CPT Description	CPT	Price	Blue Cross 2/1/24	Blue Shield 12/1/22	AETNA .51	CIGNA .506	United .35	CHPIV Health Net	Molina	Minimum Reimbursement	Maximum Reimbursement	Cash Discounted Price	
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities	216	#N/A	"$29,178.00"	"$29,604.00"	"$33,504.00"	#N/A	#N/A	"$17,100.00"	"$48,830.00"	"$17,100.00"	"$48,830.00"	"$83,757.00"	
Spinal fusion except cervical without major comorbid conditions or complications (MCC)	460	"$71,321.97"	"$14,589.00"	"$14,802.00"	"$16,752.00"	"$36,088.917"	"$24,962.69"	"$8,550.00"	"$50,782.00"	"$8,550.00"	"$50,782.00"	"$32,378.00"	
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).	470	"$48,762.81"	"$14,589.00"	"$14,802.00"	"$16,752.00"	"$24,673.982"	"$17,066.98"	"$8,550.00"	"$18,323.00"	"$8,550.00"	"$24,673.98"	"$16,437.00"	
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).	473	"$68,693.74"	"$9,726.00"	"$9,868.00"	"$11,168.00"	"$34,759.032"	"$24,042.81"	"$5,700.00"	"$20,394.00"	"$5,700.00"	"$34,759.03"	"$21,796.00"	
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)	743	"$26,643.45"	"$4,863.00"	"$4,934.00"	"$5,584.00"	"$13,481.586"	"$9,325.21"	"$2,850.00"	"$10,636.00"	"$2,850.00"	"$13,481.59"	"$10,064.00"	
U/S BREAST BIOPSY 1ST LESION	19083	"$3,885.74"	"$3,911.00"	"$3,063.63"	"$3,885.74"	"$1,966.184"	"$1,360.01"	$748.98	$816.51	$748.98	"$3,911.00"	$971.44	
"Removal of 1 or more breast growth, open procedure"	19120	"$13,895.78"	"$5,061.00"	"$3,501.30"	"$8,934.00"	"$7,031.265"	"$4,863.52"	$0.00	$0.00	$0.00	"$8,934.00"	"$3,473.95"	
INJ SACROILIAC JOINT ANESTH/STEROID	27096	"$4,502.88"	"$2,784.00"	"$2,289.31"	"$4,502.88"	"$2,278.457"	"$1,576.01"	$358.36	$390.67	$358.36	"$4,502.88"	"$1,125.72"	
Shaving of shoulder bone using an endoscope	29826	"$22,910.50"	"$7,362.00"	"$3,501.30"	"$8,934.00"	"$11,592.713"	"$8,018.68"	$514.62	$561.02	$514.62	"$11,592.71"	"$5,727.63"	
Knee arthroscopy/surgery	29880	"$13,084.56"	"$7,362.00"	"$4,329.49"	"$8,934.00"	"$6,620.787"	"$4,579.60"	$672.22	$732.83	$672.22	"$8,934.00"	"$3,271.14"	
Removal of one knee cartilage using an endoscope	29881	"$12,356.49"	"$6,731.00"	"$4,329.49"	"$8,934.00"	"$6,252.384"	"$4,324.77"	$672.22	$732.83	$672.22	"$8,934.00"	"$3,089.12"	
"BLOOD COLLECTION FEE , VENIPUNCTURE"	36415	$26.25	$8.43	#N/A	$0.00	$13.283	$9.19	#N/A	#N/A	$0.00	$13.28	$6.56	
Insert tunneled cv cath	36558	"$10,199.28"	"$3,911.00"	"$2,289.31"	"$8,934.00"	"$5,160.836"	"$3,569.75"	$165.47	$180.39	$165.47	"$8,934.00"	"$2,549.82"	
Insert tunneled cv cath	36561	"$12,882.56"	"$3,911.00"	"$4,922.01"	"$8,934.00"	"$6,518.575"	"$4,508.90"	$317.20	$345.80	$317.20	"$8,934.00"	"$3,220.64"	
TUNNL CATH REPLCMNT	36581	"$10,168.79"	"$2,784.00"	"$2,289.31"	"$8,934.00"	"$5,145.408"	"$3,559.08"	$213.41	$232.66	$213.41	"$8,934.00"	"$2,542.20"	
"INTRO CATH DIALYSIS CIRCUIT, WITH DIAG ANGIOGRAPHY"	36901	"$6,167.29"	"$2,784.00"	"$6,834.26"	"$6,167.29"	"$3,120.649"	"$2,158.55"	$632.25	$689.26	$632.25	"$6,834.26"	"$1,541.82"	
"INTRO CATH DIALYSIS CIRCUIT, WITH BALLOON ANGIO"	36902	"$15,905.17"	"$6,731.00"	"$6,834.26"	"$8,934.00"	"$8,048.016"	"$5,566.81"	"$1,356.71"	"$1,479.04"	"$1,356.71"	"$8,934.00"	"$3,976.29"	
"PLCMNT OF IV STENT(S), CATH, AV W/ANGIO,DIALYS, S/I"	36903	"$34,443.23"	"$6,731.00"	"$6,834.26"	"$8,934.00"	"$17,428.274"	"$12,055.13"	"$6,313.46"	"$6,882.71"	"$6,313.46"	"$17,428.27"	"$8,610.81"	
THRMBC/NFS DIALYSIS CIRCUIT	36905	"$27,849.63"	"$6,731.00"	"$9,197.63"	"$8,934.00"	"$14,091.913"	"$9,747.37"	"$2,528.11"	"$2,756.05"	"$2,528.11"	"$14,091.91"	"$6,962.41"	
"TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS"	36907	"$20,911.85"	"$6,731.00"	"$4,329.49"	"$8,934.00"	"$10,581.396"	"$7,319.15"	$812.12	$885.34	$812.12	"$10,581.40"	"$5,227.96"	
DIALYSIS CIRCUIT PERM VASCULAR EMBOLIZATION OR OCCLUSION	36909	"$24,520.10"	"$3,911.00"	"$4,329.49"	"$8,934.00"	"$12,407.171"	"$8,582.04"	"$2,203.36"	"$2,402.02"	"$2,203.36"	"$12,407.17"	"$6,130.03"	
Removal of tonsils and adenoid glands patient younger than age 12	42820	#N/A	"$6,731.00"	"$3,501.30"	#N/A	#N/A	#N/A	$205.75	$224.30	$205.75	"$6,731.00"	#N/A	
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	43235	"$7,646.59"	"$3,911.00"	"$2,289.31"	"$7,646.59"	"$3,869.175"	"$2,676.31"	$273.43	$298.08	$273.43	"$7,646.59"	"$1,000.00"	
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	43239	"$8,627.73"	"$3,911.00"	"$3,063.63"	"$8,627.73"	"$4,365.631"	"$3,019.71"	$285.70	$311.46	$285.70	"$8,627.73"	"$1,300.00"	
Diagnostic examination of large bowel using an endoscope	45378	"$7,502.93"	"$2,784.00"	"$3,063.63"	"$7,502.93"	"$3,796.483"	"$2,626.03"	$360.18	$392.66	$360.18	"$7,502.93"	"$1,000.00"	
Biopsy of large bowel using an endoscope	45380	"$9,199.96"	"$2,784.00"	"$3,063.63"	"$8,934.00"	"$4,655.180"	"$3,219.99"	$402.88	$439.21	$402.88	"$8,934.00"	"$1,300.00"	
Removal of polyps or growths of large bowel using an endoscope	45385	"$9,623.18"	"$2,784.00"	"$3,063.63"	"$8,934.00"	"$4,869.329"	"$3,368.11"	$488.27	$532.29	$488.27	"$8,934.00"	"$1,200.00"	
Ultrasound examination of lower large bowel using an endoscope	45391	"$9,863.86"	"$3,911.00"	"$2,289.31"	"$8,934.00"	"$4,991.113"	"$3,452.35"	$206.97	$225.63	$206.97	"$8,934.00"	"$2,465.97"	
Removal of gallbladder using an endoscope	47562	"$17,986.19"	"$12,883.00"	"$6,834.26"	"$8,934.00"	"$9,101.012"	"$6,295.17"	$568.67	$619.94	$568.67	"$12,883.00"	"$4,496.55"	
Repair of groin hernia patient age 5 years or older	49505	"$17,577.79"	"$6,731.00"	"$4,329.49"	"$8,934.00"	"$8,894.362"	"$6,152.23"	$419.69	$457.53	$419.69	"$8,934.00"	"$4,394.45"	
Biopsy of prostate gland	55700	"$7,623.61"	"$3,911.00"	"$3,063.63"	"$7,623.61"	"$3,857.547"	"$2,668.26"	$106.74	$116.36	$106.74	"$7,623.61"	"$1,905.90"	
Surgical removal of prostate and surrounding lymph nodes using an endoscope	55866	#N/A	"$8,743.00"	"$2,289.31"	#N/A	#N/A	#N/A	"$1,162.98"	"$1,267.84"	"$1,162.98"	"$8,743.00"	#N/A	
"Hysteroscopy, biopsy, with or without D&C"	58558	"$12,221.18"	"$3,911.00"	"$3,501.30"	"$8,934.00"	"$6,183.917"	"$4,277.41"	$213.89	$233.18	$213.89	"$8,934.00"	"$3,055.30"	
"Hysteroscopy, ablation"	58563	"$15,007.47"	"$6,731.00"	"$4,329.49"	"$8,934.00"	"$7,593.780"	"$5,252.61"	"$2,073.98"	"$2,260.97"	"$2,073.98"	"$8,934.00"	"$3,751.87"	
"Laparoscopy, remove adnexa"	58661	"$18,972.14"	"$7,594.00"	"$4,922.01"	"$8,934.00"	"$9,599.903"	"$6,640.25"	$119.30	$130.06	$119.30	"$9,599.90"	"$4,743.04"	
"Laparoscopy, tubal cautery"	58670	"$13,803.58"	"$5,061.00"	"$3,501.30"	"$8,934.00"	"$6,984.611"	"$4,831.25"	$514.10	$560.45	$514.10	"$8,934.00"	"$3,450.90"	
"Routine obstetric care for vaginal delivery, including pre-and post-delivery care"	59400	"$11,169.89"	"$11,220.00"	"$10,309.00"	"$11,168.00"	"$5,651.96"	"$3,909.46"	"$6,400.00"	DRG 560 $3262 - $12442	"$3,909.46"	"$11,169.89"	"$4,600 (up to 2 days, then additional $2,100 per day, both, $1000 baby only)"	
"Routine obstetric care for cesarean delivery, including pre-and post-delivery care"	59510	"$21,240.25"	"$16,830.00"	"$13,924.00"	"$20,103.00"	"$10,747.57"	"$7,434.09"	"$9,600.00"	DRG 540 $5517 - $21198	"$7,434.09"	"$21,240.25"	"$6,500 (up to 3 days, then $2,100 per day, both, $1000 baby only)"	
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care	59610	"$11,169.89"	"$11,220.00"	"$10,309.00"	"$11,168.00"	"$5,651.96"	"$3,909.46"	"$6,400.00"	DRG 560 $3262 - $12442	"$3,909.46"	"$11,169.89"	"$4,600 (up to 2 days, then additional $2,100 per day, both, $1000 baby only)"	
"INJ DIAG/THRPY CER/THORACIC,W/O IMAGING GUID"	62320	"$12,333.42"	"$2,784.00"	"$2,289.31"	"$8,934.00"	"$6,240.711"	"$4,316.70"	$180.32	$196.57	$180.32	"$8,934.00"	"$3,083.36"	
"INJ DIAG/THRPY CERV/THORACIC,WITH IMAG GUIDE"	62321	"$14,026.00"	"$2,784.00"	"$2,289.31"	"$8,934.00"	"$7,097.156"	"$4,909.10"	$272.52	$297.10	$272.52	"$8,934.00"	"$3,506.50"	
Injection of substance into spinal canal of lower back or sacrum without imaging guidance	62322	"$11,179.80"	"$2,784.00"	"$2,190.81"	"$8,934.00"	"$5,656.979"	"$3,912.93"	$168.97	$184.21	$168.97	"$8,934.00"	"$2,794.95"	
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	62323	"$11,322.00"	"$2,784.00"	"$2,289.31"	"$8,934.00"	"$5,728.932"	"$3,962.70"	$268.44	$292.64	$268.44	"$8,934.00"	"$2,830.50"	
Inj foramen epidural c/t	64479	"$6,569.82"	"$2,784.00"	"$2,289.31"	"$6,569.82"	"$3,324.329"	"$2,299.44"	$188.49	$205.49	$188.49	"$6,569.82"	"$1,642.46"	
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance	64483	"$11,931.00"	"$2,784.00"	"$2,289.31"	"$8,934.00"	"$6,037.086"	"$4,175.85"	$174.87	$190.64	$174.87	"$8,934.00"	"$2,982.75"	
INJ PARAVERT FAC C/T 1 LVL W/IMAG GUID	64490	"$11,260.00"	"$2,784.00"	"$2,289.31"	"$8,934.00"	"$5,697.560"	"$3,941.00"	$196.21	$213.90	$196.21	"$8,934.00"	"$2,815.00"	
INJ PARAVERT FACET JNT L/S 1LV W/IMAGE GUID	64493	"$4,998.84"	"$2,784.00"	"$2,289.31"	"$4,998.84"	"$2,529.413"	"$1,749.59"	$176.23	$192.12	$176.23	"$4,998.84"	"$1,249.71"	
Removal of recurring cataract in lens capsule using laser	66821	#N/A	"$3,911.00"	"$3,063.63"	#N/A	#N/A	#N/A	$227.10	$247.58	$227.10	"$3,911.00"	#N/A	
Removal of cataract with insertion of lens	66984	"$10,098.94"	"$8,743.00"	"$6,659.19"	"$8,934.00"	"$5,110.064"	"$3,534.63"	$245.27	$267.38	$245.27	"$8,934.00"	"$2,524.74"	
"CT scan, head or brain, without contrast"	70450	"$2,421.09"	$679.89	$610.64	"$2,421.09"	"$1,225.072"	$847.38	$80.31	$87.55	$80.31	"$2,421.09"	$847.38	
HEAD SCAN W/WO CONTRAST 	70470	"$3,339.84"	"$1,017.54"	$914.27	"$2,457.00"	"$1,689.96"	"$1,168.94"	$139.41	$151.98	$139.41	"$2,457.00"	"$1,168.94"	
MANDIBLE W/O CONT 	70486	"$1,802.22"	$681.94	$610.64	"$1,802.22"	$911.92	$630.78	$106.85	$116.48	$106.85	"$1,802.22"	$630.78	
FACIAL BONE W/CONT	70487	"$2,429.18"	$817.26	$730.53	"$2,429.18"	"$1,229.17"	$850.21	$121.66	$132.63	$121.66	"$2,429.18"	$850.21	
NECK SCAN W/O CONTRAST	70490	"$2,337.30"	$683.20	$610.64	"$2,337.30"	"$1,182.67"	$818.06	$119.47	$130.24	$119.47	"$2,337.30"	$818.06	
NECK SCAN WITH CONTRAST	70491	"$2,658.50"	$817.64	$730.53	"$2,457.00"	"$1,345.20"	$930.48	$156.84	$170.98	$156.84	"$2,457.00"	$930.48	
(C) CT ANGIO HEAD W/O&W CONT	70496	"$3,221.51"	"$1,059.48"	"$1,373.63"	"$2,457.00"	"$1,630.08"	"$1,127.53"	$233.67	$254.74	$233.67	"$2,457.00"	"$1,127.53"	
(C) CT ANGIO NECK W/O&W CONT 	70498	"$3,221.51"	"$1,059.48"	"$1,373.63"	"$2,457.00"	"$1,630.08"	"$1,127.53"	$232.93	$253.94	$232.93	"$2,457.00"	"$1,127.53"	
MRI ORBI/FACE/NECK W CONT	70542	"$1,841.46"	"$1,958.18"	"$1,716.41"	"$1,841.46"	$931.78	$644.51	$248.79	$271.22	$248.79	"$1,958.18"	$644.51	
MRI ORBIT/FACE/NECK W/O&W CONT	70543	"$3,408.74"	"$3,624.81"	"$3,175.66"	"$2,513.00"	"$1,724.82"	"$1,193.06"	$309.39	$337.28	$309.39	"$3,624.81"	"$1,193.06"	
MR ANGIOGRAPHY HEAD W/O DYE	70544	"$1,939.50"	"$1,652.01"	"$1,447.76"	"$1,939.50"	$981.39	$678.83	$221.32	$241.27	$221.32	"$1,939.50"	$678.83	
MR ANGIO HEAD W/O&W CONT	70546	"$3,810.45"	"$3,248.40"	"$2,844.34"	"$2,513.00"	"$1,928.09"	"$1,333.66"	$340.12	$370.79	$340.12	"$3,248.40"	"$1,333.66"	
MR ANGIOGRAPHY NECK W/O DYE	70547	"$1,939.50"	"$1,652.01"	"$1,447.76"	"$1,939.50"	$981.39	$678.83	$222.00	$242.02	$222.00	"$1,939.50"	$678.83	
MR ANGIO NECK W CONT	70548	"$1,939.50"	"$1,652.01"	"$1,447.76"	"$1,939.50"	$981.39	$678.83	$252.42	$275.18	$252.42	"$1,939.50"	$678.83	
MRI BRAIN W/O CONTRAST	70551	"$1,939.50"	"$1,606.39"	"$1,447.76"	"$1,939.50"	$981.39	$678.83	$160.08	$174.51	$160.08	"$1,939.50"	$678.83	
MRI BRAIN W/CONTRAST	70552	"$2,326.78"	"$1,924.21"	"$1,736.85"	"$2,326.78"	"$1,177.35"	$814.37	$235.32	$256.54	$235.32	"$2,326.78"	$814.37	
MRI scan of brain before and after contrast	70553	"$4,310.24"	"$3,163.54"	"$3,217.41"	"$2,513.00"	"$2,180.981"	"$1,508.58"	$269.44	$293.73	$269.44	"$3,217.41"	"$1,508.58"	
CHEST 1V	71045	$578.00	$60.85	#N/A	$268.75	$266.64	$184.80	$11.86	$12.93	$11.86	$268.75	$202.30	
CHEST 2V	71046	$636.00	$112.48	$58.02	$295.73	$293.41	$203.35	$22.13	$24.12	$22.13	$295.73	$222.60	
CHEST SCAN W/O CONTRAST	71250	"$2,986.31"	$850.80	$763.69	"$2,457.00"	"$1,511.07"	"$1,045.21"	$113.39	$123.61	$113.39	"$2,457.00"	"$1,045.21"	
CHEST SCAN W/CONTRAST	71260	"$3,097.29"	"$1,017.54"	$914.27	"$2,457.00"	"$1,567.23"	"$1,084.05"	$145.30	$158.40	$145.30	"$2,457.00"	"$1,084.05"	
CHEST SCAN W/WO CONTRAS	71270	"$3,535.35"	"$1,268.33"	"$1,143.24"	"$2,457.00"	"$1,788.89"	"$1,237.37"	$177.66	$193.68	$177.66	"$2,457.00"	"$1,237.37"	
CT CHEST ANGIO (NONCOR) W/CONTRAST	71275	"$3,097.29"	"$1,295.85"	"$1,576.47"	"$1,364.90"	$690.64	$477.72	$234.66	$255.82	$234.66	"$1,576.47"	"$1,084.05"	
C SPINE 3V	72040	$260.00	$87.35	$78.04	$121.15	$120.20	$83.14	$21.24	$23.15	$21.24	$121.15	$91.00	
C-SPINE 5V	72050	$706.00	$130.34	$115.82	$328.75	$326.17	$225.61	$32.70	$35.64	$32.70	$328.75	$247.10	
T SPINE 3V INCL SWMMERS	72072	$572.00	$107.22	$96.31	$266.52	$264.43	$182.91	$26.33	$28.70	$26.33	$266.52	$200.20	
L SPINE LIMITED	72100	$260.00	$97.25	$86.73	$121.15	$120.20	$83.14	$25.50	$27.80	$25.50	$121.15	$91.00	
"X-Ray, lower back, minimum four views"	72110	$818.00	$132.84	$118.30	$380.85	$377.861	$261.37	$36.91	$40.24	$36.91	$380.85	$286.30	
CERV SP W/O CONTRAST	72125	3266	$850.80	$763.69	"$1,662.39"	"$1,649.33"	"$1,143.10"	$109.79	$119.69	$109.79	"$1,662.39"	"$1,143.10"	
THORACIC SPINE W/O CON	72128	"$2,668.05"	$850.80	$763.69	"$2,457.00"	"$1,350.03"	$933.82	$112.56	$122.71	$112.56	"$2,457.00"	$933.82	
LUMBAR SPINE W/O CON	72131	"$2,970.87"	$850.80	$763.69	"$2,457.00"	"$1,503.26"	"$1,039.80"	$112.25	$122.38	$112.25	"$2,457.00"	"$1,039.80"	
LUMBAR SPINE W/CONT	72132	"$3,460.38"	"$1,017.17"	$914.27	"$2,457.00"	"$1,750.95"	"$1,211.13"	$149.22	$162.67	$149.22	"$2,457.00"	"$1,211.13"	
MRI CERVICAL W/O CONT.	72141	"$1,939.50"	"$1,607.21"	"$1,447.76"	"$1,939.50"	$981.39	$678.83	$154.02	$167.90	$154.02	"$1,939.50"	$678.83	
MRI CERVICAL SPINE W/CON	72142	"$2,326.78"	"$1,928.75"	"$1,736.85"	"$2,326.78"	"$1,177.35"	$814.37	$244.34	$266.37	$244.34	"$2,326.78"	$814.37	
MRI THORACIC W/O CONT.	72146	"$2,151.68"	"$1,782.63"	"$1,606.13"	"$2,151.68"	"$1,088.75"	$753.09	$156.03	$170.10	$156.03	"$2,151.68"	$753.09	
MRI scan of lower spinal canal	72148	"$2,151.68"	"$1,780.99"	"$1,606.13"	"$1,097.36"	"$1,088.750"	$753.09	$154.31	$168.22	$154.31	"$1,780.99"	$753.09	
MRI LUMBAR W/CONTRAST	72149	"$2,326.78"	"$1,927.52"	"$1,736.85"	"$2,326.78"	"$1,177.35"	$814.37	$239.72	$261.33	$239.72	"$2,326.78"	$814.37	
"MRI, CERVICAL WO/W CONTRAST"	72156	"$4,310.24"	"$3,162.31"	"$3,217.41"	"$2,513.00"	"$2,180.98"	"$1,508.58"	$271.33	$295.79	$271.33	"$3,217.41"	"$1,508.58"	
"MRI,THORACIC WO/W CONTRAST"	72157	"$1,614.01"	"$3,162.31"	"$3,217.41"	"$1,614.01"	$816.69	$564.90	$271.62	$296.11	$271.62	"$3,217.41"	$564.90	
"MRI, LUMBAR WO/W CONTRAST"	72158	"$4,310.24"	"$3,163.54"	"$3,217.41"	"$2,513.00"	"$2,180.98"	"$1,508.58"	$270.51	$294.90	$270.51	"$3,217.41"	"$1,508.58"	
PELVIC SCAN W/O CONTRAS	72192	"$2,728.32"	$850.35	$763.69	"$2,457.00"	"$1,380.53"	$954.91	$99.62	$108.60	$99.62	"$2,457.00"	$954.91	
"CT scan, pelvis, with contrast"	72193	$772.50	$982.81	$884.83	$393.98	$390.885	$270.38	$189.57	$206.66	$189.57	$982.81	$270.38	
MRI PELVIS W/O CONTRAST	72195	"$1,922.85"	"$1,638.76"	"$1,435.32"	"$1,922.85"	$972.96	$673.00	$226.43	$246.85	$226.43	"$1,922.85"	$673.00	
MRI PELVIS W/CON	72196	"$2,305.36"	"$1,607.21"	"$1,720.85"	"$2,305.36"	"$1,166.51"	$806.88	$258.67	$281.99	$258.67	"$2,305.36"	$806.88	
MRI PELVIS W/O&W CONT	72197	"$4,263.82"	"$3,631.43"	"$3,182.77"	"$2,513.00"	"$2,157.49"	"$1,492.34"	$320.86	$349.79	$320.86	"$3,631.43"	"$1,492.34"	
SHOULDER LT 2 + VWS	73030	$442.00	$82.77	$74.31	$205.80	$204.18	$141.23	$21.77	$23.73	$21.77	$205.80	$154.70	
ELBOW LT 3 + VWS	73080	$403.00	$82.77	$74.31	$187.80	$186.33	$128.88	$23.14	$25.22	$23.14	$187.80	$141.05	
FOREARM LT	73090	$329.00	$75.74	$66.33	$153.32	$152.11	$105.22	$17.49	$19.07	$17.49	$153.32	$115.15	
WRIST LT 3 + VWS	73110	$411.00	$76.97	$67.57	$191.55	$190.05	$131.46	$23.31	$25.41	$23.31	$191.55	$143.85	
HAND LT 3 + VWS	73130	$392.00	$76.97	$67.57	$182.55	$181.12	$125.28	$22.39	$24.41	$22.39	$182.55	$137.20	
FINGER(S) BILAT	73140	$589.00	$61.23	$52.67	$274.39	$272.24	$188.31	$15.03	$16.38	$15.03	$274.39	$206.15	
CT UP EXTREM LT W/O CON	73200	"$2,184.42"	$715.47	$639.19	"$2,184.42"	"$1,105.32"	$764.55	$143.16	$156.06	$143.16	"$2,184.42"	$764.55	
CT UP EXTREM LT W/CON	73201	"$1,044.00"	$850.80	$763.69	"$1,044.00"	$528.26	$365.40	$180.04	$196.28	$180.04	"$1,044.00"	$365.40	
MR FOREARM LEFT WO CONTRAST  	73218	"$1,252.20"	"$1,633.23"	"$1,429.99"	"$1,252.20"	$969.34	$670.50	$303.35	$330.70	$303.35	"$1,633.23"	$438.27	
MRI UP EXTREM JT LT W/O CON	73221	"$1,915.70"	"$1,600.55"	"$1,429.99"	"$1,915.70"	$969.34	$670.50	$175.68	$191.52	$175.68	"$1,915.70"	$670.50	
MRI UP EXTREM JT RT W/CONT	73222	"$2,299.41"	"$1,958.18"	"$1,716.41"	"$2,299.41"	"$1,163.50"	$804.79	$304.86	$332.35	$304.86	"$2,299.41"	$804.79	
MRI UP EXT RT W/JT W/WO	73223	"$4,254.30"	"$3,624.81"	"$3,175.66"	"$2,513.00"	"$2,152.68"	"$1,489.01"	$367.44	$400.57	$367.44	"$3,624.81"	"$1,489.01"	
HIP LT 2-3 VWS	73502	$191.00	$167.80	$103.93	$88.79	$88.09	$60.94	$33.66	$36.69	$33.66	$167.80	$66.85	
"HIP COMPLETE LT, 4 OR MORE VWS"	73503	$504.00	$207.93	$128.75	$234.66	$232.82	$161.04	$42.04	$45.83	$42.04	$234.66	$176.40	
KNEE LT 2 VW	73560	$191.00	$75.74	$66.33	$88.79	$88.09	$60.94	$17.17	$18.72	$17.17	$88.79	$66.85	
KNEE LT 3 VW	73562	$305.00	$82.74	$74.31	$142.10	$140.99	$97.52	$21.39	$23.32	$21.39	$142.10	$106.75	
TIBIA-FIBULA LT 2 VW	73590	$191.00	$75.74	$66.33	$88.79	$88.09	$60.94	$18.25	$19.90	$18.25	$88.79	$66.85	
ANKLE LT 3 + VWS	73610	$305.00	$76.97	$67.57	$142.10	$140.99	$97.52	$20.55	$22.40	$20.55	$142.10	$106.75	
FOOT LT 3 + VWS	73630	$191.00	$76.97	$67.57	$88.79	$88.09	$60.94	$21.27	$23.19	$21.27	$88.79	$66.85	
CT LOW EXTREM LT W/O CONT	73700	$672.83	$715.47	$639.19	$672.83	$340.45	$235.49	$112.25	$122.38	$112.25	$715.47	$235.49	
CT LOW EXTREM LT W/CON	73701	$800.09	$850.80	$763.69	$800.09	$404.85	$280.03	$149.54	$163.02	$149.54	$850.80	$280.03	
MRI scan of leg joint	73721	"$1,915.70"	"$1,600.55"	"$1,429.99"	$977.01	$969.344	$670.50	$0.00	$0.00	$0.00	"$1,600.55"	$670.50	
MRI LOW EXTREM JNT RT W/CON	73722	"$2,299.41"	"$1,958.18"	"$1,716.41"	"$2,299.41"	"$1,163.50"	$804.79	$305.50	$333.04	$305.50	"$2,299.41"	$804.79	
MRI LOW EXTREM JNT RT WO/W CON	73723	"$4,254.30"	"$3,624.81"	"$3,175.66"	"$2,513.00"	"$2,152.68"	"$1,489.01"	$0.00	$0.00	$0.00	"$3,624.81"	"$1,489.01"	
TUBE PLACEMENT CHECK (NG TUBE) W/O CONT	74018	$113.00	$94.97	$62.67	$52.57	$52.16	$36.08	$20.43	$22.28	$20.43	$94.97	$39.55	
ABDOMEN SCAN W/CONTRAST	74160	"$3,317.79"	$984.04	$884.83	"$2,457.00"	"$1,678.80"	"$1,161.23"	$188.47	$205.46	$188.47	"$2,457.00"	"$1,161.23"	
CT MULTI-PHASE LIVER W/WO CONTRAST	74170	"$4,483.50"	"$1,218.23"	"$1,095.88"	"$2,457.00"	"$2,268.65"	"$1,569.23"	$217.44	$237.05	$217.44	"$2,457.00"	"$1,569.23"	
"CT ANGIO, ABDOMEN & PELVIS WITH OR W/O CONTRAST"	74174	$682.20	"$1,825.55"	"$1,664.37"	$682.20	$345.19	$238.77	$313.29	$341.53	$238.77	"$1,825.55"	$238.77	
RENAL SCAN HELICAL/WO	74176	"$3,006.89"	$507.10	$481.31	"$2,457.00"	"$1,521.49"	"$1,052.41"	$123.34	$134.46	$123.34	"$2,457.00"	"$1,052.41"	
CT scan of abdomen and pelvis with contrast	74177	"$4,555.53"	$967.65	$918.29	"$2,457.00"	"$2,305.098"	"$1,594.44"	$247.53	$269.85	$247.53	"$2,457.00"	"$1,594.44"	
CT ABDOMEN & PELVIS W/WO CONTRAST	74178	"$1,244.60"	"$1,279.29"	"$1,213.74"	"$1,244.60"	$629.77	$435.61	$284.32	$309.95	$284.32	"$1,279.29"	$435.61	
MRI ABDOMEN W/O CON	74181	"$1,922.85"	"$1,607.21"	"$1,435.32"	"$1,922.85"	$972.96	$673.00	$184.05	$200.64	$184.05	"$1,922.85"	$673.00	
MRI ABDOMEN W CONT 	74182	"$1,845.66"	"$1,962.66"	"$1,720.85"	"$1,845.66"	$933.90	$645.98	$299.34	$326.33	$299.34	"$1,962.66"	$645.98	
MRI ABDOMEN W/O&W CONT	74183	"$4,263.82"	"$3,631.43"	"$3,182.77"	"$2,513.00"	"$2,157.49"	"$1,492.34"	$321.45	$350.43	$321.45	"$3,631.43"	"$1,492.34"	
CT CARIAC ANGIO W/WO CONTRAST	75574	$807.68	$999.44	"$1,596.09"	$807.68	$408.69	$282.69	$277.98	$303.05	$277.98	"$1,596.09"	$282.69	
"CT FEMORAL RUN-OFF,BILATERAL W CONTRAST"	75635	"$1,200.14"	"$1,245.62"	"$2,017.17"	"$1,200.14"	$607.27	$420.05	$292.53	$318.90	$292.53	"$2,017.17"	$420.05	
FLUORO UP TO 1 HR	76000	$389.01	$165.11	$168.84	$198.40	$196.84	$136.15	$28.31	$30.87	$28.31	$198.40	$136.15	
THYROID	76536	$197.16	$206.49	$184.63	$100.55	$99.76	$69.01	$56.12	$61.18	$56.12	$206.49	$69.01	
US BREAST(S) BILAT	76641	$268.88	$342.06	$247.93	$137.13	$136.05	$94.11	$79.83	$87.03	$79.83	$342.06	$94.11	
Ultrasound of abdomen	76700	$395.43	$286.77	$255.57	$201.67	$200.088	$138.40	$70.04	$76.35	$70.04	$286.77	$138.40	
ABDOMEN US (SINGLE ORGAN)	76705	$194.12	$206.49	$184.63	$99.00	$98.22	$67.94	$51.13	$55.74	$51.13	$206.49	$67.94	
RENAL BILAT	76770	$395.43	$286.77	$255.57	$201.67	$200.09	$138.40	$67.95	$74.08	$67.95	$286.77	$138.40	
ULTRA RENAL TRANSPLANT W/DOPPLER	76776	$395.43	$271.85	$379.71	$201.67	$200.09	$138.40	$103.71	$113.06	$103.71	$379.71	$138.40	
OB US 1ST TRIMESTER SGL/1ST GEST	76801	$395.43	$159.23	$271.36	$201.67	$200.09	$138.40	$58.36	$63.62	$58.36	$271.36	$138.40	
OB US 1ST TRIMESTER EA ADDL GEST	76802	$302.82	$112.48	$142.25	$154.44	$153.23	$105.99	$24.21	$26.39	$24.21	$154.44	$105.99	
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	76805	$395.43	$297.50	$271.36	$201.67	$200.088	$138.40	$77.10	$84.05	$77.10	$297.50	$138.40	
"U/S, OB < OR + 14 WEEKS - EACH ADD'L GESTATION"	76810	$144.20	$393.93	$151.13	$73.54	$72.97	$50.47	$49.05	$53.47	$49.05	$393.93	$50.47	
ULT OB AFI	76815	$395.43	$197.38	$184.63	$201.67	$200.09	$138.40	$48.38	$52.75	$48.38	$201.67	$138.40	
ULTR OB TRANS VAG CERVICAL LEN	76817	$395.43	$227.22	$194.02	$201.67	$200.09	$138.40	$63.16	$68.85	$63.16	$227.22	$138.40	
US FETAL BIOPHYSICAL PROFILE W/O NST	76819	$286.25	$238.52	$209.99	$145.99	$144.84	$100.19	$54.41	$59.32	$54.41	$238.52	$100.19	
Ultrasound pelvis through vagina	76830	$395.43	$222.61	$197.58	$201.67	$200.088	$138.40	$60.25	$65.68	$60.25	$222.61	$138.40	
US PELVIC NON-OB COMPLETE	76856	$197.16	$222.61	$197.58	$100.55	$99.76	$69.01	$57.77	$62.98	$57.77	$222.61	$69.01	
US TESTICULAR	76870	$395.43	$199.46	$197.58	$201.67	$200.09	$138.40	$40.11	$43.73	$40.11	$201.67	$138.40	
US JOINT NON-VASCULAR COMPLETE	76881	$395.43	$331.47	$314.96	$201.67	$200.09	$138.40	$48.76	$53.16	$48.76	$331.47	$138.40	
US JOINT NON VASCULAR LIMITED	76882	$268.88	$38.72	$36.89	$137.13	$136.05	$94.11	$11.53	$12.57	$11.53	$137.13	$94.11	
US GUIDANCE NEEDLE PLACEMENT	76942	$332.44	$220.77	$324.20	$169.54	$168.21	$116.35	$29.64	$32.32	$29.64	$324.20	$116.35	
MG TOMOSYNTHESIS DIAG BILAT	77062	$315.00	$305.66	$178.21	$146.59	$145.44	$100.60	$0.00	$0.00	$0.00	$305.66	$110.25	
TOMOSYNTHESIS MAMMO	77063	$151.00	$147.08	$89.03	$70.54	$69.98	$48.41	$27.25	$29.70	$27.25	$147.08	$52.85	
Mammography of one breast	77065	$381.00	$370.20	$142.35	$177.55	$176.159	$121.85	$102.84	$112.12	$102.84	$370.20	$133.35	
Mammography of both breasts	77066	$488.00	$473.91	$320.36	$227.29	$225.504	$155.98	$131.84	$143.72	$131.84	$473.91	$170.80	
"Mammography, screening, bilateral"	77067	$403.00	$391.40	$130.23	$187.72	$186.248	$128.83	$107.84	$117.56	$107.84	$391.40	$141.05	
"DXA BONE DENSITY, AXIAL"	77080	"$1,351.00"	$414.22	$105.73	$629.38	$624.44	$431.92	$31.78	$34.64	$31.78	$629.38	$472.85	
Basic metabolic panel	80048	$104.48	$42.92	$59.74	$53.28	$52.867	$36.57	$7.10	$7.74	$7.10	$59.74	$26.12	
"Blood test, comprehensive group of blood chemicals"	80053	$245.00	$53.68	$74.59	$99.76	$98.980	$68.60	$9.06	$9.87	$9.06	$99.76	$61.25	
Obstetric blood test panel	80055	#N/A	$83.53	$168.83	#N/A	#N/A	#N/A	$34.97	$38.12	$34.97	$168.83	#N/A	
"Blood test, lipids (cholesterol and triglycerides)"	80061	$97.11	$67.92	$94.54	$10.56	$10.474	$7.25	$11.26	$12.28	$7.25	$94.54	$24.28	
Kidney function panel test	80069	$107.63	$44.02	$61.26	$54.89	$54.461	$37.67	$7.42	$8.09	$7.42	$61.26	$26.91	
Liver function blood test panel	80076	$101.33	$41.46	$57.67	$51.68	$51.273	$35.47	$6.23	$6.79	$6.23	$57.67	$25.33	
"UDAS, QUAL, 6 CLASSES"	80305	$88.00	$93.53	$75.55	$44.88	$44.53	$30.80	$12.30	$13.41	$12.30	$93.53	$22.00	
ALCOHOL ETHYL	80320	$133.88	$83.90	$0.00	$68.28	$67.74	$46.86	#N/A	#N/A	$0.00	$83.90	$33.47	
SALICYLATE	80329	$148.00	$157.15	$0.00	$75.48	$74.89	$51.80	#N/A	#N/A	$0.00	$157.15	$37.00	
Manual urinalysis test with examination using microscope	81000	$39.38	$16.02	$22.37	$20.08	$19.926	$13.78	$2.52	$2.75	$2.52	$22.37	$9.85	
URINALYSIS-AUTO W/MICRO	81001	$39.38	$15.50	$22.37	$20.08	$19.93	$13.78	$2.70	$2.95	$2.70	$22.37	$9.85	
Automated urinalysis test	81002	40	$12.05	$18.03	$20.36	$20.200	$14.00	$2.10	$2.29	$2.10	$20.36	$10.00	
URINALYSIS-POC	81003	$16.29	$11.41	$15.86	$8.31	$8.24	$5.70	$1.91	$2.09	$1.91	$15.86	$4.07	
PREGNANCY TEST-POC	81025	$39.94	$25.88	$38.88	$20.37	$20.21	$13.98	$3.42	$3.72	$3.42	$38.88	$9.99	
"ACETONE, QUAL"	82009	$55.66	$22.95	$31.87	$28.39	$28.16	$19.48	$3.67	$4.00	$3.67	$31.87	$13.92	
AMMONIA	82140	$180.60	$73.93	$102.82	$92.11	$91.38	$63.21	$12.64	$13.78	$12.64	$102.82	$45.15	
"VITAMIN D, 25-OH "	82306	$214.55	$150.15	$208.87	$109.42	$108.56	$75.09	$24.20	$26.38	$24.20	$208.87	$53.64	
CPK 	82550	$80.85	$33.26	$45.96	$41.23	$40.91	$28.30	$5.65	$6.16	$5.65	$45.96	$20.21	
CKMB	82553	$142.80	$58.56	$81.46	$72.83	$72.26	$49.98	$9.89	$10.78	$9.89	$81.46	$35.70	
VITAMIN B12	82607	$186.38	$76.46	$106.35	$95.05	$94.31	$65.23	$13.01	$14.18	$13.01	$106.35	$46.60	
"VITAMIN D 1,25,DEHYDR."	82652	$35.00	$151.89	$228.46	$17.85	$17.71	$12.25	$32.38	$35.30	$12.25	$228.46	$8.75	
FERRITIN	82728	$168.53	$69.12	$96.10	$85.95	$85.28	$58.99	$11.78	$12.84	$11.78	$96.10	$42.13	
GLUCOSE (POCT)	82948	$21.00	$16.02	$22.37	$10.71	$10.63	$7.35	$2.64	$2.88	$2.64	$22.37	$5.25	
HEMOGLOBIN A1C	83036	$120.33	$49.24	$68.48	$61.37	$60.89	$42.12	$8.34	$9.09	$8.34	$68.48	$30.08	
IRON 	83540	$80.33	$32.85	$45.70	$40.97	$40.65	$28.12	$5.58	$6.09	$5.58	$45.70	$20.08	
TIBC	83550	$53.59	$34.69	$52.17	$27.33	$27.12	$18.76	$6.72	$7.33	$6.72	$52.17	$13.40	
LACTIC ACID (LACTATE)	83605	$132.30	$54.16	$75.35	$67.47	$66.94	$46.31	$9.18	$10.01	$9.18	$75.35	$33.08	
LDH 	83615	$74.55	$30.53	$42.62	$38.02	$37.72	$26.09	$5.24	$5.71	$5.24	$42.62	$18.64	
LIPASE	83690	$85.58	$34.90	$48.58	$43.65	$43.30	$29.95	$5.93	$6.47	$5.93	$48.58	$21.40	
"MAGNESIUM, 24HR URINE"	83735	$82.95	$33.77	$47.27	$4.83	$4.80	$3.32	$5.82	$6.34	$3.32	$47.27	$20.74	
NATRIURETIC PEPTIDE	83880	$246.04	$172.21	$239.52	$125.48	$124.50	$86.11	$29.43	$32.08	$29.43	$239.52	$61.51	
PHOSPHORUS 	84100	$58.80	$24.01	$33.48	$29.99	$29.75	$20.58	$4.11	$4.48	$4.11	$33.48	$14.70	
PSA (prostate specific antigen)	84153	$9.00	$93.29	$129.79	$4.59	$4.554	$3.15	$15.96	$17.40	$3.15	$129.79	$2.25	
"PSA, FREE"	84154	$9.00	$92.88	$129.79	$4.59	$4.554	$3.15	$15.96	$17.40	$3.15	$129.79	$2.25	
"THYROXINE, FREE"	84439	$65.36	$45.72	$63.63	$33.33	$33.07	$22.88	$7.72	$8.42	$7.72	$63.63	$16.34	
"Blood test, thyroid stimulating hormone (TSH)"	84443	$121.75	$85.23	$118.52	$62.09	$61.606	$42.61	$14.41	$15.70	$14.41	$118.52	$30.44	
TRANSFERRIN 	84466	$158.03	$66.66	$90.09	$80.60	$79.96	$55.31	$10.75	$11.71	$10.75	$90.09	$39.51	
TOTAL T3	84480	$412.70	$71.88	$100.04	$210.48	$208.83	$144.45	$12.29	$13.40	$12.29	$210.48	$103.18	
TROPONIN I	84484	$121.80	$96.78	$69.44	$62.12	$61.63	$42.63	$8.27	$9.01	$8.27	$96.78	$30.45	
"URIC ACID, BLOOD "	84550	$56.18	$22.95	$31.87	$28.65	$28.43	$19.66	$3.91	$4.27	$3.91	$31.87	$14.05	
HCG QUANT	84702	$186.38	$73.08	$106.20	$95.05	$94.31	$65.23	$12.92	$14.09	$12.92	$106.20	$46.60	
"SERUM PREG. TEST, QUAL"	84703	$92.40	$38.11	$52.97	$47.12	$46.75	$32.34	$6.30	$6.87	$6.30	$52.97	$23.10	
"HEMOGLOBIN, HEMOCUE"	85018	$29.32	$11.99	$16.72	$14.95	$14.84	$10.26	$2.02	$2.20	$2.02	$16.72	$7.33	
"Complete blood cell count, with differential white blood cells, automated"	85025	$158.00	$39.44	$54.84	$73.30	$72.720	$50.40	$6.59	$7.18	$6.59	$73.30	$39.50	
"Complete blood count, automated"	85027	$80.33	$32.82	$45.65	$40.97	$40.647	$28.12	$5.57	$6.08	$5.57	$45.65	$20.08	
MANUAL CELL COUNT	85032	$20.55	$21.85	$30.35	$10.48	$10.40	$7.19	$3.74	$4.08	$3.74	$30.35	$5.14	
D-DIMER QUANT	85379	$87.68	$51.60	$71.81	$44.72	$44.37	$30.69	$8.83	$9.63	$8.83	$71.81	$21.92	
"Blood test, clotting time"	85610	$48.83	$19.98	$27.72	$24.90	$24.708	$17.09	$3.41	$3.71	$3.41	$27.72	$12.21	
"SED RATE, AUTO"	85652	$44.10	$13.25	$19.04	$22.49	$22.31	$15.44	$2.34	$2.55	$2.34	$22.49	$11.03	
Coagulation assessment blood test	85730	$74.55	$30.46	$42.32	$38.02	$37.722	$26.09	$5.21	$5.68	$5.21	$42.32	$18.64	
ANACHOICE SPECIF AB CASCADING REFLEX	86038	$6.73	$61.30	$85.29	$3.43	$3.41	$2.36	$10.37	$11.31	$2.36	$85.29	$1.68	
"TB TEST, CELL IMMUN MEASURE"	86480	$51.00	$307.50	$437.28	$26.01	$25.81	$17.85	$53.72	$58.56	$17.85	$437.28	$12.75	
CSF-VDRL-QUAL-QUEST	86592	$14.35	$21.65	$30.10	$7.32	$7.26	$5.02	$3.71	$4.04	$3.71	$30.10	$3.59	
ANTIBODY; HELICOBACTER PYLORI	86677	$179.55	$75.54	$102.41	$91.57	$90.85	$62.84	$12.64	$13.78	$12.64	$102.41	$44.89	
"HB CORE AB, IGM (SHARP)"	86705	$85.29	$57.78	$83.02	$11.55	$11.46	$7.93	$10.12	$11.03	$7.93	$83.02	$21.32	
"HEPATITIS A AB, IGM (SHARP)"	86709	$81.60	$55.22	$79.44	$11.05	$10.96	$7.58	$9.67	$10.54	$7.58	$79.44	$20.40	
HEPATITIS C AB (SHARP)	86803	$103.44	$70.07	$100.70	$14.01	$13.90	$9.61	$12.27	$13.37	$9.61	$100.70	$25.86	
"ANTIBODY SCREEN, TUBE"	86850	$278.39	$54.77	#N/A	$141.98	$140.87	$97.44	$2.54	$2.77	$2.54	$141.98	$69.60	
BLOOD GROUP-ABO	86900	$36.75	$15.13	$21.06	$18.74	$18.60	$12.86	$2.32	$2.53	$2.32	$21.06	$9.19	
RH-TYPE	86901	$36.75	$31.96	$21.06	$18.74	$18.60	$12.86	$2.40	$2.62	$2.40	$31.96	$9.19	
CROSS MATCH IMMED SPIN	86920	$366.90	$182.56	#N/A	$187.12	$185.65	$128.42	$0.00	$0.00	$0.00	$187.12	$91.73	
"GRAM STAIN, BLOOD CULTURE"	87040	$127.58	$52.35	$72.82	$38.15	$37.85	$26.18	$8.76	$9.55	$8.76	$72.82	$31.90	
BACITRACIN OR OPTOCHIN DISK	87070	$62.40	$43.64	$60.75	$31.82	$31.57	$21.84	$7.33	$7.99	$7.33	$60.75	$15.60	
MICROBIOLOGY/RAP ID NH R8311001	87077	$63.30	$40.94	$57.01	$29.87	$29.63	$20.50	$6.91	$7.53	$6.91	$57.01	$15.83	
R30851401 CANDIDA ALBICANS 50TST/KT	87081	$48.04	$33.36	$46.76	$24.50	$24.31	$16.81	$5.54	$6.04	$5.54	$46.76	$12.01	
CULTURE-URINE	87086	$99.75	$40.36	$56.96	$50.87	$50.47	$34.91	$6.98	$7.61	$6.98	$56.96	$24.94	
PBP2A/PBPB2ASA	87147	$37.50	$23.73	$36.51	$19.13	$18.98	$13.13	$3.82	$4.16	$3.82	$36.51	$9.38	
SENS-ROUTINE PER ORGANISM	87186	$107.10	$43.85	$61.00	$54.62	$54.19	$37.49	$7.39	$8.05	$7.39	$61.00	$26.78	
STOOL FOR WBC	87205	$53.03	$21.65	$30.10	$27.05	$26.83	$18.56	$3.38	$3.68	$3.38	$30.10	$13.26	
WET PREP-MICRO	87210	$53.03	$21.65	$30.10	$27.05	$26.83	$18.56	$3.47	$3.79	$3.47	$30.10	$13.26	
HEPATITIS B SURFACE AG (SHARP)	87340	$74.85	$50.68	$72.87	$7.65	$7.59	$5.25	$8.90	$9.70	$5.25	$72.87	$18.71	
"INFLUENZA A&B, RAPID QUAL DETECTION"	87451	$90.09	$38.01	$52.87	$45.95	$45.59	$31.53	$5.79	$6.31	$5.79	$52.87	$22.52	
SARS-COV-2 COVID-19 AMP PRB	87635	$203.00	#N/A	#N/A	$103.53	$102.72	$71.05	$62.60	$68.24	$62.60	$103.53	$50.75	
ILLUMIGENE GROUP A STREPTOCOCCUS	87651	$254.40	$172.24	$247.65	$129.74	$128.73	$89.04	$30.44	$33.19	$30.44	$247.65	$63.60	
WAIVED FLU TEST INFLUENZA A	87804	$105.52	$45.59	$65.55	$53.82	$53.39	$36.93	$8.64	$9.42	$8.64	$65.55	$26.38	
RAPID STREP A ASSAY W/OPTIC	87880	$114.98	$45.59	$65.55	$58.64	$58.18	$40.24	$6.82	$7.44	$6.82	$65.55	$28.75	
CRYTOCOCCAL ANTIGEN	87899	$106.36	$45.59	$65.55	$34.34	$34.07	$23.57	$4.75	$5.18	$4.75	$65.55	$26.59	
"CYTOPATH, CONCENTRATE TECH SMEARS & INTERPRETATION"	88108	$85.75	$33.43	$71.30	$43.73	$43.39	$30.01	$7.06	$7.69	$7.06	$71.30	$21.44	
FNA INTERPRETATION	88173	$159.18	$55.46	#N/A	$81.18	$80.55	$55.71	$12.68	$13.83	$12.68	$81.18	$39.80	
TISSUE CULTURE BONE MARROW	88237	$375.00	$543.88	$891.17	$191.25	$189.75	$131.25	$24.31	$26.50	$24.31	$891.17	$93.75	
LEVEL I SURGICAL PATHOLOGY;GROSS EXAMINATION ONLY	88300	$151.73	$14.38	$30.68	$77.38	$76.78	$53.11	$2.04	$2.23	$2.04	$77.38	$37.93	
LEVEL II - SURGICAL PATHOLOGY; GROSS AND MICROSCOPIC EXAM	88302	$211.05	$35.45	$79.99	$107.64	$106.79	$73.87	$5.11	$5.57	$5.11	$107.64	$52.76	
LEVEL III - SURGICAL PATHOLOGY; GROSS & MICROSCOPIC	88304	$255.68	$49.86	$97.37	$130.40	$129.37	$89.49	$7.44	$8.11	$7.44	$130.40	$63.92	
LEVEL IV - SURGICAL PATHOLOGY; GROSS & MICROSCOPIC EXAM	88305	$349.13	$68.43	$177.35	$178.06	$176.66	$122.20	$10.00	$10.90	$10.00	$178.06	$87.28	
LEVEL V - SURGICAL PATHOLOGY; GROSS & MICROSCOPIC EXAM	88307	$538.63	$101.69	$248.65	$274.70	$272.55	$188.52	$21.38	$23.31	$21.38	$274.70	$134.66	
DECALCIFICATION PROCEDURE	88311	$159.18	$12.74	$12.06	$81.18	$80.55	$55.71	$1.93	$2.10	$1.93	$81.18	$39.80	
SPECIAL STAINS; GROUP I FOR MICROORGANISMS	88312	$159.18	$15.09	$138.68	$81.18	$80.55	$55.71	$8.01	$8.73	$8.01	$138.68	$39.80	
"SPECIAL STAINS; GROUP II, ALL OTHER, EXCEPT IMMUNO....."	88313	$159.18	$14.75	$122.55	$81.18	$80.55	$55.71	$9.41	$10.26	$9.41	$122.55	$39.80	
"CONSULT, COMPREHENSIVE REVIEW "	88325	$108.00	$307.37	#N/A	$55.08	$54.65	$37.80	$24.77	$27.00	$24.77	$307.37	$27.00	
FIRST TISSUE BLOCK W/FROZEN SECTION(S) SINGLE SPECIMEN	88331	$538.63	$80.76	$60.66	$274.70	$272.55	$188.52	$10.86	$11.84	$10.86	$274.70	$134.66	
1ST IHC STAIN PER SITE	88341	$30.00	$216.63	$157.31	$15.30	$15.18	$10.50	$51.03	$55.63	$10.50	$216.63	$7.50	
IMMUNOHISTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE)	88342	$30.00	$48.35	$123.43	$15.30	$15.18	$10.50	$13.12	$14.31	$10.50	$123.43	$7.50	
MORPH ANALYSIS TUMOR IMMUNOHISTOCHEMISTRY	88360	$322.00	$188.98	$158.19	$164.22	$162.93	$112.70	$13.84	$15.09	$13.84	$188.98	$80.50	
IHC QUANTITATIVE MORPH ANALYSIS-TC AUTOMATED	88361	$96.00	$336.08	$276.85	$48.96	$48.58	$33.60	$19.56	$21.32	$19.56	$336.08	$24.00	
FISH AUTO-TC(MULTIPLEX PROBE)	88374	$320.00	$756.92	$554.56	$163.20	$161.92	$112.00	$178.30	$194.38	$112.00	$756.92	$80.00	
"Psychotherapy, 30 min"	90832	#N/A	#N/A	#N/A	#N/A	#N/A	#N/A	$64.50	$70.32	$64.50	$70.32	N/A	
"Psychotherapy, 45 min"	90834	#N/A	#N/A	#N/A	#N/A	#N/A	#N/A	$81.94	$89.32	$81.94	$89.32	N/A	
"Psychotherapy, 60 min"	90837	#N/A	#N/A	#N/A	#N/A	#N/A	#N/A	$119.58	$130.37	$119.58	$130.37	N/A	
"Family psychotherapy, not including patient, 50 min"	90846	#N/A	#N/A	$54.43	#N/A	#N/A	#N/A	$105.70	$115.23	$54.43	$115.23	N/A	
"Family psychotherapy, including patient, 50 min"	90847	#N/A	#N/A	$62.39	#N/A	#N/A	#N/A	$62.22	$67.83	$62.22	$67.83	N/A	
Group psychotherapy	90853	#N/A	#N/A	$24.58	#N/A	#N/A	#N/A	$17.67	$19.26	$17.67	$24.58	N/A	
"Electrocardiogram, routine, with interpretation and report"	93000	$278.63	$135.77	$63.07	$142.10	$140.987	$97.52	$35.01	$38.17	$35.01	$142.10	$97.52	
" 12 LEAD EKG, W/O INTERPRETATION & REPORT"	93005	$96.00	$78.40	$57.64	$117.35	$116.43	$80.54	$20.01	$21.81	$20.01	$117.35	$33.60	
CARDIOVASCULAR STRESS TEST	93017	$698.00	$257.68	$219.57	$355.98	$353.19	$244.30	$64.05	$69.83	$64.05	$355.98	$244.30	
COMPLETE ECHO W/BUBBLE CONTRAST	93306	"$1,239.63"	"$1,129.92"	$768.57	$632.21	$627.25	$433.87	$216.46	$235.97	$216.46	"$1,129.92"	$433.87	
COMPLETE ECHO	93306	"$1,239.63"	"$1,129.92"	$768.57	$632.21	$627.25	$433.87	$216.46	$235.97	$216.46	"$1,129.92"	$433.87	
NEONATAL/PED ECHO	93306	"$1,420.63"	"$1,129.92"	$768.57	$724.52	$718.84	$497.22	$216.46	$235.97	$216.46	"$1,129.92"	$497.22	
COMPLETE ECHO W/O SPECT OR COLOR	93307	"$1,340.28"	$682.45	$500.86	$683.54	$678.18	$469.10	$109.87	$119.78	$109.87	$683.54	$469.10	
LIMITED BUBBLE CONTRAST ECHO	93308	$556.03	$344.45	$253.62	$283.58	$281.35	$194.61	$54.94	$59.89	$54.94	$344.45	$194.61	
(C) TRANSESOPHAGEAL ECHO	93312	"$1,743.08"	$577.03	$496.26	$888.97	$882.00	$610.08	$47.50	$51.78	$47.50	$888.97	$610.08	
(C) TRANSESOPHAGEAL DOPPLER	93320	$576.24	$304.05	$224.18	$293.88	$291.58	$201.68	$56.05	$61.10	$56.05	$304.05	$201.68	
(C) TRANSESOPHAGEAL COLOR FLOW	93325	$189.98	$447.24	$379.91	$96.89	$96.13	$66.49	$92.16	$100.47	$66.49	$447.24	$66.49	
Insertion of catheter into left heart for diagnosis	93452	"$9,907.00"	"$9,321.00"	"$6,834.26"	"$5,052.57"	"$5,012.942"	"$3,467.45"	$670.10	$730.51	$670.10	"$9,321.00"	"$2,476.75"	
US DUPLEX CAROTID BILAT	93880	"$2,103.57"	$679.82	$523.93	"$1,072.82"	"$1,064.41"	$736.25	$143.33	$156.25	$143.33	"$1,072.82"	$736.25	
NONINVAS UP/LO EXTM ART 1 LEV BILAT	93922	$349.00	$213.70	$239.97	$177.99	$176.59	$122.15	$43.22	$47.12	$43.22	$239.97	$122.15	
DUPLEX LOW EXTREM ART BILAT	93925	$556.03	$683.16	$610.83	$283.58	$281.35	$194.61	$88.64	$96.63	$88.64	$683.16	$194.61	
DUPLEX UP EXTREM ART BILAT 	93930	$556.03	$722.84	$490.95	$283.58	$281.35	$194.61	$89.64	$97.73	$89.64	$722.84	$194.61	
DUPLEX UP EXTREM ART LT 	93931	$395.43	$480.70	$357.74	$201.67	$200.09	$138.40	$79.86	$87.06	$79.86	$480.70	$138.40	
"US DOPPLER EXTREM VEINS, BILAT"	93970	$556.03	$646.11	$499.82	$283.58	$281.35	$194.61	$147.78	$161.11	$147.78	$646.11	$194.61	
DUPLEX EXTREM VEINS; UNI/LTD	93971	$474.30	$504.37	$360.41	$241.89	$240.00	$166.01	$86.66	$94.47	$86.66	$504.37	$166.01	
US DUPLEX ABD PEL RETR COM	93975	$556.03	$726.91	$686.22	$283.58	$281.35	$194.61	$148.96	$162.39	$148.96	$726.91	$194.61	
US DUPLEX ABD PEL RETR LTD 	93976	$556.03	$580.14	$406.52	$283.58	$281.35	$194.61	$149.12	$162.56	$149.12	$580.14	$194.61	
AV SHUNT	93990	$395.43	$598.79	$433.82	$201.67	$200.09	$138.40	$75.28	$82.07	$75.28	$598.79	$138.40	
Sleep study	95810	#N/A	$937.50	"$2,003.70"	#N/A	#N/A	#N/A	$233.55	$254.61	$233.55	"$2,003.70"	#N/A	
EEG EXT MONITORING >60 MINUTES	95813	$650.50	$258.16	$534.89	$331.76	$329.15	$227.68	$54.33	$59.23	$54.33	$534.89	$227.68	
EEG	95816	"$1,052.52"	$304.05	$341.58	$536.79	$532.58	$368.38	$47.95	$52.27	$47.95	$536.79	$368.38	
HYDRATION IV INFUSION FIRST HR	96360	$334.41	$465.00	$166.36	$170.55	$169.21	$117.04	$62.59	$68.23	$62.59	$465.00	$117.04	
HYDRATION IV INFUSION EA ADDL HR	96361	$63.00	$0.00	$42.04	$32.13	$31.88	$22.05	$17.81	$19.42	$0.00	$42.04	$22.05	
THER/PROPH/DIAG IV INF FIRST HR	96365	$334.41	$465.00	$202.36	$170.55	$169.21	$117.04	$76.37	$83.26	$76.37	$465.00	$117.04	
THER/PROPH/DIAG IV INF EA ADDL HR	96366	$84.00	$0.00	$49.49	$42.84	$42.50	$29.40	$23.51	$25.63	$0.00	$49.49	$29.40	
"Physical therapy, therapeutic exercise"	97110	$203.70	$302.00	$41.50	$203.70	$103.072	$71.30	$13.37	$14.58	$13.37	$302.00	$61.11	
"New patient office or other outpatient visit, typically 30 min"	99203	$289.33	#N/A	#N/A	#N/A	#N/A	#N/A	$69.78	$69.00	$69.00	$69.00	$135.00	
"New patient office of other outpatient visit, typically 45 min"	99204	$429.05	#N/A	#N/A	#N/A	#N/A	#N/A	$84.06	$69.00	$69.00	$69.00	$180.00	
"New patient office of other outpatient visit, typically 60 min"	99205	$565.68	#N/A	#N/A	#N/A	#N/A	#N/A	$100.89	$69.00	$69.00	$69.00	$225.00	
"ESTABLISHED, 10-19 MINUTES"	99212	$147.60	#N/A	#N/A	#N/A	#N/A	#N/A	$13.92	$69.00	$13.92	$69.00	$66.42	
ESTABLISHED- 20-29 MINUTES	99213	$234.35	#N/A	#N/A	#N/A	#N/A	#N/A	$29.28	$69.00	$29.28	$69.00	$105.46	
"ESTABLISHED, 30-39 MINUTES"	99214	$331.08	#N/A	#N/A	#N/A	#N/A	#N/A	$45.75	$69.00	$45.75	$69.00	$148.99	
ESTABLISHED-40-54 MINUTES	99215	$463.15	#N/A	#N/A	#N/A	#N/A	#N/A	$69.78	$69.00	$69.00	$69.00	$208.42	
"Patient office consultation, typically 40 min"	99243	$160.00	#N/A	#N/A	$81.60	$80.960	$56.00	$72.59	$79.14	$56.00	$81.60	$72.00	
"Patient office consultation, typically 60 min"	99244	$244.00	#N/A	#N/A	$124.44	$123.464	$85.40	$99.31	$108.26	$85.40	$124.44	$109.80	
Emergency -LEVEL I BRIEF	99281	$456.00	"$1,046.00"	$352.11	$426.00	$215.13	$149.10	$18.52	$20.19	$18.52	"$1,046.00"	$114.00	
Emergency- LEVEL II LIMITED	99282	$559.00	"$1,046.00"	$352.11	$522.00	$263.61	$182.70	$23.42	$25.54	$23.42	"$1,046.00"	$139.75	
Emergency-LEVEL III INTERMEDIATE 	99283	"$1,398.00"	"$1,046.00"	$831.27	"$1,307.00"	$660.04	$457.45	$54.41	$59.32	$54.41	"$1,307.00"	$349.50	
Emergency-LEVEL IV EXTENDED 	99284	"$1,630.00"	"$1,046.00"	"$1,669.80"	"$1,523.00"	$769.12	$533.05	$65.67	$71.59	$65.67	"$1,669.80"	$407.50	
Emergency-LEVEL V COMPLEX	99285	"$2,564.00"	"$1,046.00"	"$1,669.80"	"$2,396.00"	"$1,209.98"	$838.60	$131.86	$143.75	$131.86	"$2,396.00"	$641.00	
Emergency-LEVEL VI CRITICAL CARE FIRST 30-74 MIN 	99291	"$3,184.00"	#N/A	"$2,682.57"	"$2,976.00"	"$1,502.88"	"$1,041.60"	$184.26	$200.87	$184.26	"$2,976.00"	$796.00	
Initial new patient preventive medicine evaluation (18-39 years)	99385	$236.82	#N/A	#N/A	$120.78	$119.831	$82.89	$139.20	$151.75	$82.89	$151.75	$106.57	
Initial new patient preventive medicine evaluation (40-64 years)	99386	$280.00	#N/A	#N/A	$142.80	$141.680	$98.00	$0.00	$0.00	$0.00	$142.80	$126.00	
"SPECIMEN COLLECTION SARS, COV2,COVID19, ANY SOURCE"	C9803	$15.75	#N/A	#N/A	$8.03	$7.97	$5.51	$28.05	$30.58	$5.51	$30.58	$5.51	
"SURG PATH,GROSS & MICRO EXAM,PROSTATE BX,10-20 SPECIMENS"	G0416	"$1,078.98"	"$1,147.37"	#N/A	$550.28	$545.96	$377.64	$304.85	$332.34	$304.85	"$1,147.37"	$377.64	
"SARS-COV2,ANY TECH,MULT TYPES OR SUB(ALL TARGETS)NON CDC"	U0002	$203.00	#N/A	#N/A	$103.53	$102.72	$71.05	$62.60	$68.24	$62.60	$103.53	$71.05	
COVID-19 MOLECULAR/NAAT TEST	U0003	$203.00	#N/A	#N/A	$103.53	$102.72	$71.05	$91.50	$99.75	$71.05	$103.53	$71.05