| Administration of chemotherapy into artery using push technique (96420) |
$258.72 |
$616 |
0.8× |
| Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord (96450) |
$579.60 |
$1,380 |
1.7× |
| Aerosol inhalation pentamidine (94642) |
$172.62 |
$411 |
0.8× |
| Analyze pacemaker system (93724) |
$251.16 |
$598 |
0.8× |
| Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) |
$39.90 |
$95 |
— |
| Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) |
$49.98 |
$119 |
— |
| Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) |
$41.58 |
$99 |
— |
| Behavioral & qualit analysis voice and resonance (92524) |
$110.04 |
$262 |
— |
| Biopsy of heart lining (93505) |
$2,533.44 |
$6,032 |
0.8× |
| Bipap initial day (94660) |
$384.72 |
$916 |
1.7× |
| Breathing capacity test (94010) |
$181.44 |
$432 |
0.8× |
| Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) |
$241.92 |
$576 |
0.6× |
Bundle of his recording (93600)
unusually low — confirm this is the full procedure |
$2,750.58 |
$6,549 |
0.3× |
| Canalith repositioning (95992) |
$36.96 |
$88 |
— |
| Cardiopulmonary exercise testing (94621) |
$627.90 |
$1,495 |
1.6× |
| Cardiovascular procedure unlisted (93799) |
$1,391.46 |
$3,313 |
10.6× |
| Cardiovascular stress test (93017) |
$434.28 |
$1,034 |
2.0× |
| Cardioversion elective external (92960) |
$830.34 |
$1,977 |
1.2× |
| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93460) |
$10,601.22 |
$25,241 |
3.2× |
| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93459) |
$9,599.52 |
$22,856 |
2.9× |
| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93458) |
$9,113.16 |
$21,698 |
2.8× |
| Chemo anti-neopl sq/im (96401) |
$221.76 |
$528 |
3.0× |
| Chemo hormon antineopl sq/im (96402) |
$86.10 |
$205 |
1.2× |
| Chemo intralesional over 7 (96406) |
$272.16 |
$648 |
1.3× |
| Chemo intralesional up to 7 (96405) |
$174.30 |
$415 |
2.4× |
| Chemo IV infus each addl seq (96417) |
$96.18 |
$229 |
1.3× |
| Chemo IV infusion addl hr (96415) |
$56.70 |
$135 |
0.8× |
| Chemo IV push addl drug (96411) |
$115.50 |
$275 |
1.6× |
| Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour (96422) |
$305.34 |
$727 |
0.9× |
| Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) |
$264.60 |
$630 |
0.8× |
| Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) |
$209.16 |
$498 |
0.6× |
| Chest physiotherapy initial (94667) |
$81.48 |
$194 |
0.6× |
| Color/duplex Doppler, complete (93975) |
$626.22 |
$1,491 |
2.6× |
| Color/duplex Doppler, limited (93976) |
$374.64 |
$892 |
3.5× |
| Compre electrophysiologic w/o arrhyt induction (93619) |
$10,379.04 |
$24,712 |
1.3× |
| Compre ep eval abltj atr fib pulm vein isolation (93656) |
$23,868.60 |
$56,830 |
0.9× |
| Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with… (93620) |
$33,480.72 |
$79,716 |
4.2× |
| Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93653) |
$13,923 |
$33,150 |
0.5× |
| Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93654) |
$15,193.92 |
$36,176 |
0.6× |
| Coronary art/grft angio s&i (93455) |
$8,911.14 |
$21,217 |
2.7× |
| Coronary artery angio s&i (93454) |
$8,119.86 |
$19,333 |
2.5× |
| Cpr (92950) |
$623.70 |
$1,485 |
2.8× |
| Critical care ill/injured patient init 30-74 min (99291) |
$3,265.50 |
$7,775 |
3.9× |
| Debridement open wound 20 sq cm< (97597) |
$129.78 |
$309 |
0.6× |
| Dup-scan artl infl&ven o/f pen vsl compl (93980) |
$456.12 |
$1,086 |
4.3× |
| Duplex hemodialysis access (93990) |
$296.94 |
$707 |
2.8× |
| Duplex scan artl infl&ven o/f hemo compl bi std (93985) |
$370.44 |
$882 |
1.5× |
| Duplex scan artl infl&ven o/f hemo compl uni std (93986) |
$281.82 |
$671 |
2.6× |
| Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) |
$482.16 |
$1,148 |
2.0× |
| Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) |
$228.06 |
$543 |
2.1× |
| Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) |
$525.84 |
$1,252 |
2.2× |
| Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) |
$224.70 |
$535 |
2.1× |
| Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) |
$820.26 |
$1,953 |
3.4× |
| Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) |
$460.74 |
$1,097 |
4.3× |
| Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) |
$485.94 |
$1,157 |
2.0× |
| Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) |
$346.92 |
$826 |
3.2× |
| Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) |
$1,024.80 |
$2,440 |
4.2× |
| Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) |
$316.26 |
$753 |
3.0× |
| Echo transesophageal (93312) |
$506.94 |
$1,207 |
0.9× |
| Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional… (93318) |
$345.66 |
$823 |
0.6× |
| Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) |
$395.64 |
$942 |
1.6× |
| EEG 41-60 minutes (95812) |
$563.22 |
$1,341 |
2.6× |
| EEG awake & asleep (95819) |
$453.60 |
$1,080 |
2.1× |
| EEG awake/drowsy (95816) |
$371.70 |
$885 |
1.7× |
| EEG coma or sleep only (95822) |
$454.44 |
$1,082 |
2.1× |
| EEG cont rec w/video by tech min 8 channels (95700) |
$314.16 |
$748 |
1.4× |
| EEG extended monitoring 61-119 minutes (95813) |
$677.46 |
$1,613 |
3.1× |
| EEG w/o vid by tech ea incr 12-26 hr intmt mntr (95709) |
$1,025.22 |
$2,441 |
2.7× |
| EEG w/o vid by tech ea incr 12-26hr unmonitored (95708) |
$931.98 |
$2,219 |
2.4× |
| EEG w/o vid tech ea incr 12-26 hr cont r-t mntr (95710) |
$1,087.38 |
$2,589 |
2.9× |
| EEG w/o video by tech 2-12 hr intermittent mntr (95706) |
$714.42 |
$1,701 |
3.2× |
| EEG w/o video by tech 2-12 hr unmonitored (95705) |
$621.18 |
$1,479 |
2.8× |
| EEG w/o video by tech 2-12hr continuous r-t mntr (95707) |
$776.58 |
$1,849 |
3.5× |
| EKG 12 lead tracing only (93005) |
$190.26 |
$453 |
3.2× |
| EKG rhythm strip (93041) |
$58.80 |
$140 |
1.0× |
| Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes… (93642) |
$2,362.08 |
$5,624 |
1.9× |
Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or… (93624)
unusually low — confirm this is the full procedure |
$2,750.58 |
$6,549 |
0.3× |
| Emergency department visit high mdm (99285) |
$1,414.56 |
$3,368 |
2.3× |
| Emergency department visit low mdm (99283) |
$716.10 |
$1,705 |
2.6× |
| Emergency department visit may not req phys/qhp (99281) |
$281.40 |
$670 |
3.3× |
| Emergency department visit moderate mdm (99284) |
$1,029 |
$2,450 |
2.4× |
| Emergency department visit straightforward mdm (99282) |
$497.70 |
$1,185 |
3.2× |
| Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s)… (91038) |
$561.54 |
$1,337 |
1.5× |
| Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and… (91010) |
$1,093.26 |
$2,603 |
2.9× |
| Esophageal recording (93615) |
$1,107.12 |
$2,636 |
0.9× |
| Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) |
$123.48 |
$294 |
— |
| Evaluate pt use of inhaler (94664) |
$85.68 |
$204 |
0.4× |
| Evaluation of speech sound production articulate (92522) |
$112.14 |
$267 |
— |
| Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic… (94617) |
$441.42 |
$1,051 |
3.2× |
| Gas dilut/washout lung vol w/wo distrib vent&vol (94727) |
$157.08 |
$374 |
0.7× |
| Gastroesophag reflx test w/telemtry ph eltrd (91035) |
$710.22 |
$1,691 |
0.8× |
| Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and… (91110) |
$1,519.14 |
$3,617 |
1.6× |
| Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report Age… (91111) |
$908.04 |
$2,162 |
1.0× |
| Hast w/oxygen titrate (94453) |
$112.14 |
$267 |
0.8× |
| Hemodialysis procedure w/ phys/qhp evaluation (90935) |
$930.30 |
$2,215 |
1.3× |
| Immunization administration (90471) |
$55.02 |
$131 |
0.7× |
| Induction of arrhythmia by electrical pacing without Cardiac Cath (93618) |
$734.16 |
$1,748 |
0.6× |
| Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) |
$75.18 |
$179 |
1.6× |
| Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) |
$138.18 |
$329 |
0.6× |
| Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes with Cardiac Cath (93503) |
$1,590.96 |
$3,788 |
1.0× |
| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93261) |
$42 |
$100 |
1.1× |
Intra-atrial pacing (93610)
unusually low — confirm this is the full procedure |
$2,750.58 |
$6,549 |
0.3× |
Intra-atrial recording (93602)
unusually low — confirm this is the full procedure |
$2,750.58 |
$6,549 |
0.3× |
| Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete… (93650) |
$7,118.16 |
$16,948 |
0.9× |
Intraventricular pacing (93612)
likely a partial charge — not the full procedure |
$1,868.58 |
$4,449 |
0.2× |
| Irrigaj implntd venous access drug delivery syst (96523) |
$100.38 |
$239 |
1.7× |
| IV infusion hydration each additional hour (96361) |
$73.50 |
$175 |
1.5× |
| IV infusion hydration initial 31 min-1 hour (96360) |
$238.14 |
$567 |
1.1× |
| IV infusion ther proph addl sequential to 1 hr (96367) |
$146.58 |
$349 |
2.0× |
| IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) |
$199.08 |
$474 |
0.9× |
| IV tx, each additional hour (96366) |
$72.66 |
$173 |
1.5× |
| Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) |
$81.48 |
$194 |
0.6× |
| Measurement of brain wave activity (EEG) to evaluate brain death (95824) |
$405.30 |
$965 |
1.1× |
| Mechanical chest wall oscillation lung function (94669) |
$144.06 |
$343 |
0.6× |
| Mechanical traction therapy (97012) |
$38.22 |
$91 |
— |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) |
$20.58 |
$49 |
— |
| Medical nutrition group (97804) |
$15.54 |
$37 |
— |
| Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) |
$19.32 |
$46 |
— |
| Methacholine challenge (94070) |
$241.92 |
$576 |
0.6× |
| Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) |
$234.36 |
$558 |
— |
| Multiple sleep latency (95805) |
$1,648.08 |
$3,924 |
1.9× |
| Nasopharyngoscopy (92511) |
$122.64 |
$292 |
0.6× |
| Neg pressure wound therapy non dme </= 50 sq cm (97607) |
$252 |
$600 |
0.6× |
| Neg pressure wound therapy non dme >50 sq cm (97608) |
$281.40 |
$670 |
0.7× |
| Negative pressure wound therapy dme </= 50 sq cm (97605) |
$125.58 |
$299 |
0.6× |
| Negative pressure wound therapy dme >50 sq cm (97606) |
$252 |
$600 |
0.6× |
| Non-invasive physiologic study extremity 3 levels (93923) |
$469.35 |
$1,117.50 |
2.1× |
| Occupational therapy eval high complex 60 mins (97167) |
$147.42 |
$351 |
— |
| Occupational therapy eval low complex 30 mins (97165) |
$101.22 |
$241 |
— |
| Occupational therapy eval mod complex 45 mins (97166) |
$121.80 |
$290 |
— |
| Oral function therapy (92526) |
$101.22 |
$241 |
— |
| Oral speech device eval (92597) |
$143.64 |
$342 |
— |
| Orthc/prostc mgmt sbsq enc (97763) |
$70.98 |
$169 |
— |
| Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) |
$61.32 |
$146 |
— |
| Ot manual therapy ea 15 min (97140) |
$43.68 |
$104 |
— |
| Ot neuromuscular re-education (97112) |
$52.50 |
$125 |
— |
| Ot re-evaluation (97168) |
$70.14 |
$167 |
— |
| OT Therapeutic Activities Charges (97530) |
$64.68 |
$154 |
— |
| Ot wheelchair management (97542) |
$31.92 |
$76 |
— |
| Outpatient cardiac rehab w/cont ECG monitoring (93798) |
$133.98 |
$319 |
1.0× |
Percutaneous balloon valvuloplasty; pulmonary valve without Cardiac Cath (92990)
unusually low — confirm this is the full procedure |
$4,521.30 |
$10,765 |
0.4× |
| Phlebotomy therapeutic (99195) |
$123.90 |
$295 |
0.9× |
| Phy/qhp op pulm rhb w/mntr (94626) |
$105.42 |
$251 |
1.7× |
| Phy/qhp op pulm rhb w/o mntr (94625) |
$81.90 |
$195 |
1.4× |
| Physical therapy evaluation high complex 45 mins (97163) |
$147.42 |
$351 |
— |
| Physical therapy evaluation low complex 20 mins (97161) |
$101.22 |
$241 |
— |
| Physical therapy evaluation mod complex 30 mins (97162) |
$121.80 |
$290 |
— |
| Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) |
$2,420.67 |
$5,763.50 |
2.8× |
| Polysom <6 yrs sleep w/cpap/bilvl vent 4/> param (95783) |
$2,756.46 |
$6,563 |
3.1× |
| Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a… (95782) |
$2,610.30 |
$6,215 |
3.0× |
| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93282) |
$99.96 |
$238 |
2.6× |
| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93260) |
$42 |
$100 |
1.1× |
| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93284) |
$126 |
$300 |
3.3× |
| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93283) |
$116.76 |
$278 |
3.1× |
| Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) |
$42 |
$100 |
— |
| Prq trluml coronary angio/atherect one art/brnch (92924) |
$6,761.16 |
$16,098 |
0.6× |
| Prq trluml coronary angioplasty one art/branch (92920) |
$7,540.68 |
$17,954 |
1.3× |
Prq trluml coronary byp grft revasc one vessel (92937)
unusually low — confirm this is the full procedure |
$4,851 |
$11,550 |
0.4× |
| Prq trluml coronary stent w/angio one art/brnch (92928) |
$6,306.30 |
$15,015 |
0.5× |
| Prq trluml coronry chronic occlus revasc one vsl (92943) |
$7,080.36 |
$16,858 |
0.6× |
Prq trluml coronry stent/ath/angio one art/brnch (92933)
unusually low — confirm this is the full procedure |
$7,072.80 |
$16,840 |
0.4× |
Prq trluml pulmonary art balloon angiop 1 vsl (92997)
unusually low — confirm this is the full procedure |
$4,526.34 |
$10,777 |
0.4× |
| Pt gait training 15 min (97116) |
$36.12 |
$86 |
— |
| Pt physical performance test (97750) |
$44.10 |
$105 |
— |
| Pt re-evaluation (97164) |
$70.14 |
$167 |
— |
| Pulm funct tst plethysmograp (94726) |
$196.56 |
$468 |
0.5× |
| Pulmonary stress testing (94618) |
$441.42 |
$1,051 |
3.2× |
| R hrt art/grft angio (93457) |
$10,708.74 |
$25,497 |
3.2× |
| R hrt coronary artery angio (93456) |
$9,930.48 |
$23,644 |
3.0× |
| R&l hrt art/ventricle angio (93461) |
$11,689.44 |
$27,832 |
3.5× |
| R&l hrt cath w/ventriclgrphy (93453) |
$6,151.74 |
$14,647 |
1.9× |
| Refill/maint pump/resvr syst (96522) |
$106.68 |
$254 |
0.5× |
| Refilling and maintenance of portable pump (96521) |
$284.34 |
$677 |
1.3× |
| Right heart cath o2 saturation & cardiac output (93451) |
$5,183.64 |
$12,342 |
1.6× |
| Right ventricular recording (93603) |
$1,107.12 |
$2,636 |
0.9× |
| Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) |
$60.90 |
$145 |
— |
| Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) |
$65.10 |
$155 |
— |
| Sleep study attended (95807) |
$1,025.01 |
$2,440.50 |
2.7× |
| Sleep study unattended (95806) |
$274.68 |
$654 |
1.2× |
| Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or… (95800) |
$262.50 |
$625 |
1.2× |
| Speech sound lang comprehen (92523) |
$229.32 |
$546 |
— |
| Stress tte only (93350) |
$684.18 |
$1,629 |
1.2× |
| Surfactant administration (94610) |
$90.72 |
$216 |
0.4× |
| Temp transcutaneous pacing (92953) |
$441.84 |
$1,052 |
0.7× |
| Ther ivntj cog funcj cntct 1st 15 minutes (97129) |
$73.50 |
$175 |
— |
| Ther ivntj cog funcj cntct ea addl 15 minutes (97130) |
$73.08 |
$174 |
— |
| Ther/proph/diag inj ia (96373) |
$132.72 |
$316 |
0.6× |
| Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) |
$26.04 |
$62 |
— |
| Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) |
$36.54 |
$87 |
— |
| Therapeutic prophylactic/dx injection subq/im (96372) |
$91.98 |
$219 |
1.3× |
| Tilt table evaluation (93660) |
$506.10 |
$1,205 |
1.3× |
| Tobacco use cessation intermediate 3-10 minutes (99406) |
$18.90 |
$45 |
0.5× |
| Transcath closure of asd (93580) |
$15,297.24 |
$36,422 |
0.8× |
| Transcranial doppler stdy intracranial art compl (93886) |
$265.02 |
$631 |
1.1× |
| Transcranial Doppler study of the intracranial arteries; limited study Age Under 21 (93888) |
$153.72 |
$366 |
1.4× |
| Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition,… (93315) |
$350.70 |
$835 |
0.6× |
| Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) |
$345.66 |
$823 |
0.6× |
| Tte congenital complete (93303) |
$765.66 |
$1,823 |
1.4× |
| Tte f-up or lmtd (93308) |
$277.62 |
$661 |
1.1× |
| Tte w/doppler complete (93306) |
$1,123.92 |
$2,676 |
2.0× |
| Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) |
$77.70 |
$185 |
— |
| Tx speech language voice commj auditry 2/>indiv (92508) |
$28.98 |
$69 |
— |
| Upr/l xtremity art 2 levels (93922) |
$303.45 |
$722.50 |
2.2× |
| Valvuloplasty aortic valve (92986) |
$4,814.46 |
$11,463 |
0.8× |
Valvuloplasty mitral valve (92987)
unusually low — confirm this is the full procedure |
$4,950.96 |
$11,788 |
0.4× |
| Veeg by tech 2-12 hours unmonitored (95711) |
$776.58 |
$1,849 |
3.5× |
| Veeg by tech 2-12 hr continuous r-t monitoring (95713) |
$971.04 |
$2,312 |
2.5× |
| Veeg by tech 2-12 hr intermittent monitoring (95712) |
$893.34 |
$2,127 |
2.3× |
| Veeg by tech ea incr 12-26 hr cont r-t mntr (95716) |
$1,359.54 |
$3,237 |
1.5× |
| Veeg by tech ea incr 12-26 hr intermittent mntr (95715) |
$1,281.84 |
$3,052 |
3.4× |
| Veeg by tech ea incr 12-26 hr unmonitored (95714) |
$1,165.08 |
$2,774 |
3.1× |
| Ventilation ip/obs initial day (94002) |
$1,343.16 |
$3,198 |
2.1× |
| Ventilator subsequent day (94003) |
$967.26 |
$2,303 |
1.5× |
| Vital capacity total (94150) |
$79.38 |
$189 |
0.6× |
| Wound(s) care non-selective (97602) |
$125.58 |
$299 |
0.6× |