NJ PIP Fee Schedule Exhibit 1: Physicians' and ASC Facility Fees
Exhibit 1 is the largest of the seven New Jersey PIP fee schedules. Its 2,910 rows carry a physicians' fee and an ambulatory surgery center facility fee for each code, priced separately for North and South New Jersey. Every amount below is reproduced from the Department of Banking and Insurance file, effective for treatment on or after January 4, 2013.
The schedule001
Exhibit 1 in full, all 2,910 rows
How to read this table
- Mod
- Blank is the global service. TC is the technical component, 26 the professional component, under 11:3-29.4(l).
- Physicians' North, South
- The physician's own fee, chosen by the region where the service was rendered (11:3-29.3, 29.4(b)).
- ASC North, South
- The facility fee an ambulatory surgery center may be paid for the same code. It is separate money from the physician's fee, not an alternative to it.
- not listed
- In a physicians' column: no fee is published, and the service is still reimbursable. 11:3-29.4(e) prices it and FAQ Answer 5 says so outright. 1,828 rows are in this state.
- not payable in ASC
- In an ASC column: no facility fee is published, so the facility fee is not reimbursable when the service is done in an ASC (11:3-29.5(a), 29.4(e)3). It does not touch the physician's fee for the same code.
- packaged
- An ASC column with payment indicator N1. The service may be performed in an ASC, but its facility fee is paid inside another procedure instead of on its own line.
- X
- Payment indicator: this ASC code is not subject to the multiple procedure reduction.
Anesthesia base units, Category III and HCPCS codes
4 rows| Code | Mod | Description | Physicians’ North | Physicians’ South | ASC North | ASC South | Ind. |
|---|---|---|---|---|---|---|---|
| ANES | ANESTHESIA BASE UNITS | $86.47 | $84.36 | not payable in ASC | not payable in ASC | ||
| 0232T | NJX PLATELET PLASMA | $63.95 | $63.95 | $89.55 | $82.44 | X | |
| G0283 | ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, | $20.14 | $19.26 | not payable in ASC | not payable in ASC | ||
| G0289 | ARTHRO, LOOSE BODY + CHONDRO | $483.50 | $467.07 | packaged | packaged | X, N1 |
Surgery, CPT 10000 to 69999
894 rows| Code | Mod | Description | Physicians’ North | Physicians’ South | ASC North | ASC South | Ind. |
|---|---|---|---|---|---|---|---|
| 10060 | DRAIN SKIN ABSCESS | $176.46 | $168.00 | $198.84 | $183.03 | ||
| 10061 | DRAIN SKIN ABSCESS | $290.74 | $278.25 | $198.84 | $183.03 | ||
| 10120 | REMOVE FOREIGN BODY | $219.66 | $208.52 | $297.15 | $273.51 | ||
| 10121 | REMOVE FOREIGN BODY | $423.57 | $403.23 | $2,411.70 | $2,219.85 | ||
| 10140 | DRAIN HEMATOMA/FLUID | $250.71 | $238.43 | $321.75 | $296.13 | ||
| 10160 | PUNCTURE DRAIN LESION | $203.36 | $193.31 | $198.84 | $183.03 | ||
| 10180 | COMPLEX DRAIN WOUND | $381.01 | $362.70 | $2,694.69 | $2,480.34 | ||
| 11000 | DEBRIDE INFECTED SKIN | $84.28 | $80.26 | $102.96 | $94.77 | ||
| 11001 | DEBRIDE INFECTED SKIN, ADDED | $33.67 | $32.24 | $33.93 | $31.23 | ||
| 11010 | DEBRIDE SKIN, FX | $770.97 | $732.08 | $678.84 | $624.84 | ||
| 11011 | DEBRIDE SKIN/MUSCLE, FX | $842.60 | $801.49 | $678.84 | $624.84 | ||
| 11012 | DEBRIDE SKIN/MUSCLE/BONE, FX | $1,128.89 | $1,074.42 | $678.84 | $624.84 | ||
| 11042 | DEBRIDE SKIN/TISSUE | $141.88 | $134.65 | $364.44 | $335.43 | ||
| 11043 | DEBRIDE TISSUE/MUSCLE | $309.64 | $294.89 | $364.44 | $335.43 | ||
| 11044 | DEBRIDE TISSUE/MUSCLE/BONE | $467.58 | $447.17 | $1,132.98 | $1,042.83 | ||
| 11045 | DEBRIDE SUBQ TISSUE ADD-ON | $50.08 | $47.78 | $364.44 | $335.43 | ||
| 11046 | DEBRIDE MUSCLE/FASCIA ADD-ON | $86.02 | $82.37 | $364.44 | $335.43 | ||
| 11047 | DEBRIDE BONE ADD-ON | $141.04 | $135.27 | $1,132.98 | $1,042.83 | ||
| 11055 | TRIM SKIN LESION | $78.70 | $74.56 | $111.15 | $102.30 | ||
| 11056 | TRIM SKIN LESIONS, 2 TO 4 | $93.59 | $88.93 | $121.44 | $111.78 | ||
| 11057 | TRIM SKIN LESIONS, OVER 4 | $110.23 | $104.93 | $121.44 | $111.78 | ||
| 11100 | BIOPSY SKIN LESION | $168.53 | $159.57 | $199.77 | $183.90 | ||
| 11101 | BIOPSY SKIN, ADDED | $52.52 | $50.16 | $58.50 | $53.85 | ||
| 11200 | REMOVE SKIN TAGS | $136.42 | $129.65 | $121.44 | $111.78 | ||
| 11300 | SHAVE SKIN LESION | $111.63 | $105.61 | $121.44 | $111.78 | ||
| 11301 | SHAVE SKIN LESION | $150.18 | $142.55 | $121.44 | $111.78 | ||
| 11302 | SHAVE SKIN LESION | $179.35 | $170.36 | $121.44 | $111.78 | ||
| 11305 | SHAVE SKIN LESION | $110.55 | $104.93 | $121.44 | $111.78 | ||
| 11306 | SHAVE SKIN LESION | $152.62 | $145.18 | $121.44 | $111.78 | ||
| 11310 | SHAVE SKIN LESION | $137.16 | $130.09 | $121.44 | $111.78 | ||
| 11311 | SHAVE SKIN LESION | $171.78 | $163.30 | $121.44 | $111.78 | ||
| 11400 | EXCISE TRT-EXT BENIGN+MARG 0.5 < CM | $192.83 | $182.50 | $283.11 | $260.58 | ||
| 11401 | EXCISE TRT-EXT BENIGN+MARG 0.6-1 CM | $234.32 | $222.41 | $319.41 | $294.00 | ||
| 11402 | EXCISE TRT-EXT BENIGN+MARG 1.1-2 CM | $260.75 | $247.62 | $350.97 | $323.04 | ||
| 11403 | EXCISE TRT-EXT BENIGN+MARG 2.1-3 CM | $298.16 | $283.70 | $379.02 | $348.87 | ||
| 11404 | EXCISE TRT-EXT BENIGN+MARG 3.1-4 CM | $338.86 | $322.54 | $2,411.70 | $2,219.85 | ||
| 11406 | EXCISE TRT-EXT BENIGN+MARG > 4.0 CM | $478.41 | $457.22 | $2,411.70 | $2,219.85 | ||
| 11420 | EXCISE H-F-NECK-SP BENIGN+MARG 0.5 < | $191.28 | $181.36 | $266.76 | $245.52 | ||
| 11421 | EXCISE H-F-NECK-SP BENIGN+MARG 0.6-1 | $247.34 | $235.08 | $324.03 | $298.26 | ||
| 11422 | EXCISE H-F-NECK-SP BENIGN+MARG 1.1-2 | $275.21 | $261.73 | $354.48 | $326.28 | ||
| 11423 | EXCISE H-F-NECK-SP BENIGN+MARG 2.1-3 | $317.92 | $302.76 | $394.26 | $362.88 | ||
| 11424 | EXCISE H-F-NECK-SP BENIGN+MARG 3.1-4 | $364.37 | $347.38 | $2,411.70 | $2,219.85 | ||
| 11426 | EXCISE H-F-NECK-SP BENIGN+MARG > 4 CM | $516.41 | $494.20 | $3,188.13 | $2,934.54 | ||
| 11440 | EXCISE FACE-MM BENIGN+MARG 0.5 < CM | $211.84 | $200.73 | $301.83 | $277.83 | ||
| 11441 | EXCISE FACE-MM BENIGN+MARG 0.6-1 CM | $264.80 | $251.60 | $350.97 | $323.04 | ||
| 11442 | EXCISE FACE-MM BENIGN+MARG 1.1-2 CM | $298.23 | $283.53 | $388.41 | $357.51 | ||
| 11443 | EXCISE FACE-MM BENIGN+MARG 2.1-3 CM | $353.37 | $336.68 | $431.67 | $397.35 | ||
| 11444 | EXCISE FACE-MM BENIGN+MARG 3.1-4 CM | $442.21 | $422.12 | $1,132.98 | $1,042.83 | ||
| 11719 | TRIM NAIL(S) | $34.77 | $32.88 | $51.48 | $47.37 | ||
| 11720 | DEBRIDE NAIL, 1-5 | $49.82 | $47.36 | $64.35 | $59.25 | ||
| 11721 | DEBRIDE NAIL, 6 OR MORE | $67.33 | $64.26 | $76.02 | $69.99 | ||
| 11730 | REMOVE NAIL PLATE | $151.98 | $144.74 | $121.44 | $111.78 | ||
| 11732 | REMOVE NAIL PLATE, ADDED | $68.85 | $65.77 | $76.02 | $69.99 | ||
| 11740 | DRAIN BLOOD UNDER NAIL | $75.08 | $71.04 | $57.72 | $53.13 | ||
| 11750 | REMOVE NAIL BED | $343.28 | $327.09 | $411.81 | $379.05 | ||
| 11752 | REMOVE NAIL BED/FINGER TIP | $494.47 | $471.49 | $582.60 | $536.25 | ||
| 11760 | REPAIR NAIL BED | $346.62 | $328.23 | $177.81 | $163.68 | ||
| 11762 | RECONSTRUCT NAIL BED | $429.68 | $409.09 | $531.12 | $488.88 | ||
| 11765 | EXCISE NAIL FOLD, TOE | $223.00 | $209.99 | $121.44 | $111.78 | ||
| 11900 | INJECTION INTO SKIN LESIONS | $90.58 | $86.02 | $121.44 | $111.78 | ||
| 11901 | ADDED SKIN LESIONS INJECTION | $113.27 | $108.02 | $121.44 | $111.78 | ||
| 11950 | THERAPY FOR CONTOUR DEFECTS | $113.05 | $107.85 | $131.01 | $120.60 | ||
| 11951 | THERAPY FOR CONTOUR DEFECTS | $160.21 | $153.19 | $175.47 | $161.52 | ||
| 11960 | INSERT TISSUE EXPANDER(S) | $1,436.90 | $1,374.88 | $2,972.49 | $2,736.03 | ||
| 11981 | INSERT DRUG IMPLANT DEVICE | $216.27 | $206.20 | $89.55 | $82.44 | X | |
| 11982 | REMOVE DRUG IMPLANT DEVICE | $240.23 | $229.28 | $89.55 | $82.44 | X | |
| 12001 | REPAIR SUPERFICIAL WOUND(S) | $156.46 | $148.50 | $177.81 | $163.68 | ||
| 12002 | REPAIR SUPERFICIAL WOUND(S) | $182.44 | $173.64 | $177.81 | $163.68 | ||
| 12004 | REPAIR SUPERFICIAL WOUND(S) | $215.99 | $205.84 | $177.81 | $163.68 | ||
| 12005 | REPAIR SUPERFICIAL WOUND(S) | $277.27 | $264.61 | $177.81 | $163.68 | ||
| 12006 | REPAIR SUPERFICIAL WOUND(S) | $334.76 | $319.54 | $177.81 | $163.68 | ||
| 12011 | REPAIR SUPERFICIAL WOUND(S) | $187.04 | $177.76 | $177.81 | $163.68 | ||
| 12013 | REPAIR SUPERFICIAL WOUND(S) | $200.42 | $190.64 | $177.81 | $163.68 | ||
| 12014 | REPAIR SUPERFICIAL WOUND(S) | $236.44 | $225.30 | $177.81 | $163.68 | ||
| 12015 | REPAIR SUPERFICIAL WOUND(S) | $289.42 | $275.96 | $177.81 | $163.68 | ||
| 12016 | REPAIR SUPERFICIAL WOUND(S) | $360.23 | $344.19 | $177.81 | $163.68 | ||
| 12017 | REPAIR SUPERFICIAL WOUND(S) | $268.51 | $260.21 | $177.81 | $163.68 | ||
| 12018 | REPAIR SUPERFICIAL WOUND(S) | $319.54 | $309.13 | $177.81 | $163.68 | ||
| 12020 | CLOSE SPLIT WOUND | $431.60 | $410.59 | $619.29 | $570.03 | ||
| 12021 | CLOSE SPLIT WOUND | $254.10 | $242.74 | $421.80 | $388.26 | ||
| 12031 | INTERMED WOUND REPAIR S/TRT/EXT | $392.46 | $372.69 | $177.81 | $163.68 | ||
| 12032 | INTERMED WOUND REPAIR S/TRT/EXT | $496.44 | $470.58 | $421.80 | $388.26 | ||
| 12034 | INTERMED WOUND REPAIR S/TRT/EXT | $491.15 | $467.17 | $177.81 | $163.68 | ||
| 12035 | INTERMED WOUND REPAIR S/TRT/EXT | $596.60 | $567.24 | $177.81 | $163.68 | ||
| 12036 | INTERMED WOUND REPAIR S/TRT/EXT | $649.31 | $618.41 | $421.80 | $388.26 | ||
| 12037 | INTERMED WOUND REPAIR S/TRT/EXT | $726.61 | $692.45 | $421.80 | $388.26 | ||
| 12041 | INTERMED WOUND REPAIR N-HF/GENITAL | $408.73 | $388.48 | $177.81 | $163.68 | ||
| 12042 | INTERMED WOUND REPAIR N-HG/GENITAL | $468.02 | $444.84 | $177.81 | $163.68 | ||
| 12044 | INTERMED WOUND REPAIR N-HG/GENITAL | $555.19 | $527.51 | $177.81 | $163.68 | ||
| 12045 | INTERMED WOUND REPAIR N-HG/GENITAL | $592.76 | $564.13 | $421.80 | $388.26 | ||
| 12046 | INTERMED WOUND REPAIR N-HG/GENITAL | $703.34 | $669.51 | $421.80 | $388.26 | ||
| 12047 | INTERMED WOUND REPAIR N-HG/GENITAL | $763.38 | $726.74 | $421.80 | $388.26 | ||
| 12051 | INTERMED WOUND REPAIR FACE/MM | $432.90 | $411.35 | $421.80 | $388.26 | ||
| 12052 | INTERMED WOUND REPAIR FACE/MM | $494.15 | $469.44 | $177.81 | $163.68 | ||
| 12053 | INTERMED WOUND REPAIR FACE/MM | $545.55 | $518.41 | $177.81 | $163.68 | ||
| 12054 | INTERMED WOUND REPAIR FACE/MM | $577.47 | $549.29 | $177.81 | $163.68 | ||
| 12055 | INTERMED WOUND REPAIR FACE/MM | $691.03 | $658.09 | $421.80 | $388.26 | ||
| 12056 | INTERMED WOUND REPAIR FACE/MM | $826.26 | $786.00 | $421.80 | $388.26 | ||
| 12057 | INTERMED WOUND REPAIR FACE/MM | $942.59 | $896.60 | $421.80 | $388.26 | ||
| 13100 | REPAIR WOUND OR LESION | $503.63 | $479.30 | $619.29 | $570.03 | ||
| 13101 | REPAIR WOUND OR LESION | $640.87 | $609.63 | $619.29 | $570.03 | ||
| 13102 | REPAIR WOUND/LESION, ADDED | $172.70 | $164.94 | $619.29 | $570.03 | ||
| 13120 | REPAIR WOUND OR LESION | $523.71 | $498.53 | $421.80 | $388.26 | ||
| 13121 | REPAIR WOUND OR LESION | $714.49 | $679.65 | $421.80 | $388.26 | ||
| 13122 | REPAIR WOUND/LESION, ADDED | $190.24 | $181.88 | $177.81 | $163.68 | ||
| 13131 | REPAIR WOUND OR LESION | $577.33 | $549.97 | $421.80 | $388.26 | ||
| 13132 | REPAIR WOUND OR LESION | $932.23 | $889.11 | $619.29 | $570.03 | ||
| 13133 | REPAIR WOUND/LESION, ADDED | $267.99 | $256.52 | $421.80 | $388.26 | ||
| 13150 | REPAIR WOUND OR LESION | $573.56 | $546.58 | $619.29 | $570.03 | ||
| 13151 | REPAIR WOUND OR LESION | $652.83 | $622.29 | $619.29 | $570.03 | ||
| 13152 | REPAIR WOUND OR LESION | $901.38 | $859.71 | $619.29 | $570.03 | ||
| 13153 | REPAIR WOUND/LESION, ADDED | $294.26 | $281.64 | $421.80 | $388.26 | ||
| 13160 | LATE CLOSE WOUND | $1,274.88 | $1,226.45 | $2,972.49 | $2,736.03 | ||
| 14000 | SKIN TISSUE REARRANGEMENT | $1,001.58 | $953.82 | $2,296.11 | $2,113.44 | ||
| 14001 | SKIN TISSUE REARRANGEMENT | $1,289.02 | $1,229.26 | $2,296.11 | $2,113.44 | ||
| 14020 | SKIN TISSUE REARRANGEMENT | $1,124.57 | $1,070.90 | $2,296.11 | $2,113.44 | ||
| 14021 | SKIN TISSUE REARRANGEMENT | $1,408.28 | $1,342.85 | $2,296.11 | $2,113.44 | ||
| 14040 | SKIN TISSUE REARRANGEMENT | $1,235.25 | $1,177.91 | $2,296.11 | $2,113.44 | ||
| 14041 | SKIN TISSUE REARRANGEMENT | $1,529.97 | $1,459.32 | $2,296.11 | $2,113.44 | ||
| 14060 | SKIN TISSUE REARRANGEMENT | $1,251.46 | $1,194.92 | $2,296.11 | $2,113.44 | ||
| 14061 | SKIN TISSUE REARRANGEMENT | $1,643.34 | $1,566.97 | $2,296.11 | $2,113.44 | ||
| 14301 | SKIN TISSUE REARRANGEMENT | $1,770.48 | $1,689.95 | $2,972.49 | $2,736.03 | ||
| 14302 | SKIN TISSUE REARRANGE ADDED | $369.95 | $356.41 | $2,972.49 | $2,736.03 | ||
| 15002 | WOUND PREP, TRUNK/ARM/LEG | $538.12 | $513.17 | $619.29 | $570.03 | ||
| 15003 | WOUND PREP, ADDED 100 CM | $117.04 | $111.70 | $619.29 | $570.03 | ||
| 15004 | WOUND PREP, F/N/HF/G | $631.19 | $602.33 | $619.29 | $570.03 | ||
| 15005 | WOUND PREP, F/N/HF/G, ADDED CM | $191.65 | $183.76 | $619.29 | $570.03 | ||
| 15050 | SKIN PINCH GRAFT | $898.35 | $854.77 | $619.29 | $570.03 | ||
| 15100 | SKIN SPLIT GRAFT, TRUNK/ARM/LEG | $1,374.74 | $1,313.41 | $2,972.49 | $2,736.03 | ||
| 15101 | SKIN SPLIT GRAFT T/A/L, ADDED | $300.62 | $285.81 | $2,972.49 | $2,736.03 | ||
| 15120 | SKIN SPLIT A-GRAFT FAC/NECK/HF/G | $1,518.58 | $1,450.58 | $2,972.49 | $2,736.03 | ||
| 15121 | SKIN SPLIT A-GRAFT F/N/HF/G ADDED | $428.19 | $407.69 | $2,972.49 | $2,736.03 | ||
| 15130 | DERM AUTOGRAFT, TRUNK/ARM/LEG | $1,077.48 | $1,028.66 | $2,296.11 | $2,113.44 | ||
| 15170 | ACELLULAR GRAFT TRUNK/ARMS/LEGS | $684.41 | $656.88 | $619.29 | $570.03 | ||
| 15171 | ACELLULAR GRAFT T/ARM/LEG, ADDED | $147.18 | $142.17 | $421.80 | $388.26 | ||
| 15175 | ACELLULAR GRAFT, F/N/HF/G | $810.60 | $779.34 | $619.29 | $570.03 | ||
| 15220 | SKIN FULL GRAFT SCALP/ARM/LEG | $1,237.46 | $1,178.97 | $2,296.11 | $2,113.44 | ||
| 15221 | SKIN FULL GRAFT, ADDED | $222.58 | $211.34 | $619.29 | $570.03 | ||
| 15240 | SKIN FULL GRAFT FACE/GENITAL/HF | $1,491.27 | $1,422.47 | $2,296.11 | $2,113.44 | ||
| 15241 | SKIN FULL GRAFT, ADDED | $297.89 | $283.58 | $619.29 | $570.03 | ||
| 15260 | SKIN FULL GRAFT EEN & LIPS | $1,614.97 | $1,541.12 | $2,296.11 | $2,113.44 | ||
| 15330 | APPLY ACELLULAR ALLOGRAFT T/ARM/LEG | $513.93 | $491.81 | $619.29 | $570.03 | ||
| 15331 | APPLY ACELLULAR GRAFT T/A/L, ADDED | $100.16 | $96.58 | $619.29 | $570.03 | ||
| 15340 | APPLY CULT SKIN SUBSTITUTE | $497.48 | $475.21 | $421.80 | $388.26 | ||
| 15341 | APPLY CULT SKIN SUB, ADDED | $75.02 | $71.44 | $421.80 | $388.26 | ||
| 15365 | APPLY CULT DERM SUB F/N/HF/G | $542.33 | $517.83 | $421.80 | $388.26 | ||
| 15366 | APPLY CULT DERM F/HF/G ADDED | $126.15 | $121.79 | $421.80 | $388.26 | ||
| 15430 | APPLY ACELLULAR XENOGRAFT | $861.84 | $822.78 | $619.29 | $570.03 | ||
| 15431 | APPLY ACELLULAR XENOGRAFT ADDED | $328.03 | $316.57 | $619.29 | $570.03 | ||
| 15570 | FORM SKIN PEDICLE FLAP | $1,424.66 | $1,361.15 | $2,972.49 | $2,736.03 | ||
| 15572 | FORM SKIN PEDICLE FLAP | $1,388.47 | $1,326.28 | $2,972.49 | $2,736.03 | ||
| 15574 | FORM SKIN PEDICLE FLAP | $1,451.66 | $1,386.66 | $2,972.49 | $2,736.03 | ||
| 15576 | FORM SKIN PEDICLE FLAP | $1,291.01 | $1,232.56 | $2,972.49 | $2,736.03 | ||
| 15620 | SKIN GRAFT | $709.40 | $673.04 | $2,972.49 | $2,736.03 | ||
| 15732 | MUSCLE-SKIN GRAFT, HEAD/NECK | $2,390.54 | $2,290.95 | $2,972.49 | $2,736.03 | ||
| 15734 | MUSCLE-SKIN GRAFT, TRUNK | $2,429.96 | $2,329.20 | $2,972.49 | $2,736.03 | ||
| 15736 | MUSCLE-SKIN GRAFT, ARM | $2,142.30 | $2,051.77 | $2,972.49 | $2,736.03 | ||
| 15738 | MUSCLE-SKIN GRAFT, LEG | $2,272.44 | $2,179.61 | $2,972.49 | $2,736.03 | ||
| 15756 | FREE MYO/SKIN FLAP MICROVASC | $3,749.52 | $3,610.13 | not payable in ASC | not payable in ASC | ||
| 15770 | DERMA-FAT-FASCIA GRAFT | $1,066.42 | $1,022.37 | $2,972.49 | $2,736.03 | ||
| 15780 | ABRASION TREAT SKIN | $1,322.37 | $1,259.08 | $1,641.36 | $1,510.80 | ||
| 15781 | ABRASION TREAT SKIN | $879.47 | $835.31 | $678.84 | $624.84 | ||
| 15782 | ABRASION TREAT SKIN | $900.92 | $853.46 | $678.84 | $624.84 | ||
| 15786 | ABRASION, LESION, SING | $391.74 | $371.66 | $121.44 | $111.78 | ||
| 15787 | ABRASION, LESIONS, ADDED | $78.22 | $73.91 | $119.34 | $109.86 | ||
| 15823 | REVISE UPPER EYELID | $979.35 | $934.65 | $2,972.49 | $2,736.03 | ||
| 15830 | EXCISE SKIN ABD | $979.35 | $934.65 | $3,188.13 | $2,934.54 | ||
| 15832 | EXCISE EXCESSIVE SKIN TISSUE | $979.35 | $934.65 | $3,188.13 | $2,934.54 | ||
| 15851 | REMOVE SUTURES | $152.95 | $145.19 | $207.09 | $190.59 | ||
| 15852 | DRESSING CHANGE NOT FOR BURN | $73.04 | $70.73 | $89.55 | $82.44 | X | |
| 15940 | REMOVE HIP PRESSURE SORE | $1,088.76 | $1,047.78 | $3,188.13 | $2,934.54 | ||
| 15941 | REMOVE HIP PRESSURE SORE | $1,419.04 | $1,362.70 | $3,188.13 | $2,934.54 | ||
| 15944 | REMOVE HIP PRESSURE SORE | $1,410.54 | $1,354.92 | $2,972.49 | $2,736.03 | ||
| 15945 | REMOVE HIP PRESSURE SORE | $1,566.36 | $1,504.31 | $2,972.49 | $2,736.03 | ||
| 15946 | REMOVE HIP PRESSURE SORE | $2,593.22 | $2,494.79 | $2,972.49 | $2,736.03 | ||
| 15950 | REMOVE THIGH PRESSURE SORE | $898.37 | $863.19 | $3,188.13 | $2,934.54 | ||
| 15951 | REMOVE THIGH PRESSURE SORE | $1,357.84 | $1,302.86 | $3,188.13 | $2,934.54 | ||
| 15952 | REMOVE THIGH PRESSURE SORE | $1,316.96 | $1,267.76 | $2,296.11 | $2,113.44 | ||
| 15953 | REMOVE THIGH PRESSURE SORE | $1,445.87 | $1,391.23 | $2,296.11 | $2,113.44 | ||
| 15956 | REMOVE THIGH PRESSURE SORE | $1,823.53 | $1,754.01 | $2,296.11 | $2,113.44 | ||
| 15958 | REMOVE THIGH PRESSURE SORE | $1,864.20 | $1,791.74 | $2,296.11 | $2,113.44 | ||
| 16000 | INITIAL TREAT BURN(S) | $107.89 | $103.23 | $113.49 | $104.46 | ||
| 16020 | DRESS/DEBRIDE P-THICK BURN, S | $132.50 | $125.94 | $173.16 | $159.39 | ||
| 16025 | DRESS/DEBRIDE P-THICK BURN, M | $234.02 | $223.91 | $199.77 | $183.90 | ||
| 16030 | DRESS/DEBRIDE P-THICK BURN, L | $282.60 | $269.99 | $199.77 | $183.90 | ||
| 17000 | DESTROY PREMALIG LESION | $130.90 | $123.98 | $121.44 | $111.78 | ||
| 17003 | DESTROY PREMALIG LES, 2-14 | $11.64 | $11.07 | $15.21 | $14.01 | ||
| 17004 | DESTROY PREMALIG LESIONS 15+ | $279.11 | $265.83 | $343.95 | $316.59 | ||
| 17106 | DESTROY SKIN LESIONS | $550.21 | $524.12 | $364.44 | $335.43 | ||
| 17107 | DESTROY SKIN LESIONS | $713.68 | $679.99 | $364.44 | $335.43 | ||
| 17108 | DESTROY SKIN LESIONS | $1,013.03 | $967.87 | $364.44 | $335.43 | ||
| 17110 | DESTROY B9 LESION, 1-14 | $180.01 | $169.92 | $121.44 | $111.78 | ||
| 17111 | DSTRJ B9 SK TGS/CUTAN VASC 15/> | $213.26 | $201.74 | $199.77 | $183.90 | ||
| 17250 | CHEM CAUT GRANLTJ TISS PROUD FLESH SINUS/FSTL | $123.93 | $117.07 | $190.68 | $175.53 | ||
| 17261 | DESTROY SKIN LESIONS | $232.56 | $220.55 | $199.77 | $183.90 | ||
| 17262 | DESTROY SKIN LESIONS | $281.00 | $266.92 | $199.77 | $183.90 | ||
| 19000 | DRAIN BREAST LESION | $179.37 | $169.75 | $263.25 | $242.31 | ||
| 19120 | REMOVE BREAST LESION | $750.90 | $719.29 | $3,413.91 | $3,142.35 | ||
| 19125 | EXCISE BREAST LESION | $832.58 | $797.97 | $3,413.91 | $3,142.35 | ||
| 19290 | PLACE NEEDLE WIRE, BREAST | $262.84 | $248.72 | packaged | packaged | X, N1 | |
| 20100 | EXPLORE WOUND, NECK | $927.38 | $897.30 | not payable in ASC | not payable in ASC | ||
| 20101 | EXPLORE WOUND, CHEST | $648.74 | $615.47 | not payable in ASC | not payable in ASC | ||
| 20102 | EXPLORE WOUND, ABDOMEN | $764.14 | $725.33 | not payable in ASC | not payable in ASC | ||
| 20103 | EXPLORE WOUND, EXTREMITY | $914.65 | $869.73 | $1,735.95 | $1,597.86 | ||
| 20520 | REMOVE FOREIGN BODY | $311.74 | $296.49 | $401.28 | $369.36 | ||
| 20525 | REMOVE FOREIGN BODY | $763.77 | $723.36 | $3,188.13 | $2,934.54 | ||
| 20526 | THERAPEUTIC INJECTION, CARP TUNNEL | $118.45 | $113.27 | $127.50 | $117.36 | ||
| 20550 | INJECT TENDON SHEATH/LIGAMENT | $89.97 | $86.03 | $95.94 | $88.29 | ||
| 20551 | INJECT TENDON ORIGIN/INSERT | $91.72 | $87.67 | $99.45 | $91.53 | ||
| 20552 | INJECT TRIGGER POINT, 1/2 MUSCLE | $129.69 | $123.83 | $94.77 | $87.21 | ||
| 20553 | INJECT TRIGGER POINTS, =/> 3 | $256.49 | $244.86 | $107.64 | $99.06 | ||
| 20600 | DRAIN/INJ, JOINT/BURSA | $85.46 | $81.58 | $97.11 | $89.37 | ||
| 20605 | DRAIN/INJ, JOINT/BURSA | $93.41 | $89.07 | $109.98 | $101.22 | ||
| 20610 | DRAIN/INJ, JOINT/BURSA | $168.19 | $160.06 | $157.95 | $145.38 | ||
| 20612 | ASPIRATE/INJECT GANGLION CYST | $92.67 | $88.43 | $106.47 | $98.01 | ||
| 20615 | TREAT BONE CYST | $347.60 | $330.96 | $430.50 | $396.27 | ||
| 20650 | INSERT & REMOVE BONE PIN | $313.04 | $298.60 | $3,064.83 | $2,821.05 | ||
| 20662 | APPLY PELVIS BRACE | $680.98 | $652.96 | $3,064.83 | $2,821.05 | ||
| 20663 | APPLY THIGH BRACE | $724.98 | $694.28 | $3,064.83 | $2,821.05 | ||
| 20665 | REMOVE FIXATION DEVICE | not listed | not listed | $89.55 | $82.44 | X | |
| 20670 | REMOVE SUPPORT IMPLANT | not listed | not listed | $2,411.70 | $2,219.85 | ||
| 20680 | REMOVE SUPPORT IMPLANT | $976.54 | $929.22 | $3,188.13 | $2,934.54 | ||
| 20690 | APPLY BONE FIXATION DEVICE | $2,428.13 | $2,338.02 | $4,301.40 | $3,959.25 | ||
| 20692 | APPLY BONE FIXATION DEVICE | $4,571.37 | $4,397.67 | $4,301.40 | $3,959.25 | ||
| 20693 | ADJUST BONE FIXATION DEVICE | $1,941.73 | $1,861.31 | $3,064.83 | $2,821.05 | ||
| 20694 | REMOVE BONE FIXATION DEVICE | $1,824.61 | $1,737.34 | $3,064.83 | $2,821.05 | ||
| 20696 | COMP MULTIPLANE EXT FIXATION | $4,555.72 | $4,376.97 | $4,301.40 | $3,959.25 | ||
| 20697 | COMP EXT FIXATE STRUT CHANGE | $7,725.55 | $7,206.79 | $2,779.53 | $2,558.43 | ||
| 20900 | REMOVE BONE FOR GRAFT | $673.98 | $637.99 | $4,301.40 | $3,959.25 | ||
| 20902 | REMOVE BONE FOR GRAFT | $519.31 | $498.66 | $4,301.40 | $3,959.25 | ||
| 20910 | REMOVE CARTILAGE FOR GRAFT | $1,037.67 | $992.57 | $2,972.49 | $2,736.03 | ||
| 20912 | REMOVE CARTILAGE FOR GRAFT | $1,198.06 | $1,147.49 | $2,972.49 | $2,736.03 | ||
| 20920 | REMOVE FASCIA FOR GRAFT | $985.25 | $943.49 | $2,296.11 | $2,113.44 | ||
| 20922 | REMOVE FASCIA FOR GRAFT | $1,471.19 | $1,405.30 | $2,296.11 | $2,113.44 | ||
| 20924 | REMOVE TENDON FOR GRAFT | $800.25 | $767.01 | $4,301.40 | $3,959.25 | ||
| 20926 | REMOVE TISSUE FOR GRAFT | $692.39 | $664.11 | $619.29 | $570.03 | ||
| 20931 | SP BONE ALLOGRAFT STRUCT, ADDED | $480.89 | $465.78 | not payable in ASC | not payable in ASC | ||
| 20950 | FLUID PRESSURE, MUSCLE | $1,090.10 | $1,027.35 | $198.84 | $183.03 | ||
| 20955 | FIBULA BONE GRAFT, MICROVASC | $10,896.00 | $10,491.67 | not payable in ASC | not payable in ASC | ||
| 20974 | ELECTRICAL BONE STIMULATION | $388.51 | $369.13 | not payable in ASC | not payable in ASC | ||
| 20975 | ELECTRICAL BONE STIMULATION | $968.04 | $932.18 | packaged | packaged | X, N1 | |
| 20979 | US BONE STIMULATION | $288.61 | $275.42 | $89.55 | $82.44 | X | |
| 20985 | COMPUTER-ASSIST DIR MS PX | $233.28 | $225.44 | packaged | packaged | X, N1 | |
| 21060 | REMOVE JAW JOINT CARTILAGE | $1,303.59 | $1,251.23 | $5,961.75 | $5,487.51 | ||
| 21070 | REMOVE CORONOID PROCESS | $2,683.05 | $2,569.88 | $5,961.75 | $5,487.51 | ||
| 21073 | MANIPULATE TMJ W/ANESTH | $625.03 | $593.86 | $832.95 | $766.71 | ||
| 21085 | PREPARE FACE/ORAL PROSTHESIS | $1,453.19 | $1,375.54 | $1,265.82 | $1,165.11 | ||
| 21110 | INTERDENTAL FIXATION | $1,453.19 | $1,375.54 | $1,056.45 | $972.42 | ||
| 21116 | INJECTION, JAW JOINT X-RAY | $242.27 | $228.15 | packaged | packaged | X, N1 | |
| 21209 | REDUCE FACIAL BONES | $1,356.76 | $1,290.12 | $5,961.75 | $5,487.51 | ||
| 21210 | FACE BONE GRAFT | $3,584.38 | $3,377.47 | $5,961.75 | $5,487.51 | ||
| 21240 | RECONSTRUCT JAW JOINT | $3,361.24 | $3,224.68 | $5,961.75 | $5,487.51 | ||
| 21242 | RECONSTRUCT JAW JOINT | $3,085.47 | $2,959.40 | $5,961.75 | $5,487.51 | ||
| 21243 | RECONSTRUCT JAW JOINT | $5,070.37 | $4,866.28 | $5,961.75 | $5,487.51 | ||
| 21244 | RECONSTRUCT LOWER JAW | $1,701.06 | $1,626.83 | $5,961.75 | $5,487.51 | ||
| 21245 | RECONSTRUCT JAW | $1,819.98 | $1,735.61 | $5,961.75 | $5,487.51 | ||
| 21246 | RECONSTRUCT JAW | $1,327.80 | $1,275.95 | $5,961.75 | $5,487.51 | ||
| 21247 | RECONSTRUCT LOWER JAW BONE | $2,579.70 | $2,482.80 | $5,961.75 | $5,487.51 | ||
| 21248 | RECONSTRUCT JAW | $1,730.48 | $1,651.07 | $5,961.75 | $5,487.51 | ||
| 21249 | RECONSTRUCT JAW | $2,370.58 | $2,265.59 | $5,961.75 | $5,487.51 | ||
| 21310 | TREAT NOSE FX | $185.45 | $174.76 | $151.17 | $139.14 | ||
| 21315 | TREAT NOSE FX | $443.93 | $419.60 | $2,313.03 | $2,129.04 | ||
| 21320 | TREAT NOSE FX | $417.47 | $394.98 | $2,313.03 | $2,129.04 | ||
| 21325 | TREAT NOSE FX | $772.19 | $732.88 | $3,421.41 | $3,149.25 | ||
| 21330 | TREAT NOSE FX | $926.89 | $881.33 | $3,421.41 | $3,149.25 | ||
| 21335 | TREAT NOSE FX | $1,181.49 | $1,128.42 | $3,421.41 | $3,149.25 | ||
| 21356 | TREAT CHEEK BONE FX | $2,159.27 | $2,052.68 | $3,421.41 | $3,149.25 | ||
| 21360 | TREAT CHEEK BONE FX | $2,285.49 | $2,187.85 | $3,421.41 | $3,149.25 | ||
| 21365 | TREAT CHEEK BONE FX | $4,774.53 | $4,590.46 | not payable in ASC | not payable in ASC | ||
| 21366 | TREAT CHEEK BONE FX | $5,417.56 | $5,210.50 | not payable in ASC | not payable in ASC | ||
| 21385 | TREAT EYE SOCKET FX | $3,005.24 | $2,877.79 | not payable in ASC | not payable in ASC | ||
| 21386 | TREAT EYE SOCKET FX | $2,849.94 | $2,739.14 | not payable in ASC | not payable in ASC | ||
| 21390 | TREAT EYE SOCKET FX | $3,399.51 | $3,262.80 | $5,961.75 | $5,487.51 | ||
| 21395 | TREAT EYE SOCKET FX | $4,165.36 | $3,999.96 | not payable in ASC | not payable in ASC | ||
| 21400 | TREAT EYE SOCKET FX | $807.13 | $765.31 | $1,056.45 | $972.42 | ||
| 21401 | TREAT EYE SOCKET FX | $2,088.19 | $1,978.92 | $2,313.03 | $2,129.04 | ||
| 21406 | TREAT EYE SOCKET FX | $2,367.98 | $2,266.67 | $5,961.75 | $5,487.51 | ||
| 21407 | TREAT EYE SOCKET FX | $2,782.80 | $2,670.16 | $5,961.75 | $5,487.51 | ||
| 21408 | TREAT EYE SOCKET FX | $3,870.37 | $3,718.17 | not payable in ASC | not payable in ASC | ||
| 21450 | TREAT LOWER JAW FX | $954.01 | $901.26 | $474.09 | $436.38 | ||
| 21451 | TREAT LOWER JAW FX | $1,231.95 | $1,165.53 | $1,056.45 | $972.42 | ||
| 21452 | TREAT LOWER JAW FX | $969.53 | $911.95 | $2,313.03 | $2,129.04 | ||
| 21453 | TREAT LOWER JAW FX | $1,437.35 | $1,360.70 | $5,961.75 | $5,487.51 | ||
| 21454 | TREAT LOWER JAW FX | $889.43 | $850.92 | $3,421.41 | $3,149.25 | ||
| 21461 | TREAT LOWER JAW FX | $3,370.55 | $3,171.80 | $5,961.75 | $5,487.51 | ||
| 21462 | TREAT LOWER JAW FX | $3,567.33 | $3,359.58 | $5,961.75 | $5,487.51 | ||
| 21465 | TREAT LOWER JAW FX | $1,514.36 | $1,453.74 | $5,961.75 | $5,487.51 | ||
| 21470 | TREAT LOWER JAW FX | $1,919.57 | $1,843.61 | not payable in ASC | not payable in ASC | ||
| 21800 | TREAT RIB FX | $164.26 | $156.32 | $210.60 | $193.83 | ||
| 21820 | TREAT STERNUM FX | $217.62 | $207.24 | $210.60 | $193.83 | ||
| 21825 | TREAT STERNUM FX | $900.11 | $864.97 | not payable in ASC | not payable in ASC | ||
| 22305 | TREAT SPINE PROCESS FX | not listed | not listed | $210.60 | $193.83 | ||
| 22310 | TREAT SPINE FX | not listed | not listed | $734.37 | $675.96 | ||
| 22315 | TREAT SPINE FX | $3,738.68 | $3,578.03 | $2,779.53 | $2,558.43 | ||
| 22505 | MANIPULATE SPINE | $214.24 | $206.29 | $2,074.56 | $1,909.53 | ||
| 22520 | PERCUT VERTEBROPLASTY THORACIC | not listed | not listed | $4,301.40 | $3,959.25 | ||
| 22521 | PERCUT VERTEBROPLASTY LUMBAR | not listed | not listed | $4,301.40 | $3,959.25 | ||
| 22522 | PERCUT VERTEBROPLASTY ADDED | not listed | not listed | $4,301.40 | $3,959.25 | ||
| 22554 | NECK SPINE FUSION | $6,185.12 | $5,961.42 | not payable in ASC | not payable in ASC | ||
| 22585 | ADDED SPINAL FUSION | $1,650.20 | $1,597.95 | not payable in ASC | not payable in ASC | ||
| 22845 | INSERT SPINE FIXATION DEVICE | $4,518.17 | $4,376.06 | not payable in ASC | not payable in ASC | ||
| 22851 | APPLY SPINE PROSTH DEVICE | $2,507.61 | $2,427.54 | not payable in ASC | not payable in ASC | ||
| 23120 | PARTIAL REMOVE COLLAR BONE | $3,521.55 | $3,374.09 | $4,301.40 | $3,959.25 | ||
| 23125 | REMOVE COLLAR BONE | $4,270.68 | $4,099.77 | $4,301.40 | $3,959.25 | ||
| 23130 | REMOVE SHOULDER BONE, PART | $3,681.64 | $3,527.78 | $6,312.78 | $5,810.61 | ||
| 23331 | REMOVE SHOULDER FOREIGN BODY | $3,576.37 | $3,428.03 | $3,188.13 | $2,934.54 | ||
| 23332 | REMOVE SHOULDER FOREIGN BODY | $5,348.95 | $5,138.14 | not payable in ASC | not payable in ASC | ||
| 23350 | INJECTION FOR SHOULDER X-RAY | $245.78 | $232.06 | packaged | packaged | X, N1 | |
| 23405 | TX SHO AREA 1 TDN | $989.02 | $949.25 | $4,301.40 | $3,959.25 | ||
| 23406 | TX SHO AREA MLT TDN THRU SM INC | $1,228.87 | $1,180.78 | $4,301.40 | $3,959.25 | ||
| 23410 | OPEN REPAIR OF ROTATOR CUFF, RECENT | $3,500.51 | $3,361.17 | $6,312.78 | $5,810.61 | ||
| 23412 | OPEN REPAIR OF ROTATOR CUFF, OLD | $3,640.20 | $3,495.88 | $6,312.78 | $5,810.61 | ||
| 23415 | CORACOACROMIAL LIGM RLS +-ACROMP | $1,096.46 | $1,051.70 | $6,312.78 | $5,810.61 | ||
| 23420 | RECONSTRUCTION ROTATOR CUFF, OLD | $4,128.82 | $3,965.45 | $6,312.78 | $5,810.61 | ||
| 23430 | TENODIS LONG TDN BICEPS | $1,169.96 | $1,123.11 | $6,312.78 | $5,810.61 | ||
| 23440 | RESCJ/TRNSPLJ LONG TDN BICEPS | $1,192.02 | $1,145.18 | $6,312.78 | $5,810.61 | ||
| 23470 | RECONSTRUCT SHOULDER JOINT | $5,149.21 | $4,954.04 | not payable in ASC | not payable in ASC | ||
| 23472 | RECONSTRUCT SHOULDER JOINT | $6,369.05 | $6,131.80 | not payable in ASC | not payable in ASC | ||
| 23480 | REVISE COLLAR BONE | $3,481.15 | $3,344.49 | $6,312.78 | $5,810.61 | ||
| 23485 | REVISE COLLAR BONE | $4,080.99 | $3,923.94 | $11,871.09 | $10,926.78 | ||
| 23500 | TREAT CLAVICLE FX | $517.10 | $320.37 | $210.60 | $193.83 | ||
| 23505 | TREAT CLAVICLE FX | $836.78 | $519.25 | $2,779.53 | $2,558.43 | ||
| 23515 | TREAT CLAVICLE FX | $2,182.75 | $2,094.37 | $8,925.39 | $8,215.41 | ||
| 23520 | TREAT CLAVICLE DISLOCATION | $543.64 | $518.10 | $734.37 | $675.96 | ||
| 23525 | TREAT CLAVICLE DISLOCATION | $889.99 | $848.39 | $734.37 | $675.96 | ||
| 23530 | TREAT CLAVICLE DISLOCATION | $1,683.11 | $1,615.14 | $6,420.90 | $5,910.15 | ||
| 23540 | TREAT CLAVICLE DISLOCATION | $526.02 | $501.82 | $210.60 | $193.83 | ||
| 23545 | TREAT CLAVICLE DISLOCATION | $963.58 | $919.00 | $734.37 | $675.96 | ||
| 23550 | TREAT CLAVICLE DISLOCATION | $1,729.78 | $1,659.14 | $6,420.90 | $5,910.15 | ||
| 23552 | TREAT CLAVICLE DISLOCATION | $1,992.63 | $1,911.66 | $6,420.90 | $5,910.15 | ||
| 23570 | TREAT SHOULDER BLADE FX | $550.00 | $524.31 | $210.60 | $193.83 | ||
| 23600 | TREAT HUMERUS FX | $774.56 | $479.33 | $210.60 | $193.83 | ||
| 23605 | TREAT HUMERUS FX | $1,118.44 | $693.94 | $2,779.53 | $2,558.43 | ||
| 23615 | TREAT HUMERUS FX | $3,210.58 | $1,336.23 | $8,925.39 | $8,215.41 | ||
| 23616 | TREAT HUMERUS FX | $4,569.61 | $1,904.53 | $8,925.39 | $8,215.41 | ||
| 23620 | TREAT HUMERUS FX | $640.51 | $609.71 | $210.60 | $193.83 | ||
| 23625 | TREAT HUMERUS FX | $910.15 | $868.61 | $2,779.53 | $2,558.43 | ||
| 23630 | TREAT HUMERUS FX | $2,340.39 | $2,246.76 | $8,925.39 | $8,215.41 | ||
| 23650 | TREAT SHOULDER DISLOCATION | $713.19 | $443.19 | $210.60 | $193.83 | ||
| 23655 | TREAT SHOULDER DISLOCATION | $941.00 | $585.27 | $2,074.56 | $1,909.53 | ||
| 23700 | FIXATE SHOULDER | $470.07 | $338.09 | $2,074.56 | $1,909.53 | ||
| 24220 | INJECTION FOR ELBOW X-RAY | $265.46 | $251.25 | packaged | packaged | X, N1 | |
| 24300 | MANIPULATE ELBOW W/ANESTH | $640.74 | $610.08 | $2,074.56 | $1,909.53 | ||
| 24305 | ARM TENDON LENGTHENING | $912.18 | $874.28 | $4,301.40 | $3,959.25 | ||
| 24340 | REPAIR BICEPS TENDON | $2,601.25 | $2,494.51 | $6,312.78 | $5,810.61 | ||
| 24341 | REPAIR ARM TENDON/MUSCLE | $3,143.66 | $3,012.32 | $6,312.78 | $5,810.61 | ||
| 24342 | REPAIR RUPTURED TENDON | $3,306.76 | $3,175.53 | $6,312.78 | $5,810.61 | ||
| 24343 | REPAIR ELBOW LAT LIGAMENT W/TISS | $2,987.14 | $2,862.45 | $4,301.40 | $3,959.25 | ||
| 24500 | TREAT HUMERUS FX | $549.29 | $522.97 | $210.60 | $193.83 | ||
| 24505 | TREAT HUMERUS FX | $780.56 | $744.97 | $210.60 | $193.83 | ||
| 24515 | TREAT HUMERUS FX | $1,381.32 | $1,326.32 | $8,925.39 | $8,215.41 | ||
| 24516 | TREAT HUMERUS FX | $1,358.43 | $1,305.28 | $8,925.39 | $8,215.41 | ||
| 24530 | TREAT HUMERUS FX | $588.23 | $560.15 | $210.60 | $193.83 | ||
| 24535 | TREAT HUMERUS FX | $965.43 | $922.74 | $734.37 | $675.96 | ||
| 24545 | TREAT HUMERUS FX | $1,456.68 | $1,399.91 | $8,925.39 | $8,215.41 | ||
| 24546 | TREAT HUMERUS FX | $1,648.10 | $1,583.95 | $8,925.39 | $8,215.41 | ||
| 24560 | TREAT HUMERUS FX | $494.20 | $470.24 | $210.60 | $193.83 | ||
| 24565 | TREAT HUMERUS FX | $817.85 | $781.01 | $210.60 | $193.83 | ||
| 24575 | TREAT HUMERUS FX | $1,155.33 | $1,108.02 | $8,925.39 | $8,215.41 | ||
| 24576 | TREAT HUMERUS FX | $524.86 | $499.14 | $210.60 | $193.83 | ||
| 24577 | TREAT HUMERUS FX | $846.15 | $808.13 | $210.60 | $193.83 | ||
| 24579 | TREAT HUMERUS FX | $1,314.50 | $1,261.84 | $8,925.39 | $8,215.41 | ||
| 25000 | INCISE TENDON SHEATH | $547.09 | $521.24 | $3,064.83 | $2,821.05 | ||
| 25001 | INCISE FLEXOR CARPI RADIALIS | $536.36 | $511.94 | $3,064.83 | $2,821.05 | ||
| 25020 | DECOMPRESS FOREARM 1 SPACE | $1,767.91 | $1,684.75 | $4,301.40 | $3,959.25 | ||
| 25023 | DECOMPRESS FOREARM 1 SPACE | $3,363.81 | $3,221.26 | $4,301.40 | $3,959.25 | ||
| 25024 | DECOMPRESS FOREARM 2 SPACES | $2,353.42 | $2,260.29 | $4,301.40 | $3,959.25 | ||
| 25025 | DECOMPRESS FOREARM 2 SPACES | $3,669.10 | $3,530.71 | $4,301.40 | $3,959.25 | ||
| 25118 | EXCISE WRIST TENDON SHEATH | $607.03 | $580.07 | $4,301.40 | $3,959.25 | ||
| 25215 | REMOVE WRIST BONES | $1,898.51 | $1,818.66 | $4,301.40 | $3,959.25 | ||
| 25246 | INJECTION FOR WRIST X-RAY | $268.94 | $254.91 | packaged | packaged | X, N1 | |
| 25259 | MANIPULATE WRIST W/ANESTH | $644.82 | $613.89 | $2,779.53 | $2,558.43 | ||
| 25260 | REPAIR FOREARM TENDON/MUSCLE | $2,008.73 | $1,921.52 | $4,301.40 | $3,959.25 | ||
| 25263 | REPAIR FOREARM TENDON/MUSCLE | $1,999.71 | $1,913.76 | $4,301.40 | $3,959.25 | ||
| 25265 | REPAIR FOREARM TENDON/MUSCLE | $2,368.51 | $2,270.10 | $4,301.40 | $3,959.25 | ||
| 25270 | REPAIR FOREARM TENDON/MUSCLE | $1,592.68 | $1,522.50 | $4,301.40 | $3,959.25 | ||
| 25272 | REPAIR FOREARM TENDON/MUSCLE | $1,784.09 | $1,706.99 | $4,301.40 | $3,959.25 | ||
| 25274 | REPAIR FOREARM TENDON/MUSCLE | $2,130.04 | $2,040.87 | $4,301.40 | $3,959.25 | ||
| 25295 | RELEASE WRIST/FOREARM TENDON | $876.95 | $838.58 | $3,064.83 | $2,821.05 | ||
| 25500 | TREAT FX RADIUS | $413.29 | $393.45 | $210.60 | $193.83 | ||
| 25505 | TREAT FX RADIUS | $781.41 | $745.83 | $734.37 | $675.96 | ||
| 25515 | TREAT FX RADIUS | $1,050.48 | $1,007.25 | $6,420.90 | $5,910.15 | ||
| 25525 | TREAT FX RADIUS | $1,246.06 | $1,195.16 | $6,420.90 | $5,910.15 | ||
| 25526 | TREAT FX RADIUS | $1,533.29 | $1,471.52 | $6,420.90 | $5,910.15 | ||
| 25530 | TREAT FX ULNA | $402.85 | $382.70 | $210.60 | $193.83 | ||
| 25535 | TREAT FX ULNA | $760.01 | $725.62 | $210.60 | $193.83 | ||
| 25545 | TREAT FX ULNA | $981.64 | $940.37 | $6,420.90 | $5,910.15 | ||
| 25560 | TREAT FX RADIUS & ULNA | $808.02 | $769.13 | $210.60 | $193.83 | ||
| 25565 | TREAT FX RADIUS & ULNA | $1,566.66 | $1,496.29 | $734.37 | $675.96 | ||
| 25574 | TREAT FX RADIUS & ULNA | $2,025.40 | $1,942.13 | $8,925.39 | $8,215.41 | ||
| 25575 | TREAT FX RADIUS/ULNA | $2,717.76 | $2,608.67 | $8,925.39 | $8,215.41 | ||
| 25600 | TREAT FX RADIUS/ULNA | $869.76 | $827.89 | $210.60 | $193.83 | ||
| 25605 | TREAT FX RADIUS/ULNA | $1,865.53 | $1,783.62 | $734.37 | $675.96 | ||
| 25606 | TREAT FX DISTAL RADIAL | $2,018.97 | $1,933.22 | $3,542.43 | $3,260.64 | ||
| 25607 | TREAT FX RADIAL EXTRA-ARTICULAR | $2,204.51 | $2,113.59 | $8,925.39 | $8,215.41 | ||
| 25608 | TREAT FX RADIAL INTRA-ARTICULAR | $2,472.05 | $2,371.92 | $8,925.39 | $8,215.41 | ||
| 25609 | TREAT FX RADIAL 3+ FRAG | $3,148.22 | $3,022.40 | $8,925.39 | $8,215.41 | ||
| 25622 | TREAT WRIST BONE FX | $900.97 | $857.05 | $210.60 | $193.83 | ||
| 25624 | TREAT WRIST BONE FX | $1,384.38 | $1,319.72 | $734.37 | $675.96 | ||
| 25628 | TREAT WRIST BONE FX | $2,177.02 | $2,087.90 | $6,420.90 | $5,910.15 | ||
| 25630 | TREAT WRIST BONE FX | $909.36 | $866.26 | $210.60 | $193.83 | ||
| 25635 | TREAT WRIST BONE FX | $1,342.79 | $1,280.29 | $210.60 | $193.83 | ||
| 25645 | TREAT WRIST BONE FX | $1,718.80 | $1,648.07 | $6,420.90 | $5,910.15 | ||
| 25650 | TREAT WRIST BONE FX | $953.03 | $908.21 | $210.60 | $193.83 | ||
| 25652 | TREAT FX ULNAR STYLOID | $1,879.79 | $1,801.28 | $6,420.90 | $5,910.15 | ||
| 25670 | TREAT FX ULNAR STYLOID | $1,831.97 | $1,757.00 | $3,542.43 | $3,260.64 | ||
| 25671 | TREAT FX ULNAR STYLOID | $1,598.39 | $1,529.90 | $3,542.43 | $3,260.64 | ||
| 25676 | TREAT WRIST DISLOCATION | $1,911.46 | $1,832.38 | $3,542.43 | $3,260.64 | ||
| 25680 | TREAT WRIST FX | $1,383.37 | $1,326.99 | $210.60 | $193.83 | ||
| 25685 | TREAT WRIST FX | $2,218.61 | $2,130.23 | $3,542.43 | $3,260.64 | ||
| 26055 | INCISE FINGER TENDON SHEATH | $910.15 | $858.58 | $2,289.75 | $2,107.62 | ||
| 26116 | EXCISE HAND TUMOR DEEP < 1.5 CM | $1,590.71 | $1,523.59 | $2,411.70 | $2,219.85 | ||
| 26140 | REVISE FINGER JOINT, EACH | $1,527.77 | $1,462.59 | $2,289.75 | $2,107.62 | ||
| 26145 | TENDON EXCISE PALM/FINGER | $2,479.64 | $2,374.52 | $2,289.75 | $2,107.62 | ||
| 26340 | MANIPULATE FINGER W/ANESTH | $521.42 | $495.05 | $734.37 | $675.96 | ||
| 26410 | REPAIR HAND TENDON | $1,739.49 | $1,650.91 | $2,289.75 | $2,107.62 | ||
| 26418 | REPAIR FINGER TENDON | $2,125.52 | $2,014.58 | $2,289.75 | $2,107.62 | ||
| 26445 | RELEASE HAND/FINGER TENDON | $1,786.60 | $1,692.75 | $2,289.75 | $2,107.62 | ||
| 26480 | TRANSPLANT HAND TENDON | $2,307.21 | $2,192.78 | $3,971.19 | $3,655.32 | ||
| 26525 | RELEASE FINGER CONTRACTURE | $2,010.20 | $1,907.42 | $2,289.75 | $2,107.62 | ||
| 26540 | REPAIR HAND JOINT | $2,010.67 | $1,914.55 | $2,289.75 | $2,107.62 | ||
| 26600 | TREAT METACARPAL FX | $447.47 | $425.44 | $210.60 | $193.83 | ||
| 26605 | TREAT METACARPAL FX | $499.07 | $474.91 | $210.60 | $193.83 | ||
| 26607 | TREAT METACARPAL FX | $702.97 | $672.84 | $2,779.53 | $2,558.43 | ||
| 26608 | TREAT METACARPAL FX | $1,155.32 | $1,104.12 | $3,542.43 | $3,260.64 | ||
| 26615 | TREAT METACARPAL FX | $1,371.83 | $1,313.19 | $6,420.90 | $5,910.15 | ||
| 26720 | TREAT FINGER FX, EACH | $303.29 | $288.37 | $210.60 | $193.83 | ||
| 26725 | TREAT FINGER FX, EACH | $526.64 | $502.01 | $210.60 | $193.83 | ||
| 26727 | TREAT FINGER FX, EACH | $739.96 | $706.95 | $3,542.43 | $3,260.64 | ||
| 26735 | TREAT FINGER FX, EACH | $925.25 | $886.02 | $3,542.43 | $3,260.64 | ||
| 26740 | TREAT FINGER FX, EACH | $352.67 | $335.26 | $210.60 | $193.83 | ||
| 26742 | TREAT FINGER FX, EACH | $571.25 | $545.14 | $210.60 | $193.83 | ||
| 26746 | TREAT FINGER FX, EACH | $1,143.63 | $1,096.98 | $3,542.43 | $3,260.64 | ||
| 26750 | TREAT FINGER FX, EACH | $280.86 | $267.55 | $210.60 | $193.83 | ||
| 26755 | TREAT FINGER FX, EACH | $484.57 | $461.98 | $210.60 | $193.83 | ||
| 27036 | EXCISE HIP JOINT/MUSCLE | $3,050.71 | $2,932.10 | not payable in ASC | not payable in ASC | ||
| 27093 | INJECTION FOR HIP X-RAY | $313.73 | $296.32 | packaged | packaged | X, N1 | |
| 27095 | INJECTION FOR HIP X-RAY | $384.77 | $363.23 | packaged | packaged | X, N1 | |
| 27096 | INJECT SACROILIAC JOINT | $586.47 | $554.47 | $1,012.32 | $931.80 | ||
| 27130 | TOTAL HIP ARTHROPLASTY | $5,258.22 | $5,062.44 | not payable in ASC | not payable in ASC | ||
| 27132 | TOTAL HIP ARTHROPLASTY | $6,133.86 | $5,907.48 | not payable in ASC | not payable in ASC | ||
| 27193 | TREAT PELVIC RING FX | $1,417.56 | $1,359.02 | $210.60 | $193.83 | ||
| 27194 | TREAT PELVIC RING FX | $2,095.30 | $2,013.65 | $2,074.56 | $1,909.53 | ||
| 27227 | TREAT HIP FX(S) | $5,066.90 | $4,879.61 | not payable in ASC | not payable in ASC | ||
| 27228 | TREAT HIP FX(S) | $5,779.51 | $5,567.94 | not payable in ASC | not payable in ASC | ||
| 27236 | TREAT THIGH FX | $3,627.64 | $3,490.04 | not payable in ASC | not payable in ASC | ||
| 27245 | TREAT THIGH FX | $3,775.02 | $3,630.86 | not payable in ASC | not payable in ASC | ||
| 27275 | MANIPULATE HIP JOINT | $323.19 | $309.59 | $2,074.56 | $1,909.53 | ||
| 27403 | REPAIR KNEE CARTILAGE | $3,103.82 | $2,978.06 | $4,301.40 | $3,959.25 | ||
| 27405 | REPAIR KNEE LIGAMENT | $3,282.44 | $3,149.55 | $6,312.78 | $5,810.61 | ||
| 27420 | REVISE UNSTABLE KNEECAP | $2,261.71 | $2,171.44 | $6,312.78 | $5,810.61 | ||
| 27422 | REVISE UNSTABLE KNEECAP | $2,252.47 | $2,162.50 | $6,312.78 | $5,810.61 | ||
| 27424 | REVISION/REMOVE KNEECAP | $2,255.28 | $2,165.35 | $6,312.78 | $5,810.61 | ||
| 27447 | TOTAL KNEE ARTHROPLASTY | $4,684.46 | $4,509.75 | not payable in ASC | not payable in ASC | ||
| 27487 | REVISE/REPLACE KNEE JOINT | $4,295.95 | $4,137.99 | not payable in ASC | not payable in ASC | ||
| 27500 | TREAT THIGH FX | $2,180.66 | $2,087.12 | $734.37 | $675.96 | ||
| 27501 | TREAT THIGH FX | $2,131.34 | $2,042.54 | $210.60 | $193.83 | ||
| 27502 | TREAT THIGH FX | $3,311.93 | $3,184.79 | $2,779.53 | $2,558.43 | ||
| 27503 | TREAT THIGH FX | $3,407.62 | $3,273.56 | $210.60 | $193.83 | ||
| 27506 | TREAT THIGH FX | $5,689.32 | $5,472.85 | not payable in ASC | not payable in ASC | ||
| 27507 | TREAT THIGH FX | $4,156.52 | $3,999.46 | not payable in ASC | not payable in ASC | ||
| 27508 | TREAT THIGH FX | $2,209.66 | $2,113.32 | $210.60 | $193.83 | ||
| 27509 | TREAT THIGH FX | $2,744.11 | $2,628.26 | $3,542.43 | $3,260.64 | ||
| 27510 | TREAT THIGH FX | $2,936.26 | $2,821.17 | $734.37 | $675.96 | ||
| 27511 | TREAT THIGH FX | $4,295.44 | $4,134.33 | not payable in ASC | not payable in ASC | ||
| 27513 | TREAT THIGH FX | $5,359.94 | $5,162.29 | not payable in ASC | not payable in ASC | ||
| 27514 | TREAT THIGH FX | $4,219.76 | $4,059.34 | not payable in ASC | not payable in ASC | ||
| 27520 | TREAT KNEECAP FX | $1,349.20 | $1,284.12 | $210.60 | $193.83 | ||
| 27524 | TREAT KNEECAP FX | $3,198.15 | $3,070.62 | not payable in ASC | not payable in ASC | ||
| 27530 | TREAT KNEE FX | $1,671.35 | $1,593.30 | $210.60 | $193.83 | ||
| 27532 | TREAT KNEE FX | $2,604.20 | $2,492.86 | $2,779.53 | $2,558.43 | ||
| 27535 | TREAT KNEE FX | $3,857.40 | $3,711.25 | not payable in ASC | not payable in ASC | ||
| 27536 | TREAT KNEE FX | $5,066.57 | $4,872.90 | not payable in ASC | not payable in ASC | ||
| 27538 | TREAT KNEE FX(S) | $1,987.87 | $1,897.12 | $210.60 | $193.83 | ||
| 27540 | TREAT KNEE FX | $3,478.82 | $3,340.36 | not payable in ASC | not payable in ASC | ||
| 27570 | FIXATE KNEE JOINT | $235.46 | $225.20 | $2,074.56 | $1,909.53 | ||
| 27685 | REVISE LOWER LEG TENDON | $2,767.45 | $2,634.16 | $4,301.40 | $3,959.25 | ||
| 27686 | REVISE LOWER LEG TENDONS | $2,372.88 | $2,276.62 | $4,301.40 | $3,959.25 | ||
| 27690 | REVISE LOWER LEG TENDON | $2,704.36 | $2,595.44 | $6,312.78 | $5,810.61 | ||
| 27691 | REVISE LOWER LEG TENDON | $3,202.39 | $3,073.42 | $6,312.78 | $5,810.61 | ||
| 27692 | REVISE ADDEDITIONAL LEG TENDON | $461.41 | $445.92 | $6,312.78 | $5,810.61 | ||
| 27695 | REPAIR ANKLE LIGAMENT | $1,477.41 | $1,416.90 | $4,301.40 | $3,959.25 | ||
| 27696 | REPAIR ANKLE LIGAMENTS | $1,723.72 | $1,656.05 | $4,301.40 | $3,959.25 | ||
| 27698 | REPAIR ANKLE LIGAMENT | $1,965.63 | $1,888.89 | $4,301.40 | $3,959.25 | ||
| 27750 | TREAT TIBIA FX | $1,446.76 | $1,377.78 | $210.60 | $193.83 | ||
| 27752 | TREAT TIBIA FX | $2,273.94 | $2,173.81 | $2,779.53 | $2,558.43 | ||
| 27758 | TREAT TIBIA FX | $3,785.47 | $3,636.72 | $6,420.90 | $5,910.15 | ||
| 27759 | TREAT TIBIA FX | $4,257.79 | $4,093.54 | $8,925.39 | $8,215.41 | ||
| 27760 | CLOSED TREAT MEDIAL ANKLE FX | $999.35 | $951.28 | $210.60 | $193.83 | ||
| 27762 | CLOSED TREAT MED ANKLE FX W/MANIP | $1,452.26 | $1,387.19 | $2,779.53 | $2,558.43 | ||
| 27766 | OPEN TREAT MEDIAL ANKLE FX | $1,856.02 | $1,778.54 | $6,420.90 | $5,910.15 | ||
| 27786 | TREAT ANKLE FX | $491.69 | $467.93 | $210.60 | $193.83 | ||
| 27788 | TREAT ANKLE FX | $662.30 | $632.08 | $210.60 | $193.83 | ||
| 27792 | TREAT ANKLE FX | $1,121.80 | $1,076.61 | $6,420.90 | $5,910.15 | ||
| 27808 | TREAT ANKLE FX | $518.87 | $493.37 | $210.60 | $193.83 | ||
| 27810 | TREAT ANKLE FX | $739.42 | $706.28 | $210.60 | $193.83 | ||
| 27814 | TREAT ANKLE FX | $1,223.81 | $1,174.68 | $6,420.90 | $5,910.15 | ||
| 27816 | TREAT ANKLE FX | $491.32 | $467.71 | $210.60 | $193.83 | ||
| 27818 | TREAT ANKLE FX | $756.19 | $722.98 | $734.37 | $675.96 | ||
| 27822 | TREAT ANKLE FX | $1,342.67 | $1,287.42 | $6,420.90 | $5,910.15 | ||
| 27823 | TREAT ANKLE FX | $1,523.63 | $1,462.35 | $8,925.39 | $8,215.41 | ||
| 27824 | TREAT LOWER LEG FX | $936.08 | $892.85 | $210.60 | $193.83 | ||
| 27825 | TREAT LOWER LEG FX | $1,653.18 | $1,582.18 | $2,779.53 | $2,558.43 | ||
| 27826 | TREAT LOWER LEG FX | $2,537.97 | $2,434.01 | $6,420.90 | $5,910.15 | ||
| 27827 | TREAT LOWER LEG FX | $3,313.36 | $3,179.78 | $8,925.39 | $8,215.41 | ||
| 27828 | TREAT LOWER LEG FX | $3,955.96 | $3,800.93 | $8,925.39 | $8,215.41 | ||
| 27829 | TREAT LOWER LEG JOINT | $2,062.48 | $1,976.64 | $6,420.90 | $5,910.15 | ||
| 27840 | TREAT ANKLE DISLOCATION | $1,072.56 | $1,028.51 | $210.60 | $193.83 | ||
| 27842 | TREAT ANKLE DISLOCATION | $1,488.26 | $1,426.77 | $2,074.56 | $1,909.53 | ||
| 27846 | TREAT ANKLE DISLOCATION | $2,235.14 | $2,146.41 | $6,420.90 | $5,910.15 | ||
| 27848 | TREAT ANKLE DISLOCATION | $2,511.52 | $2,412.81 | $6,420.90 | $5,910.15 | ||
| 27860 | FIXATE ANKLE JOINT | $276.66 | $265.27 | $2,074.56 | $1,909.53 | ||
| 28120 | PART REMOVE ANKLE/HEEL | $1,107.25 | $1,057.06 | $3,014.25 | $2,774.49 | ||
| 28122 | PARTIAL REMOVE FOOT BONE | $1,028.92 | $981.54 | $3,014.25 | $2,774.49 | ||
| 28400 | TREAT HEEL FX | $389.18 | $369.98 | $210.60 | $193.83 | ||
| 28405 | TREAT HEEL FX | $613.23 | $585.90 | $2,779.53 | $2,558.43 | ||
| 28415 | TREAT HEEL FX | $1,782.79 | $1,712.47 | $8,925.39 | $8,215.41 | ||
| 28420 | TREAT/GRAFT HEEL FX | $2,997.32 | $2,880.42 | $6,420.90 | $5,910.15 | ||
| 28430 | TREAT ANKLE FX | $563.23 | $535.64 | $210.60 | $193.83 | ||
| 28435 | TREAT ANKLE FX | $827.86 | $789.27 | $210.60 | $193.83 | ||
| 28436 | TREAT ANKLE FX | $1,073.70 | $1,025.26 | $3,542.43 | $3,260.64 | ||
| 28445 | TREAT ANKLE FX | $2,583.35 | $2,483.99 | $6,420.90 | $5,910.15 | ||
| 28470 | TREAT METATARSAL FX | $511.87 | $486.88 | $210.60 | $193.83 | ||
| 28475 | TREAT METATARSAL FX | $622.83 | $594.36 | $210.60 | $193.83 | ||
| 28476 | TREAT METATARSAL FX | $843.05 | $802.80 | $3,542.43 | $3,260.64 | ||
| 28485 | TREAT METATARSAL FX | $1,291.11 | $1,237.46 | $6,420.90 | $5,910.15 | ||
| 28725 | FUSE FOOT BONES | $1,926.38 | $1,852.85 | $7,371.54 | $6,785.16 | ||
| 28730 | FUSE FOOT BONES | $2,050.42 | $1,969.71 | $7,371.54 | $6,785.16 | ||
| 28740 | FUSE FOOT BONES | $2,079.28 | $1,981.86 | $7,371.54 | $6,785.16 | ||
| 28750 | FUSE BIG TOE JOINT | $2,027.14 | $1,930.24 | $7,371.54 | $6,785.16 | ||
| 29065 | APPLY LONG ARM CAST | $149.13 | $141.80 | $194.19 | $178.74 | X | |
| 29075 | APPLY FOREARM CAST | $139.52 | $132.52 | $187.17 | $172.29 | X | |
| 29085 | APPLY HAND/WRIST CAST | $147.51 | $140.22 | $149.40 | $137.52 | X | |
| 29086 | APPLY FINGER CAST | $117.72 | $111.61 | $149.40 | $137.52 | X | |
| 29105 | APPLY LONG ARM SPLINT | $155.41 | $148.00 | $149.40 | $137.52 | X | |
| 29125 | APPLY FOREARM SPLINT | $125.21 | $118.86 | $147.42 | $135.69 | X | |
| 29126 | APPLY FOREARM SPLINT | $141.72 | $134.82 | $149.40 | $137.52 | X | |
| 29130 | APPLY FINGER SPLINT | $72.44 | $69.28 | $67.86 | $62.46 | X | |
| 29131 | APPLY FINGER SPLINT | $92.77 | $88.41 | $97.11 | $89.37 | X | |
| 29200 | STRAP CHEST | $82.75 | $78.96 | $94.77 | $87.21 | X | |
| 29240 | STRAP SHOULDER | $89.29 | $85.21 | $101.79 | $93.69 | X | |
| 29260 | STRAP ELBOW OR WRIST | $80.59 | $76.70 | $100.62 | $92.61 | X | |
| 29280 | STRAP HAND OR FINGER | $78.61 | $74.72 | $101.79 | $93.69 | X | |
| 29345 | APPLY LONG LEG CAST | $212.03 | $202.15 | $255.03 | $234.75 | X | |
| 29355 | APPLY LONG LEG CAST | $219.66 | $209.65 | $255.03 | $234.75 | X | |
| 29365 | APPLY LONG LEG CAST | $191.79 | $182.59 | $240.99 | $221.82 | X | |
| 29405 | APPLY SHORT LEG CAST | $138.97 | $132.16 | $178.98 | $164.73 | X | |
| 29425 | APPLY SHORT LEG CAST | $147.75 | $140.72 | $181.32 | $166.89 | X | |
| 29450 | APPLY LEG CAST | $226.46 | $217.10 | $149.40 | $137.52 | X | |
| 29505 | APPLY LONG LEG SPLINT | $121.67 | $115.58 | $149.40 | $137.52 | X | |
| 29515 | APPLY LOWER LEG SPLINT | $112.71 | $107.26 | $141.54 | $130.29 | X | |
| 29520 | STRAP HIP | $77.82 | $74.05 | $97.11 | $89.37 | X | |
| 29530 | STRAP KNEE | $81.60 | $77.69 | $100.62 | $92.61 | X | |
| 29540 | STRAP ANKLE AND/OR FT | $53.90 | $51.17 | $72.54 | $66.78 | X | |
| 29550 | STRAP TOES | $44.24 | $41.67 | $72.54 | $66.78 | X | |
| 29580 | APPLY PASTE BOOT | $82.79 | $78.81 | $102.96 | $94.77 | X | |
| 29581 | APPLY MULTILAY COMPRESS LWR LEG | $152.30 | $143.77 | $149.40 | $137.52 | X | |
| 29590 | APPLY FOOT SPLINT | $82.51 | $79.00 | $83.04 | $76.44 | X | |
| 29700 | REMOVE/REVISE CAST | $103.41 | $98.21 | $139.20 | $128.13 | X | |
| 29705 | REMOVE/REVISE CAST | $104.21 | $99.48 | $119.34 | $109.86 | X | |
| 29710 | REMOVE/REVISE CAST | $190.34 | $181.78 | $217.62 | $200.31 | X | |
| 29740 | WEDGE CAST | $141.31 | $135.19 | $149.40 | $137.52 | X | |
| 29800 | JAW ARTHROSCOPY/SURG | $2,870.02 | $2,751.17 | $3,997.71 | $3,679.71 | ||
| 29804 | JAW ARTHROSCOPY/SURG | $3,578.52 | $3,434.24 | $3,997.71 | $3,679.71 | ||
| 29805 | SHOULDER ARTHROSCOPY, DIAG | $2,575.75 | $2,467.98 | $3,997.71 | $3,679.71 | ||
| 29806 | SHOULDER ARTHROSCOPY/SURG | $5,808.16 | $5,582.08 | $6,462.39 | $5,948.34 | ||
| 29807 | SHOULDER ARTHROSCOPY/SURG | $5,671.51 | $5,449.31 | $6,462.39 | $5,948.34 | ||
| 29819 | SHOULDER ARTHROSCOPY/SURG | $3,210.18 | $3,078.79 | $6,462.39 | $5,948.34 | ||
| 29820 | SHOULDER ARTHROSCOPY/SURG | $2,953.64 | $2,833.12 | $6,462.39 | $5,948.34 | ||
| 29821 | SHOULDER ARTHROSCOPY/SURG | $3,233.10 | $3,101.41 | $6,462.39 | $5,948.34 | ||
| 29822 | SHOULDER ARTHROSCOPY/SURG | $3,144.95 | $3,016.12 | $3,997.71 | $3,679.71 | ||
| 29823 | SHOULDER ARTHROSCOPY/SURG | $3,430.85 | $3,290.80 | $6,462.39 | $5,948.34 | ||
| 29824 | SHOULDER ARTHROSCOPY/SURG | $3,689.94 | $3,539.41 | $3,997.71 | $3,679.71 | ||
| 29825 | SHOULDER ARTHROSCOPY/SURG | $3,202.11 | $3,071.26 | $6,462.39 | $5,948.34 | ||
| 29826 | SHOULDER ARTHROSCOPY/SURG | $3,650.34 | $3,504.39 | $6,462.39 | $5,948.34 | ||
| 29827 | ARTHROSCOPY ROTATOR CUFF REPAIR | $4,596.05 | $4,418.87 | $6,462.39 | $5,948.34 | ||
| 29828 | ARTHROSCOPY BICEPS TENODESIS | $3,899.18 | $3,748.17 | $6,462.39 | $5,948.34 | ||
| 29830 | ELBOW ARTHROSCOPY | $1,932.85 | $1,852.70 | $3,997.71 | $3,679.71 | ||
| 29834 | ELBOW ARTHROSCOPY/SURG | $2,095.15 | $2,008.15 | $3,997.71 | $3,679.71 | ||
| 29835 | ELBOW ARTHROSCOPY/SURG | $2,154.22 | $2,065.19 | $3,997.71 | $3,679.71 | ||
| 29837 | ELBOW ARTHROSCOPY/SURG | $2,251.82 | $2,159.47 | $3,997.71 | $3,679.71 | ||
| 29840 | WRIST ARTHROSCOPY | $1,918.73 | $1,837.85 | $3,997.71 | $3,679.71 | ||
| 29844 | WRIST ARTHROSCOPY/SURG | $2,115.96 | $2,027.77 | $3,997.71 | $3,679.71 | ||
| 29845 | WRIST ARTHROSCOPY/SURG | $2,440.18 | $2,339.75 | $3,997.71 | $3,679.71 | ||
| 29846 | WRIST ARTHROSCOPY/SURG | $2,218.96 | $2,126.68 | $3,997.71 | $3,679.71 | ||
| 29847 | WRIST ARTHROSCOPY/SURG | $2,310.86 | $2,216.47 | $6,462.39 | $5,948.34 | ||
| 29848 | WRIST ENDOSCOPY/SURG | $2,159.31 | $2,067.30 | $3,997.71 | $3,679.71 | ||
| 29850 | KNEE ARTHROSCOPY/SURG | $2,540.30 | $2,439.30 | $3,997.71 | $3,679.71 | ||
| 29855 | TIBIAL ARTHROSCOPY/SURG | $3,347.13 | $3,213.03 | $6,462.39 | $5,948.34 | ||
| 29860 | HIP ARTHROSCOPY, DIAG | $2,809.81 | $2,697.02 | $6,462.39 | $5,948.34 | ||
| 29861 | HIP ARTHROSCOPY/SURG | $3,088.61 | $2,966.10 | $6,462.39 | $5,948.34 | ||
| 29862 | HIP ARTHROSCOPY/SURG | $3,469.37 | $3,330.41 | $6,462.39 | $5,948.34 | ||
| 29863 | HIP ARTHROSCOPY/SURG | $3,458.24 | $3,320.12 | $6,462.39 | $5,948.34 | ||
| 29870 | KNEE ARTHROSCOPY, DIAG | $2,543.44 | $2,416.34 | $3,997.71 | $3,679.71 | ||
| 29871 | KNEE ARTHROSCOPY/DRAIN | $2,182.27 | $2,092.01 | $3,997.71 | $3,679.71 | ||
| 29873 | KNEE ARTHROSCOPY/SURG | $2,221.06 | $2,124.42 | $3,997.71 | $3,679.71 | ||
| 29874 | KNEE ARTHROSCOPY/SURG | $2,291.42 | $2,197.95 | $3,997.71 | $3,679.71 | ||
| 29875 | KNEE ARTHROSCOPY/SURG | $2,712.06 | $2,599.81 | $3,997.71 | $3,679.71 | ||
| 29876 | KNEE ARTHROSCOPY/SURG | $3,584.57 | $3,439.85 | $3,997.71 | $3,679.71 | ||
| 29877 | KNEE ARTHROSCOPY/SURG | $3,398.38 | $3,259.86 | $3,997.71 | $3,679.71 | ||
| 29879 | KNEE ARTHROSCOPY/SURG | $2,818.03 | $2,704.52 | $3,997.71 | $3,679.71 | ||
| 29880 | KNEE ARTHROSCOPY/SURG | $3,774.79 | $3,623.53 | $3,997.71 | $3,679.71 | ||
| 29881 | KNEE ARTHROSCOPY/SURG | $3,531.15 | $3,388.20 | $3,997.71 | $3,679.71 | ||
| 29882 | KNEE ARTHROSCOPY/SURG | $3,812.37 | $3,660.32 | $3,997.71 | $3,679.71 | ||
| 29883 | KNEE ARTHROSCOPY/SURG | $3,576.15 | $3,435.01 | $3,997.71 | $3,679.71 | ||
| 29884 | KNEE ARTHROSCOPY/SURG | $2,635.72 | $2,528.41 | $3,997.71 | $3,679.71 | ||
| 29886 | KNEE ARTHROSCOPY/SURG | $2,695.10 | $2,585.53 | $3,997.71 | $3,679.71 | ||
| 29887 | KNEE ARTHROSCOPY/SURG | $3,168.57 | $3,041.28 | $3,997.71 | $3,679.71 | ||
| 29888 | KNEE ARTHROSCOPY/SURG | $4,211.31 | $4,048.82 | $11,871.09 | $10,926.78 | ||
| 29889 | KNEE ARTHROSCOPY/SURG | $5,187.05 | $4,985.30 | $11,871.09 | $10,926.78 | ||
| 29891 | ANKLE ARTHROSCOPY/SURG | $2,944.29 | $2,825.65 | $6,462.39 | $5,948.34 | ||
| 29894 | ANKLE ARTHROSCOPY/SURG | $2,194.01 | $2,106.44 | $3,997.71 | $3,679.71 | ||
| 29895 | ANKLE ARTHROSCOPY/SURG | $2,096.49 | $2,013.20 | $3,997.71 | $3,679.71 | ||
| 29897 | ANKLE ARTHROSCOPY/SURG | $2,198.99 | $2,111.07 | $3,997.71 | $3,679.71 | ||
| 29898 | ANKLE ARTHROSCOPY/SURG | $2,437.92 | $2,342.16 | $3,997.71 | $3,679.71 | ||
| 29899 | ANKLE ARTHROSCOPY/SURG | $4,454.29 | $4,283.43 | $6,462.39 | $5,948.34 | ||
| 30100 | INTRANASAL BIOPSY | $231.61 | $218.73 | $357.99 | $329.52 | ||
| 30130 | EXCISE INFERIOR TURBINATE | $616.48 | $585.09 | $2,313.03 | $2,129.04 | ||
| 30140 | RESECT INFERIOR TURBINATE | $714.07 | $676.41 | $3,421.41 | $3,149.25 | ||
| 30200 | INJECTION TREAT NOSE | $185.69 | $175.48 | $283.11 | $260.58 | ||
| 30300 | REMOVE NASAL FOREIGN BODY | $377.61 | $355.40 | $89.55 | $82.44 | X | |
| 30310 | REMOVE NASAL FOREIGN BODY | $333.88 | $317.27 | $2,313.03 | $2,129.04 | ||
| 30520 | REPAIR NASAL SEPTUM | $1,533.94 | $1,462.07 | $3,421.41 | $3,149.25 | ||
| 30802 | ABLATE INF TURBINATE SUBMUCOSAL | $475.96 | $450.01 | $2,313.03 | $2,129.04 | ||
| 30901 | CONTROL NOSEBLEED | $154.98 | $147.82 | $151.17 | $139.14 | ||
| 30903 | CONTROL NOSEBLEED | $323.03 | $305.90 | $151.17 | $139.14 | ||
| 30905 | CONTROL NOSEBLEED | $400.32 | $379.29 | $151.17 | $139.14 | ||
| 30930 | THERAPEUTIC FX, NASAL INF TURB | $199.28 | $189.73 | $2,313.03 | $2,129.04 | ||
| 31000 | IRRIGATE MAXILLARY SINUS | $295.86 | $279.40 | $457.44 | $421.05 | ||
| 31020 | EXPLORE MAXILLARY SINUS | $793.30 | $748.88 | $3,421.41 | $3,149.25 | ||
| 31231 | NASAL ENDOSCOPY, DIAG | $316.52 | $298.37 | $268.32 | $246.99 | ||
| 31237 | NASAL/SINUS ENDOSCOPY, SURG | $533.18 | $505.96 | $2,927.49 | $2,694.60 | ||
| 31238 | NASAL/SINUS ENDOSCOPY, SURG | $547.19 | $519.83 | $2,927.49 | $2,694.60 | ||
| 31255 | REMOVE ETHMOID SINUS | $1,735.89 | $1,673.26 | $4,128.33 | $3,799.92 | ||
| 31256 | EXPLORE MAXILLARY SINUS | $1,228.03 | $1,181.96 | $4,128.33 | $3,799.92 | ||
| 31267 | ENDOSCOPY, MAXILLARY SINUS | $983.83 | $947.97 | $4,128.33 | $3,799.92 | ||
| 31500 | INSERT EMERGENCY AIRWAY | $169.29 | $164.70 | $315.78 | $290.67 | X | |
| 31505 | DIAGNOSTIC LARYNGOSCOPY | $137.08 | $129.60 | $124.02 | $114.15 | ||
| 31515 | LARYNGOSCOPY FOR ASPIRATION | $342.57 | $324.79 | $2,927.49 | $2,694.60 | ||
| 31525 | DIAG LARYNGOSCOPY EXCL NB | $409.68 | $389.77 | $2,927.49 | $2,694.60 | ||
| 31575 | DIAGNOSTIC LARYNGOSCOPY | $188.42 | $178.87 | $253.86 | $233.67 | ||
| 31579 | DIAGNOSTIC LARYNGOSCOPY | $352.14 | $335.06 | $445.74 | $410.28 | ||
| 31600 | INCISE WINDPIPE | $629.61 | $609.27 | not payable in ASC | not payable in ASC | ||
| 31605 | INCISE WINDPIPE | $287.29 | $278.92 | $1,056.45 | $972.42 | ||
| 31622 | DIAG BRONCHOSCOPE/WASH | $515.11 | $488.50 | $1,400.82 | $1,289.40 | ||
| 31624 | DIAG BRONCHOSCOPE/LAVAGE | $516.04 | $489.32 | $1,400.82 | $1,289.40 | ||
| 31645 | BRONCHOSCOPY, CLEAR AIRWAYS | $493.95 | $469.51 | $1,400.82 | $1,289.40 | ||
| 31646 | BRONCHOSCOPY, RECLEAR AIRWAY | $451.44 | $428.67 | $1,400.82 | $1,289.40 | ||
| 32405 | BIOPSY LUNG OR MEDIASTINUM | $154.47 | $149.43 | $1,298.73 | $1,195.41 | ||
| 32551 | INSERT CHEST TUBE | $523.12 | $506.94 | not payable in ASC | not payable in ASC | ||
| 32601 | THORACOSCOPY, DIAGNOSTIC | $499.24 | $483.47 | not payable in ASC | not payable in ASC | ||
| 32651 | THORACOSCOPY, SURGICAL | $1,750.69 | $1,694.03 | not payable in ASC | not payable in ASC | ||
| 32653 | THORACOSCOPY, SURGICAL | $1,686.57 | $1,632.06 | not payable in ASC | not payable in ASC | ||
| 33210 | INSERT HEART ELECTRODE | $297.55 | $288.11 | $3,763.15 | $3,209.05 | ||
| 33212 | INSERT PULSE GENERATOR | $564.31 | $544.12 | $11,119.83 | $9,530.10 | ||
| 36000 | PLACE NEEDLE IN VEIN | $41.55 | $39.31 | packaged | packaged | X, N1 | |
| 36005 | INJECTION EXT VENOGRAPHY | $590.62 | $553.75 | packaged | packaged | X, N1 | |
| 36010 | PLACE CATHETER IN VEIN | $952.65 | $895.82 | packaged | packaged | X, N1 | |
| 36011 | PLACE CATHETER IN VEIN | $1,569.24 | $1,473.07 | packaged | packaged | X, N1 | |
| 36013 | PLACE CATHETER IN ARTERY | $1,386.90 | $1,301.48 | packaged | packaged | X, N1 | |
| 36014 | PLACE CATHETER IN ARTERY | $1,452.05 | $1,363.05 | packaged | packaged | X, N1 | |
| 36140 | ESTABLISH ACCESS TO ARTERY | $818.12 | $769.44 | packaged | packaged | X, N1 | |
| 36200 | PLACE CATHETER IN AORTA | $1,104.48 | $1,039.78 | packaged | packaged | X, N1 | |
| 36215 | PLACE CATHETER IN ARTERY | $1,968.28 | $1,850.35 | packaged | packaged | X, N1 | |
| 36216 | PLACE CATHETER IN ARTERY | $2,164.58 | $2,035.32 | packaged | packaged | X, N1 | |
| 36217 | PLACE CATHETER IN ARTERY | $3,554.81 | $3,335.12 | packaged | packaged | X, N1 | |
| 36218 | PLACE CATHETER IN ARTERY | $325.68 | $306.84 | packaged | packaged | X, N1 | |
| 36245 | PLACE CATHETER IN ARTERY | $2,078.60 | $1,953.45 | packaged | packaged | X, N1 | |
| 36246 | PLACE CATHETER IN ARTERY | $2,094.97 | $1,970.56 | packaged | packaged | X, N1 | |
| 36247 | PLACE CATHETER IN ARTERY | $3,310.67 | $3,107.79 | packaged | packaged | X, N1 | |
| 36248 | PLACE CATHETER IN ARTERY | $272.11 | $256.86 | packaged | packaged | X, N1 | |
| 36400 | BLOOD DRAW < 3 YRS FEM/JUGULAR | $46.92 | $44.88 | packaged | packaged | X, N1 | |
| 36406 | BLOOD DRAW < 3 YRS OTHER VEIN | $28.17 | $26.82 | packaged | packaged | X, N1 | |
| 36410 | NON-ROUTINE BL DRAW > 3 YRS | $29.91 | $28.45 | packaged | packaged | X, N1 | |
| 36425 | VEIN ACCESS CUTDOWN > 1 YR | $62.34 | $60.40 | $35.67 | $32.82 | X | |
| 36430 | BLOOD TRANSFUSION SERVICE | $59.91 | $55.92 | $119.34 | $109.86 | X | |
| 36471 | INJECTION THERAPY VEINS | $290.72 | $276.37 | $121.44 | $111.78 | ||
| 36513 | APHERESIS PLATELETS | $158.96 | $153.73 | $1,652.49 | $1,521.03 | X | |
| 36514 | APHERESIS PLASMA | $878.54 | $824.72 | $1,652.49 | $1,521.03 | X | |
| 36515 | APHERESIS, ADSORP/REINFUSE | $3,313.31 | $3,095.86 | $4,195.89 | $3,862.11 | X | |
| 36555 | INSERT NON-TUNNEL CV CATH | $442.67 | $420.24 | $1,516.71 | $1,396.08 | ||
| 36556 | INSERT NON-TUNNEL CV CATH | $383.48 | $364.91 | $1,516.71 | $1,396.08 | ||
| 36558 | INSERT TUNNELED CV CATH | $1,353.89 | $1,277.30 | $2,289.41 | $2,017.01 | ||
| 36569 | INSERT PICC CATH | $430.72 | $406.86 | $1,516.71 | $1,396.08 | ||
| 36571 | INSERT PICVAD CATH | $2,151.26 | $2,023.38 | $2,289.41 | $2,017.01 | ||
| 36576 | REPAIR TUNNELED CV CATH | $619.78 | $588.02 | $1,516.71 | $1,396.08 | ||
| 36578 | REPLACE TUNNELED CV CATH | $855.29 | $808.35 | $2,289.41 | $2,017.01 | ||
| 36580 | REPLACE CVAD CATH | $375.27 | $353.82 | $1,516.71 | $1,396.08 | ||
| 36584 | REPLACE PICC CATH | $360.67 | $339.77 | $1,516.71 | $1,396.08 | ||
| 36589 | REMOVE TUNNELED CV CATH | $271.78 | $260.38 | $844.41 | $777.24 | ||
| 36592 | COLLECT BLOOD PICC | $44.20 | $41.25 | packaged | packaged | X, N1 | |
| 36593 | DECLOT VASCULAR DEVICE | $49.44 | $46.14 | $98.28 | $90.45 | ||
| 36598 | INJECT W/FLUOR, EVAL CV DEVICE | $189.67 | $178.99 | $298.32 | $274.59 | ||
| 36600 | WITHDRAW ARTERIAL BLOOD | $50.41 | $47.90 | packaged | packaged | X, N1 | |
| 36620 | INSERT CATHETER, ARTERY | $210.31 | $204.69 | packaged | packaged | X, N1 | |
| 36625 | INSERT CATHETER, ARTERY | $169.68 | $164.90 | packaged | packaged | X, N1 | |
| 36800 | INSERT CANNULA | $261.61 | $251.45 | $4,009.88 | $3,637.55 | ||
| 36810 | INSERT CANNULA | $340.24 | $329.61 | $4,009.88 | $3,637.55 | ||
| 36815 | INSERT CANNULA | $244.77 | $236.68 | $4,009.88 | $3,637.55 | ||
| 36818 | AV FUSE, UPPER ARM, CEPHALIC | $1,105.69 | $1,069.72 | $5,565.66 | $5,122.95 | ||
| 36833 | AV FISTULA REVISION | $1,079.72 | $1,045.86 | $5,565.66 | $5,122.95 | ||
| 36860 | EXTERNAL CANNULA DECLOTTING | $331.55 | $315.10 | $313.14 | $288.21 | ||
| 37140 | REVISE CIRCULATION | $2,310.08 | $2,235.33 | not payable in ASC | not payable in ASC | ||
| 37204 | TRANSCATHETER OCCLUSION | $1,460.69 | $1,414.57 | $8,466.97 | $7,482.97 | ||
| 37609 | TEMPORAL ARTERY PROCEDURE | $503.08 | $478.98 | $2,411.70 | $2,219.85 | ||
| 37620 | REVISE MAJOR VEIN | $2,029.20 | $1,958.69 | not payable in ASC | not payable in ASC | ||
| 37650 | REVISE MAJOR VEIN | $1,545.07 | $1,493.80 | $3,662.31 | $3,370.98 | ||
| 38100 | REMOVE SPLEEN, TOTAL | $1,765.00 | $1,708.45 | not payable in ASC | not payable in ASC | ||
| 38115 | REPAIR RUPTURED SPLEEN | $1,947.72 | $1,885.34 | not payable in ASC | not payable in ASC | ||
| 38200 | INJECTION FOR SPLEEN X-RAY | $234.86 | $227.73 | packaged | packaged | X, N1 | |
| 38206 | HARVEST AUTO STEM CELLS | $292.33 | $282.03 | $1,652.49 | $1,521.03 | X | |
| 38220 | BONE MARROW ASPIRATION | $250.35 | $236.57 | $381.36 | $351.03 | ||
| 38221 | BONE MARROW BIOPSY | $269.34 | $254.87 | $393.09 | $361.80 | ||
| 38230 | BONE MARROW COLLECTION | $838.42 | $806.23 | $4,195.89 | $3,862.11 | X | |
| 39501 | REPAIR DIAPHRAGM LACERATION | $1,328.67 | $1,283.88 | not payable in ASC | not payable in ASC | ||
| 43235 | UPPER GI ENDOSCOPY, DIAGNOSIS | $490.49 | $464.67 | $1,184.82 | $1,090.56 | ||
| 43236 | UPPER GI SCOPE W/SUBMUCOSA INJECT | $608.49 | $576.22 | $1,184.82 | $1,090.56 | ||
| 43239 | UPPER GI ENDOSCOPY, BIOPSY | $567.52 | $537.88 | $1,184.82 | $1,090.56 | ||
| 43246 | PLACE GASTROSTOMY TUBE | $403.59 | $389.45 | $1,184.82 | $1,090.56 | ||
| 43248 | UPPER GI ENDOSCOPY/GUIDE WIRE | $303.20 | $292.10 | $1,184.82 | $1,090.56 | ||
| 43249 | ESOPH ENDOSCOPY, DILATION | $279.64 | $269.41 | $1,184.82 | $1,090.56 | ||
| 43255 | OPERATIVE UPPER GI ENDOSCOPY | $453.95 | $437.69 | $1,184.82 | $1,090.56 | ||
| 43259 | ENDOSCOPIC ULTRASOUND EXAM | $488.13 | $470.63 | $1,184.82 | $1,090.56 | ||
| 43260 | ENDO CHOLANGIOPANCREATOGRAPHY | $556.81 | $536.98 | $3,099.69 | $2,853.12 | ||
| 43450 | DILATE ESOPHAGUS | $258.48 | $245.26 | $875.61 | $805.98 | ||
| 43760 | CHANGE GASTROSTOMY TUBE | $684.75 | $641.43 | $313.14 | $288.21 | ||
| 43830 | PLACE GASTROSTOMY TUBE | $1,076.48 | $1,038.48 | not payable in ASC | not payable in ASC | ||
| 44139 | MOBILIZATION COLON | $187.28 | $181.69 | not payable in ASC | not payable in ASC | ||
| 44500 | INTRODUCE GASTROINTESTINAL TUBE | $38.60 | $37.33 | $844.41 | $777.24 | ||
| 45300 | PROCTOSIGMOIDOSCOPY DIAG | $187.75 | $177.52 | $283.11 | $260.58 | ||
| 45330 | DIAGNOSTIC SIGMOIDOSCOPY | $227.77 | $215.31 | $345.12 | $317.67 | ||
| 45355 | SURGICAL COLONOSCOPY | $324.09 | $312.96 | $1,246.23 | $1,147.08 | ||
| 45378 | DIAGNOSTIC COLONOSCOPY | $647.09 | $614.70 | $1,246.23 | $1,147.08 | ||
| 46040 | INCISE RECTAL ABSCESS | $811.58 | $773.85 | $3,247.68 | $2,989.32 | ||
| 46600 | DIAGNOSTIC ANOSCOPY | $136.30 | $128.76 | $89.55 | $82.44 | X | |
| 47000 | NEEDLE BIOPSY LIVER | $575.57 | $542.24 | $1,298.73 | $1,195.41 | ||
| 49080 | PUNCTURE, PERITONEAL CAVITY | $269.24 | $254.87 | $742.11 | $683.10 | ||
| 49320 | DIAG LAP SEPARATE PROC | $508.88 | $490.86 | $5,156.19 | $4,746.03 | ||
| 49421 | INSERT ABDOM DRAIN, PERM | $425.09 | $409.71 | $3,521.06 | $3,192.08 | ||
| 49505 | PART RPR I/HERNIA INIT REDUCT >5 YR | $799.46 | $771.01 | $4,412.82 | $4,061.82 | ||
| 50392 | INSERT KIDNEY DRAIN | $289.62 | $279.48 | $2,344.41 | $2,157.93 | ||
| 50394 | INJECTION FOR KIDNEY X-RAY | $173.81 | $164.23 | packaged | packaged | X, N1 | |
| 51600 | INJECTION FOR BLADDER X-RAY | $328.90 | $309.24 | packaged | packaged | X, N1 | |
| 51610 | INJECTION FOR BLADDER X-RAY | $184.26 | $174.79 | packaged | packaged | X, N1 | |
| 51700 | IRRIGATION BLADDER | $143.15 | $135.97 | $189.51 | $174.45 | ||
| 51701 | INSERT BLADDER CATHETER | $98.42 | $93.21 | $89.55 | $82.44 | X | |
| 51702 | INSERT TEMP BLADDER CATH | $128.12 | $120.92 | $89.55 | $82.44 | X | |
| 51703 | INSERT BLADDER CATH, COMPLEX | $227.44 | $216.26 | $148.20 | $136.41 | ||
| 51705 | CHANGE BLADDER TUBE | $186.01 | $176.43 | $256.20 | $235.83 | ||
| 51720 | TREAT BLADDER LESION | $185.88 | $177.55 | $205.92 | $189.54 | ||
| 51725 | SIMPLE CYSTOMETROGRAM | $349.50 | $330.16 | not payable in ASC | not payable in ASC | ||
| 51725 | TC | SIMPLE CYSTOMETROGRAM | $228.20 | $212.91 | $428.43 | $394.35 | |
| 51725 | 26 | SIMPLE CYSTOMETROGRAM | $121.30 | $117.25 | not payable in ASC | not payable in ASC | |
| 51726 | COMPLEX CYSTOMETROGRAM | $514.29 | $484.52 | not payable in ASC | not payable in ASC | ||
| 51726 | TC | COMPLEX CYSTOMETROGRAM | $375.98 | $350.82 | $428.43 | $394.35 | |
| 51726 | 26 | COMPLEX CYSTOMETROGRAM | $138.31 | $133.68 | not payable in ASC | not payable in ASC | |
| 51741 | ELECTRO-UROFLOWMETRY, FIRST | $72.56 | $68.17 | not payable in ASC | not payable in ASC | ||
| 51741 | TC | ELECTRO-UROFLOWMETRY, FIRST | $45.36 | $42.35 | $90.09 | $82.92 | |
| 51741 | 26 | ELECTRO-UROFLOWMETRY, FIRST | $27.20 | $25.82 | not payable in ASC | not payable in ASC | |
| 51784 | ANAL/URINARY MUSCLE STUDY | $340.60 | $321.93 | not payable in ASC | not payable in ASC | ||
| 51784 | TC | ANAL/URINARY MUSCLE STUDY | $217.71 | $203.13 | $148.20 | $136.41 | |
| 51784 | 26 | ANAL/URINARY MUSCLE STUDY | $122.90 | $118.80 | not payable in ASC | not payable in ASC | |
| 51797 | INTRAABDOMINAL PRESSURE TEST | $225.40 | $212.42 | not payable in ASC | not payable in ASC | ||
| 51797 | TC | INTRAABDOMINAL PRESSURE TEST | $159.49 | $148.82 | $271.74 | $250.14 | |
| 51797 | 26 | INTRAABDOMINAL PRESSURE TEST | $65.91 | $63.61 | not payable in ASC | not payable in ASC | |
| 51798 | US URINE CAPACITY MEASURE | $33.71 | $31.48 | $66.69 | $61.38 | X | |
| 52000 | CYSTOSCOPY | $348.14 | $331.01 | $992.58 | $913.62 | ||
| 52005 | CYSTOSCOPY & URETER CATHETER | $482.13 | $456.37 | $3,512.94 | $3,233.49 | ||
| 52204 | CYSTOSCOPY W/BIOPSY(S) | $706.29 | $666.08 | $3,512.94 | $3,233.49 | ||
| 52281 | CYSTOSCOPY & TREAT | $481.96 | $456.89 | $2,344.41 | $2,157.93 | ||
| 52310 | CYSTOSCOPY & TREAT | $412.14 | $392.33 | $2,344.41 | $2,157.93 | ||
| 52332 | CYSTOSCOPY & TREAT | $837.81 | $788.80 | $3,512.94 | $3,233.49 | ||
| 52351 | CYSTOURETERO & OR PYELOSCOPE | $511.15 | $493.07 | $3,512.94 | $3,233.49 | ||
| 53600 | DILATE URETHRA STRICTURE | $139.91 | $133.85 | $146.22 | $134.61 | ||
| 53601 | DILATE URETHRA STRICTURE | $137.75 | $131.17 | $148.20 | $136.41 | ||
| 53660 | DILATE URETHRA | $121.77 | $115.58 | $148.20 | $136.41 | ||
| 53661 | DILATE URETHRA | $120.54 | $114.44 | $148.20 | $136.41 | ||
| 54235 | PENILE INJECTION | $149.95 | $143.17 | $168.48 | $155.07 | ||
| 57452 | EXAM CERVIX W/SCOPE | $174.20 | $167.01 | $171.99 | $158.31 | ||
| 57500 | BIOPSY CERVIX | $213.96 | $203.21 | $286.62 | $263.82 | ||
| 57511 | CRYOCAUTERY CERVIX | $234.32 | $224.50 | $218.10 | $200.76 | ||
| 58340 | CATHETER FOR HYSTERORRHAPHY | $203.46 | $192.36 | packaged | packaged | X, N1 | |
| 58558 | HYSTEROSCOPY, BIOPSY | $576.77 | $552.42 | $3,079.32 | $2,834.37 | ||
| 59000 | AMNIOCENTESIS, DIAGNOSTIC | $208.66 | $199.11 | $248.01 | $228.30 | ||
| 59025 | FETAL NON-STRESS TEST | $117.18 | $112.00 | not payable in ASC | not payable in ASC | ||
| 59025 | TC | FETAL NON-STRESS TEST | $45.58 | $42.59 | $58.50 | $53.85 | |
| 59025 | 26 | FETAL NON-STRESS TEST | $71.58 | $69.41 | not payable in ASC | not payable in ASC | |
| 59841 | ABORTION | $611.45 | $589.83 | $2,758.50 | $2,539.05 | ||
| 61107 | DRILL SKULL FOR IMPLANTATION | $1,155.41 | $1,120.28 | not payable in ASC | not payable in ASC | ||
| 61790 | TREAT TRIGEMINAL NERVE | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 62263 | EPIDURAL LYSIS MULT SESSIONS | $1,788.44 | $1,102.21 | $1,012.32 | $931.80 | ||
| 62264 | EPIDURAL LYSIS ON SINGLE DAY | $1,033.30 | $638.56 | $1,706.88 | $1,571.10 | ||
| 62270 | SPINAL FLUID TAP, DIAGNOSTIC | $391.43 | $371.51 | $517.89 | $476.70 | ||
| 62273 | INJECT EPIDURAL PATCH | $414.98 | $396.26 | $1,012.32 | $931.80 | ||
| 62280 | TREAT SPINAL CORD LESION | $817.78 | $775.41 | $1,012.32 | $931.80 | ||
| 62281 | TREAT SPINAL CORD LESION | $650.31 | $618.08 | $1,012.32 | $931.80 | ||
| 62282 | TREAT SPINAL CANAL LESION | $743.51 | $703.87 | $1,012.32 | $931.80 | ||
| 62284 | INJECTION FOR MYELOGRAM | $544.03 | $514.23 | packaged | packaged | X, N1 | |
| 62287 | PERCUTANEOUS DISKECTOMY | $5,347.03 | $5,141.26 | $4,972.53 | $4,576.98 | ||
| 62290 | INJECT FOR SPINE DISK X-RAY | $1,256.74 | $1,191.64 | packaged | packaged | X, N1 | |
| 62291 | INJECT FOR SPINE DISK X-RAY | $1,184.82 | $1,123.82 | packaged | packaged | X, N1 | |
| 62292 | INJECTION INTO DISK LESION | $1,982.34 | $1,907.34 | $1,012.32 | $931.80 | ||
| 62310 | INJECT SPINE C/T | $1,021.73 | $967.17 | $1,012.32 | $931.80 | ||
| 62311 | INJECT SPINE L/S (CD) | $879.37 | $831.58 | $1,012.32 | $931.80 | ||
| 62318 | INJECT SPINE W/CATH, C/T | $749.21 | $709.56 | $1,012.32 | $931.80 | ||
| 62319 | INJECT SPINE W/CATH L/S (CD) | $475.01 | $451.01 | $1,706.88 | $1,571.10 | ||
| 62350 | IMPLANT SPINAL CANAL CATH | not listed | not listed | $5,591.79 | $5,146.98 | ||
| 62355 | REMOVE SPINAL CANAL CATHETER | not listed | not listed | $1,706.88 | $1,571.10 | ||
| 62360 | INSERT SPINE INFUSION DEVICE | not listed | not listed | $5,591.79 | $5,146.98 | ||
| 62362 | IMPLANT SPINE INFUSION PUMP | not listed | not listed | $22,241.41 | $18,893.98 | ||
| 62365 | REMOVE SPINE INFUSION DEVICE | not listed | not listed | $4,972.53 | $4,576.98 | ||
| 62367 | ANALYZE SPINE INFUSION PUMP | not listed | not listed | $76.02 | $69.99 | X | |
| 62368 | ANALYZE SPINE INFUSION PUMP | not listed | not listed | $102.96 | $94.77 | X | |
| 63075 | NECK SPINE DISK SURG | $10,012.99 | $9,659.93 | not payable in ASC | not payable in ASC | ||
| 63076 | NECK SPINE DISK SURG | $1,837.46 | $1,779.74 | not payable in ASC | not payable in ASC | ||
| 63650 | IMPLANT NEUROELECTRODES | not listed | not listed | $7,941.86 | $6,926.39 | X | |
| 63655 | IMPLANT NEUROELECTRODES | not listed | not listed | $10,702.41 | $9,271.65 | X | |
| 63685 | INSERT/REDO SPINE N GENERATOR | not listed | not listed | $24,642.86 | $20,858.66 | X | |
| 63688 | REVISE/REMOVE NEURORECEIVER | not listed | not listed | $3,880.14 | $3,571.47 | ||
| 64400 | NERVE BLOCK INJ, TRIGEMINAL | not listed | not listed | $237.48 | $218.58 | ||
| 64402 | NERVE BLOCK INJ, FACIAL | $280.41 | $267.23 | $219.96 | $202.47 | ||
| 64405 | NERVE BLOCK INJ, OCCIPITAL | $278.84 | $266.46 | $202.38 | $186.30 | ||
| 64412 | NERVE BLOCK INJ, SPINAL ACCESSORY | not listed | not listed | $352.14 | $324.12 | ||
| 64413 | NERVE BLOCK INJ, CERV PLEXUS | $294.62 | $281.16 | $221.13 | $203.55 | ||
| 64415 | NERVE BLOCK INJ, BRACHIAL PLEXUS | $304.42 | $290.12 | $517.89 | $476.70 | ||
| 64416 | NERVE BLOCK CONT INFUSE, B PLEX | $191.93 | $186.58 | $1,012.32 | $931.80 | ||
| 64417 | NERVE BLOCK INJ, AXILLARY | $320.99 | $305.45 | $517.89 | $476.70 | ||
| 64418 | NERVE BLOCK INJ, SUPRASCAPULAR | $344.67 | $327.13 | $303.00 | $278.91 | ||
| 64420 | NERVE BLOCK INJ, INTERCOSTAL, SING | $343.60 | $325.60 | $517.89 | $476.70 | ||
| 64421 | NERVE BLOCK INJ, INTERCOSTAL, MULT | $493.86 | $468.06 | $1,012.32 | $931.80 | ||
| 64425 | NERVE BLOCK INJ, ILIO-ING/HYPOGI | $321.93 | $307.96 | $221.13 | $203.55 | ||
| 64430 | NERVE BLOCK INJ, PUDENDAL | not listed | not listed | $1,012.32 | $931.80 | ||
| 64435 | NERVE BLOCK INJ, PARACERV | $352.78 | $335.81 | $287.79 | $264.90 | ||
| 64445 | NERVE BLOCK INJ, SCIATIC, SING | $333.50 | $317.51 | $267.93 | $246.60 | ||
| 64446 | NERVE BLOCK INJ, SCIATIC, CONT INF | not listed | not listed | $1,012.32 | $931.80 | ||
| 64447 | NERVE BLOCK INJ, FEM, SING | $295.21 | $281.61 | $221.13 | $203.55 | ||
| 64448 | NERVE BLOCK INJ, FEM, CONT INF | not listed | not listed | $1,012.32 | $931.80 | ||
| 64449 | NERVE BLOCK INJ, LUMBAR PLEXUS | $199.08 | $193.27 | $1,012.32 | $931.80 | ||
| 64450 | NERVE BLOCK, OTHER PERIPHERAL | $253.98 | $242.28 | $190.68 | $175.53 | ||
| 64455 | NERVE BLOCK INJ, PLANTAR DIGIT | not listed | not listed | $71.37 | $65.70 | ||
| 64479 | INJECT FORAMEN EPIDURAL C/T | $670.71 | $635.70 | $1,012.32 | $931.80 | ||
| 64480 | INJECT FORAMEN EPIDURAL, ADDED | $397.14 | $377.32 | $517.89 | $476.70 | ||
| 64483 | INJECT FORAMEN EPIDURAL L/S | $611.76 | $578.07 | $1,012.32 | $931.80 | ||
| 64484 | INJECT FORAMEN EPIDURAL, ADDED | $268.13 | $254.31 | $517.89 | $476.70 | ||
| 64490 | INJECT PARAVERT F JNT C/T 1 LEV | $494.93 | $469.59 | $1,012.32 | $931.80 | ||
| 64491 | INJECT PARAVERT F JNT C/T 2 LEV | $241.80 | $230.50 | $355.95 | $327.66 | ||
| 64492 | INJECT PARAVERT F JNT C/T 3 LEV | $244.49 | $233.01 | $355.95 | $327.66 | ||
| 64493 | INJECT PARAVERT F JNT L/S 1 LEV | $442.52 | $419.26 | $1,012.32 | $931.80 | ||
| 64494 | INJECT PARAVERT F JNT L/S 2 LEV | $218.85 | $208.33 | $355.95 | $327.66 | ||
| 64495 | INJECT PARAVERT F JNT L/S 3 LEV | $222.43 | $211.68 | $355.95 | $327.66 | ||
| 64505 | NERVE BLOCK SPHENOPALATINE GANGLIA | $241.39 | $230.83 | $166.14 | $152.91 | ||
| 64510 | NERVE BLOCK STELLATE GANGLION | $340.64 | $322.89 | $1,012.32 | $931.80 | ||
| 64517 | NERVE BLOCK INJ, HYPOGAS PLXS | $429.82 | $410.19 | $1,012.32 | $931.80 | ||
| 64520 | NERVE BLOCK LUMBAR/THORACIC | $486.86 | $459.82 | $1,012.32 | $931.80 | ||
| 64550 | APPLY NEUROSTIMULATOR | $25.38 | $24.14 | not payable in ASC | not payable in ASC | ||
| 64555 | IMPLANT NEUROELECTRODES | not listed | not listed | $7,941.86 | $6,926.39 | X | |
| 64561 | IMPLANT NEUROELECTRODES | not listed | not listed | $7,941.86 | $6,926.39 | X | |
| 64565 | IMPLANT NEUROELECTRODES | $286.59 | $272.61 | $7,941.86 | $6,926.39 | X | |
| 64600 | INJECTION TREAT NERVE | $673.41 | $638.56 | $1,706.88 | $1,571.10 | ||
| 64605 | INJECTION TREAT NERVE | $1,063.67 | $1,007.56 | $2,552.34 | $2,349.30 | ||
| 64610 | INJECTION TREAT NERVE | $1,180.01 | $1,125.84 | $2,552.34 | $2,349.30 | ||
| 64612 | DESTROY NERVE, FACE MUSCLE | $316.60 | $303.63 | $278.43 | $256.26 | ||
| 64613 | DESTROY NERVE, NECK MUSCLE | $302.92 | $290.62 | $260.91 | $240.15 | ||
| 64614 | DESTROY NERVE, EXTREMITY MUSC | $324.01 | $310.13 | $295.98 | $272.43 | ||
| 64620 | INJECTION TREAT NERVE | $385.92 | $368.07 | $1,012.32 | $931.80 | ||
| 64622 | DESTROY PARAVERTEBRAL NERVE L/S | $634.27 | $601.31 | $1,706.88 | $1,571.10 | ||
| 64623 | DESTROY PARAVERT NERVE, ADDED | $317.51 | $300.33 | $1,012.32 | $931.80 | ||
| 64626 | DESTROY PARAVERTEBRAL NERVE C/T | $751.82 | $713.75 | $1,012.32 | $931.80 | ||
| 64627 | DESTROY PARAVERT NERVE, ADDED | $436.29 | $411.90 | $355.95 | $327.66 | ||
| 64640 | INJECTION TREAT NERVE | $404.68 | $386.40 | $393.09 | $361.80 | ||
| 64680 | INJECTION TREAT NERVE | $594.94 | $563.72 | $1,012.32 | $931.80 | ||
| 64702 | REVISE FINGER/TOE NERVE | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64704 | REVISE HAND/FOOT NERVE | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64708 | REVISE ARM/LEG NERVE | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64712 | REVISE SCIATIC NERVE | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64713 | REVISE ARM NERVE(S) | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64714 | REVISE LOW BACK NERVE(S) | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64716 | REVISE CRANIAL NERVE | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64718 | REVISE ULNAR NERVE AT ELBOW | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64719 | REVISE ULNAR NERVE AT WRIST | not listed | not listed | $2,552.34 | $2,349.30 | ||
| 64721 | CARPAL TUNNEL SURG | $2,074.12 | $1,982.69 | $2,552.34 | $2,349.30 | ||
| 64818 | REMOVE SYMPATHETIC NERVES | $1,606.35 | $1,552.19 | not payable in ASC | not payable in ASC | ||
| 65205 | REMOVE FOREIGN BODY EYE | $132.40 | $126.72 | $90.09 | $82.92 | X | |
| 65210 | REMOVE FOREIGN BODY EYE | $164.76 | $157.50 | $117.00 | $107.70 | X | |
| 65220 | REMOVE FOREIGN BODY EYE | $136.80 | $130.87 | $129.36 | $119.07 | X | |
| 65222 | REMOVE FOREIGN BODY EYE | $181.46 | $173.50 | $127.50 | $117.36 | X | |
| 65265 | REMOVE FOREIGN BODY EYE | $2,640.72 | $2,533.79 | $3,125.70 | $2,877.06 | ||
| 67412 | EXPLORE/TREAT EYE SOCKET | $2,070.04 | $1,979.70 | $2,669.28 | $2,456.94 | ||
| 69210 | REMOVE IMPACTED EAR WAX | $80.59 | $76.92 | $89.55 | $82.44 | X | |
| 69310 | REBUILD OUTER EAR CANAL | $1,786.26 | $1,698.11 | $5,961.75 | $5,487.51 | ||
| 69320 | REBUILD OUTER EAR CANAL | $2,511.83 | $2,392.78 | $5,961.75 | $5,487.51 | ||
| 69666 | REPAIR MIDDLE EAR STRUCTURES | $3,035.82 | $2,897.99 | $5,961.75 | $5,487.51 | ||
| 69667 | REPAIR MIDDLE EAR STRUCTURES | $3,041.01 | $2,902.91 | $5,961.75 | $5,487.51 | ||
| 69990 | MICROSURG, ADDED | $529.56 | $513.23 | packaged | packaged | X, N1 |
Radiology, CPT 70000 to 79999
1,146 rows| Code | Mod | Description | Physicians’ North | Physicians’ South | ASC North | ASC South | Ind. |
|---|---|---|---|---|---|---|---|
| 70030 | X-RAY EYE FOR FOREIGN BODY | $48.10 | $45.35 | not payable in ASC | not payable in ASC | ||
| 70030 | TC | X-RAY EYE FOR FOREIGN BODY | $34.87 | $32.57 | $69.03 | $63.54 | |
| 70030 | 26 | X-RAY EYE FOR FOREIGN BODY | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 70100 | X-RAY JAW < 4 VIEWS | $55.59 | $52.37 | not payable in ASC | not payable in ASC | ||
| 70100 | TC | X-RAY JAW < 4 VIEWS | $41.28 | $38.54 | $81.87 | $75.36 | |
| 70100 | 26 | X-RAY JAW < 4 VIEWS | $14.31 | $13.83 | not payable in ASC | not payable in ASC | |
| 70110 | X-RAY JAW MINIMUM 4 VIEWS | $66.14 | $62.37 | not payable in ASC | not payable in ASC | ||
| 70110 | TC | X-RAY JAW MINIMUM 4 VIEWS | $47.11 | $43.97 | $87.24 | $80.31 | |
| 70110 | 26 | X-RAY JAW MINIMUM 4 VIEWS | $19.03 | $18.40 | not payable in ASC | not payable in ASC | |
| 70120 | X-RAY MASTOIDS < 3 VIEWS/SIDE | $59.09 | $55.62 | not payable in ASC | not payable in ASC | ||
| 70120 | TC | X-RAY MASTOIDS < 3 VIEWS/SIDE | $44.78 | $41.81 | $87.24 | $80.31 | |
| 70120 | 26 | X-RAY MASTOIDS < 3 VIEWS/SIDE | $14.31 | $13.83 | not payable in ASC | not payable in ASC | |
| 70130 | X-RAY MASTOIDS MINIMUM 3 VIEWS/SIDE | $93.99 | $88.58 | not payable in ASC | not payable in ASC | ||
| 70130 | TC | X-RAY MASTOIDS MINIMUM 3 VIEWS/SIDE | $68.07 | $63.54 | $87.24 | $80.31 | |
| 70130 | 26 | X-RAY MASTOIDS MINIMUM 3 VIEWS/SIDE | $25.92 | $25.05 | not payable in ASC | not payable in ASC | |
| 70140 | X-RAY FACIAL BONES < 3 VIEWS | $50.86 | $47.98 | not payable in ASC | not payable in ASC | ||
| 70140 | TC | X-RAY FACIAL BONES < 3 VIEWS | $35.46 | $33.11 | $70.20 | $64.62 | |
| 70140 | 26 | X-RAY FACIAL BONES < 3 VIEWS | $15.40 | $14.86 | not payable in ASC | not payable in ASC | |
| 70150 | X-RAY FACIAL BONES MINIMUM 3 VIEWS | $71.88 | $67.76 | not payable in ASC | not payable in ASC | ||
| 70150 | TC | X-RAY FACIAL BONES MINIMUM 3 VIEWS | $51.76 | $48.32 | $87.24 | $80.31 | |
| 70150 | 26 | X-RAY FACIAL BONES MINIMUM 3 VIEWS | $20.12 | $19.44 | not payable in ASC | not payable in ASC | |
| 70160 | X-RAY NASAL BONES MINIMUM 3 VIEWS | $55.66 | $52.41 | not payable in ASC | not payable in ASC | ||
| 70160 | TC | X-RAY NASAL BONES MINIMUM 3 VIEWS | $42.45 | $39.63 | $84.21 | $77.52 | |
| 70160 | 26 | X-RAY NASAL BONES MINIMUM 3 VIEWS | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 70190 | X-RAY OPTIC FORAMINA | $60.03 | $56.57 | not payable in ASC | not payable in ASC | ||
| 70190 | TC | X-RAY OPTIC FORAMINA | $43.61 | $40.71 | $86.55 | $79.68 | |
| 70190 | 26 | X-RAY OPTIC FORAMINA | $16.41 | $15.86 | not payable in ASC | not payable in ASC | |
| 70200 | X-RAY ORBITS, MINIMUM 4 VIEWS | $74.07 | $69.85 | not payable in ASC | not payable in ASC | ||
| 70200 | TC | X-RAY ORBITS, MINIMUM 4 VIEWS | $52.34 | $48.86 | $87.24 | $80.31 | |
| 70200 | 26 | X-RAY ORBITS, MINIMUM 4 VIEWS | $21.71 | $20.98 | not payable in ASC | not payable in ASC | |
| 70210 | X-RAY SINUSES < 3 VIEWS | $52.17 | $49.16 | not payable in ASC | not payable in ASC | ||
| 70210 | TC | X-RAY SINUSES < 3 VIEWS | $38.37 | $35.83 | $76.02 | $69.99 | |
| 70210 | 26 | X-RAY SINUSES < 3 VIEWS | $13.80 | $13.33 | not payable in ASC | not payable in ASC | |
| 70220 | X-RAY SINUSES MINIMUM 3 VIEWS | $64.97 | $61.29 | not payable in ASC | not payable in ASC | ||
| 70220 | TC | X-RAY SINUSES MINIMUM 3 VIEWS | $45.94 | $42.89 | $87.24 | $80.31 | |
| 70220 | 26 | X-RAY SINUSES MINIMUM 3 VIEWS | $19.03 | $18.40 | not payable in ASC | not payable in ASC | |
| 70250 | X-RAY SKULL < 4 VIEWS | $62.13 | $58.62 | not payable in ASC | not payable in ASC | ||
| 70250 | TC | X-RAY SKULL < 4 VIEWS | $43.03 | $40.17 | $85.38 | $78.60 | |
| 70250 | 26 | X-RAY SKULL < 4 VIEWS | $19.10 | $18.45 | not payable in ASC | not payable in ASC | |
| 70260 | X-RAY SKULL MINIMUM 4 VIEWS | $78.86 | $74.45 | not payable in ASC | not payable in ASC | ||
| 70260 | TC | X-RAY SKULL MINIMUM 4 VIEWS | $52.92 | $49.41 | $105.30 | $96.93 | |
| 70260 | 26 | X-RAY SKULL MINIMUM 4 VIEWS | $25.92 | $25.05 | not payable in ASC | not payable in ASC | |
| 70300 | X-RAY TEETH SINGLE VIEW | $24.17 | $22.85 | not payable in ASC | not payable in ASC | ||
| 70300 | TC | X-RAY TEETH SINGLE VIEW | $15.08 | $14.10 | $29.22 | $26.91 | |
| 70300 | 26 | X-RAY TEETH SINGLE VIEW | $9.09 | $8.75 | not payable in ASC | not payable in ASC | |
| 70310 | X-RAY TEETH < FULL MOUTH | $63.31 | $59.51 | not payable in ASC | not payable in ASC | ||
| 70310 | TC | X-RAY TEETH < FULL MOUTH | $49.44 | $46.14 | $59.04 | $54.36 | |
| 70310 | 26 | X-RAY TEETH < FULL MOUTH | $13.88 | $13.37 | not payable in ASC | not payable in ASC | |
| 70320 | X-RAY TEETH FULL MOUTH | $83.72 | $79.89 | not payable in ASC | not payable in ASC | ||
| 70320 | TC | X-RAY TEETH FULL MOUTH | $66.90 | $62.44 | $59.04 | $54.36 | |
| 70320 | 26 | X-RAY TEETH FULL MOUTH | $18.09 | $17.45 | not payable in ASC | not payable in ASC | |
| 70328 | X-RAY TMJ UNILATERAL | $52.10 | $49.11 | not payable in ASC | not payable in ASC | ||
| 70328 | TC | X-RAY TMJ UNILATERAL | $37.79 | $35.29 | $74.85 | $68.91 | |
| 70328 | 26 | X-RAY TMJ UNILATERAL | $14.31 | $13.83 | not payable in ASC | not payable in ASC | |
| 70330 | X-RAY TMJ BILATERAL | $81.34 | $76.54 | not payable in ASC | not payable in ASC | ||
| 70330 | TC | X-RAY TMJ BILATERAL | $62.24 | $58.09 | $87.24 | $80.31 | |
| 70330 | 26 | X-RAY TMJ BILATERAL | $19.10 | $18.45 | not payable in ASC | not payable in ASC | |
| 70332 | TMJ ARTHOGRAPHY; RAD SUPER & INTERP | $143.03 | $134.89 | packaged | packaged | N1 | |
| 70332 | TC | TMJ ARTHOGRAPHY; RAD SUPER & INTERP | $98.34 | $91.77 | packaged | packaged | N1 |
| 70332 | 26 | TMJ ARTHOGRAPHY; RAD SUPER & INTERP | $44.68 | $43.10 | packaged | packaged | N1 |
| 70336 | MRI TMJ | $763.99 | $716.59 | not payable in ASC | not payable in ASC | ||
| 70336 | TC | MRI TMJ | $649.78 | $606.18 | $664.20 | $611.37 | |
| 70336 | 26 | MRI TMJ | $114.20 | $110.43 | not payable in ASC | not payable in ASC | |
| 70350 | CEPHALOGRAM, ORTHODONTIC | $35.29 | $33.41 | not payable in ASC | not payable in ASC | ||
| 70350 | TC | CEPHALOGRAM, ORTHODONTIC | $20.32 | $18.99 | $39.78 | $36.60 | |
| 70350 | 26 | CEPHALOGRAM, ORTHODONTIC | $14.96 | $14.41 | not payable in ASC | not payable in ASC | |
| 70355 | ORTHOPANTOGRAM | $35.64 | $33.81 | not payable in ASC | not payable in ASC | ||
| 70355 | TC | ORTHOPANTOGRAM | $19.16 | $17.91 | $37.44 | $34.44 | |
| 70355 | 26 | ORTHOPANTOGRAM | $16.50 | $15.90 | not payable in ASC | not payable in ASC | |
| 70360 | X-RAY NECK SOFT TISSUE | $46.36 | $43.73 | not payable in ASC | not payable in ASC | ||
| 70360 | TC | X-RAY NECK SOFT TISSUE | $33.13 | $30.94 | $65.52 | $60.30 | |
| 70360 | 26 | X-RAY NECK SOFT TISSUE | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 70450 | CT HEAD/BRAIN W/O DYE | $426.03 | $400.31 | not payable in ASC | not payable in ASC | ||
| 70450 | TC | CT HEAD/BRAIN W/O DYE | $341.76 | $318.85 | $375.45 | $345.60 | |
| 70450 | 26 | CT HEAD/BRAIN W/O DYE | $84.27 | $81.46 | not payable in ASC | not payable in ASC | |
| 70460 | CT HEAD/BRAIN W/DYE | $431.97 | $405.92 | not payable in ASC | not payable in ASC | ||
| 70460 | TC | CT HEAD/BRAIN W/DYE | $344.66 | $321.55 | $580.71 | $534.51 | |
| 70460 | 26 | CT HEAD/BRAIN W/DYE | $87.31 | $84.38 | not payable in ASC | not payable in ASC | |
| 70470 | CT HEAD/BRAIN W/O & W/DYE | $523.38 | $491.61 | not payable in ASC | not payable in ASC | ||
| 70470 | TC | CT HEAD/BRAIN W/O & W/DYE | $424.43 | $395.96 | $647.37 | $595.86 | |
| 70470 | 26 | CT HEAD/BRAIN W/O & W/DYE | $98.95 | $95.65 | not payable in ASC | not payable in ASC | |
| 70480 | CT ORBIT/EAR/FOSSA W/O DYE | $531.46 | $499.17 | not payable in ASC | not payable in ASC | ||
| 70480 | TC | CT ORBIT/EAR/FOSSA W/O DYE | $431.99 | $403.02 | $375.45 | $345.60 | |
| 70480 | 26 | CT ORBIT/EAR/FOSSA W/O DYE | $99.46 | $96.15 | not payable in ASC | not payable in ASC | |
| 70481 | CT ORBIT/EAR/FOSSA W/DYE | $617.99 | $580.17 | not payable in ASC | not payable in ASC | ||
| 70481 | TC | CT ORBIT/EAR/FOSSA W/DYE | $510.61 | $476.35 | $580.71 | $534.51 | |
| 70481 | 26 | CT ORBIT/EAR/FOSSA W/DYE | $107.38 | $103.82 | not payable in ASC | not payable in ASC | |
| 70482 | CT ORBIT/EAR/FOSSA W/O & W/DYE | $698.40 | $655.36 | not payable in ASC | not payable in ASC | ||
| 70482 | TC | CT ORBIT/EAR/FOSSA W/O & W/DYE | $586.31 | $546.96 | $647.37 | $595.86 | |
| 70482 | 26 | CT ORBIT/EAR/FOSSA W/O & W/DYE | $112.09 | $108.39 | not payable in ASC | not payable in ASC | |
| 70486 | CT MAXILLOFACIAL W/O DYE | $442.37 | $415.65 | not payable in ASC | not payable in ASC | ||
| 70486 | TC | CT MAXILLOFACIAL W/O DYE | $353.98 | $330.23 | $375.45 | $345.60 | |
| 70486 | 26 | CT MAXILLOFACIAL W/O DYE | $88.41 | $85.42 | not payable in ASC | not payable in ASC | |
| 70487 | CT MAXILLOFACIAL W/DYE | $533.63 | $501.24 | not payable in ASC | not payable in ASC | ||
| 70487 | TC | CT MAXILLOFACIAL W/DYE | $432.58 | $403.56 | $580.71 | $534.51 | |
| 70487 | 26 | CT MAXILLOFACIAL W/DYE | $101.05 | $97.69 | not payable in ASC | not payable in ASC | |
| 70488 | CT MAXILLOFACIAL W/O & W/DYE | $649.72 | $609.86 | not payable in ASC | not payable in ASC | ||
| 70488 | TC | CT MAXILLOFACIAL W/O & W/DYE | $539.73 | $503.52 | $647.37 | $595.86 | |
| 70488 | 26 | CT MAXILLOFACIAL W/O & W/DYE | $109.99 | $106.35 | not payable in ASC | not payable in ASC | |
| 70490 | CT SOFT TISSUE NECK W/O DYE | $432.46 | $406.83 | not payable in ASC | not payable in ASC | ||
| 70490 | TC | CT SOFT TISSUE NECK W/O DYE | $333.02 | $310.68 | $375.45 | $345.60 | |
| 70490 | 26 | CT SOFT TISSUE NECK W/O DYE | $99.46 | $96.15 | not payable in ASC | not payable in ASC | |
| 70491 | CT SOFT TISSUE NECK W/DYE | $521.98 | $490.57 | not payable in ASC | not payable in ASC | ||
| 70491 | TC | CT SOFT TISSUE NECK W/DYE | $415.11 | $387.27 | $580.71 | $534.51 | |
| 70491 | 26 | CT SOFT TISSUE NECK W/DYE | $106.87 | $103.30 | not payable in ASC | not payable in ASC | |
| 70492 | CT SOFT TISSUE NECK W/O & W/DYE | $632.03 | $593.43 | not payable in ASC | not payable in ASC | ||
| 70492 | TC | CT SOFT TISSUE NECK W/O & W/DYE | $519.93 | $485.04 | $647.37 | $595.86 | |
| 70492 | 26 | CT SOFT TISSUE NECK W/O & W/DYE | $112.09 | $108.39 | not payable in ASC | not payable in ASC | |
| 70496 | CT ANGIOGRAPHY, HEAD | $1,008.14 | $945.09 | not payable in ASC | not payable in ASC | ||
| 70496 | TC | CT ANGIOGRAPHY, HEAD | $871.63 | $813.13 | $655.71 | $603.54 | |
| 70496 | 26 | CT ANGIOGRAPHY, HEAD | $136.51 | $131.96 | not payable in ASC | not payable in ASC | |
| 70498 | CT ANGIOGRAPHY, NECK | $1,025.62 | $961.39 | not payable in ASC | not payable in ASC | ||
| 70498 | TC | CT ANGIOGRAPHY, NECK | $889.10 | $829.43 | $655.71 | $603.54 | |
| 70498 | 26 | CT ANGIOGRAPHY, NECK | $136.51 | $131.96 | not payable in ASC | not payable in ASC | |
| 70540 | MRI ORBIT/FACE/NECK W/O DYE | $849.38 | $795.95 | not payable in ASC | not payable in ASC | ||
| 70540 | TC | MRI ORBIT/FACE/NECK W/O DYE | $744.69 | $694.71 | $664.20 | $611.37 | |
| 70540 | 26 | MRI ORBIT/FACE/NECK W/O DYE | $104.69 | $101.24 | not payable in ASC | not payable in ASC | |
| 70542 | MRI ORBIT/FACE/NECK W/DYE | $948.56 | $889.20 | not payable in ASC | not payable in ASC | ||
| 70542 | TC | MRI ORBIT/FACE/NECK W/DYE | $822.72 | $767.50 | $846.36 | $779.04 | |
| 70542 | 26 | MRI ORBIT/FACE/NECK W/DYE | $125.84 | $121.69 | not payable in ASC | not payable in ASC | |
| 70543 | MRI ORBIT/FACE/NECK W/O & W/DYE | $1,239.11 | $1,161.59 | not payable in ASC | not payable in ASC | ||
| 70543 | TC | MRI ORBIT/FACE/NECK W/O & W/DYE | $1,073.12 | $1,001.07 | $1,033.50 | $951.27 | |
| 70543 | 26 | MRI ORBIT/FACE/NECK W/O & W/DYE | $166.00 | $160.53 | not payable in ASC | not payable in ASC | |
| 70544 | MR ANGIOGRAPHY HEAD W/O DYE | $930.92 | $871.62 | not payable in ASC | not payable in ASC | ||
| 70544 | TC | MR ANGIOGRAPHY HEAD W/O DYE | $837.86 | $781.62 | $664.20 | $611.37 | |
| 70544 | 26 | MR ANGIOGRAPHY HEAD W/O DYE | $93.07 | $90.00 | not payable in ASC | not payable in ASC | |
| 70545 | MR ANGIOGRAPHY HEAD W/DYE | $925.11 | $866.18 | not payable in ASC | not payable in ASC | ||
| 70545 | TC | MR ANGIOGRAPHY HEAD W/DYE | $832.04 | $776.19 | $846.36 | $779.04 | |
| 70545 | 26 | MR ANGIOGRAPHY HEAD W/DYE | $93.07 | $90.00 | not payable in ASC | not payable in ASC | |
| 70546 | MR ANGIOGRAPH HEAD W/O & W/DYE | $1,457.83 | $1,364.72 | not payable in ASC | not payable in ASC | ||
| 70546 | TC | MR ANGIOGRAPH HEAD W/O & W/DYE | $1,317.67 | $1,229.21 | $1,033.50 | $951.27 | |
| 70546 | 26 | MR ANGIOGRAPH HEAD W/O & W/DYE | $140.15 | $135.51 | not payable in ASC | not payable in ASC | |
| 70547 | MR ANGIOGRAPHY NECK W/O DYE | $929.19 | $869.99 | not payable in ASC | not payable in ASC | ||
| 70547 | TC | MR ANGIOGRAPHY NECK W/O DYE | $836.11 | $779.99 | $664.20 | $611.37 | |
| 70547 | 26 | MR ANGIOGRAPHY NECK W/O DYE | $93.07 | $90.00 | not payable in ASC | not payable in ASC | |
| 70548 | MR ANGIOGRAPHY NECK W/DYE | $975.77 | $913.44 | not payable in ASC | not payable in ASC | ||
| 70548 | TC | MR ANGIOGRAPHY NECK W/DYE | $882.71 | $823.45 | $846.36 | $779.04 | |
| 70548 | 26 | MR ANGIOGRAPHY NECK W/DYE | $93.07 | $90.00 | not payable in ASC | not payable in ASC | |
| 70549 | MR ANGIOGRAPH NECK W/O & W/DYE | $1,458.47 | $1,365.29 | not payable in ASC | not payable in ASC | ||
| 70549 | TC | MR ANGIOGRAPH NECK W/O & W/DYE | $1,318.84 | $1,230.29 | $1,033.50 | $951.27 | |
| 70549 | 26 | MR ANGIOGRAPH NECK W/O & W/DYE | $139.64 | $135.00 | not payable in ASC | not payable in ASC | |
| 70551 | MRI BRAIN W/O DYE | $878.11 | $823.06 | not payable in ASC | not payable in ASC | ||
| 70551 | TC | MRI BRAIN W/O DYE | $763.33 | $712.09 | $664.20 | $611.37 | |
| 70551 | 26 | MRI BRAIN W/O DYE | $114.78 | $110.97 | not payable in ASC | not payable in ASC | |
| 70552 | MRI BRAIN W/DYE | $978.74 | $917.78 | not payable in ASC | not payable in ASC | ||
| 70552 | TC | MRI BRAIN W/DYE | $839.60 | $783.26 | $846.36 | $779.04 | |
| 70552 | 26 | MRI BRAIN W/DYE | $139.14 | $134.52 | not payable in ASC | not payable in ASC | |
| 70553 | MRI BRAIN W/O & W/DYE | $1,228.68 | $1,152.44 | not payable in ASC | not payable in ASC | ||
| 70553 | TC | MRI BRAIN W/O & W/DYE | $1,045.16 | $974.99 | $1,033.50 | $951.27 | |
| 70553 | 26 | MRI BRAIN W/O & W/DYE | $183.52 | $177.45 | not payable in ASC | not payable in ASC | |
| 70554 | FMRI BRAIN BY TECH | $964.57 | $905.39 | not payable in ASC | not payable in ASC | ||
| 70554 | TC | FMRI BRAIN BY TECH | $799.43 | $745.77 | $664.20 | $611.37 | |
| 70554 | 26 | FMRI BRAIN BY TECH | $165.14 | $159.62 | not payable in ASC | not payable in ASC | |
| 70555 | 26 | FMRI BRAIN BY PHYS/PSYCH | $203.10 | $196.49 | not payable in ASC | not payable in ASC | |
| 71010 | CHEST X-RAY SINGLE VIEW FRONTAL | $46.85 | $44.31 | not payable in ASC | not payable in ASC | ||
| 71010 | TC | CHEST X-RAY SINGLE VIEW FRONTAL | $30.48 | $28.47 | $50.31 | $46.29 | |
| 71010 | 26 | CHEST X-RAY SINGLE VIEW FRONTAL | $16.37 | $15.84 | not payable in ASC | not payable in ASC | |
| 71020 | CHEST X-RAY 2 VIEWS FRONTAL & LATERAL | $55.78 | $52.69 | not payable in ASC | not payable in ASC | ||
| 71020 | TC | CHEST X-RAY 2 VIEWS FRONTAL & LATERAL | $37.56 | $35.08 | $69.03 | $63.54 | |
| 71020 | 26 | CHEST X-RAY 2 VIEWS FRONTAL & LATERAL | $18.23 | $17.61 | not payable in ASC | not payable in ASC | |
| 71021 | CHEST X-RAY 2 VIEWS W/APICAL LORD PROC | $63.65 | $60.11 | not payable in ASC | not payable in ASC | ||
| 71021 | TC | CHEST X-RAY 2 VIEWS W/APICAL LORD PROC | $43.03 | $40.17 | $85.38 | $78.60 | |
| 71021 | 26 | CHEST X-RAY 2 VIEWS W/APICAL LORD PROC | $20.62 | $19.94 | not payable in ASC | not payable in ASC | |
| 71022 | CHEST X-RAY 2 VIEWS W/OBLIQUE PROJ | $77.92 | $73.51 | not payable in ASC | not payable in ASC | ||
| 71022 | TC | CHEST X-RAY 2 VIEWS W/OBLIQUE PROJ | $54.09 | $50.49 | $87.24 | $80.31 | |
| 71022 | 26 | CHEST X-RAY 2 VIEWS W/OBLIQUE PROJ | $23.82 | $23.01 | not payable in ASC | not payable in ASC | |
| 71030 | CHEST X-RAY MINIMUM 4 VIEWS | $77.34 | $72.96 | not payable in ASC | not payable in ASC | ||
| 71030 | TC | CHEST X-RAY MINIMUM 4 VIEWS | $53.50 | $49.95 | $87.24 | $80.31 | |
| 71030 | 26 | CHEST X-RAY MINIMUM 4 VIEWS | $23.82 | $23.01 | not payable in ASC | not payable in ASC | |
| 71035 | CHEST X-RAY SPECIAL VIEWS | $59.67 | $56.18 | not payable in ASC | not payable in ASC | ||
| 71035 | TC | CHEST X-RAY SPECIAL VIEWS | $45.36 | $42.35 | $87.24 | $80.31 | |
| 71035 | 26 | CHEST X-RAY SPECIAL VIEWS | $14.31 | $13.83 | not payable in ASC | not payable in ASC | |
| 71040 | CONTRAST X-RAY BRONCHI UNILATERAL | $162.07 | $152.67 | packaged | packaged | N1 | |
| 71040 | TC | CONTRAST X-RAY BRONCHI UNILATERAL | $118.73 | $110.79 | packaged | packaged | N1 |
| 71040 | 26 | CONTRAST X-RAY BRONCHI UNILATERAL | $43.34 | $41.88 | packaged | packaged | N1 |
| 71090 | X-RAY & PACEMAKER INSERT | $169.62 | $163.54 | packaged | packaged | N1 | |
| 71090 | TC | X-RAY & PACEMAKER INSERT | $123.65 | $119.31 | packaged | packaged | N1 |
| 71090 | 26 | X-RAY & PACEMAKER INSERT | $44.62 | $43.09 | packaged | packaged | N1 |
| 71100 | X-RAY RIBS 2 VIEWS | $54.13 | $51.10 | not payable in ASC | not payable in ASC | ||
| 71100 | TC | X-RAY RIBS 2 VIEWS | $37.20 | $34.75 | $73.71 | $67.86 | |
| 71100 | 26 | X-RAY RIBS 2 VIEWS | $16.93 | $16.36 | not payable in ASC | not payable in ASC | |
| 71101 | X-RAY RIBS/CHEST MINIMUM 3 VIEWS | $82.73 | $78.10 | not payable in ASC | not payable in ASC | ||
| 71101 | TC | X-RAY RIBS/CHEST MINIMUM 3 VIEWS | $56.88 | $53.10 | $87.24 | $80.31 | |
| 71101 | 26 | X-RAY RIBS/CHEST MINIMUM 3 VIEWS | $25.85 | $25.00 | not payable in ASC | not payable in ASC | |
| 71110 | X-RAY RIBS BILATERAL 3 VIEWS | $68.31 | $64.46 | not payable in ASC | not payable in ASC | ||
| 71110 | TC | X-RAY RIBS BILATERAL 3 VIEWS | $47.69 | $44.52 | $87.24 | $80.31 | |
| 71110 | 26 | X-RAY RIBS BILATERAL 3 VIEWS | $20.62 | $19.94 | not payable in ASC | not payable in ASC | |
| 71111 | X-RAY RIBS/CHEST MINIMUM 4 VIEWS | $88.32 | $83.23 | not payable in ASC | not payable in ASC | ||
| 71111 | TC | X-RAY RIBS/CHEST MINIMUM 4 VIEWS | $63.99 | $59.73 | $127.50 | $117.36 | |
| 71111 | 26 | X-RAY RIBS/CHEST MINIMUM 4 VIEWS | $24.33 | $23.50 | not payable in ASC | not payable in ASC | |
| 71120 | X-RAY STERNUM MINIMUM 2 VIEWS | $53.70 | $50.65 | not payable in ASC | not payable in ASC | ||
| 71120 | TC | X-RAY STERNUM MINIMUM 2 VIEWS | $38.37 | $35.83 | $76.02 | $69.99 | |
| 71120 | 26 | X-RAY STERNUM MINIMUM 2 VIEWS | $15.33 | $14.82 | not payable in ASC | not payable in ASC | |
| 71130 | X-RAY STERNOCLAV JOINT MINIMUM 3 VIEWS | $62.87 | $59.24 | not payable in ASC | not payable in ASC | ||
| 71130 | TC | X-RAY STERNOCLAV JOINT MINIMUM 3 VIEWS | $45.94 | $42.89 | $87.24 | $80.31 | |
| 71130 | 26 | X-RAY STERNOCLAV JOINT MINIMUM 3 VIEWS | $16.93 | $16.36 | not payable in ASC | not payable in ASC | |
| 71250 | CT THORAX W/O DYE | $423.62 | $397.82 | not payable in ASC | not payable in ASC | ||
| 71250 | TC | CT THORAX W/O DYE | $344.07 | $320.99 | $375.45 | $345.60 | |
| 71250 | 26 | CT THORAX W/O DYE | $79.55 | $76.82 | not payable in ASC | not payable in ASC | |
| 71260 | CT THORAX W/DYE | $525.35 | $493.37 | not payable in ASC | not payable in ASC | ||
| 71260 | TC | CT THORAX W/DYE | $428.51 | $399.76 | $580.71 | $534.51 | |
| 71260 | 26 | CT THORAX W/DYE | $96.85 | $93.61 | not payable in ASC | not payable in ASC | |
| 71270 | CT THORAX W/O & W/DYE | $646.01 | $606.26 | not payable in ASC | not payable in ASC | ||
| 71270 | TC | CT THORAX W/O & W/DYE | $539.14 | $502.96 | $647.37 | $595.86 | |
| 71270 | 26 | CT THORAX W/O & W/DYE | $106.87 | $103.30 | not payable in ASC | not payable in ASC | |
| 71275 | CT ANGIOGRAPHY, CHEST | $802.43 | $753.64 | not payable in ASC | not payable in ASC | ||
| 71275 | TC | CT ANGIOGRAPHY, CHEST | $652.69 | $608.89 | $655.71 | $603.54 | |
| 71275 | 26 | CT ANGIOGRAPHY, CHEST | $149.74 | $144.75 | not payable in ASC | not payable in ASC | |
| 71550 | MRI CHEST W/O DYE | $960.37 | $899.74 | not payable in ASC | not payable in ASC | ||
| 71550 | TC | MRI CHEST W/O DYE | $847.76 | $790.86 | $664.20 | $611.37 | |
| 71550 | 26 | MRI CHEST W/O DYE | $112.61 | $108.88 | not payable in ASC | not payable in ASC | |
| 71552 | MRI CHEST W/O & W/DYE | $1,425.20 | $1,335.46 | not payable in ASC | not payable in ASC | ||
| 71552 | TC | MRI CHEST W/O & W/DYE | $1,249.54 | $1,165.66 | $1,033.50 | $951.27 | |
| 71552 | 26 | MRI CHEST W/O & W/DYE | $175.66 | $169.81 | not payable in ASC | not payable in ASC | |
| 71555 | MRI ANGIO CHEST W OR W/O DYE | $940.15 | $881.81 | not payable in ASC | not payable in ASC | ||
| 71555 | TC | MRI ANGIO CHEST W OR W/O DYE | $798.85 | $745.23 | not payable in ASC | not payable in ASC | |
| 71555 | 26 | MRI ANGIO CHEST W OR W/O DYE | $141.30 | $136.58 | not payable in ASC | not payable in ASC | |
| 72010 | X-RAY SPINE ANTEROPOST & LATERAL | $124.49 | $117.37 | not payable in ASC | not payable in ASC | ||
| 72010 | TC | X-RAY SPINE ANTEROPOST & LATERAL | $89.03 | $83.09 | $146.91 | $135.24 | |
| 72010 | 26 | X-RAY SPINE ANTEROPOST & LATERAL | $35.46 | $34.28 | not payable in ASC | not payable in ASC | |
| 72020 | X-RAY SPINE SINGLE VIEW SPECIFY LEVEL | $40.10 | $37.84 | not payable in ASC | not payable in ASC | ||
| 72020 | TC | X-RAY SPINE SINGLE VIEW SPECIFY LEVEL | $27.88 | $26.05 | $54.99 | $50.61 | |
| 72020 | 26 | X-RAY SPINE SINGLE VIEW SPECIFY LEVEL | $12.21 | $11.79 | not payable in ASC | not payable in ASC | |
| 72040 | X-RAY NECK SPINE CERV 2/3 VIEWS | $102.52 | $96.69 | not payable in ASC | not payable in ASC | ||
| 72040 | TC | X-RAY NECK SPINE CERV 2/3 VIEWS | $73.56 | $68.66 | $87.24 | $80.31 | |
| 72040 | 26 | X-RAY NECK SPINE CERV 2/3 VIEWS | $28.96 | $28.03 | not payable in ASC | not payable in ASC | |
| 72050 | X-RAY NECK SPINE CERV MINIMUM 4 VIEWS | $119.60 | $112.79 | not payable in ASC | not payable in ASC | ||
| 72050 | TC | X-RAY NECK SPINE CERV MINIMUM 4 VIEWS | $86.14 | $80.40 | $127.50 | $117.36 | |
| 72050 | 26 | X-RAY NECK SPINE CERV MINIMUM 4 VIEWS | $33.46 | $32.39 | not payable in ASC | not payable in ASC | |
| 72052 | X-RAY NECK SPINE COMPLETE | $147.68 | $139.10 | not payable in ASC | not payable in ASC | ||
| 72052 | TC | X-RAY NECK SPINE COMPLETE | $110.33 | $102.97 | $146.91 | $135.24 | |
| 72052 | 26 | X-RAY NECK SPINE COMPLETE | $37.35 | $36.13 | not payable in ASC | not payable in ASC | |
| 72069 | X-RAY TRUNK SPINE STANDING | $62.74 | $59.20 | not payable in ASC | not payable in ASC | ||
| 72069 | TC | X-RAY TRUNK SPINE STANDING | $44.20 | $41.25 | $87.24 | $80.31 | |
| 72069 | 26 | X-RAY TRUNK SPINE STANDING | $18.55 | $17.95 | not payable in ASC | not payable in ASC | |
| 72070 | X-RAY THORACIC SPINE 2 VIEWS | $80.74 | $76.17 | not payable in ASC | not payable in ASC | ||
| 72070 | TC | X-RAY THORACIC SPINE 2 VIEWS | $55.96 | $52.26 | $78.36 | $72.12 | |
| 72070 | 26 | X-RAY THORACIC SPINE 2 VIEWS | $24.78 | $23.92 | not payable in ASC | not payable in ASC | |
| 72072 | X-RAY THORACIC SPINE 3 VIEWS | $63.45 | $59.80 | not payable in ASC | not payable in ASC | ||
| 72072 | TC | X-RAY THORACIC SPINE 3 VIEWS | $46.53 | $43.43 | $87.24 | $80.31 | |
| 72072 | 26 | X-RAY THORACIC SPINE 3 VIEWS | $16.93 | $16.36 | not payable in ASC | not payable in ASC | |
| 72074 | X-RAY THORACIC SPINE MINIMUM 4 VIEWS | $75.09 | $70.66 | not payable in ASC | not payable in ASC | ||
| 72074 | TC | X-RAY THORACIC SPINE MINIMUM 4 VIEWS | $58.16 | $54.30 | $87.24 | $80.31 | |
| 72074 | 26 | X-RAY THORACIC SPINE MINIMUM 4 VIEWS | $16.93 | $16.36 | not payable in ASC | not payable in ASC | |
| 72080 | X-RAY TRUNK SPINE 2 VIEWS | $61.58 | $58.12 | not payable in ASC | not payable in ASC | ||
| 72080 | TC | X-RAY TRUNK SPINE 2 VIEWS | $43.03 | $40.17 | $85.38 | $78.60 | |
| 72080 | 26 | X-RAY TRUNK SPINE 2 VIEWS | $18.55 | $17.95 | not payable in ASC | not payable in ASC | |
| 72090 | X-RAY TRUNK SPINE SCOLIOSIS STUDY | $83.19 | $78.46 | not payable in ASC | not payable in ASC | ||
| 72090 | TC | X-RAY TRUNK SPINE SCOLIOSIS STUDY | $59.33 | $55.38 | $118.17 | $108.78 | |
| 72090 | 26 | X-RAY TRUNK SPINE SCOLIOSIS STUDY | $23.86 | $23.08 | not payable in ASC | not payable in ASC | |
| 72100 | X-RAY LOWER SPINE 2/3 VIEWS | $68.57 | $64.63 | not payable in ASC | not payable in ASC | ||
| 72100 | TC | X-RAY LOWER SPINE 2/3 VIEWS | $50.02 | $46.70 | $87.24 | $80.31 | |
| 72100 | 26 | X-RAY LOWER SPINE 2/3 VIEWS | $18.55 | $17.95 | not payable in ASC | not payable in ASC | |
| 72110 | X-RAY LOWER SPINE MINIMUM 4 VIEWS | $129.47 | $122.01 | not payable in ASC | not payable in ASC | ||
| 72110 | TC | X-RAY LOWER SPINE MINIMUM 4 VIEWS | $95.06 | $88.72 | $136.86 | $125.97 | |
| 72110 | 26 | X-RAY LOWER SPINE MINIMUM 4 VIEWS | $34.41 | $33.31 | not payable in ASC | not payable in ASC | |
| 72114 | X-RAY LOWER SPINE COMPLETE | $125.68 | $118.29 | not payable in ASC | not payable in ASC | ||
| 72114 | TC | X-RAY LOWER SPINE COMPLETE | $96.02 | $89.60 | $146.91 | $135.24 | |
| 72114 | 26 | X-RAY LOWER SPINE COMPLETE | $29.67 | $28.69 | not payable in ASC | not payable in ASC | |
| 72120 | X-RAY LOWER SPINE BENDING MINIMUM 4 VIEWS | $87.20 | $82.01 | not payable in ASC | not payable in ASC | ||
| 72120 | TC | X-RAY LOWER SPINE BENDING MINIMUM 4 VIEWS | $68.65 | $64.08 | $87.24 | $80.31 | |
| 72120 | 26 | X-RAY LOWER SPINE BENDING MINIMUM 4 VIEWS | $18.55 | $17.95 | not payable in ASC | not payable in ASC | |
| 72125 | CT NECK SPINE W/O DYE | $425.96 | $399.99 | not payable in ASC | not payable in ASC | ||
| 72125 | TC | CT NECK SPINE W/O DYE | $346.40 | $323.17 | $375.45 | $345.60 | |
| 72125 | 26 | CT NECK SPINE W/O DYE | $79.55 | $76.82 | not payable in ASC | not payable in ASC | |
| 72126 | CT NECK SPINE W/DYE | $524.34 | $492.38 | not payable in ASC | not payable in ASC | ||
| 72126 | TC | CT NECK SPINE W/DYE | $429.68 | $400.84 | $580.71 | $534.51 | |
| 72126 | 26 | CT NECK SPINE W/DYE | $94.66 | $91.53 | not payable in ASC | not payable in ASC | |
| 72127 | CT NECK SPINE W/O & W/DYE | $636.93 | $597.54 | not payable in ASC | not payable in ASC | ||
| 72127 | TC | CT NECK SPINE W/O & W/DYE | $538.56 | $502.42 | $647.37 | $595.86 | |
| 72127 | 26 | CT NECK SPINE W/O & W/DYE | $98.37 | $95.11 | not payable in ASC | not payable in ASC | |
| 72128 | CT CHEST SPINE W/O DYE | $425.37 | $399.45 | not payable in ASC | not payable in ASC | ||
| 72128 | TC | CT CHEST SPINE W/O DYE | $345.82 | $322.63 | $375.45 | $345.60 | |
| 72128 | 26 | CT CHEST SPINE W/O DYE | $79.55 | $76.82 | not payable in ASC | not payable in ASC | |
| 72129 | CT CHEST SPINE W/DYE | $525.50 | $493.47 | not payable in ASC | not payable in ASC | ||
| 72129 | TC | CT CHEST SPINE W/DYE | $430.26 | $401.38 | $580.71 | $534.51 | |
| 72129 | 26 | CT CHEST SPINE W/DYE | $95.24 | $92.07 | not payable in ASC | not payable in ASC | |
| 72130 | CT CHEST SPINE W/O & W/DYE | $637.51 | $598.08 | not payable in ASC | not payable in ASC | ||
| 72130 | TC | CT CHEST SPINE W/O & W/DYE | $539.14 | $502.96 | $647.37 | $595.86 | |
| 72130 | 26 | CT CHEST SPINE W/O & W/DYE | $98.37 | $95.11 | not payable in ASC | not payable in ASC | |
| 72131 | CT LUMBAR SPINE W/O DYE | $424.21 | $398.37 | not payable in ASC | not payable in ASC | ||
| 72131 | TC | CT LUMBAR SPINE W/O DYE | $344.66 | $321.55 | $375.45 | $345.60 | |
| 72131 | 26 | CT LUMBAR SPINE W/O DYE | $79.55 | $76.82 | not payable in ASC | not payable in ASC | |
| 72132 | CT LUMBAR SPINE W/DYE | $524.34 | $492.38 | not payable in ASC | not payable in ASC | ||
| 72132 | TC | CT LUMBAR SPINE W/DYE | $429.10 | $400.30 | $580.71 | $534.51 | |
| 72132 | 26 | CT LUMBAR SPINE W/DYE | $95.24 | $92.07 | not payable in ASC | not payable in ASC | |
| 72133 | CT LUMBAR SPINE W/O & W/DYE | $636.93 | $597.54 | not payable in ASC | not payable in ASC | ||
| 72133 | TC | CT LUMBAR SPINE W/O & W/DYE | $538.56 | $502.42 | $647.37 | $595.86 | |
| 72133 | 26 | CT LUMBAR SPINE W/O & W/DYE | $98.37 | $95.11 | not payable in ASC | not payable in ASC | |
| 72141 | MRI NECK SPINE W/O DYE | $936.23 | $878.43 | not payable in ASC | not payable in ASC | ||
| 72141 | TC | MRI NECK SPINE W/O DYE | $788.37 | $735.46 | $664.20 | $611.37 | |
| 72141 | 26 | MRI NECK SPINE W/O DYE | $147.87 | $142.97 | not payable in ASC | not payable in ASC | |
| 72142 | MRI NECK SPINE W/DYE | $989.34 | $928.01 | not payable in ASC | not payable in ASC | ||
| 72142 | TC | MRI NECK SPINE W/DYE | $840.19 | $783.80 | $846.36 | $779.04 | |
| 72142 | 26 | MRI NECK SPINE W/DYE | $149.16 | $144.21 | not payable in ASC | not payable in ASC | |
| 72146 | MRI CHEST SPINE W/O DYE | $801.97 | $752.41 | not payable in ASC | not payable in ASC | ||
| 72146 | TC | MRI CHEST SPINE W/O DYE | $677.15 | $631.70 | $664.20 | $611.37 | |
| 72146 | 26 | MRI CHEST SPINE W/O DYE | $124.83 | $120.69 | not payable in ASC | not payable in ASC | |
| 72147 | MRI CHEST SPINE W/DYE | $890.93 | $836.21 | not payable in ASC | not payable in ASC | ||
| 72147 | TC | MRI CHEST SPINE W/DYE | $741.19 | $691.46 | $846.36 | $779.04 | |
| 72147 | 26 | MRI CHEST SPINE W/DYE | $149.74 | $144.75 | not payable in ASC | not payable in ASC | |
| 72148 | MRI LUMBAR SPINE W/O DYE | $901.45 | $845.45 | not payable in ASC | not payable in ASC | ||
| 72148 | TC | MRI LUMBAR SPINE W/O DYE | $769.58 | $717.94 | $664.20 | $611.37 | |
| 72148 | 26 | MRI LUMBAR SPINE W/O DYE | $131.85 | $127.52 | not payable in ASC | not payable in ASC | |
| 72149 | MRI LUMBAR SPINE W/DYE | $887.91 | $833.04 | not payable in ASC | not payable in ASC | ||
| 72149 | TC | MRI LUMBAR SPINE W/DYE | $748.77 | $698.52 | $846.36 | $779.04 | |
| 72149 | 26 | MRI LUMBAR SPINE W/DYE | $139.14 | $134.52 | not payable in ASC | not payable in ASC | |
| 72156 | MRI NECK SPINE W/O & W/DYE | $1,227.57 | $1,151.99 | not payable in ASC | not payable in ASC | ||
| 72156 | TC | MRI NECK SPINE W/O & W/DYE | $1,027.10 | $958.16 | $1,033.50 | $951.27 | |
| 72156 | 26 | MRI NECK SPINE W/O & W/DYE | $200.46 | $193.84 | not payable in ASC | not payable in ASC | |
| 72157 | MRI CHEST SPINE W/O & W/DYE | $1,153.62 | $1,083.01 | not payable in ASC | not payable in ASC | ||
| 72157 | TC | MRI CHEST SPINE W/O & W/DYE | $953.16 | $889.17 | $1,033.50 | $951.27 | |
| 72157 | 26 | MRI CHEST SPINE W/O & W/DYE | $200.46 | $193.84 | not payable in ASC | not payable in ASC | |
| 72158 | MRI LUMBAR SPINE W/O & W/DYE | $1,209.34 | $1,134.48 | not payable in ASC | not payable in ASC | ||
| 72158 | TC | MRI LUMBAR SPINE W/O & W/DYE | $1,024.78 | $955.99 | $1,033.50 | $951.27 | |
| 72158 | 26 | MRI LUMBAR SPINE W/O & W/DYE | $184.56 | $178.49 | not payable in ASC | not payable in ASC | |
| 72170 | X-RAY PELVIS 1/2 VIEWS | $68.47 | $64.69 | not payable in ASC | not payable in ASC | ||
| 72170 | TC | X-RAY PELVIS 1/2 VIEWS | $46.19 | $43.14 | $60.84 | $56.01 | |
| 72170 | 26 | X-RAY PELVIS 1/2 VIEWS | $22.28 | $21.55 | not payable in ASC | not payable in ASC | |
| 72190 | X-RAY PELVIS MINIMUM 3 VIEWS | $70.97 | $66.85 | not payable in ASC | not payable in ASC | ||
| 72190 | TC | X-RAY PELVIS MINIMUM 3 VIEWS | $52.92 | $49.41 | $87.24 | $80.31 | |
| 72190 | 26 | X-RAY PELVIS MINIMUM 3 VIEWS | $18.03 | $17.45 | not payable in ASC | not payable in ASC | |
| 72191 | CT ANGIOGRAPH PELVIS W/O & W/DYE | $769.42 | $722.61 | not payable in ASC | not payable in ASC | ||
| 72191 | TC | CT ANGIOGRAPH PELVIS W/O & W/DYE | $627.65 | $585.53 | $655.71 | $603.54 | |
| 72191 | 26 | CT ANGIOGRAPH PELVIS W/O & W/DYE | $141.77 | $137.08 | not payable in ASC | not payable in ASC | |
| 72192 | CT PELVIS W/O DYE | $409.56 | $384.93 | not payable in ASC | not payable in ASC | ||
| 72192 | TC | CT PELVIS W/O DYE | $325.44 | $303.61 | $375.45 | $345.60 | |
| 72192 | 26 | CT PELVIS W/O DYE | $84.11 | $81.30 | not payable in ASC | not payable in ASC | |
| 72193 | CT PELVIS W/DYE | $497.42 | $467.12 | not payable in ASC | not payable in ASC | ||
| 72193 | TC | CT PELVIS W/DYE | $406.97 | $379.67 | $580.71 | $534.51 | |
| 72193 | 26 | CT PELVIS W/DYE | $90.45 | $87.45 | not payable in ASC | not payable in ASC | |
| 72194 | CT PELVIS W/O & W/DYE | $639.05 | $599.38 | not payable in ASC | not payable in ASC | ||
| 72194 | TC | CT PELVIS W/O & W/DYE | $544.39 | $507.85 | $647.37 | $595.86 | |
| 72194 | 26 | CT PELVIS W/O & W/DYE | $94.66 | $91.53 | not payable in ASC | not payable in ASC | |
| 72195 | MRI PELVIS W/O DYE | $873.48 | $818.76 | not payable in ASC | not payable in ASC | ||
| 72195 | TC | MRI PELVIS W/O DYE | $759.26 | $708.30 | $664.20 | $611.37 | |
| 72195 | 26 | MRI PELVIS W/O DYE | $114.23 | $110.47 | not payable in ASC | not payable in ASC | |
| 72196 | MRI PELVIS W/DYE | $966.38 | $906.08 | not payable in ASC | not payable in ASC | ||
| 72196 | TC | MRI PELVIS W/DYE | $831.46 | $775.64 | $846.36 | $779.04 | |
| 72196 | 26 | MRI PELVIS W/DYE | $134.92 | $130.43 | not payable in ASC | not payable in ASC | |
| 72197 | MRI PELVIS W/O & W/DYE | $1,259.25 | $1,180.65 | not payable in ASC | not payable in ASC | ||
| 72197 | TC | MRI PELVIS W/O & W/DYE | $1,084.17 | $1,011.38 | $1,033.50 | $951.27 | |
| 72197 | 26 | MRI PELVIS W/O & W/DYE | $175.08 | $169.27 | not payable in ASC | not payable in ASC | |
| 72198 | MR ANGIO PELVIS W/O & W/DYE | $936.15 | $878.06 | not payable in ASC | not payable in ASC | ||
| 72198 | TC | MR ANGIO PELVIS W/O & W/DYE | $796.52 | $743.06 | not payable in ASC | not payable in ASC | |
| 72198 | 26 | MR ANGIO PELVIS W/O & W/DYE | $139.64 | $135.00 | not payable in ASC | not payable in ASC | |
| 72200 | X-RAY EXAM SACROILIAC JOINTS | $49.85 | $46.98 | not payable in ASC | not payable in ASC | ||
| 72200 | TC | X-RAY EXAM SACROILIAC JOINTS | $36.62 | $34.19 | $72.54 | $66.78 | |
| 72200 | 26 | X-RAY EXAM SACROILIAC JOINTS | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 72202 | X-RAY EXAM SACROILIAC JOINTS | $58.43 | $55.04 | not payable in ASC | not payable in ASC | ||
| 72202 | TC | X-RAY EXAM SACROILIAC JOINTS | $43.61 | $40.71 | $86.55 | $79.68 | |
| 72202 | 26 | X-RAY EXAM SACROILIAC JOINTS | $14.82 | $14.32 | not payable in ASC | not payable in ASC | |
| 72220 | X-RAY TAILBONE | $49.27 | $46.44 | not payable in ASC | not payable in ASC | ||
| 72220 | TC | X-RAY TAILBONE | $36.04 | $33.65 | $71.37 | $65.70 | |
| 72220 | 26 | X-RAY TAILBONE | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 72240 | CONTRAST X-RAY NECK SPINE | $372.37 | $351.09 | packaged | packaged | N1 | |
| 72240 | TC | CONTRAST X-RAY NECK SPINE | $263.27 | $245.65 | packaged | packaged | N1 |
| 72240 | 26 | CONTRAST X-RAY NECK SPINE | $109.10 | $105.44 | packaged | packaged | N1 |
| 72255 | CONTRAST X-RAY THORAX SPINE | $349.17 | $329.41 | packaged | packaged | N1 | |
| 72255 | TC | CONTRAST X-RAY THORAX SPINE | $241.78 | $225.60 | packaged | packaged | N1 |
| 72255 | 26 | CONTRAST X-RAY THORAX SPINE | $107.39 | $103.80 | packaged | packaged | N1 |
| 72265 | CONTRAST X-RAY LOWER SPINE | $355.47 | $334.98 | packaged | packaged | N1 | |
| 72265 | TC | CONTRAST X-RAY LOWER SPINE | $256.12 | $238.96 | packaged | packaged | N1 |
| 72265 | 26 | CONTRAST X-RAY LOWER SPINE | $99.34 | $96.02 | packaged | packaged | N1 |
| 72270 | CONTRAST X-RAY SPINE | $552.78 | $521.08 | packaged | packaged | N1 | |
| 72270 | TC | CONTRAST X-RAY SPINE | $394.08 | $367.67 | packaged | packaged | N1 |
| 72270 | 26 | CONTRAST X-RAY SPINE | $158.70 | $153.41 | packaged | packaged | N1 |
| 72275 | EPIDUROGRAPHY | $572.81 | $540.58 | packaged | packaged | N1 | |
| 72275 | TC | EPIDUROGRAPHY | $390.38 | $364.28 | packaged | packaged | N1 |
| 72275 | 26 | EPIDUROGRAPHY | $182.38 | $176.30 | packaged | packaged | N1 |
| 72285 | X-RAY C/T SPINE DISK | $376.65 | $356.04 | packaged | packaged | N1 | |
| 72285 | TC | X-RAY C/T SPINE DISK | $236.40 | $220.57 | packaged | packaged | N1 |
| 72285 | 26 | X-RAY C/T SPINE DISK | $140.25 | $135.46 | packaged | packaged | N1 |
| 72291 | PERCUT VERT/SACROPLASTY, FLUOR | $267.82 | $258.54 | packaged | packaged | N1 | |
| 72291 | TC | PERCUT VERT/SACROPLASTY, FLUOR | $161.82 | $156.18 | packaged | packaged | N1 |
| 72291 | 26 | PERCUT VERT/SACROPLASTY, FLUOR | $113.43 | $109.79 | packaged | packaged | N1 |
| 72295 | X-RAY LOWER SPINE DISK | $217.08 | $204.71 | packaged | packaged | N1 | |
| 72295 | TC | X-RAY LOWER SPINE DISK | $151.33 | $141.20 | packaged | packaged | N1 |
| 72295 | 26 | X-RAY LOWER SPINE DISK | $65.74 | $63.49 | packaged | packaged | N1 |
| 73000 | X-RAY COLLAR BONE | $48.17 | $45.40 | not payable in ASC | not payable in ASC | ||
| 73000 | TC | X-RAY COLLAR BONE | $35.46 | $33.11 | $70.20 | $64.62 | |
| 73000 | 26 | X-RAY COLLAR BONE | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73010 | X-RAY SHOULDER BLADE | $51.47 | $48.57 | not payable in ASC | not payable in ASC | ||
| 73010 | TC | X-RAY SHOULDER BLADE | $36.62 | $34.19 | $72.54 | $66.78 | |
| 73010 | 26 | X-RAY SHOULDER BLADE | $14.85 | $14.37 | not payable in ASC | not payable in ASC | |
| 73020 | X-RAY SHOULDER 1 VIEW | $39.52 | $37.29 | not payable in ASC | not payable in ASC | ||
| 73020 | TC | X-RAY SHOULDER 1 VIEW | $27.88 | $26.05 | $54.99 | $50.61 | |
| 73020 | 26 | X-RAY SHOULDER 1 VIEW | $11.62 | $11.24 | not payable in ASC | not payable in ASC | |
| 73030 | X-RAY SHOULDER MINIMUM 2 VIEWS | $74.36 | $70.21 | not payable in ASC | not payable in ASC | ||
| 73030 | TC | X-RAY SHOULDER MINIMUM 2 VIEWS | $51.56 | $48.15 | $71.37 | $65.70 | |
| 73030 | 26 | X-RAY SHOULDER MINIMUM 2 VIEWS | $22.79 | $22.04 | not payable in ASC | not payable in ASC | |
| 73040 | CONTRAST X-RAY SHOULDER | $181.40 | $170.71 | packaged | packaged | N1 | |
| 73040 | TC | CONTRAST X-RAY SHOULDER | $138.53 | $129.26 | packaged | packaged | N1 |
| 73040 | 26 | CONTRAST X-RAY SHOULDER | $42.87 | $41.45 | packaged | packaged | N1 |
| 73050 | X-RAY SHOULDERS | $64.63 | $60.92 | not payable in ASC | not payable in ASC | ||
| 73050 | TC | X-RAY SHOULDERS | $47.11 | $43.97 | $87.24 | $80.31 | |
| 73050 | 26 | X-RAY SHOULDERS | $17.54 | $16.95 | not payable in ASC | not payable in ASC | |
| 73060 | X-RAY HUMERUS MINIMUM 2 VIEWS | $49.27 | $46.44 | not payable in ASC | not payable in ASC | ||
| 73060 | TC | X-RAY HUMERUS MINIMUM 2 VIEWS | $35.46 | $33.11 | $70.20 | $64.62 | |
| 73060 | 26 | X-RAY HUMERUS MINIMUM 2 VIEWS | $13.80 | $13.33 | not payable in ASC | not payable in ASC | |
| 73070 | X-RAY ELBOW 2 VIEWS | $47.66 | $44.91 | not payable in ASC | not payable in ASC | ||
| 73070 | TC | X-RAY ELBOW 2 VIEWS | $35.46 | $33.11 | $70.20 | $64.62 | |
| 73070 | 26 | X-RAY ELBOW 2 VIEWS | $12.21 | $11.79 | not payable in ASC | not payable in ASC | |
| 73080 | X-RAY ELBOW MINIMUM 3 VIEWS | $57.41 | $54.04 | not payable in ASC | not payable in ASC | ||
| 73080 | TC | X-RAY ELBOW MINIMUM 3 VIEWS | $44.20 | $41.25 | $87.24 | $80.31 | |
| 73080 | 26 | X-RAY ELBOW MINIMUM 3 VIEWS | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 73090 | X-RAY FOREARM | $47.01 | $44.31 | not payable in ASC | not payable in ASC | ||
| 73090 | TC | X-RAY FOREARM | $34.29 | $32.03 | $67.86 | $62.46 | |
| 73090 | 26 | X-RAY FOREARM | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73092 | X-RAY ARM, INFANT | $51.67 | $48.66 | not payable in ASC | not payable in ASC | ||
| 73092 | TC | X-RAY ARM, INFANT | $38.95 | $36.37 | $77.19 | $71.07 | |
| 73092 | 26 | X-RAY ARM, INFANT | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73100 | X-RAY WRIST 2 VIEWS | $52.13 | $49.16 | not payable in ASC | not payable in ASC | ||
| 73100 | TC | X-RAY WRIST 2 VIEWS | $37.79 | $35.29 | $74.85 | $68.91 | |
| 73100 | 26 | X-RAY WRIST 2 VIEWS | $14.34 | $13.87 | not payable in ASC | not payable in ASC | |
| 73110 | X-RAY WRIST MINIMUM 3 VIEWS | $70.95 | $66.75 | not payable in ASC | not payable in ASC | ||
| 73110 | TC | X-RAY WRIST MINIMUM 3 VIEWS | $55.03 | $51.37 | $87.24 | $80.31 | |
| 73110 | 26 | X-RAY WRIST MINIMUM 3 VIEWS | $15.92 | $15.38 | not payable in ASC | not payable in ASC | |
| 73115 | CONTRAST X-RAY WRIST | $183.73 | $172.89 | packaged | packaged | N1 | |
| 73115 | TC | CONTRAST X-RAY WRIST | $139.69 | $130.34 | packaged | packaged | N1 |
| 73115 | 26 | CONTRAST X-RAY WRIST | $44.04 | $42.55 | packaged | packaged | N1 |
| 73120 | X-RAY HAND 2 VIEWS | $46.43 | $43.77 | not payable in ASC | not payable in ASC | ||
| 73120 | TC | X-RAY HAND 2 VIEWS | $33.71 | $31.48 | $66.69 | $61.38 | |
| 73120 | 26 | X-RAY HAND 2 VIEWS | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73130 | X-RAY HAND MINIMUM 3 VIEWS | $62.21 | $58.60 | not payable in ASC | not payable in ASC | ||
| 73130 | TC | X-RAY HAND MINIMUM 3 VIEWS | $46.96 | $43.85 | $80.70 | $74.28 | |
| 73130 | 26 | X-RAY HAND MINIMUM 3 VIEWS | $15.25 | $14.76 | not payable in ASC | not payable in ASC | |
| 73140 | X-RAY FINGER(S) MINIMUM 2 VIEWS | $53.05 | $49.88 | not payable in ASC | not payable in ASC | ||
| 73140 | TC | X-RAY FINGER(S) MINIMUM 2 VIEWS | $42.45 | $39.63 | $84.21 | $77.52 | |
| 73140 | 26 | X-RAY FINGER(S) MINIMUM 2 VIEWS | $10.62 | $10.25 | not payable in ASC | not payable in ASC | |
| 73200 | CT UPPER EXTREMITY W/O DYE | $414.19 | $389.09 | not payable in ASC | not payable in ASC | ||
| 73200 | TC | CT UPPER EXTREMITY W/O DYE | $334.76 | $312.31 | $375.45 | $345.60 | |
| 73200 | 26 | CT UPPER EXTREMITY W/O DYE | $79.42 | $76.78 | not payable in ASC | not payable in ASC | |
| 73201 | CT UPPER EXTREMITY W/DYE | $506.15 | $475.27 | not payable in ASC | not payable in ASC | ||
| 73201 | TC | CT UPPER EXTREMITY W/DYE | $415.69 | $387.81 | $580.71 | $534.51 | |
| 73201 | 26 | CT UPPER EXTREMITY W/DYE | $90.45 | $87.45 | not payable in ASC | not payable in ASC | |
| 73202 | CT UPPER EXTREMITY W/O & W/DYE | $649.53 | $609.16 | not payable in ASC | not payable in ASC | ||
| 73202 | TC | CT UPPER EXTREMITY W/O & W/DYE | $554.86 | $517.63 | $647.37 | $595.86 | |
| 73202 | 26 | CT UPPER EXTREMITY W/O & W/DYE | $94.66 | $91.53 | not payable in ASC | not payable in ASC | |
| 73206 | CT ANGIO UPR EXTREMITY W/O & W/DYE | $732.98 | $688.49 | not payable in ASC | not payable in ASC | ||
| 73206 | TC | CT ANGIO UPR EXTREMITY W/O & W/DYE | $592.72 | $552.94 | $655.71 | $603.54 | |
| 73206 | 26 | CT ANGIO UPR EXTREMITY W/O & W/DYE | $140.26 | $135.54 | not payable in ASC | not payable in ASC | |
| 73218 | MRI UPPER EXTREMITY W/O DYE | $879.74 | $824.21 | not payable in ASC | not payable in ASC | ||
| 73218 | TC | MRI UPPER EXTREMITY W/O DYE | $774.97 | $722.96 | $664.20 | $611.37 | |
| 73218 | 26 | MRI UPPER EXTREMITY W/O DYE | $104.76 | $101.27 | not payable in ASC | not payable in ASC | |
| 73219 | MRI UPPER EXTREMITY W/DYE | $950.89 | $891.36 | not payable in ASC | not payable in ASC | ||
| 73219 | TC | MRI UPPER EXTREMITY W/DYE | $824.47 | $769.13 | $846.36 | $779.04 | |
| 73219 | 26 | MRI UPPER EXTREMITY W/DYE | $126.42 | $122.24 | not payable in ASC | not payable in ASC | |
| 73220 | MRI UPPER EXTREMITY W/O & W/DYE | $1,255.99 | $1,177.35 | not payable in ASC | not payable in ASC | ||
| 73220 | TC | MRI UPPER EXTREMITY W/O & W/DYE | $1,088.83 | $1,015.73 | $1,033.50 | $951.27 | |
| 73220 | 26 | MRI UPPER EXTREMITY W/O & W/DYE | $167.16 | $161.61 | not payable in ASC | not payable in ASC | |
| 73221 | MRI JOINT UPPER EXTREMITY W/O DYE | $828.31 | $776.35 | not payable in ASC | not payable in ASC | ||
| 73221 | TC | MRI JOINT UPPER EXTREMITY W/O DYE | $721.40 | $672.98 | $664.20 | $611.37 | |
| 73221 | 26 | MRI JOINT UPPER EXTREMITY W/O DYE | $106.89 | $103.37 | not payable in ASC | not payable in ASC | |
| 73222 | MRI JOINT UPPER EXTREMITY W/DYE | $901.39 | $845.19 | not payable in ASC | not payable in ASC | ||
| 73222 | TC | MRI JOINT UPPER EXTREMITY W/DYE | $774.97 | $722.96 | $846.36 | $779.04 | |
| 73222 | 26 | MRI JOINT UPPER EXTREMITY W/DYE | $126.42 | $122.24 | not payable in ASC | not payable in ASC | |
| 73223 | MRI JOINT UPPER EXTREMITY W/O & W/DYE | $1,191.36 | $1,117.06 | not payable in ASC | not payable in ASC | ||
| 73223 | TC | MRI JOINT UPPER EXTREMITY W/O & W/DYE | $1,024.78 | $955.99 | $1,033.50 | $951.27 | |
| 73223 | 26 | MRI JOINT UPPER EXTREMITY W/O & W/DYE | $166.58 | $161.07 | not payable in ASC | not payable in ASC | |
| 73225 | MR ANGIO UPPER EXTREMITY W/O & W/DYE | $1,024.20 | $959.93 | not payable in ASC | not payable in ASC | ||
| 73225 | TC | MR ANGIO UPPER EXTREMITY W/O & W/DYE | $889.10 | $829.43 | not payable in ASC | not payable in ASC | |
| 73225 | 26 | MR ANGIO UPPER EXTREMITY W/O & W/DYE | $135.10 | $130.50 | not payable in ASC | not payable in ASC | |
| 73500 | X-RAY HIP UNILATERAL 1 VIEW | $45.06 | $42.59 | not payable in ASC | not payable in ASC | ||
| 73500 | TC | X-RAY HIP UNILATERAL 1 VIEW | $30.21 | $28.22 | $59.67 | $54.93 | |
| 73500 | 26 | X-RAY HIP UNILATERAL 1 VIEW | $14.85 | $14.37 | not payable in ASC | not payable in ASC | |
| 73510 | X-RAY HIP COMPLETE MINIMUM 2 VIEWS | $71.16 | $67.09 | not payable in ASC | not payable in ASC | ||
| 73510 | TC | X-RAY HIP COMPLETE MINIMUM 2 VIEWS | $51.46 | $48.03 | $87.24 | $80.31 | |
| 73510 | 26 | X-RAY HIP COMPLETE MINIMUM 2 VIEWS | $19.70 | $19.06 | not payable in ASC | not payable in ASC | |
| 73520 | X-RAY HIPS MINIMUM 2 VIEWS | $68.27 | $64.45 | not payable in ASC | not payable in ASC | ||
| 73520 | TC | X-RAY HIPS MINIMUM 2 VIEWS | $47.11 | $43.97 | $87.24 | $80.31 | |
| 73520 | 26 | X-RAY HIPS MINIMUM 2 VIEWS | $21.16 | $20.48 | not payable in ASC | not payable in ASC | |
| 73525 | X-RAY HIP ARTHROGRAPHY | $168.58 | $158.76 | packaged | packaged | N1 | |
| 73525 | TC | X-RAY HIP ARTHROGRAPHY | $124.54 | $116.22 | packaged | packaged | N1 |
| 73525 | 26 | X-RAY HIP ARTHROGRAPHY | $44.04 | $42.55 | packaged | packaged | N1 |
| 73530 | X-RAY HIP DURING OPERATIVE PROCEDURE | $60.32 | $58.24 | packaged | packaged | N1 | |
| 73530 | TC | X-RAY HIP DURING OPERATIVE PROCEDURE | $37.53 | $36.22 | packaged | packaged | N1 |
| 73530 | 26 | X-RAY HIP DURING OPERATIVE PROCEDURE | $23.26 | $22.51 | packaged | packaged | N1 |
| 73540 | X-RAY PELVIS & HIPS MINIMUM 2 VIEWS | $68.71 | $64.73 | not payable in ASC | not payable in ASC | ||
| 73540 | TC | X-RAY PELVIS & HIPS MINIMUM 2 VIEWS | $51.76 | $48.32 | $87.24 | $80.31 | |
| 73540 | 26 | X-RAY PELVIS & HIPS MINIMUM 2 VIEWS | $16.95 | $16.40 | not payable in ASC | not payable in ASC | |
| 73542 | X-RAY EXAM, SACROILIAC JOINT | $137.42 | $129.77 | packaged | packaged | N1 | |
| 73542 | TC | X-RAY EXAM, SACROILIAC JOINT | $91.36 | $85.25 | packaged | packaged | N1 |
| 73542 | 26 | X-RAY EXAM, SACROILIAC JOINT | $46.06 | $44.51 | packaged | packaged | N1 |
| 73550 | X-RAY THIGH 2 VIEWS | $53.51 | $50.53 | not payable in ASC | not payable in ASC | ||
| 73550 | TC | X-RAY THIGH 2 VIEWS | $37.60 | $35.11 | $66.69 | $61.38 | |
| 73550 | 26 | X-RAY THIGH 2 VIEWS | $15.91 | $15.42 | not payable in ASC | not payable in ASC | |
| 73560 | X-RAY KNEE 1/2 VIEWS | $57.41 | $54.18 | not payable in ASC | not payable in ASC | ||
| 73560 | TC | X-RAY KNEE 1/2 VIEWS | $40.85 | $38.14 | $72.54 | $66.78 | |
| 73560 | 26 | X-RAY KNEE 1/2 VIEWS | $16.56 | $16.02 | not payable in ASC | not payable in ASC | |
| 73562 | X-RAY KNEE 3 VIEWS | $74.25 | $69.95 | not payable in ASC | not payable in ASC | ||
| 73562 | TC | X-RAY KNEE 3 VIEWS | $55.13 | $51.47 | $87.24 | $80.31 | |
| 73562 | 26 | X-RAY KNEE 3 VIEWS | $19.12 | $18.49 | not payable in ASC | not payable in ASC | |
| 73564 | X-RAY KNEE, COMPLETE 4/MORE VIEWS | $85.62 | $80.68 | not payable in ASC | not payable in ASC | ||
| 73564 | TC | X-RAY KNEE, COMPLETE 4/MORE VIEWS | $63.21 | $59.00 | $87.24 | $80.31 | |
| 73564 | 26 | X-RAY KNEE, COMPLETE 4/MORE VIEWS | $22.40 | $21.68 | not payable in ASC | not payable in ASC | |
| 73565 | X-RAY KNEES STANDING ANTEROPOST | $57.28 | $54.00 | not payable in ASC | not payable in ASC | ||
| 73565 | TC | X-RAY KNEES STANDING ANTEROPOST | $41.87 | $39.08 | $83.04 | $76.44 | |
| 73565 | 26 | X-RAY KNEES STANDING ANTEROPOST | $15.43 | $14.91 | not payable in ASC | not payable in ASC | |
| 73580 | X-RAY KNEE ARTHOGRAPHY | $222.68 | $209.25 | packaged | packaged | N1 | |
| 73580 | TC | X-RAY KNEE ARTHOGRAPHY | $176.95 | $165.10 | packaged | packaged | N1 |
| 73580 | 26 | X-RAY KNEE ARTHOGRAPHY | $45.73 | $44.15 | packaged | packaged | N1 |
| 73590 | X-RAY TIBIA & FIBULA 2 VIEWS | $56.34 | $53.14 | not payable in ASC | not payable in ASC | ||
| 73590 | TC | X-RAY TIBIA & FIBULA 2 VIEWS | $40.26 | $37.60 | $65.52 | $60.30 | |
| 73590 | 26 | X-RAY TIBIA & FIBULA 2 VIEWS | $16.06 | $15.54 | not payable in ASC | not payable in ASC | |
| 73592 | X-RAY LEG, INFANT MINIMUM 2 VIEWS | $52.25 | $49.20 | not payable in ASC | not payable in ASC | ||
| 73592 | TC | X-RAY LEG, INFANT MINIMUM 2 VIEWS | $39.53 | $36.92 | $78.36 | $72.12 | |
| 73592 | 26 | X-RAY LEG, INFANT MINIMUM 2 VIEWS | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73600 | X-RAY ANKLE 2 VIEWS | $47.59 | $44.85 | not payable in ASC | not payable in ASC | ||
| 73600 | TC | X-RAY ANKLE 2 VIEWS | $34.87 | $32.57 | $69.03 | $63.54 | |
| 73600 | 26 | X-RAY ANKLE 2 VIEWS | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73610 | X-RAY ANKLE MINIMUM 3 VIEWS | $62.88 | $59.23 | not payable in ASC | not payable in ASC | ||
| 73610 | TC | X-RAY ANKLE MINIMUM 3 VIEWS | $47.63 | $44.47 | $81.87 | $75.36 | |
| 73610 | 26 | X-RAY ANKLE MINIMUM 3 VIEWS | $15.25 | $14.76 | not payable in ASC | not payable in ASC | |
| 73615 | CONTRAST X-RAY ANKLE | $174.99 | $164.73 | packaged | packaged | N1 | |
| 73615 | TC | CONTRAST X-RAY ANKLE | $130.95 | $122.20 | packaged | packaged | N1 |
| 73615 | 26 | CONTRAST X-RAY ANKLE | $44.04 | $42.55 | packaged | packaged | N1 |
| 73620 | X-RAY FOOT 2 VIEWS | $45.84 | $43.23 | not payable in ASC | not payable in ASC | ||
| 73620 | TC | X-RAY FOOT 2 VIEWS | $33.71 | $31.48 | $66.69 | $61.38 | |
| 73620 | 26 | X-RAY FOOT 2 VIEWS | $12.14 | $11.74 | not payable in ASC | not payable in ASC | |
| 73630 | X-RAY FOOT MINIMUM 3 VIEWS | $61.95 | $58.35 | not payable in ASC | not payable in ASC | ||
| 73630 | TC | X-RAY FOOT MINIMUM 3 VIEWS | $46.60 | $43.51 | $79.53 | $73.20 | |
| 73630 | 26 | X-RAY FOOT MINIMUM 3 VIEWS | $15.35 | $14.86 | not payable in ASC | not payable in ASC | |
| 73650 | X-RAY HEEL | $47.01 | $44.31 | not payable in ASC | not payable in ASC | ||
| 73650 | TC | X-RAY HEEL | $34.29 | $32.03 | $67.86 | $62.46 | |
| 73650 | 26 | X-RAY HEEL | $12.72 | $12.29 | not payable in ASC | not payable in ASC | |
| 73660 | X-RAY TOE(S) | $49.57 | $46.63 | not payable in ASC | not payable in ASC | ||
| 73660 | TC | X-RAY TOE(S) | $39.53 | $36.92 | $78.36 | $72.12 | |
| 73660 | 26 | X-RAY TOE(S) | $10.03 | $9.71 | not payable in ASC | not payable in ASC | |
| 73700 | CT LOWER EXTREMITY W/O DYE | $414.77 | $389.63 | not payable in ASC | not payable in ASC | ||
| 73700 | TC | CT LOWER EXTREMITY W/O DYE | $335.35 | $312.85 | $375.45 | $345.60 | |
| 73700 | 26 | CT LOWER EXTREMITY W/O DYE | $79.42 | $76.78 | not payable in ASC | not payable in ASC | |
| 73701 | CT LOWER EXTREMITY W/DYE | $510.81 | $479.62 | not payable in ASC | not payable in ASC | ||
| 73701 | TC | CT LOWER EXTREMITY W/DYE | $420.36 | $392.16 | $580.71 | $534.51 | |
| 73701 | 26 | CT LOWER EXTREMITY W/DYE | $90.45 | $87.45 | not payable in ASC | not payable in ASC | |
| 73706 | CT ANGIO LWR EXTREMITY W/O & W/DYE | $807.23 | $758.08 | not payable in ASC | not payable in ASC | ||
| 73706 | TC | CT ANGIO LWR EXTREMITY W/O & W/DYE | $658.52 | $614.32 | $655.71 | $603.54 | |
| 73706 | 26 | CT ANGIO LWR EXTREMITY W/O & W/DYE | $148.72 | $143.76 | not payable in ASC | not payable in ASC | |
| 73718 | MRI LOWER EXTREMITY W/O DYE | $861.62 | $807.36 | not payable in ASC | not payable in ASC | ||
| 73718 | TC | MRI LOWER EXTREMITY W/O DYE | $756.93 | $706.12 | $664.20 | $611.37 | |
| 73718 | 26 | MRI LOWER EXTREMITY W/O DYE | $104.69 | $101.24 | not payable in ASC | not payable in ASC | |
| 73719 | MRI LOWER EXTREMITY W/DYE | $947.98 | $888.65 | not payable in ASC | not payable in ASC | ||
| 73719 | TC | MRI LOWER EXTREMITY W/DYE | $822.14 | $766.96 | $846.36 | $779.04 | |
| 73719 | 26 | MRI LOWER EXTREMITY W/DYE | $125.84 | $121.69 | not payable in ASC | not payable in ASC | |
| 73720 | MRI LOWER EXTREMITY W/O & W/DYE | $1,257.16 | $1,178.43 | not payable in ASC | not payable in ASC | ||
| 73720 | TC | MRI LOWER EXTREMITY W/O & W/DYE | $1,090.58 | $1,017.37 | $1,033.50 | $951.27 | |
| 73720 | 26 | MRI LOWER EXTREMITY W/O & W/DYE | $166.58 | $161.07 | not payable in ASC | not payable in ASC | |
| 73721 | MRI JOINT LOWER EXTREMITY W/O DYE | $844.02 | $791.02 | not payable in ASC | not payable in ASC | ||
| 73721 | TC | MRI JOINT LOWER EXTREMITY W/O DYE | $737.71 | $688.19 | $664.20 | $611.37 | |
| 73721 | 26 | MRI JOINT LOWER EXTREMITY W/O DYE | $106.31 | $102.82 | not payable in ASC | not payable in ASC | |
| 73722 | MRI JOINT LOWER EXTREMITY W/DYE | $916.47 | $859.30 | not payable in ASC | not payable in ASC | ||
| 73722 | TC | MRI JOINT LOWER EXTREMITY W/DYE | $788.94 | $735.99 | $846.36 | $779.04 | |
| 73722 | 26 | MRI JOINT LOWER EXTREMITY W/DYE | $127.53 | $123.31 | not payable in ASC | not payable in ASC | |
| 73723 | MRI JOINT LWR EXTREMITY W/O & W/DYE | $1,189.03 | $1,114.88 | not payable in ASC | not payable in ASC | ||
| 73723 | TC | MRI JOINT LWR EXTREMITY W/O & W/DYE | $1,022.45 | $953.82 | $1,033.50 | $951.27 | |
| 73723 | 26 | MRI JOINT LWR EXTREMITY W/O & W/DYE | $166.58 | $161.07 | not payable in ASC | not payable in ASC | |
| 73725 | MR ANGIO LOWER EXT W OR W/O DYE | $938.33 | $880.13 | not payable in ASC | not payable in ASC | ||
| 73725 | TC | MR ANGIO LOWER EXT W OR W/O DYE | $797.10 | $743.60 | not payable in ASC | not payable in ASC | |
| 73725 | 26 | MR ANGIO LOWER EXT W OR W/O DYE | $141.23 | $136.54 | not payable in ASC | not payable in ASC | |
| 74000 | X-RAY ABDOMEN SINGLE ANTEROPOST | $41.62 | $39.34 | not payable in ASC | not payable in ASC | ||
| 74000 | TC | X-RAY ABDOMEN SINGLE ANTEROPOST | $27.88 | $26.05 | $54.99 | $50.61 | |
| 74000 | 26 | X-RAY ABDOMEN SINGLE ANTEROPOST | $13.73 | $13.29 | not payable in ASC | not payable in ASC | |
| 74010 | X-RAY ABDOMEN ANTEROPOST & ADDED VW | $63.95 | $60.30 | not payable in ASC | not payable in ASC | ||
| 74010 | TC | X-RAY ABDOMEN ANTEROPOST & ADDED VW | $46.53 | $43.43 | $87.24 | $80.31 | |
| 74010 | 26 | X-RAY ABDOMEN ANTEROPOST & ADDED VW | $17.44 | $16.85 | not payable in ASC | not payable in ASC | |
| 74020 | X-RAY ABDOMEN COMPLETE | $67.15 | $63.37 | not payable in ASC | not payable in ASC | ||
| 74020 | TC | X-RAY ABDOMEN COMPLETE | $46.53 | $43.43 | $87.24 | $80.31 | |
| 74020 | 26 | X-RAY ABDOMEN COMPLETE | $20.62 | $19.94 | not payable in ASC | not payable in ASC | |
| 74022 | X-RAY EXAM SERIES, ABDOMEN | $80.75 | $76.17 | not payable in ASC | not payable in ASC | ||
| 74022 | TC | X-RAY EXAM SERIES, ABDOMEN | $56.42 | $52.67 | $112.32 | $103.38 | |
| 74022 | 26 | X-RAY EXAM SERIES, ABDOMEN | $24.33 | $23.50 | not payable in ASC | not payable in ASC | |
| 74150 | CT ABDOMEN W/O DYE | $415.67 | $390.94 | not payable in ASC | not payable in ASC | ||
| 74150 | TC | CT ABDOMEN W/O DYE | $323.11 | $301.44 | $375.45 | $345.60 | |
| 74150 | 26 | CT ABDOMEN W/O DYE | $92.56 | $89.50 | not payable in ASC | not payable in ASC | |
| 74160 | CT ABDOMEN W/DYE | $621.20 | $583.19 | not payable in ASC | not payable in ASC | ||
| 74160 | TC | CT ABDOMEN W/DYE | $512.35 | $477.98 | $580.71 | $534.51 | |
| 74160 | 26 | CT ABDOMEN W/DYE | $108.84 | $105.22 | not payable in ASC | not payable in ASC | |
| 74170 | CT ABDOMEN W/O & W/DYE | $748.27 | $701.76 | not payable in ASC | not payable in ASC | ||
| 74170 | TC | CT ABDOMEN W/O & W/DYE | $639.30 | $596.40 | $647.37 | $595.86 | |
| 74170 | 26 | CT ABDOMEN W/O & W/DYE | $108.98 | $105.36 | not payable in ASC | not payable in ASC | |
| 74175 | CT ANGIO ABDOM W/O & W/DYE | $817.07 | $767.28 | not payable in ASC | not payable in ASC | ||
| 74175 | TC | CT ANGIO ABDOM W/O & W/DYE | $668.42 | $623.56 | $655.71 | $603.54 | |
| 74175 | 26 | CT ANGIO ABDOM W/O & W/DYE | $148.66 | $143.73 | not payable in ASC | not payable in ASC | |
| 74176 | CT ANGIO ABDOM & PELVIS | $357.22 | $337.86 | not payable in ASC | not payable in ASC | ||
| 74176 | TC | CT ANGIO ABDOM & PELVIS | $225.87 | $210.73 | $375.45 | $345.60 | |
| 74176 | 26 | CT ANGIO ABDOM & PELVIS | $131.35 | $127.13 | not payable in ASC | not payable in ASC | |
| 74177 | CT ANGIO ABDOM & PELVIS W/CONTRAST | $568.57 | $535.21 | not payable in ASC | not payable in ASC | ||
| 74177 | TC | CT ANGIO ABDOM & PELVIS W/CONTRAST | $430.84 | $401.94 | $580.71 | $534.51 | |
| 74177 | 26 | CT ANGIO ABDOM & PELVIS W/CONTRAST | $137.73 | $133.28 | not payable in ASC | not payable in ASC | |
| 74178 | CT ANGIO ABDOM & PELVIS 1+ REGNS | $721.91 | $678.79 | not payable in ASC | not payable in ASC | ||
| 74178 | TC | CT ANGIO ABDOM & PELVIS 1+ REGNS | $569.43 | $531.21 | $647.37 | $595.86 | |
| 74178 | 26 | CT ANGIO ABDOM & PELVIS 1+ REGNS | $152.50 | $147.58 | not payable in ASC | not payable in ASC | |
| 74181 | MRI ABDOMEN W/O DYE | $780.43 | $731.90 | not payable in ASC | not payable in ASC | ||
| 74181 | TC | MRI ABDOMEN W/O DYE | $667.25 | $622.46 | $664.20 | $611.37 | |
| 74181 | 26 | MRI ABDOMEN W/O DYE | $113.19 | $109.42 | not payable in ASC | not payable in ASC | |
| 74183 | MRI ABDOMEN W/O & W/DYE | $1,261.00 | $1,182.28 | not payable in ASC | not payable in ASC | ||
| 74183 | TC | MRI ABDOMEN W/O & W/DYE | $1,086.50 | $1,013.56 | $1,033.50 | $951.27 | |
| 74183 | 26 | MRI ABDOMEN W/O & W/DYE | $174.49 | $168.71 | not payable in ASC | not payable in ASC | |
| 74220 | CONTRAST X-RAY, ESOPHAGUS | $151.79 | $142.85 | not payable in ASC | not payable in ASC | ||
| 74220 | TC | CONTRAST X-RAY, ESOPHAGUS | $115.82 | $108.07 | $167.97 | $154.59 | |
| 74220 | 26 | CONTRAST X-RAY, ESOPHAGUS | $35.97 | $34.77 | not payable in ASC | not payable in ASC | |
| 74230 | CINE/VIDEO X-RAY, THROAT/ESOPH | $153.59 | $144.71 | not payable in ASC | not payable in ASC | ||
| 74230 | TC | CINE/VIDEO X-RAY, THROAT/ESOPH | $112.32 | $104.80 | $167.97 | $154.59 | |
| 74230 | 26 | CINE/VIDEO X-RAY, THROAT/ESOPH | $41.27 | $39.89 | not payable in ASC | not payable in ASC | |
| 74241 | X-RAY EXAM, UPPER GI TRACT W/KUB | $198.98 | $187.44 | not payable in ASC | not payable in ASC | ||
| 74241 | TC | X-RAY EXAM, UPPER GI TRACT W/KUB | $146.09 | $136.31 | $167.97 | $154.59 | |
| 74241 | 26 | X-RAY EXAM, UPPER GI TRACT W/KUB | $52.88 | $51.12 | not payable in ASC | not payable in ASC | |
| 74246 | CONTRAST X-RAY UGI TRACT W/O KUB | $213.47 | $200.98 | not payable in ASC | not payable in ASC | ||
| 74246 | TC | CONTRAST X-RAY UGI TRACT W/O KUB | $159.49 | $148.82 | $167.97 | $154.59 | |
| 74246 | 26 | CONTRAST X-RAY UGI TRACT W/O KUB | $53.99 | $52.18 | not payable in ASC | not payable in ASC | |
| 74280 | CONTRAST X-RAY COLON W/WO GLUCOGEN | $357.90 | $336.48 | not payable in ASC | not payable in ASC | ||
| 74280 | TC | CONTRAST X-RAY COLON W/WO GLUCOGEN | $281.19 | $262.33 | $274.98 | $253.11 | |
| 74280 | 26 | CONTRAST X-RAY COLON W/WO GLUCOGEN | $76.71 | $74.15 | not payable in ASC | not payable in ASC | |
| 74290 | CONTRAST X-RAY, GALLBLADDER | $115.11 | $108.23 | not payable in ASC | not payable in ASC | ||
| 74290 | TC | CONTRAST X-RAY, GALLBLADDER | $90.78 | $84.71 | $167.97 | $154.59 | |
| 74290 | 26 | CONTRAST X-RAY, GALLBLADDER | $24.33 | $23.50 | not payable in ASC | not payable in ASC | |
| 74330 | X-RAY BILE/PANCREAS ENDOSCOPY | $300.56 | $290.09 | packaged | packaged | N1 | |
| 74330 | TC | X-RAY BILE/PANCREAS ENDOSCOPY | $230.31 | $222.27 | packaged | packaged | N1 |
| 74330 | 26 | X-RAY BILE/PANCREAS ENDOSCOPY | $72.02 | $69.63 | packaged | packaged | N1 |
| 74400 | CONTRAST X-RAY URINARY TRACT | $188.82 | $177.48 | not payable in ASC | not payable in ASC | ||
| 74400 | TC | CONTRAST X-RAY URINARY TRACT | $150.75 | $140.66 | $301.83 | $277.83 | |
| 74400 | 26 | CONTRAST X-RAY URINARY TRACT | $38.07 | $36.82 | not payable in ASC | not payable in ASC | |
| 74410 | CONTRAST X-RAY URINARY TRACT | $194.65 | $182.91 | not payable in ASC | not payable in ASC | ||
| 74410 | TC | CONTRAST X-RAY URINARY TRACT | $155.99 | $145.55 | $312.36 | $287.52 | |
| 74410 | 26 | CONTRAST X-RAY URINARY TRACT | $38.65 | $37.36 | not payable in ASC | not payable in ASC | |
| 74415 | CONTRAST X-RAY URINARY TRACT | $230.76 | $216.59 | not payable in ASC | not payable in ASC | ||
| 74415 | TC | CONTRAST X-RAY URINARY TRACT | $192.68 | $179.77 | $341.13 | $313.98 | |
| 74415 | 26 | CONTRAST X-RAY URINARY TRACT | $38.07 | $36.82 | not payable in ASC | not payable in ASC | |
| 74420 | CONTRAST X-RAY URINARY TRACT | $219.86 | $212.18 | not payable in ASC | not payable in ASC | ||
| 74420 | TC | CONTRAST X-RAY URINARY TRACT | $190.87 | $184.20 | $341.13 | $313.98 | |
| 74420 | 26 | CONTRAST X-RAY URINARY TRACT | $28.56 | $27.63 | not payable in ASC | not payable in ASC | |
| 74425 | CONTRAST X-RAY URINARY TRACT | $124.29 | $119.97 | packaged | packaged | N1 | |
| 74425 | TC | CONTRAST X-RAY URINARY TRACT | $95.30 | $91.97 | packaged | packaged | N1 |
| 74425 | 26 | CONTRAST X-RAY URINARY TRACT | $28.56 | $27.63 | packaged | packaged | N1 |
| 74430 | CONTRAST X-RAY BLADDER | $102.29 | $96.28 | packaged | packaged | N1 | |
| 74430 | TC | CONTRAST X-RAY BLADDER | $77.96 | $72.76 | packaged | packaged | N1 |
| 74430 | 26 | CONTRAST X-RAY BLADDER | $24.33 | $23.50 | packaged | packaged | N1 |
| 74450 | X-RAY URETHRA/BLADDER | $132.84 | $128.21 | packaged | packaged | N1 | |
| 74450 | TC | X-RAY URETHRA/BLADDER | $106.33 | $102.60 | packaged | packaged | N1 |
| 74450 | 26 | X-RAY URETHRA/BLADDER | $26.46 | $25.59 | packaged | packaged | N1 |
| 74455 | X-RAY URETHRA/BLADDER | $151.71 | $142.41 | packaged | packaged | N1 | |
| 74455 | TC | X-RAY URETHRA/BLADDER | $126.29 | $117.85 | packaged | packaged | N1 |
| 74455 | 26 | X-RAY URETHRA/BLADDER | $25.42 | $24.56 | packaged | packaged | N1 |
| 74475 | X-RAY CONTROL, CATH INSERT | $188.45 | $177.25 | packaged | packaged | N1 | |
| 74475 | TC | X-RAY CONTROL, CATH INSERT | $146.09 | $136.31 | packaged | packaged | N1 |
| 74475 | 26 | X-RAY CONTROL, CATH INSERT | $42.36 | $40.94 | packaged | packaged | N1 |
| 74480 | X-RAY CONTROL, CATH INSERT | $189.03 | $177.79 | packaged | packaged | N1 | |
| 74480 | TC | X-RAY CONTROL, CATH INSERT | $146.67 | $136.86 | packaged | packaged | N1 |
| 74480 | 26 | X-RAY CONTROL, CATH INSERT | $42.36 | $40.94 | packaged | packaged | N1 |
| 74485 | X-RAY GUIDE, GU DILATION | $186.12 | $175.08 | packaged | packaged | N1 | |
| 74485 | TC | X-RAY GUIDE, GU DILATION | $143.77 | $134.15 | packaged | packaged | N1 |
| 74485 | 26 | X-RAY GUIDE, GU DILATION | $42.36 | $40.94 | packaged | packaged | N1 |
| 75561 | CARDIAC MRI FOR MORPH W/DYE | $1,022.10 | $960.23 | not payable in ASC | not payable in ASC | ||
| 75561 | TC | CARDIAC MRI FOR MORPH W/DYE | $816.31 | $761.53 | $1,033.50 | $951.27 | |
| 75561 | 26 | CARDIAC MRI FOR MORPH W/DYE | $205.79 | $198.70 | not payable in ASC | not payable in ASC | |
| 75572 | CT HEART W/3D IMAGE | $489.05 | $460.69 | not payable in ASC | not payable in ASC | ||
| 75572 | TC | CT HEART W/3D IMAGE | $358.64 | $334.58 | $497.49 | $457.92 | |
| 75572 | 26 | CT HEART W/3D IMAGE | $130.41 | $126.11 | not payable in ASC | not payable in ASC | |
| 75574 | CT ANGIO HEART W/3D IMAGE | $745.46 | $701.56 | not payable in ASC | not payable in ASC | ||
| 75574 | TC | CT ANGIO HEART W/3D IMAGE | $565.93 | $527.96 | $497.49 | $457.92 | |
| 75574 | 26 | CT ANGIO HEART W/3D IMAGE | $179.53 | $173.60 | not payable in ASC | not payable in ASC | |
| 75605 | CONTRAST X-RAY AORTA | $360.73 | $339.57 | packaged | packaged | N1 | |
| 75605 | TC | CONTRAST X-RAY AORTA | $270.12 | $252.01 | packaged | packaged | N1 |
| 75605 | 26 | CONTRAST X-RAY AORTA | $90.61 | $87.55 | packaged | packaged | N1 |
| 75625 | CONTRAST X-RAY AORTA | $361.13 | $340.04 | packaged | packaged | N1 | |
| 75625 | TC | CONTRAST X-RAY AORTA | $270.70 | $252.55 | packaged | packaged | N1 |
| 75625 | 26 | CONTRAST X-RAY AORTA | $90.42 | $87.48 | packaged | packaged | N1 |
| 75630 | X-RAY AORTA, LEG ARTERIES | $417.40 | $394.12 | packaged | packaged | N1 | |
| 75630 | TC | X-RAY AORTA, LEG ARTERIES | $277.11 | $258.54 | packaged | packaged | N1 |
| 75630 | 26 | X-RAY AORTA, LEG ARTERIES | $140.29 | $135.59 | packaged | packaged | N1 |
| 75635 | CT ANGIO ABDOMINAL ARTERIES | $913.36 | $858.40 | packaged | packaged | N1 | |
| 75635 | TC | CT ANGIO ABDOMINAL ARTERIES | $725.35 | $676.75 | packaged | packaged | N1 |
| 75635 | 26 | CT ANGIO ABDOMINAL ARTERIES | $188.01 | $181.66 | packaged | packaged | N1 |
| 75650 | ARTERY X-RAYS HEAD & NECK | $389.94 | $367.78 | packaged | packaged | N1 | |
| 75650 | TC | ARTERY X-RAYS HEAD & NECK | $272.45 | $254.19 | packaged | packaged | N1 |
| 75650 | 26 | ARTERY X-RAYS HEAD & NECK | $117.50 | $113.59 | packaged | packaged | N1 |
| 75665 | ARTERY X-RAYS HEAD & NECK | $425.00 | $400.08 | packaged | packaged | N1 | |
| 75665 | TC | ARTERY X-RAYS HEAD & NECK | $319.62 | $298.19 | packaged | packaged | N1 |
| 75665 | 26 | ARTERY X-RAYS HEAD & NECK | $105.39 | $101.89 | packaged | packaged | N1 |
| 75671 | ARTERY X-RAYS HEAD & NECK | $494.52 | $465.82 | packaged | packaged | N1 | |
| 75671 | TC | ARTERY X-RAYS HEAD & NECK | $363.17 | $338.89 | packaged | packaged | N1 |
| 75671 | 26 | ARTERY X-RAYS HEAD & NECK | $131.36 | $126.95 | packaged | packaged | N1 |
| 75676 | ARTERY X-RAYS NECK UNILATERAL | $407.54 | $383.78 | packaged | packaged | N1 | |
| 75676 | TC | ARTERY X-RAYS NECK UNILATERAL | $302.73 | $282.44 | packaged | packaged | N1 |
| 75676 | 26 | ARTERY X-RAYS NECK UNILATERAL | $104.80 | $101.35 | packaged | packaged | N1 |
| 75680 | ARTERY X-RAYS NECK BILATERAL | $460.30 | $433.83 | packaged | packaged | N1 | |
| 75680 | TC | ARTERY X-RAYS NECK BILATERAL | $328.94 | $306.88 | packaged | packaged | N1 |
| 75680 | 26 | ARTERY X-RAYS NECK BILATERAL | $131.36 | $126.95 | packaged | packaged | N1 |
| 75685 | ARTERY X-RAYS SPINE | $409.47 | $385.48 | packaged | packaged | N1 | |
| 75685 | TC | ARTERY X-RAYS SPINE | $305.65 | $285.15 | packaged | packaged | N1 |
| 75685 | 26 | ARTERY X-RAYS SPINE | $103.82 | $100.33 | packaged | packaged | N1 |
| 75705 | ARTERY X-RAYS SPINE | $472.31 | $446.19 | packaged | packaged | N1 | |
| 75705 | TC | ARTERY X-RAYS SPINE | $303.32 | $282.98 | packaged | packaged | N1 |
| 75705 | 26 | ARTERY X-RAYS SPINE | $169.00 | $163.23 | packaged | packaged | N1 |
| 75710 | ARTERY X-RAYS ARM/LEG | $392.29 | $368.94 | packaged | packaged | N1 | |
| 75710 | TC | ARTERY X-RAYS ARM/LEG | $304.48 | $284.06 | packaged | packaged | N1 |
| 75710 | 26 | ARTERY X-RAYS ARM/LEG | $87.82 | $84.88 | packaged | packaged | N1 |
| 75716 | ARTERY X-RAYS ARMS/LEGS | $453.48 | $426.68 | packaged | packaged | N1 | |
| 75716 | TC | ARTERY X-RAYS ARMS/LEGS | $350.35 | $326.93 | packaged | packaged | N1 |
| 75716 | 26 | ARTERY X-RAYS ARMS/LEGS | $103.13 | $99.75 | packaged | packaged | N1 |
| 75722 | ARTERY X-RAYS KIDNEY | $379.94 | $357.49 | packaged | packaged | N1 | |
| 75722 | TC | ARTERY X-RAYS KIDNEY | $289.33 | $269.93 | packaged | packaged | N1 |
| 75722 | 26 | ARTERY X-RAYS KIDNEY | $90.61 | $87.55 | packaged | packaged | N1 |
| 75724 | ARTERY X-RAYS KIDNEYS | $449.53 | $423.26 | packaged | packaged | N1 | |
| 75724 | TC | ARTERY X-RAYS KIDNEYS | $329.39 | $307.38 | packaged | packaged | N1 |
| 75724 | 26 | ARTERY X-RAYS KIDNEYS | $120.14 | $115.88 | packaged | packaged | N1 |
| 75726 | ARTERY X-RAYS ABDOMEN | $389.19 | $366.16 | packaged | packaged | N1 | |
| 75726 | TC | ARTERY X-RAYS ABDOMEN | $299.82 | $279.71 | packaged | packaged | N1 |
| 75726 | 26 | ARTERY X-RAYS ABDOMEN | $89.37 | $86.44 | packaged | packaged | N1 |
| 75736 | ARTERY X-RAYS PELVIS | $387.64 | $364.59 | packaged | packaged | N1 | |
| 75736 | TC | ARTERY X-RAYS PELVIS | $299.24 | $279.17 | packaged | packaged | N1 |
| 75736 | 26 | ARTERY X-RAYS PELVIS | $88.41 | $85.42 | packaged | packaged | N1 |
| 75743 | ARTERY X-RAYS LUNGS | $408.48 | $385.48 | packaged | packaged | N1 | |
| 75743 | TC | ARTERY X-RAYS LUNGS | $278.28 | $259.62 | packaged | packaged | N1 |
| 75743 | 26 | ARTERY X-RAYS LUNGS | $130.20 | $125.85 | packaged | packaged | N1 |
| 75774 | ARTERY X-RAY, EACH VESSEL | $270.73 | $253.58 | packaged | packaged | N1 | |
| 75774 | TC | ARTERY X-RAY, EACH VESSEL | $242.17 | $225.94 | packaged | packaged | N1 |
| 75774 | 26 | ARTERY X-RAY, EACH VESSEL | $28.56 | $27.63 | packaged | packaged | N1 |
| 75809 | NONVASCULAR SHUNT, X-RAY | $164.52 | $154.76 | packaged | packaged | N1 | |
| 75809 | TC | NONVASCULAR SHUNT, X-RAY | $127.46 | $118.93 | packaged | packaged | N1 |
| 75809 | 26 | NONVASCULAR SHUNT, X-RAY | $37.06 | $35.83 | packaged | packaged | N1 |
| 75820 | VEIN X-RAY ARM/LEG | $210.48 | $198.23 | packaged | packaged | N1 | |
| 75820 | TC | VEIN X-RAY ARM/LEG | $155.41 | $145.01 | packaged | packaged | N1 |
| 75820 | 26 | VEIN X-RAY ARM/LEG | $55.07 | $53.22 | packaged | packaged | N1 |
| 75822 | VEIN X-RAY ARMS/LEGS | $256.52 | $242.15 | packaged | packaged | N1 | |
| 75822 | TC | VEIN X-RAY ARMS/LEGS | $174.04 | $162.39 | packaged | packaged | N1 |
| 75822 | 26 | VEIN X-RAY ARMS/LEGS | $82.47 | $79.77 | packaged | packaged | N1 |
| 75825 | VEIN X-RAY TRUNK | $345.52 | $325.41 | packaged | packaged | N1 | |
| 75825 | TC | VEIN X-RAY TRUNK | $257.32 | $240.06 | packaged | packaged | N1 |
| 75825 | 26 | VEIN X-RAY TRUNK | $88.21 | $85.35 | packaged | packaged | N1 |
| 75894 | X-RAYS, TRANSCATH THERAPY | $1,855.82 | $1,791.12 | packaged | packaged | N1 | |
| 75894 | TC | X-RAYS, TRANSCATH THERAPY | $1,753.06 | $1,691.80 | packaged | packaged | N1 |
| 75894 | 26 | X-RAYS, TRANSCATH THERAPY | $106.24 | $102.86 | packaged | packaged | N1 |
| 75898 | F/U ANGIOGRAPHY | $209.00 | $201.67 | packaged | packaged | N1 | |
| 75898 | TC | F/U ANGIOGRAPHY | $78.78 | $76.03 | packaged | packaged | N1 |
| 75898 | 26 | F/U ANGIOGRAPHY | $135.47 | $131.11 | packaged | packaged | N1 |
| 75940 | X-RAY PLACE VEIN FILTER | $957.35 | $924.02 | packaged | packaged | N1 | |
| 75940 | TC | X-RAY PLACE VEIN FILTER | $914.34 | $882.41 | packaged | packaged | N1 |
| 75940 | 26 | X-RAY PLACE VEIN FILTER | $43.27 | $41.92 | packaged | packaged | N1 |
| 75954 | 26 | ILIAC ANEURYSM ENDOVASC REPAIR | $183.83 | $178.42 | not payable in ASC | not payable in ASC | |
| 75957 | 26 | X-RAY, ENDOVASC THOR AO REPAIR | $494.34 | $480.01 | not payable in ASC | not payable in ASC | |
| 75960 | TRANSCATH IV STENT RS & I | $326.56 | $306.84 | packaged | packaged | N1 | |
| 75960 | TC | TRANSCATH IV STENT RS & I | $262.56 | $244.95 | packaged | packaged | N1 |
| 75960 | 26 | TRANSCATH IV STENT RS & I | $64.01 | $61.89 | packaged | packaged | N1 |
| 75961 | RETRIEVE BROKEN CATHETER | $601.23 | $572.18 | packaged | packaged | N1 | |
| 75961 | TC | RETRIEVE BROKEN CATHETER | $271.28 | $253.09 | packaged | packaged | N1 |
| 75961 | 26 | RETRIEVE BROKEN CATHETER | $329.93 | $319.08 | packaged | packaged | N1 |
| 75962 | REPAIR ARTERIAL BLOCKAGE | $360.81 | $338.03 | packaged | packaged | N1 | |
| 75962 | TC | REPAIR ARTERIAL BLOCKAGE | $319.03 | $297.65 | packaged | packaged | N1 |
| 75962 | 26 | REPAIR ARTERIAL BLOCKAGE | $41.78 | $40.39 | packaged | packaged | N1 |
| 75964 | REPAIR ARTERY BLOCKAGE, EACH | $224.67 | $210.63 | packaged | packaged | N1 | |
| 75964 | TC | REPAIR ARTERY BLOCKAGE, EACH | $196.17 | $183.04 | packaged | packaged | N1 |
| 75964 | 26 | REPAIR ARTERY BLOCKAGE, EACH | $28.51 | $27.61 | packaged | packaged | N1 |
| 75978 | REPAIR VENOUS BLOCKAGE | $361.40 | $338.57 | packaged | packaged | N1 | |
| 75978 | TC | REPAIR VENOUS BLOCKAGE | $320.20 | $298.73 | packaged | packaged | N1 |
| 75978 | 26 | REPAIR VENOUS BLOCKAGE | $41.20 | $39.85 | packaged | packaged | N1 |
| 75984 | X-RAY CONTROL CATHETER CHANGE | $192.29 | $181.30 | packaged | packaged | N1 | |
| 75984 | TC | X-RAY CONTROL CATHETER CHANGE | $136.20 | $127.09 | packaged | packaged | N1 |
| 75984 | 26 | X-RAY CONTROL CATHETER CHANGE | $56.09 | $54.21 | packaged | packaged | N1 |
| 75989 | ABSCESS DRAIN UNDER X-RAY | $224.22 | $212.28 | packaged | packaged | N1 | |
| 75989 | TC | ABSCESS DRAIN UNDER X-RAY | $132.70 | $123.82 | packaged | packaged | N1 |
| 75989 | 26 | ABSCESS DRAIN UNDER X-RAY | $91.52 | $88.45 | packaged | packaged | N1 |
| 76000 | FLUOROSCOPE EXAM | $304.49 | $285.18 | packaged | packaged | N1 | |
| 76000 | TC | FLUOROSCOPE EXAM | $274.00 | $255.66 | packaged | packaged | N1 |
| 76000 | 26 | FLUOROSCOPE EXAM | $30.50 | $29.51 | packaged | packaged | N1 |
| 76001 | FLUOROSCOPE EXAM, EXTENSIVE | $576.95 | $556.98 | packaged | packaged | N1 | |
| 76001 | TC | FLUOROSCOPE EXAM, EXTENSIVE | $453.41 | $437.54 | packaged | packaged | N1 |
| 76001 | 26 | FLUOROSCOPE EXAM, EXTENSIVE | $128.39 | $124.16 | packaged | packaged | N1 |
| 76010 | X-RAY NOSE TO RECTUM | $46.27 | $43.68 | not payable in ASC | not payable in ASC | ||
| 76010 | TC | X-RAY NOSE TO RECTUM | $31.96 | $29.86 | $63.18 | $58.17 | |
| 76010 | 26 | X-RAY NOSE TO RECTUM | $14.31 | $13.83 | not payable in ASC | not payable in ASC | |
| 76080 | X-RAY FISTULA | $103.44 | $97.94 | packaged | packaged | N1 | |
| 76080 | TC | X-RAY FISTULA | $61.08 | $57.01 | packaged | packaged | N1 |
| 76080 | 26 | X-RAY FISTULA | $42.36 | $40.94 | packaged | packaged | N1 |
| 76098 | X-RAY EXAM, BREAST SPECIMEN | $31.87 | $30.18 | packaged | packaged | N1 | |
| 76098 | TC | X-RAY EXAM, BREAST SPECIMEN | $19.16 | $17.91 | packaged | packaged | N1 |
| 76098 | 26 | X-RAY EXAM, BREAST SPECIMEN | $12.72 | $12.29 | packaged | packaged | N1 |
| 76100 | X-RAY BODY SECTION | $206.65 | $194.40 | not payable in ASC | not payable in ASC | ||
| 76100 | TC | X-RAY BODY SECTION | $158.32 | $147.72 | $146.91 | $135.24 | |
| 76100 | 26 | X-RAY BODY SECTION | $48.33 | $46.68 | not payable in ASC | not payable in ASC | |
| 76102 | COMPLEX BODY SECTION X-RAYS | $403.16 | $377.88 | not payable in ASC | not payable in ASC | ||
| 76102 | TC | COMPLEX BODY SECTION X-RAYS | $349.32 | $325.88 | $445.38 | $409.95 | |
| 76102 | 26 | COMPLEX BODY SECTION X-RAYS | $53.84 | $52.00 | not payable in ASC | not payable in ASC | |
| 76120 | CINE/VIDEO X-RAYS | $129.09 | $121.49 | not payable in ASC | not payable in ASC | ||
| 76120 | TC | CINE/VIDEO X-RAYS | $99.50 | $92.87 | $161.73 | $148.86 | |
| 76120 | 26 | CINE/VIDEO X-RAYS | $29.57 | $28.62 | not payable in ASC | not payable in ASC | |
| 76125 | 26 | CINE/VIDEO X-RAYS, ADDED | $22.84 | $22.06 | packaged | packaged | N1 |
| 76376 | 3D RENDER W/O POST PROCESS | $234.29 | $219.61 | packaged | packaged | N1 | |
| 76376 | TC | 3D RENDER W/O POST PROCESS | $203.68 | $190.07 | packaged | packaged | N1 |
| 76376 | 26 | 3D RENDER W/O POST PROCESS | $30.61 | $29.54 | packaged | packaged | N1 |
| 76377 | 3D RENDERING W/POST PROCESS | $297.09 | $281.18 | packaged | packaged | N1 | |
| 76377 | TC | 3D RENDERING W/POST PROCESS | $179.06 | $167.09 | packaged | packaged | N1 |
| 76377 | 26 | 3D RENDERING W/POST PROCESS | $118.06 | $114.10 | packaged | packaged | N1 |
| 76380 | CAT SCAN F/U STUDY | $318.44 | $299.62 | not payable in ASC | not payable in ASC | ||
| 76380 | TC | CAT SCAN F/U STUDY | $242.75 | $226.49 | $219.81 | $202.32 | |
| 76380 | 26 | CAT SCAN F/U STUDY | $75.69 | $73.13 | not payable in ASC | not payable in ASC | |
| 76506 | ECHO EXAM HEAD | $202.86 | $190.94 | not payable in ASC | not payable in ASC | ||
| 76506 | TC | ECHO EXAM HEAD | $153.66 | $143.37 | $120.54 | $110.97 | |
| 76506 | 26 | ECHO EXAM HEAD | $49.18 | $47.56 | not payable in ASC | not payable in ASC | |
| 76510 | OPHTHALMIC US, B & QUANT A | $273.79 | $260.13 | not payable in ASC | not payable in ASC | ||
| 76510 | TC | OPHTHALMIC US, B & QUANT A | $127.46 | $118.93 | $255.03 | $234.75 | |
| 76510 | 26 | OPHTHALMIC US, B & QUANT A | $146.33 | $141.20 | not payable in ASC | not payable in ASC | |
| 76511 | OPHTHALMIC US, QUANT A ONLY | $163.45 | $154.84 | not payable in ASC | not payable in ASC | ||
| 76511 | TC | OPHTHALMIC US, QUANT A ONLY | $83.20 | $77.65 | $166.14 | $152.91 | |
| 76511 | 26 | OPHTHALMIC US, QUANT A ONLY | $80.25 | $77.19 | not payable in ASC | not payable in ASC | |
| 76512 | OPHTHALMIC US, B W/NON-QUANT A | $151.03 | $143.36 | not payable in ASC | not payable in ASC | ||
| 76512 | TC | OPHTHALMIC US, B W/NON-QUANT A | $69.24 | $64.62 | $138.03 | $127.05 | |
| 76512 | 26 | OPHTHALMIC US, B W/NON-QUANT A | $81.81 | $78.74 | not payable in ASC | not payable in ASC | |
| 76514 | ECHO EXAM EYE, THICKNESS | $22.48 | $21.46 | not payable in ASC | not payable in ASC | ||
| 76514 | TC | ECHO EXAM EYE, THICKNESS | $7.50 | $7.03 | $14.04 | $12.93 | |
| 76514 | 26 | ECHO EXAM EYE, THICKNESS | $14.96 | $14.41 | not payable in ASC | not payable in ASC | |
| 76516 | ECHO EXAM EYE | $119.29 | $112.66 | not payable in ASC | not payable in ASC | ||
| 76516 | TC | ECHO EXAM EYE | $73.31 | $68.43 | $120.54 | $110.97 | |
| 76516 | 26 | ECHO EXAM EYE | $45.97 | $44.24 | not payable in ASC | not payable in ASC | |
| 76519 | ECHO EXAM EYE | $129.63 | $122.38 | not payable in ASC | not payable in ASC | ||
| 76519 | TC | ECHO EXAM EYE | $82.04 | $76.57 | $163.80 | $150.78 | |
| 76519 | 26 | ECHO EXAM EYE | $47.59 | $45.83 | not payable in ASC | not payable in ASC | |
| 76536 | US EXAM HEAD & NECK | $199.36 | $187.48 | not payable in ASC | not payable in ASC | ||
| 76536 | TC | US EXAM HEAD & NECK | $155.99 | $145.55 | $186.48 | $171.66 | |
| 76536 | 26 | US EXAM HEAD & NECK | $43.37 | $41.94 | not payable in ASC | not payable in ASC | |
| 76604 | US EXAM, CHEST | $147.03 | $138.64 | not payable in ASC | not payable in ASC | ||
| 76604 | TC | US EXAM, CHEST | $104.75 | $97.76 | $120.54 | $110.97 | |
| 76604 | 26 | US EXAM, CHEST | $42.28 | $40.88 | not payable in ASC | not payable in ASC | |
| 76645 | US EXAM, BREAST(S) | $161.02 | $151.70 | not payable in ASC | not payable in ASC | ||
| 76645 | TC | US EXAM, BREAST(S) | $118.73 | $110.79 | $120.54 | $110.97 | |
| 76645 | 26 | US EXAM, BREAST(S) | $42.29 | $40.91 | not payable in ASC | not payable in ASC | |
| 76700 | US EXAM, ABDOM, COMPLETE | $235.86 | $222.17 | not payable in ASC | not payable in ASC | ||
| 76700 | TC | US EXAM, ABDOM, COMPLETE | $167.06 | $161.85 | $186.48 | $171.66 | |
| 76700 | 26 | US EXAM, ABDOM, COMPLETE | $62.40 | $60.32 | not payable in ASC | not payable in ASC | |
| 76705 | ECHO EXAM ABDOMEN | $179.34 | $168.88 | not payable in ASC | not payable in ASC | ||
| 76705 | TC | ECHO EXAM ABDOMEN | $133.87 | $124.91 | $186.48 | $171.66 | |
| 76705 | 26 | ECHO EXAM ABDOMEN | $45.47 | $43.97 | not payable in ASC | not payable in ASC | |
| 76770 | US EXAM ABDOM BACK WALL, COMP | $224.16 | $211.09 | not payable in ASC | not payable in ASC | ||
| 76770 | TC | US EXAM ABDOM BACK WALL, COMP | $167.06 | $155.86 | $186.48 | $171.66 | |
| 76770 | 26 | US EXAM ABDOM BACK WALL, COMP | $57.10 | $55.21 | not payable in ASC | not payable in ASC | |
| 76775 | US EXAM ABDOM BACK WALL, LIM | $187.57 | $176.53 | not payable in ASC | not payable in ASC | ||
| 76775 | TC | US EXAM ABDOM BACK WALL, LIM | $142.02 | $132.52 | $186.48 | $171.66 | |
| 76775 | 26 | US EXAM ABDOM BACK WALL, LIM | $45.55 | $44.01 | not payable in ASC | not payable in ASC | |
| 76776 | US EXAM K TRANSPLANT W/DOPPLER | $254.87 | $239.78 | not payable in ASC | not payable in ASC | ||
| 76776 | TC | US EXAM K TRANSPLANT W/DOPPLER | $196.17 | $183.04 | $186.48 | $171.66 | |
| 76776 | 26 | US EXAM K TRANSPLANT W/DOPPLER | $58.70 | $56.76 | not payable in ASC | not payable in ASC | |
| 76800 | US EXAM, SPINAL CANAL | $220.65 | $208.77 | not payable in ASC | not payable in ASC | ||
| 76800 | TC | US EXAM, SPINAL CANAL | $135.03 | $125.99 | $186.48 | $171.66 | |
| 76800 | 26 | US EXAM, SPINAL CANAL | $85.62 | $82.78 | not payable in ASC | not payable in ASC | |
| 76801 | OBSTET US < 14 WKS, SINGLE FETUS | $216.53 | $204.54 | not payable in ASC | not payable in ASC | ||
| 76801 | TC | OBSTET US < 14 WKS, SINGLE FETUS | $140.28 | $130.88 | $186.48 | $171.66 | |
| 76801 | 26 | OBSTET US < 14 WKS, SINGLE FETUS | $76.26 | $73.65 | not payable in ASC | not payable in ASC | |
| 76805 | OBSTET US >/= 14 WKS, SINGLE FETUS | $249.13 | $234.96 | not payable in ASC | not payable in ASC | ||
| 76805 | TC | OBSTET US >/= 14 WKS, SINGLE FETUS | $172.87 | $161.31 | $186.48 | $171.66 | |
| 76805 | 26 | OBSTET US >/= 14 WKS, SINGLE FETUS | $76.26 | $73.65 | not payable in ASC | not payable in ASC | |
| 76810 | OBSTET US >/= 14 WKS, ADDED FETUS | $160.70 | $152.44 | not payable in ASC | not payable in ASC | ||
| 76810 | TC | OBSTET US >/= 14 WKS, ADDED FETUS | $85.53 | $79.82 | $170.82 | $157.23 | |
| 76810 | 26 | OBSTET US >/= 14 WKS, ADDED FETUS | $75.16 | $72.62 | not payable in ASC | not payable in ASC | |
| 76811 | OBSTET US, DETAILED, SINGLE FETUS | $317.90 | $301.40 | not payable in ASC | not payable in ASC | ||
| 76811 | TC | OBSTET US, DETAILED, SINGLE FETUS | $171.71 | $160.21 | $296.28 | $272.73 | |
| 76811 | 26 | OBSTET US, DETAILED, SINGLE FETUS | $146.19 | $141.18 | not payable in ASC | not payable in ASC | |
| 76814 | OBSTET US NUCHAL MEAS, ADDED | $131.51 | $125.24 | not payable in ASC | not payable in ASC | ||
| 76814 | TC | OBSTET US NUCHAL MEAS, ADDED | $55.83 | $52.13 | $111.15 | $102.30 | |
| 76814 | 26 | OBSTET US NUCHAL MEAS, ADDED | $75.67 | $73.11 | not payable in ASC | not payable in ASC | |
| 76815 | OBSTET US, LIMITED, FETUS(S) | $152.23 | $143.66 | not payable in ASC | not payable in ASC | ||
| 76815 | TC | OBSTET US, LIMITED, FETUS(S) | $103.00 | $96.12 | $120.54 | $110.97 | |
| 76815 | 26 | OBSTET US, LIMITED, FETUS(S) | $49.23 | $47.55 | not payable in ASC | not payable in ASC | |
| 76816 | OBSTET US, F/U, PER FETUS | $194.86 | $183.99 | not payable in ASC | not payable in ASC | ||
| 76816 | TC | OBSTET US, F/U, PER FETUS | $129.20 | $120.56 | $120.54 | $110.97 | |
| 76816 | 26 | OBSTET US, F/U, PER FETUS | $65.65 | $63.42 | not payable in ASC | not payable in ASC | |
| 76817 | TRANSVAGINAL US, OBSTETRIC | $172.32 | $162.71 | not payable in ASC | not payable in ASC | ||
| 76817 | TC | TRANSVAGINAL US, OBSTETRIC | $114.65 | $106.98 | $120.54 | $110.97 | |
| 76817 | 26 | TRANSVAGINAL US, OBSTETRIC | $57.67 | $55.73 | not payable in ASC | not payable in ASC | |
| 76818 | FETAL BIOPHYS PROFILE W/NST | $202.69 | $191.78 | not payable in ASC | not payable in ASC | ||
| 76818 | TC | FETAL BIOPHYS PROFILE W/NST | $121.64 | $113.50 | $186.48 | $171.66 | |
| 76818 | 26 | FETAL BIOPHYS PROFILE W/NST | $81.04 | $78.27 | not payable in ASC | not payable in ASC | |
| 76819 | FETAL BIOPHYS PROFILE W/O NST | $152.37 | $144.15 | not payable in ASC | not payable in ASC | ||
| 76819 | TC | FETAL BIOPHYS PROFILE W/O NST | $92.53 | $86.34 | $184.83 | $170.13 | |
| 76819 | 26 | FETAL BIOPHYS PROFILE W/O NST | $59.86 | $57.81 | not payable in ASC | not payable in ASC | |
| 76820 | UMBILICAL ARTERY ECHO | $76.50 | $72.65 | not payable in ASC | not payable in ASC | ||
| 76820 | TC | UMBILICAL ARTERY ECHO | $38.37 | $35.83 | $76.02 | $69.99 | |
| 76820 | 26 | UMBILICAL ARTERY ECHO | $38.13 | $36.82 | not payable in ASC | not payable in ASC | |
| 76821 | MIDDLE CEREBRAL ARTERY ECHO | $162.22 | $153.16 | not payable in ASC | not payable in ASC | ||
| 76821 | TC | MIDDLE CEREBRAL ARTERY ECHO | $107.66 | $100.47 | $120.54 | $110.97 | |
| 76821 | 26 | MIDDLE CEREBRAL ARTERY ECHO | $54.56 | $52.71 | not payable in ASC | not payable in ASC | |
| 76826 | ECHO EXAM FETAL HEART | $208.98 | $197.12 | not payable in ASC | not payable in ASC | ||
| 76826 | TC | ECHO EXAM FETAL HEART | $145.52 | $135.77 | $291.30 | $268.14 | |
| 76826 | 26 | ECHO EXAM FETAL HEART | $63.48 | $61.35 | not payable in ASC | not payable in ASC | |
| 76827 | ECHO EXAM FETAL HEART | $109.66 | $103.78 | not payable in ASC | not payable in ASC | ||
| 76827 | TC | ECHO EXAM FETAL HEART | $65.74 | $61.36 | $120.54 | $110.97 | |
| 76827 | 26 | ECHO EXAM FETAL HEART | $43.93 | $42.43 | not payable in ASC | not payable in ASC | |
| 76828 | ECHO EXAM FETAL HEART | $79.54 | $75.63 | not payable in ASC | not payable in ASC | ||
| 76828 | TC | ECHO EXAM FETAL HEART | $36.62 | $34.19 | $72.54 | $66.78 | |
| 76828 | 26 | ECHO EXAM FETAL HEART | $42.92 | $41.44 | not payable in ASC | not payable in ASC | |
| 76830 | TRANSVAGINAL US, NON-OB | $210.04 | $197.76 | not payable in ASC | not payable in ASC | ||
| 76830 | TC | TRANSVAGINAL US, NON-OB | $156.57 | $146.09 | $186.48 | $171.66 | |
| 76830 | 26 | TRANSVAGINAL US, NON-OB | $53.46 | $51.66 | not payable in ASC | not payable in ASC | |
| 76856 | US EXAM, PELVIC, COMPLETE | $209.45 | $197.22 | not payable in ASC | not payable in ASC | ||
| 76856 | TC | US EXAM, PELVIC, COMPLETE | $155.99 | $145.55 | $186.48 | $171.66 | |
| 76856 | 26 | US EXAM, PELVIC, COMPLETE | $53.46 | $51.66 | not payable in ASC | not payable in ASC | |
| 76857 | US EXAM, PELVIC, LIMITED | $171.60 | $161.14 | not payable in ASC | not payable in ASC | ||
| 76857 | TC | US EXAM, PELVIC, LIMITED | $140.86 | $131.42 | $120.54 | $110.97 | |
| 76857 | 26 | US EXAM, PELVIC, LIMITED | $30.74 | $29.71 | not payable in ASC | not payable in ASC | |
| 76870 | US EXAM, SCROTUM | $208.60 | $196.32 | not payable in ASC | not payable in ASC | ||
| 76870 | TC | US EXAM, SCROTUM | $158.32 | $147.72 | $186.48 | $171.66 | |
| 76870 | 26 | US EXAM, SCROTUM | $50.28 | $48.60 | not payable in ASC | not payable in ASC | |
| 76872 | US, TRANSRECTAL | $236.77 | $222.71 | not payable in ASC | not payable in ASC | ||
| 76872 | TC | US, TRANSRECTAL | $181.61 | $169.45 | $186.48 | $171.66 | |
| 76872 | 26 | US, TRANSRECTAL | $55.15 | $53.26 | not payable in ASC | not payable in ASC | |
| 76881 | US XTR NON-VASC COMPLETE | $192.67 | $181.34 | not payable in ASC | not payable in ASC | ||
| 76881 | TC | US XTR NON-VASC COMPLETE | $147.84 | $137.94 | $186.48 | $171.66 | |
| 76881 | 26 | US XTR NON-VASC COMPLETE | $44.84 | $43.40 | not payable in ASC | not payable in ASC | |
| 76882 | US XTR NON-VASC LMTD | $48.50 | $46.38 | not payable in ASC | not payable in ASC | ||
| 76882 | TC | US XTR NON-VASC LMTD | $17.41 | $16.27 | $33.93 | $31.23 | |
| 76882 | 26 | US XTR NON-VASC LMTD | $31.09 | $30.11 | not payable in ASC | not payable in ASC | |
| 76937 | US GUIDE VASCULAR ACCESS | $57.48 | $54.50 | packaged | packaged | N1 | |
| 76937 | TC | US GUIDE VASCULAR ACCESS | $33.71 | $31.48 | packaged | packaged | N1 |
| 76937 | 26 | US GUIDE VASCULAR ACCESS | $23.77 | $23.01 | packaged | packaged | N1 |
| 76942 | ECHO GUIDE FOR BIOPSY | $334.15 | $313.52 | packaged | packaged | N1 | |
| 76942 | TC | ECHO GUIDE FOR BIOPSY | $281.77 | $262.89 | packaged | packaged | N1 |
| 76942 | 26 | ECHO GUIDE FOR BIOPSY | $52.38 | $50.65 | packaged | packaged | N1 |
| 76998 | US GUIDE, INTRAOP | $293.61 | $283.70 | packaged | packaged | N1 | |
| 76998 | TC | US GUIDE, INTRAOP | $197.37 | $190.50 | packaged | packaged | N1 |
| 76998 | 26 | US GUIDE, INTRAOP | $101.78 | $98.78 | packaged | packaged | N1 |
| 77001 | FLUOROGUIDE FOR VEIN DEVICE | $193.72 | $181.78 | packaged | packaged | N1 | |
| 77001 | TC | FLUOROGUIDE FOR VEIN DEVICE | $163.57 | $152.61 | packaged | packaged | N1 |
| 77001 | 26 | FLUOROGUIDE FOR VEIN DEVICE | $30.16 | $29.16 | packaged | packaged | N1 |
| 77002 | NEEDLE LOCALIZATION BY X-RAY | $289.77 | $273.67 | packaged | packaged | N1 | |
| 77002 | TC | NEEDLE LOCALIZATION BY X-RAY | $190.67 | $177.94 | packaged | packaged | N1 |
| 77002 | 26 | NEEDLE LOCALIZATION BY X-RAY | $99.07 | $95.73 | packaged | packaged | N1 |
| 77003 | FLUOROGUIDE FOR SPINE INJECT | $236.32 | $224.15 | packaged | packaged | N1 | |
| 77003 | TC | FLUOROGUIDE FOR SPINE INJECT | $130.19 | $121.54 | packaged | packaged | N1 |
| 77003 | 26 | FLUOROGUIDE FOR SPINE INJECT | $106.12 | $102.61 | packaged | packaged | N1 |
| 77011 | CT SCAN FOR LOCALIZATION | $819.82 | $767.90 | packaged | packaged | N1 | |
| 77011 | TC | CT SCAN FOR LOCALIZATION | $724.89 | $676.25 | packaged | packaged | N1 |
| 77011 | 26 | CT SCAN FOR LOCALIZATION | $94.93 | $91.65 | packaged | packaged | N1 |
| 77012 | CT SCAN FOR NEEDLE BIOPSY | $271.67 | $256.43 | packaged | packaged | N1 | |
| 77012 | TC | CT SCAN FOR NEEDLE BIOPSY | $182.78 | $170.54 | packaged | packaged | N1 |
| 77012 | 26 | CT SCAN FOR NEEDLE BIOPSY | $88.89 | $85.90 | packaged | packaged | N1 |
| 77032 | GUIDANCE FOR NEEDLE, BREAST | $91.65 | $86.98 | packaged | packaged | N1 | |
| 77032 | TC | GUIDANCE FOR NEEDLE, BREAST | $48.27 | $45.06 | packaged | packaged | N1 |
| 77032 | 26 | GUIDANCE FOR NEEDLE, BREAST | $43.37 | $41.94 | packaged | packaged | N1 |
| 77051 | COMPUTER DIAG MAMMOGRAM, ADDED | $19.23 | $18.15 | not payable in ASC | not payable in ASC | ||
| 77051 | TC | COMPUTER DIAG MAMMOGRAM, ADDED | $14.50 | $13.56 | not payable in ASC | not payable in ASC | |
| 77051 | 26 | COMPUTER DIAG MAMMOGRAM, ADDED | $4.73 | $4.59 | not payable in ASC | not payable in ASC | |
| 77052 | COMP SCREEN MAMMOGRAM, ADDED | $19.23 | $18.15 | not payable in ASC | not payable in ASC | ||
| 77052 | TC | COMP SCREEN MAMMOGRAM, ADDED | $14.50 | $13.56 | not payable in ASC | not payable in ASC | |
| 77052 | 26 | COMP SCREEN MAMMOGRAM, ADDED | $4.73 | $4.59 | not payable in ASC | not payable in ASC | |
| 77055 | MAMMOGRAM, ONE BREAST | $142.93 | $135.22 | not payable in ASC | not payable in ASC | ||
| 77055 | TC | MAMMOGRAM, ONE BREAST | $88.45 | $82.54 | not payable in ASC | not payable in ASC | |
| 77055 | 26 | MAMMOGRAM, ONE BREAST | $54.48 | $52.68 | not payable in ASC | not payable in ASC | |
| 77056 | MAMMOGRAM, BOTH BREASTS | $182.95 | $172.99 | not payable in ASC | not payable in ASC | ||
| 77056 | TC | MAMMOGRAM, BOTH BREASTS | $115.24 | $107.53 | not payable in ASC | not payable in ASC | |
| 77056 | 26 | MAMMOGRAM, BOTH BREASTS | $67.71 | $65.47 | not payable in ASC | not payable in ASC | |
| 77057 | MAMMOGRAM, SCREENING | $133.62 | $126.53 | not payable in ASC | not payable in ASC | ||
| 77057 | TC | MAMMOGRAM, SCREENING | $79.13 | $73.85 | not payable in ASC | not payable in ASC | |
| 77057 | 26 | MAMMOGRAM, SCREENING | $54.48 | $52.68 | not payable in ASC | not payable in ASC | |
| 77058 | MRI ONE BREAST | $1,287.39 | $1,205.28 | not payable in ASC | not payable in ASC | ||
| 77058 | TC | MRI ONE BREAST | $1,160.46 | $1,082.55 | not payable in ASC | not payable in ASC | |
| 77058 | 26 | MRI ONE BREAST | $126.93 | $122.74 | not payable in ASC | not payable in ASC | |
| 77059 | MRI BOTH BREASTS | $1,336.30 | $1,250.91 | not payable in ASC | not payable in ASC | ||
| 77059 | TC | MRI BOTH BREASTS | $1,209.37 | $1,128.17 | not payable in ASC | not payable in ASC | |
| 77059 | 26 | MRI BOTH BREASTS | $126.93 | $122.74 | not payable in ASC | not payable in ASC | |
| 77072 | X-RAYS FOR BONE AGE | $39.21 | $37.12 | not payable in ASC | not payable in ASC | ||
| 77072 | TC | X-RAYS FOR BONE AGE | $24.40 | $22.79 | $47.97 | $44.16 | |
| 77072 | 26 | X-RAYS FOR BONE AGE | $14.82 | $14.32 | not payable in ASC | not payable in ASC | |
| 77073 | X-RAYS, BONE LENGTH STUDIES | $65.21 | $61.67 | not payable in ASC | not payable in ASC | ||
| 77073 | TC | X-RAYS, BONE LENGTH STUDIES | $41.87 | $39.08 | $83.04 | $76.44 | |
| 77073 | 26 | X-RAYS, BONE LENGTH STUDIES | $23.35 | $22.58 | not payable in ASC | not payable in ASC | |
| 77074 | X-RAYS, BONE SURVEY, LIMITED | $116.91 | $110.30 | not payable in ASC | not payable in ASC | ||
| 77074 | TC | X-RAYS, BONE SURVEY, LIMITED | $81.46 | $76.03 | $146.91 | $135.24 | |
| 77074 | 26 | X-RAYS, BONE SURVEY, LIMITED | $35.46 | $34.28 | not payable in ASC | not payable in ASC | |
| 77075 | X-RAYS, BONE SURVEY COMPLETE | $172.73 | $162.59 | not payable in ASC | not payable in ASC | ||
| 77075 | TC | X-RAYS, BONE SURVEY COMPLETE | $130.95 | $122.20 | $146.91 | $135.24 | |
| 77075 | 26 | X-RAYS, BONE SURVEY COMPLETE | $41.78 | $40.39 | not payable in ASC | not payable in ASC | |
| 77076 | X-RAYS, BONE SURVEY, INFANT | $167.39 | $158.04 | not payable in ASC | not payable in ASC | ||
| 77076 | TC | X-RAYS, BONE SURVEY, INFANT | $114.07 | $106.44 | $146.91 | $135.24 | |
| 77076 | 26 | X-RAYS, BONE SURVEY, INFANT | $53.32 | $51.59 | not payable in ASC | not payable in ASC | |
| 77077 | JOINT SURVEY, SINGLE VIEW | $70.16 | $66.38 | not payable in ASC | not payable in ASC | ||
| 77077 | TC | JOINT SURVEY, SINGLE VIEW | $44.20 | $41.25 | $87.24 | $80.31 | |
| 77077 | 26 | JOINT SURVEY, SINGLE VIEW | $25.96 | $25.11 | not payable in ASC | not payable in ASC | |
| 77080 | DIAG BONE DENSITY, AXIAL | $164.52 | $154.53 | not payable in ASC | not payable in ASC | ||
| 77080 | TC | DIAG BONE DENSITY, AXIAL | $147.68 | $138.21 | $136.59 | $125.73 | |
| 77080 | 26 | DIAG BONE DENSITY, AXIAL | $16.85 | $16.31 | not payable in ASC | not payable in ASC | |
| 77081 | DIAG BONE DENSITY/PERIPHERAL | $47.72 | $45.12 | not payable in ASC | not payable in ASC | ||
| 77081 | TC | DIAG BONE DENSITY/PERIPHERAL | $32.54 | $30.40 | $62.19 | $57.24 | |
| 77081 | 26 | DIAG BONE DENSITY/PERIPHERAL | $15.18 | $14.74 | not payable in ASC | not payable in ASC | |
| 77082 | DIAG BONE DENSITY, VERTEBRAL FX | $46.47 | $43.84 | not payable in ASC | not payable in ASC | ||
| 77082 | TC | DIAG BONE DENSITY, VERTEBRAL FX | $36.44 | $34.13 | $69.03 | $63.54 | |
| 77082 | 26 | DIAG BONE DENSITY, VERTEBRAL FX | $10.03 | $9.71 | not payable in ASC | not payable in ASC | |
| 77261 | RADIATION THERAPY PLANNING | $113.00 | $109.15 | not payable in ASC | not payable in ASC | ||
| 77262 | RADIATION THERAPY PLANNING | $170.00 | $164.36 | not payable in ASC | not payable in ASC | ||
| 77263 | RADIATION THERAPY PLANNING | $252.06 | $243.70 | not payable in ASC | not payable in ASC | ||
| 77280 | SET RADIATION THERAPY FIELD | $318.27 | $298.74 | not payable in ASC | not payable in ASC | ||
| 77280 | TC | SET RADIATION THERAPY FIELD | $263.72 | $246.05 | $202.35 | $186.27 | |
| 77280 | 26 | SET RADIATION THERAPY FIELD | $54.56 | $52.71 | not payable in ASC | not payable in ASC | |
| 77285 | SET RADIATION THERAPY FIELD | $559.51 | $524.71 | not payable in ASC | not payable in ASC | ||
| 77285 | TC | SET RADIATION THERAPY FIELD | $477.43 | $445.40 | $526.05 | $484.20 | |
| 77285 | 26 | SET RADIATION THERAPY FIELD | $82.08 | $79.31 | not payable in ASC | not payable in ASC | |
| 77290 | SET RADIATION THERAPY FIELD | $896.21 | $840.10 | not payable in ASC | not payable in ASC | ||
| 77290 | TC | SET RADIATION THERAPY FIELD | $774.39 | $722.42 | $526.05 | $484.20 | |
| 77290 | 26 | SET RADIATION THERAPY FIELD | $121.82 | $117.69 | not payable in ASC | not payable in ASC | |
| 77295 | SET RADIATION THERAPY FIELD | $931.90 | $881.43 | not payable in ASC | not payable in ASC | ||
| 77295 | TC | SET RADIATION THERAPY FIELD | $574.47 | $536.03 | $1,150.02 | $1,058.52 | |
| 77295 | 26 | SET RADIATION THERAPY FIELD | $357.43 | $345.39 | not payable in ASC | not payable in ASC | |
| 77300 | RADIATION THERAPY DOSE PLAN | $115.07 | $108.98 | not payable in ASC | not payable in ASC | ||
| 77300 | TC | RADIATION THERAPY DOSE PLAN | $66.32 | $61.90 | $132.18 | $121.68 | |
| 77300 | 26 | RADIATION THERAPY DOSE PLAN | $48.74 | $47.09 | not payable in ASC | not payable in ASC | |
| 77305 | TELETX ISODOSE PLAN SIMPLE | $108.64 | $103.20 | not payable in ASC | not payable in ASC | ||
| 77305 | TC | TELETX ISODOSE PLAN SIMPLE | $54.09 | $50.49 | $107.64 | $99.06 | |
| 77305 | 26 | TELETX ISODOSE PLAN SIMPLE | $54.56 | $52.71 | not payable in ASC | not payable in ASC | |
| 77310 | TELETX ISODOSE PLAN INTERMED | $153.06 | $145.56 | not payable in ASC | not payable in ASC | ||
| 77310 | TC | TELETX ISODOSE PLAN INTERMED | $70.98 | $66.25 | $141.54 | $130.29 | |
| 77310 | 26 | TELETX ISODOSE PLAN INTERMED | $82.08 | $79.31 | not payable in ASC | not payable in ASC | |
| 77315 | TELETX ISODOSE PLAN COMPLEX | $232.39 | $220.88 | not payable in ASC | not payable in ASC | ||
| 77315 | TC | TELETX ISODOSE PLAN COMPLEX | $110.57 | $103.18 | $221.13 | $203.55 | |
| 77315 | 26 | TELETX ISODOSE PLAN COMPLEX | $121.82 | $117.69 | not payable in ASC | not payable in ASC | |
| 77321 | SPECIAL TELETX PORT PLAN | $176.00 | $166.68 | not payable in ASC | not payable in ASC | ||
| 77321 | TC | SPECIAL TELETX PORT PLAN | $102.42 | $95.58 | $204.75 | $188.46 | |
| 77321 | 26 | SPECIAL TELETX PORT PLAN | $73.58 | $71.10 | not payable in ASC | not payable in ASC | |
| 77331 | SPECIAL RADIATION DOSIMETRY | $101.48 | $96.97 | not payable in ASC | not payable in ASC | ||
| 77331 | TC | SPECIAL RADIATION DOSIMETRY | $33.13 | $30.94 | $65.52 | $60.30 | |
| 77331 | 26 | SPECIAL RADIATION DOSIMETRY | $68.35 | $66.02 | not payable in ASC | not payable in ASC | |
| 77332 | RADIATION TREAT AID(S) | $130.80 | $123.48 | not payable in ASC | not payable in ASC | ||
| 77332 | TC | RADIATION TREAT AID(S) | $88.45 | $82.54 | $176.64 | $162.60 | |
| 77332 | 26 | RADIATION TREAT AID(S) | $42.36 | $40.94 | not payable in ASC | not payable in ASC | |
| 77333 | RADIATION TREAT AID(S) | $95.88 | $91.67 | not payable in ASC | not payable in ASC | ||
| 77333 | TC | RADIATION TREAT AID(S) | $30.21 | $28.22 | $59.67 | $54.93 | |
| 77333 | 26 | RADIATION TREAT AID(S) | $65.67 | $63.45 | not payable in ASC | not payable in ASC | |
| 77334 | RADIATION TREAT AID(S) | $253.55 | $239.75 | not payable in ASC | not payable in ASC | ||
| 77334 | TC | RADIATION TREAT AID(S) | $157.16 | $146.64 | $314.70 | $289.68 | |
| 77334 | 26 | RADIATION TREAT AID(S) | $96.39 | $93.11 | not payable in ASC | not payable in ASC | |
| 77336 | RADIATION PHYSICS CONSULT | $89.61 | $83.63 | $178.98 | $164.73 | ||
| 77371 | SRS, MULTISOURCE | $2,070.29 | $1,900.21 | $14,838.51 | $13,658.16 | ||
| 77403 | RADIATION TX SING AREA 6-10MEV | $224.70 | $209.65 | $189.45 | $174.39 | ||
| 77413 | RADIATION TX 3/MORE AREA 6-10MEV | $401.73 | $374.78 | $310.95 | $286.23 | ||
| 77414 | RADIATION TX 3/MORE AREA 11-19MEV | $449.47 | $419.32 | $310.95 | $286.23 | ||
| 77417 | RADIOLOGY PORT FILM(S) | $25.57 | $23.87 | packaged | packaged | N1 | |
| 77427 | RADIATION TX MANAGEMENT, X5 | $282.30 | $272.51 | not payable in ASC | not payable in ASC | ||
| 77431 | RADIATION THERAPY MANAGEMENT | $155.03 | $149.53 | not payable in ASC | not payable in ASC | ||
| 77470 | SPECIAL RADIATION TREAT | $330.15 | $313.46 | not payable in ASC | not payable in ASC | ||
| 77470 | TC | SPECIAL RADIATION TREAT | $166.48 | $155.32 | $333.42 | $306.90 | |
| 77470 | 26 | SPECIAL RADIATION TREAT | $163.67 | $158.12 | not payable in ASC | not payable in ASC | |
| 78006 | THYROID IMAGING W/UPTAKE | $400.08 | $374.61 | not payable in ASC | not payable in ASC | ||
| 78006 | TC | THYROID IMAGING W/UPTAKE | $362.01 | $337.79 | $425.13 | $391.32 | |
| 78006 | 26 | THYROID IMAGING W/UPTAKE | $38.07 | $36.82 | not payable in ASC | not payable in ASC | |
| 78007 | THYROID IMAGE, MULT UPTAKES | $330.70 | $309.92 | not payable in ASC | not payable in ASC | ||
| 78007 | TC | THYROID IMAGE, MULT UPTAKES | $292.13 | $272.61 | $425.13 | $391.32 | |
| 78007 | 26 | THYROID IMAGE, MULT UPTAKES | $38.58 | $37.32 | not payable in ASC | not payable in ASC | |
| 78102 | BONE MARROW IMAGING, LTD | $280.83 | $263.53 | not payable in ASC | not payable in ASC | ||
| 78102 | TC | BONE MARROW IMAGING, LTD | $239.14 | $223.18 | $497.82 | $458.22 | |
| 78102 | 26 | BONE MARROW IMAGING, LTD | $41.69 | $40.34 | not payable in ASC | not payable in ASC | |
| 78103 | BONE MARROW IMAGING, MULT | $370.12 | $347.33 | not payable in ASC | not payable in ASC | ||
| 78103 | TC | BONE MARROW IMAGING, MULT | $313.68 | $292.71 | $497.82 | $458.22 | |
| 78103 | 26 | BONE MARROW IMAGING, MULT | $56.45 | $54.63 | not payable in ASC | not payable in ASC | |
| 78215 | LIVER & SPLEEN IMAGING | $325.54 | $305.08 | not payable in ASC | not payable in ASC | ||
| 78215 | TC | LIVER & SPLEEN IMAGING | $287.47 | $268.26 | $513.54 | $472.68 | |
| 78215 | 26 | LIVER & SPLEEN IMAGING | $38.07 | $36.82 | not payable in ASC | not payable in ASC | |
| 78220 | LIVER FUNCTION STUDY | $230.17 | $216.05 | not payable in ASC | not payable in ASC | ||
| 78220 | TC | LIVER FUNCTION STUDY | $193.72 | $180.82 | $513.54 | $472.68 | |
| 78220 | 26 | LIVER FUNCTION STUDY | $36.45 | $35.23 | not payable in ASC | not payable in ASC | |
| 78223 | HEPATOBILIARY IMAGING | $560.43 | $525.09 | not payable in ASC | not payable in ASC | ||
| 78223 | TC | HEPATOBILIARY IMAGING | $495.93 | $462.72 | $513.54 | $472.68 | |
| 78223 | 26 | HEPATOBILIARY IMAGING | $64.50 | $62.36 | not payable in ASC | not payable in ASC | |
| 78232 | SALIVARY GLAND FUNCTION EXAM | $197.59 | $185.66 | not payable in ASC | not payable in ASC | ||
| 78232 | TC | SALIVARY GLAND FUNCTION EXAM | $163.44 | $152.57 | $463.50 | $426.63 | |
| 78232 | 26 | SALIVARY GLAND FUNCTION EXAM | $34.15 | $33.11 | not payable in ASC | not payable in ASC | |
| 78300 | BONE IMAGING, LIMITED AREA | $297.19 | $278.96 | not payable in ASC | not payable in ASC | ||
| 78300 | TC | BONE IMAGING, LIMITED AREA | $249.03 | $232.42 | $473.94 | $436.23 | |
| 78300 | 26 | BONE IMAGING, LIMITED AREA | $48.16 | $46.54 | not payable in ASC | not payable in ASC | |
| 78305 | BONE IMAGING, MULTIPLE AREAS | $392.22 | $368.16 | not payable in ASC | not payable in ASC | ||
| 78305 | TC | BONE IMAGING, MULTIPLE AREAS | $328.81 | $306.83 | $473.94 | $436.23 | |
| 78305 | 26 | BONE IMAGING, MULTIPLE AREAS | $63.41 | $61.32 | not payable in ASC | not payable in ASC | |
| 78306 | BONE IMAGING, WHOLE BODY | $427.52 | $401.16 | not payable in ASC | not payable in ASC | ||
| 78306 | TC | BONE IMAGING, WHOLE BODY | $361.42 | $337.25 | $473.94 | $436.23 | |
| 78306 | 26 | BONE IMAGING, WHOLE BODY | $66.11 | $63.91 | not payable in ASC | not payable in ASC | |
| 78315 | BONE IMAGING, 3 PHASE | $583.48 | $547.06 | not payable in ASC | not payable in ASC | ||
| 78315 | TC | BONE IMAGING, 3 PHASE | $505.25 | $471.42 | $473.94 | $436.23 | |
| 78315 | 26 | BONE IMAGING, 3 PHASE | $78.23 | $75.64 | not payable in ASC | not payable in ASC | |
| 78320 | BONE IMAGING (3D) | $410.39 | $385.64 | not payable in ASC | not payable in ASC | ||
| 78320 | TC | BONE IMAGING (3D) | $331.14 | $309.00 | $473.94 | $436.23 | |
| 78320 | 26 | BONE IMAGING (3D) | $79.25 | $76.64 | not payable in ASC | not payable in ASC | |
| 78445 | VASCULAR FLOW IMAGING | $289.56 | $271.46 | not payable in ASC | not payable in ASC | ||
| 78445 | TC | VASCULAR FLOW IMAGING | $253.11 | $236.21 | $388.05 | $357.18 | |
| 78445 | 26 | VASCULAR FLOW IMAGING | $36.45 | $35.23 | not payable in ASC | not payable in ASC | |
| 78451 | HEART MUSCLE IMAGE SPECT, SING | $573.80 | $538.92 | not payable in ASC | not payable in ASC | ||
| 78451 | TC | HEART MUSCLE IMAGE SPECT, SING | $471.47 | $439.91 | $1,471.83 | $1,354.74 | |
| 78451 | 26 | HEART MUSCLE IMAGE SPECT, SING | $102.33 | $98.99 | not payable in ASC | not payable in ASC | |
| 78452 | HEART MUSCLE IMAGE SPECT, MULT | $806.02 | $756.16 | not payable in ASC | not payable in ASC | ||
| 78452 | TC | HEART MUSCLE IMAGE SPECT, MULT | $685.12 | $639.23 | $1,471.83 | $1,354.74 | |
| 78452 | 26 | HEART MUSCLE IMAGE SPECT, MULT | $120.91 | $116.93 | not payable in ASC | not payable in ASC | |
| 78469 | HEART INFARCT IMAGE (3D) | $434.71 | $407.96 | not payable in ASC | not payable in ASC | ||
| 78469 | TC | HEART INFARCT IMAGE (3D) | $360.26 | $336.16 | $564.39 | $519.48 | |
| 78469 | 26 | HEART INFARCT IMAGE (3D) | $74.45 | $71.81 | not payable in ASC | not payable in ASC | |
| 78472 | GATED HEART, PLANAR, SING | $424.29 | $398.43 | not payable in ASC | not payable in ASC | ||
| 78472 | TC | GATED HEART, PLANAR, SING | $347.44 | $324.22 | $564.39 | $519.48 | |
| 78472 | 26 | GATED HEART, PLANAR, SING | $76.85 | $74.22 | not payable in ASC | not payable in ASC | |
| 78481 | HEART FIRST PASS, SING | $352.85 | $331.69 | not payable in ASC | not payable in ASC | ||
| 78481 | TC | HEART FIRST PASS, SING | $273.62 | $255.27 | $564.39 | $519.48 | |
| 78481 | 26 | HEART FIRST PASS, SING | $79.24 | $76.41 | not payable in ASC | not payable in ASC | |
| 78494 | HEART IMAGE, SPECT | $450.67 | $423.55 | not payable in ASC | not payable in ASC | ||
| 78494 | TC | HEART IMAGE, SPECT | $356.18 | $332.36 | $564.39 | $519.48 | |
| 78494 | 26 | HEART IMAGE, SPECT | $94.49 | $91.19 | not payable in ASC | not payable in ASC | |
| 78580 | LUNG PERFUSION IMAGING | $358.61 | $336.54 | not payable in ASC | not payable in ASC | ||
| 78580 | TC | LUNG PERFUSION IMAGING | $302.02 | $281.84 | $381.24 | $350.91 | |
| 78580 | 26 | LUNG PERFUSION IMAGING | $56.59 | $54.70 | not payable in ASC | not payable in ASC | |
| 78584 | LUNG V/Q IMAGE SINGLE BREATH | $254.13 | $239.75 | not payable in ASC | not payable in ASC | ||
| 78584 | TC | LUNG V/Q IMAGE SINGLE BREATH | $177.41 | $165.60 | $619.65 | $570.36 | |
| 78584 | 26 | LUNG V/Q IMAGE SINGLE BREATH | $76.71 | $74.15 | not payable in ASC | not payable in ASC | |
| 78585 | LUNG V/Q IMAGING | $596.93 | $559.78 | not payable in ASC | not payable in ASC | ||
| 78585 | TC | LUNG V/Q IMAGING | $513.39 | $479.02 | $619.65 | $570.36 | |
| 78585 | 26 | LUNG V/Q IMAGING | $83.53 | $80.76 | not payable in ASC | not payable in ASC | |
| 78588 | PERFUSION LUNG IMAGE | $578.30 | $542.40 | not payable in ASC | not payable in ASC | ||
| 78588 | TC | PERFUSION LUNG IMAGE | $494.76 | $461.64 | $619.65 | $570.36 | |
| 78588 | 26 | PERFUSION LUNG IMAGE | $83.53 | $80.76 | not payable in ASC | not payable in ASC | |
| 78594 | VENT IMAGE, MULT PROJ, GAS | $367.16 | $344.02 | not payable in ASC | not payable in ASC | ||
| 78594 | TC | VENT IMAGE, MULT PROJ, GAS | $327.06 | $305.21 | $381.24 | $350.91 | |
| 78594 | 26 | VENT IMAGE, MULT PROJ, GAS | $40.10 | $38.81 | not payable in ASC | not payable in ASC | |
| 78596 | LUNG DIFFERENTIAL FUNCTION | $628.84 | $589.95 | not payable in ASC | not payable in ASC | ||
| 78596 | TC | LUNG DIFFERENTIAL FUNCTION | $534.36 | $498.57 | $619.65 | $570.36 | |
| 78596 | 26 | LUNG DIFFERENTIAL FUNCTION | $94.47 | $91.38 | not payable in ASC | not payable in ASC | |
| 78607 | BRAIN IMAGING (3D) | $612.19 | $574.36 | not payable in ASC | not payable in ASC | ||
| 78607 | TC | BRAIN IMAGING (3D) | $519.80 | $485.00 | $1,154.88 | $1,062.99 | |
| 78607 | 26 | BRAIN IMAGING (3D) | $92.38 | $89.36 | not payable in ASC | not payable in ASC | |
| 78707 | KID FLOW/FUNCT IMAGE W/O DRUG | $399.99 | $375.71 | not payable in ASC | not payable in ASC | ||
| 78707 | TC | KID FLOW/FUNCT IMAGE W/O DRUG | $327.06 | $305.21 | $622.62 | $573.09 | |
| 78707 | 26 | KID FLOW/FUNCT IMAGE W/O DRUG | $72.93 | $70.51 | not payable in ASC | not payable in ASC | |
| 78708 | KID FLOW/FUNCT IMAGE W/DRUG | $300.23 | $283.29 | not payable in ASC | not payable in ASC | ||
| 78708 | TC | KID FLOW/FUNCT IMAGE W/DRUG | $207.69 | $193.85 | $622.62 | $573.09 | |
| 78708 | 26 | KID FLOW/FUNCT IMAGE W/DRUG | $92.54 | $89.46 | not payable in ASC | not payable in ASC | |
| 78709 | KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE | $617.12 | $579.46 | not payable in ASC | not payable in ASC | ||
| 78709 | TC | KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE | $509.32 | $475.22 | $622.62 | $573.09 | |
| 78709 | 26 | KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE | $107.80 | $104.25 | not payable in ASC | not payable in ASC | |
| 78802 | TUMOR IMAGING, WHOLE BODY | $553.30 | $518.48 | not payable in ASC | not payable in ASC | ||
| 78802 | TC | TUMOR IMAGING, WHOLE BODY | $487.77 | $455.12 | $919.98 | $846.78 | |
| 78802 | 26 | TUMOR IMAGING, WHOLE BODY | $65.53 | $63.37 | not payable in ASC | not payable in ASC | |
| 78803 | TUMOR IMAGING (3D) | $593.44 | $556.52 | not payable in ASC | not payable in ASC | ||
| 78803 | TC | TUMOR IMAGING (3D) | $511.06 | $476.84 | $919.98 | $846.78 | |
| 78803 | 26 | TUMOR IMAGING (3D) | $82.37 | $79.68 | not payable in ASC | not payable in ASC | |
| 78805 | ABSCESS IMAGING, LTD AREA | $310.29 | $291.48 | not payable in ASC | not payable in ASC | ||
| 78805 | TC | ABSCESS IMAGING, LTD AREA | $254.27 | $237.31 | $919.98 | $846.78 | |
| 78805 | 26 | ABSCESS IMAGING, LTD AREA | $56.00 | $54.17 | not payable in ASC | not payable in ASC | |
| 78806 | ABSCESS IMAGING, WHOLE BODY | $573.09 | $536.94 | not payable in ASC | not payable in ASC | ||
| 78806 | TC | ABSCESS IMAGING, WHOLE BODY | $507.58 | $473.59 | $919.98 | $846.78 | |
| 78806 | 26 | ABSCESS IMAGING, WHOLE BODY | $65.53 | $63.37 | not payable in ASC | not payable in ASC | |
| 78815 | PET IMAGE W/CT, SKULL-THIGH | $1,978.16 | $1,852.07 | not payable in ASC | not payable in ASC | ||
| 78815 | TC | PET IMAGE W/CT, SKULL-THIGH | $1,785.85 | $1,665.93 | $2,018.19 | $1,857.66 | |
| 78815 | 26 | PET IMAGE W/CT, SKULL-THIGH | $192.33 | $186.13 | not payable in ASC | not payable in ASC | |
| 79101 | NUCLEAR RX, IV ADMIN | $261.42 | $248.93 | not payable in ASC | not payable in ASC | ||
| 79101 | TC | NUCLEAR RX, IV ADMIN | $101.83 | $95.03 | $203.55 | $187.38 | |
| 79101 | 26 | NUCLEAR RX, IV ADMIN | $159.59 | $153.90 | not payable in ASC | not payable in ASC |
Pathology and laboratory, CPT 80000 to 89999
99 rows| Code | Mod | Description | Physicians’ North | Physicians’ South | ASC North | ASC South | Ind. |
|---|---|---|---|---|---|---|---|
| 80500 | LAB PATHOLOGY CONSULTATION | $32.57 | $31.39 | not payable in ASC | not payable in ASC | ||
| 83020 | 26 | ASSAY HEMOGLOBIN ELECTROPHORESIS | $30.24 | $29.22 | not payable in ASC | not payable in ASC | |
| 83912 | 26 | ASSAY GENETIC EXAM | $28.49 | $27.58 | not payable in ASC | not payable in ASC | |
| 84165 | 26 | ASSAY PROTEIN E-PHORESIS, SERUM | $29.66 | $28.66 | not payable in ASC | not payable in ASC | |
| 84166 | 26 | ASSAY PROTEIN E-PHORESIS/URINE/CSF | $29.66 | $28.66 | not payable in ASC | not payable in ASC | |
| 84182 | 26 | ASSAY PROTEIN, WESTERN BLOT TEST | $29.66 | $28.66 | not payable in ASC | not payable in ASC | |
| 85060 | BLOOD SMEAR INTERPRETATION | $36.04 | $34.83 | not payable in ASC | not payable in ASC | ||
| 85097 | BONE MARROW INTERPRETATION | $139.39 | $132.50 | not payable in ASC | not payable in ASC | ||
| 85576 | 26 | BLOOD PLATELET AGGREGATION | $30.24 | $29.22 | not payable in ASC | not payable in ASC | |
| 86255 | 26 | FLUORESCENT ANTIBODY, SCREEN | $30.24 | $29.22 | not payable in ASC | not payable in ASC | |
| 86256 | 26 | FLUORESCENT ANTIBODY, TITER | $29.19 | $28.17 | not payable in ASC | not payable in ASC | |
| 86334 | 26 | IMMUNOFIX E-PHORESIS, SERUM | $30.24 | $29.22 | not payable in ASC | not payable in ASC | |
| 86335 | 26 | IMMUNOFIX E-PHORESIS/URINE/CSF | $29.66 | $28.66 | not payable in ASC | not payable in ASC | |
| 86510 | HISTOPLASMOSIS SKIN TEST | $11.00 | $10.30 | not payable in ASC | not payable in ASC | ||
| 86580 | TB INTRADERMAL TEST | $12.75 | $11.92 | not payable in ASC | not payable in ASC | ||
| 88104 | CYTOPATH FL NONGYN, SMEARS | $107.49 | $101.71 | not payable in ASC | not payable in ASC | ||
| 88104 | TC | CYTOPATH FL NONGYN, SMEARS | $64.57 | $60.27 | not payable in ASC | not payable in ASC | |
| 88104 | 26 | CYTOPATH FL NONGYN, SMEARS | $42.92 | $41.44 | not payable in ASC | not payable in ASC | |
| 88106 | CYTOPATH FL NONGYN, FILTER | $132.53 | $125.06 | not payable in ASC | not payable in ASC | ||
| 88106 | TC | CYTOPATH FL NONGYN, FILTER | $90.20 | $84.17 | not payable in ASC | not payable in ASC | |
| 88106 | 26 | CYTOPATH FL NONGYN, FILTER | $42.33 | $40.88 | not payable in ASC | not payable in ASC | |
| 88108 | CYTOPATH, CONCENTRATE TECH | $124.96 | $117.99 | not payable in ASC | not payable in ASC | ||
| 88108 | TC | CYTOPATH, CONCENTRATE TECH | $82.62 | $77.11 | not payable in ASC | not payable in ASC | |
| 88108 | 26 | CYTOPATH, CONCENTRATE TECH | $42.33 | $40.88 | not payable in ASC | not payable in ASC | |
| 88112 | CYTOPATH, CELL ENHANCE TECH | $166.71 | $158.56 | not payable in ASC | not payable in ASC | ||
| 88112 | TC | CYTOPATH, CELL ENHANCE TECH | $79.13 | $73.85 | not payable in ASC | not payable in ASC | |
| 88112 | 26 | CYTOPATH, CELL ENHANCE TECH | $87.58 | $84.72 | not payable in ASC | not payable in ASC | |
| 88120 | CYTOPATH, URINE 3-5 PROBES EA SPEC | $772.67 | $723.91 | not payable in ASC | not payable in ASC | ||
| 88120 | TC | CYTOPATH, URINE 3-5 PROBES EA SPEC | $692.17 | $645.78 | not payable in ASC | not payable in ASC | |
| 88120 | 26 | CYTOPATH, URINE 3-5 PROBES EA SPEC | $80.50 | $78.13 | not payable in ASC | not payable in ASC | |
| 88121 | CYTOPATH, URINE 3-5 PROBES COMPUTER | $652.59 | $611.34 | not payable in ASC | not payable in ASC | ||
| 88121 | TC | CYTOPATH, URINE 3-5 PROBES COMPUTER | $580.48 | $541.53 | not payable in ASC | not payable in ASC | |
| 88121 | 26 | CYTOPATH, URINE 3-5 PROBES COMPUTER | $72.11 | $69.80 | not payable in ASC | not payable in ASC | |
| 88141 | CYTOPATH, C/V, INTERPRET | $46.17 | $44.20 | not payable in ASC | not payable in ASC | ||
| 88172 | CYTOPATH FNA; 1ST EVAL, EACH SITE | $82.15 | $78.16 | not payable in ASC | not payable in ASC | ||
| 88172 | TC | CYTOPATH FNA; 1ST EVAL, EACH SITE | $35.46 | $33.11 | not payable in ASC | not payable in ASC | |
| 88172 | 26 | CYTOPATH FNA; 1ST EVAL, EACH SITE | $46.68 | $45.05 | not payable in ASC | not payable in ASC | |
| 88173 | CYTOPATH FNA; INTERPRET & REPORT | $225.11 | $213.56 | not payable in ASC | not payable in ASC | ||
| 88173 | TC | CYTOPATH FNA; INTERPRET & REPORT | $118.73 | $110.79 | not payable in ASC | not payable in ASC | |
| 88173 | 26 | CYTOPATH FNA; INTERPRET & REPORT | $106.40 | $102.77 | not payable in ASC | not payable in ASC | |
| 88177 | CYTOPATH FNA; ADDED EVAL, SAME SITE | $44.48 | $42.59 | not payable in ASC | not payable in ASC | ||
| 88177 | TC | CYTOPATH FNA; ADDED EVAL, SAME SITE | $11.00 | $10.30 | not payable in ASC | not payable in ASC | |
| 88177 | 26 | CYTOPATH FNA; ADDED EVAL, SAME SITE | $33.48 | $32.29 | not payable in ASC | not payable in ASC | |
| 88184 | FLOW CYTOMETRY/ TC, 1 MARKER | $143.77 | $134.15 | not payable in ASC | not payable in ASC | ||
| 88185 | FLOW CYTOMETRY/TC, ADDED | $86.12 | $80.36 | not payable in ASC | not payable in ASC | ||
| 88187 | FLOW CYTOMETRY/READ, 2-8 | $105.20 | $101.74 | not payable in ASC | not payable in ASC | ||
| 88300 | SURGICAL PATH, GROSS | $45.28 | $42.50 | not payable in ASC | not payable in ASC | ||
| 88300 | TC | SURGICAL PATH, GROSS | $38.37 | $35.83 | not payable in ASC | not payable in ASC | |
| 88300 | 26 | SURGICAL PATH, GROSS | $6.91 | $6.68 | not payable in ASC | not payable in ASC | |
| 88302 | TISSUE EXAM BY PATHOLOGIST | $90.32 | $84.64 | not payable in ASC | not payable in ASC | ||
| 88302 | TC | TISSUE EXAM BY PATHOLOGIST | $80.29 | $74.93 | not payable in ASC | not payable in ASC | |
| 88302 | 26 | TISSUE EXAM BY PATHOLOGIST | $10.03 | $9.71 | not payable in ASC | not payable in ASC | |
| 88304 | TISSUE EXAM BY PATHOLOGIST | $105.37 | $98.91 | not payable in ASC | not payable in ASC | ||
| 88304 | TC | TISSUE EXAM BY PATHOLOGIST | $88.45 | $82.54 | not payable in ASC | not payable in ASC | |
| 88304 | 26 | TISSUE EXAM BY PATHOLOGIST | $16.93 | $16.36 | not payable in ASC | not payable in ASC | |
| 88305 | TISSUE EXAM BY PATHOLOGIST | $175.94 | $166.03 | not payable in ASC | not payable in ASC | ||
| 88305 | TC | TISSUE EXAM BY PATHOLOGIST | $119.31 | $111.33 | not payable in ASC | not payable in ASC | |
| 88305 | 26 | TISSUE EXAM BY PATHOLOGIST | $56.63 | $54.70 | not payable in ASC | not payable in ASC | |
| 88307 | TISSUE EXAM BY PATHOLOGIST | $375.59 | $354.43 | not payable in ASC | not payable in ASC | ||
| 88307 | TC | TISSUE EXAM BY PATHOLOGIST | $251.49 | $234.63 | not payable in ASC | not payable in ASC | |
| 88307 | 26 | TISSUE EXAM BY PATHOLOGIST | $124.10 | $119.80 | not payable in ASC | not payable in ASC | |
| 88309 | TISSUE EXAM BY PATHOLOGIST | $565.90 | $535.11 | not payable in ASC | not payable in ASC | ||
| 88309 | TC | TISSUE EXAM BY PATHOLOGIST | $349.19 | $325.84 | not payable in ASC | not payable in ASC | |
| 88309 | 26 | TISSUE EXAM BY PATHOLOGIST | $216.70 | $209.27 | not payable in ASC | not payable in ASC | |
| 88311 | DECALCIFY TISSUE | $30.10 | $28.73 | not payable in ASC | not payable in ASC | ||
| 88311 | TC | DECALCIFY TISSUE | $11.58 | $10.84 | not payable in ASC | not payable in ASC | |
| 88311 | 26 | DECALCIFY TISSUE | $18.52 | $17.91 | not payable in ASC | not payable in ASC | |
| 88312 | SPECIAL STAINS GROUP 1 | $178.67 | $168.06 | not payable in ASC | not payable in ASC | ||
| 88312 | TC | SPECIAL STAINS GROUP 1 | $137.94 | $128.71 | not payable in ASC | not payable in ASC | |
| 88312 | 26 | SPECIAL STAINS GROUP 1 | $40.73 | $39.35 | not payable in ASC | not payable in ASC | |
| 88313 | SPECIAL STAINS GROUP 2 | $131.42 | $123.25 | not payable in ASC | not payable in ASC | ||
| 88313 | TC | SPECIAL STAINS GROUP 2 | $113.49 | $105.90 | not payable in ASC | not payable in ASC | |
| 88313 | 26 | SPECIAL STAINS GROUP 2 | $17.93 | $17.35 | not payable in ASC | not payable in ASC | |
| 88331 | PATH CONSULT INTRAOP, 1 BLOC | $147.61 | $140.67 | not payable in ASC | not payable in ASC | ||
| 88331 | TC | PATH CONSULT INTRAOP, 1 BLOC | $54.67 | $51.03 | not payable in ASC | not payable in ASC | |
| 88331 | 26 | PATH CONSULT INTRAOP, 1 BLOC | $92.94 | $89.63 | not payable in ASC | not payable in ASC | |
| 88332 | PATH CONSULT INTRAOP, ADDED | $64.76 | $61.92 | not payable in ASC | not payable in ASC | ||
| 88332 | TC | PATH CONSULT INTRAOP, ADDED | $19.16 | $17.91 | not payable in ASC | not payable in ASC | |
| 88332 | 26 | PATH CONSULT INTRAOP, ADDED | $45.60 | $44.01 | not payable in ASC | not payable in ASC | |
| 88334 | INTRAOP CYTO PATH CONSULT, 2 | $95.03 | $90.57 | not payable in ASC | not payable in ASC | ||
| 88334 | TC | INTRAOP CYTO PATH CONSULT, 2 | $37.79 | $35.29 | not payable in ASC | not payable in ASC | |
| 88334 | 26 | INTRAOP CYTO PATH CONSULT, 2 | $57.24 | $55.28 | not payable in ASC | not payable in ASC | |
| 88342 | IMMUNOHISTOCHEMISTRY | $171.57 | $162.26 | not payable in ASC | not payable in ASC | ||
| 88342 | TC | IMMUNOHISTOCHEMISTRY | $107.66 | $100.47 | not payable in ASC | not payable in ASC | |
| 88342 | 26 | IMMUNOHISTOCHEMISTRY | $63.91 | $61.80 | not payable in ASC | not payable in ASC | |
| 88346 | IMMUNOFLUORESCENT STUDY | $168.13 | $159.00 | not payable in ASC | not payable in ASC | ||
| 88346 | TC | IMMUNOFLUORESCENT STUDY | $104.17 | $97.20 | not payable in ASC | not payable in ASC | |
| 88346 | 26 | IMMUNOFLUORESCENT STUDY | $63.96 | $61.80 | not payable in ASC | not payable in ASC | |
| 88360 | TUMOR IMMUNOHISTOCHEM/MANUAL | $202.89 | $192.09 | not payable in ASC | not payable in ASC | ||
| 88360 | TC | TUMOR IMMUNOHISTOCHEM/MANUAL | $121.64 | $113.50 | not payable in ASC | not payable in ASC | |
| 88360 | 26 | TUMOR IMMUNOHISTOCHEM/MANUAL | $81.26 | $78.59 | not payable in ASC | not payable in ASC | |
| 88363 | EXAM ARCHIVAL TISSUE MOLECULAR ANAL | $62.26 | $59.09 | not payable in ASC | not payable in ASC | ||
| 88367 | INSITU HYBRIDIZATION, AUTO | $428.95 | $403.53 | not payable in ASC | not payable in ASC | ||
| 88367 | TC | INSITU HYBRIDIZATION, AUTO | $334.76 | $312.31 | not payable in ASC | not payable in ASC | |
| 88367 | 26 | INSITU HYBRIDIZATION, AUTO | $94.19 | $91.22 | not payable in ASC | not payable in ASC | |
| 88368 | INSITU HYBRIDIZATION, MANUAL | $365.96 | $344.97 | not payable in ASC | not payable in ASC | ||
| 88368 | TC | INSITU HYBRIDIZATION, MANUAL | $270.12 | $252.01 | not payable in ASC | not payable in ASC | |
| 88368 | 26 | INSITU HYBRIDIZATION, MANUAL | $95.84 | $92.95 | not payable in ASC | not payable in ASC | |
| 88372 | 26 | PROTEIN ANALYSIS W/PROBE | $30.24 | $29.22 | not payable in ASC | not payable in ASC |
Medicine, CPT 90000 to 99999
767 rows| Code | Mod | Description | Physicians’ North | Physicians’ South | ASC North | ASC South | Ind. |
|---|---|---|---|---|---|---|---|
| 90461 | IMM ADMIN 0-18 ANY ROUTE, EA ADDED | $18.62 | $17.76 | not payable in ASC | not payable in ASC | ||
| 90471 | IMMUNIZATION ADMIN | $38.26 | $36.14 | not payable in ASC | not payable in ASC | ||
| 90472 | IMMUNIZATION ADMIN, EACH ADDED | $18.62 | $17.76 | not payable in ASC | not payable in ASC | ||
| 90801 | PSYCH DIAG INTERVIEW | $242.14 | $233.10 | not payable in ASC | not payable in ASC | ||
| 90802 | INTERACT PSYCH DIAG INTERVIEW | $263.21 | $253.31 | not payable in ASC | not payable in ASC | ||
| 90804 | PSYCH, OFF, 20-30 MIN | $103.95 | $100.23 | not payable in ASC | not payable in ASC | ||
| 90805 | PSYCH, OFF, 20-30 MINIMUM W/E & M | $118.52 | $114.27 | not payable in ASC | not payable in ASC | ||
| 90806 | PSYCH, OFF, 45-50 MIN | $137.79 | $133.55 | not payable in ASC | not payable in ASC | ||
| 90807 | PSYCH, OFF, 45-50 MINIMUM W/E & M | $163.35 | $157.87 | not payable in ASC | not payable in ASC | ||
| 90808 | PSYCH, OFF, 75-80 MIN | $202.42 | $196.35 | not payable in ASC | not payable in ASC | ||
| 90809 | PSYCH, OFF, 75-80, W/E & M | $228.55 | $221.21 | not payable in ASC | not payable in ASC | ||
| 90810 | INTERACT PSYCH, OFF, 20-30 MIN | $106.69 | $103.09 | not payable in ASC | not payable in ASC | ||
| 90811 | INTERACT PSYCH, 20-30, W/E & M | $134.04 | $129.09 | not payable in ASC | not payable in ASC | ||
| 90812 | INTERACT PSYCH, OFF, 45-50 MIN | $151.59 | $146.73 | not payable in ASC | not payable in ASC | ||
| 90813 | INTERACT PSYCH, 45-50 MINIMUM W/E & M | $177.78 | $171.60 | not payable in ASC | not payable in ASC | ||
| 90814 | INTERACT PSYCH, OFF, 75-80 MIN | $218.01 | $211.20 | not payable in ASC | not payable in ASC | ||
| 90816 | PSYCH, HOSP, 20-30 MIN | $84.68 | $82.35 | not payable in ASC | not payable in ASC | ||
| 90817 | PSYCH, HOSP, 20-30 MINIMUM W/E & M | $102.93 | $99.80 | not payable in ASC | not payable in ASC | ||
| 90818 | PSYCH, HOSP, 45-50 MIN | $125.31 | $122.00 | not payable in ASC | not payable in ASC | ||
| 90819 | PSYCH, HOSP, 45-50 MINIMUM W/E & M | $147.22 | $142.89 | not payable in ASC | not payable in ASC | ||
| 90826 | INTERACT PSYCH, HOSP, 45-50 MIN | $134.16 | $130.57 | not payable in ASC | not payable in ASC | ||
| 90846 | FAMILY PSYCH W/O PATIENT | $130.28 | $126.25 | not payable in ASC | not payable in ASC | ||
| 90847 | FAMILY PSYCH W/PATIENT | $162.90 | $157.63 | not payable in ASC | not payable in ASC | ||
| 90853 | GROUP PSYCHOTHERAPY | $77.13 | $74.33 | not payable in ASC | not payable in ASC | ||
| 90857 | INTERACT GROUP PSYCH | $57.98 | $55.73 | not payable in ASC | not payable in ASC | ||
| 90862 | MEDICATION MANAGEMENT | $105.73 | $101.47 | not payable in ASC | not payable in ASC | ||
| 90880 | HYPNOTHERAPY | $155.47 | $150.66 | not payable in ASC | not payable in ASC | ||
| 90901 | BIOFEEDBACK TRAIN, ANY METHOD | $114.92 | $109.20 | not payable in ASC | not payable in ASC | ||
| 90911 | BIOFEEDBACK PERI/URO/RECTAL | $142.55 | $135.40 | not payable in ASC | not payable in ASC | ||
| 90935 | HEMODIALYSIS, ONE EVAL | $116.53 | $112.59 | not payable in ASC | not payable in ASC | ||
| 90945 | DIALYSIS, ONE EVAL | $166.37 | $160.72 | not payable in ASC | not payable in ASC | ||
| 90961 | ESRD SERVICE, 2-3 VISITS P MO, 20+ | $129.32 | $124.73 | not payable in ASC | not payable in ASC | ||
| 90962 | ESRD SERVICE, 1 VISIT P MO, 20+ | $275.65 | $265.53 | not payable in ASC | not payable in ASC | ||
| 91010 | ESOPHAGUS MOTILITY STUDY | $311.34 | $293.84 | not payable in ASC | not payable in ASC | ||
| 91010 | TC | ESOPHAGUS MOTILITY STUDY | $203.16 | $189.54 | not payable in ASC | not payable in ASC | |
| 91010 | 26 | ESOPHAGUS MOTILITY STUDY | $108.19 | $104.29 | not payable in ASC | not payable in ASC | |
| 91013 | ESOPH MOTILITY STUDY W/STIM/PERFUS | $38.13 | $36.07 | not payable in ASC | not payable in ASC | ||
| 91013 | TC | ESOPH MOTILITY STUDY W/STIM/PERFUS | $22.65 | $21.16 | not payable in ASC | not payable in ASC | |
| 91013 | 26 | ESOPH MOTILITY STUDY W/STIM/PERFUS | $15.48 | $14.91 | not payable in ASC | not payable in ASC | |
| 92002 | EYE EXAM, NEW PATIENT | $122.24 | $116.43 | not payable in ASC | not payable in ASC | ||
| 92004 | EYE EXAM, NEW PATIENT | $225.54 | $215.25 | not payable in ASC | not payable in ASC | ||
| 92012 | EYE EXAM ESTABLISHED PAT | $129.52 | $123.31 | not payable in ASC | not payable in ASC | ||
| 92014 | EYE EXAM & TREAT | $187.31 | $178.54 | not payable in ASC | not payable in ASC | ||
| 92020 | SPECIAL EYE EVAL | $41.88 | $40.07 | not payable in ASC | not payable in ASC | ||
| 92025 | CORNEAL TOPOGRAPHY | $57.23 | $54.31 | not payable in ASC | not payable in ASC | ||
| 92025 | TC | CORNEAL TOPOGRAPHY | $27.30 | $25.51 | not payable in ASC | not payable in ASC | |
| 92025 | 26 | CORNEAL TOPOGRAPHY | $29.93 | $28.81 | not payable in ASC | not payable in ASC | |
| 92060 | SPECIAL EYE EVAL | $98.24 | $93.46 | not payable in ASC | not payable in ASC | ||
| 92060 | TC | SPECIAL EYE EVAL | $39.53 | $36.92 | not payable in ASC | not payable in ASC | |
| 92060 | 26 | SPECIAL EYE EVAL | $58.70 | $56.54 | not payable in ASC | not payable in ASC | |
| 92065 | ORTHOPTIC/PLEOPTIC TRAINING | $123.66 | $116.86 | not payable in ASC | not payable in ASC | ||
| 92065 | TC | ORTHOPTIC/PLEOPTIC TRAINING | $81.42 | $76.02 | not payable in ASC | not payable in ASC | |
| 92065 | 26 | ORTHOPTIC/PLEOPTIC TRAINING | $42.22 | $40.84 | not payable in ASC | not payable in ASC | |
| 92070 | FIT CONTACT LENS | $109.22 | $103.74 | not payable in ASC | not payable in ASC | ||
| 92081 | VISUAL FIELD EXAM(S) LIMITED | $80.77 | $76.23 | not payable in ASC | not payable in ASC | ||
| 92081 | TC | VISUAL FIELD EXAM(S) LIMITED | $54.67 | $51.03 | not payable in ASC | not payable in ASC | |
| 92081 | 26 | VISUAL FIELD EXAM(S) LIMITED | $26.11 | $25.18 | not payable in ASC | not payable in ASC | |
| 92082 | VISUAL FIELD EXAM(S) INTERMEDIATE | $112.58 | $106.17 | not payable in ASC | not payable in ASC | ||
| 92082 | TC | VISUAL FIELD EXAM(S) INTERMEDIATE | $77.96 | $72.76 | not payable in ASC | not payable in ASC | |
| 92082 | 26 | VISUAL FIELD EXAM(S) INTERMEDIATE | $34.60 | $33.40 | not payable in ASC | not payable in ASC | |
| 92083 | VISUAL FIELD EXAM(S) EXTENDED | $140.42 | $132.35 | not payable in ASC | not payable in ASC | ||
| 92083 | TC | VISUAL FIELD EXAM(S) EXTENDED | $97.19 | $90.69 | not payable in ASC | not payable in ASC | |
| 92083 | 26 | VISUAL FIELD EXAM(S) EXTENDED | $43.24 | $41.67 | not payable in ASC | not payable in ASC | |
| 92132 | SCAN COMP OPTH DX IMAGING, ANT SEG | $59.44 | $56.45 | not payable in ASC | not payable in ASC | ||
| 92132 | TC | SCAN COMP OPTH DX IMAGING, ANT SEG | $26.15 | $24.41 | not payable in ASC | not payable in ASC | |
| 92132 | 26 | SCAN COMP OPTH DX IMAGING, ANT SEG | $33.30 | $32.02 | not payable in ASC | not payable in ASC | |
| 92133 | SCAN COMP OPTH DX IMAGING, POST SEG | $72.29 | $68.79 | not payable in ASC | not payable in ASC | ||
| 92133 | TC | SCAN COMP OPTH DX IMAGING, POST SEG | $26.15 | $24.41 | not payable in ASC | not payable in ASC | |
| 92133 | 26 | SCAN COMP OPTH DX IMAGING, POST SEG | $46.14 | $44.38 | not payable in ASC | not payable in ASC | |
| 92134 | SCAN COMP OPTH DX IMAGING, RETINA | $72.29 | $68.79 | not payable in ASC | not payable in ASC | ||
| 92134 | TC | SCAN COMP OPTH DX IMAGING, RETINA | $26.15 | $24.41 | not payable in ASC | not payable in ASC | |
| 92134 | 26 | SCAN COMP OPTH DX IMAGING, RETINA | $46.14 | $44.38 | not payable in ASC | not payable in ASC | |
| 92136 | OPHTHALMIC BIOMETRY | $137.92 | $130.04 | not payable in ASC | not payable in ASC | ||
| 92136 | TC | OPHTHALMIC BIOMETRY | $91.36 | $85.25 | not payable in ASC | not payable in ASC | |
| 92136 | 26 | OPHTHALMIC BIOMETRY | $46.55 | $44.78 | not payable in ASC | not payable in ASC | |
| 92225 | SPECIAL EYE EXAM, INITIAL | $40.64 | $38.95 | not payable in ASC | not payable in ASC | ||
| 92226 | SPECIAL EYE EXAM, SUBSEQUENT | $36.48 | $34.87 | not payable in ASC | not payable in ASC | ||
| 92227 | REMOTE IMAGING RETINAL DISEASE | $19.74 | $18.45 | not payable in ASC | not payable in ASC | ||
| 92228 | REMOTE IMAGING MONITOR RETINAL DIS | $48.87 | $46.40 | not payable in ASC | not payable in ASC | ||
| 92228 | TC | REMOTE IMAGING MONITOR RETINAL DIS | $21.49 | $20.08 | not payable in ASC | not payable in ASC | |
| 92228 | 26 | REMOTE IMAGING MONITOR RETINAL DIS | $27.38 | $26.32 | not payable in ASC | not payable in ASC | |
| 92230 | 26 | FLUORESCEIN ANGIOSCOPY | $93.66 | $88.99 | not payable in ASC | not payable in ASC | |
| 92235 | FLUORESCEIN ANGIOGRAPHY | $217.30 | $204.82 | not payable in ASC | not payable in ASC | ||
| 92235 | TC | FLUORESCEIN ANGIOGRAPHY | $146.09 | $136.31 | not payable in ASC | not payable in ASC | |
| 92235 | 26 | FLUORESCEIN ANGIOGRAPHY | $71.20 | $68.50 | not payable in ASC | not payable in ASC | |
| 92250 | EYE EXAM W/PHOTOS | $122.36 | $115.28 | not payable in ASC | not payable in ASC | ||
| 92250 | TC | EYE EXAM W/PHOTOS | $86.12 | $80.36 | not payable in ASC | not payable in ASC | |
| 92250 | 26 | EYE EXAM W/PHOTOS | $36.24 | $34.92 | not payable in ASC | not payable in ASC | |
| 92275 | ELECTRORETINOGRAPHY | $234.95 | $221.80 | not payable in ASC | not payable in ASC | ||
| 92275 | TC | ELECTRORETINOGRAPHY | $147.25 | $137.40 | not payable in ASC | not payable in ASC | |
| 92275 | 26 | ELECTRORETINOGRAPHY | $87.69 | $84.41 | not payable in ASC | not payable in ASC | |
| 92285 | EYE PHOTOGRAPHY | $47.25 | $44.27 | not payable in ASC | not payable in ASC | ||
| 92285 | TC | EYE PHOTOGRAPHY | $40.70 | $38.00 | not payable in ASC | not payable in ASC | |
| 92285 | 26 | EYE PHOTOGRAPHY | $6.55 | $6.27 | not payable in ASC | not payable in ASC | |
| 92286 | INTERNAL EYE PHOTOGRAPHY | $198.16 | $186.53 | not payable in ASC | not payable in ASC | ||
| 92286 | TC | INTERNAL EYE PHOTOGRAPHY | $143.19 | $133.60 | not payable in ASC | not payable in ASC | |
| 92286 | 26 | INTERNAL EYE PHOTOGRAPHY | $54.98 | $52.94 | not payable in ASC | not payable in ASC | |
| 92311 | CONTACT LENS FITTING APHAKIA ONE EYE | $156.21 | $148.63 | not payable in ASC | not payable in ASC | ||
| 92326 | REPLACE CONTACT LENS | $61.08 | $57.01 | not payable in ASC | not payable in ASC | ||
| 92371 | EXT PAT/AUTO ECG TO 30 DAYS, DOWNLOAD | $359.22 | $335.12 | not payable in ASC | not payable in ASC | ||
| 92504 | EAR MICROSCOPY EXAM | $154.22 | $147.79 | not payable in ASC | not payable in ASC | ||
| 92506 | SPEECH/HEARING EVAL | $50.42 | $47.51 | not payable in ASC | not payable in ASC | ||
| 92507 | SPEECH/HEARING THERAPY | $279.74 | $263.23 | not payable in ASC | not payable in ASC | ||
| 92508 | SPEECH/HEARING THERAPY | $130.75 | $125.38 | not payable in ASC | not payable in ASC | ||
| 92511 | NASOPHARYNGOSCOPY | $43.47 | $41.40 | not payable in ASC | not payable in ASC | ||
| 92526 | ORAL FUNCTION THERAPY | $267.73 | $251.93 | not payable in ASC | not payable in ASC | ||
| 92540 | BASIC VESTIBULAR EVALUATION | $155.00 | $148.43 | not payable in ASC | not payable in ASC | ||
| 92540 | TC | BASIC VESTIBULAR EVALUATION | $31.96 | $29.86 | not payable in ASC | not payable in ASC | |
| 92540 | 26 | BASIC VESTIBULAR EVALUATION | $123.04 | $118.58 | not payable in ASC | not payable in ASC | |
| 92541 | SPONTANEOUS NYSTAGMUS TEST | $74.91 | $70.93 | not payable in ASC | not payable in ASC | ||
| 92541 | TC | SPONTANEOUS NYSTAGMUS TEST | $43.03 | $40.17 | not payable in ASC | not payable in ASC | |
| 92541 | 26 | SPONTANEOUS NYSTAGMUS TEST | $31.87 | $30.75 | not payable in ASC | not payable in ASC | |
| 92542 | POSITIONAL NYSTAGMUS TEST | $74.85 | $70.70 | not payable in ASC | not payable in ASC | ||
| 92542 | TC | POSITIONAL NYSTAGMUS TEST | $48.27 | $45.06 | not payable in ASC | not payable in ASC | |
| 92542 | 26 | POSITIONAL NYSTAGMUS TEST | $26.59 | $25.64 | not payable in ASC | not payable in ASC | |
| 92543 | CALORIC VESTIBULAR TEST | $37.56 | $35.36 | not payable in ASC | not payable in ASC | ||
| 92543 | TC | CALORIC VESTIBULAR TEST | $29.05 | $27.14 | not payable in ASC | not payable in ASC | |
| 92543 | 26 | CALORIC VESTIBULAR TEST | $8.51 | $8.21 | not payable in ASC | not payable in ASC | |
| 92544 | OPTOKINETIC NYSTAGMUS TEST | $61.40 | $57.98 | not payable in ASC | not payable in ASC | ||
| 92544 | TC | OPTOKINETIC NYSTAGMUS TEST | $40.70 | $38.00 | not payable in ASC | not payable in ASC | |
| 92544 | 26 | OPTOKINETIC NYSTAGMUS TEST | $20.71 | $19.98 | not payable in ASC | not payable in ASC | |
| 92545 | OSCILLATING TRACKING TEST | $57.55 | $54.31 | not payable in ASC | not payable in ASC | ||
| 92545 | TC | OSCILLATING TRACKING TEST | $38.95 | $36.37 | not payable in ASC | not payable in ASC | |
| 92545 | 26 | OSCILLATING TRACKING TEST | $18.60 | $17.95 | not payable in ASC | not payable in ASC | |
| 92546 | SINUSOIDAL ROTATIONAL TEST | $159.00 | $149.10 | not payable in ASC | not payable in ASC | ||
| 92546 | TC | SINUSOIDAL ROTATIONAL TEST | $136.20 | $127.09 | not payable in ASC | not payable in ASC | |
| 92546 | 26 | SINUSOIDAL ROTATIONAL TEST | $22.81 | $22.01 | not payable in ASC | not payable in ASC | |
| 92547 | SUPPLEMENTAL ELECTRICAL TEST | $8.67 | $8.13 | not payable in ASC | not payable in ASC | ||
| 92548 | POSTUROGRAPHY | $171.41 | $161.18 | not payable in ASC | not payable in ASC | ||
| 92548 | TC | POSTUROGRAPHY | $131.54 | $122.74 | not payable in ASC | not payable in ASC | |
| 92548 | 26 | POSTUROGRAPHY | $39.86 | $38.44 | not payable in ASC | not payable in ASC | |
| 92550 | TYMPANOMETRY & REFLEX THRESH | $32.84 | $31.52 | not payable in ASC | not payable in ASC | ||
| 92552 | PURE TONE AUDIOMETRY, AIR | $43.61 | $40.71 | not payable in ASC | not payable in ASC | ||
| 92553 | AUDIOMETRY, AIR & BONE | $55.25 | $51.59 | not payable in ASC | not payable in ASC | ||
| 92556 | SPEECH AUDIOMETRY, COMPLETE | $49.44 | $46.14 | not payable in ASC | not payable in ASC | ||
| 92557 | COMPREHENSIVE HEARING TEST | $64.62 | $61.85 | not payable in ASC | not payable in ASC | ||
| 92563 | TONE DECAY HEARING TEST | $42.45 | $39.63 | not payable in ASC | not payable in ASC | ||
| 92564 | SISI HEARING TEST | $38.37 | $35.83 | not payable in ASC | not payable in ASC | ||
| 92565 | STENGER TEST, PURE TONE | $22.07 | $20.62 | not payable in ASC | not payable in ASC | ||
| 92567 | TYMPANOMETRY | $24.64 | $23.52 | not payable in ASC | not payable in ASC | ||
| 92568 | ACOUSTIC REFLEX THRESHOLD TEST | $26.30 | $25.28 | not payable in ASC | not payable in ASC | ||
| 92570 | ACOUSTIC IMMITTANCE TESTING | $50.43 | $48.49 | not payable in ASC | not payable in ASC | ||
| 92582 | CONDITIONING PLAY AUDIOMETRY | $87.87 | $82.00 | not payable in ASC | not payable in ASC | ||
| 92584 | ELECTROCOCHLEOGRAPHY | $114.07 | $106.44 | not payable in ASC | not payable in ASC | ||
| 92585 | AUDITOR EVOKE POTENT, COMPRE | $292.37 | $274.71 | not payable in ASC | not payable in ASC | ||
| 92585 | TC | AUDITOR EVOKE POTENT, COMPRE | $231.02 | $215.57 | not payable in ASC | not payable in ASC | |
| 92585 | 26 | AUDITOR EVOKE POTENT, COMPRE | $61.33 | $59.14 | not payable in ASC | not payable in ASC | |
| 92586 | AUDITOR EVOKE POTENT, LIMIT | $120.48 | $112.42 | not payable in ASC | not payable in ASC | ||
| 92587 | EVOKED AUDITORY TEST | $62.37 | $58.58 | not payable in ASC | not payable in ASC | ||
| 92587 | TC | EVOKED AUDITORY TEST | $51.17 | $47.78 | not payable in ASC | not payable in ASC | |
| 92587 | 26 | EVOKED AUDITORY TEST | $11.20 | $10.80 | not payable in ASC | not payable in ASC | |
| 92588 | EVOKED AUDITORY TEST | $110.73 | $104.24 | not payable in ASC | not payable in ASC | ||
| 92588 | TC | EVOKED AUDITORY TEST | $81.46 | $76.03 | not payable in ASC | not payable in ASC | |
| 92588 | 26 | EVOKED AUDITORY TEST | $29.27 | $28.22 | not payable in ASC | not payable in ASC | |
| 92607 | EXCISE FOR SPEECH DEVICE RX, 1HR | $287.74 | $273.29 | not payable in ASC | not payable in ASC | ||
| 92611 | MOTION FLUOROSCOPY/SWALLOW | $183.96 | $175.16 | not payable in ASC | not payable in ASC | ||
| 92612 | ENDOSCOPY SWALLOW TEST (FEES) | $275.96 | $260.78 | not payable in ASC | not payable in ASC | ||
| 92613 | ENDOSCOPY SWALLOW TEST (FEES) | $60.24 | $58.07 | not payable in ASC | not payable in ASC | ||
| 92620 | AUDITORY FUNCTION, 60 MIN | $129.83 | $125.03 | not payable in ASC | not payable in ASC | ||
| 92621 | AUDITORY FUNCTION, + 15 MIN | $29.93 | $28.81 | not payable in ASC | not payable in ASC | ||
| 92625 | TINNITUS ASSESS | $99.39 | $95.70 | not payable in ASC | not payable in ASC | ||
| 92626 | EVAL AUDITORY REHAB STATUS | $132.91 | $127.66 | not payable in ASC | not payable in ASC | ||
| 92950 | HEART/LUNG RESUSCITATION CPR | $451.32 | $431.31 | not payable in ASC | not payable in ASC | ||
| 92960 | CARDIOVERSION ELECTRIC, EXT | $395.13 | $374.58 | not payable in ASC | not payable in ASC | ||
| 92971 | CARDIOASSIST, EXTERNAL | $156.11 | $150.32 | not payable in ASC | not payable in ASC | ||
| 92975 | DISSOLVE CLOT, HEART VESSEL | $660.35 | $639.20 | not payable in ASC | not payable in ASC | ||
| 92982 | CORONARY ARTERY DILATION | $1,011.84 | $978.97 | not payable in ASC | not payable in ASC | ||
| 93000 | ELECTROCARDIOGRAM, COMPLETE | $37.35 | $35.40 | not payable in ASC | not payable in ASC | ||
| 93005 | ELECTROCARDIOGRAM, TRACING | $28.57 | $26.72 | not payable in ASC | not payable in ASC | ||
| 93010 | ELECTROCARDIOGRAM REPORT | $19.11 | $18.46 | not payable in ASC | not payable in ASC | ||
| 93015 | CARDIOVASCULAR STRESS TEST | $152.58 | $144.27 | not payable in ASC | not payable in ASC | ||
| 93016 | CARDIOVASCULAR STRESS TEST | $36.17 | $34.87 | not payable in ASC | not payable in ASC | ||
| 93017 | CARDIOVASCULAR STRESS TEST | $92.53 | $86.34 | not payable in ASC | not payable in ASC | ||
| 93018 | CARDIOVASCULAR STRESS TEST | $23.90 | $23.06 | not payable in ASC | not payable in ASC | ||
| 93040 | RHYTHM ECG W/REPORT | $21.46 | $20.46 | not payable in ASC | not payable in ASC | ||
| 93042 | RHYTHM ECG, REPORT | $26.83 | $25.94 | not payable in ASC | not payable in ASC | ||
| 93224 | ECG MONITOR/REPORT, 24 HRS | $161.88 | $152.38 | not payable in ASC | not payable in ASC | ||
| 93225 | ECG MONITOR/RECORD, 24 HRS | $48.27 | $45.06 | not payable in ASC | not payable in ASC | ||
| 93226 | ECG MONITOR/REPORT, 24 HRS | $70.98 | $66.25 | not payable in ASC | not payable in ASC | ||
| 93227 | ECG MONITOR/REVIEW, 24 HRS | $42.63 | $41.07 | not payable in ASC | not payable in ASC | ||
| 93228 | REMOTE 30 DAY ECG REV/REPORT | $40.17 | $38.85 | not payable in ASC | not payable in ASC | ||
| 93229 | REMOTE 30 DAY ECG TECH SUPP | $1,167.45 | $1,089.06 | not payable in ASC | not payable in ASC | ||
| 93268 | EXT PAT/AUTO ECG TO 30 DAYS, COMPLETE | $425.66 | $398.44 | not payable in ASC | not payable in ASC | ||
| 93270 | EXT PAT/AUTO ECG TO 30 DAYS, RECORDING | $26.15 | $24.41 | not payable in ASC | not payable in ASC | ||
| 93272 | EXT PAT/AUTO ECG TO 30 DAYS, REPORT | $40.30 | $38.90 | not payable in ASC | not payable in ASC | ||
| 93280 | PM DEVICE PROGRAM EVAL, DUAL | $100.54 | $95.81 | not payable in ASC | not payable in ASC | ||
| 93280 | TC | PM DEVICE PROGRAM EVAL, DUAL | $36.62 | $34.19 | not payable in ASC | not payable in ASC | |
| 93280 | 26 | PM DEVICE PROGRAM EVAL, DUAL | $63.92 | $61.62 | not payable in ASC | not payable in ASC | |
| 93281 | PM DEVICE PROGRAM EVAL, MULTI | $117.04 | $111.53 | not payable in ASC | not payable in ASC | ||
| 93281 | TC | PM DEVICE PROGRAM EVAL, MULTI | $42.45 | $39.63 | not payable in ASC | not payable in ASC | |
| 93281 | 26 | PM DEVICE PROGRAM EVAL, MULTI | $74.59 | $71.89 | not payable in ASC | not payable in ASC | |
| 93282 | ICD DEVICE PROGRAM EVAL, 1 SINGLE | $107.52 | $102.52 | not payable in ASC | not payable in ASC | ||
| 93282 | TC | ICD DEVICE PROGRAM EVAL, 1 SINGLE | $37.79 | $35.29 | not payable in ASC | not payable in ASC | |
| 93282 | 26 | ICD DEVICE PROGRAM EVAL, 1 SINGLE | $69.73 | $67.23 | not payable in ASC | not payable in ASC | |
| 93283 | ICD DEVICE PROGRAM EVAL, DUAL | $137.23 | $131.01 | not payable in ASC | not payable in ASC | ||
| 93283 | TC | ICD DEVICE PROGRAM EVAL, DUAL | $43.61 | $40.71 | not payable in ASC | not payable in ASC | |
| 93283 | 26 | ICD DEVICE PROGRAM EVAL, DUAL | $93.64 | $90.30 | not payable in ASC | not payable in ASC | |
| 93284 | ICD DEVICE PROGRAM EVAL, MULT | $152.79 | $145.76 | not payable in ASC | not payable in ASC | ||
| 93284 | TC | ICD DEVICE PROGRAM EVAL, MULT | $49.44 | $46.14 | not payable in ASC | not payable in ASC | |
| 93284 | 26 | ICD DEVICE PROGRAM EVAL, MULT | $103.36 | $99.62 | not payable in ASC | not payable in ASC | |
| 93285 | ILR DEVICE EVAL PROGRAM | $71.68 | $68.21 | not payable in ASC | not payable in ASC | ||
| 93285 | TC | ILR DEVICE EVAL PROGRAM | $29.05 | $27.14 | not payable in ASC | not payable in ASC | |
| 93285 | 26 | ILR DEVICE EVAL PROGRAM | $42.63 | $41.07 | not payable in ASC | not payable in ASC | |
| 93288 | PM DEVICE EVAL IN PERSON | $64.79 | $61.56 | not payable in ASC | not payable in ASC | ||
| 93288 | TC | PM DEVICE EVAL IN PERSON | $29.63 | $27.68 | not payable in ASC | not payable in ASC | |
| 93288 | 26 | PM DEVICE EVAL IN PERSON | $35.16 | $33.88 | not payable in ASC | not payable in ASC | |
| 93289 | ICD DEVICE INTERROGATE | $109.91 | $104.92 | not payable in ASC | not payable in ASC | ||
| 93289 | TC | ICD DEVICE INTERROGATE | $36.62 | $34.19 | not payable in ASC | not payable in ASC | |
| 93289 | 26 | ICD DEVICE INTERROGATE | $73.29 | $70.71 | not payable in ASC | not payable in ASC | |
| 93290 | ICM DEVICE EVAL | $49.07 | $46.90 | not payable in ASC | not payable in ASC | ||
| 93290 | TC | ICM DEVICE EVAL | $16.83 | $15.73 | not payable in ASC | not payable in ASC | |
| 93290 | 26 | ICM DEVICE EVAL | $32.24 | $31.16 | not payable in ASC | not payable in ASC | |
| 93293 | PM PHONE R-STRIP DEVICE EVAL | $93.56 | $88.12 | not payable in ASC | not payable in ASC | ||
| 93293 | TC | PM PHONE R-STRIP DEVICE EVAL | $68.65 | $64.08 | not payable in ASC | not payable in ASC | |
| 93293 | 26 | PM PHONE R-STRIP DEVICE EVAL | $24.91 | $24.06 | not payable in ASC | not payable in ASC | |
| 93294 | PM DEVICE INTERROGATE REMOTE | $54.29 | $52.37 | not payable in ASC | not payable in ASC | ||
| 93295 | ICD DEVICE INTERROGATE REMOTE | $106.89 | $103.14 | not payable in ASC | not payable in ASC | ||
| 93296 | PM/ICD REMOTE TECH SERV | $55.83 | $52.13 | not payable in ASC | not payable in ASC | ||
| 93297 | ICM DEVICE INTERROGATE REMOTE | $40.17 | $38.85 | not payable in ASC | not payable in ASC | ||
| 93299 | ICM/ILR REMOTE TECH SERV | $73.04 | $68.85 | not payable in ASC | not payable in ASC | ||
| 93303 | ECHO TRANSTHORACIC | $350.40 | $330.22 | not payable in ASC | not payable in ASC | ||
| 93303 | TC | ECHO TRANSTHORACIC | $246.83 | $230.29 | not payable in ASC | not payable in ASC | |
| 93303 | 26 | ECHO TRANSTHORACIC | $103.57 | $99.93 | not payable in ASC | not payable in ASC | |
| 93306 | TTE W/DOPPLER, COMPLETE | $388.84 | $366.07 | not payable in ASC | not payable in ASC | ||
| 93306 | TC | TTE W/DOPPLER, COMPLETE | $282.94 | $263.97 | not payable in ASC | not payable in ASC | |
| 93306 | 26 | TTE W/DOPPLER, COMPLETE | $105.90 | $102.10 | not payable in ASC | not payable in ASC | |
| 93307 | TTE W/O DOPPLER, COMPLETE | $246.74 | $232.56 | not payable in ASC | not payable in ASC | ||
| 93307 | TC | TTE W/O DOPPLER, COMPLETE | $172.29 | $160.77 | not payable in ASC | not payable in ASC | |
| 93307 | 26 | TTE W/O DOPPLER, COMPLETE | $74.45 | $71.81 | not payable in ASC | not payable in ASC | |
| 93308 | TTE, F-UP OR LIMITED | $176.43 | $165.94 | not payable in ASC | not payable in ASC | ||
| 93308 | TC | TTE, F-UP OR LIMITED | $133.87 | $124.91 | not payable in ASC | not payable in ASC | |
| 93308 | 26 | TTE, F-UP OR LIMITED | $42.56 | $41.03 | not payable in ASC | not payable in ASC | |
| 93312 | ECHO TRANSESOPHAGEAL | $537.84 | $507.44 | not payable in ASC | not payable in ASC | ||
| 93312 | TC | ECHO TRANSESOPHAGEAL | $366.07 | $341.60 | not payable in ASC | not payable in ASC | |
| 93312 | 26 | ECHO TRANSESOPHAGEAL | $171.77 | $165.84 | not payable in ASC | not payable in ASC | |
| 93313 | ECHO TRANSESOPHAGEAL | $63.49 | $61.79 | not payable in ASC | not payable in ASC | ||
| 93314 | ECHO TRANSESOPHAGEAL | $479.33 | $450.44 | not payable in ASC | not payable in ASC | ||
| 93314 | TC | ECHO TRANSESOPHAGEAL | $381.22 | $355.71 | not payable in ASC | not payable in ASC | |
| 93314 | 26 | ECHO TRANSESOPHAGEAL | $98.13 | $94.73 | not payable in ASC | not payable in ASC | |
| 93320 | DOPPLER ECHO EXAM, HEART | $104.18 | $98.17 | not payable in ASC | not payable in ASC | ||
| 93320 | TC | DOPPLER ECHO EXAM, HEART | $73.90 | $68.97 | not payable in ASC | not payable in ASC | |
| 93320 | 26 | DOPPLER ECHO EXAM, HEART | $30.28 | $29.22 | not payable in ASC | not payable in ASC | |
| 93321 | DOPPLER ECHO EXAM, HEART | $48.83 | $45.99 | not payable in ASC | not payable in ASC | ||
| 93321 | TC | DOPPLER ECHO EXAM, HEART | $36.62 | $34.19 | not payable in ASC | not payable in ASC | |
| 93321 | 26 | DOPPLER ECHO EXAM, HEART | $12.21 | $11.79 | not payable in ASC | not payable in ASC | |
| 93325 | DOPPLER COLOR FLOW, ADDED | $60.50 | $56.67 | not payable in ASC | not payable in ASC | ||
| 93325 | TC | DOPPLER COLOR FLOW, ADDED | $54.67 | $51.03 | not payable in ASC | not payable in ASC | |
| 93325 | 26 | DOPPLER COLOR FLOW, ADDED | $5.81 | $5.63 | not payable in ASC | not payable in ASC | |
| 93350 | STRESS TTE ONLY | $349.15 | $329.46 | not payable in ASC | not payable in ASC | ||
| 93350 | TC | STRESS TTE ONLY | $229.95 | $214.54 | not payable in ASC | not payable in ASC | |
| 93350 | 26 | STRESS TTE ONLY | $119.20 | $114.94 | not payable in ASC | not payable in ASC | |
| 93351 | STRESS TTE COMPLETE | $410.89 | $387.86 | not payable in ASC | not payable in ASC | ||
| 93351 | TC | STRESS TTE COMPLETE | $267.09 | $249.26 | not payable in ASC | not payable in ASC | |
| 93351 | 26 | STRESS TTE COMPLETE | $143.81 | $138.60 | not payable in ASC | not payable in ASC | |
| 93451 | RIGHT HEART CATH | $1,284.20 | $1,206.75 | not payable in ASC | not payable in ASC | ||
| 93451 | TC | RIGHT HEART CATH | $1,053.77 | $983.10 | not payable in ASC | not payable in ASC | |
| 93451 | 26 | RIGHT HEART CATH | $230.43 | $223.66 | not payable in ASC | not payable in ASC | |
| 93452 | LEFT HEART CATH W/VENTRCLGRPHY | $1,410.49 | $1,331.17 | not payable in ASC | not payable in ASC | ||
| 93452 | TC | LEFT HEART CATH W/VENTRCLGRPHY | $1,006.61 | $939.09 | not payable in ASC | not payable in ASC | |
| 93452 | 26 | LEFT HEART CATH W/VENTRCLGRPHY | $403.89 | $392.06 | not payable in ASC | not payable in ASC | |
| 93453 | R&L HEART CATH W/VENTRICLGRPHY | $1,845.72 | $1,741.92 | not payable in ASC | not payable in ASC | ||
| 93453 | TC | R&L HEART CATH W/VENTRICLGRPHY | $1,316.32 | $1,228.06 | not payable in ASC | not payable in ASC | |
| 93453 | 26 | R&L HEART CATH W/VENTRICLGRPHY | $529.40 | $513.86 | not payable in ASC | not payable in ASC | |
| 93454 | CATH PLACE CORONARY ANGIO | $1,455.61 | $1,373.35 | not payable in ASC | not payable in ASC | ||
| 93454 | TC | CATH PLACE CORONARY ANGIO | $1,048.53 | $978.22 | not payable in ASC | not payable in ASC | |
| 93454 | 26 | CATH PLACE CORONARY ANGIO | $407.08 | $395.15 | not payable in ASC | not payable in ASC | |
| 93455 | CATH PLACE BYPASS GRAFTS | $1,698.80 | $1,602.61 | not payable in ASC | not payable in ASC | ||
| 93455 | TC | CATH PLACE BYPASS GRAFTS | $1,228.98 | $1,146.57 | not payable in ASC | not payable in ASC | |
| 93455 | 26 | CATH PLACE BYPASS GRAFTS | $469.82 | $456.03 | not payable in ASC | not payable in ASC | |
| 93456 | CATH PLACE WITH R HEART CATH | $1,820.43 | $1,717.97 | not payable in ASC | not payable in ASC | ||
| 93456 | TC | CATH PLACE WITH R HEART CATH | $1,299.44 | $1,212.30 | not payable in ASC | not payable in ASC | |
| 93456 | 26 | CATH PLACE WITH R HEART CATH | $521.00 | $505.68 | not payable in ASC | not payable in ASC | |
| 93457 | R HEART ART/GRAFT ANGIO | $2,063.64 | $1,947.25 | not payable in ASC | not payable in ASC | ||
| 93457 | TC | R HEART ART/GRAFT ANGIO | $1,479.36 | $1,380.14 | not payable in ASC | not payable in ASC | |
| 93457 | 26 | R HEART ART/GRAFT ANGIO | $584.28 | $567.10 | not payable in ASC | not payable in ASC | |
| 93458 | L HEART ARTERY/VENTRICLE ANGIO | $1,755.96 | $1,656.97 | not payable in ASC | not payable in ASC | ||
| 93458 | TC | L HEART ARTERY/VENTRICLE ANGIO | $1,259.26 | $1,174.82 | not payable in ASC | not payable in ASC | |
| 93458 | 26 | L HEART ARTERY/VENTRICLE ANGIO | $496.71 | $482.14 | not payable in ASC | not payable in ASC | |
| 93459 | L HEART ART/GRAFT ANGIO | $1,938.14 | $1,829.23 | not payable in ASC | not payable in ASC | ||
| 93459 | TC | L HEART ART/GRAFT ANGIO | $1,379.22 | $1,286.72 | not payable in ASC | not payable in ASC | |
| 93459 | 26 | L HEART ART/GRAFT ANGIO | $558.94 | $542.51 | not payable in ASC | not payable in ASC | |
| 93460 | R & L HEART ART/VENTRICLE ANGIO | $2,071.87 | $1,956.36 | not payable in ASC | not payable in ASC | ||
| 93460 | TC | R & L HEART ART/VENTRICLE ANGIO | $1,449.09 | $1,351.90 | not payable in ASC | not payable in ASC | |
| 93460 | 26 | R & L HEART ART/VENTRICLE ANGIO | $622.77 | $604.46 | not payable in ASC | not payable in ASC | |
| 93461 | R & L HEART ART/VENTRICLE ANGIO | $2,376.60 | $2,243.12 | not payable in ASC | not payable in ASC | ||
| 93461 | TC | R & L HEART ART/VENTRICLE ANGIO | $1,689.51 | $1,576.21 | not payable in ASC | not payable in ASC | |
| 93461 | 26 | R & L HEART ART/VENTRICLE ANGIO | $687.09 | $666.91 | not payable in ASC | not payable in ASC | |
| 93462 | L HEART CATH TRANSPLANT PUNCTURE | $316.47 | $307.12 | not payable in ASC | not payable in ASC | ||
| 93463 | DRUG ADMIN & HEMODYNMIC MEAS | $167.77 | $162.76 | not payable in ASC | not payable in ASC | ||
| 93464 | EXERCISE W/HEMODYNAMIC MEAS | $416.35 | $394.04 | not payable in ASC | not payable in ASC | ||
| 93464 | TC | EXERCISE W/HEMODYNAMIC MEAS | $268.95 | $250.93 | not payable in ASC | not payable in ASC | |
| 93464 | 26 | EXERCISE W/HEMODYNAMIC MEAS | $147.39 | $143.12 | not payable in ASC | not payable in ASC | |
| 93503 | INSERT/PLACE HEART CATHETER | $206.54 | $200.73 | not payable in ASC | not payable in ASC | ||
| 93563 | INJECT CONGENITAL CARD CATH | $87.15 | $84.36 | not payable in ASC | not payable in ASC | ||
| 93564 | INJECT HEART CONGNTL ART/GRAFT | $88.69 | $85.88 | not payable in ASC | not payable in ASC | ||
| 93565 | INJECT L VENTR/ATRIAL ANGIO | $67.02 | $64.90 | not payable in ASC | not payable in ASC | ||
| 93566 | INJECT R VENTR/ATRIAL ANGIO | $283.05 | $266.42 | not payable in ASC | not payable in ASC | ||
| 93567 | INJECT SUPRVLV AORTOGRAPHY | $231.57 | $218.66 | not payable in ASC | not payable in ASC | ||
| 93568 | INJECT PULM ART HEART CATH | $254.94 | $240.25 | not payable in ASC | not payable in ASC | ||
| 93609 | 26 | MAP TACHYCARDIA, ADDED | $453.72 | $439.26 | not payable in ASC | not payable in ASC | |
| 93610 | 26 | INTRA-ATRIAL PACING | $271.48 | $262.90 | not payable in ASC | not payable in ASC | |
| 93612 | 26 | INTRAVENTRICULAR PACING | $270.32 | $261.81 | not payable in ASC | not payable in ASC | |
| 93620 | ELECTROPHYSIOLOGY EVAL | $1,831.99 | $1,764.36 | not payable in ASC | not payable in ASC | ||
| 93620 | TC | ELECTROPHYSIOLOGY EVAL | $809.16 | $780.90 | not payable in ASC | not payable in ASC | |
| 93620 | 26 | ELECTROPHYSIOLOGY EVAL | $1,055.32 | $1,021.50 | not payable in ASC | not payable in ASC | |
| 93623 | 26 | STIMULATION, PACING HEART | $259.49 | $251.22 | not payable in ASC | not payable in ASC | |
| 93641 | ELECTROPHYSIOLOGY EVAL | $800.92 | $770.31 | not payable in ASC | not payable in ASC | ||
| 93641 | TC | ELECTROPHYSIOLOGY EVAL | $260.71 | $250.41 | not payable in ASC | not payable in ASC | |
| 93641 | 26 | ELECTROPHYSIOLOGY EVAL | $538.69 | $521.48 | not payable in ASC | not payable in ASC | |
| 93642 | ELECTROPHYSIOLOGY EVAL | $695.28 | $661.24 | not payable in ASC | not payable in ASC | ||
| 93642 | TC | ELECTROPHYSIOLOGY EVAL | $293.87 | $274.24 | not payable in ASC | not payable in ASC | |
| 93642 | 26 | ELECTROPHYSIOLOGY EVAL | $401.41 | $387.00 | not payable in ASC | not payable in ASC | |
| 93660 | TILT TABLE EVAL | $267.19 | $254.13 | not payable in ASC | not payable in ASC | ||
| 93660 | TC | TILT TABLE EVAL | $112.90 | $105.36 | not payable in ASC | not payable in ASC | |
| 93660 | 26 | TILT TABLE EVAL | $154.29 | $148.79 | not payable in ASC | not payable in ASC | |
| 93701 | BIOIMPD THRC ELEC | $45.94 | $42.89 | not payable in ASC | not payable in ASC | ||
| 93720 | BIOIMPEDANCE, CV ANALYSIS | $82.45 | $77.41 | not payable in ASC | not payable in ASC | ||
| 93722 | TOTAL BODY PLETHYSMOGRAPHY | $12.65 | $12.24 | not payable in ASC | not payable in ASC | ||
| 93784 | AMBULATORY BP MONITORING | $103.53 | $97.61 | not payable in ASC | not payable in ASC | ||
| 93798 | CARDIAC REHAB/MONITOR | $41.51 | $39.45 | not payable in ASC | not payable in ASC | ||
| 93875 | EXTRACRANIAL STUDY | $179.33 | $167.89 | not payable in ASC | not payable in ASC | ||
| 93875 | TC | EXTRACRANIAL STUDY | $162.40 | $151.53 | not payable in ASC | not payable in ASC | |
| 93875 | 26 | EXTRACRANIAL STUDY | $16.93 | $16.36 | not payable in ASC | not payable in ASC | |
| 93880 | EXTRACRANIAL STUDY | $424.35 | $397.49 | not payable in ASC | not payable in ASC | ||
| 93880 | TC | EXTRACRANIAL STUDY | $377.27 | $351.96 | not payable in ASC | not payable in ASC | |
| 93880 | 26 | EXTRACRANIAL STUDY | $47.08 | $45.53 | not payable in ASC | not payable in ASC | |
| 93882 | EXTRACRANIAL STUDY | $294.19 | $275.62 | not payable in ASC | not payable in ASC | ||
| 93882 | TC | EXTRACRANIAL STUDY | $262.56 | $244.95 | not payable in ASC | not payable in ASC | |
| 93882 | 26 | EXTRACRANIAL STUDY | $31.63 | $30.67 | not payable in ASC | not payable in ASC | |
| 93886 | INTRACRANIAL STUDY | $560.39 | $525.22 | not payable in ASC | not payable in ASC | ||
| 93886 | TC | INTRACRANIAL STUDY | $487.32 | $454.62 | not payable in ASC | not payable in ASC | |
| 93886 | 26 | INTRACRANIAL STUDY | $73.07 | $70.60 | not payable in ASC | not payable in ASC | |
| 93922 | EXTREMITY STUDY | $187.26 | $175.36 | not payable in ASC | not payable in ASC | ||
| 93922 | TC | EXTREMITY STUDY | $168.23 | $156.96 | not payable in ASC | not payable in ASC | |
| 93922 | 26 | EXTREMITY STUDY | $19.03 | $18.40 | not payable in ASC | not payable in ASC | |
| 93923 | EXTREMITY STUDY | $289.22 | $271.07 | not payable in ASC | not payable in ASC | ||
| 93923 | TC | EXTREMITY STUDY | $253.82 | $236.81 | not payable in ASC | not payable in ASC | |
| 93923 | 26 | EXTREMITY STUDY | $35.40 | $34.26 | not payable in ASC | not payable in ASC | |
| 93924 | EXTREMITY STUDY | $361.62 | $338.73 | not payable in ASC | not payable in ASC | ||
| 93924 | TC | EXTREMITY STUDY | $322.53 | $300.90 | not payable in ASC | not payable in ASC | |
| 93924 | 26 | EXTREMITY STUDY | $39.09 | $37.83 | not payable in ASC | not payable in ASC | |
| 93925 | LOWER EXTREMITY STUDY | $537.92 | $503.46 | not payable in ASC | not payable in ASC | ||
| 93925 | TC | LOWER EXTREMITY STUDY | $493.02 | $460.00 | not payable in ASC | not payable in ASC | |
| 93925 | 26 | LOWER EXTREMITY STUDY | $44.91 | $43.44 | not payable in ASC | not payable in ASC | |
| 93926 | LOWER EXTREMITY STUDY | $349.57 | $327.26 | not payable in ASC | not payable in ASC | ||
| 93926 | TC | LOWER EXTREMITY STUDY | $318.45 | $297.11 | not payable in ASC | not payable in ASC | |
| 93926 | 26 | LOWER EXTREMITY STUDY | $31.12 | $30.16 | not payable in ASC | not payable in ASC | |
| 93930 | UPPER EXTREMITY STUDY | $423.65 | $396.50 | not payable in ASC | not payable in ASC | ||
| 93930 | TC | UPPER EXTREMITY STUDY | $387.74 | $361.74 | not payable in ASC | not payable in ASC | |
| 93930 | 26 | UPPER EXTREMITY STUDY | $35.91 | $34.76 | not payable in ASC | not payable in ASC | |
| 93931 | UPPER EXTREMITY STUDY | $283.34 | $265.20 | not payable in ASC | not payable in ASC | ||
| 93931 | TC | UPPER EXTREMITY STUDY | $259.06 | $241.70 | not payable in ASC | not payable in ASC | |
| 93931 | 26 | UPPER EXTREMITY STUDY | $24.27 | $23.50 | not payable in ASC | not payable in ASC | |
| 93965 | EXTREMITY STUDY | $214.33 | $200.93 | not payable in ASC | not payable in ASC | ||
| 93965 | TC | EXTREMITY STUDY | $186.86 | $174.34 | not payable in ASC | not payable in ASC | |
| 93965 | 26 | EXTREMITY STUDY | $27.47 | $26.59 | not payable in ASC | not payable in ASC | |
| 93970 | EXTREMITY STUDY | $436.95 | $409.56 | not payable in ASC | not payable in ASC | ||
| 93970 | TC | EXTREMITY STUDY | $383.10 | $357.39 | not payable in ASC | not payable in ASC | |
| 93970 | 26 | EXTREMITY STUDY | $53.87 | $52.15 | not payable in ASC | not payable in ASC | |
| 93971 | EXTREMITY STUDY | $286.89 | $268.90 | not payable in ASC | not payable in ASC | ||
| 93971 | TC | EXTREMITY STUDY | $251.49 | $234.63 | not payable in ASC | not payable in ASC | |
| 93971 | 26 | EXTREMITY STUDY | $35.40 | $34.26 | not payable in ASC | not payable in ASC | |
| 93975 | VASCULAR STUDY | $637.06 | $599.26 | not payable in ASC | not payable in ASC | ||
| 93975 | TC | VASCULAR STUDY | $495.93 | $462.72 | not payable in ASC | not payable in ASC | |
| 93975 | 26 | VASCULAR STUDY | $141.13 | $136.54 | not payable in ASC | not payable in ASC | |
| 93976 | VASCULAR STUDY | $363.64 | $342.48 | not payable in ASC | not payable in ASC | ||
| 93976 | TC | VASCULAR STUDY | $268.95 | $250.93 | not payable in ASC | not payable in ASC | |
| 93976 | 26 | VASCULAR STUDY | $94.67 | $91.56 | not payable in ASC | not payable in ASC | |
| 93978 | VASCULAR STUDY | $410.98 | $385.24 | not payable in ASC | not payable in ASC | ||
| 93978 | TC | VASCULAR STUDY | $359.22 | $335.12 | not payable in ASC | not payable in ASC | |
| 93978 | 26 | VASCULAR STUDY | $51.77 | $50.12 | not payable in ASC | not payable in ASC | |
| 93979 | VASCULAR STUDY | $284.63 | $266.77 | not payable in ASC | not payable in ASC | ||
| 93979 | TC | VASCULAR STUDY | $250.32 | $233.54 | not payable in ASC | not payable in ASC | |
| 93979 | 26 | VASCULAR STUDY | $34.30 | $33.21 | not payable in ASC | not payable in ASC | |
| 94002 | VENT MGMT INPATIENT, INIT DAY | $139.58 | $135.63 | not payable in ASC | not payable in ASC | ||
| 94003 | VENT MGMT INPATIENT, SUBCUT DAY | $100.93 | $97.84 | not payable in ASC | not payable in ASC | ||
| 94010 | BREATHING CAPACITY TEST | $59.16 | $55.68 | not payable in ASC | not payable in ASC | ||
| 94010 | TC | BREATHING CAPACITY TEST | $45.94 | $42.89 | not payable in ASC | not payable in ASC | |
| 94010 | 26 | BREATHING CAPACITY TEST | $13.22 | $12.79 | not payable in ASC | not payable in ASC | |
| 94060 | EVALUATE WHEEZING | $101.79 | $95.78 | not payable in ASC | not payable in ASC | ||
| 94060 | TC | EVALUATE WHEEZING | $79.13 | $73.85 | not payable in ASC | not payable in ASC | |
| 94060 | 26 | EVALUATE WHEEZING | $22.65 | $21.93 | not payable in ASC | not payable in ASC | |
| 94070 | EVALUATE WHEEZING | $97.74 | $92.78 | not payable in ASC | not payable in ASC | ||
| 94070 | TC | EVALUATE WHEEZING | $53.50 | $49.95 | not payable in ASC | not payable in ASC | |
| 94070 | 26 | EVALUATE WHEEZING | $44.24 | $42.83 | not payable in ASC | not payable in ASC | |
| 94200 | LUNG FUNCTION TEST (MBC/MVV) | $40.40 | $38.01 | not payable in ASC | not payable in ASC | ||
| 94200 | TC | LUNG FUNCTION TEST (MBC/MVV) | $31.96 | $29.86 | not payable in ASC | not payable in ASC | |
| 94200 | 26 | LUNG FUNCTION TEST (MBC/MVV) | $8.43 | $8.17 | not payable in ASC | not payable in ASC | |
| 94240 | RESIDUAL LUNG CAPACITY | $66.63 | $62.87 | not payable in ASC | not payable in ASC | ||
| 94240 | TC | RESIDUAL LUNG CAPACITY | $47.69 | $44.52 | not payable in ASC | not payable in ASC | |
| 94240 | 26 | RESIDUAL LUNG CAPACITY | $18.96 | $18.35 | not payable in ASC | not payable in ASC | |
| 94250 | EXPIRED GAS COLLECTION | $42.72 | $40.19 | not payable in ASC | not payable in ASC | ||
| 94250 | TC | EXPIRED GAS COLLECTION | $34.29 | $32.03 | not payable in ASC | not payable in ASC | |
| 94250 | 26 | EXPIRED GAS COLLECTION | $8.43 | $8.17 | not payable in ASC | not payable in ASC | |
| 94260 | THORACIC GAS VOLUME | $54.80 | $51.51 | not payable in ASC | not payable in ASC | ||
| 94260 | TC | THORACIC GAS VOLUME | $45.36 | $42.35 | not payable in ASC | not payable in ASC | |
| 94260 | 26 | THORACIC GAS VOLUME | $9.45 | $9.17 | not payable in ASC | not payable in ASC | |
| 94350 | LUNG NITROGEN WASHOUT CURVE | $57.33 | $54.17 | not payable in ASC | not payable in ASC | ||
| 94350 | TC | LUNG NITROGEN WASHOUT CURVE | $38.37 | $35.83 | not payable in ASC | not payable in ASC | |
| 94350 | 26 | LUNG NITROGEN WASHOUT CURVE | $18.96 | $18.35 | not payable in ASC | not payable in ASC | |
| 94360 | MEASURE AIRFLOW RESISTANCE | $74.21 | $69.93 | not payable in ASC | not payable in ASC | ||
| 94360 | TC | MEASURE AIRFLOW RESISTANCE | $55.25 | $51.59 | not payable in ASC | not payable in ASC | |
| 94360 | 26 | MEASURE AIRFLOW RESISTANCE | $18.96 | $18.35 | not payable in ASC | not payable in ASC | |
| 94370 | BREATH AIRWAY CLOSING VOLUME | $56.74 | $53.63 | not payable in ASC | not payable in ASC | ||
| 94370 | TC | BREATH AIRWAY CLOSING VOLUME | $37.79 | $35.29 | not payable in ASC | not payable in ASC | |
| 94370 | 26 | BREATH AIRWAY CLOSING VOLUME | $18.96 | $18.35 | not payable in ASC | not payable in ASC | |
| 94375 | RESPIRATORY FLOW VOLUME LOOP | $63.35 | $59.93 | not payable in ASC | not payable in ASC | ||
| 94375 | TC | RESPIRATORY FLOW VOLUME LOOP | $40.70 | $38.00 | not payable in ASC | not payable in ASC | |
| 94375 | 26 | RESPIRATORY FLOW VOLUME LOOP | $22.65 | $21.93 | not payable in ASC | not payable in ASC | |
| 94620 | PULMONARY STRESS TEST/SIMPLE | $103.85 | $98.58 | not payable in ASC | not payable in ASC | ||
| 94620 | TC | PULMONARY STRESS TEST/SIMPLE | $56.42 | $52.67 | not payable in ASC | not payable in ASC | |
| 94620 | 26 | PULMONARY STRESS TEST/SIMPLE | $47.44 | $45.92 | not payable in ASC | not payable in ASC | |
| 94640 | AIRWAY INHALATION TREAT | $27.30 | $25.51 | not payable in ASC | not payable in ASC | ||
| 94660 | POS AIRWAY PRESSURE, CPAP | $95.91 | $91.49 | not payable in ASC | not payable in ASC | ||
| 94664 | EVALUATE PAT USE INHALER | $27.30 | $25.51 | not payable in ASC | not payable in ASC | ||
| 94667 | CHEST WALL MANIPULATION | $38.37 | $35.83 | not payable in ASC | not payable in ASC | ||
| 94720 | MONOXIDE DIFFUSING CAPACITY | $87.61 | $82.42 | not payable in ASC | not payable in ASC | ||
| 94720 | TC | MONOXIDE DIFFUSING CAPACITY | $68.65 | $64.08 | not payable in ASC | not payable in ASC | |
| 94720 | 26 | MONOXIDE DIFFUSING CAPACITY | $18.96 | $18.35 | not payable in ASC | not payable in ASC | |
| 94750 | PULMONARY COMPLIANCE STUDY | $131.51 | $123.29 | not payable in ASC | not payable in ASC | ||
| 94750 | TC | PULMONARY COMPLIANCE STUDY | $114.65 | $106.98 | not payable in ASC | not payable in ASC | |
| 94750 | 26 | PULMONARY COMPLIANCE STUDY | $16.85 | $16.31 | not payable in ASC | not payable in ASC | |
| 94760 | MEASURE BLOOD OXYGEN LEVEL | $28.25 | $26.59 | not payable in ASC | not payable in ASC | ||
| 94761 | MEASURE BLOOD OXYGEN LEVEL | $46.17 | $43.29 | not payable in ASC | not payable in ASC | ||
| 94762 | MEASURE BLOOD OXYGEN LEVEL | $59.35 | $55.44 | not payable in ASC | not payable in ASC | ||
| 94770 | EXHALED CARBON DIOXIDE TEST | $38.28 | $36.18 | not payable in ASC | not payable in ASC | ||
| 95004 | PERCUT ALLERGY SKIN TESTS | $10.93 | $10.25 | not payable in ASC | not payable in ASC | ||
| 95015 | ID ALLERGY TITRATE-DRUG/BUG | $23.28 | $22.11 | not payable in ASC | not payable in ASC | ||
| 95024 | ID ALLERGY TEST, DRUG/BUG | $12.68 | $11.88 | not payable in ASC | not payable in ASC | ||
| 95027 | ID ALLERGY TITRATE-AIRBORNE | $8.01 | $7.53 | not payable in ASC | not payable in ASC | ||
| 95028 | ID ALLERGY TEST-DELAYED TYPE | $21.49 | $20.08 | not payable in ASC | not payable in ASC | ||
| 95044 | ALLERGY PATCH TESTS | $10.42 | $9.75 | not payable in ASC | not payable in ASC | ||
| 95115 | IMMUNOTHERAPY, ONE INJECTION | $17.41 | $16.27 | not payable in ASC | not payable in ASC | ||
| 95117 | IMMUNOTHERAPY INJECTIONS | $21.49 | $20.08 | not payable in ASC | not payable in ASC | ||
| 95144 | ANTIGEN THERAPY SERVICES | $21.03 | $19.80 | not payable in ASC | not payable in ASC | ||
| 95800 | SLEEP STUDY UNATT; COMP W/SLEEP TIME | $344.12 | $323.75 | not payable in ASC | not payable in ASC | ||
| 95800 | TC | SLEEP STUDY UNATT; COMP W/SLEEP TIME | $252.65 | $235.71 | not payable in ASC | not payable in ASC | |
| 95800 | 26 | SLEEP STUDY UNATT; COMP W/SLEEP TIME | $91.46 | $88.02 | not payable in ASC | not payable in ASC | |
| 95801 | SLEEP STUDY UNATT; COMP W/O SLEEP TIME | $158.15 | $150.15 | not payable in ASC | not payable in ASC | ||
| 95801 | TC | SLEEP STUDY UNATT; COMP W/O SLEEP TIME | $77.96 | $72.76 | not payable in ASC | not payable in ASC | |
| 95801 | 26 | SLEEP STUDY UNATT; COMP W/O SLEEP TIME | $80.19 | $77.39 | not payable in ASC | not payable in ASC | |
| 95803 | ACTIGRAPHY TESTING | $271.28 | $255.44 | not payable in ASC | not payable in ASC | ||
| 95803 | TC | ACTIGRAPHY TESTING | $197.91 | $184.66 | not payable in ASC | not payable in ASC | |
| 95803 | 26 | ACTIGRAPHY TESTING | $73.37 | $70.78 | not payable in ASC | not payable in ASC | |
| 95805 | MULTIPLE SLEEP LATENCY TEST | $693.93 | $650.54 | not payable in ASC | not payable in ASC | ||
| 95805 | TC | MULTIPLE SLEEP LATENCY TEST | $597.18 | $557.22 | not payable in ASC | not payable in ASC | |
| 95805 | 26 | MULTIPLE SLEEP LATENCY TEST | $96.75 | $93.32 | not payable in ASC | not payable in ASC | |
| 95810 | POLYSOMNOGRAPHY, 4 OR MORE | $1,169.61 | $1,097.90 | not payable in ASC | not payable in ASC | ||
| 95810 | TC | POLYSOMNOGRAPHY, 4 OR MORE | $974.08 | $909.04 | not payable in ASC | not payable in ASC | |
| 95810 | 26 | POLYSOMNOGRAPHY, 4 OR MORE | $195.54 | $188.86 | not payable in ASC | not payable in ASC | |
| 95811 | POLYSOMNOGRAPHY W/CPAP | $1,263.07 | $1,185.40 | not payable in ASC | not payable in ASC | ||
| 95811 | TC | POLYSOMNOGRAPHY W/CPAP | $1,058.45 | $987.78 | not payable in ASC | not payable in ASC | |
| 95811 | 26 | POLYSOMNOGRAPHY W/CPAP | $204.62 | $197.62 | not payable in ASC | not payable in ASC | |
| 95812 | EEG, 41-60 MINUTES | $531.27 | $498.47 | not payable in ASC | not payable in ASC | ||
| 95812 | TC | EEG, 41-60 MINUTES | $447.02 | $417.10 | not payable in ASC | not payable in ASC | |
| 95812 | 26 | EEG, 41-60 MINUTES | $84.26 | $81.37 | not payable in ASC | not payable in ASC | |
| 95813 | EEG, OVER 1 HOUR | $594.86 | $559.52 | not payable in ASC | not payable in ASC | ||
| 95813 | TC | EEG, OVER 1 HOUR | $460.35 | $429.56 | not payable in ASC | not payable in ASC | |
| 95813 | 26 | EEG, OVER 1 HOUR | $134.52 | $129.96 | not payable in ASC | not payable in ASC | |
| 95816 | EEG, AWAKE & DROWSY | $378.16 | $355.01 | not payable in ASC | not payable in ASC | ||
| 95816 | TC | EEG, AWAKE & DROWSY | $312.51 | $291.60 | not payable in ASC | not payable in ASC | |
| 95816 | 26 | EEG, AWAKE & DROWSY | $65.65 | $63.41 | not payable in ASC | not payable in ASC | |
| 95819 | EEG, AWAKE & ASLEEP | $549.32 | $515.31 | not payable in ASC | not payable in ASC | ||
| 95819 | TC | EEG, AWAKE & ASLEEP | $464.48 | $433.39 | not payable in ASC | not payable in ASC | |
| 95819 | 26 | EEG, AWAKE & ASLEEP | $84.84 | $81.91 | not payable in ASC | not payable in ASC | |
| 95822 | EEG, COMA OR SLEEP ONLY | $513.22 | $481.63 | not payable in ASC | not payable in ASC | ||
| 95822 | TC | EEG, COMA OR SLEEP ONLY | $428.39 | $399.72 | not payable in ASC | not payable in ASC | |
| 95822 | 26 | EEG, COMA OR SLEEP ONLY | $84.84 | $81.91 | not payable in ASC | not payable in ASC | |
| 95831 | LIMB MUSCLE TESTING, MANUAL | $47.21 | $44.84 | not payable in ASC | not payable in ASC | ||
| 95832 | HAND MUSCLE TESTING, MANUAL | $52.37 | $49.80 | not payable in ASC | not payable in ASC | ||
| 95833 | BODY MUSCLE TESTING, MANUAL | $68.43 | $65.19 | not payable in ASC | not payable in ASC | ||
| 95834 | BODY MUSCLE TESTING, MANUAL | $85.99 | $82.02 | not payable in ASC | not payable in ASC | ||
| 95851 | RANGE MOTION MEASUREMENTS | $43.75 | $41.47 | not payable in ASC | not payable in ASC | ||
| 95852 | RANGE MOTION MEASUREMENTS | $24.16 | $22.84 | not payable in ASC | not payable in ASC | ||
| 95857 | TENSILON TEST | $76.14 | $72.46 | not payable in ASC | not payable in ASC | ||
| 95860 | MUSCLE TEST, ONE LIMB | $226.85 | $215.44 | not payable in ASC | not payable in ASC | ||
| 95860 | TC | MUSCLE TEST, ONE LIMB | $107.41 | $100.24 | not payable in ASC | not payable in ASC | |
| 95860 | 26 | MUSCLE TEST, ONE LIMB | $119.46 | $115.20 | not payable in ASC | not payable in ASC | |
| 95861 | MUSCLE TEST, 2 LIMBS | $327.48 | $311.61 | not payable in ASC | not payable in ASC | ||
| 95861 | TC | MUSCLE TEST, 2 LIMBS | $136.97 | $127.83 | not payable in ASC | not payable in ASC | |
| 95861 | 26 | MUSCLE TEST, 2 LIMBS | $190.51 | $183.78 | not payable in ASC | not payable in ASC | |
| 95863 | MUSCLE TEST, 3 LIMBS | $395.17 | $376.08 | not payable in ASC | not payable in ASC | ||
| 95863 | TC | MUSCLE TEST, 3 LIMBS | $166.53 | $155.40 | not payable in ASC | not payable in ASC | |
| 95863 | 26 | MUSCLE TEST, 3 LIMBS | $228.64 | $220.68 | not payable in ASC | not payable in ASC | |
| 95864 | MUSCLE TEST, 4 LIMBS | $434.98 | $413.69 | not payable in ASC | not payable in ASC | ||
| 95864 | TC | MUSCLE TEST, 4 LIMBS | $190.71 | $177.96 | not payable in ASC | not payable in ASC | |
| 95864 | 26 | MUSCLE TEST, 4 LIMBS | $244.27 | $235.72 | not payable in ASC | not payable in ASC | |
| 95865 | MUSCLE TEST, LARYNX | $296.79 | $283.01 | not payable in ASC | not payable in ASC | ||
| 95865 | TC | MUSCLE TEST, LARYNX | $101.14 | $94.40 | not payable in ASC | not payable in ASC | |
| 95865 | 26 | MUSCLE TEST, LARYNX | $195.65 | $188.61 | not payable in ASC | not payable in ASC | |
| 95867 | MUSCLE TEST CRANIAL NERVE UNILAT | $201.95 | $191.56 | not payable in ASC | not payable in ASC | ||
| 95867 | TC | MUSCLE TEST CRANIAL NERVE UNILAT | $103.83 | $96.90 | not payable in ASC | not payable in ASC | |
| 95867 | 26 | MUSCLE TEST CRANIAL NERVE UNILAT | $98.12 | $94.67 | not payable in ASC | not payable in ASC | |
| 95868 | MUSCLE TEST CRANIAL NERVE BILAT | $272.61 | $258.99 | not payable in ASC | not payable in ASC | ||
| 95868 | TC | MUSCLE TEST CRANIAL NERVE BILAT | $128.01 | $119.46 | not payable in ASC | not payable in ASC | |
| 95868 | 26 | MUSCLE TEST CRANIAL NERVE BILAT | $144.60 | $139.53 | not payable in ASC | not payable in ASC | |
| 95869 | MUSCLE TEST, THOR PARASPINAL | $149.63 | $141.08 | not payable in ASC | not payable in ASC | ||
| 95869 | TC | MUSCLE TEST, THOR PARASPINAL | $103.83 | $96.90 | not payable in ASC | not payable in ASC | |
| 95869 | 26 | MUSCLE TEST, THOR PARASPINAL | $45.80 | $44.18 | not payable in ASC | not payable in ASC | |
| 95870 | MUSCLE TEST, NONPARASPINAL | $146.04 | $137.74 | not payable in ASC | not payable in ASC | ||
| 95870 | TC | MUSCLE TEST, NONPARASPINAL | $101.14 | $94.40 | not payable in ASC | not payable in ASC | |
| 95870 | 26 | MUSCLE TEST, NONPARASPINAL | $44.91 | $43.33 | not payable in ASC | not payable in ASC | |
| 95873 | GUIDE NERVE DESTROY, ELECT STIM | $148.73 | $140.25 | not payable in ASC | not payable in ASC | ||
| 95873 | TC | GUIDE NERVE DESTROY, ELECT STIM | $101.14 | $94.40 | not payable in ASC | not payable in ASC | |
| 95873 | 26 | GUIDE NERVE DESTROY, ELECT STIM | $47.60 | $45.85 | not payable in ASC | not payable in ASC | |
| 95874 | GUIDE NERVE DESTROY, NEEDLE EMG | $141.56 | $133.56 | not payable in ASC | not payable in ASC | ||
| 95874 | TC | GUIDE NERVE DESTROY, NEEDLE EMG | $95.76 | $89.38 | not payable in ASC | not payable in ASC | |
| 95874 | 26 | GUIDE NERVE DESTROY, NEEDLE EMG | $45.80 | $44.18 | not payable in ASC | not payable in ASC | |
| 95900 | MOTOR NERVE CONDUCTION TEST | $153.54 | $144.91 | not payable in ASC | not payable in ASC | ||
| 95900 | TC | MOTOR NERVE CONDUCTION TEST | $102.03 | $95.23 | not payable in ASC | not payable in ASC | |
| 95900 | 26 | MOTOR NERVE CONDUCTION TEST | $51.51 | $49.67 | not payable in ASC | not payable in ASC | |
| 95903 | MOTOR NERVE CONDUCTION TEST | $176.35 | $166.99 | not payable in ASC | not payable in ASC | ||
| 95903 | TC | MOTOR NERVE CONDUCTION TEST | $102.93 | $96.07 | not payable in ASC | not payable in ASC | |
| 95903 | 26 | MOTOR NERVE CONDUCTION TEST | $73.44 | $70.92 | not payable in ASC | not payable in ASC | |
| 95904 | SENSE NERVE CONDUCTION TEST | $135.64 | $127.92 | not payable in ASC | not payable in ASC | ||
| 95904 | TC | SENSE NERVE CONDUCTION TEST | $93.97 | $87.71 | not payable in ASC | not payable in ASC | |
| 95904 | 26 | SENSE NERVE CONDUCTION TEST | $41.67 | $40.21 | not payable in ASC | not payable in ASC | |
| 95920 | INTRAOP NERVE TEST, ADDED | $392.31 | $374.38 | not payable in ASC | not payable in ASC | ||
| 95920 | TC | INTRAOP NERVE TEST, ADDED | $136.07 | $126.98 | not payable in ASC | not payable in ASC | |
| 95920 | 26 | INTRAOP NERVE TEST, ADDED | $256.23 | $247.38 | not payable in ASC | not payable in ASC | |
| 95921 | AUTONOMIC NERVE FUNCTION TEST | $129.86 | $123.48 | not payable in ASC | not payable in ASC | ||
| 95921 | TC | AUTONOMIC NERVE FUNCTION TEST | $60.50 | $56.47 | not payable in ASC | not payable in ASC | |
| 95921 | 26 | AUTONOMIC NERVE FUNCTION TEST | $69.36 | $67.00 | not payable in ASC | not payable in ASC | |
| 95922 | AUTONOMIC NERVE FUNCTION TEST | $161.43 | $153.08 | not payable in ASC | not payable in ASC | ||
| 95922 | TC | AUTONOMIC NERVE FUNCTION TEST | $87.28 | $81.46 | not payable in ASC | not payable in ASC | |
| 95922 | 26 | AUTONOMIC NERVE FUNCTION TEST | $74.15 | $71.62 | not payable in ASC | not payable in ASC | |
| 95923 | AUTONOMIC NERVE FUNCTION TEST | $241.02 | $227.20 | not payable in ASC | not payable in ASC | ||
| 95923 | TC | AUTONOMIC NERVE FUNCTION TEST | $169.96 | $158.59 | not payable in ASC | not payable in ASC | |
| 95923 | 26 | AUTONOMIC NERVE FUNCTION TEST | $71.04 | $68.61 | not payable in ASC | not payable in ASC | |
| 95925 | SOMATOSENSORY TESTING | $640.37 | $600.70 | not payable in ASC | not payable in ASC | ||
| 95925 | TC | SOMATOSENSORY TESTING | $538.82 | $502.74 | not payable in ASC | not payable in ASC | |
| 95925 | 26 | SOMATOSENSORY TESTING | $101.51 | $98.00 | not payable in ASC | not payable in ASC | |
| 95926 | SOMATOSENSORY TESTING | $393.84 | $369.63 | not payable in ASC | not payable in ASC | ||
| 95926 | TC | SOMATOSENSORY TESTING | $327.79 | $305.82 | not payable in ASC | not payable in ASC | |
| 95926 | 26 | SOMATOSENSORY TESTING | $66.05 | $63.82 | not payable in ASC | not payable in ASC | |
| 95927 | SOMATOSENSORY TESTING | $368.96 | $346.31 | not payable in ASC | not payable in ASC | ||
| 95927 | TC | SOMATOSENSORY TESTING | $303.59 | $283.25 | not payable in ASC | not payable in ASC | |
| 95927 | 26 | SOMATOSENSORY TESTING | $65.35 | $63.05 | not payable in ASC | not payable in ASC | |
| 95928 | C MOTOR EVOKED, UPPER LIMBS | $388.77 | $366.67 | not payable in ASC | not payable in ASC | ||
| 95928 | TC | C MOTOR EVOKED, UPPER LIMBS | $270.57 | $252.51 | not payable in ASC | not payable in ASC | |
| 95928 | 26 | C MOTOR EVOKED, UPPER LIMBS | $118.19 | $114.16 | not payable in ASC | not payable in ASC | |
| 95929 | C MOTOR EVOKED, LOWER LIMBS | $412.64 | $388.95 | not payable in ASC | not payable in ASC | ||
| 95929 | TC | C MOTOR EVOKED, LOWER LIMBS | $293.87 | $274.24 | not payable in ASC | not payable in ASC | |
| 95929 | 26 | C MOTOR EVOKED, LOWER LIMBS | $118.77 | $114.71 | not payable in ASC | not payable in ASC | |
| 95930 | VISUAL EVOKED POTENTIAL TEST | $225.51 | $211.30 | not payable in ASC | not payable in ASC | ||
| 95930 | TC | VISUAL EVOKED POTENTIAL TEST | $197.91 | $184.66 | not payable in ASC | not payable in ASC | |
| 95930 | 26 | VISUAL EVOKED POTENTIAL TEST | $27.60 | $26.63 | not payable in ASC | not payable in ASC | |
| 95933 | BLINK REFLEX TEST | $122.27 | $115.65 | not payable in ASC | not payable in ASC | ||
| 95933 | TC | BLINK REFLEX TEST | $75.05 | $70.05 | not payable in ASC | not payable in ASC | |
| 95933 | 26 | BLINK REFLEX TEST | $47.22 | $45.60 | not payable in ASC | not payable in ASC | |
| 95934 | H-REFLEX TEST | $155.93 | $147.69 | not payable in ASC | not payable in ASC | ||
| 95934 | TC | H-REFLEX TEST | $87.59 | $81.77 | not payable in ASC | not payable in ASC | |
| 95934 | 26 | H-REFLEX TEST | $68.32 | $65.89 | not payable in ASC | not payable in ASC | |
| 95936 | H-REFLEX TEST | $126.83 | $120.70 | not payable in ASC | not payable in ASC | ||
| 95936 | TC | H-REFLEX TEST | $54.09 | $50.53 | not payable in ASC | not payable in ASC | |
| 95936 | 26 | H-REFLEX TEST | $72.75 | $70.20 | not payable in ASC | not payable in ASC | |
| 95937 | NEUROMUSCULAR JUNCTION TEST | $105.46 | $100.14 | not payable in ASC | not payable in ASC | ||
| 95937 | TC | NEUROMUSCULAR JUNCTION TEST | $53.50 | $49.95 | not payable in ASC | not payable in ASC | |
| 95937 | 26 | NEUROMUSCULAR JUNCTION TEST | $51.95 | $50.19 | not payable in ASC | not payable in ASC | |
| 95950 | AMBULATORY EEG MONITORING | $451.58 | $425.29 | not payable in ASC | not payable in ASC | ||
| 95950 | TC | AMBULATORY EEG MONITORING | $332.89 | $310.63 | not payable in ASC | not payable in ASC | |
| 95950 | 26 | AMBULATORY EEG MONITORING | $118.70 | $114.65 | not payable in ASC | not payable in ASC | |
| 95951 | EEG MONITORING/VIDEO RECORD | $3,074.98 | $2,967.76 | not payable in ASC | not payable in ASC | ||
| 95951 | TC | EEG MONITORING/VIDEO RECORD | $2,599.66 | $2,508.81 | not payable in ASC | not payable in ASC | |
| 95951 | 26 | EEG MONITORING/VIDEO RECORD | $483.24 | $467.08 | not payable in ASC | not payable in ASC | |
| 95953 | EEG MONITORING/COMPUTER | $683.31 | $645.57 | not payable in ASC | not payable in ASC | ||
| 95953 | TC | EEG MONITORING/COMPUTER | $438.28 | $408.94 | not payable in ASC | not payable in ASC | |
| 95953 | 26 | EEG MONITORING/COMPUTER | $245.04 | $236.62 | not payable in ASC | not payable in ASC | |
| 95955 | EEG DURING SURG | $279.78 | $263.64 | not payable in ASC | not payable in ASC | ||
| 95955 | TC | EEG DURING SURG | $201.41 | $187.92 | not payable in ASC | not payable in ASC | |
| 95955 | 26 | EEG DURING SURG | $78.37 | $75.72 | not payable in ASC | not payable in ASC | |
| 95956 | EEG MONITORING, CABLE/RADIO | $1,700.99 | $1,596.69 | not payable in ASC | not payable in ASC | ||
| 95956 | TC | EEG MONITORING, CABLE/RADIO | $1,425.05 | $1,329.89 | not payable in ASC | not payable in ASC | |
| 95956 | 26 | EEG MONITORING, CABLE/RADIO | $275.95 | $266.79 | not payable in ASC | not payable in ASC | |
| 95957 | EEG DIGITAL ANALYSIS | $565.05 | $532.31 | not payable in ASC | not payable in ASC | ||
| 95957 | TC | EEG DIGITAL ANALYSIS | $408.70 | $381.29 | not payable in ASC | not payable in ASC | |
| 95957 | 26 | EEG DIGITAL ANALYSIS | $156.33 | $151.02 | not payable in ASC | not payable in ASC | |
| 95961 | ELECTRODE STIMULATION, BRAIN | $407.15 | $387.59 | not payable in ASC | not payable in ASC | ||
| 95961 | TC | ELECTRODE STIMULATION, BRAIN | $169.96 | $158.59 | not payable in ASC | not payable in ASC | |
| 95961 | 26 | ELECTRODE STIMULATION, BRAIN | $237.19 | $228.99 | not payable in ASC | not payable in ASC | |
| 95962 | ELECTRODE STIM, BRAIN, ADDED | $362.26 | $346.30 | not payable in ASC | not payable in ASC | ||
| 95962 | TC | ELECTRODE STIM, BRAIN, ADDED | $108.83 | $101.55 | not payable in ASC | not payable in ASC | |
| 95962 | 26 | ELECTRODE STIM, BRAIN, ADDED | $253.44 | $244.75 | not payable in ASC | not payable in ASC | |
| 95970 | ANALYZE NEUROSTIM, NO PROG | $97.12 | $91.83 | not payable in ASC | not payable in ASC | ||
| 95971 | ANALYZE NEUROSTIM, SIMPLE | $92.71 | $88.63 | not payable in ASC | not payable in ASC | ||
| 95972 | ANALYZE NEUROSTIM, COMPLEX | $170.16 | $162.88 | not payable in ASC | not payable in ASC | ||
| 95973 | ANALYZE NEUROSTIM, COMPLEX | $95.10 | $91.23 | not payable in ASC | not payable in ASC | ||
| 95981 | IO ANAL GAST N-STIM SUBSEQ | $49.98 | $47.45 | not payable in ASC | not payable in ASC | ||
| 95991 | SPIN/BRAIN PUMP REFILL & MAIN | $174.44 | $164.77 | not payable in ASC | not payable in ASC | ||
| 95992 | CANALITH REPOSITIONING PROC | $66.86 | $64.38 | not payable in ASC | not payable in ASC | ||
| 96000 | MOTION ANALYSIS, VIDEO/3D | $141.90 | $137.15 | not payable in ASC | not payable in ASC | ||
| 96002 | DYNAMIC SURFACE EMG | $32.84 | $31.75 | not payable in ASC | not payable in ASC | ||
| 96004 | PHYS REVIEW MOTION TESTS | $174.11 | $168.13 | not payable in ASC | not payable in ASC | ||
| 96101 | PSYCHO TESTING BY PSYCH/PHYS | $171.94 | $166.83 | not payable in ASC | not payable in ASC | ||
| 96102 | PSYCHO TESTING BY TECHNICIAN | $110.20 | $104.12 | not payable in ASC | not payable in ASC | ||
| 96103 | PSYCHO TESTING ADMIN BY COMP | $92.07 | $87.24 | not payable in ASC | not payable in ASC | ||
| 96105 | ASSESS APHASIA | $169.49 | $162.53 | not payable in ASC | not payable in ASC | ||
| 96111 | DEVELOPMENTAL TEST, EXTEND | $194.42 | $188.26 | not payable in ASC | not payable in ASC | ||
| 96116 | NEUROBEHAVIORAL STATUS EXAM | $163.28 | $157.97 | not payable in ASC | not payable in ASC | ||
| 96118 | NEUROPSYCH TEST BY PSYCH/PHYS | $175.60 | $169.32 | not payable in ASC | not payable in ASC | ||
| 96119 | NEUROPSYCH TESTING BY TEC | $116.36 | $109.92 | not payable in ASC | not payable in ASC | ||
| 96120 | NEUROPSYCH TEST ADMIN W/COMP | $136.91 | $129.06 | not payable in ASC | not payable in ASC | ||
| 96125 | COGNITIVE TEST BY HC PRO | $147.55 | $142.04 | not payable in ASC | not payable in ASC | ||
| 96150 | ASSESS HEALTH/BEHAVE, INIT | $32.30 | $31.39 | not payable in ASC | not payable in ASC | ||
| 96151 | ASSESS HEALTH/BEHAVE, SUBSEQ | $31.28 | $30.38 | not payable in ASC | not payable in ASC | ||
| 96152 | INTERVENE HEALTH/BEHAVE, INDIV | $29.69 | $28.85 | not payable in ASC | not payable in ASC | ||
| 96153 | INTERVENE HEALTH/BEHAVE, GROUP | $7.35 | $7.13 | not payable in ASC | not payable in ASC | ||
| 96154 | INTERVENE HEALTH/BEHAVE, FAM W/PT | $29.17 | $28.35 | not payable in ASC | not payable in ASC | ||
| 96360 | HYDRATION IV INFUSION, INIT | $96.36 | $90.41 | not payable in ASC | not payable in ASC | ||
| 96361 | HYDRATE IV INFUSION, ADDED | $25.47 | $24.02 | not payable in ASC | not payable in ASC | ||
| 96365 | THER/PROPHY/DIAG IV INF, INIT | $119.94 | $112.51 | not payable in ASC | not payable in ASC | ||
| 96366 | THER/PROPHY/DIAG IV INF ADDED | $35.85 | $33.92 | not payable in ASC | not payable in ASC | ||
| 96367 | THER/PROPHY/DIAG ADDED SEQ IV INF | $55.00 | $51.80 | not payable in ASC | not payable in ASC | ||
| 96368 | THER/DIAG CONCURRENT INF | $31.86 | $30.17 | not payable in ASC | not payable in ASC | ||
| 96370 | SC THER INFUSION, ADDED HR | $24.80 | $23.60 | not payable in ASC | not payable in ASC | ||
| 96372 | THER/PROPHY/DIAG INJ, SC/IM | $38.26 | $36.14 | not payable in ASC | not payable in ASC | ||
| 96373 | THER/PROPHY/DIAG INJ, IA | $31.28 | $29.63 | not payable in ASC | not payable in ASC | ||
| 96374 | THER/PROPHY/DIAG INJ, IV PUSH | $93.96 | $88.19 | not payable in ASC | not payable in ASC | ||
| 96375 | TX/PRO/DIAG INJECT NEW DRUG ADDED | $38.20 | $35.91 | not payable in ASC | not payable in ASC | ||
| 96409 | CHEMO IV PUSH, SINGLE DRUG | $191.22 | $179.13 | not payable in ASC | not payable in ASC | ||
| 96446 | CHEMOTHERAPY ADM PERITONEAL CAV | $300.18 | $281.16 | not payable in ASC | not payable in ASC | ||
| 96523 | IRRIG DRUG DELIVERY DEVICE | $43.31 | $40.53 | not payable in ASC | not payable in ASC | ||
| 96900 | ULTRAVIOLET LIGHT THERAPY | $35.46 | $33.11 | not payable in ASC | not payable in ASC | ||
| 96912 | PHOTOCHEMOTHERAPY W/UV-A | $152.50 | $142.29 | not payable in ASC | not payable in ASC | ||
| 97001 | PHYSICAL THERAPY EVAL | $114.74 | $110.13 | not payable in ASC | not payable in ASC | ||
| 97002 | PHYSICAL THERAPY RE-EVAL | $64.03 | $61.31 | not payable in ASC | not payable in ASC | ||
| 97003 | OT EVAL | $127.54 | $122.09 | not payable in ASC | not payable in ASC | ||
| 97004 | OT RE-EVAL | $78.59 | $74.88 | not payable in ASC | not payable in ASC | ||
| 97010 | APPLIC MODAL 1/> AREAS; HOT/COLD PACKS | $0.00 | $0.00 | not payable in ASC | not payable in ASC | ||
| 97012 | MECHANICAL TRACTION THERAPY | $28.01 | $26.87 | not payable in ASC | not payable in ASC | ||
| 97016 | VASOPNEUMATIC DEVICE THERAPY | $28.29 | $26.86 | not payable in ASC | not payable in ASC | ||
| 97014 | APPLICATION MODALITY TO 1 OR MORE AREAS; E-STIM | $0.00 | $0.00 | not payable in ASC | not payable in ASC | ||
| 97018 | PARAFFIN BATH THERAPY | $15.79 | $14.91 | not payable in ASC | not payable in ASC | ||
| 97022 | WHIRLPOOL THERAPY | $33.61 | $31.79 | not payable in ASC | not payable in ASC | ||
| 97024 | DIATHERMY EG, MICROWAVE | $9.98 | $9.48 | not payable in ASC | not payable in ASC | ||
| 97026 | INFRARED THERAPY | $8.81 | $8.40 | not payable in ASC | not payable in ASC | ||
| 97028 | ULTRAVIOLET THERAPY | $10.98 | $10.47 | not payable in ASC | not payable in ASC | ||
| 97032 | ELECTRICAL STIMULATION | $28.35 | $27.09 | not payable in ASC | not payable in ASC | ||
| 97033 | ELECTRIC CURRENT THERAPY | $46.33 | $43.88 | not payable in ASC | not payable in ASC | ||
| 97034 | CONTRAST BATH THERAPY | $26.32 | $25.10 | not payable in ASC | not payable in ASC | ||
| 97035 | ULTRASOUND THERAPY | $27.40 | $26.36 | not payable in ASC | not payable in ASC | ||
| 97036 | HYDROTHERAPY | $47.92 | $45.42 | not payable in ASC | not payable in ASC | ||
| 97039 | PHYSICAL THERAPY TREAT | $20.42 | $19.71 | not payable in ASC | not payable in ASC | ||
| 97110 | THERAPEUTIC EXERCISES | $50.87 | $48.67 | not payable in ASC | not payable in ASC | ||
| 97112 | NEUROMUSCULAR REEDUCATION | $53.36 | $51.01 | not payable in ASC | not payable in ASC | ||
| 97113 | AQUATIC THERAPY/EXERCISES | $67.87 | $64.51 | not payable in ASC | not payable in ASC | ||
| 97116 | GAIT TRAINING THERAPY | $48.21 | $46.14 | not payable in ASC | not payable in ASC | ||
| 97124 | MASSAGE THERAPY | $38.67 | $36.95 | not payable in ASC | not payable in ASC | ||
| 97139 | PHYSICAL MEDICINE PROCEDURE | $27.64 | $26.67 | not payable in ASC | not payable in ASC | ||
| 97140 | MANUAL THERAPY | $44.47 | $42.56 | not payable in ASC | not payable in ASC | ||
| 97150 | GROUP THERAPEUTIC PROCEDURES | $30.52 | $29.17 | not payable in ASC | not payable in ASC | ||
| 97530 | THERAPEUTIC ACTIVITIES | $59.96 | $57.21 | not payable in ASC | not payable in ASC | ||
| 97532 | COGNITIVE SKILLS DEVELOPMENT | $61.13 | $58.72 | not payable in ASC | not payable in ASC | ||
| 97533 | SENSORY INTEGRATION | $43.81 | $41.98 | not payable in ASC | not payable in ASC | ||
| 97535 | SELF CARE MANAGEMENT TRAINING | $51.88 | $49.54 | not payable in ASC | not payable in ASC | ||
| 97537 | COMMUNITY/WORK REINTEGRATION | $44.91 | $43.02 | not payable in ASC | not payable in ASC | ||
| 97542 | WHEELCHAIR MANAGEMENT TRAINING | $45.49 | $43.56 | not payable in ASC | not payable in ASC | ||
| 97597 | ACTIVE WOUND CARE/20 CM OR < | $119.31 | $112.72 | not payable in ASC | not payable in ASC | ||
| 97598 | ACTIVE WOUND CARE > 20 CM | $39.36 | $37.40 | not payable in ASC | not payable in ASC | ||
| 97605 | NEG PRESS WOUND TX, < 50 CM | $62.93 | $60.32 | not payable in ASC | not payable in ASC | ||
| 97606 | NEG PRESS WOUND TX, > 50 CM | $67.09 | $64.40 | not payable in ASC | not payable in ASC | ||
| 97750 | PHYSICAL PERFORMANCE TEST | $55.79 | $53.38 | not payable in ASC | not payable in ASC | ||
| 97755 | ASSISTIVE TECHNOLOGY ASSESS | $53.99 | $51.98 | not payable in ASC | not payable in ASC | ||
| 97760 | ORTHOTIC MGMT & TRAINING | $56.42 | $53.83 | not payable in ASC | not payable in ASC | ||
| 97761 | PROSTHETIC TRAINING | $49.44 | $47.32 | not payable in ASC | not payable in ASC | ||
| 97762 | C/O FOR ORTHOTIC/PROSTH USE | $67.36 | $63.48 | not payable in ASC | not payable in ASC | ||
| 97802 | MEDICAL NUTRITION, INDIV, IN | $50.58 | $48.59 | not payable in ASC | not payable in ASC | ||
| 97810 | ACUPUNCT 1/> NDLES W/O E-STIM; INIT 15 MIN 1-1 | $43.74 | $32.07 | not payable in ASC | not payable in ASC | ||
| 97811 | ACUPUNCT 1/> NDLES W/O E-STIM; EA ADD 15 MIN 1-1 | $37.49 | $27.49 | not payable in ASC | not payable in ASC | ||
| 97813 | ACUPUNCT 1/> NDLES WITH E-STIM; INIT 15 MIN 1-1 | $47.91 | $35.12 | not payable in ASC | not payable in ASC | ||
| 97814 | ACUPUNCT 1/> NDLES WITH E-STIM;EA ADD 15 MIN 1-1 | $41.66 | $30.54 | not payable in ASC | not payable in ASC | ||
| 98925 | OSTEOPATHIC MANIPULATION 1-2 REGIONS | $55.70 | $53.34 | not payable in ASC | not payable in ASC | ||
| 98926 | OSTEOPATHIC MANIPULATION 3-4 REGIONS | $74.13 | $71.10 | not payable in ASC | not payable in ASC | ||
| 98927 | OSTEOPATHIC MANIPULATION 5-6 REGIONS | $96.35 | $92.48 | not payable in ASC | not payable in ASC | ||
| 98928 | OSTEOPATHIC MANIPULATION 7-8 REGIONS | $97.37 | $93.52 | not payable in ASC | not payable in ASC | ||
| 98940 | CHIROPRACTIC MANIPULATION 1-2 REGIONS | $39.44 | $37.90 | not payable in ASC | not payable in ASC | ||
| 98941 | CHIROPRACTIC MANIPULATION 3-4 REGIONS | $54.40 | $52.41 | not payable in ASC | not payable in ASC | ||
| 98942 | CHIROPRACTIC MANIPULATION 5 REGIONS | $69.90 | $67.39 | not payable in ASC | not payable in ASC | ||
| 98943 | CHIROPRACTIC MANIP TX; XTRASPINAL 1/MORE REGIONS | $37.14 | $36.01 | not payable in ASC | not payable in ASC | ||
| 99070 | SUPPLIES & MATERIALS: ADDL TO USUAL FOR OFFICE VISIT | $0.00 | $0.00 | not payable in ASC | not payable in ASC | ||
| 99071 | EDUCATION SUPPLIES; S/A BOOKS, TAPES & PAMPHLETS FOR PATIENT EDUCATION | $0.00 | $0.00 | not payable in ASC | not payable in ASC | ||
| 99080 | SPECIAL REPORTS | $0.00 | $0.00 | not payable in ASC | not payable in ASC | ||
| 99082 | UNUSUAL PHYSICIAN TRAVEL | $0.00 | $0.00 | not payable in ASC | not payable in ASC | ||
| 99143 | MOD SEDATION SAME PHYS, < 5 YRS | $44.74 | $43.70 | not payable in ASC | not payable in ASC | ||
| 99144 | MOD SEDATION BY SAME PHYS, 5 YRS + | $64.49 | $62.24 | not payable in ASC | not payable in ASC | ||
| 99145 | MOD SEDATION BY SAME PHYS, ADDED | $22.24 | $21.44 | not payable in ASC | not payable in ASC | ||
| 99148 | MOD SEDATION DIFF PHYS < 5 YRS | $125.97 | $121.58 | not payable in ASC | not payable in ASC | ||
| 99149 | MOD SEDATION DIFF PHYS 5 YRS + | $125.97 | $121.58 | not payable in ASC | not payable in ASC | ||
| 99150 | MOD SEDATION DIFF PHYS, ADDED | $47.38 | $45.69 | not payable in ASC | not payable in ASC | ||
| 99175 | INDUCTION VOMITING | $41.87 | $39.08 | not payable in ASC | not payable in ASC | ||
| 99183 | HYPERBARIC OXYGEN THERAPY | $518.83 | $494.16 | not payable in ASC | not payable in ASC | ||
| 99195 | PHLEBOTOMY | $227.07 | $212.09 | not payable in ASC | not payable in ASC | ||
| 99201 | OFFICE/OUTPAT VISIT, NEW PAT 10 MINS | $51.25 | $48.81 | not payable in ASC | not payable in ASC | ||
| 99202 | OFFICE/OUTPAT VISIT, NEW PAT 20 MINS | $87.92 | $83.95 | not payable in ASC | not payable in ASC | ||
| 99203 | OFFICE/OUTPAT VISIT, NEW PAT 30 MINS | $126.87 | $121.39 | not payable in ASC | not payable in ASC | ||
| 99204 | OFFICE/OUTPAT VISIT, NEW PAT 45 MINS | $193.64 | $185.82 | not payable in ASC | not payable in ASC | ||
| 99205 | OFFICE/OUTPAT VISIT, NEW PAT 60 MINS | $240.25 | $230.79 | not payable in ASC | not payable in ASC | ||
| 99211 | OFFICE/OUTPAT VISIT, EST PAT 5 MINS | $32.36 | $30.67 | not payable in ASC | not payable in ASC | ||
| 99212 | OFFICE/OUTPAT VISIT, EST PAT 10 MINS | $51.69 | $49.22 | not payable in ASC | not payable in ASC | ||
| 99213 | OFFICE/OUTPAT VISIT, EST PAT 15 MINS | $85.01 | $81.31 | not payable in ASC | not payable in ASC | ||
| 99214 | OFFICE/OUTPAT VISIT, EST PAT 25 MINS | $125.71 | $120.35 | not payable in ASC | not payable in ASC | ||
| 99215 | OFFICE/OUTPAT VISIT, EST PAT 40 MINS | $168.59 | $161.61 | not payable in ASC | not payable in ASC | ||
| 99217 | OBSERVATION CARE DISCHARGE | $108.71 | $104.82 | not payable in ASC | not payable in ASC | ||
| 99218 | OBSERVATION CARE LOW SEVERITY | $99.97 | $96.66 | not payable in ASC | not payable in ASC | ||
| 99219 | OBSERVATION CARE MODERATE SEVERITY | $167.12 | $161.61 | not payable in ASC | not payable in ASC | ||
| 99220 | OBSERVATION CARE HIGH SEVERITY | $233.75 | $226.05 | not payable in ASC | not payable in ASC | ||
| 99221 | INITIAL HOSPITAL CARE 30 MINS | $151.05 | $146.22 | not payable in ASC | not payable in ASC | ||
| 99222 | INITIAL HOSPITAL CARE 50 MINS | $205.62 | $198.94 | not payable in ASC | not payable in ASC | ||
| 99223 | INITIAL HOSPITAL CARE 70 MINS | $301.80 | $291.96 | not payable in ASC | not payable in ASC | ||
| 99224 | SUBSEQ OBSERVATION CARE 15 MINS | $43.46 | $41.99 | not payable in ASC | not payable in ASC | ||
| 99225 | SUBSEQ OBSERVATION CARE 25 MINS | $76.94 | $74.29 | not payable in ASC | not payable in ASC | ||
| 99226 | SUBSEQ OBSERVATION CARE 35 MINS | $115.08 | $111.16 | not payable in ASC | not payable in ASC | ||
| 99231 | SUBSEQUENT HOSPITAL CARE 15 MINS | $69.00 | $66.70 | not payable in ASC | not payable in ASC | ||
| 99232 | SUBSEQUENT HOSPITAL CARE 25 MINS | $107.89 | $104.32 | not payable in ASC | not payable in ASC | ||
| 99233 | SUBSEQUENT HOSPITAL CARE 35 MINS | $154.90 | $149.80 | not payable in ASC | not payable in ASC | ||
| 99234 | OBSERVE/HOSP SAME DATE LOW SEVERITY | $204.82 | $198.08 | not payable in ASC | not payable in ASC | ||
| 99235 | OBSERVE/HOSP SAME DATE MOD SEVERITY | $268.27 | $259.39 | not payable in ASC | not payable in ASC | ||
| 99236 | OBSERVE/HOSP SAME DATE HIGH SEVERITY | $333.16 | $322.20 | not payable in ASC | not payable in ASC | ||
| 99238 | HOSPITAL DISCHARGE DAY 30 MINS/LESS | $108.19 | $104.29 | not payable in ASC | not payable in ASC | ||
| 99239 | HOSPITAL DISCHARGE DAY > 30 MINS | $158.62 | $152.99 | not payable in ASC | not payable in ASC | ||
| 99241 | OFFICE CONSULTATION 15 MINS | $94.26 | $81.72 | not payable in ASC | not payable in ASC | ||
| 99242 | OFFICE CONSULTATION 30 MINS | $120.18 | $104.19 | not payable in ASC | not payable in ASC | ||
| 99243 | OFFICE CONSULTATION 40 MINS | $153.17 | $132.79 | not payable in ASC | not payable in ASC | ||
| 99244 | OFFICE CONSULTATION 60 MINS | $200.30 | $173.66 | not payable in ASC | not payable in ASC | ||
| 99245 | OFFICE CONSULTATION 80 MINS | $252.93 | $219.28 | not payable in ASC | not payable in ASC | ||
| 99251 | INPATIENT CONSULTATION 20 MINS | $94.26 | $81.72 | not payable in ASC | not payable in ASC | ||
| 99252 | INPATIENT CONSULTATION 40 MINS | $142.96 | $123.94 | not payable in ASC | not payable in ASC | ||
| 99253 | INPATIENT CONSULTATION 55 MINS | $175.95 | $152.54 | not payable in ASC | not payable in ASC | ||
| 99254 | INPATIENT CONSULTATION 80 MINS | $219.94 | $190.88 | not payable in ASC | not payable in ASC | ||
| 99255 | INPATIENT CONSULTATION 110 MINS | $276.50 | $239.71 | not payable in ASC | not payable in ASC | ||
| 99281 | EMERGENCY DEPT VISIT SELF LIMIT/MINOR | $122.92 | $119.32 | not payable in ASC | not payable in ASC | ||
| 99282 | EMERGENCY DEPT VISIT LOW/MODERATE | $203.58 | $197.73 | not payable in ASC | not payable in ASC | ||
| 99283 | EMERGENCY DEPT VISIT MODERATE | $206.43 | $200.51 | not payable in ASC | not payable in ASC | ||
| 99284 | EMERGENCY DEPT VISIT HIGH SEVERITY | $375.38 | $365.00 | not payable in ASC | not payable in ASC | ||
| 99285 | EMERGENCY DEPT VISIT HIGH SEVERITY | $519.35 | $505.14 | not payable in ASC | not payable in ASC | ||
| 99291 | CRITICAL CARE, FIRST HOUR | $417.23 | $401.38 | not payable in ASC | not payable in ASC | ||
| 99292 | CRITICAL CARE, ADDED 30 MIN | $185.85 | $179.48 | not payable in ASC | not payable in ASC | ||
| 99304 | NURSING FACILITY CARE, INIT | $137.67 | $132.91 | not payable in ASC | not payable in ASC | ||
| 99305 | NURSING FACILITY CARE, INIT | $193.13 | $186.59 | not payable in ASC | not payable in ASC | ||
| 99306 | NURSING FACILITY CARE, INIT | $245.26 | $237.08 | not payable in ASC | not payable in ASC | ||
| 99307 | NURSING FACILITY CARE, SUBSEQ | $66.27 | $63.81 | not payable in ASC | not payable in ASC | ||
| 99308 | NURSING FACILITY CARE, SUBSEQ | $102.10 | $98.32 | not payable in ASC | not payable in ASC | ||
| 99309 | NURSING FACILITY CARE, SUBSEQ | $134.06 | $129.12 | not payable in ASC | not payable in ASC | ||
| 99310 | NURSING FACILITY CARE, SUBSEQ | $198.16 | $191.08 | not payable in ASC | not payable in ASC | ||
| 99315 | NURSING FACILITY DISCHARGE DAY | $96.51 | $93.02 | not payable in ASC | not payable in ASC | ||
| 99316 | NURSING FACILITY DISCHARGE DAY | $125.11 | $120.65 | not payable in ASC | not payable in ASC | ||
| 99334 | DOMICILE/REST HOME VISIT EST PAT | $91.72 | $88.41 | not payable in ASC | not payable in ASC | ||
| 99341 | HOME VISIT, NEW PATIENT 20 MINS | $85.75 | $82.71 | not payable in ASC | not payable in ASC | ||
| 99342 | HOME VISIT, NEW PATIENT 30 MINS | $124.20 | $119.95 | not payable in ASC | not payable in ASC | ||
| 99343 | HOME VISIT, NEW PATIENT 45 MINS | $202.38 | $195.60 | not payable in ASC | not payable in ASC | ||
| 99344 | HOME VISIT, NEW PATIENT 60 MINS | $272.05 | $262.80 | not payable in ASC | not payable in ASC | ||
| 99345 | HOME VISIT, NEW PATIENT 75 MINS | $326.47 | $315.44 | not payable in ASC | not payable in ASC | ||
| 99347 | HOME VISIT, EST PATIENT 15 MINS | $85.25 | $82.21 | not payable in ASC | not payable in ASC | ||
| 99348 | HOME VISIT, EST PATIENT 25 MINS | $128.62 | $124.15 | not payable in ASC | not payable in ASC | ||
| 99349 | HOME VISIT, EST PATIENT 40 MINS | $190.15 | $183.56 | not payable in ASC | not payable in ASC | ||
| 99350 | HOME VISIT, EST PATIENT 60 MINS | $264.65 | $255.65 | not payable in ASC | not payable in ASC | ||
| 99354 | PROLONGED SERVICE, OFFICE | $149.70 | $144.35 | not payable in ASC | not payable in ASC | ||
| 99355 | PROLONGED SERVICE, OFFICE | $147.95 | $142.72 | not payable in ASC | not payable in ASC | ||
| 99356 | PROLONGED SERVICE, INPATIENT | $136.17 | $131.58 | not payable in ASC | not payable in ASC | ||
| 99357 | PROLONGED SERVICE, INPATIENT | $136.75 | $132.13 | not payable in ASC | not payable in ASC | ||
| 99406 | BEHAVIOR CHANGE SMOKING 3-10 MIN | $21.43 | $20.62 | not payable in ASC | not payable in ASC | ||
| 99407 | BEHAVIOR CHANGE SMOKING > 10 MIN | $41.50 | $40.03 | not payable in ASC | not payable in ASC | ||
| 99471 | PEDIATRIC CRITICAL CARE, INITIAL | $1,202.04 | $1,163.38 | not payable in ASC | not payable in ASC | ||
| 99472 | PEDIATRIC CRITICAL CARE, SUBSEQ | $605.11 | $585.66 | not payable in ASC | not payable in ASC | ||
| 99475 | PEDIATRIC CRIT CARE AGE 2-5, INIT | $848.53 | $822.02 | not payable in ASC | not payable in ASC | ||
| 99476 | PEDIATRIC CRIT CARE AGE 2-5, SUBSEQ | $514.56 | $498.30 | not payable in ASC | not payable in ASC | ||
| 99478 | IC, LBW INF < 1500 GM SUBSEQ | $213.55 | $206.55 | not payable in ASC | not payable in ASC |
Source
- The schedule: N.J.A.C. 11:3-29 Appendix, Exhibit 1, published by the New Jersey Department of Banking and Insurance and effective for treatment rendered on or after January 4, 2013. It has not been amended since.
- Official files: the Department’s auto medical fee schedule page, the rule text and the Department’s own FAQ.
- This page: parsed from the Department’s Excel file, with every row count and every figure cross-checked against the Department’s PDF of the same exhibit. Free to download as one CSV of all seven exhibits, 7,553 rows, no sign-up.
Amounts are the maximum reimbursable under the New Jersey PIP fee schedule, not what a provider billed and not what an insurer paid. N.J.A.C. 11:3-29caps reimbursement at the lesser of the provider’s charge or the scheduled amount, and 11:3-29.6 bars a provider from billing a patient the difference. This page reproduces the schedule; it does not decide whether a service was medically necessary, correctly coded, or covered. Verify any figure against the Department’s own file before relying on it. Current Procedural Terminology (CPT) is copyright 2010 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.
Reading exhibit 1002
What the rule says about this schedule
Why does the same code appear three times?
Because the schedule prices a whole service and each of its two halves. 554 codes in Exhibit 1 appear three times: a global fee with no modifier, a technical component marked TC, and a professional component marked 26. A provider bills the global fee or one component, never the global fee and a component (11:3-29.4(l)).
The technical component covers the equipment, the room and the staff. The professional component covers the physician's reading and report. Where the professional amount is zero, the rule treats the service as 100 percent technical. Twenty codes run the other way and carry a 26 row with no global row at all, eleven of them pathology and laboratory codes. Nothing can be derived for their technical half, because there is no global amount to subtract the professional half from, and nothing is shown here that the State did not print.
One assumption a reviewer should not make: the global fee is not always exactly the sum of the two components. The Department rounded each component on its own. Across the 1,108 region cells belonging to those 554 codes, 38 differ from the sum of their parts by more than two cents, the largest by $38.04. MRI brain without contrast, CPT 70551, happens to reconcile exactly in the North: $763.33 technical plus $114.78 professional is the $878.11 global. Many do not.
What does an empty cell mean on Exhibit 1?
It depends entirely on which column is empty, and the two meanings are opposite. An empty ASC facility fee means that fee is not reimbursable in an ambulatory surgery center. An empty physicians' fee means the service is still reimbursable; 11:3-29.4(e) says how to price it. Reading one rule into the other column is the single most expensive mistake this exhibit invites.
36 rows carry an ASC facility fee and no physicians' fee. 1,828 carry a physicians' fee and no ASC facility fee. FAQ Answer 6 closes by saying that 11:3-29.5(a) and 29.4(e)3 apply only to facility fees and do not apply to physician services, which is the Department stating the asymmetry in its own words. A third case exists: the payment indicator N1 marks a service that may be performed in an ASC but whose facility fee is packaged into another procedure.
Why do third-party copies of Exhibit 1 disagree with this one?
Because the Department replaced Exhibit 1 on February 20, 2019. Its posted Excel and PDF files had omitted the X, N1 payment indicators for 17 CPT codes. The file this page is built from is the corrected one. The notice is worth reading before relying on a copy from anywhere else.
The Department went further in that notice than most corrections do. It said that official hardcopy publications of the New Jersey Administrative Code never carried the omission, but that certain online third-party legal research tools do, and should not be relied upon for the payment indicator column. If a carrier or an opposing expert is working from a version that disagrees with this one on X or N1, the 2019 notice is the document that settles it.
Does the multiple procedure reduction apply to these fees?
Only to the physicians' column, and only to CPT 10000 through 69999. FAQ Answer 12 states that the reduction formula in 11:3-29.4(f) reaches multiple and bilateral surgeries in the physicians' fee column and nothing else, so it does not touch diagnostic testing such as MRI or X-ray.
ASC facility fees have their own reduction, at 11:3-29.5(d): the highest paying procedure in a session at 100 percent and every additional one at 50 percent. FAQ Answer 16 says the provisions in 29.4(f) were intended for the physicians' column alone and do not apply to facility fees. Codes marked X in the payment indicator column are exempt from the facility reduction. Codes on Exhibit 6, the daily maximum list, are outside the reduction entirely under FAQ Answer 11.
What is the ANES row at the top of the schedule?
ANES is not a procedure code. It is the conversion factor for anesthesia units: $86.47 in the North region and $84.36 in the South. Multiplying it by the number of units gives the anesthesia allowance, so it prices no service on its own.
11:3-29.4(p) sends payors to the Medicare Claims Processing Manual and the related CMS guidance to count those units, including the cases where a physician directs or supervises a certified registered nurse anesthetist. FAQ Answer 15 says the same thing and adds nothing to it.
The other exhibits003
The rest of the New Jersey PIP fee schedule
Exhibit 7