| Adm tocilizu covid-19 1st (M0249) |
$469 |
$647 |
1.0× |
| Adm tocilizu covid-19 2nd (M0250) |
$469 |
$647 |
1.0× |
| Admin hepatitis b vaccine (G0010) |
$43 |
$85 |
0.9× |
| Alveoloplasty not w/extracts (D7321) |
— |
$2,230 |
— |
| Alveoloplasty w/extract 1-3 (D7311) |
— |
$2,106 |
— |
| Alveoplasty w/ extraction (D7310) |
— |
$2,106 |
— |
| Alveoplasty w/o extraction (D7320) |
— |
$2,230 |
— |
| Amalgam one surface permanen (D2140) |
— |
$2,503 |
— |
| Amalgam three surfaces perma (D2160) |
— |
$2,503 |
— |
| Amalgam two surfaces permane (D2150) |
— |
$2,503 |
— |
| Ant resin-based cmpst crown (D2390) |
— |
$1,917.50 |
— |
| Antibody, Treponema pallidum, total and rapid plasma reagin (RPR), immunoassay, qualitative Other Outpatient (0064U) |
— |
$77 |
— |
| Apically positioned flap (D4245) |
— |
$1,781 |
— |
| Apicoectomy - anterior (D3410) |
— |
$2,503 |
— |
| Auto tissue graft 1st tooth (D4273) |
$1,475 |
$2,019 |
0.9× |
| Bitewings - three images (D0273) |
— |
$364 |
— |
| Bitewings four images (D0274) |
$1,475 |
$2,019 |
5.9× |
| Catheterize for urine spec (P9612) |
— |
$14 |
— |
| Closd rductn splint alveolus (D7670) |
— |
$4,446 |
— |
| Comp periodontal evaluation (D0180) |
— |
$150 |
— |
| Comprehensve oral evaluation (D0150) |
$1,475 |
$2,019 |
10.6× |
| Core build-up incl any pins (D2950) |
— |
$2,503 |
— |
| Crown lengthen hard tissue (D4249) |
— |
$2,503 |
— |
| Crown porcelain fused base m (D2751) |
— |
$2,503 |
— |
| Crown porcelain/ceramic (D2740) |
— |
$2,503 |
— |
| Dental bitewing single image (D0270) |
$1,475 |
$2,019 |
16.2× |
| Dental bitewings two images (D0272) |
$1,475 |
$2,019 |
16.2× |
| Dental prophylaxis adult (D1110) |
— |
$474 |
— |
| Direct refer hospital observ (G0379) |
$555 |
$759 |
0.9× |
| Drug test def 22+ classes (G0483) |
— |
$246.92 |
— |
| End thxpy, anterior tooth (D3310) |
— |
$2,503 |
— |
| End thxpy, molar tooth (D3330) |
— |
$2,503 |
— |
| End thxpy, premolar tooth (D3320) |
— |
$2,503 |
— |
| Excision benign lesion>1.25c (D7411) |
— |
$2,106 |
— |
| Exposure of unerupted tooth (D7280) |
— |
$1,917.50 |
— |
| Extensv oral eval prob focus (D0160) |
— |
$183 |
— |
| Extra oral post radio image (D0705) |
— |
$130 |
— |
| Extraction erupted tooth/exr (D7140) |
$1,475 |
$2,011 |
2.2× |
| Extraoral 2d project image (D0250) |
$1,475 |
$2,019 |
16.2× |
| Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part… (0479T) |
$557 |
$762 |
0.7× |
| Full mouth debridement (D4355) |
$1,475 |
$2,019 |
2.2× |
| Gingivectomy/plasty 1 to 3 (D4211) |
— |
$4,446 |
— |
| Gingivectomy/plasty 4 or mor (D4210) |
— |
$4,446 |
— |
| Gross pulpal debridement (D3221) |
— |
$2,503 |
— |
| I&d absc intraoral soft tiss (D7510) |
— |
$844 |
— |
| Impact tooth remov comp bony (D7240) |
$1,475 |
$2,019 |
2.2× |
| Impact tooth remov part bony (D7230) |
$1,475 |
$2,019 |
2.2× |
| Incision/drain abscess intra (D7511) |
— |
$986 |
— |
| Incomplete endodontic tx (D3332) |
— |
$2,503 |
— |
| Insj/rplc car modulj sys ventr electrode only (0411T) |
$8,676 |
$11,873 |
1.0× |
| Insj/rplc cardiac modulj sys (0408T) |
$24,521 |
$33,559 |
0.7× |
| Insj/rplc cardiac modulj sys atr electrode only (0410T) |
$8,676 |
$11,873 |
1.0× |
| Insj/rplc cardiac modulj sys pls generator only (0409T) |
$24,521 |
$33,559 |
1.1× |
| Insj/rplcmt icds w/substernal electrode (0571T) |
$34,929 |
$48,268 |
1.1× |
| Interim crown (D2799) |
— |
$2,503 |
— |
| Intraor comprehensive series (D0210) |
— |
$338 |
— |
| Intraoral bite radio image (D0708) |
— |
$130 |
— |
| Intraoral comp image capture (D0709) |
— |
$130 |
— |
| Intraoral occlus radio image (D0706) |
— |
$130 |
— |
| Intraoral occlusal film (D0240) |
$1,475 |
$2,019 |
16.2× |
| Intraoral periap radio image (D0707) |
— |
$130 |
— |
| Intraoral periapical first (D0220) |
— |
$125 |
— |
| Limit oral eval problm focus (D0140) |
— |
$183 |
— |
| Limited occlusal adjustment (D9951) |
$1,475 |
$2,019 |
2.2× |
| Mra w/o fol w/cont, abd (C8902) |
$392 |
$2,280 |
1.1× |
| Neuro csf prion prtn qual (0035U) |
— |
$540.99 |
— |
| Njx pltlt plasma w/img harvest/preparation (0232T) |
$289 |
$550 |
0.6× |
| Occ guard, hard, full arch (D9944) |
$1,475 |
$2,019 |
2.2× |
| Occ guard, hard, part arch (D9946) |
$1,475 |
$2,011 |
2.2× |
| Occ guard, soft, full arch (D9945) |
$1,475 |
$2,019 |
2.2× |
| Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule,… (0026U) |
— |
$3,600 |
— |
| Opps service,sched team conf (G0175) |
$387 |
$481 |
0.9× |
Osseous surgery 4 or more (D4260)
likely a partial charge, not the full procedure |
$1,475 |
$8,086 |
0.2× |
| Oth resp proc, indiv (G0238) |
$26 |
$62 |
0.9× |
| Panoramic image (D0330) |
— |
$338 |
— |
| Perc drug-el cor stent sing (C9600) |
$10,681 |
$19,878 |
0.9× |
| Periodic oral evaluation (D0120) |
— |
$183 |
— |
| Periodontal maint procedures (D4910) |
— |
$2,503 |
— |
| Periodontal scaling & root (D4341) |
— |
$2,503 |
— |
| Periodontal scaling 1-3teeth (D4342) |
— |
$2,503 |
— |
| Perq sac agmntj bi w/wo balo/mchnl dev 2/> ndls (0201T) |
$6,661 |
$8,174 |
0.9× |
| Perq sac agmntj uni w/wo balo/mchnl dev 1/> ndl (0200T) |
$6,661 |
$8,174 |
0.9× |
| Place direct restoration (D2940) |
— |
$2,503 |
— |
| Post 1 srfc resinbased cmpst (D2391) |
— |
$1,917.50 |
— |
| Post 2 srfc resinbased cmpst (D2392) |
— |
$1,917.50 |
— |
| Post 3 srfc resinbased cmpst (D2393) |
— |
$1,917.50 |
— |
| Post >=4srfc resinbase cmpst (D2394) |
— |
$2,503 |
— |
| Post and core cast + crown (D2952) |
— |
$2,503 |
— |
| Prefab post/core + crown (D2954) |
— |
$2,503 |
— |
| Prefab stnlss steel crwn pri (D2930) |
— |
$1,917.50 |
— |
| Prefabricated resin crown (D2932) |
— |
$2,503 |
— |
| Psa screening (G0103) |
— |
$49 |
— |
| Pulp cap direct (D3110) |
— |
$1,917.50 |
— |
| Pulp cap indirect (D3120) |
— |
$1,917.50 |
— |
| Rad exc lesion up to 1.25 cm (D7410) |
— |
$2,106 |
— |
| Re-cement or re-bond crown (D2920) |
— |
$2,503 |
— |
| Re-eval,est pt,problem focus (D0170) |
— |
$183 |
— |
| Recement inlay onlay or part (D2910) |
— |
$2,503 |
— |
| Recement space maint - max (D1551) |
$1,475 |
$1,917.50 |
2.2× |
| Reloc skin pocket pls gen (0416T) |
$1,821 |
$2,493 |
0.8× |
| Rem exostosis any site (D7471) |
— |
$4,882 |
— |
| Rem imp tooth w mucoper flp (D7210) |
$1,475 |
$2,019 |
0.9× |
| Rem nonodonto cyst to 1.25cm (D7460) |
— |
$2,503 |
— |
| Rem odontogen cyst > 1.25 cm (D7451) |
— |
$4,446 |
— |
| Rem odontogen cyst to 1.25cm (D7450) |
— |
$4,446 |
— |
| Removal cardiac modulj sys pls generator only (0412T) |
$3,662 |
$5,011 |
0.9× |
| Removal cardiac modulj sys transvenous electrode (0413T) |
$3,662 |
$5,011 |
0.9× |
| Removal fb skin/areolar tiss (D7530) |
— |
$2,503 |
— |
| Repos Cardiac Modulj Transvenous Electrode (0415T) |
$575 |
$787 |
0.9× |
| Resin 4/> surf or w incis an (D2335) |
— |
$2,503 |
— |
| Resin one surface-anterior (D2330) |
— |
$1,917.50 |
— |
| Resin three surfaces-anterio (D2332) |
— |
$2,503 |
— |
| Resin two surfaces-anterior (D2331) |
— |
$1,917.50 |
— |
| Retreat root canal premolar (D3347) |
— |
$2,503 |
— |
| Revasc intra lithotrip-ather (C9766) |
$17,078 |
$23,372 |
0.9× |
| Revasc intra lithotrip-stent (C9765) |
$17,078 |
$23,372 |
0.9× |
| Revasc intravasc lithotripsy (C9764) |
$10,681 |
$14,618 |
0.9× |
| Revasc lith-sten-ath tib/per (C9775) |
$17,078 |
$23,372 |
0.9× |
| Revasc lithotr-ather tib/per (C9774) |
$17,078 |
$23,372 |
0.9× |
| Revasc lithotr-stent tib/per (C9773) |
$17,078 |
$23,372 |
0.9× |
| Revasc lithotrip tibi/perone (C9772) |
$10,681 |
$23,372 |
0.9× |
| Revasc lithotrip-stent-ather (C9767) |
$17,078 |
$23,372 |
0.9× |
| Rmvl & Rpl Cardiac Modulj Sys Pls Generator Only (0414T) |
$24,521 |
$33,559 |
1.1× |
| Root surgery premolar (D3421) |
— |
$2,503 |
— |
| Scaling gingiv inflammation (D4346) |
— |
$2,503 |
— |
| Space maintainer fxd unilat (D1510) |
$1,475 |
$1,917.50 |
2.2× |
| Splint extra-coronal (D4323) |
— |
$2,503 |
— |
| Splint intra-coronal (D4322) |
— |
$2,503 |
— |
| Targeted genomic sequence analysis panel, cholangiocarcinoma and non-small cell lung neoplasia, DNA and RNA analysis,… (0022U) |
— |
$2,200 |
— |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) |
— |
$26,905.65 |
— |
| Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) |
— |
$26,905.65 |
— |
| Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) |
— |
$26,905.65 |
— |
| Tcat insj perm dual chamber ldls pm compl sys (0795T) |
— |
$26,905.65 |
— |
| Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) |
— |
$4,401.36 |
— |
| Tcat rmvl perm 2chmbr ldls pm r atr pm compnt (0799T) |
— |
$4,401.36 |
— |
| Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt (0800T) |
— |
$4,401.36 |
— |
| Tcat rmvl perm dual chamber ldls pm compl sys (0798T) |
— |
$4,401.36 |
— |
| Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) |
— |
$26,905.65 |
— |
| Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) |
— |
$26,905.65 |
— |
| Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T) |
— |
$26,905.65 |
— |
| Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt (0803T) |
— |
$26,905.65 |
— |
| Therapeutic procd strg endur (G0237) |
$26 |
$251 |
0.9× |
| Therapeutic pulpotomy (D3220) |
— |
$1,917.50 |
— |
| Therapeutic ultrafiltration (0692T) |
— |
$2,468 |
— |
| Tooth reimplantation (D7270) |
— |
$2,503 |
— |
| Tooth root removal (D7250) |
$1,475 |
$2,019 |
2.2× |
| Trauma respons w/hosp criti (G0390) |
$1,013 |
$2,221 |
0.7× |
| Trim nail(s) (G0127) |
$59 |
$69 |
1.0× |
| Trluml perip athrc iliac art (0238T) |
$17,078 |
$27,034 |
0.9× |
| Tte w or wo fol wcon,doppler (C8929) |
$761 |
$2,573 |
0.9× |
| Unsched dialysis esrd pt hos (G0257) |
$696 |
$883 |
1.0× |