Note: Services Highlights in Yellow represent the 70 specified services by CMS.  Shoppable Service  Service Description CPT/ HCPCS Code  Revenue vode  Gross Charge  Discouonted Cash Price De-identified Minimum negotaited Charge De-identified Maximum negotiated charge  Aetna   BCBS TX Trad   BCBS TX PPO   BCBS TX HMO   Cigna   Humana   United (Outpatient Services)   Medicaid and Medicaid Advantage Plans (STAR, STAR + PLUS, STAR Kids, First Care and Superior Medicaid)   Medicare and Medicare Advanatge Plans (Humana Medicare, Aetna Medicare, United Healthcare Medicare Solutions, BCBS Medicare, Superior Medicare)   Worker's Compensation Plans 
Evaluation and  Management   Psychiatric diagnostic evaluation 90791 961  $                             358.05  $                      250.64  $                               139.64  $                               286.44  $           257.80  $             -    $              -    $                -    $           275.70  $             286.44  $                    250.64  $       139.64  $         239.89  $           239.89
  Psychotherapy, 30 min  90832 914  $                             193.20  $                      135.24  $                                 75.35  $                               154.56  $           139.10  $             -    $              -    $                -    $           148.76  $             154.56  $                    135.24  $         75.35  $         129.44  $           129.44
  Psychotherapy, 45 min  90834 914  $                             347.55  $                      243.29  $                               135.54  $                               278.04  $           250.24  $             -    $              -    $                -    $           267.61  $             278.04  $                    243.29  $       135.54  $         232.86  $           232.86
  Psychotherapy, 60 min  90837  NA   NA   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Family psychotherapy, not including patient, 50 min  90846  NA   NA   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Family psychotherapy, including patient, 50 min  90847  NA   NA   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Group psychotherapy  90853 915  $                             193.20  $                      135.24  $                                 75.35  $                               154.56  $           139.10  $             -    $              -    $                -    $           148.76  $             154.56  $                    135.24  $         75.35  $         129.44  $           129.44
  Hydration infusion into a vein 31 minutes to 1 hour 96360 260  $                             491.34  $                      343.94  $                               109.42  $                               393.07  $           353.76  $     109.42  $      109.42  $         109.42  $           378.33  $             393.07  $                    343.94  $       191.62  $         329.20  $           329.20
  Hydration infusion into a vein 96361 260  $                               99.45  $                        69.61  $                                 32.34  $                                 79.56  $             71.60  $       32.34  $        32.34  $           32.34  $             76.57  $               79.56  $                      69.61  $         38.78  $           66.63  $             66.63
  Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour 96365 260  $                             491.34  $                      343.94  $                               170.78  $                               393.07  $           353.76  $     170.78  $      170.78  $         170.78  $           378.33  $             393.07  $                    343.94  $       191.62  $         329.20  $           329.20
  Infusion into a vein for therapy, prevention, or diagnosis 96366 260  $                             119.18  $                        83.42  $                                 46.48  $                                 95.34  $             85.81  $       51.40  $        51.40  $           51.40  $             91.76  $               95.34  $                      83.42  $         46.48  $           79.85  $             79.85
  Injection beneath the skin or into muscle for therapy, diagnosis, or prevention 96372 521  $                             156.85  $                      109.79  $                                 61.17  $                               134.44  $           112.93  $     134.44  $      134.44  $         134.44  $           120.77  $             125.48  $                    109.79  $         61.17  $         105.09  $           105.09
  Injection of drug or substance into a vein for therapy, diagnosis, or prevention 96374 940  $                             491.34  $                      343.94  $                               108.59  $                               393.07  $           353.76  $     108.59  $      108.59  $         108.59  $           378.33  $             393.07  $                    343.94  $       191.62  $         329.20  $           329.20
  Injection of different drug or substance into a vein for therapy, diagnosis, or prevention 96375 940  $                               99.45  $                        69.61  $                                 38.78  $                                 79.56  $             71.60  $       42.27  $        42.27  $           42.27  $             76.57  $               79.56  $                      69.61  $         38.78  $           66.63  $             66.63
  Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility 96376 940  $                               54.60  $                        38.22  $                                 21.29  $                                 53.06  $             39.31  $       53.06  $        53.06  $           53.06  $             42.04  $               43.68  $                      38.22  $         21.29  $           36.58  $             36.58
  New patient office or other outpatient visit, typically 10 minutes 99201 761  $                               68.25  $                        47.78  $                                 26.62  $                                 63.02  $             49.14  $       63.02  $        63.02  $           63.02  $             52.55  $               54.60  $                      47.78  $         26.62  $           45.73  $             45.73
  New patient office or other outpatient visit, typically 30 minutes 99203 521  $                             162.75  $                      113.93  $                                 63.47  $                               179.90  $           117.18  $     179.90  $      179.90  $         179.90  $           125.32  $             130.20  $                    113.93  $         63.47  $         109.04  $           109.04
  New patient office or other outpatient visit, typically 45 minutes 99204 521  $                             220.50  $                      154.35  $                                 86.00  $                               303.42  $           158.76  $     303.42  $      303.42  $         303.42  $           169.79  $             176.40  $                    154.35  $         86.00  $         147.74  $           147.74
  New patient office or other outpatient visit, typically 60 minutes 99205 521  $                             556.50  $                      389.55  $                               217.04  $                               445.20  $           400.68  $     396.28  $      396.28  $         396.28  $           428.51  $             445.20  $                    389.55  $       217.04  $         372.86  $           372.86
  Established patient office or other outpatient visit, typically 5 minutes 99211 521  $                             432.71  $                      302.89  $                                 21.55  $                               346.16  $           311.55  $       21.55  $        21.55  $           21.55  $           333.18  $             346.16  $                    302.89  $       168.75  $         289.91  $           289.91
  Established patient office or other outpatient visit, typically 10 minutes 99212 521  $                             432.71  $                      302.89  $                                 59.69  $                               346.16  $           311.55  $       59.69  $        59.69  $           59.69  $           333.18  $             346.16  $                    302.89  $       168.75  $         289.91  $           289.91
  Established patient office or other outpatient visit, typically 15 minutes 99213 521  $                             498.23  $                      348.76  $                               120.21  $                               398.58  $           358.72  $     120.21  $      120.21  $         120.21  $           383.63  $             398.58  $                    348.76  $       194.31  $         333.81  $           333.81
  Established patient office or other outpatient visit, typically 15 minutes 99213 521  $                             498.23  $                      348.76  $                               120.21  $                               398.58  $           358.72  $     120.21  $      120.21  $         120.21  $           383.63  $             398.58  $                    348.76  $       194.31  $         333.81  $           333.81
  Established patient office or other outpatient, visit typically 25 minutes 99214 521  $                             556.50  $                      389.55  $                               184.04  $                               445.20  $           400.68  $     184.04  $      184.04  $         184.04  $           428.51  $             445.20  $                    389.55  $       217.04  $         372.86  $           372.86
  Established patient office or other outpatient, visit typically 40 minutes 99215 521  $                             556.50  $                      389.55  $                               217.04  $                               445.20  $           400.68  $     260.31  $      260.31  $         260.31  $           428.51  $             445.20  $                    389.55  $       217.04  $         372.86  $           372.86
  Patient office consultation, typically 40 minutes 99243  NA   NA   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Patient office consultation, typically 60 minutes 99244  NA   NA   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Initial new patient preventive medicine evaluation age 18-39 years 99385 521  $                             148.05  $                      103.64  $                                 57.74  $                               229.64  $           106.60  $     229.64  $      229.64  $         229.64  $           114.00  $             118.44  $                    103.64  $         57.74  $           99.19  $             99.19
  Initial new patient preventive medicine evaluation age 40-64 years 99386 521  $                             159.60  $                      111.72  $                                 62.24  $                               279.37  $           114.91  $     279.37  $      279.37  $         279.37  $           122.89  $             127.68  $                    111.72  $         62.24  $         106.93  $           106.93
  Observation per Hour  G0378 762  $                               39.59  $                        27.71  $                                 15.44  $                               292.65  $             28.50  $     292.65  $      292.65  $         292.65  $             30.48  $               31.67  $                      27.71  $         15.44  $           26.52  $             26.52
Laboratory & Pathology Services   Insertion of needle into vein for collection of blood sample 36415 300  $                               25.94  $                        18.15  $                                 10.11  $                                 20.75  $             18.67  $             -    $              -    $                -    $             19.97  $               20.75  $                      18.15  $         10.11  $           17.38  $             17.38
  Blood test, basic group of blood chemicals 80048 301  $                             184.28  $                      128.99  $                                 30.80  $                               147.42  $           132.68  $       36.23  $        30.80  $           36.23  $           141.89  $             147.42  $                    128.99  $         71.87  $         123.46  $           123.46
  Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) 80051 301  $                               94.50  $                        66.15  $                                 25.55  $                                 75.60  $             68.04  $       30.05  $        30.05  $           25.55  $             72.77  $               75.60  $                      66.15  $         36.86  $           63.32  $             63.32
  Blood test, comprehensive group of blood chemicals 80053 301  $                             245.70  $                      171.99  $                                 38.47  $                               196.56  $           176.90  $       45.25  $        38.47  $           45.25  $           189.19  $             196.56  $                    171.99  $         95.82  $         164.62  $           164.62
  Obstetric blood test panel 80055 301  $                             276.15  $                      193.31  $                               107.70  $                               220.92  $           198.83  $     204.80  $      174.11  $         204.80  $           212.64  $             220.92  $                    193.31  $       107.70  $         185.02  $           185.02
  Blood test, lipids (cholesterol and triglycerides) 80061 301  $                             203.70  $                      142.59  $                                 48.76  $                               162.96  $           146.66  $       57.36  $        48.76  $           57.36  $           156.85  $             162.96  $                    142.59  $         79.44  $         136.48  $           136.48
  Kidney function blood test panel 80069 301  $                             159.60  $                      111.72  $                                 31.62  $                               127.68  $           114.91  $       37.20  $        31.62  $           37.20  $           122.89  $             127.68  $                    111.72  $         62.24  $         106.93  $           106.93
  Liver function blood test panel 80076 301  $                             184.28  $                      128.99  $                                 29.77  $                               147.42  $           132.68  $       35.01  $        29.77  $           35.01  $           141.89  $             147.42  $                    128.99  $         71.87  $         123.46  $           123.46
  Vancomycin (antibiotic) level 80202 301  $                             170.10  $                      119.07  $                                 49.32  $                               136.08  $           122.47  $       58.02  $        49.32  $           58.02  $           130.98  $             136.08  $                    119.07  $         66.34  $         113.97  $           113.97
  Testing for presence of drug 80305 301  $                             117.39  $                        82.17  $                                 39.71  $                                 93.91  $             84.52  $       46.71  $        39.71  $           46.71  $             90.39  $               93.91  $                      82.17  $         45.78  $           78.65  $             78.65
  Manual urinalysis test with examination using microscope 81000 NA N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
  Manual urinalysis test with examination using microscope 81001 300  $                               66.89  $                        46.82  $                                 11.56  $                                 53.51  $             48.16  $       13.60  $        11.56  $           13.60  $             51.50  $               53.51  $                      46.82  $         26.09  $           44.81  $             44.81
  Urinalysis, manual test 81002 306  $                               28.35  $                        19.85  $                                 10.27  $                                 22.68  $             20.41  $       12.08  $        10.27  $           12.08  $             21.83  $               22.68  $                      19.85  $         11.06  $           18.99  $             18.99
  Automated urinalysis test 81003 301  $                               30.45  $                        21.32  $                                   8.17  $                                 24.36  $             21.92  $         9.61  $          8.17  $             9.61  $             23.45  $               24.36  $                      21.32  $         11.88  $           20.40  $             20.40
  Urine pregnancy test 81025 301  $                               69.62  $                        48.73  $                                 25.40  $                                 55.69  $             50.12  $       29.88  $        25.40  $           29.88  $             53.60  $               55.69  $                      48.73  $         27.15  $           46.64  $             46.64
  Albumin (protein) level 82040 300  $                               36.86  $                        25.80  $                                 14.37  $                                 29.48  $             26.54  $       21.20  $        21.20  $           18.02  $             28.38  $               29.48  $                      25.80  $         14.37  $           24.69  $             24.69
  Urine microalbumin (protein) analysis 82044 301  $                               19.95  $                        13.97  $                                   7.78  $                                 21.62  $             14.36  $       21.62  $        21.62  $           18.38  $             15.36  $               15.96  $                      13.97  $           7.78  $           13.37  $             13.37
  Ammonia level 82140 301  $                             150.15  $                      105.11  $                                 53.07  $                               120.12  $           108.11  $       62.43  $        62.43  $           53.07  $           115.62  $             120.12  $                    105.11  $         58.56  $         100.60  $           100.60
  Amylase (enzyme) level 82150 301  $                               58.80  $                        41.16  $                                 22.93  $                                 47.04  $             42.34  $       27.76  $        27.76  $           23.60  $             45.28  $               47.04  $                      41.16  $         22.93  $           39.40  $             39.40
  Bilirubin level 82247 301  $                               61.43  $                        43.00  $                                 18.26  $                                 49.14  $             44.23  $       21.48  $        21.48  $           18.26  $             47.30  $               49.14  $                      43.00  $         23.96  $           41.15  $             41.15
  Stool analysis for blood to screen for colon tumors 82270 301  $                               32.76  $                        22.93  $                                 12.78  $                                 26.21  $             23.59  $       15.20  $        15.20  $           12.92  $             25.23  $               26.21  $                      22.93  $         12.78  $           21.95  $             21.95
  Vitamin D-3 level 82306 301  $                             278.25  $                      194.78  $                               107.82  $                               222.60  $           200.34  $     126.83  $      126.83  $         107.82  $           214.25  $             222.60  $                    194.78  $       108.52  $         186.43  $           186.43
  Calcium level 82310 301  $                               49.35  $                        34.55  $                                 18.79  $                                 39.48  $             35.53  $       22.10  $        22.10  $           18.79  $             38.00  $               39.48  $                      34.55  $         19.25  $           33.06  $             33.06
  Carcinoembryonic antigen (CEA) protein level 82378 301  $                             215.67  $                      150.97  $                                 69.06  $                               172.54  $           155.28  $       81.23  $        81.23  $           69.06  $           166.07  $             172.54  $                    150.97  $         84.11  $         144.50  $           144.50
  Cholesterol level 82465 301  $                               34.65  $                        24.26  $                                 13.51  $                                 27.72  $             24.95  $       18.63  $        18.63  $           15.84  $             26.68  $               27.72  $                      24.26  $         13.51  $           23.22  $             23.22
  Creatine kinase (cardiac enzyme) level 82550 301  $                             118.76  $                        83.13  $                                 23.72  $                                 95.00  $             85.50  $       27.90  $        27.90  $           23.72  $             91.44  $               95.00  $                      83.13  $         46.31  $           79.57  $             79.57
  Creatine kinase (cardiac enzyme) level 82553 301  $                             203.39  $                      142.37  $                                 42.07  $                               162.71  $           146.44  $       49.48  $        49.48  $           42.07  $           156.61  $             162.71  $                    142.37  $         79.32  $         136.27  $           136.27
  Blood creatinine level 82565 301  $                               36.75  $                        25.73  $                                 14.33  $                                 29.40  $             26.46  $       21.97  $        21.97  $           18.67  $             28.30  $               29.40  $                      25.73  $         14.33  $           24.62  $             24.62
  Cyanocobalamin (vitamin B-12) level 82607 301  $                             127.05  $                        88.94  $                                 49.55  $                               101.64  $             91.48  $       64.58  $        64.58  $           54.90  $             97.83  $             101.64  $                      88.94  $         49.55  $           85.12  $             85.12
  Ferritin (blood protein) level 82728 301  $                             130.20  $                        91.14  $                                 49.65  $                               104.16  $             93.74  $       58.40  $        58.40  $           49.65  $           100.25  $             104.16  $                      91.14  $         50.78  $           87.23  $             87.23
  Folic acid level 82746 301  $                             161.07  $                      112.75  $                                 53.54  $                               128.86  $           115.97  $       62.98  $        62.98  $           53.54  $           124.02  $             128.86  $                    112.75  $         62.82  $         107.92  $           107.92
  Gammaglobulin (immune system protein) measurement 82784 301  $                             110.57  $                        77.40  $                                 33.87  $                                 88.45  $             79.61  $       39.84  $        39.84  $           33.87  $             85.14  $               88.45  $                      77.40  $         43.12  $           74.08  $             74.08
  Blood glucose (sugar) level 82947 301  $                               53.55  $                        37.49  $                                 14.31  $                                 42.84  $             38.56  $       16.83  $        16.83  $           14.31  $             41.23  $               42.84  $                      37.49  $         20.88  $           35.88  $             35.88
  Blood glucose (sugar) tolerance test 82951 301  $                             150.15  $                      105.11  $                                 46.88  $                               120.12  $           108.11  $       55.14  $        55.14  $           46.88  $           115.62  $             120.12  $                    105.11  $         58.56  $         100.60  $           100.60
  Blood glucose (sugar) test performed by hand-held instrument 82962 301  $                               45.05  $                        31.53  $                                   9.68  $                                 36.04  $             32.43  $       11.38  $        11.38  $             9.68  $             34.68  $               36.04  $                      31.53  $         17.57  $           30.18  $             30.18
  Hemoglobin A1C level 83036 301  $                             124.22  $                        86.95  $                                 35.37  $                                 99.37  $             89.43  $       41.61  $        41.61  $           35.37  $             95.65  $               99.37  $                      86.95  $         48.44  $           83.22  $             83.22
  Iron binding capacity 83550 301  $                               84.00  $                        58.80  $                                 31.83  $                                 67.20  $             60.48  $       37.44  $        37.44  $           31.83  $             64.68  $               67.20  $                      58.80  $         32.76  $           56.28  $             56.28
  Lactic acid level 83605 301  $                             131.25  $                        91.88  $                                 38.91  $                               105.00  $             94.50  $       45.77  $        45.77  $           38.91  $           101.06  $             105.00  $                      91.88  $         51.19  $           87.94  $             87.94
  Lactate dehydrogenase (enzyme) level 83615 301  $                               86.00  $                        60.20  $                                 21.98  $                                 68.80  $             61.92  $       25.85  $        25.85  $           21.98  $             66.22  $               68.80  $                      60.20  $         33.54  $           57.62  $             57.62
  Lipase (fat enzyme) level 83690 301  $                             101.01  $                        70.71  $                                 25.10  $                                 80.81  $             72.73  $       29.53  $        29.53  $           25.10  $             77.78  $               80.81  $                      70.71  $         39.39  $           67.68  $             67.68
  Magnesium level 83735 301  $                             107.84  $                        75.48  $                                 24.40  $                                 86.27  $             77.64  $       28.70  $        28.70  $           24.40  $             83.03  $               86.27  $                      75.48  $         42.06  $           72.25  $             72.25
  Natriuretic peptide (heart and blood vessel protein) level 83880 301  $                             335.48  $                      234.83  $                               123.61  $                               268.38  $           241.54  $     145.39  $      145.39  $         123.61  $           258.32  $             268.38  $                    234.83  $       130.84  $         224.77  $           224.77
  Parathormone (parathyroid hormone) level 83970 301  $                             323.51  $                      226.45  $                               126.17  $                               258.80  $           232.92  $     176.83  $      176.83  $         150.33  $           249.10  $             258.80  $                    226.45  $       126.17  $         216.75  $           216.75
  Blood potassium level 84132 301  $                               43.05  $                        30.14  $                                 16.76  $                                 34.44  $             31.00  $       19.71  $        19.71  $           16.76  $             33.15  $               34.44  $                      30.14  $         16.79  $           28.84  $             28.84
  Progesterone (reproductive hormone) level 84144 301  $                             149.10  $                      104.37  $                                 58.15  $                               119.28  $           107.35  $       89.39  $        89.39  $           75.99  $           114.81  $             119.28  $                    104.37  $         58.15  $           99.90  $             99.90
  PSA (prostate specific antigen) measurement 84153 301  $                             181.55  $                      127.08  $                                 66.99  $                               145.24  $           130.71  $       78.80  $        78.80  $           66.99  $           139.79  $             145.24  $                    127.08  $         70.80  $         121.64  $           121.64
  PSA (prostate specific antigen) measurement 84154 301  $                             124.95  $                        87.47  $                                 48.73  $                                 99.96  $             89.96  $       78.80  $        78.80  $           66.99  $             96.21  $               99.96  $                      87.47  $         48.73  $           83.72  $             83.72
  Testosterone (hormone) level 84402 301  $                             157.50  $                      110.25  $                                 61.43  $                               126.00  $           113.40  $     109.13  $      109.13  $           92.78  $           121.28  $             126.00  $                    110.25  $         61.43  $         105.53  $           105.53
  Thyroxine (thyroid chemical) measurement 84439 301  $                             143.33  $                      100.33  $                                 32.83  $                               114.66  $           103.19  $       38.62  $        38.62  $           32.83  $           110.36  $             114.66  $                    100.33  $         55.90  $           96.03  $             96.03
  Blood test, thyroid stimulating hormone (TSH) 84443 301  $                             187.01  $                      130.90  $                                 61.21  $                               149.60  $           134.64  $       72.00  $        72.00  $           61.21  $           143.99  $             149.60  $                    130.90  $         72.93  $         125.29  $           125.29
  Thyroid hormone, T3 measurement 84480 301  $                             155.61  $                      108.93  $                                 51.65  $                               124.49  $           112.04  $       60.76  $        60.76  $           51.65  $           119.82  $             124.49  $                    108.93  $         60.69  $         104.26  $           104.26
  Troponin (protein) analysis 84484 301  $                             221.13  $                      154.79  $                                 36.79  $                               176.90  $           159.21  $       43.27  $        43.27  $           36.79  $           170.27  $             176.90  $                    154.79  $         86.24  $         148.16  $           148.16
  Urea nitrogen level to assess kidney function 84520 301  $                               48.83  $                        34.18  $                                 14.40  $                                 39.06  $             35.15  $       16.93  $        16.93  $           14.40  $             37.60  $               39.06  $                      34.18  $         19.04  $           32.71  $             32.71
  Uric acid level, blood 84550 300  $                               34.65  $                        24.26  $                                 13.51  $                                 27.72  $             24.95  $       19.36  $        19.36  $           16.46  $             26.68  $               27.72  $                      24.26  $         13.51  $           23.22  $             23.22
  Microscopic examination for white blood cells with manual cell count 85007 305  $                               42.32  $                        29.62  $                                 12.51  $                                 33.85  $             30.47  $       14.71  $        14.71  $           12.51  $             32.58  $               33.85  $                      29.62  $         16.50  $           28.35  $             28.35
  Hemoglobin measurement 85018 305  $                               28.67  $                        20.07  $                                   8.64  $                                 22.93  $             20.64  $       10.17  $        10.17  $             8.64  $             22.07  $               22.93  $                      20.07  $         11.18  $           19.21  $             19.21
  Complete blood cell count (red cells, white blood cell, platelets), automated test 85025 305  $                             125.58  $                        87.91  $                                 28.29  $                               100.46  $             90.42  $       33.28  $        33.28  $           28.29  $             96.70  $             100.46  $                      87.91  $         48.98  $           84.14  $             84.14
  Complete blood cell count (red cells, white blood cell, platelets), automated test 85027 305  $                               79.80  $                        55.86  $                                 23.54  $                                 63.84  $             57.46  $       27.69  $        27.69  $           23.54  $             61.45  $               63.84  $                      55.86  $         31.12  $           53.47  $             53.47
  Clotting factor V (AcG or proaccelerin) measurement 85220 305  $                             248.85  $                      174.20  $                                 64.28  $                               199.08  $           179.17  $       75.61  $        75.61  $           64.28  $           191.61  $             199.08  $                    174.20  $         97.05  $         166.73  $           166.73
  Coagulation function measurement 85378 305  $                             143.85  $                      100.70  $                                 28.67  $                               115.08  $           103.57  $       33.73  $        33.73  $           28.67  $           110.76  $             115.08  $                    100.70  $         56.10  $           96.38  $             96.38
  Fibrinogen (factor 1) activity measurement 85384 305  $                             228.90  $                      160.23  $                                 30.95  $                               183.12  $           164.81  $       36.40  $        36.40  $           30.95  $           176.25  $             183.12  $                    160.23  $         89.27  $         153.36  $           153.36
  Blood test, clotting time 85610 305  $                               72.35  $                        50.64  $                                 14.31  $                                 57.88  $             52.09  $       16.83  $        16.83  $           14.31  $             55.71  $               57.88  $                      50.64  $         28.21  $           48.47  $             48.47
  Red blood cell sedimentation rate, to detect inflammation 85652 305  $                               35.49  $                        24.84  $                                   9.82  $                                 28.39  $             25.55  $       11.56  $        11.56  $             9.82  $             27.33  $               28.39  $                      24.84  $         13.84  $           23.78  $             23.78
  Coagulation assessment blood test 85730 305  $                             118.76  $                        83.13  $                                 21.89  $                                 95.00  $             85.50  $       25.75  $        25.75  $           21.89  $             91.44  $               95.00  $                      83.13  $         46.31  $           79.57  $             79.57
  Measurement of antibody (IgE) to allergic substance 86003 302  $                               40.95  $                        28.67  $                                 15.97  $                                 32.76  $             29.48  $       22.35  $        22.35  $           19.00  $             31.53  $               32.76  $                      28.67  $         15.97  $           27.44  $             27.44
  Measurement C-reactive protein for detection of infection or inflammation 86140 302  $                             103.74  $                        72.62  $                                 18.85  $                                 82.99  $             74.69  $       22.17  $        22.17  $           18.85  $             79.88  $               82.99  $                      72.62  $         40.46  $           69.51  $             69.51
  Analysis for detection of tumor marker 86316 300  $                             100.80  $                        70.56  $                                 39.31  $                                 89.18  $             72.58  $       89.18  $        89.18  $           75.82  $             77.62  $               80.64  $                      70.56  $         39.31  $           67.54  $             67.54
  Rheumatoid factor level 86431 302  $                               73.50  $                        51.45  $                                 20.65  $                                 58.80  $             52.92  $       24.29  $        24.29  $           20.65  $             56.60  $               58.80  $                      51.45  $         28.67  $           49.25  $             49.25
  Analysis for antibody to Herpes simplex virus 86694 302  $                               94.50  $                        66.15  $                                 36.86  $                                 75.60  $             68.04  $       61.66  $        61.66  $           52.42  $             72.77  $               75.60  $                      66.15  $         36.86  $           63.32  $             63.32
  Bacterial blood culture 87040 306  $                             222.50  $                      155.75  $                                 37.58  $                               178.00  $           160.20  $       44.21  $        44.21  $           37.58  $           171.32  $             178.00  $                    155.75  $         86.77  $         149.07  $           149.07
  Bacterial culture for aerobic isolates 87077 300  $                             102.38  $                        71.66  $                                 29.41  $                                 81.90  $             73.71  $       34.60  $        34.60  $           29.41  $             78.83  $               81.90  $                      71.66  $         39.93  $           68.59  $             68.59
  Bacterial colony count, urine 87086 300  $                             137.87  $                        96.51  $                                 29.38  $                               110.29  $             99.26  $       34.56  $        34.56  $           29.38  $           106.16  $             110.29  $                      96.51  $         53.77  $           92.37  $             92.37
  Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) 87186 300  $                             120.12  $                        84.08  $                                 31.48  $                                 96.10  $             86.49  $       37.02  $        37.02  $           31.48  $             92.49  $               96.10  $                      84.08  $         46.85  $           80.48  $             80.48
  Immunologic analysis for detection of organism 87449 300  $                             137.87  $                        96.51  $                                 43.66  $                               110.29  $             99.26  $       51.36  $        51.36  $           43.66  $           106.16  $             110.29  $                      96.51  $         53.77  $           92.37  $             92.37
  Detection test for chlamydia 87490 306  $                             124.95  $                        87.47  $                                 48.73  $                                 99.96  $             89.96  $       85.92  $        85.92  $           73.04  $             96.21  $               99.96  $                      87.47  $         48.73  $           83.72  $             83.72
  Detection test for multiple types influenza virus 87502 300  $                             296.21  $                      207.34  $                               115.52  $                               364.56  $           213.27  $     364.56  $      364.56  $         309.93  $           228.08  $             236.96  $                    207.34  $       115.52  $         198.46  $           198.46
  Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria) 87590 306  $                             189.00  $                      132.30  $                                 73.71  $                               151.20  $           136.08  $       93.27  $        93.27  $           79.30  $           145.53  $             151.20  $                    132.30  $         73.71  $         126.63  $           126.63
  Infectious agent detection by nucleic acid (DNA or  RNA); severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique 87635 309  $                             157.50  $                      110.25  $                                 61.43  $                               178.12  $           113.40  $     178.12  $      178.12  $         151.42  $           121.28  $             126.00  $                    110.25  $         61.43  $         105.53  $           105.53
  Detection test for Strep (Streptococcus, group A) 87651 306  $                             131.25  $                        91.88  $                                 51.19  $                               150.36  $             94.50  $     150.36  $      150.36  $         127.82  $           101.06  $             105.00  $                      91.88  $         51.19  $           87.94  $             87.94
  Detection test for influenza virus 87804 306  $                             129.68  $                        90.77  $                                 48.82  $                               103.74  $             93.37  $       57.43  $        57.43  $           48.82  $             99.85  $             103.74  $                      90.77  $         50.57  $           86.88  $             86.88
  Detection test for respiratory syncytial virus (RSV) 87807 301  $                               57.75  $                        40.43  $                                 22.52  $                                 51.36  $             41.58  $       51.36  $        51.36  $           43.66  $             44.47  $               46.20  $                      40.43  $         22.52  $           38.69  $             38.69
  Pathology examination of tissue using a microscope, intermediate complexity 88305 971  $                             467.25  $                      327.08  $                               131.87  $                               373.80  $           336.42  $     155.11  $      155.11  $         131.87  $           359.78  $             373.80  $                    327.08  $       182.23  $         313.06  $           313.06
  Handling and/or conveyance of specimen for transfer to a laboratory 99001 300  $                               56.70  $                        39.69  $                                 18.00  $                                 45.36  $             40.82  $       21.17  $        21.17  $           18.00  $             43.66  $               45.36  $                      39.69  $         22.11  $           37.99  $             37.99
Radiology Services   CT scan head or brain 70450 351  $                          1,267.35  $                      887.15  $                               402.90  $                            1,013.88  $           912.49  $     453.26  $      453.26  $         402.90  $           975.86  $          1,013.88  $                    887.15  $       494.27  $         849.12  $           849.12
  MRI scan of brain before and after contrast 70553 611  $                          2,879.10  $                   2,015.37  $                            1,122.85  $                            2,303.28  $        2,072.95  $  1,807.23  $   1,807.23  $      1,606.42  $        2,216.91  $          2,303.28  $                 2,015.37  $    1,122.85  $      1,929.00  $        1,929.00
  X-ray of chest, 1 view 71045 324  $                             315.00  $                      220.50  $                                 77.03  $                               252.00  $           226.80  $       90.70  $        90.70  $           77.03  $           242.55  $             252.00  $                    220.50  $       122.85  $         211.05  $           211.05
  X-ray of chest, 2 views 71046 324  $                             345.45  $                      241.82  $                                 77.03  $                               276.36  $           248.72  $       90.70  $        90.70  $           77.03  $           266.00  $             276.36  $                    241.82  $       134.73  $         231.45  $           231.45
  MRI scan of chest before and after contrast 71552 610  $                          1,197.89  $                      838.52  $                               467.18  $                            1,807.23  $           862.48  $  1,807.23  $   1,807.23  $      1,606.42  $           922.38  $             958.31  $                    838.52  $       467.18  $         802.59  $           802.59
  X-ray of spine of neck, 2 or 3 views 72040 320  $                             409.50  $                      286.65  $                                 77.03  $                               327.60  $           294.84  $       90.70  $        90.70  $           77.03  $           315.32  $             327.60  $                    286.65  $       159.71  $         274.37  $           274.37
  X-ray of upper spine, 4 or 5 views 72050 320  $                             716.63  $                      501.64  $                               141.93  $                               573.30  $           515.97  $     167.11  $      167.11  $         141.93  $           551.80  $             573.30  $                    501.64  $       279.48  $         480.14  $           480.14
  X-ray of middle and lower spine, 2 views 72080 320  $                             315.00  $                      220.50  $                                 77.03  $                               252.00  $           226.80  $       90.70  $        90.70  $           77.03  $           242.55  $             252.00  $                    220.50  $       122.85  $         211.05  $           211.05
  X-ray of lower and sacral spine, 2 or 3 views 72100 320  $                             409.50  $                      286.65  $                               141.93  $                               327.60  $           294.84  $     167.11  $      167.11  $         141.93  $           315.32  $             327.60  $                    286.65  $       159.71  $         274.37  $           274.37
  X-ray of lower and sacral spine, minimum of 4 views 72110 320  $                             716.63  $                      501.64  $                               141.93  $                               573.30  $           515.97  $     167.11  $      167.11  $         141.93  $           551.80  $             573.30  $                    501.64  $       279.48  $         480.14  $           480.14
  MRI scan of lower spinal canal 72148 612  $                          3,186.75  $                   2,230.73  $                               817.73  $                            2,549.40  $        2,294.46  $     919.95  $      919.95  $         817.73  $        2,453.80  $          2,549.40  $                 2,230.73  $    1,242.83  $      2,135.12  $        2,135.12
  CT scan pelvis with contrast 72193 350  $                          2,093.70  $                   1,465.59  $                               816.54  $                            1,674.96  $        1,507.46  $  1,000.85  $   1,000.85  $         889.64  $        1,612.15  $          1,674.96  $                 1,465.59  $       816.54  $      1,402.78  $        1,402.78
  MRI scan of pelvis before and after contrast 72197 610  $                          5,682.60  $                   3,977.82  $                            1,606.42  $                            4,546.08  $        4,091.47  $  1,807.23  $   1,807.23  $      1,606.42  $        4,375.60  $          4,546.08  $                 3,977.82  $    2,216.21  $      3,807.34  $        3,807.34
  X-ray of shoulder, minimum of 2 views 73030 320  $                             421.79  $                      295.25  $                                 77.03  $                               337.43  $           303.69  $       90.70  $        90.70  $           77.03  $           324.77  $             337.43  $                    295.25  $       164.50  $         282.60  $           282.60
  X-ray of elbow, minimum of 3 views 73080 521  $                             492.77  $                      344.94  $                                 77.03  $                               394.21  $           354.79  $       90.70  $        90.70  $           77.03  $           379.43  $             394.21  $                    344.94  $       192.18  $         330.15  $           330.15
  X-ray of forearm, 2 views 73090 320  $                             475.02  $                      332.51  $                                 77.03  $                               380.02  $           342.01  $       90.70  $        90.70  $           77.03  $           365.77  $             380.02  $                    332.51  $       185.26  $         318.26  $           318.26
  X-ray of wrist, minimum of 3 views 73110 320  $                             410.87  $                      287.61  $                                 77.03  $                               328.69  $           295.82  $       90.70  $        90.70  $           77.03  $           316.37  $             328.69  $                    287.61  $       160.24  $         275.28  $           275.28
  X-ray of hand, minimum of 3 views 73130 320  $                             475.02  $                      332.51  $                                 77.03  $                               380.02  $           342.01  $       90.70  $        90.70  $           77.03  $           365.77  $             380.02  $                    332.51  $       185.26  $         318.26  $           318.26
  CT scan of arm 73200 352  $                          2,729.48  $                   1,910.63  $                               402.90  $                            2,183.58  $        1,965.22  $     453.26  $      453.26  $         402.90  $        2,101.70  $          2,183.58  $                 1,910.63  $    1,064.50  $      1,828.75  $        1,828.75
  CT scan of arm with contrast 73201 352  $                          2,107.35  $                   1,475.15  $                               821.87  $                            1,685.88  $        1,517.29  $  1,000.85  $   1,000.85  $         889.64  $        1,622.66  $          1,685.88  $                 1,475.15  $       821.87  $      1,411.92  $        1,411.92
  CT scan of arm before and after contrast 73202 352  $                          2,136.75  $                   1,495.73  $                               833.33  $                            1,709.40  $        1,538.46  $  1,000.85  $   1,000.85  $         889.64  $        1,645.30  $          1,709.40  $                 1,495.73  $       833.33  $      1,431.62  $        1,431.62
  X-ray of hip with pelvis, 2-3 views 73502 320  $                             521.43  $                      365.00  $                                 77.03  $                               417.14  $           375.43  $       90.70  $        90.70  $           77.03  $           401.50  $             417.14  $                    365.00  $       203.36  $         349.36  $           349.36
  X-ray of knee, 1 or 2 views 73560 320  $                             341.25  $                      238.88  $                                 77.03  $                               273.00  $           245.70  $       90.70  $        90.70  $           77.03  $           262.76  $             273.00  $                    238.88  $       133.09  $         228.64  $           228.64
  X-ray of knee, 3 views 73562 320  $                             541.91  $                      379.33  $                                 77.03  $                               433.52  $           390.17  $       90.70  $        90.70  $           77.03  $           417.27  $             433.52  $                    379.33  $       211.34  $         363.08  $           363.08
  X-ray of ankle, 2 views 73600 521  $                             360.36  $                      252.25  $                                 77.03  $                               288.29  $           259.46  $       90.70  $        90.70  $           77.03  $           277.48  $             288.29  $                    252.25  $       140.54  $         241.44  $           241.44
  X-ray of ankle, minimum of 3 views 73610 320  $                             421.79  $                      295.25  $                                 77.03  $                               337.43  $           303.69  $       90.70  $        90.70  $           77.03  $           324.77  $             337.43  $                    295.25  $       164.50  $         282.60  $           282.60
  X-ray of foot, minimum of 3 views 73630 521  $                             409.50  $                      286.65  $                                 77.03  $                               327.60  $           294.84  $       90.70  $        90.70  $           77.03  $           315.32  $             327.60  $                    286.65  $       159.71  $         274.37  $           274.37
  CT scan leg 73700 352  $                          1,962.45  $                   1,373.72  $                               402.90  $                            1,569.96  $        1,412.96  $     453.26  $      453.26  $         402.90  $        1,511.09  $          1,569.96  $                 1,373.72  $       765.36  $      1,314.84  $        1,314.84
  CT scan leg with contrast injection 73701 350  $                          1,962.45  $                   1,373.72  $                               765.36  $                            1,569.96  $        1,412.96  $  1,000.85  $   1,000.85  $         889.64  $        1,511.09  $          1,569.96  $                 1,373.72  $       765.36  $      1,314.84  $        1,314.84
  CT scan of leg before and after contrast injection 73702 352  $                          2,116.80  $                   1,481.76  $                               825.55  $                            1,693.44  $        1,524.10  $  1,000.85  $   1,000.85  $         889.64  $        1,629.94  $          1,693.44  $                 1,481.76  $       825.55  $      1,418.26  $        1,418.26
  MRI scan of leg joint 73721 610  $                          2,971.50  $                   2,080.05  $                               817.73  $                            2,377.20  $        2,139.48  $     919.95  $      919.95  $         817.73  $        2,288.06  $          2,377.20  $                 2,080.05  $    1,158.89  $      1,990.91  $        1,990.91
  MRI scan of leg joint with contrast 73722 610  $                          3,105.90  $                   2,174.13  $                            1,211.30  $                            2,700.24  $        2,236.25  $  2,700.24  $   2,700.24  $      2,400.22  $        2,391.54  $          2,484.72  $                 2,174.13  $    1,211.30  $      2,080.95  $        2,080.95
  MRI scan of leg joint before and after contrast 73723 610  $                          3,870.30  $                   2,709.21  $                            1,509.42  $                            3,096.24  $        2,786.62  $  1,807.23  $   1,807.23  $      1,606.42  $        2,980.13  $          3,096.24  $                 2,709.21  $    1,509.42  $      2,593.10  $        2,593.10
  X-ray of abdomen, 1 view 74018 320  $                             315.00  $                      220.50  $                                 77.03  $                               252.00  $           226.80  $       90.70  $        90.70  $           77.03  $           242.55  $             252.00  $                    220.50  $       122.85  $         211.05  $           211.05
  X-ray of abdomen, 2 views 74019 320  $                             332.85  $                      233.00  $                               129.81  $                               266.28  $           239.65  $     167.11  $      167.11  $         141.93  $           256.29  $             266.28  $                    233.00  $       129.81  $         223.01  $           223.01
  X-ray of abdomen, minimum of 3 views 74021 320  $                             491.40  $                      343.98  $                               141.93  $                               393.12  $           353.81  $     167.11  $      167.11  $         141.93  $           378.38  $             393.12  $                    343.98  $       191.65  $         329.24  $           329.24
  Complete X-ray study of abdomen with single X-ray of chest 74022 320  $                             722.09  $                      505.46  $                               141.93  $                               577.67  $           519.90  $     167.11  $      167.11  $         141.93  $           556.01  $             577.67  $                    505.46  $       281.61  $         483.80  $           483.80
  CT scan of abdomen and pelvis 74176 352  $                          2,049.08  $                   1,434.35  $                               799.14  $                            1,639.26  $        1,475.33  $     919.95  $      919.95  $         817.73  $        1,577.79  $          1,639.26  $                 1,434.35  $       799.14  $      1,372.88  $        1,372.88
  CT scan of abdomen and pelvis with contrast 74177 352  $                          2,360.40  $                   1,652.28  $                               889.64  $                            1,888.32  $        1,699.49  $  1,000.85  $   1,000.85  $         889.64  $        1,817.51  $          1,888.32  $                 1,652.28  $       920.56  $      1,581.47  $        1,581.47
  CT scan of abdomen and pelvis before and after contrast 74178 352  $                          3,027.15  $                   2,119.01  $                               889.64  $                            2,421.72  $        2,179.55  $  1,000.85  $   1,000.85  $         889.64  $        2,330.91  $          2,421.72  $                 2,119.01  $    1,180.59  $      2,028.19  $        2,028.19
  MRI scan of abdomen before and after contrast 74183 610  $                          5,227.95  $                   3,659.57  $                            1,606.42  $                            4,182.36  $        3,764.12  $  1,807.23  $   1,807.23  $      1,606.42  $        4,025.52  $          4,182.36  $                 3,659.57  $    2,038.90  $      3,502.73  $        3,502.73
  Imaging for evaluation of swallowing function 74230 320  $                             840.84  $                      588.59  $                               141.93  $                               672.67  $           605.40  $     167.11  $      167.11  $         141.93  $           647.45  $             672.67  $                    588.59  $       327.93  $         563.36  $           563.36
  X-ray of large bowel with single contrast 74270 320  $                          1,279.01  $                      895.30  $                               313.40  $                            1,023.20  $           920.88  $     369.00  $      369.00  $         313.40  $           984.83  $          1,023.20  $                    895.30  $       498.81  $         856.93  $           856.93
  Imaging of urinary tract 74420 320  $                          1,131.90  $                      792.33  $                               441.44  $                               905.52  $           814.97  $     664.40  $      664.40  $         564.29  $           871.56  $             905.52  $                    792.33  $       441.44  $         758.37  $           758.37
  CT scan of abdominal aorta and both leg arteries with contrast 75635 352  $                          3,505.95  $                   2,454.17  $                               889.64  $                            2,804.76  $        2,524.28  $  1,000.85  $   1,000.85  $         889.64  $        2,699.58  $          2,804.76  $                 2,454.17  $    1,367.32  $      2,348.99  $        2,348.99
  Ultrasound of abdomen 76700 402  $                             996.45  $                      697.52  $                               141.93  $                               797.16  $           717.44  $     167.11  $      167.11  $         141.93  $           767.27  $             797.16  $                    697.52  $       388.62  $         667.62  $           667.62
  Ultrasound behind abdominal cavity 76770 402  $                             933.66  $                      653.56  $                               141.93  $                               746.93  $           672.24  $     167.11  $      167.11  $         141.93  $           718.92  $             746.93  $                    653.56  $       364.13  $         625.55  $           625.55
  Ultrasound of spinal canal 76800 402  $                             330.75  $                      231.53  $                               128.99  $                               264.60  $           238.14  $     167.11  $      167.11  $         141.93  $           254.68  $             264.60  $                    231.53  $       128.99  $         221.60  $           221.60
  Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus 76805 402  $                             426.30  $                      298.41  $                               116.60  $                               341.04  $           306.94  $     137.28  $      137.28  $         116.60  $           328.25  $             341.04  $                    298.41  $       166.26  $         285.62  $           285.62
  Vaginal ultrasound of pregnant uterus 76817 402  $                             426.30  $                      298.41  $                               141.93  $                               341.04  $           306.94  $     167.11  $      167.11  $         141.93  $           328.25  $             341.04  $                    298.41  $       166.26  $         285.62  $           285.62
  Ultrasound pelvis through vagina 76830 402  $                             933.66  $                      653.56  $                               110.81  $                               746.93  $           672.24  $     130.47  $      130.47  $         110.81  $           718.92  $             746.93  $                    653.56  $       364.13  $         625.55  $           625.55
  Ultrasound of pelvis 76857 402  $                             268.80  $                      188.16  $                               104.83  $                               215.04  $           193.54  $     167.11  $      167.11  $         141.93  $           206.98  $             215.04  $                    188.16  $       104.83  $         180.10  $           180.10
  Complete ultrasound of joint of arm or leg 76881 402  $                             718.20  $                      502.74  $                                 88.56  $                               574.56  $           517.10  $     104.27  $      104.27  $           88.56  $           553.01  $             574.56  $                    502.74  $       280.10  $         481.19  $           481.19
  Partial ultrasound of joint or other non-blood vessel structure of arm or leg 76882 402  $                             551.25  $                      385.88  $                               141.93  $                               441.00  $           396.90  $     167.11  $      167.11  $         141.93  $           424.46  $             441.00  $                    385.88  $       214.99  $         369.34  $           369.34
  Mammography of one breast 77065 401  $                             289.80  $                      202.86  $                               113.02  $                               231.84  $           208.66  $     139.90  $      139.90  $         118.82  $           223.15  $             231.84  $                    202.86  $       113.02  $         194.17  $           194.17
  Mammography of both breasts 77066 401  $                             578.55  $                      404.99  $                               151.75  $                               462.84  $           416.56  $     178.67  $      178.67  $         151.75  $           445.48  $             462.84  $                    404.99  $       225.63  $         387.63  $           387.63
  Mammography of both breasts 77067 403  $                             226.80  $                      158.76  $                                 88.45  $                               181.44  $           163.30  $     147.77  $      147.77  $         125.50  $           174.64  $             181.44  $                    158.76  $         88.45  $         151.96  $           151.96
  Bone density measurement using dedicated X-ray machine 77080 320  $                             404.25  $                      282.98  $                                 40.05  $                               323.40  $           291.06  $       47.16  $        47.16  $           40.05  $           311.27  $             323.40  $                    282.98  $       157.66  $         270.85  $           270.85
  Nuclear medicine imaging for thyroid uptake measurements 78012 341  $                             840.00  $                      588.00  $                                 93.46  $                               672.00  $           604.80  $     110.04  $      110.04  $           93.46  $           646.80  $             672.00  $                    588.00  $       327.60  $         562.80  $           562.80
  Bone and/or joint imaging 78300 341  $                          1,226.40  $                      858.48  $                               261.68  $                               981.12  $           883.01  $     308.10  $      308.10  $         261.68  $           944.33  $             981.12  $                    858.48  $       478.30  $         821.69  $           821.69
  Routine electrocardiogram (EKG) with tracing using at least 12 leads 93005 730  $                             342.62  $                      239.83  $                               129.27  $                               274.09  $           246.68  $     129.27  $      129.27  $         129.27  $           263.81  $             274.09  $                    239.83  $       133.62  $         229.55  $           229.55
  Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck 93880 921  $                          1,519.35  $                   1,063.55  $                               272.74  $                            1,215.48  $        1,093.93  $     272.74  $      272.74  $         272.74  $        1,169.90  $          1,215.48  $                 1,063.55  $       592.55  $      1,017.96  $        1,017.96
  Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers 93970 921  $                          1,553.37  $                   1,087.36  $                               383.83  $                            1,242.70  $        1,118.43  $     383.83  $      383.83  $         383.83  $        1,196.09  $          1,242.70  $                 1,087.36  $       605.81  $      1,040.76  $        1,040.76
  Initial nursing facility visit, typically 45 minutes per day 99306    $                             265.65  $                      185.96  $                               103.60  $                               212.52  $           191.27  $             -    $              -    $                -    $           204.55  $             212.52  $                    185.96  $       103.60  $         177.99  $           177.99
  MRI Contrast - Multihance 20 ml A9577  636  $                                 8.37  $                          5.86  $                                   3.26  $                                   6.69  $               6.03  N/A   N/A   N/A   $               6.44  $                 6.69  $                        5.86  $           3.26  $             5.61  $               5.61
  CT Lung Cancer screening G0297    $                          2,935.80  $                   2,055.06  $                               234.52  $                            2,348.64  $        2,113.78  $     276.13  $      276.13  $         234.52  $        2,260.57  $          2,348.64  $                 2,055.06  $    1,144.96  $      1,966.99  $        1,966.99
  CT scan contrast 100ML or 75ML low osmolar contrast Q9967  636  $                                 2.58  $                          1.81  $                                   1.01  $                                   2.07  $               1.86  N/A   N/A   N/A   $               1.99  $                 2.07  $                        1.81  $           1.01  $             1.73  $               1.73
Medicine and Surgery Services    Drainage of tailbone cyst 10080 981  $                             280.22  $                      196.16  $                               109.29  $                               224.18  $           201.76  $     140.62  $      140.62  $         133.92  $           215.77  $             224.18  $                    196.16  $       109.29  $         187.75  $           187.75
  Drainage of tailbone cyst 10081 981  $                             465.71  $                      325.99  $                               174.24  $                               372.57  $           335.31  $     182.95  $      182.95  $         174.24  $           358.59  $             372.57  $                    325.99  $       181.63  $         312.02  $           312.02
  Removal of skin and tissue first 20 sq cm or less 11042 761  $                          2,199.05  $                   1,539.33  $                               310.80  $                            1,759.24  $        1,583.31  $     326.34  $      326.34  $         310.80  $        1,693.27  $          1,759.24  $                 1,539.33  $       857.63  $      1,473.36  $        1,473.36
  Removal of skin and tissue 11045 761  $                          1,227.14  $                      858.99  $                               478.58  $                               981.71  $           883.54  $             -    $              -    $                -    $           944.89  $             981.71  $                    858.99  $       478.58  $         822.18  $           822.18
  Removal of growth (0.5 centimeters or less) of the trunk, arms or legs 11400 983  $                             222.81  $                      155.97  $                                 86.90  $                               178.25  $           160.42  $       96.39  $        96.39  $           91.80  $           171.56  $             178.25  $                    155.97  $         86.90  $         149.28  $           149.28
  Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs 11401 983  $                             824.46  $                      577.12  $                               100.80  $                               659.57  $           593.61  $     105.84  $      105.84  $         100.80  $           634.83  $             659.57  $                    577.12  $       321.54  $         552.39  $           552.39
  Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs 11402 960  $                             314.42  $                      220.10  $                               110.88  $                               251.54  $           226.38  $     116.42  $      116.42  $         110.88  $           242.11  $             251.54  $                    220.10  $       122.62  $         210.66  $           210.66
  Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs 11403 521  $                             198.45  $                      138.92  $                                 77.40  $                               158.76  $           142.88  $     126.63  $      126.63  $         120.60  $           152.81  $             158.76  $                    138.92  $         77.40  $         132.96  $           132.96
  Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs 11404 983  $                             254.10  $                      177.87  $                                 99.10  $                            1,415.43  $           182.95  $  1,415.43  $   1,415.43  $      1,348.03  $           195.66  $             203.28  $                    177.87  $         99.10  $         170.25  $           170.25
  Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals 11420 977  $                             237.30  $                      166.11  $                                 84.60  $                               189.84  $           170.86  $       88.83  $        88.83  $           84.60  $           182.72  $             189.84  $                    166.11  $         92.55  $         158.99  $           158.99
  Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals 11421 983  $                             166.95  $                      116.87  $                                 65.11  $                               133.56  $           120.20  $     106.22  $      106.22  $         101.16  $           128.55  $             133.56  $                    116.87  $         65.11  $         111.86  $           111.86
  Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals 11422 977  $                             216.30  $                      151.41  $                                 84.36  $                               173.04  $           155.74  $     117.18  $      117.18  $         111.60  $           166.55  $             173.04  $                    151.41  $         84.36  $         144.92  $           144.92
  Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals 11423 983  $                             210.00  $                      147.00  $                                 81.90  $                               168.00  $           151.20  $     127.01  $      127.01  $         120.96  $           161.70  $             168.00  $                    147.00  $         81.90  $         140.70  $           140.70
  Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals 11424 521  $                             226.80  $                      158.76  $                                 88.45  $                            1,415.43  $           163.30  $  1,415.43  $   1,415.43  $      1,348.03  $           174.64  $             181.44  $                    158.76  $         88.45  $         151.96  $           151.96
  Removal of malignant growth (0.5 centimeters or less) of the trunk, arms, or legs 11600 521  $                             176.40  $                      123.48  $                                 68.80  $                               141.12  $           127.01  $     137.97  $      137.97  $         131.40  $           135.83  $             141.12  $                    123.48  $         68.80  $         118.19  $           118.19
  Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs 11601 977  $                             280.35  $                      196.25  $                               109.34  $                               224.28  $           201.85  $     157.25  $      157.25  $         149.76  $           215.87  $             224.28  $                    196.25  $       109.34  $         187.83  $           187.83
  Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs 11602 977  $                             475.65  $                      332.96  $                               161.28  $                               380.52  $           342.47  $     169.34  $      169.34  $         161.28  $           366.25  $             380.52  $                    332.96  $       185.50  $         318.69  $           318.69
  Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs 11603 983  $                             248.85  $                      174.20  $                                 97.05  $                               199.08  $           179.17  $     183.33  $      183.33  $         174.60  $           191.61  $             199.08  $                    174.20  $         97.05  $         166.73  $           166.73
  Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs 11604 521  $                             226.80  $                      158.76  $                                 88.45  $                               601.49  $           163.30  $     601.49  $      601.49  $         572.85  $           174.64  $             181.44  $                    158.76  $         88.45  $         151.96  $           151.96
  Removal of malignant growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals 11620 521  $                             159.60  $                      111.72  $                                 62.24  $                               138.73  $           114.91  $     138.73  $      138.73  $         132.12  $           122.89  $             127.68  $                    111.72  $         62.24  $         106.93  $           106.93
  Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals 11621 521  $                             193.20  $                      135.24  $                                 75.35  $                               157.63  $           139.10  $     157.63  $      157.63  $         150.12  $           148.76  $             154.56  $                    135.24  $         75.35  $         129.44  $           129.44
  Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals 11622 983  $                             236.25  $                      165.38  $                                 92.14  $                               189.00  $           170.10  $     171.99  $      171.99  $         163.80  $           181.91  $             189.00  $                    165.38  $         92.14  $         158.29  $           158.29
  Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals 11623 521  $                             255.15  $                      178.61  $                                 99.51  $                               204.12  $           183.71  $     188.62  $      188.62  $         179.64  $           196.47  $             204.12  $                    178.61  $         99.51  $         170.95  $           170.95
  Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals 11624 521  $                             263.55  $                      184.49  $                               102.78  $                            1,415.43  $           189.76  $  1,415.43  $   1,415.43  $      1,348.03  $           202.93  $             210.84  $                    184.49  $       102.78  $         176.58  $           176.58
  Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips 11640 977  $                             211.05  $                      147.74  $                                 82.31  $                               168.84  $           151.96  $     144.02  $      144.02  $         137.16  $           162.51  $             168.84  $                    147.74  $         82.31  $         141.40  $           141.40
  Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips 11641 521  $                             216.30  $                      151.41  $                                 84.36  $                               173.04  $           155.74  $     162.16  $      162.16  $         154.44  $           166.55  $             173.04  $                    151.41  $         84.36  $         144.92  $           144.92
  Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips 11642 983  $                             296.10  $                      207.27  $                               115.48  $                               236.88  $           213.19  $     178.42  $      178.42  $         169.92  $           228.00  $             236.88  $                    207.27  $       115.48  $         198.39  $           198.39
  Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips 11643 521  $                             295.05  $                      206.54  $                               115.07  $                               236.04  $           212.44  $     195.43  $      195.43  $         186.12  $           227.19  $             236.04  $                    206.54  $       115.07  $         197.68  $           197.68
  Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips 11644 521  $                             347.55  $                      243.29  $                               135.54  $                            1,415.43  $           250.24  $  1,415.43  $   1,415.43  $      1,348.03  $           267.61  $             278.04  $                    243.29  $       135.54  $         232.86  $           232.86
  Repair of finger or toe nail bed 11760 981  $                             313.01  $                      219.10  $                               122.07  $                               512.61  $           225.36  $     512.61  $      512.61  $         488.20  $           241.01  $             250.40  $                    219.10  $       122.07  $         209.71  $           209.71
  Removal of skin of finger or toe nail 11765 983  $                             373.80  $                      261.66  $                               145.78  $                               326.34  $           269.14  $     326.34  $      326.34  $         310.80  $           287.83  $             299.04  $                    261.66  $       145.78  $         250.45  $           250.45
  Biopsy of breast accessed through the skin with ultrasound guidance 19083 361  $                          5,285.18  $                   3,699.62  $                            1,348.03  $                            4,228.14  $        3,805.33  $  1,415.43  $   1,415.43  $      1,348.03  $        4,069.58  $          4,228.14  $                 3,699.62  $    2,061.22  $      3,541.07  $        3,541.07
  Needle biopsy of breast 19100 983  $                             205.80  $                      144.06  $                                 80.26  $                            1,415.43  $           148.18  $  1,415.43  $   1,415.43  $      1,348.03  $           158.47  $             164.64  $                    144.06  $         80.26  $         137.89  $           137.89
  Removal of 1 or more breast growth, open procedure 19120 521  N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Injections of tendon sheath, ligament, or muscle membrane 20550 521  $                             100.80  $                        70.56  $                                 24.12  $                                 80.64  $             72.58  $       25.33  $        25.33  $           24.12  $             77.62  $               80.64  $                      70.56  $         39.31  $           67.54  $             67.54
  Biopsy of tissue of back or flank 21920 521  $                             246.75  $                      172.73  $                                 96.23  $                               197.40  $           177.66  $     185.98  $      185.98  $         177.12  $           190.00  $             197.40  $                    172.73  $         96.23  $         165.32  $           165.32
  Drainage of fluid-filled sac (bursa) of upper arm or elbow 23931 981  $                             428.01  $                      299.61  $                               166.92  $                            1,415.43  $           308.17  $  1,415.43  $   1,415.43  $      1,348.03  $           329.57  $             342.41  $                    299.61  $       166.92  $         286.77  $           286.77
  Closed treatment of knee dislocation 27550 521  $                             663.60  $                      464.52  $                               214.90  $                               530.88  $           477.79  $     225.65  $      225.65  $         214.90  $           510.97  $             530.88  $                    464.52  $       258.80  $         444.61  $           444.61
  Shaving of shoulder bone using an endoscope 29826 521  N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of one knee cartilage using an endoscope 29881 521  N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of fluid from chest cavity 32554 981  $                             247.01  $                      172.91  $                                 96.33  $                               643.20  $           177.85  $     643.20  $      643.20  $         612.57  $           190.20  $             197.61  $                    172.91  $         96.33  $         165.50  $           165.50
  Removal of fluid from chest cavity with imaging guidance 32555 361  $                          1,853.67  $                   1,297.57  $                               612.57  $                            1,482.94  $        1,334.64  $     643.20  $      643.20  $         612.57  $        1,427.33  $          1,482.94  $                 1,297.57  $       722.93  $      1,241.96  $        1,241.96
  Transfusion of blood or blood products 36430 391  $                             868.35  $                      607.85  $                                 35.28  $                               694.68  $           625.21  $       37.04  $        37.04  $           35.28  $           668.63  $             694.68  $                    607.85  $       338.66  $         581.79  $           581.79
  Diagnostic bone marrow aspiration 38220 310  $                          2,022.30  $                   1,415.61  $                               124.56  $                            1,617.84  $        1,456.06  $     130.79  $      130.79  $         124.56  $        1,557.17  $          1,617.84  $                 1,415.61  $       788.70  $      1,354.94  $        1,354.94
  Bone marrow biopsy 38221 521  $                          1,011.47  $                      708.03  $                               107.64  $                               809.17  $           728.25  $     113.02  $      113.02  $         107.64  $           778.83  $             809.17  $                    708.03  $       394.47  $         677.68  $           677.68
  Removal of tonsils and adenoid glands patient younger than age 12 42820 521  N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope 43235 521  N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope 43239 521  N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
Diagnostic examination of large bowel using an endoscope  Diagnostic examination of large bowel using an endoscope 45378 521  $                          1,086.54  $                      760.58  $                               423.75  $                               869.23  $           782.31  $     745.48  $      745.48  $         709.98  $           836.64  $             869.23  $                    760.58  $       423.75  $         727.98  $           727.98
Professional Fee (Anesthesia) 45378 521  $                          2,828.70  $                   1,980.09  $                            1,103.19  $                            2,262.96  $        2,036.66        $        2,178.10  $          2,262.96  $                 1,980.09  $    1,103.19  $      1,895.23  $        1,895.23
Additional Professional Fee 45378    $                             542.19  $                      379.54  $                               211.46  $                               433.76  $           390.38        $           417.49  $             433.76  $                    379.54  $       211.46  $         363.27  $           363.27
Biopsy of large bowel using an endoscope  Biopsy of large bowel using an endoscope  45380 521  $                          3,577.61  $                   2,504.33  $                               936.39  $                            2,862.09  $        2,575.88  $     983.21  $      983.21  $         936.39  $        2,754.76  $          2,862.09  $                 2,504.33  $    1,395.27  $      2,397.00  $        2,397.00
Professional Fee (Anesthesia) 45380 521  $                          3,156.30  $                   2,209.41  $                            1,230.96  $                            2,525.04  $        2,272.54        $        2,430.35  $          2,525.04  $                 2,209.41  $    1,230.96  $      2,114.72  $        2,114.72
Additional Professional Fee 45380    $                             481.95  $                      337.37  $                               187.96  $                               385.56  $           347.00        $           371.10  $             385.56  $                    337.37  $       187.96  $         322.91  $           322.91
Biopsy of large bowel using an endoscope  Removal of polyps or growths of large bowel using an endoscope  45385 521  $                          4,984.81  $                   3,489.37  $                               936.39  $                            3,987.85  $        3,589.06  $     983.21  $      983.21  $         936.39  $        3,838.31  $          3,987.85  $                 3,489.37  $    1,944.08  $      3,339.82  $        3,339.82
Professional Fee (Anesthesia) 45385 521  $                          3,249.75  $                   2,274.83  $                            1,267.40  $                            2,599.80  $        2,339.82        $        2,502.31  $          2,599.80  $                 2,274.83  $    1,267.40  $      2,177.33  $        2,177.33
Additional Professional Fee 45385    $                             623.29  $                      436.30  $                               243.08  $                               498.63  $           448.77        $           479.93  $             498.63  $                    436.30  $       243.08  $         417.60  $           417.60
  Ultrasound examination of lower large bowel using an endoscope 45391    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of engorged hemorrhoid 46320 521  $                             307.37  $                      215.16  $                               119.87  $                               245.89  $           221.30  $     127.76  $      127.76  $         121.68  $           236.67  $             245.89  $                    215.16  $       119.87  $         205.94  $           205.94
  Removal of gallbladder using an endoscope 47562    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Repair of groin hernia patient age 5 years or older 49505    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of foreskin of using clamp or device 54150 521  $                             311.85  $                      218.30  $                               121.62  $                            1,780.46  $           224.53  $  1,780.46  $   1,780.46  $      1,695.68  $           240.12  $             249.48  $                    218.30  $       121.62  $         208.94  $           208.94
  Removal of foreskin, neonate (28 days of age or less) 54160 521  $                             337.05  $                      235.94  $                               165.15  $                               115.61  $           242.68  $  1,780.46  $   1,780.46  $      1,695.68  $           259.53  $             269.64  $                    235.94  $       131.45  $         225.82  $           225.82
  Biopsy of prostate gland 55700    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Surgical removal of prostate and surrounding lymph nodes using an endoscope 55866    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Obstetrical pre- and postpartum care and vaginal delivery 59400    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Cesarean delivery with pre- and post-delivery care 59510    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Vaginal delivery after prior cesarean delivery 59610    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Injection of substance into spinal canal of lower back or sacrum 62322    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Injection of substance into spinal canal of lower back or sacrum using imaging guidance 62323    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance 64483    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of recurring cataract in lens capsule using laser 66821    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of cataract with insertion of lens 66984    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Removal of impacted ear wax by washing 69209 981  $                               38.22  $                        26.75  $                                 14.91  $                                 58.76  $             27.52  $       58.76  $        58.76  $           55.96  $             29.43  $               30.58  $                      26.75  $         14.91  $           25.61  $             25.61
  Removal of impact ear wax, one ear 69210 521  $                               89.96  $                        62.97  $                                 35.09  $                                 71.97  $             64.77  $       58.76  $        58.76  $           55.96  $             69.27  $               71.97  $                      62.97  $         35.09  $           60.28  $             60.28
  Administration of 1 vaccine 90471 521  $                               69.62  $                        48.73  $                                 27.15  $                               134.44  $             50.12  $     134.44  $      134.44  $         134.44  $             53.60  $               55.69  $                      48.73  $         27.15  $           46.64  $             46.64
  Vaccine for human papilloma virus (3 dose schedule) injection into muscle 90649 521  $                             221.55  $                      155.09  $                                 86.40  $                               177.24  $           159.52  $             -    $              -    $                -    $           170.59  $             177.24  $                    155.09  $         86.40  $         148.44  $           148.44
  Vaccine for measles, mumps, and rubella (German measles) injection beneath skin 90707 521  $                               67.20  $                        47.04  $                                 26.21  $                                 53.76  $             48.38  $             -    $              -    $                -    $             51.74  $               53.76  $                      47.04  $         26.21  $           45.02  $             45.02
  Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older 90715 521  $                               51.45  $                        36.02  $                                 20.07  $                                 41.16  $             37.04  $             -    $              -    $                -    $             39.62  $               41.16  $                      36.02  $         20.07  $           34.47  $             34.47
  Behavioral and qualitative analysis of voice and resonance 92524 440  $                             189.00  $                      132.30  $                                 73.71  $                               206.42  $           136.08  $     206.42  $      206.42  $         206.42  $           145.53  $             151.20  $                    132.30  $         73.71  $         126.63  $           126.63
  Routine EKG using at least 12 leads including interpretation and report 93000    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Routine electrocardiogram (EKG) with tracing using at least 12 leads 93005 730  $                             342.62  $                      239.83  $                               129.27  $                               274.09  $           246.68  $     129.27  $      129.27  $         129.27  $           263.81  $             274.09  $                    239.83  $       133.62  $         229.55  $           229.55
  Insertion of catheter into left heart for diagnosis 93452    N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Measurement and graphic recording of total and timed exhaled air capacity 94010 460  $                             849.45  $                      594.62  $                               314.90  $                               679.56  $           611.60  $     314.90  $      314.90  $         314.90  $           654.08  $             679.56  $                    594.62  $       331.29  $         569.13  $           569.13
  Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen 94640 521  $                             281.40  $                      196.98  $                               109.75  $                               430.54  $           202.61  $     430.54  $      430.54  $         430.54  $           216.68  $             225.12  $                    196.98  $       109.75  $         188.54  $           188.54
  Measurement of oxygen saturation in blood using ear or finger device 94760 521  $                               91.46  $                        64.02  $                                   6.63  $                                 73.16  $             65.85  $         6.63  $          6.63  $             6.63  $             70.42  $               73.16  $                      64.02  $         35.67  $           61.27  $             61.27
  Sleep monitoring of patient (6 years or older) in sleep lab 95810 920  $                          2,123.10  $                   1,486.17  $                               828.01  $                            1,698.48  $        1,528.63  $  1,184.68  $   1,184.68  $      1,184.68  $        1,634.79  $          1,698.48  $                 1,486.17  $       828.01  $      1,422.48  $        1,422.48
  Hydration infusion into a vein 31 minutes to 1 hour 96360 260  $                             491.34  $                      343.94  $                               109.42  $                               393.07  $           353.76  $     109.42  $      109.42  $         109.42  $           378.33  $             393.07  $                    343.94  $       191.62  $         329.20  $           329.20
  Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour 96365 260  $                             214.31  $                      150.01  $                                 83.58  $                               171.44  $           154.30  $     170.78  $      170.78  $         170.78  $           165.01  $             171.44  $                    150.01  $         83.58  $         143.58  $           143.58
  Infusion into a vein for therapy, prevention, or diagnosis 96366 260  $                             182.91  $                      128.04  $                                 51.40  $                               146.33  $           131.70  $       51.40  $        51.40  $           51.40  $           140.84  $             146.33  $                    128.04  $         71.33  $         122.55  $           122.55
  Injection of drug or substance into a vein for therapy, diagnosis, or prevention 96374 940  $                             491.34  $                      343.94  $                               108.59  $                               393.07  $           353.76  $     108.59  $      108.59  $         108.59  $           378.33  $             393.07  $                    343.94  $       191.62  $         329.20  $           329.20
  Injection of different drug or substance into a vein for therapy, diagnosis, or prevention 96375 940  $                             167.90  $                      117.53  $                                 42.27  $                               134.32  $           120.88  $       42.27  $        42.27  $           42.27  $           129.28  $             134.32  $                    117.53  $         65.48  $         112.49  $           112.49
  Application of ultrasound to 1 or more areas, each 15 minutes 97035 420  $                               71.40  $                        49.98  $                                 27.85  $                                 57.12  $             51.41  $       31.51  $        31.51  $           31.51  $             54.98  $               57.12  $                      49.98  $         27.85  $           47.84  $             47.84
  Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes 97110 420  $                               77.81  $                        54.46  $                                 30.34  $                                 72.12  $             56.02  $       72.12  $        72.12  $           72.12  $             59.91  $               62.24  $                      54.46  $         30.34  $           52.13  $             52.13
  Walking training to 1 or more areas, each 15 minutes 97116 420  $                               61.43  $                        43.00  $                                 23.96  $                                 71.29  $             44.23  $       71.29  $        71.29  $           71.29  $             47.30  $               49.14  $                      43.00  $         23.96  $           41.15  $             41.15
  Evaluation of physical therapy, typically 30 minutes 97162 424  $                             191.10  $                      133.77  $                                 74.53  $                               197.32  $           137.59  $     197.32  $      197.32  $         197.32  $           147.15  $             152.88  $                    133.77  $         74.53  $         128.04  $           128.04
  Evaluation of occupational therapy, typically 45 minutes 97166 434  $                             191.10  $                      133.77  $                                 74.53  $                               213.05  $           137.59  $     213.05  $      213.05  $         213.05  $           147.15  $             152.88  $                    133.77  $         74.53  $         128.04  $           128.04
  Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes 97530 420  $                               72.35  $                        50.64  $                                 28.21  $                                 95.33  $             52.09  $       95.33  $        95.33  $           95.33  $             55.71  $               57.88  $                      50.64  $         28.21  $           48.47  $             48.47
  Removal of tissue from wounds per session 97602 521  $                             371.18  $                      259.82  $                               144.76  $                               390.27  $           267.25  $     390.27  $      390.27  $         390.27  $           285.80  $             296.94  $                    259.82  $       144.76  $         248.69  $           248.69
  Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session 97605 761  $                             532.35  $                      372.65  $                               207.62  $                               425.88  $           383.29  $     390.27  $      390.27  $         390.27  $           409.91  $             425.88  $                    372.65  $       207.62  $         356.67  $           356.67
  Removal of skin and tissue first 20 sq cm or less 11042 270  $                          2,199.05  $                   1,539.33  $                               310.80  $                            1,759.24  $        1,583.31  $     326.34  $      326.34  $         310.80  $        1,693.27  $          1,759.24  $                 1,539.33  $       857.63  $      1,473.36  $        1,473.36
  Hernia Plug/Patch C1781 278  $                             963.90  $                      674.73  $                               375.92  $                               771.12  $           694.01  $             -    $              -    $                -    $           742.20  $             771.12  $                    674.73  $       375.92  $         645.81  $           645.81
  Exparel 266Mg Vial C9290  636  $                                 1.58  $                          1.10  $                                   0.61  $                                   1.26  $               1.13  N/A   N/A   N/A   $               1.21  $                 1.26  $                        1.10  $           0.61  $             1.06  $               1.06
  Diabetes self-management, individual  G0108 942  $                               96.60  $                        67.62  $                                 37.67  $                               125.18  $             69.55  $     125.18  $      125.18  $         125.18  $             74.38  $               77.28  $                      67.62  $         37.67  $           64.72  $             64.72
  Diabetes self-management, group  G0109 942  $                               52.50  $                        36.75  $                                 20.48  $                                 42.00  $             37.80  $       33.98  $        33.98  $           33.98  $             40.43  $               42.00  $                      36.75  $         20.48  $           35.18  $             35.18
  Observation  G0378 762  $                               39.59  $                        27.71  $                                 15.44  $                               292.65  $             28.50  $     292.65  $      292.65  $         292.65  $             30.48  $               31.67  $                      27.71  $         15.44  $           26.52  $             26.52
  Cefazolin 1Gm Via J0690  636  $                                 0.63  $                          0.44  $                                   0.25  $                                   0.50  $               0.45  $         0.40  $          0.40  $             0.40  $               0.49  $                 0.50  $                        0.44  $           0.25  $             0.42  $               0.42
  Ceftriaxone 1Gm Vial J0696  636  $                               42.00  $                        29.40  $                                   6.33  $                                 33.60  $             30.24  $         6.33  $          6.33  $             6.33  $             32.34  $               33.60  $                      29.40  $         16.38  $           28.14  $             28.14
  Primaxin 500Mg Vial J0743  636  $                               12.60  $                          8.82  $                                   4.91  $                                 11.23  $               9.07  $       11.23  $        11.23  $           11.23  $               9.70  $               10.08  $                        8.82  $           4.91  $             8.44  $               8.44
  Dexamethasone 10Mg/Ml 1 Ml J1094  636  $                                 0.16  $                          0.11  $                                   0.06  $                                   0.13  $               0.11        $               0.12  $                 0.13  $                        0.11  $           0.06  $             0.11  $               0.11
  Dexamethasone 4Mg/1Ml Vial J1100  636  $                                 0.49  $                          0.35  $                                   0.08  $                                   0.39  $               0.36  $         0.08  $          0.08  $             0.08  $               0.38  $                 0.39  $                        0.35  $           0.19  $             0.33  $               0.33
  Heparin Lock Flush 300Units/3Ml J1642  636  $                                 0.02  $                          0.01  $                                   0.01  $                                   0.05  $               0.02  $         0.05  $          0.05  $             0.05  $               0.02  $                 0.02  $                        0.01  $           0.01  $             0.01  $               0.01
  Heparin Flush Syr 100 Units/Ml J1642  636  $                                 0.05  $                          0.04  $                                   0.02  $                                   0.05  $               0.04  $         0.05  $          0.05  $             0.05  $               0.04  $                 0.04  $                        0.04  $           0.02  $             0.04  $               0.04
  Heparin Flush 10,000 Units/Ml J1642  636  $                                 0.02  $                          0.01  $                                   0.01  $                                   0.05  $               0.02  $         0.05  $          0.05  $             0.05  $               0.02  $                 0.02  $                        0.01  $           0.01  $             0.01  $               0.01
  Lovenox 40Mg Syringe J1650  636  $                                 1.21  $                          0.85  $                                   0.47  $                                   0.97  $               0.87  $         0.68  $          0.68  $             0.68  $               0.93  $                 0.97  $                        0.85  $           0.47  $             0.81  $               0.81
  Humalog 100 Units/1Ml J1815  637  $                                 0.24  $                          0.17  $                                   0.09  $                                   0.35  $               0.17  $         0.35  $          0.35  $             0.35  $               0.19  $                 0.19  $                        0.17  $           0.09  $             0.16  $               0.16
  Humulin R Per 5 Units J1815  637  $                                 0.26  $                          0.18  $                                   0.10  $                                   0.35  $               0.19  $         0.35  $          0.35  $             0.35  $               0.20  $                 0.21  $                        0.18  $           0.10  $             0.18  $               0.18
  Ketorolac Tromethamine 60Mg Vial J1885  636  $                                 0.26  $                          0.18  $                                   0.10  $                                   0.55  $               0.19  $         0.55  $          0.55  $             0.55  $               0.20  $                 0.21  $                        0.18  $           0.10  $             0.18  $               0.18
  Ketorolac Trometh 30Mg/Ml Vial J1885  636  $                                 0.47  $                          0.33  $                                   0.18  $                                   0.55  $               0.34  $         0.55  $          0.55  $             0.55  $               0.36  $                 0.38  $                        0.33  $           0.18  $             0.32  $               0.32
  Furosemide 40Mg Vial J1940  636  $                                 0.63  $                          0.44  $                                   0.25  $                                   4.13  $               0.45  $         4.13  $          4.13  $             4.13  $               0.49  $                 0.50  $                        0.44  $           0.25  $             0.42  $               0.42
  Meropen 1Gm Vial J2185  637  $                                 0.74  $                          0.51  $                                   0.29  $                                   6.90  $               0.53  $         6.90  $          6.90  $             6.90  $               0.57  $                 0.59  $                        0.51  $           0.29  $             0.49  $               0.49
  Ondamsetron 4Mg/2Ml Vial J2405  636  $                                 0.08  $                          0.06  $                                   0.03  $                                   1.48  $               0.06  $         1.48  $          1.48  $             1.48  $               0.06  $                 0.07  $                        0.06  $           0.03  $             0.06  $               0.06
  Zosyn 3.375Gm J2543  636  $                                 1.31  $                          0.92  $                                   0.51  $                                   6.40  $               0.95  $         6.40  $          6.40  $             6.40  $               1.01  $                 1.05  $                        0.92  $           0.51  $             0.88  $               0.88
  Propofol 200Mg Per 20Ml J2704  636  $                                 0.11  $                          0.07  $                                   0.04  $                                   0.18  $               0.08  $         0.18  $          0.18  $             0.18  $               0.08  $                 0.08  $                        0.07  $           0.04  $             0.07  $               0.07
  Solu-Medrol 40 Mg/Ml J2920  636  $                                 6.14  $                          4.30  $                                   2.40  $                                   8.65  $               4.42  $         8.65  $          8.65  $             8.65  $               4.73  $                 4.91  $                        4.30  $           2.40  $             4.12  $               4.12
  Kenalog 40Mg/Ml J3301  636  $                                 2.17  $                          1.52  $                                   0.85  $                                   4.28  $               1.56  $         4.28  $          4.28  $             4.28  $               1.67  $                 1.74  $                        1.52  $           0.85  $             1.46  $               1.46
  Vancomycin Hcl 1000Mg Vial J3370  636  $                                 2.10  $                          1.47  $                                   0.82  $                                 11.18  $               1.51  $       11.18  $        11.18  $           11.18  $               1.62  $                 1.68  $                        1.47  $           0.82  $             1.41  $               1.41
  Vancomycin 500Mg Vial J3370  636  $                                 3.05  $                          2.13  $                                   1.19  $                                 11.18  $               2.19  $       11.18  $        11.18  $           11.18  $               2.34  $                 2.44  $                        2.13  $           1.19  $             2.04  $               2.04
  Albuterol Sulfate Inhal Solu 2.5Mg/3Ml J7613  636  $                                 0.06  $                          0.04  $                                   0.02  $                                   0.20  $               0.05  $         0.20  $          0.20  $             0.20  $               0.05  $                 0.05  $                        0.04  $           0.02  $             0.04  $               0.04
  Levalbuterol Inhal Solu 1.25Mg/3Ml J7614  636  $                                 0.53  $                          0.37  $                                   0.20  $                                   3.70  $               0.38  $         3.70  $          3.70  $             3.70  $               0.40  $                 0.42  $                        0.37  $           0.20  $             0.35  $               0.35
  Budesonide Inhal Susp 0.5Mg/2Ml J7626  636  $                                 2.73  $                          1.91  $                                   1.06  $                                 15.95  $               1.97  $       15.95  $        15.95  $           15.95  $               2.10  $                 2.18  $                        1.91  $           1.06  $             1.83  $               1.83
  Ipratropium Bromide Solu 0.5Mg/2.5Ml J7644  636  $                                 0.16  $                          0.11  $                                   0.06  $                                   1.28  $               0.11  $         1.28  $          1.28  $             1.28  $               0.12  $                 0.13  $                        0.11  $           0.06  $             0.11  $               0.11
  Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities       N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Spinal fusion except cervical without major comorbid conditions or complications (MCC)       N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).       N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).       N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)       N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A   N/A 
  Swing bed, semi-private   120  $                             887.25  $                      621.08  $                               346.03  $                               709.80  $           638.82        $           683.18  $             709.80  $                    621.08  $       346.03  $         594.46  $           594.46
  Semi-private hospital room    120  $                          1,182.30  $                      827.61  $                               461.10  $                               945.84  $           851.26        $           910.37  $             945.84  $                    827.61  $       461.10  $         792.14  $           792.14
  Private hospital room   110  $                          1,204.35  $                      843.05  $                               469.70  $                               963.48  $           867.13        $           927.35  $             963.48  $                    843.05  $       469.70  $         806.91  $           806.91
  Swing bed, private   110  $                          1,045.80  $                      732.06  $                               407.86  $                               836.64  $           752.98        $           805.27  $             836.64  $                    732.06  $       407.86  $         700.69  $           700.69
  Sodium Chloride For Injection   250  $                                 0.42  $                          0.29  $                                   0.16  $                                   0.34  $               0.30        $               0.32  $                 0.34  $                        0.29  $           0.16  $             0.28  $               0.28
  Acetaminophen 325Mg Ud Tablets   637  $                                 0.03  $                          0.02  $                                   0.01  $                                   0.03  $               0.02        $               0.02  $                 0.03  $                        0.02  $           0.01  $             0.02  $               0.02
  Mapap Es 500Mg Tablet   257  $                                 0.01  $                          0.01  $                                   0.00  $                                   0.01  $               0.01        $               0.01  $                 0.01  $                        0.01  $           0.00  $             0.01  $               0.01
  Klor Con 20Meq Tablet   637  $                                 0.32  $                          0.22  $                                   0.12  $                                   0.25  $               0.23        $               0.24  $                 0.25  $                        0.22  $           0.12  $             0.21  $               0.21
  Sucralfate  1Gm Tablet   637  $                                 0.24  $                          0.17  $                                   0.09  $                                   0.19  $               0.17        $               0.19  $                 0.19  $                        0.17  $           0.09  $             0.16  $               0.16
  Xylocaine 1% Mdv 5Ml   250  $                                 0.37  $                          0.26  $                                   0.14  $                                   0.29  $               0.26        $               0.28  $                 0.29  $                        0.26  $           0.14  $             0.25  $               0.25
  Pantoprazole Dr 40Mg Tablet   637  $                                 0.16  $                          0.11  $                                   0.06  $                                   0.13  $               0.11        $               0.12  $                 0.13  $                        0.11  $           0.06  $             0.11  $               0.11
  Lisinopril U D 20Mg Tabs   637  $                                 0.05  $                          0.04  $                                   0.02  $                                   0.04  $               0.04        $               0.04  $                 0.04  $                        0.04  $           0.02  $             0.04  $               0.04
  Clindamycin Capsule 150 Mg   637  $                                 0.08  $                          0.06  $                                   0.03  $                                   0.07  $               0.06        $               0.06  $                 0.07  $                        0.06  $           0.03  $             0.06  $               0.06
  Lidocaine  Hcl/Pf Vial 2% 20Mg/Ml 5Ml   250  $                                 3.47  $                          2.43  $                                   1.35  $                                   2.77  $               2.49        $               2.67  $                 2.77  $                        2.43  $           1.35  $             2.32  $               2.32
  Major surgery between two hundred eleven minutes and two hundred fourty minutes   360  $                        10,056.90  $                   7,039.83  $                            3,922.19  $                            8,045.52  $        7,240.97        $        7,743.81  $          8,045.52  $                 7,039.83  $    3,922.19  $      6,738.12  $        6,738.12
  Major surgery, more than two hundred fourty-one minutes   360  $                        11,030.25  $                   7,721.18  $                            4,301.80  $                            8,824.20  $        7,941.78        $        8,493.29  $          8,824.20  $                 7,721.18  $    4,301.80  $      7,390.27  $        7,390.27
  Hernia Tacker   270  $                               68.25