| 2d cephal radio image (D0702) |
$108.63 |
— |
1.0× |
| 2d cephalometric image (D0340) |
$108.63 |
— |
1.0× |
| 2d oral/facial photo image (D0703) |
$108.63 |
— |
1.0× |
| 2d tee w or w/o fol w/con,in (C8925) |
$978.56 |
— |
1.0× |
| 2d tte w or w/o fol w/con,co (C8923) |
$978.56 |
— |
1.0× |
| 2d tte w or w/o fol w/con,fu (C8924) |
$435.49 |
— |
1.0× |
| 3d anat seg imaging preop (C8001) |
$160.62 |
— |
1.0× |
| 3d bn img algor drvd fr mri (G0566) |
$160.62 |
— |
1.0× |
| Add proc construct new crown (D2971) |
$807 |
— |
1.0× |
| Adm of soc dtr assess 5-15 m (G0136) |
$46.77 |
— |
1.0× |
| Adm tocilizu covid-19 1st (M0249) |
$550.43 |
— |
1.0× |
| Adm tocilizu covid-19 2nd (M0250) |
$550.43 |
— |
1.0× |
| Admin hepatitis b vaccine (G0010) |
$58.45 |
— |
1.0× |
| Admin influenza virus vac (G0008) |
$58.45 |
— |
1.0× |
| Admin pneumococcal vaccine (G0009) |
$58.45 |
— |
1.0× |
| Adv prim care mgmt lvl 1 (G0556) |
$46.77 |
— |
1.0× |
| Adv prim care mgmt lvl 2 (G0557) |
$46.77 |
— |
1.0× |
| Adv prim care mgmt lvl 3 (G0558) |
$126.81 |
— |
1.0× |
| Alcohol/sub misuse assess (G2011) |
$36.10 |
— |
1.0× |
| Alcohol/subs interv 15-30mn (G0396) |
$46.77 |
— |
1.0× |
| Alcohol/subs interv >30 min (G0397) |
$221.56 |
— |
1.0× |
| Alveoloplasty not w/extracts (D7321) |
$1,936.82 |
— |
1.0× |
| Alveoloplasty w/extract 1-3 (D7311) |
$1,936.82 |
— |
1.0× |
| Alveolus clsd reduc stblz te (D7771) |
$4,138.63 |
— |
1.0× |
| Alveolus open reduction (D7671) |
$7,389.63 |
— |
1.0× |
| Alveoplasty w/ extraction (D7310) |
$1,936.82 |
— |
1.0× |
| Alveoplasty w/o extraction (D7320) |
$1,936.82 |
— |
1.0× |
| Amalgam 4 or > surfaces perm (D2161) |
$807 |
— |
1.0× |
| Amalgam one surface permanen (D2140) |
$807 |
— |
1.0× |
| Amalgam three surfaces perma (D2160) |
$807 |
— |
1.0× |
| Amalgam two surfaces permane (D2150) |
$807 |
— |
1.0× |
| Ana crown exp 1-3 per quad (D4231) |
$1,936.82 |
— |
1.0× |
| Ana crown exp 4 or> per quad (D4230) |
$4,138.63 |
— |
1.0× |
| Annual alcohol screen 15 min (G0442) |
$46.77 |
— |
1.0× |
| Ant resin-based cmpst crown (D2390) |
$807 |
— |
1.0× |
| Apexification/recalc final (D3353) |
$807 |
— |
1.0× |
| Apexification/recalc initial (D3351) |
$807 |
— |
1.0× |
| Apexification/recalc interim (D3352) |
$807 |
— |
1.0× |
| Apically positioned flap (D4245) |
$1,936.82 |
— |
1.0× |
| Apicoectomy - anterior (D3410) |
$807 |
— |
1.0× |
| Arthro/shoul surg; w/spacer (C9781) |
$16,026.32 |
— |
1.0× |
| Ascvd rsk mng clin stf pr mo (G0538) |
$126.81 |
— |
1.0× |
| Assessment of a patient (D0191) |
$166.19 |
— |
1.0× |
| Auto tissue graft 1st tooth (D4273) |
$1,936.82 |
— |
1.0× |
| Autolog prp not diab ulcer (G0460) |
$2,575.56 |
— |
1.0× |
| Behavior counsel obesity 15m (G0447) |
$126.81 |
— |
1.0× |
| Bio mtrls to aid soft/os reg (D4265) |
$807 |
— |
1.0× |
| Biological materials (D3431) |
$807 |
— |
1.0× |
| Bitewings - three images (D0273) |
$297.84 |
— |
1.0× |
| Bitewings four images (D0274) |
$297.84 |
— |
1.0× |
| Blind cor sinus reducer impl (C9783) |
$14,410.43 |
— |
1.0× |
| Blind interatrial shunt ide (C9758) |
$21,382.46 |
— |
1.0× |
| Blind myocar trpl bon marrow (C9782) |
$21,382.46 |
— |
1.0× |
| Blind/nonblind trans atrial (C9792) |
$11,913.36 |
— |
1.0× |
| Blinded conv. tx mdd clin tr (G2000) |
$465.81 |
— |
1.0× |
| Bone graft peri per tooth (D3428) |
$807 |
— |
1.0× |
| Bone replce graft first site (D4263) |
$807 |
— |
1.0× |
| Brief alcohol misuse counsel (G0443) |
$126.81 |
— |
1.0× |
| Ca screen;flexi sigmoidscope (G0104) |
$1,160.85 |
— |
1.0× |
| Ca screen;pelvic/breast exam (G0101) |
$126.81 |
— |
1.0× |
| Canal prep/fitting of dowel (D3950) |
$807 |
— |
1.0× |
| Cardiac mri seg dys strain (C9762) |
$682.08 |
— |
1.0× |
| Cardiac mri seg dys stress (C9763) |
$682.08 |
— |
1.0× |
| Cardiokymography (Q0035) |
$46.62 |
— |
1.0× |
| Care manage beh svs 20mins (G0323) |
$46.77 |
— |
1.0× |
| Care manage serv, pr cal mo (G0570) |
$46.77 |
— |
1.0× |
| Chemo extend iv infus w/pump (G0498) |
$412.32 |
— |
1.0× |
| Closd rductn splint alveolus (D7670) |
$4,138.63 |
— |
1.0× |
| Colon ca scrn not hi rsk ind (G0121) |
$1,160.85 |
— |
1.0× |
| Colorectal scrn; hi risk ind (G0105) |
$1,160.85 |
— |
1.0× |
| Colpopexy, min/inv, ex-perit (C9778) |
$6,244.48 |
— |
1.0× |
| Comm hlth intg svs sdoh 60mn (G0019) |
$126.81 |
— |
1.0× |
| Commissure splint (D5987) |
$807 |
— |
1.0× |
| Comp periodontal evaluation (D0180) |
$166.19 |
— |
1.0× |
| Complete occlusal adjustment (D9952) |
$807 |
— |
1.0× |
| Complex simulation w/pet-ct (G0562) |
$2,383.16 |
— |
1.0× |
| Comprehensve oral evaluation (D0150) |
$166.19 |
— |
1.0× |
| Con tissue w pedicle graft (D4276) |
$1,936.82 |
— |
1.0× |
| Cone beam ct both jaws (D0383) |
$130.50 |
— |
1.0× |
| Cone beam ct capt & interp (D0364) |
$130.50 |
— |
1.0× |
| Cone beam ct capt mandible (D0381) |
$130.50 |
— |
1.0× |
| Cone beam ct capt maxilla (D0382) |
$130.50 |
— |
1.0× |
| Cone beam ct capture limited (D0380) |
$130.50 |
— |
1.0× |
| Cone beam ct capture tmj (D0384) |
$130.50 |
— |
1.0× |
| Cone beam ct interp both jaw (D0367) |
$130.50 |
— |
1.0× |
| Cone beam ct interprete man (D0365) |
$130.50 |
— |
1.0× |
| Cone beam ct interprete max (D0366) |
$130.50 |
— |
1.0× |
| Cone beam ct interprete tmj (D0368) |
$130.50 |
— |
1.0× |
| Coping (D2975) |
$807 |
— |
1.0× |
| Core build-up incl any pins (D2950) |
$807 |
— |
1.0× |
| Coronectomy (D7251) |
$1,936.82 |
— |
1.0× |
| Crown 3/4 cast base metal (D2781) |
$807 |
— |
1.0× |
| Crown 3/4 cast hi noble met (D2780) |
$807 |
— |
1.0× |
| Crown 3/4 cast noble metal (D2782) |
$807 |
— |
1.0× |
| Crown 3/4 porcelain/ceramic (D2783) |
$807 |
— |
1.0× |
| Crown 3/4 resin-based compos (D2712) |
$807 |
— |
1.0× |
| Crown full cast base metal (D2791) |
$807 |
— |
1.0× |
| Crown full cast high noble m (D2790) |
$807 |
— |
1.0× |
| Crown full cast noble metal (D2792) |
$807 |
— |
1.0× |
| Crown lengthen hard tissue (D4249) |
$807 |
— |
1.0× |
| Crown porc fused to titanium (D2753) |
$807 |
— |
1.0× |
| Crown porcelain fused base m (D2751) |
$807 |
— |
1.0× |
| Crown porcelain w/ h noble m (D2750) |
$807 |
— |
1.0× |
| Crown porcelain w/ noble met (D2752) |
$807 |
— |
1.0× |
| Crown porcelain/ceramic (D2740) |
$807 |
— |
1.0× |
| Crown repair (D2980) |
$807 |
— |
1.0× |
| Crown resin w/ base metal (D2721) |
$807 |
— |
1.0× |
| Crown resin w/ high noble me (D2720) |
$807 |
— |
1.0× |
| Crown resin w/ noble metal (D2722) |
$807 |
— |
1.0× |
| Crown resin-based indirect (D2710) |
$807 |
— |
1.0× |
| Crown-titanium (D2794) |
$807 |
— |
1.0× |
| Cysto impl 4 or more (C9740) |
$11,816.83 |
— |
1.0× |
| Cysto, litho, vacuum kidney (C9761) |
$11,816.83 |
— |
1.0× |
| Cystoscopy prostatic imp 1-3 (C9739) |
$6,693.04 |
— |
1.0× |
| Decor or submerg erupt tooth (D3921) |
$807 |
— |
1.0× |
| Demonstrate use home inr mon (G0248) |
$166.19 |
— |
1.0× |
| Dental bitewing single image (D0270) |
$108.63 |
— |
1.0× |
| Dental bitewings two images (D0272) |
$108.63 |
— |
1.0× |
| Dental connector bar (D6920) |
$807 |
— |
1.0× |
| Dental gold foil one surface (D2410) |
$807 |
— |
1.0× |
| Dental gold foil three surfa (D2430) |
$807 |
— |
1.0× |
| Dental gold foil two surface (D2420) |
$807 |
— |
1.0× |
| Dental inlay metalic 1 surf (D2510) |
$807 |
— |
1.0× |
| Dental inlay metallic 2 surf (D2520) |
$807 |
— |
1.0× |
| Dental inlay metl 3/more sur (D2530) |
$807 |
— |
1.0× |
| Dental inlay resin 3/mre sur (D2652) |
$807 |
— |
1.0× |
| Dental onlay metallic 2 surf (D2542) |
$807 |
— |
1.0× |
| Dental onlay metallic 3 surf (D2543) |
$807 |
— |
1.0× |
| Dental onlay metl 4/more sur (D2544) |
$807 |
— |
1.0× |
| Dental onlay porc 3/more sur (D2630) |
$807 |
— |
1.0× |
| Dental onlay porc 4/more sur (D2644) |
$807 |
— |
1.0× |
| Dental onlay porcelin 2 surf (D2642) |
$807 |
— |
1.0× |
| Dental onlay porcelin 3 surf (D2643) |
$807 |
— |
1.0× |
| Dental onlay resin 2 surface (D2662) |
$807 |
— |
1.0× |
| Dental onlay resin 3 surface (D2663) |
$807 |
— |
1.0× |
| Dental onlay resin 4/mre sur (D2664) |
$807 |
— |
1.0× |
| Dental prophylaxis adult (D1110) |
$166.19 |
— |
1.0× |
| Dental saliography (D0310) |
$297.84 |
— |
1.0× |
| Dental tmj arthrogram incl i (D0320) |
$297.84 |
— |
1.0× |
| Dental tomographic survey (D0322) |
$130.50 |
— |
1.0× |
| Dental unspec restorative pr (D2999) |
$807 |
— |
1.0× |
| Depression screen annual (G0444) |
$46.77 |
— |
1.0× |
| Dermal filler injection(s) (G0429) |
$2,575.56 |
— |
1.0× |
| Devlopment test interpt&rep (G0451) |
$126.81 |
— |
1.0× |
| Diab manage trn ind/group (G0109) |
— |
$200 |
— |
| Digital sub 2 or more images (D0394) |
$108.63 |
— |
1.0× |
| Direct refer hospital observ (G0379) |
$743.39 |
— |
1.0× |
| Dist space maint, fixed unil (D1575) |
$807 |
— |
1.0× |
| Dstry eye lesn,fdr vssl tech (G0186) |
$686.55 |
— |
1.0× |
| Each addtnl prefab post (D2957) |
$807 |
— |
1.0× |
| Ekg tracing for initial prev (G0404) |
$36.10 |
— |
1.0× |
| End thxpy, anterior tooth (D3310) |
$807 |
— |
1.0× |
| End thxpy, molar tooth (D3330) |
$807 |
— |
1.0× |
| End thxpy, premolar tooth (D3320) |
$807 |
— |
1.0× |
| Endo defect closure gi tract (C9901) |
$13,269.05 |
— |
1.0× |
| Endo outlet restrict w/tube (C9785) |
$13,269.05 |
— |
1.0× |
| Endodontic endosseous implan (D3460) |
$807 |
— |
1.0× |
| Endodontic procedure (D3999) |
$807 |
— |
1.0× |
| Esd endoscopy or colonoscopy (C9779) |
$4,812.72 |
— |
1.0× |
| Esophag muc integ w/eso egd (C9777) |
$4,812.72 |
— |
1.0× |
| Excision benign lesion compl (D7412) |
$1,936.82 |
— |
1.0× |
| Excision benign lesion>1.25c (D7411) |
$1,936.82 |
— |
1.0× |
| Excision malig les complicat (D7415) |
$1,936.82 |
— |
1.0× |
| Excision malig lesion<=1.25c (D7413) |
$1,936.82 |
— |
1.0× |
| Excision malig lesion>1.25cm (D7414) |
$1,936.82 |
— |
1.0× |
| Exposure of unerupted tooth (D7280) |
$807 |
— |
1.0× |
| Extensv oral eval prob focus (D0160) |
$166.19 |
— |
1.0× |
| Extra oral post radio image (D0705) |
$108.63 |
— |
1.0× |
| Extraction coronal remnants (D7111) |
$807 |
— |
1.0× |
| Extraction erupted tooth/exr (D7140) |
$807 |
— |
1.0× |
| Extraoral 2d project image (D0250) |
$108.63 |
— |
1.0× |
| Extraoral posterior image (D0251) |
$108.63 |
— |
1.0× |
| Extrnl counterpulse, per tx (G0166) |
$166.08 |
— |
1.0× |
| Facial moulage complete (D5912) |
$807 |
— |
1.0× |
| Facial moulage sectional (D5911) |
$807 |
— |
1.0× |
| Facility svs dental rehab (G0330) |
$4,138.63 |
— |
1.0× |
| Fecal microbiota prep instil (G0455) |
$1,160.85 |
— |
1.0× |
| Fixed bilat space maint, man (D1517) |
$807 |
— |
1.0× |
| Fixed bilat space maint, max (D1516) |
$807 |
— |
1.0× |
| Followup eval of foot pt lop (G0246) |
$166.19 |
— |
1.0× |
| Full mouth debridement (D4355) |
$807 |
— |
1.0× |
| Fusion 2 or more 3d images (D0395) |
$108.63 |
— |
1.0× |
| Gingival flap proc w/ planin (D4240) |
$4,138.63 |
— |
1.0× |
| Gingival irrigation per quad (D4921) |
$166.19 |
— |
1.0× |
| Gingivectomy/plasty 1 to 3 (D4211) |
$4,138.63 |
— |
1.0× |
| Gingivectomy/plasty 4 or mor (D4210) |
$4,138.63 |
— |
1.0× |
| Gingivectomy/plasty rest (D4212) |
$4,138.63 |
— |
1.0× |
| Glaucoma scrn hgh risk direc (G0118) |
$46.62 |
— |
1.0× |
| Glaucoma scrn hgh risk direc (G0117) |
$36.10 |
— |
1.0× |
| Gngvl flap w rootplan 1-3 th (D4241) |
$1,936.82 |
— |
1.0× |
| Gross pulpal debridement (D3221) |
$807 |
— |
1.0× |
| Group behave couns 2-10 (G0473) |
$46.77 |
— |
1.0× |
| Group train w/o patient (G0543) |
$36.10 |
— |
1.0× |
| Guided tiss regen nonresorb (D4267) |
$1,936.82 |
— |
1.0× |
| Guided tiss regen resorble (D4266) |
$1,936.82 |
— |
1.0× |
| Guided tissue regeneration (D3432) |
$807 |
— |
1.0× |
| Hbot, full body chamber, 30m (G0277) |
$171.78 |
$2,176 |
1.0× |
| High inten beh couns std 30m (G0445) |
$126.81 |
— |
1.0× |
| Hiv prep counsel, clin staff (G0013) |
$46.77 |
— |
1.0× |
| Home sleep test/type 2 porta (G0398) |
$269.53 |
— |
1.0× |
| Home sleep test/type 3 porta (G0399) |
$269.53 |
— |
1.0× |
| Home sleep test/type 4 porta (G0400) |
$269.53 |
— |
1.0× |
| Hopd mntl hlt, 15-29 min (C7900) |
$46.77 |
— |
1.0× |
| Hopd mntl hlt, 30-60 min (C7901) |
$126.81 |
— |
1.0× |
| Hopd mntl hlt, grp (C7903) |
$46.77 |
— |
1.0× |
| Hospital outpt clinic visit (G0463) |
$166.19 |
— |
1.0× |
| I&d absc intraoral soft tiss (D7510) |
$883.95 |
— |
1.0× |
| I&d abscess extraoral (D7520) |
$883.95 |
— |
1.0× |
| Imp extar knee shck absrb (C8003) |
$21,887.18 |
— |
1.0× |
| Impact tooth rem bony w/comp (D7241) |
$807 |
— |
1.0× |
| Impact tooth remov comp bony (D7240) |
$807 |
— |
1.0× |
| Impact tooth remov part bony (D7230) |
$807 |
— |
1.0× |
| Impact tooth remov soft tiss (D7220) |
$807 |
— |
1.0× |
| Incision/drain abscess extra (D7521) |
$883.95 |
— |
1.0× |
| Incision/drain abscess intra (D7511) |
$883.95 |
— |
1.0× |
| Incomplete endodontic tx (D3332) |
$807 |
— |
1.0× |
| Init/sub psych care m 1st 30 (G2214) |
$126.81 |
— |
1.0× |
| Initial foot exam pt lops (G0245) |
$166.19 |
— |
1.0× |
| Initial preventive exam (G0402) |
$166.19 |
— |
1.0× |
| Inj for sacroiliac jt anesth (G0260) |
$881.14 |
— |
1.0× |
| Injection of hiv prep drug (G0012) |
$89.88 |
— |
1.0× |
| Inlay composite/resin one su (D2650) |
$807 |
— |
1.0× |
| Inlay composite/resin two su (D2651) |
$807 |
— |
1.0× |
| Inlay porcelain/ceramic 1 su (D2610) |
$807 |
— |
1.0× |
| Inlay porcelain/ceramic 2 su (D2620) |
$807 |
— |
1.0× |
| Inlay repair (D2981) |
$807 |
— |
1.0× |
| Insert cv cath inf & sup app (C9780) |
$10,080.63 |
— |
1.0× |
| Insert drug del implant, >=4 (G0516) |
$557.64 |
— |
1.0× |
| Insert palate implants (C9727) |
$1,936.82 |
— |
1.0× |
| Inst pleu-perit shnt w pump (C8006) |
$8,081.17 |
— |
1.0× |
| Instill pharm renal pelvis (C9789) |
$1,527.89 |
— |
1.0× |
| Int psych care mng, 1 cal mo (G0568) |
$126.81 |
— |
1.0× |
| Intens behave ther cardio dx (G0446) |
$46.77 |
— |
1.0× |
| Intens cardiac rehab no exer (G0423) |
$160.91 |
— |
1.0× |
| Intens cardiac rehab w/exerc (G0422) |
$160.91 |
— |
1.0× |
| Intentional replantation (D3470) |
$807 |
— |
1.0× |
| Interim crown (D2799) |
$807 |
— |
1.0× |
| Internal root repair (D3333) |
$807 |
— |
1.0× |
| Intraor comprehensive series (D0210) |
$297.84 |
— |
1.0× |
| Intraoral bite radio image (D0708) |
$108.63 |
— |
1.0× |
| Intraoral comp image capture (D0709) |
$108.63 |
— |
1.0× |
| Intraoral occlus radio image (D0706) |
$108.63 |
— |
1.0× |
| Intraoral occlusal film (D0240) |
$108.63 |
— |
1.0× |
| Intraoral periap radio image (D0707) |
$108.63 |
— |
1.0× |
| Intraoral periapical first (D0220) |
$108.63 |
— |
1.0× |
| Intraorifice barrier (D3911) |
$807 |
— |
1.0× |
| Intrav inf, mon anti, fir do (M0235) |
$550.43 |
— |
1.0× |
| Intrav inf, mon anti, sec do (M0236) |
$550.43 |
— |
1.0× |
| Intrav inf, toci, first dose (M0237) |
$550.43 |
— |
1.0× |
| Intrav inf, toci, second dos (M0238) |
$550.43 |
— |
1.0× |
| Isolation- tooth w rubb dam (D3910) |
$807 |
— |
1.0× |
| Iv cipaglucosidase alfa-atga (G0138) |
$794.79 |
— |
1.0× |
| Labial veneer porc indirect (D2962) |
$807 |
— |
1.0× |
| Labial veneer resin direct (D2960) |
$807 |
— |
1.0× |
| Labial veneer resin indirect (D2961) |
$807 |
— |
1.0× |
| Lev 1 hosp type b ed visit (G0380) |
$92.79 |
— |
1.0× |
| Lev 2 hosp type b ed visit (G0381) |
$115.95 |
— |
1.0× |
| Lev 3 hosp type b ed visit (G0382) |
$214.56 |
— |
1.0× |
| Lev 4 hosp type b ed visit (G0383) |
$329.93 |
— |
1.0× |
| Lev 5 hosp type b ed visit (G0384) |
$512.70 |
— |
1.0× |
| Limit oral eval problm focus (D0140) |
$166.19 |
— |
1.0× |
| Limited occlusal adjustment (D9951) |
$807 |
— |
1.0× |
| Localized delivery antimicro (D4381) |
$807 |
— |
1.0× |
| Malig tumor > 1.25 cm (D7441) |
$4,138.63 |
— |
1.0× |
| Malig tumor exc to 1.25 cm (D7440) |
$4,138.63 |
— |
1.0× |
| Mandible graft (D7950) |
$7,389.63 |
— |
1.0× |
| Max mri capture & interprete (D0369) |
$130.50 |
— |
1.0× |
| Max mri image capture (D0385) |
$130.50 |
— |
1.0× |
| Max ultrasound capt & interp (D0370) |
$130.50 |
— |
1.0× |
| Max ultrasound image capture (D0386) |
$130.50 |
— |
1.0× |
| Mesial/distal wedge proc (D4274) |
$807 |
— |
1.0× |
| Monthly tx for dmht 20mins (G0553) |
$166.19 |
— |
1.0× |
| Mra w/cont, abd (C8900) |
$435.49 |
— |
1.0× |
| Mra w/cont, chest (C8909) |
$435.49 |
— |
1.0× |
| Mra w/cont, lwr ext (C8912) |
$435.49 |
— |
1.0× |
| Mra w/cont, pelvis (C8918) |
$435.49 |
— |
1.0× |
| Mra w/o cont, abd (C8901) |
$297.84 |
— |
1.0× |
| Mra w/o cont, chest (C8910) |
$297.84 |
— |
1.0× |
| Mra w/o cont, lwr ext (C8913) |
$297.84 |
— |
1.0× |
| Mra w/o cont, pelvis (C8919) |
$297.84 |
— |
1.0× |
| Mra w/o fol w/cont, abd (C8902) |
$435.49 |
— |
1.0× |
| Mra w/o fol w/cont, chest (C8911) |
$435.49 |
— |
1.0× |
| Mra w/o fol w/cont, lwr ext (C8914) |
$435.49 |
— |
1.0× |
| Mra w/o fol w/cont, pelvis (C8920) |
$435.49 |
— |
1.0× |
| Mra, w/dye, spinal canal (C8931) |
$435.49 |
— |
1.0× |
| Mra, w/dye, upper extremity (C8934) |
$435.49 |
— |
1.0× |
| Mra, w/o dye, spinal canal (C8932) |
$297.84 |
— |
1.0× |
| Mra, w/o dye, upper extr (C8935) |
$297.84 |
— |
1.0× |
| Mra, w/o&w/dye, spinal canal (C8933) |
$435.49 |
— |
1.0× |
| Mra, w/o&w/dye, upper extr (C8936) |
$435.49 |
— |
1.0× |
| Mri hyperpolarized xenon129 (C9791) |
$1,527.89 |
— |
1.0× |
| Mri w/cont, breast, bi (C8906) |
$435.49 |
— |
1.0× |
| Mri w/cont, breast, uni (C8903) |
$218.95 |
— |
1.0× |
| Mri w/o fol w/cont, breast, (C8908) |
$435.49 |
— |
1.0× |
| Mri w/o fol w/cont, brst, un (C8905) |
$435.49 |
— |
1.0× |
| Nav srv peer sup 60 min pr m (G0140) |
$126.81 |
— |
1.0× |
| No pt prsnt train initial 30 (G0541) |
$36.10 |
— |
1.0× |
| Non-auto graft 1st tooth (D4275) |
$1,936.82 |
— |
1.0× |
| Non-blind interatrial shunt (C9760) |
$33,600.66 |
— |
1.0× |
| Non-cov proc, clinical trial (G0294) |
$46.62 |
— |
1.0× |
| Non-cov surg proc,clin trial (G0293) |
$46.62 |
— |
1.0× |
| Non-ionizing diag proc (D0600) |
$807 |
— |
1.0× |
| Non-ophthalmic fva (C9733) |
$435.49 |
— |
1.0× |
| Non-surg tx root canal obs (D3331) |
$807 |
— |
1.0× |
| Obtaining screen pap smear (Q0091) |
$36.10 |
— |
1.0× |
| Occ guard, hard, full arch (D9944) |
$807 |
— |
1.0× |
| Occ guard, hard, part arch (D9946) |
$807 |
— |
1.0× |
| Occ guard, soft, full arch (D9945) |
$807 |
— |
1.0× |
| Occlusion analysis (D9950) |
$807 |
— |
1.0× |
| Off base opioid tx 70min (G2086) |
$221.56 |
— |
1.0× |
| Off base opioid tx, 60 m (G2087) |
$221.56 |
— |
1.0× |
| Onlay repair (D2982) |
$807 |
— |
1.0× |
| Open reduc compd alveolus fx (D7770) |
$7,389.63 |
— |
1.0× |
| Open tx iliac spine uni/bil (G0412) |
$9,057.82 |
— |
1.0× |
| Open tx post pelvic fxcture (G0415) |
$4,084.39 |
— |
1.0× |
| Opps service,sched team conf (G0175) |
$520.86 |
— |
1.0× |
| Oral antral fistula closure (D7260) |
$807 |
— |
1.0× |
| Oral/facial photo images (D0350) |
$108.63 |
— |
1.0× |
| Osseous surg 1 to 3 teeth (D4261) |
$4,138.63 |
— |
1.0× |
| Osseous surgery 4 or more (D4260) |
$7,389.63 |
— |
1.0× |
| Oth resp proc, group (G0239) |
$46.62 |
$1,033 |
1.0× |
| Oth resp proc, indiv (G0238) |
$36.10 |
— |
1.0× |
| Other tmj images by report (D0321) |
$108.63 |
— |
1.0× |
| Pano radio image (D0701) |
$108.63 |
— |
1.0× |
| Panoramic image (D0330) |
$297.84 |
— |
1.0× |
| Part pulp for apexogenesis (D3222) |
$807 |
— |
1.0× |
| Pathogen test for platelets (P9100) |
$73.64 |
$166 |
1.0× |
| Pedicle soft tissue graft pr (D4270) |
$1,936.82 |
— |
1.0× |
| Pef bronch ablt 3d nav ebus (C8005) |
$21,382.46 |
— |
1.0× |
| Pelvic ring fracture uni/bil (G0413) |
$9,057.82 |
— |
1.0× |
| Pelvic ring fx treat int fix (G0414) |
$9,057.82 |
— |
1.0× |
| Pemivibart infusion (M0224) |
$550.43 |
— |
1.0× |
| Perc d-e cor revasc chro sin (C9607) |
$22,883.09 |
— |
1.0× |
| Perc d-e cor revasc t cabg s (C9604) |
$14,410.43 |
— |
1.0× |
| Perc d-e cor stent ather s (C9602) |
$22,883.09 |
$89,568 |
1.0× |
| Perc drug-el cor stent sing (C9600) |
$14,410.43 |
$62,996 |
1.0× |
| Periodic oral evaluation (D0120) |
$166.19 |
— |
1.0× |
| Periodontal maint procedures (D4910) |
$807 |
— |
1.0× |
| Periodontal scaling & root (D4341) |
$807 |
— |
1.0× |
| Periodontal scaling 1-3teeth (D4342) |
$807 |
— |
1.0× |
| Pet not otherwise specified (G0235) |
$499.03 |
— |
1.0× |
| Pild/placebo control clin tr (G0276) |
$9,057.82 |
— |
1.0× |
| Pin service 60m per month (G0023) |
$126.81 |
— |
1.0× |
| Place device/marker, non pro (C9728) |
$1,727.79 |
— |
1.0× |
| Place direct restoration (D2940) |
$807 |
— |
1.0× |
| Place endorectal app (C9725) |
$1,160.85 |
— |
1.0× |
| Place intra-socket bio dress (D7922) |
$807 |
— |
1.0× |
| Pne flu hepb cov home admin (M0201) |
$45.02 |
— |
1.0× |
| Post 1 srfc resinbased cmpst (D2391) |
$807 |
— |
1.0× |
| Post 2 srfc resinbased cmpst (D2392) |
$807 |
— |
1.0× |
| Post 3 srfc resinbased cmpst (D2393) |
$807 |
— |
1.0× |
| Post >=4srfc resinbase cmpst (D2394) |
$807 |
— |
1.0× |
| Post and core cast + crown (D2952) |
$807 |
— |
1.0× |
| Post d/c phone follow up (G0544) |
$126.81 |
— |
1.0× |
| Post op service lvrs min 6 (G0305) |
$465.81 |
— |
1.0× |
| Pre 3d mdl w/ccta and/or mri (C9793) |
$1,071.95 |
— |
1.0× |
| Pre-op service lvrs 1-9 dos (G0304) |
$465.81 |
— |
1.0× |
| Pre-op service lvrs 10-15dos (G0303) |
$269.53 |
— |
1.0× |
| Pre-op service lvrs complete (G0302) |
$465.81 |
— |
1.0× |
| Prefab porc/cer crown perm (D2928) |
$807 |
— |
1.0× |
| Prefab porc/ceram crown pri (D2929) |
$807 |
— |
1.0× |
| Prefab post/core + crown (D2954) |
$807 |
— |
1.0× |
| Prefab stainless steel crown (D2933) |
$807 |
— |
1.0× |
| Prefab steel crown primary (D2934) |
$807 |
— |
1.0× |
| Prefab stnlss steel crown pe (D2931) |
$807 |
— |
1.0× |
| Prefab stnlss steel crwn pri (D2930) |
$807 |
— |
1.0× |
| Prefabricated resin crown (D2932) |
$807 |
— |
1.0× |
| Prep skin cell susp, automtd (C8002) |
$8,858.81 |
— |
1.0× |
| Primary closure sinus perf (D7261) |
$807 |
— |
1.0× |
| Prolonged iv inf, req pump (C8957) |
$265.51 |
— |
1.0× |
| Prostate biopsy, any mthd (G0416) |
$447.44 |
— |
1.0× |
| Provide inr test mater/equip (G0249) |
$166.19 |
— |
1.0× |
| Pulp cap direct (D3110) |
$807 |
— |
1.0× |
| Pulp cap indirect (D3120) |
$807 |
— |
1.0× |
| Pulp vitality test (D0460) |
$807 |
— |
1.0× |
| Pulpal regeneration complete (D3357) |
$807 |
— |
1.0× |
| Pulpal regeneration initial (D3355) |
$807 |
— |
1.0× |
| Pulpal regeneration interim (D3356) |
$807 |
— |
1.0× |
| Pulpal therapy anterior prim (D3230) |
$807 |
— |
1.0× |
| Pulpal therapy posterior pri (D3240) |
$807 |
— |
1.0× |
| Rad exc lesion up to 1.25 cm (D7410) |
$1,936.82 |
— |
1.0× |
| Radiation applicator (D5983) |
$807 |
— |
1.0× |
| Radiation cone locator (D5985) |
$807 |
— |
1.0× |
| Radiation shield (D5984) |
$807 |
— |
1.0× |
| Re-cement or re-bond crown (D2920) |
$807 |
— |
1.0× |
| Re-eval post-op visit (D0171) |
$166.19 |
— |
1.0× |
| Re-eval,est pt,problem focus (D0170) |
$166.19 |
— |
1.0× |
| Reattach tooth fragment (D2921) |
$807 |
— |
1.0× |
| Recement cast or prefab post (D2915) |
$807 |
— |
1.0× |
| Recement inlay onlay or part (D2910) |
$807 |
— |
1.0× |
| Recement space maint - man (D1552) |
$807 |
— |
1.0× |
| Recement space maint - max (D1551) |
$807 |
— |
1.0× |
| Recement unilat space maint (D1553) |
$807 |
— |
1.0× |
| Rem exostosis any site (D7471) |
$4,138.63 |
— |
1.0× |
| Rem imp tooth w mucoper flp (D7210) |
$1,936.82 |
— |
1.0× |
| Rem nonodonto cyst > 1.25 cm (D7461) |
$807 |
— |
1.0× |
| Rem nonodonto cyst to 1.25cm (D7460) |
$807 |
— |
1.0× |
| Rem odontogen cyst > 1.25 cm (D7451) |
$4,138.63 |
— |
1.0× |
| Rem odontogen cyst to 1.25cm (D7450) |
$4,138.63 |
— |
1.0× |
| Removal fb skin/areolar tiss (D7530) |
$807 |
— |
1.0× |
| Removal of fb reaction (D7540) |
$807 |
— |
1.0× |
| Removal of sloughed off bone (D7550) |
$807 |
— |
1.0× |
| Removal of torus palatinus (D7472) |
$807 |
— |
1.0× |
| Remove bilat space main, man (D1527) |
$807 |
— |
1.0× |
| Remove bilat space main, max (D1526) |
$807 |
— |
1.0× |
| Remove drug implant (G0517) |
$557.64 |
— |
1.0× |
| Remove torus mandibularis (D7473) |
$807 |
— |
1.0× |
| Remove unilat space maintain (D1520) |
$807 |
— |
1.0× |
| Remove w insert drug implant (G0518) |
$557.64 |
— |
1.0× |
| Replacment pt electronic sys (G0555) |
$1,071.95 |
— |
1.0× |
| Reshaping bone orthognathic (D7940) |
$807 |
— |
1.0× |
| Resin 4/> surf or w incis an (D2335) |
$807 |
— |
1.0× |
| Resin infiltration of lesion (D2990) |
$807 |
— |
1.0× |
| Resin one surface-anterior (D2330) |
$807 |
— |
1.0× |
| Resin three surfaces-anterio (D2332) |
$807 |
— |
1.0× |
| Resin two surfaces-anterior (D2331) |
$807 |
— |
1.0× |
| Restorative foundation (D2949) |
$807 |
— |
1.0× |
| Retreat root canal anterior (D3346) |
$807 |
— |
1.0× |
| Retreat root canal molar (D3348) |
$807 |
— |
1.0× |
| Retreat root canal premolar (D3347) |
$807 |
— |
1.0× |
| Retrograde filling (D3430) |
$807 |
— |
1.0× |
| Revasc intra lithotrip-ather (C9766) |
$22,883.09 |
— |
1.0× |
| Revasc intra lithotrip-stent (C9765) |
$22,883.09 |
— |
1.0× |
| Revasc intravasc lithotripsy (C9764) |
$14,410.43 |
— |
1.0× |
| Revasc lith-sten-ath tib/per (C9775) |
$22,883.09 |
— |
1.0× |
| Revasc lithotr-ather tib/per (C9774) |
$22,883.09 |
— |
1.0× |
| Revasc lithotr-stent tib/per (C9773) |
$22,883.09 |
— |
1.0× |
| Revasc lithotrip tibi/perone (C9772) |
$14,410.43 |
— |
1.0× |
| Revasc lithotrip-stent-ather (C9767) |
$22,883.09 |
— |
1.0× |
| Risk ascvd tst once pr 12 mo (G0537) |
$46.77 |
— |
1.0× |
| Root amputation (D3450) |
$807 |
— |
1.0× |
| Root surgery molar (D3425) |
$807 |
— |
1.0× |
| Root surgery premolar (D3421) |
$807 |
— |
1.0× |
| Routine footcare pt w lops (G0247) |
$250.45 |
— |
1.0× |
| Rpr intst excl anrect fist (C9796) |
$3,464.81 |
— |
1.0× |
| Sbrt w/positron emission del (G0563) |
$3,971.53 |
— |
1.0× |
| Scaling gingiv inflammation (D4346) |
$807 |
— |
1.0× |
| Sialoendoscopy capt & interp (D0371) |
$108.63 |
— |
1.0× |
| Sim ang w/prs cath rad emb (C8004) |
$14,410.43 |
— |
1.0× |
| Single energy x-ray study (G0130) |
$130.50 |
— |
1.0× |
| Soft tissue graft firsttooth (D4277) |
$1,936.82 |
— |
1.0× |
| Software meas of cardiac vol (G0183) |
$108.63 |
— |
1.0× |
| Space maintainer fxd unilat (D1510) |
$807 |
— |
1.0× |
| Spine device implant surgery (C9757) |
$16,026.32 |
— |
1.0× |
| Splint extra-coronal (D4323) |
$807 |
— |
1.0× |
| Splint intra-coronal (D4322) |
$807 |
— |
1.0× |
| Subs psych care mng, subs mo (G0569) |
$126.81 |
— |
1.0× |
| Supply of digital device (G0552) |
$166.19 |
— |
1.0× |
| Surg exp root surf anterior (D3501) |
$807 |
— |
1.0× |
| Surg exp root surf molar (D3503) |
$807 |
— |
1.0× |
| Surg exp root surf premolar (D3502) |
$807 |
— |
1.0× |
| Surg reduct osseoustuberosit (D7485) |
$7,389.63 |
— |
1.0× |
| Surg rep root res anterior (D3471) |
$807 |
— |
1.0× |
| Surg rep root res molar (D3473) |
$807 |
— |
1.0× |
| Surg rep root res premolar (D3472) |
$807 |
— |
1.0× |
| Surgical revision procedure (D4268) |
$807 |
— |
1.0× |
| Surgical splint (D5988) |
$807 |
— |
1.0× |
| Tee w or w/o fol w/cont, mon (C8927) |
$978.56 |
— |
1.0× |
| Tee w or w/o fol w/cont,cong (C8926) |
$978.56 |
— |
1.0× |
| Therapeutic procd strg endur (G0237) |
$36.10 |
$189 |
1.0× |
| Therapeutic pulpotomy (D3220) |
$807 |
— |
1.0× |
| Tmj arthroscopy disc reposit (D7874) |
$4,084.39 |
— |
1.0× |
| Tomosynthesis, mammo (G0279) |
— |
$334 |
— |
| Tooth pin retention (D2951) |
$807 |
— |
1.0× |
| Tooth reimplantation (D7270) |
$807 |
— |
1.0× |
| Tooth root removal (D7250) |
$807 |
— |
1.0× |
| Tooth splitting (D3920) |
$807 |
— |
1.0× |
| Tooth transplantation (D7272) |
$807 |
— |
1.0× |
| Transseptal fiberotomy (D7291) |
$807 |
— |
1.0× |
| Trauma respons w/hosp criti (G0390) |
$1,663.85 |
$9,003 |
1.0× |
| Treatment of complications (D9930) |
$807 |
— |
1.0× |
| Trim nail(s) (G0127) |
$73.64 |
— |
1.0× |
| Trtmnt simulation 3d image (D0393) |
$108.63 |
— |
1.0× |
| Tte w or w/o contr, cont ecg (C8930) |
$978.56 |
— |
1.0× |
| Tte w or w/o fol w/con,stres (C8928) |
$978.56 |
— |
1.0× |
| Tte w or w/o fol w/cont, com (C8921) |
$978.56 |
— |
1.0× |
| Tte w or w/o fol w/cont, f/u (C8922) |
$978.56 |
— |
1.0× |
| Tte w or wo fol wcon,doppler (C8929) |
$978.56 |
— |
1.0× |
| U/s trtmt, not leiomyomata (C9734) |
$16,026.32 |
— |
1.0× |
| Unsched dialysis esrd pt hos (G0257) |
$856.72 |
— |
1.0× |
| Unscheduled dressing change (D4920) |
$807 |
— |
1.0× |
| Unspecified periodontal proc (D4999) |
$295.66 |
— |
1.0× |
| Vasc emb/occ w/prs cath (C9797) |
$22,883.09 |
— |
1.0× |
| Veneer repair (D2983) |
$807 |
— |
1.0× |
| Vert bitewings 7 to 8 images (D0277) |
$297.84 |
— |
1.0× |
| Vestibuloplasty exten graft (D7350) |
$7,389.63 |
— |
1.0× |
| Vestibuloplasty ridge extens (D7340) |
$7,389.63 |
— |
1.0× |
| Visit esketamine 56m or less (G2082) |
$1,283.52 |
— |
1.0× |
| Visit esketamine, > 56m (G2083) |
$2,016.61 |
— |
1.0× |
| Visit to determ ldct elig (G0296) |
$126.81 |
— |
1.0× |