extremity Addition, Thigh Weight Bearing, Hi" $814.00 "Lower Extremity Addition, Thigh Weight Bearing, Qu" "$1,282.00 " "Lower Extremity Addition, Thigh/Gluteal/Ischial We" $749.00 "Lower Extremity Addition, Thigh/Weight Bearing Isc" "$2,365.00 " "Lower Extremity Addition, Thigh/Weight Bearing Qua" "$2,567.00 " "Lower Extremity Addition, Thoracic Control Band" $828.00 "Lower Extremity Addition, Thoracic Control Lateral" $680.00 "Lower Extremity Addition, Thoracic Control, Parasp" $383.00 "Lower Extremity Addition, Torsion Control, Ankle J" $294.00 "Lower Extremity Addition, Torsion Control, Straigh" $309.00 "Lower Extremity Addition, Valgus/Varus Correction " $284.00 "Lower Extremity Addition, Valgus/Varus Correction " $606.00 "Lower Extremity Foot Orthosis Addition, Adj Motion" $368.00 "Lower Extremity Foot Orthosis Addition, Drop Lock " $531.00 "Lower Extremity Foot Orthosis Addition, Hip Jt, Pe" $793.00 "Lower Extremity Foot Orthosis Addition, Limited Mo" $276.00 "Lower Extremity Foot Orthosis Addition, Plastic, S" $316.00 "Lower Extremity Foot Orthosis Addition, Quadrilate" $670.00 "Lower Extremity Foot Orthosis Addition, Waist belt" $203.00 "Lower Extremity Orthosis Addition, Carbon Laminati" $607.00 "Lower Extremity Orthosis Addition, Condylar Pad" $379.00 "Lower Extremity Orthosis Addition, Drop Lock Retai" $138.00 "Lower Extremity Orthosis Addition, Extension Per B" $505.00 "Lower Extremity Orthosis Addition, Femoral Length " $281.00 "Lower Extremity Orthosis Addition, Full Knee Cap" $383.00 "Lower Extremity Orthosis Addition, Knee Cap, Media" $469.00 "Lower Extremity Orthosis Addition, Plating Chrome/" $187.00 "Lower Extremity Orthosis Addition, Sidebar Disconn" $606.00 "Lower Extremity Orthosis Addition, Soft Interface " $376.00 "Lower Extremity Orthosis Addition, Soft Interface " $406.00 "Lower Extremity Orthosis, Tibial Length Sock, Fx o" $202.00 LSO SAG CTR RIGI POS PRE OTS (L0643) $696.00 LSO SAG R AN/POS PNL PRE OTS (L0648) "$4,409.00 " LSO SAG-CO SHELL PNL PRE OTS (L0651) "$5,564.00 " LSO SC R ANT/POS PNL PRE OTS (L0650) "$5,564.00 " LSO SC R POS/LAT PNL PRE OTS (L0649) "$1,231.00 " "LTV CIRCUIT W/O PEEP, ADULT" $43.00 "LTV CIRCUIT WITH PEEP, ADULT W/MOUTHPICE DEVICE" $61.00 LUBRICATING JELLY SURGILUBE FLIP-TOP 4.25-OZ TUBE $7.00 LUBRIDERM 3.3oz $12.00 Lumbar Discography (62290) $797.00 Lumbar Epidural (64483) "$3,272.00 " "Lumbar Orthosis, Flexible, Prefabricated, w/ Strap" $255.00 "Lumbar Orthosis, Sagittal, Prefabricated, Rigid Pa" $913.00 "Lumbar Orthosis, Sagittal, Prefabricated, w/ Pads/" $362.00 Lumbar TFESI add'l level x___ "$1,147.00 " Lumbar Transforaminal Epidural Inj-Add'l Level BiL "$2,573.00 " Lumbar Transforaminal Epidural Injection-Additiona "$2,025.00 " Lumbar/Sacral Contour Option $119.00 "Lumbar-Sacral Orthosis, Corset Front" $348.00 "Lumbar-Sacral Orthosis, Flexible, Custom Fabricate" $216.00 "Lumbar-Sacral Orthosis, Flexible, Prefabricated, S" $389.00 "Lumbar-Sacral Orthosis, Full Corset" $693.00 "Lumbar-Sacral Orthosis, Protective Body Sock for S" $315.00 "Lumbar-Sacral Orthosis, Rigid Anterior, Sac - T9, " "$2,282.00 " "Lumbar-Sacral Orthosis, Rigid Anterior-Posterior F" "$2,881.00 " "Lumbar-Sacral Orthosis, Rigid Anterior-Posterior P" "$2,872.00 " "Lumbar-Sacral Orthosis, Rigid Posterior Frame/Pane" "$2,933.00 " "Lumbar-Sacral Orthosis, Rigid Posterior, Prefabric" $753.00 "Lumbar-Sacral Orthosis, Thoracic Extension" $539.00 Lumbosacral Transforaminal-Bilateral (64483) "$5,181.00 " Lupus Activity Reporter $935.00 Luteinizing Hormone $581.00 Lyme Disease by PCR $185.00 Lyme Disease by PCR $682.00 "Lyme Disease DNA, Real-Time PCR, Blood" "$1,055.00 " "Lyme Disease, Serum (Confirmatory IgG & IgM)" $225.00 Lyme's Disease Antibodies (Total IgG/IgM) Serum $463.00 "Lymes Disease, Serum Confirmatory IgM" $116.00 Magnesium Level $244.00 "Magnesium, Random Urine" $91.00 "Magnesium, Timed Urine" $83.00 Malarial Prep $64.00 "Mammaplasty, augmentation; with prosthetic implant" "$2,360.00 " "Manganese, RBC" $327.00 Manipulation Elbow G/A "$1,278.00 " Manipulation Knee Under G/A $613.00 Manipulation of Hip Joint $695.00 MASK TRACHEOSTOMOY PEDIATRIC $5.00 Massage Therapy 30 minutes $80.00 Massage Therapy 60 minutes $126.00 Massage Therapy 90 minutes $190.00 Maximum Breathing Capacity and Maximum Voluntary V $160.00 MC Abductor Hardware Removable $136.00 MC Abductor Hardware Swingaway $136.00 MC Abductor Pad $169.00 MC Lateral Trunk Support Pad $176.00 Measure Blood Oxygen Level $11.00 Mechanical In-ExSufflator Charge $210.00 Mechanical Ventilation Initiation Charge $833.00 Mechanical Ventilation Subsequent Days Charge $675.00 "Med Nutrition Assess and Intervention, Individual " $79.00 Med Nutrition Re-Assessment and Intervention each $79.00 MEDELA WOUND VAC $587.00 "MEDIHONEY ADHESIVE DRESSING 4 1/2""X 4 1/2""" $57.00 "MEDIHONEY CALCIUM ALGINATE DRESSING 2""X 2""" $22.00 "MEDIHONEY CALCIUM ALGINATE DRESSING 4""X5""" $62.00 MEDIHONEY GEL 0.5 TUBE $24.00 MEDIHONEY GEL 1.5 TUBE $57.00 "MEDIHONEY NON-ADHESIVE DRESSING (HCS) 4.33""X 4.33""" $49.00 MEPILEX TRANSFER 6X8 $50.00 "Mercury Level, Serum" $618.00 MESH UNDERWEAR SZ 2X/3X 2/PK $6.00 MESH UNDERWEAR SZ 4X 2/PK $9.00 MESH UNDERWEAR SZ LG/ XL 2/PK $6.00 MESH UNDERWEAR SZ SM/MD 2/PK $5.00 METACARP FX ORTHOSIS PRE OTS (L3918) $413.00 METANEB CIRCUITS $310.00 Metanephrines $65.00 "Metanephrines, Fractionated -24 Hr Urine" $136.00 "Metanephrines, Plasma Free" $482.00 "Metatarsal Bar, Rocker" $151.00 Meter Dose Inhaler $75.00 Meter dose inhaler teaching = inhaler $186.00 Meter Dose Inhaler Teaching Charge $116.00 Methotrexate Level $796.00 Methylmalonic Acid $211.00 MIC-KEY FEED TUBE 12FR 1.5CM $421.00 MIC-KEY SECUR-LOK EXT SET $66.00 MIC-KEY SKIN LEVEL 12 FR 1.2 KIT $402.00 "Microalbumin with Creatinine, Urine Timed" $72.00 "Microalbumin with Creatinine, Urine, Random" $153.00 "Microproc control feature, addtion to upper-limb p" "$9,610.00 " Microsporidium $205.00 Midfoot/Post Talotibial Capsulotomy with Tendon Le "$5,197.00 " Mini-Nebulizer $105.00 Minor Inhalation Therapy $144.00 MIRROR LONG HANDLE HAND HELD $119.00 Mirtazapine Level $796.00 "MN Phenotyping, blood" $114.00 "MOD SED SAME PHYS/QHP 5/>YRS, initial 15 minutes (" $38.00 Modified Education Binder $35.00 MOTOR&/SENS 1-2 NRV CNDJ TST (95907) $323.00 MOTOR&/SENS 3-4 NRV CNDJ TST (95908) $358.00 MOTOR&/SENS 5-6 NRV CNDJ TST (95909) $389.00 MOTOR&SEN 11-12 NRV CND TEST (95912) $752.00 MOTOR&SEN 9-10 NRV CNDJ TEST (95911) $684.00 MOTOR&SENS 13/> NRV CND TEST (95913) $824.00 MOTOR&SENS 7-8 NRV CNDJ TEST (95910) $457.00 Motor/Sensory Nerve Conduct Test $247.00 MR290 AUTO FILL HUMIDIFICATION CHAMBER $51.00 MRA Abdomen W/O Contrast "$4,221.00 " MRA Abdomen W&W/O Contrast "$4,221.00 " MRA Abdomen W/ Contrast "$4,221.00 " MRA Chest W/O Contrast "$4,152.00 " MRA Chest W/ Contrast "$4,152.00 " MRA Head W/O Contrast "$4,995.00 " MRA Head W&W/O Contrast "$6,751.00 " MRA Head W/ Contrast "$3,401.00 " MRA Lower Ext W/O Contrast "$4,188.00 " MRA Lower Ext W&W/O Contrast "$4,188.00 " MRA Lower Ext W/Contrast "$4,188.00 " MRA Neck W/O Contrast "$3,995.00 " MRA Neck W&W/O Contrast "$5,651.00 " MRA Neck W/ Contrast "$4,520.00 " MRA Pelvis W/O Contrast "$4,196.00 " MRA Pelvis W/ Contrast "$4,196.00 " MRA Spinal Canal W/O Contrast "$4,382.00 " MRA Spinal Canal W&W/O Contrast "$4,382.00 " MRA Spinal Canal W/ Contrast "$4,382.00 " MRA Upper Ext W/O Contrast "$4,345.00 " MRA Upper Ext W&W/O Contrast "$4,345.00 " MRA Upper Ext W/ Contrast "$4,345.00 " MRI Abdomen W/O Contrast "$4,375.00 " MRI Abdomen Enterography W&W/O Contrast "$5,591.00 " MRI Abdomen MRCP W/O Contrast "$4,375.00 " MRI Abdomen MRCP W&W/O Contrast "$5,591.00 " MRI Abdomen Urography W&W/O Contrast "$5,591.00 " MRI Abdomen W&W/O Contrast "$5,591.00 " MRI Abdomen W/ Contrast "$5,472.00 " MRI Abdominal Wall W/O Contrast "$4,375.00 " MRI Abdominal Wall W/ Contrast "$5,472.00 " MRI Ankle/Hindfoot W/O Contrast Left "$4,761.00 " MRI Ankle/Hindfoot W/O Contrast Right "$4,761.00 " MRI Ankle/Hindfoot W&W/O Contrast Left "$5,757.00 " MRI Ankle/Hindfoot W&W/O Contrast Right "$5,757.00 " MRI Brachial Plexus W/O Contrast Lt "$3,800.00 " MRI Brachial Plexus W/O Contrast Rt "$3,800.00 " MRI Brachial Plexus W&W/O Contrast Lt "$5,579.00 " MRI Brachial Plexus W/W&O Contrast Rt "$5,579.00 " MRI Brain W/O Contrast "$2,897.00 " MRI Brain CSF Study W/O Contrast "$2,897.00 " MRI Brain CSF Study W&W/O Contrast "$3,401.00 " MRI Brain FMRI "$2,897.00 " MRI Brain IAC/Cranial Nerve W/O Contrast "$2,897.00 " MRI Brain IAC/Cranial Nerve W&W/O Cont "$3,401.00 " MRI Brain IAC/Cranial Nerve W/Contrast "$5,472.00 " MRI Brain W&W/O Contrast "$3,401.00 " MRI Brain W&W/O Contrast w/ Perfusion "$3,401.00 " MRI Brain W&W/O Contrast-70553 "$5,538.00 " MRI Brain W/Contrast "$5,472.00 " MRI Chest W/O Contrast "$3,800.00 " MRI Chest W&W/O Contrast "$5,579.00 " MRI Chest W/Contrast "$8,428.00 " MRI Chest Wall W/O Contrast "$3,800.00 " MRI Chest Wall W&W/O Contrast "$5,579.00 " MRI Elbow W/O Contrast Left "$4,404.00 " MRI Elbow W&W/O Contrast Left "$5,472.00 " MRI Elbow W&W/O Contrast Right "$5,472.00 " MRI Elbow W/O Contrast Right "$4,404.00 " MRI Face/Neck W&W/O Contrast "$6,136.00 " MRI Face/Neck W/Contrast "$5,472.00 " MRI Face/Neck W/O Contrast "$2,897.00 " MRI Femur W&W/O Contrast Left "$5,329.00 " MRI Femur W&W/O Contrast Right "$5,329.00 " MRI Femur W/O Contrast Left "$4,404.00 " MRI Femur W/O Contrast Right "$4,404.00 " MRI Finger W&W/O Contrast Left "$5,472.00 " MRI Finger W&W/O Contrast Right "$5,472.00 " MRI Finger W/O Contrast Left "$2,897.00 " MRI Finger W/O Contrast Right "$2,897.00 " MRI Foot W&W/O Contrast Lt "$5,329.00 " MRI Foot W&W/O Contrast Rt "$5,329.00 " MRI Foot W/O Contrast Lt "$4,404.00 " MRI Foot W/O Contrast Rt "$4,404.00 " MRI Forearm W&W/O Contrast Left "$5,472.00 " MRI Forearm W&W/O Contrast Right "$5,472.00 " MRI Forearm W/O Contrast Left "$2,897.00 " MRI Forearm W/O Contrast Right "$2,897.00 " MRI Hand W/O Contrast Left "$2,897.00 " MRI Hand W/O Contrast Right "$2,897.00 " MRI Hand W&W/O Contrast Left "$5,472.00 " MRI Hand W&W/O Contrast Right "$5,472.00 " MRI Hip W&W/O Contrast Lt "$5,757.00 " MRI Hip W&W/O Contrast Rt "$5,757.00 " MRI Hip W/O Contrast Lt "$4,761.00 " MRI Hip W/O Contrast Rt "$4,761.00 " MRI Humerus W&W/O Contrast Lt "$5,472.00 " MRI Humerus W&W/O Contrast Rt "$5,472.00 " MRI Humerus W/O Contrast Lt "$2,897.00 " MRI Humerus W/O Contrast Rt "$2,897.00 " MRI Knee W&W/O Contrast Lt "$5,757.00 " MRI Knee W&W/O Contrast Rt "$5,757.00 " MRI Knee W/O Contrast Lt "$4,761.00 " MRI Knee W/O Contrast Rt "$4,761.00 " MRI Lower Ext Joint W/Contrast Lt "$4,761.00 " MRI Lower Ext Joint W/Contrast Rt "$4,761.00 " MRI Lower Ext Joint W/O Contrast Lt-73721 "$4,761.00 " MRI Lower Ext Joint W/O Contrast Rt-73721 "$4,761.00 " MRI Lower Ext W/Contrast Left "$5,757.00 " MRI Lower Ext W/Contrast Right "$5,757.00 " MRI Lower Ext W/O Contrast Lt-73718 "$4,404.00 " MRI Lower Ext W/O Contrast Rt-73718 "$4,404.00 " MRI Orbits W&W/O Contrast "$6,136.00 " MRI Orbits W/ Contrast "$5,472.00 " MRI Orbits W/O Contrast "$2,897.00 " MRI Pelvis Enterography W&W/O Contrast "$5,591.00 " MRI Pelvis MSK W&WO Contrast "$6,229.00 " MRI Pelvis MSK W/O Contrast "$4,215.00 " MRI Pelvis Urography W&W/O Contrast "$5,591.00 " MRI Pelvis Viscera W&W/O Contrast "$6,229.00 " MRI Pelvis Viscera W/O Contrast "$4,215.00 " MRI Prostate W&W/O Contrast "$6,229.00 " MRI Prostate W/O Contrast "$4,215.00 " MRI Sacrum Coccyx W/O Contrast "$4,215.00 " MRI Sacrum Coccyx W&W/O Contrast "$6,229.00 " MRI Sacrum Coccyx W/ Contrast "$5,472.00 " MRI Shoulder W&W/O Contrast Lt "$5,472.00 " MRI Shoulder W&W/O Contrast Rt "$5,472.00 " MRI Shoulder W/O Contrast Lt "$4,404.00 " MRI Shoulder W/O Contrast Rt "$4,404.00 " MRI Spine Cervical W&W/O Contrast "$6,001.00 " MRI Spine Cervical W/Contrast "$5,472.00 " MRI Spine Cervical W/O Contrast "$4,656.00 " MRI Spine Lumbar W&W/O Contrast "$6,001.00 " MRI Spine Lumbar W/Contrast "$5,472.00 " MRI Spine Lumbar W/O Contrast "$4,649.00 " MRI Spine Thoracic W&W/O Contrast "$6,001.00 " MRI Spine Thoracic W/ Contrast "$5,472.00 " MRI Spine Thoracic W/O Contrast "$4,649.00 " MRI Tibia W&W/O Contrast Lt "$5,329.00 " MRI Tibia W&W/O Contrast Rt "$5,329.00 " MRI Tibia W/O Contrast Lt "$4,404.00 " MRI Tibia W/O Contrast Rt "$4,404.00 " MRI TMJ W&W/O Contrast "$2,897.00 " MRI TMJ W/O Contrast "$2,897.00 " MRI Upper Ext Joint W/Contrast Lt "$8,428.00 " MRI Upper Ext Joint W/Contrast Rt "$8,428.00 " MRI Upper Ext W/ Contrast Left "$5,472.00 " MRI Upper Ext W/ Contrast Right "$5,472.00 " MRI Wrist W&W/O Contrast Lt "$5,472.00 " MRI Wrist W&W/O Contrast Rt "$5,472.00 " MRI Wrist W/O Contrast Lt "$4,404.00 " MRI Wrist W/O Contrast Rt "$4,404.00 " "MRSA Screen, PCR" $534.00 MRV Head W&W/O Contrast "$6,751.00 " MRV Head W/O Contrast "$4,995.00 " MRV Pelvis W&W/O Contrast "$4,196.00 " Multi Density Insert $139.00 "Multiple Density Insert, Custom Fabricated, Molde" $208.00 "Multiple Density Insert, Prefabricated, Molded to " $139.00 Multiple Family Group Psychotherapy $146.00 Mumps Antibody IgG (Immunity) $246.00 Mumps Antibody IgM $178.00 Mumps Virus Culture $157.00 MUSCLE BX; PERC NDL (20206) $157.00 MUSCLE BX; SUPERF (20200) "$5,244.00 " MUSCLE FLAP; LOWER EXTREMITY (15738) "$10,184.00 " MUSCLE FLAP; TRUNK (15734) "$3,710.00 " MUSCLE FLAP; UPPER EXTREMITY (15736) "$3,218.00 " "Muscle/Tendon Transfer Upper Arm/Elbow, Single" "$2,560.00 " MUSK Antibody "$1,735.00 " Mycobacteria Smear $106.00 Mycobacterium Tuberculosis PCR $778.00 Mycophenolic acid Level $217.00 Mycoplasma Antibody $178.00 "Myelin Basic Protein, CSF" $209.00 Myeloperoxidase $316.00 Myoglobin Serum $370.00 "Myoglobin, Urine Random" $370.00 Mysoline Level $664.00 NAIL CARE KIT $6.00 NASAL CANNULA 21FT $6.00 Nasal Saline Irrigation $88.00 Natural Killer Cells(NK cells) $303.00 NB INJ HYPOGAS PLXS (64517) "$3,278.00 " NEBULIZER CAP 1000MI $13.00 "Needle electromyography, each extremity, with rela" $266.00 "Needle electromyography, each extremity, with rela" $398.00 "Needle electromyography, each extremity; limited (" $180.00 "Needle electromyography, each extremity; limited B" $271.00 "Needle Electromyography, non-extremity (95887)" $240.00 "Needle Electromyography, non-extremity Bilateral (" $363.00 Needle Electromyography; Thoracic Paraspinal Muscl $492.00 "Needle EMG, Anal/Urethral Sphincter (51785)" "$1,111.00 " NEEDLE NEXIVA 18G X 1 1/4 $26.00 NEEDLE NEXIVA 20G X 1 IN $26.00 NEEDLE NEXIVA 22G X 1 IN $26.00 NEEDLE NEXIVA 24G X 3/4 IN $26.00 "NEEDLE, INOJECT 38 X 0.45 MM X 26G" $138.00 "NEEDLE, INOJECT 50 X 0.50 MM X 25G" $138.00 Neg Pressure Wound Tx < 50 sq cm (97605) $456.00 Neg Pressure Wound Tx > 50 sq cm (97606) $730.00 Negative Inspiratory Force $387.00 Negative Inspiratory Force Charge $387.00 Nephelometry $94.00 Nerve Block Ilioing/Iliohypogastric Bilateral "$2,480.00 " Nerve Block Ilioning/Iliohypogastric "$1,566.00 " Nerve Destruction Other Peripheral or Branch Charg "$3,457.00 " Nerve Destruction Other Peripheral or Branch Charg "$3,852.00 " Neurobehavioral Status Exam Add On (96121) $103.00 "Neurobehavioral Status Exam, per hour" $541.00 Neuromyelitis Optica IgG $945.00 Neuroplasty; ulnar nerve "$8,640.00 " Neuropsych testing by physician or other qualified $814.00 Neuropsych testing by physician or other qualified $906.00 "NJX INTERLAMINAR CRV/THR, C without imaging guidan" "$2,246.00 " "NJX INTERLAMINAR CRV/THRC, incl indw cath, cont in" "$2,765.00 " "NJX INTERLAMINAR CRV/THRC, incl indw cath/cont fus" "$2,721.00 " "NJX INTERLAMINAR CRV/THRC, with imaging guidance (" "$2,270.00 " "NJX INTERLAMINAR LMBR/SAC, with imaging guidance (" "$2,239.00 " "NJX INTERLAMINAR LMBR/SAC, without imaging guidanc" "$2,200.00 " "NJX INTERLAMINAR LMBR/SAC,incl ind cath, cont infu" "$2,711.00 " "NJX INTERLAMINAR LMBR/SAC,incl indw cath, cont inf" "$2,732.00 " NO SHOW / CANCELLATION PAIN PROGRAM CHARGE $1500 "$1,500.00 " No Show/Cancellation $25.00 No Show/Cancellation-P&O $25.00 No Show/Cancellation-Program $25.00 NON ADHERENT CONTACT LAYER DRESSING 2X2 $9.00 NON- ADHERENT CONTACT LAYER W/TRIACT 6X8 $51.00 "NON BORDERED FOAM, DRESSING 4X4" $10.00 "NON BORDERED FOAM, HEEL" $37.00 Nonadjustable Hip Block Hardware $897.00 NON-BORDERED FOAM DRESSING 2.5 X 2.5 $10.00 NON-PNEUM WALK BOOT PRE OTS (L4387) $680.00 Non-Pneumatic Walking Splint $735.00 Non-Selective Debridement Including Topical Applic $726.00 Nontunnelled Catheter Charge $606.00 Norovirus $358.00 Norpace (Disopyramide) Level $796.00 N-Telopeptide Serum $292.00 "N-Telopeptides (NTX) with Creatinine, Urine Random" $488.00 "N-Telopeptides (NTX), Urine Timed" $486.00 NU Pro Control "$8,302.00 " "Nursing fac care, subseq comprehensive exam" $399.00 "Nursing fac care, subseq detail exam" $271.00 "Nursing fac care, subseq expanded problem focused" $203.00 "Nursing fac care, subseq problem focused exam" $104.00 O2 Uptk Exp Gas Alys Rest Indir Spx Charge-95805 "$2,609.00 " OASIS SALINE MOUTH SPRAY 1oz $32.00 OASIS WOUND MATRIX 3X7CM FENESTRATED $880.00 Oasis wound matrix skin sub per sq cm (Q4102) $37.00 OAT BETA GLUCAN OCCLUSIVE OINTMENT $182.00 OB Combination Headrest $183.00 OB Elevating/Swivel Arm Trough Hardware $272.00 "OB Flat Headrest, Large" $194.00 "OB Flat Headrest, Small" $161.00 OB Forearm Trough $117.00 "OB Hand Pad, Flat" $95.00 "OB Hand Pad, Molded" $95.00 "OB Headrest Hardware, Clamp Only" $72.00 OB Single Axis Headrest Hardware $236.00 Occult Blood Exam $145.00 Occult Blood Screen $145.00 "Occult Blood, Feces-POCT" $145.00 OCEAN SALINE NASAL SPRAY 45cc $28.00 Office Consult Level 1 Charge- 99241 $204.00 Office Consult Level 2 Charge- 99242 $370.00 Office Consult Level 3 Charge- 99243 $460.00 Office Consult Level 4 Charge- 99244 $689.00 Office Consult Level 5 Charge- 99245 $867.00 Office Visit Level 1 Est Charge- 99211 $228.00 Office Visit Level 1 New Charge- 99201 $275.00 Office Visit Level 2 Est Charge- 99212 $312.00 Office Visit Level 2 New Charge- 99202 $385.00 Office Visit Level 3 Est Charge- 99213 $378.00 Office Visit Level 3 New Charge- 99203 $541.00 Office Visit Level 4 Est Charge- 99214 $535.00 Office Visit Level 4 New Charge- 99204 $772.00 Office Visit Level 5 Est Charge- 99215 $719.00 Office Visit Level 5 New Charge- 99205 "$1,004.00 " Off-set Heel $151.00 OINTMENT BARRIER 5.6-OZ $32.00 Oligoclonal Bands $422.00 One Piece Foot Board $132.00 "ONLI HYDRO CATHETER 14FR-16"" MALE" $4.00 ONM IN OPERATNG ROOM 15 MIN (95940) $122.00 OP EPIPHYSEAL ARREST- DISTL TIB & FIB (27734) "$1,622.00 " OP TX ELBOW PA FX/DISLOC (24586) "$26,911.00 " OP TX PATEL FX W IF &/REP (27524) "$2,535.00 " OP TX SCLAV DISL ACUTE/CHR (23530) "$17,583.00 " OP TX SF EPIPHYSIS; OSTEOTOMY (27181) "$3,119.00 " Open lateral release "$1,846.00 " "Open periprosthetic capsulotomy, breast (19370)" "$2,507.00 " Open Reduction Hip "$5,596.00 " "Open Reduction Hip, Bilateral" "$6,682.00 " Open Reduction with Femoral Shortening "$6,268.00 " OPEN SUPERF BONE BX (20240) "$7,974.00 " Open treament of humeral supracondylar fracture "$3,717.00 " "Open Treatment Bimalleolar Ankle Fracture, Include" "$4,629.00 " Open treatment intercondylar spine fracture "$3,610.00 " Open treatment of bimall fracture "$3,299.00 " Open treatment of clavicular fracture "$2,817.00 " Open treatment of distal femoreal epiphyseal separ "$4,132.00 " Open treatment of distal fibula fracture "$2,849.00 " Open treatment of distal radial fracture "$2,886.00 " Open treatment of distal tibia articular fracture "$4,631.00 " Open treatment of femoral neck fracture "$4,958.00 " Open treatment of femoral shaft fracture with intr "$5,572.00 " Open treatment of femoral shaft fracure with plate "$4,186.00 " Open treatment of femoral supracondylar fracture "$4,367.00 " Open treatment of Galeazzi fracture "$3,502.00 " Open treatment of humeral condylar fracture "$3,525.00 " Open treatment of humeral epicondylar fracture "$3,137.00 " Open treatment of humeral supacondylar fracture wi "$4,529.00 " Open treatment of medial mall fracture "$2,598.00 " Open treatment of Monteggia fracture "$3,580.00 " Open treatment of olecranon fracture "$2,745.00 " "Open Treatment of Osteotomy, Shortening, Angular " "$1,375.00 " Open treatment of phalangeal fracture "$2,250.00 " Open treatment of proximal humerus fracture "$3,550.00 " Open treatment of radial AND ulna shaft fracture "$2,693.00 " Open treatment of radial neck fracture "$2,712.00 " Open treatment of radial shaft fracture "$2,815.00 " Open treatment of tib fib synostosis "$2,619.00 " Open treatment of tibia fracture with plate/screws "$3,739.00 " Open treatment of ulna shaft fracture "$2,677.00 " "Open Tx distal Phalang FX ,each" "$10,681.00 " OPEN TX FEMORAL SUPRACONDYLAR FRACT W XTN (27513) "$4,078.00 " ORAL SWAB SYSTEM KIT 6001 $27.00 ORAL TEMPERATURE PROBE $417.00 "Orbicularis Oculi (Blink) Reflex, by electrodiagno" $353.00 "Orthopedic Shoe Addition, Convert Firm Counter to " $130.00 "Orthopedic Shoe Addition, Convert to Velcro Closur" $300.00 "Orthopedic Shoe Addition, Insole, Felt Covered w/ " $69.00 "Orthopedic Shoe Addition, March Bar" $101.00 "Orthopedic Shoe Addition, Sole, Full" $238.00 "Orthopedic Shoe Addition, Sole, Half" $146.00 "Orthopedic Shoe Addition, Special Extension to Ins" $203.00 "Orthopedic Shoe Addition, Toe Tap Horseshoe" $59.00 "Orthopedic Shoe Addition, Toe Tap Standard" $39.00 "Orthopedic Shoe Addition/Modification, Transfer Or" $263.00 "Orthopedic Shoe, Custom Plastizote" $171.00 "Orthopedic Shoe, Custom, Depth Inlay" "$2,990.00 " "Orthopedic Shoe, Ladies, Depth Inlay" $666.00 "Orthopedic Shoe, Ladies, High Top Depth Inlay" $526.00 "Orthopedic Shoe, Ladies, Oxford" $481.00 "Orthopedic Shoe, Mens, Depth Inlay" $856.00 "Orthopedic Shoe, Mens, High Top Depth Inlay" $630.00 "Orthopedic Shoe, Mens, Oxford" $748.00 "Orthopedic Shoe, Mens, Oxford, Used as Part of Bra" $199.00 "Orthopedic Shoe, Womens, Oxford, Used as Part of B" $315.00 "Orthosis, Transfer, Caliper Plate" $123.00 "Orthosis, Transfer, Existing Stirrup" $353.00 "Orthosis, Transfer, New Stirrup" $468.00 Osmolality $263.00 "Osmolality, Urine Random" $263.00 "Osmolality, Urine Timed" $292.00 Osteocalcin $197.00 Osteocalcin $486.00 OSTEOPATHIC MANIPULATION 1-2 BODY REGIONS (98925) $196.00 OSTEOPATHIC MANIPULATION 3-4 BODY REGIONS (98926) $235.00 OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS (98927) $275.00 OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS (98928) $316.00 OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS (98929) $362.00 Osteotomy 1st Metatarsal "$1,732.00 " Osteotomy Cuneiform "$2,802.00 " Osteotomy Femur Shaft/Supracondylar w/o Fix "$3,478.00 " Osteotomy humerus "$3,464.00 " Osteotomy Intertrochanteric "$6,874.00 " OSTEOTOMY MIDT BONE;Bilateral (28304-50) "$31,637.00 " Osteotomy Oscalcis "$2,544.00 " "Osteotomy Oscalcis, Bilateral" "$22,074.00 " "Osteotomy Prox. Phalanx, First Toe (Separate)" "$1,542.00 " Osteotomy proximal tibia "$3,995.00 " Osteotomy Radius & Ulna "$4,379.00 " Osteotomy Radius (Distal) "$3,364.00 " Osteotomy Ulna "$3,283.00 " "Osteotomy, metatarsals multiple for cavus foot" "$3,823.00 " "Osteotomy, tibia" "$3,267.00 " Osteotomy; Tibia and Fibula "$5,358.00 " Osteotomy; Tibia and Fibula; Bilateral "$8,802.00 " "OSTOMY, DURAHESIVE WAFER 2-3/4IN" $144.00 "OSTOMY, POUCH HIGH OUTPUT DRAINABLE 1-3/4""" $109.00 "OSTOMY, SEAL COHESIVE EAKIN LARGE" $31.00 "OSTOMY, SEAL COHESIVE EAKIN SMALL" $28.00 "OSTOMY, STOMAHESIVE POWDER EACH" $28.00 "OSTOMY, STOMAHESVE PASTE EACH" $38.00 OT Assistive Technology Eval Units $172.00 OT Attended E-Stim Units $205.00 OT Biofeedback Units $179.00 OT Class Units $89.00 OT Community/Work Reintegration Units $133.00 OT Contrast Bath Units $83.00 OT Double Therapy Units $89.00 OT Dynamic Finger Splint App Units $360.00 OT Dynamic Short Arm Splint App Units $446.00 OT Elbow Orthosis Left Charge L3702 $678.00 OT Elbow Orthosis Right Charge L3702 $678.00 OT Evaluation High Complexity Charge $195.00 OT Evaluation Low Complexity $195.00 OT Evaluation Moderate Complexity $195.00 OT Finger Cast Units $180.00 OT Finger Orthosis Left Charge L3933 $503.00 OT Finger Orthosis Right Charge L3933 $503.00 OT FO Left Charge L3935 $517.00 OT FO Right Charge L3935 $517.00 OT Group Therapy Units $89.00 OT Hand and Lower Forearm Cast Units $180.00 OT Hand Finger Orthosis LT Charge L3913 $637.00 OT Hand Finger Orthosis RT Charge L3913 $637.00 OT Hand Orthosis Left Charge L3919 $637.00 OT Hand Orthosis Right Charge L3919 $637.00 OT HFO Left Charge L3921 $755.00 OT HFO Right Charge L3921 $755.00 OT Hot/Cold Pack Units $90.00 OT Infrared Units $139.00 OT Iontophoresis Units $169.00 OT Long Arm Cast Units $180.00 OT Long Arm Splint Application Units $347.00 OT Manual Therapy Units $185.00 OT Massage Units $87.00 OT Mechanical Traction Units $223.00 OT Neuromuscular Reeducation Units $180.00 OT Orthotic Management/Train Units $153.00 OT Orthotic/Prosthetic Use Subsequent Unit(s) $160.00 OT Paraffin Bath Units $280.00 OT Physical Performance Test $196.00 OT Prosthetic Management/Train Units $168.00 OT Re-Evaluation $162.00 OT ROM/Extremity Units $238.00 OT ROM/Hand Units $61.00 OT Self Care/Home Management Units $152.00 OT Sensory Integrative Techniques Units $152.00 OT Short Arm Cast Units $180.00 OT Static Finger Splint App Units $160.00 OT Static Short Arm Splint App Units $180.00 OT Strapping Elbow/Wrist Units $180.00 OT Strapping Hand/Finger Units $180.00 OT Strapping Shoulder Units $180.00 OT Therapeutic Activities Units $169.00 OT Therapeutic Exercise Units $182.00 OT Ultrasound Units $149.00 OT Unattended E-Stim Units $139.00 OT Vasopneumatic Devices Units $223.00 OT Wheelchair Management Units $152.00 OT WHFO Left Charge L3807 $582.00 OT WHFO Orthosis Left Charge L3806 "$1,067.00 " OT WHFO Orthosis Right Charge L3806 "$1,067.00 " OT WHFO Right Charge L3807 $582.00 OT Whirpool Units $223.00 OT Work Hardening-Each Addl Hour Units $221.00 OT Work Hardening-Initial 2 Hours Units $552.00 OT Wrist Hand Finger Orthosis LT L3808 $837.00 OT Wrist Hand Finger Orthosis RT L3808 $837.00 OT Wrist Hand Orthosis Left Charge L3906 "$1,192.00 " OT Wrist Hand Orthosis RT Charge L3906 "$1,192.00 " Other Nerve Block Peripheral or Branch BiL Charge "$2,582.00 " Other Nerve Block Peripheral or Branch Charge (644 "$1,990.00 " Other Respiratory Procedure Group 15 min $84.00 Other Than 1st Metatarsal (ea) "$1,571.00 " Outpatient Physical Therapy Treatment ABN $182.00 Ova and Parasites-Stool $211.00 "Oxalate, Urine timed" $271.00 Oxcarbazepine Level $796.00 Oximetry Exercise $374.00 Oximetry Monitor $91.00 Oximetry Night $477.00 OXY - VENT W/TUBE $10.00 Oxygen Therapy 0-60 minutes $91.00 Oxygen Therapy Charge $117.00 P1 Typing (unit or patient) $159.00 PAD DECUBIOUS 30IN X 60IN $68.00 PAD ELBOW HEEL PROTECTOR WHITE LG $47.00 PAD EYE CURVED BLACK W/ELASTIC STRAP $6.00 PAD PROTECTOR ELBOW HEEL X-LG $35.00 PAD THERMAL FOR K-PAD MACHINE $40.00 "Pad, Sheepskin, Lambs Wool, Any Size" $31.00 "Pad, Sheepskin, Synthetic" $12.00 Pain Program Full Day $40.00 Pain Program Half Day $28.00 PAMPERS SENSITIVE BABY WIPES $10.00 Panel-Alpha Fetoprotein (Maternal) $550.00 Pap Smear-Diagnostic $74.00 Pap Smear-Liquid and Thin Prep $150.00 Pap Smear-Screening $74.00 PARAMETER KIT ADAPTER TRACH T W/ONE WAY VALVE $6.00 Parasite Identification $225.00 "Parathyroid Hormone , C-Terminal" $656.00 "Parathyroid Hormone , C-Terminal" $964.00 PARI LCD PARINEB NEBULIZER DISPOSABLE $24.00 Paring or cutting of benign hyperkeratotic lesion $96.00 "Paring or cutting of benign hyperkeratotic lesion," $136.00 "Paring or cutting of benign hyperkeratotic lesion," $179.00 PART HAND MYO EXCLU TERM DEV (L6026) "$12,688.00 " "Partial foot, molded socket, ankle height, with to" "$4,960.00 " "Partial foot, molded socket, tibial tubercle heigh" "$7,848.00 " "Partial foot, shoe insert with longitudinal arch, " "$2,373.00 " "Partial hand, Robin-Aids, little and/or ring finge" "$4,687.00 " "Partial hand, Robin-Aids, no fingers remaining (or" "$5,663.00 " "Partial Hand, Robin-Aids, thumb remaining, (or equ" "$5,618.00 " PARTL EXC ANKLE OR HEEL BONE (28120) "$8,996.00 " "Parvovirus B19 IgG, IgM Antibodies" $395.00 PASSY MUIR VALVE BLUE $342.00 PASSY MUIR VALVE CLEAR SPEAKING $342.00 Patella Dislocation Reconstruction Misc. "$3,356.00 " Patellectomy or hemipatellectomy (27350) "$2,265.00 " PATIENT CIRCUIT W/OUT PEEP PEDIATRIC $42.00 PEAK FLOW METER $64.00 Peak Flow Meter $89.00 Peak Flow Meter Charge $114.00 PED TERM DEV HOOK VOL CLOS L6712 "$3,333.00 " PED TERM DEV HOOK VOL OPEN "$2,084.00 " Pedialyte $4.00 Pediasure $6.00 Pediasure with fiber $6.00 PEDIATRIC OXYGEN MASK $5.00 Pediatric Pain Program Half Day ED Materials $22.00 PEDIATRIC TUBING CUSHION CANNULA $5.00 PEDIATRIC VENTED SYRINGE ADAPTAR SET for ALARIS PU $24.00 PEDIPRINTS TRACH TIES $4.00 PEDS RESUSCITATION BAG W/MASK SPUR II $35.00 Pelvic Osteotomy "$6,555.00 " Pencil Holder $145.00 Peptamen Jr. $7.00 Perc Fix Fem Prox NK Fx "$3,660.00 " PERC SK FIX IP JNT DISL; W MANIP (28666) "$7,580.00 " Percutaneous Disc Decompression (62287) "$16,622.00 " Percutaneous fixation of distal radial fracture "$2,789.00 " Percutaneous fixation of tibial fracture "$2,370.00 " Percutaneous skeletal fixation of distal femoral f "$2,706.00 " Percutaneous skeletal fixation of metacarpal fract "$1,963.00 " Percutaneous skeletal fixation of metatarsal fract "$1,412.00 " Percutaneous skeletal fixation of phalangeal fract "$1,929.00 " Percutaneous skeletal fixation of supracondylar fr "$3,131.00 " Percutaneous TAL gen anesthesia - bilateral "$12,321.00 " Percutaneous TAL general anesthesia "$1,271.00 " Percutaneus skeletal fixation of fracture great to $953.00 "Peroneal Straps, Pair" $39.00 Peroneus Lengthening "$1,919.00 " "Pessary, non rubber, any type" $110.00 "pH, Timed Urine" $92.00 "pH, Urine Timed" $178.00 Phalangetomy Toe (ea) "$1,247.00 " PHARMACOLOGIC MGMT W/PSYTX (90863) $545.00 Phase 3 Pulmonary Rehab $14.00 Phenobarbital Level $302.00 Phosphorous Level $143.00 "Phosphorous, Urine timed" $285.00 "Phosphorus, Random Urine" $77.00 Physician Review and Interpretation of data (96004 $430.00 Physician Supervision HH Patient; 15-29 min. $192.00 Physician Supervision HH Patient; 30 mins or more $102.00 "Physician, special service or report (99199)" $320.00 PILL CRUSHER $12.00 PILL SPLITTER $13.00 "Plasminogen Activity, Tissue" $136.00 "Plastic Heel Stabilizer, Cup" $238.00 Plate Removal "$9,082.00 " Platelet Aggregation $126.00 "Platelet Aggregation, Plavix" $436.00 Platelet Antibody Screen $523.00 Platelet Antibody Screen/Identification Referred "$2,498.00 " Platelet Count $180.00 Platelet Function Analysis $126.00 Platelet Function Analysis II $126.00 Platelet Pheresis "$2,817.00 " "Platelet Pheresis, Leukoreduced, Irradiated" "$3,832.00 " "Platelet Pheresis, Irradiated" "$2,426.00 " "Platelet Pheresis, Leukoreduced" "$2,910.00 " "Platelet Pheresis, Leukoreduced each unit" "$3,832.00 " Platelet/Cryoprecipitate Pooling "$1,017.00 " "Platelets for transfusion, each unit" $291.00 "Platelets for Transfusion, each unit" $612.00 "Platelets for Transfusion, Irradiated, each unit" $534.00 "Platelets for Transfusion, Leukoreduced, each unit" $534.00 "Platelets for Transfusion, Leukoreduced, Irradiate" $691.00 "Platelets for transfusion, leukoreduced,each unit" $253.00 "Platelets for transfusion,leukoreduced,irradiated" $328.00 "Platelets, PHR, LR, IR, each unit" "$1,856.00 " "Platelets, PRH, LR, each unit" "$1,388.00 " PLUG CLOSURE FLANGE 10MM $321.00 PLUG CLOSURE FLANGE 12MM $321.00 PLUG CLOSURE FLANGE 9MM $321.00 PNEUMA/VAC WALK BOOT PRE OTS (L4361) "$1,112.00 " "Pneumatic Ankle Control Splint, Aircast, Prefabric" $450.00 "Pneumatic Ankle-Foot Orthosis, w/ or w/out Jts, Pr" "$1,204.00 " PNEUMATIC COMPRESSION PUMP $130.00 "Pneumatic Full Leg Splint, Prefabricated" $521.00 "POLYSOMNOGRAPHY, 1-3 Charge-95808" "$4,890.00 " "POLYSOMNOGRAPHY, 4 OR MORE Charge-95810" "$5,064.00 " "POLYSOMNOGRAPHY, W/CPAP Charge-95811" "$5,121.00 " "Porphobilinogen, Random Urine Quant." $401.00 "Porphyrins, Fractionated, Urine, Random" $602.00 "Porphyrins-Fractionated, Urine timed" $602.00 "Potassium, Urine Random" $184.00 "Potassium, Urine Timed" $62.00 Potassium/K+ Level $153.00 "Powered UE Orthosis, Elbow Wrist Hand Finger, Cust" "$88,915.00 " "Powered UE Orthosis, Elbow Wrist Hand, Custom" "$46,664.00 " Prealbumin $560.00 "Pregnancy, Urine" $227.00 "Pregnanetriol, Urine timed" $848.00 Pregnenolone Level $467.00 "Prehensile actuator, Hosmer or equal, switch contr" "$7,623.00 " Prenatal Screen $219.00 "Prep, AK or knee disartic, ischial level socket, n" "$5,578.00 " "Prep, AK or knee disartic, ischial level socket, n" "$7,870.00 " "Prep, AK or knee disartic, ischial level socket, n" "$9,085.00 " "Prep, BK """"PTB"""" type socket, non-align sys, pylon" "$6,429.00 " "Prep, BK """"PTB"""" type socket, non-alignable sys, p" "$3,771.00 " "Prep, BK """"PTB"""" type socket, non-alignable sys, p" "$4,208.00 " "Prep, BK """"PTB"""" type socket, non-alignable sys, p" "$4,621.00 " "Prep, BK """"PTB"""" type socket, non-alignable sys, p" "$6,410.00 " "Prep, elbow disartic or AE, single wall plastic so" "$6,041.00 " "Prep, hip disartic - hemipel, pylon, no cover, SAC" "$14,201.00 " "Prep, hip disartic or hemipel, pylon, no cover, SA" "$16,159.00 " "Prep, shoulder disartic or interscapular thoracic," "$7,422.00 " "Prep, shoulder disartic or interscapular thoracic," "$8,574.00 " "Prep, wrist disartic or BE, single wall plastic so" "$4,857.00 " "Prep, wrist disartic or BE, single wall plastic so" "$6,257.00 " Preventive Medicine 18-39 years Est Charge- 99395 $238.00 Preventive Medicine 18-39 years New Charge- 99385 $347.00 Preventive Medicine 40-64 years Est Charge- 99396 $265.00 Preventive Medicine 40-64 years New Charge- 99386 $379.00 Preventive Medicine 65+ years Est Charge- 99397 $300.00 Preventive Medicine 65+ years New Charge- 99387 $426.00 Primidone Level $664.00 Private Duty Nursing $60.00 PROBE OXISENSOR D-25 $138.00 Procainamide and NAPA $283.00 Procalcitonin $356.00 Procollagen Type 1-N Terminal Propeptide $767.00 Progesterone Level $438.00 Prolactin $966.00 Prolonged E/M (Non face to face); first hour-9935 $320.00 Prolonged E/M (non-face to face); each additional $151.00 Prolonged Face to Face (1-60 min) Charge-99354 $391.00 Prolonged Phys Srv Outpt Direct Pt Contact add 30 $283.00 Prolonged Physician Service Inpatient with Direct $283.00 Prolonged Physician Service Inpatient with Direct $391.00 Pronator Teres Release Each Tendon "$2,319.00 " Pronestyl Level $556.00 Propanolol Level $112.00 Propanolol Level $796.00 "Prophylactic treatment femoral neck, proximal femu" "$4,219.00 " Prophylactic treatment femur "$4,802.00 " "Prostate Specific Antigen, Diagnostic" $29.00 "Prostate Specific Antigen, Diagnostic" $60.00 "Prostate Specific Antigen, Screening" $279.00 "Prosthetic sheath, above knee, each" $66.00 "Prosthetic sheath, below knee, each" $52.00 "Prosthetic sheath, upper limb, each" $66.00 "Prosthetic sheath/sock, including a gel cushion la" $247.00 "Prosthetic shrinker, above knee, each" $207.00 "Prosthetic shrinker, below knee, each" $145.00 "Prosthetic shrinker, upper limb, each" $190.00 "Prosthetic sock, multiple ply, above knee, each" $76.00 "Prosthetic sock, multiple ply, below knee, each" $66.00 "Prosthetic sock, multiple ply, upper limb, each" $69.00 "Prosthetic sock, single ply fitting, above knee, e" $33.00 "Prosthetic sock, single ply fitting, below knee, e" $23.00 "Prosthetic sock, single ply, upper limb, each" $39.00 "Protector, Heel or Elbow, Each" $28.00 Protein C Activity $347.00 Protein C Antigen $252.00 "Protein Electrophoresis, Random Urine" $329.00 "Protein Electrophoresis, Serum" $370.00 "Protein Electrophoresis, Timed Urine" $354.00 Protein Probe ID band $431.00 Protein S Activity $387.00 "Protein S Antigen, Free" $387.00 "Protein, Total" $176.00 "Protein, Total, Spinal Fluid" $132.00 "Protein, Urine" $209.00 "Protein, Urine Timed" $114.00 Prothrombin Time/INR $96.00 Prothrombin Time/INR $186.00 Prothrombin Time/PT $79.00 Prothrombin Time/PT $96.00 PROVALE DRINKING CUP 10CC $164.00 PROVALE DRINKING CUP 5CC $164.00 Psych or neuropsych test admin and scoring by tech $361.00 "Psych or neuropsych test admin and scoring, each a" $407.00 "Psych or neuropsych test admin by technician, each" $324.00 Psych or Neuropsych test admin or scoring by physi $453.00 Psych or neuropsych test admin with single automat $361.00 Psych testing by physician or other health profess $769.00 Psych testing by physician or other qualified heal $856.00 Psychiatric Diagnostic Evaluation with Medical Ser $415.00 Psychiatric Diagnostic Evalutation (90791) $397.00 Psychoanalysis $317.00 "Psychotherapy, 30 minutes with Patient and/or Fami" $181.00 PSYTX CRISIS EA ADDL 30 MIN (90840) $181.00 PSYTX CRISIS INITIAL 60 MIN (90839) $545.00 PSYTX PT&/FAM W/E&M 45 MINS (90836) $363.00 PSYTX PT&/FAM W/E&M 60 MIN (90838) $545.00 PSYTX PT&/FAMILY 45 MINUTES (90834) $363.00 PSYTX PT&/FAMILY 60 MINUTES (90837) $545.00 "PSYTX PT&FA, W/E&M 30 MIN (90833)" $181.00 PT Aquatic Therapy Therapeutic Exercise $185.00 PT Aquatic Units $185.00 PT Assistive Technology Eval Units $172.00 PT Attended E-Stim Units $205.00 PT Biofeedback Units $179.00 PT Club Foot w/Molding/Manip App Units $116.00 PT Community/Work Reintegration Units $133.00 PT Contrast Bath Units $83.00 PT Cylindrical Cast Application Units $180.00 PT Double Therapy Units $89.00 PT Dynamic Finger Splint App Units $360.00 PT Dynamic Short Arm Splint App Units $446.00 PT Evaluation Assistive Technology $154.00 PT Evaluation High Complexity $195.00 PT Evaluation Low Complexity Charge $195.00 PT Evaluation Moderate Complexity Charge $195.00 PT Evaluation Physical Performance Functional Capa $196.00 PT Gait Training Units $153.00 PT Group Therapy Units $89.00 PT Hot/Cold Pack Units $90.00 PT Infrared Units $139.00 PT Iontophoresis Units $169.00 PT Iontophoresis Units $347.00 PT Long Leg Cast Application Units $180.00 PT Long Leg Splint App Units $328.00 PT Manual Therapy 1+ region $185.00 PT Manual Therapy Units $185.00 PT Massage Units $87.00 PT Mechanical Traction Units $223.00 PT Mixing Studies $293.00 PT Mixing Study $293.00 PT Modality 1+ area/ Hot Cold Pack Application $90.00 PT Modality 1+ area/ Iontophoresis $169.00 PT Neuromuscular Re-Education $180.00 PT Neuromuscular Reeducation Units $180.00 PT NM Reed Units $180.00 PT Orthotic Management and Training $153.00 PT Orthotic Management/Train Units $153.00 PT Orthotic/Prosthetic Use Subsequent Unit(s) $160.00 PT Paraffin Units $280.00 PT Patellar Tendon Bearing Cast App Unit $260.00 PT Physical Performance Test $196.00 PT Prosthetic Management and Training $168.00 PT Prosthetic Management/Train Units $168.00 PT Re-Evaluation $150.00 PT Rigid Total Contact Leg Cast App Unit $260.00 PT Self Care/Home Management Units $152.00 PT Sensory Integration Units $152.00 PT Short Leg Cast Application Units $180.00 PT Short Leg Splint App Units $260.00 PT Static Finger Splint App Units $160.00 PT Static Short Arm Splint App Units $446.00 PT Strapping Ankle/Foot Units $180.00 PT Strapping Elbow/Wrist Units $180.00 PT Strapping Hand/Finger Units $180.00 PT Strapping Hip Units $180.00 PT Strapping Knee Units $180.00 PT Strapping Shoulder Units $180.00 PT Strapping Toes Units $180.00 PT Taping/Thorax Units $214.00 PT Therapeutic Activity Functional Performance $169.00 PT Therapeutic Activity Units $169.00 PT Therapeutic Exercise Strength Endurance ROM Fle $182.00 PT Therapeutic Exercise Units $182.00 "PT Therapeutic procedure, massage" $87.00 PT Treatment Double $89.00 PT Treatment Group $89.00 PT Treatment Self Care Home Management $128.00 PT Ultrasound Units $149.00 PT Unattended E-Stim Units $139.00 PT Unna Boot Units $198.00 PT Vasopeumatic Devices Units $223.00 PT Wheelchair Management Units $152.00 PT Whirlpool/Fluidotherapy Units $223.00 PT Work hardening/conditioning: each additional ho $221.00 PT Work hardening/conditioning: initial 2 hours $552.00 PT Work Hardening-Each Addl Hour Units $221.00 PT Work Hardening-Initial 2 Hours Units $552.00 PT/INR POC $90.00 PTH Intact $656.00 PTH-Related Protein $327.00 PTT Mixing Studies $577.00 PTT Mixing Studies "$1,117.00 " PULL UP BRIEF DIAPER ADULT PROTECTION PLUS LG $112.00 PULL UP BRIEF DIAPER ADULT PROTECTION PLUS MED $112.00 "PULL-UP ADULT PROTECT PLUS XL 48"" - 68""" $108.00 "PULL-UP,ADULT PROTECT PLUS XXL" $61.00 Pulmonary Exercise Oximetry Charge $485.00 Pulmonary Flutter Valve-Initial Charge $216.00 Pulmonary Flutter Valve-Subsequent Charge $178.00 Pulmonary Group Education IP $151.00 Pulmonary NIF $319.00 Pulmonary Recheck $69.00 Pulse Oximetry $97.00 Pulse oximetry $240.00 Pulse Oximetry- Overnight $191.00 Pulse Oximetry Overnight Monitoring Charge $249.00 Pulse Oximetry- Spot Check $240.00 Pulse oximetry-by continuous overnight monitoring $191.00 Pulse Oximetry-Cont/Exercise $191.00 Pulse oximetry-multiple determinations $191.00 Pulse Oximetry-Multiple Determinations Charge $249.00 Pulse Oximetry-Spot Check Charge $313.00 Pump Analysis with Reprogramming (62368) $827.00 Pump Analysis with Reprogramming Charge (62368) "$1,043.00 " Pump Analysis Without Reprogramming (62367) $827.00 Pump Analysis without Reprogramming Charge (62367) $987.00 Purkinje Cell (Yo) Autoantibodies $236.00 Pyruvic Acid Level $304.00 Q4 PED's 24 HOUR ORAL SUCTION CLEANING KIT $114.00 Quadricepsplasty "$2,946.00 " "Quadricepsplasty, Bilateral" "$4,417.00 " Quantitative IgA $163.00 Quantitative IgG $163.00 Quantitative IgM $163.00 Quinidine Level $809.00 Rabies Antibodies Titer $252.00 Radiological Interpretation for Lumbar Discography "$8,822.00 " RBC Pre-treatment $219.00 "RBC, LR, each unit" "$1,075.00 " "RBC's Autologous, each unit" "$1,400.00 " "RBC's for transfusion, each unit" $455.00 "RBC's for Transfusion, each unit" $962.00 "RBC's for Transfusion, Washed, each unit" "$1,390.00 " "RBC's for transfusion,washed,each unit" $658.00 "RBC's Irradiated, each unit" "$1,286.00 " "RBC's Irradiated, leukoreduced each unit" "$1,481.00 " RBC's Leukoreduced $530.00 "RBC's, irradiated, each unit" $609.00 "RBC's,irradiated,leukoreduced,each unit" $702.00 RD SET PDT/PED $41.00 Reciprocator "$1,549.00 " Recondition VV Hand "$5,741.00 " Reconstruction of Hip Socket "$4,439.00 " "Reconstruction of Hip Socket, Bilateral" "$6,658.00 " Reconstruction Polydactyly "$3,864.00 " Reconstruction toe polydactyly "$1,290.00 " Rectal Sensation Test (91120) $490.00 "Red Blood Cells, Leukoreduced" "$1,119.00 " "Release or recession, hamstring, proximal (27097)" "$2,401.00 " REM PREV IMPL EPID CATH (62355) "$7,544.00 " REM Shoulder Or Hip Spica "$1,259.00 " "REM Shoulder Or Hip Spica, Bilateral" "$2,512.00 " REM Sq RSVR/Pump For Prev Epid DR Inf "$15,759.00 " Removal Impacted Ceruman $384.00 "Removal of FB, foot, Bilateral; subcut. (28190-50)" "$4,757.00 " "Removal of FB, foot; subcutaneous (28190)" "$3,170.00 " Removal of foreign body in muscle or tendon sheath "$2,019.00 " "Removal of foreign body, deep, thigh region or kne" "$8,721.00 " Removal of Hip Bone Lesion "$3,366.00 " Removal of Humerus Lesion;with allograft "$2,794.00 " "Removal of Humerus Lesion;with allograft, Bilatera" "$4,005.00 " Removal of mammary implant material (19330) "$2,313.00 " REMOVAL OF TAIL BONE (27080) "$11,658.00 " Removal of Wrist Bone "$2,459.00 " Removal Skin Tags $579.00 "Removal, under anesthesia, of external fixation sy" "$1,415.00 " REMOVE SKIN TAGS ADD-ON =<10 LESIONS (11201) $359.00 REMOVE SPINE ELTRD PERQ ARAY (63661) "$1,153.00 " Remove/Graft bone lesion; with allograft "$3,628.00 " "Remove/Graft bone lesion; with allograft, Bilatera" "$5,163.00 " "Renin Activity, Plasma" "$1,121.00 " Rep Spica Body Cast or Jacket (29720) $152.00 Repair extensor tendon finger "$2,506.00 " Repair extensor tendon hand "$2,497.00 " Repair flexor tendon not in zone 2 "$3,132.00 " "Repair Flexor Tendon, Zone 2" "$4,450.00 " REPAIR KIT HICKMAN CATH 9.6FR $679.00 Repair Nail Bed (11760) "$1,272.00 " Repair Non-Union Femur w/Graft "$5,400.00 " Repair Non-Union Femur w/o Graft "$4,982.00 " "Repair of prosthetic device, labor component, per " $130.00 "Repair, complex, scalp, arms, and/or legs; 2.6 cm " "$2,702.00 " "Repair, Complex, Trunk; 2.6 cm to 7.5 cm" $945.00 "Repair, Intermediate S/T/Ext/2.5 cm/<" "$1,158.00 " "Repair, intermediate, wounds of neck, hands, feet " "$1,597.00 " Repetitive Stimulation Charge (95937) $690.00 "Replace Calf Lacer, Molded, Custom Fabrication" "$1,310.00 " "Replace Calf Lacer, Non-Molded, Custom Fabrication" $596.00 "Replace Foot, Drop Splint" $78.00 Replace Girdle for Milwaukee Orthosis "$3,154.00 " Replace High Roll Cuff $779.00 "Replace Interface, Ankle Contracture Splint" $60.00 "Replace Leather Cuff, Calf or Distal Thigh" $368.00 "Replace Leather Cuff, Proximal Thigh" $471.00 "Replace Metal bBands KAFO, Proximal Thigh" $460.00 "Replace Metals Bands KAFO, Calf or Distal Thigh" $352.00 Replace Pretibial Shell "$1,144.00 " Replace Proximal and Distal Upright for KAFO "$1,221.00 " Replace Quadrilateral Socket Brim "$3,070.00 " "Replace Thigh Lacer, Molded, Custom Fabrication" $982.00 "Replace Thigh Lacer, Non-Molded, Custom Fabricatio" $982.00 Replace Trilateral Socket Brim "$1,915.00 " "Replacement, socket, AK/knee disartic, incl attach" "$11,791.00 " "Replacement, socket, BK, molded to patient model" "$9,994.00 " "Replacement, socket, hip disartic, incl hip joint," "$12,017.00 " "Reposition Gastric Feeding Tube, through the duode" "$3,728.00 " REPR FOOT EXTENSOR TENDON EA (28208) "$1,057.00 " Research MRI 15 minute interval of time $125.00 RESECT PHALANX OF TOE TUMOR (28175) "$1,726.00 " Resource 2.0 $7.00 Resource Fruit Beverage- Berry $4.00 Resource Fruit Beverage- Orange $4.00 Resource Fruit Beverage- Peach $4.00 Resource Pulmonary $7.00 Resource Renal $7.00 Respiratory Aerosol Therapy $186.00 Respiratory Aerosol Therapy- Initial $186.00 Respiratory Bronchial Hygiene Evaluation $176.00 Respiratory Inspiratory Resistance Trainer $613.00 Respiratory Parameter Assessment $89.00 Respiratory Pathogen Panel by Muliplex PCR "$4,469.00 " Respiratory Sputum Induction $156.00 Respiratory Synctial Virus DFA $130.00 "RESTRAINT, MITT PAD FINGER CONTROL DBL" $93.00 Reticulocyte Count Manual $126.00 Retinol Binding Protein $180.00 Reverse T3 $209.00 Review Patient Spirometry (94010) $105.00 "Revise thigh muscle/tendons, Bilateral(Rectus Tran" "$27,579.00 " Revise thigh muscles/tendons (Rectus Transfer) "$3,918.00 " Revise/Remove Neuroreceiver "$14,744.00 " Rh Phenotyping $157.00 "Rh Typing, each unit" $128.00 "Rh Typing, includes DU, each unit" $128.00 Rheumatoid Factor Quant. $250.00 Rheumatoid Factor Quntitative $41.00 Rheumatoid Factor Quntitative * $41.00 RHINOPL 1'; COMPLETE EXT PARTS (30410) "$3,995.00 " "Rib Belt, Thoracic" $105.00 "Rib Belt, Thoracic, Custom Fabricated" $286.00 RIC Laboratory Bench $2.00 Ristocetin Cofactor $664.00 RNP/Sm Quantitative $244.00 Rock Bottom $151.00 Rocker Switch $861.00 ROM Extr/Trunk Exclude Hands PT $238.00 ROM Measurement Hand Units PT $61.00 ROOM/BED: General "$2,290.00 " ROOM/BED: International "$2,760.00 " ROOM/BED: International Family 25 "$3,910.00 " ROOM/BED: Medically Advanced Care Unit "$3,100.00 " ROOM/BED: Neuro "$2,550.00 " "Rotavirus Antigen, Stool" $252.00 Routine Blood Culture $492.00 Routine Respiratory Culture and Gram Stain $136.00 Routine Urine Culture $354.00 RPLC GTUBE NO REVJ TRC (43762) $915.00 Rubella $149.00 Rubeola (Immunity) Antibody IgG $329.00 Rubeola (measles) Antibody IgM $329.00 "Russell viper venom time, diluted" $152.00 SA Circuit "$1,264.00 " "Saccharomyces Cerevisae IgG, IgA" $482.00 "Sacoilac, Flexible, Custom Fabricated, Pelvic-Sacr" $595.00 "Sacoilac, Flexible, Prefabricated, Pelvic-Sacral S" $401.00 "Sacoilac, Rigid or Semi-Rigid Panels, Pelvic-Sagit" $116.00 Sacroiliac Joint Injection (27096) "$1,184.00 " Sacroiliac Joint Injection-Bilateral (27096) "$1,771.00 " SALINE IRRIGATION 0.90% STERILE 1000ML $7.00 "Salivary Gland Procedure, unlisted" "$1,313.00 " SALLY SLIDER SHEET $35.00 SARNA LOTION 7.5oz $42.00 SCALPEL STERILE DISPOSABLE #10 $9.00 SCALPEL STERILE DISPOSABLE #11 $12.00 SCALPEL STERILE DISPOSABLE #15 $12.00 Scapulopexy "$3,356.00 " "SCISSORS,DISPOSABLE" $7.00 Scl-70 Quantitative $244.00 "Scoliosis Procedures, Body Jacket Molded to Patien" "$3,807.00 " "Scoliosis Procedures, Post-Op Body Jacket" "$3,968.00 " Scottish Rite Orthosis "$3,348.00 " Seat Cushion Cover $486.00 Seat Cushion Cover Upgrade - Complex Upcharge $238.00 Seat Hardware - Adjustable Growth $725.00 Seat Hardware - Drop/Flat Hooks $380.00 Seat Hardware - Flat Hooks w/ Spacers $451.00 "Secondary closure of surgical wound or dehiscence," "$10,441.00 " Sedimentation Rate Non-automated $132.00 Selective Debridement Less than or Equal to 20 cm $769.00 "Selective Debridement, Each Additional sq. 20 CM (" $822.00 Selenium Level $335.00 "SELF-CATH COUDE TIP STRL 8 FR 16""" $5.00 SENSOR MASIMO SET LNOP ADHESIVE DISPOSABLE $58.00 SEPTAL OR OTHER IN DERMATOPLASTY (30620) "$2,190.00 " "Serology, Fungus" $149.00 Serotonin $873.00 "Serotonin Release Assay, 1 Drug" $970.00 Sex Hormone Binding Globulin $335.00 SHAMPOO CAP $10.00 SHAVE LES S/N/H/F/G; 0.6-1.0CM (11306) $542.00 SHAVE LES S/N/H/F/G; 1.1-2.0CM (11307) $595.00 SHOELACE ELASTIC BLACK 24IN $7.00 Short Arm Cast (29075) "$1,137.00 " Short Leg Cast "$1,215.00 " "Short Leg Cast, Bilateral" "$2,322.00 " Short Leg Splint $193.00 "Shoulder disartic, ext power, molded inner socket," "$39,313.00 " "Shoulder disartic, ext power, molded inner socket," "$46,571.00 " "Shoulder disartic, molded socket, endo sys, incl s" "$10,870.00 " "Shoulder disartic, molded socket, shoulder bulkhea" "$13,755.00 " "Shoulder disartic, passive restoration (complete p" "$9,613.00 " "Shoulder disartic, passive restoration (shoulder c" "$6,497.00 " "Shoulder Orthosis, Acro/Clavicular Canvas" $479.00 "Shoulder Orthosis, Cap Design, Custom Fabricated" "$1,737.00 " "Shoulder Orthosis, Figure 8 Abduction Restrainer" $306.00 "Shoulder Orthosis, Figure of Eight, Canvas" $435.00 "Shoulder-Elbow Orthosis, Addition to Mobile Arm, E" $142.00 "Shoulder-Elbow Orthosis, Addition to Mobile Arm, O" $92.00 "Shoulder-Elbow Orthosis, Addition to Mobile Arm, S" $76.00 "Shoulder-Elbow Orthosis, Mobile Arm Support Attach" $333.00 "Shoulder-Elbow Orthosis, Mobile Arm Support Attach" $402.00 "Shoulder-Elbow Orthosis, Mobile Arm Support Attach" $454.00 "Shoulder-Elbow Orthosis, Mobile Arm Support Attach" $506.00 "Shoulder-Elbow Orthosis, Mobile Arm Support, Monos" $355.00 "Shoulder-Elbow-Wrist-Hand Orthosis, Abduction Posi" "$1,451.00 " "Shoulder-Elbow-Wrist-Hand Orthosis, Airplane Desig" "$1,651.00 " "Shoulder-Elbow-Wrist-Hand-Finger Orthosis, Molded " "$3,238.00 " Sickle Cell Screen $114.00 SILVER CALCIUM AGINATE DRESSING 4X4.75 $31.00 "SILVER CALCIUM ALGINATE, ROPE HYDROGEL GAUZE PAD 1" $37.00 SILVER NON ADHERENT CONTACT LAYER 4X5 $43.00 Simple Cystometrogram (51725) "$1,496.00 " Simple Repair PS/N/A/G/TR/E; 2.6-7.5 CM $723.00 Simple Repair S/N/A/G/TR/E; 2.5CM/< (12001) $502.00 Simple repair S/N/G/TR/E; 7.6-12.5 CM $648.00 Simple Uroflowmetry (51736) $555.00 Sirolimus $331.00 "Six volt battery, Otto Bock or equal, each" $820.00 Sjogren's Antibodies $244.00 SKIN FULL GRAFT F/C/C/M/N/AX/G/H/F ADDL =<20 SQ CM $310.00 SKIN FULL GRAFT S/A/L ADDL =<20 SQ CM (15221) $200.00 SKIN FULL GRAFT SCLP/ARM/LEG =< 20 SQ CM (15220) "$1,703.00 " SKIN FULL GRFT FACE/GENIT/HF =< 20 SQ CM (15240) "$2,209.00 " SKIN SPLT GRFT T/A/L ADDL 100 SQ CM/1% BA (15101) $310.00 SKIN SPLT GRFT TRNK/ARM/LEG 100 SQ CM/1% BA (15100 "$2,002.00 " SKIN SUB GRAFT F/N/HF/G ADDL (15276) $464.00 SKIN SUB GRAFT FACE/NK/HF/G (15275) "$1,394.00 " SKIN SUB GRAFT T/A/L ADD-ON (15272) $436.00 SKIN SUB GRAFT TRNK/ARM/LEG (15271) "$5,705.00 " SKIN TISSUE REARRANGE ADDL 30.0 SQ CM (14302) "$7,303.00 " SKIN TISSUE REARRANGEMENT 30.1-60.0 SQ CM (14301) "$9,137.00 " SKN SPLT A-GRFT F/N/HF/G ADDL 100 SQ CM/1% BA (151 $368.00 SKN SPLT A-GRFT FAC/NCK/HF/G 100 SQ CM/1% BA (1512 "$1,930.00 " SLING GIVMOHR LG $298.00 SLING GIVMOHR M $309.00 SLING GIVMOHR SMALL $309.00 "SLING, GIVMOHR; EXTRA LARGE" $225.00 SLIPPER DBL TREAD LG BEIGE $25.00 SLIPPER DBL TREAD MD BLUE $28.00 SLIPPER DBL TREAD SM YELLOW $13.00 SLIPPER DBL TREAD XLG GREY $26.00 SLIPPER DBL TREAD XXL GREEN $13.00 SLP Assessment of Aphasia Units $349.00 SLP Auditory Processing Treatment Units $122.00 SLP Class Units $103.00 SLP Double Therapy Units $103.00 SLP Fiber Optic Endo Swallow Eval Units $729.00 SLP Fluoroscopic Evaluation Units $748.00 SLP Group Therapy Units $103.00 SLP Non-Speech AAC Device Tx Units $139.00 SLP Pharyngeal Swallow Fnctn Eval Units $217.00 "SLP Screening Test, Pure Tone, Air Units" $162.00 SLP Sensory Integrative Techniques $147.00 SLP Speech AAC Eval Addl 1/2 Hour Units $327.00 SLP Speech AAC Eval First Hour Units $600.00 SLP Swallow Dysfnction Oral Feed Tx Unit $172.00 SLP Treatment-Speech Gen Device Units $128.00 SLP Use/Fit Speech Prosthetic Eval Units $104.00 Sm Quantitative $244.00 Sm. Volume Neb. for Delivery of Pentamidine $244.00 Small Volume Nebulizer Charge $117.00 "Smear, primary source, with interpretation" $43.00 Smoking and tobacco use cessation counseling visit $30.00 SO AIRPLANE W/WO JOINT CF "$4,154.00 " SOCK AID $38.00 Sodium Level $256.00 "Sodium, Urine Random" $184.00 "Sodium, Urine Timed" $184.00 "Solid Back Cushion w/ Cover, Non-Adjustable Hardwa" "$1,256.00 " Solid Backboard Only w/ Vinyl Cover $382.00 Solid Seat Cushion w/ Cover $857.00 Somatomedin C $449.00 Somatostatin $153.00 "Specific Gravity, Fluid" $27.00 Specimen Processing $122.00 Spica $560.00 Spirometry with Bronchodilators Charge $229.00 Spirometry without Bronchodilators Charge $647.00 SPO2 CABLE ASSEMBLY GE V100 VITAL SIGNS MONITOR $264.00 Spoon Holder $28.00 SPRAY ADHESIVE MEDICAL 3.2-OZ $101.00 Spriometry with Bronchodilators $249.00 Spriometry without Bronchodilators $477.00 SSA (Ro) Quantitative $329.00 SSB (La) Quantitative $329.00 SSEP (B) Lower Extremities Charge "$1,705.00 " SSEP (B) Upper Extremities Charge "$1,705.00 " SSEP Single Lower Extremity Charge "$1,438.00 " SSEP Single Upper Extremity Charge "$1,438.00 " STATIC OR DYNAMI AFO PRE OTS (L4397) $722.00 "STERILE WATER 650ML, AQUAPAK 640" $6.00 STING-FREE ADHESIVE RELEASER SPRAY $34.00 "Stocking, Supporter Grips, Set of 4, Replacement" $36.00 "Stone Analysis, Kidney" $209.00 "Stone Analysis, Non-Kidney" $209.00 Straight Cath Charge (51701) $116.00 STRAP LEG BAG CATH VELCRO DALE $32.00 "Strep Pneumoniae Antigen Test, Urine" $193.00 Streptococcus Pneumoniae IgG Antibodies $94.00 Streptococcus Pneumoniae IgG Antibodies $182.00 Subsequent Hospital Care Level 1 Charge - 99231 $173.00 Subsequent Hospital Care Level 2 Charge - 99232 $242.00 Subsequent Hospital Care Level 3 Charge - 99233 $336.00 Subtalar Arthrodesis "$3,183.00 " Suctioning- Respiratory Therapy $75.00 SUPERF TRANF/TRASPL SGL TENDON (27690) "$2,171.00 " SUPERF TRANF/TRASPL SGL TENDON Bilateral (27690-50 "$25,345.00 " Supracondylar Osteo Femur "$4,089.00 " Surgical Boot $655.00 "Surgical Pathology, Abscess" $402.00 "Surgical Pathology, Bone Fragments Non-Pathologica" $402.00 "Surgical Pathology, Cervical Polyp" $546.00 "Surgical Pathology, Endocervix Biopsy" $546.00 "Surgical Pathology, Endocervix Curettings" $546.00 "Surgical Pathology, Endometrium Biopsy" $546.00 "Surgical Pathology, Endometrium Curettings" $546.00 "Surgical Pathology, Endometrium Polyp" $546.00 "Surgical Pathology, Skin, other" $629.00 "Surgical Pathology, Skin, Tag, Cyst, Debridement" $625.00 "Surgical Pathology, Soft Tissue Biopsy" "$1,216.00 " "Surgical Pathology, Soft Tissue Simple Excision" "$1,216.00 " "Surgical Pathology, Vaginal Biopsy" $546.00 "Surgical Pathology, Vulva Biopsy" "$1,059.00 " Susceptibility studies $32.00 Susceptibility Studies x1 $62.00 Susceptibility Studies x2 $62.00 Susceptibility Studies x3 $62.00 Susceptibility Studies x4 $62.00 Susceptibility Studies x5 $62.00 SUSPENSORY SCROTUM SUPPORT MED $28.00 SUSPENSORY SCROTUM SUPPORT XLG $28.00 SUSPENSORY SCROTUM SUPPORTLG $28.00 Suture of Infrapatellar Tendon; Primary "$9,980.00 " "Suture of Infrapatellar Tendon; Primary, Bilateral" "$16,301.00 " SWIMSUIT WOMEN SZ-32 $104.00 SWIMSUIT WOMEN SZ-34 $104.00 SWIMSUIT WOMEN SZ-36 $104.00 SWIMSUIT WOMEN SZ-38 $104.00 SWIMSUIT WOMEN SZ-40 $104.00 SWIMSUIT WOMEN SZ-42 $104.00 SWIMSUIT WOMEN SZ-44 $104.00 SWIMSUIT WOMEN SZ-46 $104.00 SWIMSUIT WOMEN SZ-48 $104.00 SWIMSUIT WOMEN SZ-50 $104.00 SWIMSUIT WOMEN SZ-52 $104.00 SWIMSUIT WOMEN SZ-54 $104.00 SWIMTRUNK MENS LG $113.00 SWIMTRUNK MENS MED $113.00 SWIMTRUNK MENS SZ-SM $113.00 SWIMTRUNK MENS XLG $113.00 SWIMTRUNK MENS XXL $129.00 "Syphilis Antibody, Treponemal w/ Reflex" $182.00 T Cell Monitoring $644.00 T Cell Monitoring "$1,247.00 " T3 Free $106.00 T3 Total $162.00 T3 Uptake $263.00 "T3, Free" $205.00 "T3, Total" $314.00 "T4, Total" $263.00 Tacrolimus Level $622.00 Talectomy (astragalectomy); Bilateral "$3,958.00 " Talectomy (astraglectomy) "$3,677.00 " TAPE HYPAFIX 2IN X 10YDS $51.00 TC CO2/ET CO2 $96.00 TCC-EZ 3 INCH SINGLE APPLICATION $458.00 TCC-EZ BOOT/EXTRA LARGE $326.00 TCC-EZ BOOT/LARGE $310.00 TEAM CONF W/O PAT BY PHYS 30+ MINS (99367) $262.00 Tegretol/Carbamezapine $273.00 "Tendon Lengthening, upper arm/elbow, each tendon" "$4,559.00 " Tendon Transfer Hand (ea) "$2,718.00 " Tenotomy Abductors "$2,958.00 " Tenotomy Elbow/Shoulder (ea) "$1,971.00 " Tenotomy Flexor Tendon Foot "$1,437.00 " Tenotomy Lengthening Abductor Hallucis "$1,361.00 " "Tenotomy Toe, Percutaneous, Multiple Tendons" "$1,277.00 " "Tenotomy Toe, Single Tendon" $983.00 "Tenotomy, adductor of hip, open; Bilateral" "$4,559.00 " "Tenotomy, Adductor or Hip, Open" "$2,079.00 " "Tenotomy, Hip Flexor(s), Open (separate procedure)" "$4,238.00 " "Tenotomy, Hip Flexor(s), open (separate procedure)" "$6,134.00 " "Tenotomy, open, extensor, foot or toe, each tendon" $887.00 "Tenotomy, Percutaneous, Toe Single Tendon" $895.00 "Term Device, Multi Art Digit" "$8,840.00 " "Terminal device, hand, Bock, VC" "$4,308.00 " "Terminal device, hand, Bock, VO" "$3,036.00 " "Terminal Device, Hand, Mechanical, Voluntary Openi" "$5,084.00 " "Terminal device, hand, passive hand" "$1,453.00 " "Terminal device, hook, Dorrance or equal, model #5" "$1,854.00 " "Terminal device, hook, Dorrance or equal, model #6" "$3,152.00 " "Terminal device, hook, TRS Grip, Grip III, VC or e" "$4,592.00 " "Terminal device, modifier wrist flexion" "$1,587.00 " "Terminal device, pincher tool, Otto Bock or equal" $631.00 "Testosterone, Free" $678.00 "Testosterone, total" $247.00 "Testosterone, Total" $538.00 "TFN Laptray, All Sizes" $293.00 Theophylline/Aminophylline $312.00 "Therapeutic,prophylactic or diagnostic injection" $206.00 THERASKIN 1.00 in X 1.00 in "$2,313.00 " THERASKIN 1.00 in x 2.00 in "$2,100.00 " THERASKIN BVR 2 x 3IN "$4,841.00 " THERMOMETER PROBE 9 FOOT ORAL VITAL SIGNS MONITOR $317.00 THERMOMETER WITH U/ADAPT- IT BOTH 22MM $5.00 Thicken Up $7.00 Thigh Gradient Comp Stocking 30-40mmHG by size eac $234.00 Thoracic-Lumbar-Sacral Orthosis 2-Piece Rigid Shel "$3,563.00 " Thoracic-Lumbar-Sacral Orthosis 3-Piece Rigid Shel "$1,111.00 " "Thoracic-Lumbar-Sacral Orthosis, 1-Piece Rigid She" "$4,657.00 " "Thoracic-Lumbar-Sacral Orthosis, 2 Rigid Plastic S" "$1,985.00 " "Thoracic-Lumbar-Sacral Orthosis, 2 Rigid Plastic S" "$2,903.00 " "Thoracic-Lumbar-Sacral Orthosis, 2-Piece Rigid She" "$8,454.00 " "Thoracic-Lumbar-Sacral Orthosis, 2-Piece Rigid She" "$9,496.00 " "Thoracic-Lumbar-Sacral Orthosis, 3 Rigid Shells, S" "$2,776.00 " "Thoracic-Lumbar-Sacral Orthosis, 4 Rigid Shells, S" "$3,308.00 " "Thoracic-Lumbar-Sacral Orthosis, Addition, Abdomin" $181.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Anterio" $210.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Anterio" $368.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Anterio" $527.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Lateral" $361.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Lateral" $539.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Lumbar " $202.00 "Thoracic-Lumbar-Sacral Orthosis, Addition, Milwauk" "$1,473.00 " "Thoracic-Lumbar-Sacral Orthosis, Addition, Rib Gus" $194.00 "Thoracic-Lumbar-Sacral Orthosis, Corset Front" $348.00 "Thoracic-Lumbar-Sacral Orthosis, Extra Padding" $128.00 "Thoracic-Lumbar-Sacral Orthosis, Flexible, Dorsolu" "$2,212.00 " "Thoracic-Lumbar-Sacral Orthosis, Flexible, Prefabr" "$1,608.00 " "Thoracic-Lumbar-Sacral Orthosis, Full Corset" $521.00 "Thoracic-Lumbar-Sacral Orthosis, Hyperextension Ri" "$1,878.00 " "Thoracic-Lumbar-Sacral Orthosis, Inclusive of Init" "$3,953.00 " "Thoracic-Lumbar-Sacral Orthosis, Rigid Frame, Pref" "$1,759.00 " "Thoracic-Lumbar-Sacral Orthosis, Rigid Frame, Pref" "$2,205.00 " "Thoracic-Lumbar-Sacral Orthosis, Triplaner Control" "$1,463.00 " "Thoracic-Lumbar-Sacral Orthosis, Triplaner Control" "$7,008.00 " "Thoracic-Lumbar-Sacral Orthosis, Triplaner Control" "$7,827.00 " Threshold $64.00 THRESHOLD PEP THERAPY $112.00 Throat Strept Screen $124.00 Thyroglobulin $211.00 Thyroglobulin Evaluation $211.00 Thyroid Antibodies $393.00 Thyroid Peroxidase Antibodies $10.00 Thyroid Peroxidase Antibodies $422.00 Thyroid Peroxidase Antibodies * $10.00 Thyroid Stimulating Immunogloblins w/TSH $399.00 Thyroxine 4 RIA $263.00 Thyroxine Free $159.00 TIE TRACHEOSTOMY LARGE $13.00 TIE TRACHEOSTOMY MEDIUM $13.00 TIE TRACHEOSTOMY SMALL $13.00 Timed Urine Creatinine $165.00 Tissue/Biopsy & Anaerobic Culture with Gram Stain $622.00 TLSO FLEX TRNK SJ-SS PRE OTS (L0457) "$4,270.00 " TLSO FLEX TRNK SJ-T9 PRE OTS (L0455) "$1,489.00 " TLSO R FRAM SOFT PRE OTS (L0467) "$4,270.00 " TLSO RIG FRAM PELVIC PRE OTS (L0469) "$2,042.00 " "TMS Chest Strap, 4 and 6 inch" $77.00 "TMS Pelvic Positioning Belt, Lever Release" $77.00 "TMS Pelvic Positioning Belt, Push-Button" $77.00 "TMS Pelvic Positioning Belt, Velcro" $77.00 Tobramycin-Peak $835.00 Tobramycin-Random $835.00 Tobramycin-Trough $835.00 TOPICAL GEL SHEETS 4IN X 6IN 5/BX $171.00 Topiramate Level $736.00 TORSION MECHANISM KNEE/ANKLE $268.00 TORSION MECHANISM WRIST/ELBO $268.00 TORTOISE REPOSITIONING SYSTEM-BARIATRIC $819.00 TORTOISE REPOSITIONING SYSTEM-REGULAR $564.00 "Total Protein, Fluid" $68.00 Total Vital Capacity Charge $114.00 Toxoplasma Antibody $620.00 Toxoplasma Antibody IgM $304.00 Toxoplasma DNA by PCR $784.00 TRACH 5.5 PDL $218.00 TRACH CARE - 72 CLOSED SUCTION SYSTEM 14FR $179.00 TRACH CARE 10FR PED ELBOW $72.00 TRACH CARE 72 CLOSED SUCTION SYSTEM 12FR $179.00 TRACH CARE 8 FRENCH PED ELBOW TRACH $45.00 TRACH CFN #4 $286.00 TRACH CFS #8 $256.00 TRACH CUFFED 5.0 TTS BIVONA "$1,226.00 " TRACH DCP #4 $32.00 TRACH DCP #6 $29.00 TRACH DCP #8 $29.00 TRACH DCT #4 $262.00 TRACH DCT #6 $297.00 TRACH DCT #8 $284.00 TRACH DIC #4 $26.00 TRACH DIC #6 $26.00 TRACH DIC #8 $26.00 TRACH SCT #7 $184.00 TRACH SIC #4 $49.00 TRACH SIC #6 $59.00 TRACH SIC #8 $59.00 TRACH TUBE # 3.0 PED $199.00 TRACH TUBE # 5.0 PED $223.00 TRACH TUBE # 5.5 PED $204.00 TRACH TUBE # 8 SCT $200.00 TRACH TUBE # 9 SCT $200.00 TRACH TUBE CFN # 6 $281.00 TRACH TUBE CFN # 8 $262.00 TRACH TUBE CFS # 4 $256.00 TRACH TUBE CFS # 6 78MM CUFFLESS ADULT $256.00 Trach Tube Change $613.00 TRACH TUBE CUFFLESS # 5 BIVONA $396.00 TRACH TUBE CUFFLESS # 6 BIVONA $334.00 TRACH TUBE CUFFLESS # 7 BIVONA $333.00 TRACH TUBE CUFFLESS # 8 BIVONA $333.00 TRACH TUBE CUFFLESS # 9 BIVONA $396.00 TRACH TUBE CUFFLESS PEDS # 4.0 $389.00 TRACH TUBE CUFFLESS PEDS # 4.5 $346.00 TRACH TUBE FLEXTEND CUFFLESS PEDS # 5.0 $917.00 TRACH TUBE LPC # 4 $298.00 TRACH TUBE LPC # 6 $298.00 TRACH TUBE LPC # 8 $298.00 TRACH TUBE SLEEP APNEA # 6.0MM BIVONA $401.00 TRACH TUBE TTS # 6 BIVONA $453.00 TRACH TUBE TTS # 7 BIVONA $453.00 TRACH TUBE TTS # 7.5 BIVONA $453.00 TRACH TUBE TTS # 8 BIVONA $342.00 TRACH TUBE TTS # 8.5 BIVONA $525.00 TRACH TUBE TTS # 9.0 BIVONA $428.00 "TRACH,FLEX-END PED 4.0 TTS" $642.00 "TRACH,FLEX-END PED 4.5 TTS" $642.00 "TRACH,FLEX-END PED 5.0 TTS" $642.00 "TRACH,FLEX-END PED 5.5 TTS" $642.00 Tracheostomy Tube Management Charge $135.00 TRANSCUTANEOUS ADHESIVE $32.00 TRANSCUTANEOUS EAR CLIP $47.00 TRANSCUTANEOUS MEMBRANE KIT $279.00 Transfer of tendon deep "$3,095.00 " Transferrin $58.00 Transferrin $509.00 Transglutaminase IgG and IgA Autoantibodies $577.00 TRANSPL FEMUR RIDGE (27140) "$2,487.00 " "Transversus abdominis plane (TAP) Block, by inject" $557.00 "Transversus abdominis plane (TAP) block, injection" $610.00 TRAP MUCOUS SPECIMEN 80CC $13.00 Traumacal $5.00 TRAY CATHETER FOLEY SILIC-ELAST 16FR 5CC-10CC $29.00 TRAY CATHETER URETHAL 15FR $12.00 TRAY INCISION & DRAINAGE $74.00 TRAY KIT FOLEY INSERTION $21.00 TRAY LUMBAR PUNCTURE ADULT 20G $178.00 TRAY SHARP DEBRIDEMENT $27.00 Trazodone Level $796.00 Treat Big Toe Fracture (28505) "$1,727.00 " TREAT FINGER DISLOCATION (26785) "$9,937.00 " Treat Hip Dislocation with Manipulation & Anesthes "$1,347.00 " Treat Hip Dislocation with Manipulation & Anesthes "$2,021.00 " Treat Hip Wall Fracture "$4,202.00 " Treat Hip Wall Fracture Bilateral "$6,304.00 " Treat Humerus Fracture "$3,186.00 " "Treat Humerus Fracture, Bilateral" "$5,593.00 " TREAT KNUCKLE DISLOCATION (26715) "$10,411.00 " Treatment of humeral shaft fracture with intramedu "$3,651.00 " Treatment of intertroch/subtroch fracture with int "$5,023.00 " Treatment of intertroch/subtroch fracture with pla "$4,903.00 " Treatment of slipped femoral epiphysis; by single "$3,842.00 " Treatment of Slipped Femoral Epiphysis; by Single "$5,761.00 " Treatment of tibia fracture with intramedullary im "$4,248.00 " Treponema Pallidum Antibody Assay $461.00 Trigger Finger "$1,189.00 " Triglycerides $97.00 Triglycerides $190.00 TRILOGY PASSIVE CIRCUIT PEDIATRIC $261.00 TRIOLOGY PASSIVE CIRCUIT $12.00 Triple Arthrodesis "$4,134.00 " Troponin I $465.00 Troponin I with CKMB Reflex $465.00 TSH w/Reflex to FT4 $370.00 "TSH, 3rd Generation" $399.00 T-sp Disc. Add'l level x___ "$1,740.00 " T-spine TFESI add'l level x___ "$1,147.00 " TUBE ENTERIC DOBHOFF 8FR 43 $72.00 TUBE FEEDING INDWELLING 8FR 42IN $32.00 TUBE GAST BALLOON MIC 12FR 5CC $202.00 TUBE GAST BALLOON MIC 14FR 20CC $202.00 TUBE GAST BALLOON MIC 16FR 20CC $245.00 TUBE GAST BALLOON MIC 18FR 20CC $289.00 TUBE GAST BALLOON MIC 20F $192.00 TUBE GAST BALLOON MIC 24FR 20CC $202.00 TUBE MIC LOW PROFILE GASTROSTOMY FEEDING 14FR 1.5C $519.00 TUBE NG WITHOUT STYLET 6 FR 36 INCH $41.00 Tube Sock $7.00 TUBE SPECL EXT STL LTXF18IN $6.00 TUBE SUCTION HANDLE AND COVERED YANKAUER $25.00 TUBE SUCTION NOSEATTACH DEVICE 5-18FR $31.00 TUBE TRACHEOSTOMY TUBE HOLDER ALL SIZE $27.00 Tuberculosis Immunity Test $881.00 Tuberculosis Intradermal $32.00 Tubular Elastic Dressing $4.00 "Twelve volt battery, Utah or equal, each" "$1,282.00 " TX CL ELBOW DISLOC W ANESTH (24605) "$1,423.00 " "Type & Screen, PAT" $112.00 "Type & Screen, PAT" $217.00 "UE Addition, BE/AE suspension locking mech, exclud" "$2,125.00 " "UE Addition, BE/AE, custom fab from mold or prefab" "$1,641.00 " "UE Addition, BE/AE, custom fab from mold or prefab" "$2,562.00 " "UE Addition, BE/AE, custom fab socket insert for c" "$3,296.00 " "UE Addition, BE/AE, custom fab socket insert for o" "$3,296.00 " "UE addition, electric lock feature, w/ manually po" "$7,749.00 " "UE addition, excursion amplifier, lever type" $719.00 "UE addition, excursion amplifier, pulley type" $625.00 "UE addition, external locking elbow, forearm count" "$9,248.00 " "UE addition, frame type socket, AE or elbow disart" "$2,068.00 " "UE addition, frame type socket, BE or wrist disart" "$1,873.00 " "UE addition, frame type socket, interscapular-thor" "$2,231.00 " "UE addition, frame type socket, shoulder disartic" "$2,408.00 " "UE addition, harness, chest or shoulder, saddle ty" $906.00 "UE addition, harness, figure of 8 type, for dual c" $518.00 "UE addition, harness, figure of 8 type, for single" $495.00 "UE addition, heavy duty control cable" $426.00 "UE addition, hook to hand, cable adapter" $199.00 "UE addition, latex suspension sleeve, each" $265.00 "UE addition, lift assist for elbow" $855.00 "UE addition, nudge control elbow lock" "$1,289.00 " "UE addition, removable insert" "$1,457.00 " "UE addition, shoulder abduction joint, pair" $842.00 "UE addition, shoulder flexion-abduction joint, eac" "$1,128.00 " "UE addition, shoulder jt, multipositional lock, fl" "$9,775.00 " "UE addition, shoulder lock mechanism, body powered" "$1,608.00 " "UE addition, shoulder lock mechanism, external pow" "$10,079.00 " "UE addition, shoulder universal joint, each" "$1,223.00 " "UE addition, silicone gel insert or equal, each" "$1,982.00 " "UE addition, standard control cable, extra" $317.00 "UE addition, suction socket" "$2,840.00 " "UE addition, Teflon or equal, cable lining" $190.00 "UE addition, test socket, elbow disartic or AE" "$1,408.00 " "UE addition, test socket, shoulder disartic or int" "$1,433.00 " "UE addition, test socket, wrist disartic or BE" "$1,275.00 " "UE additions, additional disconnect insert for loc" $265.00 "UE additions, disconnect locking wrist unit" $889.00 "UE additions, flexible metal hinge, pair" $549.00 "UE additions, flexion-friction wrist unit" "$1,552.00 " "UE additions, polycentric hinge, pair" $565.00 "UE additions, quick disconnect hook adapter, Otto " "$1,766.00 " "UE additions, quick disconnect lam collar with cou" $634.00 "UE additions, rotation wrist unit with cable lock" "$1,640.00 " "UE additions, single pivot hinge, pair" $723.00 "UE additions, spring assisted rotational wrist uni" "$2,273.00 " "UE additions, stainless steel, any wrist" $930.00 "UE Pros Addition, glove for terminal device, any m" $650.00 Ultrasonic Guidance for Injection Charge (76942) $393.00 UNIVERSAL KIT $60.00 Unlisted Child Orthopedic Shoe $76.00 "UNLISTED CODE, PELVIC FLOOR INJ (64999)" "$3,052.00 " "Unlisted Procedure, Nervous System" "$3,052.00 " Unlisted Psychiatric Service or Procedure $136.00 "Upper Extremity addition, flexion/extension and ro" "$9,626.00 " "Upper Extremity Addition, Sock, Fx or Equal" $92.00 "Upper Extremity, Forearm Fx, Hand w/ Wrist Hinge" "$1,289.00 " "Upper Extremity, Humeral Fx Cuff" "$1,636.00 " "Upper Extremity, Radius/Ulner Fx Cuff" $788.00 "Upper Extremity, Wrist Fx Cuff" $753.00 "Urea Nitrogen, Random Urine" $134.00 "Urea Nitrogen, Timed Urine" $134.00 Uric Acid $118.00 "Uric Acid, Urine Random" $157.00 "Uric Acid, Urine Timed" $205.00 URINAL FEMALE $29.00 Urinalysis $126.00 Urinalysis with Microscopic $190.00 URINALYSIS; QUAL NOT IA $13.00 URINARY CATHETER ANCHOR $20.00 Urinary Reflex Study (51792) $661.00 Urine Creatinine $70.00 Urine Osmolality $136.00 Urine Pregnancy POC $211.00 US Arterial Bilateral Lower Extremity Duplex Scan $849.00 US Arterial Extracranial Duplex Scan $678.00 US Arterial Unilateral Lower Extremity Duplex Scan $543.00 US Complete Abdonimal Duplex Scan $849.00 US Guide Vascular Access Charge "$1,211.00 " US Limited Abdominal Duplex Scan $543.00 US Venous Bilateral Lower Extremity Duplex Scan $849.00 US Venous Bilateral Upper Extremity Duplex Scan $849.00 US Venous Unilateral Lower Extremity Duplex Scan $543.00 US Venous Unilateral Upper Extremity Duplex Scan $543.00 US XTR NON-VASC COMPLETE (76881) $502.00 US XTR NON-VASC LMTD (76882) $335.00 USA (ANTI ROTATION ATTACHMENT) $62.00 USA BOOT AVERAGE SIZE $158.00 USA BOOT BARIATRIC SIZE $158.00 USA BOOT SMALL SIZE $158.00 USA BOOT X-LENGTH SIZE $158.00 Utensil Slot $171.00 UTILITY POSITIONER MEDIUM $507.00 VAGINAL IRRIGATION KIT MDI $7.00 Vaginitis Screen $248.00 Valproic Acid Level $345.00 "Valproic Acid, Free" $221.00 VALUE GASTRIC FARELL SYSTEM $4.00 Vancomycin-Random $449.00 Vancomycin-Trough $449.00 Varicella Zoster Antibody IgG $271.00 Varicella Zoster Antibody IgM $271.00 Varicella Zoster DFA $95.00 Varicella Zoster PCR $769.00 "VDRL, CSF" $122.00 Venous Stasis Four Layer Wrap $492.00 Vent Mgmt Inpat Initial Day (94002) "$1,562.00 " "Vent Mgmt Inpat, subq Day (94003)" "$1,226.00 " Ventilator Management- Initial $643.00 Ventilatory Parameters $89.00 VENTURI MASK ADULT $5.00 Vertebral fracture assessment via dual-energy X-ra $61.00 Video Fluroscopy Physician Charge $233.00 Viracore Quant Adenovirus PCR "$1,148.00 " Viral Titre CSF $492.00 "Virus isolation, tissue culture inoculation" $157.00 Virus Shell Isolation $292.00 Viscosity $124.00 Viscosity $296.00 Visual Evoked Potentials "$1,438.00 " Vital Capacity Test Charge-94150 $220.00 Vitamin A Level $469.00 VITAMIN A&D OINTMENT 4oz $12.00 Vitamin B1 Level "$1,017.00 " Vitamin B12 and Folate $513.00 Vitamin B-12 Level $513.00 Vitamin B6 Level $986.00 Vitamin C Level $145.00 "Vitamin D, 125-Dihydroxy" $441.00 "Vitamin D, 125-Dihydroxy" $972.00 "Vitamin D, 25-Hydroxy" $441.00 "Vitamin D, 25-Hydroxy" "$1,030.00 " Vitamin E Level $87.00 Vitamin K Level $145.00 Vivonex Pediatric $7.00 VMA $106.00 "VMA (vanilylmandelic Acid), Urine Timed" $811.00 VMA/CAT/MET Profile $753.00 Voc Rehab Case Management Units $147.00 Voc Rehab Group Units $104.00 Voc Rehab Indiv Eval/Counseling Units $173.00 Voc Rehab Initial Evaluation Units $173.00 Voc Rehab Inpatient Evaluations Units $173.00 Vocational Rehab Case Management $110.00 Vocational Rehab Counseling - Group $104.00 Vocational Rehab Evaluation - Initial Assessment $173.00 Vocational Rehab Evaluation/Counseling - Individua $173.00 Von Willebrand Antigen $300.00 Voriconazole Level $544.00 VRE Screen $134.00 WATER IRRIGATION STERILE 250ML $7.00 WATER SOLUTION FOR INHALATION 1000M $12.00 WATER STERILE FOR INHALATION BOTTLE 1000ML $6.00 Wedge Exc Nail Fold $558.00 "Wedge, Clubfoot" $230.00 "Wedge, Heel" $105.00 "Wedge, Heel, Sach" $397.00 "Wedge, Heel/Full Sole, Between Sole" $253.00 "Wedge, Metatarsal Bar, Between Sole" $353.00 "Wedge, Metatarsal Bar, Rocker" $187.00 "Wedge, Outflare" $230.00 "Wedge, Shoe" $95.00 "Wedge, Sole, Between Sole" $230.00 "Wedge, Sole, Outside Sole" $166.00 Wet mount $30.00 Wheeled Walker Frame with Trunk Support "$1,302.00 " "WHFO Nontorsion Joint, Prefabricated" $882.00 WHFO W/O JOINTS PRE OTS (L3809) $977.00 "WHFO With Joint(s), Custom Fabricated" "$3,462.00 " "WHFO, Rigid without joints, custom fabricated" "$3,268.00 " "WHISPER VALVE, TEMP CONTROLLED" $173.00 WHO NONTORSION JNTS PRE OTS (L3916) "$2,078.00 " "WHO prefab, one or more nontorsion joints, elastic" "$2,359.00 " "WIPE, BABY FLUSHABLE" $9.00 "WIPES, SHIELD BARRIER CLOTHS" $41.00 With Debridement Muscle "$4,676.00 " With Internal Fixation "$1,254.00 " With Internal Fixation of Radial AND Ulna "$3,689.00 " Withdrawl of Arterial Blood $154.00 WND PREP F/N/HF/G ADDL 100 SQ CM/1% BA (15005) $255.00 Work Related or Medical Disability Exam by Non-Tre "$2,398.00 " Work Related or Medical Disability Exam by Treatin "$1,199.00 " Work Trial Assessment Units $173.00 Worm Identification $109.00 WOUND PREP ADDL 100 CM (15003) $129.00 WOUND PREP F/N/HF/G 100 SQ CM/1% BA (15004) $748.00 WOUND PREP TRK/ARM/LEG 100 SQ CM/1% BA (15002) $610.00 WOUND VEIL 12 X 12 $21.00 Wound(s) Care Non-Selective Units $180.00 WRAP ELASTIC BANDAGE LF W/VELCRO 4IN X 5YARD $31.00 "Wrist disartic, ext power, self-susp inner socket," "$20,993.00 " "Wrist disartic, ext power, self-susp inner socket," "$22,424.00 " "Wrist disartic, molded socket, flexible elbow hing" "$7,771.00 " "Wrist disarticulation, molded socket, flexible elb" "$9,825.00 " "Wrist Strap Padded, Each" $62.00 "Wrist-Hand Orthosis, Gauntlet, Molded to Pt" "$2,140.00 " "Wrist-Hand Orthosis, Nontorsion Joints, Custom Fab" "$1,912.00 " "Wrist-Hand Orthosis, Thumb Wrist Spica" $406.00 "Wrist-Hand Orthosis, Wrist Extension Control Cock-" $310.00 "Wrist-Hand-Finger Orthosis, Dorsal Wrist" $273.00 "Wrist-Hand-Finger Orthosis, Dorsal Wrist, w/ Outri" $263.00 "Wrist-Hand-Finger Orthosis, Dynamic Flexor Hinge, " "$3,764.00 " "Wrist-Hand-Finger Orthosis, Dynamic Flexor Hinge, " "$4,363.00 " "Wrist-Hand-Finger Orthosis, Electric, External Pow" "$9,053.00 " "Wrist-Hand-Finger Orthosis, Finger Extension w/ Wr" $186.00 "Wrist-Hand-Finger Orthosis, Oppenheimer" $282.00 "Wrist-Hand-Finger Orthosis, Oppenheimer w/ Knuckle" $402.00 "Wrist-Hand-Finger Orthosis, Palmer" $276.00 "Wrist-Hand-Finger Orthosis, Swanson Design" $803.00 "Wrist-Hand-Finger Orthosis, Thomas Suspension" $230.00 "Wrist-Hand-Finger Orthosis, w/o joints, Prefabrica" "$1,057.00 " "Wrist-Hand-Finger Orthosis, Wrist Extension Cock-u" $315.00 XR Abdomen 1 View $610.00 XR Abdomen 2 View $530.00 XR Ankle Complete Left $238.00 XR Bone Age Studies $128.00 XR Bone Survey Complete (Mets) "$1,039.00 " XR Bone Survey Limited (Mets) $666.00 XR Calcaneous Left $223.00 XR Calcaneous Right $223.00 XR Chest 1 View $403.00 XR Chest 2 View $523.00 XR Chest 3 View $603.00 XR Chest 4 View $603.00 XR Clavicle Right $262.00 XR Diskography Lumbar "$2,550.00 " XR Diskography Thoracic "$2,628.00 " XR Epidurography "$1,773.00 " XR Exam Scoliosis 4 Views $481.00 XR Facial Bones Minimum 3 Views $632.00 XR Fluoro Guidance Needle Loc Spine "$2,330.00 " XR Fluoro Guidance Needle Placement "$2,330.00 " XR Foot Complete Left $238.00 XR Foot Complete Right $238.00 XR Forearm 2 Views Left $223.00 XR Forearm 2 Views Right $223.00 XR Hand Complete Left $223.00 XR Hand Complete Right $223.00 XR Humerus Left $512.00 XR Humerus Right $512.00 XR Knee 3 Views Left $225.00 XR Knee 3 Views Right $225.00 XR Neck Soft Tissue $128.00 XR Pelvis Judet Series $481.00 XR Ribs w/ PA Chest Left $535.00 XR Ribs w/ PA Chest Right $535.00 XR Sinuses Paranasal < 3 Views $136.00 XR Skull < 4 Views $315.00 XR Sternum Minimum 2 Views $287.00 XR Swallowing Function w/ Video $341.00 XR Wrist Complete Left $223.00 XR Wrist Complete Right $223.00 "XTRASORB SUPER ABSORBENT DRESSING 4"" X 5""" $13.00 "XTRASORB SUPER ABSORBENT DRESSING 6"" X 9""" $35.00 Zinc Level $488.00 Zinc Protoporphyrins $188.00