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Bill Item Long Desc Procedure/Service Description Reference Number (CPT/HCPCS) Clinic Price Hospital & Ancillary Services Outpatient Lab Price Physician Fees
Minimum Inhibitory Concentration Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate 87186 109.00 43.00
Gram negative identification (Vitek) Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate 87077 102.00 41.00
Gram positive identification (Vitek) Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate 87077 102.00 41.00
Anti-D Blood typing, serologic; Rh (D) 86901 38.00
Urine Dipstick POC Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automat 81000 40.00
Urine Pregnancy Test POC Urine pregnancy test, by visual color comparison methods 81025 73.00 73.00
Vision Testing Screening test of visual acuity, quantitative, bilateral 99173 0.00
Stool for Occult Blood POC Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations 82274 65.00 65.00
Urine Dipstick POC Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automat 81002 42.00 42.00 42.00
URINE PREGNANCY TEST POC Urine pregnancy test, by visual color comparison methods 81025 73.00 73.00
Prolonged Physician Service Outpatient with Direct Patient Contact First Hour - 99354 Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact b 99354 253.00 289.00
Amylase Level Amylase 82150 82.00
After Hours Visit - 99050 Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service 99050 63.00 25.00 0.00
Antepartum Care 7 or More Visits - 59426 Antepartum care only; 7 or more visits 59426 2,759.00 2,759.00 1,679.00
Critical Care Services Evaluation and Treatment for Each Additional 30 Minutes - 99292 Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) 99292 572.00 660.00 459.00
Emergency Department Visit Level 1 - 99281 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical 99281 25.00 126.00 101.00
Emergency Department Visit Level 2 - 99282 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Med 99282 193.00 246.00 198.00
Emergency Department Visit Level 3 - 99283 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Med 99283 289.00 377.00 309.00
Emergency Department Visit Level 4 - 99284 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate c 99284 547.00 701.00 576.00
Emergency Department Visit Level 5 - 99285 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/ 99285 809.00 1,037.00 855.00
Hospital Discharge Management 30 min or Less - 99238 Hospital discharge day management; 30 minutes or less 99238 338.00 338.00 211.00
Hospital Discharge Management More Than 30 min - 99239 Hospital discharge day management; more than 30 minutes 99239 502.00 502.00 314.00
Initial Hospital Care Level 1 - 99221 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; an 99221 474.00 474.00 317.00
Initial Hospital Care Level 2 - 99222 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision makin 99222 639.00 639.00 431.00
Initial Hospital Care Level 3 - 99223 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision makin 99223 946.00 946.00 637.00
Initial Inpatient Consultation Level 1 - 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. 99251 228.00 228.00 165.00
Initial Inpatient Consultation Level 2 - 99252 Inpatient consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medic 99252 349.00 349.00 248.00
Initial Inpatient Consultation Level 3 - 99253 Inpatient consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling a 99253 535.00 535.00 375.00
Initial Inpatient Consultation Level 4 - 99254 Inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexit 99254 777.00 777.00 543.00
Initial Inpatient Consultation Level 5 - 99255 Inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. C 99255 937.00 937.00 660.00
Initial Observation Care Level 1 - 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; 99218 466.00 466.00 317.00
Initial Observation Care Level 2 - 99219 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision ma 99219 634.00 633.00 428.00
Initial Observation Care Level 3 - 99220 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision ma 99220 866.00 866.00 587.00
Obs/ Same Day Inpatient Care Level 1 - 99234 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A detailed or compreh 99234 622.00 622.00 422.00
Observation/ Same Day Inpatient Care Level 2 - 99235 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive histo 99235 789.00 789.00 535.00
Observation/ Same Day Inpatient Care Level 3 - 99236 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive histo 99236 1,016.00 1,016.00 693.00
Observation Care Discharge - 99217 Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initia 99217 340.00 340.00 211.00
Office Consultation Level 1 - 99241 Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Cou 99241 174.00 211.00 120.00
Office Consultation Level 2 - 99242 Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical 99242 303.00 374.00 232.00
Office Consultation Level 3 - 99243 Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/ 99243 373.00 462.00 292.00
Office Consultation Level 4 - 99244 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. 99244 516.00 648.00 434.00
Office/Outpatient Visit Level 1 Established - 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, th Hospital outpatient clinic visit for assessment and management of a patient 99211 74.00 92.00 41.00
Office/Outpatient Visit Level 1 New - 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward m Hospital outpatient clinic visit for assessment and management of a patient 99201 124.00 143.00 67.00
Office/Outpatient Visit Level 3 Established Specialty- 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded pro Hospital outpatient clinic visit for assessment and management of a patient 99213 214.00 242.00 129.00
Postpartum Care only - 59430 Postpartum care only (separate procedure) 59430 877.00 1,134.00 665.00
Preventive Medicine 1-4 years Established - 99392 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 99392 254.00 310.00 184.00
Preventive Medicine 1-4 years New - 99382 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99382 276.00 336.00 196.00
Preventive Medicine 12-17 years Established - 99394 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 99394 278.00 341.00 208.00
Preventive Medicine 12-17 years New - 99384 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99384 324.00 400.00 246.00
Preventive Medicine 18-39 years New - 99385 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99385 313.00 385.00 235.00
Preventive Medicine 40-64 years Established - 99396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 99396 302.00 373.00 233.00
Preventive Medicine 40-64 years New - 99386 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99386 365.00 453.00 286.00
Preventive Medicine 5-11 years New - 99383 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99383 289.00 352.00 208.00
Preventive Medicine 65+ years Established - 99397 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 99397 292.00 385.00 246.00
Preventive Medicine 65+ years New - 99387 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99387 396.00 521.00 338.00
Preventive Medicine < 1 year Established - 99391 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 99391 237.00 289.00 168.00
Preventive Medicine < 1 year New - 99381 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reducti 99381 265.00 321.00 184.00
Prolonged Physician Service Inpatient with Direct Patient Contact Each Additional 30 Minutes - 99357 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service) 99357 429.00 414.00 267.00
Prolonged Physician Service Inpatient with Direct Patient Contact First Hour - 99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management 99356 266.00 368.00 277.00
Prolonged Physician Service Without Direct Patient Contact First Hour - 99358 Prolonged evaluation and management service before and/or after direct patient care; first hour 99358 522.00 522.00 347.00
Subsequent Hospital Care Level 1 - 99231 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examinati 99231 183.00 183.00 125.00
Subsequent Hospital Care Level 2 - 99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded probl 99232 336.00 336.00 229.00
Subsequent Hospital Care Level 3 - 99233 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical de 99233 487.00 487.00 330.00
Glucose Level Glucose; quantitative, blood (except reagent strip) 82947 49.00 20.00
Glucose Urine Glucose, body fluid, other than blood 82945 49.00
Glucose Cerebrospinal Fluid Glucose, body fluid, other than blood 82945 49.00
Blood Urea Nitrogen Urea nitrogen; quantitative 84520 49.00 20.00
Creatinine Level Creatinine; blood 82565 64.00 25.00
Creatinine Level Urine Creatinine; other source 82570 65.00 26.00
Sodium Level Sodium; serum, plasma or whole blood 84295 61.00
Sodium Level 24 Hour Urine Sodium; urine 84300 61.00
Potassium Level Potassium; serum, plasma or whole blood 84132 58.00
Potassium Level 24 Hour Urine Potassium; urine 84133 54.00
Chloride Level Chloride; blood 82435 58.00
Chloride Level 24 Hour Urine Chloride; urine 82436 63.00
Carbon Dioxide Level Carbon dioxide (bicarbonate) 82374 62.00
Alanine Aminotransferase Transferase; alanine amino (ALT) (SGPT) 84460 66.00
Aspartate Aminotransferase Transferase; aspartate amino (AST) (SGOT) 84450 65.00
Albumin Level Albumin; serum, plasma or whole blood 82040 62.00
Alkaline Phosphatase Phosphatase, alkaline; 84075 65.00
Ammonia Level Ammonia 82140 184.00
Bilirubin Direct Bilirubin; direct 82248 63.00
Bilirubin Total Bilirubin; total 82247 63.00
Venous Blood Gas Gases, blood, pH only 82800 106.00
Calcium Level 24 Hour Urine Calcium; urine quantitative, timed specimen 82340 65.00
Calcium Level Calcium; total 82310 65.00
Carbamazepine Level Carbamazepine; total 80156 183.00
Cholesterol High Density Lipid Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) 83718 103.00
Cholesterol Low Density Lipids Lipoprotein, direct measurement; LDL cholesterol 83721 120.00
Cholesterol Total Cholesterol, serum or whole blood, total 82465 55.00
Creatine Kinase Creatine kinase (CK), (CPK); total 82550 82.00
C-Reactive Protein C-reactive protein; high sensitivity (hsCRP) 86141 163.00
D-Dimer Fibrin degradation products, D-dimer; quantitative 85379 128.00
Digoxin Level Digoxin; total 80162 167.00
Gamma Glutamyl Transferase Glutamyltransferase, gamma (GGT) 82977 90.00
HEMOGLOBIN Blood count; hemoglobin (Hgb) 85018 29.00 12.00
Hematocrit Blood count; hematocrit (Hct) 85014 29.00 12.00
Hemoglobin A1c Hemoglobin; glycosylated (A1C) 83036 122.00 48.00
Lactic Acid Lactate (lactic acid) 83605 134.00
Lactate Dehydrogenase Lactate dehydrogenase (LD), (LDH); 83615 76.00
Lipase Level Lipase 83690 87.00
Lithium Level Lithium 80178 83.00
Magnesium Level Magnesium 83735 84.00 34.00
Mononucleosis Screen Heterophile antibodies; screening 86308 65.00
Prothrombin Time Prothrombin time; 85610 49.00 20.00
Partial Thromboplastin Time Thromboplastin time, partial (PTT); plasma or whole blood 85730 76.00
pH Body Fluid pH; body fluid, not otherwise specified 83986 45.00
Phenobarbital Level Phenobarbital 80184 144.00
Phosphorus Level Phosphorus inorganic (phosphate); 84100 60.00 24.00
Platelet Count Blood count; platelet, automated 85049 57.00
Protein Level 24 Hour Urine Protein, total, except by refractometry; urine 84156 46.00
Protein Cerebrospinal Fluid Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid) 84157 46.00
Protein, total, refractometry; serum, plasma or whole blood Protein, total, except by refractometry; serum, plasma or whole blood 84155 46.00
Protein Level Urine Protein, total, except by refractometry; urine 84156 46.00
Rubella Antibody; rubella 86762 168.00
Sedimentation Rate Sedimentation rate, erythrocyte; non-automated 85651 44.00 18.00
T3 Uptake Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) 84479 82.00
Thyroid Stimulating Hormone Thyroid stimulating hormone (TSH) 84443 211.00 84.00
Triglycerides Triglycerides 84478 72.00
Uric Acid Uric acid; blood 84550 57.00
Urinalysis Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, 81003 41.00 12.00
Valproic Acid Level Valproic acid (dipropylacetic acid); total 80164 170.00
Vitamin B12 Level Cyanocobalamin (Vitamin B-12); 82607 189.00
White Blood Count Blood count; leukocyte (WBC), automated 85048 32.00
Eye Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 87070 108.00 43.00
Genital Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 87070 108.00 43.00
Beta Lactamase Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme 87185 11.00
Antigen Type Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test 86902 48.00
Destruct, Vulva Lesion Simple Charge Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 56501 438.00 485.00
Destruct, Vulva Lesion Extensive Charge Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 56515 1,064.00 774.00
Biopsy Vulva/Perineum, One Charge Biopsy of vulva or perineum (separate procedure); 1 lesion 56605 312.00 250.00
Bartholin's Gland/Cyst Remove Charge Marsupialization of Bartholin's gland cyst 56440 857.00 477.00
Destruct Vagina Lesion Extensive Charge Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 57065 918.00 822.00
Fitting/Insert Pessary/Other Support Charge Fitting and insertion of pessary or other intravaginal support device 57160 268.00 198.00
Fitting Diaphragm/Cervical Cap Charge Diaphragm or cervical cap fitting with instructions 57170 285.00 229.00
Colposcopy Entire Vagina w/Cervix Charge Colposcopy of the entire vagina, with cervix if present; 57420 412.00 436.00
Colposcopy Cervix Upper Vag Charge Colposcopy of the cervix including upper/adjacent vagina; 57452 362.00 278.00
Colposcopy Cervix/Upper Vag w/Bx Cervix & Endo Charge Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage 57454 524.00 448.00
Colposcopy Cervix/Upper Vag w/Bx Cervix Charge Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix 57455 533.00 390.00
Colposcopy Cervix/Upper Vag w/Loop Bx Charge Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix 57460 1,320.00 766.00
Biopsy, Single or Multiple, or Local Excision of Lesion Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) 57500 449.00 358.00
Endocervical Curettage Charge Endocervical curettage (not done as part of a dilation and curettage) 57505 339.00 334.00
Cryocautery Cervix Charge Cautery of cervix; cryocautery, initial or repeat 57511 678.00 620.00
Cervix Conization, Remove Charge Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser 57520 1,444.00 1,295.00
Cervix Conization w/Loop Elec, Remove Charge Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision 57522 1,068.00 1,143.00
Dilation Cervix Canal Charge Dilation of cervical canal, instrumental (separate procedure) 57800 284.00 229.00
Biopsy Endometrial Charge Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) 58100 387.00 304.00
IUD, Insert Charge Insertion of intrauterine device (IUD) 58300 340.00 254.00
REMOVE INTRAUTERINE DEVICE (IUD) Removal of intrauterine device (IUD) 58301 326.00 285.00
Insert Cervical Dilator Charge Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure) 59200 340.00 215.00
Anoscopy Charge Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 46600 306.00 174.00
Hepatitis A Adult Vaccine Hepatitis A vaccine (HepA), adult dosage, for intramuscular 90632 156.00
Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use 90633 67.00 67.00
Flu Vaccine Split 6-35 Months IM POC Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use 90657 32.00 32.00
Flu Vaccine Split 3 yrs and above IM Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE (AFLURIA) 90658 37.00 37.00
Flu Vaccine Live Intranasal POC Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use 90660 38.00 38.00
Pneumococcal Conjugate Polyvalent Vaccine < 5yrs POC 145.00 145.00
DTaP Diphtheria/Pertussis, acellular/Tetanus Vaccine DTaP Under 7 yrs POC Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use 90700 46.00 46.00
DT Diphtheria-Tetanus toxoids < 7 yrs POC Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use 90702 39.00 39.00
MMR Measles/Mumps/Rubella Virus Vaccine POC Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use 90707 92.00 92.00
IPV Inactivated Poliovirus Vaccine POC Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use 90713 51.00 0.00
Varicella Virus Vaccine POC Varicella virus vaccine (VAR), live, for subcutaneous use 90716 136.00 136.00
Tetanus-Diphtheria Toxoids 7 yrs and Older POC Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use 90715 60.00 60.00 60.00
Diphth/HepB/Pertussis,Acel/Polio/Tetanus Vaccine POC Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use 90723 140.00 140.00
Pneumococcal 23-Valent Adult Vaccine POC Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use 90732 108.00
Meningococcal Vaccine POC Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use 90733 185.00 185.00
Hepatitis B Vaccine, Pediatric 3 Dose Sched POC Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use 90744 64.00 0.00
EKG 12 Lead, Interp/Report Only Charge Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report 93000 76.00 133.00
Cervical/Vaginal CA Screen; Pelvic/Breast Exam Medicare Charge CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION 0 180.00 132.00
Betamethasone Acetate/Betamethasone Sodium Injection 3 mg Charge Injection, betamethasone acetate 3 mg and betamethasone sodi 0 23.00 23.00
Depo-Provera Injection 150 mg Charge Injection, medroxyprogesterone acetate, 1 mg 0 251.00
Furosemide Injection 20 mg Charge INJECTION, FUROSEMIDE, UP TO 20 MG 0 14.00 14.00
Wet Mount POC Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) 0 63.00
Strep A POC Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A 0 42.00
Hemoglobin A1c POC Hemoglobin; glycosylated (A1C) 0 124.00 124.00
Community/Work Reintegration Charges Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive techn 0 119.00
Cognitive Skills Development Charges Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes 0 106.00
Therapeutic Activities Charges Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 0 137.00
Therapeutic Exercise Charges Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 0 127.00
Ultrasound Charges Application of a modality to 1 or more areas; ultrasound, each 15 minutes 0 50.00
Neuromuscular Reeducation Charges Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing ac 0 132.00
Massage Charge Units Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 0 25.00
Manual Therapy Charge Units Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 0 118.00
Iontophoresis Charges Application of a modality to 1 or more areas; iontophoresis, each 15 minutes 0 130.00
Attended E-Stim Charges ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE 0 55.00
ADL Training Charges Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adapti 0 137.00
Therapeutic Exercise Charges Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 0 127.00
Ultrasound Charges Application of a modality to 1 or more areas; ultrasound, each 15 minutes 0 50.00
Neuromuscular Reeducation Charges Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing ac 0 132.00
Wheelchair Management Charges Wheelchair management (eg, assessment, fitting, training), each 15 minutes 0 121.00
Prosthetic Training Charges Prosthetic training, upper and/or lower extremity(s), each 15 minutes 0 131.00
Orthotic Mgmt and Training Charges Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes 0 150.00
Therapeutic Activities Charge Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 0 137.00
Gait Training Charges Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) 0 112.00
Massage Charge Units Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 0 25.00
Manual Therapy Charge Units Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 0 118.00
Iontophoresis Charges Application of a modality to 1 or more areas; iontophoresis, each 15 minutes 0 130.00
Attended E-Stim Charges Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes 0 75.00
E-Stim for Wound Other Charge ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE 0 62.00
Drain Skin Abscess, Simple/Single Charge Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single 0 333.00 401.00
Drain Skin Abscess, Complex/Multiple Charge Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple 0 591.00 846.00
Drainage of Skin Lesion Charge Incision and drainage of hematoma, seroma or fluid collection 0 455.00 558.00
Biopsy of Skin Lesion Charge Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion 0 280.00 198.00
Biopsy, Skin Subq/Mucous, Ea Add'l Charge Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary proced 0 97.00 90.00
Remove Lesion, Trunk/Arm/Leg <.5 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less 0 331.00 296.00
Remove Lesion, Trunk/Arm/Leg .6 to 1.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm 0 394.00 356.00
Remove Lesion, Trunk/Arm/Leg 1.1 to 2.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm 0 455.00 481.00
Remove Lesion, Trunk/Arm/Leg 2.1 to 3.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm 0 530.00 698.00
Remove Lesion, Trunk/Arm/Leg 3.1 to 4.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm 0 599.00 1,769.00
Remove Lesion, Trunk/Arm/Leg >4.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm 0 864.00 1,170.00
Remove Lesion, Scalp/Neck/Hand/Foot < .5 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less 0 345.00 395.00
Remove Lesion, Scalp/Neck/Hand/Foot .6 to 1.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm 0 430.00 521.00
Remove Lesion, Scalp/Neck/Hand/Foot 1.1 to 2.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 0 475.00 642.00
Remove Lesion, Scalp/Neck/Hand/Foot 2.1 to 3.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm 0 556.00 681.00
Remove Lesion, Scalp/Neck/Hand/Foot 3.1 to 4.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm 0 623.00 974.00
Remove Lesion, Scalp/Neck/Hand/Foot >4.0 cm Charge Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm 0 868.00 1,304.00
Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less 0 381.00 393.00
Remove Lesion, Face/Lid/Ear/Nose/Lip .6 to 1.0 cm Charge Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm 0 464.00 482.00
Remove Lesion, Face/Lid/Ear/Nose/Lip 1.1 to 2.0 cm Charge Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm 0 512.00 621.00
Remove Lesion, Face/Lid/Ear/Nose/Lip 2.1 to 3.0 cm Charge Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm 0 612.00 843.00
Tetanus Injection Charge Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use 0 60.00 60.00
Inhalations, Aerosol/Vapor, Initial Charge Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device 0 57.00 0.00
Destruction Benign/Premalig Lesion Charge Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion 0 202.00 162.00
Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance 0 206.00 177.00
APIRATE/INJECT MAJOR JOINT/BURSA Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance 0 274.00 219.00
ECHO, Transthoracic, w/or w/o M Mode Recording w/o Doppler Charge Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echo 0 855.00 299.00
Shave (Epi)Dermal Lesion, Single, Trunk, Arms or Legs; Diam 0.5 cm > Charge Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less 0 218.00 158.00
Shave (Epi)Dermal Lesion, Single, Trunk, Arms or Legs; Diam 0.6 to 1.0 cm Charge Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm 0 281.00 209.00
Shave (Epi)Dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 0.5 cm > Charge Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less 0 201.00 176.00
Remove Other Benign Lesion w/Margins , Face/Ears/Eyelids/Nose/Lips; Diam 4.0+ cm Charge Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm 0 933.00 1,544.00
Remove Malig Lesion w/Margins, Trunk, Arms, or Legs; Diam 4.0+ cm Charge Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm 0 1,172.00 1,525.00
Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 3.1 to 4.0 cm Charge Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm 0 853.00 1,145.00
Remove Malig Lesion w/Margins, Scalp, Neck, Hands, Feet, Genital; Diam 4.0+ cm Charge Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm 0 944.00 1,403.00
Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 2.1 to 3.0 cm Charge Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm 0 804.00 908.00
Remove Malig Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Diam 3.1 to 4.0 cm Charge Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm 0 1,090.00 1,356.00
Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm > Charge Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less 0 342.00 317.00
Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm to 7.5 cm Charge Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm 0 394.00 379.00
Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 7.6 cm to 12.5 cm Charge Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm 0 454.00 466.00
Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extrem Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm 0 754.00 591.00
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less 0 390.00 369.00
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.6 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 0 424.00 416.00
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 5.1 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm 0 624.00 487.00
PT/INR POC Prothrombin time; 0 24.00 24.00
Debride Skin/Partial Thickness Charge 0 111.00 111.00
Debride Skin/Soft Tissue Charge Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less 0 316.00 292.00
Debride Skin/Tissue/Muscle Charge Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less 0 828.00 739.00
Debride Skin/Tissue/Muscle/Bone Charge Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less 0 1,014.00 1,097.00
Stick Assay of Blood Glucose Charge Glucose; blood, reagent strip 0 42.00
Unna Boot (UNI) Strapping; Unna boot 0 186.00 152.00
Proctosigmoidoscopy w/ or w/o Specimen Collection Charge Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 0 479.00 259.00
Hormone Pellet Implant; Subcutaneous Charge Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) 0 349.00 267.00
Voiding Pressure Study Charge 0 1,018.00 1,017.00
Catheterization/Introduction Saline for SIS or HSG Charge Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography 0 437.00 274.00
Appendectomy Charge Appendectomy; 0 3,067.00 1,749.00
Breast Biopsy Open Incision Charge Biopsy of breast; open, incisional 0 1,601.00 1,049.00
Breast Aspiration, Puncture Charge Puncture aspiration of cyst of breast; 0 380.00 208.00
Salpingectomy, Partial or Complete, Unilat or Bilat Charge Salpingectomy, complete or partial, unilateral or bilateral (separate procedure) 0 3,667.00 2,137.00
Hysteroscopy Surgical w/ Endometrial Ablation Charge Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation) 0 7,421.00 2,183.00
Hysteroscopy Surgical w/ Sampling Endometrium/Polypectomy Charge Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C 0 1,342.00 1,109.00
US Pregnancy Transvaginal Charge Ultrasound, pregnant uterus, real time with image documentation, transvaginal 0 383.00 163.00
US Follow-Up/Re-evaluation, Transabdominal, Per Fetus Charge Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ s 0 422.00 178.00
US 1st Trimester (First Gestation) Charge Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation 0 904.00 462.00
US 1st Trimester (Each Add'l Gestation) Charge Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separatel 0 304.00 200.00
Routine OB Care, Antepartum/Vaginal Delivery/Postpartum Charge Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care 0 9,946.00 5,306.00
Vaginal Delivery Only (With Or Without Episiotomy And/Or Forceps); Vaginal delivery only (with or without episiotomy and/or forceps); 0 3,891.00 2,371.00
Delivery Vaginal-Only w/ Postpartum Care Charge Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care 0 4,967.00 2,972.00
Routine OB Care, Antepartum/Vaginal Delivery After Cesarean/Postpartum Charge Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery 0 10,470.00 5,589.00
Delivery Cesarean-Only Charge Cesarean delivery only; 0 4,385.00 2,368.00
Delivery Cesarean-Only w/ Postpartum Care Charge Cesarean delivery only; including postpartum care 0 6,038.00 3,543.00
Curettage Postpartum Charge Curettage, postpartum 0 965.00 827.00
Laparoscopic Treatment Ectopic Pregnancy; w/o Salp/Ooph Charge Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy 0 3,660.00 2,028.00
Surgical Treatment Ectopic Pregnancy; w/ Salp/Ooph Charge Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach 0 3,771.00 2,091.00
Treatment Incomplete Abortion, Surgical; Any Trimester Charge Treatment of incomplete abortion, any trimester, completed surgically 0 1,513.00 1,409.00
Treatment Missed Abortion, Surgical; First Trimester Charge Treatment of missed abortion, completed surgically; first trimester 0 1,801.00 1,696.00
Treatment Missed Abortion, Surgical; Second Trimester Charge Treatment of missed abortion, completed surgically; second trimester 0 1,815.00 1,700.00
Laparoscopy Surgical w/ Adhesiolysis Charge Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) 0 3,164.00 1,821.00
Laparoscopy Surgical w/ Removal Adnexal Structures Charge Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) 0 3,056.00 1,873.00
Laparoscopy Surgical w/ Fulguration/Excsicion Lesions Charge Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 0 3,338.00 2,005.00
Laparoscopy Surgical w/ Fulguration Oviducts Charge Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 0 1,708.00 975.00
Dilation & Curettage, Non-OB Charge Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) 0 1,211.00 1,030.00
Ligation/Transection Fallopian Tubes During Cesarean Delivery Charge Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedur 0 361.00 239.00
Ligation/Transection Fallopian Tubes Postpartum Charge Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure) 0 1,539.00 871.00
US Pregnancy Limited Charge Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses 0 379.00 155.00
Pelvic Examination w/ Anesthesia Charge Pelvic examination under anesthesia (other than local) 0 508.00 438.00
Colpopexy Abdominal Charge Colpopexy, abdominal approach 0 4,483.00 2,752.00
Combined Anteroposterior Colporrhaphy Charge Combined anteroposterior colporrhaphy; 0 3,906.00 2,343.00
Posterior Colporrhaphy; Repair Rectocele w/ or w/o Perineorrhaphy Charge Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy 0 3,172.00 1,898.00
Excision Vaginal Cyst/Tumor Charge Excision of vaginal cyst or tumor 0 901.00 815.00
Perineoplasty Non-OB Charge Perineoplasty, repair of perineum, nonobstetrical (separate procedure) 0 1,223.00 708.00
Laparoscopy Diagnostic Charge Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 0 1,553.00 913.00
Laparoscopy Surgical w/ Biopsy Charge Laparoscopy, surgical; with biopsy (single or multiple) 0 1,645.00 898.00
Laparoscopy Surgical w/ Aspiration Cavity/Cyst Charge Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple) 0 1,761.00 992.00
Laparoscopy Surgical Appendectomy Charge Laparoscopy, surgical, appendectomy 0 2,867.00 1,559.00
Incision & Removal of Foreign Body, Subcutaneous Tissues; Simple Charge Incision and removal of foreign body, subcutaneous tissues; simple 0 411.00 629.00
Incision & Removal of Foreign Body, Subcutaneous Tissues; Complicated Charge Incision and removal of foreign body, subcutaneous tissues; complicated 0 890.00 957.00
Puncture Aspirtn of Abscess, Hematoma, Bulla, or Cyst Charge Puncture aspiration of abscess, hematoma, bulla, or cyst 0 383.00 408.00
I&D, Complex, Postoperative Wound Infectn Charge Incision and drainage, complex, postoperative wound infection 0 690.00 845.00
Debride of Extensive Eczematous or Infected Skin; Up to 10% of Body Surface Charge Debridement of extensive eczematous or infected skin; up to 10% of body surface 0 126.00 204.00
Paring or Cutting of Benign Hyperkeratotic Lesion (eg, Corn or Callus); Single Lesion Charge Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion 0 112.00 76.00
Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to & w/15 Lesions Charge Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions 0 248.00 203.00
Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; each Addtl Ten Lesions Charge Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) 0 89.00 79.00
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Less Charge Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less 0 510.00 484.00
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.6 to 1.0 cm Charge Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm 0 606.00 513.00
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 1.1 to 2.0 cm Charge Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm 0 650.00 621.00
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 2.1 to 3.0 cm Charge Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm 0 720.00 725.00
Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 3.1 to 4.0 cm Charge Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm 0 812.00 988.00
Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0.5 cm or Less Charge Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less 0 525.00 544.00
Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0.6 to 1.0 cm Charge Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm 0 607.00 521.00
Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 1.1 to 2.0 cm Charge Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm 0 709.00 815.00
Avulsion of Nail Plate, Partial or Complete, Simple; Single Charge Avulsion of nail plate, partial or complete, simple; single 0 249.00 251.00
Evac of Subungual Hematoma Charge Evacuation of subungual hematoma 0 147.00 153.00
Repair of Nail Bed Charge Repair of nail bed 0 624.00 636.00
Excise of Pilonidal Cyst or Sinus; Extensive Charge Excision of pilonidal cyst or sinus; extensive 0 2,690.00 2,033.00
Treatment of Superficial Wound Dehiscence; Simple Closure Charge Treatment of superficial wound dehiscence; simple closure 0 784.00 893.00
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 2.6 cm to 7.5 cm Charge Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm 0 771.00 791.00
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 7.6 cm to 12.5 cm Charge Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm 0 745.00 1,021.00
Repair Complex, Scalp, Arms, and/or Legs; 1.1 cm to 2.5 cm Charge Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm 0 961.00 901.00
Repair Complex, Scalp, Arms, and/or Legs; 2.6 cm to 7.5 cm Charge Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm 0 1,250.00 1,213.00
Secondary Closure of Surgical Wound or Dehiscence, Extensive or Complicated Charge Secondary closure of surgical wound or dehiscence, extensive or complicated 0 1,703.00 2,004.00
Initial Trtmt, First Degree Burn, When No More Than Local Trtmt Is Required Charge Initial treatment, first degree burn, when no more than local treatment is required 0 180.00 218.00
Mastotomy w/Explore or Drainage of Abscess, Deep Charge Mastotomy with exploration or drainage of abscess, deep 0 2,218.00 1,449.00
Explore of Penetrating Wound; Extremity Charge Exploration of penetrating wound (separate procedure); extremity 0 2,739.00 1,655.00
Biopsy, Muscle, Percutaneous Needle Charge Biopsy, muscle, percutaneous needle 0 852.00 292.00
Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar ""Fascia"") Charge Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") 0 206.00 206.00
20552 Inj(s); Single or Mult Trigger Point(S), One or Two Muscle(s) Charge Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) 0 193.00 218.00
20553 Inj(s); Single or Mult Trigger Point(S), Three or More Muscle(s) Charge Injection(s); single or multiple trigger point(s), 3 or more muscles 0 244.00 205.00
Arthrocentesis, Aspirtn and/or Inj; Small Joint or Bursa (eg, Fingers, toes) Charge Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance 0 182.00 187.00
Aspirtn and/or Inj of Ganglion Cyst(s) Any Location Charge Aspiration and/or injection of ganglion cyst(s) any location 0 202.00 145.00
Removal of Implanter; Superficial, (eg, Buried Wire, Pin or Rod)Charge Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure) 0 1,284.00 823.00
Removal of Implanter; Deep (eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod or Plate) Charge Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 0 1,546.00 2,006.00
Excise Tumor, Soft Tissue of Neck or Thorax; Subcutaneous Charge Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm 0 1,371.00 1,452.00
Excise, Soft Tissue Tumor, Shoulder Area; Subcutaneous Charge Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm 0 2,210.00 1,549.00
Repair of Ruptured Musculotendinous Cuff (eg, Rotator Cuff) Open; Chronic Charge Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic 0 4,039.00 2,973.00
Closed Trtmt of Clavicular Fx; w/o Manipulation Charge Closed treatment of clavicular fracture; without manipulation 0 871.00 1,041.00
Closed Trtmt of Clavicular Fx; w/Manipulation Charge Closed treatment of clavicular fracture; with manipulation 0 1,647.00 1,556.00
Closed Trtmt of Scapular Fx; w/o Manipulation Charge Closed treatment of scapular fracture; without manipulation 0 835.00 1,117.00
Closed Trtmt of Proximal Humeral (Surgical or Anatomical Neck) Fx; w/o Manipulation Charge Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation 0 1,236.00 1,357.00
Closed Trtmt of Greater Humeral Tuberosity Fx; w/o Manipulation Charge Closed treatment of greater humeral tuberosity fracture; without manipulation 0 1,014.00 1,203.00
Closed Trtmt of Shoulder Dislocation, w/Manipulation; w/o Anesthesia Charge Closed treatment of shoulder dislocation, with manipulation; without anesthesia 0 1,471.00 1,353.00
Closed Trtmt of Shoulder Dislocation, w/Manipulation; Requiring Anesthesia Charge Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia 0 1,892.00 1,251.00
Closed Trtmt of Humeral Shaft Fx; w/o Manipulation Charge Closed treatment of humeral shaft fracture; without manipulation 0 1,393.00 1,095.00
Closed Trtmt of Humeral Epicondylar Fx, Medial or Lateral; w/o Manipulation Charge Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation 0 1,503.00 1,350.00
Closed Trtmt of Humeral Condylar Fx, Medial or Lateral; w/o Manipulation Charge Closed treatment of humeral condylar fracture, medial or lateral; without manipulation 0 1,594.00 1,434.00
Trtmt of Closed Elbow Dislocation; w/o Anesthesia Charge Treatment of closed elbow dislocation; without anesthesia 0 1,708.00 1,566.00
Closed Trtmt of Radial Head Subluxation In Child, Nursemaid Elbow, w/Manipulation Charge Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation 0 549.00 404.00
Closed Trtmt of Radial Head or Neck Fx; w/o Manipulation Charge Closed treatment of radial head or neck fracture; without manipulation 0 996.00 1,115.00
Closed Trtmt of Ulnar Fx, Proximal End (Olecranon Process); w/o Manipulation Charge Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without manipulation 0 1,363.00 1,026.00
Open Trtmt of Ulnar Fx Proximal End (Olecranon Process), w/ or w/o Inter or Ext Fixation Charge Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed 0 3,094.00 1,958.00
Incision, Extensor Tendon Sheath, Wrist (eg, Dequervains Disease) Charge Incision, extensor tendon sheath, wrist (eg, deQuervains disease) 0 1,586.00 1,817.00
Excise of Ganglion, Wrist (Dorsal or Volar); Primary Charge Excision of ganglion, wrist (dorsal or volar); primary 0 1,511.00 1,564.00
Closed Trtmt of Radial Shaft Fx; w/o Manipulation Charge Closed treatment of radial shaft fracture; without manipulation 0 1,282.00 1,178.00
Closed Trtmt of Ulnar Shaft Fx; w/o Manipulation Charge Closed treatment of ulnar shaft fracture; without manipulation 0 961.00 1,114.00
Closed Trtmt of Radial & Ulnar Shaft Fxs; w/o Manipulation Charge Closed treatment of radial and ulnar shaft fractures; without manipulation 0 1,302.00 1,180.00
Closed Trtmt of Radial & Ulnar Shaft Fxs; w/Manipulation Charge Closed treatment of radial and ulnar shaft fractures; with manipulation 0 2,430.00 2,199.00
Closed Trtmt of Carpal Scaphoid (Navicular) Fx; w/o Manipulation Charge Closed treatment of carpal scaphoid (navicular) fracture; without manipulation 0 1,162.00 1,240.00
Closed Trtmt of Ulnar Styloid Fx Charge Closed treatment of ulnar styloid fracture 0 1,497.00 1,406.00
Drainage of Finger Abscess; Simple Charge Drainage of finger abscess; simple 0 894.00 647.00
Synovectomy, Proximal Interphalangeal Joint, w/Extensor Reconstr, each Interphalangeal Joint Charge Synovectomy, proximal interphalangeal joint, including exten 0 1,046.00
Repair, Extensor Tendon, Hand, Primary or Secondary; w/o Free Graft, each Tendon Charge Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon 0 2,625.00 1,801.00
Repair, Extensor Tendon, Finger, Primary or Secondary; w/o Free Graft, each Tendon Charge Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon 0 2,683.00 1,741.00
Closed Trtmt of Metacarpal Fx, Single; w/o Manipulation, each Bone Charge Closed treatment of metacarpal fracture, single; without manipulation, each bone 0 1,086.00 1,251.00
Closed Trtmt of Metacarpal Fx, Single; w/Manipulation, each Bone Charge Closed treatment of metacarpal fracture, single; with manipulation, each bone 0 1,505.00 1,374.00
Open Trtmt of Metacarpal Fx, Single, w/ or w/o Inter or Ext Fixation, each Bone Charge Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone 0 2,721.00 2,946.00
Closed Trtmt of Distal Phalangeal Fx, Finger or Thumb; w/o Manipulation, each Charge Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each 0 666.00 863.00
Open Trtmt of Distal Phalangeal Fx, Finger or Thumb, w/ or w/o Inter or Ext Fixation, each Charge Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each 0 2,363.00 1,754.00
Closed Trtmt of Interphalangeal Joint Dislocation, Single, w/Manipulation; w/o Anesthesia Charge Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia 0 832.00 1,193.00
Removal of Foreign Body, Pelvis or Hip; Subcutaneous Tissue Charge Removal of foreign body, pelvis or hip; subcutaneous tissue 0 259.00
Inj Procedure For Sacroiliac Joint, Arthrography and/or Anesthetic/Steroid Charge Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 0 746.00 522.00
Hemiarthroplasty, Hip, Partial (eg, Femoral Stem Prosthesis, Bipolar Arthroplasty) Charge Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty) 0 5,391.00 3,056.00
Closed Trtmt of Pelvic Ring Fx, Dislocation, Diastasis or Subluxation; w/o Manipulation Charge 0 1,847.00 1,847.00
Closed Trtmt of Femoral Fx, Proximal End, Neck; w/o Manipulation Charge Closed treatment of femoral fracture, proximal end, neck; without manipulation 0 2,244.00 2,229.00
Percutaneous Skeletal Fixation of Femoral Fx, Proximal End, Neck Charge Percutaneous skeletal fixation of femoral fracture, proximal end, neck 0 4,321.00 2,673.00
Open Trtmt of Femoral Fx, Proximal End, Neck, Inter Fixation or Prosthetic Replacement Charge Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement 0 5,690.00 2,906.00
Closed Trtmt of Post Hip Arthroplasty Dislocation; w/o Anesthesia Charge Closed treatment of post hip arthroplasty dislocation; without anesthesia 0 1,878.00 1,453.00
I&D, Deep Abscess, Bursa, or Hematoma, Thigh or Knee Region Charge Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region 0 3,167.00 2,371.00
Suture of Quadriceps or Hamstring Muscle Rupture; Primary Charge Suture of quadriceps or hamstring muscle rupture; primary 0 2,714.00 1,732.00
Closed Trtmt of Patellar Fx, w/o Manipulation Charge Closed treatment of patellar fracture, without manipulation 0 1,237.00 1,229.00
Closed Trtmt of Tibial Fx, Proximal (Plateau); w/o Manipulation Charge Closed treatment of tibial fracture, proximal (plateau); without manipulation 0 1,310.00 1,304.00
Open Trtmt of Tibial Fx, Proximal (Plateau); Unicondylar, w/ or w/o Inter or Ext Fixation Charge Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed 0 4,266.00 2,213.00
Decompression Fasciotomy, Leg; Anter and/or Lateral Compartments Only Charge Decompression fasciotomy, leg; anterior and/or lateral compartments only 0 1,937.00 1,928.00
Arthrotomy, w/Synovectomy, Ankle; Charge Repair, dislocating peroneal tendons; with fibular osteotomy 0 1,440.00
Excise or Curettage of Bone Cyst or Benign Tumor, Tibia or Fibula; Charge Excision or curettage of bone cyst or benign tumor, tibia or fibula; 0 2,774.00 1,699.00
Tenolysis, Flexor or Extensor Tendon, Leg and/or Ankle; Single, each Tendon Charge Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon 0 1,895.00
Closed Trtmt of Tibial Shaft Fx (With or w/o Fibular Fx); w/o Manipulation Charge Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation 0 1,444.00 1,356.00
Closed Trtmt of Medial Malleolus Fx; w/o Manipulation Charge Closed treatment of medial malleolus fracture; without manipulation 0 1,430.00 1,123.00
Closed Trtmt of Proximal Fibula or Shaft Fx; w/o Manipulation Charge Closed treatment of proximal fibula or shaft fracture; without manipulation 0 1,126.00 1,310.00
Closed Trtmt of Distal Fibular Fx (Lateral Malleolus); w/o Manipulation Charge Closed treatment of distal fibular fracture (lateral malleolus); without manipulation 0 1,172.00 1,235.00
Open Trtmt of Distal Fibular Fx (Lateral Malleolus), w/ or w/o Inter or Ext Fixation Charge Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed 0 3,092.00 2,395.00
Closed Trtmt of Bimalleolar Ankle Fx, (Including Potts); w/o Manipulation Charge Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation 0 1,268.00 1,243.00
Closed Trtmt of Trimalleolar Ankle Fx; w/o Manipulation Charge Closed treatment of trimalleolar ankle fracture; without manipulation 0 1,512.00 1,228.00
Closed Trtmt of Trimalleolar Ankle Fx; w/Manipulation Charge Closed treatment of trimalleolar ankle fracture; with manipulation 0 2,274.00 2,041.00
Amputation, Leg, Through Tibia & Fibula; Charge Amputation, leg, through tibia and fibula; 0 4,389.00 2,536.00
I&D Below Fascia, w/ or w/o Tendon Sheath Involvement, Foot; Single Bursal Space Charge Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space 0 719.00
Ostectomy, Calcaneus; Charge Ostectomy, calcaneus; 0 1,954.00
Resection, Partial or Complete, Phalangeal Base, each to e Charge Resection, partial or complete, phalangeal base, each toe 0 490.00
Removal of Foreign Body, Foot; Subcutaneous Charge Removal of foreign body, foot; subcutaneous 0 747.00 635.00
Ostectomy, Partial, Exostectomy or Condylectomy, Metatarsal Head, each Metatarsal Head Charge Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head 0 2,038.00
Closed Trtmt of Calcaneal Fx; w/o Manipulation Charge Closed treatment of calcaneal fracture; without manipulation 0 839.00 676.00
Closed Trtmt of Talus Fx; w/o Manipulation Charge Closed treatment of talus fracture; without manipulation 0 1,113.00 990.00
Trtmt of Tarsal Bone Fx (Except Talus & Calcaneus); w/o Manipulation, each Charge Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each 0 1,018.00 908.00
Closed Trtmt of Metatarsal Fx; w/o Manipulation, each Charge Closed treatment of metatarsal fracture; without manipulation, each 0 779.00 845.00
Closed Trtmt of Fx, Phalanx or Phalanges, Other Than Great toe; w/o Manipulation, each Charge Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each 0 431.00 568.00
Open Trtmt of Tarsal Bone Dislocation, w/ or w/o Inter or Ext Fixation Charge Open treatment of tarsal bone dislocation, includes internal fixation, when performed 0 3,168.00
Arthrodesis, Midtarsal or Tarsometatarsal, Single Joint Charge Arthrodesis, midtarsal or tarsometatarsal, single joint 0 4,028.00 2,958.00
Amputation, to e; Metatarsophalangeal Joint Charge Amputation, toe; metatarsophalangeal joint 0 1,273.00 1,879.00
Amputation, toe; Interphalangeal Joint Charge Amputation, toe; interphalangeal joint 0 1,764.00
Applic, Cast; Shoulder to Hand (Long Arm) Charge Application, cast; shoulder to hand (long arm) 0 349.00 179.00
Applic, Cast; Elbow to Finger (Short Arm) Charge Application, cast; elbow to finger (short arm) 0 321.00 201.00
Applic, Cast; Hand & Lower Forearm (Gauntlet) Charge Application, cast; hand and lower forearm (gauntlet) 0 332.00 224.00
Applic of Short Arm Splint (Forearm to Hand); Static Charge Application of short arm splint (forearm to hand); static 0 231.00 186.00
Applic of Short Leg Cast (Below Knee to toes); Charge Application of short leg cast (below knee to toes); 0 295.00 199.00
Applic of Short Leg Cast (Below Knee to toes); Walking or Ambulatory Type Charge Application of short leg cast (below knee to toes); walking or ambulatory type 0 313.00 269.00
Applic of Short Leg Splint (Calf to Foot) Charge Application of short leg splint (calf to foot) 0 245.00 236.00
Arthroscopy, Knee, Surgical; w/Meniscectomy (Medial or Lateral, w/Any Meniscal Shaving) Charge Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s 0 2,567.00 2,570.00
Insert or Replacement of Pacemaker Pulse Generator Only; Dual Chamber Charge Insertion of pacemaker pulse generator only; with existing d 0 871.00
Insert of Non-Tunneled Centrally Inserted Central Venous Catheter; Age 5 Yrs or Older Charge Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older 0 1,096.00 574.00
Unlisted Procedure, Vascular Surgery Charge Unlisted procedure, vascular surgery 0 985.00
Bone Marrow; Aspirtn Only Charge Bone marrow; aspiration only 0 450.00 294.00
Laparoscopy, Surgical; Colectomy, Partial, w/Anastomosis Charge Laparoscopy, surgical; colectomy, partial, with anastomosis 0 7,362.00 4,359.00
Biopsy of Anorectal Wall, Anal Approach (eg, Congenital Megacolon) Charge Biopsy of anorectal wall, anal approach (eg, congenital megacolon) 0 1,500.00
Sigmoidoscopy, Flexible; w/Biopsy, Single or Mult Charge Sigmoidoscopy, flexible; with biopsy, single or multiple 0 587.00 534.00
Colonoscopy, Flexible, Proximal to Splenic Flexure; w/Biopsy, Single or Mult Charge Colonoscopy, flexible; with biopsy, single or multiple 0 1,636.00 1,131.00
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia Removal of fecal impaction or foreign body (separate procedure) under anesthesia 0 1,564.00 1,035.00
I&D of Ischiorectal and/or Perirectal AbscessCharge Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) 0 1,847.00 1,901.00
I&D, Perianal Abscess, Superficial Charge Incision and drainage, perianal abscess, superficial 0 692.00 464.00
Incision of Thrombosed Hemorrhoid, Ext Charge Incision of thrombosed hemorrhoid, external 0 550.00 488.00
Papillectomy or Excise of Single Tag, AnusCharge Excision of single external papilla or tag, anus 0 646.00 564.00
Excise of Ext Hemorrhoid Tags and/or Mult Papillae Charge Excision of multiple external papillae or tags, anus 0 353.00
Hemorrhoidectomy, Inter & External, Complex or Extensive; Charge Hemorrhoidectomy, internal and external, 2 or more columns/groups; 0 2,262.00 1,470.00
Enucleation or Excise of Ext Thrombotic Hemorrhoid Charge Excision of thrombosed hemorrhoid, external 0 593.00 439.00
Ligation of Inter Hemorrhoids; Single Procedure Charge Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group 0 1,457.00 1,073.00
Laparoscopy, Surgical; Cholecystectomy Charge Laparoscopy, surgical; cholecystectomy 0 3,140.00 1,870.00
Repair Initial Inguinal Hernia, Age 5 Yrs or Over; Reducible Charge Repair initial inguinal hernia, age 5 years or older; reducible 0 2,481.00 1,877.00
Lithotripsy, Extracorporeal Shock Wave Charge Lithotripsy, extracorporeal shock wave 0 2,564.00 2,704.00
Complex Cystometrogram (eg, Calibrated Electronic Equipment) Charge Complex cystometrogram (ie, calibrated electronic equipment); 0 1,026.00 364.00
Complex Uroflowmetry (eg, Calibrated Electronic Equipment) Charge Complex uroflowmetry (eg, calibrated electronic equipment) 0 133.00 74.00
Measurement of Post-Voiding Residual Urine and/or Bladder Capacity By Ultrasound, Non-Imaging Charge Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging 0 77.00 61.00
Cystourethroscopy Charge Cystourethroscopy (separate procedure) 0 700.00 665.00
Circumcision, Using Clamp or Other Device; Newborn Charge Circumcision, using clamp or other device with regional dorsal penile or ring block 0 380.00 379.00
Excise of Hydrocele; Unilateral Charge Excision of hydrocele; unilateral 0 1,610.00 1,572.00
Vasectomy, Unilateral or Bilateral (Separate Procedure), w/Postoperative Semen Exam(s) Charge Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) 0 1,301.00 776.00
I&D of Vulva or Perineal Abscess Charge Incision and drainage of vulva or perineal abscess 0 376.00 510.00
I&D of Bartholin's Gland Abscess Charge Incision and drainage of Bartholin's gland abscess 0 392.00 429.00
Fetal Non-Stress Test Charge Fetal non-stress test 0 172.00 133.00
Routine Obstetric Care w/Anterepartum Care, Cesarean Delivery, & Postpartum Care Charge Routine obstetric care including antepartum care, cesarean delivery, and postpartum care 0 11,041.00 5,881.00
Inj, Anesthetic Agent; Greater Occipital Nerve Charge Injection, anesthetic agent; greater occipital nerve 0 472.00 627.00
Inj, Anesthetic Agent; Intercostal Nerve, Single Charge Injection, anesthetic agent; intercostal nerve, single 0 520.00 399.00
Inj, Anesthetic Agent; Other Peripheral Nerve or Branch Charge Injection, anesthetic agent; other peripheral nerve or branch 0 333.00 621.00
Neuroplasty and/or Transposition; Median Nerve At Carpal Tunnel Charge Neuroplasty and/or transposition; median nerve at carpal tunnel 0 1,624.00 2,018.00
Ear Piercing Charge Ear piercing 0 45.00 0.00
Vital Capacity, total Charge Vital capacity, total (separate procedure) 0 118.00 18.00
Chemotherapy Admin, Subcutaneous or IM; Hormonal Anti-Neoplastic Charge Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic 0 139.00 31.00
Handling and/or Conveyance of Specimen For Transfer From The Physician's Office to A Lab Charge Handling and/or conveyance of specimen for transfer from the office to a laboratory 0 20.00 0.00
Medical Testimony Charge Medical testimony 0 450.00 0.00
Insertion, Implantable Contraceptive Capsules Charge 0 345.00 346.00
Removal, Implantable Contraceptive Capsules Charge Removal, implantable contraceptive capsules 0 669.00 446.00
Breast Biopsy; Percutaneous, Needle Core (Not Using Imaging Guidance) Charge Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) 0 533.00 333.00
Routine OB Care, Antepartum/Cesarean/Postpartum Care for Vaginal Deliv Attempt (after previou C-sect Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery 0 11,188.00 5,966.00
Ovarian Cystectomy, Unilat or Bilat Charge Ovarian cystectomy, unilateral or bilateral 0 3,515.00 2,051.00
Oophorectomy, Partial or Total, Unilat or Bilat Charge Oophorectomy, partial or total, unilateral or bilateral; 0 2,481.00 1,257.00
Lysis of Adhesions (Salpingolysis, Ovariolysis) Charge Lysis of adhesions (salpingolysis, ovariolysis) 0 4,159.00 2,459.00
Total abd. hysterectomy, w/ or w/o removal of tube(s) or ovary(s) Charge Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 0 4,787.00 2,856.00
Vag. hysterectomy, uterus 250 grams or less; w/removal of tube(s), &/or ovary(s) Charge Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) 0 4,320.00 2,630.00
Chromotubation of oviduct, including materials Charge Chromotubation of oviduct, including materials 0 452.00 370.00
Ligation or transection of fallopian tube(s), abd. or vag. approach, unilateral or bilateral Charge Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral 0 1,699.00 975.00
Salpingo-oophorectomy, complete or partial, unilateral or bilateral Charge Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure) 0 3,478.00 2,006.00
Laparoscopy, Surgical, Enterolysis Charge Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure) 0 4,394.00 2,520.00
Excise of Nail & matrix, Part. or Complete, for Permanent Removal Charge Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal 0 568.00 539.00
Intrauterine Copper Contraceptive Charge Paraguard Intra Copper Contraceptive 0 567.00 567.00
LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG Levonorgestrel Releasing IUD Levonorgestrel-releasing intrauterine contraceptive system ( 0 961.00 961.00 961.00
I&D Pilonidal Cyst; Simple Charge Incision and drainage of pilonidal cyst; simple 0 548.00 662.00
I&D Pilonidal cyst; complicated Charge Incision and drainage of pilonidal cyst; complicated 0 1,259.00 800.00
Removal Foreign Body, Intranasal; Office Type Procedure Removal foreign body, intranasal; office type procedure 0 782.00 497.00
Removal foreign body from external auditory canal; without general anesthesia Charge Removal foreign body from external auditory canal; without general anesthesia 0 388.00 224.00
Dressings and/or debridement of partial-thickness burns,initial or subsequent;(less than 5%) Charge Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) 0 254.00 256.00
Chemical cauterization of granulation tissue (proud flesh, sinus or fistula) Charge Chemical cauterization of granulation tissue (proud flesh, sinus or fistula) 0 243.00 168.00
Blood, occult, by peroxidase activity, qualitative, feces, single specimen Charge Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening 0 31.00
Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for IM Use POC Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use 0 51.00 51.00
Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use POC Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use 0 136.00 136.00
Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use POC Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use 0 242.00 242.00
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for IM Use POC Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MCV4 or MenACWY), for intramuscular use 0 171.00 0.00
Pressurized or nonpressurized inhalation treatment for acute airway obstruction Charge Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, 0 66.00 0.00
Monospot POC Heterophile antibodies; screening 0 52.00 52.00
Fine needle aspiration; w/image guidance Charge Fine needle aspiration; with imaging guidance 0 660.00
Simple cystometrogram (CMG) (eg, spinal manometer) Charge Simple cystometrogram (CMG) (eg, spinal manometer) 0 648.00 282.00
Insert of non-indwelling bladder catheter; simple Charge Insertion of temporary indwelling bladder catheter; simple (eg, Foley) 0 271.00 151.00
Urethral pressure profile studies (UPP) (urethral closure pressure profile), any technique Charge 0 649.00 649.00
Hysteroscopy, diagnostic (sp) Charge Hysteroscopy, diagnostic (separate procedure) 0 1,254.00 726.00
Colposcopy of the Cervix incl. upper/adj. Vag.; w/Endocervical Curettage Charge Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage 0 464.00 404.00
Removal w/Reinsertion, implantable contraceptive capsules Charge 0 571.00 571.00
Amniocentesis; diagnostic Charge Amniocentesis; diagnostic 0 595.00 388.00
External cephalic version, with or without tocolysis Charge External cephalic version, with or without tocolysis 0 493.00 282.00
US Pregnancy, After 1st Trimester (Single or First Gestation) Charge Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation 0 488.00 238.00
US Pregnancy, After 1st Trimester, Each Add'l Gestation Charge Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (Lis 0 439.00 236.00
Fetal Biophysical Profile; w/Non-Stress Testing Charge Fetal biophysical profile; with non-stress testing 0 582.00 342.00
US, Pregnancy, Fetal/Maternal Eval.+Fetal Anatomic Exam; Single or 1st Gestation Charge Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation 0 854.00 438.00
US, Pregnancy, Fetal/Maternal Eval.+Fetal Anatomic Exam; Each Add'l Gestation Charge Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separ 0 969.00 437.00
0521Inj(s); Single Tendon Sheath, or Ligament, Aponeurosis (eg, Planterar Fascia) Med Admin POC Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") 0 206.00 206.00
Injection, Methylprednisolone sodium succinate, up to 40 mg Med Admin POC INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG 0 48.00
Injection(s); single tendon origin/insertion Med Admin POC Injection(s); single tendon origin/insertion 0 215.00 201.00
Inj., Therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel Med Admin POC Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel 0 312.00 279.00
Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 14 lesions Charge Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions 0 288.00 230.00
Destruction (laser/electro/cryo/chemosurgery/curette), of warts; 15 or more lesions Charge Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions 0 309.00 254.00
Zoster (shingles) vaccine, live, subcutaneous injection POC Zoster (shingles) vaccine (HZV), live, for subcutaneous injection 0 293.00 0.00
Sensory Integration Charges Sensory integrative techniques to enhance sensory processing 0 115.00
Standardized Aphasia Assessment Charge Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagn 0 394.00
Cognitive Skills Development Charges Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes 0 106.00
Tx of Speech/Lang/Voice/Comm/Auditory Chg Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 0
Eval of Oral and Pharyngeal Swallowing Fx Chg Evaluation of oral and pharyngeal swallowing function 0 275.00
Influenza virus vaccine, splie virus, preservative free, for children 6-35 months of age, IM POC (in Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use 0 37.00 37.00
Human Papilloma virus (HPV) Vaccine POC Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 3 dose schedule, for intramuscular use 0 303.00 303.00
Brain Natriuretic Peptide (BNP) Natriuretic peptide 0 424.00
Injection, Ketorolac Tromethamine Charge INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG 0 8.00
Creatine Kinase-MB Creatine kinase (CK), (CPK); MB fraction only 0 145.00
Injection, Promethazine HCL, up to 50 mg Charge INJECTION, PROMETHAZINE HCL, UP TO 50 MG 0 22.00 22.00 22.00
Strep A Screen Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantit 0 151.00
Respiratory Syncytial Virus Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus 0 151.00
Insert Foley Cath Insertion of temporary indwelling bladder catheter; simple (eg, Foley) 0 284.00
J3301 Inj, Triamcinolone Acetonide, Per 10mg Charge INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG 0 31.00 31.00
Vitamin B-12 Cyanocobalamin Inj, up to 1000 mcg INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG 0 19.00 19.00 19.00
Injection, Ceftriaxone Sodium, Per 250 MG Charge INJECTION, CEFTRIAXONE SODIUM, PER 250 MG 0 38.00
Biopsy, Uretha Charge Biopsy of urethra 0 741.00 975.00
COLLECTION: Capillary Collection of capillary blood specimen (eg, finger, heel, ear stick) 0 27.00
COLLECTION: Venous Draw Collection of venous blood by venipuncture 0 27.00
Hematocrit Blood count; hematocrit (Hct) 0 29.00
Hemoglobin Blood count; hemoglobin (Hgb) 0 29.00
BD DEXA Axial Skeleton Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) 0 357.00
CT Abdomen w/ + w/o Cont Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections 0 2,705.00
CT Abdomen w/ Cont Computed tomography, abdomen; with contrast material(s) 0 2,350.00
CT Abdomen w/o Cont Computed tomography, abdomen; without contrast material 0 1,265.00
CT Head or Brain w/ + w/o Cont Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections 0 1,800.00
CT Head or Brain w/ Cont Computed tomography, head or brain; with contrast material(s) 0 1,485.00
CT Head or Brain w/o Cont Computed tomography, head or brain; without contrast material 0 1,030.00
CT LE w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT LE w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT LE w/o Cont Lt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT LE w/o Cont Rt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Maxillofacial w/ Cont Computed tomography, maxillofacial area; with contrast material(s) 0 1,560.00
CT Maxillofacial w/o Cont Computed tomography, maxillofacial area; without contrast material 0 1,355.00
CT Orbit Sella etc. w/ Cont Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) 0 2,905.00
CT Orbit Sella etc. w/o Cont Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material 0 2,375.00
CT Pelvis w/ + w/o Cont Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections 0 2,800.00
CT Pelvis w/ Cont Computed tomography, pelvis; with contrast material(s) 0 2,360.00
CT Pelvis w/o Cont Computed tomography, pelvis; without contrast material 0 1,285.00
CT Neck Soft Tissue w/ + w/o Cont Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections 0 2,885.00
CT Neck Soft Tissue w/ Cont Computed tomography, soft tissue neck; with contrast material(s) 0 2,335.00
CT Neck Soft Tissue w/o Cont Computed tomography, soft tissue neck; without contrast material 0 1,810.00
CT Spine Cervical w/o Cont Computed tomography, cervical spine; without contrast material 0 1,845.00
CT Spine Lumbar w/o Cont Computed tomography, lumbar spine; without contrast material 0 1,825.00
CT Spine Thoracic w/o Cont Computed tomography, thoracic spine; without contrast material 0 1,835.00
CT UE w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 0 2,310.00
CT UE w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 0 2,310.00
CT UE w/o Cont Lt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT UE w/o Cont Rt Computed tomography, upper extremity; without contrast material 0 1,820.00
MRI Brachial Plexus w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 4,099.00
MRA Head w/ Cont Magnetic resonance angiography, head; with contrast material(s) 0 3,420.00
MRA Neck w/o Cont Magnetic resonance angiography, neck; without contrast material(s) 0 3,503.00
MRI Brain w/ + w/o Cont Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences 0 3,184.00
MRI Brain w/ Cont Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) 0 2,793.00
MRI Brain w/o Cont Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material 0 1,888.00
MRI Chest w/ + w/o Cont Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences 0 4,883.00
MRI Face Neck Orbit w/ + w/o Cont Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences 0 4,028.00
MRI Face Neck Orbit w/ Cont Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) 0 3,368.00
MRI Femur w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 0 2,493.00
MRI Femur w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 0 2,493.00
MRI Unlisted Procedure 0 0.00
MRI Pelvis w/ Cont Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) 0 3,394.00
MRI Pelvis w/o Cont Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) 0 3,169.00
MRI Spine Cervical w/ Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) 0 2,836.00
MRI Spine Cervical w/o Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material 0 1,805.00
MRI Spine Lumbar w/ Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) 0 2,788.00
MRI Spine Lumbar w/o Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 0 1,788.00
MRI Spine Thoracic w/ Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) 0 2,810.00
MRI Spine Thoracic w/o Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material 0 1,805.00
NM Bone Ltd Bone and/or joint imaging; limited area 0 1,742.00
NM Bone Whole Body Bone and/or joint imaging; whole body 0 1,963.00
NM Bone 3 Phase Study Bone and/or joint imaging; 3 phase study 0 3,474.00
NM Cardiac Blood Pool Gated Single Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitativ 0 2,132.00
NM GI Blood Loss Acute gastrointestinal blood loss imaging 0 3,510.00
NM Hepa Duct System Hepatobiliary system imaging, including gallbladder when present; 0 3,445.00
NM Kidney w/ Flow w/ Pharm Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic) 0 1,341.00
NM Myocard Perf Spect Mult Rest+Stress Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantifica 0 1,872.00
NM Myocard Perf Spect Single Rest+Stress 0 2,137.00
NM Pulm Perf Pulmonary perfusion imaging (eg, particulate) 0 2,366.00
NM Thyroid Only Thyroid imaging (including vascular flow, when performed); 0 2,008.00
NM Thyroid Uptake Mult Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) 0 819.00
US Abdomen Comp Ultrasound, abdominal, real time with image documentation; complete 0 596.00
US Abdomen Ltd Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) 0 450.00
US Abdomen/Pelvic/Scrotal Art/Vein Ltd Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study 0 893.00
US Carotid Duplex Bil Duplex scan of extracranial arteries; complete bilateral study 0 1,414.00
US Chest Ultrasound, chest (includes mediastinum), real time with image documentation 0 439.00
US Head +Neck Soft Tissue Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation 0 576.00
US LE Art Doppler Mult Level Bil Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibi 0 761.00
US LE Art Doppler Single Level Bil Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis 0 839.00
US LE Art Duplex Bil Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study 0 2,408.00
US LE Art Duplex Lt Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study 0 931.00
US LE Art Duplex Rt Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study 0 931.00
US LE Veins Duplex Bil Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study 0 1,414.00
US LE Veins Duplex Lt Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 0 717.00
US LE Veins Duplex Rt Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 0 717.00
US Pregnant < 14 Weeks Ea Addl Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separatel 0 165.00
US Pregnant Transvaginal Ultrasound, pregnant uterus, real time with image documentation, transvaginal 0 425.00
US Unlisted Procedure Unlisted ultrasound procedure (eg, diagnostic, interventional) 0 465.00
US Retroperitoneal Comp Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 0 552.00
US Scrotum +Contents Ultrasound, scrotum and contents 0 255.00
US Transvaginal Ultrasound, transvaginal 0 537.00
US UE Art Doppler Mult Level Bil Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibi 0 761.00
US UE Art Duplex Bil Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study 0 1,849.00
US UE Art Duplex Lt Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study 0 763.00
US UE Art Duplex Rt Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study 0 763.00
US UE Veins Duplex Bil Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study 0 1,414.00
US UE Veins Duplex Lt Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 0 717.00
US UE Veins Duplex Rt Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 0 717.00
XR Abdomen 1 View Radiologic examination, abdomen; 1 view 0 213.00
XR Abdomen 2 Views Radiologic examination, abdomen; 2 views 0 351.00
XR Ankle Comp Min 3 Views Lt Radiologic examination, ankle; complete, minimum of 3 views 0 330.00
XR Ankle Comp Min 3 Views Rt Radiologic examination, ankle; complete, minimum of 3 views 0 330.00
XR Heel Min 2 Views Lt Radiologic examination; calcaneus, minimum of 2 views 0 235.00
XR Heel Min 2 Views Rt Radiologic examination; calcaneus, minimum of 2 views 0 235.00
XR Chest 1 View Radiologic examination, chest; single view 0 196.00
XR Chest 2 Views Radiologic examination, chest; 2 views 0 250.00
XR Clavicle Comp Lt Radiologic examination; clavicle, complete 0 282.00
XR Clavicle Comp Rt Radiologic examination; clavicle, complete 0 282.00
XR Elbow 2 Views Lt Radiologic examination, elbow; 2 views 0 282.00
XR Elbow 2 Views Rt Radiologic examination, elbow; 2 views 0 282.00
XR Facial Bones < 3 Views Radiologic examination, facial bones; less than 3 views 0 282.00
XR Facial Bones Comp Min 3 Views Radiologic examination, facial bones; complete, minimum of 3 views 0 415.00
FLUOROSCOPY, Up to 1 Hour Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy) 0 570.00
XR Foot 2 Views Lt Radiologic examination, foot; 2 views 0 266.00
XR Foot 2 Views Rt Radiologic examination, foot; 2 views 0 266.00
XR Foot Comp Min 3 Views Lt Radiologic examination, foot; complete, minimum of 3 views 0 303.00
XR Foot Comp Min 3 Views Rt Radiologic examination, foot; complete, minimum of 3 views 0 303.00
XR Forearm 2 Views Lt Radiologic examination; forearm, 2 views 0 256.00
XR Forearm 2 Views Rt Radiologic examination; forearm, 2 views 0 256.00
XR Hand 2 Views Lt Radiologic examination, hand; 2 views 0 261.00
XR Hand 2 Views Rt Radiologic examination, hand; 2 views 0 261.00
XR Hand Min 3 Views Lt Radiologic examination, hand; minimum of 3 views 0 320.00
XR Hand Min 3 Views Rt Radiologic examination, hand; minimum of 3 views 0 320.00
XR Hip 1 View Lt Radiologic examination, hip, unilateral, with pelvis when performed; 1 view 0 256.00
XR Hip 1 View Rt Radiologic examination, hip, unilateral, with pelvis when performed; 1 view 0 256.00
XR Hip Comp Min 2 Views Lt Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views 0 382.00
XR Hip Comp Min 2 Views Rt Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views 0 382.00
XR Hip Operative Lt 0 297.00
XR Hip Operative Rt 0 297.00
XR Humerus Min 2 Views Lt Radiologic examination; humerus, minimum of 2 views 0 261.00
XR Humerus Min 2 Views Rt Radiologic examination; humerus, minimum of 2 views 0 261.00
XR Knee 3 Views Lt Radiologic examination, knee; 3 views 0 363.00
XR Knee 3 Views Rt Radiologic examination, knee; 3 views 0 363.00
XR Knee 1 or 2 Views Lt Radiologic examination, knee; 1 or 2 views 0 264.00
XR Knee 1 or 2 Views Rt Radiologic examination, knee; 1 or 2 views 0 264.00
XR Mandible Comp Min 4 Views Radiologic examination, mandible; complete, minimum of 4 views 0 373.00
XR Nasal Bones Comp Min 3 Views Radiologic examination, nasal bones, complete, minimum of 3 views 0 351.00
XR Neck Soft Tissue Radiologic examination; neck, soft tissue 0 287.00
XR ORBITS COMP MIN 4 VIEWS BIL_x000D_ XR ORBITS COMP MIN 4 VIEWS BIL Radiologic examination; orbits, complete, minimum of 4 views 0 622.00
XR Ribs 2 Views Lt Radiologic examination, ribs, unilateral; 2 views 0 282.00
XR Ribs 2 Views Rt Radiologic examination, ribs, unilateral; 2 views 0 282.00
XR Ribs 3 Views Bil Radiologic examination, ribs, bilateral; 3 views 0 519.00
XR Sacrum +Coccyx Min 2 Views Radiologic examination, sacrum and coccyx, minimum of 2 views 0 282.00
XR Scapula Comp Lt Radiologic examination; scapula, complete 0 303.00
XR Scapula Comp Rt Radiologic examination; scapula, complete 0 303.00
XR Shoulder 1 View Lt Radiologic examination, shoulder; 1 view 0 224.00
XR Shoulder 1 View Rt Radiologic examination, shoulder; 1 view 0 224.00
XR Sinuses Paranasal Comp Min 3 Views Radiologic examination, sinuses, paranasal, complete, minimum of 3 views 0 363.00
XR Skull < 4 Views Radiologic examination, skull; less than 4 views 0 341.00
XR Spine Cerv 2 or 3 Views Radiologic examination, spine, cervical; 2 or 3 views 0 320.00
XR Spine Lumbosacral 2 or 3 Views Radiologic examination, spine, lumbosacral; 2 or 3 views 0 329.00
XR Spine Lumbosacral Min 4 Views Radiologic examination, spine, lumbosacral; minimum of 4 views 0 484.00
XR Spine Thoracic 2 Views Radiologic examination, spine; thoracic, 2 views 0 293.00
XR Spine Thoracic 3 Views Radiologic examination, spine; thoracic, 3 views 0 346.00
XR Sternoclavicular Joint(s) Min 3 Views Radiologic examination; sternoclavicular joint or joints, minimum of 3 views 0 363.00
XR Sternum Min 2 Views Radiologic examination; sternum, minimum of 2 views 0 282.00
XR Wrist Comp Min 3 Views Rt Radiologic examination, wrist; complete, minimum of 3 views 0 331.00
XR Wrist Comp Min 3 Views Lt Radiologic examination, wrist; complete, minimum of 3 views 0 331.00
XR Wrist 2 Views Rt Radiologic examination, wrist; 2 views 0 303.00
XR Wrist 2 Views Lt Radiologic examination, wrist; 2 views 0 303.00
NM Parathyroid Parathyroid planar imaging (including subtraction, when performed); 0 3,052.00
H1N1 Immunization Admin, Including Counseling When Performed (Charge) 0 40.00 40.00
Blood Culture Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) 0 168.00
Throat Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00 43.00
Urine Culture Culture, bacterial; quantitative colony count, urine 0 102.00 40.00
NT Pro-BNP Natriuretic peptide 0 424.00
Renal Function Panel Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus 0 109.00
Critical Care Services Evaluation and Treatment for First 30 - 74 Minutes Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes 0 920.00 1,358.00 972.00
Preventive Medicine 18-39 years Established Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 0 283.00
Preventive Medicine 5-11 years Established Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor redu 0 253.00
Influenza A Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantit 0 151.00
Influenza B Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantit 0 151.00
Influenza A Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantit 0 151.00
Influenza B Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantit 0 151.00
RHIG Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) 0 404.00
RBC CPD AS1 500 LR Irr RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT 0 727.00
RBC CPD 450 LR Irr RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT 0 669.00
PACKED CELLS LR RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT 0 524.00
Aph Plt ACDA LR PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT 0 1,198.00
Aph Plt ACDA LR 1 PLATELETS, LEUKOCYTES REDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT 0 1,315.00
Aph Plt ACDA LR 2 PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT 0 1,198.00
Aph Plt ACDA LR 3 PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT 0 1,198.00
Aph Plt ACDA LR Irr PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT 0 1,225.00
Aph Plt ACDA LR Irr 1 PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT 0 1,225.00
Aph Plt ACDA LR Irr 2 PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT 0 1,225.00
Aph Plt ACDA LR Irr 3 PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT 0 1,225.00
Acetaminophen Level Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), 0 310.00
Free T4 Thyroxine; free 0 113.00
CSF Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00
Body Fluid Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00 43.00
Sputum Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00 43.00
Wound Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00 43.00
Gentamycin Level Peak Gentamicin 0 206.00
Gentamycin Level Trough Gentamicin 0 206.00
Phenytoin Level Phenytoin; total 0 167.00
Vancomycin Trough 1 Vancomycin 0 170.00
IMM ADM < 8 1ST INJ NSG Charge 0 48.00 48.00
IMM ADM <8 EA ADD IN NSG Charge 0 29.00 29.00
IMM ADM <8 1ST ORL/N NSG Charge 0 37.00 37.00
IMM ADM >8 1ST ORL/N NSG Charge Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) 0 61.00
IV Push Initial/ SIN Charge Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug 0 211.00 30.00
ROOM/BED: Private 0 2,470.00
ROOM/BED: Swing 0 2,470.00
ROOM/BED: Telemetry 0 3,525.00
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 2.5 cm or Less Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less 0 665.00 614.00
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 2.6 cm to 07.5 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm 0 820.00 859.00
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 7.6 cm to 12.5 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm 0 840.00 977.00
Layer Closure of Wounds of Scalp, Axillae, Trunk, Extremities(Exclude Hands and Feet) 20.1 cm to 30. Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm 0 1,973.00 1,325.00
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 12.6 cm to 20.0 cm Charge Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm 0 1,876.00 1,280.00
Layer Closure of Wounds of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.5 cm or Less Charge Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less 0 710.00 784.00
Layer Closure of Wounds of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.6 cm to 05.0 cm Charge Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 0 768.00 948.00
Repair Complex Trunk 01.1 to 02.5 cm Charge Repair, complex, trunk; 1.1 cm to 2.5 cm 0 829.00 957.00
Repair Complex Trunk Each Additional 5cm or Less Charge Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure) 0 340.00 355.00
Repair Complex, Scalp, Arms, and/or Leg Each Additional 5cm or Less Charge Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure) 0 353.00 409.00
Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet 01.1 to 02.5 cm Charge Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm 0 1,019.00 963.00
Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet 02.6 to 07.5 cm Charge Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm 0 1,392.00 1,471.00
Repair Complex Forehead/Cheek/Mouth/Neck/Axillae/Genitalia/Hands/Feet Each Additional 5cm or Less Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure) 0 523.00 531.00
Closed treatment of distal radial fracture (eg, Colles or Smith type) w/o manipualtion charge Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation 0 1,164.00 1,189.00
Closed treatment of distal radial fracture (eg, Colles or Smith type) w/ manipulation charge Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation 0 2,011.00 3,281.00
110 - ROOM-BOARD/PVT 0 0.00
120 - ROOM-BOARD/SEMI 0 0.00
130 - ROOM-BOARD/3&4BED 0 0.00
164 - R&B/STERILE 0 0.00
202 - ICU/MEDICAL 0 0.00
260 - IV THERAPY 0 0.00
270 - MED-SUR SUPPLIES 0 0.00
271 - NON-STER SUPPLY 0 0.00
272 - STERILE SUPPLY 0 0.00
274 - PROSTH/ORTH DEVICE 0 0.00
290 - MED EQUIP/DURAB 0 0.00
300 - LABORATORY 0 0.00
301 - LAB/CHEMISTRY 0 0.00
302 - LAB/IMMUNOLOGY 0 0.00
320 - DX X-RAY 0 0.00
350 - CT SCAN 0 0.00
401- DIAG MAMMOGRAPHY 0 0.00
402 - ULTRASOUND 0 0.00
403 - SCRN MAMMOGRAPHY 0 0.00
410 - RESPIRATORY SVC 0 0.00
420 - PHYSICAL THERAPY 0 0.00
421 - PHYS THERP/VISIT 0 0.00
430 - OCCUPATION THER 0 0.00
440- SPEECH PATHOL 0 0.00
444 - SPEECH PATH/EVAL 0 0.00
450 - EMERG ROOM 0 0.00
519 - OTHER CLINIC 0 0.00
519 - OTHER CLINIC PROFEE 0 0.00
540 - AMBULANCE 0 0.00
610 - MRI 0 0.00
618 - MRA 0 0.00
730 - EKG/ECG 0 0.00
760 - TREATMENT/OBSERVATION RM 0 0.00
761 - TREATMENT RM 0 0.00
771 - VACCINE ADMIN 0 0.00
914 - BH/INDIV RX 0 0.00
921 - PERI VASCUL LAB 0 0.00
940 - OTHER RX SVS 0 0.00
942 - EDUC/TRAINING 0 0.00
969 - OTHER PRO FEE TECH 0 0.00
969 - OTHER PRO FEE 0 0.00
972 - PRO FEE/RAD/DX TECH 0 0.00
972 - PRO FEE/RAD/DX 0 0.00
981 - PRO FEE/ER 0 0.00
983 - PRO FEE/CLINIC 0 0.00
985 - PRO FEE/EKG 0 0.00
250 - PHARMACY 0 0.00
255 - DRUGS/INCIDENT RAD 0 0.00
370 - ANESTHESIA 0 0.00
424 - PHYS THERP/EVAL 0 0.00
434 - OCCUP THERP/EVAL 0 0.00
450 - EMERG ROOM PROFEE 0 0.00
460 - PULMONARY FUNC 0 0.00
740 - EEG 0 0.00
450 - EMERG ROOM ER 0 0.00
Closed tx of phalangeal shaft fx, proximal or midlle phalanx, finger or thumb: without manipulation, Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each 0 697.00 863.00
Closed tx of patellar dislocation; without anesthesia Closed treatment of patellar dislocation; without anesthesia 0 1,689.00 1,561.00
Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method 0 651.00 404.00
Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed (separ Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) 0 753.00 539.00
Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (dx or therapeutic): initial 0 397.00 397.00
258 - IV Solutions 0 0.00
Fecal Leukocytes Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types 0 54.00
Sodium Level Urine Sodium; urine 0 61.00
Potassium Level Urine Potassium; urine 0 54.00
Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; 0 4,134.00 2,388.00
Cataract Extraction with Intraocular Lens Implantation POSTERIOR CHAMBER INTRAOCULAR LENS 0 4,000.00
Esophagogastroduodenoscopy and Colonoscopy 0 2,606.00
OPERATING ROOM MINOR 0 0.00
OPERATING ROOM LEVEL 1 0 0.00
OPERATING ROOM LEVEL 2 0 0.00
OPERATING ROOM LEVEL 3 0 0.00
OPERATING ROOM LEVEL 4 0 0.00
OPERATING ROOM LEVEL 5 0 0.00
Antibody ID Antibody identification, RBC antibodies, each panel for each serum technique 0 256.00
CT 3D Reconstruction 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; no 0 266.00
CT Abdomen +Pelvis w/ + w/o Cont Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions 0 3,555.00
CT Abdomen +Pelvis w/ Cont Computed tomography, abdomen and pelvis; with contrast material(s) 0 3,095.00
CT Abdomen +Pelvis w/o Cont Computed tomography, abdomen and pelvis; without contrast material 0 1,595.00
CT Angio Neck w/ Cont Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing 0 2,880.00
CT Angio Pelvis Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing 0 4,083.00
CT Biopsy Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation 0 1,384.00
CT Chest +Abdomen +Pelvis w/ + w/o Cont Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections 0 2,895.00
CT Chest +Abdomen +Pelvis w/ Cont Computed tomography, thorax; with contrast material(s) 0 2,350.00
CT Chest +Abdomen +Pelvis w/o Cont Computed tomography, thorax; without contrast material 0 1,729.00
CT Fingers w/o Cont Rt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT Chest w/o Cont Computed tomography, thorax; without contrast material 0 1,729.00
CT Chest w/ + w/o Cont Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections 0 2,895.00
CT Chest +Abdomen w/ + w/o Cont Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections 0 2,895.00
CT Chest +Abdomen w/o Cont Computed tomography, thorax; without contrast material 0 1,729.00
CT Heel w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Ltd or Localized Fol-Up Computed tomography, limited or localized follow-up study 0 2,013.00
CT Maxillofacial w/ + w/o Cont Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections 0 1,980.00
CT Orbit Sella etc. w/ + w/o Cont Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections 0 3,215.00
CT Sinus or Facial w/ Cont Computed tomography, maxillofacial area; without contrast material 0 1,355.00
CT Spine Cervical w/ + w/o Cont Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections 0 2,905.00
CT Spine Cervical w/ Cont Computed tomography, cervical spine; with contrast material 0 2,355.00
CT Spine Lumbar w/ + w/o Cont Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections 0 2,900.00
CT Spine Lumbar w/ Cont Computed tomography, lumbar spine; with contrast material 0 2,350.00
CT Spine Thoracic w/ + w/o Cont Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections 0 2,920.00
CT Spine Thoracic w/ Cont Computed tomography, thoracic spine; with contrast material 0 2,365.00
CT UE w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 0 3,040.00
CT UE w/ + w/o Cont Rt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 0 3,040.00
MA Breast Tissue Specimen Radiological examination, surgical specimen 0 28.00
MA Addl Views BCCP Bil. Diagnostic mammography, including computer-aided detection ( 0 390.00
MA Addl Views BCCP Lt. Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 0 228.00
MA Addl Views BCCP Rt. Diagnostic mammography, including computer-aided detection ( 0 305.00
MA Addl Views Bil. Diagnostic mammography, including computer-aided detection ( 0 390.00
MA Addl Views Rt. Diagnostic mammography, including computer-aided detection ( 0 305.00
MA Diag BCCP Rt. Diagnostic mammography, including computer-aided detection ( 0 305.00
MA Diag Ltd Marker Placement Rt. Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 0 228.00
MRA Chest w/ + w/o Cont Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) 0 3,225.00
MRA Head w/ + w/o Cont Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences 0 5,344.00
MRA Head w/o Cont Magnetic resonance angiography, head; without contrast material(s) 0 3,484.00
MRA LE w/o Cont Rt Magnetic resonance angiography, lower extremity, with or without contrast material(s) 0 3,274.00
MRA Neck w/ + w/o Cont Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences 0 5,370.00
MRA Neck w/ Cont Magnetic resonance angiography, neck; with contrast material(s) 0 3,705.00
MRA Pelvis w/o Cont Magnetic resonance angiography, pelvis, with or without contrast material(s) 0 3,270.00
MRA Pelvis w/ + w/o Cont Magnetic resonance angiography, pelvis, with or without contrast material(s) 0 3,270.00
MRA Spinal Canal +Contents Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) 0 3,416.00
MRA UE w/o Cont Lt Magnetic resonance angiography, upper extremity, with or without contrast material(s) 0 3,334.00
MRA UE w/o Cont Rt Magnetic resonance angiography, upper extremity, with or without contrast material(s) 0 3,334.00
MRI Abdomen w/ + w/o Cont Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences 0 4,118.00
MRI Abdomen w/ Cont Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) 0 3,855.00
MRI Abdomen w/o Cont Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) 0 3,154.00
MRI Bone Marrow Blood Supply Magnetic resonance (eg, proton) imaging, bone marrow blood supply 0 3,248.00
MRI Breast w/ + w/o Cont Bil Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral 0 3,617.00
MRI Fingers w/ Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 0 3,371.00
MRI Chest w/ Cont Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s) 0 3,885.00
MRI Chest w/o Cont Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s) 0 3,578.00
MRI Toes w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 3,306.00
MRI Face Neck Orbit w/o Cont Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) 0 3,049.00
MRI Foot w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 3,306.00
MRI Foot w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 3,306.00
MRI Foot w/ Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 0 3,386.00
MRI Foot w/ Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 0 3,386.00
MRI Foot w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 0 2,493.00
MRI Foot w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 0 2,493.00
MRI Toes w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 0 2,493.00
MRI Toes w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 0 2,493.00
MRI Pelvis w/ + w/o Cont Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences 0 4,106.00
MRI Spine Cervical w/ + w/o Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical 0 3,210.00
MRI Spine Lumbar w/ + w/o Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar 0 3,189.00
MRI Spine Thoracic w/ + w/o Cont Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic 0 3,215.00
MRI TMJ Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) 0 2,993.00
MRI UE Non Joint w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 4,375.00
MRI UE Non Joint w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 4,375.00
MRI UE Non Joint w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 0 3,315.00
MRI UE Non Joint w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 0 3,315.00
MRI Wrist w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences 0 3,780.00
MRI Wrist w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences 0 3,780.00
MRI Wrist w/ Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 0 3,109.00
MRI Wrist w/ Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 0 3,109.00
MRI Wrist w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 0 2,027.00
MRI Wrist w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 0 2,027.00
NM Bone Mult Areas Bone and/or joint imaging; multiple areas 0 2,221.00
NM Bone Spect Bone and/or joint imaging; tomographic (SPECT) 0 2,081.00
NM Gastric Emptying Study Gastric emptying imaging study (eg, solid, liquid, or both); 0 2,923.00
NM Kidney w/ Flow w/o Pharm Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention 0 2,173.00
NM Liver Spect Liver imaging (SPECT); 0 1,042.00
NM Liver +Spleen Static Only Liver and spleen imaging; static only 0 998.00
NM Lymphatics +Lymph Nodes Lymphatics and lymph nodes imaging 0 3,479.00
NM Myocard Perf w/ Ejection Fraction 0 249.00
NM Myocard Perf w/ Wall Motion 0 249.00
NM Myocard Perf Spect Mult Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantifica 0 4,606.00
NM Pulm Perf w/ Vent Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging 0 3,301.00
US Guide Amniocentesis Amniocentesis; diagnostic 0 703.00
US Hysterosonography Saline infusion sonohysterography (SIS), including color flow Doppler, when performed 0 590.00
US Liver Biopsy Biopsy of liver, needle; percutaneous 0 1,647.00
US Thyroid Biopsy Biopsy thyroid, percutaneous core needle 0 477.00
US Echoencephalography Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abno 0 627.00
US Fetal Biophys Profile w/ Non-Stress Fetal biophysical profile; with non-stress testing 0 485.00
US Pregnant Fol-Up Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ s 0 516.00
US Hips Infant Dynamic Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation) 0 784.00
US Pregnant > 14 Weeks Ea Addl Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (Lis 0 319.00
US Pelvic Non-OB Comp Ultrasound, pelvic (nonobstetric), real time with image documentation; complete 0 547.00
US Pelvic Non-OB Ltd Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) 0 165.00
US Pregnant Ltd Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses 0 372.00
US Retroperitoneal Ltd Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited 0 209.00
US Spinal Canal +Contents Ultrasound, spinal canal and contents 0 586.00
XR Chest Special Views Decubitus Rt 0 346.00
XR Ankle 2 Views Lt Radiologic examination, ankle; 2 views 0 277.00
XR Ankle 2 Views Rt Radiologic examination, ankle; 2 views 0 277.00
XR Ankle Arthrography Lt Radiologic examination, ankle, arthrography, radiological supervision and interpretation 0 1,032.00
XR Ankle Arthrography Rt Radiologic examination, ankle, arthrography, radiological supervision and interpretation 0 1,032.00
XR Elbow Arthrography Lt Radiologic examination, elbow, arthrography, radiological supervision and interpretation 0 1,038.00
XR Elbow Arthrography Rt Radiologic examination, elbow, arthrography, radiological supervision and interpretation 0 1,038.00
XR Knee Arthrography Lt Radiologic examination, knee, arthrography, radiological supervision and interpretation 0 1,288.00
XR Barium Enema w/ or w/o KUB Radiologic examination, colon; contrast (eg, barium) enema, with or without KUB 0 1,709.00
XR Barium Enema w/ Air Cont Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon 0 2,411.00
XR Bone Age Studies Bone age studies 0 202.00
XR Bone Length Studies Scanograms Bone length studies (orthoroentgenogram, scanogram) 0 320.00
XR Bone Survey Infant Radiologic examination, osseous survey, infant 0 889.00
XR Chest 2 Views w/ Apical Lordotic Radiologic examination, chest; 2 views 0 299.00
XR Chest 2 Views w/ Fluoro Radiologic examination, chest; 2 views 0 85.00
XR Chest 2 Views w/ Obl Radiologic examination, chest; 2 views 0 373.00
XR Nose to Rectum FB 1 View Child Radiologic examination from nose to rectum for foreign body, single view, child 0 250.00
XR Cholecystography Oral Cont 0 485.00
XR Elbow Comp Min 3 Views Lt Radiologic examination, elbow; complete, minimum of 3 views 0 330.00
XR Elbow Comp Min 3 Views Rt Radiologic examination, elbow; complete, minimum of 3 views 0 330.00
XR Fingers Min 2 Views Lt Radiologic examination, finger(s), minimum of 2 views 0 320.00
XR Fingers Min 2 Views Rt Radiologic examination, finger(s), minimum of 2 views 0 320.00
XR Fistula or Sinus Tract Abscess Study Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation 0 425.00
XR Fluoro Over 1 Hour Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP 0 1,504.00
XR Hand 2 Views Bil Radiologic examination, hand; 2 views 0 391.00
XR Hip Min 2 Views Bil w/ Pelvis Radiologic examination, hips, bilateral, with pelvis when performed; 2 views 0 567.00
XR Pelvis +Hip Infant Min 2 Views 0 432.00
XR Hysterosalpingography Hysterosalpingography, radiological supervision and interpretation 0 831.00
XR Knee Comp Min 4 Views Lt Radiologic examination, knee; complete, 4 or more views 0 415.00
XR Knee Comp Min 4 Views Rt Radiologic examination, knee; complete, 4 or more views 0 415.00
XR Knee Standing AP Bil Radiologic examination, knee; both knees, standing, anteroposterior 0 337.00
XR Mandible Partial < 4 Views Radiologic examination, mandible; partial, less than 4 views 0 351.00
XR Mastoids Comp Min 3 Views Bil Radiologic examination, mastoids; complete, minimum of 3 views per side 0 831.00
XR Spine Myelography 2 or More Regions Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation 0 889.00
XR Spine Lumbosacral Myelography Myelography, lumbosacral, radiological supervision and interpretation 0 740.00
XR Urography Retrograde w/ or w/o KUB Urography, retrograde, with or without KUB 0 1,206.00
XR Ribs Min 3 Views Rt w/ AP Chest Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views 0 335.00
XR SI Joints 1 or 2 Views Radiologic examination, sacroiliac joints; less than 3 views 0 287.00
XR Salivary Gland Calculus Bil Radiologic examination, salivary gland for calculus 0 590.00
XR Spine Thoracic Standing (Scoliosis) Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view 0 303.00
XR Sella Turcica Radiologic examination, sella turcica 0 293.00
XR Sialography  Sialography, radiological supervision and interpretation 0 1,113.00
XR Sinuses Paranasal < 3 Views Radiologic examination, sinuses, paranasal, less than 3 views 0 308.00
XR Skull Comp Min 4 Views Radiologic examination, skull; complete, minimum of 4 views 0 410.00
XR Spine 1 View Cerv Radiologic examination, spine, single view, specify level 0 207.00
XR Spine Entire AP +Lateral Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views 0 693.00
XR Spine Cerv Comp w/ Obl +Flex +/or Ext Radiologic examination, spine, cervical; 6 or more views 0 498.00
XR Spine Lumbosacral Comp w/ Bending Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views 0 676.00
XR Spine Thoracolumbar 2 Views Radiologic examination, spine; thoracolumbar junction, minimum of 2 views 0 320.00
XR TMJ Open +Closed Bil Radiologic examination, temporomandibular joint, open and closed mouth; bilateral 0 759.00
XR UGI w/o KUB Radiologic examination, gastrointestinal tract, upper; with or without delayed images, without KUB 0 757.00
XR UGI w/ Air Cont w/o KUB Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed images, without KUB 0 1,373.00
XR UGI w/ SB Radiologic examination, gastrointestinal tract, upper; with small intestine, includes multiple serial images 0 1,863.00
Aph RBC CP2D AS3 LR RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT 0 524.00
Cryo AHF CRYOPRECIPITATE, EACH UNIT 0 803.00
HCG QUANTITATIVE Gonadotropin, chorionic (hCG); quantitative 0 189.00
PSA Screen PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA) 0 231.00 92.00
PSA Diagnostic Prostate specific antigen (PSA); total 0 231.00
Alcohol Level 1 Alcohols 0 201.00
CT Angio Pelvis w/ Cont Computed tomography, pelvis; with contrast material(s) 0 2,360.00
CT Ankle w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Ankle w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Ankle w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Ankle w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Ankle w/o Cont Lt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Ankle w/o Cont Rt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Elbow w/o Cont Lt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT Elbow w/o Cont Rt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT Foot w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Foot w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Foot w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Foot w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Foot w/o Cont Lt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Foot w/o Cont Rt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Knee w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Knee w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Knee w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Knee w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 0 2,360.00
CT Knee w/o Cont Lt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Knee w/o Cont Rt Computed tomography, lower extremity; without contrast material 0 1,825.00
CT Shoulder w/o Cont Lt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT Shoulder w/o Cont Rt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT Wrist w/o Cont Lt Computed tomography, upper extremity; without contrast material 0 1,820.00
CT Wrist w/o Cont Rt Computed tomography, upper extremity; without contrast material 0 1,820.00
MRI Cardiac Morph w/o Cont Cardiac magnetic resonance imaging for morphology and function without contrast material; 0 2,440.00
US Aorta Duplex IVC Iliac Ltd Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study 0 696.00
XR Hip Comp Min 2 Views Lt +Pelvis Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views 0 256.00
XR Cholangiography Intraoperative Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and int 0 596.00
XR Optic Foramina Lt Radiologic examination; optic foramina 0 351.00
XR Optic Foramina Rt Radiologic examination; optic foramina 0 351.00
XR Pelvis Comp Min 3 Views Radiologic examination, pelvis; complete, minimum of 3 views 0 399.00
XR SI Joints Min 3 Views Radiologic examination, sacroiliac joints; 3 or more views 0 346.00
XR Spine 1 View Lumbar Radiologic examination, spine, single view, specify level 0 207.00
XR Spine 1 View Thoracic Radiologic examination, spine, single view, specify level 0 207.00
XR TMJ Open +Closed Lt Radiologic examination, temporomandibular joint, open and closed mouth; unilateral 0 320.00
XR TMJ Open +Closed Rt Radiologic examination, temporomandibular joint, open and closed mouth; unilateral 0 320.00
CT Angio LE Bil Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing 0 4,905.00
MRI Brachial Plexus w/ Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 0 3,371.00
Anaerobic Culture Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates 0 119.00
Ear Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00 43.00
Group B Strep Culture Culture, presumptive, pathogenic organisms, screening only; 0 83.00
111 - MED-SUR-GY/PVT 0 0.00
121 - MED-SUR-GY/2BED 0 0.00
206 - POST ICU 0 0.00
259 - DRUGS/OTHER 0 0.00
275 - PACE MAKER 0 0.00
276 - INTROC LENS 0 0.00
278 - SUPPLY/IMPLANTS 0 0.00
279 - SUPPLY/OTHER 0 0.00
305 - LAB/HEMATOLOGY 0 0.00
306 - LAB/BACT-MICRO 0 0.00
307 - LAB/UROLOGY 0 0.00
309 - LAB/OTHER 0 0.00
310 - PATHOLOGY LAB 0 0.00
312 - PATHOL/HYSTOL 0 0.00
322 - DX X-RAY/ARTH 0 0.00
323 - DX X-RAY/ARTER 0 0.00
329 - DX X-RAY/OTHER 0 0.00
343 - Diagnostic radiopharmaceuticals 0 0.00
351 - CT SCAN/HEAD 0 0.00
352 - CT SCAN/BODY 0 0.00
360 - OR SERVICES 0 0.00
390 - BLOOD/STOR-PROC 0 0.00
460 - PULMONARY FUNC 0 0.00
480 - CARDIOLOGY 0 0.00
481 - CARDIAC CATH LAB 0 0.00
482 - STRESS TEST 0 0.00
612 - MRI - SPINE 0 0.00
636 - DRUGS/DETAIL CODE 0 0.00
637 - DRUGS/SELF ADMIN 0 0.00
710 - RECOVERY ROOM 0 0.00
721 - LABOR 0 0.00
730 - EKG/ECG 0 0.00
731 - HOLTER MONT 0 0.00
732 - TELEMETRY 0 0.00
762 - OBSERVATION RM 0 0.00
Add'l 30 Min Increments CC > 74 Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) 0 763.00
US Guide Ndl Placement Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 0 195.00
.GTT Fasting Glucose Glucose; quantitative, blood (except reagent strip) 0 95.00
Work Hardening Additional Hours Charge Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) 0 191.00
US Hips Infant Static Ltd Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation) 0 544.00
ROOM/BED: Nursery 0 1,317.00
ROOM/BED: Obstetrics 0 2,140.00
Biopsy or excision of lymph node(s); open, deep cervical node(s) Biopsy or excision of lymph node(s); open, deep cervical node(s) 0 2,453.00 2,000.00
Change of cystostomy tube; simple Change of cystostomy tube; simple 0 345.00 248.00
Initial hospital or birthing center care, per day, for E&M of normal newborn infant Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant 0 467.00 317.00
Subsequent hospital care, per day, for evaluation and management of normal newborn Subsequent hospital care, per day, for evaluation and management of normal newborn 0 208.00 139.00
PET Ltd Area Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) 0 2,491.00
PET Whole Body Positron emission tomography (PET) imaging; whole body 0 3,267.00
CT Chest w/ Cont Computed tomography, thorax; with contrast material(s) 0 2,350.00
MA Addl Views Lt. Diagnostic mammography, including computer-aided detection ( 0 305.00
MA Diag BCCP Bil. Diagnostic mammography, including computer-aided detection ( 0 390.00
MA Diag BCCP Lt. Diagnostic mammography, including computer-aided detection ( 0 305.00
XR MRI Screen Waters View Radiologic examination, eye, for detection of foreign body 0 282.00
XR Chest Special Views 0 346.00
XR Spine Cerv Min 4 Views Radiologic examination, spine, cervical; 4 or 5 views 0 425.00
XR Toe(s) Min 2 Views Lt Radiologic examination; toe(s), minimum of 2 views 0 267.00
XR Toe(s) Min 2 Views Radiologic examination; toe(s), minimum of 2 views 0 267.00
Report Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 0 513.00
US Guide Abdomen Paracentesis Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance 0 1,545.00
US Guide Thoracentesis Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 0 195.00
US Pregnant < 14 Weeks 1st Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation 0 529.00
Iron Level Iron 0 82.00
Creatinine Level 24 Hour Urine Creatinine; other source 0 62.00
Cord DAT Antihuman globulin test (Coombs test); direct, each antiserum 0 68.00
zzCMP 3 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine ( 0 132.00 53.00
Removal of tunneled cntrl venous access device w/subcutaneous port/pump cntrl/peripheral insertion Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion 0 1,006.00 912.00
Ligation major artery (eg post-traumatic rupture) neck Ligation, major artery (eg, post-traumatic, rupture); neck 0 2,429.00 1,287.00
Stool Culture Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species 0 119.00 47.00
Environmental Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 183.00
GC Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 0 108.00
US Retroperitoneal Aorta Comp Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study 0 1,101.00
.GTT-1 Hr Glucose; post glucose dose (includes glucose) 0 49.00
.GTT-2 Hr Glucose; post glucose dose (includes glucose) 0 49.00
.GTT-3 Hr Glucose; post glucose dose (includes glucose) 0 49.00
US LE Doppler w/ Stress Test Noninvasive physiologic studies of lower extremity arteries, 0
MRI Ankle w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 0 1,926.00
MRI Ankle w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 0 1,926.00
MRI Elbow w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 0 2,027.00
MRI Elbow w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 0 2,027.00
MRI Femur w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 3,306.00
MRI Femur w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 3,306.00
MRI Forearm w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 4,099.00
MRI Forearm w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 0 4,099.00
MRI Knee w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 0 1,926.00
MRI Knee w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 0 1,926.00
US Echo 2D Comp Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echo 0 1,169.00
Report Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echo 0 855.00 299.00
Tibia fracture, distal, wt bearing articular surface portion - closed treatment of w or wo anesthes Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation 0 1,475.00 1,434.00
Thoracentesis with insertion of tube, includes water seal eg, for pneumothorax , when performed (sep Thoracentesis with insertion of tube, includes water seal eg 0 555.00 555.00
BD DEXA Appendicular Skeleton Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 0 197.00
PET Whole Body w/ CT Scan Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body 0 4,042.00
CT Angio Abdomen Aorta +Iliofemoral Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing 0 4,966.00
CT Angio Head Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing 0 3,563.00
CT Toes w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT Guide Ndl Placement Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation 0 1,384.00
CT LE w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
CT LE w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 0 2,995.00
MA Diag Ltd Marker Placement Lt. Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 0 228.00
MA Routine Screen BCCP Bil. Screening mammography, bilateral (2-view study of each breas 0 322.00
MA Routine Screen Implant Bil. Screening mammography, bilateral (2-view study of each breas 0 322.00
MA Routine Screen Lt. Screening mammography, bilateral (2-view study of each breas 0 322.00
MA Routine Screen Rt. Screening mammography, bilateral (2-view study of each breas 0 322.00
MRI Ankle w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences 0 3,803.00
MRI Ankle w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences 0 3,803.00
MRI Ankle w/ Cont Lt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) 0 3,139.00
MRI Ankle w/ Cont Rt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) 0 3,139.00
MRI Elbow w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences 0 3,780.00
MRI Elbow w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences 0 3,780.00
MRI Elbow w/ Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 0 3,109.00
MRI Elbow w/ Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 0 3,109.00
MRI Femur w/ Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 0 3,386.00
MRI Femur w/ Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 0 3,386.00
MRI Forearm w/ Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 0 3,371.00
MRI Forearm w/ Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 0 3,371.00
MRI Forearm w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 0 3,109.00
MRI Forearm w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 0 3,109.00
MRI Knee w/ Cont Lt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) 0 3,139.00
MRI Knee w/ Cont Rt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) 0 3,139.00
US Abdomen/Pelvic/Scrotal Art/Vein Comp Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study 0 1,630.00
US Carotid Duplex Lt Duplex scan of extracranial arteries; unilateral or limited study 0 754.00
US Carotid Duplex Rt Duplex scan of extracranial arteries; unilateral or limited study 0 754.00
US Guide Intraoperative Ultrasonic guidance, intraoperative 0 597.00
US Transrectal Ultrasound, transrectal; 0 434.00
XR Spine Puncture Lumbar Diag Spinal puncture, lumbar, diagnostic 0 710.00
XR GI Tube Inj for Placement Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report 0 1,204.00
XR Hip Arthrography Lt Radiologic examination, hip, arthrography, radiological supervision and interpretation 0 1,081.00
XR Hip Arthrography Rt Radiologic examination, hip, arthrography, radiological supervision and interpretation 0 1,081.00
XR Knee Arthrography Rt Radiologic examination, knee, arthrography, radiological supervision and interpretation 0 1,288.00
XR Shoulder Arthrography Lt Radiologic examination, shoulder, arthrography, radiological supervision and interpretation 0 1,081.00
XR Shoulder Arthrography Rt Radiologic examination, shoulder, arthrography, radiological supervision and interpretation 0 1,081.00
XR Wrist Arthrography Lt Radiologic examination, wrist, arthrography, radiological supervision and interpretation 0 1,165.00
XR Wrist Arthrography Rt Radiologic examination, wrist, arthrography, radiological supervision and interpretation 0 1,165.00
XR Chest Comp Min 4 Views Radiologic examination, chest; 4 or more views 0 382.00
XR Chest Comp Min 4 Views w/ Fluoro Radiologic examination, chest; 4 or more views 0 905.00
XR Cholangiography Perc Transhepatic Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and int 0 990.00
XR Fluoro Guide CVA Placement Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, an 0 766.00
XR Fluoro Guide Ndl Loc Spine Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 0 766.00
XR Manual Stress Application to Joint Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated 0
XR Spine Cerv Myelography Myelography, cervical, radiological supervision and interpretation 0 771.00
XR Small Bowel w/ Serial Films Radiologic examination, small intestine, includes multiple serial images; 0 1,191.00
XR Spine Lumbosacral Bending Only Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views 0 420.00
XR Swallowing Funct w/ Video Swallowing function, with cineradiography/videoradiography 74230 1,511.00
XR Urethrocystography Retrograde Urethrocystography, retrograde, radiological supervision and interpretation 74450 746.00
XR Urography Antegrade Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation 74425 666.00
XR Venography LE Bil Venography, extremity, bilateral, radiological supervision and interpretation 75822 1,900.00
XR Venography LE Lt Venography, extremity, unilateral, radiological supervision and interpretation 75820 1,198.00
XR Venography LE Rt Venography, extremity, unilateral, radiological supervision and interpretation 75820 1,198.00
Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma) Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma) 54700 1,019.00 749.00
Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age 54161 759.00 759.00
Bladder instillation of anticarcinogenic agent (including retention time) Bladder instillation of anticarcinogenic agent (including retention time) 51720 392.00 303.00
Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm Adjacent tissue transfer or rearrangement, trunk; defect 10. 14001 1,183.00
Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area Excision, excessive skin and subcutaneous tissue (includes l 15839 3,486.00
Biopsy or excision of lymph node(s); open, deep axillary node(s) Biopsy or excision of lymph node(s); open, deep axillary node(s) 38525 2,082.00 1,350.00
Open treatment of phalangeal shaft fracture, mid phalanx, finger/thumb, incl int. fixation Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each 26735 2,818.00 1,965.00
Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation,ea Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each 28515 764.00 675.00
Excision of lesion of tendon sheath or joint capsule (eg, cyst, ganglion), hand/finger Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger 26160 1,770.00 1,644.00
Excision of skin and subcutaneous tissue for hidradenitis, axillary,w simple or intermed repai Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair 11450 1,788.00 1,196.00
MRSA Screen Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 87070 108.00
Bone marrow; biopsy, needle or trocar Bone marrow; biopsy, needle or trocar 38221 697.00 355.00
Reference ABO/Rh Blood typing, serologic; ABO 86900 38.00
Reference ABSC Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test 86902 192.00
CT Angio Abdomen w/ Cont Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing 74175 3,045.00
CT Angio Chest w/ Cont Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing 71275 2,940.00
Acne surgery eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) 10040 181.00 417.00
Incision and drainage of submucosal abscess, rectum Incision and drainage of submucosal abscess, rectum 45005 769.00
Colonoscopy, flexible, proximal to splenic flexure; w/ ablation of tumor, polyp,lesion not amenable Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 45388 15,008.00 1,393.00
Colonoscopy, flexible, proximal to splenic flexure; w/ removal of tumor, polyp,lesion by hot biopsy Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 45384 2,106.00 1,107.00
Orchiectomy, partial Orchiectomy, partial 54522 2,820.00 1,691.00
Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication 55000 402.00 406.00
Total thyroid lobectomy, unilateral; with or without isthmusectomy Total thyroid lobectomy, unilateral; with or without isthmusectomy 60220 1,507.00
Thyroidectomy, total or subtotal for malignancy; with limited neck dissection Thyroidectomy, total or subtotal for malignancy; with limited neck dissection 60252 2,964.00
Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure 67840 787.00 741.00
Pneumococcal conjugate vaccine, 13 valent, for intramuscular use Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90670 441.00 441.00
Bronchial Wash Culture Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 87070 108.00
Cardiovas stress test using maximal/submaximal treadmill or bike exercise, cont.electrocardiographic Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and r 93015 357.00 124.00
Interrogation device evaluation (in person) with physician analysis, review and report, connection Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient e 93288 133.00 148.00 69.00
Initial hospital or birthing center care, per day, for eval and mgmt of normal newborn infant Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant 99460 467.00 317.00
Initial hospital or birthing cntr care, per day, for eval and mgmt of normal newborn infant same day Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date 99463 557.00 351.00
Vaginal hysterectomy, for uterus greater than 250 g; Vaginal hysterectomy, for uterus greater than 250 g; 58290 5,393.00 3,345.00
Endometrial ablation, thermal, without hysteroscopic guidance Endometrial ablation, thermal, without hysteroscopic guidance 58353 4,688.00 1,026.00
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) 58571 4,231.00 2,656.00
Occlusion of fallopian tube(s) by device (eg, band, clip,Falope ring) vaginal or suprapubic approach Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach 58615 1,166.00 650.00
Unlisted laparoscopy procedure, oviduct, ovary Unlisted laparoscopy procedure, oviduct, ovary 58679 869.00 0.00
Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy 59151 3,567.00 1,998.00
Episiotomy or vaginal repair, by other than attending physician Episiotomy or vaginal repair, by other than attending 59300 913.00 706.00
Prednisolone oral per 5 mg METHYLPREDNISOLONE ORAL, PER 4 MG 3.00
Removal of tunneled central venous catheter, without subcutaneous port or pump Removal of tunneled central venous catheter, without subcutaneous port or pump 36589 629.00 579.00
Hemoccult POC Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards 82270 44.00 44.00
112 - OB/PVT 0.00
119 - OTHER/PVT 0.00
170 - NURSERY 0.00
174 - NURSERY/LEVEL IV 0.00
210 - CORONARY CARE 0.00
324 - DX X-RAY/CHEST 0.00
361 - OR/MINOR 0.00
371 - ANESTHE/INCIDENT RAD 0.00
379 - ANESTHE/OTHER 0.00
381 - BLOOD/PKD RED 0.00
391 - BLOOD/ADMIN 0.00
419 - OTHER RESPIR SVS 0.00
490 - AMBUL SURG 0.00
510 - CLINIC 0.00
520 - FREESTAND CLINIC 0.00
551 - SKILLED NURS/VISIT 0.00
561 - MED SOC SERVS/VISIT 0.00
569 - MED SOC SERV/OTHER 0.00
571 - AIDE/HOME HLTH/VISIT 0.00
314 - Laboratory Biopsy 0.00
611 - MRI - BRAIN 0.00
615 - MRI-Head and neck 0.00
651 - HOSPICE/RTN HOME 0.00
655 - HOSPICE/IP RESPITE 0.00
656 - HOSPICE/IP NON-RESPITE 0.00
720 - DELIVEROOM/LABOR 0.00
770 - PREVENT CARE SVS 0.00
780 - TELEMEDICINE 0.00
920 - OTHER DX SVS 0.00
960 - PRO FEE 0.00
973 - PRO FEE/RAD/RX 0.00
975 - PRO FEE/OR 0.00
982 - PRO FEE/OUTPT 0.00
96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 96372 76.00 115.00 57.00
90471 Immunization Administration 1 vaccine Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90471 72.00
90472 Each additional vaccine Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in additio 90472 28.00
96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 96372 76.00 115.00 57.00
Imitrex 6mg Injection INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR 165.00 165.00
Hydroxyzine HCl 25mg Injection Injection, hydroxyzine hcl, up to 25 mg 22.00
US Breast Bil. 459.00
US Breast Lt. 459.00
US Breast Rt. Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76641 413.00
MRI Breast w/ + w/o Cont Bil. Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral 77059 4,759.00
MRI Breast w/ + w/o Cont Lt. Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral 77058 4,819.00
MRI Breast w/ + w/o Cont Rt. Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral 77058 4,819.00
MA Diag Bil. Diagnostic mammography, including computer-aided detection ( 77066 390.00
MA Routine Screen Bil. Screening mammography, bilateral (2-view study of each breas 77067 322.00
99291 - Critical Care Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes 99291 2,592.00
99285 - Level 5 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/ 99285 2,017.00
99284 - Level 4 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate c 99284 1,374.00
99283 - Level 3 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Med 99283 732.00
99282 - Level 2 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Med 99282 500.00
99281 - Level 1 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical 99281 250.00
Excision of pilonidal cyst or sinus simple Excision of pilonidal cyst or sinus; simple 11770 1,299.00 876.00
Excision of pilonidal cyst or sinus complicated Excision of pilonidal cyst or sinus; complicated 11772 3,259.00 2,380.00
Split-thickness autograft trunk arms legs first 100 sq cm or less Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 15100 4,035.00 3,385.00
Unlisted procedure skin mucous membrane and subcutaneous tissue Unlisted procedure, skin, mucous membrane and subcutaneous tissue 17999 184.00 805.00
Excision of cyst fibroadenoma aberrant breast tissue duct lesion areolar lesion 1 or more Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions 19120 1,666.00 1,960.00
Mastectomy for gynecomastia Mastectomy for gynecomastia 19300 2,462.00 1,955.00
Mastectomy partial (eg lumpectomy tylectomy quadrantectomy segmentectomy) Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); 19301 3,097.00 1,894.00
Mastectomy radical including pectoral muscles axillary lymph nodes Mastectomy, radical, including pectoral muscles, axillary ly 19305 2,881.00
Exploration of penetrating wound (separate procedure) abdomen/flank/back Exploration of penetrating wound (separate procedure); abdomen/flank/back 20102 2,286.00 1,211.00
Excision tumor soft tissue of back or flank subcutaneous less than 3 cm Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm 21930 1,524.00 1,669.00
Excision tumor soft tissue of abdominal wall subfascial (eg intramuscular) less than 5 cm Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm 22900 2,685.00 1,544.00
Closed treatment of supracondylar humeral fracture w/wo intercondylar ext. without manipulation Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation 24530 1,785.00 1,619.00
Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension 24538 3,529.00 1,612.00
Closed treatment of carpal bone fracture without manipulation each bone Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone 25630 1,169.00 1,121.00
Closed treatment of phalangeal shaft fracture with manipulation w/wo skin or skeletal traction Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each 26725 1,204.00 1,424.00
Closed treatment of articular fracture metacarpophalangeal or interphalangeal joint wo manip. Each Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each 26740 1,080.00 1,015.00
Arthroplasty acetabular and proximal femoral prosthetic replacement w/wo autograft or allograft Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 27130 2,728.00 3,419.00
Treatment of intertrochanteric peritrochanteric femoral fracture with plate/screw type implant Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage 27244 5,856.00 3,095.00
Arthroplasty knee condyle and plateau medial AND lateral compartments w/wo patella resurfacing Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 27447 3,137.00 3,446.00
Treatment of tibial shaft fracture by intramedullary implant w/wo interlocking screws Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage 27759 4,744.00 2,525.00
Open treatment of trimalleolar ankle fracture includes internal fixation when performed Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip 27822 4,071.00 2,366.00
Open treatment of fracture of weight bearing articular surface/portion of distal tibia of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only 27827 5,215.00 3,132.00
Open treatment of distal tibiofibular joint (syndesmosis) disruption when performed Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed 27829 3,297.00 1,972.00
Bronchoscopy rigid or flex incl. fluoroscopic w/ therapeutic aspiration tracheobronchial initial Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess) 31645 1,196.00 711.00
Insertion of tunneled centrally inserted cntrl venous access device w/ sub port age 5 yr+ Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older 36561 3,970.00 1,753.00
Upper GI endoscopy incl. esophagus stomach the duodenum/jejunum w/ biopsy single or multi Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 43239 1,149.00 906.00
Upper GI endoscopy incl esophagus stomach duodenum/ejunum w/dilation of gastric outlet for obstr Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) 43245 2,585.00 978.00
Upper GI endoscopy incl esophagus stomach either duodenum and/or jejunum w/percutaneous gastro tube Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube 43246 970.00 665.00
Upper GI endoscopy incl esophagus stomach either duodenum/ jejunum w/ remov of foreign body Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) 43247 1,640.00 858.00
Upper GI endoscopy incl. esophagus stomach either duodenum and/or jejunum w/ cntrl of bleeding Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method 43255 3,112.00 975.00
Gastrotomy with exploration or foreign body removal Unlisted procedure, esophagus 43499 3,031.00 2,859.00
Change of gastrostomy tube percutaneous without imaging or endoscopic guidance Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance 43760 1,252.00 452.00
Gastrorrhaphy suture of perforated duodenal or gastric ulcer wound or injury Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury 43840 6,496.00 3,767.00
Enterolysis (freeing of intestinal adhesion) (separate procedure) Enterolysis (freeing of intestinal adhesion) (separate procedure) 44005 5,236.00 3,046.00
Enterectomy resection of small intestine single resection and anastomosis Enterectomy, resection of small intestine; single resection and anastomosis 44120 5,851.00 3,435.00
Colectomy partial with anastomosis Colectomy, partial; with anastomosis 44140 6,415.00 3,727.00
Colectomy partial with skin level cecostomy or colostomy Colectomy, partial; with skin level cecostomy or colostomy 44141 8,735.00 4,935.00
Colectomy partial with end colostomy and closure of distal segment (Hartmann type procedure) Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure) 44143 7,964.00 4,585.00
Colectomy partial with coloproctostomy (low pelvic anastomosis) Colectomy, partial; with coloproctostomy (low pelvic anastomosis) 44145 7,935.00 4,716.00
Colectomy partial with removal of terminal ileum with ileocolostomy Colectomy, partial, with removal of terminal ileum with ileocolostomy 44160 5,939.00 3,447.00
Laparoscopy surgical enterectomy resection of small intestine single resection and anastomosis Laparoscopy, surgical, closure of enterostomy, large or smal 44227 4,722.00
Ileostomy or jejunostomy non-tube Ileostomy or jejunostomy, non-tube 44310 2,902.00
Colostomy or skin level cecostomy Colostomy or skin level cecostomy; 44320 3,285.00
Suture of sm. intestine for perforated ulcer diverticulum wound injury or rupture single perforation Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation 44602 6,755.00 4,079.00
Suture of lg. intestine for perforated ulcer diverticulum wound injury or rupture w/o colostomy Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy 44604 5,062.00 2,996.00
Biopsy or excision of lymph node(s) open superficial Biopsy or excision of lymph node(s); open, superficial 38500 1,039.00 1,211.00
Proctosigmoidoscopy rigid with control of bleeding (eg injection bipolar cautery laser) Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 45317 859.00 538.00
Sigmoidoscopy flexible diagnostic with or without collection of specimen by brushing or washing Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 45330 523.00 423.00
Sigmoidoscopy flexible with directed submucosal injection(s) any substance Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance 45335 1,094.00 604.00
Colonoscopy flexible proximal to splenic flexure w/ directed submucosal injection any substance Colonoscopy, flexible; with directed submucosal injection(s), any substance 45381 970.00 1,070.00
Colonoscopy flexible proximal to splenic flexure with control of bleeding Colonoscopy, flexible; with control of bleeding, any method 45382 3,374.00 1,297.00
Colonoscopy flexible proximal splenic flexure w/ removal of tumor polyp lesion snare technique Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 45385 1,812.00 1,234.00
Placement of seton Placement of seton 46020 404.00
Hemorrhoidectomy internal by rubber band ligation(s) Hemorrhoidectomy, internal, by rubber band ligation(s) 46221 870.00 717.00
Hemorrhoidectomy external 2 or more columns/groups Hemorrhoidectomy, external, 2 or more columns/groups 46250 2,184.00 1,498.00
Hemorrhoidectomy internal and external single column/group Hemorrhoidectomy, internal and external, single column/group; 46255 2,390.00 1,683.00
Surgical treatment of anal fistula (fistulectomy/fistulotomy) subcutaneous Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous 46270 2,399.00 1,861.00
Laparoscopy surgical cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy with cholangiography 47563 3,411.00 1,893.00
Transrectal drainage of pelvic abscess Cholecystectomy; 47600 5,098.00 2,884.00
Exploratory laparotomy exploratory celiotomy with or without biopsy(s) Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) 49000 3,678.00 2,069.00
Reopening of recent laparotomy Reopening of recent laparotomy 49002 4,996.00 2,909.00
Drainage of peritoneal abscess or localized peritonitis exclusive of appendiceal abscess open Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open 49020 7,605.00 4,401.00
Closure of enterovesical fistula with intestine and or bladder resection Closure of enterovesical fistula; with intestine and/or blad 44661 4,513.00
Appendectomy for ruptured appendix with abscess or generalized peritonitis Appendectomy; for ruptured appendix with abscess or generalized peritonitis 44960 4,178.00 2,393.00
Omentectomy epiploectomy resection of omentum Omentectomy, epiploectomy, resection of omentum (separate procedure) 49255 3,776.00 2,072.00
Repair recurrent inguinal hernia any age reducible Repair recurrent inguinal hernia, any age; reducible 49520 3,014.00 2,002.00
Repair recurrent inguinal hernia any age incarcerated or strangulated Repair recurrent inguinal hernia, any age; incarcerated or strangulated 49521 3,419.00 1,906.00
Repair initial femoral hernia any age reducible Repair initial femoral hernia, any age; reducible 49550 2,744.00 2,024.00
Repair recurrent incisional or ventral hernia incarcerated or strangulated Repair recurrent incisional or ventral hernia; incarcerated or strangulated 49566 4,479.00 2,562.00
Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for 49568 1,280.00 805.00
Repair epigastric hernia (eg preperitoneal fat) reducible (separate procedure) Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure) 49570 1,985.00 1,329.00
Repair epigastric hernia (eg preperitoneal fat) incarcerated or strangulated Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated 49572 2,461.00 1,673.00
Repair umbilical hernia age 5 years or older reducible Repair umbilical hernia, age 5 years or older; reducible 49585 2,120.00 1,423.00
Repair umbilical hernia age 5 years or older incarcerated or strangulated Repair umbilical hernia, age 5 years or older; incarcerated or strangulated 49587 2,264.00 1,705.00
Repair spigelian hernia Repair spigelian hernia 49590 2,731.00 1,469.00
Laparoscopy surgical repair recurrent inguinal hernia Laparoscopy, surgical; repair recurrent inguinal hernia 49651 2,654.00 1,913.00
Laparoscopy surgical repair ventral umbilical hernia Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated 49653 4,429.00 2,822.00
Suture secondary of abdominal wall for evisceration or dehiscence Suture, secondary, of abdominal wall for evisceration or dehiscence 49900 3,886.00 2,048.00
Cystorrhaphy suture of bladder wound injury or rupture simple Cystorrhaphy, suture of bladder wound, injury or rupture; simple 51860 3,554.00 1,991.00
Ligation (percutaneous) of vas deferens unilateral or bilateral (separate procedure) Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure) 55450 1,731.00 1,246.00
Colpotomy with drainage of pelvic abscess Colpotomy; with drainage of pelvic abscess 57010 2,040.00 1,129.00
Colpocleisis (Le Fort type) Colpocleisis (Le Fort type) 57120 2,386.00 1,366.00
Insertion of mesh or other prosthesis for repair of pelvic floor defect each site vaginal approach Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) 57267 1,206.00 805.00
Sling operation for stress incontinence (eg fascia or synthetic) Sling operation for stress incontinence (eg, fascia or synthetic) 57288 3,371.00 2,001.00
Revision (including removal) of prosthetic vaginal graft vaginal approach Revision (including removal) of prosthetic vaginal graft; vaginal approach 57295 2,242.00 1,290.00
Irrigation Bladder, Simple Technical Charge Bladder irrigation, simple, lavage and/or instillation 51700 304.00 172.00
Acetabulum (hip socket) fracture(s) - closed treatment of; wo manipulation Charge Closed treatment of acetabulum (hip socket) fracture(s); without manipulation 27220 2,506.00 1,991.00
Malleolus fracture, posture - closed treatment of; without manipulation Charge Closed treatment of posterior malleolus fracture; without manipulation 27767 1,317.00 1,325.00
Foreskin manipulation including lysis of preputial adhesions and stretching Charge Foreskin manipulation including lysis of preputial adhesions and stretching 54450 230.00 238.00
Drainage of abscess, scrotal wall Charge Drainage of scrotal wall abscess 55100 1,016.00 789.00
MA Diag Rt. Diagnostic mammography, including computer-aided detection ( 77065 305.00
15002 Surgical preparation or creation of recipient site by excision of open wounds, first 100 sq cm Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; fir 15002 1,329.00 1,081.00
General 0.00
CT Chest +Abdomen w/ Cont Computed tomography, thorax; with contrast material(s) 71260 2,350.00
TRAY EPIDURAL 180.00
MECONIUM ASPIRATOR 37.00
C-SECTION PACK 524.00
Pooled Cryo AHF Thawed CRYOPRECIPITATE, EACH UNIT 520.00
Hepatitis B immune globulin (HBIg), human, for intramuscular use Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use 90746 203.00 203.00
DTaP-Hib-IPV Vaccine IM Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use 90698 137.00 137.00
Yes- PT Unattended Electrical Therapy Charge Application of a modality to 1 or more areas; electrical stimulation (unattended) ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE 97014 61.00
Yes- PT Mechanical Traction Charge Application of a modality to 1 or more areas; traction, mechanical 97012 61.00
Yes- PT Paraffin Bath Charge Application of a modality to 1 or more areas; paraffin bath 97018 42.00
Yes- OT Paraffin Bath Charge Application of a modality to 1 or more areas; paraffin bath 97018 42.00
Yes 159.00
Yes 284.00
Yes 321.00
Yes 198.00
Yes- Eval of Oral and Pharyngeal Swallowing Fx Chg Evaluation of oral and pharyngeal swallowing function 92610 275.00
Yes- Treatment of Swallowing Dysfunction Charge Treatment of swallowing dysfunction and/or oral function for feeding 92526 326.00
Yes 349.00
Yes- ST Tx of Speech/Lang/Voice/Comm/Auditory Chg Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 92507 299.00
Yes- ST Fluoro Eval of Swallow Function Chg Motion fluoroscopic evaluation of swallowing function by cine or video recording 92611 328.00
Prosthetic Charge Prosthetic training, upper and/or lower extremity(s), each 15 minutes 97761 131.00
Aquatic Therapy Charges Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises 97113 170.00
CT Fingers w/ + w/o Cont Rt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
MA Diag Lt. Diagnostic mammography, including computer-aided detection ( 77065 305.00
MA Breast Tissue Specimen. Radiological examination, surgical specimen 76098 28.00
Methotrexate sodium inj METHOTREXATE SODIUM, 50 MG 2.50 3.00
Dilation of urethral stricture by passage of filiform and follower, male initial Dilation of urethral stricture by passage of filiform and fo 53620 417.00
Dilation of urethral stricture by passage of sound, male initial Dilation of urethral stricture by passage of sound or urethral dilator, male; initial 53600 283.00 233.00
Removal/revision of cast Removal or bivalving; gauntlet, boot or body cast 29700 297.00 160.00
Repair of foot tendon Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon 28200 2,341.00 1,867.00
Windowing of cast Windowing of cast 29730 160.00 213.00
Repair of circumcision Repair incomplete circumcision 54163 844.00 845.00
Treat elbow fracture Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation 24620 2,590.00 1,191.00
Attendance at delivery Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn 99464 360.00 248.00
Closed Treatment of proximal humerus w/manip Charge Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation 27508 2,475.00 1,971.00
Treatment of tibia fracture Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction 27752 2,528.00 2,260.00
Office/OP New Visit Level 2 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examinatio Hospital outpatient clinic visit for assessment and management of a patient 99202 216.00 253.00 132.00
Office/OP New Visit Level 3 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low Hospital outpatient clinic visit for assessment and management of a patient 99203 327.00 370.00 195.00
Office/OP New Visit Level 4 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision maki Hospital outpatient clinic visit for assessment and management of a patient 99204 463.00 576.00 356.00
Office/OP Established Visit Level 2 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examina Hospital outpatient clinic visit for assessment and management of a patient 99212 125.00 76.00
Office/OP Established Visit Level 4 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical Hospital outpatient clinic visit for assessment and management of a patient 99214 303.00 356.00 203.00
Office/OP Established Visit Level 5 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination Hospital outpatient clinic visit for assessment and management of a patient 99215 408.00 504.00 307.00
ADL Training Charge Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adapti 97535 137.00
Office/OP Consult Level 5 - 99245 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Coun 99245 629.00 789.00 537.00
CPM Daily Treatment Charge Unlisted therapeutic procedure (specify) 97139 176.00
CPM Initial Fit Charge Unlisted therapeutic procedure (specify) 97139 226.00
Compression Bandage Application Charge 950.00
Whirlpool Full Body Charge Application of a modality to 1 or more areas; whirlpool 97022 92.00
Whirlpool Extremity Charge Application of a modality to 1 or more areas; whirlpool 97022 92.00
Acromioplasty Or Acromionectomy, Partial, With Or Without Coracoacromial Ligament Release Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release 23130 2,886.00 2,172.00
Repair Of Ruptured Musculotendinous Cuff (Eg, Rotator Cuff) Open; Acute Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute 23410 3,897.00 2,383.00
Coracoacromial Ligament Release Coracoacromial ligament release, with or without acromioplasty 23415 3,305.00 1,523.00
Reconstruction Of Complete Shoulder (Rotator) Cuff Avulsion, Chronic (Includes Acromioplasty) Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) 23420 4,597.00 3,149.00
Tenodesis Of Long Tendon Of Biceps Tenodesis of long tendon of biceps 23430 3,533.00 2,235.00
Arthroplasty, Glenohumeral Joint; Hemiarthroplasty Arthroplasty, glenohumeral joint; hemiarthroplasty 23470 5,709.00 2,952.00
Arthroplasty, Glenohumeral Joint; Total Shoulder (Glenoid And Proximal Humeral Replacement) Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) 23472 6,926.00 3,651.00
Open Treatment Of Clavicular Fracture, With Or Without Internal Or External Fixation Open treatment of clavicular fracture, includes internal fixation, when performed 23515 3,414.00 2,931.00
Open Treatment Of Greater Humeral Tuberosity Fracture, With Or Without Internal Or External Fixation Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; 23615 4,195.00 2,049.00
Manipulation Under Anesthesia, Shoulder Joint, Including Application Of Fixation Apparatus Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded) 23700 929.00 915.00
Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without Tendon Graft Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft 24342 3,675.00 2,418.00
Open Treatment Of Humeral Shaft Fracture With Plate/Screws, With Or Without Cerclage Open treatment of humeral shaft fracture with plate/screws, with or without cerclage 24515 4,157.00 2,276.00
Open Treatment Of Unla Shft Dxr W Int Fix Open treatment of ulnar shaft fracture, includes internal fixation, when performed 25545 2,948.00 1,798.00
Open Treatment Of Radius And Unla Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius OR ulna 25574 3,191.00 1,452.00
Open Treatment Of Radial & Ulnar Shaft Fractures, With Internal /External Fixation; Radius And Ulna Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna 25575 4,270.00 2,868.00
Percutaneous Skeletal Fixation Of Metacarpal Fracture, Each Bone Percutaneous skeletal fixation of metacarpal fracture, each bone 26608 2,244.00 1,773.00
Treatment of Intertrochanteric,Pertrochanteric,Subtrochanteric Femoral Fract, w/ implant Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage 27245 5,856.00 3,238.00
Excision, Prepatellar Bursa Excision, prepatellar bursa 27340 1,756.00 1,718.00
Suture Of Infrapatellar Tendon; Primary Suture of infrapatellar tendon; primary 27380 2,805.00 1,657.00
Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment Arthroplasty, knee, hinge prosthesis (eg, Walldius type) 27445 5,958.00 3,079.00
Open Treatment Of Femoral Shaft Fracture,w/ wo External Fix,w/ Insertion of Intramedullary Implant Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws 27506 6,361.00 3,398.00
Open Treatment Of Patellar Fracture, w/ Internal Fixation And/Or Partial Or Complete Patellectomy Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair 27524 3,566.00 2,020.00
Open Treatment Of Tibial Fracture, Proximal (Plateau); Bicondylar, With Or Without Internal Fixation Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation 27536 3,377.00
Repair, Primary, Open Or Percutaneous, Ruptured Achilles Tendon; Repair, primary, open or percutaneous, ruptured Achilles tendon; 27650 3,119.00 2,800.00
Open Treatment Of Medial Malleolus Fracture, With Or Without Internal Or External Fixation Open treatment of medial malleolus fracture, includes internal fixation, when performed 27766 2,884.00 2,233.00
Open Treatment Of Bimalleolar Ankle Fracture, With Or Without Internal Or External Fixation Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed 27814 3,658.00 2,128.00
Open Treatment Of Fracture Of Weight Bearing Articular Surface/Portion Of Distal Tibia Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only 27826 4,031.00 2,350.00
Treat Lower leg Fracture Tib and Fib Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula 27828 6,239.00 3,422.00
Open Treatment Of Metatarsal Fracture, With Or Without Internal Or External Fixation, Each Open treatment of metatarsal fracture, includes internal fixation, when performed, each 28485 2,568.00 2,242.00
Arthroscopy, Shoulder, Diagnostic, With Or Without Synovial Biopsy (Separate Procedure) Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) 29805 2,237.00 1,497.00
Arthroscopy, Shoulder, Surgical; Capsulorrhaphy Arthroscopy, shoulder, surgical; capsulorrhaphy 29806 5,046.00 4,206.00
Arthroscopy, Shoulder, Surgical; Repair Of Slap Lesion Arthroscopy, shoulder, surgical; repair of SLAP lesion 29807 4,921.00 4,093.00
Arthroscopy, Shoulder, Surgical; Synovectomy, Partial Arthroscopy, shoulder, surgical; with removal of loose body or foreign body 29819 2,778.00 2,828.00
Arthroscopy, Shoulder, Surgical; Synovectomy, Complete Arthroscopy, shoulder, surgical; synovectomy, complete 29821 2,767.00 2,667.00
Arthroscopy, Shoulder, Surgical; Debridement, Limited Arthroscopy, shoulder, surgical; debridement, limited 29822 2,688.00 1,890.00
Arthroscopy, Shoulder, Surgical; Debridement, Extensive Arthroscopy, shoulder, surgical; debridement, extensive 29823 2,932.00 2,490.00
Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articular Surface Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) 29824 3,160.00 2,569.00
Arthroscopy, Shoulder, Surgical; With Lysis And Resection Of Adhesions, With Or Without Manipulation Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation 29825 2,735.00 2,041.00
Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial Acromioplasty Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code fo 29826 1,295.00 1,009.00
Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair Arthroscopy, shoulder, surgical; with rotator cuff repair 29827 5,009.00 3,428.00
Arthroscopically Aided Treatment Of Intercondylar Spine(S) And/Or Tuberosity Fracture(S) Of The Knee Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy) 29850 2,878.00 1,365.00
Arthroscopy, Knee, Diagnostic, With Or Without Synovial Biopsy (Separate Procedure) Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) 29870 2,750.00 1,940.00
Arthroscopy, Knee, Surgical; With Lateral Release Arthroscopy, knee, surgical; with lateral release 29873 2,480.00 2,925.00
Arthroscopy, Knee, Surgical; Synovectomy, Limited (Eg Plica Or Shelf Resection) (Separate Procedure) Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) 29875 2,348.00 1,880.00
Arthroscopy, Knee, Surgical; Synovectomy, Major, Two Or More Compartments (Eg, Medial Or Lateral) Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral) 29876 3,122.00 2,713.00
Arthroscopy, Knee, Surgical; Debridement/Shaving Of Articular Cartilage (Chondroplasty) Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) 29877 2,949.00 2,479.00
Arthroscopy, Knee, Surgical; Abrasion Arthroplasty Or Multiple Drilling Or Microfracture Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture 29879 3,143.00 2,623.00
Arthroscopy, Knee, Surgical; W/ Meniscectomy-Medial & Lateral, Any Meniscal Shaving Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment( 29880 2,668.00 2,638.00
Arthroscopy, Knee, Surgical; With Meniscus Repair (Medial Or Lateral) Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 29882 3,331.00 4,064.00
Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation Or Reconstruction Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 29888 4,683.00 4,116.00
Treat fracture rad extra-articul Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation 25607 3,478.00 2,874.00
Treat fracture rad intra-articul Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments 25608 3,903.00 3,249.00
Treat fracture radial 3+ frag Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments 25609 4,964.00 3,451.00
TENS Setup Charge Application of surface (transcutaneous) neurostimulator 64550 36.00
Sensory Stimulation Charge Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes 97533 115.00
Yes Application of a modality to 1 or more areas; contrast baths, each 15 minutes 97034 0.00
Yes- PT Apply Hot or Cold Pack Charge Application of a modality to 1 or more areas; hot or cold packs 97010 0.00
H1N1 DRUG IM 36.00 36.00
Debridement of skin for necrotizing soft tissue infection Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum 11004 1,782.00
Biopsy, Bone, Excisional; Superficial (Eg, Ilium, Sternum, Spinous Process) Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx) 20240 728.00 599.00
Arthrotomy, Elbow, Incl Exploration, Drainage, Or Removal Of Foreign Body Arthrotomy, elbow, including exploration, drainage, or removal of foreign body 24000 2,260.00 1,003.00
Salicylate Level Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), 80307 223.00
Excision, tumor or vascular malformation, hand or finger; subcutaneous. Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cm 26115 2,278.00 1,571.00
Biopsy, soft tissue of thigh or knee area; superficial Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) 27324 1,885.00 1,366.00
Fasciotomy, foot and/or toe Fasciotomy, foot and/or toe 28008 2,061.00 1,394.00
Arthrotomy, w exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint 28022 2,312.00 1,349.00
Excision of lesion of tendon or fibrous sheath or capsule (cyst or ganglion); foot. Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot 28090 2,246.00 613.00
Neuroplasty and/or transposition; ulnar nerve at wrist Neuroplasty and/or transposition; ulnar nerve at wrist 64719 1,894.00 1,365.00
Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia 69433 762.00 544.00
Urography, Retrograde, With Or Without Kub Urography, retrograde, with or without KUB 74420 954.00 92.00
Ultrasound, Transvaginal Ultrasound, transvaginal 76830 379.00 163.00
T4, Total Thyroxine; total 84436 86.00
Pure Tone Audiometry (Threshold); Air Only Tympanometry (impedance testing) 92567 58.00 34.00
CT Elbow w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Elbow w/ + w/o Cont Rt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Elbow w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Elbow w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
MRA Abdomen w/ + w/o Cont Magnetic resonance angiography, abdomen, with or without contrast material(s) 74185 3,281.00
NM Sentinel Node Inj Only Injection procedure; radioactive tracer for identification of sentinel node 38792 1,542.00
NM Hepa Duct System w/ Pharm Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed 78227 4,731.00
NM Hepa Duct System w/o Pharm Hepatobiliary system imaging, including gallbladder when present; 78226 3,445.00
Report Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretati 93016 98.00 74.00
US Pregnant Detailed Ea Addl Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separ 76812 821.00
XR Chest Special Views Decubitus Lt 346.00
XR Shoulder Comp Min 2 Views Lt Radiologic examination, shoulder; complete, minimum of 2 views 73030 282.00
XR Shoulder Comp Min 2 Views Rt Radiologic examination, shoulder; complete, minimum of 2 views 73030 282.00
Venipuncture Collection of venous blood by venipuncture 36415 21.00 21.00
Hematocrit POC Blood count; hematocrit (Hct) 85014 12.00 12.00
CT Femur w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Femur w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Femur w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Femur w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Femur w/o Cont Lt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Femur w/o Cont Rt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Forearm w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Forearm w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Forearm w/o Cont Lt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Forearm w/o Cont Rt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Hand w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Hand w/ + w/o Cont Rt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Hand w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Hand w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Hand w/o Cont Lt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Hand w/o Cont Rt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Humerus w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Humerus w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Humerus w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Humerus w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Humerus w/o Cont Lt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Humerus w/o Cont Rt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Shoulder w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Shoulder w/ + w/o Cont Rt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Shoulder w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Shoulder w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Tibia/Fibula w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Tibia/Fibula w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Tibia/Fibula w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Tibia/Fibula w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Tibia/Fibula w/o Cont Lt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Tibia/Fibula w/o Cont Rt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Wrist w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Wrist w/ + w/o Cont Rt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Wrist w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Wrist w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
MA Breast Ndl Loc Placement Lt. Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation 77021 1,056.00
MA Breast Ndl Loc Placement Rt. Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation 77021 1,056.00
MRA UE w/ Cont Rt Magnetic resonance angiography, upper extremity, with or without contrast material(s) 73225 3,334.00
Negative pressure wound therapy (e.g., vacuum-assisted drainage collection)<50 sq cm Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoin 97605 137.00 117.00
Negative pressure wound therapy (e.g., vacuum-assisted drainage collection)>50 sq cm Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoin 97606 228.00 129.00
200 - INTENSIVE CARE 0.00
022 - SNF PPS (RUG) 0.00
253 - DRUGS/TAKEHOME 0.00
254 - DRUGS/INCIDENT ODX 0.00
273 - TAKEHOME SUPPLY 0.00
321 - DX X-RAY/ANGIO 0.00
340 - NUCLEAR MEDICINE 0.00
341 - NUC MED/DX 0.00
342 - NUC MED/RX 0.00
380 - BLOOD 0.00
382 - BLOOD/WHOLE 0.00
383 - BLOOD/PLASMA 0.00
384 - BLOOD/PLATELETS 0.00
400 - IMAGE SERVICE 0.00
412 - INHALATION SVC 0.00
422 - PHYS THERP/HOUR 0.00
431 - OCCUP THERP/VISIT 0.00
432 - OCCUP THERP/HOUR 0.00
441 - SPEECH PATH/VISIT 0.00
442 - SPEECH/PATH/HOUR 0.00
483 - ECHOCARDIOLOGY 0.00
750 - GASTR-INTS SVS 0.00
964 - PRO FEE/ANES CRNA 0.00
986 - PRO FEE/EEG 0.00
987 - PRO FEE/HOS VIS 0.00
988 - PRO FEE/CONSULT 0.00
US Breast Biopsy Lt. Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 195.00
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Eg, Altered Anatomy, Fractured Cath Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon) 51703 465.00 366.00
Electromyography Studies (Emg) Of Anal Or Urethral Sphincter, Other Than Needle, Any Technique Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique 51784 445.00 236.00
Voiding Pressure Studies(Vp);Intra-Abdominal Voiding Pressure (Ap) (Rectal,Gastric,Intraperitoneal) Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure) 51797 477.00 191.00
Cystourethroscopy With Irrigation And Evacuation Of Multiple Obstructing Clots Cystourethroscopy with irrigation and evacuation of multiple obstructing clots 52001 1,238.00 1,212.00
Cystourethroscopy, With Biopsy Cystourethroscopy, with biopsy(s) 52204 1,423.00 1,006.00
Cystourethroscopy, With Fulguration Or Treatment Of Minor (Less Than 0.5 Cm) Lesion(S) W/ Or W/o Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy 52224 2,499.00 1,832.00
Cystourethroscopy, With Fulguration And/Or Resection Of; Small Bladder Tumor(S) (0.5 To 2.0 Cm) Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm) 52234 1,034.00 1,005.00
Cystourethroscopy, With Fulguration And/Or Resection Of; Medium Bladder Tumor(S) (2.0 To 5.0 Cm) Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm) 52235 1,380.00 1,104.00
Cystourethroscopy, With Fulguration And/Or Resection Of; Large Bladder Tumor(S) Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s) 52240 1,873.00 1,270.00
Cystourethroscopy With Direct Vision Internal Urethrotomy Cystourethroscopy with direct vision internal urethrotomy 52276 1,265.00 1,029.00
Cystourethroscopy,w/ Calibration And/Or Dilation of Urethral Stricture or Stenosis,w/ w/o Meatotomy Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female 52281 945.00 985.00
Cystourethroscopy, With Removal Of Foreign Body, Calculus, Or Ureteral Stent From Urethra Or Bladder Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple 52310 859.00 960.00
Litholapaxy: Crushing Or Fragmentation Of Calculus, Removal Of Fragments Simple Or Small Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm) 52317 2,334.00 1,660.00
Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (Eg, Gibbons Or Double-J Type) Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 52332 1,460.00 1,111.00
Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; Diagnostic Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic 52351 1,447.00 1,049.00
Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Removal Or Manipulation Of Calculus Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision) 52342 1,478.00 965.00
Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Lithotripsy Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) 52353 1,873.00 1,238.00
Transurethral Resection Of Bladder Neck (Separate Procedure) Transurethral resection of bladder neck (separate procedure) 52500 2,323.00 1,359.00
Transurethral Electrosurgical Resection Prostate, Inc Control Of Postoperative Bleeding, Complete Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal 52601 4,031.00 2,518.00
Transurethral Resection; Of Regrowth Of Obstructive Tissue Longer Than One Year Postoperative Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/o 52630 1,906.00 1,337.00
Contact Laser Vaporization W W/O Transurethral Resection Prostate,control Postoperative Bleeding Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transure 52648 8,607.00 3,287.00
Orchiectomy, Simple, W/ W/O Testicular Prosthesis, Scrotal Or Inguinal Approach Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach 54520 1,555.00 1,082.00
Orchiectomy, Radical, For Tumor; Inguinal Approach Orchiectomy, radical, for tumor; inguinal approach 54530 2,406.00 1,548.00
Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach Biopsy, prostate; needle or punch, single or multiple, any approach 55700 732.00 864.00
Subsequent observation care, per day Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded pr 99225 229.00
Change stent via transureth Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation 50385 5,062.00 1,049.00
Biopsy, Muscle; Superficial Biopsy, muscle; superficial 20200 974.00 519.00
Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater 21012 1,172.00 1,154.00
Claviculectomy; Partial Claviculectomy; partial 23120 2,765.00 1,826.00
Partial Excision (Craterization, Saucerization, Or Diaphysectomy) Bone (Eg, Osteomyelitis), Clavicle Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle 23180 3,135.00 1,483.00
Incision And Drainage, Upper Arm Or Elbow Area; Deep Abscess Or Hematoma Incision and drainage, upper arm or elbow area; deep abscess or hematoma 23930 1,669.00 1,026.00
Treatment Of Humeral Shaft Fracture, With Insertion Of Intramedullary Implant Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws 24516 4,077.00 2,044.00
Open Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed 24575 3,476.00 1,602.00
Tendon Sheath Incision (Eg, For Trigger Finger) Proc Charge Tendon sheath incision (eg, for trigger finger) 26055 2,058.00 1,609.00
Arthrotomy, Knee, With Exploration, Drainage, Or Removal Of Foreign Body (Eg, Infection) Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection) 27310 3,463.00 2,033.00
Excision Of Lesion Of Meniscus Or Capsule (Eg, Cyst, Ganglion), Knee Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee 27347 2,501.00 1,467.00
Osteochondral allograft, knee, open Osteochondral allograft, knee, open 27415 6,537.00 3,300.00
Decompression Fasciotomy, Leg; Anterior And/Or Lateral, And Posterior Compartment(S) Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s) 27602 2,328.00 1,290.00
Incision And Drainage, Leg Or Ankle; Deep Abscess Or Hematoma Incision and drainage, leg or ankle; deep abscess or hematoma 27603 2,492.00 1,784.00
Open Treatment Of Trimalleolar Ankle Fracture, Medial And/Or Lateral Malleolus Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip 27823 4,616.00 2,854.00
Arthrodesis, Ankle, Open Arthrodesis, ankle, open 27870 2,076.00
Hallux Rigidus Correction W Cheilectomy, Debridement/Capsular Release, First Metatarsophalangeal Jnt Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant 28289 3,561.00 2,208.00
Arthroscopy, Knee, Surgical; For Infection, Lavage And Drainage Arthroscopy, knee, surgical; for infection, lavage and drainage 29871 2,442.00 1,560.00
Arthroscopy, Knee, Surgical; For Removal Of Loose Body Or Foreign Body Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) 29874 2,549.00 1,839.00
Cystostomy, Cystotomy With Drainage Cystostomy, cystotomy with drainage 51040 1,378.00 885.00
Cystourethroscopy, W Ureteral Catheterization, W Wo Irrigation, Instillation, Or Ureteropyelography Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; 52005 903.00 818.00
Slitting Of Prepuce, Dorsal Or Lateral (Separate Procedure); Except Newborn Slitting of prepuce, dorsal or lateral (separate procedure); except newborn 54001 662.00 660.00
Biopsy Of Penis (Separate Procedure) Biopsy of penis; (separate procedure) 54100 593.00 601.00
55060 Repair Of Tunica Vaginalis Hydrocele (Bottle Type) Repair of tunica vaginalis hydrocele (Bottle type) 55060 1,814.00 1,220.00
Excision Of Lesion Of Spermatic Cord (Separate Procedure) Excision of lesion of spermatic cord (separate procedure) 55520 1,196.00
Colpotomy; With Exploration Colpotomy; with exploration 57000 866.00 498.00
Excision Of Vaginal Septum Excision of vaginal septum 57130 828.00 744.00
Paravaginal defectrepair (including repair of cystocele) Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach 57285 3,160.00 1,914.00
Closure Of Rectovaginal Fistula; Vaginal Or Transanal Approach Closure of rectovaginal fistula; vaginal or transanal approach 57300 2,655.00 1,437.00
Trachelorrhaphy, Plastic Repair Of Uterine Cervix, Vaginal Approach Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach 57720 1,442.00 761.00
Vaginal Hysterectomy, Uterus 250 Grams Or Less; W/ Removal Of Tube(S), And/Or Ovary(S) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele 58263 4,635.00 2,843.00
Endometrial cryoablation with ultrasonic guidance, including endometrial curettage Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed 58356 8,778.00 1,620.00
Debridement, subcutaneous tissue (incl epidermis and dermis); ea adtl 20 sqcm Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 11045 160.00 126.00
Removal Of Sutures Under Anesthesia (Other Than Local), Other Surgeon Removal of sutures under anesthesia (other than local), other surgeon 15851 180.00 216.00
Repair Blood Vessel, Direct; Neck Repair blood vessel, direct; neck 35201 4,557.00 2,793.00
Exploration For Postoperative Hemorrhage, Thrombosis Or Infection; Neck Exploration for postoperative hemorrhage, thrombosis or infection; neck 35800 3,440.00 1,980.00
Catheterization Of Umbilical Vein For Diagnosis Or Therapy, Newborn Catheterization of umbilical vein for diagnosis or therapy, newborn 36510 408.00 267.00
Splenectomy; Total (Separate Procedure) Splenectomy; total (separate procedure) 38100 2,633.00
Upper GI Endoscopy, Simple Primary Exam (Eg, With Small Diameter Flexible Endoscope) Upper GI Endoscopy, Simple Primary Exam (Eg, With Small Diam 43234 764.00 764.00
Upper GI Endoscopy Including Esophagus, Stomach,Duodenum And/Or Jejunum; With Removal Of Tumor(S), Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 43251 2,063.00 992.00
Gastrectomy, Partial, Distal; With Gastroduodenostomy Gastrectomy, partial, distal; with gastroduodenostomy 43631 4,044.00
Excision Of Meckel'S Diverticulum (Diverticulectomy) Or Omphalomesenteric Duct Excision of Meckel's diverticulum (diverticulectomy) or omph 44800 1,988.00
Anoscopy; With Dilation (Eg, Balloon, Guide Wire, Bougie) Anoscopy; with dilation (eg, balloon, guide wire, bougie) 46604 139.00
Unlisted Laparoscopic Procedure, Liver Unlisted laparoscopic procedure, liver 47379 2,099.00 3,557.00
Exploration, Retroperitoneal Area With Or Without Biopsy(S) (Separate Procedure) Exploration, retroperitoneal area with or without biopsy(s) (separate procedure) 49010 4,465.00 2,650.00
Nephrectomy, Including Partial Ureterectomy, Any Open Approach Including Rib Resection; Nephrectomy, including partial ureterectomy, any open approach including rib resection; 50220 4,989.00 3,082.00
Parathyroidectomy Or Exploration Of Parathyroid(S); Parathyroidectomy or exploration of parathyroid(s); 60500 2,101.00
Vaginal Delivery Only, After Previous Cesarean Delivery (With Or Without Episiotomy And/Or Forceps); Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); 59612 4,391.00 2,655.00
Induced Abortion, By 1+ Vaginal Suppositories W W/O Cervical Dilation, Inc Hosp Admission & Visits Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; 59855 1,982.00 1,061.00
Uterine Evacuation And Curettage For Hydatidiform Mole Uterine evacuation and curettage for hydatidiform mole 59870 2,247.00 1,084.00
Prolonged Eval And Mgmt Service Before And/Or After Direct Patient Care; Each Additional 30 Minutes Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service) 99359 251.00 251.00 165.00
Subsequent observation care, per day, for the evaluation and management of a patient,w/ 2 key Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examinatio 99224 186.00 186.00 125.00
Smoking and tobacco-use cessation counseling visit 10 min Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99406 43.00 48.00
Phone E&M by Physician 5 to 10 minutes of medical discussion Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or 99441 51.00 47.00
Phone E&M by Physician 11 to 20 minutes of medical discussion Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or 99442 91.00 86.00
Phone E&M by Physician 11 to 20 minutes of medical discussion Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or 99442 91.00 86.00
Phone E&M by Physician 21 to 31 minutes of medical discussion Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or 99443 121.00 117.00
Yes Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85027 50.00
No Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85025 98.00 39.00
Yes Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, 81001 41.00
UA w/Micro, Auto Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, 81001 41.00
No Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, 81003 41.00
No Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, 81003 41.00
CT Guide Drain Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and int 75989 1,280.00
MRI Hand w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Hand w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Hand w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
MRI Hand w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
MRI Hip w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73720 3,306.00
MRI Hip w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73720 3,306.00
MRI Hip w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 73718 2,493.00
MRI Hip w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 73718 2,493.00
MRI Humerus w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Humerus w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Humerus w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
MRI Humerus w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
MRI Knee w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences 73723 3,803.00
MRI Knee w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences 73723 3,803.00
MRI Shoulder w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences 73223 3,780.00
MRI Shoulder w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences 73223 3,780.00
MRI Shoulder w/o Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 73221 2,027.00
MRI Shoulder w/o Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 73221 2,027.00
MRI Tibia/Fibula w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73720 3,306.00
MRI Tibia/Fibula w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73720 3,306.00
MRI Tibia/Fibula w/o Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 73718 2,493.00
MRI Tibia/Fibula w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 73718 2,493.00
US Kidney Transplant Lt Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation 76776 858.00
US Kidney Transplant Rt Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation 76776 858.00
XR AC Joints w/ or w/o Weights Bil Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction 73050 551.00
XR Bone Survey Comp Radiologic examination, osseous survey; complete (axial and appendicular skeleton) 77075 889.00
XR Bone Survey Ltd Mets Radiologic examination, osseous survey; limited (eg, for metastases) 77074 612.00
XR Cystography Min 3 Views Cystography, minimum of 3 views, radiological supervision and interpretation 74430 314.00
XR Urethrocystography Voiding Urethrocystography, voiding, radiological supervision and interpretation 74455 969.00
XR IVP Urography (pyelography), intravenous, with or without KUB, with or without tomography 74400 1,260.00
XR Pelvis 1 View Radiologic examination, pelvis; 1 or 2 views 72170 271.00
XR SB Series Radiologic examination, small intestine, includes multiple serial images; 74250 1,191.00
XR Venography UE Lt 763.00
XR Venography UE Rt
Repair, complex, trunk; 2.6-7.5 cm Technical Charge Repair, complex, trunk; 2.6 cm to 7.5 cm 13101 1,146.00 1,138.00
Arthrocentesis, aspiration and or injection; intermediate joint or bursa Technical Charge Arthrocentesis, aspiration and/or injection, intermediate jo 20605 168.00
Arthrocentesis, aspiration and or injection; major joint or bursa Technical Charge Arthrocentesis, aspiration and/or injection, major joint or 20610 207.00
Replace Porta-Cath Technical Charge Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access 36582 4,725.00 1,396.00
Hernia Repair Inguinal Child Technical Charge Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible 49500 1,878.00 964.00
Hernia Repair Ventral Incisional, recurrent Technical Charge Repair recurrent incisional or ventral hernia; reducible 49565 3,666.00 2,041.00
Colposcopy of the entire vagina, with cervix if present; with biopsy(s) Technical Charge Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix 57421 568.00 587.00
Laparoscopy, surgical; with occlusion of oviducts by device Technical Charge Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) 58671 1,703.00 975.00
Upper GI endoscopy; w balloon dilation of esophagus less than 30 MM Technical Charge Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 43249 4,756.00 1,220.00
Colorectal cancer screening; colonoscopy on indiv meeting criteria for high risk Technical Charge COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK 1,480.00 894.00
Upper GI endoscopy w removal of tumor(s),polyp(s),/other lesion(s) by hot biopsy forceps Tech Chg Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 43250 1,861.00 825.00
Closure of enterostomy, large or small intestine;w resection and colorectal anastomosis Tech Chg Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure) 44626 7,673.00 4,604.00
Colorectal cancer screening; colonoscopy on indiv not meeting criteria for high risk Tech Chg COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK 1,483.00 898.00
129 - ROOM-BOARD/SBI 0.00
311 - CYTOLOGY 0.00
359 - CT SCAN/OTHER 0.00
Bill Antibody Screen Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test 86902 192.00
Bill Immunohisto Ea Ab IHC 88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 88342 343.00
Orthotic Mgmt and Training Charges Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes 97760 190.00
Esophagogastroduodenoscopy Charge Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 43235 710.00 731.00
Hernia Repair Inguinal Charge Laparoscopy, surgical; repair initial inguinal hernia 49650 2,041.00 2,385.00
Mastectomy Charge Mastectomy, simple, complete 19303 2,745.00
US LE Veins Duplex Lt Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study 93926 931.00
US LE Veins Duplex Rt Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 93971 717.00
HyAlgan Injection HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTICULAR INJECTION, PER DOSE 291.00 291.00
XR Esophagus Radiologic examination; esophagus 74220 678.00
Orthovisc inj per dose HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE 257.00
Cast Supplies, Long Arm Cast, Adult (11 Years +), Plaster CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), PLASTER 46.00 0.00
Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Plaster CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER 20.00 0.00
Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Fiberglass CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS 31.00 0.00
Cast Supplies, Short Arm Cast, Adult (11 Years +), Plaster CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), PLASTER 24.00 0.00
Cast Supplies, Short Arm Cast, Adult (11 Years +), Fiberglass CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), FIBERGLASS 46.00 46.00
Cast Supplies, Short Arm Cast, Pediatric (0-10 Years), Plaster CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER 19.00 0.00
Cast Supplies, Short Arm Cast, Pediatric (0-10 Years), Fiberglass CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS 24.00 0.00
Cast Supplies, Short Leg Cast, Adult (11 Years +), Fiberglass CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS 71.00 0.00
Cast Supplies, Short Leg Cast, Pediatric (0-10 Years), Fiberglass CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS 46.00 0.00
Influenza A H1N1,admin w cou 36.00 36.00
ANASCOPE DISPOSABLE 5.00
Basic Metabolic Panel 3 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium 80048 106.00 42.00
REF Antibody ID Antibody identification, RBC antibodies, each panel for each serum technique 86870 256.00
Carboxy Hgb Carboxyhemoglobin; quantitative 82375 155.00
D Control Blood typing, serologic; Rh (D) 86901 38.00
Pregnancy Test Urine Urine pregnancy test, by visual color comparison methods 81025 80.00 32.00
MRI Brachial Plexus w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
US Pregnant > 14 Weeks 1st Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation 76805 663.00
US Pregnant Detailed 1st Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation 76811 604.00
MASK OXYGEN PEDIATRIC 9.00
Oxygen Hours 25.00
ABO/Rh Interp Blood typing, serologic; ABO 86900 38.00
Crossmatch AHG Interp Compatibility test each unit; antiglobulin technique 86922 192.00
Microalb/Creat Ratio Creatinine; other source 82570 72.00
Rheumatoid Factor1 Rheumatoid factor; qualitative 86430 71.00
Anti-D Blood typing, serologic; Rh (D) 86901 38.00
Cord ABO/Rh Interp Blood typing, serologic; ABO 86900 38.00
Miscellaneous Charge Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echo 93306 2,454.00
CT Angio UE Bil Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing 73206 4,514.00
CT Aspiration Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation 77012 1,384.00
MA Ductogram or Galactogram Mult Bil. Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation 77054 177.00
MA Ductogram or Galactogram Single Lt. Mammary ductogram or galactogram, single duct, radiological supervision and interpretation 77053 131.00
MA Ductogram or Galactogram Single Rt. Mammary ductogram or galactogram, single duct, radiological supervision and interpretation 77053 131.00
US Breast Biopsy Rt. Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 195.00
US Breast Biopsy Lt Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 195.00
US Breast Biopsy Rt Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 195.00
XR Chest 1 View Discount Radiologic examination, chest; single view 71045 196.00
Computer XM Interp Compatibility test each unit; electronic 86923 207.00
LARYNGOSCOPY (FLEXIBLE) Charge Laryngoscopy, flexible; diagnostic 31575 189.00
.GTT-4 Hr Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure) 82952 49.00
.GTT-5 Hr Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure) 82952 49.00
Complete Blood Count with Manual Diff Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85027 50.00
Computer XM OK Compatibility test each unit; antiglobulin technique 86922 238.00
X-Match AHG Tube Interp Compatibility test each unit; antiglobulin technique 86922 204.00
Compatible Compatibility test each unit; antiglobulin technique 86922 238.00
Excise Tumor Soft Tissue Back/ Flank >3 Cm Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater 21931 1,633.00 1,656.00
Exc Shoulder Tum Deep >5Cm Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater 23073 3,301.00 1,884.00
Exc Shoulder Area Les Sf <5Cm Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm 23076 2,561.00 1,756.00
Lap Inc Hernia Repair Recur Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible 49656 2,488.00
Vaginal Hysterectomy, for uterus 250g or less Vaginal hysterectomy, for uterus 250 g or less; 58260 3,871.00 2,335.00
Pinworm Prep Pinworm exam (eg, cellophane tape prep) 87172 54.00
Reducing Substance Urinalysis; qualitative or semiquantitative, except immunoassays 81005 27.00
Layer Closure of Wounds of Neck, Hands, Feet and/or Ext Genitalia; 2.5 cm or Less Charge Tech Chg Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less 12041 673.00 687.00
MRI Hand w/ Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73219 3,371.00
MRI Hand w/ Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73219 3,371.00
MRI Hip w/ Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73719 3,386.00
MRI Hip w/ Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73719 3,386.00
MRI Humerus w/ Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73219 3,371.00
MRI Humerus w/ Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73219 3,371.00
MRI Shoulder w/ Cont Lt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 73222 3,109.00
MRI Shoulder w/ Cont Rt Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 73222 3,109.00
MRI Tibia/Fibula w/ Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73719 3,386.00
MRI Tibia/Fibula w/ Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73719 3,386.00
XR Spine Thoracic Myelography Myelography, thoracic, radiological supervision and interpretation 72255 762.00
XR Ribs Min 4 Views Bil w/ PA Chest Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views 71111 687.00
XR Shuntogram Non-Vascular Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation 75809 1,122.00
Ear Lavage Tech Chg Removal impacted cerumen requiring instrumentation, unilateral 69210 161.00 104.00
Wound Debridement Less than 20 cm Tech Chg Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, d 97597 189.00 121.00
Office/OP New Visit Level 5 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision maki Hospital outpatient clinic visit for assessment and management of a patient 99205 583.00 744.00 478.00
Plasma Thawed CPD FRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH UNIT 176.00
Legionella Pneumophila Antigen, Urine ARUP Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquanti 87449 107.00
HSV 2 Glycoprotein G Ab, IgG ARUP Antibody; herpes simplex, type 2 86696 93.00
HSV 1 Glycoprotein G Ab, IgG ARUP Antibody; herpes simplex, type 1 86695 93.00
Incompatible Compatibility test each unit; antiglobulin technique 86922 238.00
X-MATCH COMPUTER Compatibility test each unit; antiglobulin technique 86922 238.00
Esophagogastroduodenoscopy with Biopsy 1,404.00
Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-I Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use 90696 136.00 136.00
Vision Acuity Screening Screening test of visual acuity, quantitative, bilateral 99173 0.00 0.00
Non-Medicare Pap Collection SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVEYANCE OF CERVICAL OR VAGINAL SMEAR TO LABORATORY 210.00 92.00
XR Facet Injection Injection(s), diagnostic or therapeutic agent, paravertebral 64493 429.00
US Echo Congenital Cardiac Anomaly Comp Transthoracic echocardiography for congenital cardiac anomalies; complete 93303 1,318.00
US Echo Congenital Cardiac Anomaly Ltd Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study 93304 855.00
OxS Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) 87184 87.00
Acetone Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative 82010 103.00
Excision of Spermatocele Excision of spermatocele, with or without epididymectomy 54840 1,530.00 1,890.00
ECHO 2D LTD- PRO FEE Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in 93321 153.00
Report Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study 93308 365.00 126.00
EKG RT Charge Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 93005 264.00 1.00
Sputum Induction - RT Charge Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, 94640 210.00
Mini-Neb Initial Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, 94640 210.00
Mini-Neb Subsequent Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, 94640 146.00
PEP Therapy Initial Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation 94667 298.00
PEP Therapy Subsequent Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent 94668 327.00
Ventilator Services Initial Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day 94002 2,157.00
XR Fluoro Guide Therapeutic Inj Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 77002 766.00
XR Drain Abscess or Cyst Injection procedure for hip arthrography; with anesthesia 27095 581.00
Remv Non-biodegradable Rx Del Removal, non-biodegradable drug delivery implant 11982 751.00 479.00
Full Thick Gft Chin/ax/ft; 20 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 15240 2,566.00 2,797.00
Tenotomy Debridement Of Bone And Tissue Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment 24359 3,122.00 2,470.00
Part Exc Bone; Dist Phalanx-fi Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger 26236 2,081.00 1,466.00
I&d Pelvis/hip Jt; Deep Absces Incision and drainage, pelvis or hip joint area; deep abscess or hematoma 26990 2,967.00 1,757.00
Revis Tot Knee Arthroplas; Fem Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 27487 8,370.00 4,473.00
Manip Knee Jt Under Gen Anes Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) 27570 714.00 985.00
Unlisted Proc Femur/knee Unlisted procedure, femur or knee 27599 1,343.00 0.00
Repr Prim Op Rupt Achilles; W/ Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft) 27652 3,246.00 1,779.00
Repr Secnd Disrupt Lig Ank Col Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) 27698 3,038.00 1,833.00
Heel/finger Stick PKU Collection of capillary blood specimen (eg, finger, heel, ear stick) 36416 20.00 0.00
Esophagoscopy; Dx (separt Proc Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 43200 525.00 629.00
Esophagoscopy; W/remov Fb Esophagoscopy, flexible, transoral; with removal of foreign body(s) 43215 1,688.00 686.00
Omental Flap Omental flap, intra-abdominal (List separately in addition to code for primary procedure) 49905 1,693.00 1,079.00
Remov/revis Stress Incont Slin Removal or revision of sling for stress incontinence (eg, fascia or synthetic) 57287 3,208.00 1,840.00
Needle Emg; 1 Extrem W/wo Para Needle electromyography; 1 extremity with or without related paraspinal areas 95860 339.00 201.00
Needle Emg; 2 Extrem W/wo Para Needle electromyography; 2 extremities with or without related paraspinal areas 95861 501.00 389.00
Cast sup gauntlet plaster CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS +), PLASTER 37.00 0.00
Cast sup gauntlet fiberglass CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS +), FIBERGLASS 45.00 0.00
Cast sup shrt leg plaster CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER 53.00 0.00
Cast sup shrt leg ped plster CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER 26.00 0.00
US Pregnant Detailed Ea Addl Gest Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separ 76812 821.00
Oxacillin Screen Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) 87184 87.00
635 - DRUG/EPO>10,000 UNITS 0.00
155 - HOSPICE/WARD 0.00
Whirlpool Full Body Charge Application of a modality to 1 or more areas; whirlpool 97022 92.00
Sigmoidoscopy w/ Decompres of Volvulus Sigmoidoscopy, flexible; with decompression (for pathologic 45337 283.00
PEG TUBE KIT 714.00
Vancomycin Peak 1 Vancomycin 80202 170.00
AMNISURE ROM TEST 325.00
Scrotal exploration CHARGE Scrotal exploration 55110 1,848.00 1,044.00
INCISION AND DRAINAGE COMPLEX POST OP WOUND INFECTION CHARGE Incision and drainage, complex, postoperative wound infectio 10180 1,154.00
MONITORING OF INTERSTITIAL FLUID PRESSURE IN DETECTION OF MUSCLE COMPARTMENT SYNDROME CHARGE Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique, needle manometer technique) in detection of muscle compartment syndrome 20950 316.00
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION (THUMB) WITH MANIPULATION CHARGE Closed treatment of carpometacarpal dislocation, thumb, with 26641 1,369.00
CLOSED TREATMENT OF ANKLE DISLOCATION REQUIRING ANESTHESIA CHARGE Closed treatment of ankle dislocation; requiring anesthesia, 27842 1,790.00
NASO OR ORO-GASTRIC TUBE PLACEMENT REQUIRING PHYSICIAN SKILL AND FLUOROSCOPIC GUIDANCE CHARGE Naso- or oro-gastric tube placement, requiring physician's s 43752 80.00
INCISION OF THROMBOSED EXTERNAL HEMORRHOID CHARGE Incision of thrombosed hemorrhoid, external 46083 382.00
FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING CHARGE Foreskin manipulation including lysis of preputial adhesions and stretching 54450 230.00 238.00
Biofeedback Biofeedback training by any modality 90901 77.00
Colonoscopy Diag By Brush/Wash Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 45378 1,255.00 944.00
Foot examination Foot examination performed (includes examination through vis 0.00
140 - ROOM-BOARD/PVT/DLX 0.00
252 - DRUGS/NONGENERIC 0.00
456 - URGENT CARE 0.00
21 - RURAL/CLINIC 0.00
521 - RURAL/CLINIC 0.00
681 - LEVEL 1 TRAUMA TEAM ACTIV 0.00
943 - CARDIAC REHAB 0.00
999 - PT CONVENCE/OTH 0.00
Yes- OT Unattended Electrical Therapy Charge Application of a modality to 1 or more areas; electrical stimulation (unattended) ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE 97014 61.00
Work Reconditioning Initial Charge Work hardening/conditioning; initial 2 hours 97545 380.00
RT CO2 Monitor, Single Charge Carbon dioxide, expired gas determination by infrared analyzer 94770 86.00
Functional Capacity Eval Charge Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes 97750 64.00
Splint/Equipment Charge Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes 97760 150.00
RT Pulmonary Rehab Charge PULMONARY REHABILITATION, INCLUDING EXERCISE (INCLUDES MONITORING), ONE HOUR, PER SESSION, UP TO TWO SESSIONS PER DAY 244.00
Standardized Cognitive Eval Charge Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the pati 96125 463.00
NM Myocard Perf Spect Single Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantifica 78451 3,212.00
Yes Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 92507 299.00
Yes Motion fluoroscopic evaluation of swallowing function by cine or video recording 92611 328.00
Yes Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech 92597 273.00
Yes Evaluation of oral and pharyngeal swallowing function 92610 275.00
Compatible Compatibility test each unit; antiglobulin technique 86922 238.00
Incompatible Compatibility test each unit; antiglobulin technique 86922 238.00
Incompatible Compatibility test each unit; antiglobulin technique 86922 238.00
Compatible Compatibility test each unit; antiglobulin technique 86922 238.00
Pulse Oximetry Single Determination Noninvasive ear or pulse oximetry for oxygen saturation; single determination 94760 19.00
Bill FNA Rapid 88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site 88172 189.00
Arthrotomy, Knee, With Synovectomy; Anterior And Posterior Including Popliteal Area Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area 27335 3,612.00 1,109.00
Repair, Extensor Tendon, Leg; Primary, Without Graft, Each Tendon Repair, extensor tendon, leg; primary, without graft, each tendon 27664 1,716.00 1,152.00
Lysis Or Excision Of Penile Post-Circumcision Adhesions Lysis or excision of penile post-circumcision adhesions 54162 770.00 770.00
Excise Tumor Subq Abd Wall >3cm Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater 22903 2,087.00 1,167.00
Excise Tumor Sub Q Upperarm/elbow >3 Cm Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or greater 24071 1,928.00 1,527.00
Installation Through Chest Tube Agent For Pleurode Instillation, via chest tube/catheter, agent for pleurodesis (eg, talc for recurrent or persistent pneumothorax) 32560 1,143.00 426.00
CT 3D Reconstruction w/ Workstation 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; re 76377 503.00
CT 3D Reconstruction w/o Workstation 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; re 76377 503.00
CT Sinus or Facial w/o Cont Computed tomography, maxillofacial area; without contrast material 70486 1,355.00
MRA Abdomen w/ Cont Magnetic resonance angiography, abdomen, with or without contrast material(s) 74185 3,281.00
MRA Abdomen w/o Cont Magnetic resonance angiography, abdomen, with or without contrast material(s) 74185 3,281.00
MRA Chest w/ Cont Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) 71555 3,225.00
MRA Chest w/o Cont Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) 71555 3,225.00
MRA LE w/ Cont Lt Magnetic resonance angiography, lower extremity, with or without contrast material(s) 73725 3,274.00
MRA LE w/ Cont Rt Magnetic resonance angiography, lower extremity, with or without contrast material(s) 73725 3,274.00
MRA LE w/o Cont Lt Magnetic resonance angiography, lower extremity, with or without contrast material(s) 73725 3,274.00
MRA Pelvis w/ Cont Magnetic resonance angiography, pelvis, with or without contrast material(s) 72198 3,270.00
MRI Brachial Plexus w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
XR Radiologic Examination, Abdomen 3 or More Views Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest 74022 415.00
XR Femur 2 Views Lt Radiologic examination, femur; minimum 2 views 73552 266.00
XR Femur 2 Views Rt Radiologic examination, femur; minimum 2 views 73552 266.00
XR LE Infant Min 2 Views Lt Radiologic examination; lower extremity, infant, minimum of 2 views 73592 282.00
XR LE Infant Min 2 Views Rt Radiologic examination; lower extremity, infant, minimum of 2 views 73592 282.00
XR Ribs Min 3 Views Lt w/ AP Chest Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views 71101 335.00
XR Tibia +Fibula 2 Views Lt Radiologic examination; tibia and fibula, 2 views 73590 261.00
XR Tibia +Fibula 2 Views Rt Radiologic examination; tibia and fibula, 2 views 73590 261.00
XR UE Infant Min 2 Views Lt Radiologic examination; upper extremity, infant, minimum of 2 views 73092 282.00
XR UE Infant Min 2 Views Rt Radiologic examination; upper extremity, infant, minimum of 2 views 73092 282.00
Ferritin Level Ferritin 82728 110.00
POX, Multiple Determination Charge Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise) 94761 56.00
Pre-Employment Post Offer Exam Charge Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive techn 97537 119.00
NM Urea Breath Test C-14 Acquisition Urea breath test, C-14 (isotopic); acquisition for analysis 78267 343.00
NM Urea Breath Test C-14 Analysis Urea breath test, C-14 (isotopic); analysis 78268 212.00
US Breast Biopsy Bil. Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 293.00
US Pregnant > 14 Weeks 1st Gest WC Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation 76805 663.00
Blood Glucose POC Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use 82962 19.00 19.00
XR Hip Comp Min 2 Views Rt +Pelvis Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views 73502 256.00
Repair tendon/muscle upper arm or elbow, primary or secondary Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff) 24341 2,620.00
Insertion, Non-Biodegradable Drug Delivery Implant Insertion, non-biodegradable drug delivery implant 11981 661.00 394.00
Nasal/Sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (Separate Procedure) Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure) 31237 1,208.00 788.00
Injection Procedure For Sacroiliac Joint; Provision Of Anesthetic, Steroid And/Or Other Therapeutic Injection procedure for sacroiliac joint, anesthetic/steroid 27096 374.00
Urinalysis Dipstick Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automat 81002 33.00
Programming device evaluation; single lead pacemaker Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review a 93279 173.00 215.00 121.00
Programming device evaluation; dual lead pacemaker Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review a 93280 277.00
Programming device evaluation; multiple lead pacemaker Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review a 93281 237.00 165.00
Programming device eval; 1 lead implantable cardio-defib Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review a 93282 217.00 150.00
Programming device eval; multiple lead cardio-defib Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review a 93284 321.00 390.00 226.00
DEVELOPMENT TEST LIMIT Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument 96110 45.00 0.00
DEVELOPMENT TEST EXTENDED Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report 96111 307.00 584.00
ALBUTEROL 1MG UD INH S Albuterol, inhalation solution, FDA-approved final product, 10.00 10.00 10.00
BUPIVACAINE 0.5% 2ML INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML 33.00 33.00
XOPENEX 1.25MG/3ML INH Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg 42.00
Pregnancy Test Serum Gonadotropin, chorionic (hCG); qualitative 84703 95.00
MA Breast Ndl Loc Placement Lt Magnetic resonance guidance for needle placement (eg, for bi 77021 1,056.00
MA Breast Ndl Loc Placement Rt Magnetic resonance guidance for needle placement (eg, for bi 77021 1,056.00
TB Test POC Skin test; tuberculosis, intradermal 86580 29.00 29.00
EMG anal urethral Needle electromyography studies (EMG) of anal or urethral sphincter, any technique 51785 824.00 330.00
TREAT FRACTURE DISTAL RADIUS CHARGE Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation 25606 3,135.00 2,141.00
LARYNGOSCOPY (PRO FEE) Laryngoscopy, flexible; diagnostic 31575 212.00
WBC w/ Auto Diff Blood count; automated differential WBC count 85004 82.00
US Breast BCCP Lt. Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76641 390.00
US Breast BCCP Rt. Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76641 390.00
SURGICEL 4X8 397.00
CLSD TX METACARPAL FX W/O MAN Charge Closed treatment of metacarpal fracture, single; with manipulation, each bone 26605 1,218.00
Checkout for Prosth/Orth Use Charges Checkout for orthotic/prosthetic use, established patient, each 15 minutes 97762 190.00
Creatinine Clearance Creatinine; clearance 82575 69.00
Cord Blood Gases Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); 82803 244.00
HIV 1&2 Antibody Antibody; HIV-1 and HIV-2, single result 86703 172.00 68.00
Rheumatoid Arthritis Titer Rheumatoid factor; qualitative 86430 71.00
DRAIN FINGER ABSCESS, COMP Drainage of finger abscess; complicated (eg, felon) 26011 1,827.00 884.00
FRACTURE METACARPAL MANIP EXTERNAL FIXATION Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone 26607 2,145.00 904.00
REPAIR OF VAGINA Colporrhaphy, suture of injury of vagina (nonobstetrical) 57200 1,422.00 729.00
RHO D IMM GLOBULIN, 300 Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use 90384 230.00 230.00
VENIPUNCTURE Collection of venous blood by venipuncture 36415 21.00 21.00
CATHERIZATION NON INDWELLING Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) 51701 207.00 122.00
99080 ADDITIONAL SPECIAL REPORTS Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form 99080 582.00 233.00 0.00
CAST LONG ARM FIBERGLASS ADULT CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), FIBERGLASS 53.00 0.00
SPLINT, PEDIATRIC FIBERGLASS CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS 26.00 26.00
CAST, FIBERGLASS LONG LEG ADUL CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), FIBERGLASS 94.00 0.00
CAST SUPP LONG LEG UP TOAGE 10 CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS 60.00 0.00
RT Spirometry with Graphic Record Charge Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation 94010 412.00
RT Peak Flow Procedure Charge Unlisted pulmonary service or procedure 94799 59.00
96372 Therapeutic, prophylactic, or diagnostic injection, subcutaneous or intramuscular Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 96372 76.00 115.00 57.00
CATARACT EXTRACTION WITH INTRAOCULAR LENS IMPLANT 4,000.00
Colonoscopy 2,080.00
Esophagogastroduodenoscopy 1,404.00
Esophagogastroduodenoscopy and Colonoscopy 2,606.00
NM Pulm Vent Pulmonary ventilation imaging (eg, aerosol or gas) 78579 1,884.00
US UE Art Doppler Single Level Bil Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis 93922 839.00
26ML APPLICATOR 2% CHLORHEXIDINE 348.00
Aph RBC CP2D AS3 LR 1 RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT 524.00
APH RBC CP2D AS3 LR 2 RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT 524.00
DRBC CPD AS1 500 LR RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT 524.00
Esophagogastroduodenoscopy and Colonoscopy with Biopsy and Polypectomy 4,493.00
Plasma Thawed CP2D FRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH UNIT 176.00
Plasma Thawed CPDA1 FRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH UNIT 176.00
COLONOSCOPY WITH BIOPSY 2,080.00
Esophagogastroduodenoscopy with Balloon Dilatation 1,404.00
Esophagogastroduodenoscopy with Biopsy 1,404.00
Esophagogastroduodenoscopy with Hot Biopsy or Cautery 1,404.00
Esophagogastroduodenoscopy with Biopsy and Colonoscopy 2,606.00
Esophagogastroduodenoscopy and Colonoscopy with Biopsy 2,606.00
Esophagogastroduodenoscopy and Colonoscopy with Polypectomy 4,493.00
Esophagogastroduodenoscopy with Biopsy and Colonoscopy with Biopsy 2,606.00
Colonoscopy with Polypectomy 3,632.00
Colonoscopy with Biopsy and Polypectomy 3,632.00
Esophagogastroduodenoscopy with Biopsy and Dilation 1,404.00
Cataract Extraction with Toric Implantation ASTIGMATISM CORRECTING FUNCTION OF INTRAOCULAR LENS 7,557.00
Esophagogastroduodenoscopy with Foreign Body Removal 1,404.00
Esophagogastroduodenoscopy with Polyp Ablation 4,493.00
Esophagogastroduodenoscopy with Snare Removal of Polyp 2,606.00
Implant Exchange 10,587.00
Multi-layer compression application Application of multi-layer compression system; leg (below knee), including ankle and foot 29581 292.00 171.00
Arthroscopy, Shoulder, Surgical; Bicep Arthroscopy, shoulder, surgical; biceps tenodesis 29828 4,323.00 2,816.00
Esophagogastroduodenoscopy w/ Submucosal Injection Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance 43236 1,541.00 844.00
Esophagogastroduodenoscopy w/ Insertion guide wire Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 43248 1,642.00 913.00
Venipuncture Charge Only Collection of venous blood by venipuncture 36415 28.00
TRAY THORACENTESIS 294.00
Fibrinogen Fibrinogen; activity 85384 107.00
ANALYZE NEUROSTIM, SIMPLE Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulat 95971 196.00 172.00
REMOVE DEVITALIZE TISSUE MORE 20 SQ Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, d 97598 116.00 87.00
Lumpectomy with Sentinel Node Biopsy Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy 19302 4,273.00 2,595.00
EXC SOFT TISSUE TUMOR 5CMS OR>BACK/ Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater 21933 3,512.00 2,117.00
TENOTOMY; DEBRID OPEN Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open 24358 2,470.00 2,068.00
Arthroscopy, Knee, Surgical, For Removal Of Loose Body, Foreign Body, Debridement/Shaving Of Articul Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartme 417.00 244.00
RT Methacholine Challenge Charge Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine) 94070 677.00
Bill Surg Level IV 88305 Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, 88305 207.00
Hearing Screen POC Pure tone audiometry (threshold); air only 92552 0.00 0.00 0.00
REMOVAL OF KNEE CARTILAGE (ARTHROSCOPY) Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateral 27332 3,038.00 1,396.00
ESOPHAGOSCOPY WITH BIOPSY ONE OR MORE Esophagoscopy, flexible, transoral; with biopsy, single or multiple 43202 1,439.00 652.00
HEMORRHOIDECTOMY W/FISSURECTOMY Hemorrhoidectomy, internal and external, single column/group; with fissurectomy 46257 2,001.00 950.00
RESECTION OF SCROTUM Resection of scrotum 55150 2,343.00 1,343.00
90460 - IM ADMIN 1st Component with Counseling by Provider Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine 90460 61.00 14.00
90461 Immun Admin, Each Addtl Peds Vacc Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid compon 90461 31.00 13.00
X-Match AHG Gel Interp Compatibility test each unit; antiglobulin technique 86922 204.00
X-MATCH ANTIGLOBULIN Compatibility test each unit; antiglobulin technique 86922 238.00
Incompatible Compatibility test each unit; antiglobulin technique 86922 238.00
Least Incomp Compatibility test each unit; antiglobulin technique 86922 238.00
CT Renal Biopsy Renal biopsy; percutaneous, by trocar or needle 50200 2,477.00
IR Enteroclysis Tube Placement Percutaneous placement of enteroclysis tube, radiological supervision and interpretation 74355 1,315.00
IR Nephrostomy Dilation Rt Dilation of nephrostomy, ureters, or urethra, radiological supervision and interpretation 74485 979.00
IR Renal Cath Perc Drain +/or Inj Lt 979.00
IR Renal Cyst Study Translumbar Lt Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation 74470 629.00
IR Ureteral Cath or Stent Perc Lt 979.00
IR Ureteral Cath or Stent Perc Rt 979.00
MA Ductogram or Galactogram Mult Lt. Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation 77054 177.00
MA Ductogram or Galactogram Mult Rt. Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation 77054 177.00
MA Ductogram or Galactogram Single Bil. Mammary ductogram or galactogram, single duct, radiological supervision and interpretation 77053 131.00
MA Stereotactic Loc Lt Placement of breast localization device(s) (eg, clip, metall 19283 0.00
MA Stereotactic Loc Rt Placement of breast localization device(s) (eg, clip, metall 19283 0.00
MRA UE w/ Cont Lt Magnetic resonance angiography, upper extremity, with or without contrast material(s) 73225 3,334.00
MRI Breast w/ Cont Bil. Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral 77059
MRI Breast w/ Cont Rt. Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral 77058
MRI Breast w/o Cont Bil. Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral 77059 4,759.00
MRI Breast w/o Cont Lt. Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral 77058 4,819.00
MRI Breast w/o Cont Rt. Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral 77058 4,819.00
MRI Cardiac M+F w/ + w/o Cont Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; 75561 3,090.00
NM Adrenal Adrenal imaging, cortex and/or medulla 78075 4,848.00
NM Cerebrospinal Fluid Cisternography Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography 78630 3,574.00
NM Intestine Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) 78290 3,493.00
NM Radiopharm Ther Interstitial Colloid Radiopharmaceutical therapy, by oral administration 79005 554.00
NM Radiopharm Ther Intracavity Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance 32555 1,261.00
NM Thyroid Uptake Mult Determinations Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) 78012 819.00
PET Brain Metabolic Eval Brain imaging, positron emission tomography (PET); metabolic evaluation 78608 2,397.00
PET Ltd Area w/ CT Scan Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck) 78814 3,630.00
PET Skull Base to Midthigh Positron emission tomography (PET) imaging; skull base to mid-thigh 78812 3,137.00
PET Skull Base to Midthigh w/ CT Scan Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh 78815 3,995.00
US Biopsy Fine Ndl Asp Fine needle aspiration; with imaging guidance 10022 560.00
US Breast Biopsy Bil Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 195.00
US Guide Pericardiocentesis Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging) 76936 1,251.00
US Prostate Vol Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) 76873 642.00
XR Mastoids < 3 Views Lt Radiologic examination, mastoids; less than 3 views per side 70120 368.00
XR Mastoids < 3 Views Rt Radiologic examination, mastoids; less than 3 views per side 70120 368.00
XR Pharynx or Cerv Esophagus Radiologic examination; pharynx and/or cervical esophagus 74210 883.00
Cardioversion External Cardioversion, elective, electrical conversion of arrhythmia; external 92960 1,121.00
101 - ALL INCL R&B 0.00
122 - OB/2BED 0.00
123 - PEDS/2BED 0.00
171 - NURSERY/LEVEL I 0.00
179 - NURSERY/OTHER 0.00
251 - DRUGS/GENERIC 0.00
291 - MED EQUIP/RENT 0.00
292 - MED EQUIP/NEW 0.00
294 - MED EQUIP/SUPPLIES/DRUGS 0.00
311 - PATHOL/CYTOLOGY 0.00
314 - PATHOL/BIOPSY 0.00
470 - AUDIOLOGY 0.00
522 - RURAL/HOME 0.00
582 - VISIT/HOME HLTH/HOUR 0.00
590 - UNIT/HOME HEALTH 0.00
722 - DELIVERY ROOM 0.00
971 - PRO FEE/LAB 0.00
524 - COVERED SNF VISIT 0.00
684 - TRAUMA/LEVEL IV 0.00
950 - OTHER THERAPEUTIC SERVICES 0.00
948 - PULMONARY REHABILITATION 0.00
264 - IV THER/SUPPLIES 0.00
FETAL NON-STRESS TEST CHARGE Fetal non-stress test 59025 172.00 133.00
NM Thyroid Uptake Single Determination Thyroid uptake, single or multiple quantitative measurement( 78012 716.00
21931 EXC TUMOR SFT TIS BK/FLNK 3CM+ CHARGE Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater 21931 1,633.00 1,656.00
30520 SEPTOPLASTY OR SUBMUC0US RESEC CHARGE Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft 30520 1,871.00
54150 CIRCUM CLAMP OR DEVICE W BLOCK CHARGE Circumcision, using clamp or other device with regional dorsal penile or ring block 54150 257.00
62273 INJ EPIDURAL BLOOD OR CLOT PAT CHARGE Injection, epidural, of blood or clot patch 62273 1,069.00
59025 FETAL NONSTRESS TEST CHARGE Fetal non-stress test 59025 219.00
59200 INSERT HYGROS CERVICAL DILATOR CHARGE Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure) 59200 107.00
Plt CPD 500 PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT 1,198.00
ROOM/BED: Nursery Level 2 1,839.00
ROOM/BED: Nursery Level 3 2,513.00
46600 ANOSCOPY DIAGNOSTIC CHARGE Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included) 52352 1,692.00 1,189.00
OT Transfer Charges Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 97530 137.00
EKG w/ Interpretation and/or Report Charge Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only 93010 39.00 39.00
PT Canalith Repositioning Charge Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day 95992 147.00
880 - DIALYSIS/MISC 0.00
US Axilla Lt Ultrasound, extremity, nonvascular, real-time with image doc 76882 79.00
US Axilla Rt Ultrasound, extremity, nonvascular, real-time with image doc 76882 79.00
US Echo Exercise Stress Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/o 93351 1,472.00
Report Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/o 93351 1,163.00 399.00
US Echo TEE Comp w/ Spec +CF Doppler Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 93312 1,397.00
US Extremity Nonvascular Comp Lt Ultrasound, extremity, nonvascular, real-time with image documentation; complete 76881 613.00
US Extremity Nonvascular Comp Rt Ultrasound, extremity, nonvascular, real-time with image documentation; complete 76881 613.00
US Pelvis Transvaginal Ultrasound, transvaginal 76830 537.00
XR Fluoro Hip Joint Inj Asp Lt Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 77002 766.00
XR Fluoro Hip Joint Inj Asp Rt Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 77002 766.00
XR Urethrocystography Retrograde in OR Urethrocystography, voiding, radiological supervision and interpretation 74455 969.00
NM Unlisted Procedure 0.00
Amputation, metatarsal, with toe, single Amputation, metatarsal, with toe, single 28810 2,055.00 1,184.00
Aph RBC ACDA LR Irr RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT 669.00
Electrical bone stimulation; noninvasive Electrical stimulation to aid bone healing; noninvasive (nonoperative) 20974 301.00 241.00
Closed treatment,radiocarpal dislocation Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation 25660 1,936.00 822.00
Open treatment, trans-scaphoperilunar fracture Open treatment of trans-scaphoperilunar type of fracture dislocation 25685 3,473.00 1,665.00
Complex cystometrogram; w/ urethral pressure profile studies Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique 51727 1,049.00 510.00
Complex cystometrogram; with voiding pressure studies Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique 51728 958.00 498.00
Simple uroflowmetry (UFR) Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter) 51736 73.00 40.00
Cystourethroscopy, fulguration trigone Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands 52214 2,187.00 1,366.00
Cystourethroscopy, urethral stent insert Cystourethroscopy, with insertion of permanent urethral stent 52282 1,608.00 1,054.00
Cystourethroscopy with ureteral meatotomy Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral 52290 1,165.00 756.00
Cystourethroscopy, ureteral calculus removal Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus 52320 1,180.00 774.00
Cystourethroscopy w/ manipulation w/o calculus removal Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus 52330 2,325.00 1,310.00
Cystourethroscopy, w/ biopsy and/or fulguration of lesion Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion 52354 1,993.00 1,320.00
Urinary system surgery, unlisted Unlisted procedure, urinary system 53899 1,001.00 1,110.00
Removal of non-inflatable or inflatable penile prothesis Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis 54415 2,518.00 1,465.00
Penis plastic surgery for injury Plastic operation of penis for injury 54440 3,511.00 0.00
Excision of spermatocele Excision of spermatocele, with or without epididymectomy 54840 1,530.00 1,890.00
Inject/anesthesia, steroid facet nerve lumbar/sacral 1 level 64475 524.00 525.00
Inject, anesthesia, steroid facet nerve, lumbar/sacral, each additional 64476 218.00 218.00
Percutaneous implantation neurostimulator; peripheral Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve) 64555 989.00 12,911.00
Percutaneous implantation neurostimulator, neuromus Percutaneous implantation of neurostimulator electrode array; neuromuscular 64565 908.00 635.00
Posterior tibial neurostimulation, percutaneous needle eledtrode, prog Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming 64566 461.00 144.00
Ultrasound, transrectal Ultrasound, transrectal; 76872 388.00 188.00
Ultrasonic guidance for needle placement Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 76942 396.00 196.00
CT Fingers w/ + w/o Cont Lt Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73202 3,040.00
CT Fingers w/ Cont Lt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Fingers w/ Cont Rt Computed tomography, upper extremity; with contrast material(s) 73201 2,310.00
CT Fingers w/o Cont Lt Computed tomography, upper extremity; without contrast material 73200 1,820.00
CT Heel w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Heel w/ + w/o Cont Rt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Heel w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Heel w/o Cont Lt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Heel w/o Cont Rt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Mandible Ltd Dental Plan Computed tomography, maxillofacial area; without contrast material 70486 2,005.00
CT Toes w/ + w/o Cont Lt Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73702 2,995.00
CT Toes w/ Cont Lt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Toes w/ Cont Rt Computed tomography, lower extremity; with contrast material(s) 73701 2,360.00
CT Toes w/o Cont Lt Computed tomography, lower extremity; without contrast material 73700 1,825.00
CT Toes w/o Cont Rt Computed tomography, lower extremity; without contrast material 73700 1,825.00
MRI Brachial Plexus w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Brachial Plexus w/ Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73219 3,371.00
MRI Fingers w/ + w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Fingers w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73220 4,099.00
MRI Fingers w/ Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73219 3,371.00
MRI Fingers w/o Cont Lt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
MRI Fingers w/o Cont Rt Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73218 3,109.00
MRI Toes w/ + w/o Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences 73720 3,306.00
MRI Toes w/ Cont Lt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73719 3,386.00
MRI Toes w/ Cont Rt Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73719 3,386.00
US Pregnant < 14 Weeks 1st Gest WC