| Servie Description |
ProcedureCode |
Code Description |
Self Pay |
Aetna |
BCBS |
Cigna |
UHC |
Oscar |
De-identified minimumnegotiated charge(Hospital) |
De-identified maximumnegotiated charge(Hospital) |
| Complete blood count |
85027 |
Complete cbc automated |
$12.94 |
|
$12.73 |
|
$7.76 |
$4.85 |
$4.85 |
$12.73 |
| Basic metabolic panel |
80048 |
Basic metabolic pnl total ca |
$16.92 |
|
$18.75 |
|
$10.15 |
$6.35 |
$6.35 |
$18.75 |
| Urine pregnancy test |
81025 |
Urine pregnancy test |
$17.22 |
|
$5.47 |
|
$10.33 |
$6.46 |
$5.47 |
$10.33 |
| Venous blood draw |
36415 |
Coll venous bld venipuncture |
$18.68 |
|
|
|
$11.21 |
$7.01 |
$7.01 |
$11.21 |
| Comprehensive metabolic panel |
80053 |
Comprehen metabolic panel |
$21.12 |
|
$18.75 |
|
$12.67 |
$7.92 |
$7.92 |
$18.75 |
| Electrocardiogram tracing only |
93005 |
Electrocardiogram tracing |
$113.48 |
|
$16.54 |
$91.64 |
$123.95 |
|
$16.54 |
$123.95 |
| Chest X-ray, 2 views |
71046 |
X-ray exam chest 2 views |
$167.40 |
|
$37.98 |
$135.19 |
$182.85 |
|
$37.98 |
$182.85 |
| Complete foot X-ray |
73630 |
X-ray exam of foot |
$167.40 |
|
$37.98 |
$135.19 |
$182.85 |
|
$37.98 |
$182.85 |
| Application of short-leg splint |
29515 |
Application short leg splint |
$312.58 |
|
$565.35 |
$252.44 |
$341.43 |
$2,048.00 |
$187.55 |
$2,048.00 |
| Compatibility test, each unit |
86920 |
Compatibility test spin |
$327.72 |
|
$5.13 |
$264.67 |
$357.97 |
|
$5.13 |
$357.97 |
| Compatibility test / blood typing |
86922 |
Compatibility test antiglob |
$327.72 |
|
$80.04 |
$264.67 |
$357.97 |
|
$80.04 |
$357.97 |
| Trimming of corn or callus (single) |
11055 |
Paring/cutg b9 hyprker les 1 |
$385.92 |
$938.08 |
$592.39 |
$311.68 |
$421.55 |
$2,048.00 |
$231.55 |
$2,048.00 |
| Removal of nail plate |
11730 |
Avulsion nail plate simple 1 |
$385.92 |
$938.08 |
$615.76 |
$311.68 |
$421.55 |
$2,048.00 |
$231.55 |
$2,048.00 |
| Wart destruction (up to 14) |
17110 |
Destruction b9 les up to 14 |
$385.92 |
$938.08 |
$592.39 |
$311.68 |
$421.55 |
$2,048.00 |
$231.55 |
$2,048.00 |
| Unlisted procedure, dentoalveolar structures |
41899 |
Unlisted px dentalvlr strux |
$455.60 |
$938.08 |
$3,717.36 |
$367.95 |
$497.65 |
|
$273.36 |
$5,026.41 |
| X-ray used to guide a procedure |
76000 |
Fluoroscopy <1 hr phys/qhp |
$458.96 |
|
$37.98 |
$370.66 |
$501.32 |
|
$37.98 |
$501.32 |
| Non-surgical realignment of a broken bone in the hand (metacarpal). |
26605 |
Treat metacarpal fracture |
$474.48 |
$1,254.24 |
$1,298.89 |
$383.20 |
$518.28 |
$2,048.00 |
$284.69 |
$2,048.00 |
| Unlisted foot or toe procedure |
28899 |
Unlisted px foot/toes |
$474.48 |
$938.08 |
$971.24 |
$383.20 |
$518.28 |
|
$284.69 |
$1,313.26 |
| Unlisted arthroscopy procedure |
29999 |
Unlisted px arthroscopy |
$474.48 |
$5,457.00 |
$6,043.65 |
$383.20 |
$518.28 |
|
$284.69 |
$8,171.90 |
| Injection into tendon sheath |
20550 |
Njx 1 tendon sheath/ligament |
$590.44 |
$938.08 |
$837.45 |
$476.84 |
$644.93 |
$2,048.00 |
$354.26 |
$2,048.00 |
| Joint fluid removal / injection (major joint) |
20610 |
Drain/inj joint/bursa w/o us |
$590.44 |
$938.08 |
$837.45 |
$476.84 |
$644.93 |
$2,048.00 |
$354.26 |
$2,048.00 |
| Hip X-ray with contrast (arthrogram) |
73525 |
Contrast x-ray of hip |
$671.08 |
|
$130.83 |
$541.96 |
$733.01 |
|
$130.83 |
$733.01 |
| Ingrown toenail removal |
11750 |
Excision nail&nail matrix |
$781.94 |
$938.08 |
$2,078.53 |
$631.50 |
$854.12 |
$2,048.00 |
$469.16 |
$2,810.48 |
| Intermediate wound repair (2.6–7.5 cm) |
12032 |
Intmd rpr s/a/t/ext 2.6-7.5 |
$781.94 |
$938.08 |
$615.76 |
$631.50 |
$854.12 |
$2,048.00 |
$469.16 |
$2,048.00 |
| Surgical wound bed preparation |
15004 |
Wound prep f/n/hf/g |
$781.94 |
$1,254.24 |
$4,290.25 |
$631.50 |
$854.12 |
$2,048.00 |
$469.16 |
$5,801.05 |
| Joint injection in ASC (knee or other) |
G0260 |
Inj for sacroiliac jt anesth |
$1,357.80 |
$938.08 |
$837.45 |
$1,096.57 |
$1,483.13 |
$2,048.00 |
$719.62 |
$2,048.00 |
| Cartilage graft harvest |
20910 |
Remove cartilage for graft |
$1,421.64 |
$1,514.24 |
$1,636.72 |
$1,148.13 |
$1,552.86 |
$2,048.00 |
$852.98 |
$2,213.09 |
| Injection of anesthetic around the brachial plexus (major nerve bundle to the arm) for pain or surgery. |
64415 |
Njx aa&/strd brch plxs img |
$1,701.32 |
$938.08 |
$1,233.59 |
$1,374.00 |
$1,858.36 |
$2,048.00 |
$938.08 |
$2,048.00 |
| Injection around a nerve coming out of the neck spine (transforaminal epidural, cervical/thoracic, single level). |
64479 |
Njx aa&/strd tfrm epi c/t 1 |
$1,701.32 |
$938.08 |
$2,013.68 |
$1,374.00 |
$1,858.36 |
$2,048.00 |
$938.08 |
$2,722.79 |
| Injection into a facet joint in the neck or mid-back (single level). |
64490 |
Inj paravert f jnt c/t 1 lev |
$1,701.32 |
$938.08 |
$2,013.68 |
$1,374.00 |
$1,858.36 |
$2,048.00 |
$938.08 |
$2,722.79 |
| Injection into a facet joint in the lower back (lumbar/sacral, single level). |
64493 |
Inj paravert f jnt l/s 1 lev |
$1,701.32 |
$938.08 |
$2,013.68 |
$1,374.00 |
$1,858.36 |
$2,048.00 |
$938.08 |
$2,722.79 |
| Injection around the stellate ganglion (nerve cluster in the neck) for pain or circulation issues. |
64510 |
N block stellate ganglion |
$1,701.32 |
$938.08 |
$2,013.68 |
$1,374.00 |
$1,858.36 |
$2,048.00 |
$938.08 |
$2,722.79 |
| Injection around the lumbar or thoracic sympathetic nerves for pain. |
64520 |
N block lumbar/thoracic |
$1,701.32 |
$938.08 |
$2,013.68 |
$1,374.00 |
$1,858.36 |
$2,048.00 |
$938.08 |
$2,722.79 |
| Removal of external fixation device |
20694 |
Rmvl ext fixj sys under anes |
$3,093.04 |
$938.08 |
$4,465.93 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$938.08 |
$6,038.59 |
| Incision of wrist tendon sheath |
25000 |
Incision of tendon sheath |
$3,093.04 |
$1,514.24 |
$4,465.93 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,514.24 |
$6,038.59 |
| Ganglion cyst removal (wrist) |
25111 |
Remove wrist tendon lesion |
$3,093.04 |
$1,514.24 |
$3,905.56 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,514.24 |
$5,280.88 |
| Trigger finger release |
26055 |
Incise finger tendon sheath |
$3,093.04 |
$1,254.24 |
$3,905.56 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,254.24 |
$5,280.88 |
| Finger tendon release |
26060 |
Incision of finger tendon |
$3,093.04 |
$1,254.24 |
$5,207.30 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,254.24 |
$7,041.03 |
| Removal of hand tendon / capsule cyst |
26160 |
Remove tendon sheath lesion |
$3,093.04 |
$1,514.24 |
$3,905.56 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,514.24 |
$5,280.88 |
| Extensor tendon repair, hand |
26418 |
Repair finger tendon |
$3,093.04 |
$1,838.72 |
$3,905.56 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,838.72 |
$5,280.88 |
| Hip joint incision with biopsy |
27052 |
Biopsy of hip joint |
$3,093.04 |
$1,514.24 |
$6,889.88 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,514.24 |
$9,316.12 |
| Hip manipulation under anesthesia |
27275 |
Manipulation of hip joint |
$3,093.04 |
$1,254.24 |
$2,424.51 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,254.24 |
$3,378.55 |
| Knee manipulation under anesthesia |
27570 |
Fixation of knee joint |
$3,093.04 |
$938.08 |
$2,424.51 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$938.08 |
$3,378.55 |
| Toe tendon release (single) |
28010 |
Incision of toe tendon |
$3,093.04 |
$1,254.24 |
$5,207.30 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,254.24 |
$7,041.03 |
| Morton’s neuroma removal |
28080 |
Removal of foot lesion |
$3,093.04 |
$1,514.24 |
$5,112.23 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,514.24 |
$6,912.48 |
| Foot ganglion / tendon cyst removal |
28090 |
Removal of foot lesion |
$3,093.04 |
$1,514.24 |
$5,112.23 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,514.24 |
$6,912.48 |
| Knee arthroscopy (surgical) |
29851 |
Knee arthroscopy/surgery |
$3,093.04 |
$5,457.00 |
$13,298.57 |
$2,497.97 |
$3,378.55 |
$2,048.00 |
$1,855.82 |
$17,981.61 |
| Removal of large benign lesion (trunk/extremity) |
11406 |
Exc tr-ext b9+marg >4.0 cm |
$3,176.92 |
$1,254.24 |
$4,290.25 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,254.24 |
$5,801.05 |
| Removal of small benign lesion (head/face/neck) |
11420 |
Exc h-f-nk-sp b9+marg 0.5/< |
$3,176.92 |
$1,254.24 |
$2,078.53 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,254.24 |
$3,470.18 |
| Skin lesion excision (benign) |
11424 |
Exc h-f-nk-sp b9+marg 3.1-4 |
$3,176.92 |
$1,254.24 |
$4,290.25 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,254.24 |
$5,801.05 |
| Forearm/wrist soft-tissue tumor removal |
25075 |
Exc forearm les sc < 3 cm |
$3,176.92 |
$1,254.24 |
$4,290.25 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,254.24 |
$5,801.05 |
| Removal of hand tumor (subcutaneous) |
26111 |
Exc hand les sc 1.5 cm/> |
$3,176.92 |
$1,514.24 |
$3,905.56 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,514.24 |
$5,280.88 |
| Removal of small subcutaneous foot tumor |
28043 |
Exc foot/toe tum sc < 1.5 cm |
$3,176.92 |
$1,254.24 |
$4,290.25 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,254.24 |
$5,801.05 |
| Removal of deep foreign body, foot |
28192 |
Removal of foot foreign body |
$3,176.92 |
$1,254.24 |
$4,290.25 |
$2,565.72 |
$3,470.18 |
$2,048.00 |
$1,254.24 |
$5,801.05 |
| Tarsal tunnel nerve release |
28035 |
Decompression of tibia nerve |
$3,756.14 |
$1,838.72 |
$4,168.82 |
$3,033.51 |
$4,102.87 |
$2,048.00 |
$1,838.72 |
$5,636.86 |
| Destroying a nerve in the neck facet joint using heat (radiofrequency ablation, single level). |
64633 |
Destroy cerv/thor facet jnt |
$3,756.14 |
$938.08 |
$2,013.68 |
$3,033.51 |
$4,102.87 |
$2,048.00 |
$938.08 |
$4,102.87 |
| Destroying a nerve in the lower back facet joint using heat (radiofrequency ablation, single level). |
64635 |
Destroy lumb/sac facet jnt |
$3,756.14 |
$938.08 |
$2,013.68 |
$3,033.51 |
$4,102.87 |
$2,048.00 |
$938.08 |
$4,102.87 |
| Ulnar nerve transposition at elbow |
64718 |
Revise ulnar nerve at elbow |
$3,756.14 |
$1,254.24 |
$4,168.82 |
$3,033.51 |
$4,102.87 |
$2,048.00 |
$1,254.24 |
$5,636.86 |
| Carpal tunnel release |
64721 |
Carpal tunnel surgery |
$3,756.14 |
$1,254.24 |
$4,168.82 |
$3,033.51 |
$4,102.87 |
$2,048.00 |
$1,254.24 |
$5,636.86 |
| Amputation revision, upper arm |
23921 |
Disarticulation sho sec clsr |
$3,968.80 |
$1,514.24 |
$4,261.22 |
$3,205.24 |
$4,335.15 |
$2,048.00 |
$1,514.24 |
$5,761.80 |
| Open bone biopsy (superficial) |
20240 |
Bone biopsy open superficial |
$5,587.34 |
$1,254.24 |
$4,290.25 |
$4,512.40 |
$6,103.10 |
$2,048.00 |
$1,254.24 |
$6,103.10 |
| Deep hardware / implant removal |
20680 |
Removal of implant deep |
$5,587.34 |
$1,514.24 |
$4,290.25 |
$4,512.40 |
$6,103.10 |
$2,048.00 |
$1,514.24 |
$6,103.10 |
| Removal of larger subcutaneous foot tumor |
28039 |
Exc foot/toe tum sc 1.5 cm/> |
$5,587.34 |
$938.08 |
$5,112.23 |
$4,512.40 |
$6,103.10 |
$2,048.00 |
$938.08 |
$6,912.48 |
| Removal of larger deep foot tumor |
28041 |
Exc foot/toe tum dep 1.5cm/> |
$5,587.34 |
$1,514.24 |
$5,112.23 |
$4,512.40 |
$6,103.10 |
$2,048.00 |
$1,514.24 |
$6,912.48 |
| Removal of deep foot/toe tumor |
28045 |
Exc foot/toe tum deep <1.5cm |
$5,587.34 |
$1,514.24 |
$5,112.23 |
$4,512.40 |
$6,103.10 |
$2,048.00 |
$1,514.24 |
$6,912.48 |
| Cone biopsy / loop excision of cervix |
57522 |
Conization of cervix |
$6,226.74 |
$1,254.24 |
$4,258.83 |
$5,028.78 |
$6,801.52 |
$2,048.00 |
$1,254.24 |
$6,801.52 |
| Dilation and curettage (D&C) of the uterus to remove tissue from the lining. |
58120 |
Dilation and curettage |
$6,226.74 |
$1,254.24 |
$4,355.10 |
$5,028.78 |
$6,801.52 |
$2,048.00 |
$1,254.24 |
$6,801.52 |
| Hysteroscopy with biopsy / polyp removal |
58558 |
Hysteroscopy biopsy |
$6,226.74 |
$6,822.00 |
$5,779.50 |
$5,028.78 |
$6,801.52 |
$2,048.00 |
$2,048.00 |
$7,814.73 |
| Treatment of missed miscarriage |
59820 |
Care of miscarriage |
$6,226.74 |
$2,055.04 |
$3,743.59 |
$5,028.78 |
$6,801.52 |
$2,048.00 |
$2,048.00 |
$6,801.52 |
| Partial removal of collarbone |
23120 |
Claviculectomy partial |
$6,293.82 |
$2,055.04 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$9,316.12 |
| Removal of elbow bursa |
24105 |
Excision olecranon bursa |
$6,293.82 |
$1,514.24 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Reconstruction of elbow (osteotomy) |
24470 |
Hemiepiphyseal arrest |
$6,293.82 |
$1,514.24 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,316.12 |
| Release of stuck wrist tendon |
25295 |
Release wrist/forearm tendon |
$6,293.82 |
$1,514.24 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Percutaneous pinning of wrist fracture |
25606 |
Perq skel fixj dstl rdl fx |
$6,293.82 |
$1,514.24 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,316.12 |
| Dupuytren’s contracture release, palm |
26123 |
Release palm contracture |
$6,293.82 |
$1,838.72 |
$5,743.21 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$7,765.66 |
| Flexor tendon repair, finger |
26350 |
Repair finger/hand tendon |
$6,293.82 |
$938.08 |
$3,905.56 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$938.08 |
$6,947.94 |
| Repair of a tendon in the finger or hand that bends the finger (flexor tendon). |
26433 |
Repair finger tendon |
$6,293.82 |
$1,514.24 |
$3,905.56 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Open surgery to fix a broken metacarpal bone in the hand. |
26615 |
Treat metacarpal fracture |
$6,293.82 |
$1,838.72 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$11,696.80 |
| Percutaneous pinning of finger fracture |
26727 |
Treat finger fracture each |
$6,293.82 |
$2,866.24 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$11,696.80 |
| Open surgery to fix a broken finger bone near the knuckle. |
26735 |
Treat finger fracture each |
$6,293.82 |
$1,838.72 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$11,696.80 |
| Open knee joint incision (arthrotomy) |
27310 |
Exploration of knee joint |
$6,293.82 |
$1,838.72 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$9,316.12 |
| Removal of kneecap bursa |
27340 |
Removal of kneecap bursa |
$6,293.82 |
$1,514.24 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Percutaneous Achilles / calf tenotomy |
27606 |
Incision of achilles tendon |
$6,293.82 |
$938.08 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$938.08 |
$6,947.94 |
| Opening the ankle joint to inspect or treat it (arthrotomy). |
27610 |
Explore/treat ankle joint |
$6,293.82 |
$1,254.24 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$9,316.12 |
| Partial removal of tibia bone |
27640 |
Partial removal of tibia |
$6,293.82 |
$1,254.24 |
$10,034.31 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$13,567.86 |
| Partial removal of fibula bone |
27641 |
Partial removal of fibula |
$6,293.82 |
$1,254.24 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$9,316.12 |
| Repair of ankle flexor tendon |
27658 |
Repair of leg tendon each |
$6,293.82 |
$938.08 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$938.08 |
$6,947.94 |
| Release of leg / ankle tendon sheath |
27680 |
Release of lower leg tendon |
$6,293.82 |
$1,514.24 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Lengthening of leg / ankle tendon |
27685 |
Revision of lower leg tendon |
$6,293.82 |
$1,514.24 |
$4,465.93 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Gastrocnemius (calf) recession |
27687 |
Revision of calf tendon |
$6,293.82 |
$1,514.24 |
$6,889.88 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,316.12 |
| Plantar fascia release |
28008 |
Incision of foot fascia |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Partial plantar fascia removal |
28060 |
Partial removal foot fascia |
$6,293.82 |
$1,254.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$6,947.94 |
| Partial removal of midfoot bone |
28104 |
Removal of foot lesion |
$6,293.82 |
$1,254.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$6,947.94 |
| Bunionette (tailor’s bunion) removal |
28110 |
Part removal of metatarsal |
$6,293.82 |
$1,514.24 |
$6,978.03 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,435.32 |
| Removing part of a bone in the midfoot or related area. |
28111 |
Part removal of metatarsal |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Complete removal of metatarsal bone |
28113 |
Part removal of metatarsal |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Removal of heel spur / bone |
28118 |
Removal of heel bone |
$6,293.82 |
$1,838.72 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$6,947.94 |
| Removing a bump or prominence on the heel bone. |
28119 |
Removal of heel spur |
$6,293.82 |
$1,838.72 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$6,947.94 |
| Partial removal of heel bone |
28120 |
Part removal of ankle/heel |
$6,293.82 |
$2,866.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$6,947.94 |
| Partial removal of foot bone |
28122 |
Partial removal of foot bone |
$6,293.82 |
$1,514.24 |
$7,041.78 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,521.52 |
| Partial removal of toe bone |
28124 |
Partial removal of toe |
$6,293.82 |
$1,254.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$6,947.94 |
| Removal of toe bone (phalanx) |
28150 |
Removal of toe |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Repair of a torn tendon in the foot. |
28200 |
Repair of foot tendon |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Release of contracted foot fascia |
28250 |
Revision of foot fascia |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Release of tight toe joint capsule |
28270 |
Release of foot contracture |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Correction of webbed toes |
28280 |
Fusion of toes |
$6,293.82 |
$1,254.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$6,947.94 |
| Hammertoe correction |
28285 |
Repair of hammertoe |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Removal of metatarsal head bump |
28288 |
Partial removal of foot bone |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Big-toe joint cleanup (cheilectomy) |
28289 |
Corrj halux rigdus w/o implt |
$6,293.82 |
$1,514.24 |
$7,041.78 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,521.52 |
| Bunion correction (Keller / resection) |
28292 |
Cor hlx vlgs rsc prx phlx bs |
$6,293.82 |
$1,254.24 |
$6,978.03 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$9,435.32 |
| Bunion correction with metatarsal osteotomy |
28296 |
Cor hlx vlgs dstl mtar osteo |
$6,293.82 |
$1,514.24 |
$6,978.03 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,435.32 |
| Soft-tissue correction of crooked toe |
28313 |
Repair deformity of toe |
$6,293.82 |
$1,254.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$6,947.94 |
| Removal of sesamoid bone (big toe) |
28315 |
Removal of sesamoid bone |
$6,293.82 |
$1,838.72 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$6,947.94 |
| Reconstruction of oversized toe |
28340 |
Resect enlarged toe tissue |
$6,293.82 |
$1,838.72 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,838.72 |
$6,947.94 |
| Percutaneous pinning of big-toe fracture |
28496 |
Treat big toe fracture |
$6,293.82 |
$1,254.24 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$11,696.80 |
| Open repair of big-toe fracture |
28505 |
Treat big toe fracture |
$6,293.82 |
$1,514.24 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$11,696.80 |
| Open repair of toe fracture |
28525 |
Treat toe fracture |
$6,293.82 |
$1,514.24 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$11,696.80 |
| Closed treatment of a broken bone in the midfoot or related tarsal bone with manipulation. |
28575 |
Treat foot dislocation |
$6,293.82 |
$938.08 |
$2,424.51 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$938.08 |
$6,947.94 |
| Open treatment of a dislocation in the midfoot joints. |
28645 |
Repair toe dislocation |
$6,293.82 |
$1,514.24 |
$8,650.54 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$11,696.80 |
| Amputation through midfoot |
28805 |
Amputation thru metatarsal |
$6,293.82 |
$1,514.24 |
$7,041.78 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$9,521.52 |
| Amputation of a toe through the metatarsal bone. |
28810 |
Amputation toe & metatarsal |
$6,293.82 |
$1,254.24 |
$7,041.78 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$9,521.52 |
| Amputation of toe at MTP joint |
28820 |
Amputation of toe |
$6,293.82 |
$1,254.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,254.24 |
$6,947.94 |
| Shoulder scope, limited cleanup |
29822 |
Sho arthrs srg lmtd dbrdmt |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Shoulder scope, extensive cleanup |
29823 |
Sho arthrs srg xtnsv dbrdmt |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Shoulder scope, end of collarbone removal |
29824 |
Sho arthrs srg dstl claviclc |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Elbow arthroscopy |
29834 |
Elbow arthroscopy/surgery |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee arthroscopy (diagnostic) |
29870 |
Arthrs knee dx w/wo syn bx |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, lateral retinacular release |
29873 |
Arthrs knee surg w/lat rls |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, remove loose body |
29874 |
Arthrs knee surg rmv loos/fb |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, limited synovium removal |
29875 |
Arthrs knee surg synvct lmtd |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, major synovium removal |
29876 |
Arthrs knee surg synvct maj |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, cartilage shaving |
29877 |
Arthrs knee surg dbrdmt/shvg |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, microfracture / cartilage drill |
29879 |
Arthrs kne srg abrasj arthrp |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, meniscus removal (both sides) |
29880 |
Arthrs kne srg mnisectmy m&l |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, meniscus removal (one side) |
29881 |
Arthrs kne srg mnisectmy m/l |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Knee scope, meniscus repair |
29882 |
Arthrs kne srg mnisc rpr m/l |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Endoscopic tarsal tunnel release |
29893 |
Endoscopic plantr fasciotomy |
$6,293.82 |
$1,514.24 |
$5,112.23 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$1,514.24 |
$6,947.94 |
| Ankle scope, synovium removal |
29895 |
Ankle arthroscopy/surgery |
$6,293.82 |
$5,457.00 |
$6,043.65 |
$6,947.94 |
$6,874.80 |
$2,048.00 |
$2,048.00 |
$8,171.90 |
| Facility fee for dental surgery under anesthesia |
G0330 |
Facility svs dental rehab |
$6,377.42 |
|
|
$5,150.48 |
$6,966.11 |
$2,048.00 |
$2,048.00 |
$6,966.11 |
| Spinal cord stimulator replacement |
63662 |
Remove spine eltrd plate |
$6,724.90 |
$938.08 |
$7,486.45 |
$5,431.11 |
$7,345.67 |
$2,048.00 |
$938.08 |
$10,122.78 |
| Revision or removal of spine stimulator |
63688 |
Rev/rmv imp sp npg/r dtch cn |
$6,724.90 |
$938.08 |
$7,486.45 |
$5,431.11 |
$7,345.67 |
$2,048.00 |
$938.08 |
$10,122.78 |
| Secondary closure of surgical wound |
13160 |
Sec clsr surg wnd/dehsn xtn |
$6,816.50 |
$1,254.24 |
$4,261.22 |
$5,505.08 |
$7,445.72 |
$2,048.00 |
$1,254.24 |
$7,445.72 |
| Surgical repair of the back wall of the vagina (posterior colporrhaphy) for prolapse or related issues. |
57250 |
Repair rectum & vagina |
$9,622.40 |
$6,822.00 |
$6,165.87 |
$7,771.17 |
$10,510.65 |
$2,048.00 |
$2,048.00 |
$10,510.65 |
| Vaginal hysterectomy |
58260 |
Vaginal hysterectomy |
$9,622.40 |
$6,822.00 |
$8,130.08 |
$7,771.17 |
$10,510.65 |
$2,048.00 |
$2,048.00 |
$10,993.05 |
| Hysteroscopy, remove fibroid |
58561 |
Hysteroscopy remove myoma |
$9,622.40 |
$6,822.00 |
$5,779.50 |
$7,771.17 |
$10,510.65 |
$2,048.00 |
$2,048.00 |
$10,510.65 |
| Hysteroscopy with lining ablation |
58563 |
Hysteroscopy ablation |
$9,622.40 |
$6,822.00 |
$5,779.50 |
$7,771.17 |
$10,510.65 |
$2,048.00 |
$2,048.00 |
$10,510.65 |
| Using a scope through the urethra to break up and remove bladder or ureter stones (with lithotripsy). |
52327 |
Cystoscopy inject material |
$10,313.62 |
$1,254.24 |
$6,004.21 |
$8,329.39 |
$11,265.66 |
$2,048.00 |
$1,254.24 |
$11,265.66 |
| Cystoscopy with prostatic implant (1–3) |
C9739 |
Cystoscopy prostatic imp 1-3 |
$10,313.62 |
$1,838.72 |
$8,483.42 |
$8,329.39 |
$11,265.66 |
$2,048.00 |
$1,838.72 |
$11,470.82 |
| Diagnostic laparoscopy |
49320 |
Diag laparo separate proc |
$11,628.82 |
$1,514.24 |
$6,614.75 |
$9,391.56 |
$12,702.26 |
$2,048.00 |
$1,514.24 |
$12,702.26 |
| Laparoscopic removal of the uterus (laparoscopic hysterectomy, often with other work). |
58550 |
Laparo-asst vag hysterectomy |
$11,628.82 |
$2,323.36 |
$9,436.45 |
$9,391.56 |
$12,702.26 |
$2,048.00 |
$2,048.00 |
$12,759.46 |
| Laparoscopy, remove ovary / tube |
58661 |
Laparoscopy remove adnexa |
$11,628.82 |
$2,055.04 |
$8,451.21 |
$9,391.56 |
$12,702.26 |
$2,048.00 |
$2,048.00 |
$12,702.26 |
| Percutaneous implantation of a spinal cord stimulator electrode (trial or permanent lead). |
63650 |
Implant neuroelectrodes |
$12,258.70 |
$5,723.00 |
$9,522.12 |
$13,532.75 |
$13,390.30 |
$2,048.00 |
$2,048.00 |
$13,532.75 |
| Bone graft harvest (minor) |
20900 |
Removal of bone for graft |
$13,957.62 |
$1,514.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Vertebral augmentation (spine cement) |
22513 |
Perq vertebral augmentation |
$13,957.62 |
$2,055.04 |
$30,102.59 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$40,703.10 |
| Removal of spine rods / hardware |
22850 |
Remove spine fixation device |
$13,957.62 |
$2,323.36 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Removal of posterior spine hardware |
22852 |
Remove spine fixation device |
$13,957.62 |
$2,323.36 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Removal of anterior spine hardware |
22855 |
Removal anterior instrmj |
$13,957.62 |
$2,323.36 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Rotator cuff repair |
23412 |
Repair rotator cuff chronic |
$13,957.62 |
$2,866.24 |
$10,034.31 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Biceps tendon reattachment (shoulder) |
23430 |
Repair biceps tendon |
$13,957.62 |
$6,822.00 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Excision / repair of biceps tendon lesion |
23440 |
Remove/transplant tendon |
$13,957.62 |
$1,838.72 |
$10,034.31 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Repair of AC (shoulder) joint |
23550 |
Optx acromclv dislc aqt/chrn |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Reattachment of distal biceps tendon |
24342 |
Repair of ruptured tendon |
$13,957.62 |
$1,514.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open treatment of elbow fracture |
24615 |
Optx aqt/chrnc elbow dislc |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open treatment of ulnar fracture at elbow |
24685 |
Optx ulnar fx prox end w/fix |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open repair of wrist fracture (extra-articular) |
25607 |
Optx dst rd xartc fx/epi sep |
$13,957.62 |
$2,055.04 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Open repair of wrist fracture (2 fragments) |
25608 |
Optx dst rd xart fx/epi sep2 |
$13,957.62 |
$2,055.04 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Open repair of wrist fracture (complex) |
25609 |
Optx dst rd xart fx/ep sep3+ |
$13,957.62 |
$2,055.04 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Open repair of scaphoid fracture |
25628 |
Optx carpl scphd fx int fixj |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Finger joint replacement (arthroplasty) |
26531 |
Revise knuckle with implant |
$13,957.62 |
$2,866.24 |
$7,640.49 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Quadriceps / thigh muscle repair |
27385 |
Repair of thigh muscle |
$13,957.62 |
$1,514.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Kneecap realignment (tibial tubercle) |
27418 |
Repair degenerated kneecap |
$13,957.62 |
$1,514.24 |
$10,034.31 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Extra-articular knee ligament reconstruction |
27427 |
Reconstruction knee |
$13,957.62 |
$1,514.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open repair of kneecap fracture |
27524 |
Treat kneecap fracture |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Primary Achilles tendon repair |
27650 |
Repair achilles tendon |
$13,957.62 |
$1,514.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Secondary Achilles tendon repair |
27654 |
Repair of achilles tendon |
$13,957.62 |
$1,514.24 |
$10,034.31 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Secondary repair of flexor tendon |
27659 |
Repair of leg tendon each |
$13,957.62 |
$1,254.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Repair of ankle extensor tendon |
27664 |
Repair of leg tendon each |
$13,957.62 |
$1,254.24 |
$4,465.93 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Transferring a tendon in the lower leg or ankle to restore function. |
27691 |
Revise lower leg tendon |
$13,957.62 |
$1,838.72 |
$10,034.31 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Repair of both ankle ligaments |
27696 |
Repair of ankle ligaments |
$13,957.62 |
$1,254.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Repair of ankle ligament (secondary) |
27698 |
Repair of ankle ligament |
$13,957.62 |
$1,254.24 |
$6,889.88 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Repair of tibia nonunion |
27720 |
Repair of tibia |
$13,957.62 |
$2,055.04 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Tibia nonunion repair with graft |
27724 |
Repair/graft of tibia |
$13,957.62 |
$2,055.04 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Repair of tibia-fibula nonunion |
27726 |
Repair fibula nonunion |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Percutaneous pinning of tibia fracture |
27756 |
Treatment of tibia fracture |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open repair of bimalleolar ankle fracture |
27814 |
Treatment of ankle fracture |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open repair of trimalleolar ankle fracture |
27823 |
Treatment of ankle fracture |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Repair of syndesmosis (high ankle) |
27829 |
Treat lower leg joint |
$13,957.62 |
$1,254.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Posterior tibial tendon reconstruction (Kidner) |
28238 |
Revision of foot tendon |
$13,957.62 |
$1,514.24 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Major reconstruction of the front of the foot for severe deformity (e.g., clubfoot-type or cavus). |
28262 |
Revision of foot and ankle |
$13,957.62 |
$1,838.72 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Big-toe joint correction with implant |
28291 |
Corrj halux rigdus w/implt |
$13,957.62 |
$1,514.24 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Correction of a bunion with removal of bone from the big toe side. |
28298 |
Cor hlx vlgs prx phlx osteot |
$13,957.62 |
$1,514.24 |
$6,978.03 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Correction of a bunion using a double osteotomy (two bone cuts). |
28299 |
Cor hlx vlgs double osteot |
$13,957.62 |
$2,055.04 |
$6,978.03 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Heel bone cut / realignment |
28300 |
Incision of heel bone |
$13,957.62 |
$1,254.24 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Cut / realign midfoot bones |
28304 |
Incision of midfoot bones |
$13,957.62 |
$1,254.24 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,254.24 |
$15,408.22 |
| Midfoot bone cut with graft |
28305 |
Incise/graft midfoot bones |
$13,957.62 |
$1,514.24 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Multiple osteotomies in the midfoot to correct alignment. |
28309 |
Incision of metatarsals |
$13,957.62 |
$1,838.72 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Repair of a non-healing or poorly healed fracture in the midfoot. |
28322 |
Repair of metatarsals |
$13,957.62 |
$1,838.72 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Open surgery to fix a broken heel bone (calcaneus) with plates/screws. |
28415 |
Optx calcaneal fracture |
$13,957.62 |
$1,514.24 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,514.24 |
$15,408.22 |
| Open repair of metatarsal fracture |
28485 |
Optx metatarsal fx each |
$13,957.62 |
$1,838.72 |
$8,650.54 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Fusion of midfoot joint (single) |
28740 |
Fusion of foot bones |
$13,957.62 |
$1,838.72 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Big-toe joint fusion |
28750 |
Fusion of big toe joint |
$13,957.62 |
$1,838.72 |
$7,041.78 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Big-toe IP joint fusion |
28755 |
Fusion of big toe joint |
$13,957.62 |
$1,838.72 |
$5,112.23 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$1,838.72 |
$15,408.22 |
| Shoulder scope, capsule / labrum repair |
29806 |
Sho arthrs srg capsulorraphy |
$13,957.62 |
$5,457.00 |
$13,298.57 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$17,981.61 |
| Shoulder scope, SLAP tear repair |
29807 |
Sho arthrs srg rpr slap les |
$13,957.62 |
$5,457.00 |
$13,298.57 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$17,981.61 |
| Shoulder scope, rotator cuff repair |
29827 |
Sho arthrs srg rt8tr cuf rpr |
$13,957.62 |
$5,457.00 |
$13,298.57 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$17,981.61 |
| Shoulder scope, biceps tenodesis |
29828 |
Sho arthrs srg bicp tenodsis |
$13,957.62 |
$5,457.00 |
$6,043.65 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Minimally invasive (arthroscopic) repair or reconstruction of the ACL (anterior cruciate ligament) in the knee using a graft. |
29888 |
Arthrs aid acl rpr/agmntj |
$13,957.62 |
$5,457.00 |
$13,298.57 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$17,981.61 |
| Arthroscopic reshaping of the ball of the hip joint to treat cam-type femoroacetabular impingement (FAI). |
29914 |
Hip arthro w/femoroplasty |
$13,957.62 |
$5,457.00 |
$13,298.57 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$17,981.61 |
| Endoscopic lumbar decompression |
62380 |
Ndsc dcmprn 1 ntrspc lumbar |
$13,957.62 |
$2,055.04 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Lumbar laminectomy for decompression |
63005 |
Remove spine lamina 1/2 lmbr |
$13,957.62 |
$2,055.04 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Lumbar disc removal (discectomy) |
63030 |
Lamot dcmprn nrv rt 1 lmbr |
$13,957.62 |
$8,868.00 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Repeat lumbar laminotomy / disc removal |
63042 |
Laminotomy single lumbar |
$13,957.62 |
$2,055.04 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Thoracic laminectomy for decompression |
63046 |
Lam facetec & foramot thrc |
$13,957.62 |
$2,055.04 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Lower back decompression (laminectomy) |
63047 |
Lam facetec & foramot lumbar |
$13,957.62 |
$8,868.00 |
$10,376.86 |
$15,408.22 |
$15,246.03 |
$2,048.00 |
$2,048.00 |
$15,408.22 |
| Laparoscopic placement of an adjustable gastric band (and port) for weight-loss surgery. |
43770 |
Lap place gastr adj device |
$20,446.90 |
$13,644.00 |
$9,436.45 |
$16,513.16 |
$22,334.34 |
$2,048.00 |
$2,048.00 |
$22,334.34 |
| Anterior cervical fusion with disc removal |
22551 |
Arthrd ant ntrbdy cervical |
$24,695.72 |
$2,323.36 |
$10,376.86 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,262.32 |
| Revision total shoulder replacement |
23474 |
Revis reconst shoulder joint |
$24,695.72 |
$2,055.04 |
$20,245.18 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,374.45 |
| Interscapular-thoracic amputation |
23900 |
Interthoracoscplr amputation |
$24,695.72 |
|
$10,034.31 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,262.32 |
| Repair of humerus nonunion without graft |
24430 |
Rpr non/mal humerus wo graft |
$24,695.72 |
$1,514.24 |
$10,034.31 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$1,514.24 |
$27,262.32 |
| Humerus repair with graft |
24435 |
Rpr non/mal hum with agrft |
$24,695.72 |
$1,838.72 |
$10,034.31 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$1,838.72 |
$27,262.32 |
| Open treatment of humerus at elbow |
24545 |
Optx hum fx wo ntrcndylr xtn |
$24,695.72 |
$1,838.72 |
$8,650.54 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$1,838.72 |
$27,262.32 |
| Open treatment of complex elbow fracture |
24546 |
Optx hum fx w/ntrcndylr xtn |
$24,695.72 |
$2,055.04 |
$8,650.54 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,262.32 |
| Total hip replacement |
27130 |
Total hip arthroplasty |
$24,695.72 |
$14,212.00 |
$20,245.18 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,374.45 |
| Partial knee replacement |
27446 |
Revision of knee joint |
$24,695.72 |
$14,212.00 |
$20,245.18 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,374.45 |
| Total knee replacement |
27447 |
Total knee arthroplasty |
$24,695.72 |
$14,212.00 |
$20,245.18 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,374.45 |
| Revision of one knee replacement part |
27486 |
Revise/replace knee joint |
$24,695.72 |
$2,323.36 |
$10,034.31 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,262.32 |
| Bunion correction with midfoot fusion (Lapidus) |
28297 |
Cor hlx vlgs jt arthrd |
$24,695.72 |
$1,514.24 |
$6,978.03 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$1,514.24 |
$27,262.32 |
| Subtalar (hindfoot) fusion |
28725 |
Arthrodesis subtalar |
$24,695.72 |
$1,838.72 |
$7,041.78 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$1,838.72 |
$27,262.32 |
| Fusion of midfoot joints (multiple) |
28730 |
Fusion of foot bones |
$24,695.72 |
$1,838.72 |
$7,041.78 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$1,838.72 |
$27,262.32 |
| Shoulder surgery with antibiotic spacer |
C9781 |
Arthro/shoul surg; w/spacer |
$24,695.72 |
$2,055.04 |
$13,298.57 |
$27,262.32 |
$26,975.35 |
$2,048.00 |
$2,048.00 |
$27,262.32 |
| Lumbar spinal fusion |
22612 |
Arthrd pst tq 1ntrspc lumbar |
$33,727.00 |
$2,323.36 |
$10,376.86 |
$37,232.21 |
$36,840.29 |
$2,048.00 |
$2,048.00 |
$37,232.21 |
| Cervical disc replacement |
22856 |
Tot disc arthrp 1ntrspc crv |
$33,727.00 |
$2,323.36 |
$10,376.86 |
$37,232.21 |
$36,840.29 |
$2,048.00 |
$2,048.00 |
$37,232.21 |
| Total shoulder replacement |
23472 |
Reconstruct shoulder joint |
$33,727.00 |
$2,055.04 |
$20,245.18 |
$37,232.21 |
$36,840.29 |
$2,048.00 |
$2,048.00 |
$37,232.21 |
| Sacroiliac joint fusion |
27279 |
Arthrd si jt plmt tartclr dv |
$33,727.00 |
$2,055.04 |
$9,522.12 |
$37,232.21 |
$36,840.29 |
$2,048.00 |
$2,048.00 |
$37,232.21 |
| Laminectomy for spine stimulator electrodes |
63655 |
Implant neuroelectrodes |
$37,316.88 |
$2,323.36 |
$10,376.86 |
$30,137.54 |
$40,761.56 |
$2,048.00 |
$2,048.00 |
$40,761.56 |
| Lumbar fusion, combined approach |
22633 |
Arthrd cmbn 1ntrspc lumbar |
$52,193.36 |
$2,323.36 |
$6,889.88 |
$42,151.94 |
$57,011.26 |
$2,048.00 |
$2,048.00 |
$57,011.26 |
| Insertion of spine stimulator generator |
63685 |
Ins/rplc spi npg/rcvr pocket |
$59,356.00 |
$2,705.00 |
$30,102.59 |
$65,524.83 |
$64,835.09 |
$2,048.00 |
$2,048.00 |
$65,524.83 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities |
216 |
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Spinal fusion except cervical without major comorbid conditions or complications (MCC) |
460 |
Spinal fusion except cervical without major comorbid conditions or complications (MCC) |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Major joint replacement or reattachment of lower extremity without MCC |
470 |
Major joint replacement or reattachment of lower extremity without MCC |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Cervical spinal fusion without CC or MCC |
473 |
Cervical spinal fusion without CC or MCC |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Uterine and adnexa procedures for non-malignancy without CC or MCC |
743 |
Uterine and adnexa procedures for non-malignancy without CC or MCC |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Removal of 1 or more breast growth, open procedure |
19120 |
Removal of 1 or more breast growth, open procedure |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Shaving of shoulder bone using an endoscope |
29826 |
Shaving of shoulder bone using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Removal of tonsils and adenoid glands, patient younger than age 12 |
42820 |
Removal of tonsils and adenoid glands, patient younger than age 12 |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope |
43235 |
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope |
43239 |
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Diagnostic examination of large bowel using an endoscope |
45378 |
Diagnostic examination of large bowel using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Biopsy of large bowel using an endoscope |
45380 |
Biopsy of large bowel using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Removal of polyps or growths of large bowel using an endoscope |
45385 |
Removal of polyps or growths of large bowel using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Ultrasound examination of lower large bowel using an endoscope |
45391 |
Ultrasound examination of lower large bowel using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Removal of gallbladder using an endoscope |
47562 |
Removal of gallbladder using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Repair of groin hernia, patient age 5 years or older |
49505 |
Repair of groin hernia, patient age 5 years or older |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Biopsy of prostate gland |
55700 |
Biopsy of prostate gland |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Surgical removal of prostate and surrounding lymph nodes using an endoscope |
55866 |
Surgical removal of prostate and surrounding lymph nodes using an endoscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Routine obstetric care for vaginal delivery, including pre- and post-delivery care |
59400 |
Routine obstetric care for vaginal delivery, including pre- and post-delivery care |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Routine obstetric care for cesarean delivery, including pre- and post-delivery care |
59510 |
Routine obstetric care for cesarean delivery, including pre- and post-delivery care |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre- and post-delivery care |
59610 |
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre- and post-delivery care |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance |
64483 |
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Removal of recurring cataract in lens capsule using laser |
66821 |
Removal of recurring cataract in lens capsule using laser |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Removal of cataract with insertion of lens |
66984 |
Removal of cataract with insertion of lens |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| CT scan, head or brain, without contrast |
70450 |
CT scan, head or brain, without contrast |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| MRI scan of brain before and after contrast |
70553 |
MRI scan of brain before and after contrast |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| X-ray, lower back, minimum four views |
72110 |
X-ray, lower back, minimum four views |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| MRI scan of lower spinal canal |
72148 |
MRI scan of lower spinal canal |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| CT scan, pelvis, with contrast |
72193 |
CT scan, pelvis, with contrast |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| MRI scan of leg joint |
73721 |
MRI scan of leg joint |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| CT scan of abdomen and pelvis with contrast |
74177 |
CT scan of abdomen and pelvis with contrast |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Ultrasound of abdomen |
76700 |
Ultrasound of abdomen |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Abdominal ultrasound of pregnant uterus (=14 weeks 0 days), single or first fetus |
76805 |
Abdominal ultrasound of pregnant uterus (=14 weeks 0 days), single or first fetus |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Ultrasound pelvis through vagina |
76830 |
Ultrasound pelvis through vagina |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Mammography of one breast |
77065 |
Mammography of one breast |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Mammography of both breasts |
77066 |
Mammography of both breasts |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Mammography, screening, bilateral |
77067 |
Mammography, screening, bilateral |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Obstetric blood test panel |
80055 |
Obstetric blood test panel |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Blood test, lipids (cholesterol and triglycerides) |
80061 |
Blood test, lipids (cholesterol and triglycerides) |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Kidney function panel test |
80069 |
Kidney function panel test |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Liver function blood test panel |
80076 |
Liver function blood test panel |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Blood test, thyroid stimulating hormone (TSH) |
84443 |
Blood test, thyroid stimulating hormone (TSH) |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Complete blood cell count, with differential white blood cells, automated |
85025 |
Complete blood cell count, with differential white blood cells, automated |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Blood test, clotting time |
85610 |
Blood test, clotting time |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Coagulation assessment blood test |
85730 |
Coagulation assessment blood test |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Psychotherapy, 30 min |
90832 |
Psychotherapy, 30 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Psychotherapy, 45 min |
90834 |
Psychotherapy, 45 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Psychotherapy, 60 min |
90837 |
Psychotherapy, 60 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Family psychotherapy, not including patient, 50 min |
90846 |
Family psychotherapy, not including patient, 50 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Family psychotherapy, including patient, 50 min |
90847 |
Family psychotherapy, including patient, 50 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Group psychotherapy |
90853 |
Group psychotherapy |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Electrocardiogram, routine, with interpretation and report |
93000 |
Electrocardiogram, routine, with interpretation and report |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Insertion of catheter into left heart for diagnosis |
93452 |
Insertion of catheter into left heart for diagnosis |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Sleep study |
95810 |
Sleep study |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Physical therapy, therapeutic exercise |
97110 |
Physical therapy, therapeutic exercise |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| New patient office or other outpatient visit, typically 30 min |
99203 |
New patient office or other outpatient visit, typically 30 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| New patient office or other outpatient visit, typically 45 min |
99204 |
New patient office or other outpatient visit, typically 45 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| New patient office or other outpatient visit, typically 60 min |
99205 |
New patient office or other outpatient visit, typically 60 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Patient office consultation, typically 40 min |
99243 |
Patient office consultation, typically 40 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Patient office consultation, typically 60 min |
99244 |
Patient office consultation, typically 60 min |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Initial new patient preventive medicine evaluation (18–39 years) |
99385 |
Initial new patient preventive medicine evaluation (18–39 years) |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Initial new patient preventive medicine evaluation (40–64 years) |
99386 |
Initial new patient preventive medicine evaluation (40–64 years) |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Injection of substance into spinal canal of lower back or sacrum using imaging guidance |
62322–62323 |
Injection of substance into spinal canal of lower back or sacrum using imaging guidance |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Manual urinalysis test with examination using microscope |
81000 or 81001 |
Manual urinalysis test with examination using microscope |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| Automated urinalysis test |
81002 or 81003 |
Automated urinalysis test |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
| PSA (prostate specific antigen) |
84153–84154 |
PSA (prostate specific antigen) |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
not offered |
