Story County Medical - Machine Readable Report - Generated on 09/25/2023 "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 Story County Medical. This was generated on 09/25/2023 and is a yearly snapshot based on history. All amounts reported may change due to several factors including but not limited to hospital service area where the service is provided, payer contracts and negotiations. This data will be further refined." CPT Description Charges Charges Low Charges High Discounted Cash Price Min Negotiated Max Negotiated Aetna Aetna - coventry Aetna insurance Aetna medicare supplemental ins. American republic Bankers life & casualty Blue cross Blue cross medicare blue ppo Blue cross of wisconsin Champus Champva Cigna Commercial Coresource Coventry health care Geha Great west Health partners Health partners uph medicare adv h3416 Health partners uph self funded Humana choice Iowa total care Medical mutual 29076 Medicare community plan uhc Medico Meritain Midlands choice Molina wi badgercare Mutual of omaha Securehorizons direct Trustmark Uhc medicare dir Uhc medicare solutions Uhc medicare solutions ppo Uhc river valley Umr uhc United healthcare United healthcare aarp ins. Va Institutional Outpatients 00140 Anesthesia for procedures on eye; not otherwise specified 904 904 904 904 6 877 524 797 849 551 551 551 396 482 6 549 433 871 775 88 527 551 555 626 517 566 664 704 877 616 551 793 873 709 551 584 585 524 611 590 646 670 641 551 262 00142 Anesthesia for procedures on eye; lens surgery 565 101 749 565 4 548 141 498 531 345 308 345 308 103 4 343 271 544 484 55 329 345 347 432 323 354 415 308 548 385 345 495 546 443 345 365 365 328 382 369 404 419 401 345 164 00400 "Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified" 622 535 1017 622 4 603 360 548 584 379 379 379 272 331 4 378 298 598 533 60 362 379 382 430 355 389 456 484 603 424 379 545 600 487 379 402 402 360 420 406 444 461 441 379 180 00404 "Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast" 1111 1111 1111 1111 8 1078 644 980 1043 678 678 678 487 592 8 675 532 1070 952 108 648 678 682 769 635 696 816 865 1078 757 678 974 1073 871 678 718 718 644 750 725 794 824 788 678 322 0064U HC ANTB TP TOTAL&RPR IA QUAL 68 50 72 68 0 66 39 60 64 41 41 41 48 36 0 41 33 65 58 7 40 41 42 47 39 43 50 46 66 46 41 60 66 45 41 44 44 39 46 46 49 50 48 41 20 0070U HB CYP2D6 GEN COM&SLCT RAR VRNT 542 542 542 542 4 526 314 478 509 331 331 331 287 289 4 330 260 522 465 53 316 331 333 375 310 340 398 422 526 370 331 475 524 425 331 350 351 314 366 354 388 402 384 331 157 00731 PR ANES UPR GI NDSC PX NOS 749 642 808 749 5 727 24 661 703 457 457 457 328 399 5 455 359 721 642 73 437 457 460 518 428 469 550 583 727 511 457 657 724 587 457 484 484 434 506 489 535 555 531 457 217 00750 Anesthesia for hernia repairs in upper abdomen; not otherwise specified 808 808 808 808 6 784 469 713 759 493 493 493 354 430 6 491 387 778 693 78 471 493 496 559 462 506 593 629 784 551 493 709 781 633 493 522 523 469 546 528 578 599 573 493 235 00790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified 1428 1356 1428 1428 10 1385 828 1259 1341 871 871 871 626 761 10 868 684 1375 1224 139 832 871 877 988 816 895 1049 1112 1385 974 871 1252 1380 1119 871 923 923 828 965 932 1021 1059 1012 871 414 00811 PR ANES LWR INTST NDSC NOS 678 535 749 678 5 658 393 598 637 414 414 414 297 361 5 412 325 653 581 66 395 414 416 469 387 425 498 528 658 462 414 595 655 531 414 438 438 393 458 443 485 503 481 414 197 00812 PR ANES LWR INTST SCR COLSC 535 428 791 535 4 519 132 472 502 326 326 326 234 78 4 325 256 515 459 52 312 326 329 370 499 335 393 417 519 365 326 469 517 419 326 346 346 310 361 349 382 397 379 326 155 00813 PR ANES UPR LWR GI NDSC PX 770 749 904 770 6 747 447 679 723 470 470 470 337 410 6 468 369 741 660 75 449 470 473 533 440 482 566 600 747 525 470 675 744 604 470 498 498 447 520 503 550 571 546 470 223 00830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified 904 101 1177 904 6 877 524 797 849 551 551 551 396 482 6 549 433 871 775 88 527 551 555 626 517 566 664 86 877 616 551 793 873 709 551 584 585 524 611 590 646 670 641 551 262 00832 Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias 1070 1017 1243 1070 8 1038 236 944 1005 653 653 653 469 570 8 650 512 1030 917 104 624 653 657 741 611 670 786 833 1038 730 653 938 1034 839 653 691 692 621 723 699 765 793 759 653 311 00873 "Anesthesia for lithotripsy, extracorporeal shock wave; without water bath" 808 707 1111 808 6 784 469 713 759 493 493 493 493 430 6 491 387 778 693 78 471 493 496 559 462 506 593 629 784 551 493 709 781 633 493 522 523 469 546 528 578 599 573 493 235 00944 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy" 1582 1582 1582 1582 11 1535 917 1395 1485 965 965 965 693 843 11 962 758 1523 1356 154 922 965 972 1095 904 991 1162 1232 1535 1079 965 1387 1528 1240 965 1022 1023 918 1069 1033 1131 1173 1122 965 459 00952 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography" 791 791 791 791 6 767 459 698 743 483 483 483 347 421 6 481 379 762 678 77 461 483 486 548 452 496 581 616 767 539 483 694 764 620 483 511 512 459 534 517 565 586 561 483 230 01214 Anesthesia for open procedures involving hip joint; total hip arthroplasty 2034 2033 2034 2034 15 1972 1179 1793 1909 1240 1240 1240 891 1083 15 1236 974 1958 1743 197 1185 1240 1249 1408 1162 1274 1494 1584 1972 1386 1240 1783 1964 1594 1240 1314 1315 1179 1374 1328 1453 1508 1442 1240 590 01320 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area" 1130 1130 1130 1130 8 1096 655 997 1061 689 689 689 495 602 8 687 541 1088 969 110 659 689 694 782 646 708 830 880 1096 770 689 991 1092 886 689 730 731 655 763 738 808 838 801 689 328 01400 Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified 904 904 904 904 6 877 524 797 849 551 551 551 396 482 6 549 433 871 775 88 527 551 555 626 517 566 664 704 877 616 551 793 873 709 551 584 585 524 611 590 646 670 641 551 262 01402 Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty 2034 1808 2147 2034 15 1973 1180 1794 1910 1241 1241 1241 891 1084 15 1236 974 1959 1743 197 1186 1241 1249 1408 1162 1274 1494 1584 1973 1387 1241 1784 1965 1594 1241 1314 1315 1180 1374 1328 1454 1508 1442 1241 590 01470 "Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified" 1070 565 1666 1070 8 1038 621 944 1005 653 653 653 469 570 8 650 512 1030 917 104 624 653 657 741 611 670 786 833 1038 730 653 938 1034 839 653 691 692 621 723 699 765 793 759 653 311 01480 "Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified" 904 565 2599 904 6 877 524 797 849 551 551 551 396 482 6 549 433 871 775 88 527 551 555 626 517 566 445 704 877 616 551 793 873 709 551 584 585 524 611 590 646 670 641 551 262 01610 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla" 1070 1070 1070 1070 8 1038 621 944 1005 653 653 653 469 570 8 650 512 1030 917 104 624 653 657 741 611 670 786 833 1038 730 653 938 1034 839 653 691 692 621 723 699 765 793 759 653 311 01630 "Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified" 1560 1498 1605 1560 11 1513 905 1376 1465 952 952 952 684 831 11 948 747 1502 1337 151 909 952 958 1080 891 977 1146 1215 1513 1064 952 1368 1507 1223 952 1008 1009 905 1054 1019 1115 1157 1106 952 453 01638 "Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement" 3164 3164 3164 3164 23 3069 1835 2791 2971 1930 1930 1930 1387 1686 23 1923 1515 3047 2712 307 1844 1930 1943 2190 1808 1982 2324 2464 3069 2157 1930 2775 3057 2480 1930 2045 2046 1835 2137 2066 2262 2346 2243 1930 918 01810 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand" 565 535 1469 565 4 548 82 498 531 345 345 345 248 301 4 343 271 544 484 55 329 345 347 391 323 354 415 440 548 385 345 495 546 443 345 365 365 328 382 369 404 419 401 345 164 01922 Anesthesia for non-invasive imaging or radiation therapy 909 909 909 909 7 882 527 802 854 554 554 554 398 484 7 553 435 875 779 88 530 554 558 629 519 569 668 708 882 620 554 797 878 713 554 587 588 527 614 594 650 674 644 554 264 0202U HC NFCT DS 22 TRGT SARS-COV-2 543 343 543 543 4 527 315 479 510 331 331 331 304 289 4 330 260 523 465 53 316 331 333 376 365 340 399 436 527 370 331 476 525 426 331 351 351 315 367 355 388 403 385 331 158 0241U HC NFCT DS VIR RESP RNA 4 TRGT 145 145 155 145 1 143 84 128 136 88 88 88 121 96 1 88 69 140 124 14 85 88 89 100 140 91 142 124 141 99 88 127 143 114 88 94 94 84 98 97 104 107 103 88 42 10060 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single" 237 231 244 237 2 349 137 209 223 145 145 145 349 126 2 144 113 228 203 23 138 145 146 164 135 148 174 93 230 162 145 208 229 186 145 153 153 137 160 155 169 176 172 145 69 10061 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple" 205 195 5797 205 1 349 119 181 192 125 125 125 349 109 1 125 98 197 176 20 119 125 126 142 117 128 151 160 199 140 125 180 198 161 125 132 133 119 138 134 147 152 131 125 59 10120 "Incision and removal of foreign body, subcutaneous tissues; simple" 189 180 5676 189 1 333 110 167 177 115 115 115 333 101 1 115 91 182 162 18 110 115 116 131 108 118 139 162 183 129 115 166 183 148 115 122 122 110 128 123 135 140 134 115 55 10121 "Incision and removal of foreign body, subcutaneous tissues; complicated" 372 368 5520 372 3 361 216 328 349 227 227 227 163 198 3 226 178 358 319 36 217 227 228 258 213 233 273 290 361 254 227 326 359 292 227 240 241 216 251 243 266 276 264 227 108 10180 "Incision and drainage, complex, postoperative wound infection" 5901 798 11004 5901 42 5724 3422 5204 5541 3600 3600 3600 2586 3144 42 3587 2826 5682 5058 573 3440 3600 3624 4085 3372 3697 4334 4596 5724 4023 3600 5175 5701 4625 3600 3813 3816 3423 3986 3853 4218 4375 4184 3600 1713 11042 "Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less" 8945 8945 8945 8945 64 8677 5188 7889 8399 5456 5456 5456 818 4766 64 5437 4283 8614 7667 868 5214 5456 5493 6192 5112 5604 6570 6966 8677 6099 5456 7844 8641 7012 5456 5780 5785 5188 6042 5841 6394 6631 6342 5456 2596 11043 "Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less" 377 377 377 377 3 366 219 333 354 230 230 230 165 201 3 229 181 363 323 37 220 230 232 261 215 236 277 294 366 257 230 331 364 296 230 244 244 219 255 246 269 279 267 230 109 11045 "Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)" 1 1 1 1 0 3884 1 1 1 1 1 1 3884 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 11104 PR PUNCH BX SKIN SINGLE LESION 4376 4376 4376 4376 31 4245 2538 3859 4109 2669 2669 2669 1918 2331 31 2660 2095 4214 3751 425 2551 2669 2687 3029 2501 2741 3214 3408 4245 2984 2669 3838 4227 3430 2669 2828 2830 2538 2956 2857 3128 3244 3102 2669 1270 11106 PR INCISIONAL BX SKN SINGLE LES 5196 5196 5196 5196 37 5040 3013 4583 4879 3170 3170 3170 806 2768 37 3158 2488 5004 4454 504 3029 3170 3191 3597 2969 3255 3817 4047 5040 3543 3170 4557 5020 4073 3170 3358 3360 3014 3510 3393 3714 3852 3684 3170 1508 11400 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less" 5520 5520 5520 5520 40 5354 3201 4868 5183 3367 3367 3367 2419 2941 40 3355 2643 5316 4731 536 3217 3367 3390 3821 3154 3458 4054 4299 5354 3764 3367 4841 5333 4327 3367 3567 3570 3202 3729 3604 3946 4092 3913 3367 1602 11402 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm" 8132 8132 8132 8132 58 7888 4716 7172 7636 4961 4961 4961 802 4333 58 4943 3894 7831 6970 790 4740 4961 4994 5629 4647 5094 5973 6333 7888 5544 4961 7131 7856 6374 4961 5255 5259 4717 5493 5310 5813 6029 5765 4961 2360 11403 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm" 5254 4711 5796 5254 38 5096 3047 4633 4933 3205 3205 3205 403 2799 38 3193 2516 5059 4503 510 3062 3205 3226 3637 3002 3291 3859 4091 5096 3582 3205 4607 5075 4118 3205 3395 3397 3047 3549 3430 3755 3895 3724 3205 1525 11404 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm" 5520 5520 5674 5520 40 5354 3201 4868 5183 3367 3367 3367 2801 2941 40 3355 2643 5316 4731 536 3217 3367 3390 3821 3154 3458 4054 4299 5354 3764 3367 4841 5333 4327 3367 3567 3570 3202 3729 3698 3946 4092 3913 3367 1602 11406 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm" 5674 4947 22391 5674 41 11841 3291 5004 5328 3461 3461 3461 5162 3023 41 3449 2717 5464 4863 551 3307 3461 3485 3928 3242 3555 4168 11841 5504 3869 3461 4976 5481 4448 3461 3667 3669 3291 3833 3705 4056 4206 4023 3461 1647 11420 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less" 16837 7317 20267 16837 121 16332 9764 14850 15809 10271 10271 10271 1438 8970 121 10234 8062 16213 14431 1635 9814 10271 10340 11655 9621 10548 12367 14387 16332 11480 10271 14765 16266 13198 10271 10881 10888 9765 11373 10994 12035 12482 11937 10271 4887 11421 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm" 7685 512 9763 7685 55 7454 4457 6778 7216 4688 4688 4688 806 4094 55 4671 3680 7400 6587 746 4479 4688 4720 5320 4392 4814 5645 5985 7454 5240 4688 6739 7424 6024 4688 4966 4970 4457 5191 5018 5493 5697 5448 4688 2230 11422 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm" 5520 5196 7318 5520 40 5354 3201 4868 5183 3367 3367 3367 2876 2941 40 3355 2643 5316 4731 536 3217 3367 3390 3821 3154 3458 4054 4299 5354 3764 3367 4841 5333 4327 3367 3567 3570 3202 3729 3604 3946 4092 3913 3367 1602 11424 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm" 4711 4711 4711 4711 34 4570 2732 4155 4423 2874 2874 2874 2065 2510 34 2863 2256 4537 4038 457 2746 2874 2893 3261 2692 2951 3460 3669 4570 3212 2874 4131 4551 3693 2874 3044 3047 2732 3182 3076 3367 3493 3340 2874 1367 11601 "Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm" 5526 5254 5798 5526 40 5360 3205 4874 5189 3371 3371 3371 1385 2944 40 3359 2646 5321 4736 537 3221 3371 3394 3825 3158 3462 4059 4304 5360 3768 3371 4846 5338 4332 3371 3571 3574 3205 3733 3608 3950 4097 3918 3371 1604 11602 "Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm" 6092 6092 6092 6092 44 5909 3533 5373 5720 3716 3716 3716 2670 3246 44 3703 2917 5866 5222 591 3551 3716 3741 4217 3481 3816 4475 4744 5909 4154 3716 5342 5885 4775 3716 3937 3940 3533 4115 3978 4354 4516 4319 3716 1768 11603 "Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm" 5798 5798 5798 5798 42 5624 3362 5114 5444 3537 3537 3537 1451 3089 42 3524 2776 5583 4970 563 3379 3537 3561 4013 3313 3632 4259 4515 5624 3953 3537 5085 5601 4545 3537 3747 3750 3363 3916 3786 4144 4298 4110 3537 1683 11604 "Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm" 8133 8133 8133 8133 58 7889 4717 7173 7637 4961 4961 4961 3564 4333 58 4943 3894 7832 6971 790 4740 4961 4995 5630 4648 5095 5974 6334 7889 5545 4961 7132 7857 6375 4961 5256 5260 4717 5494 5311 5813 6029 5766 4961 2361 11606 "Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm" 10577 10577 10577 10577 76 10260 6134 9329 9931 6452 6452 6452 4973 5635 76 6429 5065 10185 9066 1027 6165 6452 6496 7322 6044 6626 7769 8237 10260 7211 6452 9276 10218 8291 6452 6835 6840 6135 7145 6907 7560 7841 7499 6452 3070 11620 "Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less" 5520 5520 5520 5520 40 5354 3201 4868 5183 3367 3367 3367 2419 2941 40 3355 2643 5316 4731 536 3217 3367 3390 3821 3154 3458 4054 4299 5354 3764 3367 4841 5333 4327 3367 3567 3570 3202 3729 3604 3946 4092 3698 3367 1602 11622 "Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm" 8714 8132 9297 8714 62 8453 5054 7686 8183 5316 5316 5316 802 4643 62 5297 4173 8392 7469 846 5079 5316 5352 6032 4980 5459 6401 6787 8453 5942 5316 7642 8419 6831 5316 5632 5636 5054 5887 5690 6229 6461 6178 5316 2529 11626 "Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm" 8596 5799 11393 8596 62 8338 4985 7581 8071 5244 5244 5244 3767 4580 62 5225 4116 8278 7368 835 5010 5244 5279 5950 4912 5385 6314 6695 8338 5861 5244 7538 8304 6738 5244 5555 5559 4986 5807 5613 6144 6373 6094 5244 2495 11641 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm" 8948 8948 8948 8948 64 8680 5189 7892 8402 5458 5458 5458 3921 4767 64 5439 4285 8617 7670 869 5216 5458 5495 6194 5113 5606 6572 6969 8680 6101 5458 7847 8644 7014 5458 5782 5787 5190 6044 5843 6396 6634 6344 5458 2597 11642 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm" 8521 5254 9762 8521 61 8265 4942 7515 8001 5198 5198 5198 1126 4540 61 5179 4080 8205 7304 827 4967 5198 5233 5898 4869 5338 6259 6636 8265 5810 5198 7473 8232 6679 5198 5506 5510 4942 5756 4287 6091 6317 6041 5198 2473 11644 "Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm" 8521 8521 8521 8521 61 8265 4942 7515 8001 5198 5198 5198 3734 4540 61 5179 4080 8205 7304 827 4967 5198 5233 5898 4869 5338 6259 6636 8265 5810 5198 7473 8232 6679 5198 5506 5510 4942 5756 5564 6091 6317 6041 5198 2473 11730 "Avulsion of nail plate, partial or complete, simple; single" 156 156 156 156 1 227 90 138 146 95 95 95 227 83 1 95 75 150 134 15 91 95 96 108 89 98 115 121 151 106 95 137 151 122 95 101 101 90 105 102 112 116 111 95 45 11740 Evacuation of subungual hematoma 128 117 128 128 1 124 74 113 120 78 78 78 56 68 1 78 61 123 110 12 75 78 79 89 73 80 94 110 124 87 78 112 124 100 78 83 83 74 86 84 91 95 91 78 37 11750 "Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;" 5196 4948 6670 5196 37 5040 3013 4583 4879 3170 3170 3170 806 2768 37 3158 2488 5004 4454 504 3029 3170 3191 3597 2969 3255 3817 3998 5040 3543 3170 4557 5020 4073 3170 3358 3360 3014 3510 3393 3714 3852 3684 3170 1508 11760 Repair of nail bed 441 441 441 441 3 428 256 389 414 269 269 269 193 235 3 268 211 425 378 43 257 269 271 305 252 276 324 343 428 301 269 387 426 346 269 285 285 256 298 288 315 327 313 269 128 11765 "Wedge excision of skin of nail fold (eg, for ingrown toenail)" 142 142 142 142 1 138 82 125 133 87 87 87 62 76 1 86 68 137 122 14 83 87 87 98 81 89 104 58 138 97 87 125 137 111 87 92 92 82 96 93 101 105 101 87 41 11770 Excision of pilonidal cyst or sinus; simple 9142 9142 9142 9142 66 8868 5302 8063 8584 5577 5577 5577 4006 4871 66 5557 4378 8803 7836 888 5329 5577 5614 6328 5224 5727 6715 7120 8868 6233 5577 8017 8832 7166 5577 5908 5912 5302 6175 5970 6534 6778 6481 5577 2653 11982 "Removal, non-biodegradable drug delivery implant" 14616 14616 14616 14616 105 14177 8476 12891 13724 8916 8916 8916 6405 7787 105 8884 6999 14075 12528 1419 8519 8916 8976 10117 8352 9156 10736 12548 14177 9965 8916 12818 14120 11457 8916 9445 9452 8477 9873 9544 10447 10836 10362 8916 4242 12001 "Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less" 247 223 260 247 2 597 228 216 232 151 151 151 597 132 2 166 118 238 212 24 144 151 152 166 141 155 244 205 240 168 151 217 239 221 151 160 160 143 167 165 177 178 181 151 72 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" 284 257 284 284 2 657 122 250 267 173 173 173 657 151 2 182 136 273 243 28 166 173 174 197 162 178 209 244 275 194 173 249 274 223 173 184 184 165 192 190 203 208 208 173 82 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" 361 361 380 361 3 501 209 318 339 220 220 220 501 192 3 219 173 348 309 35 210 220 222 250 206 226 265 281 350 246 220 317 349 283 220 233 233 209 244 236 258 268 269 220 105 12011 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less" 300 259 315 300 2 627 112 291 282 183 183 183 627 160 2 194 144 272 257 29 175 183 184 212 171 188 220 240 291 205 183 263 290 268 183 194 194 174 203 196 214 206 220 183 87 12013 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 333 311 344 333 2 493 193 294 313 203 203 203 493 177 2 202 159 321 285 32 194 203 205 231 190 209 245 295 323 227 203 292 322 261 203 215 215 193 225 217 238 247 236 203 97 12014 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm" 409 399 419 409 3 597 237 361 384 249 249 249 597 218 3 249 196 394 351 40 238 249 251 283 234 256 300 319 397 279 249 359 395 321 249 264 264 237 276 267 292 303 290 249 119 12015 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm" 498 498 502 498 4 483 289 439 468 304 304 304 218 265 4 303 238 480 427 48 290 304 306 345 285 312 366 354 483 340 304 437 481 390 304 322 322 289 336 325 356 369 353 304 145 12032 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm" 178 2 371 178 1 626 103 157 167 108 108 108 626 95 1 108 85 171 152 17 103 108 109 123 101 111 130 283 172 121 108 156 171 139 108 115 115 103 120 249 127 132 126 108 52 12034 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm" 252 1 508 252 1 530 146 222 236 153 153 153 530 134 2 153 120 242 216 24 147 153 154 174 144 158 185 1 244 171 153 221 243 197 153 163 163 146 170 164 180 186 178 153 73 12035 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm" 601 601 601 601 4 1635 349 530 564 367 367 367 1635 320 4 365 288 579 515 58 350 367 369 416 343 377 441 468 583 410 367 527 581 471 367 388 389 349 406 392 430 446 426 367 174 12041 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less" 129 129 136 129 1 967 75 114 121 79 79 79 967 69 1 78 62 124 111 13 75 79 79 89 74 81 95 106 125 88 79 113 125 101 79 83 83 75 87 84 92 96 91 79 37 12042 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm" 382 375 394 382 3 1486 222 337 359 233 233 233 1486 204 3 232 183 368 327 37 223 233 235 264 218 239 281 298 371 260 233 335 369 299 233 247 247 222 258 249 273 283 271 233 111 12045 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm" 1196 1196 1196 1196 9 1160 694 1055 1123 730 730 730 524 637 9 727 573 1152 1025 116 697 730 734 828 759 749 878 931 1160 815 730 1049 1155 937 730 773 773 694 808 781 855 887 848 730 347 12052 "Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 490 490 490 490 4 475 284 432 460 299 299 299 215 261 4 298 235 472 420 48 286 299 301 339 280 307 360 382 475 334 299 430 473 384 299 317 317 284 331 320 350 372 347 299 142 13100 "Repair, complex, trunk; 1.1 cm to 2.5 cm" 1 1 1 1 0 530 1 1 1 1 1 1 530 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 13101 "Repair, complex, trunk; 2.6 cm to 7.5 cm" 1 1 1 1 0 401 1 1 1 1 1 1 401 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 13102 "Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure)" 1 1 1 1 0 486 1 1 1 1 1 1 486 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 13120 "Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm" 1 1 1594 1 0 441 1 1 1 1 1 1 441 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 13121 "Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm" 58 1 2821 58 0 441 34 51 54 35 35 35 441 31 0 35 28 56 50 6 34 35 36 40 33 36 43 45 56 40 35 51 56 45 35 37 38 34 39 38 41 43 41 35 17 13122 "Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)" 177 36 318 177 1 172 103 156 166 108 108 108 78 94 1 108 85 170 152 17 103 108 109 123 101 111 130 138 172 121 108 155 171 139 108 114 114 103 120 116 127 131 125 108 51 13131 "Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm" 1 1 1 1 0 350 1 1 1 1 1 1 350 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 13132 "Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm" 5674 5674 5674 5674 41 5504 3291 5004 5328 3461 3461 3461 385 3023 41 3449 2717 5464 4863 551 3307 3461 3485 3928 3242 3555 4168 4419 5504 3869 3461 4976 5481 4448 3461 3667 3669 3291 3833 3705 4056 4206 4023 3461 1647 13133 "Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure)" 1 1 1 1 0 441 1 1 1 1 1 1 441 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 13160 "Secondary closure of surgical wound or dehiscence, extensive or complicated" 9607 7685 11108 9607 69 9446 5571 8473 9021 5860 5860 5860 3544 5118 69 5839 4600 9251 8234 933 5600 5860 5900 6650 5490 6018 7056 9446 9319 6550 5860 8425 9281 7530 5860 6208 6213 5572 6489 6273 6867 7122 6811 5860 2788 15002 "Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children" 4474 1 8948 4474 32 4340 2595 3946 4201 2729 2729 2729 1942 2384 32 2720 2143 4309 3835 434 2608 2729 2748 3097 2557 2803 3287 3485 4340 3051 2729 3924 4323 3507 2729 2892 2894 2595 3022 2922 3198 3317 3172 2729 1299 15271 PR SKIN SUB GRAFT T/A/L 25 SQ CM 406 232 449 406 3 394 236 358 381 248 248 248 178 216 3 247 195 391 348 39 237 248 249 281 232 254 298 316 394 277 248 356 392 318 248 263 263 236 274 248 290 301 142 248 118 15275 PR SKIN SUB GRFT F/NK/HF/G 25 SQ CM 7318 7318 7318 7318 52 7098 4244 6454 6871 4464 4464 4464 3207 3899 52 4448 3504 7047 6272 711 4265 4464 4494 5066 4182 4584 5375 5699 7098 4989 4464 6418 7070 5736 4464 4729 4732 4244 4943 4778 5231 5425 5188 4464 2124 17999 "Unlisted procedure, skin, mucous membrane and subcutaneous tissue" 1 1 1 1 0 190 1 1 1 1 1 1 190 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 19101 "Biopsy of breast; open, incisional" 8133 8133 8133 8133 58 7889 4717 7173 7637 4961 4961 4961 3564 4333 58 4943 3894 7832 6971 790 4740 4961 4995 5630 4648 5095 5974 6334 7889 5545 4961 7132 7857 6375 4961 5256 5260 4717 5494 5311 5813 6029 6067 4961 2361 19120 "Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions" 8327 8133 8521 8327 60 8077 4829 7344 7819 5079 5079 5079 2595 4436 60 5061 3987 8019 7137 808 4854 5079 5114 5764 4758 5217 6116 6485 8077 5677 5079 7302 8044 6527 5079 5381 5385 4830 5625 5437 5952 6173 5903 5079 2417 19301 "Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);" 7745 7745 7745 7745 56 7513 4492 6831 7272 4724 4724 4724 7194 4126 56 4707 3709 7458 6638 752 4514 4724 4756 5361 4426 4852 5689 6032 7513 5281 4724 6792 7482 6071 4724 5005 5009 4492 5232 5057 5536 5742 5491 4724 2248 19307 "Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle" 12247 12247 12247 12247 88 11880 7102 10801 11499 7471 7471 7471 5367 6525 88 7444 5864 11793 10497 1189 7138 7471 7521 8478 6998 7672 8996 9538 11880 8350 7471 10740 11831 9600 7471 7914 7920 7103 8273 7997 8754 9079 8683 7471 3555 20103 Exploration of penetrating wound (separate procedure); extremity 322 322 322 322 2 1061 187 284 303 197 197 197 1061 172 2 196 154 310 276 31 188 197 198 223 184 202 237 251 313 220 197 283 311 253 197 208 208 187 218 211 230 239 229 197 94 20240 "Biopsy, bone, open; superficial (eg, ilium, sternum, spinous process, ribs, trochanter of femur)" 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 20550 "Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar ""fascia"")" 58 24 274 58 0 56 34 51 54 35 35 35 25 31 0 35 28 56 50 6 34 35 36 40 33 36 43 41 56 40 35 51 56 45 35 37 38 34 39 38 41 43 41 35 17 20552 "Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)" 91 25 224 91 1 88 56 80 85 56 56 56 40 48 1 55 44 88 78 9 53 56 56 63 52 57 67 71 88 62 56 80 88 71 56 59 59 53 61 59 65 67 65 56 26 20553 "Injection(s); single or multiple trigger point(s), 3 or more muscle(s)" 104 31 272 104 1 101 60 92 98 63 63 63 46 55 1 63 50 100 89 10 61 63 64 72 59 65 83 81 101 71 63 91 100 82 63 67 67 60 70 21 74 77 74 63 30 20600 "Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)" 118 24 7317 118 1 123 68 104 110 72 72 72 51 63 1 71 56 113 101 11 68 72 72 81 78 74 86 92 114 80 72 103 114 92 72 76 76 68 79 77 84 87 123 72 34 20605 "Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)" 59 18 431 59 0 1059 34 52 55 36 36 36 1059 31 0 36 28 57 51 6 34 36 36 41 34 37 43 46 57 40 36 52 57 46 36 38 38 34 40 39 42 44 42 36 17 20610 "Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)" 39 21 16036 39 0 70 49 34 37 24 24 24 37 21 0 24 19 38 33 4 23 24 24 27 70 24 38 30 38 27 24 34 38 31 24 25 25 23 26 15 28 29 14 24 11 20680 "Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)" 13793 7318 19059 13793 99 13379 7999 12165 12951 8414 8414 8414 6099 7349 99 8384 6605 13282 11822 1339 8040 8414 8471 9548 7882 8641 10131 10742 13379 9404 8414 12096 13325 10812 8414 8913 8920 8000 9317 9007 9859 10226 9779 8414 4003 21480 Closed treatment of temporomandibular dislocation; initial or subsequent 69 61 69 69 0 310 40 61 65 42 42 42 310 37 0 42 33 66 59 7 40 42 42 48 39 43 51 54 67 47 42 61 67 54 42 45 45 40 47 45 49 51 49 42 20 21552 "Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater" 2 2 2 2 0 3781 1 2 2 1 1 1 3781 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 23120 Claviculectomy; partial 20157 16275 23501 20157 145 19552 11690 17778 18927 12296 12296 12296 8258 10739 145 12252 9652 19410 17277 1957 11749 12296 12379 13953 11519 12628 14806 15698 19552 13743 12296 17677 19473 15800 12296 13026 13035 11691 13616 11112 14408 14944 14290 12296 5850 23410 "Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute" 17094 2 17094 17094 123 16581 9913 15076 16051 10427 10427 10427 4129 9107 123 10390 8185 16461 14652 1660 9964 10427 10498 11833 9768 10709 12556 13313 16581 11655 10427 14991 16514 13399 10427 11047 11055 9915 11547 11162 12218 12673 12119 10427 4961 23412 "Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic" 18152 18151 22621 18152 130 17607 10527 16009 17044 11073 11073 11073 7955 9671 130 11033 8692 17480 15558 1762 10580 11073 11148 12565 10373 11372 13333 14666 17607 12376 11073 15919 17536 14228 11073 11730 11739 10528 12262 11853 12975 13457 12869 11073 5268 23430 Tenodesis of long tendon of biceps 2137 2 15268 2137 15 4129 1239 1885 2007 1304 1304 1304 4129 1139 15 1299 1023 2058 1832 207 1246 1304 1312 1479 1221 1339 1570 1664 2073 1457 1304 1874 2064 1675 1304 1381 1382 1239 1444 1395 1527 1584 1515 1304 620 23472 "Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))" 8320 4845 11796 8320 60 8071 4825 7338 7813 5076 5076 5076 3646 4433 60 5057 3984 8012 7132 808 4850 5076 5110 5760 4755 5212 6111 6480 8071 5673 5076 7297 8038 6522 5076 5377 5381 4826 5620 5433 5947 6168 5899 5076 2415 23545 Closed treatment of acromioclavicular dislocation; with manipulation 189 189 189 189 1 183 110 167 177 115 115 115 83 101 1 115 91 182 162 18 110 115 116 134 108 118 139 147 183 129 115 166 183 148 115 122 122 110 128 123 135 140 134 115 55 23600 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation 313 313 313 313 2 304 182 276 294 191 191 191 137 167 2 190 150 301 268 30 182 191 192 217 179 196 230 244 304 213 191 274 302 245 191 202 202 182 211 204 224 232 222 191 91 23650 "Closed treatment of shoulder dislocation, with manipulation; without anesthesia" 1884 1794 2078 1884 14 2834 1093 1662 1769 1149 1149 1149 2834 1004 14 1145 902 1814 1615 183 1098 1149 1157 1334 1077 1180 1384 1467 1827 1285 1149 1652 1820 1477 1149 1217 1218 1093 1273 1230 1347 1397 701 1149 547 24640 "Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation" 588 588 618 588 4 2858 341 519 552 359 359 359 2858 313 4 357 282 566 504 57 343 359 361 407 336 368 432 475 570 401 359 516 568 461 359 380 380 341 397 384 420 436 417 359 171 25000 "Incision, extensor tendon sheath, wrist (eg, deQuervains disease)" 8113 7685 8541 8113 58 7870 4705 7155 7618 4949 4949 4949 3556 4322 58 4931 3885 7813 6954 788 4729 4949 4982 5616 4636 5082 5959 6318 7870 5531 4949 7115 7838 6359 4949 5243 5247 4706 5480 5298 5799 6015 5752 4949 2355 25111 "Excision of ganglion, wrist (dorsal or volar); primary" 5255 4711 6969 5255 38 5097 3048 4635 4934 3206 3206 3206 3527 2800 38 3194 2516 5060 4504 510 3063 3206 3227 3638 3003 3292 3860 4093 5097 3583 3206 4608 5077 4119 3206 3396 3398 3048 3550 3431 3756 3896 3580 3206 1525 25118 "Synovectomy, extensor tendon sheath, wrist, single compartment;" 8948 8948 8948 8948 64 8680 5189 7892 8402 5458 5458 5458 4488 4767 64 5439 4285 8617 7670 869 5216 5458 5495 6194 5113 5606 6572 6969 8680 6101 5458 7847 8644 7014 5458 5782 5787 5190 6044 5843 6396 6634 6344 5458 2597 25600 "Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation" 278 278 278 278 2 270 161 245 261 170 170 170 122 148 2 169 133 268 238 27 162 170 171 192 159 174 204 217 270 190 170 244 269 218 170 180 180 161 188 182 199 206 197 170 81 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" 857 777 857 857 6 3119 497 756 805 523 523 523 3119 457 6 521 410 825 735 83 500 523 526 593 490 537 629 667 831 584 523 752 828 672 523 554 554 497 579 560 613 635 627 523 249 25675 Closed treatment of distal radioulnar dislocation with manipulation 990 198 1783 990 7 961 574 874 930 604 604 604 434 528 7 602 474 954 849 96 577 604 608 686 566 621 728 771 961 675 604 869 957 776 604 640 641 574 669 647 708 734 702 604 287 26010 Drainage of finger abscess; simple 154 154 193 154 1 149 89 136 145 94 94 94 67 82 1 94 74 148 132 15 90 94 95 107 88 96 113 131 149 105 94 135 149 121 94 100 100 89 104 101 110 114 109 94 45 26055 "Tendon sheath incision (eg, for trigger finger)" 5358 1911 9763 5358 38 5467 3698 4726 5031 3268 3268 3268 1910 2855 38 3257 2566 5160 4592 520 3123 3268 3290 3709 3062 3357 5467 3998 5197 3653 3268 4699 5176 4200 3268 3462 3465 3108 3619 3698 3830 3972 4928 3268 1555 26121 "Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)" 6565 1505 11625 6565 47 6368 3807 5790 6164 4005 4005 4005 2877 3498 47 3990 3144 6322 5627 637 3827 4005 4032 4544 3752 4113 4822 5113 6368 4476 4005 5757 6342 5146 4005 4242 4246 3808 4435 4287 4692 4867 4654 4005 1905 26123 "Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);" 5799 5799 5799 5799 42 5625 3363 5115 5445 3537 3537 3537 2541 3090 42 3525 2777 5584 4970 563 3380 3537 3561 4014 3314 3633 4259 4516 5625 3954 3537 5085 5602 4546 3537 3747 3750 3363 3917 3787 4145 4407 4111 3537 1683 26525 "Capsulectomy or capsulotomy; interphalangeal joint, each joint" 5255 5255 5255 5255 38 5097 3048 4635 4934 3206 3206 3206 3527 2800 38 3194 2516 5060 4504 510 3063 3206 3227 3638 3003 3292 3860 4093 5097 3583 3206 4608 5077 4119 3206 3396 3398 3048 3550 3431 3756 3896 3726 3206 1525 26535 "Arthroplasty, interphalangeal joint; each joint" 8209 8209 8209 8209 59 7963 4761 7240 7708 5007 5008 5007 6746 4374 59 4990 3931 7905 7036 797 4785 5007 5041 5682 4691 5143 6030 6393 7963 5597 5007 7199 7930 6435 5007 5305 5309 4761 5545 5360 5868 6086 5820 5007 2383 26605 "Closed treatment of metacarpal fracture, single; with manipulation, each bone" 650 602 699 650 5 631 584 574 611 397 397 397 285 347 5 395 311 626 558 63 379 397 399 450 372 408 478 507 631 444 397 570 628 510 397 420 421 377 439 425 465 482 461 397 189 26608 "Percutaneous skeletal fixation of metacarpal fracture, each bone" 8948 8948 8948 8948 64 8680 5189 7892 8402 5458 5458 5458 3921 4767 64 5439 4285 8617 7670 869 5216 5458 5495 6194 5113 5606 6572 6352 8680 6101 5458 7847 8644 7014 5458 5782 5787 5190 6044 5843 6396 6634 6344 5458 2597 26615 "Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone" 12247 12247 12247 12247 88 11880 7102 10801 11499 7471 7471 7471 9671 6525 88 7444 5864 11793 10497 1189 7138 7471 7521 8478 6998 7672 8996 9538 11880 8350 7471 10740 11831 9600 7471 7914 7920 7103 8273 7997 8754 9079 8683 7471 3555 26725 "Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each" 44 42 47 44 0 3119 26 39 41 27 27 27 3119 23 0 27 21 42 38 4 26 27 27 30 25 28 32 36 43 30 27 39 43 34 27 28 28 26 30 29 31 33 32 27 13 26742 "Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each" 182 182 182 182 1 177 106 161 171 111 111 111 80 97 1 111 87 176 156 18 106 111 112 126 104 114 134 130 177 124 111 160 176 143 111 118 118 106 123 119 130 135 129 111 53 26750 "Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each" 218 218 218 218 2 211 126 192 205 133 133 133 96 116 2 133 104 210 187 21 127 133 134 151 125 137 160 170 211 149 133 191 211 171 133 141 141 126 147 142 156 162 155 133 63 26770 "Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia" 260 235 260 260 2 3094 151 229 244 159 159 159 3094 139 2 158 124 255 223 25 152 159 160 180 149 163 191 202 252 177 159 228 251 204 159 168 168 151 176 170 186 193 184 159 75 26951 "Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure" 12247 12247 12247 12247 88 11880 7102 10801 11499 7471 7471 7471 5367 6525 88 7444 5864 11793 10497 1189 7138 7471 7521 8478 6998 7672 8996 9538 11880 8350 7471 10740 11831 9600 7471 7914 7920 7103 8273 7997 8754 9079 8683 7471 3555 27096 "Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid" 660 660 991 660 5 640 383 582 620 403 403 403 289 352 5 401 316 636 566 64 385 403 405 457 377 413 485 514 640 450 403 579 638 517 403 427 427 383 446 431 472 489 468 403 192 27130 "Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft" 23598 4881 29099 23598 169 23126 13685 20813 22158 14395 14395 14395 21979 12572 169 14343 11300 23126 20226 2291 13755 14395 14492 16335 13485 14783 17333 20259 22890 16089 14395 20694 22797 18497 14395 15250 15261 13687 15940 15409 16867 17495 19671 14395 6849 27301 "Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region" 6212 3026 9397 6212 45 6025 3602 5478 5832 3789 3789 3789 2722 3309 45 3775 2974 5981 5324 603 3620 3789 3815 4300 3550 3891 4562 4838 6025 4235 3789 5447 6001 4869 3789 4014 4017 3603 4196 4056 4440 4605 4404 3789 1803 27380 Suture of infrapatellar tendon; primary 10233 10233 10233 10233 73 9926 5934 9025 9608 6242 6242 6242 4485 5452 73 6220 4900 9854 8771 994 5965 6242 6284 7083 5848 6411 7516 7969 9926 6977 6242 8974 9886 8021 6242 6613 6618 5935 6912 6682 7314 7586 7255 6242 2970 27385 Suture of quadriceps or hamstring muscle rupture; primary 12208 12208 12208 12208 88 11842 7080 10767 11463 7447 7447 7447 5350 6504 88 7420 5846 11756 10464 1185 7116 7447 7497 8451 6976 7648 8967 9508 11842 8323 7447 10706 11794 9569 7447 7889 7895 7081 8246 7972 8726 9051 8655 7447 3543 27447 "Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)" 16330 4881 65406 16330 117 22870 15165 14403 15334 9962 9962 9962 21979 8701 117 9926 7820 15726 13997 1586 9519 9962 10029 11304 9332 10230 22870 21268 15841 11134 9962 14321 15776 12801 9962 10553 10561 9472 11031 13980 11673 12107 19189 9962 4740 27514 "Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when performed" 2 2 2 2 0 4948 1 2 2 1 1 1 4948 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 27524 "Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair" 14978 14978 14978 14978 107 14529 8686 13210 14064 9137 9137 9137 9707 7980 107 9104 7172 14423 12838 1454 8730 9137 9198 10368 8559 9383 11001 11665 14529 10212 9137 13135 14470 11740 9137 9679 9686 8687 10118 9780 10706 11104 10619 9137 4347 27560 Closed treatment of patellar dislocation; without anesthesia 214 203 225 214 21 3347 124 189 201 131 131 131 94 114 3347 130 102 206 183 21 125 131 131 148 122 134 157 167 208 146 131 188 207 168 131 138 138 124 145 140 153 159 162 131 62 27634 "Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); 5 cm or greater" 20525 20525 20525 20525 147 19909 11903 18102 19272 12520 12520 12520 5661 10935 147 12475 9828 19765 17592 1993 11963 12520 12605 14208 11729 12858 15076 15985 19909 13994 12520 18000 19828 16088 12520 13264 13273 11904 13864 13402 14671 15216 14551 12520 5957 27654 "Repair, secondary, Achilles tendon, with or without graft" 11800 11393 12206 11800 85 11445 6843 10407 11079 7198 7198 7198 8932 6287 85 7172 5650 11362 10114 1146 6878 7198 7246 8168 6743 7392 8667 9189 11445 8045 7198 10348 11399 9249 7198 7625 7631 6844 7970 7705 8434 8748 8365 7198 3425 27658 "Repair, flexor tendon, leg; primary, without graft, each tendon" 12707 12391 13023 12707 91 12326 7369 11207 11931 7751 7751 7751 3115 6770 91 7723 6085 12236 10891 1234 7407 7751 7804 8796 7261 7960 9333 9896 12326 8664 7751 11143 12276 9960 7751 8212 8217 7370 8583 8297 9083 9420 9009 7751 3688 27664 "Repair, extensor tendon, leg; primary, without graft, each tendon" 17946 17946 17946 17946 129 17408 10408 15828 16851 10947 10947 10947 6230 9561 129 10908 8593 17281 15382 1742 10460 10947 11021 12423 10255 11242 13182 13976 17408 12236 10947 15738 17337 14067 10947 11597 11606 10409 12122 11718 12827 13304 12723 10947 5209 27687 "Gastrocnemius recession (eg, Strayer procedure)" 16276 11933 23804 16276 117 15787 9439 14354 15282 9928 9928 9928 3248 8671 117 9892 7793 15673 13950 1580 9486 9928 9995 11266 9301 10196 11955 12675 15787 11097 9928 14273 15723 12758 9928 10518 10525 9440 10994 10628 11633 12066 11539 9928 4724 27690 "Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)" 7752 2 15501 7752 56 9035 4495 6837 7278 4728 4728 4728 9035 4130 56 4711 3712 7464 6644 753 4518 4728 4760 5366 4430 4856 5694 6037 7519 5285 4728 6798 7488 6076 4728 5009 5013 4496 5236 5062 5541 5747 5495 4728 2250 27696 "Repair, primary, disrupted ligament, ankle; both collateral ligaments" 18150 18150 18150 18150 130 17605 10526 16008 17042 11072 11072 11072 8932 9670 130 11032 8691 17478 15557 1762 10579 11072 11146 12564 10372 11370 13331 14135 17605 12375 11072 15917 17534 14227 11072 11729 11737 10527 12260 11852 12973 13456 12867 11072 5268 27766 "Open treatment of medial malleolus fracture, includes internal fixation, when performed" 12862 12862 12862 12862 92 12476 7459 11344 12077 7846 7846 7846 9707 6853 92 7818 6159 12386 11024 1249 7497 7846 7899 8903 7350 8058 9447 10392 12476 8769 7846 11279 12425 10082 7846 8312 8318 7460 8688 8399 9193 9535 9119 7846 3733 27788 Closed treatment of distal fibular fracture (lateral malleolus); with manipulation 224 224 224 224 2 217 130 198 210 137 137 137 98 119 2 136 107 216 192 22 131 137 138 155 128 140 165 184 217 153 137 196 216 176 137 145 145 130 151 146 160 166 159 137 65 27792 "Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed" 14261 9575 14615 14261 102 13833 8270 12578 13391 8699 8699 8699 8991 7598 102 8668 6829 13733 12223 1385 8312 8699 8758 9872 8149 8934 10475 11106 13833 9723 8699 12506 13777 11178 8699 9216 9222 8271 9633 9312 10193 10573 10110 8699 4139 27814 "Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed" 12247 12247 12247 12247 88 11880 7102 10801 11499 7471 7471 7471 5367 6525 88 7444 5864 11793 10497 1189 7138 7471 7521 8478 6998 7672 8996 9538 11880 8350 7471 10740 11831 9600 7471 7914 7920 7103 8273 7997 8754 9079 8683 7471 3555 27818 Closed treatment of trimalleolar ankle fracture; with manipulation 365 365 404 365 3 3119 212 322 343 223 223 223 3119 194 3 222 175 351 313 35 213 223 224 253 209 229 268 284 354 249 223 320 353 286 223 236 236 212 247 238 261 271 259 223 106 28002 "Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space" 19208 19208 19208 19208 138 18632 11139 16941 18036 11717 11717 11717 4476 10234 138 11675 9198 18497 16464 1865 11196 11717 11796 13296 10976 12033 14108 14959 18632 13096 11717 16845 18556 15056 11717 12413 12422 11141 12975 12542 13729 14240 13618 11717 5575 28035 "Release, tarsal tunnel (posterior tibial nerve decompression)" 16966 1 22617 16966 122 16456 9839 14963 15930 10349 10349 10349 6495 9039 122 7473 8124 16337 14541 1647 9889 10349 10419 11744 9695 10628 12461 7760 16456 11567 10349 14878 16390 13298 10349 10964 10971 9840 11460 11078 12127 12578 15908 10349 4924 28043 "Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm" 6736 6503 6969 6736 48 6534 3906 5941 6325 4109 4109 4109 3982 3589 48 4094 3225 6487 5774 654 3926 4109 4137 4663 3849 4220 4948 5246 6534 4593 4109 5907 6507 5280 4109 4353 4356 3907 4550 4398 4815 4994 4775 4109 1955 28060 "Fasciectomy, plantar fascia; partial (separate procedure)" 1 1 2 1 0 2463 1 1 1 1 1 1 2463 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 28080 "Excision, interdigital (Morton) neuroma, single, each" 5799 5799 5799 5799 42 5625 3363 5115 5445 3537 3537 3537 4235 3090 42 3525 2777 5584 4970 563 3380 3537 3561 4014 3314 3633 4259 4516 5625 3954 3537 5085 5602 4546 3537 3747 3750 3363 3917 3787 4145 4299 4111 3537 1683 28092 "Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each" 8229 7318 9140 8229 59 7982 4772 7258 7727 5020 5020 5020 4916 4384 59 5002 3940 7924 7053 799 4796 5020 5054 5696 4702 5155 6044 6409 7982 5611 5020 7216 7950 6450 5020 5318 5322 4773 5559 5373 5882 6101 5834 5020 2388 28104 "Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;" 7916 5255 10578 7916 57 7679 4591 6982 7433 4829 4829 4829 4476 4218 57 4812 3791 7623 6785 769 4614 4829 4862 5480 4524 4959 5815 6165 7679 5397 4829 6942 7648 6205 4829 5116 5120 4592 5348 5169 5659 5869 5612 4829 2298 28110 "Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)" 11961 10073 12819 11961 86 11602 6937 10549 11231 7296 7296 7296 10562 6373 86 7270 5727 11518 10252 1161 6972 7296 7346 8280 6835 7493 8785 9315 11602 8155 7296 10489 11555 9376 7296 7730 7735 6937 8080 7810 8549 8867 8480 7296 3472 28118 "Ostectomy, calcaneus;" 11393 1 20266 11393 82 11051 6607 10048 10698 6950 6950 6950 3572 6070 82 6925 5455 10971 9765 1106 6641 6950 6997 7886 6510 7137 8368 8873 11051 7768 6950 9991 11006 8930 6950 7362 7368 6608 7696 7439 8143 8446 8077 6950 3307 28119 "Ostectomy, calcaneus; for spur, with or without plantar fascial release" 10761 10761 10761 10761 77 10438 6241 9491 10104 6564 6564 6564 4458 5733 77 6541 5153 10362 9223 1045 6272 6564 6609 7449 6149 6741 7904 8381 10438 7337 6564 9437 10396 8435 6564 6954 6959 6241 7269 7027 7692 7978 7629 6564 3123 28122 "Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus" 17918 12394 23442 17918 128 17380 10391 15803 16824 10930 10930 10930 11624 9546 128 10891 8580 17254 15358 1740 10444 10930 11004 12403 10239 11225 13161 13955 17380 12217 10930 15713 17310 14045 10930 11579 11587 10392 12103 11700 12807 13284 15706 10930 5201 28124 "Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe" 5676 2 6352 5676 41 5506 3292 5006 5330 3462 3462 3462 2229 3024 41 3450 2718 5466 4865 551 3308 3462 3486 3929 3244 3556 4169 4420 5506 3870 3462 4978 5483 4449 3462 3668 3671 3292 3834 4256 4057 4208 4024 3462 1647 28160 "Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each" 2 2 2 2 0 2453 1 2 2 1 1 1 2453 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 28200 "Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon" 2 2 2 2 0 2229 1 2 2 1 1 1 2229 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 28230 "Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)" 12205 12205 12205 12205 88 11839 7078 10764 11460 7445 7445 7445 2463 6503 88 7418 5844 11753 10461 1185 7114 7445 7495 8449 6974 7646 8965 9505 11839 8321 7445 10703 11791 9567 7445 7887 7893 7079 8244 7970 8724 9048 8653 7445 3542 28232 "Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)" 12203 12203 12203 12203 87 11837 7077 10763 11458 7444 7444 7444 2238 6501 87 7417 5843 11751 10459 1185 7113 7444 7494 8447 6973 7645 8963 9504 11837 8320 7444 10702 11789 9565 7444 7886 7892 7078 8243 7968 8722 9047 8651 7444 3542 28234 "Tenotomy, open, extensor, foot or toe, each tendon" 22237 22237 22237 22237 159 21570 12896 19612 20880 13565 13565 13565 9745 11847 159 13516 10648 21413 19060 2159 12961 13565 13656 15393 12707 13931 16333 17318 21570 15161 13565 19501 21482 17430 13565 14370 14380 12897 15021 14520 15894 16486 15765 13565 6454 28238 "Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)" 13675 13675 13675 13675 98 13265 7931 12061 12840 8342 8342 8342 10562 7286 98 8312 6548 13169 11721 1328 7971 8342 8398 9466 7815 8567 10044 10650 13265 9324 8342 11992 13211 10719 8342 8837 8843 7932 9237 8929 9775 10138 9695 8342 3969 28285 "Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)" 8211 1 22392 8211 0 12904 4762 7242 7710 5009 5009 5009 2463 4375 59 0 3932 7907 7038 797 4786 5009 5043 5684 4692 5144 9782 6395 7965 5598 5009 7201 7932 6436 5009 5306 5310 4762 5546 5362 5869 6087 12904 5009 2383 28296 "Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)" 8948 2 9762 8948 64 10562 5189 7892 8402 5458 5458 5458 10562 4767 64 5439 4285 8617 7670 869 5216 5458 5495 6194 5113 5601 6572 6969 8680 6101 5458 7847 8644 7014 5458 5782 5787 5190 6044 5843 6396 6634 6344 5458 2597 28297 "Correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus-type procedure" 11108 1 11934 11108 80 10775 6442 9797 10430 6776 6776 6776 5281 5918 80 6752 5319 10697 9521 1078 6475 6776 6822 7689 6348 6959 8159 8651 10775 7573 6776 9741 10731 8707 6776 7178 7183 6443 7503 7253 7940 8235 4368 6776 3224 28298 "Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy" 1 1 1 1 0 10033 1 1 1 1 1 1 10033 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 28300 "Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation" 1 1 1 1 0 10033 1 1 1 1 1 1 10033 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 28308 "Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each" 1 1 1 1 0 2463 1 1 1 1 1 1 2463 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 28485 "Open treatment of metatarsal fracture, includes internal fixation, when performed, each" 14615 14615 14615 14615 105 14177 8476 12890 13723 8915 8915 8915 9896 7787 105 8883 6998 14074 12527 1419 8519 8915 8975 10117 8352 9156 10735 11382 14177 9965 8915 12817 14119 11456 8915 9445 9451 8477 9872 9543 10446 10835 10361 8915 4242 28505 "Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when performed" 8133 8133 8133 8133 58 8822 4717 7173 7637 4961 4961 4961 8822 4333 58 4943 3894 7832 6971 790 4740 4961 4995 5630 4648 5095 5974 6334 7889 5545 4961 7132 7857 6375 4961 5256 5260 4717 5494 5311 5813 6029 5766 4961 2361 28635 Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia 8521 8521 8521 8521 61 8265 4942 7515 8001 5198 5198 5198 2831 4540 61 5179 4080 8205 7304 827 4967 5198 5233 5898 4869 5338 6259 6636 8265 5810 5198 7473 8232 6679 5198 5506 5510 4942 5756 5564 6091 6317 6041 5198 2473 28645 "Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed" 2 2 2 2 0 4948 1 2 2 1 1 1 4948 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 28675 "Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed" 8211 8211 8211 8211 59 9896 4762 7242 7710 5009 5009 5009 9896 4375 59 4991 3932 7907 7038 797 4786 5009 5043 5684 4692 5144 6031 6395 7965 5598 5009 7201 7932 6436 5009 5306 5310 4762 5546 5362 5869 6087 5821 5009 2383 28730 "Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;" 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 28740 "Arthrodesis, midtarsal or tarsometatarsal, single joint" 7280 1 17092 7280 52 12751 4222 6421 6836 4441 4441 4441 8320 3879 52 4425 3486 7010 6240 707 4243 4441 4471 5039 4160 4561 5347 5670 7062 4964 4441 6384 7033 5706 4441 4705 4708 4222 4918 4754 5204 5397 12751 4441 2113 28750 "Arthrodesis, great toe; metatarsophalangeal joint" 7054 1 12207 7054 51 10033 4091 6222 6624 4303 4303 4303 10033 3758 51 4288 3378 6793 6047 685 4112 4303 4332 4883 4031 4419 5182 5494 6843 4810 4303 6186 6815 5530 4303 4559 4562 4092 4765 4606 5042 5230 4066 4303 2047 28755 "Arthrodesis, great toe; interphalangeal joint" 1 1 1 1 0 2463 1 1 1 1 1 1 2463 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 28810 "Amputation, metatarsal, with toe, single" 8133 1459 8948 8133 58 7889 4717 7173 7637 4961 4961 4961 3564 4333 58 4943 3894 7832 6971 790 4740 4961 4995 5630 4648 5095 5974 6768 7889 5545 4961 7132 7857 6375 4961 5256 5260 4717 5494 5311 5813 6029 5766 4961 2361 28820 "Amputation, toe; metatarsophalangeal joint" 4948 1 5797 4948 35 5097 2870 4364 4646 3018 3018 3018 2463 2636 35 3007 2369 4765 4241 480 2884 3018 3039 3425 2828 3100 5097 3854 4800 3374 3018 4339 4780 3878 3018 3198 3200 2870 3342 3231 3537 3691 3508 3018 1436 28825 "Amputation, toe; interphalangeal joint" 5650 4948 6352 5650 41 5480 3277 4983 5305 3446 3447 3446 4925 3010 41 3434 2705 5441 4843 549 3293 3446 3470 3911 3229 3539 4150 4400 5480 3852 3446 4955 5458 4429 3446 3651 3654 3277 3817 3689 4038 4189 4006 3446 1640 29065 "Application, cast; shoulder to hand (long arm)" 151 147 155 151 1 661 88 133 142 92 92 92 661 80 1 92 72 145 129 15 88 92 93 105 86 95 111 118 146 103 92 132 146 118 92 98 98 88 102 99 108 112 107 92 44 29075 "Application, cast; elbow to finger (short arm)" 109 103 219 109 1 412 63 96 102 66 66 66 412 58 1 66 52 105 93 11 64 66 67 75 62 68 80 85 106 74 66 96 105 85 66 70 70 63 74 71 78 81 77 66 32 29105 Application of long arm splint (shoulder to hand) 171 162 180 171 1 178 99 151 161 104 104 104 178 91 1 104 82 168 147 17 100 104 105 118 98 107 126 133 166 117 104 150 165 134 104 111 111 99 116 112 122 127 121 104 50 29125 Application of short arm splint (forearm to hand); static 292 116 307 292 2 283 169 258 274 178 178 178 157 156 2 177 140 281 250 28 170 178 179 202 167 183 214 264 283 199 178 256 282 229 178 189 189 169 197 191 209 225 225 178 85 29126 Application of short arm splint (forearm to hand); dynamic 147 147 147 147 1 143 85 130 138 90 90 90 64 78 1 89 70 142 126 14 86 90 90 102 84 92 108 114 143 100 90 129 142 115 90 95 95 85 99 96 105 109 104 90 43 29130 Application of finger splint; static 144 130 166 144 1 163 83 127 135 88 88 88 142 77 1 87 69 163 123 14 84 88 88 99 82 90 106 112 139 98 88 126 139 113 88 93 93 83 97 94 103 107 99 88 42 29131 Application of finger splint; dynamic 141 141 141 141 1 142 82 124 132 86 86 86 142 75 1 86 68 136 121 14 82 86 87 98 81 88 104 110 137 96 86 124 136 111 86 91 91 82 95 92 101 105 100 86 41 29405 Application of short leg cast (below knee to toes); 27 27 27 27 0 26 16 24 25 16 16 16 12 14 0 16 13 26 23 3 16 16 17 19 15 17 20 21 26 18 16 24 26 21 16 17 17 16 18 18 19 20 19 16 8 29515 Application of short leg splint (calf to foot) 158 150 166 158 1 153 92 139 148 96 96 96 69 84 1 96 76 152 135 15 92 96 97 109 90 99 116 134 153 108 96 139 153 124 96 102 102 92 107 103 113 117 114 96 46 29824 "Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)" 10231 2170 13254 10231 73 9924 5933 9023 9607 6241 6241 6241 2557 5451 73 6219 4899 9852 8769 993 5963 6241 6283 7082 5846 6409 7515 7968 9924 6976 6241 8972 9884 8020 6241 6612 6616 5934 6911 8085 7313 7585 7253 6241 2969 29826 "Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release" 1 1 578 1 0 2557 1 1 1 1 1 1 2557 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 29827 "Arthroscopy, shoulder, surgical; with rotator cuff repair" 1618 1 3236 1618 12 9828 939 1427 1520 987 987 987 9828 862 12 984 775 1559 1387 157 943 987 994 1120 925 1014 1189 1260 1570 1103 987 1419 1564 1269 987 1046 1047 939 1093 1057 1157 1200 1147 987 470 29828 "Arthroscopy, shoulder, surgical; biceps tenodesis" 1 1 2796 1 0 7863 1 1 1 1 1 1 7863 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 29848 "Endoscopy, wrist, surgical, with release of transverse carpal ligament" 10233 8948 11240 10233 73 9926 5934 9025 9608 6242 6242 6242 5358 5452 73 6220 4900 9854 8771 994 5965 6242 6284 7083 5848 6411 7516 7969 9926 6977 6242 8974 9886 8021 6242 6613 6618 5935 6912 6682 7314 7586 5995 6242 2970 29870 "Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)" 2 2 2 2 0 2 1 2 2 1 1 1 1 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 29877 "Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)" 11284 11284 11284 11284 81 10945 6544 9952 10595 6883 6883 6883 4945 6012 81 6859 5403 10866 9672 1096 6577 6883 6930 7811 6448 7069 8288 8788 10945 7693 6883 9896 10901 8845 6883 7292 7297 6545 7622 7368 8066 8366 8000 6883 3275 29880 "Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)" 11240 1973 12395 11240 81 10903 6518 9913 10554 6856 6856 6856 4749 5988 81 6832 5382 10824 9634 1091 6551 6856 6903 7781 6423 7041 8256 7979 10903 7663 6856 9857 10858 8810 6856 7264 7269 6519 7593 7339 8034 8333 7969 6856 3262 29881 "Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)" 11284 1546 13133 11284 81 10945 6544 9952 10595 6883 6883 6883 5358 6012 81 6859 5403 10866 9672 1096 6577 6883 6930 7811 6448 7069 8288 8304 10945 7693 6883 9896 10901 8845 6883 7292 7297 6545 7622 7368 8066 8366 9595 6883 3275 29882 "Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)" 11346 10746 11947 11346 81 11006 6580 10007 10654 6921 6921 6921 5226 6045 81 6897 5433 10926 9725 1102 6614 6921 6968 7854 6484 7108 8334 8837 11006 7736 6921 9950 10961 8894 6921 7332 7338 6581 7664 7409 8110 8412 8745 6921 3293 30300 "Removal foreign body, intranasal; office type procedure" 177 177 177 177 1 172 103 156 166 108 108 108 78 94 1 108 85 170 152 17 103 108 109 123 101 111 130 138 172 121 108 155 171 139 108 114 114 103 120 116 127 131 125 108 51 30901 "Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method" 230 219 242 230 2 248 133 203 216 140 140 140 248 123 2 140 110 221 197 22 134 140 141 159 131 144 169 179 223 157 140 202 222 180 140 149 149 133 155 154 164 171 163 140 67 30905 "Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial" 462 413 479 462 3 544 268 407 434 282 282 282 544 246 3 281 221 445 396 45 269 282 284 320 264 289 339 340 448 315 282 405 446 362 282 299 299 268 312 321 330 343 328 282 134 31500 "Intubation, endotracheal, emergency procedure" 466 421 466 466 3 2014 270 411 438 284 284 284 2014 248 3 283 223 449 399 45 272 284 286 323 266 292 342 358 452 318 284 409 450 365 284 301 301 270 315 304 333 345 341 284 135 32551 "Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed (separate procedure)" 353 185 521 353 3 342 205 311 331 215 215 215 155 188 3 215 169 340 303 34 206 215 217 244 202 221 259 275 342 241 215 310 341 277 215 228 228 205 238 231 252 262 250 215 102 36415 Collection of venous blood by venipuncture 12 9 185 12 0 151 8 11 10 7 6 7 15 8 0 8 8 10 10 1 2 7 7 8 3 8 12 10 11 8 7 12 151 11 7 7 10 7 8 8 9 9 9 7 3 36430 "Transfusion, blood or blood components" 918 874 2754 918 7 900 586 810 862 560 560 560 249 489 7 558 440 900 787 89 535 560 564 635 525 575 674 788 890 626 560 805 887 720 560 593 594 532 620 532 656 681 672 560 266 36569 "Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older" 3768 654 4155 3768 27 3655 2185 3323 3538 2298 2298 2298 1651 2008 27 2290 1804 3628 3230 366 2196 2298 2314 2608 2153 2361 2768 3197 3655 2569 2298 3304 3640 2954 2298 2435 2437 2185 2545 2784 2693 2793 2671 2298 1094 36591 Collection of blood specimen from a completely implantable venous access device 120 120 120 120 1 116 70 106 113 73 73 73 53 64 1 73 57 116 103 12 70 73 74 83 69 75 88 93 116 82 73 105 116 94 73 78 78 70 81 78 86 89 85 73 35 36592 "Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified" 88 83 93 88 1 85 51 78 83 54 54 54 39 47 1 53 42 85 75 9 51 54 54 61 50 55 65 73 85 60 54 77 85 69 54 57 57 51 59 57 63 65 62 54 26 36600 "Arterial puncture, withdrawal of blood for diagnosis" 109 98 309 109 1 174 40 96 102 66 66 66 48 174 1 66 52 105 93 11 64 66 67 64 69 68 80 83 106 74 66 96 105 85 66 70 70 63 74 69 78 81 160 66 32 37618 "Ligation, major artery (eg, post-traumatic, rupture); extremity" 1557 1557 1557 1557 11 1510 903 1373 1462 950 950 950 682 830 11 946 746 1499 1335 151 908 950 956 1078 890 975 1144 1213 1510 1062 950 1365 1504 1220 950 1006 1007 903 1052 1017 1113 1154 1104 950 452 38525 "Biopsy or excision of lymph node(s); open, deep axillary node(s)" 8133 6969 8133 8133 58 7889 4717 7173 7637 4961 4961 4961 3564 4333 58 4943 3894 7832 6971 790 4740 4961 4995 5630 4648 5095 5974 6334 7889 5545 4961 7132 7857 6375 4961 5256 5260 4717 5494 5449 5813 6029 5766 4961 2361 41899 "Unlisted procedure, dentoalveolar structures" 10253 8114 11965 10253 74 9945 7871 9043 9627 6254 6254 6254 3728 5463 74 5460 4910 9873 8788 995 5976 6254 6297 7097 5859 7490 7531 9353 9945 6991 6254 8991 9905 8037 6254 6626 6631 5947 6926 6695 7329 8055 7283 6254 2976 43235 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)" 3820 2042 14319 3820 27 3705 2113 3369 3587 2330 2330 2330 1676 2035 27 2397 1829 3679 3274 371 2227 2330 2346 2644 2183 2393 3202 2609 3705 2604 2330 3350 3690 2994 2330 2469 2470 2216 2580 2281 2730 2832 2796 2330 1109 43239 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple" 3447 2681 3830 3447 25 3344 1999 3040 3237 2103 2103 2103 2167 1836 25 2095 1651 3319 2954 335 2009 2103 2117 2386 1970 2159 2532 2768 3344 2350 2103 3023 3330 2702 2103 2228 2229 1999 2328 2251 2464 2555 2444 2103 1000 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)" 3830 1341 7379 3830 27 4490 2221 3184 3596 2336 2336 2336 2167 2041 27 2328 1834 3688 3283 372 2232 2336 2352 2651 2189 2399 2813 3108 3715 2611 2336 3359 3700 3002 2336 2475 2477 2221 2587 2496 2738 2966 4490 2336 1112 43251 "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique" 3620 3620 3620 3620 26 3511 2099 3193 3399 2208 2208 2208 1586 1929 26 2200 1733 3486 3103 351 2110 2208 2223 2506 2069 2268 2659 2819 3511 2468 2208 3175 3497 2838 2208 2339 2341 2100 2445 2364 2587 2684 2566 2208 1051 43270 PR EGD LESION ABLATION 4210 4210 4210 4210 30 4084 2442 3713 3953 2568 2568 2568 3657 2243 30 2559 2016 4054 3608 409 2454 2568 2585 2914 2406 2637 3092 3279 4084 2870 2568 3692 4067 3300 2568 2721 2723 2442 2844 2749 3009 3121 2985 2568 1222 45330 "Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)" 2666 2553 2780 2666 19 2586 1546 2352 2504 1627 1627 1627 1169 1421 19 1621 1277 2568 2286 259 1554 1627 1638 1846 1524 1670 1959 2077 2586 1818 1627 2338 2576 2090 1627 1723 1724 1547 1801 1741 1906 1977 1890 1627 774 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)" 2553 917 2917 2553 18 2490 1481 2252 2397 1557 1557 1557 2490 1360 18 599 1222 2458 2188 248 1488 1557 1568 1767 1459 1740 1875 1726 2476 1741 1557 2239 2466 2001 1557 1650 1651 1481 1725 1407 1825 1786 1905 1557 741 45380 "Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple" 3063 1021 4600 3063 22 2971 1776 2701 2876 1868 1868 1868 2457 1632 22 1862 558 2950 2625 297 1785 1868 1881 2120 2554 1919 2250 2302 2971 2088 1868 2686 2959 2401 1868 1979 1981 1777 2069 2563 2189 2000 2550 1868 889 45384 "Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery" 2778 1277 3647 2778 20 2695 1611 2450 2608 1695 1695 1695 1217 1480 20 1688 1330 2675 2381 270 1619 1695 1706 1923 1587 1740 2040 1964 2695 1894 1695 2436 2684 2178 1695 1795 1797 1611 1877 1814 1986 2059 1969 1695 806 45385 "Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique" 2917 1277 4600 2917 21 2829 1692 2573 2695 1779 1779 1779 2425 1554 21 1773 1397 2809 2500 283 1700 1779 1791 2019 1667 1827 2143 2272 2829 1989 1779 2558 2818 2286 1779 1885 1886 1692 1970 1905 2085 1898 2245 1779 847 45388 PR COLONOSCOPY W ABLATION 2105 2105 2105 2105 15 2042 1221 1857 1977 1284 1284 1284 1212 1121 15 1279 1008 2027 1804 204 1227 1284 1293 1457 1203 1319 1546 1639 2042 1435 1284 1846 2034 1650 1284 1360 1361 1221 1422 1375 1505 1561 1492 1284 611 46083 "Incision of thrombosed hemorrhoid, external" 307 307 307 307 2 3747 178 271 288 187 187 187 3747 164 2 187 147 296 263 30 179 187 189 213 175 192 225 239 298 209 187 269 297 241 187 198 199 178 207 200 219 228 218 187 89 46221 "Hemorrhoidectomy, internal, by rubber band ligation(s)" 2431 2431 2431 2431 17 2358 1410 2144 2283 1483 1483 1483 1066 1295 17 1478 1164 2341 2084 236 1417 1483 1493 1683 1389 1523 1786 1894 2358 1658 1483 2132 2349 1906 1483 1571 1572 1410 1642 1588 1738 1802 1724 1483 706 47562 "Laparoscopy, surgical; cholecystectomy" 11284 2 16034 11284 81 13101 6544 9952 10595 6883 6883 6883 8547 6012 81 6859 5403 10866 9672 1096 6577 6883 6930 7811 6448 7069 8288 7828 10945 7693 6883 13101 10901 8845 6883 7292 7297 6545 7622 7368 8066 8542 7877 6883 3275 49320 "Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)" 13131 10745 15503 13131 94 13502 7615 13502 12330 8010 8010 8010 6552 6996 94 7981 6288 12645 11255 1275 7654 8010 8064 9090 7504 8226 9645 10226 12737 8953 8010 11515 12685 10293 8010 8486 8492 7616 8870 8574 9386 9735 9309 8010 3811 49321 "Laparoscopy, surgical; with biopsy (single or multiple)" 12395 12395 12395 12395 89 12023 7188 10932 11638 7561 7561 7561 5432 6604 89 7534 5935 11936 10624 1203 7225 7561 7612 8580 7083 7765 9104 10641 12023 8451 7561 10870 11974 9716 7561 8010 8016 7189 8373 8094 8860 9189 8787 7561 3598 49322 "Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)" 13254 13254 13254 13254 95 12856 7686 11690 12445 8085 8085 8085 5809 7061 95 8056 6347 12763 11360 1287 7725 8085 8140 9175 7574 8303 9735 10322 12856 9037 8085 11623 12804 10389 8085 8565 8571 7687 8953 8655 9474 9826 9396 8085 3847 49505 "Repair initial inguinal hernia, age 5 years or older; reducible" 8948 8133 11935 8948 64 8680 5189 7892 8402 5458 5458 5458 6755 4767 64 5439 4285 8617 7670 869 5216 5458 5495 6194 5113 5606 6572 7332 8680 6101 5458 7847 8644 7014 5458 5782 5787 5190 6044 5843 6396 6634 6879 5458 2597 49507 "Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated" 10578 10578 10578 10578 76 10261 6135 9329 9932 6453 6453 6453 4636 5636 76 6429 5065 10186 9067 1027 6166 6453 6496 7322 6045 6627 7770 8238 10261 7212 6453 9276 10219 8292 6453 6836 6841 6135 7145 6907 7561 7842 7499 6453 3070 49521 "Repair recurrent inguinal hernia, any age; incarcerated or strangulated" 8948 8948 8948 8948 64 8680 5189 7892 8402 5458 5458 5458 3921 4767 64 5439 4285 8617 7670 869 5216 5458 5495 6194 5113 5606 6572 6969 8680 6101 5458 7847 8644 7014 5458 5782 5787 5190 6044 5843 6396 6634 6344 5458 2597 49550 "Repair initial femoral hernia, any age; reducible" 8541 8541 8541 8541 61 8285 4953 7533 8020 5210 5210 5210 7386 4550 61 5191 4090 8225 7321 829 4978 5210 5245 5912 4881 5351 6273 6652 8285 5823 5210 7490 8251 6695 5210 5519 5523 4954 5769 5577 6105 6332 6055 5210 2479 49560 Repair initial incisional or ventral hernia; reducible 7144 1 7744 7144 51 6929 4903 6300 6707 4358 4358 4358 3377 3806 51 4342 3421 6879 6123 694 4164 4358 4387 4945 4082 4475 5247 5563 6929 4870 4358 6265 6901 5599 4358 4616 4620 4143 4825 4665 5106 5296 5064 4358 2073 49561 Repair initial incisional or ventral hernia; incarcerated or strangulated 9172 1 10253 9172 1 10089 5319 8090 8613 5595 5595 5595 4020 4887 66 5575 4392 8833 7862 891 5346 5595 5633 6349 5242 5746 10089 1 8897 6254 5595 8044 8861 7190 5595 5928 5932 5320 6196 5989 6556 6800 6503 5595 2662 49566 Repair recurrent incisional or ventral hernia; incarcerated or strangulated 12400 12400 12400 12400 89 12028 7191 10936 11643 7564 7564 7564 5434 6606 89 7537 5938 11941 10628 1204 7228 7564 7615 8583 7086 7768 9108 9657 12028 8454 7564 10874 11979 9720 7564 8013 8019 7192 8376 8097 8863 9193 8791 7564 3599 49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) 1 1 1 1 0 3377 1 1 1 1 1 1 3377 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 49585 "Repair umbilical hernia, age 5 years or older; reducible" 7745 1 8541 7745 1 7513 4492 6831 7272 4724 4724 4724 6711 4126 56 4707 3709 7458 6638 752 4514 4724 4756 5361 4426 4852 5689 7332 7513 5281 4724 6792 7482 6071 4724 5005 5009 4492 5232 5057 5536 1 5562 4724 2248 49587 "Repair umbilical hernia, age 5 years or older; incarcerated or strangulated" 8133 8133 11393 8133 58 9148 4717 7173 7637 4961 4961 4961 6755 4333 58 4943 3894 7832 6971 790 4740 4961 4995 5630 4648 5095 5974 9148 7889 5545 4961 7132 7857 6375 4961 5256 5260 4717 5494 5311 5813 6029 5766 4961 2361 49591 Repair AA HRN 1ST < 3 CM RDC 9142 9142 9142 9142 66 8938 5302 8063 8584 5577 5577 5577 8938 4871 66 5557 4378 8803 7836 888 5329 5577 5614 6328 5224 5727 6715 7120 8868 6233 5577 8017 8832 7166 5577 5908 5912 5302 6175 5970 6534 6778 6481 5577 2653 49592 Repair AA HRN 1ST <3 NCR/STR 8211 8211 8211 8211 59 7965 4762 7242 7710 5009 5009 5009 3598 4375 59 4991 3932 7907 7038 797 4786 5009 5043 5684 4692 5144 6031 6395 7965 5598 5009 7201 7932 6436 5009 5306 5310 4762 5546 5362 5869 6087 5821 5009 2383 49593 Repair AA HRN 1ST < 3 NCR/STRN 2 2 2 2 0 8938 1 2 2 1 1 1 8938 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 50386 "Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation" 13653 13653 13653 13653 98 13243 7918 12042 12820 8328 8328 8328 5983 7274 98 8298 6538 13147 11702 1326 7958 8328 8385 9451 7802 8553 10028 10633 13243 9309 8328 11973 13190 10702 8328 8823 8829 7919 9222 8915 9759 10122 9679 8328 3963 50590 "Lithotripsy, extracorporeal shock wave" 6685 6367 15968 6685 48 10376 3877 6809 6277 4078 4078 4078 6838 3562 48 4063 3201 9966 5730 649 3896 4078 4105 4627 3820 4188 4910 4726 6484 4558 4078 5862 6458 5240 4078 4320 4323 3877 4516 4078 7128 5237 10376 4078 1940 51700 "Bladder irrigation, simple, lavage and/or instillation" 132 132 132 132 1 128 77 116 124 81 81 81 58 70 1 80 63 127 113 13 77 81 81 91 75 83 97 103 128 90 81 116 128 103 81 85 85 77 89 86 94 98 94 81 38 51701 "Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)" 116 1 482 116 1 297 67 102 109 71 71 71 51 62 1 71 56 158 99 11 68 71 71 80 66 73 297 39 113 79 71 102 112 91 71 75 75 67 78 76 83 86 90 71 34 51702 "Insertion of temporary indwelling bladder catheter; simple (eg, Foley)" 243 231 365 243 2 240 155 214 228 148 148 148 106 129 2 148 116 234 208 24 142 148 149 200 139 152 240 93 236 166 148 213 235 190 148 157 157 141 164 159 174 180 172 148 71 51798 "Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging" 38 1 75 38 0 39 22 34 36 23 23 23 17 20 0 26 18 1 33 4 22 23 23 15 22 24 39 34 37 26 23 33 37 30 23 25 25 22 26 25 27 28 22 23 11 52000 Cystourethroscopy (separate procedure) 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 52310 "Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple" 1 1 1 1 0 1206 1 1 1 1 1 1 1206 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 52332 "Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)" 1 1 1 1 0 844 1 1 1 1 1 1 844 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 56405 Incision and drainage of vulva or perineal abscess 570 570 570 570 4 553 331 503 535 348 348 348 250 304 4 346 273 549 489 55 332 348 350 395 326 357 419 444 553 389 348 500 551 447 348 368 369 331 385 372 407 423 404 348 165 56420 Incision and drainage of Bartholin's gland abscess 500 50 5255 500 4 485 290 441 469 305 305 305 219 266 4 304 239 481 429 49 291 305 307 346 286 313 367 389 485 341 305 438 483 392 305 323 323 290 338 326 357 371 354 305 145 56620 Vulvectomy simple; partial 5255 5255 5255 5255 38 5117 3048 4635 4934 3206 3206 3206 5117 2800 38 3194 2516 5060 4504 510 3063 3206 3227 3638 3003 3292 3860 4093 5097 3583 3206 4608 5077 4119 3206 3396 3398 3048 3550 3431 3756 3896 3726 3206 1525 57288 "Sling operation for stress incontinence (eg, fascia or synthetic)" 16835 10172 22617 16835 121 16330 9763 14848 10902 10269 10269 10269 4379 8969 121 10024 8061 16211 14430 1635 9813 10269 10339 14280 9620 10546 12365 15408 16330 11478 10269 14764 16264 13196 10269 10879 10887 9764 11372 10993 12033 12481 11935 10269 4886 57454 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage 10071 10071 10071 10071 72 9769 5841 8882 9456 6143 6143 6143 4414 5366 72 6121 4822 9698 8632 978 5870 6143 6185 7130 5755 6309 7397 7843 9769 6866 6143 8832 9729 7894 6143 6508 6513 5841 6803 6576 7198 7466 7140 6143 2923 57520 "Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser" 5194 5194 5520 5194 37 5038 3012 4581 4877 3168 3168 3168 2276 2767 37 3157 2487 5002 4452 504 3027 3168 3190 3595 2968 3254 3815 4045 5038 3541 3168 4555 5018 4071 3168 3356 3359 3013 3508 3392 3713 3851 3802 3168 1508 57522 "Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision" 5795 5795 5795 5795 42 5621 3361 5111 5441 3535 3535 3535 2540 3087 42 3522 2775 5580 4967 563 3378 3535 3559 4011 3312 3630 4256 4513 5621 3951 3535 5082 5598 4542 3535 3745 3748 3361 3914 3784 4142 4296 96 3535 1682 58110 Endometrial sampling (biopsy) performed in conjunction with colposcopy (List separately in addition to code for primary procedure) 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 58150 "Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);" 28732 28732 28732 28732 206 27870 16663 25341 26978 17527 17527 17527 12592 15308 206 17464 13758 27668 24627 2790 16747 17527 17645 20342 16419 17999 21104 22376 27870 19590 17527 25197 27757 22522 17527 18567 18581 16665 19408 18761 20537 21301 20370 17527 8339 58300 Insertion of intrauterine device (IUD) 3252 1 7316 3252 23 3154 1886 2868 3053 1983 1983 1983 311 1732 23 1976 1557 3131 2787 316 1895 1983 1997 2251 1858 2037 2388 2532 3154 2217 1983 2851 3141 2549 1983 2101 2103 1886 2196 2123 2324 2411 2305 1983 944 58301 Removal of intrauterine device (IUD) 1 1 1 1 0 156 1 1 1 1 1 1 156 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography 82 1 162 82 1 121 47 72 77 50 50 50 36 43 1 50 39 78 70 8 48 50 50 1 47 51 60 63 79 56 50 71 79 64 50 53 53 47 55 53 58 60 121 50 24 58552 "Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)" 15728 1 20268 15728 1 15256 9121 13872 14768 9594 9594 9594 12248 8380 113 9560 7531 15145 13481 1527 9167 9594 9659 1 8988 9853 11552 6906 15256 10723 9594 13793 15194 12328 9594 10164 10171 9122 10624 10270 11242 11660 12357 9594 4565 58555 "Hysteroscopy, diagnostic (separate procedure)" 1 1 1 1 0 5687 1 1 1 1 1 1 5687 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 58558 "Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C" 7909 1 9142 7909 1 7672 4587 6975 7426 4824 4825 4824 5513 4214 57 4807 3787 4900 6779 768 4610 4824 4857 1 4520 4955 5809 6979 7672 5392 4824 6936 7641 6199 4824 5111 5115 4587 5342 5164 5653 5863 5198 4824 2296 58563 "Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)" 7930 1 12393 7930 0 7692 4599 6994 7446 4837 4837 4837 5168 4225 57 0 3797 7636 6797 770 4622 4837 4870 5489 4531 4968 5824 7332 7692 5406 4837 6954 7660 6216 4837 5124 5128 4599 5356 5178 5668 5879 5622 4837 2301 58661 "Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)" 11935 1 13920 11935 0 11577 6922 10526 11207 7280 7280 7280 7195 6359 86 0 5715 11493 10230 1159 6957 7280 7330 8262 6820 7477 8766 9295 11577 8137 7280 10466 11530 9355 7280 7713 7718 6922 8062 7793 8531 8848 9613 7280 3464 58662 "Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method" 11804 10746 13920 11804 85 11450 6846 10411 11084 7200 7200 7200 7556 6289 85 7175 5652 11367 10117 1146 6880 7200 7249 8171 6745 7395 8670 9193 11450 8048 7200 10352 11403 9253 7200 7628 7634 6846 7973 7708 8437 8751 8368 7200 3426 58670 "Laparoscopy, surgical; with fulguration of oviducts (with or without transection)" 11818 11240 12395 11818 85 11463 6853 10423 11096 7209 7209 7209 5179 6296 85 7183 5659 11380 10129 1147 6888 7209 7257 8180 6753 7403 8680 9203 11463 8057 7209 10363 11416 9263 7209 7637 7642 6854 7983 7717 8447 8761 9073 7209 3430 58925 "Ovarian cystectomy, unilateral or bilateral" 20172 20172 20172 20172 145 19567 11698 17791 18941 12305 12305 12305 8840 10747 145 12261 9659 19425 17290 1959 11758 12305 12388 13963 11527 12637 14817 15710 19567 13753 12305 17690 19487 15812 12305 13036 13045 11700 13626 13172 14418 14955 14301 12305 5855 62321 PR INJ INTERLAM C/T W IMG 82 82 730 82 1 80 48 72 77 50 50 50 36 44 1 50 39 79 70 8 48 50 50 57 47 51 60 64 80 56 50 72 79 64 50 53 53 48 55 54 59 61 58 50 24 62323 Injection of substance into spinal canal of lower back or sacrum using imaging guidance 105 100 937 105 1 102 88 93 99 64 64 64 46 83 1 64 50 101 90 10 61 64 64 73 60 66 77 82 102 72 64 92 101 82 64 68 68 61 71 69 75 78 67 64 30 64415 "Injection, anesthetic agent; brachial plexus, single" 511 486 537 511 4 496 296 451 480 312 312 312 224 272 4 311 245 492 438 50 298 312 314 354 292 320 375 398 496 348 312 448 494 401 312 330 330 296 345 334 365 379 362 312 148 64420 "Injection, anesthetic agent; intercostal nerve, single" 157 63 251 157 1 152 91 138 147 96 96 96 69 84 1 95 75 151 135 15 92 96 96 109 90 98 115 122 152 107 96 138 152 123 96 101 102 91 106 103 112 116 111 96 46 64447 "Injection, anesthetic agent; femoral nerve, single" 394 394 394 394 3 382 228 347 370 240 240 240 173 210 3 239 189 379 338 38 230 240 242 273 225 247 289 307 382 269 240 346 381 309 240 255 255 229 266 257 282 292 279 240 114 64450 "Injection, anesthetic agent; other peripheral nerve or branch" 335 26 370 335 2 727 194 295 315 204 204 204 727 178 2 204 160 323 287 33 195 204 206 232 191 210 246 261 325 228 204 294 324 263 204 216 217 194 226 219 239 248 237 204 97 64454 PR NJX AA&/STRD GNCLR NRV BRNCH 901 858 901 901 6 874 523 795 846 550 550 550 395 480 6 548 431 868 772 87 525 550 553 624 515 564 662 724 874 614 550 790 870 706 550 582 583 523 609 588 644 668 639 550 262 64483 "Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level" 106 72 1018 106 1 240 62 94 100 65 65 65 47 81 1 65 51 103 91 10 62 65 65 74 240 67 78 83 103 73 65 93 103 83 65 69 69 62 72 48 76 79 48 65 31 64484 "Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)" 29 27 248 29 0 88 17 26 27 18 18 18 13 15 0 18 14 28 25 3 17 18 18 20 88 18 21 23 28 20 18 25 28 23 18 19 19 17 20 18 21 21 18 18 8 64490 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level" 98 67 596 98 1 95 57 86 92 59 59 59 43 52 1 59 47 94 84 9 57 59 60 67 56 61 72 76 95 66 59 86 94 76 59 63 63 57 66 67 70 72 64 59 28 64491 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)" 48 33 293 48 0 47 28 43 46 30 30 30 21 26 0 29 23 47 42 5 28 30 30 34 28 30 36 38 47 33 30 43 47 38 30 31 31 28 33 34 35 36 31 30 14 64492 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)" 89 89 356 89 1 86 52 78 84 54 54 54 39 47 1 54 43 86 76 9 52 54 55 62 51 56 65 69 86 61 54 78 86 70 54 58 58 52 60 58 64 66 54 54 26 64493 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level" 131 76 1742 131 1 127 76 116 123 80 80 80 57 70 1 80 63 126 112 13 76 80 80 91 75 82 96 102 127 89 80 115 127 103 80 85 85 76 88 76 94 97 51 80 38 64494 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)" 76 48 677 76 1 74 44 67 71 46 46 46 33 40 1 46 36 73 65 7 44 46 47 53 43 48 56 59 74 52 46 67 73 60 46 49 49 44 51 48 54 56 32 46 22 64495 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)" 193 128 424 193 1 187 112 170 181 118 118 118 85 103 1 117 92 186 165 19 112 118 119 134 110 121 142 150 187 132 118 169 186 151 118 125 125 112 130 126 138 143 137 118 56 64615 PBB CHEMODENERV MUSC MIGRAINE 291 36 381 291 2 282 76 257 273 178 178 178 128 155 2 177 139 280 249 28 170 178 179 201 166 182 214 227 282 198 178 255 281 228 178 188 188 169 197 190 208 216 206 178 84 64633 PBB DESTROY CERV/THOR FACET JNT 192 173 1629 192 1 186 111 169 180 117 117 117 84 102 1 117 92 185 165 19 112 117 118 133 110 120 141 150 186 131 117 168 185 150 117 124 124 111 130 182 137 142 116 117 56 64634 PBB DESTROY C/TH FACET JNT ADDL 255 230 2172 255 2 247 148 225 239 156 156 156 112 136 2 155 122 246 219 25 149 156 157 177 146 160 187 199 247 174 156 224 246 200 156 165 165 148 172 243 182 189 154 156 74 64635 PBB DESTROY LUMB/SAC FACET JNT 462 302 3322 462 3 448 202 407 434 282 282 282 202 209 3 281 221 445 396 45 269 282 284 320 264 289 339 360 448 315 282 405 446 362 282 299 299 268 312 213 330 343 328 282 134 64636 PBB DESTROY L/S FACET JNT ADDL 72 68 962 72 1 70 46 64 68 44 44 44 32 56 1 44 34 69 62 7 42 44 44 50 41 45 53 56 70 49 44 63 70 56 44 47 47 42 49 48 51 53 51 44 21 64704 Neuroplasty; nerve of hand or foot 2 1 20249 2 0 1706 1 2 2 1 1 1 1706 1 0 0 1 2 2 0 1 1 1 1 1 1 1 1 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 64708 "Neuroplasty, major peripheral nerve, arm or leg, open; other than specified" 2 1 21283 2 0 8493 1 2 2 1 1 1 1736 1 0 8493 1 2 2 0 1 1 1 1 1 1 1 1 2 1 1 2 2 2 1 1 1 1 1 1 1 1 6416 1 1 64718 Neuroplasty and/or transposition; ulnar nerve at elbow 6092 6092 6092 6092 44 5909 3533 5373 5720 3716 3716 3716 3156 3246 44 3703 2917 5866 5222 591 3551 3716 3741 4217 3481 3816 4475 4744 5909 4154 3716 5342 5885 4775 3716 3937 3940 3533 4115 3978 4354 4516 4319 3716 1768 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 7318 2 10746 7318 52 7889 7889 6454 6871 4464 4464 4464 3413 3899 52 4448 3504 7047 6272 711 4265 4464 4494 5066 4182 5140 5375 6598 7098 4989 4464 6418 7070 5736 4464 4729 4732 4244 4943 4778 5231 5425 5625 4464 2124 64774 "Excision of neuroma; cutaneous nerve, surgically identifiable" 6092 1768 19209 6092 44 5909 3533 5373 5720 3716 3716 3716 2670 3246 44 3703 2917 5866 5222 591 3551 3716 3741 4217 3481 3816 4475 4744 5909 4154 3716 5342 5885 4775 3716 3937 3940 3533 4115 3978 4354 4516 4319 3716 1768 64782 "Excision of neuroma; hand or foot, except digital nerve" 5676 5676 5676 5676 41 5506 3292 5006 5330 3462 3462 3462 2487 3024 41 3450 2718 5466 4865 551 3308 3462 3486 3929 3244 3556 4169 4420 5506 3870 3462 4978 5483 4449 3462 3668 3671 3292 3834 3706 4057 4208 4024 3462 1647 64784 "Excision of neuroma; major peripheral nerve, except sciatic" 5968 2 11933 5968 43 5788 3461 5263 5603 3640 3640 3640 2482 3179 43 3627 2857 5746 5115 579 3478 3640 3665 4131 3410 3738 4383 4647 5788 4069 3640 5233 5765 4678 3640 3856 3859 3461 4031 3897 4265 4424 4231 3640 1732 64787 Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision) 2 1 2 2 0 1628 1 2 2 1 1 1 1628 1 0 1 1 2 2 0 1 1 1 1 1 1 1 2 2 1 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 66850 "Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration" 6829 6829 6829 6829 49 6624 3960 6023 6412 4166 4166 4166 2993 3638 49 4151 3270 6576 5853 663 3980 4166 4194 4727 3902 4278 5016 5318 6624 4656 4166 5989 6597 5353 4166 4413 4416 3961 4613 4459 4881 5063 4841 4166 1982 66982 "Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage" 6193 6193 8211 6193 44 6007 4149 5337 5815 3778 3778 3778 4123 3299 44 3764 2965 5964 5308 601 3610 3778 3803 4287 3539 3880 4549 4823 6007 4222 3778 5431 5983 4854 3778 4002 4005 3592 4183 3778 4427 4591 3778 3778 1797 66984 "Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)" 6829 6193 7644 6829 49 7013 6308 4732 6412 4166 3778 4166 4472 4359 49 4151 3270 6576 5853 663 3980 4166 4194 4375 3902 4278 7013 6188 6624 4656 4166 5989 6597 5353 4166 4413 4416 3961 4613 4575 4881 5329 5595 4166 1982 66991 XCAPSL CTRC RMVL INSJ 1+ 7280 7280 7280 7280 52 7062 4222 6421 6836 4441 4441 4441 3190 3879 52 4425 3486 7010 6240 707 4243 4441 4471 5039 4160 4561 5347 5670 7062 4964 4441 6384 7033 5706 4441 4705 4708 4222 4918 4754 5204 5397 5161 4441 2113 69000 "Drainage external ear, abscess or hematoma; simple" 84 84 756 84 1 273 49 74 79 51 51 51 273 45 1 51 40 81 72 8 49 51 52 58 48 53 62 36 81 57 51 74 81 66 51 54 54 49 57 55 60 62 60 51 24 69100 Biopsy external ear 5255 5255 5255 5255 38 5097 3048 4635 4934 3206 3206 3206 1451 2800 38 3194 2516 5060 4504 510 3063 3206 3227 3638 3003 3292 3860 4093 5097 3583 3206 4608 5077 4119 3206 3396 3398 3048 3550 3431 3756 3896 3726 3206 1525 69200 Removal foreign body from external auditory canal; without general anesthesia 71 69 122 71 1 69 41 63 67 43 43 43 31 38 1 43 34 68 61 7 41 43 44 49 41 44 52 49 69 48 43 62 69 56 43 46 46 41 48 46 51 53 50 43 21 69210 "Removal impacted cerumen (separate procedure), 1 or both ears" 158 158 158 158 1 268 92 139 148 96 96 96 268 84 1 96 76 152 135 15 92 96 97 109 90 99 116 123 153 108 96 139 153 124 96 102 102 92 107 103 113 117 112 96 46 69436 "Tympanostomy (requiring insertion of ventilating tube), general anesthesia" 4486 4376 4595 4486 32 4351 2601 3956 4212 2736 2736 2736 1966 2390 32 2726 2148 4319 3845 435 2614 2736 2755 3105 2563 2808 3295 3493 4351 3058 2736 3934 4333 3516 2736 2899 2901 2602 3030 2929 3206 3325 3180 2736 1302 70030 "Radiologic examination, eye, for detection of foreign body" 101 96 101 101 1 98 59 89 95 62 62 62 44 54 1 61 48 97 87 10 59 62 62 70 58 63 74 75 98 69 62 89 98 79 62 65 65 59 68 66 72 75 72 62 29 70110 "Radiologic examination, mandible; complete, minimum of 4 views" 215 204 226 215 2 209 125 190 202 131 131 131 65 115 2 131 103 207 184 21 125 131 132 149 123 135 149 167 209 147 131 189 208 169 131 139 139 125 145 140 154 159 152 131 62 70150 "Radiologic examination, facial bones; complete, minimum of 3 views" 220 209 243 220 2 213 128 194 207 134 134 134 96 117 2 134 105 212 189 21 128 134 135 152 126 138 162 172 213 150 134 193 213 172 134 142 142 128 149 144 157 163 156 134 64 70160 "Radiologic examination, nasal bones, complete, minimum of 3 views" 191 191 201 191 1 185 111 168 179 117 117 117 62 102 1 116 91 184 164 19 111 117 117 132 109 120 140 124 185 130 117 167 185 150 117 123 124 111 129 125 137 145 135 117 55 70220 "Radiologic examination, sinuses, paranasal, complete, minimum of 3 views" 365 365 365 365 3 354 212 322 343 223 223 223 73 194 3 222 175 351 313 35 213 223 224 253 209 229 268 284 354 249 223 320 353 286 223 236 236 212 247 238 261 271 259 223 106 70250 "Radiologic examination, skull; less than 4 views" 193 183 193 193 1 187 112 170 181 118 118 118 85 103 1 117 92 186 165 19 112 118 119 134 110 121 142 165 187 132 118 169 186 151 118 125 125 112 130 126 138 143 137 118 56 70260 "Radiologic examination, skull; complete, minimum of 4 views" 280 280 280 280 2 272 162 247 263 171 171 171 123 149 2 170 134 270 240 27 163 171 172 194 160 175 206 225 272 191 171 246 270 219 171 181 181 162 189 183 200 208 199 171 81 70330 "Radiologic examination, temporomandibular joint, open and closed mouth; bilateral" 239 227 251 239 2 232 139 211 224 146 146 146 65 127 2 145 114 230 205 23 139 146 147 165 137 150 176 193 232 163 146 210 231 187 146 154 155 139 161 156 171 177 169 146 69 70360 "Radiologic examination; neck, soft tissue" 122 122 122 122 1 118 71 108 115 74 74 74 53 65 1 74 58 117 105 12 71 74 75 84 70 76 90 95 118 83 74 107 118 96 74 79 79 71 82 80 87 90 86 74 35 70450 "Computed tomography, head or brain; without contrast material" 1775 1532 1864 1775 13 1740 1078 1639 1667 1083 1083 1083 993 946 13 1148 850 1740 1521 172 1035 1083 1090 628 1126 1112 1132 1366 1722 1210 1083 1722 1715 1584 1083 1147 1148 1030 1199 1081 1299 1261 1261 1083 515 70460 "Computed tomography, head or brain; with contrast material(s)" 1765 1765 1765 1765 13 1712 1024 1557 1657 1077 1077 1077 774 940 13 1073 845 1700 1513 171 1029 1077 1084 1222 1009 1106 1296 1253 1712 1203 1077 1548 1705 1383 1077 1141 1141 1024 1192 1153 1262 1309 1251 1077 512 70470 "Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections" 2063 1870 2063 2063 15 2001 1196 1819 1937 1258 1258 1258 1042 1099 15 1254 988 1987 1768 200 1202 1258 1267 1428 1179 1292 1515 1607 2001 1407 1258 1809 1993 1617 1258 1333 1334 1197 1394 1347 1475 1529 1463 1258 599 70480 "Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material" 1738 1738 1825 1738 12 1686 1008 1533 1632 1060 1060 1060 457 926 12 1056 832 1674 1490 169 1013 1060 1067 1203 993 1089 1277 1354 1686 1185 1060 1524 1679 1362 1060 1123 1124 1008 1174 1135 1242 1288 1336 1060 504 70486 "Computed tomography, maxillofacial area; without contrast material" 1905 1727 2001 1905 14 1848 621 1680 1789 1162 1162 1162 424 1015 14 1158 912 1834 1633 185 1110 1162 1170 1349 1089 1193 1399 1457 1848 1299 1162 1671 1840 1701 1162 1231 1232 1105 1287 1276 1362 1394 1353 1162 553 70487 "Computed tomography, maxillofacial area; with contrast material(s)" 1982 1887 2082 1982 14 1923 1149 1748 1861 1209 1209 1209 993 1056 14 1205 949 1909 1699 192 1155 1209 1217 1372 1133 1242 1456 1544 1923 1351 1209 1738 1915 1554 1209 1281 1282 1150 1339 1328 1417 1469 1524 1209 575 70491 "Computed tomography, soft tissue neck; with contrast material(s)" 2018 1829 2119 2018 14 1957 1170 1780 1895 1231 1231 1231 914 1075 14 1305 966 1943 1730 196 1176 1231 1239 1429 1153 1264 1482 1552 1957 1376 1231 1770 1950 1582 1231 1304 1305 1170 1363 1314 1442 1496 1460 1231 586 70492 "Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections" 2030 2030 2030 2030 15 1969 1177 1790 1906 1238 1238 1238 890 1082 15 1234 972 1955 1740 197 1183 1238 1247 1405 1160 1272 1491 1581 1969 1384 1238 1780 1961 1591 1238 1312 1313 1177 1371 1326 1451 1505 1439 1238 589 70496 "Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 1985 1714 2085 1985 14 1925 1151 1751 1864 1211 1211 1211 564 1058 14 1284 950 1911 1701 193 1157 1211 1219 1374 1134 1244 1458 1412 1925 1353 1211 1741 1918 1556 1211 1283 1284 1151 1341 1330 1419 1472 1410 1211 576 70498 "Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2063 1781 2167 2063 15 2001 1196 1819 1937 1258 1258 1258 376 1099 15 1334 988 1987 1768 200 1202 1258 1267 1428 1179 1292 1515 1466 2001 1407 1258 1809 1993 1617 1258 1333 1334 1197 1394 1382 1475 1529 1465 1258 599 70543 "Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences" 2896 2825 2967 2896 21 2809 1679 2554 2719 1767 1767 1767 1269 1543 21 1760 1387 2789 2482 281 1688 1767 1778 2005 1655 1814 2127 2255 2809 1974 1767 2540 2798 2270 1767 1871 1873 1680 1956 1891 2070 2147 2053 1767 841 70544 "Magnetic resonance angiography, head; without contrast material(s)" 2528 2466 2720 2528 18 2452 1466 2230 2374 1542 1542 1542 676 1347 18 1537 1211 2434 2167 245 1473 1542 1553 1750 1445 1584 1857 1969 2452 1724 1542 2217 2442 1982 1542 1634 1635 1466 1708 1651 1807 1874 1504 1542 734 70549 "Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences" 3227 3227 3227 3227 23 3130 1871 2846 3030 1968 1968 1968 1414 1719 23 1961 1545 3107 2766 313 1881 1968 1982 2234 1844 2022 2370 2513 3130 2200 1968 2830 3117 2529 1968 2085 2087 1872 2180 2107 2307 2392 2288 1968 937 70551 "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" 2879 2741 3023 2879 21 2793 1670 2539 2703 1756 1756 1756 891 1534 21 1750 1379 2772 2468 280 1678 1756 1768 1993 1746 1804 1895 2215 2793 1963 1756 2525 2781 2257 1756 1860 1862 1670 1945 1799 2058 2134 2107 1756 836 70553 "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences" 3233 3079 3565 3233 23 3136 2317 2851 3036 1972 1972 1972 1225 1722 23 1965 1548 3113 2771 314 1884 1972 1985 2289 1847 2025 2197 2546 3136 2204 1972 2835 3123 2534 1972 2089 2091 1875 2184 2166 2311 2397 2610 1972 938 71045 PR X-RAY EXAM CHEST 1 VIEW 237 71 249 237 2 230 162 209 223 145 145 145 69 152 2 144 113 228 203 23 138 145 146 168 150 148 228 201 230 162 145 230 229 186 145 153 153 137 160 159 169 173 173 145 69 71046 PR X-RAY EXAM CHEST 2 VIEWS 269 232 283 269 2 275 275 232 216 164 148 164 73 178 2 174 174 264 231 26 157 164 165 190 171 169 171 229 248 183 164 261 251 241 164 174 174 156 182 176 197 197 197 164 78 71100 "Radiologic examination, ribs, unilateral; 2 views" 218 120 229 218 2 211 126 26 205 133 133 133 73 116 2 133 104 210 187 21 127 133 134 151 125 137 118 139 211 149 133 191 211 171 133 141 141 126 147 146 156 154 154 133 63 71101 "Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views" 326 295 343 326 2 316 208 288 306 199 199 199 77 174 2 198 156 314 279 32 190 199 200 226 186 204 137 195 316 222 199 286 315 256 199 211 211 189 220 218 233 245 235 199 95 71110 "Radiologic examination, ribs, bilateral; 3 views" 257 244 270 257 2 249 149 249 241 157 157 157 65 137 2 156 123 247 220 25 150 157 158 178 147 161 189 213 249 175 157 225 248 201 157 166 166 149 174 168 184 191 188 157 75 71120 "Radiologic examination; sternum, minimum of 2 views" 213 197 229 213 2 207 124 188 200 130 130 130 93 113 2 129 102 205 183 21 124 130 131 147 122 133 156 140 207 145 130 187 206 167 130 138 138 124 144 139 152 158 151 130 62 71130 "Radiologic examination; sternoclavicular joint or joints, minimum of 3 views" 168 164 173 168 1 163 98 149 158 103 103 103 73 90 1 102 81 162 144 16 98 103 103 117 96 106 124 131 163 115 103 148 163 132 103 109 109 98 114 110 120 125 119 103 49 71250 "Computed tomography, thorax; without contrast material" 1825 1655 1917 1825 13 1770 1164 1686 1714 1113 1113 1113 385 972 13 1240 874 1703 1564 177 1064 1113 1121 1263 1043 1143 1203 1404 1770 1244 1113 190 1703 1431 1113 1179 1180 1058 1233 1141 1304 1353 1336 1113 530 71260 "Computed tomography, thorax; with contrast material(s)" 1928 1748 2025 1928 14 2063 662 1870 1810 1176 1176 1176 914 1027 14 1297 923 1857 1653 187 1124 1176 1184 1335 1102 1208 1340 1483 1870 1315 1176 1691 2063 1511 1176 1246 257 1118 1302 1230 1378 1429 1411 1176 560 71270 "Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections" 1980 1931 2028 1980 14 1920 1148 1746 1859 1207 1207 1207 868 1055 14 1203 948 1906 1697 192 1154 1207 1216 1370 1131 1240 1454 1542 1920 1350 1207 1736 1912 1552 1207 1279 1280 1148 1337 1293 1415 1468 1403 1207 575 71271 HC CT THORAX LUNG CANCER SCREEN 574 73 603 574 4 557 366 506 539 350 350 350 385 306 4 349 275 553 492 56 335 350 353 397 367 359 371 490 557 391 350 503 535 450 350 371 371 333 388 385 410 414 420 350 167 71275 "Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2378 2053 2497 2378 17 2307 1445 2097 2233 1451 1451 1451 762 1365 17 1445 1139 2290 2038 231 1386 1451 1460 1510 1359 1490 1710 1973 2307 1621 1451 2085 2297 1061 1451 1537 1538 1379 1606 1593 1700 1741 1935 1451 690 71550 "Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)" 2917 2917 2917 2917 21 2829 1692 2573 2739 1779 1779 1779 807 1554 21 1773 1397 2809 2500 283 1700 1779 1791 2019 1667 1827 2143 2272 2829 1989 1779 2558 2818 2286 1779 1885 1886 1692 1970 1905 2085 2163 2068 1779 847 71552 "Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences" 3848 3848 3848 3848 28 3733 2232 3394 3613 2347 2347 2347 1077 2050 28 2339 1843 3705 3298 374 2243 2347 2363 2664 2199 2411 2826 2997 3733 2624 2347 3375 3717 3016 2347 2487 2488 2232 2599 2513 2750 2853 2728 2347 1117 72040 "Radiologic examination, spine, cervical; 2 or 3 views" 290 68 305 290 2 281 160 28 272 177 177 177 69 155 2 168 139 270 249 28 169 177 178 201 166 182 176 223 281 198 177 254 270 227 177 187 188 168 196 185 207 212 209 177 84 72050 "Radiologic examination, spine, cervical; minimum of 4 views" 302 287 318 302 2 293 175 266 284 184 184 184 65 161 2 184 145 291 259 29 176 184 185 209 173 189 222 244 293 206 184 265 292 237 184 195 195 175 204 197 216 224 214 184 88 72052 "Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies" 317 317 317 317 2 307 184 280 298 193 193 193 139 169 2 193 152 305 272 31 185 193 195 219 181 199 233 247 307 216 193 278 306 248 193 205 205 184 214 207 227 235 225 193 92 72070 "Radiologic examination, spine; thoracic, 2 views" 221 221 221 221 2 214 128 195 208 135 135 135 65 118 2 134 106 213 189 21 129 135 136 153 126 138 162 172 214 151 135 194 213 173 135 143 143 128 149 144 158 164 157 135 64 72072 "Radiologic examination, spine; thoracic, 3 views" 294 280 309 294 2 285 171 259 276 179 179 179 81 157 2 179 141 274 252 29 171 179 181 198 168 184 216 226 285 200 179 258 284 230 179 190 190 171 199 188 210 215 215 179 85 72080 "Radiologic examination, spine; thoracolumbar, 2 views" 200 200 210 200 1 194 116 176 188 122 122 122 59 107 1 122 96 193 171 19 117 122 123 149 114 125 147 162 194 136 122 175 193 157 122 129 129 116 135 134 143 148 142 122 58 72082 PR X-RAY EXAM ENTIRE SPINE 2/3 VW 267 254 281 267 2 259 155 235 251 163 163 163 73 142 2 173 128 257 229 26 156 163 164 199 153 167 196 229 259 182 163 234 258 209 163 173 173 155 180 174 191 198 189 163 77 72100 "Radiologic examination, spine, lumbosacral; 2 or 3 views" 269 62 283 269 2 261 184 248 261 164 164 164 73 143 2 156 38 251 231 26 157 164 165 181 171 168 172 229 261 183 164 261 260 211 164 174 174 156 182 180 192 207 186 164 78 72110 "Radiologic examination, spine, lumbosacral; minimum of 4 views" 312 282 312 312 2 308 181 275 293 190 190 190 73 166 2 190 149 300 267 30 182 190 192 210 178 195 308 268 303 213 190 274 301 245 190 202 202 181 211 199 223 214 214 190 91 72125 "Computed tomography, cervical spine; without contrast material" 1825 286 1917 1825 13 1770 1058 1610 1714 1113 1113 1113 229 972 13 1109 874 1757 1564 177 1064 1113 1121 1292 1043 1143 364 1559 1770 1244 1113 1600 1763 1629 1113 1179 1180 1058 1233 1192 1304 1297 1336 1113 530 72128 "Computed tomography, thoracic spine; without contrast material" 1825 1738 1917 1825 13 1770 1058 1610 1714 1113 1113 1113 800 972 13 1109 874 1757 1564 177 1064 1113 1121 1263 1043 1143 1340 1421 1770 1244 1113 1600 1763 1431 1113 1179 1180 1058 1233 1192 1304 1403 1164 1113 530 72131 "Computed tomography, lumbar spine; without contrast material" 1825 1655 1917 1825 13 1802 1010 1610 1714 1113 1113 1113 800 972 13 1109 874 1757 1564 177 1064 1113 1121 1263 1043 1143 1802 1551 1770 1244 1113 1600 1763 1431 1113 1179 1180 1058 1233 1192 1304 1353 1294 1113 530 72132 "Computed tomography, lumbar spine; with contrast material" 1599 1599 1599 1599 11 1551 927 1410 1501 975 975 975 701 852 11 972 766 1540 1371 155 932 975 982 1107 914 1002 1174 1245 1551 1090 975 1402 1545 1253 975 1033 1034 927 1080 1044 1143 1185 1215 975 464 72141 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material" 2994 2715 2994 2994 21 2904 1736 2641 2811 1826 1826 1826 888 1853 21 1918 1434 2883 2566 291 1745 1826 1839 2072 1816 1876 1910 2437 2904 2041 1826 2626 2892 2347 1826 1935 1936 1737 2022 1910 2140 2220 2192 1826 869 72146 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material" 3185 3033 3345 3185 23 3089 1847 2809 2991 1943 1943 1943 891 1697 23 1936 1525 3067 2730 309 1856 1943 1956 2205 1820 1995 2339 2707 3089 2172 1943 2793 3077 2497 1943 2058 2060 1847 2151 2032 2277 2361 2074 1943 924 72148 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material" 3242 2940 3405 3242 23 3177 1970 2859 3044 1978 1978 1978 889 1727 23 1971 1552 3177 2779 315 1890 1978 1991 2244 1853 2029 1705 2494 3145 2210 1978 3145 3132 2541 1978 2095 2097 1880 2190 2172 2317 2373 2303 1978 941 72156 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical" 3216 3062 3377 3216 23 3152 1865 2836 3020 1962 1962 1962 557 1713 23 1955 1540 3152 2756 312 1875 1962 1975 2226 1838 2015 2362 2870 3120 2193 1962 2820 3107 2521 1962 2078 2080 1865 2172 2100 2299 2384 2327 1962 933 72157 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic" 3350 3190 3350 3350 24 3283 1943 2955 3146 2044 2044 2044 1225 1785 24 2036 1604 3283 2871 325 1953 2044 2057 2319 1914 2099 2461 2609 3249 2284 2044 2938 3236 2626 2044 2165 2166 1943 2263 2187 2394 2484 2424 2044 972 72158 "Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar" 3638 3299 3638 3638 26 3529 2110 3209 3416 2219 2219 2219 1225 1938 26 2211 1742 3503 3118 353 2120 2219 2234 2518 2079 2279 2672 3123 3529 2480 2219 3190 3515 2852 2219 2351 2353 2110 2457 2376 2600 2697 2579 2219 1056 72170 "Radiologic examination, pelvis; 1 or 2 views" 197 187 207 197 1 191 114 174 185 120 120 120 90 105 1 120 94 190 169 19 115 120 121 136 113 123 145 153 191 134 120 173 190 154 120 127 127 114 133 125 141 146 152 120 57 72190 "Radiologic examination, pelvis; complete, minimum of 3 views" 203 203 203 203 1 197 118 179 191 124 124 124 89 108 1 123 97 195 174 20 118 124 125 141 116 127 149 158 197 138 124 178 196 159 124 131 131 118 137 133 145 150 144 124 59 72192 "Computed tomography, pelvis; without contrast material" 1922 1742 2019 1922 14 1864 1115 1695 1805 1172 1172 1172 480 1024 14 1168 920 1851 1647 187 1120 1172 1180 1330 1098 1204 1273 1497 1864 1310 1172 1686 1857 1507 1172 1242 1243 1115 1298 1255 1374 1425 1363 1172 558 72193 "Computed tomography, pelvis; with contrast material(s)" 2126 2024 2126 2126 15 2062 1233 1875 1996 1297 1297 1297 914 1133 15 1375 1018 2047 1822 206 1239 1297 1306 1472 1215 1332 1562 1825 2062 1450 1297 1864 2054 1666 1297 1374 1375 1233 1436 1388 1520 1576 1356 1297 617 72194 "Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections" 2196 2196 2196 2196 16 2130 1274 1937 2062 1340 1340 1340 457 1170 16 1335 1052 2115 1882 213 1280 1340 1349 1520 1255 1376 1613 1710 2130 1497 1340 1926 2121 1721 1340 1419 1420 1274 1483 1434 1570 1628 1557 1340 637 72195 "Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)" 2879 2879 2879 2879 21 2793 1670 2539 2703 1756 1756 1756 810 1534 21 1750 1379 2772 2468 280 1678 1756 1768 1993 1645 1804 2115 2242 2793 1963 1756 2525 2781 2257 1756 1860 1862 1670 1945 1880 2058 2134 2107 1756 836 72197 "Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences" 3558 3305 3645 3558 26 3536 2063 3138 3341 2170 2170 2170 1559 1896 26 2163 1704 3426 3050 345 2074 2170 2185 2463 2033 2229 2613 2958 3451 2426 2170 3536 3437 2789 2170 2299 2301 2064 2403 2323 2543 2638 2522 2170 1033 72200 "Radiologic examination, sacroiliac joints; less than 3 views" 215 80 226 215 2 209 125 190 202 131 131 131 37 115 2 131 103 207 184 21 125 131 132 149 123 135 145 184 209 147 131 189 208 169 131 139 139 125 145 144 154 157 152 131 62 72220 "Radiologic examination, sacrum and coccyx, minimum of 2 views" 198 89 208 198 1 192 115 175 186 121 121 121 73 105 1 120 95 191 170 19 115 121 122 137 113 124 141 168 192 135 121 174 191 155 121 128 128 115 134 129 142 152 126 121 57 73000 "Radiologic examination; clavicle, complete" 237 214 249 237 2 230 137 209 223 145 145 145 81 126 2 144 113 220 203 23 138 145 146 176 135 148 174 151 230 162 145 208 229 186 145 153 153 137 160 155 169 176 173 145 69 73010 "Radiologic examination; scapula, complete" 193 174 193 193 1 187 112 170 181 118 118 118 77 103 1 117 92 186 165 19 112 118 119 134 117 121 142 150 187 132 118 169 186 151 118 125 125 112 130 126 138 141 132 118 56 73020 "Radiologic examination, shoulder; 1 view" 237 237 237 237 2 230 137 209 223 145 145 145 73 126 2 144 113 228 203 23 138 145 146 164 135 148 174 185 230 162 145 208 229 186 145 153 153 137 160 155 169 176 168 145 69 73030 "Radiologic examination, shoulder; complete, minimum of 2 views" 243 220 512 243 2 327 134 130 228 148 148 148 73 151 2 157 116 234 208 24 236 148 149 327 154 152 48 204 236 166 148 213 235 218 148 157 157 141 164 155 174 175 178 148 71 73050 "Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction" 190 185 195 190 1 184 110 168 178 116 116 116 83 101 1 115 91 183 163 18 111 116 117 132 109 119 140 167 184 130 116 167 184 149 116 123 123 110 128 124 136 141 135 116 55 73060 "Radiologic examination; humerus, minimum of 2 views" 186 168 196 186 1 180 108 164 175 113 113 113 65 107 1 113 89 179 159 18 108 113 114 129 106 117 137 119 180 127 113 163 180 146 113 120 120 108 126 121 133 138 128 113 54 73070 "Radiologic examination, elbow; 2 views" 230 230 230 230 2 223 133 203 216 140 140 140 101 123 2 140 110 221 197 22 134 140 141 159 131 144 169 179 223 157 140 202 222 180 140 149 149 133 155 150 164 171 163 140 67 73080 "Radiologic examination, elbow; complete, minimum of 3 views" 237 214 249 237 2 230 26 209 223 145 145 145 69 126 2 155 153 220 203 23 138 145 146 168 135 148 212 182 230 162 145 208 229 186 145 153 153 137 160 155 169 176 171 145 69 73090 "Radiologic examination; forearm, 2 views" 205 185 410 205 1 199 119 164 192 125 125 125 73 109 1 125 98 197 176 20 119 125 126 145 117 128 151 174 199 140 125 180 198 161 125 132 133 119 138 134 147 158 150 125 59 73100 "Radiologic examination, wrist; 2 views" 243 231 243 243 2 236 141 214 228 148 148 148 106 129 2 148 116 234 208 24 142 148 149 168 139 152 178 189 236 166 148 213 235 190 148 157 157 141 164 159 174 180 178 148 71 73110 "Radiologic examination, wrist; complete, minimum of 3 views" 257 220 540 257 2 252 25 227 241 157 157 157 73 137 2 156 123 252 220 25 150 157 158 178 164 153 189 197 249 175 157 225 239 115 157 166 166 149 174 163 184 188 188 157 75 73120 "Radiologic examination, hand; 2 views" 243 243 243 243 2 236 141 214 228 148 148 148 106 129 2 148 116 234 208 24 142 148 149 168 139 152 134 189 236 166 148 213 235 190 148 157 157 141 164 159 174 180 172 148 71 73130 "Radiologic examination, hand; minimum of 3 views" 257 232 514 257 2 252 249 243 241 157 157 157 73 148 2 173 123 252 220 24 150 157 158 182 164 161 134 216 249 175 157 225 248 115 157 166 166 149 174 168 184 188 188 157 75 73140 "Radiologic examination, finger(s), minimum of 2 views" 186 168 372 186 1 180 108 172 175 113 113 113 81 99 1 113 89 179 159 18 108 113 114 132 118 117 119 156 180 127 113 163 180 146 113 120 120 108 126 121 133 136 136 113 54 73200 "Computed tomography, upper extremity; without contrast material" 1672 1516 1672 1672 12 1622 187 1475 1570 1020 1020 1020 424 891 12 925 801 1610 1433 162 975 1020 1027 1157 955 1047 1228 1302 1622 1140 1020 1466 1615 1311 1020 1080 1081 970 1129 1092 1195 1240 1185 1020 485 73202 "Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections" 1575 1575 1575 1575 11 1528 913 1389 1479 961 961 961 1146 839 11 957 754 1517 1350 153 918 961 967 1090 900 987 1157 1227 1528 1074 961 1381 1522 1235 961 1018 1019 914 1064 1028 1126 1168 1117 961 457 73218 "Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)" 2335 2335 2575 2335 17 2265 311 2059 2192 1424 1424 1424 888 1244 17 1419 1118 2249 2001 227 1361 1424 1434 1616 1334 1463 1715 2034 2265 1592 1424 2048 2256 1830 1424 1509 1510 1354 1577 1525 1669 1731 1885 1424 678 73220 "Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences" 2548 2486 2611 2548 18 2472 1478 2248 2393 1555 1555 1555 1117 1358 18 1549 1220 2454 2184 247 1485 1555 1565 1764 1456 1597 1872 2242 2472 1738 1555 2235 2462 1998 1555 1647 1648 1478 1721 1664 1822 1889 1807 1555 740 73221 "Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)" 2885 2616 3030 2885 21 2798 311 2544 2709 1760 1760 1760 810 1537 21 1941 1381 2778 2473 280 1682 1760 1772 2145 1649 1806 1517 2423 2798 1967 1760 2530 2787 2261 1760 1864 1866 1673 1949 1673 2062 2112 1860 1760 837 73223 "Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences" 2942 2801 3090 2942 21 2854 1706 2595 2762 1795 1795 1795 1228 1567 21 1788 1409 2833 2522 286 1715 1795 1807 2037 1681 1843 2161 2291 2854 2006 1795 2580 2842 2306 1795 1901 1903 1706 1987 1971 2103 2181 2086 1795 854 73501 PR X-RAY EXAM HIP UNI 1 VIEW 204 194 215 204 1 213 137 180 192 124 124 124 73 109 1 124 98 196 175 20 119 124 125 141 117 128 213 164 198 139 124 179 197 160 124 132 132 118 138 118 146 155 147 124 59 73502 PR X-RAY EXAM HIP UNI 2-3 VIEWS 152 137 160 152 1 149 104 133 147 93 93 93 59 88 1 92 73 149 130 15 89 93 93 102 96 95 125 129 147 104 93 147 147 119 93 98 98 88 103 88 109 111 111 93 44 73521 PR X-RAY EXAM HIPS BI 2 VIEWS 243 231 243 243 2 236 31 214 228 148 148 148 81 129 2 164 116 234 208 24 142 148 149 168 139 152 134 207 236 166 148 213 235 190 148 157 157 141 164 163 174 180 176 148 71 73552 PR X-RAY EXAM OF FEMUR 2/> VW 177 160 186 177 1 172 103 156 166 108 108 108 66 94 1 108 85 170 152 17 103 108 109 125 101 111 130 114 172 121 108 155 171 139 108 114 114 103 120 116 127 131 114 108 51 73560 "Radiologic examination, knee; 1 or 2 views" 225 117 450 225 2 218 136 198 211 137 137 137 65 120 2 137 108 217 193 22 131 137 138 156 129 141 98 193 218 153 137 197 217 176 137 145 146 130 152 151 161 167 165 137 65 73562 "Radiologic examination, knee; 3 views" 243 62 486 243 2 431 166 214 228 268 148 148 73 129 2 157 116 238 208 24 142 148 149 172 154 152 148 209 236 166 148 213 431 218 148 157 157 141 164 159 174 178 178 148 71 73564 "Radiologic examination, knee; complete, 4 or more views" 464 464 464 464 3 450 269 409 436 283 283 283 203 247 3 282 222 447 398 45 270 283 285 321 265 291 341 329 450 316 283 407 448 364 283 300 300 269 313 303 332 344 329 283 135 73565 "Radiologic examination, knee; both knees, standing, anteroposterior" 225 214 237 225 2 218 141 198 211 137 137 137 30 120 2 137 108 217 193 22 131 137 138 156 129 141 165 151 218 153 137 197 217 176 137 145 146 130 152 131 161 167 151 137 65 73590 "Radiologic examination; tibia and fibula, 2 views" 193 174 193 193 1 187 112 170 181 118 118 118 73 103 1 117 92 186 165 19 112 118 119 137 110 121 158 148 187 132 118 169 186 151 118 125 125 112 130 106 138 137 137 118 56 73592 "Radiologic examination; lower extremity, infant, minimum of 2 views" 110 110 110 110 1 107 64 97 103 67 67 67 48 59 1 67 53 106 94 11 64 67 68 76 63 69 81 44 107 75 67 96 106 86 67 71 71 64 74 72 79 82 78 67 32 73610 "Radiologic examination, ankle; complete, minimum of 3 views" 250 210 500 250 2 580 104 219 235 152 153 152 73 144 2 162 120 245 214 24 146 152 154 177 160 156 226 202 242 170 152 219 580 168 152 162 162 145 169 163 179 183 185 152 73 73620 "Radiologic examination, foot; 2 views" 226 214 237 226 2 219 131 199 212 138 138 138 99 120 2 137 108 217 193 22 131 138 138 156 129 141 166 152 219 154 138 198 218 177 138 146 146 131 152 147 161 167 160 138 65 73630 "Radiologic examination, foot; complete, minimum of 3 views" 250 226 526 250 2 245 195 231 159 152 153 152 73 155 2 160 33 245 214 24 146 152 154 168 159 149 189 212 242 170 152 219 239 224 152 162 162 145 169 159 179 183 183 152 73 73650 "Radiologic examination; calcaneus, minimum of 2 views" 182 164 182 182 1 177 106 161 171 111 111 111 73 97 1 111 87 175 156 18 106 111 112 126 104 114 134 140 177 124 111 160 176 143 111 118 118 106 123 119 130 135 129 111 53 73660 "Radiologic examination; toe(s), minimum of 2 views" 186 24 372 186 1 180 20 130 175 113 113 113 77 99 1 113 89 179 159 18 108 113 114 129 106 117 4 80 180 127 113 163 180 146 113 120 120 108 126 121 133 132 132 113 54 73700 "Computed tomography, lower extremity; without contrast material" 1571 1496 1571 1571 11 1524 1002 1386 1475 958 958 958 385 837 11 955 752 1513 1347 153 916 958 965 1087 898 984 1154 1209 1524 1071 958 1378 1518 1231 958 1015 1016 911 1061 1002 1123 1165 1002 958 456 73718 "Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)" 2955 2680 2955 2955 21 2896 1714 2606 2775 1803 1803 1803 849 1574 21 1911 1415 2846 2533 287 1722 1803 1815 2046 1689 1851 2170 1902 2866 2015 1803 2591 2896 2316 1803 1910 1911 1714 1996 1930 2112 2191 2163 1803 858 73720 "Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences" 3470 3304 3644 3470 25 3366 2012 3060 3258 2117 2117 2117 1207 1849 25 2109 1662 3341 2974 337 2023 2117 2131 2402 1983 2174 2549 2824 3366 2366 2117 3043 3352 2720 2117 2242 2244 2013 2344 2325 2480 2573 2214 2117 1007 73721 "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material" 1667 1511 1751 1667 12 1634 1138 1470 1565 1017 1017 1017 810 888 12 1013 798 1634 1429 162 972 1017 1024 1154 953 1044 1224 1417 1617 1137 1017 1462 1555 1307 1017 1077 1078 967 1126 1063 1192 1184 1220 1017 484 73723 "Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences" 3207 3054 3368 3207 23 3111 1860 2828 3011 1956 1956 1956 1488 1709 23 1949 1536 3088 2749 311 1869 1956 1969 2220 1833 2009 2356 2498 3111 2187 1956 2812 3098 2514 1956 2072 2074 1860 2166 2094 2292 2378 2580 1956 931 74018 PR X-RAY EXAM ABDOMEN 1 VIEW 230 208 242 230 2 223 143 223 216 140 127 140 81 132 2 140 110 221 197 22 134 140 141 155 131 144 108 196 223 157 140 202 222 180 140 149 149 133 155 150 164 168 147 140 67 74019 PR X-RAY EXAM ABDOMEN 2 VIEWS 276 249 290 276 2 270 167 215 259 168 168 168 73 147 2 182 132 270 237 27 161 168 169 195 175 182 133 233 268 188 168 242 267 185 168 178 221 160 186 185 197 202 195 168 80 74150 "Computed tomography, abdomen; without contrast material" 1922 1830 1922 1922 14 1864 1115 1695 1805 1172 1172 1172 193 1024 14 1168 920 1851 1647 187 1120 1172 1180 1330 1098 1204 1412 1497 1864 1310 1172 1686 1857 1507 1172 1242 1243 1115 1298 1255 1374 1425 1363 1172 558 74160 "Computed tomography, abdomen; with contrast material(s)" 2024 1836 2126 2024 15 1963 1174 1785 1900 1235 1235 1235 457 1078 15 1230 969 1949 1735 197 1180 1235 1243 1401 1157 1268 1487 1062 1963 1380 1235 1775 1955 1587 1235 1308 1309 1174 1367 1322 1447 1501 1435 1235 587 74170 "Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections" 2138 1985 2300 2138 15 2073 1211 1885 2007 1304 1304 1304 999 1139 15 1299 1024 2058 1832 208 1246 1304 1313 1480 1221 1339 1570 1665 2073 1457 1304 1874 2065 1675 1304 1381 1382 1240 1444 1397 1528 1585 1509 1304 620 74174 PR CT ANGIO ABD AND PELV WO W CONTRAST 3300 3300 3465 3300 24 3396 1914 2910 3099 2013 2013 2013 749 1990 24 2006 1580 3178 2828 320 1923 2013 2027 2284 1886 2067 3396 2570 3201 2250 2013 2894 3188 2587 2013 2133 2134 1914 2229 2155 2359 2446 2211 2013 958 74175 "Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 2157 2157 2157 2157 15 2092 1251 1902 2025 1316 1316 1316 945 1149 15 1311 1033 2077 1849 209 1257 1316 1325 1493 1233 1351 1625 1680 2092 1471 1316 1892 2084 1691 1316 1394 1395 1251 1457 1408 1542 1599 1529 1316 626 74176 "Computed tomography, abdomen and pelvis; without contrast material" 3842 3484 4035 3842 28 3765 2497 3727 3607 2344 2344 2344 993 2047 28 2335 1840 3765 3293 373 2239 2344 2359 2591 2195 2291 2347 3227 3727 2619 2344 3727 3712 3012 2344 2483 2485 2228 2452 2513 2746 2812 2812 2344 774 74177 "Computed tomography, abdomen and pelvis; with contrast material(s)" 4245 3666 4458 4245 30 4160 2898 4019 3986 2589 2348 2589 993 2262 30 2720 2033 4160 3638 412 2474 2589 2607 3005 2693 2530 2850 3266 4118 2894 2589 3723 4101 3789 2589 2743 244 2462 2867 2844 3034 3107 3107 2589 1232 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" 4384 4175 4604 4384 31 4252 2542 3867 4116 2674 2674 2674 914 2336 31 2665 2099 4222 3758 426 2555 2674 2692 3035 2505 2746 3220 3569 4252 2989 2674 3845 4235 3436 2674 2833 2835 2543 2961 2937 3134 3250 3260 2674 1272 74181 "Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)" 2803 2669 2944 2803 20 2719 1626 2472 2632 1710 1710 1710 1228 1493 20 1704 1342 2699 2403 272 1634 1710 1721 1940 1602 1756 2059 2366 2719 1911 1710 2458 2708 2197 1710 1811 1813 1626 1893 1830 2004 2078 1987 1710 814 74183 "Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences" 2999 413 2999 2999 22 2909 484 2645 2816 1829 1829 1829 1119 1598 22 1823 1436 2888 2571 291 1748 1829 1842 2076 1714 1879 2208 2575 2909 2045 1829 2630 2897 2351 1829 1938 1939 1739 2026 1914 2144 2223 2195 1829 870 75635 "Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing" 3345 3185 3345 3345 24 3245 1940 2950 3141 2040 2040 2040 762 1782 24 2033 1602 3221 2867 325 1950 2040 2054 2315 1911 2096 2457 2605 3245 2281 2040 2933 3231 2622 2040 2162 2163 1940 2260 2184 2391 2480 2371 2040 971 76000 "Fluoroscopy (separate procedure), up to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)" 318 318 334 318 2 308 184 280 299 194 194 194 179 169 2 193 152 306 273 31 185 194 195 220 182 199 234 270 308 217 194 279 307 249 194 205 206 184 215 208 227 236 225 194 92 76010 "Radiologic examination from nose to rectum for foreign body, single view, child" 132 129 136 132 1 129 77 117 124 81 81 81 58 71 1 81 63 128 114 13 77 81 81 92 76 83 97 103 129 90 81 116 128 104 81 86 86 77 90 87 95 98 94 81 38 76536 "Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation" 741 705 779 741 5 763 430 654 696 452 452 452 249 395 5 450 355 714 635 72 432 452 455 525 423 464 450 570 719 505 452 650 763 581 452 479 479 430 501 472 530 534 542 452 215 76604 "Ultrasound, chest (includes mediastinum), real time with image documentation" 709 709 709 709 5 688 411 625 666 432 432 432 249 378 5 431 339 683 608 69 413 432 435 491 405 444 521 609 688 483 432 622 685 556 432 458 459 411 479 463 507 526 503 432 206 76642 Specific area/quadrant breast ultrasound examination 576 576 576 576 4 559 334 508 541 351 351 351 252 307 4 350 276 555 494 56 336 351 354 399 329 361 423 449 559 393 351 505 556 451 351 372 372 334 389 376 412 427 408 351 167 76700 "Ultrasound, abdominal, real time with image documentation; complete" 1073 972 1127 1073 8 1041 102 1016 1008 655 655 655 384 572 8 652 514 1033 920 104 625 655 659 760 613 672 788 921 1041 732 655 941 1026 841 655 693 694 622 725 719 767 785 785 655 311 76705 "Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)" 735 89 772 735 5 720 76 615 690 448 448 448 274 392 5 495 352 686 630 71 428 448 451 509 467 460 274 588 713 501 448 645 720 576 448 475 475 426 496 469 538 522 538 448 213 76706 PR US ABDL AORTA SCREEN AAA 690 625 725 690 5 669 400 609 648 421 421 421 274 458 5 419 330 664 591 67 402 421 424 478 394 432 152 537 669 470 421 605 667 541 421 446 446 400 466 451 493 512 450 421 200 76770 "Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete" 792 718 832 792 6 768 98 699 744 483 483 483 384 422 6 481 379 763 679 77 462 483 486 519 453 496 414 680 768 540 483 695 765 621 483 512 512 459 535 518 566 587 505 483 230 76775 "Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited" 674 625 690 674 5 653 391 594 632 411 411 411 249 359 5 409 322 649 577 65 393 411 414 466 385 422 421 531 653 459 411 591 651 528 411 435 436 391 455 462 481 499 419 411 195 76776 "Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation" 717 717 753 717 5 695 416 632 673 437 437 437 314 382 5 436 343 690 615 70 418 437 440 496 410 449 527 558 695 489 437 629 693 562 437 463 464 416 484 468 512 532 508 437 208 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" 646 646 646 646 5 627 375 570 607 394 394 394 283 344 5 393 309 622 554 63 377 394 397 447 369 405 474 555 627 440 394 567 624 506 394 417 418 375 436 422 462 479 458 394 187 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" 542 542 542 542 4 526 314 478 509 331 331 331 238 289 4 329 260 522 465 53 316 331 333 375 310 340 398 383 526 370 331 475 524 425 331 350 351 314 366 354 387 402 384 331 157 76817 "Ultrasound, pregnant uterus, real time with image documentation, transvaginal" 917 831 963 917 7 889 532 809 861 559 559 559 210 489 7 557 439 883 786 89 534 559 563 635 524 574 674 742 889 625 559 804 886 719 559 593 593 532 619 599 655 680 650 559 266 76830 "Ultrasound, transvaginal" 971 880 1020 971 7 1747 563 856 912 592 592 592 272 517 7 628 465 952 832 94 566 592 596 687 555 608 713 786 942 662 592 852 1747 761 592 627 628 563 619 634 694 711 711 592 282 76831 "Saline infusion sonohysterography (SIS), including color flow Doppler, when performed" 900 900 945 900 6 873 522 794 845 549 549 549 303 480 6 547 431 867 771 87 525 549 553 563 514 564 661 701 873 614 549 789 869 705 549 582 582 522 608 588 643 667 705 549 261 76856 "Ultrasound, pelvic (nonobstetric), real time with image documentation; complete" 997 903 1047 997 7 977 578 879 936 608 608 608 423 531 7 645 477 977 855 97 581 608 612 689 570 624 732 847 967 680 608 874 963 781 608 644 645 578 673 651 713 730 719 608 289 76857 "Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)" 952 862 952 952 7 923 552 840 894 581 581 581 158 507 7 579 456 917 816 92 555 581 585 674 544 596 699 609 923 649 581 835 920 746 581 615 616 552 643 622 680 706 697 581 276 76870 "Ultrasound, scrotum and contents" 697 631 732 697 5 676 87 615 654 425 425 425 249 371 5 424 334 671 597 68 406 425 428 493 398 436 227 598 676 475 425 611 673 546 425 450 451 404 471 455 498 510 495 425 202 76881 "Ultrasound, extremity, nonvascular, real-time with image documentation; complete" 576 576 576 576 4 559 334 508 541 351 351 351 274 307 4 350 276 555 494 56 336 351 354 399 329 361 423 449 559 393 351 505 556 451 351 372 372 334 389 376 412 427 408 351 167 76882 "Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific" 471 448 942 471 3 457 273 415 442 287 287 287 249 251 3 286 226 454 404 46 275 287 289 326 269 295 346 402 457 321 287 413 455 421 287 304 305 273 318 316 337 349 307 287 137 76937 "Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)" 702 651 719 702 5 680 407 619 659 428 428 428 307 374 5 426 336 676 601 68 409 428 431 486 401 439 515 553 680 478 428 615 678 550 428 453 454 407 474 482 501 520 497 428 204 77072 Bone age studies 212 212 212 212 2 206 123 187 199 129 129 129 61 113 2 137 102 204 182 21 124 129 130 147 121 133 156 165 206 145 129 186 205 166 129 137 137 123 143 138 152 157 150 129 62 77075 "Radiologic examination, osseous survey; complete (axial and appendicular skeleton)" 456 434 479 456 3 443 265 403 429 278 278 278 200 243 3 277 219 440 391 44 266 278 280 316 261 286 335 407 443 311 278 400 441 358 278 295 295 265 308 265 326 338 324 278 132 77080 "Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)" 397 360 417 397 3 385 63 350 373 242 242 242 253 228 3 267 190 382 340 39 231 242 244 275 246 249 261 321 385 271 242 348 370 354 242 257 257 230 268 266 284 278 286 242 115 78013 PR THYROID IMAGING W/BLOOD FLOW 990 990 990 990 7 960 574 873 930 604 604 604 434 527 7 602 474 953 849 96 577 604 608 685 566 620 727 771 960 675 604 868 956 776 604 640 640 574 669 646 708 734 702 604 287 78071 PR PARATHYRD PLANAR W/WO SUBTRJ 985 985 985 985 7 955 571 869 925 601 601 601 432 525 7 599 472 949 844 96 574 601 605 682 563 617 723 767 955 672 601 864 952 772 601 637 637 571 665 643 704 730 698 601 286 78227 PR HEPATOBIL SYST IMAGE W/DRUG 1775 1609 1864 1775 13 2463 1029 1565 1667 1083 1083 1083 1157 946 13 1079 850 1709 1521 172 1035 1083 1090 1229 1014 1112 1304 1142 1722 1210 1083 1722 2463 1391 1083 1147 1148 1030 1199 1109 1269 1280 1299 1083 515 78264 Gastric emptying study 1191 1191 1251 1191 9 1251 195 1050 1118 727 727 727 1251 635 9 724 570 1147 1021 116 694 727 731 824 681 746 875 928 1155 812 727 1044 1151 934 727 770 770 691 805 778 851 883 844 727 346 78306 Bone and/or joint imaging; whole body 1247 1247 1310 1247 9 1210 723 1100 1171 761 761 761 1137 664 9 758 597 1201 1069 121 727 761 766 863 713 781 916 1008 1210 850 761 1094 1205 977 761 806 806 723 842 814 891 924 930 761 362 78315 Bone and/or joint imaging; 3 phase study 1343 1279 1411 1343 10 1303 779 1184 1261 819 819 819 589 716 10 816 643 1293 1151 130 783 819 825 930 767 841 986 1046 1303 916 819 1178 1297 1053 819 868 869 779 907 900 960 1002 972 819 390 78452 "Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection" 2348 2348 2348 2348 17 2278 1362 2071 2205 1432 1432 1432 1432 1251 17 1427 1124 2261 2013 228 1369 1432 1442 1625 1342 1471 1725 1829 2278 1601 1432 2059 2268 1840 1432 1517 1518 1362 1586 1533 1678 1741 1665 1432 681 78580 "Pulmonary perfusion imaging, particulate" 1158 1158 1158 1158 8 1123 672 1021 1087 706 706 706 507 617 8 704 554 1115 993 112 675 706 711 802 662 725 851 902 1123 790 706 1016 1119 908 706 748 749 672 782 756 828 858 821 706 336 78582 PR LUNG VENTILAT&PERFUS IMAGING 2720 2720 2720 2720 20 2638 1577 2399 2554 1659 1659 1659 1192 1449 20 1653 1302 2619 2331 264 1585 1659 1670 1883 1554 1704 1998 2335 2638 1855 1659 2385 2628 2132 1659 1758 1759 1578 1837 1776 1944 2016 1928 1659 789 78815 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh 4340 4133 4557 4340 31 4210 2517 3828 4075 2647 2647 2647 2929 2312 31 2638 2078 4179 3720 421 2530 2647 2665 3004 2480 2719 2732 3912 4210 2959 2647 3806 4193 3402 2647 2805 2807 2517 2932 2834 3102 3218 3141 2647 1260 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)" 30 24 230 30 0 59 21 28 28 18 18 18 59 8 0 19 19 28 26 3 17 18 18 21 8 19 29 24 29 20 18 29 29 27 18 18 19 17 20 19 21 22 22 18 9 80050 "General health panel This panel must include the following: Comprehensive metabolic panel (80053), Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004), OR, Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009), Thyroid stimulating hormone (TSH) (84443)" 121 107 128 121 1 117 70 107 114 74 74 74 59 64 1 81 27 117 104 12 71 74 74 84 69 76 89 94 117 82 74 106 117 95 74 78 78 70 82 79 86 89 86 74 35 80051 "Electrolyte panel This panel must include the following: Carbon dioxide (82374), Chloride (82435), Potassium (84132), Sodium (84295)" 21 21 25 21 0 59 12 19 20 13 13 13 59 11 0 13 10 20 18 2 12 13 13 15 12 13 15 16 20 14 13 18 20 16 13 14 14 12 14 14 15 16 15 13 6 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)" 36 30 72 36 0 59 24 33 31 22 20 22 59 21 0 24 23 35 31 3 21 22 22 25 16 21 35 30 33 22 22 35 35 32 22 23 29 21 23 24 26 26 26 22 7 80061 "Lipid panel This panel must include the following: Cholesterol, serum, total (82465), Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478)" 48 40 51 48 0 47 33 45 39 29 29 29 29 13 0 12 7 44 39 5 28 29 29 32 13 28 25 39 47 32 29 42 47 43 29 31 31 28 32 30 34 35 35 29 14 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)" 104 99 116 104 1 101 63 92 98 63 63 63 59 55 1 63 50 100 89 10 61 63 64 72 70 65 76 42 101 71 63 91 100 82 63 67 67 60 70 70 74 75 72 63 30 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)" 164 150 173 164 1 159 95 145 154 100 100 100 40 87 1 41 79 158 141 16 96 100 101 116 94 103 120 133 159 112 100 144 158 134 100 106 106 95 111 110 117 122 122 100 48 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)" 29 25 31 29 0 53 11 26 27 18 18 18 53 15 0 15 14 25 25 3 17 18 18 20 17 18 11 25 28 19 18 25 28 26 18 19 19 17 20 17 21 21 19 18 8 80143 HC DRUG ASSAY ACETAMINOPHEN 171 154 180 171 1 166 109 151 161 104 104 104 75 113 1 115 82 165 147 17 100 104 105 115 98 107 160 147 166 117 104 150 165 153 104 111 111 99 116 112 122 117 117 104 50 80145 HC DRUG ASSAY ADALIMUMAB 381 381 381 381 3 369 221 336 358 232 232 232 167 203 3 231 182 367 326 37 222 232 234 264 218 239 280 297 369 260 232 334 368 299 232 246 246 221 257 249 272 282 289 232 111 80156 Carbamazepine; total 40 33 51 40 0 39 23 36 38 25 25 25 18 22 0 25 19 39 35 4 24 25 25 28 23 25 30 32 39 28 25 36 39 32 25 26 26 23 27 26 29 30 29 25 12 80158 Cyclosporine 77 77 77 77 1 75 45 68 72 47 47 47 50 41 1 47 37 74 66 7 45 47 47 53 44 48 57 60 75 52 47 68 74 60 47 50 50 45 52 50 55 57 55 47 22 80159 HC DRUG SCREEN QUANT CLOZAPINE 44 44 70 44 0 43 26 39 41 27 27 27 19 23 0 27 21 42 38 4 26 27 27 30 25 28 32 34 43 30 27 39 43 34 27 28 28 26 30 29 31 33 31 27 13 80162 Digoxin 41 10 45 41 0 40 24 36 38 25 25 25 18 22 0 25 20 39 35 4 24 25 25 28 23 26 5 32 40 28 25 36 40 32 25 26 27 24 28 30 29 30 29 25 12 80164 Dipropylacetic acid (valproic acid) 130 117 137 130 1 126 71 115 122 79 79 79 56 69 1 79 62 125 111 13 76 79 80 90 13 81 95 99 126 89 79 114 126 102 79 75 84 75 88 85 93 96 85 79 38 80173 Haloperidol 74 74 74 74 1 72 43 65 69 45 45 45 32 39 1 45 35 71 63 7 43 45 45 51 42 46 54 58 72 50 45 65 71 58 45 48 48 43 50 48 53 55 52 45 21 80175 HC DRUG SCREEN QUANT LAMOTRIGINE 45 31 50 45 0 56 26 40 42 27 27 27 56 24 0 27 22 43 39 4 26 27 28 31 26 28 33 32 44 31 27 39 43 35 27 29 29 26 30 29 32 33 20 27 13 80177 Drug Screen quantitative Levetiracetam level 71 49 79 71 1 69 41 63 67 43 43 43 31 28 1 43 34 68 61 7 41 43 44 49 41 44 52 42 69 48 43 62 69 56 43 46 46 41 48 46 51 53 54 43 21 80178 Lithium 22 21 27 22 0 51 13 20 21 13 13 13 51 12 0 13 3 21 19 2 13 13 14 15 13 14 16 11 21 15 13 19 21 17 13 14 14 13 15 14 16 16 15 13 6 80179 HC DRUG ASSAY SALICYLATE 171 154 180 171 1 166 109 151 161 104 104 104 75 113 1 115 82 165 147 17 100 104 105 115 98 107 160 146 166 117 104 150 165 153 104 111 111 99 116 112 122 117 117 104 50 80183 HC DRUG SCREEN QUANT OXCARBAZEPIN 32 30 73 32 0 63 19 28 30 20 20 20 30 17 0 19 15 31 27 3 19 20 20 22 18 20 24 63 31 22 20 28 31 25 20 21 21 19 22 21 23 24 23 20 9 80184 Phenobarbital 38 15 45 38 0 37 22 33 35 23 23 23 17 20 0 23 18 36 32 4 22 23 23 26 22 24 28 28 37 26 23 33 37 30 23 24 24 22 26 25 27 28 27 23 11 80185 Phenytoin; total 40 32 45 40 0 39 23 35 38 24 24 24 18 21 0 24 19 39 34 4 23 24 25 28 23 25 29 28 39 27 24 35 39 31 24 26 26 23 27 26 29 30 28 24 12 80186 Phenytoin; free 34 34 34 34 0 33 20 30 32 21 21 21 15 18 0 21 16 33 29 3 20 21 21 24 19 21 25 26 33 23 21 30 33 27 21 22 22 20 23 22 24 25 24 21 10 80188 Primidone 15 15 26 15 0 15 9 13 14 9 9 9 7 8 0 9 7 14 13 1 9 9 9 10 9 9 11 12 15 10 9 13 14 12 9 10 10 9 10 10 11 11 11 9 4 80195 Sirolimus 103 100 114 103 1 100 60 91 97 63 63 63 50 55 1 63 49 99 88 10 60 63 63 71 59 65 76 80 100 70 63 90 100 81 63 67 67 60 70 67 74 76 73 63 30 80197 Tacrolimus 133 125 140 133 1 129 77 117 125 81 81 81 54 71 1 81 64 128 114 13 78 81 82 92 76 83 98 104 129 91 81 117 128 104 81 86 86 77 90 87 95 99 94 81 39 80201 Topiramate 111 100 117 111 1 108 64 98 104 68 68 68 55 59 1 67 53 107 95 11 65 68 68 77 63 70 82 86 108 76 68 97 107 87 68 72 72 64 75 72 79 82 79 68 32 80202 Vancomycin 47 43 47 47 0 46 27 41 44 29 29 29 21 25 0 29 23 45 40 5 27 29 29 33 27 29 35 37 46 32 29 41 45 37 29 30 30 27 32 31 34 35 33 29 14 80299 "Quantitation of drug, not elsewhere specified" 205 205 205 205 1 199 119 181 192 125 125 125 25 109 1 125 98 197 176 20 119 125 126 142 117 128 151 160 199 140 125 180 198 161 125 132 133 119 138 134 147 152 145 125 59 80305 Drug Test presumptive 241 207 254 241 2 234 10 234 226 147 147 147 54 12 2 162 115 232 207 23 140 147 148 162 146 151 120 185 222 164 147 211 233 216 147 156 156 140 163 153 172 168 174 147 70 80307 Drug Test presumptive 28 27 28 28 0 113 16 24 26 17 17 17 113 15 0 17 13 26 24 3 16 17 17 19 16 17 20 22 27 19 17 24 27 22 17 18 18 16 19 18 20 20 19 17 8 80346 HC DRUG TEST DEF 8-12 CLASS BENZODIAZEPINES 53 53 53 53 0 51 31 47 50 32 32 32 23 28 0 32 25 51 45 5 31 32 33 37 30 33 39 41 51 36 32 46 51 42 32 34 34 31 36 35 38 39 38 32 15 80354 HC DRUG TEST DEF 22+ CLASS FENTANYL 65 65 65 65 0 63 38 57 61 40 40 40 28 35 0 40 31 63 56 6 38 40 40 45 37 41 48 51 63 44 40 57 63 51 40 42 42 38 44 42 46 48 46 40 19 80356 HC DRUG TEST DEF 22+ CLASS HEROIN METABOLITE 50 50 50 50 0 48 29 44 47 30 31 30 22 27 0 30 24 48 43 5 29 30 31 35 29 31 37 39 48 34 30 44 48 39 30 32 32 29 34 33 36 37 35 30 15 80365 HC DRUG TEST DEF 22+ CLASS OXYCODONE 55 55 55 55 0 53 32 49 52 34 34 34 24 29 0 33 26 53 47 5 32 34 34 38 31 34 40 43 53 37 34 48 53 43 34 36 36 32 37 36 39 41 39 34 16 80424 "Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2)" 188 188 188 188 1 182 109 166 177 115 115 115 82 100 1 114 90 181 161 18 110 115 115 130 107 118 138 146 182 128 115 165 182 147 115 121 122 109 127 123 134 139 133 115 55 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" 18 15 19 18 0 24 10 13 17 11 11 11 24 10 0 11 9 17 15 2 10 11 11 12 3 11 18 14 16 10 11 17 17 16 11 12 12 10 12 12 13 13 13 11 5 81003 "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy" 8 1 10 8 0 22 4 6 8 5 5 5 22 2 0 5 4 6 7 1 5 5 5 4 3 5 4 5 8 5 5 8 8 7 5 5 7 5 5 5 4 5 6 5 1 81015 Urinalysis; microscopic only 11 9 12 11 0 22 6 6 10 7 7 7 22 6 0 7 5 11 9 1 6 7 7 8 3 7 3 9 11 7 7 10 11 5 7 7 7 6 7 7 8 8 8 7 3 81025 "Urine pregnancy test, by visual color comparison methods" 40 36 42 40 0 39 37 37 38 24 24 24 22 21 0 26 19 39 34 4 23 24 25 28 23 24 25 31 39 27 24 35 39 27 24 26 26 23 27 26 29 29 29 24 8 81206 HC BCR/ABL1 GENE MAJOR BP 1125 257 1241 1125 8 1091 652 992 1056 686 686 686 136 599 8 684 539 1083 964 109 656 686 691 779 643 705 826 876 1091 767 686 987 1087 882 686 727 728 652 760 735 804 834 798 686 327 81207 HC BCR/ABL1 GENE MINOR BP 174 174 174 174 1 168 101 153 163 106 106 106 92 92 1 106 83 167 149 17 101 106 107 120 99 109 128 135 168 118 106 152 168 136 106 112 112 101 117 113 124 129 123 106 50 81208 HC BCR/ABL1 GENE OTHER BP 197 197 197 197 1 191 114 173 185 120 120 120 104 105 1 119 94 189 168 19 115 120 121 136 112 123 144 153 191 134 120 172 190 154 120 127 127 114 133 128 140 146 139 120 57 81240 HC F2 GENE 126 120 132 126 1 158 73 111 118 77 77 77 158 67 1 77 60 121 108 12 73 77 77 87 72 79 93 99 122 86 77 110 122 99 77 81 81 73 85 82 90 93 89 77 37 81241 HC F5 GENE 123 87 132 123 1 119 71 108 115 75 75 75 79 65 1 75 59 118 105 12 72 75 75 85 70 77 90 99 119 84 75 108 119 96 75 79 79 71 83 80 88 91 64 75 36 81256 HC HFE GENE 365 290 440 365 3 354 212 322 343 223 223 223 191 194 3 222 175 351 313 35 213 223 224 253 209 229 268 284 354 249 223 320 353 286 223 236 236 212 247 238 261 271 259 223 106 81270 HC JAK2 GENE 1031 1031 1138 1031 7 1000 598 909 968 629 629 629 452 549 7 627 494 993 884 100 601 629 633 714 589 646 757 803 1000 703 629 904 996 808 629 666 667 598 696 673 737 764 731 629 299 82009 "Acetone or other ketone bodies, serum; qualitative" 16 14 70 16 0 42 9 14 15 9 9 9 7 8 0 9 7 16 13 2 9 9 10 11 9 10 42 12 15 11 9 14 15 12 9 10 10 9 10 10 11 11 11 9 4 82010 "Acetone or other ketone bodies, serum; quantitative" 38 38 58 38 0 37 22 34 36 23 23 23 17 20 0 23 18 37 33 4 22 23 23 26 22 24 28 33 37 26 23 33 37 30 23 25 25 22 26 25 27 28 27 23 11 82024 Adrenocorticotropic hormone (ACTH) 45 45 74 45 0 55 26 40 42 27 27 27 55 24 0 27 22 43 39 4 26 27 28 31 26 28 33 39 44 31 27 39 43 35 27 29 29 26 30 29 32 33 32 27 13 82040 "Albumin; serum, plasma or whole blood" 17 15 17 17 0 29 10 15 16 10 10 10 29 9 0 10 8 16 15 2 10 10 10 12 10 11 12 13 16 12 10 15 16 13 10 11 11 10 11 11 12 13 11 10 5 82043 "Albumin; urine, microalbumin, quantitative" 20 18 23 20 0 24 5 18 19 12 12 12 24 6 0 12 10 19 17 2 12 12 12 14 6 13 11 16 19 14 12 18 19 20 12 13 13 12 14 13 14 14 15 12 6 82044 "Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay)" 19 18 20 19 0 18 12 17 18 12 12 12 8 10 0 12 9 18 16 2 11 12 12 13 11 12 14 13 18 13 12 17 18 15 12 12 12 11 13 13 14 14 13 12 6 82077 "Alcohol (ethanol); any specimen except urine and breath, immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)" 161 146 170 161 1 158 93 142 151 98 98 98 46 86 1 98 77 155 138 16 94 98 99 108 92 101 158 138 156 110 98 141 156 144 98 104 104 93 109 105 115 118 111 98 47 82088 Aldosterone 75 45 133 75 1 73 46 66 70 46 46 46 55 40 1 46 36 72 64 7 44 46 46 52 43 47 55 53 73 51 46 66 72 59 46 48 49 44 51 49 54 56 53 46 22 82103 Alpha-1-antitrypsin; total 62 27 67 62 0 61 36 54 58 38 38 38 61 33 0 37 29 59 53 6 36 38 38 43 35 39 45 48 60 42 38 54 59 48 38 40 40 36 42 40 44 46 49 38 18 82104 Alpha-1-antitrypsin; phenotype 32 30 33 32 0 31 18 28 30 19 19 19 30 17 0 19 15 30 27 3 18 19 19 22 18 20 23 25 31 21 19 28 30 25 19 20 20 18 21 21 23 23 22 19 9 82105 Alpha-fetoprotein (AFP); serum 71 47 76 71 1 69 41 63 67 43 43 43 57 38 1 43 34 68 61 7 41 43 44 49 41 44 52 61 69 48 43 62 69 56 43 46 46 41 48 46 51 53 48 43 21 82135 "Aminolevulinic acid, delta (ALA)" 90 90 90 90 1 87 52 79 85 55 55 55 39 48 1 55 43 87 77 9 52 55 55 62 51 56 66 70 87 61 55 79 87 71 55 58 58 52 61 59 64 67 64 55 26 82139 "Amino acids, 6 or more amino acids, quantitative, each specimen" 154 154 154 154 1 149 89 136 145 94 94 94 67 82 1 94 74 148 132 15 90 94 95 107 88 96 113 120 149 105 94 135 149 121 94 100 100 89 104 101 110 114 109 94 45 82140 Ammonia 51 45 54 51 0 50 30 45 48 31 31 31 22 27 0 31 24 49 44 5 30 31 31 35 29 32 50 43 49 35 31 45 49 40 31 33 33 30 34 33 36 38 34 31 15 82150 Amylase 23 19 25 23 0 32 14 20 22 14 14 14 32 12 0 14 11 22 20 2 13 14 14 16 6 14 23 17 20 16 14 20 22 18 14 15 15 13 16 15 16 15 15 14 7 82180 "Ascorbic acid (Vitamin C), blood" 38 36 42 38 0 48 22 34 36 23 23 23 48 20 0 23 18 37 33 4 22 23 23 26 22 24 28 36 37 26 23 33 37 30 23 25 25 22 26 25 27 28 27 23 11 82232 Beta-2 microglobulin 30 30 60 30 0 49 17 26 28 18 18 18 49 16 0 18 14 29 26 3 17 18 18 21 17 19 22 23 29 20 18 26 29 24 18 19 19 17 20 20 21 22 21 18 9 82247 Bilirubin; total 27 27 30 27 0 26 16 24 25 16 16 16 23 14 0 16 13 26 23 3 16 16 17 19 15 17 20 21 26 18 16 24 26 21 16 17 17 16 18 18 19 20 19 16 8 82248 Bilirubin; direct 17 16 17 17 0 17 10 15 16 10 10 10 12 9 0 10 8 16 15 2 10 10 10 12 10 11 17 10 16 12 10 15 16 13 10 11 11 10 11 11 12 13 12 10 5 82261 "Biotinidase, each specimen" 122 122 122 122 1 118 71 108 115 74 74 74 53 65 1 74 58 117 105 12 71 74 75 84 70 76 90 95 118 83 74 107 118 96 74 79 79 71 82 80 87 90 86 74 35 82274 "Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations" 53 47 59 53 0 55 36 47 50 32 32 32 55 28 0 32 25 51 45 5 31 32 33 37 30 33 39 35 51 36 32 46 51 42 32 34 34 31 36 36 38 39 34 32 15 82306 "Vitamin D; 25 hydroxy, includes fraction(s), if performed" 40 26 42 40 0 61 18 33 38 24 24 24 61 15 0 24 19 37 34 4 23 24 25 18 23 26 26 32 39 27 24 35 39 31 24 26 26 23 27 27 29 29 27 24 12 82310 Calcium; total 18 15 20 18 0 29 3 17 17 11 11 11 29 10 0 11 9 17 15 2 10 11 11 12 11 11 13 10 17 12 11 16 17 14 11 12 12 10 12 10 13 13 11 11 5 82330 Calcium; ionized 57 39 57 57 0 55 33 50 54 35 35 35 46 30 0 35 27 55 49 6 33 35 35 39 33 36 14 44 55 39 35 50 55 45 35 37 37 33 39 37 41 42 40 35 17 82340 "Calcium; urine quantitative, timed specimen" 23 16 24 23 0 26 13 20 22 14 14 14 26 12 0 14 11 22 20 2 13 14 14 16 13 14 17 18 22 16 14 20 22 18 14 15 15 13 16 15 16 17 16 14 7 82365 Calculus; infrared spectroscopy 68 65 70 68 0 65 39 60 63 41 41 41 48 36 0 41 32 65 58 7 39 41 41 47 39 42 50 60 65 46 41 59 65 53 41 44 44 39 46 44 48 50 48 41 20 82374 Carbon dioxide (bicarbonate) 15 15 15 15 0 15 9 13 14 9 9 9 7 8 0 9 7 14 13 1 9 9 9 10 9 9 11 12 15 10 9 13 14 12 9 10 10 9 10 10 11 11 11 9 4 82375 Carboxyhemoglobin; quantitative 42 32 52 42 0 41 24 37 39 26 26 26 18 22 0 26 20 40 36 4 24 26 26 29 24 26 31 33 41 29 26 37 41 33 26 27 27 24 28 27 30 31 30 26 12 82378 Carcinoembryonic antigen (CEA) 62 43 69 62 0 60 36 55 58 38 38 38 24 33 0 38 30 60 53 6 36 38 38 43 35 39 49 37 60 42 38 54 60 49 38 40 40 36 42 44 44 46 44 38 18 82379 "Carnitine (total and free), quantitative, each specimen" 85 81 90 85 1 82 49 75 80 52 52 52 50 45 1 52 41 82 73 8 50 52 52 59 49 53 62 69 82 58 52 75 82 67 52 55 55 49 57 56 61 63 60 52 25 82384 Catecholamines; fractionated 124 41 265 124 1 120 72 109 116 76 76 76 50 66 1 75 59 119 106 12 72 76 76 86 71 78 91 88 120 85 76 109 120 97 76 80 80 72 84 81 89 92 88 76 36 82390 Ceruloplasmin 20 19 20 20 0 50 6 18 19 12 12 12 50 11 0 12 10 19 17 2 12 12 12 14 11 13 15 7 19 14 12 18 19 16 12 13 13 12 14 13 14 15 13 12 6 82436 Chloride; urine 17 17 17 17 0 16 10 15 16 10 10 10 7 9 0 10 8 16 15 2 10 10 10 12 10 11 12 13 16 12 10 15 16 13 10 11 11 10 11 11 12 13 10 10 5 82438 Chloride; other source 17 17 17 17 0 23 10 15 16 10 10 10 23 9 0 10 8 16 15 2 10 10 10 12 10 11 12 13 16 12 10 15 16 13 10 11 11 10 11 11 12 13 12 10 5 82465 "Cholesterol, serum or whole blood, total" 25 25 25 25 0 29 14 22 23 15 15 15 29 13 0 15 12 24 21 2 15 15 15 17 14 16 18 19 24 17 15 22 24 20 15 16 16 14 17 16 18 19 18 15 7 82507 Citrate 39 37 39 39 0 53 23 34 37 24 24 24 53 21 0 24 19 38 33 4 23 24 24 27 22 24 29 30 38 27 24 34 38 31 24 25 25 23 26 25 28 29 28 24 11 82523 "Collagen cross links, any method" 20 20 20 20 0 19 12 18 19 12 12 12 9 11 0 12 10 19 17 2 12 12 12 14 11 13 15 16 19 14 12 18 19 16 12 13 13 12 14 13 14 15 14 12 6 82525 Copper 39 26 39 39 0 38 7 34 37 24 24 24 35 21 0 24 19 38 33 4 23 24 24 27 22 24 29 22 38 27 24 34 38 31 24 25 25 23 26 25 28 29 28 24 11 82530 Cortisol; free 39 36 41 39 0 55 23 34 37 24 24 24 55 21 0 24 19 38 33 4 23 24 24 27 22 24 29 35 38 27 24 34 38 31 24 25 25 23 26 25 28 29 28 24 11 82533 Cortisol; total 63 44 71 63 0 61 37 56 59 38 38 38 54 34 0 38 30 61 54 6 37 38 39 44 36 39 46 53 61 43 38 55 61 49 38 41 41 37 43 41 45 47 45 38 18 82542 "Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary and mobile phase" 239 228 250 239 2 232 139 211 224 146 146 146 105 127 2 145 114 230 205 23 139 146 147 165 137 150 176 186 232 163 146 210 231 187 146 154 155 139 161 156 171 177 169 146 69 82550 "Creatine kinase (CK), (CPK); total" 23 20 25 23 0 30 13 20 22 14 14 14 30 12 0 14 11 22 20 2 13 14 14 16 15 14 17 20 22 16 14 13 22 18 14 15 15 13 16 15 16 17 17 14 7 82553 "Creatine kinase (CK), (CPK); MB fraction only" 37 35 38 37 0 36 7 33 35 23 23 23 16 20 0 22 18 36 32 4 22 23 23 26 21 23 27 31 36 25 23 32 36 29 23 24 24 21 25 24 26 27 25 23 11 82565 Creatinine; blood 18 16 19 18 0 23 12 16 17 11 11 11 23 10 0 11 9 17 15 2 10 11 11 12 10 11 17 15 17 12 11 16 17 16 11 12 12 10 12 11 13 13 12 11 5 82570 Creatinine; other source 18 13 32 18 0 29 3 16 17 11 11 11 29 5 0 11 9 17 15 2 10 11 11 12 5 11 18 14 17 12 11 16 17 16 11 12 12 10 12 12 13 13 11 11 5 82607 Cyanocobalamin (Vitamin B-12); 51 45 80 51 0 62 9 62 48 31 31 31 54 22 0 13 24 44 44 5 30 31 31 35 15 32 49 44 49 35 31 9 49 40 31 33 33 30 34 34 36 38 37 31 15 82627 Dehydroepiandrosterone-sulfate (DHEA-S) 78 50 80 78 1 76 45 69 73 48 48 48 50 42 1 47 37 75 67 8 45 48 48 54 45 49 57 61 76 53 48 68 75 61 48 50 50 45 53 51 56 58 55 48 23 82652 "Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed" 81 81 81 81 1 79 47 71 76 49 49 49 35 43 1 49 39 78 69 8 47 49 50 56 46 51 59 58 79 55 49 71 78 63 49 52 52 47 55 53 58 60 57 49 24 82653 "Elastase, pancreatic (EL-1), fecal" 168 168 168 168 1 163 97 148 158 102 102 102 55 90 1 102 80 162 144 16 98 102 103 116 96 105 123 131 163 115 102 147 162 132 102 109 109 97 113 110 120 125 119 102 49 82657 "Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen" 250 250 250 250 2 242 145 220 235 152 153 152 110 133 2 152 120 241 214 24 146 152 154 173 143 157 184 195 242 170 152 219 242 196 152 162 162 145 169 163 179 185 177 152 73 82668 Erythropoietin 38 38 42 38 0 48 27 34 36 23 23 23 48 20 0 23 18 37 33 4 22 23 23 26 22 24 28 30 37 26 23 33 37 30 23 25 25 22 26 25 27 29 27 23 11 82670 Estradiol 84 70 89 84 1 81 78 68 80 51 51 51 50 45 1 51 40 81 72 8 49 51 52 50 48 56 64 60 81 57 51 74 81 66 51 54 54 49 57 55 60 65 65 51 24 82679 Estrone 51 51 51 51 0 49 30 45 48 31 31 31 27 27 0 31 24 49 44 5 30 31 31 35 29 32 37 40 49 35 31 45 49 40 31 33 33 30 34 33 36 38 39 31 15 82710 "Fat or lipids, feces; quantitative" 74 74 74 74 1 72 43 65 69 45 45 45 28 39 1 45 35 71 63 7 43 45 45 51 42 46 54 58 72 50 45 65 71 58 45 48 48 43 50 48 53 55 52 45 21 82726 Very long chain fatty acids 138 138 138 138 1 134 80 122 130 84 84 84 60 74 1 84 66 133 118 13 80 84 85 96 79 86 101 107 134 94 84 121 133 108 84 89 89 80 93 90 99 102 98 84 40 82728 Ferritin 47 41 69 47 0 53 27 44 44 29 29 29 53 27 0 29 23 41 40 5 27 29 29 33 27 29 30 40 46 32 29 8 45 37 29 30 30 27 32 30 34 31 34 29 14 82746 Folic acid; serum 50 31 80 50 0 62 9 62 47 30 31 30 30 29 0 13 24 45 43 5 29 30 31 35 29 31 30 43 48 34 30 9 48 39 30 32 32 29 34 51 36 33 57 30 15 82784 "Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each" 28 17 56 28 0 32 16 25 26 17 17 17 32 15 0 17 13 27 24 3 16 17 17 18 16 18 21 22 27 19 17 25 27 22 17 18 18 16 19 18 20 21 25 17 8 82785 Gammaglobulin (immunoglobulin); IgE 46 46 48 46 0 46 27 41 43 28 28 28 46 25 0 28 22 44 39 4 27 28 28 32 26 29 34 36 45 31 28 40 44 36 28 30 30 27 31 30 33 34 33 28 13 82787 "Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each" 22 21 63 22 0 21 13 19 21 13 13 13 10 12 0 13 11 21 19 2 13 13 14 15 13 14 16 17 21 15 13 19 21 17 13 14 14 13 15 14 16 16 16 13 6 82803 "Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);" 54 46 114 54 0 53 33 48 51 33 33 33 24 35 0 33 26 53 46 5 31 33 33 38 34 34 50 44 52 37 33 47 52 42 33 35 35 31 36 34 39 40 40 33 16 82947 "Glucose; quantitative, blood (except reagent strip)" 7 6 65 7 0 29 2 6 7 4 4 4 29 4 0 4 3 6 6 1 4 4 4 4 4 4 5 6 7 5 4 6 7 5 4 5 5 4 5 5 5 5 4 4 2 82977 "Glutamyltransferase, gamma (GGT)" 100 67 105 100 1 97 4 88 94 61 61 61 26 53 1 68 48 96 86 10 58 61 61 69 57 63 73 77 97 68 61 97 97 89 61 65 65 58 68 64 71 74 65 61 29 82985 Glycated protein 63 63 63 63 0 61 37 56 59 38 38 38 28 34 0 38 30 61 54 6 37 38 39 44 36 39 46 49 61 43 38 55 61 49 38 41 41 37 43 41 45 47 45 38 18 83001 Gonadotropin; follicle stimulating hormone (FSH) 25 21 27 25 0 27 20 24 21 15 15 15 27 13 0 15 12 24 21 2 15 15 15 17 14 16 18 21 24 17 15 22 24 20 15 16 16 14 17 16 18 18 18 15 7 83002 Gonadotropin; luteinizing hormone (LH) 25 22 27 25 0 25 14 22 23 15 15 15 25 13 0 15 12 24 21 2 15 15 15 17 14 16 18 21 24 17 15 22 24 20 15 16 16 14 17 16 18 19 16 15 7 83010 Haptoglobin; quantitative 61 42 68 61 0 59 43 54 57 37 37 37 24 32 0 37 29 59 52 6 36 37 37 42 35 38 45 48 59 42 37 53 59 48 37 39 39 35 41 24 44 45 43 37 18 83036 Hemoglobin; glycosylated (A1C) 34 30 36 34 0 33 22 31 32 21 21 21 32 10 0 21 16 33 29 3 20 21 21 17 10 19 21 26 33 21 21 30 33 31 21 23 22 20 23 21 24 24 24 21 10 83051 Hemoglobin; plasma 23 23 38 23 0 22 13 20 22 14 14 14 10 12 0 14 11 22 20 2 13 14 14 16 13 14 17 18 22 16 14 20 22 18 14 15 15 13 16 15 16 17 16 14 7 83090 Homocysteine 72 72 72 72 1 70 42 64 68 44 44 44 32 38 1 44 34 69 62 7 42 44 44 50 41 45 53 56 70 49 44 63 70 56 44 47 47 42 49 47 51 53 51 44 21 83497 "Hydroxyindolacetic acid, 5-(HIAA)" 57 39 57 57 0 55 33 50 54 35 35 35 25 30 0 35 27 55 49 6 33 35 35 39 33 36 42 44 55 39 35 50 55 45 35 37 37 33 39 37 41 42 40 35 17 83498 "Hydroxyprogesterone, 17-d" 57 57 57 57 0 55 33 50 54 35 35 35 25 30 0 35 27 55 49 6 33 35 35 39 33 36 42 40 55 39 35 50 55 45 35 37 37 33 39 37 41 42 40 35 17 83516 "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method" 50 26 150 50 0 55 17 44 47 30 31 30 55 27 0 30 24 48 43 5 29 30 31 35 29 16 37 40 48 34 30 44 48 39 30 32 32 29 34 33 36 37 35 30 15 83520 "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified" 59 41 163 59 0 57 34 52 55 36 36 36 53 31 0 36 28 57 51 6 34 36 36 41 17 37 43 16 57 40 36 52 57 46 36 38 38 34 40 42 42 44 46 36 17 83521 IG LIGHT CHAINS FREE EACH 70 60 83 70 0 67 40 61 65 42 42 42 30 37 0 42 33 67 60 7 41 42 43 48 40 44 51 54 67 47 42 61 67 54 42 45 45 40 47 35 50 52 49 42 20 83525 Insulin; total 25 16 28 25 0 25 14 22 23 15 15 15 25 13 0 15 12 24 21 2 15 15 15 17 14 16 18 20 24 17 15 22 24 20 15 16 16 14 17 16 18 19 18 15 7 83540 Iron 23 13 25 23 0 26 13 21 22 14 14 14 26 13 0 14 11 20 20 2 13 14 14 16 13 14 12 20 22 16 14 4 22 18 14 15 15 13 16 14 16 15 17 14 7 83550 Iron binding capacity 45 23 48 45 0 44 31 42 42 27 27 27 30 26 0 27 22 43 39 4 26 27 28 32 26 28 44 39 44 31 27 5 43 35 27 29 29 26 30 29 32 33 33 27 13 83605 Lactate (lactic acid) 36 30 290 36 0 55 21 25 34 22 22 22 55 23 0 25 17 35 31 3 21 22 22 25 23 23 35 30 35 25 22 35 35 32 22 23 23 21 24 23 26 26 26 22 10 83615 "Lactate dehydrogenase (LD), (LDH);" 20 18 20 20 0 23 12 18 19 12 12 12 23 11 0 12 10 19 17 2 12 12 12 14 11 13 15 10 19 14 12 18 19 16 12 13 13 12 14 12 14 15 14 12 6 83630 "Lactoferrin, fecal; qualitative" 62 40 66 62 0 60 60 55 58 38 38 38 34 33 0 38 30 60 53 6 36 38 38 43 35 39 46 48 60 42 38 54 60 49 38 40 40 36 42 40 44 46 48 38 18 83655 Lead 13 12 25 13 0 37 8 11 12 8 8 8 37 7 0 8 6 21 11 1 8 8 8 9 7 8 10 12 13 9 8 11 13 10 8 8 8 8 9 8 9 10 9 8 4 83690 Lipase 25 20 27 25 0 24 16 19 23 15 15 15 16 14 0 17 12 24 21 2 15 15 15 18 11 15 24 18 21 16 15 24 24 23 15 16 20 14 15 17 18 18 18 15 5 83721 "Lipoprotein, direct measurement; LDL cholesterol" 20 13 21 20 0 54 12 18 19 12 12 12 54 11 0 12 10 19 17 2 12 12 12 14 11 13 15 18 19 14 12 18 19 16 12 13 13 12 14 13 14 15 14 12 6 83735 Magnesium 23 19 205 23 0 23 9 20 22 14 14 14 23 7 0 15 11 21 20 2 13 14 14 16 7 14 23 20 22 13 14 20 22 16 14 14 15 13 15 15 16 17 17 14 7 83789 "Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; quantitative, each specimen" 72 72 72 72 1 70 42 64 68 44 44 44 32 38 1 44 34 69 62 7 42 44 44 50 41 45 53 56 70 49 44 63 70 56 44 47 47 42 49 47 51 53 51 44 21 83835 Metanephrines 51 34 81 51 0 49 30 45 48 31 31 31 25 27 0 31 24 49 44 5 30 31 31 35 29 32 37 40 49 35 31 45 49 40 31 33 33 30 34 33 36 38 36 31 15 83874 Myoglobin 57 57 57 57 0 55 33 50 54 35 35 35 23 30 0 35 27 55 49 6 33 35 35 39 33 36 42 44 55 39 35 50 55 45 35 37 37 33 39 37 41 42 40 35 17 83880 Natriuretic peptide 115 98 267 115 1 112 69 105 108 70 70 70 102 39 1 70 55 111 99 11 67 70 71 81 72 72 107 98 112 78 70 101 111 90 70 74 74 67 78 77 82 92 81 70 33 83883 "Nephelometry, each analyte not elsewhere specified" 75 67 79 75 1 73 53 66 70 46 46 46 37 40 1 46 36 72 64 7 44 46 46 52 43 47 55 58 73 51 46 66 72 59 46 48 49 44 51 49 54 56 52 46 22 83921 "Organic acid, single, quantitative" 67 45 72 67 0 70 39 70 63 41 41 41 29 36 0 41 32 65 57 7 39 41 41 46 38 42 49 52 65 46 41 59 65 53 41 43 43 39 45 48 48 50 47 41 19 83930 Osmolality; blood 26 25 40 26 0 25 15 23 24 16 16 16 19 14 0 16 12 25 22 3 15 16 16 18 15 16 19 21 25 18 16 23 25 20 16 17 17 15 18 17 19 19 18 16 8 83935 Osmolality; urine 33 32 52 33 0 32 19 29 31 20 20 20 21 18 0 20 16 32 28 3 19 20 20 23 19 21 24 26 32 22 20 29 32 26 20 21 21 19 22 22 24 24 28 20 10 83945 Oxalate 62 59 62 62 0 60 36 55 58 38 38 38 26 33 0 38 30 60 53 6 36 38 38 43 35 39 46 48 60 42 38 54 60 49 38 40 40 36 42 40 44 46 44 38 18 83970 Parathormone (parathyroid hormone) 106 80 113 106 1 110 61 110 100 65 65 65 107 56 1 64 51 102 91 10 62 65 65 73 61 66 78 39 103 72 65 93 102 83 65 68 69 61 72 73 76 79 65 65 31 83993 "Calprotectin, fecal" 220 168 437 220 2 213 128 194 207 134 134 134 52 117 2 134 105 212 189 21 128 134 135 152 126 138 162 177 213 150 134 193 213 172 134 142 142 128 149 144 157 163 159 134 64 84075 "Phosphatase, alkaline;" 18 12 23 18 0 17 3 16 17 11 11 11 12 10 0 11 9 17 15 2 10 11 11 12 5 11 13 17 17 12 11 16 17 14 11 12 12 10 12 12 13 13 10 11 5 84080 "Phosphatase, alkaline; isoenzymes" 19 18 35 19 0 30 9 17 18 12 12 12 30 10 0 12 9 18 16 2 11 12 12 13 15 12 14 15 18 13 12 17 18 15 12 12 12 11 13 12 14 14 27 12 6 84100 Phosphorus inorganic (phosphate); 17 15 146 17 0 16 3 15 16 10 10 10 16 9 0 11 8 16 15 2 10 10 10 11 10 11 12 15 16 12 10 15 16 13 10 11 11 10 11 11 12 13 11 10 5 84105 Phosphorus inorganic (phosphate); urine 20 19 20 20 0 19 12 18 19 12 12 12 13 11 0 12 10 19 17 2 12 12 12 14 11 13 15 16 19 14 12 18 19 16 12 13 13 12 14 13 14 15 14 12 6 84110 "Porphobilinogen, urine; quantitative" 59 59 59 59 0 57 34 52 55 36 36 36 26 31 0 36 28 57 51 6 34 36 36 41 34 37 43 46 57 40 36 52 57 46 36 38 38 34 40 39 42 44 42 36 17 84120 "Porphyrins, urine; quantitation and fractionation" 60 60 60 60 0 58 35 53 56 37 37 37 26 32 0 36 29 58 51 6 35 37 37 42 34 38 44 47 58 41 37 53 58 47 37 39 39 35 41 39 43 44 43 37 17 84132 "Potassium; serum, plasma or whole blood" 16 15 17 16 0 26 11 14 15 10 10 10 26 9 0 10 8 15 14 2 9 10 10 11 9 10 12 12 16 11 10 14 15 13 10 10 10 9 11 10 11 12 11 10 5 84133 Potassium; urine 20 19 20 20 0 19 11 17 18 12 12 12 13 10 0 12 9 19 17 2 11 12 12 13 11 12 14 15 19 13 12 17 19 15 12 13 13 11 13 13 14 14 12 12 6 84134 Prealbumin 68 50 70 68 0 66 40 60 64 42 42 42 25 36 0 42 33 66 59 7 40 42 42 47 39 43 50 48 66 47 42 60 66 54 42 44 44 40 46 45 49 51 47 42 20 84144 Progesterone 57 54 60 57 0 55 33 50 54 35 35 35 39 30 0 35 27 55 49 6 33 35 35 39 33 34 42 49 55 39 35 50 55 45 35 37 37 33 39 37 41 42 36 35 17 84145 Procalcitonin (PCT) 212 175 228 212 2 206 123 187 199 129 129 129 93 113 2 129 102 204 182 21 124 129 130 154 111 133 180 175 206 145 129 186 205 156 129 137 137 123 143 126 152 164 128 129 62 84146 Prolactin 57 51 60 57 0 55 33 50 54 35 35 35 27 30 0 35 27 55 49 6 11 35 35 34 33 36 42 46 55 39 35 50 55 45 35 37 37 33 39 37 41 42 42 35 17 84152 Prostate specific antigen (PSA); complexed (direct measurement) 61 55 65 61 0 60 42 53 57 37 37 37 55 35 0 16 29 54 52 6 36 37 37 39 18 38 60 52 59 38 37 53 60 48 37 39 39 35 41 41 44 43 42 37 18 84153 Prostate specific antigen (PSA); total 60 60 60 60 0 58 35 53 56 37 37 37 26 32 0 36 29 58 51 6 35 37 37 42 18 38 44 47 58 41 37 53 58 47 37 39 39 35 41 39 43 44 43 37 17 84154 Prostate specific antigen (PSA); free 34 34 34 34 0 33 20 30 32 21 21 21 15 18 0 21 16 33 29 3 20 21 21 24 18 21 25 26 33 23 21 30 33 27 21 22 22 20 23 22 24 25 24 21 10 84155 "Protein, total, except by refractometry; serum, plasma or whole blood" 15 14 15 15 0 15 9 13 14 9 9 9 15 8 0 9 7 14 13 1 9 9 9 10 9 9 11 12 15 10 9 13 14 12 9 10 10 9 10 10 11 11 9 9 4 84156 "Protein, total, except by refractometry; urine" 23 19 25 23 0 22 13 20 22 14 14 14 16 12 0 14 11 22 20 2 13 14 14 16 13 14 17 18 22 16 14 20 22 18 14 15 15 13 16 15 16 17 12 14 7 84165 "Protein; electrophoretic fractionation and quantitation, serum" 25 24 28 25 0 25 17 22 23 15 15 15 25 13 0 15 12 24 21 2 15 15 15 17 14 18 18 24 24 17 15 22 24 20 15 16 16 14 17 19 18 19 16 15 7 84207 Pyridoxal phosphate (Vitamin B-6) 43 40 46 43 0 42 25 38 40 26 26 26 28 23 0 26 21 41 37 4 25 26 26 30 25 27 32 33 42 29 26 38 42 34 26 28 28 25 29 28 31 32 30 26 12 84244 Renin 45 31 133 45 0 58 58 40 42 27 27 27 27 24 0 27 22 43 39 4 26 27 28 31 26 28 33 17 44 31 27 39 43 35 27 29 29 26 30 29 32 33 32 27 13 84255 Selenium 28 28 28 28 0 28 16 25 26 17 17 17 28 15 0 17 13 27 24 3 16 17 17 19 16 18 21 24 27 19 17 25 27 22 17 18 18 16 19 18 20 21 20 17 8 84270 Sex hormone binding globulin (SHBG) 15 15 54 15 0 35 9 13 14 9 9 9 7 8 0 9 7 14 13 1 9 9 9 10 9 9 35 12 15 10 9 13 14 12 9 10 10 9 10 10 11 11 11 9 4 84295 "Sodium; serum, plasma or whole blood" 17 15 17 17 0 16 12 15 16 10 10 10 7 9 0 10 8 16 15 2 10 10 10 12 10 11 12 15 16 12 10 15 16 13 10 11 11 10 11 11 12 13 12 10 5 84300 Sodium; urine 16 13 21 16 0 16 10 15 15 10 10 10 9 9 0 10 8 16 14 2 10 10 10 11 9 10 12 13 16 11 10 14 16 13 10 11 11 10 11 11 12 12 12 10 5 84302 Sodium; other source 86 21 150 86 1 83 50 75 80 52 52 52 11 46 1 52 41 82 73 8 50 52 53 59 49 54 63 67 83 58 52 75 83 67 52 55 55 50 58 56 61 63 61 52 25 84305 Somatomedin 88 88 88 88 1 85 51 78 83 54 54 54 39 47 1 53 42 85 75 9 51 54 54 61 50 55 65 71 85 60 54 77 85 69 54 57 57 51 59 57 63 65 62 54 26 84402 Testosterone; free 58 14 213 58 0 99 34 52 55 36 36 36 27 33 0 36 28 56 50 6 34 36 36 41 33 37 43 81 57 40 36 51 57 46 36 38 38 34 40 51 42 43 99 36 17 84403 Testosterone; total 22 14 25 22 0 27 10 15 21 13 13 13 27 9 0 13 11 20 19 2 13 13 14 11 14 16 16 18 21 15 13 19 21 17 13 14 14 13 15 12 16 18 17 13 6 84410 HC TESTOSTERONE BIOAVAILABLE 41 29 46 41 0 102 20 36 38 25 25 25 102 22 0 25 20 40 35 4 24 25 25 28 28 26 30 31 40 28 25 36 40 32 25 26 27 24 28 25 29 30 29 25 12 84425 Thiamine (Vitamin B-1) 62 50 66 62 0 60 36 55 58 38 38 38 30 33 0 38 30 60 53 6 36 38 38 43 35 39 46 50 60 42 38 54 60 49 38 40 40 36 42 44 44 46 44 38 18 84432 Thyroglobulin 33 33 33 33 0 55 19 29 31 20 20 20 55 18 0 20 16 32 28 3 19 20 20 23 19 21 24 28 32 22 20 29 32 26 20 21 21 19 22 22 24 24 23 20 10 84436 Thyroxine; total 22 21 25 22 0 49 13 19 21 13 13 13 49 12 0 13 11 21 19 2 13 13 14 15 13 14 16 17 21 15 13 19 21 17 13 14 14 13 15 14 16 16 16 13 6 84439 Thyroxine; free 28 24 30 28 0 50 5 27 26 17 17 17 50 9 0 8 13 27 24 3 16 17 17 19 9 15 27 22 27 19 17 27 27 26 17 18 18 16 19 19 20 19 20 17 8 84442 Thyroxine binding globulin (TBG) 54 54 54 54 0 52 31 48 51 33 33 33 24 29 0 33 26 52 46 5 31 33 33 37 31 34 40 42 52 37 33 47 52 42 33 35 35 31 36 35 39 40 38 33 16 84443 Thyroid stimulating hormone (TSH) 57 35 60 57 0 56 37 52 54 35 35 35 27 17 0 15 27 56 49 6 33 35 35 38 16 32 56 44 55 39 35 55 55 51 35 37 37 33 38 38 41 40 42 35 17 84445 Thyroid stimulating immune globulins (TSI) 197 130 207 197 1 201 114 174 185 120 120 120 118 105 1 120 94 190 169 19 115 120 121 136 113 123 145 178 191 134 120 201 190 154 120 127 127 114 133 129 141 146 140 120 57 84446 Tocopherol alpha (Vitamin E) 68 61 68 68 0 66 39 60 64 41 41 41 27 36 0 41 33 65 58 7 40 41 42 47 39 43 50 58 66 46 41 60 66 53 41 44 44 39 46 44 49 50 45 41 20 84450 Transferase; aspartate amino (AST) (SGOT) 30 27 67 30 0 57 17 26 28 18 18 18 15 16 0 18 14 29 26 3 17 18 18 21 17 19 15 57 29 20 18 26 29 27 18 19 19 17 20 18 21 22 22 18 9 84460 Transferase; alanine amino (ALT) (SGPT) 30 26 67 30 0 29 21 26 28 18 18 18 16 5 0 18 14 29 26 3 17 18 18 19 5 19 17 26 29 20 18 26 29 27 18 19 19 17 20 18 21 20 22 18 9 84466 Transferrin 40 40 49 40 0 40 27 35 38 24 24 24 24 21 0 24 19 40 34 4 23 24 25 28 23 25 29 34 39 27 24 35 39 31 24 26 26 23 27 24 29 30 28 24 12 84478 Triglycerides 38 36 38 38 0 37 22 34 36 23 23 23 14 20 0 23 18 37 33 4 22 23 23 26 22 24 28 32 37 26 23 33 37 30 23 25 25 22 26 25 27 28 27 23 11 84480 Triiodothyronine T3; total (TT-3) 43 40 44 43 0 42 25 38 40 26 26 26 27 23 0 26 21 41 37 4 25 26 26 30 25 27 32 30 42 29 26 38 42 34 26 28 28 25 29 28 31 32 29 26 12 84481 Triiodothyronine T3; free 37 30 39 37 0 38 21 29 35 23 23 23 27 20 0 22 18 36 32 4 22 23 23 26 21 24 8 28 36 25 23 38 36 27 23 24 24 21 25 17 26 27 29 23 11 84482 Triiodothyronine T3; reverse 62 43 66 62 0 60 36 55 58 38 38 38 27 33 0 38 30 60 53 6 36 38 38 43 35 39 46 48 60 42 38 54 60 49 38 40 40 36 42 40 44 46 44 38 18 84484 "Troponin, quantitative" 32 27 96 32 0 38 27 21 30 20 20 20 38 21 0 22 21 31 27 3 19 20 20 23 20 19 31 27 29 22 20 31 31 29 20 21 21 19 22 21 23 23 22 20 9 84520 Urea nitrogen; quantitative 14 13 67 14 0 16 8 13 13 9 9 9 16 7 0 9 7 13 12 1 8 9 9 10 8 9 10 13 14 10 9 12 14 11 9 9 9 8 9 10 10 10 10 9 4 84540 "Urea nitrogen, urine" 19 19 19 19 0 18 11 17 18 12 12 12 8 10 0 12 9 18 16 2 11 12 12 13 11 12 14 15 18 13 12 17 18 15 12 12 12 11 13 12 14 14 13 12 6 84550 Uric acid; blood 16 14 17 16 0 16 6 15 15 10 10 10 16 9 0 10 8 15 14 2 9 10 10 11 4 10 12 13 16 11 10 14 15 13 10 10 10 9 11 9 11 11 12 10 5 84560 Uric acid; other source 20 19 20 20 0 19 12 18 19 12 12 12 13 11 0 12 10 19 17 2 12 12 12 14 11 13 15 16 19 14 12 18 19 16 12 13 13 12 14 13 14 15 14 12 6 84585 "Vanillylmandelic acid (VMA), urine" 83 83 83 83 1 81 48 73 78 51 51 51 36 44 1 50 40 80 71 8 48 51 51 57 47 52 61 65 81 57 51 73 80 65 51 54 54 48 56 54 59 62 59 51 24 84588 "Vasopressin (antidiuretic hormone, ADH)" 186 186 186 186 1 180 108 164 175 113 113 113 82 99 1 113 89 179 159 18 108 113 114 129 106 117 137 145 180 127 113 163 180 146 113 120 120 108 126 121 133 138 132 113 54 84590 Vitamin A 48 42 48 48 0 47 28 47 45 29 29 29 29 26 0 29 23 46 41 5 28 29 29 33 27 30 35 41 47 33 29 42 46 38 29 31 31 28 32 32 34 36 29 29 14 84597 Vitamin K 106 106 162 106 1 103 61 93 100 65 65 65 28 56 1 64 51 102 91 10 62 65 65 73 61 66 78 91 103 72 65 93 102 83 65 68 69 61 72 69 76 79 75 65 31 84630 Zinc 36 32 36 36 0 35 21 32 34 22 22 22 18 19 0 22 17 35 31 3 21 22 22 25 21 23 26 31 35 25 22 32 35 28 22 23 23 21 24 24 26 27 26 22 10 84681 C-peptide 42 30 44 42 0 48 24 37 39 26 26 26 48 22 0 26 20 40 36 4 24 26 26 29 24 26 31 33 41 29 26 37 41 33 26 27 27 24 28 27 30 31 30 26 12 84702 "Gonadotropin, chorionic (hCG); quantitative" 52 46 55 52 0 52 30 46 49 32 32 32 52 28 0 35 25 50 45 5 30 32 32 36 30 30 38 41 50 35 32 46 50 41 32 34 34 30 35 34 37 38 38 32 15 84703 "Gonadotropin, chorionic (hCG); qualitative" 28 24 42 28 0 29 24 25 26 17 17 17 26 15 0 17 13 27 24 3 16 17 17 19 16 18 21 20 27 19 17 25 27 22 17 18 18 16 19 18 20 20 29 17 8 84999 Unlisted chemistry procedure 17 17 17 17 0 50 10 15 16 10 10 10 50 9 0 10 8 16 15 2 10 10 10 12 10 11 12 13 16 12 10 15 16 13 10 11 11 10 11 11 12 13 12 10 5 85004 Blood count; automated differential WBC count 25 25 25 25 0 24 14 22 23 15 15 15 11 13 0 15 12 24 21 2 15 15 15 17 14 16 18 10 24 17 15 22 24 20 15 16 16 14 17 16 18 19 18 15 7 85014 Blood count; hematocrit (Hct) 9 7 43 9 0 28 2 8 8 5 5 5 28 5 0 5 4 9 8 1 5 5 6 6 5 6 9 6 9 6 5 8 9 7 5 6 6 5 6 6 6 7 5 5 3 85018 Blood count; hemoglobin (Hgb) 9 5 10 9 0 15 2 8 8 5 5 5 15 5 0 6 4 9 8 1 5 5 6 6 5 6 9 6 9 6 5 8 9 8 5 6 6 5 6 6 6 7 6 5 3 85025 "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count" 28 22 47 28 0 29 20 24 23 17 15 17 29 16 0 18 18 27 24 3 5 17 17 20 17 18 27 24 24 15 17 27 27 26 17 19 22 16 17 17 20 20 20 17 5 85027 "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)" 21 20 25 21 0 29 14 14 20 13 13 13 29 11 0 13 10 20 18 2 12 13 13 16 12 13 15 20 20 14 13 18 20 16 13 14 14 12 14 14 15 16 16 13 6 85046 "Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV], RNA content), direct measurement" 20 18 21 20 0 19 6 18 19 12 12 12 15 11 0 12 10 18 17 2 12 12 12 5 11 13 15 15 19 14 12 18 19 16 12 13 13 12 14 13 14 15 15 12 6 85048 "Blood count; leukocyte (WBC), automated" 8 8 10 8 0 16 5 7 8 5 5 5 16 4 0 5 4 8 7 1 5 5 5 6 5 5 6 4 8 5 5 7 8 6 5 5 5 5 5 5 6 6 6 5 2 85049 "Blood count; platelet, automated" 13 13 14 13 0 27 8 11 12 8 8 8 27 7 0 8 6 13 11 1 8 8 8 9 7 8 10 10 13 9 8 11 13 10 8 8 8 8 9 8 9 10 9 8 4 85060 "Blood smear, peripheral, interpretation by physician with written report" 66 63 71 66 0 64 28 58 62 40 40 40 62 35 0 23 32 64 57 6 38 40 41 46 38 41 48 61 64 45 40 58 64 52 40 43 43 38 45 44 47 49 52 40 19 85210 "Clotting; factor II, prothrombin, specific" 130 130 130 130 1 126 75 115 122 79 79 79 57 69 1 79 62 125 111 13 76 79 80 90 74 81 95 101 126 89 79 114 126 102 79 84 84 75 88 85 93 96 92 79 38 85220 "Clotting; factor V (AcG or proaccelerin), labile factor" 64 64 64 64 0 62 37 56 60 39 39 39 28 34 0 39 31 62 55 6 37 39 39 44 37 40 47 50 62 44 39 56 62 50 39 41 41 37 43 42 46 47 45 39 19 85230 "Clotting; factor VII (proconvertin, stable factor)" 134 134 134 134 1 130 78 119 126 82 82 82 46 72 1 82 64 129 115 13 78 82 83 93 77 84 99 105 130 92 82 118 130 105 82 87 87 78 91 88 96 100 95 82 39 85240 "Clotting; factor VIII (AHG), 1-stage" 142 122 166 142 1 138 83 126 134 87 87 87 62 76 1 86 68 137 122 14 83 87 87 99 81 89 105 115 138 97 87 125 137 112 87 92 92 83 96 93 102 105 101 87 41 85246 "Clotting; factor VIII, VW factor antigen" 228 156 240 228 2 221 132 201 214 139 139 139 31 121 2 138 109 219 195 22 133 139 140 158 130 143 167 189 221 155 139 200 220 179 139 147 147 132 154 149 163 169 162 139 66 85300 "Clotting inhibitors or anticoagulants; antithrombin III, activity" 109 99 109 109 1 106 63 96 102 66 66 66 48 58 1 66 52 105 93 11 64 66 67 75 62 68 80 82 106 74 66 96 105 85 66 70 70 63 74 71 78 81 77 66 32 85302 "Clotting inhibitors or anticoagulants; protein C, antigen" 38 38 40 38 0 37 22 34 36 23 23 23 17 20 0 23 18 37 33 4 22 23 23 26 22 24 28 30 37 26 23 33 37 30 23 25 25 22 26 25 27 29 27 23 11 85303 "Clotting inhibitors or anticoagulants; protein C, activity" 104 99 109 104 1 101 60 92 98 63 63 63 24 55 1 63 50 100 89 10 61 63 64 72 59 65 76 82 101 71 63 91 100 82 63 67 67 60 70 68 74 79 74 63 30 85305 "Clotting inhibitors or anticoagulants; protein S, total" 74 72 76 74 1 72 43 65 69 45 45 45 12 39 1 45 35 71 63 7 43 45 45 51 42 46 54 58 72 50 45 65 71 58 45 48 48 43 50 48 53 55 52 45 21 85306 "Clotting inhibitors or anticoagulants; protein S, free" 106 57 118 106 1 103 62 94 100 65 65 65 12 57 1 64 51 102 91 10 62 65 65 73 61 66 78 88 103 72 65 93 102 83 65 69 69 62 72 69 76 79 75 65 31 85380 "Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative" 24 20 26 24 0 53 25 23 23 15 15 15 53 15 0 16 11 24 21 2 14 15 15 15 14 15 23 18 23 16 15 21 23 11 15 16 16 14 16 15 17 18 18 15 7 85384 Fibrinogen; activity 49 49 49 49 0 48 28 43 46 30 30 30 21 26 0 30 23 47 42 5 29 30 30 34 28 31 36 38 48 33 30 43 47 38 30 32 32 28 33 32 35 36 35 30 14 85397 "Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte" 228 156 240 228 2 221 132 201 214 139 139 139 31 121 2 138 109 219 195 22 133 139 140 158 130 143 167 189 221 155 139 200 220 179 139 147 147 132 154 149 163 169 162 139 66 85610 Prothrombin time; 14 12 16 14 0 26 10 15 13 9 9 9 26 9 0 10 7 14 12 1 8 9 9 11 9 9 9 12 14 10 9 13 14 13 9 9 9 8 9 9 10 11 9 9 4 85613 Russell viper venom time (includes venom); diluted 24 22 25 24 0 23 14 21 23 15 15 15 12 13 0 15 11 23 21 2 14 15 15 17 14 15 18 19 23 16 15 21 23 19 15 16 16 14 16 16 17 18 17 15 7 85652 "Sedimentation rate, erythrocyte; automated" 10 8 11 10 0 15 5 8 9 6 6 6 15 5 0 7 5 10 9 1 6 6 6 6 3 6 10 8 10 7 6 8 10 5 6 6 6 6 7 6 7 6 7 6 3 85660 "Sickling of RBC, reduction" 54 54 54 54 0 52 31 48 51 33 33 33 24 29 0 33 26 52 46 5 31 33 33 37 31 34 40 42 52 37 33 47 52 42 33 35 35 31 36 35 39 40 38 33 16 85670 Thrombin time; plasma 38 38 38 38 0 37 22 34 36 23 23 23 17 20 0 23 18 37 33 4 22 23 23 26 22 24 28 31 37 26 23 33 37 30 23 25 25 22 26 25 27 28 27 23 11 85730 "Thromboplastin time, partial (PTT); plasma or whole blood" 18 15 19 18 0 17 4 17 17 11 11 11 14 10 0 11 9 17 15 2 10 11 11 13 10 11 17 13 16 12 11 16 17 14 11 12 12 10 12 12 13 13 13 11 5 86003 "Allergen specific IgE; quantitative or semiquantitative, each allergen" 26 16 286 26 0 25 15 22 24 16 16 16 8 14 0 15 12 25 22 2 15 16 16 18 15 16 19 20 25 17 16 22 25 20 16 16 16 15 17 17 18 19 18 16 7 86008 HC ALLG SPEC IGE RECOMB EA 92 92 92 92 1 89 53 81 86 56 56 56 52 49 1 56 44 88 79 9 53 56 56 63 52 57 67 71 89 63 56 80 89 72 56 59 59 53 62 60 66 68 65 56 27 86015 Smooth muscle antibody titer (ASMA) 44 20 69 44 0 67 26 39 42 27 27 27 20 24 0 27 21 43 38 4 26 27 27 31 25 13 33 35 43 30 27 67 43 35 27 29 29 26 30 29 32 33 32 27 13 86038 Antinuclear antibodies (ANA); 41 10 862 41 0 540 7 36 38 25 25 25 34 22 0 25 20 39 35 4 24 25 25 28 12 540 30 12 40 28 25 36 40 32 25 26 27 24 28 27 29 30 46 25 12 86039 Antinuclear antibodies (ANA); titer 29 28 29 29 0 28 17 26 27 18 18 18 25 15 0 18 14 28 25 3 17 18 18 20 17 18 21 23 28 20 18 25 28 23 18 19 19 17 20 19 21 21 19 18 8 86060 Antistreptolysin 0; titer 32 29 122 32 0 31 19 28 30 20 20 20 14 17 0 19 15 31 27 3 19 20 20 22 18 20 24 27 31 22 20 28 31 25 20 21 21 19 22 21 23 24 23 20 9 86140 C-reactive protein; 17 14 18 17 0 46 10 14 15 10 10 10 46 11 0 11 8 17 15 2 10 10 10 12 11 10 17 14 16 12 10 16 16 11 10 11 11 10 11 11 12 12 12 10 5 86141 C-reactive protein; high sensitivity (hsCRP) 41 27 44 41 0 40 24 36 38 25 25 25 23 22 0 25 20 39 35 4 24 25 25 28 23 26 30 38 40 28 25 36 40 32 25 26 27 24 28 27 29 30 29 25 12 86146 "Beta 2 Glycoprotein I antibody, each" 70 67 74 70 1 68 41 62 66 43 43 43 32 38 1 43 34 68 60 7 41 43 43 49 40 44 52 55 68 48 43 62 68 55 43 46 46 41 48 46 50 51 50 43 20 86147 "Cardiolipin (phospholipid) antibody, each Ig class" 67 63 75 67 0 65 39 59 63 41 41 41 22 36 0 41 32 65 57 7 39 41 41 46 38 42 49 48 65 46 41 59 65 53 41 43 43 39 45 44 48 51 47 41 19 86160 "Complement; antigen, each component" 52 50 56 52 0 51 30 45 48 31 31 31 26 27 0 31 25 50 44 5 30 31 32 36 29 32 38 40 50 35 31 51 50 40 31 33 33 30 35 34 37 38 37 31 15 86162 Complement; total hemolytic (CH50) 35 35 39 35 0 34 20 31 33 21 21 21 15 19 0 21 17 34 30 3 20 21 21 24 20 22 26 25 34 24 21 31 34 27 21 23 23 20 24 23 25 26 25 21 10 86200 "Cyclic citrullinated peptide (CCP), antibody" 39 38 62 39 0 38 23 34 37 24 24 24 17 21 0 24 19 38 33 4 23 24 24 27 22 24 29 30 38 27 24 34 38 31 24 25 25 23 26 25 28 29 28 24 11 86215 "Deoxyribonuclease, antibody" 36 34 37 36 0 34 21 31 33 22 22 22 16 19 0 22 17 34 30 3 21 22 22 25 20 22 26 28 34 24 22 31 34 28 22 23 23 21 24 23 25 26 25 22 10 86225 Deoxyribonucleic acid (DNA) antibody; native or double stranded 54 36 58 54 0 53 31 47 50 33 33 33 35 29 0 33 26 52 46 5 31 33 33 37 31 34 39 42 52 36 33 53 52 42 33 35 35 31 36 35 38 40 38 33 16 86231 EMA EACH IG CLASS 84 66 101 84 1 81 48 74 78 51 51 51 37 44 1 51 40 80 72 8 49 51 51 58 48 52 61 11 81 57 51 73 81 65 51 54 54 48 56 55 60 62 59 51 24 86235 "Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody" 67 41 670 67 0 245 39 59 63 41 41 41 37 36 0 41 32 65 57 7 39 41 41 46 18 45 49 51 65 46 41 61 65 53 41 43 43 39 45 120 48 50 245 41 19 86255 "Fluorescent noninfectious agent antibody; screen, each antibody" 81 25 154 81 1 79 12 71 76 49 49 49 39 43 1 49 39 78 69 8 47 49 50 56 46 51 59 63 79 55 49 71 78 63 49 52 52 47 55 53 58 60 63 49 24 86256 "Fluorescent noninfectious agent antibody; titer, each antibody" 431 431 431 431 3 418 250 380 405 263 263 263 189 230 3 262 206 415 369 42 251 263 265 298 246 270 317 336 418 294 263 378 416 338 263 279 279 250 291 281 308 320 306 263 125 86258 GLIADIN IGG ANTIBODY 50 50 50 50 0 48 29 44 47 30 31 30 22 27 0 30 24 48 43 5 29 30 31 35 29 31 37 39 48 34 30 44 48 39 30 32 32 29 34 33 36 37 35 30 15 86300 "Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)" 56 56 59 56 0 54 32 49 53 34 34 34 25 30 0 34 27 54 48 5 33 34 34 39 32 35 41 44 54 38 34 49 54 44 34 36 36 32 38 37 40 42 40 34 16 86301 "Immunoassay for tumor antigen, quantitative; CA 19-9" 109 75 114 109 1 106 63 96 102 66 66 66 36 58 1 66 52 105 93 11 64 66 67 75 62 68 80 64 106 74 66 96 105 85 66 70 70 63 74 76 78 81 76 66 32 86304 "Immunoassay for tumor antigen, quantitative; CA 125" 83 54 88 83 1 81 48 73 78 51 51 51 31 44 1 50 40 80 71 8 48 51 51 57 47 52 13 65 81 57 51 73 80 65 51 54 54 48 56 57 59 62 59 51 24 86308 Heterophile antibodies; screening 18 17 19 18 0 43 10 16 17 11 11 11 43 10 0 11 9 18 15 2 10 11 11 12 10 11 13 15 17 12 11 16 17 14 11 12 12 10 12 12 13 13 13 11 5 86316 "Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each" 110 73 110 110 1 107 64 97 103 67 67 67 26 59 1 67 53 106 94 11 64 67 68 76 63 69 81 86 107 75 67 96 106 86 67 71 71 64 74 72 79 82 78 67 32 86334 Immunofixation electrophoresis; serum 51 51 71 51 0 49 30 45 48 31 31 31 26 27 0 31 24 49 44 5 30 31 31 35 29 32 37 40 49 35 31 45 49 40 31 33 33 30 34 41 36 41 36 31 15 86335 "Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)" 103 103 103 103 1 100 60 91 97 63 63 63 45 55 1 63 49 99 88 10 60 63 63 71 59 65 76 80 100 70 63 90 100 81 63 67 67 60 70 67 74 76 73 63 30 86337 Insulin antibodies 110 110 110 110 1 107 64 97 103 67 67 67 48 59 1 67 53 106 94 11 64 67 68 76 63 69 81 89 107 75 67 96 106 86 67 71 71 64 74 72 79 82 78 67 32 86359 T cells; total count 54 54 54 54 0 52 31 48 51 33 33 33 24 29 0 33 26 52 46 5 31 33 33 37 31 34 40 44 52 37 33 47 52 42 33 35 35 31 36 35 39 40 38 33 16 86360 "T cells; absolute CD4 and CD8 count, including ratio" 365 56 384 365 3 354 212 322 343 223 223 223 66 194 3 222 175 351 313 35 213 223 224 253 209 229 268 176 354 249 223 320 353 286 223 236 236 212 247 238 261 271 259 223 106 86364 TISSUE TRANSGLUTAMINASE IGA AB 53 50 53 53 0 51 31 47 50 32 32 32 24 28 0 32 25 51 45 5 31 32 33 38 30 33 39 46 51 36 32 46 51 42 32 34 34 31 36 35 38 39 39 32 15 86376 "Microsomal antibodies (eg, thyroid or liver-kidney), each" 36 36 58 36 0 56 21 35 34 22 22 22 48 19 0 22 17 35 31 3 21 22 22 25 21 23 26 31 35 25 22 56 35 32 22 23 23 21 24 24 26 27 26 22 10 86381 ANTI-MITOCHONDRIAL ANTIBODY 44 34 54 44 0 43 26 39 41 27 27 27 19 23 0 27 21 42 38 4 26 27 27 30 25 21 32 34 43 30 27 39 43 34 27 28 28 26 30 29 31 33 40 27 13 86382 "Neutralization test, viral" 137 137 137 137 1 133 79 121 129 84 84 84 46 73 1 83 66 132 117 13 80 84 84 95 78 86 101 107 133 93 84 120 132 107 84 88 89 79 92 89 98 102 97 84 40 86431 Rheumatoid factor; quantitative 10 9 11 10 0 35 3 9 9 6 6 6 35 5 0 6 5 10 9 1 6 6 6 7 6 6 7 7 10 7 6 9 10 8 6 6 6 6 7 6 7 7 7 6 3 86480 "Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon" 135 135 142 135 1 131 78 119 127 82 82 82 106 72 1 82 65 130 116 13 79 82 83 93 77 85 99 96 131 92 82 118 130 106 82 87 87 78 91 88 96 100 95 82 39 86481 "Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension" 150 142 158 150 1 145 87 132 141 92 92 92 63 80 1 91 72 144 129 15 87 92 92 101 86 94 110 115 145 102 92 132 145 118 92 97 97 87 101 98 107 110 106 92 44 86580 "Skin test; tuberculosis, intradermal" 53 50 56 53 0 51 31 47 50 32 32 32 23 28 0 32 25 51 45 5 31 32 33 37 30 33 39 35 51 36 32 46 51 42 32 34 34 31 36 35 38 39 38 32 15 86592 "Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)" 58 50 67 58 0 57 34 52 55 36 36 36 26 31 0 36 28 56 50 6 34 36 36 40 33 37 43 43 57 40 36 51 57 46 36 38 38 34 40 38 42 43 41 36 17 86617 "Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)" 39 39 39 39 0 38 23 34 37 24 24 24 17 21 0 24 19 38 33 4 23 24 24 27 22 24 29 30 38 27 24 34 38 31 24 25 25 23 26 25 28 29 23 24 11 86618 Antibody; Borrelia burgdorferi (Lyme disease) 48 33 54 48 0 47 28 42 45 29 29 29 23 26 0 29 23 46 41 5 28 29 29 33 27 30 35 34 47 33 29 42 46 30 29 31 31 28 32 26 34 36 19 29 14 86635 Antibody; Coccidioides 59 30 118 59 0 57 34 52 55 36 36 36 26 31 0 36 28 57 51 6 34 36 36 41 34 37 43 46 57 40 36 52 57 46 36 38 38 34 40 40 42 44 42 36 17 86644 Antibody; cytomegalovirus (CMV) 53 53 53 53 0 51 31 47 50 32 32 32 46 28 0 32 25 51 45 5 31 32 33 37 30 33 39 41 51 36 32 46 51 42 32 34 34 31 36 35 38 39 38 32 15 86645 "Antibody; cytomegalovirus (CMV), IgM" 116 116 116 116 1 113 67 102 109 71 71 71 23 62 1 71 56 112 99 11 68 71 71 80 66 73 85 90 113 79 71 102 112 91 71 75 75 67 78 76 83 86 82 71 34 86664 "Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)" 52 51 54 52 0 51 30 46 49 32 32 32 23 28 0 32 25 51 45 5 31 32 32 36 30 33 39 46 51 36 32 46 51 41 32 34 34 30 35 34 38 39 37 32 15 86665 "Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)" 61 38 65 61 0 59 35 54 57 37 37 37 23 32 0 37 29 59 52 6 36 37 37 42 35 38 45 56 59 42 37 53 59 48 37 39 39 35 41 40 44 45 43 37 18 86692 "Antibody; hepatitis, delta agent" 318 318 318 318 2 308 184 280 299 194 194 194 139 169 2 193 152 306 273 31 185 194 195 220 182 199 234 248 308 217 194 279 307 249 194 205 206 184 215 208 227 236 225 194 92 86695 "Antibody; herpes simplex, type 1" 19 19 24 19 0 18 11 17 18 12 12 12 8 10 0 12 9 18 16 2 11 12 12 13 11 12 14 16 18 13 12 17 18 15 12 12 12 11 13 12 14 18 13 12 6 86696 "Antibody; herpes simplex, type 2" 19 19 24 19 0 18 11 17 18 12 12 12 8 10 0 12 9 18 16 2 11 12 12 13 11 12 14 16 18 13 12 17 18 15 12 12 12 11 13 12 14 18 13 12 6 86704 Hepatitis B core antibody (HBcAb); total 55 36 58 55 0 53 32 49 52 34 34 34 48 29 0 33 26 53 47 5 32 34 34 38 31 34 40 50 53 37 34 48 53 32 34 36 36 32 37 36 39 41 39 34 16 86706 Hepatitis B surface antibody (HBsAb) 48 32 52 48 0 47 28 42 45 29 29 29 43 26 0 29 23 46 41 5 28 29 29 33 27 30 31 45 47 33 29 42 46 38 29 31 31 28 32 31 34 36 32 29 14 86708 Hepatitis A antibody (HAAb); total 55 52 58 55 0 53 32 49 52 34 34 34 24 29 0 33 26 53 47 5 32 34 34 38 31 34 40 50 53 37 34 48 53 43 34 36 36 32 37 36 39 41 36 34 16 86735 Antibody; mumps 30 28 32 30 0 43 17 26 28 18 18 18 43 16 0 18 14 28 25 3 17 18 18 20 17 18 22 21 29 20 18 26 28 23 18 19 19 17 20 19 21 22 21 18 9 86738 Antibody; mycoplasma 32 32 85 32 0 31 19 28 30 20 20 20 14 17 0 19 15 31 27 3 19 20 20 22 18 20 24 27 31 22 20 28 31 25 20 21 21 19 22 21 23 24 23 20 9 86762 Antibody; rubella 31 27 35 31 0 30 18 27 29 19 19 19 24 17 0 19 15 30 27 3 18 19 19 21 18 19 23 22 30 21 19 27 30 24 19 20 20 18 21 20 22 23 22 19 9 86765 Antibody; rubeola 28 28 31 28 0 27 16 25 26 17 17 17 22 15 0 17 13 27 24 3 16 17 17 19 16 18 21 20 27 19 17 25 27 22 17 18 18 16 19 18 20 21 20 17 8 86769 HC SARS-COV-2 COVID-19 ANTIBODY 35 30 72 35 0 33 20 30 32 21 21 21 15 18 0 21 17 33 30 3 20 21 21 24 20 22 25 26 33 24 21 30 33 27 21 22 22 20 23 21 25 26 24 21 10 86777 Antibody; Toxoplasma 49 47 51 49 0 48 28 43 46 30 30 30 21 26 0 30 23 47 42 5 29 30 30 34 28 31 36 38 48 33 30 43 47 38 30 32 32 28 33 32 35 36 35 30 14 86778 "Antibody; Toxoplasma, IgM" 30 30 30 30 0 29 17 26 28 18 18 18 13 16 0 18 14 29 26 3 17 18 18 21 17 19 22 24 29 20 18 26 29 24 18 19 19 17 20 20 21 22 21 18 9 86780 Antibody; Treponema pallidum 55 52 68 55 0 58 32 49 52 34 34 34 24 29 0 33 26 53 47 5 32 34 34 38 31 34 40 58 53 37 34 48 53 43 34 36 36 32 37 36 39 42 39 34 16 86787 Antibody; varicella-zoster 29 28 35 29 0 35 17 26 27 18 18 18 35 15 0 18 14 28 25 3 17 18 18 20 13 18 21 12 28 20 18 25 28 23 18 19 19 17 20 19 21 21 21 18 8 86800 Thyroglobulin antibody 32 32 59 32 0 57 19 28 30 20 20 20 48 17 0 19 15 31 27 3 19 20 20 22 18 20 24 27 31 22 20 57 31 25 20 21 21 19 22 21 23 24 23 20 9 86803 Hepatitis C antibody; 65 58 69 65 0 63 38 57 61 40 40 40 25 35 0 40 31 63 56 6 38 40 40 45 37 41 48 49 63 44 40 57 63 59 40 42 42 38 44 42 46 48 44 40 19 86812 "HLA typing; A, B, or C (eg, A10, B7, B27), single antigen" 65 65 104 65 0 63 38 57 61 40 40 40 28 35 0 40 31 63 56 6 38 40 40 45 37 41 48 51 63 44 40 57 63 51 40 42 42 38 44 42 46 48 46 40 19 86832 HC HLA CLASS I HIGH DEFIN QUAL 485 485 510 485 3 470 281 428 455 296 296 296 100 258 3 295 232 467 416 47 283 296 298 336 277 304 356 378 470 331 296 425 469 380 296 313 314 281 328 317 347 360 344 296 141 86833 HC HLA CLASS II HIGH DEFIN QUAL 485 485 510 485 3 470 281 428 455 296 296 296 50 258 3 295 232 467 416 47 283 296 298 336 277 304 356 378 470 331 296 425 469 380 296 313 314 281 328 317 347 360 344 296 141 86850 "Antibody screen, RBC, each serum technique" 83 75 89 83 1 81 48 81 78 51 51 51 40 44 1 50 40 81 71 8 48 51 51 56 47 52 61 71 81 57 51 73 80 65 51 54 54 48 56 56 59 62 61 51 24 86870 "Antibody identification, RBC antibodies, each panel for each serum technique" 103 15 123 103 1 100 78 91 97 63 63 63 45 55 1 63 49 99 88 10 60 63 63 71 59 65 76 80 100 70 63 90 100 81 63 67 67 60 70 67 74 76 73 63 30 86900 Blood typing; ABO 95 21 100 95 1 93 54 92 89 58 58 58 20 51 1 58 45 93 81 9 55 58 58 63 54 60 70 81 92 65 58 83 92 74 58 61 61 55 64 64 68 70 70 58 28 86901 Blood typing; Rh (D) 28 22 30 28 0 27 15 27 26 17 17 17 19 15 0 17 13 27 24 3 16 17 17 18 16 18 21 24 27 19 17 25 27 22 17 18 18 16 19 19 20 21 20 17 8 86905 "Blood typing; RBC antigens, other than ABO or Rh (D), each" 81 79 324 81 1 79 53 71 76 49 49 49 35 43 1 49 39 78 69 8 47 49 50 56 46 51 59 63 79 55 49 71 78 63 49 52 52 47 55 53 58 60 57 49 24 86920 Compatibility test each unit; immediate spin technique 158 149 316 158 1 173 92 139 148 96 96 96 69 84 1 96 76 152 135 15 92 96 97 109 90 99 116 123 153 108 96 139 153 124 96 102 102 92 107 103 113 117 173 96 46 87015 "Concentration (any type), for infectious agents" 29 29 29 29 0 28 17 26 27 18 18 18 13 15 0 18 14 28 25 3 17 18 18 20 17 18 21 23 28 20 18 25 28 23 18 19 19 17 20 19 21 21 19 18 8 87040 "Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)" 30 24 32 30 0 29 17 26 28 18 18 18 13 20 0 18 14 29 26 3 17 18 18 21 19 19 29 25 29 20 18 26 29 27 18 19 19 17 20 18 22 22 22 18 9 87045 "Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species" 80 80 111 80 1 78 46 71 75 49 49 49 33 43 1 49 38 77 69 8 47 49 49 55 46 50 78 62 78 55 49 70 77 63 49 52 52 46 54 52 57 59 70 49 23 87046 "Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate" 99 16 99 99 1 96 96 87 93 60 60 60 15 53 1 60 47 95 85 10 58 60 61 69 57 62 73 77 96 67 60 87 96 78 60 64 64 57 67 65 71 73 66 60 29 87070 "Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates" 35 21 105 35 0 34 5 31 33 21 21 21 34 19 0 21 17 34 30 3 20 21 21 24 22 22 22 27 34 24 21 31 34 27 21 23 23 20 24 23 25 25 25 21 10 87075 "Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates" 40 26 126 40 0 39 23 35 38 24 24 24 18 21 0 24 19 39 34 4 23 24 25 28 23 25 29 22 39 27 24 35 39 31 24 26 26 23 27 28 29 30 27 24 12 87076 "Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate" 39 27 44 39 0 38 23 34 37 24 24 24 17 21 0 24 19 38 33 4 23 24 24 27 22 24 29 23 38 27 24 34 38 31 24 25 25 23 26 25 28 29 27 24 11 87077 "Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate" 19 13 60 19 0 36 11 13 18 12 12 12 36 10 0 12 9 18 16 2 11 12 12 13 10 12 19 15 18 13 12 17 18 12 12 12 12 8 13 13 14 10 10 12 4 87081 "Culture, presumptive, pathogenic organisms, screening only;" 24 15 27 24 0 33 14 21 23 15 15 15 33 7 0 15 11 23 21 2 14 15 15 17 14 15 19 19 23 16 15 21 23 19 15 16 16 14 16 13 17 18 18 15 7 87086 "Culture, bacterial; quantitative colony count, urine" 25 16 28 25 0 30 14 16 23 15 15 15 30 13 0 15 7 16 21 2 15 15 15 17 8 16 11 20 24 17 15 22 24 7 15 16 16 14 17 17 18 12 19 15 5 87102 "Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)" 55 41 61 55 0 53 32 49 52 34 34 34 24 29 0 33 26 53 47 5 32 34 34 38 31 34 40 43 53 37 34 48 53 43 34 36 36 32 37 36 39 41 39 34 16 87103 "Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood" 52 52 52 52 0 50 30 46 49 32 32 32 31 28 0 32 25 50 45 5 30 32 32 36 30 33 38 40 50 35 32 46 50 41 32 34 34 30 35 34 37 39 37 32 15 87106 "Culture, fungi, definitive identification, each organism; yeast" 31 31 35 31 0 30 18 27 29 19 19 19 14 17 0 19 15 30 27 3 18 19 19 21 18 19 23 22 30 21 19 27 30 24 19 20 20 18 21 20 22 23 22 19 9 87107 "Culture, fungi, definitive identification, each organism; mold" 32 31 33 32 0 31 19 28 30 20 20 20 14 17 0 19 15 31 27 3 19 20 20 22 18 20 24 25 31 22 20 28 31 25 20 21 21 19 22 21 23 24 23 20 9 87116 "Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates" 49 49 49 49 0 48 28 43 46 30 30 30 21 26 0 30 23 47 42 5 29 30 30 34 28 31 36 38 48 33 30 43 47 38 30 32 32 28 33 32 35 36 33 30 14 87147 "Culture, typing; immunologic method, other than immunofluoresence (eg, agglutination grouping), per antiserum" 20 19 20 20 0 19 12 18 19 12 12 12 16 11 0 12 10 19 17 2 12 12 12 14 11 13 15 17 19 14 12 18 19 16 12 13 13 12 14 13 14 15 14 12 6 87150 "Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed" 297 27 648 297 2 288 172 262 279 181 181 181 130 158 2 181 142 286 255 29 173 181 182 192 170 186 161 255 288 202 181 260 287 233 181 192 192 172 201 94 119 220 34 181 86 87172 "Pinworm exam (eg, cellophane tape prep)" 33 33 33 33 0 32 19 29 31 20 20 20 14 18 0 20 16 32 28 3 19 20 20 23 19 21 24 26 32 22 20 29 32 26 20 21 21 19 22 22 24 24 23 20 10 87176 "Homogenization, tissue, for culture" 13 13 21 13 0 13 8 11 12 8 8 8 6 7 0 8 6 13 11 1 8 8 8 9 7 8 10 11 13 9 8 11 13 10 8 8 8 8 9 8 9 10 9 8 4 87177 "Ova and parasites, direct smears, concentration and identification" 55 14 58 55 0 53 38 49 52 34 34 34 16 29 0 33 26 53 47 5 32 34 34 38 9 34 28 46 53 37 34 48 53 43 34 36 36 32 37 36 39 41 25 34 16 87181 "Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)" 16 15 17 16 0 23 9 14 15 10 10 10 23 9 0 10 8 15 14 2 9 10 10 11 9 10 12 15 16 11 10 14 15 13 10 10 10 9 11 10 11 12 11 10 5 87184 "Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)" 24 24 31 24 0 23 14 21 23 15 15 15 11 13 0 15 12 23 21 2 14 15 15 17 14 15 18 19 23 16 15 21 23 19 15 16 16 14 16 16 17 18 17 15 7 87185 "Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme" 16 16 17 16 0 16 9 14 15 10 10 10 7 9 0 10 8 15 14 2 9 10 10 11 9 10 12 12 16 11 10 14 15 13 10 10 10 9 11 10 11 12 11 10 5 87186 "Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate" 31 27 93 31 0 30 20 27 29 19 19 19 18 17 0 19 15 30 27 3 18 19 19 21 14 19 30 23 30 21 19 27 30 28 19 20 20 18 21 21 22 23 21 19 6 87205 "Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types" 20 8 60 20 0 20 2 18 19 12 12 12 17 11 0 12 10 20 17 2 12 12 12 14 13 13 18 15 19 14 12 18 19 16 12 13 13 12 14 13 14 14 14 12 6 87206 "Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types" 23 11 35 23 0 22 13 20 22 14 14 14 10 12 0 14 11 22 20 2 13 14 14 16 13 14 17 14 22 16 14 20 22 18 14 15 15 13 16 15 16 17 16 14 7 87209 "Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites" 34 28 100 34 0 43 43 30 32 21 21 21 16 18 0 21 16 33 29 3 20 21 21 24 18 21 25 27 33 23 21 30 33 27 21 22 22 20 23 22 24 25 29 21 10 87210 "Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)" 16 14 17 16 0 732 9 3 15 10 10 10 33 9 0 10 8 15 14 2 9 10 10 11 9 10 12 14 16 11 10 14 15 14 10 10 10 9 11 10 11 12 732 10 5 87305 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Aspergillus" 16 16 16 16 0 16 9 14 15 10 10 10 7 9 0 10 8 15 14 2 9 10 10 11 9 10 12 12 16 11 10 14 15 13 10 10 10 9 11 10 11 12 11 10 5 87324 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin(s)" 69 69 113 69 0 67 40 61 65 42 42 42 36 37 0 42 33 66 59 7 40 42 42 48 39 43 51 59 67 47 42 61 67 54 42 45 45 40 47 45 49 51 49 42 20 87327 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Cryptococcus neoformans" 66 66 66 66 0 64 38 58 62 40 40 40 29 35 0 40 32 64 57 6 38 40 41 46 38 41 48 51 64 45 40 58 64 52 40 43 43 38 45 43 47 49 47 40 19 87328 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; cryptosporidium" 36 36 36 36 0 35 21 32 34 22 22 22 16 19 0 22 17 35 31 3 21 22 22 25 21 23 26 28 35 25 22 32 35 28 22 23 23 21 24 24 26 27 26 22 10 87338 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool" 138 125 145 138 1 134 80 122 130 84 84 84 36 74 1 84 66 133 118 13 80 84 85 96 79 86 101 112 134 94 84 121 133 108 84 89 89 80 93 90 99 100 98 84 40 87340 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)" 48 46 52 48 0 47 28 42 45 29 29 29 35 26 0 29 23 46 41 5 28 29 29 33 27 30 35 45 47 33 29 42 46 38 29 31 31 28 32 31 34 36 32 29 14 87341 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization" 65 65 65 65 0 63 38 57 61 40 40 40 28 35 0 40 31 63 56 6 38 40 40 45 37 41 48 51 63 44 40 57 63 51 40 42 42 38 44 42 46 48 46 40 19 87385 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Histoplasma capsulatum" 195 195 195 195 1 189 113 172 183 119 119 119 85 104 1 119 93 188 167 19 114 119 120 135 111 122 143 152 189 133 119 171 188 153 119 126 126 113 132 127 139 145 138 119 57 87389 HC HIV-1 AG W/ HIV-1 & HIV-2 AB 34 32 36 34 0 33 20 30 32 21 21 21 18 18 0 21 16 33 29 3 20 21 21 24 19 21 33 29 33 23 21 30 33 31 21 22 22 20 23 22 24 24 24 21 10 87420 "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; respiratory syncytial virus" 60 41 60 60 0 58 35 53 56 37 37 37 26 32 0 39 29 58 51 6 35 37 37 42 34 38 44 51 58 41 37 53 58 47 37 39 39 35 41 39 43 44 43 37 17 87426 HC CORONAVIRUS AG IA 56 50 56 56 0 55 32 54 53 34 34 34 25 34 0 36 27 55 48 5 33 34 34 32 36 32 55 48 51 38 34 54 54 44 34 36 36 32 38 38 41 41 40 34 16 87449 "Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism" 347 199 495 347 2 337 201 306 326 212 212 212 152 185 2 211 166 334 297 34 202 212 213 240 198 217 255 270 337 237 212 304 335 272 212 224 224 201 234 227 248 257 246 212 101 87486 "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique" 37 37 37 37 0 36 21 33 35 23 23 23 16 20 0 22 18 36 32 4 22 23 23 26 21 23 27 30 36 25 23 32 36 29 23 24 24 21 25 24 26 27 26 23 11 87491 "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique" 50 20 56 50 0 64 29 20 47 30 31 30 64 27 0 30 24 48 43 5 29 30 31 35 29 31 11 33 48 34 30 44 48 20 30 32 32 29 34 33 36 15 27 30 15 87493 "Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique" 53 50 59 53 0 63 51 47 50 32 32 32 63 28 0 32 25 51 45 5 31 32 33 37 30 33 39 41 51 36 32 46 51 42 32 34 34 31 36 35 38 39 35 32 15 87497 "Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification" 78 78 381 78 1 76 45 69 73 48 48 48 69 42 1 47 37 75 67 8 45 48 48 54 45 49 57 61 76 53 48 68 75 61 48 50 50 45 53 51 56 58 55 48 23 87502 "Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, reverse transcription and amplified probe technique, first 2 types or sub-types" 142 60 150 142 1 147 82 58 133 87 87 87 89 76 1 97 68 147 122 14 83 87 87 98 38 89 59 64 138 97 87 125 137 111 87 92 92 82 96 40 101 77 110 87 41 87507 HC IADNA-DNA/RNA PROBE TQ 12-25 445 350 468 445 3 432 258 392 418 271 271 271 279 237 3 360 213 429 381 43 259 271 273 308 409 279 327 360 432 303 271 390 430 349 271 288 288 258 301 298 318 330 332 271 129 87517 "Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification" 291 192 306 291 2 282 169 257 273 178 178 178 128 155 2 177 139 280 249 28 170 178 179 201 166 182 214 163 282 198 178 255 281 228 178 188 188 169 197 190 208 216 206 178 84 87522 "Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification" 216 200 246 216 2 210 125 191 203 132 132 132 65 115 2 131 103 208 185 21 126 132 133 150 123 135 159 171 210 147 132 189 209 178 132 140 140 125 146 141 154 160 153 132 63 87529 "Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique" 170 150 183 170 1 165 99 150 160 104 104 104 75 91 1 103 81 164 146 17 99 104 104 118 97 106 125 33 165 116 104 149 164 133 104 110 110 99 115 111 122 126 121 104 49 87530 "Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification" 580 580 580 580 4 563 336 512 545 354 354 354 69 309 4 353 278 559 497 56 338 354 356 401 331 363 426 452 563 395 354 509 560 455 354 375 375 336 392 379 415 430 411 354 168 87536 "Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification" 148 148 148 148 1 144 86 131 139 90 90 90 65 79 1 90 71 143 127 14 86 90 91 102 85 93 109 126 144 101 90 130 143 116 90 96 96 86 100 97 106 110 105 90 43 87581 "Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique" 37 37 37 37 0 36 21 33 35 23 23 23 16 20 0 22 18 36 32 4 22 23 23 26 21 23 27 30 36 25 23 32 36 29 23 24 24 21 25 24 26 27 26 23 11 87591 "Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique" 50 20 56 50 0 48 29 20 47 30 31 30 32 27 0 30 24 48 43 5 29 30 31 35 29 31 37 33 48 34 30 44 48 20 30 32 32 29 34 33 36 15 27 30 15 87624 PBB HPV HIGH-RISK TYPES 131 125 145 131 1 127 76 116 123 80 80 80 67 70 1 80 63 126 112 13 76 80 80 91 34 82 96 106 127 89 80 115 127 123 80 85 85 76 88 88 94 97 76 80 38 87631 HC RESP VIRUS 3-11 TARGETS 143 143 143 143 1 139 83 126 134 87 87 87 63 76 1 87 68 138 123 14 83 87 88 99 82 90 105 111 139 97 87 125 138 112 87 92 92 83 97 93 102 106 101 87 42 87633 HC RESP VIRUS 20 TARGETS 433 433 543 433 3 420 251 382 407 264 264 264 307 231 3 263 207 417 371 42 252 264 266 300 247 271 318 350 420 295 264 380 418 339 264 280 280 251 292 283 309 321 307 264 126 87635 Infectious agent detection by nucleic acid; severe acute respiratory syndrome coronavirus COVID-19 100 92 118 100 1 97 58 88 94 61 61 61 44 53 1 61 48 96 86 10 58 61 61 69 57 63 63 73 97 68 61 88 97 78 61 65 65 58 68 65 71 74 71 61 29 87636 Sarscov2 & inf a&b amp prb 143 143 143 143 1 139 83 126 134 87 87 87 63 76 1 87 68 138 123 14 83 87 88 99 82 90 105 111 139 97 87 125 138 112 87 92 92 83 97 96 102 106 101 87 42 87641 "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique" 104 74 106 104 1 100 60 91 97 63 63 63 45 55 1 63 50 100 89 10 60 63 64 72 59 65 76 58 100 71 63 91 100 81 63 67 67 60 70 68 74 77 73 63 30 87651 "Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique" 72 72 72 72 1 70 42 64 68 44 44 44 32 38 1 44 34 69 62 7 42 44 44 50 41 45 53 56 70 49 44 63 70 46 44 47 47 42 49 47 51 53 51 44 21 87661 Trichomonas vaginalis by Amplified Probe Technique 312 312 312 312 2 303 181 275 293 190 190 190 137 166 2 190 149 300 267 30 182 190 192 216 178 195 229 33 303 213 190 274 301 245 190 202 202 181 211 204 223 231 221 190 91 87798 "Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism" 80 37 636 80 1 617 617 71 75 49 49 49 31 43 1 49 38 77 69 8 47 49 49 55 46 50 59 113 78 55 49 70 77 63 49 52 52 46 54 52 57 165 154 49 23 87799 "Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism" 145 74 576 145 1 141 84 128 136 88 88 88 61 77 1 88 69 140 124 14 85 88 89 100 83 91 107 113 141 99 88 127 140 114 88 94 94 84 98 95 104 107 103 88 42 87804 Infectious agent antigen detection by immunoassay with direct optical observation; Influenza 40 34 40 40 0 39 25 37 38 24 24 24 30 20 0 24 19 39 34 4 23 24 25 28 24 25 26 31 39 27 24 35 39 31 24 26 26 23 27 25 29 28 28 24 12 87807 Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus 98 60 98 98 1 95 57 86 92 60 60 60 30 52 1 63 47 91 84 10 57 60 60 68 56 61 72 84 95 67 60 86 95 77 60 63 63 57 66 64 70 73 72 60 28 87811 HC SARS-COV-2 COVID19 W/OPTIC 90 90 90 90 1 87 52 79 85 55 55 55 39 48 1 55 43 87 77 9 52 55 55 62 51 56 66 73 87 61 55 79 87 71 55 58 58 52 61 59 64 67 64 55 26 87880 "Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A" 40 38 48 40 0 44 9 44 38 24 24 24 25 16 0 29 19 39 34 4 23 24 25 32 23 25 17 34 39 27 24 35 39 31 24 26 26 23 27 28 29 33 29 24 12 87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus 239 239 239 239 2 232 139 211 224 146 146 146 105 127 2 145 114 230 205 23 139 146 147 165 137 150 176 186 232 163 146 210 231 187 146 154 155 139 161 156 171 177 169 146 69 87999 Unlisted microbiology procedure 523 523 523 523 4 507 303 461 491 319 319 319 229 279 4 318 250 504 448 51 305 319 321 362 299 328 384 407 507 357 319 459 505 410 319 338 338 303 353 342 374 388 371 319 152 88104 "Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation" 38 38 38 38 0 37 22 34 36 23 23 23 17 20 0 23 18 37 33 4 22 23 23 26 22 24 28 30 37 26 23 33 37 30 23 25 25 22 26 25 27 28 27 23 11 88142 "Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision" 42 42 42 42 0 41 24 37 39 26 26 26 18 22 0 26 20 40 36 4 24 26 26 29 24 26 31 34 41 29 26 37 41 33 26 27 27 24 28 27 30 31 30 26 12 88184 "Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker" 255 103 255 255 2 247 148 225 239 156 156 156 160 136 2 155 122 246 219 25 149 156 157 177 146 160 187 199 247 174 156 224 246 200 156 165 165 148 172 167 182 189 181 156 74 88185 "Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (List separately in addition to code for first marker)" 121 84 3944 121 1 117 70 106 113 74 74 74 80 64 1 73 58 116 103 12 70 74 74 83 69 76 89 94 117 82 74 106 117 95 74 78 78 70 81 79 86 89 86 74 35 88271 "Molecular cytogenetics; DNA probe, each (eg, FISH)" 1111 1111 1248 1111 8 1078 644 980 1043 678 678 678 487 592 8 675 532 1070 952 108 648 678 682 769 635 696 816 865 1078 757 678 974 1073 871 678 718 718 644 750 725 794 824 788 678 322 88275 "Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells" 555 418 555 555 4 539 322 490 521 339 339 339 243 296 4 338 266 535 476 54 324 339 341 384 317 348 408 433 539 379 339 487 537 435 339 359 359 322 375 363 397 412 394 339 161 88302 "Level II - Surgical pathology, gross and microscopic examination Appendix, incidental, Fallopian tube, sterilization, Fingers/toes, amputation, traumatic, Foreskin, newborn, Hernia sac, any location, Hydrocele sac, Nerve, Skin, plastic repair, Sympathetic ganglion, Testis, castration, Vaginal mucosa, incidental, Vas deferens, sterilization" 193 183 193 193 1 187 112 170 181 118 118 118 85 103 1 125 92 186 165 19 112 118 119 134 110 121 142 150 187 132 118 169 186 151 118 125 125 112 130 126 138 143 137 118 56 88304 "Level III - Surgical pathology, gross and microscopic examination Abortion, induced, Abscess, Aneurysm - arterial/ventricular, Anus, tag, Appendix, other than incidental, Artery, atheromatous plaque, Bartholin's gland cyst, Bone fragment(s), other than pathologic fracture, Bursa/synovial cyst, Carpal tunnel tissue, Cartilage, shavings, Cholesteatoma, Colon, colostomy stoma, Conjunctiva - biopsy/pterygium, Cornea, Diverticulum - esophagus/small intestine, Dupuytren's contracture tissue, Femoral head, other than fracture, Fissure/fistula, Foreskin, other than newborn, Gallbladder, Ganglion cyst, Hematoma, Hemorrhoids, Hydatid of Morgagni, Intervertebral disc, Joint, loose body, Meniscus, Mucocele, salivary, Neuroma - Morton's/traumatic, Pilonidal cyst/sinus, Polyps, inflammatory - nasal/sinusoidal, Skin - cyst/tag/debridement, Soft tissue, debridement, Soft tissue, lipoma, Spermatocele, Tendon/tendon sheath, Testicular appendage, Thrombus or embolus, Tonsil and/or adenoids, Varicocele, Vas deferens, other than sterilization, Vein, varicosity" 205 185 216 205 1 199 119 181 192 125 125 125 90 109 1 125 98 197 176 20 119 125 126 142 117 128 151 160 199 140 125 180 198 161 125 132 133 119 138 137 147 141 145 125 59 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" 269 243 1280 269 2 261 148 237 253 164 164 164 139 155 2 32 129 259 231 26 157 164 165 186 154 169 198 209 261 183 164 236 260 211 164 174 174 156 182 180 192 199 172 164 78 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" 572 544 601 572 4 555 332 504 537 349 349 349 160 305 4 348 274 551 490 56 333 349 351 396 327 358 420 445 555 390 349 502 553 448 349 370 370 332 386 383 409 424 406 349 166 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" 752 752 752 752 5 729 436 663 706 459 459 459 330 401 5 457 360 724 645 73 438 459 462 521 430 471 552 586 729 513 459 659 726 589 459 486 486 436 508 491 538 558 533 459 218 88311 Decalcification procedure (List separately in addition to code for surgical pathology examination) 33 31 93 33 0 32 19 29 31 20 20 20 14 18 0 20 16 32 28 3 19 20 20 23 19 21 24 26 32 22 20 29 32 26 20 21 21 19 22 22 24 24 23 20 10 88312 "Special stains; Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), including interpretation and report, each" 390 243 807 390 3 379 226 344 367 238 238 238 171 208 3 237 187 376 335 38 228 238 240 270 223 245 287 304 379 266 238 342 377 306 238 252 253 226 264 255 279 290 277 238 113 88313 "Special stains; Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each" 197 197 197 197 1 191 114 174 185 120 120 120 86 105 1 120 94 190 169 19 115 120 121 136 113 123 145 153 191 134 120 173 190 154 120 127 127 114 133 129 141 146 140 120 57 88331 "Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen" 129 122 136 129 1 125 75 114 121 79 79 79 57 69 1 78 62 124 111 13 75 79 79 89 74 81 95 100 125 88 79 113 125 101 79 83 83 75 87 91 92 96 86 79 37 88332 Pathology consultation during surgery; each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure) 49 46 52 49 0 48 28 43 46 30 30 30 21 26 0 30 23 47 42 5 29 30 30 34 28 31 36 38 48 33 30 43 47 38 30 32 32 28 33 35 35 36 35 30 14 88341 PBB IMMUNOHISTO ANTIBODY ADDL SLIDE 930 562 2670 930 7 1789 620 820 873 567 567 567 80 495 7 565 445 895 797 90 542 567 571 643 531 582 683 724 902 634 567 815 898 729 567 601 601 539 628 1789 664 689 659 567 270 88342 "Immunohistochemistry (including tissue immunoperoxidase), each antibody" 257 232 464 257 2 249 142 227 241 157 157 157 113 137 2 156 123 247 220 25 150 157 158 178 147 161 189 200 249 175 157 225 248 201 157 166 166 149 174 163 184 191 182 157 75 88360 "Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual" 729 729 729 729 5 707 423 643 685 445 445 445 319 388 5 443 349 702 625 71 425 445 448 505 417 457 535 568 707 497 445 639 704 571 445 471 471 423 492 476 521 540 517 445 212 88364 HC INSITU HYBRIDIZATION (FISH) EA ADDTL SGL PROC 286 286 286 286 2 277 166 252 269 174 174 174 125 152 2 174 137 275 245 28 167 174 176 198 163 179 210 223 277 195 174 251 276 224 174 185 185 166 193 187 204 212 203 174 83 88365 "In situ hybridization (eg, FISH), each probe" 382 382 382 382 3 371 222 337 359 233 233 233 167 204 3 232 183 368 327 37 223 233 235 264 218 239 281 298 371 260 233 335 369 299 233 247 247 222 258 249 273 283 271 233 111 88377 HC MORPHOM ANALYS MANUAL EA MULTIPLX PROC 1017 1017 1017 1017 7 986 590 897 955 620 620 620 446 542 7 618 487 979 872 99 593 620 625 704 581 637 747 792 986 693 620 892 982 797 620 657 658 590 687 681 727 754 721 620 295 88720 "Bilirubin, total, transcutaneous" 12 7 12 12 0 12 7 11 11 7 7 7 5 6 0 7 6 12 10 1 7 7 7 8 7 8 9 7 12 8 7 11 12 9 7 8 8 7 8 8 9 9 9 7 3 89051 "Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count" 23 16 27 23 0 22 13 20 22 14 14 14 10 12 0 14 11 22 20 2 13 14 14 16 13 14 17 16 22 16 14 20 22 18 14 15 15 13 16 15 16 17 14 14 7 89060 "Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)" 21 20 21 21 0 20 12 19 20 13 13 13 9 11 0 13 10 20 18 2 12 13 13 15 12 13 15 16 20 14 13 18 20 16 13 14 14 12 14 14 15 16 15 13 6 90375 "Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use" 4566 1113 10707 4566 33 4429 2648 4027 4287 2785 2785 2785 2714 2433 33 2775 2186 4397 3914 443 2661 2785 2804 3161 2609 2860 3354 2294 4429 3113 2785 4004 4411 3579 2785 2951 2953 2648 3084 2982 3264 3385 3237 2785 1325 90471 "Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)" 40 36 42 40 0 39 23 39 38 24 24 24 18 21 0 26 19 35 34 4 23 24 25 28 23 25 39 31 39 27 24 35 39 18 24 26 26 23 27 25 29 29 29 24 12 90472 "Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)" 31 31 31 31 0 30 18 27 29 19 19 19 19 17 0 19 15 30 27 3 18 19 19 21 18 19 23 24 30 21 19 27 30 24 19 20 20 18 21 20 22 23 22 19 9 90662 "Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use" 57 57 70 57 0 56 33 51 54 35 35 35 43 31 0 35 27 55 49 6 33 35 35 40 33 36 42 45 56 39 35 50 55 45 35 37 37 33 39 37 41 43 41 35 17 90670 "Pneumococcal conjugate vaccine, 13 valent, for intramuscular use" 511 492 511 511 4 496 296 451 480 312 312 312 224 272 4 311 245 492 438 50 298 312 314 354 292 320 376 398 496 349 312 448 494 401 312 330 331 297 345 334 365 379 230 312 148 90675 "Rabies vaccine, for intramuscular use" 846 742 846 846 6 820 490 746 794 516 516 516 318 451 6 514 405 814 725 82 493 516 519 585 483 530 621 463 820 577 516 742 817 663 516 546 547 490 571 552 604 627 599 516 245 90686 Influenza virus vaccine 29 18 122 29 0 30 17 26 27 18 18 18 19 15 0 18 14 28 25 3 17 18 18 20 17 11 21 7 28 20 18 25 28 23 18 19 19 17 20 19 21 30 30 18 8 90714 "Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use" 163 160 163 163 1 158 95 144 153 100 100 100 72 87 1 99 78 157 140 16 95 100 100 113 93 102 120 132 158 111 100 143 158 128 100 106 106 95 110 107 117 121 116 100 47 90715 "Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use" 177 145 180 177 1 172 84 172 166 108 108 108 36 94 1 116 85 171 152 17 103 108 109 123 101 112 130 143 172 121 108 155 171 139 108 114 115 103 120 119 127 132 132 108 51 92507 "Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual" 219 198 219 219 2 212 127 193 206 134 134 134 142 117 2 133 105 211 188 21 128 134 134 152 125 137 144 171 212 149 134 192 212 172 134 142 142 127 148 143 157 162 155 134 64 92521 HC EVALUATE SPEECH FLUENCY 194 194 194 194 1 188 113 171 182 118 118 118 85 103 1 118 93 187 166 19 113 118 119 134 111 122 142 151 188 132 118 170 187 152 118 125 125 113 131 127 139 144 138 118 56 92522 HC EVALUATE SPEECH PRODUCTION 223 223 247 223 2 216 216 197 209 136 136 136 71 119 2 136 107 215 191 22 130 136 137 154 127 140 164 174 216 152 136 196 215 175 136 144 144 129 151 146 159 165 158 136 65 92523 HC EVAL SPEECH SOUND LANG COMPREHEN 313 283 313 313 2 304 190 304 294 191 191 191 142 167 2 190 150 301 268 30 182 191 192 217 179 196 206 244 304 213 191 274 302 245 191 202 202 182 211 204 224 232 222 191 91 92524 HC BEHAVIORAL QUAL ANALYSIS VOICE 157 157 157 157 1 189 91 138 147 96 96 96 189 84 1 95 75 151 135 15 92 96 96 109 90 98 115 122 152 107 96 138 152 123 96 101 102 91 106 103 112 116 91 96 46 92526 Treatment of swallowing dysfunction and/or oral function for feeding 177 160 177 177 1 172 98 156 166 108 108 108 119 102 1 108 85 170 152 17 103 108 109 123 101 111 130 138 172 121 108 155 171 139 108 114 114 103 120 116 127 131 122 108 51 92610 Evaluation of oral and pharyngeal swallowing function 262 237 270 262 2 254 159 231 246 160 160 160 143 151 2 159 125 252 225 25 153 160 161 181 150 164 167 167 254 179 160 230 253 205 160 169 169 152 177 167 187 194 186 160 76 92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; 195 195 195 195 1 189 113 172 183 119 119 119 85 104 1 119 93 188 167 19 114 119 120 135 111 122 143 152 189 133 119 171 188 153 119 126 126 113 132 127 139 145 138 119 57 92950 "Cardiopulmonary resuscitation (eg, in cardiac arrest)" 594 538 1188 594 4 843 344 524 558 362 362 362 260 316 4 361 284 572 509 58 346 362 365 411 339 372 436 463 576 405 362 521 574 466 362 384 384 345 401 398 425 440 843 362 172 93005 "Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report" 105 90 210 105 1 103 72 99 99 64 64 64 82 68 1 71 68 103 67 10 61 64 64 74 67 63 52 89 97 72 64 102 101 94 64 68 68 61 71 70 77 77 77 64 30 93017 "Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report" 702 668 702 702 5 681 407 619 659 428 428 428 404 374 5 427 336 676 602 68 409 428 431 486 401 440 516 498 681 479 428 616 678 550 428 454 454 407 474 458 502 520 534 428 204 93225 "External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)" 249 249 498 249 2 310 144 220 234 152 152 152 310 133 2 151 119 240 213 24 145 152 153 172 142 156 144 176 242 170 152 218 241 195 152 161 161 144 168 163 178 189 189 152 72 93242 PBB EXT ECG 48HR TO 7 DAY RECORDING 45 42 48 45 0 235 14 40 42 27 27 27 235 24 0 26 22 43 39 4 26 27 28 31 26 28 29 39 44 31 27 39 43 35 27 29 29 26 30 28 32 33 31 27 13 93243 HC EXT ECG 48HR TO 7 DAY SCAN W/ REPORT 65 65 69 65 0 165 38 57 61 40 40 40 165 35 0 40 31 63 56 6 38 40 40 45 37 41 42 56 63 44 40 57 63 51 40 42 42 38 44 42 46 48 48 40 19 93244 PBB EXT ECG 48HR TO 7 DAY REVIEW & INTERP 65 65 65 65 0 63 22 57 61 40 40 40 28 35 0 40 31 63 56 6 38 40 40 45 37 41 48 51 63 44 40 57 63 51 40 42 42 38 44 42 46 48 46 40 19 93246 PBB EXT ECG 7 TO 15 DAY RECORDING 45 42 48 45 0 220 26 40 42 27 27 27 220 24 0 27 22 43 39 4 26 27 28 30 26 30 30 39 44 31 27 39 43 35 27 29 29 26 30 30 32 33 33 27 13 93247 HC EXT ECG 7 TO 15 DAY SCAN W/ REPORT 72 72 76 72 1 213 42 64 68 44 44 44 213 38 1 44 34 69 62 7 42 44 44 51 41 45 53 62 70 49 44 63 70 56 44 47 47 42 49 48 51 53 50 44 21 93248 PBB EXT ECG 7 TO 15 DAY REVIEW & INTERP 72 72 72 72 1 70 42 64 68 44 44 44 32 38 1 44 34 69 62 7 42 44 44 50 41 45 53 56 70 49 44 63 70 56 44 47 47 42 49 47 51 53 51 44 21 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" 2352 445 2594 2352 17 2305 788 1366 2208 1435 1435 1435 458 1253 17 1430 1126 2305 2016 228 1371 1435 1444 1665 1498 1473 2221 1762 2281 1604 1435 2063 2305 1844 1435 1520 1521 1364 1589 1576 1681 1745 1665 1435 683 93350 "Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;" 1229 1229 1229 1229 9 1192 713 1084 1154 750 750 750 539 655 9 747 589 1184 1054 119 717 750 755 851 702 770 903 957 1192 838 750 1078 1188 964 750 794 795 713 830 803 879 911 872 750 357 93798 Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) 191 191 382 191 1 255 117 168 179 117 117 117 255 102 1 116 91 187 164 19 111 117 117 132 109 120 140 149 185 130 117 167 185 150 117 123 124 111 129 117 137 142 145 117 55 93880 Duplex scan of extracranial arteries; complete bilateral study 1182 1071 1242 1182 8 1147 685 1042 1110 721 721 721 384 630 8 718 566 1138 1013 115 689 721 726 818 733 740 754 909 1147 806 721 1037 1142 927 721 764 764 686 798 792 845 814 704 721 343 93922 "Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels)" 554 527 582 554 4 537 321 489 520 338 338 338 249 295 4 337 265 533 475 54 323 338 340 383 317 347 407 448 537 378 338 486 535 434 338 358 358 321 374 362 396 411 393 338 161 93923 "Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more level(s), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)" 1130 1024 2152 1130 8 1096 655 997 1061 689 689 689 366 649 8 687 541 1088 969 110 659 689 694 782 646 708 830 970 1096 770 689 991 1092 886 689 730 731 655 763 738 808 838 778 689 328 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study 1394 1360 1500 1394 10 1352 808 1229 1309 850 850 850 192 743 10 847 668 1342 1195 135 813 850 856 965 797 873 1024 1154 1352 950 850 1222 1347 1093 850 901 901 809 942 910 996 1034 1034 850 405 93926 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study 1119 1119 1175 1119 8 1085 649 987 1051 683 683 683 192 596 8 680 536 1078 959 109 652 683 687 775 639 701 822 871 1085 763 683 981 1081 877 683 723 724 649 756 750 800 830 793 683 325 93930 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study 1386 1386 1386 1386 10 1344 804 1222 1301 845 845 845 607 738 10 842 664 1335 1188 135 808 845 851 959 792 868 1018 1079 1344 945 845 1215 1339 1086 845 896 896 804 936 905 991 1028 983 845 402 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study 1417 181 1563 1417 10 1374 822 1250 1331 864 864 864 384 755 10 861 679 1365 1215 138 826 864 870 981 810 888 762 1277 1374 966 864 1243 1369 1329 864 916 916 822 957 863 1013 1051 1005 864 411 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study 933 805 980 933 7 905 555 823 876 569 569 569 211 497 7 628 447 898 800 91 544 569 573 646 533 584 400 730 905 636 569 818 901 731 569 603 603 541 630 610 667 683 673 569 271 93975 "Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study" 1335 1271 1473 1335 10 1295 774 1177 1254 814 814 814 384 711 10 811 639 1286 1144 130 778 814 820 924 763 836 981 1040 1295 910 814 1171 1290 1046 814 863 863 774 902 872 954 990 996 814 387 94010 "Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation" 97 97 108 97 1 187 56 86 91 59 59 59 187 52 1 59 46 93 83 9 57 59 60 67 55 61 71 69 94 66 59 85 94 76 59 63 63 56 66 63 69 72 59 59 28 94060 "Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration" 164 156 173 164 1 430 95 45 154 100 100 100 430 106 1 112 79 158 141 16 96 100 101 105 104 103 99 126 159 112 100 144 158 129 100 106 106 95 111 107 117 120 105 100 48 94150 "Vital capacity, total (separate procedure)" 58 58 58 58 0 56 34 51 54 35 35 35 25 31 0 35 28 56 50 6 34 35 36 40 33 36 43 45 56 40 35 51 56 45 35 37 38 34 39 38 41 43 41 35 17 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)" 144 61 1233 144 1 443 92 133 135 88 88 88 443 93 1 93 93 139 123 14 84 88 88 112 111 90 141 111 140 98 88 126 139 129 88 93 93 84 97 96 103 102 105 88 42 94644 Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour 203 183 203 203 1 197 118 179 191 124 124 124 89 108 1 123 97 195 174 20 118 124 125 141 116 127 149 158 197 138 124 178 196 159 124 131 131 118 137 133 145 150 112 124 59 94660 "Continuous positive airway pressure ventilation (CPAP), initiation and management" 204 194 215 204 1 198 118 180 192 124 124 124 89 138 1 124 98 196 175 20 119 124 125 141 117 128 150 165 198 139 124 179 197 160 124 132 132 118 138 133 146 151 145 124 59 94667 "Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation" 72 68 145 72 1 221 42 64 68 44 44 44 221 38 1 44 34 69 62 7 42 44 44 48 46 45 71 62 70 49 44 63 70 56 44 47 47 42 49 47 51 53 46 44 21 94668 "Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent" 130 61 325 130 1 126 75 115 122 79 79 79 57 69 1 79 62 125 111 13 76 79 80 90 74 81 95 101 126 89 79 114 126 102 79 84 84 75 88 85 93 96 41 79 38 95806 "Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)" 580 525 609 580 4 563 336 512 545 354 354 354 508 309 4 390 278 541 497 56 151 354 356 401 331 346 477 498 563 395 354 563 541 455 354 375 375 336 392 370 415 425 412 354 168 95810 "Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist" 4822 4822 4822 4822 35 4677 2796 4253 4528 2941 2941 2941 2113 2569 35 2931 2309 4643 4133 468 2811 2941 2961 3338 2756 3021 3542 3755 4677 3288 2941 4229 4658 3780 2941 3116 3118 2797 3257 3149 3447 3575 3419 2941 1400 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" 5300 5300 5565 5300 38 5141 3074 4674 4977 3233 3233 3233 2323 2824 38 3221 2538 5104 4543 515 467 3233 3255 3669 3029 3320 3893 4128 5141 3614 3233 4648 5120 4154 3233 3425 3427 3074 3580 3233 3788 3929 4028 3233 1538 95992 "Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day" 105 95 105 105 1 391 44 93 99 64 64 64 128 56 1 64 50 101 90 10 61 64 64 73 60 66 64 81 102 72 58 92 391 82 64 68 68 61 71 69 75 78 76 64 30 96125 "Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report" 314 314 324 314 2 305 182 277 295 192 192 192 138 167 2 191 150 302 269 30 183 192 193 217 179 197 231 245 305 214 192 275 303 246 192 203 203 182 212 196 224 233 223 192 91 96360 "Intravenous infusion, hydration; initial, 31 minutes to 1 hour" 161 138 170 161 1 541 103 142 151 98 98 98 541 107 1 98 77 155 138 16 94 98 99 111 102 101 160 124 148 110 98 156 156 144 98 104 104 93 109 103 115 114 118 98 47 96361 "Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)" 58 50 696 58 6 563 56 56 50 35 32 35 563 38 305 51 28 56 50 6 34 35 36 80 110 69 213 50 53 40 35 225 56 52 35 37 38 34 90 74 24 42 42 35 17 96365 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour" 271 131 588 271 2 298 185 226 238 165 149 165 298 144 2 174 130 261 232 26 158 165 166 192 172 170 267 230 263 185 165 238 262 242 165 175 175 157 183 177 198 195 198 165 79 96366 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)" 257 55 3855 257 2 679 163 227 241 157 157 157 342 137 2 156 123 247 220 25 150 157 158 205 163 161 265 182 249 175 157 225 248 201 157 166 166 149 174 327 564 191 679 157 75 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)" 73 66 219 73 1 265 46 64 69 45 45 45 265 39 1 44 35 70 63 7 43 45 45 51 49 46 75 65 71 50 45 64 71 57 45 47 47 42 49 49 113 54 55 45 21 96368 "Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)" 33 31 99 33 0 298 19 29 31 20 20 20 298 18 0 20 16 32 28 3 19 20 20 23 21 21 24 28 32 22 20 29 32 30 20 21 21 19 22 22 24 72 23 20 10 96372 "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular" 65 58 195 65 0 506 67 57 61 40 40 40 35 53 0 52 31 63 56 6 38 40 40 45 37 41 57 49 63 44 40 57 506 29 40 42 42 38 41 44 46 48 48 40 19 96374 "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug" 97 83 577 97 1 96 62 83 91 59 59 59 32 59 1 65 46 93 83 9 57 59 60 69 62 58 96 74 89 66 59 94 94 65 59 63 78 56 62 65 71 71 71 59 19 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)" 77 66 405 77 1 224 50 130 67 47 84 47 16 49 1 51 37 74 66 7 45 47 47 53 49 46 75 73 71 52 47 224 74 69 47 50 62 45 147 52 169 109 83 47 22 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)" 61 50 580 61 0 116 39 83 57 37 63 37 16 74 0 44 29 59 52 6 36 37 37 45 111 38 60 56 59 42 37 116 59 44 37 39 39 35 82 41 42 95 46 37 18 96523 Irrigation of implanted venous access device for drug delivery systems 39 39 39 39 0 38 23 34 37 24 24 24 32 21 0 24 19 38 33 4 23 24 24 27 22 24 29 30 38 27 24 34 38 31 24 25 25 23 26 25 28 29 28 24 11 97014 Application of a modality to 1 or more areas; electrical stimulation (unattended) 76 76 76 76 1 74 44 67 71 46 46 46 33 40 1 46 36 73 65 7 44 46 47 53 43 48 56 59 74 52 46 67 73 60 46 49 49 44 51 50 54 56 54 46 22 97032 "Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes" 79 55 83 79 1 99 46 70 74 48 48 48 99 42 1 48 38 76 68 8 46 48 49 55 45 49 58 62 77 54 48 69 76 62 48 51 51 46 53 34 56 59 56 48 23 97033 "Application of a modality to 1 or more areas; iontophoresis, each 15 minutes" 138 131 150 138 1 134 80 122 130 84 84 84 66 74 1 84 66 133 118 13 80 84 85 96 79 86 101 118 134 94 84 121 133 108 84 89 89 80 93 92 99 102 92 84 40 97034 "Application of a modality to 1 or more areas; contrast baths, each 15 minutes" 69 69 69 69 0 67 40 61 65 42 42 42 66 37 0 42 33 66 59 7 40 42 42 48 39 43 51 54 67 47 42 61 67 54 42 45 45 40 47 45 49 51 49 42 20 97035 "Application of a modality to 1 or more areas; ultrasound, each 15 minutes" 80 72 289 80 1 346 53 71 75 44 49 49 66 43 1 51 38 74 69 8 74 49 49 57 46 50 51 69 78 55 49 70 346 71 49 52 52 46 54 54 57 58 57 49 23 97110 "Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility" 83 67 332 83 1 1573 56 81 78 82 92 137 122 95 1 55 59 81 71 8 81 92 101 59 50 52 54 71 81 57 51 81 1573 73 92 53 54 48 56 106 57 61 61 43 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" 87 75 348 87 1 409 58 84 82 53 53 53 67 58 1 56 42 85 75 8 82 53 53 58 55 54 57 75 84 87 53 84 409 76 53 58 56 50 59 58 64 64 64 53 25 97116 "Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)" 84 80 89 84 1 81 49 74 79 51 51 51 60 45 1 51 40 81 72 8 49 51 52 58 48 53 62 67 81 57 51 74 81 66 51 54 54 49 57 55 60 62 2 51 24 97129 HC THER IVNTJ COG FUNCJ 1ST 15 MIN 139 125 139 139 1 135 81 123 131 85 85 85 61 74 1 84 67 134 119 13 81 85 85 96 79 87 102 108 135 95 85 122 134 109 85 90 90 81 94 93 99 103 99 85 40 97130 HC THER IVNTJ COG FUNCJ EA ADDL 15 MIN 278 125 278 278 2 270 161 245 261 170 170 170 122 148 2 169 133 268 238 27 162 170 171 192 159 174 204 217 270 190 170 244 269 218 170 180 180 161 188 186 199 206 197 170 81 97140 "Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes" 99 89 396 99 1 182 66 96 93 54 60 60 61 131 1 67 47 97 85 10 182 60 61 70 63 124 64 85 96 67 54 40 167 87 81 126 64 57 67 66 145 72 72 60 29 97161 Physical Therapy Evaluation of low complexity 133 103 266 133 1 190 77 122 125 81 81 81 190 71 1 85 83 130 114 13 66 81 81 94 76 79 81 113 129 91 81 129 128 116 81 86 86 77 90 89 97 97 97 81 39 97162 Physical Therapy Evaluation of moderate complexity 133 120 137 133 1 190 88 105 125 81 73 73 190 89 1 86 64 130 114 13 98 81 82 92 85 83 84 113 129 91 73 117 128 104 73 87 86 77 90 87 97 97 97 81 39 97163 Physical Therapy Evaluation of high complexity 133 120 133 133 1 190 73 117 125 81 81 81 190 85 1 81 64 123 114 13 78 81 82 92 76 83 84 113 129 89 81 117 128 104 73 86 86 77 90 84 95 91 94 81 39 97164 Physical Therapy Re-Evaluation of an established plan of care 91 81 91 91 1 200 49 80 85 49 56 56 200 48 1 60 44 84 78 9 53 56 56 64 52 57 56 78 88 62 56 80 88 71 56 59 59 53 61 61 67 62 64 56 26 97165 HC OT EVAL LOW COMPLEX 137 123 187 137 1 161 75 121 129 84 84 84 161 73 1 83 66 132 117 13 80 84 84 89 78 84 135 118 133 93 84 120 132 107 84 89 89 79 93 89 98 102 100 75 40 97166 HC OT EVAL MOD COMPLEX 137 123 142 137 1 161 82 121 129 84 75 84 161 88 1 83 66 134 117 13 80 84 84 97 87 86 87 118 133 93 84 75 132 121 75 89 89 79 93 87 93 100 97 84 40 97167 HC OT EVAL HIGH COMPLEX 137 123 137 137 1 161 79 121 129 84 84 84 161 73 1 86 66 132 117 13 80 84 84 95 78 86 86 107 133 93 84 120 132 107 84 89 89 79 93 79 98 102 82 84 40 97168 HC OT RE-EVAL EST PLAN CARE 93 88 93 93 1 100 54 82 87 57 57 57 100 50 1 57 45 90 80 9 54 57 57 64 53 58 68 67 90 63 57 82 90 73 57 60 60 54 63 61 66 69 66 57 27 97530 "Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes" 83 71 415 83 1 111 57 81 78 69 46 51 61 107 1 54 38 81 71 8 79 46 51 56 53 49 54 71 81 111 51 81 80 75 46 56 54 48 56 106 61 61 61 46 24 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" 71 63 213 71 1 139 42 63 67 43 43 43 66 38 1 43 34 139 61 7 41 43 44 49 41 89 46 61 69 48 43 62 69 56 38 46 46 41 48 48 51 53 52 43 21 97597 "Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less" 124 124 124 124 1 120 72 109 116 76 76 76 54 66 1 75 59 119 106 12 72 76 76 86 71 78 91 97 120 85 76 109 120 97 76 80 80 72 84 81 89 92 88 76 36 97605 "Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters" 2 1 2 2 0 322 1 1 1 1 1 1 322 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 97760 "Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes" 82 82 87 82 1 108 48 72 77 50 50 50 108 44 1 50 39 79 70 8 48 50 50 57 47 51 60 64 80 56 50 72 79 64 50 53 53 48 55 54 59 61 55 50 24 97802 "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes" 174 165 232 174 1 170 101 153 163 106 106 106 134 93 1 106 83 168 149 17 101 106 107 120 99 109 128 136 169 119 106 153 168 136 106 112 113 101 118 114 124 170 146 106 51 97810 "Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient" 42 38 84 42 0 66 23 37 39 26 26 26 66 22 0 26 20 40 36 4 24 26 26 29 24 26 31 33 41 29 26 37 41 33 26 27 27 24 28 27 30 31 31 26 12 97811 "Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)" 28 26 56 28 0 33 18 25 26 17 17 17 33 15 0 17 13 27 24 3 16 17 17 19 16 18 1 22 27 19 17 25 27 22 17 18 18 16 19 3 20 20 20 17 8 97813 "Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient" 42 42 42 42 0 60 24 37 39 26 26 26 60 22 0 26 20 40 36 4 24 26 26 29 24 26 31 33 41 29 26 37 41 33 26 27 27 24 28 27 30 31 30 26 12 97814 "Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)" 28 28 28 28 0 30 16 25 26 17 17 17 30 15 0 17 13 27 24 3 16 17 17 19 16 18 21 22 27 19 17 25 27 22 17 18 18 16 19 18 20 21 20 17 8 99152 HC MOD SED SAME PHYS/QHP 5/>YRS 15M 67 67 67 67 0 65 39 59 63 41 41 41 29 36 0 41 32 65 57 7 39 41 41 46 38 42 49 52 65 46 41 59 65 53 41 43 43 39 45 44 48 50 47 41 19 99153 HC MOD SED SAME PHYS/QHP EA ADD 15M 29 29 29 29 0 28 17 26 27 18 18 18 13 15 0 18 14 28 25 3 17 18 18 20 17 18 21 23 28 20 18 25 28 23 18 19 19 17 20 19 21 21 21 18 8 99195 "Phlebotomy, therapeutic (separate procedure)" 338 306 338 338 2 328 104 298 317 206 206 206 148 180 2 205 162 325 290 33 197 206 208 239 193 212 248 263 328 230 206 296 327 265 206 218 219 196 228 221 242 251 240 206 98 99202 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family." 249 249 249 249 2 242 144 220 234 152 152 152 109 133 2 151 119 240 213 24 145 152 153 172 142 156 183 194 242 170 152 218 241 195 152 161 161 144 168 163 178 185 177 152 72 99203 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family." 369 165 388 369 3 358 91 325 346 225 225 225 162 91 3 224 177 355 316 36 215 225 227 255 234 231 81 287 358 252 225 324 356 289 225 238 239 214 249 241 264 274 262 225 107 99204 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family." 549 549 610 549 4 533 149 484 515 335 335 335 143 143 4 334 263 529 471 53 320 335 337 380 366 344 403 428 533 374 335 481 530 430 335 355 355 318 371 358 392 407 389 335 159 99205 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of 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 moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family." 438 427 449 438 3 425 254 386 411 267 267 267 192 233 3 266 210 422 375 43 255 267 269 303 250 274 322 341 425 299 267 384 423 343 267 283 283 254 296 286 313 325 311 267 127 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." 92 39 194 92 1 89 53 81 86 56 56 56 40 49 1 56 44 89 79 9 54 56 56 64 53 58 68 74 89 63 56 81 89 87 56 59 59 53 62 60 66 68 65 56 27 99212 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family." 152 144 152 152 1 147 88 134 143 93 93 93 67 81 1 92 73 146 130 15 89 93 93 105 96 95 38 118 147 104 93 133 147 119 93 98 98 88 103 99 109 113 108 93 44 99213 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family." 256 150 269 256 2 248 74 226 240 156 156 156 112 72 2 156 123 55 219 25 149 156 157 177 162 160 64 199 248 175 156 225 247 201 156 165 166 148 173 167 183 190 181 156 74 99214 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family." 403 144 424 403 3 391 109 355 378 246 246 246 177 215 3 245 193 388 345 39 235 246 247 279 230 252 122 314 391 275 246 353 389 316 246 260 261 234 272 263 288 299 286 246 117 99215 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family." 552 539 566 552 4 536 320 487 519 337 337 337 242 294 4 336 265 532 474 54 322 337 339 382 316 346 406 430 536 377 337 485 534 433 337 357 357 320 373 361 395 410 392 337 160 99217 "Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from ""observation status"" if the discharge is on other than the initial date of ""observation status."" To report services to a patient designated as ""observation status"" or ""inpatient status"" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])" 164 164 164 164 1 159 95 145 154 100 100 100 72 87 1 100 79 158 141 16 96 100 101 114 94 103 120 128 159 112 100 144 158 129 100 106 106 95 111 107 117 122 116 100 48 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." 237 225 264 237 2 512 137 209 223 145 145 145 512 126 2 144 113 228 203 23 138 145 146 164 135 148 174 187 230 162 145 208 229 186 145 153 153 137 160 155 169 193 193 145 69 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." 294 61 745 294 29 565 282 340 276 179 179 179 565 45 456 229 232 352 252 29 171 179 181 248 179 219 283 226 285 200 179 348 352 263 179 190 190 171 241 188 246 263 226 179 85 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." 486 76 924 486 3 657 309 542 456 296 296 296 621 77 3 361 361 548 358 47 283 296 253 396 209 341 548 356 516 331 296 426 657 413 296 314 447 282 328 375 409 409 397 296 141 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." 708 220 1490 708 69 742 509 687 654 432 432 432 728 429 742 482 339 730 607 69 413 432 435 527 473 455 730 473 687 512 432 723 684 550 432 458 458 411 474 499 545 545 545 432 150 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." 1066 781 10066 1066 8 1045 686 984 1001 650 589 650 739 709 8 700 510 1019 914 103 621 650 655 755 676 668 1045 696 1034 727 650 1034 1030 808 650 689 689 618 720 697 762 780 768 650 309 99291 "Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes" 1216 599 1216 1216 9 1877 705 1072 1142 742 742 742 1877 648 9 739 582 1171 1042 118 709 742 747 842 695 762 1193 1044 1180 829 742 1066 1175 953 742 786 786 705 821 794 869 890 890 742 353 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)" 521 290 521 521 4 505 302 460 489 318 318 318 228 278 4 317 249 502 447 51 304 318 320 361 298 326 383 447 505 355 318 457 503 408 318 337 337 302 352 340 372 386 381 318 151 99442 "Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion" 58 55 65 58 0 57 49 51 54 35 35 35 25 31 0 35 28 56 50 6 34 35 36 40 33 36 57 45 56 40 35 51 56 45 35 37 38 34 39 38 41 43 41 35 17 A0425 "Ground mileage, per statute mile" 299 3 4558 299 2 2120 34 76 660 182 182 182 13 16 2 267 143 24 256 29 174 182 183 795 60 401 657 31 290 36 182 262 2120 234 182 159 193 173 202 202 214 539 255 182 197 A0426 "Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1)" 718 684 792 718 5 696 416 633 674 438 438 438 465 383 5 436 344 691 615 70 419 438 441 497 410 450 426 102 696 490 438 630 694 563 438 464 464 416 485 469 513 532 509 438 186 A0427 "Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)" 1183 1021 2252 1183 8 1148 808 1148 1111 722 722 722 735 630 8 421 566 1103 1014 115 690 722 727 838 473 769 613 127 1148 793 722 1037 1143 927 722 764 765 686 799 754 846 866 840 722 343 A0428 "Ambulance service, basic life support, non-emergency transport, (BLS)" 594 538 624 594 4 576 344 524 558 362 362 362 387 316 4 361 284 572 509 58 346 362 365 411 339 372 436 85 576 405 362 521 574 466 362 384 384 345 401 408 425 440 345 362 172 A0429 "Ambulance service, basic life support, emergency transport (BLS-emergency)" 964 832 1928 964 7 935 643 890 597 588 588 588 620 369 7 355 462 900 826 94 562 588 592 683 369 604 522 114 935 657 588 845 931 756 588 533 623 559 651 646 689 706 706 588 280 A0433 "Advanced life support, level 2 (ALS 2)" 1617 1466 1783 1617 12 1568 938 1426 1518 986 986 986 1065 862 12 983 774 1557 1386 157 942 986 993 1119 924 1013 814 233 1568 1102 986 1418 1562 1267 986 1045 1046 938 1092 1138 1156 1243 1170 986 469 A0434 Specialty care transport (SCT) 1806 1720 1806 1806 13 1752 1047 1593 1696 1102 1102 1102 791 962 13 1098 865 1739 1548 175 1053 1102 1109 1250 1032 1131 1327 1407 1752 1231 1102 1584 1745 1416 1102 1167 1168 1047 1220 1179 1291 1339 1280 1102 524 A9270 Non-covered item or service 2 1 136 2 0 2 1 1 2 1 1 1 1 1 0 1 1 2 2 0 1 1 1 1 1 1 1 1 2 1 1 2 2 1 1 1 1 1 1 2 1 1 1 1 1 A9500 "Technetium Tc-99M sestamibi, diagnostic, per study dose" 1212 606 1212 1212 9 1176 703 1069 1138 739 739 739 739 646 9 737 580 1167 1039 118 706 739 744 839 693 759 457 944 1176 826 739 1063 1171 950 739 783 784 703 819 791 866 899 859 739 352 A9503 "Technetium Tc-99M medronate, diagnostic, per study dose, up to 30 millicuries" 244 232 257 244 2 237 142 215 229 149 149 149 107 130 2 148 117 235 209 24 142 149 150 169 139 153 179 197 237 166 149 214 236 191 149 158 158 142 165 163 174 182 179 149 71 A9512 "Technetium Tc-99M pertechnetate, diagnostic, per millicurie" 250 250 250 250 2 242 145 220 235 152 153 152 110 133 2 152 120 241 214 24 146 152 154 173 143 157 184 195 242 170 152 219 242 196 152 162 162 145 169 163 179 185 177 152 73 A9537 "Technetium Tc-99M mebrofenin, diagnostic, per study dose, up to 15 millicuries" 390 353 390 390 3 378 226 344 366 238 238 238 171 208 3 237 187 376 334 38 227 238 240 270 223 244 286 251 378 266 238 378 377 306 238 252 252 226 263 244 279 281 285 238 113 A9540 "Technetium Tc-99M macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries" 402 382 423 402 3 390 233 355 378 246 246 246 176 214 3 245 193 388 345 39 235 246 247 279 230 252 296 363 390 274 246 353 389 315 246 260 260 233 272 263 288 298 285 246 117 A9541 "Technetium Tc-99M sulfur colloid, diagnostic, per study dose, up to 20 millicuries" 650 650 683 650 5 630 300 573 610 396 397 396 285 346 5 395 311 626 557 63 379 396 399 450 371 407 477 506 630 443 396 570 628 510 396 420 420 377 439 424 465 482 461 396 189 A9552 "Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries" 471 426 471 471 3 457 273 415 442 287 287 287 206 251 3 286 226 454 404 46 275 287 289 326 269 295 446 404 457 321 287 413 455 369 287 304 305 273 318 308 337 349 324 287 137 A9567 "Technetium Tc-99M pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries" 616 616 616 616 4 598 357 543 578 376 376 376 270 328 4 374 295 593 528 60 359 376 378 426 352 386 452 529 598 420 376 540 595 483 376 398 398 357 416 402 440 457 437 376 179 A9579 "Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS), per ml" 214 214 214 214 2 207 124 188 200 130 130 130 94 114 2 130 102 206 183 21 124 130 131 148 122 134 157 166 207 146 130 207 206 167 130 138 138 124 144 139 153 158 151 130 62 A9585 HC GADOBUTROL INJECTION 0.1 ML 266 187 357 266 2 258 232 234 249 162 162 162 116 141 2 161 127 256 228 26 155 162 163 188 152 166 195 215 258 181 162 233 256 208 162 172 172 154 179 178 190 197 170 162 77 C1713 "HC ANCHOR/SCREW BN/BN,TIS/BN LVL 35" 1 1 5930 1 0 1 1 1 1 1 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 C1771 "HC REP DEV, URINARY, W/SLING LVL 20" 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 C1776 HC JOINT DEVICE (IMPLANTABLE) LVL 45 10252 1 23072 10252 1 12725 5946 9042 9627 6254 6254 6254 4493 5462 74 6232 4909 1 8788 995 5976 6254 6296 7097 5859 6423 12725 1 9945 6990 6254 8991 9905 8036 6254 6625 6630 5946 6925 5246 7328 7601 1 6254 2976 C9113 "Injection, pantoprazole sodium, per vial" 98 98 108 98 1 95 57 86 92 59 59 59 5 52 1 59 47 94 84 9 57 59 60 67 56 61 72 76 95 66 59 95 94 76 59 63 63 57 66 65 71 71 69 59 28 C9290 "Injection, bupivacaine liposome" 466 448 932 466 3 452 270 411 438 284 284 284 182 248 3 283 223 449 400 45 272 284 286 323 266 292 342 388 452 318 284 409 450 365 284 301 302 270 315 273 333 354 341 284 135 G0008 Administration of influenza virus vaccine 88 83 93 88 1 85 51 78 83 54 54 54 51 47 1 53 42 85 75 9 51 54 54 61 50 55 65 69 85 60 54 77 85 69 54 57 57 51 59 57 63 65 62 54 26 G0009 Administration of pneumococcal vaccine 88 83 88 88 1 85 51 78 83 54 54 54 39 47 1 53 42 85 75 9 51 54 54 61 50 55 65 69 85 60 54 77 85 69 54 57 57 51 59 57 63 65 13 54 26 G0105 Colorectal cancer screening; colonoscopy on individual at high risk 2553 2100 2919 2553 18 2697 158 2697 2397 1557 1557 1557 2263 1597 18 1552 1222 2458 2188 248 1488 1557 1568 1767 1459 1599 2252 2063 2476 1741 1557 2239 2466 2001 1557 1650 1651 1481 1725 1667 1825 1893 1785 1557 741 G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 2681 1 3063 2681 19 2697 158 158 2697 1635 1635 1635 2425 1428 19 1630 1284 2582 2298 260 1563 1635 1646 1856 1532 1680 1969 2225 2601 1828 1635 2351 2590 2101 1635 1733 1734 1555 1811 1711 1916 2035 2035 1635 778 G0259 Injection procedure for sacroiliac joint; arthrograpy 70 66 204 70 1 1317 41 62 66 43 43 43 1317 37 1 43 34 67 60 7 41 43 43 48 40 44 124 64 68 48 43 61 68 55 43 45 45 41 47 47 50 52 44 43 20 G0260 "Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography" 108 105 1865 108 1 660 63 95 101 66 66 66 47 58 1 66 52 104 93 10 63 66 66 75 62 68 79 84 105 74 66 95 104 85 66 70 70 63 73 70 77 80 660 66 31 G0283 "Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care" 80 72 83 80 1 78 44 74 75 49 49 49 66 53 1 49 38 77 69 8 9 49 49 57 46 50 51 68 78 55 49 70 77 63 44 51 52 46 54 54 59 59 57 49 23 G0297 PR CT LUNG CANCER SCREEN 500 500 500 500 4 529 290 441 469 305 305 305 529 266 4 304 239 481 429 49 291 305 307 346 286 313 290 355 485 341 305 438 483 392 305 323 323 290 338 326 357 371 388 305 145 G0378 "Hospital observation service, per hour" 2929 662 12310 2929 21 4902 2312 2583 2750 1787 1040 1787 1106 2070 21 1780 1403 4902 2511 284 1707 1787 1799 2010 1341 1835 898 1608 2841 1997 1787 2569 2830 2296 1787 1893 1894 1699 1979 1924 1188 2171 2025 1787 850 G0463 Hospital outpt clinic visit 29 9 122 29 0 74 24 26 27 18 18 18 42 19 0 18 14 74 25 3 17 18 18 20 22 18 27 32 28 20 18 25 28 23 18 19 19 17 20 19 21 48 27 18 8 G0472 HC HEP C SCREEN HIGH RISK/OTHER 65 58 69 65 0 64 26 57 61 40 40 40 46 35 0 40 31 63 56 6 38 40 40 45 46 41 64 51 63 44 40 57 63 51 40 42 42 38 44 41 46 48 41 40 19 G0480 Drug test def 1-7 classes 146 51 300 146 1 177 85 129 137 89 89 89 121 78 1 89 70 141 125 14 85 89 90 101 83 91 107 177 142 100 89 128 141 114 89 94 94 85 99 95 104 108 103 89 42 G0481 Drug test def 8-14 classes 65 65 130 65 0 263 38 58 61 40 40 40 263 35 0 40 31 63 56 6 38 40 40 45 37 41 48 46 63 44 40 57 63 51 40 42 42 38 44 43 47 48 46 40 19 G0482 Drug test def 15-21 classes 81 81 81 81 1 79 47 72 76 50 50 50 36 43 1 49 39 78 70 8 47 50 50 56 46 51 60 63 79 55 50 71 78 64 50 53 53 47 55 53 58 60 58 50 24 J0131 Acetaminophen injection 182 144 365 182 1 245 177 161 177 111 111 111 18 97 1 245 87 179 156 18 106 111 112 129 104 114 134 147 177 124 111 160 176 143 111 118 118 106 123 111 130 208 133 111 53 J0153 PBB ADENOSINE INJ 1 MG 105 5 322 105 1 241 61 93 99 64 64 64 46 56 1 64 50 101 90 10 61 64 65 73 60 66 77 132 102 72 64 92 102 83 64 68 68 61 71 69 75 78 241 64 31 J0171 "Injection, adrenalin, epinephrine, 0.1 mg" 156 96 385 156 1 154 91 138 147 95 95 95 22 83 1 95 75 151 134 15 91 95 96 108 89 98 115 141 152 107 95 137 151 123 95 101 101 91 106 82 112 116 154 95 45 J0248 REMDESIVIR 100 MG INJ 2168 1128 2373 2168 16 2102 1257 1912 2035 1322 1322 1322 950 1155 16 1317 1038 2087 1858 210 1263 1322 1331 1500 1239 1358 1592 1688 2102 1478 1322 1901 2094 1699 1322 1401 1402 1257 1464 1415 1549 1607 1537 1322 629 J0282 "Injection, amiodarone hydrochloride, 30 mg" 112 112 112 112 1 108 65 98 105 68 68 68 49 59 1 68 53 107 96 11 65 68 69 77 64 70 82 87 108 76 68 98 108 87 68 72 72 65 75 75 80 83 79 68 32 J0295 "Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm" 116 94 117 116 1 113 67 103 109 71 71 71 5 62 1 71 56 112 100 11 68 71 71 83 66 73 85 91 113 79 71 102 112 91 71 75 75 67 79 64 83 86 87 71 34 J0330 "Injection, succinylcholine chloride, up to 20 mg" 126 126 126 126 1 122 84 122 122 77 77 77 14 67 1 77 60 122 108 12 74 77 78 87 72 79 93 102 122 86 77 122 122 99 77 82 82 73 85 77 90 96 92 77 37 J0360 "Injection, hydralazine HCl, up to 20 mg" 106 91 211 106 1 138 129 93 99 64 64 64 7 56 1 64 51 102 90 10 61 64 65 73 60 66 77 82 102 72 64 93 102 83 64 68 68 61 71 69 75 71 138 64 31 J0456 "Injection, azithromycin, 500 mg" 98 92 98 98 1 95 57 86 92 59 59 59 3 52 1 59 47 94 84 9 57 59 60 67 66 61 72 65 95 66 59 86 94 76 59 63 63 57 66 64 70 72 59 59 28 J0461 "Injection, atropine sulfate, 0.01 mg" 104 104 310 104 1 100 60 91 97 63 63 63 7 55 1 63 50 100 89 10 60 63 64 72 59 65 76 84 100 71 63 91 100 81 63 67 67 60 70 68 74 77 73 63 30 J0500 "Injection, dicyclomine HCl, up to 20 mg" 256 166 256 256 2 248 148 225 240 156 156 156 33 136 2 155 122 246 219 25 149 156 157 177 146 160 188 199 248 174 156 224 247 200 156 165 165 148 173 167 183 190 181 156 74 J0561 "Injection, penicillin G benzathine, 100,000 units" 466 277 546 466 3 452 270 411 438 284 284 284 204 248 3 283 223 449 400 45 272 284 286 323 266 292 342 300 452 318 284 409 450 365 284 301 302 270 315 304 333 346 331 284 135 J0585 "Injection, onabotulinumtoxinA, 1 unit" 2576 2188 2624 2576 18 2498 1705 2272 2418 1571 1571 1571 1129 1372 18 1565 1233 2480 2208 250 1501 1571 1582 1783 1472 1613 1892 2006 2498 1756 1571 2259 2488 2019 1571 1664 1666 1494 1740 1682 1841 1909 1826 1571 748 J0610 "Injection, calcium gluconate, per 10 ml" 112 108 128 112 1 108 65 98 105 68 68 68 4 59 1 68 53 107 96 11 65 68 69 77 64 70 82 99 108 76 68 98 108 87 68 72 72 65 75 73 80 83 79 68 32 J0612 128 128 128 128 1 124 74 113 120 78 78 78 56 68 1 78 61 123 109 12 74 78 78 88 73 80 94 99 124 87 78 112 123 100 78 82 83 74 86 83 91 95 90 78 37 J0665 90 88 92 90 1 88 52 80 85 55 55 55 40 48 1 55 43 87 77 9 53 55 55 62 52 57 66 70 88 62 55 79 87 71 55 58 58 52 61 59 65 67 67 55 26 J0690 "Injection, cefazolin sodium, 500 mg" 99 88 339 99 1 125 125 87 110 61 61 61 3 53 1 65 48 94 85 10 58 61 61 67 57 61 73 85 96 68 61 87 96 78 61 64 64 58 67 66 71 69 73 61 29 J0692 "Injection, Cefepime hydrochloride, 500 mg" 116 94 116 116 1 112 67 102 109 71 71 71 7 62 1 70 55 112 99 11 67 71 71 80 66 73 85 82 112 79 71 102 112 91 71 75 75 67 78 68 83 86 82 71 34 J0696 "Injection, ceftriaxone sodium, per 250 mg" 92 90 202 92 1 90 60 77 86 56 56 56 4 49 1 68 44 90 79 9 54 56 56 65 62 58 68 78 89 63 56 81 89 82 56 59 59 53 62 62 67 67 67 56 27 J0702 "Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg" 104 100 129 104 1 100 60 91 97 63 63 63 14 55 1 63 50 100 89 10 60 63 64 72 59 65 76 81 100 71 63 91 100 81 63 67 67 60 70 67 74 77 72 63 30 J0735 "Injection, clonidine hydrochloride, 1 mg" 91 91 91 91 1 88 53 80 85 55 55 55 40 48 1 55 44 88 78 9 53 55 56 63 52 57 67 71 88 62 55 80 88 71 55 59 59 53 61 59 65 67 64 55 26 J0743 "Injection, cilastatin sodium; imipenem, per 250 mg" 153 138 153 153 1 148 89 135 144 93 93 93 67 81 1 93 73 147 131 15 89 93 94 106 87 96 112 51 148 104 93 134 148 120 93 99 99 89 103 100 109 113 108 93 44 J0744 "Injection, Ciprofloxacin for intravenous infusion, 200 mg" 100 100 100 100 1 97 58 88 93 61 61 61 44 53 1 60 48 96 85 10 58 61 61 69 57 62 73 77 97 68 61 87 96 78 61 64 64 58 67 65 71 74 71 61 29 J0780 "Injection, prochlorperazine, up to 10 mg" 106 96 211 106 1 103 63 83 99 64 76 64 4 56 1 64 51 103 90 10 61 64 65 73 60 66 77 91 102 72 64 102 102 90 64 68 68 61 83 76 75 95 77 64 31 J0878 "Injection, daptomycin, 1 mg" 1870 508 1870 1870 13 1813 1084 1649 1755 1140 1140 1140 819 996 13 1136 895 1800 1602 182 1090 1140 1148 1294 1068 1171 1373 1456 1813 1275 1140 1639 1806 1465 1140 1208 1209 1084 1263 1221 1336 1386 1325 1140 543 J0897 PBB DENOSUMAB INJECTION 1 MG 3042 2645 3216 3042 22 2951 1764 2683 2856 1856 1856 1856 1351 1854 22 2080 1457 2929 2607 295 1773 1856 1868 2106 1738 1906 2234 2369 2951 2074 1856 2668 2939 2384 1856 1966 1967 1764 2055 2009 2174 2255 1873 1856 883 J1030 "Injection, methylprednisolone acetate, 40 mg" 110 110 110 110 1 107 64 97 104 67 67 67 48 59 1 71 53 106 94 11 64 67 68 76 63 69 81 86 107 75 67 97 107 86 67 71 71 64 74 72 79 82 78 67 32 J1040 "Injection, methylprednisolone acetate, 80 mg" 124 96 124 124 1 121 72 110 117 76 76 76 55 66 1 76 60 120 107 12 73 76 76 86 71 78 91 97 121 85 76 109 120 98 76 80 80 72 84 81 89 92 88 76 36 J1100 "Injection, dexamethasone sodium phosphate, 1 mg" 91 88 180 91 1 89 78 80 86 55 55 55 1 52 1 61 43 87 78 9 53 55 56 64 59 60 67 76 88 62 55 89 88 61 55 59 59 53 61 61 74 65 66 55 26 J1170 "Injection, hydromorphone, up to 4 mg" 91 88 716 91 1 171 53 72 171 55 55 55 3 48 1 60 43 87 78 9 53 55 56 63 52 57 67 71 88 62 55 88 88 71 55 59 59 53 61 59 65 66 68 55 26 J1200 "Injection, diphenhydramine HCl, up to 50 mg" 90 88 266 90 1 89 60 80 85 55 55 55 1 48 1 55 43 89 77 9 53 55 55 63 59 57 66 76 88 62 55 79 87 58 55 58 58 52 61 56 65 65 66 55 26 J1335 "Injection, Ertapenem sodium, 500 mg" 345 345 365 345 2 335 200 304 324 210 210 210 151 184 2 210 165 332 296 33 201 210 212 239 197 216 253 269 335 235 210 302 333 270 210 223 223 200 233 225 246 256 210 210 100 J1439 HC INJ FERRIC CARBOXYMALTOS 1MG 2367 2367 2367 2367 17 2296 1373 2087 2222 1444 1444 1444 1037 1261 17 1439 1133 2279 2029 230 1380 1444 1454 1638 1353 1483 1738 1843 2296 1614 1444 2076 2287 1855 1444 1530 1531 1373 1599 1546 1692 1755 1678 1444 687 J1450 "Injection fluconazole, 200 mg" 106 106 106 106 1 102 61 93 99 64 64 64 46 56 1 64 51 102 90 10 61 64 65 73 60 66 77 75 102 72 64 93 102 83 64 68 68 61 71 69 75 78 75 64 31 J1561 "Injection, immune globulin, (gamunex), intravenous, non-lyophilized (e.g. liquid), 500 mg" 3374 1389 5564 3374 24 3273 1957 2976 3169 2058 2058 2058 1479 1798 24 2051 1616 3250 2892 328 1967 2058 2072 2336 1928 2114 2479 2628 3273 2301 2058 2959 3260 2645 2058 2181 2182 1957 2279 2203 2412 2502 2392 2058 979 J1569 "Injection, immune globulin, (gammagard liquid), intravenous, non-lyophilized, (e.g. liquid), 500 mg" 6058 1580 7850 6058 43 5877 3513 5343 5689 3696 3696 3696 2655 3228 43 3682 2901 5834 5193 588 3531 3696 3721 4194 3462 3795 4450 4718 5877 4131 3696 5313 5853 4749 3696 3915 3918 3514 4092 3956 4330 4491 4295 3696 1758 J1610 "Injection, glucagon hydrochloride, per 1 mg" 649 368 1298 649 5 630 376 572 609 396 396 396 170 346 5 395 311 625 556 63 378 396 399 449 371 407 477 506 630 443 396 569 627 509 396 419 420 376 438 424 464 481 484 396 188 J1630 "Injection, haloperidol, up to 5 mg" 89 88 176 89 1 98 52 79 84 54 54 54 1 48 1 54 43 86 77 9 52 54 55 62 51 56 66 76 87 61 54 78 86 70 54 58 58 52 60 58 64 66 98 54 26 J1642 "Injection, Heparin sodium, (Heparin lock flush), per 10 units" 88 88 129 88 1 86 59 78 83 54 54 54 1 47 1 54 42 85 76 9 52 54 54 61 51 55 65 64 86 60 54 78 85 69 54 57 57 51 60 58 63 66 59 54 26 J1644 "Injection, Heparin sodium, per 1000 units" 111 89 130 111 1 108 64 98 104 68 68 68 1 59 1 67 53 107 95 11 65 68 68 71 63 70 82 66 108 76 68 97 107 87 68 72 72 64 75 72 79 67 67 68 32 J1650 "Injection, enoxaparin sodium, 10 mg" 105 99 254 105 1 105 79 92 98 64 64 64 4 105 1 64 50 101 90 10 61 64 64 72 60 66 77 87 101 71 64 92 101 82 64 68 68 61 71 79 75 78 69 64 30 J1750 "Injection, iron dextran, 50 mg" 118 88 149 118 1 115 69 104 111 72 72 72 52 63 1 72 57 114 101 11 69 72 73 82 68 74 87 92 115 81 72 104 114 93 72 76 76 69 80 77 84 88 84 72 34 J1756 "Injection, iron sucrose, 1 mg" 318 308 318 318 2 309 185 281 299 194 194 194 140 170 2 194 153 307 273 31 186 194 196 220 182 200 234 272 309 217 194 279 308 250 194 206 206 185 215 208 228 229 226 194 92 J1790 "Injection, droperidol, up to 5 mg" 92 90 184 92 1 90 53 81 86 56 56 56 9 49 1 59 44 90 79 9 54 56 56 64 61 58 67 57 87 63 56 81 89 78 56 59 59 53 64 62 66 67 68 56 27 J1815 "Injection, insulin, per 5 units" 6 6 18 6 0 6 3 5 6 4 4 4 3 3 0 4 3 6 5 1 3 4 4 4 3 4 4 5 6 4 4 5 6 5 4 4 4 3 4 4 4 4 4 4 2 J1885 "Injection, ketorolac tromethamine, per 15 mg" 90 2 359 90 0 348 88 87 134 55 57 55 0 48 1 59 43 88 77 9 52 55 55 64 51 56 66 72 87 71 55 348 87 76 55 58 72 52 65 60 66 67 67 55 89 J1930 "Injection, lanreotide, 1 mg" 12264 11740 12264 12264 88 11896 7112 10816 11515 7481 7481 7481 4058 6534 88 7454 5872 11809 10511 1191 7148 7481 7531 8489 7008 7683 9008 9909 11896 8361 7481 10755 11847 9613 7481 7925 7931 7113 8284 8008 8766 9092 8694 7481 3559 J1940 "Injection, furosemide, up to 20 mg" 93 89 268 93 1 91 63 82 88 57 57 57 1 63 1 57 45 90 80 9 54 57 57 65 53 58 69 77 91 64 57 82 90 73 57 60 60 54 63 60 67 66 66 57 27 J1953 "Injection, levetiracetam, 10 mg" 108 108 150 108 1 105 63 96 102 66 66 66 48 58 1 66 52 104 93 11 63 66 67 75 62 68 80 77 105 74 66 95 105 85 66 70 70 63 73 71 78 80 77 66 31 J1956 "Injection, levofloxacin, 250 mg" 92 91 113 92 1 90 73 89 86 56 56 56 2 49 1 56 44 90 79 9 53 56 56 63 52 57 67 65 89 63 56 80 89 72 56 59 59 53 62 56 66 68 70 56 27 J2020 "Injection, linezolid, 200 mg" 212 182 425 212 2 206 123 187 199 130 130 130 93 113 2 129 102 204 182 21 124 130 130 147 121 133 156 165 206 145 130 186 205 166 130 137 137 123 143 139 152 157 151 130 62 J2060 "Injection, lorazepam, 2 mg" 89 88 533 89 1 86 59 86 83 54 54 54 1 47 1 54 43 86 76 9 52 54 55 55 56 56 65 75 86 61 54 78 86 70 54 57 57 52 60 59 63 66 56 54 26 J2175 "Injection, meperidine hydrochloride, per 100 mg" 93 93 185 93 1 90 54 82 87 56 56 56 6 49 1 56 44 89 79 9 54 56 57 64 53 58 68 72 90 63 56 81 89 73 56 60 60 54 63 60 66 69 66 56 27 J2185 "Injection, meropenem, 100 mg" 108 106 116 108 1 104 62 95 101 66 66 66 47 57 1 65 52 104 92 10 63 66 66 75 62 67 79 84 104 73 66 94 104 84 66 70 70 62 73 70 77 80 76 66 31 J2212 Methylnaltrexone injection 357 357 378 357 3 346 207 314 335 217 217 217 143 190 3 217 171 343 306 35 208 217 219 247 204 223 262 278 346 243 217 313 344 279 217 230 231 207 241 233 255 264 253 217 103 J2250 "Injection, midazolam hydrochloride, per 1 mg" 89 57 355 89 0 87 86 58 83 54 54 54 0 59 1 57 43 87 76 9 52 54 55 63 51 56 65 76 86 61 54 78 86 70 54 57 57 52 60 60 63 66 65 54 26 J2270 "Injection, morphine sulfate, up to 10 mg" 92 89 450 92 1 270 60 65 87 56 56 56 3 49 1 56 44 270 79 9 54 56 57 64 53 58 68 76 90 63 56 81 89 73 56 60 60 54 62 62 66 69 68 56 27 J2274 Inj morphine pf epid ithc 103 102 104 103 1 100 69 90 96 63 63 63 12 55 1 62 49 100 88 10 60 63 63 71 59 64 75 88 99 70 63 90 99 80 63 66 66 59 69 67 73 76 73 63 30 J2300 "Injection, nalbuphine hydrochloride, per 10 mg" 95 95 95 95 1 92 55 84 89 58 58 58 3 51 1 58 46 92 82 9 56 58 58 66 54 60 70 74 92 65 58 84 92 75 58 62 62 55 64 62 68 71 68 58 28 J2310 "Injection, naloxone hydrochloride, per 1 mg" 120 101 736 120 1 117 70 106 113 74 74 74 10 64 1 73 58 116 103 12 70 74 74 83 69 75 89 93 117 82 74 106 116 94 74 78 78 70 81 79 86 89 112 74 35 J2360 "Injection, orphenadrine citrate, up to 60 mg" 119 104 119 119 1 116 70 105 112 73 73 73 5 64 1 72 57 115 102 12 70 73 73 83 68 75 88 84 116 81 73 105 115 93 73 77 77 69 81 75 85 87 88 73 35 J2370 "Injection, phenylephrine HCl, up to 1 ml" 96 96 263 96 1 94 64 84 90 58 58 58 4 51 1 58 46 94 82 9 56 58 59 66 55 60 70 82 93 65 58 84 92 75 58 62 62 55 65 64 68 71 61 58 28 J2405 "Injection, ondansetron hydrochloride, per 1 mg" 88 16 354 88 0 88 57 86 86 54 81 54 0 51 1 59 42 88 76 9 52 54 54 63 51 55 16 75 86 67 54 87 85 75 54 57 71 51 59 60 65 66 65 54 41 J2543 "Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)" 105 98 115 105 1 112 61 93 112 64 64 64 5 56 1 64 50 101 90 10 61 64 65 73 60 72 77 90 102 72 64 92 102 82 64 68 68 61 71 68 75 78 78 64 31 J2550 "Injection, promethazine HCl, up to 50 mg" 91 88 95 91 1 88 53 80 86 56 56 56 3 49 1 55 44 88 78 9 53 56 56 63 52 57 67 58 88 62 56 80 88 71 56 59 59 53 62 60 65 68 67 56 26 J2704 "Inj, propofol, 10 mg" 112 100 696 112 1 301 97 97 193 68 68 68 5 64 1 72 53 207 96 11 65 68 68 145 74 62 82 90 108 76 68 301 108 87 68 72 72 65 75 69 80 82 78 68 32 J2710 "Injection, neostigmine methylsulfate, up to 0.5 mg" 138 138 138 138 1 133 92 133 133 84 84 84 17 73 1 84 66 132 118 13 80 84 84 97 79 86 101 118 133 94 84 121 133 108 84 89 89 80 93 90 98 104 103 84 40 J2765 "Injection, metoclopramide HCl, up to 10 mg" 94 88 270 94 1 91 57 83 91 57 57 57 1 50 1 59 45 87 81 9 55 57 58 67 63 59 69 76 91 64 57 83 91 38 57 61 61 55 64 63 67 70 70 57 27 J2780 "Injection, ranitidine hydrochloride, 25 mg" 112 112 112 112 1 109 65 99 105 69 69 69 49 60 1 68 54 108 96 11 65 69 69 78 64 70 82 46 109 77 69 98 108 88 69 73 73 65 76 73 80 83 80 69 33 J2785 "Injection, regadenoson, 0.1 mg" 573 573 573 573 4 556 333 506 538 350 350 350 251 306 4 349 275 552 492 56 334 350 352 397 328 359 421 447 556 391 350 503 554 449 350 371 371 333 387 374 410 425 407 350 166 J2791 "Injection, Rho(D) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 IU" 274 140 408 274 2 289 159 242 258 167 167 167 14 146 2 167 131 264 235 27 160 167 168 190 157 172 202 289 266 187 167 241 265 215 167 177 177 159 185 179 196 203 195 167 80 J2795 "Injection, ropivacaine hydrochloride, 1 mg" 90 88 181 90 1 89 61 88 85 55 55 55 1 48 1 61 43 87 77 9 53 55 56 64 58 56 66 73 88 62 55 79 89 71 55 58 58 52 61 61 65 67 80 55 26 J2805 "Injection, sincalide, 5 micrograms" 216 205 227 216 2 210 125 191 203 132 132 132 121 115 2 131 103 208 185 21 126 132 133 150 123 135 159 146 210 147 132 189 209 169 132 140 140 125 146 142 154 160 166 132 63 J2920 "Injection, methylprednisolone sodium succinate, up to 40 mg" 100 93 200 100 1 134 134 88 94 61 61 61 4 53 1 61 48 96 86 10 58 61 62 69 57 63 74 86 97 68 61 88 97 79 61 65 65 58 68 65 72 74 75 61 29 J2930 "Injection, methylprednisolone sodium succinate, up to 125 mg" 108 97 431 108 1 106 65 86 101 66 66 66 6 73 1 66 52 106 92 10 63 66 66 76 73 68 79 92 105 74 66 95 104 92 66 70 70 63 73 67 77 75 79 66 31 J2997 "Injection, alteplase recombinant, 1 mg" 590 394 787 590 4 573 342 521 554 360 360 360 259 315 4 359 283 569 506 57 344 360 363 409 337 370 434 460 573 403 360 518 570 463 360 382 382 342 399 386 422 438 419 360 171 J3010 "Injection, fentanyl citrate, 0.1 mg" 88 4 795 88 1 268 133 86 268 54 56 54 1 59 1 146 42 87 76 9 51 54 54 125 50 55 65 76 86 70 54 77 85 69 54 57 57 51 178 59 63 66 66 54 32 J3030 "Injection, sumatriptan succinate, 6 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)" 136 136 224 136 1 170 79 120 127 83 83 83 26 72 1 82 65 130 116 13 79 83 83 94 77 85 100 59 131 92 83 119 131 106 83 88 88 79 92 88 97 100 170 83 39 J3101 "Injection, Tenecteplase, 1 mg" 5893 1300 10485 5893 42 5716 3417 5197 5533 3594 3594 3594 2582 3139 42 3582 2822 5674 5051 572 3435 3594 3619 4079 3367 3691 4328 4589 5716 4018 3594 5168 5693 4619 3594 3808 3811 3418 3980 3848 4212 4369 3948 3594 1710 J3230 "Injection, chlorpromazine HCl, up to 50 mg" 203 203 203 203 1 197 118 179 191 124 124 124 89 108 1 123 97 196 174 20 118 124 125 141 116 127 149 158 197 138 124 178 196 159 124 131 131 118 137 136 145 151 144 124 59 J3260 "Injection, tobramycin sulfate, up to 80 mg" 254 254 254 254 2 249 148 224 239 155 155 155 26 136 2 155 122 249 218 25 148 155 156 176 145 159 187 216 247 174 155 223 246 199 155 164 165 148 172 171 182 189 186 155 74 J3301 "Injection, triamcinolone acetonide, not otherwise specified, 10 mg" 104 90 209 104 1 119 71 118 98 64 64 64 5 69 1 82 50 102 90 10 61 64 64 86 73 65 64 96 101 71 64 92 119 103 64 68 68 61 71 70 75 78 81 64 30 J3304 HC INJ TRIAMCINOLONE ACE XR 1MG 1228 1228 2455 1228 9 1191 712 1083 1153 749 749 749 601 654 9 746 588 1182 1052 119 715 749 754 850 701 769 902 956 1191 837 749 1076 1186 962 749 793 794 712 829 802 877 910 870 749 356 J3360 "Injection, diazepam, up to 5 mg" 112 100 249 112 1 109 65 99 105 68 68 68 6 60 1 68 54 108 96 11 65 68 69 78 64 70 82 89 109 76 68 98 108 88 68 72 73 65 76 73 82 83 84 68 33 J3370 "Injection, vancomycin HCl, 500 mg" 128 99 184 128 1 124 85 113 120 78 78 78 56 68 1 78 61 123 109 12 74 78 78 88 73 80 94 123 124 87 78 112 123 108 78 82 83 74 86 74 88 95 90 78 37 J3410 "Injection, hydroxyzine HCl, up to 25 mg" 139 103 143 139 1 135 80 122 130 85 85 85 61 74 1 84 66 134 119 13 81 85 85 96 79 87 102 108 135 95 85 122 134 109 85 90 90 80 94 91 99 103 98 85 40 J3411 "Injection, thiamine HCl, 100 mg" 97 97 107 97 1 95 57 86 92 59 59 59 3 52 1 59 47 94 84 9 57 59 60 67 56 61 72 92 95 66 59 85 94 76 59 63 63 57 66 64 70 72 69 59 28 J3430 "Injection, phytonadione (vitamin K), per 1 mg" 185 136 185 185 1 180 108 164 174 113 113 113 33 99 1 113 89 179 159 18 108 113 114 128 106 116 136 144 180 126 113 163 179 145 113 120 120 108 125 121 133 137 131 113 54 J3475 "Injection, magnesium sulfate, per 500 mg" 92 89 181 92 1 90 54 81 87 56 56 56 3 49 1 56 44 89 79 9 54 56 57 65 53 58 68 79 90 63 56 81 89 72 56 60 60 54 62 60 66 68 62 56 27 J3480 "Injection, potassium chloride, per 2 meq" 60 60 287 60 0 210 37 53 56 37 37 37 3 32 0 36 29 58 51 6 35 37 37 42 34 38 44 52 58 41 37 53 58 51 37 39 39 35 41 39 43 44 210 37 17 J3486 "Injection, ziprasidone mesylate, 10 mg" 153 153 192 153 1 149 89 135 144 93 93 93 67 82 1 93 73 147 131 15 89 93 94 106 87 96 112 119 149 104 93 134 148 120 93 99 99 89 103 100 109 114 146 93 44 J3489 HC ZOLEDRONIC ACID 1MG 688 688 688 688 5 667 399 606 646 419 419 419 301 366 5 418 329 662 589 67 401 419 422 476 393 431 505 535 667 469 419 603 664 539 419 444 445 399 464 449 491 510 487 419 200 J3490 Unclassified drugs 89 89 89 89 1 86 52 78 84 54 54 54 47 47 1 54 43 86 76 9 52 54 55 62 51 56 65 69 86 61 54 78 86 70 54 58 58 52 60 58 64 66 63 54 26 J7030 "Infusion, normal saline solution, 1000 cc" 60 60 60 60 0 58 35 53 56 37 37 37 26 32 0 36 29 58 51 6 35 37 37 42 34 38 44 47 58 41 37 53 58 47 37 39 39 35 41 39 43 44 45 37 17 J7042 5% dextrose/normal saline (500 ml = 1 unit) 60 60 120 60 0 58 35 53 56 37 37 37 26 32 0 36 29 58 51 6 35 37 37 42 34 38 44 47 58 41 37 53 58 47 37 39 39 35 41 39 43 44 43 37 17 J7120 "Ringers lactate infusion, up to 1000 cc" 60 60 120 60 0 59 58 58 58 37 37 37 2 34 0 39 29 59 51 6 35 37 37 42 40 38 44 51 58 41 37 58 58 47 37 39 39 35 41 40 43 44 44 37 17 J7121 5% dextrose in lac ringers 60 60 60 60 0 58 35 53 56 37 37 37 26 32 0 36 29 58 51 6 35 37 37 42 34 38 44 47 58 41 37 53 58 47 37 39 39 35 41 39 43 44 43 37 17 J7298 HC LEVONORGESTREL IU 52MG MIRENA 1338 1338 1338 1338 10 1298 776 1180 1256 816 816 816 1059 713 10 813 641 1288 1147 130 780 816 822 926 765 838 983 1042 1298 912 816 1173 1293 1049 816 865 865 776 904 874 956 992 949 816 388 J7300 Intrauterine copper contraceptive 1986 1986 1986 1986 14 1926 1152 1752 1865 1211 1211 1211 870 1058 14 1207 951 1912 1702 193 1158 1211 1220 1375 1135 1244 1459 1547 1926 1354 1211 1742 1919 1557 1211 1283 1284 1152 1342 1297 1420 1472 1408 1211 576 J7321 "Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose" 468 468 468 468 3 453 271 412 439 285 285 285 205 249 3 284 224 450 401 45 272 285 287 324 267 293 343 364 453 319 285 410 452 366 285 302 302 271 316 305 334 347 331 285 136 J7325 "Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg" 2686 2686 2686 2686 12 2606 1558 2369 2522 1639 1639 1639 12 1431 19 1633 1286 2587 2303 261 1566 1639 1650 1860 1535 1683 1973 2092 2606 1832 1639 2356 2595 2106 1639 1736 1737 1558 1815 1754 1920 1992 1905 1639 780 J7331 "Synojoynt, inj., 1 mg" 6175 6175 6175 6175 44 5990 3581 5446 5798 3767 3767 3767 2706 3290 44 3753 2957 5946 5293 600 3599 3767 3792 4274 3529 3868 4536 5084 5990 4210 3767 5415 5965 4840 3767 3990 3993 3582 4171 4032 4414 4578 4378 3767 1792 J7336 Capsaicin 8% patch 1927 1927 1927 1927 14 1870 1118 1700 1810 1176 1176 1176 845 1027 14 1172 923 1856 1652 187 1123 1176 1184 1334 1101 1207 1416 1501 1870 1314 1176 1690 1862 1511 1176 1246 1246 1118 1302 1259 1378 1429 1366 1176 559 J7510 "Prednisolone oral, per 5 mg" 3 2 6 3 0 3 2 3 3 2 2 2 1 2 0 3 1 3 2 0 2 2 2 2 2 2 2 2 3 2 2 2 3 2 2 2 2 2 2 2 2 2 3 2 1 J7512 Prednisone ir or dr oral 1mg 1 1 4 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 J7626 "Budesonide, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 0.5 mg" 11 10 12 11 0 11 6 10 10 7 7 7 1 6 0 7 5 11 10 1 6 7 7 8 6 7 8 9 11 8 7 10 11 9 7 7 7 6 8 7 8 8 8 7 3 J8540 "Dexamethasone, oral, 0.25 mg" 3 3 4 3 0 3 2 3 3 2 2 2 1 2 0 2 1 3 2 0 2 2 2 2 2 2 2 2 3 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 1 J9999 "Not otherwise classified, antineoplastic drugs" 2 1 311 2 0 2 1 1 2 1 1 1 1 1 0 1 1 2 2 0 1 1 1 1 1 1 1 1 2 1 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 P9016 "Red blood cells, leukocytes reduced, each unit" 415 395 1245 415 3 608 265 366 390 253 253 253 392 221 3 252 199 407 356 40 242 253 255 287 237 260 305 356 403 283 253 364 401 325 253 268 268 241 280 241 297 308 608 253 120 P9035 "Platelets, pheresis, leukocytes reduced, each unit" 769 769 769 769 6 903 446 678 722 469 469 469 903 410 6 467 368 741 659 75 448 469 472 532 439 482 565 599 746 524 469 674 743 603 469 497 497 446 519 502 550 570 545 469 223 P9040 "Red blood cells, leukocytes reduced, irradiated, each unit" 468 468 468 468 3 454 271 413 439 285 285 285 205 249 3 284 224 451 401 45 273 285 287 324 267 293 344 364 454 319 285 410 452 367 285 302 303 271 316 306 335 347 332 285 136 P9047 "Infusion, albumin (human), 25%, 50 ml" 317 202 317 317 2 308 184 280 298 193 193 193 139 169 2 193 152 305 272 31 185 193 195 220 181 199 233 247 308 216 193 278 306 249 193 205 205 184 214 207 227 235 225 193 92 Q0138 "Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)" 2405 2316 2405 2405 17 2333 1395 2121 2258 1467 1467 1467 1054 1281 17 1462 1152 2316 2062 234 1402 1467 1477 1665 1374 1507 1767 1931 2333 1640 1467 2109 2324 1885 1467 1554 1555 1395 1625 1571 1719 1760 1705 1467 698 Q0144 "Azithromycin dihydrate, oral, capsules/powder, 1 gram" 4 4 4 4 0 4 2 4 4 2 2 2 2 2 0 2 2 4 3 0 2 2 2 3 2 3 3 3 4 3 2 4 4 3 2 3 3 2 3 3 3 3 3 2 1 Q3014 Telehealth originating site facility fee 55 55 55 55 0 107 32 49 52 34 34 34 107 29 0 33 26 53 47 5 32 34 34 38 31 34 40 43 53 37 34 48 53 43 34 36 36 32 37 36 39 41 39 34 16 Q4101 "Apligraf, per square centimeter" 1277 1277 1277 1277 9 1239 741 1126 1199 779 779 779 677 680 9 776 611 1230 1095 124 744 779 784 884 730 800 938 995 1239 871 779 1120 1234 1001 779 825 826 741 863 834 913 947 905 779 371 Q4153 "HC DERMAVEST, PLURIVEST SQ CM LVL 6" 1102 1102 1102 1102 8 1069 639 972 1035 673 673 673 483 587 8 670 528 1062 945 107 643 673 677 763 630 691 810 859 1069 752 673 967 1065 864 673 712 713 639 745 720 788 817 673 673 320 Q9966 "Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml" 189 189 189 189 1 183 110 167 177 115 115 115 83 109 1 122 91 182 162 18 110 115 116 131 108 118 28 162 183 129 115 183 183 148 115 122 122 110 128 127 135 138 134 115 55 Q9967 "Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml" 269 181 743 269 2 261 201 261 252 164 164 164 164 178 2 181 129 259 230 26 157 164 165 190 143 141 46 230 261 183 164 236 260 180 164 174 14 156 182 180 192 227 197 164 78 S0028 "Injection, famotidine, 20 mg" 89 89 89 89 1 87 52 79 84 54 54 54 1 48 1 54 43 86 77 9 52 54 55 62 51 56 66 70 87 61 54 78 86 70 54 58 58 52 60 58 64 66 67 54 26 S0030 "Injection, metronidazole, 500 mg" 92 91 92 92 1 89 53 81 86 56 56 56 2 49 1 56 44 89 79 9 54 56 57 64 53 58 68 72 89 63 56 81 89 72 56 60 60 53 62 60 66 68 65 56 27 S0077 "Injection, clindamycin phosphate, 300 mg" 96 95 97 96 1 93 56 85 90 59 59 59 1 51 1 58 46 92 82 9 56 59 59 66 55 60 70 75 93 65 59 84 93 75 59 62 62 56 65 63 69 71 68 59 28 S0191 "Misoprostol, oral, 200 mcg" 6 6 6 6 0 6 3 5 5 4 4 4 3 3 0 4 3 6 5 1 3 4 4 4 3 4 4 5 6 4 4 5 6 5 4 4 4 3 4 4 4 4 4 4 2 S5010 "5% dextrose and 0.45% normal saline, 1000 ml" 60 60 60 60 0 58 35 53 56 37 37 37 5 32 0 36 29 58 51 6 35 37 37 42 34 38 44 47 58 41 37 53 58 47 37 39 39 35 41 39 43 44 43 37 17 S5550 "Insulin, rapid onset, 5 units" 6 6 6 6 0 6 3 5 6 4 4 4 0 3 0 4 3 6 5 1 3 4 4 4 3 4 4 5 6 4 4 5 6 5 4 4 4 3 4 4 4 4 4 4 2 S5553 "Insulin, long acting; 5 units" 258 258 258 258 2 250 149 227 242 157 157 157 113 137 2 157 123 248 221 25 150 157 158 178 147 161 189 201 250 176 157 226 249 202 157 167 167 149 174 168 184 191 183 157 75 S9443 "Lactation classes, non-physician provider, per session" 125 125 125 125 1 121 72 110 117 76 76 76 55 67 1 76 60 120 107 12 73 76 77 87 71 78 92 97 121 85 76 110 121 98 76 81 81 72 84 82 89 92 89 76 36 S9472 "Cardiac rehabilitation program, non-physician provider, per diem" 191 191 280 191 1 185 111 168 179 117 117 117 84 102 1 116 91 184 164 19 111 117 117 132 109 120 140 136 185 130 117 167 185 150 117 123 124 111 129 125 137 142 135 117 55 U0003 HC SARS-COV-2 COVID-19 AMP PRB HIGH THROUGHPUT TECH 112 100 118 112 1 109 82 109 105 68 65 68 75 76 1 65 54 108 96 11 65 68 69 75 74 75 74 90 109 76 68 98 75 88 68 72 72 65 76 75 80 86 85 68 33 V2632 Posterior chamber intraocular lens 821 781 863 821 6 796 796 724 771 501 476 501 564 550 6 499 393 791 704 80 479 501 504 552 469 514 603 476 796 560 501 720 793 644 501 531 531 476 555 578 587 609 537 501 238 DRG Description Charges Charges Low Charges High Discounted Cash Price Min Negotiated Max Negotiated Aetna Aetna - coventry Aetna insurance Aetna medicare supplemental ins. American republic Bankers life & casualty Blue cross Blue cross medicare blue ppo Blue cross of wisconsin Champus Champva Cigna Commercial Coresource Coventry health care Geha Great west Health partners Health partners uph medicare adv h3416 Health partners uph self funded Humana choice Iowa total care Medical mutual 29076 Medicare community plan uhc Medico Meritain Midlands choice Molina wi badgercare Mutual of omaha Securehorizons direct Trustmark Uhc medicare dir Uhc medicare solutions Uhc medicare solutions ppo Uhc river valley Umr uhc United healthcare United healthcare aarp ins. Va Inpatients 92 DRG OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION OR COMORBIDITY (CC) 4053 2988 11058 4053 29 3931 2350 3574 3805 2472 2472 2472 1776 2159 29 2463 1941 3903 3474 393 2362 2472 2489 2805 2316 2539 2977 3156 3931 2763 2472 3554 3915 3177 2472 2619 2621 2351 2738 2646 2897 3005 2873 2472 1176 176 DRG PULMONARY EMBOLISM WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) 10730 10730 10730 10730 77 10408 6223 9463 10075 6545 6545 6545 4702 5717 77 6522 5138 10332 9197 1042 6254 6545 6589 7427 6131 6722 7881 8356 10408 7316 6545 9410 10366 8411 6545 6934 6939 6223 7248 7006 7669 7955 7607 6545 3114 177 DRG RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) 24464 4506 50017 24464 175 23730 14188 21576 22971 14923 14923 14923 10721 13034 175 14869 11714 23558 20969 2375 14259 14923 15024 16934 13980 15326 17969 19053 23730 16680 14923 21454 23634 19176 14923 15809 15821 14189 16525 15974 17486 18137 22230 14923 7100 178 DRG RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH COMPLICATION OR COMORBIDITY (CC) 21664 21664 21664 21664 155 21014 12564 19107 20342 13215 13215 13215 9494 11542 155 13168 10374 20862 18569 2103 12627 13215 13304 14996 12380 13572 20917 16872 21014 14771 13215 18998 20929 16981 13215 14000 14010 12565 14634 14146 15485 16061 15359 13215 6288 180 DRG RESPIRATORY NEOPLASMS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) 20019 20019 20019 20019 144 19418 11610 17656 18797 12211 12211 12211 8773 10665 144 12168 9586 19277 17158 1944 11668 12211 12294 13857 11440 12541 13446 15591 19418 13649 12211 17556 19339 15692 12211 12937 12946 11611 13522 13072 14309 14841 14192 12211 5810 185 DRG MAJOR CHEST TRAUMA WITHOUT CC/MCC 19009 1140 36878 19009 136 18439 11024 16765 17849 11595 11595 11595 8331 10128 136 11554 9102 18305 16293 1846 11080 11595 11674 13158 10863 11908 13962 14804 18439 12960 11595 16670 18364 14900 11595 12284 12293 11025 12840 12412 13587 14092 13476 11595 5517 189 "DRG PULMONARY EDEMA AND RESPIRATORY FAILURE - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 17975 14873 47050 17975 129 17435 10424 15853 16878 10965 10965 10965 7877 13473 129 10925 8607 17309 15406 1745 10477 10965 11039 12442 10272 11260 10672 13999 17435 12255 10965 15763 17365 14089 10965 11616 11624 10425 12142 11737 12848 13326 12743 10965 5217 192 "DRG CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 20811 20811 20811 20811 149 26403 12069 18355 19541 12695 12695 12695 9121 11088 149 12649 9965 20041 17838 2021 12130 12695 12781 14406 11893 13038 26403 16208 20187 14189 12695 18251 20105 16313 12695 13449 13459 12071 14058 13589 14875 15429 14754 12695 6040 193 "DRG SIMPLE PNEUMONIA AND PLEURISY WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 5856 5856 5856 5856 42 5681 3396 5165 5499 3572 3572 3572 2567 3120 42 3560 2804 5639 5020 569 3413 3572 3597 4054 3347 3669 5238 4561 5681 3993 3572 5136 5658 4590 3572 3785 3787 3397 3956 3824 4186 4342 4152 3572 1700 194 "DRG SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 9057 9057 9057 9057 65 8785 5252 7988 8504 5525 5525 5525 3969 4825 65 5505 4337 8722 7763 879 5279 5525 5562 6269 5176 5674 7924 7054 8785 6175 5525 7943 8750 7099 5525 5853 5857 5253 6118 5914 6474 6714 6421 5525 2629 293 "DRG HEART FAILURE AND SHOCK WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 11543 11543 11543 11543 83 11197 6694 10181 10839 7041 7041 7041 5059 6150 83 7016 5527 11116 9894 1121 6728 7041 7089 7990 6596 7231 7858 8990 11197 7870 7041 10123 11151 9048 7041 7460 7465 6695 7797 7537 8251 8558 8184 7041 3350 305 DRG HYPERTENSION WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) 2557 2557 2557 2557 18 2480 1483 2255 2401 1560 1560 1560 1120 1362 18 1554 1224 2462 2191 248 1490 1560 1570 1770 1461 1602 1878 1991 2480 1743 1560 2242 2470 2004 1560 1652 1653 1483 1727 1670 1828 1895 1907 1560 742 389 DRG G.I. OBSTRUCTION WITH COMPLICATION OR COMORBIDITY (CC) 3029 3029 3029 3029 22 2938 1757 2672 2844 1848 1848 1848 1328 1614 22 1841 1451 2917 2596 294 1766 1848 1860 2097 1731 1898 2225 2359 2938 2065 1848 2657 2926 2375 1848 1958 1959 1757 2046 1978 2165 2246 2148 1848 879 561 "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" 21682 21682 21682 21682 155 21031 12574 19123 20358 13226 13226 13226 9502 11552 155 13178 10382 20879 18584 2105 12638 13226 13315 15008 12390 13583 15925 16886 21031 14783 13226 19014 20946 16995 13226 14011 14021 12575 14646 14158 15498 16074 15371 13226 6293 594 ANOXIC AND OTHER SEVERE BRAIN DAMAGE 19650 14826 24473 19650 141 19060 11396 17330 18450 11986 11986 11986 8611 10469 141 11943 9409 18922 16842 1908 11453 11986 12067 13602 11229 12310 14433 15303 19060 13397 11986 17232 18983 15402 11986 12698 12707 11397 13273 12831 14045 14567 13931 11986 5703 603 "DRG CELLULITIS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 5672 3065 38458 5672 41 5501 3289 5002 5325 3460 3460 3460 2486 3022 41 3447 2716 5462 4861 551 3306 3460 3483 3926 3241 3553 4166 4417 5501 3867 3460 4974 5479 3065 3460 3665 3668 3290 3831 3703 4054 4205 4021 3460 1646 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" 14148 14148 14148 14148 101 13723 8205 12478 13284 8630 8630 8630 6200 7537 101 8599 6774 13624 12126 1374 8246 8630 8688 9793 8085 8863 2607 11018 13723 9646 8630 12407 13667 11089 8630 9142 9149 8206 9557 9238 10112 10488 10030 8630 4106 683 "DRG RENAL FAILURE WITH COMPLICATION OR COMORBIDITY (CC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 15996 15996 15996 15996 115 15516 9277 14108 15020 9758 9758 9758 7010 8522 115 9723 7660 15404 13710 1553 9324 9758 9823 11073 9141 10021 13388 12458 15516 10906 9758 14028 15453 12538 9758 10337 10344 9278 10805 10445 11434 11859 11340 9758 4643 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" 12982 8456 17508 12982 93 12593 7529 11450 12190 7919 7919 7919 5689 6917 93 7891 6216 12501 11127 1260 7567 7919 7973 8986 7419 8133 7865 10111 12593 8851 7919 11385 12542 10176 7919 8389 8395 7530 8769 8477 9279 9624 9204 7919 3768 947 "DRG SIGNS AND SYMPTOMS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 20179 6025 40193 20179 145 32821 11703 17798 18948 12309 12309 12309 8844 32821 145 12265 9663 19432 17296 1959 11762 12309 12393 13969 11531 12642 14574 15716 19574 13758 12309 17696 19494 15818 12309 13040 13050 11704 13631 13177 14424 14960 14306 12309 5857 948 "DRG SIGNS AND SYMPTOMS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) - MARKET SIZE, PREVALENCE, INCIDENCE, QUALITY OUTCOMES, TOP HOSPITALS & PHYSICIANS" 15989 10 50889 15989 115 18621 9273 14102 15013 9753 9753 9753 7007 8519 115 9718 7656 15397 13705 1552 9320 9753 9819 11068 9137 10017 18621 12452 15510 10902 9753 14022 15447 12533 9753 10333 10340 9274 10801 10441 11429 11854 11336 9753 4641 CPT Description Charges Charges Low Charges High Discounted Cash Price Min Negotiated Max Negotiated Aetna Aetna - coventry Aetna insurance Blue cross Blue cross of wisconsin Champus Champva Cigna Commercial Great west Health partners Health partners uph self funded Humana choice Iowa total care Medical mutual 29076 Meritain Midlands choice Molina wi badgercare Trustmark Uhc medicare solutions Uhc medicare solutions ppo Uhc river valley Umr uhc United healthcare Va Professionals Outpatients 126 "Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy" 606 535 678 606 79 425 220 232 255 286 290 112 127 244 135 208 271 425 79 96 187 153 266 105 175 124 117 138 203 206 91 142 Anesthesia for procedures on eye; lens surgery 678 113 791 678 82 332 180 259 285 104 324 125 142 273 151 232 303 332 89 83 209 171 297 118 195 139 82 154 256 240 102 170 "Anesthesia for intraoral procedures, including biopsy; not otherwise specified" 1154 1130 1469 1154 151 1028 418 441 486 544 551 213 241 465 257 395 516 1028 151 167 356 292 505 200 333 237 223 262 494 508 173 300 "Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified" 993 808 1177 993 130 486 360 380 418 469 474 184 207 400 222 340 444 486 130 136 306 251 435 172 286 204 186 226 333 136 149 400 "Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified" 642 452 856 642 81 314 233 246 270 303 307 119 134 259 143 220 287 314 84 81 198 162 281 112 185 132 98 146 215 287 96 731 PR ANES UPR GI NDSC PX NOS 749 642 904 749 98 403 272 241 315 403 358 138 156 302 167 256 335 366 98 101 231 189 328 130 216 154 116 170 306 287 112 790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified 1194 1070 1582 1194 156 669 433 457 503 669 571 221 250 481 267 409 534 584 156 165 369 450 523 207 344 245 231 272 569 465 179 811 PR ANES LWR INTST NDSC NOS 904 642 1243 904 94 442 328 346 381 156 432 167 189 364 202 309 404 442 118 94 279 229 396 157 261 185 111 206 303 258 136 812 PR ANES LWR INTST SCR COLSC 452 404 791 452 19 316 216 216 216 19 216 84 106 182 101 155 202 316 59 72 140 114 198 79 130 93 123 103 263 263 68 813 PR ANES UPR LWR GI NDSC PX 904 678 1017 904 118 442 328 346 381 427 432 143 189 364 202 309 404 442 118 126 279 229 396 157 261 185 142 206 376 362 136 830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified 934 749 1284 934 122 457 339 357 393 441 446 173 195 376 208 319 418 457 122 137 288 236 409 162 381 191 180 212 313 252 140 832 Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias 1010 1010 1010 1010 132 494 366 386 425 477 483 187 211 407 225 346 452 494 132 176 312 255 442 175 291 207 195 230 339 342 151 840 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified 1695 1284 3164 1695 222 2311 615 468 714 942 810 261 354 683 378 580 2311 1345 222 238 523 429 742 294 1080 348 327 385 568 550 254 851 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection 1243 1243 1243 1243 163 608 451 476 523 587 594 230 260 501 277 425 556 608 163 197 384 314 544 216 358 255 240 283 417 526 186 860 "Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; not otherwise specified" 1111 1111 1111 1111 145 543 403 425 378 524 531 205 232 447 248 380 497 543 145 176 343 281 486 193 320 228 215 253 372 377 167 873 "Anesthesia for lithotripsy, extracorporeal shock wave; without water bath" 808 707 1177 808 106 570 293 288 340 530 386 149 169 570 180 277 362 395 106 127 249 204 354 140 233 166 114 184 334 367 121 940 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified" 791 565 904 791 103 723 287 303 333 373 378 146 165 319 177 271 723 387 103 125 244 200 346 137 228 162 153 180 265 306 119 944 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy" 1712 1469 2034 1712 224 1627 621 655 721 1178 818 316 358 689 382 586 1627 837 224 240 528 433 750 297 494 351 331 389 574 501 257 952 "Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography" 678 565 952 678 89 400 246 259 285 372 324 125 142 273 151 232 303 332 89 112 209 171 297 118 195 139 131 154 227 400 102 1214 Anesthesia for open procedures involving hip joint; total hip arthroplasty 2147 1243 2599 2147 281 1480 779 822 904 1013 1026 397 449 1480 479 735 961 1050 281 320 663 543 940 373 619 440 415 488 940 1015 322 1250 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg" 1712 1712 1712 1712 224 837 621 655 721 808 818 316 358 689 382 586 766 837 224 271 528 433 750 297 494 351 331 389 574 580 257 1320 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area" 1547 1547 1547 1547 202 757 561 592 651 730 739 286 323 623 345 529 692 757 202 245 477 391 677 269 446 317 299 352 519 555 232 1400 Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified 986 808 1070 986 129 547 358 377 415 547 471 182 206 397 220 338 441 482 129 139 304 249 432 171 284 202 191 224 331 409 148 1402 Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty 2034 1921 2486 2034 113 994 737 778 856 755 972 376 425 819 454 696 910 994 266 113 628 514 890 353 586 417 246 462 682 902 305 1462 "Anesthesia for all closed procedures on lower leg, ankle, and foot" 274 274 274 274 36 134 99 105 115 129 131 51 57 110 61 94 123 134 36 43 85 69 120 48 79 56 53 62 92 64 41 1470 "Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified" 1469 963 1819 1469 192 1034 533 562 618 1034 702 272 307 592 328 503 657 718 192 247 453 371 643 255 424 301 284 334 492 698 220 1480 "Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified" 963 678 2034 963 126 608 349 324 405 608 460 178 201 388 215 330 431 524 126 141 297 244 422 167 278 197 138 219 273 491 144 1610 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla" 1391 1177 1605 1391 172 680 504 532 586 657 665 257 291 560 310 476 622 680 182 252 429 352 609 242 401 285 172 316 466 471 209 1630 "Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified" 1769 1391 2147 1769 231 865 642 677 745 835 845 327 370 712 395 605 792 865 231 280 546 447 775 307 510 363 342 402 593 616 265 1810 "Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand" 749 565 856 749 98 432 252 287 315 426 358 138 156 302 167 256 335 366 98 98 231 189 432 130 216 154 144 170 381 256 112 1820 "Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones" 782 707 856 782 102 382 283 299 329 369 373 144 163 315 174 267 350 382 102 128 241 198 342 136 225 160 151 178 262 265 117 10060 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single" 257 244 257 257 34 196 93 98 108 196 123 48 54 104 57 88 115 126 34 41 79 65 113 45 74 53 50 58 86 153 39 10061 "Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple" 280 280 280 280 37 163 102 107 118 132 134 52 58 113 63 96 125 137 37 44 86 71 123 49 81 57 54 64 94 163 42 10120 "Incision and removal of foreign body, subcutaneous tissues; simple" 171 171 171 171 22 84 62 65 72 81 82 32 36 69 38 59 77 84 22 27 53 43 75 30 49 35 33 39 57 58 26 11106 PR INCISIONAL BX SKN SINGLE LES 552 552 552 552 72 270 200 211 232 115 264 102 115 222 123 189 247 270 72 87 170 140 242 96 159 113 107 126 185 187 83 11421 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm" 281 281 281 281 37 225 102 108 118 225 134 52 59 113 63 96 126 138 37 45 87 71 123 49 81 58 54 64 94 95 42 11422 "Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm" 412 412 412 412 54 233 149 158 173 233 197 76 86 166 92 141 184 201 54 65 127 104 180 72 119 84 80 94 138 140 62 11730 "Avulsion of nail plate, partial or complete, simple; single" 149 138 153 149 19 100 54 57 63 100 71 28 31 60 33 51 67 73 19 24 46 38 65 26 43 31 29 34 50 51 22 11740 Evacuation of subungual hematoma 117 117 117 117 15 57 42 45 49 55 56 22 24 47 26 40 52 57 15 19 36 30 51 20 34 24 23 27 39 40 18 11750 "Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;" 658 596 691 658 86 322 239 252 277 192 314 122 137 265 147 225 294 322 86 86 203 166 288 114 190 135 127 150 221 223 99 11982 "Removal, non-biodegradable drug delivery implant" 530 530 530 530 39 259 192 203 223 250 253 98 111 213 118 181 237 259 69 39 164 134 232 92 153 109 102 121 178 180 79 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" 235 212 247 235 31 165 165 165 99 85 112 42 49 95 52 80 105 115 31 54 73 59 103 54 68 48 41 53 68 68 35 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" 271 245 271 271 35 129 98 104 114 111 129 46 57 109 60 93 121 105 35 43 84 69 119 47 78 56 51 62 91 91 41 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" 368 368 387 368 48 180 133 141 155 137 176 68 77 148 82 126 165 180 48 58 114 93 161 64 106 75 71 84 123 113 55 12011 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less" 286 259 301 286 37 174 104 174 120 104 137 43 60 115 64 98 108 140 37 58 88 72 125 58 82 59 55 65 85 85 37 12013 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 325 301 333 325 43 159 118 124 137 110 155 60 68 131 73 111 145 159 43 51 100 82 142 56 94 67 63 74 109 110 49 12014 "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm" 395 385 405 395 52 193 143 151 166 141 189 73 83 159 88 135 177 193 52 63 122 100 173 69 114 81 76 90 132 134 59 12032 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm" 370 361 380 370 48 181 134 142 156 175 177 68 77 149 83 127 166 181 48 59 114 94 162 64 107 76 165 84 124 126 56 12035 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm" 604 604 604 604 79 522 219 231 254 522 289 112 126 243 135 207 270 295 79 96 186 153 264 105 174 124 117 137 202 205 91 12041 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less" 541 541 541 541 71 312 196 207 228 312 258 100 113 218 121 185 242 265 71 86 167 137 237 94 156 111 105 123 181 183 81 12042 "Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm" 363 363 363 363 47 345 132 139 153 345 173 67 76 146 81 124 162 178 47 57 112 92 159 63 105 74 70 83 122 123 54 12052 "Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm" 478 478 478 478 63 307 173 183 201 226 228 88 100 193 107 164 214 234 63 76 148 121 209 83 138 98 92 109 307 162 72 13121 "Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm" 579 579 579 579 76 283 210 222 244 273 277 107 121 233 129 198 259 283 76 92 179 146 254 101 167 119 112 132 194 196 87 13122 "Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)" 364 364 364 364 48 178 132 139 153 172 174 67 76 147 81 125 163 178 48 58 112 92 159 63 105 75 70 83 122 123 55 15002 "Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children" 884 884 884 884 116 442 321 338 372 442 422 163 185 356 197 303 396 432 116 140 273 224 387 154 255 181 171 201 296 300 133 15271 PR SKIN SUB GRAFT T/A/L 25 SQ CM 427 406 449 427 56 209 155 163 180 181 204 79 89 172 95 146 191 209 56 68 132 108 187 74 123 88 77 97 143 130 64 20103 Exploration of penetrating wound (separate procedure); extremity 1290 1290 1290 1290 169 758 468 493 543 758 616 238 269 519 288 441 577 631 169 204 398 326 565 224 372 264 249 293 432 437 193 20550 "Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar ""fascia"")" 194 137 194 194 25 95 70 74 82 70 93 36 41 78 43 66 87 95 25 31 60 49 82 34 56 40 37 44 65 36 29 20551 Injection(s); single tendon origin/insertion 173 173 173 173 23 86 63 66 73 86 83 32 36 70 39 59 77 85 23 27 53 44 76 30 50 35 33 39 58 59 26 20552 "Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)" 269 262 276 269 35 138 70 103 113 138 129 50 56 108 60 92 120 132 35 43 83 68 118 47 78 55 52 61 90 91 40 20553 "Injection(s); single or multiple trigger point(s), 3 or more muscle(s)" 310 183 318 310 35 152 112 119 131 136 148 57 65 125 69 106 139 152 41 49 96 78 136 54 89 64 35 70 104 105 46 20600 "Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)" 240 209 245 240 31 117 87 92 101 79 115 44 50 97 54 82 107 117 31 38 74 61 105 42 69 49 46 55 80 56 36 20605 "Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)" 168 156 259 168 22 81 61 64 71 80 81 31 35 68 38 58 75 70 22 27 52 43 74 29 49 35 33 38 58 58 25 20606 PR DRAIN/INJ INTER JOINT/BURSA W/US 396 396 396 396 52 194 144 152 167 138 189 73 83 159 88 136 177 194 52 63 122 100 173 69 114 81 76 90 133 134 59 20610 "Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)" 219 188 404 219 29 107 79 89 92 98 105 42 46 88 49 75 96 107 29 35 68 55 94 51 63 45 39 50 70 70 33 20680 "Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)" 1921 1269 2119 1921 251 939 697 735 809 798 918 355 401 774 429 657 860 939 251 304 593 486 841 334 554 394 371 437 644 651 288 21480 Closed treatment of temporomandibular dislocation; initial or subsequent 256 243 269 256 33 125 93 98 108 87 122 47 53 103 57 88 115 125 33 41 79 65 112 44 74 53 49 58 86 87 38 23120 Claviculectomy; partial 1597 1597 1597 1597 209 781 579 611 672 754 763 295 334 643 356 547 715 781 209 253 493 404 699 277 460 328 309 363 535 478 240 23410 "Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute" 1852 1852 1852 1852 242 906 672 709 780 901 885 342 387 746 413 634 829 906 242 293 572 468 811 322 534 380 358 421 621 628 278 23412 "Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic" 2644 2518 2777 2644 346 1865 812 1012 1113 1865 1263 489 552 1065 590 905 1183 1293 346 418 816 669 1158 459 762 542 511 601 886 896 397 23430 Tenodesis of long tendon of biceps 2137 2035 2244 2137 280 1045 775 818 900 1009 1021 395 446 861 477 731 956 1045 280 338 660 540 936 371 616 438 413 486 716 576 321 23545 Closed treatment of acromioclavicular dislocation; with manipulation 1696 1696 1696 1696 222 829 615 649 714 800 810 313 354 683 379 580 593 829 222 268 523 429 743 295 489 348 328 386 569 575 254 23620 Closed treatment of greater humeral tuberosity fracture; without manipulation 730 730 730 730 96 561 265 279 307 561 349 135 153 294 163 250 327 357 96 116 225 185 320 127 210 150 141 166 245 247 109 23650 "Closed treatment of shoulder dislocation, with manipulation; without anesthesia" 1873 1783 1967 1873 57 916 679 717 789 57 895 346 391 754 418 641 544 916 245 296 578 474 820 325 540 384 362 426 628 520 281 24640 "Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation" 220 214 225 220 29 144 80 84 92 144 105 41 46 88 49 75 98 107 29 35 68 56 96 38 63 45 42 50 74 74 33 25000 "Incision, extensor tendon sheath, wrist (eg, deQuervains disease)" 958 958 958 958 125 469 347 367 403 452 458 177 200 386 214 328 429 469 125 152 296 242 419 166 276 196 185 218 321 325 144 25111 "Excision of ganglion, wrist (dorsal or volar); primary" 781 781 781 781 102 700 283 299 329 700 373 144 163 315 174 267 349 382 102 124 241 197 342 136 225 160 151 178 262 485 117 25600 "Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation" 926 926 926 926 121 565 336 354 390 565 442 171 193 373 207 317 414 453 121 147 286 234 405 161 267 190 179 211 310 314 139 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" 834 756 834 834 109 770 302 319 351 394 398 154 174 336 186 285 373 408 109 132 257 211 365 145 240 171 161 190 280 770 125 26055 "Tendon sheath incision (eg, for trigger finger)" 607 607 1820 607 79 297 220 232 255 286 290 112 127 244 135 208 271 297 79 96 187 153 266 105 175 124 117 138 203 206 91 26123 "Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);" 2495 2495 2495 2495 326 1263 905 955 1050 1178 1192 461 521 1005 557 854 1116 1220 326 395 770 631 1093 433 719 512 482 567 1263 846 374 26525 "Capsulectomy or capsulotomy; interphalangeal joint, each joint" 1775 1775 1775 1775 232 1438 644 679 747 1438 848 328 371 715 396 607 794 868 232 281 548 449 777 308 512 364 343 404 595 602 266 26600 "Closed treatment of metacarpal fracture, single; without manipulation, each bone" 660 660 660 660 86 611 239 253 278 611 315 122 138 266 147 226 295 323 86 104 204 167 289 115 190 135 127 150 221 224 99 26605 "Closed treatment of metacarpal fracture, single; with manipulation, each bone" 567 567 567 567 74 385 385 217 239 268 271 105 118 228 127 194 254 277 74 90 175 143 248 98 163 116 110 129 190 192 85 26742 "Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each" 730 730 730 730 96 357 265 279 307 345 349 135 153 294 163 250 327 357 96 116 225 185 320 127 210 150 141 166 245 277 109 26750 "Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each" 435 435 435 435 57 213 158 166 183 205 208 80 91 175 97 149 195 213 57 69 134 110 190 76 125 89 84 99 146 147 65 27096 "Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid" 733 598 1100 733 74 367 266 280 309 367 350 135 153 97 164 251 328 358 96 116 226 185 321 127 211 150 74 167 246 94 110 27130 "Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft" 5126 4881 5126 5126 671 2507 1859 1961 2158 1618 2449 947 1071 1650 1144 1754 2294 2507 671 811 1582 1296 2245 890 1478 1051 990 1166 1169 1048 769 27380 Suture of infrapatellar tendon; primary 1042 1042 1042 1042 136 510 378 399 439 492 498 193 218 420 233 357 466 510 136 165 322 264 457 181 301 214 201 237 349 353 156 27447 "Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)" 5126 4648 5126 5126 371 2507 1220 1961 2158 371 2449 947 1071 2064 1144 1754 2294 2507 671 811 1582 1296 2245 890 1478 1051 642 1166 1718 1167 769 27520 "Closed treatment of patellar fracture, without manipulation" 1030 1030 1030 1030 135 532 374 394 434 532 492 190 215 415 230 353 461 504 135 163 318 260 451 179 297 211 199 234 345 349 154 27524 "Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair" 3290 3290 3290 3290 430 1645 1193 1259 1385 1645 1572 608 687 1325 734 1126 1472 1609 430 521 1015 832 1441 571 949 675 636 748 1103 1115 493 27560 Closed treatment of patellar dislocation; without anesthesia 855 814 898 855 112 748 310 327 360 404 748 158 179 344 191 293 383 418 112 135 264 216 374 149 247 175 165 194 287 517 128 27654 "Repair, secondary, Achilles tendon, with or without graft" 3098 3098 3098 3098 405 1515 1124 1185 1304 1279 1480 573 647 1248 692 1060 1386 1515 405 490 956 783 1357 538 893 635 598 704 1039 1050 465 27766 "Open treatment of medial malleolus fracture, includes internal fixation, when performed" 2650 2650 2650 2650 347 1325 961 1014 1116 1325 1266 490 554 1067 592 907 1186 1296 347 419 818 670 1160 460 764 543 512 603 888 898 397 27792 "Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed" 1766 1766 1766 1766 231 864 641 676 744 834 844 326 369 711 394 605 790 864 231 279 545 447 773 307 509 362 341 402 592 599 265 27810 "Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation" 1276 1276 1276 1276 167 624 463 488 537 602 610 236 267 514 285 437 571 624 167 202 394 323 559 222 368 262 247 290 428 433 191 27814 "Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed" 2095 2095 2095 2095 274 1025 760 802 882 989 1001 387 438 844 468 717 937 1025 274 332 647 530 917 364 604 430 405 476 702 710 314 27818 Closed treatment of trimalleolar ankle fracture; with manipulation 1622 1622 1622 1622 212 835 588 621 683 835 775 300 339 653 362 555 726 793 212 257 501 410 710 282 468 333 313 369 544 550 243 28043 "Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm" 1018 1018 1018 1018 133 498 369 390 429 480 486 188 213 410 227 348 456 498 133 161 314 257 446 177 294 209 197 231 341 345 153 28080 "Excision, interdigital (Morton) neuroma, single, each" 1702 1702 1702 1702 223 832 617 651 717 662 813 315 356 685 380 583 762 832 223 269 525 430 745 296 491 349 329 387 571 577 255 28092 "Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each" 1368 1368 1368 1368 179 669 496 523 576 581 654 253 286 551 305 468 612 669 179 216 422 346 599 238 394 281 264 311 459 464 205 28104 "Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;" 1532 1532 1532 1532 200 749 556 586 645 632 732 283 320 617 342 524 686 749 200 242 473 387 671 266 442 314 296 348 514 519 230 28119 "Ostectomy, calcaneus; for spur, with or without plantar fascial release" 1246 1246 1246 1246 163 682 452 477 525 682 595 230 260 502 278 426 558 609 163 197 385 315 546 216 359 256 241 283 418 422 187 28124 "Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe" 703 703 703 703 92 344 255 269 296 332 336 130 147 283 157 241 315 344 92 111 217 178 308 122 203 144 293 160 236 238 105 28285 "Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)" 1154 1071 1182 1154 151 772 418 441 486 772 551 213 241 465 257 395 516 564 151 183 356 292 505 200 333 237 223 262 387 391 173 28296 "Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)" 1483 1412 1558 1483 194 1031 538 567 624 1031 709 274 310 597 331 508 664 974 194 235 458 375 649 258 428 304 286 337 497 503 222 28635 Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia 507 507 507 507 66 289 184 194 213 289 242 94 106 204 113 174 227 248 66 80 156 128 222 88 146 104 98 115 170 172 76 28675 "Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed" 1848 1848 1848 1848 242 910 670 707 778 910 883 342 386 744 413 632 827 904 242 292 570 467 809 321 533 379 357 420 619 626 277 28750 "Arthrodesis, great toe; metatarsophalangeal joint" 2553 2553 2681 2553 334 1260 926 977 1075 1260 1220 472 533 1028 570 874 1142 1249 334 404 788 646 1118 443 736 524 493 581 856 894 383 28810 "Amputation, metatarsal, with toe, single" 1459 1459 1459 1459 191 714 529 558 614 689 697 270 305 588 326 499 653 714 191 231 450 369 639 253 421 299 282 332 489 495 219 28820 "Amputation, toe; metatarsophalangeal joint" 2669 2541 2803 2669 349 1305 968 1021 1124 857 1275 493 558 1075 596 913 1194 1305 349 422 824 675 1169 464 770 547 516 607 603 905 400 28825 "Amputation, toe; interphalangeal joint" 1704 1622 1704 1704 223 833 618 652 717 377 814 315 356 686 380 583 762 833 223 270 526 431 746 296 491 349 329 387 571 578 256 29105 Application of long arm splint (shoulder to hand) 171 162 180 171 22 91 62 65 72 91 82 32 36 87 38 59 77 84 22 27 53 43 75 30 49 35 33 39 57 58 26 29125 Application of short arm splint (forearm to hand); static 147 147 147 147 19 88 53 56 62 88 70 27 31 59 33 50 66 72 19 23 45 37 64 26 42 30 28 33 59 59 22 29130 Application of finger splint; static 155 147 155 155 20 76 56 59 65 53 74 29 32 62 35 53 69 76 20 25 48 39 68 27 45 32 30 35 52 53 23 29505 Application of long leg splint (thigh to ankle or toes) 139 139 139 139 18 93 50 53 59 93 66 26 29 56 31 48 62 68 18 22 43 35 61 24 40 29 27 32 47 47 21 29515 Application of short leg splint (calf to foot) 139 139 154 139 18 91 50 53 59 91 66 26 29 56 31 48 62 68 18 22 43 35 61 24 40 29 27 32 47 75 21 29822 "Arthroscopy, shoulder, surgical; debridement, limited" 1629 1629 1629 1629 213 797 591 623 686 769 778 301 340 656 364 558 729 797 213 258 503 412 713 283 470 334 315 370 546 552 244 29824 "Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)" 2066 2066 2066 2066 57 1010 749 791 870 57 987 382 432 832 461 707 924 1010 270 327 638 522 905 359 596 424 399 470 693 700 310 29826 "Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release" 550 550 550 550 72 269 199 210 232 175 263 102 115 222 123 188 246 269 72 87 170 139 241 96 159 113 91 125 184 186 82 29827 "Arthroscopy, shoulder, surgical; with rotator cuff repair" 3236 3236 3236 3236 423 1583 1174 1238 1362 1074 1546 598 676 1303 722 1108 1448 1583 423 512 999 818 1417 562 933 664 558 736 1085 1097 485 29828 "Arthroscopy, shoulder, surgical; biceps tenodesis" 2796 2796 2796 2796 256 1367 1014 1070 1177 256 1336 517 584 1126 624 957 1251 1367 366 442 863 707 1224 486 806 573 540 636 937 948 419 29870 "Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)" 2370 2370 2370 2370 310 1159 860 907 998 1119 1132 438 495 954 529 811 1060 1159 310 375 731 599 1038 412 683 486 458 539 794 803 355 29880 "Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)" 1834 1789 1879 1834 240 998 665 702 772 998 876 339 383 739 409 628 821 897 240 507 566 464 803 319 529 376 354 417 615 622 275 29881 "Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)" 1472 1401 1624 1472 193 1108 534 563 620 1108 703 272 308 593 329 504 659 720 193 488 454 372 645 256 424 302 284 335 493 817 221 29882 "Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)" 2298 2298 2413 2298 301 1453 833 879 967 1453 1098 425 480 925 513 786 1028 1124 301 364 709 581 1006 399 663 471 444 523 770 1047 345 30300 "Removal foreign body, intranasal; office type procedure" 323 323 323 323 42 158 117 124 136 152 154 60 67 130 72 111 145 158 42 51 100 82 141 56 93 66 62 73 108 109 48 30901 "Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method" 230 230 230 230 30 112 83 88 97 106 110 43 48 93 51 79 103 112 30 36 71 58 101 40 66 47 51 52 77 78 34 30905 "Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial" 446 423 468 446 58 218 162 170 188 191 213 82 93 179 99 152 199 218 58 70 138 113 195 77 128 91 92 101 149 151 67 36569 "Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older" 687 623 722 687 31 336 249 263 289 324 328 127 144 277 153 235 307 336 90 31 212 174 301 119 198 141 87 156 230 148 103 37618 "Ligation, major artery (eg, post-traumatic, rupture); extremity" 173 173 173 173 23 85 63 66 73 82 83 32 36 70 39 59 77 85 23 27 53 44 76 30 50 35 33 39 58 59 26 46040 Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) 1908 1908 1908 1908 250 933 692 730 803 901 912 353 399 768 426 653 854 933 250 302 589 482 835 331 550 391 369 434 640 634 286 46083 "Incision of thrombosed hemorrhoid, external" 454 454 454 454 59 222 165 174 191 208 217 84 95 183 101 155 203 222 59 72 140 115 199 79 131 93 88 103 152 154 68 47562 "Laparoscopy, surgical; cholecystectomy" 2836 2836 2836 2836 371 1387 1029 1085 1194 1338 1355 524 592 1142 633 971 1269 1387 371 449 875 717 1242 493 818 582 548 645 951 961 425 49320 "Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)" 991 991 1041 991 130 597 359 510 417 597 473 183 207 399 221 339 443 485 130 157 306 251 434 172 286 203 191 225 332 336 149 49321 "Laparoscopy, surgical; with biopsy (single or multiple)" 1472 1472 1472 1472 193 720 534 563 620 695 703 272 308 593 329 504 659 720 193 311 454 372 645 256 424 302 284 335 493 499 221 49322 "Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)" 1013 1013 1013 1013 133 495 367 388 426 478 484 187 212 408 226 347 453 495 133 160 313 256 444 176 292 208 196 230 340 343 152 56420 Incision and drainage of Bartholin's gland abscess 460 434 469 460 60 250 167 176 193 250 220 85 96 185 103 157 206 225 60 73 142 116 201 80 132 94 89 104 154 156 69 57288 "Sling operation for stress incontinence (eg, fascia or synthetic)" 1855 1681 1855 1855 243 1406 673 710 1040 1406 886 695 388 747 414 635 729 907 243 294 573 469 812 322 535 380 358 422 622 629 278 57454 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage 475 475 475 475 62 232 172 182 200 224 227 88 99 191 106 163 139 232 62 75 147 120 208 83 137 97 92 108 159 161 71 57520 "Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser" 1304 1304 1304 1304 171 638 473 499 549 615 623 241 272 525 291 446 583 638 171 206 402 330 571 227 376 267 252 297 437 436 196 57522 "Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision" 1366 1366 1366 1366 179 668 495 523 575 645 653 252 285 550 305 468 611 668 179 216 422 345 598 237 394 280 264 311 458 381 205 58150 "Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);" 5450 4468 5450 5450 713 2604 1976 2085 2294 1280 2604 1007 1139 2195 1217 1865 1133 1061 713 862 1682 1378 2387 947 725 1118 1053 1239 1827 1847 817 58262 "Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)" 2162 2162 2162 2162 283 1058 784 827 910 1021 1033 400 452 871 483 740 968 1058 283 342 667 547 947 376 623 443 418 492 725 733 324 58300 Insertion of intrauterine device (IUD) 502 502 502 502 56 246 182 192 211 56 240 93 105 202 112 172 225 246 66 79 155 127 220 87 145 103 97 114 168 81 75 58301 Removal of intrauterine device (IUD) 279 279 279 279 37 136 101 107 117 120 133 52 58 112 62 95 125 136 37 44 86 71 122 48 80 57 54 63 94 95 42 58552 "Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)" 3076 2929 3076 3076 395 1942 1116 1177 1295 1777 1470 569 643 1239 687 1053 1942 1504 402 395 949 778 1347 534 887 631 594 699 1031 1510 461 58555 "Hysteroscopy, diagnostic (separate procedure)" 852 852 852 852 111 417 309 326 359 332 407 157 178 343 190 292 381 417 111 135 263 215 373 148 246 175 165 194 286 289 128 58558 "Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C" 743 673 743 743 62 544 269 284 313 510 355 137 155 412 166 254 544 363 97 62 229 188 325 129 214 152 144 169 249 257 111 58563 "Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)" 4085 3704 4085 4085 114 1998 1481 1563 1720 543 1952 114 853 1645 912 1398 1828 1998 534 231 1261 1033 1789 710 1178 838 789 929 1369 1385 613 58661 "Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)" 2013 1917 2013 2013 250 1774 730 770 847 1774 962 304 421 811 449 689 901 984 263 319 621 509 881 350 580 413 389 458 675 250 302 58662 "Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method" 3106 3106 3106 3106 406 1519 1126 1189 1308 1413 1484 574 649 1251 693 1063 1390 1519 406 491 959 785 1360 540 896 637 600 706 1041 1053 466 58670 "Laparoscopy, surgical; with fulguration of oviducts (with or without transection)" 1284 975 1592 1284 168 628 465 491 540 606 613 237 268 517 286 439 574 628 168 203 396 325 562 223 370 263 248 292 430 566 193 58925 "Ovarian cystectomy, unilateral or bilateral" 3430 3430 3430 3430 449 1677 1244 1312 1444 1619 1639 634 717 1381 766 1174 1535 1677 449 543 1059 867 1502 596 989 703 663 780 1150 1163 514 62321 PR INJ INTERLAM C/T W IMG 772 735 811 772 101 481 280 295 325 481 369 143 161 311 172 264 345 454 101 122 238 195 338 134 223 158 149 176 259 167 116 62323 Injection of substance into spinal canal of lower back or sacrum using imaging guidance 991 486 1146 991 80 473 359 379 417 459 473 80 207 399 221 339 443 459 130 157 306 273 434 172 286 203 191 225 332 90 149 64415 "Injection, anesthetic agent; brachial plexus, single" 498 486 511 498 45 244 181 191 210 235 238 92 104 201 111 171 223 244 65 45 154 126 218 87 144 102 96 113 167 63 75 64450 "Injection, anesthetic agent; other peripheral nerve or branch" 1409 1340 1478 1409 93 689 511 539 593 93 673 260 294 567 315 482 630 689 184 223 435 356 617 245 406 289 272 320 472 478 211 64483 "Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level" 718 646 792 718 94 413 260 275 302 413 343 133 150 289 160 246 321 351 94 114 222 182 314 125 207 147 100 163 241 151 108 64484 "Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)" 248 236 276 248 33 229 90 95 105 229 119 46 52 100 55 85 111 122 33 97 77 63 109 43 72 51 47 57 83 81 37 64490 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level" 872 630 993 872 114 756 316 334 367 756 417 161 182 351 195 299 390 427 114 138 269 221 382 152 252 179 139 198 292 143 131 64491 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)" 430 310 490 430 56 344 156 164 181 344 205 79 90 173 96 147 192 210 56 68 133 109 188 75 124 88 79 98 144 82 64 64492 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)" 400 311 492 400 52 344 145 153 169 344 191 74 84 161 89 137 179 196 52 63 124 101 175 70 115 82 77 91 134 76 60 64493 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level" 1065 676 1578 1065 111 620 386 408 448 620 509 197 222 429 238 364 477 521 139 112 329 269 466 185 307 218 120 242 140 111 160 64494 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)" 677 430 1002 677 44 331 246 259 285 274 323 125 141 273 151 232 303 331 89 44 209 171 296 118 195 139 57 154 81 64 102 64495 "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)" 616 411 616 616 45 301 223 236 259 262 294 114 129 248 138 211 276 301 81 45 190 156 270 107 178 126 119 140 82 209 92 64615 PBB CHEMODENERV MUSC MIGRAINE 403 403 403 403 53 218 146 154 170 218 193 74 84 162 90 138 180 197 53 64 124 102 176 70 116 83 78 92 135 137 60 64633 PBB DESTROY CERV/THOR FACET JNT 1724 1551 1811 1724 203 843 625 660 726 576 824 319 360 694 385 590 771 843 226 273 532 436 755 299 497 354 254 392 578 203 259 64634 PBB DESTROY C/TH FACET JNT ADDL 2356 2068 4826 2356 62 1152 854 901 992 266 1125 435 492 949 526 806 1054 1152 308 373 727 596 1031 409 679 483 89 536 790 62 353 64635 PBB DESTROY LUMB/SAC FACET JNT 3012 2847 3163 3012 169 1473 1092 1153 1268 582 1439 557 629 1213 672 1031 1348 1473 394 477 930 762 1319 523 868 618 169 685 344 1021 452 64636 PBB DESTROY L/S FACET JNT ADDL 713 642 1938 713 52 349 259 273 300 275 341 132 149 287 159 244 319 349 93 115 220 180 312 124 206 146 52 162 93 242 107 64718 Neuroplasty and/or transposition; ulnar nerve at elbow 1507 1507 1507 1507 197 1081 547 577 634 1081 720 279 315 607 336 516 674 737 197 238 465 381 660 262 435 309 291 343 505 511 226 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 1254 1194 1317 1254 164 949 455 480 528 949 599 232 262 505 280 429 561 786 164 198 387 317 892 218 362 257 242 285 420 648 188 64782 "Excision of neuroma; hand or foot, except digital nerve" 1419 1419 1419 1419 186 694 515 543 597 670 678 262 296 571 317 486 635 694 186 225 438 359 621 246 409 291 274 323 476 481 213 65205 "Removal of foreign body, external eye; conjunctival superficial" 161 161 161 161 21 79 58 62 68 54 77 30 34 65 36 55 72 79 21 25 50 41 71 28 46 33 31 37 54 55 24 69200 Removal foreign body from external auditory canal; without general anesthesia 116 116 116 116 15 87 42 44 49 87 55 21 24 47 26 40 52 57 15 18 36 29 51 20 33 24 22 26 39 39 17 69210 "Removal impacted cerumen (separate procedure), 1 or both ears" 158 158 158 158 21 77 57 60 67 71 75 29 33 64 35 54 71 77 21 25 49 40 69 27 46 32 31 36 53 54 24 92950 "Cardiopulmonary resuscitation (eg, in cardiac arrest)" 533 533 533 533 70 261 193 204 224 252 255 99 111 215 119 182 238 261 70 84 165 135 233 93 154 109 103 121 179 181 80 93244 PBB EXT ECG 48HR TO 7 DAY REVIEW & INTERP 65 65 65 65 9 44 24 25 27 44 31 20 14 26 15 22 29 32 9 10 20 16 28 11 19 13 23 15 22 31 10 93248 PBB EXT ECG 7 TO 15 DAY REVIEW & INTERP 72 72 72 72 9 35 26 28 30 34 34 13 15 29 16 25 32 35 9 11 22 18 32 13 21 15 14 16 24 34 11 97802 "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes" 232 232 232 232 30 113 84 89 98 109 111 43 48 93 52 79 104 113 30 38 72 59 102 40 67 48 45 53 78 79 35 99202 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family." 276 122 290 276 36 135 100 106 116 68 132 51 58 111 62 94 123 135 36 39 85 70 121 48 80 57 53 63 93 94 41 99203 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family." 410 351 431 410 54 196 115 115 173 115 196 73 86 165 92 140 139 124 54 58 127 104 124 71 118 84 78 93 83 83 61 99204 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family." 610 549 674 610 80 291 221 233 257 168 291 113 127 246 136 209 273 210 80 93 188 163 267 106 176 125 124 139 204 133 91 99205 "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of 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 moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family." 449 449 449 449 59 220 163 172 189 212 215 83 94 181 100 154 201 220 59 120 139 114 197 78 129 92 87 102 151 152 67 99212 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family." 168 152 168 168 18 82 61 64 71 48 80 31 35 68 38 57 75 82 22 18 52 42 74 29 48 34 32 38 28 57 25 99213 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family." 284 243 299 284 31 136 67 67 120 88 136 64 59 48 63 97 83 83 37 31 88 72 100 31 82 58 63 65 57 57 43 99214 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family." 447 383 470 447 49 219 162 171 188 135 214 83 93 180 100 153 200 219 58 49 138 113 196 78 129 92 93 102 88 88 67 99215 "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family." 599 524 599 599 78 293 217 229 252 161 286 111 125 241 134 205 268 293 78 95 185 151 262 104 173 123 134 136 201 124 90 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." 193 193 194 193 18 94 70 74 81 28 92 36 40 78 43 66 86 94 25 18 60 49 85 34 56 40 37 44 65 65 29 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." 205 185 205 205 27 86 44 44 86 55 66 34 43 63 46 70 69 66 27 29 60 44 63 29 59 39 40 47 48 48 29 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." 330 284 331 330 41 139 82 82 139 93 84 68 69 107 70 99 97 94 43 59 102 82 107 59 98 68 66 72 72 72 41 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." 567 514 567 567 74 277 127 127 127 157 182 115 118 182 127 182 209 277 74 91 175 143 182 91 163 116 114 132 132 132 83 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." 919 875 920 919 120 449 333 194 387 264 439 170 192 370 205 315 270 449 120 143 279 232 402 160 265 188 165 191 191 191 138 99291 "Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes" 629 599 629 629 82 308 228 241 265 280 301 116 131 253 140 215 281 308 82 144 194 159 275 109 181 129 122 143 211 246 94 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)" 290 290 290 290 38 142 105 111 122 137 139 54 61 117 65 99 130 142 38 80 90 73 127 50 84 59 56 66 97 123 43 99417 "Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)" 104 104 104 104 14 51 38 40 44 40 50 19 22 42 23 36 47 51 14 16 32 26 46 18 30 21 20 24 35 35 16 99441 "Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion" 32 32 32 32 4 20 12 12 13 20 15 6 7 13 7 11 14 16 4 5 10 8 14 6 9 7 6 7 11 11 5 99442 "Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion" 58 58 65 58 8 57 21 29 24 33 28 11 12 23 13 20 26 28 8 36 18 15 25 10 17 12 49 13 57 57 9 A0425 "Ground mileage, per statute mile" 302 5 3229 302 39 147 109 115 127 142 144 56 63 121 67 103 135 147 39 48 93 76 132 52 87 62 58 69 101 102 45 A0427 "Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)" 1183 1072 1183 1183 155 579 429 453 498 558 565 219 247 476 264 405 529 579 155 187 365 299 518 205 341 243 229 269 397 401 177 A0429 "Ambulance service, basic life support, emergency transport (BLS-emergency)" 964 874 1013 964 126 471 350 369 406 455 461 178 201 388 215 330 431 471 126 153 298 244 422 167 278 198 186 219 323 327 145 A0433 "Advanced life support, level 2 (ALS 2)" 1698 1698 1698 1698 222 830 616 650 715 801 811 314 355 684 379 581 760 830 222 269 524 429 744 295 490 348 328 386 569 576 255 A0998 "Ambulance response and treatment, no transport" 237 237 237 237 31 116 86 91 100 112 113 44 50 95 53 81 106 116 31 38 73 60 104 41 68 49 46 54 79 80 36 G0259 Injection procedure for sacroiliac joint; arthrograpy 74 74 74 74 10 36 27 28 31 35 35 14 15 30 17 25 33 36 10 12 23 19 32 13 21 15 14 17 30 25 11