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HomeMy WebLinkAboutC.054.93010_008687210 Net Prep S 20 00 87081 GC Culture S3000 $2465 M'Cholesterol $2000 $7205 Gram Stain $ 1500 89300 Semen .Analysis S 40 00 CPT CODE SERVIC FEES 87166 Darkfield $ 30 00 86592 Stat RPR $ 20 00 36415 Venipuncture/stick $ 1000 99000 Handling Fee S 1000 Once Procedures 54050 Wan Treatment/Male $ 90 00 56501 Wan Treatment/Female $115 00 76815 Ultrasound $15000 59025 Non -Stress Test $10500 59412 Cephalic Version/External $35000 11975 Norplant Insertion S50500 11976 Norplant Remo%al $21000 58300 FUD Insenion S185 00 58301 IUD Removal $ 85 00 99070 ••IIID Supply $ 1000 57170 Diaphragm Fitting S 7000 96110 Denver Developmental $15000 92551 Audiometry $ 30 00 69210 Ear Irrigation S 60 00 Im m u n izat ion/In i ection 90782 Therapeutic/Diagnostic S 1000 Admin. Fee 90471 Admin. Sinale Vaccine $ 1000 90472 Admin. 2+ Vaccine S 15 00 .pC TCODES SERVICE FEES 90788 .Admin. .Antibiotics S 1000 90384 Rho Gam S11000 J1055 DepoProvera S45 00 90716 -Adult Varicella $ 55 00 00707 -Adult MMR S 40 00 90733 'Adult Meningitis S 64 00 90746 -Adult Hepatitis B $ 45 00 90612 'Adult Hepatitis A S 50 00 00633 'Pcd/Adol Hepatitis A S'_5 00 90657 $ 90658 *Influenza Vaccine S 900 90732 'Pneumonia Vaccine S1600 86580 'PPD (TB Skin Test) S 1000 7