| 2d tte w or w/o fol w/con,co (C8923) |
$250 |
$1,000 |
0.3× |
| 2d tte w or w/o fol w/con,fu (C8924) |
$189 |
$754 |
0.5× |
| Admin hepatitis b vaccine (G0010) |
$35 |
$141 |
0.7× |
| Admin influenza virus vac (G0008) |
$17 |
$66 |
0.4× |
| Admin pneumococcal vaccine (G0009) |
$17 |
$66 |
0.4× |
| Annual alcohol screen 15 min (G0442) |
$11 |
$44 |
0.3× |
| Behavior counsel obesity 15m (G0447) |
$50 |
$200 |
0.5× |
| Ca screen;flexi sigmoidscope (G0104) |
$36 |
$142 |
0.0× |
| Ca screen;pelvic/breast exam (G0101) |
$23 |
$90 |
0.2× |
| Colon ca scrn not hi rsk ind (G0121) |
$118 |
$470 |
0.1× |
| Colorectal scrn; hi risk ind (G0105) |
$118 |
$470 |
0.1× |
| Depression screen annual (G0444) |
$11 |
$44 |
0.3× |
| Direct refer hospital observ (G0379) |
$613 |
$2,452 |
1.0× |
| Drug test def 1-7 classes (G0480) |
$50 |
$200 |
0.4× |
| Drug test def 15-21 classes (G0482) |
$208 |
$830 |
1.0× |
| Drug test def 22+ classes (G0483) |
$269 |
$1,076 |
1.1× |
| Elec stim other than wound (G0283) |
$20 |
$80 |
1.6× |
| Elec stim unattend for press (G0281) |
$18 |
$70 |
1.5× |
| Hep c screen high risk/other (G0472) |
$38 |
$150 |
0.8× |
| Home sleep test/type 3 porta (G0399) |
$250 |
$1,000 |
1.2× |
| Hospital outpt clinic visit (G0463) |
$91 |
$363 |
0.7× |
| Initial preventive exam (G0402) |
$100 |
$400 |
0.7× |
| Mra w/o fol w/cont, abd (C8902) |
$669 |
$2,675 |
1.9× |
| Mra w/o fol w/cont, chest (C8911) |
$525 |
$2,100 |
1.5× |
| Obtaining screen pap smear (Q0091) |
$13 |
$53 |
0.4× |
| Ppps, initial visit (G0438) |
$121 |
$484 |
0.7× |
| Ppps, subseq visit (G0439) |
$95 |
$378 |
0.7× |
| Prostate biopsy, any mthd (G0416) |
$360 |
$1,440 |
1.0× |
| Psa screening (G0103) |
$37 |
$147 |
1.9× |
| Pure tone audiometry (threshold), automated; air only (0208T) |
$10 |
$40 |
0.3× |
| Therapeutic procd strg endur (G0237) |
$35 |
$138 |
1.2× |
| Tomosynthesis, mammo (G0279) |
$113.50 |
$454.50 |
8.9× |
| Trauma respons w/hosp criti (G0390) |
$584 |
$2,334 |
0.4× |
| Trim nail(s) (G0127) |
$56 |
$223 |
0.9× |
| Tte w or w/o fol w/con,stres (C8928) |
$375 |
$1,500 |
0.5× |