| Admin hepatitis b vaccine (G0010) |
$49.31 |
— |
0.8× |
| Admin influenza virus vac (G0008) |
$74.54 |
— |
1.3× |
| Admin pneumococcal vaccine (G0009) |
$74.54 |
— |
1.3× |
| Alcohol/sub misuse assess (G2011) |
$50.99 |
— |
1.4× |
| Alcohol/subs interv 15-30mn (G0396) |
$111.51 |
— |
2.4× |
| Alcohol/subs interv >30 min (G0397) |
$214.54 |
— |
1.0× |
| Amalgam 4 or > surfaces perm (D2161) |
— |
$319 |
— |
| Amalgam one surface permanen (D2140) |
— |
$117 |
— |
| Amalgam three surfaces perma (D2160) |
— |
$255 |
— |
| Amalgam two surfaces permane (D2150) |
— |
$164 |
— |
| Annual alcohol screen 15 min (G0442) |
$29.28 |
— |
0.6× |
| Behavior counsel obesity 15m (G0447) |
$72.57 |
— |
0.6× |
| Blood thymol turbidity (P2033) |
$19.08 |
— |
3.9× |
| Bone replce graft first site (D4263) |
— |
$578 |
— |
| Brief alcohol misuse counsel (G0443) |
$72.57 |
— |
0.6× |
| Brief chkin by md/qhp, 11-20 (G2252) |
$79.59 |
— |
2.8× |
| Brief chkin, 5-10, non-e/m (G2251) |
$41.40 |
— |
3.0× |
| Ca screen;flexi sigmoidscope (G0104) |
$477 |
— |
0.4× |
| Ca screen;pelvic/breast exam (G0101) |
$113.66 |
$168.52 |
0.9× |
| Cbc without platelet (G0307) |
$27.57 |
— |
4.3× |
| Cbc/diffwbc w/o platelet (G0306) |
$32.94 |
— |
4.2× |
| Cephalin floculation test (P2028) |
$19.08 |
— |
3.9× |
| Chemo extend iv infus w/pump (G0498) |
$761.60 |
$600.74 |
1.8× |
| Colon ca scrn not hi rsk ind (G0121) |
$658.56 |
— |
0.6× |
| Colorectal scrn; hi risk ind (G0105) |
$3,710 |
— |
3.2× |
| Congo red blood test (P2029) |
$19.08 |
— |
3.9× |
| Core build-up incl any pins (D2950) |
— |
$399 |
— |
| Crown lengthen hard tissue (D4249) |
— |
$472 |
— |
| Crown porcelain/ceramic (D2740) |
— |
$986 |
— |
| Demonstrate use home inr mon (G0248) |
$325.27 |
$391.87 |
2.0× |
| Dental prophylaxis adult (D1110) |
— |
$157 |
— |
| Depression screen annual (G0444) |
$28.26 |
— |
0.6× |
| Dermal filler injection(s) (G0429) |
$299.72 |
— |
0.1× |
| Devlopment test interpt&rep (G0451) |
$23.92 |
— |
0.2× |
| Diab manage trn per indiv (G0108) |
$161.27 |
— |
2.9× |
| Diab manage trn ind/group (G0109) |
$44.49 |
— |
2.8× |
| Direct refer hospital observ (G0379) |
$3,671.37 |
$733.58 |
4.9× |
| Drug test def 1-7 classes (G0480) |
$249.61 |
— |
2.2× |
| Drug test def 15-21 classes (G0482) |
$518.42 |
— |
2.6× |
| Drug test def 22+ classes (G0483) |
$672.05 |
— |
2.7× |
| Drug test def 8-14 classes (G0481) |
$384.04 |
— |
2.5× |
| Drug test def simple all cl (G0659) |
$249.21 |
— |
4.0× |
| Dstry eye lesn,fdr vssl tech (G0186) |
$2,921.36 |
— |
4.3× |
| Ed svc ckd grp per session (G0421) |
$77.13 |
— |
2.8× |
| Ed svc ckd ind per session (G0420) |
$333.76 |
— |
2.9× |
| Eia hiv-1/hiv-2 screen (G0432) |
$39.65 |
— |
2.0× |
| Ekg tracing for initial prev (G0404) |
$23.92 |
— |
0.7× |
| Elec stim other than wound (G0283) |
$41.94 |
— |
3.3× |
| Elec stim unattend for press (G0281) |
$41.94 |
— |
3.6× |
| Electromagntic tx for ulcers (G0329) |
$29.57 |
— |
2.8× |
| Elisa hiv-1/hiv-2 screen (G0433) |
$39.65 |
— |
2.2× |
| End thxpy, anterior tooth (D3310) |
— |
$1,049 |
— |
| End thxpy, molar tooth (D3330) |
— |
$1,408 |
— |
| End thxpy, premolar tooth (D3320) |
— |
$1,227 |
— |
| Extraction erupted tooth/exr (D7140) |
— |
$226 |
— |
| Extraoral posterior image (D0251) |
— |
$106 |
— |
| Extrnl counterpulse, per tx (G0166) |
$402.02 |
— |
2.4× |
| Fecal blood scrn immunoassay (G0328) |
$53.06 |
— |
2.9× |
| Fecal microbiota prep instil (G0455) |
$477 |
— |
0.4× |
| Followup eval of foot pt lop (G0246) |
$114.72 |
— |
0.7× |
| Glaucoma scrn hgh risk direc (G0118) |
$133.54 |
— |
2.9× |
| Glaucoma scrn hgh risk direc (G0117) |
$166.37 |
— |
4.6× |
| Gngvl flap w rootplan 1-3 th (D4241) |
— |
$221 |
— |
| Group behave couns 2-10 (G0473) |
$36.10 |
— |
0.8× |
| Group mnt 2 or more 30 mins (G0271) |
$48.72 |
— |
2.9× |
| Hair analysis (P2031) |
$19.08 |
— |
3.9× |
| Hbot, full body chamber, 30m (G0277) |
$139.11 |
$530.39 |
0.8× |
| Hep c screen high risk/other (G0472) |
$60.70 |
— |
1.3× |
| Hepb screen high risk indiv (G0499) |
$108.98 |
— |
3.9× |
| High inten beh couns std 30m (G0445) |
$72.57 |
— |
0.6× |
| Hiv combination assay (G0475) |
$90.96 |
— |
3.8× |
| Home sleep test/type 2 porta (G0398) |
$357.87 |
— |
1.3× |
| Home sleep test/type 3 porta (G0399) |
$325.57 |
— |
1.2× |
| Home sleep test/type 4 porta (G0400) |
$112.94 |
— |
0.4× |
| Hpv combo assay ca screen (G0476) |
$150.32 |
— |
4.3× |
| Impact tooth remov soft tiss (D7220) |
— |
$578 |
— |
| Init/sub psych care m 1st 30 (G2214) |
$121.31 |
— |
1.0× |
| Initial foot exam pt lops (G0245) |
$199.06 |
— |
1.2× |
| Initial preventive exam (G0402) |
$497.01 |
$570.22 |
3.0× |
| Inj for sacroiliac jt anesth (G0260) |
$2,717 |
— |
3.1× |
| Insert drug del implant, >=4 (G0516) |
$477 |
— |
0.9× |
| Intens behave ther cardio dx (G0446) |
$72.57 |
— |
1.6× |
| Intens cardiac rehab no exer (G0423) |
$310.47 |
— |
1.9× |
| Intens cardiac rehab w/exerc (G0422) |
$310.47 |
— |
1.9× |
| Labial veneer porc indirect (D2962) |
— |
$1,227 |
— |
| Labial veneer resin direct (D2960) |
— |
$421 |
— |
| Mnt subs tx for change dx (G0270) |
$92.58 |
— |
2.9× |
| Obtaining screen pap smear (Q0091) |
— |
$23.30 |
— |
| Off base opioid tx 70min (G2086) |
$914.96 |
— |
4.1× |
| Off base opioid tx, 60 m (G2087) |
$892.08 |
— |
4.0× |
Open tx iliac spine uni/bil (G0412)
likely a partial charge, not the full procedure |
$2,189.74 |
— |
0.2× |
| Open tx post pelvic fxcture (G0415) |
$4,146.93 |
— |
1.0× |
| Oral hiv-1/hiv-2 screen (G0435) |
$48.77 |
— |
4.1× |
| Oth resp proc, group (G0239) |
$37.63 |
— |
0.8× |
| Oth resp proc, indiv (G0238) |
$31.28 |
— |
0.9× |
Pelvic ring fracture uni/bil (G0413)
unusually low: confirm this is the full procedure |
$3,222.65 |
— |
0.4× |
Pelvic ring fx treat int fix (G0414)
unusually low: confirm this is the full procedure |
$2,999.27 |
— |
0.3× |
| Periodontal maint procedures (D4910) |
— |
$183 |
— |
| Periodontal scaling & root (D4341) |
— |
$328 |
— |
| Place direct restoration (D2940) |
— |
$148 |
— |
| Post 1 srfc resinbased cmpst (D2391) |
— |
$198 |
— |
| Post 2 srfc resinbased cmpst (D2392) |
— |
$223 |
— |
| Post 3 srfc resinbased cmpst (D2393) |
— |
$279 |
— |
| Post >=4srfc resinbase cmpst (D2394) |
— |
$386 |
— |
| Ppps, initial visit (G0438) |
$512.81 |
— |
2.9× |
| Ppps, subseq visit (G0439) |
$342.82 |
— |
2.5× |
| Prefab post/core + crown (D2954) |
— |
$421 |
— |
| Prostate biopsy, any mthd (G0416) |
$1,372.64 |
— |
3.1× |
| Provide inr test mater/equip (G0249) |
$326.32 |
— |
2.0× |
| Psa screening (G0103) |
$78.34 |
— |
4.1× |
| Rem imp tooth w mucoper flp (D7210) |
— |
$378 |
— |
| Remot img sub by pt, non e/m (G2250) |
$29.52 |
— |
2.3× |
| Remove drug implant (G0517) |
$477 |
— |
0.9× |
| Remove w insert drug implant (G0518) |
$477 |
— |
0.9× |
| Resin 4/> surf or w incis an (D2335) |
— |
$357 |
— |
| Resin one surface-anterior (D2330) |
— |
$176 |
— |
| Resin three surfaces-anterio (D2332) |
— |
$288 |
— |
| Resin two surfaces-anterior (D2331) |
— |
$241 |
— |
| Routine footcare pt w lops (G0247) |
$216.95 |
— |
0.9× |
| Scr c/v cyto, automated sys (G0147) |
$45.03 |
— |
2.4× |
| Scr c/v cyto, autosys, rescr (G0148) |
$45.03 |
— |
1.4× |
| Scr c/v cyto,thinlayer,rescr (G0144) |
$81.59 |
— |
1.9× |
| Scr c/v cyto,thinlayer,rescr (G0145) |
$93.64 |
— |
3.5× |
| Scr c/v cyto,thinlayer,rescr (G0143) |
$78.93 |
— |
2.9× |
| Screen cerv/vag thin layer (G0123) |
$78.93 |
— |
3.9× |
| Semen analysis (G0027) |
$15.37 |
— |
2.4× |
| Single energy x-ray study (G0130) |
$67.13 |
— |
0.5× |
| Therapeutic procd strg endur (G0237) |
$29.19 |
— |
0.8× |
| Therapeutic pulpotomy (D3220) |
— |
$221 |
— |
| Tomosynthesis, mammo (G0279) |
$75.91 |
— |
6.0× |
| Tooth pin retention (D2951) |
— |
$75 |
— |
| Trauma respons w/hosp criti (G0390) |
— |
$15,322.74 |
— |
| Trim nail(s) (G0127) |
$23.98 |
— |
0.3× |
| Visit esketamine 56m or less (G2082) |
$76.38 |
$1,090.29 |
0.1× |
| Visit esketamine, > 56m (G2083) |
$76.38 |
$1,593.13 |
0.0× |
| Visit to determ ldct elig (G0296) |
$81.87 |
— |
0.6× |
| Warfarin respon genetic test (G9143) |
$514.24 |
— |
4.3× |