| 2d tte w or w/o fol w/con,fu (C8924) |
— |
$1,200 |
— |
| Admin hepatitis b vaccine (G0010) |
— |
$20 |
— |
| Admin influenza virus vac (G0008) |
— |
$20 |
— |
Admin pneumococcal vaccine (G0009)
range across 5 matching MRF lines |
— |
$20–$132.15 |
— |
| Alcohol/subs interv 15-30mn (G0396) |
— |
$71.74 |
— |
| Alcohol/subs interv >30 min (G0397) |
— |
$134.66 |
— |
| Ca screen;flexi sigmoidscope (G0104) |
— |
$330.66 |
— |
| Ca screen;pelvic/breast exam (G0101) |
— |
$81.36 |
— |
| Cardiokymography (Q0035) |
— |
$39.16 |
— |
| Catheterize for urine spec (P9612) |
— |
$169 |
— |
| Colon ca scrn not hi rsk ind (G0121) |
— |
$683.49 |
— |
| Colorectal scrn; hi risk ind (G0105) |
— |
$635.82 |
— |
| Demonstrate use home inr mon (G0248) |
— |
$273.55 |
— |
| Diab manage trn per indiv (G0108) |
— |
$109.42 |
— |
| Diab manage trn ind/group (G0109) |
— |
$30.16 |
— |
| Direct refer hospital observ (G0379) |
— |
$777.23 |
— |
| Ekg tracing for initial prev (G0404) |
— |
$16.99 |
— |
| Elec stim other than wound (G0283) |
— |
$27.76 |
— |
| Elec stim unattend for press (G0281) |
— |
$27.76 |
— |
| Electromagntic tx for ulcers (G0329) |
— |
$21.10 |
— |
| Extrnl counterpulse, per tx (G0166) |
— |
$233.13 |
— |
| Followup eval of foot pt lop (G0246) |
— |
$76.78 |
— |
| Glaucoma scrn hgh risk direc (G0118) |
— |
$79.58 |
— |
| Glaucoma scrn hgh risk direc (G0117) |
— |
$107.92 |
— |
| Group mnt 2 or more 30 mins (G0271) |
— |
$33.46 |
— |
| Hbot, full body chamber, 30m (G0277) |
— |
$501.50 |
— |
| Initial foot exam pt lops (G0245) |
— |
$130.92 |
— |
| Initial preventive exam (G0402) |
— |
$327.98 |
— |
| Inj for sacroiliac jt anesth (G0260) |
— |
$782.63 |
— |
| Intens cardiac rehab no exer (G0423) |
— |
$208.73 |
— |
| Intens cardiac rehab w/exerc (G0422) |
— |
$228.36 |
— |
| Mnt subs tx for change dx (G0270) |
— |
$63.32 |
— |
| Obtaining screen pap smear (Q0091) |
— |
$84.46 |
— |
Oth resp proc, group (G0239)
range across 3 matching MRF lines |
— |
$23.40–$205.29 |
— |
| Oth resp proc, indiv (G0238) |
— |
$18.76 |
— |
| Ppps, initial visit (G0438) |
— |
$338.12 |
— |
| Ppps, subseq visit (G0439) |
— |
$228.10 |
— |
| Provide inr test mater/equip (G0249) |
— |
$158.67 |
— |
Psa screening (G0103)
range across 3 matching MRF lines |
— |
$22.71–$133.33 |
— |
| Routine footcare pt w lops (G0247) |
— |
$147.28 |
— |
| Single energy x-ray study (G0130) |
— |
$67.28 |
— |
| Therapeutic procd strg endur (G0237) |
— |
$20.09 |
— |
| Trim nail(s) (G0127) |
— |
$46.24 |
— |
| Tte w or w/o fol w/con,stres (C8928) |
— |
$2,870 |
— |
| Tte w or wo fol wcon,doppler (C8929) |
— |
$3,394 |
— |