| Fine needle aspiration of first lesion using ultrasound guidance |
10005 |
$721.00 |
$288.40 |
| Fine needle aspiration of additional lesion using ultrasound guidance |
10006 |
$361.00 |
$144.40 |
| Fine needle aspiration of first lesion using fluoroscopice guidance |
10007 |
$721.00 |
$288.40 |
| Fine needle aspiration of additional lesion using fluoroscopice guidance |
10008 |
$361.00 |
$144.40 |
| Fine needle aspiration of first lesion using CT guidance |
10009 |
$721.00 |
$288.40 |
| Fine needle aspiration of additional lesion using CT guidance |
10010 |
$361.00 |
$144.40 |
| Fine needle aspiration of first lesion using MR guidance |
10011 |
$721.00 |
$288.40 |
| Fine needle aspiration of additional lesion using MR guidance |
10012 |
$361.00 |
$144.40 |
| Fine needle aspiration of first lesion |
10021 |
$268.00 |
$107.20 |
| Fluid collection drainage by catheter using imaging guidance, accessed through the skin |
10030 |
$220.00 |
$88.00 |
| Drainage of abscess |
10060 |
$371.00 |
$148.40 |
| Drainage of multiple abscess |
10061 |
$371.00 |
$148.40 |
| Removal of foreign body from tissue, accessed beneath the skin |
10120 |
$216.00 |
$86.40 |
| Drainage of blood or fluid accumulation |
10140 |
$2,017.00 |
$806.80 |
| Aspiration of abscess, blood accumulation, blister, or cyst |
10160 |
$132.00 |
$52.80 |
| Drainage of wound infection after surgery |
10180 |
$3,068.00 |
$1,227.20 |
| Removal of skin and tissue first 20 sq cm or less |
11042 |
$1,220.00 |
$488.00 |
| Removal of skin and/or muscle first 20 sq cm or less |
11043 |
$1,480.00 |
$592.00 |
| Removal of skin and bone first 20 sq cm or less |
11044 |
$3,166.00 |
$1,266.40 |
| Removal of skin and tissue |
11045 |
$651.00 |
$260.40 |
| Removal of skin and/or muscle |
11046 |
$808.00 |
$323.20 |
| Removal of skin and bone |
11047 |
$1,580.00 |
$632.00 |
| Removal of single thickened skin growth |
11055 |
$205.00 |
$82.00 |
| Removal of 2 to 4 thickened skin growths |
11056 |
$212.00 |
$84.80 |
| Removal of more than 4 thickened skin growths |
11057 |
$265.00 |
$106.00 |
| Tangential biopsy of single skin lesion |
11102 |
$239.00 |
$95.60 |
| Tangential biopsy of additional skin lesion |
11103 |
$165.00 |
$66.00 |
| Punch biopsy of single skin lesion |
11104 |
$239.00 |
$95.60 |
| Punch biopsy of additional skin lesion |
11105 |
$165.00 |
$66.00 |
| Incisional biopsy of single skin lesion |
11106 |
$426.00 |
$170.40 |
| Incisional biopsy of additional skin lesion |
11107 |
$294.00 |
$117.60 |
| Trimming of fingernails or toenails |
11719 |
$78.00 |
$31.20 |
| Removal of tissue from 1 to 5 finger or toe nails |
11720 |
$78.00 |
$31.20 |
| Removal of tissue from 6 or more finger or toe nails |
11721 |
$78.00 |
$31.20 |
| Separation of nail plate from nail bed |
11730 |
$245.00 |
$98.00 |
| Separation of nail plate from nail bed |
11732 |
$170.00 |
$68.00 |
| Removal of drug delivery implant from tissue |
11982 |
$114.00 |
$45.60 |
| Repair of separation of wound closure with insertion of packing |
12021 |
$351.00 |
$140.40 |
| Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less) |
15271 |
$1,714.00 |
$685.60 |
| Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs |
15272 |
$719.00 |
$287.60 |
| Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children) |
15273 |
$3,726.00 |
$1,490.40 |
| Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs |
15274 |
$1,546.00 |
$618.40 |
| Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less) |
15275 |
$1,714.00 |
$685.60 |
| Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes |
15276 |
$816.00 |
$326.40 |
| Application of skin substitute (wound surface great than or equal to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children) |
15277 |
$2,011.00 |
$804.40 |
| Application of skin substitute (wound surface great than or equal to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes |
15278 |
$1,008.00 |
$403.20 |
| Dressing change and/or removal of burn tissue (less than 5% total body surface) |
16020 |
$174.00 |
$69.60 |
| Dressing change and/or removal of burn tissue (5% to 10% total body surface) |
16025 |
$174.00 |
$69.60 |
| Dressing change and/or removal of burn tissue (greater than 10% total body surface) |
16030 |
$268.00 |
$107.20 |
| Application of chemical agent to excessive wound tissue |
17250 |
$215.00 |
$86.00 |
| Aspiration of breast cyst |
19000 |
$153.00 |
$61.20 |
| Puncture aspiration of breast cyst |
19001 |
$96.00 |
$38.40 |
| Injection for X-ray imaging of breast duct |
19030 |
$335.00 |
$134.00 |
| Biopsy of breast accessed through the skin with stereotactic guidance |
19081 |
$4,187.00 |
$1,674.80 |
| Biopsy of breast accessed through the skin with stereotactic guidance |
19082 |
$1,046.00 |
$418.40 |
| Biopsy of breast accessed through the skin with ultrasound guidance |
19083 |
$1,542.00 |
$616.80 |
| Biopsy of breast accessed through the skin with ultrasound guidance |
19084 |
$771.00 |
$308.40 |
| Biopsy of breast accessed through the skin with MRI guidance |
19085 |
$2,178.00 |
$871.20 |
| Biopsy of breast accessed through the skin with MRI guidance |
19086 |
$1,089.00 |
$435.60 |
| Placement of breast localization devices accessed through the skin with mammographic guidance |
19281 |
$158.00 |
$63.20 |
| Placement of breast localization devices accessed through the skin with mammographic guidance |
19282 |
$79.00 |
$31.60 |
| Placement of breast localization devices accessed through the skin with ultrasound guidance |
19285 |
$158.00 |
$63.20 |
| Placement of breast localization devices accessed through the skin with ultrasound guidance |
19285 |
$316.00 |
$126.40 |
| Placement of breast localization devices accessed through the skin with ultrasound guidance |
19286 |
$79.00 |
$31.60 |
| Breast procedure |
19499 |
$2,794.00 |
$1,117.60 |
| Needle biopsy of muscle, accessed through the skin |
20206 |
$57.00 |
$22.80 |
| Biopsy of bone using needle or trocar |
20220 |
$808.00 |
$323.20 |
| Deep biopsy of bone using needle or trocar |
20225 |
$1,112.00 |
$444.80 |
| Injection for repair of abnormal muscle drainage tract |
20500 |
$1,110.00 |
$444.00 |
| Injection of abnormal muscle drainage tract for X-ray study |
20501 |
$121.00 |
$48.40 |
| Removal of foreign body in muscle or tendon |
20520 |
$154.00 |
$61.60 |
| Injections of tendon sheath, ligament, or muscle membrane |
20550 |
$971.00 |
$388.40 |
| Injections of tendon sheath, ligament, or muscle membrane |
20550 |
$647.00 |
$258.80 |
| Injections of trigger points in 1 or 2 muscles |
20552 |
$678.00 |
$271.20 |
| Injections of trigger points in 3 or more muscles |
20553 |
$807.00 |
$322.80 |
| Aspiration and/or injection of small joint or joint capsule |
20600 |
$1,007.00 |
$402.80 |
| Aspiration and/or injection of small joint or joint capsule |
20600 |
$671.00 |
$268.40 |
| Aspiration and/or injection of small joint or joint capsule with recording and reporting using ultrasound guidance |
20604 |
$481.00 |
$192.40 |
| Aspiration and/or injection of medium joint or joint capsule |
20605 |
$669.00 |
$267.60 |
| Aspiration and/or injection of medium joint or joint capsule |
20605 |
$1,004.00 |
$401.60 |
| Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance |
20606 |
$568.00 |
$227.20 |
| Aspiration and/or injection of large joint or joint capsule |
20610 |
$1,179.00 |
$471.60 |
| Aspiration and/or injection of large joint or joint capsule |
20610 |
$786.00 |
$314.40 |
| Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance |
20611 |
$650.00 |
$260.00 |
| Aspiration and/or injection of cysts |
20612 |
$158.00 |
$63.20 |
| Destruction of 1 or more bone growths accessed through the skin |
20982 |
$8,925.00 |
$3,570.00 |
| Muscle and bone procedure |
20999 |
$2,136.00 |
$854.40 |
| Musculoskeletal procedure on head |
21499 |
$150.00 |
$60.00 |
| Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest |
21501 |
$935.00 |
$374.00 |
| Biopsy of soft tissue of neck or chest |
21550 |
$767.00 |
$306.80 |
| Neck or chest procedure |
21899 |
$606.00 |
$242.40 |
| Biopsy of tissue of back or flank |
21920 |
$454.00 |
$181.60 |
| Biopsy of tissue of back or flank |
21925 |
$1,281.00 |
$512.40 |
| Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance |
22510 |
$4,558.00 |
$1,823.20 |
| Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance |
22511 |
$4,558.00 |
$1,823.20 |
| Injection of bone cement into body of middle or lower spine accessed through the skin using imaging guidance |
22512 |
$617.00 |
$246.80 |
| Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance |
22513 |
$7,943.00 |
$3,177.20 |
| Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance |
22514 |
$8,175.00 |
$3,270.00 |
| Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance |
22515 |
$3,539.00 |
$1,415.60 |
| Spine procedure |
22899 |
$315.00 |
$126.00 |
| Procedure on abdomen, muscle or bone |
22999 |
$77.00 |
$30.80 |
| Incision to repair joints between shoulder, chest and collar bones |
23101 |
$2,789.00 |
$1,115.60 |
| Injection of dye for X-ray imaging of shoulder joint |
23350 |
$383.00 |
$153.20 |
| Shoulder procedure |
23929 |
$392.00 |
$156.80 |
| Biopsy of soft tissue of upper arm or elbow |
24065 |
$1,900.00 |
$760.00 |
| Injection of dye for X-ray imaging of elbow joint |
24220 |
$212.00 |
$84.80 |
| Incision of tendon to repair elbow joint, accessed through the skin |
24357 |
$4,020.00 |
$1,608.00 |
| Incision of tendon to repair elbow joint, accessed through the skin |
24357 |
$6,030.00 |
$2,412.00 |
| Biopsy of tissue of forearm and/or wrist |
25065 |
$773.00 |
$309.20 |
| Injection of dye for X-ray imaging of wrist joint |
25246 |
$343.00 |
$137.20 |
| Drainage of abscess or blood accumulation in pelvis or hip joint |
26990 |
$1,490.00 |
$596.00 |
| Biopsy of tissue of pelvis and hip |
27040 |
$1,098.00 |
$439.20 |
| Biopsy of tissue of pelvis and hip |
27041 |
$1,295.00 |
$518.00 |
| Injection of dye for X-ray imaging of hip joint |
27093 |
$369.00 |
$147.60 |
| Injection procedure into sacroiliac joint for anesthetic or steroid |
27096 |
$2,460.00 |
$984.00 |
| Injection procedure into sacroiliac joint for anesthetic or steroid |
27096 |
$1,640.00 |
$656.00 |
| Pelvis or hip joint procedure |
27299 |
$174.00 |
$69.60 |
| Biopsy of thigh or knee region tissue |
27323 |
$1,604.00 |
$641.60 |
| Biopsy of thigh or knee region tissue |
27324 |
$2,469.00 |
$987.60 |
| Injection of contrast for imaging of knee joint |
27369 |
$76.00 |
$30.40 |
| Injection of contrast for imaging of knee joint |
27369 |
$151.00 |
$60.40 |
| Incision of Achilles tendon, accessed through the skin using local anesthetic |
27605 |
$4,392.00 |
$1,756.80 |
| Incision of Achilles tendon, accessed through the skin using local anesthetic |
27605 |
$2,928.00 |
$1,171.20 |
| Injection for X-ray imaging of ankle |
27648 |
$283.00 |
$113.20 |
| Incision of tissues of muscle compartment of foot and/or toe |
28008 |
$4,056.00 |
$1,622.40 |
| Incision of tissues of muscle compartment of foot and/or toe |
28008 |
$6,084.00 |
$2,433.60 |
| Removal of foreign body of foot tissue |
28192 |
$250.00 |
$100.00 |
| Removal of foreign body of foot tissue |
28193 |
$344.00 |
$137.60 |
| Application of rigid total contact leg cast |
29445 |
$346.00 |
$138.40 |
| Strapping, Unna boot |
29580 |
$366.00 |
$146.40 |
| Strapping, Unna boot |
29580 |
$244.00 |
$97.60 |
| Application of vein wound compression system lower leg below knee including ankle and foot |
29581 |
$244.00 |
$97.60 |
| Application of vein wound compression system lower leg below knee including ankle and foot |
29581 |
$366.00 |
$146.40 |
| Emergent insertion of breathing tube into windpipe cartilage using an endoscope |
31500 |
$700.00 |
$280.00 |
| Diagnostic examination of voice box using flexible endoscope |
31575 |
$623.00 |
$249.20 |
| Voice box procedure |
31599 |
$150.00 |
$60.00 |
| Insertion of stents into windpipe using an endoscope |
31631 |
$1,586.00 |
$634.40 |
| Insertion of catheter for suction of secretions |
31720 |
$46.00 |
$18.40 |
| Windpipe or lung airway procedure |
31899 |
$1,312.00 |
$524.80 |
| Needle biopsy of lining of lung, accessed through the skin |
32400 |
$856.00 |
$342.40 |
| Needle biopsy of lung or chest tissue, accessed through the skin |
32405 |
$1,109.00 |
$443.60 |
| Insertion of permanent catheter for drainage of lung fluid |
32550 |
$968.00 |
$387.20 |
| Removal of fluid from between lung and chest cavity, open procedure |
32551 |
$379.00 |
$151.60 |
| Removal of tunneled catheter in lung lining |
32552 |
$451.00 |
$180.40 |
| Removal of fluid from chest cavity |
32554 |
$1,268.00 |
$507.20 |
| Removal of fluid from chest cavity with imaging guidance |
32555 |
$2,714.00 |
$1,085.60 |
| Removal of fluid from chest cavity with imaging guidance |
32555 |
$1,809.00 |
$723.60 |
| Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin |
32556 |
$2,027.00 |
$810.80 |
| Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin |
32556 |
$1,351.00 |
$540.40 |
| Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin |
32557 |
$2,221.00 |
$888.40 |
| Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin |
32557 |
$3,331.00 |
$1,332.40 |
| Catheter instillation of agent onto lung surface |
32560 |
$266.00 |
$106.40 |
| Catheter instillations of agent onto lung lining to break up scar tissue |
32561 |
$1,070.00 |
$428.00 |
| Destruction of growths in one lung, accessed through the skin |
32998 |
$3,700.00 |
$1,480.00 |
| Lung and lung lining procedure |
32999 |
$142.00 |
$56.80 |
| Aspiration of fluid from sac that covers the heart |
33010 |
$1,164.00 |
$465.60 |
| Insertion of catheter for drainage into sac that covers the heart |
33015 |
$430.00 |
$172.00 |
| Insertion or replacement of permanent pacemaker and upper chamber electrodes |
33206 |
$3,675.00 |
$1,470.00 |
| Insertion or replacement of permanent pacemaker and lower chamber electrodes |
33207 |
$3,675.00 |
$1,470.00 |
| Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes |
33208 |
$10,412.00 |
$4,164.80 |
| Placement of temporary pacemaker leads |
33210 |
$5,350.00 |
$2,140.00 |
| Conversion to two chamber pacemaker system |
33214 |
$3,853.00 |
$1,541.20 |
| Repositioning of implanted pacemaker or defibrillator device |
33215 |
$2,613.00 |
$1,045.20 |
| Insertion of electrode for permanent pacemaker or pacing defibrillator device |
33216 |
$2,053.00 |
$821.20 |
| Insertion of electrodes for permanent pacemaker or pacing defibrillator device |
33217 |
$2,060.00 |
$824.00 |
| Repair of electrode for permanent pacemaker or defibrillator device |
33218 |
$5,419.00 |
$2,167.60 |
| Relocation of pacemaker generator skin pocket |
33222 |
$2,000.00 |
$800.00 |
| Relocation of defibrillator device skin pocket |
33223 |
$2,000.00 |
$800.00 |
| Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device |
33224 |
$8,468.00 |
$3,387.20 |
| Insertion of left heart electrode for pacing defibrillator device |
33225 |
$9,945.00 |
$3,978.00 |
| Repositioning of implanted left heart electrode |
33226 |
$1,128.00 |
$451.20 |
| Removal and replacement of single lead permanent pacemaker pulse generator |
33227 |
$10,235.00 |
$4,094.00 |
| Removal and replacement of dual lead permanent pacemaker pulse generator |
33228 |
$11,624.00 |
$4,649.60 |
| Removal and replacement of multiple lead permanent pacemaker pulse generator |
33229 |
$17,885.00 |
$7,154.00 |
| Removal of permanent pacemaker pulse generator |
33233 |
$1,293.00 |
$517.20 |
| Removal of electrode from right heart |
33234 |
$1,214.00 |
$485.60 |
| Removal of electrodes from right heart |
33235 |
$1,463.00 |
$585.20 |
| Removal of defibrillator pulse generator |
33241 |
$3,087.00 |
$1,234.80 |
| Removal of defibrillator electrodes |
33244 |
$3,110.00 |
$1,244.00 |
| Insertion or replacement of single or dual chamber pacing defibrillator leads |
33249 |
$30,278.00 |
$12,111.20 |
| Removal and replacement of defibrillator pulse generator |
33262 |
$19,966.00 |
$7,986.40 |
| Removal and replacement of defibrillator pulse generator |
33263 |
$20,439.00 |
$8,175.60 |
| Removal and replacement of defibrillator pulse generator |
33264 |
$29,869.00 |
$11,947.60 |
| Insertion or replacement of defibrillator with electrode |
33270 |
$8,969.00 |
$3,587.60 |
| Insertion of defibrillator electrode |
33271 |
$2,053.00 |
$821.20 |
| Removal of defibrillator electrode |
33272 |
$1,699.00 |
$679.60 |
| Repositioning of previously implanted defibrillator electrode |
33273 |
$2,613.00 |
$1,045.20 |
| Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance |
33274 |
$20,849.00 |
$8,339.60 |
| Removal of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance |
33275 |
$3,587.00 |
$1,434.80 |
| Insertion of heart rhythm monitor under skin |
33285 |
$10,053.00 |
$4,021.20 |
| Removal of heart rhythm monitor from under skin |
33286 |
$787.00 |
$314.80 |
| Insertion of assistive heart blood flow device into aorta, accessed through the skin |
33967 |
$3,140.00 |
$1,256.00 |
| Removal of blood flow assist device in aorta, accessed through the skin |
33968 |
$1,679.00 |
$671.60 |
| Insertion of lower heart chamber blood flow assist device through the skin including radiological supervision and interpretation |
33990 |
$6,198.00 |
$2,479.20 |
| Removal of lower heart chamber blood flow assist device, accessed through the skin |
33992 |
$5,000.00 |
$2,000.00 |
| Heart surgery procedure |
33999 |
$412.00 |
$164.80 |
| Insertion of prosthesis for repair of abdominal or groin artery including radiological supervision and interpretation |
34709 |
$3,029.00 |
$1,211.60 |
| Insertion of needle or catheter into a vein |
36000 |
$110.00 |
$44.00 |
| Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin |
36002 |
$607.00 |
$242.80 |
| Injection for X-ray imaging procedure on veins of arm or leg |
36005 |
$434.00 |
$173.60 |
| Injection for X-ray imaging procedure on veins of arm or leg |
36005 |
$651.00 |
$260.40 |
| Introduction of catheter into the upper or lower major vein (vena cava) |
36010 |
$70.00 |
$28.00 |
| Insertion of catheter into vein |
36011 |
$318.00 |
$127.20 |
| Insertion of catheter into vein |
36011 |
$565.00 |
$226.00 |
| Insertion of catheter into vein |
36012 |
$1,186.00 |
$474.40 |
| Insertion of catheter into vein |
36012 |
$1,778.00 |
$711.20 |
| Insertion of catheter into right heart or main pulmonary (lung) artery |
36013 |
$94.00 |
$37.60 |
| Insertion of catheter into left or right pulmonary (lung) artery |
36014 |
$597.00 |
$238.80 |
| Insertion of catheter into left or right pulmonary (lung) artery |
36014 |
$398.00 |
$159.20 |
| Insertion of catheter into an artery of a lobe of the lung |
36015 |
$418.00 |
$167.20 |
| Insertion of catheter into an artery of a lobe of the lung |
36015 |
$209.00 |
$83.60 |
| Insertion of needle or catheter into the carotid (neck) or vertebral (brain) artery |
36100 |
$111.00 |
$44.40 |
| Insertion of needle or catheter into an artery of arm or leg |
36140 |
$1,179.00 |
$471.60 |
| Insertion of needle or catheter into aorta |
36160 |
$641.00 |
$256.40 |
| Insertion of catheter into aorta |
36200 |
$1,686.00 |
$674.40 |
| Insertion of catheter into aorta |
36200 |
$1,124.00 |
$449.60 |
| Insertion of catheter into chest or arm artery |
36215 |
$361.00 |
$144.40 |
| Insertion of catheter into chest or arm artery |
36215 |
$723.00 |
$289.20 |
| Insertion of catheter into chest or arm artery |
36216 |
$758.00 |
$303.20 |
| Insertion of catheter into chest or arm artery |
36216 |
$606.00 |
$242.40 |
| Insertion of catheter into chest or arm artery |
36217 |
$1,038.00 |
$415.20 |
| Insertion of catheter into chest or arm artery |
36217 |
$692.00 |
$276.80 |
| Insertion of catheter into chest or arm artery |
36218 |
$62.00 |
$24.80 |
| Insertion of catheter into chest or arm artery |
36218 |
$125.00 |
$50.00 |
| Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation |
36221 |
$4,987.00 |
$1,994.80 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36222 |
$8,874.00 |
$3,549.60 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36222 |
$5,916.00 |
$2,366.40 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36223 |
$5,916.00 |
$2,366.40 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36223 |
$8,874.00 |
$3,549.60 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36224 |
$10,890.00 |
$4,356.00 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36224 |
$5,445.00 |
$2,178.00 |
| Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation |
36225 |
$5,916.00 |
$2,366.40 |
| Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation |
36225 |
$8,874.00 |
$3,549.60 |
| Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation |
36226 |
$5,445.00 |
$2,178.00 |
| Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation |
36226 |
$10,890.00 |
$4,356.00 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36227 |
$1,107.00 |
$442.80 |
| Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation |
36227 |
$824.00 |
$329.60 |
| Insertion of catheter into artery on one side of neck or chest for diagnosis or treatment including radiological supervision and interpretation |
36228 |
$1,107.00 |
$442.80 |
| Insertion of catheter into artery on one side of neck or chest for diagnosis or treatment including radiological supervision and interpretation |
36228 |
$824.00 |
$329.60 |
| Insertion of catheter into abdominal pelvic or leg artery |
36245 |
$2,306.00 |
$922.40 |
| Insertion of catheter into abdominal pelvic or leg artery |
36245 |
$1,688.00 |
$675.20 |
| Insertion of catheter into abdominal pelvic or leg artery |
36246 |
$2,722.00 |
$1,088.80 |
| Insertion of catheter into abdominal pelvic or leg artery |
36246 |
$1,815.00 |
$726.00 |
| Insertion of catheter into abdominal pelvic or leg artery |
36247 |
$2,614.00 |
$1,045.60 |
| Insertion of catheter into abdominal pelvic or leg artery |
36247 |
$2,013.00 |
$805.20 |
| Insertion of catheter into each additional abdominal, pelvic or leg artery |
36248 |
$349.00 |
$139.60 |
| Insertion of catheter into each additional abdominal, pelvic or leg artery |
36248 |
$182.00 |
$72.80 |
| Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation |
36251 |
$4,303.00 |
$1,721.20 |
| Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation |
36252 |
$4,977.00 |
$1,990.80 |
| Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation |
36253 |
$1,459.00 |
$583.60 |
| Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation |
36254 |
$1,959.00 |
$783.60 |
| Insertion of needle into vein for collection of blood sample |
36415 |
$35.00 |
$14.00 |
| Transfusion of blood or blood products |
36430 |
$253.00 |
$101.20 |
| Intrauterine fetal transfusion |
36460 |
$235.00 |
$94.00 |
| Injection of chemical agent into single incompetent vein of leg using ultrasound guidance |
36465 |
$5,785.00 |
$2,314.00 |
| Injection of chemical agent into single incompetent vein |
36470 |
$197.00 |
$78.80 |
| Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
36473 |
$4,794.00 |
$1,917.60 |
| Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
36473 |
$3,196.00 |
$1,278.40 |
| Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
36474 |
$3,011.00 |
$1,204.40 |
| Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
36474 |
$2,007.00 |
$802.80 |
| Laser destruction of incompetent vein of arm or leg using imaging guidance, accessed through the skin |
36478 |
$2,573.00 |
$1,029.20 |
| Laser destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
36479 |
$3,094.00 |
$1,237.60 |
| Insertion of catheter into portal vein of liver, accessed through the skin |
36481 |
$626.00 |
$250.40 |
| Insertion of catheter into vein with collection of blood sample |
36500 |
$358.00 |
$143.20 |
| Mechanical separation of plasma from opening blood |
36514 |
$3,026.00 |
$1,210.40 |
| Mechanical separation of plasma and abnormal antibodies from blood |
36516 |
$5,165.00 |
$2,066.00 |
| Insertion of central venous catheter for infusion, patient younger than 5 years |
36555 |
$1,568.00 |
$627.20 |
| Insertion of central venous catheter for infusion, patient 5 years or older |
36556 |
$1,332.00 |
$532.80 |
| Insertion of central venous catheter for infusion, patient younger than 5 years |
36557 |
$2,220.00 |
$888.00 |
| Insertion of central venous catheter for infusion, patient 5 years or older |
36558 |
$2,096.00 |
$838.40 |
| Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older |
36561 |
$4,424.00 |
$1,769.60 |
| Insertion of central venous catheter for infusion, patient younger than 5 years |
36568 |
$842.00 |
$336.80 |
| Insertion of central venous catheter for infusion, patient 5 years or older |
36569 |
$1,424.00 |
$569.60 |
| Insertion of central venous catheter for infusion with port beneath the skin, patient 5 years or older |
36571 |
$2,598.00 |
$1,039.20 |
| Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years |
36572 |
$842.00 |
$336.80 |
| Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older |
36573 |
$1,424.00 |
$569.60 |
| Repair of central venous catheter for infusion |
36575 |
$468.00 |
$187.20 |
| Repair of central venous catheter for infusion |
36576 |
$468.00 |
$187.20 |
| Catheter replacement of central venous access device |
36578 |
$979.00 |
$391.60 |
| Replacement of central venous catheter |
36580 |
$1,085.00 |
$434.00 |
| Replacement of central venous catheter |
36581 |
$3,279.00 |
$1,311.60 |
| Replacement of central venous catheter |
36582 |
$1,801.00 |
$720.40 |
| Replacement of catheter in peripheral vein accessed through same vein |
36584 |
$736.00 |
$294.40 |
| Removal of central venous catheter for infusion |
36589 |
$1,512.00 |
$604.80 |
| Removal of peripheral venous catheter for infusion |
36590 |
$610.00 |
$244.00 |
| Collection of blood specimen from a completely implantable venous access device |
36591 |
$222.00 |
$88.80 |
| Collection of blood specimen from central or peripheral venous catheter |
36592 |
$90.00 |
$36.00 |
| Declotting infusion of implanted central venous access device or catheter |
36593 |
$597.00 |
$238.80 |
| Mechanical removal of obstructive material from central venous catheter |
36595 |
$1,063.00 |
$425.20 |
| Mechanical removal of tissue or obstructive material in central venous catheter |
36596 |
$305.00 |
$122.00 |
| Repositioning of central venous catheter using fluoroscopic guidance |
36597 |
$325.00 |
$130.00 |
| Contrast injections for X-ray imaging procedure to evaluate central venous access device |
36598 |
$505.00 |
$202.00 |
| Arterial puncture withdrawal of blood for diagnosis |
36600 |
$118.00 |
$47.20 |
| Insertion of arterial catheter for blood sampling or infusion, accessed through the skin |
36620 |
$282.00 |
$112.80 |
| Insertion of needle for infusion into bone |
36680 |
$277.00 |
$110.80 |
| Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation |
36901 |
$926.00 |
$370.40 |
| Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation |
36902 |
$6,352.00 |
$2,540.80 |
| Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation |
36903 |
$13,202.00 |
$5,280.80 |
| Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation |
36904 |
$6,352.00 |
$2,540.80 |
| Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation |
36905 |
$13,202.00 |
$5,280.80 |
| Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation |
36906 |
$20,011.00 |
$8,004.40 |
| Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation |
36907 |
$7,565.00 |
$3,026.00 |
| Insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation |
36908 |
$15,159.00 |
$6,063.60 |
| Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation |
36909 |
$12,188.00 |
$4,875.20 |
| Insertion of shunts to bypass blood flow to liver using imaging guidance |
37182 |
$7,546.00 |
$3,018.40 |
| Revision of shunts to bypass blood flow to liver using imaging guidance |
37183 |
$3,010.00 |
$1,204.00 |
| Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin |
37184 |
$6,175.00 |
$2,470.00 |
| Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin |
37185 |
$3,088.00 |
$1,235.20 |
| Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed beneath the skin |
37186 |
$4,281.00 |
$1,712.40 |
| Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance |
37187 |
$7,863.00 |
$3,145.20 |
| Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance |
37188 |
$4,890.00 |
$1,956.00 |
| Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation |
37191 |
$8,359.00 |
$3,343.60 |
| Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation |
37192 |
$2,958.00 |
$1,183.20 |
| Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation |
37193 |
$5,958.00 |
$2,383.20 |
| Retrieval of foreign body of blood vessels, accessed through the skin including radiological supervision and interpretation |
37197 |
$4,560.00 |
$1,824.00 |
| Biopsy of blood vessel via catheter |
37200 |
$1,338.00 |
$535.20 |
| Insertion of catheter into artery for drug infusion for blood clot including radiological supervision and interpretation |
37211 |
$2,558.00 |
$1,023.20 |
| Insertion of catheter into vein for drug infusion for blood clot including radiological supervision and interpretation |
37212 |
$2,558.00 |
$1,023.20 |
| Insertion of catheter into artery or vein for drug infusion for blood clot including radiological supervision and interpretation |
37213 |
$2,631.00 |
$1,052.40 |
| Removal of catheter in artery or vein including radiological supervision and interpretation |
37214 |
$5,049.00 |
$2,019.60 |
| Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin |
37215 |
$10,611.00 |
$4,244.40 |
| Insertion of stents in neck artery, open or accessed through the skin |
37216 |
$7,944.00 |
$3,177.60 |
| Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure |
37220 |
$12,704.00 |
$5,081.60 |
| Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure |
37220 |
$8,736.00 |
$3,494.40 |
| Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure |
37221 |
$27,211.00 |
$10,884.40 |
| Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure |
37221 |
$18,141.00 |
$7,256.40 |
| Balloon dilation of groin artery, endovascular, open, or percutaneous approach |
37222 |
$2,109.00 |
$843.60 |
| Balloon dilation of groin artery, endovascular, open, or percutaneous approach |
37222 |
$4,218.00 |
$1,687.20 |
| Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure |
37223 |
$13,931.00 |
$5,572.40 |
| Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure |
37223 |
$6,965.00 |
$2,786.00 |
| Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure |
37224 |
$18,760.00 |
$7,504.00 |
| Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure |
37224 |
$12,507.00 |
$5,002.80 |
| Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure |
37225 |
$20,549.00 |
$8,219.60 |
| Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure |
37225 |
$30,823.00 |
$12,329.20 |
| Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure |
37226 |
$23,508.00 |
$9,403.20 |
| Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure |
37226 |
$35,262.00 |
$14,104.80 |
| Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure |
37227 |
$43,652.00 |
$17,460.80 |
| Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure |
37227 |
$29,101.00 |
$11,640.40 |
| Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure |
37228 |
$11,908.00 |
$4,763.20 |
| Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure |
37228 |
$17,862.00 |
$7,144.80 |
| Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure |
37229 |
$26,406.00 |
$10,562.40 |
| Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure |
37229 |
$17,604.00 |
$7,041.60 |
| Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37230 |
$22,017.00 |
$8,806.80 |
| Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37230 |
$33,026.00 |
$13,210.40 |
| Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37231 |
$15,155.00 |
$6,062.00 |
| Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37231 |
$25,944.00 |
$10,377.60 |
| Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure |
37232 |
$8,170.00 |
$3,268.00 |
| Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure |
37232 |
$12,255.00 |
$4,902.00 |
| Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure |
37233 |
$11,864.00 |
$4,745.60 |
| Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure |
37233 |
$5,932.00 |
$2,372.80 |
| Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37234 |
$14,099.00 |
$5,639.60 |
| Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37234 |
$7,049.00 |
$2,819.60 |
| Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37235 |
$21,577.00 |
$8,630.80 |
| Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure |
37235 |
$10,788.00 |
$4,315.20 |
| Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation |
37236 |
$19,130.00 |
$7,652.00 |
| Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation |
37237 |
$9,586.00 |
$3,834.40 |
| Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation |
37238 |
$19,159.00 |
$7,663.60 |
| Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation |
37239 |
$9,542.00 |
$3,816.80 |
| Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance |
37241 |
$12,188.00 |
$4,875.20 |
| Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance |
37242 |
$12,188.00 |
$4,875.20 |
| Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance |
37243 |
$12,188.00 |
$4,875.20 |
| Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance |
37244 |
$13,263.00 |
$5,305.20 |
| Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation |
37246 |
$6,352.00 |
$2,540.80 |
| Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation |
37246 |
$9,528.00 |
$3,811.20 |
| Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation |
37247 |
$4,754.00 |
$1,901.60 |
| Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation |
37248 |
$9,528.00 |
$3,811.20 |
| Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation |
37248 |
$6,352.00 |
$2,540.80 |
| Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation |
37249 |
$4,754.00 |
$1,901.60 |
| Ultrasound evaluation of blood vessel during diagnosis or treatment |
37252 |
$1,745.00 |
$698.00 |
| Ultrasound evaluation of blood vessel during diagnosis or treatment |
37253 |
$1,408.00 |
$563.20 |
| Multiple incisions for removal of varicose veins of arm or leg |
37765 |
$2,835.00 |
$1,134.00 |
| Multiple incisions for removal of varicose veins of arm or leg |
37766 |
$3,618.00 |
$1,447.20 |
| Blood vessel procedure |
37799 |
$1,453.00 |
$581.20 |
| Bone marrow biopsy |
38221 |
$1,242.00 |
$496.80 |
| Bone marrow biopsy and aspiration |
38222 |
$291.00 |
$116.40 |
| Needle biopsy or removal of lymph nodes |
38505 |
$1,032.00 |
$412.80 |
| Injection of radioactive dye for X-ray identification of lymph node |
38792 |
$90.00 |
$36.00 |
| Lymph node procedure |
38999 |
$1,040.00 |
$416.00 |
| Insertion of needles, catheters, or devices into head and/or neck for radiation delivery |
41019 |
$2,291.00 |
$916.40 |
| Drainage of abscess of salivary gland |
42300 |
$1,813.00 |
$725.20 |
| Needle biopsy of salivary gland |
42400 |
$575.00 |
$230.00 |
| Insertion of stomach tube using an endoscope |
43246 |
$1,879.00 |
$751.60 |
| Dilation of esophagus |
43453 |
$908.00 |
$363.20 |
| Esophagus procedure |
43499 |
$328.00 |
$131.20 |
| Insertion of nasal or oral stomach tube using fluoroscopic guidance |
43752 |
$372.00 |
$148.80 |
| Repositioning of stomach feeding tube |
43761 |
$41.00 |
$16.40 |
| Replacement of stomach stoma tube accessed through skin |
43762 |
$314.00 |
$125.60 |
| Replacement of stomach stoma tube accessed through skin with revision of stoma opening |
43763 |
$314.00 |
$125.60 |
| Oral introduction of long drainage tube into small bowel |
44500 |
$416.00 |
$166.40 |
| Assessment and overseeing preparation of donor fecal specimen |
44705 |
$181.00 |
$72.40 |
| Small bowel procedure |
44799 |
$1,800.00 |
$720.00 |
| Dilation of rectum and large bowel using an endoscope |
45303 |
$1,280.00 |
$512.00 |
| Large bowel procedure |
45399 |
$1,011.00 |
$404.40 |
| Dilation of rectal scar tissue under anesthesia |
45910 |
$1,280.00 |
$512.00 |
| Needle biopsy of liver, accessed through the skin |
47000 |
$1,415.00 |
$566.00 |
| Destruction of 1 or more growths in liver, accessed through the skin |
47382 |
$2,869.00 |
$1,147.60 |
| Liver procedure |
47399 |
$474.00 |
$189.60 |
| Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation |
47490 |
$760.00 |
$304.00 |
| Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation |
47531 |
$526.00 |
$210.40 |
| Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation |
47532 |
$3,266.00 |
$1,306.40 |
| Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation |
47533 |
$3,266.00 |
$1,306.40 |
| Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation |
47534 |
$3,266.00 |
$1,306.40 |
| Conversion of external biliary drainage catheter to internal-external biliary drainage catheter accessed through the skin using imaging guidance with study of bile ducts and radiological supervision and interpretation |
47535 |
$3,266.00 |
$1,306.40 |
| Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation |
47536 |
$3,266.00 |
$1,306.40 |
| Removal of biliary drainage catheter, accessed through the skin using imaging guidance and radiological supervision and interpretation |
47537 |
$724.00 |
$289.60 |
| Placement of stent of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation |
47538 |
$6,177.00 |
$2,470.80 |
| Placement of stent of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation |
47539 |
$6,177.00 |
$2,470.80 |
| Placement of stent and drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation |
47540 |
$6,177.00 |
$2,470.80 |
| Placement of access device into biliary tract, accessed through the skin with imaging including radiological supervision and interpretation |
47541 |
$3,266.00 |
$1,306.40 |
| Balloon dilation of bile duct accessed through the skin using imaging guidance including radiological supervision and interpretation |
47542 |
$718.00 |
$287.20 |
| Biopsy of bile duct or liver duct accessed through the skin using imaging guidance with radiological supervision and interpretation |
47543 |
$1,047.00 |
$418.80 |
| Removal of biliary duct or gallbladder stone, accessed through the skin using imaging guidance and radiological supervision and interpretation |
47544 |
$393.00 |
$157.20 |
| Biopsy of bile ducts using an endoscope, accessed through the skin |
47553 |
$1,047.00 |
$418.80 |
| Dilation of bile ducts using an endoscope, accessed through the skin |
47555 |
$737.00 |
$294.80 |
| Dilation of bile ducts with stent insertion using an endoscope, accessed through the skin |
47556 |
$785.00 |
$314.00 |
| Insertion of stent into bile duct |
47801 |
$238.00 |
$95.20 |
| Bile duct procedure |
47999 |
$226.00 |
$90.40 |
| Needle biopsy of pancreas, accessed through the skin |
48102 |
$518.00 |
$207.20 |
| Drainage of fluid from abdominal cavity |
49082 |
$1,213.00 |
$485.20 |
| Drainage of fluid from abdominal cavity using imaging guidance |
49083 |
$1,710.00 |
$684.00 |
| Irrigation of abdominal cavity |
49084 |
$536.00 |
$214.40 |
| Needle biopsy of abdominal cavity growth, accessed through the skin |
49180 |
$1,027.00 |
$410.80 |
| Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation |
49185 |
$2,546.00 |
$1,018.40 |
| Injection of air or X-ray contrast material into abdominal cavity |
49400 |
$141.00 |
$56.40 |
| Fluid collection drainage by catheter using imaging guidance, accessed through the skin |
49405 |
$2,986.00 |
$1,194.40 |
| Fluid collection drainage by catheter using imaging guidance, accessed through the skin |
49406 |
$2,986.00 |
$1,194.40 |
| Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum |
49407 |
$1,044.00 |
$417.60 |
| Insertion of abdominal catheter through the skin using imaging guidance including radiological supervision and interpretation |
49418 |
$3,203.00 |
$1,281.20 |
| Insertion of abdominal cavity catheter for drainage or dialysis, open procedure |
49421 |
$1,970.00 |
$788.00 |
| Removal of abdominal cavity catheter |
49422 |
$1,223.00 |
$489.20 |
| Exchange of abdominal cavity drainage catheter using imaging guidance |
49423 |
$663.00 |
$265.20 |
| Injection of contrast through abdominal cavity catheter for X-ray study |
49424 |
$133.00 |
$53.20 |
| Insertion of shunt from jugular vein to abdominal cavity |
49425 |
$5,781.00 |
$2,312.40 |
| Revision of shunt from jugular vein to abdominal cavity |
49426 |
$4,384.00 |
$1,753.60 |
| Removal of shunt from jugular vein to abdominal cavity |
49429 |
$2,364.00 |
$945.60 |
| Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast |
49440 |
$554.00 |
$221.60 |
| Percutaneous insertion of small bowel tube (accessed through the skin) using fluoroscopic guidance with contrast |
49441 |
$1,441.00 |
$576.40 |
| Insertion of large bowel tube (accessed through the skin) using fluoroscopic guidance with contrast |
49442 |
$3,757.00 |
$1,502.80 |
| Conversion of stomach tube to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin |
49446 |
$1,300.00 |
$520.00 |
| Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin |
49450 |
$708.00 |
$283.20 |
| Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin |
49451 |
$748.00 |
$299.20 |
| Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin |
49452 |
$815.00 |
$326.00 |
| Mechanical removal of obstructive material in stomach, large, or small bowel tube using fluoroscopic guidance with contrast |
49460 |
$1,044.00 |
$417.60 |
| Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin |
49465 |
$158.00 |
$63.20 |
| Abdominal procedure |
49999 |
$2,028.00 |
$811.20 |
| Removal of kidney stone |
50060 |
$1,689.00 |
$675.60 |
| Needle biopsy of kidney, accessed through the skin |
50200 |
$1,309.00 |
$523.60 |
| Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin |
50382 |
$2,695.00 |
$1,078.00 |
| Removal of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin |
50384 |
$2,413.00 |
$965.20 |
| Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation |
50385 |
$3,580.00 |
$1,432.00 |
| Removal of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation |
50386 |
$393.00 |
$157.20 |
| Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation |
50387 |
$1,099.00 |
$439.60 |
| Removal of kidney drainage tube (ureter) using fluoroscopic guidance |
50389 |
$1,117.00 |
$446.80 |
| Aspiration and/or injection kidney cyst, accessed through the skin |
50390 |
$1,108.00 |
$443.20 |
| Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation |
50430 |
$1,181.00 |
$472.40 |
| Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation |
50430 |
$787.00 |
$314.80 |
| Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation |
50431 |
$787.00 |
$314.80 |
| Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation |
50431 |
$1,181.00 |
$472.40 |
| Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation |
50432 |
$2,260.00 |
$904.00 |
| Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation |
50432 |
$3,390.00 |
$1,356.00 |
| Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation |
50433 |
$3,390.00 |
$1,356.00 |
| Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation |
50433 |
$2,260.00 |
$904.00 |
| Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation |
50434 |
$787.00 |
$314.80 |
| Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation |
50434 |
$1,181.00 |
$472.40 |
| Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation |
50435 |
$787.00 |
$314.80 |
| Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation |
50435 |
$1,181.00 |
$472.40 |
| Enlargement of existing opening into urinary tract accessed through skin using imaging guidance |
50436 |
$2,362.00 |
$944.80 |
| Enlargement of existing opening into urinary tract accessed through skin and creation of new access into urine collecting system of kidney, using imaging guidance |
50437 |
$3,974.00 |
$1,589.60 |
| Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening |
50561 |
$1,420.00 |
$568.00 |
| Destruction of 1 or more growths in one kidney, accessed through the skin |
50592 |
$1,691.00 |
$676.40 |
| Destruction of growths in one kidney, accessed through the skin |
50593 |
$9,107.00 |
$3,642.80 |
| Destruction of growths in one kidney, accessed through the skin |
50593 |
$13,661.00 |
$5,464.40 |
| Injection of urinary duct (ureter) for X-ray imaging |
50684 |
$279.00 |
$111.60 |
| Change of tube or stent in urinary duct (ureter) |
50688 |
$1,033.00 |
$413.20 |
| Injection of bladder and urinary duct (ureter) for X-ray imaging |
50690 |
$430.00 |
$172.00 |
| Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation |
50693 |
$3,365.00 |
$1,346.00 |
| Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation |
50693 |
$5,048.00 |
$2,019.20 |
| Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation |
50694 |
$5,048.00 |
$2,019.20 |
| Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation |
50694 |
$3,365.00 |
$1,346.00 |
| Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation |
50695 |
$3,365.00 |
$1,346.00 |
| Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation |
50695 |
$5,048.00 |
$2,019.20 |
| Occlusion of urinary duct (ureter) using imaging guidance with radiological supervision and interpretation |
50705 |
$211.00 |
$84.40 |
| Occlusion of urinary duct (ureter) using imaging guidance with radiological supervision and interpretation |
50705 |
$317.00 |
$126.80 |
| Balloon dilation treatment of stricture of urinary duct (ureter) using imaging guidance with radiological supervision and interpretation |
50706 |
$211.00 |
$84.40 |
| Aspiration of bladder with insertion of bladder tube to skin surface |
51102 |
$232.00 |
$92.80 |
| Injection procedure for X-ray imaging of the bladder or during voiding |
51600 |
$350.00 |
$140.00 |
| Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging |
51610 |
$100.00 |
$40.00 |
| Bladder irrigation and/or instillation |
51700 |
$210.00 |
$84.00 |
| Insertion of temporary bladder catheter |
51701 |
$108.00 |
$43.20 |
| Insertion of indwelling bladder catheter |
51702 |
$120.00 |
$48.00 |
| Insertion of indwelling bladder catheter |
51703 |
$282.00 |
$112.80 |
| Removal of skin suture with change of bladder tube |
51705 |
$130.00 |
$52.00 |
| Bladder instillation of cancer preventive, inhibiting, or suppressive agent |
51720 |
$709.00 |
$283.60 |
| Needle measurement and recording of electrical activity of muscles at bladder and bowel openings |
51785 |
$656.00 |
$262.40 |
| Ultrasound measurement of bladder capacity after voiding |
51798 |
$62.00 |
$24.80 |
| Urinary system procedure |
53899 |
$211.00 |
$84.40 |
| Biopsy of vaginal mucous membrane |
57100 |
$560.00 |
$224.00 |
| Insertion of radiation therapy devices in vagina for radiation therapy |
57156 |
$374.00 |
$149.60 |
| Biopsy of uterine lining |
58100 |
$272.00 |
$108.80 |
| Introduction of saline or X-ray contrast material for X-ray imaging of the uterus and tubes |
58340 |
$386.00 |
$154.40 |
| Insertion of catheter through the cervix into fallopian tube |
58345 |
$554.00 |
$221.60 |
| Insertion of catheter through the cervix into fallopian tube |
58345 |
$1,108.00 |
$443.20 |
| Vaginal or abdominal biopsy of ovaries |
58900 |
$2,540.00 |
$1,016.00 |
| Female genital system (nonobstetric) procedure |
58999 |
$27.00 |
$10.80 |
| Fetal contraction stress test |
59020 |
$240.00 |
$96.00 |
| Fetal non-stress test |
59025 |
$358.00 |
$143.20 |
| Needle biopsy of thyroid, accessed through the skin |
60100 |
$266.00 |
$106.40 |
| Aspiration and/or injection of thyroid cyst |
60300 |
$53.00 |
$21.20 |
| Endocrine system procedure |
60699 |
$275.00 |
$110.00 |
| Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir |
61070 |
$720.00 |
$288.00 |
| Occlusion of abnormal artery, accessed through the skin |
61624 |
$5,244.00 |
$2,097.60 |
| Occlusion of head or neck artery, accessed through the skin |
61626 |
$1,673.00 |
$669.20 |
| Balloon dilation of blood vessel in head, accessed through the skin |
61630 |
$5,854.00 |
$2,341.60 |
| Removal of blood clot and injection to dissolve blood clot from head artery using fluoroscopic guidance, accessed through skin |
61645 |
$7,800.00 |
$3,120.00 |
| Infusion of chemical agent into the artery of brain with insertion of catheter and imaging |
61650 |
$2,571.00 |
$1,028.40 |
| Infusion of chemical agent into the artery of brain with insertion of catheter and imaging |
61651 |
$1,286.00 |
$514.40 |
| Diagnostic aspiration of spinal disc or tissue, accessed through the skin |
62267 |
$1,172.00 |
$468.80 |
| Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin |
62268 |
$118.00 |
$47.20 |
| Spinal tap for diagnosis |
62270 |
$1,009.00 |
$403.60 |
| Spinal tap with drainage of spinal fluid |
62272 |
$1,009.00 |
$403.60 |
| Injection of blood or blood clot into spinal canal |
62273 |
$1,763.00 |
$705.20 |
| Injection of dye for X-ray imaging and/or CT of lower spinal canal |
62284 |
$659.00 |
$263.60 |
| Aspiration of lower spine disc, accessed through the skin |
62287 |
$1,922.00 |
$768.80 |
| Injection of dye for X-ray imaging of spine disc |
62290 |
$331.00 |
$132.40 |
| X-ray of upper spinal canal with radiological supervision and interpretation |
62302 |
$1,311.00 |
$524.40 |
| X-ray of middle spinal canal with radiological supervision and interpretation |
62303 |
$1,235.00 |
$494.00 |
| Injection of substance into spinal canal of upper or middle back |
62320 |
$1,850.00 |
$740.00 |
| Injection of substance into spinal canal of upper or middle back using imaging guidance |
62321 |
$2,495.00 |
$998.00 |
| Injection of substance into spinal canal of upper or middle back using imaging guidance |
62321 |
$1,031.00 |
$412.40 |
| Injection of substance into spinal canal of upper or middle back using imaging guidance |
62321 |
$687.00 |
$274.80 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$1,850.00 |
$740.00 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$1,850.00 |
$740.00 |
| Injection into the lower back with help of imaging of some type |
62323 |
$687.00 |
$274.80 |
| Injection into the lower back with help of imaging of some type |
62323 |
$687.00 |
$274.80 |
| Injection into the lower back with help of imaging of some type |
62323 |
$1,031.00 |
$412.40 |
| Injection into the lower back with help of imaging of some type |
62323 |
$1,031.00 |
$412.40 |
| Injection into the lower back with help of imaging of some type |
62323 |
$2,495.00 |
$998.00 |
| Injection into the lower back with help of imaging of some type |
62323 |
$2,495.00 |
$998.00 |
| Insertion of indwelling catheter and administration of substance into spinal canal of upper or middle back |
62324 |
$2,210.00 |
$884.00 |
| Insertion of indwelling catheter and administration of substance into spinal canal of upper or middle back using imaging guidance |
62325 |
$2,279.00 |
$911.60 |
| Insertion of indwelling catheter and administration of substance into spinal canal of upper or middle back using imaging guidance |
62325 |
$1,298.00 |
$519.20 |
| Insertion of indwelling catheter and administration of substance into spinal canal of upper or middle back using imaging guidance |
62325 |
$865.00 |
$346.00 |
| Insertion of indwelling catheter and administration of substance into spinal canal of lower back |
62326 |
$2,210.00 |
$884.00 |
| Insertion of indwelling catheter and administration of substance into spinal canal of lower back lower back using imaging guidance |
62327 |
$2,279.00 |
$911.60 |
| Insertion of indwelling catheter and administration of substance into spinal canal of lower back lower back using imaging guidance |
62327 |
$1,298.00 |
$519.20 |
| Insertion of indwelling catheter and administration of substance into spinal canal of lower back lower back using imaging guidance |
62327 |
$865.00 |
$346.00 |
| Injection of anesthetic agent, trigeminal nerve |
64400 |
$789.00 |
$315.60 |
| Injection of anesthetic agent, trigeminal nerve |
64400 |
$1,184.00 |
$473.60 |
| Injection of anesthetic agent, greater occipital nerve |
64405 |
$1,451.00 |
$580.40 |
| Injection of anesthetic agent, greater occipital nerve |
64405 |
$967.00 |
$386.80 |
| Injection of anesthetic agent, brachial (arm) nerve bundle |
64415 |
$1,766.00 |
$706.40 |
| Injection of anesthetic agent, brachial (arm) nerve bundle |
64415 |
$1,177.00 |
$470.80 |
| Injection by continuous infusion of anesthetic agent, brachial (arm) nerve bundle |
64416 |
$2,836.00 |
$1,134.40 |
| Injection by continuous infusion of anesthetic agent, brachial (arm) nerve bundle |
64416 |
$1,891.00 |
$756.40 |
| Injection of anesthetic agent underarm (axillary) nerve |
64417 |
$1,112.00 |
$444.80 |
| Injection of anesthetic agent underarm (axillary) nerve |
64417 |
$1,668.00 |
$667.20 |
| Injection of anesthetic agent, collar bone nerve |
64418 |
$1,710.00 |
$684.00 |
| Injection of anesthetic agent, collar bone nerve |
64418 |
$1,140.00 |
$456.00 |
| Injection of anesthetic agent, of rib nerve |
64420 |
$1,427.00 |
$570.80 |
| Injection of anesthetic agent, of rib nerve |
64420 |
$2,141.00 |
$856.40 |
| Injection of anesthetic agent of multiple rib nerves |
64421 |
$1,850.00 |
$740.00 |
| Injection of anesthetic agent of multiple rib nerves |
64421 |
$2,775.00 |
$1,110.00 |
| Injection of anesthetic agent, groin nerves |
64425 |
$1,802.00 |
$720.80 |
| Injection of anesthetic agent, groin nerves |
64425 |
$1,201.00 |
$480.40 |
| Injection of anesthetic agent, pudendal (external genital) nerve |
64430 |
$784.00 |
$313.60 |
| Injection of anesthetic agent, sciatic nerve |
64445 |
$1,787.00 |
$714.80 |
| Injection of anesthetic agent, sciatic nerve |
64445 |
$2,681.00 |
$1,072.40 |
| Injection by continuous infusion of anesthetic agent, sciatic nerve |
64446 |
$1,898.00 |
$759.20 |
| Injection by continuous infusion of anesthetic agent, sciatic nerve |
64446 |
$2,847.00 |
$1,138.80 |
| Injection of anesthetic agent, thigh nerve |
64447 |
$1,073.00 |
$429.20 |
| Injection of anesthetic agent, thigh nerve |
64447 |
$1,610.00 |
$644.00 |
| Injection by continuous infusion of anesthetic agent, thigh nerve |
64448 |
$1,898.00 |
$759.20 |
| Injection by continuous infusion of anesthetic agent, thigh nerve |
64448 |
$2,847.00 |
$1,138.80 |
| Injection of anesthetic agent, other peripheral nerve or branch |
64450 |
$987.00 |
$394.80 |
| Injection of anesthetic agent, other peripheral nerve or branch |
64450 |
$1,481.00 |
$592.40 |
| Injection of anesthetic agent, thoracic vertebra |
64461 |
$878.00 |
$351.20 |
| Injection of anesthetic agent, thoracic vertebra |
64462 |
$439.00 |
$175.60 |
| Injection of anesthetic agent, thoracic vertebra |
64463 |
$878.00 |
$351.20 |
| Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance |
64479 |
$1,398.00 |
$559.20 |
| Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance |
64480 |
$1,248.00 |
$499.20 |
| Epidural steroid injections for lower back pain |
64483 |
$1,850.00 |
$740.00 |
| Epidural steroid injections for lower back pain |
64483 |
$2,775.00 |
$1,110.00 |
| Epidural steroid injections for lower back pain |
64483 |
$1,850.00 |
$740.00 |
| Epidural steroid injections for lower back pain |
64483 |
$2,775.00 |
$1,110.00 |
| Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance |
64484 |
$925.00 |
$370.00 |
| Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance |
64484 |
$1,388.00 |
$555.20 |
| Injections of upper or middle spine facet joint using imaging guidance |
64490 |
$1,850.00 |
$740.00 |
| Injections of upper or middle spine facet joint using imaging guidance |
64490 |
$2,775.00 |
$1,110.00 |
| Injections of upper or middle spine facet joint using imaging guidance |
64491 |
$925.00 |
$370.00 |
| Injections of upper or middle spine facet joint using imaging guidance |
64491 |
$1,388.00 |
$555.20 |
| Injections of upper or middle spine facet joint using imaging guidance |
64492 |
$1,388.00 |
$555.20 |
| Injections of upper or middle spine facet joint using imaging guidance |
64492 |
$925.00 |
$370.00 |
| Injections of lower or sacral spine facet joint using imaging guidance |
64493 |
$1,850.00 |
$740.00 |
| Injections of lower or sacral spine facet joint using imaging guidance |
64493 |
$2,775.00 |
$1,110.00 |
| Injections of lower or sacral spine facet joint using imaging guidance |
64494 |
$925.00 |
$370.00 |
| Injections of lower or sacral spine facet joint using imaging guidance |
64494 |
$1,388.00 |
$555.20 |
| Injections of lower or sacral spine facet joint using imaging guidance |
64495 |
$925.00 |
$370.00 |
| Injections of lower or sacral spine facet joint using imaging guidance |
64495 |
$1,388.00 |
$555.20 |
| Injection of anesthetic agent, trigeminal nerve bundle |
64505 |
$1,443.00 |
$577.20 |
| Injection of anesthetic agent, trigeminal nerve bundle |
64505 |
$962.00 |
$384.80 |
| Injection of anesthetic agent, sympathetic nerve bundle |
64510 |
$2,775.00 |
$1,110.00 |
| Injection of anesthetic agent, sympathetic nerve bundle |
64510 |
$1,850.00 |
$740.00 |
| Injection of anesthetic agent, middle or lower spine sympathetic nerves |
64520 |
$1,578.00 |
$631.20 |
| Injection of anesthetic agent, abdominal sympathetic nerve bundle |
64530 |
$2,775.00 |
$1,110.00 |
| Injection of anesthetic agent, abdominal sympathetic nerve bundle |
64530 |
$1,850.00 |
$740.00 |
| Injection of agent to destroy rib nerve |
64620 |
$1,786.00 |
$714.40 |
| Destruction of pudendal (external genital) nerve |
64630 |
$1,379.00 |
$551.60 |
| Destruction of pudendal (external genital) nerve |
64630 |
$919.00 |
$367.60 |
| Destruction of upper or middle spinal facet joint nerves using imaging guidance |
64633 |
$2,495.00 |
$998.00 |
| Destruction of upper or middle spinal facet joint nerves using imaging guidance |
64633 |
$3,743.00 |
$1,497.20 |
| Destruction of upper or middle spinal facet joint nerves with imaging guidance |
64634 |
$925.00 |
$370.00 |
| Destruction of upper or middle spinal facet joint nerves with imaging guidance |
64634 |
$1,388.00 |
$555.20 |
| Destruction of lower or sacral spinal facet joint nerves using imaging guidance |
64635 |
$6,006.00 |
$2,402.40 |
| Destruction of lower or sacral spinal facet joint nerves using imaging guidance |
64635 |
$4,004.00 |
$1,601.60 |
| Destruction of lower or sacral spinal facet joint nerves with imaging guidance |
64636 |
$925.00 |
$370.00 |
| Destruction of lower or sacral spinal facet joint nerves with imaging guidance |
64636 |
$1,388.00 |
$555.20 |
| Injection of agent to destroy abdominal sympathetic nerve bundle |
64680 |
$1,181.00 |
$472.40 |
| Nervous system procedure |
64999 |
$258.00 |
$103.20 |
| Fine needle aspiration of orbital contents |
67415 |
$2,052.00 |
$820.80 |
| Removal of impacted ear wax by washing |
69209 |
$114.00 |
$45.60 |
| X-ray of eye |
70030 |
$211.00 |
$84.40 |
| X-ray of eye |
70030 |
$105.00 |
$42.00 |
| X-ray of mandible, less than 4 views |
70100 |
$162.00 |
$64.80 |
| X-ray of mandible, minimum of 4 views |
70110 |
$194.00 |
$77.60 |
| X-ray of mastoid, less than 3 views per side |
70120 |
$177.00 |
$70.80 |
| X-ray of internal ear canal |
70134 |
$460.00 |
$184.00 |
| X-ray of bones of face, less than 3 views |
70140 |
$102.00 |
$40.80 |
| X-ray of bones of face, minimum of 3 views |
70150 |
$197.00 |
$78.80 |
| X-ray of bones of nose, minimum of 3 views |
70160 |
$149.00 |
$59.60 |
| X-ray of eye bones, minimum of 4 views |
70200 |
$164.00 |
$65.60 |
| X-ray of paranasal sinus, less than 3 views |
70210 |
$254.00 |
$101.60 |
| X-ray of paranasal sinus, complete, minimum of 3 views |
70220 |
$447.00 |
$178.80 |
| X-ray of bone at base of skull |
70240 |
$132.00 |
$52.80 |
| X-ray of skull, less than 4 views |
70250 |
$133.00 |
$53.20 |
| X-ray of skull, complete, minimum of 4 views |
70260 |
$282.00 |
$112.80 |
| X-ray of jaw joint on one side of the face |
70328 |
$246.00 |
$98.40 |
| X-ray of jaw joints on both sides of the face |
70330 |
$384.00 |
$153.60 |
| MRI scan of jaw joints |
70336 |
$626.00 |
$250.40 |
| X-ray imaging of teeth |
70355 |
$255.00 |
$102.00 |
| X-ray of soft tissue of neck |
70360 |
$282.00 |
$112.80 |
| CT scan of the head or brain without contrast or dye |
70450 |
$327.00 |
$130.80 |
| CT scan of the head or brain without contrast or dye |
70450 |
$327.00 |
$130.80 |
| CT scan head or brain with contrast |
70460 |
$341.00 |
$136.40 |
| CT scan head or brain before and after contrast |
70470 |
$341.00 |
$136.40 |
| CT scan of cranial cavity |
70480 |
$327.00 |
$130.80 |
| CT scan of cranial cavity with contrast |
70481 |
$520.00 |
$208.00 |
| CT scan of cranial cavity before and after contrast |
70482 |
$574.00 |
$229.60 |
| CT scan of face |
70486 |
$327.00 |
$130.80 |
| CT scan of face with contrast |
70487 |
$341.00 |
$136.40 |
| CT scan of face before and after contrast |
70488 |
$354.00 |
$141.60 |
| CT scan of neck |
70490 |
$327.00 |
$130.80 |
| CT scan of neck with contrast |
70491 |
$341.00 |
$136.40 |
| CT scan of neck before and after contrast |
70492 |
$412.00 |
$164.80 |
| CT scan of blood vessel of head with contrast |
70496 |
$517.00 |
$206.80 |
| CT scan of neck blood vessels with contrast |
70498 |
$515.00 |
$206.00 |
| MRI scan bones of the eye, face, and/or neck |
70540 |
$513.00 |
$205.20 |
| MRI scan bones of the eye, face, and/or neck with contrast |
70542 |
$606.00 |
$242.40 |
| MRI scan bones of the eye, face, and/or neck before and after contrast |
70543 |
$749.00 |
$299.60 |
| MRA scan of head blood vessels |
70544 |
$671.00 |
$268.40 |
| MRA scan of head blood vessels with contrast |
70545 |
$667.00 |
$266.80 |
| MRA scan of head blood vessels before and after contrast |
70546 |
$1,034.00 |
$413.60 |
| MRA scan of neck blood vessels |
70547 |
$671.00 |
$268.40 |
| MRA scan of neck blood vessels with contrast |
70548 |
$717.00 |
$286.80 |
| MRA scan of neck blood vessels before and after contrast |
70549 |
$1,041.00 |
$416.40 |
| MRI scan brain |
70551 |
$493.00 |
$197.20 |
| MRI scan of brain with contrast |
70552 |
$583.00 |
$233.20 |
| MRI scan of the brain with and without contrast |
70553 |
$665.00 |
$266.00 |
| MRI scan of the brain with and without contrast |
70553 |
$665.00 |
$266.00 |
| X-ray of chest, 1 view |
71045 |
$316.00 |
$126.40 |
| X-ray of the chest, 2 views |
71046 |
$388.00 |
$155.20 |
| X-ray of the chest, 2 views |
71046 |
$388.00 |
$155.20 |
| X-ray of chest, 3 views |
71047 |
$406.00 |
$162.40 |
| X-ray of chest, minimum of 4 views |
71048 |
$438.00 |
$175.20 |
| X-ray of ribs of one side of body, 2 views |
71100 |
$152.00 |
$60.80 |
| X-ray of ribs on one side of body including the chest, minimum of 3 views |
71101 |
$244.00 |
$97.60 |
| X-ray of both sides of the ribs, 3 views |
71110 |
$255.00 |
$102.00 |
| X-ray of both sides of the ribs including the chest, minimum of 4 views |
71111 |
$273.00 |
$109.20 |
| X-ray of breast bone, minimum of 2 views |
71120 |
$143.00 |
$57.20 |
| X-ray of junction of breast and collar bones, minimum of 2 views |
71130 |
$85.00 |
$34.00 |
| CT scan chest |
71250 |
$327.00 |
$130.80 |
| CT scan chest with contrast |
71260 |
$341.00 |
$136.40 |
| CT scan chest before and after contrast |
71270 |
$418.00 |
$167.20 |
| CT scan of blood vessels in chest with contrast |
71275 |
$526.00 |
$210.40 |
| MRI scan of chest |
71550 |
$671.00 |
$268.40 |
| MRI scan of chest with contrast |
71551 |
$935.00 |
$374.00 |
| MRI scan of chest before and after contrast |
71552 |
$1,122.00 |
$448.80 |
| MRI scan of blood vessels of chest |
71555 |
$671.00 |
$268.40 |
| MRI scan of blood vessels of chest |
71555 |
$782.00 |
$312.80 |
| X-ray of spine, 1 view |
72020 |
$196.00 |
$78.40 |
| X-ray of spine of neck, 2 or 3 views |
72040 |
$273.00 |
$109.20 |
| X-ray of upper spine, 4 or 5 views |
72050 |
$381.00 |
$152.40 |
| X-ray of upper spine, 6 or more views |
72052 |
$429.00 |
$171.60 |
| X-ray of middle spine, 3 views |
72070 |
$287.00 |
$114.80 |
| X-ray of middle spine, 3 views |
72072 |
$324.00 |
$129.60 |
| X-ray of middle and lower spine, 2 views |
72080 |
$269.00 |
$107.60 |
| X-ray of spine, 2 or 3 views |
72082 |
$305.00 |
$122.00 |
| X-ray of spine, 4 or 5 views |
72083 |
$350.00 |
$140.00 |
| X-ray of spine, minimum of 6 views |
72084 |
$382.00 |
$152.80 |
| X-ray of lower and sacral spine, 2 or 3 views |
72100 |
$491.00 |
$196.40 |
| X-ray of the lower spine with 4 or more views |
72110 |
$702.00 |
$280.80 |
| X-ray of the lower spine with 4 or more views |
72110 |
$702.00 |
$280.80 |
| X-ray lower and sacral spine including bending views minimum 6 views |
72114 |
$776.00 |
$310.40 |
| X-ray lower and sacral spine including bending views 2 or 3 views |
72120 |
$544.00 |
$217.60 |
| CT scan of upper spine |
72125 |
$327.00 |
$130.80 |
| CT scan of upper spine with contrast |
72126 |
$420.00 |
$168.00 |
| CT scan of upper spine before and after contrast |
72127 |
$521.00 |
$208.40 |
| CT scan of middle spine |
72128 |
$327.00 |
$130.80 |
| CT scan of middle spine with contrast |
72129 |
$422.00 |
$168.80 |
| CT scan of lower spine |
72131 |
$327.00 |
$130.80 |
| CT scan of lower spine with contrast |
72132 |
$420.00 |
$168.00 |
| CT scan of lower spine before and after contrast |
72133 |
$518.00 |
$207.20 |
| MRI scan of upper spinal canal |
72141 |
$493.00 |
$197.20 |
| MRI scan of upper spinal canal with contrast |
72142 |
$597.00 |
$238.80 |
| MRI scan of middle spinal canal |
72146 |
$493.00 |
$197.20 |
| MRI scan of middle spinal canal with contrast |
72147 |
$592.00 |
$236.80 |
| MRI scan of lower spinal canal |
72148 |
$493.00 |
$197.20 |
| MRI scan of lower spinal canal with contrast |
72149 |
$586.00 |
$234.40 |
| MRI scan of upper spinal canal before and after contrast |
72156 |
$670.00 |
$268.00 |
| MRI scan of middle spinal canal before and after contrast |
72157 |
$672.00 |
$268.80 |
| MRI scan of lower spinal canal before and after contrast |
72158 |
$667.00 |
$266.80 |
| X-ray of pelvis, 1 or 2 views |
72170 |
$206.00 |
$82.40 |
| X-ray of pelvis, minimum of 3 views |
72190 |
$270.00 |
$108.00 |
| CT scan of pelvic blood vessels with contrast |
72191 |
$542.00 |
$216.80 |
| CT scan pelvis |
72192 |
$327.00 |
$130.80 |
| CT scan of the pelvis with contrast or dye |
72193 |
$422.00 |
$168.80 |
| CT scan of the pelvis with contrast or dye |
72193 |
$422.00 |
$168.80 |
| CT scan of pelvis before and after contrast |
72194 |
$501.00 |
$200.40 |
| MRI scan of pelvis |
72195 |
$614.00 |
$245.60 |
| MRI scan of pelvis with contrast |
72196 |
$658.00 |
$263.20 |
| MRI scan of pelvis before and after contrast |
72197 |
$797.00 |
$318.80 |
| MRA scan of pelvic blood vessels |
72198 |
$671.00 |
$268.40 |
| MRA scan of pelvic blood vessels |
72198 |
$786.00 |
$314.40 |
| X-ray of sacroiliac joints, less than 3 views |
72200 |
$140.00 |
$56.00 |
| X-ray of pelvis, minimum of 2 views |
72220 |
$309.00 |
$123.60 |
| Radiological supervision and interpretation X-ray of upper spinal canal |
72240 |
$1,311.00 |
$524.40 |
| Radiological supervision and interpretation X-ray of middle spinal canal |
72255 |
$1,235.00 |
$494.00 |
| Radiological supervision and interpretation X-ray of lower spinal canal |
72265 |
$1,243.00 |
$497.20 |
| Radiological supervision and interpretation X-ray of spinal canal, 2 or more spinal regions |
72270 |
$1,547.00 |
$618.80 |
| Radiological supervision and interpretation X-ray of disc of vertebra, upper or middle spine |
72285 |
$1,714.00 |
$685.60 |
| Radiological supervision and interpretation X-ray of disc of vertebra, lower spine |
72295 |
$1,604.00 |
$641.60 |
| X-ray of collar bone |
73000 |
$137.00 |
$54.80 |
| X-ray of collar bone |
73000 |
$274.00 |
$109.60 |
| X-ray of shoulder blade |
73010 |
$125.00 |
$50.00 |
| X-ray of shoulder blade |
73010 |
$249.00 |
$99.60 |
| X-ray of shoulder, 1 view |
73020 |
$474.00 |
$189.60 |
| X-ray of shoulder, 1 view |
73020 |
$237.00 |
$94.80 |
| X-ray of shoulder, minimum of 2 views |
73030 |
$320.00 |
$128.00 |
| X-ray of shoulder, minimum of 2 views |
73030 |
$640.00 |
$256.00 |
| Radiological supervision and interpretation X-ray of shoulder joint |
73040 |
$1,472.00 |
$588.80 |
| Radiological supervision and interpretation X-ray of shoulder joint |
73040 |
$736.00 |
$294.40 |
| X-ray of both collar bones |
73050 |
$130.00 |
$52.00 |
| X-ray of upper arm, minimum of 2 views |
73060 |
$132.00 |
$52.80 |
| X-ray of upper arm, minimum of 2 views |
73060 |
$264.00 |
$105.60 |
| X-ray of elbow, 2 views |
73070 |
$96.00 |
$38.40 |
| X-ray of elbow, 2 views |
73070 |
$192.00 |
$76.80 |
| Radiological supervision and interpretation X-ray of elbow |
73085 |
$233.00 |
$93.20 |
| X-ray of forearm, 2 views |
73090 |
$571.00 |
$228.40 |
| X-ray of forearm, 2 views |
73090 |
$286.00 |
$114.40 |
| X-ray of arm in infant minimum of 2 views |
73092 |
$204.00 |
$81.60 |
| X-ray of arm in infant minimum of 2 views |
73092 |
$102.00 |
$40.80 |
| X-ray of wrist, 2 views |
73100 |
$140.00 |
$56.00 |
| X-ray of wrist, 2 views |
73100 |
$280.00 |
$112.00 |
| X-ray of wrist, minimum of 3 views |
73110 |
$320.00 |
$128.00 |
| X-ray of wrist, minimum of 3 views |
73110 |
$160.00 |
$64.00 |
| Radiological supervision and interpretation X-ray of wrist joint |
73115 |
$468.00 |
$187.20 |
| Radiological supervision and interpretation X-ray of wrist joint |
73115 |
$936.00 |
$374.40 |
| X-ray of hand, 2 views |
73120 |
$452.00 |
$180.80 |
| X-ray of hand, 2 views |
73120 |
$226.00 |
$90.40 |
| X-ray of hand, minimum of 3 views |
73130 |
$281.00 |
$112.40 |
| X-ray of hand, minimum of 3 views |
73130 |
$561.00 |
$224.40 |
| X-ray of fingers, minimum of 2 views |
73140 |
$219.00 |
$87.60 |
| CT scan of arm |
73200 |
$327.00 |
$130.80 |
| CT scan of arm with contrast |
73201 |
$414.00 |
$165.60 |
| CT scan of arm before and after contrast |
73202 |
$546.00 |
$218.40 |
| CT scan of arm blood vessels with contrast |
73206 |
$600.00 |
$240.00 |
| MRI scan of arm |
73218 |
$671.00 |
$268.40 |
| MRI scan of arm |
73218 |
$1,342.00 |
$536.80 |
| MRI scan of arm with contrast |
73219 |
$812.00 |
$324.80 |
| MRI scan of arm with contrast |
73219 |
$1,624.00 |
$649.60 |
| MRI scan of arm before and after contrast |
73220 |
$1,978.00 |
$791.20 |
| MRI scan of arm before and after contrast |
73220 |
$989.00 |
$395.60 |
| MRI scan of arm joint |
73221 |
$493.00 |
$197.20 |
| MRI scan of arm joint |
73221 |
$986.00 |
$394.40 |
| MRI scan of arm joint with contrast |
73222 |
$751.00 |
$300.40 |
| MRI scan of arm joint with contrast |
73222 |
$1,502.00 |
$600.80 |
| MRI scan of arm joint before and after contrast |
73223 |
$915.00 |
$366.00 |
| MRI scan of arm joint before and after contrast |
73223 |
$1,830.00 |
$732.00 |
| MRA scan of arm blood vessels |
73225 |
$671.00 |
$268.40 |
| MRA scan of arm blood vessels |
73225 |
$1,626.00 |
$650.40 |
| MRA scan of arm blood vessels |
73225 |
$1,342.00 |
$536.80 |
| MRA scan of arm blood vessels |
73225 |
$813.00 |
$325.20 |
| X-ray of hip with pelvis, 1 view |
73501 |
$170.00 |
$68.00 |
| X-ray of hip with pelvis, 2-3 views |
73502 |
$326.00 |
$130.40 |
| X-ray of both hips with pelvis, 2 views |
73521 |
$387.00 |
$154.80 |
| X-ray of both hips with pelvis, 3-4 views |
73522 |
$314.00 |
$125.60 |
| Radiological supervision and interpretation X-ray of hip joint |
73525 |
$1,398.00 |
$559.20 |
| Radiological supervision and interpretation X-ray of hip joint |
73525 |
$699.00 |
$279.60 |
| X-ray of femur, minimum 2 views |
73552 |
$132.00 |
$52.80 |
| X-ray of femur, minimum 2 views |
73552 |
$264.00 |
$105.60 |
| X-ray of knee, 1 or 2 views |
73560 |
$300.00 |
$120.00 |
| X-ray of knee, 1 or 2 views |
73560 |
$150.00 |
$60.00 |
| X-ray of knee, 3 views |
73562 |
$167.00 |
$66.80 |
| X-ray of knee, 3 views |
73562 |
$334.00 |
$133.60 |
| X-ray of knee, 4 or more views |
73564 |
$204.00 |
$81.60 |
| X-ray of knee, 4 or more views |
73564 |
$408.00 |
$163.20 |
| Radiological supervision and interpretation X-ray of knee joint |
73580 |
$498.00 |
$199.20 |
| X-ray of lower leg, 2 views |
73590 |
$167.00 |
$66.80 |
| X-ray of lower leg, 2 views |
73590 |
$334.00 |
$133.60 |
| X-ray of leg in infant minimum of 2 views |
73592 |
$334.00 |
$133.60 |
| X-ray of leg in infant minimum of 2 views |
73592 |
$167.00 |
$66.80 |
| X-ray of ankle, 2 views |
73600 |
$484.00 |
$193.60 |
| X-ray of ankle, 2 views |
73600 |
$242.00 |
$96.80 |
| X-ray of ankle, minimum of 3 views |
73610 |
$294.00 |
$117.60 |
| X-ray of ankle, minimum of 3 views |
73610 |
$587.00 |
$234.80 |
| Radiological supervision and interpretation X-ray of ankle joint |
73615 |
$426.00 |
$170.40 |
| X-ray of foot, 2 views |
73620 |
$260.00 |
$104.00 |
| X-ray of foot, 2 views |
73620 |
$130.00 |
$52.00 |
| X-ray of foot, minimum of 3 views |
73630 |
$167.00 |
$66.80 |
| X-ray of foot, minimum of 3 views |
73630 |
$334.00 |
$133.60 |
| X-ray of heel, minimum of 2 views |
73650 |
$139.00 |
$55.60 |
| X-ray of heel, minimum of 2 views |
73650 |
$278.00 |
$111.20 |
| X-ray of toes, minimum of 2 views |
73660 |
$211.00 |
$84.40 |
| CT scan leg |
73700 |
$327.00 |
$130.80 |
| CT scan leg with contrast injection |
73701 |
$422.00 |
$168.80 |
| CT scan of leg before and after contrast injection |
73702 |
$537.00 |
$214.80 |
| MRI scan of leg |
73718 |
$1,206.00 |
$482.40 |
| MRI scan of leg |
73718 |
$603.00 |
$241.20 |
| MRI scan of leg with contrast |
73719 |
$1,316.00 |
$526.40 |
| MRI scan of leg with contrast |
73719 |
$658.00 |
$263.20 |
| MRI scan of leg before and after contrast |
73720 |
$802.00 |
$320.80 |
| MRI scan of leg before and after contrast |
73720 |
$1,604.00 |
$641.60 |
| MRI scan of leg joint |
73721 |
$493.00 |
$197.20 |
| MRI scan of leg joint |
73721 |
$986.00 |
$394.40 |
| MRI scan of leg joint with contrast |
73722 |
$1,514.00 |
$605.60 |
| MRI scan of leg joint with contrast |
73722 |
$757.00 |
$302.80 |
| MRI scan of leg joint before and after contrast |
73723 |
$914.00 |
$365.60 |
| MRI scan of leg joint before and after contrast |
73723 |
$1,828.00 |
$731.20 |
| MRA scan of leg blood vessels |
73725 |
$784.00 |
$313.60 |
| MRA scan of leg blood vessels |
73725 |
$1,342.00 |
$536.80 |
| MRA scan of leg blood vessels |
73725 |
$1,568.00 |
$627.20 |
| X-ray of abdomen, 1 view |
74018 |
$354.00 |
$141.60 |
| X-ray of abdomen, 2 views |
74019 |
$448.00 |
$179.20 |
| X-ray of abdomen, minimum of 3 views |
74021 |
$453.00 |
$181.20 |
| Imaging of abdomen and chest |
74022 |
$604.00 |
$241.60 |
| CT scan abdomen |
74150 |
$327.00 |
$130.80 |
| CT scan of the abdomen with contrast or dye |
74160 |
$421.00 |
$168.40 |
| CT scan of the abdomen with contrast or dye |
74160 |
$421.00 |
$168.40 |
| CT scan abdomen before and after contrast |
74170 |
$484.00 |
$193.60 |
| CT scan of abdominal and pelvic blood vessels with contrast |
74174 |
$2,223.00 |
$889.20 |
| CT scan of abdominal blood vessels with contrast |
74175 |
$545.00 |
$218.00 |
| CT scan of abdomen and pelvis |
74176 |
$341.00 |
$136.40 |
| CT scan of abdomen and pelvis with contrast |
74177 |
$554.00 |
$221.60 |
| CT scan of abdomen and pelvis before and after contrast |
74178 |
$636.00 |
$254.40 |
| MRI scan of abdomen |
74181 |
$528.00 |
$211.20 |
| MRI scan of abdomen with contrast |
74182 |
$747.00 |
$298.80 |
| MRI scan of abdomen before and after contrast |
74183 |
$799.00 |
$319.60 |
| MRI scan of blood vessels of abdomen |
74185 |
$791.00 |
$316.40 |
| MRI scan of blood vessels of abdomen |
74185 |
$671.00 |
$268.40 |
| Radiological supervision and interpretation X-ray of lower abdominal and genital region |
74190 |
$689.00 |
$275.60 |
| X-ray of esophagus |
74220 |
$539.00 |
$215.60 |
| Imaging for evaluation of swallowing function |
74230 |
$535.00 |
$214.00 |
| Radiological supervision and interpretation of removal of foreign bodies in esophagus with balloon catheter |
74235 |
$500.00 |
$200.00 |
| X-ray of upper digestive tract |
74240 |
$624.00 |
$249.60 |
| X-ray upper GI series, with small bowel films |
74245 |
$944.00 |
$377.60 |
| X-ray of upper digestive tract with contrast |
74246 |
$706.00 |
$282.40 |
| X-ray of upper digestive tract with contrast followed by x-ray of small bowel at later point |
74249 |
$1,268.00 |
$507.20 |
| X-ray of small intestine |
74250 |
$616.00 |
$246.40 |
| X-ray of small intestine by small bowel tube |
74251 |
$780.00 |
$312.00 |
| X-ray of large bowel with contrast |
74270 |
$774.00 |
$309.60 |
| X-ray of large bowel with contrast |
74280 |
$1,006.00 |
$402.40 |
| Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery |
74300 |
$255.00 |
$102.00 |
| Radiological supervision and interpretation of insertion of catheter into biliary duct using an endoscope |
74328 |
$934.00 |
$373.60 |
| Radiological supervision and interpretation of placement of long small bowel tube procedure |
74340 |
$488.00 |
$195.20 |
| Radiological supervision and interpretation of placement (accessed through the skin) of small bowel tube |
74355 |
$207.00 |
$82.80 |
| Radiological supervision and interpretation of opening of digestive tract procedure |
74360 |
$248.00 |
$99.20 |
| Radiological supervision and interpretation of dilation of biliary duct (accessed through the skin) |
74363 |
$492.00 |
$196.80 |
| Imaging of urinary tract using infusion technique |
74410 |
$598.00 |
$239.20 |
| Imaging of urinary tract using infusion technique with kidney section filming |
74415 |
$558.00 |
$223.20 |
| Imaging of urinary tract |
74420 |
$501.00 |
$200.40 |
| Radiological supervision and interpretation X-ray of urinary tract |
74425 |
$501.00 |
$200.40 |
| Radiological supervision and interpretation X-ray of urinary tract |
74425 |
$1,003.00 |
$401.20 |
| Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views |
74430 |
$564.00 |
$225.60 |
| Radiological supervision and interpretation X-ray of urinary bladder and urethra |
74450 |
$532.00 |
$212.80 |
| Radiological supervision and interpretation X-ray of urinary bladder and urethra |
74455 |
$676.00 |
$270.40 |
| Radiological supervision and interpretation X-ray of kidney cyst, lower back contrast injection |
74470 |
$580.00 |
$232.00 |
| Radiological supervision and interpretation of dilation of urinary ducts (ureters) or bladder canal (urethra) |
74485 |
$1,669.00 |
$667.60 |
| Radiological supervision and interpretation of dilation of urinary ducts (ureters) or bladder canal (urethra) |
74485 |
$1,821.00 |
$728.40 |
| Radiological supervision and interpretation X-ray of uterine tubes and ovaries |
74740 |
$695.00 |
$278.00 |
| Radiological supervision and interpretation of placement of catheter of uterine tube procedure |
74742 |
$324.00 |
$129.60 |
| Radiological supervision and interpretation of placement of catheter of uterine tube procedure |
74742 |
$648.00 |
$259.20 |
| MRI of heart |
75557 |
$538.00 |
$215.20 |
| MRI of heart before and after contrast |
75561 |
$772.00 |
$308.80 |
| CT scan of heart with evaluation of blood vessel calcium |
75571 |
$181.00 |
$72.40 |
| CT scan of heart blood vessels and grafts with contrast dye |
75574 |
$587.00 |
$234.80 |
| Radiological supervision and interpretation X-ray of chest aorta |
75605 |
$4,392.00 |
$1,756.80 |
| Radiological supervision and interpretation X-ray of abdominal aorta |
75625 |
$2,523.00 |
$1,009.20 |
| Radiological supervision and interpretation X-ray of abdominal aorta and both leg arteries |
75630 |
$4,140.00 |
$1,656.00 |
| CT scan of abdominal aorta and both leg arteries with contrast |
75635 |
$587.00 |
$234.80 |
| Radiological supervision and interpretation of imaging of spinal artery |
75705 |
$4,948.00 |
$1,979.20 |
| Radiological supervision and interpretation of imaging of artery of one arm or leg |
75710 |
$3,770.00 |
$1,508.00 |
| Radiological supervision and interpretation of imaging of arteries of both arms or legs |
75716 |
$4,492.00 |
$1,796.80 |
| Radiological supervision and interpretation of imaging of abdominal artery |
75726 |
$5,400.00 |
$2,160.00 |
| Radiological supervision and interpretation of imaging of artery of one adrenal gland |
75731 |
$3,951.00 |
$1,580.40 |
| Radiological supervision and interpretation of imaging of artery of pelvis |
75736 |
$4,049.00 |
$1,619.60 |
| Radiological supervision and interpretation of imaging of artery of one lung |
75741 |
$3,240.00 |
$1,296.00 |
| Radiological supervision and interpretation of imaging of arteries of both lungs |
75743 |
$4,634.00 |
$1,853.60 |
| Radiological supervision and interpretation of imaging of lung artery, contrast inserted by catheter or injection into vein |
75746 |
$2,252.00 |
$900.80 |
| Radiological supervision and interpretation of imaging of artery of breast |
75756 |
$2,589.00 |
$1,035.60 |
| Radiological supervision and interpretation of imaging of artery |
75774 |
$1,895.00 |
$758.00 |
| Radiological supervision and interpretation of imaging of artery |
75774 |
$2,515.00 |
$1,006.00 |
| Radiological supervision and interpretation of imaging of previous placed shunt |
75809 |
$538.00 |
$215.20 |
| Radiological supervision and interpretation X-ray of vein of spleen and liver |
75810 |
$993.00 |
$397.20 |
| Radiological supervision and interpretation of imaging of vein of one arm or leg |
75820 |
$974.00 |
$389.60 |
| Radiological supervision and interpretation of imaging of veins of both arms or legs |
75822 |
$1,988.00 |
$795.20 |
| Radiological supervision and interpretation of imaging of major abdominal vein |
75825 |
$501.00 |
$200.40 |
| Radiological supervision and interpretation of imaging of major chest vein |
75827 |
$2,250.00 |
$900.00 |
| Radiological supervision and interpretation of imaging of vein of one kidney |
75831 |
$2,810.00 |
$1,124.00 |
| Radiological supervision and interpretation of imaging of vein of both kidneys |
75833 |
$3,300.00 |
$1,320.00 |
| Radiological supervision and interpretation of imaging of vein system in head or neck vein |
75860 |
$2,939.00 |
$1,175.60 |
| Radiological supervision and interpretation of imaging of vein system in head or neck vein |
75860 |
$2,672.00 |
$1,068.80 |
| Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow, injection of contrast (accessed through the skin) |
75885 |
$3,443.00 |
$1,377.20 |
| Radiological supervision and interpretation of imaging of liver vein, injection of contrast (accessed through the skin) |
75887 |
$738.00 |
$295.20 |
| Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow |
75889 |
$2,944.00 |
$1,177.60 |
| Radiological supervision and interpretation of imaging of liver vein |
75891 |
$3,145.00 |
$1,258.00 |
| Radiological supervision and interpretation of drawing blood via catheter procedure |
75893 |
$4,224.00 |
$1,689.60 |
| Radiological supervision and interpretation of obstruction of blood vessel via catheter |
75894 |
$1,901.00 |
$760.40 |
| Imaging of blood vessel |
75898 |
$1,451.00 |
$580.40 |
| Imaging of blood vessel |
75898 |
$1,160.00 |
$464.00 |
| Radiological supervision and interpretation of removal of obstructive material in catheter procedure |
75901 |
$296.00 |
$118.40 |
| Radiological supervision and interpretation of removal of obstructive material from large vein catheter procedure |
75902 |
$462.00 |
$184.80 |
| Radiological supervision and interpretation of repair of chest aorta with graft |
75956 |
$2,696.00 |
$1,078.40 |
| Radiological supervision and interpretation of repair of chest aorta with graft |
75957 |
$2,322.00 |
$928.80 |
| Radiological supervision and interpretation of placement of blood vessel prosthesis procedure |
75958 |
$1,564.00 |
$625.60 |
| Radiological supervision and interpretation of biopsy procedure |
75970 |
$1,910.00 |
$764.00 |
| Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring |
75984 |
$309.00 |
$123.60 |
| Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring |
75984 |
$616.00 |
$246.40 |
| Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure |
75989 |
$535.00 |
$214.00 |
| Imaging guidance for procedure, up to 1 hour |
76000 |
$498.00 |
$199.20 |
| Imaging from nose to rectum, single view, child |
76010 |
$338.00 |
$135.20 |
| Imaging for abscess or abnormal drainage tract procedure |
76080 |
$649.00 |
$259.60 |
| Imaging of surgical specimen |
76098 |
$649.00 |
$259.60 |
| Single plane imaging procedure |
76100 |
$323.00 |
$129.20 |
| CT scan limited or follow-up study |
76380 |
$181.00 |
$72.40 |
| CT scan |
76497 |
$987.00 |
$394.80 |
| MRI scan |
76498 |
$181.00 |
$72.40 |
| Ultrasound of brain |
76506 |
$185.00 |
$74.00 |
| Ultrasound of head and neck |
76536 |
$620.00 |
$248.00 |
| Ultrasound of chest |
76604 |
$464.00 |
$185.60 |
| Ultrasound of one breast |
76641 |
$688.00 |
$275.20 |
| Ultrasound of one breast |
76641 |
$1,023.00 |
$409.20 |
| Ultrasound of one breast |
76642 |
$602.00 |
$240.80 |
| Ultrasound of one breast |
76642 |
$888.00 |
$355.20 |
| Ultrasound of the abdomen |
76700 |
$1,102.00 |
$440.80 |
| Ultrasound of the abdomen |
76700 |
$1,102.00 |
$440.80 |
| Ultrasound of abdomen |
76705 |
$812.00 |
$324.80 |
| Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm) |
76706 |
$528.00 |
$211.20 |
| Ultrasound behind abdominal cavity |
76770 |
$900.00 |
$360.00 |
| Ultrasound behind abdominal cavity, limited |
76775 |
$742.00 |
$296.80 |
| Ultrasound of transplanted kidney |
76776 |
$209.00 |
$83.60 |
| Ultrasound of spinal canal |
76800 |
$162.00 |
$64.80 |
| Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus |
76801 |
$215.00 |
$86.00 |
| Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) |
76802 |
$215.00 |
$86.00 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$294.00 |
$117.60 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$294.00 |
$117.60 |
| Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) |
76810 |
$256.00 |
$102.40 |
| Ultrasound of pregnant uterus, 1 or more fetus(es) |
76815 |
$175.00 |
$70.00 |
| Vaginal ultrasound of pregnant uterus |
76817 |
$192.00 |
$76.80 |
| Ultrasound of fetus |
76819 |
$220.00 |
$88.00 |
| Ultrasound pelvis through vagina |
76830 |
$793.00 |
$317.20 |
| Ultrasound of pelvis |
76856 |
$704.00 |
$281.60 |
| Ultrasound of pelvis |
76857 |
$561.00 |
$224.40 |
| Ultrasound of scrotum |
76870 |
$561.00 |
$224.40 |
| Partial ultrasound of joint or other non-blood vessel structure of arm or leg |
76882 |
$222.00 |
$88.80 |
| Ultrasound of hips with manipulation, infant |
76885 |
$527.00 |
$210.80 |
| Ultrasonic guidance for drainage of sac that covers the heart |
76930 |
$382.00 |
$152.80 |
| Ultrasound guidance for repair of blood vessel |
76936 |
$881.00 |
$352.40 |
| Ultrasound guidance for accessing into blood vessel |
76937 |
$613.00 |
$245.20 |
| Ultrasound guidance for tissue destruction |
76940 |
$552.00 |
$220.80 |
| Ultrasonic guidance imaging supervision and interpretation for insertion of needle |
76942 |
$1,800.00 |
$720.00 |
| Ultrasonic guidance imaging supervision and interpretation for insertion of needle |
76942 |
$900.00 |
$360.00 |
| Ultrasonic guidance imaging supervision and interpretation for amniocentesis |
76946 |
$488.00 |
$195.20 |
| Ultrasound follow-up study |
76970 |
$217.00 |
$86.80 |
| Ultrasonic guidance during surgery |
76998 |
$429.00 |
$171.60 |
| Fluoroscopic guidance for insertion, replacement or removal of central venous access device |
77001 |
$636.00 |
$254.40 |
| Fluoroscopic guidance for insertion of needle |
77002 |
$717.00 |
$286.80 |
| Fluoroscopic guidance for insertion of needle |
77002 |
$478.00 |
$191.20 |
| Fluoroscopic guidance for injection into spine or muscle next to spine |
77003 |
$746.00 |
$298.40 |
| CT scan guidance for stereotactic localization |
77011 |
$413.00 |
$165.20 |
| Radiological supervision and interpretation of CT guidance for needle insertion |
77012 |
$341.00 |
$136.40 |
| CT scan guidance for and monitoring of tissue destruction |
77013 |
$744.00 |
$297.60 |
| CT scan guidance for insertion of radiation therapy fields |
77014 |
$341.00 |
$136.40 |
| Radiological supervision and interpretation of MRI guidance for insertion of needle |
77021 |
$1,284.00 |
$513.60 |
| MRI of one breast |
77046 |
$671.00 |
$268.40 |
| MRI of both breasts |
77047 |
$671.00 |
$268.40 |
| MRI of one breast with and without contrast |
77048 |
$1,122.00 |
$448.80 |
| MRI of both breasts with and without contrast |
77049 |
$1,122.00 |
$448.80 |
| Radiological supervision and interpretation of imaging of breast duct |
77053 |
$442.00 |
$176.80 |
| Radiological supervision and interpretation of imaging of breast duct |
77053 |
$221.00 |
$88.40 |
| Radiological supervision and interpretation of imaging of breast ducts |
77054 |
$397.00 |
$158.80 |
| Screening digital tomography of both breasts |
77063 |
$73.00 |
$29.20 |
| Mammography of one breast |
77065 |
$200.00 |
$80.00 |
| Mammography of both breasts |
77066 |
$255.00 |
$102.00 |
| Mammogram of both breasts |
77067 |
$211.00 |
$84.40 |
| Mammogram of both breasts |
77067 |
$211.00 |
$84.40 |
| Imaging for bone age assessment |
77072 |
$158.00 |
$63.20 |
| Imaging for bone length assessment |
77073 |
$346.00 |
$138.40 |
| X-ray of bones |
77074 |
$232.00 |
$92.80 |
| X-ray survey of forearm or wrist bone density |
77075 |
$332.00 |
$132.80 |
| X-ray survey of bones, infant |
77076 |
$274.00 |
$109.60 |
| Imaging of 2 or more joints, single view |
77077 |
$294.00 |
$117.60 |
| Bone density measurement using dedicated X-ray machine |
77080 |
$454.00 |
$181.60 |
| Bone density measurement using dedicated X-ray machine |
77081 |
$242.00 |
$96.80 |
| Management of radiation therapy simulation, simple |
77280 |
$640.00 |
$256.00 |
| Management of radiation therapy, simulation, intermediate |
77285 |
$953.00 |
$381.20 |
| Management of radiation therapy, simulation, complex |
77290 |
$1,256.00 |
$502.40 |
| Respiratory motion management simulation |
77293 |
$1,409.00 |
$563.60 |
| Management of radiation therapy, 3D |
77295 |
$3,998.00 |
$1,599.20 |
| Calculation of radiation therapy dose |
77300 |
$436.00 |
$174.40 |
| Management of modulation radiotherapy planning |
77301 |
$4,197.00 |
$1,678.80 |
| Radiation therapy plan |
77306 |
$457.00 |
$182.80 |
| Radiation therapy plan |
77307 |
$714.00 |
$285.60 |
| Radiation therapy plan |
77316 |
$352.00 |
$140.80 |
| Radiation therapy plan |
77317 |
$377.00 |
$150.80 |
| Radiation therapy total body port plan |
77321 |
$989.00 |
$395.60 |
| Special radiation therapy planning |
77331 |
$438.00 |
$175.20 |
| Radiation treatment devices, design and construction, simple |
77332 |
$413.00 |
$165.20 |
| Radiation treatment devices, design and construction, intermediate |
77333 |
$505.00 |
$202.00 |
| Radiation treatment devices, design and construction, complex |
77334 |
$1,047.00 |
$418.80 |
| Radiation therapy consultation per week |
77336 |
$539.00 |
$215.60 |
| Design and construction of device for radiation therapy |
77338 |
$952.00 |
$380.80 |
| Radiation therapy consultation |
77370 |
$316.00 |
$126.40 |
| Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session |
77372 |
$7,700.00 |
$3,080.00 |
| Stereotactic body radiation therapy 1 or more lesions using imaging guidance |
77373 |
$9,394.00 |
$3,757.60 |
| Radiation therapy delivery |
77385 |
$1,455.00 |
$582.00 |
| Radiation therapy delivery |
77386 |
$2,286.00 |
$914.40 |
| Guidance for localization of target delivery of radiation treatment |
77387 |
$705.00 |
$282.00 |
| Radiation treatment delivery, superficial |
77401 |
$167.00 |
$66.80 |
| Radiation treatment delivery |
77402 |
$422.00 |
$168.80 |
| Radiation treatment delivery |
77407 |
$543.00 |
$217.20 |
| Radiation treatment delivery |
77412 |
$859.00 |
$343.60 |
| Therapeutic radiology port films |
77417 |
$208.00 |
$83.20 |
| Special radiation treatment procedure |
77470 |
$1,912.00 |
$764.80 |
| Application of organ cavity radiation source, simple |
77761 |
$475.00 |
$190.00 |
| Application of organ cavity radiation source, intermediate |
77762 |
$475.00 |
$190.00 |
| High dose brachytherapy , 1 channel |
77770 |
$3,375.00 |
$1,350.00 |
| High dose brachytherapy , 2- 12 channels |
77771 |
$3,715.00 |
$1,486.00 |
| Application of radiation source, complex |
77778 |
$2,318.00 |
$927.20 |
| Supervision, handling, loading of radiation |
77790 |
$111.00 |
$44.40 |
| Nuclear medicine imaging of thyroid |
78013 |
$498.00 |
$199.20 |
| Nuclear medicine imaging for thyroid uptake measurements |
78014 |
$704.00 |
$281.60 |
| Nuclear medicine whole body study for thyroid cancer |
78018 |
$1,687.00 |
$674.80 |
| Imaging of parathyroid |
78070 |
$1,192.00 |
$476.80 |
| Imaging of parathyroid with nuclear medicine study |
78071 |
$1,192.00 |
$476.80 |
| Imaging of parathyroid with CT and nuclear medicine study |
78072 |
$1,192.00 |
$476.80 |
| Imaging of bone marrow limited area |
78102 |
$1,005.00 |
$402.00 |
| Imaging of lymphatic tissue and lymph node |
78195 |
$783.00 |
$313.20 |
| Nuclear medicine study of liver |
78205 |
$1,466.00 |
$586.40 |
| Imaging of liver and spleen |
78215 |
$1,376.00 |
$550.40 |
| Imaging of liver and bile duct system |
78226 |
$1,534.00 |
$613.60 |
| Imaging of liver and bile duct system with use of drugs |
78227 |
$1,534.00 |
$613.60 |
| Imaging of esophagus using radioisotopes |
78258 |
$395.00 |
$158.00 |
| Stomach emptying study |
78264 |
$1,361.00 |
$544.40 |
| Acute digestive tract blood loss imaging |
78278 |
$611.00 |
$244.40 |
| Intestine imaging |
78290 |
$592.00 |
$236.80 |
| Peritoneal-venous shunt patency test |
78291 |
$539.00 |
$215.60 |
| Bone and/or joint imaging |
78300 |
$1,330.00 |
$532.00 |
| Bone and/or joint imaging, whole body |
78306 |
$2,023.00 |
$809.20 |
| Bone and/or joint imaging, 3 phase study |
78315 |
$2,133.00 |
$853.20 |
| Nuclear medicine study of bone and/or joint |
78320 |
$2,238.00 |
$895.20 |
| Nuclear medicine study of vessels of heart using drugs or exercise single study |
78451 |
$3,242.00 |
$1,296.80 |
| Nuclear medicine study of vessels of heart using drugs or exercise multiple studies |
78452 |
$4,414.00 |
$1,765.60 |
| Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study |
78472 |
$724.00 |
$289.60 |
| Nuclear medicine study of blood circulation in the lungs |
78580 |
$1,409.00 |
$563.60 |
| Nuclear medicine study of lung ventilation and blood circulation in the lungs |
78582 |
$1,869.00 |
$747.60 |
| Nuclear medicine study with measurement of blood circulation in the lungs and ventilation |
78598 |
$2,203.00 |
$881.20 |
| Imaging of brain with blood flow, less than 4 static views |
78601 |
$671.00 |
$268.40 |
| Imaging of brain, blood flow |
78610 |
$608.00 |
$243.20 |
| Imaging of brain and spinal cord fluid flow at base of brain |
78630 |
$893.00 |
$357.20 |
| Nuclear medicine study of kidney with assessment of blood flow and function |
78707 |
$714.00 |
$285.60 |
| Nuclear medicine study of kidney with assessment of blood flow and function |
78708 |
$1,031.00 |
$412.40 |
| Nuclear medicine study of radioactive material distribution at multiple tumor locations |
78801 |
$1,545.00 |
$618.00 |
| Nuclear medicine study of radioactive material distribution |
78803 |
$1,750.00 |
$700.00 |
| Nuclear medicine study of radioactive material distribution at site of inflammation |
78805 |
$1,456.00 |
$582.40 |
| Nuclear medicine study of radioactive material distribution at sites of inflammation in whole body |
78806 |
$1,456.00 |
$582.40 |
| Injection of radioactive contrast material into a vein for non-imaging gamma probe |
78808 |
$494.00 |
$197.60 |
| Nuclear medicine study with CT imaging skull base to mid-thigh |
78815 |
$2,866.00 |
$1,146.40 |
| Nuclear medicine study with CT imaging whole body |
78816 |
$2,866.00 |
$1,146.40 |
| Oral administration of radioactive material therapy agent |
79005 |
$1,302.00 |
$520.80 |
| Radioactive material therapy into vein |
79101 |
$631.00 |
$252.40 |
| Radioactive material therapy into artery |
79445 |
$1,111.00 |
$444.40 |
| Basic Metabolic Panel |
80048 |
$79.00 |
$31.60 |
| Basic Metabolic Panel |
80048 |
$79.00 |
$31.60 |
| Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) |
80051 |
$66.00 |
$26.40 |
| Comprehensive Metabolic Panel |
80053 |
$108.00 |
$43.20 |
| Comprehensive Metabolic Panel |
80053 |
$108.00 |
$43.20 |
| Lipid Panel |
80061 |
$103.00 |
$41.20 |
| Lipid Panel |
80061 |
$103.00 |
$41.20 |
| Kidney function blood test panel |
80069 |
$81.00 |
$32.40 |
| Acute hepatitis panel |
80074 |
$320.00 |
$128.00 |
| Liver function blood test panel |
80076 |
$79.00 |
$31.60 |
| Amikacin (antibiotic) level |
80150 |
$53.00 |
$21.20 |
| Caffeine level |
80155 |
$142.00 |
$56.80 |
| Carbamazepine level |
80156 |
$99.00 |
$39.60 |
| Carbamazepine level |
80157 |
$77.00 |
$30.80 |
| Cyclosporine level |
80158 |
$114.00 |
$45.60 |
| Clozapine level |
80159 |
$118.00 |
$47.20 |
| Digoxin level |
80162 |
$42.00 |
$16.80 |
| Valproic acid level |
80164 |
$115.00 |
$46.00 |
| Ethosuximide level |
80168 |
$139.00 |
$55.60 |
| Everolimus level |
80169 |
$92.00 |
$36.80 |
| Gentamicin (antibiotic) level |
80170 |
$127.00 |
$50.80 |
| Gabapentin level |
80171 |
$92.00 |
$36.80 |
| Haloperidol level |
80173 |
$74.00 |
$29.60 |
| Lamotrigine level |
80175 |
$111.00 |
$44.40 |
| Lidocaine level |
80176 |
$79.00 |
$31.60 |
| Levetiracetam level |
80177 |
$92.00 |
$36.80 |
| Lithium level |
80178 |
$70.00 |
$28.00 |
| Oxcarbazepine level |
80183 |
$97.00 |
$38.80 |
| Phenobarbital level |
80184 |
$88.00 |
$35.20 |
| Phenytoin level |
80185 |
$40.00 |
$16.00 |
| Phenytoin level |
80186 |
$57.00 |
$22.80 |
| Primidone level |
80188 |
$105.00 |
$42.00 |
| Sirolimus level |
80195 |
$77.00 |
$30.80 |
| Tacrolimus level |
80197 |
$132.00 |
$52.80 |
| Theophylline level |
80198 |
$44.00 |
$17.60 |
| Tobramycin (antibiotic) level |
80200 |
$53.00 |
$21.20 |
| Topiramate level |
80201 |
$84.00 |
$33.60 |
| Vancomycin (antibiotic) level |
80202 |
$42.00 |
$16.80 |
| Zonisamide level |
80203 |
$92.00 |
$36.80 |
| Quantitation of therapeutic drug |
80299 |
$92.00 |
$36.80 |
| Testing for presence of drug |
80307 |
$151.00 |
$60.40 |
| Alkaloids levels |
80323 |
$139.00 |
$55.60 |
| Amphetamines levels |
80324 |
$139.00 |
$55.60 |
| Analgesics levels |
80329 |
$139.00 |
$55.60 |
| Antidepressants levels |
80335 |
$139.00 |
$55.60 |
| Barbiturates levels |
80345 |
$139.00 |
$55.60 |
| Benzodiazepines levels |
80346 |
$139.00 |
$55.60 |
| Cocaine level |
80353 |
$139.00 |
$55.60 |
| Methadone level |
80358 |
$139.00 |
$55.60 |
| Opiates levels |
80361 |
$139.00 |
$55.60 |
| Oxycodone levels |
80365 |
$139.00 |
$55.60 |
| Propoxyphene level |
80367 |
$139.00 |
$55.60 |
| Skeletal muscle relaxants levels |
80369 |
$139.00 |
$55.60 |
| Thyrotropin releasing hormone (TRH) (hypothalamus hormone) stimulation panel, 1 hour |
80438 |
$149.00 |
$59.60 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$77.00 |
$30.80 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$77.00 |
$30.80 |
| Automated urinalysis test |
81003 |
$18.00 |
$7.20 |
| Urine pregnancy test |
81025 |
$99.00 |
$39.60 |
| Gene analysis (cystic fibrosis transmembrane conductance regular) common variants |
81220 |
$184.00 |
$73.60 |
| Gene analysis (prothrombin, coagulation factor II) A variant |
81240 |
$133.00 |
$53.20 |
| Gene analysis (coagulation factor V) Leiden variant |
81241 |
$151.00 |
$60.40 |
| Gene analysis (fragile X mental retardation) abnormal alleles |
81243 |
$421.00 |
$168.40 |
| Gene analysis (hemochromatosis) common variants |
81256 |
$371.00 |
$148.40 |
| Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants |
81291 |
$287.00 |
$114.80 |
| Gene analysis (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) common variants |
81332 |
$100.00 |
$40.00 |
| Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma) |
81342 |
$417.00 |
$166.80 |
| HLA class I typing, low resolution one antigen equivalent |
81374 |
$245.00 |
$98.00 |
| HLA class II typing low resolution one locus |
81376 |
$375.00 |
$150.00 |
| HLA class II typing high resolution one locus |
81382 |
$514.00 |
$205.60 |
| Molecular pathology procedure level 2 |
81401 |
$402.00 |
$160.80 |
| Molecular pathology procedure level 3 |
81402 |
$413.00 |
$165.20 |
| Molecular pathology procedure |
81479 |
$609.00 |
$243.60 |
| Ketone bodies analysis |
82009 |
$38.00 |
$15.20 |
| Ketone bodies analysis |
82010 |
$65.00 |
$26.00 |
| Adrenocorticotropic hormone (ACTH) level |
82024 |
$145.00 |
$58.00 |
| Albumin (protein) level |
82040 |
$20.00 |
$8.00 |
| Cerebrospinal fluid, or amniotic fluid albumin (protein) level |
82042 |
$28.00 |
$11.20 |
| Urine microalbumin (protein) level |
82043 |
$60.00 |
$24.00 |
| Aldolase (enzyme) level |
82085 |
$55.00 |
$22.00 |
| Aldosterone hormone level |
82088 |
$140.00 |
$56.00 |
| Alpha-1-antitrypsin (protein) blood test |
82103 |
$85.00 |
$34.00 |
| Alpha-1-antitrypsin (protein) blood test |
82104 |
$88.00 |
$35.20 |
| Alpha-fetoprotein (AFP) level, serum |
82105 |
$91.00 |
$36.40 |
| Alpha-fetoprotein (AFP) analysis |
82107 |
$190.00 |
$76.00 |
| Aluminum level |
82108 |
$95.00 |
$38.00 |
| Amino acid analysis |
82131 |
$125.00 |
$50.00 |
| Amino acid level, multiple amino acids |
82139 |
$278.00 |
$111.20 |
| Ammonia level |
82140 |
$85.00 |
$34.00 |
| Amylase (enzyme) level |
82150 |
$75.00 |
$30.00 |
| Androstenedione (hormone) level |
82157 |
$102.00 |
$40.80 |
| Angiotensin l - converting enzyme (ACE) level |
82164 |
$80.00 |
$32.00 |
| Arsenic level |
82175 |
$82.00 |
$32.80 |
| Beta-2 microglobulin (protein) level |
82232 |
$78.00 |
$31.20 |
| Bile acids level |
82239 |
$74.00 |
$29.60 |
| Bilirubin level |
82247 |
$70.00 |
$28.00 |
| Bilirubin level |
82248 |
$64.00 |
$25.60 |
| Specimen analysis for blood |
82271 |
$17.00 |
$6.80 |
| Stool analysis for blood |
82272 |
$12.00 |
$4.80 |
| Stool analysis for blood |
82274 |
$85.00 |
$34.00 |
| Cadmium level |
82300 |
$68.00 |
$27.20 |
| Vitamin D-3 level |
82306 |
$124.00 |
$49.60 |
| Calcitonin (hormone) level |
82308 |
$110.00 |
$44.00 |
| Calcium level |
82310 |
$20.00 |
$8.00 |
| Calcium level |
82330 |
$42.00 |
$16.80 |
| Urine calcium level |
82340 |
$51.00 |
$20.40 |
| Chemical analysis of stone |
82360 |
$75.00 |
$30.00 |
| Carbon dioxide (bicarbonate) level |
82374 |
$50.00 |
$20.00 |
| Carboxyhemoglobin (protein) level |
82375 |
$69.00 |
$27.60 |
| Carcinoembryonic antigen (CEA) protein level |
82378 |
$122.00 |
$48.80 |
| Catecholamines (organic nitrogen) level |
82384 |
$135.00 |
$54.00 |
| Ceruloplasmin (protein) level |
82390 |
$68.00 |
$27.20 |
| Analysis using chemiluminescent technique (light and chemical )reaction |
82397 |
$125.00 |
$50.00 |
| Blood chloride level |
82435 |
$43.00 |
$17.20 |
| Urine chloride level |
82436 |
$49.00 |
$19.60 |
| Chloride level |
82438 |
$53.00 |
$21.20 |
| Screening test for chlorinated hydrocarbons |
82441 |
$35.00 |
$14.00 |
| Cholesterol level |
82465 |
$25.00 |
$10.00 |
| Cholinesterase (enzyme) level, to test for exposure to chemical or liver disease |
82480 |
$52.00 |
$20.80 |
| Chromium level to test for poisoning or deficiency |
82495 |
$82.00 |
$32.80 |
| Citrate level |
82507 |
$104.00 |
$41.60 |
| Collagen cross links test, (urine test to evaluate bone health) |
82523 |
$78.00 |
$31.20 |
| Copper level |
82525 |
$59.00 |
$23.60 |
| Cortisol (hormone) measurement |
82530 |
$93.00 |
$37.20 |
| Cortisol (hormone) measurement |
82533 |
$95.00 |
$38.00 |
| Chemical analysis using chromatography technique |
82542 |
$116.00 |
$46.40 |
| Chemical analysis using chromatography technique |
82542 |
$139.00 |
$55.60 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$46.00 |
$18.40 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$46.00 |
$18.40 |
| Creatine kinase (cardiac enzyme) level |
82552 |
$82.00 |
$32.80 |
| Creatine kinase (cardiac enzyme) level |
82553 |
$70.00 |
$28.00 |
| Blood creatinine level |
82565 |
$55.00 |
$22.00 |
| Creatinine level to test for kidney function or muscle injury |
82570 |
$58.00 |
$23.20 |
| Creatinine clearance measurement to test for kidney function |
82575 |
$103.00 |
$41.20 |
| Cryofibrinogen (protein) level |
82585 |
$47.00 |
$18.80 |
| Cryoglobulin (protein) measurement |
82595 |
$52.00 |
$20.80 |
| Cyanocobalamin (vitamin B-12) level |
82607 |
$48.00 |
$19.20 |
| Cystatin C (enzyme inhibitor) level |
82610 |
$58.00 |
$23.20 |
| Dehydroepiandrosterone (DHEA) hormone level |
82626 |
$94.00 |
$37.60 |
| Dehydroepiandrosterone (DHEA-S) hormone level |
82627 |
$118.00 |
$47.20 |
| Desoxycorticosterone, 11 (hormone) level |
82633 |
$163.00 |
$65.20 |
| Dihydroxyvitamin D, 1, 25 level |
82652 |
$185.00 |
$74.00 |
| Pancreatic elastase (enzyme) measurement |
82656 |
$254.00 |
$101.60 |
| Erythropoietin (protein) level |
82668 |
$104.00 |
$41.60 |
| Estradiol (hormone) level |
82670 |
$128.00 |
$51.20 |
| Estrogen analysis |
82671 |
$152.00 |
$60.80 |
| Estrogen analysis |
82672 |
$133.00 |
$53.20 |
| Estriol (hormone) level |
82677 |
$91.00 |
$36.40 |
| Estrone (hormone) level |
82679 |
$96.00 |
$38.40 |
| Ethylene glycol (antifreeze) measurement |
82693 |
$146.00 |
$58.40 |
| Stool fat analysis |
82705 |
$29.00 |
$11.60 |
| Ferritin (blood protein) level |
82728 |
$42.00 |
$16.80 |
| Fetal fibronectin (protein) analysis |
82731 |
$314.00 |
$125.60 |
| Fluoride level |
82735 |
$119.00 |
$47.60 |
| Folic acid level |
82746 |
$46.00 |
$18.40 |
| Folic acid level |
82747 |
$73.00 |
$29.20 |
| Gammaglobulin (immune system protein) measurement |
82784 |
$54.00 |
$21.60 |
| IgE (immune system protein) level |
82785 |
$86.00 |
$34.40 |
| Gammaglobulin (immune system protein) measurement |
82787 |
$48.00 |
$19.20 |
| Blood pH level |
82800 |
$81.00 |
$32.40 |
| Blood gases measurement |
82803 |
$84.00 |
$33.60 |
| Blood gas, oxygen saturation measurement |
82810 |
$60.00 |
$24.00 |
| Gastrin (GI tract hormone) level |
82941 |
$89.00 |
$35.60 |
| Glucose (sugar) level on body fluid |
82945 |
$51.00 |
$20.40 |
| Blood glucose (sugar) level |
82947 |
$15.00 |
$6.00 |
| Blood glucose (sugar) level after receiving dose of glucose |
82950 |
$57.00 |
$22.80 |
| Blood glucose (sugar) tolerance test |
82951 |
$85.00 |
$34.00 |
| Blood glucose (sugar) tolerance test |
82952 |
$12.00 |
$4.80 |
| G6PD (enzyme) level |
82955 |
$71.00 |
$28.40 |
| Blood glucose (sugar) test performed by hand-held instrument |
82962 |
$44.00 |
$17.60 |
| Glutamyltransferase (liver enzyme) level |
82977 |
$72.00 |
$28.80 |
| Gonadotropin, follicle stimulating (reproductive hormone) level |
83001 |
$111.00 |
$44.40 |
| Gonadotropin, luteinizing (reproductive hormone) level |
83002 |
$114.00 |
$45.60 |
| Human growth hormone level |
83003 |
$70.00 |
$28.00 |
| Haptoglobin (serum protein) level |
83010 |
$86.00 |
$34.40 |
| Heavy metal level |
83018 |
$99.00 |
$39.60 |
| Hemoglobin analysis and measurement |
83020 |
$75.00 |
$30.00 |
| Hemoglobin analysis and measurement |
83021 |
$53.00 |
$21.20 |
| Fetal hemoglobin analysis |
83033 |
$48.00 |
$19.20 |
| Hemoglobin A1C level |
83036 |
$34.00 |
$13.60 |
| Methemoglobin (hemoglobin) analysis |
83050 |
$53.00 |
$21.20 |
| Sulfhemoglobin (hemoglobin) level |
83060 |
$33.00 |
$13.20 |
| Hemosiderin (hemoglobin breakdown product) analysis |
83070 |
$42.00 |
$16.80 |
| Homocysteine (amino acid) level |
83090 |
$130.00 |
$52.00 |
| Homovanillic acid (organic acid) level |
83150 |
$64.00 |
$25.60 |
| Hydroxyindolacetic acid (product of metabolism) level |
83497 |
$77.00 |
$30.80 |
| Hydroxyprogesterone, 17-D (synthetic hormone) level |
83498 |
$113.00 |
$45.20 |
| Analysis of substance using immunoassay technique |
83516 |
$75.00 |
$30.00 |
| Measurement of substance using immunoassay technique |
83519 |
$134.00 |
$53.60 |
| Measurement of substance using immunoassay technique |
83520 |
$125.00 |
$50.00 |
| Insulin measurement |
83525 |
$61.00 |
$24.40 |
| Insulin measurement |
83527 |
$78.00 |
$31.20 |
| Iron level |
83540 |
$22.00 |
$8.80 |
| Iron binding capacity |
83550 |
$28.00 |
$11.20 |
| Lactic acid level |
83605 |
$33.00 |
$13.20 |
| Lactate dehydrogenase (enzyme) level |
83615 |
$61.00 |
$24.40 |
| Stool lactoferrin (immune system protein) analysis |
83630 |
$75.00 |
$30.00 |
| Lead level |
83655 |
$59.00 |
$23.60 |
| Fetal lung maturity assessment |
83664 |
$74.00 |
$29.60 |
| Lipase (fat enzyme) level |
83690 |
$87.00 |
$34.80 |
| Lipoprotein level |
83700 |
$84.00 |
$33.60 |
| Lipoprotein measurement |
83701 |
$73.00 |
$29.20 |
| HDL cholesterol level |
83718 |
$47.00 |
$18.80 |
| Magnesium level |
83735 |
$23.00 |
$9.20 |
| Manganese (heavy metal) level |
83785 |
$73.00 |
$29.20 |
| Mass spectrometry (laboratory testing method) |
83789 |
$139.00 |
$55.60 |
| Mass spectrometry (laboratory testing method) |
83789 |
$97.00 |
$38.80 |
| Mercury level |
83825 |
$68.00 |
$27.20 |
| Metanephrines level |
83835 |
$85.00 |
$34.00 |
| Myoglobin (muscle protein) level |
83874 |
$75.00 |
$30.00 |
| Myeloperoxidase (white blood cell enzyme) measurement |
83876 |
$81.00 |
$32.40 |
| Natriuretic peptide (heart and blood vessel protein) level |
83880 |
$113.00 |
$45.20 |
| Nephelometry, test method using light |
83883 |
$58.00 |
$23.20 |
| Measurement of immune substance (oligoclonal bands) |
83916 |
$101.00 |
$40.40 |
| Organic acid level |
83921 |
$109.00 |
$43.60 |
| Blood osmolality (concentration) measurement |
83930 |
$22.00 |
$8.80 |
| Urine osmolality (concentration) measurement |
83935 |
$42.00 |
$16.80 |
| Oxalate level |
83945 |
$60.00 |
$24.00 |
| Parathormone (parathyroid hormone) level |
83970 |
$124.00 |
$49.60 |
| Body fluid pH level |
83986 |
$38.00 |
$15.20 |
| PCP drug level |
83992 |
$99.00 |
$39.60 |
| Stool calprotectin (protein) level |
83993 |
$249.00 |
$99.60 |
| Phenylalanine, PKU (amino acid) level |
84030 |
$109.00 |
$43.60 |
| Phosphatase (enzyme) level |
84075 |
$64.00 |
$25.60 |
| Phosphatase (enzyme) level |
84078 |
$122.00 |
$48.80 |
| Phosphatase (enzyme) measurement |
84080 |
$76.00 |
$30.40 |
| Phosphate level |
84100 |
$17.00 |
$6.80 |
| Urine phosphate level |
84105 |
$48.00 |
$19.20 |
| Urine porphobilinogen (metabolism substance) level |
84110 |
$50.00 |
$20.00 |
| Cervicovaginal secretion of placenta protein |
84112 |
$175.00 |
$70.00 |
| Urine porphyrins (metabolism substance) measurement |
84120 |
$85.00 |
$34.00 |
| Blood potassium level |
84132 |
$20.00 |
$8.00 |
| Urine potassium level |
84133 |
$47.00 |
$18.80 |
| Prealbumin (protein) level |
84134 |
$40.00 |
$16.00 |
| Pregnenolone (reproductive hormone) level |
84140 |
$122.00 |
$48.80 |
| 17-hydroxypregnenolone (hormone) level |
84143 |
$133.00 |
$53.20 |
| Progesterone (reproductive hormone) level |
84144 |
$81.00 |
$32.40 |
| Procalcitonin (hormone) level |
84145 |
$226.00 |
$90.40 |
| Prolactin (milk producing hormone) level |
84146 |
$127.00 |
$50.80 |
| PSA (prostate specific antigen) measurement |
84153 |
$119.00 |
$47.60 |
| PSA (prostate specific antigen) measurement |
84154 |
$68.00 |
$27.20 |
| Total protein level, blood |
84155 |
$54.00 |
$21.60 |
| Total protein level, urine |
84156 |
$58.00 |
$23.20 |
| Total protein level, body fluid |
84157 |
$58.00 |
$23.20 |
| Pregnancy-associated plasma protein-A level |
84163 |
$72.00 |
$28.80 |
| Protein measurement, serum |
84165 |
$55.00 |
$22.00 |
| Protein measurement, body fluid |
84166 |
$95.00 |
$38.00 |
| Protein measurement |
84182 |
$185.00 |
$74.00 |
| Protoporphyrin (metabolism substance) level |
84202 |
$60.00 |
$24.00 |
| Proinsulin (pancreatic hormone) level |
84206 |
$141.00 |
$56.40 |
| Vitamin B-6 level |
84207 |
$123.00 |
$49.20 |
| Pyruvate (organic acid) level |
84210 |
$69.00 |
$27.60 |
| Quinine (drug) level |
84228 |
$47.00 |
$18.80 |
| Chemical receptor analysis |
84238 |
$171.00 |
$68.40 |
| Renin (kidney enzyme) level |
84244 |
$101.00 |
$40.40 |
| Vitamin B-2 (riboflavin) level |
84252 |
$170.00 |
$68.00 |
| Selenium (vitamin) level |
84255 |
$66.00 |
$26.40 |
| Serotonin (hormone) level |
84260 |
$104.00 |
$41.60 |
| Sex hormone binding globulin (protein) level |
84270 |
$73.00 |
$29.20 |
| Blood sodium level |
84295 |
$43.00 |
$17.20 |
| Urine sodium level |
84300 |
$55.00 |
$22.00 |
| Sodium level |
84302 |
$39.00 |
$15.60 |
| Somatomedin (growth factor) level |
84305 |
$105.00 |
$42.00 |
| Specific gravity (liquid weight) measurement |
84315 |
$13.00 |
$5.20 |
| Carbohydrate analysis |
84376 |
$39.00 |
$15.60 |
| Testosterone (hormone) level |
84402 |
$107.00 |
$42.80 |
| Testosterone (hormone) level |
84403 |
$125.00 |
$50.00 |
| Vitamin B-1 (thiamine) level |
84425 |
$119.00 |
$47.60 |
| Thyroglobulin (thyroid related hormone) level |
84432 |
$71.00 |
$28.40 |
| Thyroxine (thyroid chemical) measurement |
84436 |
$23.00 |
$9.20 |
| Thyroxine (thyroid chemical) measurement |
84439 |
$29.00 |
$11.60 |
| Thyroxine binding globulin (thyroid related protein) level |
84442 |
$63.00 |
$25.20 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$56.00 |
$22.40 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$56.00 |
$22.40 |
| Thyroid stimulating immune globulins (thyroid related protein) level |
84445 |
$183.00 |
$73.20 |
| Vitamin E level |
84446 |
$77.00 |
$30.80 |
| Liver enzyme (SGOT), level |
84450 |
$67.00 |
$26.80 |
| Liver enzyme (SGPT), level |
84460 |
$70.00 |
$28.00 |
| Transferrin (iron binding protein) level |
84466 |
$52.00 |
$20.80 |
| Triglycerides level |
84478 |
$25.00 |
$10.00 |
| Thyroid hormone evaluation |
84479 |
$53.00 |
$21.20 |
| Thyroid hormone, T3 measurement |
84480 |
$89.00 |
$35.60 |
| Thyroid hormone, T3 measurement |
84481 |
$99.00 |
$39.60 |
| Thyroid hormone, T3 measurement |
84482 |
$108.00 |
$43.20 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$64.00 |
$25.60 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$64.00 |
$25.60 |
| Tyrosine (amino acid) level |
84510 |
$31.00 |
$12.40 |
| Urea nitrogen level to assess kidney function |
84520 |
$54.00 |
$21.60 |
| Urea nitrogen level to assess kidney function |
84540 |
$51.00 |
$20.40 |
| Urea nitrogen level to assess kidney function |
84545 |
$55.00 |
$22.00 |
| Uric acid level, blood |
84550 |
$60.00 |
$24.00 |
| Uric acid level |
84560 |
$60.00 |
$24.00 |
| Urine vanillylmandelic acid |
84585 |
$79.00 |
$31.60 |
| Vasoactive intestinal peptide (intestinal hormone) level |
84586 |
$132.00 |
$52.80 |
| Vitamin A level |
84590 |
$70.00 |
$28.00 |
| Vitamin K level |
84597 |
$88.00 |
$35.20 |
| Volatile chemical measurement |
84600 |
$68.00 |
$27.20 |
| Zinc level |
84630 |
$66.00 |
$26.40 |
| C-peptide (protein) level |
84681 |
$109.00 |
$43.60 |
| Gonadotropin, chorionic (reproductive hormone) level |
84702 |
$137.00 |
$54.80 |
| Gonadotropin (reproductive hormone) analysis |
84703 |
$110.00 |
$44.00 |
| Chemistry procedures |
84999 |
$138.00 |
$55.20 |
| White blood cell count |
85004 |
$27.00 |
$10.80 |
| Red blood cell hemoglobin concentration |
85013 |
$28.00 |
$11.20 |
| Red blood cell concentration measurement |
85014 |
$17.00 |
$6.80 |
| Hemoglobin measurement |
85018 |
$26.00 |
$10.40 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$143.00 |
$57.20 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$143.00 |
$57.20 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85027 |
$52.00 |
$20.80 |
| Red blood cell count, automated test |
85041 |
$21.00 |
$8.40 |
| Red blood count, automated test |
85045 |
$15.00 |
$6.00 |
| Automated white blood cell count |
85048 |
$29.00 |
$11.60 |
| Platelet count, automated test |
85049 |
$44.00 |
$17.60 |
| Bone marrow, smear interpretation |
85097 |
$172.00 |
$68.80 |
| Clotting factor II prothrombin, measurement |
85210 |
$144.00 |
$57.60 |
| Clotting factor V (AcG or proaccelerin) measurement |
85220 |
$158.00 |
$63.20 |
| Clotting factor VII (proconvertin, stable factor) |
85230 |
$158.00 |
$63.20 |
| Clotting factor VIII (AHG) measurement |
85240 |
$153.00 |
$61.20 |
| Clotting factor VIII related antigen measurement |
85244 |
$214.00 |
$85.60 |
| Clotting factor VIII (VW factor) measurement |
85245 |
$117.00 |
$46.80 |
| Clotting factor VIII (VW factor) antigen |
85246 |
$129.00 |
$51.60 |
| Clotting factor IX (PTC or Christmas) measurement |
85250 |
$180.00 |
$72.00 |
| Clotting factor XIII (fibrin stabilizing) measurement |
85290 |
$175.00 |
$70.00 |
| Fletcher factor (clotting factor) measurement |
85292 |
$153.00 |
$61.20 |
| Fitzgerald factor (clotting factor) measurement |
85293 |
$167.00 |
$66.80 |
| Antithrombin III antigen (clotting inhibitor) activity |
85300 |
$127.00 |
$50.80 |
| Protein C antigen (clotting inhibitor) measurement |
85303 |
$184.00 |
$73.60 |
| Protein S (clotting inhibitor) level |
85305 |
$175.00 |
$70.00 |
| Activated protein resistance assay |
85307 |
$116.00 |
$46.40 |
| Clotting factor inhibitor test |
85335 |
$150.00 |
$60.00 |
| Coagulation time measurement |
85347 |
$58.00 |
$23.20 |
| Coagulation function measurement |
85379 |
$130.00 |
$52.00 |
| Fibrinogen (factor 1) activity measurement |
85384 |
$51.00 |
$20.40 |
| Coagulation function screening test with interpretation and report |
85390 |
$24.00 |
$9.60 |
| Measurement of blood coagulation and fibrinolysis (clot dissolving) function |
85397 |
$203.00 |
$81.20 |
| Plasminogen (fibrinolytic factor) measurement |
85420 |
$104.00 |
$41.60 |
| Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation |
85460 |
$91.00 |
$36.40 |
| Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation |
85461 |
$51.00 |
$20.40 |
| Heparin assay |
85520 |
$120.00 |
$48.00 |
| Platelet function test |
85576 |
$131.00 |
$52.40 |
| Phospholipid test |
85598 |
$110.00 |
$44.00 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$25.00 |
$10.00 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$25.00 |
$10.00 |
| Blood test, clotting time |
85611 |
$38.00 |
$15.20 |
| Clotting factor X assessment test |
85613 |
$66.00 |
$26.40 |
| Red blood cell sedimentation rate, to detect inflammation |
85652 |
$25.00 |
$10.00 |
| Red blood cell sickling measurement |
85660 |
$48.00 |
$19.20 |
| Thrombin time, fibrinogen screening test |
85670 |
$53.00 |
$21.20 |
| Coagulation assessment blood test |
85730 |
$41.00 |
$16.40 |
| Coagulation assessment blood test |
85732 |
$21.00 |
$8.40 |
| Measurement of antibody to infectious organism |
86000 |
$47.00 |
$18.80 |
| Measurement of antibody (IgG) to allergic substance |
86001 |
$28.00 |
$11.20 |
| Measurement of antibody (IgE) to allergic substance |
86003 |
$29.00 |
$11.60 |
| Antibody identification test for platelet antibodies |
86022 |
$42.00 |
$16.80 |
| Screening test for autoimmune disorder |
86038 |
$55.00 |
$22.00 |
| Measurement of antibody for assessment of autoimmune disorder |
86039 |
$88.00 |
$35.20 |
| Measurement for Strep antibody (strep throat) |
86060 |
$78.00 |
$31.20 |
| Blood bank physician services for investigation of transfusion reaction with written report |
86078 |
$152.00 |
$60.80 |
| Measurement C-reactive protein for detection of infection or inflammation |
86140 |
$35.00 |
$14.00 |
| Measurement C-reactive protein for detection of infection or inflammation |
86141 |
$65.00 |
$26.00 |
| Beta 2 glycoprotein 1 antibody (autoantibody) measurement |
86146 |
$97.00 |
$38.80 |
| Cardiolipin antibody (tissue antibody) measurement |
86147 |
$107.00 |
$42.80 |
| Phospholipid antibody (autoimmune antibody) measurement |
86148 |
$75.00 |
$30.00 |
| Measurement of cold agglutinin (protein) to screen for infection or disease |
86156 |
$64.00 |
$25.60 |
| Measurement of cold agglutinin (protein) to detect infection or disease |
86157 |
$83.00 |
$33.20 |
| Measurement of complement (immune system proteins) |
86160 |
$106.00 |
$42.40 |
| Measurement of complement function (immune system proteins) |
86161 |
$124.00 |
$49.60 |
| Measurement of complement (immune system proteins) |
86162 |
$119.00 |
$47.60 |
| Measurement of antibody for rheumatoid arthritis assessment |
86200 |
$73.00 |
$29.20 |
| Measurement of DNA antibody |
86225 |
$96.00 |
$38.40 |
| Measurement of antibody for assessment of autoimmune disorder |
86235 |
$107.00 |
$42.80 |
| Screening test for antibody to noninfectious agent |
86255 |
$161.00 |
$64.40 |
| Measurement of antibody to noninfectious agent |
86256 |
$113.00 |
$45.20 |
| Immunologic analysis for detection of tumor antigen |
86300 |
$109.00 |
$43.60 |
| Immunologic analysis for detection of tumor antigen |
86301 |
$113.00 |
$45.20 |
| Immunologic analysis for detection of tumor antigen |
86304 |
$101.00 |
$40.40 |
| Screening test for mononucleosis (mono) |
86308 |
$71.00 |
$28.40 |
| Analysis for detection of tumor marker |
86316 |
$142.00 |
$56.80 |
| Detection of infectious agent antibody |
86317 |
$77.00 |
$30.80 |
| Immunologic analysis technique on serum |
86334 |
$66.00 |
$26.40 |
| Immunologic analysis technique on body fluid |
86335 |
$87.00 |
$34.80 |
| Inhibin A (reproductive organ hormone) measurement |
86336 |
$86.00 |
$34.40 |
| Intrinsic factor (stomach protein) antibody measurement |
86340 |
$86.00 |
$34.40 |
| Islet cell (pancreas) antibody measurement |
86341 |
$112.00 |
$44.80 |
| Analysis of cell function and analysis for genetic marker |
86352 |
$308.00 |
$123.20 |
| Total cell count for B cells (white blood cells) |
86355 |
$159.00 |
$63.60 |
| White blood cell antigen measurement |
86356 |
$139.00 |
$55.60 |
| Total cell count for natural killer cells (white blood cell) |
86357 |
$166.00 |
$66.40 |
| T cells count, total |
86359 |
$180.00 |
$72.00 |
| T cell count and ratio |
86360 |
$226.00 |
$90.40 |
| T cell count and ratio |
86361 |
$150.00 |
$60.00 |
| Microsomal antibodies (autoantibody) measurement |
86376 |
$103.00 |
$41.20 |
| Viral neutralization test to detect viral antibody level |
86382 |
$90.00 |
$36.00 |
| Nitroblue tetrazolium dye test to measure white blood cell function |
86384 |
$173.00 |
$69.20 |
| Screening test for presence of antibody |
86403 |
$94.00 |
$37.60 |
| Rheumatoid factor level |
86431 |
$78.00 |
$31.20 |
| Tuberculosis test |
86480 |
$183.00 |
$73.20 |
| Syphilis detection test |
86592 |
$65.00 |
$26.00 |
| Syphilis test |
86593 |
$74.00 |
$29.60 |
| Analysis for antibody to aspergillus (fungus) |
86606 |
$93.00 |
$37.20 |
| Analysis for antibody bacteria |
86609 |
$63.00 |
$25.20 |
| Analysis for antibody to Bartonella (bacteria) |
86611 |
$47.00 |
$18.80 |
| Analysis for antibody to blastomyces (fungus) |
86612 |
$87.00 |
$34.80 |
| Analysis for antibody bordetella (respiratory bacteria) |
86615 |
$85.00 |
$34.00 |
| Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria) |
86617 |
$78.00 |
$31.20 |
| Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria) |
86618 |
$104.00 |
$41.60 |
| Analysis for antibody to Brucella (bacteria) |
86622 |
$50.00 |
$20.00 |
| Analysis for antibody to Candida (yeast) |
86628 |
$58.00 |
$23.20 |
| Analysis for antibody to Chlamydia (bacteria) |
86631 |
$43.00 |
$17.20 |
| Analysis for antibody (IgM) to Chlamydia (bacteria) |
86632 |
$38.00 |
$15.20 |
| Analysis for antibody to Coccidioides (bacteria) |
86635 |
$80.00 |
$32.00 |
| Analysis for antibody to Coxiella burnetii (Q fever bacteria) |
86638 |
$59.00 |
$23.60 |
| Analysis for antibody to Cytomegalovirus (CMV) |
86644 |
$85.00 |
$34.00 |
| Analysis for antibody (IgM) to Cytomegalovirus (CMV) |
86645 |
$60.00 |
$24.00 |
| Analysis for antibody to Diphtheria (bacteria) |
86648 |
$106.00 |
$42.40 |
| Analysis for antibody to La crosse (California) virus (encephalitis causing virus) |
86651 |
$53.00 |
$21.20 |
| Analysis for antibody to Eastern equine virus (viral encephalitis) |
86652 |
$53.00 |
$21.20 |
| Analysis for antibody to St. Louis virus (viral encephalitis) |
86653 |
$53.00 |
$21.20 |
| Analysis for antibody to Western equine virus (viral encephalitis) |
86654 |
$53.00 |
$21.20 |
| Analysis for antibody to Enterovirus (gastrointestinal virus) |
86658 |
$83.00 |
$33.20 |
| Analysis for antibody to Epstein-Barr virus (mononucleosis virus) |
86663 |
$65.00 |
$26.00 |
| Analysis for antibody to Epstein-Barr virus (mononucleosis virus) |
86664 |
$67.00 |
$26.80 |
| Analysis for antibody to Epstein-Barr virus (mononucleosis virus) |
86665 |
$83.00 |
$33.20 |
| Analysis for antibody to Ehrlichia (bacteria transmitted by ticks) |
86666 |
$108.00 |
$43.20 |
| Analysis for antibody to Helicobacter pylori (gastrointestinal bacteria) |
86677 |
$124.00 |
$49.60 |
| Analysis for antibody to helminth (intestinal worm) |
86682 |
$126.00 |
$50.40 |
| Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV |
86689 |
$136.00 |
$54.40 |
| Analysis for antibody to Hepatitis D virus |
86692 |
$97.00 |
$38.80 |
| Analysis for antibody to Herpes simplex virus |
86694 |
$66.00 |
$26.40 |
| Analysis for antibody to Herpes simplex virus, type 1 |
86695 |
$75.00 |
$30.00 |
| Analysis for antibody to Herpes simplex virus, type 2 |
86696 |
$84.00 |
$33.60 |
| Analysis for antibody to histoplasma (fungus) |
86698 |
$87.00 |
$34.80 |
| Analysis for antibody to HIV -1 virus |
86701 |
$110.00 |
$44.00 |
| Analysis for antibody to HIV-2 virus |
86702 |
$97.00 |
$38.80 |
| Analysis for antibody to HIV-1 and HIV-2 virus |
86703 |
$109.00 |
$43.60 |
| Hepatitis B core antibody measurement |
86704 |
$59.00 |
$23.60 |
| Hepatitis B core antibody (IgM) measurement |
86705 |
$82.00 |
$32.80 |
| Hepatitis B surface antibody measurement |
86706 |
$90.00 |
$36.00 |
| Hepatitis Be antibody measurement |
86707 |
$63.00 |
$25.20 |
| Measurement of Hepatitis A antibody |
86708 |
$75.00 |
$30.00 |
| Measurement of Hepatitis A antibody (IgM) |
86709 |
$78.00 |
$31.20 |
| Analysis for antibody to Influenza virus |
86710 |
$60.00 |
$24.00 |
| Analysis for antibody to lymphocytic choriomeningitis virus (viral meningitis) |
86727 |
$52.00 |
$20.80 |
| Analysis for antibody to mumps virus |
86735 |
$64.00 |
$25.60 |
| Analysis for antibody to Mycoplasma (bacteria) |
86738 |
$97.00 |
$38.80 |
| Analysis for antibody to parvovirus |
86747 |
$71.00 |
$28.40 |
| Analysis for antibody to Plasmodium (malaria parasite) |
86750 |
$55.00 |
$22.00 |
| Analysis for antibody to respiratory syncytial virus (RSV) |
86756 |
$87.00 |
$34.80 |
| Analysis for antibody to Rickettsia (bacteria) |
86757 |
$108.00 |
$43.20 |
| Analysis for antibody to Rubella (German measles virus) |
86762 |
$78.00 |
$31.20 |
| Analysis for antibody to Rubeola (measles virus) |
86765 |
$62.00 |
$24.80 |
| Analysis for antibody to Salmonella (intestinal bacteria) |
86768 |
$40.00 |
$16.00 |
| Analysis for antibody to Toxoplasma (parasite) |
86777 |
$84.00 |
$33.60 |
| Analysis for antibody (IgM) to Toxoplasma (parasite) |
86778 |
$89.00 |
$35.60 |
| Analysis for antibody, Treponema pallidum |
86780 |
$67.00 |
$26.80 |
| Analysis for antibody to varicella-zoster virus (chicken pox) |
86787 |
$80.00 |
$32.00 |
| Analysis for antibody (IgM) to West Nile virus |
86788 |
$104.00 |
$41.60 |
| Analysis for antibody to West Nile virus |
86789 |
$101.00 |
$40.40 |
| Analysis for antibody to virus |
86790 |
$95.00 |
$38.00 |
| Thyroglobulin (thyroid protein) antibody measurement |
86800 |
$78.00 |
$31.20 |
| Hepatitis C antibody measurement |
86803 |
$100.00 |
$40.00 |
| Immunologic analysis for autoimmune disease |
86812 |
$160.00 |
$64.00 |
| Screening test for red blood cell antibodies |
86850 |
$32.00 |
$12.80 |
| Removal of antibodies from surface of red blood cell |
86860 |
$92.00 |
$36.80 |
| Identification of red blood cell antibodies |
86870 |
$144.00 |
$57.60 |
| Red blood cell antibody detection test |
86880 |
$75.00 |
$30.00 |
| Red blood cell antibody level |
86886 |
$80.00 |
$32.00 |
| Processing and storage of blood unit or component |
86890 |
$151.00 |
$60.40 |
| Blood group typing (ABO) |
86900 |
$18.00 |
$7.20 |
| Blood typing for Rh (D) antigen |
86901 |
$22.00 |
$8.80 |
| Screening test for compatible blood unit |
86902 |
$83.00 |
$33.20 |
| Blood typing for red blood cell antigens |
86905 |
$74.00 |
$29.60 |
| Blood typing for Rh (D) antigen |
86906 |
$121.00 |
$48.40 |
| Blood unit compatibility test |
86920 |
$47.00 |
$18.80 |
| Blood unit compatibility test |
86921 |
$59.00 |
$23.60 |
| Blood unit compatibility test |
86922 |
$50.00 |
$20.00 |
| Blood unit compatibility test |
86923 |
$120.00 |
$48.00 |
| Pooling of platelets or other blood products |
86965 |
$79.00 |
$31.60 |
| Pretreatment of red blood cells for use in red blood cells antibody analysis and measurement |
86970 |
$74.00 |
$29.60 |
| Pretreatment of serum for use in red blood cell antibody analysis and measurement |
86976 |
$47.00 |
$18.80 |
| Pretreatment of serum for use in red blood cell antibody analysis and measurement |
86977 |
$47.00 |
$18.80 |
| Pretreatment of serum for use in red blood cell antibody analysis and measurement |
86978 |
$84.00 |
$33.60 |
| Splitting of blood or blood products |
86985 |
$34.00 |
$13.60 |
| Concentration of specimen for infectious agents |
87015 |
$47.00 |
$18.80 |
| Bacterial blood culture |
87040 |
$35.00 |
$14.00 |
| Stool culture |
87046 |
$55.00 |
$22.00 |
| Bacterial culture |
87070 |
$101.00 |
$40.40 |
| Bacterial culture |
87075 |
$159.00 |
$63.60 |
| Bacterial culture for anaerobic isolates |
87076 |
$91.00 |
$36.40 |
| Bacterial culture for aerobic isolates |
87077 |
$25.00 |
$10.00 |
| Screening test for pathogenic organisms |
87081 |
$30.00 |
$12.00 |
| Bacterial colony count, urine |
87086 |
$45.00 |
$18.00 |
| Fungal culture (mold or yeast) of skin, hair, or nail |
87101 |
$72.00 |
$28.80 |
| Fungal culture (mold or yeast) |
87102 |
$82.00 |
$32.80 |
| Fungal blood culture (mold or yeast) |
87103 |
$43.00 |
$17.20 |
| Fungal culture, yeast |
87106 |
$34.00 |
$13.60 |
| Culture for identification of yeast |
87107 |
$43.00 |
$17.20 |
| Culture for acid-fast bacilli |
87116 |
$82.00 |
$32.80 |
| Identification of mycobacteria (TB or TB like organism) |
87118 |
$65.00 |
$26.00 |
| Identification of organisms by immunologic analysis |
87140 |
$40.00 |
$16.00 |
| Identification of organisms by immunologic analysis |
87147 |
$44.00 |
$17.60 |
| Identification of organisms by genetic analysis |
87153 |
$318.00 |
$127.20 |
| Macroscopic examination (visual inspection) of insect |
87168 |
$42.00 |
$16.80 |
| Macroscopic examination (visual inspection) of parasite |
87169 |
$42.00 |
$16.80 |
| Pinworm test |
87172 |
$39.00 |
$15.60 |
| Tissue preparation for culture |
87176 |
$56.00 |
$22.40 |
| Smear for parasites |
87177 |
$58.00 |
$23.20 |
| Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) |
87181 |
$51.00 |
$20.40 |
| Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) |
87184 |
$88.00 |
$35.20 |
| Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) |
87185 |
$45.00 |
$18.00 |
| Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) |
87186 |
$126.00 |
$50.40 |
| Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) |
87188 |
$32.00 |
$12.80 |
| Antimicrobial study, mycobacteria (TB organism family) |
87190 |
$10.00 |
$4.00 |
| Special stain for microorganism |
87205 |
$24.00 |
$9.60 |
| Special stain for microorganism |
87206 |
$60.00 |
$24.00 |
| Special stain for microorganism |
87207 |
$76.00 |
$30.40 |
| Special stain for parasites |
87209 |
$78.00 |
$31.20 |
| Smear for infectious agents |
87210 |
$53.00 |
$21.20 |
| Tissue fungi or parasites |
87220 |
$26.00 |
$10.40 |
| Microbial toxin or antitoxin assay |
87230 |
$76.00 |
$30.40 |
| Tissue culture inoculation for virus isolation |
87252 |
$126.00 |
$50.40 |
| Tissue culture for virus isolation |
87253 |
$100.00 |
$40.00 |
| Virus isolation |
87254 |
$113.00 |
$45.20 |
| Virus isolation |
87255 |
$182.00 |
$72.80 |
| Detection test for legionella pneumophila (water borne bacteria) |
87278 |
$81.00 |
$32.40 |
| Detection test for aspergillus (fungus) |
87305 |
$93.00 |
$37.20 |
| Detection test for clostridium difficile toxins (stool pathogen) |
87324 |
$46.00 |
$18.40 |
| Detection test for cryptosporidium (parasite) |
87328 |
$66.00 |
$26.40 |
| Detection test for giardia (intestinal parasite) |
87329 |
$79.00 |
$31.60 |
| Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method |
87338 |
$109.00 |
$43.60 |
| Detection test for Hepatitis B surface antigen |
87340 |
$60.00 |
$24.00 |
| Detection test for Hepatitis Be surface antigen |
87350 |
$54.00 |
$21.60 |
| Detection test for histoplasma capsulatum (parasite) |
87385 |
$96.00 |
$38.40 |
| Detection test for Rotavirus |
87425 |
$80.00 |
$32.00 |
| Detection test for Strep (Streptococcus, group A) |
87430 |
$70.00 |
$28.00 |
| Immunologic analysis for detection of organism |
87449 |
$156.00 |
$62.40 |
| Test for detecting nucleic acid of organism causing infection of central nervous system |
87483 |
$858.00 |
$343.20 |
| Detection test for Chlamydia pneumoniae |
87486 |
$126.00 |
$50.40 |
| Detection test for chlamydia |
87491 |
$146.00 |
$58.40 |
| Detection test for clostridium difficile |
87493 |
$199.00 |
$79.60 |
| Detection test for Cytomegalovirus (CMV) |
87496 |
$148.00 |
$59.20 |
| Detection test for cytomegalovirus, quantification |
87497 |
$267.00 |
$106.80 |
| Detection test for enterovirus (intestinal virus) |
87498 |
$189.00 |
$75.60 |
| Detection test for digestive tract pathogen |
87505 |
$198.00 |
$79.20 |
| Detection test for Hepatitis B virus |
87517 |
$182.00 |
$72.80 |
| Detection test for Hepatitis C virus |
87522 |
$245.00 |
$98.00 |
| Detection test for herpes simplex virus |
87529 |
$200.00 |
$80.00 |
| Detection test for HIV-1 virus |
87535 |
$235.00 |
$94.00 |
| Detection test for HIV-1 virus |
87536 |
$251.00 |
$100.40 |
| Detection test for Mycobacteria species (bacteria) |
87550 |
$60.00 |
$24.00 |
| Detection test for Mycoplasma pneumoniae (bacteria) |
87581 |
$142.00 |
$56.80 |
| Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria) |
87591 |
$141.00 |
$56.40 |
| Detection test for human papillomavirus (hpv) |
87624 |
$104.00 |
$41.60 |
| Detection test for human papillomavirus (hpv) |
87625 |
$208.00 |
$83.20 |
| Detection test for multiple types of respiratory virus |
87631 |
$477.00 |
$190.80 |
| Detection test for multiple types of respiratory virus |
87633 |
$1,055.00 |
$422.00 |
| Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria) |
87641 |
$198.00 |
$79.20 |
| Detection test for Strep (Streptococcus, group B) |
87653 |
$212.00 |
$84.80 |
| Detection test for Trichomonas vaginalis (genital parasite) |
87661 |
$155.00 |
$62.00 |
| Detection test for organism |
87798 |
$200.00 |
$80.00 |
| Detection test for organism |
87799 |
$231.00 |
$92.40 |
| Detection test for multiple organisms |
87801 |
$198.00 |
$79.20 |
| Detection test for influenza virus |
87804 |
$75.00 |
$30.00 |
| Detection test for respiratory syncytial virus (RSV) |
87807 |
$87.00 |
$34.80 |
| Detection test for identification of organism |
87899 |
$72.00 |
$28.80 |
| Infectious agent drug susceptibility analysis |
87900 |
$493.00 |
$197.20 |
| Analysis test for Hepatitis C virus |
87902 |
$612.00 |
$244.80 |
| Analysis test for HIV-1 virus |
87903 |
$912.00 |
$364.80 |
| Analysis test for HIV-1 virus |
87904 |
$127.00 |
$50.80 |
| Cell examination of body fluid |
88104 |
$78.00 |
$31.20 |
| Cell examination of specimen |
88108 |
$114.00 |
$45.60 |
| Cell examination of specimen |
88112 |
$102.00 |
$40.80 |
| Pap test (Pap smear) |
88142 |
$69.00 |
$27.60 |
| Examination of cervical or vaginal slide for hormonal evaluation |
88155 |
$21.00 |
$8.40 |
| Screening examination of specimen cells |
88161 |
$66.00 |
$26.40 |
| Pap test (Pap smear) |
88164 |
$31.00 |
$12.40 |
| Evaluation of fine needle aspirate |
88172 |
$41.00 |
$16.40 |
| Evaluation of fine needle aspirate with interpretation and report |
88173 |
$137.00 |
$54.80 |
| Pap test |
88175 |
$152.00 |
$60.80 |
| Flow cytometry technique for DNA or cell analysis |
88184 |
$146.00 |
$58.40 |
| Flow cytometry technique for DNA or cell analysis |
88185 |
$91.00 |
$36.40 |
| Tissue culture to identify white blood cell disorders |
88230 |
$344.00 |
$137.60 |
| Tissue culture for disorders of amniotic fluid or placenta cells |
88235 |
$435.00 |
$174.00 |
| Cryopreservation, freezing and storage of cells |
88240 |
$48.00 |
$19.20 |
| Chromosome analysis of amniotic fluid or placenta for genetic defects |
88267 |
$531.00 |
$212.40 |
| Chromosome analysis of amniotic fluid for genetic defects |
88269 |
$492.00 |
$196.80 |
| DNA testing for genetic defects |
88271 |
$176.00 |
$70.40 |
| Chromosome analysis for genetic defects |
88273 |
$172.00 |
$68.80 |
| Genetic testing |
88274 |
$181.00 |
$72.40 |
| Genetic testing |
88275 |
$184.00 |
$73.60 |
| Chromosome analysis for genetic defects |
88280 |
$147.00 |
$58.80 |
| Genetic studies |
88299 |
$50.00 |
$20.00 |
| Pathology examination of tissue using a microscope, limited examination |
88300 |
$68.00 |
$27.20 |
| Pathology examination of tissue using a microscope |
88302 |
$117.00 |
$46.80 |
| Pathology examination of tissue using a microscope, moderately low complexity |
88304 |
$158.00 |
$63.20 |
| Pathology examination of tissue using a microscope, intermediate complexity |
88305 |
$222.00 |
$88.80 |
| Pathology examination of tissue using a microscope, moderately high complexity |
88307 |
$325.00 |
$130.00 |
| Pathology examination of tissue using a microscope, high complexity |
88309 |
$404.00 |
$161.60 |
| Preparation of tissue for examination by removing any calcium present |
88311 |
$22.00 |
$8.80 |
| Special stained specimen slides to identify organisms including interpretation and report |
88312 |
$138.00 |
$55.20 |
| Special stained specimen slides to examine tissue including interpretation and report |
88313 |
$131.00 |
$52.40 |
| Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report |
88314 |
$134.00 |
$53.60 |
| Evaluation of specimen enzymes |
88319 |
$200.00 |
$80.00 |
| Surgical pathology consultation and report |
88321 |
$148.00 |
$59.20 |
| Comprehensive surgical pathology consultation and report |
88325 |
$402.00 |
$160.80 |
| Pathology examination of specimen during surgery |
88329 |
$51.00 |
$20.40 |
| Pathology examination of tissue during surgery |
88331 |
$173.00 |
$69.20 |
| Pathology examination of specimen during surgery |
88332 |
$67.00 |
$26.80 |
| Special stained specimen slides to examine tissue |
88341 |
$201.00 |
$80.40 |
| Tissue or cell analysis by immunologic technique |
88342 |
$201.00 |
$80.40 |
| Special stained specimen slides to examine tissue |
88344 |
$201.00 |
$80.40 |
| Antibody evaluation |
88346 |
$120.00 |
$48.00 |
| Microscopic genetic analysis of tumor |
88360 |
$165.00 |
$66.00 |
| Microscopic genetic analysis of tumor |
88361 |
$262.00 |
$104.80 |
| Analysis of genetic material |
88365 |
$293.00 |
$117.20 |
| Body fluid cell count |
89050 |
$79.00 |
$31.60 |
| Body fluid cell count with cell identification |
89051 |
$90.00 |
$36.00 |
| White blood cell measure, stool specimen |
89055 |
$25.00 |
$10.00 |
| Crystal identification from tissue or body fluid |
89060 |
$55.00 |
$22.00 |
| Fat stain of stool, urine, or respiratory secretions |
89125 |
$25.00 |
$10.00 |
| Examination of stool for meat fibers |
89160 |
$28.00 |
$11.20 |
| Nasal smear for eosinophils (allergy related white blood cells) |
89190 |
$44.00 |
$17.60 |
| Sputum specimen collection |
89220 |
$57.00 |
$22.80 |
| Sweat collection |
89230 |
$149.00 |
$59.60 |
| Semen evaluation volume, sperm count, motility and analysis |
89320 |
$97.00 |
$38.80 |
| Semen analysis for sperm presence |
89321 |
$56.00 |
$22.40 |
| Administration of 1 vaccine |
90471 |
$54.00 |
$21.60 |
| Administration of vaccine |
90472 |
$27.00 |
$10.80 |
| Psychotherapy, 30 minutes |
90832 |
$213.00 |
$85.20 |
| Psychotherapy, 60 minutes |
90837 |
$385.00 |
$154.00 |
| Group psychotherapy |
90853 |
$237.00 |
$94.80 |
| Hemodialysis procedure with one physician evaluation |
90935 |
$499.00 |
$199.60 |
| Dialysis procedure including one evaluation |
90945 |
$374.00 |
$149.60 |
| Measurement of esophageal swallowing movement |
91010 |
$1,530.00 |
$612.00 |
| Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation |
91035 |
$1,480.00 |
$592.00 |
| Imaging of digestive tract done from the inside of the digestive tract |
91110 |
$3,150.00 |
$1,260.00 |
| Study of anorectal pressure generated by muscles surrounding anus (sphincter) |
91122 |
$1,390.00 |
$556.00 |
| Measuring the stiffness in the liver via elastography |
91200 |
$191.00 |
$76.40 |
| Treatment of speech, language, voice, communication, and/or hearing processing disorder |
92507 |
$299.00 |
$119.60 |
| Group treatment of speech, language, voice, communication, and/or hearing processing disorder |
92508 |
$59.00 |
$23.60 |
| Examination of the nose and throat using an endoscope |
92511 |
$199.00 |
$79.60 |
| Evaluation of speech fluency |
92521 |
$228.00 |
$91.20 |
| Evaluation of speech sound production |
92522 |
$228.00 |
$91.20 |
| Evaluation of speech sound production with evaluation of language comprehension and expression |
92523 |
$228.00 |
$91.20 |
| Behavioral and qualitative analysis of voice and resonance |
92524 |
$228.00 |
$91.20 |
| Treatment of swallowing and/or oral feeding function |
92526 |
$303.00 |
$121.20 |
| Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system, infant |
92586 |
$370.00 |
$148.00 |
| Evaluation of patient with prescription of speech-generating and alternative communication device |
92607 |
$351.00 |
$140.40 |
| Evaluation and prescription of speech-generating and alternative communication device |
92608 |
$197.00 |
$78.80 |
| Therapeutic services for use of speech-generating device with programming |
92609 |
$232.00 |
$92.80 |
| Evaluation of swallowing function |
92610 |
$210.00 |
$84.00 |
| Fluoroscopic and video recorded motion evaluation of swallowing function |
92611 |
$290.00 |
$116.00 |
| Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) |
92920 |
$12,079.00 |
$4,831.60 |
| Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin) |
92921 |
$5,578.00 |
$2,231.20 |
| Removal of plaque of major coronary artery or branch, accessed through the skin |
92924 |
$16,117.00 |
$6,446.80 |
| Removal of plaque of major coronary artery or branch, accessed through the skin |
92925 |
$8,455.00 |
$3,382.00 |
| Catheter insertion of stents in major coronary artery or branch, accessed through the skin |
92928 |
$16,974.00 |
$6,789.60 |
| Catheter insertion of stents in major coronary artery or branch, accessed through the skin |
92928 |
$18,362.00 |
$7,344.80 |
| Catheter placement of stents in major coronary artery or branch, accessed through the skin |
92929 |
$7,916.00 |
$3,166.40 |
| Catheter placement of stents in major coronary artery or branch, accessed through the skin |
92929 |
$9,138.00 |
$3,655.20 |
| Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin |
92933 |
$19,832.00 |
$7,932.80 |
| Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin |
92933 |
$18,512.00 |
$7,404.80 |
| Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin |
92934 |
$9,148.00 |
$3,659.20 |
| Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin |
92934 |
$7,326.00 |
$2,930.40 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92937 |
$18,553.00 |
$7,421.20 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92937 |
$18,204.00 |
$7,281.60 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92938 |
$9,936.00 |
$3,974.40 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92938 |
$8,708.00 |
$3,483.20 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin |
92941 |
$18,932.00 |
$7,572.80 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin |
92941 |
$18,163.00 |
$7,265.20 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92943 |
$18,833.00 |
$7,533.20 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92943 |
$18,248.00 |
$7,299.20 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92944 |
$8,419.00 |
$3,367.60 |
| Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin |
92944 |
$8,675.00 |
$3,470.00 |
| Attempt to restart heart and lungs |
92950 |
$850.00 |
$340.00 |
| Temporary pacemaker to regulate heart beat |
92953 |
$485.00 |
$194.00 |
| External shock to heart to regulate heart beat |
92960 |
$1,050.00 |
$420.00 |
| Removal of blood clot in heart artery, accessed through the skin |
92973 |
$3,190.00 |
$1,276.00 |
| Infusion of drug into vein to dissolve coronary blood clot |
92977 |
$875.00 |
$350.00 |
| Ultrasound evaluation of heart blood vessel or graft |
92978 |
$3,046.00 |
$1,218.40 |
| Ultrasound evaluation of heart blood vessel or graft |
92979 |
$2,075.00 |
$830.00 |
| Catheter based repair of left lower heart (aortic) valve, accessed through the skin |
92986 |
$11,292.00 |
$4,516.80 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$361.00 |
$144.40 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$361.00 |
$144.40 |
| Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring |
93017 |
$380.00 |
$152.00 |
| Heart rhythm tracing of 48-hour EKG |
93225 |
$282.00 |
$112.80 |
| Heart rhythm analysis, interpretation and report of 48-hour EKG |
93226 |
$282.00 |
$112.80 |
| Ultrasound examination of congenital heart defect |
93303 |
$2,021.00 |
$808.40 |
| Ultrasound examination of congenital heart defect |
93303 |
$1,448.00 |
$579.20 |
| Follow-up or limited ultrasound examination of congenital heart defect |
93304 |
$1,250.00 |
$500.00 |
| Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function |
93306 |
$3,025.00 |
$1,210.00 |
| Follow-up or limited ultrasound examination of heart |
93308 |
$832.00 |
$332.80 |
| Insertion of probe in esophagus for heart ultrasound examination including interpretation and report |
93312 |
$2,414.00 |
$965.60 |
| Insertion of probe in esophagus for heart ultrasound examination including interpretation and report |
93312 |
$2,580.00 |
$1,032.00 |
| Insertion of probe in esophagus for heart ultrasound examination |
93313 |
$1,056.00 |
$422.40 |
| Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report |
93350 |
$1,801.00 |
$720.40 |
| Injection of X-ray contrast material for ultrasound examination of the heart |
93352 |
$150.00 |
$60.00 |
| Insertion of catheter for diagnostic evaluation of right heart structures |
93451 |
$5,800.00 |
$2,320.00 |
| Insertion of catheter into left heart for diagnosis |
93452 |
$6,966.00 |
$2,786.40 |
| Insertion of catheter into left heart for diagnosis |
93452 |
$6,966.00 |
$2,786.40 |
| Insertion of catheter into right and left heart for diagnosis |
93453 |
$7,680.00 |
$3,072.00 |
| Insertion of catheter for imaging of heart blood vessels or grafts |
93454 |
$10,046.00 |
$4,018.40 |
| Insertion of catheter for imaging of heart blood vessels or grafts |
93455 |
$8,765.00 |
$3,506.00 |
| Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts |
93456 |
$11,155.00 |
$4,462.00 |
| Insertion of catheter in right heart for imaging of blood vessels or grafts |
93457 |
$12,259.00 |
$4,903.60 |
| Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart |
93458 |
$17,896.00 |
$7,158.40 |
| Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart |
93459 |
$16,042.00 |
$6,416.80 |
| Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart |
93460 |
$17,362.00 |
$6,944.80 |
| Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart |
93461 |
$17,317.00 |
$6,926.80 |
| Insertion of catheter into left heart for diagnosis |
93462 |
$7,021.00 |
$2,808.40 |
| Drug infusion during cardiac catheterization |
93463 |
$712.00 |
$284.80 |
| Insertion of catheter into right upper heart chamber and pulmonary (lung) artery for monitoring purposes |
93503 |
$572.00 |
$228.80 |
| Biopsy of the wall dividing the left and right heart |
93505 |
$5,898.00 |
$2,359.20 |
| Injection for X-ray imaging of aorta above heart valve |
93567 |
$897.00 |
$358.80 |
| Injection for X-ray imaging of pulmonary (lung) artery from heart |
93568 |
$1,279.00 |
$511.60 |
| Ultrasound evaluation of heart blood vessel during diagnosis or treatment |
93571 |
$3,212.00 |
$1,284.80 |
| Ultrasound evaluation of heart blood vessel during diagnosis or treatment |
93572 |
$1,466.00 |
$586.40 |
| Catheter based closure of congenital heart defect with implant, accessed through the skin |
93580 |
$16,301.00 |
$6,520.40 |
| Insertion of catheter for recording upper heart rhythm |
93600 |
$2,445.00 |
$978.00 |
| Insertion of catheter for recording upper heart rhythm |
93602 |
$2,336.00 |
$934.40 |
| Insertion of catheter for recording of right lower heart chamber rhythm |
93603 |
$3,210.00 |
$1,284.00 |
| Insertion of catheter for recording to identify origin of abnormal heart rhythm |
93609 |
$4,436.00 |
$1,774.40 |
| Insertion of temporary pacemaker electrode for diagnostic upper heart pacing |
93610 |
$2,579.00 |
$1,031.60 |
| Insertion of temporary pacemaker electrode for diagnostic lower heart pacing |
93612 |
$3,038.00 |
$1,215.20 |
| Insertion of catheters for 3D mapping of electrical impulses to heart muscles |
93613 |
$6,619.00 |
$2,647.60 |
| Insertion of catheters for recording and pacing right upper and lower heart rhythm |
93619 |
$5,782.00 |
$2,312.80 |
| Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart |
93620 |
$10,620.00 |
$4,248.00 |
| Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart |
93621 |
$7,023.00 |
$2,809.20 |
| Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left lower heart |
93622 |
$6,691.00 |
$2,676.40 |
| Programmed heart rhythm stimulation after drug infusion into a vein |
93623 |
$4,469.00 |
$1,787.60 |
| Insertion of catheters for assessment of heart pacing, recording, or attempted induction of abnormal rhythm |
93624 |
$2,979.00 |
$1,191.60 |
| Intra-operative heart pacing and mapping of abnormal heart rhythm for surgical correction |
93631 |
$3,622.00 |
$1,448.80 |
| Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement |
93641 |
$2,485.00 |
$994.00 |
| Evaluation of single or dual chamber pacing cardioverter-defibrillator with programming or reprogramming |
93642 |
$2,643.00 |
$1,057.20 |
| Evaluation implantable defibrillator |
93644 |
$2,230.00 |
$892.00 |
| Insertion of catheters for creation of complete heart block |
93650 |
$9,127.00 |
$3,650.80 |
| Evaluation and insertion of catheters for creation of complete heart block |
93653 |
$23,190.00 |
$9,276.00 |
| Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm |
93654 |
$24,901.00 |
$9,960.40 |
| Insertion of catheters for treatment of abnormal heart rhythm |
93655 |
$8,668.00 |
$3,467.20 |
| Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm |
93656 |
$29,953.00 |
$11,981.20 |
| Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm |
93657 |
$8,745.00 |
$3,498.00 |
| Evaluation of heart function using tilt table |
93660 |
$1,639.00 |
$655.60 |
| Ultrasound evaluation of heart blood vessel |
93662 |
$3,958.00 |
$1,583.20 |
| Physician services for outpatient heart cardiac rehabilitation per session |
93797 |
$237.00 |
$94.80 |
| Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session |
93798 |
$259.00 |
$103.60 |
| Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck |
93880 |
$1,284.00 |
$513.60 |
| Ultrasound study of arteries of both arms and legs |
93922 |
$271.00 |
$108.40 |
| Ultrasound study of arteries of both arms and legs |
93923 |
$356.00 |
$142.40 |
| Ultrasound study of arteries and arterial grafts of both legs |
93925 |
$510.00 |
$204.00 |
| Ultrasound study of arteries and arterial grafts of one leg or limited |
93926 |
$255.00 |
$102.00 |
| Ultrasound study of arteries and arterial grafts of both arms |
93930 |
$510.00 |
$204.00 |
| Ultrasound study of arteries and arterial grafts of one arm or limited |
93931 |
$255.00 |
$102.00 |
| Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers |
93970 |
$1,397.00 |
$558.80 |
| Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers |
93971 |
$938.00 |
$375.20 |
| Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow |
93976 |
$649.00 |
$259.60 |
| Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan |
93979 |
$544.00 |
$217.60 |
| Ultrasound of dialysis access |
93990 |
$237.00 |
$94.80 |
| Ventilation assistance and management, hospital inpatient or observation |
94002 |
$1,021.00 |
$408.40 |
| Ventilation assistance and management, hospital inpatient or observation |
94003 |
$870.00 |
$348.00 |
| Measurement and graphic recording of total and timed exhaled air capacity |
94010 |
$143.00 |
$57.20 |
| Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration |
94060 |
$337.00 |
$134.80 |
| Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration |
94070 |
$503.00 |
$201.20 |
| Measurement of largest amount of air exhaled from lungs |
94150 |
$42.00 |
$16.80 |
| Single measurement of remaining air or lung capacity after exhalation |
94250 |
$56.00 |
$22.40 |
| Administration of medication through breathing tube |
94610 |
$150.00 |
$60.00 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$214.00 |
$85.60 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$214.00 |
$85.60 |
| Inhaled pneumonia treatment |
94642 |
$330.00 |
$132.00 |
| Respiratory inhaled aerosol treatment to relieve airway obstruction |
94645 |
$91.00 |
$36.40 |
| Initiation and management of continued pressured respiratory assistance by mask or breathing tube |
94660 |
$350.00 |
$140.00 |
| Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device |
94664 |
$83.00 |
$33.20 |
| Demonstration and/or evaluation of manual maneuvers to chest wall to assist movement of lung secretions |
94667 |
$163.00 |
$65.20 |
| Manual maneuvers to chest wall to assist movement of lung secretions |
94668 |
$42.00 |
$16.80 |
| Determination of lung volumes using plethysmography |
94726 |
$127.00 |
$50.80 |
| Determination of lung volumes using gas dilution or washout |
94727 |
$102.00 |
$40.80 |
| Measurement of lung diffusing capacity |
94729 |
$240.00 |
$96.00 |
| Overnight measurement of oxygen saturation in blood using ear or finger device |
94762 |
$109.00 |
$43.60 |
| Measurement of exhaled carbon dioxide gas |
94770 |
$185.00 |
$74.00 |
| Rapid desensitization procedure, each hour |
95180 |
$257.00 |
$102.80 |
| Study of sleep and wake patterns including interpretation and report, minimum of 72 hours to 14 consecutive days of recording |
95803 |
$288.00 |
$115.20 |
| Diagnostic test for sleep disorder |
95805 |
$3,173.00 |
$1,269.20 |
| Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort |
95806 |
$1,014.00 |
$405.60 |
| Sleep monitoring of patient (6 years or older) in sleep lab |
95810 |
$5,151.00 |
$2,060.40 |
| Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube |
95811 |
$5,551.00 |
$2,220.40 |
| Measurement of brain wave (EEG) activity, 41-60 minutes |
95812 |
$485.00 |
$194.00 |
| Measurement of brain wave (EEG) activity greater than 1 hour |
95813 |
$650.00 |
$260.00 |
| Measurement and recording of brain wave (EEG) activity, awake and drowsy |
95816 |
$514.00 |
$205.60 |
| Measurement and recording of brain wave (EEG) activity, awake and asleep |
95819 |
$514.00 |
$205.60 |
| Measurement and recording of brain wave (EEG) activity, in coma or asleep |
95822 |
$498.00 |
$199.20 |
| Measurement and recording of brain wave (EEG) activity, cerebral death evaluation |
95824 |
$498.00 |
$199.20 |
| Measurement and recording of brain wave (EEG) activity, overnight |
95827 |
$650.00 |
$260.00 |
| Manual muscle testing of arm, leg or trunk |
95831 |
$42.00 |
$16.80 |
| Needle measurement and recording of electrical activity of muscles of arm or leg |
95860 |
$239.00 |
$95.60 |
| Needle measurement and recording of electrical activity of muscles of arms or legs |
95861 |
$423.00 |
$169.20 |
| Needle measurement and recording of electrical activity of muscles in arms or legs |
95863 |
$607.00 |
$242.80 |
| Needle measurement and recording of electrical activity of muscles in arms or legs |
95864 |
$791.00 |
$316.40 |
| Needle measurement and recording of electrical activity of middle spine muscles |
95869 |
$162.00 |
$64.80 |
| Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study |
95870 |
$146.00 |
$58.40 |
| Needle measurement and recording electrical activity of muscles including jitter blocking and/or fiber density using single electrode |
95872 |
$550.00 |
$220.00 |
| Needle measurement and recording of electrical activity of muscles of arm or leg limited study |
95885 |
$137.00 |
$54.80 |
| Needle measurement and recording of electrical activity of muscles of arm or leg complete study |
95886 |
$147.00 |
$58.80 |
| Needle measurement and recording of electrical activity of head or trunk muscles |
95887 |
$103.00 |
$41.20 |
| Nerve transmission studies, 1-2 studies |
95907 |
$176.00 |
$70.40 |
| Nerve transmission studies, 3-4 studies |
95908 |
$298.00 |
$119.20 |
| Nerve transmission studies, 5-6 studies |
95909 |
$420.00 |
$168.00 |
| Nerve transmission studies, 7-8 studies |
95910 |
$542.00 |
$216.80 |
| Nerve transmission studies, 9-10 studies |
95911 |
$664.00 |
$265.60 |
| Nerve transmission studies, 11-12 studies |
95912 |
$786.00 |
$314.40 |
| Nerve transmission studies, 13 or more studies |
95913 |
$908.00 |
$363.20 |
| Measurement of nerve conduction patterns of eye blink reflex |
95933 |
$155.00 |
$62.00 |
| Testing with stimulation for assessment of function at muscle-nerve junction |
95937 |
$109.00 |
$43.60 |
| Monitoring and localization of seizure activity over 24-hour period using 16-channel electroencephalograph (EEG) |
95951 |
$3,415.00 |
$1,366.00 |
| Monitoring and localization of seizure activity over 24-hour period using portable 16-channel electroencephalograph (EEG) |
95953 |
$2,363.00 |
$945.20 |
| Repositioning maneuvers for treatment of vertigo, per day |
95992 |
$156.00 |
$62.40 |
| Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes |
96112 |
$240.00 |
$96.00 |
| Developmental test administration by qualified health care professional with interpretation and report, additonal 30 minutes |
96113 |
$100.00 |
$40.00 |
| Hydration infusion into a vein 31 minutes to 1 hour |
96360 |
$148.00 |
$59.20 |
| Hydration infusion into a vein |
96361 |
$62.00 |
$24.80 |
| Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour |
96365 |
$188.00 |
$75.20 |
| Infusion into a vein for therapy, prevention, or diagnosis |
96366 |
$62.00 |
$24.80 |
| Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour |
96367 |
$48.00 |
$19.20 |
| Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion |
96368 |
$48.00 |
$19.20 |
| Infusion into tissue for therapy or prevention up to 1 hour |
96369 |
$151.00 |
$60.40 |
| Infusion into tissue for therapy or prevention, beneath the skin |
96370 |
$40.00 |
$16.00 |
| Infusion for therapy or prevention, beneath the skin |
96371 |
$150.00 |
$60.00 |
| Injection beneath the skin or into muscle for therapy, diagnosis, or prevention |
96372 |
$107.00 |
$42.80 |
| Injection of drug or substance into a vein for therapy, diagnosis, or prevention |
96374 |
$170.00 |
$68.00 |
| Injection of different drug or substance into a vein for therapy, diagnosis, or prevention |
96375 |
$148.00 |
$59.20 |
| Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility |
96376 |
$148.00 |
$59.20 |
| Application of on-body injector for injection under skin |
96377 |
$107.00 |
$42.80 |
| Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle |
96401 |
$196.00 |
$78.40 |
| Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle |
96402 |
$186.00 |
$74.40 |
| Infusion of chemotherapy into a vein using push technique |
96409 |
$264.00 |
$105.60 |
| Infusion of different chemotherapy drug or substance into a vein |
96411 |
$186.00 |
$74.40 |
| Infusion of chemotherapy into a vein up to 1 hour |
96413 |
$302.00 |
$120.80 |
| Infusion of chemotherapy into a vein |
96415 |
$76.00 |
$30.40 |
| Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours |
96416 |
$451.00 |
$180.40 |
| Infusion of different chemotherapy drug or substance into a vein up to 1 hour |
96417 |
$186.00 |
$74.40 |
| Injection of chemotherapy using push technique into an artery |
96420 |
$235.00 |
$94.00 |
| Chemotherapy infusion into abdominal cavity |
96446 |
$602.00 |
$240.80 |
| Chemotherapy administration into spinal canal requiring spinal tap |
96450 |
$1,001.00 |
$400.40 |
| Refilling and maintenance of portable pump |
96521 |
$188.00 |
$75.20 |
| Irrigation of implanted venous access drug delivery device |
96523 |
$61.00 |
$24.40 |
| Chemotherapy injection into brain through reservoir beneath the skin |
96542 |
$188.00 |
$75.20 |
| Application of ultraviolet light to skin |
96900 |
$138.00 |
$55.20 |
| Application of mechanical traction to 1 or more areas |
97012 |
$55.00 |
$22.00 |
| Application of electrical stimulation to 1 or more areas, unattended by physical therapist |
97014 |
$78.00 |
$31.20 |
| Application of blood vessel compression or decompression device to 1 or more areas |
97016 |
$101.00 |
$40.40 |
| Application of hot wax bath to 1 or more areas |
97018 |
$39.00 |
$15.60 |
| Application of whirlpool therapy to 1 or more areas |
97022 |
$91.00 |
$36.40 |
| Application of low energy heat (infrared) to 1 or more areas |
97026 |
$10.00 |
$4.00 |
| Application of electrical stimulation to 1 or more areas, each 15 minutes |
97032 |
$80.00 |
$32.00 |
| Application of medication through skin using electrical current, each 15 minutes |
97033 |
$91.00 |
$36.40 |
| Therapeutic hot and cold baths to 1 or more areas, each 15 minutes |
97034 |
$51.00 |
$20.40 |
| Application of ultrasound to 1 or more areas, each 15 minutes |
97035 |
$98.00 |
$39.20 |
| Physical therapy treatment to 1 or more areas, Hubbard tank, each 15 minutes |
97036 |
$91.00 |
$36.40 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$92.00 |
$36.80 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$92.00 |
$36.80 |
| Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes |
97112 |
$75.00 |
$30.00 |
| Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes |
97113 |
$120.00 |
$48.00 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$78.00 |
$31.20 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$78.00 |
$31.20 |
| Manual (physical) therapy techniques to 1 or more regions, each 15 minutes |
97140 |
$97.00 |
$38.80 |
| Therapeutic procedures in a group setting |
97150 |
$56.00 |
$22.40 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$200.00 |
$80.00 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$200.00 |
$80.00 |
| Evaluation of physical therapy, typically 30 minutes |
97162 |
$220.00 |
$88.00 |
| Evaluation of physical therapy, typically 45 minutes |
97163 |
$240.00 |
$96.00 |
| Re-evaluation of physical therapy, typically 20 minutes |
97164 |
$100.00 |
$40.00 |
| Evaluation of occupational therapy, typically 30 minutes |
97165 |
$200.00 |
$80.00 |
| Evaluation of occupational therapy, typically 45 minutes |
97166 |
$220.00 |
$88.00 |
| Evaluation of occupational therapy established plan of care, typically 60 minutes |
97167 |
$240.00 |
$96.00 |
| Re-evaluation of occupational therapy established plan of care, typically 30 minutes |
97168 |
$100.00 |
$40.00 |
| Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes |
97530 |
$115.00 |
$46.00 |
| Self-care or home management training, each 15 minutes |
97535 |
$65.00 |
$26.00 |
| Community or work reintegration training, each 15 minutes |
97537 |
$57.00 |
$22.80 |
| Wheelchair management, each 15 minutes |
97542 |
$58.00 |
$23.20 |
| Work hardening or conditioning, first 2 hours |
97545 |
$246.00 |
$98.40 |
| Work hardening or conditioning |
97546 |
$99.00 |
$39.60 |
| Removal of tissue from wounds per session |
97597 |
$249.00 |
$99.60 |
| Removal of tissue from wounds per session |
97598 |
$189.00 |
$75.60 |
| Removal of tissue from wounds per session |
97602 |
$193.00 |
$77.20 |
| Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session |
97605 |
$224.00 |
$89.60 |
| Negative pressure wound therapy, surface area greater than 50 square centimeters, per session |
97606 |
$310.00 |
$124.00 |
| Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session |
97607 |
$584.00 |
$233.60 |
| Negative pressure wound therapy surface area greater than 50 square centimeters |
97608 |
$716.00 |
$286.40 |
| Physical performance test or measurement with report, each 15 minutes |
97750 |
$86.00 |
$34.40 |
| Assistive technology assessment to enhance functional performance, each 15 minutes |
97755 |
$71.00 |
$28.40 |
| Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes |
97760 |
$87.00 |
$34.80 |
| Training in use of prosthesis for arms and/or legs, per 15 minutes |
97761 |
$101.00 |
$40.40 |
| Management and/or training in use of orthotics (supports, braces, or splints) for arms, legs, and/or trunk, per 15 minutes |
97763 |
$80.00 |
$32.00 |
| Medical nutrition therapy, assessment and intervention, each 15 minutes |
97802 |
$50.00 |
$20.00 |
| Medical nutrition therapy re-assessment and intervention, each 15 minutes |
97803 |
$50.00 |
$20.00 |
| Education and training for patient self-management, each 30 minutes |
98960 |
$175.00 |
$70.00 |
| Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes |
99151 |
$87.00 |
$34.80 |
| Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes |
99152 |
$87.00 |
$34.80 |
| Moderate sedation services by physician also performing a procedure, additional 15 minutes |
99153 |
$33.00 |
$13.20 |
| Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes |
99155 |
$87.00 |
$34.80 |
| Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes |
99156 |
$87.00 |
$34.80 |
| Moderate sedation services by physician not performing a procedure, each additional 15 minutes |
99157 |
$33.00 |
$13.20 |
| Management and supervision of oxygen chamber therapy per session |
99183 |
$1,788.00 |
$715.20 |
| Therapeutic removal of whole blood to correct blood level imbalance |
99195 |
$68.00 |
$27.20 |
| New patient office or other outpatient visit, typically 10 minutes |
99201 |
$116.00 |
$46.40 |
| New patient office or other outpatient visit, typically 20 minutes |
99202 |
$155.00 |
$62.00 |
| New patient office or other outpatient visit, typically 30 minutes |
99203 |
$192.00 |
$76.80 |
| New patient office or other outpatient visit, typically 45 minutes |
99204 |
$266.00 |
$106.40 |
| Established patient office or other outpatient visit, typically 5 minutes |
99211 |
$112.00 |
$44.80 |
| Established patient office or other outpatient visit, typically 10 minutes |
99212 |
$120.00 |
$48.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$140.00 |
$56.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$140.00 |
$56.00 |
| Established patient office or other outpatient, visit typically 25 minutes |
99214 |
$163.00 |
$65.20 |
| Established patient office or other outpatient, visit typically 40 minutes |
99215 |
$206.00 |
$82.40 |
| Emergency department visit, self limited or minor problem |
99281 |
$295.00 |
$118.00 |
| Emergency department visit, low to moderately severe problem |
99282 |
$512.00 |
$204.80 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$851.00 |
$340.40 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$851.00 |
$340.40 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$1,387.00 |
$554.80 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$1,387.00 |
$554.80 |
| Emergency department visit, problem with significant threat to life or function |
99285 |
$2,679.00 |
$1,071.60 |
| Critical care delivery critically ill or injured patient, first 30-74 minutes |
99291 |
$2,979.00 |
$1,191.60 |
| Critical care delivery critically ill or injured patient |
99292 |
$333.00 |
$133.20 |
