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Home My WebLink AboutC.054.93010_0176CPT COD SERVICE FEE EV➢I/Maltil Visits (Established) 99211 Minimal $ 35.00 99212 Limited S 45 00 99213 Expanded $ 65 00 -99214 Detailed S85 00 99215 Comprehensive $105.00 Antepartum Care 59425 4 -6 visits S37300 59426 7 or more visits $1,00000 aboratory 82947 Glucose SIS 00 82950 1 hour Glucola S 25.00 82951 GTT (3 hr.) S4000 85013 Hematocrit S 15.00 81002 Urine Dipstick S 12.00 81000 Urine with micro S 18.00 87087 Urine Colony Count S 25.00 81025 *Pregnancy Test (urine) S 10.00 (19 years & over) 87210 Wet Prep $ 20.00 87081 GC Culture S 30.00 82465 k'Cholesterol $ 20.00 87205 Gram Stain S 15A0 89300 Semen Analysis $ 40.00 CPT CODE 5ERVICE FEES $7166 Duk6eld $ 30.00 86592 Stat RPR S2000 36415 Venipunctur 'stick $ 10.00 99000 Handling Fee $ 10.00 Mice Procedures 54050 Wart Treatment/Male S9000 36501 Wart Treatmem/Female 5115.00 76815 Ultrasound $150.00 59025 Non -Stress Test $105.00 X9412 Cephalic Versiory External 5350.00 11973 Norplant Insertion 5505.00 11976 Norplant Removal 5210.00 58300 IUD Insertion 5185.00 58301 IUD Removal S 85 00 99070 '*IUD Supply $1000 6