,Van Buren County Hospital - Machine Readable Report - Generated on 01/11/2021,,,,,,,,,,,,, ,"Disclaimer: The information provided in this machine readable file is to fulfill the CMS requirements for Price Transparency. Charges, allowed amount, cash discounted price, min and max negotiated rates provided in this report are based on historic claim and remittance information provided by Van Buren County Hospital. This was generated on 01/11/2021 and is a yearly snapshot based on history. All amounts reported may change due to several factors including but not limited to hospital service area where the service is provided, payer contracts and negotiations. This data will be further refined.",,,,,,,,,,,,, CPT,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Medicare,United healthcare,Amerigroup,Iowa total care,Blue cross blue shield,Medicaid of iowa,Coventry health care,Cigna,Commercial insurance Institutional,,,,,,,,,,,,,, Outpatients,,,,,,,,,,,,,, 00731,PR ANES UPR GI NDSC PX NOS,1154,1039,216,1119,733,744,729,725,475,775,635,1119,216 00811,PR ANES LWR INTST NDSC NOS,989,890,185,959,624,637,625,621,407,664,544,959,185 00812,PR ANES LWR INTST SCR COLSC,825,742,155,800,517,532,521,518,340,554,454,800,155 00813,PR ANES UPR LWR GI NDSC PX,1154,1039,216,1119,739,744,729,725,475,775,635,1119,216 00830,Anesthesia for hernia repairs in lower abdomen; not otherwise specified,1319,1187,247,1279,838,850,834,829,543,886,725,1279,247 00902,Anesthesia for; anorectal procedure,1154,1039,216,1119,739,744,729,725,475,775,635,1119,216 10060,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single",254,229,48,246,163,164,79,160,105,171,140,246,48 10080,Incision and drainage of pilonidal cyst; simple,250,225,47,242,154,161,156,157,103,168,137,242,47 10120,"Incision and removal of foreign body, subcutaneous tissues; simple",166,150,31,161,106,100,105,118,68,112,91,161,31 10140,"Incision and drainage of hematoma, seroma or fluid collection",250,225,47,242,143,161,158,157,103,168,137,242,47 11102,PR TANGNTL BX SKIN SINGLE LES,217,195,41,210,90,140,137,136,89,146,119,210,41 11104,PR PUNCH BX SKIN SINGLE LESION,217,195,41,210,139,140,137,166,89,146,119,210,41 11106,PR INCISIONAL BX SKN SINGLE LES,414,372,78,401,227,266,261,260,170,278,227,401,78 11401,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm",278,251,52,273,172,273,176,175,115,187,153,270,52 11402,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm",267,241,50,259,169,172,169,168,110,180,147,259,50 11404,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm",384,346,72,372,189,247,243,241,158,258,211,372,72 11421,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm",1929,1736,361,1871,1234,1212,1571,1211,794,1295,1060,1871,361 11422,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm",443,399,83,430,172,371,280,278,183,298,244,430,83 11442,"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",270,243,51,275,173,275,171,170,111,182,149,262,51 11602,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm",339,305,64,329,209,249,214,213,140,228,186,329,64 11603,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm",378,341,71,367,239,295,239,238,156,254,208,367,71 11604,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm",375,337,70,363,232,241,237,235,154,252,206,363,70 11641,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm",250,225,47,242,160,161,158,157,103,168,137,242,47 11642,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm",472,425,88,458,195,300,298,297,195,317,260,458,88 11730,"Avulsion of nail plate, partial or complete, simple; single",186,167,35,180,116,120,118,142,77,125,102,180,35 11740,Evacuation of subungual hematoma,60,54,11,59,37,59,38,21,25,40,33,58,11 11750,"Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;",371,334,69,360,229,223,172,233,153,249,204,360,69 11981,"Insertion, non-biodegradable drug delivery implant",1455,1309,273,1411,898,937,905,1158,1014,977,800,1411,273 11982,"Removal, non-biodegradable drug delivery implant",177,160,33,172,112,114,134,142,73,119,98,172,33 11983,"Removal with reinsertion, non-biodegradable drug delivery implant",395,355,74,383,244,247,246,248,163,265,217,383,74 12001,"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less",247,222,46,240,155,191,179,155,102,166,136,240,46 12002,"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",290,261,54,281,176,187,214,184,119,195,159,281,54 12004,"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",593,534,111,575,380,382,375,372,244,398,326,575,111 12005,"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",715,644,134,694,458,461,452,449,295,480,393,694,134 12011,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",242,218,45,242,150,242,179,176,100,163,133,235,45 12013,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",290,261,54,281,185,187,183,182,119,195,159,281,54 12014,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm",326,294,57,317,202,210,57,205,134,219,179,317,61 12032,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm",496,446,93,481,317,206,313,379,299,333,273,481,93 12034,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm",987,888,185,957,426,356,624,620,407,663,543,957,185 12041,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less",618,556,116,600,382,371,391,388,255,415,340,600,116 12042,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm",290,261,54,281,186,187,183,182,119,195,159,281,54 12051,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",504,453,94,489,188,371,318,317,208,338,277,489,94 12052,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",367,330,69,356,227,168,127,231,302,247,202,356,69 17000,"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion",161,145,30,156,100,136,102,101,66,108,89,156,30 17110,"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",1854,1669,347,1799,1145,1195,1286,1165,764,1246,1020,1799,347 17261,"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm",338,304,63,327,216,218,213,212,139,227,186,327,63 17262,"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm",304,274,57,295,172,196,192,191,125,205,167,295,57 17272,"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm",238,214,45,230,128,153,150,149,98,160,131,230,45 20526,"Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel",177,160,33,174,110,174,117,108,73,119,98,172,33 20552,"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)",336,302,63,326,108,216,212,211,138,226,185,326,63 20553,"Injection(s); single or multiple trigger point(s), 3 or more muscle(s)",277,249,52,447,171,223,447,174,114,186,152,269,52 20610,"Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)",746,672,140,870,510,870,271,469,307,501,410,724,140 20680,"Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)",2572,2315,482,2495,1646,1657,1625,1616,1059,1728,1414,2495,482 21552,"Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater",3000,2700,562,2910,1852,1933,1896,1884,1451,2015,1650,2910,562 25605,"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",586,527,110,568,375,378,370,448,241,394,322,568,110 27096,"Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid",1048,943,196,1189,671,518,662,1189,547,746,576,1016,196 27250,"Closed treatment of hip dislocation, traumatic; without anesthesia",300,270,56,291,185,180,187,188,124,202,165,291,56 27265,Closed treatment of post hip arthroplasty dislocation; without anesthesia,371,334,70,360,229,223,234,233,153,249,204,360,70 27810,"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation",400,360,75,388,247,258,253,274,165,269,220,388,75 28299,"Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy",5000,4500,937,4850,3200,3222,3160,3141,2059,3359,2749,4850,937 28435,Closed treatment of talus fracture; with manipulation,450,405,84,436,288,290,284,283,185,302,247,436,84 28515,"Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each",312,281,59,303,188,201,197,196,129,210,172,303,59 29075,"Application, cast; elbow to finger (short arm)",385,346,72,373,237,231,243,242,158,258,211,373,72 29405,Application of short leg cast (below knee to toes);,400,360,75,388,243,240,157,251,165,269,220,388,75 29445,Application of rigid total contact leg cast,185,166,35,179,114,119,145,116,76,124,101,179,35 29505,Application of long leg splint (thigh to ankle or toes),165,149,31,160,102,106,115,104,68,111,91,160,31 30140,"Submucous resection inferior turbinate, partial or complete, any method",2040,1836,382,1979,1260,1314,1289,1281,1337,1370,1122,1979,382 30901,"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method",326,293,61,316,148,210,206,205,134,219,179,316,61 30905,"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial",378,340,71,366,151,243,239,237,155,254,208,366,71 31500,"Intubation, endotracheal, emergency procedure",279,251,52,271,162,161,176,175,115,187,153,271,52 31575,"Laryngoscopy, flexible fiberoptic; diagnostic",177,160,33,172,114,106,112,111,73,119,98,172,33 32551,"Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed (separate procedure)",300,270,56,291,189,193,190,188,124,202,165,291,56 36415,Collection of venous blood by venipuncture,37,33,7,36,24,23,25,22,20,25,20,36,7 36430,"Transfusion, blood or blood components",628,565,118,609,402,384,226,395,259,422,345,609,118 36556,Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older,268,241,50,260,131,173,169,168,110,180,147,260,50 36569,"Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older",201,181,38,195,127,129,127,126,83,135,110,195,38 36600,"Arterial puncture, withdrawal of blood for diagnosis",45,40,8,44,29,27,37,31,18,30,25,44,8 42820,Tonsillectomy and adenoidectomy; younger than age 12,3060,2754,573,2999,1889,2999,1904,1922,1260,2056,1683,2968,573 42821,Tonsillectomy and adenoidectomy; age 12 or over,3300,2970,618,3201,2038,2126,2592,2073,1359,2217,1815,3201,618 43239,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple",2370,2133,444,2299,823,1479,1306,1786,1206,1592,1303,2299,444 45378,"Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)",3272,2945,613,3174,1094,2485,2570,2055,2432,2198,1799,3174,613 45380,"Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple",3397,3057,636,3295,1181,2038,2774,2072,2293,2282,1868,3295,636 45384,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery",3827,3444,717,3712,2363,2466,2654,2404,2944,2571,2104,3712,717 45385,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique",3980,3582,746,3861,1346,2296,3126,3045,2673,2674,2188,3861,746 45915,Removal of fecal impaction or foreign body (separate procedure) under anesthesia,325,292,61,315,205,209,205,204,134,218,179,315,61 46040,Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure),254,229,48,246,157,152,161,160,105,171,140,246,48 46050,"Incision and drainage, perianal abscess, superficial",216,194,40,209,133,139,141,136,89,145,119,209,40 46922,"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision",793,714,149,769,484,511,501,498,327,533,436,769,149 47562,"Laparoscopy, surgical; cholecystectomy",8485,7636,1590,8230,5239,5467,7998,4738,3495,5700,4666,8230,1590 49083,PR ABD PARACENTESIS W/IMAGING,330,297,62,320,200,213,209,207,136,222,181,320,62 49505,"Repair initial inguinal hernia, age 5 years or older; reducible",4080,3672,765,3958,1683,2448,2578,2563,1681,2741,2243,3958,765 49520,"Repair recurrent inguinal hernia, any age; reducible",3252,2927,609,3154,1621,2095,2055,2043,1339,2185,1788,3154,609 49521,"Repair recurrent inguinal hernia, any age; incarcerated or strangulated",7700,6930,1443,7469,4755,4961,4866,5891,3172,5172,4234,7469,1443 51702,"Insertion of temporary indwelling bladder catheter; simple (eg, Foley)",119,107,22,116,78,90,75,75,49,80,66,116,22 52000,Cystourethroscopy (separate procedure),2078,1870,389,2016,1283,1339,1313,1320,1857,1396,1143,2016,389 56420,Incision and drainage of Bartholin's gland abscess,232,209,43,225,143,149,182,146,96,156,128,225,43 57452,Colposcopy of the cervix including upper/adjacent vagina;,295,265,55,286,182,190,186,185,162,198,162,286,55 57456,Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage,448,403,84,434,283,289,283,281,184,301,246,434,84 58100,"Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)",395,355,74,383,256,254,249,248,201,265,217,383,74 58300,Insertion of intrauterine device (IUD),333,299,62,323,205,320,266,209,212,223,183,323,62 58301,Removal of intrauterine device (IUD),245,221,46,238,152,158,155,165,203,165,135,238,46 58558,"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C",5100,4590,956,4947,3219,2156,3223,3204,2101,3426,2804,4947,956 58563,"Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)",5050,4545,946,5745,3118,3254,2356,3172,5745,3392,2777,4898,946 59025,Fetal non-stress test,174,157,33,169,108,112,110,106,72,117,96,169,33 62321,PR INJ INTERLAM C/T W IMG,1159,1043,217,1124,737,723,732,728,477,779,637,1124,217 62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,1159,1043,217,1124,732,695,946,808,477,748,637,1124,217 64450,"Injection, anesthetic agent; other peripheral nerve or branch",223,200,42,216,138,144,81,152,92,150,122,216,42 64493,"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level",764,688,143,741,489,407,483,480,315,513,420,741,143 64494,"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)",764,688,143,741,489,407,483,480,315,513,420,741,143 64495,"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)",764,688,143,741,489,407,483,480,315,513,420,741,143 69424,Ventilating tube removal requiring general anesthesia,3000,2700,562,2910,1852,1933,1896,1830,1236,2015,1650,2910,562 69436,"Tympanostomy (requiring insertion of ventilating tube), general anesthesia",3000,2700,562,2910,1852,1933,2265,1830,1236,2015,1650,2910,562 70030,"Radiologic examination, eye, for detection of foreign body",207,186,39,201,128,133,162,130,85,139,114,201,39 70160,"Radiologic examination, nasal bones, complete, minimum of 3 views",150,135,28,145,93,90,95,94,62,101,82,145,28 70200,"Radiologic examination; orbits, complete, minimum of 4 views",226,204,42,220,140,136,143,142,93,152,125,220,42 70220,"Radiologic examination, sinuses, paranasal, complete, minimum of 3 views",252,227,47,244,164,162,159,158,62,169,138,244,47 70250,"Radiologic examination, skull; less than 4 views",231,207,43,224,142,138,146,145,95,155,127,224,43 70450,"Computed tomography, head or brain; without contrast material",1908,1718,253,1851,1221,1145,983,1164,253,1282,1049,1851,358 70460,"Computed tomography, head or brain; with contrast material(s)",2115,1904,396,2052,1354,1363,1337,1329,871,1421,1163,2052,396 70470,"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections",2356,2120,441,2285,1497,1870,718,1480,1146,1582,1295,2285,441 70486,"Computed tomography, maxillofacial area; without contrast material",1626,1463,305,1577,1033,976,1128,1074,374,1092,894,1577,305 70491,"Computed tomography, soft tissue neck; with contrast material(s)",1469,1322,275,1425,940,946,928,1045,392,987,808,1425,275 70492,"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections",2477,2229,464,2427,1529,2427,1565,1556,1020,1664,1362,2403,464 70496,"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing",2541,2287,476,2465,1569,1637,1581,1596,1047,1707,1397,2465,476 70544,"Magnetic resonance angiography, head; without contrast material(s)",3132,2819,587,3038,1934,2018,1980,1968,806,2104,1722,3038,587 70551,"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material",3529,3176,661,3423,2143,2117,2230,1278,1082,2371,1940,3423,661 70553,"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences",3842,3458,720,3727,2425,2305,3138,2414,1075,2581,2113,3727,720 71045,PR X-RAY EXAM CHEST 1 VIEW,143,129,27,139,91,86,89,87,64,96,79,139,27 71046,PR X-RAY EXAM CHEST 2 VIEWS,268,241,50,260,172,167,167,164,65,180,148,260,50 71100,"Radiologic examination, ribs, unilateral; 2 views",272,245,51,264,172,163,172,217,112,183,150,264,51 71101,"Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views",272,245,51,264,174,170,222,171,65,183,150,264,51 71110,"Radiologic examination, ribs, bilateral; 3 views",283,255,53,275,181,182,179,178,117,190,156,275,53 71111,"Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views",604,544,113,586,387,389,382,380,249,406,332,586,113 71120,"Radiologic examination; sternum, minimum of 2 views",152,137,28,147,97,98,96,95,63,102,84,147,28 71250,"Computed tomography, thorax; without contrast material",2309,2078,433,2240,1478,1413,1519,1642,529,1551,1270,2240,433 71260,"Computed tomography, thorax; with contrast material(s)",2511,2260,471,2436,1607,1507,871,1577,1042,1687,1381,2436,471 71270,"Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections",1314,1183,246,1275,821,788,830,825,541,883,723,1275,246 71275,"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing",1606,1446,301,1558,1049,1003,836,765,780,1079,883,1558,301 72040,"Radiologic examination, spine, cervical; 2 or 3 views",412,370,65,399,263,237,274,271,65,317,196,399,77 72050,"Radiologic examination, spine, cervical; minimum of 4 views",497,447,60,482,314,320,314,170,60,334,273,482,93 72070,"Radiologic examination, spine; thoracic, 2 views",264,238,49,256,169,170,167,161,109,177,145,256,49 72072,"Radiologic examination, spine; thoracic, 3 views",304,274,57,295,193,182,211,214,68,185,167,295,57 72081,PR X-RAY EXAM ENTIRE SPINE 1 VW,123,111,23,120,76,80,86,78,51,83,68,120,23 72100,"Radiologic examination, spine, lumbosacral; 2 or 3 views",361,325,65,350,231,225,260,257,65,220,199,350,68 72110,"Radiologic examination, spine, lumbosacral; minimum of 4 views",496,446,93,481,318,298,195,312,204,333,273,481,93 72125,"Computed tomography, cervical spine; without contrast material",2309,2078,337,2240,1458,1386,943,1740,337,1551,1270,2240,433 72128,"Computed tomography, thoracic spine; without contrast material",2309,2078,433,2240,1458,1488,943,1451,951,1551,1270,2240,433 72131,"Computed tomography, lumbar spine; without contrast material",2309,2078,433,2240,1458,1441,1415,747,951,1551,1270,2240,433 72141,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material",3132,2819,582,3038,2045,1917,1980,2493,582,1911,1722,3038,587 72146,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material",3258,2932,611,3160,2045,1955,2059,2047,832,2509,1791,3160,611 72148,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material",3258,2932,611,3160,2085,1917,2254,2493,1082,2189,1791,3160,611 72149,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)",3521,3169,660,3415,2222,2269,2225,2212,1450,2365,1936,3415,660 72158,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar",3592,3232,528,3484,2344,2113,2270,2256,528,2413,1975,3484,673 72170,"Radiologic examination, pelvis; 1 or 2 views",243,218,45,235,158,148,84,148,60,163,133,235,45 72192,"Computed tomography, pelvis; without contrast material",2356,2120,441,2285,1478,1441,1489,1480,970,1582,1295,2285,441 72193,"Computed tomography, pelvis; with contrast material(s)",2511,2260,471,2436,1607,1618,1742,1998,1034,1687,1381,2436,471 72195,"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)",3195,2876,599,3099,2031,2059,2019,2007,1316,2146,1757,3099,599 72220,"Radiologic examination, sacrum and coccyx, minimum of 2 views",213,192,40,207,135,137,135,134,88,143,117,207,40 73000,"Radiologic examination; clavicle, complete",173,156,32,168,106,111,136,109,65,116,95,168,32 73010,"Radiologic examination; scapula, complete",156,140,29,151,96,94,99,98,64,105,86,151,29 73020,"Radiologic examination, shoulder; 1 view",222,200,42,216,137,133,141,140,92,149,122,216,42 73030,"Radiologic examination, shoulder; complete, minimum of 2 views",222,200,34,216,145,133,154,158,34,149,122,216,42 73060,"Radiologic examination; humerus, minimum of 2 views",161,145,30,156,105,98,104,101,66,108,89,156,30 73080,"Radiologic examination, elbow; complete, minimum of 3 views",190,171,36,184,117,110,127,138,68,128,104,184,36 73090,"Radiologic examination; forearm, 2 views",143,129,27,139,90,84,84,104,68,96,79,139,27 73110,"Radiologic examination, wrist; complete, minimum of 3 views",277,249,52,269,170,166,175,189,65,213,152,269,52 73130,"Radiologic examination, hand; minimum of 3 views",267,241,50,259,171,167,166,163,68,180,147,259,50 73140,"Radiologic examination, finger(s), minimum of 2 views",162,146,30,157,103,101,112,114,67,109,89,157,30 73201,"Computed tomography, upper extremity; with contrast material(s)",1242,1118,233,1205,784,800,785,780,512,834,683,1205,233 73218,"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)",3132,2819,587,3038,1977,2018,1980,1968,1290,2104,1722,3038,587 73221,"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)",3132,2819,587,3038,1977,2475,2173,1911,639,1911,1722,3038,587 73501,PR X-RAY EXAM HIP UNI 1 VIEW,238,214,45,231,147,153,148,149,98,160,131,231,45 73502,PR X-RAY EXAM HIP UNI 2-3 VIEWS,238,214,45,231,152,143,148,145,49,190,131,231,45 73521,PR X-RAY EXAM HIPS BI 2 VIEWS,442,397,60,428,294,285,279,269,60,297,243,428,83 73552,PR X-RAY EXAM OF FEMUR 2/> VW,155,140,18,150,101,97,96,95,68,104,85,150,18 73560,"Radiologic examination, knee; 1 or 2 views",201,181,38,195,129,121,127,126,102,135,110,195,38 73562,"Radiologic examination, knee; 3 views",279,251,52,271,179,167,176,183,65,187,153,271,52 73564,"Radiologic examination, knee; complete, 4 or more views",305,274,57,296,239,197,120,104,126,205,168,296,57 73590,"Radiologic examination; tibia and fibula, 2 views",138,124,26,134,92,84,96,84,50,92,76,134,26 73610,"Radiologic examination, ankle; complete, minimum of 3 views",266,240,50,258,174,163,172,179,67,159,146,258,50 73630,"Radiologic examination, foot; complete, minimum of 3 views",272,244,51,263,167,163,162,186,65,182,149,263,51 73660,"Radiologic examination; toe(s), minimum of 2 views",123,110,23,119,76,79,49,82,51,82,68,119,23 73700,"Computed tomography, lower extremity; without contrast material",913,822,171,886,576,559,577,573,376,613,502,886,171 73701,"Computed tomography, lower extremity; with contrast material(s)",1314,1183,246,1275,841,788,831,825,541,883,723,1275,246 73718,"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)",3258,2932,611,3160,2012,1917,2059,2047,1082,2189,1791,3160,611 73720,"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences",3662,3296,686,3552,2344,2359,2314,2300,1508,2460,2014,3552,686 73721,"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material",3132,2819,587,3038,1991,2018,2173,2360,639,2104,1722,3038,587 73723,"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences",3257,2931,610,3159,2084,2098,2058,2046,639,2188,1791,3159,610 74018,PR X-RAY EXAM ABDOMEN 1 VIEW,252,227,47,244,161,146,198,193,65,169,139,244,47 74019,PR X-RAY EXAM ABDOMEN 2 VIEWS,309,278,58,300,198,185,192,220,68,208,170,300,58 74022,"Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest",385,346,72,373,243,248,243,242,158,258,211,373,72 74150,"Computed tomography, abdomen; without contrast material",1947,1752,365,1888,1246,1254,1230,1223,802,1308,1070,1888,365 74160,"Computed tomography, abdomen; with contrast material(s)",2193,1974,411,2127,1404,1413,1312,1678,903,1473,1206,2127,411 74170,"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections",2356,2120,441,2285,1537,2263,1489,1480,970,1582,1295,2285,441 74174,PR CT ANGIO ABD AND PELV WO W CONTRAST,5042,4538,945,4891,3213,3025,3186,3167,2077,3387,2772,4891,945 74175,"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing",1607,1446,301,1559,1014,1035,1016,1009,662,1079,884,1559,301 74176,"Computed tomography, abdomen and pelvis; without contrast material",4384,3946,822,4252,2806,2529,3443,2883,883,2572,2411,4252,822 74177,"Computed tomography, abdomen and pelvis; with contrast material(s)",4618,4156,620,4479,2955,2881,2873,3158,620,3102,2539,4479,865 74178,"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",4848,4363,908,4703,3060,2909,2522,3857,1146,3257,2666,4703,908 74181,"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)",3258,2932,611,3160,2085,2099,2059,2047,1342,2189,1791,3160,611 74185,"Magnetic resonance angiography, abdomen, with or without contrast material(s)",3662,3296,686,3552,2344,2359,2314,2300,1508,2460,2014,3552,686 74220,Radiologic examination; esophagus,278,250,52,270,172,179,176,190,115,187,153,270,52 74240,"Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB",640,576,120,620,395,412,404,402,463,430,352,620,120 74280,"Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon",780,702,146,757,499,503,493,490,321,524,429,757,146 76536,"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation",344,309,64,334,220,265,254,216,211,231,189,334,64 76604,"Ultrasound, chest (includes mediastinum), real time with image documentation",632,569,118,613,405,379,399,397,253,425,348,613,118 76641,Complete unilateral ultrasound examination of the breast,485,436,91,470,310,291,381,351,211,326,267,470,91 76700,"Ultrasound, abdominal, real time with image documentation; complete",1044,940,196,1013,651,626,820,756,293,804,574,1013,196 76705,"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)",756,680,142,733,484,453,524,461,211,508,416,733,142 76706,PR US ABDL AORTA SCREEN AAA,283,254,53,274,177,176,179,177,116,190,155,274,53 76770,"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete",712,641,133,691,474,427,443,434,253,478,391,691,133 76801,"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation",835,752,157,810,516,538,579,540,344,561,459,810,157 76805,"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",870,783,163,844,537,561,603,547,358,584,478,844,163 76811,"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation",962,866,180,933,594,620,667,676,187,587,529,933,180 76817,"Ultrasound, pregnant uterus, real time with image documentation, transvaginal",1015,914,190,985,627,654,641,777,418,682,558,985,190 76819,Fetal biophysical profile; without non-stress testing,242,218,45,234,149,156,153,165,100,162,133,234,45 76830,"Ultrasound, transvaginal",888,800,166,862,569,544,616,542,169,711,489,862,166 76856,"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete",835,752,157,810,527,501,579,255,253,561,459,810,157 76857,"Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)",869,782,163,843,556,560,549,546,358,584,478,843,163 76870,"Ultrasound, scrotum and contents",479,431,90,465,307,309,376,281,242,322,263,465,90 76881,"Ultrasound, extremity, nonvascular, real-time with image documentation; complete",501,451,94,486,309,323,312,315,206,336,275,486,94 76882,"Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific",308,277,58,299,197,181,195,208,253,207,169,299,58 77002,"Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)",395,355,74,383,253,254,260,248,163,265,217,383,74 77062,HC BREAST TOMOSYNTHESIS DIG DX BILAT,166,150,31,163,103,163,105,104,68,112,91,161,31 77063,HC BREAST TOMOSYNTHESIS DIG SCREEN UNIL,173,156,32,168,111,52,136,118,106,116,95,168,32 77065,Diagnostic Mammography computer aided detection when performed; unilateral,166,150,31,161,105,107,105,104,68,112,91,161,31 77066,Diagnostic Mammography computer aided detection when performed; bilateral,173,156,32,168,111,104,109,109,111,116,95,168,32 77067,Screening mammography,173,156,32,168,90,128,136,118,114,116,95,168,32 78226,PR HEPATOBILIARY SYSTEM IMAGING,1828,1645,343,1773,1129,1097,1155,1148,753,1228,1005,1773,343 78227,PR HEPATOBIL SYST IMAGE W/DRUG,1865,1679,350,1809,1154,1202,1179,1378,1066,1253,1026,1809,350 78264,Gastric emptying study,707,636,132,686,452,408,447,541,291,475,389,686,132 78315,Bone and/or joint imaging; 3 phase study,2119,1907,397,2055,1337,1365,1339,1331,873,1423,1165,2055,397 80048,"Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310), Carbon dioxide (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (84132), Sodium (84295), Urea nitrogen (BUN) (84520)",148,133,28,143,95,92,92,101,57,119,81,143,28 80050,"General health panel This panel must include the following: Comprehensive metabolic panel (80053), Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004), OR, Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009), Thyroid stimulating hormone (TSH) (84443)",419,377,79,407,259,270,265,263,89,282,231,407,79 80051,"Electrolyte panel This panel must include the following: Carbon dioxide (82374), Chloride (82435), Potassium (84132), Sodium (84295)",105,95,20,102,66,68,66,66,43,71,58,102,20 80053,"Comprehensive metabolic panel This panel must include the following: Albumin (82040), Bilirubin, total (82247), Calcium, total (82310), Carbon dioxide (bicarbonate) (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Phosphatase, alkaline (84075), Potassium (84132), Protein, total (84155), Sodium (84295), Transferase, alanine amino (ALT) (SGPT) (84460), Transferase, aspartate amino (AST) (SGOT) (84450), Urea nitrogen (BUN) (84520)",182,163,34,176,116,113,113,124,81,111,102,176,34 80061,"Lipid panel This panel must include the following: Cholesterol, serum, total (82465), Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478)",144,129,27,140,96,90,118,102,45,102,79,140,27 80069,"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 inorganic (phosphate) (84100), Potassium (84132), Sodium (84295), Urea nitrogen (BUN) (84520)",167,151,31,162,109,100,106,105,89,112,92,162,31 80074,"Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709), Hepatitis B core antibody (HBcAb), IgM antibody (86705), Hepatitis B surface antigen (HBsAg) (87340), Hepatitis C antibody (86803)",356,320,67,345,223,229,196,224,89,239,196,345,67 80076,"Hepatic function panel This panel must include the following: Albumin (82040), Bilirubin, total (82247), Bilirubin, direct (82248), Phosphatase, alkaline (84075), Protein, total (84155), Transferase, alanine amino (ALT) (SGPT) (84460), Transferase, aspartate amino (AST) (SGOT) (84450)",128,115,24,124,82,76,88,82,57,86,70,124,24 80081,HC OBSTETRIC PANEL W HIV TEST,214,193,40,208,132,138,149,131,73,144,118,208,40 80156,Carbamazepine; total,129,116,24,125,78,83,82,81,53,99,71,125,24 80162,Digoxin,137,123,26,133,88,82,86,86,61,92,75,133,26 80164,Dipropylacetic acid (valproic acid),129,116,13,125,13,75,101,49,53,87,71,125,24 80169,HC DRUG SCREEN QUANT EVEROLIMUS,287,258,54,278,183,185,181,180,118,193,158,278,54 80175,HC DRUG SCREEN QUANT LAMOTRIGINE,83,75,16,81,51,53,52,64,34,56,46,81,16 80177,Drug Screen quantitative Levetiracetam level,79,71,15,76,32,49,50,49,32,53,43,76,15 80178,Lithium,86,77,7,83,7,55,65,61,35,58,47,83,16 80180,HC DRUG SCREEN QUANT MYCOPHENOLATE,100,90,19,97,62,60,63,63,41,67,55,97,19 80185,Phenytoin; total,132,118,13,128,13,85,83,83,54,88,72,128,25 80195,Sirolimus,107,96,20,104,66,64,68,67,44,72,59,104,20 80197,Tacrolimus,138,124,26,134,86,83,87,86,58,92,76,134,26 80200,Tobramycin,52,47,10,50,33,34,33,33,21,35,29,50,10 80202,Vancomycin,158,142,30,153,100,102,100,99,65,106,87,153,30 80299,"Quantitation of drug, not elsewhere specified",109,98,20,106,67,70,69,42,45,73,60,106,20 80307,Drug Test presumptive,147,132,28,143,94,88,100,99,113,74,81,143,28 80320,Drug screen quantitative alcohols 22 or more classes,109,98,20,106,67,65,38,75,45,70,60,106,20 80329,HC DRUG TEST DEF 1-2 CLASS ANALGESICS NON-OPIOID,156,140,29,151,96,101,54,107,64,101,86,151,29 80346,HC DRUG TEST DEF 8-12 CLASS BENZODIAZEPINES,66,60,12,64,41,40,41,40,27,45,36,64,12 80349,HC DRUG TEST DEF 22+ CLASS CANNABINOIDS NATURAL,50,45,9,48,31,30,33,23,21,34,27,48,9 80359,HC DRUG TEST DEF 22+ CLASS METHYLENEDIOXYAMPHETAMINES,48,43,9,47,30,31,30,29,20,32,26,47,9 80361,HC DRUG TEST DEF 22+ CLASS OPIATES,31,28,6,30,19,19,19,19,13,21,17,30,6 81000,"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-automated, with microscopy",53,48,10,51,33,33,33,34,27,36,29,51,10 81002,"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-automated, without microscopy",37,33,7,36,24,22,23,22,21,22,20,36,7 81015,Urinalysis; microscopic only,32,28,6,31,20,19,22,19,13,21,17,31,6 82010,"Acetone or other ketone bodies, serum; quantitative",50,45,9,48,32,32,33,31,21,34,27,48,9 82024,Adrenocorticotropic hormone (ACTH),98,88,18,95,38,63,62,62,40,66,54,95,18 82040,"Albumin; serum, plasma or whole blood",61,55,11,59,39,38,38,38,25,41,34,59,11 82043,"Albumin; urine, microalbumin, quantitative",93,84,17,90,60,56,73,55,27,62,51,90,17 82085,Aldolase,40,36,7,39,25,26,28,25,16,27,22,39,7 82088,Aldosterone,128,115,24,124,79,82,67,80,53,86,70,124,24 82103,Alpha-1-antitrypsin; total,59,53,11,57,38,38,37,37,24,40,33,57,11 82104,Alpha-1-antitrypsin; phenotype,58,52,11,56,37,37,37,37,24,39,32,56,11 82105,Alpha-fetoprotein (AFP); serum,60,54,11,58,37,39,42,38,25,40,33,58,11 82140,Ammonia,115,104,22,112,74,69,73,72,47,77,63,112,22 82150,Amylase,103,93,19,100,66,83,71,73,61,69,57,100,19 82247,Bilirubin; total,82,73,15,79,50,53,51,50,32,55,45,79,15 82248,Bilirubin; direct,37,33,7,36,24,23,25,22,21,25,20,36,7 82306,"Vitamin D; 25 hydroxy, includes fraction(s), if performed",75,68,14,73,48,47,47,52,31,46,42,73,14 82308,Calcitonin,86,77,16,83,27,55,54,54,35,58,47,83,16 82310,Calcium; total,66,60,12,64,42,41,42,42,30,45,36,64,12 82330,Calcium; ionized,45,40,8,44,28,29,28,28,18,30,25,44,8 82340,"Calcium; urine quantitative, timed specimen",36,32,7,35,22,21,23,22,15,24,20,35,7 82355,Calculus; qualitative analysis,57,51,11,55,35,37,45,36,23,38,31,55,11 82374,Carbon dioxide (bicarbonate),78,70,15,75,49,47,49,49,32,52,43,75,15 82378,Carcinoembryonic antigen (CEA),119,107,22,115,76,77,75,75,49,80,65,115,22 82384,Catecholamines; fractionated,105,94,20,102,67,68,66,66,43,71,58,102,20 82495,Chromium,57,52,11,56,37,37,36,36,24,39,32,56,11 82525,Copper,47,42,9,46,30,30,30,30,19,32,26,46,9 82530,Cortisol; free,76,68,14,74,47,49,53,48,61,51,42,74,14 82542,"Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase",302,272,57,293,186,195,191,190,86,203,166,293,57 82550,"Creatine kinase (CK), (CPK); total",103,93,19,100,65,64,53,70,33,69,57,100,19 82553,"Creatine kinase (CK), (CPK); MB fraction only",121,109,23,117,75,78,55,76,50,81,66,117,23 82565,Creatinine; blood,70,63,13,68,45,42,53,48,32,47,39,68,13 82570,Creatinine; other source,73,66,14,71,46,44,57,43,33,49,40,71,14 82607,Cyanocobalamin (Vitamin B-12);,90,81,17,87,57,55,62,61,55,55,49,87,17 82652,"Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed",115,104,22,113,74,69,83,72,113,77,63,112,22 82656,"Elastase, pancreatic (EL-1), fecal, qualitative or semi-quantitative",145,130,27,141,90,93,92,91,50,97,80,141,27 82668,Erythropoietin,86,77,16,83,53,55,54,54,50,58,47,83,16 82670,Estradiol,219,197,41,213,140,141,139,134,64,147,121,213,41 82677,Estriol,55,50,10,53,34,35,38,32,23,37,30,53,10 82710,"Fat or lipids, feces; quantitative",81,73,15,78,50,52,51,49,33,54,44,78,15 82728,Ferritin,103,93,19,100,66,64,64,68,64,69,57,100,19 82746,Folic acid; serum,119,107,22,115,76,71,75,75,56,80,65,115,22 82784,"Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each",46,41,9,81,29,30,22,81,50,31,25,45,9 82785,Gammaglobulin (immunoglobulin); IgE,44,40,8,43,27,28,28,26,18,30,24,43,8 82803,"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);",243,218,45,235,155,151,160,166,100,165,133,235,45 82945,"Glucose, body fluid, other than blood",20,18,4,20,13,13,14,13,20,14,11,20,4 82951,"Glucose; tolerance test (GTT), 3 specimens (includes glucose)",114,103,21,111,71,74,86,70,78,77,63,111,21 82952,"Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)",50,45,9,48,31,32,38,31,39,34,27,48,9 82977,"Glutamyltransferase, gamma (GGT)",87,79,16,85,55,56,59,55,23,59,48,85,16 83001,Gonadotropin; follicle stimulating hormone (FSH),84,75,16,81,52,54,68,59,45,56,46,81,16 83002,Gonadotropin; luteinizing hormone (LH),54,49,10,52,33,35,41,33,22,36,30,52,10 83003,"Growth hormone, human (HGH) (somatotropin)",43,39,8,42,16,28,27,27,18,29,24,42,8 83010,Haptoglobin; quantitative,74,67,14,72,46,45,47,51,31,50,41,72,14 83018,"Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each",275,247,51,266,176,177,174,172,113,184,151,266,51 83036,Hemoglobin; glycosylated (A1C),99,89,19,96,63,62,69,70,50,60,54,96,19 83090,Homocysteine,91,82,17,88,57,58,57,57,37,61,50,88,17 83516,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method",170,153,28,165,105,110,136,28,52,115,94,165,32 83520,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified",185,166,27,179,118,111,111,60,27,124,102,179,35 83525,Insulin; total,49,44,9,48,31,32,38,31,20,33,27,48,9 83540,Iron,47,42,9,46,30,30,30,30,19,32,26,46,9 83550,Iron binding capacity,93,84,17,90,60,56,62,61,43,62,51,90,17 83605,Lactate (lactic acid),40,36,7,39,25,24,16,24,16,27,22,39,7 83615,"Lactate dehydrogenase (LD), (LDH);",75,68,14,73,48,45,42,52,20,51,42,73,14 83655,Lead,41,37,8,41,25,40,32,26,41,28,23,40,8 83690,Lipase,86,77,16,83,55,53,35,52,30,58,47,83,16 83735,Magnesium,136,122,23,132,87,85,55,83,23,88,75,132,25 83789,"Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; quantitative, each specimen",147,132,28,142,91,95,93,100,60,99,81,142,28 83835,Metanephrines,149,134,28,144,93,96,105,93,61,100,82,144,28 83874,Myoglobin,68,62,13,66,42,44,47,43,43,46,38,66,13 83880,Natriuretic peptide,96,86,18,93,61,60,66,34,39,64,53,93,18 83883,"Nephelometry, each analyte not elsewhere specified",170,153,32,165,111,100,107,107,70,114,93,165,32 83921,"Organic acid, single, quantitative",125,112,23,122,78,122,79,79,51,84,69,121,23 83930,Osmolality; blood,36,32,7,35,23,22,23,22,15,24,20,35,7 83935,Osmolality; urine,36,32,7,35,23,23,23,22,15,24,20,35,7 83970,Parathormone (parathyroid hormone),86,77,16,83,54,51,54,54,35,58,47,83,16 83993,"Calprotectin, fecal",264,238,50,256,163,170,167,166,145,177,145,256,50 84030,"Phenylalanine (PKU), blood",86,77,16,83,53,55,54,54,33,58,47,83,16 84075,"Phosphatase, alkaline;",66,60,11,64,42,40,41,42,11,45,36,64,12 84078,"Phosphatase, alkaline; heat stable (total not included)",41,37,8,39,25,26,26,26,23,27,22,39,8 84100,Phosphorus inorganic (phosphate);,103,93,17,100,66,64,36,67,17,69,57,100,19 84110,"Porphobilinogen, urine; quantitative",67,61,13,65,42,43,43,23,28,45,37,65,13 84132,"Potassium; serum, plasma or whole blood",70,63,13,68,44,42,49,50,33,47,39,68,13 84133,Potassium; urine,12,11,2,12,8,8,4,8,5,8,7,12,2 84144,Progesterone,136,122,25,132,84,87,86,83,50,91,75,132,25 84146,Prolactin,127,114,24,123,78,82,89,80,52,85,70,123,24 84153,Prostate specific antigen (PSA); total,129,116,24,125,83,77,82,88,50,87,71,125,24 84154,Prostate specific antigen (PSA); free,180,162,34,175,115,116,114,113,74,121,99,175,34 84155,"Protein, total, except by refractometry; serum, plasma or whole blood",37,33,7,36,23,22,23,22,30,25,20,36,7 84156,"Protein, total, except by refractometry; urine",54,49,10,52,35,32,34,34,22,36,30,52,10 84165,"Protein; electrophoretic fractionation and quantitation, serum",37,34,7,36,24,22,24,22,15,25,21,36,7 84206,Proinsulin,97,87,18,94,62,62,61,61,40,65,53,94,18 84244,Renin,71,64,13,69,44,46,49,45,29,48,39,69,13 84295,"Sodium; serum, plasma or whole blood",86,77,16,83,54,51,54,54,30,58,47,83,16 84300,Sodium; urine,29,26,5,28,18,18,24,18,12,19,16,28,5 84311,"Spectrophotometry, analyte not elsewhere specified",62,56,12,61,39,40,39,21,26,42,34,61,12 84402,Testosterone; free,76,69,14,75,49,75,53,49,58,62,42,74,14 84403,Testosterone; total,181,162,32,175,116,143,125,110,32,145,99,175,34 84425,Thiamine (Vitamin B-1),162,146,30,157,100,97,102,102,67,109,89,157,30 84432,Thyroglobulin,38,34,7,37,24,24,30,24,16,26,21,37,7 84436,Thyroxine; total,37,33,7,37,23,37,23,23,15,25,21,36,7 84439,Thyroxine; free,103,93,19,100,66,64,71,73,52,63,57,100,19 84443,Thyroid stimulating hormone (TSH),135,121,25,131,86,84,93,92,47,82,76,131,25 84450,Transferase; aspartate amino (AST) (SGOT),86,77,16,83,55,52,70,52,17,58,47,83,16 84460,Transferase; alanine amino (ALT) (SGPT),86,77,16,83,55,52,70,52,17,58,47,83,16 84466,Transferrin,45,40,8,44,29,29,28,28,18,30,25,44,8 84480,Triiodothyronine T3; total (TT-3),107,96,20,104,68,63,78,82,26,72,59,104,20 84481,Triiodothyronine T3; free,72,65,14,70,46,43,45,50,28,49,40,70,14 84482,Triiodothyronine T3; reverse,65,59,12,63,40,42,41,41,55,44,36,63,12 84484,"Troponin, quantitative",177,160,33,172,114,111,110,121,46,119,98,172,33 84520,Urea nitrogen; quantitative,45,40,8,44,30,27,31,29,16,30,25,44,8 84550,Uric acid; blood,74,67,14,72,47,44,50,51,30,50,41,72,14 84630,Zinc,47,42,9,46,30,30,30,30,19,32,26,46,9 84681,C-peptide,68,62,13,66,45,41,52,45,43,46,38,66,13 84702,"Gonadotropin, chorionic (hCG); quantitative",129,116,24,125,79,83,83,83,53,86,71,125,24 84703,"Gonadotropin, chorionic (hCG); qualitative",89,80,17,87,57,87,53,52,23,63,49,86,17 85007,"Blood count; blood smear, microscopic examination with manual differential WBC count",50,45,9,48,30,32,33,31,21,33,27,48,9 85014,Blood count; hematocrit (Hct),37,33,7,36,23,22,30,26,35,25,20,36,7 85018,Blood count; hemoglobin (Hgb),32,28,6,31,20,19,26,25,19,21,17,31,6 85025,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count",103,93,19,100,66,64,64,63,36,66,58,100,19 85027,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)",75,68,14,73,46,45,56,51,36,50,41,73,14 85045,"Blood count; reticulocyte, automated",51,46,10,51,33,51,32,34,19,34,28,49,10 85048,"Blood count; leukocyte (WBC), automated",42,38,8,41,14,25,29,26,17,28,23,41,8 85049,"Blood count; platelet, automated",37,33,7,36,23,22,23,23,15,25,20,36,7 85060,"Blood smear, peripheral, interpretation by physician with written report",52,47,10,50,33,30,35,35,21,35,29,50,10 85379,"Fibrin degradation products, D-dimer; quantitative",156,140,29,151,100,95,103,56,63,105,86,151,29 85610,Prothrombin time;,60,54,11,58,39,36,42,41,27,40,33,58,11 85613,Russell viper venom time (includes venom); diluted,106,95,20,103,65,68,67,62,44,71,58,103,20 85651,"Sedimentation rate, erythrocyte; non-automated",53,48,10,51,34,33,37,32,20,32,29,51,10 85730,"Thromboplastin time, partial (PTT); plasma or whole blood",70,63,13,68,45,42,46,48,27,47,39,68,13 86003,"Allergen specific IgE; quantitative or semiquantitative, each allergen",21,19,4,20,13,13,13,13,8,14,11,20,4 86038,Antinuclear antibodies (ANA);,98,88,18,95,64,60,66,62,53,58,54,95,18 86060,Antistreptolysin 0; titer,73,66,14,71,45,47,46,46,30,49,40,71,14 86140,C-reactive protein;,53,48,10,51,34,33,33,32,47,32,29,51,10 86147,"Cardiolipin (phospholipid) antibody, each Ig class",94,85,18,91,58,61,59,55,39,63,52,91,18 86161,"Complement; functional activity, each component",110,99,21,107,70,71,70,73,45,74,60,107,21 86200,"Cyclic citrullinated peptide (CCP), antibody",79,71,15,77,51,47,52,56,26,53,43,77,15 86225,Deoxyribonucleic acid (DNA) antibody; native or double stranded,50,45,9,48,31,32,32,32,21,34,27,48,9 86235,"Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody",220,198,41,214,136,142,139,151,91,148,121,214,41 86255,"Fluorescent noninfectious agent antibody; screen, each antibody",39,35,7,38,24,25,25,36,16,26,21,38,7 86256,"Fluorescent noninfectious agent antibody; titer, each antibody",54,49,10,52,33,35,34,34,45,36,30,52,10 86301,"Immunoassay for tumor antigen, quantitative; CA 19-9",50,45,9,48,32,32,32,31,21,34,27,48,9 86308,Heterophile antibodies; screening,74,67,14,72,47,48,39,51,53,50,41,72,14 86334,Immunofixation electrophoresis; serum,79,71,15,77,51,51,50,50,33,53,44,77,15 86336,Inhibin A,55,50,10,53,34,35,38,35,23,37,30,53,10 86337,Insulin antibodies,51,46,10,49,33,33,32,32,21,34,28,49,10 86376,"Microsomal antibodies (eg, thyroid or liver-kidney), each",64,58,12,62,41,38,40,42,26,43,35,62,12 86430,Rheumatoid factor; qualitative,76,68,14,74,49,46,51,54,27,51,42,74,14 86480,"Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon",129,116,24,125,83,77,94,85,90,87,71,125,24 86606,Antibody; Aspergillus,51,46,10,49,32,33,32,32,21,34,28,49,10 86611,Antibody; Bartonella,103,93,19,100,67,61,70,67,33,69,57,100,19 86618,Antibody; Borrelia burgdorferi (Lyme disease),132,118,25,128,88,79,91,80,52,88,72,128,25 86664,"Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)",21,19,4,20,13,13,13,12,9,14,11,20,4 86665,"Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)",20,18,4,20,13,13,13,12,8,14,11,20,4 86666,Antibody; Ehrlichia,105,94,20,102,67,99,70,67,33,71,58,102,20 86695,"Antibody; herpes simplex, type 1",72,65,13,70,44,46,46,55,47,48,40,70,13 86696,"Antibody; herpes simplex, type 2",72,65,13,70,44,46,46,55,24,48,40,70,13 86703,"Antibody; HIV-1 and HIV-2, single assay",61,55,11,59,41,39,42,49,49,41,34,59,11 86704,Hepatitis B core antibody (HBcAb); total,90,81,17,87,60,56,57,63,52,60,49,87,17 86706,Hepatitis B surface antibody (HBsAb),48,43,9,66,46,37,66,37,27,32,26,47,9 86708,Hepatitis A antibody (HAAb); total,51,46,10,49,31,33,32,32,27,34,28,49,10 86709,Hepatitis A antibody (HAAb); IgM antibody,100,90,19,97,62,64,63,65,27,67,55,97,19 86735,Antibody; mumps,89,80,17,86,55,57,56,56,52,60,49,86,17 86762,Antibody; rubella,107,96,20,104,66,69,68,67,26,72,59,104,20 86765,Antibody; rubeola,40,36,7,39,25,26,25,25,26,27,22,39,7 86769,HC SARS-COV-2 COVID-19 ANTIBODY,90,81,17,87,58,54,43,57,63,60,49,87,17 86787,Antibody; varicella-zoster,80,72,13,77,13,51,50,50,33,53,44,77,15 86800,Thyroglobulin antibody,45,40,8,44,29,27,28,28,19,30,25,44,8 86803,Hepatitis C antibody;,89,80,17,86,57,53,59,59,45,60,49,86,17 86812,"HLA typing; A, B, or C (eg, A10, B7, B27), single antigen",74,67,14,72,46,48,47,46,31,50,41,72,14 86850,"Antibody screen, RBC, each serum technique",95,85,18,92,60,58,39,60,54,64,52,92,18 86880,"Antihuman globulin test (Coombs test); direct, each antiserum",81,73,15,79,52,52,51,51,33,54,45,79,15 86900,Blood typing; ABO,61,55,11,59,39,37,25,38,54,41,34,59,11 86901,Blood typing; Rh (D),90,81,17,87,57,55,37,56,34,60,49,87,17 86922,Compatibility test each unit; antiglobulin technique,262,236,49,254,165,160,135,165,108,176,144,254,49 87040,"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)",177,160,33,172,114,106,110,108,105,119,98,172,33 87045,"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species",114,102,21,110,71,65,76,76,37,76,62,110,21 87070,"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates",103,93,18,100,65,62,71,82,18,69,57,100,19 87075,"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates",103,93,19,100,66,66,65,65,42,69,57,100,19 87077,"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate",90,81,17,87,57,56,62,61,37,55,49,87,17 87081,"Culture, presumptive, pathogenic organisms, screening only;",72,65,7,83,7,83,45,44,33,67,40,70,14 87086,"Culture, bacterial; quantitative colony count, urine",103,93,19,100,66,64,71,63,34,82,57,100,19 87088,"Culture, bacterial; with isolation and presumptive identification of each isolate, urine",95,85,17,92,61,59,66,58,17,64,52,92,18 87102,"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)",103,93,19,103,66,103,71,70,34,58,57,100,19 87147,"Culture, typing; immunologic method, other than immunofluoresence (eg, agglutination grouping), per antiserum",21,19,4,20,13,13,13,13,9,14,11,20,4 87169,Macroscopic examination; parasite,75,68,4,73,4,48,26,44,31,50,41,73,14 87177,"Ova and parasites, direct smears, concentration and identification",60,54,11,58,38,39,38,37,25,40,33,58,11 87188,"Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent",103,93,17,100,66,64,71,70,17,69,57,100,19 87205,"Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types",63,57,12,61,40,39,44,44,18,36,35,61,12 87324,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)",103,93,19,100,65,62,71,65,41,69,57,100,19 87328,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; cryptosporidium",58,52,11,56,37,34,39,39,27,39,32,56,11 87329,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; giardia",95,86,18,92,58,55,64,64,27,64,52,92,18 87338,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool",82,73,15,80,33,80,59,57,52,55,45,79,15 87340,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)",89,80,17,86,57,53,65,55,29,60,49,86,17 87400,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Influenza, A or B, each",78,70,15,96,50,50,96,49,32,52,43,75,15 87426,HC CORONAVIRUS AG IA,55,50,10,53,35,33,43,42,15,37,30,53,10 87450,"Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; single step method, not otherwise specified, each organism",91,82,17,88,34,59,61,62,37,61,50,88,17 87491,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique",123,111,23,120,77,77,86,75,54,64,68,120,23 87497,"Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification",162,146,30,157,100,104,101,102,115,109,89,157,30 87507,HC IADNA-DNA/RNA PROBE TQ 12-25,779,701,115,756,481,502,492,489,115,523,428,756,146 87522,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification",292,263,55,283,180,188,184,200,120,196,160,283,55 87536,"Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification",199,179,37,193,123,128,126,125,92,134,109,193,37 87591,"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique",123,111,23,120,77,77,86,75,38,64,68,120,23 87624,PBB HPV HIGH-RISK TYPES,53,48,10,51,33,33,38,34,22,36,29,51,10 87635,Infectious agent detection by nucleic acid; severe acute respiratory syndrome coronavirus COVID-19,110,99,21,107,70,66,52,51,77,74,60,107,21 87799,"Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism",211,190,40,205,135,136,133,133,87,142,116,205,40 87880,"Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A",91,82,17,88,56,59,36,57,37,61,50,88,17 87899,Infectious agent antigen detection by immunoassay with direct optical observation; not otherwise specified,55,50,10,53,35,33,43,38,34,37,30,53,10 88304,"Level III - Surgical pathology, gross and microscopic examination Abortion, induced, Abscess, Aneurysm - arterial/ventricular, Anus, tag, Appendix, other than incidental, Artery, atheromatous plaque, Bartholin's gland cyst, Bone fragment(s), other than pathologic fracture, Bursa/synovial cyst, Carpal tunnel tissue, Cartilage, shavings, Cholesteatoma, Colon, colostomy stoma, Conjunctiva - biopsy/pterygium, Cornea, Diverticulum - esophagus/small intestine, Dupuytren's contracture tissue, Femoral head, other than fracture, Fissure/fistula, Foreskin, other than newborn, Gallbladder, Ganglion cyst, Hematoma, Hemorrhoids, Hydatid of Morgagni, Intervertebral disc, Joint, loose body, Meniscus, Mucocele, salivary, Neuroma - Morton's/traumatic, Pilonidal cyst/sinus, Polyps, inflammatory - nasal/sinusoidal, Skin - cyst/tag/debridement, Soft tissue, debridement, Soft tissue, lipoma, Spermatocele, Tendon/tendon sheath, Testicular appendage, Thrombus or embolus, Tonsil and/or adenoids, Varicocele, Vas deferens, other than sterilization, Vein, varicosity",201,181,38,195,129,129,127,126,83,135,110,195,38 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, biopsy, not requiring microscopic evaluation of surgical margins, Breast, reduction mammoplasty, Bronchus, biopsy, Cell block, any source, Cervix, biopsy, Colon, biopsy, Duodenum, biopsy, Endocervix, curettings/biopsy, Endometrium, curettings/biopsy, Esophagus, biopsy, Extremity, amputation, traumatic, Fallopian tube, biopsy, Fallopian tube, ectopic pregnancy, Femoral head, fracture, Fingers/toes, amputation, non-traumatic, Gingiva/oral mucosa, biopsy, Heart valve, Joint, resection, Kidney, biopsy, Larynx, biopsy, Leiomyoma(s), uterine myomectomy - without uterus, Lip, biopsy/wedge resection, Lung, transbronchial biopsy, Lymph node, biopsy, Muscle, biopsy, Nasal mucosa, biopsy, Nasopharynx/oropharynx, biopsy, Nerve, biopsy, Odontogenic/dental cyst, Omentum, biopsy, Ovary with or without tube, non-neoplastic, Ovary, biopsy/wedge resection, Parathyroid gland, Peritoneum, biopsy, Pituitary tumor, Placenta, other than third trimester, Pleura/pericardium - biopsy/tissue, Polyp, cervical/endometrial, Polyp, colorectal, Polyp, stomach/small intestine, Prostate, needle biopsy, Prostate, TUR, Salivary gland, biopsy, Sinus, paranasal biopsy, Skin, other than cyst/tag/debridement/plastic repair, Small intestine, biopsy, Soft tissue, other than tumor/mass/lipoma/debridement, Spleen, Stomach, biopsy, Synovium, Testis, other than tumor/biopsy/castration, Thyroglossal duct/brachial cleft cyst, Tongue, biopsy, Tonsil, biopsy, Trachea, biopsy, Ureter, biopsy, Urethra, biopsy, Urinary bladder, biopsy, Uterus, with or without tubes and ovaries, for prolapse, Vagina, biopsy, Vulva/labia, biopsy",268,241,50,260,172,167,170,213,110,180,148,260,50 88342,"Immunohistochemistry (including tissue immunoperoxidase), each antibody",195,176,37,189,137,117,123,122,80,131,107,189,37 88364,HC INSITU HYBRIDIZATION (FISH) EA ADDTL SGL PROC,109,98,20,106,70,70,69,69,45,73,60,106,20 88365,"In situ hybridization (eg, FISH), each probe",165,149,31,160,106,106,104,104,68,111,91,160,31 89051,"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count",58,52,11,56,36,35,37,37,24,39,32,56,11 89060,"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)",29,26,5,28,18,17,18,18,12,19,16,28,5 90375,"Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use",7065,6358,1324,6853,3018,4552,5549,4438,4871,4746,3885,6853,1324 90471,"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)",185,166,35,179,118,119,145,116,36,124,102,179,35 90651,PBB 9VHPV VACCINE 2/3 DOSE IM,246,222,46,239,152,159,156,155,239,165,135,239,46 90670,"Pneumococcal conjugate vaccine, 13 valent, for intramuscular use",231,208,43,230,143,230,146,145,95,155,127,224,43 90675,"Rabies vaccine, for intramuscular use",377,339,71,366,241,243,296,237,292,253,207,366,71 90686,Influenza virus vaccine,30,27,6,29,19,20,12,21,12,20,16,29,6 90714,"Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use",63,57,12,61,40,41,40,40,26,43,35,61,12 90715,"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use",75,67,14,72,48,45,49,57,34,50,41,72,14 90732,"Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use",132,119,25,128,82,120,83,83,54,89,73,128,25 90746,"Hepatitis B vaccine, adult dosage, for intramuscular use",152,137,29,148,97,98,96,96,63,102,84,148,29 90792,PBB PSYCH DIAG EVAL W/MED SRVCS,382,344,72,371,218,246,242,240,158,257,210,371,72 92507,"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual",259,233,49,251,160,180,203,198,107,174,142,251,49 92523,HC EVAL SPEECH SOUND LANG COMPREHEN,453,408,85,439,280,272,302,285,187,304,249,439,85 92610,Evaluation of oral and pharyngeal swallowing function,280,252,53,272,177,181,177,176,116,188,154,272,53 92960,"Cardioversion, elective, electrical conversion of arrhythmia; external",168,151,31,163,108,101,106,106,69,113,92,163,31 93005,"Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report",256,230,48,248,170,160,159,175,91,156,141,248,48 93010,"Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only",51,46,9,52,9,33,32,32,52,34,28,49,10 93225,"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)",349,314,65,338,228,209,251,213,336,234,192,338,65 93226,External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report,752,677,141,729,491,451,541,459,168,505,413,729,141 93227,External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; physician review and interpretation,212,191,29,206,29,137,134,133,87,143,117,206,40 93270,"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)",227,205,43,221,145,147,164,156,94,153,125,221,43 93272,"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; physician review and interpretation",57,51,11,55,27,37,36,36,24,38,31,55,11 93306,"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography",1106,995,207,1073,708,664,699,695,456,743,608,1073,207 93798,Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session),303,273,57,294,194,182,191,190,255,204,167,294,57 93880,Duplex scan of extracranial arteries; complete bilateral study,1421,1279,168,1378,909,887,898,1131,168,954,781,1378,266 93922,"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 arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels)",562,506,105,545,359,362,355,353,231,377,309,545,105 93925,Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study,943,849,177,915,604,566,596,592,388,633,519,915,177 93970,Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study,1573,1416,295,1526,993,981,994,1076,648,1057,865,1526,295 93971,Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study,855,769,160,829,547,513,540,521,362,574,470,829,160 93975,"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study",812,731,152,788,501,641,513,510,334,545,446,788,152 94002,"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day",1754,1579,329,1702,1107,1095,1433,1102,723,1179,965,1702,329 94003,"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day",1237,1113,232,1200,764,742,972,777,510,831,680,1200,232 94010,"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation",272,245,51,264,170,163,214,171,112,183,150,264,51 94060,"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration",740,666,139,718,474,427,581,566,282,497,407,718,139 94618,HC PULMONARY STRESS TESTING,403,363,75,395,263,395,255,253,166,271,222,391,75 94640,"Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device)",551,496,103,534,353,330,208,196,262,370,303,534,103 94660,"Continuous positive airway pressure ventilation (CPAP), initiation and management",138,124,26,134,88,84,87,86,57,92,76,134,26 94667,"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation",128,115,24,124,80,78,104,80,53,86,70,124,24 94668,"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent",110,99,21,107,67,66,70,69,45,74,60,107,21 94726,PBB PULM FUNCT TST PLETHYSMOGRAP,188,169,35,182,118,113,130,118,77,126,103,182,35 94729,HC C0/MEMBRANE DIFFUSE CAPACITY,230,207,43,223,147,133,181,176,141,155,126,223,43 95004,"Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests",800,720,150,776,512,515,506,569,330,537,440,776,150 95992,"Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day",149,134,28,145,95,96,94,94,61,100,82,145,28 96105,"Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour",336,303,63,326,208,206,212,225,138,226,185,326,63 96360,"Intravenous infusion, hydration; initial, 31 minutes to 1 hour",350,315,66,339,222,210,243,213,195,235,192,339,66 96361,"Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)",172,155,32,277,110,169,115,107,277,116,95,167,32 96365,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour",350,315,66,339,224,218,143,239,195,235,192,339,66 96366,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)",172,155,32,167,110,103,93,101,71,116,95,167,32 96367,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure)",190,171,36,184,121,173,77,116,177,127,104,184,36 96368,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)",190,171,36,184,121,116,66,87,78,127,104,184,36 96372,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",121,109,23,117,77,73,48,71,38,79,67,117,23 96374,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug",166,150,31,161,106,104,103,59,68,133,91,161,31 96375,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)",97,87,18,117,117,58,76,66,40,75,53,94,18 96376,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)",97,87,18,94,62,58,64,63,40,65,53,94,18 96523,Irrigation of implanted venous access device for drug delivery systems,195,175,37,189,120,117,123,122,80,131,107,189,37 97033,"Application of a modality to 1 or more areas; iontophoresis, each 15 minutes",113,102,21,110,71,68,70,71,47,76,62,110,21 97035,"Application of a modality to 1 or more areas; ultrasound, each 15 minutes",89,80,17,86,59,53,62,61,37,60,49,86,17 97110,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility",190,171,36,149,120,114,78,84,149,114,104,92,36 97112,"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 activities",171,154,32,166,68,103,108,108,71,115,94,166,32 97116,"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)",95,85,18,92,60,57,66,60,39,64,52,92,18 97129,HC THER IVNTJ COG FUNCJ 1ST 15 MIN,108,97,20,105,69,70,68,68,44,73,59,105,20 97140,"Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes",89,80,17,149,55,53,59,68,149,60,49,83,17 97161,Physical Therapy Evaluation of low complexity,231,207,43,224,148,138,188,184,149,185,127,224,43 97162,Physical Therapy Evaluation of moderate complexity,231,207,43,224,153,141,160,158,149,155,127,224,43 97164,Physical Therapy Re-Evaluation of an established plan of care,51,46,10,49,33,31,32,33,21,34,28,49,10 97165,HC OT EVAL LOW COMPLEX,218,196,41,212,138,141,138,149,139,147,120,212,41 97166,HC OT EVAL MOD COMPLEX,227,204,43,220,145,136,143,174,93,152,125,220,43 97167,HC OT EVAL HIGH COMPLEX,218,196,41,212,135,131,138,137,90,147,120,212,41 97530,"Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes",108,97,20,105,69,65,85,68,44,73,59,105,20 97535,"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/adaptive equipment) direct one-on-one contact by provider, each 15 minutes",91,82,17,88,60,58,63,57,37,61,50,88,17 97750,"Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes",154,139,29,149,99,89,97,97,63,103,85,149,29 97760,"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",252,227,47,244,161,162,159,158,104,169,139,244,47 97763,HC ORTH/PROSTH MGMT SUBQ ENC 15M,92,83,17,89,60,59,58,62,38,62,50,89,17 99070,"Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)",6,5,1,6,4,4,4,4,2,4,3,6,1 99199,"Unlisted special service, procedure or report",3,3,1,3,2,2,2,2,3,2,2,3,1 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 examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family.",205,184,38,199,186,136,130,129,84,138,113,199,38 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 complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.",306,275,57,297,206,136,158,192,126,206,168,297,57 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.",355,320,67,344,210,136,224,223,146,238,195,344,67 99211,"Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.",177,160,33,172,118,106,110,111,73,119,98,172,33 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 examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.",279,252,52,271,198,136,110,176,115,188,154,271,52 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 problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.",149,134,28,174,174,136,57,33,61,100,82,145,28 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 decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.",248,223,46,241,192,136,83,67,102,167,136,241,46 99217,"Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from ""observation status"" if the discharge is on other than the initial date of ""observation status."" To report services to a patient designated as ""observation status"" or ""inpatient status"" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])",317,285,59,308,77,204,200,199,131,213,174,308,59 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; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to ""observation status"" are of low severity.",304,274,57,295,94,196,192,191,125,204,167,295,57 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to ""observation status"" are of moderate severity.",514,463,96,499,147,331,325,323,212,345,283,499,96 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 making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to ""observation status"" are of high severity.",709,638,133,688,205,457,448,445,292,476,390,688,133 99224,"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 examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.",85,76,16,82,42,55,54,53,35,57,47,82,16 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 comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of low severity.",473,426,89,459,122,305,299,297,195,318,260,459,89 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 decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.",203,183,38,197,135,127,83,72,84,136,112,197,38 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 Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.",273,246,51,265,173,164,170,167,113,184,150,265,51 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 Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.",377,340,102,384,239,236,154,150,384,257,208,366,102 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 complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.",536,482,100,519,340,321,219,213,476,429,294,519,100 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/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.",750,675,140,727,480,468,466,457,515,504,412,727,140 99291,"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes",1359,1223,255,1318,858,848,790,853,607,913,747,1318,255 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)",1000,900,173,970,627,644,173,628,412,672,550,970,187 99304,"Initial nursing facility 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; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes at the bedside and on the patient's facility floor or unit.",265,239,50,257,198,171,168,167,109,178,146,257,50 99305,"Initial nursing facility 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes at the bedside and on the patient's facility floor or unit.",382,344,72,371,218,136,242,240,158,257,210,371,72 99307,"Subsequent nursing facility 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 examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 10 minutes at the bedside and on the patient's facility floor or unit.",115,104,22,155,155,74,73,72,47,77,63,112,22 99308,"Subsequent nursing facility 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 problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 15 minutes at the bedside and on the patient's facility floor or unit.",167,151,31,175,175,136,106,105,69,112,92,162,31 99309,"Subsequent nursing facility 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 decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Physicians typically spend 25 minutes at the bedside and on the patient's facility floor or unit.",250,225,47,242,192,136,158,157,103,168,137,242,47 99315,Nursing facility discharge day management; 30 minutes or less,257,231,48,249,196,136,162,161,106,173,141,249,48 99316,Nursing facility discharge day management; more than 30 minutes,321,289,60,312,195,207,203,202,132,216,177,312,60 99324,"Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes with the patient and/or family or caregiver.",185,166,35,179,173,119,117,116,76,124,102,179,35 99325,"Domiciliary or rest home 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 examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or caregiver.",225,203,42,219,181,136,142,142,93,151,124,219,42 99334,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver.",167,151,31,175,175,136,33,33,69,112,92,162,31 99335,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver.",204,184,38,198,172,136,38,128,84,137,112,198,38 99336,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver.",257,231,48,249,182,166,162,161,106,173,141,249,48 99347,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family.",186,167,35,181,181,120,118,117,77,125,102,180,35 99348,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.",227,205,43,221,187,147,144,143,94,153,125,221,43 99395,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years",201,181,38,195,124,129,88,126,83,135,110,195,38 99396,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years",201,181,38,195,124,136,98,126,83,135,110,195,38 99397,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older",237,213,44,230,146,136,150,149,98,159,130,230,44 A0000,,80,72,15,78,49,48,51,50,33,54,44,78,15 A0425,"Ground mileage, per statute mile",325,292,61,1157,173,189,205,204,1157,218,179,315,61 A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1)",1559,1403,292,1512,329,1004,985,979,642,1047,857,1512,292 A0427,"Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)",1499,1349,281,1454,520,935,948,942,720,1007,824,1454,281 A0428,"Ambulance service, basic life support, non-emergency transport, (BLS)",1099,989,206,1066,223,647,695,690,387,738,604,1066,206 A0429,"Ambulance service, basic life support, emergency transport (BLS-emergency)",1099,989,206,1066,438,659,695,690,453,738,604,1066,206 A0433,"Advanced life support, level 2 (ALS 2)",2142,1928,401,2078,734,1380,1354,1345,882,1439,1178,2078,401 A0434,Specialty care transport (SCT),3290,2961,617,3191,890,2120,2079,2067,1355,2210,1809,3191,617 ANCIL,,256,230,48,248,158,165,162,161,93,172,141,248,48 C9113,"Injection, pantoprazole sodium, per vial",33,30,5,32,21,20,13,20,5,22,18,32,6 DXRAY,,771,694,144,748,476,497,487,484,222,518,424,748,144 G0101,Cervical or vaginal cancer screening; pelvic and clinical breast examination,201,181,38,195,177,171,127,126,83,135,110,195,38 G0103,Prostate cancer screening; prostate specific antigen test (PSA),124,112,23,121,83,77,79,78,86,84,68,121,23 G0105,Colorectal cancer screening; colonoscopy on individual at high risk,2288,2060,429,2220,1109,1474,1446,1437,943,1537,1258,2220,429 G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,3272,2945,613,3174,1089,1963,2068,2055,1348,2198,1799,3174,613 G0168,Wound closure utilizing tissue adhesive(s) only,69,62,13,68,43,68,54,50,64,46,38,67,13 G0239,"Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)",319,287,60,309,204,206,202,200,131,214,175,309,60 G0279,PR BREAST TOMOSYNTHESIS DIG DX UNIL/BILAT,173,156,32,168,111,104,109,109,71,116,95,168,32 G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",106,95,20,103,68,64,83,70,44,71,58,103,20 G0378,"Hospital observation service, per hour",1976,1778,370,1917,1263,1652,920,896,814,1327,1087,1917,370 G0402,"Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment",217,196,41,211,181,136,137,136,89,146,119,211,41 G0424,"Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day",334,300,63,324,211,200,211,210,137,224,183,324,63 G0432,"Infectious agent antibody detection by enzyme immunoassay (eia) technique, HIV-1 and/or HIV-2, screening",63,56,12,61,41,37,40,39,26,42,34,61,12 G0438,"Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit",249,224,47,241,181,136,157,156,103,167,137,241,47 G0439,"Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit",237,213,44,230,181,136,99,149,98,159,130,230,44 G0463,Hospital outpt clinic visit,177,160,33,172,110,114,112,111,80,119,98,172,33 G0475,Hiv combination assay,64,58,12,62,40,38,40,40,26,43,35,62,12 G0480,Drug test def 1-7 classes,43,39,8,42,37,29,27,27,18,29,24,42,8 G2025,Dis site tele svcs rhc/fqhc,181,163,34,176,92,136,114,114,75,122,100,176,34 J0129,"Injection, abatacept, 10 mg",6066,5459,1137,5884,3882,3908,3834,3810,2498,4075,3335,5884,1137 J0131,Acetaminophen injection,161,145,30,156,103,97,100,53,48,108,89,156,30 J0132,"Injection, acetylcysteine, 100 mg",383,345,55,372,237,247,242,241,55,258,211,372,72 J0133,"Injection, acyclovir, 5 mg",29,26,6,29,18,19,23,18,12,20,16,29,6 J0153,PBB ADENOSINE INJ 1 MG,47,43,9,46,38,22,30,30,20,32,26,46,9 J0171,"Injection, adrenalin, epinephrine, 0.1 mg",30,27,3,29,25,20,19,19,3,20,16,29,6 J0282,"Injection, amiodarone hydrochloride, 30 mg",27,24,5,26,17,16,17,17,11,18,15,26,5 J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",37,33,4,36,24,24,24,21,4,25,20,36,7 J0330,"Injection, succinylcholine chloride, up to 20 mg",50,45,9,48,33,33,37,31,11,33,27,48,9 J0360,"Injection, hydralazine HCl, up to 20 mg",51,46,4,49,32,16,32,32,4,34,28,49,10 J0456,"Injection, azithromycin, 500 mg",34,30,6,33,21,20,21,21,14,23,18,33,6 J0485,Belatacept injection,3979,3581,746,3859,2457,2564,2515,2499,2214,2673,2188,3859,746 J0500,"Injection, dicyclomine HCl, up to 20 mg",116,105,22,113,72,75,73,35,48,78,64,113,22 J0610,"Injection, calcium gluconate, per 10 ml",39,35,7,38,25,25,25,25,16,26,22,38,7 J0690,"Injection, cefazolin sodium, 500 mg",22,20,2,22,16,15,16,19,2,15,12,22,4 J0692,"Injection, Cefepime hydrochloride, 500 mg",35,32,7,34,26,18,16,12,14,24,19,34,7 J0694,"Injection, cefoxitin sodium, 1 gm",42,38,7,41,26,27,17,26,7,28,23,41,8 J0696,"Injection, ceftriaxone sodium, per 250 mg",23,20,2,22,17,14,15,14,2,15,12,22,4 J0712,Ceftaroline fosamil inj,385,347,72,374,246,248,243,242,159,259,212,374,72 J0713,"Injection, ceftazidime, per 500 mg",43,39,8,42,27,27,27,27,18,29,24,42,8 J0717,Certolizumab pegol inj 1mg,6575,5918,1232,6378,4208,4236,4155,4130,2708,4417,3615,6378,1232 J0744,"Injection, Ciprofloxacin for intravenous infusion, 200 mg",26,23,3,25,17,17,18,17,3,17,14,25,5 J0780,"Injection, prochlorperazine, up to 10 mg",65,58,12,63,41,42,20,22,27,43,36,63,12 J0878,"Injection, daptomycin, 1 mg",1026,924,192,995,648,661,649,645,423,689,564,995,192 J0881,"Injection, darbepoetin alfa, 1 microgram (non-ESRD use)",370,333,69,359,237,239,234,233,152,249,204,359,69 J0897,PBB DENOSUMAB INJECTION 1 MG,2200,1980,412,2134,1408,1320,1390,1382,1200,1478,1209,2134,412 J1040,"Injection, methylprednisolone acetate, 80 mg",53,47,10,51,34,32,45,34,12,44,29,51,10 J1100,"Injection, dexamethasone sodium phosphate, 1 mg",21,19,1,20,13,13,15,15,1,14,12,20,4 J1160,"Injection, digoxin, up to 0.5 mg",35,31,6,34,17,21,22,22,14,23,19,34,6 J1170,"Injection, hydromorphone, up to 4 mg",26,23,3,25,16,15,20,18,3,17,14,25,5 J1200,"Injection, diphenhydramine HCl, up to 50 mg",21,19,1,21,14,13,8,8,1,14,12,21,4 J1335,"Injection, Ertapenem sodium, 500 mg",231,208,43,224,148,149,146,145,78,155,127,224,43 J1439,HC INJ FERRIC CARBOXYMALTOS 1MG,2320,2088,435,2251,1485,1495,1466,1457,956,1559,1276,2251,435 J1450,"Injection fluconazole, 200 mg",45,41,8,44,37,29,29,15,19,30,25,44,8 J1561,"Injection, immune globulin, (gamunex), intravenous, non-lyophilized (e.g. liquid), 500 mg",8429,7587,1580,8177,5205,5058,5327,5295,3472,5662,4635,8177,1580 J1610,"Injection, glucagon hydrochloride, per 1 mg",652,586,122,632,402,517,412,409,268,438,358,632,122 J1630,"Injection, haloperidol, up to 5 mg",21,19,4,20,13,17,12,6,9,14,11,20,4 J1642,"Injection, Heparin sodium, (Heparin lock flush), per 10 units",21,19,4,20,13,12,13,13,9,14,12,20,4 J1644,"Injection, Heparin sodium, per 1000 units",32,29,1,31,21,18,17,22,1,22,18,31,6 J1650,"Injection, enoxaparin sodium, 10 mg",38,34,7,37,24,23,26,26,9,26,21,37,7 J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",55,50,10,67,35,35,35,67,23,37,30,53,10 J1756,"Injection, iron sucrose, 1 mg",320,288,42,311,199,206,102,260,42,215,176,311,60 J1790,"Injection, droperidol, up to 5 mg",21,19,3,20,13,14,13,15,3,14,11,20,4 J1815,"Injection, insulin, per 5 units",24,21,3,23,13,14,15,18,3,16,13,23,4 J1885,"Injection, ketorolac tromethamine, per 15 mg",21,19,1,20,13,20,8,13,1,15,11,20,4 J1940,"Injection, furosemide, up to 20 mg",31,28,2,30,20,17,15,20,2,21,17,30,6 J1953,"Injection, levetiracetam, 10 mg",81,73,15,79,51,49,25,56,34,55,45,79,15 J1956,"Injection, levofloxacin, 250 mg",37,33,7,36,23,24,23,30,15,25,20,36,7 J2060,"Injection, lorazepam, 2 mg",20,18,1,20,12,15,12,13,1,14,11,20,4 J2175,"Injection, meperidine hydrochloride, per 100 mg",49,44,9,48,30,48,31,31,20,33,27,47,9 J2182,"Injection, mepolizumab, 1mg",4365,3929,818,4234,2794,2813,2759,2742,1798,2932,2400,4234,818 J2185,"Injection, meropenem, 100 mg",46,41,9,46,29,46,29,29,19,31,25,44,9 J2250,"Injection, midazolam hydrochloride, per 1 mg",20,18,0,19,13,13,15,15,0,13,11,19,4 J2270,"Injection, morphine sulfate, up to 10 mg",24,22,5,23,18,22,17,17,5,16,13,23,5 J2310,"Injection, naloxone hydrochloride, per 1 mg",31,28,6,36,16,18,36,19,13,21,17,30,6 J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",6056,5450,1135,5935,3739,5935,3827,3804,2494,4068,3330,5874,1135 J2370,"Injection, phenylephrine HCl, up to 1 ml",36,33,7,35,23,23,23,23,15,24,20,35,7 J2405,"Injection, ondansetron hydrochloride, per 1 mg",21,19,0,20,13,13,12,14,0,14,12,20,4 J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",47,42,6,46,34,26,19,32,6,32,26,46,9 J2550,"Injection, promethazine HCl, up to 50 mg",21,19,4,20,13,12,14,14,8,14,11,20,4 J2690,"Injection, procainamide HCl, up to 1 gm",232,209,44,225,149,150,147,146,96,156,128,225,44 J2704,"Inj, propofol, 10 mg",81,73,2,79,56,41,66,37,2,54,45,79,15 J2710,"Injection, neostigmine methylsulfate, up to 0.5 mg",43,39,8,42,19,26,34,27,18,29,24,42,8 J2720,"Injection, protamine sulfate, per 10 mg",44,40,8,43,27,27,28,28,18,30,24,43,8 J2765,"Injection, metoclopramide HCl, up to 10 mg",21,19,2,21,14,18,8,15,2,19,12,21,4 J2795,"Injection, ropivacaine hydrochloride, 1 mg",24,22,1,23,15,14,19,15,1,16,13,23,5 J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",51,46,10,50,32,30,40,32,21,34,28,50,10 J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",42,38,6,41,27,25,26,11,6,28,23,41,8 J2997,"Injection, alteplase recombinant, 1 mg",5811,5230,1089,5637,3719,3744,3672,3650,2393,3903,3195,5637,1089 J3010,"Injection, fentanyl citrate, 0.1 mg",22,20,1,22,14,21,16,15,1,15,12,22,4 J3111,Inj. romosozumab-aqqg 1 mg,3340,3006,626,3239,2062,2152,2111,2098,1951,2243,1836,3239,626 J3260,"Injection, tobramycin sulfate, up to 80 mg",82,74,15,80,52,53,52,52,34,55,45,80,15 J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",42,37,8,40,27,27,26,26,17,28,23,40,8 J3360,"Injection, diazepam, up to 5 mg",49,44,9,48,21,29,19,15,10,33,27,48,9 J3370,"Injection, vancomycin HCl, 500 mg",58,53,9,57,37,38,37,22,9,39,32,57,11 J3380,"Injection, vedolizumab",9553,8598,1790,9267,5899,5732,6038,6001,3935,6417,5253,9267,1790 J3410,"Injection, hydroxyzine HCl, up to 25 mg",72,65,13,70,44,46,45,22,30,48,39,70,13 J3411,"Injection, thiamine HCl, 100 mg",31,28,2,30,19,19,20,21,2,21,17,30,6 J3430,"Injection, phytonadione (vitamin K), per 1 mg",115,104,22,112,73,74,26,73,48,78,63,112,22 J3475,"Injection, magnesium sulfate, per 500 mg",22,20,4,22,14,13,13,12,4,15,12,22,4 J3480,"Injection, potassium chloride, per 2 meq",39,35,1,38,25,23,11,22,1,26,22,38,7 J3489,HC ZOLEDRONIC ACID 1MG,728,655,136,706,464,469,460,457,300,489,400,706,136 J3490,Unclassified drugs,230,207,43,223,147,148,145,173,95,154,126,223,43 J7296,"HC KYLEENA, 19.5 MG",1163,1047,218,1128,718,750,914,731,1049,781,640,1128,218 J7298,HC LEVONORGESTREL IU 52MG MIRENA,1163,1047,218,1140,718,1140,735,731,1030,781,640,1128,218 J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",1140,1026,214,1106,704,684,710,916,1019,766,627,1106,214 J7507,"Tacrolimus, oral, per 1 mg",11,10,1,11,7,7,7,7,1,8,6,11,2 J7510,"Prednisolone oral, per 5 mg",3,3,1,3,2,2,3,2,1,2,2,3,1 J7512,Prednisone ir or dr oral 1mg,3,3,0,3,2,2,2,1,0,2,2,3,1 J7517,"Mycophenolate mofetil, oral, 250 mg",5,5,1,5,3,3,3,3,1,3,3,5,1 J8540,"Dexamethasone, oral, 0.25 mg",8,7,2,8,5,5,6,2,3,5,4,8,2 P9016,"Red blood cells, leukocytes reduced, each unit",500,450,94,606,606,395,173,314,206,336,275,485,94 P9035,"Platelets, pheresis, leukocytes reduced, each unit",882,794,165,856,564,568,557,554,363,592,485,856,165 P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",940,846,176,912,602,606,594,591,387,632,517,912,176 Q0138,"Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)",2182,1964,409,2117,1377,1406,1379,1371,899,1466,1200,2117,409 Q0144,"Azithromycin dihydrate, oral, capsules/powder, 1 gram",13,12,0,13,8,4,7,8,0,9,7,13,2 Q0162,Ondansetron oral,3,3,0,3,2,2,2,2,0,2,2,3,1 Q0169,"Promethazine hydrochloride, 12.5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",3,3,0,3,2,2,2,2,0,2,2,3,1 Q0177,"Hydroxyzine pamoate, 25 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",3,3,0,3,2,2,2,2,0,2,2,3,1 Q5101,"Injection, zarxio",817,735,153,792,504,526,516,513,283,549,449,792,153 Q9967,"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml",86,77,16,83,55,52,54,56,35,58,47,83,16 T1015,"Clinic visit/encounter, all-inclusive",149,134,28,145,92,96,94,86,61,100,82,145,28 ,,,,,,,,,,,,,, DRG,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Medicare,United healthcare,Amerigroup,Iowa total care,Blue cross blue shield,Medicaid of iowa,Coventry health care,Cigna,Commercial insurance Inpatients,,,,,,,,,,,,,, 177,DRG RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),8447,7603,1583,8278,5216,8278,5339,5306,3479,5674,4645,8194,1583 178,DRG RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH COMPLICATION OR COMORBIDITY (CC),7893,7104,1479,7893,4874,5086,7893,4958,3251,5302,4340,7656,1479 180,DRG RESPIRATORY NEOPLASMS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),5099,4589,956,4997,3149,4997,3223,3203,2100,3425,2804,4946,956 193,"DRG SIMPLE PNEUMONIA AND PLEURISY WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",8447,7603,1583,8278,5216,8278,5339,5306,3479,5674,4645,8194,1583 389,DRG G.I. OBSTRUCTION WITH COMPLICATION OR COMORBIDITY (CC),9281,8353,1739,9002,5730,5980,6543,5830,3823,6234,5103,9002,1739 390,"DRG G.I. OBSTRUCTION WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",7439,6695,1394,7215,4593,4793,5495,4673,3064,4997,4090,7215,1394 392,"DRG ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",3961,3565,742,3961,2446,2552,3961,2488,1631,2661,2178,3842,742 639,DRG DIABETES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),12381,11143,2320,12009,7645,7977,6815,7777,5100,8317,6808,12009,2320 694,DRG URINARY STONES WITHOUT ESW LITHOTRIPSY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),16715,15044,3132,16213,10321,10770,11783,10500,6885,11228,9191,16213,3132 759,,7488,6739,1403,7263,4624,4825,5149,4704,3084,5030,4117,7263,1403 ,,,,,,,,,,,,,, CPT,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Blue cross blue shield,United healthcare,Amerigroup,Iowa total care,Medicare,Medicaid of iowa,Commercial insurance,Golden rule,Allied benefit systems inc Professionals,,,,,,,,,,,,,, Outpatients,,,,,,,,,,,,,, 00126,"Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy",824,742,85,601,290,313,101,85,222,273,456,531,601 00160,Anesthesia for procedures on nose and accessory sinuses; not otherwise specified,1485,1336,312,1083,522,565,312,319,399,491,823,956,1083 00170,"Anesthesia for intraoral procedures, including biopsy; not otherwise specified",1319,1187,135,962,522,432,135,284,355,436,731,849,962 00300,"Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified",1402,1261,178,1022,471,178,295,301,377,464,776,902,1022 00400,"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified",825,742,85,602,428,198,85,177,222,273,457,531,602 00731,PR ANES UPR GI NDSC PX NOS,989,890,101,721,380,123,101,102,266,327,548,637,721 00790,Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified,1979,1781,203,1444,648,753,203,212,532,655,1096,1274,1444 00811,PR ANES LWR INTST NDSC NOS,989,890,117,721,514,117,127,213,266,327,548,637,721 00812,PR ANES LWR INTST SCR COLSC,660,594,68,481,351,107,102,68,178,218,366,425,481 00813,PR ANES UPR LWR GI NDSC PX,1154,1039,118,842,406,432,118,127,310,382,639,743,842 00830,Anesthesia for hernia repairs in lower abdomen; not otherwise specified,1154,1039,170,842,406,170,243,248,310,382,639,743,842 00840,Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified,2639,2375,220,1925,1102,1004,220,567,710,873,1462,1699,1925 00851,Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection,1979,1781,416,1444,707,753,416,425,532,655,1096,1274,1444 00902,Anesthesia for; anorectal procedure,1154,1039,243,842,406,439,243,248,310,382,639,743,842 00940,"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified",1155,1040,243,842,600,439,243,248,311,382,640,744,842 00952,"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography",1154,1039,135,842,409,227,135,248,310,382,639,743,842 01480,"Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified",1402,1262,295,1023,497,533,295,301,377,464,777,903,1023 10060,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single",292,263,40,213,208,111,40,63,78,97,162,188,213 10080,Incision and drainage of pilonidal cyst; simple,245,221,48,184,184,93,48,53,66,81,136,158,179 10120,"Incision and removal of foreign body, subcutaneous tissues; simple",202,182,42,147,105,98,42,43,54,67,112,130,147 10140,"Incision and drainage of hematoma, seroma or fluid collection",250,225,53,182,130,95,53,54,67,83,138,161,182 11055,"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion",120,108,25,115,115,46,25,26,32,40,66,77,88 11056,"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions",237,213,50,173,159,90,50,51,64,78,131,153,173 11102,PR TANGNTL BX SKIN SINGLE LES,209,188,44,201,201,80,44,45,56,69,116,135,153 11104,PR PUNCH BX SKIN SINGLE LESION,209,188,44,209,209,80,44,45,56,69,116,135,153 11200,"Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions",139,125,29,101,72,96,29,30,37,46,77,89,101 11401,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm",238,214,50,173,123,119,50,51,64,79,132,153,173 11421,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm",266,240,57,227,227,131,74,57,72,88,147,171,194 11422,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm",293,263,62,292,152,292,62,63,79,97,162,188,214 11442,"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",492,443,103,359,256,170,103,106,132,163,273,317,359 11443,"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",545,490,115,397,283,207,115,134,147,180,302,351,397 11642,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm",657,591,138,479,341,404,138,141,177,217,364,423,479 11730,"Avulsion of nail plate, partial or complete, simple; single",246,221,52,179,117,93,52,53,66,81,136,158,179 11740,Evacuation of subungual hematoma,106,95,22,77,55,38,22,23,29,35,59,68,77 11750,"Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;",458,412,41,334,194,41,86,98,123,152,254,295,334 11981,"Insertion, non-biodegradable drug delivery implant",471,424,63,344,143,179,63,63,127,156,261,303,344 11982,"Removal, non-biodegradable drug delivery implant",414,373,77,302,166,157,77,89,111,137,229,267,302 11983,"Removal with reinsertion, non-biodegradable drug delivery implant",868,781,90,633,378,90,156,187,233,287,481,559,633 12001,"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less",345,310,46,252,84,85,46,74,93,114,191,222,252 12002,"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",421,379,55,307,105,160,55,64,113,139,233,271,307 12004,"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",428,386,90,312,131,163,90,92,115,142,237,276,312 12011,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",360,324,50,263,123,131,50,77,97,119,199,232,263 12013,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",446,401,94,325,130,170,94,96,120,148,247,287,325 12032,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm",473,426,99,414,414,173,99,102,127,156,262,305,345 12034,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm",541,487,114,440,440,177,114,116,146,179,300,348,395 12041,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less",496,446,104,494,257,494,104,107,133,164,275,319,362 12051,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",504,453,106,502,309,502,106,108,136,167,279,324,368 12052,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",632,569,122,461,392,171,122,136,170,209,350,407,461 17000,"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion",161,145,34,133,133,61,34,35,43,53,89,104,118 17003,"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)",104,93,12,75,12,39,22,22,28,34,57,67,75 17110,"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",129,116,28,126,67,126,29,28,35,43,71,83,94 20526,"Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel",110,99,30,82,57,82,43,43,30,36,61,71,80 20550,"Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar ""fascia"")",193,174,41,141,108,71,41,41,52,64,107,124,141 20552,"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)",395,355,64,288,116,64,83,85,106,131,219,254,288 20553,"Injection(s); single or multiple trigger point(s), 3 or more muscle(s)",422,380,39,308,92,52,39,91,114,140,234,272,308 20600,"Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)",311,280,65,227,106,118,65,67,84,103,172,200,227 20605,"Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)",143,129,30,105,93,71,30,31,39,47,79,92,105 20610,"Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)",205,184,37,150,120,61,51,44,37,68,114,132,150 20612,Aspiration and/or injection of ganglion cyst(s) any location,191,172,40,139,107,73,40,41,51,63,106,123,139 24640,"Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation",277,249,58,202,146,105,58,60,75,92,153,178,202 27096,"Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid",271,244,57,198,141,102,57,58,73,90,150,174,198 27250,"Closed treatment of hip dislocation, traumatic; without anesthesia",386,347,81,325,325,148,81,83,104,128,214,249,282 27265,Closed treatment of post hip arthroplasty dislocation; without anesthesia,806,725,169,588,419,324,169,173,217,267,446,519,588 28285,"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)",745,670,157,658,658,283,157,160,200,246,412,479,543 28295,PR CORRECTION HALLUX VALGUS,1225,1102,258,1224,1224,466,258,263,329,405,679,789,894 29075,"Application, cast; elbow to finger (short arm)",198,178,43,144,131,52,125,43,53,66,110,127,144 29085,"Application, cast; hand and lower forearm (gauntlet)",120,108,26,88,62,46,62,26,32,40,66,77,88 29125,Application of short arm splint (forearm to hand); static,127,114,34,93,71,48,47,41,34,42,45,82,93 29130,Application of finger splint; static,124,111,22,90,64,47,22,27,33,41,69,80,90 29405,Application of short leg cast (below knee to toes);,198,178,43,145,103,50,68,43,53,66,110,128,145 29445,Application of rigid total contact leg cast,250,225,54,182,130,95,151,54,67,83,138,161,182 29505,Application of long leg splint (thigh to ankle or toes),165,149,36,121,86,63,44,36,44,55,92,106,121 29515,Application of short leg splint (calf to foot),122,110,26,89,64,47,26,44,33,40,68,79,89 30520,"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft",1650,1485,347,1204,1088,628,347,355,444,546,914,1062,1204 31500,"Intubation, endotracheal, emergency procedure",504,453,97,368,267,117,106,97,136,167,279,324,368 31575,"Laryngoscopy, flexible fiberoptic; diagnostic",145,130,30,144,144,55,30,31,39,48,80,93,106 36556,Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older,229,206,48,170,170,87,48,49,62,76,127,147,167 42820,Tonsillectomy and adenoidectomy; younger than age 12,561,505,121,409,291,362,255,121,151,186,311,361,409 42821,Tonsillectomy and adenoidectomy; age 12 or over,2052,1847,286,1497,637,780,286,441,552,679,1137,1321,1497 43239,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple",2196,1976,120,1602,299,120,149,149,591,727,1217,1414,1602 45378,"Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)",2561,2305,209,1868,416,220,209,551,689,847,1419,1649,1868 45380,"Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple",2789,2510,175,2034,451,175,212,212,750,923,1545,1796,2034 45384,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery",2837,2553,216,2069,513,1079,216,610,763,938,1571,1826,2069 45385,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique",3146,2831,215,2295,474,215,288,288,846,1041,1743,2025,2295 46040,Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure),1135,1022,239,828,590,388,239,244,305,376,629,731,828 46050,"Incision and drainage, perianal abscess, superficial",292,263,52,213,152,111,52,63,78,97,162,188,213 46230,"Excision of multiple external papillae or tags, anus",678,610,143,495,369,258,143,146,182,224,376,437,495 47562,"Laparoscopy, surgical; cholecystectomy",3147,2832,634,2295,1401,1197,634,676,846,1041,1743,2026,2295 49505,"Repair initial inguinal hernia, age 5 years or older; reducible",1831,1648,385,1335,951,430,385,394,492,606,1014,1179,1335 49585,"Repair umbilical hernia, age 5 years or older; reducible",1705,1535,359,1244,951,649,359,367,459,564,945,1098,1244 49587,"Repair umbilical hernia, age 5 years or older; incarcerated or strangulated",1878,1690,395,1370,830,714,395,404,505,621,1040,1209,1370 56420,Incision and drainage of Bartholin's gland abscess,398,358,74,290,207,151,74,86,107,132,220,256,290 57452,Colposcopy of the cervix including upper/adjacent vagina;,293,263,62,214,194,117,62,63,79,97,162,188,214 57500,"Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)",210,189,44,164,164,80,44,45,56,69,116,135,153 57520,"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser",897,807,188,654,466,341,188,193,241,297,497,577,654 58100,"Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)",194,175,41,142,132,74,41,42,52,64,108,125,142 58150,"Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);",3026,2724,636,2207,2150,1151,636,651,814,1001,1676,1949,2207 58300,Insertion of intrauterine device (IUD),390,351,71,284,113,71,72,84,105,129,216,251,284 58301,Removal of intrauterine device (IUD),271,244,55,198,122,103,55,55,73,90,150,175,198 58558,"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C",3883,3495,345,2832,2017,345,816,835,1044,1285,2151,2500,2832 58563,"Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)",4870,4383,231,3552,532,1852,231,1047,1310,1611,2698,3136,3552 58615,"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach",1708,1537,359,1246,548,650,359,367,459,565,946,1100,1246 58671,"Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)",1925,1732,405,1404,656,732,405,414,518,637,1066,1239,1404 58700,"Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)",1769,1592,380,1290,919,673,411,380,476,585,980,1139,1290 59025,Fetal non-stress test,133,119,28,97,69,38,28,29,36,44,73,85,97 59425,Antepartum care only; 4-6 visits,1416,1274,310,1033,693,538,310,310,381,468,784,912,1033 59426,Antepartum care only; 7 or more visits,2485,2236,531,1812,1237,945,531,534,668,822,1376,1600,1812 62270,"Spinal puncture, lumbar, diagnostic",648,583,136,472,140,246,136,139,174,214,359,417,472 62321,PR INJ INTERLAM C/T W IMG,243,218,51,177,126,89,51,52,65,80,134,156,177 62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,220,198,59,161,114,82,77,90,59,77,122,142,161 64450,"Injection, anesthetic agent; other peripheral nerve or branch",115,104,25,84,79,44,39,25,31,38,64,74,84 64493,"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level",2278,2050,93,1662,591,93,479,490,613,754,1262,1467,1662 64494,"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)",468,421,43,341,262,43,98,101,126,155,259,301,341 64495,"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)",468,421,44,341,175,44,98,101,126,155,259,301,341 69210,"Removal impacted cerumen (separate procedure), 1 or both ears",146,131,31,106,99,60,31,31,39,48,81,94,106 69424,Ventilating tube removal requiring general anesthesia,115,104,24,84,60,44,24,31,31,38,64,74,84 69436,"Tympanostomy (requiring insertion of ventilating tube), general anesthesia",584,526,126,426,418,222,206,126,157,193,324,376,426 86580,"Skin test; tuberculosis, intradermal",28,25,6,20,16,6,6,6,7,9,15,18,20 87880,"Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A",35,32,7,26,18,18,7,8,9,12,19,23,26 90632,"Hepatitis A vaccine, adult dosage, for intramuscular use",101,91,21,74,61,38,21,22,27,33,56,65,74 90633,"Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use",63,57,13,46,35,39,13,14,17,21,45,41,46 90647,"Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use",55,50,12,40,27,31,12,12,15,18,31,36,40 90651,PBB 9VHPV VACCINE 2/3 DOSE IM,257,231,54,246,246,98,54,55,69,85,142,166,188 90662,"Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use",78,71,17,58,58,30,17,17,21,26,43,51,57 90670,"Pneumococcal conjugate vaccine, 13 valent, for intramuscular use",231,208,49,223,223,88,49,50,62,77,128,149,169 90680,"Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use",114,102,24,101,90,101,24,24,31,38,63,73,83 90686,Influenza virus vaccine,30,27,6,22,19,21,6,6,8,10,17,21,22 90700,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use",53,48,11,39,32,20,11,11,14,18,36,34,39 90707,"Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use",106,96,22,94,83,94,22,23,29,35,59,69,78 90710,"Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use",252,227,53,215,215,96,53,54,68,83,140,162,184 90715,"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use",75,67,16,54,34,51,16,16,20,25,41,52,54 90716,"Varicella virus vaccine, live, for subcutaneous use",165,148,35,163,141,163,35,35,44,55,91,106,120 90723,"Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use",109,98,23,96,86,96,23,23,29,36,60,70,80 90732,"Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use",132,119,28,126,120,126,28,28,36,44,73,85,96 90734,"Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use",158,142,33,150,138,150,33,34,42,52,87,101,115 90744,"Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use",54,49,11,39,29,21,11,12,15,18,30,35,39 90746,"Hepatitis B vaccine, adult dosage, for intramuscular use",91,82,19,70,70,35,19,20,25,30,50,59,66 90792,PBB PSYCH DIAG EVAL W/MED SRVCS,398,358,84,290,194,151,84,86,107,132,220,256,290 92587,"Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)",48,43,10,40,40,18,10,10,13,16,27,31,35 92960,"Cardioversion, elective, electrical conversion of arrhythmia; external",573,516,96,418,298,96,120,123,154,190,317,369,418 93010,"Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only",51,46,8,37,18,8,10,10,8,10,28,33,37 93227,External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; physician review and interpretation,212,191,26,155,54,26,45,32,57,70,118,137,155 93272,"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; physician review and interpretation",57,51,15,52,52,22,29,29,15,19,32,37,42 95004,"Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests",612,551,129,446,260,233,129,138,165,202,339,394,446 95115,Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection,19,17,4,14,13,7,4,4,5,6,11,12,14 95117,Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections,37,33,8,27,14,14,8,8,10,12,20,24,27 96372,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",242,218,50,177,50,92,51,52,65,80,134,156,177 98925,Osteopathic manipulative treatment (OMT); 1-2 body regions involved,143,129,30,104,52,38,30,31,38,47,79,92,104 98926,Osteopathic manipulative treatment (OMT); 3-4 body regions involved,188,169,40,137,70,71,40,40,51,62,104,121,137 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 medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.",86,77,18,72,72,49,18,18,23,28,48,55,63 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 examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family.",205,184,43,150,117,85,43,44,55,68,114,132,150 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 complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.",294,264,62,214,167,123,62,63,79,97,163,189,214 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.",342,308,72,249,215,130,72,73,92,113,189,220,249 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 examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.",107,96,22,78,70,49,22,23,29,35,59,69,78 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 problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.",149,134,31,114,114,83,31,32,40,49,70,83,113 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 decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.",238,214,50,174,168,93,50,51,64,79,132,153,174 99217,"Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from ""observation status"" if the discharge is on other than the initial date of ""observation status."" To report services to a patient designated as ""observation status"" or ""inpatient status"" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])",317,285,62,231,112,68,62,62,85,105,176,204,231 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; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to ""observation status"" are of low severity.",304,274,55,222,130,86,55,55,82,101,168,196,222 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to ""observation status"" are of moderate severity.",504,453,107,368,209,111,107,107,136,167,279,324,368 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 making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to ""observation status"" are of high severity.",709,638,144,517,288,149,144,144,191,235,393,456,517 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; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 30 minutes at the bedside and on the patient's hospital floor or unit.",307,276,55,224,134,85,55,55,83,102,170,198,224 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit.",526,473,107,384,214,124,107,113,129,174,291,339,384 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 making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 70 minutes at the bedside and on the patient's hospital floor or unit.",720,648,151,525,315,250,151,155,194,238,399,464,525 99224,"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 examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.",86,78,22,63,52,38,25,22,23,29,48,56,63 99225,"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 problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.",158,142,34,115,82,60,45,34,43,52,88,102,115 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 examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.",160,144,33,117,60,34,33,33,37,53,89,103,117 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 problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.",252,227,53,184,131,93,53,54,68,83,140,162,184 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 comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of low severity.",473,426,99,345,208,128,99,102,109,156,262,305,345 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 history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of moderate severity.",741,666,156,540,385,282,156,159,160,245,410,477,540 99238,Hospital discharge day management; 30 minutes or less,226,203,53,165,112,63,62,53,69,75,125,145,165 99239,Hospital discharge day management; more than 30 minutes,390,351,82,285,203,133,82,84,103,129,216,251,285 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 decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.",128,115,17,93,29,18,17,17,34,42,71,82,93 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 Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.",150,135,25,109,56,40,25,25,40,29,83,97,109 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 Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.",278,251,50,203,84,55,50,50,75,59,154,179,203 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 complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.",446,402,77,326,155,97,77,77,120,148,247,287,326 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/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.",697,627,97,509,225,142,97,122,188,231,386,449,509 99291,"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes",1194,1075,144,871,313,187,144,257,321,395,661,769,871 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)",1530,1377,322,1116,510,582,322,329,412,506,848,985,1116 99304,"Initial nursing facility 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; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes at the bedside and on the patient's facility floor or unit.",276,248,58,201,143,83,58,59,87,91,153,178,201 99305,"Initial nursing facility 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 making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes at the bedside and on the patient's facility floor or unit.",390,351,82,285,203,116,82,84,105,129,216,251,285 99307,"Subsequent nursing facility 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 examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 10 minutes at the bedside and on the patient's facility floor or unit.",115,104,24,84,51,36,24,25,42,38,64,74,84 99308,"Subsequent nursing facility 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 problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 15 minutes at the bedside and on the patient's facility floor or unit.",167,151,35,122,106,64,35,36,65,55,93,108,122 99315,Nursing facility discharge day management; 30 minutes or less,267,240,56,195,139,63,56,57,60,88,148,172,195 99316,Nursing facility discharge day management; more than 30 minutes,321,289,68,234,167,99,68,69,100,106,178,207,234 99334,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver.",167,151,35,122,87,64,35,36,57,55,93,108,122 99348,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.",237,213,50,173,131,90,50,51,64,78,131,153,173 99349,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.",249,224,52,200,200,95,52,54,67,82,138,160,182 99381,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)",187,168,39,162,162,71,39,40,50,62,104,120,136 99385,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years",232,209,49,169,168,88,49,50,62,77,129,150,169 99386,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years",232,209,49,226,226,88,49,50,62,77,129,150,169 99387,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older",252,227,53,184,131,177,53,54,68,83,140,162,184 99391,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)",150,135,32,149,149,97,32,32,40,50,83,97,109 99392,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)",150,135,32,135,135,108,32,32,40,50,83,97,109 99393,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)",150,135,32,134,134,108,32,32,40,50,83,97,109 99394,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)",209,188,44,152,148,119,44,45,56,69,116,135,152 99395,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years",209,188,44,152,151,119,44,45,56,69,116,135,152 99396,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years",209,188,44,185,185,131,44,45,56,69,116,131,152 99397,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older",237,213,50,202,202,147,50,51,64,78,131,153,173 A0425,"Ground mileage, per statute mile",783,705,5,571,407,298,154,43,211,5,434,504,571 A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1)",1559,1403,102,1137,810,593,102,335,419,516,864,1004,1137 A0427,"Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)",1499,1349,127,1094,779,570,127,127,403,127,831,965,1094 A0428,"Ambulance service, basic life support, non-emergency transport, (BLS)",1099,989,85,802,571,418,85,85,296,364,609,708,802 A0429,"Ambulance service, basic life support, emergency transport (BLS-emergency)",1057,951,114,771,549,402,114,114,284,350,585,680,771 A0433,"Advanced life support, level 2 (ALS 2)",2142,1928,233,1562,1112,815,450,233,576,709,1187,1379,1562 A0999,Unlisted ambulance service,1231,1108,331,1184,639,468,724,1184,331,407,682,793,898 G0101,Cervical or vaginal cancer screening; pelvic and clinical breast examination,209,188,44,152,59,79,44,45,56,69,116,135,152 G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",119,107,25,87,72,45,25,26,32,39,66,77,87 G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,1431,1288,159,1044,743,159,301,308,385,473,793,921,1044 G0438,"Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit",249,224,52,220,129,220,52,53,67,82,138,160,182 G0439,"Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit",227,205,48,166,152,87,48,49,61,75,126,146,166 J0558,"Injection, penicillin G benzathine and penicillin G procaine, 100,000 units",157,141,33,114,66,60,33,34,42,52,87,101,114 J0561,"Injection, penicillin G benzathine, 100,000 units",366,329,77,267,172,166,77,79,98,121,203,236,267 J0696,"Injection, ceftriaxone sodium, per 250 mg",23,20,2,16,2,2,5,5,6,7,12,15,16 J1040,"Injection, methylprednisolone acetate, 80 mg",64,58,12,47,12,12,14,14,17,21,36,41,47 J1100,"Injection, dexamethasone sodium phosphate, 1 mg",20,18,1,15,1,1,4,4,5,7,11,13,15 J1200,"Injection, diphenhydramine HCl, up to 50 mg",19,17,1,14,1,7,4,4,5,6,10,12,14 J1885,"Injection, ketorolac tromethamine, per 15 mg",21,19,2,15,2,2,4,5,6,7,12,14,15 J2405,"Injection, ondansetron hydrochloride, per 1 mg",20,18,0,15,0,8,4,4,5,7,11,13,15 J2550,"Injection, promethazine HCl, up to 50 mg",22,20,2,16,2,8,5,5,6,7,12,14,16 J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",42,38,6,31,6,16,9,9,11,14,23,27,31 J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",42,38,2,31,6,2,9,9,11,14,23,27,31 OFFCV,,149,134,31,109,97,57,31,32,40,49,83,96,109 RXINJ,,32,29,4,24,4,12,7,7,9,11,18,21,24 T1015,"Clinic visit/encounter, all-inclusive",149,134,40,185,77,57,86,86,40,185,83,96,109 ,,,,,,,,,,,,,, DRG,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Blue cross blue shield,United healthcare,Amerigroup,Iowa total care,Medicare,Medicaid of iowa,Commercial insurance,Golden rule,Allied benefit systems inc Inpatients,,,,,,,,,,,,,,