,Warm Springs Medical Center - Machine Readable Report - Generated on 01/20/2021,,,,,,,,,,,,,,,,,,,
,"Disclaimer: The information provided in this machine readable file is to fulfill the CMS requirements for Price Transparency. Charges, allowed amount, cash discounted price, min and max negotiated rates provided in this report are based on historic claim and remittance information provided by Warm Springs Medical Center. This was generated on 01/20/2021 and is a yearly snapshot based on history. All amounts reported may change due to several factors including but not limited to hospital service area where the service is provided, payer contracts and negotiations. This data will be further refined.",,,,,,,,,,,,,,,,,,,
CPT,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Medicare,Uhc,Aetna,Wellcare,Medicaid,Humana,Blue cross,Caresource,Amerigroup,Peach state,Cigna,Umr,Triwest,Tricare,Veterans admin
Institutional,,,,,,,,,,,,,,,,,,,,
Outpatients,,,,,,,,,,,,,,,,,,,,
10060,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single",179,90,11,151,82,82,94,78,74,120,74,64,54,47,151,150,75,62,11
10120,"Incision and removal of foreign body, subcutaneous tissues; simple",179,90,11,151,81,82,94,76,113,120,74,64,54,47,151,150,75,62,11
11730,"Avulsion of nail plate, partial or complete, simple; single",82,41,5,70,37,70,43,30,34,55,34,29,25,22,69,69,34,28,5
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",218,109,14,183,100,102,115,89,90,146,91,85,92,100,183,183,91,75,14
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",218,109,14,183,100,100,159,80,90,146,91,90,92,58,183,183,91,75,14
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",218,109,14,183,99,104,102,80,138,146,91,78,66,58,183,183,91,75,14
12011,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",218,109,14,183,99,100,115,80,138,146,90,152,92,100,183,183,91,75,14
12013,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",239,120,15,201,110,110,126,88,98,160,99,85,72,100,201,201,100,83,15
12015,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm",290,145,19,244,132,139,153,107,184,194,121,104,87,77,244,244,122,100,19
12041,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less",218,109,14,183,99,102,115,80,138,146,91,78,66,58,183,183,91,75,14
16020,"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)",160,80,10,135,74,77,84,59,66,107,67,90,67,42,135,134,67,55,10
20610,"Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)",216,108,14,182,98,102,114,80,137,145,90,77,65,57,182,181,91,75,14
25605,"Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation",2033,1017,130,1710,935,935,1069,749,1289,1362,846,726,612,539,1710,1707,853,704,130
29105,Application of long arm splint (shoulder to hand),157,79,10,132,73,75,83,58,100,105,65,56,47,42,132,132,66,54,10
29125,Application of short arm splint (forearm to hand); static,157,79,10,132,72,72,72,58,65,105,66,110,66,42,132,132,66,54,10
29130,Application of finger splint; static,157,79,10,132,71,75,115,58,100,105,65,56,47,42,132,132,66,54,10
29505,Application of long leg splint (thigh to ankle or toes),100,50,6,84,46,48,53,37,63,67,42,36,30,26,84,84,42,35,6
29515,Application of short leg splint (calf to foot),202,101,13,172,93,172,147,90,128,135,84,91,61,54,170,170,85,70,13
30901,"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method",198,99,13,167,90,95,104,73,126,133,82,71,60,52,167,166,83,69,13
31500,"Intubation, endotracheal, emergency procedure",722,361,46,607,332,502,253,266,458,484,300,258,217,191,607,606,303,250,46
36415,Collection of venous blood by venipuncture,11,6,1,18,5,5,5,5,7,11,5,5,2,3,18,9,5,4,1
36430,"Transfusion, blood or blood components",868,434,55,730,395,399,457,320,638,581,361,310,261,230,730,729,364,300,55
36556,Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older,482,241,31,472,219,231,169,178,306,472,201,172,145,128,405,405,202,167,31
41800,"Drainage of abscess, cyst, hematoma from dentoalveolar structures",840,420,54,706,382,402,442,310,532,563,350,300,253,100,706,705,353,291,54
43239,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple",4577,2289,292,3850,2918,2191,2408,1687,1886,3066,742,1635,1378,1213,3850,3844,1921,1584,292
43245,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with dilation of gastric outlet for obstruction (eg, balloon, guide wire, bougie)",4396,2198,281,3697,2022,2104,2313,1620,2787,2944,1829,1570,1324,1165,3697,3692,1845,1522,281
43246,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube",417,209,27,351,190,200,196,154,333,279,174,149,126,110,351,350,175,144,27
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)",1548,774,99,1302,1249,741,814,571,294,1037,644,553,466,410,1302,1300,650,536,99
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)",1548,774,99,2655,704,1316,2655,571,638,831,642,553,466,410,1302,1300,650,536,99
45380,"Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple",2262,1131,144,1902,712,1083,1190,834,981,1515,941,808,681,599,1902,1900,949,783,144
45385,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique",1666,833,106,1402,704,798,768,614,1056,1116,693,595,502,441,1402,1400,699,577,106
51701,"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)",184,92,12,155,84,86,86,68,117,123,77,66,55,49,155,155,77,64,12
51702,"Insertion of temporary indwelling bladder catheter; simple (eg, Foley)",250,125,16,245,114,115,132,106,103,245,104,89,75,66,210,210,105,87,16
69200,Removal foreign body from external auditory canal; without general anesthesia,94,47,6,79,43,45,44,35,32,63,39,34,28,25,79,79,39,33,6
70110,"Radiologic examination, mandible; complete, minimum of 4 views",303,152,19,255,138,145,139,112,192,203,126,108,91,80,255,254,127,105,19
70200,"Radiologic examination; orbits, complete, minimum of 4 views",253,127,16,213,115,116,133,108,160,169,105,90,76,67,213,212,106,88,16
70220,"Radiologic examination, sinuses, paranasal, complete, minimum of 3 views",242,121,15,204,110,111,127,89,153,162,101,86,73,64,204,203,102,84,15
70360,"Radiologic examination; neck, soft tissue",201,101,13,169,92,96,106,74,127,135,84,72,61,53,169,169,84,70,13
70450,"Computed tomography, head or brain; without contrast material",1213,607,77,1031,558,558,722,507,500,108,505,433,511,321,1020,1031,509,420,77
70460,"Computed tomography, head or brain; with contrast material(s)",1394,697,89,1172,641,667,733,514,884,570,580,498,420,369,1172,1171,585,483,89
70480,"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material",1041,521,66,875,474,489,548,384,660,697,433,372,313,276,875,874,437,360,66
70486,"Computed tomography, maxillofacial area; without contrast material",1250,625,80,1213,575,575,1213,461,684,837,520,447,526,331,1051,1050,525,433,80
70487,"Computed tomography, maxillofacial area; with contrast material(s)",1470,735,94,1236,669,691,773,542,932,984,612,525,443,389,1236,1235,617,509,94
70488,"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections",1661,831,106,1397,772,795,874,612,1053,1112,691,593,500,440,1397,1395,697,575,106
70490,"Computed tomography, soft tissue neck; without contrast material",1135,568,72,955,517,522,597,418,468,760,472,405,342,301,955,953,476,393,72
70491,"Computed tomography, soft tissue neck; with contrast material(s)",1246,623,80,1048,573,573,655,459,790,834,519,445,375,330,1048,1046,523,431,80
71045,PR X-RAY EXAM CHEST 1 VIEW,129,65,8,110,59,59,60,54,53,33,54,46,54,34,108,110,54,45,8
71046,PR X-RAY EXAM CHEST 2 VIEWS,170,85,11,144,78,78,78,72,70,78,72,74,72,72,143,144,71,59,11
71100,"Radiologic examination, ribs, unilateral; 2 views",153,77,10,129,70,70,68,56,97,102,64,55,46,41,129,128,64,53,10
71111,"Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views",420,210,27,353,191,193,221,180,266,281,177,150,126,111,353,353,176,145,27
71250,"Computed tomography, thorax; without contrast material",1182,591,75,994,544,544,863,436,749,154,492,422,356,313,994,993,496,409,75
71260,"Computed tomography, thorax; with contrast material(s)",1291,646,82,1086,594,594,775,550,532,193,545,530,389,342,1086,1084,542,447,82
71270,"Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections",1420,710,91,1194,646,667,747,523,900,951,591,507,428,376,1194,1193,596,492,91
72040,"Radiologic examination, spine, cervical; 2 or 3 views",179,90,11,177,82,82,77,77,74,177,74,125,54,47,151,150,75,62,11
72050,"Radiologic examination, spine, cervical; minimum of 4 views",402,201,26,338,185,185,189,148,166,183,170,144,121,106,338,338,169,139,26
72052,"Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies",448,224,29,377,204,206,236,165,284,300,186,160,135,119,377,376,188,155,29
72070,"Radiologic examination, spine; thoracic, 2 views",213,107,14,199,97,98,98,79,135,199,89,76,64,56,179,179,89,74,14
72072,"Radiologic examination, spine; thoracic, 3 views",233,117,15,196,106,107,123,86,148,156,97,83,70,62,196,196,98,81,15
72100,"Radiologic examination, spine, lumbosacral; 2 or 3 views",195,98,12,164,89,90,91,80,80,92,81,136,59,52,164,164,82,67,12
72110,"Radiologic examination, spine, lumbosacral; minimum of 4 views",301,151,19,253,137,138,141,111,124,139,125,108,127,80,253,253,126,104,19
72125,"Computed tomography, cervical spine; without contrast material",1243,622,79,1045,565,572,654,458,512,378,517,444,374,329,1045,1044,522,430,79
72128,"Computed tomography, thoracic spine; without contrast material",1268,634,81,1066,577,583,667,467,804,849,528,453,382,336,1066,1065,532,439,81
72131,"Computed tomography, lumbar spine; without contrast material",1352,676,86,1137,618,622,711,498,557,905,563,483,407,358,1137,1135,567,468,86
72170,"Radiologic examination, pelvis; 1 or 2 views",134,67,9,113,62,62,62,49,85,90,57,48,40,35,113,113,56,46,9
72192,"Computed tomography, pelvis; without contrast material",1135,568,72,955,517,522,597,418,468,760,472,405,342,301,955,953,476,393,72
72193,"Computed tomography, pelvis; with contrast material(s)",1262,631,81,1061,581,604,664,465,800,845,525,451,380,334,1061,1060,530,437,81
72202,"Radiologic examination, sacroiliac joints; 3 or more views",218,109,14,183,99,104,115,80,90,146,91,78,66,58,183,183,91,75,14
72220,"Radiologic examination, sacrum and coccyx, minimum of 2 views",156,78,10,131,72,72,82,57,99,104,65,56,47,41,131,131,65,54,10
73010,"Radiologic examination; scapula, complete",201,101,13,169,91,96,106,74,127,135,84,72,61,53,169,169,84,70,13
73030,"Radiologic examination, shoulder; complete, minimum of 2 views",190,95,12,160,87,87,89,81,120,138,80,107,57,50,160,160,80,66,12
73060,"Radiologic examination; humerus, minimum of 2 views",201,101,13,178,92,171,92,74,83,178,85,72,61,53,169,169,84,70,13
73070,"Radiologic examination, elbow; 2 views",127,64,8,107,58,58,67,47,81,85,53,45,38,34,107,107,53,44,8
73080,"Radiologic examination, elbow; complete, minimum of 3 views",184,92,12,155,85,85,79,77,117,123,77,66,55,49,155,155,77,64,12
73090,"Radiologic examination; forearm, 2 views",175,88,11,147,80,80,80,65,72,117,72,63,74,46,147,147,73,61,11
73100,"Radiologic examination, wrist; 2 views",114,57,7,107,52,107,60,49,72,76,47,80,34,30,96,96,48,39,7
73110,"Radiologic examination, wrist; complete, minimum of 3 views",175,88,11,147,80,80,80,65,111,80,74,63,74,46,147,147,73,61,11
73120,"Radiologic examination, hand; 2 views",118,59,8,99,54,56,62,43,75,79,49,42,36,31,99,99,50,41,8
73130,"Radiologic examination, hand; minimum of 3 views",131,66,8,111,60,111,96,48,83,60,55,54,39,35,110,110,55,45,8
73140,"Radiologic examination, finger(s), minimum of 2 views",110,55,7,93,50,52,58,46,70,74,46,62,46,29,93,92,46,38,7
73200,"Computed tomography, upper extremity; without contrast material",946,473,60,796,431,445,498,349,391,634,394,338,285,251,796,795,397,327,60
73502,PR X-RAY EXAM HIP UNI 2-3 VIEWS,247,124,16,210,114,114,114,101,157,114,104,172,74,207,208,210,104,85,16
73521,PR X-RAY EXAM HIPS BI 2 VIEWS,553,277,35,465,252,254,291,234,228,370,230,386,166,146,465,464,232,191,35
73552,PR X-RAY EXAM OF FEMUR 2/> VW,201,101,13,169,92,94,94,74,127,135,83,140,85,53,169,169,84,70,13
73560,"Radiologic examination, knee; 1 or 2 views",130,65,8,109,89,60,68,109,82,87,54,53,39,34,109,109,55,45,8
73562,"Radiologic examination, knee; 3 views",192,96,12,175,87,88,88,80,79,175,79,134,162,81,161,163,81,66,12
73590,"Radiologic examination; tibia and fibula, 2 views",148,74,9,124,68,68,68,55,94,99,61,53,45,39,124,124,62,51,9
73600,"Radiologic examination, ankle; 2 views",136,68,9,114,62,65,99,50,86,91,57,49,41,36,114,114,57,47,9
73610,"Radiologic examination, ankle; complete, minimum of 3 views",175,88,11,147,80,80,80,75,111,117,73,97,74,74,147,147,73,61,11
73620,"Radiologic examination, foot; 2 views",118,59,8,108,108,54,86,51,75,79,49,42,36,31,99,99,50,41,8
73630,"Radiologic examination, foot; complete, minimum of 3 views",148,74,9,126,68,68,68,65,94,68,62,103,62,39,124,126,62,51,9
73650,"Radiologic examination; calcaneus, minimum of 2 views",118,59,8,99,54,56,62,43,75,79,49,42,36,31,99,99,50,41,8
73660,"Radiologic examination; toe(s), minimum of 2 views",110,55,7,94,51,53,58,41,70,74,46,39,33,29,93,94,46,38,7
73700,"Computed tomography, lower extremity; without contrast material",946,473,60,796,435,435,435,349,390,634,394,338,285,251,796,795,397,327,60
74018,PR X-RAY EXAM ABDOMEN 1 VIEW,136,68,9,160,63,63,160,50,56,91,57,49,41,36,114,116,57,47,9
74019,PR X-RAY EXAM ABDOMEN 2 VIEWS,203,102,13,200,92,94,148,75,129,200,84,88,61,54,171,170,85,70,13
74022,"Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest",249,125,16,230,113,115,115,105,103,230,105,89,75,66,209,209,105,86,16
74150,"Computed tomography, abdomen; without contrast material",1112,556,71,935,512,532,585,410,705,745,463,397,335,295,935,934,467,385,71
74160,"Computed tomography, abdomen; with contrast material(s)",1277,639,82,1074,593,611,932,471,809,855,531,456,384,338,1074,1072,536,442,82
74176,"Computed tomography, abdomen and pelvis; without contrast material",2266,1133,145,1906,1031,1042,1360,975,934,574,957,809,954,600,1906,1903,951,784,145
74177,"Computed tomography, abdomen and pelvis; with contrast material(s)",2575,1288,164,2166,1171,1184,1210,1094,1632,281,1066,1798,775,682,2166,2163,1081,891,164
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",2987,1494,191,2512,1358,1956,1571,1101,1893,1026,1243,1067,899,791,2512,2509,1254,1034,191
76536,"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation",294,147,19,247,149,148,155,127,121,197,122,105,89,124,247,247,123,102,19
76641,Complete unilateral ultrasound examination of the breast,461,231,29,388,231,221,193,170,292,309,192,165,139,122,388,387,193,160,29
76642,Specific area/quadrant breast ultrasound examination,257,129,16,216,117,118,118,137,106,172,109,215,77,68,216,216,108,89,16
76700,"Ultrasound, abdominal, real time with image documentation; complete",501,251,32,421,230,230,301,185,207,96,208,179,211,133,421,421,210,173,32
76705,"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)",423,212,27,360,195,195,195,177,174,195,179,151,178,112,356,360,178,146,27
76706,PR US ABDL AORTA SCREEN AAA,369,185,24,310,168,177,194,156,234,247,154,132,111,98,310,310,155,128,24
76770,"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete",449,225,29,378,207,207,207,200,185,205,189,160,135,119,378,377,188,155,29
76830,"Ultrasound, transvaginal",287,144,18,241,132,137,151,106,182,192,119,103,86,76,241,241,120,99,18
76856,"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete",404,202,26,340,185,186,213,149,158,271,168,166,122,170,340,339,170,140,26
76870,"Ultrasound, scrotum and contents",302,151,19,254,137,139,159,111,191,202,126,108,91,80,254,254,127,105,19
76881,"Ultrasound, extremity, nonvascular, real-time with image documentation; complete",348,174,22,293,160,160,183,128,221,233,145,124,105,92,293,292,146,120,22
76942,"Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation",88,44,6,74,40,42,46,32,56,59,37,31,26,23,74,74,37,30,6
77065,Diagnostic Mammography computer aided detection when performed; unilateral,332,166,21,279,151,153,153,136,137,151,140,232,100,88,279,279,139,115,21
77066,Diagnostic Mammography computer aided detection when performed; bilateral,411,206,26,346,188,189,191,179,169,187,174,147,124,109,346,345,173,142,26
77067,Screening mammography,348,174,89,293,89,127,160,146,143,160,147,143,147,146,293,292,146,120,89
77080,"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)",312,156,20,304,142,144,164,128,198,304,132,111,94,83,262,262,131,108,20
77081,"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)",206,103,13,202,94,99,108,76,131,202,86,74,62,55,173,173,86,71,13
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)",98,49,4,96,45,45,45,40,96,96,41,30,11,26,82,82,41,34,4
80051,"Electrolyte panel This panel must include the following: Carbon dioxide (82374), Chloride (82435), Potassium (84132), Sodium (84295)",76,38,5,64,35,35,40,28,48,51,32,27,23,20,64,64,32,26,5
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)",125,63,8,122,58,58,58,52,122,122,53,20,13,14,105,106,52,43,8
80061,"Lipid panel This panel must include the following: Cholesterol, serum, total (82465), Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478)",127,64,8,124,58,58,76,53,124,82,54,22,17,17,107,107,53,44,8
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)",114,57,7,96,52,54,60,42,72,32,47,41,34,30,96,96,48,39,7
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)",345,173,22,290,157,159,181,127,219,231,144,123,104,91,290,290,145,119,22
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)",113,57,7,95,52,75,82,42,72,76,47,40,34,30,95,95,47,39,7
80162,Digoxin,83,42,5,70,38,38,44,31,53,56,35,30,25,22,70,70,35,29,5
80164,Dipropylacetic acid (valproic acid),102,51,7,101,47,47,54,38,101,68,42,36,31,27,86,86,43,35,7
80170,Gentamicin,85,43,5,84,39,39,45,31,83,84,35,30,26,23,71,71,36,29,5
80178,Lithium,100,50,6,99,46,48,53,37,99,67,42,36,30,26,84,84,42,35,6
80185,Phenytoin; total,85,43,5,82,39,39,45,17,82,57,35,30,26,23,71,71,36,29,5
80200,Tobramycin,115,58,7,97,53,55,60,42,73,77,48,41,35,30,97,97,48,40,7
80202,Vancomycin,101,51,6,100,46,48,53,37,64,100,42,36,30,27,85,85,42,35,6
80235,HC DRUG ASSAY LACOSAMIDE,225,113,14,189,102,104,118,83,143,151,94,80,68,60,189,189,94,78,14
80307,Drug Test presumptive,143,72,9,120,64,66,104,61,91,106,60,47,43,38,120,120,60,49,9
80320,Drug screen quantitative alcohols 22 or more classes,143,72,9,120,65,68,75,62,91,96,60,29,60,38,120,120,60,49,9
80329,HC DRUG TEST DEF 1-2 CLASS ANALGESICS NON-OPIOID,107,54,7,90,48,51,56,46,68,72,45,22,43,28,90,90,45,37,7
80345,HC DRUG TEST DEF 22+ CLASS BARBITURATES,109,55,7,92,50,52,57,40,69,73,45,39,33,29,92,92,46,38,7
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",52,26,2,51,24,24,24,4,51,24,22,4,4,4,44,44,22,18,2
81050,"Volume measurement for timed collection, each",12,6,1,10,5,6,6,4,8,8,5,4,4,3,10,10,5,4,1
82009,"Acetone or other ketone bodies, serum; qualitative",54,27,3,45,24,25,28,23,34,36,22,19,16,14,45,45,23,19,3
82024,Adrenocorticotropic hormone (ACTH),79,40,5,66,36,38,42,29,50,53,33,28,24,21,66,66,33,27,5
82040,"Albumin; serum, plasma or whole blood",51,26,3,43,23,43,27,19,32,34,21,18,15,14,43,43,21,18,3
82043,"Albumin; urine, microalbumin, quantitative",107,54,7,90,23,61,56,21,68,72,45,38,32,28,90,90,45,37,7
82085,Aldolase,63,32,4,62,29,30,33,23,40,62,26,23,19,17,53,53,26,22,4
82088,Aldosterone,139,70,9,128,63,65,64,51,128,93,58,50,42,37,117,117,58,48,9
82108,Aluminum,145,73,9,122,66,68,76,53,92,97,60,52,44,38,122,122,61,50,9
82131,"Amino acids; single, quantitative, each specimen",208,104,13,175,94,96,109,77,132,139,87,74,63,55,175,175,87,72,13
82140,Ammonia,162,81,10,136,73,75,85,69,103,108,67,58,49,43,136,136,68,56,10
82150,Amylase,94,47,6,93,43,43,44,24,93,92,39,34,28,25,79,79,39,33,6
82247,Bilirubin; total,40,20,3,34,18,19,21,15,25,27,17,14,12,11,34,34,17,14,3
82248,Bilirubin; direct,42,21,3,35,19,20,22,15,27,28,17,15,13,11,35,35,18,15,3
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)",42,21,3,35,19,19,20,11,27,19,17,15,13,11,35,35,18,15,3
82306,"Vitamin D; 25 hydroxy, includes fraction(s), if performed",253,127,16,245,116,116,118,106,245,83,105,39,37,38,213,212,106,88,16
82310,Calcium; total,59,30,4,50,27,28,31,22,37,40,25,21,18,16,50,50,25,20,4
82330,Calcium; ionized,48,24,3,40,22,23,25,18,30,32,20,17,14,13,40,40,20,17,3
82340,"Calcium; urine quantitative, timed specimen",92,46,6,77,42,44,48,34,58,62,38,33,28,24,77,77,39,32,6
82378,Carcinoembryonic antigen (CEA),133,67,8,112,61,63,70,49,84,89,55,48,40,35,112,112,56,46,8
82390,Ceruloplasmin,29,15,2,24,13,14,21,11,18,19,12,10,9,8,24,24,12,10,2
82465,"Cholesterol, serum or whole blood, total",60,30,4,50,27,28,32,22,38,40,25,21,18,16,50,50,25,21,4
82525,Copper,252,126,16,212,115,121,184,93,160,169,105,90,76,67,212,212,106,87,16
82530,Cortisol; free,144,72,9,121,65,69,76,53,91,96,60,51,43,38,121,121,60,50,9
82533,Cortisol; total,136,68,9,132,63,64,63,50,132,91,57,49,41,36,114,114,57,47,9
82542,"Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase",152,76,10,128,70,71,80,56,96,102,63,54,46,40,128,128,64,53,10
82550,"Creatine kinase (CK), (CPK); total",56,28,4,50,25,26,26,23,35,50,23,9,6,15,47,48,24,19,4
82552,"Creatine kinase (CK), (CPK); isoenzymes",93,47,6,78,43,45,49,34,59,62,39,33,28,25,78,78,39,32,6
82553,"Creatine kinase (CK), (CPK); MB fraction only",66,33,4,65,30,30,31,28,63,65,28,15,15,17,56,56,28,23,4
82565,Creatinine; blood,47,24,3,47,22,22,28,20,46,47,20,17,14,12,40,39,20,16,3
82570,Creatinine; other source,74,37,3,73,34,34,34,30,73,73,31,26,22,20,62,62,31,26,3
82575,Creatinine; clearance,145,73,9,143,67,67,67,61,143,78,60,52,44,38,122,122,61,50,9
82607,Cyanocobalamin (Vitamin B-12);,101,51,6,99,46,46,53,37,97,99,43,36,30,27,85,85,42,35,6
82652,"Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed",253,127,16,213,116,121,133,106,160,156,105,90,76,67,213,212,106,88,16
82670,Estradiol,80,40,5,67,37,37,42,29,51,54,33,29,24,21,67,67,34,28,5
82728,Ferritin,92,46,6,88,42,42,42,38,88,59,39,33,28,24,77,77,39,32,6
82746,Folic acid; serum,87,44,6,83,40,40,46,32,83,48,36,31,26,23,73,73,37,30,6
82747,Folic acid; RBC,71,36,5,60,33,34,33,26,45,48,30,25,21,19,60,60,30,25,5
82784,"Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each",293,147,19,246,132,116,138,108,186,196,122,105,88,78,246,246,123,101,19
82785,Gammaglobulin (immunoglobulin); IgE,107,54,7,90,49,51,56,39,68,72,45,38,32,28,90,90,45,37,7
82803,"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);",251,126,16,246,113,115,132,93,159,246,104,90,76,66,211,211,105,87,16
82945,"Glucose, body fluid, other than blood",42,21,3,35,19,20,22,15,27,28,17,15,13,11,35,35,18,15,3
82947,"Glucose; quantitative, blood (except reagent strip)",66,33,4,56,30,31,35,24,42,44,27,24,20,17,56,55,28,23,4
82948,"Glucose; blood, reagent strip",10,5,1,10,5,5,5,4,6,10,4,4,3,3,8,8,4,3,1
82951,"Glucose; tolerance test (GTT), 3 specimens (includes glucose)",128,64,8,126,58,59,67,47,126,86,53,46,39,34,108,108,54,44,8
82977,"Glutamyltransferase, gamma (GGT)",76,38,5,64,35,36,55,28,48,51,32,27,23,20,64,64,32,26,5
82985,Glycated protein,32,16,2,27,15,15,17,13,20,21,13,11,10,8,27,27,13,11,2
83001,Gonadotropin; follicle stimulating hormone (FSH),114,57,7,96,52,52,83,42,72,76,47,41,34,30,96,96,48,39,7
83002,Gonadotropin; luteinizing hormone (LH),131,66,8,126,60,60,96,48,83,126,55,47,39,35,110,110,55,45,8
83020,"Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)",144,72,9,121,66,69,76,53,91,96,60,13,43,38,121,121,60,50,9
83036,Hemoglobin; glycosylated (A1C),91,46,6,89,42,42,42,25,89,42,38,13,12,12,77,76,38,31,6
83516,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method",50,25,3,57,23,57,36,18,32,18,21,18,15,13,42,42,21,17,3
83519,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)",278,139,18,234,127,133,146,102,176,117,116,99,84,74,234,233,117,96,18
83525,Insulin; total,57,29,4,48,26,26,30,21,36,38,24,20,17,15,48,48,24,20,4
83540,Iron,64,32,3,63,29,29,30,27,63,38,27,23,19,17,54,54,27,22,3
83550,Iron binding capacity,83,42,5,81,38,38,39,35,81,79,35,30,25,22,70,70,35,29,5
83605,Lactate (lactic acid),82,41,5,80,37,38,38,13,80,80,34,29,25,22,69,69,34,28,5
83615,"Lactate dehydrogenase (LD), (LDH);",67,34,4,56,31,32,35,25,42,45,28,24,20,18,56,56,28,23,4
83690,Lipase,93,47,6,92,43,43,44,39,92,91,39,33,28,25,78,78,39,32,6
83695,Lipoprotein (a),113,57,7,95,52,54,59,42,72,76,47,40,34,30,95,95,47,39,7
83735,Magnesium,94,47,4,92,43,43,43,39,92,78,40,34,28,25,79,79,39,33,4
83835,Metanephrines,354,177,23,350,161,169,186,130,350,237,147,126,107,94,298,297,149,123,23
83874,Myoglobin,93,47,6,78,42,45,49,34,59,62,39,33,28,25,78,78,39,32,6
83880,Natriuretic peptide,242,121,15,239,109,111,114,100,239,222,102,45,73,64,204,203,102,84,15
83883,"Nephelometry, each analyte not elsewhere specified",304,152,19,256,137,139,143,133,193,204,127,109,92,81,256,255,128,105,19
83918,"Organic acids; total, quantitative, each specimen",232,116,15,195,106,107,122,86,147,155,97,83,70,61,195,195,97,80,15
83921,"Organic acid, single, quantitative",250,125,16,210,113,115,132,92,158,167,104,89,75,66,210,210,105,87,16
83930,Osmolality; blood,65,33,4,62,30,31,34,24,62,44,27,23,20,17,55,55,27,22,4
83935,Osmolality; urine,70,35,4,59,32,33,37,26,44,47,29,25,21,19,59,59,29,24,4
83970,Parathormone (parathyroid hormone),89,45,6,87,41,41,41,37,78,87,37,32,27,24,75,75,37,31,6
83986,"pH; body fluid, not otherwise specified",66,33,4,56,30,32,35,24,42,44,27,24,20,17,56,55,28,23,4
84075,"Phosphatase, alkaline;",76,38,5,64,35,36,55,28,48,51,32,27,23,20,64,64,32,26,5
84100,Phosphorus inorganic (phosphate);,49,25,3,48,23,23,23,20,31,48,20,18,15,13,41,41,21,17,3
84132,"Potassium; serum, plasma or whole blood",54,27,3,45,25,25,28,20,34,19,22,11,16,14,45,45,23,19,3
84134,Prealbumin,51,26,3,49,23,23,27,19,49,34,21,18,15,14,43,43,21,18,3
84144,Progesterone,139,70,9,117,63,67,73,51,88,93,58,50,42,37,117,117,58,48,9
84146,Prolactin,143,72,9,120,65,68,104,24,91,96,60,53,43,38,120,120,60,49,9
84153,Prostate specific antigen (PSA); total,133,67,8,130,61,61,55,56,130,89,55,48,40,35,112,112,56,46,8
84154,Prostate specific antigen (PSA); free,191,96,12,188,86,88,90,70,188,128,79,68,58,51,161,160,80,66,12
84155,"Protein, total, except by refractometry; serum, plasma or whole blood",66,33,2,56,30,30,30,24,42,44,27,24,20,17,56,55,28,23,2
84156,"Protein, total, except by refractometry; urine",107,54,7,106,49,49,49,45,106,66,45,38,32,28,90,90,45,37,7
84165,"Protein; electrophoretic fractionation and quantitation, serum",47,24,3,44,22,22,22,21,44,31,20,17,14,12,40,39,20,16,3
84166,"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)",165,83,11,160,76,65,76,61,160,111,69,59,50,44,139,139,69,57,11
84207,Pyridoxal phosphate (Vitamin B-6),293,147,19,246,135,135,154,108,186,196,122,105,88,78,246,246,123,101,19
84244,Renin,144,72,9,138,66,68,66,28,138,96,60,51,43,38,121,121,60,50,9
84255,Selenium,154,77,10,130,71,74,81,57,98,103,64,55,46,41,130,129,65,53,10
84270,Sex hormone binding globulin (SHBG),123,62,8,103,55,59,65,45,78,82,51,44,37,33,103,103,52,43,8
84300,Sodium; urine,56,28,4,47,25,27,29,21,35,24,23,20,17,15,47,47,24,19,4
84402,Testosterone; free,57,29,4,48,26,27,42,21,36,38,24,20,17,15,48,48,24,20,4
84403,Testosterone; total,85,43,5,71,39,40,62,31,54,57,35,30,26,23,71,71,36,29,5
84425,Thiamine (Vitamin B-1),78,39,5,73,31,36,41,29,73,52,32,28,23,21,66,66,33,27,5
84436,Thyroxine; total,92,46,6,90,42,42,42,39,90,62,39,33,28,9,77,77,39,32,6
84439,Thyroxine; free,91,46,6,89,41,42,42,38,89,70,38,15,11,12,77,76,38,31,6
84443,Thyroid stimulating hormone (TSH),120,60,8,116,55,55,55,50,116,106,50,24,21,22,101,101,50,42,8
84445,Thyroid stimulating immune globulins (TSI),297,149,19,250,135,137,156,109,188,199,124,106,89,79,250,249,125,103,19
84446,Tocopherol alpha (Vitamin E),48,24,3,40,22,23,25,18,30,32,20,17,14,13,40,40,20,17,3
84450,Transferase; aspartate amino (AST) (SGOT),76,38,5,64,35,36,40,28,48,51,32,27,23,20,64,64,32,26,5
84466,Transferrin,169,85,11,167,77,78,89,62,167,166,71,60,51,45,142,142,71,58,11
84478,Triglycerides,113,57,7,95,52,54,59,42,72,76,47,40,34,30,95,95,47,39,7
84479,Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR),99,50,6,97,45,46,52,36,97,66,42,35,30,26,83,83,42,34,6
84480,Triiodothyronine T3; total (TT-3),33,17,2,33,15,15,17,14,33,22,14,7,10,16,28,28,14,11,2
84481,Triiodothyronine T3; free,205,103,13,203,92,94,108,76,203,137,85,73,62,54,172,172,86,71,13
84484,"Troponin, quantitative",190,95,12,186,87,87,89,79,120,186,80,13,12,50,160,162,80,66,12
84550,Uric acid; blood,59,30,4,50,27,27,27,25,37,24,25,12,6,6,50,50,25,20,4
84560,Uric acid; other source,42,21,3,35,19,20,22,15,27,28,17,15,13,11,35,35,18,15,3
84590,Vitamin A,124,62,8,104,57,59,65,46,79,83,52,44,37,33,104,104,52,43,8
84630,Zinc,38,19,2,32,17,18,20,14,24,25,16,14,11,10,32,32,16,13,2
84681,C-peptide,137,69,9,115,63,63,72,50,87,92,57,49,41,36,115,115,58,47,9
84702,"Gonadotropin, chorionic (hCG); quantitative",139,70,8,117,63,65,73,8,88,93,58,50,42,37,117,117,58,48,9
84703,"Gonadotropin, chorionic (hCG); qualitative",66,33,4,65,30,56,31,8,65,44,27,8,8,17,56,55,28,23,4
85007,"Blood count; blood smear, microscopic examination with manual differential WBC count",44,22,3,43,20,20,20,4,43,43,18,5,13,12,37,37,18,15,3
85014,Blood count; hematocrit (Hct),20,10,1,17,9,10,15,8,13,13,8,7,6,5,17,17,8,7,1
85018,Blood count; hemoglobin (Hgb),20,10,1,17,9,10,15,8,13,13,8,7,6,5,17,17,8,7,1
85025,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count",72,36,4,91,33,33,34,30,70,71,30,12,10,10,91,61,30,25,4
85027,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)",47,24,3,59,22,22,22,8,45,46,19,9,14,12,40,39,59,16,3
85044,"Blood count; reticulocyte, manual",62,31,4,52,28,30,33,23,39,42,26,22,19,16,52,52,26,21,4
85379,"Fibrin degradation products, D-dimer; quantitative",106,53,7,104,48,49,49,44,103,104,45,29,13,13,89,90,44,37,7
85611,"Prothrombin time; substitution, plasma fractions, each",66,33,4,65,30,30,31,28,65,24,27,24,20,17,56,56,28,23,4
85651,"Sedimentation rate, erythrocyte; non-automated",57,29,4,57,26,26,26,24,57,56,24,12,4,5,48,48,24,20,4
85730,"Thromboplastin time, partial (PTT); plasma or whole blood",75,38,5,74,34,34,35,31,74,74,31,27,23,20,63,64,31,26,5
85810,Viscosity,88,44,6,74,40,42,46,32,56,59,37,31,26,23,74,74,37,30,6
86003,"Allergen specific IgE; quantitative or semiquantitative, each allergen",125,63,8,105,57,58,66,46,79,84,52,45,38,33,105,105,52,43,8
86038,Antinuclear antibodies (ANA);,100,50,6,97,46,47,46,37,97,67,42,36,30,26,84,84,42,35,6
86039,Antinuclear antibodies (ANA); titer,89,45,6,86,41,41,42,39,86,60,37,15,27,24,75,75,37,31,6
86060,Antistreptolysin 0; titer,76,38,5,64,35,36,35,28,48,51,32,27,23,20,64,64,32,26,5
86140,C-reactive protein;,82,41,5,81,38,38,60,35,81,55,34,29,25,22,69,69,34,28,5
86146,"Beta 2 Glycoprotein I antibody, each",306,153,20,257,138,146,161,113,194,205,127,109,92,81,257,257,128,106,20
86160,"Complement; antigen, each component",99,50,6,108,46,47,51,42,108,66,41,35,30,26,83,83,42,34,6
86162,Complement; total hemolytic (CH50),92,46,6,87,42,42,42,39,87,62,38,33,28,24,77,77,39,32,6
86225,Deoxyribonucleic acid (DNA) antibody; native or double stranded,146,73,9,123,67,68,77,62,93,98,61,52,44,39,123,123,61,51,9
86226,Deoxyribonucleic acid (DNA) antibody; single stranded,101,51,6,85,46,46,53,37,64,68,42,36,30,27,85,85,42,35,6
86235,"Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody",165,83,11,139,74,78,87,63,105,111,69,59,50,44,139,139,69,57,11
86255,"Fluorescent noninfectious agent antibody; screen, each antibody",210,105,13,177,97,97,97,92,133,144,87,75,63,56,177,176,88,73,13
86301,"Immunoassay for tumor antigen, quantitative; CA 19-9",133,67,8,112,61,63,70,49,84,89,55,48,40,35,112,112,56,46,8
86308,Heterophile antibodies; screening,75,38,5,64,34,64,39,28,48,50,31,27,23,20,63,63,31,26,5
86320,Immunoelectrophoresis; serum,199,100,13,167,92,94,92,73,126,133,83,71,60,53,167,167,84,69,13
86329,Immunodiffusion; not elsewhere specified,88,44,6,74,40,40,46,32,56,59,37,31,26,23,74,74,37,30,6
86334,Immunofixation electrophoresis; serum,164,82,10,138,75,75,39,107,80,109,68,58,49,43,138,137,69,57,10
86376,"Microsomal antibodies (eg, thyroid or liver-kidney), each",120,60,8,101,54,55,63,44,76,80,50,43,36,32,101,101,50,42,8
86431,Rheumatoid factor; quantitative,92,46,6,91,41,44,42,39,91,62,38,33,28,24,77,77,39,32,6
86480,"Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon",227,114,14,191,102,104,107,84,144,97,94,81,68,60,191,191,95,79,14
86592,"Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)",37,19,2,31,17,17,17,5,22,25,15,13,11,10,31,31,16,13,2
86677,Antibody; Helicobacter pylori,66,33,4,56,30,30,35,24,42,44,27,24,20,17,56,55,28,23,4
86687,Antibody; HTLV-I,106,53,7,89,49,49,50,39,67,71,44,38,32,28,89,89,44,37,7
86705,Hepatitis B core antibody (HBcAb); IgM antibody,46,23,3,39,21,22,24,17,29,31,19,16,14,12,39,39,19,16,3
86706,Hepatitis B surface antibody (HBsAb),80,40,5,77,37,37,37,33,77,54,33,29,24,14,67,67,34,28,5
86769,HC SARS-COV-2 COVID-19 ANTIBODY,50,25,3,49,23,23,30,18,49,33,21,18,15,13,42,42,21,17,3
86780,Antibody; Treponema pallidum,71,36,5,60,32,34,37,26,45,48,30,25,21,30,60,60,30,25,5
86800,Thyroglobulin antibody,58,29,4,49,19,34,31,22,37,39,24,21,18,15,49,49,25,20,4
86803,Hepatitis C antibody;,75,38,5,63,34,34,34,10,48,41,31,27,18,20,63,63,31,26,5
86850,"Antibody screen, RBC, each serum technique",169,85,11,142,76,78,79,71,107,113,70,60,51,45,142,142,71,58,11
86900,Blood typing; ABO,119,60,8,119,54,55,56,50,119,80,50,43,36,32,100,100,50,41,8
86901,Blood typing; Rh (D),39,20,2,33,18,18,18,16,28,26,16,14,12,10,33,33,16,13,2
86920,Compatibility test each unit; immediate spin technique,202,101,13,170,61,124,127,113,128,136,84,72,61,54,170,170,85,70,13
86931,"Frozen blood, each unit; thawing",516,258,33,434,235,247,271,190,327,346,215,184,155,137,434,433,217,179,33
87040,"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)",146,73,9,246,66,134,67,68,143,143,121,14,44,39,246,123,61,51,9
87045,"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species",139,70,9,117,64,65,60,61,88,93,58,50,42,37,117,117,58,48,9
87070,"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates",102,51,7,101,47,61,74,11,101,10,43,21,11,27,86,87,43,35,7
87075,"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates",162,81,10,136,73,75,85,60,103,135,67,58,49,43,136,136,68,56,10
87081,"Culture, presumptive, pathogenic organisms, screening only;",51,26,3,50,23,24,23,19,50,34,21,18,15,14,43,43,21,18,3
87088,"Culture, bacterial; with isolation and presumptive identification of each isolate, urine",92,46,4,155,41,42,42,10,90,65,39,11,28,24,155,77,38,32,4
87101,"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail",128,64,8,108,58,59,67,47,81,86,53,46,39,34,108,108,54,44,8
87177,"Ova and parasites, direct smears, concentration and identification",77,39,5,66,35,36,41,34,66,52,32,28,23,20,65,65,32,27,5
87205,"Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types",66,33,4,56,35,32,35,25,42,45,28,24,20,18,56,56,28,23,4
87210,"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)",76,38,5,71,35,36,40,5,71,51,32,6,23,20,64,64,32,26,5
87324,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)",113,57,7,98,52,53,49,49,98,76,47,40,34,30,95,95,47,39,7
87338,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool",323,162,21,321,147,149,170,119,321,216,134,115,97,86,272,271,136,112,21
87340,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)",75,38,5,74,34,34,35,31,72,74,14,27,23,20,63,63,31,26,5
87430,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Streptococcus, group A",68,34,4,58,31,31,50,15,53,46,28,28,15,18,57,58,29,24,4
87490,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique",113,57,7,100,51,54,59,25,100,76,47,23,34,30,95,95,47,39,7
87491,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique",90,45,6,76,41,43,47,25,57,60,37,32,27,25,76,76,38,31,6
87521,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique",417,209,27,351,188,200,192,154,264,279,174,149,126,110,351,350,175,144,27
87522,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification",802,401,51,796,362,369,422,296,796,537,334,287,241,212,674,674,337,278,51
87536,"Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification",506,253,32,426,228,242,266,187,321,339,211,181,152,134,426,425,212,175,32
87590,"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique",136,68,9,114,62,65,72,50,86,91,57,28,41,36,114,114,57,47,9
87591,"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique",90,45,6,76,41,43,47,21,57,60,37,32,27,22,76,76,38,31,6
87635,Infectious agent detection by nucleic acid; severe acute respiratory syndrome coronavirus COVID-19,300,150,19,255,138,138,24,51,51,138,22,41,90,51,252,255,125,104,19
87804,Infectious agent antigen detection by immunoassay with direct optical observation; Influenza,258,129,15,253,116,119,154,15,243,253,107,106,15,68,217,219,108,89,16
87807,Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus,59,30,4,50,27,28,31,22,37,40,25,24,18,16,50,50,25,20,4
88182,"Flow cytometry, cell cycle or DNA analysis",167,84,11,140,77,80,88,62,106,112,69,60,50,44,140,140,70,58,11
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",93,47,6,78,43,43,44,34,59,62,39,33,28,25,78,78,39,32,6
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",891,446,57,750,406,427,419,329,565,597,371,318,268,236,750,749,374,309,57
88309,"Level VI - Surgical pathology, gross and microscopic examination Bone resection, Breast, mastectomy - with regional lymph nodes, Colon, segmental resection for tumor, Colon, total resection, Esophagus, partial/total resection, Extremity, disarticulation, Fetus, with dissection, Larynx, partial/total resection - with regional lymph nodes, Lung - total/lobe/segment resection, Pancreas, total/subtotal resection, Prostate, radical resection, Small intestine, resection for tumor, Soft tissue tumor, extensive resection, Stomach - subtotal/total resection for tumor, Testis, tumor, Tongue/tonsil -resection for tumor, Urinary bladder, partial/total resection, Uterus, with or without tubes and ovaries, neoplastic, Vulva, total/subtotal resection",938,469,60,788,426,431,493,346,594,628,390,335,282,248,788,787,393,325,60
88312,"Special stains; Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), including interpretation and report, each",938,469,60,788,426,441,441,346,594,628,390,335,282,248,788,787,393,325,60
89050,"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood;",36,18,2,30,16,17,19,13,23,24,15,13,11,10,30,30,15,12,2
89060,"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)",59,30,4,50,27,28,31,22,37,40,25,21,18,16,50,50,25,20,4
90471,"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)",90,45,6,77,41,41,66,37,57,60,37,37,27,24,76,77,38,31,6
90661,"Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use",55,28,4,46,25,26,29,20,35,37,23,20,17,15,46,46,23,19,4
90670,"Pneumococcal conjugate vaccine, 13 valent, for intramuscular use",965,483,62,812,435,462,508,356,612,646,402,345,291,256,812,810,405,334,62
90700,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use",120,60,8,102,55,55,88,44,76,80,50,43,36,32,101,102,50,42,8
90714,"Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use",117,59,7,98,54,54,55,43,25,78,49,48,35,31,98,98,49,40,7
92507,"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual",64,32,4,54,29,31,30,24,41,43,27,23,19,17,54,54,27,22,4
92523,HC EVAL SPEECH SOUND LANG COMPREHEN,234,117,15,197,107,112,110,86,148,157,97,84,70,62,197,197,98,81,15
92610,Evaluation of oral and pharyngeal swallowing function,203,102,13,171,92,95,107,75,129,136,84,73,61,54,171,170,85,70,13
92950,"Cardiopulmonary resuscitation (eg, in cardiac arrest)",1276,638,81,1073,587,587,517,470,526,855,531,456,384,338,1073,1072,536,442,81
93005,"Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report",262,131,17,329,119,121,123,110,108,123,111,113,110,69,220,223,329,91,17
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",1218,609,78,1024,554,560,641,449,772,683,507,435,367,512,1024,1023,511,422,78
93880,Duplex scan of extracranial arteries; complete bilateral study,843,422,54,709,388,388,443,311,534,390,356,301,254,223,709,708,354,292,54
93925,Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study,819,410,52,689,375,377,431,302,519,548,341,293,247,217,689,688,344,283,52
93926,Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study,430,215,27,362,198,206,226,158,273,288,179,154,129,114,362,361,180,149,27
93970,Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study,602,301,38,506,274,277,317,252,248,272,222,122,181,159,506,506,253,208,38
93971,Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study,388,194,25,326,176,178,178,143,160,176,161,139,117,103,326,326,163,134,25
94002,"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day",1429,715,80,1202,650,684,752,527,906,80,595,510,430,379,1202,1200,600,495,91
94010,"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation",238,119,15,200,108,114,109,100,151,94,99,85,72,63,200,200,100,82,15
94016,Patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only,238,119,15,200,109,112,125,88,151,159,98,85,72,63,200,200,100,82,15
94060,"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration",313,157,20,263,144,147,165,135,198,182,130,112,94,83,263,263,131,108,20
94150,"Vital capacity, total (separate procedure)",60,30,4,50,27,29,32,22,38,40,25,21,18,16,50,50,25,21,4
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)",306,153,20,266,82,145,134,133,42,246,84,90,92,81,257,257,266,106,20
94660,"Continuous positive airway pressure ventilation (CPAP), initiation and management",536,268,34,451,244,247,282,198,340,359,223,191,161,142,451,450,225,186,34
94667,"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation",84,42,5,71,38,40,44,36,53,56,35,30,25,22,71,71,35,29,5
95810,"Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist",2441,1221,156,2053,1122,1168,1284,900,1547,1126,1016,872,735,647,2053,2050,1025,845,156
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",2857,1429,182,2428,1299,2428,1286,1053,1811,1318,1189,1021,860,757,2403,2399,1195,989,182
96360,"Intravenous infusion, hydration; initial, 31 minutes to 1 hour",161,81,10,135,74,74,75,67,66,37,68,58,68,48,135,135,68,56,10
96361,"Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)",44,22,3,73,20,31,32,28,27,65,73,16,19,12,37,37,18,15,3
96365,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour",209,105,13,205,95,96,98,87,86,205,86,75,63,55,176,176,88,72,13
96366,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)",228,114,15,191,148,30,153,109,54,152,95,81,68,60,191,191,95,79,15
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)",65,33,4,55,30,30,34,24,41,44,54,23,20,17,55,55,27,22,4
96368,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)",105,53,7,88,48,50,55,39,67,70,44,38,32,28,88,88,44,36,7
96372,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",90,45,6,151,41,41,66,38,37,60,38,39,38,24,151,77,38,31,6
96374,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug",164,82,10,139,75,75,98,69,104,110,69,71,69,43,138,139,69,57,10
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)",67,34,4,113,31,31,49,28,42,45,42,24,20,18,113,56,112,23,4
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)",100,50,6,196,46,31,123,28,64,67,42,36,30,27,85,84,196,35,6
97110,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility",60,30,4,50,28,42,14,22,38,40,25,21,18,16,50,50,25,21,4
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",31,16,2,26,14,15,15,11,20,21,13,11,9,8,26,26,13,11,2
97116,"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)",39,20,2,33,18,19,18,14,25,26,16,14,12,10,33,33,16,13,2
97163,Physical Therapy Evaluation of high complexity,250,125,16,210,114,116,118,92,158,167,104,89,75,66,210,210,105,87,16
97167,HC OT EVAL HIGH COMPLEX,235,118,15,198,107,109,110,87,149,157,98,84,71,62,198,197,99,81,15
97530,"Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes",31,16,2,29,14,29,15,11,20,21,13,11,9,8,26,26,13,11,2
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",48,24,3,40,22,30,23,18,30,32,20,17,14,13,40,40,20,17,3
99070,"Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)",45,23,3,38,21,22,24,17,29,30,19,16,14,12,38,38,19,16,3
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.",223,112,14,188,104,107,117,82,141,149,93,80,67,59,188,187,94,77,14
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.",180,90,11,151,82,83,85,75,74,83,75,37,65,100,151,151,76,62,11
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.",485,243,31,412,223,223,354,201,200,226,203,339,204,128,408,412,204,168,31
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.",600,300,38,510,274,276,276,251,247,349,250,260,253,100,505,510,252,208,38
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.",800,400,51,680,368,368,376,334,330,467,338,338,337,100,673,680,336,277,51
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.",1250,625,80,1192,568,575,581,530,515,1192,528,515,526,100,1051,1050,523,433,80
99291,"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes",1489,745,95,1461,685,685,603,549,613,1461,620,611,448,394,1252,1251,625,515,95
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)",352,176,22,345,160,165,185,130,223,345,146,126,106,93,296,296,148,122,22
99499,Unlisted evaluation and management service,800,400,51,673,364,383,421,295,507,536,333,286,241,212,673,672,336,277,51
A4570,Splint,30,15,2,25,14,14,16,11,19,20,12,21,9,8,25,25,13,10,2
C9113,"Injection, pantoprazole sodium, per vial",149,75,10,125,69,71,78,55,94,100,62,53,45,39,125,125,63,52,10
E0114,"Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and hanDRrips",35,18,2,29,16,23,18,13,22,23,14,19,15,9,29,29,15,12,2
G0008,Administration of influenza virus vaccine,67,34,4,56,30,32,35,25,42,45,28,24,20,18,56,56,28,23,4
G0009,Administration of pneumococcal vaccine,67,34,4,56,30,32,35,25,42,45,28,24,20,18,56,56,28,23,4
G0105,Colorectal cancer screening; colonoscopy on individual at high risk,1548,774,99,1302,698,741,814,571,981,1037,644,553,466,410,1302,1300,650,536,99
G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,1548,774,99,1302,698,741,814,571,981,1037,644,553,466,410,1302,1300,650,536,99
G0378,"Hospital observation service, per hour",1025,513,65,862,469,491,539,378,650,686,427,366,309,272,862,861,430,355,65
J0153,PBB ADENOSINE INJ 1 MG,66,33,4,55,30,31,35,24,33,44,27,23,20,17,55,55,28,23,4
J0171,"Injection, adrenalin, epinephrine, 0.1 mg",9,5,1,27,27,4,7,1,4,6,4,2,4,2,8,8,4,3,1
J0282,"Injection, amiodarone hydrochloride, 30 mg",21,11,1,18,10,10,11,8,13,14,9,8,6,6,18,18,9,7,1
J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",49,25,3,42,22,42,26,18,31,33,20,18,15,13,41,41,21,17,3
J0330,"Injection, succinylcholine chloride, up to 20 mg",21,11,1,18,10,10,11,8,13,14,9,8,6,6,18,18,9,7,1
J0360,"Injection, hydralazine HCl, up to 20 mg",97,49,6,82,44,45,51,36,61,65,40,35,29,26,82,81,41,34,6
J0456,"Injection, azithromycin, 500 mg",47,24,3,40,21,22,22,20,30,31,20,17,14,12,40,39,20,16,3
J0558,"Injection, penicillin G benzathine and penicillin G procaine, 100,000 units",258,129,11,217,119,123,136,11,164,173,107,92,78,68,217,217,108,89,16
J0561,"Injection, penicillin G benzathine, 100,000 units",323,162,14,272,147,149,170,14,14,216,134,115,97,86,272,271,136,112,21
J0690,"Injection, cefazolin sodium, 500 mg",21,11,1,18,10,10,10,8,13,14,9,8,6,6,18,18,9,7,1
J0696,"Injection, ceftriaxone sodium, per 250 mg",21,11,0,18,10,10,11,1,0,14,9,9,6,6,18,18,9,7,1
J0780,"Injection, prochlorperazine, up to 10 mg",21,11,1,18,10,10,15,8,13,14,9,11,6,6,18,18,9,7,1
J0885,"Injection, epoetin alfa, (for non-ESRD use), 1000 units",952,476,61,801,442,456,501,351,603,638,396,340,287,252,801,800,400,330,61
J1030,"Injection, methylprednisolone acetate, 40 mg",28,14,2,24,13,13,15,10,6,19,12,10,8,7,24,24,12,10,2
J1040,"Injection, methylprednisolone acetate, 80 mg",89,45,6,75,41,41,47,12,9,60,37,32,27,24,75,75,37,31,6
J1100,"Injection, dexamethasone sodium phosphate, 1 mg",21,11,0,18,10,10,11,0,0,14,9,8,6,6,18,18,9,7,1
J1165,"Injection, phenytoin sodium, per 50 mg",84,42,4,71,38,39,44,31,4,56,35,30,25,22,71,71,35,29,5
J1170,"Injection, hydromorphone, up to 4 mg",21,11,1,18,10,10,15,3,3,14,9,8,6,6,18,18,9,7,1
J1265,"Injection, dopamine HCl, 40 mg",80,40,5,67,36,38,42,29,51,54,33,29,24,21,67,67,34,28,5
J1439,HC INJ FERRIC CARBOXYMALTOS 1MG,5210,2605,333,4382,2397,2397,2741,1920,3303,3489,2168,1861,1569,1380,4382,4376,2187,1803,333
J1580,"Injection, garamycin, gentamicin, up to 80 mg",40,20,3,34,18,19,24,12,25,27,17,14,12,11,34,34,23,14,3
J1610,"Injection, glucagon hydrochloride, per 1 mg",515,258,33,433,237,237,242,190,326,345,214,184,155,136,433,433,216,178,33
J1630,"Injection, haloperidol, up to 5 mg",46,23,3,39,14,22,36,13,29,31,19,17,14,12,39,39,20,16,3
J1642,"Injection, Heparin sodium, (Heparin lock flush), per 10 units",21,11,1,18,10,10,11,9,13,14,9,8,6,6,18,18,9,7,1
J1644,"Injection, Heparin sodium, per 1000 units",27,14,0,23,12,16,14,10,0,18,11,0,8,7,23,23,11,9,2
J1750,"Injection, iron dextran, 50 mg",1527,764,97,1284,695,731,718,563,225,1023,636,546,460,405,1284,1283,641,529,97
J1815,"Injection, insulin, per 5 units",154,77,10,130,70,74,81,67,98,103,64,55,46,41,130,129,65,53,10
J1817,Insulin for administration through DME (i.e. insulin pump) per 50 units,30,15,2,25,14,14,16,11,19,20,12,11,9,8,25,25,13,10,2
J1885,"Injection, ketorolac tromethamine, per 15 mg",21,11,0,18,10,10,15,1,1,14,9,1,0,6,18,18,9,7,1
J1940,"Injection, furosemide, up to 20 mg",16,8,1,21,5,9,4,7,10,21,7,6,5,4,13,13,7,6,1
J2001,"Injection, lidocaine HCl for intravenous infusion, 10 mg",32,16,2,26,14,15,17,12,20,21,13,11,9,8,26,26,13,11,2
J2060,"Injection, lorazepam, 2 mg",21,11,1,18,10,10,15,9,1,14,9,8,6,6,18,18,9,7,1
J2175,"Injection, meperidine hydrochloride, per 100 mg",21,11,1,18,10,10,11,8,13,14,9,8,6,6,18,18,9,7,1
J2250,"Injection, midazolam hydrochloride, per 1 mg",107,54,7,90,13,49,65,39,68,72,56,38,32,28,90,90,45,37,7
J2270,"Injection, morphine sulfate, up to 10 mg",21,11,1,18,10,10,13,9,4,14,9,8,6,6,18,18,9,7,1
J2274,Inj morphine pf epid ithc,21,11,1,36,10,36,10,9,13,14,9,8,6,6,18,18,9,7,1
J2405,"Injection, ondansetron hydrochloride, per 1 mg",21,11,0,19,10,10,19,0,0,14,9,9,0,6,18,18,9,7,1
J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",184,92,2,2199,112,57,159,2199,2,124,77,66,56,49,103,155,77,64,12
J2550,"Injection, promethazine HCl, up to 50 mg",21,11,1,18,10,10,15,2,2,14,9,8,2,6,18,18,18,7,1
J2800,"Injection, methocarbamol, up to 10 ml",86,43,6,72,39,40,45,32,55,58,36,31,26,23,72,72,36,30,6
J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",21,11,1,18,10,10,11,8,13,14,9,8,6,6,18,18,9,7,1
J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",31,16,2,26,14,20,23,13,20,21,13,7,9,8,26,26,13,11,2
J2997,"Injection, alteplase recombinant, 1 mg",13071,6536,834,10993,5951,6013,6876,4818,8286,8754,5439,4669,3935,3463,10993,10978,5486,4525,834
J3010,"Injection, fentanyl citrate, 0.1 mg",21,11,1,18,10,10,10,9,1,14,9,8,6,6,18,18,9,7,1
J3260,"Injection, tobramycin sulfate, up to 80 mg",84,42,5,71,39,40,44,31,53,56,35,30,25,22,71,71,35,29,5
J3411,"Injection, thiamine HCl, 100 mg",64,32,4,120,29,120,60,24,41,43,27,23,19,17,54,54,27,22,4
J3420,"Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg",21,11,1,18,10,10,11,8,13,14,9,8,6,6,18,18,9,7,1
J3475,"Injection, magnesium sulfate, per 500 mg",40,20,3,34,18,24,17,15,25,27,17,14,12,11,34,34,17,14,3
J3480,"Injection, potassium chloride, per 2 meq",540,270,34,454,246,258,242,199,342,361,233,193,162,143,454,453,226,187,34
J3490,Unclassified drugs,21,11,1,39,4,39,11,8,13,14,9,8,6,6,18,18,9,7,1
J7040,"Infusion, normal saline solution, sterile (500 ml=1 unit)",53,27,3,45,24,24,28,20,34,35,22,19,16,14,45,45,22,18,3
J7042,5% dextrose/normal saline (500 ml = 1 unit),28,14,2,24,13,13,13,24,18,19,12,10,8,7,24,24,12,10,2
J7050,"Infusion, normal saline solution, 250 cc",28,14,2,53,13,13,13,53,18,19,12,10,8,7,24,24,12,10,2
J7120,"Ringers lactate infusion, up to 1000 cc",54,27,3,59,25,26,59,20,35,36,12,19,16,14,46,46,23,19,3
J7510,"Prednisolone oral, per 5 mg",20,10,1,17,9,6,11,7,13,13,8,7,8,5,17,17,8,7,1
J7512,Prednisone ir or dr oral 1mg,20,10,1,18,4,11,18,7,13,13,8,1,7,5,17,17,8,7,1
J7613,"Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg",42,21,2,35,19,4,22,15,27,28,34,2,13,11,35,35,18,15,3
J8540,"Dexamethasone, oral, 0.25 mg",16,8,1,13,7,8,8,6,10,11,7,6,5,4,13,13,7,6,1
L1836,,72,36,5,61,22,34,38,27,46,48,30,26,22,19,61,60,30,25,5
L4350,"Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf",42,21,3,35,19,20,19,15,27,28,17,23,13,11,35,35,18,15,3
P9016,"Red blood cells, leukocytes reduced, each unit",392,196,25,330,178,188,206,145,249,263,163,140,118,104,330,329,165,136,25
P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",114,57,7,96,52,55,60,42,72,76,47,41,34,30,96,96,48,39,7
P9021,"Red blood cells, each unit",621,311,40,643,141,585,292,259,230,643,258,222,187,164,522,521,260,215,40
Q0162,Ondansetron oral,8,4,1,7,4,4,6,3,5,5,3,3,2,2,7,7,7,3,1
Q9967,"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml",500,250,6,420,230,235,235,213,6,335,208,20,151,132,420,420,210,173,32
,,,,,,,,,,,,,,,,,,,,
DRG,Description,Charges,Discounted Cash Price,Min Negotiated,Max Negotiated,Medicare,Uhc,Aetna,Wellcare,Medicaid,Humana,Blue cross,Caresource,Amerigroup,Peach state,Cigna,Umr,Triwest,Tricare,Veterans admin
Inpatients,,,,,,,,,,,,,,,,,,,,
004,"DRG TRACHEOSTOMY WITH MV >96 HOURS OR PDX EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURE",6700,3350,428,5635,3050,3207,3525,2470,4247,3087,2788,2393,2017,1775,5635,5627,2812,2319,428
007,,13279,6640,847,11167,6045,6355,6986,4894,8417,10290,5526,4744,3998,3518,11167,11152,5573,4597,847
018,,3636,1818,232,3087,1655,1740,1913,1340,2305,3087,1513,1299,1095,963,3058,3054,1526,1259,232
056,DRG DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),8029,4015,512,9261,3655,3843,4224,2959,5090,9261,3341,2868,2417,2127,6752,6743,3370,2779,512
057,"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",13345,6673,846,11223,6075,6387,7020,4919,8459,846,5553,4767,4018,3535,11223,11208,5601,4619,852
064,DRG INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),13227,6614,844,14405,6022,6330,6958,4875,8385,14405,5504,4725,3982,3504,11124,11109,5552,4579,844
094,DRG BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),23898,11949,1525,20098,10880,11437,12572,8808,15149,17492,9945,8537,7195,6331,20098,20071,10030,8272,1525
181,DRG RESPIRATORY NEOPLASMS WITH COMPLICATION OR COMORBIDITY (CC),15536,7768,992,15536,7073,7435,15536,5726,9848,10405,6465,5550,4677,4116,13065,13048,6521,5378,992
190,"DRG CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",20868,10434,1332,17550,9500,9987,10978,7692,13228,12348,8684,7455,6283,5528,17550,17526,8759,7224,1332
202,DRG BRONCHITIS AND ASTHMA WITH COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),5627,2814,359,4732,2562,2693,2960,2074,3567,3851,2342,2010,1694,1491,4732,4726,2362,1948,359
300,"DRG PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",17703,8852,1130,14888,8060,8472,9313,6525,11222,12739,7367,6324,5330,4690,14888,14868,7430,6128,1130
309,DRG CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH COMPLICATION OR COMORBIDITY (CC),23298,11649,1487,19593,10607,11150,12256,8587,14768,14132,9695,8323,7014,6172,19593,19567,9778,8065,1487
378,"DRG G.I. HEMORRHAGE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",15048,7524,960,20168,6851,7202,1304,5546,9539,20168,6262,5376,4531,3986,12655,12638,6316,5209,960
556,"DRG SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",23537,11769,1502,19794,10715,11264,12382,8675,14920,18151,9795,8408,7086,6235,19794,19767,9879,8147,1502
560,"DRG AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",12976,6488,828,14273,5907,6210,6826,4783,8225,14273,5400,4635,3907,3437,10912,10898,5446,4492,828
561,"DRG AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",8287,4144,529,8287,3773,3966,8287,3055,5253,5550,3449,2961,2495,2195,6970,6960,3478,2869,529
566,DRG OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),14023,7012,895,14165,6384,6711,7377,5169,8889,14165,5836,5010,4222,3715,11793,11778,5886,4854,895
638,"DRG DIABETES WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",23810,11905,1269,20024,10840,11395,12525,8776,15093,1269,9908,8506,7169,6307,20024,19997,9993,8242,1520
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",15500,7750,989,14130,7056,7418,14130,5713,9825,10380,6450,5537,4667,4106,13035,13017,6505,5365,989
682,"DRG RENAL FAILURE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",9723,4862,621,9127,4427,4653,5115,3584,6164,9127,4046,3473,2927,2576,8177,8166,4081,3366,621
689,"DRG KIDNEY AND URINARY TRACT INFECTIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",19600,9800,1251,16483,8923,9380,10311,7224,12424,12348,8156,7002,5901,5192,16483,16461,8226,6785,1251
690,DRG KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),6599,3300,421,5549,3004,3158,3471,2432,4183,592,2746,2357,1987,1748,5549,5542,2770,2284,421
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",16955,8478,1082,14259,7719,8115,8920,6250,10748,10260,7056,6057,5105,4492,14259,14240,7116,5869,1082
914,DRG TRAUMATIC INJURY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),8612,4306,550,7243,3921,4122,4530,3174,5459,6071,3584,3076,2593,2281,7243,7233,3615,2981,550
948,"DRG SIGNS AND SYMPTOMS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",5297,2649,338,4455,2412,2535,2787,1952,3358,1184,2204,1892,1595,1403,4455,4449,2223,1834,338