hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|CA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,
Christiana Care Hospital,8/13/2025,2.0.0,"Christiana Care Hospital, West Grove Campus","1015 W. Baltimore Pike, West Grove, PA 19390",51440101,TRUE,,,,,,,,,,,,,,,,
description,code | 1,code | 1 | type,code | 2,code | 2 | type,code | 3,code | 3 | type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,modifiers,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|min,standard_charge|max,standard_charge|methodology,additional_generic_notes
"Inpatient Pvt R&B, per day - L1",110,RC,,,411000001,CDM,inpatient,,,2232.38,1897.52,,,,,,,,,,,hospital's standard charge pricing
"Inpt Semi Pvt R&B, per day - L1",120,RC,,,412000001,CDM,inpatient,,,2232.38,1897.52,,,,,,,,,,,hospital's standard charge pricing
Lidocaine 1% 20 ml inj,250,RC,,,425000003,CDM,both,1,ML,0.10,0.09,,,,,,,,,,,hospital's standard charge pricing
Lidocaine (CARDIAC) 2% 5ml syr,250,RC,J2003,HCPCS,425000012,CDM,both,1,ML,1.20,1.02,,,,,,,,,,,hospital's standard charge pricing
Ampicillin 1 gm inj,250,RC,J0290,HCPCS,425000015,CDM,both,1,UN,56.10,47.69,,,,,,,,,,,hospital's standard charge pricing
Diphenhydramine 12.5mg/5mL soln,250,RC,,,425000018,CDM,both,1,ML,1012.20,860.37,,,,,,,,,,,hospital's standard charge pricing
Diphenhydramine 50 mg/ml inj,250,RC,J1200,HCPCS,425000019,CDM,both,1,ML,16.20,13.77,,,,,,,,,,,hospital's standard charge pricing
Dicyclomine 20mg/2mL inj,250,RC,J0500,HCPCS,425000021,CDM,both,1,ML,169.00,143.65,,,,,,,,,,,hospital's standard charge pricing
"Calcium Chloride 10% 1,000mg/10mL syr",250,RC,,,425000023,CDM,both,1,ML,97.35,82.75,,,,,,,,,,,hospital's standard charge pricing
Nicardipine 25mg/10mL inj,250,RC,,,425000026,CDM,both,1,ML,2.01,1.71,,,,,,,,,,,hospital's standard charge pricing
Actidose w/ Sorbitol 25 grams/120 ml,250,RC,,,425000029,CDM,both,1,ML,106.45,90.48,,,,,,,,,,,hospital's standard charge pricing
Diltiazem 25mg/5mL inj,250,RC,,,425000030,CDM,both,1,ML,32.55,27.67,,,,,,,,,,,hospital's standard charge pricing
Ciprofloxacin 0.3% Eye Drops 2.5ml,250,RC,,,425000031,CDM,both,1,ML,82.40,70.04,,,,,,,,,,,hospital's standard charge pricing
Famotidine 20mg/2mL inj (per 20mg),250,RC,,,425000039,CDM,both,1,ML,14.70,12.50,,,,,,,,,,,hospital's standard charge pricing
Metronidazole 500 mg IV,250,RC,,,425000041,CDM,both,1,ML,0.45,0.38,,,,,,,,,,,hospital's standard charge pricing
Bupivacaine 0.5% 10mL inj,250,RC,,,425000042,CDM,both,1,ML,0.28,0.24,,,,,,,,,,,hospital's standard charge pricing
Dextrose 50% syr 50 ml,250,RC,,,425000051,CDM,both,1,ML,125.85,106.97,,,,,,,,,,,hospital's standard charge pricing
Dextrose 25% syr 10 ml,250,RC,,,425000052,CDM,both,1,ML,128.30,109.06,,,,,,,,,,,hospital's standard charge pricing
Enalaprilat 1.25mg/ml inj,250,RC,,,425000061,CDM,both,1,ML,45.85,38.97,,,,,,,,,,,hospital's standard charge pricing
Epinephrine 1:1000 inj 1 ml,250,RC,J0171,HCPCS,425000062,CDM,both,1,ML,10.76,9.15,,,,,,,,,,,hospital's standard charge pricing
Erythromycin eye ointment,250,RC,,,425000063,CDM,both,1,GR,119.95,101.96,,,,,,,,,,,hospital's standard charge pricing
Etomidate 20mg/10mL inj,250,RC,,,425000064,CDM,both,1,ML,52.25,44.41,,,,,,,,,,,hospital's standard charge pricing
Fleet Enema (for adults),250,RC,,,425000068,CDM,both,1,ML,18.60,15.81,,,,,,,,,,,hospital's standard charge pricing
Cyclobenzaprine 5mg tablet,250,RC,,,425000069,CDM,both,1,UN,15.80,13.43,,,,,,,,,,,hospital's standard charge pricing
Gentamycin eye drops,250,RC,,,425000073,CDM,both,1,ML,135.80,115.43,,,,,,,,,,,hospital's standard charge pricing
Multivitamin 10mL inj,250,RC,,,425000077,CDM,both,1,ML,1561.65,1327.40,,,,,,,,,,,hospital's standard charge pricing
Albuterol 2.5mg/3ml UD,250,RC,,,425000082,CDM,both,1,ML,13.15,11.18,,,,,,,,,,,hospital's standard charge pricing
Ketamine 500mg/10mL inj,250,RC,,,425000083,CDM,both,1,ML,12.95,11.01,,,,,,,,,,,hospital's standard charge pricing
Labetalol 5mg/ml 20ml Inj MDV - per 5 mg,250,RC,J1920,HCPCS,425000084,CDM,both,1,ML,8.70,7.40,,,,,,,,,,,hospital's standard charge pricing
Norepinephrine 4mg/4mL inj,250,RC,,,425000090,CDM,both,1,ML,110.00,93.50,,,,,,,,,,,hospital's standard charge pricing
Lidocaine Topical 4% soln 50ml bottle,250,RC,,,425000092,CDM,both,1,ML,290.20,246.67,,,,,,,,,,,hospital's standard charge pricing
Lidocaine 2% inj 20 ml,250,RC,,,425000096,CDM,both,1,ML,0.06,0.05,,,,,,,,,,,hospital's standard charge pricing
Metoprolol 5mg/5mL inj,250,RC,,,425000100,CDM,both,1,ML,17.15,14.58,,,,,,,,,,,hospital's standard charge pricing
Magnesium Citrate 296mL,250,RC,,,425000103,CDM,both,1,ML,18.85,16.02,,,,,,,,,,,hospital's standard charge pricing
Ibuprofen 100mg/5mL suspension,250,RC,,,425000108,CDM,both,1,UN,9.35,7.95,,,,,,,,,,,hospital's standard charge pricing
"Bupivacaine w/EPI 0.5%/1:200,000 inj 30 ml",250,RC,,,425000110,CDM,both,1,ML,27.85,23.67,,,,,,,,,,,hospital's standard charge pricing
Nitro-bid 2% oint,250,RC,,,425000111,CDM,both,1,GR,26.20,22.27,,,,,,,,,,,hospital's standard charge pricing
Nitroglycerin in Dextrose inj 50 mg/250ml Premixed bottle,250,RC,,,425000113,CDM,both,1,ML,104.40,88.74,,,,,,,,,,,hospital's standard charge pricing
Nitrostat 0.4mg SL tab,250,RC,,,425000114,CDM,both,1,UN,159.15,135.28,,,,,,,,,,,hospital's standard charge pricing
Trimeth/Polymyxin B opth soln,250,RC,,,425000129,CDM,both,1,ML,110.70,94.10,,,,,,,,,,,hospital's standard charge pricing
"Propofol 1,000mg/100mL inj",250,RC,J2704,HCPCS,425000132,CDM,both,1,ML,14.39,12.23,,,,,,,,,,,hospital's standard charge pricing
Flumazenil 0.5mg/5mL inj,250,RC,,,425000135,CDM,both,1,ML,58.35,49.60,,,,,,,,,,,hospital's standard charge pricing
Racepinephrine 2.25% soln,250,RC,,,425000137,CDM,both,1,UN,23.10,19.64,,,,,,,,,,,hospital's standard charge pricing
Timolol 0.5% Ophtalmic Drops,250,RC,,,425000144,CDM,both,1,ML,108.25,92.01,,,,,,,,,,,hospital's standard charge pricing
Vasopressin 20u inj,250,RC,,,425000147,CDM,both,1,ML,35.23,29.95,,,,,,,,,,,hospital's standard charge pricing
Acetaminophen 160mg/5mL suspension,250,RC,,,425000148,CDM,both,1,ML,10.40,8.84,,,,,,,,,,,hospital's standard charge pricing
Sodium bicarb 8.4% 50 ml,250,RC,,,425000156,CDM,both,1,ML,143.55,122.02,,,,,,,,,,,hospital's standard charge pricing
Vecuronium 10 mg/10 ml inj,250,RC,,,425000159,CDM,both,1,UN,45.05,38.29,,,,,,,,,,,hospital's standard charge pricing
Lidocaine Viscous 2% 100mL,250,RC,,,425000162,CDM,both,1,ML,47.95,40.76,,,,,,,,,,,hospital's standard charge pricing
Phytonadione 10 mg/ml inj (per 1mg),250,RC,J3430,HCPCS,425000163,CDM,both,1,ML,33.28,28.29,,,,,,,,,,,hospital's standard charge pricing
Procainamide 1gm/10mL inj (up to 1gm),250,RC,J2690,HCPCS,425000165,CDM,both,1,ML,618.30,525.56,,,,,,,,,,,hospital's standard charge pricing
Azithromycin 250 mg tab,250,RC,,,425000166,CDM,both,1,UN,54.15,46.03,,,,,,,,,,,hospital's standard charge pricing
Azithromycin 500mg vial,250,RC,J0456,HCPCS,425000167,CDM,both,1,UN,69.15,58.78,,,,,,,,,,,hospital's standard charge pricing
Ondansetron 4 mg ODT tab,250,RC,,,425000168,CDM,both,1,UN,139.30,118.41,,,,,,,,,,,hospital's standard charge pricing
Ceftriaxone 500 mg inj,250,RC,J0696,HCPCS,425000183,CDM,both,1,UN,7.43,6.32,,,,,,,,,,,hospital's standard charge pricing
Cefazolin sodium 1 gm inj,250,RC,J0690,HCPCS,425000185,CDM,both,1,UN,8.75,7.44,,,,,,,,,,,hospital's standard charge pricing
Cefoxitin sodium 1 gm inj,250,RC,J0694,HCPCS,425000187,CDM,both,1,UN,48.20,40.97,,,,,,,,,,,hospital's standard charge pricing
Ceftriaxone sodium 1 gm inj,250,RC,J0696,HCPCS,425000188,CDM,both,1,UN,4.64,3.94,,,,,,,,,,,hospital's standard charge pricing
Chlorpromazine 25 mg/ml inj,250,RC,J3230,HCPCS,425000189,CDM,both,1,ML,211.95,180.16,,,,,,,,,,,hospital's standard charge pricing
Dexamethasone 10mg/1mL inj,250,RC,J1100,HCPCS,425000192,CDM,both,1,ML,1.79,1.52,,,,,,,,,,,hospital's standard charge pricing
Diazepam 10 mg/2 ml inj,250,RC,J3360,HCPCS,425000193,CDM,both,1,ML,115.70,98.35,,,,,,,,,,,hospital's standard charge pricing
Fentanyl 0.1mg/2mL inj,250,RC,J3010,HCPCS,425000196,CDM,both,1,ML,20.25,17.21,,,,,,,,,,,hospital's standard charge pricing
Furosemide 40mg/4mL inj,250,RC,J1940,HCPCS,425000197,CDM,both,1,ML,13.95,11.86,,,,,,,,,,,hospital's standard charge pricing
Enoxaparin 100mg/1mL syr (per 10mg),250,RC,J1650,HCPCS,425000199,CDM,both,1,ML,13.76,11.70,,,,,,,,,,,hospital's standard charge pricing
Adenosine 6mg/2mL inj,250,RC,J0153,HCPCS,425000204,CDM,both,1,ML,8.31,7.06,,,,,,,,,,,hospital's standard charge pricing
Ketorolac 30mg/mL 1mL inj (per 15mg),250,RC,J1885,HCPCS,425000205,CDM,both,1,ML,10.03,8.53,,,,,,,,,,,hospital's standard charge pricing
Levofloxacin 750mg-Dextrose 5% 150mL soln (per 250mg),250,RC,J1956,HCPCS,425000206,CDM,both,1,ML,16.60,14.11,,,,,,,,,,,hospital's standard charge pricing
Lorazepam 2 mg/ml inj,250,RC,J2060,HCPCS,425000207,CDM,both,1,ML,17.85,15.17,,,,,,,,,,,hospital's standard charge pricing
Methylprednisolone Sodium Succinate 125 mg/ 2ml inj,250,RC,J2930,HCPCS,425000209,CDM,both,1,UN,2.35,2.00,,,,,,,,,,,hospital's standard charge pricing
Metoclopramide 10mg/2mL inj,250,RC,J2765,HCPCS,425000210,CDM,both,1,ML,16.65,14.15,,,,,,,,,,,hospital's standard charge pricing
Protonix 40 mg inj,250,RC,C9113,HCPCS,425000215,CDM,both,1,UN,55.35,47.05,,,,,,,,,,,hospital's standard charge pricing
Silver Sulfadiazine 1 % 20gm cream,250,RC,,,425000216,CDM,both,1,GR,61.20,52.02,,,,,,,,,,,hospital's standard charge pricing
"Rho(D) Immune Globulin 1,500unit (300mCg) syr (per 300mCg)",250,RC,J2790,HCPCS,425000217,CDM,both,1,UN,52.67,44.77,,,,,,,,,,,hospital's standard charge pricing
Vancomycin 1 gm injection,250,RC,J3373,HCPCS,425000219,CDM,both,1,UN,57.35,48.75,,,,,,,,,,,hospital's standard charge pricing
Digoxin 0.5mg/2mL amp,250,RC,J1160,HCPCS,425000220,CDM,both,1,ML,49.70,42.25,,,,,,,,,,,hospital's standard charge pricing
Gentamicin 80mg/2mL inj,250,RC,J1580,HCPCS,425000221,CDM,both,1,ML,39.20,33.32,,,,,,,,,,,hospital's standard charge pricing
Hydralazine 20 mg/ml inj,250,RC,J0360,HCPCS,425000223,CDM,both,1,ML,107.80,91.63,,,,,,,,,,,hospital's standard charge pricing
Prochlorperazine 10mg/2mL inj,250,RC,J0780,HCPCS,425000225,CDM,both,1,ML,43.55,37.02,,,,,,,,,,,hospital's standard charge pricing
Succinylcholine 200mg/10mL inj,250,RC,J0330,HCPCS,425000226,CDM,both,1,ML,13.55,11.52,,,,,,,,,,,hospital's standard charge pricing
Sumatriptan succinate 6 mg inj,250,RC,J3030,HCPCS,425000227,CDM,both,1,ML,81.30,69.11,,,,,,,,,,,hospital's standard charge pricing
Naloxone 0.4mg/1mL inj,250,RC,J2310,HCPCS,425000228,CDM,both,1,ML,41.55,35.32,,,,,,,,,,,hospital's standard charge pricing
Amiodarone 150mg/3mL inj,250,RC,J0282,HCPCS,425000231,CDM,both,1,ML,3.21,2.73,,,,,,,,,,,hospital's standard charge pricing
Dopamine 400mg/D5W 250ml,250,RC,J1265,HCPCS,425000233,CDM,both,1,ML,85.70,72.85,,,,,,,,,,,hospital's standard charge pricing
Droperidol 2.5 mg inj,250,RC,J1790,HCPCS,425000234,CDM,both,1,ML,70.10,59.59,,,,,,,,,,,hospital's standard charge pricing
"Heparin 25,000 units/D5W 500ml Premix bag",250,RC,J1644,HCPCS,425000235,CDM,both,1,ML,117.20,99.62,,,,,,,,,,,hospital's standard charge pricing
Terbutaline 1 mg/ml inj,250,RC,J3105,HCPCS,425000239,CDM,both,1,ML,138.95,118.11,,,,,,,,,,,hospital's standard charge pricing
Haloperidol 5 mg/ml inj,250,RC,J1630,HCPCS,425000240,CDM,both,1,ML,16.40,13.94,,,,,,,,,,,hospital's standard charge pricing
Piperacillin/tazobactam 3.375 gm,250,RC,J2543,HCPCS,425000248,CDM,both,1,UN,34.80,29.58,,,,,,,,,,,hospital's standard charge pricing
Verapamil 5 mg inj 2 ml,250,RC,,,425000252,CDM,both,1,ML,81.75,69.49,,,,,,,,,,,hospital's standard charge pricing
Td Vaccine (Tenivac),250,RC,90714,HCPCS,425000253,CDM,both,1,ML,268.05,227.84,,,,,,,,,,,hospital's standard charge pricing
Acyclovir 400mg tab,250,RC,,,425000259,CDM,both,1,UN,30.45,25.88,,,,,,,,,,,hospital's standard charge pricing
Nicotine Tran 21 mg patch,250,RC,,,425000261,CDM,both,1,UN,19.75,16.79,,,,,,,,,,,hospital's standard charge pricing
Atropine Sulfate 1% Oph Sol 2 ml,250,RC,,,425000266,CDM,both,1,ML,275.35,234.05,,,,,,,,,,,hospital's standard charge pricing
Doxycycline 100 mg tab,250,RC,,,425000269,CDM,both,1,UN,31.90,27.12,,,,,,,,,,,hospital's standard charge pricing
Doxycycline 100 mg Vl 20 ml,250,RC,J0120,HCPCS,425000270,CDM,both,1,UN,123.20,104.72,,,,,,,,,,,hospital's standard charge pricing
Cyanocobalamin 1000 mcg/ml inj,250,RC,J3420,HCPCS,425000276,CDM,both,1,ML,40.60,34.51,,,,,,,,,,,hospital's standard charge pricing
Oxytocin 10unit/1mL (up to 10 units),250,RC,J2590,HCPCS,425000285,CDM,both,1,ML,54.15,46.03,,,,,,,,,,,hospital's standard charge pricing
Promethazine 25mg suppository,250,RC,,,425000287,CDM,both,1,UN,112.35,95.50,,,,,,,,,,,hospital's standard charge pricing
Zolpidem Tartrate 5mg tab,250,RC,,,425000292,CDM,both,1,UN,18.75,15.94,,,,,,,,,,,hospital's standard charge pricing
Clopidogrel Bisulfate 75 mg tab,250,RC,,,425000294,CDM,both,1,UN,37.50,31.88,,,,,,,,,,,hospital's standard charge pricing
Prednisolone 15mg/5mL (per 5mg),250,RC,J7510,HCPCS,425000322,CDM,both,1,ML,169.60,144.16,,,,,,,,,,,hospital's standard charge pricing
Guaifenesin 600mg tab,250,RC,,,425000325,CDM,both,1,UN,14.35,12.20,,,,,,,,,,,hospital's standard charge pricing
"Penicillin g benzathine 1,200,000 units/2mL syr",250,RC,J0561,HCPCS,425000347,CDM,both,1,ML,169.06,143.70,,,,,,,,,,,hospital's standard charge pricing
Hypertet (Tetanus ImG),250,RC,J1670,HCPCS,425000354,CDM,both,1,UN,3694.05,3139.94,,,,,,,,,,,hospital's standard charge pricing
Lidocaine 2 gm w/D5W 500 ml,250,RC,J2001,HCPCS,425000358,CDM,both,1,ML,0.03,0.03,,,,,,,,,,,hospital's standard charge pricing
Olanzapine IM inj 10 mg/2ml,250,RC,J2358,HCPCS,425000360,CDM,both,1,UN,13.50,11.48,,,,,,,,,,,hospital's standard charge pricing
Thiamine 200mg/2mL inj,250,RC,J3411,HCPCS,425000363,CDM,both,1,ML,37.18,31.60,,,,,,,,,,,hospital's standard charge pricing
Carvedilol 6.25 mg tabs,250,RC,,,425000365,CDM,both,1,UN,20.95,17.81,,,,,,,,,,,hospital's standard charge pricing
Amoxicillin-Potassium Clavulanate 875mg/125mg tab,250,RC,,,425000367,CDM,both,1,UN,38.10,32.39,,,,,,,,,,,hospital's standard charge pricing
Phenytoin 100mg/2ml,250,RC,J1165,HCPCS,425000381,CDM,both,1,ML,4.11,3.49,,,,,,,,,,,hospital's standard charge pricing
NALOXONE 1MG/ML SYR 2ML,250,RC,J2310,HCPCS,425000384,CDM,both,1,ML,113.53,96.50,,,,,,,,,,,hospital's standard charge pricing
Acetylcysteine 200mg/mL (20%) 30mL inj (IV use) (per 100mg),250,RC,J0132,HCPCS,425000392,CDM,both,1,ML,24.98,21.23,,,,,,,,,,,hospital's standard charge pricing
Ciprofloxacin 400mg/200ml Premix bag,250,RC,J0744,HCPCS,425000393,CDM,both,1,ML,27.38,23.27,,,,,,,,,,,hospital's standard charge pricing
Sodium Polystyrene Sulfonate 15gm/60ml,250,RC,,,425000394,CDM,both,1,ML,137.15,116.58,,,,,,,,,,,hospital's standard charge pricing
Levetiracetam (Keppra) IV 500mg/5ml,250,RC,J1953,HCPCS,425000398,CDM,both,1,ML,0.68,0.58,,,,,,,,,,,hospital's standard charge pricing
Tamsulosin 0.4mg cap,250,RC,,,425000399,CDM,both,1,UN,33.20,28.22,,,,,,,,,,,hospital's standard charge pricing
Propofol 200mg/20mL inj,250,RC,J2704,HCPCS,425000401,CDM,both,1,ML,1.85,1.57,,,,,,,,,,,hospital's standard charge pricing
Cephalexin 500mg cap,250,RC,,,425000402,CDM,both,1,UN,16.40,13.94,,,,,,,,,,,hospital's standard charge pricing
Levalbuterol 0.63mg/3ml inhalation sol UD,250,RC,,,425000403,CDM,both,1,ML,20.20,17.17,,,,,,,,,,,hospital's standard charge pricing
Levalbuterol 1.25mg/3mL neb soln,250,RC,,,425000404,CDM,both,1,ML,20.20,17.17,,,,,,,,,,,hospital's standard charge pricing
Penicillin g benzathine (Bicillin LA) inj 0.6 mu,250,RC,J0561,HCPCS,425000411,CDM,both,1,ML,195.82,166.45,,,,,,,,,,,hospital's standard charge pricing
Bismuth Subsalicylate 262mg/15mL 240mL susp,250,RC,,,425000412,CDM,both,1,ML,33.50,28.48,,,,,,,,,,,hospital's standard charge pricing
Colchicine 0.6mg cap,250,RC,,,425000413,CDM,both,1,UN,73.90,62.82,,,,,,,,,,,hospital's standard charge pricing
Plan B One-Step 1.5 mg tab,250,RC,,,425000417,CDM,both,1,UN,223.05,189.59,,,,,,,,,,,hospital's standard charge pricing
Rocuronium 10 mg/ml 5 ml vial,250,RC,,,425000419,CDM,both,1,ML,41.45,35.23,,,,,,,,,,,hospital's standard charge pricing
Enoxaparin 30 mg/0.3 ml syr,250,RC,J1650,HCPCS,425000421,CDM,both,1,ML,15.70,13.35,,,,,,,,,,,hospital's standard charge pricing
"GABAPENTIN, CAP 300MG UD ",250,RC,,,425000427,CDM,both,1,UN,16.25,13.81,,,,,,,,,,,hospital's standard charge pricing
Amiodarone 200mg tab,250,RC,,,425000432,CDM,both,1,UN,55.10,46.84,,,,,,,,,,,hospital's standard charge pricing
Ampicillin-Sulbactam 1.5gm vial,250,RC,J0295,HCPCS,425000435,CDM,both,1,UN,36.95,31.41,,,,,,,,,,,hospital's standard charge pricing
Sucralfate 1gm tab,250,RC,,,425000437,CDM,both,1,UN,36.60,31.11,,,,,,,,,,,hospital's standard charge pricing
Levofloxacin 500mg tab,250,RC,,,425000442,CDM,both,1,UN,121.65,103.40,,,,,,,,,,,hospital's standard charge pricing
"Potassium Chloride 20mEq-Sodium Chloride 0.9% 1,000mL (per 2mEq)",250,RC,J3480,HCPCS,425000444,CDM,both,1,ML,56.75,48.24,,,,,,,,,,,hospital's standard charge pricing
Carbamide Peroxide 6.5% 15mL susp,250,RC,,,425000446,CDM,both,1,ML,64.95,55.21,,,,,,,,,,,hospital's standard charge pricing
Oxymetazoline 0.05 % Nasal Spray 30ml,250,RC,,,425000449,CDM,both,1,ML,31.85,27.07,,,,,,,,,,,hospital's standard charge pricing
Cyclopentalate HCI 1% Ophthalmic Drops,250,RC,,,425000451,CDM,both,1,ML,246.10,209.19,,,,,,,,,,,hospital's standard charge pricing
Olanzapine 10mg ODT tab,250,RC,,,425000453,CDM,both,1,UN,26.35,22.40,,,,,,,,,,,hospital's standard charge pricing
Antibacterial Mupirocin 2% Top Oint/tube,250,RC,,,425000456,CDM,both,1,GR,259.40,220.49,,,,,,,,,,,hospital's standard charge pricing
Sodium Chloride-Aloe Vera Nasal 0.5gm gel,250,RC,,,425000461,CDM,both,1,GR,26.50,22.53,,,,,,,,,,,hospital's standard charge pricing
Polyethylene Glycol 3350 17gm pkt,250,RC,,,425000463,CDM,both,1,UN,17.20,14.62,,,,,,,,,,,hospital's standard charge pricing
Tobramycin/Dexameth susp 0.3-0.1% 2.5 ml,250,RC,,,425000464,CDM,both,1,ML,434.35,369.20,,,,,,,,,,,hospital's standard charge pricing
Butalbital-Acetaminophen-Caffeine 50mg/325mg/40mg tab,250,RC,,,425000466,CDM,both,1,UN,19.90,16.92,,,,,,,,,,,hospital's standard charge pricing
Cyklokapron amp 100 mg/ml 10 ml,250,RC,,,425000467,CDM,both,1,ML,156.35,132.90,,,,,,,,,,,hospital's standard charge pricing
Xarelto 10 mg tab,250,RC,,,425000469,CDM,both,1,UN,142.40,121.04,,,,,,,,,,,hospital's standard charge pricing
Phenylrphrine 10mg/1ml inj (per 20 mcg),250,RC,J2371,HCPCS,425000470,CDM,both,1,ML,0.07,0.06,,,,,,,,,,,hospital's standard charge pricing
Amlodipine 5mg tab,250,RC,,,425000482,CDM,both,1,UN,18.10,15.39,,,,,,,,,,,hospital's standard charge pricing
DILTIAZEM 60MG TAB,250,RC,,,425000484,CDM,both,1,UN,17.65,15.00,,,,,,,,,,,hospital's standard charge pricing
"FLUCONAZOLE, TAB 150MG ",250,RC,,,425000485,CDM,both,1,UN,90.25,76.71,,,,,,,,,,,hospital's standard charge pricing
"Acyclovir Sodium 1,000mg/20mL inj (per 5mg)",250,RC,J0133,HCPCS,425000486,CDM,both,1,ML,0.87,0.74,,,,,,,,,,,hospital's standard charge pricing
Acetazolamide Sterile Powder 500 mg/10 ml vial,250,RC,J1120,HCPCS,425000487,CDM,both,1,UN,225.80,191.93,,,,,,,,,,,hospital's standard charge pricing
"ASPIRIN, SUP 300MG",250,RC,,,425000490,CDM,both,1,UN,17.00,14.45,,,,,,,,,,,hospital's standard charge pricing
"Nystatin 100,000u/g topical powder 15g bottle",250,RC,,,425000495,CDM,both,1,GR,228.35,194.10,,,,,,,,,,,hospital's standard charge pricing
Oseltamivir 75mg cap,250,RC,,,425000499,CDM,both,1,UN,99.20,84.32,,,,,,,,,,,hospital's standard charge pricing
Mineral Oil Enema 133mL,250,RC,,,425000500,CDM,both,1,ML,20.65,17.55,,,,,,,,,,,hospital's standard charge pricing
Nicotine Trans 14 mg Patch,250,RC,,,425000502,CDM,both,1,UN,21.00,17.85,,,,,,,,,,,hospital's standard charge pricing
Ketoconazole 2% Crm (15gm),250,RC,,,425000505,CDM,both,1,GR,377.35,320.75,,,,,,,,,,,hospital's standard charge pricing
Insulin LISPRO 3 ML VIAL,250,RC,J1815,HCPCS,425000509,CDM,both,1,ML,0.01,0.01,,,,,,,,,,,hospital's standard charge pricing
Valproate sodium 100 mg/mL 5mL Inj,250,RC,,,425000510,CDM,both,1,ML,130.20,110.67,,,,,,,,,,,hospital's standard charge pricing
Vancomycin 500mg vial,250,RC,J3373,HCPCS,425000511,CDM,both,1,UN,28.30,24.06,,,,,,,,,,,hospital's standard charge pricing
Aztreonam 1gm injection,250,RC,,,425000516,CDM,both,1,UN,24.75,21.04,,,,,,,,,,,hospital's standard charge pricing
"Water, purified 98.3% Ophth Soln; 30 ml",250,RC,,,425000518,CDM,both,1,ML,580.75,493.64,,,,,,,,,,,hospital's standard charge pricing
Glucose 40% Oral Gel 37.5 g,250,RC,,,425000524,CDM,both,1,GR,31.65,26.90,,,,,,,,,,,hospital's standard charge pricing
Albuterol/Ipratropium 3 mg/0.5 mg 3 ml unit,250,RC,,,425000527,CDM,both,1,ML,21.30,18.11,,,,,,,,,,,hospital's standard charge pricing
Montelukast 10mg tab,250,RC,,,425000531,CDM,both,1,UN,41.60,35.36,,,,,,,,,,,hospital's standard charge pricing
Ampicillin-Sulbactam 3g inj (per 1.5g),250,RC,J0295,HCPCS,425000534,CDM,both,1,UN,52.45,44.58,,,,,,,,,,,hospital's standard charge pricing
Benzocaine-Menthol 15mg/3.6mg lozenge,250,RC,,,425000537,CDM,both,1,UN,17.05,14.49,,,,,,,,,,,hospital's standard charge pricing
Benzocaine 20% topical gel,250,RC,,,425000538,CDM,both,1,GR,736.10,625.69,,,,,,,,,,,hospital's standard charge pricing
"Bupivacaine w/EPI 0.25%/1:200,000 inj 10 ml",250,RC,,,425000540,CDM,both,1,ML,52.95,45.01,,,,,,,,,,,hospital's standard charge pricing
"Bupivacaine w/EPI 0.5%/1:200,000 inj 1.8 ml cartridge",250,RC,,,425000541,CDM,both,1,ML,14.45,12.28,,,,,,,,,,,hospital's standard charge pricing
Cefuroxime 500mg tab,250,RC,,,425000546,CDM,both,1,UN,73.65,62.60,,,,,,,,,,,hospital's standard charge pricing
Fosphenytoin 500mg PE/10mL inj (per 50mg),250,RC,Q2009,HCPCS,425000549,CDM,both,1,ML,81.19,69.01,,,,,,,,,,,hospital's standard charge pricing
Losartan 25mg tab,250,RC,,,425000553,CDM,both,1,UN,18.30,15.56,,,,,,,,,,,hospital's standard charge pricing
Morphine sulfate 2 mg/ml PF inj,250,RC,,,425000556,CDM,both,1,ML,22.95,19.51,,,,,,,,,,,hospital's standard charge pricing
Oseltamivir Phosphate 30mg cap,250,RC,,,425000557,CDM,both,1,UN,91.70,77.95,,,,,,,,,,,hospital's standard charge pricing
Potassium Chloride 10mEq/100mL soln,250,RC,,,425000561,CDM,both,1,ML,8.68,7.38,,,,,,,,,,,hospital's standard charge pricing
Alum Hydroxide/Mag Hydroxide/Simethicone 200/200/20 /5ml 30ml cup,250,RC,,,425000570,CDM,both,1,ML,30.70,26.10,,,,,,,,,,,hospital's standard charge pricing
Vancomycin 125mg cap,250,RC,,,425000571,CDM,both,1,UN,192.20,163.37,,,,,,,,,,,hospital's standard charge pricing
"Rabies immune globulin (Rlg), human, 300 iu/ml, IM or SC 1ML SDV",250,RC,90375,HCPCS,425000572,CDM,both,1,ML,2505.28,2129.49,,,,,,,,,,,hospital's standard charge pricing
Albumin (25%) 12.5 grams IV 50ml,250,RC,,,425000574,CDM,both,1,ML,490.10,416.59,,,,,,,,,,,hospital's standard charge pricing
Albumin Human 25% 25g 100mL inj,250,RC,,,425000575,CDM,both,1,ML,501.03,425.88,,,,,,,,,,,hospital's standard charge pricing
Hydrocortisone Sodium Succinate PF IV 100 mg / 2 ml,250,RC,J1720,HCPCS,425000577,CDM,both,1,UN,143.55,122.02,,,,,,,,,,,hospital's standard charge pricing
Digoxin 125mcg tab,250,RC,,,425000578,CDM,both,1,UN,23.45,19.93,,,,,,,,,,,hospital's standard charge pricing
Nifedipine 30mg ER tab,250,RC,,,425000579,CDM,both,1,UN,15.15,12.88,,,,,,,,,,,hospital's standard charge pricing
Apixaban 5mg tab,250,RC,,,425000582,CDM,both,1,UN,78.25,66.51,,,,,,,,,,,hospital's standard charge pricing
Budesonide 0.5mg/ml 2ml neb,250,RC,,,425000585,CDM,both,1,ML,74.00,62.90,,,,,,,,,,,hospital's standard charge pricing
Pilocarpine HCl 2% 15ml sol,250,RC,,,425000588,CDM,both,1,ML,577.65,491.00,,,,,,,,,,,hospital's standard charge pricing
Lidocaine 2% 20mg/ml 10ml (Uro-Jet),250,RC,,,425000592,CDM,both,1,ML,58.05,49.34,,,,,,,,,,,hospital's standard charge pricing
Magnesium Sulfate 50% 1g/2ml vial,250,RC,J3475,HCPCS,425000597,CDM,both,1,ML,8.20,6.97,,,,,,,,,,,hospital's standard charge pricing
"Nystatin 100,000u/ml 5ml UD cup",250,RC,,,425000599,CDM,both,1,ML,18.15,15.43,,,,,,,,,,,hospital's standard charge pricing
Levetiracetam 500mg tab,250,RC,,,425000607,CDM,both,1,UN,29.05,24.69,,,,,,,,,,,hospital's standard charge pricing
Midazolam 5 mg/ml 1 ml,250,RC,J2250,HCPCS,425000616,CDM,both,1,ML,3.28,2.79,,,,,,,,,,,hospital's standard charge pricing
Bumetanide 0.25 mg/ml inj 4ml,250,RC,,,425000617,CDM,both,1,ML,14.23,12.10,,,,,,,,,,,hospital's standard charge pricing
Amoxicillin 400mg/5ml suspension,250,RC,,,425000624,CDM,both,1,ML,11.30,9.61,,,,,,,,,,,hospital's standard charge pricing
Enoxaparin 120 mg/0.8 ml syringe,250,RC,J1650,HCPCS,425000625,CDM,both,1,ML,13.90,11.82,,,,,,,,,,,hospital's standard charge pricing
Enoxaparin 150 mg/1 ml syringe,250,RC,J1650,HCPCS,425000626,CDM,both,1,ML,13.55,11.52,,,,,,,,,,,hospital's standard charge pricing
"Esmolol 2,500mg/250ml premix",250,RC,,,425000629,CDM,both,1,ML,3.20,2.72,,,,,,,,,,,hospital's standard charge pricing
Diltiazem 125mg/25mL inj,250,RC,,,425000630,CDM,both,1,ML,85.95,73.06,,,,,,,,,,,hospital's standard charge pricing
Azithromycin 200mg/5mL 15mL suspension,250,RC,,,425000634,CDM,both,1,ML,76.70,65.20,,,,,,,,,,,hospital's standard charge pricing
Hyaluronidase 150u/mL 1mL inj (per 150 units),250,RC,J3470,HCPCS,425000636,CDM,both,1,ML,378.05,321.34,,,,,,,,,,,hospital's standard charge pricing
Clindamycin in Dextrose 5% 900mg/50mL bag,250,RC,J3490,HCPCS,425000644,CDM,both,1,ML,36.17,30.74,,,,,,,,,,,hospital's standard charge pricing
D5W+NS+20 meq KCL 1000mL,250,RC,J3490,HCPCS,425000649,CDM,both,1,ML,58.50,49.73,,,,,,,,,,,hospital's standard charge pricing
Penicillin V Potassium 500mg tab,250,RC,,,425000651,CDM,both,1,UN,20.30,17.26,,,,,,,,,,,hospital's standard charge pricing
Ertapenem 1 gram injection (per 500mg),250,RC,J1335,HCPCS,425000656,CDM,both,1,UN,391.95,333.16,,,,,,,,,,,hospital's standard charge pricing
"Hydroxyzine HCL, injection, up to 25mg",250,RC,J3410,HCPCS,425000657,CDM,both,1,ML,185.90,158.02,,,,,,,,,,,hospital's standard charge pricing
Proparacaine 0.5% Opthalmic Drops,250,RC,,,425000662,CDM,both,1,ML,266.00,226.10,,,,,,,,,,,hospital's standard charge pricing
Cephalexin 125mg/5ml susp 100ml (per ml),250,RC,,,425000665,CDM,both,1,ML,3.07,2.61,,,,,,,,,,,hospital's standard charge pricing
ESCITALOPRAM 10 MG TABLET,250,RC,,,425000666,CDM,both,1,UN,34.15,29.03,,,,,,,,,,,hospital's standard charge pricing
Divalproex Sodium ER 250mg tablet,250,RC,,,425000667,CDM,both,1,UN,22.80,19.38,,,,,,,,,,,hospital's standard charge pricing
Mirtazapine 15mg tablet,250,RC,,,425000670,CDM,both,1,UN,28.35,24.10,,,,,,,,,,,hospital's standard charge pricing
Isosorbide Mononitrate ER 30mg tab,250,RC,,,425000671,CDM,both,1,UN,18.20,15.47,,,,,,,,,,,hospital's standard charge pricing
Amoxicillin/Clavulanate 400mg/57mg/5ml susp 50ml (per 50ml),250,RC,,,425000673,CDM,both,1,ML,25.10,21.34,,,,,,,,,,,hospital's standard charge pricing
Eliquis 2.5mg Tablet,250,RC,,,425000674,CDM,both,1,UN,78.25,66.51,,,,,,,,,,,hospital's standard charge pricing
Xarelto 15mg tablet,250,RC,,,425000675,CDM,both,1,UN,142.20,120.87,,,,,,,,,,,hospital's standard charge pricing
DIFICID (Fidaxomicin) 200 mg Tablet,250,RC,,,425000676,CDM,both,1,UN,1762.70,1498.30,,,,,,,,,,,hospital's standard charge pricing
Ofloxacin 0.3% Otic Drops 5ml,250,RC,,,425000678,CDM,both,1,ML,914.05,776.94,,,,,,,,,,,hospital's standard charge pricing
Piperacillin/Tazobactam 4.5gm inj,250,RC,J2543,HCPCS,425800013,CDM,both,1,UN,32.13,27.31,,,,,,,,,,,hospital's standard charge pricing
Nix Cream Rinse,250,RC,,,463700037,CDM,both,1,GR,70.60,60.01,,,,,,,,,,,hospital's standard charge pricing
Omnipaque 300mg/mL 100mL (per 1mL),254,RC,Q9967,HCPCS,425400004,CDM,both,1,ML,3.18,2.70,,,,,,,,,,,hospital's standard charge pricing
Omnipaque 300mg/mL 150mL (per 1mL),254,RC,Q9967,HCPCS,425400005,CDM,both,1,ML,3.09,2.63,,,,,,,,,,,hospital's standard charge pricing
Omnipaque 300mg/mL 50mL (per 1mL),254,RC,Q9967,HCPCS,425400006,CDM,both,1,ML,3.24,2.75,,,,,,,,,,,hospital's standard charge pricing
Omnipaque 350mg/100mL (per 1mL),254,RC,Q9967,HCPCS,425400008,CDM,both,1,ML,3.53,3.00,,,,,,,,,,,hospital's standard charge pricing
Omnipaque 350mg/150mL (per 1mL),254,RC,Q9967,HCPCS,425400009,CDM,both,1,ML,3.25,2.76,,,,,,,,,,,hospital's standard charge pricing
Iodixanol 320 mg/ml 100ml,254,RC,Q9967,HCPCS,463600134,CDM,both,1,ML,3.71,3.15,,,,,,,,,,,hospital's standard charge pricing
Hydration IV Infu Init Up to 1Hr,260,RC,96360,HCPCS,426000001,CDM,both,,,747.25,635.16,,,,,,,,,,,hospital's standard charge pricing
Hydration IV Infusion Ea Addl Hr,260,RC,96361,HCPCS,426000002,CDM,both,,,122.56,104.18,,,,,,,,,,,hospital's standard charge pricing
Ther/Proph/Dg IV Inf Init to 1Hr,260,RC,96365,HCPCS,426000003,CDM,both,,,746.59,634.60,,,,,,,,,,,hospital's standard charge pricing
Ther/Proph/Diag IV Inf Ea Adl Hr,260,RC,96366,HCPCS,426000004,CDM,both,,,162.30,137.96,,,,,,,,,,,hospital's standard charge pricing
IV Infusion Sequential Up to 1Hr,260,RC,96367,HCPCS,426000005,CDM,both,,,464.38,394.72,,,,,,,,,,,hospital's standard charge pricing
IV Infusion Concurrent,260,RC,96368,HCPCS,426000006,CDM,both,,,85.45,72.63,,,,,,,,,,,hospital's standard charge pricing
Ther/Proph/Diag Inj SC/IM,260,RC,96372,HCPCS,426000007,CDM,both,,,294.79,250.57,,,,,,,,,,,hospital's standard charge pricing
IV Push Single or Initial,260,RC,96374,HCPCS,426000008,CDM,both,,,294.79,250.57,,,,,,,,,,,hospital's standard charge pricing
"IV Push Ea Sequential, New Drug",260,RC,96375,HCPCS,426000009,CDM,both,,,183.51,155.98,,,,,,,,,,,hospital's standard charge pricing
"IV Push Ea Sequential, Same Drug",260,RC,96376,HCPCS,426000010,CDM,both,,,70.22,59.69,,,,,,,,,,,hospital's standard charge pricing
Arterial Line Kit,270,RC,,,427000043,CDM,both,,,886.00,753.10,,,,,,,,,,,hospital's standard charge pricing
Tracheotomy Kit,270,RC,,,427000048,CDM,both,,,1579.00,1342.15,,,,,,,,,,,hospital's standard charge pricing
Chest tube surgical tray,272,RC,,,427200012,CDM,both,,,2261.00,1921.85,,,,,,,,,,,hospital's standard charge pricing
Surgical tray for lumbar puncture,272,RC,,,427200013,CDM,both,,,394.00,334.90,,,,,,,,,,,hospital's standard charge pricing
Basic Metabolic Panel,300,RC,80048,HCPCS,430000001,CDM,both,,,309.37,262.96,,,,,,,,,,,hospital's standard charge pricing
Electrolyte panel,300,RC,80051,HCPCS,430000002,CDM,both,,,159.65,135.70,,,,,,,,,,,hospital's standard charge pricing
Comprehensive metabolic panel,300,RC,80053,HCPCS,430000003,CDM,both,,,563.08,478.62,,,,,,,,,,,hospital's standard charge pricing
Lipid panel,300,RC,80061,HCPCS,430000004,CDM,both,,,172.24,146.40,,,,,,,,,,,hospital's standard charge pricing
Acute hepatitis panel,300,RC,80074,HCPCS,430000005,CDM,both,,,675.05,573.79,,,,,,,,,,,hospital's standard charge pricing
Hepatic Function Panel,300,RC,80076,HCPCS,430000006,CDM,both,,,293.47,249.45,,,,,,,,,,,hospital's standard charge pricing
Drug screen qualitate/multi,300,RC,80305,HCPCS,430000007,CDM,both,,,102.00,86.70,,,,,,,,,,,hospital's standard charge pricing
Digoxin,300,RC,80162,HCPCS,430000009,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
Assay dipropylacetic acid,300,RC,80164,HCPCS,430000010,CDM,both,,,230.53,195.95,,,,,,,,,,,hospital's standard charge pricing
Lithium,300,RC,80178,HCPCS,430000011,CDM,both,,,120.57,102.48,,,,,,,,,,,hospital's standard charge pricing
Phenytoin; total,300,RC,80185,HCPCS,430000012,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
Theophylline,300,RC,80198,HCPCS,430000014,CDM,both,,,147.74,125.58,,,,,,,,,,,hospital's standard charge pricing
Vancomycin,300,RC,80202,HCPCS,430000015,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
Urinalysis auto w/scope,300,RC,81001,HCPCS,430000016,CDM,both,,,48.38,41.12,,,,,,,,,,,hospital's standard charge pricing
Urinalysis auto w/o scope,300,RC,81003,HCPCS,430000017,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Microscopic exam of urine,300,RC,81015,HCPCS,430000018,CDM,both,,,24.00,20.40,,,,,,,,,,,hospital's standard charge pricing
Urine pregnancy test,300,RC,81025,HCPCS,430000019,CDM,both,,,230.53,195.95,,,,,,,,,,,hospital's standard charge pricing
Test for acetone/ketones,300,RC,82009,HCPCS,430000021,CDM,both,,,58.97,50.12,,,,,,,,,,,hospital's standard charge pricing
Acetone assay,300,RC,82010,HCPCS,430000022,CDM,both,,,84.79,72.07,,,,,,,,,,,hospital's standard charge pricing
Assay of acth,300,RC,82024,HCPCS,430000023,CDM,both,,,325.92,277.03,,,,,,,,,,,hospital's standard charge pricing
Microalbumin quantitative,300,RC,82043,HCPCS,430000024,CDM,both,,,114.60,97.41,,,,,,,,,,,hospital's standard charge pricing
Aldosterone,300,RC,82088,HCPCS,430000026,CDM,both,,,242.45,206.08,,,,,,,,,,,hospital's standard charge pricing
Ammonia,300,RC,82140,HCPCS,430000027,CDM,both,,,120.57,102.48,,,,,,,,,,,hospital's standard charge pricing
Amylase,300,RC,82150,HCPCS,430000028,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
Bilirubin; total,300,RC,82247,HCPCS,430000029,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Bilirubin; direct,300,RC,82248,HCPCS,430000030,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Occult Blood Feces Scrn 1-3,300,RC,82270,HCPCS,430000031,CDM,both,,,35.00,29.75,,,,,,,,,,,hospital's standard charge pricing
Occult blood other sources,300,RC,82271,HCPCS,430000032,CDM,both,,,43.00,36.55,,,,,,,,,,,hospital's standard charge pricing
Occult bld feces 1-3 tests,300,RC,82272,HCPCS,430000033,CDM,both,,,31.80,27.03,,,,,,,,,,,hospital's standard charge pricing
Vitamin d 25 hydroxy,300,RC,82306,HCPCS,430000034,CDM,both,,,394.15,335.03,,,,,,,,,,,hospital's standard charge pricing
Calculus assay quant,300,RC,82360,HCPCS,430000035,CDM,both,,,131.17,111.49,,,,,,,,,,,hospital's standard charge pricing
Calculus spectroscopy,300,RC,82365,HCPCS,430000036,CDM,both,,,104.00,88.40,,,,,,,,,,,hospital's standard charge pricing
Assay carboxyhb quant,300,RC,82375,HCPCS,430000037,CDM,both,,,93.42,79.41,,,,,,,,,,,hospital's standard charge pricing
Carcinoembryonic antigen,300,RC,82378,HCPCS,430000038,CDM,both,,,268.96,228.62,,,,,,,,,,,hospital's standard charge pricing
Assay bld/serum cholesterol,300,RC,82465,HCPCS,430000039,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Cortisol; total,300,RC,82533,HCPCS,430000040,CDM,both,,,301.42,256.21,,,,,,,,,,,hospital's standard charge pricing
Assay of ck (cpk),300,RC,82550,HCPCS,430000041,CDM,both,,,120.57,102.48,,,,,,,,,,,hospital's standard charge pricing
Creatine mb fraction,300,RC,82553,HCPCS,430000042,CDM,both,,,94.00,79.90,,,,,,,,,,,hospital's standard charge pricing
Assay of creatinine,300,RC,82565,HCPCS,430000043,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Vitamin B-12,300,RC,82607,HCPCS,430000044,CDM,both,,,301.42,256.21,,,,,,,,,,,hospital's standard charge pricing
Enzyme cell activity,300,RC,82657,HCPCS,430000045,CDM,both,,,180.00,153.00,,,,,,,,,,,hospital's standard charge pricing
Estradiol,300,RC,82670,HCPCS,430000046,CDM,both,,,359.73,305.77,,,,,,,,,,,hospital's standard charge pricing
Ethylene glycol,300,RC,82693,HCPCS,430000047,CDM,both,,,296.78,252.26,,,,,,,,,,,hospital's standard charge pricing
Ferritin,300,RC,82728,HCPCS,430000048,CDM,both,,,194.11,164.99,,,,,,,,,,,hospital's standard charge pricing
Folic acid; serum,300,RC,82746,HCPCS,430000049,CDM,both,,,301.42,256.21,,,,,,,,,,,hospital's standard charge pricing
Arterial blood gases,300,RC,82803,HCPCS,430000051,CDM,both,,,128.57,109.28,,,,,,,,,,,hospital's standard charge pricing
Glucose Body Fluid other than Blood,300,RC,82945,HCPCS,430000052,CDM,both,,,35.12,29.85,,,,,,,,,,,hospital's standard charge pricing
Assay glucose blood quant,300,RC,82947,HCPCS,430000053,CDM,both,,,35.12,29.85,,,,,,,,,,,hospital's standard charge pricing
Whole blood glucose by meter,300,RC,82947,HCPCS,430000054,CDM,both,,,35.12,29.85,,,,,,,,,,,hospital's standard charge pricing
Assay of GGT,300,RC,82977,HCPCS,430000055,CDM,both,,,35.12,29.85,,,,,,,,,,,hospital's standard charge pricing
Gonadotropin (FSH),300,RC,83001,HCPCS,430000056,CDM,both,,,220.60,187.51,,,,,,,,,,,hospital's standard charge pricing
Gonadotropin (LH),300,RC,83002,HCPCS,430000057,CDM,both,,,220.60,187.51,,,,,,,,,,,hospital's standard charge pricing
Glycosylated hemoglobin test,300,RC,83036,HCPCS,430000058,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
Homocysteine,300,RC,83090,HCPCS,430000059,CDM,both,,,148.38,126.12,,,,,,,,,,,hospital's standard charge pricing
Immunoassay quant nos nonab,300,RC,83520,HCPCS,430000060,CDM,both,,,55.30,47.01,,,,,,,,,,,hospital's standard charge pricing
Iron,300,RC,83540,HCPCS,430000061,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
Iron binding capacity,300,RC,83550,HCPCS,430000062,CDM,both,,,156.33,132.88,,,,,,,,,,,hospital's standard charge pricing
Lactate (lactic acid),300,RC,83605,HCPCS,430000063,CDM,both,,,165.62,140.78,,,,,,,,,,,hospital's standard charge pricing
Lactate (LD) (LDH) enzyme,300,RC,83615,HCPCS,430000064,CDM,both,,,48.38,41.12,,,,,,,,,,,hospital's standard charge pricing
Lipase,300,RC,83690,HCPCS,430000065,CDM,both,,,120.57,102.48,,,,,,,,,,,hospital's standard charge pricing
Magnesium,300,RC,83735,HCPCS,430000066,CDM,both,,,115.94,98.55,,,,,,,,,,,hospital's standard charge pricing
Myoglobin,300,RC,83874,HCPCS,430000067,CDM,both,,,217.28,184.69,,,,,,,,,,,hospital's standard charge pricing
Natriuretic peptide; BNP,300,RC,83880,HCPCS,430000068,CDM,both,,,202.05,171.74,,,,,,,,,,,hospital's standard charge pricing
Organic acids total quant,300,RC,83918,HCPCS,430000075,CDM,both,,,641.26,545.07,,,,,,,,,,,hospital's standard charge pricing
Oxalate,300,RC,83945,HCPCS,430000076,CDM,both,,,176.22,149.79,,,,,,,,,,,hospital's standard charge pricing
Assay of phosphorus,300,RC,84100,HCPCS,430000077,CDM,both,,,126.54,107.56,,,,,,,,,,,hospital's standard charge pricing
Progesterone,300,RC,84144,HCPCS,430000078,CDM,both,,,220.60,187.51,,,,,,,,,,,hospital's standard charge pricing
Prolactin,300,RC,84146,HCPCS,430000079,CDM,both,,,251.08,213.42,,,,,,,,,,,hospital's standard charge pricing
Assay of psa total,300,RC,84153,HCPCS,430000080,CDM,both,,,230.53,195.95,,,,,,,,,,,hospital's standard charge pricing
Assay of protein serum,300,RC,84155,HCPCS,430000081,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Protein e-phoresis serum,300,RC,84165,HCPCS,430000083,CDM,both,,,236.50,201.03,,,,,,,,,,,hospital's standard charge pricing
Protein e-phoresis/urine/csf,300,RC,84166,HCPCS,430000084,CDM,both,,,274.24,233.10,,,,,,,,,,,hospital's standard charge pricing
Assay of sex hormone globul,300,RC,84270,HCPCS,430000085,CDM,both,,,137.14,116.57,,,,,,,,,,,hospital's standard charge pricing
Assay of total testosterone,300,RC,84403,HCPCS,430000086,CDM,both,,,202.70,172.30,,,,,,,,,,,hospital's standard charge pricing
Assay of thyroglobulin,300,RC,84432,HCPCS,430000087,CDM,both,,,217.28,184.69,,,,,,,,,,,hospital's standard charge pricing
Assay of total thyroxine,300,RC,84436,HCPCS,430000088,CDM,both,,,87.44,74.32,,,,,,,,,,,hospital's standard charge pricing
Assay of free thyroxine,300,RC,84439,HCPCS,430000089,CDM,both,,,255.06,216.80,,,,,,,,,,,hospital's standard charge pricing
Assay thyroid stim hormone,300,RC,84443,HCPCS,430000090,CDM,both,,,165.62,140.78,,,,,,,,,,,hospital's standard charge pricing
Transferase (AST) (SGOT),300,RC,84450,HCPCS,430000091,CDM,both,,,45.72,38.86,,,,,,,,,,,hospital's standard charge pricing
Assay of thyroid (t3 or t4),300,RC,84479,HCPCS,430000092,CDM,both,,,52.00,44.20,,,,,,,,,,,hospital's standard charge pricing
Assay triiodothyronine (t3),300,RC,84480,HCPCS,430000093,CDM,both,,,217.28,184.69,,,,,,,,,,,hospital's standard charge pricing
Free assay (FT-3),300,RC,84481,HCPCS,430000094,CDM,both,,,366.34,311.39,,,,,,,,,,,hospital's standard charge pricing
T3 reverse,300,RC,84482,HCPCS,430000095,CDM,both,,,128.00,108.80,,,,,,,,,,,hospital's standard charge pricing
"Troponin, quantitative",300,RC,84484,HCPCS,430000096,CDM,both,,,202.70,172.30,,,,,,,,,,,hospital's standard charge pricing
Assay of urea nitrogen,300,RC,84520,HCPCS,430000097,CDM,both,,,35.12,29.85,,,,,,,,,,,hospital's standard charge pricing
Uric acid; blood,300,RC,84550,HCPCS,430000098,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Chorionic Gonadotropin Quantitative,300,RC,84702,HCPCS,430000099,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
Chorionic Gonadotropin Qualitative,300,RC,84703,HCPCS,430000100,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
Bl smear w/diff wbc count,300,RC,85007,HCPCS,430000101,CDM,both,,,31.00,26.35,,,,,,,,,,,hospital's standard charge pricing
Complete cbc w/auto diff wbc,300,RC,85025,HCPCS,430000102,CDM,both,,,104.67,88.97,,,,,,,,,,,hospital's standard charge pricing
Complete cbc automated,300,RC,85027,HCPCS,430000103,CDM,both,,,78.84,67.01,,,,,,,,,,,hospital's standard charge pricing
Automated reticulocyte count,300,RC,85045,HCPCS,430000104,CDM,both,,,32.00,27.20,,,,,,,,,,,hospital's standard charge pricing
Automated leukocyte count,300,RC,85048,HCPCS,430000105,CDM,both,,,45.72,38.86,,,,,,,,,,,hospital's standard charge pricing
Antithrombin III test,300,RC,85300,HCPCS,430000106,CDM,both,,,208.67,177.37,,,,,,,,,,,hospital's standard charge pricing
"Clot inhibitr;protein C,Antigen",300,RC,85302,HCPCS,430000107,CDM,both,,,97.00,82.45,,,,,,,,,,,hospital's standard charge pricing
"Clot inhibitr;protein C,Actvity",300,RC,85303,HCPCS,430000108,CDM,both,,,274.24,233.10,,,,,,,,,,,hospital's standard charge pricing
"Clot inhibitr;protein S, total",300,RC,85305,HCPCS,430000109,CDM,both,,,422.65,359.25,,,,,,,,,,,hospital's standard charge pricing
"Clot inhibitor; protein S, free",300,RC,85306,HCPCS,430000110,CDM,both,,,124.00,105.40,,,,,,,,,,,hospital's standard charge pricing
Assay activated protein c,300,RC,85307,HCPCS,430000111,CDM,both,,,233.85,198.77,,,,,,,,,,,hospital's standard charge pricing
Fibrin degradation quant,300,RC,85379,HCPCS,430000112,CDM,both,,,139.12,118.25,,,,,,,,,,,hospital's standard charge pricing
Clotting assay whole blood,300,RC,85396,HCPCS,430000113,CDM,both,,,153.00,130.05,,,,,,,,,,,hospital's standard charge pricing
Prothrombin time,300,RC,85610,HCPCS,430000116,CDM,both,,,67.56,57.43,,,,,,,,,,,hospital's standard charge pricing
Russell viper venom diluted,300,RC,85613,HCPCS,430000118,CDM,both,,,133.16,113.19,,,,,,,,,,,hospital's standard charge pricing
Rbc sed rate automated,300,RC,85652,HCPCS,430000119,CDM,both,,,22.00,18.70,,,,,,,,,,,hospital's standard charge pricing
Thromboplastin time partial,300,RC,85730,HCPCS,430000120,CDM,both,,,109.32,92.92,,,,,,,,,,,hospital's standard charge pricing
Antinuclear Antibodies (ANA),300,RC,86038,HCPCS,430000122,CDM,both,,,395.49,336.17,,,,,,,,,,,hospital's standard charge pricing
Antinuclear Antibodies (ANA Titer),300,RC,86039,HCPCS,430000123,CDM,both,,,395.49,336.17,,,,,,,,,,,hospital's standard charge pricing
Antistreptolysin 0; titer,300,RC,86060,HCPCS,430000124,CDM,both,,,95.40,81.09,,,,,,,,,,,hospital's standard charge pricing
C-reactive protein,300,RC,86140,HCPCS,430000125,CDM,both,,,90.76,77.15,,,,,,,,,,,hospital's standard charge pricing
C-reactive protein hs,300,RC,86141,HCPCS,430000126,CDM,both,,,236.50,201.03,,,,,,,,,,,hospital's standard charge pricing
Glycoprotein antibody,300,RC,86146,HCPCS,430000127,CDM,both,,,141.11,119.94,,,,,,,,,,,hospital's standard charge pricing
Cardiolipin antibody,300,RC,86147,HCPCS,430000128,CDM,both,,,141.11,119.94,,,,,,,,,,,hospital's standard charge pricing
Phospholipid antibody,300,RC,86148,HCPCS,430000129,CDM,both,,,131.00,111.35,,,,,,,,,,,hospital's standard charge pricing
Complement antigen,300,RC,86160,HCPCS,430000130,CDM,both,,,176.22,149.79,,,,,,,,,,,hospital's standard charge pricing
Complement total (ch50),300,RC,86162,HCPCS,430000131,CDM,both,,,172.24,146.40,,,,,,,,,,,hospital's standard charge pricing
DNA antibody,300,RC,86225,HCPCS,430000132,CDM,both,,,400.12,340.10,,,,,,,,,,,hospital's standard charge pricing
Dna antibody single strand,300,RC,86226,HCPCS,430000133,CDM,both,,,98.00,83.30,,,,,,,,,,,hospital's standard charge pricing
Fluorescent antibody screen,300,RC,86255,HCPCS,430000134,CDM,both,,,243.79,207.22,,,,,,,,,,,hospital's standard charge pricing
Immunoassay tumor ca 125,300,RC,86304,HCPCS,430000135,CDM,both,,,307.37,261.26,,,,,,,,,,,hospital's standard charge pricing
Heterophile antibodies,300,RC,86308,HCPCS,430000136,CDM,both,,,96.06,81.65,,,,,,,,,,,hospital's standard charge pricing
Immunoassay tumor other,300,RC,86316,HCPCS,430000137,CDM,both,,,168.00,142.80,,,,,,,,,,,hospital's standard charge pricing
Immunfix e-phorsis/urine/csf,300,RC,86335,HCPCS,430000138,CDM,both,,,236.50,201.03,,,,,,,,,,,hospital's standard charge pricing
Microsomal antibody,300,RC,86376,HCPCS,430000139,CDM,both,,,161.63,137.39,,,,,,,,,,,hospital's standard charge pricing
Rheumatoid factor quant,300,RC,86431,HCPCS,430000140,CDM,both,,,95.40,81.09,,,,,,,,,,,hospital's standard charge pricing
TB intradermal test,300,RC,86580,HCPCS,430000141,CDM,both,,,230.00,195.50,,,,,,,,,,,hospital's standard charge pricing
Syphilis test non-trep qual,300,RC,86592,HCPCS,430000142,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
Syphilis test non-trep quant,300,RC,86593,HCPCS,430000143,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
Bartonella antibody,300,RC,86611,HCPCS,430000144,CDM,both,,,31.11,26.44,,,,,,,,,,,hospital's standard charge pricing
Lyme disease antibody,300,RC,86618,HCPCS,430000145,CDM,both,,,249.09,211.73,,,,,,,,,,,hospital's standard charge pricing
Campylobacter antibody,300,RC,86625,HCPCS,430000146,CDM,both,,,106.00,90.10,,,,,,,,,,,hospital's standard charge pricing
Chlamydia antibody,300,RC,86631,HCPCS,430000147,CDM,both,,,13.02,11.07,,,,,,,,,,,hospital's standard charge pricing
"Epstein-barr Virus Antibody,(EA)",300,RC,86663,HCPCS,430000148,CDM,both,,,172.90,146.97,,,,,,,,,,,hospital's standard charge pricing
"Epstein-barr Virus Antibody,(NA)",300,RC,86664,HCPCS,430000149,CDM,both,,,137.79,117.12,,,,,,,,,,,hospital's standard charge pricing
Epstein-barr Virus Antibody(VCA),300,RC,86665,HCPCS,430000150,CDM,both,,,119.91,101.92,,,,,,,,,,,hospital's standard charge pricing
Helicobacter pylori,300,RC,86677,HCPCS,430000151,CDM,both,,,304.07,258.46,,,,,,,,,,,hospital's standard charge pricing
Hepatitis delta agent,300,RC,86692,HCPCS,430000152,CDM,both,,,369.65,314.20,,,,,,,,,,,hospital's standard charge pricing
"Herpes Simplex, nonspecific type",300,RC,86694,HCPCS,430000153,CDM,both,,,117.00,99.45,,,,,,,,,,,hospital's standard charge pricing
"Herpes Simplex, type 1",300,RC,86695,HCPCS,430000154,CDM,both,,,151.71,128.95,,,,,,,,,,,hospital's standard charge pricing
Herpes simplex type 2,300,RC,86696,HCPCS,430000155,CDM,both,,,202.70,172.30,,,,,,,,,,,hospital's standard charge pricing
HIV-1,300,RC,86701,HCPCS,430000156,CDM,both,,,154.36,131.21,,,,,,,,,,,hospital's standard charge pricing
HIV-1/HIV-2 single assay,300,RC,86703,HCPCS,430000157,CDM,both,,,151.71,128.95,,,,,,,,,,,hospital's standard charge pricing
Hep b core antibody total,300,RC,86704,HCPCS,430000158,CDM,both,,,200.07,170.06,,,,,,,,,,,hospital's standard charge pricing
Hep b surface antibody,300,RC,86706,HCPCS,430000159,CDM,both,,,153.04,130.08,,,,,,,,,,,hospital's standard charge pricing
Hep a antibody total,300,RC,86708,HCPCS,430000160,CDM,both,,,200.07,170.06,,,,,,,,,,,hospital's standard charge pricing
Hep a antibody igm,300,RC,86709,HCPCS,430000161,CDM,both,,,172.90,146.97,,,,,,,,,,,hospital's standard charge pricing
Influenza virus antibody,300,RC,86710,HCPCS,430000162,CDM,both,,,110.00,93.50,,,,,,,,,,,hospital's standard charge pricing
Mycoplasma antibody,300,RC,86738,HCPCS,430000163,CDM,both,,,221.93,188.64,,,,,,,,,,,hospital's standard charge pricing
Rubella antibody,300,RC,86762,HCPCS,430000164,CDM,both,,,211.32,179.62,,,,,,,,,,,hospital's standard charge pricing
Varicella-zoster antibody,300,RC,86787,HCPCS,430000165,CDM,both,,,221.93,188.64,,,,,,,,,,,hospital's standard charge pricing
Virus antibody nos,300,RC,86790,HCPCS,430000166,CDM,both,,,177.91,151.22,,,,,,,,,,,hospital's standard charge pricing
Thyroglobulin antibody,300,RC,86800,HCPCS,430000167,CDM,both,,,161.63,137.39,,,,,,,,,,,hospital's standard charge pricing
Hepatitis C antibody,300,RC,86803,HCPCS,430000168,CDM,both,,,176.22,149.79,,,,,,,,,,,hospital's standard charge pricing
RBC antibody screen,300,RC,86850,HCPCS,430000169,CDM,both,,,288.17,244.94,,,,,,,,,,,hospital's standard charge pricing
Blood typing; ABO,300,RC,86900,HCPCS,430000170,CDM,both,,,71.54,60.81,,,,,,,,,,,hospital's standard charge pricing
Blood typing; Rh (D),300,RC,86901,HCPCS,430000171,CDM,both,,,71.54,60.81,,,,,,,,,,,hospital's standard charge pricing
Blood culture for bacteria,300,RC,87040,HCPCS,430000172,CDM,both,,,396.14,336.72,,,,,,,,,,,hospital's standard charge pricing
Feces culture bacteria,300,RC,87045,HCPCS,430000173,CDM,both,,,234.50,199.33,,,,,,,,,,,hospital's standard charge pricing
Stool cultr bacteria each,300,RC,87046,HCPCS,430000174,CDM,both,,,87.44,74.32,,,,,,,,,,,hospital's standard charge pricing
Culture bacteria except blood,300,RC,87075,HCPCS,430000176,CDM,both,,,483.59,411.05,,,,,,,,,,,hospital's standard charge pricing
Culture anaerobe ident each,300,RC,87073,HCPCS,430000177,CDM,both,,,78.00,66.30,,,,,,,,,,,hospital's standard charge pricing
Culture screen only,300,RC,87081,HCPCS,430000178,CDM,both,,,166.27,141.33,,,,,,,,,,,hospital's standard charge pricing
Urine culture/colony count,300,RC,87086,HCPCS,430000179,CDM,both,,,124.54,105.86,,,,,,,,,,,hospital's standard charge pricing
Urine bacteria culture,300,RC,87088,HCPCS,430000180,CDM,both,,,53.65,45.60,,,,,,,,,,,hospital's standard charge pricing
Fungus isolation culture,300,RC,87102,HCPCS,430000181,CDM,both,,,270.28,229.74,,,,,,,,,,,hospital's standard charge pricing
Blood fungus culture,300,RC,87103,HCPCS,430000182,CDM,both,,,408.75,347.44,,,,,,,,,,,hospital's standard charge pricing
Chlamydia culture,300,RC,87110,HCPCS,430000183,CDM,both,,,158.00,134.30,,,,,,,,,,,hospital's standard charge pricing
Macroscopic exam parasite,300,RC,87169,HCPCS,430000184,CDM,both,,,48.38,41.12,,,,,,,,,,,hospital's standard charge pricing
Ova and parasites smears,300,RC,87177,HCPCS,430000185,CDM,both,,,209.33,177.93,,,,,,,,,,,hospital's standard charge pricing
Microbe susceptible diffuse,300,RC,87181,HCPCS,430000186,CDM,both,,,61.61,52.37,,,,,,,,,,,hospital's standard charge pricing
Microbe susceptible mic,300,RC,87186,HCPCS,430000187,CDM,both,,,119.24,101.35,,,,,,,,,,,hospital's standard charge pricing
Microbe suscept macrobroth,300,RC,87188,HCPCS,430000188,CDM,both,,,54.00,45.90,,,,,,,,,,,hospital's standard charge pricing
Smear gram stain,300,RC,87205,HCPCS,430000189,CDM,both,,,78.17,66.44,,,,,,,,,,,hospital's standard charge pricing
Smear fluorescent/acid stai,300,RC,87206,HCPCS,430000190,CDM,both,,,78.17,66.44,,,,,,,,,,,hospital's standard charge pricing
Smear special stain,300,RC,87207,HCPCS,430000191,CDM,both,,,41.46,35.24,,,,,,,,,,,hospital's standard charge pricing
Smear complex stain,300,RC,87209,HCPCS,430000192,CDM,both,,,85.45,72.63,,,,,,,,,,,hospital's standard charge pricing
Tissue exam for fungi,300,RC,87220,HCPCS,430000193,CDM,both,,,34.00,28.90,,,,,,,,,,,hospital's standard charge pricing
Virus inoculation tissue,300,RC,87252,HCPCS,430000194,CDM,both,,,212.00,180.20,,,,,,,,,,,hospital's standard charge pricing
Virus inoculation shell via,300,RC,87254,HCPCS,430000195,CDM,both,,,158.00,134.30,,,,,,,,,,,hospital's standard charge pricing
Genet virus isolate hsv,300,RC,87255,HCPCS,430000196,CDM,both,,,275.00,233.75,,,,,,,,,,,hospital's standard charge pricing
Clostridium ag eia,300,RC,87324,HCPCS,430000197,CDM,both,,,124.54,105.86,,,,,,,,,,,hospital's standard charge pricing
Hepatitis b surface ag eia,300,RC,87340,HCPCS,430000198,CDM,both,,,156.33,132.88,,,,,,,,,,,hospital's standard charge pricing
Rotavirus ag eia,300,RC,87425,HCPCS,430000200,CDM,both,,,97.00,82.45,,,,,,,,,,,hospital's standard charge pricing
Shiga-like toxin ag eia,300,RC,87427,HCPCS,430000201,CDM,both,,,97.00,82.45,,,,,,,,,,,hospital's standard charge pricing
Chylmd trach dna dir probe,300,RC,87490,HCPCS,430000203,CDM,both,,,138.00,117.30,,,,,,,,,,,hospital's standard charge pricing
Chylmd trach dna amp probe,300,RC,87491,HCPCS,430000204,CDM,both,,,314.01,266.91,,,,,,,,,,,hospital's standard charge pricing
Hepatitis b dna quant,300,RC,87517,HCPCS,430000205,CDM,both,,,221.25,188.06,,,,,,,,,,,hospital's standard charge pricing
Hepatitis c rna quant,300,RC,87522,HCPCS,430000206,CDM,both,,,553.16,470.19,,,,,,,,,,,hospital's standard charge pricing
Hiv-1 dna quant,300,RC,87536,HCPCS,430000207,CDM,both,,,654.50,556.33,,,,,,,,,,,hospital's standard charge pricing
N.gonorrhoeae dna dir prob,300,RC,87590,HCPCS,430000208,CDM,both,,,178.00,151.30,,,,,,,,,,,hospital's standard charge pricing
N.gonorrhoeae dna amp prob,300,RC,87591,HCPCS,430000209,CDM,both,,,314.01,266.91,,,,,,,,,,,hospital's standard charge pricing
Trichomonas vagin dir probe,300,RC,87660,HCPCS,430000210,CDM,both,,,46.37,39.41,,,,,,,,,,,hospital's standard charge pricing
Detect agent nos dna amp,300,RC,87798,HCPCS,430000212,CDM,both,,,130.46,110.89,,,,,,,,,,,hospital's standard charge pricing
Cell Count w/diff; except blood,300,RC,89051,HCPCS,430000216,CDM,both,,,139.12,118.25,,,,,,,,,,,hospital's standard charge pricing
Leukocyte assessment fecal,300,RC,89055,HCPCS,430000217,CDM,both,,,34.00,28.90,,,,,,,,,,,hospital's standard charge pricing
Exam Synovial Fluid Cryst ID,300,RC,89060,HCPCS,430000218,CDM,both,,,15.51,13.18,,,,,,,,,,,hospital's standard charge pricing
PSA screening,300,RC,G0103,HCPCS,430000219,CDM,both,,,230.53,195.95,,,,,,,,,,,hospital's standard charge pricing
Albumin,300,RC,82040,HCPCS,430000220,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Alkaline Phosphatase,300,RC,84075,HCPCS,430000221,CDM,both,,,45.72,38.86,,,,,,,,,,,hospital's standard charge pricing
Carbamazepine Level,300,RC,80156,HCPCS,430000229,CDM,both,,,230.53,195.95,,,,,,,,,,,hospital's standard charge pricing
"Culture, CSF w/ Gram Stain",300,RC,87070,HCPCS,430000230,CDM,both,,,270.28,229.74,,,,,,,,,,,hospital's standard charge pricing
CSF Glucose,300,RC,82945,HCPCS,430000231,CDM,both,,,35.12,29.85,,,,,,,,,,,hospital's standard charge pricing
CSF Protein,300,RC,84157,HCPCS,430000232,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Cell Count w/o dif; except Bld,300,RC,89050,HCPCS,430000234,CDM,both,,,86.79,73.77,,,,,,,,,,,hospital's standard charge pricing
Wet Mount Infect Agents (KOH),300,RC,87210,HCPCS,430000235,CDM,both,,,78.17,66.44,,,,,,,,,,,hospital's standard charge pricing
Cytomegalovirus quantity IGG/IGM,300,RC,87497,HCPCS,430000236,CDM,both,,,415.36,353.06,,,,,,,,,,,hospital's standard charge pricing
"West Nile Virus, IgG",300,RC,86789,HCPCS,430000237,CDM,both,,,117.00,99.45,,,,,,,,,,,hospital's standard charge pricing
"West Nile Virus, IgM",300,RC,86788,HCPCS,430000238,CDM,both,,,137.00,116.45,,,,,,,,,,,hospital's standard charge pricing
IAAD immune Q/SQ NOS each org,300,RC,87449,HCPCS,430000239,CDM,both,,,200.72,170.61,,,,,,,,,,,hospital's standard charge pricing
Antistreptolysin O; screen,300,RC,86063,HCPCS,430000241,CDM,both,,,47.00,39.95,,,,,,,,,,,hospital's standard charge pricing
"Legionella Pneumophilia, Dir Prb",300,RC,87540,HCPCS,430000242,CDM,both,,,148.00,125.80,,,,,,,,,,,hospital's standard charge pricing
Alanine amino (ALT) (SGPT),300,RC,84460,HCPCS,430000244,CDM,both,,,45.72,38.86,,,,,,,,,,,hospital's standard charge pricing
Calcium: Total,300,RC,82310,HCPCS,430000246,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Carbon Dioxide (bicarbonate),300,RC,82374,HCPCS,430000247,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Entamoeba Histoytica ag EIA,300,RC,86753,HCPCS,430000248,CDM,both,,,258.35,219.60,,,,,,,,,,,hospital's standard charge pricing
Giardia lamblia ag EIA,300,RC,87329,HCPCS,430000249,CDM,both,,,209.33,177.93,,,,,,,,,,,hospital's standard charge pricing
Cryptosporidium ag EIA,300,RC,87328,HCPCS,430000250,CDM,both,,,209.33,177.93,,,,,,,,,,,hospital's standard charge pricing
Chloride; Blood,300,RC,82435,HCPCS,430000251,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Infect antig immuno w/obs; NOS,300,RC,83516,HCPCS,430000252,CDM,both,,,48.21,40.98,,,,,,,,,,,hospital's standard charge pricing
"Influenza, A or B, each",300,RC,87400,HCPCS,430000253,CDM,both,,,138.00,117.30,,,,,,,,,,,hospital's standard charge pricing
Influenza B,300,RC,87400,HCPCS,430000254,CDM,both,,,138.00,117.30,,,59   ,,,,,,,,hospital's standard charge pricing
Osmolality; blood,300,RC,83930,HCPCS,430000255,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
Osmolality; urine,300,RC,83935,HCPCS,430000256,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
Renal Function Panel,300,RC,80069,HCPCS,430000258,CDM,both,,,390.86,332.23,,,,,,,,,,,hospital's standard charge pricing
"Sodium; serum, plasma, whole blood",300,RC,84295,HCPCS,430000259,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Sodium; urine,300,RC,84300,HCPCS,430000260,CDM,both,,,77.51,65.88,,,,,,,,,,,hospital's standard charge pricing
"Rikettsia Antibody, per antibody",300,RC,86757,HCPCS,430000261,CDM,both,,,37.67,32.02,,,,,,,,,,,hospital's standard charge pricing
"Culture, Bacterial, Aerobic, each isolate",300,RC,87077,HCPCS,430000262,CDM,both,,,141.76,120.50,,,,,,,,,,,hospital's standard charge pricing
Levetiracetam Assay,300,RC,80177,HCPCS,430000265,CDM,both,,,70.89,60.26,,,,,,,,,,,hospital's standard charge pricing
Phenobarbital Level,300,RC,80184,HCPCS,430000266,CDM,both,,,264.32,224.67,,,,,,,,,,,hospital's standard charge pricing
Dilantin; Free,300,RC,80186,HCPCS,430000267,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
Primidone,300,RC,80188,HCPCS,430000268,CDM,both,,,301.42,256.21,,,,,,,,,,,hospital's standard charge pricing
Tobramycin Level,300,RC,80200,HCPCS,430000269,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
"Tricyclic Antidepressant Screen, Urine",300,RC,80307,HCPCS,430000271,CDM,both,,,162.78,138.36,,,,,,,,,,,hospital's standard charge pricing
Amphetamines; 1 or 2,300,RC,80324,HCPCS,430000272,CDM,both,,,927.00,787.95,,,,,,,,,,,hospital's standard charge pricing
"Antidepressants, serotonergic class; 1 or 2",300,RC,G0480,HCPCS,430000274,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
Trazodone Level,300,RC,G0480,HCPCS,430000277,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
Barbiturates,300,RC,80345,HCPCS,430000278,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
Benzodiazepines; 1-2,300,RC,80346,HCPCS,430000279,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
"Cannabinoids, natural",300,RC,80349,HCPCS,430000280,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
Cocaine,300,RC,G0480,HCPCS,430000281,CDM,both,,,99.36,84.46,,,,,,,,,,,hospital's standard charge pricing
Opiates Urine Confirmation,300,RC,G0480,HCPCS,430000282,CDM,both,,,927.00,787.95,,,,,,,,,,,hospital's standard charge pricing
Meprobamate Level,300,RC,G0480,HCPCS,430000283,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
"Calcium, Ionized",300,RC,82330,HCPCS,430000284,CDM,both,,,93.42,79.41,,,,,,,,,,,hospital's standard charge pricing
Cholesterol HDL,300,RC,83718,HCPCS,430000285,CDM,both,,,90.76,77.15,,,,,,,,,,,hospital's standard charge pricing
Cholesterol LDL,300,RC,83721,HCPCS,430000286,CDM,both,,,141.11,119.94,,,,,,,,,,,hospital's standard charge pricing
pH Body Fluid,300,RC,83986,HCPCS,430000287,CDM,both,,,29.00,24.65,,,,,,,,,,,hospital's standard charge pricing
Phencyclidine Urine Confirmation,300,RC,83992,HCPCS,430000288,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
Transferrin,300,RC,84466,HCPCS,430000289,CDM,both,,,153.04,130.08,,,,,,,,,,,hospital's standard charge pricing
Triglycerides,300,RC,84478,HCPCS,430000290,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
"Platelet count, automated",300,RC,85049,HCPCS,430000292,CDM,both,,,67.56,57.43,,,,,,,,,,,hospital's standard charge pricing
Factor V Activity,300,RC,85220,HCPCS,430000293,CDM,both,,,333.88,283.80,,,,,,,,,,,hospital's standard charge pricing
Factor VIII C: Activity,300,RC,85240,HCPCS,430000294,CDM,both,,,333.88,283.80,,,,,,,,,,,hospital's standard charge pricing
Factor X Assay,300,RC,85260,HCPCS,430000297,CDM,both,,,333.88,283.80,,,,,,,,,,,hospital's standard charge pricing
Quantiferon,300,RC,86480,HCPCS,430000299,CDM,both,,,274.24,233.10,,,,,,,,,,,hospital's standard charge pricing
Lyme Immunoblot Confirmatory Test,300,RC,86617,HCPCS,430000300,CDM,both,,,125.00,106.25,,,,,,,,,,,hospital's standard charge pricing
Rubeola IgG,300,RC,86765,HCPCS,430000301,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
Rubeola IgM,300,RC,86765,HCPCS,430000302,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
FTA,300,RC,86780,HCPCS,430000303,CDM,both,,,107.00,90.95,,,,,,,,,,,hospital's standard charge pricing
Unlisted Immunology Procedure,300,RC,86849,HCPCS,430000304,CDM,both,,,1183.00,1005.55,,,,,,,,,,,hospital's standard charge pricing
Mycoplasma pneumoniae (respiratory) culture,300,RC,87109,HCPCS,430000305,CDM,both,,,125.00,106.25,,,,,,,,,,,hospital's standard charge pricing
Sensitivity Disk Method,300,RC,87184,HCPCS,430000306,CDM,both,,,120.57,102.48,,,,,,,,,,,hospital's standard charge pricing
"HIV-1 antigen(s), with HIV-1 and HIV-2 Antibodies, single result",300,RC,87389,HCPCS,430000310,CDM,both,,,251.08,213.42,,,,,,,,,,,hospital's standard charge pricing
C Difficile Toxin Gene by PCR,300,RC,87493,HCPCS,430000311,CDM,both,,,512.08,435.27,,,,,,,,,,,hospital's standard charge pricing
Hepatitis C RNA Qualitative,300,RC,87521,HCPCS,430000312,CDM,both,,,284.00,241.40,,,,,,,,,,,hospital's standard charge pricing
"Human Papillomavirus, high risk types",300,RC,87624,HCPCS,430000313,CDM,both,,,377.61,320.97,,,,,,,,,,,hospital's standard charge pricing
RSV Antigen,300,RC,87420,HCPCS,430000314,CDM,both,,,151.71,128.95,,,,,,,,,,,hospital's standard charge pricing
"Streptococcus, group A",300,RC,87880,HCPCS,430000315,CDM,both,,,134.00,113.90,,,,,,,,,,,hospital's standard charge pricing
Infect Agent Antigen Det by Immun w/Direct Opt OBS; NOS,300,RC,87899,HCPCS,430000316,CDM,both,,,131.00,111.35,,,,,,,,,,,hospital's standard charge pricing
Hepatitis C Genotyping,300,RC,87902,HCPCS,430000317,CDM,both,,,984.40,836.74,,,,,,,,,,,hospital's standard charge pricing
Eosinophil Count Nasal,300,RC,89190,HCPCS,430000318,CDM,both,,,47.00,39.95,,,,,,,,,,,hospital's standard charge pricing
Amikacin,300,RC,80150,HCPCS,430000319,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
Gentamicin Level,300,RC,80170,HCPCS,430000320,CDM,both,,,227.22,193.14,,,,,,,,,,,hospital's standard charge pricing
Methadone,300,RC,80358,HCPCS,430000322,CDM,both,,,927.00,787.95,,,,,,,,,,,hospital's standard charge pricing
"Culture, AFB",300,RC,87116,HCPCS,430000323,CDM,both,,,315.32,268.02,,,,,,,,,,,hospital's standard charge pricing
"Culture, Fungus, Skin, Hair and Nail",300,RC,87101,HCPCS,430000324,CDM,both,,,62.00,52.70,,,,,,,,,,,hospital's standard charge pricing
Von Willebrand Factor Ag,300,RC,85246,HCPCS,430000325,CDM,both,,,590.90,502.27,,,,,,,,,,,hospital's standard charge pricing
Lyme Immunoblot 2,300,RC,86617,HCPCS,430000326,CDM,both,,,125.00,106.25,,,59   ,,,,,,,,hospital's standard charge pricing
"Epstein-barr virus antibody,(EA) 2",300,RC,86663,HCPCS,430000328,CDM,both,,,172.90,146.97,,,59   ,,,,,,,,hospital's standard charge pricing
"CANDIDA SPECIES, DIR PROBE",300,RC,87480,HCPCS,430000332,CDM,both,,,103.33,87.83,,,,,,,,,,,hospital's standard charge pricing
"GARDNERELLA VAGINALS, DIR PROBE",300,RC,87510,HCPCS,430000333,CDM,both,,,103.33,87.83,,,,,,,,,,,hospital's standard charge pricing
"Herpes Simplex Virus 1 and 2, amplified probe technique",300,RC,87529,HCPCS,430000335,CDM,both,,,353.75,300.69,,,,,,,,,,,hospital's standard charge pricing
"Herpes Simplex Virus 2, amplified probe technique",300,RC,87529,HCPCS,430000336,CDM,both,,,353.75,300.69,,,59   ,,,,,,,,hospital's standard charge pricing
Venous blood gases,300,RC,82803,HCPCS,430000345,CDM,both,,,128.57,109.28,,,,,,,,,,,hospital's standard charge pricing
ANAEROB ID,300,RC,87076,HCPCS,430000346,CDM,both,,,96.06,81.65,,,,,,,,,,,hospital's standard charge pricing
FUNGUS ID,300,RC,87106,HCPCS,430000347,CDM,both,,,84.00,71.40,,,,,,,,,,,hospital's standard charge pricing
MUMPS,300,RC,86735,HCPCS,430000348,CDM,both,,,105.00,89.25,,,,,,,,,,,hospital's standard charge pricing
SURESWAB TRICH VAG RNA QUALITATIVE TM,300,RC,87661,HCPCS,430000349,CDM,both,,,314.01,266.91,,,,,,,,,,,hospital's standard charge pricing
HERPES VIRUS PCR QUANTITATIVE,300,RC,87530,HCPCS,430000350,CDM,both,,,347.00,294.95,,,,,,,,,,,hospital's standard charge pricing
STREP PNEUMO AG,300,RC,86403,HCPCS,430000355,CDM,both,,,94.00,79.90,,,,,,,,,,,hospital's standard charge pricing
MUMPS IGM,300,RC,86735,HCPCS,430000357,CDM,both,,,249.75,212.29,,,,,,,,,,,hospital's standard charge pricing
HIV 2 ANTIBODY DIFFERENTIATION,300,RC,86702,HCPCS,430000358,CDM,both,,,110.00,93.50,,,,,,,,,,,hospital's standard charge pricing
"HIV 1 RNA, QL BY TMA",300,RC,87535,HCPCS,430000359,CDM,both,,,284.00,241.40,,,,,,,,,,,hospital's standard charge pricing
Sedimentation Rate Westergren,300,RC,85651,HCPCS,430000361,CDM,both,,,60.29,51.25,,,,,,,,,,,hospital's standard charge pricing
"Enzyme detection (eg, beta lactamase), per enzyme",300,RC,87185,HCPCS,430000362,CDM,both,,,39.00,33.15,,,,,,,,,,,hospital's standard charge pricing
Tricyclic & cyclicals 6/more,300,RC,80337,HCPCS,430000368,CDM,both,,,891.00,757.35,,,,,,,,,,,hospital's standard charge pricing
Pinworm Exam,300,RC,87172,HCPCS,430000389,CDM,both,,,60.29,51.25,,,,,,,,,,,hospital's standard charge pricing
Ehrlichia Chaf AB,300,RC,86666,HCPCS,430000390,CDM,both,,,54.00,45.90,,,,,,,,,,,hospital's standard charge pricing
Parathormone (or parathyroid hormone),300,RC,83970,HCPCS,430000391,CDM,both,,,271.61,230.87,,,,,,,,,,,hospital's standard charge pricing
AFP Tumor,300,RC,82105,HCPCS,430000392,CDM,both,,,192.78,163.86,,,,,,,,,,,hospital's standard charge pricing
Random Urine Creatinine,300,RC,82570,HCPCS,430000393,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
IGG Subclass,300,RC,82787,HCPCS,430000395,CDM,both,,,65.00,55.25,,,,,,,,,,,hospital's standard charge pricing
Random Urine Total Protein,300,RC,84156,HCPCS,430000396,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Procalcitonin,300,RC,84145,HCPCS,430000397,CDM,both,,,404.77,344.05,,,,,,,,,,,hospital's standard charge pricing
Alpha 1 Antitrypsin,300,RC,82103,HCPCS,430000399,CDM,both,,,273.60,232.56,,,,,,,,,,,hospital's standard charge pricing
Urine Chloride,300,RC,82436,HCPCS,430000400,CDM,both,,,89.43,76.02,,,,,,,,,,,hospital's standard charge pricing
Potassium Urine,300,RC,84133,HCPCS,430000403,CDM,both,,,77.51,65.88,,,,,,,,,,,hospital's standard charge pricing
Plasma Renin Activity LC/Ms/MS,300,RC,84244,HCPCS,430000405,CDM,both,,,155.02,131.77,,,,,,,,,,,hospital's standard charge pricing
Meningitis/Encephalitis Molecular Panel,300,RC,87483,HCPCS,430000407,CDM,both,,,3529.53,3000.10,,,,,,,,,,,hospital's standard charge pricing
"Listeria Antibody, C",300,RC,86723,HCPCS,430000408,CDM,both,,,107.00,90.95,,,,,,,,,,,hospital's standard charge pricing
"FDP, Plasma",300,RC,85362,HCPCS,430000409,CDM,both,,,56.00,47.60,,,,,,,,,,,hospital's standard charge pricing
Tacrolimus,300,RC,80197,HCPCS,430000410,CDM,both,,,112.00,95.20,,,,,,,,,,,hospital's standard charge pricing
"Catecholamines, Fractionated, plasma",300,RC,82384,HCPCS,430000411,CDM,both,,,453.80,385.73,,,,,,,,,,,hospital's standard charge pricing
"Chlamydia pneumoniae, amplified probe technique",300,RC,87486,HCPCS,430000412,CDM,both,,,284.00,241.40,,,,,,,,,,,hospital's standard charge pricing
Sureswab Candidiasis,300,RC,87481,HCPCS,430000413,CDM,both,,,164.96,140.22,,,,,,,,,,,hospital's standard charge pricing
BV DNA quantification each org,300,RC,87799,HCPCS,430000414,CDM,both,,,572.71,486.80,,,,,,,,,,,hospital's standard charge pricing
Phospholipid neutralization; hexagonal,300,RC,85598,HCPCS,430000418,CDM,both,,,146.00,124.10,,,,,,,,,,,hospital's standard charge pricing
Thrombin time,300,RC,85670,HCPCS,430000419,CDM,both,,,109.32,92.92,,,,,,,,,,,hospital's standard charge pricing
"Helicobacter Pylori, stool",300,RC,87338,HCPCS,430000420,CDM,both,,,116.00,98.60,,,,,,,,,,,hospital's standard charge pricing
"Mycoplasma pneumoniae, amplified probe technique",300,RC,87581,HCPCS,430000424,CDM,both,,,467.70,397.55,,,,,,,,,,,hospital's standard charge pricing
"Staphylococcus aureus, methicillin resistant, amp probe technique",300,RC,87641,HCPCS,430000426,CDM,both,,,270.28,229.74,,,,,,,,,,,hospital's standard charge pricing
"Resp virus multi rev trans; multi amp probe, 12-25 targets",300,RC,87633,HCPCS,430000427,CDM,both,,,1623.95,1380.36,,,,,,,,,,,hospital's standard charge pricing
Prealbumin,300,RC,84134,HCPCS,430000428,CDM,both,,,176.22,149.79,,,,,,,,,,,hospital's standard charge pricing
AB Elution RBC Ea,300,RC,86860,HCPCS,430000430,CDM,both,,,1319.00,1121.15,,,,,,,,,,,hospital's standard charge pricing
AB ID Red Blood Cell Ea PNL,300,RC,86870,HCPCS,430000431,CDM,both,,,2774.00,2357.90,,,,,,,,,,,hospital's standard charge pricing
Coombs Dirct Ea Antiserum,300,RC,86880,HCPCS,430000432,CDM,both,,,131.17,111.49,,,,,,,,,,,hospital's standard charge pricing
"Compatibility Test, Antiglobulin Tech",300,RC,86922,HCPCS,430000433,CDM,both,,,1319.00,1121.15,,,,,,,,,,,hospital's standard charge pricing
"Compatibility Test, Electronic",300,RC,86923,HCPCS,430000434,CDM,both,,,1319.00,1121.15,,,,,,,,,,,hospital's standard charge pricing
Pretreat Serum ADB ID Inhibitor Ea,300,RC,86977,HCPCS,430000435,CDM,both,,,1319.00,1121.15,,,,,,,,,,,hospital's standard charge pricing
Cult Typ Sero Agglutin Ea,300,RC,87147,HCPCS,430000436,CDM,both,,,42.00,35.70,,,,,,,,,,,hospital's standard charge pricing
EIA AG Qual Sngl Ea Org NOS,300,RC,87450,HCPCS,430000437,CDM,both,,,86.00,73.10,,,,,,,,,,,hospital's standard charge pricing
RSV Amp Probe,300,RC,87634,HCPCS,430000438,CDM,both,,,569.00,483.65,,,,,,,,,,,hospital's standard charge pricing
Trichomonas Vaginalis Optic,300,RC,87808,HCPCS,430000439,CDM,both,,,124.00,105.40,,,,,,,,,,,hospital's standard charge pricing
"RBC’S Ea Unit, Leuk Reduced; Irradiated",300,RC,P9040,HCPCS,430000440,CDM,both,,,1515.00,1287.75,,,,,,,,,,,hospital's standard charge pricing
Compatibility Test Imm Spin,300,RC,86920,HCPCS,430000441,CDM,both,,,219.27,186.38,,,,,,,,,,,hospital's standard charge pricing
SARS-CoV-2 (COVID-19),300,RC,87635,HCPCS,430000444,CDM,both,,,183.50,155.98,,,,,,,,,,,hospital's standard charge pricing
Urine Calcium,300,RC,82340,HCPCS,430000445,CDM,both,,,93.42,79.41,,,,,,,,,,,hospital's standard charge pricing
Metanephrines,300,RC,83835,HCPCS,430000446,CDM,both,,,220.60,187.51,,,,,,,,,,,hospital's standard charge pricing
Fluor Noninfect AB Titer ea,300,RC,86256,HCPCS,430000447,CDM,both,,,97.00,82.45,,,,,,,,,,,hospital's standard charge pricing
Conc for Infectious Agent,300,RC,87015,HCPCS,430000448,CDM,both,,,54.00,45.90,,,,,,,,,,,hospital's standard charge pricing
"CULT TYPING, NAT AMP PROBE EA ORG",300,RC,87150,HCPCS,430000450,CDM,both,,,284.00,241.40,,,,,,,,,,,hospital's standard charge pricing
FLU PCR 1ST 2 TYPES/SUBTYPES,300,RC,87502,HCPCS,430000451,CDM,both,,,776.00,659.60,,,,,,,,,,,hospital's standard charge pricing
RESP VIRUS 3-5 TARGETS,300,RC,87631,HCPCS,430000452,CDM,both,,,1156.00,982.60,,,,,,,,,,,hospital's standard charge pricing
CULT FUNGI ID MOLD,300,RC,87107,HCPCS,430000453,CDM,both,,,84.00,71.40,,,,,,,,,,,hospital's standard charge pricing
Antibody; Severe Acute Resp Syndrome Coronavirus 2 (SAR-CoV-2),300,RC,86769,HCPCS,430000456,CDM,both,,,81.46,69.24,,,,,,,,,,,hospital's standard charge pricing
"Infect agent det, nucl acid (DNA or RNA), multi organ; ampl probe",300,RC,87801,HCPCS,430000458,CDM,both,,,207.43,176.32,,,,,,,,,,,hospital's standard charge pricing
"Immunoassay for tumor antigen, quantitative; CA 19-9",300,RC,86301,HCPCS,430000459,CDM,both,,,183.51,155.98,,,,,,,,,,,hospital's standard charge pricing
Fibrinogen activity,300,RC,85384,HCPCS,430000463,CDM,both,,,95.40,81.09,,,,,,,,,,,hospital's standard charge pricing
Erythropoetin,300,RC,82668,HCPCS,430000464,CDM,both,,,152.00,129.20,,,,,,,,,,,hospital's standard charge pricing
JAK2 gene analysis,300,RC,81270,HCPCS,430000465,CDM,both,,,330.00,280.50,,,,,,,,,,,hospital's standard charge pricing
"Haptoglobin, Qnt.",300,RC,83010,HCPCS,430000466,CDM,both,,,102.00,86.70,,,,,,,,,,,hospital's standard charge pricing
JAK2 EXON 12 Mutation Analysis,300,RC,81403,HCPCS,430000467,CDM,both,,,667.00,566.95,,,,,,,,,,,hospital's standard charge pricing
SARS Antigen FIA (Rapid Test),300,RC,87426,HCPCS,430000469,CDM,both,,,346.00,294.10,,,,,,,,,,,hospital's standard charge pricing
GASTRIN,300,RC,82941,HCPCS,430000471,CDM,both,,,143.00,121.55,,,,,,,,,,,hospital's standard charge pricing
INSULIN-LIKE GROWTH FACTOR 1,300,RC,84305,HCPCS,430000472,CDM,both,,,172.00,146.20,,,,,,,,,,,hospital's standard charge pricing
HEPARIN ANTI-XA ASSAY,300,RC,85520,HCPCS,430000473,CDM,both,,,106.00,90.10,,,,,,,,,,,hospital's standard charge pricing
EXTRACT NUCLEAR AG EA AB,300,RC,86235,HCPCS,430000474,CDM,both,,,202.70,172.30,,,,,,,,,,,hospital's standard charge pricing
"SCREEN, RHEUMATOID FACTOR",300,RC,86430,HCPCS,430000475,CDM,both,,,50.00,42.50,,,,,,,,,,,hospital's standard charge pricing
IG IGA IGD IGG IGM EACH,300,RC,82784,HCPCS,430000476,CDM,both,,,148.27,126.03,,,,,,,,,,,hospital's standard charge pricing
FUNGUS AB NOS,300,RC,86671,HCPCS,430000477,CDM,both,,,99.00,84.15,,,,,,,,,,,hospital's standard charge pricing
MYCOPLASMA GENITALIUM,300,RC,87563,HCPCS,430000479,CDM,both,,,314.01,266.91,,,,,,,,,,,hospital's standard charge pricing
Gastrointestinal PCR 6-11,300,RC,87506,HCPCS,430000481,CDM,both,,,694.25,590.11,,,,,,,,,,,hospital's standard charge pricing
Hemoglobin Fractionation & Quantification; Chromatography,300,RC,83021,HCPCS,430000482,CDM,both,,,147.00,124.95,,,,,,,,,,,hospital's standard charge pricing
"Sickling of RBC, reduction",300,RC,85660,HCPCS,430000483,CDM,both,,,123.89,105.31,,,,,,,,,,,hospital's standard charge pricing
SARS Antigen/Influenza A and B Antigens FIA (Rapid Test),300,RC,87428,HCPCS,430000484,CDM,both,,,561.00,476.85,,,QW   ,,,,,,,,hospital's standard charge pricing
C-PEPTIDE,300,RC,84681,HCPCS,430000490,CDM,both,,,201.38,171.17,,,,,,,,,,,hospital's standard charge pricing
LACTOFERRIN FECAL QUAL,300,RC,83630,HCPCS,430000491,CDM,both,,,159.00,135.15,,,,,,,,,,,hospital's standard charge pricing
SURG PATH GR\T\M LVL 4,300,RC,88305,HCPCS,430000493,CDM,both,,,267.63,227.49,,,,,,,,,,,hospital's standard charge pricing
"SARS-CoV-2, Flu A, Flu B; Pathogen Specific RNA, 4 targets",300,RC,0241U,HCPCS,430000494,CDM,both,,,596.21,506.78,,,,,,,,,,,hospital's standard charge pricing
IHC QUANT EA SINGLE AB MANUAL,300,RC,88360,HCPCS,430000495,CDM,both,,,586.00,498.10,,,,,,,,,,,hospital's standard charge pricing
IHC INITIAL SINGLE AB STAIN,300,RC,88342,HCPCS,430000496,CDM,both,,,586.00,498.10,,,,,,,,,,,hospital's standard charge pricing
VALPROIC ACID FREE,300,RC,80165,HCPCS,430000497,CDM,both,,,110.00,93.50,,,,,,,,,,,hospital's standard charge pricing
METHYLMALON ACID,300,RC,83921,HCPCS,430000498,CDM,both,,,172.00,146.20,,,,,,,,,,,hospital's standard charge pricing
VITAMIN B1 (THIAMINE),300,RC,84425,HCPCS,430000499,CDM,both,,,172.00,146.20,,,,,,,,,,,hospital's standard charge pricing
VITAMIN B6,300,RC,84207,HCPCS,430000500,CDM,both,,,329.24,279.85,,,,,,,,,,,hospital's standard charge pricing
COPPER LEVEL,300,RC,82525,HCPCS,430000502,CDM,both,,,119.24,101.35,,,,,,,,,,,hospital's standard charge pricing
CERULOPLASMIN,300,RC,82390,HCPCS,430000503,CDM,both,,,165.62,140.78,,,,,,,,,,,hospital's standard charge pricing
"Acetaminophen Blood, Assay",300,RC,80143,HCPCS,430000504,CDM,both,,,151.00,128.35,,,,,,,,,,,hospital's standard charge pricing
Haptoglobin; quantitative,300,RC,83013,HCPCS,430000505,CDM,both,,,545.00,463.25,,,,,,,,,,,hospital's standard charge pricing
ETHANOL ANY EXCEPT URINE AND BREATH,300,RC,82077,HCPCS,430000506,CDM,both,,,140.00,119.00,,,,,,,,,,,hospital's standard charge pricing
SALICYLATE,300,RC,80179,HCPCS,430000507,CDM,both,,,151.00,128.35,,,,,,,,,,,hospital's standard charge pricing
CALPROTECTIN FECAL,300,RC,83993,HCPCS,430000508,CDM,both,,,432.59,367.70,,,,,,,,,,,hospital's standard charge pricing
TESTOSTERONE FREE,300,RC,84402,HCPCS,430000509,CDM,both,,,206.00,175.10,,,,,,,,,,,hospital's standard charge pricing
TOPIRAMATE,300,RC,80201,HCPCS,430000510,CDM,both,,,291.48,247.76,,,,,,,,,,,hospital's standard charge pricing
LAMOTRIGINE,300,RC,80175,HCPCS,430000511,CDM,both,,,157.66,134.01,,,,,,,,,,,hospital's standard charge pricing
Thyroid Stimulating Immunoglobin (TSIG),300,RC,84445,HCPCS,430000514,CDM,both,,,612.77,520.85,,,,,,,,,,,hospital's standard charge pricing
"HIV-1 Antigen, w/ HIV-1 & HIV-2 antibodies",300,RC,87806,HCPCS,430000516,CDM,both,,,266.00,226.10,,,,,,,,,,,hospital's standard charge pricing
"Microbacteria TB, amplified probe tech",300,RC,87556,HCPCS,430000517,CDM,both,,,423.96,360.37,,,,,,,,,,,hospital's standard charge pricing
"Culture, Microbact, definitive ID, EA Isolate",300,RC,87118,HCPCS,430000519,CDM,both,,,118.00,100.30,,,,,,,,,,,hospital's standard charge pricing
"Culture, Typing; ID nucleic acid sequencing",300,RC,87153,HCPCS,430000520,CDM,both,,,934.00,793.90,,,,,,,,,,,hospital's standard charge pricing
Urine Aminolevulinic Delta (ALA),300,RC,82135,HCPCS,430000521,CDM,both,,,247.10,210.04,,,,,,,,,,,hospital's standard charge pricing
Urine Porphobilinogen (PBG),300,RC,84106,HCPCS,430000522,CDM,both,,,47.00,39.95,,,,,,,,,,,hospital's standard charge pricing
IMMUNOASSAY RIA QUANT,300,RC,83519,HCPCS,430000526,CDM,both,,,149.00,126.65,,,,,,,,,,,hospital's standard charge pricing
SURG PATH GR\T\M LVL 3,300,RC,88304,HCPCS,430000527,CDM,both,,,184.83,157.11,,,,,,,,,,,hospital's standard charge pricing
CULTURE TYPING DNA DIR PROBE EA,300,RC,87149,HCPCS,430000528,CDM,both,,,162.00,137.70,,,,,,,,,,,hospital's standard charge pricing
"Infectious Agent Cytomegalovirus, direct Probe",300,RC,87496,HCPCS,430000529,CDM,both,,,239.16,203.29,,,,,,,,,,,hospital's standard charge pricing
ASPERGILLUS,300,RC,87305,HCPCS,430000530,CDM,both,,,162.09,137.78,,,,,,,,,,,hospital's standard charge pricing
"Flow cytometry, surface, cytoplasmic, nuclear marker; 1st marker",300,RC,88184,HCPCS,430000531,CDM,both,,,1233.00,1048.05,,,,,,,,,,,hospital's standard charge pricing
"Flow cytometry, surface, cytoplasmic, nuclear marker; ea addl",300,RC,88185,HCPCS,430000532,CDM,both,,,149.00,126.65,,,,,,,,,,,hospital's standard charge pricing
"Special stain, Group 1; interp and report",300,RC,88312,HCPCS,430000534,CDM,both,,,186.00,158.10,,,,,,,,,,,hospital's standard charge pricing
"Occult Blood, fecal hgb determination, immunoassay; qualitative",300,RC,82274,HCPCS,430000538,CDM,both,,,146.00,124.10,,,,,,,,,,,hospital's standard charge pricing
Cytomegalovirus (CMV) IgG,300,RC,86644,HCPCS,430000541,CDM,both,,,235.83,200.46,,,,,,,,,,,hospital's standard charge pricing
"Cytomegalovirus (CMV), IgM",300,RC,86645,HCPCS,430000542,CDM,both,,,156.33,132.88,,,,,,,,,,,hospital's standard charge pricing
Infectious agent detect (DNA/RNA) SARS-CoV-2 & Flu A/B Amp Probe,300,RC,87636,HCPCS,430000543,CDM,both,,,220.83,187.71,,,,,,,,,,,hospital's standard charge pricing
"Level 1, Surgical Pathology, Gross Only, 1 Specimen, PC",300,RC,88300,HCPCS,430000546,CDM,both,,,102.00,86.70,,,,,,,,,,,hospital's standard charge pricing
Interleukin-6 (IL-6),300,RC,83529,HCPCS,430000547,CDM,both,,,140.00,119.00,,,,,,,,,,,hospital's standard charge pricing
"Infect agent detect immunoassay, optical, SARS-CoV-2 (COVID-19)",300,RC,87811,HCPCS,430000548,CDM,both,,,335.00,284.75,,,,,,,,,,,hospital's standard charge pricing
ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL,300,RC,86885,HCPCS,430000549,CDM,both,,,1268.00,1077.80,,,,,,,,,,,hospital's standard charge pricing
"IHC INITIAL SINGLE AB STAIN, EACH ADD STAIN",300,RC,88341,HCPCS,430000551,CDM,both,,,391.51,332.78,,,,,,,,,,,hospital's standard charge pricing
"ALBUMIN; OTHER SOURCE, QUANT, EACH SPEC.",300,RC,82042,HCPCS,430000555,CDM,both,,,102.68,87.28,,,,,,,,,,,hospital's standard charge pricing
BIOFIRE RESPIRATORY PANEL 2.1,300,RC,0202U,HCPCS,430000556,CDM,both,,,1857.38,1578.77,,,,,,,,,,,hospital's standard charge pricing
"TB TEST, IMMUN. ANTIGN; GAMMA INT-FERON T-CELLS IN SUSP.",300,RC,86481,HCPCS,430000558,CDM,both,,,810.00,688.50,,,,,,,,,,,hospital's standard charge pricing
Monkeypox Infectious Agent Detection,300,RC,87593,HCPCS,430000563,CDM,both,,,149.04,126.68,,,,,,,,,,,hospital's standard charge pricing
Methotrexate,300,RC,80204,HCPCS,430000564,CDM,both,,,312.00,265.20,,,,,,,,,,,hospital's standard charge pricing
Insulin Antibodies,300,RC,86337,HCPCS,430000568,CDM,both,,,174.00,147.90,,,,,,,,,,,hospital's standard charge pricing
"Blood Typing, RBC antigen, other than ABO or RH, each",300,RC,86905,HCPCS,430000570,CDM,both,,,2774.00,2357.90,,,,,,,,,,,hospital's standard charge pricing
"Blood typing, antigen test donor blood, each antigen test",300,RC,86902,HCPCS,430000571,CDM,both,,,2774.00,2357.90,,,,,,,,,,,hospital's standard charge pricing
"Infect Agent, Yeast Culture (Vaginal fluid)",300,RC,87905,HCPCS,430000573,CDM,both,,,30.55,25.97,,,,,,,,,,,hospital's standard charge pricing
Histoplasma Capsulatum,300,RC,87385,HCPCS,430000574,CDM,both,,,424.64,360.94,,,,,,,,,,,hospital's standard charge pricing
Bordetella,300,RC,86615,HCPCS,430000576,CDM,both,,,195.96,166.57,,,,,,,,,,,hospital's standard charge pricing
Macroscopic examination; arthropod,300,RC,87168,HCPCS,430000577,CDM,both,,,87.44,74.32,,,,,,,,,,,hospital's standard charge pricing
"Borrelia burgdorferi, amplified probe technique",300,RC,87476,HCPCS,430000578,CDM,both,,,1254.67,1066.47,,,,,,,,,,,hospital's standard charge pricing
Islet Cell antibody,300,RC,86341,HCPCS,430000579,CDM,both,,,311.35,264.65,,,,,,,,,,,hospital's standard charge pricing
IMMUNOGLOBULIN E,300,RC,82785,HCPCS,430000580,CDM,both,,,141.11,119.94,,,,,,,,,,,hospital's standard charge pricing
Lidocaine,300,RC,80176,HCPCS,430000581,CDM,both,,,268.96,228.62,,,,,,,,,,,hospital's standard charge pricing
Oxcarbazepine,300,RC,80183,HCPCS,430000582,CDM,both,,,374.29,318.15,,,,,,,,,,,hospital's standard charge pricing
Lacosamide,300,RC,80235,HCPCS,430000583,CDM,both,,,144.48,122.81,,,,,,,,,,,hospital's standard charge pricing
"Hemoglobin; methemoglobin, quanitative",300,RC,83050,HCPCS,430000584,CDM,both,,,90.76,77.15,,,,,,,,,,,hospital's standard charge pricing
"Actin (smooth muscle) antibody (ASMA),each",300,RC,86015,HCPCS,430000585,CDM,both,,,97.00,82.45,,,,,,,,,,,hospital's standard charge pricing
"Antineutrophil cytoplasmic antibody (ANCA); titer, each antibody",300,RC,86037,HCPCS,430000586,CDM,both,,,97.00,82.45,,,,,,,,,,,hospital's standard charge pricing
"Immunoassay for tumor antigen, quantitative; CA",300,RC,86300,HCPCS,430000587,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
"Tissue transglutaminase, each immunoglobin (Ig) class",300,RC,86364,HCPCS,430000588,CDM,both,,,94.00,79.90,,,,,,,,,,,hospital's standard charge pricing
"Mitochondrial antibody (eg, M2), each",300,RC,86381,HCPCS,430000589,CDM,both,,,206.00,175.10,,,,,,,,,,,hospital's standard charge pricing
"Pretx RBC in RBC AB Detct, Ident/Compat test;Incub w/chem/drug ea",300,RC,86970,HCPCS,430000590,CDM,both,,,123.22,104.74,,,,,,,,,,,hospital's standard charge pricing
"IA Detct Nucleic Acid DNA/RNA; anaplasma phagocytophilum, AP tech",300,RC,87468,HCPCS,430000591,CDM,both,,,284.00,241.40,,,,,,,,,,,hospital's standard charge pricing
"Ehrlichia chaffeensis, amplified probe technique",300,RC,87484,HCPCS,430000592,CDM,both,,,284.00,241.40,,,,,,,,,,,hospital's standard charge pricing
"Clotting; factor VII (proconvertin, stable factor)",300,RC,85230,HCPCS,430000593,CDM,both,,,333.88,283.80,,,,,,,,,,,hospital's standard charge pricing
"Thromboplastin time, partial (PTT); subs, plasma fractions, each",300,RC,85732,HCPCS,430000594,CDM,both,,,202.05,171.74,,,,,,,,,,,hospital's standard charge pricing
"Gases, blood, O2 sat only, by direct meas, except Puls Ox",300,RC,82810,HCPCS,430000595,CDM,both,,,58.97,50.12,,,,,,,,,,,hospital's standard charge pricing
Gastrointestinal PCR 12-25 targets,300,RC,87507,HCPCS,430000596,CDM,both,,,3376.00,2869.60,,,,,,,,,,,hospital's standard charge pricing
Pretx of Serum for use in RBC AB ID; Ea Absorption,300,RC,86978,HCPCS,430000597,CDM,both,,,91.41,77.70,,,,,,,,,,,hospital's standard charge pricing
Legionella Pneumophilia,300,RC,87278,HCPCS,430000598,CDM,both,,,279.55,237.62,,,,,,,,,,,hospital's standard charge pricing
"HBB /Sickle Cell anemia, common variants (EG, HBS, HBC, HBE)",300,RC,81361,HCPCS,430000601,CDM,both,,,629.00,534.65,,,,,,,,,,,hospital's standard charge pricing
Unlisted Chemistry Procedure (Fecal Osmolality),300,RC,84999,HCPCS,430000602,CDM,both,,,113.00,96.05,,,,,,,,,,,hospital's standard charge pricing
Unlisted hematology and coagulation procedure (Urine Eosinophils),300,RC,85999,HCPCS,430000603,CDM,both,,,118.00,100.30,,,,,,,,,,,hospital's standard charge pricing
"HIV Antigen/antibody, combination assay, screening",300,RC,G0475,HCPCS,430000604,CDM,both,,,195.00,165.75,,,,,,,,,,,hospital's standard charge pricing
Lead,300,RC,83655,HCPCS,430000605,CDM,both,,,240.47,204.40,,,,,,,,,,,hospital's standard charge pricing
Viscosity,300,RC,85810,HCPCS,430000606,CDM,both,,,178.21,151.48,,,,,,,,,,,hospital's standard charge pricing
Mycophenolate,300,RC,80180,HCPCS,430000607,CDM,both,,,96.06,81.65,,,,,,,,,,,hospital's standard charge pricing
Total CK and CK isoenzymes,300,RC,82552,HCPCS,430000608,CDM,both,,,359.73,305.77,,,,,,,,,,,hospital's standard charge pricing
Hemoglobin fractionation and quantification; electrophoresis,300,RC,83020,HCPCS,430000609,CDM,both,,,394.15,335.03,,,,,,,,,,,hospital's standard charge pricing
"PSA, Free",300,RC,84154,HCPCS,430000610,CDM,both,,,544.54,462.86,,,,,,,,,,,hospital's standard charge pricing
"Clotting Factor II, prothrombin specific",300,RC,85210,HCPCS,430000611,CDM,both,,,333.88,283.80,,,,,,,,,,,hospital's standard charge pricing
Plasminogen,300,RC,85420,HCPCS,430000612,CDM,both,,,208.67,177.37,,,,,,,,,,,hospital's standard charge pricing
Immunofixation electrophoresis; serum,300,RC,86334,HCPCS,430000614,CDM,both,,,177.60,150.96,,,,,,,,,,,hospital's standard charge pricing
Coxiella burnetti (Q fever) Ab,300,RC,86638,HCPCS,430000615,CDM,both,,,91.56,77.83,,,,,,,,,,,hospital's standard charge pricing
"Homogenation, tissue for culture",300,RC,87176,HCPCS,430000616,CDM,both,,,48.38,41.12,,,,,,,,,,,hospital's standard charge pricing
Intrinsic Factor Antibodies,300,RC,86340,HCPCS,430000617,CDM,both,,,230.53,195.95,,,,,,,,,,,hospital's standard charge pricing
"T cells; absolute CD4 and CD8 count, including ratio",300,RC,86360,HCPCS,430000618,CDM,both,,,398.80,338.98,,,,,,,,,,,hospital's standard charge pricing
"HIV-2, amplified probe technique, includes reverse trans",300,RC,87538,HCPCS,430000621,CDM,both,,,463.06,393.60,,,,,,,,,,,hospital's standard charge pricing
" Immunoassay for infectious agent antibody, quant, NOS",300,RC,86317,HCPCS,430000622,CDM,both,,,96.14,81.72,,,,,,,,,,,hospital's standard charge pricing
"Allergen specific IgE; quant or semiquant, crude extract, each",300,RC,86003,HCPCS,430000626,CDM,both,,,37.11,31.54,,,,,,,,,,,hospital's standard charge pricing
High Sensitivity Troponin-I,300,RC,84484,HCPCS,430000644,CDM,both,,,202.70,172.30,,,,,,,,,,,hospital's standard charge pricing
"Potassium; serum, plasma, whole blood",300,RC,84132,HCPCS,430100004,CDM,both,,,39.09,33.23,,,,,,,,,,,hospital's standard charge pricing
Venipuncture Lab Draw,300,RC,36415,HCPCS,445000121,CDM,both,,,38.42,32.66,,,,,,,,,,,hospital's standard charge pricing
Pathogens Test for Platelets,302,RC,P9100,HCPCS,430200001,CDM,both,,,473.00,402.05,,,,,,,,,,,hospital's standard charge pricing
Hematocrit,305,RC,85014,HCPCS,430500001,CDM,both,,,38.42,32.66,,,,,,,,,,,hospital's standard charge pricing
Hemoglobin,305,RC,85018,HCPCS,430500002,CDM,both,,,30.46,25.89,,,,,,,,,,,hospital's standard charge pricing
"F2 gene analysis, 20210G>A variant",310,RC,81240,HCPCS,431000001,CDM,both,,,380.91,323.77,,,,,,,,,,,hospital's standard charge pricing
Factor V Leiden,310,RC,81241,HCPCS,431000002,CDM,both,,,733.35,623.35,,,,,,,,,,,hospital's standard charge pricing
"PAP, thin prep automated",310,RC,88142,HCPCS,431000003,CDM,both,,,173.56,147.53,,,,,,,,,,,hospital's standard charge pricing
"Cytopath, Cell Enhance Tech w/Interp, except cervical or vaginal",310,RC,88112,HCPCS,431000004,CDM,both,,,107.31,91.21,,,,,,,,,,,hospital's standard charge pricing
"Cytopathology, evaluation of fine needle aspirate; interpretation",310,RC,88173,HCPCS,431000005,CDM,both,,,235.83,200.46,,,,,,,,,,,hospital's standard charge pricing
"Molecular cytogenetics; DNA probe, each",310,RC,88271,HCPCS,431000006,CDM,both,,,287.51,244.38,,,,,,,,,,,hospital's standard charge pricing
"Molecular cytogenetics; interphase ISH, analyze 100-300 cells",310,RC,88275,HCPCS,431000007,CDM,both,,,508.75,432.44,,,,,,,,,,,hospital's standard charge pricing
"Tissue culture for neoplastic disorders; bone marrow, blood cells",310,RC,88237,HCPCS,431000008,CDM,both,,,484.91,412.17,,,,,,,,,,,hospital's standard charge pricing
Unlisted molecular pathology procedure,310,RC,81479,HCPCS,431000009,CDM,both,,,585.00,497.25,,,,,,,,,,,hospital's standard charge pricing
Tissue Cult Non-neoplastic disorder; skin/other tiss biopsy,310,RC,88233,HCPCS,431000010,CDM,both,,,545.85,463.97,,,,,,,,,,,hospital's standard charge pricing
"Chromosone analysis; count 15-20 cells, 2 karyotypes w/banding",310,RC,88262,HCPCS,431000011,CDM,both,,,629.33,534.93,,,,,,,,,,,hospital's standard charge pricing
Chromosone analysis; additional karyotypes each study,310,RC,88280,HCPCS,431000012,CDM,both,,,121.00,102.85,,,,,,,,,,,hospital's standard charge pricing
F5 (Coag Factor V) hered hypercoag HR2 variant,310,RC,81400,HCPCS,431000013,CDM,both,,,593.56,504.53,,,,,,,,,,,hospital's standard charge pricing
XRAY FACIAL BONES < 3 VIEWS,320,RC,70140,HCPCS,432000003,CDM,both,,,470.80,400.18,,,,,,,,,,,hospital's standard charge pricing
XRAY SINUS < 3 VIEWS,320,RC,70210,HCPCS,432000007,CDM,both,,,459.15,390.28,,,,,,,,,,,hospital's standard charge pricing
"Xray TMJ, Open/Closed Unilateral",320,RC,70328,HCPCS,432000011,CDM,both,,,459.15,390.28,,,,,,,,,,,hospital's standard charge pricing
"Xray TMJ, Open/Closed Bilateral",320,RC,70330,HCPCS,432000012,CDM,both,,,308.97,262.62,,,,,,,,,,,hospital's standard charge pricing
X-ray of chest w/ api lordic,320,RC,71047,HCPCS,432000016,CDM,both,,,273.26,232.27,,,,,,,,,,,hospital's standard charge pricing
XR Cervical 1vw,320,RC,72020,HCPCS,432000026,CDM,both,,,156.67,133.17,,,,,,,,,,,hospital's standard charge pricing
X-ray exam thoracic spine min 4v,320,RC,72074,HCPCS,432000032,CDM,both,,,712.80,605.88,,,,,,,,,,,hospital's standard charge pricing
XRAY THORACOLUMBAR 2 VIEWS,320,RC,72080,HCPCS,432000033,CDM,both,,,470.80,400.18,,,,,,,,,,,hospital's standard charge pricing
XR exam arm infant min 2v,320,RC,73092,HCPCS,432000048,CDM,both,,,190.19,161.66,,,,,,,,,,,hospital's standard charge pricing
XR Abdomen 3 or more views,320,RC,74021,HCPCS,432000072,CDM,both,,,234.63,199.44,,,,,,,,,,,hospital's standard charge pricing
"Xray Bil Knees, standing Anteroposterior",320,RC,73565,HCPCS,432000082,CDM,both,,,190.19,161.66,,,,,,,,,,,hospital's standard charge pricing
"Radiologic examination, foot; 2 views Left",320,RC,73620,HCPCS,432000084,CDM,both,,,190.19,161.66,,,LT   ,,,,,,,,hospital's standard charge pricing
"Radiologic examination, foot; 2 views Right",320,RC,73620,HCPCS,432000085,CDM,both,,,190.19,161.66,,,RT   ,,,,,,,,hospital's standard charge pricing
X-Ray SI Joints <3 views,320,RC,72200,HCPCS,432000086,CDM,both,,,196.03,166.63,,,,,,,,,,,hospital's standard charge pricing
X-Ray SI Joints >3 views,320,RC,72202,HCPCS,432000087,CDM,both,,,234.63,199.44,,,,,,,,,,,hospital's standard charge pricing
XR ANKLE 2V LEFT,320,RC,73600,HCPCS,432000089,CDM,both,,,190.19,161.66,,,LT   ,,,,,,,,hospital's standard charge pricing
XR ANKLE 2V RIGHT,320,RC,73600,HCPCS,432000090,CDM,both,,,190.19,161.66,,,RT   ,,,,,,,,hospital's standard charge pricing
XR ANKLE 3V+ LEFT,320,RC,73610,HCPCS,432000091,CDM,both,,,199.67,169.72,,,LT   ,,,,,,,,hospital's standard charge pricing
XR ANKLE 3V+ RIGHT,320,RC,73610,HCPCS,432000092,CDM,both,,,199.67,169.72,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Abdomen; 2 View Upright and Supine,320,RC,74019,HCPCS,432000094,CDM,both,,,415.39,353.08,,,,,,,,,,,hospital's standard charge pricing
XR Eye FB,320,RC,70030,HCPCS,432000095,CDM,both,,,470.80,400.18,,,,,,,,,,,hospital's standard charge pricing
XR Mastoid COMPLT Min 3V,320,RC,70130,HCPCS,432000096,CDM,both,,,569.80,484.33,,,,,,,,,,,hospital's standard charge pricing
XR Chest COMPLT Min 4V,320,RC,71048,HCPCS,432000097,CDM,both,,,273.26,232.27,,,,,,,,,,,hospital's standard charge pricing
XR Rib Bilat 3V,320,RC,71110,HCPCS,432000098,CDM,both,,,332.28,282.44,,,,,,,,,,,hospital's standard charge pricing
Unlisted Ultrasound Procedure,320,RC,76999,HCPCS,432000099,CDM,both,,,170.52,144.94,,,,,,,,,,,hospital's standard charge pricing
XR MANDIBLE LIMITED,320,RC,70100,HCPCS,432900001,CDM,both,,,459.15,390.28,,,,,,,,,,,hospital's standard charge pricing
XR MANDIBLE 4V+,320,RC,70110,HCPCS,432900002,CDM,both,,,235.38,200.07,,,,,,,,,,,hospital's standard charge pricing
XR Facial bones 3+ Views,320,RC,70150,HCPCS,432900003,CDM,both,,,459.76,390.80,,,,,,,,,,,hospital's standard charge pricing
XR NASAL BONES 3+ VIEWS,320,RC,70160,HCPCS,432900004,CDM,both,,,196.03,166.63,,,,,,,,,,,hospital's standard charge pricing
XR ORBIT SERIES (4 VIEWS),320,RC,70200,HCPCS,432900005,CDM,both,,,234.63,199.44,,,,,,,,,,,hospital's standard charge pricing
XR SINUS  3V+,320,RC,70220,HCPCS,432900006,CDM,both,,,295.12,250.85,,,,,,,,,,,hospital's standard charge pricing
XR Skull < 4 Views,320,RC,70250,HCPCS,432900007,CDM,both,,,234.63,199.44,,,,,,,,,,,hospital's standard charge pricing
XR SKULL 4V+,320,RC,70260,HCPCS,432900008,CDM,both,,,332.28,282.44,,,,,,,,,,,hospital's standard charge pricing
"XR NECK, SOFT TISSUE",320,RC,70360,HCPCS,432900009,CDM,both,,,156.67,133.17,,,,,,,,,,,hospital's standard charge pricing
XR Ribs Unilat Left 2v,320,RC,71100,HCPCS,432900010,CDM,both,,,338.11,287.39,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Ribs 3VW Right w/ PA chest,320,RC,71101,HCPCS,432900012,CDM,both,,,396.41,336.95,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Ribs 3VW Left w/ PA chest,320,RC,71101,HCPCS,432900013,CDM,both,,,396.41,336.95,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Ribs w/ PA Chest Bilateral 4+ views,320,RC,71111,HCPCS,432900014,CDM,both,,,499.18,424.30,,,,,,,,,,,hospital's standard charge pricing
XR STERNUM,320,RC,71120,HCPCS,432900016,CDM,both,,,239.01,203.16,,,,,,,,,,,hospital's standard charge pricing
XR SC JOINT,320,RC,71130,HCPCS,432900017,CDM,both,,,259.41,220.50,,,,,,,,,,,hospital's standard charge pricing
XR SPINE-CERVICAL 2-3V,320,RC,72040,HCPCS,432900018,CDM,both,,,224.44,190.77,,,,,,,,,,,hospital's standard charge pricing
XR SPINE-CERVICAL  W/ OBLIQUES,320,RC,72050,HCPCS,432900019,CDM,both,,,333.74,283.68,,,,,,,,,,,hospital's standard charge pricing
XR C SPINE COMPLETE  W/ FLEX A,320,RC,72052,HCPCS,432900020,CDM,both,,,416.09,353.68,,,,,,,,,,,hospital's standard charge pricing
XR T SPINE 2V,320,RC,72070,HCPCS,432900021,CDM,both,,,239.01,203.16,,,,,,,,,,,hospital's standard charge pricing
XR SPINE-THORACIC (3 VIEWS),320,RC,72072,HCPCS,432900022,CDM,both,,,273.26,232.27,,,,,,,,,,,hospital's standard charge pricing
XR SPINE-LUMBAR (2-3 VIEWS),320,RC,72100,HCPCS,432900023,CDM,both,,,249.94,212.45,,,,,,,,,,,hospital's standard charge pricing
XR SPINE-LUMBER SERIES (4+ VIE,320,RC,72110,HCPCS,432900025,CDM,both,,,338.11,287.39,,,,,,,,,,,hospital's standard charge pricing
XR L SPINE W/ FLEXION AND EXTE,320,RC,72114,HCPCS,432900026,CDM,both,,,435.04,369.78,,,,,,,,,,,hospital's standard charge pricing
XR SACRUM AND COCCYX 2+ VIEWS,320,RC,72220,HCPCS,432900027,CDM,both,,,215.70,183.35,,,,,,,,,,,hospital's standard charge pricing
XR CLAVICLE  2V LEFT,320,RC,73000,HCPCS,432900029,CDM,both,,,196.03,166.63,,,LT   ,,,,,,,,hospital's standard charge pricing
XR CLAVICLE  2V RIGHT,320,RC,73000,HCPCS,432900030,CDM,both,,,196.03,166.63,,,RT   ,,,,,,,,hospital's standard charge pricing
XR SCAPULA LEFT,320,RC,73010,HCPCS,432900032,CDM,both,,,196.03,166.63,,,LT   ,,,,,,,,hospital's standard charge pricing
XR SCAPULA RIGHT,320,RC,73010,HCPCS,432900033,CDM,both,,,196.03,166.63,,,RT   ,,,,,,,,hospital's standard charge pricing
XR SHOULDER 1V LEFT,320,RC,73020,HCPCS,432900035,CDM,both,,,177.79,151.12,,,LT   ,,,,,,,,hospital's standard charge pricing
XR SHOULDER 1V RIGHT,320,RC,73020,HCPCS,432900036,CDM,both,,,177.79,151.12,,,RT   ,,,,,,,,hospital's standard charge pricing
XR SHOULDER 2V+ LEFT,320,RC,73030,HCPCS,432900038,CDM,both,,,215.70,183.35,,,LT   ,,,,,,,,hospital's standard charge pricing
XR SHOULDER 2V+ RIGHT,320,RC,73030,HCPCS,432900039,CDM,both,,,215.70,183.35,,,RT   ,,,,,,,,hospital's standard charge pricing
XR AC JTS BILAT W/WO WTS,320,RC,73050,HCPCS,432900040,CDM,both,,,470.80,400.18,,,,,,,,,,,hospital's standard charge pricing
XR HUMERUS LEFT,320,RC,73060,HCPCS,432900044,CDM,both,,,215.70,183.35,,,LT   ,,,,,,,,hospital's standard charge pricing
XR HUMERUS RIGHT,320,RC,73060,HCPCS,432900045,CDM,both,,,215.70,183.35,,,RT   ,,,,,,,,hospital's standard charge pricing
XR ELBOW 2V LEFT,320,RC,73070,HCPCS,432900046,CDM,both,,,196.03,166.63,,,LT   ,,,,,,,,hospital's standard charge pricing
XR ELBOW 2V RIGHT,320,RC,73070,HCPCS,432900047,CDM,both,,,196.03,166.63,,,RT   ,,,,,,,,hospital's standard charge pricing
XR ELBOW 3V LEFT,320,RC,73080,HCPCS,432900050,CDM,both,,,215.70,183.35,,,LT   ,,,,,,,,hospital's standard charge pricing
XR ELBOW 3V RIGHT,320,RC,73080,HCPCS,432900051,CDM,both,,,215.70,183.35,,,RT   ,,,,,,,,hospital's standard charge pricing
XR FOREARM 2V LEFT,320,RC,73090,HCPCS,432900053,CDM,both,,,196.03,166.63,,,LT   ,,,,,,,,hospital's standard charge pricing
XR FOREARM 2V RIGHT,320,RC,73090,HCPCS,432900054,CDM,both,,,196.03,166.63,,,RT   ,,,,,,,,hospital's standard charge pricing
XR UP EXT INFANT 2V+ LEFT  (PE,320,RC,73092,HCPCS,432900056,CDM,both,,,190.19,161.66,,,LT   ,,,,,,,,hospital's standard charge pricing
XR UP EXT INFANT 2V+ RIGHT (PE,320,RC,73092,HCPCS,432900057,CDM,both,,,190.19,161.66,,,RT   ,,,,,,,,hospital's standard charge pricing
XR WRIST 2V LEFT,320,RC,73100,HCPCS,432900059,CDM,both,,,190.19,161.66,,,LT   ,,,,,,,,hospital's standard charge pricing
XR WRIST 2V RIGHT,320,RC,73100,HCPCS,432900060,CDM,both,,,190.19,161.66,,,RT   ,,,,,,,,hospital's standard charge pricing
XR WRIST 3V LEFT,320,RC,73110,HCPCS,432900062,CDM,both,,,199.67,169.72,,,LT   ,,,,,,,,hospital's standard charge pricing
XR WRIST 3V RIGHT,320,RC,73110,HCPCS,432900063,CDM,both,,,199.67,169.72,,,RT   ,,,,,,,,hospital's standard charge pricing
XR HAND 2V LEFT,320,RC,73120,HCPCS,432900065,CDM,both,,,190.19,161.66,,,LT   ,,,,,,,,hospital's standard charge pricing
XR HAND 2V RIGHT,320,RC,73120,HCPCS,432900066,CDM,both,,,190.19,161.66,,,RT   ,,,,,,,,hospital's standard charge pricing
XR HAND 3V+ LEFT,320,RC,73130,HCPCS,432900068,CDM,both,,,199.67,169.72,,,LT   ,,,,,,,,hospital's standard charge pricing
XR HAND 3V+ RIGHT,320,RC,73130,HCPCS,432900069,CDM,both,,,199.67,169.72,,,RT   ,,,,,,,,hospital's standard charge pricing
XR FINGER 3V LEFT,320,RC,73140,HCPCS,432900071,CDM,both,,,156.67,133.17,,,LT   ,,,,,,,,hospital's standard charge pricing
XR FINGER 3V RIGHT,320,RC,73140,HCPCS,432900072,CDM,both,,,156.67,133.17,,,RT   ,,,,,,,,hospital's standard charge pricing
XR KNEE 1-2V LEFT,320,RC,73560,HCPCS,432900077,CDM,both,,,196.03,166.63,,,LT   ,,,,,,,,hospital's standard charge pricing
XR KNEE 1-2V RIGHT,320,RC,73560,HCPCS,432900078,CDM,both,,,196.03,166.63,,,RT   ,,,,,,,,hospital's standard charge pricing
XR KNEE 3V LEFT,320,RC,73562,HCPCS,432900080,CDM,both,,,215.70,183.35,,,LT   ,,,,,,,,hospital's standard charge pricing
XR KNEE 3V RIGHT,320,RC,73562,HCPCS,432900081,CDM,both,,,215.70,183.35,,,RT   ,,,,,,,,hospital's standard charge pricing
XR KNEE 4V+ LEFT,320,RC,73564,HCPCS,432900083,CDM,both,,,234.63,199.44,,,LT   ,,,,,,,,hospital's standard charge pricing
XR KNEE 4V+ RIGHT,320,RC,73564,HCPCS,432900084,CDM,both,,,234.63,199.44,,,RT   ,,,,,,,,hospital's standard charge pricing
XR TIB FIB LEFT,320,RC,73590,HCPCS,432900085,CDM,both,,,196.03,166.63,,,LT   ,,,,,,,,hospital's standard charge pricing
XR TIB FIB RIGHT,320,RC,73590,HCPCS,432900086,CDM,both,,,196.03,166.63,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Lower Extremity Infant Left min 2v,320,RC,73592,HCPCS,432900088,CDM,both,,,190.19,161.66,,,LT   ,,,,,,,,hospital's standard charge pricing
XR FOOT 3V+ LEFT,320,RC,73630,HCPCS,432900095,CDM,both,,,199.67,169.72,,,LT   ,,,,,,,,hospital's standard charge pricing
XR FOOT 3V+ RIGHT,320,RC,73630,HCPCS,432900096,CDM,both,,,199.67,169.72,,,RT   ,,,,,,,,hospital's standard charge pricing
XR CALCANEOUS 2V LEFT,320,RC,73650,HCPCS,432900097,CDM,both,,,177.79,151.12,,,LT   ,,,,,,,,hospital's standard charge pricing
XR CALCANEOUS 2V RIGHT,320,RC,73650,HCPCS,432900098,CDM,both,,,177.79,151.12,,,RT   ,,,,,,,,hospital's standard charge pricing
XR TOES 2V+ LEFT,320,RC,73660,HCPCS,432900103,CDM,both,,,156.67,133.17,,,LT   ,,,,,,,,hospital's standard charge pricing
XR TOES 2V+ RIGHT,320,RC,73660,HCPCS,432900104,CDM,both,,,156.67,133.17,,,RT   ,,,,,,,,hospital's standard charge pricing
XR ABD (KUB),320,RC,74018,HCPCS,432900105,CDM,both,,,196.03,166.63,,,,,,,,,,,hospital's standard charge pricing
"XR Abdomen 2V, CXR 1VW",320,RC,74022,HCPCS,432900107,CDM,both,,,618.49,525.72,,,,,,,,,,,hospital's standard charge pricing
XR Foreign Body single view Child,320,RC,76010,HCPCS,432900108,CDM,both,,,177.79,151.12,,,,,,,,,,,hospital's standard charge pricing
XR ADDITIONAL VIEWS/UNLISTED P,320,RC,76499,HCPCS,432900109,CDM,both,,,96.65,82.15,,,,,,,,,,,hospital's standard charge pricing
XR PELVIS 1 OR 2V,320,RC,72170,HCPCS,432900121,CDM,both,,,196.03,166.63,,,,,,,,,,,hospital's standard charge pricing
XR PELVIS 3V+,320,RC,72190,HCPCS,432900127,CDM,both,,,249.94,212.45,,,,,,,,,,,hospital's standard charge pricing
XR BONE AGE STUDIES,320,RC,77072,HCPCS,432900132,CDM,both,,,196.03,166.63,,,,,,,,,,,hospital's standard charge pricing
XR Hip Left w/ or w/o Pelvis 1v,320,RC,73501,HCPCS,432900137,CDM,both,,,177.79,151.12,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Hip Left w/ or w/o Pelvis 2-3V,320,RC,73502,HCPCS,432900138,CDM,both,,,215.70,183.35,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Hip Left w/pelvis min 4V,320,RC,73503,HCPCS,432900139,CDM,both,,,712.80,605.88,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Hip Bilat w/ or w/o pelvis min 2v,320,RC,73521,HCPCS,432900140,CDM,both,,,249.94,212.45,,,,,,,,,,,hospital's standard charge pricing
XR Hip Bilat w/ or w/o Pelvis 3-4v,320,RC,73522,HCPCS,432900141,CDM,both,,,712.80,605.88,,,,,,,,,,,hospital's standard charge pricing
XR Hip Bilat w/ or w/o Pelvis min 5v,320,RC,73523,HCPCS,432900142,CDM,both,,,370.69,315.09,,,,,,,,,,,hospital's standard charge pricing
XR Left Femur 1V,320,RC,73551,HCPCS,432900143,CDM,both,,,174.15,148.03,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Left Femur min 2V,320,RC,73552,HCPCS,432900144,CDM,both,,,215.70,183.35,,,LT   ,,,,,,,,hospital's standard charge pricing
XR Hip Right w/ or w/o Pelvis 1v,320,RC,73501,HCPCS,432900145,CDM,both,,,177.79,151.12,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Hip Right w/ or w/o Pelvis 2-3V,320,RC,73502,HCPCS,432900146,CDM,both,,,215.70,183.35,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Hip RIGHT w/Pelvis min 4V,320,RC,73503,HCPCS,432900147,CDM,both,,,712.80,605.88,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Right Femur 1V,320,RC,73551,HCPCS,432900148,CDM,both,,,174.15,148.03,,,RT   ,,,,,,,,hospital's standard charge pricing
XR RIGHT Femur min 2V,320,RC,73552,HCPCS,432900149,CDM,both,,,215.70,183.35,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Shunt Series,320,RC,,,432900150,CDM,both,,,234.63,199.44,,,,,,,,,,,hospital's standard charge pricing
XR Lower Extremity Infant Right min 2v,320,RC,73592,HCPCS,432900160,CDM,both,,,190.19,161.66,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Ribs Unilat Right 2v,320,RC,71100,HCPCS,432900161,CDM,both,,,338.11,287.39,,,RT   ,,,,,,,,hospital's standard charge pricing
XR Lumbar 1vw,320,RC,72020,HCPCS,432900162,CDM,both,,,156.67,133.17,,,,,,,,,,,hospital's standard charge pricing
XR Thoracic 1vw,320,RC,72020,HCPCS,432900163,CDM,both,,,156.67,133.17,,,,,,,,,,,hospital's standard charge pricing
X-ray bone survey complete,320,RC,77075,HCPCS,435000038,CDM,both,,,524.67,445.97,,,,,,,,,,,hospital's standard charge pricing
XR PORTABLE CXR,324,RC,71045,HCPCS,432400100,CDM,both,,,177.79,151.12,,,,,,,,,,,hospital's standard charge pricing
XR CXR 2V,324,RC,71046,HCPCS,432400101,CDM,both,,,234.63,199.44,,,,,,,,,,,hospital's standard charge pricing
XR CXR FRONTAL,324,RC,71045,HCPCS,432400102,CDM,both,,,177.79,151.12,,,,,,,,,,,hospital's standard charge pricing
CT orbit/ear/fossa w/o dye,350,RC,70480,HCPCS,435000005,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT orbit/ear/fossa w/dye,350,RC,70481,HCPCS,435000006,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT soft tissue neck w/o dye,350,RC,70490,HCPCS,435000011,CDM,both,,,1240.24,1054.20,,,,,,,,,,,hospital's standard charge pricing
CT soft tissue neck w/dye,350,RC,70491,HCPCS,435000012,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT sft tsue nck w/o & w/dye,350,RC,70492,HCPCS,435000013,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT abdomen&pelvis w/contrast,350,RC,74177,HCPCS,435000035,CDM,both,,,3135.57,2665.23,,,,,,,,,,,hospital's standard charge pricing
CT HEAD/BRAIN W AND W/O CONTRA,351,RC,70470,HCPCS,435100001,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT HEAD/BRAIN W CONTRAST,351,RC,70460,HCPCS,435100002,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT HEAD/BRAIN W/O CONTRAST,351,RC,70450,HCPCS,435100003,CDM,both,,,1240.24,1054.20,,,,,,,,,,,hospital's standard charge pricing
CT MAXILLOFACIAL W CONTRAST,351,RC,70487,HCPCS,435100004,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT MAXILLOFACIAL W/WO CONTRAST,351,RC,70488,HCPCS,435100005,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT MAXILLOFACIAL WO CONTRAST,351,RC,70486,HCPCS,435100006,CDM,both,,,1240.24,1054.20,,,,,,,,,,,hospital's standard charge pricing
CT NECK SOFT TISSUE W CONTRAST,351,RC,70491,HCPCS,435100007,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT NECK SOFT TISSUE W/O CONTRA,351,RC,70490,HCPCS,435100008,CDM,both,,,1240.24,1054.20,,,,,,,,,,,hospital's standard charge pricing
CT NECK SOFT TISSUE W/WO CONTR,351,RC,70492,HCPCS,435100009,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT ORBIT W CONTRAST,351,RC,70481,HCPCS,435100010,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT ORBIT W/O CONTRAST,351,RC,70480,HCPCS,435100011,CDM,both,,,1240.24,1054.20,,,,,,,,,,,hospital's standard charge pricing
CT ORBIT W/WO CONTRAST,351,RC,70482,HCPCS,435100012,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT SINUSES W CONTRAST,351,RC,70487,HCPCS,435100013,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT SINUSES W/O CONTRAST,351,RC,70486,HCPCS,435100014,CDM,both,,,1240.24,1054.20,,,,,,,,,,,hospital's standard charge pricing
CT SINUSES W/WO CONTRAST,351,RC,70488,HCPCS,435100015,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT ABD AND PELVIS W AND W/O CO,352,RC,74178,HCPCS,435200001,CDM,both,,,4871.33,4140.63,,,,,,,,,,,hospital's standard charge pricing
CT ABDOMEN AND PELVIS W/ CONTR,352,RC,74177,HCPCS,435200002,CDM,both,,,3135.57,2665.23,,,,,,,,,,,hospital's standard charge pricing
CT ABDOMEN AND PELVIS W/O CONT,352,RC,74176,HCPCS,435200003,CDM,both,,,2646.61,2249.62,,,,,,,,,,,hospital's standard charge pricing
CT ABDOMEN W AND W/O CONTRAST,352,RC,74170,HCPCS,435200005,CDM,both,,,3209.89,2728.41,,,,,,,,,,,hospital's standard charge pricing
CT ABDOMEN W/ CONTRAST,352,RC,74160,HCPCS,435200006,CDM,both,,,1792.58,1523.69,,,,,,,,,,,hospital's standard charge pricing
CT ABDOMEN W/O CONTRAST,352,RC,74150,HCPCS,435200007,CDM,both,,,1483.61,1261.07,,,,,,,,,,,hospital's standard charge pricing
CT CHEST W AND W/O CONTRAST,352,RC,71270,HCPCS,435200009,CDM,both,,,2309.23,1962.85,,,,,,,,,,,hospital's standard charge pricing
CT CHEST W/ CONTRAST,352,RC,71260,HCPCS,435200010,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT CHEST W/O CONTRAST,352,RC,71250,HCPCS,435200011,CDM,both,,,1547.01,1314.96,,,,,,,,,,,hospital's standard charge pricing
CT LOWER EXT W CONTRAST LEFT,352,RC,73701,HCPCS,435200014,CDM,both,,,1547.01,1314.96,,,LT   ,,,,,,,,hospital's standard charge pricing
CT LOWER EXT W CONTRAST RIGHT,352,RC,73701,HCPCS,435200015,CDM,both,,,1547.01,1314.96,,,RT   ,,,,,,,,hospital's standard charge pricing
CT LOWER EXT W/WO CONTRAST LEF,352,RC,73702,HCPCS,435200017,CDM,both,,,1942.70,1651.30,,,LT   ,,,,,,,,hospital's standard charge pricing
CT LOWER EXT W/WO CONTRAST RIG,352,RC,73702,HCPCS,435200018,CDM,both,,,1942.70,1651.30,,,RT   ,,,,,,,,hospital's standard charge pricing
CT LOWER EXT WO CONTRAST LEFT,352,RC,73700,HCPCS,435200020,CDM,both,,,1299.98,1104.98,,,LT   ,,,,,,,,hospital's standard charge pricing
CT LOWER EXT WO CONTRAST RIGHT,352,RC,73700,HCPCS,435200021,CDM,both,,,1299.98,1104.98,,,RT   ,,,,,,,,hospital's standard charge pricing
CT PELVIS W CONTRAST,352,RC,72193,HCPCS,435200023,CDM,both,,,1792.58,1523.69,,,,,,,,,,,hospital's standard charge pricing
CT PELVIS W/O CONTRAST,352,RC,72192,HCPCS,435200024,CDM,both,,,1547.74,1315.58,,,,,,,,,,,hospital's standard charge pricing
CT PELVIS W/WO CONTRAST,352,RC,72194,HCPCS,435200025,CDM,both,,,2214.50,1882.33,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-CERVICAL W AND W/O CO,352,RC,72127,HCPCS,435200026,CDM,both,,,2197.73,1868.07,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-CERVICAL W CONTRAST,352,RC,72126,HCPCS,435200027,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-CERVICAL W/O CONTRAST,352,RC,72125,HCPCS,435200028,CDM,both,,,1547.01,1314.96,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-LUMBAR W AND W/O CONT,352,RC,72133,HCPCS,435200029,CDM,both,,,2309.23,1962.85,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-LUMBAR W CONTRAST,352,RC,72132,HCPCS,435200030,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-LUMBAR W/O CONTRAST,352,RC,72131,HCPCS,435200031,CDM,both,,,1547.01,1314.96,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-THORACIC W CONTRAST,352,RC,72129,HCPCS,435200032,CDM,both,,,1852.33,1574.48,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-THORACIC W/O CONTRAST,352,RC,72128,HCPCS,435200033,CDM,both,,,1547.01,1314.96,,,,,,,,,,,hospital's standard charge pricing
CT SPINE-THORACIC W/WO CONTRAS,352,RC,72130,HCPCS,435200034,CDM,both,,,2309.23,1962.85,,,,,,,,,,,hospital's standard charge pricing
CT UPPER EXT W CONTRAST LEFT,352,RC,73201,HCPCS,435200036,CDM,both,,,1547.74,1315.58,,,LT   ,,,,,,,,hospital's standard charge pricing
CT UPPER EXT W CONTRAST RIGHT,352,RC,73201,HCPCS,435200037,CDM,both,,,1547.74,1315.58,,,RT   ,,,,,,,,hospital's standard charge pricing
CT UPPER EXT W/WO CONTRAST LEF,352,RC,73202,HCPCS,435200039,CDM,both,,,1942.70,1651.30,,,LT   ,,,,,,,,hospital's standard charge pricing
CT UPPER EXT W/WO CONTRAST RIG,352,RC,73202,HCPCS,435200040,CDM,both,,,1942.70,1651.30,,,RT   ,,,,,,,,hospital's standard charge pricing
CT UPPER EXT WO CONTRAST BILAT,352,RC,73200,HCPCS,435200041,CDM,both,,,1313.11,1116.14,,,50   ,,,,,,,,hospital's standard charge pricing
CT UPPER EXT WO CONTRAST LEFT,352,RC,73200,HCPCS,435200042,CDM,both,,,1313.11,1116.14,,,LT   ,,,,,,,,hospital's standard charge pricing
CT UPPER EXT WO CONTRAST RIGHT,352,RC,73200,HCPCS,435200043,CDM,both,,,1313.11,1116.14,,,RT   ,,,,,,,,hospital's standard charge pricing
CTA Pelvis W & W/O Contrast,352,RC,72191,HCPCS,435200045,CDM,both,,,2700.53,2295.45,,,,,,,,,,,hospital's standard charge pricing
CTA Runoff,352,RC,75635,HCPCS,435200054,CDM,both,,,2941.74,2500.48,,,,,,,,,,,hospital's standard charge pricing
CTA Abd w& w/o contrast,352,RC,74175,HCPCS,435200055,CDM,both,,,2700.53,2295.45,,,,,,,,,,,hospital's standard charge pricing
CTA Abd/Pelvis w &  w/o contrast,352,RC,74174,HCPCS,435200056,CDM,both,,,5399.60,4589.66,,,,,,,,,,,hospital's standard charge pricing
CTA Chest w & w/o contrast,352,RC,71275,HCPCS,435200057,CDM,both,,,2787.97,2369.77,,,,,,,,,,,hospital's standard charge pricing
CTA Head w & w/o contrast,352,RC,70496,HCPCS,435200058,CDM,both,,,2591.96,2203.17,,,,,,,,,,,hospital's standard charge pricing
CTA Neck w & w/o contrast,352,RC,70498,HCPCS,435200059,CDM,both,,,2591.96,2203.17,,,,,,,,,,,hospital's standard charge pricing
"CTA, LOWER EXT LT W/CONTRAST; INCLS W/O CONTRAST, IF PERF",352,RC,73706,HCPCS,435200060,CDM,both,,,2437.49,2071.87,,,LT   ,,,,,,,,hospital's standard charge pricing
"CTA, LOWER EXT RT W/CONTRAST; INCLS W/O CONTRAST, IF PERF",352,RC,73706,HCPCS,435200061,CDM,both,,,2437.49,2071.87,,,RT   ,,,,,,,,hospital's standard charge pricing
"CTA, Upper Ext LT W/Contrast; Incls W/O Contrast, if perf",352,RC,73206,HCPCS,435200062,CDM,both,,,2437.49,2071.87,,,LT   ,,,,,,,,hospital's standard charge pricing
"CTA, Upper Ext RT W/Contrast; Incls W/O Contrast, if perf",352,RC,73206,HCPCS,435200063,CDM,both,,,2437.49,2071.87,,,RT   ,,,,,,,,hospital's standard charge pricing
Insertion of PICC line >/= 5yrs w/ imaging guid,361,RC,36573,HCPCS,436100003,CDM,both,,,1889.31,1605.91,,,,,,,,,,,hospital's standard charge pricing
ABG Draw,361,RC,36600,HCPCS,445000297,CDM,both,,,121.24,103.05,,,,,,,,,,,hospital's standard charge pricing
"Mod Sed (1MD) pt<5 yrs old, initial 15 min",370,RC,99151,HCPCS,437000004,CDM,both,,,784.00,666.40,,,,,,,,,,,hospital's standard charge pricing
"Mod Sed (1MD) pt>5 yrs old, initial 15 min",370,RC,99152,HCPCS,437000005,CDM,both,,,784.00,666.40,,,,,,,,,,,hospital's standard charge pricing
Mod Sed (1MD) each additional 15 min,370,RC,99153,HCPCS,437000006,CDM,both,,,413.00,351.05,,,,,,,,,,,hospital's standard charge pricing
"Platelets, pheresis, leukoreduced, each unit",384,RC,P9035,HCPCS,438400001,CDM,both,,,0.01,0.01,,,BL   ,,,,,,,,hospital's standard charge pricing
Blood Transfusion,391,RC,36430,HCPCS,445000123,CDM,both,,,1000.96,850.82,,,,,,,,,,,hospital's standard charge pricing
"Fresh Frozen Plasma between 8-24 hours, each unit,
Proc & Storage",392,RC,P9059,HCPCS,439200003,CDM,both,,,220.60,187.51,,,,,,,,,,,hospital's standard charge pricing
"Platelets, pheresis, leukoreduc, irradiated, each U, Proc & Storg",392,RC,P9037,HCPCS,439200006,CDM,both,,,4035.00,3429.75,,,,,,,,,,,hospital's standard charge pricing
"Platelets, pheresis, leukoreduced, each unit, processing&storage",392,RC,P9035,HCPCS,439200007,CDM,both,,,2834.00,2408.90,,,,,,,,,,,hospital's standard charge pricing
"Red Blood Cells, Leuko redcd, ea un, Proc & Strage",399,RC,P9016,HCPCS,439200002,CDM,both,,,531.28,451.59,,,,,,,,,,,hospital's standard charge pricing
"US Extremity, Nonvascular Lmtd Left",402,RC,76882,HCPCS,440200019,CDM,both,,,155.02,131.77,,,LT   ,,,,,,,,hospital's standard charge pricing
US Retroperitoneal,402,RC,76770,HCPCS,440200026,CDM,both,,,653.84,555.76,,,,,,,,,,,hospital's standard charge pricing
US HEAD/NECK SOFT TISSUE,402,RC,76536,HCPCS,440200100,CDM,both,,,469.69,399.24,,,,,,,,,,,hospital's standard charge pricing
US CHEST,402,RC,76604,HCPCS,440200101,CDM,both,,,429.27,364.88,,,,,,,,,,,hospital's standard charge pricing
US ABDOMEN COMPLETE,402,RC,76700,HCPCS,440200103,CDM,both,,,653.84,555.76,,,,,,,,,,,hospital's standard charge pricing
US ABDOMEN LIMITED,402,RC,76705,HCPCS,440200104,CDM,both,,,469.69,399.24,,,,,,,,,,,hospital's standard charge pricing
US LIMITED RETROPERITONEAL,402,RC,76775,HCPCS,440200105,CDM,both,,,469.69,399.24,,,,,,,,,,,hospital's standard charge pricing
US OB < 14 WKS,402,RC,76801,HCPCS,440200106,CDM,both,,,997.66,848.01,,,,,,,,,,,hospital's standard charge pricing
US EACH ADDITIONAL GESTATION <,402,RC,76802,HCPCS,440200107,CDM,both,,,112.61,95.72,,,,,,,,,,,hospital's standard charge pricing
US OB >14 WKS,402,RC,76805,HCPCS,440200108,CDM,both,,,695.57,591.23,,,,,,,,,,,hospital's standard charge pricing
US EACH ADDITIONAL GESTATION >,402,RC,76810,HCPCS,440200109,CDM,both,,,1381.87,1174.59,,,,,,,,,,,hospital's standard charge pricing
"US OB, LIMITED",402,RC,76815,HCPCS,440200110,CDM,both,,,469.69,399.24,,,,,,,,,,,hospital's standard charge pricing
US TRANSVAGINAL OB,402,RC,76817,HCPCS,440200111,CDM,both,,,728.04,618.83,,,,,,,,,,,hospital's standard charge pricing
US TRANSVAGINAL (NON-OB),402,RC,76830,HCPCS,440200112,CDM,both,,,506.12,430.20,,,,,,,,,,,hospital's standard charge pricing
"US PELVIC (NON-OB), COMPLETE",402,RC,76856,HCPCS,440200113,CDM,both,,,506.12,430.20,,,,,,,,,,,hospital's standard charge pricing
US SCROTUM AND CONTENTS,402,RC,76870,HCPCS,440200114,CDM,both,,,506.12,430.20,,,,,,,,,,,hospital's standard charge pricing
"US Extremity, Nonvascular Left",402,RC,76881,HCPCS,440200115,CDM,both,,,261.00,221.85,,,LT   ,,,,,,,,hospital's standard charge pricing
US EACH ADD GESTATION > 14 WKS,402,RC,76812,HCPCS,440200118,CDM,both,,,1100.00,935.00,,,,,,,,,,,hospital's standard charge pricing
US RETROPERITONEAL (I.E. RENAL,402,RC,76770,HCPCS,440200119,CDM,both,,,653.84,555.76,,,,,,,,,,,hospital's standard charge pricing
"US INFANT HIPS, DYNAM PHYSICIA",402,RC,76885,HCPCS,440200121,CDM,both,,,453.80,385.73,,,,,,,,,,,hospital's standard charge pricing
"US INFANT HIPS, LIMITED NO PHY",402,RC,76886,HCPCS,440200122,CDM,both,,,584.00,496.40,,,,,,,,,,,hospital's standard charge pricing
US OB ADDL FETUS TRANSVAGINAL,402,RC,76814,HCPCS,440200125,CDM,Both,,,177.00,150.45,,,,,,,,,,,hospital's standard charge pricing
US OB FIRST TRI TRANS ABDOM OR,402,RC,76813,HCPCS,440200126,CDM,Both,,,707.00,600.95,,,,,,,,,,,hospital's standard charge pricing
US PELVIS (NON-OB) LIMITED,402,RC,76857,HCPCS,440200127,CDM,Both,,,350.44,297.87,,,,,,,,,,,hospital's standard charge pricing
US AAA SCREEN,402,RC,76706,HCPCS,440200130,CDM,Both,,,75.52,64.19,,,,,,,,,,,hospital's standard charge pricing
US Breast Complete Left,402,RC,76641,HCPCS,440200134,CDM,Both,,,350.44,297.87,,,LT   ,,,,,,,,hospital's standard charge pricing
US Breast Complete Right,402,RC,76641,HCPCS,440200135,CDM,Both,,,350.44,297.87,,,RT   ,,,,,,,,hospital's standard charge pricing
US Breast Limited Left,402,RC,76642,HCPCS,440200136,CDM,Both,,,262.99,223.54,,,LT   ,,,,,,,,hospital's standard charge pricing
US Breast Limited Right,402,RC,76642,HCPCS,440200137,CDM,both,,,262.99,223.54,,,RT   ,,,,,,,,hospital's standard charge pricing
"US Extremity, Nonvascular Right",402,RC,76881,HCPCS,440200138,CDM,both,,,261.00,221.85,,,RT   ,,,,,,,,hospital's standard charge pricing
"US Extremity, Nonvascular Lmtd Right",402,RC,76882,HCPCS,440200139,CDM,both,,,155.02,131.77,,,RT   ,,,,,,,,hospital's standard charge pricing
US Breast Complete Bilateral,402,RC,76641,HCPCS,440200140,CDM,both,,,700.87,595.74,,,50   ,,,,,,,,hospital's standard charge pricing
US Breast Limited Bilateral,402,RC,76642,HCPCS,440200141,CDM,both,,,527.30,448.21,,,50   ,,,,,,,,hospital's standard charge pricing
Inhalation Trmt,410,RC,94640,HCPCS,441000001,CDM,both,,,94.07,79.96,,,,,,,,,,,hospital's standard charge pricing
Cont Inhalation Trmt 1st hour,410,RC,94644,HCPCS,441000002,CDM,both,,,356.00,302.60,,,,,,,,,,,hospital's standard charge pricing
"CPAP, initiation and management",410,RC,94660,HCPCS,441000005,CDM,both,,,98.05,83.34,,,,,,,,,,,hospital's standard charge pricing
Sub Continuous Adult Ventilator,412,RC,94003,HCPCS,441200001,CDM,both,,,1634.26,1389.12,,,,,,,,,,,hospital's standard charge pricing
"Therapeutic Exercise, 1 or more areas; each 15 min",420,RC,97110,HCPCS,442000001,CDM,both,,,156.33,132.88,,,,,,,,,,,hospital's standard charge pricing
"Therapeutic Neuromuscular, 1 or more areas; each 15 min",420,RC,97112,HCPCS,442000002,CDM,both,,,161.63,137.39,,,,,,,,,,,hospital's standard charge pricing
Therapeutic Gait training (includes stair climbing) each 15 min,420,RC,97116,HCPCS,442000003,CDM,both,,,130.50,110.93,,,,,,,,,,,hospital's standard charge pricing
"Self-Care/home mgmt training, 1 on 1 patient contact, each 15 min",420,RC,97535,HCPCS,442000004,CDM,both,,,135.14,114.87,,,,,,,,,,,hospital's standard charge pricing
"Wheelchair Management (assessment, fitting, training) each 15 min",420,RC,97542,HCPCS,442000005,CDM,both,,,137.14,116.57,,,,,,,,,,,hospital's standard charge pricing
Therap activity 1:1 pt contact (improve funct. perform.) ea 15min,420,RC,97530,HCPCS,442000006,CDM,both,,,149.06,126.70,,,,,,,,,,,hospital's standard charge pricing
"CANALITH REPOSITIONING PROCEDURE, PER DAY",420,RC,95992,HCPCS,442000008,CDM,both,,,90.10,76.59,,,,,,,,,,,hospital's standard charge pricing
Physical Therapy Evaluation - Low - PT,424,RC,97161,HCPCS,442400001,CDM,both,,,483.59,411.05,,,,,,,,,,,hospital's standard charge pricing
Physical Therapy Evaluation - Moderate - PT,424,RC,97162,HCPCS,442400002,CDM,both,,,483.59,411.05,,,,,,,,,,,hospital's standard charge pricing
Physical Therapy Evaluation - High - PT,424,RC,97163,HCPCS,442400003,CDM,both,,,483.59,411.05,,,,,,,,,,,hospital's standard charge pricing
Re-evaluation of PT established plan of care,424,RC,97164,HCPCS,442400004,CDM,both,,,336.52,286.04,,,,,,,,,,,hospital's standard charge pricing
I&D Simple Skin Abscess,450,RC,10060,HCPCS,445000001,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
I&D Complicated Skin Abscess,450,RC,10061,HCPCS,445000002,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
I&D Pilonidal Cyst Simple,450,RC,10080,HCPCS,445000003,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
I&D Pilonidal Cyst Complicated,450,RC,10081,HCPCS,445000004,CDM,both,,,2319.52,1971.59,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal Tissue Simp,450,RC,10120,HCPCS,445000005,CDM,both,,,513.31,436.31,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal Tissue Cplx,450,RC,10121,HCPCS,445000006,CDM,both,,,3212.99,2731.04,,,,,,,,,,,hospital's standard charge pricing
"I&D Hemat, Seroma, Fluid Collec",450,RC,10140,HCPCS,445000008,CDM,both,,,2319.52,1971.59,,,,,,,,,,,hospital's standard charge pricing
I&D Puncture Aspiration,450,RC,10160,HCPCS,445000009,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
"Debride Skin, SQ Tissue Open FX",450,RC,11010,HCPCS,445000010,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
Debride FX Skin to Bone,450,RC,11012,HCPCS,445000012,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
Debride SQ Tissue 20 sq cm/<,450,RC,11042,HCPCS,445000013,CDM,both,,,513.31,436.31,,,,,,,,,,,hospital's standard charge pricing
Debride SQ Muscle/Fascia 20 sq cm/<,450,RC,11043,HCPCS,445000014,CDM,both,,,513.31,436.31,,,,,,,,,,,hospital's standard charge pricing
Debride SQ Bone 20 sq cm/<,450,RC,11044,HCPCS,445000015,CDM,both,,,1507.27,1281.18,,,,,,,,,,,hospital's standard charge pricing
Avulsion Single Nail Plate,450,RC,11730,HCPCS,445000016,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Evacuation Subungal Hematoma,450,RC,11740,HCPCS,445000017,CDM,both,,,81.23,69.05,,,,,,,,,,,hospital's standard charge pricing
Removal Nail Bed,450,RC,11750,HCPCS,445000018,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
Repair Nail Bed,450,RC,11760,HCPCS,445000019,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep S/N/A/G/TR/E 2.5<CM,450,RC,12001,HCPCS,445000020,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep S/N/A/G/TR/E 2.6-7.5CM,450,RC,12002,HCPCS,445000021,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep S/N/A/G/TR/E 7.6-12.5CM,450,RC,12004,HCPCS,445000022,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep S/N/A/G/TR/E 12.6-20CM,450,RC,12005,HCPCS,445000023,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep S/N/A/G/TR/E 20.1-30CM,450,RC,12006,HCPCS,445000024,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep S/N/A/G/TR/E 30>CM,450,RC,12007,HCPCS,445000025,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face < 2.5 CM,450,RC,12011,HCPCS,445000026,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face 2.6-5cm,450,RC,12013,HCPCS,445000027,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face 7.6-12.5CM,450,RC,12015,HCPCS,445000028,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face 12.6-20CM,450,RC,12016,HCPCS,445000029,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face 20.1-30CM,450,RC,12017,HCPCS,445000031,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face  30>CM,450,RC,12018,HCPCS,445000032,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep Scalp/Trunk/EXT <2.5 CM,450,RC,12031,HCPCS,445000033,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep Scalp/Trunk/EXT 2.6-7.5CM,450,RC,12032,HCPCS,445000034,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep Scalp/Trunk/EXT 12.6-20CM,450,RC,12035,HCPCS,445000036,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep Scalp/Trunk/EXT 20.1-30CM,450,RC,12036,HCPCS,445000037,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep Scalp/Trunk/EXT 30>CM,450,RC,12037,HCPCS,445000038,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep N/H/F/G 2.5<CM,450,RC,12041,HCPCS,445000039,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep N/H/F/G 2.6-7.5CM,450,RC,12042,HCPCS,445000040,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep N/H/F/G 7.6-12.5CM,450,RC,12044,HCPCS,445000041,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep N/H/F/G 12.6-20CM,450,RC,12045,HCPCS,445000042,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep N/H/F/G 20.1-30CM,450,RC,12046,HCPCS,445000043,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep N/H/F/G 30>CM,450,RC,12047,HCPCS,445000044,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM < 2.5 CM,450,RC,12051,HCPCS,445000045,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM  2.6-5CM,450,RC,12052,HCPCS,445000046,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM 5.1-7.5CM,450,RC,12053,HCPCS,445000047,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM 7.6-12.5CM,450,RC,12054,HCPCS,445000048,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM 12.6-20CM,450,RC,12055,HCPCS,445000049,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM 20.1<30CM,450,RC,12056,HCPCS,445000050,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Intmd Rep F/E/N/L/MM 30>CM,450,RC,12057,HCPCS,445000051,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Complex Rep Trunk 1.1-2.5CM,450,RC,13100,HCPCS,445000052,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Complex Rep Trunk 2.6-7.5CM,450,RC,13101,HCPCS,445000053,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Cplx Rep Trunk >7.5CM EA Addl 5CM,450,RC,13102,HCPCS,445000054,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Complex Rep S/A/L 1.1-2.5CM,450,RC,13120,HCPCS,445000055,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Complex Rep  S/A/L 2.6-7.5CM,450,RC,13121,HCPCS,445000056,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Cplx Rep S/A/L >7.5CM EA Addl 5CM,450,RC,13122,HCPCS,445000057,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Complex Rep Face 1.1-2.5CM,450,RC,13131,HCPCS,445000058,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Complex Rep Face 2.6-7.5CM,450,RC,13132,HCPCS,445000059,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Cplx Rep Face >7.5CM EA Addl 5CM,450,RC,13133,HCPCS,445000060,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Complex Rep E/N/E/L  1.1-2.5CM,450,RC,13151,HCPCS,445000062,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Complex RepE/N/E/L  2.6-7.5CM,450,RC,13152,HCPCS,445000063,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Cplx Rep E/N/E/L  >7.5CM EA Addl 5CM,450,RC,13153,HCPCS,445000064,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Minor Local Burn Trmt,450,RC,16000,HCPCS,445000065,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Small Burn Trmt,450,RC,16020,HCPCS,445000066,CDM,both,,,282.19,239.86,,,,,,,,,,,hospital's standard charge pricing
Medium Burn Trmt,450,RC,16025,HCPCS,445000067,CDM,both,,,282.19,239.86,,,,,,,,,,,hospital's standard charge pricing
Major Burn Trmt,450,RC,16030,HCPCS,445000068,CDM,both,,,282.19,239.86,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Reml Muscle/Tendon Simp,450,RC,20520,HCPCS,445000070,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
Inj Tendon Sheath/Ligament,450,RC,20550,HCPCS,445000072,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Inj Tendon Origin/Insertion,450,RC,20551,HCPCS,445000073,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Inj Trigger Pt 1-2 Muscle,450,RC,20552,HCPCS,445000074,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Inj Trigger Pts 3/> or More Muscles,450,RC,20553,HCPCS,445000075,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Nasal Bone w/o Manip,450,RC,21310,HCPCS,445000076,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Nasal Bone w/o Stblz,450,RC,21315,HCPCS,445000077,CDM,both,,,3155.22,2681.94,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Nasal Bone w/ Stblz,450,RC,21320,HCPCS,445000078,CDM,both,,,3155.22,2681.94,,,,,,,,,,,hospital's standard charge pricing
I&D Shoulder; Deep Abscess,450,RC,23030,HCPCS,445000080,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal Shoulder,450,RC,23330,HCPCS,445000081,CDM,both,,,1507.27,1281.18,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Clavicle FX,450,RC,23500,HCPCS,445000082,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Shldr Dislc w/ Manip w/o Anes,450,RC,23650,HCPCS,445000083,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Shldr Dislc w/Manip w/Anes,450,RC,23655,HCPCS,445000084,CDM,both,,,2806.87,2385.84,,,,,,,,,,,hospital's standard charge pricing
Deep I&D - Upper Arm/Elbow,450,RC,23930,HCPCS,445000085,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Bursa I&D - Upper Arm/Elbow,450,RC,23931,HCPCS,445000086,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rem UA/Elbow SQ,450,RC,24200,HCPCS,445000087,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Humerus FX w/o Manip,450,RC,24500,HCPCS,445000089,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Humerus FX w/ Manip,450,RC,24530,HCPCS,445000090,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Posterior Elbow Reduction w/o Anes,450,RC,24600,HCPCS,445000091,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Posterior Elbow Reduction w/Anes,450,RC,24605,HCPCS,445000092,CDM,both,,,2806.87,2385.84,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Monteggia FX w/ Manip,450,RC,24620,HCPCS,445000093,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
Reduc Nursemaids Elbow w/ Manip,450,RC,24640,HCPCS,445000094,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Rdal Shaft FX w/o Manip,450,RC,25500,HCPCS,445000095,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Rdal Shaft FX w/Manip,450,RC,25505,HCPCS,445000096,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Ulnr Shaft FX w/o Manip,450,RC,25530,HCPCS,445000097,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Ulnr Shaft FX w/Manip,450,RC,25535,HCPCS,445000098,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Radius/Ulna FX w/o Manip,450,RC,25600,HCPCS,445000099,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Radius/Ulna FX w Manip,450,RC,25605,HCPCS,445000100,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Met FX Sing w/o Manip EA Bone,450,RC,26600,HCPCS,445000101,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Met FX Sing w/ Manip EA Bone,450,RC,26605,HCPCS,445000102,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Phal Shft FX w/o Manip,450,RC,26720,HCPCS,445000103,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Phal Shft FX w/ Manip,450,RC,26725,HCPCS,445000104,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Tib Shft FX w/o Manip,450,RC,27750,HCPCS,445000106,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Metatar FX w/o Manip,450,RC,28470,HCPCS,445000108,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Metatar FX w/ Manip,450,RC,28475,HCPCS,445000109,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Phlx/Phlg FX w/o Manip,450,RC,28510,HCPCS,445000110,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Trmt Phlx/Phlg FX w/ Manip,450,RC,28515,HCPCS,445000111,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Apply Long Arm Splint,450,RC,29105,HCPCS,445000112,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Apply Short Arm Splint,450,RC,29125,HCPCS,445000113,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Apply Finger Splint Static,450,RC,29130,HCPCS,445000114,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Apply Long Leg Splint,450,RC,29505,HCPCS,445000116,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Apply Short Leg Splint,450,RC,29515,HCPCS,445000117,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Insertion of Chest Tube,450,RC,32551,HCPCS,445000119,CDM,both,,,1019.08,866.22,,,,,,,,,,,hospital's standard charge pricing
Capillary Blood Draw,450,RC,36416,HCPCS,445000122,CDM,both,,,54.32,46.17,,,,,,,,,,,hospital's standard charge pricing
Central Line Insertion < 5yrs,450,RC,36555,HCPCS,445000124,CDM,both,,,2051.56,1743.83,,,,,,,,,,,hospital's standard charge pricing
Central Line Insertion > 5yrs,450,RC,36556,HCPCS,445000125,CDM,both,,,2051.56,1743.83,,,,,,,,,,,hospital's standard charge pricing
Collect Blood From PICC,450,RC,36592,HCPCS,445000126,CDM,both,,,695.57,591.23,,,,,,,,,,,hospital's standard charge pricing
Nasal/Orogastric w/Stent,450,RC,43752,HCPCS,445000127,CDM,both,,,232.79,197.87,,,,,,,,,,,hospital's standard charge pricing
Gastric Lavage MD Skill,450,RC,43753,HCPCS,445000128,CDM,both,,,105.51,89.68,,,,,,,,,,,hospital's standard charge pricing
Bladder Irrigation,450,RC,51700,HCPCS,445000129,CDM,both,,,372.63,316.74,,,,,,,,,,,hospital's standard charge pricing
Removal IUD,450,RC,58301,HCPCS,445000130,CDM,both,,,257.71,219.05,,,,,,,,,,,hospital's standard charge pricing
Lumbar Puncture Diagnostic,450,RC,62270,HCPCS,445000131,CDM,both,,,684.97,582.22,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rem Eye Sprfcl,450,RC,65205,HCPCS,445000132,CDM,both,,,175.85,149.47,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rem Eye Embed,450,RC,65210,HCPCS,445000133,CDM,both,,,175.85,149.47,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rem Ear w/o GA,450,RC,69200,HCPCS,445000134,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rem Ear w/ GA,450,RC,69205,HCPCS,445000135,CDM,both,,,4294.88,3650.65,,,,,,,,,,,hospital's standard charge pricing
"Cerumen Removal, requiring instrument, unilateral",450,RC,69210,HCPCS,445000136,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Cardioversion Electric Ext,450,RC,92960,HCPCS,445000137,CDM,both,,,886.35,753.40,,,,,,,,,,,hospital's standard charge pricing
ER Visit - Level 1,450,RC,99281,HCPCS,445000139,CDM,outpatient,,,446.98,379.93,,,,,,,,,,,hospital's standard charge pricing
ER Visit - Level 2,450,RC,99282,HCPCS,445000140,CDM,outpatient,,,835.62,710.28,,,U5   ,,,,,,,,hospital's standard charge pricing
ER Visit - Level 3,450,RC,99283,HCPCS,445000141,CDM,outpatient,,,1443.72,1227.16,,,,,,,,,,,hospital's standard charge pricing
ER Visit - Level 4,450,RC,99284,HCPCS,445000142,CDM,both,,,2195.15,1865.88,,,U5   ,,,,,,,,hospital's standard charge pricing
ER Visit - Level 5,450,RC,99285,HCPCS,445000143,CDM,both,,,3216.53,2734.05,,,,,,,,,,,hospital's standard charge pricing
Critical Care first 30-74 min,450,RC,99291,HCPCS,445000146,CDM,both,,,4580.65,3893.55,,,,,,,,,,,hospital's standard charge pricing
Critical Care ea Addl 30 min,450,RC,99292,HCPCS,445000147,CDM,both,,,1325.87,1126.99,,,,,,,,,,,hospital's standard charge pricing
Catheterize for urine spec,450,RC,P9612,HCPCS,445000148,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
I&D Post-op Wnd Inf,450,RC,10180,HCPCS,445000156,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Debrid SQ Tiss Ech Add 20 SQ CM,450,RC,11045,HCPCS,445000157,CDM,both,,,424.55,360.87,,,,,,,,,,,hospital's standard charge pricing
Debrd SQ Tiss/Mus Add 20 SQ CM,450,RC,11046,HCPCS,445000158,CDM,both,,,424.55,360.87,,,,,,,,,,,hospital's standard charge pricing
Skin Tag Rem 1-15,450,RC,11200,HCPCS,445000159,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Avulsion of Addl Nail Plate,450,RC,11732,HCPCS,445000160,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Excision Skin Edge Toenail,450,RC,11765,HCPCS,445000162,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Simple Wound Dehiscence ONLY,450,RC,12020,HCPCS,445000163,CDM,both,,,815.60,693.26,,,,,,,,,,,hospital's standard charge pricing
Smpl Wound Dehiscence w/Packing,450,RC,12021,HCPCS,445000164,CDM,both,,,577.79,491.12,,,,,,,,,,,hospital's standard charge pricing
Escharotomy Initial,450,RC,16035,HCPCS,445000165,CDM,both,,,282.19,239.86,,,,,,,,,,,hospital's standard charge pricing
Wnd Explor Chest,450,RC,20101,HCPCS,445000166,CDM,both,,,4394.53,3735.35,,,,,,,,,,,hospital's standard charge pricing
Wnd Explor Trunk,450,RC,20102,HCPCS,445000167,CDM,both,,,4394.53,3735.35,,,,,,,,,,,hospital's standard charge pricing
Wnd Explor Extremity,450,RC,20103,HCPCS,445000168,CDM,both,,,2319.52,1971.59,,,,,,,,,,,hospital's standard charge pricing
Arthtrocentesis Small Joint,450,RC,20600,HCPCS,445000169,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Arthrocentesis Intermed Joint,450,RC,20605,HCPCS,445000170,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Arthrocentesis Major Joint,450,RC,20610,HCPCS,445000171,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
TX Orbit FX No-Blow/O w/o Manip,450,RC,21400,HCPCS,445000172,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
Closed TX Mandible w/o Manip,450,RC,21450,HCPCS,445000173,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
Closed TX Sternum w/o Manip,450,RC,21820,HCPCS,445000175,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Closed TX Clavicle w/Manip,450,RC,23505,HCPCS,445000177,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
TX Sternoclavic Dis w/o Manip,450,RC,23520,HCPCS,445000178,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
TX Sternoclavicular Dis w/Manip,450,RC,23525,HCPCS,445000179,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
TX Acromoclavicular Dis w/o Man,450,RC,23540,HCPCS,445000180,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
TX Acromioclavicular Dis w/Man,450,RC,23545,HCPCS,445000181,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Closed TX Scapula w/o Manip,450,RC,23570,HCPCS,445000182,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Closed TX Prox. Humerus w/o Man,450,RC,23600,HCPCS,445000183,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Closed TX Prox. Humerus w/ Man,450,RC,23605,HCPCS,445000184,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Greater Hum Tub w/o Man,450,RC,23620,HCPCS,445000185,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
ClsdTX HumTub FX/Shdr Dis w/Man,450,RC,23665,HCPCS,445000186,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Closed TX Humeral Shaft w/Man,450,RC,24505,HCPCS,445000187,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Supra/TransCon FX w/Man,450,RC,24535,HCPCS,445000188,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
ClsdTX Hum M&L EpiconFX w/o Man,450,RC,24560,HCPCS,445000189,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Hum M&L Epicon FX w/Man,450,RC,24565,HCPCS,445000190,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX HumCondFX M/Lat Incl IF,450,RC,24576,HCPCS,445000191,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Hum M& L Con FX w/Man,450,RC,24577,HCPCS,445000192,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Rad Head/Neck w/o Man,450,RC,24650,HCPCS,445000193,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Rad Head/Neck w/Man,450,RC,24655,HCPCS,445000194,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Olcran/Cornd FX w/o Man,450,RC,24670,HCPCS,445000195,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Olcran/Cornd FX w/Man,450,RC,24675,HCPCS,445000196,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Rad/Ulnar Shaft w/o Man,450,RC,25560,HCPCS,445000197,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Rad/Ulnar Shaft w/Man,450,RC,25565,HCPCS,445000198,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Closed TX Navicular FX w/o Man,450,RC,25622,HCPCS,445000199,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Navicular FX w/Man,450,RC,25624,HCPCS,445000200,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Carpal FX w/o Man,450,RC,25630,HCPCS,445000201,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Carpal FX w/Man,450,RC,25635,HCPCS,445000202,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Ulnar Styloid w/o Man,450,RC,25650,HCPCS,445000203,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Wrist Reduction,450,RC,25660,HCPCS,445000204,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
I&D Simple Finger Abscess,450,RC,26010,HCPCS,445000205,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
I&D Complicated Finger Abscess,450,RC,26011,HCPCS,445000206,CDM,both,,,2319.52,1971.59,,,,,,,,,,,hospital's standard charge pricing
Finger/Hand Flexor Tendon Rpair,450,RC,26350,HCPCS,445000207,CDM,both,,,5185.00,4407.25,,,,,,,,,,,hospital's standard charge pricing
Hand Extensor Tend Repair Each,450,RC,26410,HCPCS,445000208,CDM,both,,,3130.09,2660.58,,,,,,,,,,,hospital's standard charge pricing
Finger Extensor Tendon Repair,450,RC,26418,HCPCS,445000209,CDM,both,,,3130.09,2660.58,,,,,,,,,,,hospital's standard charge pricing
Thumb Reduction,450,RC,26641,HCPCS,445000210,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd Tx Bennet Fx,450,RC,26645,HCPCS,445000211,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Hand Reduction,450,RC,26670,HCPCS,445000212,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Finger MP Reduction,450,RC,26700,HCPCS,445000213,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Articular FX w/o Man,450,RC,26740,HCPCS,445000214,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Articular FX w/Man,450,RC,26742,HCPCS,445000215,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
ClsdTX DisPhalFing/Thmb No Man,450,RC,26750,HCPCS,445000216,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX DisPhalFing/Thmb w/Man,450,RC,26755,HCPCS,445000217,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rmvl Hip/Pelvis SQ,450,RC,27086,HCPCS,445000218,CDM,both,,,1507.27,1281.18,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Pelvic Ring FX w/o Man,450,RC,27197,HCPCS,445000219,CDM,both,,,809.00,687.65,,,,,,,,,,,hospital's standard charge pricing
Coccygeal FX,450,RC,27200,HCPCS,445000220,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Acetabular FX w/o Man,450,RC,27220,HCPCS,445000221,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Femoral Neck FX w/o Man,450,RC,27230,HCPCS,445000222,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Femoral Neck FX w/Man,450,RC,27232,HCPCS,445000223,CDM,both,,,3796.64,3227.14,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Trochanter w/o Man,450,RC,27238,HCPCS,445000224,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Grtr Trochanter w/o Man,450,RC,27246,HCPCS,445000225,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Reduction Hip Trauma,450,RC,27250,HCPCS,445000226,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduct Hip (Spont) w/o Anesth,450,RC,27256,HCPCS,445000227,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduct Hip Post Arhtroplasty,450,RC,27265,HCPCS,445000228,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Fem FX Prox Hd w/o Man,450,RC,27267,HCPCS,445000229,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
I&D Thigh or Knee,450,RC,27301,HCPCS,445000230,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Forgn Bdy Rmvl Thigh/Knee Deep,450,RC,27372,HCPCS,445000231,CDM,both,,,4294.88,3650.65,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Femoral Shaft w/o Man,450,RC,27500,HCPCS,445000232,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Femoral Shaft w/Man,450,RC,27502,HCPCS,445000233,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
ClsdTX DisFem M&L Cond w/o Man,450,RC,27508,HCPCS,445000234,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Patella w/o Man,450,RC,27520,HCPCS,445000235,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Tibial Plateau w/o Man,450,RC,27530,HCPCS,445000236,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduction Knee (ONLY),450,RC,27550,HCPCS,445000237,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduction Knee Patella,450,RC,27560,HCPCS,445000238,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
I&D Leg Or Ankle Infected Bursa,450,RC,27604,HCPCS,445000239,CDM,both,,,4041.99,3435.69,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Tibial Shaft w/Man,450,RC,27752,HCPCS,445000240,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Medl Malleolus w/o Man,450,RC,27760,HCPCS,445000241,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Medl Malleolus w/Man,450,RC,27762,HCPCS,445000242,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
ClsdTX Post Maleolus FX w/o Man,450,RC,27767,HCPCS,445000243,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Post Maleolus FX w/Man,450,RC,27768,HCPCS,445000244,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
ClsdTX Prox Fib Or Shft w/o Man,450,RC,27780,HCPCS,445000245,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
ClsdTX Prox Fib Or Shaft w/Man,450,RC,27781,HCPCS,445000246,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Lat Malleolus w/o Man,450,RC,27786,HCPCS,445000247,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Lat Malleolus w/Man,450,RC,27788,HCPCS,445000248,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Bimalleolar w/o Man,450,RC,27808,HCPCS,445000249,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Bimalleolar w/Man,450,RC,27810,HCPCS,445000250,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Trimalleolar w/o Man,450,RC,27816,HCPCS,445000251,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Trimalleolar w/Man,450,RC,27818,HCPCS,445000252,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Reduction Ankle,450,RC,27840,HCPCS,445000253,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal SQ Foot,450,RC,28190,HCPCS,445000254,CDM,both,,,1507.27,1281.18,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal Foot Deep,450,RC,28192,HCPCS,445000255,CDM,both,,,3212.99,2731.04,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rmvl Foot Comp,450,RC,28193,HCPCS,445000256,CDM,both,,,1507.27,1281.18,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Calcaneus w/o Man,450,RC,28400,HCPCS,445000257,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Calcaneus w/Man,450,RC,28405,HCPCS,445000258,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Talus w/o Man,450,RC,28430,HCPCS,445000259,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Tarsal Bone w/o Man,450,RC,28450,HCPCS,445000260,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Great Toe W/O Man,450,RC,28490,HCPCS,445000261,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Clsd TX Great Toe w/Man,450,RC,28495,HCPCS,445000262,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduction Foot,450,RC,28540,HCPCS,445000263,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduction Talotarsal Joint,450,RC,28570,HCPCS,445000264,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Reduct Tarsometatarsal Joint,450,RC,28600,HCPCS,445000265,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduction Toe MP,450,RC,28630,HCPCS,445000266,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Reduction Toe IP,450,RC,28660,HCPCS,445000267,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
Shoulder Spica Cast,450,RC,29055,HCPCS,445000268,CDM,both,,,432.08,367.27,,,,,,,,,,,hospital's standard charge pricing
Apply Long Arm Cast,450,RC,29065,HCPCS,445000269,CDM,both,,,432.08,367.27,,,,,,,,,,,hospital's standard charge pricing
Apply Short Arm Cast,450,RC,29075,HCPCS,445000270,CDM,both,,,432.08,367.27,,,,,,,,,,,hospital's standard charge pricing
Hand/Wrist Cast,450,RC,29085,HCPCS,445000271,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Apply Long Leg Cast,450,RC,29345,HCPCS,445000272,CDM,both,,,432.08,367.27,,,,,,,,,,,hospital's standard charge pricing
Apply Short Leg Cast,450,RC,29405,HCPCS,445000273,CDM,both,,,432.08,367.27,,,,,,,,,,,hospital's standard charge pricing
Walking Cast Application,450,RC,29425,HCPCS,445000274,CDM,both,,,432.08,367.27,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Rmvl Nose,450,RC,30300,HCPCS,445000275,CDM,Both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Anterior Nasal Pack Simple,450,RC,30901,HCPCS,445000276,CDM,Both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Anterior Nasal Pack Complex,450,RC,30903,HCPCS,445000277,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Posterior Nasal Pack Intial,450,RC,30905,HCPCS,445000278,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Posterior Nasal Pack Subsequent,450,RC,30906,HCPCS,445000279,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Emergent Intubation,450,RC,31500,HCPCS,445000280,CDM,both,,,450.51,382.93,,,,,,,,,,,hospital's standard charge pricing
Tracheostomy Tube Replace,450,RC,31502,HCPCS,445000281,CDM,both,,,260.42,221.36,,,,,,,,,,,hospital's standard charge pricing
Emergent Tracheotomy,450,RC,31603,HCPCS,445000282,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
Emergent Cricothyrotomy,450,RC,31605,HCPCS,445000283,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
Insert Chest Tube Pneumothorax,450,RC,32556,HCPCS,445000285,CDM,both,,,1143.01,971.56,,,,,,,,,,,hospital's standard charge pricing
Venipuntcure Scalp Vein By MD,450,RC,36405,HCPCS,445000290,CDM,both,,,83.00,70.55,,,,,,,,,,,hospital's standard charge pricing
Venipuncture >3YRS Age MD Skill,450,RC,36410,HCPCS,445000292,CDM,both,,,27.82,23.65,,,,,,,,,,,hospital's standard charge pricing
Venipunc Cutdown 1YR OR Older,450,RC,36425,HCPCS,445000294,CDM,both,,,41.87,35.59,,,,,,,,,,,hospital's standard charge pricing
Declot Thrombolytic VAD/Cath,450,RC,36593,HCPCS,445000296,CDM,both,,,439.62,373.68,,,,,,,,,,,hospital's standard charge pricing
Art Line Insert Percutaneous,450,RC,36620,HCPCS,445000298,CDM,both,,,263.77,224.20,,,,,,,,,,,hospital's standard charge pricing
Intraosseous Infusion,450,RC,36680,HCPCS,445000301,CDM,both,,,277.17,235.59,,,,,,,,,,,hospital's standard charge pricing
Thrombolysis Cerebral IV Infus,450,RC,37195,HCPCS,445000302,CDM,both,,,439.62,373.68,,,,,,,,,,,hospital's standard charge pricing
Cmplx Repr Lip Vermillion Only,450,RC,40650,HCPCS,445000303,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
Comp Repr Lip Up To 1/2 Vert HT,450,RC,40652,HCPCS,445000304,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
Comp Repr Lip > 1/2 Vert HT,450,RC,40654,HCPCS,445000305,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
I&D Vestibule of Mouth Simple,450,RC,40800,HCPCS,445000306,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
FB Rmvl Mouth Embedded Simple,450,RC,40804,HCPCS,445000307,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
FB Rmvl Mouth Embedded Comp,450,RC,40805,HCPCS,445000308,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
I&D Intraoral Lingual Abscess,450,RC,41000,HCPCS,445000309,CDM,both,,,3155.22,2681.94,,,,,,,,,,,hospital's standard charge pricing
"Repr 2.5cm or less FL Mouth, Ant 2/3 Tongue",450,RC,41250,HCPCS,445000311,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Repair lac - 2.5cm or less; posterior 1/3 of tongue,450,RC,41251,HCPCS,445000312,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
Cmplx Repr Tongue/FL Mouth over 2.6cm,450,RC,41252,HCPCS,445000313,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
I&D Palate or Uvula,450,RC,42000,HCPCS,445000314,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
Lac Repr Palate Up TO 2CM,450,RC,42180,HCPCS,445000315,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
Drn Intoral Submax/Subling Abs,450,RC,42310,HCPCS,445000317,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
I&D Tonsil Abscess,450,RC,42700,HCPCS,445000318,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal Pharynx,450,RC,42809,HCPCS,445000319,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Cntl Orphargeal Hem Pst Tonslct,450,RC,42960,HCPCS,445000320,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Replace Gastromony Tube,450,RC,43762,HCPCS,445000321,CDM,both,,,400.12,340.10,,,,,,,,,,,hospital's standard charge pricing
I&D Perirectal Abscess,450,RC,46040,HCPCS,445000322,CDM,both,,,4403.74,3743.18,,,,,,,,,,,hospital's standard charge pricing
I&D Perianal Abscess,450,RC,46050,HCPCS,445000323,CDM,both,,,2591.66,2202.91,,,,,,,,,,,hospital's standard charge pricing
I&D Thrombosed Hemorrhoid,450,RC,46083,HCPCS,445000324,CDM,both,,,372.63,316.74,,,,,,,,,,,hospital's standard charge pricing
Exc Extrnl Thromb Hemorrhoid,450,RC,46320,HCPCS,445000326,CDM,both,,,4403.74,3743.18,,,,,,,,,,,hospital's standard charge pricing
Diagnostic Anoscopy,450,RC,46600,HCPCS,445000327,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Paracentesis Intial,450,RC,49082,HCPCS,445000328,CDM,both,,,337.46,286.84,,,,,,,,,,,hospital's standard charge pricing
Irrig Corpra Cavrnosa Priapism,450,RC,54220,HCPCS,445000330,CDM,both,,,372.63,316.74,,,,,,,,,,,hospital's standard charge pricing
Drainage Scrotal Wall Abscess,450,RC,55100,HCPCS,445000331,CDM,both,,,2319.52,1971.59,,,,,,,,,,,hospital's standard charge pricing
Foreign Body Removal Scrotum,450,RC,55120,HCPCS,445000332,CDM,both,,,4274.78,3633.56,,,,,,,,,,,hospital's standard charge pricing
I&D Vulva/Perineum,450,RC,56405,HCPCS,445000333,CDM,both,,,280.52,238.44,,,,,,,,,,,hospital's standard charge pricing
I&D Bartholins Gland,450,RC,56420,HCPCS,445000334,CDM,both,,,280.52,238.44,,,,,,,,,,,hospital's standard charge pricing
Non-OB Vaginal Hem. Control,450,RC,57180,HCPCS,445000335,CDM,both,,,280.52,238.44,,,,,,,,,,,hospital's standard charge pricing
Suture Vaginal Injury,450,RC,57200,HCPCS,445000336,CDM,both,,,3679.41,3127.50,,,,,,,,,,,hospital's standard charge pricing
Vaginal Delivery & Method,450,RC,59409,HCPCS,445000337,CDM,both,,,6269.40,5328.99,,,,,,,,,,,hospital's standard charge pricing
Delivery Placenta Only,450,RC,59414,HCPCS,445000338,CDM,both,,,3634.19,3089.06,,,,,,,,,,,hospital's standard charge pricing
Dental Block,450,RC,64400,HCPCS,445000339,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Digital Block,450,RC,64450,HCPCS,445000340,CDM,both,,,684.97,582.22,,,,,,,,,,,hospital's standard charge pricing
Rem Corneal FB w/o Slit Lamp,450,RC,65220,HCPCS,445000341,CDM,both,,,175.85,149.47,,,,,,,,,,,hospital's standard charge pricing
Rmvl Coreal FB w/Slit Lam,450,RC,65222,HCPCS,445000342,CDM,both,,,175.85,149.47,,,,,,,,,,,hospital's standard charge pricing
I&D Eyelid Abscess,450,RC,67700,HCPCS,445000343,CDM,both,,,592.86,503.93,,,,,,,,,,,hospital's standard charge pricing
Removal FB Eyelid,450,RC,67938,HCPCS,445000344,CDM,both,,,360.91,306.77,,,,,,,,,,,hospital's standard charge pricing
I&D Ear Abscess Simple,450,RC,69000,HCPCS,445000345,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
I&D Ear Abscess Complicated,450,RC,69005,HCPCS,445000346,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Cardiopulmonary Resusciation,450,RC,92950,HCPCS,445000349,CDM,both,,,1076.00,914.60,,,,,,,,,,,hospital's standard charge pricing
Transcutaneous Pacing,450,RC,92953,HCPCS,445000350,CDM,both,,,2232.00,1897.20,,,,,,,,,,,hospital's standard charge pricing
Thrombolysis Coronary IV Infus,450,RC,92977,HCPCS,445000351,CDM,both,,,1162.00,987.70,,,,,,,,,,,hospital's standard charge pricing
Smke/tob Cess Counsel 3-10 Min,450,RC,99406,HCPCS,445000356,CDM,both,,,86.00,73.10,,,,,,,,,,,hospital's standard charge pricing
Smke/Tob Cess Counsel > 10 Min,450,RC,99407,HCPCS,445000357,CDM,both,,,86.00,73.10,,,,,,,,,,,hospital's standard charge pricing
Newborn Resuscitation,450,RC,99465,HCPCS,445000359,CDM,both,,,2065.00,1755.25,,,,,,,,,,,hospital's standard charge pricing
"I&D Leg/Ankle,Deep Absc/Hematoma",450,RC,27603,HCPCS,445000362,CDM,both,,,3563.85,3029.27,,,,,,,,,,,hospital's standard charge pricing
Foley Catheter Indwelling Insert,450,RC,51702,HCPCS,445000365,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Insertion of PICC line > 5 yrs,450,RC,36569,HCPCS,445000366,CDM,both,,,1866.77,1586.75,,,,,,,,,,,hospital's standard charge pricing
"Inj, ansth; Intrcstl nrve, sngl",450,RC,64420,HCPCS,445000367,CDM,both,,,684.97,582.22,,,,,,,,,,,hospital's standard charge pricing
EXCB9 LESMRG-SKTG T/A/L 1.1-2.0 CM,450,RC,11402,HCPCS,445000368,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
DRG ABS/CST/HMTMA DENTAVER STRXS,450,RC,41800,HCPCS,445000370,CDM,both,,,267.96,227.77,,,,,,,,,,,hospital's standard charge pricing
Reduction Temporomandibular Dislocation,450,RC,21480,HCPCS,445000373,CDM,both,,,210.18,178.65,,,,,,,,,,,hospital's standard charge pricing
Intmd Scalp/Trunk/EXT 7.6-12.5 CM,450,RC,12034,HCPCS,445000374,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Thoracentesis(needle)asprtn w/o img,450,RC,32554,HCPCS,445000378,CDM,both,,,1143.01,971.56,,,,,,,,,,,hospital's standard charge pricing
Reduction Interphalang Joint w/ Manip w/o Anes,450,RC,26770,HCPCS,445000401,CDM,both,,,304.80,259.08,,,,,,,,,,,hospital's standard charge pricing
"Cerumen Removal, irrigation/lavage, unilateral",450,RC,69209,HCPCS,445000404,CDM,both,,,86.12,73.20,,,,,,,,,,,hospital's standard charge pricing
"Laceration Repair, Vestibule of Mouth; 2.5cm or less",450,RC,40830,HCPCS,445000405,CDM,both,,,628.03,533.83,,,,,,,,,,,hospital's standard charge pricing
Aspiration/Injection ganglion cyst(s),450,RC,20612,HCPCS,445000406,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
"Closed Tx Fem Fx, Distal, Condyles w/ Manip",450,RC,27510,HCPCS,445000407,CDM,both,,,880.91,748.77,,,,,,,,,,,hospital's standard charge pricing
Closed Tx Grt Humeral Tuberosity w/ Manip,450,RC,23625,HCPCS,445000408,CDM,both,,,5513.00,4686.05,,,,,,,,,,,hospital's standard charge pricing
"Closed Tx Pilon/Plafond Fx, w/ Traction or Manip",450,RC,27824,HCPCS,445000409,CDM,both,,,809.00,687.65,,,,,,,,,,,hospital's standard charge pricing
"Closed Tx Pilon/Plafond Fx, w/o Manip",450,RC,27825,HCPCS,445000410,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
"Closed Tx Tib Plat Fx, w/ Traction",450,RC,27532,HCPCS,445000411,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
Cmplx Vestibule of Mouth >2.5cm,450,RC,40831,HCPCS,445000413,CDM,both,,,1398.41,1188.65,,,,,,,,,,,hospital's standard charge pricing
Complicated Foley Cath Insert,450,RC,51703,HCPCS,445000414,CDM,both,,,200.97,170.82,,,,,,,,,,,hospital's standard charge pricing
Corneal Burring,450,RC,65435,HCPCS,445000415,CDM,both,,,3473.00,2952.05,,,,,,,,,,,hospital's standard charge pricing
Cryosurgery of Skin Lesions 1-14,450,RC,17110,HCPCS,445000416,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Debridement of Nail(s) 1-5,450,RC,11720,HCPCS,445000417,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
Debridement of Nails 6+,450,RC,11721,HCPCS,445000418,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
ED Blood Collection from Implanted Port,450,RC,36591,HCPCS,445000419,CDM,both,,,695.57,591.23,,,,,,,,,,,hospital's standard charge pricing
Fecal Disimpaction w/ Anesthesia,450,RC,45915,HCPCS,445000420,CDM,both,,,3155.22,2681.94,,,,,,,,,,,hospital's standard charge pricing
Foreskin Manipulation,450,RC,54450,HCPCS,445000421,CDM,both,,,554.34,471.19,,,,,,,,,,,hospital's standard charge pricing
"I&D Pelvis/Hip Joint, Deep Absc/Hemat",450,RC,26990,HCPCS,445000423,CDM,both,,,4041.99,3435.69,,,,,,,,,,,hospital's standard charge pricing
I&D Shoulder; Infected Bursa,450,RC,23031,HCPCS,445000424,CDM,both,,,9746.00,8284.10,,,,,,,,,,,hospital's standard charge pricing
Indirect Laryngoscopy,450,RC,31505,HCPCS,445000425,CDM,both,,,145.70,123.85,,,,,,,,,,,hospital's standard charge pricing
Injection Facial Nerve,450,RC,64402,HCPCS,445000426,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
Injection Greater Occiptal Nerve,450,RC,64405,HCPCS,445000427,CDM,both,,,684.97,582.22,,,,,,,,,,,hospital's standard charge pricing
Puncture Aspiration of Cyst of Breast,450,RC,19000,HCPCS,445000428,CDM,both,,,845.75,718.89,,,,,,,,,,,hospital's standard charge pricing
Removal/Bivalv Full Arm or Leg Cast,450,RC,29705,HCPCS,445000430,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Simp Rep Face 5.1-7.5CM,450,RC,12014,HCPCS,445000431,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
Wound Debridement,450,RC,97597,HCPCS,445000432,CDM,both,,,247.02,209.97,,,,,,,,,,,hospital's standard charge pricing
"Cystostomy Tube Change, Simple",450,RC,51705,HCPCS,445000433,CDM,both,,,372.63,316.74,,,,,,,,,,,hospital's standard charge pricing
Abdominal Paracentesis; with imaging guidance,450,RC,49083,HCPCS,445000434,CDM,both,,,520.85,442.72,,,,,,,,,,,hospital's standard charge pricing
Contrast Injec Eval Exist Gastro tube percutan w/Imaging & report,450,RC,49465,HCPCS,445000437,CDM,both,,,240.33,204.28,,,,,,,,,,,hospital's standard charge pricing
"Closed TX of lunate dislocation, with manipulation",450,RC,25690,HCPCS,445000438,CDM,both,,,3378.79,2871.97,,,,,,,,,,,hospital's standard charge pricing
"Thoracentesis, Needle/Cath, Aspirat Pleura Space; w/image guid",450,RC,32555,HCPCS,445000439,CDM,both,,,1143.01,971.56,,,,,,,,,,,hospital's standard charge pricing
Aspiration of Bladder; by needle,450,RC,51100,HCPCS,445000440,CDM,both,,,372.63,316.74,,,,,,,,,,,hospital's standard charge pricing
"Arthrocent, Aspir or Inj, Interm joint w/US guid",450,RC,20606,HCPCS,445000441,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
"US Post Void Measurement, Non Imaging",450,RC,51798,HCPCS,445000442,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
"Unlisted Procedure, Nervous System",450,RC,64999,HCPCS,445000443,CDM,both,,,468.93,398.59,,,,,,,,,,,hospital's standard charge pricing
"Laryngoscopy, direct, operative, with Foreign Body Removal",450,RC,31530,HCPCS,445000444,CDM,both,,,3976.67,3380.17,,,,,,,,,,,hospital's standard charge pricing
"Inj, Intralesional; >/= 7 lesions",450,RC,11900,HCPCS,445000445,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
"Excision, Excpt Skin Tag Trnk/Arm/Leg; < = 0.5cm",450,RC,11400,HCPCS,445000446,CDM,both,,,801.36,681.16,,,,,,,,,,,hospital's standard charge pricing
"Destruction, premalignant lesion; first lesion",450,RC,17000,HCPCS,445000447,CDM,both,,,162.45,138.08,,,,,,,,,,,hospital's standard charge pricing
"Anoscopy, w/removal of foreign body",450,RC,46608,HCPCS,445000448,CDM,both,,,1699.03,1444.18,,,,,,,,,,,hospital's standard charge pricing
ER Visit - Level 1 w/ 25 Modifier,450,RC,99281,HCPCS,445000449,CDM,outpatient,,,343.83,292.26,,,25   ,,,,,,,,hospital's standard charge pricing
ER Visit - Level 2 w/ 25 Modifier,450,RC,99282,HCPCS,445000450,CDM,outpatient,,,596.87,507.34,,,25   ,,,,,,,,hospital's standard charge pricing
ER Visit - Level 3 w/ 25 Modifier,450,RC,99283,HCPCS,445000451,CDM,outpatient,,,995.67,846.32,,,25   ,,,,,,,,hospital's standard charge pricing
ER Visit - Level 4 w/ 25 Modifier,450,RC,99284,HCPCS,445000452,CDM,both,,,1688.58,1435.29,,,25   ,,,,,,,,hospital's standard charge pricing
ER Visit - Level 5 w/ 25 Modifier,450,RC,99285,HCPCS,445000453,CDM,both,,,2474.25,2103.11,,,25   ,,,,,,,,hospital's standard charge pricing
Critical Care first 30-74 min w/ 25 Modifier,450,RC,99291,HCPCS,445000454,CDM,both,,,3523.58,2995.04,,,25   ,,,,,,,,hospital's standard charge pricing
Injection of Corpora Cavernosa w/pharmacologic agent(s),450,RC,54235,HCPCS,445000455,CDM,both,,,372.63,316.74,,,,,,,,,,,hospital's standard charge pricing
"Removal or bivalving; gauntlet, boot or body cast",450,RC,29700,HCPCS,445000456,CDM,both,,,195.94,166.55,,,,,,,,,,,hospital's standard charge pricing
Chemical cauterization of granulation tissue,450,RC,17250,HCPCS,445000457,CDM,both,,,282.19,239.86,,,,,,,,,,,hospital's standard charge pricing
"Urethrotomy or urethrostomy, Ext (sep proc); pendulous urethra",450,RC,53000,HCPCS,445000458,CDM,both,,,3734.68,3174.48,,,,,,,,,,,hospital's standard charge pricing
"Rpr Tendon/muscle, Exts FA/Wrist; primary single ea Tendon/muscle",450,RC,25270,HCPCS,445000459,CDM,both,,,5833.13,4958.16,,,,,,,,,,,hospital's standard charge pricing
"Fine Needle Aspiration biopsy, w/o imag guide, 1st lesion",450,RC,10021,HCPCS,445000460,CDM,both,,,277.17,235.59,,,,,,,,,,,hospital's standard charge pricing
"Repair, extensor tendon, leg; primary w/o graft, each tendon",450,RC,27664,HCPCS,445000461,CDM,both,,,5833.13,4958.16,,,,,,,,,,,hospital's standard charge pricing
"Sialolithotomy; submand, subling or parotid, uncompl, intraoral",450,RC,42330,HCPCS,445000462,CDM,both,,,3155.22,2681.94,,,,,,,,,,,hospital's standard charge pricing
"Hemorrhoidectomy, internal, single, w/o imaging guidance",450,RC,46945,HCPCS,445000463,CDM,both,,,2591.66,2202.91,,,,,,,,,,,hospital's standard charge pricing
Continuous Pulse Oximetry,460,RC,94762,HCPCS,446000003,CDM,both,,,436.00,370.60,,,,,,,,,,,hospital's standard charge pricing
Pacemaker Interrogation,480,RC,93288,HCPCS,448000000,CDM,both,,,162.00,137.70,,,,,,,,,,,hospital's standard charge pricing
"Echocardiogram transthoracic, 2D w/color w/doppler Complete",483,RC,93306,HCPCS,448300001,CDM,both,,,3658.04,3109.33,,,,,,,,,,,hospital's standard charge pricing
"Echocardiogram, transthoracic, 2D Limited",483,RC,93308,HCPCS,448300002,CDM,both,,,830.71,706.10,,,,,,,,,,,hospital's standard charge pricing
Octreotide 50mCg/1mL inj (per 25mCg),636,RC,J2353,HCPCS,425000043,CDM,both,1,ML,13.83,11.76,,,,,,,,,,,hospital's standard charge pricing
"Calcium Gluconate 10% 1,000mg/10mL inj (per 10mg)",636,RC,J0612,HCPCS,425000232,CDM,both,1,ML,0.75,0.64,,,,,,,,,,,hospital's standard charge pricing
Orphenadrine Citrate 30mg/mL 2mL inj (up to 60mg),636,RC,J2360,HCPCS,425000587,CDM,both,1,ML,253.60,215.56,,,,,,,,,,,hospital's standard charge pricing
Alteplase 2mg inj (per 1mg),636,RC,J2997,HCPCS,425000601,CDM,both,1,UN,1176.60,1000.11,,,,,,,,,,,hospital's standard charge pricing
Remdesivir 100mg injection (per 1mg),636,RC,J0248,HCPCS,425000618,CDM,both,1,UN,4.53,3.85,,,,,,,,,,,hospital's standard charge pricing
Protamine 10mg/ml 25ml Inj,636,RC,J2720,HCPCS,463600144,CDM,both,1,ML,14.36,12.21,,,,,,,,,,,hospital's standard charge pricing
Meropenem 1000 mg inj,636,RC,J2185,HCPCS,463600148,CDM,both,1,UN,8.13,6.91,,,,,,,,,,,hospital's standard charge pricing
Cefepime 2gm injection,636,RC,J0692,HCPCS,463600149,CDM,both,1,UN,18.68,15.88,,,,,,,,,,,hospital's standard charge pricing
Zoledronic Acid 4mg/5ml inj (per mg),636,RC,J3489,HCPCS,463600150,CDM,both,1,ML,78.01,66.31,,,,,,,,,,,hospital's standard charge pricing
Midazolam 25mg/5mL inj (per 1mg),636,RC,J2250,HCPCS,463600151,CDM,both,1,ML,3.19,2.71,,,,,,,,,,,hospital's standard charge pricing
Fentanyl 50mcg/ml 20ml (per 2ml),636,RC,J3010,HCPCS,463600152,CDM,both,1,ML,5.99,5.09,,,,,,,,,,,hospital's standard charge pricing
Phentolamine 5mg/2ml inj (up to 5mg),636,RC,J2760,HCPCS,463600153,CDM,both,1,UN,2961.55,2517.32,,,,,,,,,,,hospital's standard charge pricing
"Acetaminophen 1,000mg/100mL inj (per 10mg)",636,RC,J0131,HCPCS,463600154,CDM,both,1,ML,2.54,2.16,,,,,,,,,,,hospital's standard charge pricing
"Kcentra 1,000 unit 40mL (range 800-1,240 units) (per I.U.)",636,RC,J7168,HCPCS,463600155,CDM,both,1,UN,19.71,16.75,,,,,,,,,,,hospital's standard charge pricing
Buprenorphine/Naloxone 4mg/1mg SL film,636,RC,J0573,HCPCS,463600157,CDM,both,1,UN,56.95,48.41,,,,,,,,,,,hospital's standard charge pricing
Methylergonovine 0.2mg/mL 1mL inj,636,RC,J2210,HCPCS,463600158,CDM,both,1,ML,139.35,118.45,,,,,,,,,,,hospital's standard charge pricing
Desmopressin 4mcg/1mL amp (per 1mcg),636,RC,J2597,HCPCS,463600160,CDM,both,1,ML,99.48,84.56,,,,,,,,,,,hospital's standard charge pricing
Linezolid 600mg/300mL bag (per 200mg),636,RC,J2020,HCPCS,463600161,CDM,both,1,ML,146.57,124.58,,,,,,,,,,,hospital's standard charge pricing
Pneumococcal 20 valent conjugate (Prevnar) vaccine,636,RC,90677,HCPCS,463600162,CDM,both,1,ML,1850.30,1572.76,,,,,,,,,,,hospital's standard charge pricing
Ryanodex Dantrolene Sodium 250 mg injection single-use vial 5mL,636,RC,J3490,HCPCS,463600165,CDM,both,1,UN,22033.25,18728.26,,,,,,,,,,,hospital's standard charge pricing
Sodium Zirconium Cyclosilicate 10gm packet,637,RC,,,463700026,CDM,both,1,UN,201.10,170.94,,,,,,,,,,,hospital's standard charge pricing
Nitrofurantoin Macrocrystals 100mg cap,637,RC,,,463700028,CDM,both,1,UN,29.15,24.78,,,,,,,,,,,hospital's standard charge pricing
Duloxetine 30mg cap,637,RC,,,463700030,CDM,both,1,UN,54.55,46.37,,,,,,,,,,,hospital's standard charge pricing
Guaifenesin 200mg/10mL UD cup,637,RC,,,463700033,CDM,both,1,ML,19.75,16.79,,,,,,,,,,,hospital's standard charge pricing
ECG Tracing 12 Lead w/ Interp,730,RC,93005,HCPCS,473000001,CDM,both,,,147.07,125.01,,,,,,,,,,,hospital's standard charge pricing
Rhythm ECG Tracing,730,RC,93041,HCPCS,473000003,CDM,both,,,210.00,178.50,,,,,,,,,,,hospital's standard charge pricing
Catheterize for urine spec Observation Only,761,RC,P9612,HCPCS,476100001,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Foley Catheter Indwelling Insert Observation Only,761,RC,51702,HCPCS,476100002,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
"US Post Void Measurement, Non Imaging Observation Only",761,RC,51798,HCPCS,476100003,CDM,both,,,123.93,105.34,,,,,,,,,,,hospital's standard charge pricing
Hospital observation per hr,762,RC,G0378,HCPCS,476200007,CDM,both,,,89.63,76.19,,,,,,,,,,,hospital's standard charge pricing
Observation - Direct Admission,762,RC,G0379,HCPCS,476200008,CDM,both,,,1928.00,1638.80,,,,,,,,,,,hospital's standard charge pricing
"Immunization Admin, 1 vacc",771,RC,90471,HCPCS,477100001,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
Admin influenza virus vacc,771,RC,G0008,HCPCS,477100002,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
Admin pneumococcal vaccine,771,RC,G0009,HCPCS,477100003,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
Admin hepatitis b vaccine,771,RC,G0010,HCPCS,477100004,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
"Immunization Admin, addtl vacc",771,RC,90472,HCPCS,477100005,CDM,both,,,86.00,73.10,,,,,,,,,,,hospital's standard charge pricing
Admin hepatitis b addtl vaccine,771,RC,90472,HCPCS,477100006,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
Admin influenza virus addtl vaccine,771,RC,90472,HCPCS,477100007,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
Admin pneumococcal addtl vaccine,771,RC,90472,HCPCS,477100008,CDM,both,,,35.77,30.40,,,,,,,,,,,hospital's standard charge pricing
US Art Dopp/Bypass Graft Up Ext Limt/unl Left,920,RC,93931,HCPCS,492000004,CDM,both,,,942.68,801.28,,,LT   ,,,,,,,,hospital's standard charge pricing
US Ext Venous Dop Unilat Left,920,RC,93971,HCPCS,492000007,CDM,both,,,981.76,834.50,,,LT   ,,,,,,,,hospital's standard charge pricing
Vascular Study Complete,920,RC,93975,HCPCS,492000008,CDM,both,,,1667.40,1417.29,,,,,,,,,,,hospital's standard charge pricing
US Art/Vein Abd/Pelvis/Scrotal Limited,920,RC,93976,HCPCS,492000009,CDM,both,,,1114.91,947.67,,,,,,,,,,,hospital's standard charge pricing
Aorta Dup Scan Unilat or Lmtd,920,RC,93979,HCPCS,492000010,CDM,both,,,1370.61,1165.02,,,,,,,,,,,hospital's standard charge pricing
Art Dup Scan LE Bilat,920,RC,93925,HCPCS,492000012,CDM,both,,,1331.52,1131.79,,,,,,,,,,,hospital's standard charge pricing
Art Dup Scan LE Unilat or Lmtd Left,920,RC,93926,HCPCS,492000013,CDM,both,,,1010.91,859.27,,,LT   ,,,,,,,,hospital's standard charge pricing
US Venous Dup Scan Ext Study Bilat,920,RC,93970,HCPCS,492000016,CDM,both,,,1472.63,1251.74,,,,,,,,,,,hospital's standard charge pricing
DupScan Extrcranal Artries; comp,920,RC,93880,HCPCS,492000017,CDM,both,,,1323.57,1125.03,,,,,,,,,,,hospital's standard charge pricing
DupScan Extrcranal Artries; limt Left,920,RC,93882,HCPCS,492000018,CDM,both,,,881.73,749.47,,,LT   ,,,,,,,,hospital's standard charge pricing
US Aorta IVC Iliac Duplex Complete,920,RC,93978,HCPCS,492000059,CDM,both,,,1200.36,1020.31,,,,,,,,,,,hospital's standard charge pricing
US Art Doppl or Bypass graft/Up Ext Bil,920,RC,93930,HCPCS,492000061,CDM,both,,,1050.00,892.50,,,,,,,,,,,hospital's standard charge pricing
US Duplex Scan Hemodialysis Access,920,RC,93990,HCPCS,492000062,CDM,both,,,472.00,401.20,,,,,,,,,,,hospital's standard charge pricing
US Ext Venous Dop Unilat Right,920,RC,93971,HCPCS,492000063,CDM,both,,,981.76,834.50,,,RT   ,,,,,,,,hospital's standard charge pricing
Art Dup Scan LE Unilat or Lmtd Right,920,RC,93926,HCPCS,492000064,CDM,both,,,1010.91,859.27,,,RT   ,,,,,,,,hospital's standard charge pricing
US Art Dopp/Bypass Graft Up Ext Limt/unl Right,920,RC,93931,HCPCS,492000065,CDM,both,,,942.68,801.28,,,RT   ,,,,,,,,hospital's standard charge pricing
DupScan Extrcranal Artries; limt Right,920,RC,93882,HCPCS,492000066,CDM,both,,,881.73,749.47,,,RT   ,,,,,,,,hospital's standard charge pricing