Procedure Code Description

Procedure Code

Contracted Rate

Effective Date

Impl absrb msh/prsth dly cls

15778

307.95

1/1/2023

Removal sutr/stapl xreq anes

15853

8.91

1/1/2023

Removal sutr/stapl xreq anes

15853

8.91

1/1/2023

Removal sutr&stapl xreq anes

15854

12.55

1/1/2023

Removal sutr&stapl xreq anes

15854

12.55

1/1/2023

Rpr nsl vlv collapse w/rmdlg

30469

1,994.20

1/1/2023

Tis Cgen Car Anomal 1St Shnt

33745

830.13

1/1/2021

Perq p-art revsc 1 nm nt uni

33900

462.60

1/1/2023

Perq p-art revsc 1 nm nt bi

33901

608.02

1/1/2023

Perq p-art revsc 1 abnor uni

33902

587.38

1/1/2023

Perq p-art revsc 1 abnor bi

33903

692.25

1/1/2023

Perq p-art revsc each addl

33904

232.31

1/1/2023

Prq av fstl crt uxtr sep acs

36837

7,894.74

1/1/2023

Rpr aa hrn 1st < 3 cm rdc

49591

273.58

1/1/2023

Rpr aa hrn 1st < 3 ncr/strn

49592

380.62

1/1/2023

Rpr aa hrn 1st 3-10 rdc

49593

458.47

1/1/2023

Rpr aa hrn 1st 3-10 ncr/strn

49594

597.07

1/1/2023

Rpr aa hrn 1st > 10 rdc

49595

616.83

1/1/2023

Rpr aa hrn 1st > 10 ncr/strn

49596

819.43

1/1/2023

Rpr aa hrn rcr < 3 rdc

49613

337.39

1/1/2023

Rpr aa hrn rcr < 3 ncr/strn

49614

457.40

1/1/2023

Rpr aa hrn rcr 3-10 rdc

49615

511.84

1/1/2023

Rpr aa hrn rcr 3-10 ncr/strn

49616

687.39

1/1/2023

Rpr aa hrn rcr > 10 rdc

49617

708.68

1/1/2023

Rpr aa hrn rcr > 10 ncr/strn

49618

992.84

1/1/2023

Rpr parastomal hernia rdc

49621

595.77

1/1/2023

Rpr parastomal hrna ncr/strn

49622

735.43

1/1/2023

Rmvl ninfct mesh hernia rpr

49623

158.61

1/1/2023

Ct Thorax Lung Cancer Scr C-

71271

40.38

1/1/2021

Ct Thorax Lung Cancer Scr C-

71271

114.58

1/1/2021

Us nrv&acc strux 1xtr compre

76883

58.65

1/1/2023

Metabolic Panel Ionized Ca

80047

26.73

1/1/2022

Metabolic Panel Total Ca

80048

9.88

1/1/2022

General Health Panel

80050

11.38

1/1/2022

Electrolyte Panel

80051

8.51

1/1/2022

Comprehen Metabolic Panel

80053

10.42

1/1/2022

Obstetric Panel

80055

27.81

1/1/2022

Lipid Panel

80061

16.53

1/1/2022

Renal Function Panel

80069

9.88

1/1/2022

Acute Hepatitis Panel

80074

57.47

1/1/2022

Hepatic Function Panel

80076

9.88

1/1/2022

Drug Assay Caffeine

80155

16.69

1/1/2022

Drug Assay Clozapine

80159

21.83

1/1/2022

Assay Of Digoxin Free

80163

16.88

1/1/2022

Dipropylacetic Acid Free

80165

17.04

1/1/2022

Drug Assay Everolimus

80169

16.20

1/1/2022

Drug Screen Quant Gabapentin

80171

15.65

1/1/2022

Drug Screen Quan Lamotrigine

80175

15.65

1/1/2022

Drug Scrn Quan Levetiracetam

80177

15.65

1/1/2022

Drug Scrn Quan Mycophenolate

80180

21.31

1/1/2022

Drug Scrn Quant Oxcarbazepin

80183

15.65

1/1/2022

Assay Of Phenobarbital

80184

14.13

1/1/2022

Assay Of Sirolimus

80195

16.92

1/1/2022

Drug Screen Quant Tiagabine

80199

21.31

1/1/2022

Drug Screen Quant Zonisamide

80203

15.65

1/1/2022

Quantitative Assay Drug

80299

16.89

1/1/2022

Urinalysis Nonauto W/Scope

81000

3.91

1/1/2022

Urinalysis Auto W/Scope

81001

3.91

1/1/2022

Urinalysis Nonauto W/O Scope

81002

3.15

1/1/2022

Urinalysis Auto W/O Scope

81003

2.77

1/1/2022

Urinalysis

81005

2.68

1/1/2022

Urine Screen For Bacteria

81007

3.17

1/1/2022

Microscopic Exam Of Urine

81015

3.74

1/1/2022

Urinalysis Glass Test

81020

4.55

1/1/2022

Urine Pregnancy Test

81025

7.80

1/1/2022

Urinalysis Volume Measure

81050

3.70

1/1/2022

Ur Albumin Quantitative

82043

7.14

1/1/2022

Ur Albumin Semiquantitative

82044

3.53

1/1/2022

Albumin Ischemia Modified

82045

41.87

1/1/2022

Assay Of Breath Ethanol

82075

14.86

1/1/2022

Alpha-Fetoprotein L3

82107

79.43

1/1/2022

Amines Vaginal Fluid Qual

82120

4.64

1/1/2022

Assay Of Amylase

82150

7.99

1/1/2022

Bile Acids Total

82239

20.09

1/1/2022

Bilirubin Total

82247

6.20

1/1/2022

Bilirubin Direct

82248

6.20

1/1/2022

Occult Blood Feces

82270

4.01

1/1/2022

Occult Blood Other Sources

82271

4.01

1/1/2022

Occult Bld Feces 1-3 Tests

82272

4.01

1/1/2022

Assay Test For Blood Fecal

82274

19.61

1/1/2022

Vitamin D 25 Hydroxy

82306

36.51

1/1/2022

Assay Of Calcium

82310

6.35

1/1/2022

Assay Of Calcium In Urine

82340

6.42

1/1/2022

Calculus Spectroscopy

82365

15.90

1/1/2022

Assay Blood Carbon Dioxide

82374

6.03

1/1/2022

Assay Of Ceruloplasmin

82390

13.25

1/1/2022

Assay Bld/Serum Cholesterol

82465

5.36

1/1/2022

Assay Of Copper

82525

15.31

1/1/2022

Total Cortisol

82533

20.11

1/1/2022

Col Chromotography Qual/Quan

82542

22.27

1/1/2022

Assay Of Ck (Cpk)

82550

8.03

1/1/2022

Assay Of Cpk In Blood

82552

16.52

1/1/2022

Creatine Mb Fraction

82553

14.24

1/1/2022

Assay Of Creatinine

82565

6.32

1/1/2022

Assay Of Urine Creatinine

82570

6.38

1/1/2022

Vitamin B-12

82607

18.59

1/1/2022

Cystatin C

82610

16.77

1/1/2022

Pancreatic Elastase Fecal

82656

14.13

1/1/2022

Electrophoretic Test

82664

42.37

1/1/2022

Assay Of Estradiol

82670

29.37

1/1/2022

Assay Of Estrone

82679

30.79

1/1/2022

Fats/Lipids Feces Qual

82705

6.28

1/1/2022

Long Chain Fatty Acids

82726

22.27

1/1/2022

Assay Of Ferritin

82728

16.80

1/1/2022

Assay Of Fetal Fibronectin

82731

79.43

1/1/2022

Assay Of Folic Acid Serum

82746

18.13

1/1/2022

Assay Iga/Igd/Igg/Igm Each

82784

11.47

1/1/2022

Blood Gases W/O2 Saturation

82805

35.00

1/1/2022

Glucose Other Fluid

82945

4.84

1/1/2022

Assay Glucose Blood Quant

82947

4.84

1/1/2022

Reagent Strip/Blood Glucose

82948

3.91

1/1/2022

Glucose Test

82950

5.86

1/1/2022

Glucose Tolerance Test (Gtt)

82951

15.88

1/1/2022

Gtt-Added Samples

82952

4.84

1/1/2022

Glucose Blood Test

82962

2.89

1/1/2022

Assay Of Ggt

82977

8.88

1/1/2022

Assay Of Gonadotropin (Fsh)

83001

22.92

1/1/2022

Assay Of Gonadotropin (Lh)

83002

22.84

1/1/2022

H Pylori (C-13) Blood

83009

83.07

1/1/2022

H Pylori (C-13) Breath

83013

83.07

1/1/2022

H Pylori Drug Admin

83014

9.69

1/1/2022

Hemoglobin Electrophoresis

83020

15.02

1/1/2022

Hemoglobin Electrophoresis

83020

15.50

1/1/2022

Glycosylated Hemoglobin Test

83036

11.97

1/1/2022

Blood Methemoglobin Assay

83050

9.03

1/1/2022

Assay Of Insulin

83525

14.10

1/1/2022

Assay Of Iron

83540

7.99

1/1/2022

Iron Binding Test

83550

10.78

1/1/2022

Lactoferrin Fecal (Qual)

83630

25.30

1/1/2022

Assay Of Lead

83655

14.93

1/1/2022

Assay Of Lead

83655

15.01

1/1/2022

Assay Of Lipase

83690

8.49

1/1/2022

Assay Of Lipoprotein(A)

83695

15.97

1/1/2022

Lipopro Bld Electrophoretic

83700

13.88

1/1/2022

Lipoprotein Bld Hr Fraction

83701

30.61

1/1/2022

Lipoprotein Bld Quan Part

83704

33.64

1/1/2022

Assay Of Lipoprotein

83718

10.10

1/1/2022

Assay Of Blood Lipoprotein

83721

11.77

1/1/2022

Assay Of Magnesium

83735

8.26

1/1/2022

Mass Spectrometry Qual/Quan

83789

22.27

1/1/2022

Assay Of Myoglobin

83874

15.93

1/1/2022

Assay Myeloperoxidase

83876

16.69

1/1/2022

Assay Of Natriuretic Peptide

83880

41.87

1/1/2022

Oncoprotein Dcp

83951

83.01

1/1/2022

Assay Of Parathormone

83970

50.91

1/1/2022

Assay Ph Body Fluid Nos

83986

4.41

1/1/2022

Assay For Calprotectin Fecal

83993

24.20

1/1/2022

Assay Alkaline Phosphatase

84075

6.38

1/1/2022

Assay Of Phosphorus

84100

5.85

1/1/2022

Assay Of Serum Potassium

84132

5.66

1/1/2022

Assay Of Progesterone

84144

25.73

1/1/2022

Procalcitonin (Pct)

84145

24.50

1/1/2022

Assay Of Prolactin

84146

23.90

1/1/2022

Assay Of Psa Total

84153

22.69

1/1/2022

Assay Of Protein Serum

84155

4.52

1/1/2022

Assay Of Protein Urine

84156

4.52

1/1/2022

Pappa Serum

84163

10.79

1/1/2022

Protein E-Phoresis Serum

84165

14.74

1/1/2022

Protein E-Phoresis Serum

84165

13.19

1/1/2022

Protein E-Phoresis/Urine/Csf

84166

14.74

1/1/2022

Protein E-Phoresis/Urine/Csf

84166

22.00

1/1/2022

Western Blot Test

84181

14.74

1/1/2022

Western Blot Test

84181

14.50

1/1/2022

Protein Western Blot Test

84182

15.21

1/1/2022

Protein Western Blot Test

84182

14.50

1/1/2022

Assay Of Sex Hormone Globul

84270

26.80

1/1/2022

Assay Of Serum Sodium

84295

5.94

1/1/2022

Assay Of Urine Sodium

84300

5.99

1/1/2022

Assay Of Sweat Sodium

84302

5.99

1/1/2022

Spectrophotometry

84311

8.62

1/1/2022

Body Fluid Specific Gravity

84315

3.09

1/1/2022

Assay Of Free Testosterone

84402

31.40

1/1/2022

Assay Of Total Testosterone

84403

31.85

1/1/2022

Testosterone Bioavailable

84410

31.85

1/1/2022

Assay Of Total Thyroxine

84436

7.11

1/1/2022

Assay Of Free Thyroxine

84439

11.13

1/1/2022

Assay Thyroid Stim Hormone

84443

20.10

1/1/2022

Transferase (Ast) (Sgot)

84450

6.37

1/1/2022

Alanine Amino (Alt) (Sgpt)

84460

6.53

1/1/2022

Assay Of Transferrin

84466

15.74

1/1/2022

Assay Of Triglycerides

84478

7.10

1/1/2022

Assay Of Thyroid (T3 Or T4)

84479

7.35

1/1/2022

Assay Triiodothyronine (T3)

84480

17.49

1/1/2022

Free Assay (Ft-3)

84481

20.89

1/1/2022

Assay Of Urea Nitrogen

84520

4.86

1/1/2022

Assay Of Blood/Uric Acid

84550

5.57

1/1/2022

Assay Of Urine/Uric Acid

84560

5.86

1/1/2022

Assay Of Zinc

84630

14.05

1/1/2022

Assay Of C-Peptide

84681

19.59

1/1/2022

Chorionic Gonadotropin Test

84702

10.79

1/1/2022

Chorionic Gonadotropin Assay

84703

9.26

1/1/2022

Hcg Free Betachain Test

84704

10.79

1/1/2022

Automated Diff Wbc Count

85004

7.98

1/1/2022

Bl Smear W/Diff Wbc Count

85007

4.25

1/1/2022

Spun Microhematocrit

85013

2.92

1/1/2022

Hematocrit

85014

2.92

1/1/2022

Hemoglobin

85018

2.92

1/1/2022

Complete Cbc W/Auto Diff Wbc

85025

9.58

1/1/2022

Complete Cbc Automated

85027

7.98

1/1/2022

Manual Cell Count Each

85032

5.31

1/1/2022

Manual Reticulocyte Count

85044

5.31

1/1/2022

Automated Leukocyte Count

85048

3.13

1/1/2022

Automated Platelet Count

85049

5.52

1/1/2022

Reticulated Platelet Assay

85055

33.02

1/1/2022

Antithrombin Iii Activity

85300

14.61

1/1/2022

Fibrin Degradation Quant

85379

11.36

1/1/2022

Fibrin Degradj D-Dimer

85380

11.36

1/1/2022

Fibrinolysins Screen I&R

85390

15.02

1/1/2022

Fibrinolysins Screen I&R

85390

6.37

1/1/2022

Clotting Funct Activity

85397

29.58

1/1/2022

Blood Platelet Aggregation

85576

15.02

1/1/2022

Blood Platelet Aggregation

85576

26.49

1/1/2022

Prothrombin Time

85610

4.85

1/1/2022

Rbc Sed Rate Nonautomated

85651

4.37

1/1/2022

Rbc Sed Rate Automated

85652

3.33

1/1/2022

Thromboplastin Time Partial

85730

7.40

1/1/2022

Agglutinins Febrile Antigen

86000

8.60

1/1/2022

Allg Spec Ige Crude Xtrc Ea

86003

6.44

1/1/2022

Antinuclear Antibodies

86038

14.91

1/1/2022

Antistreptolysin O Screen

86063

7.12

1/1/2022

C-Reactive Protein

86140

6.38

1/1/2022

C-Reactive Protein Hs

86141

15.97

1/1/2022

Complement Total (Ch50)

86162

25.06

1/1/2022

Complement Fixation Each

86171

12.36

1/1/2022

Ccp Antibody

86200

15.97

1/1/2022

Dna Antibody Native

86225

16.95

1/1/2022

Nuclear Antigen Antibody

86235

22.12

1/1/2022

Fluorescent Antibody Screen

86255

15.02

1/1/2022

Fluorescent Antibody Screen

86255

14.86

1/1/2022

Fluorescent Antibody Titer

86256

15.02

1/1/2022

Fluorescent Antibody Titer

86256

14.86

1/1/2022

Hemagglutination Inhibition

86280

10.10

1/1/2022

Heterophile Antibody Screen

86308

6.38

1/1/2022

Heterophile Antibody Titer

86309

7.98

1/1/2022

Heterophile Antibody Absrbj

86310

9.09

1/1/2022

Immunoassay Tumor Other

86316

25.66

1/1/2022

Immunoassay Infectious Agent

86317

17.90

1/1/2022

Immunoassay Infectious Agent

86318

15.97

1/1/2022

Serum Immunoelectrophoresis

86320

15.02

1/1/2022

Serum Immunoelectrophoresis

86320

27.65

1/1/2022

Other Immunoelectrophoresis

86325

14.74

1/1/2022

Other Immunoelectrophoresis

86325

27.58

1/1/2022

Immunoelectrophoresis Assay

86327

17.29

1/1/2022

Immunoelectrophoresis Assay

86327

27.98

1/1/2022

Immunodiffusion Nes

86329

17.31

1/1/2022

Immunofix E-Phoresis Serum

86334

15.02

1/1/2022

Immunofix E-Phoresis Serum

86334

27.55

1/1/2022

Immunfix E-Phorsis/Urine/Csf

86335

14.74

1/1/2022

Immunfix E-Phorsis/Urine/Csf

86335

36.19

1/1/2022

Islet Cell Antibody

86341

16.57

1/1/2022

B Cells Total Count

86355

46.52

1/1/2022

Mononuclear Cell Antigen

86356

33.02

1/1/2022

Nk Cells Total Count

86357

46.52

1/1/2022

Stem Cells Total Count

86367

46.52

1/1/2022

Microsomal Antibody Each

86376

17.09

1/1/2022

Particle Agglut Antbdy Scrn

86403

12.57

1/1/2022

Rheumatoid Factor Test Qual

86430

7.00

1/1/2022

Rheumatoid Factor Quant

86431

7.00

1/1/2022

Tb Test Cell Immun Measure

86480

76.44

1/1/2022

Skin Test Nos Antigen

86486

3.74

1/1/2022

Tb Intradermal Test

86580

5.42

1/1/2022

Syphilis Test Non-Trep Qual

86592

5.26

1/1/2022

Epstein-Barr Antibody

86663

16.18

1/1/2022

Epstein-Barr Nuclear Antigen

86664

17.90

1/1/2022

Helicobacter Pylori Antibody

86677

17.90

1/1/2022

Hiv-1Antibody

86701

10.95

1/1/2022

Hiv-1/Hiv-2 1 Result Antbdy

86703

14.50

1/1/2022

Hep B Surface Antibody

86706

13.25

1/1/2022

Hepatitis A Antibody

86708

15.28

1/1/2022

John Cunningham Antibody

86711

17.43

1/1/2022

Respiratory Virus Antibody

86756

15.90

1/1/2022

Treponema Pallidum

86780

16.74

1/1/2022

West Nile Virus Ab Igm

86788

17.90

1/1/2022

West Nile Virus Antibody

86789

17.72

1/1/2022

Thyroglobulin Antibody

86800

19.61

1/1/2022

Hepatitis C Ab Test

86803

17.61

1/1/2022

Hla Class I&Ii Antibody Qual

86828

48.02

1/1/2022

Hla Class I/Ii Antibody Qual

86829

36.02

1/1/2022

Hla Class I Phenotype Qual

86830

97.25

1/1/2022

Hla Class Ii Phenotype Qual

86831

83.36

1/1/2022

Hla Class I High Defin Qual

86832

152.83

1/1/2022

Hla Class Ii High Defin Qual

86833

138.93

1/1/2022

Hla Class I Semiquant Panel

86834

430.71

1/1/2022

Hla Class Ii Semiquant Panel

86835

389.03

1/1/2022

Culture Othr Specimn Aerobic

87070

10.62

1/1/2022

Culture Aerobic Identify

87077

9.96

1/1/2022

Culture Screen Only

87081

7.11

1/1/2022

Urine Culture/Colony Count

87086

9.95

1/1/2022

Skin Fungi Culture

87101

9.51

1/1/2022

Mycoplasma

87109

18.98

1/1/2022

Chlamydia Culture

87110

24.16

1/1/2022

Culture Type Immunofluoresc

87140

6.88

1/1/2022

Dark Field Examination

87164

14.74

1/1/2022

Dark Field Examination

87164

7.81

1/1/2022

Ova And Parasites Smears

87177

10.97

1/1/2022

Microbe Susceptible Disk

87184

8.50

1/1/2022

Smear Gram Stain

87205

5.26

1/1/2022

Smear Fluorescent/Acid Stai

87206

6.63

1/1/2022

Smear Complex Stain

87209

22.16

1/1/2022

Smear Wet Mount Saline/Ink

87210

4.70

1/1/2022

Tissue Exam For Fungi

87220

5.26

1/1/2022

Genet Virus Isolate Hsv

87255

30.14

1/1/2022

Enterovirus Antibody Dfa

87267

14.13

1/1/2022

Influenza B Ag If

87275

14.13

1/1/2022

Influenza A Ag If

87276

14.13

1/1/2022

Aspergillus Ag Ia

87305

14.13

1/1/2022

Giardia Ag Ia

87329

14.13

1/1/2022

Hepatitis B Surface Ag Ia

87340

11.48

1/1/2022

Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab

87389

29.61

1/1/2022

Influenza A/B Ag Ia

87400

14.13

1/1/2022

Resp Syncytial Ag Ia

87420

14.13

1/1/2022

Strep A Ag Ia

87430

14.13

1/1/2022

Ag Detect Nos Ia Mult

87449

14.13

1/1/2022

Candida Dna Dir Probe

87480

24.74

1/1/2022

Cns Dna Amp Probe Type 12-25

87483

243.45

1/1/2022

Chylmd Trach Dna Dir Probe

87490

24.74

1/1/2022

Chylmd Trach Dna Amp Probe

87491

30.24

1/1/2022

Enterovirus Probe&Revrs Trns

87498

30.24

1/1/2022

Vanomycin Dna Amp Probe

87500

30.24

1/1/2022

Influenza Dna Amp Probe

87502

66.04

1/1/2022

Nfct Agent Detection Gi

87505

89.56

1/1/2022

Iadna-Dna/Rna Probe Tq 6-11

87506

135.68

1/1/2022

Iadna-Dna/Rna Probe Tq 12-25

87507

250.98

1/1/2022

Gardner Vag Dna Dir Probe

87510

24.74

1/1/2022

N.Gonorrhoeae Dna Dir Prob

87590

24.74

1/1/2022

N.Gonorrhoeae Dna Amp Prob

87591

30.24

1/1/2022

Hpv Low-Risk Types

87623

31.18

1/1/2022

Hpv High-Risk Types

87624

31.18

1/1/2022

Hpv Types 16 & 18 Only

87625

31.18

1/1/2022

Resp Virus 3-5 Targets

87631

86.87

1/1/2022

Resp Virus 6-11 Targets

87632

131.61

1/1/2022

Resp Virus 12-25 Targets

87633

243.45

1/1/2022

Staph A Dna Amp Probe

87640

30.24

1/1/2022

Mr-Staph Dna Amp Probe

87641

30.24

1/1/2022

Strep A Dna Dir Probe

87650

24.74

1/1/2022

Strep A Dna Amp Probe

87651

30.24

1/1/2022

Strep A Dna Quant

87652

40.17

1/1/2022

Strep B Dna Amp Probe

87653

30.24

1/1/2022

Trichomonas Vagin Dir Probe

87660

24.74

1/1/2022

Trichomonas Vaginalis Amplif

87661

28.94

1/1/2022

Detect Agnt Mult Dna Direc

87800

49.46

1/1/2022

Strep B Assay W/Optic

87802

14.13

1/1/2022

Influenza Assay W/Optic

87804

14.13

1/1/2022

Hiv Antigen W/Hiv Antibodies

87806

30.53

1/1/2022

Rsv Assay W/Optic

87807

14.13

1/1/2022

Trichomonas Assay W/Optic

87808

14.13

1/1/2022

Adenovirus Assay W/Optic

87809

14.13

1/1/2022

Strep A Assay W/Optic

87880

14.13

1/1/2022

Phenotype Infect Agent Drug

87900

100.45

1/1/2022

Sialidase Enzyme Assay

87905

16.42

1/1/2022

Genotype Cytomegalovirus

87910

94.69

1/1/2022

Genotype Dna Hepatitis B

87912

94.69

1/1/2022

Bilirubin Total Transcut

88720

6.23

1/1/2022

Hgb Quant Transcutaneous

88738

6.34

1/1/2022

Transcutaneous Carboxyhb

88740

6.47

1/1/2022

Transcutaneous Methb

88741

6.47

1/1/2022

Body Fluid Cell Count

89050

5.84

1/1/2022

Body Fluid Cell Count

89051

6.42

1/1/2022

Leukocyte Assessment Fecal

89055

5.26

1/1/2022

Exam Synovial Fluid Crystals

89060

8.82

1/1/2022

Specimen Fat Stain

89125

5.33

1/1/2022

Nasal Smear For Eosinophils

89190

5.74

1/1/2022

Cmv Ig Iv

90291

22.70

1/1/2022

Hep B Ig Im

90371

114.50

1/1/2022

Rabies Ig Im/Sc

90375

64.74

1/1/2022

Rabies Ig Heat Treated

90376

74.52

1/1/2022

Tetanus Ig Im

90389

133.57

1/1/2022

Varicella-Zoster Ig Im

90396

105.38

1/1/2022

Immunization Admin

90471

20.45

1/1/2022

Immunization Admin

90471

13.30

1/1/2022

Immunization Admin Each Add

90472

20.45

1/1/2022

Immunization Admin Each Add

90472

13.30

1/1/2022

Immune Admin Oral/Nasal

90473

20.45

1/1/2022

Immune Admin Oral/Nasal

90473

13.30

1/1/2022

Immune Admin Oral/Nasal Addl

90474

20.45

1/1/2022

Immune Admin Oral/Nasal Addl

90474

13.30

1/1/2022

ADMN SARSCOV2 VACC 1 DOSE

90480

65.00

10/1/2023

2Vhpv Vaccine 3 Dose Im

90650

131.92

1/1/2022

Iiv3 Vacc No Prsv 0.25 Ml Im

90655

15.37

1/1/2022

Iiv3 Vacc No Splt 0.25 Ml Im

90657

6.31

1/1/2022

Esrd Home Pt Serv P Mo <2Yrs

90963

442.10

1/1/2022

Esrd Home Pt Serv P Mo 2-11

90964

368.92

1/1/2022

Esrd Home Pt Serv P Mo 12-19

90965

350.91

1/1/2022

Esrd Home Pt Serv P Mo 20+

90966

182.72

1/1/2022

Esrd Svc Pr Day Pt <2

90967

15.81

1/1/2022

Esrd Svc Pr Day Pt 2-11

90968

12.34

1/1/2022

Esrd Svc Pr Day Pt 12-19

90969

12.04

1/1/2022

Esrd Svc Pr Day Pt 20+

90970

6.38

1/1/2022

Ext Ecg>48Hr<7D Recording

93242

11.61

1/1/2021

Njx cth slct p-art angrp uni

93569

30.56

1/1/2023

Njx cath slct p-art angrp bi

93573

50.93

1/1/2023

Njx cath slct pulm vn angrph

93574

56.23

1/1/2023

Njx cath slct p angrph mapca

93575

75.20

1/1/2023

Breathing Capacity Test

94010

6.73

1/1/2022

Breathing Capacity Test

94010

25.58

1/1/2022

Breathing Capacity Test

94010

18.85

1/1/2022

Evaluation Of Wheezing

94060

11.80

1/1/2022

Evaluation Of Wheezing

94060

44.85

1/1/2022

Evaluation Of Wheezing

94060

33.04

1/1/2022

Vital Capacity Test

94150

3.15

1/1/2022

Vital Capacity Test

94150

17.32

1/1/2022

Vital Capacity Test

94150

14.17

1/1/2022

Lung Function Test (Mbc/Mvv)

94200

4.37

1/1/2022

Lung Function Test (Mbc/Mvv)

94200

17.32

1/1/2022

Lung Function Test (Mbc/Mvv)

94200

12.98

1/1/2022

Hypoxia Response Curve

94450

15.28

1/1/2022

Hypoxia Response Curve

94450

39.44

1/1/2022

Hypoxia Response Curve

94450

24.16

1/1/2022

Surfactant Admin Thru Tube

94610

50.42

1/1/2022

Cardiopulm Exercise Testing

94621

57.24

1/1/2022

Cardiopulm Exercise Testing

94621

126.59

1/1/2022

Cardiopulm Exercise Testing

94621

69.34

1/1/2022

Airway Inhalation Treatment

94640

10.18

1/1/2022

Aerosol Inhalation Treatment

94642

8.92

1/1/2022

Cbt 1St Hour

94644

26.12

1/1/2022

Cbt Each Addl Hour

94645

10.18

1/1/2022

Exhaled Air Analysis O2

94680

10.01

1/1/2022

Exhaled Air Analysis O2

94680

44.46

1/1/2022

Exhaled Air Analysis O2

94680

34.44

1/1/2022

Exhaled Air Analysis O2/Co2

94681

7.63

1/1/2022

Exhaled Air Analysis O2/Co2

94681

47.99

1/1/2022

Exhaled Air Analysis O2/Co2

94681

40.35

1/1/2022

Exhaled Air Analysis

94690

2.87

1/1/2022

Exhaled Air Analysis

94690

38.61

1/1/2022

Exhaled Air Analysis

94690

35.74

1/1/2022

Pulm Funct Tst Plethysmograp

94726

7.06

1/1/2022

Pulm Funct Tst Plethysmograp

94726

30.24

1/1/2022

Pulm Funct Tst Plethysmograp

94726

23.18

1/1/2022

Pulm Function Test By Gas

94727

7.06

1/1/2022

Pulm Function Test By Gas

94727

23.80

1/1/2022

Pulm Function Test By Gas

94727

16.74

1/1/2022

Pulm Funct Test Oscillometry

94728

7.06

1/1/2022

Pulm Funct Test Oscillometry

94728

23.80

1/1/2022

Pulm Funct Test Oscillometry

94728

16.74

1/1/2022

Co/Membane Diffuse Capacity

94729

4.68

1/1/2022

Co/Membane Diffuse Capacity

94729

30.01

1/1/2022

Co/Membane Diffuse Capacity

94729

25.33

1/1/2022

Measure Blood Oxygen Level

94760

2.07

1/1/2022

Measure Blood Oxygen Level

94761

3.95

1/1/2022

Allergy Patch Tests

95044

4.67

1/1/2022

Cont Gluc Mntr Pt Prov Eqp

95249

44.80

1/1/2022

Cont Gluc Mntr Phys/Qhp Eqp

95250

122.63

1/1/2022

Cholinesterase Challenge

95857

8.16

1/1/2022

Cholinesterase Challenge

95857

32.64

1/1/2022

Hlth Bhv Ivntj Indiv Ea Addl

96159

19.86

1/1/2022

Pt-Focused Hlth Risk Assmt

96160

3.74

1/1/2022

Pt-Focused Hlth Risk Assmt

96160

3.74

1/1/2022

Caregiver Health Risk Assmt

96161

3.74

1/1/2022

Caregiver Health Risk Assmt

96161

3.74

1/1/2022

Rem Ther Mntr 1St Setup&Edu

98975

15.40

1/1/2022

Rem Ther Mntr Dv Sply Mscskl

98977

44.43

1/1/2022

Rem Ther Mntr Ea Addl 20 Min

98981

33.73

1/1/2022

Med Serv Eve/Wkend/Holiday

99051

26.48

1/1/2022

Med Serv 10Pm-8Am 24 Hr Fac

99053

26.48

1/1/2022

Special Supplies Phys/Qhp

99070

9.42

1/1/2022

Special Pump Services

99190

89.74

1/1/2022

Special Pump Services

99191

57.63

1/1/2022

Special Pump Services

99192

41.73

1/1/2022

Office/Outpatient Visit New

99202

55.81

1/1/2022

Office/Outpatient Visit New

99203

80.86

1/1/2022

Office/Outpatient Visit New

99204

125.39

1/1/2022

Office/Outpatient Visit New

99205

158.51

1/1/2022

Office/Outpatient Visit Est

99211

16.32

1/1/2022

Office/Outpatient Visit Est

99212

32.50

1/1/2022

Office/Outpatient Visit Est

99213

54.26

1/1/2022

Office/Outpatient Visit Est

99214

81.76

1/1/2022

Office/Outpatient Visit Est

99215

110.58

1/1/2022

Office Consultation

99241

38.78

1/1/2022

Office Consultation

99242

72.65

1/1/2022

Office Consultation

99243

99.91

1/1/2022

Office Consultation

99244

148.40

1/1/2022

Office Consultation

99245

182.39

1/1/2022

Inpatient Consultation

99251

39.60

1/1/2022

Inpatient Consultation

99252

61.35

1/1/2022

Inpatient Consultation

99253

93.14

1/1/2022

Inpatient Consultation

99254

134.72

1/1/2022

Inpatient Consultation

99255

164.15

1/1/2022

Emergency Dept Visit

99281

16.52

1/1/2022

Emergency Dept Visit

99282

32.14

1/1/2022

Emergency Dept Visit

99283

49.81

1/1/2022

Emergency Dept Visit

99284

93.26

1/1/2022

Emergency Dept Visit

99285

138.64

1/1/2022

Direct Advanced Life Support

99288

43.29

1/1/2022

Critical Care First Hour

99291

225.61

1/1/2022

Critical Care Addl 30 Min

99292

102.31

1/1/2022

Nursing Facility Care Init

99304

71.78

1/1/2022

Nursing Facility Care Init

99305

100.36

1/1/2022

Nursing Facility Care Init

99306

128.96

1/1/2022

Nursing Fac Care Subseq

99307

35.42

1/1/2022

Nursing Fac Care Subseq

99308

54.16

1/1/2022

Nursing Fac Care Subseq

99309

71.84

1/1/2022

Nursing Fac Care Subseq

99310

106.22

1/1/2022

Nursing Fac Discharge Day

99315

51.83

1/1/2022

Nursing Fac Discharge Day

99316

67.72

1/1/2022

Annual Nursing Fac Assessmnt

99318

75.10

1/1/2022

Home Visit New Patient

99341

48.15

1/1/2022

Home Visit New Patient

99342

70.13

1/1/2022

Home Visit New Patient

99343

112.94

1/1/2022

Home Visit New Patient

99344

148.27

1/1/2022

Home Visit New Patient

99345

178.34

1/1/2022

Home Visit Est Patient

99347

46.99

1/1/2022

Home Visit Est Patient

99348

70.95

1/1/2022

Home Visit Est Patient

99349

103.31

1/1/2022

Home Visit Est Patient

99350

144.04

1/1/2022

Prolong E&M/Psyctx Serv O/P

99354

82.03

1/1/2022

Prolong E&M/Psyctx Serv O/P

99355

81.21

1/1/2022

Init Pm E/M New Pat Infant

99381

79.65

1/1/2022

Init Pm E/M New Pat Infant

99381

77.92

1/1/2022

Init Pm E/M New Pat 1-4 Yrs

99382

86.83

1/1/2022

Init Pm E/M New Pat 1-4 Yrs

99382

77.92

1/1/2022

Prev Visit New Age 5-11

99383

86.22

1/1/2022

Prev Visit New Age 5-11

99383

77.92

1/1/2022

Prev Visit New Age 12-17

99384

93.93

1/1/2022

Prev Visit New Age 12-17

99384

77.92

1/1/2022

Prev Visit New Age 18-39

99385

93.93

1/1/2022

Prev Visit New Age 18-39

99385

77.92

1/1/2022

Prev Visit New Age 40-64

99386

110.08

1/1/2022

Init Pm E/M New Pat 65+ Yrs

99387

120.67

1/1/2022

Per Pm Reeval Est Pat Infant

99391

66.41

1/1/2022

Per Pm Reeval Est Pat Infant

99391

77.92

1/1/2022

Prev Visit Est Age 1-4

99392

74.12

1/1/2022

Prev Visit Est Age 1-4

99392

77.92

1/1/2022

Prev Visit Est Age 5-11

99393

73.81

1/1/2022

Prev Visit Est Age 5-11

99393

77.92

1/1/2022

Prev Visit Est Age 12-17

99394

81.30

1/1/2022

Prev Visit Est Age 12-17

99394

77.92

1/1/2022

Prev Visit Est Age 18-39

99395

81.61

1/1/2022

Prev Visit Est Age 18-39

99395

77.92

1/1/2022

Prev Visit Est Age 40-64

99396

89.32

1/1/2022

Per Pm Reeval Est Pat 65+ Yr

99397

100.21

1/1/2022

Behav Chng Smoking 3-10 Min

99406

11.57

1/1/2022

Behav Chng Smoking 3-10 Min

99406

11.57

1/1/2022

Behav Chng Smoking > 10 Min

99407

22.36

1/1/2022

Behav Chng Smoking > 10 Min

99407

22.36

1/1/2022

Prolng Off/Op E/M Ea 15 Min

99417

82.03

1/1/2021

Prolng ip/obs e/m ea 15 min

99418

32.04

1/1/2023

Immunization Administration By Intramusc

0001A

65.00

4/1/2021

Immunization Administration By Intramusc

0001A

65.00

4/1/2021

Immunization Administration By Intramusc

0002A

65.00

4/1/2021

Immunization Administration By Intramusc

0002A

65.00

4/1/2021

Pfizer-Biontech Covid-19 Vaccine Adminis

0003A

65.00

8/12/2021

Pfizer-Biontech Covid-19 Vaccine Adminis

0003A

65.00

8/12/2021

Pfizer-Biontech Covid-19 Vaccine Adminis

0004A

65.00

9/22/2021

Pfizer-Biontech Covid-19 Vaccine Adminis

0004A

65.00

9/22/2021

Immunization Administration By Intramusc

0011A

65.00

4/1/2021

Immunization Administration By Intramusc

0011A

65.00

4/1/2021

Immunization Administration By Intramusc

0012A

65.00

4/1/2021

Immunization Administration By Intramusc

0012A

65.00

4/1/2021

Moderna Covid-19 Vaccine Administration

0013A

65.00

8/12/2021

Moderna Covid-19 Vaccine Administration

0013A

65.00

8/12/2021

Immunization Administration By Intramusc

0031A

65.00

4/1/2021

Immunization Administration By Intramusc

0031A

65.00

4/1/2021

Fee Covid-19 Vac 4 Res

0034A

65.00

10/20/2021

Fee Covid-19 Vac 4 Res

0034A

65.00

10/20/2021

ADM SARSCOV2 5MCG/0.5ML BST

0044A

65.00

10/19/2022

Adm Sarscv2 30Mcg Trs-Sucr 1

0051A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr 1

0051A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr 2

0052A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr 2

0052A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr 3

0053A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr 3

0053A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr B

0054A

65.00

1/3/2022

Adm Sarscv2 30Mcg Trs-Sucr B

0054A

65.00

1/3/2022

Fee Covid-19 Vac 7 Res

0064A

65.00

10/20/2021

Fee Covid-19 Vac 7 Res

0064A

65.00

10/20/2021

Adm Sarscv2 10Mcg Trs-Sucr 1

0071A

65.00

10/29/2021

Adm Sarscv2 10Mcg Trs-Sucr 1

0071A

65.00

10/29/2021

Adm Sarscv2 10Mcg Trs-Sucr 2

0072A

65.00

10/29/2021

Adm Sarscv2 10Mcg Trs-Sucr 2

0072A

65.00

10/29/2021

Fee Covid-19 Vac 8 Booster

0073A

65.00

1/3/2022

Fee Covid-19 Vac 8 Booster

0073A

65.00

1/3/2022

Immun Admin By Intramusc Inject (Sars-

0081A

65.00

2/15/2022

Immun Admin By Intramusc Inject (Sars-

0081A

65.00

2/15/2022

Immun Admin By Intra Inj Sars-Cov-2

0082A

65.00

2/15/2022

Immun Admin By Intra Inj Sars-Cov-2

0082A

65.00

2/15/2022

Immunization Administration By Intramusc

0111A

65.00

6/17/2022

DIAB MANAGE TRN PER INDIV

G0108

17.82

1/1/2018