hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|TX,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",additional_generic_notes,,,,,,,,,, Altus Lumberton Hospital,10/14/2025,2.0.0,Altus Lumberton Hospital,"137 N Lhs Dr, Lumberton, TX 77657",100499,TRUE,"Altus Lumberton Hospital does not have a universal discounted cash price. Only select Evaluation & Management (E/M) codes have specified discounted cash rates, which vary by E/M code tier. For all other descriptions, patients without insurance or who are self-pay are charged the standard gross amount. Please contact billing for specific quotes.",,,,,,,,,, description,code|1,code|1|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|Region_Health_Insurance|HMO|negotiated_dollar,standard_charge|Region_Health_Insurance|HMO|negotiated_percentage,standard_charge|Region_Health_Insurance|HMO|negotiated_algorithm,estimated_amount|Region_Health_Insurance|HMO,standard_charge|Region_Health_Insurance|HMO|methodology,additional_payer_notes|Region_Health_Insurance|HMO,standard_charge|min,standard_charge|max,additional_generic_notes "ANESTH, BLEPHAROPLASTY",103,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, EAR SURGERY",120,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, EAR EXAM",124,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, PROCEDURES ON EYE",140,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, EYE EXAM",148,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, NOSE/SINUS SURGERY",160,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, PROCEDURE ON MOUTH",170,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, FACE/SKULL BONE SURG",190,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, HEAD/NECK/PTRUNK",300,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, NECK ORGAN, 1 & OVER",320,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, SKIN, EXT/PER/ATRUNK",400,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, CORRECT HEART RHYTHM",410,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, CHEST PROCEDURE",520,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, VASCULAR ACCESS",532,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, CHEST SURGERY",540,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, SPINE, CORD SURGERY",630,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LUMBAR PUNCTURE",635,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, ABDOMINAL WALL SURG",700,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, UPPER GI VISUALIZE",740,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, ABDOMINAL WALL SURG",800,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, REPAIR OF HERNIA",830,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, ANORECTAL SURGERY",902,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, BLADDER SURGERY",910,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, GENITALIA SURGERY",920,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, VAGINAL PROCEDURES",940,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, SURG ON VAG/URETHRAL",942,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, HIP JOINT PROCEDURE",1200,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, PROCEDURE ON FEMUR",1220,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, KNEE AREA SURGERY",1320,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, KNEE AREA PROCEDURE",1340,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, KNEE JOINT PROCEDURE",1380,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, KNEE AREA PROCEDURE",1390,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LOWER LEG PROCEDURE",1462,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LOWER LEG CASTING",1490,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, SHOULDER PROCEDURE",1620,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, SHOULDER CASTING",1680,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, UPPR ARM PROCEDURE",1730,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LOWER ARM SURGERY",1810,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LOWER ARM PROCEDURE",1820,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LOWER ARM SURGERY",1830,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, LOWER ARM CASTING",1860,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, CAT OR MRI SCAN",1922,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, VAGINAL DELIVERY",1960,CPT ,,Both,,,274,,,,,,,,,, "ANESTH, CS DELIVERY",1961,CPT ,,Both,,,274,,,,,,,,,, "ANESTH/ANALG, VAG DELIVERY",1967,CPT ,,Both,,,274,,,,,,,,,, FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,10021,CPT ,,Both,,,1927,,,,,,,,,, FINE NEEDLE ASPIRATION W IMAGING GUIDANCE ER,10022,CPT ,,Both,,,1768,,,,,,,,,, ACNE SURGERY,10040,CPT ,,Both,,,1289,,,,,,,,,, INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,10060,CPT ,,Both,,,1478,,,,,,,,,, INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE,10061,CPT ,,Both,,,2605,,,,,,,,,, INCISION & DRAINAGE PILONIDAL CYST SIMPLE,10080,CPT ,,Both,,,2319,,,,,,,,,, DRAINAGE OF PILONIDAL CYST - COMPLICATED/MULT,10081,CPT ,,Both,,,3504,,,,,,,,,, INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,CPT ,,Both,,,1954,,,,,,,,,, INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL,10121,CPT ,,Both,,,3531,,,,,,,,,, I&D HEMATOMA SEROMA/FLUID COLLECTION,10140,CPT ,,Both,,,2473,,,,,,,,,, PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,10160,CPT ,,Both,,,1665,,,,,,,,,, "COMPLEX DRAINAGE WOUND, POST-OP WOUND INFECTION",10180,CPT ,,Both,,,3161,,,,,,,,,, DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,11000,CPT ,,Both,,,1260,,,,,,,,,, DEBRIDE INFECTED SKIN EACH ADDL 10% BSA,11001,CPT ,,Both,,,268,,,,,,,,,, Debridement of skin: external genitalia and perineum,11004,CPT ,,Both,,,7187,,,,,,,,,, DEBRIDEMENT OF ABDOMINAL WALL,11005,CPT ,,Both,,,9731,,,,,,,,,, DEBRIDE SKIN AND SC TISSUE WITH OPEN FRACTURE,11010,CPT ,,Both,,,6345,,,,,,,,,, "DEBRIDE, FB SKIN OPEN FX; MUSCLE",11011,CPT ,,Both,,,6868,,,,,,,,,, DEB SKIN BONE WITH OPEN FX,11012,CPT ,,Both,,,9066,,,,,,,,,, DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,11042,CPT ,,Both,,,1503,,,,,,,,,, DEB MUSC/FASCIA 20 SQ CM/<,11043,CPT ,,Both,,,535,,,,,,,,,, DEB BONE 20 SQ CM/<,11044,CPT ,,Both,,,738,,,,,,,,,, DEB SUBQ TISSUE EACH ADDITIONAL 20 SQ CM,11045,CPT ,,Both,,,535,,,,,,,,,, DEB MUSC/FASCIA EACH ADDITIONAL 20 SQ CM,11046,CPT ,,Both,,,1120,,,,,,,,,, "DEBRIDEMENT, BONE; EACH ADDTL 20SQ CM OR PART OF",11047,CPT ,,Both,,,1911,,,,,,,,,, PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,11055,CPT ,,Both,,,783,,,,,,,,,, PARING OR CUTTING OF LESION; 2-4 LESIONS,11056,CPT ,,Both,,,738,,,,,,,,,, PARING OR CUTTING OF LESION; >4 LESIONS,11057,CPT ,,Both,,,2242,,,,,,,,,, "BIOPSY OF SKIN AND SUBCUTANEOUS TISSUE, SINGLE LESION",11100,CPT ,,Both,,,1333,,,,,,,,,, "BIOPSY OF SKIN AND SUBCUTANEOUS TISSUE, EACH ADDL LESION",11101,CPT ,,Both,,,2153,,,,,,,,,, REMOVAL OF SKIN TAGS 30.0 CM,12007,CPT ,,Both,,,2915,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS,12011,CPT ,,Both,,,1412,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,12013,CPT ,,Both,,,1544,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM,12014,CPT ,,Both,,,1803,,,,,,,,,, SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM,12015,CPT ,,Both,,,2198,,,,,,,,,, RPR FE/E/EN/L/M 12.6-20.0 CM,12016,CPT ,,Both,,,2728,,,,,,,,,, RPR FE/E/EN/L/M 20.1-30.0 CM,12017,CPT ,,Both,,,2079,,,,,,,,,, RPR F/E/E/N/L/M >30.0 CM,12018,CPT ,,Both,,,2542,,,,,,,,,, CLOSURE OF SPLIT WOUND,12020,CPT ,,Both,,,3603,,,,,,,,,, CLOSURE OF SPLIT WOUND,12021,CPT ,,Both,,,2177,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,12031,CPT ,,Both,,,3055,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,12032,CPT ,,Both,,,3902,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,12034,CPT ,,Both,,,3994,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,12035,CPT ,,Both,,,4970,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,12036,CPT ,,Both,,,5414,,,,,,,,,, REPAIR INTERMEDIATE S/A/T/E >30.0 CM,12037,CPT ,,Both,,,5953,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,12041,CPT ,,Both,,,3102,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,12042,CPT ,,Both,,,3689,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,12044,CPT ,,Both,,,4611,,,,,,,,,, REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,12045,CPT ,,Both,,,5150,,,,,,,,,, INTMD RPR N-HF/GENIT20.1-30,12046,CPT ,,Both,,,6863,,,,,,,,,, INTMD RPR N-HF/GENIT >30.0CM,12047,CPT ,,Both,,,7525,,,,,,,,,, REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,12051,CPT ,,Both,,,3315,,,,,,,,,, REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM,12052,CPT ,,Both,,,3757,,,,,,,,,, INTMD RPR FACE/MM 5.1-7.5 CM,12053,CPT ,,Both,,,4437,,,,,,,,,, INTMD RPR FACE/MM 7.6-12.5CM,12054,CPT ,,Both,,,4734,,,,,,,,,, INTMD RPR FACE/MM 12.6-20 CM,12055,CPT ,,Both,,,6049,,,,,,,,,, INTMD RPR FACE/MM 20.1-30.0,12056,CPT ,,Both,,,6995,,,,,,,,,, INTMD RPR FACE/MM >30.0 CM,12057,CPT ,,Both,,,7058,,,,,,,,,, CMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT ,,Both,,,4276,,,,,,,,,, CMPLX RPR TRUNK 2.6-7.5 CM,13101,CPT ,,Both,,,5080,,,,,,,,,, CMPLX RPR TRUNK ADDL 5CM/<,13102,CPT ,,Both,,,1556,,,,,,,,,, REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM,13120,CPT ,,Both,,,4480,,,,,,,,,, REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM,13121,CPT ,,Both,,,5467,,,,,,,,,, CMPLX RPR S/A/L ADDL 5 CM/>,13122,CPT ,,Both,,,1704,,,,,,,,,, CMPLX RPR F/C/C/M/N/AX/G/H/F,13131,CPT ,,Both,,,4927,,,,,,,,,, CMPLX RPR F/C/C/M/N/AX/G/H/F,13132,CPT ,,Both,,,6080,,,,,,,,,, CMPLX RPR F/C/C/M/N/AX/G/H/F,13133,CPT ,,Both,,,2258,,,,,,,,,, CMPLX RPR E/N/E/L 1.0 CM/<,13150,CPT ,,Both,,,4781,,,,,,,,,, CMPLX RPR E/N/E/L 1.1-2.5 CM,13151,CPT ,,Both,,,5382,,,,,,,,,, REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,13152,CPT ,,Both,,,6109,,,,,,,,,, CMPLX RPR E/N/E/L ADDL 5CM/<,13153,CPT ,,Both,,,2453,,,,,,,,,, LATE CLOSURE OF WOUND,13160,CPT ,,Both,,,10218,,,,,,,,,, TIS TRNFR F/C/C/M/N/A/G/H/F,14040,CPT ,,Both,,,9736,,,,,,,,,, CULT SKIN GRAFT F/N/HF/G,15155,CPT ,,Both,,,9716,,,,,,,,,, CULT SKIN GRFT F/N/HFG ADD,15156,CPT ,,Both,,,2000,,,,,,,,,, SKIN FULL GRAFT EEN & LIPS; 20 CM OR LESS,15260,CPT ,,Both,,,12926,,,,,,,,,, DERMABRASION OTHER THAN FACE,15782,CPT ,,Both,,,7288,,,,,,,,,, REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,15850,CPT ,,Both,,,1026,,,,,,,,,, INITIAL TX 1ST DEGREE BURN LOCAL TX,16000,CPT ,,Both,,,1512,,,,,,,,,, DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL,16020,CPT ,,Both,,,1362,,,,,,,,,, DRESS/DEBRID P-THICK BURN MEDIUM,16025,CPT ,,Both,,,1876,,,,,,,,,, DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,16030,CPT ,,Both,,,2338,,,,,,,,,, "ESCHAROTOMY, INITIAL INCISION",16035,CPT ,,Both,,,2491,,,,,,,,,, DESTRUCT PREMALG LESION,17000,CPT ,,Both,,,1043,,,,,,,,,, DESTRUCT B9 LESION 1-14,17110,CPT ,,Both,,,1431,,,,,,,,,, CHEMICAL CAUTERY GRANULATION TISSUE,17250,CPT ,,Both,,,1135,,,,,,,,,, "UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE, SC TICCUE",17999,CPT ,,Both,,,355,,,,,,,,,, PUNCTURE ASPIRATION CYST BREAST,19000,CPT ,,Both,,,3024,,,,,,,,,, "MASTOTOMY WITH EXP OR DRAINAGE OF ABSCESS, DEEP",19020,CPT ,,Both,,,6113,,,,,,,,,, BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,19100,CPT ,,Both,,,3024,,,,,,,,,, EXPLORE WOUND NECK,20100,CPT ,,Both,,,7529,,,,,,,,,, EXPLORE WOUND CHEST,20101,CPT ,,Both,,,5914,,,,,,,,,, EXPLORE WOUND ABDOMEN,20102,CPT ,,Both,,,6352,,,,,,,,,, EXPLORE WOUND EXTREMITY,20103,CPT ,,Both,,,7496,,,,,,,,,, REMOVAL OF FOREIGN BODY FROM MUSCLE - SIMPLE WITH INCISION,20520,CPT ,,Both,,,2604,,,,,,,,,, REMOVAL OF FOREIGN BODY FROM MUSCLE - DEEP OR COMPLICATED WITH INCISION,20525,CPT ,,Both,,,6241,,,,,,,,,, "Injection, therapeutic, carpal tunnel",20526,CPT ,,Both,,,957,,,,,,,,,, INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT ,,Both,,,1020,,,,,,,,,, INJECTION SINGLE TENDON ORIGIN/INSERTION,20551,CPT ,,Both,,,1309,,,,,,,,,, INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,20552,CPT ,,Both,,,1020,,,,,,,,,, INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,20553,CPT ,,Both,,,1020,,,,,,,,,, ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US,20600,CPT ,,Both,,,1200,,,,,,,,,, ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US,20605,CPT ,,Both,,,1260,,,,,,,,,, "Athrocentesis, Aspiration Or Injection W US",20606,CPT ,,Both,,,978,,,,,,,,,, ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US,20610,CPT ,,Both,,,1260,,,,,,,,,, ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US,20611,CPT ,,Both,,,1152,,,,,,,,,, ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ,20612,CPT ,,Both,,,762,,,,,,,,,, INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION,20650,CPT ,,Both,,,2622,,,,,,,,,, "REMOVAL OF IMPLANT, SUPERFICIAL",20670,CPT ,,Both,,,4990,,,,,,,,,, FLUID PRESSURE MUSCLE,20950,CPT ,,Both,,,3324,,,,,,,,,, MUSCULOSKELETAL SURGERY - UNLISTED,20999,CPT ,,Both,,,19441,,,,,,,,,, INTERDENTAL FIXATION,21110,CPT ,,Both,,,10390,,,,,,,,,, CLOSED TX NOSE FX W/O MANJ,21310,CPT ,,Both,,,1746,,,,,,,,,, CLOSED TX NOSE FX W/O STABLJ,21315,CPT ,,Both,,,10027,,,,,,,,,, CLOSED TX NOSE FX W/ STABLJ,21320,CPT ,,Both,,,3372,,,,,,,,,, OPEN TREATMENT OF NOSE FX,21325,CPT ,,Both,,,6067,,,,,,,,,, CLOSED TX SEPTAL&NOSE FX,21337,CPT ,,Both,,,5298,,,,,,,,,, CLOSED TX NOSE/JAW FX WITH FIXATION,21345,CPT ,,Both,,,10773,,,,,,,,,, TREAT EYE SOCKET FRACTURE,21390,CPT ,,Both,,,10261,,,,,,,,,, CLOSED TX ORBIT FX W/O MANIP,21400,CPT ,,Both,,,2527,,,,,,,,,, CLOSED TX ORBIT FX W/ MANIP,21401,CPT ,,Both,,,6089,,,,,,,,,, CLOSED TX PALATAL OR MAXILLARY FX,21421,CPT ,,Both,,,10474,,,,,,,,,, CLOSED TX MANDIBULAR OR MAX ALVEOLAR RIDGE FX,21440,CPT ,,Both,,,7607,,,,,,,,,, TREAT LOWER JAW FRACTURE W/O MANIPULATION,21450,CPT ,,Both,,,8048,,,,,,,,,, TREAT LOWER JAW FRACTURE W/ MANIPULATION,21451,CPT ,,Both,,,9888,,,,,,,,,, TREAT LOWER JAW FRACTURE W/ WIRING,21453,CPT ,,Both,,,11929,,,,,,,,,, RESET DISLOCATED JAW,21480,CPT ,,Both,,,1281,,,,,,,,,, CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,21485,CPT ,,Both,,,9122,,,,,,,,,, OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,21490,CPT ,,Both,,,7200,,,,,,,,,, DRAIN NECK/CHEST LESION,21501,CPT ,,Both,,,5914,,,,,,,,,, BIOPSY OF NECK/CHEST,21550,CPT ,,Both,,,3384,,,,,,,,,, TREATMENT OF RIB FRACTURE EACH,21800,CPT ,,Both,,,1467,,,,,,,,,, TREATMENT OF RIB FRACTURE(S) W/ EXTERNAL FIXATION,21810,CPT ,,Both,,,6614,,,,,,,,,, TREAT STERNUM FRACTURE,21820,CPT ,,Both,,,1832,,,,,,,,,, EXC BACK LES SC < 3 CM,21930,CPT ,,Both,,,6087,,,,,,,,,, CLOSED TX SPINE PROCESS FX,22305,CPT ,,Both,,,2451,,,,,,,,,, CLOSED TX VERT FX W/O MANJ,22310,CPT ,,Both,,,3880,,,,,,,,,, CLOSED TX VERT FX W/MANJ,22315,CPT ,,Both,,,11190,,,,,,,,,, I&D SHOULDER DEEP ABSCESS/HEMATOMA,23030,CPT ,,Both,,,3086,,,,,,,,,, TREAT CLAVICLE FRACTURE W/O MANIPULATION,23500,CPT ,,Both,,,2805,,,,,,,,,, TREAT CLAVICLE FRACTURE W/ MANIPULATION,23505,CPT ,,Both,,,4492,,,,,,,,,, CLOSED TX STERNOCLAVICULAR DISLOCATION; W/O MANIP,23520,CPT ,,Both,,,2941,,,,,,,,,, CLOSED TX STERNOCLAVICULAR DISLOCATION; W/ MANIP,23525,CPT ,,Both,,,4811,,,,,,,,,, CLOSED TX ACROMIOCLAVICULAR DISLOCATION; W/O MANIP,23540,CPT ,,Both,,,2869,,,,,,,,,, CLOSED TX ACROMIOCLAVICULAR DISLOCATION; W/ MANIP,23545,CPT ,,Both,,,4456,,,,,,,,,, OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,23550,CPT ,,Both,,,1020,,,,,,,,,, CLOSED TX SCAPULAR FX W/O MANIPULATION,23570,CPT ,,Both,,,2962,,,,,,,,,, CLOSED TX SCAPULAR FX W/ MANIPULATION,23575,CPT ,,Both,,,5094,,,,,,,,,, CLOSED TX PROX HUMERAL FX W/O MANIP,23600,CPT ,,Both,,,4200,,,,,,,,,, CLOSED TX PROX HUMERAL FX W/ MANIP,23605,CPT ,,Both,,,5923,,,,,,,,,, CLOSED TX GREATER HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT ,,Both,,,3460,,,,,,,,,, CLOSED TX GREATER HUMERAL TUBEROSITY FX W/ MANIP,23625,CPT ,,Both,,,4848,,,,,,,,,, CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,23650,CPT ,,Both,,,4030,,,,,,,,,, CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,23655,CPT ,,Both,,,5077,,,,,,,,,, Treatment for dislocated shoulder,23660,CPT ,,Both,,,1500,,,,,,,,,, CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,23665,CPT ,,Both,,,5413,,,,,,,,,, "CLOSED TX SHOULDER DISLO, W/ SURGICAL OR ANAT NECK FX, W/ MANIP",23675,CPT ,,Both,,,6971,,,,,,,,,, DRAINAGE OF ARM LESION - DEEP ABSCESS/HEMATOMA,23930,CPT ,,Both,,,4578,,,,,,,,,, DRAINAGE OF ARM BURSA,23931,CPT ,,Both,,,3706,,,,,,,,,, EXCISION OLECRANON BURSA,24105,CPT ,,Both,,,1140,,,,,,,,,, RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,24200,CPT ,,Both,,,2633,,,,,,,,,, REMOVAL ELBOX/UPPER ARM FOREIGN BODY - DEEP,24201,CPT ,,Both,,,7193,,,,,,,,,, REPAIR ARM TENDON/MUSCLE,24341,CPT ,,Both,,,9473,,,,,,,,,, TREAT HUMERAL SHAFT FX W/O MANIP,24500,CPT ,,Both,,,4582,,,,,,,,,, TREAT HUMERAL SHAFT FX W/ MANIP,24505,CPT ,,Both,,,6381,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FX W/O MANIP,24530,CPT ,,Both,,,4859,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FX W/ MANIP,24535,CPT ,,Both,,,7808,,,,,,,,,, "CLOSED TX HUMERAL EPICONDYLAR FX, MED OR LAT, W/O MANIP",24560,CPT ,,Both,,,4136,,,,,,,,,, "CLOSED TX HUMERAL EPICONDYLAR FX, MED OR LAT, W/ MANIP",24565,CPT ,,Both,,,6767,,,,,,,,,, "CLOSED TX HUMERAL CONDYLAR FX, MED OR LAT, W/O MANIP",24576,CPT ,,Both,,,4374,,,,,,,,,, "CLOSED TX HUMERAL CONDYLAR FX, MED OR LAT, W/ MANIP",24577,CPT ,,Both,,,6963,,,,,,,,,, PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR,24582,CPT ,,Both,,,10225,,,,,,,,,, TX CLOSED ELBOW DISLOCATION W/O ANESTH,24600,CPT ,,Both,,,4675,,,,,,,,,, TX CLOSED ELBOW DISLOCATION W/ ANESTH,24605,CPT ,,Both,,,5959,,,,,,,,,, "CLOSED TX MONTEGGIA FX DISLO AT ELBOW, W/ MANIP",24620,CPT ,,Both,,,7003,,,,,,,,,, CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,24640,CPT ,,Both,,,1833,,,,,,,,,, CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,24650,CPT ,,Both,,,3364,,,,,,,,,, CLOSED TX RADIAL HEAD OR NECK FX W/ MANIP,24655,CPT ,,Both,,,5597,,,,,,,,,, "CLOSED TX ULNAR FX, PROX, W/O MANIP",24670,CPT ,,Both,,,3737,,,,,,,,,, "CLOSED TX ULNAR FX, PROX LEG, OLECRANON OR CORONOID PROCESS, W/O MANIP",24675,CPT ,,Both,,,5817,,,,,,,,,, UNLISTED UPPER ARM/ELBOW SURGERY,24999,CPT ,,Both,,,1671,,,,,,,,,, EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,25248,CPT ,,Both,,,8000,,,,,,,,,, "RPR TENDON OR MUSCLE, EACH",25260,CPT ,,Both,,,7956,,,,,,,,,, "RPR TENDON/MUSCLE FLEXOR,FOREARM,WRIST PRIM SGL EA",25270,CPT ,,Both,,,6188,,,,,,,,,, CLOSED TX RADIAL SHAFT FX W/O MANIP,25500,CPT ,,Both,,,3483,,,,,,,,,, CLOSED TX RADIAL SHAFT FX W/ MANIP,25505,CPT ,,Both,,,6412,,,,,,,,,, CLOSED TX RADIAL SHAFT FX/ W/ DISTAL RADIOULNAR DISLOCATION,25520,CPT ,,Both,,,7187,,,,,,,,,, CLOSED TX ULNAR SHAFT FX W/O MANIP,25530,CPT ,,Both,,,3368,,,,,,,,,, CLOSED TX ULNAR SHAFT FX W/ MANIP,25535,CPT ,,Both,,,6233,,,,,,,,,, CLOSED TX RADIAL AND ULNAR SHAFT FX W/O MANIP,25560,CPT ,,Both,,,3575,,,,,,,,,, CLOSED TX RADIAL AND ULNAR SHAFT FX W/ MANIP,25565,CPT ,,Both,,,6645,,,,,,,,,, CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,25600,CPT ,,Both,,,4218,,,,,,,,,, CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,25605,CPT ,,Both,,,6988,,,,,,,,,, PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,25606,CPT ,,Both,,,1152,,,,,,,,,, CLOSED TX NAVICULAR FX W/O MANIP,25622,CPT ,,Both,,,3911,,,,,,,,,, CLOSED TX NAVICULAR FX W/ MANIP,25624,CPT ,,Both,,,6070,,,,,,,,,, "CLOSED TX CARPAL BONE FX W/O MANIP, EACH BONE",25630,CPT ,,Both,,,3902,,,,,,,,,, "CLOSED TX CARPAL BONE FX W/ MANIP, EACH BONE",25635,CPT ,,Both,,,5788,,,,,,,,,, CLOSED TX ULNAR STYLOID FX,25650,CPT ,,Both,,,4102,,,,,,,,,, CLOSED TX RADIOCARPAL OR INTERCARPAL DISLO W/ MANIP,25660,CPT ,,Both,,,5205,,,,,,,,,, CLOSED TX DISTAL RADIOULNAR DISLO W/ MANIP,25675,CPT ,,Both,,,5653,,,,,,,,,, "CLOSED TX TRANS-SCAPHOPERIULNAR FX DISLO, W/ MANIP",25680,CPT ,,Both,,,6068,,,,,,,,,, "CLOSED TX LUNATE DISLO, W/ MANIP",25690,CPT ,,Both,,,6090,,,,,,,,,, DRAINAGE FINGER ABSCESS SIMPLE,26010,CPT ,,Both,,,3435,,,,,,,,,, DRAINAGE OF FINGER ABSCESS - COMPLICATED,26011,CPT ,,Both,,,5048,,,,,,,,,, "ARTHROTOMY, INTERPHALANGEAL JOINT, EACH",26080,CPT ,,Both,,,4935,,,,,,,,,, "RPR/ADVNCE FLEXOR TENDN PRIMRY/SECONDRY W/O FREE GRFT, EA",26350,CPT ,,Both,,,9019,,,,,,,,,, REPAIR FLEXOR TENDON W/O FREE GRAFT,26356,CPT ,,Both,,,13817,,,,,,,,,, Repair Profundus tendon with intact Superficialis tendon,26370,CPT ,,Both,,,9560,,,,,,,,,, "REPAIR EXTENSOR TENDON, HAND, W/O FREE GRAFT",26410,CPT ,,Both,,,7153,,,,,,,,,, "REPAIR EXTENSOR TENDOR, W/O FREE GRAFT",26418,CPT ,,Both,,,7354,,,,,,,,,, CLOSED TX DISTAL EXTENSOR TENDON INSERTION,26432,CPT ,,Both,,,6320,,,,,,,,,, "EXTEN TENDON REPAIR, DISTAL",26433,CPT ,,Both,,,6714,,,,,,,,,, REPAIR HAND JOINT,26540,CPT ,,Both,,,8277,,,,,,,,,, "CLOSED TX METACARPAL FX, SINGLE W/O MANIP",26600,CPT ,,Both,,,1635,,,,,,,,,, "CLOSED TX METACARPAL FX, SINGLE W/ MANIP",26605,CPT ,,Both,,,4120,,,,,,,,,, "CLOSED TX METACARPAL FX, W/ MANIP, W/ EXT FIXATION",26607,CPT ,,Both,,,5772,,,,,,,,,, PERC SKELETAL FIXATION METACARPAL FX EACH BONE,26608,CPT ,,Both,,,6037,,,,,,,,,, "CLOSED TX CARPOMETACARPAL DISLO, THUMB, W/ MANIP",26641,CPT ,,Both,,,4688,,,,,,,,,, "CLOSED TX CARPOMETACARPAL FX DISLO, THUMB W/ MANIP (BENNETT FX)",26645,CPT ,,Both,,,5417,,,,,,,,,, "CLOSED TX CARPOMETACARPAL DISLO, W/ MANIP (OTHER THAN THUMB)",26670,CPT ,,Both,,,4212,,,,,,,,,, Dislocation carpometacarpal finger each with anesthesia,26675,CPT ,,Both,,,5769,,,,,,,,,, "CLOSED TX MEGACARPOPHALANGEAL DISLO, W/ MANIP",26700,CPT ,,Both,,,4140,,,,,,,,,, Dislocation metacarpophalangeal W/ MANIPULATION each with anesthesia,26705,CPT ,,Both,,,5270,,,,,,,,,, "CLOSED TX PHALANGEAL SHAFT FX, PROX OR MID PHALANX, FINGER OR THUMB W/O MANIP",26720,CPT ,,Both,,,2551,,,,,,,,,, CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,26725,CPT ,,Both,,,4306,,,,,,,,,, PERCUTANEOUS SKELETAL FIXATION OF FINGER FX,26727,CPT ,,Both,,,5932,,,,,,,,,, OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA,26735,CPT ,,Both,,,7536,,,,,,,,,, "CLOSED TX ARTICULAR FX, W/O MANIP",26740,CPT ,,Both,,,2926,,,,,,,,,, "CLOSED TX ARTICULAR FX, W/ MANIP",26742,CPT ,,Both,,,4671,,,,,,,,,, CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,26750,CPT ,,Both,,,2364,,,,,,,,,, "CLOSED TX DIST PHALANGEAL FX, W/ MANIP",26755,CPT ,,Both,,,4025,,,,,,,,,, PERCUTANEOUS SKEL FIXATION OF DISTAL PHALANGEL FX,26756,CPT ,,Both,,,5308,,,,,,,,,, "Open reduction, distal phalynx, with internal fixation",26765,CPT ,,Both,,,6352,,,,,,,,,, CLTX IPHAL JT DISLC W/MANJ W/O ANES,26770,CPT ,,Both,,,3541,,,,,,,,,, Dislocation interphalangeal joint with manipulation with anesthesia,26775,CPT ,,Both,,,4915,,,,,,,,,, OPEN TX INTERPHALANGEAL JOINT DISLOCATION,26785,CPT ,,Both,,,6912,,,,,,,,,, "ARTHRODESIS, METACARPOPHALANGEAL JOINT",26860,CPT ,,Both,,,7116,,,,,,,,,, AMPUTATION OF FINGER/THUMB,26951,CPT ,,Both,,,8247,,,,,,,,,, AMPUTATION OF FINGER/THUMB W/ LOCAL ADVANCEMENT FLAPS,26952,CPT ,,Both,,,8114,,,,,,,,,, UNLISTED HAND/FINGER SURGERY,26989,CPT ,,Both,,,1671,,,,,,,,,, "CLOSED TX PELVIC RING FX, DISLO, DIASTASIS OR SUBLUXATION W/O MANIP",27193,CPT ,,Both,,,5957,,,,,,,,,, "CLOSED TX PELVIC RING FX, DISLO, DIASTASIS OR SUBLUXATION W/ MANIP",27194,CPT ,,Both,,,8928,,,,,,,,,, TREAT TAIL BONE FRACTURE,27200,CPT ,,Both,,,2295,,,,,,,,,, TREAT HIP SOCKET FRACTURE W/O MANIP,27220,CPT ,,Both,,,6704,,,,,,,,,, TREAT HIP SOCKET FRACTURE W/ MANIP,27222,CPT ,,Both,,,12162,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, NECK W/O MANIP",27230,CPT ,,Both,,,6034,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, NECK W/ MANIP",27232,CPT ,,Both,,,9582,,,,,,,,,, "CLOSED TX INTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEM FX W/O MANIP",27238,CPT ,,Both,,,5847,,,,,,,,,, "CLOSED TX INTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEM FX W/ MANIP",27240,CPT ,,Both,,,12104,,,,,,,,,, CLOSED TX GREATER TROCHANTERIC FX,27246,CPT ,,Both,,,4871,,,,,,,,,, "CLOSED TX HIP DISLO, TRAUMATIC",27250,CPT ,,Both,,,2277,,,,,,,,,, "CLOSED TX HIP DISLO, TRAUMATIC W/ ANESTHESIA",27252,CPT ,,Both,,,9566,,,,,,,,,, "TX SPONTANEOUS HIP DISLO, W/O MANIP",27256,CPT ,,Both,,,3887,,,,,,,,,, "Hip dislocation reduction, with manip., with anesthesia",27257,CPT ,,Both,,,4202,,,,,,,,,, CLOSED TX POST HIP ARTHROPLASTY DISLOCATION,27265,CPT ,,Both,,,5124,,,,,,,,,, Post arthroplasty hip dislocation reduction with anesthesia,27266,CPT ,,Both,,,7336,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, HEAD W/O MANIP",27267,CPT ,,Both,,,5545,,,,,,,,,, "CLOSED TX FEMORAL FX, PROX END, HEAD W/ MANIP",27268,CPT ,,Both,,,6784,,,,,,,,,, "I&D DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE",27301,CPT ,,Both,,,8608,,,,,,,,,, REMOVAL FOREIGN BODY DEEP THIGH/KNEE,27372,CPT ,,Both,,,7813,,,,,,,,,, REPAIR OF KNEECAP TENDON,27380,CPT ,,Both,,,7533,,,,,,,,,, CLOSED TX FEMORAL SHAFT FX W/O MANIP,27500,CPT ,,Both,,,6549,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FX W/O MANIP,27501,CPT ,,Both,,,6369,,,,,,,,,, CLOSED TX FEMORAL SHAFT FX W/ MANIP,27502,CPT ,,Both,,,9716,,,,,,,,,, CLOSED TX SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FX W/ MANIP,27503,CPT ,,Both,,,10127,,,,,,,,,, "CLOSED TX FEMORAL FX,M DISTAL, MED OR LATERAL CONDYLE W/O MANIP",27508,CPT ,,Both,,,6690,,,,,,,,,, "CLOSED TX FEMORAL FX, DISTAL END, MED OR LATERAL CONDYLE W/ MANIP",27510,CPT ,,Both,,,8659,,,,,,,,,, CLOSED TX DISTAL FEMORAL EPIPHYSEAL SEPARATION W/O MANIP,27516,CPT ,,Both,,,6461,,,,,,,,,, CLOSED TX DISTAL FEMORAL EPIPHYSEAL SEPARATION W/ MANIP,27517,CPT ,,Both,,,8643,,,,,,,,,, CLOSED TX PATELLAR FX W/O MANIP,27520,CPT ,,Both,,,4161,,,,,,,,,, "CLOSED TX TIBIAL FX, PROX W/O MANIP",27530,CPT ,,Both,,,3886,,,,,,,,,, "CLOSED TX TIBIAL FX, PROX W/ MANIP",27532,CPT ,,Both,,,7801,,,,,,,,,, CLOSED TX INTERCONDYLAR/TUBEROSITY KNEE FX,27538,CPT ,,Both,,,6042,,,,,,,,,, CLOSED TX KNEE DISLO,27550,CPT ,,Both,,,6347,,,,,,,,,, "CLOSED TX KNEE DISLO, W/ ANESTHESIA",27552,CPT ,,Both,,,7922,,,,,,,,,, CLOSED TX PATELLAR DISLO W/O ANESTH,27560,CPT ,,Both,,,4674,,,,,,,,,, CLOSED TX PATELLA W/ ANESTH,27562,CPT ,,Both,,,6115,,,,,,,,,, "I&D DEEP ABSCESS, BURSA, OR HEMATOMA, LEG OR ANKLE",27603,CPT ,,Both,,,6923,,,,,,,,,, REPAIR ACHILLES TENDON,27650,CPT ,,Both,,,8440,,,,,,,,,, REPAIR FLEXOR TENDON LEG,27658,CPT ,,Both,,,4800,,,,,,,,,, CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE WITHOUT MANIPULATION,27750,CPT ,,Both,,,4442,,,,,,,,,, TX TIBIAL SHAFT FX W/ MANIP,27752,CPT ,,Both,,,6843,,,,,,,,,, CLOSED TX MEDIAL MALLEOLUS FX W/O MANIP,27760,CPT ,,Both,,,4307,,,,,,,,,, CLOSED TX MEDIAL MALLEOLUS FX W/ MANIP,27762,CPT ,,Both,,,6085,,,,,,,,,, CLSD TX POSTERIOR MALLEOLUS FX W/O MANIPULATION,27767,CPT ,,Both,,,3622,,,,,,,,,, CLSD TX POSTERIOR MALLEOLUS FX W/ MANIPULATION,27768,CPT ,,Both,,,5589,,,,,,,,,, CLOSED TX PROX FIBULA OR SHAFT FX W/O MANIP,27780,CPT ,,Both,,,3950,,,,,,,,,, CLOSED TX PROX FIBULA OR SHAFT FX W/ MANIP,27781,CPT ,,Both,,,5333,,,,,,,,,, CLOSED TX DISTAL FIB FX (LATERAL MALLEOLUS) W/O MANIP,27786,CPT ,,Both,,,4078,,,,,,,,,, CLOSED TX DISTAL FIB FX (LATERAL MALLEOLUS) W/ MANIP,27788,CPT ,,Both,,,5402,,,,,,,,,, CLOSED TX BIMALLEOLAR ANKLE FX W/O MANIP,27808,CPT ,,Both,,,4311,,,,,,,,,, CLOSED TX BIMALLEOLAR ANKLE FX W/ MANIP,27810,CPT ,,Both,,,6016,,,,,,,,,, "CLOSED TX TRIMALLEOLAR ANKLE FX, W/O MANIP",27816,CPT ,,Both,,,4095,,,,,,,,,, "CLOSED TX TRIMALLEOLAR ANKLE FX, W/ MANIP",27818,CPT ,,Both,,,6195,,,,,,,,,, CLOSED TX FX OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIB W/O MANIP,27824,CPT ,,Both,,,3995,,,,,,,,,, TREAT LOWER LEG FRACTURE,27825,CPT ,,Both,,,6902,,,,,,,,,, CLOSED TX PROX TIBIOFIBULAR JOINT DISLO W/O ANESTH,27830,CPT ,,Both,,,4849,,,,,,,,,, "CLOSED TX PROX TIBIOFIBULAR JOINT DISLO, W/O ANESTH",27831,CPT ,,Both,,,5063,,,,,,,,,, CLOSED TX ANKLE DISLO W/O ANESTH,27840,CPT ,,Both,,,4768,,,,,,,,,, CLOSED TX ANKLE DISLO W/ ANESTH,27842,CPT ,,Both,,,6285,,,,,,,,,, UNLISTED LEG/ANKLE SURGERY PROCEDURE,27899,CPT ,,Both,,,1671,,,,,,,,,, EXPLORATION OF TOE JOINT,28024,CPT ,,Both,,,5974,,,,,,,,,, "HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROX END OF PHALANX",28160,CPT ,,Both,,,5466,,,,,,,,,, REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,CPT ,,Both,,,3353,,,,,,,,,, REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT ,,Both,,,6147,,,,,,,,,, REMOVAL OF FOOT FOREIGN BODY - FOOT - COMPLICATED,28193,CPT ,,Both,,,6924,,,,,,,,,, "RPR TENDON, FLEXOR, FOOT W/O FREE GRAFT",28200,CPT ,,Both,,,6289,,,,,,,,,, "RPR TENDON, EXTENSOR, FOOT W/O FREE GRAFT",28208,CPT ,,Both,,,6082,,,,,,,,,, "TENOTOMY, OPEN TENDON FLEXOR",28234,CPT ,,Both,,,5355,,,,,,,,,, CLOSED TX CALCANEAL FX W/O MANIP,28400,CPT ,,Both,,,3242,,,,,,,,,, CLOSED TX CALCANEAL FX W/ MANIP,28405,CPT ,,Both,,,4846,,,,,,,,,, CLOSED TX TALUS FX W/O MANIP,28430,CPT ,,Both,,,3046,,,,,,,,,, CLOSED TX TALUS FX W/ MANIP,28435,CPT ,,Both,,,4611,,,,,,,,,, TX TARSAL BONE FX (EXCEPT TALUS AND CALCANEUS) W/O MANIP,28450,CPT ,,Both,,,2796,,,,,,,,,, TX TARSAL BONE FX (EXCEPT TALUS AND CALCANEUS) W/ MANIP,28455,CPT ,,Both,,,3336,,,,,,,,,, CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,28470,CPT ,,Both,,,2854,,,,,,,,,, CLOSED TX METATARSAL FX W/ MANIP,28475,CPT ,,Both,,,3260,,,,,,,,,, CLTX FX GRT TOE PHLX/PHLG W/O MANJ,28490,CPT ,,Both,,,1899,,,,,,,,,, CLOSED TX FX GREAT TOE W/ MANIP,28495,CPT ,,Both,,,2304,,,,,,,,,, "OPEN TX FX, GREAT TOE",28505,CPT ,,Both,,,8607,,,,,,,,,, "CLOSED TX FX PHALANX OR PHALANGESOTHER THAN GREAT TOE, W/O MANIP, EACH",28510,CPT ,,Both,,,1597,,,,,,,,,, "CLOSED TX FX PHALANX OR PHALANGESOTHER THAN GREAT TOE, W/ MANIP, EACH",28515,CPT ,,Both,,,2087,,,,,,,,,, CLOSED TX SESAMOID FX,28530,CPT ,,Both,,,1478,,,,,,,,,, "CLOSED TX TARSAL BONE DISLO, LTHER THAN TALOTARSAL, W/O ANESTH",28540,CPT ,,Both,,,2488,,,,,,,,,, "CLOSED TX TALOTARSAL JOINT DISLO, W/O ANESTH",28570,CPT ,,Both,,,2085,,,,,,,,,, "CLOSED TX TARSOMETATARSAL JOINT DISLO, W/O ANESTH",28600,CPT ,,Both,,,2408,,,,,,,,,, CLOSED TX METATARSOPHALANGEAL JOINT W/O ANESTH,28630,CPT ,,Both,,,2026,,,,,,,,,, CLTX METATARSOPHLNGL JT DISLC REQ ANES,28635,CPT ,,Both,,,2227,,,,,,,,,, "CLOSED TX INTERPHALANGEAL JOINT DISLO, W/O ANESTH",28660,CPT ,,Both,,,1506,,,,,,,,,, Dislocation reduction interphalangeal joint with anesthesia,28665,CPT ,,Both,,,1992,,,,,,,,,, "Amputation, metatarsal, with toe",28810,CPT ,,Both,,,5580,,,,,,,,,, "AMPUTATION, TOE, METATARSOPHALANGEAL JOINT",28820,CPT ,,Both,,,7446,,,,,,,,,, "AMPUTATION, TOE, INTERPHALANGEAL JOINT",28825,CPT ,,Both,,,7078,,,,,,,,,, APPLICATION OF FIGURE EIGHT,29049,CPT ,,Both,,,1275,,,,,,,,,, "APPLICATION OF CAST, SHOULDER SPICA",29055,CPT ,,Both,,,2879,,,,,,,,,, "APPLIATION OF CAST, PLASTER Velpeau",29058,CPT ,,Both,,,1573,,,,,,,,,, APPLICATION OF LONG ARM CAST,29065,CPT ,,Both,,,1242,,,,,,,,,, APPLICATION CAST ELBOW FINGER SHORT ARM,29075,CPT ,,Both,,,1118,,,,,,,,,, APPLY HAND/WRIST CAST (GAUNTLET),29085,CPT ,,Both,,,1225,,,,,,,,,, APPLICATION CAST FINGER,29086,CPT ,,Both,,,1062,,,,,,,,,, APPLICATION LONG ARM SPLINT SHOULDER HAND,29105,CPT ,,Both,,,1455,,,,,,,,,, APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,29125,CPT ,,Both,,,1014,,,,,,,,,, APPLICATION SHORT ARM SPLINT DYNAMIC,29126,CPT ,,Both,,,1268,,,,,,,,,, APPLICATION FINGER SPLINT STATIC,29130,CPT ,,Both,,,583,,,,,,,,,, APPLICATION FINGER SPLINT DYNAMIC,29131,CPT ,,Both,,,853,,,,,,,,,, STRAPPING THORAX,29200,CPT ,,Both,,,678,,,,,,,,,, STRAPPING SHOULDER,29240,CPT ,,Both,,,1260,,,,,,,,,, STRAPPING OF ELBOW OR WRIST,29260,CPT ,,Both,,,843,,,,,,,,,, STRAPPING HAND/FINGER,29280,CPT ,,Both,,,1260,,,,,,,,,, APPLICATION OF HIP SPICA CAST,29305,CPT ,,Both,,,3193,,,,,,,,,, APPLICATION OF HIP SPICA CAST - 1 1/2 OR BOTH LEGS,29325,CPT ,,Both,,,3529,,,,,,,,,, APPLICATION OF LONG LEG CAST,29345,CPT ,,Both,,,1755,,,,,,,,,, APPLICATION OF LONG LEG CAST - WALKER OR AMBULATORY TYPE,29355,CPT ,,Both,,,1823,,,,,,,,,, APPLY LONG LEG CAST BRACE,29358,CPT ,,Both,,,2070,,,,,,,,,, APPLICATION OF CYLINDER CAST (THIGH TO ANKLE),29365,CPT ,,Both,,,1590,,,,,,,,,, APPLY SHORT LEG CAST (BELOW ANKLE TO TOES),29405,CPT ,,Both,,,1051,,,,,,,,,, APPLY SHORT LEG CAST - WALKING OR AMBULATORY TYPE,29425,CPT ,,Both,,,1009,,,,,,,,,, APPLY PATELLAR TENDON BEARING CAST,29435,CPT ,,Both,,,1543,,,,,,,,,, ADDITION OF WALKER TO CAST,29440,CPT ,,Both,,,570,,,,,,,,,, APPLY RIGID LEG CAST,29445,CPT ,,Both,,,1744,,,,,,,,,, APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,29450,CPT ,,Both,,,1840,,,,,,,,,, APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,29505,CPT ,,Both,,,1379,,,,,,,,,, APPLICATION SHORT LEG SPLINT CALF FOOT,29515,CPT ,,Both,,,1019,,,,,,,,,, STRAPPING OF HIP,29520,CPT ,,Both,,,622,,,,,,,,,, STRAPPING KNEE,29530,CPT ,,Both,,,2040,,,,,,,,,, STRAPPING ANKLE &/FOOT,29540,CPT ,,Both,,,1362,,,,,,,,,, STRAPPING TOES,29550,CPT ,,Both,,,1362,,,,,,,,,, APPLICATION OF UNNA BOOT,29580,CPT ,,Both,,,677,,,,,,,,,, APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,29581,CPT ,,Both,,,806,,,,,,,,,, REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,29700,CPT ,,Both,,,1260,,,,,,,,,, REMOVAL OR BIVALVING OF CAST; FULL ARM OR FULL LEG,29705,CPT ,,Both,,,851,,,,,,,,,, REMOVAL OR BIVALVING SHOULDER OR HIP SPICA CAST,29710,CPT ,,Both,,,1580,,,,,,,,,, WINDOWING OF CAST,29730,CPT ,,Both,,,834,,,,,,,,,, WEDGING OF CAST (EXCEPT CLUBFOOT),29740,CPT ,,Both,,,1195,,,,,,,,,, WEDGING CLUBFOOT CAST,29750,CPT ,,Both,,,1372,,,,,,,,,, UNLISTED CASTING/STRAPPING PROCEDURE,29799,CPT ,,Both,,,1182,,,,,,,,,, "DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH",30000,CPT ,,Both,,,3044,,,,,,,,,, "DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM",30020,CPT ,,Both,,,3092,,,,,,,,,, REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,30300,CPT ,,Both,,,3088,,,,,,,,,, Cauterize inner nose/superficial - simple,30801,CPT ,,Both,,,3041,,,,,,,,,, CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,CPT ,,Both,,,1512,,,,,,,,,, CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,30903,CPT ,,Both,,,2707,,,,,,,,,, CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,30905,CPT ,,Both,,,3367,,,,,,,,,, "NASAL HEMORRHAGE CONTROL, POSTERIOR, SUBSEQUENT",30906,CPT ,,Both,,,3678,,,,,,,,,, UNLISTED PROCEDURE NOSE,30999,CPT ,,Both,,,1800,,,,,,,,,, 12-LEAD ECG PERFORMED,3120F,CPT ,,Both,,,276,,,,,,,,,, NASAL ENDOSCOPY DX,31231,CPT ,,Both,,,3739,,,,,,,,,, ENDOSCOPY NASAL/SINUS,31238,CPT ,,Both,,,4300,,,,,,,,,, INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,31500,CPT ,,Both,,,1373,,,,,,,,,, TRACHEOTOMY TUBE CHANGE,31502,CPT ,,Both,,,7085,,,,,,,,,, "DIAGNOSTIC LARYNGOSCOPY, INDIRECT",31505,CPT ,,Both,,,1090,,,,,,,,,, REMOVE FOREIGN BODY LARYNX,31511,CPT ,,Both,,,2787,,,,,,,,,, LARYNGOSCOPY FOR ASPIRATION,31515,CPT ,,Both,,,2716,,,,,,,,,, DX LARYNGOSCOPY EXCL NB,31525,CPT ,,Both,,,3256,,,,,,,,,, "LARYNGOSCOPY DIRECT, OPERATIVE, W/ FB REMOVAL",31530,CPT ,,Both,,,2540,,,,,,,,,, LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP,31541,CPT ,,Both,,,1200,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC",31575,CPT ,,Both,,,1478,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC, WITH BIOPSY",31576,CPT ,,Both,,,2913,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC, WITH REMOVAL OF FB",31577,CPT ,,Both,,,3167,,,,,,,,,, "LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC",31579,CPT ,,Both,,,2728,,,,,,,,,, UNLISTED PROCEDURE LARYNX,31599,CPT ,,Both,,,2160,,,,,,,,,, "TRACHEOSTOMY, EMERGENCY PROCEDURE",31603,CPT ,,Both,,,41201,,,,,,,,,, "TRACHEOSTOMY, CRICOTHYROID MEMBRANE",31605,CPT ,,Both,,,2299,,,,,,,,,, VISUALIZATION OF WINDPIPE,31615,CPT ,,Both,,,2346,,,,,,,,,, DX BRONCHOSCOPE/WASH,31622,CPT ,,Both,,,4088,,,,,,,,,, "Bronchoscopy, including fluoro guidance; with brushing",31624,CPT ,,Both,,,4074,,,,,,,,,, BRONCHOSCOPY W/BIOPSY(S),31625,CPT ,,Both,,,4359,,,,,,,,,, BRONCHOSCOPY W/FB REMOVAL,31635,CPT ,,Both,,,4502,,,,,,,,,, BRONCHOSCOPY WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE,31645,CPT ,,Both,,,4146,,,,,,,,,, "BRONCHOSCOPY W/ FLUOROSCOPIC GUIDANCE, DIAGNOSTIC, W/ CELL WASHING",31720,CPT ,,Both,,,627,,,,,,,,,, "Unlisted procedure, trachea, bronchi",31899,CPT ,,Both,,,9549,,,,,,,,,, THORACOTOMY for trauma,32110,CPT ,,Both,,,18552,,,,,,,,,, THORACOTOMY WITH OPEN INTRAPLEURAL PNEUMONOLYSIS,32124,CPT ,,Both,,,11808,,,,,,,,,, OPEN CHEST HEART MASSAGE,32160,CPT ,,Both,,,10025,,,,,,,,,, INSERT PLEURAL CATH,32550,CPT ,,Both,,,13504,,,,,,,,,, INSERTION OF CHEST TUBE,32551,CPT ,,Both,,,3346,,,,,,,,,, Removal of indwelling tunneled pleural catheter with cuff,32552,CPT ,,Both,,,2451,,,,,,,,,, PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING,32557,CPT ,,Both,,,1260,,,,,,,,,, CHEST SURGERY PROCEDURE,32999,CPT ,,Both,,,5155,,,,,,,,,, PERICARDIOCENTESIS,33010,CPT ,,Both,,,1479,,,,,,,,,, PERICARDIOCENTESIS SUBSEQUENT,33011,CPT ,,Both,,,1499,,,,,,,,,, TEMPORARY TRANSVENOUS PACEMAKER,33210,CPT ,,Both,,,2215,,,,,,,,,, CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS,33512,CPT ,,Both,,,3024,,,,,,,,,, "REPAIR BLOOD VESSEL LESION, UPPER EXTREMITY",35206,CPT ,,Both,,,10042,,,,,,,,,, "REPAIR BLOOD VESSEL, HAND OR FINGER",35207,CPT ,,Both,,,9526,,,,,,,,,, "REPAIR BLOOD VESSEL LESION, LOWER EXTREMITY",35226,CPT ,,Both,,,10836,,,,,,,,,, INTRODUCTION NEEDLE/INTRACATHETER VEIN,36000,CPT ,,Both,,,364,,,,,,,,,, INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,36010,CPT ,,Both,,,6558,,,,,,,,,, ARTERIAL LINE PLACEMENT,36140,CPT ,,Both,,,5797,,,,,,,,,, BL DRAW < 3 YRS FEM/JUGULAR,36400,CPT ,,Both,,,370,,,,,,,,,, BL DRAW <3 YRS SCALP VEIN,36405,CPT ,,Both,,,336,,,,,,,,,, BL DRAW <3 YRS OTHER VEIN,36406,CPT ,,Both,,,251,,,,,,,,,, COLLECTION VENOUS BLOOD VENIPUNCTURE,36410,CPT ,,Both,,,378,,,,,,,,,, COLLECTION VENOUS BLOOD VENIPUNCTURE,36415,CPT ,,Both,,,456,,,,,,,,,, COLLECTION CAPILLARY BLOOD SPECIMEN,36416,CPT ,,Both,,,684,,,,,,,,,, VEIN ACCESS CUTDOWN < 1 YR,36420,CPT ,,Both,,,655,,,,,,,,,, VEIN ACCESS CUTDOWN > 1 YR,36425,CPT ,,Both,,,501,,,,,,,,,, BLOOD TRANSFUSION SERVICE,36430,CPT ,,Both,,,434,,,,,,,,,, "PUSH TRANS, BLOOD 2 YRS OR UNDER",36440,CPT ,,Both,,,737,,,,,,,,,, INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y,36555,CPT ,,Both,,,3320,,,,,,,,,, INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>,36556,CPT ,,Both,,,3014,,,,,,,,,, "Insertion of tunneled centrally inserted central venous catheter, < 5 YR",36557,CPT ,,Both,,,10074,,,,,,,,,, INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,36558,CPT ,,Both,,,10252,,,,,,,,,, INSRT TUNNELED CV CATH W PORT,36561,CPT ,,Both,,,15667,,,,,,,,,, INSERT PICC CATH < 5 YR,36568,CPT ,,Both,,,3775,,,,,,,,,, INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,36569,CPT ,,Both,,,3170,,,,,,,,,, "INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP",36572,CPT ,,Both,,,600,,,,,,,,,, REPAIR OF TUNNELED OR NON-TUNNELED CV CATH,36575,CPT ,,Both,,,2215,,,,,,,,,, "REPLACEMENT, COMPLETE, OF A NON-TUNNELED CENTRALLY",36580,CPT ,,Both,,,2786,,,,,,,,,, Removal of Tunneled Catheter w/ subcu port by Incision and Sutures,36590,CPT ,,Both,,,3790,,,,,,,,,, DRAW BLOOD OFF VENOUS DEVICE,36591,CPT ,,Both,,,298,,,,,,,,,, COLLECT BLOOD FROM PICC,36592,CPT ,,Both,,,345,,,,,,,,,, DECLOT VASCULAR DEVICE,36593,CPT ,,Both,,,396,,,,,,,,,, MECH REMOV TUNNELED CV CATH,36595,CPT ,,Both,,,7353,,,,,,,,,, ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,36600,CPT ,,Both,,,900,,,,,,,,,, "INSERTION CATHETER ARTERY FOR SAMPLING, MONITORING, OR TRANSFUSION, PERCUTANEOUS",36620,CPT ,,Both,,,635,,,,,,,,,, "INSERTION CATHETER ARTERY FOR SAMPLING, MONITORING, OR TRANSFUSION, CUTDOWN",36625,CPT ,,Both,,,1330,,,,,,,,,, PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,36680,CPT ,,Both,,,746,,,,,,,,,, THROMBOLYTIC THERAPY STROKE,37195,CPT ,,Both,,,1523,,,,,,,,,, TEMPORAL ARTERY PROCEDURE,37609,CPT ,,Both,,,4091,,,,,,,,,, Unlisted Vascular Surgery Procedure,37799,CPT ,,Both,,,614,,,,,,,,,, DRAINAGE LYMPH NODE ABSCESS,38300,CPT ,,Both,,,3662,,,,,,,,,, Repair of Lip full thickness Vermilion,40650,CPT ,,Both,,,5802,,,,,,,,,, Repair of Lip full thickness up to half vertical height,40652,CPT ,,Both,,,6431,,,,,,,,,, Repair of Lip full thickness over half vertical height,40654,CPT ,,Both,,,7413,,,,,,,,,, LIP SURGERY PROCEDURE,40799,CPT ,,Both,,,976,,,,,,,,,, "DRAINAGE OF MOUTH LESION, SIMPLE",40800,CPT ,,Both,,,2810,,,,,,,,,, "DRAINAGE OF MOUTH LESION, COMPLICATED",40801,CPT ,,Both,,,4129,,,,,,,,,, RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,40804,CPT ,,Both,,,2879,,,,,,,,,, REMV EMBEDDED FB MOUTH-COMPLIC,40805,CPT ,,Both,,,5208,,,,,,,,,, FRENOTOMY,40806,CPT ,,Both,,,1525,,,,,,,,,, Destruction of lesion or scar vestibule mouth,40820,CPT ,,Both,,,3569,,,,,,,,,, REPAIR MOUTH LACERATION 2.5 CM OR LESS,40830,CPT ,,Both,,,3541,,,,,,,,,, REPAIR MOUTH LACERATION OVER 2.5 CM OR COMPLX,40831,CPT ,,Both,,,4481,,,,,,,,,, "INTRAORAL I&D ABSCESS,CYST,HEMATOMA TONGUE OR FLOOR MOUTH, LINGUAL",41000,CPT ,,Both,,,2129,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, SUBLINGUAL, SUPERFICIAL",41005,CPT ,,Both,,,3075,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, SUBMENTAL SPACE",41007,CPT ,,Both,,,4658,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, SUBMANDIBULAR SPACE",41008,CPT ,,Both,,,4922,,,,,,,,,, "INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, MASTICATOR SPACE",41009,CPT ,,Both,,,5224,,,,,,,,,, "EXTRAORAL I&D OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH, SUBMANDIBULAR",41017,CPT ,,Both,,,5756,,,,,,,,,, Repair of lac <2.5 cm to floor of mouth and/or tongue,41250,CPT ,,Both,,,3562,,,,,,,,,, REP LAC 2.5 CM OR LESS POST THIRD OF TONGUE,41251,CPT ,,Both,,,3905,,,,,,,,,, "Repair of laceration of tongue, floor of mouth, over 2.6cm or complex",41252,CPT ,,Both,,,4156,,,,,,,,,, "Unlisted procedure, tongue,floor of mouth",41599,CPT ,,Both,,,976,,,,,,,,,, I&D DENTAL ABSCESS,41800,CPT ,,Both,,,3661,,,,,,,,,, "Removal of embedded foreign body from dentalalveolar structure, soft tissue",41805,CPT ,,Both,,,3275,,,,,,,,,, "Destruction Lesion,dentoalveolar Structure",41850,CPT ,,Both,,,543,,,,,,,,,, DENTAL SURGERY PROCEDURE,41899,CPT ,,Both,,,976,,,,,,,,,, "DRAINAGE OF ABSCESS OF PALATE, UVULA",42000,CPT ,,Both,,,2666,,,,,,,,,, BIOPSY OF PALATE UVULA,42100,CPT ,,Both,,,1975,,,,,,,,,, "REPAIR, LACERATION OF PALATE, UP TO 2 CM",42180,CPT ,,Both,,,3214,,,,,,,,,, "REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX",42182,CPT ,,Both,,,4176,,,,,,,,,, Drainage of Abscess; intraoral,42310,CPT ,,Both,,,2154,,,,,,,,,, REMOVAL OF SALIVARY STONE,42330,CPT ,,Both,,,3061,,,,,,,,,, DRAINAGE OF TONSIL ABSCESS,42700,CPT ,,Both,,,2516,,,,,,,,,, DRAINAGE OF THROAT ABSCESS,42720,CPT ,,Both,,,5863,,,,,,,,,, REMOVE PHARYNX FOREIGN BODY,42809,CPT ,,Both,,,2264,,,,,,,,,, SUTURE PHARYNX FOR WOUND OR INJURY,42900,CPT ,,Both,,,4344,,,,,,,,,, CONTROL OROPHARYNGEAL HEMORRHAGE,42960,CPT ,,Both,,,2196,,,,,,,,,, CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,42970,CPT ,,Both,,,5282,,,,,,,,,, "Unlisted Procedures pharynx,adenoids or tonsils",42999,CPT ,,Both,,,976,,,,,,,,,, "ESOPHAGUS ENDOSCOPY, DIAGNOSTIC",43200,CPT ,,Both,,,2805,,,,,,,,,, ESOPHAGOS W DIRECT SUBM INJECT,43201,CPT ,,Both,,,4091,,,,,,,,,, ESOPHAGUS ENDOSCOPY WITH FB REMOVAL,43215,CPT ,,Both,,,1959,,,,,,,,,, UPPR GI ENDOSCOPY DIAGNOSIS,43235,CPT ,,Both,,,3898,,,,,,,,,, UPPER GI ENDOSCOPY BIOPSY,43239,CPT ,,Both,,,4495,,,,,,,,,, UPPER GI ENDOSCOPY WITH TUBE,43241,CPT ,,Both,,,1980,,,,,,,,,, Gastrointestional Endoscopy Upper with Ligation,43244,CPT ,,Both,,,3728,,,,,,,,,, "Upper Endoscopy with dilation (balloon,guide wire, bougie)",43245,CPT ,,Both,,,2383,,,,,,,,,, EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE,43246,CPT ,,Both,,,4000,,,,,,,,,, UPPER GI ENDOSCOPY WITH REMOVAL OF FB,43247,CPT ,,Both,,,2541,,,,,,,,,, UP GI ENDO W DILATION ESOPHAG,43248,CPT ,,Both,,,2385,,,,,,,,,, Uper GI Endo with balloon dilation of esophagus,43249,CPT ,,Both,,,2202,,,,,,,,,, "EGD,Control of Bleeding,Any Method",43255,CPT ,,Both,,,3570,,,,,,,,,, ENDOSCOPIC ERCP SURG,43260,CPT ,,Both,,,4374,,,,,,,,,, "DILATION OF ESOPHAGUS, SINGLE/MULTI PASS",43450,CPT ,,Both,,,2017,,,,,,,,,, ESOPHAGUS UNLISTED PROCEDURE,43499,CPT ,,Both,,,7793,,,,,,,,,, NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE,43752,CPT ,,Both,,,2332,,,,,,,,,, GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE,43753,CPT ,,Both,,,1500,,,,,,,,,, GASTRIC INTUBATION AND ASPIRATION,43754,CPT ,,Both,,,1249,,,,,,,,,, CHANGE GASTROSTOMY TUBE,43760,CPT ,,Both,,,6659,,,,,,,,,, REPOSITION GASTROSTOMY TUBE,43761,CPT ,,Both,,,1460,,,,,,,,,, Replacement G-tube No Imaging,43762,CPT ,,Both,,,1599,,,,,,,,,, Replacement Gtube Requiring Revision,43763,CPT ,,Both,,,1756,,,,,,,,,, Laparoscopy; revision of adjustable gastric device,43771,CPT ,,Both,,,15944,,,,,,,,,, LONGITUDINAL GASTRECTOMY,43775,CPT ,,Both,,,15996,,,,,,,,,, UNLISTED PROCEDURE STOMACH,43999,CPT ,,Both,,,7793,,,,,,,,,, INTRO LONG FI TUBE (SPR PROC),44500,CPT ,,Both,,,303,,,,,,,,,, UNLISTED PROCEDURE INTESTINE,44799,CPT ,,Both,,,23157,,,,,,,,,, DRAINAGE OF RECTAL ABSCESS,45005,CPT ,,Both,,,3543,,,,,,,,,, BIOPSY ANORECTAL WALL ANAL APPROACH,45100,CPT ,,Both,,,3840,,,,,,,,,, PROCTOSIGMOIDOSCOPY DX,45300,CPT ,,Both,,,1622,,,,,,,,,, PROCTOSIGMOIDOSCOPY FB REMOVAL,45307,CPT ,,Both,,,3049,,,,,,,,,, SIGMOIDOSCOPY W/FB REMOVAL,45332,CPT ,,Both,,,3920,,,,,,,,,, REDUCTION OF RECTAL PROLAPSE,45900,CPT ,,Both,,,2590,,,,,,,,,, Removal of fecal impaction or foreign body (separate procedure) under anesthesia,45915,CPT ,,Both,,,4262,,,,,,,,,, ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX,45990,CPT ,,Both,,,1260,,,,,,,,,, UNLISTED PROCEDURE RECTUM,45999,CPT ,,Both,,,5492,,,,,,,,,, I&D ISCHIORECTAL AND/OR PERIRECTAL ABSCESS,46040,CPT ,,Both,,,6871,,,,,,,,,, "I&D INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL",46045,CPT ,,Both,,,5527,,,,,,,,,, INCISION OF PERIANAL ABSCESS,46050,CPT ,,Both,,,3150,,,,,,,,,, INCISE EXTERNAL HEMORRHOID,46083,CPT ,,Both,,,2293,,,,,,,,,, LIGATION OF HEMORRHOID(S),46221,CPT ,,Both,,,3513,,,,,,,,,, REMOVAL OF ANAL TAGS,46230,CPT ,,Both,,,3554,,,,,,,,,, REMOVE EXT HEM GROUPS 2+,46250,CPT ,,Both,,,5977,,,,,,,,,, REMOVAL OF HEMORRHOID CLOT,46320,CPT ,,Both,,,2386,,,,,,,,,, DIAGNOSTIC ANOSCOPY,46600,CPT ,,Both,,,1162,,,,,,,,,, ANOSCOPY REMOVE FB,46608,CPT ,,Both,,,3073,,,,,,,,,, REMOVE BY LIGAT INT HEM GRP,46945,CPT ,,Both,,,4021,,,,,,,,,, "UNLISTED PROCEDURE, ANUS",46999,CPT ,,Both,,,5492,,,,,,,,,, ABD PARACENTESIS,49082,CPT ,,Both,,,2263,,,,,,,,,, ABD PARACENTESIS W/IMAGING,49083,CPT ,,Both,,,4078,,,,,,,,,, PERITONEAL LAVAGE,49084,CPT ,,Both,,,1274,,,,,,,,,, INSERT GASTROSTOMY TUBE PERCUTANEOUS,49440,CPT ,,Both,,,1260,,,,,,,,,, REPLACE G/C TUBE PERC,49450,CPT ,,Both,,,8744,,,,,,,,,, REPLACE DUOD/JEJ TUBE PERC,49451,CPT ,,Both,,,9536,,,,,,,,,, Replacement of gastro-jejunostomy tube,49452,CPT ,,Both,,,11710,,,,,,,,,, REPAIR ING HERNIA REDUCE,49520,CPT ,,Both,,,7932,,,,,,,,,, RPR UMBIL HERN REDUC > 5 YR,49585,CPT ,,Both,,,5607,,,,,,,,,, UNLISTED PROCEDURE ABDOMEN,49999,CPT ,,Both,,,23157,,,,,,,,,, Change of Nephrostomy tube,50398,CPT ,,Both,,,6444,,,,,,,,,, "CYSTOSTOMY, CYSTOTOMY W/DRAINAGE",51040,CPT ,,Both,,,3587,,,,,,,,,, ASPIRATION OF BLADDER BY NEEDLE,51100,CPT ,,Both,,,775,,,,,,,,,, ASPIRATION OF BLADDER W/ SUPRAPUBIC CATH INSERTION,51102,CPT ,,Both,,,2849,,,,,,,,,, BLDR IRRIGATION SMPL LAVAGE &/INSTLJ,51700,CPT ,,Both,,,1500,,,,,,,,,, INSJ NON-NDWELLG BLADDER CATHETER,51701,CPT ,,Both,,,1140,,,,,,,,,, INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,51702,CPT ,,Both,,,1260,,,,,,,,,, INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,51703,CPT ,,Both,,,1619,,,,,,,,,, CHANGE OF BLADDER TUBE,51705,CPT ,,Both,,,1142,,,,,,,,,, "CHANGE OF BLADDER TUBE, COMPLICATED",51710,CPT ,,Both,,,1163,,,,,,,,,, US URINE CAPACITY MEASURE (BLADDER SCAN),51798,CPT ,,Both,,,1262,,,,,,,,,, CYSTOSCOPY,52000,CPT ,,Both,,,2534,,,,,,,,,, "Cystoscopy, with calibration and /or dilation of urethral stricture or stenosis",52281,CPT ,,Both,,,3391,,,,,,,,,, CYSTOSCOPY W/ FB REMOVAL,52310,CPT ,,Both,,,3011,,,,,,,,,, "DILATE URETHRA STRICTURE BY SOUND OR URETHRAL DILATOR, MALE",53600,CPT ,,Both,,,1027,,,,,,,,,, "DILATE URETHRA STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE",53620,CPT ,,Both,,,1436,,,,,,,,,, "UNLISTED PROCEDURE, URINARY SYSTEM",53899,CPT ,,Both,,,1025,,,,,,,,,, SLITTING OF PREPUCE,54001,CPT ,,Both,,,2304,,,,,,,,,, LYSIS OR EXCISION OF PENILE POST CIRCUM ADHESIONS,54162,CPT ,,Both,,,3203,,,,,,,,,, IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM,54220,CPT ,,Both,,,2534,,,,,,,,,, PENILE INJECTION,54235,CPT ,,Both,,,1121,,,,,,,,,, REVISION OF PENIS,54435,CPT ,,Both,,,5151,,,,,,,,,, FORSKIN MANIPULATION INCLUDING LYSIS,54450,CPT ,,Both,,,857,,,,,,,,,, REPAIR TESTIS INJURY,54670,CPT ,,Both,,,5010,,,,,,,,,, I&D OF SCROTUM,54700,CPT ,,Both,,,2661,,,,,,,,,, DRAINAGE OF SCROTUM ABSCESS,55100,CPT ,,Both,,,2720,,,,,,,,,, UNLISTED PROCEDURE MALE GENITAL SYSTEM,55899,CPT ,,Both,,,1025,,,,,,,,,, I & D OF VULVA/PERINEUM,56405,CPT ,,Both,,,1402,,,,,,,,,, DRAINAGE OF GLAND ABSCESS (BARTHOLIN'S GLAND),56420,CPT ,,Both,,,1564,,,,,,,,,, MARSUPLIALIZATION OF BARTHOLIN'S GLAND CYST,56440,CPT ,,Both,,,2327,,,,,,,,,, DESTROY VULVA LESIONS SIM,56501,CPT ,,Both,,,1675,,,,,,,,,, EXCISION OF BARTHOLIN'S GLAND OR CYST,56740,CPT ,,Both,,,3792,,,,,,,,,, DRAINAGE OF PELVIC FLUID (COLPOCENTESIS),57020,CPT ,,Both,,,1193,,,,,,,,,, Biopsy of vaginal mucosa; simple,57100,CPT ,,Both,,,1122,,,,,,,,,, FITTING/INSERTION PESSARY OR INTRAVAGINAL SUPPORT DEVICE,57160,CPT ,,Both,,,978,,,,,,,,,, Vaginal Packing,57180,CPT ,,Both,,,1807,,,,,,,,,, "Colporrhaphy, suture of injury of vagina",57200,CPT ,,Both,,,3812,,,,,,,,,, Repair of Laceration of Vagina and/or Perineum(non ob),57210,CPT ,,Both,,,4657,,,,,,,,,, REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL,57415,CPT ,,Both,,,4171,,,,,,,,,, "Colposcopy of the entire vagina, with cervix if present",57420,CPT ,,Both,,,1479,,,,,,,,,, COLPOSCOPY WITH BIOPSY,57452,CPT ,,Both,,,1386,,,,,,,,,, BIOPSY OF CERVIX,57500,CPT ,,Both,,,1650,,,,,,,,,, ENDOCERVICAL CURETTAGE,57505,CPT ,,Both,,,1309,,,,,,,,,, Cautery of Cervix,57510,CPT ,,Both,,,1674,,,,,,,,,, ENDOMETRIAL BIOPSY,58100,CPT ,,Both,,,1394,,,,,,,,,, Insertion of Intrauterine Device (IUD),58300,CPT ,,Both,,,896,,,,,,,,,, REMOVAL INTRAUTERINE DEVICE IUD,58301,CPT ,,Both,,,1260,,,,,,,,,, D & C AFTER DELIVERY,59160,CPT ,,Both,,,2603,,,,,,,,,, EPISIOTOMY OR VAGINAL REPAIR,59300,CPT ,,Both,,,2477,,,,,,,,,, VAGINAL DELIVERY,59409,CPT ,,Both,,,10384,,,,,,,,,, DELIVER PLACENTA,59414,CPT ,,Both,,,1166,,,,,,,,,, TREATMENT OF INCOMPLETE ABORTION,59812,CPT ,,Both,,,4066,,,,,,,,,, PUNCTURE SHUNT TUBING FOR ASPIRATION/INJECTION,61070,CPT ,,Both,,,1100,,,,,,,,,, DRILL SKULL FOR IMPLANTATION,61107,CPT ,,Both,,,3914,,,,,,,,,, Burr holes(s)Ventricular Cath or other Cerebral Monitoring device,61210,CPT ,,Both,,,4575,,,,,,,,,, LUMBAR PUNCTURE,62270,CPT ,,Both,,,2046,,,,,,,,,, SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID,62272,CPT ,,Both,,,2627,,,,,,,,,, "INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",62273,CPT ,,Both,,,2237,,,,,,,,,, "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE, EPIDURAL , LUMBAR, SACRAL",62282,CPT ,,Both,,,3688,,,,,,,,,, Injection of substance into lower spine canal using imaging guidance,62323,CPT ,,Both,,,3500,,,,,,,,,, NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH,64400,CPT ,,Both,,,1585,,,,,,,,,, Block Inj-FACIAL NERVE,64402,CPT ,,Both,,,1562,,,,,,,,,, BLOCK - GREATER OCCIPITAL NERVE,64405,CPT ,,Both,,,1315,,,,,,,,,, BLOCK INJ INTERCOSTAL NERVE SNG,64420,CPT ,,Both,,,1470,,,,,,,,,, "BLOCK INJ INTERCOSTAL NERVE MULTIPLE, REGIONAL BLOCK",64421,CPT ,,Both,,,1993,,,,,,,,,, BLOCK INJ ILIOINGUINAL NERVE,64425,CPT ,,Both,,,1733,,,,,,,,,, BLOCK INJ PUDENDAL NERVE,64430,CPT ,,Both,,,1751,,,,,,,,,, BLOCK INJ SCIATIC NERVE,64445,CPT ,,Both,,,1742,,,,,,,,,, BLOCK INJ FEMORAL NERVE,64447,CPT ,,Both,,,1522,,,,,,,,,, INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,64450,CPT ,,Both,,,1362,,,,,,,,,, "Injection(s), anesthetic agent(s) and/or steroid;",64451,CPT ,,Both,,,600,,,,,,,,,, N BLOCK INJ PLANTAR DIGIT,64455,CPT ,,Both,,,1175,,,,,,,,,, CHEMODENERV FACIAL NERVE,64612,CPT ,,Both,,,1740,,,,,,,,,, CHEMODENERV NECK MUSCLE,64613,CPT ,,Both,,,2181,,,,,,,,,, "Suture of digital nerve, hand or foot; one nerve",64831,CPT ,,Both,,,8653,,,,,,,,,, Each additional digital nerve repair,64832,CPT ,,Both,,,4219,,,,,,,,,, REPAIR OF HAND OR FOOT NERVE,64836,CPT ,,Both,,,10492,,,,,,,,,, REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,65205,CPT ,,Both,,,1512,,,,,,,,,, RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR,65210,CPT ,,Both,,,1260,,,,,,,,,, RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,65220,CPT ,,Both,,,1362,,,,,,,,,, RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,65222,CPT ,,Both,,,1512,,,,,,,,,, RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION,65435,CPT ,,Both,,,1362,,,,,,,,,, "INJECT MEDICATION, ANTERIOR CHAMBER OF EYE",66030,CPT ,,Both,,,2163,,,,,,,,,, DRAINAGE OF EYELID ABSCESS,67700,CPT ,,Both,,,3516,,,,,,,,,, Canthotomy,67715,CPT ,,Both,,,3140,,,,,,,,,, REMOVE EYELID LESION,67800,CPT ,,Both,,,1662,,,,,,,,,, REVISE EYELASHES,67820,CPT ,,Both,,,655,,,,,,,,,, REPAIR EYELID WOUND,67935,CPT ,,Both,,,7818,,,,,,,,,, REMOVE FB EYELID,67938,CPT ,,Both,,,3176,,,,,,,,,, PROBE NASOLACRIMAL DUCT,68810,CPT ,,Both,,,3189,,,,,,,,,, "UNLISTED PROCEDURE, LACRIMAL SYSTEM",68899,CPT ,,Both,,,2897,,,,,,,,,, DRAIN EXTERNAL EAR ABSCESS OR HEMATOMA - SIMPLE,69000,CPT ,,Both,,,2460,,,,,,,,,, DRAIN EXTERNAL EAR ABSCESS OR HEMATOMA - COMPLICATED,69005,CPT ,,Both,,,2801,,,,,,,,,, "DRAIN EXTERNAL AUDITORY CANAL, ABSCESS",69020,CPT ,,Both,,,3083,,,,,,,,,, DEBRIDE EAR,69145,CPT ,,Both,,,5263,,,,,,,,,, RMVL FB XTRNL AUDITORY CANAL W/O ANES,69200,CPT ,,Both,,,1623,,,,,,,,,, RMVL FB XTRNL AUDITORY CANAL ANES,69205,CPT ,,Both,,,1512,,,,,,,,,, REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT,69209,CPT ,,Both,,,1362,,,,,,,,,, REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,69210,CPT ,,Both,,,1512,,,,,,,,,, UNLISTED PROCEDURE EXTERNAL EAR,69399,CPT ,,Both,,,976,,,,,,,,,, INCISION OF EARDRUM,69420,CPT ,,Both,,,2529,,,,,,,,,, RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,70030,CPT ,,Both,,,2190,,,,,,,,,, RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,70100,CPT ,,Both,,,154,,,,,,,,,, RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,70110,CPT ,,Both,,,2538,,,,,,,,,, MASTOIDS 1-2V,70120,CPT ,,Both,,,464,,,,,,,,,, RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,70130,CPT ,,Both,,,1824,,,,,,,,,, RADEX FACIAL BONES < 3 VIEWS,70140,CPT ,,Both,,,2394,,,,,,,,,, RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,70150,CPT ,,Both,,,2394,,,,,,,,,, RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,70160,CPT ,,Both,,,3024,,,,,,,,,, RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,70200,CPT ,,Both,,,3024,,,,,,,,,, RADEX SINUSES PARANASAL <3 VIEWS,70210,CPT ,,Both,,,3024,,,,,,,,,, RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,70220,CPT ,,Both,,,3024,,,,,,,,,, RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,70250,CPT ,,Both,,,2724,,,,,,,,,, RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,70260,CPT ,,Both,,,2724,,,,,,,,,, RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,70330,CPT ,,Both,,,3024,,,,,,,,,, "TUBING, Y BLOOD",70355,CPT ,,Both,,,268,,,,,,,,,, RADIOLOGIC EXAMINATION NECK SOFT TISSUE,70360,CPT ,,Both,,,3024,,,,,,,,,, MODIFIED BA SWALLOW W/ VIDEO,70371,CPT ,,Both,,,1173,,,,,,,,,, CT HEAD/BRAIN W/O CONTRAST MATERIAL,70450,CPT ,,Both,,,7429,,,,,,,,,, CT HEAD/BRAIN W/CONTRAST MATERIAL,70460,CPT ,,Both,,,6804,,,,,,,,,, CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,70470,CPT ,,Both,,,7507,,,,,,,,,, CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,70480,CPT ,,Both,,,6804,,,,,,,,,, CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,70481,CPT ,,Both,,,6804,,,,,,,,,, CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,70482,CPT ,,Both,,,6804,,,,,,,,,, CT MAXILLOFACIAL W/O CONTRAST MATERIAL,70486,CPT ,,Both,,,6804,,,,,,,,,, CT MAXILLOFACIAL W/CONTRAST MATERIAL,70487,CPT ,,Both,,,6804,,,,,,,,,, CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,70488,CPT ,,Both,,,6250,,,,,,,,,, CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,70490,CPT ,,Both,,,6048,,,,,,,,,, CT SOFT TISSUE NECK W/CONTRAST MATERIAL,70491,CPT ,,Both,,,6804,,,,,,,,,, CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,70492,CPT ,,Both,,,6650,,,,,,,,,, CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,70496,CPT ,,Both,,,7000,,,,,,,,,, CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,70498,CPT ,,Both,,,7010,,,,,,,,,, MRI ORB/FACE &/OR NECK WO CONT 70540,70540,CPT ,,Both,,,5055,,,,,,,,,, MRI ORB/FACE/NECK W/CONT,70542,CPT ,,Both,,,5844,,,,,,,,,, MRI ORB/FACE/NECK W&WO CONT,70543,CPT ,,Both,,,7174,,,,,,,,,, MRA HEAD WO CONT,70544,CPT ,,Both,,,6383,,,,,,,,,, MRA HEAD W/CONT,70545,CPT ,,Both,,,5750,,,,,,,,,, MRA HEAD W&WO CONT,70546,CPT ,,Both,,,7974,,,,,,,,,, MRA NECK WO CONT,70547,CPT ,,Both,,,6367,,,,,,,,,, MRA NECK W/CONT,70548,CPT ,,Both,,,6188,,,,,,,,,, MRA NECK W&WO CONT,70549,CPT ,,Both,,,7971,,,,,,,,,, MRI IAC WO CONT 70551,70551,CPT ,,Both,,,6086,,,,,,,,,, MRI IAC W/CONT 70552,70552,CPT ,,Both,,,6116,,,,,,,,,, MRI IAC W&WO CONT 70553,70553,CPT ,,Both,,,10265,,,,,,,,,, RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,71010,CPT ,,Both,,,2724,,,,,,,,,, CHEST X-RAY STEREO FRONTAL,71015,CPT ,,Both,,,392,,,,,,,,,, RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,71020,CPT ,,Both,,,2724,,,,,,,,,, CHEST 2V AND LORDOTIC,71021,CPT ,,Both,,,611,,,,,,,,,, CHEST X-RAY FRNT LAT OBLIQUE,71022,CPT ,,Both,,,2019,,,,,,,,,, CHEST X-RAY AND FLUOROSCOPY,71023,CPT ,,Both,,,844,,,,,,,,,, CHEST 4 VIEWS,71030,CPT ,,Both,,,2019,,,,,,,,,, CHEST X-RAY&FLUORO 4/> VIEWS,71034,CPT ,,Both,,,1100,,,,,,,,,, RADEX CHEST SPECIAL VIEWS,71035,CPT ,,Both,,,3024,,,,,,,,,, "Radiologic examination, chest ; single view",71045,CPT ,,Both,,,2370,,,,,,,,,, "Radiologic examination, chest ; 2 views",71046,CPT ,,Both,,,3024,,,,,,,,,, "Radiologic examination, chest ; 3 views",71047,CPT ,,Both,,,3024,,,,,,,,,, "(Radiologic examination, chest ; 4 or more",71048,CPT ,,Both,,,3024,,,,,,,,,, RADEX RIBS UNILATERAL 2 VIEWS,71100,CPT ,,Both,,,2274,,,,,,,,,, RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,71101,CPT ,,Both,,,2634,,,,,,,,,, RADEX RIBS BILATERAL 3 VIEWS,71110,CPT ,,Both,,,3024,,,,,,,,,, RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,71111,CPT ,,Both,,,3024,,,,,,,,,, RADEX STERNUM MINIMUM 2 VIEWS,71120,CPT ,,Both,,,3024,,,,,,,,,, STERNOCLAVICULAR JOINTS MIN 3V,71130,CPT ,,Both,,,2270,,,,,,,,,, CT THORAX W/O CONTRAST MATERIAL,71250,CPT ,,Both,,,6804,,,,,,,,,, CT THORAX W/CONTRAST MATERIAL,71260,CPT ,,Both,,,6804,,,,,,,,,, CT THORAX W/O & W/CONTRAST MATERIAL,71270,CPT ,,Both,,,6804,,,,,,,,,, CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,71275,CPT ,,Both,,,10046,,,,,,,,,, MRI CHEST WO CONT,71550,CPT ,,Both,,,6086,,,,,,,,,, MRI CHEST W/CONT,71551,CPT ,,Both,,,6649,,,,,,,,,, MRI CHEST W&WO CONT,71552,CPT ,,Both,,,8244,,,,,,,,,, SPINE COMP AP&LAT-ENTIRE,72010,CPT ,,Both,,,1023,,,,,,,,,, RADEX SPINE 1 VIEW SPECIFY LEVEL,72020,CPT ,,Both,,,3024,,,,,,,,,, RADEX SPINE CERVICAL 2 OR 3 VIEWS,72040,CPT ,,Both,,,3024,,,,,,,,,, RADEX SPINE CERVICAL 4 OR 5 VIEWS,72050,CPT ,,Both,,,3025,,,,,,,,,, RADEX SPINE CERVICAL 6 OR MORE VIEWS,72052,CPT ,,Both,,,3025,,,,,,,,,, SPINE THORACOLUMBAR STAND,72069,CPT ,,Both,,,555,,,,,,,,,, RADEX SPINE THORACIC 2 VIEWS,72070,CPT ,,Both,,,3024,,,,,,,,,, RADEX SPINE THORACIC 3 VIEWS,72072,CPT ,,Both,,,3024,,,,,,,,,, RADEX SPINE THORACIC MINIMUM 4 VIEWS,72074,CPT ,,Both,,,3024,,,,,,,,,, RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,72080,CPT ,,Both,,,3024,,,,,,,,,, RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,72082,CPT ,,Both,,,3024,,,,,,,,,, X-RAY EXAM SCLOIOSIS ERECT,72090,CPT ,,Both,,,673,,,,,,,,,, RADEX SPINE LUMBOSACRAL 2/3 VIEWS,72100,CPT ,,Both,,,3258,,,,,,,,,, RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,72110,CPT ,,Both,,,3571,,,,,,,,,, RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,72114,CPT ,,Both,,,3024,,,,,,,,,, RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,72120,CPT ,,Both,,,13053,,,,,,,,,, CT CERVICAL SPINE W/O CONTRAST MATERIAL,72125,CPT ,,Both,,,8000,,,,,,,,,, CT CERVICAL SPINE W/CONTRAST MATERIAL,72126,CPT ,,Both,,,6048,,,,,,,,,, CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,72127,CPT ,,Both,,,6930,,,,,,,,,, CT THORACIC SPINE W/O CONTRAST MATERIAL,72128,CPT ,,Both,,,6804,,,,,,,,,, CT THORACIC SPINE W/CONTRAST MATERIAL,72129,CPT ,,Both,,,6048,,,,,,,,,, CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,72130,CPT ,,Both,,,6804,,,,,,,,,, CT LUMBAR SPINE W/O CONTRAST MATERIAL,72131,CPT ,,Both,,,6804,,,,,,,,,, CT LUMBAR SPINE W/CONTRAST MATERIAL,72132,CPT ,,Both,,,6804,,,,,,,,,, CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,72133,CPT ,,Both,,,7366,,,,,,,,,, MRI C-SPINE WO CONT,72141,CPT ,,Both,,,8786,,,,,,,,,, MRI C-SPINE W/CONT,72142,CPT ,,Both,,,6240,,,,,,,,,, MRI T-SPINE WO CONT,72146,CPT ,,Both,,,4859,,,,,,,,,, MRI T-SPINE W/CONT,72147,CPT ,,Both,,,5512,,,,,,,,,, MRI L-SPINE WO CONT,72148,CPT ,,Both,,,8385,,,,,,,,,, MRI L-SPINE W/CONT,72149,CPT ,,Both,,,6031,,,,,,,,,, MRI C-SPINE W&WO CONT,72156,CPT ,,Both,,,10265,,,,,,,,,, MRI T-SPINE W&WO CONT,72157,CPT ,,Both,,,10265,,,,,,,,,, MRI L-SPINE W&WO CONT,72158,CPT ,,Both,,,12204,,,,,,,,,, RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,72170,CPT ,,Both,,,2111,,,,,,,,,, RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,72190,CPT ,,Both,,,2214,,,,,,,,,, CTA PELVIS W&W/O CONTRAST,72191,CPT ,,Both,,,5991,,,,,,,,,, CT PELVIS W/O CONTRAST MATERIAL,72192,CPT ,,Both,,,6804,,,,,,,,,, CT PELVIS W/CONTRAST MATERIAL,72193,CPT ,,Both,,,6827,,,,,,,,,, CT PELVIS W/W/O CONTRAST,72194,CPT ,,Both,,,7507,,,,,,,,,, MRI PELVIS WO CONT,72195,CPT ,,Both,,,8080,,,,,,,,,, MRI PELVIS W/CONT,72196,CPT ,,Both,,,9075,,,,,,,,,, MRI PELVIS W&WO CONT,72197,CPT ,,Both,,,7341,,,,,,,,,, RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,72200,CPT ,,Both,,,2940,,,,,,,,,, SACROILIAC JOINTS MIN 3V,72202,CPT ,,Both,,,447,,,,,,,,,, RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,72220,CPT ,,Both,,,3024,,,,,,,,,, MYELOGRAM CERVICAL S&I,72240,CPT ,,Both,,,1646,,,,,,,,,, MYELOGRAM THORACIC S&I,72255,CPT ,,Both,,,3903,,,,,,,,,, MYELOGRAM LUMBAR S&I,72265,CPT ,,Both,,,7196,,,,,,,,,, MYELOGRAPY 2/MORE REGIONS RS&I,72270,CPT ,,Both,,,3024,,,,,,,,,, PERC VERTEBROPLSTY PER VRT S&I,72291,CPT ,,Both,,,2211,,,,,,,,,, DISKOGRAPHYLUMBAR S&I,72295,CPT ,,Both,,,1309,,,,,,,,,, RADEX CLAVICLE COMPLETE,73000,CPT ,,Both,,,3024,,,,,,,,,, RADEX SCAPULA COMPLETE,73010,CPT ,,Both,,,3024,,,,,,,,,, RADEX SHOULDER 1 VIEW,73020,CPT ,,Both,,,2279,,,,,,,,,, RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,CPT ,,Both,,,3235,,,,,,,,,, ARTHROGRAPHY SHOULDER S&I,73040,CPT ,,Both,,,4222,,,,,,,,,, RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,73050,CPT ,,Both,,,3024,,,,,,,,,, RADEX HUMERUS MINIMUM 2 VIEWS,73060,CPT ,,Both,,,3024,,,,,,,,,, RADEX ELBOW 2 VIEWS,73070,CPT ,,Both,,,3024,,,,,,,,,, RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,73080,CPT ,,Both,,,3024,,,,,,,,,, CONTRAST X-RAY OF ELBOW,73085,CPT ,,Both,,,1317,,,,,,,,,, RADEX FOREARM 2 VIEWS,73090,CPT ,,Both,,,3024,,,,,,,,,, UPPER EXTREMITY INFANT,73092,CPT ,,Both,,,2019,,,,,,,,,, RADEX WRIST 2 VIEWS,73100,CPT ,,Both,,,3024,,,,,,,,,, RADEX WRIST COMPLETE MINIMUM 3 VIEWS,73110,CPT ,,Both,,,3164,,,,,,,,,, ARTHROGRAPHY WRIST S&I,73115,CPT ,,Both,,,1440,,,,,,,,,, RADEX HAND 2 VIEWS,73120,CPT ,,Both,,,2584,,,,,,,,,, RADEX HAND MINIMUM 3 VIEWS,73130,CPT ,,Both,,,3024,,,,,,,,,, RADEX FINGR MINIMUM 2 VIEWS,73140,CPT ,,Both,,,2274,,,,,,,,,, CT UPPER EXTREMITY W/O CONTRAST MATERIAL,73200,CPT ,,Both,,,6804,,,,,,,,,, CT UPPER EXTREMITY W/CONTRAST MATERIAL,73201,CPT ,,Both,,,6804,,,,,,,,,, CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,73202,CPT ,,Both,,,6804,,,,,,,,,, CTA UPPER EXTRM W&W/O CONTRAST,73206,CPT ,,Both,,,7115,,,,,,,,,, MRI UP EXTREM WO CONT,73218,CPT ,,Both,,,5060,,,,,,,,,, MRI UP EXTREM W/CONT,73219,CPT ,,Both,,,5907,,,,,,,,,, MRI UP EXTREM W&WO CONT,73220,CPT ,,Both,,,10265,,,,,,,,,, MRI UP EXTREM JT WO CONT,73221,CPT ,,Both,,,6086,,,,,,,,,, MRI UP EXTREM JT W/CONT,73222,CPT ,,Both,,,5545,,,,,,,,,, MRI UP EXTREM JT W&WO CONT,73223,CPT ,,Both,,,10265,,,,,,,,,, MRA UP EXTREM W&WO CONT,73225,CPT ,,Both,,,6045,,,,,,,,,, HIP 1V LT,73500,CPT ,,Both,,,357,,,,,,,,,, RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,73501,CPT ,,Both,,,2572,,,,,,,,,, RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,CPT ,,Both,,,3024,,,,,,,,,, RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,73503,CPT ,,Both,,,3024,,,,,,,,,, X-RAY HIP UNILATERAL 2 VIEWS,73510,CPT ,,Both,,,2154,,,,,,,,,, HIP BI W/PELVIS,73520,CPT ,,Both,,,532,,,,,,,,,, RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,73521,CPT ,,Both,,,3024,,,,,,,,,, RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,73522,CPT ,,Both,,,3024,,,,,,,,,, Xray Hips Min 5 View,73523,CPT ,,Both,,,582,,,,,,,,,, ARTHROGRAPHY HIP S&I,73525,CPT ,,Both,,,1364,,,,,,,,,, HIP OPERATIVE PROC,73530,CPT ,,Both,,,451,,,,,,,,,, X-RAY EXAM OF PELVIS & HIPS,73540,CPT ,,Both,,,583,,,,,,,,,, FEMUR MIN 2V RT,73550,CPT ,,Both,,,370,,,,,,,,,, RADIOLOGIC EXAMINATION FEMUR 1 VIEW,73551,CPT ,,Both,,,1320,,,,,,,,,, RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,73552,CPT ,,Both,,,2382,,,,,,,,,, RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,73560,CPT ,,Both,,,2019,,,,,,,,,, RADIOLOGIC EXAMINATION KNEE 3 VIEWS,73562,CPT ,,Both,,,3300,,,,,,,,,, RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,73564,CPT ,,Both,,,3024,,,,,,,,,, RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,73565,CPT ,,Both,,,7196,,,,,,,,,, ARTHROGRAPHY KNEE S&I,73580,CPT ,,Both,,,1691,,,,,,,,,, RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,73590,CPT ,,Both,,,3024,,,,,,,,,, RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,73592,CPT ,,Both,,,3024,,,,,,,,,, RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,CPT ,,Both,,,3024,,,,,,,,,, RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,CPT ,,Both,,,3024,,,,,,,,,, CONTRAST X-RAY OF ANKLE,73615,CPT ,,Both,,,1364,,,,,,,,,, RADIOLOGIC EXAMINATION FOOT 2 VIEWS,73620,CPT ,,Both,,,2538,,,,,,,,,, RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,CPT ,,Both,,,2700,,,,,,,,,, RADEX CALCANEUS MINIMUM 2 VIEWS,73650,CPT ,,Both,,,3024,,,,,,,,,, RADEX TOE MINIMUM 2 VIEWS,73660,CPT ,,Both,,,1760,,,,,,,,,, CT LOWER EXTREMITY W/O CONTRAST MATERIAL,73700,CPT ,,Both,,,8004,,,,,,,,,, CT LOWER EXTREMITY W/CONTRAST MATERIAL,73701,CPT ,,Both,,,7770,,,,,,,,,, CT LOWER EXT W/W/O CONT,73702,CPT ,,Both,,,6408,,,,,,,,,, CTA LOWER EXTRM W&W/O CONTRAST,73706,CPT ,,Both,,,5992,,,,,,,,,, MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,73718,CPT ,,Both,,,7814,,,,,,,,,, MRI LOW EXTREM W/CONT,73719,CPT ,,Both,,,6005,,,,,,,,,, MRI LOW EXTREM W&WO CONT,73720,CPT ,,Both,,,10265,,,,,,,,,, MRI LOW EXTREM JT WO CONT,73721,CPT ,,Both,,,6086,,,,,,,,,, MRI LOW EXTREM JT W/CONT,73722,CPT ,,Both,,,9075,,,,,,,,,, MRI LOW EXTREM JT W&WO CONT,73723,CPT ,,Both,,,10265,,,,,,,,,, RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,74000,CPT ,,Both,,,3024,,,,,,,,,, "XR ABDOMEN, 2 OR MORE VIEWS",74010,CPT ,,Both,,,5637,,,,,,,,,, "Radiologic examination, abdomen; 1 view",74018,CPT ,,Both,,,2142,,,,,,,,,, "Radiologic examination, abdomen; 2 views",74019,CPT ,,Both,,,2058,,,,,,,,,, RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,74020,CPT ,,Both,,,8389,,,,,,,,,, "Radiologic examination, abdomen; 3 or more views",74021,CPT ,,Both,,,2389,,,,,,,,,, RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,74022,CPT ,,Both,,,2275,,,,,,,,,, CT ABDOMEN W/O CONTRAST MATERIAL,74150,CPT ,,Both,,,7177,,,,,,,,,, CT ABDOMEN W/CONTRAST MATERIAL,74160,CPT ,,Both,,,7177,,,,,,,,,, CT ABDOMEN W/W/O CONT,74170,CPT ,,Both,,,7262,,,,,,,,,, CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,74174,CPT ,,Both,,,10369,,,,,,,,,, CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,74175,CPT ,,Both,,,7170,,,,,,,,,, CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,74176,CPT ,,Both,,,12476,,,,,,,,,, CT ABDOMEN & PELVIS W/CONTRAST MATERIAL,74177,CPT ,,Both,,,14401,,,,,,,,,, CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,74178,CPT ,,Both,,,12555,,,,,,,,,, MRI ABD WO CONT,74181,CPT ,,Both,,,6668,,,,,,,,,, MRI ABD W/CONT,74182,CPT ,,Both,,,6615,,,,,,,,,, MRI ABD W&WO CONT,74183,CPT ,,Both,,,10265,,,,,,,,,, PERITONEOGRAM RS&I,74190,CPT ,,Both,,,3024,,,,,,,,,, ESOPHAGUS W/GASTROGRAFFIN,74220,CPT ,,Both,,,2161,,,,,,,,,, BARIUM SWALLOW,74230,CPT ,,Both,,,1168,,,,,,,,,, REMOVE ESOPHAGUS OBSTRUCTION,74235,CPT ,,Both,,,1960,,,,,,,,,, RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB,74240,CPT ,,Both,,,3024,,,,,,,,,, RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB,74241,CPT ,,Both,,,3024,,,,,,,,,, RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES,74245,CPT ,,Both,,,3024,,,,,,,,,, CONTRST X-RAY UPPR GI TRACT,74246,CPT ,,Both,,,1654,,,,,,,,,, CONTRST X-RAY UPPR GI TRACT,74247,CPT ,,Both,,,7069,,,,,,,,,, CONTRST X-RAY UPPR GI TRACT,74249,CPT ,,Both,,,2089,,,,,,,,,, RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES,74250,CPT ,,Both,,,3024,,,,,,,,,, RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE,74251,CPT ,,Both,,,3024,,,,,,,,,, BARIUM ENEMA W/GAST,74270,CPT ,,Both,,,1956,,,,,,,,,, BARIUM ENEMA/AIR CONTRAST,74280,CPT ,,Both,,,2136,,,,,,,,,, CHOLECYSTO ORAL CONTRAST,74290,CPT ,,Both,,,899,,,,,,,,,, CHOLECYSTO REPEAT EXAM,74291,CPT ,,Both,,,882,,,,,,,,,, X-RAY BILE DUCTS/PANCREAS,74300,CPT ,,Both,,,570,,,,,,,,,, X-RAYS AT SURGERY ADD-ON,74301,CPT ,,Both,,,336,,,,,,,,,, CHOLANGIOGRAM T TUBE S&I,74305,CPT ,,Both,,,681,,,,,,,,,, CONTRAST X-RAY OF BILE DUCTS,74320,CPT ,,Both,,,1262,,,,,,,,,, X-RAY BILE STONE REMOVAL,74327,CPT ,,Both,,,1800,,,,,,,,,, ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,74328,CPT ,,Both,,,4282,,,,,,,,,, ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,74329,CPT ,,Both,,,3024,,,,,,,,,, CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,74330,CPT ,,Both,,,3286,,,,,,,,,, INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I,74340,CPT ,,Both,,,1734,,,,,,,,,, X-RAY GUIDE INTESTINAL TUBE,74355,CPT ,,Both,,,1874,,,,,,,,,, X-RAY GUIDE GI DILATION,74360,CPT ,,Both,,,2039,,,,,,,,,, X-RAY BILE DUCT DILATION,74363,CPT ,,Both,,,1377,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74400,CPT ,,Both,,,7069,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74410,CPT ,,Both,,,1436,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74415,CPT ,,Both,,,1781,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74420,CPT ,,Both,,,1623,,,,,,,,,, CONTRST X-RAY URINARY TRACT,74425,CPT ,,Both,,,915,,,,,,,,,, CONTRAST X-RAY BLADDER,74430,CPT ,,Both,,,520,,,,,,,,,, VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,74440,CPT ,,Both,,,3024,,,,,,,,,, X-RAY EXAM OF PENIS,74445,CPT ,,Both,,,1301,,,,,,,,,, X-RAY URETHRA/BLADDER,74450,CPT ,,Both,,,5637,,,,,,,,,, URETHROCYSTOGRAM VOIDING S&I,74455,CPT ,,Both,,,1087,,,,,,,,,, X-RAY EXAM OF KIDNEY LESION,74470,CPT ,,Both,,,997,,,,,,,,,, X-RAY CONTROL CATH INSERT,74475,CPT ,,Both,,,1245,,,,,,,,,, X-RAY CONTROL CATH INSERT,74480,CPT ,,Both,,,1245,,,,,,,,,, X-RAY GUIDE GU DILATION,74485,CPT ,,Both,,,1249,,,,,,,,,, X-RAY MEASUREMENT OF PELVIS,74710,CPT ,,Both,,,422,,,,,,,,,, HYSTEROSALPINGOGRAPHY S&I,74740,CPT ,,Both,,,993,,,,,,,,,, X-RAY FALLOPIAN TUBE,74742,CPT ,,Both,,,962,,,,,,,,,, X-RAY EXAM OF PERINEUM,74775,CPT ,,Both,,,1163,,,,,,,,,, AORTOGRAPHY THORACIC S&I,75605,CPT ,,Both,,,1965,,,,,,,,,, AORTOGRAM ABDOMINAL S&I,75625,CPT ,,Both,,,1969,,,,,,,,,, AORTA ABD W/BI ILIOFEM S&I,75630,CPT ,,Both,,,2337,,,,,,,,,, CTA AORTA W/RUNOFFS W&W/O CONT,75635,CPT ,,Both,,,7069,,,,,,,,,, ANGIO EXTREME UNI W/CONT S&I,75710,CPT ,,Both,,,2286,,,,,,,,,, ANGIO VISCERAL S&I,75726,CPT ,,Both,,,2293,,,,,,,,,, ANGIO PELVIC SEL/SUP SEL S&I,75736,CPT ,,Both,,,2217,,,,,,,,,, ANGIO PUL UN SELECT S&I,75741,CPT ,,Both,,,2063,,,,,,,,,, ANGIO SELEC ADD VESSEL S&I,75774,CPT ,,Both,,,1287,,,,,,,,,, VENO EXTREMITY UNI S&I,75820,CPT ,,Both,,,1611,,,,,,,,,, VENO EXTREMITY BI S&I,75822,CPT ,,Both,,,2003,,,,,,,,,, VENO CAVAL INF W/SERIAL S&I,75825,CPT ,,Both,,,1897,,,,,,,,,, ANGIO VIA EXIST CATH S&I,75898,CPT ,,Both,,,1600,,,,,,,,,, TRANSCATH INT IV STENT S&I,75960,CPT ,,Both,,,1590,,,,,,,,,, ANGIOPLASTY PERIPH ART S&I,75962,CPT ,,Both,,,1918,,,,,,,,,, ANGIOPLASTY ADD PERIP ART S&I,75964,CPT ,,Both,,,1240,,,,,,,,,, ANGIOPLSTY RENAL/VISC ART S&I,75966,CPT ,,Both,,,2251,,,,,,,,,, ANGIOPLASTY ADD VISC ART S&I,75968,CPT ,,Both,,,1125,,,,,,,,,, ANGIOPLASTY VENOUS S&I,75978,CPT ,,Both,,,1901,,,,,,,,,, DRAIN PERC TRANS HEP S&I,75980,CPT ,,Both,,,3772,,,,,,,,,, INT/EX BILIARY STENT/DRAIN S&I,75982,CPT ,,Both,,,2254,,,,,,,,,, CHG PERC TUBE/CATH CONT S&I,75984,CPT ,,Both,,,1424,,,,,,,,,, S&I RAD GUID PERC DRN/CATH PLT,75989,CPT ,,Both,,,1587,,,,,,,,,, "C-ARM: FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR, OTHER THAN 71023 OR 71034",76000,CPT ,,Both,,,665,,,,,,,,,, C-ARM OVER 1 HOUR,76001,CPT ,,Both,,,1839,,,,,,,,,, RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,76010,CPT ,,Both,,,2520,,,,,,,,,, "ABS, FISTULA, SINUS TRACT S&I",76080,CPT ,,Both,,,772,,,,,,,,,, SURGICAL SPECIMEN X-RAY,76098,CPT ,,Both,,,239,,,,,,,,,, TOMOGRAPHY,76100,CPT ,,Both,,,1274,,,,,,,,,, 3D ULTSND PRCSS NO IND WRKSTN,76376,CPT ,,Both,,,1855,,,,,,,,,, 3D ULTSND PRCSS IND WRKSTN,76377,CPT ,,Both,,,1036,,,,,,,,,, CT LIMITED/LOCALIZED FOLLOW UP STUDY,76380,CPT ,,Both,,,6804,,,,,,,,,, UNLISTED FLUOROSCOPIC PROC,76496,CPT ,,Both,,,1428,,,,,,,,,, UNLISTED CT PROC,76497,CPT ,,Both,,,1236,,,,,,,,,, Ophthalmic Ultrasound;Diagnostic of Eye,76512,CPT ,,Both,,,3141,,,,,,,,,, US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,76536,CPT ,,Both,,,3024,,,,,,,,,, US CHEST REAL TIME W/IMAGE DOCUMENTATION,76604,CPT ,,Both,,,2866,,,,,,,,,, US BREAST UNI REAL TIME WITH IMAGE COMPLETE,76641,CPT ,,Both,,,2866,,,,,,,,,, US BREAST UNI REAL TIME WITH IMAGE LIMITED,76642,CPT ,,Both,,,1941,,,,,,,,,, US ECHO BREAST UNI/BI,76645,CPT ,,Both,,,1142,,,,,,,,,, US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,76700,CPT ,,Both,,,3224,,,,,,,,,, US ABDOMINAL REAL TIME W/IMAGE LIMITED,76705,CPT ,,Both,,,4003,,,,,,,,,, US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,76770,CPT ,,Both,,,2866,,,,,,,,,, US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,76775,CPT ,,Both,,,3024,,,,,,,,,, US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,76801,CPT ,,Both,,,2866,,,,,,,,,, US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,76802,CPT ,,Both,,,1170,,,,,,,,,, US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,76805,CPT ,,Both,,,3024,,,,,,,,,, US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,76810,CPT ,,Both,,,3024,,,,,,,,,, ULS OBSTETRIC DETAIL FIRST TRI,76811,CPT ,,Both,,,2377,,,,,,,,,, ULS OBSTETRIC DETAILED EA ADDL,76812,CPT ,,Both,,,1917,,,,,,,,,, ULTRSND PREGNANCY LMTD,76815,CPT ,,Both,,,2300,,,,,,,,,, US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,76816,CPT ,,Both,,,1854,,,,,,,,,, US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,76817,CPT ,,Both,,,3024,,,,,,,,,, U/S FETAL BIOPHYS PROF W/NST,76818,CPT ,,Both,,,1579,,,,,,,,,, ULTZ FETAL BIOPHY W/O NONSTRES,76819,CPT ,,Both,,,1147,,,,,,,,,, DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,76827,CPT ,,Both,,,1948,,,,,,,,,, US TRANSVAGINAL,76830,CPT ,,Both,,,3208,,,,,,,,,, 3N-HYSTROSONOGRAM,76831,CPT ,,Both,,,1616,,,,,,,,,, US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,76856,CPT ,,Both,,,3024,,,,,,,,,, US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,76857,CPT ,,Both,,,2724,,,,,,,,,, US SCROTUM & CONTENTS,76870,CPT ,,Both,,,3654,,,,,,,,,, ECHOGRAHY TRANSRECTAL,76872,CPT ,,Both,,,921,,,,,,,,,, ECHOGRAP TRANS R PROS STUDY,76873,CPT ,,Both,,,2171,,,,,,,,,, US POPLITEAL FOSSA,76880,CPT ,,Both,,,2009,,,,,,,,,, US EXTREMITY NON-VASC REAL-TIME IMG COMPL,76881,CPT ,,Both,,,3024,,,,,,,,,, US EXTREMITY NON-VASC REAL-TIME IMG LMTD,76882,CPT ,,Both,,,1521,,,,,,,,,, USG PERICARDIOCENTESIS,76930,CPT ,,Both,,,1075,,,,,,,,,, U/S GUIDED REPAIR PSEUDO-ANEUR,76936,CPT ,,Both,,,2572,,,,,,,,,, US GUIDE FOR VASCULAR ACCESS,76937,CPT ,,Both,,,2671,,,,,,,,,, ECHO GUIDE FOR BIOPSY,76942,CPT ,,Both,,,2613,,,,,,,,,, U/S AMNIOCENTESIS GUIDE,76946,CPT ,,Both,,,410,,,,,,,,,, UNLISTED US EXAM PROCEDURE,76999,CPT ,,Both,,,807,,,,,,,,,, FLUORO CENT VEN ACCESS DEV,77001,CPT ,,Both,,,1517,,,,,,,,,, FLUORO GUIDE SPINE,77003,CPT ,,Both,,,1202,,,,,,,,,, CT GUIDED NEEDLE BIOPSY,77012,CPT ,,Both,,,1613,,,,,,,,,, MAMMO GUIDE NEEDLE LOC BREAST,77032,CPT ,,Both,,,657,,,,,,,,,, CAD W/DR W/WO DIGIT DX MAMO,77051,CPT ,,Both,,,127,,,,,,,,,, CAD W/DR W/WO DIGIT SCR MAMO,77052,CPT ,,Both,,,127,,,,,,,,,, MAMMO EXTRA VIEW,77055,CPT ,,Both,,,1117,,,,,,,,,, MAMMOGRAPHY-CONED MAGNIFI,77056,CPT ,,Both,,,1437,,,,,,,,,, MAMMOGRAM SCREENING,77057,CPT ,,Both,,,1023,,,,,,,,,, BONE AGE STUDIES,77072,CPT ,,Both,,,298,,,,,,,,,, BONE SURVEY LIMITED,77074,CPT ,,Both,,,895,,,,,,,,,, BONE SURVEY COMPLETE,77075,CPT ,,Both,,,1215,,,,,,,,,, BONE SURVEY INFANT,77076,CPT ,,Both,,,2019,,,,,,,,,, BONE DENSITY DEXA,77080,CPT ,,Both,,,631,,,,,,,,,, THYROID METASTASES W/BODY,78018,CPT ,,Both,,,4036,,,,,,,,,, PARATHYROID SCAN,78070,CPT ,,Both,,,3388,,,,,,,,,, PLASMA VOLUMNE SINGLE SAMPLE,78110,CPT ,,Both,,,1188,,,,,,,,,, RBC DETERM SINGLE SAMPLE,78120,CPT ,,Both,,,1171,,,,,,,,,, LIVER SCAN (SPECT),78205,CPT ,,Both,,,2740,,,,,,,,,, LIVER/SPLEEN SCAN STATIC ONLY,78215,CPT ,,Both,,,2518,,,,,,,,,, GASTRIC EMPTYING SCAN,78264,CPT ,,Both,,,3690,,,,,,,,,, UREA BREATH TEST C-14ACQ ANALY,78267,CPT ,,Both,,,135,,,,,,,,,, UREA BREATH TEST C-14 ANALYSIS,78268,CPT ,,Both,,,1157,,,,,,,,,, SCHILLING TEST W/O INTR FACTOR,78270,CPT ,,Both,,,1099,,,,,,,,,, SCHILLING TEST W/FACTOR,78271,CPT ,,Both,,,1202,,,,,,,,,, SCHILLING TEST W&W/O FACTOR,78272,CPT ,,Both,,,1210,,,,,,,,,, GI BLEEDING SCAN ACUTE,78278,CPT ,,Both,,,3802,,,,,,,,,, MECKELS DIVERTICULUM SCAN,78290,CPT ,,Both,,,3618,,,,,,,,,, PERITONEAL SHUNT PATENCY TEST,78291,CPT ,,Both,,,3298,,,,,,,,,, BONE IMAGING LIMITED AREA PRO,78300,CPT ,,Both,,,2322,,,,,,,,,, BONE IMAGING MULT AREAS,78305,CPT ,,Both,,,3056,,,,,,,,,, BONE IMAGING WHOLE BODY,78306,CPT ,,Both,,,3235,,,,,,,,,, BONE IMAGING 3 PHASE,78315,CPT ,,Both,,,3940,,,,,,,,,, BONE IMAGING SPECT,78320,CPT ,,Both,,,3940,,,,,,,,,, ACUTE VENOUS THROMB IMAG PEPTI,78456,CPT ,,Both,,,4578,,,,,,,,,, CARD BLOOD POOL IMG SNGL STUDY,78472,CPT ,,Both,,,3032,,,,,,,,,, LUNG PERFUSION,78580,CPT ,,Both,,,3064,,,,,,,,,, BRAIN IMAGING LIMITED STATIC,78600,CPT ,,Both,,,2365,,,,,,,,,, BRAIN IMAGING COMPLETE STATIC 78605,78605,CPT ,,Both,,,2548,,,,,,,,,, BRAIN SCAN W/FLOW COMPLET,78606,CPT ,,Both,,,4292,,,,,,,,,, BRAIN SCAN TOMOGRAP SPECT,78607,CPT ,,Both,,,4535,,,,,,,,,, CISTERNOGRAPHY,78630,CPT ,,Both,,,4457,,,,,,,,,, CSF SHUNT EVALUATION,78645,CPT ,,Both,,,3643,,,,,,,,,, CSF LEAKAGE DETECT/LOCALIZE,78650,CPT ,,Both,,,4308,,,,,,,,,, KIDNEY W/FLOW&FUNCT W/O PHARM,78707,CPT ,,Both,,,2971,,,,,,,,,, KIDNEY W/FLOW&FUNCT W/ PHARM,78708,CPT ,,Both,,,2196,,,,,,,,,, KIDNEY SPECT,78710,CPT ,,Both,,,2634,,,,,,,,,, TESTICULAR SCAN W/FLOW,78761,CPT ,,Both,,,2783,,,,,,,,,, TUMOR LOCAL LTD AREA,78800,CPT ,,Both,,,2446,,,,,,,,,, TUMOR LOCAL MULT AREAS,78801,CPT ,,Both,,,3141,,,,,,,,,, TUMOR LOCAL WHOLE BODY,78802,CPT ,,Both,,,4168,,,,,,,,,, TUMOR LOCAL SPECT,78803,CPT ,,Both,,,4390,,,,,,,,,, TUMOR LOCAL WHOLE BODY>1DAY,78804,CPT ,,Both,,,7342,,,,,,,,,, LOCAL INFLAMM PROCESS LMT AREA,78805,CPT ,,Both,,,2352,,,,,,,,,, LOCAL INFLAMM PROCESS WB,78806,CPT ,,Both,,,4274,,,,,,,,,, LOCAL INFLAMM PROCESS SPECT,78807,CPT ,,Both,,,4352,,,,,,,,,, UNLISTED NUC MED PROC,78999,CPT ,,Both,,,1425,,,,,,,,,, BASIC METABOLIC PANEL CALCIUM IONIZED,80047,CPT ,,Both,,,1554,,,,,,,,,, BASIC METABOLIC PANEL CALCIUM TOTAL,80048,CPT ,,Both,,,1430,,,,,,,,,, ELECTROLYTE PANEL,80051,CPT ,,Both,,,540,,,,,,,,,, COMPREHENSIVE METABOLIC PANEL,80053,CPT ,,Both,,,1794,,,,,,,,,, LIPID PANEL,80061,CPT ,,Both,,,1512,,,,,,,,,, RENAL FUNCTION PANEL,80069,CPT ,,Both,,,149,,,,,,,,,, ACUTE HEPATITIS PANEL,80074,CPT ,,Both,,,1440,,,,,,,,,, HEPATIC FUNCTION PANEL,80076,CPT ,,Both,,,1458,,,,,,,,,, Drug Screen Only - Non-DOT,80100,CPT ,,Both,,,342,,,,,,,,,, DRUG SCREEN BLOOD,80101,CPT ,,Both,,,246,,,,,,,,,, "Drug confirmation, each procedure",80102,CPT ,,Both,,,276,,,,,,,,,, THERAPEUTIC DRUG ASSAYS,80143,CPT ,,Both,,,1020,,,,,,,,,, AMIKACIN LEVEL,80150,CPT ,,Both,,,259,,,,,,,,,, CARBAMAZEPINE (TEGRETOL),80156,CPT ,,Both,,,327,,,,,,,,,, CYCLOSPORINE LEVEL,80158,CPT ,,Both,,,310,,,,,,,,,, DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL,80162,CPT ,,Both,,,780,,,,,,,,,, DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL,80164,CPT ,,Both,,,960,,,,,,,,,, DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE,80165,CPT ,,Both,,,1140,,,,,,,,,, DOXEPIN (SINEQUAN),80166,CPT ,,Both,,,266,,,,,,,,,, GENTAMICIN LEVEL TROUGH,80170,CPT ,,Both,,,495,,,,,,,,,, IMPRAMINE,80174,CPT ,,Both,,,296,,,,,,,,,, LIDOCAINE,80176,CPT ,,Both,,,252,,,,,,,,,, LITHIUM,80178,CPT ,,Both,,,114,,,,,,,,,, Therapeutic Drug Assays,80179,CPT ,,Both,,,1020,,,,,,,,,, NORTRIPTYLINE,80182,CPT ,,Both,,,233,,,,,,,,,, PHENOBARBITAL (LUMINAL),80184,CPT ,,Both,,,197,,,,,,,,,, PHENYTOIN (DILANTIN),80185,CPT ,,Both,,,243,,,,,,,,,, PRIMIDONE (MYSOLINE),80188,CPT ,,Both,,,285,,,,,,,,,, N-ACETYL PROCAINAMIDE,80192,CPT ,,Both,,,288,,,,,,,,,, QUINIDINE LEVEL,80194,CPT ,,Both,,,251,,,,,,,,,, SALICYLATE,80196,CPT ,,Both,,,167,,,,,,,,,, PROGRAF (TACROLIMUS) LEVEL,80197,CPT ,,Both,,,521,,,,,,,,,, THEOPHYLLINE (AMNIOPHYLLIN,80198,CPT ,,Both,,,459,,,,,,,,,, TOBRAMYCIN PEAK,80200,CPT ,,Both,,,277,,,,,,,,,, VANCOMYCIN PEAK,80202,CPT ,,Both,,,1765,,,,,,,,,, QUANTITATION DRUG NOT ELSEWHERE SPECIFIED,80299,CPT ,,Both,,,1020,,,,,,,,,, Drug Screen Class A direct optical observation,80300,CPT ,,Both,,,342,,,,,,,,,, DRUG TEST PRSMV QUAL DIR OPTICAL OBS PER DAY,80305,CPT ,,Both,,,493,,,,,,,,,, DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS,80307,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREEN QUANTITATIVE ALCOHOLS,80320,CPT ,,Both,,,684,,,,,,,,,, DRUG SCREEN QUANT AMPHETAMINES 1 OR 2,80324,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2,80329,CPT ,,Both,,,684,,,,,,,,,, ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2,80335,CPT ,,Both,,,310,,,,,,,,,, DRUG SCREENING BARBITURATES,80345,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING BENZODIAZEPINES 1-12,80346,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING BENZODIAZEPINES 13 OR MORE,80347,CPT ,,Both,,,630,,,,,,,,,, DRUG SCREENING BUPRENORPHINE,80348,CPT ,,Both,,,630,,,,,,,,,, DRUG SCREENING CANNABINOIDS NATURAL,80349,CPT ,,Both,,,480,,,,,,,,,, DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6,80351,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE,80352,CPT ,,Both,,,204,,,,,,,,,, DRUG SCREENING COCAINE,80353,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING HEROIN METABOLITE,80356,CPT ,,Both,,,138,,,,,,,,,, DRUG SCREENING METHADONE,80358,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING METHYLENEDIOXYAMPHETAMINES,80359,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING OPIATES 1 OR MORE,80361,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2,80362,CPT ,,Both,,,684,,,,,,,,,, DRUG SCREENING OXYCODONE,80365,CPT ,,Both,,,756,,,,,,,,,, DRUG SCREENING PREGABALIN,80366,CPT ,,Both,,,342,,,,,,,,,, DRUG SCREENING PROPOXYPHENE,80367,CPT ,,Both,,,276,,,,,,,,,, DRUG SCREENING TRAMADOL,80373,CPT ,,Both,,,684,,,,,,,,,, DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS,80374,CPT ,,Both,,,684,,,,,,,,,, URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY,81000,CPT ,,Both,,,510,,,,,,,,,, URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY,81001,CPT ,,Both,,,690,,,,,,,,,, URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP,81002,CPT ,,Both,,,300,,,,,,,,,, URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY,81003,CPT ,,Both,,,545,,,,,,,,,, REDUCING SUBSTANCE URINE,81005,CPT ,,Both,,,37,,,,,,,,,, URINE SCREEN FOR BACTERIA,81007,CPT ,,Both,,,350,,,,,,,,,, MICROSCOPIC EXAM OF URINE,81015,CPT ,,Both,,,124,,,,,,,,,, URINALYSIS GLASS TEST,81020,CPT ,,Both,,,63,,,,,,,,,, URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,81025,CPT ,,Both,,,684,,,,,,,,,, TIMED VOLUME MEASUREMENT,81050,CPT ,,Both,,,52,,,,,,,,,, ACETAMINOPHEN,82003,CPT ,,Both,,,348,,,,,,,,,, KETONE SERUM,82009,CPT ,,Both,,,196,,,,,,,,,, KETONE BODIES SERUM QUANTITATIVE,82010,CPT ,,Both,,,382,,,,,,,,,, ACETYLCHOLINESTERASE,82013,CPT ,,Both,,,121,,,,,,,,,, ACTH,82024,CPT ,,Both,,,664,,,,,,,,,, ALBUMIN SERUM PLASMA/WHOLE BLOOD,82040,CPT ,,Both,,,204,,,,,,,,,, ALBUMIN FLUID,82042,CPT ,,Both,,,89,,,,,,,,,, MICROALBUMIN URINE,82043,CPT ,,Both,,,96,,,,,,,,,, "MICROALBUMIN, URINE, SEMIQUANTITATIVE ASSAY",82044,CPT ,,Both,,,79,,,,,,,,,, ALCOHOL BLOOD,82055,CPT ,,Both,,,186,,,,,,,,,, ASSAY OF ALCOHOL BREATH,82075,CPT ,,Both,,,600,,,,,,,,,, Measurement of alcohol level in specimen other than breath or urine,82077,CPT ,,Both,,,780,,,,,,,,,, ALDOLASE,82085,CPT ,,Both,,,167,,,,,,,,,, ALDOSTERONE,82088,CPT ,,Both,,,700,,,,,,,,,, ALPHA-1-ANTITRYPSIN;PHE,82104,CPT ,,Both,,,249,,,,,,,,,, ALPHA-FETOPROTEIN SERUM,82105,CPT ,,Both,,,288,,,,,,,,,, "AMINES, VAGINAL FLUID, QUALITATIVE",82120,CPT ,,Both,,,65,,,,,,,,,, ASSAY OF AMMONIA,82140,CPT ,,Both,,,1020,,,,,,,,,, ASSAY OF AMYLASE,82150,CPT ,,Both,,,572,,,,,,,,,, ANGIOTENSION II,82163,CPT ,,Both,,,150,,,,,,,,,, ANGIOTENSIN CONV ENZYME,82164,CPT ,,Both,,,251,,,,,,,,,, BETA 2 MICROGLOBULIN,82232,CPT ,,Both,,,278,,,,,,,,,, BILIRUBIN TOTAL,82247,CPT ,,Both,,,366,,,,,,,,,, BILIRUBIN DIRECT,82248,CPT ,,Both,,,450,,,,,,,,,, BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER,82270,CPT ,,Both,,,1512,,,,,,,,,, GASTROCULT (POC),82271,CPT ,,Both,,,349,,,,,,,,,, BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC,82272,CPT ,,Both,,,1512,,,,,,,,,, ASSAY TEST FOR BLOOD FECAL,82274,CPT ,,Both,,,273,,,,,,,,,, CADMIUM,82300,CPT ,,Both,,,398,,,,,,,,,, 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,82306,CPT ,,Both,,,1020,,,,,,,,,, CALCITONIN,82308,CPT ,,Both,,,460,,,,,,,,,, CALCIUM TOTAL,82310,CPT ,,Both,,,504,,,,,,,,,, CALCIUM IONIZED,82330,CPT ,,Both,,,504,,,,,,,,,, CALCIUM 24HR URINE,82340,CPT ,,Both,,,104,,,,,,,,,, STONE ANALYSIS QUAN,82360,CPT ,,Both,,,221,,,,,,,,,, CARBON DIOXIDE BICARBONATE,82374,CPT ,,Both,,,360,,,,,,,,,, CARBOXYHEMOGLOBIN,82375,CPT ,,Both,,,212,,,,,,,,,, CARBON MONOXIDE TEST,82376,CPT ,,Both,,,103,,,,,,,,,, CEA,82378,CPT ,,Both,,,326,,,,,,,,,, CATECHOLAMINES TOTAL URIN,82382,CPT ,,Both,,,296,,,,,,,,,, CATECHOLAMINES BLOOD,82383,CPT ,,Both,,,431,,,,,,,,,, CERULOPLASMIN,82390,CPT ,,Both,,,185,,,,,,,,,, CHLORIDE BLD,82435,CPT ,,Both,,,335,,,,,,,,,, CHLORIDE RANDOM URINE,82436,CPT ,,Both,,,86,,,,,,,,,, CHOLESTEROL SERUM/WHOLE BLOOD TOTAL,82465,CPT ,,Both,,,540,,,,,,,,,, "CHOLINESTERASE,SERUM",82480,CPT ,,Both,,,135,,,,,,,,,, "CHOLINESTERASE,RBC",82482,CPT ,,Both,,,132,,,,,,,,,, GABAPENTIN (NEURONTIN),82491,CPT ,,Both,,,310,,,,,,,,,, CHROMIUM,82495,CPT ,,Both,,,349,,,,,,,,,, CITRATE,82507,CPT ,,Both,,,478,,,,,,,,,, COLLAGEN CROSSLINKS,82523,CPT ,,Both,,,322,,,,,,,,,, COPPER,82525,CPT ,,Both,,,213,,,,,,,,,, CORTISOL 24HR URINE,82530,CPT ,,Both,,,287,,,,,,,,,, CORTISOL TOTAL,82533,CPT ,,Both,,,408,,,,,,,,,, CREATINE KINASE TOTAL,82550,CPT ,,Both,,,468,,,,,,,,,, CREATINE KINASE MB FRACTION ONLY,82553,CPT ,,Both,,,780,,,,,,,,,, CREATININE BLOOD,82565,CPT ,,Both,,,468,,,,,,,,,, CREATININE URINE RANDOM,82570,CPT ,,Both,,,136,,,,,,,,,, CREATININE CLEARANCE,82575,CPT ,,Both,,,162,,,,,,,,,, CRYOGLOBULIN,82595,CPT ,,Both,,,111,,,,,,,,,, VITAMIN B 12,82607,CPT ,,Both,,,281,,,,,,,,,, CYSTATIN C,82610,CPT ,,Both,,,234,,,,,,,,,, DHEA,82626,CPT ,,Both,,,434,,,,,,,,,, DOC (DEOXYCORT 11-),82634,CPT ,,Both,,,356,,,,,,,,,, ASSAY OF ERYTHROPOIETIN,82668,CPT ,,Both,,,780,,,,,,,,,, ESTRADIOL,82670,CPT ,,Both,,,480,,,,,,,,,, ESTRIOL,82677,CPT ,,Both,,,416,,,,,,,,,, ESTRONE ASSAY,82679,CPT ,,Both,,,429,,,,,,,,,, FECAL FAT SCREEN,82705,CPT ,,Both,,,87,,,,,,,,,, ASSAY OF FERRITIN,82728,CPT ,,Both,,,660,,,,,,,,,, LD - FETAL FIBRONECTIN,82731,CPT ,,Both,,,1107,,,,,,,,,, FOLATE SERUM,82746,CPT ,,Both,,,253,,,,,,,,,, ASSAY OF FOLIC ACID RBC,82747,CPT ,,Both,,,358,,,,,,,,,, ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH,82784,CPT ,,Both,,,810,,,,,,,,,, IMMUNOGLOBULIN E,82785,CPT ,,Both,,,283,,,,,,,,,, "Gases, blood, pH only",82800,CPT ,,Both,,,193,,,,,,,,,, BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3,82803,CPT ,,Both,,,649,,,,,,,,,, BLOOD GASES W/O2 SATURATION,82805,CPT ,,Both,,,426,,,,,,,,,, BLD GASES O2 SAT ONLY,82810,CPT ,,Both,,,150,,,,,,,,,, Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen),82820,CPT ,,Both,,,172,,,,,,,,,, GASTRIN,82941,CPT ,,Both,,,303,,,,,,,,,, GLUCOSE BODY FLUID OTHER THAN BLOOD,82945,CPT ,,Both,,,474,,,,,,,,,, GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,82947,CPT ,,Both,,,276,,,,,,,,,, GLUCOSE BLOOD REAGENT STRIP,82948,CPT ,,Both,,,684,,,,,,,,,, GLUCOSE 1HR PC/50G,82950,CPT ,,Both,,,82,,,,,,,,,, GLUCOSE TOL 2HR,82951,CPT ,,Both,,,221,,,,,,,,,, GLUCOSE TOL 4TH HR ONLY,82952,CPT ,,Both,,,67,,,,,,,,,, GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE,82962,CPT ,,Both,,,283,,,,,,,,,, ASSAY OF GLUTAMYLTRASE GAMMA,82977,CPT ,,Both,,,600,,,,,,,,,, GLYCATED PROTEIN,82985,CPT ,,Both,,,260,,,,,,,,,, FSH,83001,CPT ,,Both,,,319,,,,,,,,,, LUTEINIZING HORMONE,83002,CPT ,,Both,,,319,,,,,,,,,, GROWTH HORMONE (HGH),83003,CPT ,,Both,,,287,,,,,,,,,, HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE,83009,CPT ,,Both,,,1157,,,,,,,,,, HAPTOGLOBIN QUANT,83010,CPT ,,Both,,,216,,,,,,,,,, HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE,83013,CPT ,,Both,,,684,,,,,,,,,, HEAVY METAL SCREEN,83015,CPT ,,Both,,,324,,,,,,,,,, HGB ELECT,83020,CPT ,,Both,,,252,,,,,,,,,, HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT ,,Both,,,310,,,,,,,,,, HEMOGLOBIN GLYCOSYLATED A1C,83036,CPT ,,Both,,,330,,,,,,,,,, "A1C HEMOGLOBIN, GLYCOSYLATED, HOME DEVICE",83037,CPT ,,Both,,,167,,,,,,,,,, METHEMOGLOBIN,83050,CPT ,,Both,,,51,,,,,,,,,, HYDROXYINDOLACETIC 5-HIAA,83497,CPT ,,Both,,,80,,,,,,,,,, HYDROXYPROGESTERONE 17-D,83498,CPT ,,Both,,,467,,,,,,,,,, MYELOPEROXIDASE (MPO) ANTIBODS,83516,CPT ,,Both,,,198,,,,,,,,,, "IMMUNOASSAY ANALYSIS, QUAL/SEMI-QUANT, SINGLE-STEP",83518,CPT ,,Both,,,146,,,,,,,,,, GLUTAMIC ACID DECARBOXYLASE,83519,CPT ,,Both,,,232,,,,,,,,,, CELIAC DISEASE ANTIBOD,83520,CPT ,,Both,,,226,,,,,,,,,, ASSAY OF INSULIN TOTAL,83525,CPT ,,Both,,,342,,,,,,,,,, ASSAY OF IRON,83540,CPT ,,Both,,,1020,,,,,,,,,, IRON BINDING CAPACITY,83550,CPT ,,Both,,,300,,,,,,,,,, ASSAY OF LACTATE,83605,CPT ,,Both,,,570,,,,,,,,,, LACTATE DEHYDROGENASE LDH,83615,CPT ,,Both,,,600,,,,,,,,,, LDH ISOENZYMES,83625,CPT ,,Both,,,220,,,,,,,,,, LEAD ASSAY,83655,CPT ,,Both,,,208,,,,,,,,,, ASSAY OF LIPASE,83690,CPT ,,Both,,,556,,,,,,,,,, LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL,83718,CPT ,,Both,,,420,,,,,,,,,, "LDL CHOLESTEROL, LIPOPROTEIN ASSAY",83721,CPT ,,Both,,,164,,,,,,,,,, ASSAY OF MAGNESIUM,83735,CPT ,,Both,,,600,,,,,,,,,, METANEPHRINES,83835,CPT ,,Both,,,780,,,,,,,,,, METHADONE,83840,CPT ,,Both,,,281,,,,,,,,,, "MICROFLUID ANALYSIS, TEARS",83861,CPT ,,Both,,,284,,,,,,,,,, MUCIN SYNOVIAL FLUID,83872,CPT ,,Both,,,101,,,,,,,,,, MYELIN BASIC PROTEIN CSF,83873,CPT ,,Both,,,296,,,,,,,,,, MYOGLOBIN,83874,CPT ,,Both,,,780,,,,,,,,,, NATRIURETIC PEPTIDE,83880,CPT ,,Both,,,1056,,,,,,,,,, CSF ALBUMIN,83883,CPT ,,Both,,,234,,,,,,,,,, OLIGOCLONAL BANDS,83916,CPT ,,Both,,,346,,,,,,,,,, METHYLMALONIC ACID URINE QUANT,83921,CPT ,,Both,,,283,,,,,,,,,, FENTANYL AND METABOLITE,83925,CPT ,,Both,,,334,,,,,,,,,, OSMOLALITY BLOOD,83930,CPT ,,Both,,,159,,,,,,,,,, OSMOLALITY URINE,83935,CPT ,,Both,,,170,,,,,,,,,, OXALATE 24 HR URINE,83945,CPT ,,Both,,,221,,,,,,,,,, PARATHYROID HORMONE,83970,CPT ,,Both,,,709,,,,,,,,,, "PH ASSAY, BODY FLUID, NOS",83986,CPT ,,Both,,,62,,,,,,,,,, ASSAY OF PHENCYCLIDINE,83992,CPT ,,Both,,,540,,,,,,,,,, PKU BLOOD,84030,CPT ,,Both,,,95,,,,,,,,,, PROSTATIC ACID PHOSPHATAS,84066,CPT ,,Both,,,166,,,,,,,,,, ASSAY OF PHOSPHATASE ALKALINE,84075,CPT ,,Both,,,306,,,,,,,,,, ALKALINE PHOS ISOENZYME,84080,CPT ,,Both,,,150,,,,,,,,,, ASSAY OF PHOSPHORUS INORGANIC,84100,CPT ,,Both,,,292,,,,,,,,,, PHOSPHORUS 24HR URINE,84105,CPT ,,Both,,,89,,,,,,,,,, PORPHOB. URINE(QUANT),84110,CPT ,,Both,,,145,,,,,,,,,, PORPHYRIN URINE QUANT,84120,CPT ,,Both,,,253,,,,,,,,,, POTASSIUM SERUM PLASMA/WHOLE BLOOD,84132,CPT ,,Both,,,300,,,,,,,,,, POTASSIUM RANDOM URINE,84133,CPT ,,Both,,,74,,,,,,,,,, PREALBUMIN,84134,CPT ,,Both,,,171,,,,,,,,,, HYDROXYPREGNENOLONE-17,84143,CPT ,,Both,,,387,,,,,,,,,, PROGESTERONE,84144,CPT ,,Both,,,359,,,,,,,,,, PROCALCITONIN (PCT),84145,CPT ,,Both,,,1020,,,,,,,,,, PROLACTIN,84146,CPT ,,Both,,,754,,,,,,,,,, ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,84153,CPT ,,Both,,,650,,,,,,,,,, PSA FREE,84154,CPT ,,Both,,,316,,,,,,,,,, PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD,84155,CPT ,,Both,,,347,,,,,,,,,, PROTEIN RANDOM URINE,84156,CPT ,,Both,,,63,,,,,,,,,, PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC,84157,CPT ,,Both,,,524,,,,,,,,,, PROTEIN PHORESIS SERUM,84165,CPT ,,Both,,,252,,,,,,,,,, PROTEIN PHORESIS URINE,84166,CPT ,,Both,,,252,,,,,,,,,, PROINSULIN,84206,CPT ,,Both,,,306,,,,,,,,,, "ESTROGEN ASSAY, ESTROGEN",84233,CPT ,,Both,,,1107,,,,,,,,,, ACETYLCHOLINE RECEPTOR BINDING,84238,CPT ,,Both,,,628,,,,,,,,,, RENIN,84244,CPT ,,Both,,,378,,,,,,,,,, SELENIUM,84255,CPT ,,Both,,,439,,,,,,,,,, SEROTONIN,84260,CPT ,,Both,,,299,,,,,,,,,, SODIUM SERUM PLASMA OR WHOLE BLOOD,84295,CPT ,,Both,,,240,,,,,,,,,, SODIUM RANDOM URINE,84300,CPT ,,Both,,,346,,,,,,,,,, INSULIN LK GRWTH FAC 1 (IGF-1),84305,CPT ,,Both,,,365,,,,,,,,,, SPECIFIC GRAVITY-OTHER,84315,CPT ,,Both,,,43,,,,,,,,,, TESTOSTERONE FREE,84402,CPT ,,Both,,,438,,,,,,,,,, TESTOSTERONE TOTAL,84403,CPT ,,Both,,,444,,,,,,,,,, THYROGLOBULIN,84432,CPT ,,Both,,,276,,,,,,,,,, ASSAY OF THYROXINE TOTAL,84436,CPT ,,Both,,,438,,,,,,,,,, ASSAY OF FREE THYROXINE,84439,CPT ,,Both,,,538,,,,,,,,,, ASSAY OF THYROID STIMULATING HORMONE TSH,84443,CPT ,,Both,,,774,,,,,,,,,, TRANSFERASE ASPARTATE AMINO AST SGOT,84450,CPT ,,Both,,,356,,,,,,,,,, TRANSFERASE ALANINE AMINO ALT SGPT,84460,CPT ,,Both,,,300,,,,,,,,,, ASSAY OF L7383TRANSFERRIN,84466,CPT ,,Both,,,360,,,,,,,,,, ASSAY OF TRIGLYCERIDES,84478,CPT ,,Both,,,858,,,,,,,,,, THYROID HORM UPTK/THYROID HORMONE BINDING RATIO,84479,CPT ,,Both,,,402,,,,,,,,,, ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3,84480,CPT ,,Both,,,684,,,,,,,,,, ASSAY OF TRIIODOTHYRONINE T3 FREE,84481,CPT ,,Both,,,570,,,,,,,,,, T-3 REVERSE,84482,CPT ,,Both,,,275,,,,,,,,,, ASSAY OF TROPONIN QUANTITATIVE,84484,CPT ,,Both,,,1055,,,,,,,,,, ASSAY OF TROPONIN QUALITATIVE,84512,CPT ,,Both,,,408,,,,,,,,,, ASSAY OF UREA NITROGEN QUANTITATIVE,84520,CPT ,,Both,,,431,,,,,,,,,, UREA NITROGEN 24HR URINE,84540,CPT ,,Both,,,82,,,,,,,,,, ASSAY OF BLOOD/URIC ACID,84550,CPT ,,Both,,,684,,,,,,,,,, ASSAY OF URIC ACID OTHER SOURCE,84560,CPT ,,Both,,,540,,,,,,,,,, URINE VANILYMANDELIC ACID,84585,CPT ,,Both,,,266,,,,,,,,,, VASOACT INTES PEPTIDE-VIP,84586,CPT ,,Both,,,240,,,,,,,,,, C PEPTIDE,84681,CPT ,,Both,,,358,,,,,,,,,, GONADOTROPIN CHORIONIC QUANTITATIVE,84702,CPT ,,Both,,,1176,,,,,,,,,, GONADOTROPIN CHORIONIC QUALITATIVE,84703,CPT ,,Both,,,1020,,,,,,,,,, BLEEDING TIME,85002,CPT ,,Both,,,77,,,,,,,,,, WBC DIFF ONLY,85007,CPT ,,Both,,,269,,,,,,,,,, HEMATOCRIT,85014,CPT ,,Both,,,151,,,,,,,,,, HEMOGLOBIN (HGB),85018,CPT ,,Both,,,151,,,,,,,,,, BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC,85025,CPT ,,Both,,,1512,,,,,,,,,, BLOOD COUNT COMPLETE AUTOMATED,85027,CPT ,,Both,,,408,,,,,,,,,, MANUAL CELL COUNT EACH,85032,CPT ,,Both,,,227,,,,,,,,,, RETICULOCYTE COUNT,85044,CPT ,,Both,,,149,,,,,,,,,, BLOOD COUNT RETICULOCYTE AUTOMATED,85045,CPT ,,Both,,,1512,,,,,,,,,, "Red blood count automated, with additional calculations",85046,CPT ,,Both,,,1020,,,,,,,,,, WBC COUNT ONLY,85048,CPT ,,Both,,,268,,,,,,,,,, BLOOD COUNT PLATELET AUTOMATED,85049,CPT ,,Both,,,1020,,,,,,,,,, BONE MARROW INTER ONLY,85097,CPT ,,Both,,,1079,,,,,,,,,, LUPUS ANTICOAGULANT S,85210,CPT ,,Both,,,223,,,,,,,,,, FACTOR VII PROCONVERTIN,85230,CPT ,,Both,,,308,,,,,,,,,, FACTOR VIII CLOT;ANTIGEN,85244,CPT ,,Both,,,351,,,,,,,,,, FACTOR VIII RISTOCETIN COFACT,85245,CPT ,,Both,,,141,,,,,,,,,, FACTOR VIII VW FACTOR ANTIGEN,85246,CPT ,,Both,,,141,,,,,,,,,, VONWILLEBRAND FACT MULTIM ANAL,85247,CPT ,,Both,,,141,,,,,,,,,, ANTITHROMBIN III;ACTIVITY,85300,CPT ,,Both,,,204,,,,,,,,,, PROTEIN C ANTIGEN,85302,CPT ,,Both,,,207,,,,,,,,,, PROTEIN C ACTIVITY,85303,CPT ,,Both,,,238,,,,,,,,,, PROTEIN S TOTAL,85305,CPT ,,Both,,,199,,,,,,,,,, PROTEIN S ACTIVITY,85306,CPT ,,Both,,,237,,,,,,,,,, COAGULATION TIME,85345,CPT ,,Both,,,74,,,,,,,,,, COAGULATION TIME: ACTIV,85347,CPT ,,Both,,,73,,,,,,,,,, FDP,85362,CPT ,,Both,,,118,,,,,,,,,, D-DIMER,85378,CPT ,,Both,,,224,,,,,,,,,, FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE,85379,CPT ,,Both,,,1050,,,,,,,,,, FIBRINOGEN ACTIVITY,85384,CPT ,,Both,,,228,,,,,,,,,, KLEIHAUER-BETKE,85460,CPT ,,Both,,,133,,,,,,,,,, FETAL SCREEN ROSETTE,85461,CPT ,,Both,,,114,,,,,,,,,, "IRON STAIN, BONE MARROW",85536,CPT ,,Both,,,111,,,,,,,,,, LEUKOCYTE ALKALINE PHOS.,85540,CPT ,,Both,,,148,,,,,,,,,, PLATELET FUNCTION ASSAY #2,85576,CPT ,,Both,,,252,,,,,,,,,, HEX PHOSPHOLIPID NEUTRALIZTION,85597,CPT ,,Both,,,249,,,,,,,,,, PROTHROMBIN TIME,85610,CPT ,,Both,,,934,,,,,,,,,, RUSS VIPER VENOM TIME DIL,85613,CPT ,,Both,,,124,,,,,,,,,, SEDIMENTATION RATE RBC NON-AUTOMATED,85651,CPT ,,Both,,,684,,,,,,,,,, SEDIMENTATION RATE RBC AUTOMATED,85652,CPT ,,Both,,,168,,,,,,,,,, RBC SICKLE CELL TEST,85660,CPT ,,Both,,,95,,,,,,,,,, THROMBIN TIME PLASMA,85670,CPT ,,Both,,,1020,,,,,,,,,, THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,85730,CPT ,,Both,,,359,,,,,,,,,, PTT FRACTIONATED,85732,CPT ,,Both,,,111,,,,,,,,,, ROCKY MTN SPOTTED FEVER,86000,CPT ,,Both,,,120,,,,,,,,,, ALLERGY BERMUDA,86003,CPT ,,Both,,,82,,,,,,,,,, ALLERG SCR FOOD,86005,CPT ,,Both,,,137,,,,,,,,,, P-ANCA (MYELOPEROXIDASE AB),86021,CPT ,,Both,,,259,,,,,,,,,, PLATELET ANTIBODY PANEL,86022,CPT ,,Both,,,168,,,,,,,,,, ANTINUCLEAR ANTIBODIES ANA,86038,CPT ,,Both,,,411,,,,,,,,,, ANTINUCLEAR ANTIBODIES ANA TITER,86039,CPT ,,Both,,,521,,,,,,,,,, ANTISTREPTOLYSIN O TITER,86060,CPT ,,Both,,,186,,,,,,,,,, TRANSFUSN REACTION INVESTIGATN,86078,CPT ,,Both,,,674,,,,,,,,,, C-REACTIVE PROTEIN,86140,CPT ,,Both,,,504,,,,,,,,,, CRP ULTRASENSITIVE,86141,CPT ,,Both,,,230,,,,,,,,,, CARDIOLIPIN ANTIBODY,86147,CPT ,,Both,,,135,,,,,,,,,, C1 ESTERASE INHIBITOR,86160,CPT ,,Both,,,206,,,,,,,,,, COMPLEMENT C4,86161,CPT ,,Both,,,206,,,,,,,,,, COMPLEMENT TOTAL (CH 50),86162,CPT ,,Both,,,323,,,,,,,,,, CYCLIC CITRULLINATED PEPTIDE ANTIBODY,86200,CPT ,,Both,,,850,,,,,,,,,, DNA ANTIBODIES NATIVE,86225,CPT ,,Both,,,236,,,,,,,,,, DNA ANTIBODY SINGLE,86226,CPT ,,Both,,,208,,,,,,,,,, EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD,86235,CPT ,,Both,,,684,,,,,,,,,, ANTIBODY RETICULIN IGA,86255,CPT ,,Both,,,446,,,,,,,,,, ANTIBODY MYOCARDIAL TITER,86256,CPT ,,Both,,,239,,,,,,,,,, "IMMUNOASSAY TUMOR ANTIGEN, QUAL",86294,CPT ,,Both,,,337,,,,,,,,,, CA 27-29,86300,CPT ,,Both,,,358,,,,,,,,,, CA-19-9,86301,CPT ,,Both,,,358,,,,,,,,,, CA-125,86304,CPT ,,Both,,,358,,,,,,,,,, HUMAN EPIDIDYMIS PROTEIN 4 (HE4),86305,CPT ,,Both,,,850,,,,,,,,,, HETEROPHILE ANTIBODIES SCREEN,86308,CPT ,,Both,,,524,,,,,,,,,, CHROMOGRANIN A,86316,CPT ,,Both,,,358,,,,,,,,,, "IMMUNOASSAY INFECTIOUS ANTIGEN, QUAL/SEMI-QUANT, SINGLE",86318,CPT ,,Both,,,223,,,,,,,,,, IMMUNOELECTROPHORESIS,86320,CPT ,,Both,,,231,,,,,,,,,, IGG SYNTHSIS & INDEX,86325,CPT ,,Both,,,228,,,,,,,,,, "Immunoassay for infectious agent antibody(ies), qualitative or semi-quantitative",86328,CPT ,,Both,,,360,,,,,,,,,, IMMUNOFIXATION ELECTROPHO,86334,CPT ,,Both,,,247,,,,,,,,,, ANTIBODY INTRINSIC FACTOR,86340,CPT ,,Both,,,259,,,,,,,,,, T CELL HELPER/SUPPRESSOR,86360,CPT ,,Both,,,807,,,,,,,,,, MICROSOMAL ANTIBODIES EACH,86376,CPT ,,Both,,,850,,,,,,,,,, "NUCLEAR MATRIX PROTEIN 22 (NMP22), QUAL",86386,CPT ,,Both,,,274,,,,,,,,,, H. INFLU GP.B ANTIGEN EIA,86403,CPT ,,Both,,,198,,,,,,,,,, Quantitative Of SARS-CoV2antibodies,86413,CPT ,,Both,,,200,,,,,,,,,, RA LATEX QUAL,86430,CPT ,,Both,,,110,,,,,,,,,, RHEUMATOID FACTOR QUANTITATIVE,86431,CPT ,,Both,,,307,,,,,,,,,, TB INTRADERMAL TEST,86580,CPT ,,Both,,,102,,,,,,,,,, SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL,86592,CPT ,,Both,,,384,,,,,,,,,, SYPHILIS TEST QUANTITATIVE,86593,CPT ,,Both,,,756,,,,,,,,,, ADENOVIRUS ANTIBODY,86603,CPT ,,Both,,,141,,,,,,,,,, BARTONELLA HENSALAE/QUINTANA,86611,CPT ,,Both,,,141,,,,,,,,,, Antibody,86617,CPT ,,Both,,,300,,,,,,,,,, LYME DISEASE (BORRELIA BUGDORFERI) ANTIBODY,86618,CPT ,,Both,,,293,,,,,,,,,, CHLAMYDIA ANTIBODY,86631,CPT ,,Both,,,194,,,,,,,,,, ANTIBODY COCCIDIOIDES,86635,CPT ,,Both,,,360,,,,,,,,,, ANTIBODY CRYPTOCOCCUS,86641,CPT ,,Both,,,141,,,,,,,,,, CYTOMEGALO IGG,86644,CPT ,,Both,,,347,,,,,,,,,, COXSACKIE A VIRAL TITER,86658,CPT ,,Both,,,141,,,,,,,,,, EPSTEIN BARR (EA),86663,CPT ,,Both,,,365,,,,,,,,,, ANTIBODY EPSTEIN BARR (EBNA),86664,CPT ,,Both,,,300,,,,,,,,,, ANTIBODY EPSTEIN BARR VCA,86665,CPT ,,Both,,,322,,,,,,,,,, ANTIBODY HELICOBACTER PYLORI,86677,CPT ,,Both,,,684,,,,,,,,,, ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86689,CPT ,,Both,,,465,,,,,,,,,, ANTIBODY HERPES SMPLX TYPE 1,86695,CPT ,,Both,,,408,,,,,,,,,, ANTIBODY HERPES SMPLX TYPE 2,86696,CPT ,,Both,,,480,,,,,,,,,, ANTIBODY HIV-1,86701,CPT ,,Both,,,503,,,,,,,,,, ANTIBODY HIV-2,86702,CPT ,,Both,,,690,,,,,,,,,, HEP B CORE ANTIBODY TOTAL,86704,CPT ,,Both,,,181,,,,,,,,,, HEP B CORE ANTIBODY IGM,86705,CPT ,,Both,,,190,,,,,,,,,, HEPATITIS B SURF ANTIBODY,86706,CPT ,,Both,,,299,,,,,,,,,, HEPATITIS A ANTIBODY IGG,86708,CPT ,,Both,,,213,,,,,,,,,, HEP A ANTIBODY IGM,86709,CPT ,,Both,,,208,,,,,,,,,, PARAINFLUENZA TYPE 1,86710,CPT ,,Both,,,233,,,,,,,,,, LEGIONELLA ANTIBODY,86713,CPT ,,Both,,,263,,,,,,,,,, ANTIBODY MUMPS,86735,CPT ,,Both,,,720,,,,,,,,,, MYCOPLASMA PNEU IGG,86738,CPT ,,Both,,,228,,,,,,,,,, RESPIRATORY SYNCYTIAL VIRU,86756,CPT ,,Both,,,345,,,,,,,,,, ANTIBODY RICKETTSIA,86757,CPT ,,Both,,,1020,,,,,,,,,, ROTAVIRUS,86759,CPT ,,Both,,,227,,,,,,,,,, ANTIBODY RUBELLA,86762,CPT ,,Both,,,480,,,,,,,,,, ANTIBODY RUBEOLA,86765,CPT ,,Both,,,600,,,,,,,,,, Antibody; severe acute respiratory syndrome coronavirus 2,86769,CPT ,,Both,,,1020,,,,,,,,,, TOXOPLASMA IGG,86777,CPT ,,Both,,,247,,,,,,,,,, ANTIBODY TREPONEMA PALLIDUM,86780,CPT ,,Both,,,650,,,,,,,,,, ANTIBODY VARICELLA-ZOSTER,86787,CPT ,,Both,,,300,,,,,,,,,, WEST NILE VIRUS AB IGM,86788,CPT ,,Both,,,319,,,,,,,,,, RABIES ANTIBODY,86790,CPT ,,Both,,,171,,,,,,,,,, THYROGLOBULIN ANTIBODY,86800,CPT ,,Both,,,850,,,,,,,,,, HEPATITIS C ANTIBODY,86803,CPT ,,Both,,,245,,,,,,,,,, HEPATITIS C RIBA,86804,CPT ,,Both,,,266,,,,,,,,,, HLA B27,86812,CPT ,,Both,,,444,,,,,,,,,, ANTIBODY SCREEN RBC,86850,CPT ,,Both,,,282,,,,,,,,,, ANTIBODY ELUTION,86860,CPT ,,Both,,,412,,,,,,,,,, ANTIBODY ID,86870,CPT ,,Both,,,153,,,,,,,,,, CORD BLOOD STUDIES,86880,CPT ,,Both,,,219,,,,,,,,,, ANTIBODY TITER,86886,CPT ,,Both,,,89,,,,,,,,,, AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT ,,Both,,,225,,,,,,,,,, BLOOD TYPING SEROLOGIC ABO,86900,CPT ,,Both,,,1020,,,,,,,,,, BLOOD TYPING SEROLOGIC RH (D),86901,CPT ,,Both,,,1020,,,,,,,,,, ANTIGEN TYPING W/AHG,86905,CPT ,,Both,,,66,,,,,,,,,, RH PHENOTYPING,86906,CPT ,,Both,,,194,,,,,,,,,, CROSSMATCH 1 UNIT,86920,CPT ,,Both,,,190,,,,,,,,,, CROSSMATCH AHG/UNIT,86922,CPT ,,Both,,,222,,,,,,,,,, COMPATIBILITY EA UNIT ELECTRON,86923,CPT ,,Both,,,216,,,,,,,,,, FRESH FROZ PLASMA THAWING/UNIT,86927,CPT ,,Both,,,225,,,,,,,,,, IRRADIATED BLOOD PRODUCT,86945,CPT ,,Both,,,225,,,,,,,,,, ANTIBODY AUTOABSORPTION,86978,CPT ,,Both,,,312,,,,,,,,,, MULTIPLE SCL PROFILE,86999,CPT ,,Both,,,225,,,,,,,,,, CONCENTRATION INFECTIOUS AGENTS,87015,CPT ,,Both,,,344,,,,,,,,,, CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES,87040,CPT ,,Both,,,463,,,,,,,,,, CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL,87045,CPT ,,Both,,,953,,,,,,,,,, CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA,87046,CPT ,,Both,,,1140,,,,,,,,,, CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL,87070,CPT ,,Both,,,612,,,,,,,,,, CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL,87071,CPT ,,Both,,,1020,,,,,,,,,, CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID,87075,CPT ,,Both,,,684,,,,,,,,,, CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL,87076,CPT ,,Both,,,516,,,,,,,,,, CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,87077,CPT ,,Both,,,684,,,,,,,,,, CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ,87081,CPT ,,Both,,,684,,,,,,,,,, CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,87086,CPT ,,Both,,,465,,,,,,,,,, CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE,87088,CPT ,,Both,,,344,,,,,,,,,, CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL,87101,CPT ,,Both,,,1020,,,,,,,,,, CULTURE FUNGUS (OTHER),87102,CPT ,,Both,,,569,,,,,,,,,, CULTURE FUNGUS (BLOOD),87103,CPT ,,Both,,,215,,,,,,,,,, CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST,87106,CPT ,,Both,,,1020,,,,,,,,,, CULTURE MYCOPLASMA,87109,CPT ,,Both,,,179,,,,,,,,,, CULTURE CHLAMYDIA,87110,CPT ,,Both,,,385,,,,,,,,,, CULTURE TB/AFB ISO ONLY,87116,CPT ,,Both,,,350,,,,,,,,,, SEROL AGGLUT/ANTISERUM,87147,CPT ,,Both,,,89,,,,,,,,,, PINWORM PREP,87172,CPT ,,Both,,,73,,,,,,,,,, HOMOGENIZATION TISSUE CELL,87176,CPT ,,Both,,,101,,,,,,,,,, OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID,87177,CPT ,,Both,,,1140,,,,,,,,,, E-TEST AMOXICIL CLAVULAN ACID,87181,CPT ,,Both,,,82,,,,,,,,,, SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD,87184,CPT ,,Both,,,780,,,,,,,,,, SENSITIVITY MIC,87186,CPT ,,Both,,,149,,,,,,,,,, SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,87205,CPT ,,Both,,,420,,,,,,,,,, AFB SMEAR ONLY,87206,CPT ,,Both,,,92,,,,,,,,,, PNEUMOCYSTIS PREP,87207,CPT ,,Both,,,252,,,,,,,,,, SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS,87209,CPT ,,Both,,,1140,,,,,,,,,, SMR PRIM SRC WET MOUNT NFCT AGT,87210,CPT ,,Both,,,1020,,,,,,,,,, TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT,87220,CPT ,,Both,,,1020,,,,,,,,,, TOXIN/ANTITOXIN ASSAY TISSUE CULTURE,87230,CPT ,,Both,,,1140,,,,,,,,,, CULTURE VIRUS,87252,CPT ,,Both,,,448,,,,,,,,,, VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC,87255,CPT ,,Both,,,498,,,,,,,,,, CYTOMEGALOVIRUS IMM EARLY AG,87299,CPT ,,Both,,,206,,,,,,,,,, IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,87324,CPT ,,Both,,,463,,,,,,,,,, AG GIARDIC ANTIGEN EIA,87328,CPT ,,Both,,,206,,,,,,,,,, AG N MEN B/E.COLI,87335,CPT ,,Both,,,206,,,,,,,,,, IAAD IA HPYLORI STOOL,87338,CPT ,,Both,,,756,,,,,,,,,, HEPATITIS B SURF ANTIGEN,87340,CPT ,,Both,,,211,,,,,,,,,, IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE,87389,CPT ,,Both,,,720,,,,,,,,,, HIV-1,87390,CPT ,,Both,,,303,,,,,,,,,, INFLUENZA A&B ANTIGEN,87400,CPT ,,Both,,,259,,,,,,,,,, IAAD IA RESPIRATORY SYNCTIAL VIRUS,87420,CPT ,,Both,,,570,,,,,,,,,, IAAD IA ROTAVIRUS,87425,CPT ,,Both,,,1140,,,,,,,,,, "severe acute respiratory syndrome CoV eg SARSCoV,SARSCoV-2 COVID-19",87426,CPT ,,Both,,,360,,,,,,,,,, IAAD IA SHIGA-LIKE TOXIN,87427,CPT ,,Both,,,660,,,,,,,,,, Sarscov & inf vir a&b ag ia,87428,CPT ,,Both,,,480,,,,,,,,,, STREP GROUP A ANTIGEN,87430,CPT ,,Both,,,348,,,,,,,,,, AG N MEN C/W,87449,CPT ,,Both,,,206,,,,,,,,,, LEGIONELLA ANTIGEN SCRN,87450,CPT ,,Both,,,165,,,,,,,,,, CANDIDA DNA AMP PROBE,87481,CPT ,,Both,,,206,,,,,,,,,, IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ,87486,CPT ,,Both,,,480,,,,,,,,,, IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,87491,CPT ,,Both,,,756,,,,,,,,,, INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE,87493,CPT ,,Both,,,1020,,,,,,,,,, IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25,87507,CPT ,,Both,,,3002,,,,,,,,,, GARDNER VAG DNA DIR PROBE,87510,CPT ,,Both,,,1751,,,,,,,,,, GARDNER VAG DNA QUANT,87512,CPT ,,Both,,,347,,,,,,,,,, HEPATITIS C PRR QUAL,87521,CPT ,,Both,,,603,,,,,,,,,, HEPATITIS C/RNA/PCR,87522,CPT ,,Both,,,584,,,,,,,,,, IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ,87529,CPT ,,Both,,,1020,,,,,,,,,, HIV VIRAL LOAD 3RD GENERATION,87536,CPT ,,Both,,,1462,,,,,,,,,, IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ,87581,CPT ,,Both,,,360,,,,,,,,,, GONORRHEA BY DNA PROBE,87590,CPT ,,Both,,,345,,,,,,,,,, IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ,87591,CPT ,,Both,,,408,,,,,,,,,, IADNA NEISSERIA GONORRHOEAE QUANTIFICATION,87592,CPT ,,Both,,,756,,,,,,,,,, "Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each",87593,CPT ,,Both,,,850,,,,,,,,,, IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS,87631,CPT ,,Both,,,1663,,,,,,,,,, IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,87633,CPT ,,Both,,,8576,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2,87635,CPT ,,Both,,,600,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87636,CPT ,,Both,,,500,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87637,CPT ,,Both,,,600,,,,,,,,,, IADNA S AUREUS AMPLIFIED PROBE TQ,87640,CPT ,,Both,,,1200,,,,,,,,,, IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ,87641,CPT ,,Both,,,1440,,,,,,,,,, IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,87651,CPT ,,Both,,,480,,,,,,,,,, IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ,87653,CPT ,,Both,,,480,,,,,,,,,, IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ,87660,CPT ,,Both,,,780,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87661,CPT ,,Both,,,505,,,,,,,,,, CHLAMYDIA/GC DNA PROB,87797,CPT ,,Both,,,345,,,,,,,,,, IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM,87798,CPT ,,Both,,,567,,,,,,,,,, IADNA NOS QUANTIFICATION EACH ORGANISM,87799,CPT ,,Both,,,720,,,,,,,,,, "Detection Test by nucliec acid for multiple organisms, direct probe(s) technique",87800,CPT ,,Both,,,480,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA),87801,CPT ,,Both,,,1133,,,,,,,,,, IAADIADOO INFLUENZA,87804,CPT ,,Both,,,575,,,,,,,,,, IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES,87806,CPT ,,Both,,,1260,,,,,,,,,, IAADIADOO RESPIRATORY SYNCTIAL VIRUS,87807,CPT ,,Both,,,2896,,,,,,,,,, TRICHOMONAS ASSAY W/OPTIC,87808,CPT ,,Both,,,206,,,,,,,,,, ADENOVIRUS ASSAY W/OPTIC,87809,CPT ,,Both,,,206,,,,,,,,,, CHLAMYDIA TRACHOMATIS,87810,CPT ,,Both,,,206,,,,,,,,,, IAADIADOO STREPTOCOCCUS GROUP A,87880,CPT ,,Both,,,1038,,,,,,,,,, IAADIADOO NOT OTHERWISE SPECIFIED,87899,CPT ,,Both,,,780,,,,,,,,,, HCV GENOTYPE,87902,CPT ,,Both,,,3149,,,,,,,,,, SIALIDASE ENZYME ASSAY,87905,CPT ,,Both,,,210,,,,,,,,,, CYTO NON GYN SMEAR INTERP,88104,CPT ,,Both,,,956,,,,,,,,,, CYTP CONCENTRATION SMEARS & INTERPRETATION,88108,CPT ,,Both,,,989,,,,,,,,,, CYTOPATHOLOGY FORENSIC,88125,CPT ,,Both,,,281,,,,,,,,,, PAP SMEAR THIN PREP DIAGNOSTIC,88142,CPT ,,Both,,,348,,,,,,,,,, PAP SMEAR DIAGNOSTIC,88150,CPT ,,Both,,,182,,,,,,,,,, PAP SMEAR DIAGNOSTIC-BETHESDA,88164,CPT ,,Both,,,182,,,,,,,,,, "FNA EVALUATION, INTERP/REPORT",88173,CPT ,,Both,,,1882,,,,,,,,,, FLOW CYTOMETRY/DNA ANALYSIS,88182,CPT ,,Both,,,1368,,,,,,,,,, "TISSUE CULTURE,LYMPHOCYTE",88230,CPT ,,Both,,,2002,,,,,,,,,, TISSUE CULTURE BONE MARROW,88237,CPT ,,Both,,,2170,,,,,,,,,, CHROM COUNT 15-20 CELLS,88262,CPT ,,Both,,,2142,,,,,,,,,, CHROM ANALYSIS 20-25 CELLS,88264,CPT ,,Both,,,2142,,,,,,,,,, MOLECULAR CYTO DNA PROBE,88271,CPT ,,Both,,,368,,,,,,,,,, CHROM ANALYSIS 25-99 CELLS,88274,CPT ,,Both,,,598,,,,,,,,,, MOLEC INTERPHASE INSITU,88275,CPT ,,Both,,,690,,,,,,,,,, CHROM ANAL KARYOTYPE,88280,CPT ,,Both,,,431,,,,,,,,,, CYTO AND MOLEC CYTOGEN INT&REP,88291,CPT ,,Both,,,403,,,,,,,,,, PATHOLOGY LEVEL I,88300,CPT ,,Both,,,183,,,,,,,,,, PATHOLOGY LEVEL II,88302,CPT ,,Both,,,388,,,,,,,,,, PATHOLOGY LEVEL III,88304,CPT ,,Both,,,558,,,,,,,,,, PATHOLOGY LEVEL IV,88305,CPT ,,Both,,,879,,,,,,,,,, PATHOLOGY LEVEL V,88307,CPT ,,Both,,,3728,,,,,,,,,, PATHOLOGY LEVEL VI,88309,CPT ,,Both,,,5634,,,,,,,,,, DECALCIFICATION PROCEDURE,88311,CPT ,,Both,,,256,,,,,,,,,, SPECIAL STAINS GROUP I,88312,CPT ,,Both,,,1224,,,,,,,,,, SPECIAL STAINS GROUP II,88313,CPT ,,Both,,,848,,,,,,,,,, HISTO STAIN FROZEN SECT,88314,CPT ,,Both,,,1015,,,,,,,,,, REFERRED PATHOLOGY CONSULT,88321,CPT ,,Both,,,1169,,,,,,,,,, CONSULT COMPREHENSIVE,88325,CPT ,,Both,,,2637,,,,,,,,,, PATHOLOGY CONSULT IN SURG,88329,CPT ,,Both,,,721,,,,,,,,,, FROZEN SECTION SINGLE SPECIMEN,88331,CPT ,,Both,,,1252,,,,,,,,,, FROZEN SECTION ADDL TISSUE BLK,88332,CPT ,,Both,,,547,,,,,,,,,, PATH CONSULT OR INITIAL SITE,88333,CPT ,,Both,,,1319,,,,,,,,,, PATH CONSULT OR EA ADD SITE,88334,CPT ,,Both,,,823,,,,,,,,,, IMMUNOCYTOCHEMISTRY EA ANTIBDY,88342,CPT ,,Both,,,1446,,,,,,,,,, L.E. PREP,88346,CPT ,,Both,,,1370,,,,,,,,,, ELECTRON MICROSCOPY DIAGNOSTIC,88348,CPT ,,Both,,,9086,,,,,,,,,, ESTROGEN RECEPTOR,88360,CPT ,,Both,,,1596,,,,,,,,,, INSITU HYBRIDIZATION MANUAL,88368,CPT ,,Both,,,2909,,,,,,,,,, UNLISTED MISC PATH LAB,88399,CPT ,,Both,,,159,,,,,,,,,, BILIRUBIN TRANSCUTANEOUS,88720,CPT ,,Both,,,86,,,,,,,,,, CELL COUNT MISCELLANEOUS BODY FLUIDS,89050,CPT ,,Both,,,1038,,,,,,,,,, CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT,89051,CPT ,,Both,,,497,,,,,,,,,, LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE,89055,CPT ,,Both,,,684,,,,,,,,,, CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,89060,CPT ,,Both,,,780,,,,,,,,,, EOSINOPHILS NASAL SMEAR,89190,CPT ,,Both,,,82,,,,,,,,,, "Sputum, obtaining specimen, aerosol induced technique (separate procedure)",89220,CPT ,,Both,,,221,,,,,,,,,, UNLIS MISC,89240,CPT ,,Both,,,246,,,,,,,,,, TC HEPATITIS B IMMUNE GLOBLIN,90371,CPT ,,Both,,,1400,,,,,,,,,, RABIES IG IM/SC,90375,CPT ,,Both,,,2748,,,,,,,,,, RH IG MINIDOSE IM,90385,CPT ,,Both,,,316,,,,,,,,,, VARICELLA-ZOSTER IG IM,90396,CPT ,,Both,,,999,,,,,,,,,, IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,90471,CPT ,,Both,,,324,,,,,,,,,, IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE,90472,CPT ,,Both,,,420,,,,,,,,,, IMMUNE ADMIN ORAL/NASAL,90473,CPT ,,Both,,,324,,,,,,,,,, ED-IMMUNIZATION NASAL\ORAL 2or more,90474,CPT ,,Both,,,158,,,,,,,,,, BCG VACCINE PERCUT,90585,CPT ,,Both,,,1511,,,,,,,,,, BCG VACCINE INTRAVESICAL,90586,CPT ,,Both,,,1511,,,,,,,,,, HEP A VACCINE ADULT IM,90632,CPT ,,Both,,,621,,,,,,,,,, HEP A VACC PED/ADOL 2 DOSE,90633,CPT ,,Both,,,476,,,,,,,,,, HEP A/HEP B VACC ADULT IM,90636,CPT ,,Both,,,1536,,,,,,,,,, HIB VACCINE PRP-T IM,90648,CPT ,,Both,,,378,,,,,,,,,, HPV VACCINE 4 VALENT IM,90649,CPT ,,Both,,,2247,,,,,,,,,, HPV VACCINE 2 VALENT IM,90650,CPT ,,Both,,,2141,,,,,,,,,, FLU VAC NO PRSV 3 VAL 6-35 M,90655,CPT ,,Both,,,216,,,,,,,,,, FLU VACCINE NO PRESERV 3 & >,90656,CPT ,,Both,,,174,,,,,,,,,, FLU VACCINE 3 YRS IM,90657,CPT ,,Both,,,75,,,,,,,,,, FLU VACCINE 3 YRS & > IM,90658,CPT ,,Both,,,257,,,,,,,,,, FLU VACCINE NASAL,90660,CPT ,,Both,,,319,,,,,,,,,, FLU VACC PRSV FREE INC ANTIG,90662,CPT ,,Both,,,398,,,,,,,,,, PNEUMOCOCCAL VACC 7 VAL IM,90669,CPT ,,Both,,,1194,,,,,,,,,, PNEUMOCOCCAL VACC 13 VAL IM,90670,CPT ,,Both,,,1814,,,,,,,,,, FLU VACCINE 4 VALENT NASAL,90672,CPT ,,Both,,,307,,,,,,,,,, RABIES VACCINE IM,90675,CPT ,,Both,,,2905,,,,,,,,,, RABIES VACCINE ID,90676,CPT ,,Both,,,1946,,,,,,,,,, ROTOVIRUS VACC 3 DOSE ORAL,90680,CPT ,,Both,,,1239,,,,,,,,,, TETANUS VACCINE IM,90703,CPT ,,Both,,,491,,,,,,,,,, MEASLES MUMPS RUBELLA VACCINE,90707,CPT ,,Both,,,928,,,,,,,,,, TC DPT,90710,CPT ,,Both,,,2493,,,,,,,,,, TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE,90714,CPT ,,Both,,,806,,,,,,,,,, TDAP VACCINE 7 YRS/> IM,90715,CPT ,,Both,,,756,,,,,,,,,, DTAP-HEP B-IPV VACCINE IM,90723,CPT ,,Both,,,1167,,,,,,,,,, PNEUMOCOCCAL VACCINE,90732,CPT ,,Both,,,904,,,,,,,,,, MENINGOCOCCAL VACCINE SC,90733,CPT ,,Both,,,1331,,,,,,,,,, HEPB VACC ILL PAT 3 DOSE IM,90740,CPT ,,Both,,,1493,,,,,,,,,, HEP B VACC ADOL 2 DOSE IM,90743,CPT ,,Both,,,303,,,,,,,,,, HEPATIT B VIR VACC 10MCG/.5ML,90744,CPT ,,Both,,,303,,,,,,,,,, HEP B VACC ADULT 3 DOSE IM,90746,CPT ,,Both,,,746,,,,,,,,,, HEPB VACC ILL PAT 4 DOSE IM,90747,CPT ,,Both,,,1493,,,,,,,,,, HEP B/HIB VACCINE IM,90748,CPT ,,Both,,,721,,,,,,,,,, PSYTX COMPLEX INTERACTIVE,90785,CPT ,,Both,,,60,,,,,,,,,, PSYCH DIAGNOSTIC EVALUATION,90791,CPT ,,Both,,,1892,,,,,,,,,, PSYCH DIAG EVAL W/MED SRVCS,90792,CPT ,,Both,,,1561,,,,,,,,,, Family psychotherapy (without the patient present),90846,CPT ,,Both,,,928,,,,,,,,,, Family psychotherapy (conjoint psychotherapy) (with patient present),90847,CPT ,,Both,,,1112,,,,,,,,,, Multiple-family group psychotherapy,90849,CPT ,,Both,,,427,,,,,,,,,, Group psychotherapy (other than of a multiple-family group),90853,CPT ,,Both,,,308,,,,,,,,,, NASOPHARYNGOSCOPY WITH ENDOSCOPE,92511,CPT ,,Both,,,1803,,,,,,,,,, HEART/LUNG RESUSCITATION CPR,92950,CPT ,,Both,,,3858,,,,,,,,,, TEMPORARY EXTERNAL PACING,92953,CPT ,,Both,,,133,,,,,,,,,, CARDIOVERSION ELECTRIC EXT,92960,CPT ,,Both,,,3369,,,,,,,,,, CORONARY THROMBOLYSIS BY IV INFUSION,92977,CPT ,,Both,,,711,,,,,,,,,, ECG ROUTINE ECG W/LEAST 12 LDS W/I&R,93000,CPT ,,Both,,,756,,,,,,,,,, ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,93005,CPT ,,Both,,,960,,,,,,,,,, ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY,93010,CPT ,,Both,,,240,,,,,,,,,, RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT,93040,CPT ,,Both,,,960,,,,,,,,,, RHYTHM ECG TRACING,93041,CPT ,,Both,,,217,,,,,,,,,, RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON,93042,CPT ,,Both,,,756,,,,,,,,,, XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I,93224,CPT ,,Both,,,1212,,,,,,,,,, ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,93307,CPT ,,Both,,,2880,,,,,,,,,, INTRAOP EPICAR& ENDOCAR PACG& MAPG,93631,CPT ,,Both,,,912,,,,,,,,,, "MONITOR CVP, VENOUS PRESSURE",93770,CPT ,,Both,,,109,,,,,,,,,, DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,93880,CPT ,,Both,,,2500,,,,,,,,,, EXTRACRANIAL STUDY Uni,93882,CPT ,,Both,,,2957,,,,,,,,,, NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,93922,CPT ,,Both,,,2921,,,,,,,,,, NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,93923,CPT ,,Both,,,3024,,,,,,,,,, DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,93925,CPT ,,Both,,,3570,,,,,,,,,, DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,93926,CPT ,,Both,,,3050,,,,,,,,,, DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,93930,CPT ,,Both,,,3280,,,,,,,,,, DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,93931,CPT ,,Both,,,2976,,,,,,,,,, DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,CPT ,,Both,,,3455,,,,,,,,,, DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,93971,CPT ,,Both,,,3024,,,,,,,,,, DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,93975,CPT ,,Both,,,3815,,,,,,,,,, VASCULAR STUDY,93976,CPT ,,Both,,,2022,,,,,,,,,, DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,93980,CPT ,,Both,,,2080,,,,,,,,,, US Lower EXT L Venous And Arterial Duplex,93990,CPT ,,Both,,,1759,,,,,,,,,, SPIROM SIMPL PFT VC,94010,CPT ,,Both,,,469,,,,,,,,,, BRONCH EVAL PRE/POST,94060,CPT ,,Both,,,806,,,,,,,,,, VITAL CAPACITY,94150,CPT ,,Both,,,335,,,,,,,,,, MAX VOLUNTARY VENT (MVV),94200,CPT ,,Both,,,328,,,,,,,,,, PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,94640,CPT ,,Both,,,347,,,,,,,,,, "CONTINUOUS INHALATION TX W/ AEROSOL MEDICATION, FIRST HOUR",94644,CPT ,,Both,,,588,,,,,,,,,, EACH ADD'L HOUR CONTINUOUS INHALATION TX W/ AEROSOL MEDICATION,94645,CPT ,,Both,,,201,,,,,,,,,, POS AIRWAY PRESSURE CPAP,94660,CPT ,,Both,,,802,,,,,,,,,, "DEMO AND/OR EVAL OF PT UTILIZATION OF AEROSOL, NEB, MDI, OR IPPB DEVICE",94664,CPT ,,Both,,,234,,,,,,,,,, "CHEST WALL MANIPULATION, INITIAL DEMO AND/OR EVAL",94667,CPT ,,Both,,,328,,,,,,,,,, NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,94760,CPT ,,Both,,,457,,,,,,,,,, NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,94761,CPT ,,Both,,,408,,,,,,,,,, NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,94762,CPT ,,Both,,,684,,,,,,,,,, CO2 Expired Gas Determination,94770,CPT ,,Both,,,102,,,,,,,,,, ALLERGY INJECTION,95115,CPT ,,Both,,,119,,,,,,,,,, IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,CPT ,,Both,,,1512,,,,,,,,,, IV INFUSION HYDRATION EACH ADDITIONAL HOUR,96361,CPT ,,Both,,,714,,,,,,,,,, IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR,96365,CPT ,,Both,,,1512,,,,,,,,,, IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,96366,CPT ,,Both,,,937,,,,,,,,,, IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,96367,CPT ,,Both,,,1247,,,,,,,,,, IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,96368,CPT ,,Both,,,960,,,,,,,,,, THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,96372,CPT ,,Both,,,1512,,,,,,,,,, THER/PROPH/DIAG INJ IA,96373,CPT ,,Both,,,360,,,,,,,,,, THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,96374,CPT ,,Both,,,1236,,,,,,,,,, THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,96375,CPT ,,Both,,,1406,,,,,,,,,, THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,96376,CPT ,,Both,,,853,,,,,,,,,, APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,96377,CPT ,,Both,,,960,,,,,,,,,, CHEMO ANTI-NEOPL SQ/IM,96401,CPT ,,Both,,,950,,,,,,,,,, IRRIG DRUG DELIVERY DEVICE,96523,CPT ,,Both,,,315,,,,,,,,,, APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS,97010,CPT ,,Both,,,171,,,,,,,,,, THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR,97116,CPT ,,Both,,,780,,,,,,,,,, WHEELCHAIR MGMT EA 15 MIN,97542,CPT ,,Both,,,615,,,,,,,,,, DEBRIDEMENT OPEN WOUND 20 SQ CM/<,97597,CPT ,,Both,,,1195,,,,,,,,,, "DEBRIDEMENT OPEN WOUND, EACH ADD'L 20 SQ CM",97598,CPT ,,Both,,,319,,,,,,,,,, "WOUND CARE, NON-SELECT DEBRIDEMENT W/O ANESTH",97602,CPT ,,Both,,,894,,,,,,,,,, Application of wound VAC dressing,97605,CPT ,,Both,,,532,,,,,,,,,, OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,98925,CPT ,,Both,,,392,,,,,,,,,, OMT 3-4 Body Regions,98926,CPT ,,Both,,,559,,,,,,,,,, HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB,99000,CPT ,,Both,,,1020,,,,,,,,,, POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX,99024,CPT ,,Both,,,50,,,,,,,,,, SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP,99070,CPT ,,Both,,,300,,,,,,,,,, Miscellaneous Medicine Services,99072,CPT ,,Both,,,150,,,,,,,,,, MOD/CON SED <5YRS 1ST 30M,99143,CPT ,,Both,,,652,,,,,,,,,, MOD/CON SED AGE 5+ 1ST 30M,99144,CPT ,,Both,,,646,,,,,,,,,, MOD/CON SED EA ADDL 15 MIN,99145,CPT ,,Both,,,252,,,,,,,,,, "MODERATE SEDATION BY DIFF. PHYS, 30 MIN, OVER 5Y",99149,CPT ,,Both,,,540,,,,,,,,,, MODERATE SEDATION BY DIFF. PHYS ADD ON (15 MIN.),99150,CPT ,,Both,,,166,,,,,,,,,, MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS,99151,CPT ,,Both,,,687,,,,,,,,,, MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS,99152,CPT ,,Both,,,1500,,,,,,,,,, MOD SED SAME PHYS/QHP EACH ADDL 15 MINS,99153,CPT ,,Both,,,1200,,,,,,,,,, ANOGENITAL ABUSE EXAM CHILD,99170,CPT ,,Both,,,1578,,,,,,,,,, SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT,99173,CPT ,,Both,,,1812,,,,,,,,,, INDUCTION OF VOMITING,99175,CPT ,,Both,,,213,,,,,,,,,, "Phlebotomy, therapeutic (separate procedure)",99195,CPT ,,Both,,,1285,,,,,,,,,, OBSERVATION CARE DISCHARGE MANAGEMENT,99217,CPT ,,Both,,,1434,,,,,,,,,, INITIAL OBSERVATION CARE/DAY 30 MINUTES,99218,CPT ,,Both,,,1500,,,,,,,,,, INITIAL OBSERVATION CARE/DAY 50 MINUTES,99219,CPT ,,Both,,,1710,,,,,,,,,, INITIAL OBSERVATION CARE/DAY 70 MINUTES,99220,CPT ,,Both,,,1950,,,,,,,,,, INITIAL Observation care straightforward or low level MDM,99221,CPT ,,Both,,,1500,,,,,,,,,, INITIAL HOSPITAL CARE/DAY 50 MINUTES,99222,CPT ,,Both,,,1710,,,,,,,,,, INITIAL HOSPITAL CARE/DAY 70 MINUTES,99223,CPT ,,Both,,,1950,,,,,,,,,, SBSQ OBSERVATION CARE/DAY 15 MINUTES,99224,CPT ,,Both,,,1500,,,,,,,,,, SBSQ OBSERVATION CARE/DAY 25 MINUTES,99225,CPT ,,Both,,,1710,,,,,,,,,, SBSQ OBSERVATION CARE/DAY 35 MINUTES,99226,CPT ,,Both,,,1950,,,,,,,,,, SBSQ HOSPITAL CARE/DAY 15 MINUTES,99231,CPT ,,Both,,,1500,,,,,,,,,, SBSQ HOSPITAL CARE/DAY 25 MINUTES,99232,CPT ,,Both,,,1710,,,,,,,,,, SBSQ HOSPITAL CARE/DAY 35 MINUTES,99233,CPT ,,Both,,,1950,,,,,,,,,, OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES,99234,CPT ,,Both,,,1560,,,,,,,,,, OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES,99235,CPT ,,Both,,,2223,,,,,,,,,, OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES,99236,CPT ,,Both,,,2867,,,,,,,,,, HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/<,99238,CPT ,,Both,,,1434,,,,,,,,,, HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN,99239,CPT ,,Both,,,1710,,,,,,,,,, EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,99281,CPT ,,Both,,,1199,,,,,,,,,, EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,99282,CPT ,,Both,,,2400,,,,,,,,,, EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,99283,CPT ,,Both,,,5040,,,,,,,,,, EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,99284,CPT ,,Both,,,5400,,,,,,,,,, EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,99285,CPT ,,Both,,,7553,,,,,,,,,, CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,99291,CPT ,,Both,,,9026,,,,,,,,,, CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,99292,CPT ,,Both,,,3427,,,,,,,,,, PED CRITICAL CARE INITIAL,99471,CPT ,,Both,,,10472,,,,,,,,,, PED CRITICAL CARE SUBSQ,99472,CPT ,,Both,,,4976,,,,,,,,,, BASIC SUPPORT ROUTINE SUPPLS,A0382,HCPCS,,Both,,,20,,,,,,,,,, ALS IV DRUG THERAPY SUPPLIES,A0394,HCPCS,,Both,,,83,,,,,,,,,, 1 CC STERILE SYRINGE&NEEDLE,A4206,HCPCS,,Both,,,10,,,,,,,,,, 2 CC STERILE SYRINGE&NEEDLE,A4207,HCPCS,,Both,,,15,,,,,,,,,, Syringe with needle sterile 3cc ,A4208,HCPCS,,Both,,,138,,,,,,,,,, FIVE PLUS CC STERILE SYRINGE&NEEDLE,A4209,HCPCS,,Both,,,138,,,,,,,,,, NONNEEDLE INJECTION DEVICE,A4210,HCPCS,,Both,,,15,,,,,,,,,, SUPP FOR SELF-ADM INJECTIONS,A4211,HCPCS,,Both,,,15,,,,,,,,,, NON CORING NEEDLE OR STYLET,A4212,HCPCS,,Both,,,15,,,,,,,,,, 20+ CC SYRINGE ONLY,A4213,HCPCS,,Both,,,138,,,,,,,,,, BUTTERFLY VACUTAINER,A4215,HCPCS,,Both,,,19,,,,,,,,,, STERILE NEEDLE,A4215,HCPCS,,Both,,,138,,,,,,,,,, "STERILE WATER/SALINE, 10 ML",A4216,HCPCS,,Both,,,138,,,,,,,,,, "STERILE WATER/SALINE, 500 ML",A4217,HCPCS,,Both,,,99,,,,,,,,,, STERILE SALINE OR WATER,A4218,HCPCS,,Both,,,138,,,,,,,,,, SUPP NON-INSULIN INF CATH/WK,A4221,HCPCS,,Both,,,210,,,,,,,,,, IV TUBING SECONDARY,A4223,HCPCS,,Both,,,6,,,,,,,,,, IV TUBING BURETROL,A4223,HCPCS,,Both,,,31,,,,,,,,,, IV START KIT,A4223,HCPCS,,Both,,,7,,,,,,,,,, PROTECTIVE IV CATHETER,A4223,HCPCS,,Both,,,12,,,,,,,,,, IV TUBING PRIMARY,A4223,HCPCS,,Both,,,19,,,,,,,,,, IV LOOP CONNECTOR,A4223,HCPCS,,Both,,,19,,,,,,,,,, IV TUBING PUMP,A4223,HCPCS,,Both,,,24,,,,,,,,,, DIAL A FLOW,A4223,HCPCS,,Both,,,25,,,,,,,,,, SUPPLY INSULIN INF CATH/WK,A4224,HCPCS,,Both,,,138,,,,,,,,,, SYRINGE W/NEEDLE INSULIN 3CC,A4232,HCPCS,,Both,,,99,,,,,,,,,, ALCOHOL OR PEROXIDE PER PINT,A4244,HCPCS,,Both,,,138,,,,,,,,,, ALCOHOL WIPES PER BOX,A4245,HCPCS,,Both,,,5,,,,,,,,,, BETADINE/PHISOHEX SOLUTION,A4246,HCPCS,,Both,,,138,,,,,,,,,, BETADINE/IODINE SWABS/WIPES,A4247,HCPCS,,Both,,,83,,,,,,,,,, CHLORHEXIDINE ANTISEPT 15mL Individual Packet 4% Strength,A4248,HCPCS,,Both,,,138,,,,,,,,,, URINE REAGENT STRIPS/TABLETS,A4250,HCPCS,,Both,,,5,,,,,,,,,, "Blood ketone test strips, per strip",A4252,HCPCS,,Both,,,138,,,,,,,,,, BLOOD GLUCOSE/REAGENT STRIPS,A4253,HCPCS,,Both,,,5,,,,,,,,,, Lancet device each,A4258,HCPCS,,Both,,,5,,,,,,,,,, REPLACEMENT BREASTPUMP TUBE,A4281,HCPCS,,Both,,,138,,,,,,,,,, REPLACEMENT BREASTPUMP CAP,A4283,HCPCS,,Both,,,138,,,,,,,,,, CATH IMPL VASC ACCESS PORTAL,A4300,HCPCS,,Both,,,99,,,,,,,,,, INSERT TRAY W/O BAG/CATH,A4310,HCPCS,,Both,,,138,,,,,,,,,, CATHETER W/O BAG 2-WAY LATEX,A4311,HCPCS,,Both,,,138,,,,,,,,,, CATHETER W/BAG 3-WAY,A4313,HCPCS,,Both,,,138,,,,,,,,,, CATH W/DRAINAGE 2-WAY LATEX,A4314,HCPCS,,Both,,,138,,,,,,,,,, CATH W/DRAINAGE 2-WAY SILCNE,A4315,HCPCS,,Both,,,99,,,,,,,,,, Irrigation tray,A4320,HCPCS,,Both,,,23,,,,,,,,,, IRRIGATION SYRINGE,A4322,HCPCS,,Both,,,127,,,,,,,,,, FEM URINARY COLLECT DEV CUP,A4327,HCPCS,,Both,,,138,,,,,,,,,, FEM URINARY COLLECT POUCH,A4328,HCPCS,,Both,,,150,,,,,,,,,, LUBE STERILE PACKET,A4332,HCPCS,,Both,,,83,,,,,,,,,, INDWELLING CATHETER LATEX,A4338,HCPCS,,Both,,,128,,,,,,,,,, INDWELLING CATHETER (COUDE CATH ALL),A4340,HCPCS,,Both,,,94,,,,,,,,,, CATH INDW FOLEY 2 WAY SILICN,A4344,HCPCS,,Both,,,150,,,,,,,,,, CATH INDW FOLEY 3 WAY,A4346,HCPCS,,Both,,,130,,,,,,,,,, COUDE TIP URINARY CATHETER,A4352,HCPCS,,Both,,,99,,,,,,,,,, INTERMITTENT URINARY CATH,A4353,HCPCS,,Both,,,138,,,,,,,,,, BLADDER IRRIGATION TUBING,A4355,HCPCS,,Both,,,150,,,,,,,,,, URINARY LEG OR ABDOMEN BAG,A4358,HCPCS,,Both,,,138,,,,,,,,,, "ADHESIVE, LIQUID OR EQUAL",A4364,HCPCS,,Both,,,166,,,,,,,,,, SKIN BARRIER LIQUID PER OZ,A4369,HCPCS,,Both,,,138,,,,,,,,,, LUBRICANT PER OUNCE,A4402,HCPCS,,Both,,,5,,,,,,,,,, PECTIN BASED OSTOMY PASTE,A4406,HCPCS,,Both,,,99,,,,,,,,,, NON-WATERPROOF TAPE,A4450,HCPCS,,Both,,,138,,,,,,,,,, WATERPROOF TAPE,A4452,HCPCS,,Both,,,138,,,,,,,,,, REUSABLE ENEMA BAG,A4458,HCPCS,,Both,,,127,,,,,,,,,, SURGICL DRESS HOLD NON-REUSE,A4461,HCPCS,,Both,,,30,,,,,,,,,, NON-ELASTIC EXTREMITY BINDER,A4465,HCPCS,,Both,,,99,,,,,,,,,, GRAVLEE JET WASHER,A4470,HCPCS,,Both,,,83,,,,,,,,,, Pelvic Tray,A4550,HCPCS,,Both,,,119,,,,,,,,,, I&D TRAY,A4550,HCPCS,,Both,,,119,,,,,,,,,, DISPOSABLE UNDERPADS,A4554,HCPCS,,Both,,,83,,,,,,,,,, "ELECTRODES, PAIR",A4556,HCPCS,,Both,,,138,,,,,,,,,, CONDUCTIVE GEL OR PASTE,A4558,HCPCS,,Both,,,127,,,,,,,,,, Coupling gel or paste (20 ounces),A4559,HCPCS,,Both,,,50,,,,,,,,,, "PESSARY, NON RUBBER,ANY TYPE",A4562,HCPCS,,Both,,,99,,,,,,,,,, SLINGS,A4565,HCPCS,,Both,,,217,,,,,,,,,, SHOULD SLING/VEST/ABRESTRAIN,A4566,HCPCS,,Both,,,179,,,,,,,,,, SPLINT,A4570,HCPCS,,Both,,,413,,,,,,,,,, CAST SUPPLIES (PLASTER),A4580,HCPCS,,Both,,,127,,,,,,,,,, OXYGEN PROBE USED W OXIMETER,A4606,HCPCS,,Both,,,189,,,,,,,,,, BATTERY CHARGER,A4613,HCPCS,,Both,,,138,,,,,,,,,, CANNULA NASAL,A4615,HCPCS,,Both,,,138,,,,,,,,,, TUBING (OXYGEN) PER FOOT,A4616,HCPCS,,Both,,,99,,,,,,,,,, FACE TENT,A4619,HCPCS,,Both,,,138,,,,,,,,,, VARIABLE CONCENTRATION MASK,A4620,HCPCS,,Both,,,138,,,,,,,,,, OROPHARYNGEAL SUCTION CATH,A4628,HCPCS,,Both,,,138,,,,,,,,,, TRACHEOSTOMY CARE KIT,A4629,HCPCS,,Both,,,83,,,,,,,,,, UNDERARM CRUTCH PAD,A4635,HCPCS,,Both,,,55,,,,,,,,,, I&D LOOPS,A4649,HCPCS,,Both,,,665,,,,,,,,,, RHINO ROCKET,A4649,HCPCS,,Both,,,665,,,,,,,,,, NoseBleed tray,A4649,HCPCS,,Both,,,665,,,,,,,,,, Katz Extractor,A4649,HCPCS,,Both,,,665,,,,,,,,,, Dental Box,A4649,HCPCS,,Both,,,665,,,,,,,,,, Alligator Forceps,A4649,HCPCS,,Both,,,665,,,,,,,,,, Rapid Rhino,A4649,HCPCS,,Both,,,665,,,,,,,,,, Vaginal Delivery Kit,A4649,HCPCS,,Both,,,665,,,,,,,,,, Rapid Rhino X 2,A4649,HCPCS,,Both,,,665,,,,,,,,,, PNEUMOTHORAX TRAY,A4649,HCPCS,,Both,,,756,,,,,,,,,, PD CATHETER ANCHOR BELT,A4653,HCPCS,,Both,,,83,,,,,,,,,, SYRINGE W/WO NEEDLE,A4657,HCPCS,,Both,,,138,,,,,,,,,, "AUTOMATIC BP MONITOR, DIAL",A4670,HCPCS,,Both,,,138,,,,,,,,,, EXT LINE W EASY LOCK CONNECT,A4673,HCPCS,,Both,,,138,,,,,,,,,, ART OR VENOUS BLOOD TUBING,A4750,HCPCS,,Both,,,83,,,,,,,,,, BLOOD COLLECTION TUBE/VACUUM,A4770,HCPCS,,Both,,,138,,,,,,,,,, NON-STERILE GLOVES,A4927,HCPCS,,Both,,,50,,,,,,,,,, SURGICAL MASK,A4928,HCPCS,,Both,,,5,,,,,,,,,, "STERILE, GLOVES PER PAIR",A4930,HCPCS,,Both,,,50,,,,,,,,,, REUSABLE ORAL THERMOMETER,A4931,HCPCS,,Both,,,150,,,,,,,,,, URINARY LEG BAG,A5112,HCPCS,,Both,,,138,,,,,,,,,, "SKIN BARRIER, WIPE OR SWAB",A5120,HCPCS,,Both,,,138,,,,,,,,,, DISK/FOAM PAD +OR- ADHESIVE,A5126,HCPCS,,Both,,,30,,,,,,,,,, COLLAGEN DRESSING <=16 SQ IN,A6021,HCPCS,,Both,,,127,,,,,,,,,, ALGINATE DRESSING <=16 SQ IN,A6196,HCPCS,,Both,,,40,,,,,,,,,, COMPOSITE DRSG <= 16 SQ IN,A6203,HCPCS,,Both,,,50,,,,,,,,,, CONTACT LAYER > 48 SQ IN,A6208,HCPCS,,Both,,,30,,,,,,,,,, FOAM DRSG <=16 SQ IN W/O BDR,A6209,HCPCS,,Both,,,30,,,,,,,,,, FOAM DRG <=16 SQ IN W/BORDER,A6212,HCPCS,,Both,,,99,,,,,,,,,, FOAM DRG >16<=48 SQ IN W/BDR,A6213,HCPCS,,Both,,,135,,,,,,,,,, NON-STERILE GAUZE<=16 SQ IN,A6216,HCPCS,,Both,,,138,,,,,,,,,, NON-STERILE GAUZE>16<=48 SQ,A6217,HCPCS,,Both,,,138,,,,,,,,,, NON-STERILE GAUZE > 48 SQ IN,A6218,HCPCS,,Both,,,99,,,,,,,,,, GAUZE <= 16 SQ IN W/BORDER,A6219,HCPCS,,Both,,,99,,,,,,,,,, GAUZE >16 <=48 SQ IN W/BORDR,A6220,HCPCS,,Both,,,99,,,,,,,,,, GAUZE > 48 SQ IN W/BORDER,A6221,HCPCS,,Both,,,83,,,,,,,,,, GAUZE <=16 IN NO W/SAL W/O B,A6222,HCPCS,,Both,,,99,,,,,,,,,, GAUZE >16<=48 NO W/SAL W/O B,A6223,HCPCS,,Both,,,83,,,,,,,,,, GAUZE > 48 IN NO W/SAL W/O B,A6224,HCPCS,,Both,,,138,,,,,,,,,, HYDROGEL DSG<=16 SQ IN,A6231,HCPCS,,Both,,,138,,,,,,,,,, HYDROGEL DRESSING >48 SQ IN,A6233,HCPCS,,Both,,,40,,,,,,,,,, HYDROCOLLD DRG >16<=48 W/O B,A6235,HCPCS,,Both,,,83,,,,,,,,,, HYDROCOLLD DRG >16<=48 W/BDR,A6238,HCPCS,,Both,,,83,,,,,,,,,, HYDROCOLLD DRG > 48 IN W/BDR,A6239,HCPCS,,Both,,,99,,,,,,,,,, HYDROGEL DRG >16<=48 IN W/B,A6246,HCPCS,,Both,,,40,,,,,,,,,, HYDROGEL DRSG GEL FILLER,A6248,HCPCS,,Both,,,30,,,,,,,,,, Hydrocortisone Topical Cream,A6250,HCPCS,,Both,,,83,,,,,,,,,, SKIN SEAL PROTECT MOISTURIZR,A6250,HCPCS,,Both,,,138,,,,,,,,,, ABSORPT DRG <=16 SQ IN W/O B,A6251,HCPCS,,Both,,,20,,,,,,,,,, ABSORPT DRG >16 <=48 W/O BDR,A6252,HCPCS,,Both,,,30,,,,,,,,,, ABSORPT DRG > 48 SQ IN W/O B,A6253,HCPCS,,Both,,,40,,,,,,,,,, ABSORPT DRG <=16 SQ IN W/BDR,A6254,HCPCS,,Both,,,50,,,,,,,,,, ABSORPT DRG >16<=48 IN W/BDR,A6255,HCPCS,,Both,,,99,,,,,,,,,, TRANSPARENT FILM <= 16 SQ IN,A6257,HCPCS,,Both,,,40,,,,,,,,,, TRANSPARENT FILM >16<=48 IN,A6258,HCPCS,,Both,,,50,,,,,,,,,, DRESSING TEGADERM 4x4 3/4 X3,A6259,HCPCS,,Both,,,21,,,,,,,,,, WOUND CLEANSER ANY TYPE/SIZE,A6260,HCPCS,,Both,,,147,,,,,,,,,, IMPREG GAUZE NO H20/SAL/YARD,A6266,HCPCS,,Both,,,138,,,,,,,,,, "Gauze nonimpregnated, sterile, pad size 16sq in or less, wo adhesive border",A6402,HCPCS,,Both,,,138,,,,,,,,,, STERILE GAUZE>16 <= 48 SQ IN,A6403,HCPCS,,Both,,,25,,,,,,,,,, STERILE GAUZE > 48 SQ IN,A6404,HCPCS,,Both,,,40,,,,,,,,,, "PACKING STRIPS, NON-IMPREG STERILE up to 2in in width, per linear yd",A6407,HCPCS,,Both,,,99,,,,,,,,,, OCCLUSIVE EYE PATCH,A6412,HCPCS,,Both,,,83,,,,,,,,,, "ADHESIVE BANDAGE, FIRST-AID",A6413,HCPCS,,Both,,,5,,,,,,,,,, PAD BAND W>=3 <5/YD,A6441,HCPCS,,Both,,,99,,,,,,,,,, CONFORM BAND N/S W<3/YD,A6442,HCPCS,,Both,,,127,,,,,,,,,, CONFORM BAND N/S W>=3<5/YD,A6443,HCPCS,,Both,,,150,,,,,,,,,, CONFORM BAND S W <3/YD,A6445,HCPCS,,Both,,,50,,,,,,,,,, CONFORM BAND S W>=3 <5/YD,A6446,HCPCS,,Both,,,138,,,,,,,,,, CONFORM BAND S W >=5/YD,A6447,HCPCS,,Both,,,83,,,,,,,,,, LT COMPRES BAND <3/YD,A6448,HCPCS,,Both,,,138,,,,,,,,,, LT COMPRES BAND >=3 <5/YD,A6449,HCPCS,,Both,,,127,,,,,,,,,, LT COMPRES BAND >=5/YD,A6450,HCPCS,,Both,,,99,,,,,,,,,, MOD COMPRES BAND W>=3 <5 /YD (Ace X2),A6451,HCPCS,,Both,,,20,,,,,,,,,, MOD COMPRES BAND W>=3 <5 YD (Ace),A6451,HCPCS,,Both,,,20,,,,,,,,,, MOD COMPRES BAND W>=3 <5 /YD (Ace X3),A6451,HCPCS,,Both,,,30,,,,,,,,,, HIGH COMPRES BAND W>=3 <5 YD (Ace X4),A6452,HCPCS,,Both,,,39,,,,,,,,,, SELF-ADHER BAND W <3/YD,A6453,HCPCS,,Both,,,138,,,,,,,,,, SELF-ADHER BAND W>=3 <5/YD,A6454,HCPCS,,Both,,,99,,,,,,,,,, SELF-ADHER BAND >=5/YD,A6455,HCPCS,,Both,,,5,,,,,,,,,, ZINC PASTE BAND W >=3<5/YD,A6456,HCPCS,,Both,,,50,,,,,,,,,, TUBULAR DRESSING,A6457,HCPCS,,Both,,,150,,,,,,,,,, COMPRESSION STOCKING BK18-30,A6530,HCPCS,,Both,,,45,,,,,,,,,, GRAD COMP NON-ELASTIC BK,A6545,HCPCS,,Both,,,30,,,,,,,,,, DISPOSABLE CANISTER FOR PUMP,A7000,HCPCS,,Both,,,150,,,,,,,,,, NONDISPOSABLE PUMP CANISTER,A7001,HCPCS,,Both,,,150,,,,,,,,,, TUBING USED W SUCTION PUMP,A7002,HCPCS,,Both,,,150,,,,,,,,,, NEBULIZER ADMINISTRATION SET,A7003,HCPCS,,Both,,,150,,,,,,,,,, DISPOSABLE NEBULIZER SML VOL,A7004,HCPCS,,Both,,,150,,,,,,,,,, NONDISPOSABLE NEBULIZER SET,A7005,HCPCS,,Both,,,150,,,,,,,,,, FILTERED NEBULIZER ADMIN SET,A7006,HCPCS,,Both,,,113,,,,,,,,,, AEROSOL MASK USED W NEBULIZE,A7015,HCPCS,,Both,,,108,,,,,,,,,, CPAP FULL FACE MASK,A7030,HCPCS,,Both,,,108,,,,,,,,,, REPLACEMENT FACEMASK INTERFA,A7031,HCPCS,,Both,,,150,,,,,,,,,, DRAINAGE CHEST PLEUR-EVAC,A7040,HCPCS,,Both,,,618,,,,,,,,,, Water seal drain container,A7041,HCPCS,,Both,,,210,,,,,,,,,, CHEST TUBE,A7042,HCPCS,,Both,,,103,,,,,,,,,, "REPL WATER CHAMBER, PAP DEV",A7046,HCPCS,,Both,,,150,,,,,,,,,, RESP SUCTION ORAL INTERFACE,A7047,HCPCS,,Both,,,150,,,,,,,,,, MISC/EXPER NON-PRESCRIPT DRU,A9150,HCPCS,,Both,,,172,,,,,,,,,, CATHETER KIT - FEMAL 8 FR,A9270,HCPCS,,Both,,,19,,,,,,,,,, HOT/COLD H2OBOT/CAP/COL/WRAP,A9273,HCPCS,,Both,,,150,,,,,,,,,, REACHING/GRABBING DEVICE,A9281,HCPCS,,Both,,,150,,,,,,,,,, IODINE I-125 SODIUM IODIDE,A9527,HCPCS,,Both,,,150,,,,,,,,,, STAPLE REMOVER KIT,A9900,HCPCS,,Both,,,337,,,,,,,,,, NEONATAL PROCEDURE TRAY,A9900,HCPCS,,Both,,,337,,,,,,,,,, LACERATION TRAY,A9999,HCPCS,,Both,,,79,,,,,,,,,, ET TUBE,A9999,HCPCS,,Both,,,12,,,,,,,,,, EASY CAP II CO2 DETECTOR,A9999,HCPCS,,Both,,,67,,,,,,,,,, SKIN STAPLER,A9999,HCPCS,,Both,,,73,,,,,,,,,, AMBU BAG EASY CAP,A9999,HCPCS,,Both,,,110,,,,,,,,,, SECURESEAL TOPICAL SKIN ADHESIVE,A9999,HCPCS,,Both,,,137,,,,,,,,,, EASY CAP END-TIDAL CO2 DETECTR,A9999,HCPCS,,Both,,,67,,,,,,,,,, SURGICEL,A9999,HCPCS,,Both,,,153,,,,,,,,,, CATUERY HIGH TEMP FINE TEMP,A9999,HCPCS,,Both,,,73,,,,,,,,,, LUMBAR PUNCTURE TRAY,A9999,HCPCS,,Both,,,91,,,,,,,,,, ENTERAL NG TUBING W/O STYLET,B4082,HCPCS,,Both,,,300,,,,,,,,,, "AICD, SINGLE CHAMBER",C1722,HCPCS,,Both,,,2580,,,,,,,,,, "CATH, INF, PER/CENT/MIDLINE",C1751,HCPCS,,Both,,,2544,,,,,,,,,, MESH (IMPLANTABLE),C1781,HCPCS,,Both,,,1849,,,,,,,,,, "PROBE/NEEDLE, CRYO",C2618,HCPCS,,Both,,,408,,,,,,,,,, MRA ABD W/CONT,C8900,HCPCS,,Both,,,5682,,,,,,,,,, MRA ABD WO CONT,C8901,HCPCS,,Both,,,4231,,,,,,,,,, MRA ABD W&WO CONT,C8902,HCPCS,,Both,,,6868,,,,,,,,,, MRI BREAST BI WO CON,C8907,HCPCS,,Both,,,4231,,,,,,,,,, MRI BREAST BI W&WO CONT,C8908,HCPCS,,Both,,,6868,,,,,,,,,, MRA LOW EXTREM W&WO,C8914,HCPCS,,Both,,,6868,,,,,,,,,, MRA PELVIS W/CONTRAST,C8918,HCPCS,,Both,,,5682,,,,,,,,,, MRA PELVIS W/O CONTRAST,C8919,HCPCS,,Both,,,4231,,,,,,,,,, MRA PELVIS W/WO CONTRAST,C8920,HCPCS,,Both,,,6868,,,,,,,,,, ECHO TTE 2D CONTRAST W DOPP/CF,C8929,HCPCS,,Both,,,7230,,,,,,,,,, Prolonged IA Infusion>8hours requiring a pump,C8957,HCPCS,,Both,,,2881,,,,,,,,,, PROTONIX - PANTROPRAZOLE 40MG INJ (MCR CARRIER),C9113,HCPCS,,Both,,,38,,,,,,,,,, ARGATROBAN 100MG/ML 2.5ML INJ,C9121,HCPCS,,Both,,,226,,,,,,,,,, "PATCH, LIDOCAINE/TETRACAINE",C9285,HCPCS,,Both,,,115,,,,,,,,,, CRUTCH FOREARM PAIR,E0110,HCPCS,,Both,,,84,,,,,,,,,, CRUTCH UNDERARM PAIR NO WOOD,E0114,HCPCS,,Both,,,955,,,,,,,,,, CRUTCH UNDERARM EACH NO WOOD,E0116,HCPCS,,Both,,,720,,,,,,,,,, WALKER RIGID ADJUST/FIXED HT,E0130,HCPCS,,Both,,,1146,,,,,,,,,, WALKER FOLDING WHEELED W/O S,E0143,HCPCS,,Both,,,660,,,,,,,,,, HEAVYDUTY/WIDE COMMODE CHAIR,E0168,HCPCS,,Both,,,456,,,,,,,,,, WATER CIRC HEAT PAD W PUMP,E0217,HCPCS,,Both,,,150,,,,,,,,,, BATH/SHOWER CHAIR,E0240,HCPCS,,Both,,,138,,,,,,,,,, BED PAN STANDARD,E0275,HCPCS,,Both,,,276,,,,,,,,,, URINAL MALE JUG-TYPE,E0325,HCPCS,,Both,,,174,,,,,,,,,, URINAL FEMALE JUG-TYPE,E0326,HCPCS,,Both,,,174,,,,,,,,,, ELECTRONIC SPIROMETER,E0487,HCPCS,,Both,,,420,,,,,,,,,, NEBULIZER WITH COMPRESSION,E0570,HCPCS,,Both,,,1092,,,,,,,,,, BLOOD GLUCOSE MONITOR HOME,E0607,HCPCS,,Both,,,684,,,,,,,,,, PATIENT LIFT BATHROOM OR TOI,E0625,HCPCS,,Both,,,546,,,,,,,,,, Admin influenza virus vac,G0008,HCPCS,,Both,,,45,,,,,,,,,, Admin pneumococcal vaccine,G0009,HCPCS,,Both,,,45,,,,,,,,,, WOUND CLOSURE BY ADHESIVE,G0168,HCPCS,,Both,,,456,,,,,,,,,, Inject for sacroiliac joint,G0259,HCPCS,,Both,,,243,,,,,,,,,, Inj for sacroiliac jt anesth,G0260,HCPCS,,Both,,,661,,,,,,,,,, Removal of impacted wax md,G0268,HCPCS,,Both,,,401,,,,,,,,,, HOSPITAL OBSERVATION PER HR,G0378,HCPCS,,Both,,,3024,,,,,,,,,, INITIAL PREVENTIVE EXAM,G0402,HCPCS,,Both,,,2520,,,,,,,,,, DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,,Both,,,684,,,,,,,,,, DRUG TEST DEF 8-14 CLASSES,G0481,HCPCS,,Both,,,600,,,,,,,,,, "Drug confirmation, each procedure",G6058,HCPCS,,Both,,,684,,,,,,,,,, ASA/ANTIPLAT THER USED,G8598,HCPCS,,Both,,,72,,,,,,,,,, NO ELIG TPA INIT W/IN 3 HRS,G8601,HCPCS,,Both,,,1362,,,,,,,,,, NO TPA INIT W/IN 3 HRS,G8602,HCPCS,,Both,,,1362,,,,,,,,,, AMOXICILLIN 400MG SUS 100ML,G9315,HCPCS,,Both,,,5,,,,,,,,,, TETRACYCLIN INJECTION,J0120,HCPCS,,Both,0.25,GM,228,,,,,,,,,, ABATACEPT INJECTION,J0129,HCPCS,,Both,0.01,GM,288,,,,,,,,,, ABCIXIMAB 2MG/ML 5ML INJ,J0130,HCPCS,,Both,0.01,GM,8141,,,,,,,,,, "Injection, acetaminophen, not otherwise specified, 10 mg",J0131,HCPCS,,Both,0.01,GM,15,,,,,,,,,, ACYCLOVIR 500MG INJ,J0133,HCPCS,,Both,0.005,GM,71,,,,,,,,,, Injection adenosine 6 MG,J0150,HCPCS,,Both,0.006,GM,97,,,,,,,,,, Adenosine injection,J0152,HCPCS,,Both,0.03,GM,1367,,,,,,,,,, ADENOSINE INJ 1MG,J0153,HCPCS,,Both,0.001,GM,138,,,,,,,,,, EPINEPHRINE 0.1MG/ML 10ML 3.5in,J0170,HCPCS,,Both,1,ML,65,,,,,,,,,, AMIFOSTINE 500MG INJ,J0207,HCPCS,,Both,0.5,GM,3732,,,,,,,,,, METHYLDOPATE 500MG/10ML INJ,J0210,HCPCS,,Both,0.25,GM,530,,,,,,,,,, Alpha 1 proteinase inhibitor,J0256,HCPCS,,Both,0.01,GM,50,,,,,,,,,, AMIKACIN 500MG/2ML 2ML,J0278,HCPCS,,Both,0.1,GM,13,,,,,,,,,, AMINOPHYLLINE 250MG/10ML 10ML,J0280,HCPCS,,Both,0.25,GM,15,,,,,,,,,, AMIODARONE 500 ML IV SOLUTION,J0282,HCPCS,,Both,0.03,GM,20,,,,,,,,,, AMIODARONE HCL (Nexterone),J0283,HCPCS,,Both,0.03,GM,138,,,,,,,,,, Amiodarone 30mg INJECTION,J0282,HCPCS,,Both,0.03,GM,20,,,,,,,,,, AMPHOTERICIN B 50MG INJ,J0285,HCPCS,,Both,0.05,GM,142,,,,,,,,,, AMPHOTERICIN 5MG/ML 20ML INJ,J0287,HCPCS,,Both,0.01,GM,143,,,,,,,,,, Amphotericin b liposome inj,J0289,HCPCS,,Both,0.01,GM,195,,,,,,,,,, AMPICILLIN 500 MG INJ,J0290,HCPCS,,Both,0.5,GM,60,,,,,,,,,, AMPICILLIN SODIUM PER 1.5 GM,J0295,HCPCS,,Both,1.5,GM,337,,,,,,,,,, SUCCINYLCHOLINE 20MG/ML 200 MG SOLN,J0330,HCPCS,,Both,0.02,GM,257,,,,,,,,,, ANIDULAFUNGIN 50MG INJ,J0348,HCPCS,,Both,0.001,GM,11,,,,,,,,,, HYDRALAZINE HCL INJECTION,J0360,HCPCS,,Both,0.02,GM,228,,,,,,,,,, APROTININ 10MU/ML 200ML INJ,J0365,HCPCS,,Both,10000,UN,33,,,,,,,,,, INJ METARAMINOL BITARTRATE,J0380,HCPCS,,Both,0.01,GM,228,,,,,,,,,, "Injection, azithromycin, 500 mg",J0456,HCPCS,,Both,0.5,GM,228,,,,,,,,,, ATROPINE 1MG/10ML 1 MG SYRINGE,J0460,HCPCS,,Both,0.0003,GM,68,,,,,,,,,, ATROPINE SULFATE INJECTION,J0461,HCPCS,,Both,0.00001,GM,72,,,,,,,,,, Baclofen 10 MG injection,J0475,HCPCS,,Both,0.01,GM,2004,,,,,,,,,, DICYCLOMINE INJECTION,J0500,HCPCS,,Both,0.02,GM,271,,,,,,,,,, BENZTROPINE 1MG/ML 2ML,J0515,HCPCS,,Both,0.001,GM,263,,,,,,,,,, PENICILLIN G BENZATHINE 600000 U/ML 1 ML DISP SYRIN,J0530,HCPCS,,Both,600000,UN,291,,,,,,,,,, Penicillin g benzathine inj,J0540,HCPCS,,Both,1200000,UN,504,,,,,,,,,, PenG benzathine/procaine inj,J0558,HCPCS,,Both,100000,UN,51,,,,,,,,,, "Injection, penicillin G benzathine, 100,000 units",J0561,HCPCS,,Both,100000,UN,78,,,,,,,,,, BIVALIRUDIN 1MG INJ,J0583,HCPCS,,Both,0.001,GM,40,,,,,,,,,, BOTULINUM 100U INJ,J0585,HCPCS,,Both,1,UN,68,,,,,,,,,, Abobotulinumtoxin A,J0586,HCPCS,,Both,5,UN,88,,,,,,,,,, "INJ, RIMABOTULINUMTOXINB",J0587,HCPCS,,Both,100,UN,136,,,,,,,,,, BUPRENORPHINE 0.3MG/ML,J0592,HCPCS,,Both,0.0001,GM,12,,,,,,,,,, Butorphanol tartrate 1 mg,J0595,HCPCS,,Both,0.001,GM,22,,,,,,,,,, Butorphanol Tartrate (Stadol) 2mg Inj,J0595,HCPCS,,Both,0.001,GM,37,,,,,,,,,, CALCIUM GLUCONATE INJECTION,J0610,HCPCS,,Both,10,ML,205,,,,,,,,,, "Injection, calcium gluconate (fresenius kabi), per 10 mg",J0612,HCPCS,,Both,0.01,GM,138,,,,,,,,,, CALCITONIN 200IU/ML 0.5ML,J0630,HCPCS,,Both,400,UN,863,,,,,,,,,, CALCITRIOL 1MCG/ML 1ML,J0636,HCPCS,,Both,1,GM,5,,,,,,,,,, CASPOFUNGIN ACET 50MG 10ML INJ,J0637,HCPCS,,Both,0.005,GM,167,,,,,,,,,, LEUCOVORIN CA 100MG INJ,J0640,HCPCS,,Both,0.05,GM,56,,,,,,,,,, Levoleucovorin injection,J0641,HCPCS,,Both,0.0005,GM,22,,,,,,,,,, "Injection, bupivicaine 0.5mg",J0665,HCPCS,,Both,0.0005,GM,50,,,,,,,,,, INJ MEPIVACAINE HCL/10 ML,J0670,HCPCS,,Both,10,ML,166,,,,,,,,,, CEFAZOLIN SODIUM INJECTION,J0690,HCPCS,,Both,0.5,GM,228,,,,,,,,,, CEFEPIME HCL FOR INJECTION 500MG,J0692,HCPCS,,Both,0.5,GM,228,,,,,,,,,, Cefoxitin sodium injection 1GM,J0694,HCPCS,,Both,1,GM,506,,,,,,,,,, CEFTRIAXONE SODIUM INJECTION,J0696,HCPCS,,Both,0.25,GM,228,,,,,,,,,, STERILE CEFUROXIME INJECTION,J0697,HCPCS,,Both,0.75,GM,50,,,,,,,,,, Cefotaxime sodium injection,J0698,HCPCS,,Both,1,GM,64,,,,,,,,,, Betamethasone acet&sod phosp,J0702,HCPCS,,Both,0.003,GM,502,,,,,,,,,, Caffeine citrate injection,J0706,HCPCS,,Both,0.005,GM,6,,,,,,,,,, Inj ceftazidime per 500 mg,J0713,HCPCS,,Both,0.5,GM,26,,,,,,,,,, CHLORAMPHENICOL 1GRAM INJ,J0720,HCPCS,,Both,1,GM,368,,,,,,,,,, Chorionic gonadotropin/1000u,J0725,HCPCS,,Both,1000,UN,193,,,,,,,,,, CLONIDINE HYDROCHLORIDE,J0735,HCPCS,,Both,0.001,GM,138,,,,,,,,,, "Injection, clindamycin phosphate, 300 mg",J0736,HCPCS,,Both,0.3,GM,50,,,,,,,,,, PRIMAXIN 500MG INJ,J0743,HCPCS,,Both,0.25,GM,71,,,,,,,,,, Ciprofloxacin 200mg-100mL Intravenous Injection ,J0744,HCPCS,,Both,0.2,GM,228,,,,,,,,,, CODEINE PHOSPHATE 60MG INJ,J0745,HCPCS,,Both,0.03,GM,20,,,,,,,,,, COLCHICINE 0.5MG/ML 2ML INJ,J0760,HCPCS,,Both,0.001,GM,100,,,,,,,,,, COLISTIMETHATE 150MG INJ,J0770,HCPCS,,Both,0.15,GM,154,,,,,,,,,, Prochlorperazine Edisylate up to 10 mg injection,J0780,HCPCS,,Both,0.01,GM,228,,,,,,,,,, Cosyntropin cortrosyn inj,J0834,HCPCS,,Both,0.005,GM,818,,,,,,,,,, DAPTOMYCIN 500MG INJ,J0878,HCPCS,,Both,0.001,GM,8,,,,,,,,,, DARBEPOETIN ALFA 60MCG/ML,J0881,HCPCS,,Both,0.000001,GM,45,,,,,,,,,, "Darbepoetin alfa, esrd use",J0882,HCPCS,,Both,0.000001,GM,45,,,,,,,,,, "EPOETIN ALFA 20,000U/1ML",J0885,HCPCS,,Both,1000,UN,140,,,,,,,,,, Decitabine injection,J0894,HCPCS,,Both,0.001,GM,435,,,,,,,,,, DEFEROXAMINE 2GM INJ,J0895,HCPCS,,Both,0.5,GM,99,,,,,,,,,, DENOSUMAB INJECTION,J0897,HCPCS,,Both,0.001,GM,177,,,,,,,,,, TESTOSTERON ENANT 200MG/ML 1ML,J0900,HCPCS,,Both,1,ML,417,,,,,,,,,, Depo-estradiol cypionate inj,J1000,HCPCS,,Both,0.005,GM,101,,,,,,,,,, METHYLPREDNISOLONE 20 MG INJ,J1020,HCPCS,,Both,0.02,GM,108,,,,,,,,,, METHYLPREDNISOLONE 40 MG INJ,J1030,HCPCS,,Both,0.04,GM,120,,,,,,,,,, MEDROXYPROGESTERONE ACETATE,J1050,HCPCS,,Both,0.001,GM,3,,,,,,,,,, DEXAMETHASONE 8MG/ML 1ML,J1094,HCPCS,,Both,0.001,GM,32,,,,,,,,,, DEXAMETHASONE SODIUM PHOS 1MG INJ,J1100,HCPCS,,Both,0.001,GM,28,,,,,,,,,, DIHYDROERGOTAMINE 1MG/ML,J1110,HCPCS,,Both,0.001,GM,418,,,,,,,,,, ACETAZOLAMIDE 500MG 1ML,J1120,HCPCS,,Both,0.5,GM,2960,,,,,,,,,, DIGOXIN INJECTION,J1160,HCPCS,,Both,0.0005,GM,180,,,,,,,,,, DIGOXIN IMMUNE 38MG INJ,J1162,HCPCS,,Both,1,EA,15517,,,,,,,,,, PHENYTOIN SODIUM INJECTION,J1165,HCPCS,,Both,0.05,GM,61,,,,,,,,,, Dexrazoxane HCl injection,J1190,HCPCS,,Both,0.25,GM,1746,,,,,,,,,, DIPHENHYDRAMINE HCL INJECTIO,J1200,HCPCS,,Both,0.05,GM,26,,,,,,,,,, CHLOROTHIAZIDE 500MG INJ,J1205,HCPCS,,Both,0.5,GM,2050,,,,,,,,,, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,Both,50,ML,992,,,,,,,,,, DIMENHYDRINATE 50MG/ML 1ML INJ,J1240,HCPCS,,Both,0.05,GM,65,,,,,,,,,, DIPYRIDAMOLE 5MG/ML 10ML,J1245,HCPCS,,Both,0.01,GM,10,,,,,,,,,, DOBUTAMINE INJECTION 250MG,J1250,HCPCS,,Both,0.25,GM,55,,,,,,,,,, DOLASETRON 100MG/5ML INJ,J1260,HCPCS,,Both,0.01,GM,68,,,,,,,,,, DOPAMINE INJECTION,J1265,HCPCS,,Both,0.04,GM,48,,,,,,,,,, EPTIFIBATIDE 0.75MG/ML 100ML,J1327,HCPCS,,Both,0.005,GM,351,,,,,,,,,, ERTAPENEM INJECTION 500MG,J1335,HCPCS,,Both,0.5,GM,595,,,,,,,,,, "Injection, erythromycin lactobionate, per 500 mg",J1364,HCPCS,,Both,0.5,GM,144,,,,,,,,,, Estradiol valerate 10 MG inj,J1380,HCPCS,,Both,0.01,GM,109,,,,,,,,,, ESTROGEN CONJ 25MG INJ,J1410,HCPCS,,Both,0.025,GM,1870,,,,,,,,,, ETHANOLAMINE OLEATE 5% 2ML INJ,J1430,HCPCS,,Both,0.1,GM,3749,,,,,,,,,, Etanercept injection,J1438,HCPCS,,Both,0.025,GM,3189,,,,,,,,,, FILGRASTIM 300MCG/ML 1ML,J1440,HCPCS,,Both,1,ML,3609,,,,,,,,,, FILGRASTIM 300MCG/ML 1.6ML,J1441,HCPCS,,Both,0.00048,GM,5731,,,,,,,,,, Fluconazole,J1450,HCPCS,,Both,0.2,GM,49,,,,,,,,,, Fosaprepitant injection,J1453,HCPCS,,Both,0.001,GM,21,,,,,,,,,, Inj IVIG privigen 500 mg,J1459,HCPCS,,Both,0.5,GM,456,,,,,,,,,, "Injection, gamma globulin, intramuscular, 10 cc",J1550,HCPCS,,Both,10,ML,36,,,,,,,,,, GAMUNEX-C/GAMMAKED,J1561,HCPCS,,Both,0.5,GM,506,,,,,,,,,, "Immune globulin, powder",J1566,HCPCS,,Both,0.5,GM,447,,,,,,,,,, Octagam injection,J1568,HCPCS,,Both,0.5,GM,394,,,,,,,,,, Gammagard liquid injection,J1569,HCPCS,,Both,0.5,GM,491,,,,,,,,,, GANCICLOVIR 500MG INJ,J1570,HCPCS,,Both,0.5,GM,921,,,,,,,,,, Garamycin gentamicin inj 80 MG,J1580,HCPCS,,Both,0.08,GM,59,,,,,,,,,, Gold sodium thiomaleate inj,J1600,HCPCS,,Both,0.05,GM,377,,,,,,,,,, GLUCAGON HYDROCHLORIDE/1 MG,J1610,HCPCS,,Both,0.001,GM,1251,,,,,,,,,, GRANISETRON 1MG/ML INJ,J1626,HCPCS,,Both,0.0001,GM,6,,,,,,,,,, HALOPERIDOL 5MG INJ,J1630,HCPCS,,Both,0.0001,GM,452,,,,,,,,,, HALOPERIDOL DECANOATE INJ,J1631,HCPCS,,Both,0.05,GM,378,,,,,,,,,, INJ HEPARIN SODIUM PER 10 U,J1642,HCPCS,,Both,10,ML,35,,,,,,,,,, INJ HEPARIN SODIUM PER 1000U,J1644,HCPCS,,Both,1000,ML,228,,,,,,,,,, DALTEPARIN 2500 UNITS,J1645,HCPCS,,Both,2500,UN,162,,,,,,,,,, ENOXAPARIN SODIUM (LOVENOX) - INJ 10MG,J1650,HCPCS,,Both,0.01,GM,70,,,,,,,,,, FONDAPARINUX 2.5MG/0.5ML INJ,J1652,HCPCS,,Both,0.0005,GM,49,,,,,,,,,, TETANUS IMMUNE GLOBULIN INJ,J1670,HCPCS,,Both,250,UN,753,,,,,,,,,, HYDROCORTISONE 100MG INJ,J1720,HCPCS,,Both,0.1,GM,117,,,,,,,,,, DIAZOXIDE 300MG/20ML INJ,J1730,HCPCS,,Both,0.3,GM,1699,,,,,,,,,, Ibandronate sodium injection,J1740,HCPCS,,Both,0.001,GM,1941,,,,,,,,,, IBUPROFEN INJECTION,J1741,HCPCS,,Both,0.1,GM,35,,,,,,,,,, IBUTILIDE 0.1MG/ML 10ML INJ,J1742,HCPCS,,Both,0.001,GM,987,,,,,,,,,, INFLIXIMAB 100MG INJ,J1745,HCPCS,,Both,0.01,GM,874,,,,,,,,,, Inj iron dextran,J1750,HCPCS,,Both,0.05,GM,152,,,,,,,,,, IRON SUCROSE 20MG/ML 5ML,J1756,HCPCS,,Both,0.001,GM,3,,,,,,,,,, DROPERIDOL 2.5MG/ML 1ML INJ,J1790,HCPCS,,Both,0.005,GM,27,,,,,,,,,, "propranolol HCl, up to 1 mg Injection",J1800,HCPCS,,Both,0.001,GM,32,,,,,,,,,, HUMULIN R INSULIN INJECTION,J1815,HCPCS,,Both,5,UN,60,,,,,,,,,, INSULIN FOR INSULIN PUMP USE,J1817,HCPCS,,Both,50,UN,138,,,,,,,,,, ITRACONAZOLE 200MG IV KIT,J1835,HCPCS,,Both,0.05,GM,4,,,,,,,,,, "Injection, metronidazole, 10 mg",J1836,HCPCS,,Both,0.01,GM,50,,,,,,,,,, KANAMYCIN 1GM/3ML 3ML INJ,J1840,HCPCS,,Both,0.5,GM,96,,,,,,,,,, INJECTION KETOROLAC TROMETHAMINE PER 15MG,J1885,HCPCS,,Both,0.015,GM,114,,,,,,,,,, "Injection, labetalol hydrochloride, 5 mg",J1920,HCPCS,,Both,0.005,GM,350,,,,,,,,,, "Inj labetalol hcl hikma, 5mg",J1921,HCPCS,,Both,0.005,GM,350,,,,,,,,,, LANREOTIDE INJECTION,J1930,HCPCS,,Both,0.001,GM,359,,,,,,,,,, "Injection, furosemide (furoscix), 20 mg",J1941,HCPCS,,Both,0.02,GM,198,,,,,,,,,, LEPIRUDIN 50MG 1ML INJ,J1945,HCPCS,,Both,0.05,GM,7132,,,,,,,,,, LEUPROLIDE 11.25MG DEPOT 3MO,J1950,HCPCS,,Both,0.00375,GM,9349,,,,,,,,,, Levetiracetam injection,J1953,HCPCS,,Both,0.01,GM,77,,,,,,,,,, "Injection, levofloxacin, 250mg ",J1956,HCPCS,,Both,0.25,GM,178,,,,,,,,,, HYOSCYAMINE 0.5MG/ML INJ,J1980,HCPCS,,Both,0.00025,GM,889,,,,,,,,,, "Injection, lidocaine HCl for intravenous infusion 10 mg",J2001,HCPCS,,Both,0.01,GM,43,,,,,,,,,, LINCOMYCIN 600MG/2ML 2ML,J2010,HCPCS,,Both,0.3,GM,97,,,,,,,,,, LINEZOLID 600MG/300ML,J2020,HCPCS,,Both,0.2,GM,496,,,,,,,,,, LORAZEPAM INJECTION,J2060,HCPCS,,Both,0.002,GM,228,,,,,,,,,, MANNITOL 25% 50ML INJ,J2150,HCPCS,,Both,,,38,,,,,,,,,, MEPERIDINE HYDROCHL /100 MG,J2175,HCPCS,,Both,0.1,GM,138,,,,,,,,,, MEROPENEM 1GM INJ,J2185,HCPCS,,Both,0.1,GM,9,,,,,,,,,, METHYLERGONOVINE INJ Up To 0.2 Mg,J2210,HCPCS,,Both,0.0002,GM,46,,,,,,,,,, INJ MIDAZOLAM HYDROCHLORIDE,J2250,HCPCS,,Both,0.001,GM,228,,,,,,,,,, MILRINONE 1MG/ML 20ML,J2260,HCPCS,,Both,0.005,GM,32,,,,,,,,,, MORPHINE SULFATE INJECTION UP TO 10MG,J2270,HCPCS,,Both,0.01,GM,8,,,,,,,,,, IN MORPHINE PRESERVATIV FREE,J2274,HCPCS,,Both,0.01,GM,228,,,,,,,,,, "Inj, moxifloxacin 100 mg",J2280,HCPCS,,Both,0.1,GM,42,,,,,,,,,, Inj nalbuphine hydrochloride 10 Mg,J2300,HCPCS,,Both,0.01,GM,75,,,,,,,,,, "Inj, nitroglycerin, 5 mg",J2305,HCPCS,,Both,0.005,GM,22,,,,,,,,,, Natalizumab injection,J2323,HCPCS,,Both,0.001,GM,161,,,,,,,,,, NESIRITIDE 1.5MG 5ML INJ,J2325,HCPCS,,Both,0.0001,GM,753,,,,,,,,,, "Octreotide injection, depot",J2353,HCPCS,,Both,0.001,GM,1702,,,,,,,,,, OCTREOTIDE INJ 25 MCG,J2354,HCPCS,,Both,0.000025,GM,33,,,,,,,,,, OPRELVEKIN 5MG INJ,J2355,HCPCS,,Both,0.005,GM,3457,,,,,,,,,, Omalizumab injection,J2357,HCPCS,,Both,0.005,GM,319,,,,,,,,,, ORPHENADRINE INJECTION,J2360,HCPCS,,Both,0.06,GM,228,,,,,,,,,, PHENYLEPHRINE HCL INJECTION,J2370,HCPCS,,Both,1,ML,180,,,,,,,,,, "Injection, phenylephrine hydrochloride, 20 micrograms",J2371,HCPCS,,Both,0.00002,GM,180,,,,,,,,,, CHLOROPROCAINE HCL 2% 30ML,J2400,HCPCS,,Both,30,ML,207,,,,,,,,,, ONDANSETRON HCL INJECTION,J2405,HCPCS,,Both,0.001,GM,28,,,,,,,,,, OXYMORPHONE HCL INJECTION,J2410,HCPCS,,Both,0.001,GM,138,,,,,,,,,, PALIFERMIN INJECTION,J2425,HCPCS,,Both,0.00005,GM,138,,,,,,,,,, Pamidronate disodium /30 MG,J2430,HCPCS,,Both,0.03,GM,134,,,,,,,,,, PAPAVERINE 30MG/ML 10ML,J2440,HCPCS,,Both,0.06,GM,19,,,,,,,,,, Palonosetron hcl,J2469,HCPCS,,Both,0.000025,GM,242,,,,,,,,,, PARICALCITOL 5MCG INJ,J2501,HCPCS,,Both,0.000001,GM,20,,,,,,,,,, "PEGADEMASE BOVINE, 25 IU",J2504,HCPCS,,Both,25,UN,138,,,,,,,,,, PEGFILGRASTIM 6MG INJ,J2505,HCPCS,,Both,0.006,GM,39003,,,,,,,,,, PENICILLIN G PRO 1.2MU/2ML 2ML,J2510,HCPCS,,Both,600000,UN,187,,,,,,,,,, PENTOBARBITAL 50MG/ML 2ML INJ,J2515,HCPCS,,Both,100,ML,402,,,,,,,,,, PENICILLIN G POT 10MMU,J2540,HCPCS,,Both,600000,UN,99,,,,,,,,,, PIPERACILLIN/TAZOBACTAM,J2543,HCPCS,,Both,1,GM,228,,,,,,,,,, Pentamidine non-comp unit,J2545,HCPCS,,Both,0.3,GM,1037,,,,,,,,,, PROMETHAZINE HCL INJECTION,J2550,HCPCS,,Both,0.05,GM,173,,,,,,,,,, PHENOBARBITAL 130MG/ML INJ,J2560,HCPCS,,Both,0.12,GM,132,,,,,,,,,, OXYTOCIN 10U/ML 1ML INJ,J2590,HCPCS,,Both,10,UN,135,,,,,,,,,, Inj desmopressin acetate,J2597,HCPCS,,Both,0.000001,GM,70,,,,,,,,,, Inj progesterone per 50 MG,J2675,HCPCS,,Both,0.05,GM,19,,,,,,,,,, FLUPHENAZINE DEC 25MG/ML 1ML,J2680,HCPCS,,Both,0.025,GM,237,,,,,,,,,, PROCAINAMIDE HCL 100MG/ML 10ML,J2690,HCPCS,,Both,1,GM,236,,,,,,,,,, OXACILLIN 1GM INJ,J2700,HCPCS,,Both,0.25,GM,27,,,,,,,,,, "INJ, PROPOFOL, 10 MG",J2704,HCPCS,,Both,0.01,GM,138,,,,,,,,,, NEOSTIGMINE 1:2000 10ML INJ,J2710,HCPCS,,Both,0.0005,GM,7,,,,,,,,,, PROTAMINE 250MG/25ML INJ,J2720,HCPCS,,Both,0.01,GM,11,,,,,,,,,, PHENTOLAMINE 5MG INJ,J2760,HCPCS,,Both,0.005,GM,1433,,,,,,,,,, METOCLOPRAMIDE HCL INJECTION,J2765,HCPCS,,Both,0.01,GM,228,,,,,,,,,, QUINOPRISTIN/DALFOPRISTIN 10ML,J2770,HCPCS,,Both,0.5,GM,2429,,,,,,,,,, RANITIDINE HYDROCHLORIDE INJ,J2780,HCPCS,,Both,0.025,GM,138,,,,,,,,,, RASBURICASE 1.5MG INJ,J2783,HCPCS,,Both,0.0005,GM,2642,,,,,,,,,, Injection Rho D immune globulin human full dose 300mcg - 1500 IU,J2790,HCPCS,,Both,0.0003,GM,1034,,,,,,,,,, Rhophylac injection,J2791,HCPCS,,Both,100,UN,60,,,,,,,,,, WINRHO 5000U 2.5ML,J2792,HCPCS,,Both,100,UN,233,,,,,,,,,, RISPERIDONE 25MG INJ,J2794,HCPCS,,Both,0.0005,GM,72,,,,,,,,,, ROPIVACAINE 5MG/ML 30ML INJ,J2795,HCPCS,,Both,0.001,GM,1,,,,,,,,,, METHOCARBAMOL INJECTION,J2800,HCPCS,,Both,10,ML,603,,,,,,,,,, SINCALIDE 5MCG INJ,J2805,HCPCS,,Both,0.000005,GM,1039,,,,,,,,,, SARGRAMOSTIM 500MCG INJ,J2820,HCPCS,,Both,0.00005,GM,357,,,,,,,,,, SECRETIN 16MCG INJ,J2850,HCPCS,,Both,0.000001,GM,344,,,,,,,,,, Na ferric gluconate complex,J2916,HCPCS,,Both,0.0125,GM,36,,,,,,,,,, RETEPLASE 10U,J2993,HCPCS,,Both,0.0181,GM,28774,,,,,,,,,, Alteplase recombinant Per 1 Mg,J2997,HCPCS,,Both,0.001,GM,203,,,,,,,,,, Streptomycin injection,J3000,HCPCS,,Both,1,GM,129,,,,,,,,,, FENTANYL CITRATE INJECITON 0.1MG,J3010,HCPCS,,Both,0.0001,GM,228,,,,,,,,,, SUMATRIPTAN SUCCINATE / 6 MG,J3030,HCPCS,,Both,0.006,GM,378,,,,,,,,,, PENTAZOCINE 30MG/ML INJ,J3070,HCPCS,,Both,0.03,GM,397,,,,,,,,,, "Injection, tenecteplase, 1 mg",J3101,HCPCS,,Both,0.001,GM,162,,,,,,,,,, TERBUTALINE 1MG/ML 1ML INJ,J3105,HCPCS,,Both,0.001,GM,57,,,,,,,,,, Testosterone enanthate inj,J3120,HCPCS,,Both,0.1,GM,90,,,,,,,,,, Testosterone enanthate inj,J3130,HCPCS,,Both,0.2,GM,127,,,,,,,,,, TESTOSTERON PROP 100MG/ML 10ML,J3150,HCPCS,,Both,0.1,GM,11,,,,,,,,,, CHLORPROMAZINE HCL 50 MG INJECTION,J3230,HCPCS,,Both,0.05,GM,182,,,,,,,,,, TIGECYCLINE 50MG INJ,J3243,HCPCS,,Both,0.001,GM,22,,,,,,,,,, TIROFIBAN HCL 12.5MG/50ML,J3246,HCPCS,,Both,0.00025,GM,112,,,,,,,,,, TRIMETHOBENZAMIDE 100MG/ML 2ML,J3250,HCPCS,,Both,0.2,GM,129,,,,,,,,,, TOBRAMYCIN SULFATE INJECTION,J3260,HCPCS,,Both,0.08,GM,528,,,,,,,,,, Tocilizumab injection,J3262,HCPCS,,Both,0.001,GM,46,,,,,,,,,, TORSEMIDE 20MG/2ML INJ,J3265,HCPCS,,Both,0.01,GM,60,,,,,,,,,, TRIAMCINOLONE ACET INJ (KENALOG 10MG),J3301,HCPCS,,Both,0.01,GM,60,,,,,,,,,, TRIAMCINOLONE 20MG/ML 1ML INJ,J3302,HCPCS,,Both,0.005,GM,4,,,,,,,,,, Triamcinolone hexacetonl inj,J3303,HCPCS,,Both,0.005,GM,36,,,,,,,,,, Inj trimetrexate glucoronate,J3305,HCPCS,,Both,0.025,GM,2203,,,,,,,,,, Ustekinumab injection,J3357,HCPCS,,Both,0.001,GM,1777,,,,,,,,,, DIAZEPAM INJECTION,J3360,HCPCS,,Both,0.005,GM,184,,,,,,,,,, UROKINASE 250MU INJ,J3365,HCPCS,,Both,250000,UN,7095,,,,,,,,,, HYDROXYZINE HCL INJECTION 25 Mg,J3410,HCPCS,,Both,0.025,GM,32,,,,,,,,,, THIAMINE HCL 100 MG,J3411,HCPCS,,Both,0.1,GM,228,,,,,,,,,, PYRIDOXINE 100MG/ML 1ML,J3415,HCPCS,,Both,0.1,GM,103,,,,,,,,,, CYANOCOBALAMIN 1000MG/ML 30ML,J3420,HCPCS,,Both,0.001,GM,133,,,,,,,,,, "VITAMIN K1, AMP 1MG INJECTION",J3430,HCPCS,,Both,0.001,GM,62,,,,,,,,,, VORICONAZOLE 200MG/20ML INJ,J3465,HCPCS,,Both,0.01,GM,56,,,,,,,,,, INJ MAGNESIUM SULFATE,J3475,HCPCS,,Both,0.5,GM,138,,,,,,,,,, INJ POTASSIUM CHLORIDE,J3480,HCPCS,,Both,2,ME,150,,,,,,,,,, ZIPRASIDONE MESYLATE,J3486,HCPCS,,Both,0.01,GM,228,,,,,,,,,, ZOLEDRONIC ACID 4MG INJ,J3487,HCPCS,,Both,0.001,GM,3425,,,,,,,,,, Acetylcysteine 200MG/ML INJ/ORAL SOLUTION,J3490,HCPCS,,Both,,,5,,,,,,,,,, AMMONIA AROMATIC ASPIROL 1 EA INHA,J3490,HCPCS,,Both,,,5,,,,,,,,,, Rocuronium Bromide 10 mg / mL Injection,J3490,HCPCS,,Both,,,26,,,,,,,,,, Robinul(Glycopyrrolate) 0.2 mg / mL Injection 1 mL ,J3490,HCPCS,,Both,,,404,,,,,,,,,, RACONIC (Bronchodilator Nephron) 2.25% Strength Inhalation Solution 0.5 mL,J3490,HCPCS,,Both,,,12,,,,,,,,,, LIDOCAINE JELLY 2% 30 APP GEL,J3490,HCPCS,,Both,,,18,,,,,,,,,, BUPIVICAINE (MARCAINE) 0.5% 10 ML INJECTION,J3490,HCPCS,,Both,,,22,,,,,,,,,, ENALAPRILAT 1.25MG/ML 2.5 MG INJECTION,J3490,HCPCS,,Both,,,24,,,,,,,,,, LABETALOL 5MG/ 20ML INJECTION,J3490,HCPCS,,Both,,,29,,,,,,,,,, CLINDAMYCIN 150MG/ML 300 MG INJECTION,J3490,HCPCS,,Both,,,30,,,,,,,,,, Erythromycin Eye Ointment 1 Application,J3490,HCPCS,,Both,,,34,,,,,,,,,, Vasopressin 20 Unit / mL Injection 10 mL,J3490,HCPCS,,Both,,,36,,,,,,,,,, Bupivacaine 0.5 % 5MG,J3490,HCPCS,,Both,,,38,,,,,,,,,, Pantoprazole Sodium (Protonix) 40mg inj,J3490,HCPCS,,Both,,,38,,,,,,,,,, NITROGLYCERIN 25MG/250ML 250 ML INJECTION,J3490,HCPCS,,Both,,,47,,,,,,,,,, Etomidate 2 mg / mL Injection 10 mL,J3490,HCPCS,,Both,,,84,,,,,,,,,, Scopolamine 1 mg / 3 Day Patch ,J3490,HCPCS,,Both,,,208,,,,,,,,,, BISACODYL 10 MG SUPP,J3490,HCPCS,,Both,,,5,,,,,,,,,, METRONIDAZOLE IN 0.9% SODIUM CHLORIDE 500 MG INJ,J3490,HCPCS,,Both,,,13,,,,,,,,,, ELA-MAX 5% 5 GM KIT,J3490,HCPCS,,Both,,,14,,,,,,,,,, "Sodium Bicarbonate, Preservative Free 8.4%, 1 mEq / mL Injection 50 mL",J3490,HCPCS,,Both,,,19,,,,,,,,,, "METOPROLOL TARTRATE, 1MG/ML 5ML/VL",J3490,HCPCS,,Both,,,20,,,,,,,,,, CLINDAMYCIN 600mg/4ml inj,J3490,HCPCS,,Both,,,27,,,,,,,,,, DILTIAZEM 25MG/5ML 25 MG INJECTION,J3490,HCPCS,,Both,,,35,,,,,,,,,, BUPIVICAINE 0.5%,J3490,HCPCS,,Both,,,38,,,,,,,,,, TETRACAINE 0.5% EYE DROPS,J3490,HCPCS,,Both,,,68,,,,,,,,,, Silvadene Cream 20gm,J3490,HCPCS,,Both,,,73,,,,,,,,,, Activated charcoal 15 gm,J3490,HCPCS,,Both,,,140,,,,,,,,,, FLUMAZENIL 0.1MG/ML 1 MG INJECTION,J3490,HCPCS,,Both,,,151,,,,,,,,,, Polytrim 10mu-0.1% eye drop,J3490,HCPCS,,Both,,,1,,,,,,,,,, ACETAMINOPHEN 120 MG SUPP,J3490,HCPCS,,Both,,,5,,,,,,,,,, ACETAMINOPHEN 325 MG SUPP,J3490,HCPCS,,Both,,,5,,,,,,,,,, ACTIVATED CHARCOAL/SORBITOL 240 ML LIQD,J3490,HCPCS,,Both,,,137,,,,,,,,,, TETANUS TOXOID ADSORBED 5 UNIT/ML 5 ML SOLN,J3490,HCPCS,,Both,,,302,,,,,,,,,, Lidocaine 2% Viscous SOL 10ML,J3490,HCPCS,,Both,,,17,,,,,,,,,, OXYMETAZOLINE 0.05% 1 EA SOLN,J3490,HCPCS,,Both,,,5,,,,,,,,,, STERILE WATER 10 ML SOLN,J3490,HCPCS,,Both,,,8,,,,,,,,,, RACEMIC EPINEPHRINE 2.25% 1 APP NEBU,J3490,HCPCS,,Both,,,11,,,,,,,,,, SODIUM BORATE 120 GTT SOLN (eye wash),J3490,HCPCS,,Both,,,12,,,,,,,,,, NOREPINEPHRINE 1MG/ML INJECTION,J3490,HCPCS,,Both,,,26,,,,,,,,,, KEPPRA(LEVETIRACETAM) 500 MG INJECTION VIAL,J3490,HCPCS,,Both,,,38,,,,,,,,,, Metoprolol Tartrate (Lopressor) 1mg inj,J3490,HCPCS,,Both,,,38,,,,,,,,,, Odansetron (Zofran) 2mg inj,J3490,HCPCS,,Both,,,38,,,,,,,,,, PROTONIX 40MG INJECTION,J3490,HCPCS,,Both,,,46,,,,,,,,,, PROPOFOL 10MG/ML 20 MLEMUL,J3490,HCPCS,,Both,,,48,,,,,,,,,, MULTI VITAMIN INJECTION,J3490,HCPCS,,Both,,,77,,,,,,,,,, KETAMINE 100MG/10ML 10MG/ML 1 EA SYRINGE,J3490,HCPCS,,Both,,,122,,,,,,,,,, NITROGLYCERIN 2% 1 IN OINT,J3490,HCPCS,,Both,,,200,,,,,,,,,, PROPOFOL 1OMG/ML 100 ML EMUL,J3490,HCPCS,,Both,,,235,,,,,,,,,, Tdap Injection,J3490,HCPCS,,Both,,,328,,,,,,,,,, NITROPRUSSIDE SODIUM 25MG/ML 1 ml vial,J3490,HCPCS,,Both,,,393,,,,,,,,,, NICARDIPINE(Cardene) INJ 0.9% SODIUM CHORIDE 20MG/200ML ,J3490,HCPCS,,Both,,,763,,,,,,,,,, ALLU_MAG HYDROX 30 ML LIQD,J3490,HCPCS,,Both,,,5,,,,,,,,,, CARBAMAZEPINE 100 MG CHEW,J3490,HCPCS,,Both,,,5,,,,,,,,,, DIPHENHYDRAMINE 12.5MG/5ML 12.5 MG ELIX,J3490,HCPCS,,Both,,,5,,,,,,,,,, FLUORISTRIPS 1 APP STRP,J3490,HCPCS,,Both,,,5,,,,,,,,,, GLYCERIN INFANT 1 SUP SUPP 1 Gram,J3490,HCPCS,,Both,,,5,,,,,,,,,, KEPPRA 500 MG CAPSULES,J3490,HCPCS,,Both,,,5,,,,,,,,,, TETRACAINE - PONTOCAINE 1% 2ML IMIIV,J3490,HCPCS,,Both,,,84,,,,,,,,,, Silver Nitrate 75%-25% 70 mg Applicator,J3490,HCPCS,,Both,,,5,,,,,,,,,, Vecuronium Bromide 1 mg / mL Injection,J3490,HCPCS,,Both,,,23,,,,,,,,,, Fluorescein Eye Drop,J3490,HCPCS,,Both,,,23,,,,,,,,,, Rocuronium BR 10mg/ml,J3490,HCPCS,,Both,,,50,,,,,,,,,, AURALGAN 15 GTT SOLN,J3490,HCPCS,,Both,,,50,,,,,,,,,, SODIUM BICARBONATE 4.2% 0.5 MEQ,J3490,HCPCS,,Both,,,82,,,,,,,,,, DIAZEPAM (CIV) 5MG/ML 10 MG INJECTION,J3490,HCPCS,,Both,,,155,,,,,,,,,, NORMAL SALINE SOLUTION INFUS INFUS 1000CC,J7030,HCPCS,,Both,1000,ML,296,,,,,,,,,, NORMAL SALINE SOLUTION INFUS,J7040,HCPCS,,Both,500,ML,265,,,,,,,,,, 5% DEXTROSE & 0.45% SODIUM CHLORIDE 500 ML INJECTI,J7042,HCPCS,,Both,500,ML,6,,,,,,,,,, 5% DEXTROSE & 0.45% SODIUM CHLORIDE 500 ML INJECTI,J7042,HCPCS,,Both,,,6,,,,,,,,,, 5% DEXTROSE & 0.9% SODIUM CHLORIDE 1000 ML INJECT,J7042,HCPCS,,Both,,,14,,,,,,,,,, NORMAL SALINE SOLUTION INFUS,J7050,HCPCS,,Both,250,ML,300,,,,,,,,,, 5% DEXTROSE/WATER,J7060,HCPCS,,Both,500,ML,300,,,,,,,,,, D5W INFUSION,J7070,HCPCS,,Both,1000,ML,138,,,,,,,,,, RINGERS LACTATE INFUSION,J7120,HCPCS,,Both,1000,ML,300,,,,,,,,,, 5% DEXTROSE IN LAC RINGERS,J7121,HCPCS,,Both,1000,ML,300,,,,,,,,,, HYPERTONIC SALINE SOL,J7131,HCPCS,,Both,1,ML,138,,,,,,,,,, FACTOR VIII RECOMBINANT NOS,J7192,HCPCS,,Both,1,UN,138,,,,,,,,,, "AMINOLEVULAN, 354MG (1 UNIT=354MG)",J7308,HCPCS,,Both,0.354,GM,2158,,,,,,,,,, FLUOCINOL ACET INTRAVIT IMP,J7313,HCPCS,,Both,0.00001,GM,138,,,,,,,,,, "GENVISC 850, INJ, 1MG",J7320,HCPCS,,Both,0.001,GM,138,,,,,,,,,, Hyalgan/supartz inj per dose,J7321,HCPCS,,Both,0.00001,GM,1111,,,,,,,,,, Orthovisc inj per dose,J7324,HCPCS,,Both,0.01,GM,2214,,,,,,,,,, Synvisc or Synvisc-One,J7325,HCPCS,,Both,1,GM,160,,,,,,,,,, AZATHIOPRINE 50MG TAB,J7500,HCPCS,,Both,0.05,GM,2,,,,,,,,,, CYCLOSPORINE MICR 100MG CAP,J7502,HCPCS,,Both,0.1,GM,40,,,,,,,,,, TACROLIMUS 1MG CAP,J7507,HCPCS,,Both,0.001,GM,20,,,,,,,,,, PREDNISOLONE ORAL PER 5 MG,J7510,HCPCS,,Both,0.005,GM,12,,,,,,,,,, PREDNISONE IMMEDIATE OR DELAYED RELEASE ORAL 1MG,J7512,HCPCS,,Both,0.001,GM,11,,,,,,,,,, CYCLOSPORINE 25MG CAP,J7515,HCPCS,,Both,0.025,GM,11,,,,,,,,,, CYCLOSPORINE 250MG 5ML INJ,J7516,HCPCS,,Both,0.25,GM,394,,,,,,,,,, MYCOPHENOLATE MOFET 250MG CAP,J7517,HCPCS,,Both,0.25,GM,13,,,,,,,,,, SIROLIMUS 1MG TAB,J7520,HCPCS,,Both,0.001,GM,166,,,,,,,,,, Arformoterol non-comp unit,J7605,HCPCS,,Both,0.000015,GM,69,,,,,,,,,, ACETYLCYSTEINE SOLN 1gm,J7608,HCPCS,,Both,1,GM,75,,,,,,,,,, ALBUTEROL NON-COMP CON,J7611,HCPCS,,Both,0.001,GM,228,,,,,,,,,, Levalbuterol neb non-compounded concentrated form 0.5 milligram,J7612,HCPCS,,Both,0.0005,GM,228,,,,,,,,,, ALBUTEROL NON-COMP UNIT,J7613,HCPCS,,Both,0.001,GM,228,,,,,,,,,, LEVALBUTEROL NON-COMP UNIT,J7614,HCPCS,,Both,0.0005,GM,228,,,,,,,,,, LEVALBUTEROL COMP UNIT,J7615,HCPCS,,Both,0.0005,GM,228,,,,,,,,,, ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,,Both,0.0025,GM,228,,,,,,,,,, BUDESONIDE NON-COMP UNIT,J7626,HCPCS,,Both,0.0005,GM,228,,,,,,,,,, CROMOLYN SODIUM NONCOMP UNIT,J7631,HCPCS,,Both,0.01,GM,138,,,,,,,,,, DEXAMETHASONE COMP CON,J7637,HCPCS,,Both,1,GM,138,,,,,,,,,, DEXAMETHASONE COMP UNIT,J7638,HCPCS,,Both,1,GM,138,,,,,,,,,, IPRATROPIUM BROMIDE NON-COMP,J7644,HCPCS,,Both,1,GM,228,,,,,,,,,, IPRATROPIUM BROMIDE COMP,J7645,HCPCS,,Both,1,GM,228,,,,,,,,,, TOBRAMYCIN NON-COMP UNIT,J7682,HCPCS,,Both,0.3,GM,138,,,,,,,,,, INHALATION SOLUTION FOR DME,J7699,HCPCS,,Both,,,138,,,,,,,,,, ANTIEMETIC RECTAL/SUPP NOS,J8498,HCPCS,,Both,,,138,,,,,,,,,, Promethazine 25mg Or 1 Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Glucotrol 10mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, Oral prescrip drug non chemo,J8499,HCPCS,,Both,,,5,,,,,,,,,, Xofluza,J8499,HCPCS,,Both,,,33,,,,,,,,,, PO Capsule75 Mg Tamiflu,J8499,HCPCS,,Both,,,36,,,,,,,,,, Linzess 145 Mcg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,, Oral prescrip drug non chemo,J8499,HCPCS,,Both,,,43,,,,,,,,,, Eliquis 2.5mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, Valtrex 100 Mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, APREPITANT 80MG TAB,J8501,HCPCS,,Both,0.005,GM,84,,,,,,,,,, CAPECITABINE 500MG TAB,J8520,HCPCS,,Both,0.15,GM,121,,,,,,,,,, CYCLOPHOSPHAMIDE 50MG TAB,J8530,HCPCS,,Both,0.025,GM,12,,,,,,,,,, DEXAMETHASONE 0.25 MG TAB,J8540,HCPCS,,Both,0.00025,GM,2,,,,,,,,,, MELPHALAN 2MG TAB,J8600,HCPCS,,Both,0.002,GM,109,,,,,,,,,, METHOTREXATE 2.5MG TAB,J8610,HCPCS,,Both,0.0025,GM,14,,,,,,,,,, DOXORUBICIN 10MG INJ,J9000,HCPCS,,Both,0.01,GM,43,,,,,,,,,, Arsenic trioxide injection,J9017,HCPCS,,Both,0.001,GM,618,,,,,,,,,, "ASPARAGINASE, NOS",J9020,HCPCS,,Both,10000,UN,807,,,,,,,,,, Azacitidine injection,J9025,HCPCS,,Both,0.001,GM,72,,,,,,,,,, Bcg live intravesical vac,J9031,HCPCS,,Both,0.001,GM,1511,,,,,,,,,, "Injection, bendamustine hydrochloride 1mg",J9033,HCPCS,,Both,0.001,GM,263,,,,,,,,,, Bevacizumab injection,J9035,HCPCS,,Both,0.01,GM,808,,,,,,,,,, BLEOMYCIN 15U INJ,J9040,HCPCS,,Both,15,UN,263,,,,,,,,,, Bortezomib injection,J9041,HCPCS,,Both,0.0001,GM,561,,,,,,,,,, Cabazitaxel injection,J9043,HCPCS,,Both,0.001,GM,1739,,,,,,,,,, CARBOPLATIN 50MG INJ,J9045,HCPCS,,Both,0.05,GM,38,,,,,,,,,, Carmustine injection,J9050,HCPCS,,Both,0.1,GM,10887,,,,,,,,,, Cetuximab injection,J9055,HCPCS,,Both,0.01,GM,657,,,,,,,,,, Cisplatin 10 MG injection,J9060,HCPCS,,Both,0.01,GM,26,,,,,,,,,, Inj cladribine per 1 MG,J9065,HCPCS,,Both,0.001,GM,300,,,,,,,,,, Cyclophosphamide 100 MG inj,J9070,HCPCS,,Both,0.1,GM,496,,,,,,,,,, CYTARABINE 100MG INJ,J9100,HCPCS,,Both,0.1,GM,12,,,,,,,,,, Dacarbazine 100 mg inj,J9130,HCPCS,,Both,0.1,GM,50,,,,,,,,,, Degarelix injection,J9155,HCPCS,,Both,0.001,GM,46,,,,,,,,,, Docetaxel injection,J9171,HCPCS,,Both,0.001,GM,58,,,,,,,,,, "Inj, epirubicin hcl, 2 mg",J9178,HCPCS,,Both,0.002,GM,15,,,,,,,,,, ERIBULIN MESYLATE INJECTION,J9179,HCPCS,,Both,0.0001,GM,1230,,,,,,,,,, ETOPOSIDE 100MG/ML 5ML,J9181,HCPCS,,Both,0.01,GM,9,,,,,,,,,, FLUDARABINE PHOS 50MG INJ,J9185,HCPCS,,Both,0.05,GM,1052,,,,,,,,,, FLUOROURACIL 50MG/ML 10ML,J9190,HCPCS,,Both,0.5,GM,25,,,,,,,,,, Floxuridine injection,J9200,HCPCS,,Both,0.5,GM,838,,,,,,,,,, GEMCITABINE 1GM INJ,J9201,HCPCS,,Both,0.2,GM,100,,,,,,,,,, GOSERELIN 3.6 MG SYRINGE,J9202,HCPCS,,Both,0.0036,GM,2427,,,,,,,,,, IRINOTECAN INJECTION,J9206,HCPCS,,Both,0.02,GM,138,,,,,,,,,, Ixabepilone injection,J9207,HCPCS,,Both,0.001,GM,858,,,,,,,,,, IFOSFAMIDE INJECTION,J9208,HCPCS,,Both,1,GM,388,,,,,,,,,, MESNA 1GM/10ML INJ,J9209,HCPCS,,Both,0.2,GM,36,,,,,,,,,, Idarubicin hcl injection,J9211,HCPCS,,Both,0.005,GM,441,,,,,,,,,, Interferon alfacon-1 inj,J9212,HCPCS,,Both,0.000001,GM,254,,,,,,,,,, Interferon alfa-2a inj,J9213,HCPCS,,Both,3000000,UN,574,,,,,,,,,, Interferon alfa-2b inj,J9214,HCPCS,,Both,1000000,UN,259,,,,,,,,,, Interferon alfa-n3 inj,J9215,HCPCS,,Both,250000,UN,476,,,,,,,,,, LEUPROLIDE 22.5MG KIT,J9217,HCPCS,,Both,0.0075,GM,2535,,,,,,,,,, LEUPROLIDE 30MG (4MOS),J9218,HCPCS,,Both,0.001,GM,128,,,,,,,,,, IPILIMUMAB INJECTION,J9228,HCPCS,,Both,0.001,GM,1612,,,,,,,,,, METHOTREXATE 25MG/ML 4ML INJ,J9250,HCPCS,,Both,0.005,GM,3,,,,,,,,,, Methotrexate sodium inj,J9260,HCPCS,,Both,0.05,GM,31,,,,,,,,,, Oxaliplatin,J9263,HCPCS,,Both,0.0005,GM,7,,,,,,,,,, Paclitaxel protein bound,J9264,HCPCS,,Both,0.001,GM,119,,,,,,,,,, PACLITAXEL 100MG/16.7ML INJ,J9265,HCPCS,,Both,0.03,GM,54,,,,,,,,,, MITOMYCIN 5MG INJ,J9280,HCPCS,,Both,0.005,GM,307,,,,,,,,,, MITOXANTRONE 2MG/ML 10ML,J9293,HCPCS,,Both,0.005,GM,433,,,,,,,,,, Panitumumab injection,J9303,HCPCS,,Both,0.01,GM,1142,,,,,,,,,, PEMETREXED 500MG INJ,J9305,HCPCS,,Both,0.01,GM,744,,,,,,,,,, Pralatrexate injection,J9307,HCPCS,,Both,0.001,GM,2283,,,,,,,,,, RITUXIMAB 500MG INJ,J9310,HCPCS,,Both,0.1,GM,8484,,,,,,,,,, Temsirolimus injection,J9330,HCPCS,,Both,0.001,GM,700,,,,,,,,,, Topotecan injection,J9351,HCPCS,,Both,0.0001,GM,27,,,,,,,,,, TRASTUZUMAB 440MG KIT,J9355,HCPCS,,Both,0.01,GM,984,,,,,,,,,, VINBLASTINE 1MG INJ,J9360,HCPCS,,Both,0.001,GM,21,,,,,,,,,, VINCRISTINE 1MG/ML 1ML,J9370,HCPCS,,Both,0.001,GM,72,,,,,,,,,, VINORELBINE 10MG/ML 5ML INJ,J9390,HCPCS,,Both,0.01,GM,110,,,,,,,,,, FULVESTRANT 250MG/5ML INJ,J9395,HCPCS,,Both,0.025,GM,1121,,,,,,,,,, CRANIAL CERVICAL ORTHOSIS,L0112,HCPCS,,Both,,,1362,,,,,,,,,, CERV FLEX N/ADJ FOAM PRE OTS,L0120,HCPCS,,Both,,,774,,,,,,,,,, CERV SEMI-RIG ADJ MOLDED CHN,L0150,HCPCS,,Both,,,812,,,,,,,,,, CERVICAL COLLAR MOLDED TO PT,L0170,HCPCS,,Both,,,420,,,,,,,,,, CERV COL SR FOAM 2PC PRE OTS,L0172,HCPCS,,Both,,,180,,,,,,,,,, CERV SR 2PC THOR EXT PRE OTS,L0174,HCPCS,,Both,,,1512,,,,,,,,,, CERVICAL COLLAR,L0180,HCPCS,,Both,,,32,,,,,,,,,, LO FLEX L1-BELOW L5 PRE OTS,L0625,HCPCS,,Both,,,780,,,,,,,,,, KO ELASTIC WITH JOINTS,L1810,HCPCS,,Both,,,1872,,,,,,,,,, KO IMMOBILIZER CANVAS LONGIT (Splint Knee 3 panel,L1830,HCPCS,,Both,,,635,,,,,,,,,, AFO ANKLE GAUNTLET PRE OTS,L1902,HCPCS,,Both,,,666,,,,,,,,,, AFO MULTILIG ANK SUP PRE OTS,L1906,HCPCS,,Both,,,420,,,,,,,,,, AFO POS SOLID ANK PLASTIC MO,L1960,HCPCS,,Both,,,504,,,,,,,,,, EXTENDED STEEL SHANK,L2360,HCPCS,,Both,,,564,,,,,,,,,, FOOT LAMIN/PREPREG COMPOSITE,L3031,HCPCS,,Both,,,690,,,,,,,,,, OXFORD W SUPINAT/PRONAT INF,L3201,HCPCS,,Both,,,510,,,,,,,,,, SURGICAL BOOT EACH CHILD,L3209,HCPCS,,Both,,,510,,,,,,,,,, CUSTOM MOLD SHOE REMOV PROST,L3250,HCPCS,,Both,,,690,,,,,,,,,, AMBULATORY SURGICAL BOOT EAC,L3260,HCPCS,,Both,,,780,,,,,,,,,, SHOE LIFT ELEV HEEL/SOLE NEO,L3310,HCPCS,,Both,,,498,,,,,,,,,, SHOE LIFTS ELEVATION HEEL /I,L3334,HCPCS,,Both,,,60,,,,,,,,,, ORTHO SHOE ADD LEATHER INSOL,L3500,HCPCS,,Both,,,468,,,,,,,,,, ORTHO SHOE ADD FULL SOLE,L3540,HCPCS,,Both,,,690,,,,,,,,,, SO 8 ABD RESTRAINT PRE OTS,L3650,HCPCS,,Both,,,373,,,,,,,,,, SO 8 AB RSTR CAN/WEB PRE OTS,L3660,HCPCS,,Both,,,690,,,,,,,,,, SO ACRO/CLAV CAN WEB PRE OTS,L3670,HCPCS,,Both,,,807,,,,,,,,,, FOREARM/ARM CUFFS FREE MOTIO,L3720,HCPCS,,Both,,,1170,,,,,,,,,, WHFO W/O JOINTS PRE CST,L3807,HCPCS,,Both,,,1532,,,,,,,,,, "WHFO, RIGID W/O JOINTS",L3808,HCPCS,,Both,,,2268,,,,,,,,,, WHFO W/O JOINTS PRE OTS,L3809,HCPCS,,Both,,,2268,,,,,,,,,, WHO W/NONTORSION JNT(S) CF,L3905,HCPCS,,Both,,,2268,,,,,,,,,, WHO W/O JOINTS CF,L3906,HCPCS,,Both,,,2421,,,,,,,,,, WHO COCK-UP NONMOLDE PRE OTS,L3908,HCPCS,,Both,,,640,,,,,,,,,, ANKLE CONTROL ORTHO PRE OTS,L4350,HCPCS,,Both,,,575,,,,,,,,,, PNEUMAT WALKING BOOT PRE CST,L4360,HCPCS,,Both,,,330,,,,,,,,,, PNEUMA/VAC WALK BOOT PRE OTS,L4361,HCPCS,,Both,,,330,,,,,,,,,, NON-PNEUM WALK BOOT PRE CST,L4386,HCPCS,,Both,,,1252,,,,,,,,,, NON-PNEUM WALK BOOT PRE OTS,L4387,HCPCS,,Both,,,615,,,,,,,,,, STATIC OR DYNAMI AFO PRE CST,L4396,HCPCS,,Both,,,318,,,,,,,,,, FOOT DROP SPLINT PRE OTS,L4398,HCPCS,,Both,,,184,,,,,,,,,, "AFO, WALK BOOT TYPE, CUS FAB",L4631,HCPCS,,Both,,,721,,,,,,,,,, Synthetic implnt urinary 1ml,L8606,HCPCS,,Both,,,2558,,,,,,,,,, "Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",M0239,HCPCS,,Both,,,1512,,,,,,,,,, "Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",M0243,HCPCS,,Both,,,1512,,,,,,,,,, "Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring",M0245,HCPCS,,Both,,,1512,,,,,,,,,, "Intravenous infusion, sotrovimab, includes infusion and post administration monitoring",M0247,HCPCS,,Both,,,450,,,,,,,,,, WHOLE BLOOD PROCESSING,P9010,HCPCS,,Both,,,3081,,,,,,,,,, CRYOPRECIPITATE PROCESSING,P9012,HCPCS,,Both,,,712,,,,,,,,,, RBC leukocytes reduced,P9016,HCPCS,,Both,,,2960,,,,,,,,,, Plasma 1 donor frz w/in 8 hr,P9017,HCPCS,,Both,,,1205,,,,,,,,,, PLATELET CONCENTRATE PROCESS,P9019,HCPCS,,Both,,,1128,,,,,,,,,, PLATELET RICH PLASMA PROCESS,P9020,HCPCS,,Both,,,2172,,,,,,,,,, RBC DIRECTED PROCESSING,P9021,HCPCS,,Both,,,2344,,,,,,,,,, WASHED RED BLOOD CELLS PROC,P9022,HCPCS,,Both,,,4341,,,,,,,,,, PLASMA POOL MLTI DNR TREAT FRZ,P9023,HCPCS,,Both,,,926,,,,,,,,,, PLATELET CONC L/R PROCESSING,P9031,HCPCS,,Both,,,1679,,,,,,,,,, "Platelets, irradiated",P9032,HCPCS,,Both,,,2198,,,,,,,,,, "Platelets, pheresis",P9034,HCPCS,,Both,,,6965,,,,,,,,,, PLATELET APHER/PHER L/R PROC,P9035,HCPCS,,Both,,,8180,,,,,,,,,, RBC irradiated,P9038,HCPCS,,Both,,,3406,,,,,,,,,, RED BLOOD CELLS DEGLYC PROCESS,P9039,HCPCS,,Both,,,5544,,,,,,,,,, RBC leukoreduced irradiated,P9040,HCPCS,,Both,,,3765,,,,,,,,,, ALBUMIN 5% 250ML,P9041,HCPCS,,Both,,,119,,,,,,,,,, "Albumin (human), 5%, 250 ml",P9045,HCPCS,,Both,,,597,,,,,,,,,, "Albumin (human), 25%, 20 ml",P9046,HCPCS,,Both,,,246,,,,,,,,,, "Albumin (human), 25%, 50ml",P9047,HCPCS,,Both,,,615,,,,,,,,,, "Plt, aph/pher, l/r, cmv-neg",P9055,HCPCS,,Both,,,6699,,,,,,,,,, CATHETERIZE FOR URINE SPEC,P9612,HCPCS,,Both,,,263,,,,,,,,,, "AZITHROMYCIN DIHYDRATE, ORAL",Q0144,HCPCS,,Both,,,239,,,,,,,,,, ONDANSETRON ODT 1 MG TBDP,Q0162,HCPCS,,Both,,,24,,,,,,,,,, DIPHENHYDRAMINE HCI 50mg,Q0163,HCPCS,,Both,,,32,,,,,,,,,, PROCHLORPERAZINE 5MG/ML 10 MG INJECTION,Q0165,HCPCS,,Both,,,19,,,,,,,,,, PROMETHAZINE HCL 12.5MG ORAL,Q0169,HCPCS,,Both,,,30,,,,,,,,,, Promethazine HCl 25 mg oral,Q0170,HCPCS,,Both,,,5,,,,,,,,,, "Injection, casirivimab and imdevimab, 2400 mg",Q0243,HCPCS,,Both,,,1,,,,,,,,,, "Injection, casirivimab and imdevimab, 1200 mg",Q0244,HCPCS,,Both,,,1,,,,,,,,,, "Injection, sotrovimab, 500 mg",Q0247,HCPCS,,Both,,,1,,,,,,,,,, FOSPHEYTOIN INJ 50 MG,Q2009,HCPCS,,Both,,,28,,,,,,,,,, "Afluria vacc, 3 yrs & >, im",Q2035,HCPCS,,Both,,,144,,,,,,,,,, "Flulaval vacc, 3 yrs & >, im",Q2036,HCPCS,,Both,,,107,,,,,,,,,, "Fluvirin vacc, 3 yrs & >, im",Q2037,HCPCS,,Both,,,187,,,,,,,,,, "Fluzone vacc, 3 yrs & >, im",Q2038,HCPCS,,Both,,,151,,,,,,,,,, SIPULEUCEL-T AUTO CD54+,Q2043,HCPCS,,Both,,,408875,,,,,,,,,, IMPORTED LIPODOX INJ,Q2049,HCPCS,,Both,,,6228,,,,,,,,,, Telehealth facility fee,Q3014,HCPCS,,Both,,,280,,,,,,,,,, INTERFERON BETA-1A 30MCG,Q3025,HCPCS,,Both,,,3839,,,,,,,,,, CAST SUP BODY CAST PLASTER,Q4001,HCPCS,,Both,,,1212,,,,,,,,,, CAST SUP LONG ARM ADULT FBRG,Q4006,HCPCS,,Both,,,1212,,,,,,,,,, "Cast supplies, long arm splint, adult (11 years +), fiberglass",Q4018,HCPCS,,Both,,,408,,,,,,,,,, CAST SUP LNG ARM SPLNT PED P,Q4019,HCPCS,,Both,,,960,,,,,,,,,, CAST SUP LNG ARM SPLNT PED F,Q4020,HCPCS,,Both,,,816,,,,,,,,,, CAST SUP SHT ARM SPLINT PLST,Q4021,HCPCS,,Both,,,882,,,,,,,,,, CAST SUP SHT ARM SPLINT FBRG,Q4022,HCPCS,,Both,,,684,,,,,,,,,, CAST SUP SHT ARM SPLNT PED P,Q4023,HCPCS,,Both,,,684,,,,,,,,,, CAST SUP SHT ARM SPLNT PED F,Q4024,HCPCS,,Both,,,684,,,,,,,,,, CAST SUP LNG LEG SPLNT FBRGL ADULT(11yrs+),Q4042,HCPCS,,Both,,,1212,,,,,,,,,, "Cast supplies, short leg splint, adult (11 years +), fiberglass",Q4046,HCPCS,,Both,,,1212,,,,,,,,,, "FINGER SPLINT, STATIC",Q4049,HCPCS,,Both,,,307,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 2in),Q4050,HCPCS,,Both,,,31,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 5in),Q4050,HCPCS,,Both,,,113,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 4in),Q4050,HCPCS,,Both,,,92,,,,,,,,,, CAST SUPPLIES UNLISTED (ORTHOGLASS 3in),Q4050,HCPCS,,Both,,,83,,,,,,,,,, SPLINT SUPPLIES MISC,Q4051,HCPCS,,Both,,,1212,,,,,,,,,, "HOCM <=149 mg/ml iodine, 1ml",Q9958,HCPCS,,Both,,,3,,,,,,,,,, "High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml",Q9960,HCPCS,,Both,,,31,,,,,,,,,, "HOCM 300-349MG/ML IODINE,1ML",Q9962,HCPCS,,Both,,,684,,,,,,,,,, "HOCM 350-399MG/ML IODINE,1ML",Q9963,HCPCS,,Both,,,276,,,,,,,,,, "LOCM 200-299MG/ML IODINE,1ML",Q9966,HCPCS,,Both,,,31,,,,,,,,,, "LOCM 300-399MG/ML IODINE,1ML",Q9967,HCPCS,,Both,,,2,,,,,,,,,, "INJECTION, BUPIVICAINE HYDRO",S0020,HCPCS,,Both,,,210,,,,,,,,,, "INJECTION, METRONIDAZOLE",S0030,HCPCS,,Both,,,370,,,,,,,,,, "INJECTION, CLINDAMYCIN PHOSP",S0077,HCPCS,,Both,,,150,,,,,,,,,, Cerebryx fosphenytoin 750 MG INJ,S0078,HCPCS,,Both,,,167,,,,,,,,,, ONDANSETRON ORAL 4 MG,S0119,HCPCS,,Both,,,174,,,,,,,,,, PROTONIX - PANTROPRAZOLE 40MG INJ (NON-MCR CARRIER),S0164,HCPCS,,Both,,,38,,,,,,,,,, Medical conference by physic,S0220,HCPCS,,Both,,,275,,,,,,,,,, "Medical conference, 60 min",S0221,HCPCS,,Both,,,275,,,,,,,,,, REMOVAL OF SUTURES,S0630,HCPCS,,Both,,,26,,,,,,,,,, IV TUBING EXTENSION SET,S1015,HCPCS,,Both,,,90,,,,,,,,,, SPACER WITHOUT MASK,S8100,HCPCS,,Both,,,138,,,,,,,,,, SPACER WITH MASK,S8101,HCPCS,,Both,,,138,,,,,,,,,, Quicktrach,S8189,HCPCS,,Both,,,1334,,,,,,,,,, PADDING FOR COMPRSSN BDG,S8430,HCPCS,,Both,,,83,,,,,,,,,, COMPRESSION BANDAGE,S8431,HCPCS,,Both,,,105,,,,,,,,,, SPLINT WRIST OR ANKLE,S8451,HCPCS,,Both,,,177,,,,,,,,,, Med record admin OLD FEE EFF UNTIL 4/3/24,S9981,HCPCS,,Both,,,89,,,,,,,,,, 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.,U0001,HCPCS,,Both,,,300,,,,,,,,,, "2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19)",U0002,HCPCS,,Both,,,360,,,,,,,,,, "Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",U0003,HCPCS,,Both,,,480,,,,,,,,,, "2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies",U0004,HCPCS,,Both,,,600,,,,,,,,,, MORGAN LENS X2,V2797,HCPCS,,Both,,,328,,,,,,,,,, MORGAN LENS X3,V2797,HCPCS,,Both,,,491,,,,,,,,,, MORGAN LENS,V2797,HCPCS,,Both,,,491,,,,,,,,,, Presumptive Drug Screening,80306,CPT ,,Both,,,249,,,,,,,,,, Respiratory Snycytial Virus Vaccine,90678,CPT ,,Both,,,1267,,,,,,,,,, Colon Cancer Screening,G0328,HCPCS,,Both,,,79,,,,,,,,,, "Pathogen specific RNA, 3 targets (SARS, FLU A, FLUB B)",0240U,CPT ,,Both,,,671,,,,,,,,,, "Pathogen Specific RNA, 4 targets (SARS, Flu A, Flu B, RSV)",0241U,CPT ,,Both,,,894,,,,,,,,,, Lidocaine 2% with Epinephrine,J3490,HCPCS,,Both,,,30,,,,,,,,,, Versed 3 mg Intranasal ,J3490,HCPCS,,Both,,,10,,,,,,,,,, Hydroxyzine 25 mg,S5001,HCPCS,,Both,,,3,,,,,,,,,, TRANEXAMI ACID 1000 MG,S5000,HCPCS,,Both,,,10,,,,,,,,,, CIPRODEX DROPS,J3490,HCPCS,,Both,,,10,,,,,,,,,, TAMSULOSIN HCI/FLOMAX CAP 0.4MG,J8499,HCPCS,,Both,,,34,,,,,,,,,, Cetirizine 10mg PO (ZYRTEC) ,A9150,HCPCS,,Both,,,5,,,,,,,,,, Lidocaine HCL Mucous Membrane,J3490,HCPCS,,Both,,,22,,,,,,,,,, Lidocaine 4% 50 ml,J3490,HCPCS,,Both,,,38,,,,,,,,,, Marcaine(Bupivacaine HCl) 0.5% 50 ml,J3490,HCPCS,,Both,,,36,,,,,,,,,, Simethicone 180 mg,J3490,HCPCS,,Both,,,5,,,,,,,,,, LET Gel Topical Anesthetic 1 oz,J3490,HCPCS,,Both,,,18,,,,,,,,,, Lidocaine 4% 50ml topical ,J3490,HCPCS,,Both,,,22,,,,,,,,,, Macrobid 25 mg,J8499,HCPCS,,Both,,,8,,,,,,,,,, Verapamil HCl 2.5 mg / 1 mL Inj,J3490,HCPCS,,Both,,,5,,,,,,,,,, Propranolol 20 mg,J8499,HCPCS,,Both,,,15,,,,,,,,,, Lidocaine 1% Muscosal Solution ,J3490,HCPCS,,Both,,,5,,,,,,,,,, Flexeril Cyclobenzarprine 5 mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, Albuterol inh non-comp per 1mg or Levalbuterol per 0.50mg(MCR replace code for J7611 & J7612),Q4093,HCPCS,,Both,,,228,,,,,,,,,, Albuterol inh non-comp u d per 1mg or Levalbuterol per 0.50mg(MCR replaced code for J7613 & J7614),Q4094,HCPCS,,Both,,,228,,,,,,,,,, Flexeril Cyclobenzaprine 5 mg,J8499,HCPCS,,Both,,,3,,,,,,,,,, Initial Comp Preventative Med E&M Age 5-11,99383,CPT ,,Both,,,457,,,,,,,,,, Initial Comp Preventative Med E&M Age 12-17,99384,CPT ,,Both,,,457,,,,,,,,,, Initial Comp Preventative Med E&M Age 18-39 ,99385,CPT ,,Both,,,559,,,,,,,,,, Inj Methylprednisolone Sodium Succinate 5 mg,J2919,HCPCS,,Both,,,50,,,,,,,,,, Albuterol COomp Con,J7610,HCPCS,,Both,,,19,,,,,,,,,, LIBRIUM 50MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,, NEOSYNEPHRINE NASAL SPRAY,J3490,HCPCS,,Both,,,5,,,,,,,,,, MACROBID 100MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,, FIORICET (BUTALBITAL 50MG-CAFFEINE 40MG-TYLENOL-325MG) PO,J8499,HCPCS,,Both,,,15,,,,,,,,,, METOCLOPRAMIDE 10MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,, IBUPROFEN (PED) 10MG,A9150,HCPCS,,Both,,,5,,,,,,,,,, PHENERGAN 25MG PO,J8499,HCPCS,,Both,,,15,,,,,,,,,, GI COCKTAIL,J8499,HCPCS,,Both,,,75,,,,,,,,,, "Injection, methylprednisolone acetate, 1 mg",J1010,HCPCS,,Both,,,10,,,,,,,,,, FAMOTIDINE 20 MG TABS,J8499,HCPCS,,Both,,,10,,,,,,,,,, Codeine Phosphate/Guaifenesin 10mg-100mg/5mL,J8499,HCPCS,,Both,,,53,,,,,,,,,, Removing sutures OR staples that do not require anesthesia,15853,CPT ,,Both,,,408,,,,,,,,,, Removal of sutures AND staples not requiring anesthesia,15854,CPT ,,Both,,,508,,,,,,,,,, CAST SUP LNG ARM CAST PED F,Q4008,HCPCS,,Both,,,1016,,,,,,,,,, CAST SUP SHT ARM CAST FBRG,Q4010,HCPCS,,Both,,,884,,,,,,,,,, GUAIFENESIN DM 10 ML ,J8499,HCPCS,,Both,,,50,,,,,,,,,, ASPIRIN 325MG ED TABLET,A9150,HCPCS,,Both,,,10,,,,,,,,,, Echocardiography transthoracic RT w image2D incl M-mode recording if done,93308,CPT ,,Both,,,899,,,,,,,,,, NICOTINE PATCH,S4990,HCPCS,,Both,,,23,,,,,,,,,, Trazodone HCl 150 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Losartan Potassium 25 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Losartan Potassium 50 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Metoprolol Tartrate 25 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Diltiazem HCl 120 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Lisinopril 20 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Ingestion challenge test seq/incremental ingestion of test items-initial 120min,95076,CPT ,,Both,,,616,,,,,,,,,, "ngestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing",95079,CPT ,,Both,,,426,,,,,,,,,, Risperidone 3 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Gabapentin 300 mg PO,J8499,HCPCS,,Both,,,75,,,,,,,,,, FLEET ENEMA,J3490,HCPCS,,Both,,,10,,,,,,,,,, CIPROFLOXACIN HCI OPHTALMIC 0.3% 2.5mL (drops),J3490,HCPCS,,Both,,,38,,,,,,,,,, Fluconazole 150 mg Tablet PO,J8499,HCPCS,,Both,,,75,,,,,,,,,, CARBAMIDE/DEBROX EAR DROPS,J3490,HCPCS,,Both,,,10,,,,,,,,,, Buspirone HCl 30 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Lovastatin 20 mg PO ,J8499,HCPCS,,Both,,,75,,,,,,,,,, Montelukast 10mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Sertraline 100 mg tablet ,J8499,HCPCS,,Both,,,75,,,,,,,,,, Lamotrigine 150mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Simvastatin 20mg tablet ,J8499,HCPCS,,Both,,,75,,,,,,,,,, Meloxicam 15mg tab,J8499,HCPCS,,Both,,,75,,,,,,,,,, Allopurinol 300 mg tablet ,J8499,HCPCS,,Both,,,75,,,,,,,,,, Isosorbide Dinitrate 10 mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Nebivolol 10 mg tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, BILLING RECORDS EFF 4/4/24,S9981,HCPCS,,Both,,,35,,,,,,,,,, MEC RCRDS ADMIN FEE EFF 4/4/24,S9981,HCPCS,,Both,,,45,,,,,,,,,, RADIOLOGY FILMS ADMIN EFF 4/4/24,S9981,HCPCS,,Both,,,75,,,,,,,,,, Questionnaire -(per set of 10) EFF AS OF 4/4/24,S9981,HCPCS,,Both,,,25,,,,,,,,,, SUBPOENAS ADMIN FEE EFF AS OF 4/4/24,S9981,HCPCS,,Both,,,125,,,,,,,,,, Radiology CD OLD FEE EFF UNTIL 4/3/24,S9981,HCPCS,,Both,,,75,,,,,,,,,, Direct Questions per set old fee eff until 4/3/24,S9981,HCPCS,,Both,,,10,,,,,,,,,, BACTRIM DS 800/160 TABLET,J8499,HCPCS,,Both,,,10,,,,,,,,,, Furosemide 40 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Amlodipine Besylate(NORASAC) 5 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Lorazepam(Ativan) 1 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Acetaminophen 500 mg tab,A9150,HCPCS,,Both,,,5,,,,,,,,,, ACTIVATED CHARCOAL-25GM LIQD(actidose),A9150,HCPCS,,Both,,,43,,,,,,,,,, Lidocaine / Prilocaine 2.5% - 2.5% Cream,J3490,HCPCS,,Both,,,38,,,,,,,,,, Acetaminophen 325 mg tab,A9150,HCPCS,,Both,,,5,,,,,,,,,, KEFLEX(Cephalexin) 500 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,, Phenytoin Sodium 100 mg Capsule,J8499,HCPCS,,Both,,,10,,,,,,,,,, Prilosec(Omeprazole) 20MG CAPSULE,A9150,HCPCS,,Both,,,5,,,,,,,,,, Carbamazepine 100 mg Chewable Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Tylenol with Codenine 300 Mg,J8499,HCPCS,,Both,,,10,,,,,,,,,, SODIUM POLYSTYRENE SULFONATE 15GM/60ML 15 GM SUSP,J8499,HCPCS,,Both,,,58,,,,,,,,,, ENALAPRIL 5 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,, IMODIUM/LOPERAMIDE 2MG PO,A9150,HCPCS,,Both,,,8,,,,,,,,,, DOXYCYCLINE 100MG TAB PO,J8499,HCPCS,,Both,,,37,,,,,,,,,, Fentanyl intranasal 100mg,J3490,HCPCS,,Both,,,30,,,,,,,,,, Ketamine HCl 50 mg IV/IM Injection,J3490,HCPCS,,Both,,,112,,,,,,,,,, PROPARACAINE HYDROCHLORIDE 5 mg/mL Ophthalmic Solution,J3490,HCPCS,,Both,,,26,,,,,,,,,, Oxcarbazepine 600 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, "Cast supplies, long arm splint, adult (11 years +), plaster",Q4017,HCPCS,,Both,,,408,,,,,,,,,, Lurasidone(LATUDA) HCl 60 mg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, "BACITRACIN, OINT 500U/GM",J3490,HCPCS,,Both,,,5,,,,,,,,,, "Tranexamic Acid 1,000 mg Injection/Solution 10mL",J3490,HCPCS,,Both,,,75,,,,,,,,,, Capsaicin 8% Gel,J3490,HCPCS,,Both,,,20,,,,,,,,,, Amitriptyline HCL 25mg TABLET,J8499,HCPCS,,Both,,,75,,,,,,,,,, Venlafaxine HCl 75 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Colcrys® Colchicine 0.6 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Compazine(Prochlorperazine Maleate) 10 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Escitalopram Oxalate 10 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Atorvastatin Calcium 10 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Kayexalate(Sodium Polystyrene Sulfonate) 15 Gram / 60 mL Suspension,J8499,HCPCS,,Both,,,20,,,,,,,,,, "Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass",Q4036,HCPCS,,Both,,,1212,,,,,,,,,, Levothyroxine Sodium 112 mcg Tablet,J8499,HCPCS,,Both,,,75,,,,,,,,,, Donnatal P Hyoscyamine-Atropine S Scopolamine Bromaide16.2mg Elixir 5 mL,J8499,HCPCS,,Both,,,66,,,,,,,,,, "Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use",90700,HCPCS,,Both,,,808,,,,,,,,,, "Cast supplies, long leg splint, pediatric (0-10 years), fiberglass",Q4044,HCPCS,,Both,,,1212,,,,,,,,,, HurriCaine® 20% Strength Benzocaine Unit Dose Spray 0.5 mL,J3490,HCPCS,,Both,,,90,,,,,,,,,, MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS,99155,CPT ,,Both,,,687,,,,,,,,,, MODERATE SEDATION OTHER PHYS/QHP ADDITIONAL 15 MINUTES 5YRS AND OLDER,99157,CPT ,,Both,,,294,,,,,,,,,, DRUG SCRN QUAN LEVETIRACETAM,80177,CPT ,,Both,,,77,,,,,,,,,, POTASSIUM CHLORIDE 20MEQ ER 1 TAB,J8499,HCPCS,,Both,,,5,,,,,,,,,, ORASOL 20% Strength Benzocaine Oral Gel 0.75 Gram ,J8499,HCPCS,,Both,,,10,,,,,,,,,, DEPAKOTE(Divalproex Sodium) 500 mg Tablet,J8499,HCPCS,,Both,,,210,,,,,,,,,, DEXTROSE 50% 50 ML SYRINGE,J3490,HCPCS,,Both,,,67,,,,,,,,,, PHENOBARBITAL (CIV) 20MG/5ML 20MG ELIX,J8499,HCPCS,,Both,,,132,,,,,,,,,, "CroFab Antivenin,Crotalidae Polyvalent Immune Fab 1GM Inj",J3490,HCPCS,,Both,,,18931,,,,,,,,,, Milk of Magnesia Oral Suspension 30 mL ,A9150,HCPCS,,Both,,,5,,,,,,,,,, Acetaminophen Codeine 120mg/12mg Strength Solution 5mL,J8499,HCPCS,,Both,,,15,,,,,,,,,, BACTRIM(Sulfamethoxazole/Trimethoprim)200-40mg/5 mL Suspension,J8499,HCPCS,,Both,,,15,,,,,,,,,, Azithromycin 200 mg / 5 mL Suspension,J8499,HCPCS,,Both,,,53,,,,,,,,,, MAALOX Antacid 200mg/ 5 mL Strength Liquid,A9150,HCPCS,,Both,,,5,,,,,,,,,, Methocarbamol 750 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Magnesium Citrate 240ML,A9150,HCPCS,,Both,,,5,,,,,,,,,, Naproxen sodium 220 mg,A9150,HCPCS,,Both,,,5,,,,,,,,,, AFRIN 0.05% (Oxymetazoline HCL) Nasal Spray,A9150,HCPCS,,Both,,,5,,,,,,,,,, Metronidazole - FLAGYL 250 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Metronidazole - FLAGYL 500 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Simethicone 180mg PO,J8499,HCPCS,,Both,,,5,,,,,,,,,, Hydralazine HCl 25 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, ALPRAZOLAM (CIV) 0.25 MG TABS (Xanax),J8499,HCPCS,,Both,,,15,,,,,,,,,, ALPRAZOLAM CIV 1 MG TABS (Xanax),J8499,HCPCS,,Both,,,15,,,,,,,,,, Dicyclomine HCl 20 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Clopidogrel Bisulfate 75 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Coumadin® Warfarin Sodium 5 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Cyclobenzaprine (FLEXRIL) HCl 10 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Diazepam 5 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, DEPAKOTE(Divalproex Sodium) 250 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, HYDROCODONE APAP 5/325 MG TABLET,J8499,HCPCS,,Both,,,15,,,,,,,,,, HYDROCODONE/APAP 7.5/325 MG TABLET,J8499,HCPCS,,Both,,,15,,,,,,,,,, HYDROCODONE APAP 10/325 MG TABLET,J8499,HCPCS,,Both,,,15,,,,,,,,,, Ibuprofen 200 mg Tablet,A9150,HCPCS,,Both,,,5,,,,,,,,,, MECLIZINE 25 MG TABS,J8499,HCPCS,,Both,,,15,,,,,,,,,, Metformin HCl 500 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Oxycodone HCl 20 mg Tablet ,J8499,HCPCS,,Both,,,5,,,,,,,,,, Oxycodone HCl / Acetaminophen 5 mg - 325 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, PHENOBARBITAL (CIV) 100MG TABLETS,J8499,HCPCS,,Both,,,5,,,,,,,,,, Pilocarpine HCl(VUITY) 1.25% Solution 5 mL OPHTH DROPS,J3490,HCPCS,,Both,,,1070,,,,,,,,,, Tramadol HCl 50 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Clindamycin 300 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,, Pyridium (Phenazopyridine HCl) 100 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Protonix (Pantoprazole Sodium) 40 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Robatussin Liquid(GUAIFENESIN) PO 100mg-10mg/5 mL,A9150,HCPCS,,Both,,,6,,,,,,,,,, Verapamil HCl 40 mg Tablet ,J8499,HCPCS,,Both,,,8,,,,,,,,,, TYLENOL/Codeine 120 mg-2 mg Strength Solution 5 mL(LIQUID),J8499,HCPCS,,Both,,,10,,,,,,,,,, Infuvite Adult Multivitamin Infusion Vitamin K 200mg-150mcg/10mL Injection 50 mL,J3490,HCPCS,,Both,,,302,,,,,,,,,, Infuvite Pediatric Pediatric Multivitamin Infusion Vitamin K 400MG-200MCG/5mL Injection ,J3490,HCPCS,,Both,,,302,,,,,,,,,, LEVOFLOXACIN 500 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,, Ciprofloxacin HCl 500 mg Tablet(CIPRO),J8499,HCPCS,,Both,,,5,,,,,,,,,, Levofloxacin 750 mg Tablet ,J8499,HCPCS,,Both,,,6,,,,,,,,,, Zanaflex(Tizanidine HCl) 4 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, ATENOLOL 50 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,, CLONIDINE 0.1 MG TABS,J8499,HCPCS,,Both,,,5,,,,,,,,,, IBUPROFEN 100MG/5ML 100 MG SUSP,A9150,HCPCS,,Both,,,5,,,,,,,,,, Hydrocodone Bitartrate/Acetaminophen 7.5mg-325mg/15mL Solution,J8499,HCPCS,,Both,,,5,,,,,,,,,, Clindamycin HCl 150 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,, URINE STRAINER,A9270,HCPCS,,Both,,,19,,,,,,,,,, Spacer with or wo mask for use with metered dose inhaler,A4627,HCPCS,,Both,,,100,,,,,,,,,, "Capsaicin 8% patch, per sq cm",J7336,HCPCS,,Both,,,941,,,,,,,,,, Azithromycin 250 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, "Levofloxacin/Dextrose 5%,750mg/150mL Injection",J3490,HCPCS,,Both,,,205,,,,,,,,,, Acetaminophen 160 mg/5mL Strength Liquid,A9150,HCPCS,,Both,,,5,,,,,,,,,, Amoxicillin 500mg Capsule,J8499,HCPCS,,Both,,,15,,,,,,,,,, Azithromycin 500mg Tablet,J8499,HCPCS,,Both,,,30,,,,,,,,,, TESSALON PERLES(Benzonatate) 200MG CAPSULE,J8499,HCPCS,,Both,,,5,,,,,,,,,, Carvedilol (Coreg) 12.5mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Ibuprofen 800mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Amoxicillin-Clavulanate 875mg-125mg Tablet ,J8499,HCPCS,,Both,,,15,,,,,,,,,, "NITROGLYCERIN SUBLINGUAL, TAB 0.4MG ",J8499,HCPCS,,Both,,,54,,,,,,,,,, Sucralfate(CARAFATE) 1Gram Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, KEFLEX(Cephalexin) 250 mg Capsule,J8499,HCPCS,,Both,,,5,,,,,,,,,, TESSALON PERLES(Benzonatate) 100MG CAPSULE,J8499,HCPCS,,Both,,,5,,,,,,,,,, Pyridium (Phenazopyridine HCl) 95mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, MAALOX Antacid Max 800mg/800mg/80mg Strength Liquid,A9150,HCPCS,,Both,,,5,,,,,,,,,, LIDOCAINE 2GM W/D5W 500ML INJECTION,J3490,HCPCS,,Both,,,43,,,,,,,,,, Dexamethasone 4mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Amiodarone 200mg tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Amlodipine Besylate-Valsartan 5mg-320mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Levothyroxine Sodium 50 mcg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Eliquis Apixaban 5mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, Potassium Chloride 25mEq Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, "DIPHENHYDRAMINE HCL, 25MG CAP",A9150,HCPCS,,Both,,,5,,,,,,,,,, Diphenhydramine HCl 12.5mg Elixir 5mL,A9150,HCPCS,,Both,,,5,,,,,,,,,, Dicyclomine HCl 10mg CAP,J8499,HCPCS,,Both,,,10,,,,,,,,,, Calcium Carbonate-Mylanta 500mg ,A9150,HCPCS,,Both,,,5,,,,,,,,,, Atorvastatin Calcium-LIPITOR 40mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Celecoxib 100mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,, LYRICA - Pregabalin 75mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,, Olmesartan Medoxomil-Hydrochlorothiazide 40mg-25mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Levothyroxine Sodium 25mcg Tablet ,J8499,HCPCS,,Both,,,10,,,,,,,,,, Hyoscyamine Sulfate-LEVESIN 0.125 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Acetaminophen Codeine 300mg-30mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, "Polymyxin B Sulfate Trimethoprim 10,000/mL- 0.1 Eye Drops",J3490,HCPCS,,Both,,,10,,,,,,,,,, DIPHENHYDRAMINE HCI 50mg,A9150,HCPCS,,Both,,,5,,,,,,,,,, Haloperidol 5mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, ZOLPIDEM TARTRATE-AMBIEN 5MG TABLET,J8499,HCPCS,,Both,,,20,,,,,,,,,, Robatussin Liquid(GUAIFENESIN) PO 200mg-10mg/5 mL,A9150,HCPCS,,Both,,,5,,,,,,,,,, Potassium Bicarbonate 25mEq Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, LACTULOSE 20GM/30ML SOLUTION,J8499,HCPCS,,Both,,,100,,,,,,,,,, LACTULOSE 10GM/15ML SOLUTION,J8499,HCPCS,,Both,,,50,,,,,,,,,, Gabapentin 100mg CAP PO,J8499,HCPCS,,Both,,,20,,,,,,,,,, Hydroxyzine Pamoate 25 mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,, Fluorescein Sodium 1 mg Strip,J3490,HCPCS,,Both,,,10,,,,,,,,,, Lisinopril 10 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Pantoprazole Sodium (Protonix) 40mg inj,J2470,HCPCS,,Both,,,38,,,,,,,,,, Amoxicillin Potassium Clavulanate-AUGMENTIN 200mg-28.5mg 5mL Suspension,J8499,HCPCS,,Both,,,20,,,,,,,,,, CAPSAICIN CREAM 0.1%,J3490,HCPCS,,Both,,,5,,,,,,,,,, Cyclopentolate-Cyclogyl 1% Eye Drop,J3490,HCPCS,,Both,,,10,,,,,,,,,, Augementin 875 mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, Pedia-Lax Suppository 1Gram Strength Glycerin,J3490,HCPCS,,Both,,,10,,,,,,,,,, "Lacosamide, VIMPAT Serum or Plasma",80235,CPT ,,Both,,,271,,,,,,,,,, "Col chromotography qual/quan - Bile Acids, Fractionated and Total, Serum",82542,CPT ,,Both,,,248,,,,,,,,,, ROBAXIN-Methocarbamol 500 mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Sodium Chloride Supplement 1 Gram Strength Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, XARELTO-Rivaroxaban 2.5 MG TABLET,J8499,HCPCS,,Both,,,20,,,,,,,,,, Digoxin 0.125 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, "OPEN TX OF FX, PHALANX OR PHALANGES, OTHER THAN GREAT TOE,, INCLUDES INTERNAL FIXATION",28525,CPT ,,Both,,,2086,,,,,,,,,, IBUPROFEN 600MG TABLET,J8499,HCPCS,,Both,,,7,,,,,,,,,, Norflex Orphenadrine Citrate 100mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, Procardia Nifedipine 10mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,, TOBRADEX OPHTHALMIC,J3490,HCPCS,,Both,,,15,,,,,,,,,, Librium Chlordiazepoxide 25mg CAP,J8499,HCPCS,,Both,,,15,,,,,,,,,, NEOMYCIN HYDROCORTISONE OTIC DROPS,J3490,HCPCS,,Both,,,25,,,,,,,,,, Potassium Chloride 10 mEq Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, MELATONIN 10MG TAB,A9150,HCPCS,,Both,,,5,,,,,,,,,, Terazosin HCl 5 mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,, Memantine HCl 5 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, DSTRJ NULYT OTH PRPH NRV/BRANCH,64640,CPT ,,Both,,,1601,,,,,,,,,, Librium (Chlordiazepoxide) HCl 5 mg Capsule,J8499,HCPCS,,Both,,,20,,,,,,,,,, Sertraline 100 mg tablet ,J8499,HCPCS,,Both,,,50,,,,,,,,,, Olanzapine - Zyprexa 2.5 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, CAST SUP SHT LEG SPLNT FBRGL PED ,Q4048,HCPCS,,Both,,,1212,,,,,,,,,, Quetiapine Fumarate -Seroquel- 25 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, Glimepiride 2 mg Tablet,J8499,HCPCS,,Both,,,10,,,,,,,,,, Eszopiclone 3 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, "Injection, acetylcysteine, 100 mg",J0132,HCPCS,,Both,,,50,,,,,,,,,, HYDROCORTISONE SODIUM PHOSPHATE UP TO 50 MG INJECTION,J1710,HCPCS,,Both,,,18,,,,,,,,,, "Trypanosoma cruzi Antibody, IgG (PROTOZOA)",86753,CPT ,,Both,,,45,,,,,,,,,, Diphenoxylate-atropine (Lomotil) PO 2.5-0.025Mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, Levetiracetam 500 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, Simethicone 80 mg tab chewable,A9150,HCPCS,,Both,,,5,,,,,,,,,, Cast sup short leg splint plaster adult(11yrs+),Q4045,HCPCS,,Both,,,668,,,,,,,,,, "TRIPLE ANTIBIOTIC,OINT 0.9gram Individual Packet",A9150,HCPCS,,Both,,,5,,,,,,,,,, Acetaminophen Susp 80MG PED,A9150,HCPCS,,Both,,,5,,,,,,,,,, Simethicone Mag-Al 30ML PO,A9150,HCPCS,,Both,,,5,,,,,,,,,, Docusate Sodium - COLACE 100mg TABLET,A9150,HCPCS,,Both,,,5,,,,,,,,,, "Vasopressin (antidiuretic hormone, ADH)",84588,CPT ,,Both,,,75,,,,,,,,,, Baclofen 10mg Tablet,J8499,HCPCS,,Both,,,50,,,,,,,,,, Timolol Maleate 0.5% Solution 5mL,J3490,HCPCS,,Both,,,25,,,,,,,,,, Iron 65mg Strength Tablet,A9150,HCPCS,,Both,,,5,,,,,,,,,, Knee orthosis(KO) elastic w joints prefabricated off-the-shelf,L1812,HCPCS,,Both,,,327,,,,,,,,,, "Injection, lidocaine HCl in 5% dextrose, 1 mg",J2002,HCPCS,,Both,,,43,,,,,,,,,, "Injection, lidocaine HCl , 1 mg",J2003,HCPCS,,Both,,,53,,,,,,,,,, "Injection, lidocaine HCl with epinephrine, 1 mg",J2004,HCPCS,,Both,,,63,,,,,,,,,, Bordetella pertussis/parapertussis,87265,CPT ,,Both,,,209,,,,,,,,,, Mycoplasma genitalium,87563,CPT ,,Both,,,756,,,,,,,,,, Probiotic Cap 250mg,J8499,HCPCS,,Both,,,5,,,,,,,,,, Polyethylene glycol 17gm,A9150,HCPCS,,Both,,,5,,,,,,,,,, HYDROMORPHONE 0.1mg,J1171,HCPCS,,Both,,,228,,,,,,,,,, Folic Acid 1MG Oral Tablet,A9150,HCPCS,,Both,,,2,,,,,,,,,, "Oral magnetic resonance contrast agent, per 100 ml",Q9954,HCPCS,,Both,,,2,,,,,,,,,, "GI PANEL-eg,Clostridium difficile,Ecoli,Salmonella,Shigella,norovirus,Giardia",87505,CPT ,,Both,,,614,,,,,,,,,, "GLUCOSE FAST ACT, TAB 4GM",A9150,HCPCS,,Both,,,5,,,,,,,,,, Vancomycin HCl 125 mg Capsule,J8499,HCPCS,,Both,,,15,,,,,,,,,, "Injection, nicardipine, 0.1 mg, HCl 25mg/10mL ",J2404,HCPCS,,Both,,,217,,,,,,,,,, SUDAFED 30MG TABLET,A9150,HCPCS,,Both,,,5,,,,,,,,,, Debrox 0.5oz Otic Drops 6.5% Strength Carbamide Peroxide,A9150,HCPCS,,Both,,,5,,,,,,,,,, Torsemide 20 mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, "Vitamin B12 1,000 mcg Strength Tablet",A9150,HCPCS,,Both,,,5,,,,,,,,,, Infectious agent detection by nucleic acid (DNA or RNA); Zika virus,87662,CPT ,,Both,,,136,,,,,,,,,, Romiplostim 500mcg Injection 1mL,J2802,HCPCS,,Both,,,11,,,,,,,,,, Lansoprazole 30 mg Capsule - PREVACID,A9150,HCPCS,,Both,,,5,,,,,,,,,, ROOM AND BOARD INPATIENT,110,DRG,,Both,,,5000,,,,,,,,,, Zonisamide,80203,CPT ,,Both,,,277,,,,,,,,,, ASPIRIN 81MG CHEWABLE,A9150,HCPCS,,Both,,,8,,,,,,,,,, "SENNA LAX, SENNOSIDES TAB 8.6MG",A9150,HCPCS,,Both,,,5,,,,,,,,,, "Spirometer, nonelectronic,includes all accessories",A9284,HCPCS,,Both,,,25,,,,,,,,,, BACTROBAN(Mupirocin) 2% Ointment,J3490,HCPCS,,Both,,,20,,,,,,,,,, "Cast sup short leg splint, ped 0-10 years plaster",Q4047,HCPCS,,Both,,,568,,,,,,,,,, Gastrostomy/jejunostomy tube standard,B4089,HCPCS,,Both,,,93,,,,,,,,,, Gastrostomy/jejunostomy tube standard any material/type,B4087,HCPCS,,Both,,,92,,,,,,,,,, Acetylcysteine 100MG/ML INJ/ORAL SOLUTION,J3490,HCPCS,,Both,,,5,,,,,,,,,, Famotidine Injection 0.25 mg,J1308,HCPCS,,Both,,,1,,,,,,,,,, LASIX - FUROSEMIDE INJECTION 1MG,J1938,HCPCS,,Both,,,10,,,,,,,,,, "Injection, folic acid, 0.1 mg",J1808,HCPCS,,Both,,,1,,,,,,,,,, "Injection, testosterone cypionate, 1 mg",J1071,HCPCS,,Both,,,1,,,,,,,,,, "Infectious disease,bacterial vaginosis,quantitative RT amp of RNA markers ",81513,CPT ,,Both,,,200,,,,,,,,,, Amoxicillin 400mg/5mL Oral Suspension 100mL,J8499,HCPCS,,Both,,,5,,,,,,,,,, BACTRIM 400-80 MG TABLET,J8499,HCPCS,,Both,,,10,,,,,,,,,, Loratadine-Claritin 10MG TABLET,A9150,HCPCS,,Both,,,5,,,,,,,,,, "Injection anesthetic agent and/or steroid brachial plexus,incl imaging guidance",64415,CPT ,,Both,,,487,,,,,,,,,, Narcan - Naloxone HCl 4mg Spray 0.1 mL,J3490,HCPCS,,Both,,,50,,,,,,,,,, Gentamicin Sulfate 0.3% Ophthalmic Solution 5mL,J3490,HCPCS,,Both,,,15,,,,,,,,,, Hydrocortisone/AceticAcid1%-2%Otic Drops10mL,J3490,HCPCS,,Both,,,15,,,,,,,,,, Valsartan 160 mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Lomotil(Diphenoxylate HCl)/Atropine Sulfate 2.5mg-0.025mg Tablet,J8499,HCPCS,,Both,,,5,,,,,,,,,, Antiseptic Benzoin Tincture 3m Steri-Strip Topical Liq0.667mL Ampule,J3490,HCPCS,,Both,,,5,,,,,,,,,, Glyburide 5mg Tablet,J8499,HCPCS,,Both,,,20,,,,,,,,,, Ropinirole HCl 0.25mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, Amoxicillin 200mg/5mL Oral Suspension 100mL,J8499,HCPCS,,Both,,,5,,,,,,,,,, Acyclovir 400mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, EMERGENCY SERVICES BUNDLE FLAT RATE FRONTIER,99499,CPT ,,Both,,,850,,,,,,,,,, "Injection, doxycycline hyclate, 1 mg",J1271,HCPCS,,Both,,,50,,,,,,,,,, Epinephrine 0.1 mg Injection,J0165,HCPCS,,Both,,,65,,,,,,,,,, "Injection, vancomycin HCl, 10 mg",J3373,HCPCS,,Both,,,20,,,,,,,,,, "Inj, naloxone HCl, not otherwise specified, 0.01mg",J2312,HCPCS,,Both,,,30,,,,,,,,,, Ofloxacin 0.3% Ophthalmic Drops 5 mL,J3490,HCPCS,,Both,,,30,,,,,,,,,, "Injection, metoprolol tartrate, 1 mg",J0616,HCPCS,,Both,,,30,,,,,,,,,, Hydrochlorothiazide 12.5 mg Tablet,J8499,HCPCS,,Both,,,25,,,,,,,,,, "Injection, diltiazem HCl, 0.5mg",J1163,HCPCS,,Both,,,5,,,,,,,,,, Tranexamic Acid 100mg Injection,J3490,HCPCS,,Both,,,5,,,,,,,,,, Spironolactone 25mg Tablet,J8499,HCPCS,,Both,,,15,,,,,,,,,, US abdominal aorta real time w image doc. screening study abdominal aortic aneurysm AAA,76706,CPT ,,Both,,,414,,,,,,,,,, "Injection, calcium chloride, 2 mg",J0618,HCPCS,,Both,,,50,,,,,,,,,,