​​Monday - Friday 8:30 am to 5:30 pm

Wednesday 7:00 am - 5:30 pm​

​Challis Area Health Center

Make an appointment today!

​(208) 879-4351​

After Hours Care Line - (208) 879-1111

​Monday - Friday 8:30 am to 5:30 pm

Wednesday 7:00 am - 5:30 pm​​


Challis Area Health Center Fee Schedule Effective 10/1/2019
 CPTDescription Fee GroupRevenue Code

10060           

Inc & Drain Abcess Simple

 $213.00

Procedures521
10061 I&D Abscess Complicated/Multipl $ 375.00 Procedures521
10120Incision & Removal Fb Skin Simple $ 276.00 Procedures521
10140Inc & Drain Hematoma Simple $ 300.00 Procedures521
10160Puncture Aspiration Abscess Etc $ 266.00 Procedures521
11042Debridement, sub tiss; 20 sq cm/< $ 248.00 Procedures521
11055Paring/Cutting Benign Lesion; single $   85.00 Procedures521
11102Tangential biopsy skin (shave, scoop, saucerize, curette); single $ 195.00 Procedures521
11103Tangential biopsy skin; ea sep/add lesion $ 106.00 Procedures521
11104Punch biopsy skin; single $ 182.00 Procedures521
11105Punch biopsy skin; ea sep/add lesion $   95.00 Procedures521
11106Incisional biopsy skin (wedge); single $ 331.30 Procedures521
11107Incisional biopsy skin; ea sep/add lesion $ 180.83 Procedures521
11200Rem Skin/Multi Fibro Tags to 15 $ 155.00 Procedures521
11300Shave Dermal Les Trunk Ext to 0.5cm $ 126.00 Procedures521
11301Shave Dermal Les Trunk Ext 0.6-1.0 $ 173.00 Procedures521
11305Shave Dermal Les Scald Etc to 0.5cm $ 127.00 Procedures521
11306Shave Dermal Les Scald Etc 0.6-1.0 $ 207.00 Procedures521
11310Shave Dermal Les Face/Ear to 0.5cm $ 192.00 Procedures521
11311Shave Dermal Les Face/Ear 0.6-1.0cm $ 187.00 Procedures521
11400Exc Benign Les Trnk/Arm/Leg to 0.5cm $  211.00 Procedures521
11402Exc Benign Les Trnk/Arm/Leg 1.1-2.0 $  289.00 Procedures521
11403Exc Ben Les Trunk Limbs 2-3cm $  325.00 Procedures521
11420Exc Benign Les Sclp/Hnd/Ft to 0.5cm $  210.00 Procedures521
11421Ex Ben Les Scalp/Hand etc 0.5-1cm $  275.00 Procedures521
11422Exc Benign Les Sclp/Hnd/Ft 1.1-2.0 $  303.00 Procedures521
11441Exc Ben Les Face Adnexa 0.5-1cm $  298.00 Procedures521
11602Exc Malig Les Trnk/Arm/Leg 1.1-2.0 $  418.00 Procedures521
11603Exc Malig Les Trnk/Arm/Leg 2.1-3.0cm $  477.00 Procedures521
11621Ex Mal Les Scalp/Hand etc 0.5-1cm $  396.17 Procedures521
11622Exc Malig Les Sclp/Hnd/Ft 1.1-2.0cm $  440.00 Procedures521
11719Trimming Of Nails, any number $    35.89 Procedures521
11720Debridement of Nail(s); One to Five $    65.00 Procedures521
11730Avul Nail Plate Part/Comp Single $  185.15 Procedures521
11765Wedge Exc Skin Nail Fold (Ingrown) $  279.00 Procedures521
11981Insertion, Non-Biodegradable Drug Delivery Implant $  273.00 Procedures521
11982Removal, Non-Biodegradable Drug Delivery Implant $  300.00 Procedures521
12001Simp Rpr Sclp Trnk etc to 2.5cm $  246.00 Procedures521
12002Rep Simple Scalp etc 2.5-7.5cm $  263.00 Procedures521
12004Simp Rpr Sclp Trnk etc 7.6-12.5cm $  300.00 Procedures521
12005Rep Simple Scalp etc 12.5-20.0cm $  583.91 Procedures521
12011Simp Rpr Face Ear etc to 2.5cm $  289.00 Procedures521
12031Repair Intermediate Slp/Axll/Trnk/Ext 2.5cm/< $  540.00 Procedures521
12032Int Rpr Sclp Trnk Extrm 2.6-7.5cm $  518.00 Procedures521
12035Int Rpr Sclp Trnk Extrm 12.6-20.0cm $  836.52 Procedures521
12041Repair Intermediate Neck/Hands/Feet/Ext Gen 2.5cm/< $  420.00 Procedures521
12042Int Rpr Neck Hnd Ft 2.6-7.5cm $  495.00 Procedures521
12051Repair Intermediate Face/Ears/Eyelids/Nose/Lips/etc 2.5cm/< $  497.47 Procedures521
12052Int Rpr Face Nose Lip 2.6-5.0cm $  511.00 Procedures521
16000Init Treat 1st Degree Burn Local $  149.08 Procedures521
16020Dressings and/or debridement of partial-thickness burns, small (less than 5%) $  148.84 Procedures521
16030Large (whole face or extrm, or 5 to 10%) $  543.88 Procedures521
17000Dest Any Methd Benign/Premal Les/First les $  138.00 Procedures521
17003Dest All Benign/Premal Les (Keratoses); 2-14, ea $    22.17 Procedures521
17004Dest Premal Les (Esctinic Deratoses); 15 or more $  341.00 Procedures521
17110Dest Benign Les; up to 14 $  199.00 Procedures521
20103Exploration of Extremity $1,457.84 Procedures521
20550Inj Tendon Sheath Lig Trigger Pnt Gangli $   140.00 Procedures521
20552Injection; Single or Multiple Trigger Point(s); 1 or 2 muscl grps $   120.00 Procedures521
20553Injection; Single or Multiple Trigger Point(s); 3 or more muscl grps $   173.40 Procedures521
20605Arthrocentesis Asp Inj Intermed Joint Bu $   153.00 Procedures521
20610Arthrocentesis Aspir/Inject Major $   205.00 Procedures521
21931Excision, Tumor, Soft Tissue of Back or Flank, Sub; 3cm/> $1,239.81 Procedures521
23330Removal of Foreign Body, Shoulder; Subcu $   492.83 Procedures521
23650Red Disloc-Shoulder $   788.26 Procedures521
27372Removal Fb Knee Deep $1,737.79 Procedures521
29065Apply Cast; Shoulder to Hand (Long Arm) $   194.00 Procedures521
29075Cast Short Arm $   221.00 Procedures521
29125Apply Short Arm Splint (Forearm to Hand) $   163.00 Procedures521
29405Cast Short Leg $   229.00 Procedures521
29580Strapping Unna Boot $   105.00 Procedures521
29581Application of Multi-Layer Venous Wound Compression System, Below Knee) $   100.00 Procedures521
30100Biopsy, Intranasal $   272.22 Procedures521
30300Remov FB Intranasal $   379.30 Procedures521
30901Cntrl Nasal Hemor; Anter; Smple $   272.00 Procedures521
30903Contrl Nasal Hemor; Anter; Cmplx $   538.00 Procedures521
30905Cntrl Nasal Hemor; Post; Init $   367.00 Procedures521
30906Control Hemorr Nasal Post Subseq $   596.04 Procedures521
31500Integral Intubation $    971.00 Procedures521
36000Intro Needle/Cath Vein Unilat $      60.00 Procedures260
36415Collection Venous Blood Venipuncture $      13.00  Lab300
36416Collection Blood Capillary  $      10.00  Lab300
36591Collection Blood from Implant Venous Access Device $      56.20  Lab300
40800Drain Lesion Oral Vestibule $    336.72  Procedures521
51701Insertion of Non-Indwelling Bladder Catheter (Straight Cath) $    140.00 Procedures521
51702Insertion of Temporary Indwelling Bladder Catheter; Simple (Foley) $    214.16 Procedures521
51705Change Cystostomy Tube Simple $    259.31 Procedures521
58301Removal Intrauterine Device $    235.00 Procedures521
59425Antepartum Care Only; 4-6 Visits $    895.00 Procedures521
59426antepartum Care Only; 7 or more Visits $ 1,594.00 Procedures521
59430Postpartum Care $    306.00 Procedures521
64450Injec, Anes; oth Peripher Nerv/Branch $    265.00 Procedures521
65220Remove FB; External Eye; Corneal, w/o Sli $    184.49 Procedures521
65222Rem FB Corneal w/ Slit Lamp $    148.00 Procedures521
67938Removal FB Eyelid Embedded $    367.68 Procedures521
69200Remv FB From Ext Aud Canal; w/o Anes $    210.00 Procedures521
69209Removal impacted cerumen using irrigation/lavage; unilateral $      34.12 Procedures521
69210Removal Impacted Cerumen, 1-2 Ears $    116.66 Procedures479
70140Radiologic Exam Facial Bones; less than 3 views $    100.79  Imaging329
70150Radiologic Exam Facial Bones; Cmplt; min 3 views $    121.43  Imaging329
70250Radiologic Exam Skull; less than 4 views $      95.93  Imaging329
71045Radiologic Exam Chest; 1 view $      38.18  Imaging324
71046Radiologic Exam Chest; 2 views $      75.00  Imaging324
71100Radiologic Exam Ribs, Unilateral; 2 views $      88.00  Imaging329
71110Radiologic Exam Ribs, Bilateral; 3 views $    114.14  Imaging329
72020Radiologic Exam Spine, Specify Level; 1 view $      50.00  Imaging329
72040Radiologic Exam Spine, Cervical; 3 views or Less $    103.00  Imaging329
72050Radiologic Exam Spine, Cervical; 4 or 5 views $    139.00  Imaging320
72052Radiologic Exam Spine, Cervical; 6 or more views $    200.00  Imaging329
72070Radiologic Exam Spine, Thoracic; 2 views $       80.00  Imaging329
72082Radiologic Eam Spine, Entire Thoracic and Lumbar (Scoliosis Eval); 2 or 3 views $     168.00  Imaging329
72100Radiologic Exam Spine, Lumbosacral; 2 or 3 views $     100.10  Imaging329
72110Radiologic Exam Spine, Lumbosacral; min of 4 views $     141.00  Imaging320
72114Radiologic Exam Spine, Lumbosacral, Complete; min of 6 views $     181.00  Imaging329
72170Radiologic Exam, Pelvis; 1 or 2 views $       84.00  Imaging329
73000Radiologic Exam, Clavicle; Complete $       74.00  Imaging329
73020Radiologic Exam, Shoulder; 1 view $       71.64  Imaging329
73030Radiologic Exam, Shoulder, Complete; min of 2 views $       85.00  Imaging329
73060Radiologic Exam, Humerus; min or 2 views $       75.00  Imaging329
73070Radiologic Exam, Elbow; 2 views $       72.00  Imaging329
73080Radiologic Exam, Elbow, Complete; min of 3 views $       87.00  Imaging329
73090Radiologic Exam, Forearm; 2 views $       80.00  Imaging329
73100Radiologic Exam, Wrist; 2 views $       80.00  Imaging329
73110Radiologic Exam, Wrist, Complete; min of 3 views $       96.00  Imaging329
73120Radiologic Exam, Hand; 2 views

 $       70.00

 Imaging329
73130Radiologic Exam, Hand; min of 3 views $       92.00  Imaging329
73140Radiologic Exam, Finger(s); min of 2 views $       82.00  Imaging329
73501Radiologic Exam, Hip, Unilateral, with Pelvis; 1 view $       97.14  Imaging329
73502Radiologic Exam, Hip, Unilateral, with Pelvis; 2-3 views $     105.00  Imaging329
73503Radiologic Exam, Hip, Unilateral, with Pelvis; min of 4 views $     168.79  Imaging329
73521Radiologic Exam, Hips, Bilateral, with Pelvis; 2 views $       97.00  Imaging329
73522Radiologic Exam, Hips, Bilateral, with Pelvis; 3-4 views $     115.00  Imaging329
73523Radiologic Exam, Hips, Bilateral, with Pelvis; min of 5 views $     185.79  Imaging329
73551Radiologic Exam, Femur; 1 view $       91.07  Imaging329
73552Radiologic Exam, Femur; min 2 views $       90.00  Imaging329
73560Radiologic Exam, Knee; Anter & Lat view $       90.00  Imaging329
73562Radiological Exam, Knee, Ap & Lat, Obliq; min 3 $     101.00  Imaging329
73590Radiological Exam, Tibia & Fibula; 2 views $       90.00  Imaging329
73600Radiologic Exam, Ankle; 2 views $     105.00  Imaging329
73610Radiologic Exam, Ankle, Complete; min of 3 views $       97.00  Imaging329
73620Radiologic Exam, Foot; 2 views $     129.00  Imaging329
73630Radiologic Exam, Foot, Complete; min or 3 views $       80.00  Imaging329
73650Radiologic Exam, Calcaneus; min of 2 views $       76.00  Imaging329
73660Radiologic Exam, Toe(s); min of 2 views $       73.00  Imaging324
74018Radiologic Exam, Abdomen; 1 view $       66.00  Imaging329
74019Radiologic Exam, Abdomen; 2 views $       75.57  Imaging329
74021Radiologic Exam, Abdomen; 3 or more views $     143.29  Imaging329
80048Basic Metabolic Panel (Calcium, Total) $       48.00  Lab300
80050General Health Panel   $     118.00  Lab300
80053Comprehensive Metabolic Panel $       53.00  Lab300
80061Lipid Panel $       57.00  Lab300
80069Renal Function Panel $       51.00  Lab300
80074Acute Hepatitis Panel $     135.00  Lab300
80076Hepatic Function Panel   $       23.00  Lab300
80081Obstetric Panel (includes HIV Testing) $     150.00  Lab300
80156Carbamazepine; Total $       74.00  Lab300
80162Digoxin $       61.00  Lab300
80164Dipropylacetic Acid (Valproic Acid) $       60.00  Lab300
80165Valproic Acid; Free $       63.00  Lab300
80175Lamotrigine   $       78.00  Lab300
80178Lithium $       48.00  Lab300
80185Phenytoin; Total $       67.00  Lab300
80197Tacrolimus $       50.00  Lab300
80299Quantitation Drug Not Elsewh Specif $       50.00  Lab300
80305Drug Test(s), Prsmptv, Any Number; Direct Optical Obsrvtion $       58.00  Lab300
80307Drug Test(s), Prsmptv, Any Number; Instrmnt Analyzers $     137.00  Lab300
80323Drug Testing, Alkaloids, Not Otherwise Specified $       96.00  Lab300
80329Drug Testing, Analgesics, Non-Opioid; 1 or 2 $       76.00  Lab300
80361Drug Testing, Opiates; 1 or more $     123.00  Lab300
80365Drug Testing, Oxycodone $       70.00  Lab300
81001Urinalysis, Automated, with Microscopy $       17.00  Lab300
81002Urinalysis, w/o Microscopy $       15.00  Lab300
81025Urine Pregnancy Test $       24.00  Lab300
81162BRCA1, BRCA2, Gene Analysis; Full Seq & Full Dup $  4,506.00  Lab300
81240F2 Gene Analysis, 20210G>A Variant $     140.00  Lab300
81241F5 Gene Analysis, Leiden Variant $     156.00  Lab300
81256HFE Gene Analysis, Comm Variants $     373.00  Lab300
81270JAK2 Gene Analysis, P.Val617PHE Variant $     348.00  Lab300
82024Adrenocorticotropic Hormone ACTH $     157.00  Lab300
82040Albumin; Serum, Plasma, or Whole Blood $       23.00  Lab300
82043Albumin Urine Microalbumin Quan $       46.00  Lab300
82075Alcohol (Ethanol), Breath $       40.00  Lab300
82105Alpha-Fetoprotein Serum $       48.00  Lab300
82107AFP; AFP-L3 Fraction Isoform & Total AFP (including Ratio) $     192.00  Lab300
82140Ammonia  $       60.00  Lab300
82150Amylase, Serum $       35.00  Lab300
82172Apoliprprotein, Immunoassay $       35.00  Lab300
82175Arsenic, Blood, Urine, Gastric Cont, Hair/Na $       91.00  Lab300
82247Bilirubin Total $       16.00  Lab300
82248Bilirubin Direct $       28.00  Lab300
82270Blood Occult; Feces, Consec. Coll, Spec w/Sngl Det $       20.00  Lab300
82274Blood Occult; Fecal Hemoglobin Det by Immunoassay, Qual; 1-3 Sim Det $       32.00  Lab300
82306Vitamin D-3 (25-Dihydroxy) $       85.00  Lab300
82310Calcium Total $       22.00  Lab300
82340Calcui (Urinary Stones) Analysis $       35.00  Lab300
82365Calculus (Stone), Quant; Infra. Spectr $       28.00  Lab307
82374Carbon Dioxide, Combining Poweror Conten $       26.00  Lab300
82397Chemiluminescent Assay $       65.00  Lab300
82523Collagen Cross Links, Any Method $     107.00  Lab300
82533Cortisol Total $       50.00  Lab300
82542Col-Chrom/Mass Spect Analyte NES Quant 1 Stat & Mobile Phase $     125.00  Lab300
82550CPK, Blood; Timed Kinetic Ultraviolet Meth $       35.00  Lab300
82553Creatine Kinase (Ck/Cpk) Mb Fract $       30.00  Lab300
82565Creatinine; Blood $       29.00  Lab300
82570Creatinine; Urine $       24.00  Lab300
82607Cyanocobalamin (Vitamin B-12) $       65.00  Lab300
82627Dehydroepiandrosterone-Sulfate $       54.00  Lab300
82652Dihydroxyvitamin D, 1, 25 $     100.00  Lab300
82670Estradiol, Ria (Placental) $       90.00  Lab300
82672Estrogens; Total $       57.00  Lab300
82728Ferritin, Specify Method $       56.00  Lab300
82746Folic Acid Serum $       33.00  Lab300
82784Gammaglobulin/Immunoglobulin, A, D, G, M Nephelometric, Ea $       65.00  Lab300
82785Gammaglobulin Ige $       35.00  Lab300
82947Glucose; Quantitative, Blood (Except Reagent Strip) $       18.00  Lab300
82948Glucose; Blood, Stick Test $       15.00  Lab300
82950Glucose; Post Glucose Dose $       16.00  Lab300
82951Glucose; Tolerance (GTT); 3 Specimens $       37.00  Lab300
82962Glucose Blood - Device for Home Use $       13.20  Lab300
82977Glutamyl Transpeptidase, Gamma (GGT) $       13.00  Lab300
83001Gonadotropin Follicle Stim Hormone $       80.00  Lab300
83002Gonadotropin, Pituitary, Luteinizing Hormo $       76.00  Lab300
83010Haptoglobin; Chemical $       70.00  Lab300
83013Helicobacter Pylori; Breath Analysis $     216.00  Lab309
83036Hemoglobin Glycosylated (A1C) $       41.00  Lab300
83090Homocystine $       66.00  Lab300
83516Immunoassay F Analyte Otr Thn Antibdy/Nfcts Agent Antign/ Mult Step $       55.00  Lab300
83519Immunoassay Analyt Radionuclid Tech $     103.00  Lab300
83520Immunoassay Analyte Nes $       65.00  Lab300
83525Insulin $       23.00  Lab300
83540Iron, Serum; Chemical $       28.00  Lab300
83550Iron Binding Capacity $       40.00  Lab300
83615Lactate Dehydrogenase (LD, LDH) $       24.00  Lab300
83655Lead, Quant; Blood $       30.00  Lab300
83690Lipase, Blood $       45.00  Lab300
83704Lipoprotein, Blood; Quanit, includes Lipoprotein Particle Subclass(es) $       68.00  Lab300
83721Lipoprotein Direct Meas Ldl Choles $       47.00  Lab300
83735Magnesium $       25.00  Lab300
83789Mass Spectrometry & Tandem Mass Spectrometry Analyte NES Quant, ea spec $       49.00  Lab300
83825Mercury Quantitative $       97.00  Lab300
83874Myoglobin, Electrophoresis $       59.00  Lab300
83880Natriuretic Peptide $     100.00  Lab300
83883Nephelometry Ea Analyte Nes $       83.00  Lab300
83921Organic Acid, Single, Quantitative $     110.00  Lab300
83970Parathormone (Parathyroid Hormone), Ria $     115.00  Lab300
84075Phosphatase Alkaline $       15.00  Lab300
84100Phosphorus (Po4) $       20.00  Lab300
84132Potassium; Blood $       18.00  Lab300
84134Prealbumin $       61.00  Lab300
84144Progesterone   $       75.00  Lab300
84146Prolactin (Mammotropin), Ria $       80.00  Lab300
84152Prostate Specific Antigen (PSA); Complexed (Direct Measurement) $       62.00  Lab300
84153Prostate Specific Antigen (PSA); Total $       66.00  Lab300
84154Prostate Specific Antigen (PSA); Free $       40.00  Lab300
84156Protein, Total, Except by Refractometry; Urine $       10.00  Lab300
84207Pyridoxine (Vitamin B-6) $       44.00  Lab300
84270Sex Hormone Binding Globulin (SHBG) $     100.00  Lab300
84300Sodium, Urine $       19.00  Lab300
84305Somatomedin $     115.00  Lab300
84402Testosterone; Free $       45.00  Lab300
84403Testosterone; Total $       78.00  Lab300
84425Thiamine (Vitamin B-1) $     100.00  Lab300
84432Thyroglobulin   $       95.00  Lab300
84436Thyroxine; Total $       24.00  Lab300
84439Thyroxine; Free $       55.00  Lab300
84443Thyroid Stimulating Hormone (TSH) $       55.00  Lab300
84445Thyroid Stimulating Immunoglobins $     240.00  Lab300
84450Transferase Aspartate Amino (AST) $       13.00  Lab300
84460Transferase Alanine Amino (ALT) $       12.00  Lab300
84466Transferrin $       30.00  Lab300
84479Tridothronine (T-3) Resin Uptake $       30.00  Lab300
84480Triiodothyronine True (TT-3), Ria $       41.00  Lab300
84481Tridothyronine (T-3) Free $       55.00  Lab300
84482Tridothyronine (T-3) Reverse $       45.00  Lab300
84484Troponin  $       60.00  Lab300
84520Urea Nitrogen Quant $       20.00  Lab300
84550Uric Acid; Blood; Chemical $       25.00  Lab300
84681C-Peptide, Any Method $       96.00  Lab300
84702Gonadotropin, Chorionic; Quant $       50.00  Lab300
84703Gonadotropin, Chorionic; Qual $       20.00  Lab300
85013Microhematrocrit; Blood Ct Spun $       12.00  Lab300
85014Hematocrit; Blood Ct Other Than Spun $         8.00  Lab300
85018Hemoglobin $       10.00  Lab300
85025Bld Cnt; Hemo/Plt, Auto, Cmplt Dif. WBC $       30.00  Lab300
85045Blood Count; Reticulocyte Count, Flow Cy $       27.00  Lab300
85048Blood Count; White Blood Cell (WBC) $         7.00  Lab300
85049Blood Count; Platelet; Automated $       22.00  Lab300
85060Blood Smear, Peripheral, Interpret by Dr $       46.00  Lab300
85300Clot Inhibit/Anticoag Antithrom III $       93.00  Lab300
85301Clotting Inhib/Anticoag; Antithrombin III $       79.00  Lab300
85303Clot Inhib/Anticoag Protein C Activ $     132.00  Lab300
85306Clot Inhib/Anticoag Protein S Free $     114.00  Lab300
85597Phospholipid Neutralization; Platelet $       81.00  Lab300
85610Prothrombin Time $       23.00  Lab300
85613Russell Viper Venom Time Diluted $       60.00  Lab300
85651Sed Rate Erythroyte Non-Automated $       22.00  Lab300
85730Thromboplast Time, Part (PTT) Plasma/Whol $       37.00  Lab300
86001Allergen Spec IGG Quant/Semi-Quant, ea Allergen $         8.00  Lab300
86003Allergen Spec IGE ea Panel $       30.00  Lab300
86021Antibodies ID; Leukocyte Antibodies $       99.00  Lab300
86038Antinuclear Antibodies (ANA) $       35.00  Lab300
86039Antinuclear Antibodies (ANA) Titer $       15.00  Lab300
86140C-Reactive Protein $       33.00  Lab300
86146Beta 2 Glycoprotein I Antibody, ea $       50.00  Lab300
86147Cardiolipin (Phospholipid) Antibody, ea IG Class $       55.00  Lab300
86148Anti-Phosphatidylserine (Phospholipid) Antibody $       50.00  Lab300
86200Cyclic Citrullinated Peptide (CCP), Antibody $        96.00  Lab300
86225Deoxyribonucleic Acid Antib Dbl Str $       66.00  Lab300
86235Extractable Nuclear Antig/Antib Ea $       68.60  Lab300
86300Heterophile Antbdy; scrn, slide/tube $       93.00  Lab300
86301Immunoassay Tumor Antigen Quant; CA 19-9 $     100.00  Lab300
86304Immunoassay Tumor Antigen Quant; CA 125 $       91.00  Lab300
86308Heterophile Antibodies Screening $       21.00  Lab300
86316Immunoassay Tumor Antigen; Other Antigen, Quant (eg, CA 50, 72-4, 549), ea $     117.00  Lab300
86317Immunoassay Infec. Agent Antib/Anti $       30.00  Lab300
86318Immunoassay Infec. Agent Antib Qual $       78.00  Lab300
86334Immunofixation Electrophoresis $      111.00  Lab300
86337Insulin Antibodies, Ria $     137.00  Lab300
86341Islet Cell Antibody $       75.00  Lab300
86376Microsomal Antibody (Thyroid); Ria $       85.00  Lab300
86431Rheumatoid Factor Quant $       36.00  Lab300
86580Skin Test; Tuberculosis, Intradermal $       25.00  Lab636
86592Non-Treponemal Syphilis Test; Qual $       25.00  Lab300
86606Antibody Aspirgillus $       52.00  Lab300
86609Antibody Bacterium Nes $       28.00  Lab300
86644Antibody Cytomegalovirus (CMV) $     107.00  Lab300
86663Antibody Epstein-Barr Virus Early $       30.00  Lab300
86664Antibody Epstein-Barr Virus Nuclear $       95.00  Lab300
86665Antibody Epstein-Barr Virus Capsid $       90.00  Lab300
86677Antibody Helicobacter Pylori $       53.00  Lab300
86703Antibody HIV-1 & HIV-2 Singl Result $       45.00  Lab300
86704Hepatitis B Core Antibody (HBcAB), Total $       30.00  Lab300
86706Hepatitis B Surface Antibody (HBsAB) $       48.00  Lab300
86708Hepatitis A Antibody (HAAB), Total $       40.00  Lab300
86735Antibody Mumps $       47.00  Lab300
86762Antibody Rubella $       52.00  Lab300
86765Antibody Rubeola $       61.10  Lab300
86800Thyroglobulin Antibody $       80.00  Lab300
86803Hepatitis C Antibody $       32.00  Lab300
86850Antibody Screen RBC ea Serum Techni $       37.00  Lab300
86900Blood Typing Abo $       32.00  Lab300
86901Blood Typing Rh (D) $       38.00  Lab300
87045Cul, Stool, w/ Iso & Pre Exam, Salmonella & Shigella Spec $       75.00  Lab300
87046Cul, Bact; Stool, add Pathogens, ea Plate $       40.00  Lab300
87070Cul, any other source excpt Urine, Blood, or Stool w/ Iso & Pre ID of Isolates $       60.00  Lab300
87075Cul, any source, Anaerobic w/ Iso & Pre ID of Isolates $       59.00  Lab300
87077Cul, Bact; Aerobic Isolate, add methods, ea Isolate $       66.00  Lab300
87081Cul, Presumptive, Pathogenic Organisms, Screening Only $       14.25  Lab300
87086Cul, Bact; Quant Colony Count, Urine $       45.00  Lab300
87088Cul, Bact; w/ Iso & Pre ID, ea Isolate, Urine $       35.00  Lab300
87101Cul, Fungi (Mold/Yeast); Iso w/ Pre ID; Skin, Hair, Nail $       39.00  Lab300
87102Cul, Fungi; Iso; Source - Hair/Nail, not Blood $       35.00  Lab300
87140Culture Typing Immunofluorescent Method, ea Antiserum $       37.00  Lab300
87147Culture Typing Immunologic Method, other than Immunofluorescence, per Antiserum $       23.00  Lab300
87168Macroscopic Exam; Arthropod $       34.00  Lab300
87169Macroscopic Exam; Parasite $       23.00  Lab300
87177Ova/Parasites, Dir. Smears, Concen/Id $       25.00  Lab300
87181Susceptiblty Stdy Antimicrbial Agar Dilut $       21.00  Lab300
87186Susceptiblty Stdy Antimicrbial Micro/Agar Dilut, eac, per Plate $       43.00  Lab300
87205Smear, Prim Src w/ Intrpt; Gram/Giemsa Stain $       30.00  Lab300
87209Smear, Prim Src w/ Intrpt; Complex Special Stain $       50.00  Lab300
87210Smear, Prim Src w/ Intrpt; Wet Mount for Infec. Agents (eg, Saline, India Ink, KOH preps) $       15.00  Lab300
87220Tiss Exam KOH Slide Skn, Hair, Nails (Scabies) $       25.00  Lab300
87230Toxin/Antitoxin Assay, Tiss. Culture $     110.00  Lab300
87324IAAD IA Clostridium $       64.00  Lab300
87329IAAD IA Giardia $       25.00  Lab300
87338IAAD IA H-Pylori $       35.00  Lab300
87340IAAD IA Hepatitis B $       50.00  Lab300
87385IAAD IA Histoplasma Capsulatum $     112.00  Lab300
87389IAAD IA HIV-1, HIV-1 & HIV-2 $       65.00  Lab300
87427IAAD IA Shiga-like Toxin $       25.00  Lab300
87430IAAD IA Streptococcus Grp A $       33.00  Lab306
87449IAAD IA Qual/Sem; Mult-Step; NOS, ea Org $       22.00  Lab300
87491Nuc Acid Det; Chlamydia Trachomatis, by Amp Prb $       85.00  Lab300
87502IADNA Flu Virus $     150.00  Lab300
87517Nuc Acid Det; Hep B Virus, Quan $     322.00  Lab300
87522Nuc Acid Det; Hep C, Rev Trnsceptn & Quan $     266.00  Lab300
87530Nuc Acid Det; Herpes Simplx Virus, Quan $     161.00  Lab300
87591Nuc Acid Det; Neisseria Gonorrhoeae, Amp Prb $       82.00  Lab300
87623IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES $     100.00  Lab300
87624IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES $       78.00  Lab300
87625IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY $     120.00  Lab300
87641IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ $       75.00  Lab300
87651IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ $       75.00  Lab300
87653IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ $     101.00  Lab300
87799IADNA NOS QUANTIFICATION EACH ORGANISM $     152.00  Lab300
87804IAADIADOO INFLUENZA $       30.00  Lab300
87807IAADIADOO RESPIRATORY SYNCTIAL VIRUS $       31.20  Lab300
87880IAADIADOO STREPTOCOCCUS GROUP A $       35.00  Lab300
87902NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS $     529.00  Lab300
88104CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ $     186.00  Lab300
88142CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN $       59.00  Lab300
89055LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE $       28.00  Lab300
90471IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE $       42.00  Procedures771
90472IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE $       20.13  Procedures636
90632HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE $       79.00  Procedures636
90653IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE $       60.00  Procedures636
90656IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE $       20.00  Procedures636
90658IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE $       20.00  Procedures636
90662IIV VACCINE PRESERV FREE INCREASED AG COUNT IM $       53.37  Procedures636
90686IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE $       25.00  Procedures636
90715TDAP VACCINE 7 YRS/> IM $       55.00  Procedures636
90791PSYCHIATRIC DIAGNOSTIC EVALUATION $     220.00  Procedures900
90832PSYCHOTHERAPY W/PATIENT 30 MINUTES $       90.00  Procedures900
90833PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN $     112.00  Procedures900
90834PSYCHOTHERAPY W/PATIENT 45 MINUTES $     125.00  Procedures900
90837PSYCHOTHERAPY W/PATIENT 60 MINUTES $     150.00  Procedures900
92552PURE TONE AUDIOMETRY AIR ONLY $       30.00  Procedures470
92950CARDIOPULMONARY RESUSCITATION $     714.06  Procedures521
93000ECG ROUTINE ECG W/LEAST 12 LDS W/I&R $       56.00  Procedures730
93005ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R $       28.00  Procedures730
93010ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY $       58.00  Procedures730
93040RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT $       30.00  Procedures730
93041RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R $       17.50  Procedures730
94010SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ $       95.00  Procedures460
94060BRNCDILAT RSPSE SPMTRY PRE&POST-BRONCDILAT ADMIN $     155.00  Procedures460
94150VITAL CAPACITY TOTAL SEPARATE PROCEDURE $       37.50  Procedures521
94640PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT $       40.00  Procedures419
95115PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX $       12.00  Procedures521
95117PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS $       25.00  Procedures521
96127BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT $       20.00  Procedures900
96150HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT $       68.31  Procedures900
96152HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV $       21.57  Procedures900
96160PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM $       10.00  E&M Est521
96360IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR $     102.00  Procedures260
96361IV INFUSION HYDRATION EACH ADDITIONAL HOUR $       27.00  Procedures260
96365IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR $     135.00  Procedures260
96372THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM $       45.00  Procedures761
96374THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG $     101.00  Procedures269
96375THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG $       40.00  Procedures269
96376THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC $     146.25  Procedures269
96523IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST $       70.00  Procedures300
97602RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS $       76.20  Procedures521
99000HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB $         5.60  Lab300
99024POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX $       65.91  E&M Est521
99050SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS $       42.00  E&M Est521
99058SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS $       59.92  E&M Est521
99188APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP $       19.00  Procedures521
99195PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE $     150.00  Procedures521
99201OFFICE OUTPATIENT NEW 10 MINUTES $       75.00  E&M New521
99202OFFICE OUTPATIENT NEW 20 MINUTES $     136.00  E&M New521
99203OFFICE OUTPATIENT NEW 30 MINUTES $     197.00  E&M New521
99204OFFICE OUTPATIENT NEW 45 MINUTES $     303.00  E&M New521
99205OFFICE OUTPATIENT NEW 60 MINUTES $     400.00  E&M New521
99211OFFICE OUTPATIENT VISIT 5 MINUTES $       37.00  E&M Est521
99212OFFICE OUTPATIENT VISIT 10 MINUTES $       80.00  E&M Est521
99213OFFICE OUTPATIENT VISIT 15 MINUTES $     133.00  E&M Est521
99214OFFICE OUTPATIENT VISIT 25 MINUTES $     197.00  E&M Est521
99215OFFICE OUTPATIENT VISIT 40 MINUTES $     308.00  E&M Est521
99291CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN $     468.00  E&M Est521
99348HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES $     126.54  E&M Est521
99349HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES $     203.95  E&M Est521
99354PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR $     175.00  E&M Est521
99355PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30 $     192.04  E&M Est521
99381INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR $     198.00  E&M New521
99382INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS $     213.00  E&M New521
99383INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS $     224.00  E&M New521
99384INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR $     240.00  E&M New521
99385INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS $     244.00  E&M New521
99386INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS $     275.00  E&M New521
99387INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> $     292.00  E&M New521
99391PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y $     180.00  E&M Est521
99392PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS $     190.00  E&M Est521
99393PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS $     195.00  E&M Est521
99394PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS $     213.00  E&M Est521
99395PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS $     215.00  E&M Est521
99396PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS $     230.00  E&M Est521
99397PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER $     250.00  E&M Est521
99401PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN $       65.00  E&M Est521
99402PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN $     119.10  E&M Est521
99403PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN $     105.00  E&M Est521
99404PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN $     135.00  E&M Est521
99406TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES $       30.00  E&M Est521
99407TOBACCO USE CESSATION INTENSIVE >10 MINUTES $       30.00  E&M Est521
99408ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN $       86.35  E&M Est521
99409ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN $     153.34  E&M Est521
99429DOT/FAA PHYSICAL $     150.00  E&M Est521
99495TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE $     309.65  E&M Est521
99496TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE $     400.00  E&M Est521
99497ADVANCE CARE PLANNING FIRST 30 MINS $     245.73  E&M Est521
36415,SPECLABLAB DRAW FOR SPECTRA LABS $       19.40  Lab300
82075,BMRBAT BLUE MTN REFUSE $       28.00  Lab300
82075,BPHBREATH ETOH BENGAL PHARMACY $       28.00  Lab300
82075,CITYBAT CITY OF CHALLIS $       28.00  Lab300
82075,RNBCUSTER CO ROAD AND BRIDGE ALCOHOL TESTING $       28.00  Lab300
82075,SAFEBREATH ALCOHOL TEST FOR SAFE HAVEN $       28.00  Lab300
82075,SREBAT SALMON RIVER ELECTRIC $       28.00  Lab300
84443,TT4FREE T4 WITH TOTAL T4 $       55.00  Lab300
90471,FLUINFLUENZA ADMINISTRATION $         5.00  Procedures771
99000,1ST1ST FRUITS COLLECTION $       30.00  Lab300
99000,ACGACG, INC. THROUGH SAFE TRACK $       30.00  Lab300
99000,BAVDSC BLACK & VEATCH ACCT 80800 $       30.00  Lab300
99000,BMRBLUE MTN REFUSE COLLECTION $       30.00  Lab300
99000,BPHBENGAL PHARMACY COLLECTION $       30.00  Lab300
99000,CITYCITY OF CHALLIS COLLECTION $       30.00  Lab300
99000,CTCCUSTERTEL COLLECTION $       30.00  Lab300
99000,DEBCODEBCO CONSTRUCTION COLLECTION $       30.00  Lab300
99000,DOLDEPT. OF LABOR $       30.00  Lab300
99000,IPLHIDAHO PRECISION LOG HOME, LLC DRUG SCREEN $       30.00  Lab301
99000,ITDIDAHO TRANSPORTATION DEPT. DOT DRUG SCREEN $       30.00  Lab300
99000,K9PIPEK9 PIPE INSPECTIONS FOR DRUG FREE IDAHO $       30.00  Lab300
99000,KMBKIMBLE OIL COLLECTION $       30.00  Lab300
99000,LRMCLOST RIVER MED CTR COLLECTION $       30.00  Lab300
99000,MFADRUG SCREEN FOR MIDDLE FORK AVIATION $       30.00  Lab300
99000,NWTCNORTHWEST TRAFFIC CONTROL COLLECTION $       30.00  Lab300
99000,PEMPEMBROOK COLLECTION $       30.00  Lab300
99000,RNBCUSTER COUNTY ROAD AND BRIDGE COLLECTION $       30.00  Lab300
99000,SAFESAFE HAVEN COLLECTION $       30.00  Lab300
99000,SCHSCHOOL DIST 181 CHALLIS, COLLECTION $       30.00  Lab300
99000,SRESALMON RIVER ELECTRIC COLLECTION $       30.00  Lab300
99000,SRPSALMON RIVER PROPANE COLLECTION $       30.00  Lab300
99000,SS88STINKER STATION, CHALLIS, COLLECTION $       30.00  Lab300
99000,SWESOUTHWEST ENERGY COLLECTION $       30.00  Lab300
99000,TCMDRUG SCREEN COLLECTION THOMPSON CREEK MINE $       30.00  Lab300
99000,TCPT-CUP COLLECTION $       30.00  Lab300
99999XCONFUSAQUE STERCORE $             -    Procedures
A4300IV CATHETER $       30.00  HCPCS278
A4351INTERMITTENT URINARY CATHETER/ STRA $         4.00  HCPCS521
A4355FOLEY CATH $       15.00  HCPCS521
A4357BEDSIDE DRAINAGE BAG $       17.33  HCPCS521
A4364DERMABOND $         8.47  HCPCS521
A4467BELT STRAP SLEEV GRMNT COVER $       39.00  HCPCS521
A4565SLING $       20.00  HCPCS521
A4590CASTING FIBERGLASS $       75.01  HCPCS521
A4615NASAL CANNULA $         3.50  HCPCS521
A4620NON-REBREATHER MASK ADULT $       10.00  HCPCS521
A4750IV TUBING SET UP $       75.00  HCPCS521
A6238HYDROCOLLOID DRESSING, WOUND COVER $       36.75  HCPCS521
A6257TEGADERM-TRANSPARENT FILM $         1.99  HCPCS521
COUNALCALCOHOL USE CESSATION COUNSELING $             -    HCPCS
COUNDRGDRUG USE CESSATION COUNSELING $             -    HCPCS
COUNTOBTOBACCO USE CESSATION COUNSELING $             -    HCPCS
G0008ADMINISTRATION OF INFLUENZA VIRUS VACCINE $       41.27  HCPCS636
G0402WELCOME INITIAL PREV EXAM MEDICARE $     282.20  HCPCS521
G0438MEDICARE INIT ANNUAL EXAM $     291.00  HCPCS521
G0439SUBSEQUENT ANNUAL MEDICARE WELLNESS $     223.00  HCPCS521
G0444ANNUAL DEPRESSION SCREENING, MEDICARE $       40.00  HCPCS521
G0466FQHC VISIT, NEW PATIENT $     230.00  HCPCS521
G0467FQHC VISIT, ESTABLISHED PATIENT $     175.00  HCPCS521
G0468FQHC VISIT, IPPE OR AWV $     226.00  HCPCS521
G0469FQHC VISIT, MENTAL HEALTH, NEW PATIENT $     232.00  HCPCS521
G0470FQHC VISIT, MENTAL HEALTH, EST. PATIENT $     180.00  HCPCS521
G0511CHRONIC CARE MANAGEMENT $       93.23  HCPCS521
J0171INJECTION ADRENALIN EPINEPHRINE $         2.00  HCPCS636
J0690CEFAZOLIN SODIUM $         5.27  HCPCS636
J0696ROCEPHIN $       16.00  HCPCS636
J1100DEXAMETHASONE SODIUM PHOS $         2.00  HCPCS636
J1170HYDROMORPHONE INJECTION $         6.00  HCPCS636
J1200DIPHENHYDRAMINE HCL 50 IV OR IM $         4.00  HCPCS636
J1642HEP LOCK / J LOOP $         0.65  HCPCS636
J1644HEPARIN PER 10K UNITS $         2.00  HCPCS636
J1650LOVENOX 10MG SC $       15.64  HCPCS636
J1815INSULIN $         2.70  HCPCS636
J1885TORADOL PER 15 MG $         9.00  HCPCS636
J1940LASIX UP TO 20MG $         7.00  HCPCS636
J2060LORAZEPAM TABLETS $         3.00  HCPCS636
J2175DERMROL PER 100MG $       14.00  HCPCS636
J2180PROMETHAZINE UP TO 50 MG $       78.00  HCPCS636
J2250MIDAZOLAM PER ML $         4.00  HCPCS636
J2270MORPHINE UP TO 10 MG $         5.20  HCPCS636
J2310NARCAN PER 1ML $       32.00  HCPCS636
J2405ZOFRAN $         2.00  HCPCS636
J2550PHENERGAN UP TO 50 MG $       10.00  HCPCS636
J2930INJ. METHYLPREDNISOLONE UP TO 125MG $       15.00  HCPCS636
J3300TRIMCINOLONE ACETONIDE 1MG (KENALOG) $         8.00  HCPCS636
J3301KENALOG 10 MG $         6.30  HCPCS636
J3360INJECTION, DIAZEPAM, UP TO 5MG $       13.13  HCPCS636
J3420VITAMIN B12 INJECTION $       10.00  HCPCS636
J3475MGSO4 500MG $         2.00  HCPCS636
J3490METOPROLOL PER 5MG $         5.00  HCPCS636
J7030NORMAL SALINE $       15.01  HCPCS258
J7060DEXTROSE 500ML RTE IV $       12.00  HCPCS636
J8540DEXAMETHASONE, ORAL, 0.25MG $         1.00  HCPCS636
L0120CERVICAL FLEXABLE NONADJUSTABLE FOA $       36.14  HCPCS521
L1820KO ELAS W/ CONDYLE PADS & JO $     160.28  HCPCS521
L1830KO IMMOB CANVAS LONG PRE OTS $     114.18  HCPCS521
L1902ANKLE FOOT ORTHOSIS, PREFABRICATED $     108.01  HCPCS521
L3260POST OP SHOE RIGID ROCKER $       36.00  HCPCS521
L3650SHOULDER ORTHOSIS FIGURE 8 DESIGN ABDUCTION RESTRAINER PREFAB $       74.09  HCPCS521
L3807THUMBKEEPER SPLINT $     268.93  HCPCS521
L3809WRIST/THUMB SUPPORT OST $     255.96  HCPCS521
L3908COMFORT FORM WRIST $       79.83  HCPCS521
L3923WRIST SPLINT $     102.99  HCPCS521
L4386WALKING BOOT,PREFABRICATED,FITTING/ $     201.99  HCPCS521
L4387LOW PROFILE WALKING BOOT, SMALL $     181.05  HCPCS521
MISCMRMEDICAL RECORD COPY 1-10 $         5.00  HCPCS
MISCMR2MEDICAL RECORD COPY 11-20 $       15.00  HCPCS
MISCMR3MEDICAL RECORD COPY 20+ $       20.00  HCPCS
MISCNSNO SHOW $            -    HCPCS
MISCNSFINSUFFICIENT FUNDS $       35.00  HCPCS
MISCSCHOOLSCHOOL PE $       29.00  HCPCS
NURSECMACMA $            -    HCPCS
NURSELPNLPN $            -    HCPCS
NURSERNRN $            -    HCPCS
Q0091PAP,MEDICARE $      75.00  HCPCS300
Q0163DIPHENHYDRAMINE HCL, 50MG, ORAL $        1.00  HCPCS521
Q2038INFLUENZA VIRUS VACCINE 3 YEARS OR OLDER, IM $      30.00  HCPCS636
Q4022CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YRS +) $      36.30  HCPCS521
Q4038SHORT LEG CAST 11+ YEARS OLD $      76.04  HCPCS521
Q4042CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS $      64.99  HCPCS521
Q4046SHORT LEG SPLINT SUPPLIES $      45.01  HCPCS521
Q4049FINGER SPLINT $      15.00  HCPCS521
S0020MARCAINE 30 ML $        9.50  HCPCS521
S8450SPLINT, FINGER $       11.00  HCPCS521
SPORTPEADULTSPORT PHYSICAL FOR AFTER HIGH SCHOOL $       29.00  E&M Est521
SPORTPEPEDSSPORT PHYSICAL FOR MIDDLE-HIGH SCHOOL $       29.00  E&M Est521
T1015FQHC, ALL INCLUSIVE VISIT $     169.98  HCPCS521
T1502ADMINISTRATION OF ORAL, INTRAMUSCULAR AND/OR SUBCUTANEOUS MEDICATION BY HEALTH CARE AGENCY/PROFESSIONAL, PER VISIT $         0.90  HCPCS521
T1503ADMINISTRATION OF MEDICATION, OTHER THAN ORAL AND/OR INJECTABLE, BY A HEALTH CARE AGENCY/PROFESSIONAL, PER VISIT $       26.00  HCPCS521