Procedure Description CPT(R)/ HCPCS Code Unit Price Discounted Cash Price Website Link *here* HC ED I&D ABSCESS SMPL SNGL 10060 $422.10 $337.68 HP ID ABSCESS SMPL SNGL 10060 $336.00 $268.80 HC ED REMOVAL FOREIGN BODY SUBQ SIMPLE 10120 $389.55 $311.64 HP REMOVAL FOREIGN BODY SUBQ SIMPLE 10120 $378.00 $302.40 HC ED I&D HEMATOMA SEROMA FLUID 10140 "$3,441.90 " "$2,753.52 " HP ID HEMATOMA SEROMA FLUID 10140 $337.05 $269.64 HC ED DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS 11042 $719.25 $575.40 HP DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS 11042 $243.60 $194.88 HP EXC SKIN BENIGN TRNK/EXTRM 0.6-1CM 11401 $349.65 $279.72 HP RMVL LESN BENIGN TK/EXTRM 1.1-2CM 11402 $436.80 $349.44 HP RMVL LESN BENIGN TK/EXTRM 3.1-4CM 11404 $570.15 $456.12 HP EXC SKIN BENIGN SC/NK/HD/FT 0.6-1.0CM 11421 $563.85 $451.08 HP EXC SKIN BENIGN SC NK HD FT 1.1-2.0CM 11422 $563.85 $451.08 HP EXC SKIN BENIGN SC/NK/HD/FT 3.1-4CM 11424 $661.50 $529.20 HP EXC SKIN BENIGN FACE <=0.5CM 11440 $360.15 $288.12 HP EXCISE LESN FACE BENIGN 0.6-1CM 11441 $462.00 $369.60 HP EXCISE LESN FACE BENIGN 1.1-2CM 11442 $515.55 $412.44 HC ED REMV NAIL PLATE PART OR CMPLT SNGL 11730 $564.90 $451.92 HP AVULSION NAIL PLATE SPLE SGL 11730 $193.20 $154.56 HP REMOVAL NAIL FINGER OR TOE 11750 $639.45 $511.56 HP EXC WEDGE SKIN NAIL FOLD 11765 $246.75 $197.40 HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM 12001 $391.65 $313.32 HP RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM 12001 $428.40 $342.72 HC ED RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM 12002 $391.65 $313.32 HP RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM 12002 $479.85 $383.88 HC ED RPR SCLP/TRNK/EXTRM SMPL 7.6-12.5 CM 12004 $483.00 $386.40 HP RPR SCLP/TRNK/EXTRM SMP 7.6-12.5 CM CC 12004 $569.10 $455.28 HC ED RPR SCLP/TRNK/EXTRM SMPL 12.6-20 CM 12005 $318.15 $254.52 HP RPR SCLP/TRNK/EXTRM SMPL 12.6-20 CM 12005 $262.50 $210.00 HC ED RPR SCLP/TRNK/EXTRM SMPL 20.1-30 CM 12006 $827.40 $661.92 HP RPR SCLP/TRNK/EXTRM SMPL 20.1-30 CM 12006 $353.85 $283.08 HC ED RPR SCLP/TRNK/EXTRM SMPL >30 CM 12007 $827.40 $661.92 HP RPR SCLP/TRNK/EXTRM SMPL >30 CM 12007 $413.70 $330.96 HC ED RPR FACE EAR SMPL <=2.5CM 12011 $391.65 $313.32 HP RPR FACE EAR SMPL <=2.5CM 12011 $442.05 $353.64 HC ED RPR FACE EAR SMPL 2.6-5 CM 12013 $436.80 $349.44 HP RPR FACE EAR SMPL 2.6-5 CM 12013 $508.20 $406.56 HC ED RPR FACE EAR SMPL 5.1-7.5 CM 12014 $318.15 $254.52 HP RPR FACE EAR SMPL 5.1-7.5 CM 12014 $205.80 $164.64 HC ED RPR SCLP/TRNK/EXTREM INTERMED <=2.5CM 12031 $491.40 $393.12 HC ED RPR SCLP/TRNK/EXTRM INTRMD 2.6-7.5 CM 12032 $674.10 $539.28 HP RPR SCLP/TRNK/EXTRM INTRMD 2.6-7.5 CM 12032 $761.25 $609.00 HC ED WND RPR INTERMD NK HD FT GEN <=2.5CM 12041 $542.85 $434.28 HP WND RPR INTEERMD NK HD FT GEN <=2.5CM 12041 $606.90 $485.52 HC ED RPR NK/HD/FT/GEN INTRMD 2.6-7.5 CM 12042 $642.60 $514.08 HP WND RPR INT NK HN FT GN 2.6-7.5 CM 12042 $717.15 $573.72 HC ED RPR TRUNK CMPLX 1.1-2.5 CM 13100 "$1,298.85 " "$1,039.08 " HP WND RPR COMPLX TRUNK 1.1-2.5CM 13100 $591.15 $472.92 HC ED WND RPR COMPLEX TRUNK 2.6-7.5CM 13101 "$1,298.85 " "$1,039.08 " HP WND RPR COMPLX TRUNK 2.6-7.5CM 13101 $708.75 $567.00 HC ED WND CPX TK EA ADD 5CM OR LESS 13102 $213.15 $170.52 HP WND RPR COMPLEX TRUNK EA ADDL 5CM 13102 $213.15 $170.52 HC ED RPR SCLP EXTRM CMPLX 1.1-2.5 CM 13120 "$1,298.85 " "$1,039.08 " HP WND RPR CMP SCLP ARM LEG 1.1-2.5CM 13120 $708.75 $567.00 HC ED RPR SCLP EXTRM CMPLX 2.6-7.5 CM 13121 "$1,298.85 " "$1,039.08 " HP RPR SCLP EXTRM CMPLX 2.6-7.5 CM 13121 $767.55 $614.04 HC ED RPR SCLP EXTRM CMPLX EA ADDL 5 CM 13122 $236.25 $189.00 HP RPR SCLP EXTRM CMPLX EA ADDL 5 CM 13122 $236.25 $189.00 HC ED RPR FACE/NK/HD/FT CMP 1.1CM-2.5 CM 13131 $919.80 $735.84 HP RPR FACE/NK/HD/FT CMPLX 1.1CM-2.5 CM 13131 "$1,100.40 " $880.32 HC ED RPR FACE/NK/HD/FT CMPLX 2.6-7.5 CM 13132 "$1,239.00 " $991.20 HP RPR FACE/NK/HD/FT CMPLX 2.6-7.5 CM 13132 "$1,707.30 " "$1,365.84 " HC APP SKIN SUB HIGH T/A/L <100CM 1ST 25CM 15271 "$3,070.20 " "$2,456.16 " HC APP SKIN SUB HIGH T/A/L <100CM ADDL 25CM 15272 $12.60 $10.08 HP EXC SKIN SUBQ TISSUE 15830 "$4,060.35 " "$3,248.28 " HC ED BURN TREATMENT INIT FIRST DEGREE 16000 $318.15 $254.52 HP BURN TREATMNT INIT FST DGRE 16000 $189.00 $151.20 HC ED BURN DRESS DEBRID NO ANESTHES SM 16020 $318.15 $254.52 HP BURN DRESS DEBRID NO ANES SM 16020 $224.70 $179.76 HC ED BURN DRESS DEBRID NO ANESTHES MED 16025 $430.50 $344.40 HP BURN DRESS DEBRID NO ANES MED 16025 $490.35 $392.28 HC ED BURN DRESS DEBRID NO ANESTHES LG 16030 $609.00 $487.20 HP BURN DRESS DEBRID NO ANES LG 16030 $501.90 $401.52 HP EXCISE BREAST LESION OPEN >=1 19120 "$1,455.30 " "$1,164.24 " HP MASTECTOMY SMPL COMPL 19303 "$3,586.80 " "$2,869.44 " HC ED DRAIN/INJECT SMALL JOINT/BURSA 20600 $648.90 $519.12 HP ARTHROCENTESIS JOINT SMALL WO US 20600 $100.80 $80.64 HC ED ARTHROCENTESIS JOINT MAJOR WO US 20610 $565.95 $452.76 HP ARTHROCENTESIS JOINT MAJOR WO US 20610 $193.20 $154.56 HC ED TX FX NASAL CLSD WO STABILIZATION 21315 "$4,369.05 " "$3,495.24 " HP TX FX NASAL CLOSED NO STABILIZATION 21315 $424.20 $339.36 HC ED TX FX NASAL CLSD W/STABILIZATION 21320 "$4,369.05 " "$3,495.24 " HP TX FX NASAL CLSD W/STABILIZATION 21320 $378.00 $302.40 HC ED FX CLAVICLE CLOSED TX NO MANIP 23500 $464.10 $371.28 HP FX CLAVICLE CLS TX NO MANIP 23500 $710.85 $568.68 HC ED TX FX HUMERUS PROX CLSD W/O MANIP 23600 $464.10 $371.28 HP TX FX HUMERUS PROX CLSD W/O MANIP 23600 $991.20 $792.96 HC ED TX DISLOC SHLDR CLSD W MANIP WO ANES 23650 $464.10 $371.28 HC ED TX DISLOC SHLDR CLSD W MANIP W ANES 23655 "$4,431.00 " "$3,544.80 " HP TX DISLOC SHOULDER CLSD W MANIP W ANES 23655 "$1,384.95 " "$1,107.96 " HP BURSECTOMY OLECRANON 24105 "$1,199.10 " $959.28 HC ED TX FX HUMERAL EPICON CLSD W/O MANIP 24560 $529.20 $423.36 HC ED TX DISLOC ELBOW CLSD W/O ANS 24600 $596.40 $477.12 HP TX DISLOC ELBOW CLS NO ANES 24600 $908.25 $726.60 HC ED TX FX ELBOW DISL CLSD W ANS 24605 "$3,463.95 " "$2,771.16 " HP CLOSED ELBOW DIS REQ ANESTHESIA 24605 "$1,277.85 " "$1,022.28 " HC ED TX NURSEMAID ELBOW W/ MANIP 24640 $315.00 $252.00 HP EXCISE GANGLION WRIST PRIMARY 25111 "$1,164.45 " $931.56 HC ED CLSD TX ULNR SHFT FX NO MANIP 25530 $464.10 $371.28 HC ED TX FX RADIAL ULNR SHFT CLSD W/O MANIP 25560 $468.30 $374.64 HP CLSD TREATMENT OF RAD/ULN SHAFT FRA 25560 $763.35 $610.68 HC ED TX FX RADIAL DISTAL CLSD W/O MANIP 25600 $464.10 $371.28 HP TX FX RADIAL DISTAL CLSD W/O MANIP 25600 "$1,085.70 " $868.56 HC ED TX FX CARPAL SCAPHOID CLSD W/O MANIP 25622 $929.25 $743.40 HC ED TX FX SCAPHOPERILUNAR CLSD W MANIP 25680 $415.80 $332.64 HP TX FX SCAPHOPERILUNAR CLSD W MANIP 25680 "$1,695.75 " "$1,356.60 " HP FASCIOTOMY PALMAR PERCUTANEOUS 26040 "$1,087.80 " $870.24 HC ED TX FX METACARPAL CLSD EA W/O MANIP 26600 $786.45 $629.16 HP CLOSED METACAR.FRAC.SING.W/O MAN 26600 $711.90 $569.52 HC ED FX PHALANX SHAFT CLSD TX NO MANIP 26720 $609.00 $487.20 HC ED FX PHALANX DISTL CLSD TX NO MANIP 26750 $555.45 $444.36 HP FX PHALANX DIST CLS TX NO MAN 26750 $574.35 $459.48 HC ED DISLOC FINGER IP CLOSED TX NO ANESTH 26770 $533.40 $426.72 HC ED TX FX FIBULA DISTAL CLSD W/O MANIP 27786 "$1,031.10 " $824.88 HC ED TX FX ANKLE TRIMALL CLSD W/O MANIP 27816 $934.50 $747.60 HP CL TX TRIMALLEOLR ANKLE FX W/O MAN 27816 $985.95 $788.76 HC ED TX FX METATARSAL CLSD EA W/O MANIP 28470 $468.30 $374.64 HP CLOSED METATARSAL FRACTURE W/O MAN. 28470 $645.75 $516.60 HC ED APPLIC SPLINT ARM LONG 29105 $325.50 $260.40 HP APPLIC SPLINT LONG ARM 29105 $165.90 $132.72 HC ED APPLIC SPLINT SHORT ARM STATIC 29125 $310.80 $248.64 HP APPLIC SPLINT SHORT ARM STATIC 29125 $154.35 $123.48 HC ED APPLIC SPLINT FINGER STATIC 29130 $153.30 $122.64 HP APPLIC SPLINT FINGER STATIC 29130 $112.35 $89.88 HC APPLIC SPLINT FINGER DYNAMIC OT 29131 $118.65 $94.92 HC ED STRAPPING SHOULDER 29240 $294.00 $235.20 HP STRAPPING SHOULDER 29240 $279.30 $223.44 HC ED STRAPPING ELBOW/WRIST 29260 $143.85 $115.08 HC ED STRAPPING HAND/FINGER 29280 $123.90 $99.12 HP STRAPPING HAND OR FINGER 29280 $82.95 $66.36 HC ED APPLIC SPLINT LONG LEG 29505 $348.60 $278.88 HP APPLIC SPLINT LONG LEG 29505 $141.75 $113.40 HC ED APPLIC SPLINT SHORT LEG 29515 $327.60 $262.08 HP APPLIC SPLINT SHORT LEG 29515 $178.50 $142.80 HC ED STRAPPING KNEE 29530 $286.65 $229.32 HC ED STRAPPING ANKLE/FOOT 29540 $364.35 $291.48 HP APPLY MULTLAY COMPRS LWR LEG 29581 "$1,362.90 " "$1,090.32 " HC ED REMV FB NOSE 30300 $185.85 $148.68 HP FB REMOV INTRANASAL 30300 $418.95 $335.16 HC ED EPISTAXIS CONTRL ANTERIOR SIMPLE 30901 $278.25 $222.60 HP CONTROL EPISTAXIS ANT SMPL 30901 $162.75 $130.20 HC ED CONTROL EPISTAXIS ANT COMPLX 30903 $278.25 $222.60 HP EPISTAXIS CNTRL ANTER CMPLX 30903 $232.05 $185.64 HC ED EPISTAXIS CONTRL POST & PACK INIT 30905 $278.25 $222.60 HP EPISTAXIS CNTL POST&PACK INIT 30905 $304.50 $243.60 HC ED EPISTAXIS CONTRL POST & PACK SUBS 30906 $492.45 $393.96 HP EPISTAX CONTR POST & PACK SUBS 30906 $391.65 $313.32 HC ED INTUBATION ENDOTRACHEAL EMERGENT 31500 $883.05 $706.44 HC ED THORACOSTOMY W TUBE OPEN 32551 "$3,307.50 " "$2,646.00 " HC ED THORACENTESIS W IMAGING 32555 "$1,825.95 " "$1,460.76 " LCHG BLOOD DRAW 36415 $23.10 $18.48 LCHG BLOOD DRAW CAPILLARY 36416 $- $- HC BLOOD TRANSFUSION SERVICE 36430 $918.75 $735.00 LCHG PLASMAPHERESIS THERAPEUTIC 36514 $691.95 $553.56 LCHG BLOOD COLLECTION/PORT 36591 $284.55 $227.64 HC COLLECTION BLOOD CENTRL OR PERIPH CATH 36592 $284.55 $227.64 HC ED COLLECTION BLOOD CENTRL OR PERIPH CATH 36592 $284.55 $227.64 HC ED INTEROSSEOUS NEEDLE PLACEMENT 36680 $203.70 $162.96 HP BX RMVL LYMPH NODES OPEN SUPERFICIAL 38500 $934.50 $747.60 HP EGD FLEX TRANSORAL DX 43235 $488.25 $390.60 HP EGD FLEX TRANSORAL W BX SNGL OR MULT 43239 $547.05 $437.64 HP EGD W BALLOON DILATION ESOPHAGUS<30MM 43249 $607.95 $486.36 HC ED NASO GASTRIC TUBE PLCMT W FLUORO 43752 $357.00 $285.60 HC ED INTUBATE GASTRIC W ASP DX SNGL 43753 $190.05 $152.04 HP APPENDECTOMY 44950 "$2,394.00 " "$1,915.20 " HP APPENDECTOMY 44950 $478.80 $383.04 HP APPENDECTOMY W OTHER MAJOR PROC 44955 $306.60 $245.28 HP APPENDECTOMY RUPTURED W INFECTION 44960 "$3,108.00 " "$2,486.40 " HC ED PROCTOSIGMOIDSCPY REMVL FOREIGN BODY 45307 "$4,065.60 " "$3,252.48 " HP SIGMOIDOSCOPY FLEX DIAGNOSTIC 45330 $228.90 $183.12 HP SIGMOIDOSCOPY FLEX W BX 45331 $281.40 $225.12 HP COLONOSCOPY FLEX DIAGNOSTIC 45378 $796.95 $637.56 HP COLONOSCOPY FLEX WITH BIOPSY 45380 $953.40 $762.72 HP COLONOSCOPY FLEX W REMV LES SNARE 45385 "$1,134.00 " $907.20 HC ED RMVL FECAL IMPACT OR FB W ANESTH 45915 "$4,478.25 " "$3,582.60 " HP RMVL FECAL IMPACT OR FB W ANESTH 45915 $631.05 $504.84 HP REMOVE EXT HEM GROUPS 2 OR MORE 46250 "$1,127.70 " $902.16 HP REMOVE INT/EXT HEM 1 GROUP 46255 "$1,236.90 " $989.52 HC ED PARACENTESIS ABD WO GUIDANCE 49082 $724.50 $579.60 HP RPR HERNIA ING INIT REDUCIBLE >=5YRS 49505 "$1,849.05 " "$1,479.24 " HC INSERT CATH STRAIGHT 51701 $380.10 $304.08 HC ED INSERT CATH STRAIGHT 51701 $180.60 $144.48 HC INSERT CATH TEMP INDWELL BLADDER SMPL 51702 $241.50 $193.20 HC ED INSERT CATH TEMP INDWELL BLADDER SMPL 51702 $241.50 $193.20 HP CIRCUM NO CLAMP >28DAYS 54161 $822.15 $657.72 HP DILATATION AND CURETTAGE 58120 $822.15 $657.72 HP HYSTERECTOMY TOTAL ABDOMINAL 58150 "$3,482.85 " "$2,786.28 " HP HYSTERECTOMY TOTAL ABDOMINAL 58150 $697.20 $557.76 HP LIGATION FALLOPIAN TUBE W CSECTION 58611 $306.60 $245.28 HP INJ EPIDURAL CERVICAL THOR WO IMG 62320 $242.55 $194.04 HC ED INJ EPIDURAL CERVICAL THOR WO IMG 62320 $27.30 $21.84 HP INJ EPIDURAL LUMBAR SACRAL WO IMG 62322 $292.95 $234.36 HC ED INJ EPIDURAL LUMBAR SACRAL WO IMG 62322 $33.60 $26.88 HC ED INJ AA STRD PERIPHERAL NERVE 64450 "$1,416.45 " "$1,133.16 " HP INJ AA STRD PERIPHERAL NERVE OTHER 64450 $129.15 $103.32 HP CARPAL TUNNEL RELEASE UNILAT 64721 "$1,471.05 " "$1,176.84 " HC ED REMV FB EYE CONJUNCTIVAL SUPERFICIAL 65205 $318.15 $254.52 HP FB REMOV EYE CONJ SURF 65205 $171.15 $136.92 HC ED REMV FB EYE CORNEAL W/O LAMP 65220 $298.20 $238.56 HP FB REMOV CORNEA NO LMP 65220 $151.20 $120.96 HC ED REMV FB AUDITORY CANAL EXT NO GEN ANS 69200 $205.80 $164.64 HP FOR BODY REMOV EAR NO ANES 69200 $287.70 $230.16 HC ED REMV CERUMEN IMPACTED W INSTRMNT UNI 69210 $193.20 $154.56 HP REMOVE CERUMEN IMPACTED W INSTRUMENT UNI 69210 $123.90 $99.12 HC MANDIBLE < 4 VW 70100 $193.20 $154.56 HC MANDIBLE 4+ VW 70110 $318.15 $254.52 HC FACIAL BONES < 3 VW 70140 $193.20 $154.56 HC FACIAL BONES 3+ VW 70150 $193.20 $154.56 HC NASAL BONES 70160 $193.20 $154.56 HC ORBITS 4+ VW 70200 $193.20 $154.56 HC XR SINUSES < 3VW 70210 $193.20 $154.56 HC SINUSES 3+ VW 70220 $193.20 $154.56 HC SKULL < 4 VW 70250 $193.20 $154.56 HC SKULL COMPLETE 4+ VW 70260 $193.20 $154.56 HC TEMPOROMANDIBULAR JOINTS BILATERAL 70330 $219.45 $175.56 HC NECK SOFT TISSUE 70360 $193.20 $154.56 HC CT HEAD NON CONTRAST 70450 $820.05 $656.04 HC CT HEAD WITH CONTRAST 70460 "$1,082.55 " $866.04 HC CT HEAD WITH & WITHOUT CONTRAST 70470 "$1,436.40 " "$1,149.12 " HC CT ORBIT POST FOSSA EAR NON CONTRAST 70480 $820.05 $656.04 HC CT ORBIT POST FOSSA EAR WITH & WITHOUT CONTRAST 70482 "$1,192.80 " $954.24 HC CT SINUS FACIAL BONES NON CONTRAST 70486 $820.05 $656.04 HC CT MAXILLOFACIAL W CONTRAST 70487 "$1,082.55 " $866.04 HC CT MAXILLOFACIAL W & WO CONTRAST 70488 "$1,380.75 " "$1,104.60 " HC CT SOFT TISSUE NECK NON CONTRAST 70490 $820.05 $656.04 HC CT SOFT TISSUE NECK WITH CONTRAST 70491 "$1,192.80 " $954.24 HC CT SOFT TISSUE NECK WITH & WITHOUT CONTRAST 70492 "$1,436.40 " "$1,149.12 " HC CT ANGIO HEAD WITH AND WITHOUT CONTRAST 70496 "$1,323.00 " "$1,058.40 " HC CT ANGIO NECK 70498 "$1,323.00 " "$1,058.40 " HC MRI ORBIT FACE NECK NON CONTRAST 70540 $624.75 $499.80 HC MRI ORBIT FACE NECK WITH & WITHOUT CONTRAST 70543 "$1,891.05 " "$1,512.84 " HC MRA ANGIO HEAD NON CONTRAST 70544 "$1,504.65 " "$1,203.72 " HC MRA ANGIO HEAD WITH CONTRAST 70545 "$1,808.10 " "$1,446.48 " HC MRA ANGIO HEAD WITH & WITHOUT CONTRAST 70546 "$2,323.65 " "$1,858.92 " HC MRA ANGIO NECK NON CONTRAST 70547 "$1,504.65 " "$1,203.72 " HC MRA ANGIO NECK WITH CONTRAST 70548 "$1,808.10 " "$1,446.48 " HC MRA ANGIO NECK WITH & WITHOUT CONTRAST 70549 "$2,323.65 " "$1,858.92 " HC MRI BRAIN NON CONTRAST 70551 "$1,504.65 " "$1,203.72 " HC MRI BRAIN WITH CONTRAST 70552 "$1,633.80 " "$1,307.04 " HC MRI BRAIN WITH & WITHOUT CONTRAST 70553 "$2,323.65 " "$1,858.92 " HC XRAY CHEST 1 VIEW 71045 $219.45 $175.56 HC XRAY CHEST 2 VIEWS 71046 $219.45 $175.56 HC XRAY CHEST 3 VIEWS 71047 $219.45 $175.56 HC XRAY CHEST 4 OR MORE VIEWS 71048 $420.00 $336.00 HC RIBS UNILATERAL 2 VW 71100 $193.20 $154.56 HC RIBS UNILATERAL W PA CHEST 71101 $193.20 $154.56 HC RIBS BILATERAL 3 VW 71110 $193.20 $154.56 HC RIBS BILATERAL W PA CHEST 71111 $348.60 $278.88 HC STERNUM 2+ VW 71120 $193.20 $154.56 HC XR STERNOCLAVICULAR JOINTS 3+ VW 71130 $193.20 $154.56 HC CT CHEST NON CONTRAST 71250 $820.05 $656.04 HC CT CHEST WITH CONTRAST 71260 "$1,082.55 " $866.04 HC CT CHEST WITH & WITHOUT CONTRAST 71270 "$1,436.40 " "$1,149.12 " HC CT CHEST LOW DOSE FOR LUNG CA SCREEN 71271 $226.80 $181.44 HC CT ANGIO CHEST W CONTRAST 71275 "$1,119.30 " $895.44 HC MRI CHEST WITH & WITHOUT CONTRAST 71552 "$2,323.65 " "$1,858.92 " HC SPINE 1 VIEW 72020 $193.20 $154.56 HC CERVICAL SPINE 2 OR 3 VW 72040 $193.20 $154.56 HC CERVICAL SPINE MIN 4+ VW 72050 $324.45 $259.56 HC CERVICAL SPINE W OBL AND FLEX/EXT 72052 $334.95 $267.96 HC THORACIC SPINE 2 VW 72070 $193.20 $154.56 HC THORACIC SPINE 3 VW 72072 $193.20 $154.56 HC THORACOLUMBAR SPINE 2 VW 72080 $193.20 $154.56 HC XRAY SPINE ENTIRE 1 VIEW 72081 $184.80 $147.84 HC LUMBAR SPINE 2 OR 3 VW 72100 $193.20 $154.56 HC LUMBAR SPINE 4+ VW 72110 $318.15 $254.52 HC LUMBAR SPINE W BENDING VW 72114 $324.45 $259.56 HC XR LUMBAR SPINE BENDING ONLY 2-3 VW 72120 $193.20 $154.56 HC CT CERVICAL SPINE NON CONTRAST 72125 $820.05 $656.04 HC CT CERVICAL SPINE WITH CONTRAST 72126 "$1,186.50 " $949.20 HC CT CERVICAL SPINE WITH & WITHOUT CONTRAST 72127 "$1,436.40 " "$1,149.12 " HC CT THORACIC SPINE NON CONTRAST 72128 $820.05 $656.04 HC CT THORACIC SPINE WITH CONTRAST 72129 "$1,186.50 " $949.20 HC CT THORACIC SPINE WITH & WITHOUT CONTRAST 72130 "$1,437.45 " "$1,149.96 " HC CT LUMBAR SPINE NON CONTRAST 72131 $820.05 $656.04 HC CT LUMBAR SPINE WITH CONTRAST 72132 "$1,226.40 " $981.12 HC CT LUMBAR SPINE WITH & WITHOUT CONTRAST 72133 "$1,436.40 " "$1,149.12 " HC MRI SPINE CERVICAL NON CONTRAST 72141 "$1,504.65 " "$1,203.72 " HC MRI SPINE CERVICAL WITH CONTRAST 72142 "$1,633.80 " "$1,307.04 " HC MRI SPINE THORACIC NON CONTRAST 72146 "$1,504.65 " "$1,203.72 " HC MRI SPINE THORACIC WITH CONTRAST 72147 "$1,633.80 " "$1,307.04 " HC MRI SPINE LUMBAR NON CONTRAST 72148 "$1,504.65 " "$1,203.72 " HC MRI SPINE LUMBAR WITH CONTRAST 72149 "$1,150.80 " $920.64 HC MRI SPINE CERVICAL WITH & WITHOUT CONTRAST 72156 "$2,323.65 " "$1,858.92 " HC MRI SPINE THORACIC WITH & WITHOUT CONTRAST 72157 "$2,212.35 " "$1,769.88 " HC MRI SPINE LUMBAR WITH & WITHOUT CONTRAST 72158 "$2,323.65 " "$1,858.92 " HC PELVIS 1 OR 2 VW 72170 $193.20 $154.56 HC PELVIS 3+ VW 72190 $270.90 $216.72 HC CT PELVIS WO CONTRAST 72192 $820.05 $656.04 HC CT PELVIS WITH IV CONTRAST 72193 "$1,082.55 " $866.04 HC CT PELVIS WITH & WITHOUT IV CONTRAST 72194 "$1,436.40 " "$1,149.12 " HC MRI PELVIS NON CONTRAST 72195 "$1,504.65 " "$1,203.72 " HC MRI PELVIS WITH & WITHOUT CONTRAST 72197 "$2,323.65 " "$1,858.92 " HC SACROILIAC JOINTS < 3 VW 72200 $219.45 $175.56 HC SACROILIAC JOINTS 3+ VW 72202 $324.45 $259.56 HC SACRUM AND COCCYX 72220 $193.20 $154.56 HC XRAY CLAVICLE COMPLETE 73000 $193.20 $154.56 HC SCAPULA 73010 $193.20 $154.56 HC SHOULDER 1 VW 73020 $193.20 $154.56 HC SHOULDER 2+ VW 73030 $193.20 $154.56 HC ACROMIOCLAVICULAR JOINTS BILATERAL 73050 $273.00 $218.40 HC HUMERUS 2+ VW 73060 $193.20 $154.56 HC ELBOW 2 VW 73070 $193.20 $154.56 HC ELBOW 3+ VW 73080 $193.20 $154.56 HC FOREARM 2 VW 73090 $193.20 $154.56 HC WRIST 2 VW 73100 $193.20 $154.56 HC WRIST 2 VW REDUCED SERVICE 73100 $117.60 $94.08 HC WRIST 3+ VW 73110 $193.20 $154.56 HC HAND 2 VW 73120 $193.20 $154.56 HC XR HAND 1 VW 73120 $177.45 $141.96 HC HAND 3+ VW 73130 $193.20 $154.56 HC XRAY FINGER(S) MIN 2 VW 73140 $193.20 $154.56 HC CT UPPER EXTREMITY NON CONTRAST 73200 $820.05 $656.04 HC CT UPPER EXTREMITY WITH CONTRAST 73201 $938.70 $750.96 HC MRI UPPER EXT NON JOINT NON CONTRAST 73218 "$1,446.90 " "$1,157.52 " HC MRI UPPER EXT NON JOINT WITH & WITHOUT CONTRAST 73220 "$2,323.65 " "$1,858.92 " HC MRI UPPER EXT ANY JOINT NON CONTRAST 73221 "$1,504.65 " "$1,203.72 " HC MRI UPPER EXT ANY JOINT WITH CONTRAST 73222 "$1,771.35 " "$1,417.08 " HC MRI UPPER EXT ANY JOINT WITH & WITHOUT CONTRAST 73223 "$1,891.05 " "$1,512.84 " HC XRAY HIP UNILAT 1 VIEW 73501 $184.80 $147.84 HC XRAY HIP UNILAT 2-3 VIEWS 73502 $184.80 $147.84 HC XRAY HIPS BILAT W PELVIS 2 VIEWS 73521 $324.45 $259.56 HC XRAY HIPS BILAT W PELVIS 3-4 VIEWS 73522 $310.80 $248.64 HC XRAY HIPS BILATERAL W PELV MIN 5 VW 73523 $310.80 $248.64 HC XRAY FEMUR 1 VIEW 73551 $276.15 $220.92 HC XRAY FEMUR MINIMUM 2 VIEWS 73552 $184.80 $147.84 HC KNEE 1 OR 2 VW 73560 $193.20 $154.56 HC KNEE 3 VW 73562 $193.20 $154.56 HC XR KNEE 4+ VW 73564 $273.00 $218.40 HC KNEES AP BILATERAL STANDING 73565 $219.45 $175.56 HC TIBIA AND FIBULA 2 VW 73590 $193.20 $154.56 HC XR LOWER EXTREMITY INFANT 2+ VW 73592 $165.90 $132.72 HC ANKLE 2 VW 73600 $193.20 $154.56 HC ANKLE 3+ VW 73610 $193.20 $154.56 HC FOOT 2 VW 73620 $193.20 $154.56 HC FOOT 2 VW REDUCED SERVICE 73620 $117.60 $94.08 HC FOOT 3+ VW 73630 $193.20 $154.56 HC CALCANEUS 2+ VW 73650 $193.20 $154.56 HC TOES 2+ VW 73660 $193.20 $154.56 HC CT LOWER EXTREMITY NON CONTRAST 73700 $765.45 $612.36 HC CT LOWER EXTREMITY WITH CONTRAST 73701 "$1,082.55 " $866.04 HC CT LOWER EXTREMITY WITH & WITHOUT CONTRAST 73702 "$1,074.15 " $859.32 HC MRI LOWER EXT NON JOINT NON CONTRAST 73718 "$1,504.65 " "$1,203.72 " HC MRI LOWER EXT NON JOINT WITH CONTRAST 73719 "$1,633.80 " "$1,307.04 " HC MRI LOWER EXT NON JOINT WITH & WITHOUT CONTRAST 73720 "$2,212.35 " "$1,769.88 " HC MRI LOWER EXT ANY JOINT NON CONTRAST 73721 "$1,504.65 " "$1,203.72 " HC MRI LOWER EXT ANY JOINT WITH CONTRAST 73722 "$1,633.80 " "$1,307.04 " HC MRI LOWER EXT ANY JNT W AND WO CONTRAST 73723 "$2,191.35 " "$1,753.08 " HC XRAY ABDOMEN 1 VIEW 74018 $219.45 $175.56 HC XRAY ABDOMEN 2 VIEWS 74019 $420.00 $336.00 HC XRAY ABDOMEN 3 OR MORE VIEWS 74021 $420.00 $336.00 HC XRAY ABD ACUTE SERIES W PA CHEST 74022 $324.45 $259.56 HC CT ABDOMEN NON IV CONTRAST 74150 $820.05 $656.04 HC CT ABDOMEN WITH IV CONTRAST 74160 "$1,082.55 " $866.04 HC CT ABDOMEN WITH & WITHOUT IV CONTRAST 74170 "$1,436.40 " "$1,149.12 " HC CT ANGIO ABDOMEN PELVIS W WO CON 74174 "$1,323.00 " "$1,058.40 " HC CT ABDOMEN PELVIS WO CONTRAST 74176 $820.05 $656.04 HC CT ABDOMEN PELVIS W CONTRAST 74177 "$1,242.15 " $993.72 HC CT ABDOMEN PELVIS WWO CONTRAST 74178 "$1,436.40 " "$1,149.12 " HC MRI ABDOMEN NON CONTRAST 74181 "$1,504.65 " "$1,203.72 " HC MRI ABDOMEN WITH & WITHOUT CONTRAST 74183 "$2,323.65 " "$1,858.92 " HC FLUORO IV PYELOGRAM (IVP) 74400 $748.65 $598.92 HC ECHO EXAM OF HEAD 76506 $515.55 $412.44 HC US HEAD NECK TISSUES B - SCAN REAL TIME 76536 $409.50 $327.60 HC US CHEST 76604 $515.55 $412.44 HC US BREAST UNILATERAL COMPLETE 76641 $331.80 $265.44 HC US BREAST UNILATERAL LIMITED 76642 $331.80 $265.44 HC US ABDOMEN COMPLETE 76700 $460.95 $368.76 HC US ABDOMEN LIMITED 76705 $413.70 $330.96 HC US AAA SCREENING 76706 $447.30 $357.84 HC US RETROPERITONEAL COMPLETE 76770 $447.30 $357.84 HC US RETROPERITONEAL LIMITED 76775 $447.30 $357.84 HC US OB < 14 WKS SINGLE GEST 76801 $496.65 $397.32 HC US OB < 14 WKS EA ADDITIONAL GEST 76802 $262.50 $210.00 HC US OB 14+ WKS ADDITIONAL GEST 76810 $262.50 $210.00 HC US PREG UTERUS FOLLOW UP PER FETUS 76816 $512.40 $409.92 HC US PREGNANT UTERUS TRANSVAGINAL 76817 $248.85 $199.08 HC US TRANSVAGINAL NON OB 76830 $413.70 $330.96 HC US PELVIS COMPLETE 76856 $413.70 $330.96 HC US PELVIS LIMITED 76857 $340.20 $272.16 HC US SCROTUM AND CONTENTS 76870 $413.70 $330.96 HC US JOINT COMPLETE 76881 $382.20 $305.76 HC US JOINT OR NONVASC EXT LIMITED 76882 $265.65 $212.52 HC US SOFT TISSUE LESION(S) 76999 $411.60 $329.28 HC CT BONE DENS STUDY 1+ SITE AXIAL 77078 $310.80 $248.64 HC DEXA BONE DENSITY AXIAL SKELETON 77080 $310.80 $248.64 LCHG BASIC METABOLIC PANEL (CA TOTAL) 80048 $51.45 $41.16 LCHG LYTES (NA K CL CO2) BLOOD 80051 $40.95 $32.76 LCHG COMPREHENSIVE METABOLIC PANEL 80053 $58.80 $47.04 LCHG OBSTETRIC PANEL 80055 $560.70 $448.56 LCHG LIPID PROFILE 80061 $82.95 $66.36 LCHG HEPATITIS SCREEN ACUTE 80074 $288.75 $231.00 LCHG HEPATIC FUNCTION PANEL 80076 $51.45 $41.16 LCHG ACETAMINOPHEN ASSAY I 80143 $75.60 $60.48 LCHG CARBAMAZEPINE LEVEL TOTAL 80156 $45.15 $36.12 LCHG CYCLOSPORINE LEVEL 80158 $68.25 $54.60 LCHG DIGOXIN LEVEL 80162 $30.45 $24.36 LCHG VALPROIC ACID LEVEL 80164 $21.00 $16.80 LCHG FELBAMATE ASSAY 80167 $69.30 $55.44 LCHG EVEROLIMUS LEVEL I 80169 $147.00 $117.60 LCHG GENTAMICIN LEVEL PEAK 80170 $61.95 $49.56 LCHG GENTAMICIN LEVEL TROUGH 80170 $99.75 $79.80 LCHG HALOPERIDOL LEVEL 80173 $81.90 $65.52 LCHG LAMOTRIGINE LEVEL I 80175 $121.80 $97.44 LCHG LEVETIRACETAM LEVEL I 80177 $72.45 $57.96 LCHG LITHIUM LEVEL 80178 $24.15 $19.32 LCHG SALICYLATE ASSAY I 80179 $99.75 $79.80 LCHG OXCARBAZEPINE II 80183 $31.50 $25.20 LCHG PHENOBARBITAL LEVEL 80184 $71.40 $57.12 LCHG PHENOBARBITAL LEVEL I 80184 $71.40 $57.12 LCHG PHENYTOIN LEVEL 80185 $40.95 $32.76 LCHG PHENYTOIN FREE LEVEL 80186 $75.60 $60.48 LCHG PRIMIDONE LEVEL 80188 $87.15 $69.72 LCHG QUINIDINE LEVEL 80194 $50.40 $40.32 LCHG SIROLIMUS 80195 $71.40 $57.12 LCHG TACROLIMUS LEVEL 80197 $196.35 $157.08 LCHG THEOPHYLLINE LEVEL 80198 $45.15 $36.12 LCHG TOBRAMICIN LEVEL TROUGH 80200 $55.65 $44.52 LCHG TOPIRAMATE LEVEL 80201 $105.00 $84.00 LCHG VANCOMYCIN LEVEL PEAK 80202 $86.10 $68.88 LCHG VANCOMYCIN LEVEL TROUGH 80202 $86.10 $68.88 LCHG ACETAMINOPHEN LEVEL III 80299 $227.85 $182.28 LCHG SALICYLATE LEVEL BLOOD III 80299 $111.30 $89.04 LCHG LAMOTRIGINE LEVEL 80299 $126.00 $100.80 LCHG LEVETIRACETAM LEVEL 80299 $72.45 $57.96 LCHG TRILEPTAL 80299 $102.90 $82.32 LCHG ALCOHOL ETHYL URINE QUANT II 80307 $28.35 $22.68 LCHG DRUG SCREEN SGLCLS A V 80307 $86.10 $68.88 LCHG DRUG SCREEN SGLCLS A VI 80307 $122.85 $98.28 LCHG DRUG SCREEN PRESUMP SGLCLS B EACH II 80307 $160.65 $128.52 LCHG DRUG SCREEN COMPREHENSIVE 80307 80307 $205.80 $164.64 LCHG BUPRENORPHINE URINE QUALITATIVE 80307 $191.10 $152.88 LCHG ALCOHOL ETHYL BLOOD II 80320 $55.65 $44.52 LCHG NICOTINE+METABOLITE I 80323 $271.95 $217.56 LCHG DIHYDROTESTOSTERONE (DHT) I 80327 $242.55 $194.04 LCHG ACETAMINOPHEN LEVEL II 80329 $227.85 $182.28 LCHG SALICYLATE LEVEL BLOOD II 80329 $111.30 $89.04 LCHG FELBAMATE LEVEL I 80339 $64.05 $51.24 LCHG CLONAZEPAM LEVEL I 80346 $55.65 $44.52 LCHG BENZODIAZEPINES 1-12 I 80346 $409.50 $327.60 LCHG DEXAMETHASONE LEVEL II 80375 $242.55 $194.04 LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC 81001 $23.10 $18.48 LCHG URINALYSIS DIPSTICK AUTO 81003 $11.55 $9.24 LCHG URINALYSIS MICROSCOPIC ONLY 81015 $- $- HC LAB HCG URINE QUAL POCT (IP) BEAKER 81025 $37.80 $30.24 LCHG HCG URINE QUALITATIVE 81025 $37.80 $30.24 LCHG VOLUME MEASURE URINE 81050 $23.10 $18.48 LCHG VOLUME MEASURE URINE II 81050 $14.70 $11.76 LCHG FACTOR II GENE G20210A PROTHROMBIN 81240 $320.25 $256.20 LCHG FACTOR V GENE LEIDEN 81241 $234.15 $187.32 LCHG HFE GENE HEMOCHROMATOSIS 81256 $353.85 $283.08 LCHG JAK2 GENE V6172F QUAL 81270 $688.80 $551.04 LCHG MTHFR GENE 81291 $291.90 $233.52 LCHG HLA TYPING B27 I 81374 $86.10 $68.88 HC STATLOK UNIV MED 10-12 817300 $24.15 $19.32 LCHG ACETONE BLOOD QUALITATIVE 82009 $51.45 $41.16 LCHG HYDROXYBUTYRATE BETA I 82010 $42.00 $33.60 LCHG ACTH 82024 $95.55 $76.44 LCHG ALBUMIN BLOOD 82040 $30.45 $24.36 LCHG MICROALBUMIN URINE RANDOM QUANT 82043 $30.45 $24.36 LCHG ALBUMIN URINE RANDOM QUANT 82043 $30.45 $24.36 LCHG MICROALBUMIN URINE SEMIQUANT 82044 $16.80 $13.44 LCHG ALDOLASE 82085 $9.45 $7.56 LCHG ALDOSTERONE 82088 $65.10 $52.08 LCHG ALDOSTERONE URINE TIMED 82088 $81.90 $65.52 LCHG ALPHA-1-ANTITRYPSIN BLOOD 82103 $26.25 $21.00 LCHG ALPHA-1-ANTITRYPSIN BLOOD PHENOTYPE 82104 $68.25 $54.60 LCHG ALPHA FETOPROTEIN BLOOD TUMOR 82105 $25.20 $20.16 LCHG ALPHA FETOPROTEIN BLOOD MATERNAL 82105 $27.30 $21.84 LCHG AMINO ACID BLOOD QUANTIATIVE 82139 $563.85 $451.08 LCHG AMMONIA 82140 $68.25 $54.60 LCHG AMYLASE BLOOD 82150 $40.95 $32.76 LCHG AMYLASE FLUID 82150 $19.95 $15.96 LCHG AMYLASE URINE TIMED 82150 $- $- LCHG ANDROSTENEDIONE 82157 $75.60 $60.48 LCHG ANGIOTENSIN CONVERT ENZYME BLOOD 82164 $21.00 $16.80 LCHG APOLIPOPROTEIN B 82172 $43.05 $34.44 LCHG ARSENIC BLOOD 82175 $121.80 $97.44 LCHG VITAMIN C 82180 $44.10 $35.28 LCHG BETA-2-MICROGLOBULIN 82232 $37.80 $30.24 LCHG BILIRUBIN TOTAL BLOOD 82247 $34.65 $27.72 LCHG BILIRUBIN DIRECT 82248 $34.65 $27.72 LCHG OCCULT BLOOD FECES 1-3 SCREEN 82270 $23.10 $18.48 LCHG OCCULT BLOOD FECES 82270 $23.10 $18.48 LCHG OCCULT BLOOD GASTRIC 82271 $23.10 $18.48 LCHG OCCULT BLOOD FECES 1-3 DIAG 82272 $23.10 $18.48 LCHG OCCULT BLOOD FECES 1-3 IMMUNO 82274 $224.70 $179.76 LCHG CADMIUM BLOOD 82300 $124.95 $99.96 LCHG VITAMIN D 25-HYDROXY D2+D3 82306 $296.10 $236.88 LCHG VITAMIN D 25-HYDROXY 82306 $53.55 $42.84 LCHG CALCITONIN 82308 $67.20 $53.76 LCHG CALCIUM BLOOD 82310 $34.65 $27.72 LCHG CALCIUM IONIZED BLOOD 82330 $21.00 $16.80 LCHG CALCIUM URINE TIMED 82340 $24.15 $19.32 LCHG CALCIUM URINE RANDOM 82340 $21.00 $16.80 LCHG STONE ANALYSIS QUANT 82360 $75.60 $60.48 LCHG STONE CALCULUS INFRARED SPECTROSCOPY 82365 $47.25 $37.80 LCHG CARBON DIOXIDE 82374 $45.15 $36.12 LCHG CARBON MONOXIDE 82375 $43.05 $34.44 LCHG CEA BLOOD 82378 $30.45 $24.36 LCHG CARNITINE FREE+TOTAL 82379 $90.30 $72.24 LCHG CATECHOLAMINES URINE FRACTIONATED 82384 $107.10 $85.68 LCHG CATECHOLAMINES BLOOD FRACT 82384 $89.25 $71.40 LCHG CERULOPLASMIN 82390 $24.15 $19.32 LCHG ANTI-MULLERIAN HORMONE I 82397 $244.65 $195.72 LCHG PTH RELATED PEPTIDE II 82397 $476.70 $381.36 LCHG CHLORIDE BLOOD 82435 $29.40 $23.52 LCHG CHLORIDE URINE RANDOM 82436 $14.70 $11.76 LCHG CHOLESTEROL BLOOD 82465 $30.45 $24.36 LCHG CHOLINESTERASE 82480 $45.15 $36.12 LCHG COPPER BLOOD 82525 $65.10 $52.08 LCHG CORTISOL URINE FREE 82530 $51.45 $41.16 LCHG CORTISOL BLOOD FREE 82530 $304.50 $243.60 LCHG CORTISOL BLOOD 82533 $26.25 $21.00 LCHG CORTISOL BLOOD AM 82533 $24.15 $19.32 LCHG CORTISOL BLOOD PM 82533 $24.15 $19.32 LCHG CORTISOL SALIVA 82533 $846.30 $677.04 LCHG CK BLOOD 82550 $40.95 $32.76 LCHG CKMB 82553 $329.70 $263.76 LCHG CREATININE BLOOD 82565 $34.65 $27.72 LCHG CREATININE URINE RANDOM 82570 $37.80 $30.24 LCHG CREATININE URINE TIMED 82570 $37.80 $30.24 LCHG CREATININE CLEARANCE URINE TIMED 82575 $61.95 $49.56 LCHG CRYOGLOBULIN QUALITATIVE 82595 $14.70 $11.76 LCHG VITAMIN B12 82607 $24.15 $19.32 LCHG DHEA 82626 $34.65 $27.72 LCHG DHEA SULFATE 82627 $40.95 $32.76 LCHG DIHYDROTESTOSTERONE (DHT) IV 82642 $219.45 $175.56 LCHG VITAMIN D 1 25 DIHYDROXY 82652 $232.05 $185.64 LCHG ERYTHROPOIETIN 82668 $27.30 $21.84 LCHG ESTRADIOL 82670 $68.25 $54.60 LCHG ESTROGEN TOTAL 82672 $68.25 $54.60 LCHG ESTRIOL FREE 82677 $61.95 $49.56 LCHG ESTRONE 82679 $134.40 $107.52 LCHG FAT QUALITATIVE FECES RANDOM 82705 $29.40 $23.52 LCHG FAT QUANTITATIVE FECES TIMED 82710 $61.95 $49.56 LCHG FERRITIN 82728 $21.00 $16.80 LCHG FOLATE 82746 $90.30 $72.24 LCHG FOLATE RBC 82747 $45.15 $36.12 LCHG IGA BLOOD 82784 $21.00 $16.80 LCHG IGG BLOOD 82784 $19.95 $15.96 LCHG IGM BLOOD 82784 $19.95 $15.96 LCHG IGD 82784 $37.80 $30.24 LCHG IMMUNOGLOBULIN 82784 $25.20 $20.16 LCHG IGA BLOOD I 82784 $17.85 $14.28 LCHG IGE 82785 $102.90 $82.32 LCHG ALLERGEN IGE 82785 $25.20 $20.16 LCHG PH VENOUS 82800 $30.45 $24.36 LCHG BLOOD GASES ARTERIAL 82805 $173.25 $138.60 LCHG GASTRIN 82941 $35.70 $28.56 LCHG GLUCOSE FLUID 82945 $13.65 $10.92 LCHG GLUCOSE CSF 82945 $45.15 $36.12 LCHG GLUCOSE FASTING 82947 $25.20 $20.16 LCHG GLUCOSE 82947 $25.20 $20.16 HC GLUCOSE BLOOD REAGENT STRIP POC 82948 $22.05 $17.64 LCHG GLUCOSE 2 HR POST PRANDIAL 82950 $30.45 $24.36 LCHG GLUCOSE 1 HR POST PRANDIAL 82950 $30.45 $24.36 LCHG GTT 1 HR GESTATIONAL SCREEN 82950 $30.45 $24.36 LCHG GTT 3 SPEC + DOSE 82951 $79.80 $63.84 LCHG GTT 2 HR GESTATIONAL DIAGNOSTIC 82951 $79.80 $63.84 LCHG GTT EACH ADD SPEC 82952 $27.30 $21.84 LCHG G6PD QUANTITATIVE 82955 $17.85 $14.28 HC LAB GLUCOSE BLD POCT (IP) 82962 $18.90 $15.12 LCHG GGT 82977 $14.70 $11.76 LCHG FRUCTOSAMINE 82985 $24.15 $19.32 LCHG FSH 83001 $27.30 $21.84 LCHG LH 83002 $37.80 $30.24 LCHG GROWTH HORMONE HUMAN 83003 $34.65 $27.72 LCHG HAPTOGLOBIN 83010 $34.65 $27.72 LCHG HEMOGLOBIN ELECTROPHORESIS 83021 $75.60 $60.48 LCHG HEMOGLOBIN A1C 83036 $59.85 $47.88 LCHG HEMOGLOBIN A1C W EAG 83036 $59.85 $47.88 LCHG HOMOCYSTEINE BLOOD QUANT 83090 $118.65 $94.92 LCHG HYDROXYPROGESTERONE 17- 83498 $69.30 $55.44 LCHG F-ACTIN ANTIBODY 83516 $33.60 $26.88 LCHG PROTEINASE 3 IMMUNO 83516 $44.10 $35.28 LCHG MITOCHONDRIAL ANTIBODY TITER ELISA 83516 $33.60 $26.88 LCHG MYELOPEROXIDASE ANTIBODY I 83516 $44.10 $35.28 LCHG GLIADIN ANTIBODY IGG 83516 $34.65 $27.72 LCHG GLIADIN ANTIBODY IGA 83516 $34.65 $27.72 LCHG TISSUE TRANSGLUTAMINASE AB IGA 83516 $68.25 $54.60 LCHG TISSUE TRANSGLUTAMINASE AB IGG 83516 $116.55 $93.24 LCHG ACETYLCHOLINE RECEPTOR BIND AB 83519 $107.10 $85.68 LCHG ACETYLCHOLINE RECEPTOR BLOCK AB 83519 $107.10 $85.68 LCHG ACETYLCHOLINE RECEPTOR MODUL AB 83519 $107.10 $85.68 LCHG PROTEINASE 3 I 83520 $51.45 $41.16 LCHG TRYPTASE 83520 $459.90 $367.92 LCHG MYELOPEROXIDASE ANTIBODY III 83520 $51.45 $41.16 LCHG IMMUNOASSAY ANALYTE QUANTITATIVE 83520 $100.80 $80.64 "LCHG LIGHT CHAINS (KAPPA, LAMBDA) FREE" 83521 $115.50 $92.40 LCHG INSULIN LEVEL 83525 $14.70 $11.76 LCHG INSULIN FREE LEVEL 83527 $26.25 $21.00 LCHG IRON BLOOD 83540 $14.70 $11.76 LCHG TIBC 83550 $57.75 $46.20 LCHG LACTIC ACID BLOOD 83605 $45.15 $36.12 LCHG LDH BLOOD 83615 $37.80 $30.24 LCHG LDH FLUID 83615 $14.70 $11.76 LCHG LDH ISOENZYMES 83625 $45.15 $36.12 LCHG LACTOFERRIN FECAL QUANTITATIVE 83631 $326.55 $261.24 LCHG LEAD BLOOD 83655 $14.70 $11.76 LCHG LEAD BLOOD I 83655 $14.70 $11.76 LCHG LIPASE BLOOD 83690 $40.95 $32.76 LCHG HDL CHOLESTEROL 83718 $51.45 $41.16 LCHG LDL CHOLESTEROL 83721 $30.45 $24.36 LCHG MAGNESIUM BLOOD 83735 $14.70 $11.76 LCHG MERCURY BLOOD 83825 $107.10 $85.68 LCHG METANEPHRINES URINE FRAC 83835 $85.05 $68.04 LCHG METANEPHRINES PLASMA 83835 $75.60 $60.48 LCHG MYOGLOBIN URINE QUANTITATIVE 83874 $49.35 $39.48 LCHG MYOGLOBIN BLOOD 83874 $37.80 $30.24 LCHG PRO BRAIN NATRIURETIC PEPTIDE 83880 $132.30 $105.84 LCHG B-TYPE NATRIURETIC PEPTIDE 83880 $153.30 $122.64 LCHG LIGHT CHAINS FREE EA 83883 $70.35 $56.28 LCHG KAPPA LIGHT CHAINS 83883 $223.65 $178.92 LCHG LAMBDA LIGHT CHAINS 83883 $223.65 $178.92 LCHG ORGANIC ACIDS URINE 83918 $99.75 $79.80 LCHG METHYLMALONIC ACID BLOOD 83921 $72.45 $57.96 LCHG OSMOLALITY BLOOD 83930 $24.15 $19.32 LCHG OSMOLALITY URINE 83935 $24.15 $19.32 LCHG PTH INTACT 83970 $24.15 $19.32 LCHG PH FLUID 83986 $34.65 $27.72 LCHG PH FECES 83986 $24.15 $19.32 LCHG CALPROTECTIN 83993 $708.75 $567.00 LCHG PKU NEONATAL 84030 $34.65 $27.72 LCHG PROSTATIC ACID PHOSPHATASE 84066 $30.45 $24.36 LCHG ALKALINE PHOSPHATASE BLOOD 84075 $37.80 $30.24 LCHG ALKALINE PHOSPHATASE ISOENZYMES 84080 $34.65 $27.72 LCHG PHOSPHORUS BLOOD 84100 $27.30 $21.84 LCHG POTASSIUM BLOOD 84132 $30.45 $24.36 LCHG POTASSIUM URINE TIMED 84133 $35.70 $28.56 LCHG POTASSIUM URINE RANDOM I 84133 $19.95 $15.96 LCHG PREALBUMIN 84134 $27.30 $21.84 LCHG PROGESTERONE 84144 $34.65 $27.72 LCHG PROCALCITONIN LEVEL 84145 $924.00 $739.20 LCHG PROLACTIN 84146 $30.45 $24.36 LCHG PSA COMPLEXED 84152 $59.85 $47.88 LCHG PSA TOTAL 84153 $61.95 $49.56 LCHG PROSTATE SPECIFIC ANTIGEN DIAG 84153 $70.35 $56.28 LCHG PSA FREE 84154 $50.40 $40.32 LCHG PROTEIN TOTAL BLOOD 84155 $27.30 $21.84 LCHG PROTEIN TOTAL BLOOD I 84155 $27.30 $21.84 LCHG PROTEIN URINE TIMED QUANTITATIVE 84156 $14.70 $11.76 LCHG PROTEIN URINE RANDOM QUANTITATIVE 84156 $14.70 $11.76 LCHG PROTEIN FLUID 84157 $14.70 $11.76 LCHG PROTEIN ELECTROPHORESIS BLOOD 84165 $34.65 $27.72 LCHG PROTEIN ELECTROPHORESIS BLOOD I 84165 $35.70 $28.56 LCHG PROTEIN ELECTROPHORESIS URINE TIMED 84166 $68.25 $54.60 LCHG PROTEIN ELECTROPHORESIS URINE RANDOM 84166 $68.25 $54.60 LCHG VITAMIN B6 84207 $88.20 $70.56 LCHG RENIN 84244 $58.80 $47.04 LCHG SELENIUM 84255 $112.35 $89.88 LCHG SEROTONIN 84260 $88.20 $70.56 LCHG SEX HORMONE BINDING GLOBULIN 84270 $71.40 $57.12 LCHG SODIUM BLOOD 84295 $30.45 $24.36 LCHG SODIUM URINE TIMED 84300 $43.05 $34.44 LCHG SODIUM URINE RANDOM 84300 $14.70 $11.76 LCHG SOMATOMEDIN C (IGF-1) 84305 $58.80 $47.04 LCHG TESTOSTERONE FREE 84402 $95.55 $76.44 LCHG TESTOSTERONE TOTAL MALE 84403 $27.30 $21.84 LCHG TESTOSTERONE TOTAL 84403 $27.30 $21.84 LCHG TESTOSTERONE TOTAL I 84403 $27.30 $21.84 LCHG TESTOSTERONE FREE AND WEAKLY BOUND 84410 $97.65 $78.12 LCHG VITAMIN B1 84425 $65.10 $52.08 LCHG THYROGLOBULIN 84432 $99.75 $79.80 LCHG T4 TOTAL 84436 $14.70 $11.76 LCHG T4 TOTAL I 84436 $14.70 $11.76 LCHG T4 FREE 84439 $34.65 $27.72 LCHG THYROID BINDING GLOBULIN 84442 $40.95 $32.76 LCHG TSH 84443 $64.05 $51.24 LCHG TSI 84445 $177.45 $141.96 LCHG VITAMIN E 84446 $45.15 $36.12 LCHG CORTISOL BINDING GLOBULIN 84449 $109.20 $87.36 LCHG AST BLOOD 84450 $34.65 $27.72 LCHG ALT 84460 $34.65 $27.72 LCHG TRANSFERRIN 84466 $30.45 $24.36 LCHG TRIGLYCERIDES BLOOD 84478 $37.80 $30.24 LCHG T3 UPTAKE 84479 $14.70 $11.76 LCHG T3 TOTAL 84480 $27.30 $21.84 LCHG T3 FREE 84481 $102.90 $82.32 LCHG T3 REVERSE 84482 $88.20 $70.56 LCHG TROPONIN I 84484 $37.80 $30.24 LCHG TROPONIN QUALITATIVE 84512 $47.25 $37.80 LCHG BUN 84520 $27.30 $21.84 LCHG URIC ACID BLOOD 84550 $30.45 $24.36 LCHG URIC ACID URINE TIMED 84560 $14.70 $11.76 LCHG VMA URINE TIMED 84585 $58.80 $47.04 LCHG VITAMIN A 84590 $66.15 $52.92 LCHG VITAMIN K1 84597 $110.25 $88.20 LCHG ZINC BLOOD 84630 $21.00 $16.80 LCHG C-PEPTIDE 84681 $27.30 $21.84 LCHG HCG BETA BLOOD QUANTITATIVE 84702 $30.45 $24.36 LCHG HCG BLOOD QUALITATIVE 84703 $47.25 $37.80 LCHG ESTRADIOL FREE 84999 $204.75 $163.80 LCHG BLEEDING TIME 85002 $30.45 $24.36 LCHG WBC COUNT W AUTO DIFFERENTIAL 85004 $27.30 $21.84 LCHG HEMATOCRIT 85014 $13.65 $10.92 LCHG HEMOGLOBIN 85018 $13.65 $10.92 LCHG CBC W AUTO DIFFERENTIAL 85025 $51.45 $41.16 LCHG CBC W AUTO DIFFERENTIAL I 85025 $12.60 $10.08 LCHG CBC W/O AUTO DIFFERENTIAL 85027 $38.85 $31.08 LCHG RBC COUNT 85041 $17.85 $14.28 LCHG RETIC COUNT 85045 $14.70 $11.76 LCHG WBC COUNT AUTO 85048 $13.65 $10.92 LCHG PLATELET COUNT AUTO 85049 $13.65 $10.92 LCHG PERIPHERAL BLOOD SMEAR W INTERP NL 85060 $55.65 $44.52 LCHG FACTOR V ASSAY 85220 $214.20 $171.36 LCHG FACTOR VIII ASSAY I 85240 $240.45 $192.36 LCHG FACTOR VIII RISTOCETIN COFACTOR 85245 $199.50 $159.60 LCHG FACTOR VIII VW ANTIGEN 85246 $244.65 $195.72 LCHG ANTITHROMBIN III ACTIVITY I 85300 $85.05 $68.04 LCHG ANTITHROMBIN III ANTIGEN 85301 $65.10 $52.08 LCHG PROTEIN C ANTIGEN 85302 $141.75 $113.40 LCHG PROTEIN C ACTIVITY 85303 $115.50 $92.40 LCHG PROTEIN S TOTAL 85305 $77.70 $62.16 LCHG PROTEIN S ACTIVITY 85306 $134.40 $107.52 LCHG PROTEIN S FREE 85306 $123.90 $99.12 LCHG FIBRIN SPLIT PRODUCTS 85362 $51.45 $41.16 LCHG D-DIMER QUANTITATIVE 85379 $75.60 $60.48 LCHG FIBRINOGEN ACTIVITY 85384 $21.00 $16.80 LCHG PLASMINOGEN ACTIVITY 85420 $73.50 $58.80 LCHG PT-INR 85610 $25.20 $20.16 LCHG DRVVT SCREEN 85613 $213.15 $170.52 LCHG SED RATE WINTROBE 85651 $23.10 $18.48 LCHG SED RATE WESTERGREN AUTO 85652 $12.60 $10.08 LCHG SICKLE CELL SCREEN 85660 $15.75 $12.60 LCHG THROMBIN TIME 85670 $61.95 $49.56 LCHG LUPUS LIKE ANTICOAGULANT 85705 $657.30 $525.84 LCHG PTT 85730 $37.80 $30.24 LCHG PTT MIX 85732 $111.30 $89.04 LCHG ALLERGEN INDIVIDUAL 86003 $12.60 $10.08 LCHG MULTIALLERGEN SCREEN QUALITATIVE 86005 $59.85 $47.88 LCHG ALLERGEN ALPHA-GAL IGE 86008 $184.80 $147.84 LCHG ACTIN (SMOOTH MUSCLE) AB 86015 $29.40 $23.52 LCHG ANCA TITER 86037 $44.10 $35.28 LCHG ANCA TITER I 86037 $44.10 $35.28 LCHG ANA BLOOD SCREEN 86038 $14.70 $11.76 LCHG ASO TITER 86060 $14.70 $11.76 LCHG C-REACTIVE PROTEIN 86140 $21.00 $16.80 LCHG C-REACTIVE PROTEIN SENSITIVE 86141 $24.15 $19.32 LCHG BETA-2 GLYCOPROTEIN 1 AB IGA 86146 $11.55 $9.24 LCHG BETA-2 GLYCOPROTEIN 86146 $11.55 $9.24 LCHG CARDIOLIPIN ANTIBODY IGG 86147 $39.90 $31.92 LCHG CARDIOLIPIN ANTIBODY IGM 86147 $39.90 $31.92 LCHG CARDIOLIPIN ANTIBODY IGA 86147 $39.90 $31.92 LCHG COMPLEMENT C3 86160 $27.30 $21.84 LCHG COMPLEMENT C4 86160 $27.30 $21.84 LCHG COMPLEMENT C2 86160 $11.55 $9.24 LCHG COMPLEMENT TOTAL 86162 $19.95 $15.96 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP) 86200 $238.35 $190.68 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP) I 86200 $72.45 $57.96 LCHG DNA ANTIBODY DOUBLE STRANDED 86225 $27.30 $21.84 LCHG ENDOMYSIAL ANTIBODY (EMA) 86231 $44.10 $35.28 LCHG CENTROMERE B ANTIBODY 86235 $215.25 $172.20 LCHG JO-1 ANTIBODY 86235 $153.30 $122.64 LCHG SCL70 ANTIBODY 86235 $40.95 $32.76 LCHG SM/RNP ANTIBODY 86235 $57.75 $46.20 LCHG SS-A ANTIBODY 86235 $68.25 $54.60 LCHG SS-B ANTIBODY 86235 $68.25 $54.60 LCHG HISTONE ANTIBODY I 86235 $61.95 $49.56 LCHG RNP ANTIBODY 86235 $34.65 $27.72 LCHG SM ANTIBODY ENA 86235 $68.25 $54.60 LCHG CHROMATIN ANTIBODY 86235 $68.25 $54.60 LCHG NEURONAL NUCLEAR ANTIBODY 86255 $171.15 $136.92 LCHG ADRENAL ANTIBODY SCREEN 86255 $127.05 $101.64 LCHG ENDOMYSIAL ANTIBODY 86255 $534.45 $427.56 LCHG ANCA TITER 86256 $27.30 $21.84 LCHG ENDOMYSIAL ANTIBODY IGA 86256 $50.40 $40.32 LCHG C-ANCA TITER I 86256 $43.05 $34.44 LCHG P-ANCA TITER I 86256 $43.05 $34.44 LCHG P-ANCA ATYPICAL TITER I 86256 $43.05 $34.44 LCHG DEAMIDATED GLIADIN ANTIBODY (DGP) AB 86258 $37.80 $30.24 LCHG CA 15-3 86300 $45.15 $36.12 LCHG CA 27.29 86300 $40.95 $32.76 LCHG CA 19-9 86301 $37.80 $30.24 LCHG CA 125 BLOOD 86304 $30.45 $24.36 LCHG HUMAN EPIDIDYMIS PROTEIN 4 86305 $705.60 $564.48 LCHG HETEROPHILE ANTIBODY SCREEN W/ REFLX 86308 $26.25 $21.00 LCHG MONONUCLEOSIS SCREEN 86308 $34.65 $27.72 LCHG HETEROPHILE ANTIBODY TITER 86309 $122.85 $98.28 LCHG HEPATITIS B SURFACE ANTIBODY QUANT I 86317 $60.90 $48.72 LCHG IFE BLOOD 86334 $141.75 $113.40 LCHG IFE URINE 86335 $118.65 $94.92 LCHG IFE URINE I 86335 $168.00 $134.40 LCHG INHIBIN A 86336 $490.35 $392.28 LCHG INTRINSIC FACTOR AB 86340 $39.90 $31.92 LCHG ZINC TRANSPORT 8 ANTIBODY 86341 $576.45 $461.16 LCHG IA-2 ANTIBODY I 86341 $269.85 $215.88 LCHG GAD-65 ANTIBODY I 86341 $96.60 $77.28 LCHG CHRONIC URTICARIA INDEX (CU) I 86343 $252.00 $201.60 LCHG CD4 (ABSOLUTE T4) 86361 $107.10 $85.68 LCHG TISSUE TRANSGLUTAMINASE ANTIBODY 86364 $94.50 $75.60 LCHG MICROSOMAL ANTIBODY 86376 $58.80 $47.04 LCHG THYROID PEROXIDASE ANTIBODY 86376 $24.15 $19.32 LCHG MICROSOMAL ANTIBODY LIVER/KIDNEY 86376 $58.80 $47.04 LCHG RHEUMATOID FACTOR BLOOD QUANT 86431 $21.00 $16.80 LCHG RHEUMATOID FACTOR BLOOD QUANT I 86431 $18.90 $15.12 LCHG QUANTIFERON TB-GOLD 86480 $213.15 $170.52 LCHG RPR 86592 $11.55 $9.24 LCHG RPR I 86592 $15.75 $12.60 LCHG RPR W REFLEX CONFIRM 86592 $12.60 $10.08 LCHG BARTONELLA AB IGG 86611 $43.05 $34.44 LCHG BARTONELLA AB IGM 86611 $43.05 $34.44 LCHG BORDETELLA PERTUSSIS IGG IMMUNOBLOT 86615 $71.40 $57.12 LCHG BORDETELLA PERTUSSIS ANTIBODY 86615 $64.05 $51.24 LCHG LYME DISEASE WESTERN BLOT IGG 86617 $59.85 $47.88 LCHG LYME DISEASE WESTERN BLOT IGM 86617 $59.85 $47.88 LCHG LYME DISEASE AB IGM 86618 $69.30 $55.44 LCHG LYME DISEASE ANTIBODY SCREEN BLOOD 86618 $71.40 $57.12 LCHG LYME DISEASE AB TOTAL I 86618 $59.85 $47.88 LCHG BRUCELLA ANTIBODY 86622 $50.40 $40.32 LCHG CHLAMYDIA ANTIBODY IGG 86631 $53.55 $42.84 LCHG COCCIDIOIDES ANTIBODY I 86635 $68.25 $54.60 LCHG CMV ANTIBODY IGG BLOOD 86644 $24.15 $19.32 LCHG CMV ANTIBODY IGM BLOOD 86645 $30.45 $24.36 LCHG EPSTEIN-BARR VIRUS ANTIBODY TO EARLY AG 86663 $49.35 $39.48 LCHG EPSTEIN-BARR VIRUS ANTIBODY NUCLEAR AG 86664 $72.45 $57.96 LCHG EPSTEIN-BARR VIRUS ANTIBODY IGG 86665 $72.45 $57.96 LCHG EPSTEIN-BARR VIRUS ANTIBODY IGM 86665 $50.40 $40.32 LCHG EPSTEIN-BARR VIRUS ANTIBODY VCA 86665 $100.80 $80.64 LCHG EPSTEIN-BARR VIRUS ANTIBODY VCA IGM 86665 $50.40 $40.32 LCHG EHRLICHIA ANTIBODY 86666 $265.65 $212.52 LCHG EHRLICHIA ANTIBODY IGG 86666 $153.30 $122.64 LCHG EHRLICHIA ANTIBODY IGM 86666 $153.30 $122.64 LCHG HELICOBACTER PYLORI IGM 86677 $53.55 $42.84 LCHG HELICOBACTER PYLORI ANTIBODY IGG 86677 $53.55 $42.84 LCHG HELICOBACTER PYLORI IGA 86677 $53.55 $42.84 LCHG HERPES SIMPLEX 1+2 ANTIBODY IGG 86694 $50.40 $40.32 LCHG HERPES SIMPLEX 1+2 ANTIBODY IGM 86694 $48.30 $38.64 LCHG HERPES SIMPLEX 1 ANTIBODY IGG 86695 $52.50 $42.00 LCHG HERPES SIMPLEX 2 ANTIBODY IGG 86696 $67.20 $53.76 LCHG HISTOPLASMA ANTIBODY 86698 $58.80 $47.04 LCHG HIV-1 ANTIBODY 86701 $78.75 $63.00 LCHG HIV-2 ANTIBODY 86702 $117.60 $94.08 LCHG HIV-1 HIV-2 ANTIBODY 86703 $86.10 $68.88 LCHG HEPATITIS B CORE ANTIBODY 86704 $27.30 $21.84 LCHG HEPATITIS B CORE ANTIBODY I 86704 $27.30 $21.84 LCHG HEPATITIS B CORE ANTIBODY IGM 86705 $24.15 $19.32 LCHG HEPATITIS B SURFACE ANTIBODY 86706 $14.70 $11.76 LCHG HEPATITIS B SURFACE ANTIBODY I 86706 $12.60 $10.08 LCHG HEPATITIS BE ANTIBODY 86707 $28.35 $22.68 LCHG HEPATITIS A ANTIBODY 86708 $24.15 $19.32 LCHG HEPATITIS A ANTIBODY IGM 86709 $24.15 $19.32 LCHG MUMPS ANTIBODY IGM 86735 $37.80 $30.24 LCHG MUMPS ANTIBODY IGG 86735 $27.30 $21.84 LCHG MYCOPLASMA PNEUMO ANTIBODY IGG 86738 $27.30 $21.84 LCHG MYCOPLASMA PNEUMO ANTIBODY IGM 86738 $27.30 $21.84 LCHG PARVOVIRUS B19 ANTIBODY IGG 86747 $153.30 $122.64 LCHG PARVOVIRUS B19 ANTIBODY IGM 86747 $153.30 $122.64 LCHG BABESIA AB IGG 86753 $141.75 $113.40 LCHG BABESIA AB IGM 86753 $141.75 $113.40 LCHG ROCKY MT SPOTTED FEVER ANTIBODY IGM 86757 $85.05 $68.04 LCHG ROCKY MT SPOTTED FEVER ANTIBODY IGG 86757 $68.25 $54.60 LCHG RUBELLA ANTIBODY IGG 86762 $21.00 $16.80 LCHG RUBELLA ANTIBODY IGM TITER 86762 $40.95 $32.76 LCHG RUBELLA IMMUNE STATUS 86762 $21.00 $16.80 LCHG RUBEOLA ANTIBODY IGM 86765 $37.80 $30.24 LCHG RUBEOLA ANTIBODY IGG 86765 $30.45 $24.36 LCHG SALMONELLA TYPHI AB 86768 $157.50 $126.00 LCHG SARS-COV-2 (COVID-19) ANTIBODY IGG I 86769 $171.15 $136.92 LCHG SARS-COV-2 (COVID-19) ANTIBODY IGA 86769 $165.90 $132.72 LCHG SARS-COV-2 (COVID-19) ANTIBODY IGM 86769 $165.90 $132.72 LCHG TOXOPLASMA ANTIBODY IGG 86777 $34.65 $27.72 LCHG TOXOPLASMA ANTIBODY IGM 86778 $50.40 $40.32 LCHG FTA ANTIBODY 86780 $34.65 $27.72 LCHG VARICELLA ZOSTER ANTIBODY IGG 86787 $139.65 $111.72 LCHG VARICELLA ZOSTER ANTIBODY IGM 86787 $139.65 $111.72 LCHG WEST NILE VIRUS ANTIBODY IGM 86788 $279.30 $223.44 LCHG WEST NILE VIRUS ANTIBODY IGG 86789 $279.30 $223.44 LCHG THYROGLOBULIN ANTIBODY 86800 $55.65 $44.52 LCHG HEPATITIS C ANTIBODY 86803 $24.15 $19.32 LCHG HEPATITIS C ANTIBODY I 86803 $18.90 $15.12 LCHG HLA TYPING B27 86812 $91.35 $73.08 LCHG ANTIBODY SCREEN REF 86850 $34.65 $27.72 LCHG ANTIBODY SCREEN 86850 $47.25 $37.80 LCHG ANTIBODY SCREEN I 86850 $15.75 $12.60 LCHG COOMBS DIRECT 86880 $34.65 $27.72 LCHG COOMBS INDIRECT QUALITATIVE EACH 86885 $34.65 $27.72 LCHG BLOOD TYPE ABO 86900 $34.65 $27.72 LCHG BLOOD TYPE ABO I 86900 $42.00 $33.60 LCHG BLOOD TYPE RH I 86901 $34.65 $27.72 LCHG COMPATIBILITY TEST IMMEDIATE SPIN 86920 $95.55 $76.44 LCHG COMPATIBILITY TEST EACH INCUB REF 86921 $61.95 $49.56 LCHG COMPATIBILITY TEST EACH INCUB TECH 86921 $61.95 $49.56 LCHG COMPATIBILITY TEST ANTIGLOBULIN REF 86922 $95.55 $76.44 LCHG COMPATIBILITY TEST ANTIGLOBULIN 86922 $95.55 $76.44 LCHG CULTURE BLOOD 87040 $40.95 $32.76 LCHG CULTURE SALMONELLA+SHIGELLA 87045 $40.95 $32.76 LCHG CULTURE STOOL EACH ORGANISM 87046 $40.95 $32.76 LCHG CULTURE FLUID 87070 $61.95 $49.56 LCHG CULTURE CSF 87070 $61.95 $49.56 LCHG CULTURE RESPIRATORY 87070 $57.75 $46.20 LCHG CULTURE GENITAL 87070 $57.75 $46.20 LCHG CULTURE ROUTINE 87070 $40.95 $32.76 LCHG CULTURE SPUTUM 87070 $57.75 $46.20 LCHG CULTURE ANAEROBE 87075 $61.95 $49.56 LCHG ORGANISM ID ANAEROBE 87076 $326.55 $261.24 LCHG ORGANISM ID AEROBE 87077 $61.95 $49.56 LCHG CULTURE STREP A 87081 $47.25 $37.80 LCHG CULTURE GC 87081 $102.90 $82.32 LCHG CULTURE MRSA 87081 $99.75 $79.80 LCHG HELICOBACTER PYLORI UREASE 87081 $38.85 $31.08 LCHG CULTURE URINE 87086 $30.45 $24.36 LCHG CULTURE FUNGUS SKIN HAIR NAILS 87101 $284.55 $227.64 LCHG CULTURE AFB 87116 $147.00 $117.60 LCHG ORGANISM ID STAPH 87147 $33.60 $26.88 LCHG CULTURE DNA PROBE 87149 $405.30 $324.24 LCHG O+P 87177 $51.45 $41.16 LCHG SUSCEPTIBILITY ANAEROBIC 87181 $147.00 $117.60 LCHG SUSCEPTIBILITY EACH REFER 87186 $57.75 $46.20 LCHG SUSCEPTIBILITY MIC 87186 $147.00 $117.60 LCHG SUSCEPTIBILITY AFB III 87186 $405.30 $324.24 LCHG SUSCEPTIBILITY URINE 87186 $57.75 $46.20 LCHG GRAM STAIN SMEAR 87205 $27.30 $21.84 LCHG AFB SMEAR 87206 $34.65 $27.72 LCHG FUNGUS SMEAR 87206 $47.25 $37.80 LCHG ACID FAST STAIN 87206 $34.65 $27.72 LCHG STAIN TRICHROME 87209 $53.55 $42.84 LCHG WET PREP SMEAR 87210 $37.80 $30.24 LCHG VIRAL CULTURE 87252 $147.00 $117.60 LCHG VIRAL CULTURE MISC 87252 $134.40 $107.52 LCHG VIRAL CULTURE RESPIRATORY 87254 $108.15 $86.52 LCHG CULTURE HSV W/TYPING I 87255 $78.75 $63.00 LCHG ADENOVIRUS ANTIGEN ENTERIC FECES 87301 $71.40 $57.12 LCHG CLOSTRIDIUM DIFFICILE TOXIN BY EIA 87324 $72.45 $57.96 LCHG GIARDIA LAMBLIA ANTIGEN 87329 $163.80 $131.04 LCHG HELICOBACTER PYLORI ANTIGEN STOOL 87338 $137.55 $110.04 LCHG HEPATITIS B SURFACE ANTIGEN 87340 $27.30 $21.84 LCHG HEPATITIS B SURFACE ANTIGEN I 87340 $12.60 $10.08 LCHG HEPATITIS BE ANTIGEN 87350 $25.20 $20.16 LCHG HIV-1 AG W HIV-1+HIV-2 AB 87389 $88.20 $70.56 LCHG ROTAVIRUS ANTIGEN FECES 87425 $74.55 $59.64 LCHG ROTAVIRUS ANTIGEN FECES I 87425 $45.15 $36.12 LCHG SARS-COV-2 (COVID-19) ANTIGEN 87426 $115.50 $92.40 LCHG SHIGA-LIKE TOXIN 87427 $40.95 $32.76 LCHG SARS-COV-2 INFLU A+B ANTIGEN 87428 $159.60 $127.68 LCHG STREP A SCREEN DIRECT BY EIA 87430 $70.35 $56.28 LCHG LEGIONELLA ANTIGEN URINE 87449 $82.95 $66.36 LCHG CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE II 87486 $115.50 $92.40 LCHG CHLAMYDIA DNA PROBE 87491 $30.45 $24.36 LCHG CHLAMYDIA DNA PROBE I 87491 $170.10 $136.08 LCHG CLOSTRIDIUM DIFF PCR 87493 $393.75 $315.00 LCHG CMV DNA REAL-TIME PCR QUAL 87496 $481.95 $385.56 LCHG CMV DNA REAL-TIME PCR QUANT 87497 $735.00 $588.00 LCHG GASTROINTESTINAL PATHOGEN 12-25 TARGETS 87507 "$2,150.40 " "$1,720.32 " LCHG HEPATITIS B VIRUS DNA QUANT 87517 $816.90 $653.52 LCHG HEPATITIS C RNA QUAL 87521 $318.15 $254.52 LCHG HEPATITIS C RNA PCR QUANT 87522 $483.00 $386.40 LCHG HEPATITIS C RNA PCR QUANT I 87522 $86.10 $68.88 LCHG HEPATITIS C QUANTITATIVE 87522 $446.25 $357.00 LCHG HERPES SIMPLEX PCR 87529 $369.60 $295.68 LCHG MYCOPLASMA DNA PCR II 87581 $115.50 $92.40 LCHG GC DNA PROBE 87591 $226.80 $181.44 LCHG GC AMPLIFIED PROBE 87591 $111.30 $89.04 LCHG GC AMPLIFIED PROBE II 87591 $170.10 $136.08 LCHG HPV HIGH RISK TYPES 87624 $135.45 $108.36 LCHG RESPIRATORY VIRUS PNL PCR 87633 "$1,669.50 " "$1,335.60 " LCHG RESPIRATORY VIRUS PNL PCR I 87633 "$1,378.65 " "$1,102.92 " LCHG SARS-COV-2 (COVID-19) 87635 $171.15 $136.92 LCHG TRICHOMONAS DNA PROBE 87660 $156.45 $125.16 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE 87661 $156.45 $125.16 LCHG BORDETELLA PERTUSSIS PCR II 87798 $115.50 $92.40 LCHG WEST NILE VIRUS PCR 87798 $784.35 $627.48 LCHG BORDETELLA PERTUSSIS/PARAPERTUSSIS PCR I 87798 $177.45 $141.96 LCHG EPSTEIN-BARR VIRUS PCR QUANT 87799 $793.80 $635.04 LCHG INFLUENZA A+B ANTIGEN RAPID 87804 $64.05 $51.24 LCHG RSV RAPID AG BY IMMUNOASSAY 87807 $74.55 $59.64 LCHG STREP A SCREEN DIRECT IMMUNO 87880 $63.00 $50.40 LCHG HEPATITIS C GENOTYPE 87902 $756.00 $604.80 LCHG CYTOPATH CERV/VAG THIN LAYER 88142 $67.20 $53.76 LCHG CYTOPATH SUREPATH PAP 88175 $105.00 $84.00 LCHG SP G+M LEVEL IV TC NL 88305 $248.85 $199.08 LCHG SP STAIN GROUP I TC NL 88312 $254.10 $203.28 LCHG CELL COUNT W DIFFERENTIAL FLUID 89051 $118.65 $94.92 LCHG CELL COUNT W DIFFERENTIAL CSF 89051 $61.95 $49.56 LCHG CELL COUNT W DIFFERENTIAL FLUID II 89051 $22.05 $17.64 LCHG FECAL LEUKOCYTES 89055 $29.40 $23.52 LCHG CRYSTAL IDENTIFICATION 89060 $34.65 $27.72 LCHG FAT STAIN 89125 $27.30 $21.84 LCHG SEMEN ANALYSIS POST VASECTOMY 89321 $99.75 $79.80 HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID 90471 $103.95 $83.16 HC PSYCHOTHERAPY W PT 30 MIN 90832 $265.65 $212.52 HC PSYCHOTHERAPY W PT 45 MIN 90834 $353.85 $283.08 HC PSYCHOTHERAPY W PT 60 MIN 90837 $443.10 $354.48 HC FAMILY PSYCHOTHERAPY WO PT 50 MIN 90846 $443.10 $354.48 HC FAMILY PSYCHOTHERAPY W PT 50 MIN 90847 $443.10 $354.48 HC IOP PSYCHOTHERAPY GROUP 90853 $796.95 $637.56 HC TX SPEECH DISORDER INDIVID 15 MIN ST 92507 $107.10 $85.68 HC TX SPEECH DISORDER INDIVID 30 MIN ST 92507 $215.25 $172.20 HC TX SPEECH DISORDER INDIVID 45 MIN ST 92507 $321.30 $257.04 HC TX SPEECH DISORDER INDIVID 60 MIN ST 92507 $428.40 $342.72 HC EVAL SPEECH FLUENCY 15 MIN 92521 $273.00 $218.40 HC EVAL SPEECH FLUENCY 30 MIN 92521 $410.55 $328.44 HC EVAL SPEECH FLUENCY 45 MIN 92521 $410.55 $328.44 HC EVAL SPEECH FLUENCY 60 MIN 92521 $410.55 $328.44 HC EVAL SPEECH SOUND PRODUCTION 15 MIN 92522 $212.10 $169.68 HC EVAL SPEECH SOUND PRODUCTION 30 MIN 92522 $333.90 $267.12 HC EVAL SPEECH SOUND PRODUCTION 45 MIN 92522 $333.90 $267.12 HC EVAL SPEECH SOUND PRODUCTION 60 MIN 92522 $333.90 $267.12 HC EVAL SPEECH SOUND PROD W LANG 15 MIN 92523 $462.00 $369.60 HC EVAL SPEECH SOUND PROD W LANG 30 MIN 92523 $462.00 $369.60 HC EVAL SPEECH SOUND PROD W LANG 45 MIN 92523 $695.10 $556.08 HC EVAL SPEECH SOUND PROD W LANG 60 MIN 92523 $695.10 $556.08 HC BEHAV AND QUAL ANALYSIS FOR VOICE 15 MIN 92524 $232.05 $185.64 HC BEHAV AND QUAL ANALYSIS FOR VOICE 30 MIN 92524 $232.05 $185.64 HC BEHAV AND QUAL ANALYSIS FOR VOICE 45 MIN 92524 $232.05 $185.64 HC BEHAV AND QUAL ANALYSIS FOR VOICE 60 MIN 92524 $232.05 $185.64 HC TREATMENT DYSPHAGIA 15 MIN ST 92526 $226.80 $181.44 HC TREATMENT DYSPHAGIA 30 MIN ST 92526 $226.80 $181.44 HC TREATMENT DYSPHAGIA 45 MIN ST 92526 $226.80 $181.44 HC TREATMENT DYSPHAGIA 60 MIN ST 92526 $226.80 $181.44 HC EVAL SWALLOW FUNCTION 15 MIN ST 92610 $422.10 $337.68 HC EVAL SWALLOW FUNCTION 30 MIN ST 92610 $422.10 $337.68 HC EVAL SWALLOW FUNCTION 45 MIN ST 92610 $422.10 $337.68 HC EVAL SWALLOW FUNCTION 60 MIN ST 92610 $422.10 $337.68 HC EVAL SWALLOW FUNC CINE/VID RCRD 15MIN ST 92611 $353.85 $283.08 HC EVAL SWALLOW FUNC CINE/VID RCRD 30MIN ST 92611 $353.85 $283.08 HC EVAL SWALLOW FUNC CINE/VID RCRD 45MIN ST 92611 $353.85 $283.08 HC EVAL SWALLOW FUNC CINE/VID RCRD 60MIN ST 92611 $353.85 $283.08 HC CARDIOPULMONARY RESUSCITATION 92950 $739.20 $591.36 HC EKG 12 LEAD 93005 $99.75 $79.80 HP CARDIAC STRESS TST COMPLETE 93015 $237.30 $189.84 HC CARD STRESS TEST ROUTINE 93017 $729.75 $583.80 HC ECG RHYTHM TRACING 93041 $99.75 $79.80 HC ECG MONITOR UP TO 48 HRS RECORDING 93225 $282.45 $225.96 HC ECG MONITOR UP TO 48HRS SCAN W REPORT 93226 $282.45 $225.96 HP EKG MONITORING TO 48 HRS INTERP 93227 $77.70 $62.16 HP REMOTE 30 DAY ECG REVIEW AND INTERP 93228 $77.70 $62.16 HC REMOTE 30 DAY ECG TECH SUPP 93229 $152.25 $121.80 HC EKG >48HRS TO 7 DAYS CONT RECORD 93242 $33.60 $26.88 HC EKG >48HRS TO 7 DAYS CONT SCAN ANLY 93243 $496.65 $397.32 HC EKG >7DAYS TO 15 DAYS CONT RECORD 93246 $33.60 $26.88 HC EKG >7DAYS TO 15 DAYS CONT SCAN ANLY 93247 $496.65 $397.32 HC EVENT RECORDING EKG REMOTE UP TO 30 DAYS 93270 $284.55 $227.64 HC EVENT TRANS ANALYS EKG REMOTE TO 30 DAYS 93271 $284.55 $227.64 HP EVENT RECRD SNGL/MULT INTERP/RPT 93272 $77.70 $62.16 HC TTE 2D WO CON W DOPPLER AND COLOR CMPL 93306 "$1,859.55 " "$1,487.64 " HC TTE FOLLOW UP OR LIMITED WO CONTRAST 93308 $777.00 $621.60 HC DUPLEX CAROTID BILAT 93880 $904.05 $723.24 HC DUPLEX ARTERY OR BYPASS LE BILAT 93925 "$1,094.10 " $875.28 HC ART DUPLEX LE OR BYPASS GRAFT/UNI 93926 $677.25 $541.80 HC ART DUPLEX UE OR BYPASS GRAFT/BIL 93930 $584.85 $467.88 HC DUPLEX ARTERY OR BYPASS UE UNILAT 93931 $413.70 $330.96 HC DUPLEX VEIN EXTREM BILAT 93970 $887.25 $709.80 HC DUPLEX VEIN EXTREM UNILAT 93971 $595.35 $476.28 HC US ART DOPPLER ABD PELV RETROP SC CMPLT 93975 "$1,388.10 " "$1,110.48 " HC US LTD DOPPLER ABD PELV SCROT RETROP 93976 $353.85 $283.08 HC DUPLEX AO IVC ILIAC OR BYPASS CMPLT 93978 $447.30 $357.84 HC DUPLEX AO IVC ILIAC OR BYPASS LMTD 93979 $413.70 $330.96 HC SPIROMETRY 94010 $249.90 $199.92 HC BRONCHODILATOR PRE/POST TEST 94060 $443.10 $354.48 HC INHALATION TREATMENT W/MED SUBSEQUENT 94640 $90.30 $72.24 HC INHALATION TREATMENT W/MED 94640 $90.30 $72.24 HC CHEST WALL MANIPULATION INIT 94667 $90.30 $72.24 HC CHEST WALL MANIPULATION SUBSEQ 94668 $90.30 $72.24 HC NONINVASIVE OXYGEN SATURATION MULT 94761 $243.60 $194.88 HC NONINVAS OXYGEN SATURATION CONT 94762 $353.85 $283.08 HC SLEEP STUDY UNATTENDED 95806 $357.00 $285.60 HC POLYSOMN 4 OR MORE >=6YRS 95810 "$2,172.45 " "$1,737.96 " HC POLYSOMN W/CPAP >=6YRS 95811 "$2,269.05 " "$1,815.24 " HC ASSESSMENT OF APHASIA PER HR 96105 $370.65 $296.52 HC COGNITIVE TEST BY HC PRO PER HR 96125 $318.15 $254.52 HC IV INF HYDRATION INIT 31 MIN TO 1HR 96360 $560.70 $448.56 HC ED IV INF HYDRATION INIT 31 MIN TO 1HR 96360 $560.70 $448.56 HC IV INF HYDRATION EA ADDL HR 96361 $107.10 $85.68 HC ED IV INF HYDRATION EA ADDL HR 96361 $107.10 $85.68 HC IV INF THER/PROPH/DIAG 1ST HR 96365 $560.70 $448.56 HC ED IV INF THER/PROPH/DIAG 1ST HR 96365 $560.70 $448.56 HC IV INF THER/PROPH/DIAG EA ADDL HR 96366 $107.10 $85.68 HC ED IV INF THER/PROPH/DIAG EA ADDL HR 96366 $107.10 $85.68 HC IV INF THER/PROPH/DIAG SEQ INF 1ST HR 96367 $107.10 $85.68 HC ED IV INF THER/PROPH/DIAG SEQ INF 1ST HR 96367 $107.10 $85.68 HC ED IV INF THER/PROPH/DIAG CONCURRENT 96368 $107.10 $85.68 HC INJ THER/PROPH/DIAG SUBQ/IM 96372 $107.10 $85.68 HC ED INJ THER/PROPH/DIAG SUBQ/IM 96372 $107.10 $85.68 HC INJ THER/PROPH/DIAG IVP SNGL OR INIT 96374 $154.35 $123.48 HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT 96374 $538.65 $430.92 HC INJ THER/DIAG IVP EA ADDL NEW DRUG 96375 $154.35 $123.48 HC ED INJ THER/DIAG IVP EA ADDL NEW DRUG 96375 $154.35 $123.48 HC IVP TPD EA ADD PUSH SAME DRUG 96376 $72.45 $57.96 HC ED IVP TPD EA ADD PUSH SAME DRUG 96376 $72.45 $57.96 HC IRRIGATION VAD 96523 $310.80 $248.64 HC HOT OR COLD PACKS THERAPY OT 97010 $29.40 $23.52 HC HOT OR COLD PACK THERAPY PT 97010 $29.40 $23.52 HC ELECTRICAL STIMULATION EA 15 MIN PT 97032 $61.95 $49.56 HC CONTRAST BATHS EA 15 MIN OT 97034 $61.95 $49.56 HC CONTRAST BATHS EA 15 MIN PT 97034 $61.95 $49.56 HC ULTRASOUND THERAPY EA 15 MIN OT 97035 $45.15 $36.12 HC ULTRASOUND THERAPY EA 15 MIN PT 97035 $45.15 $36.12 HC THER EXERCISE EA 15 MIN PT 97110 $107.10 $85.68 HC THER EXERCISE EA 15 MIN OT 97110 $107.10 $85.68 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN OT 97112 $110.25 $88.20 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN PT 97112 $110.25 $88.20 HC GAIT TRAINING EA 15 MIN PT 97116 $95.55 $76.44 HC MANUAL THER TECH 1+REGIONS EA 15 MIN OT 97140 $99.75 $79.80 HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT 97140 $99.75 $79.80 HC PT EVAL LOW COMPLEXITY 97161 $177.45 $141.96 HC PT EVAL MOD COMPLEXITY 97162 $236.25 $189.00 HC PT EVAL HIGH COMPLEXITY 97163 $276.15 $220.92 HC PT REEVAL LOW COMPLEXITY 97164 $59.85 $47.88 HC PT REEVAL MOD COMPLEXITY 97164 $111.30 $89.04 HC PT REEVAL HIGH COMPLEXITY 97164 $147.00 $117.60 HC OT EVAL LOW COMPLEXITY 97165 $189.00 $151.20 HC OT EVAL MOD COMPLEXITY 97166 $247.80 $198.24 HC OT EVAL HIGH COMPLEXITY 97167 $292.95 $234.36 HC THER ACTIVITIES EA 15 MIN OT 97530 $111.30 $89.04 HC THER ACTIVITIES EA 15 MIN PT 97530 $111.30 $89.04 HC SENSORY INTEGRATIVE DEVEL EA 15 MIN PT 97533 $286.65 $229.32 HC SENSORY INTEGRATIVE DEVEL 15 MIN OT 97533 $286.65 $229.32 HC TRAIN SELF CARE EA 15 MIN OT 97535 $122.85 $98.28 HC TRAIN SELF CARE EA 15 MIN PT 97535 $122.85 $98.28 HC DEBRID SELECTIVE 1ST 20SQ CM OR < PT 97597 $119.70 $95.76 HC NEG PRESSURE WND TX <=50 SQ CM W DME EQ 97605 $177.45 $141.96 HC MOD SED SAME PHYS 5>=YRS INIT 15 MIN 99152 $382.20 $305.76 HC MOD SED SAME PHYS EA ADDL 15 MIN 99153 $382.20 $305.76 HC FACLTY OP EST PT LEVEL 1 99211 $179.55 $143.64 HC FACLTY OP EST PT LEVEL 2 99212 $252.00 $201.60 HC FACLTY OP EST PT LEVEL 3 99213 $324.45 $259.56 HP OFFICE OUTPT VISIT EST LEVL III 99213 $184.80 $147.84 HC FACLTY OP EST PT LEVEL 4 99214 $393.75 $315.00 HP OFFICE/OUTPT VISIT EST LEVEL IV 99214 $137.55 $110.04 HC FACLTY OP EST PT LEVEL 5 99215 $467.25 $373.80 HC ED EMERGENT LEVEL I 99281 $179.55 $143.64 HP EMERGENCY DEPT VISIT LEVEL I 99281 $71.40 $57.12 HC ED EMERGENT LEVEL II 99282 $330.75 $264.60 HP EMERGENCY DEPT VISIT LEVEL 2 99282 $119.70 $95.76 HC ED EMERGENT LEVEL III 99283 $581.70 $465.36 HP EMERGENCY DEPT VISIT LEVEL 3 99283 $262.50 $210.00 HC ED EMERGENT LEVEL IV 99284 "$1,020.60 " $816.48 HP EMERGENCY DEPT VISIT LEVEL 4 99284 $405.30 $324.24 HC ED EMERGENT LEVEL V 99285 "$1,020.60 " $816.48 HP EMERGENCY DEPT VISIT LEVEL 5 99285 $636.30 $509.04 HC ED CRITICAL CARE E/M 30-74 MIN 99291 "$2,154.60 " "$1,723.68 " HC ED CRITICAL CARE ADDL 30 MIN 99292 "$1,076.25 " $861.00 HC STERILE GLOVES PER PAIR A4930 $2.10 $1.68 HC MRI MRA ABD W/O FOL W/CONTRAST C8902 "$2,326.80 " "$1,861.44 " HC MRI MRA CHEST W/O FOL W/CONTRAST C8911 "$2,323.65 " "$1,858.92 " HC ADMIN VAC INFLUENZA G0008 $28.35 $22.68 HC ADMIN VAC PNEUMOCOCCAL G0009 $26.25 $21.00 HC ADMIN VAC HEPATITIS B G0010 $26.25 $21.00 LCHG PROSTATE SPECIFIC ANTIGEN SCREEN G0103 $70.35 $56.28 HP SIGMOIDSCPY FLEX SCREN HGH RSK G0105 $796.95 $637.56 HP COLON CA SCRN NOT HI RSK IND G0121 $796.95 $637.56 HC ELEC STIM UNATTENDED NON WOUND PT G0283 $47.25 $37.80 HC ELEC STIM UNATTENDED NON WOUND OT G0283 $47.25 $37.80 HC RB OBSERVATION PER HR G0378 $33.60 $26.88 HC EKG SCREENING 12 LEADS TRACING ONLY G0404 $88.20 $70.56 HC INF OR INJ CASIRVIMAB AND IMDEVIMAB ADMIN M0243 $771.75 $617.40 LCHG RBC LR P9016 $962.85 $770.28 LCHG PLATELET PHERESIS P9034 "$2,249.10 " "$1,799.28 " LCHG PLATELET PHERESIS LR P9035 "$2,249.10 " "$1,799.28 " LCHG RBC LR IRRAD P9040 "$1,042.65 " $834.12 LCHG FFP W/I 24HRS P9059 $691.95 $553.56 LCHG ONE-WAY ALLOW PRORATED TRIP P9604 $13.65 $10.92 HC TELEMEDICINE FACILITY FEE Q3014 $39.90 $31.92 HC EPIFIX PER SQ CM Q4186 $441.00 $352.80 HC ENDOSCOPY SERVICES 1 "$2,299.50 " "$1,839.60 " HC ENDOSCOPY SERVICES 2 "$3,066.00 " "$2,452.80 " HC ENDOSCOPY SERVICES 3 "$3,832.50 " "$3,066.00 " HC RB HOSPITAL OBS PER HR WO ORDER $33.60 $26.88 HC RB MED/SURG UNIT ISOLATION "$1,148.70 " $918.96 HC RB RESPITE ROOM LVL 1 DAILY $178.50 $142.80 HC SWING - SPECIAL BED DAILY $703.50 $562.80 HC RB PRIVATE MED/SURG/GYN $830.55 $664.44 HC RB ICU GENERAL "$1,181.25 " $945.00 HC RB SEMI PVT M/S/GYN $798.00 $638.40