Guttenberg Muni Hosp - Machine Readable Report - Generated on 02/10/2023 "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 Guttenberg Muni Hosp. This was generated on 02/10/2023 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 Charges Low Charges High Discounted Cash Price Min Negotiated Max Negotiated Aetna Aetna - coventry Aetna insurance Aetna medicare Alliance umr American postal workers Amerigroup ia medicaid Iowa Total Care Blue cross Blue cross medicare blue ppo Blue cross out of state Champus Champva Cigna Commercial Coventry advantra Coventry health care Employee benefits systems Health partners Health partners uph medicare adv h3416 Health partners uph self funded Healtheos - aetna insurance Iowa total care Liability Medicaid Medical associates Medicare Medicare community plan uhc Midlands choice Network health Quartz insurance Securehorizons direct Trustmark Uhc medicare dir Uhc medicare solutions Uhc medicare solutions hmo Uhc medicare solutions ppo Uhc river valley Umr uhc United healthcare Va Institutional Outpatients 00103 "Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)" 2156 2156 2156 1725 525 2091 1170 845 1281 1163 1789 2088 1185 1185 837 1349 820 1142 525 2060 2070 1188 729 1372 1201 1140 1168 1418 1154 1121 1139 1334 1186 1186 2027 1177 528 1186 2091 1186 1128 1175 1169 1984 1975 1517 1052 00140 Anesthesia for procedures on eye; not otherwise specified 1534 667 2400 1227 374 1487 832 601 911 827 1272 1485 843 843 595 960 583 812 374 1466 1472 845 518 976 854 811 831 1009 821 797 810 949 823 843 1442 837 376 843 1487 843 802 836 831 1411 1405 1079 748 00142 Anesthesia for procedures on eye; lens surgery 667 437 3082 534 163 647 362 261 396 360 553 646 366 366 259 417 254 353 163 637 640 368 225 424 326 326 361 439 357 347 352 413 367 367 627 364 163 367 647 367 349 364 362 614 611 469 326 00148 Anesthesia for procedures on eye; ophthalmoscopy 621 621 621 497 151 602 337 243 369 335 515 601 341 341 241 389 236 329 151 593 596 342 210 395 346 328 336 408 332 323 328 384 342 342 584 339 152 342 602 342 325 338 337 571 569 437 303 00300 "Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified" 954 874 1035 764 233 926 518 374 567 515 792 924 524 524 370 597 363 505 233 912 916 526 323 607 626 505 517 628 481 496 504 590 499 525 897 521 234 525 926 525 499 520 518 878 874 672 466 0031A IMM ADMN SARSCOV2 AD26 5X1010VP/0.5 ML 1 DOSE 50 50 50 40 12 48 27 20 30 27 41 48 27 27 19 31 19 26 12 48 48 28 17 32 28 26 27 33 27 26 26 31 28 28 47 27 12 28 48 28 26 27 27 46 46 35 24 00731 PR ANES UPR GI NDSC PX NOS 528 528 528 422 129 512 286 207 314 285 438 511 290 290 205 330 201 280 129 505 507 291 178 336 294 279 290 347 283 275 279 327 276 290 496 288 129 290 512 290 276 288 286 486 484 372 258 00790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified 2211 1914 2508 1769 539 2145 1199 867 1314 1193 1835 2141 1215 1215 858 1383 841 1171 539 2113 2123 1218 747 1407 1232 1169 1198 1454 976 1150 1254 1368 1155 1216 2079 1207 542 1216 2145 1216 1157 1205 1199 2034 2025 1556 1079 00811 PR ANES LWR INTST NDSC NOS 792 552 1128 634 193 768 430 310 471 427 657 767 435 435 307 496 301 419 193 535 760 436 268 504 590 419 436 521 462 412 418 490 414 436 745 432 194 436 768 436 414 432 429 729 725 557 387 00812 PR ANES LWR INTST SCR COLSC 744 484 1012 595 181 722 404 292 442 401 617 720 409 409 289 466 283 394 181 469 714 410 251 473 414 393 316 489 458 387 393 460 394 409 700 406 182 409 722 409 389 405 403 684 682 524 363 00813 PR ANES UPR LWR GI NDSC PX 897 897 897 718 219 870 487 352 533 484 744 869 493 493 348 561 341 475 219 857 861 494 303 571 500 474 493 590 480 466 474 555 469 493 843 490 220 493 870 493 469 489 486 825 822 631 438 00830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified 3232 3036 3427 2585 787 3135 1753 1267 1920 1743 2681 3129 1776 1776 1254 2022 1229 1711 787 3088 3102 1781 1092 2056 2073 1709 1751 2126 1672 1680 1707 1999 1689 1777 3038 1764 791 1777 3135 1777 1691 1761 1752 2973 2960 2274 1577 00840 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified 1564 1564 2139 1251 381 1517 848 613 929 844 1298 1514 859 859 607 979 595 828 381 1495 1501 862 528 995 1294 827 847 1029 860 813 826 967 817 860 1471 854 383 860 1517 860 818 852 848 1439 1433 1101 763 00902 Anesthesia for; anorectal procedure 943 943 943 754 230 915 512 370 560 509 782 913 518 518 366 590 359 499 230 901 905 520 319 600 525 499 511 620 519 490 498 583 493 519 887 515 231 519 915 519 493 514 511 868 864 664 460 0097U "Gastrointestinal pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 22 targets" 562 331 562 450 137 545 305 220 334 172 466 544 313 313 307 352 307 298 137 537 540 310 190 358 313 297 182 370 301 292 297 348 363 309 528 307 138 309 545 309 294 309 309 517 515 413 274 01250 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg" 1150 1150 1150 920 280 1116 624 451 683 620 954 1113 632 632 446 720 437 609 280 1099 1104 634 389 732 641 608 623 756 616 598 607 711 583 632 1081 628 282 632 1116 633 602 627 624 1058 1053 809 561 01462 "Anesthesia for all closed procedures on lower leg, ankle, and foot" 851 851 851 681 207 825 462 334 506 459 706 824 468 468 330 532 324 451 207 813 817 469 288 541 474 450 461 560 469 443 449 526 445 468 800 465 208 468 825 468 445 464 461 783 780 599 415 01470 "Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified" 1496 1496 1496 1197 365 1451 812 586 889 807 1241 1449 822 822 580 936 569 792 365 1430 1436 824 505 952 833 791 810 984 801 778 790 925 798 823 1407 817 366 823 1451 823 783 815 811 1376 1370 1053 730 01480 "Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified" 1452 1452 1452 1162 354 1408 788 569 863 783 1205 1406 798 798 563 909 552 769 354 1388 1394 800 491 924 799 768 787 955 777 755 767 898 759 799 1365 793 356 799 1408 799 760 791 787 1336 1330 1022 709 01810 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand" 1230 1219 1242 984 300 1194 668 482 731 664 1021 1191 676 676 477 770 468 652 300 1176 1181 678 416 783 685 651 667 809 684 640 650 761 670 677 1157 672 301 677 1194 677 644 671 667 1132 1127 866 601 0202U HC NFCT DS 22 TRGT SARS-COV-2 580 580 580 464 141 563 315 227 345 313 481 562 323 323 225 363 221 307 141 554 557 320 196 369 323 307 314 381 319 302 306 359 293 319 545 317 142 319 563 319 304 316 314 534 531 408 283 10060 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single" 252 229 3759 202 61 244 137 99 150 136 209 244 103 103 98 158 96 133 61 241 242 139 85 160 140 133 137 166 73 131 133 156 132 139 237 138 62 139 244 139 132 137 137 232 231 177 123 10061 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple" 519 519 519 415 126 503 282 203 308 280 431 503 285 285 201 325 197 275 126 496 498 286 175 330 289 274 281 341 278 270 274 321 277 285 488 283 127 285 503 285 272 283 281 477 475 365 253 10080 Incision and drainage of pilonidal cyst; simple 331 331 331 265 81 1014 180 130 197 179 275 320 182 182 1014 207 126 175 81 316 318 182 112 211 184 175 179 218 177 172 175 205 173 182 311 181 81 182 321 182 173 180 179 305 303 233 162 10120 "Incision and removal of foreign body, subcutaneous tissues; simple" 221 221 244 177 54 1014 120 87 131 119 183 214 132 132 175 138 1014 117 54 211 212 122 75 141 123 117 120 145 118 115 117 137 115 122 208 121 54 122 214 122 116 120 120 203 202 156 108 10140 "Incision and drainage of hematoma, seroma or fluid collection" 3580 3580 3580 2864 872 3473 1942 1403 2127 1931 2971 3466 1967 1967 2772 2240 1361 1896 872 3421 3437 1973 1210 2278 1994 1893 1939 2355 1917 1862 1891 2215 1871 1969 3366 1954 877 1969 3473 1969 1873 1951 1941 3294 3279 2519 1747 11106 PR INCISIONAL BX SKN SINGLE LES 2738 2408 3068 2190 667 2656 1485 1073 1627 1477 2272 2651 1504 1504 1062 1713 1041 1450 667 2617 2628 1509 925 1742 1525 1448 1483 1801 1466 1424 1446 1694 1431 1506 2574 1495 671 1506 2656 1506 1433 1492 1687 2519 2508 1324 1336 11402 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm" 1 1 1 1 0 653 1 0 1 1 1 1 1 1 653 1 0 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 11404 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm" 2482 1 2781 1986 605 2408 1346 973 1475 1339 2060 2403 1661 1661 686 1553 944 1314 605 2372 2383 1368 839 1579 1383 1313 1345 1633 1329 1291 1311 1535 1297 1365 2334 1355 608 1365 2408 1365 1299 1353 1346 2283 2274 1747 1211 11406 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm" 2607 2293 2738 2086 635 5162 1414 1022 1549 1406 2163 2524 1432 1432 5162 1631 991 1380 635 2491 2503 1436 881 1659 1452 1379 1412 1715 1436 1356 1377 1613 1162 1434 2451 1423 639 1434 2529 1434 1364 1421 1413 2398 2388 1835 1272 11420 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less" 1 1 1 1 0 1 1 0 1 1 1 1 0 0 0 1 0 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 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" 2293 2293 2293 1834 559 2224 1244 899 1362 1237 1903 2220 1275 1275 890 1435 872 1214 559 2191 2201 1263 775 1459 1277 1213 1242 1508 1228 1192 1211 1418 1198 1261 2156 1252 562 1261 2224 1261 1200 1250 1243 2110 2100 1614 1119 11426 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm" 2607 2607 2738 2086 635 5162 1414 1022 1549 1406 2163 2524 1432 1432 5162 1631 991 1380 635 2491 2503 1436 881 1659 1452 1379 1412 1715 1396 1356 1377 1613 1378 1434 2451 1423 639 1434 2529 1434 1364 1421 1413 2398 2388 1835 1272 11444 "Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm" 2920 2920 2920 2336 712 4441 1584 1145 1735 1575 2423 2827 1604 1604 1133 1827 1110 1546 712 2791 2803 1609 987 1858 1627 1544 1582 1921 1563 1518 1542 1806 1526 1606 2745 1594 715 1606 2832 1606 1528 1591 1583 2686 2675 4441 1425 11446 "Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm" 2737 2737 3235 2190 667 4150 1485 1073 1626 1476 2271 2650 1504 1504 1062 1713 1041 1449 667 2616 2628 1508 925 1741 1525 1447 1483 1800 1465 1423 1446 1693 1779 1505 2573 1494 670 1505 2655 1505 1432 1492 1484 2518 2507 4150 1336 11470 "Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair" 5351 5351 5351 4281 1304 5190 2903 2098 3179 2886 4440 5181 2940 2940 5162 3348 2035 2833 1304 5114 5137 2948 1808 3404 2981 2830 2899 3520 2865 2783 2826 3310 2796 2943 5031 2921 1311 2943 5190 2943 2800 2916 2901 4923 4902 3766 2612 11606 "Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm" 2607 2607 2607 2086 635 2529 1414 1022 1549 1406 2163 2524 1432 1432 1011 1631 991 1380 635 2491 2503 1436 881 1659 1452 1379 1412 1715 1396 1356 1377 1613 1434 1434 2451 1423 639 1434 2529 1434 1364 1421 1413 2398 2388 1835 1272 11626 "Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm" 2782 2782 2782 2226 678 2699 1509 1091 1653 1501 2308 2694 1529 1529 1079 1741 1058 1473 678 2659 2671 1533 940 1770 1550 1471 1507 1830 1489 1447 1469 1721 1483 1530 2616 1519 681 1530 2699 1530 1456 1516 1508 2559 2548 1958 1358 11643 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm" 2921 2921 2921 2337 712 2833 1585 1145 1735 1576 2424 2828 1605 1605 1133 1828 1111 1547 712 2792 2804 1609 987 1858 1627 1545 1582 1921 1564 1519 1543 1807 1607 1607 2746 1595 715 1607 2833 1607 1529 1607 1584 2687 2676 2056 1426 11644 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm" 2607 2607 2607 2086 635 2529 1414 1022 1549 1406 2163 2524 1432 1432 1011 1631 991 1380 635 2491 2503 1436 881 1659 1452 1379 1412 1715 1396 1356 1377 1613 1321 1434 2451 1423 639 1434 2529 1434 1364 1421 1413 2398 2388 1835 1272 11646 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm" 3068 2482 3398 2454 748 3588 1664 1203 1823 1655 2546 2971 1686 1686 3588 1920 1167 1624 748 2932 2945 1690 1037 1952 1709 1623 1662 2018 1643 1595 1620 1898 1636 1687 2885 1675 751 1687 2976 1687 1605 1672 1663 2823 2810 2159 1497 11750 "Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;" 2607 2607 2607 2086 635 2529 1414 1022 1549 1406 2163 2524 1432 1432 1011 1631 991 1380 635 2491 2503 1436 881 1659 1452 1379 1412 1715 1436 1356 1377 1613 1362 1434 2451 1423 639 1434 2529 1434 1364 1421 1413 2398 2388 1835 1272 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" 240 229 425 192 58 657 122 94 223 129 199 232 133 133 657 150 633 134 58 229 230 132 81 153 134 127 130 158 147 125 127 148 132 132 226 131 59 132 233 132 126 124 132 221 211 221 117 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" 331 315 448 265 81 770 180 130 197 164 275 320 184 184 657 207 633 175 81 316 318 182 112 211 184 175 179 218 142 172 175 205 168 182 770 181 81 182 321 182 173 180 161 305 303 305 162 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" 221 221 244 177 54 633 120 87 131 119 183 214 143 143 633 138 84 117 54 211 212 122 75 141 123 117 120 145 118 115 117 137 113 122 208 121 54 122 214 122 116 120 120 203 202 128 108 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" 315 315 315 252 77 306 171 123 187 170 261 305 173 173 122 197 120 167 77 301 302 174 106 200 175 167 171 207 169 164 166 195 168 173 296 172 77 173 306 173 165 172 171 290 289 222 154 12011 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less" 331 315 468 265 81 673 180 130 197 179 275 320 184 184 673 207 475 181 81 316 318 182 112 211 184 175 179 218 195 172 175 205 182 182 311 181 81 182 321 182 173 180 162 305 303 290 162 12013 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 331 315 524 265 81 689 180 130 197 179 275 320 194 194 449 207 689 175 81 316 318 182 112 211 184 175 179 218 177 172 158 205 182 182 311 181 81 182 321 182 173 180 191 305 303 233 162 12014 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm" 244 244 244 195 59 329 132 96 145 132 202 236 134 134 329 153 93 129 59 233 234 134 82 155 136 129 134 160 131 127 129 151 130 134 229 133 60 134 237 134 128 133 132 224 224 134 119 12015 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm" 315 315 315 252 77 306 171 123 187 170 261 305 173 173 122 197 120 167 77 301 302 174 106 200 175 167 171 207 169 164 166 195 161 173 296 172 77 173 306 173 165 172 171 290 289 222 154 12032 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm" 1 1 1 1 0 1 1 0 1 1 1 1 0 0 0 1 0 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 12034 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm" 596 315 876 476 145 578 323 233 354 321 494 577 327 327 231 373 226 315 145 569 572 328 201 379 332 315 323 392 319 310 315 368 174 328 560 325 146 328 578 328 312 325 323 548 545 419 291 12042 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm" 348 348 348 278 85 338 189 136 207 188 289 337 191 191 135 218 132 184 85 333 334 192 118 221 194 184 189 229 186 181 184 215 186 191 327 190 85 191 338 191 182 190 189 320 319 245 170 12044 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm" 331 331 331 265 81 321 180 130 197 179 275 320 182 182 128 207 126 175 81 316 318 182 112 211 184 175 179 218 177 172 175 205 182 182 311 181 81 182 321 182 173 180 179 305 303 233 162 12052 "Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 1 1 1 1 0 317 1 0 1 1 1 1 1 1 317 1 0 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 14001 "Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm" 5543 5543 5543 4434 1351 5377 3007 2173 3293 2990 4599 5367 3046 3046 2151 3468 2108 2935 1351 5297 5321 3054 1873 3526 3088 2931 3003 3646 2968 2882 2928 3429 3049 3049 5212 3026 1358 3049 5377 3049 2901 3021 3005 5100 5078 3901 2705 15822 "Blepharoplasty, upper eyelid;" 4058 4058 4058 3246 989 3936 2201 1591 2411 2189 3367 3929 2230 2230 1574 2539 1543 2149 989 3878 3896 2236 1371 2582 2261 2146 2198 2669 2173 2110 2143 2510 2164 2232 3815 2215 994 2232 3936 2232 2124 2212 2232 3733 3717 2856 1981 19000 Puncture aspiration of cyst of breast; 668 668 668 534 163 1138 362 262 397 360 554 647 367 367 259 418 254 354 163 638 641 368 226 425 372 353 362 439 358 347 353 413 349 367 1138 365 164 367 648 367 350 364 362 615 612 470 326 19081 PR BX BREAST 1ST LESION STRTCTC 3638 3638 7276 2910 886 3529 1973 1426 2161 1962 3019 3522 2023 2023 2638 2276 1383 1926 886 3477 3492 2005 1229 2314 2027 1924 1971 2393 1948 1892 1921 2250 1898 2001 3421 1986 891 2001 3529 2001 1904 1983 1972 3347 3333 2560 1776 19083 HC BX BREAST 1ST LESION US IMAG 4011 3409 7639 3209 977 7789 2176 1572 2383 2164 3328 3884 2355 2355 2754 2510 1525 2124 977 3833 3851 2210 1355 2552 2234 2121 2173 2638 2147 2086 2118 2481 2139 2206 7789 2190 982 2206 3891 2206 2099 2186 2101 3690 3674 2101 1958 19084 HC BX BREAST ADD LESION US IMAG 3409 3409 3409 2727 831 3306 1849 1336 2025 1839 2828 3300 1873 1873 1251 2133 1296 1805 831 3258 3272 1878 1152 2169 1899 1803 1847 2242 1825 1773 1800 2109 1781 1875 3205 1861 835 1875 3306 1875 1784 1858 1848 3136 3122 2399 1664 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" 4005 4005 4651 3204 976 3885 2173 1570 2379 2160 3323 3878 2587 2587 2731 2506 1523 2121 976 3827 3845 2207 1353 2548 2231 2118 2170 2634 2144 2083 2115 2477 2093 2203 3766 2186 981 2203 3885 2203 2096 2183 2171 3685 3669 2819 1955 19301 "Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);" 6882 6882 6882 5506 1677 6676 3733 2698 4089 3712 5711 6663 3781 3781 2670 4306 2617 3644 1677 6577 6607 3792 2325 4378 3834 3640 3728 4527 3685 3579 3635 4257 3235 3785 6471 3757 1686 3785 6676 3785 3601 3751 3731 6331 6304 4843 3359 19328 Removal of intact mammary implant 5543 5543 5543 4434 1351 5377 3007 2173 3293 2990 4599 5367 4625 4625 2151 3468 2108 2935 1351 5297 5321 3054 1873 3526 3088 2931 3003 3646 2968 2882 2928 3429 2896 3049 5212 3026 1358 3049 5377 3049 2901 3021 3005 5100 5078 3901 2705 20552 "Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)" 663 221 2318 530 162 2133 360 260 394 358 550 642 408 408 257 415 252 351 162 634 636 365 224 422 369 351 359 436 355 345 350 410 338 365 623 362 162 365 643 365 347 361 365 610 607 2133 324 20605 "Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)" 697 218 731 558 170 676 378 273 414 376 578 675 383 383 270 436 265 369 170 666 669 384 236 443 388 369 378 458 373 362 368 431 214 383 655 381 171 383 676 383 365 380 370 641 638 491 340 20610 "Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)" 731 1 1044 585 178 709 397 287 434 394 607 708 429 429 534 457 278 387 178 699 702 403 247 465 407 387 396 481 391 380 386 452 386 402 687 399 179 402 709 402 383 398 396 673 670 514 357 20611 HC DRAIN/INJ MAJOR JOINT/BURSA W US 278 278 278 222 68 270 151 109 165 150 231 269 153 153 108 174 106 147 68 266 267 153 94 177 155 147 151 183 149 145 147 172 148 153 261 152 68 153 270 153 145 152 153 256 255 196 136 20694 "Removal, under anesthesia, of external fixation system" 4415 4415 4415 3532 1076 4755 2395 1731 2623 2382 3664 4275 2426 2426 4755 2763 1679 2338 1076 4219 4238 2433 1492 2809 2459 2335 2392 2904 2364 2296 2332 2731 2307 2428 4151 2410 1081 2428 4283 2428 2310 2406 2394 4062 4044 3107 2155 21012 "Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater" 2483 2483 2483 1986 605 2409 1347 973 1475 1339 2060 2404 1364 1364 963 1554 944 1315 605 2373 2384 1368 839 1580 1383 1313 1345 1633 1329 1291 1311 1536 1266 1366 2335 1356 608 1366 2409 1366 1299 1353 1346 2284 2274 1747 1212 21931 "Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater" 2607 2607 2607 2086 635 2529 1414 1022 1549 1406 2163 2524 1432 1432 1011 1631 991 1380 635 2491 2503 1436 881 1659 1577 1379 1412 1715 1396 1356 1377 1613 1362 1434 2451 1423 639 1434 2529 1434 1364 1421 1413 2398 2388 1835 1272 23350 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography 225 225 225 180 55 3407 122 88 134 121 187 218 124 124 87 141 86 119 55 215 216 124 76 143 125 119 122 148 120 117 119 139 118 124 212 123 55 124 218 124 118 123 122 207 206 3407 110 23655 "Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia" 1654 1654 1654 1323 403 2831 897 648 983 892 1372 1601 909 909 2831 1035 629 876 403 1581 1588 911 559 1052 921 875 896 1088 886 860 874 1023 864 910 1555 903 405 910 1604 910 866 901 897 1522 1515 1164 807 25111 "Excision of ganglion, wrist (dorsal or volar); primary" 2483 2483 2483 1986 605 2409 1347 973 1475 1339 2060 2404 1364 1364 963 1554 944 1315 605 2373 2384 1368 839 1580 1383 1313 1345 1633 1329 1291 1311 1536 1297 1366 2335 1356 608 1366 2409 1366 1299 1353 1291 2284 2274 1747 1212 26160 "Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger" 1092 1 2184 874 266 3637 593 428 649 589 907 1058 600 600 3445 684 415 578 266 1044 1049 602 369 695 609 578 592 719 585 568 577 676 571 601 1027 596 268 601 1060 601 572 595 592 1005 1001 3637 533 26725 "Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each" 582 582 582 466 142 565 316 228 346 314 483 564 320 320 226 364 221 308 142 556 559 321 197 370 324 308 315 383 312 303 307 360 304 320 547 318 143 320 565 320 305 317 316 535 535 410 284 26770 "Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia" 566 513 566 453 138 549 307 222 336 305 470 548 311 311 220 354 215 300 138 541 543 312 191 360 315 299 307 372 329 294 299 350 302 311 532 309 139 311 549 311 296 308 307 521 518 472 276 27093 Injection procedure for hip arthrography; without anesthesia 400 400 400 320 97 388 217 157 238 216 332 387 220 220 155 250 152 212 97 382 384 220 135 254 223 212 217 263 233 208 211 247 209 220 376 218 98 220 388 220 209 218 217 368 366 282 195 27096 "Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid" 273 248 411 218 67 265 148 107 162 147 227 264 148 148 106 171 104 145 67 261 262 150 92 174 152 144 148 180 146 142 144 169 146 150 257 149 67 150 265 150 143 149 148 251 250 192 133 27620 "Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body" 4415 4415 4415 3532 1076 4283 2395 1731 2623 2382 3664 4275 2426 2426 1713 2763 1679 2338 1076 4219 4238 2433 1492 2809 2459 2335 2392 2904 2364 2296 2332 2731 2307 2428 4151 2410 1081 2428 4283 2428 2310 2406 2428 4062 4044 3107 2155 28110 "Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)" 4430 4430 4430 3544 1079 4297 2403 1737 2632 2390 3676 4289 2434 2434 1719 2772 1684 2346 1079 4234 4253 2441 1497 2818 2436 2343 2400 2914 2372 2304 2340 2740 2315 2436 4165 2418 1085 2436 4297 2437 2318 2414 2402 4076 4058 3118 2162 28232 "Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)" 3479 3479 3479 2783 848 3375 1887 1364 2067 1877 2887 3369 1912 1912 1350 2177 1323 1842 848 3325 3340 1917 1176 2213 1938 1840 1885 2288 1863 1809 1837 2152 1818 1913 3271 1899 852 1913 3375 1913 1821 1896 1886 3201 3187 1913 1698 28285 "Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)" 4430 4430 4430 3544 1079 4297 2403 1737 2632 2390 3676 4289 2434 2434 1719 2772 1684 2346 1079 4234 4253 2441 1497 2818 2468 2343 2400 2914 2372 2304 2340 2740 2362 2436 4165 2418 1085 2436 4297 2437 2318 2414 2402 4076 4058 3118 2162 28296 "Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)" 5351 5351 5351 4281 1304 11624 2903 2098 3179 2886 4440 5181 2940 2940 11624 3348 2035 2833 1304 5114 5137 2948 1808 3404 2981 2830 2899 3520 2865 2783 2826 3310 2796 2943 5031 2921 1311 2943 5190 2943 2800 2916 2901 4923 4902 3766 2612 28810 "Amputation, metatarsal, with toe, single" 3235 3235 3235 2588 788 10033 1755 1268 1922 1745 2684 3132 1777 1777 10033 2024 1230 1713 788 3092 3106 1782 1093 2058 1802 1711 1753 2128 1732 1682 1709 2001 1690 1779 3042 1766 792 1779 3138 1779 1693 1763 1754 2976 2963 2277 1579 29125 Application of short arm splint (forearm to hand); static 232 232 232 186 57 225 126 91 138 125 193 225 139 139 90 145 88 123 57 222 223 128 78 148 129 123 126 153 124 121 123 144 121 128 218 127 57 128 225 128 121 126 126 213 213 163 113 29130 Application of finger splint; static 168 168 168 134 30 163 91 66 100 91 139 163 92 92 65 105 64 89 41 161 161 93 57 107 94 89 91 111 90 87 89 104 30 92 158 92 41 92 163 92 88 92 91 155 154 118 82 29515 Application of short leg splint (calf to foot) 188 188 188 150 46 182 102 74 112 101 156 182 103 103 73 118 71 100 46 180 180 104 64 120 105 99 102 124 101 98 99 116 53 103 177 103 46 103 182 103 98 102 102 173 172 132 92 29581 "Application of multi-layer venous wound compression system, below knee" 470 313 470 376 115 456 255 184 279 254 390 455 258 258 182 257 179 249 115 449 451 259 159 299 262 249 255 309 252 244 248 291 251 258 442 257 115 258 456 259 246 256 255 432 431 258 229 29881 "Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)" 6648 6648 6648 5318 1620 6449 3606 2606 3950 3586 5516 6437 3653 3653 5226 4160 2528 3520 1620 6353 6382 3663 2246 4229 3703 3516 3602 4373 3559 3457 3511 4112 3474 3656 6251 3629 1628 3656 6449 3656 3479 3623 3604 6116 6090 4679 3245 30901 "Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method" 318 303 334 254 77 308 173 125 189 172 264 308 175 175 268 199 121 168 77 304 305 175 107 202 177 168 172 209 170 165 168 197 167 175 299 174 78 175 308 175 166 173 172 293 291 307 155 30905 "Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial" 427 303 551 342 104 414 232 167 254 230 354 413 235 235 166 267 162 226 104 408 410 235 144 272 238 226 231 281 229 222 226 264 134 235 401 233 105 235 414 235 223 233 232 393 391 301 208 31500 "Intubation, endotracheal, emergency procedure" 290 276 460 232 71 1815 157 114 172 156 241 281 179 179 1815 181 110 154 71 277 278 160 98 184 162 153 157 191 155 151 153 179 153 160 273 158 71 160 281 160 152 144 160 267 266 204 142 31720 Catheter aspiration (separate procedure); nasotracheal 735 735 735 588 179 713 399 288 437 396 610 712 404 404 285 460 279 389 179 702 706 405 248 468 409 389 398 483 394 382 388 455 404 404 691 401 180 404 713 404 385 401 399 676 673 517 359 32551 "Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed (separate procedure)" 875 875 875 700 213 849 475 343 520 472 726 847 481 481 339 548 333 463 213 836 840 482 296 557 487 463 474 576 468 455 462 541 467 481 823 478 214 481 849 481 458 477 474 805 802 616 427 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)" 278 176 292 222 68 270 151 109 165 150 231 269 153 153 108 174 106 147 68 266 267 153 94 177 155 147 151 183 96 145 147 172 156 153 261 152 68 153 270 153 145 152 153 256 255 196 136 36415 Collection of venous blood by venipuncture 22 21 368 18 3 450 12 19 20 12 17 22 12 12 15 13 17 12 3 20 236 12 19 14 12 12 13 14 12 11 13 11 12 12 450 12 5 12 21 13 11 12 12 20 20 13 16 36416 "Collection of capillary blood specimen (eg, finger, heel, ear stick)" 22 19 23 18 5 21 12 9 13 12 18 21 12 12 17 14 8 12 5 21 21 12 7 14 12 12 12 14 12 11 12 14 10 12 21 12 5 12 21 12 12 12 10 20 20 15 11 36430 "Transfusion, blood or blood components" 864 823 1814 691 211 961 469 339 513 466 717 837 961 961 231 541 329 457 211 826 829 476 292 550 481 457 468 568 839 449 456 534 484 475 812 472 212 475 838 475 452 471 475 795 757 795 422 36569 "Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older" 711 711 711 569 173 690 386 279 422 384 590 688 391 391 276 445 270 376 173 679 683 392 240 452 396 376 385 468 381 370 376 440 372 391 668 388 174 391 690 391 372 387 363 654 651 500 347 36591 Collection of blood specimen from a completely implantable venous access device 103 103 113 82 25 100 56 96 61 56 85 100 57 57 40 64 39 55 25 98 99 57 35 66 57 54 56 68 55 54 54 64 60 57 97 56 25 57 100 57 54 56 53 95 94 72 50 36592 "Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified" 64 60 66 52 16 63 35 25 38 35 54 62 36 36 25 40 25 34 16 62 62 36 22 41 36 34 35 42 35 34 34 40 35 35 61 35 16 35 63 35 34 35 35 59 59 45 31 36600 "Arterial puncture, withdrawal of blood for diagnosis" 75 68 355 60 18 387 41 29 45 35 62 73 40 40 29 47 387 51 18 72 72 41 25 48 42 40 41 49 44 39 40 46 40 41 71 41 18 41 73 41 39 41 41 69 69 39 37 36680 Placement of needle for intraosseous infusion 332 324 340 266 81 322 180 130 197 179 275 321 182 182 129 208 126 176 81 317 319 183 112 211 185 176 180 218 178 173 175 205 187 183 312 181 81 183 322 183 174 168 180 305 304 234 162 37609 "Ligation or biopsy, temporal artery" 4430 4005 4855 3544 1079 4297 2403 1737 2632 2390 3676 4289 2434 2434 1719 2772 1684 2346 1079 4234 4253 2441 1497 2818 2468 2343 2400 2914 2372 2304 2340 2740 2282 2436 4165 2418 1085 2436 4297 2437 2318 2414 2402 4076 4058 3118 2162 38500 "Biopsy or excision of lymph node(s); open, superficial" 2782 2782 3380 2226 678 5792 1509 1091 1653 1501 2308 2694 1529 1529 5792 1741 1058 1473 678 2659 2671 1533 940 1770 1550 1471 1507 1830 1489 1447 1469 1721 1454 1530 2616 1519 681 1530 2699 1530 1456 1516 1447 2559 2548 1958 1358 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)" 3155 3155 3155 2524 769 3060 1711 1237 1874 1702 2618 3055 1734 1734 1224 1974 2264 1670 769 3015 3029 1738 1066 2007 1758 1669 1709 2075 1689 1641 1666 1952 1649 1735 2966 1722 773 1735 3060 1735 1651 1719 1711 2903 2890 2220 1540 43239 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple" 3478 1739 4651 2782 848 3374 1641 1363 2066 1738 2886 3368 1843 1843 2215 2176 1192 1901 848 3324 3339 1738 1175 2213 1937 1839 1990 2288 1862 1809 1837 2151 1822 1913 3270 1899 852 1913 3374 1913 1820 2067 1890 3200 2902 2171 1697 43247 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body" 3155 2607 3155 2524 769 3060 1711 1237 1874 1702 2618 3055 1885 1885 1224 1974 1200 1670 769 3015 3029 1738 1066 2007 1758 1669 1709 2075 1689 1641 1666 1952 1609 1735 2966 1722 773 1735 3060 1735 1651 1719 1434 2903 2890 2220 1540 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)" 3479 3313 3479 2783 848 3375 1887 1364 2067 1877 2887 3369 1912 1912 2385 2177 1323 1842 848 3325 3340 1917 1176 2213 1938 1840 1885 2288 1863 1809 1837 2152 1855 1913 3271 1899 852 1913 3375 1913 1821 1896 1822 3201 3187 1913 1698 44970 "Laparoscopy, surgical, appendectomy" 6374 5780 8198 5099 1553 13270 3458 2499 3787 3438 5289 6172 3828 3828 8663 3988 3647 3375 1553 6091 6119 3512 2154 4055 4372 3371 3453 4192 3337 3314 3366 3943 3331 3506 5993 3480 1561 3506 6183 3506 3335 3474 3006 5864 5839 13270 3111 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)" 3313 1 3947 2650 1 4256 1797 1299 4229 1787 2749 3208 1843 1843 2490 2073 2669 1754 807 3060 3180 1825 1119 2108 1846 1752 1822 2179 1774 1723 1750 2049 1826 1822 3115 1809 811 1822 3214 1822 1734 1822 1609 3962 1 4256 1617 45380 "Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple" 3313 1 3947 2650 1 4382 1797 1299 1968 1787 2749 3208 1625 1625 2278 2073 1290 1754 807 3166 3180 1825 1119 2108 1909 1752 1969 2179 1818 1723 1750 2049 1855 1822 3115 1809 811 1822 3214 1822 1734 1641 1609 3048 1 4382 1617 45381 "Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance" 1 1 1 1 0 1234 1 0 1 1 1 1 1 1 1234 1 0 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 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" 3313 1 4205 2650 1 4536 4536 1299 1968 1859 2749 3208 922 922 2669 2073 2717 838 807 3214 3180 1738 1119 2108 1846 1752 1 2179 2070 1723 1750 2049 1855 1822 3115 1809 811 1822 3214 1822 1734 1868 1822 3048 1730 4068 1617 45385 "Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique" 3479 1 5280 2783 848 5026 1887 1364 2067 1877 2887 3369 2028 2028 2669 2177 2944 1842 848 3325 3340 1917 1176 2213 2064 1840 1885 2288 1609 1809 1837 2152 1880 1913 3271 1899 852 1913 3375 1913 1821 1609 2171 3201 3047 5026 1698 46221 "Hemorrhoidectomy, internal, by rubber band ligation(s)" 3759 3759 3759 3007 916 3646 2039 1474 2233 2028 3119 3640 2065 2065 1458 2352 1429 1990 916 3592 3609 2071 1270 2391 2094 1988 2036 2472 2013 1955 1985 2325 1964 2067 3534 2052 921 2067 3646 2067 1967 2049 2067 3458 3443 2645 1835 46250 "Hemorrhoidectomy, external, 2 or more columns/groups" 4005 4005 4005 3204 976 3885 2173 1570 2379 2160 3323 3878 2201 2201 1554 2506 1523 2121 976 3827 3845 2207 1353 2548 2231 2118 2170 2634 2144 2083 2115 2477 2043 2203 3766 2186 981 2203 3885 2203 2096 2183 2171 3685 3669 2819 1955 46260 "Hemorrhoidectomy, internal and external, 2 or more columns/groups;" 4210 4005 4415 3368 1026 7902 2284 1650 2501 2271 3493 4076 2313 2313 4601 2634 1601 2229 1026 4023 4042 2320 1423 2678 2345 2226 2281 2769 2254 2189 2224 2604 2200 2316 3958 2298 1031 2316 4084 2316 2203 2294 2283 3873 3856 7902 2055 46270 Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous 3882 3759 4005 3106 946 3766 2106 1522 2306 2094 3221 3759 2133 2133 1506 2429 1476 2055 946 3710 3727 2139 1312 2470 2163 2053 2103 2553 2070 2019 2050 2401 2135 2135 3650 2119 951 2135 3766 2135 2031 2116 2105 3571 3556 2732 1895 46320 "Excision of thrombosed hemorrhoid, external" 3853 3759 3947 3082 939 3926 2090 1510 2289 2078 3197 3731 2117 2117 3926 2411 1465 2040 939 3682 3699 2123 1302 2451 2146 2038 2087 2534 2063 2004 2035 2383 2013 2119 3623 2103 944 2119 3737 2119 2016 2100 2089 3545 3529 2067 1880 46606 "Anoscopy; with biopsy, single or multiple" 2921 2921 2921 2337 712 2833 1585 1145 1735 1576 2424 2828 1605 1605 1133 1828 1111 1547 712 2792 2804 1609 987 1858 1627 1545 1582 1921 1564 1519 1543 1807 1607 1607 2746 1595 715 1607 2833 1607 1529 1592 1584 2687 2676 2056 1426 46614 "Anoscopy; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)" 3068 3068 3068 2454 748 2976 1664 1203 1823 1655 2546 2971 1686 1686 2425 1920 1167 1624 748 2932 2945 1690 1037 1952 1709 1623 1662 2018 1643 1595 1620 1898 1603 1687 2885 1675 751 1687 2976 1687 1605 1672 1663 2823 2810 2159 1497 47562 "Laparoscopy, surgical; cholecystectomy" 11116 9281 12273 8893 2709 12838 6030 4357 6604 5996 9224 10763 6676 6676 9523 6956 4227 5886 2709 10623 10671 6125 3756 7072 6192 5879 6022 7311 4733 5780 5444 6876 6286 6114 10451 6068 2723 6114 10783 6114 5817 5627 6027 10227 10183 12838 5425 49255 "Omentectomy, epiploectomy, resection of omentum (separate procedure)" 7433 7433 7433 5946 1811 7945 4032 2914 4416 4009 6168 7197 4084 4084 7945 4651 2826 3936 1811 7104 7136 4096 2512 4729 4141 3931 4027 4889 3980 3865 3926 4598 3884 4088 6989 4058 1821 4088 7210 4088 3890 4051 4030 6838 6809 5231 3628 49322 "Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)" 1 1 1 1 0 1 1 0 1 1 1 1 1 1 0 1 0 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 49406 HC IMAGE CATH FLUID COLL PERI/RETRO 1464 1464 1464 1171 357 1542 794 574 870 790 1215 1418 804 804 1542 916 557 775 357 1399 1405 807 495 931 816 774 793 963 784 761 773 906 765 805 1376 799 359 805 1420 805 766 798 794 1347 1341 1030 715 49505 "Repair initial inguinal hernia, age 5 years or older; reducible" 5213 4883 5543 4170 1270 7386 2828 2044 3097 2812 4326 5047 2864 2864 2023 3262 7386 2760 1270 4982 5004 2872 1761 3317 2904 2757 2824 3429 2791 2711 2753 3225 3049 2867 4901 2846 1277 2867 5057 2867 2728 2841 2826 4796 4775 3669 2544 49521 "Repair recurrent inguinal hernia, any age; incarcerated or strangulated" 5989 5989 5989 4791 1459 5809 3249 2348 3558 3231 4970 5799 3291 3291 2324 3748 2277 3171 1459 5724 5749 3300 2024 3810 3336 3167 3245 3939 3207 3114 3163 3705 3036 3294 5631 3270 1467 3294 5809 3294 3134 3264 3247 5510 5486 4215 2923 49560 Repair initial incisional or ventral hernia; reducible 6130 6130 6130 4904 1494 5946 3325 2403 3642 3307 5087 5935 3368 3368 2378 3836 2331 3246 1494 5858 5885 3378 2071 3900 3415 3242 3321 4032 3282 3188 3238 3792 3372 3372 5764 3347 1501 3372 5946 3372 3208 3341 3324 5640 5615 4314 2992 49561 Repair initial incisional or ventral hernia; incarcerated or strangulated 4131 3611 4651 3305 1007 8938 2241 1619 2454 2228 3428 4000 2270 2270 8938 2585 1571 2187 1007 3948 3966 2276 1396 2628 2301 2185 2238 2717 2212 2148 2182 2555 2558 2272 3884 2255 1012 2272 4007 2272 2162 2251 2240 3801 3784 2907 2016 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) 3611 3611 3611 2889 880 4469 1959 1416 2145 1948 2996 3496 1984 1984 4469 2260 1373 1912 880 3451 3467 1990 1220 2297 2012 1910 1956 2375 1933 1878 1907 2234 1887 1986 3395 1971 884 1986 3503 1986 1890 1968 1958 3322 3308 2541 1762 49585 "Repair umbilical hernia, age 5 years or older; reducible" 4430 4430 4430 3544 1079 6149 2403 1737 2632 2390 3676 4289 2434 2434 6149 2772 1684 2346 1079 4234 4253 2441 1497 2818 2468 2343 2400 2914 2372 2304 2340 2740 2315 2436 4165 2418 1085 2436 4297 2437 2318 2414 2402 4076 4058 3118 2162 49587 "Repair umbilical hernia, age 5 years or older; incarcerated or strangulated" 4430 4430 4430 3544 1079 4297 2403 1737 2632 2390 3676 4289 2434 2434 1719 2772 1684 2346 1079 4234 4253 2441 1497 2818 2468 2343 2400 2914 2372 2304 2340 2740 2362 2436 4165 2418 1085 2436 4297 2437 2318 2414 2402 4076 4058 3118 2162 49650 "Laparoscopy, surgical; repair initial inguinal hernia" 11846 10587 13296 9476 2886 17514 6426 4643 7037 6390 9829 11469 6509 6509 9523 7412 4504 6272 2886 11320 11372 6527 4003 7536 6599 6265 6417 7791 6342 6160 6256 7328 5794 6515 11137 6467 2901 6515 11490 6515 6199 6079 6422 10898 10851 17514 5781 49651 "Laparoscopy, surgical; repair recurrent inguinal hernia" 13116 13116 13116 10493 3196 12723 7115 5142 7792 7075 10883 12700 7207 7207 5089 8207 4987 6945 3196 12535 12591 7227 4432 8344 7935 6937 7106 8627 7022 6820 6927 8114 6853 7214 12332 7160 3212 7214 12723 7214 6863 7148 7111 12067 12015 9231 6401 49653 "Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated" 12580 12273 14655 10064 3065 12202 6824 4931 7473 6786 10438 12180 6912 6912 9231 7871 4783 7808 3065 12022 12076 6931 4251 8003 7008 6653 6815 8274 6760 6541 6644 7782 6573 6919 11827 6867 3081 6919 12202 6919 6583 6856 6820 11573 11523 8853 6139 51700 "Bladder irrigation, simple, lavage and/or instillation" 448 448 448 358 109 435 243 176 266 242 372 434 246 246 174 280 170 237 109 428 430 247 151 285 250 237 243 295 240 233 237 277 228 246 421 245 110 246 435 246 234 244 243 412 410 315 219 51701 "Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)" 232 221 244 186 57 225 126 91 138 130 193 225 143 143 90 145 88 123 57 222 223 128 78 148 129 123 126 153 124 121 123 144 128 128 218 127 57 128 225 128 121 128 128 213 213 128 113 51702 "Insertion of temporary indwelling bladder catheter; simple (eg, Foley)" 232 221 244 186 57 231 130 91 138 115 193 231 125 125 90 145 88 127 57 222 223 128 78 148 129 123 134 153 128 121 123 144 128 128 218 127 57 128 225 128 121 104 128 213 213 128 63 51798 "Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging" 69 66 72 55 17 70 37 27 41 34 57 70 37 37 27 43 26 37 17 66 66 38 23 44 38 36 40 45 38 36 36 43 38 38 65 38 17 38 67 38 36 31 38 63 63 66 34 55250 "Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)" 1 1 1 1 0 1 1 0 1 1 1 1 1 1 0 1 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 56420 Incision and drainage of Bartholin's gland abscess 3068 3068 3068 2454 748 2976 1664 1203 1823 1655 2546 2971 1686 1686 1190 1920 1167 1624 748 2932 2945 1690 1037 1952 1709 1623 1662 2018 1643 1595 1620 1898 1603 1687 2885 1675 751 1687 2976 1687 1605 1672 1663 2823 2810 1687 1497 58120 "Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)" 2921 2607 3081 2337 712 2833 1585 1145 1735 1576 2424 2828 1605 1605 1133 1828 1111 1547 712 2792 2804 1609 987 1858 1627 1545 1582 1921 1564 1519 1543 1807 1544 1607 2746 1595 715 1607 2833 1607 1529 1602 1434 2687 2676 2056 1426 58301 Removal of intrauterine device (IUD) 474 474 474 379 116 460 257 186 282 256 393 459 283 283 184 297 180 251 116 453 455 261 160 302 264 251 257 312 254 246 250 293 248 261 446 259 116 261 460 261 248 258 257 436 434 334 231 58573 "Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)" 17311 17311 17311 13849 4218 16792 9391 6786 10284 9338 14364 16761 10342 10342 6716 10832 6582 9166 4218 16544 16618 9538 5849 11013 9643 9155 9378 11386 9268 9002 9143 10709 9046 9521 16276 9450 4240 9521 16792 9521 9059 9434 9386 15926 15857 12183 8449 58661 "Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)" 11116 11116 11116 8893 2709 10783 6030 4357 6604 5996 9224 10763 6108 6108 7407 6956 4227 5886 2709 10623 10671 6125 3756 7072 6192 5879 6022 7311 5951 5780 5871 6876 5808 6114 10451 6068 2723 6114 10783 6114 5817 6058 6027 10227 10183 7823 5425 62321 PR INJ INTERLAM C/T W IMG 1852 592 2042 1482 451 1796 1005 726 1100 999 1537 1793 1018 1018 1487 1159 704 981 451 1770 1778 1020 626 1178 1032 979 1003 1218 992 963 978 1146 550 1019 1741 1011 454 1019 1796 1019 969 1009 1004 1704 1696 1070 904 62323 Injection of substance into spinal canal of lower back or sacrum using imaging guidance 1945 582 2314 1556 474 1887 1055 762 1156 1049 1614 1883 1069 1069 1274 1217 1617 1030 474 1859 1867 1072 657 1237 1083 1029 1054 1279 1187 1011 1027 1203 546 1070 1829 1062 476 1070 1887 1070 1018 1123 1070 1789 1782 1456 949 64400 "Injection, anesthetic agent; trigeminal nerve, any division or branch" 581 581 581 465 142 564 315 228 345 313 482 563 347 347 225 364 221 308 142 555 558 320 196 370 324 307 315 382 311 302 307 359 304 320 546 317 142 320 564 320 304 317 315 535 532 409 284 64451 PR INJ ANESTH/STER SI JOINT NRV NRVTG 5087 970 5087 4070 1240 4934 2760 1994 3022 2744 4221 4925 2795 2795 1974 3183 1934 2693 1240 4862 4883 2803 1719 3236 2834 2690 2756 3346 2724 2645 2687 3147 2712 2798 4783 2777 1246 2798 4934 2798 2662 2772 2758 4680 4660 3580 2483 64454 PR NJX AA&/STRD GNCLR NRV BRNCH 435 192 870 348 106 422 236 171 258 235 361 421 239 239 169 272 165 230 106 416 418 240 147 277 242 230 236 286 233 226 230 269 193 239 409 237 107 239 422 239 228 237 239 400 398 306 212 64483 "Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level" 1891 351 1986 1513 461 1886 1026 741 1123 1020 1569 1831 1039 1039 1886 1183 1886 1001 461 1807 1815 1042 639 1203 1053 1000 1024 1244 1012 983 999 1170 578 1040 1778 1032 463 1040 1834 1040 990 1031 1066 1740 1732 1331 923 64488 PR TAP BLOCK BILAT BY INJ 986 420 1035 789 240 1274 535 387 586 532 818 955 295 295 1274 617 375 522 240 942 947 543 333 627 626 521 534 649 503 513 521 610 515 542 927 538 241 542 956 542 516 537 535 907 903 694 481 64490 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level" 1846 316 2702 1477 450 1791 1001 724 1097 996 1532 1787 1014 1014 716 1155 702 977 450 1764 1772 1017 624 1174 1028 976 1000 1214 988 960 975 1142 837 1015 1736 1008 452 1015 1791 1015 966 1378 1066 1698 1691 1299 901 64491 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)" 688 179 758 550 168 667 373 270 409 371 571 666 378 378 267 431 262 364 168 658 660 379 232 438 383 364 373 453 368 358 363 426 320 378 647 376 169 378 667 378 360 375 407 633 630 484 336 64493 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level" 2744 298 4117 2195 669 3465 1489 1076 1630 1480 2277 2657 1281 1281 2571 1717 3465 1453 669 2622 2634 1512 927 1746 1529 1451 1487 1805 1469 1427 1449 1697 811 1509 2580 1498 672 1509 2662 1509 1436 2264 1652 2524 2514 2264 1339 64494 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)" 169 1 338 135 1 1733 92 66 100 91 140 164 1 1 1286 106 1733 89 41 162 162 93 57 108 94 89 92 111 90 88 89 105 81 93 159 92 41 93 164 93 88 92 92 155 155 119 82 64495 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)" 153 1 1032 122 37 916 83 60 91 83 127 148 84 84 916 96 58 81 37 146 147 84 52 97 85 81 83 101 82 80 81 95 78 84 144 84 37 84 148 84 80 83 83 141 140 108 75 64510 "Injection, anesthetic agent; stellate ganglion (cervical sympathetic)" 1815 1815 1815 1452 442 2310 985 711 1078 979 1506 1757 997 997 2310 1136 690 961 442 1735 1742 1000 613 1155 1011 960 983 1194 972 944 959 1123 948 998 1706 991 445 998 1761 998 950 989 984 1670 1663 1277 886 64625 PR RF ABLTJ NRV NRVTG SI JT 716 425 1034 572 174 694 388 280 425 386 594 693 393 393 278 448 272 379 174 684 687 394 242 455 399 378 388 471 383 372 378 443 374 394 673 391 175 394 694 394 374 390 388 658 655 504 349 64633 PBB DESTROY CERV/THOR FACET JNT 2234 1314 3155 1788 481 2167 1212 876 1328 1205 1854 2164 1228 1228 867 1398 850 1183 544 2135 2145 1231 755 1422 1245 1182 1211 1470 1196 1162 1180 1382 481 1229 2101 1220 547 1229 2167 1229 1169 1218 1212 2056 2047 1573 1091 64634 PBB DESTROY C/TH FACET JNT ADDL 890 623 1157 712 208 863 483 349 529 480 739 862 489 489 345 557 338 471 217 851 854 490 301 566 496 471 482 585 477 463 470 551 208 490 837 486 218 490 863 490 466 485 483 819 815 626 434 64635 PBB DESTROY LUMB/SAC FACET JNT 1384 1284 1985 1107 337 1886 751 543 822 747 1148 1340 1527 1527 1714 866 1886 733 337 1323 1329 763 468 880 771 732 750 910 741 720 731 856 704 761 1301 756 339 761 1342 761 724 799 750 1273 1268 974 675 64636 PBB DESTROY L/S FACET JNT ADDL 632 1 1348 506 154 943 343 248 375 341 524 612 590 590 857 395 943 335 154 604 607 348 214 402 352 334 342 416 338 329 334 391 651 348 594 345 155 348 613 348 331 348 343 581 579 445 308 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 3853 3759 4205 3082 939 3737 2090 1510 2289 2078 3197 3731 2117 2117 3156 2411 1465 2040 939 3682 3699 2123 1302 2451 2146 2038 2087 2534 2316 2004 2035 2383 2105 2119 3623 2103 944 2119 3737 2119 2016 2100 2089 3545 3529 2067 1880 65220 "Removal of foreign body, external eye; corneal, without slit lamp" 331 331 331 265 81 321 180 130 197 179 275 320 184 184 128 207 126 175 81 316 318 182 112 211 184 175 179 218 177 172 175 205 173 182 311 181 81 182 321 182 173 182 179 305 303 233 162 65222 "Removal of foreign body, external eye; corneal, with slit lamp" 255 255 255 204 62 247 138 100 151 138 212 247 142 142 99 160 97 135 62 244 245 141 86 162 142 135 138 168 137 133 135 158 133 140 240 139 62 140 247 140 133 139 138 235 234 179 124 66850 "Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration" 3479 3479 3479 2783 848 3375 1887 1364 2067 1877 2887 3369 1912 1912 1350 2177 1323 1842 848 3325 3340 1917 1176 2213 1938 1840 1885 2288 1863 1809 1837 2152 1855 1913 3271 1899 852 1913 3375 1913 1821 1896 1886 3201 3187 2448 1698 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" 3853 3479 6435 3082 939 3737 2090 1510 2289 2078 3197 3731 2117 2117 1495 2411 1465 2040 939 3682 3699 2123 1302 2451 2146 2038 2087 2534 2063 2004 2035 2383 2105 2119 3623 2103 944 2119 3737 2119 2016 2100 2067 3545 3529 2712 1880 66984 "Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)" 3479 3155 4205 2783 848 4065 1887 1364 2067 1877 2887 3369 2091 2091 4065 2177 1323 1842 848 3325 3340 1917 1176 2213 1819 1819 1885 2288 1863 1809 1837 2152 1855 1913 3271 1899 852 1913 3375 1913 1821 2067 2067 3201 3187 1913 1698 66991 "Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) with insertion of IOL anterior segment" 3479 3313 3759 2783 848 14707 1887 1364 2067 1877 2887 3369 1912 1912 14707 2177 1323 1842 848 3325 3340 1917 1176 2213 1938 1840 1885 2288 1863 1809 1837 2152 1818 1913 3271 1899 852 1913 3375 1913 1821 1913 1990 3201 3187 1913 1698 67904 "Repair of blepharoptosis; (tarso) levator resection or advancement, external approach" 4388 4388 4388 3510 1069 4256 2380 1720 2607 2367 3641 4249 2411 2411 1702 2746 1669 2323 1069 4194 4212 2418 1483 2792 2444 2321 2377 2886 2349 2282 2318 2714 2293 2413 4126 2396 1075 2413 4256 2413 2296 2391 2379 4037 4020 2413 2142 67917 "Repair of ectropion; extensive (eg, tarsal strip operations)" 3380 3380 3380 2704 824 3279 1834 1325 2008 1823 2805 3273 1857 1857 1311 2115 1285 1790 824 3230 3245 1862 1142 2150 1883 1788 1831 2223 1810 1758 1785 2091 1766 1859 3178 1845 828 1859 3279 1859 1769 1842 1758 3110 3096 2379 1650 69209 HC REMOVE IMPACTED EAR WAX UNI 33 33 33 26 8 32 18 13 20 18 27 32 18 18 13 21 13 17 8 32 32 18 11 21 18 17 18 22 18 17 17 20 17 18 31 18 8 18 32 18 17 18 18 30 30 23 16 70030 "Radiologic examination, eye, for detection of foreign body" 237 226 249 190 58 230 129 93 141 118 197 229 116 116 65 148 90 125 58 230 228 131 80 151 132 125 128 156 131 123 125 147 132 130 223 129 58 130 230 130 124 129 128 218 208 130 116 70140 "Radiologic examination, facial bones; less than 3 views" 182 182 182 146 44 177 99 71 108 98 151 176 100 100 71 114 69 96 44 174 175 100 61 116 101 96 99 120 97 95 96 113 93 100 171 99 45 100 177 100 95 99 99 167 167 128 89 70150 "Radiologic examination, facial bones; complete, minimum of 3 views" 415 405 425 332 101 403 225 163 247 224 344 402 209 209 161 260 158 221 101 397 398 229 140 264 231 219 225 273 222 216 219 257 217 228 390 227 102 228 403 228 217 226 225 382 391 292 203 70160 "Radiologic examination, nasal bones, complete, minimum of 3 views" 240 240 240 192 58 233 130 94 143 129 199 232 132 132 93 150 91 127 58 229 230 132 81 153 134 127 130 158 128 125 127 148 125 132 226 131 59 132 233 132 126 131 130 221 220 221 117 70220 "Radiologic examination, sinuses, paranasal, complete, minimum of 3 views" 318 318 318 254 65 308 173 125 189 172 264 308 175 175 65 199 121 168 77 304 305 175 107 202 177 168 172 209 170 165 168 197 166 175 299 174 78 175 308 175 166 173 172 293 291 224 155 70250 "Radiologic examination, skull; less than 4 views" 303 303 318 242 74 294 164 119 180 163 251 293 166 166 118 190 115 174 74 290 291 167 102 193 169 160 164 199 162 158 160 187 155 167 285 165 74 167 294 167 159 165 164 279 278 213 148 70360 "Radiologic examination; neck, soft tissue" 222 211 233 178 54 215 120 87 132 120 184 215 120 120 86 139 84 118 54 212 213 122 75 141 124 117 120 146 61 115 117 137 122 122 209 121 54 122 215 122 116 121 110 204 204 194 108 70450 "Computed tomography, head or brain; without contrast material" 1904 1813 2009 1523 464 1939 1068 746 1131 1068 1580 1939 1059 1059 1006 1191 999 1008 464 1759 1828 1049 643 1211 1061 1007 550 1252 1049 990 943 1178 1047 1047 1759 1039 466 1047 1847 1047 996 1073 1047 1752 1839 1099 929 70480 "Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material" 1594 1594 1594 1275 388 1546 865 625 947 860 1323 1543 952 952 618 997 606 844 388 1523 1530 878 539 1014 888 843 864 1048 853 829 842 986 833 877 1499 870 390 877 1546 877 834 869 864 1466 1460 1122 778 70481 "Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)" 2158 1912 2158 1726 526 2093 1171 846 1282 1164 1791 2089 1186 1186 837 1350 821 1143 526 2062 2072 1189 729 1373 1202 1141 1169 1419 1155 1122 1140 1335 1151 1187 2029 1178 529 1187 2093 1187 1129 1176 1170 1985 1977 1519 1053 70486 "Computed tomography, maxillofacial area; without contrast material" 1876 1787 1970 1501 229 1911 1786 735 1115 1012 1557 1816 1043 1043 229 1174 264 1024 457 1820 1801 1034 634 1194 1045 992 1016 1234 1103 976 991 1160 1032 1032 1911 1024 459 1032 1820 1032 982 1084 1058 1726 1644 1032 916 70487 "Computed tomography, maxillofacial area; with contrast material(s)" 2258 2150 2371 1806 550 2190 1225 885 1341 1218 1874 2186 1392 1392 993 1413 1006 1196 550 2158 2168 1244 763 1437 1258 1194 1223 1485 1209 1174 1193 1397 1145 1242 2123 1233 553 1242 2190 1242 1182 1231 1224 2077 2068 1589 1102 70490 "Computed tomography, soft tissue neck; without contrast material" 1909 1909 1909 1527 465 1852 1036 748 1134 1030 1584 1848 1049 1049 741 1195 726 1011 465 1824 1833 1052 645 1215 1063 1010 1034 1256 1022 993 1008 1181 1012 1050 1795 1042 468 1050 1852 1050 999 1040 1035 1756 1749 1343 932 70491 "Computed tomography, soft tissue neck; with contrast material(s)" 2471 2353 2595 1977 196 2517 1340 969 1468 1333 2050 2393 1212 1212 999 1546 196 1308 602 2361 2372 1362 835 1572 1377 1307 1339 1625 600 1285 1305 1529 1371 1359 2517 1349 605 1359 2397 1359 1293 1200 1224 2273 2165 1427 1206 70492 "Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections" 2029 2029 2029 1623 494 1968 1101 795 1205 1094 1684 1965 1115 1115 787 1270 772 1074 494 1939 1948 1118 686 1291 1130 1073 1099 1335 1086 1055 1072 1255 1028 1116 1908 1108 497 1116 1968 1116 1062 1106 1100 1867 1859 1428 990 70496 "Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2431 2315 2553 1945 591 2358 1319 953 1444 1311 2017 2354 1336 1336 591 1521 924 1287 592 2323 2334 1339 821 1547 1354 1286 1317 1599 1302 1264 1284 1504 1361 1337 2286 1327 595 1337 2358 1337 1272 1337 1204 2237 2227 2237 1186 70498 "Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2664 2537 2797 2131 178 2584 1445 1044 1583 1437 2211 2579 1464 1464 178 1667 1013 1411 649 2546 2557 1468 900 1695 1484 1409 1443 1752 1426 1385 1407 1648 1478 1465 2505 1454 652 1465 2584 1465 1394 1465 1319 2451 2440 1538 1300 70543 "Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences" 4327 4327 4327 3462 1054 4197 2347 1696 2571 2334 3590 4190 2377 2377 1232 2708 1645 2291 1054 4135 4154 2384 1462 2753 2410 2288 2344 2846 2317 2250 2285 2677 2261 2380 4068 2362 1060 2380 4197 2380 2264 2358 2346 3981 3964 3045 2112 70544 "Magnetic resonance angiography, head; without contrast material(s)" 2996 2853 2996 2397 730 2906 1625 1174 1780 1616 2486 2901 1646 1646 734 1875 1139 1586 730 2863 2876 1651 1012 1906 1669 1584 1623 1971 1604 1558 1582 1853 1597 1648 2817 1636 734 1648 2906 1648 1568 1633 1624 2756 2744 2108 1462 70549 "Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences" 4822 4704 4939 3857 1175 4677 2616 1890 2864 2601 4001 4668 2649 2649 1871 3017 1833 2553 1175 4608 4629 2657 1629 3067 2686 2550 2612 3171 2581 2507 2547 2983 2610 2652 4533 2632 1181 2652 4677 2652 2523 2628 2614 4436 4417 3393 2353 70551 "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" 3339 3029 3339 2671 814 3239 1811 1309 1984 1801 2771 3233 1960 1960 889 2089 937 1608 814 3191 3205 1840 1128 2124 1860 1766 1809 2196 1941 1736 1514 2065 1780 1836 3139 1823 818 1836 3239 1836 1747 1545 1749 3072 3059 1836 1630 70552 "Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)" 3625 3625 3625 2900 883 3516 1966 1421 2154 1955 3008 3510 1992 1992 1406 2268 1378 1919 883 3464 3480 1997 1225 2306 2019 1917 1964 2384 1941 1885 1915 2242 1894 1994 3408 1979 888 1994 3516 1994 1897 1976 1965 3335 3321 1994 1769 70553 "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences" 5331 5077 5598 4265 1232 5430 2892 2090 3167 2991 4424 5430 3047 3047 1232 3336 1294 2910 1299 5095 5118 2937 1801 3392 2970 2819 2888 3506 2936 2772 2816 3298 2842 2932 5012 2910 1306 2932 5171 2932 2790 2932 2761 4905 4883 2932 2602 71045 PR X-RAY EXAM CHEST 1 VIEW 267 254 560 214 65 259 150 105 159 141 222 259 142 142 73 167 102 146 65 246 256 147 90 170 149 141 145 176 147 139 147 165 147 147 251 146 65 147 259 147 140 147 147 246 258 147 130 71046 PR X-RAY EXAM CHEST 2 VIEWS 292 278 307 234 37 5174 158 37 173 145 242 291 162 162 65 183 65 163 71 283 280 161 99 186 161 161 153 192 161 152 166 181 161 161 5174 159 68 161 283 161 145 161 161 269 256 169 143 71100 "Radiologic examination, ribs, unilateral; 2 views" 293 279 308 234 65 284 159 115 174 158 243 284 134 134 65 183 111 155 71 280 281 161 99 186 160 155 159 193 161 152 155 181 164 161 275 160 72 161 284 161 153 161 169 270 268 226 143 71101 "Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views" 368 350 386 294 65 357 200 144 219 182 305 356 227 227 65 230 65 195 90 352 353 203 124 234 205 195 199 242 97 191 194 228 202 202 340 201 90 202 357 202 193 201 207 339 322 275 180 71110 "Radiologic examination, ribs, bilateral; 3 views" 399 399 399 319 97 387 216 156 237 215 331 386 219 219 155 250 152 211 97 381 383 220 135 254 222 211 216 262 214 207 211 247 213 219 375 218 98 219 387 219 209 217 216 367 365 281 195 71111 "Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views" 428 408 449 342 81 415 232 168 254 231 355 414 238 238 81 268 163 227 104 409 411 236 145 272 238 226 232 282 229 223 226 265 226 235 402 234 105 235 415 235 224 233 208 394 392 241 209 71120 "Radiologic examination; sternum, minimum of 2 views" 235 235 247 188 57 228 127 92 140 127 195 228 129 129 68 147 65 124 57 225 226 129 79 150 131 124 129 155 126 122 124 145 123 129 221 128 58 129 228 129 123 128 127 216 215 165 115 71130 "Radiologic examination; sternoclavicular joint or joints, minimum of 3 views" 256 256 256 205 62 248 139 100 152 138 212 248 141 141 99 160 68 136 62 245 246 141 87 163 143 135 139 168 137 133 135 158 134 141 241 140 63 141 248 141 134 140 139 236 235 180 125 71250 "Computed tomography, thorax; without contrast material" 1796 1710 1886 1437 424 1742 974 534 1067 1710 1490 1739 999 999 424 1124 457 951 438 1716 1724 990 607 1143 1000 986 940 1181 872 934 949 1111 988 988 1689 980 440 988 1742 988 940 988 988 1652 1573 988 877 71260 "Computed tomography, thorax; with contrast material(s)" 1763 1679 2286 1410 430 1710 606 691 1047 951 1463 1707 1087 1087 948 1103 993 933 430 1685 1692 971 596 1122 962 962 629 1160 967 917 931 1091 970 970 1658 962 432 970 1710 970 923 856 970 1622 1545 1257 860 71270 "Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections" 2073 2073 2073 1658 505 2011 1125 813 1232 1118 1720 2007 1139 1139 804 1297 788 1098 505 1981 1990 1142 700 1319 1155 1096 1123 1364 1110 1078 1095 1282 1051 1140 1949 1132 508 1140 2011 1140 1085 1130 1124 1907 1899 1459 1012 71271 HC CT THORAX LUNG CANCER SCREEN 550 300 550 440 134 534 298 216 327 297 456 533 161 161 424 344 424 291 134 526 528 303 186 350 306 291 298 362 294 286 290 340 165 302 517 300 135 302 534 303 288 300 302 506 504 404 268 71275 "Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2430 2314 2552 1944 592 2357 1318 953 1444 1203 2016 2353 1352 1352 749 1521 749 1287 592 2245 2333 1339 821 1546 1400 1285 1316 1598 1338 1264 1283 1503 1336 1336 2285 1327 595 1336 2357 1337 1272 1273 1336 2236 2348 2236 1186 71550 "Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)" 3077 3077 3077 2462 750 2985 1669 1206 1828 1660 2553 2979 1691 1691 1194 1925 1170 1629 750 2941 2954 1695 1040 1958 1714 1627 1667 2024 1647 1600 1625 1903 1641 1692 2893 1680 754 1692 2985 1692 1610 1677 1668 2831 2819 2166 1502 72020 "Radiologic examination, spine, single view, specify level" 233 222 245 186 57 226 126 91 138 126 193 226 99 99 90 146 89 127 57 223 224 128 79 148 130 123 126 153 125 121 123 144 131 128 219 127 57 128 226 128 122 127 126 214 213 164 114 72040 "Radiologic examination, spine, cervical; 2 or 3 views" 303 289 318 242 65 642 164 119 180 163 251 308 169 169 69 190 65 174 74 290 291 167 102 193 169 160 164 199 139 158 160 187 167 167 642 165 74 167 294 167 159 147 175 279 278 171 148 72050 "Radiologic examination, spine, cervical; minimum of 4 views" 353 353 371 282 86 342 191 138 210 190 293 342 218 218 137 221 134 187 86 337 339 195 119 225 197 187 191 232 189 184 186 218 194 194 332 193 86 194 342 194 185 192 191 325 323 325 172 72070 "Radiologic examination, spine; thoracic, 2 views" 319 311 327 255 78 309 173 125 190 172 265 309 173 173 124 200 121 169 78 305 306 176 108 203 178 169 173 210 190 166 168 197 167 175 300 174 78 175 309 175 167 174 173 293 292 225 156 72072 "Radiologic examination, spine; thoracic, 3 views" 328 312 344 262 30 648 184 129 195 162 272 318 182 182 30 205 67 174 80 313 315 181 111 209 183 173 178 216 100 171 173 203 172 180 648 179 80 180 318 180 172 162 189 302 300 302 160 72100 "Radiologic examination, spine, lumbosacral; 2 or 3 views" 309 294 324 247 66 631 168 121 66 163 256 314 172 172 73 193 73 156 75 300 297 170 104 197 170 163 167 203 188 161 147 191 170 170 631 169 76 170 300 170 162 170 170 284 270 178 151 72110 "Radiologic examination, spine, lumbosacral; minimum of 4 views" 438 428 449 351 107 425 238 172 261 237 364 425 241 241 170 274 167 232 107 419 421 242 148 279 244 232 238 288 235 228 232 271 238 241 412 239 107 241 425 241 229 239 238 403 402 309 214 72125 "Computed tomography, cervical spine; without contrast material" 2186 2009 2295 1749 212 2120 1226 857 2033 1226 1814 2117 1216 1216 212 1368 229 1157 533 2089 2099 1204 739 1391 1218 1156 631 1438 1204 1137 1155 1352 1202 1202 2120 1193 535 1202 2120 1202 1144 1232 1174 2011 1915 1262 1067 72128 "Computed tomography, thoracic spine; without contrast material" 2078 1979 2182 1662 229 2016 1127 815 1235 1121 1724 2012 867 867 326 1300 229 1100 506 1986 1995 1145 702 1322 1158 1099 1126 1367 1140 1081 1098 1285 1143 1143 1954 1134 509 1143 2016 1143 1087 1133 1009 1912 1904 1462 1014 72131 "Computed tomography, lumbar spine; without contrast material" 2078 1979 2182 1662 229 2016 1127 815 1235 1121 1724 2012 826 826 318 1300 229 1100 506 1986 1995 1145 702 1322 1158 1099 1143 1367 634 1081 1098 1285 1143 1143 1954 1134 509 1143 2016 1143 1087 1009 1143 1912 1904 1556 1014 72141 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material" 2734 2317 2871 2187 666 2652 1483 1072 1624 1475 2269 2647 1603 1603 888 1711 1082 1448 666 2613 2625 1506 924 1739 1432 1446 1432 1798 1506 1422 1444 1691 1504 1504 2571 1493 670 1504 2652 1504 1431 1504 1504 2515 2504 1579 1334 72142 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)" 2825 2825 2825 2260 688 2740 1532 1107 1678 1524 2344 2735 1552 1552 1096 1768 1074 1496 688 2700 2712 1557 955 1797 1574 1494 1554 1858 1513 1469 1492 1748 1476 1554 2656 1542 692 1554 2740 1554 1478 1540 1532 2599 2588 1988 1379 72146 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material" 2802 2604 2871 2242 683 3710 1520 1099 1665 1512 2325 2714 3710 3710 891 1754 1082 1484 683 2678 2690 1544 947 1783 1561 1482 1518 1843 1500 1457 1480 1734 1386 1541 2635 1530 686 1541 2718 1541 1467 1527 1519 2578 2567 1972 1368 72147 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)" 3271 3271 3271 2617 797 4344 1774 1282 1943 1764 2714 3167 4344 4344 1269 2047 1244 1732 797 3126 3140 1802 1105 2081 1822 1730 1772 2151 1751 1701 1728 2023 1709 1799 3075 1786 801 1799 3173 1799 1712 1783 1773 3009 2996 2302 1596 72148 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material" 2802 2669 2942 2242 683 2718 1520 1098 1665 1511 2325 2713 1727 1727 888 1753 889 1417 683 2678 2690 1544 947 1783 1561 1482 1518 1843 1627 1457 1480 1733 1541 1541 2718 1530 686 1541 2718 1541 1466 1618 1541 2578 2567 1618 1368 72149 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)" 3342 3342 3342 2674 814 3242 1813 1310 1985 1803 2773 3236 1836 1836 1297 2091 1271 1770 814 3194 3208 1841 1129 2126 1862 1767 1811 2198 1789 1738 1765 2067 1782 1838 3142 1824 819 1838 3242 1838 1749 1821 1812 3075 3061 2352 1631 72156 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical" 3738 3390 3738 2990 582 3626 2028 1465 2221 2016 3102 3619 1746 1746 1232 2339 582 1979 911 3572 3588 2060 1263 2378 2082 1977 2025 2459 2173 1944 1974 2312 1993 2056 3515 2041 916 2056 3626 2056 1956 1958 2027 3439 3424 2631 1824 72157 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic" 3510 3350 3671 2808 855 3405 1904 1376 2086 1894 2913 3399 1929 1929 1114 2197 1335 1859 855 3355 3370 1934 1186 2233 1956 1857 1902 2309 2134 1825 1854 2172 1834 1931 3301 1916 860 1931 3405 1931 1837 1913 1903 3230 3216 2471 1713 72158 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar" 3560 3390 3742 2848 867 3453 1931 1396 2115 1920 2954 3447 1956 1956 1225 2228 1357 1801 867 3402 3418 1962 1203 2265 1983 1883 1929 2342 2176 1851 1880 2202 1958 1958 3288 1943 872 1958 3453 1958 1863 1958 1958 3275 3261 2588 1737 72170 "Radiologic examination, pelvis; 1 or 2 views" 227 216 238 182 26 220 26 89 135 122 188 220 117 117 62 142 86 120 55 217 218 125 77 144 126 120 123 149 122 118 120 140 125 125 213 124 56 125 220 125 119 125 119 209 208 199 111 72190 "Radiologic examination, pelvis; complete, minimum of 3 views" 294 280 294 235 72 285 159 115 175 159 244 285 162 162 81 184 112 156 72 281 282 162 99 187 164 155 159 193 157 153 155 182 155 162 276 161 72 162 285 162 154 160 159 270 269 207 143 72192 "Computed tomography, pelvis; without contrast material" 1978 1884 2077 1582 482 1919 1073 775 1175 1067 1641 1915 970 970 767 1238 752 1047 482 1890 1899 1090 668 1258 1102 1046 1072 1301 604 1029 1045 1224 1088 1088 1919 1080 484 1088 1919 1088 1035 933 961 1820 1812 1088 965 72193 "Computed tomography, pelvis; with contrast material(s)" 2435 2319 2557 1948 593 2362 1321 955 1447 1313 2021 2358 1194 1194 945 1524 926 1289 593 2327 2338 1342 823 1549 1356 1288 1319 1602 1304 1266 1286 1506 1339 1339 2289 1329 596 1339 2362 1339 1274 1327 1320 2240 2231 1714 1188 72195 "Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)" 2704 2575 2839 2163 659 2623 1467 1060 690 1459 2244 2618 1486 1486 1049 1692 1028 1432 659 2584 2596 1490 914 1720 1506 1430 1465 1779 1448 1406 1428 1673 1500 1487 2542 1476 662 1487 2623 1487 1415 1474 1487 2488 2477 1903 1320 72197 "Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences" 4413 4203 4413 3530 1075 4527 2394 1730 2622 2380 3662 4273 2425 2425 1228 2761 1678 2337 1075 4217 4236 2432 1491 2808 2458 2334 2391 2903 2363 2295 2331 2730 2353 2427 4527 2409 1081 2427 4281 2427 2309 2405 2427 4060 4042 3106 2154 72202 "Radiologic examination, sacroiliac joints; 3 or more views" 349 332 349 279 85 339 189 137 207 188 290 338 192 192 135 218 133 185 85 334 335 192 118 222 194 185 189 230 187 181 184 216 186 192 328 191 85 192 339 192 183 190 183 321 320 321 170 72220 "Radiologic examination, sacrum and coccyx, minimum of 2 views" 264 251 277 211 37 256 143 103 157 142 219 256 112 112 37 165 65 140 64 252 253 145 89 168 147 140 143 174 141 137 139 163 140 145 256 144 65 145 256 145 138 144 128 243 242 152 129 73000 "Radiologic examination; clavicle, complete" 299 285 314 239 73 290 162 117 178 161 248 290 166 166 81 187 81 158 73 286 287 165 101 190 160 158 162 197 183 155 142 185 164 164 281 163 73 164 290 164 156 163 162 275 274 269 146 73010 "Radiologic examination; scapula, complete" 318 318 318 254 34 308 173 125 189 172 264 308 175 175 34 199 121 168 77 304 305 175 107 202 177 168 172 209 170 165 168 197 166 175 299 174 78 175 308 175 166 173 172 293 291 224 155 73020 "Radiologic examination, shoulder; 1 view" 204 204 204 163 50 198 111 80 121 110 169 198 112 112 79 128 78 108 50 195 196 112 69 130 114 108 111 134 109 106 108 126 107 112 192 111 50 112 198 112 107 111 112 188 187 144 100 73030 "Radiologic examination, shoulder; complete, minimum of 2 views" 308 293 646 246 53 299 167 53 183 161 256 298 171 171 65 193 81 168 75 294 296 170 104 196 169 163 178 203 188 160 146 191 169 169 299 168 75 169 299 169 161 178 169 283 282 224 150 73050 "Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction" 322 322 322 258 78 312 175 126 191 174 267 312 177 177 125 201 122 170 78 308 309 177 109 205 179 170 174 212 172 167 170 199 172 177 303 176 79 177 312 177 168 175 175 296 295 296 157 73060 "Radiologic examination; humerus, minimum of 2 views" 250 238 263 200 61 255 136 98 149 131 207 255 137 137 81 156 65 132 61 239 240 138 84 159 136 132 135 164 145 130 132 155 138 138 235 136 61 138 242 138 131 138 138 230 229 242 122 73070 "Radiologic examination, elbow; 2 views" 214 214 236 171 52 229 116 84 127 115 178 207 55 55 59 134 68 113 52 229 205 118 72 136 119 113 116 141 115 111 113 132 112 118 201 117 52 118 208 118 112 124 109 197 196 151 104 73080 "Radiologic examination, elbow; complete, minimum of 3 views" 293 279 586 234 65 284 159 115 272 145 243 284 163 163 65 183 111 155 71 280 281 161 99 186 163 155 159 193 157 152 155 181 161 161 275 160 72 161 284 161 153 169 161 270 283 219 143 73090 "Radiologic examination; forearm, 2 views" 276 263 580 221 63 281 150 108 164 149 229 281 136 136 63 173 68 146 67 264 265 152 93 176 154 146 150 182 152 144 146 171 146 152 260 151 68 152 268 152 144 152 135 254 267 242 135 73100 "Radiologic examination, wrist; 2 views" 238 227 476 190 33 231 129 93 141 128 197 230 131 131 33 149 90 126 58 227 228 131 80 151 133 126 129 157 131 124 126 147 191 131 224 130 58 131 231 131 125 131 129 219 218 209 116 73110 "Radiologic examination, wrist; complete, minimum of 3 views" 282 269 564 226 65 571 153 111 168 152 234 273 165 165 65 176 65 154 69 274 271 155 95 179 154 154 153 185 155 147 149 174 155 155 571 154 69 155 274 155 148 163 152 259 258 163 138 73130 "Radiologic examination, hand; minimum of 3 views" 279 266 586 223 55 447 151 55 166 150 232 270 155 155 65 175 81 160 68 267 268 154 94 177 155 148 151 184 154 145 133 173 153 153 447 152 68 153 271 153 146 161 161 257 256 245 136 73140 "Radiologic examination, finger(s), minimum of 2 views" 242 230 254 194 59 455 131 95 144 131 201 234 135 135 65 151 94 128 59 231 232 133 82 154 139 128 131 159 148 126 128 150 133 133 455 132 59 133 235 133 127 133 130 223 212 223 118 73200 "Computed tomography, upper extremity; without contrast material" 2144 2042 4502 1715 196 2476 1163 840 1274 1156 1779 2076 1322 1322 196 1342 815 1135 522 2049 2058 1181 724 1364 1194 1134 1162 1410 1309 1115 1132 1326 1179 1179 2016 1170 525 1179 2080 1179 1122 1168 1041 1972 1964 2476 1046 73218 "Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)" 2778 2642 2913 2222 677 2694 1507 1089 1650 1374 2305 2689 1526 1526 1078 1738 1056 1471 677 2654 2666 1530 939 1767 1547 1469 1505 1827 1487 1444 1467 1718 1451 1528 2611 1516 680 1528 2694 1528 1453 1514 1506 2555 2544 2680 1356 73221 "Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)" 2633 2508 2765 2106 642 2582 1428 1032 1564 1420 2185 2549 2582 2582 891 1648 1082 1394 642 2554 2528 1451 890 1675 1467 1392 1379 967 1410 1369 1391 1629 1448 1448 2476 1437 645 1448 2554 1448 1378 1279 1484 2422 2544 1448 1285 73222 "Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)" 3165 3165 3165 2532 771 3070 1717 1241 1880 1707 2626 3065 1739 1739 1232 1980 1203 1676 771 3025 3038 1744 1069 2014 1763 1674 1715 2082 1695 1646 1672 1958 1654 1741 2976 1728 775 1741 3070 1741 1656 1725 1716 2912 2899 2227 1545 73223 "Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences" 4530 4530 4530 3624 1104 4394 2457 1776 2691 2444 3759 4386 2489 2489 1758 2835 1723 2399 1104 4329 4349 2496 1531 2882 2524 2396 2454 2980 2425 2356 2393 2802 2415 2492 4259 2473 1110 2492 4394 2492 2371 2469 2456 4168 4150 3188 2211 73501 PR X-RAY EXAM HIP UNI 1 VIEW 207 202 212 166 50 201 112 81 123 112 172 200 114 114 80 130 79 110 50 198 199 114 70 132 115 109 112 136 111 108 109 128 105 114 195 113 51 114 201 114 108 113 112 190 190 146 101 73502 PR X-RAY EXAM HIP UNI 2-3 VIEWS 279 266 293 223 59 277 151 109 166 157 232 270 155 155 59 175 73 148 68 277 268 154 94 177 155 148 146 184 154 145 147 173 153 153 258 152 68 153 271 153 146 153 153 257 257 153 76 73522 PR X-RAY EXAM HIPS BI 3-4 VIEWS 405 386 425 324 73 393 220 159 241 218 336 392 199 199 73 253 154 214 99 387 389 223 137 258 226 214 219 266 217 211 214 251 212 223 381 221 99 223 393 223 212 221 218 373 371 228 198 73523 PR X-RAY EXAM HIPS BI 5/> VIEWS 463 463 463 370 113 449 251 181 275 250 384 448 254 254 180 290 176 245 113 442 444 255 156 295 258 245 251 305 248 241 245 286 235 255 435 253 113 255 449 255 242 252 251 426 424 326 226 73551 PR X-RAY EXAM OF FEMUR 1 VW 198 188 207 158 48 192 107 77 117 107 164 191 122 122 77 124 75 105 48 189 190 109 67 126 110 104 107 130 106 103 104 122 88 109 186 108 48 109 192 109 103 108 107 182 181 139 96 73552 PR X-RAY EXAM OF FEMUR 2/> VW 255 243 268 204 33 832 138 100 151 138 212 247 140 140 33 160 97 135 62 244 245 141 86 162 142 135 138 168 137 133 135 158 134 140 832 139 62 140 247 140 133 139 126 235 234 144 124 73560 "Radiologic examination, knee; 1 or 2 views" 258 246 542 206 63 595 140 101 153 139 214 263 135 135 69 161 98 137 63 247 248 142 87 164 144 136 140 170 158 134 136 160 142 142 595 141 63 142 250 142 135 142 142 237 237 232 126 73562 "Radiologic examination, knee; 3 views" 326 310 684 261 36 438 183 128 194 171 271 332 181 181 65 204 81 173 79 312 313 180 110 207 170 172 177 214 199 170 170 202 179 179 438 178 80 179 316 179 171 179 179 300 300 188 36 73564 "Radiologic examination, knee; complete, 4 or more views" 422 402 886 338 37 465 229 165 251 228 350 409 232 232 37 264 65 223 103 403 405 233 143 268 235 223 229 278 465 219 223 261 232 232 397 230 103 232 409 232 221 232 229 388 387 244 206 73590 "Radiologic examination; tibia and fibula, 2 views" 236 225 248 189 58 480 128 93 140 127 196 229 124 124 65 148 90 125 58 226 227 130 80 150 131 125 128 155 144 123 125 146 130 130 480 129 58 130 229 130 123 129 127 217 216 173 115 73600 "Radiologic examination, ankle; 2 views" 167 167 350 134 41 193 91 65 99 90 139 162 92 92 65 104 64 88 41 160 160 92 56 106 93 88 90 110 193 87 88 103 78 92 157 91 41 92 162 92 87 91 91 154 153 118 82 73610 "Radiologic examination, ankle; complete, minimum of 3 views" 284 270 596 227 65 275 154 111 169 140 236 275 158 158 65 178 73 150 69 271 273 156 96 181 148 150 148 187 156 148 150 176 156 156 262 155 70 156 275 156 149 152 164 261 268 248 139 73620 "Radiologic examination, foot; 2 views" 167 167 175 134 41 162 91 65 99 90 139 162 92 92 65 104 64 88 41 160 160 92 56 106 93 88 90 110 89 87 88 103 94 92 157 91 41 92 162 92 87 85 91 154 153 118 82 73630 "Radiologic examination, foot; complete, minimum of 3 views" 246 234 516 197 60 477 125 96 146 122 204 238 137 137 65 154 65 130 60 235 236 136 83 157 134 130 129 162 143 128 130 152 135 135 477 134 60 135 239 135 129 142 139 226 226 226 120 73650 "Radiologic examination; calcaneus, minimum of 2 views" 230 225 236 184 56 224 125 90 137 124 191 223 127 127 65 144 88 122 56 220 221 127 78 147 128 122 125 152 123 120 122 143 126 127 217 126 56 127 224 127 121 126 125 212 211 162 112 73660 "Radiologic examination; toe(s), minimum of 2 views" 256 244 269 205 35 248 139 35 152 138 212 248 158 158 81 160 97 136 62 245 246 141 87 163 138 135 139 168 141 133 138 158 141 141 241 140 63 141 248 141 134 140 139 236 235 141 125 73700 "Computed tomography, lower extremity; without contrast material" 2067 1875 2067 1654 416 2005 1121 810 1228 1115 1715 2001 1095 1095 416 1293 786 1094 504 2005 1984 1139 698 1315 1151 1093 1120 1360 1202 1075 1092 1279 1102 1137 1943 1128 506 1137 2005 1137 1082 1083 1083 1811 1811 1137 1009 73701 "Computed tomography, lower extremity; with contrast material(s)" 2467 2367 4934 1974 601 2393 1338 967 1466 1331 2047 2389 1355 1355 957 1544 938 1306 601 2358 2368 1359 834 1570 1374 1305 1337 1623 1321 1283 1303 1526 1973 1357 2320 1347 604 1357 2393 1357 1291 1345 1302 2270 2260 1736 1204 73718 "Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)" 2661 2661 2794 2129 648 2581 1444 1043 1581 1435 2208 2577 1480 1480 810 1665 1012 1409 648 2543 2555 1466 899 1693 1482 1407 1442 1750 1425 1384 1405 1646 1464 1464 2581 1453 652 1464 2581 1464 1392 1450 1464 2448 2438 1537 1299 73720 "Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences" 4413 4203 4413 3530 1075 4281 2394 1730 2622 2186 3662 4273 2425 2425 1225 2761 1294 2337 1075 4217 4236 2432 1491 2808 2458 2334 2391 2903 2363 2295 2331 2730 2427 2427 4149 2409 1081 2427 4281 2427 2309 2405 2144 4060 4042 3106 2154 73721 "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material" 2735 2605 2872 2188 666 2786 1484 1072 1625 1435 2269 2648 1521 1521 888 1711 888 1448 666 2614 2626 1507 924 1740 1524 1446 1482 1799 1670 1355 1445 1692 1531 1504 2786 1493 670 1504 2653 1504 1431 1580 1504 2516 2516 1580 2434 73722 "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)" 3272 3272 3272 2618 797 3174 1775 1283 1944 1765 2715 3168 1798 1798 1269 2047 1244 1732 797 3127 3141 1803 1106 2082 1823 1730 1773 2152 1902 1701 1728 2024 1710 1800 3076 1786 801 1800 3174 1800 1712 1783 1774 3010 2997 2303 1597 73723 "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences" 4313 4103 4523 3450 1051 4184 2340 1691 2562 2326 3579 4176 2370 2370 1673 2699 1640 2284 1051 4122 4140 2376 1457 2744 2403 2281 2337 2837 2309 2243 2278 2668 1928 2372 4055 2355 1056 2372 4184 2372 2257 2351 2488 3968 3951 3035 2105 74018 PR X-RAY EXAM ABDOMEN 1 VIEW 347 330 364 278 68 337 188 136 206 187 288 336 193 193 73 217 68 189 85 332 333 191 117 221 193 184 188 228 96 180 183 215 191 191 326 189 85 191 337 191 182 189 168 319 318 319 169 74019 PR X-RAY EXAM ABDOMEN 2 VIEWS 392 373 412 314 32 380 213 40 233 194 325 380 218 218 69 245 73 214 32 375 376 216 132 249 218 207 212 258 216 204 207 242 216 216 369 214 96 216 380 216 205 216 216 361 343 361 191 74022 "Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest" 426 406 447 341 65 413 231 88 253 225 353 412 209 209 65 267 65 226 104 407 409 235 144 271 237 225 231 280 235 222 235 264 234 234 401 233 104 234 413 234 223 215 234 392 392 246 208 74150 "Computed tomography, abdomen; without contrast material" 1952 1770 1952 1562 476 1893 1059 765 1160 1053 1620 1890 1073 1073 757 1221 742 1034 476 1865 1874 1076 660 1242 1087 1032 1058 1284 1135 1015 1031 1208 903 1074 1835 1066 478 1074 1893 1074 1021 1064 1058 1796 1788 1374 953 74160 "Computed tomography, abdomen; with contrast material(s)" 2324 2267 2499 1859 310 2254 1260 911 1380 1253 1928 2250 1168 1168 310 1454 496 1230 566 2221 2231 1280 785 1478 1294 1229 1259 1528 1453 1208 1227 1437 1214 1278 2185 1268 569 1278 2254 1278 1216 1266 1260 2138 2128 2190 1134 74170 "Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections" 2442 2442 2899 1954 595 2369 1325 957 1451 1317 2026 2364 1702 1702 620 1528 620 1293 595 2334 2344 1346 825 1554 1360 1291 1323 1606 1412 1270 1290 1511 1410 1343 2296 1333 598 1343 2369 1343 1278 1331 1270 2247 2237 2247 1192 74174 PR CT ANGIO ABD AND PELV WO W CONTRAST 3432 3432 3432 2746 836 3329 1862 1345 2039 1851 2848 3323 1886 1886 1332 2148 1305 1817 836 3280 3295 1891 1160 2183 1912 1815 1859 2257 1837 1785 1813 2123 1888 1888 3227 1874 841 1888 3329 1888 1796 1870 1861 3157 3144 2415 1675 74175 "Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2624 2499 2624 2099 639 2545 1423 1029 1559 1415 2177 2541 1442 1442 1018 1642 998 1389 639 2424 2519 1446 887 1669 1462 1388 1422 1726 1405 1364 1386 1623 1330 1443 2467 1433 643 1443 2545 1443 1373 1443 1423 2414 2404 1847 1281 74176 "Computed tomography, abdomen and pelvis; without contrast material" 3733 3555 3920 2986 910 3868 2025 1463 2218 1959 3098 3621 2076 2076 993 2336 999 1963 910 3568 3584 2057 1261 2375 2080 1974 2156 2455 2056 1941 1972 2309 2053 2053 3868 2038 914 2053 3621 2053 1953 2053 2053 3434 3420 3434 1822 74177 "Computed tomography, abdomen and pelvis; with contrast material(s)" 4516 4301 4742 3613 993 4381 2450 1770 2683 2533 3747 4373 2363 2363 993 2826 993 2589 1100 4172 4335 2488 1526 2873 2516 2388 2608 2970 2487 2348 2150 2794 2484 2484 4172 2465 1106 2484 4381 2608 2363 2366 2484 4155 3957 4155 2204 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" 4870 4638 4870 3896 993 4724 2642 1909 2893 2627 4041 4715 2370 2370 1006 3047 993 2579 1187 4654 4675 2683 1646 3098 2713 2576 2638 3203 2607 2532 2572 3013 2574 2678 4579 2659 1193 2678 4724 2679 2548 2365 2551 4480 4461 3427 2377 74181 "Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)" 2557 2557 2557 2046 623 2480 1387 1002 1519 1379 2122 2476 1405 1405 992 1600 972 1354 623 2444 2455 1409 864 1627 1424 1352 1385 1682 1369 1330 1350 1582 1406 1406 2404 1396 626 1406 2480 1406 1338 1394 1386 2352 2342 1800 1248 74183 "Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences" 4206 3748 4416 3365 1025 4080 2282 1649 2499 2269 3490 4072 2513 2513 1225 2632 1225 2227 1025 4020 4038 2317 1421 2676 2343 2224 2279 2766 1073 2187 2221 2602 1998 2313 3955 2296 1030 2313 4080 2313 2201 2292 2280 3870 3853 3870 2053 74230 "Swallowing function, with cineradiography/videoradiography" 313 298 329 250 76 420 170 123 186 169 260 303 172 172 420 196 119 166 76 299 300 172 106 199 174 166 170 206 168 163 165 194 174 172 294 171 77 172 304 172 164 171 155 288 287 172 153 75635 "Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 3647 3473 3647 2918 839 3538 1978 1430 2167 1967 3026 3531 2004 2004 839 2282 1387 1931 889 3485 3501 2009 1232 2320 2032 1929 1976 2399 1953 1896 1926 2256 1853 2006 3429 1991 893 2006 3538 2006 1908 1988 1977 3355 3341 2567 1780 76000 "Fluoroscopy (separate procedure), up to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)" 578 578 578 462 141 561 314 227 343 312 480 560 318 318 196 362 220 306 141 552 555 318 195 368 322 306 313 380 309 301 305 358 302 318 543 316 142 318 561 318 302 315 313 532 529 407 282 76010 "Radiologic examination from nose to rectum for foreign body, single view, child" 185 185 185 148 45 179 100 73 110 100 154 179 102 102 65 116 70 98 45 177 178 102 63 118 103 98 100 122 99 96 98 114 97 102 174 101 45 102 179 102 97 101 100 170 169 130 90 76536 "Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation" 696 663 731 557 170 675 378 273 413 375 578 674 436 436 249 436 274 369 170 665 668 383 235 443 388 368 402 458 383 362 417 431 365 383 675 380 170 383 675 383 364 370 365 640 610 402 340 76604 "Ultrasound, chest (includes mediastinum), real time with image documentation" 675 643 675 540 164 655 366 265 401 364 560 654 371 371 262 422 257 357 164 645 648 372 228 429 371 357 366 444 361 351 357 418 343 371 635 368 165 371 655 371 353 368 366 621 618 475 329 76641 Complete unilateral ultrasound examination of the breast 1218 1158 1277 974 297 1181 660 477 723 657 1010 1179 669 669 472 762 463 645 297 1164 1169 671 411 775 678 644 660 801 652 633 643 753 659 670 1145 665 298 670 1181 670 637 664 660 1120 1115 857 594 76642 Specific area/quadrant breast ultrasound examination 557 505 836 446 107 540 302 107 331 263 419 539 295 295 249 349 127 304 297 532 535 307 188 354 310 295 302 366 299 290 294 345 297 306 490 304 136 306 540 306 291 304 299 512 488 383 272 76700 "Ultrasound, abdominal, real time with image documentation; complete" 1022 973 1073 818 249 991 554 401 607 551 848 990 562 562 423 639 389 541 249 977 981 563 345 650 569 540 554 672 563 531 540 632 549 562 961 558 250 562 991 562 535 506 554 940 936 719 499 76705 "Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)" 660 629 693 528 161 672 358 259 392 356 548 639 367 367 211 413 211 349 161 631 634 364 223 420 399 349 346 434 364 343 365 408 363 363 672 360 162 363 640 363 345 363 342 607 605 607 322 76706 PR US ABDL AORTA SCREEN AAA 574 547 603 459 140 557 311 225 341 310 476 556 315 315 223 359 218 304 140 549 551 316 194 365 320 304 311 378 307 298 303 355 303 316 540 313 141 316 557 316 300 313 311 528 526 404 280 76770 "Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete" 874 792 874 699 213 848 474 343 519 471 725 846 513 513 423 547 332 463 213 835 839 482 295 556 481 462 473 575 468 454 462 541 466 481 822 477 214 481 848 481 457 476 404 804 801 481 427 76775 "Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited" 574 547 603 459 139 682 311 225 341 310 476 556 682 682 211 359 253 304 140 557 551 316 194 365 320 304 311 378 139 298 303 355 316 316 540 313 141 316 557 316 300 332 290 528 503 332 280 76776 "Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation" 590 590 590 472 144 572 320 231 351 318 490 571 324 324 229 369 224 312 144 564 566 325 199 375 329 312 320 388 316 307 312 365 274 324 555 322 145 324 572 325 309 322 320 543 540 415 288 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" 879 879 879 703 214 853 477 345 522 474 729 851 483 483 341 550 334 465 214 840 844 484 297 559 490 465 476 578 471 457 464 544 459 483 826 480 215 483 853 483 460 483 477 809 805 619 429 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" 533 507 559 426 129 517 289 209 317 288 442 516 293 293 231 334 203 282 130 509 512 294 180 339 297 282 289 351 129 277 282 330 279 293 501 291 131 293 517 293 279 290 289 490 488 375 260 76817 "Ultrasound, pregnant uterus, real time with image documentation, transvaginal" 545 519 545 436 133 529 296 214 324 294 452 528 304 304 231 341 207 289 133 521 523 300 184 347 304 288 295 358 292 283 288 337 285 300 512 298 133 300 529 300 285 297 295 501 499 384 266 76830 "Ultrasound, transvaginal" 764 728 802 611 186 741 414 195 454 412 634 740 390 390 211 478 274 405 186 730 733 421 258 486 420 404 400 503 421 397 364 473 424 420 706 417 187 420 741 420 400 441 420 703 703 738 373 76856 "Ultrasound, pelvic (nonobstetric), real time with image documentation; complete" 504 480 529 403 123 489 273 198 299 272 418 488 287 287 196 315 334 267 123 482 484 278 170 321 281 267 273 332 270 262 266 312 277 277 474 275 123 277 489 277 264 275 273 464 462 355 246 76857 "Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)" 471 428 471 377 115 457 256 185 280 254 391 456 347 347 274 295 179 249 115 450 452 260 159 300 259 249 255 310 252 245 249 291 251 259 443 257 115 259 457 259 246 257 255 433 431 433 230 76870 "Ultrasound, scrotum and contents" 727 692 763 582 177 705 394 285 432 392 603 704 621 621 211 455 274 417 177 695 698 401 246 463 405 384 394 478 444 378 346 450 400 400 684 397 178 400 705 400 380 396 394 669 666 669 355 76881 "Ultrasound, extremity, nonvascular, real-time with image documentation; complete" 546 546 546 437 133 530 296 214 324 295 453 529 300 300 212 342 208 289 133 522 524 301 184 347 304 289 296 359 292 284 288 338 300 300 513 298 134 300 530 300 286 298 296 502 500 384 266 76882 "Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific" 530 505 557 424 129 514 288 208 315 286 440 513 302 302 274 332 202 281 129 507 509 292 179 337 295 280 287 349 284 276 280 328 292 292 498 289 130 292 514 292 277 289 258 488 485 373 259 77002 "Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)" 758 722 758 606 185 735 411 297 450 409 629 734 445 445 294 474 288 401 185 724 728 418 256 482 422 401 411 499 441 394 400 469 397 417 713 414 186 417 735 417 397 413 411 697 694 533 370 77061 HC BREAST TOMOSYNTHESIS DIG DX UNIL 35 35 35 28 9 34 19 14 21 19 29 34 19 19 14 22 13 19 9 33 34 19 12 22 19 19 19 23 19 18 18 22 18 19 33 19 9 19 34 19 18 19 19 32 32 25 17 77063 HC BREAST TOMOSYNTHESIS DIG SCREEN UNIL 56 37 56 45 14 56 30 22 33 30 46 54 31 31 22 55 21 30 14 54 54 31 19 36 31 30 30 37 30 29 30 35 55 31 53 31 14 31 54 31 29 31 30 52 51 56 27 77065 Diagnostic Mammography computer aided detection when performed; unilateral 410 390 485 328 100 398 222 161 244 221 324 397 228 228 224 257 254 217 258 392 394 226 139 261 228 217 222 270 226 213 217 254 230 226 385 224 100 226 398 226 215 223 226 359 377 226 200 77066 Diagnostic Mammography computer aided detection when performed; bilateral 546 520 573 437 133 1150 296 214 324 295 453 529 304 304 224 342 254 313 133 522 524 301 184 347 315 289 296 359 308 284 288 338 277 300 1150 298 134 300 530 300 286 298 315 502 500 315 266 77067 Screening mammography 525 431 525 420 128 564 285 206 312 283 436 508 278 278 243 519 243 278 128 502 504 289 177 334 262 278 284 345 282 273 277 325 523 289 564 287 129 289 509 289 275 128 128 483 481 523 256 77080 "Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)" 667 605 667 534 141 647 362 141 396 360 553 646 392 392 253 363 253 353 163 637 640 368 225 424 333 353 367 439 373 347 352 413 353 367 647 364 163 367 647 367 349 349 367 584 611 476 326 78226 PR HEPATOBILIARY SYSTEM IMAGING 1284 1284 1284 1027 313 1245 697 503 763 693 1065 1243 705 705 498 803 488 680 313 1227 1233 707 434 817 715 679 696 845 687 668 678 794 655 706 1207 701 314 706 1245 706 672 700 696 1181 1176 904 627 78227 PR HEPATOBIL SYST IMAGE W/DRUG 1741 1658 1828 1393 424 1937 944 682 1034 939 1445 1686 1073 1073 1251 1089 662 922 424 1689 1671 959 588 1108 970 921 943 1145 932 905 829 1077 883 958 1937 950 426 958 1689 958 911 1005 958 1602 1595 1602 850 78306 Bone and/or joint imaging; whole body 1325 1202 1325 1060 323 1285 719 519 787 715 1099 1283 728 728 514 829 504 702 323 1266 1272 730 448 843 738 701 718 872 709 689 700 820 706 729 1246 723 325 729 1285 729 693 565 718 1219 1214 932 647 78451 "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); single study, at rest or stress (exercise or pharmacologic)" 2200 2200 2200 1760 536 2134 1193 862 1307 1187 1826 2130 1209 1209 854 1377 837 1165 536 2102 2112 1212 743 1400 1226 1163 1192 1447 1178 1144 1162 1361 1173 1210 2068 1201 539 1210 2134 1210 1151 1199 1193 2024 2015 1548 1074 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" 3609 3437 3789 2887 879 5474 1958 1415 2144 1947 2995 3494 2225 2225 2132 2258 1372 1911 879 3449 3465 1989 1219 2296 2010 1909 1955 2374 1932 1877 1906 2233 1985 1985 5474 1970 884 1985 3501 1985 1889 1985 1985 3320 3306 3403 1761 78582 PR LUNG VENTILAT&PERFUS IMAGING 792 753 831 634 193 768 430 310 471 427 657 767 435 435 307 496 301 419 193 757 760 436 268 504 441 419 429 521 424 412 418 490 429 436 745 432 194 436 768 436 414 432 429 729 725 557 387 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)" 133 127 140 106 13 136 75 13 124 68 105 136 74 74 59 83 59 73 32 129 128 73 13 85 73 73 70 87 73 69 80 82 73 73 125 73 33 73 129 73 70 73 73 117 122 77 65 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)" 396 359 396 317 45 384 215 155 235 214 329 383 218 218 59 248 59 206 45 378 380 218 134 252 221 209 215 260 212 206 209 245 207 218 372 216 97 218 384 218 207 216 215 364 364 279 193 80051 "Electrolyte panel This panel must include the following: Carbon dioxide (82374), Chloride (82435), Potassium (84132), Sodium (84295)" 110 105 116 88 27 107 60 43 65 59 91 107 61 61 54 69 42 58 27 107 106 61 37 70 61 58 60 72 59 57 58 68 60 60 103 60 27 60 107 61 58 60 54 101 101 64 54 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)" 144 137 151 115 9 2709 81 16 16 81 113 143 80 80 59 82 59 79 9 143 131 79 49 92 81 79 83 95 79 75 73 70 79 79 2709 79 35 79 140 83 71 79 79 132 132 83 90 80061 "Lipid panel This panel must include the following: Cholesterol, serum, total (82465), Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478)" 127 121 133 102 12 123 71 28 28 70 101 116 71 71 29 72 30 71 12 123 116 70 43 81 70 68 73 84 70 66 76 79 70 70 119 69 31 70 123 73 66 70 70 114 117 73 62 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)" 148 134 148 118 36 144 80 58 88 80 123 143 78 78 59 93 59 78 36 141 142 82 50 94 82 78 80 97 79 77 78 92 78 81 139 81 36 81 144 81 77 78 78 136 136 81 72 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)" 373 355 392 298 59 362 202 146 222 201 310 361 156 156 59 233 59 197 91 356 358 206 126 237 208 197 202 245 205 194 185 231 198 205 351 204 91 205 362 205 195 203 195 343 342 352 182 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)" 133 127 140 106 29 129 72 52 79 72 110 129 74 74 59 83 29 70 32 127 128 73 45 85 73 73 73 87 55 69 70 82 70 73 125 73 33 73 129 73 70 65 71 122 122 77 65 80143 HC DRUG ASSAY ACETAMINOPHEN 170 162 179 136 41 174 92 67 101 92 141 174 95 95 66 106 65 90 41 162 163 94 57 108 95 90 92 112 94 88 90 105 95 94 160 93 42 94 165 94 89 96 94 156 156 98 83 80156 Carbamazepine; total 122 116 128 98 30 118 66 48 72 66 101 118 67 67 51 76 51 65 30 117 117 67 41 78 68 65 66 80 37 63 64 75 67 67 115 67 30 67 118 67 64 61 66 112 112 67 60 80158 Cyclosporine 181 181 181 144 44 175 98 71 107 97 150 175 99 99 70 113 69 96 44 173 173 100 61 115 101 96 98 119 97 94 95 112 96 99 170 99 44 99 175 99 95 98 98 166 165 127 88 80159 HC DRUG SCREEN QUANT CLOZAPINE 181 181 181 145 44 176 98 71 108 98 150 175 100 100 70 113 69 96 44 173 174 100 61 115 101 96 98 119 97 94 96 112 95 100 170 99 44 100 176 100 95 99 98 167 166 127 88 80162 Digoxin 114 108 120 91 28 111 62 45 68 61 95 110 63 63 44 71 43 60 28 109 109 63 39 73 64 60 62 75 61 59 60 71 63 63 107 62 28 63 111 63 60 62 63 105 104 66 56 80164 Dipropylacetic acid (valproic acid) 114 108 120 91 28 111 62 45 68 61 95 110 63 63 55 71 51 59 28 109 109 63 39 73 64 60 62 75 70 59 60 71 63 63 107 62 28 63 111 63 60 60 56 105 110 66 56 80167 HC DRUG ASSAY FELBAMATE 213 213 213 170 52 207 116 83 127 115 177 206 117 117 83 133 81 113 52 204 204 117 72 136 119 113 115 140 114 111 112 132 117 117 200 116 52 117 207 117 111 116 115 196 195 150 104 80168 Ethosuximide 130 130 130 104 32 127 71 51 77 70 108 126 72 72 55 82 61 69 32 125 125 72 44 83 73 69 71 86 70 68 69 81 68 72 123 71 32 72 127 72 68 71 71 120 119 92 64 80175 HC DRUG SCREEN QUANT LAMOTRIGINE 225 214 236 180 31 218 122 88 134 121 187 218 125 125 87 141 31 119 55 215 216 124 76 143 125 119 122 148 120 117 119 139 125 124 212 123 55 124 218 124 118 123 122 207 206 207 110 80177 Drug Screen quantitative Levetiracetam level 236 214 236 189 51 229 128 93 140 127 196 229 125 125 51 148 51 125 58 226 227 130 80 150 131 125 128 155 137 123 125 146 125 130 222 129 58 130 229 130 123 130 128 217 217 130 115 80178 Lithium 80 76 84 64 19 78 43 31 48 43 66 77 49 49 61 50 30 42 19 76 77 44 27 51 45 42 43 53 44 42 42 49 42 44 75 44 20 44 78 44 42 44 43 74 73 56 39 80179 HC DRUG ASSAY SALICYLATE 170 162 179 136 41 174 92 67 101 92 141 174 95 95 66 106 65 90 41 162 163 94 57 108 95 90 92 112 94 88 102 105 95 94 160 93 42 94 165 94 89 96 94 156 156 98 83 80180 HC DRUG SCREEN QUANT MYCOPHENOLATE 206 206 216 165 50 200 112 81 122 111 171 199 113 113 80 129 78 109 50 197 198 113 70 131 115 109 112 135 110 107 109 127 119 113 194 112 50 113 200 113 108 112 112 189 189 189 100 80183 HC DRUG SCREEN QUANT OXCARBAZEPIN 75 75 75 60 18 73 41 29 45 40 62 73 41 41 29 47 29 40 18 72 72 41 25 48 42 40 41 49 40 39 40 46 39 41 71 41 18 41 73 41 39 41 41 69 69 69 37 80184 Phenobarbital 70 70 70 56 17 68 38 27 42 38 58 68 38 38 27 44 27 37 17 67 67 39 24 45 39 37 38 46 37 36 37 43 36 38 66 38 17 38 68 39 37 38 38 64 64 49 34 80185 Phenytoin; total 111 106 117 89 27 108 60 44 66 60 92 107 61 61 43 69 42 59 27 106 107 61 38 71 62 59 60 73 59 58 59 69 62 61 104 61 27 61 108 61 58 60 60 102 102 102 54 80197 Tacrolimus 205 195 215 164 50 199 111 80 122 111 170 198 113 113 56 128 78 109 50 196 197 113 69 130 112 112 111 135 110 107 108 127 113 113 193 112 50 113 199 113 107 112 111 189 188 189 100 80198 Theophylline 45 45 45 36 11 44 24 18 27 24 37 44 25 25 17 28 17 24 11 43 43 25 15 29 25 24 24 30 24 23 24 28 24 25 42 25 11 25 44 25 24 25 24 41 41 32 22 80201 Topiramate 125 85 125 100 26 121 68 49 74 67 104 121 70 70 48 78 26 66 30 119 120 69 42 80 70 66 68 82 67 65 66 77 67 69 118 68 31 69 121 69 65 68 68 115 115 88 61 80202 Vancomycin 149 149 164 119 36 144 77 58 88 77 123 144 89 89 58 93 57 79 36 142 143 82 50 95 83 79 81 98 88 77 79 92 78 82 140 81 36 82 144 82 78 86 90 137 136 105 73 80203 HC DRUG SCREEN QUANT ZONISAMIDE 206 187 206 165 48 200 112 81 122 111 171 199 105 105 48 129 78 109 50 197 198 114 70 131 115 109 112 135 110 107 109 127 109 113 194 112 50 113 200 113 108 112 112 190 189 145 101 80235 HC DRUG ASSAY LACOSAMIDE 198 198 234 158 48 192 107 78 118 107 164 192 109 109 77 124 75 105 48 189 190 109 67 126 110 105 107 130 106 103 105 122 105 109 186 108 48 109 192 109 104 108 107 182 181 139 97 80299 "Quantitation of drug, not elsewhere specified" 189 189 198 151 46 183 103 74 112 102 157 183 104 104 73 118 72 100 46 181 181 104 64 120 105 100 102 124 101 98 100 117 106 104 178 103 46 104 183 104 99 103 98 174 173 133 92 80305 Drug Test presumptive 100 100 100 80 24 97 54 39 59 54 83 97 55 55 39 62 55 53 24 95 96 55 34 63 56 53 54 66 53 52 53 62 52 55 94 54 24 55 97 55 52 54 54 92 91 70 49 80306 HC DRUG TEST(S) PRSMV INSTRUMENT 105 100 110 84 26 107 57 41 62 52 87 107 58 58 53 66 52 57 26 100 101 58 35 67 58 56 60 69 58 55 63 51 58 58 107 57 26 58 102 58 55 58 59 97 96 58 51 80307 Drug Test presumptive 210 210 210 168 51 204 114 82 125 113 174 203 115 115 81 131 80 111 51 201 202 116 71 134 117 111 114 138 112 109 111 130 116 116 197 115 51 116 204 116 110 114 114 193 192 148 102 80320 Drug screen quantitative alcohols 22 or more classes 96 96 96 77 23 93 52 38 57 52 80 93 53 53 37 60 37 51 23 92 92 53 33 61 54 51 52 63 52 50 51 50 50 53 91 53 24 53 93 53 50 52 52 89 88 68 47 80329 HC DRUG TEST DEF 1-2 CLASS ANALGESICS NON-OPIOID 162 162 162 130 40 157 88 64 96 88 135 157 89 89 63 102 62 86 40 155 156 89 55 103 90 86 88 107 87 84 86 84 85 89 153 89 40 89 157 89 85 88 88 149 149 114 79 80339 HC DRUG TEST DEF 1-2 CLASS ANTIEPILEPTICS NOS 171 171 171 137 42 166 93 67 102 92 142 166 94 94 66 107 65 91 42 163 164 94 58 109 95 90 93 112 92 89 90 106 90 94 161 93 42 94 166 94 89 93 93 157 157 120 83 80349 HC DRUG TEST DEF 22+ CLASS CANNABINOIDS NATURAL 140 140 140 112 34 136 76 55 83 76 116 136 82 82 54 88 53 74 34 134 134 77 47 89 78 74 76 92 75 73 74 87 73 77 132 76 34 77 136 77 73 76 76 129 128 99 68 80400 ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2) 274 274 274 219 67 266 149 107 163 148 227 265 152 152 106 171 104 145 67 262 263 151 93 174 153 145 148 180 147 142 145 169 143 151 258 150 67 151 266 151 143 149 149 252 251 193 134 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" 48 22 50 38 5 48 27 5 5 24 40 48 27 27 24 30 24 26 12 44 46 26 16 31 26 26 28 32 26 25 25 24 26 26 45 26 12 26 47 28 25 26 26 44 44 28 23 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" 23 14 25 18 6 24 12 9 22 12 19 22 13 13 24 14 24 12 6 22 22 13 8 15 14 13 14 15 13 12 13 14 8 13 22 13 6 13 22 13 12 13 9 22 21 11 11 81015 Urinalysis; microscopic only 26 26 28 20 6 25 14 10 15 14 21 25 14 14 24 16 25 14 6 24 24 14 9 16 14 13 14 17 14 13 13 16 14 14 24 14 6 14 25 14 13 14 14 23 23 18 12 81025 "Urine pregnancy test, by visual color comparison methods" 53 39 56 42 13 54 29 21 31 29 44 51 26 26 18 33 24 28 13 51 51 29 18 34 30 28 29 35 29 28 32 26 28 29 54 29 13 29 51 29 28 20 29 49 46 49 26 81240 HC F2 GENE 419 419 419 335 102 406 227 164 249 226 348 406 230 230 163 262 159 222 102 400 402 231 142 267 233 222 227 276 224 218 221 259 219 230 394 229 103 230 406 230 219 228 214 385 384 295 204 81241 HC F5 GENE 440 419 462 352 107 427 239 173 262 238 365 426 242 242 236 276 167 233 107 406 423 243 149 280 245 233 239 290 236 229 233 272 230 242 414 240 108 242 427 242 230 240 239 405 403 310 215 81256 HC HFE GENE 368 368 368 295 90 357 200 144 219 199 306 357 205 205 115 231 140 195 90 352 354 203 125 234 205 195 200 242 197 192 195 228 193 203 346 201 90 203 357 203 193 201 200 339 338 259 180 81270 HC JAK2 GENE 400 400 400 320 97 388 217 157 238 216 332 387 220 220 155 250 152 212 97 382 384 220 135 254 223 212 217 263 214 208 211 247 209 220 376 218 98 220 388 220 209 204 217 368 366 282 195 81374 HC HLA I TYPING 1 ANTIGEN LR 100 100 100 80 24 127 54 39 59 54 83 97 55 55 127 63 38 53 24 96 96 55 34 64 56 53 54 66 54 52 53 62 52 55 94 55 24 55 97 55 52 54 54 92 92 70 49 81377 HC HLA II TYPE 1 AG EQUIV LR 345 345 345 276 84 335 187 135 205 186 286 334 190 190 191 216 131 183 84 330 331 190 117 219 192 182 187 227 185 179 182 213 180 190 324 188 85 190 335 190 181 188 187 317 316 243 168 81383 HC HLA II TYPING 1 ALLELE HR 345 345 345 276 84 335 187 135 205 186 286 334 190 190 96 216 131 183 84 330 331 190 117 219 192 182 187 227 185 179 182 213 180 190 324 188 85 190 335 190 181 188 187 317 316 243 168 82009 "Acetone or other ketone bodies, serum; qualitative" 39 36 40 31 10 38 21 15 23 21 32 38 21 21 15 24 15 21 10 37 37 21 13 25 22 21 21 26 23 20 21 24 21 21 37 21 10 21 38 21 20 22 21 36 36 27 19 82024 Adrenocorticotropic hormone (ACTH) 244 220 244 195 55 237 132 96 145 132 202 236 134 134 55 153 93 129 59 233 234 134 82 155 136 129 132 160 131 127 129 151 112 134 229 133 60 134 237 134 128 133 132 224 224 172 119 82040 "Albumin; serum, plasma or whole blood" 41 39 43 33 10 40 22 16 24 22 34 40 23 23 27 26 23 22 10 39 39 23 14 26 23 22 22 27 22 21 22 25 23 23 39 22 10 23 40 23 21 22 23 38 38 38 20 82043 "Albumin; urine, microalbumin, quantitative" 73 70 77 58 9 71 41 9 9 41 58 71 41 41 24 46 24 38 18 71 67 40 25 46 42 38 41 48 40 38 39 45 40 40 71 40 18 40 71 40 38 40 40 64 67 42 36 82077 "Alcohol (ethanol); any specimen except urine and breath, immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)" 101 96 289 81 25 103 55 40 60 50 84 103 56 56 47 63 38 53 25 97 97 56 34 64 56 53 58 66 56 53 60 62 56 56 95 55 25 56 98 56 53 56 57 93 93 73 49 82085 Aldolase 58 58 61 47 14 68 32 23 35 32 48 57 32 32 68 37 22 31 14 56 56 32 20 37 33 31 32 38 31 30 31 36 31 32 55 32 14 32 57 32 31 32 32 54 54 41 29 82088 Aldosterone 248 236 248 198 60 241 135 97 147 134 206 240 138 138 79 155 94 131 60 237 238 137 84 158 138 131 134 163 133 129 131 153 131 136 233 135 61 136 241 136 130 135 134 228 227 175 121 82103 Alpha-1-antitrypsin; total 136 132 139 108 33 131 74 53 81 73 112 131 74 74 61 85 52 72 33 129 130 75 46 86 75 72 73 89 73 70 72 84 71 75 127 74 33 75 131 75 71 74 73 125 124 73 66 82104 Alpha-1-antitrypsin; phenotype 146 146 146 117 36 142 79 57 87 79 121 141 80 80 57 91 56 77 36 140 140 80 49 93 81 77 79 96 78 76 77 90 76 80 137 80 36 80 142 80 76 80 79 134 134 80 71 82105 Alpha-fetoprotein (AFP); serum 160 160 176 128 39 155 87 63 95 86 133 155 96 96 86 100 61 85 39 153 153 88 54 102 89 85 87 105 86 83 84 99 92 88 150 87 39 88 155 88 84 87 82 147 146 113 78 82140 Ammonia 104 99 109 83 25 106 56 41 62 56 86 106 58 58 40 65 40 55 25 99 100 57 35 66 58 55 56 68 57 54 55 64 57 57 98 57 25 57 101 57 54 60 52 96 91 91 51 82150 Amylase 68 64 71 54 17 66 37 27 40 38 56 66 38 38 29 43 26 36 17 65 65 37 23 43 38 36 39 45 37 35 32 42 37 37 64 37 17 37 66 37 36 37 37 63 59 63 33 82164 Angiotensin I - converting enzyme (ACE) 94 94 94 75 23 91 51 37 56 50 78 91 51 51 61 59 36 50 23 89 90 52 32 59 52 49 51 61 50 49 49 58 49 51 88 51 23 51 91 51 49 51 51 86 86 66 46 82172 "Apolipoprotein, each" 187 187 187 150 46 181 101 73 111 101 155 181 103 103 73 117 71 99 46 179 180 103 63 119 104 99 101 123 100 97 99 116 99 103 176 102 46 103 181 103 98 102 101 172 171 132 91 82232 Beta-2 microglobulin 90 90 90 72 22 87 49 35 53 49 75 87 49 49 55 56 34 48 22 86 86 50 30 57 50 48 49 59 48 47 48 56 47 50 85 49 22 50 87 50 47 49 49 83 82 63 44 82247 Bilirubin; total 48 46 50 38 12 47 26 19 29 27 40 46 27 27 27 30 26 25 12 46 46 26 16 31 27 26 26 32 26 25 25 30 26 26 45 26 12 26 47 26 25 26 26 44 44 26 23 82248 Bilirubin; direct 51 48 54 41 12 49 28 20 30 29 42 49 32 32 32 32 13 27 12 49 49 28 17 32 28 27 28 34 25 27 27 32 28 28 48 28 12 28 49 28 27 26 24 47 47 30 25 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)" 53 24 56 42 13 51 29 21 31 29 44 51 29 29 21 33 20 28 13 51 51 29 18 34 30 28 29 35 13 28 28 33 26 29 50 29 13 29 51 29 28 29 26 49 49 29 26 82272 "Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening" 26 24 56 21 6 49 14 10 15 14 22 24 16 16 10 16 10 14 6 49 25 14 9 17 14 14 14 17 14 14 14 16 14 14 24 14 6 14 25 14 14 29 14 24 24 22 13 82306 "Vitamin D; 25 hydroxy, includes fraction(s), if performed" 289 125 303 231 61 280 157 113 172 148 240 280 161 161 85 165 61 158 70 276 277 159 98 184 161 153 157 190 176 150 153 179 159 159 272 158 71 159 280 159 151 150 159 266 254 167 141 82310 Calcium; total 52 49 55 42 13 50 28 20 31 26 43 50 27 27 26 33 33 28 13 50 50 29 18 33 29 28 28 34 28 27 27 32 29 29 49 28 13 29 50 29 27 28 25 48 48 30 25 82330 Calcium; ionized 73 69 73 58 18 71 40 29 43 39 61 71 41 41 52 46 28 39 18 70 70 40 25 46 41 39 40 48 39 38 39 45 38 40 69 40 18 40 71 40 38 40 40 67 67 51 36 82340 "Calcium; urine quantitative, timed specimen" 54 34 69 43 13 52 29 21 32 29 44 52 29 29 26 33 20 28 13 51 51 29 18 34 30 28 29 35 29 28 28 33 29 29 50 29 13 29 52 29 28 29 29 49 49 47 26 82360 "Calculus; quantitative analysis, chemical" 74 74 74 59 18 86 40 29 44 40 61 72 44 44 86 46 28 39 18 71 71 41 25 47 41 39 40 49 40 38 39 46 39 41 70 40 18 41 72 41 39 40 40 68 68 52 36 82365 Calculus; infrared spectroscopy 78 74 82 62 19 76 42 31 46 42 65 76 43 43 50 49 30 41 19 75 75 43 26 50 43 41 42 51 42 41 41 48 28 43 73 43 19 43 76 43 41 43 42 72 71 75 38 82374 Carbon dioxide (bicarbonate) 52 52 55 42 11 51 28 20 31 28 43 51 36 36 11 33 20 28 13 50 50 29 18 33 29 28 28 34 28 27 28 32 28 29 49 28 13 29 51 29 27 28 28 48 48 48 25 82375 Carboxyhemoglobin; quantitative 104 104 104 83 25 101 56 41 62 56 86 101 57 57 40 65 40 55 25 99 100 57 35 66 58 55 56 68 56 54 55 64 57 57 98 57 25 57 101 57 54 57 56 96 95 73 51 82378 Carcinoembryonic antigen (CEA) 159 151 167 127 39 154 86 62 94 86 132 154 87 87 62 99 60 84 39 152 153 88 54 101 89 84 86 105 85 83 84 98 83 87 149 87 39 87 154 87 83 87 78 146 146 92 78 82390 Ceruloplasmin 64 61 67 51 16 62 35 25 38 35 53 62 35 35 30 40 24 34 16 61 61 35 22 41 36 34 35 42 34 33 34 40 33 35 60 35 16 35 62 35 33 35 32 59 59 35 31 82397 Chemiluminescent assay 134 134 134 107 33 130 73 53 80 72 111 130 74 74 52 84 51 71 33 128 129 74 45 85 75 71 73 88 72 70 71 83 68 74 126 73 33 74 130 74 70 73 73 123 123 94 65 82435 Chloride; blood 52 52 55 42 13 51 28 20 31 28 43 51 36 36 20 33 20 28 13 50 50 29 18 33 29 28 28 34 28 27 28 32 27 29 49 28 13 29 51 29 27 28 28 48 48 48 25 82465 "Cholesterol, serum or whole blood, total" 44 44 44 35 11 43 24 17 26 24 37 43 24 24 17 28 17 23 11 42 42 24 15 28 25 23 24 29 24 23 23 27 24 24 41 24 11 24 43 24 23 24 24 40 40 31 21 82530 Cortisol; free 164 160 168 131 40 159 89 64 97 88 136 159 90 90 54 103 62 87 40 157 157 90 55 104 91 87 89 108 88 85 87 101 86 90 154 90 40 90 159 90 86 89 89 151 150 115 80 82533 Cortisol; total 140 130 144 112 27 136 76 55 83 76 117 136 76 76 27 88 53 74 34 134 135 77 47 89 78 74 76 92 75 73 74 87 69 77 132 77 34 77 136 77 74 77 76 129 129 99 69 82542 "Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase" 146 146 146 117 26 142 79 57 87 79 121 141 80 80 26 91 56 77 36 140 140 80 49 93 81 77 79 96 78 76 77 90 76 80 137 80 36 80 142 80 76 80 79 134 134 103 71 82550 "Creatine kinase (CK), (CPK); total" 91 86 96 73 22 88 49 36 54 51 76 88 48 48 32 57 33 48 22 87 87 50 31 58 51 48 49 60 39 47 43 56 50 50 86 50 22 50 88 50 48 50 49 79 83 51 44 82553 "Creatine kinase (CK), (CPK); MB fraction only" 125 125 125 100 31 122 68 49 74 68 104 121 69 69 49 78 48 66 31 120 120 69 42 80 70 66 68 82 67 65 66 77 69 69 118 68 31 69 122 69 66 68 68 115 115 88 61 82565 Creatinine; blood 55 52 58 44 13 53 30 22 33 27 46 53 34 34 16 34 22 28 13 53 53 30 19 35 30 30 30 36 31 29 29 34 30 30 52 30 13 30 53 30 29 27 29 51 51 32 27 82570 Creatinine; other source 53 51 56 42 13 51 29 21 31 27 44 51 29 29 26 33 29 28 13 49 51 29 18 34 30 28 29 35 33 28 28 33 29 29 50 29 13 29 51 29 28 29 29 49 47 31 26 82575 Creatinine; clearance 89 86 96 71 22 86 48 35 53 48 74 86 49 49 34 55 34 47 22 85 85 49 30 56 49 47 48 58 47 46 47 55 51 49 83 48 22 49 86 49 46 48 45 82 81 60 43 82595 "Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)" 92 92 92 74 22 89 50 36 55 50 76 89 51 51 36 58 35 49 22 88 88 51 31 59 51 49 50 61 49 48 49 57 42 51 87 50 23 51 89 51 48 50 43 85 84 65 45 82607 Cyanocobalamin (Vitamin B-12); 126 120 132 101 31 122 68 49 75 62 105 122 70 70 55 79 53 69 31 116 121 69 43 80 70 69 68 83 73 66 67 78 69 69 118 69 31 69 122 69 66 73 69 116 110 73 61 82610 Cystatin C 168 168 168 134 41 163 91 66 100 91 139 163 99 99 65 105 64 89 41 161 161 93 57 107 94 89 91 111 90 87 89 104 88 92 158 92 41 92 163 92 88 92 91 155 154 118 82 82627 Dehydroepiandrosterone-sulfate (DHEA-S) 225 214 225 180 40 218 122 88 134 121 187 218 124 124 40 141 86 119 55 218 216 124 76 143 125 119 122 148 120 117 119 139 118 124 212 123 55 124 218 124 118 123 122 207 206 158 110 82652 "Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed" 292 292 292 234 71 283 158 115 174 158 242 283 160 160 113 183 111 155 71 279 280 161 99 186 163 154 158 192 156 152 154 181 99 161 275 159 72 161 283 161 153 159 158 269 268 269 143 82656 "Elastase, pancreatic (EL-1), fecal, qualitative or semi-quantitative" 523 523 578 418 13 507 284 205 311 282 434 506 287 287 40 327 199 277 127 500 502 288 177 333 291 277 283 344 280 272 276 324 13 288 492 286 128 288 507 288 274 285 284 481 479 368 255 82668 Erythropoietin 175 175 175 140 43 170 95 69 104 94 145 169 96 96 68 109 66 93 43 167 168 96 59 111 97 92 95 115 94 91 92 108 91 96 164 95 43 96 170 96 92 89 95 161 160 123 85 82670 Estradiol 166 159 174 133 40 161 90 65 99 90 138 161 92 92 54 104 54 88 40 159 159 91 56 106 92 88 90 109 91 86 88 103 88 91 156 91 41 91 161 91 87 90 90 153 152 153 81 82677 Estriol 123 123 123 99 30 120 67 48 73 66 102 119 74 74 64 77 47 65 30 118 118 68 42 78 69 65 67 81 66 64 65 76 64 68 116 67 30 68 120 68 65 67 67 113 113 87 60 82728 Ferritin 114 109 120 91 21 116 62 21 68 64 95 116 63 63 53 71 50 60 28 109 109 63 39 73 64 62 62 75 63 59 68 71 63 63 107 62 28 63 111 63 60 63 63 105 100 66 56 82746 Folic acid; serum 123 117 129 98 25 119 67 48 73 61 102 119 68 68 55 77 25 65 30 118 118 68 42 78 69 67 67 81 75 64 65 76 68 68 116 67 30 68 119 68 64 69 68 113 108 69 60 82784 "Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each" 185 176 388 148 32 179 100 73 110 100 154 179 97 97 32 116 53 98 45 177 178 102 63 118 103 98 100 122 99 96 98 114 102 102 174 101 45 102 179 102 97 135 90 170 169 138 90 82787 "Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each" 88 44 132 70 21 85 48 34 52 47 73 85 48 48 34 55 33 46 21 84 84 48 30 56 49 46 48 58 47 46 46 54 46 48 82 48 21 48 85 48 46 48 46 81 80 62 43 82800 "Gases, blood, pH only" 79 75 83 63 19 77 43 31 47 43 66 76 39 39 31 49 30 42 19 75 76 44 27 50 44 42 43 52 42 41 42 49 43 43 74 43 19 43 77 43 41 43 43 73 72 56 39 82803 "Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);" 96 92 384 77 23 93 52 38 57 48 80 93 53 53 37 60 50 52 23 92 92 53 32 61 53 51 52 63 59 50 51 59 53 53 90 52 24 53 93 53 50 56 54 88 93 53 47 82945 "Glucose, body fluid, other than blood" 55 55 55 44 13 53 30 22 33 30 46 53 30 30 21 34 21 29 13 53 53 30 19 35 31 29 30 36 29 29 29 34 29 30 52 30 13 30 53 30 29 30 30 51 50 39 27 82947 "Glucose; quantitative, blood (except reagent strip)" 41 39 43 33 6 40 22 16 6 22 34 40 23 23 26 26 23 22 10 40 39 23 14 26 23 22 22 27 22 21 22 25 23 23 39 22 10 23 40 23 21 23 23 38 40 38 20 82948 "Glucose; blood, reagent strip" 18 18 19 14 4 17 10 7 11 10 15 17 10 10 7 11 7 10 4 17 17 10 6 11 10 10 10 12 10 9 10 11 10 10 17 10 4 10 17 10 9 10 10 17 16 10 9 82950 Glucose; post glucose dose (includes glucose) 42 42 42 34 10 41 23 17 25 23 35 41 22 22 33 26 16 22 10 40 40 23 14 27 23 22 23 28 23 22 22 26 22 23 40 23 10 23 41 23 22 23 23 39 39 30 21 82951 "Glucose; tolerance test (GTT), 3 specimens (includes glucose)" 88 86 90 70 21 85 48 34 52 47 73 85 48 48 53 55 33 47 21 84 84 48 30 56 49 47 48 58 52 46 46 54 46 48 83 48 22 48 85 48 46 48 48 81 81 62 43 82952 "Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)" 42 41 43 34 10 41 23 16 25 23 35 41 23 23 26 26 16 22 10 40 40 23 14 27 23 22 23 28 25 22 22 26 22 23 39 23 10 23 41 23 22 23 23 39 38 30 20 82955 Glucose-6-phosphate dehydrogenase (G6PD); quantitative 98 98 116 78 24 95 53 38 58 53 81 95 54 54 86 61 37 52 24 94 94 54 33 62 55 52 53 64 52 51 52 61 51 54 92 54 24 54 95 54 51 53 53 90 90 64 48 82960 Glucose-6-phosphate dehydrogenase (G6PD); screen 106 106 106 85 26 103 57 41 63 57 88 102 58 58 43 66 40 56 26 101 102 58 36 67 59 56 57 70 57 55 56 65 55 58 100 58 26 58 103 58 55 58 57 97 97 74 52 82962 "Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use" 51 49 714 41 12 49 29 20 30 27 42 49 28 28 20 32 19 28 12 47 49 28 17 32 30 27 28 34 31 27 27 32 28 28 48 28 12 28 49 28 27 30 28 47 45 28 25 82977 "Glutamyltransferase, gamma (GGT)" 63 60 66 50 15 61 34 25 37 35 52 61 31 31 26 39 26 33 15 60 60 35 21 40 34 34 33 41 35 33 30 39 35 35 59 34 15 35 61 35 33 35 35 58 55 58 31 82985 Glycated protein 121 121 133 97 29 117 65 47 72 63 100 117 66 66 86 76 46 64 29 115 116 66 41 77 67 64 65 79 65 63 64 75 66 66 113 66 30 66 117 66 63 66 65 111 111 85 59 83001 Gonadotropin; follicle stimulating hormone (FSH) 156 148 164 125 27 151 85 61 93 84 129 151 96 96 27 98 27 83 38 144 150 86 53 99 87 83 85 103 91 81 82 97 82 86 147 85 38 86 151 86 82 85 85 144 143 147 76 83002 Gonadotropin; luteinizing hormone (LH) 156 148 164 125 27 151 85 61 93 84 129 151 89 89 27 98 59 83 38 151 150 86 53 99 87 83 85 103 95 81 82 97 84 86 147 85 38 86 151 86 82 85 85 144 143 110 76 83003 "Growth hormone, human (HGH) (somatotropin)" 90 90 90 72 22 87 49 35 53 49 75 87 49 49 27 56 34 48 22 86 86 50 30 57 50 48 49 59 48 47 48 56 47 50 85 49 22 50 87 50 47 49 49 83 82 63 44 83018 "Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each" 158 158 158 126 39 153 86 62 94 85 131 153 87 87 61 99 60 84 39 151 152 87 53 101 88 84 86 104 85 82 83 98 83 87 149 86 39 87 153 87 83 86 87 145 145 111 77 83036 Hemoglobin; glycosylated (A1C) 95 60 100 76 15 97 47 15 33 53 79 95 53 53 32 59 52 52 23 97 91 52 32 60 57 52 55 62 52 49 50 59 52 52 89 52 23 52 92 55 50 52 52 87 92 55 46 83090 Homocysteine 282 282 282 226 69 274 153 111 168 152 234 273 155 155 109 176 107 149 69 270 271 155 95 179 157 149 153 185 151 147 149 174 155 155 265 154 69 155 274 155 148 154 153 259 258 198 138 83498 "Hydroxyprogesterone, 17-d" 145 135 155 116 26 140 79 57 86 78 120 140 80 80 26 91 55 77 35 131 139 80 49 92 81 77 78 95 78 75 76 90 76 80 136 79 35 80 140 80 76 79 78 133 133 102 71 83516 "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method" 72 66 296 58 18 70 39 28 43 39 60 70 41 41 41 45 51 38 18 69 69 40 24 46 40 66 39 47 44 37 38 45 38 40 68 39 18 40 70 40 38 38 39 64 66 68 35 83519 "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)" 350 350 350 280 85 340 190 137 208 189 290 339 192 192 136 219 133 185 85 334 336 193 118 223 195 185 190 230 187 182 185 217 192 192 329 191 86 192 340 193 183 191 190 322 321 246 171 83520 "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified" 82 78 450 66 20 140 44 32 49 44 68 79 45 45 32 51 31 43 20 78 79 45 28 52 46 43 44 54 44 43 43 51 43 45 77 45 20 45 80 45 43 45 140 75 75 58 40 83525 Insulin; total 66 66 74 53 16 68 36 26 39 36 55 64 38 38 26 41 55 35 16 68 64 36 22 42 37 35 36 44 35 34 35 41 35 36 62 36 16 36 64 36 35 36 36 61 61 47 32 83540 Iron 54 52 57 43 10 55 29 10 32 30 45 55 30 30 26 34 18 29 13 52 52 30 18 34 30 29 29 36 30 28 32 33 30 30 51 29 13 30 52 30 28 31 30 50 47 31 26 83550 Iron binding capacity 66 62 69 53 13 67 36 13 39 37 55 67 37 37 28 41 26 35 16 63 63 36 22 42 37 36 36 43 36 34 39 41 36 36 62 36 16 36 64 36 35 38 36 61 57 38 32 83605 Lactate (lactic acid) 168 160 672 134 41 163 94 66 100 94 139 163 91 91 53 105 85 89 41 155 161 93 57 107 94 92 88 111 93 87 80 104 92 92 158 92 41 92 163 92 88 92 92 155 162 97 82 83615 "Lactate dehydrogenase (LD), (LDH);" 82 60 86 66 20 80 44 32 49 46 68 79 46 46 26 51 33 43 20 78 79 45 28 52 46 43 44 54 44 43 43 51 45 45 77 45 20 45 80 45 43 45 45 75 79 45 40 83655 Lead 75 72 79 60 18 73 41 29 45 40 62 73 44 44 41 47 41 41 18 72 72 41 25 48 43 40 41 49 46 39 40 46 39 41 71 41 18 41 73 41 39 41 41 69 69 69 37 83690 Lipase 62 59 65 50 15 60 34 24 37 35 51 60 34 34 16 39 23 33 15 59 60 34 21 39 35 33 36 41 34 32 30 38 34 34 58 34 15 34 60 36 32 34 34 57 55 57 30 83695 Lipoprotein (a) 90 90 90 72 22 87 49 35 53 49 75 87 49 49 35 56 34 48 22 86 86 50 30 57 50 48 49 59 48 47 48 56 46 50 85 49 22 50 87 50 47 49 49 83 82 63 44 83704 "Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (eg, by nuclear magnetic resonance spectroscopy)" 115 115 115 92 28 112 62 45 68 62 95 111 63 63 45 72 103 61 28 110 110 63 39 73 64 61 62 76 62 60 61 71 60 63 108 63 28 63 112 63 60 63 62 106 105 81 56 83718 "Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)" 65 65 65 52 16 63 35 26 39 35 54 63 36 36 43 41 25 35 16 62 63 36 22 42 36 35 35 43 35 34 35 40 34 36 61 36 16 36 63 36 34 36 35 60 60 46 32 83721 "Lipoprotein, direct measurement; LDL cholesterol" 65 62 68 52 16 66 35 25 39 35 54 63 36 36 53 41 57 34 16 66 62 36 22 41 36 34 35 43 36 34 34 40 36 36 61 35 16 36 63 36 34 37 37 60 60 37 32 83735 Magnesium 59 56 124 47 11 57 32 11 35 31 49 57 33 33 26 37 26 32 14 55 57 33 20 38 36 32 31 39 32 31 29 36 32 32 55 32 14 32 57 32 31 32 32 54 52 34 29 83874 Myoglobin 136 136 136 108 33 132 74 53 81 73 113 131 75 75 53 85 52 72 33 130 130 75 46 86 76 72 73 89 73 71 72 84 64 75 127 74 33 75 132 75 71 74 74 125 124 95 66 83880 Natriuretic peptide 205 195 215 164 50 209 111 80 122 108 170 209 114 114 113 128 128 112 50 189 197 113 69 130 118 112 107 135 113 107 108 127 113 113 193 112 50 113 199 113 101 113 113 189 198 113 100 83883 "Nephelometry, each analyte not elsewhere specified" 98 88 98 78 24 95 53 38 58 47 81 95 54 54 38 61 37 52 24 94 94 54 33 62 55 52 53 64 52 51 52 61 52 54 92 54 24 54 95 54 51 51 54 90 90 41 48 83915 Nucleotidase 5'- 55 55 55 44 13 86 30 22 33 30 46 53 30 30 21 34 86 29 13 53 53 30 19 35 31 29 30 36 29 29 29 34 29 30 52 30 13 30 53 30 29 30 30 51 50 39 27 83921 "Organic acid, single, quantitative" 103 98 108 82 25 100 56 40 61 56 85 100 58 58 40 64 39 55 25 98 99 57 35 66 57 54 56 68 55 54 54 64 57 57 97 56 25 57 100 57 54 56 57 95 94 57 50 83930 Osmolality; blood 55 37 58 44 13 53 30 22 33 30 46 53 30 30 32 34 21 29 13 53 53 30 19 35 31 29 30 36 29 29 29 34 31 30 52 30 13 30 53 30 29 30 30 51 50 30 27 83935 Osmolality; urine 57 57 60 46 14 55 31 22 34 31 47 55 31 31 21 36 22 30 14 54 55 31 19 36 32 30 31 37 31 30 30 35 31 31 54 31 14 31 55 31 30 31 31 52 52 31 28 83970 Parathormone (parathyroid hormone) 245 234 257 196 60 249 133 96 146 121 203 249 144 144 107 153 118 130 60 234 235 135 83 156 136 130 133 161 149 127 129 152 135 135 230 134 60 135 238 135 128 121 135 225 224 141 120 83986 "pH; body fluid, not otherwise specified" 18 18 18 14 4 17 10 7 11 10 15 17 10 10 7 11 7 10 4 17 17 10 6 11 10 10 10 12 10 9 10 11 10 10 17 10 4 10 17 10 9 10 10 17 16 13 9 83993 "Calprotectin, fecal" 315 300 315 252 17 306 171 123 187 170 261 305 185 185 111 197 120 17 77 301 302 174 106 200 175 167 171 207 169 164 166 195 167 173 296 172 77 173 306 173 165 172 171 290 289 290 154 84075 "Phosphatase, alkaline;" 57 57 60 46 14 55 31 22 34 31 47 55 32 32 26 36 19 30 14 55 55 31 19 36 33 31 31 37 31 30 30 35 31 31 54 31 14 31 55 31 30 31 31 52 52 31 28 84080 "Phosphatase, alkaline; isoenzymes" 86 84 92 69 21 83 47 34 51 46 71 83 47 47 33 54 43 45 21 82 82 47 29 55 48 45 47 56 46 45 45 53 48 47 81 47 21 47 83 47 45 47 47 79 79 60 42 84100 Phosphorus inorganic (phosphate); 48 46 50 38 12 47 26 19 29 24 40 46 29 29 15 30 13 25 12 46 46 26 16 31 27 25 26 32 20 25 25 30 26 26 45 26 12 26 47 26 25 26 26 44 44 42 23 84110 "Porphobilinogen, urine; quantitative" 50 50 50 40 12 48 27 20 30 27 41 48 30 30 19 31 19 26 12 48 48 28 17 32 28 26 27 33 27 26 26 31 26 28 47 27 12 28 48 28 26 27 27 46 46 35 24 84132 "Potassium; serum, plasma or whole blood" 59 56 62 47 13 57 32 23 35 29 49 57 36 36 13 37 26 30 14 57 57 33 20 38 33 31 32 39 32 31 31 36 32 32 55 32 14 32 57 32 31 31 31 54 52 52 29 84133 Potassium; urine 58 55 61 46 14 56 31 23 34 31 48 56 32 32 17 36 22 31 14 55 56 32 20 37 32 31 31 38 31 30 31 36 32 32 55 32 14 32 56 32 30 32 31 53 53 41 28 84134 Prealbumin 103 98 103 82 25 100 56 40 61 56 85 100 57 57 26 64 39 55 25 98 99 57 35 66 57 54 56 68 55 54 54 64 57 57 97 56 25 57 100 57 54 56 50 95 94 95 50 84144 Progesterone 175 167 184 140 43 170 95 69 104 94 145 169 86 86 54 110 67 93 43 167 168 96 59 111 97 93 95 115 94 91 92 108 91 96 165 96 43 96 170 96 92 95 95 161 160 161 85 84146 Prolactin 171 155 171 137 27 166 93 67 102 92 142 166 80 80 27 107 32 91 42 162 164 94 58 109 95 90 93 112 90 89 90 106 87 94 161 93 42 94 166 94 89 93 93 157 157 157 83 84153 Prostate specific antigen (PSA); total 158 150 166 126 28 153 86 62 28 78 131 153 88 88 55 99 53 84 39 146 152 87 53 101 88 83 86 104 97 82 83 98 87 87 149 86 39 87 153 87 83 85 87 145 145 91 77 84154 Prostate specific antigen (PSA); free 154 147 162 123 26 149 84 60 91 83 128 149 95 95 26 96 59 82 38 143 148 85 52 98 86 81 83 101 82 80 81 95 85 85 145 84 38 85 149 85 81 85 75 142 141 87 75 84155 "Protein, total, except by refractometry; serum, plasma or whole blood" 73 70 73 58 13 71 40 29 43 39 61 71 40 40 13 46 28 39 18 70 70 40 25 46 41 39 40 48 39 38 39 45 40 40 69 40 18 40 71 40 38 40 36 67 67 67 36 84156 "Protein, total, except by refractometry; urine" 73 70 77 58 14 75 40 29 43 37 61 71 41 41 14 46 14 39 18 70 70 40 25 46 41 39 40 48 39 38 39 45 40 40 75 40 18 40 71 40 38 40 38 67 64 42 36 84157 "Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)" 62 62 62 50 15 60 34 24 37 33 51 60 34 34 24 39 24 33 15 59 60 34 21 39 35 33 34 41 33 32 33 38 33 34 58 34 15 34 60 34 32 34 34 57 57 44 30 84165 "Protein; electrophoretic fractionation and quantitation, serum" 91 86 96 73 22 88 49 36 54 45 76 88 44 44 35 57 35 48 22 87 87 50 31 58 51 48 49 60 49 47 48 56 50 50 86 50 22 50 88 50 48 53 53 84 83 50 44 84166 "Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)" 104 104 104 83 25 101 56 41 62 54 86 100 57 57 40 65 39 55 25 99 100 57 35 66 58 55 56 68 56 54 55 64 36 57 98 57 25 57 101 57 54 54 49 95 95 73 51 84207 Pyridoxal phosphate (Vitamin B-6) 259 200 272 207 63 251 140 102 154 140 215 251 142 142 100 162 98 137 63 248 249 143 88 165 144 137 140 170 139 135 137 160 135 142 244 141 63 142 251 142 136 141 104 238 237 142 126 84238 Receptor assay; non-endocrine (specify receptor) 240 240 240 192 58 233 130 94 143 129 199 232 132 132 93 150 91 127 58 229 230 132 81 153 134 127 130 158 128 125 127 148 125 132 226 131 59 132 233 132 126 131 130 221 220 132 117 84244 Renin 132 126 132 106 32 128 72 52 78 71 110 128 73 73 42 83 50 70 32 126 127 73 45 84 74 70 72 87 71 69 70 82 70 73 124 72 32 73 128 73 69 72 72 121 121 93 64 84260 Serotonin 363 363 363 290 88 352 197 142 216 196 301 351 199 199 141 227 138 192 88 347 348 200 123 231 202 192 197 239 200 189 192 225 190 200 341 198 89 200 352 200 190 198 197 334 333 255 177 84295 "Sodium; serum, plasma or whole blood" 59 56 62 47 13 57 32 23 35 29 49 57 36 36 13 37 17 31 14 57 57 33 20 38 33 31 32 39 32 31 31 36 32 32 55 32 14 32 57 32 31 32 32 54 54 54 29 84300 Sodium; urine 67 64 67 54 14 65 36 26 40 36 56 65 37 37 14 42 25 35 16 64 64 37 23 43 37 35 36 44 36 35 35 41 35 37 63 37 16 37 65 37 35 37 35 62 61 47 33 84305 Somatomedin 174 165 183 139 27 169 94 68 103 94 144 168 96 96 27 109 66 92 42 166 167 96 59 111 97 92 94 114 93 90 92 108 91 96 164 95 43 96 169 96 91 95 94 160 159 122 85 84311 "Spectrophotometry, analyte not elsewhere specified" 46 46 46 37 11 45 25 18 27 25 38 45 25 25 18 29 17 24 11 44 44 25 16 29 26 24 25 30 25 24 24 28 24 25 43 25 11 25 45 25 24 25 25 42 42 32 22 84402 Testosterone; free 161 145 161 129 27 156 87 63 96 87 134 156 75 75 27 101 61 85 39 152 155 89 54 102 90 85 87 106 86 84 73 100 85 89 151 88 39 89 156 89 84 88 87 148 147 148 79 84403 Testosterone; total 216 206 227 173 27 215 117 85 128 117 179 209 120 120 27 135 27 114 53 215 207 119 73 137 120 114 117 142 119 112 103 134 119 119 203 118 53 119 210 119 113 118 117 199 199 199 105 84425 Thiamine (Vitamin B-1) 239 228 251 191 30 232 130 94 142 129 198 231 131 131 30 150 91 127 58 228 229 132 81 152 133 126 129 157 128 124 126 148 131 131 225 130 59 131 232 131 125 130 118 220 219 131 117 84432 Thyroglobulin 182 173 191 146 44 177 99 71 108 98 151 176 100 100 55 114 69 96 44 174 175 100 61 116 101 96 99 120 97 95 96 113 84 100 171 99 45 100 177 100 95 99 100 167 167 100 89 84439 Thyroxine; free 82 78 86 66 14 83 46 14 49 41 65 83 46 46 54 51 54 45 20 81 79 45 28 52 45 45 46 54 45 43 49 51 45 45 77 45 20 45 80 45 43 45 45 75 67 72 40 84443 Thyroid stimulating hormone (TSH) 142 136 149 114 15 145 80 26 84 71 113 145 79 79 49 89 54 79 15 138 136 78 48 90 82 78 78 93 78 74 85 70 78 78 134 78 35 78 138 78 74 78 78 131 117 131 69 84446 Tocopherol alpha (Vitamin E) 74 73 76 60 18 72 40 29 44 40 62 72 41 41 29 47 28 39 18 71 71 41 25 47 41 39 40 49 40 39 39 46 37 41 70 41 18 41 72 41 39 41 38 68 68 42 36 84450 Transferase; aspartate amino (AST) (SGOT) 57 54 60 46 13 55 31 22 34 31 45 55 31 31 16 36 13 30 14 53 55 31 19 36 31 31 30 37 33 30 30 35 31 31 54 31 14 31 55 31 30 33 31 52 47 50 28 84460 Transferase; alanine amino (ALT) (SGPT) 57 54 60 46 13 55 31 22 34 31 47 55 32 32 13 36 13 30 14 54 55 31 19 36 31 31 30 37 31 30 30 35 31 31 54 31 14 31 55 31 30 31 31 52 50 33 28 84466 Transferrin 76 76 76 61 19 74 41 30 45 41 63 74 42 42 26 48 29 40 19 73 73 42 26 48 42 40 41 50 41 40 40 47 42 42 71 41 19 42 74 42 40 41 41 70 70 70 37 84478 Triglycerides 58 52 58 46 14 56 31 23 34 31 48 56 29 29 23 36 22 31 14 55 56 32 20 37 32 31 31 38 31 30 31 36 31 32 55 32 14 32 56 32 30 32 31 53 53 41 28 84480 Triiodothyronine T3; total (TT-3) 54 52 57 43 13 52 29 21 32 29 45 52 30 30 27 34 21 29 13 52 52 30 18 34 30 29 29 36 29 28 29 33 30 30 51 29 13 30 52 30 28 29 27 50 49 30 26 84481 Triiodothyronine T3; free 154 147 162 123 26 157 84 60 91 81 128 157 86 86 27 96 26 82 38 143 148 85 52 98 86 81 83 101 86 80 74 95 85 85 145 84 38 85 149 85 81 85 85 142 135 89 75 84482 Triiodothyronine T3; reverse 149 149 149 119 28 145 81 58 89 80 124 144 82 82 28 93 57 79 36 142 143 82 50 95 83 79 81 98 80 78 79 92 78 82 140 81 37 82 145 82 78 81 81 137 137 105 73 84484 "Troponin, quantitative" 231 220 729 185 15 336 130 15 137 130 192 336 128 128 53 145 53 126 56 236 222 127 78 147 134 127 134 152 127 120 121 143 127 127 217 126 57 127 224 127 114 127 127 213 224 134 113 84520 Urea nitrogen; quantitative 52 49 55 42 13 50 28 20 31 28 43 50 32 32 13 33 16 26 13 50 50 29 18 33 29 28 28 34 28 27 27 32 29 29 49 28 13 29 50 29 27 25 25 48 48 30 25 84550 Uric acid; blood 48 46 50 38 12 47 26 19 29 24 40 46 27 27 26 30 19 25 12 46 46 26 16 31 27 25 25 32 26 25 25 30 26 26 45 26 12 26 47 26 25 26 26 44 44 26 23 84588 "Vasopressin (antidiuretic hormone, ADH)" 176 176 176 141 43 171 95 69 105 95 146 170 97 97 55 110 67 93 43 168 169 97 59 112 98 93 95 116 94 92 93 109 92 97 165 96 43 97 171 97 92 96 95 162 161 124 86 84590 Vitamin A 66 66 66 53 16 64 36 26 39 36 55 64 36 36 26 41 25 35 16 63 64 36 22 42 37 35 36 44 35 34 35 41 34 36 62 36 16 36 64 36 35 36 36 61 61 47 32 84630 Zinc 101 99 104 81 25 98 55 40 60 55 84 98 56 56 42 63 39 54 25 97 97 56 34 64 56 54 55 67 54 53 54 63 52 56 95 55 25 56 98 56 53 55 55 93 93 71 49 84681 C-peptide 121 121 121 97 30 118 66 48 72 65 101 117 62 62 47 76 46 64 30 116 116 67 41 77 68 64 66 80 65 63 64 75 64 67 114 66 30 67 118 67 63 66 66 112 111 85 59 84702 "Gonadotropin, chorionic (hCG); quantitative" 142 136 149 114 27 138 77 56 84 77 118 137 79 79 27 89 54 78 35 136 136 78 48 90 82 75 82 93 43 74 75 88 74 78 134 78 35 78 138 78 74 77 77 131 130 131 69 84703 "Gonadotropin, chorionic (hCG); qualitative" 65 62 68 52 16 63 35 25 39 35 54 63 34 34 26 41 32 36 16 62 62 36 22 41 36 34 37 43 36 34 34 40 33 36 61 35 16 36 63 36 34 32 35 60 60 60 32 85004 Blood count; automated differential WBC count 42 40 44 34 10 41 23 16 25 23 35 41 23 23 16 26 16 22 10 40 40 23 14 27 23 22 23 28 22 22 22 26 23 23 39 23 10 23 41 23 22 23 23 39 38 30 20 85007 "Blood count; blood smear, microscopic examination with manual differential WBC count" 35 33 37 28 9 40 19 14 21 19 29 34 21 21 30 22 40 19 9 33 34 19 12 22 19 19 19 23 19 18 18 22 19 19 33 19 9 19 34 19 18 19 19 32 30 19 9 85014 Blood count; hematocrit (Hct) 47 45 49 38 11 46 25 18 28 25 39 46 26 26 29 29 29 26 11 45 45 26 16 30 27 26 25 31 25 24 25 29 26 26 44 26 12 26 46 26 25 26 26 43 43 43 23 85018 Blood count; hemoglobin (Hgb) 47 45 49 38 11 46 25 18 28 25 39 46 29 29 29 29 15 26 11 45 45 26 16 30 27 26 25 31 28 24 25 29 26 26 44 26 12 26 46 26 25 26 26 43 43 27 23 85025 "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count" 91 86 96 73 7 91 51 12 85 51 72 91 51 51 29 52 30 50 7 88 83 50 12 58 50 50 53 60 50 47 49 44 50 50 86 50 22 50 88 53 45 50 50 84 84 53 50 85027 "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)" 76 72 80 61 15 74 41 30 45 41 63 74 42 42 15 48 29 40 19 73 73 42 26 48 44 40 41 50 42 40 46 47 42 42 71 41 19 42 74 42 40 42 42 70 66 42 21 85044 "Blood count; reticulocyte, manual" 62 59 65 50 15 63 34 24 37 33 51 63 26 26 29 39 20 33 15 59 60 34 21 39 35 33 34 41 15 32 37 38 34 34 58 34 15 34 60 34 32 35 36 57 55 36 30 85048 "Blood count; leukocyte (WBC), automated" 52 50 55 42 13 50 28 20 31 28 43 50 29 29 18 33 20 28 13 50 50 29 18 33 29 28 28 34 28 27 27 32 29 29 49 28 13 29 50 29 27 28 29 48 48 48 25 85049 "Blood count; platelet, automated" 49 46 51 39 12 48 27 19 29 26 41 47 27 27 18 31 19 26 12 47 47 27 17 31 27 26 27 32 26 25 26 30 27 27 46 27 12 27 48 27 26 27 28 45 45 45 24 85246 "Clotting; factor VIII, VW factor antigen" 267 267 267 214 65 259 145 105 159 144 222 259 147 147 104 167 102 141 65 255 256 147 90 170 149 141 145 176 147 139 141 165 140 147 251 146 65 147 259 147 140 146 145 246 245 188 130 85306 "Clotting inhibitors or anticoagulants; protein S, free" 88 88 88 71 22 86 48 35 52 48 73 85 45 45 34 55 34 47 22 84 85 49 30 56 49 47 48 58 47 46 47 55 46 49 83 48 22 49 86 49 46 48 48 81 81 62 43 85379 "Fibrin degradation products, D-dimer; quantitative" 104 99 109 83 24 101 56 41 62 58 86 101 58 58 24 65 24 55 25 99 100 57 35 66 60 57 55 68 57 54 55 64 57 57 98 57 25 57 101 57 52 55 57 96 100 96 51 85384 Fibrinogen; activity 125 125 132 100 12 122 68 49 74 74 104 121 65 65 12 78 48 66 31 120 120 69 42 80 70 66 68 82 67 65 66 77 64 69 118 68 31 69 122 69 66 64 64 115 115 115 61 85549 Muramidase 138 138 138 110 15 133 75 54 82 74 114 133 76 76 15 86 52 73 34 131 132 76 46 87 77 73 74 90 74 72 73 85 72 76 129 75 34 76 133 76 72 75 75 126 126 97 67 85610 Prothrombin time; 48 42 50 38 12 47 26 19 29 24 40 47 26 26 24 30 27 25 12 47 46 26 16 31 26 26 26 32 26 25 24 30 26 26 45 26 12 26 47 26 25 26 26 44 42 28 23 85652 "Sedimentation rate, erythrocyte; automated" 53 48 56 42 13 54 29 21 31 27 44 54 29 29 15 33 18 28 13 51 51 29 18 34 29 29 26 35 29 28 28 33 29 29 50 29 13 29 51 29 28 28 29 44 49 31 26 85660 "Sickling of RBC, reduction" 50 48 50 40 12 48 27 20 30 27 41 48 29 29 30 31 19 26 12 48 48 28 17 32 28 26 27 33 27 26 26 31 26 28 47 27 12 28 48 28 26 27 27 46 46 44 24 85730 "Thromboplastin time, partial (PTT); plasma or whole blood" 52 49 55 42 13 50 28 20 31 29 43 50 24 24 13 33 13 28 13 50 50 29 18 33 29 28 28 34 29 27 27 32 29 29 49 28 13 29 50 29 27 27 28 48 48 48 25 86037 "Antineutrophil cytosplasmic antibody (ANCA); titer, each antibody" 202 101 303 162 48 196 110 79 120 109 168 196 111 111 48 126 77 107 49 193 194 111 68 129 113 107 109 133 108 105 107 125 82 111 190 110 49 111 196 111 106 110 110 186 185 142 99 86038 Antinuclear antibodies (ANA); 75 72 79 60 18 73 41 29 45 37 62 73 38 38 48 47 54 40 18 72 72 41 25 48 41 41 39 49 44 39 40 46 41 41 71 41 18 41 73 41 39 41 37 69 66 41 37 86039 Antinuclear antibodies (ANA); titer 75 72 79 60 18 73 41 29 45 37 62 73 43 43 24 47 29 40 18 72 72 41 25 48 41 41 41 49 41 39 40 46 41 41 71 41 18 41 73 41 39 43 34 69 66 66 37 86060 Antistreptolysin 0; titer 59 59 59 47 14 57 32 23 35 32 49 57 32 32 23 37 22 31 14 56 56 32 20 37 33 31 32 39 31 30 31 36 31 32 55 32 14 32 57 32 31 32 32 54 54 54 29 86140 C-reactive protein; 83 79 87 66 8 81 47 8 49 44 69 80 46 46 48 52 51 45 20 77 80 46 28 53 48 45 46 55 46 43 40 51 46 46 78 45 20 46 81 48 41 46 46 76 76 48 52 86141 C-reactive protein; high sensitivity (hsCRP) 92 92 92 74 22 89 50 36 55 50 76 89 51 51 25 58 35 49 22 88 88 51 31 59 51 49 50 61 49 48 49 57 48 51 87 50 23 51 89 51 48 50 50 85 84 65 45 86160 "Complement; antigen, each component" 96 96 101 77 23 93 52 38 57 52 80 93 53 53 27 60 37 51 23 92 92 53 32 61 53 51 52 63 51 50 51 59 56 53 90 52 24 53 93 53 50 52 45 88 88 68 47 86162 Complement; total hemolytic (CH50) 116 116 121 92 25 112 63 45 69 62 96 112 63 63 25 72 44 61 28 110 111 64 39 73 64 61 63 76 62 60 61 71 59 64 109 63 28 64 112 64 60 63 54 106 106 81 56 86200 "Cyclic citrullinated peptide (CCP), antibody" 87 83 91 70 21 84 47 34 52 47 72 84 49 49 24 54 33 46 21 83 84 48 29 55 47 47 47 57 47 45 46 54 45 48 82 47 21 48 84 48 46 42 47 80 80 61 42 86225 Deoxyribonucleic acid (DNA) antibody; native or double stranded 119 113 125 95 27 115 65 47 71 64 99 115 65 65 27 74 45 63 29 114 114 66 40 76 66 65 64 78 64 62 63 74 66 65 112 65 29 65 115 65 62 65 65 109 109 84 58 86231 "Endomysial antibody (EMA), each immuniglobuling )lg) class" 109 109 109 87 27 106 59 43 65 59 90 106 60 60 48 68 41 58 27 104 105 60 37 69 61 58 59 72 58 57 58 67 57 60 102 60 27 60 106 60 57 59 59 100 100 77 53 86235 "Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody" 183 165 732 146 45 224 99 72 109 99 152 177 99 99 71 115 70 97 45 175 176 101 62 116 102 132 99 120 98 95 97 113 224 101 172 100 45 101 178 101 96 100 99 168 168 129 89 86255 "Fluorescent noninfectious agent antibody; screen, each antibody" 132 104 170 105 32 149 71 52 78 71 109 127 69 69 36 82 50 70 32 126 126 73 44 84 73 70 71 87 70 68 70 81 57 72 124 72 32 72 128 72 69 89 71 149 121 93 64 86256 "Fluorescent noninfectious agent antibody; titer, each antibody" 106 101 212 85 26 103 58 42 63 57 88 103 58 58 41 66 40 56 26 101 102 58 36 67 59 83 57 70 57 55 56 66 56 58 100 58 26 58 103 58 55 58 57 98 97 75 52 86258 "Gliadan (deamidated) DGP antibody, each immunoglobulin (lg) class" 148 148 148 118 24 144 80 58 88 80 123 143 81 81 24 93 56 78 36 141 142 82 50 94 82 78 80 97 79 77 78 92 77 81 139 81 36 81 144 81 77 81 80 136 136 104 72 86301 "Immunoassay for tumor antigen, quantitative; CA 19-9" 52 50 55 42 13 51 28 21 31 28 44 51 29 29 20 33 20 28 13 50 50 29 18 33 29 28 28 35 28 27 28 32 28 29 49 29 13 29 51 29 27 29 28 48 48 37 26 86304 "Immunoassay for tumor antigen, quantitative; CA 125" 166 166 183 133 33 161 90 65 99 90 138 161 91 91 34 104 33 88 40 159 159 91 56 106 92 88 90 109 89 86 88 103 90 91 156 91 41 91 161 91 87 90 85 153 152 78 81 86308 Heterophile antibodies; screening 55 52 58 44 13 53 30 22 33 30 46 53 31 31 48 34 51 29 13 53 53 30 19 35 31 29 30 36 30 29 29 34 31 30 52 30 13 30 53 30 29 30 27 51 50 51 27 86316 "Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each" 212 212 212 170 52 206 115 83 126 114 176 205 116 116 82 133 81 112 52 203 204 117 72 135 118 112 115 139 114 110 112 131 107 117 199 116 52 117 206 117 111 116 115 195 194 149 103 86334 Immunofixation electrophoresis; serum 131 128 141 105 32 127 71 51 78 71 109 127 72 72 51 82 50 69 32 125 126 72 44 83 73 69 71 86 70 68 69 81 68 72 123 71 32 72 127 72 68 71 63 120 120 78 64 86335 "Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)" 169 169 169 135 41 164 92 66 100 88 140 163 93 93 66 106 64 89 41 161 162 93 57 107 94 89 91 111 90 88 89 104 88 93 159 92 41 93 164 93 88 92 79 155 155 119 82 86336 Inhibin A 75 75 75 60 18 73 41 30 45 41 63 73 45 45 43 47 29 40 18 72 72 42 25 48 42 40 41 50 40 39 40 47 39 41 71 41 18 41 73 41 39 41 41 69 69 53 37 86364 "Tissue translutaminase, each immunoglobuling (lrg) class" 148 148 148 118 24 144 80 58 88 80 123 143 81 81 24 93 56 78 36 141 142 82 50 94 82 78 80 97 79 77 78 92 77 81 139 81 36 81 144 81 77 81 80 136 136 104 72 86376 "Microsomal antibodies (eg, thyroid or liver-kidney), each" 116 107 122 93 28 113 63 46 69 63 96 112 64 64 45 73 44 61 28 111 111 64 39 74 65 61 63 76 62 60 61 72 67 64 109 63 28 64 113 64 61 63 63 107 107 82 57 86430 Rheumatoid factor; qualitative 52 49 55 42 13 50 28 20 31 26 43 50 29 29 25 33 27 28 13 50 50 29 18 33 28 28 28 34 29 27 27 32 29 29 49 28 13 29 50 29 27 30 27 48 45 39 25 86431 Rheumatoid factor; quantitative 71 68 71 57 17 69 39 28 42 38 59 69 39 39 24 44 27 38 17 68 68 39 24 45 40 38 38 47 38 37 37 44 37 39 67 39 17 39 69 39 37 39 39 65 65 50 35 86480 "Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon" 347 331 364 278 66 337 188 136 206 195 288 336 191 191 66 217 83 184 85 332 333 191 117 221 191 184 188 228 186 180 183 215 175 191 326 189 85 191 337 191 182 189 182 319 319 304 169 86580 "Skin test; tuberculosis, intradermal" 55 55 55 44 13 53 30 22 33 30 46 53 30 30 21 34 21 29 13 53 53 30 19 35 31 29 30 36 15 29 29 34 29 30 52 30 13 30 53 30 29 30 30 51 50 39 27 86615 Antibody; Bordetella 96 91 101 77 23 93 52 38 57 50 80 93 53 53 25 60 37 51 23 92 92 53 32 61 53 51 52 63 59 50 51 59 53 53 90 52 24 53 93 53 50 53 53 88 88 53 47 86617 "Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)" 141 138 152 113 23 137 77 55 84 76 117 137 67 67 23 88 26 75 34 135 136 78 48 90 79 75 77 93 76 74 75 87 78 78 133 77 35 78 137 78 74 77 77 130 127 100 69 86618 Antibody; Borrelia burgdorferi (Lyme disease) 103 98 108 82 25 100 56 40 61 56 85 100 50 50 25 64 26 55 25 98 99 57 35 66 57 54 54 68 60 54 54 64 57 57 97 56 25 57 100 57 54 58 57 95 90 59 50 86635 Antibody; Coccidioides 115 115 216 92 28 119 62 45 68 62 95 111 63 63 45 72 44 61 28 110 110 63 39 73 64 61 62 76 62 60 61 71 63 63 108 63 28 63 112 63 60 63 119 106 105 81 56 86638 Antibody; Coxiella burnetii (Q fever) 184 184 184 147 45 178 100 72 109 99 153 178 101 101 71 115 70 97 45 176 177 101 62 117 103 97 100 121 99 96 97 114 96 101 173 100 45 101 178 101 96 100 100 169 169 169 90 86644 Antibody; cytomegalovirus (CMV) 87 87 87 70 21 84 47 34 52 47 72 84 48 48 34 54 25 46 21 83 84 48 29 55 48 46 47 57 47 45 46 54 48 48 82 47 21 48 84 48 46 47 47 80 80 61 42 86645 "Antibody; cytomegalovirus (CMV), IgM" 103 103 108 82 24 100 56 40 61 56 85 100 57 57 24 64 25 55 25 98 99 57 35 66 57 54 56 68 55 54 54 64 57 57 97 56 25 57 100 57 54 56 56 95 94 72 50 86663 "Antibody; Epstein-Barr (EB) virus, early antigen (EA)" 78 78 86 62 19 75 42 30 46 42 64 75 46 46 22 49 45 41 19 74 75 43 26 49 43 41 42 51 42 40 41 48 41 43 73 42 19 43 75 43 41 42 42 71 71 75 38 86664 "Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)" 95 86 102 76 23 92 52 37 56 51 79 92 48 48 25 59 36 50 23 91 91 52 32 60 53 50 51 62 59 49 50 59 53 52 89 52 23 52 92 52 50 52 52 85 87 79 46 86665 "Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)" 103 92 185 82 24 100 56 40 61 55 85 100 95 95 24 64 45 54 25 98 99 57 35 65 57 54 56 68 59 54 54 64 53 57 97 56 25 57 100 57 54 56 56 85 94 100 50 86695 "Antibody; herpes simplex, type 1" 89 84 93 71 22 86 48 35 53 48 74 86 50 50 24 56 34 47 22 85 85 49 30 57 50 47 48 59 49 46 47 55 47 49 84 49 22 49 86 49 47 49 48 82 82 63 43 86696 "Antibody; herpes simplex, type 2" 76 73 80 61 19 74 41 30 45 41 63 74 42 42 24 48 29 40 19 73 73 42 26 48 42 40 41 50 42 40 40 47 40 42 71 41 19 42 74 42 40 41 41 70 70 53 37 86704 Hepatitis B core antibody (HBcAb); total 106 101 106 85 26 103 58 42 63 57 88 103 58 58 37 66 36 56 26 101 102 58 36 67 59 56 57 70 57 55 56 66 55 58 100 58 26 58 103 58 55 58 57 98 97 75 52 86705 Hepatitis B core antibody (HBcAb); IgM antibody 71 71 71 57 17 69 39 28 42 38 59 69 39 39 28 44 27 38 17 68 68 39 24 45 40 38 38 47 38 37 37 44 38 39 67 39 17 39 69 39 37 39 38 65 65 50 35 86706 Hepatitis B surface antibody (HBsAb) 90 86 95 72 22 87 49 35 53 50 75 87 38 38 24 56 24 48 22 86 86 50 30 57 50 48 49 59 48 47 48 56 47 50 85 49 22 50 87 50 47 44 49 83 82 68 44 86708 Hepatitis A antibody (HAAb); total 104 99 109 83 25 101 56 41 62 56 86 101 57 57 25 65 40 55 25 99 100 57 35 66 58 55 56 68 56 54 55 64 54 57 98 57 25 57 101 57 54 57 55 96 95 73 51 86709 Hepatitis A antibody (HAAb); IgM antibody 118 118 118 94 24 114 64 46 70 64 98 114 65 65 24 74 45 62 29 113 113 65 40 75 66 62 64 78 63 61 62 73 62 65 111 64 29 65 114 65 62 64 64 109 108 83 58 86735 Antibody; mumps 82 78 86 65 20 79 44 32 49 44 68 79 50 50 54 51 31 43 20 78 79 45 28 52 46 43 44 54 44 43 43 51 43 45 77 45 20 45 79 45 43 45 44 75 75 58 40 86738 Antibody; mycoplasma 135 128 142 108 33 131 73 53 80 71 112 131 75 75 46 84 51 71 33 129 130 74 46 86 75 71 73 89 72 70 71 84 74 74 127 74 33 74 131 74 71 74 67 124 124 74 66 86762 Antibody; rubella 89 85 93 71 22 86 48 35 53 48 74 86 55 55 47 56 34 47 22 85 85 49 30 56 49 47 48 58 48 46 47 55 46 49 83 48 22 49 86 49 46 48 48 82 81 62 43 86765 Antibody; rubeola 74 74 82 59 18 72 40 29 44 40 61 72 48 48 27 46 28 39 18 71 71 41 25 47 41 39 40 49 40 38 39 46 39 41 70 40 18 41 72 41 39 40 40 68 68 68 36 86769 HC SARS-COV-2 COVID-19 ANTIBODY 137 83 137 110 33 133 74 54 81 74 114 133 49 49 46 86 52 73 33 131 132 75 46 87 76 72 74 90 73 71 72 85 72 75 129 75 34 75 133 75 72 75 74 126 125 96 67 86777 Antibody; Toxoplasma 117 115 120 94 25 114 64 46 70 63 97 114 65 65 90 74 25 62 29 112 113 65 40 75 65 62 64 77 63 61 62 73 61 65 110 64 29 65 114 65 61 64 64 108 108 83 57 86778 "Antibody; Toxoplasma, IgM" 105 105 105 84 25 102 57 41 62 57 87 102 58 58 41 66 25 56 26 100 101 58 35 67 58 56 57 69 56 55 55 65 55 58 99 57 26 58 102 58 55 57 57 97 96 74 51 86780 Antibody; Treponema pallidum 85 77 85 68 21 82 46 26 50 46 71 82 45 45 24 53 48 45 21 81 82 47 29 54 47 45 46 56 49 44 45 53 45 47 80 46 21 47 82 47 44 46 46 78 78 60 41 86787 Antibody; varicella-zoster 80 78 82 64 19 78 43 31 48 43 66 77 48 48 51 50 30 42 19 76 77 44 27 51 45 42 43 53 43 42 42 49 42 44 75 44 20 44 78 44 42 44 43 74 73 56 39 86800 Thyroglobulin antibody 159 156 175 127 39 154 86 62 95 86 132 154 87 87 48 100 60 84 39 152 153 88 54 101 89 84 86 105 85 83 84 98 92 88 150 87 39 88 154 88 83 87 86 146 146 86 78 86803 Hepatitis C antibody; 119 114 125 95 24 115 65 47 71 67 94 115 65 65 25 74 24 63 29 114 114 66 40 76 66 63 63 78 64 62 63 74 65 65 112 65 29 65 115 65 62 65 65 109 109 84 58 86850 "Antibody screen, RBC, each serum technique" 111 105 117 89 27 108 60 44 66 55 92 107 62 62 43 69 45 59 27 102 107 61 38 71 61 61 60 73 61 58 59 69 61 61 104 61 27 61 108 61 58 61 61 102 97 61 54 86870 "Antibody identification, RBC antibodies, each panel for each serum technique" 151 151 151 121 37 146 82 59 90 81 125 146 83 83 58 94 57 80 37 144 145 83 51 96 84 80 82 99 81 78 80 93 70 83 142 82 37 83 146 83 79 82 82 139 138 106 74 86880 "Antihuman globulin test (Coombs test); direct, each antiserum" 78 52 104 63 19 76 42 31 46 42 65 76 43 43 30 49 30 41 19 75 75 43 26 50 44 41 42 51 42 41 41 48 36 43 74 43 19 43 76 43 41 43 42 72 72 55 38 86885 "Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell" 33 33 33 26 8 32 18 13 20 18 27 32 18 18 13 21 13 18 8 32 32 18 11 21 18 17 18 22 18 17 17 20 15 18 31 18 8 18 32 18 17 18 18 30 30 23 16 86900 Blood typing; ABO 30 28 64 24 7 29 16 12 18 15 25 29 25 25 21 19 22 16 7 28 29 17 10 19 17 25 16 20 17 16 16 19 17 16 28 16 7 16 29 17 16 14 16 28 26 28 15 86901 Blood typing; Rh (D) 30 28 64 24 7 32 16 12 18 15 25 29 25 25 30 19 32 16 7 28 29 17 10 19 17 25 16 20 17 16 16 19 17 16 28 16 7 16 29 17 16 14 16 28 26 28 15 86902 "Blood typing; antigen testing of donor blood using reagent serum, each antigen test" 100 100 301 80 24 97 54 39 60 54 83 97 55 55 39 63 38 53 24 96 96 55 34 64 56 53 54 66 54 52 53 62 50 55 94 55 25 55 97 55 53 55 54 92 92 71 49 86920 Compatibility test each unit; immediate spin technique 103 98 216 82 25 100 56 40 61 56 85 100 57 57 40 64 39 55 25 98 99 57 35 66 57 56 56 68 50 54 54 64 57 57 97 56 25 57 100 57 54 56 57 95 90 57 50 87015 "Concentration (any type), for infectious agents" 40 40 40 32 10 39 22 16 24 22 33 39 22 22 16 25 15 21 10 38 38 22 14 25 22 21 22 26 21 21 21 25 21 22 38 22 10 22 39 22 21 22 22 37 37 28 20 87040 "Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)" 135 128 426 108 33 134 76 53 80 76 112 134 66 66 33 84 69 71 33 125 130 74 46 86 75 71 71 89 74 70 67 84 74 74 127 74 33 74 131 74 71 74 74 124 131 78 66 87045 "Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species" 64 61 64 51 9 62 35 25 38 35 53 62 35 35 36 40 24 34 16 61 61 35 22 41 36 34 35 42 34 33 34 40 9 35 60 35 16 35 62 35 33 35 34 59 59 45 31 87070 "Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates" 91 86 96 73 22 93 49 36 54 49 76 88 51 51 33 57 36 48 22 93 87 50 31 58 52 48 49 60 50 47 43 56 50 50 84 50 22 50 88 50 48 50 53 79 83 68 44 87075 "Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates" 86 78 86 69 21 83 47 34 51 46 71 83 46 46 33 54 33 46 21 82 83 47 29 55 48 45 47 57 25 45 39 53 45 47 81 47 21 47 83 47 45 47 47 79 79 47 42 87077 "Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate" 58 54 181 46 14 213 33 23 34 29 48 59 32 32 33 36 33 32 14 56 56 32 20 37 32 31 31 38 32 30 27 36 31 32 213 32 14 32 56 32 30 32 32 53 51 34 28 87081 "Culture, presumptive, pathogenic organisms, screening only;" 39 39 39 31 6 37 21 15 23 21 32 37 23 23 37 24 37 20 6 37 37 21 13 25 21 20 21 25 21 20 20 24 20 21 36 21 9 21 37 21 20 21 21 36 36 36 19 87086 "Culture, bacterial; quantitative colony count, urine" 75 71 79 60 13 77 41 29 45 37 62 77 42 42 33 47 33 41 18 73 72 41 13 48 42 40 41 49 41 39 40 46 41 41 77 41 18 41 73 41 39 41 41 69 71 43 37 87101 "Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail" 46 46 48 37 11 44 25 18 27 25 38 44 24 24 18 29 17 24 11 44 44 25 15 29 26 24 25 30 25 24 24 28 26 25 43 25 11 25 44 25 24 25 25 42 42 32 22 87116 "Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates" 96 96 96 77 23 93 52 38 57 52 80 93 53 53 37 60 37 51 23 92 92 53 32 61 53 51 52 63 51 50 51 59 51 53 90 52 24 53 93 53 50 52 52 88 88 68 47 87172 "Pinworm exam (eg, cellophane tape prep)" 25 25 25 20 6 36 14 10 15 13 21 24 14 14 36 16 10 13 6 24 24 14 8 16 14 13 14 16 13 13 13 15 13 14 24 14 6 14 24 14 13 14 14 23 23 18 12 87177 "Ova and parasites, direct smears, concentration and identification" 96 91 192 77 9 132 52 38 57 52 80 93 53 53 18 60 37 51 23 92 92 53 32 61 53 51 52 63 51 50 51 59 9 53 90 52 24 53 93 53 50 52 52 88 88 132 47 87186 "Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate" 81 70 239 65 17 81 45 32 48 40 67 81 45 45 17 51 17 44 20 79 78 45 27 52 45 43 44 53 45 42 43 50 41 45 76 44 20 45 79 45 42 45 45 75 71 47 40 87205 "Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types" 42 39 132 34 10 41 23 16 25 23 35 41 22 22 18 26 16 22 10 40 40 23 14 27 23 22 23 28 22 22 22 26 23 23 39 23 10 23 41 23 22 24 24 39 37 39 20 87206 "Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types" 43 43 43 34 10 42 23 17 26 23 36 42 24 24 17 27 16 23 10 41 41 24 15 27 24 23 23 28 23 22 23 27 23 24 40 23 11 24 42 24 23 23 23 40 39 30 21 87209 "Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites" 70 67 140 56 17 97 38 27 42 38 58 68 38 38 18 44 27 37 17 67 67 39 24 45 39 37 38 46 37 36 37 43 18 38 66 38 17 38 68 39 37 38 38 64 64 97 34 87252 "Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect" 219 219 219 175 53 212 119 86 130 118 182 212 120 120 85 137 83 116 53 209 210 121 74 139 122 116 119 144 117 114 116 135 111 120 206 120 54 120 212 120 115 119 119 201 201 154 107 87255 "Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity)" 181 181 181 145 44 176 98 71 108 98 150 175 101 101 71 113 69 96 44 173 174 100 61 115 101 96 98 119 97 94 96 112 95 100 170 99 44 100 176 100 95 99 98 167 166 127 88 87324 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)" 70 70 70 56 17 68 38 27 42 38 58 68 38 38 27 44 54 37 17 67 67 39 24 45 39 37 38 46 37 36 37 43 37 38 66 38 17 38 68 39 37 38 38 64 64 49 34 87328 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; cryptosporidium" 76 72 76 61 14 74 41 30 45 41 63 74 42 42 18 48 29 40 19 73 73 42 26 48 42 40 41 50 41 40 40 47 14 42 71 41 19 42 74 42 40 41 41 70 70 53 37 87329 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; giardia" 137 130 137 110 12 133 74 54 81 74 114 133 75 75 18 86 52 73 33 131 132 75 46 87 76 72 74 90 73 71 72 85 12 75 129 75 34 75 133 75 72 75 74 126 125 96 67 87338 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool" 79 79 87 64 14 84 43 31 22 43 66 77 44 44 18 50 30 42 19 84 76 44 27 51 44 42 43 52 42 41 42 49 14 44 75 43 19 44 77 44 42 40 46 73 73 73 39 87340 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)" 82 78 86 66 20 80 44 32 49 46 68 79 44 44 35 51 36 43 20 78 79 45 28 52 46 43 44 54 44 43 43 51 42 45 77 45 20 45 80 45 43 42 44 75 75 47 40 87385 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Histoplasma capsulatum" 205 205 205 164 50 199 111 80 122 111 170 198 113 113 80 128 78 109 50 196 197 113 69 130 114 108 111 135 110 107 108 127 105 113 193 112 50 113 199 113 107 112 111 189 188 144 100 87389 HC HIV-1 AG W/ HIV-1 & HIV-2 AB 87 83 91 70 21 84 47 34 52 47 72 84 42 42 31 54 36 46 21 83 84 48 29 55 48 46 47 57 48 45 46 54 48 48 82 47 21 48 84 48 46 48 47 80 80 61 42 87427 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Shiga-like toxin" 79 75 79 63 12 77 43 31 47 43 66 76 43 43 18 49 30 42 19 75 76 44 27 50 44 42 43 52 41 41 42 49 12 43 74 43 19 43 77 43 41 43 41 73 72 56 39 87449 "Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism" 70 70 70 56 17 68 38 27 42 38 58 68 38 38 27 44 27 37 17 67 67 39 24 45 39 37 38 46 37 36 37 43 37 38 66 38 17 38 68 39 37 38 38 64 64 49 34 87480 "Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique" 118 112 124 94 29 327 64 46 70 64 98 114 66 66 33 74 34 62 29 113 113 65 40 75 66 62 64 78 72 61 62 73 65 65 327 64 29 65 114 65 62 68 64 109 108 114 58 87491 "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique" 169 160 177 135 41 164 92 66 100 91 140 164 94 94 69 106 69 97 41 162 162 93 57 108 97 89 92 111 98 88 89 105 94 93 159 92 41 93 164 93 88 92 92 147 163 155 82 87493 "Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique" 126 120 126 101 31 122 68 49 75 68 105 122 69 69 49 79 48 67 31 120 121 69 43 80 70 67 68 83 66 66 67 78 37 69 118 69 31 69 122 69 66 69 66 116 115 93 61 87497 "Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification" 261 237 261 209 64 253 142 102 155 141 217 253 143 143 115 163 99 138 64 249 251 144 88 166 145 138 141 172 140 136 138 161 138 144 245 142 64 144 253 144 137 142 142 240 239 218 127 87500 "Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique" 185 185 185 148 45 179 100 72 110 100 153 179 102 102 72 116 70 98 45 177 177 102 62 118 103 98 100 122 99 96 98 114 97 102 174 101 45 102 179 102 97 101 96 170 169 130 90 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" 348 210 456 278 10 420 189 136 207 116 289 337 213 213 90 218 10 184 85 333 334 192 118 221 251 184 116 229 252 181 184 215 184 182 327 190 85 191 338 191 109 191 239 320 420 191 170 87507 HC IADNA-DNA/RNA PROBE TQ 12-25 535 301 590 428 130 543 290 210 318 289 444 518 241 241 279 335 346 283 130 511 514 295 181 340 298 283 290 352 286 278 283 331 224 294 503 292 131 294 519 294 280 292 317 492 490 543 261 87510 "Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique" 118 112 124 94 17 114 64 46 70 64 98 114 66 66 17 74 17 62 29 113 113 65 40 75 66 62 64 78 72 61 62 73 65 65 111 64 29 65 114 65 62 68 64 109 108 109 58 87522 "Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification" 296 296 296 237 72 287 161 116 176 160 246 287 163 163 115 185 113 157 72 283 284 163 100 188 165 157 160 195 158 154 156 183 156 163 278 162 72 163 287 163 155 161 160 272 271 208 144 87591 "Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique" 120 114 126 96 29 116 65 47 71 65 100 116 67 67 35 75 35 69 29 115 115 66 41 76 69 63 65 79 70 62 63 74 67 66 113 66 29 66 116 66 63 65 65 105 116 110 59 87634 PBB RSV DNA/RNA AMP PROBE 305 290 320 244 7 296 165 120 181 165 253 295 159 159 118 191 7 161 74 291 293 168 103 194 176 161 165 201 186 159 161 189 168 168 287 167 75 168 296 168 160 166 168 281 279 176 149 87635 Infectious agent detection by nucleic acid; severe acute respiratory syndrome coronavirus COVID-19 121 110 127 97 29 123 68 47 107 68 100 123 59 59 79 76 90 64 29 112 116 67 41 77 52 66 52 80 67 63 72 75 64 63 51 66 30 67 117 67 63 67 67 111 117 67 59 87640 "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique" 204 185 204 163 50 198 111 80 121 110 169 198 112 112 65 128 78 108 50 195 196 112 69 130 114 108 111 134 109 106 108 126 108 112 192 111 50 112 198 112 107 111 112 188 170 150 100 87641 "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique" 204 185 204 163 32 198 111 80 121 110 169 198 110 110 32 128 78 108 50 195 196 112 69 130 114 108 111 134 109 106 108 126 108 112 192 111 50 112 198 112 107 111 112 188 170 150 100 87651 "Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique" 188 87 207 150 46 183 102 183 112 101 156 182 97 97 115 118 115 104 46 180 180 104 64 120 105 99 102 124 84 98 99 116 80 103 182 103 46 103 182 103 98 82 71 173 181 181 92 87660 "Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique" 118 112 124 94 17 114 64 46 70 64 98 114 66 66 17 74 17 62 29 113 113 65 40 75 66 62 64 78 72 61 62 73 65 65 111 64 29 65 114 65 62 68 64 109 108 114 58 87798 "Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism" 207 187 207 166 50 201 112 81 123 112 172 200 114 114 80 130 79 110 50 198 199 114 70 132 115 109 112 136 111 108 109 128 110 114 195 113 51 114 201 114 108 113 96 190 190 146 101 87799 "Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism" 289 276 303 231 69 280 157 113 172 156 240 280 159 159 69 181 110 153 70 276 277 159 98 184 161 153 157 190 155 150 153 179 160 159 272 158 71 159 280 159 151 158 157 266 265 266 141 87804 Infectious agent antigen detection by immunoassay with direct optical observation; Influenza 49 49 57 39 12 47 26 19 29 26 40 47 18 18 27 30 18 26 12 46 47 27 16 31 27 26 26 32 26 25 25 30 26 27 46 26 12 27 47 27 25 26 25 45 44 34 24 87811 HC SARS-COV-2 COVID19 W/OPTIC 115 115 121 92 28 112 62 45 68 62 95 111 63 63 45 72 44 61 28 110 110 63 39 73 64 61 62 76 62 60 61 71 63 63 108 63 28 63 112 63 60 50 67 106 105 81 56 87880 "Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A" 50 50 72 40 12 48 27 20 30 27 41 48 37 37 18 31 19 26 12 48 48 28 17 32 28 26 27 33 27 26 26 31 26 28 47 27 12 28 48 28 26 27 26 46 46 35 24 88112 "Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal" 193 176 203 154 47 187 105 76 115 104 160 187 106 106 161 121 73 102 47 184 185 106 65 123 108 102 105 127 103 100 102 119 108 106 181 105 47 106 187 106 101 105 92 178 177 106 94 88172 "Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site" 43 41 43 34 10 42 23 17 26 23 36 42 24 24 17 27 16 23 10 41 41 24 15 27 24 23 23 28 23 22 23 27 23 24 40 23 11 24 42 24 23 23 23 40 39 30 21 88173 "Cytopathology, evaluation of fine needle aspirate; interpretation and report" 160 152 160 128 39 155 87 63 95 86 133 155 88 88 62 100 61 85 39 153 154 88 54 102 89 85 87 105 84 83 85 99 85 88 150 87 39 88 155 88 84 87 87 147 147 113 78 88300 "Level I - Surgical pathology, gross examination only" 51 51 51 41 12 49 28 20 30 28 42 49 28 28 20 32 19 27 12 49 49 28 17 32 28 27 28 34 27 27 27 32 27 28 48 28 12 28 49 28 27 28 28 47 47 36 25 88302 "Level II - Surgical pathology, gross and microscopic examination Appendix, incidental, Fallopian tube, sterilization, Fingers/toes, amputation, traumatic, Foreskin, newborn, Hernia sac, any location, Hydrocele sac, Nerve, Skin, plastic repair, Sympathetic ganglion, Testis, castration, Vaginal mucosa, incidental, Vas deferens, sterilization" 106 101 106 85 26 103 58 42 63 57 88 103 59 59 41 66 40 56 26 101 102 58 36 67 59 56 57 70 57 55 56 66 56 58 100 58 26 58 103 58 55 58 57 98 97 75 52 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" 111 105 156 89 27 108 60 44 66 59 92 107 62 62 92 69 42 59 27 106 107 61 38 71 67 59 60 73 61 58 53 69 61 61 104 61 27 61 108 61 58 64 55 102 102 61 54 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" 149 142 1639 119 36 245 111 58 89 84 124 144 83 83 127 93 57 78 36 142 143 82 50 95 245 79 81 98 82 77 71 92 82 82 145 81 36 82 145 82 78 82 82 137 136 86 73 88307 "Level V - Surgical pathology, gross and microscopic examination Adrenal, resection, Bone - biopsy/curettings, Bone fragment(s), pathologic fracture, Brain, biopsy, Brain/meninges, tumor resection, Breast, excision of lesion, requiring microscopic evaluation of surgical margins, Breast, mastectomy - partial/simple, Cervix, conization, Colon, segmental resection, other than for tumor, Extremity, amputation, non-traumatic, Eye, enucleation, Kidney, partial/total nephrectomy, Larynx, partial/total resection, Liver, biopsy - needle/wedge, Liver, partial resection, Lung, wedge biopsy, Lymph nodes, regional resection, Mediastinum, mass, Myocardium, biopsy, Odontogenic tumor, Ovary with or without tube, neoplastic, Pancreas, biopsy, Placenta, third trimester, Prostate, except radical resection, Salivary gland, Sentinel lymph node, Small intestine, resection, other than for tumor, Soft tissue mass (except lipoma) - biopsy/simple excision, Stomach - subtotal/total resection, other than for tumor, Testis, biopsy, Thymus, tumor, Thyroid, total/lobe, Ureter, resection, Urinary bladder, TUR, Uterus, with or without tubes and ovaries, other than neoplastic/prolapse" 332 332 332 266 81 322 180 130 197 179 275 321 185 185 129 208 126 176 81 317 319 183 112 211 185 176 180 218 178 173 175 205 173 183 312 181 81 183 322 183 174 181 180 305 304 234 162 88311 Decalcification procedure (List separately in addition to code for surgical pathology examination) 16 16 16 13 4 16 9 6 10 9 13 16 9 9 6 10 6 8 4 15 15 9 5 10 9 8 9 11 9 8 8 10 8 9 15 9 4 9 16 9 8 9 9 15 15 11 8 88312 "Special stains; Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), including interpretation and report, each" 144 144 151 115 35 140 78 56 86 78 119 139 80 80 56 90 55 80 35 138 138 79 49 92 80 76 78 95 77 75 76 89 73 79 135 79 35 79 140 79 75 78 79 132 132 101 70 88313 "Special stains; Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each" 232 116 348 186 57 225 126 91 138 125 193 225 129 129 90 145 88 123 57 222 223 128 78 148 129 123 126 153 124 121 123 144 121 128 218 127 57 128 225 128 121 126 126 213 213 163 113 88341 PBB IMMUNOHISTO ANTIBODY ADDL SLIDE 147 133 980 118 36 143 80 58 87 79 122 142 81 81 57 92 56 78 36 140 141 81 50 94 82 78 80 97 79 76 78 91 118 81 138 80 36 81 143 81 77 80 77 135 135 116 72 88342 "Immunohistochemistry (including tissue immunoperoxidase), each antibody" 140 133 420 112 34 154 76 55 83 76 116 136 79 79 54 88 53 76 34 134 134 77 47 89 78 74 76 92 154 73 74 87 74 77 132 76 34 77 136 77 73 77 77 129 128 77 68 88361 "Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; using computer-assisted technology" 215 205 615 172 52 209 117 84 128 116 178 208 126 126 83 135 82 114 52 205 206 118 73 137 120 114 116 141 115 112 114 133 208 118 202 117 53 118 209 118 113 117 117 198 197 151 105 89051 "Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count" 143 143 158 115 35 139 78 56 85 77 119 139 79 79 108 90 55 76 35 137 138 79 48 91 80 76 78 94 77 75 76 89 79 79 135 78 35 79 139 79 75 78 87 132 131 101 70 89060 "Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)" 77 77 85 62 19 119 42 30 46 42 64 75 42 42 54 48 119 41 19 74 74 43 26 49 43 41 42 51 41 40 41 48 42 42 73 42 19 42 75 42 40 42 47 71 71 54 38 89220 "Sputum, obtaining specimen, aerosol induced technique (separate procedure)" 129 129 129 103 31 125 70 51 77 70 107 125 71 71 50 81 49 68 31 123 124 71 44 82 72 68 70 85 69 67 68 80 67 71 121 70 32 71 125 71 68 70 70 119 118 119 63 89321 "Semen analysis; sperm presence and motility of sperm, if performed" 75 72 75 60 18 73 41 29 45 40 62 73 48 48 64 47 29 40 18 72 72 41 25 48 42 40 41 49 40 39 40 46 39 41 71 41 18 41 73 41 39 41 41 69 69 53 37 90375 "Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use" 5558 617 6792 4447 149 5392 3015 2179 3302 2998 4612 5382 3054 3054 149 3478 2114 2943 1354 5312 5336 3063 1878 3536 3096 2940 3011 3656 1701 2890 2936 3438 3532 3057 5226 3034 1361 3057 5392 3057 2909 3029 3014 5114 5092 3912 2713 90471 "Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)" 97 92 102 78 24 94 54 38 58 52 80 94 54 54 35 61 37 51 24 93 93 53 33 62 54 51 53 64 54 50 51 60 53 53 91 53 24 53 94 53 51 51 52 89 80 56 47 90472 "Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)" 94 89 98 75 23 91 51 37 56 50 78 91 53 53 36 59 36 50 23 89 90 52 32 59 52 49 51 61 50 49 49 58 52 51 88 51 23 51 91 51 49 51 51 86 86 66 46 90662 "Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use" 70 57 195 56 17 171 38 27 42 36 58 68 38 38 27 44 27 37 17 67 67 39 24 45 39 37 38 46 37 36 37 43 33 38 66 38 17 38 68 39 37 38 61 64 171 56 34 90670 "Pneumococcal conjugate vaccine, 13 valent, for intramuscular use" 492 492 492 393 120 477 267 193 292 265 408 476 270 270 223 308 187 260 120 470 472 271 166 313 274 260 266 323 263 256 260 304 257 270 462 268 120 270 477 270 257 268 267 452 450 346 240 90675 "Rabies vaccine, for intramuscular use" 846 810 846 676 206 820 459 331 502 456 702 819 499 499 294 529 322 448 206 808 812 466 286 538 471 447 458 556 466 440 447 523 452 465 795 462 207 465 820 465 442 461 458 778 665 595 413 90686 Influenza virus vaccine 19 19 40 16 5 19 11 8 12 10 16 19 11 11 8 12 7 10 5 19 19 11 7 12 11 10 11 13 10 10 10 12 10 11 18 11 5 11 19 11 10 19 11 18 18 17 9 90714 "Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use" 160 157 163 128 27 155 87 63 95 86 133 155 91 91 27 100 27 85 39 153 153 88 54 102 89 85 87 105 90 83 84 99 88 88 150 87 39 88 155 88 84 87 80 147 150 120 78 90715 "Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use" 177 172 181 142 36 172 98 69 105 96 147 171 94 94 36 111 36 94 43 169 170 98 60 113 99 94 96 116 103 92 94 110 94 97 167 97 43 97 172 97 93 96 93 163 162 161 86 90732 "Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use" 298 298 308 238 73 289 162 117 177 161 247 288 164 164 116 186 113 158 73 285 286 164 101 190 166 158 161 196 170 155 157 184 137 164 280 163 73 164 289 164 156 162 162 274 273 210 145 92018 "Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete" 2293 2293 2408 1834 559 2224 1244 899 1362 1237 1903 2220 1260 1260 890 1435 872 1214 559 2191 2201 1263 775 1459 1277 1213 1242 1508 1228 1192 1211 1418 1261 1261 2156 1252 562 1261 2224 1261 1200 1293 1243 2110 2100 1261 1119 92507 "Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual" 208 198 218 166 51 202 113 82 124 112 173 201 116 116 142 130 189 110 51 199 200 115 70 132 116 110 113 137 115 108 110 129 109 114 196 114 51 114 202 114 109 113 114 191 191 191 102 92523 HC EVAL SPEECH SOUND LANG COMPREHEN 267 254 280 214 65 259 145 105 159 144 222 259 149 149 189 167 142 141 65 255 256 147 90 170 149 141 145 176 147 139 141 165 149 147 251 146 65 147 259 147 140 154 147 246 245 246 130 92524 HC BEHAVIORAL QUAL ANALYSIS VOICE 267 254 280 214 65 259 145 105 159 144 222 259 147 147 104 167 102 141 65 255 256 147 90 170 149 141 145 176 143 139 141 165 144 147 251 146 65 147 259 147 140 146 145 246 245 188 130 92526 Treatment of swallowing dysfunction and/or oral function for feeding 203 193 213 162 49 197 110 80 121 110 168 197 113 113 79 127 77 107 49 194 195 112 69 129 113 107 110 134 109 106 107 126 114 112 191 111 50 112 197 112 106 111 112 187 186 112 99 92610 Evaluation of oral and pharyngeal swallowing function 348 331 365 278 85 338 189 136 207 188 289 337 194 194 135 218 132 184 85 333 334 192 118 221 194 184 189 229 212 181 184 215 191 191 327 190 85 191 338 191 182 191 191 320 319 201 170 92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording 405 386 425 324 99 393 220 159 241 218 336 392 223 223 157 253 154 214 99 387 389 223 137 258 226 214 219 266 217 211 214 251 227 223 381 221 99 223 393 223 212 221 201 373 371 223 198 92950 "Cardiopulmonary resuscitation (eg, in cardiac arrest)" 842 722 863 674 205 908 457 330 501 454 699 816 463 463 908 527 320 471 205 805 809 464 285 536 469 446 456 554 451 438 445 521 447 463 792 460 206 463 817 463 441 427 475 775 772 593 411 92960 "Cardioversion, elective, electrical conversion of arrhythmia; external" 953 953 1051 762 232 1524 517 374 566 514 791 923 524 524 1524 596 362 505 232 911 915 525 322 606 531 504 516 627 510 496 503 590 498 524 896 520 233 524 924 524 499 496 517 877 873 448 465 93005 "Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report" 221 210 1105 177 54 220 186 200 116 109 183 214 123 123 83 138 90 112 54 220 212 122 75 141 125 121 128 145 122 115 116 108 122 122 220 121 54 122 214 122 109 122 122 203 213 128 108 93010 "Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only" 42 40 126 34 9 41 23 16 25 23 35 41 23 23 21 26 16 22 10 40 40 23 14 27 24 22 23 28 22 22 22 26 9 23 39 23 10 23 41 23 22 23 23 39 38 30 20 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" 709 675 744 567 173 688 385 628 421 382 588 686 437 437 203 444 437 375 173 678 681 391 240 451 395 375 384 466 391 369 374 439 390 390 688 387 174 390 688 390 371 390 390 652 649 652 346 93041 "Rhythm ECG, 1-3 leads; tracing only without interpretation and report" 88 88 88 70 21 85 48 34 52 47 73 85 48 48 34 55 33 47 21 84 84 48 30 56 49 47 48 58 47 46 46 54 46 48 83 48 22 48 85 48 46 48 48 81 81 81 43 93225 "External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)" 464 442 487 371 113 923 252 182 276 250 385 449 272 272 301 290 272 253 113 443 445 256 157 295 243 245 243 305 256 241 245 287 255 255 923 253 114 255 450 255 243 253 255 427 425 427 226 93226 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report 488 465 512 390 119 473 265 191 290 263 405 473 286 286 153 305 136 266 119 466 468 269 165 310 256 258 256 321 269 254 258 302 268 268 459 266 120 268 473 268 255 266 268 449 447 449 238 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" 3270 3114 3434 2616 196 3172 1774 1282 1943 1764 2713 3166 1604 1604 593 2046 555 1785 196 3125 3139 1802 1105 2080 1822 1795 1772 2151 1801 1700 1727 2023 1798 1798 3021 1785 801 1798 3172 1799 1711 1798 1844 3008 2995 1798 1596 93668 "Peripheral arterial disease (PAD) rehabilitation, per session" 170 170 170 136 41 165 92 67 101 92 141 165 93 93 66 106 65 90 41 162 163 94 57 108 95 90 92 112 91 88 90 105 91 94 160 93 42 94 165 94 89 93 92 156 156 120 83 93797 Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) 223 212 234 178 54 216 121 87 132 120 185 216 123 123 203 140 203 118 54 213 214 123 75 142 124 118 117 147 119 116 118 138 123 123 210 122 55 123 216 123 117 110 108 205 204 205 109 93798 Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) 334 210 351 267 81 324 181 131 198 180 277 323 184 184 203 209 127 177 81 319 321 184 113 212 186 177 116 220 179 174 176 207 169 184 314 182 82 184 324 184 175 109 193 307 306 307 163 93880 Duplex scan of extracranial arteries; complete bilateral study 857 816 900 686 209 831 465 759 509 462 711 830 528 528 211 536 211 454 209 819 823 472 290 545 477 453 464 564 472 446 453 530 471 471 806 468 210 471 831 471 448 495 471 788 785 471 418 93882 Duplex scan of extracranial arteries; unilateral or limited study 620 605 635 496 151 601 336 243 368 334 514 600 341 341 241 388 236 328 151 593 595 342 209 394 345 328 336 408 332 322 327 384 284 341 583 338 152 341 601 341 324 338 349 570 568 436 303 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study 718 667 735 574 175 696 389 281 426 387 595 695 394 394 378 449 273 380 175 686 689 395 242 456 400 379 389 472 386 373 379 444 392 395 675 392 176 395 696 395 375 385 372 660 657 404 350 93930 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study 655 655 655 524 160 635 355 257 389 353 544 634 360 360 254 410 249 347 160 626 629 361 221 417 365 346 355 431 351 341 346 405 360 360 616 358 160 360 635 360 343 357 355 603 600 461 320 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study 1250 1190 1313 1000 305 1212 678 490 743 674 1037 1210 687 687 423 782 475 662 305 1195 1200 689 422 795 696 661 677 822 669 650 660 773 654 688 1175 682 306 688 1212 688 654 681 607 1150 1145 880 610 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 777 337 816 622 189 754 421 305 462 408 645 752 407 407 211 486 399 411 189 743 746 428 263 494 433 411 421 511 451 404 410 481 427 427 731 424 190 427 754 427 385 427 427 715 715 427 379 93975 "Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study" 635 635 635 508 155 616 344 249 377 343 527 615 349 349 246 397 241 336 155 607 610 350 215 404 354 336 344 418 350 330 335 393 332 349 597 347 156 349 616 349 332 346 344 584 582 447 310 94002 "Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day" 1200 1200 1200 960 292 1164 651 470 713 647 996 1162 659 659 466 751 456 635 292 1147 1152 661 405 763 668 635 650 789 642 624 634 742 640 660 1128 655 294 660 1164 660 628 654 651 1104 1099 845 586 94010 "Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation" 226 215 237 181 55 257 123 89 134 122 188 219 126 126 257 141 86 120 55 216 217 125 76 144 124 123 122 149 121 118 119 140 126 124 212 123 55 124 219 124 118 124 123 208 207 159 110 94060 "Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration" 486 441 486 389 118 471 264 191 289 229 403 471 258 258 453 304 295 257 118 464 467 268 164 309 271 257 255 320 283 253 250 301 255 267 457 265 119 267 471 267 254 255 255 447 445 267 237 94617 PR EXERCISE TST BRNCSPSM W ECG 486 486 486 389 118 471 264 191 289 262 403 471 267 267 206 304 185 257 118 464 467 268 164 309 271 257 263 320 260 253 257 301 254 267 457 265 119 267 471 267 254 265 263 447 445 342 237 94618 HC PULMONARY STRESS TESTING 226 210 232 181 55 220 123 89 135 122 188 219 123 123 206 142 86 120 55 216 217 125 77 144 126 120 123 149 122 118 120 140 124 125 213 124 55 125 220 125 119 123 123 208 207 159 111 94625 Physician or other qualified health care professional services for outpatient pulmoonary rehab; without continuous oximetry monitoring (per session) 232 232 244 186 57 225 126 91 138 125 193 225 127 127 185 145 88 123 57 222 223 128 78 148 129 123 126 153 124 121 123 144 118 128 218 127 57 128 225 128 121 134 126 213 213 134 113 94626 Physician or other qualified health care professional services for outpatient pulmoonary rehab; with continuous oximetry monitoring (per session) 267 267 280 214 65 259 145 105 159 144 222 259 147 147 185 167 102 141 65 255 256 147 90 170 149 141 145 176 143 139 141 165 135 147 251 146 65 147 259 147 140 154 145 246 245 154 130 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)" 215 195 14416 172 52 244 117 84 128 113 178 208 120 120 244 135 244 123 52 205 206 118 73 137 121 117 116 141 131 112 116 133 118 118 202 117 53 118 209 118 113 124 118 198 189 124 105 94642 Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis 371 353 390 297 90 360 201 145 220 200 308 359 204 204 144 232 141 196 90 355 356 204 125 236 204 203 201 244 199 193 196 229 198 204 349 203 91 204 360 204 194 202 201 341 340 261 181 94644 Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour 195 195 195 156 48 189 106 76 116 105 162 189 107 107 76 122 74 103 48 186 187 107 66 124 109 103 106 128 104 101 103 121 107 107 183 106 48 107 189 107 102 106 106 179 179 137 95 94660 "Continuous positive airway pressure ventilation (CPAP), initiation and management" 1156 1048 1216 925 282 1122 627 453 687 624 960 1120 643 643 852 724 440 612 282 1105 1110 637 391 736 644 612 627 761 327 601 611 715 587 636 1087 631 283 636 1122 636 605 635 605 1064 1059 1091 564 94664 "Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device" 205 205 205 164 50 199 111 80 122 111 170 198 113 113 80 128 78 109 50 196 197 113 69 130 114 108 111 135 110 107 108 127 113 113 193 112 50 113 199 113 107 113 111 189 188 144 100 94667 "Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation" 179 170 188 143 44 233 97 70 106 94 149 173 100 100 233 112 68 103 44 171 172 99 60 114 100 98 97 118 109 93 95 111 98 98 168 98 44 98 174 98 94 98 98 165 156 103 87 94668 "Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent" 262 125 655 210 64 254 142 103 156 103 217 254 73 73 102 164 100 139 64 250 252 144 89 167 146 139 142 172 241 136 138 162 133 144 246 143 64 144 254 144 137 216 76 241 172 127 128 94726 PBB PULM FUNCT TST PLETHYSMOGRAP 362 345 380 290 88 351 196 142 215 179 300 351 201 201 227 227 147 192 88 346 348 199 122 230 202 191 190 238 221 188 195 224 199 199 340 198 89 199 351 199 189 199 199 333 332 209 177 94729 HC C0/MEMBRANE DIFFUSE CAPACITY 234 223 246 187 57 227 127 92 139 116 194 227 130 130 206 146 147 124 57 224 225 129 79 149 130 124 123 154 136 122 126 145 129 129 220 128 57 129 227 129 122 129 129 215 214 135 114 94760 Noninvasive ear or pulse oximetry for oxygen saturation; single determination 84 80 88 67 20 81 46 33 50 45 70 81 46 46 33 53 32 44 20 80 81 46 28 53 47 44 46 55 45 44 44 52 46 46 79 46 21 46 81 46 44 41 41 77 77 46 41 94761 "Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)" 168 160 840 134 41 163 91 66 100 91 139 163 96 96 65 105 64 89 41 161 161 93 57 107 94 92 91 111 102 87 89 104 92 92 158 92 41 92 163 92 88 92 92 155 154 92 82 94762 Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure) 344 328 361 275 84 350 187 135 204 186 285 350 191 191 187 215 282 182 84 329 330 190 116 219 192 189 186 226 210 179 164 213 189 189 323 188 84 189 334 189 180 189 189 316 315 189 168 94799 Unlisted pulmonary service or procedure 158 158 158 126 39 153 86 62 94 85 131 153 87 87 61 99 60 84 39 151 152 87 53 101 88 84 86 104 85 82 83 98 87 87 149 86 39 87 153 87 83 86 86 145 145 87 77 95800 "Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time" 602 573 632 482 147 613 327 236 358 325 500 583 371 371 508 377 538 319 147 598 578 332 203 383 335 318 326 533 367 313 318 372 337 331 613 329 147 331 584 331 315 331 269 527 551 581 294 95810 "Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist" 2967 2967 2967 2374 723 2878 1609 1163 1763 1600 2462 2873 1528 1528 1281 1857 1281 1571 723 2835 2848 1635 1003 1888 1653 1569 1632 1952 1589 1543 1567 1835 1513 1632 2790 1620 727 1632 2878 1632 1553 1617 1513 2730 2718 2730 1448 95811 "Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist" 3372 3372 3372 2698 822 3271 1829 1322 2003 1819 2798 3265 1737 1737 1227 2110 1254 1785 822 3223 3237 1858 1139 2145 1878 1783 1855 2218 1805 1753 1781 2086 1798 1855 3271 1841 826 1855 3271 1855 1765 1838 1720 3102 3089 3102 1646 95992 "Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day" 130 124 137 104 32 402 71 51 77 70 108 126 71 71 50 81 75 69 32 124 125 72 44 83 72 69 70 86 70 68 69 80 72 72 402 71 32 72 126 72 68 71 70 120 119 75 63 96125 "Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report" 256 244 269 205 62 248 139 100 152 138 212 248 141 141 99 160 97 136 62 245 246 141 87 163 143 135 139 168 137 133 135 158 142 141 241 140 63 141 248 141 134 140 141 236 235 141 125 96360 "Intravenous infusion, hydration; initial, 31 minutes to 1 hour" 285 271 299 228 69 570 155 112 169 141 236 290 140 140 298 178 570 144 69 272 274 157 96 181 159 151 164 187 157 148 136 176 157 157 268 156 70 157 276 157 149 157 157 262 275 164 139 96361 "Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)" 218 104 2736 174 53 574 118 85 130 122 181 221 61 61 512 136 574 89 53 208 209 120 74 139 126 89 63 143 106 113 60 135 162 120 205 119 53 120 211 125 114 188 240 201 210 123 106 96365 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour" 473 450 994 378 115 459 265 185 281 265 392 458 263 263 298 296 298 271 115 452 454 261 160 301 267 250 260 311 266 246 234 293 260 260 445 258 116 260 459 260 248 260 260 435 414 273 231 96366 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)" 102 92 2448 82 25 581 163 40 61 48 85 99 108 108 581 64 341 54 25 97 98 56 34 65 57 54 56 67 54 53 54 63 54 56 96 56 25 56 99 56 53 101 56 94 85 56 50 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)" 139 132 292 111 34 298 156 54 83 75 115 135 77 77 298 87 222 74 34 133 133 77 47 88 77 74 75 91 77 72 73 86 76 76 131 76 34 76 135 76 73 80 80 128 121 76 68 96368 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)" 109 104 114 87 27 285 61 43 65 59 90 106 60 60 42 68 285 58 27 104 105 60 37 69 61 58 59 72 66 57 58 67 60 60 102 60 27 60 106 60 57 63 60 100 100 60 53 96372 "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular" 97 92 679 78 24 1027 53 38 58 54 80 94 54 54 35 61 37 51 24 93 93 53 33 62 56 53 53 64 59 50 46 60 53 53 1027 53 24 53 94 53 51 53 53 89 85 53 66 96374 "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug" 167 159 334 134 32 162 37 65 99 94 139 162 82 82 32 104 84 91 41 160 160 92 56 106 92 92 96 110 92 87 80 103 92 92 157 91 41 92 162 96 90 92 92 154 161 96 45 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)" 139 126 792 111 34 232 74 54 83 74 115 128 97 97 54 87 67 67 34 133 133 77 47 88 182 145 76 91 73 72 126 86 74 76 131 76 34 76 135 76 73 76 76 128 232 128 36 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)" 82 74 814 66 20 86 44 32 49 38 68 79 43 43 32 51 31 43 20 78 79 45 28 52 46 43 44 54 48 43 37 51 43 45 77 45 20 45 80 45 43 86 45 75 68 74 62 96523 Irrigation of implanted venous access device for drug delivery systems 155 148 163 124 36 150 84 138 92 84 129 150 85 85 36 97 59 82 38 148 149 85 52 99 86 82 84 102 83 81 82 96 87 85 146 85 38 85 150 85 81 84 75 143 143 109 76 97012 "Application of a modality to 1 or more areas; traction, mechanical" 93 93 93 74 23 119 50 36 55 50 77 90 51 51 119 58 35 49 23 89 89 51 31 59 52 49 50 61 50 48 49 58 50 51 87 51 23 51 90 51 49 51 50 86 85 65 45 97018 Application of a modality to 1 or more areas; paraffin bath 100 100 110 80 24 97 54 39 59 54 83 97 55 55 39 63 38 53 24 96 96 55 34 64 56 53 54 66 59 52 53 62 59 55 94 55 24 55 97 55 52 54 52 92 92 92 49 97032 "Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes" 105 100 330 84 26 151 57 41 62 57 87 102 61 61 66 66 99 56 26 100 101 58 35 67 58 56 57 69 56 55 55 65 58 58 99 57 26 58 102 58 55 57 57 97 92 151 51 97033 "Application of a modality to 1 or more areas; iontophoresis, each 15 minutes" 110 105 116 88 27 107 60 43 65 59 91 107 68 68 99 69 42 58 27 105 106 61 37 70 61 58 60 72 59 57 58 68 60 60 103 60 27 60 107 61 58 60 60 101 101 101 54 97035 "Application of a modality to 1 or more areas; ultrasound, each 15 minutes" 82 78 86 66 20 2332 44 32 49 44 68 79 46 46 99 51 150 43 20 76 79 45 28 52 46 43 43 54 44 43 43 51 45 45 2332 45 20 45 80 45 43 45 45 75 75 47 40 97110 "Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility" 196 93 515 157 30 951 106 77 116 97 163 190 109 109 119 123 119 99 30 100 188 108 66 125 108 104 81 129 120 102 59 121 102 108 951 107 48 108 190 108 103 95 95 86 180 108 96 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" 98 93 279 78 24 100 53 38 58 53 81 95 60 60 61 61 67 52 24 100 94 54 33 62 55 52 53 64 54 51 52 61 54 54 92 54 24 54 95 54 51 54 51 86 95 57 48 97116 "Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)" 103 93 206 82 25 100 56 40 61 48 85 100 60 60 66 64 99 55 25 98 99 57 35 66 57 54 56 68 60 54 54 64 54 57 97 56 25 57 100 57 54 54 54 86 92 57 50 97129 HC THER IVNTJ COG FUNCJ 1ST 15 MIN 90 86 95 72 22 87 49 35 53 49 75 87 49 49 35 56 34 48 22 86 86 50 30 57 50 48 49 59 48 47 48 56 50 50 85 49 22 50 87 50 47 49 49 83 82 63 44 97130 HC THER IVNTJ COG FUNCJ EA ADDL 15 MIN 71 65 195 57 17 69 39 28 42 38 59 69 39 39 28 44 27 38 17 68 68 39 24 45 40 38 38 47 38 37 37 44 38 39 67 39 17 39 69 39 37 39 38 65 65 50 35 97140 "Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes" 103 93 588 82 25 883 56 55 61 48 85 100 55 55 61 168 60 56 54 95 99 57 35 66 54 54 54 68 60 54 88 64 55 57 883 56 25 57 100 57 54 54 54 95 95 95 50 97161 Physical Therapy Evaluation of low complexity 174 166 183 139 42 178 94 68 103 86 144 178 97 97 157 109 157 92 42 173 167 96 59 111 96 92 91 114 106 90 104 108 96 96 178 95 43 96 169 96 91 96 96 153 160 101 85 97162 Physical Therapy Evaluation of moderate complexity 208 198 218 166 51 202 113 82 124 109 173 201 128 128 157 119 79 119 51 199 200 115 70 132 114 110 114 137 127 108 110 129 114 114 196 114 51 114 202 114 109 101 114 191 182 120 102 97163 Physical Therapy Evaluation of high complexity 250 232 256 200 61 242 136 98 149 135 207 242 137 137 97 156 95 132 61 239 240 138 84 159 139 132 135 164 142 130 132 155 132 138 235 136 61 138 242 138 131 136 118 230 229 141 122 97164 Physical Therapy Re-Evaluation of an established plan of care 139 132 146 111 34 157 75 54 83 75 115 135 77 77 157 87 53 76 34 133 133 77 47 88 77 74 75 91 74 72 73 86 76 76 131 76 34 76 135 76 73 69 76 128 127 78 68 97165 HC OT EVAL LOW COMPLEX 174 166 183 139 43 178 94 68 103 94 144 178 102 102 177 109 66 92 87 166 167 96 59 111 97 92 91 114 96 90 92 108 96 96 164 95 43 96 169 96 91 96 96 160 168 101 85 97166 HC OT EVAL MOD COMPLEX 208 208 218 166 51 202 113 82 124 112 173 201 116 116 177 130 79 110 51 199 200 115 70 132 116 110 113 137 127 108 110 129 114 114 196 114 51 114 202 114 109 113 120 191 191 146 102 97530 "Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes" 103 93 309 82 25 100 56 40 61 48 85 100 60 60 67 64 67 50 25 100 99 57 35 66 57 54 56 68 60 54 54 64 54 57 97 56 25 57 100 57 54 57 54 95 94 95 50 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" 186 93 618 149 45 180 101 55 111 100 154 180 102 102 95 116 69 54 45 178 179 102 63 118 104 98 101 122 120 97 98 115 55 102 175 102 46 102 180 102 97 82 102 171 170 72 91 97542 "Wheelchair management (eg, assessment, fitting, training), each 15 minutes" 186 186 186 149 45 180 101 73 111 100 154 180 102 102 133 116 71 98 45 178 179 102 63 118 104 98 101 122 100 97 98 115 97 102 175 102 46 102 180 102 97 101 101 171 170 171 91 97602 "Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session" 225 225 225 180 55 218 122 88 134 121 187 218 124 124 87 141 86 119 55 215 216 124 76 143 125 119 122 148 120 117 119 139 114 124 212 123 55 124 218 124 118 123 122 207 206 158 110 97760 "Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes" 196 98 412 157 48 190 106 77 116 106 163 190 108 108 76 123 75 104 48 187 188 108 66 125 109 104 106 129 105 102 104 121 108 108 184 107 48 108 190 108 103 97 57 180 180 57 96 97761 "Prosthetic training, upper and/or lower extremity(s), each 15 minutes" 309 309 309 247 75 300 168 121 184 167 256 299 170 170 120 193 117 164 75 295 297 170 104 197 172 163 167 203 165 161 163 191 165 170 291 169 76 170 300 170 162 168 168 284 283 217 151 97763 HC ORTH/PROSTH MGMT SUBQ ENC 15M 299 146 438 239 73 290 162 117 178 161 248 290 164 164 116 187 114 158 73 286 287 165 101 190 167 158 162 197 160 155 158 185 161 164 281 163 73 164 290 164 156 163 168 275 274 210 146 99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure) 106 104 109 85 26 103 58 42 63 57 88 103 54 54 41 67 40 56 26 102 102 59 36 68 59 56 58 70 60 55 56 66 56 59 100 58 26 59 103 59 56 58 58 98 98 75 52 99195 "Phlebotomy, therapeutic (separate procedure)" 163 156 171 130 40 158 88 64 97 88 135 158 100 100 63 102 62 86 40 156 156 90 55 104 91 86 88 107 87 85 86 101 85 90 153 89 40 90 158 90 85 86 88 150 149 94 80 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." 221 221 221 177 52 214 120 87 131 119 183 214 121 121 86 138 84 117 54 211 212 122 75 141 123 117 120 145 118 115 117 137 52 122 208 121 54 122 214 122 116 120 120 203 202 156 108 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." 308 287 316 247 75 299 167 121 183 166 256 299 170 170 120 193 117 163 75 295 296 170 104 196 172 163 167 203 165 160 163 191 87 170 290 168 76 170 299 170 161 168 167 284 283 217 151 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." 26 25 166 21 6 138 14 10 15 14 138 25 14 14 10 16 10 14 6 25 25 14 9 17 14 14 14 17 15 14 12 16 14 14 24 14 6 14 25 14 14 14 14 24 24 18 13 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." 137 124 243 110 33 134 74 54 81 74 114 133 75 75 53 86 52 73 33 131 132 75 46 87 76 72 134 90 73 71 72 85 38 75 129 75 34 75 133 75 72 75 74 126 125 96 67 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.])" 214 204 225 171 52 208 116 84 127 115 178 207 118 118 83 134 81 113 52 205 205 118 72 136 119 113 116 141 115 111 113 132 76 118 201 117 52 118 208 118 112 117 116 197 196 151 104 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." 244 232 256 195 59 237 132 96 145 132 202 236 134 134 95 153 93 129 59 233 234 134 82 155 136 129 132 160 131 127 129 151 104 134 229 133 60 134 237 134 128 133 132 224 224 172 119 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." 400 381 420 320 97 388 217 157 238 216 332 387 222 222 155 250 152 212 97 382 384 220 135 254 223 212 217 263 214 208 211 247 141 220 376 218 98 220 388 220 209 218 217 368 366 282 195 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." 522 497 548 418 127 506 283 205 310 282 433 505 287 287 203 327 198 276 127 499 501 288 176 332 291 276 283 343 279 271 276 323 193 287 491 285 128 287 506 287 273 284 283 480 478 367 255 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." 87 83 91 70 21 84 47 34 52 47 72 84 48 48 34 54 33 46 21 83 84 48 29 55 48 46 47 57 47 45 46 54 43 48 82 47 21 48 84 48 46 47 47 80 80 61 42 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." 145 138 152 116 35 141 79 57 86 78 120 140 80 80 56 91 55 77 35 139 139 80 49 92 81 77 79 95 78 75 77 90 76 80 136 79 36 80 141 80 76 79 79 133 133 102 71 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." 232 221 244 186 57 225 126 91 138 125 193 225 127 127 90 145 88 123 57 222 223 128 78 148 129 123 126 153 124 121 123 144 110 128 218 127 57 128 225 128 121 126 126 213 213 163 113 99235 "Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of moderate severity." 522 522 522 418 127 506 283 205 310 282 433 505 287 287 203 327 198 276 127 499 501 288 176 332 291 276 283 343 279 271 276 323 176 287 491 285 128 287 506 287 273 284 283 480 478 367 255 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." 185 134 221 148 45 461 100 73 187 100 154 179 103 103 461 116 70 98 45 177 178 102 63 118 103 98 100 122 99 96 98 114 111 102 174 101 45 102 179 102 97 101 100 170 169 194 90 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." 232 190 259 186 39 628 126 91 138 125 193 225 102 102 562 145 628 136 57 240 223 128 78 148 129 123 136 153 121 121 123 144 39 128 218 127 57 128 225 128 121 136 116 213 216 227 113 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." 408 221 856 326 99 629 221 379 379 202 339 415 187 187 586 255 629 223 99 396 392 225 138 260 229 216 235 268 117 212 182 252 224 224 415 223 100 224 396 224 214 224 224 375 375 375 199 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." 663 355 1326 530 114 664 524 588 617 329 550 362 354 354 664 415 664 335 162 634 636 365 224 422 364 364 383 436 351 345 304 410 114 365 623 362 162 365 643 383 347 365 365 610 610 383 617 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." 952 526 999 762 166 969 166 373 566 534 790 923 480 480 701 596 618 520 232 880 914 525 322 606 549 522 549 626 510 495 459 467 524 524 969 520 233 524 923 524 472 524 524 876 919 549 209 99291 "Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes" 1985 710 2188 1588 209 1925 1169 778 1179 1071 1647 1922 1285 1285 822 1242 476 1138 484 1897 1906 1094 671 1263 1106 1050 1075 1306 1272 1032 1048 1228 209 1092 1866 1084 486 1092 1925 1092 1039 1146 1146 1826 1818 1532 969 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)" 524 344 2850 419 128 1468 284 205 311 283 435 507 1468 1468 203 328 199 277 128 501 503 289 177 333 292 277 284 345 563 272 277 324 253 288 493 286 128 288 508 288 274 727 484 482 480 369 256 99441 "Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion" 36 36 36 29 9 35 20 14 21 19 30 35 19 19 14 23 14 19 9 34 35 20 12 23 20 19 20 24 19 19 19 22 17 20 34 20 9 20 35 20 19 20 20 33 33 25 18 A0425 "Ground mileage, per statute mile" 79 2 5681 63 4 1432 43 31 47 4 66 1108 137 137 19 50 4 109 19 1046 76 44 27 50 12 252 1037 52 10 41 42 49 40 44 1432 43 19 44 77 44 41 67 62 73 106 176 39 A0426 "Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1)" 695 662 730 556 169 674 377 272 413 375 577 673 382 382 455 435 264 368 169 664 667 383 235 442 387 368 377 457 383 361 367 430 341 382 653 379 170 382 674 382 364 379 563 639 637 489 339 A0427 "Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)" 1100 460 2200 880 268 1067 597 431 654 577 913 1067 612 612 735 688 735 582 268 1017 1056 606 372 700 538 538 605 724 606 572 581 680 539 605 1034 601 269 605 1067 605 576 935 935 1012 964 982 537 A0428 "Ambulance service, basic life support, non-emergency transport, (BLS)" 579 551 608 463 141 562 314 227 344 312 480 561 357 357 387 362 220 307 141 553 556 319 196 368 323 306 314 381 319 301 306 358 274 318 544 316 142 318 562 318 303 492 468 533 507 407 283 A0429 "Ambulance service, basic life support, emergency transport (BLS-emergency)" 926 882 1944 741 226 898 502 363 550 499 768 897 515 515 620 579 352 490 226 885 889 510 313 589 516 490 502 609 565 482 489 573 454 509 871 506 227 509 898 509 485 787 787 852 894 787 452 A0433 "Advanced life support, level 2 (ALS 2)" 1505 1433 1580 1204 367 1460 816 590 894 812 1249 1457 928 928 584 942 572 793 367 1438 1445 829 509 957 838 796 815 990 806 783 795 931 780 828 1415 822 369 828 1460 828 788 1218 1218 1385 1379 1059 735 A0434 Specialty care transport (SCT) 1968 1968 1968 1574 480 1909 1068 771 1169 1062 1633 1906 1081 1081 764 1231 748 1042 480 1881 1889 1084 665 1252 1096 1041 1066 1294 1054 1023 1039 1217 930 1082 1850 1074 482 1082 1909 1082 1030 1073 1067 1811 1803 1385 960 A6196 "Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing" 222 222 222 178 54 215 120 87 132 120 184 215 122 122 86 139 84 118 54 212 213 122 75 141 124 117 120 146 119 115 117 137 116 122 209 121 54 122 215 122 116 121 122 204 203 156 108 A9270 Non-covered item or service 2 1 300 1 0 7621 6 1 1 1 1 2 1 1 1 1 6 1 0 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 0 1 2 1 1 7621 1 1 1 1 1 A9500 "Technetium Tc-99M sestamibi, diagnostic, per study dose" 498 261 522 398 121 483 270 195 296 269 413 482 274 274 193 312 189 264 121 476 478 274 168 317 277 263 270 328 267 259 263 308 274 274 468 272 122 274 483 274 261 274 274 458 456 469 243 A9537 "Technetium Tc-99M mebrofenin, diagnostic, per study dose, up to 15 millicuries" 161 161 169 129 39 156 87 63 96 87 134 156 99 99 62 101 61 85 39 154 155 89 54 102 90 85 87 106 86 84 85 100 82 89 151 88 39 89 156 89 84 93 89 148 147 148 79 A9540 "Technetium Tc-99M macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries" 353 353 353 282 86 342 191 138 210 190 293 342 194 194 137 221 134 187 86 337 339 195 119 225 197 187 191 232 189 184 186 218 194 194 332 193 86 194 342 194 185 192 191 325 323 248 172 A9561 "Technetium Tc-99M oxidronate, diagnostic, per study dose, up to 30 millicuries" 119 108 119 95 29 115 65 47 71 64 99 115 65 65 46 74 45 63 29 114 114 66 40 76 66 63 64 78 64 62 63 74 63 65 112 65 29 65 115 65 62 51 65 109 109 84 58 A9567 "Technetium Tc-99M pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries" 331 331 331 265 81 321 180 130 197 179 275 320 182 182 128 207 126 175 81 316 318 182 112 211 184 175 179 218 177 172 175 205 182 182 311 181 81 182 321 182 173 180 179 305 303 233 162 A9575 HC INJ GADOTERATE MEGLUMI 0.1ML 254 254 420 203 62 246 138 99 151 137 210 245 149 149 98 159 96 134 62 242 243 140 86 161 141 134 137 167 136 132 134 157 135 139 238 138 62 139 246 139 133 138 137 233 232 178 124 C1781 HC MESH (IMPLANTABLE) LVL 30 810 771 1542 648 197 802 439 318 481 437 672 784 445 445 314 507 308 620 197 774 778 446 274 515 490 428 439 533 611 421 428 501 411 446 762 442 198 446 786 446 424 802 439 745 742 446 395 C1783 HC OCULAR IMP AQUEOUS DRAIN LVL 11 5179 4932 5179 4143 1262 5024 2809 2030 3077 2794 4297 5015 2846 2846 2009 3241 1969 2742 1262 4949 4972 2854 1750 3295 2885 2739 2806 3406 2773 2693 2735 3204 2706 2848 4869 2827 1268 2848 5024 2848 2710 2848 2781 4765 4744 2713 2528 C8929 HC TTE W OR W/O CONTR FOLLOW W CONTR DOPPLER 4184 3985 4184 3347 458 4058 2270 1640 2486 2257 3472 4051 2456 2456 458 2618 1591 2215 1020 3999 4017 2305 1414 2662 2331 2213 2267 2752 2195 2176 2210 2588 2231 2301 3934 2284 1025 2301 4058 2301 2189 2301 2301 3849 3833 2301 2042 C9113 "Injection, pantoprazole sodium, per vial" 98 10 98 78 5 95 53 38 58 53 81 95 52 52 5 61 37 52 24 93 94 54 33 62 54 51 53 64 52 51 52 60 52 54 92 53 24 54 95 54 51 54 54 90 89 54 48 C9290 "Injection, bupivacaine liposome" 845 466 845 676 188 820 458 331 502 456 701 818 496 496 188 529 321 447 206 808 811 466 286 538 511 447 458 556 361 439 446 523 439 465 794 461 207 465 820 465 442 461 256 777 774 465 412 C9803 "HC HOSP OP CLINIC VISIT SPEC COLLEC SARS-COV-2 COVID-19, ANY SOURCE" 76 72 152 61 19 95 41 30 67 43 63 78 37 37 95 48 66 38 19 23 73 42 26 48 21 40 23 50 42 40 36 47 42 42 25 41 19 42 74 42 40 42 42 70 70 44 37 G0008 Administration of influenza virus vaccine 97 92 102 78 13 94 53 38 58 48 80 94 53 53 38 61 37 51 24 93 93 53 33 62 54 51 53 64 52 50 51 60 54 53 91 53 24 53 94 53 51 21 13 89 89 16 47 G0009 Administration of pneumococcal vaccine 92 92 97 74 22 89 50 36 55 50 76 89 51 51 36 58 35 49 22 88 88 51 31 59 51 49 50 61 53 48 49 57 42 51 87 50 23 51 89 51 48 50 50 85 84 65 45 G0103 Prostate cancer screening; prostate specific antigen test (PSA) 158 150 166 126 25 519 78 25 25 84 131 153 88 88 48 99 53 91 39 151 152 87 53 101 91 83 83 104 85 82 83 98 87 87 519 86 39 87 153 87 83 87 87 138 145 145 77 G0104 Colorectal cancer screening; flexible sigmoidoscopy 2260 1364 3155 1808 551 2192 1226 886 1342 1219 1875 2188 1241 1241 877 1414 859 1196 551 2159 2169 1245 763 1437 1259 1195 1224 1486 1210 1175 1193 1398 865 1243 2124 1234 553 1243 2192 1243 1182 1231 1225 2079 2070 1590 1103 G0105 Colorectal cancer screening; colonoscopy on individual at high risk 3155 1119 3759 2524 617 3060 1711 1237 1874 1859 2618 3055 1734 1734 1224 1974 1200 1670 769 3015 3029 1738 1066 2007 1758 1669 1709 2075 1689 1641 1666 1952 617 1735 2966 1722 773 1735 3060 1735 1651 1719 1868 2903 2890 2220 1540 G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 3234 425 3580 2587 788 3137 1754 1268 1921 1744 2684 3131 1777 1777 1255 2024 1230 1712 788 3091 3105 1782 1093 2057 1802 1710 1752 2127 1731 1682 1708 2001 937 1779 3041 1766 792 1779 3137 1779 1692 1609 1065 2975 2962 1822 1578 G0237 "Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)" 315 105 660 252 77 306 171 123 187 170 261 305 184 184 189 197 120 167 77 301 302 174 106 200 175 167 171 207 169 164 166 195 124 173 296 172 77 173 306 173 165 172 182 290 289 182 154 G0238 "Therapeutic procedures to improve respiratory function, other than described by G0237, one on one, face to face, per 15 minutes (includes monitoring)" 110 105 315 88 27 107 60 43 65 59 91 107 61 61 95 69 42 58 27 105 106 61 37 70 61 58 60 72 59 57 58 68 60 60 103 60 27 60 107 61 58 60 58 101 101 77 54 G0239 "Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)" 110 110 110 88 27 107 60 43 65 59 91 107 60 60 43 69 42 58 27 105 106 61 37 70 61 58 60 72 59 57 58 68 60 60 103 60 27 60 107 61 58 60 60 101 101 77 54 G0260 "Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography" 1826 1 2738 1461 1 1771 991 716 1085 985 1515 1768 921 921 1449 1143 1152 967 445 1745 1753 1006 617 1162 1017 966 989 1201 978 950 964 1130 974 1004 1717 997 447 1004 1771 1004 956 995 990 1680 1673 1 891 G0279 PR BREAST TOMOSYNTHESIS DIG DX UNIL/BILAT 44 35 56 36 11 43 24 33 26 24 37 43 28 28 17 28 17 31 21 43 43 25 15 28 31 24 24 29 26 23 24 28 21 24 42 24 11 24 43 24 23 24 31 41 34 30 22 G0283 "Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care" 82 78 86 66 20 119 44 32 49 44 68 79 45 45 119 51 31 43 20 78 79 45 28 52 46 43 44 54 44 43 43 51 45 45 77 45 20 45 80 45 43 40 37 75 75 47 40 G0297 PR CT LUNG CANCER SCREEN 300 300 300 240 73 392 163 118 178 156 249 290 179 179 392 188 114 159 73 287 288 165 101 191 167 159 163 197 161 156 158 186 156 165 291 164 73 165 291 165 157 147 153 276 275 211 146 G0328 "Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous" 57 54 60 46 14 55 31 22 34 31 47 55 31 31 22 36 22 30 14 54 55 31 19 36 32 30 31 37 31 30 30 35 31 31 54 31 14 31 55 31 30 33 33 52 52 33 28 G0378 "Hospital observation service, per hour" 2674 130 23063 2139 458 2758 1451 1048 1589 1063 2219 850 575 575 1709 1673 464 669 652 2555 2567 1473 904 1701 1490 458 1449 1759 634 1390 462 1654 1525 1471 2514 1460 655 1471 2594 1471 1399 2758 1866 2460 2688 2203 1305 G0379 Direct admission of patient for hospital observation care 135 129 1560 108 33 673 73 53 80 73 112 131 79 79 673 84 51 71 33 129 130 74 46 86 75 71 73 89 74 70 71 84 74 74 127 74 33 74 131 74 71 74 74 124 124 74 66 G0390 HC FULL TRAUMA RESPONS W CC FAC LEV 4 1323 1323 1458 1058 322 1283 718 519 786 714 1098 1281 727 727 513 828 503 700 322 1264 1270 729 447 842 737 700 717 870 708 688 699 818 753 728 1244 722 324 728 1283 728 692 721 717 1217 1212 1217 646 G0399 "Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation" 602 573 602 482 147 584 327 236 358 325 500 583 335 335 508 377 229 319 147 575 578 332 203 383 335 318 326 396 322 313 318 372 323 331 566 329 147 331 584 331 315 328 326 554 551 554 294 G0404 "Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination" 226 221 232 181 55 220 123 89 135 122 188 219 124 124 88 142 86 120 55 216 217 125 77 144 126 120 123 149 121 118 120 140 123 125 213 124 55 125 220 125 119 123 123 208 207 159 111 G0405 "Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination" 40 40 40 32 9 39 22 16 24 22 33 39 22 22 16 25 15 21 10 38 38 22 14 25 22 21 22 26 21 21 21 25 9 22 38 22 10 22 39 22 21 22 22 37 37 28 20 G0424 "Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day" 254 254 267 203 62 246 138 100 151 132 211 246 140 140 197 159 97 134 62 243 244 140 86 162 141 134 138 167 136 132 134 157 147 140 239 139 62 140 246 140 133 140 140 234 233 179 124 G0463 Hospital outpt clinic visit 268 1 340 214 61 287 86 105 159 86 222 259 142 142 61 168 61 142 65 256 257 148 91 171 149 142 91 176 98 139 142 166 143 147 287 146 66 147 260 147 140 147 147 247 153 147 131 G0472 HC HEP C SCREEN HIGH RISK/OTHER 120 115 126 96 29 116 65 107 71 65 100 116 67 67 88 75 86 64 29 111 115 66 41 76 67 63 63 79 66 62 63 74 66 66 113 66 29 66 116 66 63 66 69 110 116 68 59 G0480 Drug test def 1-7 classes 133 96 710 106 32 219 96 52 79 72 110 129 89 89 128 83 128 70 32 127 128 73 45 85 74 70 72 87 125 69 187 82 49 73 125 73 33 73 129 73 70 219 215 122 89 89 65 G0481 Drug test def 8-14 classes 586 586 586 469 143 569 318 230 348 316 486 568 350 350 227 367 223 310 143 560 563 323 198 373 327 310 318 386 314 305 310 363 306 322 551 320 144 322 569 322 307 320 318 539 537 413 286 G0482 Drug test def 15-21 classes 775 775 775 620 189 752 421 304 461 418 643 751 200 200 301 485 295 411 189 741 744 427 262 493 432 410 420 510 415 403 410 480 405 426 729 423 190 426 752 426 406 423 420 713 710 546 378 G0515 "Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes" 258 86 258 206 63 250 140 101 153 139 214 250 142 142 100 161 98 137 63 247 248 142 87 164 144 136 140 170 138 134 136 160 138 142 243 141 63 142 250 142 135 141 134 237 236 182 126 J0131 Acetaminophen injection 144 144 486 115 29 168 81 57 86 81 120 140 72 72 29 90 38 73 35 138 139 80 49 92 110 76 78 95 81 75 76 89 77 79 136 79 35 79 140 79 76 93 93 133 168 133 70 J0132 "Injection, acetylcysteine, 100 mg" 364 180 1216 291 89 648 197 142 216 196 302 352 151 151 141 227 138 192 89 347 349 200 123 231 202 192 197 239 195 189 192 225 648 200 342 198 89 200 353 200 190 198 197 334 333 378 177 J0133 "Injection, acyclovir, 5 mg" 163 163 163 130 8 158 88 64 97 88 135 158 89 89 63 102 8 86 40 155 156 90 55 104 91 86 88 107 87 85 86 101 85 89 153 89 40 89 158 89 85 89 88 150 149 115 79 J0153 PBB ADENOSINE INJ 1 MG 211 99 322 169 11 204 114 83 125 114 175 204 116 116 11 132 80 112 51 201 202 116 71 134 117 111 114 139 113 110 111 130 177 116 198 115 52 116 204 116 110 81 114 194 193 91 103 J0171 "Injection, adrenalin, epinephrine, 0.1 mg" 122 96 630 98 4 293 66 48 73 66 102 119 68 68 9 77 4 293 30 117 118 67 41 78 68 64 66 81 138 64 65 76 67 67 115 67 30 67 119 67 64 67 67 113 112 67 60 J0248 "Injection, remdesivir, 1 mg" 1128 1128 2168 902 275 1094 612 442 670 608 936 1092 620 620 437 706 429 616 275 1078 1082 621 381 717 628 596 611 742 604 586 595 697 601 620 1060 616 276 620 1094 620 590 614 620 1037 1033 620 550 J0282 "Injection, amiodarone hydrochloride, 30 mg" 182 180 314 145 5 176 98 71 108 98 151 176 100 100 5 114 69 96 44 173 174 100 61 115 101 96 98 119 97 94 96 112 93 100 171 99 44 100 176 100 95 99 98 167 166 128 89 J0290 "Injection, ampicillin sodium, 500 mg" 114 102 115 91 28 111 62 45 68 62 95 111 63 63 44 72 43 61 28 109 110 63 39 73 64 60 62 75 61 59 60 71 60 63 107 62 28 63 111 63 60 62 63 105 105 80 56 J0295 "Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm" 117 98 117 93 28 113 63 46 69 63 97 113 47 47 45 73 44 62 28 111 112 64 39 74 65 62 63 77 62 61 62 72 59 64 110 64 29 64 113 64 61 64 54 107 107 82 57 J0330 "Injection, succinylcholine chloride, up to 20 mg" 126 107 126 101 15 122 68 49 75 68 104 122 75 75 15 79 48 67 31 120 121 69 43 80 70 67 68 83 67 65 66 78 56 69 118 69 31 69 122 69 66 69 69 116 115 89 61 J0360 "Injection, hydralazine HCl, up to 20 mg" 101 94 101 80 5 98 55 39 60 54 83 97 55 55 5 63 38 53 25 96 97 55 34 64 56 53 55 66 54 52 53 62 52 55 95 55 25 55 98 55 53 55 55 93 92 71 49 J0456 "Injection, azithromycin, 500 mg" 100 94 100 80 3 3097 54 39 59 55 83 97 53 53 3 63 3 53 24 95 96 55 34 64 56 53 54 66 57 52 53 62 52 55 94 55 24 55 97 55 52 52 55 92 92 3097 49 J0461 "Injection, atropine sulfate, 0.01 mg" 104 104 136 83 25 100 56 41 61 56 86 100 64 64 40 65 39 55 25 99 99 57 35 66 58 65 56 68 55 54 55 64 56 57 97 57 25 57 100 57 54 57 75 95 95 57 51 J0595 "Injection, butorphanol tartrate, 1 mg" 93 91 191 75 23 90 51 37 55 50 77 90 47 47 36 58 35 49 23 89 89 51 31 59 52 49 50 61 50 48 49 58 52 51 88 51 23 51 90 51 49 51 51 86 85 66 45 J0610 "Injection, calcium gluconate, per 10 ml" 108 98 108 86 26 104 58 42 64 58 89 104 59 59 42 67 41 57 26 103 103 59 36 68 60 56 58 71 54 56 57 67 57 59 101 59 26 59 104 59 56 59 54 99 99 76 52 J0690 "Injection, cefazolin sodium, 500 mg" 113 91 339 90 3 110 61 44 67 53 94 109 63 63 3 71 5 60 28 108 109 62 38 72 68 60 61 74 62 59 57 70 60 62 106 62 28 62 110 62 59 62 62 104 104 62 55 J0692 "Injection, Cefepime hydrochloride, 500 mg" 99 99 99 79 24 96 54 39 59 53 82 96 58 58 38 62 38 52 24 95 95 55 33 63 55 52 54 65 53 51 52 61 53 54 93 54 24 54 96 54 52 54 54 91 91 54 48 J0696 "Injection, ceftriaxone sodium, per 250 mg" 122 90 272 97 2 118 68 48 72 63 101 118 63 63 3 76 2 74 30 114 117 67 41 77 68 64 66 80 67 63 46 75 69 67 114 66 30 67 118 67 64 75 67 112 111 67 59 J0712 Ceftaroline fosamil inj 491 491 491 393 120 476 266 192 292 265 407 475 270 270 191 307 187 260 120 469 471 271 166 312 274 260 266 323 263 255 259 304 257 270 462 268 120 270 476 270 257 268 250 452 450 346 240 J0713 "Injection, ceftazidime, per 500 mg" 96 96 96 77 24 94 52 38 57 52 80 93 53 53 37 60 37 51 24 92 93 53 33 61 54 51 52 63 52 50 51 60 51 53 91 53 24 53 94 53 50 53 52 89 88 68 47 J0744 "Injection, Ciprofloxacin for intravenous infusion, 200 mg" 95 95 189 76 23 92 52 37 56 51 79 92 52 52 37 60 36 50 23 91 91 52 32 61 53 50 52 63 51 49 50 59 51 52 89 52 23 52 92 52 50 52 52 87 88 67 46 J0780 "Injection, prochlorperazine, up to 10 mg" 124 106 249 100 4 121 68 49 74 67 103 121 55 55 4 78 5 66 30 119 120 69 42 79 69 55 67 82 69 65 62 77 68 68 117 68 30 68 121 68 65 68 63 115 114 106 61 J0881 "Injection, darbepoetin alfa, 1 microgram (non-ESRD use)" 2022 387 4819 1618 493 1962 1097 793 1202 1091 1678 1958 597 597 785 1266 769 1071 493 1933 1942 1114 683 1287 1127 1070 1096 1330 1083 1052 1068 1251 1656 1112 1902 1104 495 1112 1962 1112 1058 1102 559 1861 1853 1423 987 J0885 "Injection, epoetin alfa, (for non-ESRD use), 1000 units" 419 419 419 335 102 407 227 164 249 226 348 406 230 230 163 262 159 222 102 401 402 231 142 267 233 222 227 276 224 218 221 259 219 231 394 229 103 231 407 231 219 228 227 386 384 231 205 J0897 PBB DENOSUMAB INJECTION 1 MG 3042 2796 3042 2433 741 2951 1650 1192 1807 1641 2524 2945 1671 1671 1180 1903 1157 1611 741 2907 2920 1676 1028 1935 1695 1609 1648 2001 1629 1582 1607 1882 1622 1673 2860 1661 745 1673 2951 1673 1592 1658 1649 2798 2786 1626 1485 J1040 "Injection, methylprednisolone acetate, 80 mg" 124 104 127 100 11 121 67 49 74 67 103 120 68 68 11 78 47 66 30 119 119 69 42 79 69 66 67 82 37 65 66 77 55 68 117 68 30 68 121 68 65 68 67 114 114 88 61 J1100 "Injection, dexamethasone sodium phosphate, 1 mg" 91 3 351 73 1 1975 49 36 54 50 76 88 50 50 1 57 1 52 22 87 87 50 31 58 51 48 49 60 53 47 48 56 49 50 1975 50 22 50 88 50 48 49 49 84 83 68 44 J1160 "Injection, digoxin, up to 0.5 mg" 94 90 98 75 23 91 51 37 56 50 78 91 51 51 36 59 36 50 23 89 90 52 32 59 52 49 51 61 50 49 49 58 50 51 88 51 23 51 91 51 49 54 48 86 86 66 46 J1170 "Injection, hydromorphone, up to 4 mg" 90 89 631 72 3 168 49 35 54 49 75 87 50 50 3 56 3 48 22 86 86 50 30 57 50 48 50 59 52 47 93 56 49 50 85 49 22 50 87 50 47 102 99 83 168 85 26 J1200 "Injection, diphenhydramine HCl, up to 50 mg" 90 88 93 72 1 88 49 35 54 49 75 87 40 40 1 56 1 48 22 86 87 50 30 57 54 48 49 59 49 47 53 56 48 50 85 49 22 50 88 50 47 50 49 83 82 81 44 J1265 "Injection, dopamine HCl, 40 mg" 100 88 112 80 24 97 54 39 59 54 83 97 55 55 39 62 38 53 24 95 96 55 34 63 56 53 54 66 53 52 53 62 51 55 94 54 24 55 97 55 52 54 54 92 91 70 49 J1335 "Injection, Ertapenem sodium, 500 mg" 322 322 322 257 78 312 174 126 191 174 267 311 177 177 125 201 122 170 78 307 309 177 109 205 179 170 174 212 172 167 170 199 177 177 302 176 79 177 312 177 168 175 174 296 295 226 157 J1439 HC INJ FERRIC CARBOXYMALTOS 1MG 2435 2435 2435 1948 593 2362 1321 955 1447 1314 2021 2358 1338 1338 945 1524 926 1289 593 2327 2338 1342 823 1549 1357 1288 1319 1602 1304 1266 1286 1506 1339 1339 2290 1329 596 1339 2362 1339 1274 1327 1320 2240 2231 1714 1189 J1442 HC FILGRASTIM G-CSF 1MCG INJ 1422 1422 1422 1138 347 1380 772 558 845 767 1180 1377 781 781 552 890 541 753 347 1359 1365 784 481 905 792 752 771 936 761 740 751 880 725 782 1337 776 348 782 1380 782 744 775 771 1309 1303 1001 694 J1569 "Injection, immune globulin, (gammagard liquid), intravenous, non-lyophilized, (e.g. liquid), 500 mg" 8783 8783 8783 7026 2140 8519 4764 3443 5218 4737 7288 8504 4826 4826 3408 5496 3340 4650 2140 8393 8431 4839 2968 5588 4893 4645 4758 5777 4702 4567 4639 5433 4830 4830 8258 4795 2151 4830 8519 4831 4596 4787 4762 8080 8045 6181 4286 J1580 "Injection, garamycin, gentamicin, up to 80 mg" 106 91 182 85 26 103 57 41 63 57 88 102 58 58 41 66 40 56 26 101 101 58 36 67 59 56 57 70 57 55 56 65 55 58 99 58 26 58 103 58 55 58 75 97 97 74 52 J1630 "Injection, haloperidol, up to 5 mg" 89 88 89 71 1 87 48 35 53 48 74 86 49 49 1 56 34 47 22 85 86 49 30 57 50 47 48 59 25 46 47 55 48 49 84 49 22 49 87 49 47 49 48 82 82 63 44 J1642 "Injection, Heparin sodium, (Heparin lock flush), per 10 units" 89 88 89 71 22 86 48 35 53 48 74 86 51 51 35 56 34 47 22 85 86 49 30 57 50 47 48 59 48 46 47 55 48 49 84 49 22 49 86 49 47 49 45 82 82 63 44 J1644 "Injection, Heparin sodium, per 1000 units" 100 89 100 80 24 97 55 39 60 54 83 97 51 51 39 63 38 53 24 96 96 55 34 64 56 53 53 66 54 52 53 62 53 55 94 55 25 55 97 55 53 55 55 92 92 55 49 J1650 "Injection, enoxaparin sodium, 10 mg" 105 100 243 84 3 101 57 41 62 59 87 101 58 58 3 65 10 55 25 100 100 58 35 67 58 59 57 69 61 54 55 65 56 58 98 57 26 58 101 58 55 58 58 96 95 58 51 J1720 "Injection, hydrocortisone sodium succinate, up to 100 mg" 118 112 124 95 29 115 64 46 70 64 98 115 58 58 46 74 45 63 29 113 114 65 40 75 66 63 64 78 63 62 63 73 63 65 111 65 29 65 115 65 62 65 64 109 108 83 58 J1745 "Injection Infliximab, 10 mg" 11766 9430 14101 9413 2867 11413 6383 4612 6990 6347 9763 11392 6465 6465 4565 7362 4474 6230 2867 11244 11295 6483 3976 7485 6554 6222 7756 7739 6299 6118 6214 7278 6148 6471 11062 6423 2882 6471 11413 6471 6157 6412 4809 10824 10778 8280 5742 J1756 "Injection, iron sucrose, 1 mg" 318 308 528 255 78 309 173 125 189 172 264 308 175 175 124 199 121 169 78 304 306 175 108 203 177 168 173 209 240 166 168 197 169 175 299 174 78 175 309 175 167 175 175 293 292 172 155 J1815 "Injection, insulin, per 5 units" 6 6 6 5 1 6 3 2 4 3 5 6 3 3 2 4 2 3 1 6 6 3 2 4 3 3 3 4 3 3 3 4 3 3 6 3 1 3 6 3 3 3 3 6 5 6 3 J1885 "Injection, ketorolac tromethamine, per 15 mg" 91 89 273 73 1 88 49 36 54 50 76 88 47 47 1 57 1 49 22 66 87 50 31 58 53 48 49 60 50 47 50 56 49 50 86 50 22 50 88 50 48 50 51 84 83 84 45 J1940 "Injection, furosemide, up to 20 mg" 93 89 280 75 1 91 51 37 55 51 77 90 49 49 1 58 1 49 23 90 90 51 32 59 52 49 51 61 54 49 49 58 50 51 88 51 23 51 91 51 49 49 51 86 85 49 46 J1953 "Injection, levetiracetam, 10 mg" 94 91 102 76 9 92 51 37 56 51 78 91 56 56 9 59 36 50 23 90 91 52 32 60 53 50 51 62 55 49 50 58 50 52 89 52 23 52 92 52 49 52 52 87 87 67 46 J1956 "Injection, levofloxacin, 250 mg" 100 96 110 80 0 97 54 39 59 54 83 97 53 53 39 63 0 53 24 96 96 55 34 64 56 53 54 66 54 52 53 62 54 55 94 55 25 55 97 55 52 56 52 92 92 92 49 J2060 "Injection, lorazepam, 2 mg" 89 88 988 71 1 86 48 35 53 48 74 86 46 46 1 56 1 47 22 85 85 49 30 56 49 47 48 58 51 46 44 55 48 49 83 48 22 49 86 49 46 49 48 82 81 81 43 J2175 "Injection, meperidine hydrochloride, per 100 mg" 93 93 93 74 7 90 50 36 55 50 77 90 51 51 7 58 35 49 23 89 89 51 31 59 52 49 50 61 50 48 49 57 48 51 87 51 23 51 90 51 49 51 50 85 85 65 45 J2185 "Injection, meropenem, 100 mg" 128 110 128 102 31 124 69 50 76 69 106 123 56 56 49 80 48 68 31 122 122 70 43 81 71 67 69 84 68 66 67 79 68 70 120 70 31 70 124 70 67 69 69 117 117 90 62 J2250 "Injection, midazolam hydrochloride, per 1 mg" 89 88 184 72 0 87 49 35 53 50 74 87 50 50 0 56 0 46 22 87 86 49 30 57 54 47 49 59 49 47 45 55 48 49 84 49 22 49 87 49 47 49 49 82 82 49 44 J2270 "Injection, morphine sulfate, up to 10 mg" 92 88 639 73 3 209 50 36 54 49 76 89 47 47 3 57 49 49 22 88 88 50 31 58 55 48 50 60 49 48 48 57 50 50 86 50 22 50 89 50 48 50 209 84 84 84 45 J2310 "Injection, naloxone hydrochloride, per 1 mg" 117 108 117 94 13 114 64 46 70 63 97 114 65 65 46 73 13 62 29 112 113 65 40 75 65 62 64 77 63 61 62 73 65 65 110 64 29 65 114 65 61 64 64 108 108 108 57 J2350 "Injection, ocrelizumab, 1 mg" 69742 68209 71275 55794 16995 67650 37833 27339 41434 37620 57871 67528 38320 38320 27059 43640 26519 36927 16995 66651 66952 38428 23566 44370 38851 36884 37783 45872 37340 36266 36835 43142 37759 38358 65573 38074 17082 38358 67650 38358 36495 38009 37813 64162 63886 49082 34037 J2370 "Injection, phenylephrine HCl, up to 1 ml" 96 96 96 76 4 93 52 37 57 52 79 92 52 52 4 60 36 51 23 91 92 53 32 61 53 51 52 63 49 50 50 59 50 53 90 52 23 53 93 53 50 52 53 88 87 67 47 J2405 "Injection, ondansetron hydrochloride, per 1 mg" 88 88 268 71 0 86 50 35 53 50 73 86 47 47 0 55 0 46 22 85 85 49 30 56 51 46 49 58 49 46 51 55 47 49 83 48 22 49 86 49 46 49 49 81 84 81 43 J2543 "Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)" 105 94 111 84 4 102 59 41 62 57 87 102 41 41 41 66 4 56 26 100 101 58 36 67 59 56 57 69 50 55 56 65 56 58 99 57 26 58 102 58 55 61 58 97 96 102 51 J2550 "Injection, promethazine HCl, up to 50 mg" 91 89 91 73 2 88 49 36 54 49 76 88 51 51 3 57 2 48 22 87 88 50 31 58 51 48 49 60 49 47 48 56 47 50 86 50 22 50 88 50 48 50 47 84 84 84 45 J2704 "Inj, propofol, 10 mg" 92 89 185 74 3 90 50 36 55 50 77 89 51 51 3 58 3 49 22 88 89 51 31 59 56 49 50 61 51 48 46 57 51 51 87 50 23 51 90 51 48 51 51 85 85 51 45 J2710 "Injection, neostigmine methylsulfate, up to 0.5 mg" 170 129 170 136 42 165 92 67 101 92 141 165 94 94 70 107 90 90 42 163 164 94 58 108 95 90 92 112 91 89 90 105 78 94 160 93 42 94 165 94 89 93 67 157 156 120 83 J2760 "Injection, phentolamine mesylate, up to 5 mg" 927 927 927 742 226 899 503 363 551 500 769 898 509 509 360 580 353 491 226 886 890 511 313 590 516 490 502 610 496 482 490 574 494 510 872 506 227 510 899 510 485 482 503 853 849 652 452 J2765 "Injection, metoclopramide HCl, up to 10 mg" 90 89 180 72 1 92 49 35 53 48 75 87 46 46 1 56 1 48 22 86 86 49 30 57 50 47 49 59 92 47 47 56 48 49 84 49 22 49 87 49 47 49 46 83 82 49 44 J2785 "Injection, regadenoson, 0.1 mg" 588 573 603 470 143 570 319 230 349 317 488 569 323 323 238 368 224 311 143 562 564 324 199 374 328 311 319 387 315 306 311 364 315 323 553 321 144 323 570 323 308 323 323 541 539 432 287 J2790 "Injection, Rho D immune globulin, human, full dose, 300 micrograms (1500 I.U.)" 324 324 324 259 79 314 175 127 192 174 268 313 193 193 82 202 123 171 79 309 311 178 109 206 180 171 175 213 173 168 171 200 169 178 304 177 79 178 314 178 169 176 175 298 296 228 158 J2795 "Injection, ropivacaine hydrochloride, 1 mg" 144 99 144 115 12 140 78 56 86 78 119 139 82 82 12 90 53 77 35 138 138 79 49 92 80 76 78 95 51 75 76 89 77 79 135 79 35 79 140 79 75 79 52 132 132 101 70 J2920 "Injection, methylprednisolone sodium succinate, up to 40 mg" 100 94 401 80 5 138 54 39 59 54 83 97 55 55 5 63 38 53 24 96 96 55 34 64 56 53 54 66 54 52 53 62 62 55 94 55 25 55 97 55 52 138 55 92 92 59 49 J2930 "Injection, methylprednisolone sodium succinate, up to 125 mg" 108 97 302 86 6 111 59 42 64 58 89 104 56 56 6 67 6 57 26 101 104 59 36 69 55 57 58 71 63 56 57 67 55 59 101 59 26 59 105 59 56 111 59 99 98 59 53 J2997 "Injection, alteplase recombinant, 1 mg" 3168 787 13376 2535 772 4017 1719 1242 1882 1709 2629 3068 1741 1741 1229 1982 1205 1677 772 3028 3041 1746 1071 2016 1765 1676 1716 2084 1696 1647 1673 1960 1383 1742 2979 1730 776 1742 3073 1742 1658 1727 4017 2915 2902 2230 1546 J3010 "Injection, fentanyl citrate, 0.1 mg" 90 88 359 72 1 93 49 35 53 93 75 86 51 51 1 56 1 49 22 86 86 50 30 57 55 48 49 59 52 47 45 56 49 50 85 49 22 50 87 50 47 50 50 83 82 50 25 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)" 138 138 138 110 26 133 75 54 82 74 114 133 76 76 53 86 26 73 34 131 132 76 46 87 77 73 74 90 74 72 73 85 72 76 129 75 34 76 133 76 72 75 75 126 126 97 67 J3301 "Injection, triamcinolone acetonide, not otherwise specified, 10 mg" 106 106 212 85 5 103 58 42 63 57 88 103 59 59 5 66 5 56 26 102 102 59 36 68 59 56 58 70 57 55 56 66 57 58 100 58 26 58 103 58 56 58 58 98 97 98 52 J3360 "Injection, diazepam, up to 5 mg" 115 92 919 92 7 111 62 45 68 62 95 111 84 84 7 72 44 61 28 110 110 63 39 73 64 61 62 76 67 60 61 71 56 63 108 63 28 63 111 63 60 60 56 106 105 93 56 J3370 "Injection, vancomycin HCl, 500 mg" 144 19 415 115 9 246 80 56 85 62 119 139 85 85 56 90 9 76 35 137 138 79 48 91 80 76 78 94 246 75 76 89 65 79 135 78 35 79 139 79 75 75 79 132 131 70 70 J3380 "Injection, vedolizumab" 15005 14176 15005 12004 3656 14555 8140 5882 8915 8094 12451 14529 8245 8245 5822 9389 5706 7945 3656 14340 14405 8268 5070 9546 8359 7936 8129 9870 8034 7803 7925 11254 7899 8253 14108 8192 3675 8253 14555 8253 7852 8178 8136 13805 13745 10560 7323 J3411 "Injection, thiamine HCl, 100 mg" 107 97 107 86 26 104 58 42 64 58 89 104 63 63 42 67 41 57 26 103 103 59 36 68 60 57 58 71 60 56 57 66 50 59 101 59 26 59 104 59 56 59 58 99 99 90 52 J3420 "Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg" 101 101 101 81 25 98 55 40 60 55 84 98 56 56 39 63 39 54 25 97 97 56 34 64 56 54 55 67 54 53 54 63 56 56 95 55 25 56 98 56 53 55 55 93 93 71 49 J3430 "Injection, phytonadione (vitamin K), per 1 mg" 173 122 185 138 42 168 94 68 103 93 144 168 95 95 67 108 66 92 42 165 166 95 58 110 96 92 94 114 93 90 91 107 82 95 163 94 42 95 168 95 91 94 80 159 159 95 84 J3475 "Injection, magnesium sulfate, per 500 mg" 96 89 214 76 3 93 52 37 57 52 79 92 55 55 3 60 36 51 23 91 92 53 32 61 53 51 52 63 54 50 50 59 53 53 90 52 23 53 93 53 50 59 53 88 87 59 47 J3480 "Injection, potassium chloride, per 2 meq" 96 60 292 77 1 93 52 38 57 51 79 93 43 43 1 60 2 51 23 91 92 53 32 61 53 51 52 63 35 50 51 59 41 53 90 52 23 53 93 53 50 53 54 88 88 52 47 J3489 HC ZOLEDRONIC ACID 1MG 558 558 558 446 136 541 302 219 331 301 463 540 306 306 216 349 212 295 136 533 535 307 188 355 311 295 302 367 298 290 294 345 283 307 524 304 137 307 541 307 292 304 302 513 511 392 272 J7042 5% dextrose/normal saline (500 ml = 1 unit) 60 60 240 48 15 62 33 24 36 32 50 58 36 36 23 38 23 32 15 57 58 33 20 38 33 32 33 39 32 31 32 37 32 33 56 33 15 33 58 33 31 31 62 55 55 55 29 J7070 "Infusion, D5W, 1000 cc" 60 60 60 48 15 58 33 24 36 32 50 58 33 33 23 38 23 32 15 57 58 33 20 38 33 32 33 39 32 31 32 37 31 33 56 33 15 33 58 33 31 33 33 55 55 42 29 J7120 "Ringers lactate infusion, up to 1000 cc" 60 60 120 48 2 60 31 24 36 34 50 58 33 33 2 38 2 32 15 58 58 33 20 38 36 31 33 39 31 31 60 37 32 33 56 33 15 33 58 33 31 33 33 55 55 33 29 J7121 5% dextrose in lac ringers 90 60 120 72 8 87 49 35 53 49 75 87 49 49 8 56 34 48 22 86 86 50 30 57 50 48 49 59 48 47 48 56 47 50 85 49 22 50 87 50 47 49 49 83 82 63 44 J7510 "Prednisolone oral, per 5 mg" 2 2 2 2 0 2 1 1 1 1 2 2 1 1 0 1 1 1 0 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 0 1 2 1 1 1 1 2 2 1 1 J7512 Prednisone ir or dr oral 1mg 1 1 4 1 0 1 1 0 1 1 1 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 J8540 "Dexamethasone, oral, 0.25 mg" 3 2 4 2 1 3 2 1 2 2 2 3 2 2 3 2 1 2 1 3 3 2 1 2 2 2 2 2 2 1 2 2 1 2 3 2 1 2 3 2 1 2 1 3 3 2 1 J8610 "Methotrexate; oral, 2.5 mg" 25 25 25 20 6 24 14 10 15 14 21 24 14 14 10 16 10 13 6 24 24 14 9 16 14 13 14 17 13 13 13 16 12 14 24 14 6 14 24 14 13 14 14 23 23 18 12 J9999 "Not otherwise classified, antineoplastic drugs" 2 1 33 1 0 2 1 1 1 1 1 2 1 1 1 1 1 1 0 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 0 1 2 1 1 1 1 2 2 1 1 M0222 "IV injection, bebtelobimab, includes injection and post administration monitoring" 736 701 736 589 179 714 399 289 437 397 611 713 432 432 286 461 280 390 179 703 707 406 249 468 410 389 399 484 428 383 389 455 389 405 692 402 180 405 714 405 385 401 377 677 674 518 359 M0239 HC BAMLANIVIMAB-XXXX INFUSION 620 620 620 496 151 610 336 243 368 334 514 600 341 341 610 388 236 328 151 593 595 342 209 394 345 328 336 408 332 322 327 384 316 341 583 338 152 341 601 341 324 338 336 570 568 436 303 M0243 Casirivi and imdevi infusion 620 620 900 496 151 601 336 243 368 334 514 600 341 341 570 388 236 328 151 593 595 342 209 394 345 328 336 408 496 322 327 384 341 341 583 338 152 341 601 341 324 338 336 570 568 436 303 M0245 "IV infusion, bablanivimab and etesevimab, includes infusion and post administration monitoring" 900 900 900 720 219 873 488 353 535 485 747 871 726 726 570 563 570 477 219 860 864 496 304 573 501 476 488 592 482 468 475 557 495 495 846 491 220 495 873 495 471 490 495 828 824 633 439 M0247 "IV infusion, sotrovimab, includes infusion and post administration monitoring" 900 900 900 720 219 873 488 353 535 485 747 871 501 501 570 563 570 477 219 860 864 496 304 573 501 476 488 592 496 468 475 557 495 495 846 491 220 495 873 495 471 495 495 828 824 633 439 P9016 "Red blood cells, leukocytes reduced, each unit" 1002 477 1578 802 210 972 544 393 595 540 831 970 557 557 210 627 381 531 244 958 962 552 339 637 558 530 543 659 487 521 529 620 508 551 942 547 245 551 972 551 524 546 551 922 918 551 489 P9037 "Platelets, pheresis, leukocytes reduced, irradiated, each unit" 1690 1690 1690 1352 412 1639 917 663 1004 912 1402 1636 929 929 656 1058 643 895 412 1615 1623 931 571 1075 942 894 916 1112 905 879 893 1046 901 930 1589 923 414 930 1639 930 884 921 916 1555 1548 1189 825 P9040 "Red blood cells, leukocytes reduced, irradiated, each unit" 622 622 622 497 152 603 337 244 369 335 516 602 342 342 241 389 236 329 152 594 597 343 210 396 346 329 337 409 333 323 328 385 317 342 585 339 152 342 603 342 325 339 337 572 572 438 303 P9047 "Infusion, albumin (human), 25%, 50 ml" 202 180 456 162 49 292 110 79 120 109 168 196 132 132 78 127 77 107 49 193 194 111 68 129 113 107 110 133 108 105 107 125 114 111 190 110 50 111 196 111 106 99 99 186 292 142 99 Q0138 "Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)" 2230 2230 2230 1784 543 2163 1210 874 1325 1203 1851 2160 1225 1225 865 1396 848 1181 543 2131 2141 1229 754 1419 1242 1180 1208 1467 1194 1160 1178 1380 1137 1227 2097 1218 546 1227 2163 1227 1167 1216 1209 2052 2043 1570 1089 Q0222 "Injection, bebtelovimab, 175 mg" 4288 4288 4288 3430 1045 4159 2326 1681 2547 2313 3558 4151 2356 2356 1663 2683 1630 2270 1045 4097 4116 2362 1449 2728 2388 2267 2323 2820 2493 2230 2264 2652 2240 2358 4031 2341 1050 2358 4159 2358 2244 2337 2325 3944 3927 3017 2093 Q5103 "Injection, inflectra" 3873 3873 11443 3098 944 6294 2101 1518 2301 2089 3213 3750 2128 2128 1503 2423 1473 2050 944 3701 3718 2134 1309 2464 6294 2048 6294 2547 2073 2014 2045 2396 2065 2130 3641 2114 949 2130 3756 2130 2027 2111 2100 3563 3547 2725 1890 Q5104 "Injection, renflexis" 6115 6115 6115 4892 1490 5931 3317 2397 3633 3298 5074 5921 3360 3360 2372 3826 2325 3238 1490 5844 5870 3369 2066 3890 3406 3234 3313 4022 3274 3180 3229 3783 3195 3363 5749 3338 1498 3363 5931 3363 3200 3332 3363 5625 5601 3363 2984 Q5108 "Injection, fulphila" 8438 8438 8438 6750 2056 8184 4577 3308 5013 4551 7001 8170 4636 4636 3274 5280 3208 4467 2056 8064 8100 4649 2851 5368 4700 4462 4571 5550 4517 4388 4456 5219 4641 4641 7933 4606 2067 4641 8184 4641 4415 4598 4575 7762 7729 5938 4118 Q5110 Nivestym 964 964 964 771 235 935 523 378 572 520 799 933 529 529 374 603 366 510 235 921 925 531 326 613 537 510 522 634 516 501 509 596 530 530 906 526 236 530 935 530 504 525 522 886 883 678 470 S0028 "Injection, famotidine, 20 mg" 89 89 89 71 1 86 48 35 53 48 74 86 49 49 1 56 1 47 22 85 85 49 30 57 50 47 48 59 48 46 47 55 47 49 84 49 22 49 86 49 47 49 48 82 82 63 43 S0077 "Injection, clindamycin phosphate, 300 mg" 109 109 109 87 2 106 59 43 65 59 90 105 60 60 2 68 2 58 27 104 105 60 37 69 61 58 59 72 58 57 58 67 57 60 102 59 27 60 106 60 57 59 59 100 100 77 53 S5551 "Insulin, most rapid onset (Lispro or Aspart); 5 units" 300 300 300 240 26 291 163 117 178 162 249 290 165 165 26 188 41 159 73 286 288 165 101 191 167 158 162 197 160 156 158 185 157 165 282 164 73 165 291 165 157 163 162 276 275 211 146 S5552 "Insulin, intermediate acting (NPH or LENTE); 5 units" 229 229 229 183 1 222 124 90 136 123 190 222 126 126 89 143 1 121 56 219 220 126 77 146 128 121 124 151 123 119 121 142 120 126 215 125 56 126 222 126 120 125 124 211 210 161 112 S9472 "Cardiac rehabilitation program, non-physician provider, per diem" 221 221 351 177 54 214 120 87 131 119 183 214 123 123 86 138 84 117 54 211 212 122 75 141 123 117 120 145 118 115 117 137 115 122 208 121 54 122 214 122 116 120 120 203 202 156 108 U0003 HC SARS-COV-2 COVID-19 AMP PRB HIGH THROUGHPUT TECH 394 394 394 315 96 382 214 154 366 213 327 381 216 216 150 247 150 209 96 377 378 217 133 251 219 208 213 259 211 205 208 244 201 217 370 215 97 217 382 217 206 215 200 362 361 277 192 V2630 Anterior chamber intraocular lens 441 441 441 353 107 428 239 173 262 238 366 427 242 242 171 276 168 233 107 421 423 243 149 281 246 233 239 290 236 229 233 273 225 243 415 241 108 243 428 243 231 240 239 406 404 310 215 V2632 Posterior chamber intraocular lens 463 441 486 370 113 449 251 181 275 250 384 448 258 258 180 290 176 245 113 442 444 255 156 295 254 254 251 305 248 241 245 286 255 255 435 253 113 255 449 255 242 267 255 426 424 255 226 DRG Description Charges Charges Low Charges High Discounted Cash Price Min Negotiated Max Negotiated Aetna Aetna - coventry Aetna insurance Aetna medicare Alliance umr American postal workers Amerigroup ia medicaid Iowa Total Care Blue cross Blue cross medicare blue ppo Blue cross out of state Champus Champva Cigna Commercial Coventry advantra Coventry health care Employee benefits systems Health partners Health partners uph medicare adv h3416 Health partners uph self funded Healtheos - aetna insurance Iowa total care Liability Medicaid Medical associates Medicare Medicare community plan uhc Midlands choice Network health Quartz insurance Securehorizons direct Trustmark Uhc medicare dir Uhc medicare solutions Uhc medicare solutions hmo Uhc medicare solutions ppo Uhc river valley Umr uhc United healthcare Va Inpatients 92 DRG OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION OR COMORBIDITY (CC) 10984 9539 43335 8787 2677 10655 5959 4306 6526 5925 9115 10636 8968 8968 4262 6873 4177 5816 2677 10497 10545 6052 3712 6988 6119 5809 5951 7225 5881 5712 5801 6795 5740 6041 10328 5997 2690 6041 10655 6041 5748 5986 5955 10106 10062 7730 5361 98 "DRG NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 18639 18639 18639 14911 4542 18080 10111 7307 11073 10054 15466 18047 10241 10241 7232 11663 7087 9869 4542 17813 17893 10270 6298 11858 10383 9857 10098 12260 9979 9692 9844 13979 9739 10251 17525 10176 4565 10251 18080 10252 9754 10158 10106 17148 17074 13118 9097 177 DRG RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) 5673 134 25551 4538 1382 19959 3077 2224 3370 3060 4707 5493 19959 19959 2201 3550 2157 3004 1382 5421 5446 3126 1917 3609 3160 3000 3073 3731 3037 2950 2996 15956 2964 3120 5334 3097 1389 3120 5503 3120 2969 3092 3076 5219 5197 4705 2769 178 DRG RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH COMPLICATION OR COMORBIDITY (CC) 15564 15564 15564 12451 3793 15097 8443 6101 9246 8395 12915 15070 10889 10889 6039 9739 5918 8241 3793 14874 14941 8576 5259 9902 8670 8231 8432 10237 8333 8093 8220 9628 8133 8560 14633 8497 3812 8560 15097 8560 8144 8482 8438 14319 14257 10953 7596 180 DRG RESPIRATORY NEOPLASMS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) 24407 24407 24407 19525 5947 24407 13240 9568 14500 13165 20252 23632 24407 24407 9470 15272 9281 12923 5947 23325 23430 13448 8247 15528 13596 12908 13222 16053 13067 12692 12891 15098 12753 13424 22948 13324 5978 13424 23675 13424 12772 13302 13233 22454 22357 17177 11912 191 "DRG CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 15237 4754 25720 12190 3311 15219 8266 5973 9052 15219 12644 14753 3311 3311 5912 9534 5794 8068 3713 14562 14628 8396 5149 9694 8488 8058 8255 10022 8158 7923 8048 9426 7962 8380 14326 8318 3732 8380 14780 8380 7973 8304 8261 14018 13958 10723 7436 194 "DRG SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 27048 221 53874 21638 6591 26236 14673 10603 16069 14590 22444 26189 14861 14861 10494 16925 10285 14321 6591 25849 25966 14903 9139 17208 15067 14304 14653 17791 14481 14065 14285 21861 14133 14876 25431 14766 6625 14876 26236 14876 14154 14741 14665 24884 24777 19035 13201 195 "DRG SIMPLE PNEUMONIA AND PLEURISY WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 21188 21188 21188 16950 5163 20552 11494 8306 12588 11429 17581 20515 11642 11642 8221 13258 8057 11218 5163 20248 20340 11674 7159 13480 11803 11205 11478 13936 11344 11018 11190 17648 11071 11653 19921 11567 5189 11653 20552 11653 11087 11547 11488 19493 19408 14911 10341 331 DRG MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) 28661 28661 28661 22929 6984 27801 15548 11235 17028 15460 23783 27751 15748 15748 11120 17934 10898 15175 6984 27391 27515 15792 9685 18234 15966 15158 15527 18852 15345 14904 15138 17730 14976 15764 26948 15647 7020 15764 27801 15764 14998 15620 15540 26368 26255 26368 13988 388 DRG G.I. OBSTRUCTION WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) 80789 25784 135794 64631 10493 101845 43825 31669 47997 43578 67037 78224 10493 10493 31345 50552 30720 42776 19686 77208 77557 44514 27298 51398 45005 42726 43768 53138 43254 42010 42669 101845 42215 44434 75959 44104 19787 44434 78365 44434 42276 44030 43802 74326 74005 56857 39429 389 DRG G.I. OBSTRUCTION WITH COMPLICATION OR COMORBIDITY (CC) 13556 13556 13556 10844 3303 13149 7353 5314 8053 7312 11248 13125 6356 6356 5259 8482 5154 7177 3303 12955 13013 7469 4580 8624 7551 7169 7344 8916 7258 7049 7159 8385 7083 7456 12745 7400 3320 7456 13149 7456 7093 7388 7350 12471 12417 9540 6616 436 DRG MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION OR COMORBIDITY (CC) 18892 9760 28024 15114 4604 25222 10248 7406 11224 10191 15676 18292 10380 10380 7330 11821 7184 10003 4604 18055 18136 10409 6384 12019 10524 9991 10235 12426 10115 9824 9978 25222 9872 10391 17763 10314 4627 10391 18325 10391 9886 10296 10243 17381 17306 8979 9220 439 DRG DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION OR COMORBIDITY (CC) 29468 29468 29468 23574 7181 28584 15985 11551 17507 15895 24452 28532 10421 10421 11433 18439 11205 15602 7181 28162 28289 16237 9957 18747 16415 15584 15964 19382 15777 15323 15564 18229 15398 16207 27706 16087 7217 16207 28584 16207 15420 16060 15977 27110 26993 20738 14382 550 DRG SEPTIC ARTHRITIS WITHOUT CC/MCC 1811 1811 1811 1448 441 1756 982 710 1076 977 1502 1753 995 995 702 1133 688 959 441 1730 1738 998 612 1152 1009 958 981 1191 969 941 956 1557 946 996 1702 988 443 996 1756 996 947 987 982 1666 1659 1274 884 560 "DRG AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 5785 5785 5785 4628 1410 5612 3138 2268 3437 3121 4801 5602 3179 3179 2245 3620 2200 3063 1410 5529 5554 3188 1955 3681 3223 3060 3134 3805 3097 3008 3056 4339 3023 3182 5439 3158 1417 3182 5612 3182 3027 3153 3137 5322 5299 4071 2823 565 "DRG OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 10684 10684 10684 8547 2603 10363 5795 4188 6347 5763 8865 10344 7057 7057 4145 6685 4062 5657 2603 10210 10256 5887 3610 6797 5951 5650 5788 7027 5720 5555 5643 6609 5582 5876 10045 5832 2617 5876 10363 5876 5591 5823 5792 9829 9786 7519 5214 641 "DRG MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM , FLUIDS AND ELECTROLYTES WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 12115 4008 20222 9692 1198 18605 6572 4749 7198 6535 10053 11730 6657 6657 4700 7581 4607 6415 2952 11578 11630 6675 4094 7708 6749 6407 6563 7969 6486 6300 6399 7494 1198 6663 11391 6614 2967 6663 11752 6663 6340 6603 6569 11146 11098 18605 5913 862 "DRG POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 77955 77955 77955 62364 15604 75616 42288 30559 46313 42050 64686 75480 15604 15604 30246 48779 29642 41275 18996 74500 74836 42953 26341 49595 43426 41227 42232 51275 41737 40537 41173 48223 40734 42875 73295 42557 19093 42875 75616 42876 40793 42485 42266 71719 71409 54862 38046 871 "DRG SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 9917 9917 9917 7933 2416 9619 5379 3887 5891 5349 8229 9602 3834 3834 3847 6205 3771 5251 2416 9477 9520 5464 3351 6309 5524 5244 5372 6523 5309 5157 5237 6134 5182 5454 9324 5414 2429 5454 9619 5454 5189 5405 5377 9123 9084 6979 4840 872 "DRG SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 8901 1971 39062 7121 1174 8634 4829 3489 5288 4801 7386 8619 6954 6954 3454 5570 3385 4713 2169 8507 8545 4905 3008 5663 4959 4708 4822 5855 4766 4629 4701 5506 1174 4896 8369 4859 2180 4896 8634 4896 4658 4851 4826 8189 8154 6265 4344 914 DRG TRAUMATIC INJURY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) 14505 14505 14505 11604 1416 14070 7868 5686 8617 7824 12036 14044 7970 7970 5628 9076 5515 7680 3535 13862 13925 7992 4901 9228 8080 7671 7858 9540 7766 7543 7661 1416 7579 7978 13638 7919 3553 7978 14070 7978 7590 7905 7864 13344 13287 10208 7079 918 DRG POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) 21928 21928 21928 17542 4656 21270 11895 8596 13027 11828 18195 21231 4656 4656 8508 13721 8338 11610 5343 20956 21050 12082 7409 13950 12215 11597 11879 14423 11740 11402 11581 13564 11458 12060 20617 11971 5371 12060 21270 12060 11475 11951 11889 20173 20086 15432 10702 920 DRG COMPLICATIONS OF TREATMENT WITH COMPLICATION OR COMORBIDITY (CC) 8672 8672 8672 6937 2113 8412 4704 3399 5152 4678 7196 8396 4765 4765 3365 5426 3297 4591 2113 8287 8325 4778 2930 5517 4831 3283 4698 5704 4643 4509 4580 5364 4531 4769 8153 4734 2124 4769 8412 4769 4538 4726 4702 7978 7944 6103 4232 951 "DRG OTHER FACTORS INFLUENCING HEALTH STATUS - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 8923 8923 8923 7139 2174 8655 4841 3498 5301 4813 7404 8640 2203 2203 3462 5583 3393 4725 2174 8528 8566 4917 3015 5677 4971 4719 4834 5869 4777 4640 4713 5520 4663 4908 8390 4871 2186 4908 8655 4908 4669 4863 4838 8209 8174 6280 4355 CPT Description Charges Charges Low Charges High Discounted Cash Price Min Negotiated Max Negotiated Aetna Aetna - coventry Aetna insurance Aetna medicare American postal workers Amerigroup ia medicaid Iowa Total Care Blue cross Blue cross of illinois Blue cross out of state Blue cross wi badgercare Cigna Commercial Coventry advantra Health choices Health partners Health partners uph medicare adv h3416 Health partners uph self funded Humana Humana choice Iowa total care Medicaid Medical associates Medical associates smart plan med rep Medicare Midlands choice Trustmark Uhc medicare dir Uhc medicare solutions Uhc medicare solutions hmo Uhc medicare solutions ppo Uhc river valley Umr uhc United healthcare Workers compensation Professionals Outpatients 00140 Anesthesia for procedures on eye; not otherwise specified 713 575 2832 570 57 445 223 157 410 134 262 143 143 322 304 307 57 315 249 152 257 286 135 212 162 146 123 187 350 234 206 296 146 207 195 141 227 445 365 264 321 00142 Anesthesia for procedures on eye; lens surgery 716 575 1012 573 57 447 224 157 412 135 263 144 144 323 305 309 57 317 250 152 259 287 136 213 163 146 124 188 351 236 207 297 147 208 196 127 121 447 367 123 323 00148 Anesthesia for procedures on eye; ophthalmoscopy 621 621 621 497 50 388 194 136 357 117 228 125 125 280 264 268 50 275 217 132 224 249 118 185 141 127 107 163 305 204 180 257 127 180 170 115 149 388 318 233 280 00300 "Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified" 1357 720 1610 1086 109 1288 424 298 780 256 498 272 272 612 578 585 109 600 474 289 490 543 257 404 309 277 235 357 1288 446 392 719 278 393 372 178 171 847 694 666 612 00320 "Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older" 1100 1100 1100 880 88 687 344 241 632 207 404 221 221 496 468 474 88 486 385 234 397 441 209 328 250 225 190 289 539 362 318 456 226 319 301 238 196 687 563 412 496 00400 "Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified" 992 736 1248 794 79 619 310 218 570 187 364 199 199 448 422 428 79 439 347 211 358 397 188 295 226 203 172 261 589 326 287 411 203 287 272 215 129 619 508 372 447 00410 "Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; electrical conversion of arrhythmias" 528 440 550 422 42 330 165 116 304 100 194 106 106 238 225 228 42 233 185 112 191 211 100 157 120 108 91 139 259 174 153 219 108 153 145 111 127 330 270 198 238 00731 PR ANES UPR GI NDSC PX NOS 600 345 1219 480 48 479 187 132 345 113 220 120 120 206 256 412 48 265 210 128 216 240 114 179 136 123 104 158 479 197 173 249 123 174 164 133 141 375 307 133 270 00790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified 2352 1694 2990 1882 188 1775 735 516 1352 443 864 472 472 1062 1002 1014 188 1040 822 500 849 942 446 701 535 481 407 618 1775 773 680 1053 482 681 644 268 305 1468 1204 1257 1060 00800 Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified 968 968 968 774 77 604 302 212 557 182 355 194 194 412 412 417 77 428 338 206 349 388 183 288 220 198 168 254 475 318 280 401 198 280 265 210 232 604 495 363 436 00811 PR ANES LWR INTST NDSC NOS 711 506 1196 569 57 554 222 156 409 134 261 143 143 129 303 452 57 314 249 123 257 285 135 212 162 145 123 187 554 234 206 432 146 206 195 125 125 448 536 495 320 00812 PR ANES LWR INTST SCR COLSC 720 440 1265 576 58 589 279 158 246 136 264 144 144 412 307 432 58 318 252 153 260 288 136 214 164 147 125 189 589 237 208 444 148 209 197 127 124 450 561 467 325 00813 PR ANES UPR LWR GI NDSC PX 881 704 1449 705 70 681 275 193 506 166 323 177 177 508 375 508 70 389 308 150 318 353 167 262 200 180 153 232 681 290 255 499 181 255 241 155 174 550 568 585 397 00830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified 2640 2530 2838 2112 211 1648 825 579 1518 498 969 530 530 1192 1124 1138 211 1167 923 561 953 1057 500 786 600 540 457 694 1404 868 763 1095 541 765 723 250 633 1648 1351 990 1190 00840 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified 2376 1496 3630 1901 190 1483 742 522 1366 448 872 477 477 1072 1012 825 190 1050 831 505 857 952 450 708 540 486 411 624 1165 781 687 985 487 688 651 515 222 1483 1216 1361 1071 00902 Anesthesia for; anorectal procedure 920 920 920 736 74 574 287 202 529 173 338 185 185 415 392 397 74 407 322 196 332 368 174 274 209 188 159 242 451 302 266 381 189 267 252 199 158 574 471 153 415 00904 Anesthesia for; radical perineal procedure 1392 1392 1392 1114 111 869 435 306 800 262 511 279 279 628 593 600 111 615 487 296 502 557 264 415 316 285 241 366 683 458 402 577 285 403 381 302 334 869 712 216 627 00921 "Anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral or bilateral" 1955 1955 1955 1564 156 1564 611 429 1124 368 718 392 392 882 833 843 156 864 683 416 705 783 371 582 444 400 338 514 1564 643 565 811 401 566 536 424 468 1221 1000 733 881 00940 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified" 2156 2156 2156 1725 172 1346 673 473 1239 406 792 433 433 973 918 929 172 953 754 459 778 863 409 642 490 441 373 567 1057 709 623 894 442 625 591 188 517 1346 1103 808 972 00942 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); colpotomy, vaginectomy, colporrhaphy, and open urethral procedures" 989 989 989 791 79 617 309 217 569 186 363 198 198 446 421 426 79 437 346 210 357 396 187 295 225 202 171 260 485 325 286 410 203 287 271 214 141 617 506 371 446 01470 "Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified" 1560 1368 1752 1248 125 1402 487 342 897 294 573 313 313 704 664 672 125 690 545 332 563 625 296 465 355 319 270 410 1402 513 451 647 320 452 427 338 139 974 798 585 703 01480 "Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified" 4290 4290 4290 3432 343 2678 1340 942 2466 808 1575 861 861 1936 1827 1849 343 1897 1500 912 1548 1718 813 1278 975 877 743 1128 928 1410 1240 1779 880 1243 1175 930 1028 2678 2195 1608 1934 01730 Anesthesia for all closed procedures on humerus and elbow 720 720 720 576 58 576 225 158 414 136 264 144 144 325 307 310 58 318 252 153 260 288 136 214 164 147 125 189 576 237 208 299 148 209 197 156 173 450 368 270 325 01810 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand" 1012 943 1056 810 81 826 316 222 582 191 372 203 203 457 431 436 81 447 354 215 365 405 192 301 230 207 175 266 826 333 293 420 208 293 277 219 121 632 518 119 456 10060 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single" 346 337 354 276 28 216 108 76 199 65 127 69 69 156 147 149 28 153 121 73 125 138 65 103 79 71 60 91 185 114 100 143 71 100 95 75 83 216 177 130 156 10080 Incision and drainage of pilonidal cyst; simple 508 496 521 407 41 317 159 112 292 96 187 102 102 190 217 219 41 225 178 108 183 204 96 151 116 104 88 134 249 167 147 214 104 147 139 110 122 317 260 191 229 10120 "Incision and removal of foreign body, subcutaneous tissues; simple" 396 396 396 317 32 247 124 87 228 75 145 55 55 179 169 189 32 175 138 84 143 159 75 118 90 81 69 104 194 130 114 164 81 115 109 86 95 247 203 148 179 10140 "Incision and drainage of hematoma, seroma or fluid collection" 452 452 452 362 36 282 141 99 260 85 166 91 91 258 192 195 36 200 158 96 163 181 86 135 103 92 78 119 222 149 131 187 93 131 124 98 108 282 231 169 204 10160 "Puncture aspiration of abscess, hematoma, bulla, or cyst" 364 364 364 291 29 227 114 80 209 69 134 55 55 164 155 157 29 161 127 77 131 146 69 108 83 74 63 96 179 120 105 151 75 105 100 79 87 227 186 136 164 11104 PR PUNCH BX SKIN SINGLE LESION 201 201 201 161 16 125 63 44 116 38 74 40 40 91 86 87 16 89 70 43 73 80 38 60 46 41 35 53 99 66 58 83 41 58 55 44 48 125 103 66 91 11106 PR INCISIONAL BX SKN SINGLE LES 525 525 525 420 29 328 164 115 302 99 193 29 29 237 224 226 42 232 184 112 189 210 100 156 119 107 91 138 257 173 152 218 108 152 144 114 52 328 269 52 237 11107 PBB INCISIONAL BX SKN EA SEP/ADDL 207 207 207 166 17 129 65 45 119 39 76 42 42 93 88 89 17 92 72 44 75 83 39 62 47 42 36 54 102 68 60 86 42 60 57 45 29 129 106 78 93 11404 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm" 623 623 623 498 50 389 195 137 358 117 229 113 113 281 265 269 50 275 218 133 225 249 118 186 142 127 108 164 306 205 180 258 128 181 171 135 149 389 319 234 281 11406 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm" 958 958 958 766 77 598 299 210 551 181 352 192 192 505 408 413 77 424 335 204 346 384 182 285 218 196 166 252 470 315 277 397 196 278 262 208 230 598 490 359 432 11420 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less" 354 354 354 283 28 221 111 78 204 67 130 71 71 160 151 153 28 157 124 75 128 142 67 105 80 72 61 93 215 116 102 147 73 103 97 77 85 221 181 133 160 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" 529 529 529 423 42 330 165 116 304 100 194 94 94 239 225 228 42 234 185 113 191 212 100 158 120 108 92 139 259 174 153 219 108 153 145 115 127 330 271 198 238 11426 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm" 999 999 999 799 80 624 312 219 574 188 367 200 200 553 425 431 80 442 349 212 360 400 189 298 227 204 173 263 490 328 289 414 205 289 274 217 239 624 511 375 450 11440 "Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less" 397 397 397 318 32 248 124 87 228 75 146 80 80 179 169 171 32 176 139 84 143 159 75 118 90 81 69 104 195 131 115 165 81 115 109 50 95 248 203 149 179 11444 "Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm" 841 841 841 673 67 525 263 185 483 158 309 169 169 380 358 362 67 372 294 179 303 337 159 251 191 172 146 221 412 276 243 349 172 244 230 182 202 525 430 480 379 11446 "Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm" 1219 1219 1219 975 97 761 381 268 701 230 448 245 245 550 519 525 97 539 426 259 440 488 231 363 277 249 211 320 598 401 352 505 250 353 334 264 292 761 624 701 549 11470 "Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair" 894 894 894 715 71 586 279 196 514 168 328 179 179 586 381 385 71 395 313 190 323 358 169 266 203 183 155 235 438 294 258 371 183 259 245 194 214 558 457 335 403 11643 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm" 963 963 963 770 77 601 301 211 554 181 354 193 193 435 410 415 77 426 337 205 347 386 183 287 219 197 167 253 472 317 278 399 197 279 264 214 231 601 493 361 434 11646 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm" 1468 1468 1468 1174 117 917 459 322 844 277 539 295 295 820 625 633 117 649 513 312 530 588 278 437 334 300 254 386 720 483 424 609 301 425 402 318 352 917 751 550 662 11770 Excision of pilonidal cyst or sinus; simple 840 840 840 672 67 524 262 184 483 158 308 169 169 379 358 362 67 371 294 179 303 336 159 250 191 172 145 221 336 276 243 383 172 243 230 182 201 524 430 315 379 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" 425 405 446 340 34 265 133 93 244 80 156 46 46 82 181 94 34 188 149 90 156 170 81 127 97 87 74 112 82 140 123 91 87 123 116 35 41 265 211 224 192 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" 448 427 470 358 36 280 140 98 258 58 164 55 55 111 191 105 36 198 157 95 162 179 85 133 102 92 78 118 108 147 130 120 92 130 123 59 52 280 229 251 202 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" 523 498 549 418 42 327 163 115 301 99 192 69 69 131 223 225 42 231 183 111 189 209 99 156 119 107 91 137 256 172 151 149 107 152 143 113 125 327 268 68 236 12011 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less" 468 446 491 374 37 292 146 103 269 88 172 50 50 103 199 74 37 207 164 100 169 187 89 139 106 96 81 123 190 154 135 194 96 136 128 101 50 292 218 218 211 12013 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 512 499 550 409 41 319 160 112 294 96 188 56 56 111 218 108 41 226 179 109 185 205 97 152 116 46 89 134 107 168 148 212 105 148 140 111 53 319 262 192 231 12014 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm" 667 667 667 534 53 416 208 146 383 126 245 134 134 141 284 287 53 295 233 142 241 267 126 120 152 136 115 175 327 219 193 277 137 193 183 145 68 416 341 250 301 12032 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm" 858 858 858 686 69 536 268 188 493 162 315 172 172 387 365 370 69 379 300 182 310 344 163 256 195 175 149 226 421 282 248 356 176 249 235 186 190 536 439 322 387 12053 "Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm" 1073 1073 1073 858 86 670 335 236 617 202 394 215 215 484 457 462 86 474 375 228 387 430 203 320 244 219 186 282 526 353 310 445 220 311 294 233 257 670 549 232 484 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" 1409 1409 1479 1127 113 880 440 309 810 266 517 272 272 800 600 607 113 623 493 300 508 564 267 420 320 288 244 370 691 463 407 584 289 408 386 305 338 880 721 528 635 19328 Removal of intact mammary implant 1128 1128 1128 902 90 704 352 248 648 213 414 518 518 509 480 486 90 499 394 240 407 452 214 336 256 231 195 296 553 371 326 468 231 327 309 245 270 704 577 423 508 20552 "Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)" 244 221 244 195 20 152 76 54 140 46 90 34 34 110 104 105 20 108 85 52 88 98 46 73 55 50 42 64 71 80 71 101 50 71 67 53 58 152 125 91 110 20605 "Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)" 198 198 198 158 16 124 62 43 114 37 73 40 40 89 84 85 16 88 69 42 71 79 38 59 45 40 34 52 97 65 57 82 41 57 54 43 38 124 101 74 89 20610 "Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)" 244 221 331 195 20 152 76 54 140 46 90 51 51 138 104 105 20 108 85 52 88 98 46 73 55 50 42 64 116 80 71 97 50 71 67 53 58 152 125 91 110 20611 HC DRAIN/INJ MAJOR JOINT/BURSA W US 404 404 404 323 32 252 126 89 232 76 148 81 81 182 172 174 32 179 141 86 146 162 77 120 92 83 70 106 198 133 117 168 83 117 111 88 55 252 207 151 182 23650 "Closed treatment of shoulder dislocation, with manipulation; without anesthesia" 926 926 926 741 74 578 289 203 532 175 340 186 186 418 394 399 74 409 324 197 334 371 176 276 211 189 160 243 553 304 268 384 190 268 254 201 222 578 474 347 417 23655 "Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia" 1146 1146 1146 917 92 749 358 252 659 216 421 230 230 749 488 494 92 507 401 244 414 459 217 341 261 234 198 301 562 377 331 475 235 332 314 248 275 715 586 430 517 24600 Treatment of closed elbow dislocation; without anesthesia 891 891 891 713 71 613 278 196 512 168 327 179 179 402 379 384 71 394 311 190 321 357 169 265 203 182 154 234 613 293 258 369 183 258 244 193 214 556 456 334 402 25111 "Excision of ganglion, wrist (dorsal or volar); primary" 914 914 914 731 73 571 285 201 525 172 336 183 183 413 389 394 73 404 320 194 330 366 173 272 208 187 158 240 448 300 264 379 187 265 250 198 316 571 468 343 412 25112 "Excision of ganglion, wrist (dorsal or volar); recurrent" 1213 1213 1213 970 97 757 379 266 697 229 445 243 243 547 517 523 97 536 424 258 438 486 230 361 276 248 210 319 705 399 351 503 249 351 332 263 291 757 621 455 547 26160 "Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger" 1516 1516 1516 1213 121 946 473 333 872 286 557 304 304 709 646 653 121 670 530 322 547 607 287 452 345 310 262 398 743 498 438 629 311 439 415 329 363 946 776 640 683 26725 "Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each" 951 951 951 761 76 594 297 209 547 179 349 191 191 429 405 410 76 420 332 202 343 381 180 283 216 194 165 250 466 313 275 394 195 276 261 206 228 594 589 357 429 26770 "Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia" 714 714 714 571 57 470 223 157 410 135 262 143 143 322 304 308 57 316 250 152 258 286 135 213 162 146 124 188 350 235 206 296 146 207 196 155 171 446 365 470 322 27096 "Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid" 372 260 411 298 30 232 116 82 214 70 137 75 75 168 158 160 30 164 130 79 134 149 71 111 115 76 64 98 231 122 108 154 76 108 102 81 89 232 190 161 168 29105 Application of long arm splint (shoulder to hand) 206 206 216 165 16 129 64 45 118 39 76 50 50 93 88 89 16 91 72 44 74 82 39 61 47 42 36 54 77 68 60 89 42 60 56 40 49 129 105 128 93 29125 Application of short arm splint (forearm to hand); static 197 188 207 158 16 123 62 43 113 32 72 35 35 75 84 85 16 87 69 42 71 31 37 59 45 40 34 52 72 65 57 81 40 57 54 43 36 123 101 36 89 29130 Application of finger splint; static 168 160 168 134 13 105 52 37 97 32 62 20 20 55 72 72 13 74 59 36 61 67 32 50 38 34 29 44 82 55 49 59 34 49 46 36 40 105 86 63 76 29505 Application of long leg splint (thigh to ankle or toes) 170 170 170 136 14 106 53 37 98 32 62 34 34 96 72 73 14 105 59 36 61 68 32 51 39 35 29 45 83 56 49 70 35 49 47 47 41 106 104 64 77 29515 Application of short leg splint (calf to foot) 207 207 207 166 17 129 65 45 119 39 76 42 42 92 88 89 17 92 72 44 75 83 39 62 47 42 36 54 91 68 60 86 42 60 57 45 50 129 106 78 93 30901 "Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method" 322 322 338 258 26 201 101 71 185 61 118 65 65 105 137 139 26 142 113 68 116 129 61 96 73 66 56 85 158 106 93 134 66 93 88 53 77 201 165 145 145 31500 "Intubation, endotracheal, emergency procedure" 438 417 460 350 35 333 137 96 252 83 161 77 77 333 187 189 35 194 153 93 158 175 83 130 100 90 76 115 215 144 127 182 90 127 120 95 147 273 224 164 197 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)" 176 176 194 141 9 110 55 39 101 33 65 35 35 44 75 46 14 78 62 37 64 70 33 52 40 36 30 46 17 58 51 73 36 51 48 38 9 110 90 66 79 38500 "Biopsy or excision of lymph node(s); open, superficial" 956 956 956 765 76 597 299 210 550 180 351 192 192 444 407 412 76 423 334 203 345 383 181 285 217 195 165 251 469 314 276 396 196 277 262 207 249 597 489 358 431 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)" 838 838 838 670 67 523 262 184 482 158 308 168 168 378 357 134 67 370 293 178 302 336 159 250 191 171 145 220 411 275 242 347 172 243 230 182 201 523 429 314 378 43239 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple" 1006 958 1056 805 66 628 314 221 578 132 369 149 149 297 428 434 80 445 352 132 363 403 191 209 229 206 174 264 258 331 291 417 146 291 276 66 132 628 180 192 453 43246 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube" 817 817 817 654 65 510 255 179 470 154 300 164 164 369 348 352 65 361 286 174 295 327 155 243 186 167 141 215 372 269 236 339 168 237 224 177 196 510 418 306 368 43247 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body" 630 599 660 504 50 393 197 138 362 119 231 191 191 284 268 271 50 278 220 134 227 252 119 188 143 129 109 165 330 207 182 261 129 182 172 136 151 393 322 236 284 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)" 660 629 660 528 53 412 206 145 379 124 242 132 132 336 281 284 53 292 231 140 238 264 125 197 150 135 114 173 324 217 191 274 135 191 181 143 146 412 338 141 298 44204 "Laparoscopy, surgical; colectomy, partial, with anastomosis" 4256 4256 4256 3405 340 3196 1329 934 2447 802 1563 854 854 1921 1812 1834 340 1882 1488 905 1536 1704 807 1268 968 870 737 1119 2087 1399 1231 1765 873 1233 1166 923 1020 2657 2178 3196 1918 44960 Appendectomy; for ruptured appendix with abscess or generalized peritonitis 2721 2721 2721 2177 218 1966 850 597 1564 513 999 546 546 1228 1159 1966 218 1203 951 579 982 1090 516 811 619 556 471 715 1334 894 787 1128 558 788 746 590 652 1699 1392 1020 1227 44970 "Laparoscopy, surgical, appendectomy" 1832 1703 1877 1466 147 1292 572 402 1053 345 673 479 479 1292 780 1292 147 810 641 390 661 1162 347 546 417 375 317 482 1074 602 530 760 376 531 502 397 590 1144 938 1205 826 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)" 1389 1323 1458 1111 111 1388 434 305 558 178 510 209 209 424 592 424 111 614 486 176 501 556 263 385 316 284 240 365 345 457 402 377 285 402 381 175 1388 470 455 484 626 45380 "Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple" 1509 1437 1584 1207 121 1584 471 331 868 284 554 212 212 460 643 650 121 667 528 321 544 498 286 453 343 308 216 397 375 496 436 431 309 437 413 202 1584 942 772 582 680 45381 "Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance" 1509 1509 1509 1207 44 942 471 331 868 284 554 303 303 681 643 650 121 667 528 321 544 604 286 449 343 308 261 397 740 496 436 626 309 437 413 327 362 942 772 44 680 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" 1509 1437 1584 1207 41 942 471 331 868 284 554 216 216 526 643 526 121 463 528 217 446 604 41 488 343 308 220 397 424 496 436 463 241 437 413 216 212 942 362 608 680 45385 "Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique" 1572 1497 1651 1258 126 981 491 345 904 252 577 288 288 583 669 583 126 695 550 334 501 630 235 468 357 243 272 413 476 517 455 652 536 455 431 235 237 981 690 690 709 46221 "Hemorrhoidectomy, internal, by rubber band ligation(s)" 662 662 662 530 53 413 207 145 381 125 243 133 133 299 282 285 53 293 231 141 239 265 125 197 151 135 115 174 325 218 191 274 136 192 181 143 185 413 339 248 298 46260 "Hemorrhoidectomy, internal and external, 2 or more columns/groups;" 1430 1360 1499 1144 114 920 446 314 822 269 525 287 287 920 609 616 114 632 500 304 516 572 271 426 325 292 247 376 701 470 413 593 293 414 392 310 343 892 732 884 644 46320 "Excision of thrombosed hemorrhoid, external" 578 564 592 462 46 361 181 127 332 109 212 116 116 252 246 249 46 256 202 123 209 231 110 172 131 118 100 152 283 190 167 240 119 167 158 125 139 361 296 106 261 46614 "Anoscopy; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)" 354 354 354 283 28 221 111 78 204 67 130 71 71 118 151 153 28 157 124 75 128 142 67 105 80 72 61 93 174 116 102 147 73 103 97 77 85 221 181 133 160 47562 "Laparoscopy, surgical; cholecystectomy" 2129 2028 2235 1703 170 1409 665 467 1224 401 782 634 634 1409 907 918 170 941 744 453 768 853 404 634 484 435 369 634 1195 700 616 883 437 617 583 598 510 1329 1089 798 960 49083 PR ABD PARACENTESIS W/IMAGING 836 836 836 669 67 522 261 184 481 158 307 168 168 377 356 360 67 370 292 178 302 335 158 249 190 171 145 220 203 275 242 347 171 242 229 181 200 522 428 313 377 49255 "Omentectomy, epiploectomy, resection of omentum (separate procedure)" 2246 2246 2246 1797 180 1695 701 493 1291 423 825 451 451 1695 956 968 180 993 785 478 810 899 426 669 511 459 389 590 1102 738 649 931 461 651 615 487 538 1402 1149 842 1012 49418 "Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous" 2106 2106 2106 1685 168 1315 658 462 1211 397 773 423 423 950 897 908 168 931 736 448 760 843 399 627 479 430 365 554 384 692 609 873 432 610 577 457 505 1315 1078 790 949 49505 "Repair initial inguinal hernia, age 5 years or older; reducible" 1628 1628 1628 1302 130 1174 508 357 936 307 598 327 327 735 693 1174 130 720 569 346 587 652 309 485 370 333 282 428 798 535 471 675 334 472 446 353 390 1016 833 610 734 49561 Repair initial incisional or ventral hernia; incarcerated or strangulated 2894 2894 2894 2315 231 2079 904 635 1664 545 1063 581 581 2079 1232 1247 231 1279 1012 616 1044 1159 549 862 658 592 501 761 1419 951 837 1200 593 839 793 627 694 1807 1481 1085 1305 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) 827 827 827 662 66 591 258 182 475 156 304 166 166 591 352 356 66 366 289 176 298 331 157 246 188 169 143 217 406 272 239 343 170 240 227 179 198 516 423 310 373 49585 "Repair umbilical hernia, age 5 years or older; reducible" 1263 1263 1263 1010 101 951 394 277 726 238 464 253 253 951 538 544 101 558 442 269 456 506 239 376 287 258 219 332 619 415 365 524 259 366 346 274 303 789 646 474 569 49594 "Repair anterior abdominal hernia(s), initial, including implantation of mesh or other prosthesis, total length of defect 3 cm-10 cm, incarcerated or strangulated" 1474 1474 1474 1179 118 1357 460 324 847 278 541 296 296 1357 628 635 118 652 515 314 532 590 279 439 335 301 255 387 723 485 426 611 302 427 404 320 353 920 754 553 664 49650 "Laparoscopy, surgical; repair initial inguinal hernia" 1448 1379 2661 1158 116 1152 452 318 832 273 532 291 291 929 617 624 116 640 506 308 522 580 274 431 329 296 251 381 1152 476 419 600 297 420 397 643 347 904 741 543 653 49651 "Laparoscopy, surgical; repair recurrent inguinal hernia" 1611 1611 1611 1289 129 1075 503 354 926 304 592 323 323 727 686 694 129 712 563 343 581 1075 305 480 366 329 279 423 790 530 466 668 330 467 441 349 386 1006 824 604 726 49653 "Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated" 2562 2562 2825 2050 205 1994 800 562 1473 483 941 514 514 1994 1091 1104 205 1133 896 545 924 1026 486 763 582 524 443 673 1598 842 741 1757 525 742 702 555 910 1600 1311 961 1155 55250 "Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)" 1145 1117 1173 916 92 715 358 251 658 216 420 230 230 517 488 494 92 506 400 244 413 459 217 341 260 234 198 301 422 376 331 475 235 332 314 248 274 715 586 429 516 56420 Incision and drainage of Bartholin's gland abscess 391 391 391 313 31 244 122 86 225 74 144 78 78 176 167 169 31 173 137 83 141 157 74 116 89 80 68 103 192 129 113 162 80 113 107 85 94 244 200 103 176 58120 "Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)" 760 741 778 608 61 474 237 167 437 143 279 152 152 343 323 327 61 336 266 162 274 304 144 226 173 155 131 200 372 250 220 315 156 220 208 221 220 474 389 285 342 58301 Removal of intrauterine device (IUD) 209 209 209 167 17 130 65 46 120 39 77 55 55 94 89 90 17 92 73 44 75 84 40 62 48 43 36 55 103 69 60 87 43 61 57 45 50 130 107 78 94 58573 "Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)" 2949 2949 2949 2359 236 1841 921 647 1695 556 1083 949 949 1331 1256 1271 236 1304 1031 627 1064 1181 559 878 670 603 510 775 1446 969 853 1223 605 854 808 639 707 1841 1509 1106 1329 58661 "Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)" 2027 2027 2027 1622 162 1391 633 445 1165 382 744 407 407 1391 863 874 162 896 709 431 731 812 384 604 461 414 351 533 994 666 586 840 416 587 555 439 486 1266 1037 760 914 58670 "Laparoscopy, surgical; with fulguration of oviducts (with or without transection)" 1049 1049 1049 839 84 655 328 230 603 198 385 330 330 473 447 452 84 464 367 223 379 420 199 312 238 214 182 276 514 345 303 435 215 304 287 227 251 655 537 393 473 62321 PR INJ INTERLAM C/T W IMG 607 592 622 486 49 379 190 133 349 114 223 83 83 274 258 262 49 268 212 129 219 243 115 181 138 124 105 160 298 200 175 252 124 176 166 132 145 379 311 103 274 62323 Injection of substance into spinal canal of lower back or sacrum using imaging guidance 582 554 611 466 47 459 182 128 335 110 214 117 117 427 248 459 47 257 186 124 210 233 110 173 132 119 101 153 285 191 168 202 119 169 159 97 95 363 298 268 262 64400 "Injection, anesthetic agent; trigeminal nerve, any division or branch" 1562 1562 1562 1250 45 975 488 343 898 294 574 45 45 705 665 673 125 691 546 332 564 626 296 465 355 319 270 411 766 513 452 648 320 453 428 339 374 975 799 586 704 64451 PR INJ ANESTH/STER SI JOINT NRV NRVTG 338 338 338 270 27 211 106 74 194 64 124 68 68 153 144 146 27 149 118 72 122 135 64 101 77 69 59 89 166 111 98 140 69 98 93 73 81 211 173 169 152 64454 PR NJX AA&/STRD GNCLR NRV BRNCH 174 174 174 139 14 109 54 38 100 33 64 35 35 79 74 75 14 77 61 37 63 70 33 52 40 36 30 46 85 57 50 72 36 50 48 38 81 109 89 65 78 64483 "Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level" 369 351 369 295 30 230 115 81 212 70 135 74 74 167 157 159 30 163 129 78 133 148 70 110 84 75 64 97 209 121 107 153 76 107 101 80 105 230 189 138 166 64486 PR TAP BLOCK UNIL BY INJ 276 276 276 221 22 172 86 61 159 52 101 55 55 131 118 119 22 122 96 59 100 111 52 82 63 56 48 73 135 91 80 114 57 80 76 60 66 172 141 103 124 64488 PR TAP BLOCK BILAT BY INJ 1035 986 1087 828 71 646 323 227 595 195 380 208 208 134 441 138 83 458 362 220 373 414 196 308 235 212 179 272 133 340 299 429 212 300 284 71 248 646 530 104 467 64490 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level" 349 332 633 279 28 218 109 77 201 66 128 70 70 158 149 150 28 154 122 74 126 140 66 104 79 71 60 92 171 115 101 145 72 101 96 160 99 218 179 131 157 64491 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)" 192 188 197 154 15 120 60 42 111 36 71 39 39 87 82 83 15 85 67 41 69 77 36 57 44 39 33 51 94 63 56 80 39 56 53 42 56 120 99 72 87 64493 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level" 433 270 596 346 35 270 135 95 249 82 159 87 87 195 184 187 35 191 151 92 156 173 82 129 98 89 75 114 212 142 125 180 89 125 119 131 93 270 222 162 195 64494 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)" 322 153 338 258 26 268 101 71 185 61 118 65 65 268 137 256 26 142 113 68 116 129 61 96 73 66 56 85 158 106 93 134 66 93 88 75 54 201 165 121 145 64495 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)" 153 153 153 122 12 96 48 34 88 29 56 31 31 69 65 66 12 68 53 33 55 61 29 46 35 31 26 40 75 50 44 63 31 44 42 55 55 96 78 57 69 64510 "Injection, anesthetic agent; stellate ganglion (cervical sympathetic)" 217 217 217 174 17 157 68 48 125 41 80 44 44 157 92 94 17 96 76 46 78 87 41 65 49 44 38 57 106 71 63 90 44 63 59 47 52 135 111 81 98 64624 PR DSTRJ NULYT AGT GNCLR NRV 850 850 850 680 68 531 265 187 489 160 312 171 171 384 362 366 68 376 297 181 307 340 161 253 193 174 147 223 417 279 246 352 174 246 233 184 141 531 435 319 383 64625 PR RF ABLTJ NRV NRVTG SI JT 405 405 405 324 32 364 126 89 233 76 149 81 81 183 172 175 32 179 142 86 146 162 77 121 92 83 70 106 364 133 117 168 83 117 111 88 97 253 207 152 183 64635 PBB DESTROY LUMB/SAC FACET JNT 1284 1284 1284 1027 103 802 401 282 738 242 471 258 258 582 547 582 103 568 449 273 463 514 243 382 292 262 222 337 630 422 371 532 263 372 352 278 308 802 657 481 579 64636 PBB DESTROY L/S FACET JNT ADDL 1284 1284 1284 1027 103 802 401 282 738 242 471 258 258 269 547 269 103 568 449 273 463 514 243 382 292 262 222 337 630 422 371 532 263 372 352 278 308 802 657 481 579 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 1202 1143 1260 961 96 910 375 264 691 226 441 241 241 910 512 518 96 531 420 256 434 481 228 358 273 246 208 316 781 395 347 498 246 348 329 260 288 750 615 398 542 65220 "Removal of foreign body, external eye; corneal, without slit lamp" 356 348 365 285 29 223 111 78 205 67 131 94 94 76 152 154 29 158 125 76 129 143 68 106 81 73 62 94 175 117 103 148 73 103 98 39 85 223 182 134 161 65222 "Removal of foreign body, external eye; corneal, with slit lamp" 174 174 174 139 14 109 54 38 100 33 64 89 89 79 74 75 14 77 61 37 63 70 33 52 40 36 30 46 85 57 50 72 36 50 48 38 42 109 89 65 78 69200 Removal foreign body from external auditory canal; without general anesthesia 361 361 361 289 29 225 113 79 208 68 133 72 72 42 154 156 29 160 126 77 130 145 68 108 82 74 62 95 177 119 104 150 74 105 99 78 87 225 185 135 163 92950 "Cardiopulmonary resuscitation (eg, in cardiac arrest)" 740 722 758 592 59 462 231 162 425 139 272 149 149 334 315 319 59 327 259 157 267 296 140 220 168 151 128 194 363 243 214 307 152 214 203 191 178 462 379 277 334 92960 "Cardioversion, elective, electrical conversion of arrhythmia; external" 665 665 733 532 53 415 208 146 382 125 244 133 133 237 283 287 53 294 232 141 240 266 126 198 151 136 115 175 326 219 192 276 136 193 182 112 159 415 340 249 300 93010 "Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only" 42 40 44 34 3 26 13 9 24 8 15 10 10 18 18 18 3 17 15 8 13 15 8 15 10 8 10 10 13 14 12 17 9 12 9 8 8 26 21 8 19 99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure) 109 109 109 87 9 68 34 24 63 21 40 13 13 49 46 47 9 48 38 23 39 44 21 32 25 22 19 29 53 36 32 45 22 32 30 24 26 68 56 41 49 99152 HC MOD SED SAME PHYS/QHP 5/>YRS 15M 185 185 185 148 15 115 58 41 106 35 68 37 37 83 79 80 15 82 65 39 67 74 35 55 42 38 32 49 68 61 53 77 38 54 51 40 44 115 95 69 83 99201 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family." 124 124 124 99 10 77 39 27 71 23 46 25 25 41 53 53 10 55 43 26 45 50 24 37 28 25 21 33 61 41 36 51 25 36 34 27 30 77 63 47 56 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." 210 210 210 168 17 131 66 46 121 40 77 39 39 95 89 91 17 93 73 45 76 84 40 63 48 43 36 55 103 69 61 87 43 61 58 46 50 131 107 79 95 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." 316 287 316 253 25 197 99 69 182 60 116 54 54 92 135 120 25 140 114 67 114 127 60 94 72 78 50 83 112 104 91 124 65 92 87 78 78 197 162 79 142 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." 130 124 137 104 10 81 41 29 75 24 48 18 18 38 55 38 10 57 45 28 47 52 25 40 30 27 16 34 39 43 38 53 27 38 36 35 35 81 67 35 59 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." 216 205 226 172 17 135 67 47 124 41 79 43 43 97 92 93 17 95 75 46 78 86 41 64 49 44 37 57 106 71 62 89 44 62 59 69 52 135 110 93 97 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." 296 276 316 237 24 185 92 65 170 56 109 59 59 104 126 128 24 131 103 63 107 119 56 88 67 61 51 78 145 97 86 123 61 86 81 80 71 185 151 111 133 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.])" 225 204 225 180 18 140 70 49 129 42 68 45 45 68 96 97 18 99 79 48 81 90 43 67 51 46 39 59 113 74 65 93 46 65 62 49 54 140 115 84 101 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." 232 232 256 186 19 145 72 51 133 44 92 65 65 93 99 100 19 103 81 49 84 93 44 69 53 47 40 61 114 76 67 96 48 67 64 50 56 145 119 87 105 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." 381 381 420 305 30 238 119 84 219 72 140 123 123 127 162 164 30 168 133 81 137 153 72 113 87 78 66 100 187 125 110 158 78 110 104 83 120 238 195 143 172 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." 510 497 522 408 41 318 159 112 293 96 187 102 102 230 217 220 41 225 178 108 184 204 97 152 116 104 88 134 250 167 147 211 104 148 140 110 185 318 261 171 230 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." 309 309 309 247 25 193 97 68 178 58 113 65 65 139 132 133 25 137 108 66 111 124 92 92 70 63 53 81 152 102 89 128 63 90 85 67 74 193 158 116 139 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." 388 379 398 311 31 243 121 85 223 73 143 107 107 175 165 216 31 172 136 129 140 156 74 116 88 79 67 102 191 128 112 161 80 113 106 130 93 243 199 146 175 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." 91 83 232 73 7 61 28 20 52 17 33 36 36 61 39 39 7 40 32 19 33 36 17 27 21 19 16 24 45 30 26 38 19 26 25 20 22 57 47 34 41 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." 145 145 152 116 12 91 45 32 83 27 67 45 45 68 62 62 12 64 51 31 52 58 27 43 33 30 25 38 71 48 42 60 30 42 40 31 35 91 74 54 65 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." 110 108 113 88 9 69 35 24 64 21 41 33 33 60 47 48 9 49 39 24 40 44 21 33 25 23 19 29 60 36 32 46 23 32 30 24 26 69 57 41 50 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." 595 595 595 476 48 371 186 131 342 112 218 119 119 269 253 334 48 263 208 127 215 238 113 177 135 122 103 156 292 196 172 247 122 172 163 129 143 371 304 223 268 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." 134 134 141 107 11 84 42 29 77 25 49 16 16 29 57 58 11 59 47 29 48 54 25 40 30 27 23 35 30 44 39 56 27 39 37 29 32 84 42 50 60 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." 200 190 210 160 16 177 62 44 177 35 73 25 25 55 85 54 16 64 70 43 66 45 38 56 32 34 25 53 66 66 58 64 41 58 55 40 40 125 84 84 95 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." 238 221 244 190 19 149 74 52 137 54 87 50 50 93 101 88 19 105 83 51 86 95 45 71 54 49 51 63 99 78 69 99 49 69 65 52 67 149 136 101 107 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." 373 355 392 298 31 254 119 82 214 109 137 77 77 157 159 156 31 182 130 113 166 163 97 163 99 99 79 91 180 117 108 182 76 114 119 116 116 249 254 117 168 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." 552 526 580 442 44 354 147 121 317 141 203 122 122 225 224 229 44 259 193 117 240 221 140 164 125 163 124 145 262 181 160 266 113 160 151 171 168 345 354 170 249 99291 "Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes" 746 710 783 597 60 466 233 164 429 141 274 122 122 278 318 322 60 330 261 159 269 299 141 222 170 152 125 196 384 245 216 309 153 216 204 208 210 466 382 210 336 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)" 379 361 758 303 30 237 118 83 218 71 139 68 68 152 161 163 30 168 132 81 137 152 72 113 86 77 66 100 186 125 110 157 78 110 104 82 91 237 194 142 171 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." 285 285 285 228 23 178 89 63 164 54 105 57 57 129 121 123 23 126 100 61 103 114 54 85 65 58 49 75 140 94 82 118 58 83 78 62 68 178 146 107 128 99441 "Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion" 36 36 36 29 3 24 11 8 21 7 13 7 7 16 15 16 3 16 13 8 13 14 7 11 8 7 6 9 18 12 10 15 7 10 10 20 20 22 18 24 16 G0105 Colorectal cancer screening; colonoscopy on individual at high risk 1204 1175 1234 964 96 752 376 264 692 227 442 242 242 544 513 519 96 533 421 256 435 482 228 359 274 246 209 317 591 396 348 499 247 349 330 261 172 752 616 452 543 G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 1147 1119 1234 918 0 716 358 252 659 178 421 0 0 518 488 494 92 507 401 244 414 459 217 342 261 234 199 301 563 377 332 476 235 332 314 651 170 716 587 173 517