Medi-Cal Rates Information

Medi-Cal Rates as of 11/15/2020 (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 TypeProc CodeProcedure DescriptionUnit ValueBasic RateChild RateER RateConv IndER IndCut-back IndProf %Rental RateNon-Physn. Med.Prac.Ind
M87850INFECT AGT DET BY IMMUNA WITH DIR OPTICA 10.10 $10.10 --- -- 009000.20 $0.00N
M87880INFECT AGT DET BY IMMUNO WITH DIR OPTICA 6.99 $6.99 --- -- 009000.20 $0.00N
M87899INFECT AGT DET BY IMMUNO WITH DIR OPTICA 4.87 $4.87 --- -- 009000.20 $0.00N
M87900PHENOTYPE INFECT AGENT DRUG 115.86 $115.86 --- -- 009000.20 $0.00Y
M87901GENOTYPE DNA HIV REVERSE T 228.84 $228.84 --- -- 009000.20 $0.00N
M87902GENOTYPE DNA/RNA HEP C 228.84 $228.84 --- -- 009000.20 $0.00N
M87903PHENOTYPE DNA HIV W/CULTURE 434.36 $434.36 --- -- 009000.20 $0.00N
M87904PHENOTYPE DNA HIV W/CLT ADD 23.17 $23.17 --- -- 009000.20 $0.00N
M87905SIALIDASE ENZYME ASSAY 10.86 $10.86 --- -- 009000.00 $0.00Y
M87906GENOTYPE DNA/RNA HIV 114.42 $114.42 --- -- 009000.20 $0.00N
M87910GENOTYPE CYTOMEGALOVIRUS 23.38 $23.38 --- -- 009000.20 $0.00N
M87912GENOTYPE DNA HEPATITIS B 23.38 $23.38 --- -- 009000.20 $0.00N
M87999MICROBIOLOGY PROCEDURE 0.00 $0.00 --- -- 009000.20 $0.00N
M88104CYTOPATH FL NONGYN SMEARS 25.82 $25.82 --- -- 009000.80 $0.00N
M88106CYTOPATH FL NONGYN FILTER 25.82 $25.82 --- -- 009000.80 $0.00N
M88108CYTOPATH CONCENTRATE TECH 28.92 $28.92 --- -- 009000.80 $0.00N
M88112CYTOPATH CELL ENHANCE TECH 60.92 $60.92 --- -- 009000.38 $0.00N
M88120CYTP URNE 3-5 PROBES EA SPEC 363.41 $363.41 --- -- 009000.89 $0.00N
M88121CYTP URINE 3-5 PROBES CMPTR 307.14 $307.14 --- -- 009000.88 $0.00N
M88130SEX CHROMATIN IDENTIFICATION 15.97 $15.97 --- -- 009000.80 $0.00N
M88140SEX CHROMATIN IDENTIFICATION 7.10 $7.10 --- -- 009000.80 $0.00N
M88141CYTOPATH C/V INTERPRET 10.53 $10.53 --- -- 009001.00 $0.00N
M88142CYTOPATH C/V THIN LAYER 18.00 $18.00 --- -- 009000.80 $0.00N
M88143CYTOPATH C/V THIN LAYER REDO 18.43 $18.43 --- -- 009000.80 $0.00N
M88147CYTOPATH C/V AUTOMATED 12.39 $12.39 --- -- 009000.80 $0.00N
M88148CYTOPATH C/V AUTO RESCREEN 13.50 $13.50 --- -- 009000.80 $0.00N
M88150CYTOPATH C/V MANUAL 11.50 $11.50 --- -- 009000.80 $0.00Y
M88152CYTOPATH C/V AUTO REDO 11.50 $11.50 --- -- 009000.80 $0.00N
M88153CYTOPATH C/V REDO 11.50 $11.50 --- -- 009000.80 $0.00N
M88155CYTOPATH C/V INDEX ADD-ON 6.52 $6.52 --- -- 009000.80 $0.00N
M88160CYTOPATH SMEAR OTHER SOURCE 31.95 $31.95 --- -- 009000.80 $0.00N
M88161CYTOPATH SMEAR OTHER SOURCE 20.66 $20.66 --- -- 009000.80 $0.00N
M88162CYTOPATH SMEAR OTHER SOURCE 48.70 $48.70 --- -- 009000.80 $0.00N
M88164CYTOPATH TBS C/V MANUAL 9.65 $9.65 --- -- 009000.80 $0.00N
M88165CYTOPATH TBS C/V REDO 11.50 $11.50 --- -- 009000.80 $0.00N
M88166CYTOPATH TBS C/V AUTO REDO 11.50 $11.50 --- -- 009000.80 $0.00N
M88167CYTOPATH TBS C/V SELECT 11.50 $11.50 --- -- 009000.80 $0.00N
M88172CYTP DX EVAL FNA 1ST EA SITE 28.29 $28.29 --- -- 009000.80 $0.00N
M88173CYTOPATH EVAL FNA REPORT 51.98 $51.98 --- -- 009000.80 $0.00N
M88174CYTOPATH C/V AUTO IN FLUID 18.29 $18.29 --- -- 009000.80 $0.00N
M88175CYTOPATH C/V AUTO FLUID REDO 23.50 $23.50 --- -- 009000.80 $0.00N
M88177CYTP FNA EVAL EA ADDL 21.74 $21.74 --- -- 009000.22 $0.00N
M88182CELL MARKER STUDY 87.98 $87.98 --- -- 009000.80 $0.00N
M88184FLOWCYTOMETRY/ TC 1 MARKER 42.18 $42.18 --- -- 009000.00 $0.00N
M88185FLOWCYTOMETRY/TC ADD-ON 20.68 $20.68 --- -- 009000.00 $0.00N
M88187FLOWCYTOMETRY/READ 2-8 32.96 $32.96 --- -- 009001.00 $0.00N
M88188FLOWCYTOMETRY/READ 9-15 55.88 $55.88 --- -- 009001.00 $0.00N
M88189FLOWCYTOMETRY/READ 16 & > 69.18 $69.18 --- -- 009001.00 $0.00N
M88199CYTOPATHOLOGY PROCEDURE 0.00 $0.00 --- -- 009000.80 $0.00N
M88230TISSUE CULTURE LYMPHOCYTE 100.98 $100.98 --- -- 009000.80 $0.00N
M88233TISSUE CULTURE SKIN/BIOPSY 125.08 $125.08 --- -- 009000.80 $0.00N
M88235TISSUE CULTURE PLACENTA 75.03 $75.03 --- -- 009000.80 $0.00N
M88237TISSUE CULTURE BONE MARROW 99.64 $99.64 --- -- 009000.80 $0.00N
M88239TISSUE CULTURE TUMOR 131.12 $131.12 --- -- 009000.80 $0.00N
M88240CELL CRYOPRESERVE/STORAGE 7.99 $7.99 --- -- 009000.80 $0.00Y
M88241FROZEN CELL PREPARATION 7.99 $7.99 --- -- 009000.80 $0.00Y
M88245CHROMOSOME ANALYSIS 20-25 151.72 $151.72 --- -- 009000.80 $0.00N
M88248CHROMOSOME ANALYSIS 50-100 153.93 $153.93 --- -- 009000.80 $0.00N
M88249CHROMOSOME ANALYSIS 100 153.93 $153.93 --- -- 009000.80 $0.00N
M88261CHROMOSOME ANALYSIS 5 190.00 $190.00 --- -- 009000.80 $0.00N
M88262CHROMOSOME ANALYSIS 15-20 107.81 $107.81 --- -- 009000.80 $0.00N
M88263CHROMOSOME ANALYSIS 45 133.59 $133.59 --- -- 009000.80 $0.00N
M88264CHROMOSOME ANALYSIS 20-25 115.68 $115.68 --- -- 009000.80 $0.00N
M88267CHROMOSOME ANALYS PLACENTA 159.80 $159.80 --- -- 009000.80 $0.00N
M88269CHROMOSOME ANALYS AMNIOTIC 147.84 $147.84 --- -- 009000.80 $0.00N
M88271CYTOGENETICS DNA PROBE 16.80 $16.80 --- -- 009000.80 $0.00N
M88272CYTOGENETICS 3-5 29.15 $29.15 --- -- 009000.80 $0.00N
M88273CYTOGENETICS 10-30 28.56 $28.56 --- -- 009000.80 $0.00N
M88274CYTOGENETICS 25-99 33.90 $33.90 --- -- 009000.80 $0.00N
M88275CYTOGENETICS 100-300 31.68 $31.68 --- -- 009000.80 $0.00N
M88280CHROMOSOME COUNT: ADDITIONAL 19.17 $19.17 --- -- 009000.80 $0.00N
M88283CHROMOSOME BANDING STUDY 9.71 $9.71 --- -- 009000.80 $0.00N
M88285CHROMOSOME COUNT ADDITIONAL 7.60 $7.60 --- -- 009000.80 $0.00N
M88289CHROMOSOME STUDY ADDITIONAL 12.08 $12.08 --- -- 009000.80 $0.00N
M88291CYTO/MOLECULAR REPORT 13.62 $13.62 --- -- 009001.00 $0.00N
M88299CYTOGENETIC STUDY 0.00 $0.00 --- -- 009000.80 $0.00N
M88300SURGICAL PATH GROSS 8.37 $8.37 --- -- 009000.80 $0.00N
M88302TISSUE EXAM BY PATHOLOGIST 20.94 $20.94 --- -- 009000.80 $0.00N
M88304TISSUE EXAM BY PATHOLOGIST 30.48 $30.48 --- -- 009000.80 $0.00Y
M88305TISSUE EXAM BY PATHOLOGIST 40.99 $40.99 --- -- 009000.80 $0.00Y
M88307TISSUE EXAM BY PATHOLOGIST 87.64 $87.64 --- -- 009000.80 $0.00N
M88309TISSUE EXAM BY PATHOLOGIST 185.47 $185.47 --- -- 009000.80 $0.00N
M88311DECALCIFY TISSUE 7.90 $7.90 --- -- 009000.80 $0.00Y
M88312SPECIAL STAINS GROUP 1 32.83 $32.83 --- -- 009000.80 $0.00Y
M88313SPECIAL STAINS GROUP 2 38.56 $38.56 --- -- 009000.80 $0.00Y
M88314HISTOCHEMICAL STAINS ADD-ON 43.23 $43.23 --- -- 009000.80 $0.00Y
M88319ENZYME HISTOCHEMISTRY 68.78 $68.78 --- -- 009000.80 $0.00N
M88321MICROSLIDE CONSULTATION 60.98 $60.98 --- -- 009001.00 $0.00N
M88323MICROSLIDE CONSULTATION 88.41 $88.41 --- -- 009000.80 $0.00N
M88325COMPREHENSIVE REVIEW OF DATA 101.51 $101.51 --- -- 009000.80 $0.00N
M88329PATH CONSULT INTROP 32.48 $32.48 --- -- 009000.80 $0.00Y
M88331PATH CONSULT INTRAOP 1 BLOC 44.52 $44.52 --- -- 009000.80 $0.00N
M88332PATH CONSULT INTRAOP ADDL 19.39 $19.39 --- -- 009000.80 $0.00N
M88333INTRAOP CYTO PATH CONSULT 1 79.42 $79.42 --- -- 009000.63 $0.00N
M88334INTRAOP CYTO PATH CONSULT 2 49.68 $49.68 --- -- 009000.80 $0.00N
M88341IMMUNOHISTO ANTB ADDL SLIDE 60.62 $60.62 --- -- 009000.31 $0.00N
M88342IMMUNOHISTO ANTB 1ST STAIN 53.79 $53.79 --- -- 009000.80 $0.00N
M88344IMMUNOHISTO ANTIBODY SLIDE 104.92 $104.92 --- -- 009000.33 $0.00N
M88346IMMUNOFLUOR ANTB 1ST STAIN 56.05 $56.05 --- -- 009000.80 $0.00N
M88348ELECTRON MICROSCOPY 237.71 $237.71 --- -- 009000.80 $0.00N
M88350IMMUNOFLUOR ANTB ADDL STAIN 64.66 $64.66 --- -- 009000.38 $0.00N
M88355ANALYSIS SKELETAL MUSCLE 117.31 $117.31 --- -- 009000.80 $0.00N
M88356ANALYSIS NERVE 180.81 $180.81 --- -- 009000.80 $0.00N
M88358ANALYSIS TUMOR 66.78 $66.78 --- -- 009000.80 $0.00N
M88360TUMOR IMMUNOHISTOCHEM/MANUAL 56.74 $56.74 --- -- 009000.80 $0.00N
M88361TUMOR IMMUNOHISTOCHEM/COMPUT 80.16 $80.16 --- -- 009000.80 $0.00N
M88362NERVE TEASING PREPARATIONS 180.51 $180.51 --- -- 009000.80 $0.00N
M88363XM ARCHIVE TISSUE MOLEC ANAL 17.77 $17.77 --- -- 009000.00 $0.00N
M88364INSITU HYBRIDIZATION (FISH) 87.58 $87.58 --- -- 009000.21 $0.00N
M88365INSITU HYBRIDIZATION (FISH) 87.58 $87.58 --- -- 009000.21 $0.00N
M88366INSITU HYBRIDIZATION (FISH) 133.38 $133.38 --- -- 009000.40 $0.00N
M88367INSITU HYBRIDIZATION AUTO 96.07 $96.07 --- -- 009000.80 $0.00N
M88368INSITU HYBRIDIZATION MANUAL 75.41 $75.41 --- -- 009000.80 $0.00N
M88369M/PHMTRC ALYSISHQUANT/SEMIQ 65.87 $65.87 --- -- 009000.32 $0.00N
M88371PROTEIN WESTERN BLOT TISSUE 19.76 $19.76 --- -- 009000.80 $0.00N
M88372PROTEIN ANALYSIS W/PROBE 20.97 $20.97 --- -- 009000.80 $0.00N
M88373M/PHMTRC ALYS ISHQUANT/SEMIQ 54.01 $54.01 --- -- 009000.33 $0.00N
M88374M/PHMTRC ALYS ISHQUANT/SEMIQ 185.00 $185.00 --- -- 009000.21 $0.00N
M88375OPTICAL ENDOMICROSCPY INTERP 23.24 $17.66 --- -- 006000.00 $0.00N
M88377M/PHMTRC ALYS ISHQUANT/SEMIQ 192.08 $192.08 --- -- 009000.29 $0.00N
M88380MICRODISSECTION LASER 118.82 $118.82 --- -- 009000.80 $0.00N
M88381MICRODISSECTION MANUAL 112.83 $112.83 --- -- 009000.80 $0.00N
M88387TISS EXAM MOLECULAR STUDY 30.33 $30.33 --- -- 009000.20 $0.00N
M88388TISS EX MOLECUL STUDY ADD-ON 30.09 $30.09 --- -- 009000.20 $0.00N
M88399SURGICAL PATHOLOGY PROCEDURE 0.00 $0.00 --- -- 009000.80 $0.00N
M88720BILIRUBIN TOTAL TRANSCUT 4.30 $4.30 --- $4.30009100.00 $0.00Y
M88749IN VIVO LAB SERVICE 0.00 $0.00 --- -- 009001.00 $0.00Y
M89049CHCT FOR MAL HYPERTHERMIA 217.68 $217.68 --- -- 009000.80 $0.00N
M89050BODY FLUID CELL COUNT 3.55 $3.55 --- -- 009000.80 $0.00Y
P89050BODY FLUID CELL COUNT 5.22 $5.22 --- -- 009000.80 $0.00N
M89051BODY FLUID CELL COUNT 4.86 $4.86 --- -- 009000.80 $0.00N
M89055LEUKOCYTE ASSESSMENT FECAL 3.80 $3.80 --- -- 009000.00 $0.00N
M89060EXAM SYNOVIAL FLUID CRYSTALS 6.36 $6.36 --- -- 009000.80 $0.00N
M89125SPECIMEN FAT STAIN 4.70 $4.70 --- -- 009000.80 $0.00Y
M89160EXAM FECES FOR MEAT FIBERS 3.88 $3.88 --- -- 009000.80 $0.00N
M89190NASAL SMEAR FOR EOSINOPHILS 4.63 $4.63 --- -- 009000.80 $0.00N
M89220SPUTUM SPECIMEN COLLECTION 10.33 $10.33 --- -- 009000.80 $0.00Y
M89230COLLECT SWEAT FOR TEST 2.20 $2.20 --- -- 009000.20 $0.00N
M89240PATHOLOGY LAB PROCEDURE 0.00 $0.00 --- -- 009000.20 $0.00N
M89398UNLISTED REPROD MED LAB PROC 0.00 $0.00 --- -- 009000.20 $0.00N
I90284HUMAN IG SC 20.08 $20.08 --- -- 030000.00 $0.00Y
I90371HEP B IG IM 120.35 $120.35 --- -- 030000.00 $0.00Y
I90375RABIES IG IM/SC 264.01 $264.01 --- -- 030000.00 $0.00Y
I90376RABIES IG HEAT TREATED 302.07 $302.07 --- -- 030000.00 $0.00Y
I90378RSV MAB IM 50MG 1550.93 $1550.93 --- -- 030000.00 $0.00Y
I90396VAR-ZOSTER IG IM 1808.60 $1808.60 --- -- 030000.00 $0.00Y
I90471IMMUNIZATION ADMIN 4.46 $4.46 --- -- 030000.00 $0.00Y
I90585BCG VACCINE PERCUT 161.53 $161.53 --- -- 030000.00 $0.00Y
I90619MENACWY-TT VACCINE IM 0.00 $0.00 --- -- 030000.00 $0.00Y
I90620MENB PR W/OMV VACCINE IM 182.96 $182.96 --- -- 030000.00 $0.00Y
I90621MENB RLP VACCINE IM 153.60 $153.60 --- -- 030000.00 $0.00Y
190625CHOLERA VACCINE LIVE ORAL 229.46 $229.46 --- -- 030000.00 $0.00Y
I90630FLU VACC IIV4 NO PRESERVE ID 24.80 $24.80 --- -- 030000.00 $0.00Y
I90632HEPA VACCINE ADULT IM 65.69 $65.69 --- -- 030000.00 $0.00Y
I90633HEPA VACCINE PED/ADOL 3 DOSES IM 37.32 $37.32 --- -- 030000.00 $0.00Y
I90636HEP A/HEP B VACC ADULT IM 112.09 $112.09 --- -- 030000.00 $0.00Y
I90644HIB-MENCY VACCINE 6WK-18MO IM 27.67 $27.67 --- -- 030000.00 $0.00Y
I90647HIB PRP-OMP VACC 3 DOSE IM 29.94 $29.94 --- -- 030000.00 $0.00Y
I90648HIB PRP-T VACCINE 4 DOSE IM 20.15 $20.15 --- -- 030000.00 $0.00Y
I906494VHPV VACCINE 3 DOSE IM 164.72 $164.72 --- -- 030000.00 $0.00Y
I906502VHPV VACCINE 3 DOSE IM 132.59 $132.59 --- -- 030000.00 $0.00Y
I906512VHPV VACCINE 3 DOSE IM 231.64 $231.64 --- -- 030000.00 $0.00Y
I90653IIV ADJUVANT VACCINE IM 63.99 $63.99 --- -- 030000.00 $0.00Y
I90654FLU VACCINE NO PRESERVE, ID 20.36 $20.36 --- -- 030000.00 $0.00Y
I90655IIV3 VACC NO PRSV 6-35 MO IM 30.51 $30.51 --- -- 030000.00 $0.00Y
I90656IIV3 VACC NO PRSV 3YRS+ IM 24.23 $24.23 --- -- 030000.00 $0.00Y
I90657IIV3 VACCINE 6-35 MONTHS IM 10.48 $10.48 --- -- 030000.00 $0.00Y
I90658IIV3 VACCINE 3 YRS+ IM 22.70 $22.70 --- -- 030000.00 $0.00Y
190660FLU VACCINE NASAL 17.88 $17.88 --- -- 030000.00 $0.00Y
I90662IIV NO PRSV INCREASED AG IM 60.47 $60.47 --- -- 030000.00 $0.00Y
I90670PCV13 VACCINE IM 234.60 $234.60 --- -- 030000.00 $0.00Y
190672LAIV4 VACCINE INTRANASAL 31.34 $31.34 --- -- 030000.00 $0.00Y
I90673RIV3 VACCINE NO PRESEV IM 45.07 $45.07 --- -- 030000.00 $0.00Y
I90674INFLUENZA VIRUS VAV, QUADRIVALENT .5ML 32.59 $32.59 --- -- 030000.00 $0.00Y
I90675RABIES VACCINE IM 299.18 $299.18 --- -- 030000.00 $0.00Y
190680RV5 VACC 3 DOSE LIVE ORAL 88.24 $88.24 --- -- 030000.00 $0.00Y
190681RV1 VACC 2 DOSE LIVE ORAL 128.27 $128.27 --- -- 030000.00 $0.00Y
I90682RIV4 VACC RECOMBINANT DNA IM 60.47 $60.47 --- -- 030000.00 $0.00Y
I90685FLU VACC IIV4 NO PRSV 6-35 M IM 24.80 $24.80 --- -- 030000.00 $0.00Y
I90686IIV4 VACC NO PRSV 0.5 ML IM 23.49 $23.49 --- -- 030000.00 $0.00Y
I90687IIV4 VACCINE 6-35 MONTHS IM 13.86 $13.86 --- -- 030000.00 $0.00Y
I90688IIV4 VACCINE SPLT 0.5 ML IM 22.30 $22.30 --- -- 030000.00 $0.00Y
I90689VACC IIV4 NO PRSRV 0.25ML IM 0.00 $0.00 --- -- 030000.00 $0.00Y
190690TYPHOID VACCINE ORAL 90.45 $90.45 --- -- 030000.00 $0.00Y
I90691THYPHOID VACCINE IM 109.57 $109.57 --- -- 030000.00 $0.00Y
I90694VACC AIIV4 NO PRSRV 0.5ML IM 57.34 $57.34 --- -- 030000.00 $0.00Y
I90696DTAP-IPV VACCINE 4-6 YEAS IM 55.59 $55.59 --- -- 030000.00 $0.00Y
I90698DTAP-IPV/HIB VACCINE IM 100.54 $100.54 --- -- 030000.00 $0.00Y
I90700DTAP VACCINE, < 7 YRS, IM 31.76 $31.76 --- -- 030000.00 $0.00Y
I90702TD VACC UNDER 7 YRS IM 60.21 $60.21 --- -- 030000.00 $0.00Y
I90707MMR VACCINE SC 80.89 $80.89 --- -- 030000.00 $0.00Y
I90710MMRV VACCINE SC 226.40 $226.40 --- -- 030000.00 $0.00Y
I90713POLIOVIRUS IPV SC/IM 38.88 $38.88 --- -- 030000.00 $0.00Y
I90714TD VACC NO PRESV 7 YRS+ IM 33.40 $33.40 --- -- 030000.00 $0.00Y
I90715TDAP VACCINE >7 IM 37.90 $37.90 --- -- 030000.00 $0.00Y
I90716VAR VACCINE LIVE SUBQ 139.44 $139.44 --- -- 030000.00 $0.00Y
I90717YELLOW FEVER VACCINE SUBQ 146.70 $146.70 --- -- 030000.00 $0.00Y
I90723DTAP-HEP B-IPV VACCINE IM 83.63 $83.63 --- -- 030000.00 $0.00Y
I90732PPSV23 VACC 2 YRS+ SUBQ/IM 124.38 $124.38 --- -- 030000.00 $0.00Y
I90733MPSV4 VACCINE SUBQ 126.88 $126.88 --- -- 030000.00 $0.00Y
I90734MCV4 MENACWY VACCINE IM 134.00 $134.00 --- -- 030000.00 $0.00Y
I90736HZV VACCINE LIVE SUBQ 217.13 $217.13 --- -- 030000.00 $0.00Y
I90738INACTIVATED JE VACC IM 256.12 $256.12 --- -- 030000.00 $0.00Y
I90739HEP B VACC 2 DOSE ADULT IM 135.56 $135.56 --- -- 030000.00 $0.00Y
I90740HEPB VACC 3 DOSE IMMUNOSUP IM 145.22 $145.22 --- -- 030000.00 $0.00Y
I90743HEPB VACC 2 DOSE ADOLESC IM 64.93 $64.93 --- -- 030000.00 $0.00Y
I90744HEPB VACCINE 3 DOSE PED/ADOL IM 32.67 $32.67 --- -- 030000.00 $0.00Y
I90746HEPB VACCINE 3 DOSE ADULT IM 74.11 $74.11 --- -- 030000.00 $0.00Y
I90747HEPB VACC 4 DOSE IMMUNOSUP IM 145.22 $145.22 --- -- 030000.00 $0.00Y
I90748HIB-HEPB VACCINE IM 46.35 $46.35 --- -- 030000.00 $0.00Y
I90750HZV VACC RECOMBINANT IM NJX 155.87 $155.87 --- -- 030000.00 $0.00Y
I90756CCIIV4 VACC ABX FREE IM 31.12 $31.12 --- -- 030000.00 $0.00Y
N90785PSYTX COMPLEX INTERACTIVE 4.73 $3.88 --- $4.92007100.00 $0.00Y
N90791PSYCH DIAGNOSTIC EVALUATION 156.19 $128.08 --- $162.44007100.00 $0.00Y
N90792PSYCH DIAG EVAL W/MED SRVCS 125.91 $103.25 --- $130.95007100.00 $0.00Y
N90832PSYTX PT&/FAMILY 30 MINUTES 64.47 $52.87 --- $67.05007100.00 $0.00Y
Q90832PSYTX PT&/FAMILY 30 MINUTES 18.98 $18.98 --- -- 009000.00 $0.00Y
N90833PSYTX PT&/FAM W/E&M 30 MIN 42.06 $34.49 --- $43.74007100.00 $0.00Y
N90834PSYTX PT&/FAMILY 45 MINUTES 81.90 $67.16 --- $85.18007100.00 $0.00Y
N90836PSYTX PT&/FAM W/E&M 45 MIN 68.32 $56.02 --- $71.05007100.00 $0.00Y
N90837PSYTX PT&/FAMILY 60 MINUTES 119.54 $98.02 --- $124.32007100.00 $0.00Y
Q90837PSYTX PT&/FAMILY 60 MINUTES 38.01 $38.01 --- -- 009000.00 $0.00Y
G90837PSYTX OFF 45-50 MIN 51.00 $51.00 --- -- 009000.00 $0.00Y
N90838PSYTX PT&/FAM W/E&M 60 MIN 110.45 $90.57 --- $114.87007100.00 $0.00Y
N90839PSYTX CRISIS INITIAL 60 MIN 0.00 $0.00 --- -- 007100.00 $0.00Y
Q90839PSYTX CRISIS INITIAL 60 MIN 38.01 $38.01 --- -- 009000.00 $0.00N
Q90840PSYTX CRISIS EA ADDL 30 MIN 18.98 $18.98 --- -- 009000.00 $0.00N
N90840PSYTX CRISIS EA ADDL 30 MIN 0.00 $0.00 --- -- 007100.00 $0.00Y
Q90846FAMILY PSYCHOTHERAPY 86.64 $86.64 --- -- 009000.00 $0.00N
G90846FAMILY PSYCHOTHERAPY 51.00 $51.00 --- -- 009000.00 $0.00Y
G90847FAMILY PSYCHOTHERAPY WITH PT PRESENT 51.00 $51.00 --- -- 009000.00 $0.00Y
Q90847FAMILY PSCHOTHERAPY WITH PT PRESENT 89.65 $89.65 --- -- 009000.00 $0.00N
Q90849MULTIPLE FAMILY GROUP PSYTX 31.85 $31.85 --- -- 009000.00 $0.00N
Q90853GROUP PSYCHOTHERAPY 14.48 $14.48 --- -- 009000.00 $0.00Y
N90853GROUP PSYCHOTHERAPY 4.23 $3.47 --- $4.40007110.00 $0.00Y
N90863PHARMACOLOGIC MGMT W/PSYTX 27.92 $22.89 --- -- 007000.00 $0.00Y
N90870ELECTROCONVULSIVE THERAPY 92.40 $75.77 --- $96.10007100.00 $0.00Y
N90880HYPNOTHERAPY 63.55 $52.11 --- $66.09007110.00 $0.00Y
N90899PSYCHIATRIC SERVICE/THERAPY 0.00 $0.00 --- -- 007100.00 $0.00Y
N90935HEMODIALYSIS ONE EVALUATION 69.02 $56.60 --- $71.78007100.00 $0.00Y
N90937HEMODIALYSIS REPEATED EVAL 187.02 $153.36 --- $194.50007100.00 $0.00Y
N90940HEMODIALYSIS ACCESS STUDY 126.23 $103.51 --- $131.28007100.00 $0.00Y
N90945DIALYSIS ONE EVALUATION 88.00 $72.16 --- $91.52007100.00 $0.00Y
N90947DIALYSIS REPEATED EVAL 132.00 $108.24 --- $137.28007100.00 $0.00Y
N90951ESRD SERV 4 VISITS P MO <2YR 82.10 $821.00 $895.71 -- 001000.00 $0.00Y
N90952ESRD SERV 2-3 VSTS P MO <2YR 0.00 $0.00 --- -- 001000.00 $0.00Y
N90953ESRD SERV 1 VISIT P MO <2YRS 0.00 $0.00 --- -- 001000.00 $0.00Y
N90954ESRD SERV 4 VSTS P MO 2-11 66.41 $664.10 $724.53 -- 001000.00 $0.00Y
N90955ESRD SRV 2-3 VSTS P MO 2-11 37.78 $377.80 $412.18 -- 001000.00 $0.00Y
N90956ESRD SRV 1 VISIT P MO 2-11 25.60 $256.00 $279.30 -- 001000.00 $0.00Y
N90957ESRD SRV 4 VSTS P MO 12-19 53.53 $535.30 $584.01 -- 001000.00 $0.00Y
N90958ESRD SRV 2-3 VSTS P MO 12-19 36.19 $361.90 $394.83 -- 001000.00 $0.00Y
N90959ESRD SERV 1 VST P MO 12-19 23.74 $237.40 $259.00 -- 001000.00 $0.00Y
N90960ESRD SRV 4 VISITS P MO 20+ 24.00 $240.00 $261.84 -- 001000.00 $0.00Y
N90961ESRD SRV 2-3 VSTS P MO 20+ 19.32 $193.20 $210.78 -- 001000.00 $0.00Y
N90962ESRD SERV 1 VISIT P MO 20+ 13.93 $139.30 $151.98 -- 001000.00 $0.00Y
N90963ESRD HOME PT SERV P MO <2YRS 45.97 $459.70 $501.53 -- 001000.00 $0.00Y
N90964ESRD HOME PT SERV P MO 2-11 38.15 $381.50 $416.22 -- 001000.00 $0.00Y
N90965ESRD HOME PT SERV P MO 12-19 36.30 $363.00 $396.03 -- 001000.00 $0.00Y
N90966ESRD HOME PT SERV P MO 20+ 19.09 $190.90 $208.27 -- 001000.00 $0.00Y
N90967ESRD HOME PT SERV P DAY <2 1.67 $16.70 $18.22 $20.74001100.00 $0.00Y
N90968ESRD HOME PT SRV P DAY 2-11 1.28 $12.80 $13.96 $15.90001100.00 $0.00Y
N90969*09ESRD HOME PT SRV P DAY 12-19 1.25 $12.50 $13.64 $15.53001100.00 $0.00Y
N90970ESRD HOME PT SERV P DAY 20+ 0.67 $6.70 $7.31 $8.32001100.00 $0.00Y
N90989DIALYSIS TRAINING COMPLETE 667.40 $667.40 --- -- 009000.00 $0.00Y
N90993DIALYSIS TRAINING INCOMPL 33.98 $27.86 --- $35.34007100.00 $0.00Y
N90997HEMOPERFUSION 106.91 $87.67 --- $111.19007100.00 $0.00Y
N90999DIALYSIS PROCEDURE 0.00 $0.00 --- -- 007100.00 $0.00Y
N91010ESOPHAGUS MOTILITY STUDY 84.28 $69.11 --- $87.65007110.79 $0.00Y
N91013ESOPHGL MOTIL W/STIM/PERFUS 25.29 $20.74 --- $26.30007100.00 $0.00N
N91020GASTRIC MOTILITY STUDIES 112.30 $92.09 --- $116.79007110.82 $0.00Y
N91022DUODENAL MOTILITY STUDY 115.85 $95.00 --- -- 007000.82 $0.00Y
N91030ACID PERFUSION OF ESOPHAGUS 49.34 $40.46 --- $51.31007110.87 $0.00Y
N91034GASTROESOPHAGEAL REFLUX TEST 94.65 $77.61 --- -- 007000.78 $0.00Y
N91035G-ESOPH REFLX TST W/ELECTROD 124.91 $102.43 --- -- 007000.71 $0.00Y
N91037ESOPH IMPED FUNCTION TEST 163.68 $134.22 --- -- 007000.78 $0.00Y
N91038ESOPH IMPED FUNCT TEST > 1HR 138.83 $113.84 --- -- 007000.71 $0.00Y
N91040ESOPH BALLOON DISTENSION TST 508.05 $416.60 --- -- 007000.00 $0.00Y
N91065BREATH HYDROGEN TEST 32.96 $27.03 --- $34.28007110.72 $0.00Y
N91110GI TRACT CAPSULE ENDOSCOPY 980.84 $804.29 --- $1020.07007100.15 $0.00Y
N91112GI WIRELESS CAPSULE MEASURE 1318.38 $1081.07 --- -- 007000.00 $0.00Y
N91122ANAL PRESSURE RECORD 73.62 $60.37 --- $76.56007110.78 $0.00Y
N91132ELECTROGASTROGRAPHY 114.68 $94.04 --- $119.27007100.72 $0.00Y
N91133ELECTROGASTROGRAPHY W/TEST 137.62 $112.85 --- $143.12007100.72 $0.00Y
N91200LIVER ELASTOGRAPHY 39.09 $32.05 --- -- 007000.39 $0.00Y
N91299GASTROENTEROLOGY PROCEDURE 0.00 $0.00 --- -- 007100.00 $0.00Y
N92002EYE EXAM NEW PATIENT 45.30 $37.15 --- $47.11007110.00 $0.00Y
192002EYE EXAM NEW PATIENT 32.80 $32.80 --- $32.80009110.00 $0.00Y
192004EYE EXAM NEW PATIENT 39.44 $39.44 --- -- 009000.00 $0.00Y
N92004EYE EXAM NEW PATIENT 60.71 $49.78 --- $63.14007110.00 $0.00Y
N92012EYE EXAM ESTABLISH PATIENT 45.30 $37.15 --- $47.11007110.00 $0.00Y
192012EYE EXAM ESTABLISH PATIENT 22.59 $22.59 --- -- 009000.00 $0.00Y
192014EYE EXAM&TX ESTAB PT 1/>VST 39.44 $39.44 --- -- 009000.00 $0.00Y
N92014EYE EXAM&TX ESTAB PT 1/>VST 46.87 $38.43 --- $48.74007110.00 $0.00Y
N92015DETERMINE REFRACTIVE STATE 9.77 $8.01 --- -- 007000.00 $0.00Y
192015DETERMINE REFRACTIVE STATE 9.77 $8.01 --- -- 007000.00 $0.00Y
N92018NEW EYE EXAM & TREATMENT 58.39 $47.88 --- $60.73007100.00 $0.00Y
N92019EYE EXAM & TREATMENT 52.56 $43.10 --- $54.66007100.00 $0.00Y
N92020GONIOSCOPY (SEPARATE PROCEDURE) 23.43 $19.21 --- $24.37007110.00 $0.00Y
192020GONIOSCOPY (SEPARATE PROCEDURE) 16.40 $16.40 --- $16.40009110.00 $0.00Y
192025CORNEAL TOPOGRAPHY 26.82 $26.82 --- -- 009000.80 $0.00Y
N92025CORNEAL TOPOGRAPHY 32.71 $26.82 --- -- 007000.80 $0.00Y
N92060SENSORIMOTOR EXAM WITH MULTI MEASUREMNTS 41.20 $33.78 --- $42.85007110.78 $0.00Y
N92071CONTACT LENS FITTING FOR TX 39.07 $32.04 --- $40.63007100.00 $0.00Y
192071CONTACT LENS FITTING FOR TX 39.07 $32.04 --- $40.63007100.00 $0.00Y
192072FIT CONTAC LENS FOR MANAGMNT 124.31 $101.93 --- $129.28007100.00 $0.00Y
N92072FIT CONTAC LENS FOR MANAGMNT 124.31 $101.93 --- $129.28007100.00 $0.00Y
N92081VISUAL FIELD EXAM, UNILAT OR BILAT; LIMI 40.18 $32.95 --- $41.79007110.77 $0.00Y
192081VISUAL FIELD EXAM 16.40 $16.40 --- $16.40009110.00 $0.00Y
192082VISUAL FIELD EXAM 22.14 $22.14 --- $22.14009110.00 $0.00Y
N92082VISUAL FIELD EXAM; INTERMEDIATE 41.55 $34.07 --- $43.21007110.77 $0.00Y
N92083VISUAL FIELD EXAM; EXTENDED 37.21 $30.51 --- $38.70007110.78 $0.00Y
192083VISUAL EXAM 22.14 $22.14 --- $22.14009110.00 $0.00Y
192100SERIAL TONOMETRY (SEPARATE PROCEDURE) 28.93 $28.93 --- $28.93009100.00 $0.00Y
N92100SERIAL TONOMETRY (SEPARATE PROCEDURE) 35.28 $28.93 --- $36.69007100.00 $0.00Y
N92132CMPTR OPHTH DX IMG ANT SEGMT 32.24 $26.44 --- $33.53007100.56 $0.00Y
192132CMPTR OPHTH DX IMG ANT SEGMT 32.24 $32.24 --- $32.24009100.56 $0.00Y
192133CMPTR OPHTH IMG OPTIC NERVE 39.33 $39.33 --- $39.33009100.64 $0.00Y
N92133CMPTR OPHTH IMG OPTIC NERVE 39.33 $32.25 --- $40.90007100.64 $0.00Y
N92134CPTR OPHTH DX IMG POST SEGMT 39.33 $32.25 --- $40.90007100.64 $0.00Y
192134CPTR OPHTH DX IMG POST SEGMT 39.33 $39.33 --- $39.33009100.64 $0.00Y
N92136OPHTHALMIC BIOMETRY 81.88 $67.14 --- -- 007000.34 $0.00Y
N92201OPSCPY EXTND RTA DRAW UNI/BI 26.96 $22.11 --- -- 007000.00 $0.00Y
N92202OPSCPY EXTND ON/MAC DRAW 17.10 $14.02 --- -- 007000.00 $0.00Y
N92227REMOTE DX RETINAL IMAGING 10.72 $10.72 --- -- 007000.00 $0.00Y
192227REMOTE DX RETINAL IMAGING 10.72 $10.72 --- -- 009000.00 $0.00Y
192228REMOTE RETINAL IMAGING MGMT 26.66 $26.66 --- -- 009000.56 $0.00Y
N92228REMOTE RETINAL IMAGING MGMT 26.66 $26.66 --- -- 007000.56 $0.00Y
N92230FLUORESCEIN ANGIOSCOPY WITH INTERPRET 56.63 $46.44 --- $58.90007110.00 $0.00Y
N92235FLUORESCEIN ANGIOGRAPHY,INC MULT IMAGING 99.67 $81.73 --- $103.66007110.56 $0.00Y
N92240ICG ANGIOGRAPHY 90.23 $73.99 --- $93.84007100.60 $0.00Y
N92242FLUORESCEIN ICG ANGIOGRAPHY 253.37 $207.76 --- -- 007000.23 $0.00Y
N92250FUNDUS PHOTOGRAPHY WITH INTERPRETATION 42.13 $42.13 --- -- 009010.78 $0.00Y
192250FUNDUS PHOTOGRAPHY WITH INTERPRETATION 42.13 $42.13 --- -- 009000.00 $0.00Y
N92260OPHTHALMOSCOPY/DYNAMOMETRY 40.00 $32.80 --- $41.60007110.00 $0.00Y
N92265EYE MUSCLE EVALUATION 51.51 $42.24 --- $53.57007110.77 $0.00Y
N92270ELECTRO-OCULOGRAPHY 40.60 $33.29 --- $42.22007110.78 $0.00Y
N92273FULL FIELD ERG W/I&R 149.85 $122.88 --- -- 007000.00 $0.00Y
N92274MULTIFOCAL ERG W/I&R 100.80 $82.66 --- -- 007000.00 $0.00Y
N92283COLOR VISION EXAMINATION 20.48 $16.79 --- $21.30007110.77 $0.00Y
N92284DARK ADAPTATION EYE EXAM 24.87 $20.39 --- $25.86007110.77 $0.00Y
N92310SPECIAL CONTACT LENS FITTING 44.39 $36.40 --- $46.17007110.00 $0.00Y
192310SPECIAL CONTACT LENS FITTING 36.40 $36.40 --- $36.40009110.00 $0.00Y
192311SPECIAL CONTACT LENS FITTING 36.40 $36.40 --- $36.40009110.00 $0.00Y
N92311SPECIAL CONTACT LENS FITTING 44.72 $36.67 --- $46.51007110.00 $0.00Y
N92312SPECIAL CONTACT LENS FITTING 53.45 $43.83 --- $55.59007110.00 $0.00Y
192312SPECIAL CONTACT LENS FITTING 36.40 $36.40 --- $36.40009110.00 $0.00Y
N92313SPECIAL CONTACT LENS FITTING 40.18 $32.95 --- $41.79007110.00 $0.00Y
N92314SPECIAL CONTACT LENS RX 43.95 $36.04 --- $45.71007110.00 $0.00Y
N92315RX CNTACT LENS APHAKIA 1 EYE 43.95 $36.04 --- $45.71007110.00 $0.00Y
N92316RX CNTACT LENS APHAKIA 2 EYE 58.15 $47.68 --- $60.48007110.00 $0.00Y
N92317RX CORNEOSCLERAL CNTACT LENS 32.38 $26.55 --- $33.68007110.00 $0.00Y
N92325MODIFICATION OF CONTACT LENS 14.89 $12.21 --- $15.49007110.00 $0.00Y
N92340FIT SPECTACLES MONOFOCAL 10.77 $10.77 --- -- 009010.00 $0.00Y
192340FIT SPECTACLES MONOFOCAL 10.77 $10.77 --- -- 009010.00 $0.00Y
192341FIT SPECTACLES BIFOCAL 15.90 $15.90 --- -- 009010.00 $0.00Y
N92341FIT SPECTACLES BIFOCAL 15.90 $15.90 --- -- 009010.00 $0.00Y
N92342FIT SPECTACLES MULTIFOCAL 21.88 $21.88 --- -- 009010.00 $0.00Y
192342FIT SPECTACLES MULTIFOCAL 21.88 $21.88 --- -- 009010.00 $0.00Y
192352FIT APHAKIA SPECTCL MONOFOCL 10.77 $10.77 --- -- 009010.00 $0.00Y
N92352FIT APHAKIA SPECTCL MONOFOCL 10.77 $10.77 --- -- 009010.00 $0.00Y
N92353FIT APHAKIA SPECTCL MULTIFOC 15.90 $15.90 --- $15.90009110.00 $0.00N
192353FIT APHAKIA SPECTCL MULTIFOC 15.90 $15.90 --- -- 009010.00 $0.00Y
192370REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009000.00 $0.00Y
N92370REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009000.00 $0.00Y
N92371REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009000.00 $0.00Y
192371REPAIR & ADJUST SPECTACLES 6.30 $6.30 --- -- 009000.00 $0.00Y
192499OPHTHALMOLOGIC SERVICE OR PROCEDURE UN 0.00 $0.00 --- -- 008000.00 $0.00Y
N92499OPHTHALMOLOGIC SERVICE OR PROCEDURE UN 0.00 $0.00 --- -- 008010.00 $0.00Y
N92502EAR AND THROAT EXAMINATION 75.32 $61.76 --- $78.33007110.00 $0.00Y
N92504EAR MICROSCOPY EXAMINATION 20.30 $16.65 --- $21.11007110.00 $0.00Y
N92507SPEECH/HEARING THERAPY 36.24 $29.72 --- $37.69007110.00 $0.00Y
E92507IND SPEECH/LANG/VOICE TRMT 50.19 $50.19 --- -- 009000.00 $0.00Y
E92508GRP SPEECH/LANG/VOICE TRMT 2.46 $2.46 --- -- 009000.00 $0.00Y
N92508TREATMENT OF SPEECH, LANG. VOICE GROUP 25.17 $20.64 --- $26.18007110.00 $0.00Y
N92511NASOPHARYNGOSCOPY 50.96 $41.79 --- $53.00007110.00 $0.00Y
N92512NASAL FUNCTION STUDIES 29.98 $24.58 --- $31.18007110.00 $0.00Y
N92516FACIAL NERVE FUNCTION STUDIES 23.96 $19.65 --- $24.92007110.00 $0.00Y
N92520LARYNGEAL FUNCTION STUDIES 36.74 $30.13 --- $38.21007110.00 $0.00Y
N92521EVALUATION OF SPEECH FLUENCY 74.98 $74.98 --- -- 009000.00 $0.00Y
E92521EVALUATION OF SPEECH FLUENCY 62.81 $62.81 --- -- 009000.00 $0.00Y
E92522EVAL OF SPEECH SOUND PRODUCTION 53.84 $53.84 --- -- 009000.00 $0.00Y
N92522EVALUATE SPEECH PRODUCTION 64.11 $64.11 --- -- 009000.00 $0.00Y
N92523SPEECH SOUND LANG COMPREHEN 130.58 $130.58 --- -- 009000.00 $0.00Y
E92523SPEECH SOUND LANG COMPREHEN 107.68 $107.68 --- -- 009000.00 $0.00Y
E92524BEHAVRAL QUALIT ANALYS VOICE 53.84 $53.84 --- -- 009000.00 $0.00Y
N92524BEHAVRAL QUALIT ANALYS VOICE 62.08 $62.08 --- -- 009000.00 $0.00Y
N92526TREAT OF SWALLOWING DYSFUN AND/OR ORAL 41.24 $33.82 --- $42.89007110.00 $0.00Y
N92531SPONTANEOUS NYSTAGMUS STUDY 0.00 $0.00 --- -- 007110.00 $0.00Y
N92532POSITIONAL NYSTAGMUS TEST 0.00 $0.00 --- -- 007110.00 $0.00Y
N92533CALORIC VESTIBULAR TEST 33.98 $27.86 --- $35.34007110.00 $0.00Y
N92534OPTOKINETIC NYSTAGMUS TEST 0.00 $0.00 --- -- 007110.00 $0.00Y
N92537CALORIC VSTBLR TEST W/REC 43.08 $35.33 --- -- 007010.00 $0.00Y
N92538CALORIC VSTBLR TEST W/REC 21.87 $17.93 --- -- 007010.00 $0.00Y
N92540BASIC VESTIBULAR EVALUATION 100.16 $82.13 --- -- 007000.78 $0.00Y
N92541SPONTANEOUS NYSTAGMUS TEST 17.77 $14.57 --- $18.48007110.40 $0.00Y
N92542POSITIONAL NYSTAGMUS TEST 16.99 $13.93 --- $17.67007110.40 $0.00Y
N92544OPTOKINETIC NYSTAGMUS TEST 16.99 $13.93 --- $17.67007110.40 $0.00Y
N92545OSCILLATING TRACKING TEST 16.99 $13.93 --- $17.67007110.40 $0.00Y
N92546SINUSOIDAL VERTICAL AXIS ROTATIONAL TEST 16.99 $13.93 --- $17.67007110.40 $0.00Y
N92547SUPPLEMENTAL ELECTRICAL TEST 16.99 $13.93 --- $17.67007110.40 $0.00Y
N92550TYMPANOMETRY & REFLEX THRESH 21.55 $17.67 --- -- 007000.00 $0.00Y
N92551PURE TONE HEARING TEST AIR 1.02 $10.20 $11.13 $12.67053110.00 $0.00Y
E92551PURE TONE HEARING TEST AIR 7.38 $7.38 --- -- 009000.00 $0.00Y
E92552PURE TONE AUDIOMETRY AIR 11.08 $11.08 --- -- 009000.00 $0.00Y
N92552PURE TONE AUDIOMETRY AIR 1.53 $15.30 $16.69 $19.00053110.00 $0.00Y
N92553AUDIOMETRY AIR & BONE 2.04 $20.40 $22.26 $25.34053110.00 $0.00Y
N92555SPEECH AUDIOMETRY THRESHOLD 1.12 $11.20 $12.22 $13.91053110.00 $0.00Y
N92556SPEECH AUDIOMETRY COMPLETE 2.70 $27.00 $29.46 $33.53053110.00 $0.00Y
N92557COMPREHENSIVE AUDIOMETRY THRESHOLD EVAL 49.83 $40.86 --- $51.82007110.00 $0.00Y
E92557AUDIOLOGY EVALUATION 181.49 $181.49 --- -- 009000.00 $0.00Y
N92558*12EVOKED AUDITORY TEST QUAL 0.00 $0.00 --- -- 007000.00 $0.00Y
N92559GROUP AUDIOMETRIC TESTING 0.00 $0.00 --- -- 007110.00 $0.00Y
N92560BEKESY AUDIOMETRY SCREEN 18.12 $14.86 --- $18.84007110.00 $0.00Y
N92561BEKESY AUDIOMETRY DIAGNOSIS 21.27 $17.44 --- $22.12007110.00 $0.00Y
N92562LOUDNESS BALANCE TEST 9.39 $7.70 --- $9.77007110.00 $0.00Y
N92563TONE DECAY HEARING TEST 8.73 $7.16 --- $9.08007110.00 $0.00Y
N92564SISI HEARING TEST 11.06 $9.07 --- $11.50007110.00 $0.00Y
N92565STENGER TEST PURE TONE 11.33 $9.29 --- $11.78007110.00 $0.00Y
N92568ACOUSTIC REFL THRESHOLD TST 11.32 $9.28 --- $11.77007110.00 $0.00Y
N92570ACOUSTIC IMMITANCE TESTING 32.73 $26.84 --- -- 007000.00 $0.00Y
N92571FILTERED SPEECH HEARING TEST 11.62 $9.53 --- $12.08007110.00 $0.00Y
N92572STAGGERED SPONDAIC WORD TEST 2.54 $2.08 --- $2.64007110.00 $0.00Y
N92575SENSORINEURAL ACUITY TEST 9.07 $7.44 --- $9.43007110.00 $0.00Y
N92576SYNTHETIC SENTENCE TEST 14.72 $12.07 --- $15.31007110.00 $0.00Y
N92577STENGER TEST SPEECH 16.60 $13.61 --- $17.26007110.00 $0.00Y
N92579VISUAL REINFORCEMENT AUDIOMETRY (VRA) 31.01 $25.43 --- $32.25007110.00 $0.00Y
N92582CONDITIONING PLAY AUDIOMETRY 38.06 $38.06 --- -- 009010.00 $0.00Y
N92585AUDITOR EVOKE POTENT COMPRE 123.15 $123.15 --- -- 009010.35 $0.00Y
N92586AUDITOR EVOKE POTENT LIMIT 81.08 $66.49 --- $84.32007100.00 $0.00Y
N92587EVOKED AUDITORY TEST LIMITED 4.10 $41.00 $44.73 $50.92053100.15 $0.00Y
N92588COMPREHENSIVE OR DIAGNOSTIC EVAL 62.51 $51.26 --- $65.01007100.30 $0.00Y
N92590HEARING AID EXAM ONE EAR 41.90 $34.36 --- $43.58007110.00 $0.00Y
N92591HEARING AID EXAM BOTH EARS 41.90 $34.36 --- $43.58007110.00 $0.00Y
N92594ELECTRO HEARNG AID TEST ONE 20.32 $20.32 --- -- 009010.00 $0.00Y
N92595ELECTRO HEARNG AID TST BOTH 37.30 $37.30 --- -- 009010.00 $0.00Y
N92597ORAL SPEECH DEVICE EVAL 99.87 $81.89 --- $103.86007110.00 $0.00Y
N92601COCHLEAR IMPLT F/UP EXAM <7 140.16 $114.93 --- -- 007000.00 $0.00Y
N92602REPROGRAM COCHLEAR IMPLT <7 98.24 $80.56 --- -- 007000.00 $0.00Y
N92603COCHLEAR IMPLT F/UP EXAM 7/> 94.29 $77.32 --- -- 007000.00 $0.00Y
N92604REPROGRAM COCHLEAR IMPLT 7/> 64.24 $52.68 --- -- 007000.00 $0.00Y
N92605EX FOR NONSPEECH DEVICE RX 42.39 $34.76 --- $44.09007110.00 $0.00Y
N92606NONSPEECH DEVICE SERVICE 42.39 $34.76 --- -- 007000.00 $0.00Y
N92607EX FOR SPEECH DEVICE RX 1HR 117.04 $95.97 --- $121.72007110.00 $0.00Y
N92608EX FOR SPEECH DEVICE RX ADDL 22.93 $18.80 --- -- 007000.00 $0.00Y
N92609USE OF SPEECH DEVICE SERVICE 63.35 $51.95 --- -- 007000.00 $0.00Y
N92610EVALUATE SWALLOWING FUNCTION 59.49 $48.78 --- $61.87007110.00 $0.00Y
N92611MOTION FLUOROSCOPY/SWALLOW 48.72 $39.95 --- $50.67007110.00 $0.00Y
N92612ENDOSCOPY SWALLOW (FEES) VID 140.15 $114.92 --- -- 007000.00 $0.00Y
N92613ENDOSCOPY SWALLOW (FEES) I&R 41.13 $33.73 --- -- 007000.00 $0.00Y
N92614LARYNGOSCOPIC SENSORY VID 104.51 $85.70 --- -- 007000.00 $0.00Y
N92615LARYNGOSCOPIC SENSORY I&R 34.46 $28.26 --- -- 007000.00 $0.00Y
N92616FEES W/LARYNGEAL SENSE TEST 144.41 $118.42 --- -- 007000.00 $0.00Y
N92617FEES W/LARYNGEAL SENSE I&R 45.70 $37.47 --- -- 007000.00 $0.00Y
N92618EX FOR NONSPEECH DEV RX ADD 33.59 $27.54 --- -- 007000.00 $0.00Y
N92620AUDITORY FUNCTION 60 MIN 49.70 $40.75 --- $51.69007110.00 $0.00Y
N92621AUDITORY FUNCTION + 15 MIN 12.33 $10.11 --- $12.82007110.00 $0.00Y
N92625TINNITUS ASSESSMENT 48.87 $40.07 --- $50.82007110.00 $0.00Y
N92626EVAL AUD FUNCJ 1ST HOUR 24.45 $20.05 --- -- 007010.00 $0.00Y
N92627EVAL AUD FUNCJ EA ADDL 15 24.45 $20.05 --- -- 007010.00 $0.00Y
N92630AUD REHAB PRELING HEAR LOSS 0.00 $0.00 --- -- 007010.00 $0.00Y
N92633AUD REHAB POSTLING HEAR LOSS 0.00 $0.00 --- -- 007010.00 $0.00Y
N92700ENT PROCEDURE/SERVICE 0.00 $0.00 --- -- 007000.00 $0.00Y
N92920PRQ CARDIAC ANGIOPLAST 1 ART 530.64 $435.12 --- -- 007000.00 $0.00Y
N92921PRQ CARDIAC ANGIO ADDL ART 0.00 $0.00 --- -- 007000.00 $0.00Y
N92924PRQ CARD ANGIO/ATHRECT 1 ART 630.81 $517.26 --- -- 007000.00 $0.00Y
N92925PRQ CARD ANGIO/ATHRECT ADDL 0.00 $0.00 --- -- 007000.00 $0.00Y
N92928PRQ CARD STENT W/ANGIO 1 VSL 589.08 $483.05 --- -- 007000.00 $0.00Y
N92929PRQ CARD STENT W/ANGIO ADDL 0.00 $0.00 --- -- 007000.00 $0.00Y
N92933PRQ CARD STENT/ATH/ANGIO 658.72 $540.15 --- -- 007000.00 $0.00Y
N92934PRQ CARD STENT/ATH/ANGIO 0.00 $0.00 --- -- 007000.00 $0.00Y
N92937PRQ REVASC BYP GRAFT 1 VSL 588.36 $482.46 --- -- 007000.00 $0.00Y
N92938PRQ REVASC BYP GRAFT ADDL 0.00 $0.00 --- -- 007000.00 $0.00Y
N92941PRQ CARD REVASC MI 1 VSL 659.98 $541.18 --- -- 007000.00 $0.00Y
N92943PRQ CARD REVASC CHRONIC 1VSL 659.98 $541.18 --- -- 007000.00 $0.00Y
N92944PRQ CARD REVASC CHRONIC ADDL 0.00 $0.00 --- -- 007000.00 $0.00Y
N92950HEART/LUNG RESUSCITATION CPR 11.50 $115.00 $125.47 $142.83053100.00 $0.00Y
N92953TEMPORARY EXTERNAL PACING 24.88 $20.40 --- $25.88007110.00 $0.00Y
N92960CARDIOVERSION ELECTRIC EXT 122.46 $122.46 --- -- 009000.00 $0.00Y
N92961CARDIOVERSION ELECTRIC INT 210.71 $172.78 --- $219.14007100.00 $0.00Y
N92970CARDIOASSIST INTERNAL 229.87 $188.49 --- $239.06007100.00 $0.00Y
N92971CARDIOASSIST EXTERNAL 96.63 $79.24 --- $100.50007100.00 $0.00Y
N92973PRQ CORONARY MECH THROMBECT 178.91 $146.71 --- $186.07007100.00 $0.00Y
N92974CATH PLACE CARDIO BRACHYTX 194.11 $159.17 --- $201.87007100.00 $0.00Y
N92975DISSOLVE CLOT HEART VESSEL 410.72 $336.79 --- $427.15007100.00 $0.00Y
N92977DISSOLVE CLOT HEART VESSEL 304.18 $249.43 --- $316.35007100.00 $0.00Y
N92978ENDOLUMINL IVUS OCT C 1ST 58.95 $225.19 --- -- 005000.37 $0.00Y
N92979ENDOLUMINL IVUS OCT C EA 36.07 $137.79 --- -- 005000.48 $0.00Y
N92986REVISION OF AORTIC VALVE 1177.90 $965.88 --- $1225.02007100.00 $0.00Y
O92986REVISION OF AORTIC VALVE 235.59 $193.18 --- $245.01007100.00 $0.00Y
O92987PERCUTANEOUS BALLOON VALVULOPLASTY VALVE 254.60 $208.77 --- $264.78007100.00 $0.00Y
N92987PERCUTANEOUS BALLOON VALVULOPLASTY VALVE 1272.99 $1043.85 --- $1323.91007100.00 $0.00Y
N92990REVISION OF PULONARY VALVE 998.80 $819.02 --- $1038.75007100.00 $0.00Y
O92990REVISION OF PULMONARY VALVE 199.76 $163.80 --- $207.75007100.00 $0.00Y
N92992REVISION OF HEART CHAMBER 0.00 $0.00 --- -- 007100.00 $0.00Y
N92993ATRIAL SEPTECTOMY OR SEPTOSTOMY 0.00 $0.00 --- -- 007100.00 $0.00Y
N92997PUL ART BALLOON REPR PERCUT 664.40 $544.81 --- -- 007000.00 $0.00Y
N92998PUL ART BALLOON REPR PERCUT 345.99 $283.71 --- -- 007000.00 $0.00Y
N93000ELECTROCARDIOGRAM COMPLETE 35.00 $28.70 --- $36.40007110.00 $0.00Y
N93005ELECTROCARDIOGRAM TRACING 20.00 $16.40 --- $20.80007110.00 $0.00Y
193005ELECTROCARDIOGRAM TRACING 7.43 $7.43 --- $7.43009110.00 $0.00Y
N93010ELECTROCARDIOGRAM REPORT 15.00 $12.30 --- $15.60007110.00 $0.00Y
N93015CARDIOVASCULAR STRESS TEST 116.96 $95.91 --- $121.64007110.00 $0.00Y
N93016CARDIOVASCULAR STRESS TEST 29.96 $24.57 --- $31.16007100.00 $0.00Y
N93017CARDIOVASCULAR STRESS TEST 64.02 $52.50 --- $66.58007110.00 $0.00Y
N93018CARDIOVASCULAR STRESS TEST 22.98 $18.84 --- $23.90007110.00 $0.00Y
N93024CARDIAC DRUG STRESS TEST 127.48 $104.53 --- $132.58007100.70 $0.00Y
N93025MICROVOLT T-WAVE ASSESS 284.49 $233.28 --- -- 007000.70 $0.00Y
N93040RHYTHM ECG WITH REPORT 15.94 $13.07 --- $16.58007110.00 $0.00Y
N93041RHYTHM ECG TRACING 6.26 $5.13 --- $6.51007110.00 $0.00Y
193041RHYTHM ECG TRACING 16.07 $16.07 --- $16.07009110.00 $0.00Y
N93042RHYTHM ECG REPORT 10.40 $8.53 --- $10.82007110.00 $0.00Y
N93050ART PRESSURE WAVEFORM ANALYS 18.76 $15.38 --- -- 007000.47 $0.00Y
N93224ECG MONIT/REPRT UP TO 48 HRS 135.17 $110.84 --- -- 007000.00 $0.00Y
N93225ECG MONIT/REPRT UP TO 48 HRS 36.37 $29.82 --- -- 007000.00 $0.00Y
N93226ECG MONIT/REPRT UP TO 48 HRS 68.22 $55.94 --- -- 007000.00 $0.00Y
N93227ECG MONIT/REPRT UP TO 48 HRS 30.59 $25.08 --- -- 007000.00 $0.00Y
N93228REMOTE 30 DAY ECG REV/REPORT 26.28 $21.55 --- -- 007000.00 $0.00Y
N93229REMOTE 30 DAY ECG TECH SUPP 823.12 $674.96 --- -- 007000.00 $0.00Y
N93260PRGRMG DEV EVAL IMPLTBL SYS 72.01 $59.05 --- -- 007000.65 $0.00Y
N93261INTERROGATE SUBQ DEFIB 66.01 $54.13 --- -- 007000.62 $0.00Y
N93264REM MNTR WRLS P-ART PRS SNR 54.54 $44.72 --- -- 007000.00 $0.00Y
N93268ECG RECORD/REVIEW 172.49 $141.44 --- -- 007000.00 $0.00Y
N93270REMOTE 30 DAY ECG REV/REPORT 36.37 $29.82 --- -- 007000.00 $0.00Y
N93271ECG/MONITORING AND ANALYSIS 97.32 $79.80 --- -- 007000.00 $0.00Y
N93272ECG/REVIEW INTERPRET ONLY 26.52 $21.75 --- -- 007000.00 $0.00Y
N93278ECG/SIGNAL - AVERAGED 32.82 $26.91 --- -- 007000.39 $0.00Y
N93279PM DEVICE PROGR EVAL SNGL 59.50 $48.79 --- -- 007000.63 $0.00Y
N93280PM DEVICE PROGR EVAL DUAL 70.62 $57.91 --- -- 007000.64 $0.00Y
N93281PM DEVICE PROGR EVAL MULTI 82.55 $67.69 --- -- 007000.64 $0.00Y
N93282ICD DEVICE PROGR EVAL 1 SNGL 76.04 $62.35 --- -- 007000.65 $0.00Y
N93283ICD DEVICE PROGR EVAL DUAL 92.56 $75.90 --- -- 007000.67 $0.00Y
N93284ICD DEVICE PROGR EVAL MULT 108.45 $88.93 --- -- 007000.68 $0.00Y
N93285ILR DEVICE EVAL PROGR 51.50 $42.23 --- -- 007000.60 $0.00Y
N93286PERI-PX PACEMAKER DEVICE EVL 29.07 $23.84 --- -- 007000.53 $0.00Y
N93287PERI-PX ICD DEVICE EVAL&PRGR 38.04 $31.19 --- -- 007000.60 $0.00Y
N93288PM DEVICE EVAL IN PERSON 46.37 $38.02 --- -- 007000.54 $0.00Y
N93289ICD DEVICE INTERROGATE 70.98 $58.20 --- -- 007000.64 $0.00Y
N93290ICM DEVICE EVAL 33.41 $27.40 --- -- 007000.65 $0.00Y
N93291ILR DEVICE INTERROGATE 44.30 $36.33 --- -- 007000.58 $0.00Y
N93292WCD DEVICE INTERROGATE 44.66 $36.62 --- -- 007000.57 $0.00Y
N93293PM PHONE R-STRIP DEVICE EVAL 64.40 $52.81 --- -- 007000.27 $0.00Y
N93294PM DEVICE INTERROGATE REMOTE 38.22 $31.34 --- -- 007000.00 $0.00Y
N93295ICD DEVICE INTERROGAT REMOTE 69.22 $56.76 --- -- 007000.00 $0.00Y
N93296PM/ICD REMOTE TECH SERV 41.41 $33.96 --- -- 007000.00 $0.00Y
N93297ICM DEVICE INTERROGAT REMOTE 26.28 $21.55 --- -- 007000.00 $0.00Y
N93298ILR DEVICE INTERROGAT REMOTE 30.82 $25.27 --- -- 007000.00 $0.00Y
N93303ECHO TRANSTHORACIC 186.16 $152.65 --- $193.61007100.36 $0.00Y
N93304ECHO TRANSTHORACIC 101.80 $83.48 --- $105.87007100.41 $0.00Y
N93306TTE W/DOPPLER COMPLETE 292.39 $239.76 --- -- 007000.26 $0.00Y
N93307TTE W/O DOPPLER COMPLETE 183.05 $150.10 --- -- 007000.40 $0.00Y
N93308TTE F-UP OR LMTD 91.52 $75.05 --- -- 007000.40 $0.00Y
N93312ECHO TRANSESOPHAGEAL 189.93 $155.74 --- -- 007000.75 $0.00Y
N93315ECHO TRANSESOPHAGEAL 235.65 $193.23 --- -- 007000.75 $0.00Y
N93318ECHO TRANSESOPHAGEAL INTRAOP 312.19 $256.00 --- -- 007000.75 $0.00Y
N93320DOPPLER ECHO EXAM HEART 93.38 $76.57 --- $97.12007100.40 $0.00Y
N93321DOPPLER ECHO EXAM HEART 47.49 $38.94 --- $49.39007100.40 $0.00Y
N93325DOPPLER COLOR FLOW ADD-ON 94.98 $77.88 --- $98.78007100.03 $0.00Y
N93350STRESS TTE ONLY 117.22 $96.12 --- -- 007000.50 $0.00Y
N93351STRESS TTE COMPLETE 301.57 $247.29 --- -- 007000.50 $0.00Y
N93352ADMIN ECG CONTRAST AGENT 42.40 $34.77 --- -- 007000.00 $0.00Y
N93355ECHO TRANSESOPHAGEAL (TEE) 235.68 $193.26 --- -- 007000.00 $0.00Y
N93356MYOCRD STRAIN IMG SPCKL TRCK 44.74 $36.69 --- -- 007000.00 $0.00Y
N93451RIGHT HEART CATH 851.99 $698.63 --- $886.07007100.17 $0.00Y
N93452LEFT HRT CATH W/VENTRCLGRPHY 930.32 $762.86 --- $967.53007100.28 $0.00Y
N93453R&L HRT CATH W/VENTRICLGRPHY 1217.61 $998.44 --- $1266.31007100.28 $0.00Y
N93454CORONARY ARTERY ANGIO S&I 960.55 $787.65 --- $998.97007100.27 $0.00Y
N93455CORONARY ART/GRFT ANGIO S&I 1121.33 $919.49 --- $1166.18007100.27 $0.00Y
N93456R HRT CORONARY ARTERY ANGIO 1201.23 $985.01 --- $1249.28007100.28 $0.00Y
N93457R HRT ART/GRFT ANGIO 1361.88 $1116.74 --- $1416.36007100.28 $0.00Y
N93458L HRT ARTERY/VENTRICLE ANGIO 1158.55 $950.01 --- $1204.89007100.27 $0.00Y
N93459L HRT ART/GRFT ANGIO 1278.74 $1048.57 --- $1329.89007100.28 $0.00Y
N93460R&L HRT ART/VENTRICLE ANGIO 1366.21 $1120.29 --- $1420.86007100.29 $0.00Y
N93461R&L HRT ART/VENTRICLE ANGIO 1567.79 $1285.59 --- $1630.50007100.28 $0.00Y
N93462L HRT CATH TRNSPTL PUNCTURE 201.39 $165.14 --- $209.45007100.00 $0.00Y
N93463DRUG ADMIN & HEMODYNMIC MEAS 107.26 $87.95 --- $111.55007100.00 $0.00Y
N93464EXERCISE W/HEMODYNAMIC MEAS 274.16 $224.81 --- $285.13007100.34 $0.00Y
N93503RIGHT HEART CATHETERIZATION 154.85 $126.98 --- $161.04007100.00 $0.00Y
N93505BIOPSY OF HEART LINING 289.95 $237.76 --- $301.55007100.78 $0.00Y
N93530RT HEART CATH CONGENITAL 676.09 $554.39 --- $703.13007100.31 $0.00Y
N93531R & L HEART CATH CONGENITAL 1694.00 $1389.08 --- $1761.76007100.21 $0.00Y
N93532R & L HEART CATH CONGENITAL 1352.80 $1109.30 --- $1406.91007100.26 $0.00Y
N93533R & L HEART CATH CONGENITAL 1545.37 $1267.20 --- $1607.18007100.16 $0.00Y
N93561CARDIAC OUTPUT MEASUREMENT 50.00 $41.00 --- $52.00007100.76 $0.00N
N93562CARD OUTPUT MEASURE SUBSQ 21.62 $17.73 --- $22.48007100.72 $0.00N
N93563INJECT CONGENITAL CARD CATH 57.20 $46.90 --- $59.49007100.00 $0.00Y
N93564INJECT HRT CONGNTL ART/GRFT 58.09 $47.63 --- $60.41007100.00 $0.00Y
N93565INJECT L VENTR/ATRIAL ANGIO 43.94 $36.03 --- $45.70007100.00 $0.00Y
N93566INJECT R VENTR/ATRIAL ANGIO 188.65 $154.69 --- $196.20007100.00 $0.00Y
N93567INJECT SUPRVLV AORTOGRAPHY 113.66 $93.20 --- $118.21007100.00 $0.00Y
N93568INJECT PULM ART HRT CATH 113.66 $93.20 --- $118.21007100.00 $0.00Y
N93571HEART FLOW RESERVE MEASURE 296.11 $242.81 --- $307.95007100.33 $0.00Y
N93572HEART FLOW RESERVE MEASURE 274.11 $224.77 --- -- 007000.28 $0.00Y
N93580TRANSCATH CLOSURE OF ASD 736.49 $603.92 --- -- 007000.00 $0.00Y
N93581TRANSCATH CLOSURE OF VSD 927.71 $760.72 --- -- 007000.00 $0.00Y
N93582PERQ TRANSCATH CLOSURE PDA 689.35 $565.26 --- -- 007000.00 $0.00Y
N93583PERQ TRANSCATH SEPTAL REDUXN 613.67 $503.21 --- -- 007000.00 $0.00Y
N93590PERQ TRANSCATH CLS MITRAL 1006.03 $1006.03 --- -- 009000.00 $0.00Y
N93591PERQ TRANSCATH CLS AORTIC 835.12 $835.12 --- -- 009000.00 $0.00Y
N93592PERQ TRANSCATH CLOSURE EACH 367.38 $367.38 --- -- 009000.00 $0.00Y
N93600BUNDLE OF HIS RECORDING 199.33 $163.45 --- $207.30007100.72 $0.00Y
N93602INTRA-ATRIAL RECORDING 129.12 $105.88 --- $134.28007100.77 $0.00Y
N93603RIGHT VENTRICULAR RECORDING 194.28 $159.31 --- $202.05007100.71 $0.00Y
N93609MAP TACHYCARDIA ADD-ON 358.49 $293.96 --- $372.83007100.82 $0.00Y
N93610INTRA-ATRIAL PACING 129.12 $105.88 --- $134.28007100.79 $0.00Y
N93612INTRAVENTRICULAR PACING 129.12 $105.88 --- $134.28007100.76 $0.00Y
N93613ELECTROPHYS MAP 3D ADD-ON 381.15 $312.54 --- -- 007000.76 $0.00Y
N93615ESOPHAGEAL RECORDING 100.00 $82.00 --- $104.00007100.80 $0.00Y
N93616ESOPHAGEAL RECORDING WITH PACING 114.00 $93.48 --- $118.56007100.90 $0.00Y
N93618HEART RHYTHM PACING 215.76 $176.92 --- $224.39007100.71 $0.00Y
N93619ELECTROPHYSIOLOGY EVALUATION 727.39 $596.46 --- $756.49007100.70 $0.00Y
N93620ELECTROPHYSIOLOGY EVALUATION 852.85 $699.34 --- $886.96007100.73 $0.00Y
N93621ELECTROPHYSIOLOGY EVALUATION 852.85 $699.34 --- $886.96007100.70 $0.00Y
N93622ELECTROPHYSIOLOGY EVALUATION 852.85 $699.34 --- $886.96007100.70 $0.00Y
N93623STIMULATION PACING HEART 0.00 $0.00 --- -- 007100.00 $0.00Y
N93624ELECTROPHYSIOLOGIC STUDY 348.32 $285.62 --- $362.25007100.79 $0.00Y
N93631HEART PACING MAPPING 684.94 $561.65 --- $712.34007100.67 $0.00Y
N93640EVALUATION HEART DEVICE 589.52 $483.41 --- $613.10007100.59 $0.00Y
N93641ELECTROPHYSIOLOGY EVALUATION 662.27 $543.06 --- $688.76007100.64 $0.00Y
N93642ELECTROPHYSIOLOGY EVALUATION 640.06 $524.85 --- $665.66007100.63 $0.00Y
N93644ELECTROPHYSIOLOGY EVALUATION 317.85 $260.64 --- $330.56007100.62 $0.00Y
N93650ABLATE HEART DYSRHYTHM FOCUS 872.82 $715.71 --- $907.73007100.00 $0.00Y
N93653EP & ABLATE SUPRAVENT ARRHYT 804.22 $659.46 --- $836.39007100.00 $0.00Y
N93654EP & ABLATE VENTRIC TACHY 1073.44 $880.22 --- $1116.38007100.00 $0.00Y
N93655ABLATE ARRHYTHMIA ADD ON 402.20 $329.80 --- $418.29007100.00 $0.00Y
N93656TX ATRIAL FIB PULM VEIN ISOL 1073.74 $880.47 --- $1116.69007100.00 $0.00Y
N93657TX L/R ATRIAL FIB ADDL 402.40 $329.97 --- $418.50007100.00 $0.00Y
N93660TILT TABLE EVALUATION 0.00 $0.00 --- -- 007100.00 $0.00Y
N93662INTRACARDIAC ECG (ICE) 329.95 $270.56 --- $343.15007100.49 $0.00Y
N93702BIS XTRACELL FLUID ANALYSIS 128.21 $105.13 --- -- 007000.00 $0.00Y
N93724ELECT ANALYSIS OF ANTITACH PACEMAKER SYS 335.34 $274.98 --- $348.75007100.65 $0.00Y
N93745SET-UP CARDIOVERT-DEFIBRILL 90.52 $74.23 --- $94.14007110.00 $0.00Y
N93750INTERROGATION VAD IN PERSON 54.01 $44.29 --- -- 007000.00 $0.00Y
N93784AMBL BP MNTR W/SOFTWARE 59.03 $48.40 --- -- 007000.00 $0.00Y
N93786AMBL BP MNTR W/SW REC ONLY 33.40 $27.39 --- -- 007000.00 $0.00Y
N93788AMBL BP MNTR W/SW A/R 5.87 $4.81 --- -- 007000.00 $0.00Y
N93790AMBL BP MNTR W/SW I&R 19.70 $16.15 --- -- 007000.00 $0.00Y
N93793ANTICOAG MGMT PT WARFARIN 10.53 $10.53 --- -- 007000.00 $0.00Y
N93797CARDIAC REHAB 17.64 $14.46 --- -- 007000.00 $0.00Y
N93798CARDIAC REHAB/MONITOR 27.14 $22.25 --- -- 007000.00 $0.00Y
N93799CARDIOVASCULAR PROCEDURE 0.00 $0.00 --- -- 007100.00 $0.00Y
P93799CARDIOVASCULAR PROCEDURE 0.00 $0.00 --- -- 019000.00 $0.00Y
N93880EXTRACRANIAL BILAT STUDY 191.02 $156.64 --- $198.66007110.25 $0.00Y
N93882EXTRACRANIAL UNI/LTD STUDY 92.98 $76.24 --- $96.70007110.14 $0.00Y
N93886INTRACRANIAL COMPLETE STUDY 238.88 $195.88 --- $248.44007110.21 $0.00Y
N93888INTRACRANIAL LIMITED STUDY 158.73 $130.16 --- $165.08007110.21 $0.00Y
N93890TCD VASOREACTIVITY STUDY 257.61 $211.24 --- $267.91007110.40 $0.00Y
N93892TCD EMBOLI DETECT W/O INJ 274.24 $224.88 --- $285.21007110.40 $0.00Y
N93893TCD EMBOLI DETECT W/INJ 268.79 $220.41 --- $279.54007110.40 $0.00Y
N93922UPR/L XTREMITY ART 2 LEVELS 63.54 $52.10 --- $66.08007100.32 $0.00Y
N93923UPR/LXTR ART STDY 3+ LVLS 118.73 $97.36 --- $123.48007100.31 $0.00Y
N93924LWR XTR VASC STDY BILAT 129.78 $106.42 --- $134.97007100.31 $0.00Y
N93925LOWER EXTREMITY STUDY 118.13 $96.87 --- $122.86007110.25 $0.00Y
P93925LOWER EXTREMITY STUDY 118.13 $96.87 --- -- 019010.25 $0.00Y
P93926DUPLEX SCAN LOWER EXTREMITY ARTERIES OR 103.52 $84.89 --- -- 019010.14 $0.00Y
N93926DUPLEX SCAN LOWER EXTREMITY ARTERIES OR 103.52 $84.89 --- $107.66007110.14 $0.00Y
N93930UPPER EXTREMITY STUDY 113.43 $93.01 --- $117.97007110.21 $0.00Y
N93931DUPLEX SCAN UPPER EXTREMITY ARTERIES OR 101.05 $82.86 --- $105.09007110.21 $0.00Y
N93970EXTREMITY STUDY 205.17 $168.24 --- $213.38007110.28 $0.00Y
N93971DUPLEX SCAN EXTREMITY VEINS INC RESPONSE 103.12 $84.56 --- $107.24007110.16 $0.00Y
N93975VISCERAL VASCULAR STUDY 229.07 $187.84 --- $238.23007110.35 $0.00Y
N93976DUPLEX SCAN ARTER INFLW/VENOUS OUTFLW AB 188.68 $154.72 --- $196.23007110.21 $0.00Y
N93978VISCERAL VASCULAR STUDY 200.18 $164.15 --- $208.19007110.27 $0.00Y
N93979DUPLEX STDY AORTA,INF VENA CAVA,ILIAC VA 96.74 $79.33 --- $100.61007110.15 $0.00Y
N93980PENILE VASCULAR STUDY 201.97 $165.62 --- $210.05007100.30 $0.00Y
N93981PENILE VASCULAR STUDY 151.59 $124.30 --- $157.65007100.14 $0.00Y
N93985DUP-SCAN HEMO COMPL BI STD 301.63 $247.34 --- -- 007000.00 $0.00Y
N93986DUP-SCAN HEMO COMPL UNI STD 174.36 $142.98 --- -- 007000.00 $0.00Y
N93990DUPLEX SCAN OF HEMODIALYSIS ACCESS 87.50 $71.75 --- $91.00007110.14 $0.00Y
N93998NONINVAS VASC DX STUDY PROC 0.00 $0.00 --- -- 007110.00 $0.00Y
N94002VENT MGMT INPAT INIT DAY 4.48 $44.80 $48.88 -- 053000.00 $0.00Y
N94003VENT MGMT INPAT SUBQ DAY 3.53 $35.30 $38.51 -- 053000.00 $0.00Y
N94010BREATHING CAPACITY TEST 30.00 $24.60 --- $31.20007110.40 $0.00Y
N94011SPIROMETRY UP TO 2 YRS OLD 0.00 $0.00 --- -- 007000.00 $0.00Y
N94012SPIRMTRY W/BRNCHDIL INF-2 YR 0.00 $0.00 --- -- 007000.00 $0.00Y
N94013MEAS LUNG VOL THRU 2 YRS 0.00 $0.00 --- -- 007000.00 $0.00Y
N94014PATIENT RECORDED SPIROMETRY 46.23 $37.91 --- $48.08007100.00 $0.00Y
N94015PATIENT RECORDED SPIROMETRY 17.60 $14.43 --- $18.30007100.00 $0.00Y
N94016REVIEW PATIENT SPIROMETRY 28.63 $23.48 --- $29.78007100.00 $0.00Y
N94060EVALUATION OF WHEEZING 54.91 $45.03 --- $57.11007110.40 $0.00Y
N94150VITAL CAPACITY TEST 6.79 $5.57 --- $7.06007100.40 $0.00Y
N94200LUNG FUNCTION TEST (MBC/MVV) 20.00 $16.40 --- $20.80007100.40 $0.00Y
N94250EXPIRED GAS COLLECTION 8.27 $6.78 --- $8.60007110.40 $0.00Y
N94375RESPIRATORY FLOW VOLUME LOOP 28.32 $23.22 --- $29.45007100.40 $0.00Y
N94400CO2 BREATHING RESPONSE CURVE 34.55 $28.33 --- $35.93007100.40 $0.00N
N94450HYPOXIA RESPONSE CURVE 29.51 $24.20 --- $30.69007100.40 $0.00Y
N94617EXERCISE TST BRNCSPSM 105.42 $86.45 --- -- 007000.33 $0.00Y
N94618PULMONARY STRESS TESTING 36.73 $30.12 --- -- 007000.65 $0.00Y
N94621PULM STRESS TEST/COMPLEX 121.48 $99.61 --- $126.34007100.42 $0.00Y
N94640AIRWAY INHALATION TREATMENT 1.17 $11.70 $12.76 $14.53053100.00 $0.00Y
N94642AEROSOL INHALATION OF PENTAMIDINE 8.59 $85.90 $93.72 $106.69053100.00 $0.00Y
N94644CBT 1ST HOUR 1.70 $17.00 $18.55 $21.11053100.00 $0.00Y
N94645CBT EACH ADDL HOUR 1.24 $12.40 $13.53 $15.40053100.00 $0.00Y
N94660POS AIRWAY PRESSURE CPAP 4.08 $40.80 $44.51 $50.67053110.00 $0.00Y
N94662NEG PRESS VENTILATION CNP 2.80 $28.00 $30.55 $34.78053110.00 $0.00Y
N94664EVALUATE PT USE OF INHALER 0.86 $8.60 $9.38 $10.68053110.00 $0.00Y
N94667CHEST WALL MANIPULATION 1.99 $19.90 $21.71 $24.72053110.00 $0.00Y
N94668CHEST WALL MANIPULATION 1.17 $11.70 $12.76 $14.53053110.00 $0.00Y
N94669MECHANICAL CHEST WALL OSCILL 31.66 $25.96 --- -- 007000.00 $0.00Y
N94680EXHALED AIR ANALYSIS O2 50.00 $41.00 --- $52.00007110.40 $0.00Y
N94681EXHALED AIR ANALYSIS O2/CO2 100.00 $82.00 --- $104.00007110.40 $0.00Y
N94690EXHALED AIR ANALYSIS 18.12 $14.86 --- $18.84007110.40 $0.00Y
N94726PULM FUNCT TST PLETHYSMOGRAP 58.65 $48.09 --- -- 007000.21 $0.00Y
N94727PULM FUNCTION TEST BY GAS 45.88 $37.62 --- -- 007000.27 $0.00Y
N94728AIRWY RESIST BY OSCILLOMETRY 45.88 $37.62 --- $47.72007100.27 $0.00Y
N94729CO/MEMBANE DIFFUSE CAPACITY 58.78 $48.20 --- $61.13007100.14 $0.00Y
N94750PULMONARY COMPLIANCE STUDY 19.34 $15.86 --- $20.11007100.40 $0.00Y
N94760MEASURE BLOOD OXYGEN LEVEL 6.82 $5.59 --- $7.09007100.00 $0.00Y
N94770EXHALED CARBON DIOXIDE TEST 21.26 $17.43 --- $22.11007100.45 $0.00Y
N94772BREATH RECORDING INFANT 4.38 $43.80 $47.79 $54.40001110.00 $0.00Y