Medi-Cal Rates Information
Medi-Cal Rates as of 11/15/2021 (Codes 94799 thru 99600)

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
N94799PULMONARY SERVICE/PROCEDURE 0.00 $0.00 --- -- 007100.00 $0.00Y
N95004PERCUT ALLERGY SKIN TESTS 0.19 $1.90 $2.07 $2.36053110.00 $0.00Y
P95004PERCUT ALLERGY SKIN TESTS 0.19 $1.90 $2.07 -- 052010.00 $0.00Y
N95012EXHALED NITRIC OXIDE MEAS 22.87 $18.75 --- -- 007000.00 $0.00Y
N95017PERQ & ICUT ALLG TEST VENOMS 9.45 $7.75 --- $9.83007100.00 $0.00Y
N95018PERQ&IC ALLG TEST DRUGS/BIOL 23.65 $19.39 --- $24.60007100.00 $0.00Y
N95024ICUT ALLERGY TEST DRUG/BUG 0.28 $2.80 $3.05 $3.48053110.00 $0.00Y
P95024ICUT ALLERGY TEST DRUG/BUG 0.28 $2.80 $3.05 -- 052010.00 $0.00Y
P95027ICUT ALLERGY TITRATE-AIRBORN 0.28 $2.80 $3.05 -- 052010.00 $0.00Y
N95027ICUT ALLERGY TITRATE-AIRBORN 0.28 $2.80 $3.05 $3.48053110.00 $0.00Y
N95028ICUT ALLERGY TEST-DELAYED 0.42 $4.20 $4.58 $5.22053110.00 $0.00Y
P95028ICUT ALLERGY TEST-DELAYED 0.42 $4.20 $4.58 -- 052010.00 $0.00Y
N95044PATCH/APPLIC TEST(S)(SPECIFY # OF TESTS) 0.37 $3.70 $4.04 $4.60053100.00 $0.00Y
N95052PHOTO PATCH TEST(S)(SPECIFY # OF TESTS) 0.46 $4.60 $5.02 $5.71053100.00 $0.00Y
N95056PHOTOSENSITIVITY TESTS 0.32 $3.20 $3.49 $3.97053110.00 $0.00Y
N95060EYE ALLERGY TESTS 0.65 $6.50 $7.09 $8.07053110.00 $0.00Y
N95065NOSE ALLERGY TEST 0.41 $4.10 $4.47 $5.09053110.00 $0.00Y
N95070BRONCHIAL ALLERGY TESTS 4.12 $41.20 $44.95 $51.17053110.00 $0.00Y
N95076INGEST CHALLENGE INI 120 MIN 124.44 $102.04 --- -- 007000.00 $0.00Y
N95079INGEST CHALLENGE ADDL 60 MIN 86.06 $70.57 --- -- 007000.00 $0.00Y
N95115IMMUNOTHERAPY ONE INJECTION 0.49 $4.90 $5.35 $6.09001100.00 $0.00Y
N95117PROF SVC,ALLERGEN IMMUNOTHERAPY,2 OR MOR 9.45 $9.45 --- -- 009000.00 $0.00Y
N95144ANTIGEN THERAPY SERVICES 11.22 $9.20 --- -- 007000.00 $0.00N
N95170ANTIGEN THERAPY SERVICES 10.47 $8.59 --- $10.89007110.00 $0.00N
N95180RAPID DESENSITIZATION 6.10 $61.00 $66.55 $75.76053110.00 $0.00Y
N95199ALLERGY IMMUNOLOGY SERVICES 0.51 $5.10 $5.56 $6.33053110.00 $0.00Y
N95700EEG CONT REC W/VID EEG TECH 296.98 $243.52 --- -- 007000.00 $0.00Y
N95705EEG W/O VID 2-12 HR UNMNTR 270.57 $221.87 --- -- 007000.00 $0.00Y
N95706EEG WO VID 2-12HR INTMT MNTR 402.35 $329.93 --- -- 007000.00 $0.00Y
N95707EEG W/O VID 2-12HR CONT MNTR 780.43 $639.95 --- -- 007000.00 $0.00Y
N95708EEG WO VID EA 12-26HR UNMNTR 323.25 $265.07 --- -- 007000.00 $0.00Y
N95709EEG W/O VID EA 12-26HR INTMT 718.07 $588.82 --- -- 007000.00 $0.00Y
N95710EEG W/O VID EA 12-26HR CONT 1247.78 $1023.18 --- -- 007000.00 $0.00Y
N95711VEEG 2-12 HR UNMONITORED 270.57 $221.87 --- -- 007000.00 $0.00Y
N95712VEEG 2-12 HR INTMT MNTR 455.03 $373.12 --- -- 007000.00 $0.00Y
N95713VEEG 2-12 HR CONT MNTR 889.74 $729.59 --- -- 007000.00 $0.00Y
N95714VEEG EA 12-26 HR UNMNTR 323.25 $265.07 --- -- 007000.00 $0.00Y
N95715VEEG EA 12-26HR INTMT MNTR 796.64 $653.24 --- -- 007000.00 $0.00Y
N95716VEEG EA 12-26HR CONT MNTR 1426.55 $1169.77 --- -- 007000.00 $0.00Y
N95717EEG PHYS/QHP 2-12 HR W/O VID 109.59 $89.87 --- -- 007000.00 $0.00Y
N95718EEG PHYS/QHP 2-12 HR W/VEEG 144.41 $118.42 --- -- 007000.00 $0.00Y
N95719EEG PHYS/QHP EA INCR W/O VID 169.57 $139.05 --- -- 007000.00 $0.00Y
N95720EEG PHY/QHP EA INCR W/VEEG 223.53 $183.30 --- -- 007000.00 $0.00Y
N95721EEG PHY/QHP>36<60 HR W/O VID 225.57 $184.97 --- -- 007000.00 $0.00Y
N95722EEG PHY/QHP>36<60 HR W/VEEG 273.51 $224.28 --- -- 007000.00 $0.00Y
N95723EEG PHY/QHP>60<84 HR W/O VID 279.46 $229.16 --- -- 007000.00 $0.00Y
N95724EEG PHY/QHP>60<84 HR W/VEEG 349.37 $286.49 --- -- 007000.00 $0.00Y
N95725EEG PHY/QHP>84 HR W/O VID 319.14 $261.70 --- -- 007000.00 $0.00Y
N95726EEG PHY/QHP>84 HR W/VEEG 441.52 $362.05 --- -- 007000.00 $0.00Y
N95782POLYSOM <6 YRS 4/> PARAMTRS 1154.29 $946.52 --- $1200.46007100.11 $0.00Y
N95783POLYSOM <6 YRS CPAP/BILVL 1231.49 $1009.82 --- $1280.75007100.12 $0.00Y
N95805MULTIPLE SLEEP LATENCY TEST 238.68 $195.72 --- $248.23007100.35 $0.00Y
N95807SLEEP STUDY ATTENDED 257.67 $211.29 --- $267.98007100.39 $0.00Y
N95808POLYSOM ANY AGE 1-3> PARAM 285.18 $233.85 --- $296.59007100.45 $0.00Y
N95810POLYSOM 6/> YRS 4/> PARAM 424.48 $348.07 --- $441.46007100.45 $0.00Y
N95811POLYSOM 6/>YRS CPAP 4/> PARM 436.24 $357.72 --- $453.69007100.47 $0.00Y
N95812EEG 41-60 MINUTES 99.78 $81.82 --- $103.77007110.51 $0.00Y
N95813EEG EXTND MNTR 61-119 MIN 135.78 $111.34 --- $141.21007110.60 $0.00Y
N95816EEG AWAKE AND DROWSY 92.17 $75.58 --- $95.86007110.48 $0.00Y
N95819EEG AWAKE AND ASLEEP 79.28 $65.01 --- $82.45007110.53 $0.00Y
N95822EEG COMA OR SLEEP ONLY 79.28 $65.01 --- $82.45007110.46 $0.00Y
N95824EEG CEREBRAL DEATH ONLY 49.78 $40.82 --- $51.77007100.75 $0.00Y
N95829SURGERY ELECTROCORTICOGRAM 271.32 $222.48 --- $282.17007100.97 $0.00Y
N95830INSERT ELECTRODES FOR EEG 96.76 $79.34 --- $100.63007110.00 $0.00Y
N95836ECOG IMPLTD BRN NPGT <30 D 113.12 $92.76 --- -- 007000.00 $0.00Y
N95851RANGE OF MOTION MEASUREMENTS 18.12 $14.86 --- $18.84007110.00 $0.00Y
P95851RANGE OF MOTION MEASUREMENTS 18.12 $14.86 --- -- 019010.00 $0.00Y
N95852RANGE OF MOTION MEASUREMENTS 9.98 $8.18 --- $10.38007110.00 $0.00Y
N95857CHOLINESTERASE CHALLENGE 36.24 $29.72 --- $37.69007110.00 $0.00Y
N95860MUSCLE TEST ONE LIMB 80.00 $65.60 --- $83.20007110.81 $0.00Y
N95861MUSCLE TEST 2 LIMBS 120.00 $98.40 --- $124.80007110.78 $0.00Y
N95863MUSCLE TEST 3 LIMBS 135.91 $111.45 --- $141.35007110.77 $0.00Y
N95864MUSCLE TEST 4 LIMBS 200.00 $164.00 --- $208.00007110.67 $0.00Y
N95865MUSCLE TEST LARYNX 121.76 $99.84 --- -- 007000.75 $0.00Y
N95866MUSCLE TEST HEMIDIAPHRAGM 81.06 $66.47 --- -- 007000.75 $0.00Y
N95867MUSCLE TEST CRAN NERV UNILAT 58.82 $48.23 --- $61.17007110.67 $0.00Y
N95868MUSCLE TEST CRAN NERVE BILAT 99.28 $81.41 --- $103.25007110.79 $0.00Y
N95869MUSCLE TEST THOR PARASPINAL 32.00 $26.24 --- $33.28007110.75 $0.00Y
N95870MUSCLE TEST NONPARASPINAL 24.70 $20.25 --- $25.69007100.76 $0.00Y
N95872MUSCLE TEST ONE FIBER 89.33 $73.25 --- $92.90007110.77 $0.00Y
N95873GUIDE NERV DESTR ELEC STIM 29.87 $24.49 --- -- 007000.77 $0.00Y
N95874GUIDE NERV DESTR NEEDLE EMG 30.28 $24.83 --- -- 007000.77 $0.00Y
N95875LIMB EXERCISE TEST 62.41 $51.18 --- $64.91007110.77 $0.00Y
N95885MUSC TST DONE W/NERV TST LIM 60.78 $49.84 --- $63.21007110.30 $0.00Y
N95886MUSC TEST DONE W/N TEST COMP 93.71 $76.84 --- $97.46007110.52 $0.00Y
N95887MUSC TST DONE W/N TST NONEXT 83.94 $68.83 --- $87.30007110.46 $0.00Y
N95905MOTOR &/ SENS NRVE CNDJ TEST 86.34 $70.80 --- -- 007010.74 $0.00Y
N95907NVR CNDJ TST 1-2 STUDIES 100.99 $82.81 --- -- 007000.53 $0.00Y
N95908NRV CNDJ TST 3-4 STUDIES 124.62 $102.19 --- -- 007000.54 $0.00Y
N95909NRV CNDJ TST 5-6 STUDIES 149.20 $122.34 --- -- 007000.54 $0.00Y
N95910NRV CNDJ TEST 7-8 STUDIES 196.28 $160.95 --- -- 007000.55 $0.00Y
N95911NRV CNDJ TEST 9-10 STUDIES 237.26 $194.55 --- -- 007000.57 $0.00Y
N95912NRV CNDJ TEST 11-12 STUDIES 277.48 $227.53 --- -- 007000.58 $0.00Y
N95913NRV CNDJ TEST 13/> STUDIES 321.28 $263.45 --- -- 007000.06 $0.00Y
N95924ANS PARASYMP & SYMP W/TILT 157.10 $128.82 --- -- 007000.57 $0.00Y
N95925SHORTLATENCY SOMATOSENSORY, UPPER LIMBS 103.35 $84.75 --- $107.48007110.55 $0.00Y
N95926SHLATENCY SOMATOSENSORY EVOK STUDY LL 123.15 $123.15 --- -- 009010.55 $0.00Y
N95927SHLATENCY SOMATOSENORY STUDY TRUNK OR H 123.15 $123.15 --- -- 009010.55 $0.00Y
N95928C MOTOR EVOKED UPPR LIMBS 186.77 $153.15 --- $194.24007110.55 $0.00Y
N95929C MOTOR EVOKED LWR LIMBS 194.77 $159.69 --- $202.56007110.55 $0.00Y
N95930VISUAL EVOKED POTENTIAL (VEP) TESTING CE 42.00 $34.44 --- $43.68007110.79 $0.00Y
N95937NEUROMUSCULAR JUNCTION TEST 27.18 $22.29 --- $28.27007110.75 $0.00Y
N95938*12SOMATOSENSORY TESTING 326.42 $267.67 --- $339.48007110.14 $0.00Y
N95939C MOTOR EVOKED UPR&LWR LIMBS 506.75 $415.54 --- $527.02007110.23 $0.00Y
N95940IONM IN OPERATNG ROOM 15 MIN 32.99 $27.05 --- -- 007000.00 $0.00Y
N95941IONM REMOTE/>1 PT OR PER HR 0.00 $0.00 --- -- 007000.00 $0.00N
N95943PARASYMP&SYMP HRT RATE TEST 0.00 $0.00 --- -- 007000.00 $0.00N
N95955EEG DURING SURGERY 135.56 $111.16 --- $140.98007100.50 $0.00Y
N95957EEG DIGITAL ANALYSIS 141.89 $116.35 --- $147.57007110.42 $0.00Y
N95958EEG MONITORING/FUNCTION TEST 301.54 $247.26 --- $313.60007100.80 $0.00Y
N95965MEG SPONTANEOUS 0.00 $0.00 --- -- 007000.00 $0.00Y
N95966MEG EVOKED SINGLE 0.00 $0.00 --- -- 007000.00 $0.00Y
N95967MEG EVOKED EACH ADDL 0.00 $0.00 --- -- 007000.00 $0.00Y
N95970ANALYZE NEUROSTIM NO PROG 24.13 $19.79 --- $25.10007100.00 $0.00Y
N95971ANALYZE NEUROSTIM SIMPLE 41.12 $33.72 --- $42.76007100.00 $0.00Y
N95972ANALYZE NEUROSTIM COMPLEX 78.94 $64.73 --- $82.10007100.00 $0.00Y
N95976ALYS SMPL CN NPGT PRGRMG 42.71 $35.02 --- -- 007000.00 $0.00Y
N95977ALYS CPLX CN NPGT PRGRMG 56.76 $46.54 --- -- 007000.00 $0.00Y
N95983ALYS BRN NPGT PRGRMG 15 MIN 53.56 $43.92 --- -- 007000.00 $0.00Y
N95984ALYS BRN NPGT PRGRMG ADDL 15 46.70 $38.29 --- -- 007000.00 $0.00Y
N95990SPIN/BRAIN PUMP REFIL & MAIN 60.39 $49.52 --- -- 007000.00 $0.00Y
N95991SPIN/BRAIN PUMP REFIL & MAIN 88.79 $72.81 --- -- 007000.00 $0.00Y
N95992CANALITH REPOSITIONING PROC 0.00 $0.00 --- -- 007000.00 $0.00Y
N95999NEUROLOGICAL PROCEDURE 0.00 $0.00 --- -- 007110.00 $0.00Y
N96020FUNCTIONAL BRAIN MAPPING 172.32 $141.30 --- -- 007001.00 $0.00Y
N96105ASSESSMENT OF APHASIA (INCLUDES ASSESSME 62.44 $51.20 --- $64.94007110.00 $0.00Y
Q96105ASSESSMENT OF APHASIA (INCLUDES ASSESSME 51.20 $51.20 --- -- 009000.00 $0.00N
Q96110DEVELOPMENTAL SCREEN 54.90 $54.90 --- -- 009000.00 $0.00N
E96110DEVELOPMENTAL TEST LIM 6.37 $6.37 --- -- 009000.00 $0.00Y
N96110DEVELOPMENTAL SCREEN 5.49 $54.90 $59.90 -- 001010.00 $0.00Y
N96112DEVEL TST PHYS/QHP 1ST HR 142.16 $116.57 --- -- 007000.00 $0.00Y
Q96112DEVEL TST PHYS/QHP 1ST HR 142.16 $116.57 --- -- 007000.00 $0.00N
Q96113DEVEL TST PHYS/QHP EA ADDL 63.26 $51.87 --- -- 007000.00 $0.00N
N96113DEVEL TST PHYS/QHP EA ADDL 63.26 $51.87 --- -- 007000.00 $0.00Y
N96116NUBHVL XM PHYS/QHP 1ST HR 5.62 $56.20 $61.31 $69.80053110.00 $0.00Y
Q96116NUBHVL XM PHYS/QHP 1ST HR 56.20 $56.20 --- -- 009000.00 $0.00N
Q96121NUBHVL XM PHY/QHP EA ADDL HR 85.57 $70.17 --- -- 007000.00 $0.00N
N96121NUBHVL XM PHY/QHP EA ADDL HR 85.57 $70.17 --- -- 007000.00 $0.00Y
N96127BRIEF EMOTIONAL/BEHAV ASSMT 5.87 $4.81 --- -- 007000.00 $0.00Y
N96130PSYCL TST EVAL PHYS/QHP 1ST 121.46 $99.60 --- -- 007000.00 $0.00Y
Q96130PSYCL TST EVAL PHYS/QHP 1ST 121.46 $99.60 --- -- 007000.00 $0.00N
E96130PSYCL TST EVAL PHYS/QHP 1ST 257.63 $257.63 --- -- 009000.00 $0.00Y
Q96131PSYCL TST EVAL PHYS/QHP EA 92.45 $75.81 --- -- 007000.00 $0.00N
N96131PSYCL TST EVAL PHYS/QHP EA 92.45 $75.81 --- -- 007000.00 $0.00Y
N96132NRPSYC TST EVAL PHYS/QHP 1ST 138.25 $113.37 --- -- 007000.00 $0.00Y
Q96132NRPSYC TST EVAL PHYS/QHP 1ST 138.25 $113.37 --- -- 007000.00 $0.00N
Q96133NRPSYC TST EVAL PHYS/QHP EA 105.40 $86.43 --- -- 007000.00 $0.00N
N96133NRPSYC TST EVAL PHYS/QHP EA 105.40 $86.43 --- -- 007000.00 $0.00Y
N96136PSYCL/NRPSYC TST PHY/QHP 1ST 51.07 $41.88 --- -- 007000.00 $0.00Y
Q96136PSYCL/NRPSYC TST PHY/QHP 1ST 51.07 $41.88 --- -- 007000.00 $0.00N
Q96137PSYCL/NRPSYC TST PHY/QHP EA 47.57 $39.01 --- -- 007000.00 $0.00N
N96137PSYCL/NRPSYC TST PHY/QHP EA 47.57 $39.01 --- -- 007000.00 $0.00Y
N96138PSYCL/NRPSYC TECH 1ST 43.52 $35.69 --- -- 007000.00 $0.00Y
Q96138PSYCL/NRPSYC TECH 1ST 43.52 $35.69 --- -- 007000.00 $0.00N
Q96139PSYCL/NRPSYC TST TECH EA 43.52 $35.69 --- -- 007000.00 $0.00N
N96139PSYCL/NRPSYC TST TECH EA 43.52 $35.69 --- -- 007000.00 $0.00N
N96146PSYCL/NRPSYC TST AUTO RESULT 2.24 $1.84 --- -- 007000.00 $0.00Y
Q96146PSYCL/NRPSYC TST AUTO RESULT 2.24 $1.84 --- -- 007000.00 $0.00N
E96156PSYCHOSOCIAL EVALUATION 12.94 $12.94 --- -- 009000.00 $0.00Y
N96156HLTH BHV ASSMT/REASSESSMENT 102.80 $84.30 --- -- 007000.00 $0.00Y
N96158HLTH BHV IVNTJ INDIV 1ST 30 70.28 $57.63 --- -- 007000.00 $0.00Y
E96158PSYCHOLOGY/COUNSELING TREATMENT 47.45 $47.45 --- -- 009000.00 $0.00Y
E96159PSYCHOLOGY/COUNSELING TREATMENT 12.94 $12.94 --- -- 009000.00 $0.00Y
N96159HLTH BHV IVNTJ INDIV EA ADDL 24.52 $20.11 --- -- 007000.00 $0.00Y
N96164HLTH BHV IVNTJ GRP 1ST 30 10.38 $8.52 --- -- 007000.00 $0.00Y
E96164PSYCHOLOGY/COUNSELING TREATMENT 10.50 $10.50 --- -- 009000.00 $0.00Y
E96165PSYCHOLOGY/COUNSELING TREATMENT 2.16 $2.16 --- -- 009000.00 $0.00Y
N96165HLTH BHV IVNTJ GRP EA ADDL 4.89 $4.01 --- -- 007000.00 $0.00Y
N96167HLTH BHV IVNTJ FAM 1ST 30 75.40 $61.83 --- -- 007000.00 $0.00Y
N96168HLTH BHV IVNTJ FAM EA ADDL 26.76 $21.95 --- -- 007000.00 $0.00Y
N96170HLTH BHV IVNTJ FAM WO PT 1ST 85.71 $70.29 --- -- 007000.00 $0.00Y
N96171HLTH BHV IVNTJ FAM W/O PT EA 31.15 $25.55 --- -- 007000.00 $0.00Y
N96360HYDRATION IV INFUSION INIT 5.13 $51.30 $55.97 $63.71053100.00 $0.00Y
N96361HYDRATE IV INFUSION ADD-ON 1.46 $14.60 $15.93 $18.13053100.00 $0.00Y
N96365THER/PROPH/DIAG IV INF INIT 76.34 $62.60 --- $79.39007100.00 $0.00Y
N96366THER/PROPH/DIAG IV INF ADDON 23.50 $19.27 --- $24.44007100.00 $0.00Y
N96367TX/PROPH/DG ADDL SEQ IV INF 37.86 $31.05 --- $39.37007100.00 $0.00Y
N96368THER/DIAG CONCURRENT INF 21.90 $17.96 --- $22.78007100.00 $0.00Y
N96369SC THER INFUSION UP TO 1 HR 168.79 $138.41 --- $175.54007100.00 $0.00Y
N96370SC THER INFUSION ADDL HR 16.50 $13.53 --- $17.16007100.00 $0.00Y
N96371SC THER INFUSION RESET PUMP 82.60 $67.73 --- $85.90007100.00 $0.00Y
N96372THER/PROPH/DIAG INJ SC/IM 22.86 $18.75 --- $23.77007100.00 $0.00Y
N96373THER/PROPH/DIAG INJ IA 19.39 $15.90 --- $20.17007100.00 $0.00Y
N96374THER/PROPH/DIAG INJ IV PUSH 60.75 $49.82 --- $63.18007100.00 $0.00Y
N96375TX/PRO/DX INJ NEW DRUG ADDON 25.96 $21.29 --- $27.00007100.00 $0.00Y
N96377APPLICATON ON-BODY INJECTOR 0.00 $0.00 --- -- 007000.00 $0.00Y
N96379THER/PROP/DIAG INJ/INF PROC 0.00 $0.00 --- -- 007100.00 $0.00Y
N96401CHEMO ANTI-NEOPL SQ/IM 13.00 $10.66 --- $13.52007100.00 $0.00Y
N96402CHEMO HORMON ANTINEOPL SQ/IM 13.00 $10.66 --- $13.52007100.00 $0.00Y
N96405CHEMO INTRALESIONAL UP TO 7 47.94 $39.31 --- $49.86007100.00 $0.00Y
N96406CHEMO INTRALESIONAL OVER 7 63.10 $51.74 --- $65.62007100.00 $0.00Y
N96409CHEMO IV PUSH SNGL DRUG 21.90 $17.96 --- $22.78007100.00 $0.00Y
N96411CHEMO IV PUSH ADDL DRUG 21.90 $17.96 --- $22.78007100.00 $0.00Y
N96413CHEMO IV INFUSION 1 HR 34.87 $28.59 --- $36.26007100.00 $0.00Y
N96415CHEMO IV INFUSION ADDL HR 26.21 $21.49 --- -- 007000.00 $0.00Y
N96416CHEMO PROLONG INFUSE W/PUMP 56.33 $46.19 --- $58.58007100.00 $0.00Y
N96417CHEMO IV INFUS EACH ADDL SEQ 34.87 $28.59 --- $36.26007100.00 $0.00Y
N96420CHEMO IA PUSH TECNIQUE 51.43 $42.17 --- $53.49007100.00 $0.00Y
N96422CHEMO IA INFUSION UP TO 1 HR 45.30 $37.15 --- $47.11007100.00 $0.00Y
N96423CHEMO IA INFUSE EACH ADDL HR 20.39 $16.72 --- -- 007000.00 $0.00Y
N96425CHEMOTHERAPY INFUSION METHOD 186.63 $153.04 --- $194.10007100.00 $0.00Y
N96440CHEMOTHERAPY INTRACAVITARY 202.90 $166.38 --- $211.02007100.00 $0.00Y
N96446CHEMOTX ADMN PRTL CAVITY 151.54 $124.26 --- $157.60007100.00 $0.00Y
N96450CHEMOTHERAPY INTO CNS 159.32 $130.64 --- $165.69007100.00 $0.00Y
N96521REFILL/MAINT PORTABLE PUMP 20.16 $16.53 --- -- 007010.00 $0.00Y
N96522REFILL/MAINT PUMP/RESVR SYST 34.23 $28.07 --- $35.60007110.00 $0.00Y
N96523IRRIG DRUG DELIVERY DEVICE 0.00 $0.00 --- -- 007100.00 $0.00Y
N96542CHEMOTHERAPY INJECTION 104.29 $85.52 --- $108.46007100.00 $0.00Y
N96549CHEMOTHERAPY UNSPECIFIED 0.00 $0.00 --- -- 007110.00 $0.00Y
N96567PHOTODYNAMIC TX SKIN 0.00 $0.00 --- -- 007000.00 $0.00Y
N96573PDT DSTR PRMLG LES PHYS/QHP 214.62 $175.99 --- -- 007000.00 $0.00Y
N96574DBRDMT PRMLG LES W/PDT 274.79 $225.33 --- -- 007000.00 $0.00Y
N96900ULTRAVIOLET LIGHT THERAPY 9.02 $7.40 --- $9.38007110.00 $0.00Y
N96910PHOTOCHEMOTHERAPY WITH UV-B 30.00 $24.60 --- $31.20007110.00 $0.00Y
N96912PHOTOCHEMOTHERAPY WITH UV-A 19.46 $15.96 --- $20.24007110.00 $0.00Y
N96913PHOTOCHEMOTHERAPY UV-A OR B 39.79 $32.63 --- $41.38007100.00 $0.00Y
N96920LASER TX SKIN < 250 SQ CM 151.57 $124.29 --- -- 007000.00 $0.00Y
N96921LASER TX SKIN 250-500 SQ CM 162.40 $133.17 --- -- 007000.00 $0.00Y
N96922LASER TX SKIN >500 SQ CM 222.13 $182.15 --- -- 007000.00 $0.00Y
N96999DERMATOLOGICAL PROCEDURE 0.00 $0.00 --- -- 007110.00 $0.00Y
N97010APPLICATION 12.00 $9.84 --- $12.48007110.00 $0.00Y
P97010APPLICATION 12.00 $9.84 --- -- 019010.00 $0.00Y
P97012MECHANICAL TRACTION THERAPY 13.59 $11.14 --- -- 019010.00 $0.00Y
N97012MECHANICAL TRACTION THERAPY 13.59 $11.14 --- $14.13007110.00 $0.00Y
N97014ELECTRIC STIMULATION THERAPY 13.59 $11.14 --- $14.13007110.00 $0.00Y
P97014ELECTRIC STIMULATION THERAPY 13.59 $11.14 --- -- 019010.00 $0.00Y
P97016VASOPNEUMATIC DEVICE THERAPY 13.59 $11.14 --- -- 019010.00 $0.00Y
N97016VASOPNEUMATIC DEVICE THERAPY 13.59 $11.14 --- $14.13007110.00 $0.00Y
N97018PARAFFIN BATH THERAPY 12.00 $9.84 --- $12.48007110.00 $0.00Y
P97018PARAFFIN BATH THERAPY 12.00 $9.84 --- -- 019010.00 $0.00Y
P97022WHIRLPOOL THERAPY 13.59 $11.14 --- -- 019010.00 $0.00Y
N97022WHIRLPOOL THERAPY 13.59 $11.14 --- $14.13007110.00 $0.00Y
N97024DIATHERMY EG MICROWAVE 12.00 $9.84 --- $12.48007110.00 $0.00Y
P97024DIATHERMY EG MICROWAVE 12.00 $9.84 --- -- 019010.00 $0.00Y
P97026INFRARED THERAPY 12.00 $9.84 --- -- 019010.00 $0.00Y
N97026INFRARED THERAPY 12.00 $9.84 --- $12.48007110.00 $0.00Y
N97028ULTRAVIOLET THERAPY 12.00 $9.84 --- $12.48007110.00 $0.00Y
P97028ULTRAVIOLET THERAPY 12.00 $9.84 --- -- 019010.00 $0.00Y
P97032APPLICATION A MODALITY TO ONE/MORE AREA 10.56 $8.66 --- -- 019010.00 $0.00Y
N97032APPLICATION TO ONE OR MORE AREAS 10.56 $8.66 --- $10.98007110.00 $0.00Y
N97033APPLICATION A MODALITY TO ONE/MORE AREA 11.20 $9.18 --- $11.65007110.00 $0.00Y
P97033APPLICATION MODALITY TO ONE/MORE AREA 11.20 $9.18 --- -- 019010.00 $0.00Y
P97034APPLICATION MODALITY TO ONE/MORE AREA 9.55 $7.83 --- -- 019010.00 $0.00Y
N97034APPLICATION MODALITY TO ONE/MORE AREA 9.55 $7.83 --- $9.93007110.00 $0.00Y
N97035APPLICATION MODALITY TO ONE/MORE AREA 9.06 $7.43 --- $9.42007110.00 $0.00Y
P97035APPLICATION MODALITY TO ONE/MORE AREA 9.06 $7.43 --- -- 019010.00 $0.00Y
P97036APPLICATION MODALITY TO 1/MORE AREA 13.59 $11.14 --- -- 019110.00 $0.00Y
N97036APPLICATION MODALITY TO ONE/MORE AREA 13.59 $11.14 --- $14.13007110.00 $0.00Y
N97039UNLISTED MODALITY(SPEC TYPE/TIME IF CONS 17.40 $14.27 --- $18.10007110.00 $0.00Y
P97039UNLISTED MODALITY(SPEC TYPE/TIME IF CONS 17.40 $14.27 --- -- 007010.00 $0.00Y
P97110THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 13.37 $10.96 --- -- 019010.00 $0.00Y
E97110THERAPEUTIC PROC, 1 OR MORE AREAS,EA 15M 6.37 $6.37 --- -- 009000.00 $0.00Y
N97110THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 13.37 $10.96 --- $13.90007110.00 $0.00Y
N97112NEUROMUSCULAR REEDUCATION 14.90 $12.22 --- $15.50007110.00 $0.00Y
P97112NEUROMUSCULAR REEDUCATION 14.90 $12.22 --- -- 019010.00 $0.00Y
P97113THERAPEUTIC PROC ONE/MORE AREA 15 MIN 16.99 $13.93 --- -- 019010.00 $0.00Y
N97113THERAPEUTIC PROC ONE/MORE AREA 15 MIN 16.99 $13.93 --- $17.67007110.00 $0.00Y
N97116THERAPEUTIC PROCEDURE, GAIT TRAINING 13.76 $11.28 --- $14.31007110.00 $0.00Y
P97116THERAPEUTIC PROCEDURE, GAIT TRAINING 13.76 $11.28 --- -- 019010.00 $0.00Y
P97124THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 12.55 $10.29 --- -- 019010.00 $0.00Y
N97124THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 12.55 $10.29 --- $13.05007110.00 $0.00Y
N97129THER IVNTJ 1ST 15 MIN 25.34 $20.78 --- -- 007000.00 $0.00Y
N97130THER IVNTJ EA ADDL 15 MIN 24.19 $19.84 --- -- 007000.00 $0.00Y
N97139THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 9.33 $7.65 --- $9.70007110.00 $0.00Y
P97139THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 9.33 $7.65 --- -- 019010.00 $0.00Y
P97140MANUAL THERAPY 1/> REGIONS 27.09 $22.21 --- -- 019100.00 $0.00Y
N97140MANUAL THERAPY 1/> REGIONS 27.09 $22.21 --- $28.17007100.00 $0.00Y
E97150PT OR OT GROUP TREATMENT 13.54 $13.54 --- -- 009000.00 $0.00Y
E97163PT EVALUATION 135.56 $135.56 --- -- 009000.00 $0.00Y
E97164PT RE-EVALUATION 94.14 $94.14 --- -- 009000.00 $0.00Y
E97167OT EVALUATION 125.74 $125.74 --- -- 009000.00 $0.00Y
E97168OT RE-EVALUATION 87.32 $87.32 --- -- 009000.00 $0.00Y
N97530THERAPEUTIC ACTIVITIES 13.59 $11.14 --- $14.13007110.00 $0.00Y
N97533SENSORY INTEGRATION 29.48 $24.17 --- $30.66007110.00 $0.00Y
E97533Q&M TREATMENT 12.34 $12.34 --- -- 009000.00 $0.00Y
E97535ADL ASSISTANCE 5.31 $5.31 --- -- 009000.00 $0.00Y
P97597RMVL DEVITAL TIS 20 CM/< 51.35 $42.11 --- -- 019100.00 $0.00Y
N97597RMVL DEVITAL TIS 20 CM/< 51.35 $42.11 --- $53.40007100.00 $0.00Y
N97598RMVL DEVITAL TIS ADDL 20CM/< 65.21 $53.47 --- $67.82007100.00 $0.00Y
P97598RMVL DEVITAL TIS ADDL 20CM/< 65.21 $53.47 --- -- 019100.00 $0.00Y
N97750PHYSICAL PERFORMANCE TEST OR MEASUREMENT 14.02 $11.50 --- $14.58007100.00 $0.00Y
N97799UNLISTED PHYS MED/REHAB SERV OR PROC 0.00 $0.00 --- -- 007110.00 $0.00Y
N97802MEDICAL NUTRITION INDIV IN 30.35 $30.35 --- $30.35009110.00 $0.00Y
T97802MED NUTRTN TX;INITIAL ASSMNT PER 15MIN 30.35 $30.35 --- -- 009000.00 $0.00Y
T97803MED NUTRTN TX;RE-ASSMNT EACH 15MINS 26.11 $26.11 --- -- 009000.00 $0.00Y
N97803MED NUTRITION INDIV SUBSEQ 26.11 $26.11 --- $26.11009110.00 $0.00Y
N97804MEDICAL NUTRITION GROUP 13.91 $13.91 --- $13.91009110.00 $0.00Y
T97804MED NUTRITION TX EACH 30 MIN 13.91 $13.91 --- -- 009000.00 $0.00Y
P97810ACUPUNCT W/O STIMUL 15 MIN 7.06 $5.79 --- -- 019110.00 $0.00Y
N97810ACUPUNCT W/O STIMUL 15 MIN 7.06 $5.79 --- $7.34007110.00 $0.00Y
N97811ACUPUNCT W/O STIMUL ADDL 15M 7.06 $5.79 --- $7.34007110.00 $0.00Y
P97811ACUPUNCT W/O STIMUL ADDL 15M 7.06 $5.79 --- -- 019110.00 $0.00Y
P97813ACUPUNCT W/STIMUL 15 MIN 7.06 $5.79 --- -- 019110.00 $0.00Y
N97813ACUPUNCT W/STIMUL 15 MIN 7.06 $5.79 --- $7.34007110.00 $0.00Y
N97814ACUPUNCT W/STIMUL ADDL 15M 7.06 $5.79 --- $7.34007110.00 $0.00Y
P97814ACUPUNCT W/STIMUL ADDL 15M 7.06 $5.79 --- -- 019110.00 $0.00Y
N98925OSTEOPATH MANJ 1-2 REGIONS 27.57 $27.57 --- -- 009000.00 $0.00N
N98926OSTEOPATH MANJ 3-4 REGIONS 39.54 $39.54 --- -- 009000.00 $0.00N
198940CHIROPRACT MANJ 1-2 REGIONS 16.72 $16.72 --- -- 009000.00 $0.00N
198941CHIROPRACT MANJ 3-4 REGIONS 16.72 $16.72 --- -- 009000.00 $0.00N
198942CHIROPRACTIC MANJ 5 REGIONS 16.72 $16.72 --- -- 009000.00 $0.00N
N99000SPECIMEN HANDLING OFFICE-LAB 4.43 $3.63 --- -- 007000.00 $0.00Y
199056OUT OF OFFICE CALL 7.50 $7.50 --- -- 009010.00 $0.00N
P99070SPECIAL SUPPLIES PHYS/QHP 0.00 $0.00 --- -- 009000.00 $0.00Y
N99070SPECIAL SUPPLIES PHYS/QHP 0.00 $0.00 --- -- 009000.00 $0.00Y
N99082TRAVEL TIME / MEDICAL PER HOUR 50.40 $50.40 --- -- 009000.00 $0.00N
N99091COLLECT/REVIEW DATA FROM PT 56.28 $46.15 --- -- 007000.00 $0.00Y
N99151MOD SED SAME PHYS/QHP <5 YRS 4.97 $69.63 --- -- 002000.00 $0.00Y
N99152MOD SED SAME PHYS/QHP 5/>YRS 3.33 $46.65 --- -- 002000.00 $0.00Y
N99153MOD SED SAME PHYS/QHP EA 0.72 $10.09 --- -- 002000.00 $0.00Y
N99155MOD SED OTH PHYS/QHP <5 YRS 5.59 $78.32 --- -- 002000.00 $0.00Y
N99156MOD SED OTH PHYS/QHP 5/>YRS 4.54 $63.61 --- -- 002000.00 $0.00Y
N99157MOD SED OTHER PHYS/QHP EA 3.44 $48.19 --- -- 002000.00 $0.00Y
N99170ANOGENITAL EXAM CHILD 10.88 $108.80 $118.70 $135.13001100.00 $0.00Y
E99173VISUAL ACUITY SCREEN 4.03 $4.03 --- -- 009000.00 $0.00Y
N99183HYPERBARIC OXYGEN THERAPY 113.29 $92.90 --- $117.82007100.00 $0.00Y
N99184HYPOTHERMIA ILL NEONATE 242.80 $199.10 --- -- 007000.00 $0.00Y
N99188APP TOPICAL FLUORIDE VARNISH 18.00 $18.00 --- -- 009000.00 $0.00Y
N99195PHLEBOTOMY 20.00 $16.40 --- $20.80007100.00 $0.00Y
N99199SPECIAL SERVICE/PROC/REPORT 0.00 $0.00 --- -- 007100.00 $0.00Y
N99202OFFICE O/P NEW SF 15-29 MIN 3.43 $34.30 $37.42 $42.60001110.00 $0.00Y
P99202OFFICE O/P NEW SF 15-29 MIN 3.43 $34.30 $37.42 -- 052010.00 $0.00Y
199202OFFICE O/P NEW SF 15-29 MIN 34.30 $34.30 --- $34.30009100.00 $0.00Y
199203OFFICE O/P NEW LOW 30-44 MIN 57.20 $57.20 --- $57.20009100.00 $0.00Y
P99203OFFICE O/P NEW LOW 30-44 MIN 5.72 $57.20 $62.41 -- 052010.00 $0.00Y
N99203OFFICE O/P NEW LOW 30-44 MIN 5.72 $57.20 $62.41 $71.04001110.00 $0.00Y
N99204OFFICE O/P NEW MOD 45-59 MIN 6.89 $68.90 $75.17 $85.57001110.00 $0.00Y
P99204OFFICE O/P NEW MOD 45-59 MIN 6.89 $68.90 $75.17 -- 052110.00 $0.00Y
199204OFFICE O/P NEW MOD 45-59 MIN 68.90 $68.90 --- $68.90009100.00 $0.00Y
199205OFFICE O/P NEW HI 60-74 MIN 82.70 $82.70 --- $82.70009100.00 $0.00Y
P99205OFFICE O/P NEW HI 60-74 MIN 8.27 $82.70 $90.23 -- 052110.00 $0.00Y
N99205OFFICE O/P NEW HI 60-74 MIN 8.27 $82.70 $90.23 $102.71001110.00 $0.00Y
N99211OFFICE O/P EST MINIMAL PROB 1.20 $12.00 $13.09 $14.90001110.00 $0.00Y
P99211OFFICE O/P EST MINIMAL PROB 1.20 $12.00 $13.09 -- 052010.00 $0.00Y
199211OFFICE O/P EST MINIMAL PROB 12.00 $12.00 --- $12.00009100.00 $0.00Y
199212OFFICE O/P EST SF 10-19 MIN 11.41 $11.41 --- $11.41009100.00 $0.00Y
P99212OFFICE O/P EST SF 10-19 MIN 1.81 $18.10 $19.75 -- 052010.00 $0.00Y
N99212OFFICE O/P EST SF 10-19 MIN 1.81 $18.10 $19.75 $22.48001110.00 $0.00Y
N99213OFFICE O/P EST LOW 20-29 MIN 2.40 $24.00 $26.18 $29.81001110.00 $0.00Y
P99213OFFICE O/P EST LOW 20-29 MIN 2.40 $24.00 $26.18 -- 052010.00 $0.00Y
199213OFFICE O/P EST LOW 20-29 MIN 24.00 $24.00 --- $24.00009100.00 $0.00Y
199214OFFICE O/P EST MOD 30-39 MIN 37.50 $37.50 --- $37.50009100.00 $0.00Y
P99214OFFICE O/P EST MOD 30-39 MIN 3.75 $37.50 $40.91 -- 052110.00 $0.00Y
N99214OFFICE O/P EST MOD 30-39 MIN 3.75 $37.50 $40.91 $46.58001110.00 $0.00Y
N99215OFFICE O/P EST HI 40-54 MIN 5.72 $57.20 $62.41 $71.04001110.00 $0.00Y
P99215OFFICE O/P EST HI 40-54 MIN 5.72 $57.20 $62.41 -- 052110.00 $0.00Y
199215OFFICE O/P EST HI 40-54 MIN 57.20 $57.20 --- $57.20009100.00 $0.00Y
P99221INITIAL HOSPITAL CARE 3.43 $34.30 $37.42 -- 052000.00 $0.00Y
N99221INITIAL HOSPITAL CARE 3.43 $34.30 $37.42 $42.60001100.00 $0.00Y
N99222INITIAL HOSPITAL CARE 7.32 $73.20 $79.86 $90.91001100.00 $0.00Y
P99222INITIAL HOSPITAL CARE 7.32 $73.20 $79.86 -- 052000.00 $0.00Y
P99223INITIAL HOSPITAL CARE 8.01 $80.10 $87.39 -- 052000.00 $0.00Y
N99223INITIAL HOSPITAL CARE 8.01 $80.10 $87.39 $99.48001100.00 $0.00Y
N99231SUBSEQUENT HOSPITAL CARE 2.75 $27.50 $30.00 $34.16001100.00 $0.00Y
P99231SUBSEQUENT HOSPITAL CARE 2.75 $27.50 $30.00 -- 052000.00 $0.00Y
P99232SUBSEQUENT HOSPITAL CARE 3.78 $37.80 $41.24 -- 052000.00 $0.00Y
N99232SUBSEQUENT HOSPITAL CARE 3.78 $37.80 $41.24 $46.95001100.00 $0.00Y
N99233SUBSEQUENT HOSPITAL CARE 4.58 $45.80 $49.97 $56.88001100.00 $0.00Y
P99233SUBSEQUENT HOSPITAL CARE 4.58 $45.80 $49.97 -- 052100.00 $0.00Y
N99234OBSERV/HOSP SAME DATE 7.47 $74.70 $81.50 $92.78001100.00 $0.00Y
N99235OBSERV/HOSP SAME DATE 10.35 $103.50 $112.92 $128.55001100.00 $0.00Y
N99236OBSERV/HOSP SAME DATE 12.46 $124.60 $135.94 $154.75001100.00 $0.00Y
N99238HOSP DISCHARGE DAY MGMT;30 MIN OR LESS 3.76 $37.60 $41.02 $46.70001100.00 $0.00Y
P99238HOSP DISCHARGE DAY MGMT.;30 MIN OR LESS 3.76 $37.60 $41.02 -- 052100.00 $0.00Y
P99239HOSP DISCHARGE DAY MAN MORE THAN 30 MIN 5.34 $53.40 $58.26 -- 052100.00 $0.00Y
N99239HOSP DISCHARGE DAY MAN MORE THAN 30 MIN 5.34 $53.40 $58.26 $66.32001100.00 $0.00Y
N99241OFFICE CONSULTATION 3.06 $30.60 $33.38 $38.01053110.00 $0.00Y
P99241OFFICE CONSULTATION 3.06 $30.60 $33.38 -- 052010.00 $0.00Y
199241OFFICE CONSULTATION 30.60 $30.60 --- $30.60009100.00 $0.00Y
199242OFFICE CONSULTATION 47.20 $47.20 --- $47.20009100.00 $0.00Y
P99242OFFICE CONSULTATION 4.72 $47.20 $51.50 -- 052010.00 $0.00Y
N99242OFFICE CONSULTATION 4.72 $47.20 $51.50 $58.62053110.00 $0.00Y
N99243OFFICE CONSULTATION 5.95 $59.50 $64.91 $73.90053110.00 $0.00Y
P99243OFFICE CONSULTATION 5.95 $59.50 $64.91 -- 052010.00 $0.00Y
199243OFFICE CONSULTATION 59.50 $59.50 --- $59.50009100.00 $0.00Y
P99244OFFICE CONSULTATION 8.14 $81.40 $88.81 -- 052110.00 $0.00Y
N99244OFFICE CONSULTATION 8.14 $81.40 $88.81 $101.10053110.00 $0.00Y
N99245OFFICE CONSULTATION 10.22 $102.20 $111.50 $126.93053110.00 $0.00Y
P99245OFFICE CONSULTATION 10.22 $102.20 $111.50 -- 052110.00 $0.00Y
P99251INPATIENT CONSULTATION 33.98 $27.86 --- -- 019010.00 $0.00Y
N99251INPATIENT CONSULTATION 33.98 $27.86 --- -- 007010.00 $0.00Y
N99252INPATIENT CONSULTATION 39.59 $32.46 --- -- 007010.00 $0.00Y
P99252INPATIENT CONSULTATION 39.59 $32.46 --- -- 019010.00 $0.00Y
P99253INPATIENT CONSULTATION 56.63 $46.44 --- -- 019010.00 $0.00Y
N99253INPATIENT CONSULTATION 56.63 $46.44 --- -- 007010.00 $0.00Y
N99254INPATIENT CONSULTATION 79.28 $65.01 --- -- 007010.00 $0.00Y
P99254INPATIENT CONSULTATION 79.28 $65.01 --- -- 019010.00 $0.00Y
P99255INPATIENT CONSULTATION 105.18 $86.25 --- -- 019010.00 $0.00Y
N99255INPATIENT CONSULTATION 105.18 $86.25 --- -- 007010.00 $0.00Y
N99281EMERGENCY DEPT VISIT 14.60 $15.18 --- $15.18017100.00 $0.00Y
P99281EMERGENCY DEPT VISIT 12.61 $10.34 --- -- 019000.00 $0.00Y
P99282EMERGENCY DEPT VISIT 23.42 $19.20 --- -- 019000.00 $0.00Y
N99282EMERGENCY DEPT VISIT 23.44 $24.38 --- $24.38017100.00 $0.00Y
N99283EMERGENCY DEPT VISIT 42.88 $44.60 --- $44.60017100.00 $0.00Y
P99283EMERGENCY DEPT VISIT 42.83 $35.12 --- -- 019000.00 $0.00Y
P99284EMERGENCY DEPT VISIT 65.65 $53.83 --- -- 019000.00 $0.00Y
N99284EMERGENCY DEPT VISIT 65.72 $68.35 --- $68.35017100.00 $0.00Y
N99285EMERGENCY DEPT VISIT 103.92 $108.08 --- $108.08017100.00 $0.00Y
P99285EMERGENCY DEPT VISIT 131.81 $108.08 --- -- 019100.00 $0.00Y
N99291CRITICAL CARE FIRST HOUR 12.16 $121.60 $132.67 $151.03001100.00 $0.00Y
N99292CRITICAL CARE ADDL 30 MIN 5.89 $58.90 $64.26 $73.15001100.00 $0.00Y
N99304NURSING FACILITY CARE INIT 3.78 $37.80 $41.24 -- 001000.00 $0.00Y
P99304NURSING FACILITY CARE INIT 3.78 $37.80 $41.24 -- 052000.00 $0.00Y
P99305NURSING FACLILITY CARE INIT 4.69 $46.90 $51.17 -- 052000.00 $0.00Y
N99305NURSING FACILITY CARE INIT 4.69 $46.90 $51.17 -- 001000.00 $0.00Y
N99306NURSING FACILITY CARE INIT 7.21 $72.10 $78.66 -- 001000.00 $0.00Y
P99306NURSING FACILITY CARE INIT 7.21 $72.10 $78.66 -- 052000.00 $0.00Y
P99307NURSING FAC CARE SUBSEQ 1.37 $13.70 $14.95 -- 052000.00 $0.00Y
N99307NURSING FAC CARE SUBSEQ 1.37 $13.70 $14.95 -- 001000.00 $0.00Y
N99308NURSING FAC CARE SUBSEQ 2.75 $27.50 $30.00 -- 001000.00 $0.00Y
P99308NURSING FAC CARE SUBSEQ 2.75 $27.50 $30.00 -- 052000.00 $0.00Y
P99309NURSING FAC CARE SUBSEQ 4.00 $40.00 $43.64 -- 052000.00 $0.00Y
N99309NURSING FAC CARE SUBSEQ 4.00 $40.00 $43.64 -- 001000.00 $0.00Y
N99310NURSING FAC CARE SUBSEQ 5.20 $52.00 $56.73 -- 001000.00 $0.00Y
P99310NURSING FAC CARE SUBSEQ 5.20 $52.00 $56.73 -- 052000.00 $0.00Y
P99315NURSING FAC DISCHARGE DAY 3.84 $38.40 $41.89 -- 052100.00 $0.00Y
N99315NURSING FAC DISCHARGE DAY 3.84 $38.40 $41.89 $47.69001100.00 $0.00Y
N99316NURSING FAC DISCHARGE DAY 4.66 $46.60 $50.84 $57.88001100.00 $0.00Y
P99316NURSING FAC DISCHARGE DAY 4.66 $46.60 $50.84 -- 052100.00 $0.00Y
P99324DOMICIL/RHOME VISIT NEW PAT 3.74 $37.40 $40.80 -- 052000.00 $0.00Y
N99324DOMICIL/R-HOME VISIT NEW PAT 3.74 $37.40 $40.80 -- 001000.00 $0.00Y
N99325DOMICIL/R-HOME VISIT NEW PAT 5.15 $51.50 $56.19 -- 001000.00 $0.00Y
P99325DOMICIL/RHOME VISIT NEW PAT 5.15 $51.50 $56.19 -- 052000.00 $0.00Y
P99326DOMICIL/RHOME VISIT NEW PAT 6.88 $68.80 $75.06 -- 052000.00 $0.00Y
N99326DOMICIL/R-HOME VISIT NEW PAT 6.88 $68.80 $75.06 -- 001000.00 $0.00Y
N99327DOMICIL/R-HOME VISIT NEW PAT 8.00 $80.00 $87.28 -- 001000.00 $0.00Y
P99327DOMICIL/R-HOME VISIT NEW PAT 8.00 $80.00 $87.28 -- 052000.00 $0.00Y
P99328DOMICIL/R-HOME VISIT NEW PAT 8.00 $80.00 $87.28 -- 052000.00 $0.00Y
N99328DOMICIL/R-HOME VISIT NEW PAT 8.00 $80.00 $87.28 -- 001000.00 $0.00Y
N99334DOMICIL/R-HOME VISIT EST PAT 1.95 $19.50 $21.27 -- 001000.00 $0.00Y
P99334DOMICIL/RHOME VISIT EST PAT 1.95 $19.50 $21.27 -- 052000.00 $0.00Y
P99335DOMICIL/RHOME VISIT EST PAT 3.55 $35.50 $38.73 -- 052000.00 $0.00Y
N99335DOMICIL/R-HOME VISIT EST PAT 3.55 $35.50 $38.73 -- 001000.00 $0.00Y
N99336DOMICIL/R-HOME VISIT EST PAT 4.23 $42.30 $46.15 -- 001000.00 $0.00Y
P99336DOMICIL/RHOME VISIT EST PAT 4.23 $42.30 $46.15 -- 052000.00 $0.00Y
P99337DOMICIL/R-HOME VISIT EST PAT 4.23 $42.30 $46.15 -- 052000.00 $0.00Y
N99337DOMICIL/R-HOME VISIT EST PAT 4.23 $42.30 $46.15 -- 001000.00 $0.00Y
N99341HOME VISIT NEW PATIENT 4.12 $41.20 $44.95 $51.17001100.00 $0.00Y
P99341HOME VISIT NEW PATIENT 3.67 $36.70 $40.04 -- 052000.00 $0.00Y
P99342HOME VISIT NEW PATIENT 4.38 $43.80 $47.79 -- 052000.00 $0.00Y
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