cc anesthesiology nerve block, femoral 186 64447

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Department Description 2019 Charge CPT CodeCC_Anesthesiology NERVE BLOCK, FEMORAL 186 64447CC_Anesthesiology INJECTION, DIAGNOSTIC/THERAPEUTIC SUBSTANCE WITHOUT IMAGING GUIDANCE 243 62322CC_Anesthesiology NERVE BLOCK, TAP (UNILATERAL) 178 64486CC_Anesthesiology NERVE BLOCK, TAP, BILATERAL 224 64488CC_Anesthesiology PICC LINE INSERTION (PRO FEE) 550 36569CC_Anesthesiology NERVE BLOCK, BRACHIAL PLEXUS 183 64415CC_Anesthesiology SPINAL TRAY 71CC_Anesthesiology NERVE BLOCK, AXILLARY 200 64417CC_Anesthesiology EPIDURAL TRAY 96CC_Anesthesiology EXTREME AGE <1 OR >70 (PRO FEE) 165 99100CC_Anesthesiology NERVE BLOCK, POPLITEAL/SCIATIC 205 64445CC_Anesthesiology NERVE BLOCK 269CC_Anesthesiology NERVE BLOCK, THORACIC EPIDURAL 436 62281CC_Anesthesiology GENERAL ANESTHESIA 1421CC_Anesthesiology ULTRASOUND GUIDANCE/VASC ACCESS (PRO FEE 101 76937,26CC_Anesthesiology LOCAL/MAC 929CC_Anesthesiology CONS SED<5Y/O;15 MIN (CRNA W/OTHR HCP) 252 99155CC_Anesthesiology CONS SED>5Y/O;15MIN (CRNA W/OTHR HCP) 206 99156CC_Anesthesiology SPINAL/EPIDURAL/REGIONAL 1094CC_Anesthesiology CONS SED, EA ADD'L 15 M (CRNA W/OTHR HCP 157 99157CC_Anesthesiology INTUBATION (ANESTHESIA PRO FEE) 238 31500CC_Anesthesiology ANESTHESIA FOR INJ (PRO FEE) 219CC_Anesthesiology INSERT TUNNELED CVC W/O PORT >5 YRS 792 36558CC_Anesthesiology COMPLICATED/EMERG COND (PRO FEE) 165 99140CC_Anesthesiology ULTRASONIC GUIDANCE-NEEDLE PLACEMENT 168 76942CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON NECK 160 320CC_Anesthesiology ANESTHESIA FOR INTEGUMENTARY PROCEDURES:HEAD,NECK,POST TRUNK (PRO FEE) 160 300CC_Anesthesiology ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION (PRO FEE) 160 532CC_Anesthesiology ANESTHESIA FOR SCREENING COLONOSCOPY 160 812CC_Anesthesiology ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES (PRO FEE) 160 811CC_Anesthesiology ANESTHESIA FOR COMBINED UPPER/LOWER GI 160 813

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CC_Anesthesiology ANESTHESIA FOR UPPER GI ENDOSCOPIC PROCEDURES (PRO FEE) 160 731CC_Anesthesiology ANESTHESIA FOR INTRAPERITONEAL, UPPER ABDOMINAL PROCEDURES (PRO FEE) 160 790CC_Anesthesiology ANESTHESIA FOR HERNIA REPAIRS, LOWER ABDOMEN (PRO FEE) 160 830CC_Anesthesiology ANESTHESIA FOR HERNIA REPAIRS; VENTRAL, INCISIONAL (PRO FEE) 160 832CC_Anesthesiology ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN (PRO FEE) 160 840CC_Anesthesiology ANESTHESIA FOR TRANSURETHRAL PROCEDURES 160 910CC_Anesthesiology ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT 160 1214CC_Anesthesiology ANESTHESIA FOR REVISION OF TOTAL HIP ARTHROPLASTY 160 1215CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON MUSCLES OF KNEE 160 1320CC_Anesthesiology ANESTHESIA FOR CLOSED PROCEDURES ON KNEE JOINT 160 1380CC_Anesthesiology ANESTHESIA FOR SURGICAL ARTHROSCOPIC PROCEDURES, KNEE JOINT (PRO FEE) 160 1400CC_Anesthesiology ANESTHESIA FOR TOTAL KNEE ARTHROPLASTY (PRO FEE) 160 1402CC_Anesthesiology ANESTHESIA FOR OPEN PROCEDURES ON LOWER LEG 160 1480CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON SHOULDER; BURSAE (PRO FEE) 160 1610CC_Anesthesiology ANESTHESIA FOR SURGICAL ARTHROSCOPIC PROCEDURES ON SHOULDER (PRO FEE) 160 1630CC_Anesthesiology ANESTHESIA FOR TOTAL SHOULDER ARTHROPLASTY (PRO FEE) 160 1638CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON ARM AND ELBOW 160 1710CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON HAND 160 1810CC_Anesthesiology ANESTHESIA ON WRIST/HAND/DISTAL ULNA OR RADIUS 160 1830CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON MALE GENITALIA 160 930CC_Anesthesiology ANESTHESIA FOR PROCEDURES ON NERVES, ETC OF UPPER LEG 160 1250CC_Anesthesiology ANESTHESIA FOR TENOTOMY, ELBOW TO SHOULDER, OPEN 160 1712CC_Anesthesiology ANESTHESIA FOR CLOSED PROCEDURES ON RADIUS/ULNA 160 1820CC_Anesthesiology ANESTHESIA EXTRAPERITONEAL PROCEDURESS IN LOWER ABDOMEN 160 860CC_Anesthesiology PAIN MANAGEMENT LEVEL 4 - FAC FEE 170 99214CC_Anesthesiology PAIN MANAGEMENT LEVEL 1- FAC FEE 59 99211CC_Anesthesiology PAIN MANAGEMENT LEVEL 3 - FAC FEE 121 99213CC_Anesthesiology ANESTHESIA FOR TRANSURETHRAL PROCEDURES 160 912CC_Anesthesiology ANESTHESIA FOR ALL OPEN PROCS ON UPPER ENDS TIB,FIB,PAT 160 1392CC_Anesthesiology INJ, SGL L/S W/FLUORO (PRO FEE) 287 62323CC_Anesthesiology EPIDURAL BLOOD PATCH 313 62273

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CC_Anesthesiology TRIGGER POINT INJECTION (1-2 MUSCLES) 119 20552CC_Anesthesiology SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC (PRO FEE) 222 62270CC_Anesthesiology TRIGGER POINT INJECTION (3+ MUSCLES) 135 20553CC_Anesthesiology PAIN MANAGEMENT LEVEL 2 - FAC FEE 85CC_Anesthesiology NERVE BLOCK, OTHER PERIPHERAL 130 64450CC_Anesthesiology NERVE BLOCK, OTHER PERIPHERAL, BILATERAL 260 64450,50CC_Anesthesiology INJECTION, CERVICAL OR THORACIC W/IMAGING GUIDANCE (PRO FEE) 298 62321CC_Anesthesiology INJECTION FOR SI JOINT W/IMAGING GUIDANCE (PRO FEE) 225 27096CC_Anesthesiology ANESTHESIA FOR TRANSURETHRAL RESECTION OF PROSTATE 160 914CC_Anesthesiology ANESTHESIA FOR REPAIR OF RUPTURED ACHILLES TENDON 160 1472CC_Anesthesiology INJECTION, PARAVERTEBRAL FACET W/IMAGE GUIDANCE, SINGLE LEVEL 284 64490CC_Anesthesiology INJECTION, PARAVERTEBRAL FACET W/IMAGE GUIDANCE, 2ND LEVEL 162 64491CC_Anesthesiology INJECTION, PARAVERTEBRAL FACET W/IMAGE GUIDANCE, 3RD LEVEL 165 64492CC_Anesthesiology INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK 246 64421

NOTE: ALL ANESTHESIA PRO FEES ARE PRICED AT 15 MINUTES/UNIT

CC_Blood Bank WHOLE BLOOD FOR TRANSFUSION, PER UNIT 212 P9010CC_Blood Bank AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESS 1154 86891

CC_CardioPulmonary ANKLE BRACHIAL INDEX 273 93922CC_CardioPulmonary INTUBATION, ENDOTRACHEAL 358 31500CC_CardioPulmonary ARTERIAL PUNCTURE FOR DX 87 36600CC_CardioPulmonary SPUTUM AERO INDUCED 202 94640CC_CardioPulmonary OCCUPATIONAL SPIROMETRY 87 94010CC_CardioPulmonary B-SPASM EVAL (INC 94010) 597 94060CC_CardioPulmonary PULSE OX SINGLE READING 114 94760CC_CardioPulmonary PULSE OX CONT (PER DAY) 325 94762CC_CardioPulmonary CO2 BY INFRARED ANALYZER 293 94770CC_CardioPulmonary INIT AERO, MDI, IPPB 121 94640CC_CardioPulmonary SUBS AERO, MDI, IPPB 121 94640CC_CardioPulmonary INIT CONTINUOUS MED NEB 114 94644

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CC_CardioPulmonary SUBS CONT MED NEB 91 94645,76CC_CardioPulmonary MDI, AERO, IPPB INSTRUCT 121 94664CC_CardioPulmonary MECHANICAL VENT-1ST DAY 1928 94002CC_CardioPulmonary MECH VENT - SUBS DAY 1448 94003CC_CardioPulmonary NONINVASIVE CPAP/BIPAP 965 94660CC_CardioPulmonary POLY SOMN 4042 95810CC_CardioPulmonary POLYSOMN WITH CPAP 4042 95811CC_CardioPulmonary O2 HOURLY 34CC_CardioPulmonary ARTERIAL BLOOD GAS ANALY 268 82803CC_CardioPulmonary CATHETER ASPIRATION, NAS 121 31720CC_CardioPulmonary PULSE OX MULTIPLE DETERM 90 94761CC_CardioPulmonary ARTERIAL PUNCTURE DX SUB 61 36600,76CC_CardioPulmonary INCENT. SPIROMETER INSTR 0CC_CardioPulmonary PEAK EXPIRATORY FLOW 0CC_CardioPulmonary CHEST WALL VIBRATION THERAPY, INITIAL 84 94667CC_CardioPulmonary CHEST WALL VIBRATION THERAPY, SUBSEQUENT 78 94668CC_CardioPulmonary MISC RESPIRATORY SUPPLIES 0CC_CardioPulmonary PRESSURIZED INHALATION TREAT, INITIAL 132 94640CC_CardioPulmonary PRESSURIZED INHALATION TREAT, SUBSEQUENT 125 94640,76CC_CardioPulmonary SMOKING CESSATION 3-10 MIN 0 99406CC_CardioPulmonary SMOKING CESSATION >10 MIN 0 99407CC_CardioPulmonary PULMONARY STRESS TEST 440 94618CC_CardioPulmonary PFT SPIROMETRY 266 94010

CC_CT CT SINUSES, COR/AX WO/C 1583 70486,TCCC_CT CT THORAX WO/C 1880 71250,TCCC_CT CT THORAX W/C 2228 71260,TCCC_CT CT THORAX WO/W 2443 71270,TCCC_CT CT ANGIO NECK W/CONTRAST 2339 70498,TCCC_CT CT ANGIO HEAD W/CONTRAST 2339 70496,TCCC_CT CT UPPER EXT WO/C RT 1781 73200,TC

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CC_CT CT UPPER EXT WO/C LT 1781 73200,TCCC_CT CT UPPER EXT W/C RT 2089 73201,TCCC_CT CT UPPER EXT W/C LT 2089 73201,TCCC_CT CT UPPER EXT WO/W RT 2444 73202,TCCC_CT CT UPPER EXT WO/W LT 2444 73202,TCCC_CT CT LOWER EXT WO/C LT 1781 73700,TCCC_CT CT LOWER EXT W/C LT 2089 73701,TCCC_CT CT LOWER EXT WO/W LT 2444 73702,TCCC_CT CT ABDOMEN WO/C 1912 74150,TCCC_CT CT ABDOMEN W/C 2215 74160,TCCC_CT CT ABDOMEN WO/W 2444 74170,TCCC_CT CT ANGIO,ABD, W/O HEMATU 2840 74175,TCCC_CT CT-LTD OR LOCALIZED F/U 1190 76380,TCCC_CT CT LWR EXT W RT 2089 73701,TCCC_CT CT LWR EXT W/WO RT 2444 73702,TCCC_CT CT LWR EXT WO/C RT 1835 73700,TCCC_CT CT ANGIO NECK W/WO 2657 70498,TCCC_CT CT ANGIO HEAD W/WO 2657 70496,TCCC_CT CT ABD/PELVIS W/CNTRST 4428 74177,TCCC_CT CT ABD/PELVIS W/WO CNTRST 4886 74178,TCCC_CT CT ABD/PELVIS W/O CNTRST 3821 74176,TCCC_CT CT CHEST W/O LOW DOSE SCREENING 346 71250,52,TCCC_CT CT ANGIO ABD/LOWER EXT RUNOFF 4048 75635,TCCC_CT CT HEAD WO/CONTRAST 1846 70450,TCCC_CT CT HEAD W/C 1899 70460,TCCC_CT CT HEAD WO/W 2444 70470,TCCC_CT ORB/SELLA/FOS/EAR WO/C 1781 70480,TCCC_CT CT ORB/SELLA/FOS/EAR W/C 2089 70481,TCCC_CT ORB/SELLA/FOS/EAR WO/W 2444 70482,TCCC_CT CT MAX/FACIAL WO/C 1835 70486,TCCC_CT CT MAX/FACIAL W/C 2089 70487,TC

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CC_CT CT MAX/FACIAL WO/W 2444 70488,TCCC_CT CT SINUSES WO/C 1583 70486,TCCC_CT CT SOFT TIS.NECK WO/C 1781 70490,TCCC_CT CT SOFT TIS.NECK W/C 2152 70491,TCCC_CT CT SOFT TIS.NECK WO/W 2444 70492,TCCC_CT CHEST ANGIO-P.E./CT 2657 71275,TCCC_CT CT CERVICAL WO/C 1912 72125,TCCC_CT CT CERVICAL W/C 2089 72126,TCCC_CT CT CERVICAL WO/W 2444 72127,TCCC_CT CT THORACIC WO/C 1912 72128,TCCC_CT CT THORACIC W/C 2089 72129,TCCC_CT CT THORACIC WO/W 2444 72130,TCCC_CT CT LUMBAR WO/C 1912 72131,TCCC_CT CT LUMBAR W/C 2089 72132,TCCC_CT CT LUMBAR WO/W 2444 72133,TCCC_CT CT PELVIS WO/C 1912 72192,TCCC_CT CT PELVIS W/C 2215 72193,TCCC_CT CT PELVIS WO/W 2444 72194,TC

CC_EKG EKG RHYTHM STRIP ONLY 140 93041CC_EKG 30 DAY EVENT MONITOR CN 556 93268CC_EKG 48 HR TO 2 WK HOLTER MONITOR CN 876 0295TCC_EKG EKG 12 LEAD 259 93005CC_EKG WLCME TO MCARE 12LEADEKG 246 G0404CC_EKG 24 HOUR HOLTER MONITOR 473 93225CC_EKG LW CARDIAC EVNT MNTR RECORDING 374 93270CC_EKG LW CARDIAC EVNT MNTR TRANS/ANALYSIS 763 93271CC_EKG 24HR HOLTER MNTR TECH 697 93226CC_EKG CARDIAC STRESS TEST 895 93017

CC_Intravenous Therapy IV SETUP SUPPLIES 214

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CC_Intravenous Therapy BLOOD ADM IV SETUP SUPPL 271CC_Intravenous Therapy IV INFUSION THERA INITIAL UP TO 1 HR 280 96365CC_Intravenous Therapy IV INFUSION THERAPY EA ADDL HR 78 96366CC_Intravenous Therapy IV PUSH EA ADDL SAME MED 96376CC_Intravenous Therapy IV PUSH ADDL NEW MED 67 96375CC_Intravenous Therapy IV INFUSION HYDRATION, INITIAL 31 TO 60 220 96360CC_Intravenous Therapy IV INFUSION HYDRATION, EA ADDL HR 65 96361CC_Intravenous Therapy IV INFUSION THERAPY ADDL SEQU NEW MED 78 96367CC_Intravenous Therapy IV INFUSION THERAPY, CONCURRENT INFUSION 78 96368CC_Intravenous Therapy IV PUSH INITIAL MED 145 96374CC_Intravenous Therapy CHEMOTHERAPY ADMINISTRATION, IV INFUSION TECHNIQUE 530 96413CC_Intravenous Therapy CHEMOTHERAPY ADMINISTRATION, EA ADD'L HOUR 116 96415CC_Intravenous Therapy THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION 283 37195

CC_Laboratory PRENATAL SCREEN 374 80055CC_Laboratory HEP BS ANTIBODY 35 86706CC_Laboratory INSULIN-LIKE GRWTH FACTI 281 84305CC_Laboratory HEP A AB, TOTAL 35 86708CC_Laboratory TRYPSIN, FECES 275 84488CC_Laboratory PROTIME 67 85610CC_Laboratory HEP A AB, IGM 35 86709CC_Laboratory ACETYLCHOLINE RECEPTOR 197 83519CC_Laboratory PROTIME (REPEAT) 100 85610,91CC_Laboratory ERYTHROPOIETIN 149 82668CC_Laboratory CYCLOSPORINE 197 80158CC_Laboratory PTT 75 85730CC_Laboratory OVERDOSE DRUG SCREEN-BLOOD 127 80100CC_Laboratory CALCIUM, IONIZED 133 82330CC_Laboratory OCCULT BLOOD (SCREEN) 40 82270CC_Laboratory HCG, QUALITATIVE 125 84703CC_Laboratory PROGESTERONE 162 84144

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CC_Laboratory PTT (REPEAT) 100 85730CC_Laboratory RHEUMATOID FACTORS 87 86431CC_Laboratory CHLORIDE, URINE 75 82436CC_Laboratory OCC BLD SCREEN 1-3(CLINIC 74 82270CC_Laboratory HCG, URINE (CLINIC) 46 81025,QWCC_Laboratory PREGNENOLONE 284 84140CC_Laboratory RAPID STREP (CLINIC) 46 87880,QWCC_Laboratory D-DIMER 211 85379CC_Laboratory FECAL REDUCING SUBSTANCE 132 84377CC_Laboratory HCG, QUANTITATIVE 202 84702CC_Laboratory PROLACTIN 184 84146CC_Laboratory RETIC COUNT (AUTOMATED) 70 85045CC_Laboratory PSA, FREE 127 84154CC_Laboratory OCC BLD DIAG 1-3 52 82272CC_Laboratory BILIRUBIN TOTAL 30 82247CC_Laboratory RPR 74 86592CC_Laboratory TYROSINE 262 84510CC_Laboratory OCCULT BLOOD SCREEN MEDICARE 52 82272CC_Laboratory OCC BLD X1 NONSCRN CLINI 25 82272CC_Laboratory INSULIN 52 83525CC_Laboratory BILIRUBIN DIRECT 30 82248CC_Laboratory PSA, TOTAL 115 84153CC_Laboratory RUBELLA 35 86762CC_Laboratory C-PEPTIDE 180 84681CC_Laboratory BLOOD DRAW 25 36415CC_Laboratory PTH 271 83970CC_Laboratory PHENYLALANINE 227 82131CC_Laboratory SED RATE 69 85651CC_Laboratory GLUCAGON 131 82943CC_Laboratory BLOOD DRAW (CAPILLARY) 22 36416CC_Laboratory QUINIDINE, SERUM 144 80194

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CC_Laboratory VIRAL CULTURE 346 87252CC_Laboratory VANCO (PEAK) 287 80202,91CC_Laboratory BLOOD DRAW, RPT 25 36415,91CC_Laboratory ALLERGENS OTHER RAST 187 86003CC_Laboratory SEMEN, POST VAS 59 89321CC_Laboratory WEST NILE VIRUS IGM 340 86788CC_Laboratory VANCO (TROUGH) 287 80202CC_Laboratory SMOOTH MUSCLE ANTIBODY 106 83516CC_Laboratory BLOOD DRAW, CAPILL, RPT 22 36416,91CC_Laboratory BLOOD GROUP - ABO 121 86900CC_Laboratory ROCKY MT SPOTTED FEVER 190 86757CC_Laboratory HANTA VIRUS PANEL 0CC_Laboratory SENSITIVITY/ID 184 87186CC_Laboratory LIV-KIDNEY MICROSOMAL AB 146 86376CC_Laboratory ROTAVIRUS 116 86759CC_Laboratory HANTA VIRUS IGG 151 86790CC_Laboratory SENSITIVITY ID (REPEAT) 184 87186,91CC_Laboratory RH 40 86901CC_Laboratory PROTEIN C ANTIGEN 46 85302CC_Laboratory SALICYLATES 98 80329CC_Laboratory SODIUM, BLOOD 52 84295CC_Laboratory BUN 64 84520CC_Laboratory HANTA VIRUS IGM 151 86790,91CC_Laboratory GIARDIA ANTIGEN 98 87329CC_Laboratory ANTITHROMBIN III ANTIGEN 392 85301CC_Laboratory TEGRETOL, SERUM 173 80156CC_Laboratory CALCIUM, SERUM 75 82310CC_Laboratory GLYCATED PROTEIN 157 82985CC_Laboratory SODIUM, URINE 57 84300CC_Laboratory TEGRETOL, FREE 217 80157CC_Laboratory CBC W/AUTO DIFF 93 85025

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CC_Laboratory CA-125 251 86304CC_Laboratory ANTIBODY INDENT, RBC 210 86870CC_Laboratory SPECIFIC GRAVITY, BODY F 32 84315CC_Laboratory LAMICTAL (LAMOTRIGINE) 149 82542CC_Laboratory CBC (REPEAT)W/AUTO DIFF 88 85025,91CC_Laboratory PROTOPORPHYRIN, RBC 131 84202CC_Laboratory FACTOR V ACTIVITY 43 85220CC_Laboratory RBC STREP TEST 24CC_Laboratory TESTOSTERONE, TOTAL 39 84403CC_Laboratory HEMOGLOBIN ELECTROPHORES 144 83020CC_Laboratory COXSACKIE VIRUS 444 86658CC_Laboratory TESTOSTERONE, FREE 39 84402CC_Laboratory MICROALBUMIN, URINE 75 82043CC_Laboratory THYROID PEROXIDASE ABY 105 86376CC_Laboratory TOBRAMYCIN,(PEAK) 312 80200CC_Laboratory MICROALBUMIN/CREAT RATIO 75 82044CC_Laboratory ANTIGEN TYPING, RBC 108 86905CC_Laboratory TOBRAMYCIN (TROUGH) 312 80200CC_Laboratory CBC (REPEAT) 88 85027,91CC_Laboratory THYROXINE, TOTAL 45 84436CC_Laboratory THEOPHYLLINE 64 80198CC_Laboratory THERAPEUTIC PHLEBOTOMY 115 99195CC_Laboratory PROTEIN, TOTAL 64 84155CC_Laboratory PACKED CELLS 406 P9016CC_Laboratory TRIGLYCERIDES 75 84478CC_Laboratory URIC ACID, BLOOD 87 84550CC_Laboratory URIC ACID, URINE 75 84560CC_Laboratory URINALYSIS 76 81001CC_Laboratory CALCULI, URINARY 135 82360CC_Laboratory AFTER HRS TOX COLLECTION 152CC_Laboratory FACTOR IX ACTIVITY 57 85250

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CC_Laboratory ACID PHOSPHATASE 125 84060CC_Laboratory METHYLMALONIC ACID,SERUM 262 83921CC_Laboratory HELICOBACTER 115 86318CC_Laboratory FACTOR V LEIDEN MUTATION 115 81241CC_Laboratory TULAREMIA 106 86668CC_Laboratory ALBUMIN, SERUM 64 82040CC_Laboratory Q FEVER 237 86638CC_Laboratory PROTEIN S-FUNCTIONAL 69 85306CC_Laboratory PROTEIN C-FUNCT/ACTIVITY 104 85303CC_Laboratory URINE (NON DOT) DIP CLINIC 32 81003,QWCC_Laboratory PLASMINOGEN 232 85420CC_Laboratory URINE MICROSCOPIC (ONLY) 46 81015CC_Laboratory ALCOHOL (ETHANOL) BLOOD 134 80320CC_Laboratory HIV VIRAL LOAD 345 87536CC_Laboratory CHLAMYDIA, DNA PROBE 138 87491CC_Laboratory BRAIN NAT. PEPTIDE (BNP) 211 83880CC_Laboratory GC, DNA PROBE 138 87591CC_Laboratory ALKALINE PHOSPHATASE 64 84075CC_Laboratory OSMOLALITY, URINE 169 83935CC_Laboratory AMMONIA, SERUM 156 82140CC_Laboratory ANTI MITOCHONDRIAL ANTIB 131 83516CC_Laboratory ESTRIOL 46 82677CC_Laboratory AMYLASE, SERUM 97 82150CC_Laboratory DIMERIC INHIBIN A 139 86336CC_Laboratory AMYLASE (RPT) 102 82150,91CC_Laboratory CRYPTOSPORIDIUM 93 87328CC_Laboratory ANTIBODY SCREEN 122 86850CC_Laboratory URINE CYTOLOGY 144 88108CC_Laboratory PROCALCITONIN 285 84145CC_Laboratory ADRENOCORTICOTROPHIC 210 82024CC_Laboratory G6PD 104 82955

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CC_Laboratory TRILEPTAL LVL OXCARBEPIN 143 82542CC_Laboratory TOPIRAMATE LEVEL-TOPAMAX 232 80201CC_Laboratory ANDROSTENEDIONE 145 82157CC_Laboratory G6PD-SCREEN 97 82955CC_Laboratory N-TELOPEPTIDE XLNK NTX U 116 82523CC_Laboratory G6PD-RBC AUTOMATED 97 85041CC_Laboratory WET MOUNT 74 87210CC_Laboratory PLASMODIUM SPECIES PCR 345 87798CC_Laboratory WET PREP CLINIC 61 87210CC_Laboratory CARDIAC ENZYMES 0CC_Laboratory DHEA-S 111 82627CC_Laboratory CARDIAC ENZYMES(2) 0CC_Laboratory CSF CYTOLOGY 173 88112CC_Laboratory OLIGOCLONAL BANDS 93 83916CC_Laboratory PBG DEAMINASE,ERYTHROCYT 204 82657CC_Laboratory HAPTOGLOBIN 80 83010CC_Laboratory IGM, GAMMAGLOBULINS 121 82784CC_Laboratory HLA DR TYPING 786 86817CC_Laboratory ALK PHOS ISOENZYMES 231 84080CC_Laboratory BREATH ALCOHOL 62 82075CC_Laboratory T3 TOTAL(TRIIODOTHYRONIN 43 84480CC_Laboratory LEPTO SPIRA ANTIBODIES 78 86720CC_Laboratory T3, FREE 66 84481CC_Laboratory AMOEBIC ANTIBODIES 184 86753CC_Laboratory MICROSOMAL ABY 275 86376CC_Laboratory GLUCOSE (BODY FLD) 75 82945CC_Laboratory PROINSULIN 392 84206CC_Laboratory IGG TOTAL 121 82784CC_Laboratory IGA, IMMUNOGLOBULIN TOTAL 102 82784CC_Laboratory IGD 121 82784CC_Laboratory THYROXINE, FREE 69 84439

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CC_Laboratory RH PHENOTYPE 354 86906CC_Laboratory CARDIAC ENZYMES(3) 0CC_Laboratory DHEA 184 82626CC_Laboratory ELUTION 275 86860CC_Laboratory URINE SPECIFIC GRAVITY 15 81003CC_Laboratory CITRATE 332 82507CC_Laboratory CELL CT WDIFFBODY FLUI 80 89051CC_Laboratory ABSORPTION 405 86978CC_Laboratory CHLORIDE, SERUM 87 82435CC_Laboratory BETA 2 GLYCOPROTEIN ABS 224 86146CC_Laboratory COMPLEMENT C4 137 86160CC_Laboratory COMPLEMENT C1 Q 184 86160CC_Laboratory COMPLEMENT C3 137 86160CC_Laboratory CLOTEST(HELIOBACTER) 96 87081CC_Laboratory EBV PANEL 0CC_Laboratory ANTI DIURETIC HORMONE 262 84588CC_Laboratory CD4 T-LYMPH 173 86361CC_Laboratory CHOLESTEROL, SERUM 104 82465CC_Laboratory MUMPS IGM 35 86735CC_Laboratory MUMPS IGG 35 86735CC_Laboratory ENDOMYSIAL ANTIBODIES 35 86255CC_Laboratory GLIADIN ANTIBODIES 69 83516CC_Laboratory ANTI-DNASE ANTIBODY 197 86215CC_Laboratory TISSUE TRANSGLUTAMINASE 35 83516CC_Laboratory TROPONIN (QUANTITATIVE) 177 84484CC_Laboratory CELIAC DISEASE HLADQ PRO 259CC_Laboratory ACETOMINOPHEN 213 80329CC_Laboratory TOX SCREEN, MEDICAL 164 80305CC_Laboratory FFP THAWING 197 86927CC_Laboratory CK, ISOENZYME, SERUM 201 82552CC_Laboratory INFLUENZA RAPID 92 87804

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CC_Laboratory CULTURE, ACID FAST BAC 199 87116CC_Laboratory INFLUENZA RAPID (REPEAT) 80 87804CC_Laboratory ALPHA FETO PROTEIN 46 82105CC_Laboratory RENAL 190 80069CC_Laboratory TROPONIN (QUANT)-REPEAT 167 84484,91CC_Laboratory ARSENIC 238 82175CC_Laboratory MYCOPLASMA 1GG 106 86738CC_Laboratory MYCOPLASMA IGM 78 86738CC_Laboratory ACTINOMYCES ABY 262 86602CC_Laboratory CATACHOLAMINES (URINE) 167 82382CC_Laboratory THALLIUM BLOOD 262 83018CC_Laboratory THYROGLOBULIN 167 84432CC_Laboratory MERCURY BLOOD 248 83825CC_Laboratory MYOGLOBIN 177 83874CC_Laboratory CATACHOLAMINES, FRACTION 262 82384CC_Laboratory MYOGLOBIN (RPT) 167 83874,91CC_Laboratory BMP 185 80048CC_Laboratory MYOGLOBIN (URINE) 110 83874CC_Laboratory BMP (REPEAT) 184 80048,91CC_Laboratory PROTEIN S ANTIGEN 69 85305CC_Laboratory FACTOR INHIBITOR TEST 351 85335CC_Laboratory ALPH1 ANTITRYPSIN PANEL 0CC_Laboratory HEP B CORE AB, TOTAL 35 86704CC_Laboratory HEP B CORE, IGM 35 86705CC_Laboratory HEP BE ANTIBODY 35 86707CC_Laboratory HEP BE ANTIGEN 35 87350CC_Laboratory COMPREHENSIVE CHEM 14 244 80053CC_Laboratory ALPHA-1-ANTITRYPSIN TOTA 116 82103CC_Laboratory HELICOBACTER, STOOL 228 87338CC_Laboratory ALPHA-1-ANTITRYPSIN PHEN 116 82104CC_Laboratory VITAMIN B1 (THIAMINE) 98 84425

15

CC_Laboratory CMP (RPT) 262 80053,91CC_Laboratory FACTOR VIII ANTIGEN 161 85246CC_Laboratory VITAMIN B2 (RIBOFLAVIN) 251 84252CC_Laboratory FACTOR XI ACTIVITY 165 85270CC_Laboratory VITAMIN B6 277 84207CC_Laboratory FACTOR VIII ACTIVITY 117 85240CC_Laboratory VITAMIN E (TOCOPHEROL AL 193 84446CC_Laboratory HEMOGLOBIN 32 85018CC_Laboratory RETICULIN ANTIBODY 118 86255CC_Laboratory KEPPRA (LEVETIRACETAM) 162 82542CC_Laboratory TOX SCREEN, LEGAL 152 80300CC_Laboratory LUPUS ANTICOAGULANT 0CC_Laboratory ANTINUCLEAR ANTIBODIES 136 86038CC_Laboratory LUPUS DRVTT-DILUTED 169 85613CC_Laboratory ANTISTREPTOLYSIN O TITER 67 86060CC_Laboratory LUPUS-PTT-SUBSTITUTION 169 85732CC_Laboratory BARBITURATES 280 80101CC_Laboratory CARDIOLIPIN ANTIBODY 162 86147CC_Laboratory BUN (URINE) 102 84540CC_Laboratory HEMOGLOBIN (REPEAT) 54 85018,91CC_Laboratory BLOOD SMEAR-PATHOLOGIST 174 85060CC_Laboratory ALLERGEN IGE (EACH) 69 86003CC_Laboratory TOX SCRN-RBCS PRE-EMPL 90 80300CC_Laboratory VITAMIN B-12, SERUM 161 82607CC_Laboratory SJOGREN'S A AND B 81 86235CC_Laboratory ALPHA SUB UNIT 215 83520CC_Laboratory CALCIUM, URINE 66 82340CC_Laboratory ALBUMIN, URINE 64 82042CC_Laboratory HEMATOCRIT AUTOMATED 32 85014CC_Laboratory PREALBUMIN 147 84134CC_Laboratory HEMATOCRIT (REPEAT) 54 85014,91

16

CC_Laboratory CARBOXY HEMOGLOBIN 150 82375CC_Laboratory HCV RNA, PCR, QL 144 87521CC_Laboratory CEA 173 82378CC_Laboratory ANTI SM(SMITH)E.N.A. 56 86235CC_Laboratory ANTIPANCREATIC ISLET CEL 184 86341CC_Laboratory BLOOD ADMINISTRATION 872 36430CC_Laboratory DISOPYRAMIDE 173 80299CC_Laboratory CHROMOGRANIN A 231 86316CC_Laboratory AFB STAIN 60 88312CC_Laboratory GABAPENTIN (NEURONTIN) 91 80171CC_Laboratory LUPUS (SLE) PROFILE 167 86225CC_Laboratory HCV RNA, PCR, QN 156 87522CC_Laboratory CHLAMYDIA ABY (IGG) 167 86631CC_Laboratory HCV GENOTYPE 190 87902CC_Laboratory INSULIN ANTIBODIES 184 86337CC_Laboratory ANCA 127 86256CC_Laboratory ALLERGEN IGG (EACH) 133 86001CC_Laboratory SEROTONIN, SERUM 190 84260CC_Laboratory CA 27.29 217 86300CC_Laboratory OSMOLALITY, FECES 268 84999CC_Laboratory CERULOPLASMIN 57 82390CC_Laboratory ASCA (FUNGUS) 238 86671CC_Laboratory COPPER 112 82525CC_Laboratory MURAMIDASE 43 85549CC_Laboratory CHLAMYDIA PNEUMO - IGM 167 86632CC_Laboratory INTERLEUKIN-2 SOLUBLE RECEPTORA 239 83520CC_Laboratory HOMOCYSTINE (SERUM) 328 83090CC_Laboratory LACTOFERRIN, FECAL 121 83630CC_Laboratory PBG, URINE 157 84110CC_Laboratory VITAMIN D 250H, D2, D3 109 82306CC_Laboratory CSF INDIA INK 69 87210

17

CC_Laboratory TISSUE TRANSGLUTAMINASE IGA 16 83516CC_Laboratory CHLAMYDIA PSITTACI IGG 191 86631CC_Laboratory GI PANEL STOOL C. DIFFICILE 104 87493CC_Laboratory VARICELLA AB IGM 46 86787CC_Laboratory GJB2 FULL GENE SEQUENCING 838 81252CC_Laboratory CO2, SERUM 80 82374CC_Laboratory CYTOMEGALOVIRUS,IGM 145 86645CC_Laboratory NMR LIPOPROFILE 95 83704CC_Laboratory BRUCELLA AB, IGG 93 86622CC_Laboratory IODINE, URINE 117 83789CC_Laboratory BORDATELLA PERTUSSIS PCR 314 87798CC_Laboratory CORTISOL, SERUM (TOTAL) 173 82533CC_Laboratory LIPOPROTEIN ASSOC. PHOSPHOLIPASE A2 140 83698CC_Laboratory CRYSTALS, BODY FLUID 79 89060CC_Laboratory BORDATELLA PARAPERTUSSIS 314 87798CC_Laboratory DIAZEPAM (VALIUM) 114 80154CC_Laboratory FLOW CYTOMETRY INTERPRETATION 184 88189CC_Laboratory GI PANEL STOOL VIRUSES 93 87493CC_Laboratory DIGITOXIN, SERUM 106 82397CC_Laboratory GI PANEL STOOL BACTERIA 242 87798CC_Laboratory ESTRADIOL 190 82670CC_Laboratory FUNGITELL, SERUM 218 87449CC_Laboratory ESTROGEN RECEPTOR 633 84233CC_Laboratory ASPERGILLUS AG, SERUM 231 87305CC_Laboratory ETHYLENE GLYCOL, SERUM 157 82693CC_Laboratory AVPR2 GENE MUTATION 781 81403CC_Laboratory BORDATELLA PCR PANEL 0CC_Laboratory BORDATELLA PERTUSIS IGA 204 86615CC_Laboratory VAP CHOLESTEROL PROFILE 112 83701CC_Laboratory BORDATELLA PERTUSSIS IGM 204 86615CC_Laboratory MRSA SCREEN PCR 156 87641

18

CC_Laboratory MAGNESIUM, RBC 35 83735CC_Laboratory BRUCELLA AB, IGM 93 86622CC_Laboratory IMMUNOFIXATION, SERUM 291 86334CC_Laboratory HIV AG/AB 4TH GENERATION REFLEX 138 87389CC_Laboratory FDP 100 85362CC_Laboratory HIV DIFFERENTIATION REFLEX 93 87389CC_Laboratory FERRITIN, SERUM 46 82728CC_Laboratory HIV NAA REFLEX 368 87389CC_Laboratory FIBRINOGEN, SERUM 109 85384CC_Laboratory ANTI CENTROMERE AB 43 86235CC_Laboratory ANTI RNA POLYMERASE III 156 83520CC_Laboratory IMMUNOFIXATION, URINE 108 86335CC_Laboratory CD19/CD20 216 86355CC_Laboratory FSHD DNA DELETION 3643 81404CC_Laboratory COMPLEMENT, CH50 127 86162CC_Laboratory MS PROFILE 175 82040CC_Laboratory HEP BS AB, QUANT 35 86317CC_Laboratory VGKC ANTIBODY 853 83519CC_Laboratory URINE;VOLUME MEASURE 11 81050CC_Laboratory PARANEOPLASTIC AUTOANTIBODY 1608 83520CC_Laboratory XYLOSE ABSORPTION BLOOD 157 84620CC_Laboratory SENSORY/MOTOR NEUROPATHY PANEL 650 82784CC_Laboratory XYLOSE ABSORP URINE 157 84620CC_Laboratory HIV-2 187 86702CC_Laboratory METHANOL 970 84600CC_Laboratory MOLD PROFILE 122 86003CC_Laboratory TOX SCRN-RBCS RANDOM 167 80300CC_Laboratory 5-HIAA 232 83497CC_Laboratory HEMOGLOBIN SOLUBILITY 13 85660CC_Laboratory FOLATE, SERUM 127 82746CC_Laboratory METANEPHRINES 24 HR URINE 41 83835

19

CC_Laboratory GROWTH HORMONE 93 83003CC_Laboratory FLECAINIDE (TAMBOCOR) 40 80299CC_Laboratory GROWTH HORMONE (REPEAT) 106 83003,91CC_Laboratory IGA SUBCLASS 1 0 83883CC_Laboratory FRIBRINOGEN ANTIGEN 52 85385CC_Laboratory IGA SUBCLASS 2 0 83883CC_Laboratory IGG SUBCLASS 1 0 82787CC_Laboratory IGG SUBCLASS 2 0 82787CC_Laboratory IGG SUBCLASS 3 0 82787CC_Laboratory IGG SUBCLASS 4 0 82787CC_Laboratory RESPIRATORY PANEL VIRUS 627 87149CC_Laboratory RESPIRATORY PANEL PERTUSSIS 55 87149CC_Laboratory FUNGUS CULTURE, OTHER 111 87102CC_Laboratory RESPIRATORY PANEL PNEUMONIA 55 87149CC_Laboratory FUNGAL ORGANISM ID 399 87107CC_Laboratory RESPIRATORY PANEL PNEUMONIA 2 55 87149CC_Laboratory FUNGUS CULTURE, SKIN 203 87101CC_Laboratory SYPHILIS IGG 99 86780CC_Laboratory NASH FIBROSURE 461 83010CC_Laboratory EOSINOPHIL COUNT MANUEL 33 85004CC_Laboratory HEMOGLOBIN A2 117 83021CC_Laboratory CH50 11 86162CC_Laboratory ANTI IG RECEPTOR AB 166 86021CC_Laboratory PROSTATE CANCER GENE 3 655 81313CC_Laboratory STOOL CULTURE 68 87045CC_Laboratory PLATELETS, UNIT 1066 P9019CC_Laboratory BETA 2 MICROGLOBULIN 27 82232CC_Laboratory JC VIRUS QUANTITATIVE PCR 286 87799CC_Laboratory HEPATITIS PROFILE, ACUTE 40 80074CC_Laboratory 11 DEOXYCORTISOL 79 82634CC_Laboratory 17 OH PREGNENOLONE 459 84143

20

CC_Laboratory 17 ALPHA HYDROXYPROGESTERONE 97 83498CC_Laboratory MUSK ANTIBODIES 1788 83516CC_Laboratory NICOTINE/METABOLITE 75 80323CC_Laboratory AMYLOID A (AMYLOIDOSIS) 110 83789CC_Laboratory AFB CULTURE BLOOD 33 87206CC_Laboratory CHLAMYDIA PSITTACI IGG AB 140 86631CC_Laboratory HIV-1 186 86701CC_Laboratory CHLAMYDIA PSITTACI IGM AB 42 86632CC_Laboratory TIBC 46 83550CC_Laboratory AFB SPUTUM PCR 269 87556CC_Laboratory LACTIC ACID 127 83605CC_Laboratory ANTIPARIETAL CELL ANTIBODY 28 83516CC_Laboratory CALCITONIN 41 82308CC_Laboratory PAIN MANAGEMENT TOX SCREEN 294 80300CC_Laboratory THYROID STIM IMMUNOGLOBU 420 84445CC_Laboratory ZIKA VIRUS 574 87798CC_Laboratory LDH, ISOENZYMES 140 83625CC_Laboratory LEUKOTRIENE E4 24 HR URINE 468 82542CC_Laboratory VMA, URINE 162 84585CC_Laboratory N-METHYLHISTAMINE 24 HR URINE 365 82542CC_Laboratory VON WILLEBRAND 444 85247CC_Laboratory TOTAL CATECHOLAMINES 24 HR URINE 132 82384CC_Laboratory PROSTAGLANDIN E2 24 HR URINE 468 84150CC_Laboratory FACTOR IX ACTIVITY 55 85250CC_Laboratory AFP TETRA (4) SCREEN 0CC_Laboratory LH, SERUM 148 83002CC_Laboratory VON WILLEBRAND PROFILE 281 85240CC_Laboratory LIDOCAINE 203 80176CC_Laboratory T AND B LYMPHOCYTE PROFILE 190 86355CC_Laboratory DEXAMETHASONE 95 80375CC_Laboratory CD 20 B-CELL EXPRESSION 528 86356

21

CC_Laboratory C DIFF TOXIN A/B 44 87324CC_Laboratory LIPASE 111 83690CC_Laboratory FECAL CALPROTECTIN 268 83993CC_Laboratory PACKED CELLS IRRADIATED 560 P9016CC_Laboratory LITHIUM, SERUM 87 80178CC_Laboratory BETA-2 TRANSFERRIN 202 86335CC_Laboratory ZINC RBC 79 84630CC_Laboratory HEMOSIDERIN URINE 75 83070CC_Laboratory INSULIN LIKE GROWTH FACTOR 1 20 84305CC_Laboratory KARYOTYPE BLOOD 1 88245CC_Laboratory NEUROKININ A 390 83519CC_Laboratory ANTI-KD 68 173 84181CC_Laboratory STREPTOZYME 21 86403CC_Laboratory ROMA 465 81500CC_Laboratory URINE LIPASE 54 83690CC_Laboratory GI PANEL STOOL PARASITES 93 87798CC_Laboratory TRICHROME STAIN 34 87209CC_Laboratory CHRONIC URTICARIA 207 86353CC_Laboratory 5-HIAA RANDOM URINE 38 82570CC_Laboratory VON WILLEBRAND ACTIVITY 238 85245CC_Laboratory ACETONE, ISAPROPANOL, METHONAL PANEL 278 80320CC_Laboratory THIOPURINE METABOLITES 215 80375CC_Laboratory 2,3 DINOR 11B PROSTAGLANDIN F2 24 HR URI 453 84150CC_Laboratory PROSTAGLANDINS D2 24 HR URINE 330 84150CC_Laboratory LACTULOSE HYDROGEN BREATH TEST 199 91065CC_Laboratory CK, SERUM 72 82550CC_Laboratory S PNEUMONIAE AG URINE 173 87899CC_Laboratory OSMOLALITY, BLOOD 169 83930CC_Laboratory PERTUSSIS IGG, IGM 190 86615CC_Laboratory ANTI-MPO 69 83520CC_Laboratory ANTI-PR3 69 83520

22

CC_Laboratory HPV DNA SUBTYP PROBE T HI 156 87621CC_Laboratory OXALATE, URINE 81 83945CC_Laboratory FLOW CYTOMETRY DNA ANA 487 88182CC_Laboratory FLOW CYTOMETRY 1ST MRKR 20 88184CC_Laboratory FLOW CYTMTRY EA ADDL MRKR 533 88185CC_Laboratory CYTOGENETICS SOLID TISSUE 708 88233CC_Laboratory TISSUE CULTURE SLD TUMOR 876 88239CC_Laboratory CHROMOSONE ANALYSIS 785 88264CC_Laboratory INTERPHASE ANLSYS 100 300 422 88275CC_Laboratory TISSUE GROSS ONLY I 107 88300CC_Laboratory TISSUE G&M ID II 161 88302CC_Laboratory TISSUE ROUTINE III 221 88304CC_Laboratory TISSUE INTERM LEVEL IV 50 173 88305CC_Laboratory TISSUE INTERM 1SP IV 173 88305CC_Laboratory TISSUE INTERM LEVEL IV 173 88305CC_Laboratory TISSUE COMPLEX V 534 88307CC_Laboratory TISSUE COMP VI 591 88309CC_Laboratory DECALCIFICATION 52 88311CC_Laboratory HISTOCHEM STN W FRZN I&R 256 88314CC_Laboratory HISTOCHEM ENZYME CONST 238 88319CC_Laboratory HER2 NEU IMMUNOHISTOCHEM 459 88342CC_Laboratory IMMUNOPEROX ST EA AB 345 88342CC_Laboratory MICROMETASTESIS IMMUNOHIS 639 88342CC_Laboratory MOLAR PFLE INTER & RPT 173 88365CC_Laboratory TISSUE GROSS ONLY I ADDL 107 88300,59CC_Laboratory TISSUE G AND M ID II ADDL 161 88302,59CC_Laboratory TISSUE ROUTINE III ADDL 221 88304,59CC_Laboratory TISSUE INTERM LEVEL IV 173 88305,59CC_Laboratory TISSUE MULTIPLE 2 6 173 88305,59CC_Laboratory INNUMOPEROX ST EA AB ADDL 345 88342CC_Laboratory MTHFR MOLECULAR MC B 1 81291

23

CC_Laboratory D-DIMER (RPT) 211 85379,91CC_Laboratory ORGANIC ACID ANALYSIS,UR 306 83919CC_Laboratory SODIUM, BLOOD (RPT) 52 84295,91CC_Laboratory PHENOBARBITAL 162 80184CC_Laboratory CHLORIDE (RPT) 87 82435,91CC_Laboratory CK (REPEAT) 102 82550,91CC_Laboratory LIPID PANEL 117 80061CC_Laboratory CO2 (RPT) 80 82374,91CC_Laboratory PHOSPHORUS, URINE 81 84105CC_Laboratory BUN (RPT) 64 84520,91CC_Laboratory LDL, DIRECT 64 83721CC_Laboratory PROTEIN, TOTAL (RPT) 64 84155,91CC_Laboratory PROCAINAMIDE 149 80190CC_Laboratory ALKALINE PHOSP (RPT) 64 84075,91CC_Laboratory ALT (RPT) 75 84460,91CC_Laboratory AST (RPT) 75 84450,91CC_Laboratory CALCIUM (RPT) 75 82310,91CC_Laboratory CREATININE CLEARANCE 109 82575CC_Laboratory BILIRUBIN TOTAL (RPT) 30 82247,91CC_Laboratory CREATININE, SERUM 65 82565CC_Laboratory BNP (RPT) 211 83880,91CC_Laboratory HCG, URINE 69 81025CC_Laboratory CREATININE, REPEAT 102 82565,91CC_Laboratory CREATININE, URINE 70 82570CC_Laboratory X-MATCH,AHG 156 86922CC_Laboratory CML TRANSLOCATION ANALYS 144 81206CC_Laboratory BCR-ABL MINOR BRKPNT 144 81207CC_Laboratory PROTEIN/CREATININE, RATIO 59 84156CC_Laboratory HLA ONE ANTIGEN EQUIVALEN 130 81377CC_Laboratory HLA ONE ALLELE/ONE GROUP 130 81383CC_Laboratory TSH SEND OUT 45 84443

24

CC_Laboratory VON WILLEBRAND ANTIGEN 309 85246CC_Laboratory AFP TUMOR MARKER 114 82105CC_Laboratory COLD TITER AGGLUTININS 104 86157CC_Laboratory MTHFR DNA ANALYSIS 202 81291CC_Laboratory CREATININE, URINE S/O 46 82570CC_Laboratory TRIAGE D-DIMER 211 85379CC_Laboratory TRIAGE TROPONIN 177 84484CC_Laboratory TRIAGE BNP 211 83880CC_Laboratory 17-OH PROGESTERONE 104 83498CC_Laboratory TPMT (THIOPURINE METHYL) 350 82542CC_Laboratory IGE 150 82785CC_Laboratory FFP, SGL DONOR PRODUCT 115 P9017CC_Laboratory TRIAGE CARDIAC ENZ 0CC_Laboratory TRIAGE CKMB 167 82553CC_Laboratory TRIAGE MYOGLOBIN 167 83874CC_Laboratory TRIAGE CE (RPT) 0CC_Laboratory TRIAGE CKMB (RPT) 167 82553,91CC_Laboratory TRIAGE MYOGLOBIN (RPT) 167 83874,91CC_Laboratory TRIAGE TROPONIN (RPT) 167 84484,91CC_Laboratory GLUTEN SENSITIVITY SCREEN 345 83516CC_Laboratory HARMONY XY PRENATAL 1033 81599CC_Laboratory GBE1 1703 81406CC_Laboratory LSD 115 80101CC_Laboratory LIPASE (RPT) 111 83690,91CC_Laboratory TB, GAMMA INTERFERON AG 144 86480CC_Laboratory ACQUIRED THROMBOTIC RISK 1456 86849CC_Laboratory HEXAGONAL PHOSPHOLIPID 76 85598CC_Laboratory FACTOR VII ACTIVITY 117 85230CC_Laboratory APCR ACTIVATED PROT C RES 106 85307CC_Laboratory HYPERCOAGULABILITY PROFI 0CC_Laboratory SOLUB. LIVER AG(SLA)IGGAB 144 83516

25

CC_Laboratory DIHYDROTESTOSTERONE (DHT) 82 80327CC_Laboratory TRIMETHYLAMINURIA (TMAU) 368 83789CC_Laboratory ENTEROVIRUS PCR VVH 448 86658CC_Laboratory CSF CELL CT W/DIFF 232 89051CC_Laboratory XMATCH, AHG (REPEAT) 88 86922,91CC_Laboratory XMATCH, IS 156 86920CC_Laboratory GROUP B STREP PCR 156 87653CC_Laboratory CULTURE, BODY FLUID 125 87070CC_Laboratory CULTURE, CSF 125 87070CC_Laboratory CULTURE, SPUTUM 125 87070CC_Laboratory CULTURE, THROAT 125 87070CC_Laboratory SODIUM, FECAL 87 84999CC_Laboratory POTASSIUM, FECAL 87 84999CC_Laboratory CULTURE, GENITAL 125 87070CC_Laboratory FREE AND WEAKLY BOND 69 84402CC_Laboratory IMIPRAMINE 194 80174CC_Laboratory HLA A,B,C 178 81372CC_Laboratory BK VIRUS DNA PCR BLOOD 280 87799CC_Laboratory TOX SCREEN-RBC EMS/FIRE 106 80305CC_Laboratory GASTRIN 138 82941CC_Laboratory CANDIDA AB (IGA, IGG, IGM) 149 86628CC_Laboratory SALIVARY CORTISOL 104 82533CC_Laboratory CHYMOTRYPSIN (STOOL) 101 84490CC_Laboratory VAS INTEST PEPTIDE 530 84586CC_Laboratory T3 UPTAKE 43 84479CC_Laboratory XMATCH, IS (REPEAT) 88 86920,91CC_Laboratory OMEGA 3, 6 FATTY ACIDS 90 82542CC_Laboratory CRP C REACTIVE PROTEIN 74 86140CC_Laboratory LEAD 126 83655CC_Laboratory RAPID STREP IN HOUSE 52 87880CC_Laboratory NEONATAL BILIRUBIN 73 82247

26

CC_Laboratory CRP - CARDIAC 108 86141CC_Laboratory ANTI-THYROGLOBULIN 178 86800CC_Laboratory ACE LEVEL 93 82164CC_Laboratory HCV (HEP C AB) 35 86803CC_Laboratory PROTEIN, BDY FLD 74 84157CC_Laboratory LYME DISEASE IGM/IGG 102 86618CC_Laboratory CULTURE, WOUND 139 87070CC_Laboratory CULTURE, WOUND RPT 130 87070,91CC_Laboratory CULTURE, WOUND ANAEROBIC 197 87075CC_Laboratory GIARDIA ANTIBODY 162 86674CC_Laboratory CULTURE, WOUND ANAEROBIC RPT 197 87075,91CC_Laboratory CULTURE, BLOOD 125 87040CC_Laboratory PROTEIN ELECTROPHORESIS 137 84165CC_Laboratory CSF VDRL 92 86592CC_Laboratory NORTRIPTYLINE 129 80182CC_Laboratory PROTEIN 24 HOUR URINE 52 84156CC_Laboratory RENIN, PLASMA 167 84244CC_Laboratory ALDOSTERONE, SERUM 252 82088CC_Laboratory ALDOSTERONE, URINE 232 82088CC_Laboratory TRANSFERRIN 139 84466CC_Laboratory DESIPRAMINE 140 80160CC_Laboratory AMITRIPTYLINE 233 80152CC_Laboratory CYTOMEGALOVIRUS 145 86644CC_Laboratory TOXOPLASMOSIS IGM 267 86778CC_Laboratory TOXOPLASMOSIS IGG 215 86777CC_Laboratory EBV EARLY VIRUS 60 86663CC_Laboratory VALPROIC ACID 149 80164CC_Laboratory ETHOSUXIMIDE(ZARONTIN)LV 169 80168CC_Laboratory CAROTENE, SERUM 138 82380CC_Laboratory CARNITINE, FRACTIONATED 268 82379CC_Laboratory FECAL FAT, QUANT 342 82710

27

CC_Laboratory ELECTROLYTE PANEL 52 80051CC_Laboratory ELECTROLYTES (REPEAT) 145 80051,91CC_Laboratory GLUCOSE (POST DOSE) 115 82950CC_Laboratory PRIMIDONE 126 80188CC_Laboratory RUBEOLA 35 86765CC_Laboratory VARICELLA AB IGG 46 86787CC_Laboratory FOLATE, RBC 208 82747CC_Laboratory MAGNESIUM, URINE 80 83735CC_Laboratory CYSTINE/HOMOCYSTINE,URIN 108 82615CC_Laboratory HEMOSIDERIN, QUANT 52 83071CC_Laboratory CA 19-9 266 86301CC_Laboratory VITAMIN D,1,25 69 82652CC_Laboratory VITAMIN D,25 69 82306CC_Laboratory ZINC LEVEL 140 84630CC_Laboratory IMMUNOGLOBULINS-SUBCLASS 135 82787CC_Laboratory LEGIONELLA 126 86713CC_Laboratory CRYOGLOBULIN 139 82595CC_Laboratory BLASTOMYCES 145 86612CC_Laboratory COCCIDIODES 145 86635CC_Laboratory PROTEIN ELECTRO, URINE 167 84166CC_Laboratory XMATCH, 37 156 86921CC_Laboratory CULTURE, BLOOD (RPT) 125 87040,91CC_Laboratory ENTERIC ID, OTHER 98 87077CC_Laboratory XMATCH,37 (REPEAT) 88 86921,91CC_Laboratory ENTERIC ID, OTHER(REPEAT) 98 87077,91CC_Laboratory ENTERIC ID, URINE 96 87077CC_Laboratory ENTERIC ID,URINE(REPEAT) 96 87077,91CC_Laboratory CULTURE, SCREENING 82 87081CC_Laboratory CULTURE, STOOL 116 87045CC_Laboratory CULTURE, STOOL (CAMPY) 52 87046CC_Laboratory URINE CORTISOL (TOTAL) 260 82533

28

CC_Laboratory AMINO ACID PROF(QUANT)URINE 196 82139CC_Laboratory HSV TYPE 2 IGG AB 236 86696CC_Laboratory HSV WITH TYPING 208 87255CC_Laboratory ESTROGEN,TOTAL 158 82672CC_Laboratory NUCLEOTIDASE 5 80 83915CC_Laboratory CA 15-3 217 86300CC_Laboratory PROTEIN, URINE 57 84156CC_Laboratory ALA/AMINOLEVULINIC ACID 102 82135CC_Laboratory ELASTASE PANCREATIC FECAL 345 82656CC_Laboratory WHITE CELL COUNT (WBC) 88 85048CC_Laboratory WBC (REPEAT) 88 85048CC_Laboratory RSV ANTIBODY SERUM 106 86756CC_Laboratory RSV 87 87420CC_Laboratory HISTOPLASMA AB 145 86698CC_Laboratory CHROMOSOME ANALYSIS 0CC_Laboratory HISTAMINE-24HR URINE 475 83088CC_Laboratory EBV-NUCLEAR 77 86664CC_Laboratory EBV - VIRAL CAPSID 77 86665CC_Laboratory HEP BS ANTIGEN 35 87340CC_Laboratory CARDIO ADVANCED LIPID PANEL 308 83695CC_Laboratory CULTURE, URINE 139 87086CC_Laboratory PARVO B-19 AB 93 86747CC_Laboratory DIFFERENTIAL 72 85007CC_Laboratory JO-7AB 46 86235CC_Laboratory MYOSITIS PANEL 166 86235CC_Laboratory TPMT GENETIC TEST 318 81401CC_Laboratory DIFFERENTIAL (REPEAT) 57 85007,91CC_Laboratory DIGOXIN, SERUM 115 80162CC_Laboratory LIPOPROTEIN A 28 83695CC_Laboratory LAW ENFORCEMENT BLOOD TOX 35CC_Laboratory DIGOXIN (REPEAT) 187 80162,91

29

CC_Laboratory DILANTIN, SERUM 144 80185CC_Laboratory DILANTIN (REPEAT) 202 80185,91CC_Laboratory DILANTIN, FREE 232 80186CC_Laboratory CKMB 187 82553CC_Laboratory CKMB (REPEAT) 167 82553,91CC_Laboratory METHEMOGLOBIN 106 83050CC_Laboratory PKU 1 (FIRST) 106 84030CC_Laboratory GENTAMICIN 162 80170CC_Laboratory GGT, SERUM 75 82977CC_Laboratory GGT (REPEAT) 75 82977,91CC_Laboratory GLUCOSE, SERUM 52 82947CC_Laboratory GLUCOSE (REAGENT STRIP) 34 82948CC_Laboratory GLU REAGENT STRIP CLINIC 34 82948CC_Laboratory GLU TOL 3 SPECIMENS 224 82951CC_Laboratory GLU TOL EACH ADD SPEC 75 82952CC_Laboratory GLUCOSE(REPEAT) 102 82947,91CC_Laboratory AST TRANSFERASE (GOT) 75 84450CC_Laboratory ALT ALANINE AMINO (GPT) 75 84460CC_Laboratory GRAM STAIN 52 87205CC_Laboratory HDL, SERUM 144 83718CC_Laboratory HEMATOCRIT,SPUN CLINIC 46 85013CC_Laboratory LIVER FUNCTION 194 80076CC_Laboratory KOH 69 87220CC_Laboratory LDH, SERUM 75 83615CC_Laboratory LDH (REPEAT) 102 83615,91CC_Laboratory LDH, BODY FLUID 64 83615CC_Laboratory LAP 81 85540CC_Laboratory MAGNESIUM, SERUM 80 83735CC_Laboratory MAGNESIUM (REPEAT) 102 83735,91CC_Laboratory MONOTEST 78 86308CC_Laboratory MUCIN CLOT 67 83872

30

CC_Laboratory NASAL SMEAR, EOS 39 89190CC_Laboratory DAT COOMBS 75 86880CC_Laboratory DAT (REPEAT) 75 86880,91CC_Laboratory GASTROCCULT 80 82271CC_Laboratory PH, BLOOD 88 82800CC_Laboratory PH, BODY FLUID 43 83986CC_Laboratory PHOSPHORUS, BLOOD 75 84100CC_Laboratory PKU, SECOND 106 84030CC_Laboratory PLATELET COUNT/AUTOMATED 75 85049CC_Laboratory PLT. ABY. PROFILE 115 86022CC_Laboratory POTASSIUM, BLOOD 52 84132CC_Laboratory POTASSIUM (REPEAT) 102 84132,91CC_Laboratory POTASSIUM, URINE 81 84133CC_Laboratory ADALIMUMAB HUMIRA 674 80299CC_Laboratory BENZENE/PHENOL-URINE 156 84600CC_Laboratory NEUTROPHIL ASSOCIATED ANTIBODIES 175 86256CC_Laboratory ANTI-CCP (ANTI-CYCLIC CIT 137 86200CC_Laboratory 24 HR PROTEIN IMMUNOFIXATION 82 84156CC_Laboratory ANTI-GLOM BASE MEMBRANE 205 83516CC_Laboratory SPECIMEN HANDLING 46 99001CC_Laboratory STOOL WBC 46 89055CC_Laboratory ARSENIC, URINE 80 82175CC_Laboratory 24 HR URINE COLLECTION 11 82570CC_Laboratory LEAD, URINE 27 83655CC_Laboratory MERCURY, URINE 69 83825CC_Laboratory 24 HR URINE HEAVY METALS 362CC_Laboratory THYROID PROFILE/PANEL 0CC_Laboratory TACROLIMUS 173 80197CC_Laboratory ARTERIAL BLOOD GAS 231 82803CC_Laboratory EOSINOPHIL, URINE 70 87205CC_Laboratory IRON PANEL 138

31

CC_Laboratory URINE (DOT) DIP CLINIC 0 81003,QWCC_Laboratory CELIAC DISEASE PROFILE 0CC_Laboratory URINE GLUCOSE 11 81003,QWCC_Laboratory URINE KETONE 11 81003,QWCC_Laboratory GLUTAMIC ACID DECARBOXYLA 259 83519CC_Laboratory FTA-ABS (SYPHILLIS) 87 86780CC_Laboratory H1N1 INFLUENZA CONFIRM 434 87502CC_Laboratory CYSTIC FIBROSIS DNA PROF 173 81220CC_Laboratory VITAMIN A RETINOL 139 84590CC_Laboratory 24 HR URINE MERCURY 219 83825CC_Laboratory THYROTROPIN RCPT ANTIBODY 178 83520CC_Laboratory ALLERGENS ZONE 12 459 86003CC_Laboratory ASPERGILLUS ANTIBODIES 173 86606CC_Laboratory ROHYPNOL SCREEN URINE 191 80101CC_Laboratory HSV 1 AND 2 IGM 134 86695CC_Laboratory HSV 1 AND 2 IGG 250 86695CC_Laboratory GHB (URINE GAMMA HYDROXY) 250 82491CC_Laboratory SCHISTOSOMA AB IGG 148 86682CC_Laboratory TTH LIPID-SP 69 80061CC_Laboratory TTH CMP-SP 69 80053CC_Laboratory TTH CBC W/AUTO DIFF-SP 69 85025CC_Laboratory TTH TSH-SP 69 84443CC_Laboratory TTH AIC-SP 69 83036CC_Laboratory ALLERGENS ZONE 9 459 86003CC_Laboratory ALDOLASE (SERUM) 85 82085CC_Laboratory HELICOBACTER PYLORI G,A,M 231 86677CC_Laboratory ANTITHROMBIN III ACTIVITY 235 85300CC_Laboratory 24 HR URINE GROWTH HORMON 157 83003CC_Laboratory IGF BP-3 121 83520CC_Laboratory IMMUNOCAP ALLERGY TESTING 746 86003CC_Laboratory FECAL FAT, QUALITATIVE 114 82705

32

CC_Laboratory IGF BINDING PROTEIN I 272 83519CC_Laboratory SEX HORMONE BINDING GLOBU 131 84270CC_Laboratory T3 REVERSE 259 84482CC_Laboratory ESTRONE 225 82679CC_Laboratory COENZYME Q10 173 82491CC_Laboratory BILE ACIDS 96 82239CC_Laboratory ANTI-DS DNA (DBL STRD) 143 86225CC_Laboratory BCR-ABL (CML) 287CC_Laboratory HISTAMINE, PLASMA 231 83088CC_Laboratory DESMOGLEIN 1 AND 3 259 83516CC_Laboratory P0 (PROTEIN ZERO) 206 84182CC_Laboratory ANATITER 115 86038CC_Laboratory CORTISOL, FREE 24 HR URIN 62 82530CC_Laboratory CREATINE, 24 HR URINE 173 82540CC_Laboratory LABCORP PATERNITY COLLECT 25 99001CC_Laboratory ANTI-SCL 70 143 86235CC_Laboratory VARICELLA ZOSTER PCR 712 87798CC_Laboratory HERPES VIRUS PCR 287 87529CC_Laboratory HCG QUANTITATIVE (S/O) 46 84702CC_Laboratory FACTOR X ACTIVITY 140 85260CC_Laboratory METANEPHRINES BLOOD 98 83835CC_Laboratory TOX PANEL-BLOOD 374 80101CC_Laboratory EXPOSURE WORKUP EMPLOYEE 0CC_Laboratory EXPOSURE WORKUP PATIENT 0CC_Laboratory SICKLE CELL HGB SOLUBILIT 115 85660CC_Laboratory APOLIPOPROTEIN E GENE 488 81401CC_Laboratory LAW ENFORCEMENT BA 35CC_Laboratory TRYPTASE 115 83520CC_Laboratory LEPTIN 137 83520CC_Laboratory ANAPLASMA PCR 260 87798CC_Laboratory BABESIA PCR 483 87798

33

CC_Laboratory KAPPALAMBDA FR LGT CHAINS 287 83883CC_Laboratory PORPHYRINS, RANDOM URINE 133 84120CC_Laboratory PMC HEP B SURFACE ANTIBOD 35 86706CC_Laboratory PMC MUMPS 35 86735CC_Laboratory PMC RUBELLA 35 86762CC_Laboratory PMC TOX MEDICAL 164 80305CC_Laboratory NORO VIRUS STOOL 414 87798CC_Laboratory DEOXYPYRIDINOLINE, URINE 122 82523CC_Laboratory HEPARIN ANTI-XA 345 85520CC_Laboratory PMC RUBEOLA 35 86765CC_Laboratory UDS COLLECTION DIRECT OBS 103CC_Laboratory ANTIBODY TITER 147 86886CC_Laboratory HEMOGLOBIN PLASMA FREE 93 83051CC_Laboratory ADENOVIRUS, STOOL 115 87301CC_Laboratory PTH-RP (RELATED PEPTIDE) 207 82397CC_Laboratory DENGUE FEVER 231 86790CC_Laboratory KETONE, SERUM 59 82009CC_Laboratory FREE CORTISO, SERUM 133 82530CC_Laboratory VERAPAMIL (QUANT. DRUG) 270 82492CC_Laboratory ICTOTEST 0 82009CC_Laboratory CLINITEST 0 84376CC_Laboratory URINE COLLECTION 41 81099CC_Laboratory ACETEST 0 81003CC_Laboratory DRUG TEST, DEFINITIVE, TO ID INDIVIDUAL DRUGS 134 G0480CC_Laboratory KIDNEY STONE RISK 173 82340CC_Laboratory CBC 92 85027CC_Laboratory FINGERSTICK INR CLINIC 14 85610CC_Laboratory WING INR 14 85610CC_Laboratory HEMOGLOBIN A1C 74 83036CC_Laboratory PSA (SCREENING) 109 G0103CC_Laboratory THYROID STIMULATING HORM 158 84443

34

CC_Laboratory URINE DIPSTICK 50 81003,QWCC_Laboratory 5-HIAA PLASMA 509 82542CC_Laboratory INFLIXIMAB LEVEL/ANITBODY (REMICADE) 525 80299CC_Laboratory HISTOPLASMA AG QUANTITATIVE URINE 163 87385CC_Laboratory LEGIONELLA IGM 222 86713CC_Laboratory LEGIONELLA IGG 212 86713CC_Laboratory ECHOVIRUS 196 86658CC_Laboratory COXSACKIE VIRUS B AB 88 86658CC_Laboratory COXSACKIE AIGG/IGM AB 274 86658CC_Laboratory PROPEPTIDE I/COLLAGEN 134 82523CC_Laboratory C-TELOPEPTIDE (CTX) SERUM 146 82523CC_Laboratory 24 HR URINE NON 10 84300CC_Laboratory FACTOR II - DNA PROFILE 100 81240CC_Laboratory FSH, SERUM 144 83001CC_Laboratory 24 HR URINE CREATININE 10 82570CC_Laboratory HLA B27 69 81374CC_Laboratory IRON SERUM 46 83540CC_Laboratory FRACTIONATED SODIUM 80 82565CC_Laboratory ZONISAMIDE 25 80203CC_Laboratory GDF-15 309 83520CC_Laboratory NMO ANTIBODIES IGG 464 83520CC_Laboratory H. PYLORI BREATH TEST 151 83013CC_Laboratory KLEIHAUER BETKE STAIN 561 85460CC_Laboratory JAK2 MUTATION ANA, QUAL 281 81270CC_Laboratory HEMOCHROMATOSIS DNA 247 81256CC_Laboratory PMC TB QUANTIFERON 151 86480CC_Laboratory GENERAL HEALTH PANEL (CBC, CMP, TSH) 524 80050CC_Laboratory BLOOD DRAW, CAPILLARY (CLINIC) 8 36416

CC_Mammography DIGITAL SCREENING BILAT 286 77067,TCCC_Mammography DIGITAL DIAG BILAT 300 77066,TC

35

CC_Mammography DIGITAL DIAG UNI RT 242 77065,TCCC_Mammography DIGITAL DIAG UNI LT 242 77065,TCCC_Mammography 3D MAMMOGRAPHY SCREENING BREAST TOMO 75 77063,TCCC_Mammography 3D MAMMOGRAPHY; DX BREAST TOMO; RT 75 77061,TCCC_Mammography 3D MAMMOGRAPHY DX BREAST TOMO; BILATERAL 75 77062,TCCC_Mammography 3D MAMMOGRAPHY DX BREAST TOMO; LT 75 77061,TC

CC_MFHC Pro Fees DBRDMT FX/DISLC SUBQ T/M/F BONE 2024 11012CC_MFHC Pro Fees ADJ TISSUE XFR 10.1-30 SQ CM 2589 14021CC_MFHC Pro Fees ADJT TISSUE TRANS F/C/M/N 10 SQCM/< 2265 14040CC_MFHC Pro Fees ADJACENT TISSUE XFR, FACE, LESS 10SQCM 2024 14060CC_MFHC Pro Fees ADJ TISSUE XFR 30.1-60 SQ CM 2534 14301CC_MFHC Pro Fees SURG PREP OPEN WOUND, 1ST 100 SQ CM 815 15004CC_MFHC Pro Fees SURG PREP OPEN WOUND, ADDL 100 SQ CM 277 15005CC_MFHC Pro Fees APP OF SKIN SUB GRAFT, HEAD, UP TO 100 286 15275CC_MFHC Pro Fees IMPLANTATON OF BIOLOGIC IMPLANT 649 15777CC_MFHC Pro Fees BREAST BIOPSY W/CORE 446 19100CC_MFHC Pro Fees BREAST BIOPSY NEEDLE/OPEN INCISION 1002 19101CC_MFHC Pro Fees BREAST BIOPSY, EXC OF CYST 1479 19120CC_MFHC Pro Fees MASTECTOMY, PARTIAL 1875 19301CC_MFHC Pro Fees MASTECTOMY, SIMPLE COMPLETE 3045 19303CC_MFHC Pro Fees MASTECTOMY, RADICAL 3398 19305CC_MFHC Pro Fees MASTECTOMY, MOD RAD 2418 19307CC_MFHC Pro Fees EXPLORATION, WOUND, EXTREMITY 1050 20103CC_MFHC Pro Fees EXCISION SOFT TISS TUMOR NECK, GRTR 3CM 1346 21552CC_MFHC Pro Fees EXCISION TUMOR, BACK 5 CM OR GREATER 2226 21933CC_MFHC Pro Fees EXC TUMOR ABD WALL < 5 CM 1382 22900CC_MFHC Pro Fees EXCISION TUMOR SOFT TISSU 1120 24075CC_MFHC Pro Fees EXC TUMOR SOFT TISS UPR ARM/ELBOW 1506 24076CC_MFHC Pro Fees EXCISION TUMOR FORARM/WRIST >3CM 1222 25071CC_MFHC Pro Fees TENOTOMY OF ADDUCTOR, OPEN 1499 27001

36

CC_MFHC Pro Fees TENOTOMY ABDUCTOR/EXTENSOR 2031 27006CC_MFHC Pro Fees EXCISION TUMOR PELVIS/HIP >3CM 1350 27043CC_MFHC Pro Fees CLSD TX POST HIP ARTHRO DISLOCATION W/GEN ANESTH 1313 27266CC_MFHC Pro Fees INSERT PIC ACCESS W/SUBCUT PORT 5 YR/> 3874 36571CC_MFHC Pro Fees EXCISION OF PAROTID TUMOR 1869 42410CC_MFHC Pro Fees INCISION/DRAINAGE ABSCESS,PERITONSILLAR 599 42700CC_MFHC Pro Fees REMOVAL OF FOREIGN BODY FROM PHARYNX 433CC_MFHC Pro Fees TONSILLECTOMY <12 683 42825CC_MFHC Pro Fees TONSILLECTOMY >12 YO 743 42826CC_MFHC Pro Fees CONTROL OROPHARYNGEAL HEMORRHAGE 515 42960CC_MFHC Pro Fees ESOPHAGOSCOPY, FB REMOVAL 564 43215CC_MFHC Pro Fees EGD BALLON DILATION 30 MM OR GRTR 643 43233CC_MFHC Pro Fees EGD 431 43235CC_MFHC Pro Fees EGD W/ENDOSCOPIC ULTRASOUND EXAM 649 43237CC_MFHC Pro Fees EGD/BX SING OR MULTI 449 43239CC_MFHC Pro Fees EGD W/DILATION OF GASTRIC STRICTURE 555 43245CC_MFHC Pro Fees EGD WITH PEG PLACEMENT 668 43246CC_MFHC Pro Fees EGD WITH REMOVAL OF FOREIGN BODY 598 43247CC_MFHC Pro Fees EGD W/DILATION 535 43248CC_MFHC Pro Fees EGD BALLOON DILATION ESOPHAGUS <30MM 435 43249CC_MFHC Pro Fees CHANGE GASTROSTOMYTUBE 133 43760CC_MFHC Pro Fees ENTEROTOMY, SM INTESTINE, DECOMPRESSION 2415 44021CC_MFHC Pro Fees ENTERECTOMY, SGL RESCTN 2742 44120CC_MFHC Pro Fees ENTERECTOMY, ADDL RSCTN 544 44121CC_MFHC Pro Fees COLECTOMY PARTIAL W/ANASTOMOSIS 4066 44140CC_MFHC Pro Fees COLECTOMY, PARTIAL 3062 44160CC_MFHC Pro Fees LAP COLECTOMY, PTL, W/ANASTOMOSIS 4434 44204CC_MFHC Pro Fees REPAIR PERF LG INTESTINE W/O COLOSTOMY 3053 44604CC_MFHC Pro Fees EXCISION LESION MESENTERY 1886 44820CC_MFHC Pro Fees APPENDECTOMY 1960 44950CC_MFHC Pro Fees APPENDECTOMY, INCIDENTAL 259 44955

37

CC_MFHC Pro Fees LAP SURG APPENDECTOMY 2000 44970CC_MFHC Pro Fees BIOPSY ANORECTAL WALL 742 45100CC_MFHC Pro Fees FLEXIBLE SIGMOIDSCOPE 329 45330CC_MFHC Pro Fees SIGMOIDOSCOPY, FLEX W/BIOPSY 402 45331CC_MFHC Pro Fees COLONOSCOPY 1167 45378CC_MFHC Pro Fees COLONOSCOPY W/BX 1391 45380CC_MFHC Pro Fees COLONOSCOPY SNARE TECH 1570 45385CC_MFHC Pro Fees RECTAL EXAM UNDER ANESTHESIA 327 45990CC_MFHC Pro Fees HEMORRHOIDECTOMY 1361 46250CC_MFHC Pro Fees HEMORRHOIDECTOMY, INTERNAL 1398 46255CC_MFHC Pro Fees EXCISION, THROMBOSED HEMORRHOID, EXT 346 46320CC_MFHC Pro Fees ANOSCOPY W/ BIOPSY 670 46606CC_MFHC Pro Fees ANOSCOPY DX W/HRA CHEM 565 46607CC_MFHC Pro Fees EXCISION BIOPSY, ANUS 320 46999CC_MFHC Pro Fees BIOPSY LIVER-NEEDLE PERC 1133 47000CC_MFHC Pro Fees BIOPSY OF LIVER, NEEDLE 151 47001CC_MFHC Pro Fees BIOPSY OF LIVER, WEDGE 2556 47100CC_MFHC Pro Fees CHOLECYSTECTOMY, LAP 2282 47562CC_MFHC Pro Fees CHOLYCYSTECTOMY W/CHOLANGIOGRAPHY 2161 47563CC_MFHC Pro Fees LAP CHOLEYCYSTECTOMY WITH IOC 3371 47564CC_MFHC Pro Fees CHOLYCYSTECTOMY 2625 47600CC_MFHC Pro Fees PARACENTESIS, ABDOMINAL W/O IMAGING 572 49082CC_MFHC Pro Fees PARACENTESIS W/IMAGING 327 49083CC_MFHC Pro Fees LAPAROSCOPY, ABDOMEN, W/BX 1042 49321CC_MFHC Pro Fees REPAIR HERNIA, INGUINAL 1135 49505CC_MFHC Pro Fees REPAIR RECURRENT ING HERNIA, REDUCIBLE 1936 49520CC_MFHC Pro Fees REPAIR, FEMORAL HERNIA 1729 49550CC_MFHC Pro Fees REPAIR VENTRAL HERNIA 1527 49560CC_MFHC Pro Fees HERNIA 1ST INC/VENT, INCARCERATD/STRNGLD 2815 49561CC_MFHC Pro Fees REPAIR RECURRENT INC OR VENTRAL HERNIA 1888 49565CC_MFHC Pro Fees IMPLANTATION MESH/VENTRAL HERNIA REPAIR 659 49568

38

CC_MFHC Pro Fees RPR UMBILICAL HERNIA<5 REDUCIBLE 1004 49580CC_MFHC Pro Fees REPAIR UMB HERNIA >5 997 49585CC_MFHC Pro Fees REPAIR, HERNIA, ING, LAP 1297 49650CC_MFHC Pro Fees REPAIR UMB HERNIA LAP 1559 49652CC_MFHC Pro Fees ABDOMINAL PROCEDURE 134 49999CC_MFHC Pro Fees CYSTOURETHROSCOPY 509 52000CC_MFHC Pro Fees CYSTOURETHROSCOPY W/TRANSURETHRAL RESECT 955 52402CC_MFHC Pro Fees ORCHIECTOMY 981 54520CC_MFHC Pro Fees INC/DRAINAGE EPIDIDYMIS 636 54700CC_MFHC Pro Fees EPIDIDYMECTOMY, UNI 1250 54860CC_MFHC Pro Fees PUNCTURE ASPIRATION OF HYDROCELE 254 55000CC_MFHC Pro Fees EXCISION OF HYDROCELE; UNILATERAL 1005 55040CC_MFHC Pro Fees TOTAL ABD HYSTERECTOMY 2290 58150CC_MFHC Pro Fees SUPRACERVICAL ABD HYSTERECTOMY 2406 58180CC_MFHC Pro Fees TUBAL LIGATION, LAP 844 58670CC_MFHC Pro Fees TUBAL LIGATION W/BAND 843 58671CC_MFHC Pro Fees THYROID LOBECTOMY UNILATERAL 2131 60220CC_MFHC Pro Fees EXCISION THYROGLOSSAL DUCT CYST 1221 60280CC_MFHC Pro Fees NASOPHARYNGOSCOPY 317 92511CC_MFHC Pro Fees NEGATIVE PRESSURE WOUND THERAPY <50 SQCM 75 97607CC_MFHC Pro Fees HOSP INITIAL CNSLT MINOR 118 99251CC_MFHC Pro Fees HOSP INITIAL CNSLT LOW 155 99252CC_MFHC Pro Fees HOSP INITAL CNSLT MOD 193 99253CC_MFHC Pro Fees HOSP INITIAL CNSLT SEVER 248 99254CC_MFHC Pro Fees HOSP INITIAL CNSLT HIGH 327 99255CC_MFHC Pro Fees COLORECTAL CA SCREEN; CLNSCPY; LOW RISK 1110 G0121CC_MFHC Pro Fees EKG INTERP ONLY 21 93010CC_MFHC Pro Fees BN LN TNK/ARM/LEG >4CM 698 11406CC_MFHC Pro Fees EXCISON BX CYST, FINGER 954 26160

CC_MRI MRI KNEE W/O 2657 73721

39

CC_MRI MRI THORACIC W/WO 3385 72157,TCCC_MRI MRI HEAD/BRAIN W/O 2277 70551,TCCC_MRI MRI HEAD/BRAIN W 2595 70552,TCCC_MRI MRI HEAD/BRAIN W/WO 3670 70553,TCCC_MRI MRI ORBITS/FACE/NECK W 2595 70542,TCCC_MRI MRI ORBITS, FACE, NECK W/O CONTRAST 2277 70540,TCCC_MRI MRI ORBITS/FACE/NECK W/WO 3670 70543,TCCC_MRI MRI PITUITARY W/O 2277 70554,TCCC_MRI MRA BRAIN W/O 2468 70544,TCCC_MRI MRA NECK W/O 2341 70547,TCCC_MRI MRI ABDOMEN W/O 2694 74181,TCCC_MRI MRI ABDOMEN W 3012 74182,TCCC_MRI MRI ABDOMEN W/WO 4239 74183,TCCC_MRI MRI CHEST W/O 2341 71550,TCCC_MRI MRI CHEST W 2657 71551,TCCC_MRI MRI CHEST W/WO 3858 71552,TCCC_MRI MRI C SPINE W/O 2341 72141,TCCC_MRI MRI C SPINE W 2657 72142,TCCC_MRI MRI C SPINE W/WO 2910 72156,TCCC_MRI MRI THORACIC W/O 2468 72146,TCCC_MRI MRI THORACIC W 2784 72147,TCCC_MRI MRI LUMBAR W/O 2309 72148,TCCC_MRI MRI LUMBAR W 2500 72149,TCCC_MRI MRI LUMBAR W/WO 3385 72158,TCCC_MRI MRI PELVIS W/O 2720 72195,TCCC_MRI MRI PELVIS W 3037 72196,TCCC_MRI MRI PELVIS W/WO 3479 72197,TCCC_MRI MRI UPPER EXT WO JT W/O 2152 73218,TCCC_MRI MRI UPPER EXT WO JOINT W 2468 73219,TCCC_MRI MRI UPPER EXT WO JT W/WO 3163 73220,TCCC_MRI MRI UPPER EXT JOINT W/O 2341 73221,TC

40

CC_MRI MRI UPPER EXT JOINT W 2720 73222,TCCC_MRI MRI UPPER EXT JOINT W/WO 3575 73223,TCCC_MRI MRI LOWER EXT WO JT W/O 2405 73718,TCCC_MRI MRI LOWER EXT WO JOINT W 2720 73719,TCCC_MRI MRI LOWER EXT WO JT W/WO 3575 73720,TCCC_MRI MRI LOWER EXT JOINT W/O 2657 73721,TCCC_MRI MRI LOWER EXT JOINT W 2974 73722,TCCC_MRI MRI LOWER EXT JOINT W/WO 3575 73723,TCCC_MRI MRI TM JOINTS 2089 70336,TCCC_MRI MRI HUMERUS W/O 2152 73218,TCCC_MRI MRI HUMERUS W 2468 73219,TCCC_MRI MRI HUMERUS W/WO 3163 73220,TCCC_MRI MRI FOREARM W/O 2152 73218,TCCC_MRI MRI FOREARM W 2468 73219,TCCC_MRI MRI FOREARM W/WO 3163 73220,TCCC_MRI MRI SHOULDER W/O 2341 73221,TCCC_MRI MRI SHOULDER W 2720 73222,TCCC_MRI MRI SHOULDER W/WO 3575 73223,TCCC_MRI MRI ELBOW W/0 2341 73221,TCCC_MRI MRI ELBOW W 2720 73222,TCCC_MRI MRI ELBOW W/WO 3575 73223,TCCC_MRI MRI WRIST W/O 2341 73221,TCCC_MRI MRI WRIST W 2720 73222,TCCC_MRI MRI WRIST W/WO 3575 73223,TCCC_MRI MRI HAND W/O 2341 73221,TCCC_MRI MRI HAND W 2720 73222,TCCC_MRI MRI HAND W/WO 3575 73223,TCCC_MRI MRI FEMUR W/O 2405 73718,TCCC_MRI MRI FEMUR W 2720 73719,TCCC_MRI MRI FEMUR W/WO 3575 73720,TCCC_MRI MRI TIB/FIB W/O 2405 73718,TC

41

CC_MRI MRI TIB/FIB W 2720 73719,TCCC_MRI MRI TIB/FIB W/WO 3575 73720,TCCC_MRI MRI HIP W/O 2657 73721,TCCC_MRI MRI HIP W 2974 73722,TCCC_MRI MRI HIP W/WO 3575 73723,TCCC_MRI MRI KNEE W 2974 73722,TCCC_MRI MRI KNEE W/WO 3575 73723,TCCC_MRI MRI ANKLE W/O 2657 73721,TCCC_MRI MRI ANKLE W 2974 73722,TCCC_MRI MRI ANKLE W/WO 3575 73723,TCCC_MRI MRI FOOT W/O 2405 73718,TCCC_MRI MRI FOOT W 2720 73719,TCCC_MRI MRI FOOT W W/O 3575 73720,TCCC_MRI MRA NECK W/WO 3796 70549,TCCC_MRI MRA NECK W 2657 70548,TCCC_MRI MRI UPPER EXT NON-JOINT W/WO 3163 73220,TCCC_MRI MRI UPPER EXT NON-JOINT W/O CONTRAST 2152 73218,TCCC_MRI MRI BRAIN W/ W/O AND IAC 3495 70553,TC

CC_Nuclear Medicine CHOLETEC ($17/MCI) X 5 MCI 208 A9537CC_Nuclear Medicine KINEVAC 316 J2805CC_Nuclear Medicine PERTECHNETATE PER MCI 32 A9512CC_Nuclear Medicine DTPA PER MCI 178 A9539CC_Nuclear Medicine MAA PER MCI 221 A9540CC_Nuclear Medicine HDP UP TO 30 MCI 75 A9503CC_Nuclear Medicine MYOVIEW PER UNIT DOSE 259 A9502CC_Nuclear Medicine AMINOPHYLLINE UP TO 250 MG 30 J0280CC_Nuclear Medicine CARDIOLITE PER DOSE 462 A9500CC_Nuclear Medicine LEXISCAN 240 J2785CC_Nuclear Medicine SULFER COLLOID/MCI 137 A9541CC_Nuclear Medicine CARDIAC STRESS TEST 1043 93017

42

CC_Nuclear Medicine NON-HEU TC -99M ADD0ON/DOSE 11 Q9969CC_Nuclear Medicine TC99M OXIDRONATE 133 A9561CC_Nuclear Medicine TC99M PENTETATE 271 A9539CC_Nuclear Medicine TC-99M LABELED RED BLOOD CELLS 369 A9560CC_Nuclear Medicine 123 I CAPS PER 100 UCI 193 A9516CC_Nuclear Medicine KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULT 1906 78709,TCCC_Nuclear Medicine KIDNEY IMG MORPHOLOGY VASC FLOW 1 W/RX 1808 78708,TCCC_Nuclear Medicine CARDIAC BLOOD POOL IMAGING SINGLE STUDY 1816 78472,TCCC_Nuclear Medicine INTESTINE IMAGING 1277 78290,TCCC_Nuclear Medicine TC99M MERTIATIDE 786 A9562CC_Nuclear Medicine ACUTE GASTROINTESTINAL BLOOD LOSS IMAGE 1547 78278,TCCC_Nuclear Medicine MYOCARDIAL PERFUSION SING 4162 78451,TCCC_Nuclear Medicine BILIARY SCAN (HIDA) W/EF 1821 78227,TCCC_Nuclear Medicine AUTO DATA <30 MIN 178 78890,TCCC_Nuclear Medicine BONE SCAN-BODY 1846 78306,TCCC_Nuclear Medicine BONE SPECT 1931 78320,TCCC_Nuclear Medicine BONE SCAN-LIMITED 1216 78300,TCCC_Nuclear Medicine BONE SCAN-3 PHASE 1977 78315,TCCC_Nuclear Medicine LUNG PERFUSION WO VENTILA 1316 78580,TCCC_Nuclear Medicine LUNG PERFUSION & VENTILAT 1891 78582,TCCC_Nuclear Medicine LUNG VENTILATION 1261 78579,TCCC_Nuclear Medicine THYROID UPTAKE ONLY 1242 78014,TCCC_Nuclear Medicine THYROID SCAN AND UPTAKE 699 78012,TCCC_Nuclear Medicine THYROID SCAN ONLY 794 78013,TCCC_Nuclear Medicine MYOCARDIAL PERFUSION MULT 4162 78452,TCCC_Nuclear Medicine MYOCARDIAL PERF WALL MTN 1550 78453,TCCC_Nuclear Medicine PARATHYROID SCAN 1329 78070,TCCC_Nuclear Medicine GASTRIC EMPTYING STUDY 1131 78264,TC

CC_Nursing MEDICAL LEAVE OF ABSENCE 0CC_Nursing ISOLATION ROOM 2122

43

CC_Nursing PRIVATE ROOM-INPATIENT TELEMETRY 3605CC_Nursing PRIVATE ROOM-INPATIENT 3090

CC_Occupational Therapy OT THER EX 15 MIN 90 97110,GOCC_Occupational Therapy OT ADL 15 MIN EA 98 97535,GOCC_Occupational Therapy NEUROMUSCULAR 93 97112,GOCC_Occupational Therapy ERGONOMIC ASSESSMENT 237 97799,GOCC_Occupational Therapy OT EVALUATION; LOW COMPLEXITY 237 97165,GOCC_Occupational Therapy OT EVALUATION; HIGH COMPLEXITY 237 97167,GOCC_Occupational Therapy OT RE-EVALUATION 118 97168,GOCC_Occupational Therapy OT ULTRASOUND 15 MIN EA 36 97035,GOCC_Occupational Therapy SPLINT/ORTH FAB/TRAIN 15 107 97760,GOCC_Occupational Therapy SOFT TISS MOB MFR 15 M IN 83 97140,GOCC_Occupational Therapy PARAFFIN 15 MIN 32 97018,GOCC_Occupational Therapy ELECTRICAL STIM 15 MIN 55 97032,GOCC_Occupational Therapy IONTOPHORESIS 94 97033,GOCC_Occupational Therapy ORTHOTIC/SPLINT CHECK 138 97762,GOCC_Occupational Therapy THER ACTIVITIES 15 MIN 99 97530,GOCC_Occupational Therapy TRANSFER TRAINING 98 97535,GOCC_Occupational Therapy WHEELCHR MGMT 15 MIN 84 97542,GOCC_Occupational Therapy COGNITIVE THER 15 MIN 74 97532,GOCC_Occupational Therapy OT EVALUATION; MODERATE COMPLEXITY 237 97166,GO

CC_PACU PACU, PHASE 1 RECOVERY ROOM (PER MIN) 34CC_PACU PACU, PHASE 2 RECOVERY ROOM (PER MIN) 16CC_PACU EXTENDED RECOVERY (PER HOUR) 150

CC_Physical Therapy SOFT TISSUE MBLZTN-15MIN 83 97140,GPCC_Physical Therapy NEURO-MUSC REEDUCAT 91 97112,GPCC_Physical Therapy TENS APPLICATION 50 64550,GPCC_Physical Therapy ELECTRICAL STIM 15 MIN 55 97032,GP

44

CC_Physical Therapy ULTRA SOUND 36 97035,GPCC_Physical Therapy IONTOPHORESIS (15 MIN) 94 97033,GPCC_Physical Therapy ORTHOTICS FITTING/TRAIN 107 97760,GPCC_Physical Therapy MANUAL THERAPY-15 MIN 83 97140,GPCC_Physical Therapy THER. ACTIVITIES 15MIN 99 97530,GPCC_Physical Therapy E STIM UNATTENDED 15 MIN 45 97014,GPCC_Physical Therapy GAIT TRAINING 15 MIN 79 97116,GPCC_Physical Therapy MECHANICAL TRACTION 61 97012,GPCC_Physical Therapy PT EVALUATION; LOW COMPLEXITY 237 97161,GPCC_Physical Therapy PT EVALUATION; HIGH COMPLEXITY 237 97163,GPCC_Physical Therapy PT RE-EVALUATION 118 97164,GPCC_Physical Therapy THERA EXER IND-15 MIN 90 97110,GPCC_Physical Therapy PT EVALUATION 191 97001CC_Physical Therapy DRY NEEDLING 83 97799,GPCC_Physical Therapy PT EVALUATION; MODERATE COMPLEXITY 237 97162,GP

CC_Radiology SMALL BOWEL SERIES 865 74250CC_Radiology OPERATIVE CHOLANGIOGRAM 865 74300CC_Radiology OPERATIVE CHOLE,ADDL SET 285 74301CC_Radiology IVP 1009 74400CC_Radiology FOREIGN BODY SURV-INFANT 285 76010CC_Radiology BONE SURVEY 770 77074CC_Radiology JT SURVEY 1 VIEW 2 JNTS 472 77077CC_Radiology BONE AGE STUDY 234 77072CC_Radiology INFANT GRAM 285 77076CC_Radiology FLUOROSCOPY OVER 1 HR 494 76001CC_Radiology FACIAL/FB 299 70030CC_Radiology SHOULDER 1 VW LT 285 73020CC_Radiology SHOULDER 1 VW RT 285 73020CC_Radiology PMC CHEST XRAY 2CC_Radiology FLUORO GUID-CNTRL VENOUS 381 77001

45

CC_Radiology FLUORO GUIDANCE-THER INJ 381 77003CC_Radiology ORBIT FOR MRI 0 70030CC_Radiology PICC LINE PLACEMENT-FLUOR 381 77001CC_Radiology ABDOMEN CT FOLLOWUP 2CC_Radiology SHOULDER 2V 320 73030CC_Radiology ORBITS BIL. 4V 355 70200CC_Radiology DUMMY CODE NO CHARGE 0CC_Radiology XR BILATERAL HIPS STANDING 303 73501CC_Radiology XR BILATERAL HIPS INTRAOPERATIVE 303 73501CC_Radiology XR BILATERAL HIPS POST OPERATIVE 303 73501CC_Radiology XR SHOULDER 1 VIEW 250 73020CC_Radiology FLUORO GUIDANCE-FOR NEEDLE PLACEMENT 381 77002CC_Radiology DEXA AXIAL 320 77080,TCCC_Radiology LUMBAR SPINE 2V OR 3V 438 72100,TCCC_Radiology KNEE/OBLS/TUN/PAT LT 356 73564,TCCC_Radiology KNEE W/OBLS/TUN/PAT RT 356 73564,TCCC_Radiology CHEST 2V 380 71046,TCCC_Radiology PELVIS 1 VW 311 72170,TCCC_Radiology HIP 2V MIN LT 344 73502,TCCC_Radiology FEMUR 2V LT 344 73552,TCCC_Radiology 2 VW ABD 406 74019,TCCC_Radiology BOTH KNEES -STANDING- 245 73565,TCCC_Radiology XR BILATERAL HIPS 303 73501,TCCC_Radiology ANKLE 2 VIEWS LT 245 73600,TCCC_Radiology KNEE 2 VIEWS LT 299 73560,TCCC_Radiology KNEE 2 VIEWS RT 299 73560,TCCC_Radiology FEMUR 2V RT 344 73552,TCCC_Radiology FINGER(S) MIN 2V RIGHT 256 73140,TCCC_Radiology HIP 1 VIEW RT 309 73501,TCCC_Radiology HIP 1 VIEW LT 309 73501,TCCC_Radiology HIP 2V MIN RT 344 73502,TC

46

CC_Radiology AP PELVIS LAT HIP 381 73521,TCCC_Radiology INFANT PELV/HIPS 2V 285 73502,TCCC_Radiology FOOT 3V MIN RT 285 73630,TCCC_Radiology ANKLE 3V MIN RT 285 73610,TCCC_Radiology ANKLE 3V MIN LT 285 73610,TCCC_Radiology FOOT 2 VIEWS RT 245 73620,TCCC_Radiology FOOT 2 VIEWS LT 245 73620,TCCC_Radiology FOOT 3V MIN LT 285 73630,TCCC_Radiology HEEL 2V RT 256 73650,TCCC_Radiology HEEL 2V LT 256 73650,TCCC_Radiology TOE(S) MIN 2V LEFT 256 73660,TCCC_Radiology TOE(S) MIN 2V RIGHT 256 73660,TCCC_Radiology ABDOMEN KUB 311 74018,TCCC_Radiology 2 VW ABD 1 VW CHEST 476 74022,TCCC_Radiology PELVIS COMPLETE 381 72190,TCCC_Radiology SAIC JOINTS 3V MIN 356 72202,TCCC_Radiology SACRUM COCCYX 2V MIN 285 72220,TCCC_Radiology CLAVICLE, RT 299 73000,TCCC_Radiology CLAVICLE, LT 299 73000,TCCC_Radiology SCAPULA, RT 299 73010,TCCC_Radiology SCAPULA, LT 299 73010,TCCC_Radiology SHOULDER COMPLETE RT 345 73030,TCCC_Radiology SHOULDER COMPLETE LT 345 73030,TCCC_Radiology AC JOINTS BIL. 356 73050,TCCC_Radiology HUMERUS 2V MIN RT 299 73060,TCCC_Radiology HUMERUS 2V MIN LT 299 73060,TCCC_Radiology ELBOW 2 VIEWS RT 245 73070,TCCC_Radiology WRIST 3V MIN LT 285 73110,TCCC_Radiology ELBOW 2 VIEWS LT 245 73070,TCCC_Radiology ELBOW 3V RT 285 73080,TCCC_Radiology ELBOW 3V LT 285 73080,TC

47

CC_Radiology FOREARM 2V RT 285 73090,TCCC_Radiology FOREARM 2V LT 285 73090,TCCC_Radiology UPPER EXTREMITY-INF. 2V RT 256 73092,TCCC_Radiology UPPER EXTREMITY-INF 2V LT 256 73092,TCCC_Radiology WRIST 2 VIEWS RT 245 73100,TCCC_Radiology WRIST 2 VIEWS LT 245 73100,TCCC_Radiology WRIST 3V MIN RT 285 73110,TCCC_Radiology HAND 2 VIEWS RT 245 73120,TCCC_Radiology HAND 2 VIEWS LT 245 73120,TCCC_Radiology HAND 3V MIN RT 285 73130,TCCC_Radiology HAND 3V MIN LT 285 73130,TCCC_Radiology FINGER(S) MIN 2V LEFT 256 73140,TCCC_Radiology CERVICAL SP.2-3V'S 375 72040,TCCC_Radiology CERVICAL SPINE W/OBLS 445 72052,TCCC_Radiology C-SPINE FLX/EXT 4V 402 72050,TCCC_Radiology T-L SPINE STDG/SCOLIOSIS 285 72081,TCCC_Radiology THORACIC SPINE 2V 343 72070,TCCC_Radiology T SPINE W/CV-TH JT.3V 402 72072,TCCC_Radiology THORACIC SPINE 4V MIN 427 72074,TCCC_Radiology KNEE 3 VIEWS LT 335 73562,TCCC_Radiology MANDIBLE 4V MIN 368 70110,TCCC_Radiology MASTOIDS 3V/SIDE MIN 373 70130,TCCC_Radiology FACIAL BONES MIN 3V 355 70150,TCCC_Radiology NASAL BONES 3V MIN 349 70160,TCCC_Radiology SINUSES 1-2 VIEWS 299 70210,TCCC_Radiology SINUSES 3V MIN 368 70220,TCCC_Radiology SKULL <4V 355 70250,TCCC_Radiology SKULL MIN 4 V 381 70260,TCCC_Radiology TM JOINTS BIL. 381 70330,TCCC_Radiology NECK SOFT TISSUE 356 70360,TCCC_Radiology CHEST 1V 356 71045,TC

48

CC_Radiology CHEST 2V W/LORD. 402 71021,TCCC_Radiology CHEST 2V W/OBLS. 381 71022,TCCC_Radiology CHEST MIN 4V 441 71030,TCCC_Radiology CHEST/SPEC VIEW 356 71035,TCCC_Radiology RIBS UNI 2V RT 381 71100,TCCC_Radiology RIBS UNI 2V LT 381 71100,TCCC_Radiology RIBS UNI MIN 3V W/PA CXR RT 402 71101,TCCC_Radiology RIBS UNI MIN 3V W/PA CXR LT 402 71101,TCCC_Radiology RIBS BL W/PA CXR 4V MIN 465 71111,TCCC_Radiology STERNUM 2V MIN 299 71120,TCCC_Radiology SC JTS 3V MIN 299 71130,TCCC_Radiology SPINE 1 V ( SPEC. LEVEL) 299 72020,TCCC_Radiology THORACO LUMBER SPINE 2V 344 72080,TCCC_Radiology LUMBAR SPINE 4V MIN 441 72110,TCCC_Radiology LUMBO SACRAL SPINE/BEND 460 72114,TCCC_Radiology KNEE 3 VIEWS RT 335 73562,TCCC_Radiology TIB/FIB 2 VW RT 342 73590,TCCC_Radiology TIB/FIB 2 VW LT 342 73590,TCCC_Radiology LOWER EXT-INF.2V RT 256 73592,TCCC_Radiology LOWER EXT. INF. 2V MIN LT 256 73592,TCCC_Radiology ANKLE 2 VIEWS RT 245 73600,TCCC_Radiology FLUORO 1HR MINIMUM 381 76000CC_Radiology SPINE TOTAL 716 72082,TC

CC_Speech Therapy ST TENS APPLICATION 50 64550,GNCC_Speech Therapy ST SWALLOW EVALUATION 263 92610,GNCC_Speech Therapy ST MOD.BARIUM SWALLOW STUDY 218 92611,GNCC_Speech Therapy ST EVAL OF SPEECH SOUND (ARTICULATION) 608 92522,GNCC_Speech Therapy ST APHASIA EVAL. 263 96105,GNCC_Speech Therapy ST EVAL COMM DEVICE 190 92607,GNCC_Speech Therapy ST EVAL OF EXPRESSIVE/RECEPTIVE LANGUAGE 218 92523,GN

49

CC_Speech Therapy ST SWALLOW TX 215 92526,GNCC_Speech Therapy ST DYSPHAGIA EVALUATION 263 92610,GNCC_Speech Therapy ST SPCH/LANG TX-IND 198 92507,GNCC_Speech Therapy ST TX. SPEECH GEN. DEVICE 172 92609,GNCC_Speech Therapy ST SPCH GEN DEV TX 172 92609,GNCC_Speech Therapy ST VOICE PROS TX 2 92507,GNCC_Ultrasound US TRAILS TO HEALTH 160CC_Ultrasound US EXTRA CRANIEL ART,COM 1388 93880,TCCC_Ultrasound US EXTRA CRANIEL ART.LTD 981 93882,TCCC_Ultrasound US LOWER EXT.ART., COMP. 1136 93925,TCCC_Ultrasound US LOWER EXT. ART., LTD. 981 93926,TCCC_Ultrasound US UPPER EXT. ART. COM. 1136 93930,TCCC_Ultrasound US UPPER EXT. ART. LTD 981 93931,TCCC_Ultrasound US EXT. VEINS; BIL 1417 93970,TCCC_Ultrasound US EXT. VEINS; LTD, RT 981 93971,TCCC_Ultrasound US EXT. VEINS COMPLETE, LT 981 93971,TCCC_Ultrasound US DOP ABD.PEL.KID.,COMP 881 93975,TCCC_Ultrasound US DOP.ABD.PEL.KID.,LTD 823 93976,TCCC_Ultrasound US DOP AOR.IVC.ILIAC,COM 881 93978,TCCC_Ultrasound US DOP AOR.IVC.ILIAC,LTD 803 93979,TCCC_Ultrasound ECHOENCEPHALOGRAPHY 832 76506,TCCC_Ultrasound US SOFT TISSUE HEAD/NECK 823 76536,TCCC_Ultrasound US CHEST 803 76604,TCCC_Ultrasound BREAST US UNI-LATERAL 514 76641,TCCC_Ultrasound BREAST US BI-LATERAL 949 76641,TCCC_Ultrasound US ABDOMEN COMPLETE 951 76700,TCCC_Ultrasound US ABD. LTD 707 76705,TCCC_Ultrasound US RETPERI.RENAL,AORTA 803 76770,TCCC_Ultrasound US RETROPERITONEUM LTD 707 76775,TCCC_Ultrasound US OB < 14WKS 665 76801,TCCC_Ultrasound US OB<14WKS EA ADDL GEST 273 76802,TC

50

CC_Ultrasound US OB COMPLETE 697 76805,TCCC_Ultrasound US OB COM.MULTI GEST. 753 76810,TCCC_Ultrasound US OB EMERGENCY LTD 686 76815,TCCC_Ultrasound US OB FOLLOW-UP 355 76816,TCCC_Ultrasound US OB TRANSVAGINAL 430 76817,TCCC_Ultrasound US BIOPHYSICAL PROFILE 753 76818,TCCC_Ultrasound US PELVIC COMPLETE 783 76856,TCCC_Ultrasound US PELVIC LTD 538 76857,TCCC_Ultrasound US SCROTUM 753 76870,TCCC_Ultrasound US TRANS RECTAL 686 76872,TCCC_Ultrasound US EXTREMITY NON VAS COMP 628 76881,TCCC_Ultrasound US INFANT HIPS 589 76885,TCCC_Ultrasound US GUIDANCE FOR NEEDLE PLACEMENT 568 76942,TCCC_Ultrasound US PELVIC TRANSVAGINAL 430 76830,TCCC_Ultrasound US EXT NONVAS LTD 507 76882,TCCC_Ultrasound ECHOCARDIOGRAM, COMPLETE 836 93306,TCCC_Ultrasound US EXT. VEINS COMPLETE, RT 981 93971,TCCC_Ultrasound US EXT. VEINS; LTD, LT 981 93971,TCCC_Ultrasound US NON VASCULAR LIMITED, EXTREMITIES 453 76882,TC

ED ED VISIT LEVEL 2 FACILITY FEE 492 99282ED ED VISIT LEVEL 3 FACILITY FEE 673 99283ED ED VISIT LEVEL 4 FACILITY FEE 1229 99284ED ED VISIT LEVEL 5 FACILITY FEE 1563 99285ED CRITICAL CARE 1 TO74 MIN FACILITY FEE 2003 99291ED CRITICAL CARE ADDL 30 MIN FACILITY FEE 731 99292ED CHEST TUBE/THORACOSTOMY 1704 32551ED DRSG/DEBRIDEMNT SML BURN 224 16020ED INTUBATE/CARD/DEFIB/PACE 1557 92950ED DELIVERY OF INFANT 1158 99460ED WOUND CARE 184 99211

51

ED IV INF HYD INI 31 TO 60 MIN 220 96360ED IV INF HYD EA ADDL HR 65 96361ED CLSD TX IP JT,SGL W/ANEST 383 26775ED REMOVAL TUNNELED CV CATH 466 36589ED CLSD TX D RAD FX W/MANIP 600 25605ED GUM SUTURES 134 41899ED LOCAL/MAC 1098ED THORACENTESIS, PLEURA W/O 603 32554ED CLSD TX IP JT DIS SGL W/M 686 26770ED PARACENTESIS W/O IMAGING 250 49082ED THORACENTESIS, PLEURA W 387 32555ED CLSD TX ANKLE DIS W/ANEST 1386 27842ED INTUBATION, ENDOTRACHEAL 377 31500ED ER ARTERIAL PUNCTURE FOR DX 92 36600ED ESCHAROTOMY INITIAL INCISION 1611 16035ED INSERT NONTUNNELED CV CATH/CENT LINE 397 36556ED REMOVAL FOREIGN BODY PHARYNX 436 42809ED TETANUS ADMINISTRATION 105 90471ED PARACENTESIS W/IMAGING 364 49083ED TRAUMA TEAM ACT W/AMB. PRENOTIFICATION 2327 G0390ED LEVEL 4 ED W/TRAUMA TEAM ACTIVATION 3442 99284ED LEVEL 5 ED W/TRAUMA TEAM ACTIVATION 3746 99285ED TRIGGER POINT INJECTION 1-2 MUSCLES 119 20552ED IV PUSH EA ADDL NEW DRUG 67 96375ED IV PUSH EA ADDL SAME DRUG 67 96376ED IV PUSH SAME DRUG 55 96376ED IV INFUSION, THERAPEUTIC, EA ADD'L HR 78 96366ED IV INFUSION, THERAPEUTIC, EA ADD'L SEQ MED, UP TO 1 HR 78 96367ED IV INFUSION, THERAPEUTIC, CONCURRENT INFUSION 78 96368ED IV INFUSION, THERAPEUTIC, 1ST HOUR 280 96365ED NO CHARGE 0

52

ED SHOULDER/HIP DISLOCATION 979ED I AND D 501ED SIMPLE LACERATION 563ED INTERMEDIATE LACERATION 641ED COMPLEX LACERATION 799ED SIMPLE FX 613ED UPPER EXTREMITY FX WCAST 731ED LOWER EXTREMITY FX WCAST 862ED SPLINT UPPER EXT 293ED FINGER/TOE AMPUTATION 1937ED PERITONEOCENTESIS 1065ED FB REMOVAL 538ED FB REMOVAL WITH INCISION 938ED NAIL REMOVAL 306ED ARTHROCENTISIS/JT ASPIR 538ED DEBRIDE BURN 672ED DEBRIDE BURN W ANESTHESIA 2181ED I AND D PERINEUM ABSCESS 561ED REMOVAL OF IUD 293ED CHEMICAL CAUTERIZATION 306ED REMOVAL OF EYE FB 524ED REMOVAL OF EYELID FB 232ED REMOVAL OF NASAL FB 214ED REMOVAL NASAL FB W ANES 2374ED REMOVAL EAR FB/CERUMEN 196ED REMOVAL EAR FB/CER W/ANES 2374ED TONGUE LAC/MOUTH LESION 2374ED ELBOW DISLOCATION W/REDUC 819ED CLSD TX FNGR DISL W MANIP 557ED PATELLAR DISLOCATION 637ED LAW ENFORCEMENT BA 43

53

ED IV PUSH SGL/INITIAL DRUG 145 96374ED SC/IM ADMINISTRATION 105 96372ED IMMUNIZATION ADMINISTRATION 105 90471ED ELOPEMENT 70ED ED VISIT LEVEL 1 FACILITY FEE 271 99281ED TRIGGER POINT INJECTION 3+ MUSCLES 160 20553ED FOLEY INSERTION 267 51702ED CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX 733 30903ED CONTROL OF NASAL HEMORRHAGE, ANTERIOR, SIMPLE 524 30901ED CATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLE PATIENT 36 P9612ED INTEROSSEUS INFUSION, NEEDLE PLACEMENT 155 36680ED INITIAL TREATMENT, FIRST DEGREE BURN 129 16000ED INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH 129 62273ED SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC 805 62270ED SPLINT LOWER EXT 500ED CLOSED TX FEMORAL SHAFT FX, W/MANIPULATION 927 27502ED MODERATE CONS SEDATION, 15 MIN, > 5 Y/O 129 99152ED MODERATE CONS SEDATION, EA ADD'L 15 MIN 77 99153ED INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE 129 64450ED REMOVAL, FOREIGN BODY, INTRANASAL 129 30300ED MODERATE SEDATION SERVICES, PTS < 5 YRS OLD 129 99155ED MODERATE SEDATION SERVICES, EA ADD'L 15 MINUTES 77 99157ED CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION W/O ANESTHESIA 129 28630ED EVACUATION OF SUBUNGUAL HEMATOMA 129 11740ED ARTHROCENTESIS, ASPIRATION, INJECTION, MAJOR JOINT 176 20610ED MODERATE SEDATION SERVICES PROVIDED BY A PHYSICIAN OTHER THAN ATTENDING 129 99156ED REMOVAL OF SKIN TAGS 129 11200ED REPAIR OF LACERATION <2.5 CM, MOUTH 155 41250ED APPLICATION OF FINGER SPLINT 129 29130ED INCISION & DRAINAGE ABSCESS, SIMPLE 155 10060ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK 155 12002

54

ED CLOSED TREATMENT BIMALLEOLAR ANKLE FX W/MANIPULATION 927 27810ED CLOSED TREATMENT OF TIBIAL FX, PROXIMAL 778 27530ED REPAIR OF NAIL BED 129 11760ED REPAIR OF LACERATION, SIMPLE, HEAD/SCALP; 7.6-12.5 CM 206 12004

ED Pro Fees ESCHAROTOMY, INITIAL INCISION 587 16035ED Pro Fees FB REMOVAL MUSCLE DEEP/COMPL 612 20525ED Pro Fees CLSD TX FX ORBIT 438 21400ED Pro Fees CLSD TX CLAVICULAR FX, W/MANIPULATION 1022 23505ED Pro Fees CLSD TX SHOULDER DISLOCATION W/MANIPULATION 695 23650ED Pro Fees CLDS TX SHOULDER REDUCTION W/MANIP W/ ANETHS 955 23655ED Pro Fees CLSD TX HUMERAL FX W/MANIPULATION 1342 24565ED Pro Fees CLSD TX ELBOW DISLOC W/ANESTHESIA 1058 24605ED Pro Fees CLSD TX RAD SBLX CHILD W/MANIPULATION 308 24640ED Pro Fees CLSD TX RAD HD FX W/O MANIPULATION 589 24650ED Pro Fees CLSD TX RD HD FX W/MANIPULATION 993 24655ED Pro Fees CLSD FX PROXIMAL ULNA W/O MANIPULATION 655 24670ED Pro Fees CLOSED TX RADIAL SHAFT FX W/MANIPULATION 1129 25505ED Pro Fees CLSD TX RADIAL/ULNAR FX W/MANIPULATION 1412 25565ED Pro Fees CLSD TX DISTAL RADIAL FX W/MANIPULATION 1258 25605ED Pro Fees MANIPULATION, FINGER JOINT, W/ANESTHESIA, EACH JOINT 752 26340ED Pro Fees CLSD TX MC FX W/MANIP 726 26605ED Pro Fees CLSD TX MCP DISLOCATION, SGL W/MANIP. W/O ANES 926 26705ED Pro Fees CLSD TX PHALANGEAL FX W/MANIPULATION, EACH 766 26725ED Pro Fees CLSD TX PHALANGEAL W/MANIPULATION, EACH 818 26755ED Pro Fees OPEN TX DISTAL PHALANGEAL FX, EACH 1295 26765ED Pro Fees CLSD TX IP JT DISLOCATION W/MANIP W/ANESTHESIA, SINGLE 865 26775ED Pro Fees CLSD TX FEMORAL FX, PROXIMAL, W/O MANIP 1157 27230ED Pro Fees TX HIP HIP DISLOCATON, W/MANIPULATION W/ANESTH 755 27257ED Pro Fees CLSD TX DISLOCATION, POST HIP ARTH 1096 27265ED Pro Fees CLSD TX PATELLAR FX W/O MANIPULATION 730 27520

55

ED Pro Fees CLSD TX PROXIMALTIBIA FX W/O MANIPULATION 701 27530ED Pro Fees CLSD TX TIBIAL SHAFT FX W/O MANIPULATION 782 27750ED Pro Fees CLSD TX TIBIAL SHAFT FX W/MANIPULATION 1221 27752ED Pro Fees CLSD TX MEDIAL MALLEOLUS FX W/O MANIPULATION 755 27760ED Pro Fees CLSD TX PROXIMAL FIBULA FX W/O MANIPULATION 691 27780ED Pro Fees CLSD TX DISTAL FIBULAR FX W/O MANIPULATION 716 27786ED Pro Fees CLSD TX DISTAL FIBULAR FRACTURE 1200 27788ED Pro Fees CLSD TX BIMALLEOLAR ANKLE FX W/O MANIPULATION 754 27808ED Pro Fees CLSD TX BIMALLEOLAR ANKLE FX W/MANIPULATION 1050 27810ED Pro Fees OPEN TX BIMALLEOLAR ANKLE FX W/MANIPULATION 1100 27818ED Pro Fees CLSD TX ANKLE DISLOCATION W/ANESTH W/W/O SKELETAL FIXATION 1204 27842ED Pro Fees OPEN TX FX/ NOT GREAT TOE 1686 28525ED Pro Fees REMOVAL FOREIGN BODY, INTRANASAL, REQUIRING GENERAL ANETHESIA 482 30310ED Pro Fees INTUBATION 249 31500ED Pro Fees PLEURAL SCARIFICATION; RPT PNEUMOTHORAX 1995 32215ED Pro Fees TUBE THORACOSTOMY 553 32551ED Pro Fees THORACENTESIS 352 32554ED Pro Fees THORACENTESIS WITH IMAGING GUIDANCE 339 32555ED Pro Fees THORASCOPY, SURGICAL W/PLEURODESIS 1659 32650ED Pro Fees VENOGRAM 808 36005ED Pro Fees RPR EPSTMY/VAG NON ATTEND 453 59300ED Pro Fees VAGINAL DELIVERY ONLY 2273 59409ED Pro Fees SPINAL PNCTR, LMBR, DX 198 62270ED Pro Fees US GUIDANCE FOR NEEDLE PLACEMENT 631 76942ED Pro Fees MOD SEDATION; 15 MIN, < 5 Y/O 65 99151ED Pro Fees ER EXPANDED MOD HISTORY 235 99283ED Pro Fees ER MEDICAL SYSTEMS PHYSICIAN DIRECTED 339 99288ED Pro Fees CLDS TX DISTAL RADIAL FX W/O MANIPULATION 721 25600ED Pro Fees S/LAC SCLP/NK/EXT <2.5CM 190 12001ED Pro Fees CPR 679 92950ED Pro Fees CLSD TX PATELLAR DISLOCATION W/O ANESTHESIA 912 27560

56

ED Pro Fees CLSD TX GREAT TOE FX W/MANIPULATION 461 28495ED Pro Fees S/LAC FACE/EARS 2.5CM 258 12011ED Pro Fees S/LAC FACE/EARS 2.6-5.0CM 281 12013ED Pro Fees S/LAC SCLP/NK/EXT 7.6-12.5CM 302 12004ED Pro Fees I/LAC SCLP/AX/EXTR 7.6-12.5CM 706 12034ED Pro Fees ER DETAILED HISTORY 311 99284ED Pro Fees S/LAC SCLP/NK/EXTR 2.6-7.5CM 256 12002ED Pro Fees FOREIGN BODY REMOVAL, EYE, WITH SLIT LAMP 172 65222ED Pro Fees CLAVICLE FX W/O MANIPULATION 492 23500ED Pro Fees I&D ABCESS SIMPLE 260 10060ED Pro Fees INJ TRIGGER PNT 3+ MUSCLE 142 20553ED Pro Fees INJ TRIGGER POINT 1-2 MUS 127 20552ED Pro Fees I/LAC NCK/HNDS/FT <2.5CM 549 12041ED Pro Fees CLOSED TX ARTICULAR FX (MCP OR IP JT); WITH MANIPULATION, EACH 899 26742ED Pro Fees CONTROL OF NASAL HEMORRHAGE, ANTERIOR, SIMPLE 222 30901ED Pro Fees CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX 311 30903ED Pro Fees CONTROL OF NASAL HEMORRHAGE, ANTERIOR, SIMPLE, BILATERAL 445 30901ED Pro Fees CONTROL OF NASAL HEMORRHAGE, ANTERIOR, COMPLEX-BILATERAL 622 30903ED Pro Fees I/LAC NCK/HNDS/FT 2.6-7.5CM 660 12042ED Pro Fees I/LAC SCLP/AX/EXTR 2.6-7.5CM 697 12032ED Pro Fees REMOVAL, IMPACTED CERUMEN, W/INSTRUMENTATION, UNILATERAL 129 69210ED Pro Fees REMOVAL, CERUMEN W/INSTRUMENTATION, BILATERAL 258 69210ED Pro Fees CAUTERIZATION PROUD TISSUE 178 17250ED Pro Fees BURN- INITIAL 1ST DEG LOCAL 158 16000ED Pro Fees DRESSING/DEBRIDEMENT BURN, INI/SUBS, MEDIUM (FACE, EXT, 5-10% TBSA 301 16025ED Pro Fees APPLICATION SHORT ARM SPLINT 147 29125ED Pro Fees INTRAOSSEOUS INFUSION 137 36680ED Pro Fees UNUSUAL TRAVEL (TRANSPORT/ESCORT OF PATIENT) 206 99082ED Pro Fees STRAIGHT CATHETER 132 51701ED Pro Fees ASPIRATION/INJECTION LARGE JOINT/BURSA 179 20610ED Pro Fees ASPIRATION/INJECTION SMALL JOINT/ BURSA 142 20600

57

ED Pro Fees ASPIRATION/INJECTION MEDIUM JOINT/BURSA 149 20605ED Pro Fees I/LAC SCLP/AX/EXTR <2.5CM 537 12031ED Pro Fees APPLICATION SHORT LEG SPLINT 163 29515ED Pro Fees FOREIGN BODY REMOVAL, EYE 127 65205ED Pro Fees CLOSED TX FEMORAL SHAFT FX, W/MANIPULATION 2046 27502ED Pro Fees MOD SEDATION; 15 MIN, >5 Y/O 34 99152ED Pro Fees MOD SEDATION, EA ADDL 15 MIN 30 99153ED Pro Fees INJECTION PERIPHERAL NERVE 242 64450ED Pro Fees REMOVAL FOREIGN BODY, INTRANASAL, OFFICE PROCEDURE 282 30300ED Pro Fees CLOSED ELBOW DISLOCATION: WITHOUT ANESTHESIA 982 24600ED Pro Fees CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES 388 28515ED Pro Fees CLSD TX MTP JOINT DISLOCATION W/O ANESTHESIA 334 28630ED Pro Fees CLSD TX CARPAL FX W/O MANIPULATION, EACH BONE 691 25630ED Pro Fees SUBUNGUAL HEMATOMA EVACUATION 111 11740ED Pro Fees FB REMOVAL SIMPLE 337 10120ED Pro Fees REMOVAL SKIN TAGS, UP TO 15 198 11200ED Pro Fees REPAIR OF LACERATION, <2.5 CM, MOUTH 418 41250ED Pro Fees APPLICATION FINGER SPLINT,STATIC 94 29130ED Pro Fees ER FOCUS 104 99281ED Pro Fees ER EXPANDED LOW HISTORY 141 99282ED Pro Fees ER COMPREHENSIVE HISTORY 405 99285ED Pro Fees ER CRITICAL CARE 739 99291ED Pro Fees ER CRIT CARE ADDL 30 MIN 337 99292ED Pro Fees AVULSION OF NAIL SINGLE 220 11730ED Pro Fees AVULSION NAIL EACH ADDTL 82 11732ED Pro Fees REPAIR OF NAIL BED 409 11760ED Pro Fees S/LAC TRUNK >12.6CM 387 12005ED Pro Fees S/LAC REPAIR >30 CM 449 12007ED Pro Fees S/LAC FACE/EARS 5.1-7.5CM 331 12014ED Pro Fees S/LAC FACE/EARS 7.6-12.5CM 406 12015ED Pro Fees S/LAC FACE/EARS 12.6-20 CM 522 12016

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ED Pro Fees S/CLOSURE W/O PACKING 626 12020ED Pro Fees S/CLOSURE W/ PACKING 378 12021ED Pro Fees I/LAC SCLP/AX/EXTR 12.6+ 862 12035ED Pro Fees I/LAC NCK/HNDS/FT 7.6-12.5CM 805 12044ED Pro Fees I/LAC FACE/EAR/EYE <2.5CM 593 12051ED Pro Fees I/LAC FACE/EAR/EYE2.6- 5.0CM 678 12052ED Pro Fees I/LAC FACE/EAR/EYE 5.1-7.5CM 783 12053ED Pro Fees I/LAC FACE/EAR/EYE 7.6-12.5CM 833 12054ED Pro Fees I/LAC FACE/EAR/EYE 12.6-20 CM 918 12055ED Pro Fees C/LAC TRUNK 1.1-2.5CM 715 13100ED Pro Fees C/LAC TRUNK 2.6-7.5CM 907 13101ED Pro Fees C/LAC TRNK EA ADD'L 5CM 247 13102ED Pro Fees C/LAC SCLP/ARM/LEG 1.1-2.5CM 742 13120ED Pro Fees C/LAC SCLP/ARM/LEG 2.6-7.5CM 1014 13121ED Pro Fees C/LAC SCLP/ARM ADD'L 5CM 272 13122ED Pro Fees C/LAC FACE/HAND/FT 1.1-2.5CM 818 13131ED Pro Fees C/LAC FACE/HAND/FT 2.6-7.5CM 1323 13132ED Pro Fees C/LAC FAC/HD/FT ADD'L 5C 383 13133ED Pro Fees C/LAC EYE/NOSE/EAR 1.1-2.5CM 925 13151ED Pro Fees C/LAC EYE/NOSE/EAR 2.6-7.5CM 1278 13152ED Pro Fees C/LAC EYE/NOSE ADD'L 5CM 424 13153ED Pro Fees DRESSING CHANGE UNDER ANESTHESIA 210 15852ED Pro Fees BURN- SML <5% W/O ANESTHESIA 186 16020ED Pro Fees REMOVAL FOREIGN BODY, MUSCLE/TENDON SHEATH, SIMPLE 457 20520ED Pro Fees INJECTION, CARPAL TUNNEL 229 20526ED Pro Fees INJECTION TENDON/LIGAMNT 131 20550ED Pro Fees ASPIRATION/ INJ GANGLION CYST ANY LOCAT 180 20612ED Pro Fees CLSD TX NASAL BONE FX 287 21310ED Pro Fees FINE NEEDLE ASPIRATION 318 10021ED Pro Fees FOREIGN BODY REMOVAL; SHOULDER, SUBQ 589 23330ED Pro Fees FINE NEEDLE ASPIRATION W/IMGNG GUIDANCE 385 10022

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ED Pro Fees CLSD TX PROXIMAL HUMERAL FX W/O MANIPULATION 1008 23600ED Pro Fees I & D ABSCESS, MULTIPLE 430 10061ED Pro Fees CLOSED TREATMENT HUMERAL FRACTURE 843 24530ED Pro Fees CLSD TX HUMERAL EPICONDYLAR FX W/O MANIPULATION 885 24560ED Pro Fees FB REMOVAL COMPLICATED 589 10121ED Pro Fees EXCISION GANGLION CYST 779 25111ED Pro Fees EXCISION GANGLION CYST, RECURRENT 1107 25112ED Pro Fees I & D HEMATOMA 348 10140ED Pro Fees CYST/ABSCESS ASPIRATION 309 10160ED Pro Fees DEBRIDEMENT, SUBQ TISSUES, <20 SQ CM 343 11042ED Pro Fees REMOVAL, DEEP FOREIGN BODY 1248 25248ED Pro Fees CLSD TX RADIAL SHAFT FX; W/O MANIPULATIO 767 25500ED Pro Fees CLSD TX ULNAR SHAFT FX W/O MANIPULATION 810 25530ED Pro Fees TREATMENT OF MISCARRIAGE 796 59812ED Pro Fees CLSD TX ULNAR/RADIAL FX W/O MANIPULATION 616 25560ED Pro Fees FACIAL NERVE INJECTION 270 64402ED Pro Fees CLSD TX NAVICULAR FX W/O MANIP 684 25622ED Pro Fees FOREIGN BODY REMOVAL, EYE, WITHOUT SLIT LAMP 131 65220ED Pro Fees CLSD TX ULNAR STYLOID FX 951 25650ED Pro Fees DRAINAGE OF FINGER ABSCESS, SIMPLE 644 26010ED Pro Fees I & D EYELID 695 67700ED Pro Fees CLSD TX METACARPAL FX, SINGLE W/O MANIPULATION, EACH JOINT 659 26600ED Pro Fees EMBEDDED FOREIGN BODY, EYELID 550 67938ED Pro Fees CLSD TX CMC, EACH JOINT, W/O ANETHESIA 755 26670ED Pro Fees AURICLE INCISION & DRAIN 433 69000ED Pro Fees CLSD TX PHALANGEAL FX W/O MANIP, EA 446 26720ED Pro Fees CLSD TX DISTAL PHALANGEAL FX W/O MANIPULATION, EACH 478 26750ED Pro Fees FB REMOVAL EAR 293 69200ED Pro Fees REMOVAL FB HIP/PELVIS SUBQ TISSUE 576 27086ED Pro Fees REMOVAL FB FROM EAR, W/GENERAL ANESTHESIA 316 69205ED Pro Fees REMOVAL FOREIGN BODY, FOOT, SUBCUTANEOUS 579 28190

60

ED Pro Fees REMOVAL FOREIGN BODY, FOOT, DEEP 1175 28192ED Pro Fees CLSD TX CALCANELA FX W/O MANIPULATION 564 28400ED Pro Fees CLSD TX TALUS FX W/O MANIPULATION 534 28430ED Pro Fees TX TARSAL BONE FX W/O MANIPULATION, EACH 492 28450ED Pro Fees CLSD TX METATARSAL FX W/O MANIPULATION, EACH 484 28470ED Pro Fees CLSD TX METATARSAL FX W/MANIP 680 28475ED Pro Fees CLSD TX FX GREAT TOE/PHALANGES W/O MANIPULATION 330 28490ED Pro Fees CLSD TX FX PHALANX OTHER THAN GR TOE, W/O MANIP, EACH 279 28510ED Pro Fees APPLICATION, CAST, FIGURE-OF-EIGHT 308 29049ED Pro Fees APPLICATION, CAST, LONG ARM 219 29065ED Pro Fees APPLICATOIN, CAST, SHORT ARM 204 29075ED Pro Fees APPLICATION, CAST, GAUNTLET 293 29085ED Pro Fees APPLICATION, CAST, FINGER 176 29086ED Pro Fees APPLICATION LONG ARM SPLINT 199 29105ED Pro Fees STRAPPING, THORAX 119 29200ED Pro Fees STRAPPING, SHOULDER 130 29240ED Pro Fees STRAPPING:ELBOW/ WRIST 60 29260ED Pro Fees STRAPPING, HAND OR FINGER 106 29280ED Pro Fees APPLICATION LONG LEG CAST 389 29345ED Pro Fees APPLICATION SHORT LEG CAST 188 29405ED Pro Fees APPLICATION PATELLAR TENDON BEARING CAST 285 29435ED Pro Fees APPLICATION LONG LEG SPLINT 183 29505ED Pro Fees STRAPPING, KNEE 118 29530ED Pro Fees STRAPPING, ANKLE OR FOOT 83 29540ED Pro Fees STRAPPING TOES 33 29550ED Pro Fees NOSEBLEED CONTROL, POSTERIOR 314 30905ED Pro Fees REMOVAL OF PICC LINE 384 36589ED Pro Fees BIOPSY OF LIP 297 40490ED Pro Fees REPAIR CHEEK CAVITY >2.5 775 40831ED Pro Fees DRAINAGE ABSCESS DENTOALVEOLAR STRUCTURE 608 41800ED Pro Fees DENTOALVEOLAR UNLISTED P 117 41899

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ED Pro Fees CONTROL NASOPHAR HEM, SIMPLE 936 42970ED Pro Fees I & D ABSCESS, RECTUM 655 45005ED Pro Fees I & D PERIRECTAL ABSCESS 1254 46040ED Pro Fees INCISION, THROMBOSED HEMORRHOID, EXT 539 46083ED Pro Fees EXCISION OF SINGLE EXTERNAL ANAL TAG 370 46220ED Pro Fees ANOSCOPY 263 46600ED Pro Fees DESTRUCTION PENILE LESION 506 54065ED Pro Fees EPLEY MANEUVER 94 95992ED Pro Fees IRRIGATION OF PORT 79 96523ED Pro Fees CONS SEDATION, <5YRS 30 MIN 140 99143ED Pro Fees CONS SEDATION, >5YRS 30 MIN 78 99144ED Pro Fees CONS SEDATION, EA ADDL 15 22 99145ED Pro Fees CONS SEDATION, DIFF PRO, <5, 1ST 30 MIN 334 99148ED Pro Fees CONS SEDATION, DIFF PRO,>5, 1ST 30 MINUT 119 99149ED Pro Fees CONS SEDATION, DIFF PRO, EA ADDL 15 MIN 39 99150ED Pro Fees APPLICATION SHORT LEG CAST, WALKING 183 29425ED Pro Fees CLSD TX FINGER DISLOCATION W/MANIP 706 26770

Hospital Ortho Department DEBRIDE LAT/MED ELBOW 1450 24358Hospital Ortho Department OPEN TRTNMT OF DISTAL RADIAL FX 2041 25607Hospital Ortho Department ORIF DISTAL RADIOUS INTRA-ARTICULAR 2279 25608Hospital Ortho Department TENDON SHEATH INCISION; FINGERS/HAND 849 26055Hospital Ortho Department REPAIR EXTENSOR TENDON WO GRAFT 1550 26410Hospital Ortho Department OPEN TX PHALANGEAL FX 1660 26735Hospital Ortho Department HIP ARTHROPLASTY 3771 27130Hospital Ortho Department REVISION, TOTAL HIP 5330 27134Hospital Ortho Department REVISION, THA, ACETABULUM 4096 27137Hospital Ortho Department REVISON, THA, FEMUR 4255 27138Hospital Ortho Department MEDIAL COLLATERAL LIGAMENT REPAIR 1865 27405Hospital Ortho Department RECONSTRUCTION JT DISLOCATE PATELLA 2064 27420Hospital Ortho Department LATERAL RETINACULAR RELEASE 1245 27425

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Hospital Ortho Department ARTHROPLASTY, PARTIAL KNEE 3219 27446Hospital Ortho Department TOTAL KNEE ARTHROPLASTY 3713 27447Hospital Ortho Department REVISION OF TKA 3907 27486Hospital Ortho Department REVISION TKA; FEMORAL/ENTIRE TIBIAL CMPT 4879 27487Hospital Ortho Department REMOVAL OF PROSTHESIS 3339 27488Hospital Ortho Department ORIF PATELLA FX 2083 27524Hospital Ortho Department MANIPULATION KNEE JT GEN ANESTHESIA 418 27570Hospital Ortho Department REPAIR FLEXOR TENDON WO GRFT 1030 27658Hospital Ortho Department REPAIR, SECONDARY, LIGAMENT, ANKLE, COLL 1769 27698Hospital Ortho Department REMOVAL ANKLE IMPLANT 1591 27704Hospital Ortho Department OPEN TX DISTAL FIB FX 1489 27792Hospital Ortho Department OPEN TX, BIMALLEOLAR FX W/INTERNAL FIX 2138 27814Hospital Ortho Department OPEN TX DISTAL TIB/FIB JT 1898 27829Hospital Ortho Department BONE EXCISION, PARTIAL;TALUS/CALC 1368 28120Hospital Ortho Department TENOTOMY LENGTH/ABD HALLUCIS 793 28240Hospital Ortho Department CORRECTION, HALLUS VALGUS 1440 28296Hospital Ortho Department OSTEOTOMY 1ST METAR (BUNIONECTOMY) 1107 28306Hospital Ortho Department AMPUTATION, METATARSAL,W/TOE, SGL 1199 28810Hospital Ortho Department AMPUTATION, MTP JOINT 1097 28820Hospital Ortho Department ARTHROSCOPY, SHOULDER 1307 29805Hospital Ortho Department ARTHROSCOPY, SHOULDER: CAPSULORRHAPHY 2962 29806Hospital Ortho Department ARTHROSCOPY, SHOULDER: RPR SLAP LESION 2891 29807Hospital Ortho Department SURGICAL REMOVAL OF LOOSE FB 1632 29819Hospital Ortho Department ARTHROSCOPY, SHOULDER, DISTAL CLAVICULEC 1857 29824Hospital Ortho Department ARTHROSCOPY, SHOULDER W/LIG RELEASE 484 29826Hospital Ortho Department ARTHROSCOPY, SHOULDER, BICEPS TENODESIS 2544 29828Hospital Ortho Department ARTHROSCOPICALLY AIDED TRMNT, TIBIAL FX 2170 29855Hospital Ortho Department ARTHROSCOPY, KNEE W/WO SYNOVIAL BX 1141 29870Hospital Ortho Department KNEE ARTHROSCOPY, SYNOVECTOMY 2+ COMPART 1833 29876Hospital Ortho Department KNEE ARTHROSCOPY DEBRIDEMENT/SHAVING 1732 29877Hospital Ortho Department ARTHROSCOPY, KNEE MENISCECTOMY 1566 29880

63

Hospital Ortho Department KNEE ARTHROSCOPY, W/MENISCECTOMY 1509 29881Hospital Ortho Department ARTHROSCOPY, KNEE W/MENISCUS RPR 1954 29882Hospital Ortho Department RECONSTRUCTION ANT CRUC LIGAMENT 2740 29888Hospital Ortho Department NEUROPLASTY, ULNAR NERVE, ELBOW 1650 64718Hospital Ortho Department CARPAL TUNNEL RELEASE; MEDIAN NERVE 1176 64721Hospital Ortho Department PERCUTANEOUS SKELETAL FIX UNSTABLE PHALANGE 1294 26727Hospital Ortho Department ARTHROSCOPY SHLDR ROTATOR CUFF REPAIR 2410 29827Hospital Ortho Department DEBRIDEMENT MUSCLE FASCIA < 20 SQ CM 431 11043Hospital Ortho Department DEBRIDEMENT BONE MUSCLE/FASCIA <20 SQCM 640 11044Hospital Ortho Department DEBRIDEMENT BONE EA ADDL 20 SQCM 277 11047Hospital Ortho Department REMOVAL OF IMPLANT; SUPERFICIAL 1037 20670Hospital Ortho Department REMOVAL, IMPLANT, DEEP 1176 20680Hospital Ortho Department CPTR ASST SURG NAV 412 20985Hospital Ortho Department TENODESIS, LONG TENDON BICEPS 2063 23430Hospital Ortho Department ARTHROSCOPY, SHOULDER, GLENOHUMERAL JT 4031 23472Hospital Ortho Department CLAVICULAR FX, ORIF 1994 23515Hospital Ortho Department BIOPSY, SOFT TISSUE, UPPER ARM/ELBOW 1121 24066Hospital Ortho Department REINSERTION, RUPTURED BICEPS/TRICPS TEND 2143 24342Hospital Ortho Department UNSPECIFIED PROCEDURE ON HIP 2595 27299Hospital Ortho Department TOTAL KNEE ARTHROPLASTY, BILATERAL 7426 27447Hospital Ortho Department ARTHROSCOPY, KNEE W/LATERAL RELEASE 1420 29873Hospital Ortho Department ARTHROCENTESIS,/ASPIRATION/ INJECTION SMALL JOINT 142 20600Hospital Ortho Department ARTHROCENTESIS/ASPIRATION/INJECTION INTERMEDIATE JOINT 149 20605Hospital Ortho Department OPEN TREATMENT INTERCONDYLAR SPINES OF TIBIA W/INTERNAL FIXATION 2179 27540Hospital Ortho Department ARTHROCENTESIS/ASPIRATION/INJ MAJOR JT, OUTPATIENT 179 20610Hospital Ortho Department ARTHROCENTESIS/ASPIRATION/INJ, MAJOR JT, INPATIENT PROCEDURE 179 20610Hospital Ortho Department OPEN TX MEDIAL MALLEOLUS FX W/INTERNAL FIXATION 1639 27766Hospital Ortho Department REPAIR, TENDON, FLEXOR FOOT 872 28200Hospital Ortho Department ARTHROPLASTY, PATELLA; WITH PROSTHESIS 2264 27438Hospital Ortho Department REPAIR, RUPTURED ACHILLES TENDON 1774 27650Hospital Ortho Department OSTECTOMY, CALCANEUS 1118 28118

64

Hospital Ortho Department ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE 1393 29871Hospital Ortho Department REVISION OF TOTAL KNEE ARTHROPLASTY, BILATERAL 9758 27487Hospital Ortho Department ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE 1310 29843Hospital Ortho Department ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE 1669 29823Hospital Ortho Department CARPAL TUNNEL RELEASE, BILATERAL 2353 64721

Inpatient Pro Fees CENTRAL LINE > 5 YO 543 36556Inpatient Pro Fees INSERTION TUNNELED CVA, OVER 5 YRS 1072 36561Inpatient Pro Fees PICC LINE INSERTION 577 36569Inpatient Pro Fees GASTRIC INTUBATION AND ASPIRATION 67 43753Inpatient Pro Fees CARDIOVERSION 476 92960Inpatient Pro Fees HOSP INPT ADMIT LOW 178 99221Inpatient Pro Fees HOSP INPT ADMIT MODERATE 237 99222Inpatient Pro Fees HOSP INPT ADMIT HIGH 300 99223Inpatient Pro Fees HOSP IP VISIT FOCUSED 94 99231Inpatient Pro Fees HOSP IP VISIT EXP FOCUSED 137 99232Inpatient Pro Fees HOSP IP VISIT DETAILED 178 99233Inpatient Pro Fees OBS OR IP A/D SAME DAY LOW 271 99234Inpatient Pro Fees OBS OR IP A/D SAME DAY MODERATE 415 99235Inpatient Pro Fees HOSP IP DISCHARGE 167 99238Inpatient Pro Fees HOSP IP DISCHARGE >30 MIN 208 99239Inpatient Pro Fees PROLONGED SVC IN IP OR OBS SETTING, 1ST HOUR 166 99356Inpatient Pro Fees PROLONGED SVC IN IP OR OBS SETTING, EA ADDL 30 MIN 166 99357Inpatient Pro Fees TOTAL KNEE ARTHROPLASTY, ASSISTANT SURGEON 3713 27447Inpatient Pro Fees POST OP VISIT DURING GLOBAL PERIOD 0 99024

Observation OBS BED FIRST HR 721 G0378Observation OBS BED ADD'L HR 103 G0378Observation OBS BED 1ST HR W/TELE 824 G0378Observation OBS BED W/TELE ADD'L HR 122 G0378Observation DIRECT ADMIT TO OBSERVATION 1288 G0379

65

Observation DIRECT ADMIT TO OBS BED W/TELEMETRY 1545 G0379Observation INSERTION OF NON-INDWELLING BLADDER CATHETER 129 51701

OP Cardiac Rehab CARDIAC REHAB, OP, W/CONTINUOUS ECG MONITORING, OTHER HCP 234 93798OP Cardiac Rehab CARDIAC REHAB, OP, W/O CONTINUOUS ECG MONITORING, OTHER HCP 206 93797

Outpatient Pro Fees REMOVAL TUNNELED CVAD W/PORT 591 36590Outpatient Pro Fees HOSP OBS DISCHARGE 143 99217Outpatient Pro Fees HOSP OBS COMP LOW ADMIT 136 99218Outpatient Pro Fees HOSP OBS COMP MODERATE ADMIT 219 99219Outpatient Pro Fees HOSP OBS COMP HIGH ADMIT 300 99220Outpatient Pro Fees SUB OBS PROB FOCUSED VISIT 52 99224Outpatient Pro Fees SUB OBS EXP PROB FOC VISIT 81 99225Outpatient Pro Fees SUB OBS DETAILED VISIT 114 99226Outpatient Pro Fees INSERTION OF CENTRAL VENOUS ACCESS DEVICE 1030Outpatient Pro Fees EKG PRO FEE 21 93010,26Outpatient Pro Fees EKG PRO FEE, REPEAT 21 93010,26,76Outpatient Pro Fees EST PT EXPANDED FOCUSED 117 99213Outpatient Pro Fees EST PT FOCUSED VISIT 80 99212Outpatient Pro Fees EST PT DETAILED VISIT 165 99214Outpatient Pro Fees EST PT COMPREHENSIVE 224 99215Outpatient Pro Fees INSERTION NON-INDWELLING BLADDER CATHETER 132 51701Outpatient Pro Fees OBS OR IP A/D SAME DAY HIGH 471 99236

Surgery INJECTION LUMBAR/SACRAL WITHOUT IMAGING GUIDANCE 787 20552Surgery BLOOD PATCH 811Surgery INJECTION, JOINT, INTERMEDIATE 661Surgery COLONOSCOPY 2169Surgery EGD 2169Surgery EGD/COLONOSCOPY 3949Surgery FLEXIBLE SIGMOIDOSCOPY 1496

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Surgery INJ TRANSFORAMINAL LUMBAR 811 64483Surgery VASECTOMY 382 55250Surgery CHEST TUBE 1626 32551Surgery INJ, SGL L/S W/FLUORO, EPIDURAL 1192 62323Surgery INJECTION, JOINT MAJOR 811 20610Surgery REMOVAL CVA DEVICE W/PORT/PUMP 657 36590Surgery INJECTION, CERVICAL OR THORACIC W/IMAGING GUIDANCE 1193 62321Surgery INJECTION, JOINT, SMALL, WITH FLUOROSCOPIC GUIDANCE 52 20600Surgery LEVEL I OPERATING ROOM, PER MINUTE 110Surgery LEVEL III OPERATING ROOM, PER MINUTE 130Surgery LEVEL IV OPERATING ROOM, PER MINUTE 140Surgery LEVEL V OPERATING ROOM, PER MINUTE 150Surgery LEVEL II OPERATING ROOM, PER MINUTE 120Surgery INJECTION FOR SI JOINT W/IMAGING GUIDANCE 1193 27096

Swing SWING BED MLOA 0Swing SWING BED ROOM-PRIVATE 1658

Treatment Room OP IM ANTIBIOTIC ADMIN 67 96372Treatment Room OP IM/SC MED ADMIN THERAPEUTIC PROPHYLAC 80 96372Treatment Room OP VACCINE ADMIN 117 90471Treatment Room OP TREATMENT ROOM 318 99211Treatment Room OP TX ROOM-FOLEY INSERT 267 51702Treatment Room OP PNEUMONIA ADMIN 67 G0009Treatment Room OP TX RM WND CARE/VAC<50 296 97605Treatment Room OP TX RM WND CARE/VAC>50 306 97606Treatment Room OP TX ROOM CENTRAL LINE NON TUNNELED 597 36556Treatment Room PICC LINE INSERT (OP) >5 YR W/O PORT 577 36569Treatment Room OP VASECTOMY 995 55250Treatment Room OP CENTRAL LINE INSERT >5 NON TUNNELED 400 36556Treatment Room FETAL NON STRESS TEST 161 59025

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Treatment Room OP MAJOR JOINT INJECTION 176 20610Treatment Room OP CIRCUMCISION>28 DAYS 1171 54161Treatment Room OP CIRCUMCISION, W/CLAMP 1171 54150Treatment Room OP CIRCUMCISION < 28 DAYS OLD 384 54160Treatment Room OP ORAL MED ADMINISTRATION 64 99211Treatment Room PICC LINE/PORT FLUSH (TX RM) 116 96523Treatment Room OP FOREIGN BODY REMOVAL 538Treatment Room IM/SQ INJECTION CHEMO HORMONAL ANTINEO 90 96402Treatment Room TUNNELED CV CATHETER REMOVAL 446 36589Treatment Room OP TX ROOM; LUMBAR PUNCTURE, DIAGNOSTIC 456 62270Treatment Room OP SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CS FLUID 279 62272Treatment Room CATHETERIZATION FOR COLLECTION OF SPECIMEN 36 P9612Treatment Room REMOVAL OF DEVITALIZED TISSUE FROM WOUND 155 97602

cc anesthesiology nerve block, femoral 186 64447

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