Visits & medical services prices at St. John's Medical Center

Jackson, WY · every code in this section with a posted price and a Medicare benchmark.

505 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Acoustic immitance testing (92570) $81 $81 0.6×
Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of… (95803) $228 $228 3.8×
Administration of chemotherapy into artery using push technique (96420) $270 $270 0.8×
Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord (96450) $454 $454 1.3×
Advance care planning first 30 mins (99497) $200 $200 1.9×
Airway inhalation treatment (94640) $204.50 $204.50 0.9×
Allergy injection single (95115) $25 $25 0.5×
Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal),… (95018) $55 $55 1.4×
Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal),… (95017) $22 $22 0.7×
Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours… (93788) $15 $15 0.1×
Ambulatory bp recording (93786) $79 $79 0.6×
Analysis cochlear implt 7 yr/> prgrmg (92603) $370 $370 2.8×
Analysis cochlear implt 7 yr/> sbsq reprgrmg (92604) $222 $222 1.7×
Analyze pacemaker system (93724) $665 $665 2.1×
Anogenital examination, magnified, in childhood for suspected trauma, including image recording when performed (99170) $317 $317 1.5×
Anorectal manometry, with rectal sensation and rectal balloon expulsion test, when performed (91125) $870 $870 2.3×
Appl on-body injector for timed subq injection (96377) $181 $181 3.8×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $45 $45
Application of a modality to 1 or more areas; diathermy (eg, microwave) Other Outpatient (97024) $16 $16
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $104 $104
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes Other Outpatient (97036) $84 $84
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $103 $103
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $58 $58
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $132 $132
Application of ultraviolet light to skin (96900) $55 $55 1.4×
Assessment of aphasia (96105) $544 $544
Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks… (97755) $95 $95
Basic vestibular evaluation (92540) $253 $253 1.1×
Behav assmt w/score & docd/stand instrument (96127) $15 $15 0.4×
Behavioral & qualit analysis voice and resonance (92524) $431 $431
Bfb training ea addl 15 min (90913) $122.50 $122.50
Biofeedback training by any modality Other Outpatient (90901) $74.50 $74.50
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when… (90912) $224 $224
Bioimpedance-derived physiologic cardiovascular analysis (93701) $63 $63 0.5×
Biopsy of heart lining (93505) $1,976 $1,976 0.6×
Bipap initial day (94660) $922 $922 4.1×
Blink reflex test (95933) $183 $183 3.0×
Breath hydrogen/methane test (91065) $251 $251 1.1×
Breathing capacity test (94010) $95 $95 0.4×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $173 $173 0.5×
Bundle of his recording (93600)
likely a partial charge — not the full procedure
$299 $299 0.0×
C motor evoked lwr limbs (95929) $747 $747 2.0×
C motor evoked uppr limbs (95928) $921 $921 1.0×
Canalith repositioning (95992) $120 $120
Car seat/bed test inft thru 12 mo 60 min (94780) $111.50 $111.50 2.9×
Cardiopulmonary exercise testing (94621) $420 $420 1.1×
Cardiovascular stress test (93017) $1,180 $1,180 5.3×
Cardioversion elective external (92960) $517 $517 0.8×
Cardioversion elective internal (92961) $607 $607 0.9×
Caregiver hlth risk assmt score doc stnd instrm (96161) $45 $45 1.2×
Caregiver training 1st 30 min (97550) $130 $130
Caregiver training ea addl 15 (97551) $65 $65
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93460) $3,320 $3,320 1.0×
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93459) $3,097 $3,097 0.9×
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93458) $2,805 $2,805 0.8×
Chemo anti-neopl sq/im (96401) $239 $239 3.2×
Chemo hormon antineopl sq/im (96402) $179.50 $179.50 2.4×
Chemo intralesional over 7 (96406) $297 $297 1.4×
Chemo intralesional up to 7 (96405) $211 $211 2.9×
Chemo IV infus each addl seq (96417) $296 $296 4.0×
Chemo IV infusion addl hr (96415) $208.50 $208.50 2.8×
Chemo IV push addl drug (96411) $276 $276 3.8×
Chemother prolong infuse w/pump (96416) $633 $633 1.9×
Chemotherapy administration into pleural cavity, requiring and including thoracentesis (96440) $2,274 $2,274 6.7×
Chemotherapy administration into the peritoneal cavity via implanted port or catheter (96446) $940 $940 2.8×
Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to… (96423) $200 $200 4.2×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $623.50 $623.50 1.8×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $418.50 $418.50 1.2×
Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents (96542) $305 $305 0.9×
Chest physiotherapy initial (94667) $294 $294 2.2×
Chiropract manj 1-2 regions (98940) $64 $64 2.9×
Chiropract manj 3-4 regions (98941) $90 $90 4.1×
Chiropractic manipulative treatment (CMT); spinal, 5 regions (98942) $115 $115 5.2×
Chron care mgmt srvc 20 min (99490) $105 $105 1.0×
Colon motility (manometric) study, minimum 6 hours continuous recording (including provocation tests, eg, meal,… (91117) $409 $409 1.9×
Color vision examination, extended, eg, anomaloscope or equivalent (92283) $45 $45 0.7×
Color/duplex Doppler, complete (93975) $981 $981 4.0×
Color/duplex Doppler, limited (93976) $611.50 $611.50 5.7×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $109 $109
Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time… (99487) $90 $90 0.5×
Compre electrophysiologic w/o arrhyt induction (93619)
likely a partial charge — not the full procedure
$1,031 $1,031 0.1×
Compre ep eval abltj atr fib pulm vein isolation (93656)
likely a partial charge — not the full procedure
$2,832 $2,832 0.1×
Comprehensive computer-based motion analysis by video-taping and 3D kinematics; (96000) $246 $246 0.6×
Comprehensive computer-based motion analysis by video-taping and 3D kinematics; with dynamic plantar pressure… (96001) $243 $243 0.3×
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with… (93620)
likely a partial charge — not the full procedure
$1,635 $1,635 0.2×
Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93653)
likely a partial charge — not the full procedure
$2,122 $2,122 0.1×
Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93654)
likely a partial charge — not the full procedure
$2,831 $2,831 0.1×
Comprehensive hearing test (92557) $100 $100 0.8×
Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed,… (92548) $267 $267 2.0×
Concurrent chemotherapy (96549) $275 $275 5.7×
Conditioning play audiometry (92582) $188 $188 1.4×
Cont gluc mntr physician/qhp provided equipment (95250) $302 $302 2.2×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $118 $118 0.9×
Coronary art/grft angio s&i (93455) $2,721 $2,721 0.8×
Coronary artery angio s&i (93454) $2,342 $2,342 0.7×
Cpr (92950) $776 $776 3.5×
Cptrized oph dx img anterior segment uni/bi (92132) $92 $92 1.5×
Cptrized oph dx img pst segment uni/bi optic nrv (92133) $114 $114 1.9×
Cptrized oph dx img pst segment uni/bi retina (92134) $116 $116 1.9×
Critical care ill/injured patient init 30-74 min (99291) $709 $709 0.8×
Ctr motr ep std transcrnl motr stim upr&low limb (95939) $1,099 $1,099 1.3×
Debridement open wound 20 sq cm< (97597) $250 $250 1.2×
Delivery/birthing room resuscitation (99465) $510 $510 0.8×
Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming (92602) $226 $226 1.7×
Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming (92601) $334 $334 2.5×
Diagnostic analysis with programming of auditory brainstem implant, per hour (92640) $315 $315 2.4×
Diagnostic dark adaptation examination (eg, rod and cone sensitivities, rod-cone breakpoint), with interpretation and… (92284) $160 $160 0.4×
Dialysis one evaluation (90945) $239 $239 0.6×
Distrt prod evokd otoacoustic emsns comp/dx eval (92588) $83 $83 0.2×
Dup-scan artl infl&ven o/f pen vsl compl (93980) $593.50 $593.50 5.6×
Duplex hemodialysis access (93990) $526 $526 4.9×
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $680 $680 2.8×
Duplex scan artl infl&ven o/f hemo compl uni std (93986) $395 $395 3.7×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $766.50 $766.50 3.1×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $411 $411 3.8×
Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study Age Under 21 (93981) $282 $282 2.6×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $939 $939 3.9×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $441 $441 4.1×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $888 $888 3.6×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $564.50 $564.50 5.3×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $957 $957 3.9×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $371 $371 3.5×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $982 $982 4.0×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $608.50 $608.50 5.7×
Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles (96002) $54 $54 0.2×
Ear and throat examination (92502) $245 $245 0.4×
ECG monit/reprt up to 48 hrs (93226) $100 $100 1.7×
ECG/monitoring and analysis (93271) $469 $469 4.8×
Echo transesophageal (93312) $767 $767 1.4×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $588 $588 1.1×
Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional… (93318) $280 $280 0.5×
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording);… (93313) $799 $799 1.4×
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) $341 $341 1.4×
EEG 41-60 minutes (95812) $1,235.50 $1,235.50 5.6×
EEG awake & asleep (95819) $1,196 $1,196 5.4×
EEG awake/drowsy (95816) $1,041 $1,041 4.7×
EEG coma or sleep only (95822) $1,069 $1,069 4.8×
EEG extended monitoring 61-119 minutes (95813) $1,365.50 $1,365.50 6.2×
EKG 12 lead tracing only (93005) $196 $196 3.3×
EKG rhythm strip (93041) $16 $16 0.3×
Elec alys implt cplx cn npgt prgrmg (95977) $222 $222 2.3×
Elec alys implt npgt cplx sp/pn prgrmg (95972) $278 $278 2.9×
Elec alys implt npgt phys/qhp w/o programming (95970) $220.50 $220.50 1.6×
Elec alys implt npgt smpl sp/pn npgt prgrmg (95971) $273 $273 2.8×
Elec alys implt smpl cn npgt prgrmg (95976) $105 $105 2.8×
Electro-oculography with interpretation and report (92270) $236 $236 1.7×
Electrocochleography (92584) $183 $183 1.4×
Electroconvulsive therapy (90870) $450 $450 0.5×
Electrode stimulation brain (95961) $1,723 $1,723 2.0×
Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes… (93642) $981 $981 0.8×
Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or… (93624)
likely a partial charge — not the full procedure
$673 $673 0.1×
Emergency department visit high mdm (99285) $540 $540 0.9×
Emergency department visit low mdm (99283) $195 $195 0.7×
Emergency department visit may not req phys/qhp (99281) $53 $53 0.6×
Emergency department visit moderate mdm (99284) $365 $365 0.9×
Emergency department visit straightforward mdm (99282) $130 $130 0.8×
EMG thoracic paraspinal (95869) $344 $344 1.6×
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $244 $244 1.9×
Ergonovine provocation test (93024) $283 $283 0.6×
Esoph balloon distension tst (91040) $767 $767 2.0×
Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s)… (91038) $1,235 $1,235 3.2×
Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s)… (91037) $433 $433 2.0×
Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and… (91010) $471 $471 1.2×
Esophageal recording (93615) $120 $120 0.1×
Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing without Cardiac Cath (93616) $163 $163 0.1×
Esophagus, acid perfusion (Bernstein) test for esophagitis (91030) $373 $373 1.0×
Eval aud funcj cand/po surg implt dev 1st hr (92626) $225 $225 1.7×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $467 $467
Evaluate pt use of inhaler (94664) $260 $260 1.2×
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92608) $121 $121
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $420 $420
Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face… (92605) $340 $340
Evaluation of central auditory function, with report; initial 60 minutes (92620) $233 $233 1.8×
Evaluation of speech fluency (92521) $473 $473
Evaluation of speech sound production articulate (92522) $416 $416
Evoked auditory test limited (92587) $60 $60 0.3×
Excimer laser tx psoriasis tot area <250 sq cm (96920) $397 $397 1.9×
Ext ECG>48hr<7d scan a/r (93243) $525 $525 3.9×
External ECG rec>48hr<7d recording (93242) $345 $345 9.0×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $235 $235 1.7×
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data… (93229) $1,840 $1,840 4.8×
External ocular photography with interpretation and report for documentation of medical progress (eg, close-up… (92285) $54 $54 1.4×
Eye allergy tests (95060) $89 $89 0.7×
Facial nerve function studies (eg, electroneuronography) (92516) $182 $182 0.8×
Flexible endoscopic evaluation, laryngeal sensory testing by cine or video recording; Other Outpatient (92614) $388 $388
Flexible ndsc eval swlng&laryn sens c/v rec (92616) $533 $533
Fluidotherapy (97022) $174 $174
Fundus photography with interpretation and report (92250) $204 $204 1.5×
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $240.50 $240.50 1.1×
Gastroesophag reflx test w/cath ph eltrd plcmt (91034) $505 $505 1.3×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,316 $1,316 1.5×
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and… (91110) $2,429 $2,429 2.6×
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report Age… (91111) $2,028 $2,028 2.2×
Gi transit & pres meas wireless capsule w/interp (91112) $2,970 $2,970 3.2×
Gonioscopy (92020) $70 $70 0.5×
Group caregiver training strategies & technique (97552) $55 $55
Hast w/oxygen titrate (94453) $216 $216 1.6×
Health behavior assessment/re-assessment (96156) $250 $250 2.4×
Health behavior ivntj fam w/pt f2f 1st 30 min (96167) $25 $25 0.7×
Health behavior ivntj group f2f 1st 30 min (96164) $25 $25 0.7×
Health behavior ivntj indiv f2f 1st 30 min (96158) $170 $170 0.9×
Hemodialysis procedure w/ phys/qhp evaluation (90935) $179 $179 0.3×
High altitude simulation test (HAST), with interpretation and report by a physician or other qualified health care… (94452) $154 $154 1.1×
Hot/cold pack (97010) $53 $53
Hypoxia response curve (94450) $176 $176 1.3×
Im adm intransl/oral 1 vaccine (90473) $30 $30 0.4×
Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or… (92227) $35 $35 0.6×
Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care… (92228) $91 $91 2.4×
Imm admn sarscov2 vaccine single dose (90480) $65 $65 1.6×
Immunization administration (90471) $40 $40 0.5×
Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral (92240) $666 $666 3.0×
Induction of arrhythmia by electrical pacing without Cardiac Cath (93618) $600 $600 0.5×
Infrared therapy (97026) $38 $38
Ingestion challenge test initial 120 minutes (95076) $294 $294 0.8×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (99460) $212 $212 1.6×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $284 $284 2.1×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $153.50 $153.50 3.2×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $231 $231 1.1×
Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes with Cardiac Cath (93503) $327 $327 0.2×
Interrog dev eval pm/ldls pm phys/qhp in person (93288) $92 $92 2.4×
Interrog device eval heart (93289) $196 $196 5.1×
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93290) $76 $76 2.0×
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93291) $163.50 $163.50 5.5×
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93261) $135 $135 3.5×
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health… (93292) $80 $80 2.1×
Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless… (93296) $165 $165 4.3×
Interrogation vad in prson w/phys/qhp analysis (93750) $135 $135 1.4×
Intra-atrial pacing (93610)
likely a partial charge — not the full procedure
$424 $424 0.1×
Intra-atrial recording (93602)
likely a partial charge — not the full procedure
$298 $298 0.0×
Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete… (93650)
likely a partial charge — not the full procedure
$1,509 $1,509 0.2×
Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number… (95028) $37 $37 1.0×
Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and… (95024) $21 $21 0.3×
Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens,… (95027) $13 $13 0.4×
Intraventricular pacing (93612)
likely a partial charge — not the full procedure
$421 $421 0.1×
Io anal gast n-stim subsq (95981) $85 $85 1.4×
Io ga n-stim subsq w/reprog (95982) $134 $134 3.5×
Irrigaj implntd venous access drug delivery syst (96523) $149 $149 2.5×
Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) 95875 (95875) $322 $322 2.4×
IV infusion hydration each additional hour (96361) $157 $157 3.3×
IV infusion hydration initial 31 min-1 hour (96360) $374 $374 1.7×
IV infusion ther proph addl sequential to 1 hr (96367) $186 $186 2.5×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $409 $409 1.9×
IV tx, each additional hour (96366) $160 $160 3.3×
Laryngeal function studies (ie, aerodynamic testing and acoustic testing) Other Outpatient (92520) $238 $238 1.8×
Loudness balance test, alternate binaural or monaural (92562) $123 $123 0.6×
Low frequency non-thermal us (97610) $510 $510 2.5×
Lwr xtr vasc stdy bilat (93924) $864 $864 3.9×
Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (eg, sensory, motor,… (95966) $495 $495 0.6×
Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (eg, epileptic cerebral… (95965) $1,082 $1,082 1.2×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $223 $223 1.6×
Maximum voluntary ventilation (94200) $176.50 $176.50 2.9×
Measurement of adequacy of hearing protection device (92596) $113 $113 3.0×
Measurement of brain wave activity (EEG) to evaluate brain death (95824) $99 $99 0.3×
Measurement of eye artery pressure (92260) $49 $49 1.3×
Measurement of lung volumes (ie, functional residual capacity ºFRC», forced vital capacity ºFVC», and expiratory… (94013) $70 $70 0.2×
Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age (94011) $295 $295 2.2×
Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2… (94012) $480 $480 2.2×
Mechanical traction therapy (97012) $120 $120
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $96.50 $96.50
Medical nutrition group (97804) $43.50 $43.50
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $83 $83
Methacholine challenge (94070) $510 $510 1.3×
Microvolt T-wave alternans for assessment of ventricular arrhythmias (93025) $429 $429 3.3×
Modification of contact lens (separate procedure), with medical supervision of adaptation (92325) $108 $108 0.8×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $565 $565
Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study,… (95905) $178 $178 0.4×
Multi-family group psychotherapy - psychologist (90849) $86 $86 0.5×
Multiple sleep latency (95805) $2,227.50 $2,227.50 2.5×
Muscle test 3 limbs (95863) $577.50 $577.50 4.4×
Muscle test larynx (95865) $342 $342 2.5×
Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (Amytal) interview) (90865) $422 $422 2.3×
Nasal function studies (eg, rhinomanometry) (92512) $158 $158 0.7×
Nasopharyngoscopy (92511) $360 $360 1.8×
Ndl EMG 4 xtr w/wo related paraspinal areas (95864) $560 $560 4.3×
Needle electromyography 2 extremities with or without related paraspinal areas 95861 (95861) $746 $746 5.5×
Needle electromyography cranial nrv muscle uni (95867) $316.50 $316.50 1.4×
Needle electromyography hemidiaphragm (95866) $350 $350 2.7×
Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber… (95872) $360 $360 1.6×
Needle electromyography; 1 extremity with or without related paraspinal areas (95860) $369.50 $369.50 2.7×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $207 $207 1.5×
Needle measurement of electrical activity in muscles on both sides of body (95868) $456 $456 2.1×
Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report (92265) $204 $204 3.4×
Neg pressure wound therapy non dme </= 50 sq cm (97607) $534 $534 1.3×
Neg pressure wound therapy non dme >50 sq cm (97608) $538.50 $538.50 1.3×
Negative pressure wound therapy dme </= 50 sq cm (97605) $115 $115 0.6×
Negative pressure wound therapy dme >50 sq cm (97606) $382 $382 0.9×
Nerve conduction studies 1-2 studies (95907) $244 $244 1.1×
Nerve conduction studies 11-12 studies (95912) $1,103.50 $1,103.50 2.9×
Nerve conduction studies 13/> studies (95913) $760 $760 2.0×
Nerve conduction studies 3-4 studies (95908) $412 $412 1.9×
Nerve conduction studies 5-6 studies (95909) $560.50 $560.50 2.5×
Nerve conduction studies 7-8 studies (95910) $678 $678 1.8×
Nerve conduction studies 9-10 studies (95911) $933 $933 2.4×
Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, ºeg, acquired knowledge,… (96116) $225 $225 1.0×
Neuromuscular junction test (95937) $224.50 $224.50 1.7×
Neuropsychological tst eval phys/qhp 1st hour (96132) $333 $333 0.9×
Nitric oxide expired gas determination (95012) $52 $52 1.4×
Non-invasive physiologic study extremity 3 levels (93923) $656.50 $656.50 3.0×
Noninvasive ear/pulse oximetry overnight monitor (94762) $184.50 $184.50 1.4×
Occupational therapy eval high complex 60 mins (97167) $460 $460
Occupational therapy eval low complex 30 mins (97165) $304 $304
Occupational therapy eval mod complex 45 mins (97166) $397 $397
Ophthalmic biometry (92136) $233 $233 1.7×
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for… (92018) $362 $362 0.1×
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for… (92019) $176 $176 0.1×
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program;… (92004) $381 $381 2.8×
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program;… (92002) $209 $209 1.5×
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and… (92014) $318 $318 2.3×
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and… (92012) $220 $220 1.6×
Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording (92544) $59 $59 0.4×
Oral function therapy (92526) $329 $329
Oral speech device eval (92597) $272 $272
Orthc/prostc mgmt sbsq enc (97763) $135 $135
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $104.50 $104.50
Osteopath manj 1-2 regions (98925) $79 $79 3.6×
Osteopath manj 3-4 regions (98926) $112 $112 5.1×
Osteopath manj 9-10 regions (98929) $217 $217 9.8×
Osteopathic manipulative tx 5-6 body regions (98927) $147 $147 6.7×
Osteopathic manipulative tx 7-8 body regions (98928) $182 $182 8.3×
Ot manual therapy ea 15 min (97140) $107.50 $107.50
Ot neuromuscular re-education (97112) $130 $130
Ot paraffin bath (97018) $99 $99
Ot re-evaluation (97168) $251 $251
OT Therapeutic Activities Charges (97530) $147 $147
Ot wheelchair management (97542) $140 $140
Outpatient cardiac rehab w/cont ECG monitoring (93798) $210 $210 1.6×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $163 $163 1.2×
Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted (94681) $138 $138 0.4×
Oxygen uptake, expired gas analysis; rest, indirect (separate procedure) (94690) $130 $130 2.2×
Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of… (94014) $140 $140 0.3×
Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education,… (94015) $80 $80 0.4×
Pdt dstr prmlg les skn illum/activj per day (96567) $360 $360 1.8×
Percutaneous balloon valvuloplasty; pulmonary valve without Cardiac Cath (92990)
likely a partial charge — not the full procedure
$2,794 $2,794 0.2×
Percutaneous tests w/allergenic extracts (95004) $17 $17 0.0×
Percutaneous transcatheter closure of a congenital ventricular septal defect with implant (93581)
likely a partial charge — not the full procedure
$3,421 $3,421 0.2×
Pharmacological or physical activation requiring physician or other qualified health care professional attendance… (95954) $1,201 $1,201 3.2×
Phlebotomy therapeutic (99195) $247 $247 1.8×
Photo patch test(s) (specify number of tests) (95052) $18 $18 0.3×
Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least 4-8 hours of care… (96913) $344 $344 0.8×
Photochemotherapy; psoralens and ultraviolet A (PUVA) (96912) $244 $244 4.0×
Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B (96910) $191 $191 3.2×
Physical therapy evaluation high complex 45 mins (97163) $462 $462
Physical therapy evaluation low complex 20 mins (97161) $236 $236
Physical therapy evaluation mod complex 30 mins (97162) $359 $359
Pm device progr eval multi (93281) $179.50 $179.50 4.7×
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $1,698 $1,698 1.9×
Polysom <6 yrs sleep w/cpap/bilvl vent 4/> param (95783) $2,796 $2,796 3.2×
Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist (95808) $1,640 $1,640 1.9×
Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a… (95782) $2,619 $2,619 3.0×
Positional nystagmus test, minimum of 4 positions, with recording (92542) $68 $68 0.5×
Pr cholinesterase inhibitor challenge test for myasthenia gravis (95857) $135 $135 0.6×
Pr corneal topography (92025) $97 $97 1.6×
Pr gastric motility manometric studies (91020) $633 $633 1.7×
Pr hypnotherapy (90880) $241 $241 2.3×
Pr replacement of contact lens (92326) $92 $92 1.5×
Pr tympanometry and reflex threshold measurements (92550) $60 $60 0.3×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $20 $20 0.4×
Prepj& antigen allergen immunotherapy 1 insect (95145) $80 $80 1.7×
Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of… (92313) $261 $261 1.9×
Prgrmg dev eval pm/ldls pm (93279) $158.50 $158.50 4.2×
Professional services for allergen immunotherapy; 2 or more injections (95117) $33 $33 0.7×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95147) $150 $150 2.0×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95149) $300 $300 4.1×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95146) $101 $101 2.1×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95148) $230 $230 3.1×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole… (95170) $25 $25 0.5×
Program eval implantable in persn dual ld pacer (93280) $200 $200 5.2×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93282) $180 $180 4.7×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93285) $102 $102 2.7×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93284) $278 $278 7.3×
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93283) $271 $271 7.1×
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $90 $90
Prq trluml coronary angio/atherect one art/brnch (92924)
likely a partial charge — not the full procedure
$1,669 $1,669 0.1×
Prq trluml coronary angioplasty one art/branch (92920)
likely a partial charge — not the full procedure
$1,403 $1,403 0.2×
Prq trluml coronary byp grft revasc one vessel (92937)
likely a partial charge — not the full procedure
$1,557 $1,557 0.1×
Prq trluml coronary stent w/angio one art/brnch (92928)
likely a partial charge — not the full procedure
$1,559 $1,559 0.1×
Prq trluml coronry chronic occlus revasc one vsl (92943)
likely a partial charge — not the full procedure
$1,747 $1,747 0.1×
Prq trluml coronry stent/ath/angio one art/brnch (92933)
likely a partial charge — not the full procedure
$1,744 $1,744 0.1×
Psych diag eval w/med srvcs (90792) $313 $313 1.7×
Psychiatric diagnostic evaluation (90791) $382.50 $382.50 2.1×
Psychoanalysis (90845) $189 $189 1.0×
Psycl/nrpsycl tst tech 2+ tst 1st 30 min (96138) $97 $97 0.2×
Psytx crisis initial 60 min (90839) $270.50 $270.50 1.5×
Pt gait training 15 min (97116) $101.50 $101.50
Pt physical performance test (97750) $84 $84
Pt re-evaluation (97164) $220 $220
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $275 $275
Pt-focused hlth risk assmt score doc stnd instrm (96160) $43.25 $43.25 1.1×
Pulm funct tst plethysmograp (94726) $406 $406 1.1×
Pulmonary stress testing (94618) $257.50 $257.50 1.9×
R hrt art/grft angio (93457) $3,313 $3,313 1.0×
R hrt coronary artery angio (93456) $2,935 $2,935 0.9×
R&l hrt art/ventricle angio (93461) $3,802 $3,802 1.1×
R&l hrt cath w/ventriclgrphy (93453) $2,983 $2,983 0.9×
Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section… (95851) $80 $80
Rapid desensitization procedure each hour (95180) $334 $334 0.7×
Recording and interpretation of stomach electrical activity (91132) $424 $424 1.9×
Recording and interpretation of stomach electrical activity with drug administration (91133) $488 $488 3.6×
Recording to evaluate height and duration of heart beats through damaged heart tissue (93278) $78 $78 1.3×
Rectal sensation, tone, and compliance study (eg, barostat) (91124) $2,000 $2,000 9.1×
Refill/maint pump/resvr syst (96522) $288.50 $288.50 1.3×
Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain… (95990) $242 $242 0.7×
Refilling and maintenance of portable pump (96521) $655 $655 3.0×
Rem interrog icpms <30 d phys/qhp (93297) $68 $68 1.8×
Rem interrog scrms <30 d phys/qhp (93298) $76.50 $76.50 2.0×
Rem mntr physiol param 1st dev supply ea 30 d (99454) $80 $80 2.1×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $248 $248 1.8×
Remote 30 day ECG rev/report (93270) $209.50 $209.50 5.5×
Respiratory flow volume loop (94375) $135 $135 0.6×
Review patient spirometry (94016) $85 $85
Rfl&main implt pmp/rsvr dlvr spi/brn phy/qhp (95991) $322 $322 1.0×
Right heart cath o2 saturation & cardiac output (93451) $2,059 $2,059 0.6×
Right ventricular recording (93603) $297 $297 0.2×
Select picture audiometry (92583) $135 $135 2.2×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $142 $142
Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with… (92060) $168 $168 2.8×
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $123 $123
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95927) $433 $433 2.0×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95938) $1,212 $1,212 1.4×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95926) $614 $614 2.8×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95925) $411.50 $411.50 1.9×
Sleep study attended (95807) $1,252 $1,252 3.3×
Sleep study unattended (95806) $460 $460 2.1×
Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or… (95800) $457 $457 2.1×
Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis… (95801) $239 $239 4.0×
Speech audiometry threshold (92555) $61 $61 1.0×
Speech sound lang comprehen (92523) $633 $633
Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (92541) $76 $76 0.6×
Standardized cognitive performance testing (96125) $364.50 $364.50
Stenger test pure tone (92565) $44 $44 0.7×
Stenger test speech (92577) $49 $49 0.1×
Stress tte only (93350) $1,544 $1,544 2.8×
Study of upper small bowel to assess movement (91022) $455 $455 1.2×
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $44 $44 0.9×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $531 $531 2.4×
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment… (96371) $254 $254 3.5×
Surfactant administration (94610) $151 $151 0.7×
Tcd emboli detect wo inj (93892) $847 $847 7.9×
Tcd std icr art ven-artl shnt detcj IV mbubb njx (93893) $904 $904 8.5×
Telephone assmt&mgmt svc nqhp est pt 11-20 min (98967) $70 $70
Telephone assmt&mgmt svc nqhp est pt 5-10 min (98966) $36 $36
Temp transcutaneous pacing (92953) $31 $31 0.0×
Test for ability to detect and repeat spoken words with speech recognition (92556) $96 $96 1.6×
Test for abnormal eye movement using a moving target that moves back and forth with recording (92545) $53 $53 0.2×
Test for abnormal eye movement using a rotating chair (92546) $267 $267 2.0×
Test for allergy using allergenic extract by sniffing (95065) $69 $69 1.8×
Test for allergy using ultraviolet light (95056) $118 $118 0.9×
Test for hearing various pitches using earphone (92552) $85.50 $85.50 0.6×
Test for hearing various pitches using earphone and device placed against the bone (92553) $98 $98 0.7×
Test to assess by hearing by examining the repetition of real words versus nonsense words (92571) $72 $72 1.9×
Test to assess defects in adaption to sounds (92563) $83 $83 2.2×
Test to assess hearing loss using different tone pitches (92575) $198 $198 5.2×
Test to assess hearing loss using grammatically incorrect sentences (92576) $90 $90 2.4×
Test to assess hearing using 2 syllable words (92572) $138 $138 1.0×
Test to assess middle ear muscle reflex (92568) $38 $38 1.0×
Test to measure exhaled air for evaluation of lung function during rest and exercise (94680) $154 $154 1.2×
Test to measure resistance of the airways and lungs to differing frequencies (94728) $115 $115 0.9×
Testing autonomic nervous system function (95923) $424 $424 3.1×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $94.50 $94.50
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $95.50 $95.50
Ther/proph/diag inj ia (96373) $50 $50 0.2×
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $120 $120
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $197 $197
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $114 $114
Therapeutic prophylactic/dx injection subq/im (96372) $75 $75 1.0×
Therapeutic service(s) for the use of non-speech-generating device, including programming and modification (92606) $255 $255
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $282 $282
Tilt table evaluation (93660) $392 $392 1.0×
Tinnitus assessment (92625) $173 $173 1.3×
Tobacco use cessation intensive >10 minutes (99407) $68 $68 1.8×
Tobacco use cessation intermediate 3-10 minutes (99406) $42.50 $42.50 1.1×
Trans care mgmt 14 day disch (99495) $413 $413 3.0×
Trans care mgmt 7 day disch (99496) $582 $582 4.3×
Transcath closure of asd (93580)
likely a partial charge — not the full procedure
$2,536 $2,536 0.1×
Transcranial doppler stdy intracranial art compl (93886) $953 $953 3.9×
Transcranial Doppler study of the intracranial arteries; limited study Age Under 21 (93888) $876.50 $876.50 8.2×
Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition,… (93315) $720 $720 1.3×
Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only Age Under 21 (93316) $106 $106 0.2×
Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes… (93293) $133 $133 3.5×
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $470 $470 0.8×
Treatment of inflammatory skin disease using laser, 250.0-500.0 sq cm (96921) $437 $437 2.1×
Treatment of inflammatory skin disease using laser, more than 500.0 sq cm (96922) $606 $606 1.5×
Tstg ans funcj parasymp&symp w/5 min pasive tilt (95924) $371 $371 1.7×
Tte congenital complete (93303) $720 $720 1.3×
Tte f-up or lmtd (93308) $657.50 $657.50 2.7×
Tte w/doppler complete (93306) $527.50 $527.50 0.9×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $269 $269
Tx speech language voice commj auditry 2/>indiv (92508) $142 $142
Tympanometry (92567) $45 $45 1.2×
Ultraviolet therapy (97028) $19 $19
Unlisted allergy/clinical immunologic service or procedure (95199) $25 $25 0.8×
Unlisted modality (specify type and time if constant attendance) (97039) $115 $115
Upr/l xtremity art 2 levels (93922) $665.50 $665.50 4.9×
Valvuloplasty aortic valve (92986) $3,444 $3,444 0.6×
Ventilation ip/obs initial day (94002) $290 $290 0.5×
Ventilator subsequent day (94003) $210 $210 0.3×
Visual ep testing cns except glaucoma w/i&r (95930) $411 $411 1.9×
Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann… (92083) $168 $168 1.2×
Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at… (92082) $127 $127 2.1×
Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent… (92081) $88 $88 1.5×
Visual reinforcement audiometry (vra) (92579) $120 $120 0.5×
Vital capacity total (94150) $143 $143 1.1×
Wada activation test (95958) $1,472 $1,472 1.7×
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $145 $145
Wound(s) care non-selective (97602) $231.50 $231.50 1.1×