• CPTDescriptionRegularMember
    74177CT Abdomen & Pelvis w/ Contrast$475.00$427.50
    74178CT Abdomen & Pelvis w/o & w/ Contrast$475.00$427.50
    74176CT Abdomen & Pelvis w/o Contrast$390.00$351.00
    74160CT Abdomen w/ Contrast$455.00$409.50
    74170CT Abdomen w/o & w/ Contrast$455.00$409.50
    74150CT Abdomen w/o Contrast$370.00$333.00
    74175CT Angio Abdomen$510.00$459.00
    74174CT Angio Abdomen & Pelvis$510.00$459.00
    75635CT Angio Abdominal Arteries$510.00$459.00
    71275CT Angio Chest$510.00$459.00
    70496CT Angio Head$510.00$459.00
    75574CT Angio Heart w/ 3D Image$510.00$459.00
    73706CT Angio Lower Extremity$510.00$459.00
    70498CT Angio Neck$510.00$459.00
    72191CT Angio Pelvis$510.00$459.00
    73206CT Angio Upper Extremity$510.00$459.00
    72129CT Chest Spine w/ Contrast$545.00$490.50
    72130CT Chest Spine w/o & w/ Contrast$460.00$414.00
    72128CT Chest Spine w/o Contrast$370.00$333.00
    70460CT Head/Brain w/ Contrast$455.00$409.50
    70450CT Head/Brain w/o Contrast$370.00$333.00
    70470CT Head/Brain w/o & w/ Contrast$455.00$409.50
    73701CT Lower Extremity w/ Contrast$460.00$414.00
    73700CT Lower Extremity w/o Contrast$370.00$333.00
    73702CT Lower Extremity w/o & w/ Contrast$455.00$409.50
    72132CT Lumbar Spine w/ Contrast$545.00$490.50
    72133CT Lumbar Spine w/o & w/ Contrast$460.00$414.00
    72131CT Lumbar Spine w/o Contrast$370.00$333.00
    70487CT Maxillofacial w/ Contrast$455.00$409.50
    70486CT Maxillofacial w/o Contrast$370.00$333.00
    70488CT Maxillofacial w/o & w/ Contrast$455.00$409.50
    72126CT Neck Spine w/ Contrast$545.00$490.50
    72125CT Neck Spine w/o Contrast$370.00$333.00
    70481CT Orbit/Ear/Fossa w/ Contrast$460.00$414.00
    70482CT Orbit/Ear/Fossa w/o & w/ Contrast$460.00$414.00
    70480CT Orbit/Ear/Fossa w/o Contrast$370.00$333.00
    72193CT Pelvis w/ Contrast$545.00$490.50
    72194CT Pelvis w/o & w/ Contrast$460.00$414.00
    72192CT Pelvis w/o Contrast$370.00$333.00
    70491CT Soft Tissue Neck w/ Contrast$455.00$409.50
    70490CT Soft Tissue Neck w/o Contrast$370.00$333.00
    70492CT Soft Tissue Neck w/o & w/ Contrast$455.00$409.50
    71260CT Thorax w/ Contrast$455.00$409.50
    71270CT Thorax w/o & w/ Contrast$455.00$409.50
    71250CT Thorax w/o Contrast$370.00$333.00
    73201CT Upper Extremity w/ Contrast$545.00$490.50
    73202CT Upper Extremity w/o & w/ Contrast$460.00$414.00
    73200CT Upper Extremity w/o Contrast$370.00$333.00
    75571CT Cardiac Calcium Score$105.00$94.50
  • CPTDescriptionRegularMember
    A4460Ace Bandage 2-3 Inch$5.00$3.75
    A7003Nebulizer, Disposable$15.00$11.25
    A4627Aerochamber$35.00$26.25
    L1980Afo 1 Uprt Dorsiflx Slid Stirup Fab$5.00$3.75
    L3260Ambulatory Boot Or Shoe; Each$45.00$33.75
    L4350Ankle Brace$40.00$30.00
    A4615Cannula Nasal$10.00$7.50
    L0120Cervical Collar, Flexible, Non-adjustable$55.00$41.25
    E0114Crutches$90.00$67.50
    A6412Eye Patch$15.00$11.25
    A9273Hot Water Bottle/Ice Cap$10.00$7.50
    A4300Catheter, temporary$10.00$7.50
    99070Inhaler, Ventolin 90Mcg$130.00$97.50
    A4351Catheter, urine, straight$5.00$3.75
    L1830Knee Immobilizer$40.00$30.00
    99070Morgan Lens$60.00$45.00
    A4566Shoulder Sling$60.00$45.00
    A4565Arm Sling$25.00$18.75
    L3670So Acromio/Claviculr Prfab Fit&Adj$35.00$26.25
    A4570Finger Splint$20.00$15.00
    A4570Forearm Splint$5.00$3.75
    A4570Shoulder/Hand Splint$5.00$3.75
    A4358Urinary Leg Bag$10.00$7.50
    A4620Variable Concentration Mask$5.00$3.75
    L4360Walking Boot, Pneumatic w/ Fitting$105.00$78.75
    L3908Wrist Splint$40.00$30.00
  • CPTDescriptionRegularMember
    93000Electrocardiogram, Complete$100.00$90.00
    93040Rhythm ECG With Report$75.00$67.50
  • CPTDescriptionRegularMember
    69200Remove Foreign Body External Ear$190.00$171.00
    30300Remove Foreign Body Nose, Intranasal$330.00$297.00
    28190Remova Foreign Body Foot$35.00$31.50
    10120Remove Foreign Body Skin, Simple$265.00$238.50
    10121Remove Foreign Body Skin, Complex$615.00$553.50
    65205Remove Foreign Body Eye, Conjunctival, Surface$90.00$81.00
    65210Remove Foreign Body Eye, Conjunctival, Embedded$130.00$117.00
    65220Remove Foreign Body Eye, Corneal, Surface$135.00$121.50
    65222Remove Foreign Body Eye, Corneal, Embedded$45.00$40.50
  • CPTDescriptionRegularMember
    29515Application Lower Leg Splint$105.00$94.50
    29130Application Of Finger Splint$45.00$40.50
    29505Application, Long Leg Splint$200.00$180.00
    29125Apply Forearm Splint$65.00$58.50
    29105Apply Long Arm Splint$165.00$148.50
    29425Apply Short Leg Cast$295.00$265.50
    Q4002Cast Bdy Cast Adlt w/Wo Head F-Glss$5.00$4.50
    Q4020Cast Spl Lng Arm Splint Ped Fibrgls$5.00$4.50
    Q4018Cast Spl Lng Arm Splnt Adlt Fibrgls$70.00$63.00
    Q4044Cast Spl Lng Leg Splint Ped Fibrgls$55.00$49.50
    Q4042Cast Spl Lng Leg Splnt Adlt Fibrgls$115.00$103.50
    Q4010Cast Spl Short Arm Cast Adlt Fibrgls$5.00$4.50
    Q4009Cast Spl Short Arm Cast Adlt Plastr$5.00$4.50
    Q4021Cast Spl Shrt Arm Splint Adlt Plast$5.00$4.50
    Q4022Cast Spl Shrt Arm Splnt Adlt F-Glss$40.00$36.00
    Q4024Cast Spl Shrt Arm Splnt Ped Fibrgls$5.00$4.50
    Q4038Cast Spl Shrt Leg Cast Adlt Fibrgls$5.00$4.50
    Q4045Cast Spl Shrt Leg Splint Adlt Plast$5.00$4.50
    Q4046Cast Spl Shrt Leg Splnt Adlt F-Glss$55.00$49.50
    Q4048Cast Spl Shrt Leg Splnt Ped Fibrgls$5.00$4.50
    26600Closed Treatment, Metacarpal Fx, Single; w/o Manip.$885.00$796.50
    25530Closed Treatment, Ulnar Shaft Fx; w/o Manip.$895.00$805.50
    29280Strapping Of Hand Or Finger$145.00$130.50
    29550Strapping Of Toes$105.00$94.50
    28490Treat Big Toe Fracture$360.00$324.00
    23500Treat Clavicle Fracture$830.00$747.00
    24600Treat Elbow Dislocation$910.00$819.00
    24640Treat Elbow Dislocation$345.00$310.50
    26770Treat Finger Dislocation$770.00$693.00
    26720Treat Finger Fracture, Each$635.00$571.50
    26750Treat Finger Fracture, Each$605.00$544.50
    25500Treat Fracture Of Radius$930.00$837.00
    25560Treat Fracture Radius & Ulna$985.00$886.50
    25600Treat Fracture Radius/Ulna$1,005.00$904.50
    23600Treat Humerus Fracture$1,135.00$1,021.50
    24530Treat Humerus Fracture$1,325.00$1,192.50
    27530Treat Knee Fracture$1,450.00$1,305.00
    27520Treat Kneecap Fracture$1,225.00$1,102.50
    26700Treat Knuckle Dislocation$980.00$882.00
    28470Treat Metatarsal Fracture$825.00$742.50
    24650Treat Radius Fracture$845.00$760.50
    23650Treat Shoulder Dislocation$985.00$886.50
    23655Treat Shoulder Dislocation$1,395.00$1,255.50
    27230Treat Thigh Fracture$1,800.00$1,620.00
    26641Treat Thumb Dislocation$1,140.00$1,026.00
    28660Treat Toe Dislocation$370.00$333.00
    24670Treat Ulnar Fracture$920.00$828.00
    25630Treat Wrist Bone Fracture$1,045.00$940.50
    27786Treat Ankle Fracture$1,120.00$1,008.00
    28430Treat Ankle Fracture$940.00$846.00
    28400Treat Heel Fracture$965.00$868.50
    21800Treat Rib Fracture$400.00$360.00
    28510Treat Toe Fracture$335.00$301.50
    28515Treat Toe Fracture$405.00$364.50
  • CPTDescriptionRegularMember
    96361Hydrate Iv Infusion, Add-On$90.00$81.00
    96360Hydration Iv Infusion, Init$105.00$94.50
    J7042Infusion; 5% Dextrose/Normal Saline; 500Cc$5.00$4.50
    J7030Infusion; Normal Saline Solution; 1000Cc$15.00$13.50
    J7050Infusion; Normal Saline Solution; 250Cc$15.00$13.50
    J7040Infusion; Normal Saline Solution; 500Cc$15.00$13.50
    96523Irrig Drug Delivery Device$100.00$90.00
    36000Place Needle In Vein$175.00$157.50
    96370Sc Ther Infusion, Addl Hr$65.00$58.50
    A4217Sterile Water/Saline; 500Ml$10.00$9.00
    96368Ther/Diag Concurrent Inf$95.00$85.50
    96374Ther/Proph/Diag Inj, Iv Push$15.00$13.50
    96372Ther/Proph/Diag Inj, Sc/Im$15.00$13.50
    96366Ther/Proph/Diag Iv Inf Addon$95.00$85.50
    96365Ther/Proph/Diag Iv Inf, Init$150.00$135.00
    96375Tx/Pro/Dx Inj New Drug Addon$10.00$9.00
    96376Tx/Pro/Dx Inj New Drug Adon$95.00$85.50
    96367Tx/Proph/Dg Addl Seq Iv Inf$25.00$22.50
  • CPTDescriptionRegularMember
    95115Allergy Inj. Single$40.00$36.00
    20600Drain/Inject, Joint/Bursa$75.00$67.50
    20605Drain/Inject, Joint/Bursa$95.00$85.50
    20610Drain/Inject, Joint/Bursa$150.00$135.00
    20550Inj Tendon Sheath/Ligament$90.00$81.00
    20552Inject Trigger Point, 1 Or 2$130.00$117.00
    20553Inject Trigger Points, =/> 3$210.00$189.00
    64450Injection, Anesthetic Agent; Other Peripheral Nerve/Branch$310.00$279.00
    64400Injection, Anesthetic Agent; Trigeminal Nerve, Any Div/Brnch$490.00$441.00
    64447N Block Inj Fem, Single$385.00$346.50
    64415N Block Inj, Brachial Plexus$350.00$315.00
    64445N Block Inj, Sciatic, Sng$670.00$603.00
  • CPTDescriptionRegularMember
    82565Assay Of Creatinine$50.00$45.00
    83874Assay Of Myoglobin$145.00$130.50
    84484Assay Of Troponin, Quant$170.00$153.00
    99999Cardiac Enzymes$170.00$153.00
    82553Creatine, Mb Fraction$135.00$121.50
    84439T4 Free, Assay Of Free Thyroxine$145.00$130.50
    84443Tsh, Assay Thyroid Stim Hormone$135.00$121.50
  • CPTDescriptionRegularMember
    J3490Acetaminophen Oral; 160Mg/5Ml$15.00$13.50
    S5001Acetaminophen Oral; 160Mg/5Ml$10.00$9.00
    S5001Acetaminophen Oral; 325Mg$10.00$9.00
    J8499Acetaminophen Oral; 500Mg$10.00$9.00
    S5000Acetaminophen Oral; 500Mg$10.00$9.00
    S5001Acetaminophen Oral; 500Mg$10.00$9.00
    J8499Acetaminophen Suppository; 120Mg$10.00$9.00
    S5001Acetaminophen/Codeine Oral; 120/12/5Ml$10.00$9.00
    J3490Antipyrine/Benzocaine (Auralgan) Otic$5.00$4.50
    J8499Antipyrine/Benzocaine (Auralgan) Otic$10.00$9.00
    S5001Antipyrine/Benzocaine (Auralgan) Otic$10.00$9.00
    J8499Aspirin Oral; 325Mg$10.00$9.00
    S5001Aspirin Oral; 325Mg$10.00$9.00
    J8499Aspirin Oral; 81Mg$10.00$9.00
    S5001Aspirin Oral; 81Mg$10.00$9.00
    S5001Ativan Oral; 1Mg$10.00$9.00
    S5000Ativan Oral; 2Mg$15.00$13.50
    S5001Ativan Oral; 2Mg$10.00$9.00
    J3420B12$15.00$13.50
    J3490Carbamide Peroxide (Debrox)$5.00$4.50
    J8499Carbamide Peroxide Otic$5.00$0.00
    J8499Cephalexin Oral; 500Mg$10.00$9.00
    S5001Cephalexin Oral; 500Mg$10.00$9.00
    J3490Cetirizine Hcl (Zyrtec) Oral; 10Mg$15.00$13.50
    J3490Ciprofloxacin 0.3% Opthalmic$15.00$13.50
    S5001Ciprofloxacin 0.3% Opthalmic$15.00$13.50
    J3490Ciprofloxacin Oral; 500Mg$15.00$13.50
    J8499Ciprofloxacin Oral; 500Mg$10.00$9.00
    S5001Ciprofloxacin Oral; 500Mg$15.00$13.50
    J3490Clindamycin Phosphate; 150Mg$30.00$27.00
    J3490Clonidine Oral; 0.2Mg$15.00$13.50
    J8499Clonidine Oral; 0.2Mg$10.00$9.00
    S5001Clonidine Oral; 0.2Mg$10.00$9.00
    J3490Cortisporin Otic$15.00$13.50
    J3490Cyclopentolate 1% Opthalmic Soln$25.00$22.50
    J8540Dexamethasone Oral; 0.25Mg$15.00$13.50
    S5001Dexamethasone Oral; 0.25Mg$15.00$13.50
    J8499Dicyclomine Oral; 10Mg$10.00$9.00
    S5001Dicyclomine Oral; 10Mg$10.00$9.00
    J3490Diltiazem 5Mg/Ml$15.00$13.50
    S5001Diltiazem Iv; 5Mg/Ml$15.00$13.50
    S5001Diphenhydramine Oral; 25Mg$10.00$9.00
    J3490Diphenoxylate/Atropine Oral; 2.5/0.025Mg$15.00$13.50
    J8499Diphenoxylate/Atropine Oral; 2.5/0.025Mg$10.00$9.00
    S5001Diphenoxylate/Atropine Oral; 2.5/0.025Mg$10.00$9.00
    J3490Erythromycin Ointment 0.5%; Opthalmic$20.00$18.00
    J3490Famotidine 10Mg/Ml$15.00$13.50
    J8499Famotidine Oral; 10Mg/Ml$15.00$13.50
    S5001Famotidine Oral; 10Mg/Ml$15.00$13.50
    J8499Flecainide Oral; 100Mg$10.00$9.00
    S5001Flecainide Oral; 100Mg$10.00$9.00
    S5001Furosemide Oral; 20Mg$10.00$9.00
    J8499Furosemide Oral; 40Mg$10.00$9.00
    S5001Furosemide Oral; 40Mg$10.00$9.00
    S5001Gi Cocktail Oral$10.00$9.00
    J3490Hydrocodone/Apap Oral; 5/325Mg$15.00$13.50
    J8499Hydrocodone/Apap Oral; 5/325Mg$10.00$9.00
    S5001Hydrocodone/Apap Oral; 5/325Mg$10.00$9.00
    J8499Ibuprofen Oral; 100Mg/5Ml$10.00$9.00
    S5000Ibuprofen Oral; 100Mg/5Ml$10.00$9.00
    S5001Ibuprofen Oral; 100Mg/5Ml$10.00$9.00
    S5001Ibuprofen Oral; 200Mg$10.00$9.00
    J3490Ibuprofen Oral; 800Mg$15.00$13.50
    S5001Ibuprofen Oral; 800Mg$10.00$9.00
    J0696Im 5Oomg Rocephin$30.00$27.00
    J0171Injection; Adrenalin, Epinephrine; 0.1Mg$15.00$13.50
    S0020Injection; Bupivicaine; Per 30Ml$15.00$13.50
    J0696Injection; Ceftriaxone Sodium; Per 250Mg$5.00$4.50
    J0744Injection; Ciprofloxacin Iv Infusion; 200 Mg$30.00$27.00
    S0077Injection; Clindamycin Phosphate; 300Mg$40.00$36.00
    J1100Injection; Dexamethasone; 1Mg$30.00$27.00
    J0500Injection; Dicyclomine Hcl; Up To 20Mg$120.00$108.00
    J1200Injection; Diphenhydramine Hcl; Up 50 Mg$15.00$13.50
    J1650Injection; Enoxaparin Sodium; 10Mg$15.00$13.50
    S0028Injection; Famotidine; Per 20Mg$25.00$22.50
    J1940Injection; Furosemide; Up To 20Mg$15.00$13.50
    J1642Injection; Heparin Sodium; 10Un$15.00$13.50
    J1170Injection; Hydromorphone; Up To 4Mg$35.00$31.50
    J1815Injection; Insulin; Per 5U$10.00$9.00
    J1885Injection; Ketorolac Tromethamine; Per 15Mg$15.00$13.50
    J1956Injection; Levofloxacin; 250Mg$30.00$27.00
    J2001Injection; Lidocaine Iv Infusion; 10Mg$15.00$13.50
    J2060Injection; Lorazepam; 2Mg$25.00$22.50
    J1020Injection; Methylprednisolone Acetate; Per 20Mg$15.00$13.50
    J1030Injection; Methylprednisolone Acetate; Per 40Mg$35.00$31.50
    J2930Injection; Methylprednisolone Sodium; Up To 125Mg$30.00$27.00
    J2765Injection; Metoclopramide Hcl; Up To 10Mg$15.00$13.50
    S0030Injection; Metronidazole; 500Mg$15.00$13.50
    J2270Injection; Morphine Sulfate; Up To 10Mg$25.00$22.50
    J2405Injection; Ondansetron Hcl; Per 1Mg$15.00$13.50
    J2360Injection; Orphenadrine Citrate; Up To 60Mg$30.00$27.00
    S0164Injection; Pantoprazole Sodium; 40Mg$30.00$27.00
    J0558Injection; Penicillin G Benz & Procaine; 100000U$180.00$162.00
    J0561Injection; Penicillin G Benz; 100000 Units$100.00$90.00
    J2543Injection; Piperacillin/Tazobactam; 1Gm/0.125Gm$15.00$13.50
    J3480Injection; Potassium Chloride; Per 2Meq$15.00$13.50
    J0780Injection; Prochlorperazine; Up To 10Mg$45.00$40.50
    J3301Injection; Triamcinolone Acetonide; 10Mg$15.00$13.50
    J3370Injection; Vancomycin Hcl; 500Mg$50.00$45.00
    J0170Injection;Adrenline Epinephrine; Up To 1Ml Amp$15.00$13.50
    J3490Labelatol Hcl 5Mg/Ml$15.00$13.50
    S5001Lidocaine Hcl 0.01 w/ Epinephrine$15.00$13.50
    J3490Lisinopril Oral; 20Mg$15.00$13.50
    J8499Lisinopril Oral; 20Mg$10.00$9.00
    J3490Loperamide Oral; 2Mg$15.00$13.50
    S5001Loperamide Oral; 2Mg$10.00$9.00
    J8499Lorazepam Oral; 1Mg$10.00$9.00
    S5001Lorazepam Oral; 1Mg$10.00$9.00
    J8499Lorazepam Oral; 2Mg$10.00$9.00
    S5001Lorazepam Oral; 2Mg$10.00$9.00
    S5001Magnesium Citrate Oral$10.00$9.00
    J3490Marcaine 0.5% 5Mg/Ml$5.00$4.50
    J8499Meclizine Oral; 25Mg$10.00$9.00
    S5001Meclizine Oral; 25Mg$10.00$9.00
    J3490Metoprolol 1Mg/Ml$15.00$13.50
    S5001Metoprolol Oral; 25Mg$15.00$13.50
    J3490Mupirocin 2% Ointment$15.00$13.50
    J8499Mupirocin 2% Ointment$10.00$9.00
    S5001Mupirocin 2% Ointment$10.00$9.00
    S5001Mylanta Oral; 300Ml$10.00$9.00
    J8499Mylanta Oral; 5Ml$10.00$9.00
    J3490Naproxen Oral; 250Mg$15.00$13.50
    S5001Naproxen Oral; 250Mg$5.00$4.50
    J3490Nitroglycerin 2% Ointment$20.00$18.00
    J3490Nitroglycerin Sublingual Spray$15.00$13.50
    J8499Nitro-Stat Sublingual; 0.4Mg$10.00$9.00
    J3490Ofloxacin 0.3% Opthalmic$45.00$40.50
    S5001Omeprazole Dr Oral; 20Mg$10.00$9.00
    J3490Omeprazole Oral; 20Mg$15.00$13.50
    S0119Ondansetron Oral; 4Mg$10.00$9.00
    J8499Phenazopyridine Oral; 200Mg$10.00$9.00
    S5001Phenazopyridine Oral; 200Mg$10.00$9.00
    J2550Phenergan 12.5 Mg$25.00$22.50
    S5001Plavix Oral; 75Mg$10.00$9.00
    J3490Potassium Chloride Oral; 20Meq$15.00$13.50
    S5001Potassium Chloride Oral; 20Meq$10.00$9.00
    S5001Predisone 20Mg 20 Tab; Dispensed Ih$5.00$4.50
    J7510Prednisolone Oral; Per 5Mg$10.00$9.00
    J7512Prednisone, Oral; Per 1Mg$10.00$9.00
    J7506Prednisone; Oral; Per 5Mg$10.00$9.00
    J8499Propafenone Sr Oral; 325Mg$5.00$4.50
    S5001Racepinephrine 0.0225; Inhalation Dose$5.00$4.50
    S5001Ranitidine Po; 150Mg$10.00$9.00
    J3490Silvadene 1% Ointment$5.00$4.50
    J8499Sulfameth/Trimeth Oral; 400/80Mg$10.00$9.00
    S5001Sulfamethoxazole/Trimethoprom Oral; 800/160Mg$10.00$9.00
    J3490Tetracaine 0.5% Opthalmic Soln$15.00$13.50
    S5001Tylenol Oral; 325/5Ml$10.00$9.00
    S5001Tylenol Suppository; 325Mg$10.00$9.00
    J3490Unclassified Drugs$5.00$4.50
    S5001Zithromax Z-Pak 250Mg 6 Tab; Dispensed Ih$5.00$4.50
  • CPTDescriptionRegularMember
    A6203Composite Drsg; <= 16 Sq; w/ Adhesive Border; Ea$5.00$3.75
    A6205Composite Drsg; > 48Sq; w/ Adhesive Border; Ea$55.00$41.25
    A6450Compression Bndg; Light; Width > 5"; Per Yd$15.00$11.25
    A6451Compression Bndg; Mod; Width 3" To 5"; Per Yd$15.00$11.25
    30901Control Of Nosebleed$225.00$168.75
    30903Control Of Nosebleed$475.00$356.25
    11000Debride Infected Skin$75.00$56.25
    11720Debride Nail, 1-5$95.00$71.25
    11042Debride Skin/Tissue$305.00$228.75
    99070Dermabond$100.00$75.00
    17110Destruct Lesion, 1-14$290.00$217.50
    26010Drainage Of Finger Abscess$760.00$570.00
    56420Drainage Of Gland Abscess$325.00$243.75
    41800Drainage Of Gum Lesion$625.00$468.75
    10140Drainage Of Hematoma/Fluid$290.00$217.50
    55100Drainage Of Scrotum Abscess$880.00$660.00
    10060Drainage Of Skin Abscess$165.00$123.75
    10061Drainage Of Skin Abscess$415.00$311.25
    16020Dress Chg Or Debrid$105.00$78.75
    11740Evacuation, Subungual Hematoma$160.00$120.00
    11401Exc Tr-Ext B9 Marg 0.6-1 Cm$255.00$191.25
    46320Excise External Thrombotic Hemorrhoid$420.00$315.00
    11765Excision Of Nail Fold, Toe$265.00$198.75
    A6222Gauz Impreg Not H2O/Hydrgel 16 Sq/<$10.00$7.50
    A6218Gauze Non-Impreg Nonsterl > 48 Sq$5.00$3.75
    A6216Gauze Non-Impreg; Nonsterile; < 16" Sq; Ea$5.00$3.75
    A6402Gauze; Non-Impreg; Sterile <= 16Sq; w/o Adhesive Border$5.00$3.75
    A6404Gauze; Non-Impreg; Sterile > 48Sq; w/o Adhesive Border$5.00$3.75
    A6403Gauze; Non-Impreg; Sterile >16 <=48Sq; w/o Adhesive Border$5.00$3.75
    A4930Gloves Sterile Per Pair$5.00$3.75
    56405I & D Of Vulva/Perineum$605.00$453.75
    46083Incise External Hemorrhoid$410.00$307.50
    46040Incision Of Rectal Abscess$1,485.00$1,113.75
    16000Initial Treatment Of Burn(S)$60.00$45.00
    12001Laceration $100.00$75.00
    12031Layer Closure Of Wound(S)$510.00$382.50
    12032Layer Closure Of Wound(S)$690.00$517.50
    12034Layer Closure Of Wound(S)$775.00$581.25
    12041Layer Closure Of Wound(S)$520.00$390.00
    12042Layer Closure Of Wound(S)$650.00$487.50
    12051Layer Closure Of Wound(S)$565.00$423.75
    12052Layer Closure Of Wound(S)$660.00$495.00
    A6448Lt Compression Bndg; Width < 3"; Per Yd$15.00$11.25
    A6449Lt Compression Bndg; Width 3" To 5"; Per Yd$15.00$11.25
    A6407Packing Strips; Non-Impregnated; Per Yd$5.00$3.75
    A5126Pad; Disk Or Foam; Adhesive Or Non-Adhesive$5.00$3.75
    10160Puncture Drainage Of Lesion$220.00$165.00
    11750Removal Of Nail Bed$500.00$375.00
    11730Removal Of Nail Plate$250.00$187.50
    11200Removal Of Skin Tags$100.00$75.00
    11760Repair Of Nail Bed$600.00$450.00
    13151Repair Of Wound Or Lesion$1,210.00$907.50
    12002Repair Superficial Wound(S)$160.00$120.00
    12004Repair Superficial Wound(S)$570.00$427.50
    12005Repair Superficial Wound(S)$695.00$521.25
    12006Repair Superficial Wound(S)$825.00$618.75
    12011Repair Superficial Wound(S)$165.00$123.75
    12013Repair Superficial Wound(S)$190.00$142.50
    12014Repair Superficial Wound(S)$625.00$468.75
    A6453Self-Adherent Bndg; Width <= 3"; Per Yd$15.00$11.25
    A6454Self-Adherent Bndg; Width >= 3" < 5"; Per Yd$15.00$11.25
    A4550Sterile Tray$35.00$26.25
    99070Sutures; All Thickness/Material$25.00$18.75
    A4209Syringe w/ Needle; Sterile; >= 5 Cc; Ea$5.00$3.75
    A4206Syringe w/Needle Sterile 1 Cc Each$5.00$3.75
    A6260Wound Cleansers Any Type Any Size$10.00$7.50
    G0168Wound Clos Util Tissue Adhes Only$5.00$3.75
  • CPTDescriptionRegularMember
    93990Doppler Flow Testing$185.00$166.50
    93307Echo Exam Of Heart$185.00$166.50
    93306Echo TTE w/ Doppler, Complete$300.00$270.00
    93880Extracranial Study$305.00$274.50
    93882Extracranial Study, Followup$305.00$274.50
    93925Extremity Study, Lower Art/Bypass, Bilat$485.00$436.50
    93926Extremity Study, Lower Art/Bypass, Unilat$305.00$274.50
    93930Extremity Study, Upper Art/Bypass, Bilat$485.00$436.50
    93931Extremity Study, Upper Art/Bypass, Unilat$305.00$274.50
    93922Extremity Study, Upper Or Lower Art, Bilat$185.00$166.50
    93970Extremity Study, Upper/Lower Veins, Bilat$485.00$436.50
    93971Extremity Study, Upper/Lower Veins, Unilat$305.00$274.50
    76819Fetal Biophys Profil w/o Nst$185.00$166.50
    76802Ob US < 14 Wks, Addl Fetus$305.00$274.50
    76801Ob US < 14 Wks, Single Fetus$305.00$274.50
    76810Ob US >/= 14 Wks, Addl Fetus$305.00$274.50
    76805OB US >/= 14 Wks, Sngl Fetus$305.00$274.50
    76812OB US Detailed, Addl Fetus$305.00$274.50
    76811OB US Detailed, Sngl Fetus$305.00$274.50
    76816OB US Follow-Up, Per Fetus$305.00$274.50
    76815OB US Limited, Fetu(s)$305.00$274.50
    76830Transvaginal Us, Non-Ob$185.00$166.50
    76817Transvaginal Us, Obstetric$185.00$166.50
    76820Umbilical Artery Echo$185.00$166.50
    76536US Exam Of Head And Neck$185.00$166.50
    76700US Exam, Abdomen, Complete$305.00$274.50
    76705US Exam, Abdomen, Limited$185.00$166.50
    76642US Exam, Breast; Limited$355.00$319.50
    76604US Exam, Chest, B-Scan$185.00$166.50
    76881US Exam, Extremity, Non-Vascular, Complete$305.00$274.50
    76882US Exam, Extremity, Non-Vascular, Limited$185.00$166.50
    76856US Exam, Pelvic, Complete$305.00$274.50
    76857US Exam, Pelvic, Limited$185.00$166.50
    76770US Exam, Renal/Aorta/Nodes, Complete$305.00$274.50
    76775US Exam, Renal/Aorta/Nodes, Limited$185.00$166.50
    76870US Exam, Scrotum$185.00$166.50
    76641US Exam Breast; Complete$185.00$166.50
    93978Vascular Study, Aorta/Vc/Iv/Bypass, Complete$305.00$274.50
    93979Vascular Study, Aorta/Vc/Iv/Bypass, Limited$185.00$166.50
    93975Vascular Study, Art/Ven Flow, Abd Org, Complete$485.00$436.50
    93976Vascular Study, Art/Ven Flow, Abd Org, Limited$305.00$274.50
  • CPTDescriptionRegularMember
    90471Immunization Admin$55.00$49.50
    90715TDAP Vaccine >= 7Yrs Im$100.00$90.00
    90703Tetanus Vaccine, Im$70.00$63.00
  • CPTDescriptionRegularMember
    74018X-Ray Exam Abdomen 1 View$135.00$121.50
    74019X-Ray Exam Abdomen 2 Views$170.00$153.00
    74021X-Ray Exam Abdomen 3+ Views$195.00$175.50
    73600X-Ray Exam Ankle$120.00$108.00
    73610X-Ray Exam Ankle$150.00$135.00
    77072X-Ray Exam Bone Age Study$115.00$103.50
    71120X-Ray Exam Breastbone$150.00$135.00
    71045X-Ray Exam Chest 1 View$75.00$67.50
    71046X-Ray Exam Chest 2 Views$90.00$81.00
    71047X-Ray Exam Chest 3 Views$145.00$130.50
    71048X-Ray Exam Chest 4+ Views$180.00$162.00
    71020X-Ray Exam Chest; 2 View$90.00$81.00
    73000X-Ray Exam Collar Bone$140.00$126.00
    73070X-Ray Exam Elbow$125.00$112.50
    73080X-Ray Exam Elbow$165.00$148.50
    70200X-Ray Exam Eye Sockets$205.00$184.50
    70140X-Ray Exam Facial Bones$145.00$130.50
    70150X-Ray Exam Facial Bones$205.00$184.50
    73551X-Ray Exam Femur 1$135.00$121.50
    73552X-Ray Exam Femur, 2+ Views$160.00$144.00
    73140X-Ray Exam Finger(S)$120.00$108.00
    73620X-Ray Exam Foot$115.00$103.50
    73630X-Ray Exam Foot$135.00$121.50
    73090X-Ray Exam Forearm$125.00$112.50
    73120X-Ray Exam Hand$120.00$108.00
    73130X-Ray Exam Hand$145.00$130.50
    73650X-Ray Exam Heel$125.00$112.50
    73500X-Ray Exam Hip$135.00$121.50
    73510X-Ray Exam Hip$165.00$148.50
    73501X-Ray Exam Hip Uni 1 View$130.00$117.00
    73502X-Ray Exam Hip Uni 2-3 Views$185.00$166.50
    73503X-Ray Exam Hip Uni 4/> Views$230.00$207.00
    73520X-Ray Exam Hips$220.00$198.00
    73521X-Ray Exam Hips Bi 2 Views$195.00$175.50
    73522X-Ray Exam Hips Bi 3-4 Views$240.00$216.00
    73523X-Ray Exam Hips Bi 5/> Views$285.00$256.50
    73060X-Ray Exam Humerus$145.00$130.50
    70100X-Ray Exam Jaw$175.00$157.50
    70110X-Ray Exam Jaw$205.00$184.50
    70330X-Ray Exam Jaw Joints$240.00$216.00
    73560X-Ray Exam Knee, 1 Or 2$135.00$121.50
    73562X-Ray Exam Knee, 3$170.00$153.00
    73565X-Ray Exam Knees$160.00$144.00
    73590X-Ray Exam Lower Leg$140.00$126.00
    72100X-Ray Exam Lower Spine; 2 Or 3 Views$180.00$162.00
    72110X-Ray Exam Lower Spine; 4+ Views$255.00$229.50
    72114X-Ray Exam Lower Spine; Complete w/ Bending$370.00$333.00
    70160X-Ray Exam Nasal Bones$145.00$130.50
    70360X-Ray Exam Neck$130.00$117.00
    72040X-Ray Exam Neck Spine$170.00$153.00
    72050X-Ray Exam Neck Spine$240.00$216.00
    72052X-Ray Exam Neck Spine$295.00$265.50
    72170X-Ray Exam Pelvis$160.00$144.00
    72190X-Ray Exam Pelvis$220.00$198.00
    71100X-Ray Exam Ribs$165.00$148.50
    71110X-Ray Exam Ribs$215.00$193.50
    71111X-Ray Exam Ribs/ Chest$245.00$220.50
    71101X-Ray Exam Ribs/Chest$200.00$180.00
    74022X-Ray Exam Series, Abdomen$245.00$220.50
    73020X-Ray Exam Shoulder$125.00$112.50
    73030X-Ray Exam Shoulder$170.00$153.00
    73010X-Ray Exam Shoulder Blade$140.00$126.00
    73050X-Ray Exam Shoulders$180.00$162.00
    70210X-Ray Exam Sinuses$140.00$126.00
    70220X-Ray Exam Sinuses$195.00$175.50
    70250X-Ray Exam Skull$170.00$153.00
    72220X-Ray Exam Tailbone$150.00$135.00
    73550X-Ray Exam Thigh$150.00$135.00
    72070X-Ray Exam Thoracic Spine$175.00$157.50
    72072X-Ray Exam Thoracic Spine$190.00$171.00
    72074X-Ray Exam Thoracic Spine$235.00$211.50
    73660X-Ray Exam Toe(S)$115.00$103.50
    73100X-Ray Exam Wrist$125.00$112.50
    73110X-Ray Exam Wrist$150.00$135.00
    73564X-Ray Exam Knee, 4 Or More$205.00$184.50
    74241X-Ray Exam Upper GI Tract$430.00$387.00