,Lucas County Health Center - Machine Readable Report - Generated on 01/04/2021,,,,,,,,,,,,,,,,,,,,,,,
,"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 Meadville Medical Center. This was generated on 01/04/2021 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,Blue Cross,Amerigroup IA Medicaid,United Healthcare,Iowa Total Care,Aetna,Coventry Advantra,Aetna Medicare,Blue Cross Out of State,Health Partners,Humana,UHC Medicare Solutions HMO,Medicaid,Meritain,Midlands Choice,Aetna - Coventry,VA,Humana Choice,UHC Medicare Solutions PPO
Institutional,,,,,,,,,,,,,,,,,,,,,,,,
Outpatients,,,,,,,,,,,,,,,,,,,,,,,,
142,Anesthesia for procedures on eye; lens surgery,780,702,43,1724,380,305,399,423,393,43,380,388,326,464,476,390,410,741,1724,741,235,436,390
300,"Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified",1197,1077,360,2645,568,468,613,649,603,660,584,595,500,712,731,599,628,1137,2645,1137,360,669,598
400,"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified",891,802,268,1969,423,348,456,483,449,491,435,443,372,530,544,446,468,846,1969,846,268,498,446
635,Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture,564,508,170,1246,268,220,289,306,284,311,275,280,236,336,344,282,296,536,1246,536,170,315,282
731,PR ANES UPR GI NDSC PX NOS,1005,904,303,2221,477,393,515,545,506,554,490,500,420,598,614,503,528,955,2221,955,303,562,502
750,Anesthesia for hernia repairs in upper abdomen; not otherwise specified,1604,1444,483,3544,761,627,821,870,808,884,782,797,670,954,979,802,842,1524,3544,1524,483,896,802
790,Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified,3567,3210,1074,7882,1692,1393,1827,1935,1796,1965,1740,1773,1490,2122,2178,1784,1873,3389,7882,3389,1074,1993,1784
811,PR ANES LWR INTST NDSC NOS,916,824,276,2024,435,358,469,497,461,505,447,455,383,545,559,458,481,870,2024,870,276,512,458
812,PR ANES LWR INTST SCR COLSC,948,853,285,2095,483,370,485,514,477,522,462,471,396,564,579,474,498,901,2095,901,285,530,474
813,PR ANES UPR LWR GI NDSC PX,1197,1077,360,2645,568,468,613,649,603,660,584,595,500,712,731,599,628,1137,2645,1137,360,669,598
902,Anesthesia for; anorectal procedure,1613,1452,486,3564,765,630,826,875,812,889,787,802,674,960,985,807,847,1532,3564,1532,486,901,806
952,"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography",1204,1084,362,2660,571,470,617,653,606,663,587,599,503,716,735,602,632,1144,2660,1144,362,673,602
0097U,"Gastrointestinal pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 22 targets",361,325,109,798,184,115,195,177,182,177,173,180,151,215,175,180,190,343,798,343,109,202,180
0100U,"Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 21 targets",107,96,32,236,52,42,55,52,54,59,52,53,45,64,65,54,56,102,236,102,32,60,54
1462,"Anesthesia for all closed procedures on lower leg, ankle, and foot",699,629,210,1545,332,273,358,379,352,385,341,347,292,416,427,350,367,664,1545,664,210,391,350
1480,"Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified",955,860,287,2110,453,373,489,518,481,526,466,475,399,568,583,478,501,907,2110,907,287,534,478
1730,Anesthesia for all closed procedures on humerus and elbow,1035,932,312,2287,491,404,530,561,521,570,505,514,432,616,632,518,543,983,2287,983,312,578,518
1810,"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand",843,759,254,1863,430,329,432,457,424,465,411,419,352,502,515,422,443,801,1863,801,254,471,422
10060,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single",254,229,64,561,125,99,137,138,64,140,124,126,106,151,155,127,133,241,561,241,76,142,127
10061,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple",254,229,76,561,125,99,130,138,128,140,124,126,106,154,155,127,133,241,561,241,76,142,127
10120,"Incision and removal of foreign body, subcutaneous tissues; simple",162,146,49,358,80,63,83,88,81,89,79,81,68,96,99,81,85,154,358,154,49,91,81
10160,"Puncture aspiration of abscess, hematoma, bulla, or cyst",250,225,68,552,123,98,68,136,126,138,122,124,104,149,153,125,131,238,552,238,75,140,125
11042,"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less",484,436,146,1069,247,284,261,232,259,460,236,241,202,288,296,242,254,460,1069,460,146,270,242
11043,"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less",484,436,146,1069,230,189,248,262,244,267,236,241,202,288,451,242,254,460,1069,460,146,437,242
11044,"Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less",1318,1186,394,2912,394,515,675,715,664,726,643,655,550,784,805,659,692,1252,2912,1252,397,736,659
11045,"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)",484,436,146,1069,247,189,248,262,244,267,236,241,202,288,296,242,254,460,1069,460,146,270,242
11046,"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)",468,421,130,1033,130,183,239,254,235,258,228,232,195,278,285,234,245,444,1033,444,141,261,234
11055,"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion",129,116,39,285,64,50,70,70,65,71,63,64,54,77,79,65,68,123,285,123,39,72,64
11056,"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions",154,139,46,340,73,60,79,74,78,85,75,77,64,92,94,77,81,146,340,146,46,86,77
11401,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm",2985,2686,899,6596,1416,1166,1529,1619,1503,1645,1456,1484,1247,1776,1823,1493,1567,2836,6596,2836,899,1668,1492
11402,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm",1551,1396,227,3427,1341,606,794,227,781,855,757,771,648,923,947,776,814,1473,3427,1473,467,867,776
11403,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm",1572,1415,195,3475,195,1439,805,853,792,866,767,1315,657,936,960,786,826,1494,3475,1494,473,879,786
11404,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm",672,605,202,1485,331,263,344,323,338,370,328,334,281,400,410,336,353,638,1485,638,202,375,336
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",305,274,92,674,117,119,156,165,154,168,149,152,127,181,186,153,160,290,674,290,92,170,152
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",3576,3219,1077,7903,1762,1319,1832,1940,1801,1971,1744,1778,1451,2128,2184,1788,1878,3398,7903,3398,1077,1998,1788
11423,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm",2630,2367,792,5811,1341,1027,1347,1426,1324,1449,1283,1307,1098,1565,1606,1315,1381,2499,5811,2498,792,1470,1315
11603,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm",2985,2686,720,6596,864,720,1529,1619,1503,1645,1456,1484,1247,1776,1823,1493,1567,2836,6596,2836,899,1668,1492
11604,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm",3642,3277,1096,8046,1794,1379,1865,1975,1833,2007,1776,1810,1521,2166,2224,1821,1912,3459,8046,3459,1096,2035,1821
11606,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm",900,810,271,1989,333,352,461,488,453,496,439,447,376,535,550,450,473,855,1989,855,271,503,450
11642,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm",2630,2367,792,5811,1248,1027,1347,1426,1324,1449,1283,1307,1098,1565,1606,1315,1381,2499,5811,2498,792,1470,1315
11643,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm",2985,2686,899,6596,1471,1166,1529,1492,1503,1645,1456,1484,1247,1776,1823,1493,1567,2836,6596,2836,899,1668,1492
11644,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm",4170,3753,1255,9214,2054,1629,2136,2262,2100,2085,2034,2073,1742,2481,2546,2085,2189,3962,9214,3962,1255,2330,2085
11646,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm",2142,1928,645,4734,915,837,1097,1162,1079,1181,1045,1065,895,1275,1308,1071,1125,2035,4734,2035,645,1197,1071
11719,"Trimming of nondystrophic nails, any number",85,76,26,188,42,33,44,41,43,47,41,42,36,51,52,43,45,81,188,81,26,47,42
11721,Debridement of nail(s) by any method(s); 6 or more,154,139,46,340,50,132,58,84,78,85,75,77,64,92,94,77,81,146,340,146,46,86,77
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",215,194,65,475,79,84,116,167,115,118,105,107,90,128,131,108,113,204,475,204,65,120,108
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",168,151,51,371,63,66,65,108,64,80,82,84,70,100,103,84,116,160,371,160,51,94,84
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",230,207,69,507,97,90,118,124,116,126,112,114,96,137,140,115,120,218,507,218,69,128,115
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",252,227,76,557,110,98,136,137,127,139,123,125,105,150,154,126,132,239,557,239,76,141,126
12011,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",215,194,65,475,110,84,116,167,115,118,105,107,90,128,212,108,113,204,475,204,65,120,108
12013,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",162,146,49,358,80,63,83,88,81,89,79,81,68,96,99,81,85,154,358,154,49,91,81
12020,Treatment of superficial wound dehiscence; simple closure,173,156,52,382,85,68,89,94,93,95,84,86,72,103,106,87,91,164,382,164,52,97,86
12032,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm",194,175,58,429,144,76,99,105,98,107,95,96,81,115,118,97,102,184,429,184,58,108,97
12042,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm",174,157,52,384,83,68,89,94,88,96,85,86,73,104,106,87,91,165,384,165,52,97,87
12044,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm",400,360,120,884,197,156,216,217,201,220,195,199,167,238,244,200,210,380,884,380,120,224,200
12051,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",234,210,70,516,159,91,120,127,118,129,114,116,98,139,143,117,123,222,516,222,70,130,117
13121,"Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm",640,576,193,1414,315,633,346,347,322,353,312,318,267,381,391,320,336,608,1414,608,193,358,320
13122,"Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)",375,338,113,829,185,317,135,203,189,207,183,186,157,223,229,188,197,356,829,356,113,210,188
13152,"Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm",910,819,274,2011,351,355,466,494,458,501,444,452,380,541,556,455,478,865,2011,864,274,508,455
14040,"Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less",4655,4190,1401,10286,2374,1819,2384,2525,2344,2565,2271,2314,1944,2769,2842,2328,2444,4422,10286,4422,1401,2601,2328
15271,PR SKIN SUB GRAFT T/A/L 25 SQ CM,426,383,128,941,159,166,218,231,214,235,208,212,178,253,260,213,224,405,941,405,128,238,213
15272,PBB SKIN SUB GRAFT T/A/L ADD-ON,702,632,211,1551,239,274,360,381,353,387,342,349,293,418,429,351,369,667,1551,667,211,392,351
15275,PR SKIN SUB GRFT F/NK/HF/G 25 SQ CM,552,497,166,1220,282,216,283,299,278,304,269,274,231,328,337,276,290,524,1220,524,166,308,276
15276,PBB SKIN SUB GRAFT F/N/HF/G ADDL,552,497,166,1220,282,216,283,299,278,304,269,274,231,328,337,276,290,524,1220,524,166,308,276
16020,"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)",239,215,65,528,118,93,65,130,120,132,117,119,100,142,146,120,129,227,528,227,72,134,120
16030,"Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area)",272,245,82,601,136,106,139,148,137,150,133,135,114,162,166,136,143,258,601,258,82,152,136
19081,PR BX BREAST 1ST LESION STRTCTC,4326,3893,1302,9559,2206,3957,2215,2346,2178,2384,2110,2150,1807,2574,2642,2163,2271,4110,9559,4110,1302,2417,2163
19120,"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions",2548,2294,767,5631,1201,996,1305,1382,1283,1404,1243,1267,1064,1516,1556,1274,1338,2421,5631,2421,767,1424,1274
20600,"Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)",97,87,29,214,42,38,50,53,49,53,47,48,41,58,59,49,51,92,214,92,29,54,48
23350,Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography,274,247,82,605,140,107,140,149,138,151,134,136,114,163,167,137,144,260,605,260,82,153,137
23650,"Closed treatment of shoulder dislocation, with manipulation; without anesthesia",213,192,64,471,101,83,109,116,107,117,104,106,89,127,130,107,112,202,471,202,64,119,106
23655,"Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia",1008,907,303,2227,514,394,516,547,508,555,492,501,421,600,616,504,529,958,2227,958,303,563,504
23675,"Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation",1100,990,331,2431,507,430,563,597,554,606,537,547,459,654,672,550,578,1045,2431,1045,331,615,550
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",162,146,49,358,80,63,84,88,82,89,79,81,68,96,99,81,85,154,358,154,49,91,81
26775,"Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia",850,765,256,1878,437,332,435,461,428,468,415,423,355,514,519,425,446,808,1878,808,256,475,425
27650,"Repair, primary, open or percutaneous, ruptured Achilles tendon;",6595,5936,1985,14572,3363,2576,3377,3577,3320,3634,3217,3278,2754,3924,4027,3298,3462,6265,14572,6265,1985,3685,3298
27786,Closed treatment of distal fibular fracture (lateral malleolus); without manipulation,800,720,241,1768,380,313,410,434,403,441,390,398,334,476,488,400,420,760,1768,760,241,447,400
27814,"Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed",10275,9248,3093,22704,5062,4014,5548,5573,5173,5662,5012,5108,4291,6113,6274,5138,5394,9761,22704,9761,3093,5741,5138
28011,"Tenotomy, percutaneous, toe; multiple tendons",750,675,226,1657,369,293,384,407,378,413,366,373,313,446,458,375,405,713,1657,712,226,419,375
28104,"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;",2985,2686,899,6596,1471,1166,1529,1492,1503,1645,1456,1484,1247,1776,1823,1493,1567,2836,6596,2836,899,1668,1492
28112,"Ostectomy, complete excision; other metatarsal head (second, third or fourth)",1,1,0,2,0,0,1,1,1,1,0,0,0,1,1,1,1,1,2,1,0,1,0
28192,"Removal of foreign body, foot; deep",4170,3753,1255,9214,2054,1629,2136,2262,2100,3962,2034,2073,1742,2481,2546,2085,2189,3962,9214,3962,1255,2330,2085
28296,"Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)",5140,4626,1547,11357,2532,2008,2632,4004,2588,2832,2507,2555,2147,3058,3139,2570,2699,4883,11357,4883,1547,2872,2570
28298,"Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy",5625,5062,1693,12429,2869,2197,2881,3051,2832,3099,2744,2796,2349,3346,3435,2813,2953,5344,12429,5344,1693,3143,2812
28415,"Open treatment of calcaneal fracture, includes internal fixation, when performed;",10890,9801,3278,24063,5365,4254,5577,5906,5845,6001,5312,5413,4548,6479,6650,5446,5717,10346,24063,10346,3278,6085,5445
28750,"Arthrodesis, great toe; metatarsophalangeal joint",8676,7809,2612,19172,4274,3390,4443,4706,3792,4781,4232,5138,3624,5162,5298,4339,4555,8243,19172,8243,2612,4848,4338
28825,"Amputation, toe; interphalangeal joint",2985,2686,899,6596,1416,1166,1529,1619,1503,1645,1456,1484,1247,1776,1823,1493,1567,2836,6596,2836,899,1668,1492
29075,"Application, cast; elbow to finger (short arm)",94,85,28,208,54,37,48,51,47,52,46,47,39,56,57,47,49,89,208,89,28,53,47
29105,Application of long arm splint (shoulder to hand),166,149,50,367,85,65,85,90,84,91,81,83,69,99,101,83,87,158,367,158,50,93,83
29125,Application of short arm splint (forearm to hand); static,136,122,41,301,72,53,70,74,73,75,66,68,57,81,83,68,71,129,301,129,41,76,68
29515,Application of short leg splint (calf to foot),162,146,49,358,77,63,87,88,69,154,79,81,68,89,99,81,85,154,358,154,49,91,81
29580,Strapping; Unna boot,100,90,30,221,51,39,51,50,50,55,49,50,42,59,61,50,53,95,221,95,30,56,50
29581,"Application of multi-layer venous wound compression system, below knee",258,232,78,570,122,223,132,124,130,142,126,128,108,153,158,129,135,245,570,245,78,144,129
29880,"Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)",5355,4820,1612,11833,2638,2092,2892,2904,2696,2951,2612,2662,2237,3186,3270,2678,2811,5087,11833,5087,1612,2992,2678
29881,"Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)",5970,5373,1797,13191,2941,4764,3057,3238,3006,3290,2912,2968,2493,3552,3645,2985,3134,5672,13191,5672,1797,3336,2985
30802,"Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)",4169,3752,1255,9212,2054,1629,1668,2261,2099,2297,2033,2072,1741,2480,2546,2085,2189,3961,9212,3961,1255,2329,2084
30901,"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method",138,124,42,305,72,54,71,75,69,76,67,69,58,82,84,69,72,131,305,131,42,77,69
30905,"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial",298,268,90,657,120,116,152,161,150,164,145,148,124,177,182,149,156,283,657,283,90,166,149
31500,"Intubation, endotracheal, emergency procedure",185,166,56,409,94,72,92,91,99,102,89,92,77,110,113,93,97,176,409,176,56,103,92
32554,HC ASPIRATE PLEURA W/O IMAGING,214,193,64,473,117,84,110,116,108,118,104,106,89,127,131,107,112,203,473,203,64,120,107
32555,PR ASPIRATE PLEURA W/ IMAGING,1030,927,310,2276,489,402,527,559,519,568,502,512,430,613,629,515,541,979,2276,978,310,576,515
36410,"Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)",153,138,46,338,78,60,78,83,77,84,75,76,64,91,93,77,80,145,338,145,46,85,76
36415,Collection of venous blood by venipuncture,28,25,8,410,14,14,15,14,15,14,13,13,12,17,27,14,15,27,410,27,8,16,14
36416,"Collection of capillary blood specimen (eg, finger, heel, ear stick)",17,15,5,38,9,7,9,13,9,9,8,8,7,10,10,9,9,16,38,16,5,9,8
36430,"Transfusion, blood or blood components",650,585,92,1436,308,254,333,289,327,358,317,323,271,387,397,92,341,618,1436,618,196,363,325
36556,Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older,1200,1080,361,2652,612,469,615,651,604,661,585,597,501,714,733,600,630,1140,2652,1140,361,671,600
36591,Collection of blood specimen from a completely implantable venous access device,205,184,62,453,105,64,111,131,103,113,98,102,86,122,125,103,108,195,453,195,62,115,102
36592,"Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified",205,184,62,453,99,80,105,102,110,113,100,102,86,122,125,103,108,195,453,195,62,115,102
36600,"Arterial puncture, withdrawal of blood for diagnosis",60,54,18,133,31,23,26,29,31,30,29,30,25,36,37,30,32,57,133,57,18,34,30
41520,"Frenoplasty (surgical revision of frenum, eg, with Z-plasty)",2630,2367,792,5811,1296,1027,1420,1426,1324,1449,1283,1307,1098,1565,1606,1315,1381,2499,5811,2498,792,1470,1315
42830,"Adenoidectomy, primary; younger than age 12",2984,2686,898,6594,1470,1905,1611,1618,1502,1644,1455,1483,1246,1775,1822,1492,1567,2835,6594,2835,898,1667,1492
42831,"Adenoidectomy, primary; age 12 or over",1,1,0,2,0,0,0,1,1,1,0,0,0,1,1,1,1,1,2,1,0,1,0
43220,"Esophagoscopy, rigid or flexible; with balloon dilation (less than 30 mm diameter)",3685,3316,1109,8142,1879,1440,1887,1999,1855,2031,1797,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
43235,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)",3685,3316,975,8142,975,1440,1990,1769,1855,2031,1797,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
43239,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple",3685,3316,1,8142,948,2337,1990,2871,1842,2031,1797,1832,1539,2192,2250,1843,1,3501,8142,3501,1109,2059,1842
43249,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30 mm diameter)",3685,3316,1109,8142,1879,1440,1887,1999,1855,2031,1797,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
43752,"Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)",209,188,63,462,107,82,107,113,105,115,102,104,87,124,128,105,110,199,462,199,63,117,104
44970,"Laparoscopy, surgical, appendectomy",7200,6480,2167,15909,3547,2813,3888,3905,3625,3967,3512,3579,3007,4283,4396,3600,3780,6840,15909,6840,2167,4023,3600
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)",3685,3316,1009,8142,1009,2551,1990,2160,2085,2031,1797,1842,2579,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
45380,"Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple",3685,3316,1109,8142,1879,2432,1990,1842,1974,2031,1797,1832,1539,2229,2250,1843,2251,3501,8142,3501,1109,2059,1842
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",4170,3753,1255,9214,2127,2598,2136,2262,2100,2298,2034,2073,1742,2481,2546,2085,2189,3962,9214,3962,1255,2330,2085
45385,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique",3927,3534,1182,8677,1879,2944,2121,1922,1977,2164,1915,2328,1640,2336,2398,1964,2062,3731,8677,3731,1182,2194,1964
46220,"Excision of single external papilla or tag, anus",1575,1418,474,3480,776,615,807,788,793,868,768,783,658,937,962,788,827,1496,3480,1496,474,880,788
46260,"Hemorrhoidectomy, internal and external, 2 or more columns/groups;",2918,2626,878,6447,1352,1140,1494,1582,1469,1608,1423,1450,1219,1736,1781,1459,1532,2772,6447,2772,878,1630,1459
46320,"Excision of thrombosed hemorrhoid, external",4655,4190,1401,10286,2293,1819,2514,2525,2344,2565,2271,2314,1944,2769,2842,2328,2444,4422,10286,4422,1401,2601,2328
47562,"Laparoscopy, surgical; cholecystectomy",5970,5373,1797,13191,3045,2332,3224,3238,3528,3290,2912,2985,2493,3552,3645,2985,3134,5672,13191,5672,1797,3336,2985
49083,PR ABD PARACENTESIS W/IMAGING,534,481,161,1180,272,209,273,267,269,294,260,265,223,318,326,267,280,507,1180,507,161,298,267
49505,"Repair initial inguinal hernia, age 5 years or older; reducible",5140,4626,1547,11357,2621,2008,2632,2788,2588,2832,2507,2555,2147,3058,3139,2570,2699,4883,11357,4883,1547,2872,2570
49565,Repair recurrent incisional or ventral hernia; reducible,3270,2943,984,7225,1615,1277,1675,1773,1646,1802,1595,1626,1366,1945,1997,1635,1717,3107,7225,3106,984,1827,1635
49568,Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair),618,556,186,1366,276,241,316,335,311,341,301,307,258,368,377,309,324,587,1366,587,186,345,309
49650,"Laparoscopy, surgical; repair initial inguinal hernia",7815,7034,2353,17268,3850,3053,4002,4238,3935,4306,4046,3456,3264,4649,4772,3908,4103,7424,17268,7424,2353,4367,3908
51700,"Bladder irrigation, simple, lavage and/or instillation",100,90,30,221,51,39,51,54,50,55,49,50,42,59,61,50,53,95,221,95,30,56,50
51701,"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)",52,47,14,115,27,20,28,26,14,26,25,26,22,31,32,26,27,49,115,49,16,29,26
51702,"Insertion of temporary indwelling bladder catheter; simple (eg, Foley)",52,47,14,115,27,20,14,26,28,29,25,26,22,31,32,26,27,49,115,49,16,29,26
51798,"Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging",103,93,31,228,53,40,56,52,52,57,50,51,43,61,63,52,54,98,228,98,31,58,52
56405,Incision and drainage of vulva or perineal abscess,201,181,61,444,99,79,103,157,101,111,98,100,84,120,123,101,106,191,444,191,61,112,100
58558,"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C",2497,2247,752,5517,1111,975,1279,1354,1257,1376,1218,1241,1043,1486,1525,1249,1311,2372,5517,2372,752,1395,1248
59025,Fetal non-stress test,296,266,89,654,146,116,160,161,159,163,144,147,124,176,181,148,155,281,654,281,89,165,148
62270,"Spinal puncture, lumbar, diagnostic",550,495,166,1215,261,215,282,298,277,303,268,273,230,327,336,275,289,523,1215,522,166,307,275
62323,PR INJ INTERLAM L/S W IMG,1575,1418,433,3480,747,1274,850,854,793,868,433,783,658,937,962,788,827,1496,3480,1496,474,880,788
64445,"Injection, anesthetic agent; sciatic nerve, single",975,878,293,2154,463,381,499,529,491,537,476,485,407,580,595,488,512,926,2154,926,293,545,488
64447,"Injection, anesthetic agent; femoral nerve, single",975,878,293,2154,463,381,499,529,491,537,476,485,407,580,595,488,512,926,2154,926,293,545,488
64721,Neuroplasty and/or transposition; median nerve at carpal tunnel,3928,3535,1182,8678,2003,3193,2011,2478,1977,2164,1916,1952,1640,2337,2398,1964,2062,3731,8678,3731,1182,2195,1964
64782,"Excision of neuroma; hand or foot, except digital nerve",3340,3006,1005,7380,1645,3272,1710,1811,1682,1840,1629,1660,1395,1987,2039,1670,1754,3173,7380,3173,1005,1866,1670
64788,Excision of neurofibroma or neurolemmoma; cutaneous nerve,3685,3316,1109,8142,1815,1440,1887,1769,1855,2031,1797,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
65220,"Removal of foreign body, external eye; corneal, without slit lamp",84,76,25,186,41,33,45,46,42,46,41,42,35,50,51,42,44,80,186,80,25,47,42
66982,"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage",3685,3316,1109,8142,1748,1762,1887,1842,1855,2031,1797,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
66984,"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)",3685,3316,1109,8142,1879,1440,1887,1842,1908,2635,1769,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
69200,Removal foreign body from external auditory canal; without general anesthesia,150,135,45,331,74,59,77,81,75,83,73,75,63,89,92,75,79,143,331,142,45,84,75
69210,"Removal impacted cerumen (separate procedure), 1 or both ears",92,82,28,202,51,36,47,50,46,50,45,45,38,54,56,46,48,87,202,87,28,51,46
70030,"Radiologic examination, eye, for detection of foreign body",131,118,39,289,67,68,71,102,66,66,63,65,55,78,80,66,69,124,289,124,39,73,66
70110,"Radiologic examination, mandible; complete, minimum of 4 views",300,270,78,663,148,117,78,163,151,165,146,149,125,178,183,150,158,285,663,285,90,168,150
70140,"Radiologic examination, facial bones; less than 3 views",162,146,49,358,80,63,87,88,82,89,79,81,68,96,99,81,85,154,358,154,49,91,81
70160,"Radiologic examination, nasal bones, complete, minimum of 3 views",200,180,60,442,102,78,108,108,107,110,98,99,84,119,122,100,105,190,442,190,60,112,100
70210,"Radiologic examination, sinuses, paranasal, less than 3 views",130,117,39,287,64,51,67,65,65,72,63,65,54,77,79,65,68,124,287,124,39,73,65
70250,"Radiologic examination, skull; less than 4 views",192,173,58,424,95,68,104,104,97,106,94,95,80,114,117,96,101,182,424,182,58,107,96
70330,"Radiologic examination, temporomandibular joint, open and closed mouth; bilateral",400,360,120,884,190,156,205,217,201,220,195,199,167,238,244,200,210,380,884,380,120,224,200
70360,"Radiologic examination; neck, soft tissue",168,151,51,371,80,65,86,91,84,93,82,84,70,100,103,84,88,160,371,160,51,94,84
70450,"Computed tomography, head or brain; without contrast material",1580,1422,476,3491,806,1042,853,790,847,1146,758,790,1146,940,965,790,830,1501,3491,1501,476,883,790
70470,"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections",2000,1800,126,4419,1020,126,1080,960,1036,1102,976,994,835,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
70480,"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material",1450,1305,436,3204,714,480,743,786,730,799,707,721,606,863,885,725,761,1378,3204,1378,436,810,725
70486,"Computed tomography, maxillofacial area; without contrast material",1800,1620,460,3977,918,460,972,900,900,992,878,895,529,1071,1099,900,945,1710,3977,1710,542,1006,900
70487,"Computed tomography, maxillofacial area; with contrast material(s)",2000,1800,602,4419,1020,781,1024,1085,1007,1102,976,994,835,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
70488,"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections",1880,1692,566,4154,926,734,963,1020,1007,1036,917,935,785,1118,1148,940,987,1786,4154,1786,566,1050,940
70490,"Computed tomography, soft tissue neck; without contrast material",1500,1350,452,3314,765,586,768,750,755,827,732,746,626,892,916,750,788,1425,3314,1425,452,838,750
70491,"Computed tomography, soft tissue neck; with contrast material(s)",1700,1530,512,3756,867,717,871,922,911,850,829,845,710,1011,1038,850,893,1615,3756,1615,512,950,850
70492,"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections",1800,1620,542,3977,918,703,922,976,906,992,878,895,752,1071,1099,900,945,1710,3977,1710,542,1006,900
70496,"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing",2400,2160,503,5303,1224,503,1229,1200,1286,1322,1171,1193,1002,1428,1465,1200,1260,2280,5303,2280,722,1341,1200
70498,"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing",2200,1980,355,4861,1084,355,1127,1100,1108,1212,1073,1094,919,1309,1343,1100,1155,2090,4861,2090,662,1229,1100
70551,"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material",2500,2250,753,5524,1275,901,1350,1200,1259,1250,1219,1243,1044,1487,1527,1250,1313,2375,5524,2375,753,1397,1250
70552,"Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)",2650,2385,798,5855,1305,1035,1357,2064,1334,1460,1293,1317,1107,1577,1618,1325,1391,2518,5855,2518,798,1481,1325
70553,"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences",4000,3600,1204,4083,2040,1357,2160,2169,2000,2204,1951,1988,1671,2380,2442,2000,2100,3800,4083,3800,1204,2235,2000
71045,PR X-RAY EXAM CHEST 1 VIEW,156,140,47,345,80,61,78,78,78,75,75,78,65,93,95,78,82,148,345,148,47,87,78
71046,PR X-RAY EXAM CHEST 2 VIEWS,212,191,7,468,108,65,114,106,106,104,102,102,68,126,7,106,114,201,468,201,64,118,106
71100,"Radiologic examination, ribs, unilateral; 2 views",246,221,65,544,125,65,133,118,123,118,120,122,68,146,150,123,129,234,544,234,74,137,123
71101,"Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views",252,227,68,557,127,68,136,121,127,139,121,125,68,150,154,126,132,239,557,239,76,141,126
71110,"Radiologic examination, ribs, bilateral; 3 views",252,227,60,557,129,60,136,137,127,139,123,125,105,150,154,126,132,239,557,239,76,141,126
71120,"Radiologic examination; sternum, minimum of 2 views",212,191,51,468,104,68,109,115,107,117,103,105,51,126,129,106,111,201,468,201,64,118,106
71250,"Computed tomography, thorax; without contrast material",1800,1620,264,1710,918,264,972,900,964,992,878,895,752,1071,868,900,936,1710,1710,1710,542,1006,900
71260,"Computed tomography, thorax; with contrast material(s)",2000,1800,602,6090,1020,1146,1080,1279,1072,1102,976,994,835,1190,1221,1000,1050,1900,6090,1900,602,1118,1000
71270,"Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections",2000,1800,392,4419,1020,1146,1024,1085,1072,1102,976,994,392,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
71275,"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing",2435,2192,733,5380,1242,758,1315,1218,1307,1342,1169,1210,835,1449,1487,1218,1278,2313,5380,2313,733,1361,1218
72040,"Radiologic examination, spine, cervical; 2 or 3 views",220,198,65,486,112,65,119,119,118,110,106,109,92,133,134,110,116,209,486,209,66,123,110
72050,"Radiologic examination, spine, cervical; minimum of 4 views",336,302,65,319,166,65,181,182,168,161,164,167,68,200,205,168,181,319,319,319,101,188,168
72070,"Radiologic examination, spine; thoracic, 2 views",161,145,33,356,82,33,87,125,81,89,77,80,67,96,98,81,85,153,356,153,48,90,80
72072,"Radiologic examination, spine; thoracic, 3 views",271,244,68,599,138,68,139,84,136,149,132,135,113,161,264,136,146,257,599,257,82,151,136
72082,PR X-RAY EXAM ENTIRE SPINE 2/3 VW,350,315,105,773,178,137,189,190,175,193,171,174,146,208,214,175,184,333,773,332,105,196,175
72100,"Radiologic examination, spine, lumbosacral; 2 or 3 views",279,251,65,616,142,65,151,137,149,140,134,139,117,166,274,140,140,265,616,265,84,156,140
72110,"Radiologic examination, spine, lumbosacral; minimum of 4 views",299,269,48,661,152,48,161,162,160,165,146,149,125,178,183,150,157,284,661,284,90,167,150
72114,"Radiologic examination, spine, lumbosacral; complete, including bending views",376,338,65,831,185,65,193,204,189,207,183,187,157,224,230,188,197,357,831,357,113,210,188
72125,"Computed tomography, cervical spine; without contrast material",1900,1710,264,4198,969,264,1026,950,1018,912,927,944,794,1130,1230,950,988,1805,4198,1805,572,1062,950
72128,"Computed tomography, thoracic spine; without contrast material",1600,1440,429,3535,759,625,819,768,429,882,780,795,668,952,977,800,840,1520,3535,1520,482,894,800
72131,"Computed tomography, lumbar spine; without contrast material",2000,1800,529,4419,1020,529,1024,1085,768,1000,976,994,835,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
72132,"Computed tomography, lumbar spine; with contrast material",1800,1620,542,3977,918,703,922,976,906,992,878,895,752,1071,1099,900,945,1710,3977,1710,542,1006,900
72141,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material",2400,2160,555,2280,1224,555,1296,1302,1243,1322,1171,1193,1002,1428,1465,1200,1296,2280,2280,2280,722,1341,1200
72146,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material",2200,1980,662,4861,1122,859,1188,1056,1108,1212,1073,1094,919,1309,1343,1100,1155,2090,4861,2090,662,1229,1100
72148,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material",2500,2250,753,5524,1275,1032,1350,1250,1339,1812,1219,1243,1044,1512,1200,1250,1313,2375,5524,2375,753,1397,1250
72158,"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar",3550,3195,1069,7844,1810,1387,1818,1775,1775,1956,1732,1765,1483,2112,2168,1775,1864,3373,7844,3372,1069,1984,1775
72170,"Radiologic examination, pelvis; 1 or 2 views",157,141,47,347,80,61,85,78,78,78,75,78,66,93,96,79,82,149,347,149,47,88,78
72192,"Computed tomography, pelvis; without contrast material",1520,1368,458,3359,775,594,821,824,765,838,741,756,635,904,1193,760,798,1444,3359,1444,458,849,760
72220,"Radiologic examination, sacrum and coccyx, minimum of 2 views",236,212,65,521,118,65,121,118,119,130,115,117,99,140,144,118,124,224,521,224,71,132,118
73000,"Radiologic examination; clavicle, complete",168,151,45,371,83,66,86,91,45,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73010,"Radiologic examination; scapula, complete",168,151,51,371,80,66,86,91,85,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73020,"Radiologic examination, shoulder; 1 view",164,148,44,362,84,64,84,89,44,90,80,82,68,98,100,82,86,156,362,156,49,92,82
73030,"Radiologic examination, shoulder; complete, minimum of 2 views",270,243,64,597,138,64,146,130,145,132,130,134,113,161,165,135,142,257,597,256,81,151,135
73040,"Radiologic examination, shoulder, arthrography, radiological supervision and interpretation",650,585,196,1436,332,254,333,353,327,358,317,323,271,387,397,325,341,618,1436,618,196,363,325
73060,"Radiologic examination; humerus, minimum of 2 views",217,195,65,479,111,85,117,139,109,120,106,108,91,129,133,109,114,206,479,206,65,121,108
73080,"Radiologic examination, elbow; complete, minimum of 3 views",200,180,60,442,102,62,108,100,104,110,96,100,84,119,122,100,105,190,442,190,60,112,100
73090,"Radiologic examination; forearm, 2 views",168,151,51,371,86,65,86,91,90,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73100,"Radiologic examination, wrist; 2 views",168,151,51,371,86,66,86,91,85,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73110,"Radiologic examination, wrist; complete, minimum of 3 views",200,180,60,442,102,65,108,100,107,190,96,99,84,119,122,100,105,190,442,190,60,112,100
73120,"Radiologic examination, hand; 2 views",168,151,45,371,83,66,45,91,85,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73130,"Radiologic examination, hand; minimum of 3 views",200,180,60,442,102,62,108,128,107,110,98,99,68,121,122,100,105,190,442,190,60,112,100
73140,"Radiologic examination, finger(s), minimum of 2 views",154,139,46,340,76,65,83,74,83,85,74,77,64,93,94,77,83,146,340,146,46,86,77
73200,"Computed tomography, upper extremity; without contrast material",1500,1350,405,3314,765,505,405,814,755,827,732,746,626,892,916,750,780,1425,3314,1425,452,838,750
73218,"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)",2000,1800,602,4419,985,781,1080,1085,1007,1102,976,994,835,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
73221,"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)",2500,2250,639,5524,1235,639,1350,1356,1259,1378,1219,1243,1044,1487,1527,1250,1313,2375,5524,2375,753,1397,1250
73222,"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)",2200,1980,662,4861,1122,859,1127,1193,1108,1212,1073,1094,919,1309,1343,1100,1155,2090,4861,2090,662,1229,1100
73223,"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences",3200,2880,639,7071,1576,639,1639,1735,1611,1763,1561,1591,1336,1904,1954,1600,1680,3040,7071,3040,963,1788,1600
73501,PR X-RAY EXAM HIP UNI 1 VIEW,200,180,60,442,102,78,102,108,101,110,98,99,84,119,122,100,105,190,442,190,60,112,100
73502,PR X-RAY EXAM HIP UNI 2-3 VIEWS,200,180,54,442,102,62,108,96,54,100,96,99,68,119,122,100,105,190,442,190,60,112,100
73521,PR X-RAY EXAM HIPS BI 2 VIEWS,300,270,90,663,153,117,154,163,151,150,146,149,125,178,183,150,158,285,663,285,90,168,150
73522,PR X-RAY EXAM HIPS BI 3-4 VIEWS,350,315,67,773,178,67,189,190,176,175,171,174,146,208,214,175,184,333,773,332,105,196,175
73523,PR X-RAY EXAM HIPS BI 5/> VIEWS,450,405,77,994,222,176,230,244,227,248,219,224,188,268,77,225,236,428,994,428,135,251,225
73551,PR X-RAY EXAM OF FEMUR 1 VW,170,153,51,376,84,66,87,92,91,94,83,85,71,101,104,85,89,162,376,162,51,95,85
73552,PR X-RAY EXAM OF FEMUR 2/> VW,200,180,33,442,102,33,108,108,101,110,98,99,34,119,122,100,105,190,442,190,60,112,100
73560,"Radiologic examination, knee; 1 or 2 views",168,151,51,371,86,66,91,91,85,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73562,"Radiologic examination, knee; 3 views",200,180,60,190,102,65,108,100,107,100,96,99,68,121,96,100,105,190,190,190,60,112,100
73564,"Radiologic examination, knee; complete, 4 or more views",259,233,65,572,132,65,135,202,130,143,124,129,108,154,158,130,136,246,572,246,78,145,130
73565,"Radiologic examination, knee; both knees, standing, anteroposterior",161,145,48,356,79,62,82,87,81,80,77,80,67,96,98,81,85,153,356,153,48,90,80
73590,"Radiologic examination; tibia and fibula, 2 views",200,180,33,442,95,33,108,108,107,190,98,99,84,121,122,100,105,190,442,190,60,112,100
73592,"Radiologic examination; lower extremity, infant, minimum of 2 views",182,164,55,402,90,71,93,99,98,100,89,90,76,108,111,91,96,173,402,173,55,102,91
73600,"Radiologic examination, ankle; 2 views",168,151,51,371,80,66,86,91,85,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73610,"Radiologic examination, ankle; complete, minimum of 3 views",200,180,60,190,102,65,108,100,107,100,98,99,67,110,122,100,105,190,190,190,60,112,100
73620,"Radiologic examination, foot; 2 views",168,151,42,371,83,65,86,91,42,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73630,"Radiologic examination, foot; complete, minimum of 3 views",200,180,62,442,102,62,108,156,107,100,96,100,84,121,97,100,105,190,442,190,103,112,100
73650,"Radiologic examination; calcaneus, minimum of 2 views",168,151,42,371,86,50,42,91,45,93,82,84,70,100,103,84,88,160,371,160,51,94,84
73660,"Radiologic examination; toe(s), minimum of 2 views",154,139,46,340,73,62,83,84,78,85,75,77,64,92,94,77,81,146,340,146,46,86,77
73700,"Computed tomography, lower extremity; without contrast material",1400,1260,392,3093,714,392,756,672,751,771,683,696,585,833,855,700,735,1330,3093,1330,421,782,700
73701,"Computed tomography, lower extremity; with contrast material(s)",1700,1530,512,3756,837,664,871,922,850,937,829,845,710,1011,1038,850,893,1615,3756,1615,512,950,850
73718,"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)",2200,1980,662,4861,1084,1113,1127,1193,1108,1212,1073,1094,919,1309,1343,1100,1155,2090,4861,2090,662,1229,1100
73721,"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material",2500,2250,639,2375,1275,639,1350,1200,1295,1378,1219,1243,1082,1487,1527,1250,1313,2375,2375,2375,753,1397,1250
74018,PR X-RAY EXAM ABDOMEN 1 VIEW,200,180,60,442,100,62,108,100,100,100,98,99,84,119,122,100,105,190,442,190,60,112,100
74019,PR X-RAY EXAM ABDOMEN 2 VIEWS,252,227,62,557,129,62,136,126,126,126,121,126,105,139,154,126,132,239,557,239,76,141,126
74021,PR X-RAY EXAM ABDOMEN 3+ VIEWS,315,284,95,696,155,123,161,158,159,174,154,157,132,187,192,158,165,299,696,299,95,176,158
74022,"Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest",400,360,120,884,197,156,162,217,201,220,195,199,167,238,244,200,210,380,884,380,120,224,200
74150,"Computed tomography, abdomen; without contrast material",1520,1368,458,3359,775,594,778,824,765,838,741,756,635,904,928,760,798,1444,3359,1444,458,849,760
74160,"Computed tomography, abdomen; with contrast material(s)",2000,1800,602,4419,1020,781,1024,1085,1007,1102,976,994,835,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
74170,"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections",2000,1800,602,4419,949,781,1024,1085,1007,1102,976,994,835,1190,1221,1000,1050,1900,4419,1900,602,1118,1000
74174,PR CT ANGIO ABD AND PELV WO W CONTRAST,3000,2700,903,6629,1530,1172,1536,1627,1510,1653,1463,1491,1253,1785,1832,1500,1575,2850,6629,2850,903,1676,1500
74175,"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing",2400,2160,418,5303,1182,418,1229,1302,1208,1322,1171,1193,1002,1428,1465,1200,1260,2280,5303,2280,722,1341,1200
74176,"Computed tomography, abdomen and pelvis; without contrast material",3660,3294,620,8087,1867,1042,1976,1830,1961,1830,1757,1819,620,2214,1643,1830,1903,3477,8087,3477,1102,2045,1830
74177,"Computed tomography, abdomen and pelvis; with contrast material(s)",4147,3732,573,9163,2115,573,2239,3231,1593,2074,2023,1991,1732,2395,2090,2074,2177,3940,9163,3940,1248,2317,2074
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",4000,3600,620,8838,1969,620,1620,2169,2014,2204,1951,1988,1146,2380,2442,2000,2100,3800,8838,3800,1204,2235,2000
74181,"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)",2200,1980,662,4861,1084,859,1188,1193,1108,1212,1073,1094,919,1309,1343,1100,1155,2090,4861,2090,662,1229,1100
74182,"Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)",2550,2295,768,5635,1256,996,1377,1383,1284,1405,1244,1268,1065,1517,1557,1275,1339,2423,5635,2422,768,1425,1275
74183,"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences",3500,3150,1032,7734,1785,1032,1792,1898,1762,1929,1707,1740,1462,2082,2137,1750,1838,3325,7734,3325,1054,1956,1750
74220,Radiologic examination; esophagus,380,342,60,840,194,60,195,243,204,209,185,190,159,226,232,190,200,361,840,361,114,212,190
74230,"Swallowing function, with cineradiography/videoradiography",450,405,135,994,230,420,243,244,227,248,219,224,188,268,275,225,236,428,994,428,135,251,225
74240,"Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB",498,448,150,1100,245,195,269,270,251,274,243,248,208,296,304,249,261,473,1100,473,150,278,249
74246,"Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed films, without KUB",558,502,168,1233,285,463,301,303,299,307,272,277,233,338,341,279,293,530,1233,530,168,312,279
74248,PR X-RAY SM INT F-THRU STD,200,180,60,442,102,89,108,108,101,110,98,99,84,119,122,100,105,190,442,190,60,112,100
74250,"Radiologic examination, small intestine, includes multiple serial films;",380,342,114,840,180,148,195,206,191,209,185,189,159,226,232,190,200,361,840,361,114,212,190
76000,"Fluoroscopy (separate procedure), up to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)",450,405,135,994,230,176,243,351,241,248,219,225,188,268,275,225,236,428,994,428,135,251,225
76536,"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation",520,468,157,1149,265,230,281,250,279,260,250,258,217,309,318,260,273,494,1149,494,157,291,260
76641,PR US BREAST COMPLETE,500,450,151,1105,246,195,256,271,250,276,244,249,209,297,305,250,263,475,1105,475,151,279,250
76642,PR US BREAST LIMITED,319,287,96,705,163,211,172,160,171,231,156,159,133,190,195,160,167,303,705,303,96,178,160
76700,"Ultrasound, abdominal, real time with image documentation; complete",763,687,230,1686,389,333,412,382,409,420,372,379,319,454,466,382,401,725,1686,725,230,426,382
76705,"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)",580,522,127,1282,296,230,313,284,311,290,283,288,127,319,354,290,290,551,1282,551,175,324,290
76706,PR US ABDL AORTA SCREEN AAA,550,495,166,1215,280,232,297,298,277,303,268,273,230,327,336,275,289,523,1215,522,166,307,275
76770,"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete",650,585,196,1436,332,303,351,325,348,358,317,325,271,387,397,325,341,618,1436,618,196,363,325
76775,"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited",550,495,105,1215,271,215,282,275,275,303,268,273,105,327,336,275,289,523,1215,522,166,307,275
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",480,432,144,1061,236,170,259,260,257,264,234,239,200,286,293,240,252,456,1061,456,144,268,240
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",700,630,203,1547,345,203,378,545,375,386,341,348,292,416,427,350,368,665,1547,665,211,391,350
76815,"Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses",428,385,129,946,211,167,231,333,214,236,209,213,179,255,261,214,225,407,946,407,129,239,214
76816,"Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus",400,360,120,884,197,205,216,217,214,220,195,199,167,238,244,200,210,380,884,380,120,224,200
76817,"Ultrasound, pregnant uterus, real time with image documentation, transvaginal",470,423,141,1039,232,203,254,255,243,259,229,234,196,280,287,235,247,447,1039,446,141,263,235
76830,"Ultrasound, transvaginal",630,567,190,1392,299,211,340,491,338,315,307,313,263,346,385,315,315,598,1392,598,190,352,315
76856,"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete",700,630,127,1547,332,127,378,380,352,386,341,348,292,416,427,350,368,665,1547,665,211,391,350
76857,"Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)",428,385,110,946,218,110,231,333,230,210,209,213,179,255,261,214,225,407,946,407,129,239,214
76870,"Ultrasound, scrotum and contents",546,491,164,1206,259,192,295,296,275,301,266,271,228,325,333,273,287,519,1206,519,164,305,273
76882,"Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific",400,360,120,884,197,230,205,312,201,220,195,199,167,238,244,200,210,380,884,380,120,224,200
76942,"Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation",250,225,75,552,128,98,128,136,126,138,122,124,104,149,153,125,131,238,552,238,75,140,125
77063,HC BREAST TOMOSYNTHESIS DIG SCREEN UNIL,80,72,24,177,79,31,41,80,40,44,39,40,33,48,78,40,42,76,177,76,24,45,40
77065,PR DX MAMMO INCL CAD UNIL,300,270,90,663,153,230,154,150,161,165,146,149,125,178,183,150,158,285,663,285,90,168,150
77066,PR DX MAMMO INCL CAD BILAT,400,360,120,884,197,237,216,192,200,290,195,199,167,238,230,200,210,380,884,380,120,224,200
77067,PR SCR MAMMO INCL CAD UNILAT,400,360,120,884,398,156,205,398,201,220,195,199,167,238,397,200,210,380,884,380,120,224,200
77075,"Radiologic examination, osseous survey; complete (axial and appendicular skeleton)",630,567,190,1392,299,246,323,342,317,347,307,313,263,375,385,315,331,599,1392,598,190,352,315
77080,"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)",440,396,132,972,224,260,238,216,236,220,215,220,215,262,269,220,231,418,972,418,132,246,220
77081,"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)",350,315,105,773,175,137,179,190,176,193,171,174,146,208,214,175,184,333,773,332,105,196,175
77085,PR DXA BONE DENSITY W FX ASSESS,350,315,105,773,172,137,179,168,176,193,171,174,146,208,168,175,184,333,773,332,105,196,175
78226,PR HEPATOBILIARY SYSTEM IMAGING,1200,1080,361,2652,591,469,648,651,604,661,585,597,501,714,733,600,630,1140,2652,1140,361,671,600
78227,PR HEPATOBIL SYST IMAGE W/DRUG,1500,1350,452,3314,739,1066,810,814,804,750,732,746,1066,892,916,750,788,1425,3314,1425,452,838,750
78264,Gastric emptying study,1300,1170,391,2873,640,967,702,705,655,624,634,646,543,773,794,650,683,1235,2873,1235,391,726,650
78306,Bone and/or joint imaging; whole body,1096,986,330,2422,541,879,561,594,552,604,535,545,458,652,669,548,575,1041,2422,1041,330,612,548
78452,"Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection",3400,3060,1023,7513,1734,1657,1836,1700,1712,2465,1658,1690,1420,2023,2076,1700,1785,3230,7513,3230,1023,1900,1700
78582,PR LUNG VENTILAT&PERFUS IMAGING,1400,1260,421,3093,714,547,717,759,705,771,683,696,585,833,855,700,735,1330,3093,1330,421,782,700
78708,"Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)",1600,1440,482,3535,788,1032,819,868,806,882,780,795,668,952,977,800,840,1520,3535,1520,482,894,800
78815,Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh,4800,4320,1445,10606,2448,1875,2458,2304,2417,2645,2341,2386,2005,2856,2931,2400,2520,4560,10606,4560,1445,2682,2400
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)",84,76,25,186,43,57,45,42,45,42,40,42,45,51,66,42,42,80,186,80,25,47,42
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)",303,273,57,670,149,81,155,164,153,167,148,151,57,180,185,152,159,288,670,288,91,169,152
80051,"Electrolyte panel This panel must include the following: Carbon dioxide (82374), Chloride (82435), Potassium (84132), Sodium (84295)",71,64,19,157,29,28,19,39,36,39,35,35,30,42,43,36,37,67,157,67,21,40,36
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)",103,93,31,237,53,81,56,52,55,52,49,50,89,62,93,52,56,98,237,98,31,58,52
80061,"Lipid panel This panel must include the following: Cholesterol, serum, total (82465), Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478)",129,116,22,285,66,40,70,64,69,64,22,22,45,74,76,65,68,123,285,123,39,72,64
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)",85,76,22,188,43,57,22,42,43,42,41,42,36,51,52,43,45,81,188,81,26,47,42
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)",394,355,35,871,201,35,213,214,197,217,192,196,165,234,241,197,213,374,871,374,119,220,197
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)",81,73,24,179,41,35,44,40,43,45,39,40,34,48,49,40,43,77,179,77,24,45,40
80156,Carbamazepine; total,139,125,42,307,70,56,71,75,70,77,68,69,58,83,85,70,73,132,307,132,42,78,70
80159,HC DRUG SCREEN QUANT CLOZAPINE,131,118,39,289,65,51,68,63,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
80162,Digoxin,129,116,39,285,66,61,66,62,65,71,63,64,54,77,79,65,68,123,285,123,39,72,64
80164,Dipropylacetic acid (valproic acid),130,117,39,287,64,61,49,62,70,62,63,65,54,77,79,65,68,124,287,124,39,73,65
80169,HC DRUG SCREEN QUANT EVEROLIMUS,78,70,23,172,38,61,40,42,39,43,38,39,33,46,48,39,41,74,172,74,23,44,39
80170,Gentamicin,157,141,47,347,80,61,80,85,79,87,77,78,66,93,96,79,82,149,347,149,47,88,78
80171,HC DRUG SCREEN QUANT GABAPENTIN,70,63,21,155,34,27,27,42,35,39,34,35,29,42,43,35,37,67,155,66,21,39,35
80175,HC DRUG SCREEN QUANT LAMOTRIGINE,131,118,39,289,62,56,71,63,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
80177,HC DRUG SCREEN QUAN LEVETIRACETAM,168,151,31,371,86,31,91,91,85,81,81,84,70,100,103,84,88,160,371,160,51,94,84
80178,Lithium,67,60,20,148,34,26,36,34,34,37,33,33,28,40,41,34,35,64,148,64,20,37,34
80183,HC DRUG SCREEN QUANT OXCARBAZEPIN,131,118,39,289,65,51,71,102,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
80184,Phenobarbital,113,102,34,250,56,61,58,61,57,62,55,56,47,67,69,57,59,107,250,107,34,63,56
80185,Phenytoin; total,126,113,31,278,62,31,68,60,63,69,61,63,53,75,45,63,66,120,278,120,38,70,63
80186,Phenytoin; free,75,68,23,166,35,29,38,41,38,41,37,37,31,45,46,38,39,71,166,71,23,42,38
80195,Sirolimus,132,119,40,292,67,52,68,72,66,73,64,66,55,79,81,66,69,125,292,125,40,74,66
80197,Tacrolimus,132,119,40,292,67,55,71,72,66,73,63,66,55,79,81,66,69,125,292,125,40,74,66
80198,Theophylline,134,121,40,296,63,52,69,67,67,74,65,67,56,80,82,67,70,127,296,127,40,75,67
80200,Tobramycin,155,140,47,342,77,61,79,84,78,85,76,77,65,92,95,78,81,147,342,147,47,87,78
80201,Topiramate,117,105,28,259,60,28,60,63,58,64,57,58,49,70,71,59,61,111,259,111,35,65,58
80202,Vancomycin,130,117,14,287,14,55,67,71,70,72,63,65,54,77,17,65,68,124,287,124,39,73,65
80299,"Quantitation of drug, not elsewhere specified",244,220,73,539,120,95,125,117,123,134,119,121,102,145,149,122,128,232,539,232,73,136,122
80305,PBB DRUG TEST PRSMV DIR OPT OBS,210,189,14,464,107,50,14,101,105,105,101,104,86,116,128,105,113,200,464,200,63,117,105
80307,HC DRUG TEST(S) PRSMV CHEM ANLYZR,193,174,39,426,98,122,77,104,39,106,94,96,81,115,118,97,101,183,426,183,58,108,96
80371,HC DRUG TEST DEF 22+ CLASS STIMULANTS SYNTHETIC,120,108,16,265,59,47,16,65,60,66,59,60,50,71,73,60,63,114,265,114,36,67,60
81001,"Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy",44,40,13,97,22,25,24,22,23,22,21,22,18,26,27,22,23,42,97,42,13,25,22
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",10,9,3,22,5,4,5,5,5,5,5,5,4,6,5,5,5,10,22,10,3,6,5
81003,"Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy",24,22,7,53,12,22,12,12,12,12,12,12,10,15,15,12,12,23,53,23,7,13,12
81015,Urinalysis; microscopic only,32,29,10,71,15,13,16,17,16,18,16,16,13,19,20,16,17,30,71,30,10,18,16
81025,"Urine pregnancy test, by visual color comparison methods",64,58,19,141,33,25,35,50,34,35,31,32,27,38,39,32,33,61,141,61,19,36,32
81206,HC BCR/ABL1 GENE MAJOR BP,773,696,233,1708,394,527,396,386,389,426,377,384,323,460,472,387,406,734,1708,734,233,432,386
81240,HC F2 GENE,81,73,24,179,40,45,41,44,41,45,40,40,34,48,49,41,43,77,179,77,24,45,40
81241,HC F5 GENE,368,331,111,813,180,202,188,200,185,203,179,183,154,219,225,184,193,350,813,350,111,206,184
81256,HC HFE GENE,715,644,158,1580,352,158,366,388,360,394,349,355,299,425,437,358,375,679,1580,679,215,400,358
81270,HC JAK2 GENE,838,754,252,1852,413,327,429,454,422,462,402,417,350,499,512,419,440,796,1852,796,252,468,419
82010,"Acetone or other ketone bodies, serum; quantitative",80,72,22,177,38,31,22,43,40,44,39,40,33,48,49,40,42,76,177,76,24,45,40
82024,Adrenocorticotropic hormone (ACTH),362,326,109,800,183,141,195,196,182,199,177,180,151,215,221,181,190,344,800,344,109,202,181
82040,"Albumin; serum, plasma or whole blood",50,45,15,110,26,23,26,25,25,25,24,25,21,30,31,25,26,48,110,48,15,28,25
82043,"Albumin; urine, microalbumin, quantitative",42,38,13,80,21,25,23,21,22,21,20,21,27,25,41,21,22,40,80,40,13,23,21
82085,Aldolase,88,79,26,194,43,78,45,48,44,48,43,44,37,52,54,44,46,84,194,84,26,49,44
82088,Aldosterone,273,246,82,603,90,94,140,148,137,150,133,136,114,162,167,137,143,259,603,259,82,153,136
82103,Alpha-1-antitrypsin; total,136,122,41,299,61,53,69,73,70,75,66,67,57,81,83,68,71,129,299,129,41,76,68
82104,Alpha-1-antitrypsin; phenotype,137,123,41,303,64,54,70,74,69,75,67,68,57,82,84,69,72,130,303,130,41,77,68
82105,Alpha-fetoprotein (AFP); serum,161,145,48,356,82,64,79,87,79,80,79,80,67,96,98,81,85,153,356,153,48,90,80
82140,Ammonia,139,125,42,307,65,86,75,75,70,77,68,69,58,83,85,70,73,132,307,132,42,78,70
82150,Amylase,67,60,20,148,34,21,36,32,26,34,32,34,28,37,41,34,35,64,148,64,20,37,34
82175,Arsenic,213,192,64,471,109,83,109,116,107,117,104,106,89,127,130,107,112,202,471,202,64,119,106
82180,"Ascorbic acid (Vitamin C), blood",101,91,30,223,52,39,52,55,51,56,49,50,42,60,62,51,53,96,223,96,30,56,50
82232,Beta-2 microglobulin,131,118,39,289,62,52,67,71,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
82247,Bilirubin; total,52,47,16,115,25,28,28,28,26,29,25,26,22,31,32,26,27,49,115,49,16,29,26
82248,Bilirubin; direct,52,47,16,115,25,17,28,25,26,29,25,26,22,31,32,26,27,49,115,49,16,29,26
82270,"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)",33,30,10,73,17,13,18,16,16,16,16,16,14,20,16,17,17,31,73,31,10,18,16
82272,"Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening",33,30,9,73,17,30,9,21,18,18,16,16,14,20,20,17,17,31,73,31,10,18,16
82274,"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations",33,30,10,73,17,13,17,18,17,18,16,16,14,20,20,17,17,31,73,31,10,18,16
82300,Cadmium,70,63,21,155,36,27,36,38,35,39,34,35,29,42,43,35,37,67,155,66,21,39,35
82306,"Vitamin D; 25 hydroxy, includes fraction(s), if performed",278,250,84,614,142,116,150,139,149,153,136,138,116,165,170,139,146,264,614,264,84,155,139
82308,Calcitonin,227,204,68,502,112,89,116,109,114,125,111,113,95,135,139,114,119,216,502,216,68,127,114
82310,Calcium; total,53,48,16,117,27,23,29,26,27,26,26,26,22,32,32,27,28,50,117,50,16,30,26
82330,Calcium; ionized,131,118,39,289,62,86,67,71,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
82340,"Calcium; urine quantitative, timed specimen",63,57,19,139,31,43,32,34,32,35,31,31,26,37,38,32,33,60,139,60,19,35,32
82365,Calculus; infrared spectroscopy,47,42,13,104,13,18,24,25,24,26,23,23,20,28,29,24,25,45,104,45,14,26,24
82374,Carbon dioxide (bicarbonate),50,45,15,110,24,20,26,27,25,28,24,25,21,30,31,25,26,48,110,48,15,28,25
82375,Carboxyhemoglobin; quantitative,110,99,33,243,52,43,56,60,55,61,54,55,46,65,67,55,58,105,243,104,33,61,55
82378,Carcinoembryonic antigen (CEA),108,97,33,239,55,72,58,59,54,60,52,54,45,64,66,54,57,103,239,103,33,60,54
82384,Catecholamines; fractionated,238,214,64,526,117,64,122,114,120,131,116,118,99,142,145,119,125,226,526,226,72,133,119
82390,Ceruloplasmin,106,95,32,234,50,41,54,57,53,58,52,53,44,63,65,53,56,101,234,101,32,59,53
82397,Chemiluminescent assay,104,94,28,230,53,43,28,52,56,57,51,52,43,62,64,52,55,99,230,99,31,58,52
82436,Chloride; urine,52,47,16,115,26,33,27,28,26,29,25,26,22,31,32,26,27,49,115,49,16,29,26
82465,"Cholesterol, serum or whole blood, total",43,39,13,95,21,33,22,23,23,21,21,21,18,26,26,22,23,41,95,41,13,24,22
82507,Citrate,262,236,43,579,129,43,134,142,132,144,128,130,109,156,160,131,138,249,579,249,79,146,131
82533,Cortisol; total,157,141,47,347,77,58,85,75,79,87,77,78,66,93,96,79,82,149,347,149,47,88,78
82540,Creatine,67,60,17,148,33,17,34,36,34,37,33,33,28,40,41,34,35,64,148,64,20,37,34
82550,"Creatine kinase (CK), (CPK); total",96,86,29,212,49,30,52,48,48,48,46,48,33,58,59,48,48,91,212,91,29,54,48
82553,"Creatine kinase (CK), (CPK); MB fraction only",113,102,34,250,58,50,61,56,61,56,54,56,86,68,69,56,56,107,250,107,34,63,56
82565,Creatinine; blood,53,48,14,117,27,14,29,26,28,26,25,26,22,32,32,27,28,50,117,50,16,30,26
82570,Creatinine; other source,42,38,13,93,21,23,23,21,22,21,20,21,33,25,30,21,22,40,93,40,13,23,21
82595,"Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)",202,182,61,446,95,79,103,110,102,111,99,100,84,120,123,101,106,192,446,192,61,113,101
82607,Cyanocobalamin (Vitamin B-12);,147,132,44,325,75,50,79,74,79,74,71,73,55,87,90,74,77,140,325,140,44,82,74
82627,Dehydroepiandrosterone-sulfate (DHEA-S),211,190,26,466,104,26,108,114,106,116,103,105,88,126,129,106,111,200,466,200,64,118,106
82652,"Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed",360,324,108,795,184,116,184,195,181,198,176,179,150,214,220,180,189,342,795,342,108,201,180
82668,Erythropoietin,180,162,54,398,92,86,92,90,91,99,88,89,75,107,110,90,95,171,398,171,54,101,90
82670,Estradiol,264,238,58,583,135,58,143,143,133,145,129,131,110,157,161,132,139,251,583,251,79,148,132
82677,Estriol,185,166,56,409,91,58,100,100,93,102,90,92,77,110,113,93,97,176,409,176,56,103,92
82710,"Fat or lipids, feces; quantitative",131,118,17,289,17,51,67,71,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
82728,Ferritin,131,118,39,289,67,50,71,66,70,66,63,65,86,78,80,66,69,124,289,124,39,73,66
82746,Folic acid; serum,141,127,42,312,72,43,76,70,76,70,68,70,65,84,86,71,74,134,312,134,42,79,70
82784,"Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each",273,246,78,603,128,78,140,148,137,150,133,136,114,162,167,137,143,259,603,259,82,153,136
82785,Gammaglobulin (immunoglobulin); IgE,159,143,39,351,78,39,81,86,80,88,78,79,66,95,97,80,83,151,351,151,48,89,80
82787,"Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each",126,113,25,278,62,25,65,68,63,69,61,63,53,75,77,63,66,120,278,120,38,70,63
82805,"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry",185,166,56,409,94,72,69,91,92,92,89,92,77,110,113,93,97,176,409,176,56,103,92
82947,"Glucose; quantitative, blood (except reagent strip)",40,36,12,38,20,32,22,22,21,22,20,20,17,24,24,20,21,38,38,38,12,22,20
82951,"Glucose; tolerance test (GTT), 3 specimens (includes glucose)",100,90,30,221,49,68,54,54,54,55,49,50,42,59,61,50,53,95,221,95,30,56,50
82962,"Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use",5,4,2,11,3,2,3,2,3,2,2,2,2,3,3,2,3,5,11,5,2,3,2
82977,"Glutamyltransferase, gamma (GGT)",73,66,17,161,36,17,39,35,37,40,36,36,30,43,45,37,38,69,161,69,22,41,36
83001,Gonadotropin; follicle stimulating hormone (FSH),177,159,32,391,87,32,96,96,95,98,86,88,74,105,108,89,93,168,391,168,53,99,88
83002,Gonadotropin; luteinizing hormone (LH),176,158,32,389,87,32,90,95,89,97,86,87,74,105,107,88,92,167,389,167,53,98,88
83010,Haptoglobin; quantitative,122,110,37,270,62,48,62,66,61,67,60,61,51,73,74,61,64,116,270,116,37,68,61
83020,"Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)",53,48,13,117,26,21,27,29,13,29,26,26,22,32,32,27,28,50,117,50,16,30,26
83021,"Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F)",53,48,13,117,26,21,27,29,13,29,26,26,22,32,32,27,28,50,117,50,16,30,26
83036,Hemoglobin; glycosylated (A1C),94,85,14,208,15,78,25,45,32,15,14,15,86,57,18,47,47,89,208,59,28,53,47
83051,Hemoglobin; plasma,74,67,22,164,37,29,38,40,37,41,36,37,31,44,45,37,39,70,164,70,22,41,37
83090,Homocysteine,224,202,64,495,110,64,121,121,113,123,109,111,123,133,137,112,118,213,495,213,67,125,112
83497,"Hydroxyindolacetic acid, 5-(HIAA)",71,64,21,157,35,39,38,39,36,39,35,35,30,42,43,36,37,67,157,67,21,40,36
83516,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method",113,102,34,250,86,48,61,61,56,62,55,56,47,67,69,57,59,107,250,107,34,63,56
83520,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified",97,87,29,214,46,49,52,47,49,70,47,48,41,58,59,49,51,92,214,92,29,54,48
83525,Insulin; total,112,101,34,247,55,55,57,61,56,62,55,56,47,67,68,56,59,106,247,106,34,63,56
83540,Iron,65,58,17,144,33,30,35,32,35,32,31,32,17,39,40,33,34,62,144,62,20,36,32
83550,Iron binding capacity,76,68,23,168,39,32,41,38,41,38,36,38,43,45,46,38,40,72,168,72,23,42,38
83605,Lactate (lactic acid),103,93,31,228,53,40,52,52,52,52,49,49,43,61,101,52,54,98,228,98,31,58,52
83615,"Lactate dehydrogenase (LD), (LDH);",63,57,19,139,32,25,34,32,34,32,31,31,26,37,38,32,33,60,139,60,19,35,32
83630,"Lactoferrin, fecal; qualitative",134,121,21,296,21,52,69,73,67,74,65,67,56,80,82,67,70,127,296,127,40,75,67
83655,Lead,119,107,36,263,61,41,64,93,64,66,58,59,41,71,73,60,62,113,263,113,36,66,60
83690,Lipase,70,63,21,155,36,23,35,35,35,35,34,34,29,38,51,35,35,67,155,66,21,39,35
83718,"Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)",81,73,24,179,40,32,41,44,41,39,40,40,34,48,49,41,43,77,179,77,24,45,40
83721,"Lipoprotein, direct measurement; LDL cholesterol",76,68,23,168,38,39,41,36,39,36,36,38,32,45,46,38,40,72,168,72,23,42,38
83735,Magnesium,68,61,17,150,35,23,37,34,34,33,33,34,17,41,42,34,36,65,150,65,20,38,34
83825,"Mercury, quantitative",53,48,16,117,27,21,27,29,27,29,26,26,22,32,32,27,28,50,117,50,16,30,26
83835,Metanephrines,162,146,49,358,174,64,87,88,87,89,79,81,68,96,99,81,85,154,358,154,49,91,81
83874,Myoglobin,124,112,34,274,63,34,67,60,66,68,60,62,52,74,76,62,65,118,274,118,37,69,62
83880,Natriuretic peptide,318,286,21,703,162,128,172,159,170,159,153,159,96,189,21,159,167,302,703,302,96,178,159
83883,"Nephelometry, each analyte not elsewhere specified",206,185,52,455,97,52,105,112,104,114,99,102,86,123,126,103,108,196,455,196,62,115,103
83921,"Organic acid, single, quantitative",182,164,23,402,86,23,98,99,92,100,89,90,76,108,111,91,96,173,402,173,55,102,91
83935,Osmolality; urine,70,63,16,155,34,16,36,34,35,39,34,35,29,42,43,35,37,67,155,66,21,39,35
83945,Oxalate,124,112,37,274,61,43,64,67,62,68,60,62,52,74,76,62,65,118,274,118,37,69,62
83970,Parathormone (parathyroid hormone),246,221,64,544,125,64,126,123,123,121,118,122,103,146,150,123,129,234,544,234,74,137,123
83986,"pH; body fluid, not otherwise specified",39,35,12,86,19,17,20,21,20,21,19,19,16,23,24,20,20,37,86,37,12,22,20
84075,"Phosphatase, alkaline;",53,48,16,117,26,17,27,29,27,29,26,26,22,32,32,27,28,50,117,50,16,30,26
84080,"Phosphatase, alkaline; isoenzymes",151,136,43,334,74,43,77,82,76,83,74,75,63,90,92,76,79,143,334,143,45,84,76
84100,Phosphorus inorganic (phosphate);,48,43,11,106,24,11,26,24,13,24,23,24,20,29,29,24,25,46,106,46,14,27,24
84105,Phosphorus inorganic (phosphate); urine,53,48,16,117,26,17,27,29,27,29,26,26,22,32,32,27,28,50,117,50,16,30,26
84132,"Potassium; serum, plasma or whole blood",47,42,14,104,22,17,25,24,25,24,23,23,20,28,29,24,25,45,104,45,14,26,24
84133,Potassium; urine,44,40,13,97,22,17,23,24,22,24,21,22,18,26,27,22,23,42,97,42,13,25,22
84134,Prealbumin,139,125,39,307,65,39,71,70,70,77,67,69,58,83,85,70,73,132,307,132,42,78,70
84144,Progesterone,200,180,52,442,99,52,108,108,101,110,98,99,55,119,122,100,105,190,442,190,60,112,100
84145,Procalcitonin (PCT),188,169,57,415,96,64,102,94,97,104,90,93,79,112,115,94,99,179,415,179,57,105,94
84146,Prolactin,184,166,47,407,91,47,99,88,99,101,90,91,77,109,112,92,97,175,407,175,55,103,92
84150,"Prostaglandin, each",2700,2430,813,5966,1349,1055,1383,1464,1359,1488,1317,1342,1128,1606,1649,1350,1418,2565,5966,2565,813,1509,1350
84153,Prostate specific antigen (PSA); total,176,158,50,389,90,50,95,88,94,88,84,87,68,105,107,88,92,167,389,167,53,98,88
84154,Prostate specific antigen (PSA); free,176,158,25,389,90,25,90,137,89,97,86,87,74,105,107,88,92,167,389,167,53,98,88
84155,"Protein, total, except by refractometry; serum, plasma or whole blood",40,36,12,88,19,16,20,22,20,22,20,20,17,24,24,20,21,38,88,38,12,22,20
84156,"Protein, total, except by refractometry; urine",40,36,12,88,19,15,20,19,20,20,19,20,17,24,24,20,21,38,88,38,12,22,20
84157,"Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)",33,30,10,73,17,13,17,18,17,18,16,16,14,20,20,17,17,31,73,31,10,18,16
84163,Pregnancy-associated plasma protein-A (PAPP-A),106,95,32,234,52,39,57,57,53,58,52,53,44,63,65,53,56,101,234,101,32,59,53
84165,"Protein; electrophoretic fractionation and quantitation, serum",106,95,32,234,50,50,54,51,57,58,52,53,44,63,65,53,56,101,234,101,32,59,53
84166,"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)",170,153,17,376,17,50,87,92,86,94,82,85,71,101,104,85,89,162,376,162,51,95,85
84206,Proinsulin,103,93,31,228,51,61,53,56,52,57,50,51,43,61,63,52,54,98,228,98,31,58,52
84244,Renin,208,187,52,460,64,52,107,113,105,115,101,103,87,124,127,104,109,198,460,198,63,116,104
84255,Selenium,75,68,23,166,37,39,38,41,38,41,37,37,31,45,46,38,39,71,166,71,23,42,38
84295,"Sodium; serum, plasma or whole blood",48,43,14,106,24,23,25,26,24,26,23,24,20,29,29,24,25,46,106,46,14,27,24
84300,Sodium; urine,31,28,9,68,16,17,16,16,17,17,15,15,13,18,19,16,16,29,68,29,9,17,16
84392,"Sulfate, urine",33,30,10,73,16,27,17,18,17,18,16,16,14,20,20,17,17,31,73,31,10,18,16
84402,Testosterone; free,242,218,52,535,168,52,131,131,122,133,118,120,101,144,148,121,127,230,535,230,73,135,121
84403,Testosterone; total,245,220,58,541,125,58,132,133,123,135,120,122,102,148,150,123,129,233,541,233,74,137,122
84425,Thiamine (Vitamin B-1),202,182,41,446,103,41,103,97,102,111,99,100,84,120,123,101,106,192,446,192,61,113,101
84432,Thyroglobulin,155,140,47,342,79,58,79,84,78,85,76,77,65,92,95,78,81,147,342,147,47,87,78
84436,Thyroxine; total,70,63,21,155,34,39,38,35,38,35,34,35,29,42,43,35,37,67,155,66,21,39,35
84439,Thyroxine; free,76,68,23,168,39,50,41,38,41,38,36,38,52,46,46,38,40,72,168,72,23,42,38
84443,Thyroid stimulating hormone (TSH),161,145,21,356,82,26,87,80,86,80,77,80,28,97,21,80,87,153,356,153,48,90,80
84445,Thyroid stimulating immune globulins (TSI),476,428,143,1052,234,186,244,258,255,262,232,237,199,283,291,238,250,452,1052,452,143,266,238
84446,Tocopherol alpha (Vitamin E),112,101,34,247,55,43,57,61,56,62,55,56,47,67,68,56,59,106,247,106,34,63,56
84450,Transferase; aspartate amino (AST) (SGOT),53,48,16,140,27,17,29,26,28,26,25,26,23,32,32,27,28,50,140,50,16,30,26
84460,Transferase; alanine amino (ALT) (SGPT),94,85,11,208,48,15,51,47,50,47,45,47,11,56,57,47,49,89,208,89,28,53,47
84478,Triglycerides,60,54,18,133,28,25,31,33,32,29,29,30,25,36,37,30,32,57,133,57,18,34,30
84480,Triiodothyronine T3; total (TT-3),123,111,26,272,60,26,66,59,62,68,60,61,51,73,75,62,65,117,272,117,37,69,62
84481,Triiodothyronine T3; free,162,146,26,358,83,26,87,79,87,81,78,81,68,98,99,81,85,154,358,154,49,91,81
84484,"Troponin, quantitative",96,86,25,212,49,25,52,48,50,48,32,48,43,58,59,48,34,91,212,91,29,54,48
84520,Urea nitrogen; quantitative,42,38,11,93,20,11,23,21,21,23,20,21,18,25,26,21,22,40,93,40,13,23,21
84550,Uric acid; blood,46,41,14,102,23,30,19,29,23,23,22,23,19,27,28,23,24,44,102,44,14,26,23
84560,Uric acid; other source,48,43,14,106,24,17,25,26,24,26,23,24,20,29,29,24,25,46,106,46,14,27,24
84585,"Vanillylmandelic acid (VMA), urine",150,135,32,331,74,32,77,81,76,83,73,75,63,89,92,75,79,143,331,142,45,84,75
84586,Vasoactive intestinal peptide (VIP),49,44,15,108,24,32,25,27,25,27,24,24,20,29,30,25,26,47,108,47,15,27,24
84588,"Vasopressin (antidiuretic hormone, ADH)",282,254,85,623,133,110,144,153,142,155,138,140,118,168,172,141,148,268,623,268,85,158,141
84590,Vitamin A,101,91,30,223,52,33,55,55,51,56,49,50,42,60,62,51,53,96,223,96,30,56,50
84597,Vitamin K,131,118,39,289,65,43,67,71,66,72,64,65,55,78,80,66,69,124,289,124,39,73,66
84630,Zinc,112,101,34,247,55,38,57,61,56,62,55,56,47,67,68,56,59,106,247,106,34,63,56
84681,C-peptide,200,180,60,442,99,78,81,108,101,100,98,99,84,119,122,100,105,190,442,190,60,112,100
84702,"Gonadotropin, chorionic (hCG); quantitative",145,130,41,320,71,52,78,113,78,80,71,72,41,86,89,73,76,138,320,138,44,81,72
85007,"Blood count; blood smear, microscopic examination with manual differential WBC count",36,32,11,80,18,36,19,17,14,17,17,18,15,21,22,18,19,34,80,34,11,20,18
85014,Blood count; hematocrit (Hct),24,22,7,53,12,9,12,19,12,23,12,12,10,14,15,12,13,23,53,23,7,13,12
85018,Blood count; hemoglobin (Hgb),24,22,7,53,12,18,13,15,13,12,12,12,10,14,15,12,13,23,53,23,7,13,12
85025,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count",78,70,23,172,40,36,42,39,42,39,37,39,40,45,76,39,42,74,172,74,23,44,39
85027,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)",78,70,20,172,40,36,42,39,42,39,37,39,20,47,68,39,41,74,172,74,23,44,39
85046,"Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV], RNA content), direct measurement",58,52,17,128,30,18,31,29,29,32,28,29,24,35,35,29,30,55,128,55,17,32,29
85048,"Blood count; leukocyte (WBC), automated",24,22,7,53,12,20,12,12,12,13,12,12,10,14,15,12,13,23,53,23,7,13,12
85049,"Blood count; platelet, automated",46,41,14,102,23,20,24,25,23,25,22,23,19,27,28,23,24,44,102,44,14,26,23
85060,"Blood smear, peripheral, interpretation by physician with written report",73,66,22,161,36,29,39,35,37,36,36,36,30,43,45,37,38,69,161,69,22,41,36
85130,Chromogenic substrate assay,450,405,135,994,222,176,243,244,227,248,219,224,188,268,275,225,236,428,994,428,135,251,225
85240,"Clotting; factor VIII (AHG), 1-stage",194,175,58,429,96,66,99,105,104,107,95,96,81,115,121,97,102,184,429,184,58,108,97
85245,"Clotting; factor VIII, VW factor, ristocetin cofactor",130,117,33,287,64,33,67,71,107,72,63,65,54,77,79,65,68,124,287,124,39,73,65
85246,"Clotting; factor VIII, VW factor antigen",198,178,33,438,98,33,101,107,106,109,97,98,83,118,121,99,104,188,438,188,60,111,99
85247,"Clotting; factor VIII, von Willebrand factor, multimetric analysis",130,117,33,287,64,33,67,71,107,72,63,65,54,77,79,65,68,124,287,124,39,73,65
85300,"Clotting inhibitors or anticoagulants; antithrombin III, activity",68,61,20,150,33,66,35,37,34,37,33,34,28,40,42,34,36,65,150,65,20,38,34
85302,"Clotting inhibitors or anticoagulants; protein C, antigen",117,105,33,259,58,33,60,63,59,64,57,58,49,70,71,59,61,111,259,111,35,65,58
85303,"Clotting inhibitors or anticoagulants; protein C, activity",125,112,33,276,62,33,64,68,63,69,61,62,52,74,44,63,66,119,276,119,38,70,62
85305,"Clotting inhibitors or anticoagulants; protein S, total",113,102,33,250,56,33,58,61,57,62,55,56,47,67,69,57,59,107,250,107,34,63,56
85306,"Clotting inhibitors or anticoagulants; protein S, free",148,133,33,327,73,33,76,80,75,82,72,74,62,88,90,74,78,141,327,141,45,83,74
85379,"Fibrin degradation products, D-dimer; quantitative",85,76,26,188,43,60,46,42,42,62,41,42,66,51,52,43,45,81,188,81,26,47,42
85384,Fibrinogen; activity,84,76,23,186,43,27,23,42,45,46,41,42,35,50,51,42,44,80,186,80,25,47,42
85397,"Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte",198,178,33,438,98,33,101,107,106,109,97,98,83,118,121,99,104,188,438,188,60,111,99
85610,Prothrombin time;,39,35,8,86,8,27,21,8,21,8,8,20,16,23,8,20,20,37,86,37,12,22,20
85613,Russell viper venom time (includes venom); diluted,93,84,28,205,46,33,48,50,47,51,45,46,39,55,57,47,49,88,205,88,28,52,46
85652,"Sedimentation rate, erythrocyte; automated",39,35,12,86,20,20,21,20,20,19,19,20,20,21,24,20,21,37,86,37,12,22,20
85730,"Thromboplastin time, partial (PTT); plasma or whole blood",53,48,16,117,27,19,29,25,28,38,25,26,22,32,32,27,28,50,117,50,16,30,26
86003,"Allergen specific IgE; quantitative or semiquantitative, each allergen",90,81,27,199,44,47,46,49,45,50,44,45,38,54,55,45,47,86,199,86,27,50,45
86022,Antibody identification; platelet antibodies,198,178,49,438,98,49,101,107,100,109,97,98,83,118,121,99,104,188,438,188,60,111,99
86038,Antinuclear antibodies (ANA);,119,107,25,263,56,25,64,57,60,86,57,59,50,71,73,60,62,113,263,113,36,66,60
86060,Antistreptolysin 0; titer,74,67,22,164,36,54,38,40,37,41,36,37,31,44,45,37,39,70,164,70,22,41,37
86140,C-reactive protein;,53,48,16,117,27,52,29,26,28,38,25,26,22,32,32,27,28,50,117,50,16,30,26
86141,C-reactive protein; high sensitivity (hsCRP),124,112,33,274,58,49,33,67,62,68,60,62,52,74,76,62,65,118,274,118,37,69,62
86146,"Beta 2 Glycoprotein I antibody, each",171,154,51,378,84,86,88,93,86,94,83,85,71,102,104,86,90,162,378,162,51,96,86
86147,"Cardiolipin (phospholipid) antibody, each Ig class",171,154,51,378,84,66,88,93,86,94,83,85,71,102,104,86,90,162,378,162,51,96,86
86160,"Complement; antigen, each component",117,105,25,259,55,25,60,63,59,64,57,58,49,70,71,59,61,111,259,111,35,65,58
86200,"Cyclic citrullinated peptide (CCP), antibody",124,112,24,274,61,24,67,67,62,60,60,62,52,74,76,62,65,118,274,118,37,69,62
86225,Deoxyribonucleic acid (DNA) antibody; native or double stranded,132,119,27,292,65,27,68,72,66,73,64,66,55,79,81,66,69,125,292,125,40,74,66
86235,"Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody",97,87,29,739,113,46,52,233,49,264,233,48,41,58,739,49,51,92,214,92,29,54,48
86255,"Fluorescent noninfectious agent antibody; screen, each antibody",111,100,33,245,55,45,57,53,56,61,54,55,46,66,68,56,58,105,245,105,33,62,56
86300,"Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)",200,180,60,442,102,78,102,108,101,100,96,99,84,119,122,100,105,190,442,190,60,112,100
86301,"Immunoassay for tumor antigen, quantitative; CA 19-9",200,180,60,442,100,110,102,108,101,110,98,99,84,119,122,100,105,190,442,190,60,112,100
86304,"Immunoassay for tumor antigen, quantitative; CA 125",200,180,60,442,98,110,102,156,101,110,98,99,84,119,122,100,105,190,442,190,60,112,100
86308,Heterophile antibodies; screening,53,48,16,117,25,47,29,29,27,29,26,26,22,32,32,27,28,50,117,50,16,30,26
86316,"Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each",200,180,60,442,99,78,108,108,101,110,98,99,84,119,122,100,105,190,442,190,60,112,100
86318,"Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent strip)",84,76,25,186,43,33,45,46,44,46,41,42,35,50,51,42,44,80,186,80,25,47,42
86334,Immunofixation electrophoresis; serum,212,191,26,468,100,26,109,115,107,117,103,105,89,126,129,106,111,201,468,201,64,118,106
86335,"Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)",274,247,82,605,135,106,140,149,138,151,134,136,114,163,167,137,144,260,605,260,82,153,137
86336,Inhibin A,124,112,37,274,61,39,67,67,62,68,60,62,52,74,76,62,65,118,274,118,37,69,62
86355,"B cells, total count",144,130,43,318,71,90,78,78,73,79,70,72,60,86,88,72,76,137,318,137,43,80,72
86357,"Natural killer (NK) cells, total count",144,130,43,318,71,45,78,78,73,79,70,72,60,86,88,72,76,137,318,137,43,80,72
86359,T cells; total count,144,130,43,318,71,45,78,78,73,79,70,72,60,86,88,72,76,137,318,137,43,80,72
86360,"T cells; absolute CD4 and CD8 count, including ratio",333,300,45,736,164,45,180,181,168,183,162,166,139,198,203,167,175,316,736,316,100,186,166
86376,"Microsomal antibodies (eg, thyroid or liver-kidney), each",139,125,28,307,68,28,75,75,70,77,68,69,58,83,85,70,73,132,307,132,42,78,70
86431,Rheumatoid factor; quantitative,58,52,17,128,30,25,31,28,31,29,28,29,24,35,35,29,30,55,128,55,17,32,29
86480,"Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon",151,136,45,334,71,69,82,72,81,83,74,75,63,90,92,76,79,143,334,143,45,84,76
86580,"Skin test; tuberculosis, intradermal",64,58,19,141,32,25,35,35,32,35,31,32,27,38,39,32,34,61,141,61,19,36,32
86592,"Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)",44,40,13,97,22,17,23,24,22,24,21,22,18,26,27,22,23,42,97,42,13,25,22
86611,Antibody; Bartonella,61,55,18,135,30,24,31,33,31,34,30,30,25,36,37,31,33,58,135,58,18,34,30
86617,"Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)",150,135,45,331,74,52,81,81,76,83,73,75,63,89,92,75,79,143,331,142,45,84,75
86618,Antibody; Borrelia burgdorferi (Lyme disease),82,74,25,181,42,41,42,44,41,45,40,41,34,49,50,41,44,78,181,78,25,46,41
86644,Antibody; cytomegalovirus (CMV),137,123,41,303,67,82,74,74,69,75,67,68,57,82,84,69,72,130,303,130,41,77,68
86645,"Antibody; cytomegalovirus (CMV), IgM",161,145,45,356,79,45,87,87,81,89,79,80,67,96,98,81,85,153,356,153,48,90,80
86664,"Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)",60,54,18,133,30,52,32,33,30,33,29,30,25,36,37,30,32,57,133,57,18,34,30
86665,"Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)",59,53,18,130,29,26,32,32,30,33,29,29,25,35,36,30,31,56,130,56,18,33,30
86696,"Antibody; herpes simplex, type 2",125,112,38,276,62,49,64,68,63,69,61,62,52,74,76,63,66,119,276,119,38,70,62
86704,Hepatitis B core antibody (HBcAb); total,117,105,35,259,58,46,60,63,63,64,57,58,49,70,71,59,61,111,259,111,35,65,58
86705,Hepatitis B core antibody (HBcAb); IgM antibody,76,68,23,168,37,30,41,41,41,42,37,38,32,45,46,38,40,72,168,72,23,42,38
86706,Hepatitis B surface antibody (HBsAb),106,95,32,234,50,41,57,51,53,58,52,53,44,63,65,53,56,101,234,101,32,59,53
86708,Hepatitis A antibody (HAAb); total,121,109,36,267,57,47,62,66,61,67,59,60,51,72,74,61,64,115,267,115,36,68,60
86735,Antibody; mumps,125,112,38,276,62,49,64,68,67,69,61,62,52,74,76,63,66,119,276,119,38,70,62
86762,Antibody; rubella,137,123,26,303,67,26,74,74,73,75,67,68,57,82,84,69,72,130,303,130,41,77,68
86765,Antibody; rubeola,124,112,25,274,61,25,64,67,66,68,60,62,52,74,76,62,65,118,274,118,37,69,62
86780,Antibody; Treponema pallidum,126,113,38,278,62,90,68,68,63,69,61,63,53,75,77,63,66,120,278,120,38,70,63
86787,Antibody; varicella-zoster,124,112,25,274,61,25,67,67,66,68,60,62,52,74,76,62,65,118,274,118,37,69,62
86800,Thyroglobulin antibody,154,139,29,340,79,29,79,84,78,85,75,77,64,92,94,77,81,146,340,146,46,86,77
86803,Hepatitis C antibody;,135,122,41,298,69,82,73,68,72,66,65,67,90,80,54,68,71,128,298,128,41,75,68
86832,HC HLA CLASS I HIGH DEFIN QUAL,540,486,138,1193,265,138,277,293,272,298,263,268,226,321,330,270,284,513,1193,513,163,302,270
86833,HC HLA CLASS II HIGH DEFIN QUAL,350,315,69,773,178,69,179,190,176,193,171,174,146,208,214,175,184,333,773,332,105,196,175
86850,"Antibody screen, RBC, each serum technique",62,56,19,137,29,52,33,30,33,34,30,31,26,37,38,31,33,59,137,59,19,35,31
86880,"Antihuman globulin test (Coombs test); direct, each antiserum",50,45,15,110,25,20,26,27,25,28,24,25,21,30,31,25,26,48,110,48,15,28,25
86900,Blood typing; ABO,28,25,8,62,13,11,15,14,15,15,13,14,12,17,17,14,15,27,62,27,8,16,14
86901,Blood typing; Rh (D),31,28,9,68,15,12,17,15,17,17,15,15,13,18,19,16,16,29,68,29,9,17,16
86920,Compatibility test each unit; immediate spin technique,147,132,44,325,73,57,75,107,74,81,71,73,61,87,90,74,77,140,325,140,44,82,74
86922,Compatibility test each unit; antiglobulin technique,160,144,48,354,76,63,82,87,81,88,78,80,67,95,98,80,84,152,354,152,48,89,80
87040,"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)",101,91,30,223,52,52,55,50,50,56,48,48,58,60,62,50,53,96,223,96,30,56,50
87070,"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates",85,76,26,188,43,34,46,42,46,44,44,42,37,51,52,46,45,81,188,81,26,47,42
87075,"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates",92,83,28,203,45,36,50,72,49,51,45,46,38,55,56,46,48,87,203,87,28,51,46
87076,"Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate",70,63,21,155,33,27,36,38,35,39,34,35,29,42,43,35,37,67,155,66,21,39,35
87077,"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate",80,72,18,303,38,18,40,40,40,40,37,111,33,47,54,38,42,76,303,76,24,45,40
87081,"Culture, presumptive, pathogenic organisms, screening only;",60,54,18,133,28,34,32,30,32,33,29,30,25,36,37,30,32,57,133,57,18,34,30
87086,"Culture, bacterial; quantitative colony count, urine",80,72,24,76,41,31,43,40,43,40,38,38,33,48,43,40,43,76,76,76,24,45,40
87102,"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)",60,54,18,133,29,18,32,33,30,33,29,30,25,36,37,30,32,57,133,57,18,34,30
87106,"Culture, fungi, definitive identification, each organism; yeast",122,110,30,270,61,48,62,66,30,67,60,61,51,73,74,61,64,116,270,116,37,68,61
87107,"Culture, fungi, definitive identification, each organism; mold",92,83,28,203,45,36,47,50,46,51,45,46,38,55,56,46,48,87,203,87,28,51,46
87147,"Culture, typing; immunologic method, other than immunofluoresence (eg, agglutination grouping), per antiserum",53,48,16,117,27,18,29,29,28,29,26,26,22,32,32,27,28,50,117,50,16,30,26
87149,"Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed",385,346,101,851,191,150,197,209,194,212,188,101,161,229,235,193,202,366,851,366,116,215,192
87150,"Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed",311,280,80,687,80,121,92,163,156,171,152,154,130,185,190,155,163,295,687,295,94,174,155
87177,"Ova and parasites, direct smears, concentration and identification",79,71,24,175,39,31,32,43,40,44,39,39,33,47,48,40,41,75,175,75,24,44,40
87181,"Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)",85,76,5,188,5,16,23,46,43,47,41,42,36,51,52,43,45,81,188,81,26,47,42
87184,"Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)",30,27,9,66,11,17,16,15,16,17,15,15,13,18,18,15,16,29,66,28,9,17,15
87186,"Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate",85,76,17,188,42,17,46,42,46,42,41,41,36,51,65,42,46,81,188,81,26,47,42
87205,"Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types",44,40,13,97,22,17,24,22,22,21,21,22,18,27,27,22,23,42,97,42,13,25,22
87206,"Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types",25,22,8,55,12,18,14,14,13,14,12,12,10,15,15,13,13,24,55,24,8,14,12
87209,"Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites",93,84,28,205,46,36,38,50,46,51,45,46,39,55,57,47,49,88,205,88,28,52,46
87210,"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)",18,16,5,40,8,7,10,10,9,10,9,9,8,11,11,9,9,17,40,17,5,10,9
87220,"Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)",44,40,13,97,22,17,24,24,23,24,21,22,18,26,27,22,23,42,97,42,13,25,22
87324,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)",117,105,13,259,13,54,63,91,63,64,57,58,49,70,71,59,61,111,259,111,35,65,58
87338,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool",117,105,35,259,37,54,63,56,58,64,57,58,49,70,71,59,58,111,259,111,35,65,58
87340,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)",94,85,26,208,46,26,51,51,50,52,46,47,39,56,57,47,49,89,208,89,28,53,47
87341,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization",54,49,16,119,27,34,28,29,27,30,26,27,23,32,33,27,28,51,119,51,16,30,27
87389,HC HIV-1 AG W/ HIV-1 & HIV-2 AB,97,87,26,214,49,26,52,53,39,53,47,48,41,58,59,49,52,92,214,92,29,54,48
87420,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; respiratory syncytial virus",117,105,35,259,55,105,63,63,58,64,57,58,115,70,71,59,61,111,259,111,35,65,58
87449,"Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism",158,142,16,348,78,16,81,85,79,87,77,78,66,94,96,79,83,150,348,150,47,88,79
87480,"Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique",62,56,19,137,32,42,33,31,33,34,30,31,26,37,38,31,33,59,137,59,19,35,31
87483,HC CNS DNA AMP PROBE TYPE 12-25,320,288,96,707,151,125,164,174,161,176,156,159,134,190,195,160,168,304,707,304,96,179,160
87486,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique",107,96,32,236,54,76,58,32,54,51,52,53,45,64,65,54,56,102,236,102,32,60,54
87491,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique",227,204,54,431,111,54,123,177,122,125,111,113,95,137,139,114,123,216,431,216,68,127,114
87493,"Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique",60,54,18,133,30,23,31,33,30,30,29,30,25,36,37,30,32,57,133,57,18,34,30
87497,"Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification",328,295,99,725,154,115,168,178,165,181,160,163,137,195,200,164,172,312,725,312,99,183,164
87502,"Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, reverse transcription and amplified probe technique, first 2 types or sub-types",122,110,37,270,57,90,66,59,61,59,59,59,90,73,44,61,63,116,270,116,37,68,61
87507,HC IADNA-DNA/RNA PROBE TQ 12-25,361,325,109,343,178,115,195,281,193,199,176,179,151,215,220,181,190,343,343,343,109,202,180
87510,"Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique",62,56,16,137,32,16,33,31,33,34,30,31,26,37,38,31,33,59,137,59,19,35,31
87517,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification",690,621,115,1525,340,115,353,374,347,380,337,343,288,410,421,345,362,656,1525,656,208,386,345
87522,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification",401,361,69,886,198,69,217,217,200,221,196,199,167,239,245,201,211,381,886,381,121,224,200
87529,"Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique",328,295,99,725,162,105,177,256,164,181,160,163,115,195,200,164,172,312,725,312,99,183,164
87581,"Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique",107,96,32,236,53,52,58,52,54,51,52,53,45,64,65,54,56,102,236,102,32,60,54
87591,"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique",227,204,68,502,111,105,123,177,122,125,111,113,95,137,139,114,123,216,502,216,68,127,114
87633,HC RESP VIRUS 20 TARGETS,107,96,32,236,53,52,58,58,54,51,52,53,45,64,65,54,56,102,236,102,32,60,54
87635,PBB SARS-COV-2 COVID-19 AMP PRB,100,90,30,221,51,77,51,50,51,50,49,50,42,52,61,50,53,95,221,95,30,56,50
87651,"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique",50,45,15,110,26,20,27,24,25,25,24,24,21,30,31,25,27,48,110,48,15,28,25
87653,"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique",192,173,58,424,95,75,104,104,96,106,94,95,80,114,117,96,101,182,424,182,58,107,96
87660,"Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique",62,56,19,137,32,35,33,31,33,34,30,31,26,37,38,31,33,59,137,59,19,35,31
87798,"Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism",107,96,32,236,53,52,58,52,54,51,52,53,45,64,65,54,56,102,236,102,32,60,54
87799,"Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism",564,508,170,1246,288,220,289,306,284,311,275,280,236,336,344,282,296,536,1246,536,170,315,282
87804,Infectious agent antigen detection by immunoassay with direct optical observation; Influenza,53,48,16,117,25,21,27,29,27,29,26,26,22,32,32,27,28,50,117,50,16,30,26
87880,"Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A",116,104,35,256,57,45,63,63,58,64,57,58,48,69,71,58,61,110,256,110,35,65,58
87902,Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus,938,844,105,2073,462,105,480,509,472,517,458,466,392,558,573,469,492,891,2073,891,282,524,469
88184,"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker",198,178,60,438,101,77,101,107,100,109,97,98,83,118,121,99,104,188,438,188,60,111,99
88185,"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (List separately in addition to code for first marker)",656,590,197,1450,335,256,336,356,330,361,320,326,274,390,401,328,344,623,1450,623,197,367,328
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",176,158,53,389,71,69,90,84,89,97,86,88,74,105,107,88,92,167,389,167,53,98,88
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",154,139,46,340,79,60,79,77,78,74,75,77,64,92,94,77,81,146,340,146,46,86,77
88311,Decalcification procedure (List separately in addition to code for surgical pathology examination),52,47,16,115,24,20,27,28,26,29,25,26,22,31,32,26,27,49,115,49,16,29,26
88313,"Special stains; Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each",128,115,39,283,60,50,66,69,64,71,62,64,53,76,78,64,67,122,283,122,39,72,64
88341,PBB IMMUNOHISTO ANTIBODY ADDL SLIDE,994,895,145,2196,490,145,509,539,500,548,485,494,415,591,607,497,522,944,2196,944,299,555,497
88342,"Immunohistochemistry (including tissue immunoperoxidase), each antibody",129,116,39,285,63,50,66,62,65,71,63,64,54,77,79,65,68,123,285,123,39,72,64
89051,"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count",57,51,17,126,29,22,29,31,29,31,28,28,24,34,35,29,30,54,126,54,17,32,28
89060,"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)",73,66,22,161,37,48,37,40,37,40,36,36,30,43,45,37,38,69,161,69,22,41,36
90376,"Rabies immune globulin, heat-treated (RIg-HT), human, for intramuscular and/or subcutaneous use",8292,7463,948,18323,4085,948,4247,4497,4443,4569,4045,4122,3463,4933,5064,4147,4354,7878,18323,7878,2496,4634,4146
90471,"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)",82,74,25,181,42,38,44,41,44,78,40,41,34,50,50,41,43,78,181,78,25,46,41
90662,"Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use",186,167,56,411,91,73,95,56,94,103,91,92,78,111,114,93,98,177,411,177,56,104,93
90670,"Pneumococcal conjugate vaccine, 13 valent, for intramuscular use",476,428,143,1051,224,186,244,258,240,262,232,237,199,283,291,238,250,452,1051,452,143,266,238
90675,"Rabies vaccine, for intramuscular use",782,704,235,1727,385,294,400,424,419,431,381,389,327,465,477,391,410,743,1727,743,235,437,391
90686,PBB IIV4 VACC NO PRSV 0.5 ML IM,121,109,36,268,60,47,65,66,61,67,59,60,51,72,74,61,64,115,268,115,36,68,61
90688,PBB IIV4 VACCINE SPLT 0.5 ML IM,119,107,36,263,59,47,45,65,60,66,58,59,50,71,73,60,63,113,263,113,36,67,60
90714,"Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use",157,141,26,347,77,26,79,79,79,87,77,78,66,95,96,79,83,149,347,149,47,88,79
90715,"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use",172,155,34,381,88,34,93,86,69,164,84,86,72,102,105,86,90,164,381,164,52,96,86
92507,"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual",392,353,118,866,200,174,201,213,196,216,191,195,164,233,239,196,206,372,866,372,118,219,196
92522,HC EVALUATE SPEECH PRODUCTION,188,169,57,415,93,158,96,102,95,104,92,93,79,112,115,94,99,179,415,179,57,105,94
92523,HC EVAL SPEECH SOUND LANG COMPREHEN,373,336,112,824,190,174,191,202,200,206,182,185,156,222,228,187,196,354,824,354,112,208,186
92526,Treatment of swallowing dysfunction and/or oral function for feeding,392,353,118,866,200,158,212,213,197,216,191,195,164,233,239,196,206,372,866,372,118,219,196
92610,Evaluation of oral and pharyngeal swallowing function,392,353,118,866,200,153,196,213,197,216,191,195,164,233,239,196,206,372,866,372,118,219,196
92611,Motion fluoroscopic evaluation of swallowing function by cine or video recording,392,353,118,866,193,153,212,213,197,216,191,195,164,233,239,196,206,372,866,372,118,219,196
92950,"Cardiopulmonary resuscitation (eg, in cardiac arrest)",526,473,158,1162,259,205,269,263,282,290,257,261,220,313,321,263,276,500,1162,500,158,294,263
93005,"Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report",150,135,38,331,76,84,81,75,75,75,72,75,63,91,38,75,75,143,331,142,45,84,75
93010,"Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only",50,45,9,110,9,20,26,27,25,9,24,25,21,30,31,25,26,48,110,48,15,28,25
93016,"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report",110,99,24,243,24,43,56,60,55,61,54,55,46,65,67,55,58,105,243,104,33,61,55
93017,"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report",761,685,202,1682,388,202,411,380,408,552,371,378,318,453,465,381,400,723,1682,723,229,425,380
93018,"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only",110,99,16,243,16,43,56,60,55,16,54,55,46,65,67,55,58,105,243,104,33,61,55
93225,"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)",150,135,45,331,74,59,77,81,76,83,73,75,63,89,92,75,79,143,331,142,45,84,75
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",1388,1249,418,1319,708,538,750,694,744,694,677,690,682,826,666,694,729,1319,1319,1319,418,776,694
93798,Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session),195,176,59,431,99,76,100,94,98,107,95,97,81,116,94,98,102,185,431,185,59,109,98
93880,Duplex scan of extracranial arteries; complete bilateral study,1118,1006,253,2470,570,253,604,559,600,559,545,556,467,665,683,559,587,1062,2470,1062,337,625,559
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)",798,718,240,1763,407,312,409,383,402,383,389,397,333,475,487,399,419,758,1763,758,240,446,399
93925,Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study,1335,1202,362,2950,681,362,684,668,715,654,651,664,558,794,815,668,701,1268,2950,1268,402,746,668
93926,Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study,751,676,226,1659,356,399,406,407,378,376,366,373,314,447,459,376,394,713,1659,713,226,420,376
93970,Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study,1335,1202,348,2950,681,348,684,724,672,668,651,664,558,794,815,668,701,1268,2950,1268,402,746,668
93971,Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study,618,556,186,1366,315,362,334,309,331,297,301,307,258,368,377,309,324,587,1366,587,186,345,309
93975,"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study",889,800,268,1964,438,347,455,444,444,490,434,442,371,529,543,445,467,845,1964,845,268,497,444
93976,"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study",889,800,268,1964,422,347,455,482,448,490,434,442,371,529,543,445,467,845,1964,845,268,497,444
93978,"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study",889,800,268,1964,453,347,455,482,448,490,434,442,371,529,543,445,467,845,1964,845,268,497,444
94010,"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation",185,166,56,409,94,72,100,91,99,89,89,92,77,110,113,93,97,176,409,176,56,103,92
94060,"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration",381,343,115,842,181,288,206,244,190,190,183,189,295,210,233,191,200,362,842,362,115,213,190
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)",120,108,36,265,61,144,73,101,60,59,58,60,50,71,73,76,63,114,265,114,36,67,60
94660,"Continuous positive airway pressure ventilation (CPAP), initiation and management",710,639,214,1569,350,277,364,553,357,391,346,353,297,422,434,355,373,675,1569,674,214,397,355
94667,"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation",130,117,39,287,63,51,70,65,65,72,63,65,54,77,79,65,68,124,287,124,39,73,65
94668,"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent",102,92,31,225,48,40,55,51,51,56,50,51,43,61,62,51,54,97,225,97,31,57,51
94726,PBB PULM FUNCT TST PLETHYSMOGRAP,110,99,33,243,56,141,59,70,59,100,54,55,46,60,67,55,58,105,243,104,33,61,55
94727,HC PULM FUNCTION TEST BY GAS,213,192,64,471,101,83,109,166,107,117,104,106,89,127,130,107,112,202,471,202,64,119,106
94729,HC C0/MEMBRANE DIFFUSE CAPACITY,266,239,80,588,136,141,144,133,143,133,128,133,147,146,162,133,140,253,588,253,80,149,133
94750,"Pulmonary compliance study (eg, plethysmography, volume and pressure measurements)",175,158,53,387,83,134,94,84,88,96,84,87,73,104,107,88,92,166,387,166,53,98,88
94760,Noninvasive ear or pulse oximetry for oxygen saturation; single determination,129,116,39,285,63,50,70,64,47,71,63,64,54,77,79,65,68,123,285,123,39,72,64
94761,"Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)",258,232,70,570,127,101,70,140,130,142,126,128,108,153,158,129,135,245,570,245,78,144,129
94762,Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure),490,441,148,1083,250,191,251,266,247,270,239,244,205,292,299,245,257,466,1083,466,148,274,245
95992,"Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day",106,95,32,234,53,41,54,57,53,58,52,53,44,63,65,53,56,101,234,101,32,59,53
96360,"Intravenous infusion, hydration; initial, 31 minutes to 1 hour",120,108,36,265,61,47,39,60,64,58,58,60,50,71,73,60,63,114,265,114,36,67,60
96361,"Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)",320,288,40,707,163,277,43,200,40,136,442,360,134,97,79,480,168,304,707,304,96,179,160
96365,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour",160,144,48,354,82,177,86,80,82,84,81,81,67,95,157,84,91,152,354,152,48,89,80
96366,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)",76,68,14,251,39,251,42,76,62,55,36,36,32,45,14,38,40,72,168,72,23,42,38
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)",76,68,23,168,39,30,41,38,41,72,37,38,32,45,46,38,40,72,168,72,23,42,38
96368,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)",76,68,21,168,39,30,21,38,38,42,37,38,32,45,46,38,40,72,168,72,23,42,38
96372,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",88,79,26,84,42,36,44,41,44,37,53,44,37,53,54,37,71,84,84,84,26,49,44
96374,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug",88,79,26,194,45,34,34,44,44,42,42,37,37,53,87,42,44,84,194,84,26,49,44
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)",88,79,20,194,43,34,44,69,44,20,63,42,37,106,86,62,88,84,194,84,26,49,44
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)",88,79,26,194,45,34,48,84,44,44,84,44,37,52,54,44,46,84,194,84,26,49,44
96377,HC APPLICATON ON-BODY INJECTOR,74,67,22,164,35,29,38,40,37,41,36,37,31,44,45,37,39,70,164,70,22,41,37
96401,"Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic",135,122,41,298,103,53,69,73,70,66,130,67,56,80,82,68,71,128,298,128,41,75,68
96409,"Chemotherapy administration; intravenous, push technique, single or initial substance/drug",135,122,41,298,64,53,69,73,68,74,66,67,56,80,82,68,71,128,298,128,41,75,68
96411,"Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)",100,90,30,221,51,39,51,54,50,55,49,50,42,59,61,50,53,95,221,95,30,56,50
96413,"Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug",212,191,64,468,108,186,114,165,107,117,103,105,89,126,129,106,111,201,468,201,64,118,106
96415,"Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)",115,104,35,254,117,45,62,62,58,63,56,57,48,68,70,58,60,109,254,109,35,64,58
96416,"Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump",450,405,135,994,230,176,230,244,227,248,219,224,188,268,275,225,236,428,994,428,135,251,225
96417,"Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)",200,180,60,442,102,78,108,108,101,110,98,99,84,119,122,100,105,190,442,190,60,112,100
96523,Irrigation of implanted venous access device for drug delivery systems,78,70,23,172,40,30,42,42,39,39,38,39,33,46,48,39,41,74,172,74,23,44,39
97018,Application of a modality to 1 or more areas; paraffin bath,20,18,6,44,9,8,11,11,10,11,10,10,8,12,12,10,11,19,44,19,6,11,10
97032,"Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes",186,167,56,411,95,150,95,101,94,102,91,92,78,111,114,93,98,177,411,177,56,104,93
97033,"Application of a modality to 1 or more areas; iontophoresis, each 15 minutes",94,85,28,208,45,136,48,73,47,52,46,47,39,56,57,47,49,89,208,89,28,53,47
97035,"Application of a modality to 1 or more areas; ultrasound, each 15 minutes",93,84,28,205,45,36,50,45,50,46,45,46,39,55,57,47,49,88,205,88,28,52,46
97110,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility",186,167,45,1122,92,149,100,93,100,93,45,92,150,111,87,93,93,177,1122,177,56,104,93
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",93,84,28,205,47,149,50,46,50,45,45,46,39,55,45,47,49,88,205,88,28,52,46
97116,"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)",93,84,28,205,47,36,50,46,50,88,45,46,39,55,44,47,49,88,205,88,28,52,46
97140,"Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes",93,84,28,205,47,91,50,72,50,46,45,46,39,55,57,47,46,88,205,88,28,52,46
97161,HC PT EVAL LOW COMPLEX,223,201,67,493,114,111,120,112,120,112,109,111,93,133,106,112,117,212,493,212,67,125,112
97162,HC PT EVAL MOD COMPLEX,223,201,67,493,114,149,120,112,112,112,107,111,93,133,136,112,112,212,493,212,67,125,112
97163,HC PT EVAL HIGH COMPLEX,223,201,67,493,112,87,120,107,119,112,109,111,93,133,107,112,117,212,493,212,67,125,112
97165,HC OT EVAL LOW COMPLEX,223,201,67,493,114,87,114,121,112,123,109,111,93,133,136,112,117,212,493,212,67,125,112
97166,HC OT EVAL MOD COMPLEX,223,201,67,493,114,69,120,107,112,123,109,111,93,133,136,112,117,212,493,212,67,125,112
97167,HC OT EVAL HIGH COMPLEX,223,201,63,493,110,63,114,121,112,123,109,111,93,133,136,112,117,212,493,212,67,125,112
97530,"Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes",93,84,28,205,47,135,50,72,57,46,45,46,39,55,57,47,46,88,205,88,28,52,46
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",106,95,32,234,54,63,57,57,57,58,52,53,44,63,65,53,56,101,234,101,32,59,53
97597,"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less",244,220,64,539,64,95,125,190,123,134,119,121,102,145,149,122,128,232,539,232,73,136,122
97598,"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)",732,659,220,1617,304,286,375,397,369,403,357,364,306,435,447,366,384,695,1617,695,220,409,366
97605,"Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters",147,132,44,325,75,57,75,80,74,81,72,73,61,87,90,74,77,140,325,140,44,82,74
97802,"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes",120,108,36,265,61,47,61,65,60,60,59,60,50,71,73,60,63,114,265,114,36,67,60
97803,"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes",80,72,20,177,53,31,41,43,40,20,39,40,33,48,49,40,42,76,177,76,24,45,40
98925,Osteopathic manipulative treatment (OMT); 1-2 body regions involved,62,56,17,137,29,24,17,34,31,34,30,31,26,37,38,31,33,59,137,59,19,35,31
99001,Handling and/or conveyance of specimen for transfer from the patient in other than a physician's office to a laboratory (distance may be indicated),38,34,11,38,18,15,19,20,19,21,18,19,16,22,23,19,20,36,38,36,11,21,19
99152,HC MOD SED SAME PHYS/QHP 5/>YRS 15M,26,23,8,57,13,10,13,14,13,14,13,13,11,15,16,13,14,25,57,25,8,15,13
99195,"Phlebotomy, therapeutic (separate procedure)",187,168,56,413,92,73,96,90,94,103,91,93,78,111,114,94,98,178,413,178,56,104,94
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.",216,194,65,477,80,84,111,117,109,119,105,107,90,129,132,108,113,205,477,205,65,121,108
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.",30,27,9,66,15,12,18,16,16,17,15,15,13,18,18,15,16,29,66,28,9,17,15
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.",129,116,28,285,28,50,66,70,65,71,63,28,54,77,79,65,68,123,285,123,39,72,64
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.",164,148,8,362,55,64,84,89,8,90,80,82,68,98,100,82,86,156,362,156,49,92,82
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.",215,194,65,475,85,84,110,117,108,118,105,107,90,128,131,108,113,204,475,204,65,120,108
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.])",120,108,36,265,78,47,61,65,60,66,81,79,50,71,73,60,63,114,265,114,36,67,60
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.",156,140,47,345,107,61,80,85,79,110,110,108,65,93,95,78,82,148,345,148,47,87,78
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.",214,193,64,473,144,84,110,116,108,118,150,106,89,127,131,107,112,203,473,203,64,120,107
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.",292,263,88,645,200,114,150,158,147,161,142,145,122,174,178,146,153,277,645,277,88,163,146
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.",61,55,18,135,43,24,31,33,31,44,44,30,25,36,37,31,32,58,135,58,18,34,30
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.",112,101,34,247,79,44,57,61,56,62,81,79,47,67,68,56,59,106,247,106,34,63,56
99226,"Subsequent observation 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 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 patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.",160,144,48,354,113,63,82,87,81,88,116,80,67,95,98,80,84,152,354,152,48,89,80
99236,"Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive 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) requiring admission are of high severity.",346,311,104,765,235,135,177,188,174,191,169,172,145,206,211,173,182,329,765,329,104,193,173
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.",243,219,73,537,74,95,124,132,122,134,119,121,101,145,148,122,128,231,537,231,73,136,122
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.",347,312,74,346,171,346,119,174,170,174,169,174,145,191,187,174,180,330,330,330,104,74,174
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.",621,559,70,1372,70,531,168,310,167,590,298,309,259,376,498,311,335,590,1372,590,187,347,310
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.",837,753,128,1849,128,608,436,418,322,418,402,418,668,498,511,419,435,795,1849,795,252,468,418
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.",1178,1060,324,2603,582,515,636,589,589,589,565,565,324,713,719,589,618,1119,2603,1119,355,658,589
99291,"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes",1780,1602,536,3933,908,675,926,854,954,854,550,885,743,1059,1087,890,935,1691,3933,1691,536,995,890
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)",253,228,76,559,125,99,137,121,271,380,123,126,106,151,154,127,133,240,559,240,76,141,126
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.",180,162,54,398,95,70,92,98,91,99,88,89,75,107,110,90,95,171,398,171,54,101,90
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.",206,185,62,455,139,80,105,112,104,114,100,102,86,123,126,103,108,196,455,196,62,115,103
99306,"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 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 45 minutes at the bedside and on the patient's facility floor or unit.",264,238,79,583,178,103,135,143,133,145,129,131,110,157,161,132,139,251,583,251,79,148,132
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.",65,58,20,144,47,25,33,35,33,36,32,32,27,39,40,33,34,62,144,62,20,36,32
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.",110,99,33,243,74,43,56,60,55,61,54,55,46,65,67,55,58,105,243,104,33,61,55
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.",144,130,43,318,97,56,74,78,73,79,70,72,60,86,88,72,76,137,318,137,43,80,72
99310,"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 comprehensive interval history; A comprehensive examination; 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. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 35 minutes at the bedside and on the patient's facility floor or unit.",215,194,65,475,144,84,110,117,108,118,105,107,90,128,131,108,113,204,475,204,65,120,108
99315,Nursing facility discharge day management; 30 minutes or less,115,104,35,254,78,45,59,62,58,63,56,57,48,68,70,58,60,109,254,109,35,64,58
99316,Nursing facility discharge day management; more than 30 minutes,167,150,50,369,112,65,86,91,84,92,81,83,70,99,102,84,88,159,369,159,50,93,84
A0424,"Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review)",125,112,38,276,62,49,64,97,63,69,61,62,52,74,76,63,66,119,276,119,38,70,62
A0425,"Ground mileage, per statute mile",80,72,10,1532,42,91,41,20,40,88,10,40,26,48,236,40,42,76,1532,76,24,45,40
A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1)",798,718,240,1763,325,455,409,433,402,399,389,397,333,475,487,399,419,758,1763,758,240,446,399
A0427,"Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)",1259,1133,252,2782,520,720,645,630,634,630,604,626,720,749,252,630,661,1196,2782,1196,379,703,630
A0428,"Ambulance service, basic life support, non-emergency transport, (BLS)",667,600,201,1474,267,387,342,362,336,368,325,332,279,397,407,334,350,634,1474,634,201,373,334
A0429,"Ambulance service, basic life support, emergency transport (BLS-emergency)",1066,959,321,2355,438,614,546,533,537,438,520,530,607,634,651,533,560,1013,2355,1013,321,596,533
A0433,"Advanced life support, level 2 (ALS 2)",1822,1640,548,4026,734,1043,933,1419,917,1004,889,906,761,1084,1113,911,957,1731,4026,1731,548,1018,911
A0434,Specialty care transport (SCT),2139,1925,644,4726,1054,1232,1095,1160,1077,1179,1043,1063,893,1273,1306,1070,1123,2032,4726,2032,644,1195,1070
A6196,"Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing",16,14,5,35,8,6,8,9,8,9,8,8,7,10,10,8,8,15,35,15,5,9,8
A6452,"High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard",246,221,58,544,58,96,126,118,124,136,120,122,103,146,150,123,129,234,544,234,74,137,123
A7048,HC VACUUM DRAIN BOTTLE/TUBE KIT LVL 5,1639,1475,493,3622,836,640,839,889,825,903,799,815,685,975,1001,820,860,1557,3622,1557,493,916,820
A9270,Non-covered item or service,1,1,0,3,1,0,1,1,1,1,1,1,1,1,1,1,1,1,3,1,0,1,1
A9500,"Technetium Tc-99M sestamibi, diagnostic, per study dose",938,844,282,2073,478,366,507,469,472,680,458,466,392,558,573,469,492,891,2073,891,282,524,469
A9503,"Technetium Tc-99M medronate, diagnostic, per study dose, up to 30 millicuries",288,259,87,636,142,113,147,156,145,159,140,143,120,171,176,144,151,274,636,274,87,161,144
A9537,"Technetium Tc-99M mebrofenin, diagnostic, per study dose, up to 15 millicuries",2163,1947,651,4779,1066,845,1168,1173,1159,1082,1055,1075,903,1287,1321,1082,1136,2055,4779,2055,651,1209,1082
A9540,"Technetium Tc-99M macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",137,123,41,303,70,54,70,74,69,75,67,68,57,82,84,69,72,130,303,130,41,77,68
A9541,"Technetium Tc-99M sulfur colloid, diagnostic, per study dose, up to 20 millicuries",251,226,76,555,124,98,136,136,126,120,122,125,105,149,153,126,132,238,555,238,76,140,126
A9552,"Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries",808,727,243,1785,412,316,414,388,407,445,394,402,337,481,493,404,424,768,1785,768,243,451,404
A9579,"Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS), per ml",298,268,90,658,152,116,161,190,149,164,145,148,124,177,182,149,156,283,658,283,90,166,149
C1713,"HC ANCHOR/SCREW BN/BN,TIS/BN LVL 35",5731,5158,969,12664,3154,2239,6423,969,2541,3158,2796,3360,2394,3410,3500,2866,3009,5445,12664,5445,1725,3202,2866
C1725,HC TRANSLUM ANGIOPL NON-LASER CATH LVL 15,155,140,47,343,74,61,79,84,78,85,76,77,65,92,95,78,81,147,343,147,47,87,78
C1726,HC NON-VASC BALLOON DILATN CATH LVL 15,610,549,184,1349,311,238,313,331,307,336,298,303,255,363,373,305,320,580,1349,580,184,341,305
C1729,HC DRAINAGE CATH LVL 15,6,5,2,13,3,2,3,3,3,3,3,3,3,4,4,3,3,6,13,6,2,3,3
C1758,"HC CATHETER, URETERAL LVL 12",25,23,8,56,13,10,13,13,13,14,12,13,11,15,15,13,13,24,56,24,8,14,13
C1765,HC ADHESION BARRIER LVL 7,6,5,2,13,3,2,3,3,3,3,3,3,3,4,4,3,3,6,13,6,2,3,3
C1776,HC JOINT DEVICE (IMPLANTABLE) LVL 45,4113,3702,1238,9089,2026,1607,2107,2231,2071,2267,2006,2057,1718,2447,2512,2057,2160,3908,9089,3908,1238,2298,2057
C1781,HC MESH (IMPLANTABLE) LVL 30,503,453,151,1111,436,197,258,273,253,277,245,210,210,299,307,252,264,478,1111,478,151,281,252
C9290,"Injection, bupivacaine liposome",736,663,222,1627,367,386,398,399,315,406,359,363,308,438,450,368,387,700,1627,700,222,411,368
C9803,"HC HOSP OP CLINIC VISIT SPEC COLLEC SARS-COV-2 COVID-19, ANY SOURCE",28,25,8,62,14,11,15,22,15,15,14,14,12,23,17,14,15,27,62,27,8,16,14
G0008,Administration of influenza virus vaccine,82,74,16,181,40,32,38,16,41,45,40,41,34,49,50,41,43,78,181,78,25,46,41
G0009,Administration of pneumococcal vaccine,82,74,25,181,39,32,42,44,41,45,40,41,34,49,50,41,43,78,181,78,25,46,41
G0010,Administration of hepatitis B vaccine,82,74,25,181,39,32,42,44,41,45,40,41,34,49,50,41,43,78,181,78,25,46,41
G0103,Prostate cancer screening; prostate specific antigen test (PSA),176,158,53,389,90,78,90,88,89,88,84,88,74,106,172,88,92,167,389,167,53,98,88
G0105,Colorectal cancer screening; colonoscopy on individual at high risk,2276,2048,685,5028,968,889,1165,1234,1146,1254,1110,1131,950,1354,1389,1138,1195,2162,5028,2162,685,1271,1138
G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",80,72,24,114,41,31,43,40,43,44,39,40,33,48,38,40,42,76,114,76,24,45,40
G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,3685,3316,1043,8142,1043,1440,1887,1999,1855,1842,1797,1832,1539,2192,2250,1843,1935,3501,8142,3501,1109,2059,1842
G0168,Wound closure utilizing tissue adhesive(s) only,80,72,24,177,39,31,41,39,40,44,39,40,33,48,49,40,42,76,177,76,24,45,40
G0239,"Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)",150,135,45,331,74,59,81,81,76,83,73,75,63,89,92,75,79,143,331,142,45,84,75
G0279,PR BREAST TOMOSYNTHESIS DIG DX UNIL/BILAT,80,72,24,177,41,31,43,38,40,58,39,40,33,48,49,40,42,76,177,76,24,45,40
G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",57,51,17,126,29,22,31,31,31,31,28,28,24,34,35,29,30,54,126,54,17,32,28
G0297,PR CT LUNG CANCER SCREEN,600,540,181,1326,306,529,307,300,321,331,293,298,529,357,366,300,315,570,1326,570,181,335,300
G0378,"Hospital observation service, per hour",990,891,286,2188,555,1709,324,620,286,800,483,855,413,589,605,980,520,941,2188,940,298,553,495
G0379,Direct admission of patient for hospital observation care,377,339,113,833,192,147,204,188,202,208,184,187,157,224,230,189,198,358,833,358,113,211,188
G0424,"Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day",195,176,56,431,96,76,105,94,98,107,95,97,81,116,119,98,102,185,431,185,56,109,98
G0463,Hospital outpt clinic visit,163,147,49,360,83,80,83,82,87,90,80,81,68,97,100,82,88,155,360,155,49,91,82
G0472,HC HEP C SCREEN HIGH RISK/OTHER,135,122,41,298,67,53,69,65,68,74,66,67,56,80,82,68,71,128,298,128,41,75,68
G0480,Drug test def 1-7 classes,106,95,32,234,54,64,76,67,57,58,51,53,44,63,104,53,56,101,234,101,32,59,53
G0498,HC CHEMO EXTEND IV INFUS W/PUMP,404,364,122,893,206,158,207,219,203,223,197,201,169,240,247,202,212,384,893,384,122,226,202
J0131,Acetaminophen injection,182,164,48,403,93,48,98,91,49,100,89,91,76,108,111,91,96,173,403,173,55,102,91
J0153,PBB ADENOSINE INJ 1 MG,241,217,65,532,119,94,65,131,121,133,117,120,101,143,147,120,126,229,532,229,72,134,120
J0171,"Injection, adrenalin, epinephrine, 0.1 mg",92,83,9,203,47,9,53,46,49,66,45,46,38,55,56,46,48,87,203,87,28,51,46
J0185,"Inj., aprepitant, 1 mg",822,740,248,1817,387,292,421,446,414,453,401,409,343,489,502,411,432,781,1817,781,248,460,411
J0256,"Injection, alpha 1 - proteinase inhibitor - human, 10 mg",4168,3751,1255,9209,2125,1628,2134,2260,2098,2296,2033,2072,1741,2479,2545,2084,2188,3959,9209,3959,1255,2329,2084
J0280,"Injection, aminophyllin, up to 250 mg",103,93,31,227,52,40,56,56,52,57,50,51,43,61,63,51,54,98,227,98,31,57,51
J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",116,105,4,257,57,4,60,63,59,64,57,58,49,69,71,58,61,110,257,110,35,65,58
J0330,"Injection, succinylcholine chloride, up to 20 mg",126,113,15,278,62,15,68,49,57,69,61,62,53,75,77,63,66,120,278,120,38,70,63
J0360,"Injection, hydralazine HCl, up to 20 mg",92,83,3,204,46,3,47,50,46,51,45,46,39,55,56,46,48,88,204,88,28,52,46
J0456,"Injection, azithromycin, 500 mg",94,85,28,209,47,37,51,47,51,47,46,47,39,56,58,47,50,90,209,90,28,53,47
J0461,"Injection, atropine sulfate, 0.01 mg",192,173,51,425,99,75,104,51,97,106,94,96,80,115,118,96,101,183,425,183,58,108,96
J0595,"Injection, butorphanol tartrate, 1 mg",98,88,6,217,48,6,50,53,49,54,48,49,41,58,60,49,52,93,217,93,30,55,49
J0610,"Injection, calcium gluconate, per 10 ml",106,95,3,234,50,3,54,51,53,58,52,53,44,63,65,53,56,101,234,101,32,59,53
J0640,"Injection, leucovorin calcium, per 50 mg",428,386,129,946,218,167,219,232,216,236,209,213,179,255,262,214,225,407,946,407,129,239,214
J0690,"Injection, cefazolin sodium, 500 mg",91,82,3,202,45,3,49,45,49,87,44,46,38,54,56,46,48,87,202,87,27,51,46
J0692,"Injection, Cefepime hydrochloride, 500 mg",112,100,34,246,55,44,57,87,56,61,54,55,47,66,68,56,59,106,246,106,34,62,56
J0696,"Injection, ceftriaxone sodium, per 250 mg",90,81,2,200,46,2,49,47,48,48,44,43,5,54,55,45,48,86,200,86,27,51,45
J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",186,168,56,412,95,73,95,101,94,103,91,93,78,111,114,93,98,177,412,177,56,104,93
J0744,"Injection, Ciprofloxacin for intravenous infusion, 200 mg",96,86,3,211,47,3,49,52,48,53,69,47,40,57,58,48,50,91,211,91,29,53,48
J0780,"Injection, prochlorperazine, up to 10 mg",124,112,8,275,60,8,67,91,33,69,61,62,8,74,76,62,65,118,275,118,37,70,62
J0878,"Injection, daptomycin, 1 mg",398,358,120,878,196,155,204,199,200,219,194,198,166,236,243,199,209,378,878,378,120,222,199
J0881,"Injection, darbepoetin alfa, 1 microgram (non-ESRD use)",738,664,222,1630,376,288,378,400,371,406,360,367,308,439,450,369,387,701,1630,701,222,412,369
J0885,"Injection, epoetin alfa, (for non-ESRD use), 1000 units",622,560,108,1374,295,108,319,337,313,343,303,309,260,370,380,311,327,591,1374,591,187,348,311
J0894,"Injection, decitabine, 1 mg",1650,1485,497,3645,828,644,845,895,831,909,805,820,689,981,1007,825,866,1567,3645,1567,497,922,825
J0897,PBB DENOSUMAB INJECTION 1 MG,2645,2381,796,5845,1349,1200,1355,1323,1332,1457,1290,1315,1105,1574,1615,1323,1389,2513,5845,2513,796,1478,1323
J1030,"Injection, methylprednisolone acetate, 40 mg",105,94,6,232,52,6,28,57,53,58,51,52,44,62,64,52,55,100,232,100,32,59,52
J1100,"Injection, dexamethasone sodium phosphate, 1 mg",96,86,1,212,49,1,52,47,38,53,47,48,40,57,59,46,50,91,212,91,29,54,48
J1110,"Injection, dihydroergotamine mesylate, per 1 mg",285,256,86,629,140,111,118,154,94,157,139,141,119,169,174,142,149,270,629,270,86,159,142
J1165,"Injection, phenytoin sodium, per 50 mg",95,85,7,209,47,7,49,51,48,52,46,47,40,56,58,47,50,90,209,90,29,53,47
J1170,"Injection, hydromorphone, up to 4 mg",137,124,7,304,88,7,60,75,48,76,67,68,57,82,84,69,72,131,304,131,41,77,69
J1200,"Injection, diphenhydramine HCl, up to 50 mg",89,80,1,197,46,1,48,69,24,49,43,44,37,53,54,45,47,85,197,85,27,50,45
J1265,"Injection, dopamine HCl, 40 mg",112,101,34,247,57,44,57,54,56,62,55,56,47,67,68,56,59,106,247,106,34,63,56
J1335,"Injection, Ertapenem sodium, 500 mg",322,289,90,711,158,90,165,174,172,177,157,160,134,191,196,161,169,306,711,306,97,180,161
J1459,"Injection, immune globulin (Privigen), intravenous, non-lyophilized (e.g. liquid), 500 mg",5768,5191,1736,12744,2941,2253,2954,3128,2904,3178,2813,2867,2409,3431,3522,2884,3028,5479,12744,5479,1736,3223,2884
J1580,"Injection, garamycin, gentamicin, up to 80 mg",91,82,27,200,46,35,46,49,46,50,44,45,38,54,55,45,48,86,200,86,27,51,45
J1630,"Injection, haloperidol, up to 5 mg",100,90,27,220,49,39,52,54,27,55,49,49,42,59,61,50,52,95,220,95,30,56,50
J1631,"Injection, haloperidol decanoate, per 50 mg",190,171,57,421,94,74,71,103,96,105,93,95,80,113,116,95,100,181,421,181,57,106,95
J1642,"Injection, Heparin sodium, (Heparin lock flush), per 10 units",89,80,9,197,42,35,48,69,45,49,43,44,37,53,54,45,47,85,197,85,9,50,45
J1644,"Injection, Heparin sodium, per 1000 units",93,83,3,205,53,3,47,50,46,44,45,46,39,55,57,46,49,88,205,88,28,52,46
J1650,"Injection, enoxaparin sodium, 10 mg",154,138,15,340,78,15,79,77,77,77,71,76,64,91,94,77,81,146,340,146,46,86,77
J1745,"Injection Infliximab, 10 mg",4992,4493,1503,11031,2546,1950,2557,2708,2514,2751,2435,2482,2085,2970,3048,2497,2621,4743,11031,4743,1503,2790,2496
J1756,"Injection, iron sucrose, 1 mg",184,165,55,405,87,72,94,100,92,101,90,91,77,109,112,92,96,174,405,174,55,103,92
J1815,"Injection, insulin, per 5 units",6,5,2,13,3,2,2,3,3,3,3,3,3,4,4,3,3,6,13,6,2,3,3
J1885,"Injection, ketorolac tromethamine, per 15 mg",88,80,1,85,45,1,24,45,44,64,42,46,1,56,54,44,48,85,85,84,27,49,44
J1940,"Injection, furosemide, up to 20 mg",100,90,1,222,51,1,54,50,54,50,48,50,1,60,61,50,53,95,222,95,30,56,50
J1953,"Injection, levetiracetam, 10 mg",130,117,39,286,61,51,66,70,65,71,63,64,54,77,79,65,68,123,286,123,39,72,65
J1956,"Injection, levofloxacin, 250 mg",101,91,1,224,52,1,36,51,51,56,49,50,42,60,62,51,53,96,224,96,30,57,51
J2060,"Injection, lorazepam, 2 mg",89,80,1,196,45,1,34,69,47,49,43,44,37,53,54,44,46,84,196,84,27,49,44
J2150,"Injection, mannitol, 25% in 50 ml",96,87,29,213,47,38,49,52,48,53,47,48,40,57,59,48,51,91,213,91,29,54,48
J2175,"Injection, meperidine hydrochloride, per 100 mg",89,80,27,197,45,35,46,48,45,49,43,44,37,53,54,44,47,85,197,85,27,50,44
J2185,"Injection, meropenem, 100 mg",128,115,38,282,60,50,65,69,64,70,62,63,53,76,78,64,67,121,282,121,38,71,64
J2250,"Injection, midazolam hydrochloride, per 1 mg",88,79,0,195,45,0,48,44,48,84,45,44,0,52,54,44,46,84,195,84,27,49,44
J2270,"Injection, morphine sulfate, up to 10 mg",99,89,4,219,50,4,50,50,50,55,48,49,41,59,60,50,52,94,219,94,30,55,50
J2300,"Injection, nalbuphine hydrochloride, per 10 mg",95,85,29,209,47,37,51,74,47,52,46,47,40,56,58,47,50,90,209,90,29,53,47
J2310,"Injection, naloxone hydrochloride, per 1 mg",136,123,13,301,57,13,95,60,79,75,67,68,57,81,83,68,72,130,301,130,41,76,68
J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",8617,7755,2594,19040,4395,3366,4413,4673,4338,4748,4203,4283,3599,5126,5262,4309,4524,8186,19040,8186,2594,4815,4308
J2360,"Injection, orphenadrine citrate, up to 60 mg",119,107,6,263,61,7,32,93,32,66,58,59,6,71,73,60,62,113,263,113,36,67,60
J2370,"Injection, phenylephrine HCl, up to 1 ml",100,90,30,220,47,55,54,54,50,55,49,50,42,59,61,50,52,95,220,95,30,56,50
J2405,"Injection, ondansetron hydrochloride, per 1 mg",88,80,0,195,45,0,48,44,44,84,64,42,0,54,54,44,45,84,195,84,27,49,44
J2469,"Injection, palonosetron HCl, 25 mcg",288,259,82,635,136,82,147,156,145,158,140,143,120,171,176,144,151,273,635,273,87,161,144
J2505,"Injection, Pegfilgrastim, 6 mg",12550,11295,3778,27730,5954,4600,6427,6806,6319,6915,6121,6238,5241,7466,7663,6276,6589,11922,27730,11922,3778,7012,6275
J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",110,99,6,243,50,6,62,47,55,61,54,55,46,66,67,55,58,105,243,105,33,62,55
J2550,"Injection, promethazine HCl, up to 50 mg",89,80,2,198,44,2,22,43,35,49,43,44,37,53,55,45,48,85,198,85,27,50,45
J2704,"Inj, propofol, 10 mg",97,87,4,215,50,4,52,49,52,49,47,49,5,59,59,46,52,92,215,92,29,54,49
J2710,"Injection, neostigmine methylsulfate, up to 0.5 mg",105,94,23,231,36,70,38,57,53,58,51,23,44,62,64,35,55,99,231,99,32,58,52
J2765,"Injection, metoclopramide HCl, up to 10 mg",92,83,1,203,45,1,31,50,25,51,45,46,38,55,56,46,48,87,203,87,28,51,46
J2785,"Injection, regadenoson, 0.1 mg",573,516,173,1267,292,242,310,287,289,416,280,285,240,341,350,287,301,545,1267,545,173,320,287
J2790,"Injection, Rho D immune globulin, human, full dose, 300 micrograms (1500 I.U.)",258,232,78,570,127,83,139,140,130,142,126,128,108,153,158,129,135,245,570,245,78,144,129
J2791,"Injection, Rho(D) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 IU",408,367,123,902,201,160,220,221,206,225,199,203,171,243,249,204,214,388,902,388,123,228,204
J2795,"Injection, ropivacaine hydrochloride, 1 mg",113,102,21,249,51,21,61,61,61,62,55,56,47,67,69,56,59,107,249,107,34,63,56
J2805,"Injection, sincalide, 5 micrograms",164,148,49,362,81,114,89,89,88,82,80,82,114,98,100,82,86,156,362,156,49,92,82
J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",100,90,5,220,48,5,54,54,50,55,49,49,42,59,61,50,52,95,220,95,30,56,50
J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",107,96,32,236,51,51,58,73,39,51,52,53,45,64,65,53,56,102,236,102,32,60,53
J2997,"Injection, alteplase recombinant, 1 mg",17688,15919,213,39084,8714,4729,213,8490,8906,9747,8628,8793,7388,10523,10801,8845,9286,16804,39084,16804,5325,9884,8844
J3010,"Injection, fentanyl citrate, 0.1 mg",90,81,1,198,45,1,48,45,45,65,43,89,1,54,55,45,47,85,198,85,27,50,45
J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",186,167,50,410,91,72,50,101,93,102,90,92,77,110,113,93,97,176,410,176,56,104,93
J3260,"Injection, tobramycin sulfate, up to 80 mg",104,94,31,231,53,41,53,57,53,58,51,52,44,62,64,52,55,99,231,99,31,58,52
J3262,"Injection, tocilizumab, 1 mg",6728,6055,2025,14867,3315,2628,3446,3364,3388,3707,3282,3345,2810,4003,4108,3365,3532,6392,14867,6392,2025,3759,3364
J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",125,112,7,276,64,7,49,68,30,69,60,62,52,74,76,62,66,119,276,119,38,70,62
J3360,"Injection, diazepam, up to 5 mg",108,97,33,239,53,42,55,59,54,51,55,54,45,64,66,54,57,103,239,103,33,60,54
J3370,"Injection, vancomycin HCl, 500 mg",102,92,15,225,49,15,53,81,56,56,50,51,43,61,62,51,54,97,225,97,31,57,51
J3380,"Injection, vedolizumab",13133,11819,3953,29018,6698,5130,6725,7122,6612,7236,6406,6528,5485,7813,8019,6567,6895,12476,29018,12476,3953,7338,6566
J3410,"Injection, hydroxyzine HCl, up to 25 mg",126,114,7,279,62,7,65,68,64,70,62,63,53,75,77,63,66,120,279,120,38,71,63
J3411,"Injection, thiamine HCl, 100 mg",101,91,5,224,50,5,55,55,54,56,49,50,42,60,62,51,53,96,224,96,31,57,51
J3420,"Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg",102,91,31,224,51,40,55,51,51,56,50,50,42,60,62,51,53,96,224,96,31,57,51
J3430,"Injection, phytonadione (vitamin K), per 1 mg",184,166,55,407,91,72,94,88,99,101,90,91,77,109,112,92,97,175,407,175,55,103,92
J3475,"Injection, magnesium sulfate, per 500 mg",92,83,4,204,45,4,50,50,50,92,45,45,39,55,56,46,48,88,204,88,28,52,46
J3480,"Injection, potassium chloride, per 2 meq",60,54,3,133,28,3,32,33,30,33,29,30,25,36,37,30,32,57,133,57,18,34,30
J3486,"Injection, ziprasidone mesylate, 10 mg",189,170,57,418,93,74,73,103,99,104,92,94,79,113,116,95,99,180,418,180,57,106,95
J3489,HC ZOLEDRONIC ACID 1MG,305,275,54,674,156,54,156,378,154,168,149,152,127,182,186,153,160,290,674,290,92,170,153
J7042,5% dextrose/normal saline (500 ml = 1 unit),60,54,2,133,31,2,31,33,30,33,29,30,25,36,37,30,32,57,133,57,18,34,30
J7120,"Ringers lactate infusion, up to 1000 cc",60,54,2,133,31,2,32,30,32,30,29,30,2,36,37,30,32,57,133,57,18,34,30
J7121,5% dextrose in lac ringers,60,54,5,133,28,5,31,33,32,30,29,30,25,36,37,30,32,57,133,57,18,34,30
J7510,"Prednisolone oral, per 5 mg",2,2,1,5,1,1,1,1,1,1,1,1,1,1,1,1,1,2,5,2,1,1,1
J7512,Prednisone ir or dr oral 1mg,2,1,0,3,1,0,1,1,1,1,1,1,1,1,1,1,1,1,3,1,0,1,1
J8540,"Dexamethasone, oral, 0.25 mg",2,2,1,5,1,1,1,1,1,1,1,1,1,1,1,1,1,2,5,2,1,1,1
J9000,"Injection, doxorubicin hydrochloride, 10 mg",382,344,42,845,188,42,196,207,192,211,186,190,160,227,233,191,201,363,845,363,115,214,191
J9022,"Inj, atezolizumab,10 mg",17819,16037,5364,39373,8778,6961,9125,13881,8971,9818,8691,8858,7442,10601,10880,8910,9355,16928,39373,16928,5364,9956,8909
J9035,"Injection, bevacizumab, 10 mg",6710,6039,2020,14826,3422,2621,3436,3639,3378,3697,3273,3335,2802,3992,4097,3355,3523,6374,14826,6374,2020,3749,3355
J9060,"Injection, cisplatin, powder or solution, 10 mg",423,381,127,935,201,165,217,229,213,233,206,210,177,252,258,212,222,402,935,402,127,236,212
J9070,"Cyclophosphamide, 100 mg",268,241,81,592,132,108,137,145,135,148,131,133,112,159,164,134,141,255,592,255,81,150,134
J9100,"Injection, cytarabine, 100 mg",351,316,106,776,167,137,180,191,177,194,171,175,147,209,215,176,184,334,776,334,106,196,176
J9190,"Injection, fluorouracil, 500 mg",359,323,108,793,183,140,184,195,181,198,175,178,150,213,219,179,188,341,793,341,108,200,179
J9206,"Injection, irinotecan, 20 mg",451,405,136,996,226,176,243,244,227,248,220,224,188,268,275,225,237,428,996,428,136,252,225
J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",18683,16815,719,41282,8863,719,9568,10133,10044,10295,9113,9287,7803,11115,11408,9343,9809,17749,41282,17749,5624,10439,9341
J9267,HC PACLITAXEL INJECTION 1 MG,439,395,23,971,209,23,225,238,221,242,214,218,183,261,268,220,231,417,971,417,132,245,220
J9271,HC INJ PEMBROLIZUMAB 1 MG,18826,16943,5667,41598,9274,7354,10166,10210,9478,10373,9182,9358,7863,11200,11495,9414,9884,17885,41598,17885,5667,10519,9413
J9303,"Injection, panitumumab, 10 mg",12759,11483,3841,28193,6286,4984,6890,6920,6424,7031,6223,6343,5329,7591,7791,6380,6699,12121,28193,12121,3841,7129,6380
J9305,"Injection, pemetrexed, 10 mg",5889,5300,1773,13013,2909,2301,3016,3194,2965,3245,2872,2927,2460,3504,3596,2945,3092,5595,13013,5595,1773,3291,2945
J9306,"HC INJECTION, PERTUZUMAB, 1 MG",10405,9364,3132,22991,5306,4065,5329,5643,5239,5733,5075,5172,4346,6190,6353,5203,5463,9885,22991,9885,3132,5814,5202
J9355,"Injection, trastuzumab, 10 mg",3568,3211,1074,7883,1762,1394,1827,1935,1796,1966,1740,1773,1490,2122,2178,1784,1873,3389,7883,3389,1074,1993,1784
J9395,"Injection, Fulvestrant, 25 mg",4034,3631,1214,8914,2057,1576,2066,2188,2031,1977,1936,2005,1685,2400,2463,2017,2118,3833,8914,3832,1214,2254,2017
J9999,"Not otherwise classified, antineoplastic drugs",2,1,0,4,1,1,1,1,1,1,1,1,1,1,1,1,1,2,4,2,0,1,1
L8641,HC METATARSAL JOINT IMPLANT LVL 6,3788,3409,1140,8370,1866,1480,1940,2054,2030,2087,1848,1883,1582,2253,2313,1894,1989,3598,8370,3598,1140,2117,1894
P9016,"Red blood cells, leukocytes reduced, each unit",478,430,144,1056,488,187,245,229,241,229,233,238,200,284,292,478,251,454,1056,454,144,267,239
P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",1908,1717,574,4216,905,745,977,1035,961,1051,931,948,797,1135,1165,954,1002,1813,4216,1813,574,1066,954
P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",822,740,247,1816,390,321,421,446,414,453,401,409,343,489,502,411,432,781,1816,781,247,459,411
P9047,"Infusion, albumin (human), 25%, 50 ml",749,674,225,1654,344,354,383,406,377,413,365,372,313,445,457,374,393,711,1654,711,225,418,374
P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",216,194,65,477,102,84,111,117,109,119,105,107,90,129,132,108,113,205,477,205,65,121,108
Q4133,HC GRAFIX PRIME PL/STRAVIX PER 1 SQ CM LVL 3,4500,4050,1355,9943,2248,1758,2305,2441,2266,2480,2195,2237,1879,2677,2748,2250,2363,4275,9943,4275,1355,2514,2250
Q4160,HC NUSHIELD PER SQ CM LVL 6,662,596,199,1463,338,259,339,359,333,365,323,329,276,394,404,331,348,629,1463,629,199,370,331
Q4195,HC PURAPLY PER SQ CM LVL 11,3000,2700,903,6629,1247,1172,1536,1627,1510,1653,1463,1491,1253,1785,1832,1500,1575,2850,6629,2850,903,1676,1500
Q4196,HC PURAPLY AM PER SQ CM LVL 11,2240,2016,674,4950,1063,875,1147,1215,1128,1234,1093,1114,936,1333,1368,1120,1176,2128,4950,2128,674,1252,1120
Q5101,"Injection, zarxio",636,573,192,1406,313,249,326,345,320,305,310,316,266,379,389,318,334,604,1406,604,192,356,318
Q5104,"Injection, renflexis",10040,9036,3022,22184,4946,3922,5142,5445,5193,5532,4897,4991,4193,5973,6130,5021,5271,9538,22184,9538,3022,5610,5020
Q5106,Inj retacrit non-esrd use,308,277,93,681,157,120,158,167,155,170,150,153,129,183,188,154,162,293,681,293,93,172,154
Q9967,"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml",264,237,79,583,134,103,142,205,137,132,126,127,110,152,161,132,138,246,583,251,79,147,132
S0028,"Injection, famotidine, 20 mg",89,80,1,197,44,1,46,48,45,49,43,44,37,53,54,45,47,85,197,85,27,50,44
S0030,"Injection, metronidazole, 500 mg",90,81,1,198,44,1,46,49,45,49,44,44,37,53,55,45,47,85,198,85,27,50,45
S0077,"Injection, clindamycin phosphate, 300 mg",109,98,2,241,54,2,56,59,55,60,53,54,45,65,66,54,57,103,241,103,33,61,54
S0171,"Injection, Bumetanide, 0.5 mg",92,83,1,204,45,1,47,50,46,51,45,46,39,55,56,46,48,88,204,88,28,52,46
S5010,"5% dextrose and 0.45% normal saline, 1000 ml",60,54,2,133,30,2,31,33,30,33,29,30,25,36,37,30,32,57,133,57,18,34,30
S9472,"Cardiac rehabilitation program, non-physician provider, per diem",195,176,59,431,96,76,105,106,98,107,95,97,81,116,119,98,102,185,431,185,59,109,98
U0003,HC SARS-COV-2 COVID-19 AMP PRB HIGH THROUGHPUT TECH,100,90,30,221,51,55,50,78,50,50,49,50,42,59,52,50,54,95,221,95,30,56,50
V2632,Posterior chamber intraocular lens,479,431,144,1058,244,229,245,240,248,342,234,238,200,285,292,240,251,455,1058,455,144,268,240
,,,,,,,,,,,,,,,,,,,,,,,,
DRG,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Medicare,Blue cross,Amerigroup ia medicaid,United healthcare,Iowa total care,Aetna,Coventry advantra,Aetna medicare,Blue cross out of state,Health partners,Humana,Uhc medicare solutions hmo,Medicaid,Meritain,Midlands choice,Aetna - coventry,Va,Humana choice,Uhc medicare solutions ppo
Inpatients,,,,,,,,,,,,,,,,,,,,,,,,
191,"DRG CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",2126,1913,640,4698,1047,831,1089,1153,1070,2562,1037,1057,888,1265,1298,1063,1116,2020,4698,2020,640,1188,1063
293,"DRG HEART FAILURE AND SHOCK WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",18008,16208,5421,39792,8872,7035,9222,14029,9067,9923,8784,8952,7521,10714,10996,9005,9455,17108,39792,17108,5421,10062,9004
388,DRG G.I. OBSTRUCTION WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),3574,3217,1076,7898,1761,1396,2803,1938,1800,1969,1743,1777,1493,2126,2182,1787,1876,3395,7898,3395,1076,1997,1787
866,DRG VIRAL ILLNESS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),3228,2906,972,7133,1590,1261,1653,2515,1625,1779,1575,1605,1348,1921,1971,1614,1695,3067,7133,3067,972,1804,1614
897,"DRG ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)",5295,4766,1594,11700,2609,2069,5295,2872,2666,2918,2583,2632,2212,3150,3233,2648,2780,5030,11700,5030,1594,2959,2648
,,,,,,,,,,,,,,,,,,,,,,,,
CPT,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Blue cross,United healthcare,Amerigroup ia medicaid,Iowa total care,Aetna,Coventry advantra,Midlands choice,Aetna medicare,Humana,Uhc medicare solutions hmo,Blue cross out of state,Medicaid,Medicare,Va,Health partners,Humana choice,,,
Professionals,,,,,,,,,,,,,,,,,,,,,,,,
Outpatients,,,,,,,,,,,,,,,,,,,,,,,,
142,Anesthesia for procedures on eye; lens surgery,756,680,83,472,348,105,204,83,325,107,459,306,190,291,472,205,427,152,398,251,,,
170,"Anesthesia for intraoral procedures, including biopsy; not otherwise specified",1277,1149,115,797,522,463,115,377,550,540,679,518,322,491,797,346,722,257,672,424,,,
300,"Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified",1181,1063,135,737,464,135,319,349,508,499,628,479,297,454,737,320,667,238,621,392,,,
400,"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified",763,687,93,476,453,93,206,225,328,323,406,309,192,294,476,207,431,154,402,254,,,
731,PR ANES UPR GI NDSC PX NOS,877,789,101,580,580,174,101,259,378,371,467,355,221,337,547,238,496,176,462,291,,,
750,Anesthesia for hernia repairs in upper abdomen; not otherwise specified,1220,1098,246,761,493,442,330,360,525,516,649,494,307,469,761,331,689,246,642,405,,,
790,Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified,1823,1641,186,1138,870,661,186,194,785,771,970,739,459,210,1138,494,1030,367,959,606,,,
811,PR ANES LWR INTST NDSC NOS,916,824,102,572,544,332,102,270,394,124,487,371,231,352,572,248,518,184,482,304,,,
812,PR ANES LWR INTST SCR COLSC,868,781,81,490,406,113,87,81,374,367,427,352,219,334,464,235,490,175,372,288,,,
813,PR ANES UPR LWR GI NDSC PX,1245,1120,125,777,740,164,135,367,536,526,662,505,314,479,777,125,703,251,655,414,,,
830,Anesthesia for hernia repairs in lower abdomen; not otherwise specified,1580,1422,318,986,551,573,427,466,680,668,841,640,398,608,986,428,893,318,831,525,,,
840,Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified,1942,1748,276,1212,667,704,814,573,836,276,1033,787,489,747,1212,526,1097,391,1022,645,,,
902,Anesthesia for; anorectal procedure,1493,1344,152,932,887,170,152,441,643,631,794,605,376,574,932,404,844,300,786,496,,,
952,"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography",1220,1098,246,761,435,442,330,360,525,516,649,494,307,469,761,331,689,246,642,405,,,
1400,Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified,1380,1242,118,861,464,500,118,407,594,583,734,559,348,531,861,374,780,278,726,459,,,
1470,"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified",1163,1047,234,726,493,421,314,343,501,492,619,471,293,448,726,315,657,234,612,386,,,
1480,"Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified",1531,1378,308,955,910,371,414,452,659,647,814,620,386,589,955,415,865,308,806,509,,,
1810,"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand",843,759,150,526,290,150,228,249,363,356,448,342,212,324,526,228,476,170,444,280,,,
10060,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single",236,212,47,169,169,86,50,59,102,100,126,96,59,91,147,64,133,47,124,78,,,
10081,Incision and drainage of pilonidal cyst; complicated,625,562,126,390,360,226,169,184,269,264,332,253,157,240,390,169,353,126,329,208,,,
10160,"Puncture aspiration of abscess, hematoma, bulla, or cyst",300,270,55,187,178,109,55,89,129,127,160,122,76,115,187,81,170,60,158,100,,,
11042,"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less",451,406,30,281,130,52,35,133,78,191,125,183,30,174,281,122,255,91,237,150,,,
11043,"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less",484,436,87,329,329,175,87,143,208,205,324,196,148,186,302,131,273,97,255,161,,,
11045,"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)",451,406,22,281,268,22,122,133,194,191,240,183,25,174,281,122,255,91,237,150,,,
11046,"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)",451,406,53,281,119,163,122,133,194,191,240,183,53,174,281,122,255,91,237,150,,,
11055,"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion",120,108,7,75,28,7,32,35,52,51,64,49,30,46,75,33,68,24,63,40,,,
11056,"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions",145,130,16,90,39,16,39,43,62,61,77,59,37,56,90,39,82,29,76,48,,,
11402,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm",309,278,48,193,184,48,83,91,133,131,164,125,78,119,193,84,175,62,163,103,,,
11403,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm",515,464,71,321,306,187,139,152,222,218,274,71,130,198,321,140,291,104,271,171,,,
11404,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm",515,464,104,321,306,135,139,152,222,218,274,209,130,198,321,140,291,104,271,171,,,
11604,"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm",675,608,136,421,410,245,182,199,291,285,359,274,170,260,421,183,381,136,355,224,,,
11626,"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm",618,556,124,610,610,224,167,182,266,261,329,250,156,238,386,167,349,124,325,205,,,
11643,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm",618,556,124,386,367,196,167,182,266,261,329,250,156,238,386,167,349,124,325,205,,,
11644,"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm",925,832,186,577,550,335,250,273,274,391,492,375,233,356,577,251,523,186,487,307,,,
11719,"Trimming of nondystrophic nails, any number",81,73,4,51,48,4,22,24,35,34,43,33,20,31,51,22,46,16,43,27,,,
11721,Debridement of nail(s) by any method(s); 6 or more,145,130,29,90,52,53,39,43,62,61,77,59,37,56,90,39,82,29,76,48,,,
11771,Excision of pilonidal cyst or sinus; extensive,1092,983,220,681,649,407,295,322,470,462,581,443,275,420,681,296,617,220,575,363,,,
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",107,96,22,80,80,70,48,32,46,46,57,43,36,38,67,29,60,22,56,44,,,
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",168,151,34,111,111,51,64,50,72,71,89,68,42,65,105,46,95,34,88,56,,,
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",213,192,43,163,163,77,58,63,92,90,113,86,54,82,133,58,120,43,112,71,,,
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",252,227,51,157,150,91,105,74,108,107,134,102,63,97,157,68,142,51,133,84,,,
12011,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",146,131,29,116,116,86,73,50,63,62,78,59,37,56,91,40,82,29,77,49,,,
12020,Treatment of superficial wound dehiscence; simple closure,630,567,108,393,374,228,170,108,271,266,335,255,159,242,393,171,356,127,332,209,,,
12031,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less",618,556,124,386,272,224,167,182,266,261,329,250,156,238,386,167,349,124,325,205,,,
12032,"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm",618,556,124,386,367,224,167,182,266,261,329,185,156,238,386,167,349,124,325,205,,,
12041,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less",464,418,93,320,276,168,125,137,200,196,247,188,117,179,320,126,262,93,244,154,,,
12044,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm",204,184,41,127,121,74,116,60,88,86,109,83,51,78,127,55,115,41,107,68,,,
12052,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",204,184,41,127,121,86,55,60,88,86,109,83,51,78,127,55,115,41,107,68,,,
13101,"Repair, complex, trunk; 2.6 cm to 7.5 cm",1000,900,201,624,445,362,270,295,430,423,532,405,252,385,624,271,565,201,526,332,,,
13120,"Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm",850,765,171,530,501,308,230,251,366,359,452,344,214,327,530,230,480,171,447,282,,,
13121,"Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm",860,774,168,537,511,312,168,254,370,364,458,349,217,331,537,233,486,173,453,286,,,
13122,"Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)",300,270,52,187,178,109,52,89,129,127,160,122,76,115,187,81,170,60,158,100,,,
20610,"Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)",168,151,34,105,98,61,45,50,72,71,89,68,42,65,105,46,95,34,88,56,,,
27810,"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation",1200,1080,241,761,761,435,324,354,517,507,638,486,302,462,749,325,678,241,631,399,,,
28008,"Fasciotomy, foot and/or toe",1200,1080,241,749,510,435,324,354,517,507,638,486,302,462,749,325,678,241,631,399,,,
28080,"Excision, interdigital (Morton) neuroma, single, each",1200,1080,241,749,662,435,324,354,517,507,638,486,302,462,749,325,678,241,631,399,,,
28104,"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;",1400,1260,282,874,759,307,378,413,603,592,745,567,353,539,874,379,791,282,737,465,,,
28285,"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)",1200,1080,186,749,713,435,324,354,517,507,638,186,302,462,749,325,678,241,631,399,,,
28289,"Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint",1400,1260,282,1001,1001,507,378,413,603,592,745,567,353,539,874,379,791,282,737,465,,,
28296,"Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)",2000,1800,402,1248,1189,695,540,590,861,846,1064,811,504,770,1248,542,1130,402,1052,665,,,
28308,"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each",1400,1260,186,874,832,507,378,413,603,592,745,186,353,539,874,379,791,282,737,465,,,
28485,"Open treatment of metatarsal fracture, includes internal fixation, when performed, each",1500,1350,302,1157,1157,544,405,443,646,634,798,608,378,577,936,406,848,302,789,498,,,
28750,"Arthrodesis, great toe; metatarsophalangeal joint",1800,1620,362,1123,1070,652,486,531,775,761,958,566,453,693,1123,488,1017,362,947,598,,,
28805,"Amputation, foot; transmetatarsal",1550,1395,312,1262,1262,562,419,458,667,655,825,628,390,596,967,420,876,312,816,515,,,
29105,Application of long arm splint (shoulder to hand),123,111,25,92,92,45,33,36,53,52,65,50,31,47,77,33,70,25,65,41,,,
29125,Application of short arm splint (forearm to hand); static,94,85,19,73,73,34,25,41,40,40,50,38,24,36,59,25,53,19,49,31,,,
29515,Application of short leg splint (calf to foot),91,82,18,86,86,33,25,52,39,38,48,37,23,35,57,25,51,18,48,30,,,
29580,Strapping; Unna boot,127,114,26,79,60,34,34,37,55,54,68,51,32,49,79,34,72,26,67,42,,,
29581,"Application of multi-layer venous wound compression system, below knee",126,113,12,79,75,12,34,37,54,53,67,51,32,48,79,34,71,25,66,42,,,
29700,"Removal or bivalving; gauntlet, boot or body cast",150,135,30,94,71,54,41,44,65,63,80,61,38,58,94,41,85,30,79,50,,,
30901,"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method",114,103,23,98,98,41,31,34,49,48,61,46,29,44,71,31,64,23,60,38,,,
31500,"Intubation, endotracheal, emergency procedure",16,14,3,16,10,16,4,5,7,7,9,6,4,6,10,4,9,3,8,5,,,
36410,"Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)",153,138,8,95,32,8,41,45,66,65,81,62,39,59,95,41,86,31,81,51,,,
36556,Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older,564,508,69,352,335,69,152,166,243,238,300,229,142,217,352,153,319,114,297,187,,,
43235,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)",544,490,79,339,323,79,139,161,234,230,289,220,137,209,339,147,307,109,286,181,,,
43239,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple",544,490,109,339,300,139,149,149,234,230,289,220,137,209,339,147,307,109,286,181,,,
43247,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body",544,490,109,339,312,197,147,161,234,230,289,173,137,209,339,147,307,109,286,181,,,
43249,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30 mm diameter)",1500,1350,276,936,276,544,405,443,646,634,798,608,378,577,936,406,848,302,789,498,,,
44140,"Colectomy, partial; with anastomosis",4080,3672,821,2754,2425,1479,1102,1204,1756,1725,2754,1653,1027,1570,2546,1105,2305,821,2147,1356,,,
44970,"Laparoscopy, surgical, appendectomy",1030,927,207,643,612,373,479,304,443,435,548,417,259,396,643,279,582,207,542,342,,,
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)",866,779,174,513,378,513,209,209,373,366,461,181,218,333,416,235,489,174,456,288,,,
45380,"Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple",1030,927,175,643,417,175,212,304,443,435,418,417,259,396,643,279,582,207,498,342,,,
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",850,765,171,530,431,308,230,251,366,359,476,344,214,327,530,230,480,171,447,282,,,
45385,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique",831,748,167,520,520,222,224,245,358,351,442,337,209,320,519,225,470,167,437,276,,,
46220,"Excision of single external papilla or tag, anus",700,630,102,437,416,102,189,207,301,296,372,284,176,269,437,190,396,141,368,233,,,
46260,"Hemorrhoidectomy, internal and external, 2 or more columns/groups;",1180,1062,237,736,701,397,319,348,508,499,628,478,297,454,736,320,667,237,621,392,,,
46320,"Excision of thrombosed hemorrhoid, external",361,325,73,225,215,131,78,107,155,153,192,146,91,139,225,98,204,73,190,120,,,
47562,"Laparoscopy, surgical; cholecystectomy",1236,1112,249,1140,1140,448,634,365,532,523,658,628,311,476,771,335,698,249,650,411,,,
49082,PBB ABD PARACENTESIS,168,151,34,105,100,64,45,50,72,71,89,68,42,65,105,46,95,34,88,56,,,
49505,"Repair initial inguinal hernia, age 5 years or older; reducible",1030,927,207,643,612,430,278,304,443,435,548,417,259,396,643,279,582,207,542,342,,,
49585,"Repair umbilical hernia, age 5 years or older; reducible",1442,1298,290,951,951,523,390,426,621,610,767,584,363,555,900,391,815,290,759,479,,,
49587,"Repair umbilical hernia, age 5 years or older; incarcerated or strangulated",1400,1260,282,1017,1017,507,378,413,603,592,745,567,353,539,874,379,791,282,737,465,,,
49650,"Laparoscopy, surgical; repair initial inguinal hernia",1400,1260,282,874,832,507,378,413,603,589,745,567,353,539,874,379,791,282,737,465,,,
49652,"Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible",1865,1678,375,1571,1571,676,504,551,803,789,992,756,470,718,1164,505,1054,375,981,620,,,
56405,Incision and drainage of vulva or perineal abscess,201,181,40,146,119,146,54,59,87,85,107,81,51,77,125,54,114,40,106,67,,,
58563,"Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)",3700,3330,425,2309,425,1341,999,1092,1593,1564,1968,1499,932,1424,2309,1002,2091,745,1947,1229,,,
59025,Fetal non-stress test,107,96,22,67,64,39,26,32,46,45,57,43,27,41,67,29,60,22,56,36,,,
62323,PR INJ INTERLAM L/S W IMG,1308,1177,69,816,777,474,69,386,563,553,696,530,329,503,816,354,739,263,688,435,,,
64788,Excision of neurofibroma or neurolemmoma; cutaneous nerve,1000,900,201,624,594,333,270,295,430,423,532,405,252,385,624,271,565,201,526,332,,,
69200,Removal foreign body from external auditory canal; without general anesthesia,84,76,17,52,50,30,23,27,36,36,45,34,21,32,52,23,47,17,44,28,,,
76937,"Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)",290,261,10,181,172,105,10,86,125,123,154,118,73,112,181,79,164,58,153,96,,,
93010,"Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only",50,45,6,31,16,7,10,10,7,8,17,20,8,7,31,10,28,6,26,17,,,
93016,"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report",110,99,22,69,47,40,30,32,47,47,59,45,28,42,69,30,62,22,58,37,,,
93018,"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only",110,99,13,76,26,13,18,32,76,47,59,45,28,42,69,30,62,22,58,37,,,
94010,"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation",25,22,5,18,18,8,7,7,8,11,13,10,6,10,16,7,14,5,13,8,,,
94060,"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration",45,40,9,28,23,13,18,13,13,19,24,18,11,17,28,12,25,9,24,15,,,
96372,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",74,67,4,46,44,27,4,22,32,31,39,30,19,28,46,20,42,15,39,25,,,
97605,"Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters",75,68,15,47,30,27,20,22,32,32,30,30,19,29,47,20,42,15,39,25,,,
97606,"Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters",80,72,16,50,48,29,22,24,34,34,32,32,20,31,50,22,45,16,42,27,,,
98925,Osteopathic manipulative treatment (OMT); 1-2 body regions involved,62,56,12,39,37,22,20,18,27,26,33,25,16,24,39,17,35,12,33,21,,,
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.",169,152,34,105,78,61,46,50,73,71,90,68,43,65,105,46,95,34,89,56,,,
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.",216,194,43,135,117,78,58,64,93,91,115,88,54,83,135,59,122,43,114,72,,,
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.",70,63,8,44,42,25,19,8,30,30,37,28,18,27,44,19,40,14,37,23,,,
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.",129,116,18,81,39,22,18,38,25,55,69,52,32,50,81,35,73,26,68,43,,,
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.",164,148,28,102,79,43,28,31,71,69,87,66,41,44,102,44,93,33,86,54,,,
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.",215,194,43,134,122,78,58,49,79,91,114,87,54,83,134,58,121,43,113,71,,,
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.])",120,108,24,112,96,59,53,53,62,69,64,73,30,46,112,33,68,24,63,40,,,
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.",156,140,31,132,132,82,55,55,86,94,83,63,39,60,97,42,88,31,82,52,,,
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.",214,193,43,194,194,132,99,107,138,90,114,87,54,82,177,58,121,43,113,71,,,
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.",292,263,59,288,288,156,144,86,152,123,155,188,74,112,182,79,165,59,154,97,,,
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.",156,140,31,132,132,88,42,55,84,66,83,63,39,83,97,42,97,31,82,52,,,
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.",212,191,43,179,179,112,99,91,118,129,113,118,53,82,132,57,120,43,112,70,,,
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.",310,279,62,195,184,186,84,144,133,131,165,195,78,166,193,84,195,62,163,103,,,
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.",61,55,12,52,52,32,25,18,26,26,32,25,15,23,38,17,34,12,32,20,,,
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.",112,101,23,95,95,63,39,45,67,69,60,45,28,43,70,30,63,23,59,37,,,
99226,"Subsequent observation 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 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 patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.",160,144,32,137,137,89,58,68,107,99,85,65,40,62,100,43,90,32,84,53,,,
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.",60,54,12,51,51,33,16,18,26,25,32,24,15,23,37,16,34,12,32,20,,,
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.",111,100,22,95,95,63,30,44,61,47,59,66,28,59,69,52,59,22,58,37,,,
99233,"Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical 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 patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.",160,144,32,136,136,91,62,62,98,98,85,65,40,86,100,43,86,32,84,53,,,
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.",204,184,41,174,174,74,100,60,88,86,109,83,51,78,127,55,115,41,107,68,,,
99236,"Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive 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) requiring admission are of high severity.",346,311,70,309,309,182,93,196,149,146,184,140,87,133,216,94,196,70,182,115,,,
99238,Hospital discharge day management; 30 minutes or less,112,101,23,70,67,63,53,62,48,47,60,45,28,43,70,30,60,23,59,37,,,
99239,Hospital discharge day management; more than 30 minutes,164,148,33,160,140,93,69,81,88,101,160,92,41,93,102,44,88,33,86,54,,,
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.",166,149,29,94,63,38,29,29,71,70,62,67,36,64,66,29,94,29,87,43,,,
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.",212,191,43,120,94,56,59,55,52,58,93,86,61,56,94,59,120,43,108,70,,,
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.",258,232,80,182,179,103,91,91,96,111,176,105,112,99,182,91,146,80,174,86,,,
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.",385,346,77,264,264,150,143,143,163,163,262,156,163,142,240,122,218,77,203,128,,,
99291,"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes",604,544,122,377,338,204,144,144,182,255,321,245,218,232,377,164,341,122,318,201,,,
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)",316,284,64,197,170,108,80,80,136,134,168,128,80,122,197,86,179,64,166,105,,,
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.",206,185,41,129,122,106,56,61,89,87,110,83,52,79,129,56,116,41,108,68,,,
99306,"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 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 45 minutes at the bedside and on the patient's facility floor or unit.",264,238,53,256,256,141,71,78,114,112,140,107,66,102,165,72,149,53,139,88,,,
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.",65,58,13,41,39,36,18,19,28,27,35,26,16,25,41,18,37,13,34,22,,,
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.",110,99,22,90,90,60,30,32,47,47,59,45,28,42,69,30,62,22,58,37,,,
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.",144,130,29,141,141,75,39,43,62,61,77,58,36,55,90,39,81,29,76,48,,,
99310,"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 comprehensive interval history; A comprehensive examination; 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. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 35 minutes at the bedside and on the patient's facility floor or unit.",215,194,43,208,208,117,58,63,93,91,114,87,54,83,134,58,121,43,113,71,,,
99315,Nursing facility discharge day management; 30 minutes or less,115,104,23,72,68,63,31,34,50,49,61,47,29,44,72,31,65,23,61,38,,,
99316,Nursing facility discharge day management; more than 30 minutes,167,150,34,104,99,92,45,49,72,71,89,68,42,64,104,45,94,34,88,55,,,
99356,"Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service)",140,126,28,90,83,90,38,41,60,59,74,57,35,54,87,38,79,28,74,47,,,
A0424,"Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review)",125,112,20,78,74,45,34,20,54,53,66,51,31,48,78,34,71,25,66,42,,,
A0425,"Ground mileage, per statute mile",120,108,11,75,71,43,11,18,52,51,64,49,30,46,75,33,68,24,63,40,,,
A0427,"Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)",1259,1133,127,786,748,456,127,127,542,532,670,510,317,484,786,341,711,253,663,418,,,
A0428,"Ambulance service, basic life support, non-emergency transport, (BLS)",667,600,85,416,396,242,180,85,287,282,355,270,168,257,416,181,377,134,351,222,,,
A0429,"Ambulance service, basic life support, emergency transport (BLS-emergency)",1066,959,114,665,634,386,114,114,459,451,567,432,268,410,665,289,602,215,561,354,,,
A0433,"Advanced life support, level 2 (ALS 2)",1822,1640,233,1137,1083,660,492,233,784,770,969,738,459,701,1137,494,1030,367,959,605,,,
G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,866,779,174,540,515,314,234,256,181,366,461,351,218,333,540,235,489,174,456,288,,,
G0168,Wound closure utilizing tissue adhesive(s) only,213,192,19,133,127,19,58,63,92,90,113,86,54,82,133,58,120,43,112,71,,,