DESCRIPTION - cheyennecountyhospital.com Price...86160 rl complement c4-ps 86256 smooth muscle ab f-actin ps 86146 beta 2 glycoprotein 1 igg, igm, iga (rps) - ps 86147 cardiolipin

DESCRIPTIONCreatinine

Rh TypeCulture Stool Add'l Pathogens

Agent NOS Assay w/ Optic86356 RL Mononuclear Cell Antigen Quant

83520 RL Antibody Antigliadin86762 RL Antibody Rubella86765 RL Antibody Rubeola

87070 RL Culture Bact Def Other Source86789 RL Antibody West Nile Virus IGG

84155 RL Protein Total84165 RL Protein Electrophoresis

82784 RL Assay IGA/IGD/IGG/IGM Each-PSPlateletpheresis - Leukoreduced

Plateletpheresis - Leukoreduced/IrradiatedRBCs - Leukoreduced

Blood Product Irradiation FeeRed Cell Antigen Negative Type

Capillary Draw87328 RL Cryptosporidium AG IA

87329 RL Giardia by EIA87329 Giardia Antigen EIA

87328 MC Parasite PNL36415 Venipuncture

88300 SURG PATH GROSS EXAM ONLY LEV 188304 SURGICAL PATH LEVEL III88305 SURGICAL PATH LEVEL IV88307 SURGICAL PATH LEVEL V88309 SURGICAL PATH LEVEL VI

88312 SURGICAL PATH SPECIAL STAIN GP I88302 SURG PATH GROSS EXAM ONLY LEV II

Technetium 9m/Sulfur ColloidTechnetium 99m/Labeled RBC

Technetium 99m/PertechnetateTc99m/MAA

Technetium 99m /DTPA (Aerosol)Technetium 99m /DTPA

Technetium Cardiolite (Sestamibi)88720 Bilirubin Total Transcut

Urinalysis w/ MicroTC99M Mebrofenin (Choletec)

Bacterial ID86480 RL Quantiferon TB Gold

86334 Immunofixation Electrophoresis

86663 EBVA, Early Anti IgG86664 EBVA/Nuclear Antigen

86665 EBVA/VCA IgG86235 ANA Reflex

86800 RL Thyroglobulin Antibody82784 (3) RL Assay IGA/IGD/IGG/IGM Each82784 (2) RL Assay IGA/IGD/IGG/IGM Each

83520 RL Antibody Antigliadin83520 (2) RL Antibody Antigliadin

82397 Chemiluminescent Chronograin Assy PS82397 Chemiluminescent Chronograin Assy PS

93288 Pacemaker Device Eval in PersonTC99M Non-HEU Add-On Per Study q9969

73000 XR Clavicle Bilateral73020 XR Shoulder 1 View Bilateral

73030 XR Shoulder Complete Bilateral73060 XR Humerus Bilateral

73070 XR Elbow 2 Views Bilateral73080 XR Elbow Complete Bilateral73090 XR Forearm 2 Views Bilateral

73092 XR Upper Extremity Infant Bilateral73100 XR Wrist 2 Views Bilateral

73110 XR Wrist Complete Bilateral73120 XR Hand 2 Views Bilateral

73130 XR Hand Complete Bilateral73200 CT Upper Extremity w/o Contrast Bilat73201 CT Upper Extremity w/ Contrast Bilat

73202 CT Upper Extremity w/+w/o Contrast Bilat73218 MRI UE Non Joint w/o Contrast Bilateral

73560 XR Knee 1 or 2 Views Bilateral73562 XR Knee 3 Views Bilateral

73564 XR Knee Complete Bilateral73590 XR Tibia/Fibula Bilateral

73592 XR Lower Extremity Infant Bilateral73600 XR Ankle 2 Views Bilateral

73610 XR Ankle Complete Bilateral73620 XR Foot 2 Views Bilateral

73630 XR Foot Complete Bilateral73650 XR Calcaneus Bilateral

73700 CT Lower Extremity w/o Contrast Bilat73701 CT Lower Extremity w/ Contrast Bilat

73702 CT Lower Extremity w/+w/o Contrast Bilat73718 MRI LE Non Joint w/o Contrast Bilat

73720 MRI LE Non Joint w/ + w/o Contrast Bilat73721 MRI LE Joint w/o Contrast Bilateral73722 MRI LE Joint w/ Contrast Bilateral

73723 MRI LE Joint w/ + w/o Contrast Bilateral

73725 MRA Lower Extremity w/ + w/o BilatLab Spec Collect & Handle

87591 GC Probe83030 Hemoglobin Fetal Chemical

83021 - Hemoglobin Chromatography86335 Immunofixation Electrophoresis Urine

84166 Protein Electrophoresis Urine86003 Allergen Specific IgE Each86638 Q fever Ab (C. burnetii)

86666 Ehrlichia IgM71260 CT Chest w

71250 CT Chest w/o71270 CT Chest w + w/o

P9612 CATHETERIZATION FOR URINE COLL93923 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS

77061 Digital Breast Tomosynthesis UnilateralG0279 Tomosynthesis, Mammo

77062 Digital Breast Tomosynthesis Bilateral77063 Screening Digital Breast Tomosynthesis Bilateral

82570 Creatinine Other82104 RL Alpha-1 Antitrypsin-Phenotype PS

82705 RL Fats/Lipids Feces Qual86747 - Parvovirus B19 Antibodies - PS

87522 HEP C VIRUS QUANT REV TRANS-PS84270 SEX HORMONE BINDING GLOBIN (SHBG)-PS

83516 IMMUNOASSAY NONANTIBODY-PS86256 ANTIMUSCLE AB TITER-PS

86317 TETANUS TITER ANTIBODY-PS86615 Bordetella pertussis Abs, IgA and IgG - PS

86696 HERPES SIMPLEX TYPE 2-PS87205 SMEAR W/INTERP GRAM STAIN- PS

87804 Rapid Influenza A and B88342 TISSUE IMMUNOPEROXIDASE EA AB

88313 SPECIAL STAIN GP II ALL OTHER83516 RL CELIAC AB PNL TRANSGLUT IGA 1/6-PS

86235 RL EXTRACTABLE NUCLEAR ANTIGEN EACH-PS86160 RL COMPLEMENT C4-PS

86256 SMOOTH MUSCLE AB F-ACTIN PS86146 Beta 2 Glycoprotein 1 IgG, IgM, IgA (RPS) - PS86147 Cardiolipin Antibodies, IgG and IgM (RPS) - PS

85305 RL PROTEIN S TOTAL PS85303 RL PROTEIN C ACTIVITY PS85610 RL PROTHROMBIN TIME PS

85730 RL THROMBOPLASTIN TIME PARTIAL PS85670 RL THROMBIN TIME, PLASMA PS

85520 RL HEPARIN ASSAY PS81241 RL FACTOR 5 GENE ANALYSIS PS

84432 Thyroglobulin w/ Thyroglobulin Antibody (RPS) PS86003 Respiratory Region IX, Great Plains Panel (IBT 402959) - PS

84403 Testosterone, Free and Total, Females or Children - PS86255 Celiac Disease Comprehensive Antibody Profile - PS

86331 Hypersensitivity Pneumonitis (Farmer Lung Panel) - PS87329 Ova and Parasite Smear - PS

85245 FACTOR VIII (RISTOCETIN COFACTOR)-PS85246 FACTOR VIII VW FACTOR AG-PS

86255 Celiac Disease Screen-PSHemoglobin A1c POC (83036)

Rapid Strep POC (87880)TB Skin Test POC (86580)

Blood Glucose POCUrine Pregnancy POC (81025)

Hemoccult POC (82270)Hematocrit POC (85014)Influenza POC (87502)

KOH POC (87220)Wet Mount POC (87210)

PT/ INR POC (85610)Urine Microalbumin POC (82044)

Hemoglobin POC (85018)Serum Pregnancy POC (84702)

82962 Glucometer Acucheck POC36416 Finger Stick

81001 UA with Micro POC81002 UA non-automated without microscopy POC

82947 Blood Glucose ood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces,

RHB Clinic Influenza TestRHB Clinic Strep Screen

RHB Urine Preg TestRHC Clinic Influenza TestRHC Clinic Strep Screen

RHC RSVRHC Urine w/o Micro

RHB Clinic PT INRRHB Glucose/ DeviceRHB Urine w/o Micro

RHC Clinic PT/INRRHC Glucose/DeviceRHC Urine Preg Test

Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneou RSV POC (87420)

Influenza POC (87804)PT/ INR POC Coumadin Management

28450 Tx Tarsal Bone Fx W/O Manip Ea

PSYCHOTHERAPY PT &/OR FAMILY 30 MIN ChargePSYCHOTHERAPY PT &/OR FAMILY 45 MIN ChargePSYCHOTHERAPY PT &/OR FAMILY 60 MIN Charge

FAMILY PSYCHOTHERAPY W/O PATIENT ChargeFAMILY PSYCHOTHERAPY INITIAL ChargeFOCUS GROUP THERAPY INITIAL Charge

Direct Antiglobulin TestCR Phase II with ECG

CR EKG 93798CR Cardiac Stress Test (treadmill) 93017

CR Phase II 93798CR Holter Monitor 93225CR Event Monitor 93270

CR Myocardial Spect Multi Studies 78452CR Isotope Radionuclide Technetium Cardiolite A9500

CR Holter Monitor Scan 93226Holter Monitor 24 hr

Electrocardiogram Tracing Only96360- Hydration, first hour

96361- Hydration, each additional hour96365- IV tx, first hour

96366- IV tx, each additional hour96367- IV tx, sequential infusion96368- IV tx, concurrent infusion

96372- Subq/IM InjectionTR 96373- Intra-Arterial Injection96375- IV Injection, add new drug96374- IV Injection, single/initial

96376- IV Injection, add same drug99282 - Level 299281 - Level 199283 - Level 399284 - Level 499285 - Level 5

99291 - Critical Care99292 - Critical Care, each 30 min

ER 36591 BLOOD COLLECT- IMPLANT VENOUSER zz36592 BLOOD COLLECT CENTRAL/PERIPH DEV

ER 90471 IMMUNIZATION ADMIN ONE VACCINEER 36000 INTRO NEEDLE OR INTRACATH- VEIN

ER 96401 ADMIN CHEMO SC/IM NON-HORMONALER 51702 INSERT FOLEY CATHETER SIMPLE

ER 10160 PUNCTURE ASPIRATION OF ABSCESSER 92960 CARDIOVERSION ELECTIVE

ER 31500 INTUBATIONER 12001 SIMPLE RPR STHF 2.5CM OR LESSER 12013 REPAIR SIMP FEL 2.6CM-5.0CM

ER 32551 TUBE THORACOSTOMY W/WO WATER SER 10120 I&R FRGN BODY SUBCU TISS SIMPLE

ER 20610 DRN/INJ MAJOR JOINT/BURSA WO USER 65205 REM FRGN BODY EXT EYE SUPRF

ER 62270 SPINAL PUNCTURE LUMBAR DIAGER 23650 CLSD TRMT SHOULDER DISCLOC W/MNP

ER 10060 I&D ABSCESS SIMPLE/SINGLEER 11730 AVULSN NAIL PLATE PART/COM SIMP

ER 11765 EXCISION OF NAIL FOLD TOEER 12002 SIMPLE RPR STHF 2.6CM-7.5CM

ER 12004 SIMPLE RPR STHF 7.6CM-12.5CMER 12005 SIMPLE RPR STHF 12.6-20CM

ER 12007 RPR SIMP S/N/A/G/TRNK >30.0 CMER 12011 SIMPLE RPR FACE 2.5CM OR LESS

ER 12014 RPR SIMP F/E/E/N/L/M 5.1-7.5 CMER 12015 RPR SIMP F/E/E/N/L/M 7.6-12.5 CMER 12031 INTRMD RPR SATE 2.5CM OR LESS

ER 12035 INTMD RPR S/A/T/EXT 12.6-20ER 12051 INTMD RPR FACE/MM 2.5 CM/<

ER 12053 INTMD RPR FACE/MM 5.1-7.5 CMER 13121 CMPLX RPR S/A/L 2.6-7.5 CM

ER 13132 REPAIR CMPLX FNH 2.6-7.5CMER 20552 INJ TRIGGER POINT 1 OR 2 MUSCL

ER 21315 CLSD TRMT NASAL FX W/O STABLZTNER 23655 CLSD TRMT SHLDR DIS W/ANEST

ER 24600 CLSD TRMT ELBOW DISLOC WO ANESER 25500 CLSD TRT RADIAL SHAFT WO MANIP

ER 26070 ARTHROTOMY CARPOMETACARPAL JNTER 26075 EXPLORE/TREAT METACARPHAL JNTER 26080 ARTHROTOMY INTERPHALANG JNTER 26770 CLSD TX INTERPHALANGE WO ANE

ER 28190 REM FRGN BODY FOOTER 29075 APPLICATION OF FOREARM CAST

ER 29105 APPLY LONG ARM SPLINTER 29125 APPLY FOREARM SPLINT

ER 29130 APPLICATION OF FINGER SPLINTER 29240 STRAPPING OF SHOULDER

ER 29260 STRAPPING OF ELBOW OR WRISTER 29280 STRAPPING OF HAND OR FINGERER 29405 APPLY SHORT LEG WALKING CAST

ER 29505 SPLINT APPL LONG LEGER 29515 APPLICATION LOWER LEG SPLINTER 29540 STRAPPING OF ANKLE AND/OR FT

ER 29550 STRAPPING OF TOESER 31500 INTUBATION BY RN

ER 31500 INTUBATION W/VIDEO ASSISTER 32554 ASPIRATE PLEURA W/O IMAGING

ER 32555 ASPIRATE PLEURA WITH IMAGINGER 36430 BLOOD ADMIN 0-12HRS (PER DAY)ER 36430 BLOOD ADMIN 0-16HRS (PER DAY)ER 36430 BLOOD ADMIN 0-24HRS (PER DAY)ER 36430 BLOOD ADMIN 0-4HRS (PER DAY)ER 36430 BLOOD ADMIN 0-8HRS (PER DAY)

ER 36556 INSERT NT CV CATH 5+ER 36589 REMOVE TUNNELED CV CATH

ER 36680 PLACE NEEDLE INTRAOSSEOUS INFUSER 41250 REPAIR LAC MOUTH/TONGUE 2.5CM <ER 43752 NASAL/OROGASTRIC W/TUBE PLCMNTER 57200 COLPORRHAPHY SUTR INJURY VAGINA

ER 59025 FETAL NON STRESS TESTER 69200 REM FRGN BODY EXT ADTRY

ER 94664 DEMONSTRATE/EVAL NEBUL/MDI/IPPBER 96523 IRRIGATE IMPLANT VEN ACC DEVICE

ER G0390 TRAUMA ACTIVATION LEVEL IVER ADMIN INFLUENZA VACCINE

ER 24655 TREAT RADIUS FX W/MANIPULATIONER 32551 CHEST TUBE INSERT ER Charge

ER 36592 BLOOD COLLECT CENTRAL/PERIPH DEV ER ChargeER 51701 INSERT STRAIGHT CATHETER ER

ER 62270 SPINAL PUNCTURE LUMBAR DIAG ER ChargeER 94640 PRESSURIZED/NOPRESS INHAL TRMT

ER VISIT LEVEL 1 99281ER VISIT LEVEL 2 99282ER VISIT LEVEL 3 99283ER VISIT LEVEL 4 99284ER VISIT LEVEL 5 99285

ER IM OR SQ INJECTION PER STICK 96372ER 11010 DEBRIDE SKN W/RMVL FM AT FX SITE

ER 29530 STRAPPING OF KNEEER 26705 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES

ER 64400 N BLOCK INJ TREGMINALPF Hosp M1 99201 New Patient Level 1PF Hosp M1 99202 New Patient Level 2PF Hosp M1 99203 New Patient Level 3PF Hosp M1 99204 New Patient Level 4PF Hosp M1 99205 New Patient Level 5

PF Hosp M1 99211 Established Patient Level 1PF Hosp M1 99212 Established Patient Level 2PF Hosp M1 99213 Established Patient Level 3PF Hosp M1 99214 Established Patient Level 4PF Hosp M1 99215 Established Patient Level 5

PF Hosp M1 99211 Office Visit Estab Minimal Level 1PF Hosp M1 99212 Office Visit Estab Pt Focused Level 2

PF Hosp M1 99213 Office Visit Estab Pt Expanded Level 3

PF Hosp M2 99201 New Patient Level 1PF HOSP M2 99202 New Patient Level 2PF Hosp M2 99203 New Patient Level 3PF Hosp M2 99204 New Patient Level 4

PF HOSP M2 99211 Office Visit Estab Minimal Level 1PF HOSP M2 99212 Office Visit Estab Pt Focused Level 2

PF HOSP M2 MLP 99212 Office Visit Estab Pt Focused Level 2PF HOSP M2 99213 Office Visit Estab Pt Expanded Level 3

PF HOSP M2 MLP 99213 Office Visit Estab Pt Expanded Level 3PF Hosp M2 99211 Established Patient Level 1PF Hosp M2 99212 Established Patient Level 2

PF Hosp M2 MLP 99212 Established Patient Level 2PF Hosp M2 99213 Established Patient Level 3

PF Hosp M2 MLP 99213 Established Patient Level 3PF Hosp M2 99214 Established Patient Level 4

PF Hosp M2 99215 Office Visit Estab Pt ComprehensivePF Hosp M2 99205 Office Visit New Pt High Comprehensive

Amylase LevelGlucose Level

Blood Urea NitrogenCreatinine

Creatinine Clearance 1Electrolyte Panel

Sodium LevelSodium Level Urine

Sodium Level 24 Hour UrinePotassium Level

Potassium Level 24 Hour UrineChloride Level

Chloride Level UrineBasic Metabolic Panel

Alanine AminotransferaseAspartate Aminotransferase

Ammonia LevelBeta Human Chorionic Gonadotropin Quantitative

Bilirubin DirectBilirubin Total

Blood Gas ArterialComplete Blood Count w/o Diff

Carcinoembryonic AntigenCell Count w/ Diff Cerebrospinal Fluid

CholesterolComprehensive Metabolic Panel

CK-MBD-DimerFerritin

Gamma Glutamyl Transferase

HemoglobinHematocrit

Hepatitis B Surface AntigenIron Level

Lactate DehydrogenaseLipase LevelLipid Panel

Magnesium LevelMyoglobin

PTPartial Thromboplastin Time

Phosphorus LevelProtein 24 Hour Urine

Protein TotalSalicylate Level

Thyroid Stimulating HormoneTriglycerides

Urea Nitrogen 24 Hour UrineUric Acid

Vitamin D 25 Hydroxy LevelManual Differential (05)

Ferritin LevelU Drug Scrn

Urinalysis with Microscopic, if indicatedUrinalysisIron LevelHgb A1c

B-Type Natriuretic PeptideAcetaminophen Lvl

Ethanol LevelLactic AcidPro-BNP

Albumin LevelAlkaline PhosphataseCalcium Level Total

Carbon Dioxide LevelHDL

C-Reactive ProteinDigoxin LevelFolate Level

Glucose FluidGlucose Cerebrospinal Fluid

Protein FluidProtein Cerebrospinal Fluid

Prostate Specific Antigen ScreenRenal Function Panel

Reticulocyte Count Manual

Sedimentation RateTroponin-I

Creatinine 24 Hour UrineVanco Level

Vancomycin Level PeakVancomycin Level Trough

Vitamin B12 LevelRapid Clostridium Difficile Toxin A/B with QC

pH Urine DipstickCOLLECTION: Capillary

COLLECTION: Arterial DrawCOLLECTION: Capillary

COLLECTION: Venous DrawCOLLECTION: Venous Draw

Creatinine UrineMicroalbumin Level Urine

White Blood Cell CountPlatelet Count

Prostate Specific Antigen DiagnosticKetone Bodies QualitativeSemen Post Vasectomy 1

Creatine KinaseBleeding Time-DELETE

Rapid Pregnancy Test with QCRapid Pregnancy Test Urine with QC

Rapid Mono Screen with QCRapid Respiratory Syncytial Virus Screen with QC

Rapid Strep A Screen with QCRapid Urease Test with QC

.Gluc Fasting.Gluc 3 Hr

Glucose 1 Hr Post GlucolaRapid Influenza A and B with QC

Total Iron Binding CapacityIron Binding Capacity Total

KOHMicroalbumin Level 24 Hour Urine

Microalbumin/Creatinine Ratio UrinepH Fluid

Protein UrineValproic AcidWet Prep 1

Creatinine with eGFRThyroxine Free

Type and Screen GLType and Cross GL

ABORh GL

Triiodothyronine FreeKOH Prep

Complete Blood Count with Automated DifferentialComplete Blood Count with Manual Differential

Manual Differential (01)Manual Differential (03)Manual Differential (04)

WBC StoolRapid Clostridium Difficile Toxin

Rapid Influenza A and BRapid Occult Blood Diagnostic Stool

Rapid Occult Blood Screen StoolRapid Pregnancy Test

Rapid Pregnancy Test UrineRapid Respiratory Syncytial Virus Screen

Rapid Strep A ScreenRapid Urease Test

Yes - Manual Differential?Yes - Manual Differential?

Rapid Clostridium Difficile Ag/ToxinNo - Manual Differential?No - Manual Differential?

DAT GLSemen Post Vasectomy 2

Creatinine Clearance 2COLLECTION: FingerstickCOLLECTION: Fingerstick

81001 UA AUTOMATED W/ MICROGiardia

ARC AB ID PANEL 86870ARC ABS SCREEN 86885

ARC RH 86901ARC ABO 86900

ARC AG TYPE 86905ARC DAT 86880

ARC PHENOTYPING COMPLETE 86906ARC RED CELL SCREEN WITH PT SERUM 86904

ARC CROSS-MATCH 86922U Drug Scrn w QC

Antibody Screen GLRhogam Workup GL

Fecal Occult Blood Diagnostic - IARapid Occult Blood Screen Stool with QC

Protime/INR FingerstickParasite Screen with QC

PKUC Diff

Influenza by PCRNeonatal Bilirubin

Ferritin LevelIron Level

Iron Binding Capacity TotalAmylase Urine

BUN Creatinine Ratio w/ eGFRIonized CalciumCalcium Urine

Calcium Urine 24 Hr.Creatinine Clearance 3Cell Count w/ Diff CSF 2Cell Count w/ Diff FluidManual Differential (13)

FibrinogenANA Screen with reflex (RPS) PSBeta-2 Microglobulin (RPS) PS

Borrelia burgodorferi Antibodies, Total (Lyme) (RPS) PSCancer Antigen 125 PS

CD57 (HNK1) PSComplement, C3 (RPS) PS

Complement, C4 (RPS)Cortisol, AM PS

Cytology Urine PSCytomegalovirus Antibody (CMV), IgG (RPS) PSCytomegalovirus Antibody (CMV), IgM (RPS) PS

DHEA (Dehydroepiandrosterone), Serum (RPS) PSDHEA Sulfate (Dehydroepiandroseterone Sulfate) (RPS) PS

Drugs of Abuse Screen 10 Panel PSdsDNA (Double Stranded DNA) Antibody, IgG (RPS) PS

Epstein Barr Virus (EBV) Antibodies Panel (RPS) PSEstradiol PS

Estrogens, Total & Fractionated (RPS) PSFSH PS

Antibody ID, PSHaptoglobin (RPS) PS

Helicobacter Pylori Antigen, Stool PSHepatitis B Surface Antibody PSHepatitis B Surface Antigen PSHepatitis C Antibody (RPS) PS

Hepatitis C Virus (HCV) RNA Detection & Quant (RPS) PSHepatitis Panel, Acute (RPS) PS

HIV 1/2 Antibodies PSHomocysteine, Blood (RPS) PS

Immunofixation & Serum Electrophoresis (RPS) PSImmunofixation, Serum (RPS) PSImmunoglobulin E (IgE) (RPS) PSs

Immunoglobulin G (IgG) (RPS) PSImmunoglobulins (IgA, IgG, IgM), Quant (RPS) PS

Insulin (RPS) PSKappa Lambda Quant Free Light Chains w/ Ratio (RPS) PS

Lamotrigine (Lamictal) (RPS) PSLead Blood, Pediatric PS

LHS Lutenizing Hormone PSLithium PS

Measles/Mumps/Rubella Immunity PSMRSA Screen by PCR (GPRMC) PS

Nicotine & Metabolites, Serum (RPS) PSOsmolality, Urine PS

Phenobarbital PSPhenytoin PS

Procalcitonin (RPS) PSProgesterone PS

Prolactin PSProtein Electrophoresis, Serum (RPS) PS

PTH, Intact PSReverse T3 (RPS) PS

Rheumatoid Factor, Blood (RPS) PSRPR Syphilis Serology PS

Rubella Screen PSStreptolysin O (ASO) Antibody (RPS) PS

T4 Total PSTacrolimus (FK506) Level (RPS) PS

Testosterone PSTestosterone, Free (RPS) PS

Tetanus Antibody, IgG (RPS) PSTheophylline PS

Thyroglobulin (RPS) PSThyroglobulin Antibody (RPS) PS

Thyroid Peroxidase (TPO) Antibody (RPS) PSTissue Culture PS

Tissue Transglutaminase (tTG) IgA (RPS) PSVaricella-Zoster Virus Antibody, IgG (RPS) PS

Vitamin D, 1, 25-Dihydroxy (Calcitrol) (RPS) PSVitamin D, 25-Hydroxy PS

West Nile Virus Antibody, IgM & IgG PSReticulocyte

Semen Post Vasectomy 3Ova and Parasite

Wet Prep 5Rosette Test - PS

Hepatic Function Panel w/ GGTClostridium difficile Toxin - RL

Digoxin - RL

Thyroid Antibodies (RPS) PS85610 PT/INR POC Lab

Chlamydia/GC DNA Probe Amplification - PSHemoglobin Electrophoresis (Fractionation) (RPS) - PS

Protein Electrophoresis, Random Urine (Mayo via RPS) - PST3 Total - PS

Adult Food Allergy Panel I (IBT 402533) - PSLyme Disease (Borrelia Species) by PCR (RPS) - PS

Galactose-alpha-1,3-galactose (Alpha-Gal) IgE (RPS) - PSRocky Mountain Spotted Fever (Rickettsia) IgM (RPS) - PS

Ehrlichia chaffeensis Abs, IgG & IgM (RPS) - PSFungus Culture (RPS) - PS

Vitamin B1 (Thiamin) (RPS) - PSJohnson Grass, IgE (IBT 60310S) - PS

Coxiella burnetii (Q Fever) Abs, IgG and IgM Phase I/II w/ reflx to titer - PSCrystal Analysis - PS

Urine Immunofixation - PSC Peptide - PS

Cortisol, Random CRT - PSAnaerobic Culture - PS

Fungus Hair, Skin and Nails - PSSmith Ab IgG - PS

Ribonucleic Protein - PSDexamethasone - PS

Keppra (Levetiracetam) - PSMethylmalonic Acid (MMA) - PS

Osmolality, Serum - PSRBC Folate - PS

Alpha-Fetoprotein, Tumor Marker - PSMitochondrial (M2) Antibody, IgG - PSSmooth Muscle Antibody (F-Actin) - PS

Carbamazepine (Tegretol) - PSZika Virus Real Time PCR - PS

Ceruloplasmin - PSAlpha Antitrypsin Phenotype - PS

Hepatitis Delta Virus Antibody - PS24 Hour Urine Cortisol - PSDihydrotestosterone - PS

Gentamicin Peak - PSFecal Fat, Random - PS

Catecholamines Fractionated, Supine - PSChromogranin A - PS

Thiopurine Methyltransferase (TPMT), Enzyme Activity - PSTB Interferon Antigen Response (QuantiFERON-TB GOLD) - PS

West Nile Virus by PCR - PSACTH (Adrenocorticotropic) Hormone Level - PS

Metanephrines Urine Total/Fractionated Random or 24 Hr - PS

Catecholamines Fractionated, Urine, Random or 24 Hr - PSParvovirus B19 Antibodies, IgG & IgM - PS

Cyclic Citrullinated Peptide Antibody, IgG - PSHLA B27 Antigen Screen (Disease Association) - PS

Serotonin, Whole Blood - PSCalprotectin - PS

Liver-Kidney Microsome Antibody, IgG - PSMetanephrine, Fractionated, Plasma - PSHep C Antibody w/ Reflex RNA Quant - PS

Male Testosterone Panel - PSHerpes Simplex Type 1/2 - PSCA 19-9 Cancer Antigen - PS

CA 27.29 - PSAntineutrophil Cytoplasmic Abs (ANCA/MPO/PR-3) - PS

Vitamin B6 (Pyridoxine) - PSCytology-Pleural Fluid - PS

Rotavirus Direct Antigen to (RPS) - PSBody Fluid Uric Acid - PS

NT ProBNP (RPS) - PSDiptheria & Tetanus Abs, IgG (RPS) - PS

Bordetella pertussis Abs, IgA and IgG - PS17-Hydroxypregnenolone - PS

T3 Uptake - PSInsulin-Like Growth Factor Binding Protein 1 - PS

Celiac Disease Screen - PSVaricella Zoster Virus Antibody, IgM - PS

Sjogren (SSA & SSB) Antibodies - PSChromatin Antibody, IgG - PS

Histone Antibody, IgG - PSBK Virus DNA Detection and Quantitation - PS

Extractable Nuclear Antigen RNP/Smith/SSA/SSB - PSComplement Profile C3 and C4 - PS

Immunofixation & Protein Electrophoresis, Urine - PSFecal Occult Blood, Colorectal Cancer Screen - PS

Varicella Zoster Virus DNA Detection, CSF or Swab - PsMumps Virus by PCR - PS

Digoxin TroughBeta 2 Glycoprotein 1 IgG, IgM, IgA (RPS) - PSCardiolipin Antibodies, IgG and IgM (RPS) - PS

Factor V (5) Inhibitor (RPS) - PSFactor VIII Antigen (RPS) - PS

Protein S Deficiency Profile (RPS) - PSProtein C Deficiency Profile (RPS) - PSLupus Anticoagulant Panel (RPS) - PS

Antithrombin III, Activity (Functional) (RPS) - PSImmunoglobulin D (IgD) (RPS) - PS

Von Willebrand Factor (vWF) Antigen (RPS) - PS

Toxoplasma gondii by PCR (RPS) - PSFactor II DNA analysis (RPS) - PS

Prothrombin II/Leiden Factor V Mutation (FVLM) (RPS) - PSProtein C, Total Antigen - PS

Protein C Functional - PSProtein S, Total Antigen - PS

Protein S Functional - PSThyroglobulin w/ Thyroglobulin Antibody (RPS) PS

Aspergillus Galactomannan Antigen, Serum - PSCryptococcal Ab (LCH 082891) - PS

Cryoglobulin (RPS) - PSCoccidioides Antibody, IgM (RPS) - PS

Respiratory Region IX, Great Plains Panel (IBT 402959) - PSAngiotensin Converting Enzyme (ACE) (RPS) - PS

Jo-1 Antibody, IgG - PSHistoplasma capsulatum Antibodies (CF and ID) - PS

Prealbumin - PSTestosterone, Free and Total, Females and Children - PS

Osteocalcin - PSAlkaline Phosphatase, Bone Specific - PS

Intact N-Terminal Propeptide of Type 1 Procollagen (LCH 140850) - PSHepatitis B Core Antibody, Total - PS

Celiac Disease Comprehensive Antibody Profile - PSUranium, Urine (MAYO via RPS) - PS

C-telopeptide, Serum - PSBlastomyces Dermatitidis - PS

Hypersensitivity pneumonitis (Farmer Lung Panel) - PSOva and Parasite Smear - PS

Drug Screen 1 Serum (Street Drug Prof) - PSHemochromatosis Genetic Mutation Panel(RPS) - PS

Lyme Disease, IgM, Early Test w/ Reflex - PSMTHFR DNA Analysis - PS

Von Willebrand Factor (VWF) Screen (RPS) - PSRabies Antibody Screen - PS

Erythropoietin (RPS) - PSTR IV INFU HYDRAT EA ADD'L HR Charge

TR IV INF THERP 1ST HR REPEAT VISIT ChargeTR IV INFU THER EA ADD'L HR SEQ NEW Charge

TR IV CONCURRENT - 1x ONLY ChargeTR IM/SQ WITH IV Charge

TR IM/SQ HORMONAL ChargeTR CHEMO PUSH INITIAL Charge

TR CHEMO PUSH ChargeTR IV INFU CHEMO EACH ADD'L HR Charge

TR CHEMO SEQUENTIAL ChargeTR IRRIGATE IMPLANT VEN ACC DEVICE Charge

TR ADMIN INFLUENZA VACCINE Charge

TR ADMIN PNEUMONIA VAC ChargeL&D- NON VAG DELIVERY or TRANSFER OUT EA ADDL HR Charge

CIRCUMCISION ChargeL&D-Non Vag Delivery or Transfer Out 1ST HR Charge

L&D with Vag Delivery ChargeMinimum Inhibitory ConcentrationGram negative identification (Vitek)Gram positive identification (Vitek)

Blood CultureBody Fluid Culture

Cerebrospinal Fluid CultureEar Culture

Genital CultureNasal Culture

Sputum CultureStool Culture

Throat CultureUrine Culture

Wound CultureBeta LactamaseFlagellar stain

Gram Stain ReportGram Positive PanelGram Negative PanelGroup B Strep Culture

CHKS-GP75CHKS-GP74CHKS-GP67CHKS-GN72

OBS IM OR SQ INJECTION PER STICK ChargeOBS IV PUSH SINGLE OR INITIAL Charge

OBS IV PUSH EA ADD'L SEQ NEW DRUG ChargeOBS IV PUSH EA ADD'L SAME DRUG Charge

OBS IMMUNIZATION ADMIN ONE VACCINE ChargeOBS IV INFU THERAP CONCURRENT ChargeOBS IV INFU HYDRAT EA ADD'L HRCharge

OBS IV INFU THER INITIAL 16-90 MIN ChargeOBS IV INFU THERAP EA ADD'L HR Charge

OBS IV INFU THERAP EA ADD'L SEQ NEW ChargeOBS IV INFUS HYDRAT INIT 31 MIN-1HR Charge

OBSRV BLOOD ADMIN 1ST HR ChargeOBS ADMIN INJ INTRA ARTRL /STK 2ND Charge

OBS ADMIN INTRA ARTERIAL /STK ChargeOBS ADMIN INTRA ARTERIAL /STK CRNA ChargeOBS IRRIGATE IMPLANT VEN ACC DEVICE Charge

OBSRV BLOOD ADMIN EA ADDL HRPCA Pump Charge per day

Compression Device SCD Charge per daySizewise Charge per day

MED NUTRTN THER INITIAL ASSESS 15MNMED NUTRITION REASSESSMENT 15 MIN

MED NUTRITION THERAPY GROUP 30 MINDIABETIC EDUCATION INDIVIDUAL 30MIN

OBSRV ADD'L HR 1ST DAYOBSRV 1ST HOUR

OBSRV 1ST HR W/IV INFUSIONOBSRV ADD'L HR W/IV INF 1ST DAY

OBSRV NMN NO ABN/HR ChargeOBSRV NMN W/ABN/HR Charge

CL 97602 NON SELECTIVE DEBRIDEMENTCL 20550 ORTHO INJ TENDON/SHEATH LIGAMENTCL 20605 ORTHO DRAIN/INJ INTERM JNT WO US

CL 10060 INCIS & DRAIN ABSCESS SIMPLECL 11042 DEBRIDE SUBQ TISSUE 1ST 20SQCM/<

CL 11055 TRIM SKIN LESION SINGLECL 11300 SHAVE LESION TAL 0.5CM OR LESS

CL 11301 SHAVE SKIN LESION 0.6-1.0CMCL 11302 SHAVE SKIN LESION 1.1-2.0CM

CL 11303 SHAVE LESION TAL OVER 2.0CMCL 11305 SHAVE LESION SHF 0.5CM OR LESSCL 11306 SHAVE LESION SNHF 0.6 TO 1.0 CM

CL 11307 SHAVE LESION SHF 1.1-2.0CMCL 11308 SHAVE LESION SHF OVER 2.0CM

CL 11310 SHAVE LESION FEL TO 0.5CMCL 11311 SHAVE LESION FEL 0.6 TO 1.0CM

CL 11312 SHAVE LESION FEL 1.1-2.0CMCL 11313 SHAVE LESION FEL OVER 2.0CM

CL 11400 EXCIS BENIGN LES TAL 0.5CM OR <CL 11402 EXCIS LESION 1-1-2.0CM

CL 11403 EXCIS BEN LESION TAL 2.1-3.0CMCL 11406 EXCIS BEN LES TAL OVER 4.0CM

CL 11420 EXCIS BEN LES SHF 0.5CM OR LESSCL 11421 EXCIS BENIGN LES SHF 0.6-1.0CMCL 11422 EXCIS BEN LES SHF 1.1 TO 2.0CM

CL 11602 EXC TR-EXT MAL+MARG 1.1-2 CMCL 11720 DEBRIDE 1-5 NAILS

CL 11721 DEBRIDE NAILS ANY METHOD 6 OR >CL 11730 AVLSN NAIL PLATE SIMPLE 1

CL 11750 EXCIS NAIL BED PARTIAL/COMPCL 11765 EXCISION OF NAIL FOLD TOE

CL 17000 DESTRUCT ANY METHOD 1ST LESIONCL 17003 DESTROY PREMAL LES 2-14

CL 17004 DESTRUCT ANY METH 15 OR >LESIONCL 20605 DRAIN/INJECT INTERM JNT WO US

CL 21920 BIOPSY SOFT TISSUE OF BACKCL 24065 BIOPSY ARM/ELBOW SOFT TISSUE

CL 28024 EXPLORATION OF TOE JOINTCL 46255 HEMORRHOIDECTOMY INT/EXT

CL 51702 INSERT TEMP BLADDER CATHCL 67840 REMOVE EYELID LESION

CL 99201 WOUND CARE TO 10 SQ CM (NEW)CL 99202 WOUND CARE 11-25 SQ CM (NEW)

CL 99211 WOUND CARE UP TO 10 SQ CMCL 99212 OP SPECIALTY EST VISIT LEVEL II

CL 99212 WOUND CARE 11-25 SQ CMCL 99213 OP SPECIALTY EST VISIT LEVEL IIICL 99214 OP SPECIALTY EST VISIT LEVEL IV

CL 20610 DRN/INJ MAJOR JOINT/BURSA WO USCL G0463 OP VISIT

CL 11443 EXCIS BEN LES FEL 2.1 TO 3.0CMCL 90834 PSYCHOTHERAPY PT 45 MINCL 90832 PSYCHOTHERAPY PT 30 MINCL 90837 PSYCHOTHERAPY PT 60 MIN

CL 90846 FAMILY PSYCHOTHERAPY W/O PATIENTCL 90847 FAMILY PSYCHOTHERAPY WITH PATIENT

CL 90853 GROUP THERAPYCL 90837 PSYCH PT 60 MIN SEP ENCOUNTERCL 90834 PSYCH PT 45 MIN SEP ENCOUNTERCL 90832 PSYCH PT 30 MIN SEP ENCOUNTERCL 11200 REMOVAL OF SKIN TAGS UP TO 15

CL 11102 TANGNTL BX SKIN SINGLE LESROOM/BED: NurseryROOM/BED: Private

ROOM/BED: Semi PrivateROOM/BED: SB Skilled Semi Private

ROOM/BED: SB Intermediate PrivateROOM/BED: SB Intermediate Semi Private

ROOM/BED: RespiteROOM/BED: SB Skilled Private

ROOM/BED: Monitored Bed UnitROOM/BED: Special Treatment

ROOM/BED: Nursery - Baby rooming inUA Dipstick POC (Glucose and Protein)

TB Skin Test POCANES CRNA 20552 INJ TRIGGER POINTS 1 OR 2ANES CRNA 27096 INJ SACROILIAC JNT W/IMG

ANES CRNA 31500 INTUBATION ENDOTRACHEAL (1500)ANES CRNA 62270 SPINAL PUNCTURE DIAG (UB)

ANES CRNA 62272 SPINAL TAP THERAPEUTIC (UB)ANES CRNA 62273 EPIDURAL INJ BLOOD/CLOT PATCH (UB)

ANES CRNA 20553 INJ TRIGGER POINTS 3 OR> MUSCL (1500)

ANES CRNA 36571 INSERT CVP W/SUBCU PORT 5+ (UB)ANES CRNA 62326 INJ SPINE W/CATH LMB/SCRL (UB)

ANES CRNA ANESTHESIA ADMIN II (UB)ANES CRNA ANESTHESIA ADMIN II (1500)

ANES CRNA 62323 INJ SPINE LMBR/SAC W/IMGPF HOSP SG M1 45380 COLONOSCOPY W/BIOPSYPF HOSP SG M2 45380 COLONOSCOPY W/BIOPSY

PF HOSP SG M1 45378 COLONOSCOPY FLEXIBLE DIAGNOSTICPF HOSP SG M2 45378 COLONOSCOPY FLEXIBLE DIAGNOSTIC

PF HOSP SG M1 19120 EXCIS CYST BREAST 1 OR MORE LESPF HOSP SG M2 19120 EXCIS CYST BREAST 1 OR MORE LES

PF HOSP SG M1 43239 EGD BX SINGLE/MULTIPF HOSP SG M2 43239 EGD BX SINGLE/MULTI

PF HOSP M2 95811 POLYSOM 6/>YRS CPAP 4/> PARMPF HOSP M2 95810 POLYSOM 6/> YRS 4/> PARAMPF HOSP M1 95810 POLYSOM 6/> YRS 4/> PARAM

PF HOSP M1 95811 POLYSOM 6/>YRS CPAP 4/> PARMPF HOSP SG M1 36561 INSERT TUNNEL CENTRL VENOUS ACCPF HOSP SG M2 36561 INSERT TUNNEL CENTRL VENOUS ACC

PF HOSP SG M1 58600 TUBAL LIGATIONPF HOSP SG M1 55250 VASECTOMY

PF HOSP SG M1 58670 LAPAROSCOPY TUBAL CAUTERYPF HOSP SG M1 45384 COLONOSCOPY W/REM FORCEPS/CAUTPF HOSP SG M2 45384 COLONOSCOPY W/REM FORCEPS/CAUT

PF HOSP SG M1 43235 EGD DX BRUSH WASHPF HOSP SG M2 43235 EGD DX BRUSH WASH

PF HOSP SG M1 47562 SG1 LAP CHOLECYSTECTOMYPF HOSP SG M2 47562 LAP CHOLECYSTECTOMY

PF HOSP SG M1 G0121 SCREEN COLONOSCOPY NOT HIGH RISKPF HOSP SG M2 G0121 SCREEN COLONOSCOPY NOT HIGH RISK

PF HOSP SG M1 58300 IUD INSERTIONPF HOSP SG M1 58301 REMOVE INTRAUTERINE DEVICE

PF HOSP SG M1 64430 INJ ANES AGENT PUDENDAL NERVEPF HOSP M1 46600 ANOSCOPY DIAGNOSTIC

PF HOSP SG M1 56810 REPAIR OF PERINEUM NON-OBPF HOSP SG M1 38525 EXCISION/BIOPSY AXILLARY LYMPHPF HOSP SG M2 38525 EXCISION/BIOPSY AXILLARY LYMPH

PF HOSP SG M2 45385 COLONOSCOPY W/REM SNARE TECHPF HOSP SG M1 45385 COLONOSCOPY W/REM SNARE TECHPF HOSP SG M1 G0105 COLORECTAL CANCER SCRN INDIV HRPF HOSP SG M2 G0105 COLORECTAL CANCER SCRN INDIV HR

PF HOSP SG M2 64721 CARPAL TUNNEL SURGERYPF HOSP SG M1 36590 REM CENTRAL VENOUS CATH W/PORT

PF HOSP SG M1 26418 REPAIR EXTENSOR TENDON FINGERPF HOSP SG M2 26418 REPAIR EXTENSOR TENDON FINGER

PF HOSP SG M1 25105 ARTHROTOMY WRIST JNT W/SYNOVECTPF HOSP SG M2 25105 ARTHROTOMY WRIST JNT W/SYNOVECT

PF HOSP SG M1 27130 SG1 TOTAL HIP ARTHROPLASTYPF HOSP SG M2 27130 TOTAL HIP ARTHROPLASTY

PF HOSP SG M1 11401 EXCIS BEN LES TAL 0.6-1.0CMPF HOSP SG M2 11401 EXCIS BEN LES TAL 0.6-1.0CM

PF HOSP SG M2 11404 EXCIS BEN LES TAL 3.1 TO 4.0CMPF HOSP SG M1 11404 EXCIS BEN LES TAL 3.1 TO 4.0CMPF HOSP SG M1 11402 EXCIS BEN LES TAL 1.1 TO 2.0CMPF HOSP SG M2 11402 EXCIS BEN LES TAL 1.1 TO 2.0CMPF HOSP SG M1 11403 EXCIS BEN LESION TAL 2.1-3.0CMPF HOSP SG M2 11403 EXCIS BEN LESION TAL 2.1-3.0CMPF HOSP SG M1 11406 EXCIS BEN LES TAL OVER 4.0CMPF HOSP SG M2 11406 EXCIS BEN LES TAL OVER 4.0CM

PF HOSP SG M1 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTPF HOSP SG M2 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTPF HOSP SG M1 46230 EXCISE MULT EXT HEMORRHOID TAGSPF HOSP SG M2 46230 EXCISE MULT EXT HEMORRHOID TAGS

PF HOSP SG M2 11423 EXC H-F-NK-SP B9+MARG 2.1-3PF HOSP SG M1 49505 REP INGUINAL HERNIA >5YRSPF HOSP SG M2 49505 REP INGUINAL HERNIA >5YR

PF HOSP SG M1 49585 REP UMBILICAL HERNIA >5YRSPF HOSP SG M2 49585 REP UMBILICAL HERNIA > 5YRS

PF HOSP SG M2 43245 EGD DILATE STRICTUREPF HOSP SG M2 26055 INCISE FINGER TENDON SHEATHPF HOSP SG M1 26055 INCISE FINGER TENDON SHEATH

PF HOSP SG M2 11403 SG2 EXCIS BEN LES FEL 2.1 TO 3.0CMPF HOSP SG M1 45388 COLONOSCOPY W/ABLATIONPF HOSP SG M2 45388 COLONOSCOPY W/ABLATION

PF HOSP SG M2 64719 REVISE ULNAR NERVE AT WRISTPF HOSP SG M1 64719 REVISE ULNAR NERVE AT WRIST

PF HOSP SG M2 64708 REVISE ARM/LEG NERVEPF HOSP SG M1 64708 REVISE ARM/LEG NERVE

PF HOSP SG M2 26040 RELEASE PALM CONTRACTUREPF HOSP SG M1 26040 RELEASE PALM CONTRACTURE

PF HOSP SG M1 25447 REPAIR WRIST JOINTSPF HOSP SG M2 25447 REPAIR WRIST JOINTS

PF HOSP SG M1 G0120 COLON CA SCRN:BARIUM HRISKPF HOSP SG M2 G0120 COLON CA SCRN:BARIUM HRISKPF HOSP SG M2 45331 SIGMOIDOSCOPY WITH BIOPSY

PF HOSP SG M1 46505 CHEMODENERVATION INT ANAL SPINCPF HOSP SG M2 46505 CHEMODENERVATION INT ANAL SPINC

PF HOSP SG M2 23078 RESECT SHOULDER TUMOR 5 CM/>PF HOSP SG M1 23078 RESECT SHOULDER TUMOR 5 CM/>PF HOSP SG M1 28270 RELEASE OF FOOT CONTRACTUREPF HOSP SG M2 28270 RELEASE OF FOOT CONTRACTURE

PF HOSP SG M1 28230 INCISION OF FOOT TENDON(S)PF HOSP SG M2 28230 INCISION OF FOOT TENDON(S)

PF HOSP M1 46221 HEMORRHOIDECTOMY BY BANDING

PF HOSP SG M1 13100 REPAIR COMP TRUNK 1.1 TO 2.5CMPF HOSP SG M2 13100 REPAIR COMP TRUNK 1.1 TO 2.5CM

PF HOSP SG M2 21556 EXC NECK TUM DEEP < 5 CMPF HOSP M1 94729 CO/MEMBANE DIFFUSE CAPACITY

PF HOSP M1 94726 PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESISTPF HOSP M1 94060 EVALUATION OF WHEEZING

PF HOSP M1 94070 BRONCHOSPASM PROVOCATION INTRPTPF HOSP M2 94070 BRONCHOSPASM PROVOCATION INTRPT

PF HOSP M2 94729 CO DIFFUSING CAPACITYPF HOSP M2 94726 PULM FUNCT TST PLETHYSMOGRAP

PF HOSP M2 94060 EVALUATION OF WHEEZINGPF HOSP SG M2 49568 IMPLANT MESH VENTRAL HERNIA REP

PF HOSP SG M2 49560 REP HERNIA INCIS/VENT INIT REDUANES CRNA 64445 INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE

OSP M1 36576 Repair of central venous access device, with subcutaneous port or puPF HOSP SG M2 43249 EGD ESOPH DILATE <30MM

PF HOSP M2 11603 EXCIS MAL LES TAL 2.1 TO 3.0CMPF HOSP SG M2 45398 COLONOSCOPY W/BAND LIGATION

PF HOSP SG M1 43245 EGD DILATE STRICTURE9500547 LIFELINE HOOK-UP CHARGE

9501925 LIFELINE/MONTH9502477 LIFELINE AUTO ALERT MONTHLY9502479 LIFELINE AUTO ALERT JNT/MO

9500425 LIFELINE MOBILE MONTHLYPT Group Therapy Charge

Wound Care Non-Selective Debride ChargeWhirlpoolFluidotherapy Units 97022Manual Therapy Charge Units 97140

Neuromuscular Reeducation Units 97112Gait Training Units 97116

Orthotic Training Units 97760Therapeutic Activities Charge 97530Therapeutic Exercise Charges 97110

Mechanical Traction Provided Units 97012PT Massage Charge Units 97124

PT Prosthetic Training Charges 97761PT Aquatic Units 97113

PT Physical Performance Test 97750PT Ultrasound Units

PT Ultrasound Charges 97035PT TENS Use Charge 64550

PT Iontophoresis Charges 97033PT Self Care, Home Management Charges 97535

PT Parafin Bath Charge 97018PT Electrical Stimulation Unattended Charge G0283 97014

E-STIM Manual/15min Units 97032Vasopneumatic Pump Units 97016

Contrast Bath/15min Units 97034Phonophoresis Units

Sensory Integrated Techniques/15min UnitsCommunity Work/ Reintegration Units 97537

Wheelchair MGMT/15min Units 97542Work Hardening Inital 2 Hours Units 97545

Work Hardening EA Additional Hour Units 97546Fitness TEsting/Assessment CPTA UnitsPT Strapping of Ankle and/or Foot Units

Therapeutic Exercise UnitsTherapeutic Activities Units

PT Tens APP W/O ChargePT Biofeedback Peri/Uro/Rectal Units 90911

PT Development Cognitive Skills/15M Units G0515PT Low Complex Units 97161

PT Moderate Complex Units 97162PT High Complex Units 97163

PT ReEval Units 97164PT Apply Unna Boot Unilateral Units 29580

BD Bone Density DEXA Axial SkeletonXR Wrist Complete RightXR Wrist Complete Left

XR Wrist Complete BilateralXR Upper Extremity Infant Bilateral

XR Upper Extremity Infant LeftXR Upper Extremity Infant Right

XR Urethrocystography RetrogradeXR Urography RetrogradeXR Wrist 2 Views Bilateral

XR Wrist 2 Views LeftXR Wrist 2 Views RightCT 3D Reconstruction

CT Abdomen w/ + w/o ContrastCT Abdomen w/ Contrast

CT Abdomen w/o ContrastMRI Abdomen w/ + w/o Contrast

MRI Abdomen w/ ContrastUS Abdomen Complete

US Abdomen LimitedMRI Abdomen w/o Contrast

XR Abdomen 1 ViewXR Abdomen 3+ ViewsXR Abdomen 2 Views

XR Abdomen Series w/ Chest 1 ViewXR AC Joints Bilateral w/ + w/o wts

CT Ankle w/ Contrast LeftCT Ankle w/ Contrast Right

CT Ankle w/o Contrast LeftCT Ankle w/o Contrast RightXR Ankle 2 Views Bilateral

XR Ankle 2 Views LeftXR Ankle 2 Views Right

XR Ankle Complete BilateralXR Ankle Complete Left

XR Ankle Complete RightUS Aorta Duplex Complete

US Aorta Duplex LimitedUS Aorta IVC Iliac Duplex Complete

US Aorta IVC Iliac Duplex LimitedXR Barium Enema w/ Air Complete

NM Gated Blood PoolNM Bone Imaging Limited

NM Bone Imaging Limited Multiple AreasNM Bone Imaging Whole Body

NM Bone SpectXR Bone Survey Complete (Mets)

NM Bone Three Phase StudyMRI Brain w/ + w/o Contrast

MRI Brain w/ ContrastMRI Brain w/o Contrast

MRI Breast w/ + w/o Contrast BilateralMRI Breast w/ + w/o Contrast Left

MRI Breast w/ + w/o Contrast RightMRI Breast w/o Contrast Bilateral

MRI Breast w/o Contrast LeftMRI Breast w/o Contrast Right

MG Breast Ndl Loc Placement LeftMG Breast Ndl Loc Placement Right

MRI Spine Cervical w/ + w/o ContrastMRI Spine Cervical w/ Contrast

MRI Spine Cervical w/o ContrastXR Spine Cervical 2 or 3 Views

CT Spine Cervical w/ + w/o ContrastCT Spine Cervical w/ Contrast

CT Spine Cervical w/o ContrastXR Spine Cervical Minimum 4 Views

XR Calcaneus BilateralXR Calcaneus Left

XR Calcaneus RightUS Carotid Doppler BilateralUS Carotid Duplex Bilateral

US Carotid Duplex LeftUS Carotid Duplex Right

CT Thorax w/ + w/o Contrast

CT Thorax w/ ContrastCT Thorax w/o Contrast

MRI Chest w/ + w/o ContrastMRI Chest w/ Contrast

MRI Chest w/o ContrastXR Chest 2 ViewsXR Chest 3 Views

XR Chest 4+ ViewsXR Clavicle Bilateral

XR Clavicle LeftXR Clavicle Right

CT Angiography Head w/ + w/o ContrastCT Elbow w/ Contrast Left

CT Elbow w/ Contrast RightCT Elbow w/o Contrast Left

CT Elbow w/o Contrast RightXR Toes Great RightXR Toes Great Left

XR Toes 5th Digit RightXR Toes 5th Digit Left

XR Toes 4th Digit RightXR Toes 4th Digit Left

XR Toes 3rd Digit RightXR Toes 3rd Digit Left

XR Toes 2nd Digit RightXR Toes 2nd Digit LeftXR Tibia/Fibula RightXR Tibia/Fibula Left

XR Tibia/Fibula BilateralCT Head or Brain w/ + w/o Contrast

CT Head or Brain w/ ContrastXR Swallowing Function w/ Video

CT Head or Brain w/o ContrastXR Sternum Minimum 2 Views

XR Sternoclavicular Joint(s)XR Spine Thoracic 2 Views

XR Spine Single View Specify LevelXR Spine Scoliosis Study Standing

XR Spine Lumbosacral Minimum 4 ViewsXR Spine Lumbosacral Complete w/ Bending

XR Spine Lumbosacral Bending OnlyCT Knee w/o Contrast Left

CT Knee w/o Contrast RightXR Spine Lumbosacral 2 or 3 ViewsCT Spine Lumbar w/ + w/o Contrast

CT Spine Lumbar w/ ContrastCT Spine Lumbar w/o Contrast

CT Limited or Localized F/U StudyCT Lower Extremity w/+w/o Contrast BilatCT Lower Extremity w/+w/o Contrast Left

CT Lower Extremity w/+w/o Contrast RightCT Lower Extremity w/ Contrast BilatCT Lower Extremity w/ Contrast Left

CT Lower Extremity w/ Contrast RightCT Lower Extremity w/o Contrast BilatCT Lower Extremity w/o Contrast Left

CT Lower Extremity w/o Contrast RightCT Maxillofacial w/ + w/o Contrast

CT Maxillofacial w/ ContrastXR Skull Complete

CT Maxillofacial w/o ContrastXR Skull < 4 Views

CT Orbit Sella etc. w/ + w/o ContrastXR Sinuses Paranasal CompleteCT Orbit Sella etc. w/ Contrast

CT Orbit Sella etc. w/o ContrastXR Sinuses Paranasal < 3 Views

CT Pelvis w/ + w/o ContrastCT Pelvis w/ Contrast

CT Pelvis w/o ContrastXR Shoulder Complete RightXR Shoulder Complete Left

XR Shoulder Complete BilateralCT Shoulder w/ Contrast Left

CT Shoulder w/ Contrast RightXR Shoulder 1 View RightXR Shoulder 1 View Left

CT Shoulder w/o Contrast LeftXR Shoulder 1 View Bilateral

CT Shoulder w/o Contrast RightCT Soft Tissue Neck w/ + w/o Contrast

CT Soft Tissue Neck w/ ContrastCT Soft Tissue Neck w/o Contrast

XR Scapula RightCT Spine Thoracic w/ + w/o Contrast

XR Scapula LeftCT Spine Thoracic w/ Contrast

XR Scapula BilateralCT Spine Thoracic w/o Contrast

XR Sacrum/Coccyx Minimum 2 ViewsXR Sacroiliac Joints Minimum 3 Views

CT Upper Extremity w/+w/o Contrast BilatCT Upper Extremity w/+w/o Contrast Left

CT Upper Extremity w/+w/o Contrast Right

CT Upper Extremity w/ Contrast BilatCT Upper Extremity w/ Contrast Left

XR Ribs w/ PA Chest BilateralXR Ribs 2 Views RightXR Ribs 2 Views Left

CT Upper Extremity w/ Contrast RightCT Upper Extremity w/o Contrast BilatCT Upper Extremity w/o Contrast Left

CT Upper Extremity w/o Contrast RightCT Wrist w/ Contrast Left

CT Wrist w/ Contrast RightCT Wrist w/o Contrast Left

CT Wrist w/o Contrast RightXR Pelvis Complete Minimum 3 Views

XR Pelvis 1 or 2 ViewsXR Orbits Complete RightXR Orbits Complete Left

XR Orbits Complete BilateralXR Neck Soft Tissue

XR Nasal Bones Minimum 3 ViewsXR Mastoids Complete RightXR Mastoids Complete Left

XR Mastoids Complete BilateralXR Mastoids < 3 Views RightXR Mastoids < 3 Views Left

XR Mastoids < 3 Views BilateralXR Mandible Partial Less Than 4 Views

XR Mandible Complete Minimum 4 ViewsXR Lower Extremity Infant RightXR Lower Extremity Infant Left

XR Lower Extremity Infant BilateralXR Knee Standing AP Bilateral

XR Knee 1 or 2 Views RightXR Knee 1 or 2 Views Left

XR Knee 1 or 2 Views BilateralXR Knee Complete 4 or More Views RightXR Knee Complete 4 or More Views Left

XR Knee Complete 4 or More Views BilateralXR Knee 3 Views RightXR Knee 3 Views Left

XR Knee 3 Views BilateralXR IVP

XR Humerus RightXR Humerus Left

XR Humerus BilateralXR Hip Complete RightXR Hip Complete Left

XR Hip 1 View RightXR Hip 1 View Left

XR Hand Complete RightXR Hand Complete Left

XR Hand Complete BilateralXR Hand 2 Views RightXR Hand 2 Views Left

XR Hand 2 Views BilateralXR Foreign Body Loc Eye Bilateral

XR Forearm 2 Views RightXR Forearm 2 Views Left

XR Forearm 2 Views BilateralXR Foot Complete RightXR Foot Complete Left

XR Foot Complete BilateralXR Foot 2 Views RightXR Foot 2 Views Left

XR Foot 2 Views BilateralXR Fluoroscopy Up to 1 Hour

XR Fluoro Guidance Needle Loc SpineXR Finger Thumb RightXR Finger Thumb Left

XR Finger 5th Digit RightXR Finger 5th Digit Left

XR Finger 4th Digit RightXR Finger 4th Digit Left

XR Finger 3rd Digit RightXR Finger 3rd Digit Left

XR Finger 2nd Digit RightXR Finger 2nd Digit Left

XR Femur Min 2 Views RtXR Facial Bones Minimum 3 Views

XR Facial Bones < 3 ViewsXR Esophagus

XR Elbow Complete RightXR Elbow Complete Left

XR Elbow Complete BilateralXR Elbow 2 Views RightXR Elbow 2 Views Left

XR Elbow 2 Views BilateralMRA Head w/ + w/o Contrast

MRA Head w/ ContrastMRA Head w/o Contrast

MRA Neck w/ + w/o ContrastMRA Neck w/ Contrast

MRA Neck w/o ContrastMRA Spinal Canal + Contents

US UE Venous Duplex RightUS UE Venous Duplex Left

US UE Venous Duplex BilateralUS UE Arterial Duplex RightUS UE Arterial Duplex Left

US UE Arterial Duplex BilateralUS Transvaginal Non OB

US Spinal CanalUS Scrotum (Contents)

MRI Face Neck Orbit w/ + w/o ContrastUS Retroperitoneal Limited

MRI Face Neck Orbit w/ ContrastMRI Face Neck Orbit w/o Contrast

US Retroperitoneal CompleteUS Prostate Transrectal

US Pregnancy TransvaginalUS Pregnancy Limited

US Pregnancy Follow UpUS Pregnancy Complete w/ DetailUS Pregnancy After 1st Trimester

US Pregnancy 1st TrimesterUS Pelvis Non OB Limited

US Pelvis Non OB CompleteUS LE Venous Duplex RightUS LE Venous Duplex Left

US LE Venous Duplex BilateralUS LE Venous Doppler Bilateral

US LE Arterial Duplex RightUS LE Arterial Duplex Left

US LE Arterial Duplex BilateralUS Extremity Non Vascular Left

US Extremity Non Vascular RightUS Fetal Biophysical Profile w/ Non StrUS Fetal Biophysical Profile w/o N Str

MRI LE Joint w/ + w/o Contrast BilateralMRI LE Joint w/ + w/o Contrast Left

MRI LE Joint w/ + w/o Contrast RightUS Hips Infant Static Limited

MRI LE Joint w/ Contrast BilateralMRI LE Joint w/ Contrast Left

MRI LE Joint w/ Contrast RightUS Hips Infant Dynamic

MRI LE Joint w/o Contrast BilateralMRI LE Joint w/o Contrast Left

US Head/Neck Soft TissueMRI LE Joint w/o Contrast Right

MRI LE Non Joint w/ + w/o Contrast Bilat

MRI LE Non Joint w/ + w/o Contrast LeftNM Gastric Emptying Study

NM Gastrointestinal Blood Loss ImagingMRI LE Non Joint w/ + w/o Contrast Right

MRI LE Non Joint w/ Contrast BilateralMRI LE Non Joint w/ Contrast Left

MRI LE Non Joint w/ Contrast RightMRI LE Non Joint w/o Contrast BilatMRI LE Non Joint w/o Contrast Left

MRI LE Non Joint w/o Contrast RightMRI Pelvis w/ + w/o ContrastUS Guided Needle Placement

MRI Pelvis w/ ContrastMRI Pelvis w/o Contrast

NM Hepatobiliary Duct System ImagingNM Intestine Imaging

MRI UE Joint w/ + w/o Contrast BilateralMRI UE Joint w/ + w/o Contrast Left

MRI UE Joint w/ + w/o Contrast RightMRI UE Joint w/ Contrast Bilateral

MRI UE Joint w/ Contrast LeftMRI UE Joint w/ Contrast Right

MRI UE Joint w/o Contrast BilateralMRI UE Joint w/o Contrast Left

MRI UE Joint w/o Contrast RightMRI Spine Lumbar w/ + w/o Contrast

NM Kidney SpectMRI Spine Lumbar w/ Contrast

MRI Spine Lumbar w/o ContrastMRI Spine Thoracic w/ Contrast

MRI Spine Thoracic w/ + w/o ContrastMRI Spine Thoracic w/o Contrast

NM Liver Imaging SpectNM Liver/Spleen Imaging

NM Liver/Spleen Imaging w/ Vascular FlowMRI TMJ

MRI UE Non Joint w/ + w/o Contrast BilatMRI UE Non Joint w/ + w/o Contrast Left

MRI UE Non Joint w/ + w/o Contrast RightMRI UE Non Joint w/ Contrast Left

MRI UE Non Joint w/ Contrast BilateralMRI UE Non Joint w/ Contrast Right

MRI UE Non Joint w/o Contrast BilateralNM Ureteral Reflux Study

MRI UE Non Joint w/o Contrast LeftNM Myocardial Spect Multi Rest/StressNM Myocardial Spect Single Rest/Stress

MRI UE Non Joint w/o Contrast RightNM Tumor Localization/Limited

NM Thyroid Imaging with Vascular FlowNM Kidney Imaging w/ Flow w/ Pharm

NM Kidney Imaging w/ Flow w/ + w/o PharmNM Kidney Imaging w/ Flow w/o PharmNM Thyroid Imaging w/ Uptake Multiple

NM Kidney Imaging w/ FunctionNM Kidney Imaging w/ Vascular Flow

NM Parathyroid StudyNM Pulmonary Perfusion Imaging

NM Brain SpectNM Pulmonary Perfusion w/ Ventilation

NM Pulmonary Ventilation/PerfusionCT Sinus w/ + w/o Contrast

CT Sinus w/ ContrastCT Sinus w/o Contrast

US GallbladderUS Thyroid

MRA Abdomen w/ + w/o ContrastMRA Chest w/ + w/o Contrast

MRA Lower Extremity w/ + w/o BilatMRA Lower Extremity w/ + w/o RightMRA Lower Extremity w/ + w/o Left

MG Mammogram Digital Diagnostic BilatMG Mammogram Digital Diagnostic Left

MG Mammogram Digital Diagnostic RightMRA Pelvis w/ + w/o Contrast

MRA Upper Extremity w/ + w/o Contrast BtMRA Upper Extremity w/ + w/o Contrast LtMRA Upper Extremity w/ + w/o Contrast RtUS Pregnancy Nuchal Measure 1st Trimest

XR Spine Cervical Flexion + ExtensionXR Zygomatic Arches

XR Chest 1 ViewUS EchocardiogramXR Abdomen 2 View

CT Abdomen + Pelvis w/ + w/o ContrastCT Abdomen + Pelvis w/ Contrast

CT Abdomen + Pelvis w/o ContrastCT Low Dose Lung Cancer Screening

MG Mammogram Digital Screening BilatUS Ankle Brachial IndexUS Breast Left Complete

US Breast Left LimitedUS Breast Right Complete

US Breast Right Limited

US Extremity Non Vascular LimitedXR Femur 1 View LtXR Femur 1 View Rt

XR Femur Min 2 Views LtXR Hip 1 View Lt w/ PelvisXR Hip 1 View Rt w/ Pelvis

XR Hip 2-3 Views Lt w/ PelvisXR Hip 2-3 Views Rt w/ Pelvis

XR Hip Min 4 Views Lt w/ PelvisXR Hip Min 4 Views Rt w/ Pelvis

XR Hips Bil w/ Pelvis 2 ViewsXR Hips Bil w/ Pelvis 3-4 Views

XR Hips Bil w/ Pelvis Min 5 ViewsXR Ribs Min 3 Views Left w/ PA Chest

XR Ribs Min 3 Views Right w/ PA ChestXR Spine Cervical Complete

XR Spine Entire 1 ViewXR Spine Entire 2-3 Views

US BladderUS Aorta Screening

US Echo 2D Comp w/ Color Flow DopplerUS Echo 2D Comp w/o Color Flow Doppler

US Echo 2D LimitedUS Echo Doppler Complete

US Pregnancy 1st Trimester Ea Addl GestUS Pregnancy After 1st Trim Ea Addl Gest

EKG (Radiology)ECHO (Rad)

Stress Test (Rad)Holter Monitor Recording (RAD)

CT Chest/Abdomen/Pelvis w + w/oCT Chest/Abdomen/Pelvis w

CT Chest/Abdomen/Pelvis woXR Hip 2-3 View - Left

XR Hip 2-3 View - RightUS Transvaginal OBXR Hips Bil 2 Views

XR Hips Bil 3-4 ViewsCT Chest w/ + w/o Contrast

CT Chest w/ ContrastCT Chest w/o Contrast

XR Spine Cervical 6 or more viewsTreadmill Cardiovascular Stress Test

MG Mammo 3D Digital Diagnostic - BilateralMG Mammo 3D Digital Diagnostic - Left

MG Mammo 3D Digital Diagnostic - RightMG Mammo 3D Digital Screening Bilateral

Holter Monitor (RAD) - 30 DayzzAerosol Inhalation Pentamindine Charge

EKG 1-3 LEADS TRACING ONLY ChargeSTRESS TEST TRACE ONLY WO INT & RPT

HOLTER MONITOR RECORDINGHOLTER MONITOR ANALYSIS W/REPORT

ECHO 2D W/SPEC/CLR FLOW M-MODE COMPECHO 2D M-MODE DOPPLER

ECHOCARDIOGRAPHY DOPPLERCARDIAC COLOR FLOW MAP

CATHETER ASPIRATION NASOTRACHEALCARD REHAB W/O ECG

CARD REHAB W/CONT ECG MONITORINGPF BREATHING CAPACITY TEST

PF BRONCHODILATION RESPONSIVENESS PRE & POST MEDICATIONPF VITAL CAPACITY

PRESSURIZED/NOPRESS INHALATION TRMTCPAP INITIATION AND MANAGEMENT

CHEST WALL MANIP LUNG FUNCTION INICHEST WALL MANIP LUNG FUNCTION SUBQ

PF PLETHYSMOGRAPHY TESTPF DIFFUSING CAPACITY CO/MEMBRANEPF PULSE OXIMETRY SINGLE DETERMINAT

PF PULSE OXIMETRY MULT DETERMINATNSPF OXIMETRY CONT OVERNIGHT MONITOR

FETAL CONTRACTION STRESS TESTFETAL NON-STRESS TEST

CARDIAC EVENT MONITOR ANALYSISECHOCARDIOGRAPHY LIMITED/FOLLOWUP

TT ECHO WITH CONTRAST DOPPLERINTUBATION ENDOTRACHEAL EMERGENCY

TRACH TUBE CHANGEVENTILATION ASSIST/MGMT IP/OBS INI

VENTILATION ASSIST/MGMT IP/OBS SUBSPF BRONCHOSPASM PROVOCATION EVAL

PF PULMONARY STRESS TESTCONTINUOUS AEROSOL TX 1ST HR

CONTINUOUS AEROSOL TX SUB HOURDEMONSTRATE/EVAL NEBULZER/MDI/IPPB

PF CO2 EXPIRED GAS DETERMINATIONPF EXHALED NITRIC OXIDE MEASURE

SMOKING/TOBACCO CESSATION >10MINPULMONARY REHAB W/MONITORED EXER

PFT INTERPRETATIONG0237 THERAPEUTIC PROC STRG ENDUR EA 15MN

Ventilation Assist/MGMT IP/OBS SubsqIntubation Endotracheal Emergency

Demonstrate/Eval Nebulizer/MDI/IPPBTrach Tube Change

Continuous Aerosol TX Subq HRCatheter Aspiration Nasotracheal

Pressurized/Nopress Inhalation TRMTChest Wall Manip Lung Function Subsequent

Pulmonary RetrainingContinuous Aerosol TX 1st HR

Ventilation Assist/MGMT IP/OBS INICPAP Initiation and MGMT

Chest Wall Manip Lung Function InitialO2 DAILY CHARGE

O2 PER HOUR CHARGEFetal Non-Stress Test

PF Exhaled Nitric Oxide MeasurePF Vital Capacity

zzPF Pulmonary Stress TestPF Pulse Oximetry Mult DeterminatnsPulmonary Rehab W/Monitored Exer

zzSmoking/Tobacco Cessation Asym >10Pulmonary Rehab Exercise

Electrocardiogram Tracing OnlyPF Plethysmography Test

PF Pulse Oximetry Single DeterminatPF Bronchospasm Provocation EvalPF Co2 Expired Gas Determination

PF Spirometry EvaluationPF Bronchodilation ResponsivenessPF Diffusing Capacity Co/MembranePF Oximetry Cont Overnight MonitorAerosol Inhal Tx Pentamidine Charge

ABG (RT)POLYSOMNOGRAPHY =>4 ADDL PARAM 6>YRPOLYSOMNOGRAPHY W/CPAP 4+ADD PAR 6+

SLEEP STUDY UNATTENDEDSpeech Eval of Speech Fluency Units 92521Speech Eval Speech Production Units 92522

Speech Sound Lang Comprehen Eval Units 92523Speech Behavral Qualit Analys Voice Units 92524

Swallow Evaluation Units 92610Swallow Funct Fluoroscopic Eval Units 92611

Cognitive Perform Test Stnd Per Hr Units 96125Treatment of Speech,Lang,Voice Units 92507

Treatment of Swallowing Dysfunction Unit 92526MATTRESS AIR PER DAY

O2 DAILYSUTURE 0 VICRYL J346

IOL CONVENTIONAL LENSVAC MACHINE DAILY

IOL EYE TORICIOL PRESBYOPIA CORRECTING IOL

BIPAP MACHINE PER DAYPCA (PAIN) PUMP/PER DAY

ZZCATH BAL DIL NON VASCULAR 18-20 MMCATHETER FEMALE KIT

ACE WRAP 2 (LF)ACE WRAP 3 (LF)ACE WRAP 4 (LF)

CATH TRAY 16FR W METERED BAGAMNIHOOK

SLING ARM SMALLSLING ARM MEDIUM

SLING ARM LARGECIRCUIT NEONATAL T PIECE

DEBRISOFT PADUMBILICAL CATH 5FRSKIN STAPLER MINI

POST OP SHOE XSMALL NEWPOST OP SHOE SMALL NEW

POST OP SHOE MEDIUM NEWPOST OP SHOE LARGE NEW

POST OP SHOE XLARGE NEWKNEE BRACE WRAP AROUND XLG

DEBRISOFT LOLLYCATH TRAY LATEX FREE

CERVICAL COLLAR MEDIUMCERVICAL COLLAR LARGE

THORACIC CATHETER 32FRESOPHAGEAL WIREGUIDED 15mm 18mm

ESOPHAGEAL ALLIANCE II SYRINGEESOPHAGEAL WIREGUIDED 12mm 15mmESOPHAGEAL WIREGUIDED 18mm 20mm

CATHETER 14FR PLAINCATHETER 10FR FOLEY 3ccCATHETER 12FR FOLEY 5cc

CATHETER 14FR FOLEYCATHETER 16FR FOLEYCATHETER 18FR FOLEY

CATHETER 20FR FOLEY 5ccCATHETER 20FR FOLEY 30cc BALLOON

CATHETER 22FR FOLEY 5ccCATHETER 24FR FOLEY

CATHETER 22FR 30CC BALLOONENEMA BAG 1500cc

ESMARK 4ELECTRODES 5PK DO NOT ORDER

SALEM SUMP 10FRGAUZE 2 X 2GAUZE 4 X 4SURGIPAD

VASELINE GAUZE 3 X 9HEEL ELBOW PROTECTOR YELLOW

NUGAUZE 1/4NUGAUZE 1/2 MSS

NUGAUZE 1IRRIGATION TRAY

K PADCONFORM 2CONFORM 4

SALEM SUMP 14FRLUMBAR PUNCTURE TRAY ADULT

LUMBAR PUNCTURE TRAY PED/INFANTNEEDLE 22GA X 3 1/2

SUTURE 4-0 VICRYL J496 PS 2BACTERIAL VIRAL FILTER

SUCTION CATH 32FRPENROSE DRAIN 1/4SALEM SUMP 16FR

FETAL SPIRAL ELECTRODESTERI STRIP 1/4

TED HOSE MEDIUM LFTED HOSE LARGE LATEX FREE

TED HOSE XLARGE LATEX FREETED HOSE SMALL LATEX FREEJACKSON PRATT FLAT DRAIN

TED HOSE XLG THIGH HIGH LATEX FREETED HOSE MEDIUM THIGH LATEX FREE

TED HOSE LARGE THIGH LATEX FREESTOPCOCK 3WAY INPT CHG ONLY

SUTURE 2-0 PROLENE (8685)SUTURE 4-0 PROLENE 8683 FS-2SUTURE 6-0 PROLENE 8695 P 3

SUCTION CATH 10FRSUCTION CATH 14FR

SUCTION CATH 8FR DELEETELFA PAD 2 X 3

THORACIC CATHETER 16FRTHORACIC CATHETER 20FRTHORACIC CATHETER 40FR

TRACHEOSTOMY CARE TRAYTRACHEAL TUBE 3.0mm UNCUFFED

TRACHEAL TUBE 4.0mm UNCUFFEDTRACHEAL TUBE 4.5mm UNCUFFEDTRACHEAL TUBE 5.0mm UNCUFFED

TRACHEAL TUBE 5.5mmTRACHEAL TUBE 6.0mmTRACHEAL TUBE 6.5mmTRACHEAL TUBE 7mm

TRACHEAL TUBE 7.5mmTRACHEAL TUBE 8.0mmTRACHEAL TUBE 8.5mmTRACHEAL TUBE 9.0mm

TRACHEAL TUBE 10.0mmUA DRAIN BAG

BREAST PUMP ACCESSORIESEAR SYRINGE

SUTURE 5-0 PROLENE 8661 FS 2NEEDLE SPINAL 22GA X 7

ADAPTIC 3 X 8ADAPTIC TOUCH 3 X 4 1/4

TRACHEAL TUBE 3.5mm UNCUFFEDANESTHESIA BREATH CIRCUIT PEDIATRIC

SALINE 1000ccSKIN STAPLE REMOVER

STERI STRIP 1/8SUCTION CATH 8FR

SPINAL ANESTHESIA TRAYSHOULDER IMMOBILIZER MEDIUM

SHOULDER IMMOBILIZER LGAIRWAY 100mm DUAL CHANNEL ORALAIRWAY 90mm DUAL CHANNEL ORALAIRWAY 80mm DUAL CHANNEL ORALAIRWAY 60mm DUAL CHANNEL ORAL

CAST SHOE SMALLCAST SHOE MEDIUMSKIN STAPLER WIDE

DISPOZ A BAGH2O 1000cc

TED HOSE SMALL THIGH LATEX FREEZIMMER SWITCHPEN CAUTER PEN

RECTAL TUBE 24FRADAPTIC 3 X 3

MUCUS SPECIMEN TARPCONFORM 1

BIOPSY PUNCH 3mmBIOPSY PUNCH 5mm

SHOULDER IMMOBILIZER SMSUCTION CATH 18FR

KERLIX 4 1/2 MSSIODOFORM GAUZE 1/4IODOFORM GAUZE 1/2IODOFORM GAUZE 1

ACE WRAP 6 (LF)SUTURE 3-0 ETHILON 663G

PLEUR EVAC CHEST DRAINAGE UNITTRACH STYLET ADULT

PARACERVICAL PUDENDAL TRAYTHORACENTESIS TRAY

TRACHEAL TUBE 2.5mm UNCUFFEDCERVICAL COLLAR PEDIATRIC

NASOPHARYNGEAL AIRWAY 28FRNASOPHARYNGEAL AIRWAY 32FR

PORT A CATH NEEDLE 3/4SUTURE 0 PROLENE (8434)

STERI STRIP 1/2SUTURE 4-0 MONOCRYL Y496 PS 2

CATH TRAY 14FR LFCATH TRAY 16FR LATEX FREE

SALINE 250ccH2O 250ml

SUTURE 5-0 PROLENE 8698 P 3ARMBOARD ADULT

ARMBOARD PEDIATRICPORT A CATH NEEDLE 1

SUTURE 6-0 VICRYL (J492)SUTURE 5-0 VICRYL (J493)

SALEM SUMP 18FRCATHETER 14FR COUDE MSS

CATHETER 16FR COUDESURGITUBE SIZE 5

EPIDURAL ANESTHESIA TRAY OBEPIDURAL ANESTHESIA TRAY SINGLE DOSE NEW

MORGAN MEDI FLOW LENSFOREARM SPLINT SMALL RIGHT

FOREARM SPLINT MEDIUM RIGHTFOREARM SPLINT LARGE RIGHT

FOREARM SPLINT XLARGE RIGHTFOREARM SPLINT SMALL LEFT

FOREARM SPLINT MEDIUM LEFTFOREARM SPLINT LARGE LEFT

FOREARM SPLINT XLARGE LEFTWRIST SPLINT 6 PEDIATRIC RIGHT

WRIST SPLINT 6 SMALL RIGHTWRIST SPLINT 6 MEDIUM RIGHT

WRIST SPLINT 6 LARGE RIGHT

WRIST SPLINT 6 XLARGE RIGHTWRIST SPLINT 6 PEDIATRIC LEFT

WRIST SPLINT 6 SMALL LEFTWRIST SPLINT 6 MEDIUM LEFT

WRIST SPLINT 6LARGE LEFTWRIST SPLINT 6 XLARGE LEFTWRIST SPLINT 8 SMALL RIGHTWRIST SPLINT 8 LARGE RIGHT

WRIST SPLINT 8 XLARGE RIGHTWRIST SPLINT 8 SMALL LEFT

WRIST SPLINT 8 MEDIUM LEFTWRIST SPLINT 8 XLARGE LEFT

COBAN 3 ASSORTED COLORS LFCOLLES SPLINT SMALL RIGHT

COLLES SPLINT MEDIUM RIGHTCOLLES SPLINT LARGE RIGHTCOLLES SPLINT SMALL LEFT

COLLES SPLINT MEDIUM LEFTCOLLES SPLINT LARGE LEFT

BIOPSY PUNCH 4mmTRACH STYLET PEDIATRICCATH STRAP LATEX FREE

HEEL ELBOW PROTECTOR S M MESHSHOULDER IMMOBILIZER XLARGE

UMBILICAL CLAMPBIOPSY PUNCH 2mmANKLE BRACE SMALL

ANKLE BRACE MEDIUMANKLE BRACE LARGE

ANKLE BRACE XLARGEANKLE BRACE XSMALL

GASTROSTOMY FEEDING TUBESURGITUBE SIZE 1SURGITUBE SIZE 2SURGITUBE SIZE 3SURGITUBE SIZE 4SURGITUBE SIZE 6SURGITUBE SIZE 7SURGITUBE SIZE 8SURGITUBE SIZE 9

SURGITUBE SIZE 10DUODERM SIGNAL 410501

BOOT WALKER MEDIUMBOOT WALKER SMALLBOOT WALKER LARGEWET DRESSING 8 X 4

POST-OP SHOE MALE MEDIUM

TED HOSE KNEE LARGE LONG LATEX FREECOBAN 2 LATEX FREE

POST-OP SHOE MALE LARGEPOST OP SHOE FEMALE LARGE

POST OP SHOE FEMALE MEDIUMCONFORMABLE SPLINT 5 X 30CONFORMABLE SPLINT 4 X 30CONFORMABLE SPLINT 4 X 15CONFORMABLE SPLINT 3 X 12CONFORMABLE SPLINT 3 X 35

KNEE BRACE WRAP AROUND SMALLKNEE BRAC WRAP AROUND MEDIUM

KNEE BRAC WRAP AROUND LARGEKNEE BRACE WRAP AROUND XXLARGE

ZOLL STAT PAD OLDTHORACIC CATHETER 36FR

COBAN 4 LFBIPAP MASK FULL FACE SMALL

BIPAP MASK FULL FACE MEDIUMBIPAP MASK FULL FACE LG

BIPAP CIRCUIT DISPAQUACEL 4 X 5

DRESSING TRAY CENTRAL LINECOMBITUBE 42FR

VENTRIO ST PATCH SM OVAL 8 X 12ENDOPOUCH RETRIEVER 4 X 6

VENTRIO ST PATCH MD OVAL 11 X 14VENTRALEX MESH SMALL CIRCLE

AQUACEL AG 6 X 6TUOHY NEEDLE 22GA X 2

PHILADELPHIA COLLAR ADULT UNIVERSALHEM-O-LOK

AQUACEL AG 2 X 2ZOLL STAT PAD PEDIATRIC

AQUACEL AG 4 X 5HEAD BLOCK DISPOSABLEENDOPATH ETS RELOAD

SLING ARM XLARGEPORT A CATH NEEDLE 5/8

VAPOR CLEAN FILTERFOREARM SPLINT W ABDUCTED THUMB SMALL RIGHTFOREARM SPLINT W ABDUCTED THUMB MED RIGHT

FOREARM SPLINT W ABDUCTED THUMB LG RIGHTFOREARM SPLINT W ABDUCTED THUMB XLG RIGHT

FOREARM SPLINT W ABDUCTED THUMB SM LEFTFOREARM SPLINT W ABDUCTED THUMB MED LEFT

FOREARM SPLINT W ABDUCTED THUMB LG LEFT

FOREARM SPLINT W ABDUCTED THUMB XLG LEFTTRACHEAL TUBE 2.0mm UNCUFFED

SUTURE 5-0 ETHILON MONO (1666G) PS-2SUTURE 1 CHROMIC 915

SUTURE 2-0 CHROMIC (983)SUTURE 0 SILK C027

SUTURE 4-0 VICRYL J422 FS 2SUTURE 4-0 VICRYL J337 CT 1FINGER SPLINT ALUMIFOAM

PHILADELPHIA COLLAR PEDIATRIC UNIVERSALCLIPPER HEAD ASSEMBLY MSS

MEDIPORE 3 1/2 X 8TELFA PAD 3 X 8

LARYNGEAL MASK SIZE 1LARYNGEAL MASK SIZE 1.5LARYNGEAL MASK SIZE 2

LARYNGEAL MASK SIZE 2.5LARYNGEAL MASK SIZE 3LARYNGEAL MASK SIZE 4LARYNGEAL MASK SIZE 5

FEEDING TUBE 8FRNEEDLE EZ I&O ADULT 15GA 25mm

NEEDLE I&O PEDIATRIC 15GANEEDLE TRU-CUT BIOPSY

ARMBOARD INFANTGLIDESCOPE GVL #3GLIDESCOPE GVL #4

SUTURE 3-0 ETHILON (1669H) PS-2SUTURE 4-0 ETHILON (1667G) PS-2

NEEDLE EZ I&O 15GA-45mmPICC 5 FR DUAL LUMEN BARD

PORT A CATH INSERTION TRAY 8FRPORT A CATH INTRODUCER 6.5FRPORT A CATH INTRODUCER 10FR

SHOULDER IMMOBILIZER XXLARGEBOOT WALKER XLARGESPO2 LNCS ADTX ADULT

SPO2 LNCS PDTX PEDIATRICTRACHEOSTOMY TUBE UNCUFFED DIC SIZE 7

SPO2 LNCS INFANT NEO 3NEBULIZER MASK PEDIATRIC

BILI BLANKETGLIDESCOPE STYLETTE

GLIDESCOPE ET TUBE 7.OGLIDESCOPE ET TUBE 7.5GLIDESCOPE ET TUBE 8.0GLIDESCOPE ET TUBE 8.5

TEGADERM ABSORBENT 4 3/8 X 5MEPILEX AG 4 X 4 MSS

XTRASORB DRESSING 4 X 5SUTURE 5-0 CHROMIC (687)

XTRASORB 6 X 9SNAP SECURE RING

SNAP 125 CARTRIDGE KITS 10 X 10 & 15 X 15SNAP DRESSING 10 X 10

ENDOTRACHEAL TUBE INTRODUCER BOUGIESNAP WOUND CARE STRAP LARGESNAP WOUND CARE STRAP SMALL

NIPPLE SHIELD 20mm SMALLSNAP WOUND CARE STRAP MEDIUM

TEGADERM CHG 4 X 4 3/4 1658LNCS SPO2 EAR

BAKRI POSTPARTUM BALLOONGLIDESCOPE GVL #1GLIDESCOPE GVL #2

POST-OP SHOE MALE XLGFEEDING TUBE 5FR INFANT CAT)

EQUALIZER WALKER XSMALLSUTURE 4-0 MERSILENE (1778)

MEPILEX BORDER 6 X 6TEGADERM ABSORBENT 3 X 3 3/4

CURETTE DERMAL 5mmMEPILEX DRESSING 4X 4

EQUALIZER WALKER CHILD LGAQUACEL AG ROPE

MEPILEX BORDER 4 X 4PROMOGRAN WOUND DRESSING 4.75

GASTRIC TUBE 8FR SALEM SUMPRANGER STANDARD FLOW WARMING SET

RANGER HEAVY FLOW WARMING SETCURETTE DERMAL 3mmCURETTE DERMAL 4mm

SUTURE VICRYL 2-0 PS-2 J428SUTURE VICRYL 3-0 PS-2 J497

FEEDING TUBE MIC KEY 14FR X 3MEDIHONEY ROPE

MEPILEX DRESSING 6 X 6ASPEN VISTA COLLAR

SUTURE 0 PLAIN GUT (L104G)SPLINT FROG SM 2.75 X 2.25

SPLINT FROG MD 2.875 X 2.50SPLINT FROG LG 3.5 X 3.0

NASAL DRESSING LG W/STRING 8cm X 1.5cmACTICOAT DRESSING

TUBIGRIP SIZE EXEROFORM DRESSING 5 X 9PROMOGRAN AG 4.34 INCH

SLING ARM ENVELOPE W/PAD CHILDNASOPHARYNGEAL AIRWAY 60MM INFANT 12FRNASOPHARYNGEAL AIRWAY 72MM INFANT 14FR

COMPRESSION STOCKING CALF OBMEDIHONEY GEL

INFANT CATH KIT 5FRNEEDLE SPINAL PENCAN 25 GA X 3.5

DUODERM DRESSING SIGNAL 4 X 4 (403326)AQUACEL AG SURGICAL COVER

TUBIGRIP SIZE GZOLL STAT PAD CPR NEW

EQUALIZER WALKER CHILD MDEQUALIZER WALKER CHILD SM

BILICALWOUND DEBRIDEMENT TRAY CM1 LARGEWOUND DEBRIDEMENT TRAY CM4 SMALL

MEPILEX BORDER SACRUMLARYNGOSCOPE BLADE DISP MAC 1LARYNGOSCOPE BLADE DISP MAC 2LARYNGOSCOPE BLADE DISP MAC 3LARYNGOSCOPE BLADE DISP MAC 4

LARYNGOSCOPE BLADE DISP MILLER 0LARYNGOSCOPE BLADE DISP MILLER 1LARYNGOSCOPE BLADE DISP MILLER 2LARYNGOSCOPE BLADE DISP MILLER 4LARYNGOSCOPE BLADE DISP MILLER 3

TUBIGRIP SIZE FNASOPHARYNGEAL AIRWAY 22FRNASOPHARYNGEAL AIRWAY 24FRNASOPHARYNGEAL AIRWAY 26FR

SPINAL NEEDLE 25GA X 5URINE METER DRAIN BAG

TUBIGRIP SIZE CZOLL STAT PAD PEDIATRIC CPR NEW

PORT A CATH NEEDLE 1 1/4BLOOD TUBING

PCA SETSUBCLAVIAN TRIPLE LUMEN KIT

IV FILTERCLAVE EXTENSION SET 7 MICRO FOR KIDS

CLAVE ADAPTERSTATLOCK PICC LINE

CLAVE EXTENSION SET 7 MACROO2 CONNECT TUBE GREEN 25ft

O2 CONNECT TUBE CLEAR 7ftO2 HUMIDIFIER

O2 MASKVOLDYNE EXERCISERO2 MASK PEDIATRIC

O2 MASK NON-REBREATHING ADULTO2 MASK NON-REBREATHING CHILD

MASK FACE TENTTRACH TEE OXYGENATOR

NEBULIZER AEROCLIPSE BAN IIO2 CANNULA PEDIATRIC

AQUA PAK (TRACH SUPPLY)NEBULIZER ADAPTER

TRACH MASKAEROSOL DRAINAGE SYSTEM (DRAIN BAG)

TRACH TUBE HOLDERO2 CANNULA INFANT

NEBULIZERO2 CANNULA HIGH FLOW ADULT

EZPAP W MONOMETERO2 THERMOMETER W ADAPTERPULMONARY FUNCTION FILTEREXHALATION AEROSOL FILTER

NEBULIZER CONTINUOUS LO FLOO2 CANNUL TENDER GRIP ADULT

O2 MASK AEROECLIPSEAEROCHAMBER PLUS Z-STAT BLUEAIRWAY FLOW SENSOR PED/ADULT

BIPAP CIRCUIT W/MAIN FLOW FILTER (RT)BIPAP MASK W/CAPSTRAP SMALLBIPAP MASK W/CAPSTRAP LARGE

LITTLE SUCKER ASPIRATORENDOTRACHEAL TUBE HOLDER THOMASAIRWAY W/GASTRIC KING TUBE #4 RED

O2 PLUS CANNULA BI FLOAIRWAY W/GASTRIC KING TUBE #2 GREENAIRWAY W/GASTRIC KING TUBE #5 PURPLE

O2 OXYMASKO2 OXYKID MASK

ETCO2 WO2 CANNULA PEDIATRICETCO2 WO2 CANNULA ADULT

ETCO2 AIRWAY ADAPTER KIT ADULT PEDIATRICAEROCHAMBER PLUS ZSTAT YELLOW MED

HEAT & MOISTURE EXCHANGER NEONATAL HMEAEROBIKA NEBULIZER THERAPY (PICKLE)

ETCO2 CANNULA NELCOR MICROSTREAMCAPNOSTAT SPU PED ADULT AIRWAY ADAPTER

CAPNOSTAT CAPNO2 MASK LG ADULTCAPNOSTAT CAPNO2 MASK ADULT

CAPNOSTAT CAPNO2 MASK PEDIATRICNEBULIZER WITH FILTER

AIRWAY W/GASTRIC KING TUBE #2.5 ORANGECONTOUR NASAL MASK MEDIUM/LARGE

VENTILATION CIRCUIT LTV 1200SPLINT FINGER 1/2X 18

UNNA BOOT NON-CALAMINE (WOUND CARE)SUTURE 2-0 VICRYL (J275H)

PEAK FLOW METERUMBILICAL CATH TRAY 5.0 FR

NEOTECH MECONIUM ASPIRATORSUTURE 4-0 PLAIN GUT (U207H)

BIOPATCH 1 GOES WITH CENTRAL LINEBIOPSY PUNCH 8mm

ZOLL CPR-D PADZ AEDINTRA UTERINE PRESSURE CATHNIPPLE SHIELD CONTACT 24mmNIPPLE SHIELD 24mm MEDIUM

LANOLIN CREAM 2ozGASTROSTOMY TUBE 18FR (MAGNA-PORT)

TUBEGAUZE 7/8POLYMEM DRESSING 4 X 4

SNAP 100 CARTRIDGESNAP KIT 100

SALEM SUMP ANTI REFLUX VALVEMITYVAC SOFT CUP

ATTACHMENT ELECTRODE PADS SPIRALMEPILEX BORDER 3 X 3

MESALT DRESSING SHEETBROSELOW ORANGE IV MODULE

BROSELOW BLUE IV MODULEBROSELOW WHITE IV MODULE

BROSELOW YELLOW IV MODULEBROSELOW PURPLE IV MODULE

BP CUFF ADULT TWO TUBE TECHNICUFF (PT)TRACHEOSTOMY TUBE CUFFLESS SHILEY FENESTRATED

AIRWAYS GUEDEL 50mmSUTURE 3-0 VICRYL (J316H)

VENTILATION CIRCUITTRACHEOSTOMY TUBE CUFFLESS 6.0 60XLTUP

INTERDRY AG DRESSINGTRACHEOSTOMY TUBE 6DCFS

HYDROFERA BLUE DRESSING 4 X 4 (ASK BEFORE ORDERING)TUOHY NEEDLES 18GA X 5

TUBIGRIP SIZE D

DUODERM EXTRA THIN 4 X 4TRACHEOSTOMY TUBE CUFFLESS 8CFS SHILEY

0.9% NACL (SALINE FLUSH) 10ccHEP LOCK FLUSH SYRINGE (3ml FILL)

H2O FOR INHALATION 1000ml JASONNOSE CLIP

CORR-A-FLEX II TUBING 22mmPEEP VALVE

J-CIRCUIT W/O WATER TRAPFILTER PROZIMAL INLINE DISP

BIPAP MASK W/CAPSTRAP MEDIUMCPAP BUBBLE SYSTEM (INFANT)

CPAP NASAL TUBING UNIVERSAL (INFANT)CPAP NASAL PRONG 4.0MM/3.0mm

CPAP NASAL PRONG 6.0MM/6.0mm (INFANT)CPAP INFANT BONNET 25-29cm

MVP10 BREATHING CIRCUIT INFANT DISPCPAP INFANT BONNET 29-36cmCONTOUR NASAL MASK PETITECONTOUR NASAL MASK SMALLFINGER GUARD SMALL PADDED

FINGER GUARD MEDIUM PADDEDFINGER GUARD LARGE PADDEDCATHETER EXTERNAL MALE MD

MEDI DUCTTIS U TRAP

WRIST SPLINT ULNAR GUTTER SMWRIST/THUMB SPLINT COMFORT COOL SM LEFTWRIST/THUMB SPLINT COMFORT COOL MD-LEFT

SHOULDER IMMOBILIZER UNIVERSALWRIST BRACE WITH THUMB SPICA MED LEFT

KNEE IMMOBILIZERWRIST SPLINT INFANTCPM PAD PERFORMA

CATH SECUREGAUZE 4X4 10/PK

SUTURE 3-0 VICRYL J285JACKSON PRATT RESERVOIR

UNNA BOOTSUTURE 0 VICRYL J270

SUTURE 2-0 PROLENE 8423SUTURE 4-0 ETHILON 662

FEEDING BAGLOPEZ VALVE

SUTURE 3-0 VICRYL J416IV TUBING SURGICAL

SUTURE 0 CHROMIC 864

SUTURE 0 VICRYL J352SUTURE 4-0 PROLENE 8699

DERMABONDPCA STERILE EMPTY VIAL

O2 CANNULAO2 MASK MULTI-VENT

O2 HUMIDIFIER HIGH FLOWSUTURE 2-0 VICRYL J317H

SUTURE 4-0 VICRYLHEATER CHAMBER

RAPID RHINO NASAL PACK 5.5cm NO AIRWAYRAPID RHINO ANTERIOR/POSTERIOR 7.5cm

RAPID RHINO ANTERIOR 5.5cmVAGINAL RETRACTOR

CELOX NOSEBLEEDDRAIN BAG

ABD BIDNER C-SECTION WRAP SM/MDABD BINDER C-SECTION WRAP MD/LG

ABD BINDER C-SCTION WRAP LGCOBAN 2 COMPRESSION SYSTEM

OB BILIRUBIN LIGHTIV START KIT INPATIENT ONLY

COBAN 2 LITE COMPRESSION SYSTEMCATARACT KIT

MEPILEX BORDER FLEXTR 36592 BLOOD COLLECT CENTRAL/PERIPH DEV Charge

TR 36591 BLOOD COLLECT- IMPLANT VENOUS ChargeTR Q3014 TELEHEALTH FACILITY FEE

TR 90471 ADMIN IMMUNIZATION ONE VACCINE ChargeTR 96372 IM OR SQ INJECTION PER STICK Charge

TR 96374 IV PUSH SINGLE OR INITIALTR 96375 ADD'L PUSH NEW DRUG ChargeTR 96376 ADD'L PUSH SAME DRUG Charge

TR 99211 WOUND CARE UP TO 10 SQ CM ChargeTR 51700 IRRIGATION OF BLADDER Charge

TR 51701 INSERT STRAIGHT CATHETERTR 36000 INTRO NEEDLE OR INTRACATH VEIN Charge

TR 99212 WOUND CARE 11-25 SQ CM ChargeTR 96401 IM/SQ NON-HORMONAL Charge

TR 96361 IV HRDRA ADD'L > 90 MIN ChargeTR 96366 IV THER. ADD'L HRS > 91 MINS ChargeTR 96360 IV HYDRA. INITIAL 31-90 MIN Charge

TR 96365 IV THER. INITIAL 16-90 MIN Charge [SSKS]TR 96413 Chemo Therapeutic Initial Charge

TR 29580 APPLY UNNA BOOT ChargeTR 92960 CARDIOVERSION ELECTIVE Charge

TR 20610 DRN/INJ MAJ JNT/BURSA WO US Charge

TR 62270 SPINAL PUNCTURE DIAGNOSTIC ChargeTR 10060 I&D ABSCESS SIMPLE SINGLE

TR 11403 EXCIS BEN LESION TAL 2.1-3.0CM ChargeTR 11441 EXCIS EYE/NOSE/LIP 0.6-1.0CM Charge

TR 11442 EXCIS BEN LES FEL 1.1 TO 2.0CMTR 11443 EXCIS BEN LES FEL 2.1 TO 3.0CM

TR 11721 DEBRIDEMENT NAILS ANY METH >5 ChargeTR 11730 AVULSN NAIL PLATE PART/COMP SIMP Charge

TR 12001 REPAIR SPL STHF 2.5CM OR LESS ChargeTR 20605 ARTHROCENT/ASP/INJ INT JNT WO US ChargeTR 23650 CLSD TRMT SHOULDER DISCLC W/MNP Charge

TR 27096 INJ ARTHRO SACROIL JNT INCL GUID ChargeTR 29125 APPLY FOREARM SPLINTTR 29405 APPLY CAST SHORT LEG

TR 29425 APPLY SHORT LEG CAST ChargeTR 29505 APPLY LONG LEG SPLINT Charge

TR 29515 APPLICATION LOWER LEG SPLINTTR 29580 APPLY UNNA BOOT BILATERAL Charge

TR 32554 ASPIRATE PLEURA W/O IMAGINGTR 36430 BLOOD ADMIN 0-4HRS (PER DAY) ChargeTR 36430 BLOOD ADMIN 0-8HRS (PER DAY) Charge

TR 36430 BLOOD ADMIN 0-12HRS (PER DAY) ChargeTR 36430 BLOOD ADMIN 0-16 HRS (PER DAY) ChargeTR 36430 BLOOD ADMIN 0-24HRS (PER DAY) Charge

TR 36556 INSERT NT CV CATH 5+ ChargeTR 36561 INSERT TUNNELED CV CATH 5> YRS Charge

TR 36589 REMOVE CENTRAL VENOUS CATHETER ChargeTR 36590 REMOVE CENTRAL VEN DEV W/PMP-PRT Charge

TR 49082 ABD PARACENTESIS W/O IMAGINGTR 51102 ASPIRATION OF BLADDER W/INSERT ChargeTR 51705 CHANGE CYSTOSTOMY TUBE SIMPLE ChargeTR 51720 BLADDER INSTILL ANTICARCIN AGENT Charge

TR 54150 CIRCUMCISION W/REGIONL BLOCK ChargeTR 65855 LASER SURGERY OF EYE Charge

TR 66821 DISCISS POST CATARACT LASER SURG ChargeTR 94640 INHALATION TRMT (AEROSOL/NEB) ChargeTR 97597 SELECTIVE DEBRIDE 1ST 20 SQ CM Charge

TR 99211 EVAL LEVEL 1 ChargeTR 99212 EVAL LEVEL 2 ChargeTR 99213 EVAL LEVEL 3 ChargeTR 99214 EVAL LEVEL 4 Charge

OR 43239 EGD BX SINGLE/MULTI ChargeOR 45378 COLONOSCOPY DX W/WO SPECIMEN

OR 45380 COLONOSCOPY W/BIOPSY SINGLE/MULT ChargeOR 45384 COLONOSCOPY W/ REM FORCEPS CAUT Charge

OR 45385 COLONOSCOPY W/REM SNARE ChargeOR G0105 SCREEN COLONOSCOPY HIGH RISK

OR G0121 SCREEN COLONOSCOPY NOT HIGH RISKOR 11043 DEBRIDEMENT SKIN SUB TISS/MUSCLE

OR 11400 EXCIS BENIGN LES TAL 0.5CM OR < ChargeOR 11401 EXCISE BENIGN LES TAL 0.6-1.0CM

OR 11403 EXCIS BEN LESION TAL 2.1-3.0CM ChargeOR 11404 EXCIS BEN LES TAL 3.1 TO 4.0CM ChargeOR 11406 EXCIS BEN LES TAL OVER 4.0CM Charge

OR 11421 EXCIS BEN LES SHF 0.6-1.0CMOR 11423 EXCIS BEN LES SHF 2.1 TO 3.0CM Charge

OR 25111 EXCISE GANGLION WRIST PRIMARYOR 28820 AMPUTATION OF TOE

OR 36561 INSERT TUNNELED CV CATH 5> YRS ChargeOR 36590 REMOVE CENTRAL VEN DEV W/PORT Charge

TR 29130 SPLINT APPL FINGER STATICTR 29240 STRAPPING OF SHOULDER

OR 45308 PROCTOSIGMOIDOSCOPY REMOVALOR 19120 REMOVAL OF BREAST LESION

OR 20525 REMOVE FOR BODY DEEP/COMPLICATDOR 45331 SIGMOIDOSCOPY WITH BIOPSY

OR 59514 CESAREAN DELIVERY ONLYOR 45388 COLONOSCOPY W/ABLATION

OR 59160 CURETTAGE POSTPARTUMOR 17110 DESTRUCT B9 LESION 1-14

OR 11443 EXC FACE-MM B9+MARG 2.1-3 CMOR 45330 SIGMOIDOSCOPY FLEXIBLE DIAG

OR 46221 HEMORRHOIDECTOMY BY BANDINGOR 15823 BLEPHAROPLASTY

OR 58611 TUBAL LIGATION W/C-SECTION ADDONOR 44970 LAPAROSCOPIC APPENDECTOMY

OR 11440 EXCIS BEN LES FEL 0.5 OR LESSOR 43235 EGD DX BRUSH WASH

OR 47562 LAPAROSCOPY CHOLECYSTECTOMYOR 49505 REP INGUINAL HERNIA OVER 5YR

OR 49585 REP UMBILICAL HERNIA OVER 5YRSOR 64721 CARPAL TUNNEL SURGERY

OR 26055 INCISE FINGER TENDON SHEATHOR 66984 CATARACT SURG W/IOL 1 STAGEOR 66982 CATARACT SURGERY COMPLEX

OR 55250 VASECTOMYOR 43249 EGD ESOPH DILATE <30MM

OR 24075 EXC ARM/ELBOW LES SC <3CMOR 58670 LAPAROSCOPY TUBAL CAUTERY

OR 10060 I&D ABSCESS SIMPLE SINGLEOR 58671 TUBAL LIGATION LAPROSCOPIC

OR 58600 TUBAL LIGATIONOR 20680 REMOVAL OF SUPPORT IMPLANT

OR 46270 SURG TREATMENT OF ANAL FISTULA

OR 49560 REP HERNIA INCIS/VENT INIT REDUOR 49568 IMPLANT MESH VENTRAL HERNIA REP

RECOVERY ROOM MINOR 1st HOUR ChargeRECOVERY ROOM MINOR EA ADD 15 MIN ChargeOR 46220 EXCISE ANAL EXT TAG/PAPILLA Charge

OR 11603 EXCIS MAL LES TAL 2.1 TO 3.0CM ChargeOR 28222 RELEASE OF FOOT TENDONS Charge

OR 45398 COLONOSCOPY W/BAND LIGATION ChargeOR 36571 INSERT PICVAD W/PORT >5YRS Charge

OR 38525 EXCISION/BIOPSY AXILLARY LYMPH ChargeOR 56405 I&D VULVA/PERINEAL ABSCESS

RECOVERY ROOM STEP DOWN EA Add'L HROR 11402 BEN LES TAL 1.1-2.0CM

TR 62323 INJECT SPINE LMBR/SAC W/IMAGEOR 28825 PARTIAL AMPUTATION OF TOE

OR 26160 REMOVE TENDON SHEATH LESIONOR 43245 EGD DILATE STRICTURE

OR 58301 REMOVE INTRAUTERINE DEVICEOR 28285 CORRECTION HAMMERTOETR 99211 EVAL LEVEL 1 NURSE ONLY

OR 11420 EXCIS BEN LES SHF 0.5CM OR LESSTR 42300 DRAINAGE ABSCESS PAROTIC SIMPLE

TR 32555 ASPIRATE PLEURA W/ IMAGINGTR 23545 TREAT CLAVICLE DISLOCATION

OR 58300 IUD INSERTIONOR 46600 ANOSCOPY DIAGNOSTIC

OR 56810 REPAIR OF PERINEUM NON-OBOR 64430 INJ ANES AGENT PUDENDAL NERVE

TR 99213 TR WOUND CARE 26-50 SQ CMOR 56740 OR EXC BARTHOLINS GLAND/CYST

OR 26418 REPAIR EXTENSOR TENDON FINGEROR 25105 ARTHROTOMY WRIST JNT W/SYNOVECT

TR 99212 EVAL LEVEL 2 NURSE ONLYTR 99213 EVAL LEVEL 3 NURSE ONLYTR 99214 EVAL LEVEL 4 NURSE ONLYOR 66830 REMOVAL OF LENS LESION

OR 67005 PARTIAL REMOVAL OF EYE FLUIDOR 46230 EXCISE MULT EXT HEMORRHOID TAGS

OR 21556 EXC NECK TUM DEEP < 5 CMOR 97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/<

OR 64719 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRISTOR 64708 NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPECOR 25447 ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS

OR 28230 TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPXOR 28270 RELEASE OF FOOT CONTRACTURE

OR 45915 RMVL FECAL IMPACTION/FB SPX UNDER ANESOR 26040 RELEASE PALM CONTRACTURE

OR G0120 COLON CA SCRN:BARIUM HRISKOR 64630 DESTRUCT NEUROLYTIC AGENT PUDENDAL NERVE

TR 46221 HEMORRHOIDECTOMY BY BANDINGOR 46505 CHEMODENERVATION INT ANAL SPINC

OR 23078 RESECT SHOULDER TUMOR 5 CM/>OR 40819 EXCISE LIP OR CHEEK FOLD

OR 11102 TANGNTL BX SKIN SINGLE LESOR 11103 TANGNTL BX SKIN EA SEP/ADDLOR 11104 PUNCH BX SKIN SINGLE LESIONOR 11105 PUNCH BX SKIN EA SEP/ADDL

OR 11106 INCAL BX SKN SINGLE LESOR 11107 INCAL BX SKN EA SEP/ADDL

TR 33285 INSERT SUBQ CARDIAC RHYTHM MONITORTR 36573 INSERT PICC WO PORT W/IMG >5YR

TR 36569 INSERT PICC WO PORT WO IMG 5YR/>TR 46320 EXC THROMBOSED HEMORRHOID

OR 13100 REPAIR COMP TRUNK 1.1 TO 2.5CMTR 46600 ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

Repair of central venous access device, with subcutaneous port or pump, central o TR 64445 INJ ANESTHETIC AGENT SCIATIC NRV SINGLE

TR 33286 REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITORBlood Administration Transfusion

TB Skin TestTB Skin Test POC

ABG (RT)WC 10060 INCIS & DRAIN ABSCESS SIMP/SINGL

WC 10061 INCIS & DRAIN ABSCESS COM/SINGLEWC 10160 PUNCTURE ASPIRATION OF ABSCESS

WC 11000 DEBRIDEMENT INFECTED SKIN TO 10%WC 11001 DEBRIDE INFCTD SKIN EA ADDL 10%WC 11042 DEBRIDEMENT SKIN & SUB TISSUE

WC 11043 DEBRIDEMENT SKIN SUB TISS/MUSCLEWC 11044 DEBRIDEMENT SKIN TISS/MSCL/BONEWC 11045 DEBRIDE SQ TISS EA ADDL 20 SQCM

WC 11046 DEBRIDE MSCL/FACIA EA ADD 20SQCMWC 11047 DEBRIDE BONE EA ADDL 20 SQ CM

WC 11055 PARING/CUT BENIGN LESION SINGLEWC 11056 PARING/CUT BENIGN LESION 2-4WC 11057 PARING/CUT BENIGN LESION > 4

WC 11719 TRIM NONDYSTROPHIC NAILSWC 11720 DEBRIDEMENT NAILS ANY METH 1-5WC 11721 DEBRIDEMENT NAILS ANY METH >5

WC 11730 AVLSN NAIL PLATE PART/COMPWC 11732 AVLSN NAIL PLATE PRT/COM EA ADDL

WC 11750 EXCIS NAIL & MATRIX PART/COMPWC 12001 REPAIR SIMP STHF 2.5CM OR LESS

WC 12021 CLOSURE WOUND W/PACKING

WC 12053 INTERMED REPAIR FACE 5.1-7.5CMWC 16000 BURN CARE INITIAL 1ST DEGREEWC 16020 DRESS/DEBRIDE BURN <5% SM

WC 16025 DRESS/DEBRIDE BURN 5-10% MEDWC 16030 DRESS/DEBRIDE BURN >10% LGWC 17110 DESTRUCT BENIGN LESION 1-14

WC 17250 CHEMICAL CAUTERIZATION TISSUEWC 28010 INCISION OF TOE TENDON-TENOTOMY

WC 29580 APPLY UNNA BOOT SINGLEWC 29580 APPLY UNNA BOOT BILATERAL

WC 29581 APP MULTI LAYER COMPRESS LWR LEGWC 29581 APP MULTI LAYER COMPRESS BILAT

WC 29584 APPL MULT LAYER COMPRESS ARM/HNDWC 97597 DEBRIDE EA SESSION 1ST 20SQ CM <WC 97598 DEBRIDE EA SESS EA ADD'L 20SQ CM

WC 97602 NON SELECTIVE DEBRIDEMENTWC 99211 EVAL/ASSESS UP TO 10 SQ CM

WC 99211 EVAL/ASSESS UP TO 10SQCM W/PROCWC 99212 EVAL/ASSESS 11-25 SQ CM

WC 99212 EVAL/ASSESS 11-25 SQ CM W/PROCWC 99212 OFFICE VISIT EST PT EXPANDED

WC 99213 EVAL/ASSESS 26-50 SQ CMWC 99213 EVAL/ASSESS 26-50 SQ CM W/PROC

WC 99214 EVAL/ASSESS 51-75 SQ CMWC 99214 EVAL/ASSESS 51-75 SQ CM W/PROC

WC 99215 EVAL/ASSESS 76 SQ CM >WC 99215 EVAL/ASSESS 76 SQ CM > W/PROC

WC 29580 APPLY UNNA BOOT ONE SEP STRUCTWC 97607 NEG PRESS WND TX <=50 SQ CM DISP

WC 97605 NEG WOUND PRSR THPY <50CMWC 97606 NEG WOUND PRSR THPY >50CMWC 12020 TRMT SUPRFC DEHISCENCE SIMP

WC 29445 APPLICATION OF RIGID TOTAL CONTACT LEG CASTTUBIGRIP; CHARGE ONE UNIT FOR EACH LAYER USED

WC 11102 TANGNTL BX SKIN SINGLE LESWC 11103 TANGNTL BX SKIN EA SEP/ADDLWC 11104 PUNCH BX SKIN SINGLE LESIONWC 11105 PUNCH BX SKIN EA SEP/ADDL

WC 11106 INCAL BX SKN SINGLE LESWC 11107 INCAL BX SKN EA SEP/ADDL

ACTIVITY_TYPE PRICEAFC GENERIC ADD-ON 24.50$ AFC GENERIC ADD-ON 26.05$ AFC GENERIC ADD-ON 45.02$ AFC GENERIC ADD-ON 88.04$ AFC GENERIC ADD-ON 66.00$ AFC GENERIC ADD-ON 61.00$ AFC GENERIC ADD-ON 36.71$ AFC GENERIC ADD-ON 81.25$ AFC GENERIC ADD-ON 37.87$ AFC GENERIC ADD-ON 42.00$ AFC GENERIC ADD-ON 24.00$ AFC GENERIC ADD-ON 48.00$ AFC GENERIC ADD-ON 120.00$ AFC GENERIC ADD-ON 1,119.45$ AFC GENERIC ADD-ON 1,435.50$ AFC GENERIC ADD-ON 473.21$ AFC GENERIC ADD-ON 320.40$ AFC GENERIC ADD-ON 70.00$ AFC GENERIC ADD-ON 6.00$ AFC GENERIC ADD-ON 88.04$ AFC GENERIC ADD-ON 88.04$ AFC GENERIC ADD-ON 88.04$ AFC GENERIC ADD-ON 88.40$ AFC GENERIC ADD-ON 17.40$ AFC GENERIC ADD-ON 37.80$ AFC GENERIC ADD-ON 138.16$ AFC GENERIC ADD-ON 232.40$ AFC GENERIC ADD-ON 322.94$ AFC GENERIC ADD-ON 435.85$ AFC GENERIC ADD-ON 92.29$ AFC GENERIC ADD-ON 95.72$ AFC GENERIC ADD-ON 458.00$ AFC GENERIC ADD-ON 433.00$ AFC GENERIC ADD-ON 381.00$ AFC GENERIC ADD-ON 514.00$ AFC GENERIC ADD-ON 517.00$ AFC GENERIC ADD-ON 250.00$ AFC GENERIC ADD-ON 381.00$ AFC GENERIC ADD-ON 30.00$ AFC GENERIC ADD-ON 27.76$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 33.40$ AFC GENERIC ADD-ON 158.02$ AFC GENERIC ADD-ON 115.50$

AFC GENERIC ADD-ON 71.50$ AFC GENERIC ADD-ON 74.50$ AFC GENERIC ADD-ON 77.50$ AFC GENERIC ADD-ON 63.00$ AFC GENERIC ADD-ON 83.00$ AFC GENERIC ADD-ON 120.00$ AFC GENERIC ADD-ON 120.00$ AFC GENERIC ADD-ON 61.00$ AFC GENERIC ADD-ON 61.00$ AFC GENERIC ADD-ON 103.00$ AFC GENERIC ADD-ON 103.00$ AFC GENERIC ADD-ON 60.00$ AFC GENERIC ADD-ON 10.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 295.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 187.00$ AFC GENERIC ADD-ON 280.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 123.00$ AFC GENERIC ADD-ON 186.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 186.00$ AFC GENERIC ADD-ON 212.00$ AFC GENERIC ADD-ON 600.00$ AFC GENERIC ADD-ON 625.00$ AFC GENERIC ADD-ON 650.00$ AFC GENERIC ADD-ON 601.00$ AFC GENERIC ADD-ON 136.00$ AFC GENERIC ADD-ON 181.00$ AFC GENERIC ADD-ON 318.00$ AFC GENERIC ADD-ON 237.00$ AFC GENERIC ADD-ON 165.00$ AFC GENERIC ADD-ON 211.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 200.00$ AFC GENERIC ADD-ON 223.00$ AFC GENERIC ADD-ON 230.00$ AFC GENERIC ADD-ON 650.00$ AFC GENERIC ADD-ON 675.00$ AFC GENERIC ADD-ON 700.00$ AFC GENERIC ADD-ON 601.00$ AFC GENERIC ADD-ON 651.00$ AFC GENERIC ADD-ON 601.00$ AFC GENERIC ADD-ON 626.00$ AFC GENERIC ADD-ON 651.00$

AFC GENERIC ADD-ON 783.00$ AFC GENERIC ADD-ON 25.54$ AFC GENERIC ADD-ON 89.48$ AFC GENERIC ADD-ON 85.00$ AFC GENERIC ADD-ON 75.00$ AFC GENERIC ADD-ON 76.25$ AFC GENERIC ADD-ON 61.78$ AFC GENERIC ADD-ON 24.00$ AFC GENERIC ADD-ON 60.00$ AFC GENERIC ADD-ON 160.00$ AFC GENERIC ADD-ON 675.00$ AFC GENERIC ADD-ON 650.00$ AFC GENERIC ADD-ON 700.00$ AFC GENERIC ADD-ON 50.00$ AFC GENERIC ADD-ON 595.00$ AFC GENERIC ADD-ON 11.00$ AFC GENERIC ADD-ON 11.00$ AFC GENERIC ADD-ON 11.00$ AFC GENERIC ADD-ON 11.00$ AFC GENERIC ADD-ON 34.56$ AFC GENERIC ADD-ON 98.03$ AFC GENERIC ADD-ON 24.00$ AFC GENERIC ADD-ON 94.00$ AFC GENERIC ADD-ON 199.75$ AFC GENERIC ADD-ON 153.10$ AFC GENERIC ADD-ON 120.00$ AFC GENERIC ADD-ON 81.10$ AFC GENERIC ADD-ON 53.00$ AFC GENERIC ADD-ON 58.00$ AFC GENERIC ADD-ON 106.81$ AFC GENERIC ADD-ON 44.70$ AFC GENERIC ADD-ON 85.80$ AFC GENERIC ADD-ON 342.00$ AFC GENERIC ADD-ON 71.75$ AFC GENERIC ADD-ON 53.00$ AFC GENERIC ADD-ON 14.00$ AFC GENERIC ADD-ON 66.16$ AFC GENERIC ADD-ON 82.00$ AFC GENERIC ADD-ON 164.00$ AFC GENERIC ADD-ON 93.25$ AFC GENERIC ADD-ON 81.00$ AFC GENERIC ADD-ON 137.54$ AFC GENERIC ADD-ON 19.10$ AFC GENERIC ADD-ON 105.25$ AFC GENERIC ADD-ON 105.25$ AFC GENERIC ADD-ON 105.00$ AFC GENERIC ADD-ON 306.00$

AFC GENERIC ADD-ON 106.00$ AFC GENERIC ADD-ON 18.00$ AFC GENERIC ADD-ON 125.00$ AFC GENERIC ADD-ON 59.00$ AFC GENERIC ADD-ON 107.00$ AFC GENERIC ADD-ON 75.00$ AFC GENERIC ADD-ON 76.00$ AFC GENERIC ADD-ON 76.00$ AFC GENERIC ADD-ON 120.00$

Ambulatory POC 57.68$ Ambulatory POC 92.22$ Ambulatory POC 30.00$ Ambulatory POC 12.13$ Ambulatory POC 43.55$ Ambulatory POC 27.00$ Ambulatory POC 16.56$ Ambulatory POC 129.00$ Ambulatory POC 31.35$ Ambulatory POC 24.70$ Ambulatory POC 25.80$ Ambulatory POC 39.97$ Ambulatory POC 6.00$ Ambulatory POC 96.89$ Ambulatory POC 24.92$ Ambulatory POC 6.00$ Ambulatory POC 27.76$ Ambulatory POC 16.63$ Ambulatory POC 12.13$ Ambulatory POC 41.00$ Ambulatory POC 85.80$ Ambulatory POC 92.22$ Ambulatory POC 43.55$ Ambulatory POC 129.00$ Ambulatory POC 92.22$ Ambulatory POC 88.05$ Ambulatory POC 16.63$ Ambulatory POC 25.80$ Ambulatory POC 24.62$ Ambulatory POC 16.63$ Ambulatory POC 25.80$ Ambulatory POC 24.92$ Ambulatory POC 43.55$ Ambulatory POC 42.24$ Ambulatory POC 88.04$ Ambulatory POC 85.80$ Ambulatory POC 25.80$

Ambulatory Procedures STAT

Behavioral Health Charges 325.00$ Behavioral Health Charges 350.00$ Behavioral Health Charges 375.00$ Behavioral Health Charges 375.00$ Behavioral Health Charges 375.00$ Behavioral Health Charges 250.00$

Blood Bank 37.31$ Cardiac Tx/Procedures 160.00$ Cardiac Tx/Procedures 75.00$ Cardiac Tx/Procedures 450.00$ Cardiac Tx/Procedures 160.00$ Cardiac Tx/Procedures 30.00$ Cardiac Tx/Procedures 50.00$ Cardiac Tx/Procedures 1,151.00$ Cardiac Tx/Procedures 381.00$ Cardiac Tx/Procedures 405.00$

Cardiovascular 405.00$ Cardiovascular 75.00$

Critical Care 194.00$ Critical Care 174.25$ Critical Care 199.00$ Critical Care 174.25$ Critical Care 168.00$ Critical Care 168.00$ Critical Care 56.80$ Critical Care 56.80$ Critical Care 60.00$ Critical Care 151.00$ Critical Care 60.00$ Critical Care 245.00$ Critical Care 180.00$ Critical Care 365.00$ Critical Care 615.00$ Critical Care 715.00$ Critical Care 780.00$ Critical Care 216.00$ ED Charges 16.00$ ED Charges 126.25$ ED Charges 20.00$ ED Charges 88.45$ ED Charges 45.00$ ED Charges 75.00$ ED Charges 307.00$ ED Charges 400.00$ ED Charges 400.00$ ED Charges 300.00$ ED Charges 141.00$

ED Charges 750.00$ ED Charges 1,278.00$ ED Charges 337.70$ ED Charges 250.00$ ED Charges 515.00$ ED Charges 500.00$ ED Charges 942.00$ ED Charges 167.00$ ED Charges 250.00$ ED Charges 325.00$ ED Charges 325.00$ ED Charges 885.00$ ED Charges 1,828.00$ ED Charges 340.00$ ED Charges 922.00$ ED Charges 965.00$ ED Charges 370.00$ ED Charges 4,877.00$ ED Charges 369.00$ ED Charges 380.00$ ED Charges 640.00$ ED Charges 588.00$ ED Charges 70.00$ ED Charges 1,534.00$ ED Charges 800.00$ ED Charges 950.00$ ED Charges 1,584.00$ ED Charges 1,728.00$ ED Charges 1,730.00$ ED Charges 1,728.00$ ED Charges 255.00$ ED Charges 2,367.00$ ED Charges 557.00$ ED Charges 251.00$ ED Charges 255.00$ ED Charges 301.00$ ED Charges 303.00$ ED Charges 100.00$ ED Charges 412.00$ ED Charges 313.00$ ED Charges 144.00$ ED Charges 275.00$ ED Charges 363.00$ ED Charges 125.00$ ED Charges 400.00$ ED Charges 400.00$ ED Charges 1,060.00$

ED Charges 345.00$ ED Charges 583.00$ ED Charges 664.00$ ED Charges 826.00$ ED Charges 467.50$ ED Charges 502.00$ ED Charges 1,800.00$ ED Charges 783.60$ ED Charges 330.00$ ED Charges 360.00$ ED Charges 135.00$ ED Charges 750.00$ ED Charges 120.00$ ED Charges 100.00$ ED Charges 84.00$ ED Charges 119.00$ ED Charges 1,000.00$ ED Charges 11.00$ ED Charges 300.00$ ED Charges 750.00$ ED Charges 126.25$ ED Charges 88.45$ ED Charges 515.00$ ED Charges 23.00$ ED Charges 180.00$ ED Charges 245.00$ ED Charges 365.00$ ED Charges 615.00$ ED Charges 715.00$ ED Charges 56.80$ ED Charges 300.00$ ED Charges 330.00$ ED Charges 962.00$ ED Charges 430.00$

Evaluation and Management 62.00$ Evaluation and Management 93.00$ Evaluation and Management 135.00$ Evaluation and Management 206.00$ Evaluation and Management 285.00$ Evaluation and Management 45.00$ Evaluation and Management 60.00$ Evaluation and Management 91.00$ Evaluation and Management 134.00$ Evaluation and Management 181.00$ Evaluation and Management 45.00$ Evaluation and Management 60.00$ Evaluation and Management 91.00$

Evaluation and Management 62.00$ Evaluation and Management 93.00$ Evaluation and Management 135.00$ Evaluation and Management 206.00$ Evaluation and Management 45.00$ Evaluation and Management 60.00$ Evaluation and Management 60.00$ Evaluation and Management 91.00$ Evaluation and Management 91.00$ Evaluation and Management 45.00$ Evaluation and Management 60.00$ Evaluation and Management 60.00$ Evaluation and Management 91.00$ Evaluation and Management 91.00$ Evaluation and Management 133.00$ Evaluation and Management 181.00$ Evaluation and Management 258.00$

General Lab 38.08$ General Lab 12.13$ General Lab 8.40$ General Lab 24.50$ General Lab 44.75$ General Lab 28.37$ General Lab 11.25$ General Lab 31.35$ General Lab 31.35$ General Lab 10.75$ General Lab 45.67$ General Lab 10.75$ General Lab 36.14$ General Lab 28.37$ General Lab 14.64$ General Lab 15.82$ General Lab 38.00$ General Lab 96.89$ General Lab 32.41$ General Lab 34.19$ General Lab 109.24$ General Lab 83.40$ General Lab 125.10$ General Lab 66.53$ General Lab 15.70$ General Lab 35.18$ General Lab 86.74$ General Lab 118.14$ General Lab 83.40$ General Lab 17.81$

General Lab 16.48$ General Lab 16.56$ General Lab 35.55$ General Lab 83.40$ General Lab 34.64$ General Lab 44.57$ General Lab 65.67$ General Lab 41.50$ General Lab 72.47$ General Lab 25.88$ General Lab 49.50$ General Lab 24.50$ General Lab 32.67$ General Lab 14.15$ General Lab 69.00$ General Lab 63.50$ General Lab 17.09$ General Lab 28.07$ General Lab 38.40$ General Lab 292.15$ General Lab 20.00$ General Lab 83.40$ General Lab 69.00$ General Lab 27.76$ General Lab 27.76$ General Lab 83.40$ General Lab 57.68$ General Lab 81.15$ General Lab 69.00$ General Lab 73.00$ General Lab 108.17$ General Lab 81.15$ General Lab 14.80$ General Lab 18.77$ General Lab 24.50$ General Lab 21.45$ General Lab 19.15$ General Lab 38.40$ General Lab 87.00$ General Lab 73.44$ General Lab 27.37$ General Lab 27.37$ General Lab 30.23$ General Lab 30.23$ General Lab 106.41$ General Lab 29.36$ General Lab 18.67$






General Lab 200.90$ General Lab 110.00$ 86747 - Parvovirus B19 Antibodies - PS^1General Lab 39.80$ General Lab 337.09$ General Lab 146.94$ General Lab 293.25$ General Lab 61.00$ General Lab 113.98$ General Lab 54.00$ General Lab 124.75$ General Lab 106.81$ General Lab 64.76$ General Lab 65.16$ General Lab 86.66$ General Lab 243.41$ General Lab 31.00$ General Lab 88.04$ General Lab 18.00$ General Lab 138.00$ General Lab 53.00$ General Lab 58.00$ General Lab 133.73$ General Lab 23.00$ General Lab 102.00$ General Lab 120.00$ General Lab 79.00$ General Lab 63.00$ General Lab 146.00$ General Lab 60.00$ General Lab 300.00$ General Lab 14.00$ General Lab 66.16$ General Lab 120.00$ General Lab 183.00$ General Lab 162.00$ General Lab 221.00$ General Lab 87.00$ General Lab 164.00$ General Lab 93.25$ General Lab 105.49$ General Lab 233.00$ General Lab 207.00$ General Lab 170.25$ General Lab 105.25$ General Lab 80.00$ General Lab 120.00$ General Lab 294.00$

General Lab 418.00$ General Lab 318.00$ General Lab 318.00$ General Lab 170.25$ General Lab 137.54$ General Lab 81.00$ General Lab 154.75$ General Lab 82.00$ General Lab 150.00$ General Lab 154.00$ General Lab 28.00$ General Lab 80.00$ General Lab 75.00$ General Lab 62.00$ General Lab 62.08$ General Lab 70.00$ General Lab 58.00$ General Lab 153.00$ General Lab 110.00$ General Lab 109.44$ General Lab 626.70$ General Lab 54.00$ General Lab 120.00$ General Lab 212.40$ General Lab 182.00$ General Lab 45.00$ General Lab 107.00$ General Lab 75.00$ General Lab 162.00$ General Lab 267.00$ General Lab 91.00$ General Lab 96.00$ General Lab 361.00$ General Lab 100.00$ General Lab 84.00$

Infusion Charges 174.25$ Infusion Charges 236.50$ Infusion Charges 201.50$ Infusion Charges 201.50$ Infusion Charges 56.80$ Infusion Charges 49.40$ Infusion Charges 201.50$ Infusion Charges 201.50$ Infusion Charges 253.50$ Infusion Charges 253.50$ Infusion Charges 143.00$ Infusion Charges 10.00$

Infusion Charges 10.00$ Labor and Delivery Charges 16.50$ Labor and Delivery Charges 150.00$ Labor and Delivery Charges 286.00$ Labor and Delivery Charges 5,650.00$

Micro 71.54$ Micro 33.40$ Micro 33.40$ Micro 58.40$ Micro 48.49$ Micro 48.49$ Micro 48.49$ Micro 48.49$ Micro 48.49$ Micro 48.49$ Micro 45.02$ Micro 48.49$ Micro 46.20$ Micro 48.49$ Micro 20.20$ Micro 48.49$ Micro 22.12$ Micro 33.40$ Micro 33.40$ Micro 36.43$ Micro 71.54$ Micro 71.54$ Micro 71.54$ Micro 71.54$

Nursing Charges 49.79$ Nursing Charges 178.00$ Nursing Charges 71.50$ Nursing Charges 71.50$ Nursing Charges 20.00$ Nursing Charges 201.50$ Nursing Charges 26.00$ Nursing Charges 236.50$ Nursing Charges 26.00$ Nursing Charges 201.50$ Nursing Charges 194.00$ Nursing Charges 425.00$ Nursing Charges 52.00$ Nursing Charges 52.00$ Nursing Charges 52.00$ Nursing Charges 143.00$ Nursing Charges 22.50$ Nursing Charges 20.40$

Nursing Charges 35.00$ Nursing Charges 41.55$

Nutrition Services Charges 17.55$ Nutrition Services Charges 17.55$ Nutrition Services Charges 7.00$ Nutrition Services Charges 38.30$

Observation Charges 20.00$ Observation Charges 580.00$ Observation Charges 580.00$ Observation Charges 15.00$ Observation Charges 6.50$ Observation Charges 6.50$

OP Clinic Charges 170.00$ OP Clinic Charges 205.00$ OP Clinic Charges 432.00$ OP Clinic Charges 445.00$ OP Clinic Charges 360.00$ OP Clinic Charges 160.00$ OP Clinic Charges 82.00$ OP Clinic Charges 25.00$ OP Clinic Charges 25.00$ OP Clinic Charges 405.00$ OP Clinic Charges 82.00$ OP Clinic Charges 82.00$ OP Clinic Charges 110.00$ OP Clinic Charges 405.00$ OP Clinic Charges 82.00$ OP Clinic Charges 82.00$ OP Clinic Charges 25.00$ OP Clinic Charges 405.00$ OP Clinic Charges 110.00$ OP Clinic Charges 25.00$ OP Clinic Charges 82.00$ OP Clinic Charges 985.00$ OP Clinic Charges 82.00$ OP Clinic Charges 82.00$ OP Clinic Charges 110.00$ OP Clinic Charges 82.00$ OP Clinic Charges 89.00$ OP Clinic Charges 445.00$ OP Clinic Charges 185.00$ OP Clinic Charges 530.00$ OP Clinic Charges 250.00$ OP Clinic Charges 50.00$ OP Clinic Charges 25.00$ OP Clinic Charges 100.00$ OP Clinic Charges 432.00$

OP Clinic Charges 445.00$ OP Clinic Charges 340.00$ OP Clinic Charges 2,075.00$ OP Clinic Charges 2,110.00$ OP Clinic Charges 80.50$ OP Clinic Charges 572.00$ OP Clinic Charges 54.15$ OP Clinic Charges 88.45$ OP Clinic Charges 46.00$ OP Clinic Charges 60.00$ OP Clinic Charges 68.65$ OP Clinic Charges 88.00$ OP Clinic Charges 100.00$ OP Clinic Charges 445.00$ OP Clinic Charges 60.00$ OP Clinic Charges 1,638.00$ OP Clinic Charges 350.00$ OP Clinic Charges 325.00$ OP Clinic Charges 375.00$ OP Clinic Charges 375.00$ OP Clinic Charges 375.00$ OP Clinic Charges 250.00$ OP Clinic Charges 375.00$ OP Clinic Charges 350.00$ OP Clinic Charges 325.00$ OP Clinic Charges 2,502.00$ OP Clinic Charges 759.00$

Person Management 850.00$ Person Management 975.00$ Person Management 925.00$ Person Management 825.00$ Person Management 675.00$ Person Management 625.00$ Person Management 200.00$ Person Management 875.00$ Person Management 950.00$ Person Management 850.00$ Person Management 900.00$

POC Asmt/Tx/Monitoring 16.63$ POC Asmt/Tx/Monitoring 30.00$

Pro Fee Charges 360.00$ Pro Fee Charges 340.00$ Pro Fee Charges 224.65$ Pro Fee Charges 432.30$ Pro Fee Charges 295.00$ Pro Fee Charges 625.00$ Pro Fee Charges 400.00$

Pro Fee Charges 1,035.00$ Pro Fee Charges 15.00$ Pro Fee Charges 160.00$ Pro Fee Charges 160.00$ Pro Fee Charges 625.00$ Pro Fee Charges 881.60$ Pro Fee Charges 881.60$ Pro Fee Charges 746.25$ Pro Fee Charges 746.25$ Pro Fee Charges 797.00$ Pro Fee Charges 796.30$ Pro Fee Charges 648.50$ Pro Fee Charges 648.50$ Pro Fee Charges 200.00$ Pro Fee Charges 200.00$ Pro Fee Charges 200.00$ Pro Fee Charges 200.00$ Pro Fee Charges 1,437.00$ Pro Fee Charges 1,437.00$ Pro Fee Charges 457.00$ Pro Fee Charges 880.00$ Pro Fee Charges 460.00$ Pro Fee Charges 874.25$ Pro Fee Charges 874.25$ Pro Fee Charges 570.60$ Pro Fee Charges 570.60$ Pro Fee Charges 1,288.15$ Pro Fee Charges 1,288.15$ Pro Fee Charges 468.00$ Pro Fee Charges 468.00$ Pro Fee Charges 86.00$ Pro Fee Charges 86.00$ Pro Fee Charges 325.00$ Pro Fee Charges 109.00$ Pro Fee Charges 325.00$ Pro Fee Charges 549.00$ Pro Fee Charges 549.00$ Pro Fee Charges 995.50$ Pro Fee Charges 1,767.00$ Pro Fee Charges 467.00$ Pro Fee Charges 467.00$ Pro Fee Charges 540.00$ Pro Fee Charges 523.50$ Pro Fee Charges 804.00$ Pro Fee Charges 804.00$ Pro Fee Charges 688.00$ Pro Fee Charges 688.00$

Pro Fee Charges 115.00$ Pro Fee Charges 115.00$ Pro Fee Charges 149.00$ Pro Fee Charges 149.00$ Pro Fee Charges 232.00$ Pro Fee Charges 232.00$ Pro Fee Charges 164.00$ Pro Fee Charges 164.00$ Pro Fee Charges 211.00$ Pro Fee Charges 211.00$ Pro Fee Charges 354.00$ Pro Fee Charges 354.00$ Pro Fee Charges 841.50$ Pro Fee Charges 841.50$ Pro Fee Charges 338.00$ Pro Fee Charges 338.00$ Pro Fee Charges 225.00$ Pro Fee Charges 909.50$ Pro Fee Charges 909.50$ Pro Fee Charges 763.75$ Pro Fee Charges 763.75$ Pro Fee Charges 261.00$ Pro Fee Charges 355.00$ Pro Fee Charges 355.00$ Pro Fee Charges 256.00$ Pro Fee Charges 403.00$ Pro Fee Charges 403.00$ Pro Fee Charges 460.00$ Pro Fee Charges 460.00$ Pro Fee Charges 574.00$ Pro Fee Charges 574.00$ Pro Fee Charges 358.00$ Pro Fee Charges 358.00$ Pro Fee Charges 756.00$ Pro Fee Charges 756.00$ Pro Fee Charges 55.30$ Pro Fee Charges 55.30$ Pro Fee Charges 85.25$ Pro Fee Charges 355.00$ Pro Fee Charges 355.00$ Pro Fee Charges 2,114.00$ Pro Fee Charges 2,114.00$ Pro Fee Charges 738.00$ Pro Fee Charges 738.00$ Pro Fee Charges 651.00$ Pro Fee Charges 651.00$ Pro Fee Charges 400.00$

Pro Fee Charges 254.00$ Pro Fee Charges 254.00$ Pro Fee Charges 778.00$ Pro Fee Charges 66.00$ Pro Fee Charges 50.00$ Pro Fee Charges 75.00$ Pro Fee Charges 75.00$ Pro Fee Charges 75.00$ Pro Fee Charges 11.10$ Pro Fee Charges 14.95$ Pro Fee Charges 15.80$ Pro Fee Charges 529.00$ Pro Fee Charges 2,225.20$ Pro Fee Charges 625.00$ Pro Fee Charges 228.00$ Pro Fee Charges 194.00$ Pro Fee Charges 241.00$ Pro Fee Charges 296.00$ Pro Fee Charges 261.00$

Procedures 50.00$ Procedures 30.00$ Procedures 42.00$ Procedures 49.00$ Procedures 45.00$

PT Tx/Procedures 49.00$ PT Tx/Procedures 89.00$ PT Tx/Procedures 149.00$ PT Tx/Procedures 83.00$ PT Tx/Procedures 83.00$ PT Tx/Procedures 76.00$ PT Tx/Procedures 78.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 62.00$ PT Tx/Procedures 69.00$ PT Tx/Procedures 60.00$ PT Tx/Procedures 89.00$ PT Tx/Procedures 136.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 503.00$ PT Tx/Procedures 60.00$ PT Tx/Procedures 59.00$ PT Tx/Procedures 39.00$ PT Tx/Procedures 78.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 67.00$

PT Tx/Procedures 75.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 105.00$ PT Tx/Procedures 62.00$ PT Tx/Procedures 111.00$ PT Tx/Procedures 226.00$ PT Tx/Procedures 115.00$ PT Tx/Procedures 229.00$ PT Tx/Procedures 382.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 81.00$ PT Tx/Procedures 503.00$ PT Tx/Procedures 90.00$ PT Tx/Procedures 94.00$ PT Tx/Procedures 125.00$ PT Tx/Procedures 150.00$ PT Tx/Procedures 185.00$ PT Tx/Procedures 101.00$ PT Tx/Procedures 382.00$

Radiology 245.00$ Radiology 230.00$ Radiology 230.00$ Radiology 230.00$ Radiology 123.00$ Radiology 123.00$ Radiology 123.00$ Radiology 318.00$ Radiology 318.00$ Radiology 186.00$ Radiology 186.00$ Radiology 186.00$ Radiology 600.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$ Radiology 651.00$ Radiology 626.00$ Radiology 473.00$ Radiology 211.00$ Radiology 601.00$ Radiology 211.00$ Radiology 303.00$ Radiology 307.00$ Radiology 492.00$ Radiology 295.00$ Radiology 675.00$ Radiology 675.00$

Radiology 650.00$ Radiology 650.00$ Radiology 211.00$ Radiology 211.00$ Radiology 211.00$ Radiology 230.00$ Radiology 230.00$ Radiology 230.00$ Radiology 180.00$ Radiology 145.00$ Radiology 640.00$ Radiology 595.00$ Radiology 1,795.00$ Radiology 741.60$ Radiology 389.00$ Radiology 446.00$ Radiology 472.00$ Radiology 541.00$ Radiology 750.00$ Radiology 504.00$ Radiology 651.00$ Radiology 626.00$ Radiology 601.00$ Radiology 684.00$ Radiology 684.00$ Radiology 684.00$ Radiology 626.00$ Radiology 626.00$ Radiology 626.00$ Radiology 699.00$ Radiology 699.00$ Radiology 651.00$ Radiology 626.00$ Radiology 601.00$ Radiology 249.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$ Radiology 329.00$ Radiology 230.00$ Radiology 230.00$ Radiology 230.00$ Radiology 640.00$ Radiology 640.00$ Radiology 595.00$ Radiology 595.00$ Radiology 700.00$

Radiology 675.00$ Radiology 650.00$ Radiology 651.00$ Radiology 626.00$ Radiology 601.00$ Radiology 234.00$ Radiology 280.00$ Radiology 305.00$ Radiology 230.00$ Radiology 230.00$ Radiology 230.00$ Radiology 2,080.00$ Radiology 625.00$ Radiology 625.00$ Radiology 600.00$ Radiology 600.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 237.00$ Radiology 700.00$ Radiology 675.00$ Radiology 93.00$ Radiology 650.00$ Radiology 237.00$ Radiology 363.00$ Radiology 245.00$ Radiology 169.00$ Radiology 188.00$ Radiology 382.00$ Radiology 382.00$ Radiology 382.00$ Radiology 650.00$ Radiology 650.00$ Radiology 306.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$

Radiology 600.00$ Radiology 700.00$ Radiology 700.00$ Radiology 700.00$ Radiology 675.00$ Radiology 675.00$ Radiology 675.00$ Radiology 650.00$ Radiology 650.00$ Radiology 650.00$ Radiology 650.00$ Radiology 625.00$ Radiology 379.00$ Radiology 600.00$ Radiology 154.00$ Radiology 650.00$ Radiology 379.00$ Radiology 625.00$ Radiology 600.00$ Radiology 114.00$ Radiology 650.00$ Radiology 625.00$ Radiology 600.00$ Radiology 295.00$ Radiology 295.00$ Radiology 295.00$ Radiology 625.00$ Radiology 625.00$ Radiology 230.00$ Radiology 230.00$ Radiology 600.00$ Radiology 230.00$ Radiology 600.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$ Radiology 230.00$ Radiology 650.00$ Radiology 230.00$ Radiology 625.00$ Radiology 230.00$ Radiology 600.00$ Radiology 259.00$ Radiology 318.00$ Radiology 650.00$ Radiology 650.00$ Radiology 650.00$




Radiology 651.00$ Radiology 579.00$ Radiology 515.00$ Radiology 651.00$ Radiology 626.00$ Radiology 626.00$ Radiology 626.00$ Radiology 601.00$ Radiology 601.00$ Radiology 601.00$ Radiology 651.00$ Radiology 322.00$ Radiology 626.00$ Radiology 601.00$ Radiology 468.00$ Radiology 387.00$ Radiology 651.00$ Radiology 651.00$ Radiology 651.00$ Radiology 626.00$ Radiology 626.00$ Radiology 626.00$ Radiology 601.00$ Radiology 601.00$ Radiology 601.00$ Radiology 651.00$ Radiology 768.00$ Radiology 601.00$ Radiology 626.00$ Radiology 626.00$ Radiology 651.00$ Radiology 601.00$ Radiology 541.00$ Radiology 372.30$ Radiology 447.00$ Radiology 651.00$ Radiology 651.00$ Radiology 651.00$ Radiology 651.00$ Radiology 626.00$ Radiology 626.00$ Radiology 626.00$ Radiology 601.00$ Radiology 579.00$ Radiology 601.00$ Radiology 1,151.00$ Radiology 686.40$

Radiology 601.00$ Radiology 367.35$ Radiology 412.00$ Radiology 821.00$ Radiology 874.00$ Radiology 821.00$ Radiology 548.80$ Radiology 689.00$ Radiology 742.00$ Radiology 491.60$ Radiology 1,234.00$ Radiology 821.00$ Radiology 1,723.00$ Radiology 1,757.00$ Radiology 650.00$ Radiology 625.00$ Radiology 600.00$ Radiology 211.00$ Radiology 620.00$ Radiology 783.00$ Radiology 783.00$ Radiology 783.00$ Radiology 783.00$ Radiology 783.00$ Radiology 283.00$ Radiology 222.00$ Radiology 222.00$ Radiology 783.00$ Radiology 783.00$ Radiology 783.00$ Radiology 783.00$ Radiology 231.00$ Radiology 402.00$ Radiology 382.00$ Radiology 188.00$ Radiology 712.00$ Radiology 307.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$ Radiology 600.00$ Radiology 283.00$ Radiology 595.00$ Radiology 352.00$ Radiology 352.00$ Radiology 352.00$ Radiology 352.00$

Radiology 352.00$ Radiology 185.00$ Radiology 185.00$ Radiology 230.00$ Radiology 180.00$ Radiology 180.00$ Radiology 300.00$ Radiology 300.00$ Radiology 318.00$ Radiology 318.00$ Radiology 318.00$ Radiology 350.00$ Radiology 350.00$ Radiology 318.00$ Radiology 318.00$ Radiology 329.00$ Radiology 188.00$ Radiology 269.00$ Radiology 134.00$ Radiology 180.00$ Radiology 1,896.00$ Radiology 712.00$ Radiology 712.00$ Radiology 595.00$ Radiology 93.00$ Radiology 844.00$ Radiology 75.00$ Radiology 1,896.00$ Radiology 450.00$ Radiology 30.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$ Radiology 300.00$ Radiology 300.00$ Radiology 231.00$ Radiology 318.00$ Radiology 350.00$ Radiology 700.00$ Radiology 675.00$ Radiology 650.00$ Radiology 402.00$ Radiology 450.00$ Radiology 283.00$ Radiology 222.00$ Radiology 222.00$ Radiology 283.00$

Radiology 50.00$ Respiratory Therapy Charges 115.00$ Respiratory Therapy Charges 20.47$ Respiratory Therapy Charges 450.00$ Respiratory Therapy Charges 30.00$ Respiratory Therapy Charges 405.00$ Respiratory Therapy Charges 1,896.00$ Respiratory Therapy Charges 712.00$ Respiratory Therapy Charges 595.00$ Respiratory Therapy Charges 595.00$ Respiratory Therapy Charges 832.20$ Respiratory Therapy Charges 116.05$ Respiratory Therapy Charges 160.00$ Respiratory Therapy Charges 298.00$ Respiratory Therapy Charges 367.50$ Respiratory Therapy Charges 78.75$ Respiratory Therapy Charges 99.75$ Respiratory Therapy Charges 939.75$ Respiratory Therapy Charges 100.00$ Respiratory Therapy Charges 90.00$ Respiratory Therapy Charges 208.00$ Respiratory Therapy Charges 278.25$ Respiratory Therapy Charges 105.00$ Respiratory Therapy Charges 204.75$ Respiratory Therapy Charges 661.55$ Respiratory Therapy Charges 132.00$ Respiratory Therapy Charges 132.00$ Respiratory Therapy Charges 475.00$ Respiratory Therapy Charges 712.00$ Respiratory Therapy Charges 2,225.00$ Respiratory Therapy Charges 400.00$ Respiratory Therapy Charges 164.00$ Respiratory Therapy Charges 1,586.00$ Respiratory Therapy Charges 1,124.00$ Respiratory Therapy Charges 375.00$ Respiratory Therapy Charges 200.00$ Respiratory Therapy Charges 451.50$ Respiratory Therapy Charges 352.00$ Respiratory Therapy Charges 84.00$ Respiratory Therapy Charges 136.50$ Respiratory Therapy Charges 130.00$ Respiratory Therapy Charges 120.00$ Respiratory Therapy Charges 300.00$ Respiratory Therapy Charges 20.00$ Respiratory Therapy Charges 300.00$ Respiratory Therapy Charges 1,124.00$ Respiratory Therapy Charges 400.00$

Respiratory Therapy Charges 84.00$ Respiratory Therapy Charges 164.00$ Respiratory Therapy Charges 352.00$ Respiratory Therapy Charges 832.20$ Respiratory Therapy Charges 99.75$ Respiratory Therapy Charges 90.00$ Respiratory Therapy Charges 100.00$ Respiratory Therapy Charges 451.50$ Respiratory Therapy Charges 1,586.00$ Respiratory Therapy Charges 939.75$ Respiratory Therapy Charges 100.00$ Respiratory Therapy Charges 144.00$ Respiratory Therapy Charges 6.00$ Respiratory Therapy Charges 132.00$ Respiratory Therapy Charges 130.00$ Respiratory Therapy Charges 78.75$ Respiratory Therapy Charges 200.00$ Respiratory Therapy Charges 204.75$ Respiratory Therapy Charges 300.00$ Respiratory Therapy Charges 120.00$ Respiratory Therapy Charges 300.00$ Respiratory Therapy Charges 75.00$ Respiratory Therapy Charges 208.00$ Respiratory Therapy Charges 105.00$ Respiratory Therapy Charges 375.00$ Respiratory Therapy Charges 136.50$ Respiratory Therapy Charges 298.00$ Respiratory Therapy Charges 367.50$ Respiratory Therapy Charges 278.25$ Respiratory Therapy Charges 661.55$ Respiratory Therapy Charges 115.00$

RT Tx/Procedures 109.24$ Sleep Lab Charges 2,900.00$ Sleep Lab Charges 3,300.00$ Sleep Lab Charges 425.00$ SLP Tx/Procedures 215.00$ SLP Tx/Procedures 215.00$ SLP Tx/Procedures 215.00$ SLP Tx/Procedures 215.00$ SLP Tx/Procedures 180.00$ SLP Tx/Procedures 235.00$ SLP Tx/Procedures 150.00$ SLP Tx/Procedures 101.65$ SLP Tx/Procedures 110.00$

Supplies 41.55$ Supplies 144.00$ Supplies 6.00$

Supplies 150.00$ Supplies 75.00$ Supplies 350.00$ Supplies 750.00$ Supplies 9.60$ Supplies 20.40$ Supplies 394.75$ Supplies 2.00$ Supplies 1.00$ Supplies 1.00$ Supplies 1.00$ Supplies 32.15$ Supplies 1.75$ Supplies 3.75$ Supplies 3.75$ Supplies 3.75$ Supplies 29.55$ Supplies 28.20$ Supplies 15.00$ Supplies 7.30$ Supplies 10.00$ Supplies 10.00$ Supplies 10.00$ Supplies 10.00$ Supplies 10.00$ Supplies 116.45$ Supplies 28.20$ Supplies 2.50$ Supplies 7.50$ Supplies 7.50$ Supplies 11.90$ Supplies 463.50$ Supplies 58.00$ Supplies 463.50$ Supplies 394.75$ Supplies 8.30$ Supplies 3.75$ Supplies 5.40$ Supplies 5.40$ Supplies 5.40$ Supplies 5.40$ Supplies 5.40$ Supplies 8.00$ Supplies 5.40$ Supplies 10.00$ Supplies 8.00$ Supplies 1.75$





Supplies 6.25$ Supplies 1.25$ Supplies 16.60$ Supplies 16.60$ Supplies 16.60$ Supplies 18.00$ Supplies 18.00$ Supplies 18.00$ Supplies 18.00$ Supplies 18.00$ Supplies 116.45$ Supplies 116.45$ Supplies 116.45$ Supplies 116.45$ Supplies 144.60$ Supplies 11.90$ Supplies 1.25$ Supplies 49.80$ Supplies 49.80$ Supplies 49.80$ Supplies 15.75$ Supplies 5.00$ Supplies 4.25$ Supplies 142.40$ Supplies 642.00$ Supplies 124.75$ Supplies 1,148.00$ Supplies 643.15$ Supplies 27.00$ Supplies 10.75$ Supplies 21.95$ Supplies 62.35$ Supplies 7.00$ Supplies 144.60$ Supplies 13.00$ Supplies 15.95$ Supplies 301.36$ Supplies 3.75$ Supplies 5.50$ Supplies 174.50$ Supplies 16.25$ Supplies 16.00$ Supplies 16.25$ Supplies 16.25$ Supplies 16.00$ Supplies 16.25$ Supplies 16.25$







Supplies 3.85$ Supplies 7.50$ Supplies 47.75$ Supplies 12.65$ Supplies 1.00$ Supplies 3.00$ Supplies 5.25$ Supplies 2.65$ Supplies 4.00$ Supplies 23.80$ Supplies 60.55$ Supplies 60.55$ Supplies 60.55$ Supplies 42.70$ Supplies 17.85$ Supplies 3.25$ Supplies 8.00$ Supplies 8.00$ Supplies 10.00$ Supplies 13.00$ Supplies 35.00$ Supplies 27.00$ Supplies 14.00$ Supplies 4.50$ Supplies 7.00$

Surgery Charges 128.00$ Surgery Charges 17.13$ Surgery Charges 52.00$ Surgery Charges 20.00$ Surgery Charges 56.80$ Surgery Charges 178.00$ Surgery Charges 72.80$ Surgery Charges 72.80$ Surgery Charges 46.20$ Surgery Charges 120.00$ Surgery Charges 105.00$ Surgery Charges 88.45$ Surgery Charges 68.65$ Surgery Charges 49.40$ Surgery Charges 159.00$ Surgery Charges 174.25$ Surgery Charges 194.00$ Surgery Charges 236.50$ Surgery Charges 253.50$ Surgery Charges 363.00$ Surgery Charges 400.00$ Surgery Charges 445.00$

Surgery Charges 515.00$ Surgery Charges 445.00$ Surgery Charges 1,050.00$ Surgery Charges 100.00$ Surgery Charges 696.00$ Surgery Charges 1,638.00$ Surgery Charges 445.00$ Surgery Charges 185.00$ Surgery Charges 445.00$ Surgery Charges 296.00$ Surgery Charges 548.55$ Surgery Charges 1,004.00$ Surgery Charges 255.00$ Surgery Charges 396.00$ Surgery Charges 182.00$ Surgery Charges 144.00$ Surgery Charges 330.00$ Surgery Charges 302.50$ Surgery Charges 882.00$ Surgery Charges 467.50$ Surgery Charges 557.50$ Surgery Charges 647.50$ Surgery Charges 737.50$ Surgery Charges 917.50$ Surgery Charges 1,800.00$ Surgery Charges 1,800.00$ Surgery Charges 783.60$ Surgery Charges 1,200.00$ Surgery Charges 442.00$ Surgery Charges 50.00$ Surgery Charges 105.00$ Surgery Charges 375.12$ Surgery Charges 195.00$ Surgery Charges 1,300.00$ Surgery Charges 1,300.00$ Surgery Charges 25.10$ Surgery Charges 305.00$ Surgery Charges 55.00$ Surgery Charges 75.00$ Surgery Charges 95.00$ Surgery Charges 140.00$ Surgery Charges 935.00$ Surgery Charges 1,700.00$ Surgery Charges 1,700.00$ Surgery Charges 1,700.00$ Surgery Charges 1,700.00$ Surgery Charges 1,700.00$

Surgery Charges 1,700.00$ Surgery Charges 350.00$ Surgery Charges 1,526.00$ Surgery Charges 995.00$ Surgery Charges 1,568.00$ Surgery Charges 1,499.00$ Surgery Charges 2,468.00$ Surgery Charges 2,095.50$ Surgery Charges 1,949.00$ Surgery Charges 2,158.00$ Surgery Charges 2,030.00$ Surgery Charges 1,800.00$ Surgery Charges 2,266.00$ Surgery Charges 90.00$ Surgery Charges 303.00$ Surgery Charges 1,500.00$ Surgery Charges 1,810.00$ Surgery Charges 1,320.00$ Surgery Charges 1,440.00$ Surgery Charges 6,850.00$ Surgery Charges 1,800.00$ Surgery Charges 1,800.00$ Surgery Charges 450.00$ Surgery Charges 1,638.00$ Surgery Charges 360.00$ Surgery Charges 1,200.00$ Surgery Charges 400.00$ Surgery Charges 1,500.00$ Surgery Charges 1,770.00$ Surgery Charges 375.00$ Surgery Charges 935.00$ Surgery Charges 4,500.00$ Surgery Charges 4,193.00$ Surgery Charges 3,569.00$ Surgery Charges 1,930.00$ Surgery Charges 1,641.00$ Surgery Charges 2,947.00$ Surgery Charges 2,570.00$ Surgery Charges 150.00$ Surgery Charges 1,861.00$ Surgery Charges 1,550.00$ Surgery Charges 5,099.00$ Surgery Charges 650.00$ Surgery Charges 2,775.00$ Surgery Charges 2,775.00$ Surgery Charges 2,790.00$ Surgery Charges 960.00$

Surgery Charges 3,018.00$ Surgery Charges 4,827.00$ Surgery Charges 100.00$ Surgery Charges 25.00$ Surgery Charges 1,758.00$ Surgery Charges 580.00$ Surgery Charges 950.00$ Surgery Charges 1,729.00$ Surgery Charges 1,570.00$ Surgery Charges 4,223.00$ Surgery Charges 475.00$ Surgery Charges 50.00$ Surgery Charges 1,055.00$ Surgery Charges 1,171.00$ Surgery Charges 4,124.00$ Surgery Charges 1,500.00$ Surgery Charges 1,956.25$ Surgery Charges 40.00$ Surgery Charges 4,000.00$ Surgery Charges 55.00$ Surgery Charges 270.00$ Surgery Charges 200.00$ Surgery Charges 1,025.00$ Surgery Charges 965.00$ Surgery Charges 40.00$ Surgery Charges 1,005.00$ Surgery Charges 525.00$ Surgery Charges 369.00$ Surgery Charges 88.45$ Surgery Charges 485.00$ Surgery Charges 3,586.00$ Surgery Charges 3,476.00$ Surgery Charges 75.00$ Surgery Charges 95.00$ Surgery Charges 140.00$ Surgery Charges 2,800.00$ Surgery Charges 1,824.00$ Surgery Charges 4,037.00$ Surgery Charges 2,854.00$ Surgery Charges 650.00$ Surgery Charges 3,092.00$ Surgery Charges 1,810.00$ Surgery Charges 5,169.00$ Surgery Charges 1,834.75$ Surgery Charges 3,175.00$ Surgery Charges 1,124.00$ Surgery Charges 1,220.00$

Surgery Charges 1,196.50$ Surgery Charges 806.61$ Surgery Charges 900.00$ Surgery Charges 505.00$ Surgery Charges 2,789.84$ Surgery Charges 1,365.81$ Surgery Charges 760.00$ Surgery Charges 760.00$ Surgery Charges 760.00$ Surgery Charges 760.00$ Surgery Charges 2,174.00$ Surgery Charges 1,107.00$ Surgery Charges 2,650.00$ Surgery Charges 2,216.00$ Surgery Charges 1,982.00$ Surgery Charges 2,010.00$ Surgery Charges 460.50$ Surgery Charges 1,005.00$ Surgery Charges 1,570.00$ Surgery Charges 368.00$ Surgery Charges 695.00$

Task 22.50$ Task 30.00$ Task 30.00$ Task 109.24$

Wound Care Charges 307.00$ Wound Care Charges 360.00$ Wound Care Charges 307.00$ Wound Care Charges 276.00$ Wound Care Charges 250.00$ Wound Care Charges 305.00$ Wound Care Charges 305.00$ Wound Care Charges 305.00$ Wound Care Charges 305.00$ Wound Care Charges 305.00$ Wound Care Charges 305.00$ Wound Care Charges 132.00$ Wound Care Charges 159.00$ Wound Care Charges 307.00$ Wound Care Charges 74.00$ Wound Care Charges 74.00$ Wound Care Charges 307.00$ Wound Care Charges 74.00$ Wound Care Charges 50.00$ Wound Care Charges 368.00$ Wound Care Charges 307.00$ Wound Care Charges 257.00$

Wound Care Charges 307.00$ Wound Care Charges 100.00$ Wound Care Charges 368.00$ Wound Care Charges 368.00$ Wound Care Charges 368.00$ Wound Care Charges 368.00$ Wound Care Charges 307.00$ Wound Care Charges 1,500.00$ Wound Care Charges 303.00$ Wound Care Charges 605.00$ Wound Care Charges 330.00$ Wound Care Charges 413.00$ Wound Care Charges 128.00$ Wound Care Charges 305.00$ Wound Care Charges 153.00$ Wound Care Charges 200.00$ Wound Care Charges 39.00$ Wound Care Charges 39.00$ Wound Care Charges 58.00$ Wound Care Charges 58.00$ Wound Care Charges 60.00$ Wound Care Charges 74.00$ Wound Care Charges 74.00$ Wound Care Charges 88.00$ Wound Care Charges 88.00$ Wound Care Charges 110.00$ Wound Care Charges 110.00$ Wound Care Charges 303.00$ Wound Care Charges 521.00$ Wound Care Charges 130.00$ Wound Care Charges 147.00$ Wound Care Charges 257.00$ Wound Care Charges 250.00$ Wound Care Charges 40.00$ Wound Care Charges 759.60$ Wound Care Charges 759.60$ Wound Care Charges 759.60$ Wound Care Charges 759.60$ Wound Care Charges 759.60$ Wound Care Charges 759.60$

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DESCRIPTION - cheyennecountyhospital.com Price...86160 rl complement c4-ps 86256 smooth muscle ab f-actin ps 86146 beta 2 glycoprotein 1 igg, igm, iga (rps) - ps 86147 cardiolipin