,Warm Springs Medical Center - Machine Readable Report - Generated on 03/09/2023,,,,,,,,,,,,,,,,,,,,,,
,"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 Warm Springs Medical Center. This was generated on 03/09/2023 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,Amerigroup,Blue cross,Caresource,Cigna,Commercial,Humana,Medicaid,Medicare,Peach state,Tricare,Triwest,Uhc,Umr,Veterans admin,Wellcare
Institutional,,,,,,,,,,,,,,,,,,,,,,,
Outpatients,,,,,,,,,,,,,,,,,,,,,,,
10060,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single",179,179,179,143,14,152,95,58,74,57,151,36,122,74,82,100,63,75,82,152,14,78
10061,"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple",486,486,486,389,38,413,265,159,208,155,402,98,331,254,226,139,170,204,238,413,38,193
10080,Incision and drainage of pilonidal cyst; simple,179,179,179,143,14,840,98,58,840,57,151,36,122,111,83,51,63,75,88,152,14,71
10120,"Incision and removal of foreign body, subcutaneous tissues; simple",179,179,179,143,14,152,98,58,77,57,148,36,122,111,82,51,63,75,82,152,14,76
11402,"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm",373,373,373,298,29,317,204,122,160,119,309,75,254,154,174,107,130,157,183,317,29,148
11730,"Avulsion of nail plate, partial or complete, simple; single",82,82,82,66,6,70,45,27,35,26,68,17,56,34,38,24,29,34,70,70,6,33
11740,Evacuation of subungual hematoma,67,67,67,54,5,57,37,22,29,21,55,14,46,42,31,19,23,28,33,57,5,27
11750,"Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;",358,358,358,286,28,304,196,117,153,114,296,72,244,223,167,100,125,151,176,304,28,142
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",218,218,218,174,17,764,159,104,764,120,183,44,149,90,112,100,72,92,102,185,17,90
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",218,218,218,174,17,1127,130,92,1127,120,183,44,149,114,100,100,74,92,100,185,17,87
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",218,218,218,174,17,545,102,71,545,120,183,44,149,136,99,62,76,92,185,185,17,90
12011,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less",218,218,218,174,17,915,159,104,915,107,183,44,149,102,100,100,76,92,108,185,17,90
12013,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",239,239,239,191,19,850,151,78,850,76,201,48,163,98,110,100,84,101,110,203,19,95
12015,"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm",290,290,290,232,23,246,158,95,124,93,240,59,198,180,149,83,101,122,142,246,23,115
12041,"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less",218,218,218,174,17,185,119,71,93,70,180,44,149,136,101,62,76,92,102,185,17,87
12052,"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm",218,218,218,174,17,185,119,71,93,70,180,44,149,136,101,100,76,92,107,185,17,87
16000,"Initial treatment, first degree burn, when no more than local treatment is required",160,160,160,128,13,794,87,52,794,51,132,32,109,99,74,100,56,67,79,136,13,64
16020,"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)",160,160,160,128,13,136,87,67,69,69,132,32,109,75,74,100,56,67,74,136,13,64
20610,"Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)",216,216,216,173,17,184,118,71,93,69,179,44,147,134,99,62,76,91,99,184,17,86
23650,"Closed treatment of shoulder dislocation, with manipulation; without anesthesia",148,148,148,118,12,450,81,48,450,47,122,30,101,92,69,42,52,62,73,126,12,59
24640,"Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation",536,536,536,429,42,839,293,270,839,171,444,108,365,333,249,154,187,225,263,456,42,213
25565,Closed treatment of radial and ulnar shaft fractures; with manipulation,1938,1938,1938,1550,100,1647,1059,633,830,619,1604,392,1321,1205,902,100,678,815,951,1647,152,770
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",2033,2033,2033,1626,100,1728,1111,664,871,649,1682,411,1386,1264,935,100,711,855,935,1728,160,808
26700,"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia",148,148,148,118,12,748,81,48,748,47,122,30,101,92,69,42,52,62,73,126,12,59
29105,Application of long arm splint (shoulder to hand),157,157,157,126,12,133,86,51,67,50,130,32,107,98,73,45,55,66,72,133,12,62
29125,Application of short arm splint (forearm to hand); static,157,157,157,126,12,453,83,66,453,77,132,32,107,65,72,45,55,66,72,133,12,62
29130,Application of finger splint; static,157,157,157,126,12,752,115,51,752,50,132,32,107,98,73,45,55,66,77,133,12,62
29505,Application of long leg splint (thigh to ankle or toes),100,100,100,80,8,85,55,33,43,55,83,20,68,62,46,29,35,42,49,85,8,40
29515,Application of short leg splint (calf to foot),202,202,202,162,16,172,147,66,87,87,167,41,138,126,93,58,71,85,107,172,16,90
30300,"Removal foreign body, intranasal; office type procedure",151,151,151,121,12,128,83,49,65,74,125,31,103,94,70,100,53,64,74,128,12,60
30901,"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method",198,198,198,158,16,168,108,65,85,63,167,40,135,123,90,57,69,83,97,168,16,82
30905,"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial",198,198,198,158,16,168,108,65,85,63,164,40,135,123,91,57,69,83,97,168,16,79
31500,"Intubation, endotracheal, emergency procedure",722,722,1444,578,57,614,253,236,309,313,597,146,492,377,332,100,253,304,339,614,57,297
36415,Collection of venous blood by venipuncture,11,11,91,9,1,11,5,2,5,5,9,3,11,7,5,3,4,5,5,9,1,5
36430,"Transfusion, blood or blood components",868,868,868,694,68,738,474,284,358,476,718,175,592,453,399,249,304,365,399,738,68,363
36556,Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older,482,482,482,386,38,472,169,157,207,154,399,97,472,300,239,138,169,203,222,410,38,191
41800,"Drainage of abscess, cyst, hematoma from dentoalveolar structures",840,840,840,672,66,714,459,274,360,268,695,170,573,522,391,100,294,353,412,714,66,334
43239,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple",3155,1785,6416,2524,248,2682,1724,1031,742,1007,2611,638,2151,1324,1777,904,1104,1327,1150,2682,248,1253
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)",4161,3863,6179,3329,327,3537,2274,1360,1783,1328,3444,841,2837,2588,1914,1193,1456,1750,2042,3537,327,1653
43246,"Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube",417,417,1785,334,33,354,196,136,179,133,345,84,284,333,191,120,146,175,205,354,33,166
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)",2315,714,2315,1852,182,1968,1265,756,992,739,1916,468,1578,294,889,664,810,974,1065,1968,182,920
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)",1548,1548,5648,1238,122,2655,2655,506,642,494,1902,313,831,638,704,444,541,651,1316,1316,122,615
45380,"Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple",2262,1548,2499,1810,178,1923,1236,739,969,722,1872,457,1542,981,712,648,791,951,1110,1923,178,899
45385,"Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique",1666,1548,1785,1333,131,1417,768,544,714,532,1379,337,1136,1036,704,478,583,701,818,1417,131,662
51701,"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)",184,184,184,147,14,156,86,60,79,59,152,37,125,114,85,53,64,77,86,156,14,73
51702,"Insertion of temporary indwelling bladder catheter; simple (eg, Foley)",250,250,250,200,20,212,115,82,120,130,207,51,124,103,115,72,87,105,115,212,20,105
56405,Incision and drainage of vulva or perineal abscess,674,674,674,539,53,573,368,220,289,215,558,136,459,419,314,193,236,283,331,573,53,268
64450,"Injection, anesthetic agent; other peripheral nerve or branch",281,281,281,225,22,239,154,92,120,90,233,57,192,175,131,150,98,118,138,239,22,112
65205,"Removal of foreign body, external eye; conjunctival superficial",235,235,235,188,18,200,128,77,101,75,194,47,176,146,109,67,82,99,115,200,18,93
65220,"Removal of foreign body, external eye; corneal, without slit lamp",235,235,235,188,18,200,128,77,101,48,194,47,160,146,109,67,82,99,115,200,18,93
69200,Removal foreign body from external auditory canal; without general anesthesia,94,94,94,75,7,100,69,31,40,41,78,19,64,32,43,100,33,40,43,80,7,37
69210,"Removal impacted cerumen (separate procedure), 1 or both ears",94,94,94,75,7,100,51,31,40,30,78,19,64,58,44,100,33,40,46,80,7,37
70110,"Radiologic examination, mandible; complete, minimum of 4 views",303,303,303,242,27,258,139,99,130,97,255,61,207,188,141,87,106,127,149,258,27,120
70150,"Radiologic examination, facial bones; complete, minimum of 3 views",303,303,303,242,24,258,166,99,95,97,251,61,207,188,141,87,106,127,149,258,24,125
70200,"Radiologic examination; orbits, complete, minimum of 4 views",253,253,253,202,20,215,138,83,108,81,209,51,172,157,118,73,88,106,116,215,20,108
70220,"Radiologic examination, sinuses, paranasal, complete, minimum of 3 views",242,242,242,194,19,206,132,102,104,77,200,49,165,150,113,69,85,102,111,206,19,96
70260,"Radiologic examination, skull; complete, minimum of 4 views",294,294,294,235,23,250,161,96,126,94,247,59,200,183,137,84,103,124,144,250,23,117
70360,"Radiologic examination; neck, soft tissue",201,201,201,161,16,171,110,66,86,64,166,41,137,125,92,129,70,85,99,171,16,80
70450,"Computed tomography, head or brain; without contrast material",1213,1213,1213,970,65,1031,643,511,505,526,1020,245,225,501,558,348,424,510,558,1031,65,511
70460,"Computed tomography, head or brain; with contrast material(s)",1394,1394,1394,1115,110,1185,762,455,597,445,1154,282,570,867,641,400,488,586,684,1185,110,554
70470,"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections",1543,1543,1543,1234,121,1312,843,504,661,492,1277,312,291,959,718,442,540,649,710,1312,121,613
70480,"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material",1041,1041,1041,833,82,885,569,340,446,332,861,210,710,647,484,298,364,438,489,885,82,414
70486,"Computed tomography, maxillofacial area; without contrast material",1250,1250,1661,1000,98,1062,938,526,536,399,1051,253,852,753,575,358,437,526,575,1062,98,497
70487,"Computed tomography, maxillofacial area; with contrast material(s)",1470,1470,1470,1176,116,1249,803,480,630,469,1216,297,1002,914,669,421,514,618,691,1249,116,584
70488,"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections",1661,1661,1661,1329,131,1412,908,543,712,530,1375,336,1132,1033,772,476,581,699,815,1412,131,660
70490,"Computed tomography, soft tissue neck; without contrast material",1135,1135,1135,908,89,965,620,371,486,362,939,229,774,468,602,325,397,477,522,965,89,451
70491,"Computed tomography, soft tissue neck; with contrast material(s)",1246,1246,1246,997,98,1059,681,407,250,398,1031,252,788,775,573,357,436,524,573,1059,98,495
71045,PR X-RAY EXAM CHEST 1 VIEW,129,129,516,103,10,110,61,62,54,56,108,26,78,53,59,37,45,54,59,110,10,54
71046,PR X-RAY EXAM CHEST 2 VIEWS,170,78,510,136,13,144,85,72,70,81,143,34,78,89,78,91,59,71,78,144,13,72
71100,"Radiologic examination, ribs, unilateral; 2 views",153,153,153,122,12,150,70,50,73,66,127,34,150,80,70,44,54,64,70,130,12,61
71111,"Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views",420,420,420,336,33,357,193,137,177,134,348,85,336,261,193,120,147,177,193,357,33,180
71130,"Radiologic examination; sternoclavicular joint or joints, minimum of 3 views",131,131,131,105,10,111,72,70,56,42,108,26,89,81,61,38,46,55,64,111,10,52
71250,"Computed tomography, thorax; without contrast material",1182,1182,1182,946,93,1005,863,386,195,377,978,239,154,617,544,339,413,497,544,1005,93,488
71260,"Computed tomography, thorax; with contrast material(s)",1291,1291,1291,1033,102,1097,600,422,545,708,1068,261,1033,604,594,370,452,543,594,1097,102,540
71270,"Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections",1420,1420,1420,1136,112,1207,776,464,608,453,1175,287,968,883,646,407,497,597,667,1207,112,564
71271,HC CT THORAX LUNG CANCER SCREEN,240,240,240,192,19,204,131,78,117,77,199,49,164,122,122,121,84,101,110,204,19,95
72040,"Radiologic examination, spine, cervical; 2 or 3 views",179,179,179,143,14,177,131,58,74,77,151,36,177,74,82,51,63,75,82,152,14,74
72050,"Radiologic examination, spine, cervical; minimum of 4 views",402,402,402,322,32,342,241,131,110,128,338,81,183,166,185,115,141,169,185,342,32,194
72052,"Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies",448,448,448,358,35,381,245,146,192,143,371,91,305,279,208,128,157,188,206,381,35,178
72070,"Radiologic examination, spine; thoracic, 2 views",213,213,213,170,17,199,98,70,35,92,176,43,199,88,98,61,75,90,98,181,17,104
72072,"Radiologic examination, spine; thoracic, 3 views",233,233,233,186,18,198,127,76,67,101,193,47,159,145,107,67,82,98,115,198,18,93
72100,"Radiologic examination, spine, lumbosacral; 2 or 3 views",195,195,195,156,15,166,103,98,37,84,164,39,90,81,90,93,68,82,90,166,15,80
72110,"Radiologic examination, spine, lumbosacral; minimum of 4 views",301,301,301,241,24,256,220,127,129,96,249,61,241,124,138,86,105,127,138,256,24,145
72125,"Computed tomography, cervical spine; without contrast material",1243,1243,1243,994,98,1057,679,406,565,682,1045,251,191,512,572,356,435,523,572,1057,98,494
72128,"Computed tomography, thoracic spine; without contrast material",1268,1268,1268,1014,100,1078,693,414,543,405,1049,256,864,788,583,363,444,533,621,1078,100,504
72131,"Computed tomography, lumbar spine; without contrast material",1352,1352,1352,1082,106,1149,739,442,579,431,1119,273,922,557,622,387,473,569,622,1149,106,537
72170,"Radiologic examination, pelvis; 1 or 2 views",134,134,134,107,11,114,80,71,57,66,113,27,100,83,62,38,47,56,62,114,11,55
72192,"Computed tomography, pelvis; without contrast material",1135,1135,1135,908,89,965,620,371,486,362,939,229,774,468,528,325,397,477,522,965,89,451
72193,"Computed tomography, pelvis; with contrast material(s)",1262,1262,1262,1010,99,1073,690,412,541,403,1044,255,860,785,581,362,441,531,619,1073,99,501
72202,"Radiologic examination, sacroiliac joints; 3 or more views",218,218,218,174,17,185,159,71,93,70,180,44,149,90,101,92,76,92,100,185,17,87
72220,"Radiologic examination, sacrum and coccyx, minimum of 2 views",156,156,156,125,12,133,85,51,67,50,129,32,106,97,77,83,55,66,81,133,12,62
73000,"Radiologic examination; clavicle, complete",201,201,201,161,16,171,110,107,86,64,166,41,137,125,94,101,70,85,99,171,16,80
73010,"Radiologic examination; scapula, complete",201,201,201,161,16,171,110,66,86,64,166,41,137,125,92,58,70,85,99,171,16,80
73030,"Radiologic examination, shoulder; complete, minimum of 2 views",190,190,380,152,15,162,89,62,78,82,160,38,87,99,87,96,66,80,87,162,15,79
73050,"Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction",164,164,164,131,13,139,90,54,70,71,136,33,112,102,76,47,57,69,80,139,13,65
73060,"Radiologic examination; humerus, minimum of 2 views",201,201,201,161,16,178,92,66,85,110,166,41,178,83,92,58,70,85,98,171,16,83
73070,"Radiologic examination, elbow; 2 views",127,127,127,102,10,108,69,64,63,41,105,26,87,79,58,36,44,53,58,108,10,50
73080,"Radiologic examination, elbow; complete, minimum of 3 views",184,184,184,147,14,156,91,60,76,101,152,37,125,114,85,53,64,77,85,156,14,77
73090,"Radiologic examination; forearm, 2 views",175,175,350,140,14,149,93,74,51,96,119,35,143,72,80,93,61,74,80,149,14,70
73100,"Radiologic examination, wrist; 2 views",114,114,227,91,9,143,62,37,49,49,143,23,78,71,52,33,40,48,107,97,9,49
73110,"Radiologic examination, wrist; complete, minimum of 3 views",175,175,350,140,14,149,93,88,73,86,147,35,106,91,80,74,61,74,93,149,14,70
73120,"Radiologic examination, hand; 2 views",118,118,235,94,9,148,64,39,51,61,148,24,80,73,54,34,41,50,100,100,9,47
73130,"Radiologic examination, hand; minimum of 3 views",131,131,235,105,10,111,96,55,44,72,110,26,60,81,60,38,46,55,89,111,10,54
73140,"Radiologic examination, finger(s), minimum of 2 views",110,110,110,88,9,108,65,46,34,48,93,22,108,68,50,32,38,46,54,93,9,46
73200,"Computed tomography, upper extremity; without contrast material",946,946,946,757,74,804,517,309,405,302,783,191,645,391,433,271,331,398,445,804,74,376
73501,PR X-RAY EXAM HIP UNI 1 VIEW,272,272,272,218,21,231,135,89,117,87,225,55,185,169,127,78,95,114,133,231,21,108
73502,PR X-RAY EXAM HIP UNI 2-3 VIEWS,247,247,493,198,19,345,114,81,88,140,208,50,114,129,114,301,345,104,114,210,19,101
73521,PR X-RAY EXAM HIPS BI 2 VIEWS,553,553,553,442,44,470,302,181,228,239,458,112,377,228,254,295,193,233,254,470,44,234
73552,PR X-RAY EXAM OF FEMUR 2/> VW,201,201,402,161,16,214,94,214,75,87,169,41,18,94,103,58,70,85,209,171,16,80
73560,"Radiologic examination, knee; 1 or 2 views",130,130,260,104,10,219,71,42,59,53,219,26,89,81,67,37,45,55,60,110,10,109
73562,"Radiologic examination, knee; 3 views",192,192,384,154,15,254,88,162,59,103,161,39,100,100,88,81,254,81,88,163,15,81
73590,"Radiologic examination; tibia and fibula, 2 views",148,148,295,118,12,157,68,157,61,81,124,124,145,61,68,42,52,62,77,126,12,61
73600,"Radiologic examination, ankle; 2 views",136,136,272,109,11,229,99,44,58,43,229,27,93,85,70,39,48,57,63,116,11,56
73610,"Radiologic examination, ankle; complete, minimum of 3 views",175,175,349,140,14,149,104,83,35,76,147,35,119,108,80,81,61,74,80,149,14,72
73620,"Radiologic examination, foot; 2 views",118,118,235,94,9,198,86,39,51,65,198,24,80,73,85,34,41,50,54,100,9,51
73630,"Radiologic examination, foot; complete, minimum of 3 views",148,148,295,118,12,197,68,71,32,64,124,30,101,77,68,79,197,62,68,126,12,61
73650,"Radiologic examination; calcaneus, minimum of 2 views",118,118,235,94,9,100,64,39,51,38,98,24,80,73,61,34,41,50,58,100,9,47
73660,"Radiologic examination; toe(s), minimum of 2 views",110,110,110,88,9,94,58,36,47,48,93,22,75,68,51,32,38,46,54,94,9,44
73700,"Computed tomography, lower extremity; without contrast material",946,946,946,757,74,804,435,309,195,302,783,191,645,390,435,271,331,398,435,804,74,376
74018,PR X-RAY EXAM ABDOMEN 1 VIEW,136,136,341,109,11,116,63,72,67,59,113,27,63,67,63,39,48,57,64,116,11,67
74019,PR X-RAY EXAM ABDOMEN 2 VIEWS,203,203,203,162,16,200,121,66,87,88,171,41,200,106,93,58,71,85,93,173,16,81
74022,"Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest",249,249,249,199,20,231,116,105,113,108,209,50,231,103,113,71,87,105,115,212,20,104
74150,"Computed tomography, abdomen; without contrast material",1112,1112,1112,890,87,945,608,363,476,355,920,225,758,691,512,319,389,468,512,945,87,442
74160,"Computed tomography, abdomen; with contrast material(s)",1277,1277,1277,1022,100,1085,932,417,547,408,1057,258,871,794,593,644,447,537,627,1085,100,507
74170,"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections",1371,1371,1371,1097,108,1165,749,448,587,438,1135,277,840,566,638,393,480,577,673,1165,108,545
74176,"Computed tomography, abdomen and pelvis; without contrast material",2266,2266,2266,1813,178,1926,1201,1049,1088,1243,1906,458,549,936,1042,649,793,953,1042,1926,178,962
74177,"Computed tomography, abdomen and pelvis; with contrast material(s)",2575,2575,2575,2060,203,2189,1184,841,330,1117,2166,520,795,1274,1184,738,901,1083,1184,2189,203,1094
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",2987,2987,2987,2390,235,2539,1632,976,1280,953,2472,604,1772,1857,1366,856,1045,1256,1956,2539,235,1187
76010,"Radiologic examination from nose to rectum for foreign body, single view, child",209,209,209,167,16,178,114,111,90,91,173,42,142,86,97,60,73,88,103,178,16,83
76536,"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation",294,294,348,235,23,250,161,96,125,94,243,59,159,137,160,124,103,124,160,250,23,135
76641,Complete unilateral ultrasound examination of the breast,419,419,503,335,33,356,193,137,180,134,347,85,286,261,231,120,147,176,205,356,33,166
76642,Specific area/quadrant breast ultrasound examination,257,257,308,206,20,218,118,137,180,111,213,52,118,106,118,74,90,108,118,218,20,137
76700,"Ultrasound, abdominal, real time with image documentation; complete",501,501,501,401,39,426,301,211,208,160,421,101,163,207,230,253,175,211,230,426,39,207
76705,"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)",423,423,423,338,33,360,195,213,111,135,356,85,195,221,195,225,148,178,195,360,33,177
76706,PR US ABDL AORTA SCREEN AAA,369,369,369,295,29,314,202,121,158,118,305,75,252,229,172,106,129,155,181,314,29,156
76770,"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete",449,449,449,359,35,382,207,147,136,143,378,91,205,185,207,129,157,189,207,382,35,185
76775,"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited",348,348,348,278,27,296,190,114,149,111,288,70,237,216,162,100,122,146,160,296,27,138
76801,"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation",476,476,476,381,37,405,260,254,204,247,394,96,324,296,222,136,167,200,234,405,37,189
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",264,264,264,211,21,224,144,86,113,145,218,53,180,164,123,76,92,111,130,224,21,105
76830,"Ultrasound, transvaginal",287,287,287,230,23,244,157,94,129,157,241,58,196,178,132,82,100,121,152,244,23,138
76856,"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete",404,404,404,323,32,343,221,210,168,175,334,82,183,167,186,170,141,170,186,343,32,167
76870,"Ultrasound, scrotum and contents",302,302,302,242,24,257,165,99,129,96,250,61,206,188,141,87,106,127,139,257,24,120
76881,"Ultrasound, extremity, nonvascular, real-time with image documentation; complete",348,348,348,278,27,296,190,114,121,111,288,70,158,216,160,100,122,146,160,296,27,138
76942,"Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation",88,88,88,70,7,75,48,29,38,28,73,18,60,55,40,25,31,37,43,75,7,35
77065,Diagnostic Mammography computer aided detection when performed; unilateral,332,20,332,266,26,282,176,108,278,144,275,67,151,137,153,95,116,140,153,282,26,137
77066,Diagnostic Mammography computer aided detection when performed; bilateral,411,411,411,329,32,356,189,219,356,178,340,83,200,187,189,118,144,173,189,349,32,183
77067,Screening mammography,348,348,348,278,70,296,160,147,294,201,293,70,160,144,85,176,122,146,121,296,87,146
77080,"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)",312,312,312,250,25,298,170,102,50,100,262,63,298,146,144,89,109,131,144,265,25,129
77081,"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)",206,206,206,165,16,202,113,67,88,66,170,42,202,128,96,59,72,87,101,175,16,82
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)",98,98,294,78,4,96,46,11,41,11,82,20,82,96,45,11,34,41,45,83,4,40
80051,"Electrolyte panel This panel must include the following: Carbon dioxide (82374), Chloride (82435), Potassium (84132), Sodium (84295)",76,76,76,61,6,65,42,25,33,24,63,15,29,47,35,22,27,32,35,65,6,30
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)",125,125,625,100,9,122,66,13,53,14,105,9,122,122,58,14,42,53,58,106,10,52
80061,"Lipid panel This panel must include the following: Cholesterol, serum, total (82465), Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478)",127,127,127,102,10,124,93,17,53,18,107,12,78,124,58,17,44,53,58,108,10,53
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)",114,114,114,91,9,97,52,37,49,36,94,23,39,71,52,33,40,48,54,97,9,45
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)",345,345,345,276,27,293,252,113,148,110,286,70,235,215,183,99,121,145,159,293,27,137
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)",113,113,113,90,9,96,82,10,48,11,95,23,78,70,58,32,40,48,60,96,9,51
80156,Carbamazepine; total,54,54,54,43,4,50,30,18,23,17,45,11,37,50,25,15,19,23,26,46,4,21
80162,Digoxin,83,83,83,66,7,71,45,27,35,26,69,17,57,52,44,24,29,35,38,71,7,33
80164,Dipropylacetic acid (valproic acid),102,102,102,82,8,101,54,33,44,33,86,21,41,101,47,29,36,43,47,87,8,42
80170,Gentamicin,85,85,85,68,7,84,46,28,36,27,70,17,84,83,39,24,30,36,39,72,7,35
80178,Lithium,100,100,100,80,8,98,55,33,43,32,83,20,68,98,46,8,35,42,49,85,8,40
80185,Phenytoin; total,85,85,170,68,7,82,45,28,36,27,70,17,58,82,39,24,30,36,39,72,7,17
80197,Tacrolimus,238,238,238,190,19,234,130,78,102,76,197,48,234,148,118,68,83,100,117,202,19,95
80200,Tobramycin,115,115,115,92,9,98,63,38,49,37,95,23,78,72,53,33,40,48,56,98,9,46
80202,Vancomycin,101,101,101,81,8,100,55,33,43,32,84,20,100,63,47,29,35,42,50,86,8,40
80235,HC DRUG ASSAY LACOSAMIDE,225,225,225,180,18,191,123,74,96,72,186,45,153,140,105,64,79,95,104,191,18,89
80307,Drug Test presumptive,143,66,2575,114,29,124,76,60,60,64,120,29,124,82,66,41,48,60,66,122,33,61
80320,Drug screen quantitative alcohols 22 or more classes,143,73,143,114,11,122,78,45,61,14,118,29,97,89,73,41,50,60,70,122,11,59
80329,HC DRUG TEST DEF 1-2 CLASS ANALGESICS NON-OPIOID,104,102,107,84,8,89,57,43,45,22,86,21,71,65,49,30,37,44,51,89,8,46
80345,HC DRUG TEST DEF 22+ CLASS BARBITURATES,109,109,109,87,9,93,60,36,47,35,90,22,74,68,50,31,38,46,53,93,9,43
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",52,52,104,42,2,51,28,4,22,4,44,11,51,51,24,4,17,22,24,44,2,21
81002,"Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy",28,28,28,22,2,24,15,9,12,9,23,6,19,17,14,8,10,12,14,24,2,11
81050,"Volume measurement for timed collection, each",12,12,12,10,1,10,6,4,5,4,10,2,8,7,5,3,4,5,6,10,1,5
82009,"Acetone or other ketone bodies, serum; qualitative",54,54,54,43,4,46,39,18,23,4,45,11,37,34,25,15,18,23,25,46,4,22
82024,Adrenocorticotropic hormone (ACTH),79,79,79,63,6,67,43,26,34,25,65,16,54,49,36,50,28,33,39,67,6,31
82040,"Albumin; serum, plasma or whole blood",51,51,51,41,4,43,28,17,22,16,42,10,35,32,23,15,18,21,25,43,4,20
82043,"Albumin; urine, microalbumin, quantitative",133,51,133,106,10,113,37,43,57,42,110,27,67,83,61,38,47,56,61,113,10,21
82085,Aldolase,63,63,63,50,5,62,34,21,27,20,52,13,62,39,29,18,22,26,31,54,5,25
82088,Aldosterone,139,139,139,111,11,136,64,45,59,44,115,28,136,128,64,40,49,58,65,118,11,55
82108,Aluminum,145,145,145,116,11,123,79,47,62,46,120,29,99,90,67,42,51,61,68,123,11,58
82131,"Amino acids; single, quantitative, each specimen",208,208,208,166,16,177,114,68,89,66,172,42,142,129,102,60,73,87,96,177,16,83
82140,Ammonia,162,162,162,130,13,138,89,53,69,52,134,33,110,101,73,46,57,68,75,138,13,69
82150,Amylase,94,94,188,75,7,92,50,8,39,9,79,19,92,92,43,27,33,40,43,80,7,43
82157,Androstenedione,195,195,195,156,15,166,107,64,84,62,161,39,133,121,91,38,68,82,96,166,15,77
82164,Angiotensin I - converting enzyme (ACE),46,46,46,37,4,39,25,15,20,15,39,9,31,29,21,13,16,19,23,39,4,18
82180,"Ascorbic acid (Vitamin C), blood",94,94,94,75,7,80,51,31,40,30,78,19,64,58,43,27,33,40,43,80,7,37
82247,Bilirubin; total,58,40,76,46,5,49,32,19,25,19,48,12,40,36,18,17,20,24,35,49,5,23
82248,Bilirubin; direct,42,42,42,34,3,36,31,14,18,13,35,8,29,26,19,12,15,18,19,36,3,17
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)",42,18,84,34,3,36,25,14,17,4,35,8,19,26,19,12,15,18,19,36,3,18
82306,"Vitamin D; 25 hydroxy, includes fraction(s), if performed",253,253,253,202,20,245,126,37,108,39,213,26,236,245,116,38,84,106,116,215,20,104
82310,Calcium; total,59,59,59,47,5,50,32,19,25,19,49,12,40,37,31,17,21,25,31,50,5,28
82330,Calcium; ionized,48,48,48,38,4,41,26,16,21,18,40,10,33,30,22,14,17,20,22,41,4,19
82340,"Calcium; urine quantitative, timed specimen",92,92,92,74,7,78,50,30,39,29,76,19,63,57,42,26,32,39,45,78,7,37
82378,Carcinoembryonic antigen (CEA),133,133,133,106,10,113,73,43,57,42,110,17,55,83,61,38,47,56,63,113,10,53
82390,Ceruloplasmin,29,29,29,23,2,25,21,14,12,9,24,6,20,18,13,8,10,12,14,25,2,12
82465,"Cholesterol, serum or whole blood, total",60,60,60,48,5,51,33,20,26,19,50,12,41,37,28,17,21,25,51,51,5,24
82525,Copper,252,252,252,202,20,214,184,82,108,80,209,51,172,157,115,72,88,106,124,214,20,100
82530,Cortisol; free,144,144,144,115,11,122,79,47,62,46,119,29,98,90,65,41,50,61,71,122,11,57
82533,Cortisol; total,136,136,136,109,11,132,63,44,58,43,113,27,107,132,63,21,48,57,63,116,11,54
82542,"Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase",152,63,152,122,12,129,83,50,65,49,126,31,69,95,70,44,53,64,71,129,12,60
82550,"Creatine kinase (CK), (CPK); total",56,56,112,45,4,55,30,6,27,7,47,11,55,35,26,16,19,24,26,48,4,23
82552,"Creatine kinase (CK), (CPK); isoenzymes",93,93,93,74,7,79,51,30,40,30,77,19,63,58,43,27,33,39,46,79,7,37
82553,"Creatine kinase (CK), (CPK); MB fraction only",66,66,132,53,5,65,35,15,32,15,56,13,65,63,30,19,22,28,30,56,5,28
82565,Creatinine; blood,47,42,47,38,4,47,22,15,20,15,39,9,47,46,22,13,16,20,22,40,4,23
82570,Creatinine; other source,74,74,242,59,3,73,34,24,32,24,62,15,73,73,38,21,26,31,34,63,3,33
82575,Creatinine; clearance,145,145,145,116,11,143,72,47,62,46,122,29,136,143,67,12,51,61,67,123,11,60
82607,Cyanocobalamin (Vitamin B-12);,101,101,101,81,8,99,74,33,43,20,85,20,99,97,46,19,35,42,46,86,8,42
82652,"Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed",253,158,253,202,20,215,138,83,108,81,209,51,156,157,123,73,88,106,134,215,20,106
82670,Estradiol,80,80,80,64,6,68,58,26,34,37,66,16,55,50,37,23,28,34,37,68,6,32
82672,Estrogens; total,159,159,159,127,13,135,87,52,79,51,132,32,108,99,74,46,56,67,135,135,13,63
82679,Estrone,202,202,202,162,16,172,147,66,87,64,167,41,138,126,94,58,71,85,99,172,16,80
82728,Ferritin,92,92,92,74,7,90,42,30,38,18,77,19,90,88,42,17,32,39,42,78,7,38
82746,Folic acid; serum,87,87,87,70,7,83,48,28,37,28,73,18,60,83,40,19,30,37,40,74,7,36
82747,Folic acid; RBC,71,71,71,57,6,60,33,23,30,23,59,14,48,44,33,20,25,30,35,60,6,28
82784,"Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each",293,206,293,234,23,249,138,96,126,94,242,59,200,182,132,84,102,123,116,249,23,116
82785,Gammaglobulin (immunoglobulin); IgE,107,107,107,86,8,91,58,35,45,34,89,22,73,67,50,31,37,45,53,91,8,43
82803,"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);",251,251,502,201,20,213,133,82,108,80,211,51,151,156,115,72,88,106,115,213,20,115
82945,"Glucose, body fluid, other than blood",42,42,42,34,3,36,23,14,18,13,35,8,29,26,19,12,15,18,21,36,3,17
82947,"Glucose; quantitative, blood (except reagent strip)",66,66,66,53,5,56,35,22,28,21,55,13,45,41,30,19,23,28,31,56,5,26
82948,"Glucose; blood, reagent strip",10,10,50,8,1,17,5,3,4,4,8,2,10,6,5,4,3,4,5,17,1,4
82951,"Glucose; tolerance test (GTT), 3 specimens (includes glucose)",128,128,128,102,10,126,70,42,55,41,106,26,87,126,60,37,45,54,59,109,10,51
82977,"Glutamyltransferase, gamma (GGT)",76,76,76,61,6,65,55,6,33,24,63,15,52,47,35,22,27,32,37,65,6,30
82985,Glycated protein,32,32,32,26,3,27,23,10,14,10,26,6,22,20,16,9,11,13,15,27,3,13
83001,Gonadotropin; follicle stimulating hormone (FSH),114,114,114,91,9,97,83,37,57,25,94,23,78,71,52,33,40,48,52,97,9,45
83002,Gonadotropin; luteinizing hormone (LH),131,131,131,105,10,126,96,43,65,24,108,26,126,81,60,38,46,55,60,111,10,52
83010,Haptoglobin; quantitative,76,76,76,61,6,65,42,25,33,24,63,15,52,47,40,22,27,32,37,65,6,30
83020,"Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)",144,144,144,115,11,122,79,47,62,13,119,29,98,90,67,13,50,61,71,122,11,57
83036,Hemoglobin; glycosylated (A1C),91,42,91,73,7,89,48,12,38,13,77,9,70,89,42,12,32,38,42,77,7,38
83516,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method",50,50,123,40,4,57,36,16,21,16,41,10,18,31,23,14,17,21,57,42,4,21
83519,"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)",210,119,312,168,17,179,115,69,90,67,174,43,117,131,98,17,74,89,103,179,17,84
83525,Insulin; total,57,57,57,46,4,48,31,19,24,18,47,12,39,35,27,15,20,24,28,48,4,23
83540,Iron,64,64,128,51,3,62,30,21,40,9,54,13,54,62,29,8,22,27,29,54,3,26
83550,Iron binding capacity,83,83,83,66,5,81,38,27,35,12,70,17,81,81,38,11,29,35,38,71,5,34
83605,Lactate (lactic acid),82,82,82,66,6,80,38,27,34,14,68,17,71,80,38,24,27,34,38,70,6,35
83615,"Lactate dehydrogenase (LD), (LDH);",67,67,67,54,5,57,37,22,29,21,55,14,46,42,31,19,23,28,33,57,5,27
83690,Lipase,93,93,186,74,7,91,49,9,38,9,78,19,91,91,43,9,33,39,43,79,7,38
83695,Lipoprotein (a),113,113,113,90,9,96,62,37,48,36,94,23,77,70,52,32,40,48,52,96,9,45
83718,"Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)",24,24,24,19,2,20,13,8,10,8,20,5,16,15,11,7,8,10,20,20,2,10
83721,"Lipoprotein, direct measurement; LDL cholesterol",42,42,42,34,3,36,23,14,18,13,35,8,29,26,20,12,15,18,19,36,3,17
83735,Magnesium,94,94,188,75,4,92,44,31,40,9,79,19,78,92,43,9,31,40,43,80,4,39
83835,Metanephrines,354,354,354,283,28,350,193,116,152,113,293,72,241,350,165,101,124,149,174,301,28,141
83874,Myoglobin,93,93,93,74,7,79,51,30,40,30,77,19,63,58,42,27,33,39,46,79,7,37
83880,Natriuretic peptide,242,242,968,194,19,239,128,79,116,45,204,49,211,239,111,44,80,102,111,206,19,101
83883,"Nephelometry, each analyte not elsewhere specified",304,295,304,243,24,258,143,99,130,97,252,61,207,189,137,87,106,128,139,258,24,133
83918,"Organic acids; total, quantitative, each specimen",232,232,232,186,18,197,127,76,99,74,192,47,158,144,123,66,81,98,107,197,18,92
83921,"Organic acid, single, quantitative",250,250,250,200,20,212,137,82,107,80,207,51,170,155,113,72,87,105,115,212,20,99
83930,Osmolality; blood,65,59,66,52,5,63,36,21,28,21,54,13,63,62,34,8,23,27,31,55,5,26
83935,Osmolality; urine,70,70,70,56,6,59,38,23,30,22,58,14,48,44,36,20,24,29,33,59,6,28
83970,Parathormone (parathyroid hormone),89,89,89,71,7,78,41,29,37,28,75,18,65,78,41,53,31,37,41,76,7,37
83986,"pH; body fluid, not otherwise specified",66,66,66,53,5,56,36,22,28,21,55,13,45,41,30,19,23,28,32,56,5,26
84075,"Phosphatase, alkaline;",76,76,76,61,6,65,55,25,33,24,63,15,52,47,35,22,27,32,37,65,6,30
84100,Phosphorus inorganic (phosphate);,49,49,49,39,3,48,23,16,20,16,41,10,48,48,23,6,16,21,23,42,3,20
84132,"Potassium; serum, plasma or whole blood",54,54,54,43,4,46,30,18,23,11,45,11,19,34,26,15,19,23,25,46,4,27
84134,Prealbumin,51,51,51,41,4,49,27,17,22,16,42,10,35,49,26,15,18,21,23,43,4,21
84144,Progesterone,139,139,139,111,11,118,101,45,69,44,115,28,95,86,63,40,49,58,68,118,11,55
84146,Prolactin,143,143,143,114,11,122,104,24,61,26,118,29,97,89,73,41,50,60,122,122,11,24
84153,Prostate specific antigen (PSA); total,133,133,133,106,10,129,63,43,57,42,110,27,55,129,61,38,47,56,61,113,10,60
84154,Prostate specific antigen (PSA); free,191,191,191,153,15,188,90,62,82,61,158,39,133,188,86,55,67,80,88,162,15,76
84155,"Protein, total, except by refractometry; serum, plasma or whole blood",66,66,66,53,2,56,30,22,28,21,56,13,45,41,30,19,23,28,30,56,2,27
84156,"Protein, total, except by refractometry; urine",107,107,107,86,5,106,53,35,46,34,90,22,84,106,49,5,37,45,49,91,8,44
84165,"Protein; electrophoretic fractionation and quantitation, serum",47,47,99,38,4,47,22,15,20,15,40,9,47,44,22,13,16,20,22,40,4,19
84166,"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)",165,116,165,132,13,140,76,54,71,53,98,33,112,136,76,47,58,69,69,140,13,48
84207,Pyridoxal phosphate (Vitamin B-6),293,293,293,234,23,249,160,96,126,94,242,59,200,182,142,84,102,123,135,249,23,116
84244,Renin,144,144,144,115,11,141,66,47,62,46,119,29,141,138,66,28,50,61,68,122,11,28
84255,Selenium,154,154,154,123,12,131,84,50,66,49,127,31,105,96,71,44,54,65,76,131,12,61
84270,Sex hormone binding globulin (SHBG),123,123,123,98,10,105,67,40,53,39,102,25,84,76,55,35,43,52,60,105,10,49
84300,Sodium; urine,56,56,56,45,4,48,31,18,24,18,46,11,24,35,27,16,20,24,27,48,4,22
84402,Testosterone; free,57,57,57,46,4,48,42,19,24,18,47,12,39,35,26,16,20,24,26,48,4,23
84403,Testosterone; total,85,85,170,68,7,72,62,28,36,27,70,17,58,53,39,33,30,36,39,72,7,34
84425,Thiamine (Vitamin B-1),56,56,78,45,4,73,26,18,24,18,47,11,38,73,26,16,20,24,31,48,4,22
84436,Thyroxine; total,92,92,92,74,7,91,49,30,39,29,77,19,91,90,42,9,32,39,42,78,7,38
84439,Thyroxine; free,91,91,91,73,7,89,54,11,12,12,77,8,55,89,42,12,32,38,42,77,7,38
84443,Thyroid stimulating hormone (TSH),120,22,120,96,9,116,55,21,50,22,101,15,85,116,55,22,40,50,55,102,9,50
84445,Thyroid stimulating immune globulins (TSI),297,297,297,238,23,252,162,97,127,95,246,60,202,185,138,85,104,125,137,252,23,118
84446,Tocopherol alpha (Vitamin E),48,48,48,38,4,41,26,16,21,15,40,10,33,30,22,14,17,20,24,41,4,19
84450,Transferase; aspartate amino (AST) (SGOT),76,76,76,61,5,65,42,25,33,24,63,15,5,47,35,22,27,32,36,65,6,30
84460,Transferase; alanine amino (ALT) (SGPT),76,76,76,61,6,65,42,25,33,24,63,15,21,47,35,22,27,32,37,65,6,30
84466,Transferrin,169,169,169,135,13,167,92,55,71,17,140,34,166,167,79,16,59,71,78,144,13,67
84478,Triglycerides,113,113,113,90,9,96,62,37,48,36,94,23,77,70,52,32,40,48,55,96,9,45
84479,Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR),99,99,99,79,8,97,46,32,42,32,83,20,67,97,46,28,35,42,46,84,8,39
84480,Triiodothyronine T3; total (TT-3),33,33,33,26,3,31,17,11,14,7,28,7,22,31,17,16,12,14,15,28,3,14
84481,Triiodothyronine T3; free,205,205,205,164,16,203,150,67,88,65,170,41,140,203,92,22,72,86,94,174,16,81
84484,"Troponin, quantitative",190,190,570,152,12,184,101,12,91,13,160,38,184,178,87,54,64,80,87,162,15,79
84550,Uric acid; blood,59,59,59,47,4,58,27,6,24,6,50,12,58,37,27,6,21,25,27,50,4,24
84560,Uric acid; other source,42,42,42,34,3,36,23,14,18,13,35,8,29,26,19,12,15,18,21,36,3,17
84590,Vitamin A,124,124,124,99,10,105,68,41,53,40,103,25,85,77,57,36,43,52,61,105,10,49
84630,Zinc,38,38,38,30,3,32,21,12,16,12,31,8,26,24,17,11,13,16,19,32,3,15
84681,C-peptide,137,137,137,110,11,116,75,45,59,44,115,28,93,85,63,39,48,58,63,116,11,54
84702,"Gonadotropin, chorionic (hCG); quantitative",139,139,139,111,8,118,76,45,60,44,115,28,95,86,65,40,49,58,65,118,11,8
84703,"Gonadotropin, chorionic (hCG); qualitative",66,66,132,53,5,65,35,8,28,8,56,13,45,65,30,19,23,28,56,56,5,8
85007,"Blood count; blood smear, microscopic examination with manual differential WBC count",44,44,88,35,3,43,20,4,18,5,37,9,43,43,20,4,15,19,20,37,3,18
85014,Blood count; hematocrit (Hct),20,20,20,16,2,17,10,7,9,6,17,4,14,12,10,6,7,8,9,17,2,8
85018,Blood count; hemoglobin (Hgb),20,20,20,16,2,17,10,7,9,6,17,4,14,12,10,6,7,8,10,17,2,8
85025,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count",72,72,288,58,5,71,38,10,30,10,61,18,71,70,33,10,24,30,33,61,5,30
85027,"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)",47,47,94,38,4,46,22,8,19,9,40,9,46,45,22,8,16,20,22,40,4,20
85044,"Blood count; reticulocyte, manual",62,62,62,50,5,53,34,20,27,20,51,13,42,39,33,18,22,26,30,53,5,25
85379,"Fibrin degradation products, D-dimer; quantitative",106,106,106,85,8,103,56,13,45,13,89,21,94,103,49,13,35,45,49,90,8,44
85611,"Prothrombin time; substitution, plasma fractions, each",66,66,66,53,5,65,31,22,32,5,56,13,24,65,30,5,22,28,30,56,5,27
85651,"Sedimentation rate, erythrocyte; non-automated",57,57,57,46,4,57,26,4,5,5,48,12,56,57,26,5,20,24,26,48,4,24
85730,"Thromboplastin time, partial (PTT); plasma or whole blood",75,75,75,60,6,73,35,25,36,8,63,15,65,73,34,8,25,32,34,64,6,32
85810,Viscosity,88,88,88,70,7,75,48,29,38,28,73,18,60,55,40,25,31,37,43,75,7,35
86003,"Allergen specific IgE; quantitative or semiquantitative, each allergen",125,125,125,100,10,106,68,41,54,40,103,25,85,78,58,36,44,53,58,106,10,50
86038,Antinuclear antibodies (ANA);,100,55,100,80,8,97,46,33,43,32,83,20,68,97,46,29,35,42,46,85,8,41
86039,Antinuclear antibodies (ANA); titer,89,89,89,71,7,86,47,14,38,15,75,18,61,86,41,26,31,37,41,76,7,37
86060,Antistreptolysin 0; titer,76,76,76,61,6,65,35,25,33,24,63,15,52,47,35,22,27,32,37,65,6,30
86140,C-reactive protein;,82,82,82,66,6,81,38,7,35,7,69,17,56,81,38,24,28,34,38,70,6,34
86146,"Beta 2 Glycoprotein I antibody, each",306,306,306,245,24,260,167,100,131,98,253,62,209,190,138,88,107,129,150,260,24,122
86160,"Complement; antigen, each component",99,99,123,79,8,108,51,32,42,32,82,20,67,108,52,28,35,42,47,94,8,41
86162,Complement; total hemolytic (CH50),92,92,92,74,7,87,42,30,39,29,76,19,63,87,42,26,32,39,42,78,7,38
86200,"Cyclic citrullinated peptide (CCP), antibody",105,105,105,84,8,89,56,34,45,34,87,21,72,65,49,30,37,44,55,89,8,42
86225,Deoxyribonucleic acid (DNA) antibody; native or double stranded,146,146,146,117,11,142,80,48,63,47,121,30,100,142,67,42,51,61,67,124,11,60
86226,Deoxyribonucleic acid (DNA) antibody; single stranded,101,101,101,81,8,86,55,33,43,32,84,20,69,63,47,29,35,42,46,86,8,42
86235,"Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody",166,154,169,133,13,159,91,54,71,53,142,34,113,159,76,48,58,70,77,141,13,67
86255,"Fluorescent noninfectious agent antibody; screen, each antibody",210,95,210,168,17,207,97,69,90,67,174,42,144,207,97,60,73,88,98,178,17,87
86301,"Immunoassay for tumor antigen, quantitative; CA 19-9",133,133,133,106,10,113,73,43,57,42,110,27,91,83,62,38,47,56,63,113,10,53
86308,Heterophile antibodies; screening,75,75,75,60,6,64,41,25,32,7,62,15,51,47,38,21,25,32,64,64,6,30
86320,Immunoelectrophoresis; serum,199,199,199,159,16,169,92,65,85,64,165,40,136,124,92,57,70,84,93,169,16,79
86329,Immunodiffusion; not elsewhere specified,88,88,88,70,7,75,48,29,38,28,73,18,60,55,41,25,31,37,40,75,7,35
86334,Immunofixation electrophoresis; serum,244,83,244,195,19,238,112,80,105,78,202,49,166,238,112,70,85,103,112,207,19,101
86337,Insulin antibodies,154,154,154,123,12,131,84,50,66,49,127,31,105,96,72,27,54,65,76,131,12,61
86376,"Microsomal antibodies (eg, thyroid or liver-kidney), each",120,120,120,96,9,102,66,39,51,38,99,24,82,75,54,34,42,50,55,102,9,48
86431,Rheumatoid factor; quantitative,92,92,92,74,7,91,46,30,39,29,77,19,63,91,42,26,32,39,42,78,7,44
86480,"Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon",227,227,227,182,18,193,107,74,97,72,188,46,97,141,102,65,79,95,104,193,18,94
86592,"Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)",37,8,37,30,3,37,17,12,16,12,31,7,25,37,17,5,13,16,17,31,3,15
86618,Antibody; Borrelia burgdorferi (Lyme disease),72,72,72,58,6,61,38,24,31,23,60,15,49,45,34,21,25,30,35,61,6,29
86677,Antibody; Helicobacter pylori,66,40,92,53,5,56,36,22,28,21,55,13,45,41,31,19,23,28,30,56,5,26
86687,Antibody; HTLV-I,106,106,106,85,8,90,56,35,45,34,89,21,72,66,49,30,37,45,50,90,8,48
86695,"Antibody; herpes simplex, type 1",93,93,93,74,7,90,51,30,40,30,77,19,63,90,43,17,33,39,46,79,7,37
86696,"Antibody; herpes simplex, type 2",108,108,108,86,8,103,59,35,46,34,89,22,74,103,50,25,38,45,53,92,8,43
86705,Hepatitis B core antibody (HBcAb); IgM antibody,46,46,46,37,4,39,25,15,20,15,39,9,31,29,21,13,16,19,39,39,4,18
86706,Hepatitis B surface antibody (HBsAb),80,80,80,64,6,77,37,26,34,26,67,16,69,77,37,14,28,34,38,68,6,33
86709,Hepatitis A antibody (HAAb); IgM antibody,75,75,75,60,6,64,41,25,32,24,63,15,51,47,34,21,26,32,37,64,6,30
86769,HC SARS-COV-2 COVID-19 ANTIBODY,50,50,50,40,4,49,30,21,21,16,41,10,33,49,23,14,17,21,23,42,4,21
86780,Antibody; Treponema pallidum,71,71,71,57,6,60,39,23,30,23,60,14,48,44,32,30,25,30,35,60,6,28
86800,Thyroglobulin antibody,75,42,75,60,6,64,55,25,32,24,62,15,51,47,19,21,26,32,34,64,6,30
86803,Hepatitis C antibody;,75,75,75,60,6,64,34,18,32,24,63,15,57,47,34,21,26,32,34,64,6,31
86812,"HLA typing; A, B, or C (eg, A10, B7, B27), single antigen",177,177,177,142,14,150,94,58,76,56,149,36,121,110,82,51,62,74,87,150,14,70
86850,"Antibody screen, RBC, each serum technique",169,169,169,135,13,144,79,55,70,16,140,34,115,105,78,48,59,71,78,144,13,70
86900,Blood typing; ABO,119,119,119,95,4,118,56,4,49,4,99,24,81,118,55,34,42,50,55,101,9,49
86901,Blood typing; Rh (D),39,39,39,31,3,33,18,15,16,15,32,8,27,27,18,11,14,16,18,33,3,16
86920,Compatibility test each unit; immediate spin technique,135,135,405,108,11,127,127,44,111,74,112,27,92,84,62,39,47,57,124,115,11,113
86931,"Frozen blood, each unit; thawing",516,516,516,413,41,439,282,169,221,165,427,104,352,321,235,148,180,217,253,439,41,205
87040,"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)",146,146,292,117,11,246,77,48,96,14,246,30,143,143,67,26,98,61,134,124,11,124
87045,"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species",139,139,139,111,11,118,60,45,60,76,115,28,104,86,74,40,49,58,65,118,11,61
87070,"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates",102,102,294,82,8,100,74,11,43,11,86,21,52,100,52,11,34,43,61,87,8,11
87075,"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates",162,162,324,130,13,138,89,53,69,52,134,33,135,101,83,46,57,68,75,138,13,64
87081,"Culture, presumptive, pathogenic organisms, screening only;",51,51,51,41,4,50,24,17,22,16,43,10,35,50,23,15,18,21,24,43,4,20
87088,"Culture, bacterial; with isolation and presumptive identification of each isolate, urine",92,92,184,74,4,90,49,10,39,11,77,19,66,90,42,10,31,38,42,78,4,38
87101,"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail",128,128,128,102,10,109,70,42,55,41,106,26,87,80,60,37,45,54,59,109,10,51
87177,"Ova and parasites, direct smears, concentration and identification",77,77,77,62,6,70,42,25,33,12,64,16,58,70,35,22,27,32,36,65,6,34
87205,"Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types",77,56,77,62,6,65,42,25,33,25,64,16,58,48,35,22,27,32,38,65,6,25
87210,"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)",76,76,76,61,5,71,48,25,33,6,63,15,52,71,40,22,27,32,37,65,6,5
87230,"Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin)",122,122,122,98,10,104,67,40,52,39,101,25,83,76,63,35,43,51,64,104,10,48
87252,"Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect",60,60,60,48,5,51,33,20,26,29,50,12,41,37,28,17,21,25,29,51,5,24
87324,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)",113,113,113,90,9,104,49,37,48,16,94,23,77,104,56,32,40,48,53,96,9,49
87328,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; cryptosporidium",171,171,171,137,13,145,93,56,73,55,142,35,128,106,80,49,60,72,84,145,13,68
87338,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool",323,323,323,258,25,321,177,106,138,103,267,65,220,321,150,93,113,136,149,275,25,128
87340,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)",75,75,75,60,6,74,34,25,14,24,63,15,74,72,34,21,26,32,34,64,6,31
87426,HC CORONAVIRUS AG IA,200,200,400,160,16,177,106,36,35,38,45,40,177,124,102,37,66,84,92,170,16,44
87430,"Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Streptococcus, group A",68,68,68,54,5,58,50,15,28,16,57,14,51,53,31,15,22,29,31,58,5,15
87490,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique",113,113,113,90,9,111,71,25,48,26,94,23,90,111,53,32,40,48,96,96,9,25
87491,"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique",90,90,90,72,7,76,49,29,39,29,74,18,61,56,45,25,31,38,44,76,7,25
87496,"Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique",357,357,357,286,28,303,195,117,153,114,295,72,243,222,164,102,125,150,175,303,28,142
87521,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique",417,417,417,334,33,354,192,136,179,133,351,84,284,259,190,120,146,175,205,354,33,166
87522,"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification",802,802,802,642,63,796,438,262,344,256,664,162,547,796,362,230,281,337,369,682,63,319
87536,"Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification",506,506,506,405,40,430,277,165,217,161,419,102,345,315,228,145,177,213,248,430,40,201
87590,"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique",136,136,136,109,11,116,86,17,58,59,113,27,109,85,63,39,48,57,89,116,11,54
87591,"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique",90,90,90,72,7,76,49,29,39,29,76,18,61,56,45,22,31,38,47,76,7,21
87635,Infectious agent detection by nucleic acid; severe acute respiratory syndrome coronavirus COVID-19,75,51,300,60,6,149,24,51,31,54,51,15,29,51,37,52,104,125,44,149,6,51
87804,Infectious agent antigen detection by immunoassay with direct optical observation; Influenza,258,258,258,206,15,243,137,15,109,16,217,52,200,243,119,15,85,108,119,219,20,15
87807,Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus,59,59,59,47,5,50,32,19,25,24,49,12,40,37,27,17,21,25,31,50,5,15
88182,"Flow cytometry, cell cycle or DNA analysis",167,167,167,134,13,142,91,55,72,53,138,34,114,104,77,48,58,70,82,142,13,66
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",93,93,93,74,7,79,44,30,39,30,77,19,63,59,43,27,33,39,43,79,7,37
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",891,891,891,713,70,758,414,291,382,284,738,180,608,554,415,255,312,375,437,758,70,354
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",938,938,938,750,74,797,512,306,402,299,776,189,639,583,426,269,328,394,431,797,74,372
88312,"Special stains; Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), including interpretation and report, each",938,938,938,750,74,797,441,306,402,299,788,189,639,583,431,269,328,394,441,797,74,372
89050,"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood;",36,36,36,29,3,31,20,12,15,11,30,7,25,22,16,10,13,15,18,31,3,14
89060,"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)",59,59,59,47,5,50,32,19,25,19,49,12,40,37,27,17,21,25,28,50,5,23
90471,"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)",90,90,90,72,7,77,66,29,39,49,76,18,61,56,41,26,30,38,41,77,7,37
90661,"Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use",55,55,55,44,4,47,30,18,24,18,46,11,37,34,25,16,19,23,27,47,4,22
90670,"Pneumococcal conjugate vaccine, 13 valent, for intramuscular use",965,965,965,772,76,820,527,315,413,308,799,195,658,600,435,277,338,406,473,820,76,383
90700,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use",120,120,120,96,9,102,88,39,51,38,101,24,82,75,55,34,42,50,55,102,9,48
90714,"Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use",117,117,117,94,9,99,85,38,50,29,98,24,80,27,54,34,40,49,54,99,9,24
90715,"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use",120,120,120,96,9,102,88,39,51,38,101,24,82,75,62,34,40,50,102,102,9,50
92507,"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual",64,64,64,51,5,54,30,21,27,20,53,13,44,40,30,18,22,27,31,54,5,25
92523,HC EVAL SPEECH SOUND LANG COMPREHEN,234,234,234,187,18,199,110,76,100,75,194,47,160,146,109,67,82,98,115,199,18,93
92610,Evaluation of oral and pharyngeal swallowing function,203,203,203,162,16,173,111,66,87,65,168,41,138,126,94,58,71,85,95,173,16,81
92950,"Cardiopulmonary resuscitation (eg, in cardiac arrest)",1276,1276,1276,1021,100,1085,587,417,547,407,1056,258,104,597,587,366,446,537,587,1085,100,526
93005,"Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report",262,22,1310,210,21,223,139,121,127,136,220,53,121,108,121,125,92,110,121,223,21,110
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",1218,1218,1218,974,96,1035,646,398,522,389,1008,246,406,757,560,512,426,512,560,1035,96,484
93308,"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study",446,446,446,357,35,379,244,146,191,142,369,90,304,277,205,128,156,188,219,379,35,177
93880,Duplex scan of extracranial arteries; complete bilateral study,843,843,843,674,66,717,447,275,356,269,698,170,215,524,388,242,295,355,388,717,66,335
93925,Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study,819,819,819,655,64,696,448,268,366,261,678,166,214,509,421,235,286,344,377,696,64,325
93926,Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study,430,430,430,344,34,365,235,140,184,137,356,87,198,267,209,123,150,181,211,365,34,171
93970,Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study,602,602,602,482,47,512,358,197,222,122,498,122,275,298,277,173,211,253,277,512,47,273
93971,Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study,388,388,388,310,31,330,178,127,116,124,326,78,176,160,178,207,136,163,178,330,31,160
94002,"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day",1429,1429,1429,1143,80,1215,781,467,612,456,1183,289,80,668,650,410,500,601,657,1215,112,568
94010,"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation",238,238,238,190,19,202,109,78,102,76,197,48,94,148,111,68,83,100,117,202,19,100
94016,Patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only,238,238,238,190,19,202,130,78,190,76,197,48,162,148,109,68,83,100,112,202,19,95
94060,"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration",313,313,313,250,25,266,171,102,250,100,259,63,182,195,144,90,109,132,147,266,25,135
94150,"Vital capacity, total (separate procedure)",60,60,60,48,5,51,33,20,26,19,50,12,41,37,27,17,21,25,28,51,5,24
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)",102,102,1224,82,8,266,54,33,66,56,86,21,246,53,68,134,36,266,145,87,8,92
94660,"Continuous positive airway pressure ventilation (CPAP), initiation and management",536,536,536,429,42,456,293,175,230,171,444,108,365,333,244,154,187,225,247,456,42,213
94667,"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation",84,84,84,67,7,71,46,27,36,27,70,17,57,52,39,24,29,35,41,71,7,36
95810,"Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist",2441,2441,2441,1953,192,2075,1334,797,1046,779,2020,493,1126,1518,1122,700,854,1027,1198,2075,192,970
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",2857,2857,2857,2286,225,2428,1286,933,1224,912,2364,577,1318,1777,1299,819,999,1195,2428,2428,225,1135
96360,"Intravenous infusion, hydration; initial, 31 minutes to 1 hour",161,161,161,129,13,158,75,75,67,88,133,33,158,66,74,48,56,68,74,137,13,67
96361,"Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)",44,44,264,35,3,38,36,22,21,24,36,9,38,23,21,28,15,19,23,37,3,22
96365,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour",209,208,209,167,16,178,98,68,95,115,173,42,157,86,96,46,69,88,96,178,16,87
96366,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)",260,65,650,208,20,221,153,85,111,83,215,53,177,78,134,75,91,109,32,221,20,190
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)",65,65,130,52,2,55,36,21,54,21,54,13,44,34,30,2,23,27,30,55,5,26
96368,"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)",105,105,105,84,8,89,57,34,44,34,87,21,72,65,48,30,37,44,52,89,8,42
96372,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",90,90,991,72,14,151,48,38,38,47,151,18,72,37,41,26,30,38,41,77,14,37
96374,"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug",164,164,328,131,13,139,87,69,79,71,138,33,123,102,75,46,55,69,75,139,13,69
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)",67,67,402,54,5,113,49,28,33,80,113,14,75,42,31,20,22,28,31,57,5,28
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)",67,67,536,54,5,123,123,28,83,33,55,14,46,42,61,85,45,28,31,57,5,28
97110,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility",61,30,92,49,5,52,26,20,26,19,50,12,42,38,28,17,21,26,42,52,5,24
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",60,57,120,48,5,51,41,20,26,19,50,12,41,37,28,17,21,25,28,51,5,24
97116,"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)",52,26,57,42,4,44,18,17,22,17,43,11,35,32,24,15,18,22,30,44,4,21
97162,Physical Therapy Evaluation of moderate complexity,225,225,225,180,18,191,123,74,96,72,186,45,153,140,105,64,79,95,117,191,18,89
97163,Physical Therapy Evaluation of high complexity,250,250,250,200,20,212,115,82,107,80,207,51,170,155,114,72,87,105,116,212,20,99
97165,HC OT EVAL LOW COMPLEX,160,160,160,128,13,136,87,52,69,51,132,32,109,99,74,46,56,67,83,136,13,64
97167,HC OT EVAL HIGH COMPLEX,235,235,235,188,18,200,108,77,101,75,194,47,160,146,107,67,82,99,108,200,18,93
97530,"Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes",31,31,62,25,2,29,15,10,13,10,26,6,21,19,14,9,11,13,29,26,2,12
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",96,32,96,77,8,82,44,31,41,31,79,19,65,60,45,28,34,40,30,82,8,38
97799,Unlisted physical medicine/rehabilitation service or procedure,715,715,715,572,56,608,391,234,306,228,601,145,487,445,333,205,250,301,351,608,56,284
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)",24,1,529,19,2,20,13,8,10,8,20,5,16,15,11,7,8,10,12,20,2,10
99152,HC MOD SED SAME PHYS/QHP 5/>YRS 15M,148,148,148,118,12,126,81,48,61,47,122,30,101,92,69,42,52,62,73,126,12,59
99199,"Unlisted special service, procedure or report",200,200,200,160,16,170,109,65,86,64,168,40,136,124,93,57,70,84,98,170,16,79
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.",223,223,223,178,18,190,122,73,96,71,185,45,152,139,104,64,78,94,109,190,18,89
99281,"Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.",180,180,180,144,14,153,108,65,74,78,151,36,83,74,83,100,63,76,83,153,14,75
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.",485,485,800,388,38,412,354,258,191,210,408,98,233,200,223,100,160,204,252,412,38,220
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.",600,600,1200,480,47,844,438,844,250,312,505,121,334,248,276,100,201,252,276,510,47,251
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.",800,28,1600,640,63,971,424,971,384,416,673,108,531,330,368,100,268,336,368,680,63,334
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.",1250,84,2500,1000,98,1227,588,526,524,528,1051,253,1227,516,575,100,413,523,575,1062,98,530
99291,"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes",1489,1489,1489,1191,117,1461,603,486,512,646,1252,301,1461,615,685,427,498,626,685,1266,117,591
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)",352,352,704,282,28,592,192,115,151,112,592,71,345,165,162,101,123,148,162,299,28,140
A4570,Splint,30,23,51,24,2,25,16,10,13,13,25,6,20,19,14,18,10,13,15,25,2,12
C9113,"Injection, pantoprazole sodium, per vial",149,99,157,119,12,127,81,49,64,48,123,30,102,93,69,43,52,63,73,127,12,59
E0114,"Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and hanDRrips",35,35,35,28,3,29,25,11,15,15,29,7,24,22,16,10,12,15,29,29,3,14
G0008,Administration of influenza virus vaccine,67,67,67,54,5,57,37,22,29,21,55,14,46,42,30,19,23,28,33,57,5,27
G0009,Administration of pneumococcal vaccine,67,67,67,54,5,57,37,22,29,21,55,14,46,42,30,19,23,28,33,57,5,27
G0105,Colorectal cancer screening; colonoscopy on individual at high risk,1548,1548,1548,1238,122,1316,846,506,663,494,1281,313,1055,963,712,444,541,651,760,1316,122,615
G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,1548,1548,1548,1238,122,1316,846,506,663,494,1281,313,1055,963,698,444,541,651,760,1316,122,615
G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",93,93,93,74,7,88,51,30,40,65,77,19,63,88,43,27,33,39,46,79,7,37
G0378,"Hospital observation service, per hour",950,200,1200,760,75,807,519,310,407,303,786,192,648,591,458,272,116,400,466,807,75,377
J0153,PBB ADENOSINE INJ 1 MG,66,66,197,53,5,60,36,21,28,21,54,13,45,33,60,19,23,28,30,56,5,26
J0171,"Injection, adrenalin, epinephrine, 0.1 mg",20,9,180,16,1,28,7,4,8,1,8,4,13,2,28,6,3,8,8,17,2,4
J0282,"Injection, amiodarone hydrochloride, 30 mg",21,21,21,17,2,18,11,7,9,7,17,4,14,13,10,6,7,9,10,18,2,9
J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",49,49,49,39,4,42,27,16,21,16,41,10,33,30,23,14,17,21,42,42,4,19
J0330,"Injection, succinylcholine chloride, up to 20 mg",21,21,21,17,2,18,11,7,9,7,17,4,14,13,10,6,7,9,10,18,2,8
J0360,"Injection, hydralazine HCl, up to 20 mg",97,97,97,78,8,82,53,32,42,31,80,20,66,60,45,28,34,41,45,82,8,39
J0456,"Injection, azithromycin, 500 mg",47,47,47,38,2,40,23,15,20,15,39,9,32,2,22,13,16,20,22,40,4,19
J0558,"Injection, penicillin G benzathine and penicillin G procaine, 100,000 units",258,258,258,206,12,219,141,84,111,13,214,52,176,12,119,74,90,108,127,219,20,12
J0561,"Injection, penicillin G benzathine, 100,000 units",323,323,323,258,14,275,171,106,138,17,272,65,220,15,166,93,108,136,149,275,25,14
J0690,"Injection, cefazolin sodium, 500 mg",21,21,21,17,2,18,10,7,9,7,18,4,14,13,10,6,7,9,14,18,2,8
J0696,"Injection, ceftriaxone sodium, per 250 mg",21,21,776,17,1,210,11,7,9,1,17,4,14,1,10,6,7,9,210,18,2,1
J0780,"Injection, prochlorperazine, up to 10 mg",21,21,21,17,2,18,12,7,9,11,18,4,14,13,10,6,7,9,10,18,2,8
J0885,"Injection, epoetin alfa, (for non-ESRD use), 1000 units",952,952,952,762,75,809,520,311,408,304,788,192,649,592,442,273,333,400,467,809,75,378
J1030,"Injection, methylprednisolone acetate, 40 mg",28,28,28,22,2,24,15,9,12,9,23,6,19,6,14,8,10,12,14,24,2,14
J1040,"Injection, methylprednisolone acetate, 80 mg",89,89,89,71,7,76,65,29,38,28,74,18,61,8,41,26,31,37,41,76,7,37
J1100,"Injection, dexamethasone sodium phosphate, 1 mg",21,21,42,17,0,22,22,7,9,7,18,4,14,0,10,6,7,9,10,18,2,0
J1165,"Injection, phenytoin sodium, per 50 mg",84,84,84,67,4,71,46,27,36,27,70,17,57,4,39,24,29,35,39,71,7,33
J1170,"Injection, hydromorphone, up to 4 mg",21,21,42,17,2,26,15,7,9,3,26,4,14,3,10,6,7,9,10,18,2,9
J1265,"Injection, dopamine HCl, 40 mg",80,80,80,64,6,68,44,26,34,26,66,16,55,50,36,23,28,34,37,68,6,32
J1335,"Injection, Ertapenem sodium, 500 mg",1062,1062,1062,850,84,903,563,347,455,339,879,215,724,660,494,304,371,447,521,903,84,422
J1439,HC INJ FERRIC CARBOXYMALTOS 1MG,5210,5210,5210,4168,410,4428,2847,1702,2232,1663,4312,1053,3552,3240,2397,1493,1822,2191,2397,4428,410,2070
J1580,"Injection, garamycin, gentamicin, up to 80 mg",28,28,52,22,2,24,24,9,12,9,23,6,19,17,13,8,10,12,14,24,2,12
J1610,"Injection, glucagon hydrochloride, per 1 mg",515,515,1030,412,41,438,239,168,221,164,426,104,351,320,237,330,180,217,237,438,41,205
J1630,"Injection, haloperidol, up to 5 mg",31,31,93,25,2,36,36,10,13,10,26,6,21,3,14,9,11,13,16,26,2,13
J1642,"Injection, Heparin sodium, (Heparin lock flush), per 10 units",21,21,21,17,0,18,11,7,9,7,17,4,14,13,10,0,7,9,10,18,2,9
J1644,"Injection, Heparin sodium, per 1000 units",27,27,34,22,0,23,14,9,12,0,22,5,18,0,12,8,9,11,16,23,2,11
J1750,"Injection, iron dextran, 50 mg",1527,37,3017,1222,120,1298,718,499,654,487,1264,309,1041,151,685,438,534,642,703,1298,120,607
J1815,"Injection, insulin, per 5 units",76,20,154,60,6,67,41,25,32,24,34,15,51,47,35,22,37,32,9,64,6,67
J1817,Insulin for administration through DME (i.e. insulin pump) per 50 units,17,4,30,14,1,14,9,6,7,5,14,3,12,11,2,5,6,7,14,14,1,7
J1885,"Injection, ketorolac tromethamine, per 15 mg",21,21,84,17,0,18,11,0,9,1,18,4,14,1,10,1,7,9,10,18,1,9
J1940,"Injection, furosemide, up to 20 mg",16,8,105,13,0,18,8,5,7,5,13,3,11,0,7,5,6,7,10,18,1,7
J2001,"Injection, lidocaine HCl for intravenous infusion, 10 mg",32,21,42,25,2,27,17,10,13,10,26,6,21,20,14,9,11,13,15,27,2,13
J2060,"Injection, lorazepam, 2 mg",21,21,168,17,1,18,15,9,9,1,17,4,14,1,10,6,7,9,10,18,2,9
J2175,"Injection, meperidine hydrochloride, per 100 mg",32,21,42,25,2,27,17,10,13,10,26,6,21,20,15,9,11,13,14,27,2,13
J2250,"Injection, midazolam hydrochloride, per 1 mg",58,29,169,46,5,78,78,19,56,19,48,12,40,36,13,17,20,24,20,49,5,23
J2270,"Injection, morphine sulfate, up to 10 mg",21,21,42,17,2,26,13,7,9,4,26,4,14,5,10,6,7,9,10,18,2,9
J2274,Inj morphine pf epid ithc,21,21,42,17,2,22,22,7,9,7,17,4,14,13,10,6,7,9,10,18,2,9
J2310,"Injection, naloxone hydrochloride, per 1 mg",37,37,37,30,3,31,17,12,16,12,31,7,25,12,17,11,13,16,18,31,3,15
J2405,"Injection, ondansetron hydrochloride, per 1 mg",21,21,231,17,0,18,11,0,9,0,18,4,14,0,10,0,7,9,10,18,2,0
J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",123,83,5166,98,1,1129,57,40,53,1,103,25,84,2,57,35,43,52,57,105,10,1129
J2550,"Injection, promethazine HCl, up to 50 mg",21,21,42,17,2,18,15,2,9,2,18,4,14,2,10,6,7,9,10,18,2,2
J2800,"Injection, methocarbamol, up to 10 ml",86,86,86,69,7,73,46,28,37,28,71,17,59,54,40,25,30,36,40,73,7,34
J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",21,21,21,17,2,18,11,7,9,7,17,4,14,13,10,6,7,9,10,18,2,8
J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",31,31,340,25,2,26,23,10,15,7,26,6,21,19,14,9,11,13,26,26,2,13
J2997,"Injection, alteplase recombinant, 1 mg",13071,13071,13071,10457,1028,11110,7143,4270,5600,4172,10817,2642,8911,8128,6083,3746,4572,5497,6013,11110,1028,5192
J3010,"Injection, fentanyl citrate, 0.1 mg",21,21,21,17,1,18,10,7,9,7,18,4,14,1,10,1,7,9,10,18,2,9
J3260,"Injection, tobramycin sulfate, up to 80 mg",84,84,84,67,7,71,46,27,36,27,70,17,57,52,39,24,29,35,41,71,7,33
J3370,"Injection, vancomycin HCl, 500 mg",54,41,66,43,4,45,29,17,23,17,44,11,36,33,25,15,19,22,25,45,4,21
J3411,"Injection, thiamine HCl, 100 mg",64,64,448,51,5,120,47,21,27,20,53,13,44,40,29,18,22,27,120,54,5,25
J3420,"Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg",21,21,21,17,2,18,11,7,9,7,17,4,14,13,10,6,7,9,10,18,2,8
J3475,"Injection, magnesium sulfate, per 500 mg",40,12,80,32,1,34,17,13,17,13,33,8,27,1,18,11,14,17,18,34,3,16
J3480,"Injection, potassium chloride, per 2 meq",166,103,564,133,13,242,242,54,233,53,137,34,113,103,77,48,55,70,55,129,13,66
J3490,Unclassified drugs,21,21,149,17,1,18,10,7,9,1,17,4,14,13,10,6,7,9,11,18,2,8
J7030,"Infusion, normal saline solution, 1000 cc",28,28,28,22,2,24,15,9,12,9,23,6,19,17,13,8,10,12,14,24,2,11
J7040,"Infusion, normal saline solution, sterile (500 ml=1 unit)",65,28,77,52,5,55,36,21,28,21,54,13,44,40,30,19,23,27,30,55,5,26
J7042,5% dextrose/normal saline (500 ml = 1 unit),28,28,56,22,2,24,13,9,12,9,23,6,19,17,13,8,10,12,14,24,2,24
J7050,"Infusion, normal saline solution, 250 cc",28,28,224,22,2,48,13,9,12,9,23,6,19,17,13,8,10,12,13,24,2,48
J7120,"Ringers lactate infusion, up to 1000 cc",28,28,81,22,2,59,59,9,12,9,23,6,19,17,13,8,10,12,14,24,2,11
J7510,"Prednisolone oral, per 5 mg",20,8,20,16,2,17,11,7,9,4,17,4,14,12,9,6,7,8,6,17,2,8
J7512,Prednisone ir or dr oral 1mg,20,8,32,16,0,18,18,8,9,0,9,4,14,12,4,6,6,8,11,17,2,10
J7613,"Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg",8,8,117,6,1,31,6,3,31,2,7,2,5,5,4,2,3,3,4,7,1,3
J8540,"Dexamethasone, oral, 0.25 mg",16,16,16,13,1,14,9,5,7,5,13,3,11,10,7,5,6,7,8,14,1,6
L1830,"Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf",72,72,72,58,6,61,39,24,31,23,60,15,49,45,38,21,25,30,35,61,6,29
L1836,,72,26,83,58,6,61,39,24,31,23,60,15,49,45,33,21,25,30,35,61,6,29
L3960,"HC SEWHO, AIRPLANE DESIGNE LVL 6",34,34,34,27,3,29,19,11,15,11,28,7,26,21,16,10,12,14,17,29,3,17
L4350,"Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf",42,42,42,34,3,36,19,14,18,18,35,8,29,26,20,12,15,18,22,36,3,17
P9016,"Red blood cells, leukocytes reduced, each unit",392,392,392,314,31,333,214,128,168,125,325,79,267,244,208,112,137,165,192,333,31,156
P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",114,114,114,91,9,97,62,37,49,36,94,23,78,71,52,33,40,48,56,97,9,45
P9021,"Red blood cells, each unit",465,310,2418,372,37,643,292,152,461,306,385,94,643,247,143,133,163,196,585,396,37,389
P9047,"Infusion, albumin (human), 25%, 50 ml",251,251,251,201,20,213,137,82,108,80,208,51,171,156,117,72,88,106,133,213,20,100
Q0162,Ondansetron oral,8,8,16,6,0,7,6,3,3,0,7,2,5,5,4,2,3,3,4,7,1,3
Q9967,"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml",500,5,500,400,12,425,230,163,214,40,414,101,388,12,230,143,167,210,230,425,39,208
S0164,"Injection, pantoprazole sodium, 40 mg",102,102,102,82,8,87,74,33,44,33,84,21,70,63,47,29,36,43,50,87,8,41
,,,,,,,,,,,,,,,,,,,,,,,
DRG,Description,Charges,Charges Low,Charges High,Discounted Cash Price,Min Negotiated,Max Negotiated,Aetna,Amerigroup,Blue cross,Caresource,Cigna,Commercial,Humana,Medicaid,Medicare,Peach state,Tricare,Triwest,Uhc,Umr,Veterans admin,Wellcare
Inpatients,,,,,,,,,,,,,,,,,,,,,,,
4,"DRG TRACHEOSTOMY WITH MV &gt;96 HOURS OR PDX EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURE",6700,6700,6700,5360,527,5695,3661,2189,2871,2138,5545,1354,3087,4166,3118,1920,2344,2818,3287,5695,527,2661
5,,19491,3421,27424,15593,1533,16567,10651,6368,8351,6221,16130,3939,15434,12120,9071,5586,6818,8197,9563,16567,1533,7742
6,,10546,6384,14707,8437,830,11181,5763,3445,4518,3366,8727,2131,11181,6558,4908,3022,3689,4435,5174,8964,830,4189
7,,17124,10568,18906,13699,1347,14555,9357,5594,7337,5465,14171,3461,12862,10648,7969,4908,5990,7201,8402,14555,1347,6802
9,,12747,6427,21148,10197,1003,11319,6965,4164,5461,4068,10548,2576,11319,7926,5932,3653,4459,5360,6254,10835,1003,5063
10,,23008,23008,23008,18406,1810,19556,12573,7516,9858,7343,19040,4650,16463,14307,10707,6594,8048,9675,11289,19556,1810,9139
17,,33009,33009,33009,26407,2597,28057,18038,10784,14143,10535,27316,6672,18521,20526,15361,9461,11546,13881,16196,28057,2597,13112
18,,8279,3636,17328,6623,651,7037,4524,2705,3547,2642,6851,1673,5612,5148,3853,2373,2896,3482,4062,7037,651,3289
29,DRG SPINAL PROCEDURES WITH COMPLICATION OR COMORBIDITY (CC) OR SPINAL NEUROSTIMULATORS,17960,16953,30946,14368,1413,15266,9814,5867,7695,5732,14862,3630,13376,11168,8358,5147,6282,7553,8812,15266,1413,7134
30,,12802,7688,18500,10242,1007,13376,6996,4182,5485,4086,10594,2587,13376,7961,5958,3669,4478,5384,6281,10882,1007,5085
31,DRG VENTRICULAR SHUNT PROCEDURES WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),2979,1893,16613,2383,234,2532,1628,973,1276,951,2465,602,2058,1852,1386,854,1042,1253,1462,2532,234,1183
37,DRG EXTRACRANIAL PROCEDURES WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),3454,3454,3454,2763,272,3087,1887,1128,1480,1102,2858,698,3087,2148,1607,990,1208,1452,1695,2936,272,1372
39,DRG EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),15180,15180,15180,12144,1194,12903,8295,4959,6504,4845,12562,3068,12348,9439,7064,4351,5310,6384,7448,12903,1194,6030
42,"DRG PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC)",31062,31062,31062,24850,2444,26403,16974,10148,13309,9914,25705,6278,17958,19315,14456,8903,10865,13063,15241,26403,2444,12339
44,,16230,8347,24112,12984,1277,15728,8869,5302,6954,5180,13431,3280,15728,10092,7553,4652,5677,6825,7963,13795,1277,6447
54,DRG NERVOUS SYSTEM NEOPLASMS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),14957,8053,21861,11966,1177,12713,8173,4886,6408,4774,12378,3023,9775,9301,6961,4287,5232,6290,7339,12713,1177,5941
55,,17119,6209,18807,13695,1347,14551,9355,5593,7335,5464,14167,3460,13376,10645,7967,4906,5988,7199,8399,14551,1347,6800
56,DRG DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),12777,1056,39182,10222,1005,13376,6982,4174,5475,4078,10574,2582,13376,7945,5946,3662,4469,5373,6269,10861,1005,5076
57,"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",13345,9061,17628,10676,846,11343,7292,4360,5718,4259,11043,2697,846,8298,6210,3825,4668,5612,6548,11343,1050,5301
60,DRG MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),11765,8668,28096,9412,926,10001,6429,3844,5041,3755,9736,2378,6112,7316,5475,3372,4116,4948,5773,10001,926,4674
62,DRG ACUTE ISCHEMIC STROKE WITH USE OF THROMBOLYTIC AGENT WITH COMPLICATION OR COMORBIDITY (CC),27701,27701,27701,22161,2179,25724,15138,9050,11869,8841,22924,5599,25724,17225,12891,7939,9690,11649,13592,23546,2179,11004
63,,10672,3361,26160,8538,840,12348,5832,3486,4573,3406,8832,2157,12348,6636,4966,3059,3733,4488,5236,9071,840,4239
64,DRG INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),17044,13227,20861,13635,1341,16463,9314,5568,7303,5440,14105,3445,16463,10598,7932,4885,5962,7168,8363,14487,1341,6770
65,"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR COMORBIDITY (CC) OR TPA IN 24 HOURS - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",1031,1031,1031,825,81,1304,563,337,442,329,853,208,1304,641,480,295,361,434,506,876,81,410
68,DRG NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),13920,2111,28051,11136,1095,11832,7607,4548,5964,4443,11519,2813,8232,8656,6478,3990,4869,5854,6830,11832,1095,5529
87,,20293,20293,20293,16234,1597,18521,11089,6630,8695,6477,16793,4102,18521,12619,9444,5816,7098,8534,9957,17249,1597,8061
94,DRG BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),15761,1972,39009,12609,1240,14591,8612,5149,6753,5030,13043,3185,14591,9800,7335,4517,5513,6628,7733,13397,1240,6261
181,DRG RESPIRATORY NEOPLASMS WITH COMPLICATION OR COMORBIDITY (CC),15536,13479,17593,12429,1222,15536,15536,5075,6657,4958,12857,3140,10591,9661,7230,4453,5434,6533,7623,13206,1222,6171
190,"DRG CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",20868,20868,20868,16694,1642,17738,11403,6817,8941,6660,17269,4218,12348,12976,9711,5981,7300,8776,10239,17738,1642,8289
194,"DRG SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",6528,6528,6528,5222,514,5549,3567,2133,2797,2083,5402,1319,3912,4059,3038,1871,2283,2745,3203,5549,514,2593
202,DRG BRONCHITIS AND ASTHMA WITH COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),5627,5627,5627,4502,443,4783,3075,1838,2411,1796,4657,1137,3851,3499,2619,1613,1968,2366,2761,4783,443,2235
291,"DRG HEART FAILURE AND SHOCK WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",19182,19182,19182,15345,1509,18255,10482,6266,8219,6122,15874,3877,18255,11928,8927,5498,6710,8067,9412,16304,1509,7619
300,"DRG PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",17703,14364,21042,14162,1393,15048,9674,5783,7585,5650,14650,3578,12739,11008,8239,5074,6192,7445,8686,15048,1393,7032
301,DRG PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),15712,15712,15712,12570,1236,14700,8586,5133,14700,5015,13003,3176,10711,9770,7312,4503,5496,6608,7709,13355,1236,6241
309,DRG CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH COMPLICATION OR COMORBIDITY (CC),23298,23071,23524,18638,1833,19803,12731,7611,9982,7436,19280,4709,14132,14487,10842,6677,8149,9797,11431,19803,1833,9255
378,"DRG G.I. HEMORRHAGE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",15048,6674,23422,12038,1184,20168,1304,4916,6448,4803,12453,3041,20168,9357,7003,4313,5264,6328,7383,12791,1184,5978
391,"DRG ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)",2334,2334,2334,1867,184,2334,1275,762,1000,745,1931,472,1591,1451,1086,669,816,982,2334,1984,184,927
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",23537,23537,23537,18829,1852,20006,12862,7689,10085,7512,19478,4757,18151,14636,10953,6746,8233,9898,11548,20006,1852,9349
559,"DRG AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",7183,7183,7183,5746,565,6105,3925,2347,3920,2292,5944,1452,4897,4467,3343,2059,2513,3021,3524,6105,565,2853
560,"DRG AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",12976,3196,38959,10380,1021,14273,7091,4239,5560,4141,10738,2623,14273,8069,6038,3719,4539,5457,6366,11029,1021,5154
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",12118,8287,15949,9695,953,17640,8287,3959,17640,3868,10028,2449,8261,7535,5639,3473,4239,5096,5946,10300,953,4814
566,DRG OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC),14023,14023,14023,11219,1103,14165,7663,4581,6008,4476,11605,2834,14165,8720,6526,4019,4905,5897,6881,11920,1103,5570
570,DRG SKIN DEBRIDEMENT WITH MAJOR COMPLICATION OR COMORBIDITY (MCC),53511,53511,53511,42809,4210,45484,29241,17481,22927,17078,44282,10815,36479,33275,24902,15336,18718,22503,40133,45484,4210,21256
603,"DRG CELLULITIS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",18723,9990,27456,14978,1473,20580,10231,6117,20580,5976,15494,3784,5216,11642,8713,5366,6549,7874,9186,15914,1473,7437
638,"DRG DIABETES WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",14822,5835,23810,11858,1166,12599,8100,4842,6351,4731,12266,2996,1269,9217,6898,4248,5185,6233,5835,12599,1166,5888
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",15500,10131,20868,12400,1219,14130,14130,5064,6641,4947,12827,3133,10566,9638,7213,4442,5422,6518,7605,13175,1219,6157
682,"DRG RENAL FAILURE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",9723,9723,9723,7779,765,9127,5313,3177,4166,3103,8046,1965,9127,6046,4525,2787,3401,4089,4771,8265,765,3862
683,"DRG RENAL FAILURE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",12940,5597,20282,10352,1018,15212,7071,4227,2940,4130,10708,2615,8821,8046,6022,3709,4526,5442,15212,10999,1018,5140
689,"DRG KIDNEY AND URINARY TRACT INFECTIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",19600,19600,19600,15680,1542,16660,10711,6403,8398,6255,16220,3961,12348,12188,9121,5617,6856,8243,9617,16660,1542,7786
690,DRG KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),4800,3001,6599,3840,378,4080,2623,1568,1960,1532,3972,970,592,2985,2234,1376,1679,2018,2355,4080,378,1907
698,"DRG OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",27616,20625,34606,22093,2173,23473,15091,9022,15680,8814,22853,5582,18826,17172,12852,7915,9660,11613,13550,23473,2173,10970
862,"DRG POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",22917,22917,22917,18333,1803,19479,12523,7487,11673,7314,18965,4632,15623,14250,10665,6568,8016,9637,11244,19479,1803,9103
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",10793,4631,16955,8634,849,9174,5898,3526,4624,3445,8932,2181,6434,6711,5023,3093,3775,4539,5296,9174,849,4287
914,DRG TRAUMATIC INJURY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC),8612,8612,8612,6890,678,7320,4706,2813,3690,2749,7127,1741,6071,5355,4008,2468,3012,3622,4226,7320,678,3421
948,"DRG SIGNS AND SYMPTOMS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",11011,1638,20290,8808,866,9359,6017,3597,4718,3514,9112,2225,1054,6847,5124,3156,3851,4630,5402,9359,866,4374
949,"DRG AFTERCARE WITH COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS",11226,9534,16680,8981,883,9542,6135,3667,8820,3583,9290,2269,7653,6981,5224,3217,3927,4721,5508,9542,883,4459
,,,,,,,,,,,,,,,,,,,,,,,
CPT,Description,Charges,Charges Low,Charges High,Discounted Cash Price,Min Negotiated,Max Negotiated,Aetna,Blue cross,Cigna,Humana,Medicaid,Uhc,Wellcare,,,,,,,,,
Professionals,,,,,,,,,,,,,,,,,,,,,,,
Outpatients,,,,,,,,,,,,,,,,,,,,,,,
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.",342,342,342,274,91,318,181,111,318,120,91,115,110,,,,,,,,,
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.",269,269,269,215,72,250,92,88,250,85,72,97,97,,,,,,,,,
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.",342,342,342,274,99,318,102,111,318,110,99,127,111,,,,,,,,,
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.",110,110,110,88,28,102,38,40,102,31,28,37,31,,,,,,,,,
99232,"Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.",184,184,184,147,43,171,49,59,171,58,43,59,59,,,,,,,,,
99233,"Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.",272,272,272,218,73,253,86,89,253,86,73,98,88,,,,,,,,,
99238,Hospital discharge day management; 30 minutes or less,195,195,195,156,57,181,58,58,181,59,57,63,63,,,,,,,,,
99239,Hospital discharge day management; more than 30 minutes,292,292,292,234,78,272,100,95,272,92,78,86,94,,,,,,,,,