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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes 87850 thru 94772)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Proc Type Proc Code Procedure Description Unit Value Basic Rate Child Rate ER Rate Conv Ind ER Ind Cut-back Ind Prof % Rental Rate Non-Physn. Med.Prac. Ind
M 87850 INFECT AGT DET BY IMMUNA WITH DIR OPTICA 10.10 $10.10 --- -- 009 0 0 0.20 $0.00 N
M 87880 INFECT AGT DET BY IMMUNO WITH DIR OPTICA 6.99 $6.99 --- -- 009 0 0 0.20 $0.00 N
M 87899 INFECT AGT DET BY IMMUNO WITH DIR OPTICA 4.87 $4.87 --- -- 009 0 0 0.20 $0.00 N
M 87900 PHENOTYPE INFECT AGENT DRUG 128.73 $128.73 --- -- 009 0 0 0.20 $0.00 Y
M 87901 GENOTYPE DNA HIV REVERSE T 254.26 $254.26 --- -- 009 0 0 0.20 $0.00 N
M 87902 GENOTYPE DNA/RNA HEP C 232.21 $232.21 --- -- 009 0 0 0.20 $0.00 N
M 87903 PHENOTYPE DNA HIV W/CULTURE 482.62 $482.62 --- -- 009 0 0 0.20 $0.00 N
M 87904 PHENOTYPE DNA HIV W/CLT ADD 25.74 $25.74 --- -- 009 0 0 0.20 $0.00 N
M 87905 SIALIDASE ENZYME ASSAY 12.06 $12.06 --- -- 009 0 0 0.00 $0.00 Y
M 87906 GENOTYPE DNA/RNA HIV 127.13 $127.13 --- -- 009 0 0 0.20 $0.00 N
M 87910 GENOTYPE CYTOMEGALOVIRUS 23.38 $23.38 --- -- 009 0 0 0.20 $0.00 N
M 87912 GENOTYPE DNA HEPATITIS B 23.38 $23.38 --- -- 009 0 0 0.20 $0.00 N
M 87999 MICROBIOLOGY PROCEDURE 0.00 $0.00 --- -- 009 0 0 0.20 $0.00 N
M 88104 CYTOPATH FL NONGYN SMEARS 25.82 $25.82 --- -- 009 0 0 0.80 $0.00 N
M 88106 CYTOPATH FL NONGYN FILTER 25.82 $25.82 --- -- 009 0 0 0.80 $0.00 N
M 88108 CYTOPATH CONCENTRATE TECH 28.92 $28.92 --- -- 009 0 0 0.80 $0.00 N
M 88112 CYTOPATH CELL ENHANCE TECH 62.50 $62.50 --- -- 009 0 0 0.38 $0.00 N
M 88120 CYTP URNE 3-5 PROBES EA SPEC 363.41 $363.41 --- -- 009 0 0 0.89 $0.00 N
M 88121 CYTP URINE 3-5 PROBES CMPTR 307.14 $307.14 --- -- 009 0 0 0.88 $0.00 N
M 88130 SEX CHROMATIN IDENTIFICATION 16.38 $16.38 --- -- 009 0 0 0.80 $0.00 N
M 88140 SEX CHROMATIN IDENTIFICATION 7.60 $7.60 --- -- 009 0 0 0.80 $0.00 N
M 88141 CYTOPATH C/V INTERPRET 10.53 $10.53 --- -- 009 0 0 1.00 $0.00 N
M 88142 CYTOPATH C/V THIN LAYER 18.31 $18.31 --- -- 009 0 0 0.80 $0.00 N
M 88143 CYTOPATH C/V THIN LAYER REDO 19.30 $19.30 --- -- 009 0 0 0.80 $0.00 N
M 88147 CYTOPATH C/V AUTOMATED 12.39 $12.39 --- -- 009 0 0 0.80 $0.00 N
M 88148 CYTOPATH C/V AUTO RESCREEN 15.00 $15.00 --- -- 009 0 0 0.80 $0.00 N
M 88150 CYTOPATH C/V MANUAL 11.50 $11.50 --- -- 009 0 0 0.80 $0.00 Y
M 88152 CYTOPATH C/V AUTO REDO 11.50 $11.50 --- -- 009 0 0 0.80 $0.00 N
M 88153 CYTOPATH C/V REDO 11.50 $11.50 --- -- 009 0 0 0.80 $0.00 N
M 88155 CYTOPATH C/V INDEX ADD-ON 6.52 $6.52 --- -- 009 0 0 0.80 $0.00 N
M 88160 CYTOPATH SMEAR OTHER SOURCE 31.95 $31.95 --- -- 009 0 0 0.80 $0.00 N
M 88161 CYTOPATH SMEAR OTHER SOURCE 20.66 $20.66 --- -- 009 0 0 0.80 $0.00 N
M 88162 CYTOPATH SMEAR OTHER SOURCE 48.70 $48.70 --- -- 009 0 0 0.80 $0.00 N
M 88164 CYTOPATH TBS C/V MANUAL 9.65 $9.65 --- -- 009 0 0 0.80 $0.00 N
M 88165 CYTOPATH TBS C/V REDO 11.50 $11.50 --- -- 009 0 0 0.80 $0.00 N
M 88166 CYTOPATH TBS C/V AUTO REDO 11.50 $11.50 --- -- 009 0 0 0.80 $0.00 N
M 88167 CYTOPATH TBS C/V SELECT 11.50 $11.50 --- -- 009 0 0 0.80 $0.00 N
M 88172 CYTP DX EVAL FNA 1ST EA SITE 28.29 $28.29 --- -- 009 0 0 0.80 $0.00 N
M 88173 CYTOPATH EVAL FNA REPORT 51.98 $51.98 --- -- 009 0 0 0.80 $0.00 N
M 88174 CYTOPATH C/V AUTO IN FLUID 18.29 $18.29 --- -- 009 0 0 0.80 $0.00 N
M 88175 CYTOPATH C/V AUTO FLUID REDO 23.50 $23.50 --- -- 009 0 0 0.80 $0.00 N
M 88177 CYTP FNA EVAL EA ADDL 21.74 $21.74 --- -- 009 0 0 0.22 $0.00 N
M 88182 CELL MARKER STUDY 87.98 $87.98 --- -- 009 0 0 0.80 $0.00 N
M 88184 FLOWCYTOMETRY/ TC 1 MARKER 42.18 $42.18 --- -- 009 0 0 0.00 $0.00 N
M 88185 FLOWCYTOMETRY/TC ADD-ON 20.68 $20.68 --- -- 009 0 0 0.00 $0.00 N
M 88187 FLOWCYTOMETRY/READ 2-8 41.38 $41.38 --- -- 009 0 0 1.00 $0.00 N
M 88188 FLOWCYTOMETRY/READ 9-15 56.48 $56.48 --- -- 009 0 0 1.00 $0.00 N
M 88189 FLOWCYTOMETRY/READ 16 & > 69.18 $69.18 --- -- 009 0 0 1.00 $0.00 N
M 88199 CYTOPATHOLOGY PROCEDURE 0.00 $0.00 --- -- 009 0 0 0.80 $0.00 N
M 88230 TISSUE CULTURE LYMPHOCYTE 100.98 $100.98 --- -- 009 0 0 0.80 $0.00 N
M 88233 TISSUE CULTURE SKIN/BIOPSY 138.98 $138.98 --- -- 009 0 0 0.80 $0.00 N
M 88235 TISSUE CULTURE PLACENTA 75.03 $75.03 --- -- 009 0 0 0.80 $0.00 N
M 88237 TISSUE CULTURE BONE MARROW 99.64 $99.64 --- -- 009 0 0 0.80 $0.00 N
M 88239 TISSUE CULTURE TUMOR 145.69 $145.69 --- -- 009 0 0 0.80 $0.00 N
M 88240 CELL CRYOPRESERVE/STORAGE 7.99 $7.99 --- -- 009 0 0 0.80 $0.00 Y
M 88241 FROZEN CELL PREPARATION 7.99 $7.99 --- -- 009 0 0 0.80 $0.00 Y
M 88245 CHROMOSOME ANALYSIS 20-25 151.72 $151.72 --- -- 009 0 0 0.80 $0.00 N
M 88248 CHROMOSOME ANALYSIS 50-100 171.03 $171.03 --- -- 009 0 0 0.80 $0.00 N
M 88249 CHROMOSOME ANALYSIS 100 171.03 $171.03 --- -- 009 0 0 0.80 $0.00 N
M 88261 CHROMOSOME ANALYSIS 5 190.00 $190.00 --- -- 009 0 0 0.80 $0.00 N
M 88262 CHROMOSOME ANALYSIS 15-20 107.81 $107.81 --- -- 009 0 0 0.80 $0.00 N
M 88263 CHROMOSOME ANALYSIS 45 138.36 $138.36 --- -- 009 0 0 0.80 $0.00 N
M 88264 CHROMOSOME ANALYSIS 20-25 123.10 $123.10 --- -- 009 0 0 0.80 $0.00 N
M 88267 CHROMOSOME ANALYS PLACENTA 162.03 $162.03 --- -- 009 0 0 0.80 $0.00 N
M 88269 CHROMOSOME ANALYS AMNIOTIC 164.27 $164.27 --- -- 009 0 0 0.80 $0.00 N
M 88271 CYTOGENETICS DNA PROBE 16.80 $16.80 --- -- 009 0 0 0.80 $0.00 N
M 88272 CYTOGENETICS 3-5 29.15 $29.15 --- -- 009 0 0 0.80 $0.00 N
M 88273 CYTOGENETICS 10-30 31.73 $31.73 --- -- 009 0 0 0.80 $0.00 N
M 88274 CYTOGENETICS 25-99 34.38 $34.38 --- -- 009 0 0 0.80 $0.00 N
M 88275 CYTOGENETICS 100-300 31.68 $31.68 --- -- 009 0 0 0.80 $0.00 N
M 88280 CHROMOSOME COUNT: ADDITIONAL 19.17 $19.17 --- -- 009 0 0 0.80 $0.00 N
M 88283 CHROMOSOME BANDING STUDY 9.71 $9.71 --- -- 009 0 0 0.80 $0.00 N
M 88285 CHROMOSOME COUNT ADDITIONAL 7.60 $7.60 --- -- 009 0 0 0.80 $0.00 N
M 88289 CHROMOSOME STUDY ADDITIONAL 12.08 $12.08 --- -- 009 0 0 0.80 $0.00 N
M 88291 CYTO/MOLECULAR REPORT 13.62 $13.62 --- -- 009 0 0 1.00 $0.00 N
M 88299 CYTOGENETIC STUDY 0.00 $0.00 --- -- 009 0 0 0.80 $0.00 N
M 88300 SURGICAL PATH GROSS 8.37 $8.37 --- -- 009 0 0 0.80 $0.00 N
M 88302 TISSUE EXAM BY PATHOLOGIST 20.94 $20.94 --- -- 009 0 0 0.80 $0.00 N
M 88304 TISSUE EXAM BY PATHOLOGIST 30.48 $30.48 --- -- 009 0 0 0.80 $0.00 Y
M 88305 TISSUE EXAM BY PATHOLOGIST 40.99 $40.99 --- -- 009 0 0 0.80 $0.00 Y
M 88307 TISSUE EXAM BY PATHOLOGIST 87.64 $87.64 --- -- 009 0 0 0.80 $0.00 N
M 88309 TISSUE EXAM BY PATHOLOGIST 185.47 $185.47 --- -- 009 0 0 0.80 $0.00 N
M 88311 DECALCIFY TISSUE 7.90 $7.90 --- -- 009 0 0 0.80 $0.00 Y
M 88312 SPECIAL STAINS GROUP 1 32.83 $32.83 --- -- 009 0 0 0.80 $0.00 Y
M 88313 SPECIAL STAINS GROUP 2 38.56 $38.56 --- -- 009 0 0 0.80 $0.00 Y
M 88314 HISTOCHEMICAL STAINS ADD-ON 43.23 $43.23 --- -- 009 0 0 0.80 $0.00 Y
M 88319 ENZYME HISTOCHEMISTRY 68.78 $68.78 --- -- 009 0 0 0.80 $0.00 N
M 88321 MICROSLIDE CONSULTATION 60.98 $60.98 --- -- 009 0 0 1.00 $0.00 N
M 88323 MICROSLIDE CONSULTATION 88.41 $88.41 --- -- 009 0 0 0.80 $0.00 N
M 88325 COMPREHENSIVE REVIEW OF DATA 101.51 $101.51 --- -- 009 0 0 0.80 $0.00 N
M 88329 PATH CONSULT INTROP 32.48 $32.48 --- -- 009 0 0 0.80 $0.00 Y
M 88331 PATH CONSULT INTRAOP 1 BLOC 44.52 $44.52 --- -- 009 0 0 0.80 $0.00 N
M 88332 PATH CONSULT INTRAOP ADDL 19.39 $19.39 --- -- 009 0 0 0.80 $0.00 N
M 88333 INTRAOP CYTO PATH CONSULT 1 799.99 $799.99 --- -- 009 0 0 0.63 $0.00 N
M 88334 INTRAOP CYTO PATH CONSULT 2 49.68 $49.68 --- -- 009 0 0 0.80 $0.00 N
M 88341 IMMUNOHISTO ANTB ADDL SLIDE 60.62 $60.62 --- -- 009 0 0 0.31 $0.00 N
M 88342 IMMUNOHISTO ANTB 1ST STAIN 53.79 $53.79 --- -- 009 0 0 0.80 $0.00 N
M 88344 IMMUNOHISTO ANTIBODY SLIDE 104.92 $104.92 --- -- 009 0 0 0.33 $0.00 N
M 88346 IMMUNOFLUOR ANTB 1ST STAIN 56.05 $56.05 --- -- 009 0 0 0.80 $0.00 N
M 88348 ELECTRON MICROSCOPY 237.71 $237.71 --- -- 009 0 0 0.80 $0.00 N
M 88350 IMMUNOFLUOR ANTB ADDL STAIN 64.66 $64.66 --- -- 009 0 0 0.38 $0.00 N
M 88355 ANALYSIS SKELETAL MUSCLE 117.31 $117.31 --- -- 009 0 0 0.80 $0.00 N
M 88356 ANALYSIS NERVE 180.81 $180.81 --- -- 009 0 0 0.80 $0.00 N
M 88358 ANALYSIS TUMOR 66.78 $66.78 --- -- 009 0 0 0.80 $0.00 N
M 88360 TUMOR IMMUNOHISTOCHEM/MANUAL 56.74 $56.74 --- -- 009 0 0 0.80 $0.00 N
M 88361 TUMOR IMMUNOHISTOCHEM/COMPUT 80.16 $80.16 --- -- 009 0 0 0.80 $0.00 N
M 88362 NERVE TEASING PREPARATIONS 180.51 $180.51 --- -- 009 0 0 0.80 $0.00 N
M 88363 XM ARCHIVE TISSUE MOLEC ANAL 17.77 $17.77 --- -- 009 0 0 0.00 $0.00 N
M 88364 INSITU HYBRIDIZATION (FISH) 87.58 $87.58 --- -- 009 0 0 0.21 $0.00 N
M 88365 INSITU HYBRIDIZATION (FISH) 87.58 $87.58 --- -- 009 0 0 0.21 $0.00 N
M 88366 INSITU HYBRIDIZATION (FISH) 133.38 $133.38 --- -- 009 0 0 0.40 $0.00 N
M 88367 INSITU HYBRIDIZATION AUTO 96.07 $96.07 --- -- 009 0 0 0.80 $0.00 N
M 88368 INSITU HYBRIDIZATION MANUAL 75.41 $75.41 --- -- 009 0 0 0.80 $0.00 N
M 88369 M/PHMTRC ALYSISHQUANT/SEMIQ 65.87 $65.87 --- -- 009 0 0 0.32 $0.00 N
M 88371 PROTEIN WESTERN BLOT TISSUE 21.95 $21.95 --- -- 009 0 0 0.80 $0.00 N
M 88372 PROTEIN ANALYSIS W/PROBE 22.46 $22.46 --- -- 009 0 0 0.80 $0.00 N
M 88373 M/PHMTRC ALYS ISHQUANT/SEMIQ 54.01 $54.01 --- -- 009 0 0 0.33 $0.00 N
M 88374 M/PHMTRC ALYS ISHQUANT/SEMIQ 185.00 $185.00 --- -- 009 0 0 0.21 $0.00 N
M 88375 OPTICAL ENDOMICROSCPY INTERP 23.24 $17.66 --- -- 006 0 0 0.00 $0.00 N
M 88377 M/PHMTRC ALYS ISHQUANT/SEMIQ 192.08 $192.08 --- -- 009 0 0 0.29 $0.00 N
M 88380 MICRODISSECTION LASER 118.82 $118.82 --- -- 009 0 0 0.80 $0.00 N
M 88381 MICRODISSECTION MANUAL 112.83 $112.83 --- -- 009 0 0 0.80 $0.00 N
M 88387 TISS EXAM MOLECULAR STUDY 30.33 $30.33 --- -- 009 0 0 0.20 $0.00 N
M 88388 TISS EX MOLECUL STUDY ADD-ON 30.09 $30.09 --- -- 009 0 0 0.20 $0.00 N
M 88399 SURGICAL PATHOLOGY PROCEDURE 0.00 $0.00 --- -- 009 0 0 0.80 $0.00 N
M 88720 BILIRUBIN TOTAL TRANSCUT 4.30 $4.30 --- $4.30 009 1 0 0.00 $0.00 Y
M 88749 IN VIVO LAB SERVICE 0.00 $0.00 --- -- 009 0 0 1.00 $0.00 Y
M 89049 CHCT FOR MAL HYPERTHERMIA 217.68 $217.68 --- -- 009 0 0 0.80 $0.00 N
M 89050 BODY FLUID CELL COUNT 3.55 $3.55 --- -- 009 0 0 0.80 $0.00 Y
P 89050 BODY FLUID CELL COUNT 5.22 $5.22 --- -- 009 0 0 0.80 $0.00 N
M 89051 BODY FLUID CELL COUNT 4.86 $4.86 --- -- 009 0 0 0.80 $0.00 N
M 89055 LEUKOCYTE ASSESSMENT FECAL 3.83 $3.83 --- -- 009 0 0 0.00 $0.00 N
M 89060 EXAM SYNOVIAL FLUID CRYSTALS 6.36 $6.36 --- -- 009 0 0 0.80 $0.00 N
M 89125 SPECIMEN FAT STAIN 4.70 $4.70 --- -- 009 0 0 0.80 $0.00 Y
M 89160 EXAM FECES FOR MEAT FIBERS 3.88 $3.88 --- -- 009 0 0 0.80 $0.00 N
M 89190 NASAL SMEAR FOR EOSINOPHILS 4.68 $4.68 --- -- 009 0 0 0.80 $0.00 N
M 89220 SPUTUM SPECIMEN COLLECTION 10.33 $10.33 --- -- 009 0 0 0.80 $0.00 Y
M 89230 COLLECT SWEAT FOR TEST 2.20 $2.20 --- -- 009 0 0 0.20 $0.00 N
M 89240 PATHOLOGY LAB PROCEDURE 0.00 $0.00 --- -- 009 0 0 0.20 $0.00 N
M 89398 UNLISTED REPROD MED LAB PROC 0.00 $0.00 --- -- 009 0 0 0.20 $0.00 N
I 90284 HUMAN IG SC 18.70 $18.70 --- -- 030 0 0 0.00 $0.00 Y
I 90371 HEP B IG IM 122.66 $122.66 --- -- 030 0 0 0.00 $0.00 Y
I 90375 RABIES IG IM/SC 306.19 $306.19 --- -- 030 0 0 0.00 $0.00 Y
I 90376 RABIES IG HEAT TREATED 290.12 $290.12 --- -- 030 0 0 0.00 $0.00 Y
I 90378 RSV MAB IM 50MG 1469.86 $1469.86 --- -- 030 0 0 0.00 $0.00 Y
I 90384 RH IG FULL-DOSE IM 82.69 $82.69 --- -- 030 0 0 0.00 $0.00 Y
I 90385 RH IG MINIDOSE IM 30.28 $30.28 --- -- 030 0 0 0.00 $0.00 Y
I 90389 TETANUS IG IM 412.89 $412.89 --- -- 030 0 0 0.00 $0.00 Y
I 90471 IMMUNIZATION ADMIN 4.46 $4.46 --- -- 030 0 0 0.00 $0.00 Y
I 90585 BCG VACCINE PERCUT 145.49 $145.49 --- -- 030 0 0 0.00 $0.00 Y
I 90619 MENACWY-TT VACCINE IM 0.00 $0.00 --- -- 030 0 0 0.00 $0.00 Y
I 90620 MENB PR W/OMV VACCINE IM 174.46 $174.46 --- -- 030 0 0 0.00 $0.00 Y
I 90621 MENB RLP VACCINE IM 143.98 $143.98 --- -- 030 0 0 0.00 $0.00 Y
I 90630 FLU VACC IIV4 NO PRESERV ID 24.80 $24.80 --- -- 030 0 0 0.00 $0.00 Y
I 90632 HEPA VACCINE ADULT IM 64.09 $64.09 --- -- 030 0 0 0.00 $0.00 Y
I 90633 HEPA VACC PED/ADOL 2 DOSE IM 36.49 $36.49 --- -- 030 0 0 0.00 $0.00 Y
I 90636 HEP A/HEP B VACC ADULT IM 106.96 $106.96 --- -- 030 0 0 0.00 $0.00 Y
I 90644 HIB-MENCY VACC 6WK-18M0 IM 27.67 $27.67 --- -- 030 0 0 0.00 $0.00 Y
I 90647 HIB PRP-OMP VACC 3 DOSE IM 29.94 $29.94 --- -- 030 0 0 0.00 $0.00 Y
I 90648 HIB PRP-T VACCINE 4 DOSE IM 17.01 $17.01 --- -- 030 0 0 0.00 $0.00 Y
I 90649 4VHPV VACCINE 3 DOSE IM 164.72 $164.72 --- -- 030 0 0 0.00 $0.00 Y
I 90650 2VHPV VACCINE 3 DOSE IM 132.59 $132.59 --- -- 030 0 0 0.00 $0.00 Y
I 90651 9VHPV VACCINE 2/3 DOSE IM 220.82 $220.82 --- -- 030 0 0 0.00 $0.00 Y
I 90654 FLU VACCINE NO PRESERV, ID 20.36 $20.36 --- -- 030 0 0 0.00 $0.00 Y
I 90655 IIV3 VACC NO PRSV 6-35 MO IM 30.51 $30.51 --- -- 030 0 0 0.00 $0.00 Y
I 90656 IIV3 VACC NO PRSV 3 YRS+ IM 24.23 $24.23 --- -- 030 0 0 0.00 $0.00 Y
I 90657 IIV3 VACCINE 6-35 MONTHS IM 10.48 $10.48 --- -- 030 0 0 0.00 $0.00 Y
I 90658 IIV3 VACCINE 3 YRS+ IM 22.70 $22.70 --- -- 030 0 0 0.00 $0.00 Y
1 90660 LAIV3 VACCINE INTRANASAL 17.88 $17.88 --- -- 030 0 0 0.00 $0.00 Y
I 90662 IIV NO PRSV INCREASED AG IM 57.83 $57.83 --- -- 030 0 0 0.00 $0.00 Y
I 90670 PCV13 VACCINE IM 219.79 $219.79 --- -- 030 0 0 0.00 $0.00 Y
I 90673 RIV3 VACCINE NO PRESERV IM 45.07 $45.07 --- -- 030 0 0 0.00 $0.00 Y
I 90674 INFLUENZA VIRUS VAC, QUADRIVALENT .5ML 28.51 $28.51 --- -- 030 0 0 0.00 $0.00 Y
I 90675 RABIES VACCINE IM 298.99 $298.99 --- -- 030 0 0 0.00 $0.00 Y
1 90680 RV5 VACC 3 DOSE LIVE ORAL 86.60 $86.60 --- -- 030 0 0 0.00 $0.00 Y
1 90681 RV1 VACC 2 DOSE LIVE ORAL 124.66 $124.66 --- -- 030 0 0 0.00 $0.00 Y
I 90682 RIV4 VACC RECOMBINANT DNA IM 57.83 $57.83 --- -- 030 0 0 0.00 $0.00 Y
I 90685 IIV4 VACC NO PRSV 6-35 M IM 26.27 $26.27 --- -- 030 0 0 0.00 $0.00 Y
I 90686 IIV4 VACC NO PRSV IM 23.49 $23.49 --- -- 030 0 0 0.00 $0.00 Y
I 90688 IIV4 VACCINE IM 22.30 $22.30 --- -- 030 0 0 0.00 $0.00 Y
I 90689 VACC IIV4 NO PRSRV 0.25ML IM 0.00 $0.00 --- -- 030 0 0 0.00 $0.00 Y
1 90690 TYPHOID VACCINE ORAL 82.70 $82.70 --- -- 030 0 0 0.00 $0.00 Y
I 90691 TYPHOID VACCINE IM 94.19 $94.19 --- -- 030 0 0 0.00 $0.00 Y
I 90694 VACC AIIV4 NO PRSRV 0.5ML IM 0.00 $0.00 --- -- 030 0 0 0.00 $0.00 Y
I 90696 DTAP-IPV VACCINE 4-6 YRS IM 53.95 $53.95 --- -- 030 0 0 0.00 $0.00 Y
I 90698 DTAP-IPV/HIB VACCINE IM 93.29 $93.29 --- -- 030 0 0 0.00 $0.00 Y
I 90700 DTAP VACCINE < 7 YRS IM 31.36 $31.36 --- -- 030 0 0 0.00 $0.00 Y
I 90702 DT VACCINE UNDER 7 YRS IM 57.55 $57.55 --- -- 030 0 0 0.00 $0.00 Y
I 90707 MMR VACCINE SC 77.25 $77.25 --- -- 030 0 0 0.00 $0.00 Y
I 90710 MMRV VACCINE SC 215.83 $215.83 --- -- 030 0 0 0.00 $0.00 Y
I 90713 POLIOVIRUS IPV SC/IM 37.24 $37.24 --- -- 030 0 0 0.00 $0.00 Y
I 90714 TD VACC NO PRESV 7 YRS+ IM 28.08 $28.08 --- -- 030 0 0 0.00 $0.00 Y
I 90715 TDAP VACCINE >7 IM 37.30 $37.30 --- -- 030 0 0 0.00 $0.00 Y
I 90716 VAR VACCINE LIVE SUBQ 133.01 $133.01 --- -- 030 0 0 0.00 $0.00 Y
I 90717 YELLOW FEVER VACCINE SUBQ 141.60 $141.60 --- -- 030 0 0 0.00 $0.00 Y
I 90723 DTAP-HEP B-IPV VACCINE IM 79.86 $79.86 --- -- 030 0 0 0.00 $0.00 Y
I 90732 PPSV23 VACC 2 YRS+ SUBQ/IM 118.67 $118.67 --- -- 030 0 0 0.00 $0.00 Y
I 90733 MPSV4 VACCINE SUBQ 126.88 $126.88 --- -- 030 0 0 0.00 $0.00 Y
I 90734 MENACWYD/MENACWYCRM VACC IM 128.19 $128.19 --- -- 030 0 0 0.00 $0.00 Y
I 90736 HZV VACCINE LIVE SUBQ 217.13 $217.13 --- -- 030 0 0 0.00 $0.00 Y
I 90739 HEPB VACC 2 DOSE ADULT IM 135.56 $135.56 --- -- 030 0 0 0.00 $0.00 Y
I 90740 HEPB VACC 3 DOSE IMMUNSUP IM 138.58 $138.58 --- -- 030 0 0 0.00 $0.00 Y
I 90743 HEPB VACC 2 DOSE ADOLESC IM 50.86 $50.86 --- -- 030 0 0 0.00 $0.00 Y
I 90744 HEPB VACC 3 DOSE PED/ADOL IM 31.36 $31.36 --- -- 030 0 0 0.00 $0.00 Y
I 90746 HEPB VACCINE 3 DOSE ADULT IM 71.52 $71.52 --- -- 030 0 0 0.00 $0.00 Y
I 90747 HEPB VACC 4 DOSE IMMUNSUP IM 138.58 $138.58 --- -- 030 0 0 0.00 $0.00 Y
I 90748 HIB-HEPB VACCINE IM 46.35 $46.35 --- -- 030 0 0 0.00 $0.00 Y
I 90750 HZV VACC RECOMBINANT IM 148.66 $148.66 --- -- 030 0 0 0.00 $0.00 Y
I 90756 CCIIV4 VACC ABX FREE IM 27.25 $27.25 --- -- 030 0 0 0.00 $0.00 Y
N 90785 PSYTX COMPLEX INTERACTIVE 4.73 $3.88 --- $4.92 007 1 0 0.00 $0.00 Y
N 90791 PSYCH DIAGNOSTIC EVALUATION 156.19 $128.08 --- $162.44 007 1 0 0.00 $0.00 Y
N 90792 PSYCH DIAG EVAL W/MED SRVCS 125.91 $103.25 --- $130.95 007 1 0 0.00 $0.00 Y
N 90832 PSYTX PT&/FAMILY 30 MINUTES 64.47 $52.87 --- $67.05 007 1 0 0.00 $0.00 Y
Q 90832 PSYTX PT&/FAMILY 30 MINUTES 18.98 $18.98 --- -- 009 0 0 0.00 $0.00 Y
N 90833 PSYTX PT&/FAM W/E&M 30 MIN 42.06 $34.49 --- $43.74 007 1 0 0.00 $0.00 Y
N 90834 PSYTX PT&/FAMILY 45 MINUTES 81.90 $67.16 --- $85.18 007 1 0 0.00 $0.00 Y
N 90836 PSYTX PT&/FAM W/E&M 45 MIN 68.32 $56.02 --- $71.05 007 1 0 0.00 $0.00 Y
N 90837 PSYTX PT&/FAMILY 60 MINUTES 119.54 $98.02 --- $124.32 007 1 0 0.00 $0.00 Y
Q 90837 PSYTX PT&/FAMILY 60 MINUTES 38.01 $38.01 --- -- 009 0 0 0.00 $0.00 Y
G 90837 PSYTX OFF 45-50 MIN 51.00 $51.00 --- -- 009 0 0 0.00 $0.00 Y
N 90838 PSYTX PT&/FAM W/E&M 60 MIN 110.45 $90.57 --- $114.87 007 1 0 0.00 $0.00 Y
N 90839 PSYTX CRISIS INITIAL 60 MIN 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
Q 90839 PSYTX CRISIS INITIAL 60 MIN 38.01 $38.01 --- -- 009 0 0 0.00 $0.00 N
Q 90840 PSYTX CRISIS EA ADDL 30 MIN 18.98 $18.98 --- -- 009 0 0 0.00 $0.00 N
N 90840 PSYTX CRISIS EA ADDL 30 MIN 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
G 90846 FAMILY PSYCHOTHERAPY 51.00 $51.00 --- -- 009 0 0 0.00 $0.00 Y
G 90847 FAMILY PSYCHOTHERAPY WITH PT PRESENT 51.00 $51.00 --- -- 009 0 0 0.00 $0.00 Y
Q 90853 GROUP PSYCHOTHERAPY 14.48 $14.48 --- -- 009 0 0 0.00 $0.00 Y
N 90853 GROUP PSYCHOTHERAPY 4.23 $3.47 --- $4.40 007 1 1 0.00 $0.00 Y
N 90863 PHARMACOLOGIC MGMT W/PSYTX 27.92 $22.89 --- -- 007 0 0 0.00 $0.00 Y
N 90870 ELECTROCONVULSIVE THERAPY 92.40 $75.77 --- $96.10 007 1 0 0.00 $0.00 Y
N 90880 HYPNOTHERAPY 63.55 $52.11 --- $66.09 007 1 1 0.00 $0.00 Y
N 90899 PSYCHIATRIC SERVICE/THERAPY 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 90935 HEMODIALYSIS ONE EVALUATION 69.02 $56.60 --- $71.78 007 1 0 0.00 $0.00 Y
N 90937 HEMODIALYSIS REPEATED EVAL 187.02 $153.36 --- $194.50 007 1 0 0.00 $0.00 Y
N 90940 HEMODIALYSIS ACCESS STUDY 126.23 $103.51 --- $131.28 007 1 0 0.00 $0.00 Y
N 90945 DIALYSIS ONE EVALUATION 88.00 $72.16 --- $91.52 007 1 0 0.00 $0.00 Y
N 90947 DIALYSIS REPEATED EVAL 132.00 $108.24 --- $137.28 007 1 0 0.00 $0.00 Y
N 90951 ESRD SERV 4 VISITS P MO <2YR 82.10 $821.00 $895.71 -- 001 0 0 0.00 $0.00 Y
N 90952 ESRD SERV 2-3 VSTS P MO <2YR 0.00 $0.00 --- -- 001 0 0 0.00 $0.00 Y
N 90953 ESRD SERV 1 VISIT P MO <2YRS 0.00 $0.00 --- -- 001 0 0 0.00 $0.00 Y
N 90954 ESRD SERV 4 VSTS P MO 2-11 66.41 $664.10 $724.53 -- 001 0 0 0.00 $0.00 Y
N 90955 ESRD SRV 2-3 VSTS P MO 2-11 37.78 $377.80 $412.18 -- 001 0 0 0.00 $0.00 Y
N 90956 ESRD SRV 1 VISIT P MO 2-11 25.60 $256.00 $279.30 -- 001 0 0 0.00 $0.00 Y
N 90957 ESRD SRV 4 VSTS P MO 12-19 53.53 $535.30 $584.01 -- 001 0 0 0.00 $0.00 Y
N 90958 ESRD SRV 2-3 VSTS P MO 12-19 36.19 $361.90 $394.83 -- 001 0 0 0.00 $0.00 Y
N 90959 ESRD SERV 1 VST P MO 12-19 23.74 $237.40 $259.00 -- 001 0 0 0.00 $0.00 Y
N 90960 ESRD SRV 4 VISITS P MO 20+ 24.00 $240.00 $261.84 -- 001 0 0 0.00 $0.00 Y
N 90961 ESRD SRV 2-3 VSTS P MO 20+ 19.32 $193.20 $210.78 -- 001 0 0 0.00 $0.00 Y
N 90962 ESRD SERV 1 VISIT P MO 20+ 13.93 $139.30 $151.98 -- 001 0 0 0.00 $0.00 Y
N 90963 ESRD HOME PT SERV P MO <2YRS 45.97 $459.70 $501.53 -- 001 0 0 0.00 $0.00 Y
N 90964 ESRD HOME PT SERV P MO 2-11 38.15 $381.50 $416.22 -- 001 0 0 0.00 $0.00 Y
N 90965 ESRD HOME PT SERV P MO 12-19 36.30 $363.00 $396.03 -- 001 0 0 0.00 $0.00 Y
N 90966 ESRD HOME PT SERV P MO 20+ 19.09 $190.90 $208.27 -- 001 0 0 0.00 $0.00 Y
N 90967 ESRD HOME PT SERV P DAY <2 1.67 $16.70 $18.22 $20.74 001 1 0 0.00 $0.00 Y
N 90968 ESRD HOME PT SRV P DAY 2-11 1.28 $12.80 $13.96 $15.90 001 1 0 0.00 $0.00 Y
N 90969 *09ESRD HOME PT SRV P DAY 12-19 1.25 $12.50 $13.64 $15.53 001 1 0 0.00 $0.00 Y
N 90970 ESRD HOME PT SERV P DAY 20+ 0.67 $6.70 $7.31 $8.32 001 1 0 0.00 $0.00 Y
N 90989 DIALYSIS TRAINING COMPLETE 667.40 $667.40 --- -- 009 0 0 0.00 $0.00 Y
N 90993 DIALYSIS TRAINING INCOMPL 33.98 $27.86 --- $35.34 007 1 0 0.00 $0.00 Y
N 90997 HEMOPERFUSION 106.91 $87.67 --- $111.19 007 1 0 0.00 $0.00 Y
N 90999 DIALYSIS PROCEDURE 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 91010 ESOPHAGUS MOTILITY STUDY 84.28 $69.11 --- $87.65 007 1 1 0.79 $0.00 Y
N 91013 ESOPHGL MOTIL W/STIM/PERFUS 25.29 $20.74 --- $26.30 007 1 0 0.00 $0.00 N
N 91020 GASTRIC MOTILITY STUDIES 112.30 $92.09 --- $116.79 007 1 1 0.82 $0.00 Y
N 91022 DUODENAL MOTILITY STUDY 115.85 $95.00 --- -- 007 0 0 0.82 $0.00 Y
N 91030 ACID PERFUSION OF ESOPHAGUS 49.34 $40.46 --- $51.31 007 1 1 0.87 $0.00 Y
N 91034 GASTROESOPHAGEAL REFLUX TEST 94.65 $77.61 --- -- 007 0 0 0.78 $0.00 Y
N 91035 G-ESOPH REFLX TST W/ELECTROD 124.91 $102.43 --- -- 007 0 0 0.71 $0.00 Y
N 91037 ESOPH IMPED FUNCTION TEST 163.68 $134.22 --- -- 007 0 0 0.78 $0.00 Y
N 91038 ESOPH IMPED FUNCT TEST > 1HR 138.83 $113.84 --- -- 007 0 0 0.71 $0.00 Y
N 91040 ESOPH BALLOON DISTENSION TST 508.05 $416.60 --- -- 007 0 0 0.00 $0.00 Y
N 91065 BREATH HYDROGEN TEST 32.96 $27.03 --- $34.28 007 1 1 0.72 $0.00 Y
N 91110 GI TRACT CAPSULE ENDOSCOPY 980.84 $804.29 --- $1020.07 007 1 0 0.15 $0.00 Y
N 91112 GI WIRELESS CAPSULE MEASURE 1318.38 $1081.07 --- -- 007 0 0 0.00 $0.00 Y
N 91122 ANAL PRESSURE RECORD 73.62 $60.37 --- $76.56 007 1 1 0.78 $0.00 Y
N 91132 ELECTROGASTROGRAPHY 114.68 $94.04 --- $119.27 007 1 0 0.72 $0.00 Y
N 91133 ELECTROGASTROGRAPHY W/TEST 137.62 $112.85 --- $143.12 007 1 0 0.72 $0.00 Y
N 91200 LIVER ELASTOGRAPHY 39.09 $32.05 --- -- 007 0 0 0.39 $0.00 Y
N 91299 GASTROENTEROLOGY PROCEDURE 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 92002 EYE EXAM NEW PATIENT 45.30 $37.15 --- $47.11 007 1 1 0.00 $0.00 Y
1 92002 EYE EXAM NEW PATIENT 32.80 $32.80 --- $32.80 009 1 1 0.00 $0.00 Y
1 92004 EYE EXAM NEW PATIENT 39.44 $39.44 --- -- 009 0 0 0.00 $0.00 Y
N 92004 EYE EXAM NEW PATIENT 60.71 $49.78 --- $63.14 007 1 1 0.00 $0.00 Y
N 92012 EYE EXAM ESTABLISH PATIENT 45.30 $37.15 --- $47.11 007 1 1 0.00 $0.00 Y
1 92012 EYE EXAM ESTABLISH PATIENT 22.59 $22.59 --- -- 009 0 0 0.00 $0.00 Y
1 92014 EYE EXAM&TX ESTAB PT 1/>VST 39.44 $39.44 --- -- 009 0 0 0.00 $0.00 Y
N 92014 EYE EXAM&TX ESTAB PT 1/>VST 46.87 $38.43 --- $48.74 007 1 1 0.00 $0.00 Y
N 92015 DETERMINE REFRACTIVE STATE 9.77 $8.01 --- -- 007 0 0 0.00 $0.00 Y
1 92015 DETERMINE REFRACTIVE STATE 9.77 $8.01 --- -- 007 0 0 0.00 $0.00 Y
N 92018 NEW EYE EXAM & TREATMENT 58.39 $47.88 --- $60.73 007 1 0 0.00 $0.00 Y
N 92019 EYE EXAM & TREATMENT 52.56 $43.10 --- $54.66 007 1 0 0.00 $0.00 Y
N 92020 GONIOSCOPY (SEPARATE PROCEDURE) 23.43 $19.21 --- $24.37 007 1 1 0.00 $0.00 Y
1 92020 GONIOSCOPY (SEPARATE PROCEDURE) 16.40 $16.40 --- $16.40 009 1 1 0.00 $0.00 Y
1 92025 CORNEAL TOPOGRAPHY 26.82 $26.82 --- -- 009 0 0 0.80 $0.00 Y
N 92025 CORNEAL TOPOGRAPHY 32.71 $26.82 --- -- 007 0 0 0.80 $0.00 Y
N 92060 SENSORIMOTOR EXAM WITH MULTI MEASUREMNTS 41.20 $33.78 --- $42.85 007 1 1 0.78 $0.00 Y
N 92071 CONTACT LENS FITTING FOR TX 39.07 $32.04 --- $40.63 007 1 0 0.00 $0.00 Y
1 92071 CONTACT LENS FITTING FOR TX 39.07 $32.04 --- $40.63 007 1 0 0.00 $0.00 Y
1 92072 FIT CONTAC LENS FOR MANAGMNT 124.31 $101.93 --- $129.28 007 1 0 0.00 $0.00 Y
N 92072 FIT CONTAC LENS FOR MANAGMNT 124.31 $101.93 --- $129.28 007 1 0 0.00 $0.00 Y
N 92081 VISUAL FIELD EXAM, UNILAT OR BILAT; LIMI 40.18 $32.95 --- $41.79 007 1 1 0.77 $0.00 Y
1 92081 VISUAL FIELD EXAM 16.40 $16.40 --- $16.40 009 1 1 0.00 $0.00 Y
1 92082 VISUAL FIELD EXAM 22.14 $22.14 --- $22.14 009 1 1 0.00 $0.00 Y
N 92082 VISUAL FIELD EXAM; INTERMEDIATE 41.55 $34.07 --- $43.21 007 1 1 0.77 $0.00 Y
N 92083 VISUAL FIELD EXAM; EXTENDED 37.21 $30.51 --- $38.70 007 1 1 0.78 $0.00 Y
1 92083 VISUAL EXAM 22.14 $22.14 --- $22.14 009 1 1 0.00 $0.00 Y
1 92100 SERIAL TONOMETRY (SEPARATE PROCEDURE) 28.93 $28.93 --- $28.93 009 1 0 0.00 $0.00 Y
N 92100 SERIAL TONOMETRY (SEPARATE PROCEDURE) 35.28 $28.93 --- $36.69 007 1 0 0.00 $0.00 Y
N 92132 CMPTR OPHTH DX IMG ANT SEGMT 32.24 $26.44 --- $33.53 007 1 0 0.56 $0.00 Y
1 92132 CMPTR OPHTH DX IMG ANT SEGMT 32.24 $32.24 --- $32.24 009 1 0 0.56 $0.00 Y
1 92133 CMPTR OPHTH IMG OPTIC NERVE 39.33 $39.33 --- $39.33 009 1 0 0.64 $0.00 Y
N 92133 CMPTR OPHTH IMG OPTIC NERVE 39.33 $32.25 --- $40.90 007 1 0 0.64 $0.00 Y
N 92134 CPTR OPHTH DX IMG POST SEGMT 39.33 $32.25 --- $40.90 007 1 0 0.64 $0.00 Y
1 92134 CPTR OPHTH DX IMG POST SEGMT 39.33 $39.33 --- $39.33 009 1 0 0.64 $0.00 Y
N 92136 OPHTHALMIC BIOMETRY 81.88 $67.14 --- -- 007 0 0 0.34 $0.00 Y
N 92201 OPSCPY EXTND RTA DRAW UNI/BI 26.96 $22.11 --- -- 007 0 0 0.00 $0.00 Y
N 92202 OPSCPY EXTND ON/MAC DRAW 17.10 $14.03 --- -- 007 0 0 0.00 $0.00 Y
N 92227 REMOTE DX RETINAL IMAGING 10.72 $10.72 --- -- 007 0 0 0.00 $0.00 Y
1 92227 REMOTE DX RETINAL IMAGING 10.72 $10.72 --- -- 009 0 0 0.00 $0.00 Y
1 92228 REMOTE RETINAL IMAGING MGMT 26.66 $26.66 --- -- 009 0 0 0.56 $0.00 Y
N 92228 REMOTE RETINAL IMAGING MGMT 26.66 $26.66 --- -- 007 0 0 0.56 $0.00 Y
N 92230 FLUORESCEIN ANGIOSCOPY WITH INTERPRET 56.63 $46.44 --- $58.90 007 1 1 0.00 $0.00 Y
N 92235 FLUORESCEIN ANGIOGRAPHY,INC MULT IMAGING 99.67 $81.73 --- $103.66 007 1 1 0.56 $0.00 Y
N 92240 ICG ANGIOGRAPHY 90.23 $73.99 --- $93.84 007 1 0 0.60 $0.00 Y
N 92242 FLUORESCEIN ICG ANGIOGRAPHY 253.37 $207.76 --- -- 007 0 0 0.23 $0.00 Y
N 92250 FUNDUS PHOTOGRAPHY WITH INTERPRETATION 42.13 $42.13 --- -- 009 0 1 0.78 $0.00 Y
1 92250 FUNDUS PHOTOGRAPHY WITH INTERPRETATION 42.13 $42.13 --- -- 009 0 0 0.00 $0.00 Y
N 92260 OPHTHALMOSCOPY/DYNAMOMETRY 40.00 $32.80 --- $41.60 007 1 1 0.00 $0.00 Y
N 92265 EYE MUSCLE EVALUATION 51.51 $42.24 --- $53.57 007 1 1 0.77 $0.00 Y
N 92270 ELECTRO-OCULOGRAPHY 40.60 $33.29 --- $42.22 007 1 1 0.78 $0.00 Y
N 92273 FULL FIELD ERG W/I&R 149.85 $122.88 --- -- 007 0 0 0.00 $0.00 Y
N 92274 MULTIFOCAL ERG W/I&R 100.80 $82.66 --- -- 007 0 0 0.00 $0.00 Y
N 92283 COLOR VISION EXAMINATION 20.48 $16.79 --- $21.30 007 1 1 0.77 $0.00 Y
N 92284 DARK ADAPTATION EYE EXAM 24.87 $20.39 --- $25.86 007 1 1 0.77 $0.00 Y
N 92310 SPECIAL CONTACT LENS FITTING 44.39 $36.40 --- $46.17 007 1 1 0.00 $0.00 Y
1 92310 SPECIAL CONTACT LENS FITTING 36.40 $36.40 --- $36.40 009 1 1 0.00 $0.00 Y
1 92311 SPECIAL CONTACT LENS FITTING 36.40 $36.40 --- $36.40 009 1 1 0.00 $0.00 Y
N 92311 SPECIAL CONTACT LENS FITTING 44.72 $36.67 --- $46.51 007 1 1 0.00 $0.00 Y
N 92312 SPECIAL CONTACT LENS FITTING 53.45 $43.83 --- $55.59 007 1 1 0.00 $0.00 Y
1 92312 SPECIAL CONTACT LENS FITTING 36.40 $36.40 --- $36.40 009 1 1 0.00 $0.00 Y
N 92313 SPECIAL CONTACT LENS FITTING 40.18 $32.95 --- $41.79 007 1 1 0.00 $0.00 Y
N 92314 SPECIAL CONTACT LENS RX 43.95 $36.04 --- $45.71 007 1 1 0.00 $0.00 Y
N 92315 RX CNTACT LENS APHAKIA 1 EYE 43.95 $36.04 --- $45.71 007 1 1 0.00 $0.00 Y
N 92316 RX CNTACT LENS APHAKIA 2 EYE 58.15 $47.68 --- $60.48 007 1 1 0.00 $0.00 Y
N 92317 RX CORNEOSCLERAL CNTACT LENS 32.38 $26.55 --- $33.68 007 1 1 0.00 $0.00 Y
N 92325 MODIFICATION OF CONTACT LENS 14.89 $12.21 --- $15.49 007 1 1 0.00 $0.00 Y
N 92340 FIT SPECTACLES MONOFOCAL 10.77 $10.77 --- -- 009 0 1 0.00 $0.00 Y
1 92340 FIT SPECTACLES MONOFOCAL 10.77 $10.77 --- -- 009 0 1 0.00 $0.00 Y
1 92341 FIT SPECTACLES BIFOCAL 15.90 $15.90 --- -- 009 0 1 0.00 $0.00 Y
N 92341 FIT SPECTACLES BIFOCAL 15.90 $15.90 --- -- 009 0 1 0.00 $0.00 Y
N 92342 FIT SPECTACLES MULTIFOCAL 21.88 $21.88 --- -- 009 0 1 0.00 $0.00 Y
1 92342 FIT SPECTACLES MULTIFOCAL 21.88 $21.88 --- -- 009 0 1 0.00 $0.00 Y
1 92352 FIT APHAKIA SPECTCL MONOFOCL 10.77 $10.77 --- -- 009 0 1 0.00 $0.00 Y
N 92352 FIT APHAKIA SPECTCL MONOFOCL 10.77 $10.77 --- -- 009 0 1 0.00 $0.00 Y
N 92353 FIT APHAKIA SPECTCL MULTIFOC 15.90 $15.90 --- $15.90 009 1 1 0.00 $0.00 N
1 92353 FIT APHAKIA SPECTCL MULTIFOC 15.90 $15.90 --- -- 009 0 1 0.00 $0.00 Y
1 92370 REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009 0 0 0.00 $0.00 Y
N 92370 REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009 0 0 0.00 $0.00 Y
N 92371 REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009 0 0 0.00 $0.00 Y
1 92371 REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009 0 0 0.00 $0.00 Y
1 92499 OPHTHALMOLOGIC SERVICE OR PROCEDURE UN 0.00 $0.00 --- -- 008 0 0 0.00 $0.00 Y
N 92499 OPHTHALMOLOGIC SERVICE OR PROCEDURE UN 0.00 $0.00 --- -- 008 0 1 0.00 $0.00 Y
N 92502 EAR AND THROAT EXAMINATION 75.32 $61.76 --- $78.33 007 1 1 0.00 $0.00 Y
N 92504 EAR MICROSCOPY EXAMINATION 20.30 $16.65 --- $21.11 007 1 1 0.00 $0.00 Y
N 92507 SPEECH/HEARING THERAPY 36.24 $29.72 --- $37.69 007 1 1 0.00 $0.00 Y
E 92507 IND SPEECH/LANG/VOICE TRMT 48.67 $48.67 --- -- 009 0 0 0.00 $0.00 Y
E 92508 GRP SPEECH/LANG/VOICE TRMT 2.46 $2.46 --- -- 009 0 0 0.00 $0.00 Y
N 92508 TREATMENT OF SPEECH, LANG. VOICE GROUP 25.17 $20.64 --- $26.18 007 1 1 0.00 $0.00 Y
N 92511 NASOPHARYNGOSCOPY 50.96 $41.79 --- $53.00 007 1 1 0.00 $0.00 Y
N 92512 NASAL FUNCTION STUDIES 29.98 $24.58 --- $31.18 007 1 1 0.00 $0.00 Y
N 92516 FACIAL NERVE FUNCTION STUDIES 23.96 $19.65 --- $24.92 007 1 1 0.00 $0.00 Y
N 92520 LARYNGEAL FUNCTION STUDIES 36.74 $30.13 --- $38.21 007 1 1 0.00 $0.00 Y
N 92521 EVALUATION OF SPEECH FLUENCY 74.98 $74.98 --- -- 009 0 0 0.00 $0.00 Y
E 92521 EVALUATION OF SPEECH FLUENCY 62.81 $62.81 --- -- 009 0 0 0.00 $0.00 Y
E 92522 EVAL OF SPEECH SOUND PRODUCTION 53.84 $53.84 --- -- 009 0 0 0.00 $0.00 Y
N 92522 EVALUATE SPEECH PRODUCTION 64.11 $64.11 --- -- 009 0 0 0.00 $0.00 Y
N 92523 SPEECH SOUND LANG COMPREHEN 130.58 $130.58 --- -- 009 0 0 0.00 $0.00 Y
E 92523 SPEECH SOUND LANG COMPREHEN 107.68 $107.68 --- -- 009 0 0 0.00 $0.00 Y
E 92524 BEHAVRAL QUALIT ANALYS VOICE 53.84 $53.84 --- -- 009 0 0 0.00 $0.00 Y
N 92524 BEHAVRAL QUALIT ANALYS VOICE 62.08 $62.08 --- -- 009 0 0 0.00 $0.00 Y
N 92526 TREAT OF SWALLOWING DYSFUN AND/OR ORAL 41.24 $33.82 --- $42.89 007 1 1 0.00 $0.00 Y
N 92531 SPONTANEOUS NYSTAGMUS STUDY 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 92532 POSITIONAL NYSTAGMUS TEST 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 92533 CALORIC VESTIBULAR TEST 33.98 $27.86 --- $35.34 007 1 1 0.00 $0.00 Y
N 92534 OPTOKINETIC NYSTAGMUS TEST 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 92537 CALORIC VSTBLR TEST W/REC 43.08 $35.33 --- -- 007 0 1 0.00 $0.00 Y
N 92538 CALORIC VSTBLR TEST W/REC 21.87 $17.93 --- -- 007 0 1 0.00 $0.00 Y
N 92540 BASIC VESTIBULAR EVALUATION 100.16 $82.13 --- -- 007 0 0 0.78 $0.00 Y
N 92541 SPONTANEOUS NYSTAGMUS TEST 17.77 $14.57 --- $18.48 007 1 1 0.40 $0.00 Y
N 92542 POSITIONAL NYSTAGMUS TEST 16.99 $13.93 --- $17.67 007 1 1 0.40 $0.00 Y
N 92544 OPTOKINETIC NYSTAGMUS TEST 16.99 $13.93 --- $17.67 007 1 1 0.40 $0.00 Y
N 92545 OSCILLATING TRACKING TEST 16.99 $13.93 --- $17.67 007 1 1 0.40 $0.00 Y
N 92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TEST 16.99 $13.93 --- $17.67 007 1 1 0.40 $0.00 Y
N 92547 SUPPLEMENTAL ELECTRICAL TEST 16.99 $13.93 --- $17.67 007 1 1 0.40 $0.00 Y
N 92550 TYMPANOMETRY & REFLEX THRESH 21.55 $17.67 --- -- 007 0 0 0.00 $0.00 Y
N 92551 PURE TONE HEARING TEST AIR 1.02 $10.20 $11.13 $12.67 053 1 1 0.00 $0.00 Y
E 92551 PURE TONE HEARING TEST AIR 7.39 $7.39 --- -- 009 0 0 0.00 $0.00 Y
E 92552 PURE TONE AUDIOMETRY AIR 11.08 $11.08 --- -- 009 0 0 0.00 $0.00 Y
N 92552 PURE TONE AUDIOMETRY AIR 1.53 $15.30 $16.69 $19.00 053 1 1 0.00 $0.00 Y
N 92553 AUDIOMETRY AIR & BONE 2.04 $20.40 $22.26 $25.34 053 1 1 0.00 $0.00 Y
N 92555 SPEECH AUDIOMETRY THRESHOLD 1.12 $11.20 $12.22 $13.91 053 1 1 0.00 $0.00 Y
N 92556 SPEECH AUDIOMETRY COMPLETE 2.70 $27.00 $29.46 $33.53 053 1 1 0.00 $0.00 Y
N 92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVAL 49.83 $40.86 --- $51.82 007 1 1 0.00 $0.00 Y
E 92557 AUDIOLOGY EVALUATION 181.49 $181.49 --- -- 009 0 0 0.00 $0.00 Y
N 92558 *12EVOKED AUDITORY TEST QUAL 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92559 GROUP AUDIOMETRIC TESTING 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 92560 BEKESY AUDIOMETRY SCREEN 18.12 $14.86 --- $18.84 007 1 1 0.00 $0.00 Y
N 92561 BEKESY AUDIOMETRY DIAGNOSIS 21.27 $17.44 --- $22.12 007 1 1 0.00 $0.00 Y
N 92562 LOUDNESS BALANCE TEST 9.39 $7.70 --- $9.77 007 1 1 0.00 $0.00 Y
N 92563 TONE DECAY HEARING TEST 8.73 $7.16 --- $9.08 007 1 1 0.00 $0.00 Y
N 92564 SISI HEARING TEST 11.06 $9.07 --- $11.50 007 1 1 0.00 $0.00 Y
N 92565 STENGER TEST PURE TONE 11.33 $9.29 --- $11.78 007 1 1 0.00 $0.00 Y
N 92568 ACOUSTIC REFL THRESHOLD TST 11.32 $9.28 --- $11.77 007 1 1 0.00 $0.00 Y
N 92570 ACOUSTIC IMMITANCE TESTING 32.73 $26.84 --- -- 007 0 0 0.00 $0.00 Y
N 92571 FILTERED SPEECH HEARING TEST 11.62 $9.53 --- $12.08 007 1 1 0.00 $0.00 Y
N 92572 STAGGERED SPONDAIC WORD TEST 2.54 $2.08 --- $2.64 007 1 1 0.00 $0.00 Y
N 92575 SENSORINEURAL ACUITY TEST 9.07 $7.44 --- $9.43 007 1 1 0.00 $0.00 Y
N 92576 SYNTHETIC SENTENCE TEST 14.72 $12.07 --- $15.31 007 1 1 0.00 $0.00 Y
N 92577 STENGER TEST SPEECH 16.60 $13.61 --- $17.26 007 1 1 0.00 $0.00 Y
N 92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA) 31.01 $25.43 --- $32.25 007 1 1 0.00 $0.00 Y
N 92582 CONDITIONING PLAY AUDIOMETRY 38.06 $38.06 --- -- 009 0 1 0.00 $0.00 Y
N 92585 AUDITOR EVOKE POTENT COMPRE 123.15 $123.15 --- -- 009 0 1 0.35 $0.00 Y
N 92586 AUDITOR EVOKE POTENT LIMIT 81.08 $66.49 --- $84.32 007 1 0 0.00 $0.00 Y
N 92587 EVOKED AUDITORY TEST LIMITED 4.10 $41.00 $44.73 $50.92 053 1 0 0.15 $0.00 Y
N 92588 COMPREHENSIVE OR DIAGNOSTIC EVAL 62.51 $51.26 --- $65.01 007 1 0 0.30 $0.00 Y
N 92590 HEARING AID EXAM ONE EAR 41.90 $34.36 --- $43.58 007 1 1 0.00 $0.00 Y
N 92591 HEARING AID EXAM BOTH EARS 41.90 $34.36 --- $43.58 007 1 1 0.00 $0.00 Y
N 92594 ELECTRO HEARNG AID TEST ONE 20.32 $20.32 --- -- 009 0 1 0.00 $0.00 Y
N 92595 ELECTRO HEARNG AID TST BOTH 37.30 $37.30 --- -- 009 0 1 0.00 $0.00 Y
N 92597 ORAL SPEECH DEVICE EVAL 99.87 $81.89 --- $103.86 007 1 1 0.00 $0.00 Y
N 92601 COCHLEAR IMPLT F/UP EXAM <7 140.16 $114.93 --- -- 007 0 0 0.00 $0.00 Y
N 92602 REPROGRAM COCHLEAR IMPLT <7 98.24 $80.56 --- -- 007 0 0 0.00 $0.00 Y
N 92603 COCHLEAR IMPLT F/UP EXAM 7/> 94.29 $77.32 --- -- 007 0 0 0.00 $0.00 Y
N 92604 REPROGRAM COCHLEAR IMPLT 7/> 64.24 $52.68 --- -- 007 0 0 0.00 $0.00 Y
N 92605 EX FOR NONSPEECH DEVICE RX 42.39 $34.76 --- $44.09 007 1 1 0.00 $0.00 Y
N 92606 NONSPEECH DEVICE SERVICE 42.39 $34.76 --- -- 007 0 0 0.00 $0.00 Y
N 92607 EX FOR SPEECH DEVICE RX 1HR 117.04 $95.97 --- $121.72 007 1 1 0.00 $0.00 Y
N 92608 EX FOR SPEECH DEVICE RX ADDL 22.93 $18.80 --- -- 007 0 0 0.00 $0.00 Y
N 92609 USE OF SPEECH DEVICE SERVICE 63.35 $51.95 --- -- 007 0 0 0.00 $0.00 Y
N 92610 EVALUATE SWALLOWING FUNCTION 59.49 $48.78 --- $61.87 007 1 1 0.00 $0.00 Y
N 92611 MOTION FLUOROSCOPY/SWALLOW 48.72 $39.95 --- $50.67 007 1 1 0.00 $0.00 Y
N 92612 ENDOSCOPY SWALLOW (FEES) VID 140.15 $114.92 --- -- 007 0 0 0.00 $0.00 Y
N 92613 ENDOSCOPY SWALLOW (FEES) I&R 41.13 $33.73 --- -- 007 0 0 0.00 $0.00 Y
N 92614 LARYNGOSCOPIC SENSORY VID 104.51 $85.70 --- -- 007 0 0 0.00 $0.00 Y
N 92615 LARYNGOSCOPIC SENSORY I&R 34.46 $28.26 --- -- 007 0 0 0.00 $0.00 Y
N 92616 FEES W/LARYNGEAL SENSE TEST 144.41 $118.42 --- -- 007 0 0 0.00 $0.00 Y
N 92617 FEES W/LARYNGEAL SENSE I&R 45.70 $37.47 --- -- 007 0 0 0.00 $0.00 Y
N 92618 EX FOR NONSPEECH DEV RX ADD 33.59 $27.54 --- -- 007 0 0 0.00 $0.00 Y
N 92620 AUDITORY FUNCTION 60 MIN 49.70 $40.75 --- $51.69 007 1 1 0.00 $0.00 Y
N 92621 AUDITORY FUNCTION + 15 MIN 12.33 $10.11 --- $12.82 007 1 1 0.00 $0.00 Y
N 92625 TINNITUS ASSESSMENT 48.87 $40.07 --- $50.82 007 1 1 0.00 $0.00 Y
N 92626 EVAL AUD FUNCJ 1ST HOUR 24.45 $20.05 --- -- 007 0 1 0.00 $0.00 Y
N 92627 EVAL AUD FUNCJ EA ADDL 15 24.45 $20.05 --- -- 007 0 1 0.00 $0.00 Y
N 92630 AUD REHAB PRELING HEAR LOSS 0.00 $0.00 --- -- 007 0 1 0.00 $0.00 Y
N 92633 AUD REHAB POSTLING HEAR LOSS 0.00 $0.00 --- -- 007 0 1 0.00 $0.00 Y
N 92700 ENT PROCEDURE/SERVICE 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92920 PRQ CARDIAC ANGIOPLAST 1 ART 530.64 $435.12 --- -- 007 0 0 0.00 $0.00 Y
N 92921 PRQ CARDIAC ANGIO ADDL ART 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92924 PRQ CARD ANGIO/ATHRECT 1 ART 630.81 $517.26 --- -- 007 0 0 0.00 $0.00 Y
N 92925 PRQ CARD ANGIO/ATHRECT ADDL 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92928 PRQ CARD STENT W/ANGIO 1 VSL 589.08 $483.05 --- -- 007 0 0 0.00 $0.00 Y
N 92929 PRQ CARD STENT W/ANGIO ADDL 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92933 PRQ CARD STENT/ATH/ANGIO 658.72 $540.15 --- -- 007 0 0 0.00 $0.00 Y
N 92934 PRQ CARD STENT/ATH/ANGIO 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92937 PRQ REVASC BYP GRAFT 1 VSL 588.36 $482.46 --- -- 007 0 0 0.00 $0.00 Y
N 92938 PRQ REVASC BYP GRAFT ADDL 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92941 PRQ CARD REVASC MI 1 VSL 659.98 $541.18 --- -- 007 0 0 0.00 $0.00 Y
N 92943 PRQ CARD REVASC CHRONIC 1VSL 659.98 $541.18 --- -- 007 0 0 0.00 $0.00 Y
N 92944 PRQ CARD REVASC CHRONIC ADDL 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 92950 HEART/LUNG RESUSCITATION CPR 11.50 $115.00 $125.47 $142.83 053 1 0 0.00 $0.00 Y
N 92953 TEMPORARY EXTERNAL PACING 24.88 $20.40 --- $25.88 007 1 1 0.00 $0.00 Y
N 92960 CARDIOVERSION ELECTRIC EXT 122.46 $122.46 --- -- 009 0 0 0.00 $0.00 Y
N 92961 CARDIOVERSION ELECTRIC INT 210.71 $172.78 --- $219.14 007 1 0 0.00 $0.00 Y
N 92970 CARDIOASSIST INTERNAL 229.87 $188.49 --- $239.06 007 1 0 0.00 $0.00 Y
N 92971 CARDIOASSIST EXTERNAL 96.63 $79.24 --- $100.50 007 1 0 0.00 $0.00 Y
N 92973 PRQ CORONARY MECH THROMBECT 178.91 $146.71 --- $186.07 007 1 0 0.00 $0.00 Y
N 92974 CATH PLACE CARDIO BRACHYTX 194.11 $159.17 --- $201.87 007 1 0 0.00 $0.00 Y
N 92975 DISSOLVE CLOT HEART VESSEL 410.72 $336.79 --- $427.15 007 1 0 0.00 $0.00 Y
N 92977 DISSOLVE CLOT HEART VESSEL 304.18 $249.43 --- $316.35 007 1 0 0.00 $0.00 Y
N 92978 ENDOLUMINL IVUS OCT C 1ST 58.95 $225.19 --- -- 005 0 0 0.37 $0.00 Y
N 92979 ENDOLUMINL IVUS OCT C EA 36.07 $137.79 --- -- 005 0 0 0.48 $0.00 Y
N 92986 REVISION OF AORTIC VALVE 1177.90 $965.88 --- $1225.02 007 1 0 0.00 $0.00 Y
O 92986 REVISION OF AORTIC VALVE 235.59 $193.18 --- $245.01 007 1 0 0.00 $0.00 Y
O 92987 PERCUTANEOUS BALLOON VALVULOPLASTY VALVE 254.60 $208.77 --- $264.78 007 1 0 0.00 $0.00 Y
N 92987 PERCUTANEOUS BALLOON VALVULOPLASTY VALVE 1272.99 $1043.85 --- $1323.91 007 1 0 0.00 $0.00 Y
N 92990 REVISION OF PULONARY VALVE 998.80 $819.02 --- $1038.75 007 1 0 0.00 $0.00 Y
O 92990 REVISION OF PULMONARY VALVE 199.76 $163.80 --- $207.75 007 1 0 0.00 $0.00 Y
N 92992 REVISION OF HEART CHAMBER 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 92993 ATRIAL SEPTECTOMY OR SEPTOSTOMY 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 92997 PUL ART BALLOON REPR PERCUT 664.40 $544.81 --- -- 007 0 0 0.00 $0.00 Y
N 92998 PUL ART BALLOON REPR PERCUT 345.99 $283.71 --- -- 007 0 0 0.00 $0.00 Y
N 93000 ELECTROCARDIOGRAM COMPLETE 35.00 $28.70 --- $36.40 007 1 1 0.00 $0.00 Y
N 93005 ELECTROCARDIOGRAM TRACING 20.00 $16.40 --- $20.80 007 1 1 0.00 $0.00 Y
1 93005 ELECTROCARDIOGRAM TRACING 7.43 $7.43 --- $7.43 009 1 1 0.00 $0.00 Y
N 93010 ELECTROCARDIOGRAM REPORT 15.00 $12.30 --- $15.60 007 1 1 0.00 $0.00 Y
N 93015 CARDIOVASCULAR STRESS TEST 116.96 $95.91 --- $121.64 007 1 1 0.00 $0.00 Y
N 93016 CARDIOVASCULAR STRESS TEST 29.96 $24.57 --- $31.16 007 1 0 0.00 $0.00 Y
N 93017 CARDIOVASCULAR STRESS TEST 64.02 $52.50 --- $66.58 007 1 1 0.00 $0.00 Y
N 93018 CARDIOVASCULAR STRESS TEST 22.98 $18.84 --- $23.90 007 1 1 0.00 $0.00 Y
N 93024 CARDIAC DRUG STRESS TEST 127.48 $104.53 --- $132.58 007 1 0 0.70 $0.00 Y
N 93025 MICROVOLT T-WAVE ASSESS 284.49 $233.28 --- -- 007 0 0 0.70 $0.00 Y
N 93040 RHYTHM ECG WITH REPORT 15.94 $13.07 --- $16.58 007 1 1 0.00 $0.00 Y
N 93041 RHYTHM ECG TRACING 6.26 $5.13 --- $6.51 007 1 1 0.00 $0.00 Y
1 93041 RHYTHM ECG TRACING 16.07 $16.07 --- $16.07 009 1 1 0.00 $0.00 Y
N 93042 RHYTHM ECG REPORT 10.40 $8.53 --- $10.82 007 1 1 0.00 $0.00 Y
N 93050 ART PRESSURE WAVEFORM ANALYS 18.76 $15.38 --- -- 007 0 0 0.47 $0.00 Y
N 93224 ECG MONIT/REPRT UP TO 48 HRS 135.17 $110.84 --- -- 007 0 0 0.00 $0.00 Y
N 93225 ECG MONIT/REPRT UP TO 48 HRS 36.37 $29.82 --- -- 007 0 0 0.00 $0.00 Y
N 93226 ECG MONIT/REPRT UP TO 48 HRS 68.22 $55.94 --- -- 007 0 0 0.00 $0.00 Y
N 93227 ECG MONIT/REPRT UP TO 48 HRS 30.59 $25.08 --- -- 007 0 0 0.00 $0.00 Y
N 93228 REMOTE 30 DAY ECG REV/REPORT 26.28 $21.55 --- -- 007 0 0 0.00 $0.00 Y
N 93229 REMOTE 30 DAY ECG TECH SUPP 823.12 $674.96 --- -- 007 0 0 0.00 $0.00 Y
N 93260 PRGRMG DEV EVAL IMPLTBL SYS 72.01 $59.05 --- -- 007 0 0 0.65 $0.00 Y
N 93261 INTERROGATE SUBQ DEFIB 66.01 $54.13 --- -- 007 0 0 0.62 $0.00 Y
N 93264 REM MNTR WRLS P-ART PRS SNR 54.54 $44.72 --- -- 007 0 0 0.00 $0.00 Y
N 93268 ECG RECORD/REVIEW 172.49 $141.44 --- -- 007 0 0 0.00 $0.00 Y
N 93270 REMOTE 30 DAY ECG REV/REPORT 36.37 $29.82 --- -- 007 0 0 0.00 $0.00 Y
N 93271 ECG/MONITORING AND ANALYSIS 97.32 $79.80 --- -- 007 0 0 0.00 $0.00 Y
N 93272 ECG/REVIEW INTERPRET ONLY 26.52 $21.75 --- -- 007 0 0 0.00 $0.00 Y
N 93278 ECG/SIGNAL - AVERAGED 32.82 $26.91 --- -- 007 0 0 0.39 $0.00 Y
N 93279 PM DEVICE PROGR EVAL SNGL 59.50 $48.79 --- -- 007 0 0 0.63 $0.00 Y
N 93280 PM DEVICE PROGR EVAL DUAL 70.62 $57.91 --- -- 007 0 0 0.64 $0.00 Y
N 93281 PM DEVICE PROGR EVAL MULTI 82.55 $67.69 --- -- 007 0 0 0.64 $0.00 Y
N 93282 ICD DEVICE PROGR EVAL 1 SNGL 76.04 $62.35 --- -- 007 0 0 0.65 $0.00 Y
N 93283 ICD DEVICE PROGR EVAL DUAL 92.56 $75.90 --- -- 007 0 0 0.67 $0.00 Y
N 93284 ICD DEVICE PROGR EVAL MULT 108.45 $88.93 --- -- 007 0 0 0.68 $0.00 Y
N 93285 ILR DEVICE EVAL PROGR 51.50 $42.23 --- -- 007 0 0 0.60 $0.00 Y
N 93286 PERI-PX PACEMAKER DEVICE EVL 29.07 $23.84 --- -- 007 0 0 0.53 $0.00 Y
N 93287 PERI-PX ICD DEVICE EVAL&PRGR 38.04 $31.19 --- -- 007 0 0 0.60 $0.00 Y
N 93288 PM DEVICE EVAL IN PERSON 46.37 $38.02 --- -- 007 0 0 0.54 $0.00 Y
N 93289 ICD DEVICE INTERROGATE 70.98 $58.20 --- -- 007 0 0 0.64 $0.00 Y
N 93290 ICM DEVICE EVAL 33.41 $27.40 --- -- 007 0 0 0.65 $0.00 Y
N 93291 ILR DEVICE INTERROGATE 44.30 $36.33 --- -- 007 0 0 0.58 $0.00 Y
N 93292 WCD DEVICE INTERROGATE 44.66 $36.62 --- -- 007 0 0 0.57 $0.00 Y
N 93293 PM PHONE R-STRIP DEVICE EVAL 64.40 $52.81 --- -- 007 0 0 0.27 $0.00 Y
N 93294 PM DEVICE INTERROGATE REMOTE 38.22 $31.34 --- -- 007 0 0 0.00 $0.00 Y
N 93295 ICD DEVICE INTERROGAT REMOTE 69.22 $56.76 --- -- 007 0 0 0.00 $0.00 Y
N 93296 PM/ICD REMOTE TECH SERV 41.41 $33.96 --- -- 007 0 0 0.00 $0.00 Y
N 93297 ICM DEVICE INTERROGAT REMOTE 26.28 $21.55 --- -- 007 0 0 0.00 $0.00 Y
N 93298 ILR DEVICE INTERROGAT REMOTE 30.82 $25.27 --- -- 007 0 0 0.00 $0.00 Y
N 93303 ECHO TRANSTHORACIC 186.16 $152.65 --- $193.61 007 1 0 0.36 $0.00 Y
N 93304 ECHO TRANSTHORACIC 101.80 $83.48 --- $105.87 007 1 0 0.41 $0.00 Y
N 93306 TTE W/DOPPLER COMPLETE 292.39 $239.76 --- -- 007 0 0 0.26 $0.00 Y
N 93307 TTE W/O DOPPLER COMPLETE 183.05 $150.10 --- -- 007 0 0 0.40 $0.00 Y
N 93308 TTE F-UP OR LMTD 91.52 $75.05 --- -- 007 0 0 0.40 $0.00 Y
N 93312 ECHO TRANSESOPHAGEAL 189.93 $155.74 --- -- 007 0 0 0.75 $0.00 Y
N 93315 ECHO TRANSESOPHAGEAL 235.65 $193.23 --- -- 007 0 0 0.75 $0.00 Y
N 93318 ECHO TRANSESOPHAGEAL INTRAOP 312.19 $256.00 --- -- 007 0 0 0.75 $0.00 Y
N 93320 DOPPLER ECHO EXAM HEART 93.38 $76.57 --- $97.12 007 1 0 0.40 $0.00 Y
N 93321 DOPPLER ECHO EXAM HEART 47.49 $38.94 --- $49.39 007 1 0 0.40 $0.00 Y
N 93325 DOPPLER COLOR FLOW ADD-ON 94.98 $77.88 --- $98.78 007 1 0 0.03 $0.00 Y
N 93350 STRESS TTE ONLY 117.22 $96.12 --- -- 007 0 0 0.50 $0.00 Y
N 93351 STRESS TTE COMPLETE 301.57 $247.29 --- -- 007 0 0 0.50 $0.00 Y
N 93352 ADMIN ECG CONTRAST AGENT 42.40 $34.77 --- -- 007 0 0 0.00 $0.00 Y
N 93355 ECHO TRANSESOPHAGEAL (TEE) 235.68 $193.26 --- -- 007 0 0 0.00 $0.00 Y
N 93356 MYOCRD STRAIN IMG SPCKL TRCK 44.74 $36.69 --- -- 007 0 0 0.00 $0.00 Y
N 93451 RIGHT HEART CATH 851.99 $698.63 --- $886.07 007 1 0 0.17 $0.00 Y
N 93452 LEFT HRT CATH W/VENTRCLGRPHY 930.32 $762.86 --- $967.53 007 1 0 0.28 $0.00 Y
N 93453 R&L HRT CATH W/VENTRICLGRPHY 1217.61 $998.44 --- $1266.31 007 1 0 0.28 $0.00 Y
N 93454 CORONARY ARTERY ANGIO S&I 960.55 $787.65 --- $998.97 007 1 0 0.27 $0.00 Y
N 93455 CORONARY ART/GRFT ANGIO S&I 1121.33 $919.49 --- $1166.18 007 1 0 0.27 $0.00 Y
N 93456 R HRT CORONARY ARTERY ANGIO 1201.23 $985.01 --- $1249.28 007 1 0 0.28 $0.00 Y
N 93457 R HRT ART/GRFT ANGIO 1361.88 $1116.74 --- $1416.36 007 1 0 0.28 $0.00 Y
N 93458 L HRT ARTERY/VENTRICLE ANGIO 1158.55 $950.01 --- $1204.89 007 1 0 0.27 $0.00 Y
N 93459 L HRT ART/GRFT ANGIO 1278.74 $1048.57 --- $1329.89 007 1 0 0.28 $0.00 Y
N 93460 R&L HRT ART/VENTRICLE ANGIO 1366.21 $1120.29 --- $1420.86 007 1 0 0.29 $0.00 Y
N 93461 R&L HRT ART/VENTRICLE ANGIO 1567.79 $1285.59 --- $1630.50 007 1 0 0.28 $0.00 Y
N 93462 L HRT CATH TRNSPTL PUNCTURE 201.39 $165.14 --- $209.45 007 1 0 0.00 $0.00 Y
N 93463 DRUG ADMIN & HEMODYNMIC MEAS 107.26 $87.95 --- $111.55 007 1 0 0.00 $0.00 Y
N 93464 EXERCISE W/HEMODYNAMIC MEAS 274.16 $224.81 --- $285.13 007 1 0 0.34 $0.00 Y
N 93503 RIGHT HEART CATHETERIZATION 154.85 $126.98 --- $161.04 007 1 0 0.00 $0.00 Y
N 93505 BIOPSY OF HEART LINING 289.95 $237.76 --- $301.55 007 1 0 0.78 $0.00 Y
N 93530 RT HEART CATH CONGENITAL 676.09 $554.39 --- $703.13 007 1 0 0.31 $0.00 Y
N 93531 R & L HEART CATH CONGENITAL 1694.00 $1389.08 --- $1761.76 007 1 0 0.21 $0.00 Y
N 93532 R & L HEART CATH CONGENITAL 1352.80 $1109.30 --- $1406.91 007 1 0 0.26 $0.00 Y
N 93533 R & L HEART CATH CONGENITAL 1545.37 $1267.20 --- $1607.18 007 1 0 0.16 $0.00 Y
N 93561 CARDIAC OUTPUT MEASUREMENT 50.00 $41.00 --- $52.00 007 1 0 0.76 $0.00 N
N 93562 CARD OUTPUT MEASURE SUBSQ 21.62 $17.73 --- $22.48 007 1 0 0.72 $0.00 N
N 93563 INJECT CONGENITAL CARD CATH 57.20 $46.90 --- $59.49 007 1 0 0.00 $0.00 Y
N 93564 INJECT HRT CONGNTL ART/GRFT 58.09 $47.63 --- $60.41 007 1 0 0.00 $0.00 Y
N 93565 INJECT L VENTR/ATRIAL ANGIO 43.94 $36.03 --- $45.70 007 1 0 0.00 $0.00 Y
N 93566 INJECT R VENTR/ATRIAL ANGIO 188.65 $154.69 --- $196.20 007 1 0 0.00 $0.00 Y
N 93567 INJECT SUPRVLV AORTOGRAPHY 113.66 $93.20 --- $118.21 007 1 0 0.00 $0.00 Y
N 93568 INJECT PULM ART HRT CATH 113.66 $93.20 --- $118.21 007 1 0 0.00 $0.00 Y
N 93571 HEART FLOW RESERVE MEASURE 296.11 $242.81 --- $307.95 007 1 0 0.33 $0.00 Y
N 93572 HEART FLOW RESERVE MEASURE 274.11 $224.77 --- -- 007 0 0 0.28 $0.00 Y
N 93580 TRANSCATH CLOSURE OF ASD 736.49 $603.92 --- -- 007 0 0 0.00 $0.00 Y
N 93581 TRANSCATH CLOSURE OF VSD 927.71 $760.72 --- -- 007 0 0 0.00 $0.00 Y
N 93582 PERQ TRANSCATH CLOSURE PDA 689.35 $565.26 --- -- 007 0 0 0.00 $0.00 Y
N 93583 PERQ TRANSCATH SEPTAL REDUXN 613.67 $503.21 --- -- 007 0 0 0.00 $0.00 Y
N 93590 PERQ TRANSCATH CLS MITRAL 1006.03 $1006.03 --- -- 009 0 0 0.00 $0.00 Y
N 93591 PERQ TRANSCATH CLS AORTIC 835.12 $835.12 --- -- 009 0 0 0.00 $0.00 Y
N 93592 PERQ TRANSCATH CLOSURE EACH 367.38 $367.38 --- -- 009 0 0 0.00 $0.00 Y
N 93600 BUNDLE OF HIS RECORDING 199.33 $163.45 --- $207.30 007 1 0 0.72 $0.00 Y
N 93602 INTRA-ATRIAL RECORDING 129.12 $105.88 --- $134.28 007 1 0 0.77 $0.00 Y
N 93603 RIGHT VENTRICULAR RECORDING 194.28 $159.31 --- $202.05 007 1 0 0.71 $0.00 Y
N 93609 MAP TACHYCARDIA ADD-ON 358.49 $293.96 --- $372.83 007 1 0 0.82 $0.00 Y
N 93610 INTRA-ATRIAL PACING 129.12 $105.88 --- $134.28 007 1 0 0.79 $0.00 Y
N 93612 INTRAVENTRICULAR PACING 129.12 $105.88 --- $134.28 007 1 0 0.76 $0.00 Y
N 93613 ELECTROPHYS MAP 3D ADD-ON 381.15 $312.54 --- -- 007 0 0 0.76 $0.00 Y
N 93615 ESOPHAGEAL RECORDING 100.00 $82.00 --- $104.00 007 1 0 0.80 $0.00 Y
N 93616 ESOPHAGEAL RECORDING WITH PACING 114.00 $93.48 --- $118.56 007 1 0 0.90 $0.00 Y
N 93618 HEART RHYTHM PACING 215.76 $176.92 --- $224.39 007 1 0 0.71 $0.00 Y
N 93619 ELECTROPHYSIOLOGY EVALUATION 727.39 $596.46 --- $756.49 007 1 0 0.70 $0.00 Y
N 93620 ELECTROPHYSIOLOGY EVALUATION 852.85 $699.34 --- $886.96 007 1 0 0.73 $0.00 Y
N 93621 ELECTROPHYSIOLOGY EVALUATION 852.85 $699.34 --- $886.96 007 1 0 0.70 $0.00 Y
N 93622 ELECTROPHYSIOLOGY EVALUATION 852.85 $699.34 --- $886.96 007 1 0 0.70 $0.00 Y
N 93623 STIMULATION PACING HEART 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 93624 ELECTROPHYSIOLOGIC STUDY 348.32 $285.62 --- $362.25 007 1 0 0.79 $0.00 Y
N 93631 HEART PACING MAPPING 684.94 $561.65 --- $712.34 007 1 0 0.67 $0.00 Y
N 93640 EVALUATION HEART DEVICE 589.52 $483.41 --- $613.10 007 1 0 0.59 $0.00 Y
N 93641 ELECTROPHYSIOLOGY EVALUATION 662.27 $543.06 --- $688.76 007 1 0 0.64 $0.00 Y
N 93642 ELECTROPHYSIOLOGY EVALUATION 640.06 $524.85 --- $665.66 007 1 0 0.63 $0.00 Y
N 93644 ELECTROPHYSIOLOGY EVALUATION 317.85 $260.64 --- $330.56 007 1 0 0.62 $0.00 Y
N 93650 ABLATE HEART DYSRHYTHM FOCUS 872.82 $715.71 --- $907.73 007 1 0 0.00 $0.00 Y
N 93653 EP & ABLATE SUPRAVENT ARRHYT 804.22 $659.46 --- $836.39 007 1 0 0.00 $0.00 Y
N 93654 EP & ABLATE VENTRIC TACHY 1073.44 $880.22 --- $1116.38 007 1 0 0.00 $0.00 Y
N 93655 ABLATE ARRHYTHMIA ADD ON 402.20 $329.80 --- $418.29 007 1 0 0.00 $0.00 Y
N 93656 TX ATRIAL FIB PULM VEIN ISOL 1073.74 $880.47 --- $1116.69 007 1 0 0.00 $0.00 Y
N 93657 TX L/R ATRIAL FIB ADDL 402.40 $329.97 --- $418.50 007 1 0 0.00 $0.00 Y
N 93660 TILT TABLE EVALUATION 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 93662 INTRACARDIAC ECG (ICE) 329.95 $270.56 --- $343.15 007 1 0 0.49 $0.00 Y
N 93702 BIS XTRACELL FLUID ANALYSIS 128.21 $105.13 --- -- 007 0 0 0.00 $0.00 Y
N 93724 ELECT ANALYSIS OF ANTITACH PACEMAKER SYS 335.34 $274.98 --- $348.75 007 1 0 0.65 $0.00 Y
N 93745 SET-UP CARDIOVERT-DEFIBRILL 90.52 $74.23 --- $94.14 007 1 1 0.00 $0.00 Y
N 93750 INTERROGATION VAD IN PERSON 54.01 $44.29 --- -- 007 0 0 0.00 $0.00 Y
N 93784 AMBL BP MNTR W/SOFTWARE 59.03 $48.40 --- -- 007 0 0 0.00 $0.00 Y
N 93786 AMBL BP MNTR W/SW REC ONLY 33.40 $27.39 --- -- 007 0 0 0.00 $0.00 Y
N 93788 AMBL BP MNTR W/SW A/R 5.87 $4.81 --- -- 007 0 0 0.00 $0.00 Y
N 93790 AMBL BP MNTR W/SW I&R 19.70 $16.15 --- -- 007 0 0 0.00 $0.00 Y
N 93793 ANTICOAG MGMT PT WARFARIN 10.53 $10.53 --- -- 007 0 0 0.00 $0.00 Y
N 93797 CARDIAC REHAB 17.64 $14.46 --- -- 007 0 0 0.00 $0.00 Y
N 93798 CARDIAC REHAB/MONITOR 27.14 $22.25 --- -- 007 0 0 0.00 $0.00 Y
N 93799 CARDIOVASCULAR PROCEDURE 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
P 93799 CARDIOVASCULAR PROCEDURE 0.00 $0.00 --- -- 019 0 0 0.00 $0.00 Y
N 93880 EXTRACRANIAL BILAT STUDY 191.02 $156.64 --- $198.66 007 1 1 0.25 $0.00 Y
N 93882 EXTRACRANIAL UNI/LTD STUDY 92.98 $76.24 --- $96.70 007 1 1 0.14 $0.00 Y
N 93886 INTRACRANIAL COMPLETE STUDY 238.88 $195.88 --- $248.44 007 1 1 0.21 $0.00 Y
N 93888 INTRACRANIAL LIMITED STUDY 158.73 $130.16 --- $165.08 007 1 1 0.21 $0.00 Y
N 93890 TCD VASOREACTIVITY STUDY 257.61 $211.24 --- $267.91 007 1 1 0.40 $0.00 Y
N 93892 TCD EMBOLI DETECT W/O INJ 274.24 $224.88 --- $285.21 007 1 1 0.40 $0.00 Y
N 93893 TCD EMBOLI DETECT W/INJ 268.79 $220.41 --- $279.54 007 1 1 0.40 $0.00 Y
N 93922 UPR/L XTREMITY ART 2 LEVELS 63.54 $52.10 --- $66.08 007 1 0 0.32 $0.00 Y
N 93923 UPR/LXTR ART STDY 3+ LVLS 118.73 $97.36 --- $123.48 007 1 0 0.31 $0.00 Y
N 93924 LWR XTR VASC STDY BILAT 129.78 $106.42 --- $134.97 007 1 0 0.31 $0.00 Y
N 93925 LOWER EXTREMITY STUDY 118.13 $96.87 --- $122.86 007 1 1 0.25 $0.00 Y
P 93925 LOWER EXTREMITY STUDY 118.13 $96.87 --- -- 019 0 1 0.25 $0.00 Y
P 93926 DUPLEX SCAN LOWER EXTREMITY ARTERIES OR 103.52 $84.89 --- -- 019 0 1 0.14 $0.00 Y
N 93926 DUPLEX SCAN LOWER EXTREMITY ARTERIES OR 103.52 $84.89 --- $107.66 007 1 1 0.14 $0.00 Y
N 93930 UPPER EXTREMITY STUDY 113.43 $93.01 --- $117.97 007 1 1 0.21 $0.00 Y
N 93931 DUPLEX SCAN UPPER EXTREMITY ARTERIES OR 101.05 $82.86 --- $105.09 007 1 1 0.21 $0.00 Y
N 93970 EXTREMITY STUDY 205.17 $168.24 --- $213.38 007 1 1 0.28 $0.00 Y
N 93971 DUPLEX SCAN EXTREMITY VEINS INC RESPONSE 103.12 $84.56 --- $107.24 007 1 1 0.16 $0.00 Y
N 93975 VISCERAL VASCULAR STUDY 229.07 $187.84 --- $238.23 007 1 1 0.35 $0.00 Y
N 93976 DUPLEX SCAN ARTER INFLW/VENOUS OUTFLW AB 188.68 $154.72 --- $196.23 007 1 1 0.21 $0.00 Y
N 93978 VISCERAL VASCULAR STUDY 200.18 $164.15 --- $208.19 007 1 1 0.27 $0.00 Y
N 93979 DUPLEX STDY AORTA,INF VENA CAVA,ILIAC VA 96.74 $79.33 --- $100.61 007 1 1 0.15 $0.00 Y
N 93980 PENILE VASCULAR STUDY 201.97 $165.62 --- $210.05 007 1 0 0.30 $0.00 Y
N 93981 PENILE VASCULAR STUDY 151.59 $124.30 --- $157.65 007 1 0 0.14 $0.00 Y
N 93985 DUP-SCAN HEMO COMPL BI STD 301.63 $247.34 --- -- 007 0 0 0.00 $0.00 Y
N 93986 DUP-SCAN HEMO COMPL UNI STD 174.36 $142.98 --- -- 007 0 0 0.00 $0.00 Y
N 93990 DUPLEX SCAN OF HEMODIALYSIS ACCESS 87.50 $71.75 --- $91.00 007 1 1 0.14 $0.00 Y
N 93998 NONINVAS VASC DX STUDY PROC 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 94002 VENT MGMT INPAT INIT DAY 4.48 $44.80 $48.88 -- 053 0 0 0.00 $0.00 Y
N 94003 VENT MGMT INPAT SUBQ DAY 3.53 $35.30 $38.51 -- 053 0 0 0.00 $0.00 Y
N 94010 BREATHING CAPACITY TEST 30.00 $24.60 --- $31.20 007 1 1 0.40 $0.00 Y
N 94011 SPIROMETRY UP TO 2 YRS OLD 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 94012 SPIRMTRY W/BRNCHDIL INF-2 YR 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 94013 MEAS LUNG VOL THRU 2 YRS 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 94014 PATIENT RECORDED SPIROMETRY 46.23 $37.91 --- $48.08 007 1 0 0.00 $0.00 Y
N 94015 PATIENT RECORDED SPIROMETRY 17.60 $14.43 --- $18.30 007 1 0 0.00 $0.00 Y
N 94016 REVIEW PATIENT SPIROMETRY 28.63 $23.48 --- $29.78 007 1 0 0.00 $0.00 Y
N 94060 EVALUATION OF WHEEZING 54.91 $45.03 --- $57.11 007 1 1 0.40 $0.00 Y
N 94150 VITAL CAPACITY TEST 6.79 $5.57 --- $7.06 007 1 0 0.40 $0.00 Y
N 94200 LUNG FUNCTION TEST (MBC/MVV) 20.00 $16.40 --- $20.80 007 1 0 0.40 $0.00 Y
N 94250 EXPIRED GAS COLLECTION 8.27 $6.78 --- $8.60 007 1 1 0.40 $0.00 Y
N 94375 RESPIRATORY FLOW VOLUME LOOP 28.32 $23.22 --- $29.45 007 1 0 0.40 $0.00 Y
N 94400 CO2 BREATHING RESPONSE CURVE 34.55 $28.33 --- $35.93 007 1 0 0.40 $0.00 N
N 94450 HYPOXIA RESPONSE CURVE 29.51 $24.20 --- $30.69 007 1 0 0.40 $0.00 Y
N 94617 EXERCISE TST BRNCSPSM 105.42 $86.45 --- -- 007 0 0 0.33 $0.00 Y
N 94618 PULMONARY STRESS TESTING 36.73 $30.12 --- -- 007 0 0 0.65 $0.00 Y
N 94621 PULM STRESS TEST/COMPLEX 121.48 $99.61 --- $126.34 007 1 0 0.42 $0.00 Y
N 94640 AIRWAY INHALATION TREATMENT 1.17 $11.70 $12.76 $14.53 053 1 0 0.00 $0.00 Y
N 94642 AEROSOL INHALATION OF PENTAMIDINE 8.59 $85.90 $93.72 $106.69 053 1 0 0.00 $0.00 Y
N 94644 CBT 1ST HOUR 1.70 $17.00 $18.55 $21.11 053 1 0 0.00 $0.00 Y
N 94645 CBT EACH ADDL HOUR 1.24 $12.40 $13.53 $15.40 053 1 0 0.00 $0.00 Y
N 94660 POS AIRWAY PRESSURE CPAP 4.08 $40.80 $44.51 $50.67 053 1 1 0.00 $0.00 Y
N 94662 NEG PRESS VENTILATION CNP 2.80 $28.00 $30.55 $34.78 053 1 1 0.00 $0.00 Y
N 94664 EVALUATE PT USE OF INHALER 0.86 $8.60 $9.38 $10.68 053 1 1 0.00 $0.00 Y
N 94667 CHEST WALL MANIPULATION 1.99 $19.90 $21.71 $24.72 053 1 1 0.00 $0.00 Y
N 94668 CHEST WALL MANIPULATION 1.17 $11.70 $12.76 $14.53 053 1 1 0.00 $0.00 Y
N 94669 MECHANICAL CHEST WALL OSCILL 31.66 $25.96 --- -- 007 0 0 0.00 $0.00 Y
N 94680 EXHALED AIR ANALYSIS O2 50.00 $41.00 --- $52.00 007 1 1 0.40 $0.00 Y
N 94681 EXHALED AIR ANALYSIS O2/CO2 100.00 $82.00 --- $104.00 007 1 1 0.40 $0.00 Y
N 94690 EXHALED AIR ANALYSIS 18.12 $14.86 --- $18.84 007 1 1 0.40 $0.00 Y
N 94726 PULM FUNCT TST PLETHYSMOGRAP 58.65 $48.09 --- -- 007 0 0 0.21 $0.00 Y
N 94727 PULM FUNCTION TEST BY GAS 45.88 $37.62 --- -- 007 0 0 0.27 $0.00 Y
N 94728 AIRWY RESIST BY OSCILLOMETRY 45.88 $37.62 --- $47.72 007 1 0 0.27 $0.00 Y
N 94729 CO/MEMBANE DIFFUSE CAPACITY 58.78 $48.20 --- $61.13 007 1 0 0.14 $0.00 Y
N 94750 PULMONARY COMPLIANCE STUDY 19.34 $15.86 --- $20.11 007 1 0 0.40 $0.00 Y
N 94760 MEASURE BLOOD OXYGEN LEVEL 6.82 $5.59 --- $7.09 007 1 0 0.00 $0.00 Y
N 94770 EXHALED CARBON DIOXIDE TEST 21.26 $17.43 --- $22.11 007 1 0 0.45 $0.00 Y
N 94772 BREATH RECORDING INFANT 4.38 $43.80 $47.79 $54.40 001 1 1 0.00 $0.00 Y