| Code | Price | Type | Description |
| 0 | $0.00 | HCPCS / CPT® | COURTESY – MEDICARE |
| 1 | $0.00 | HCPCS / CPT® | COURTESY – MEDICAID |
| 2 | $0.00 | HCPCS / CPT® | COURTESY – TRICARE |
| 10101 | $0.00 | HCPCS / CPT® | INTEREST |
| 10021 | $759.00 | HCPCS / CPT® | FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE |
| 10060 | $994.92 | HCPCS / CPT® | INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE |
| 10061 | $1306.68 | HCPCS / CPT® | INCISION&DRAINAGE ABSCESS COMPLICATED/MULTIPLE |
| 10080 | $574.38 | HCPCS / CPT® | INCISION & DRAINAGE PILONIDAL CYST SIMPLE |
| 10081 | $772.98 | HCPCS / CPT® | INCISION & DRAINAGE PILONIDAL CYST COMPLICATED |
| 10120 | $263.27 | HCPCS / CPT® | INCISION&REMOVAL FOREIGN BODY SUBQ TISS SMPL |
| 10121 | $765.32 | HCPCS / CPT® | INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMP |
| 10140 | $750.00 | HCPCS / CPT® | I&D HEMATOMA SEROMA/FLUID COLLECTION |
| 10160 | $810.00 | HCPCS / CPT® | PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST |
| 11000 | $1000.00 | HCPCS / CPT® | DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN UP TO 10 OF BODY SURFACE |
| 11011 | $344.40 | HCPCS / CPT® | DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC |
| 11040 | $269.40 | HCPCS / CPT® | DEBRIDEMENT SKIN PARTIAL THICKNESS |
| 11042 | $336.74 | HCPCS / CPT® | REMOVAL DAMAGED SKIN AND UNDERLYING TISSUE |
| 11200 | $384.19 | HCPCS / CPT® | REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA UP&W/15< |
| 11400 | $1134.36 | HCPCS / CPT® | Exc tr-ext b9+marg 0.5 cm< |
| 11404 | $1092.88 | HCPCS / CPT® | EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM |
| 11730 | $381.13 | HCPCS / CPT® | AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 |
| 11740 | $396.83 | HCPCS / CPT® | EVACUATION SUBUNGUAL HEMATOMA |
| 11750 | $700.92 | HCPCS / CPT® | EXCISION NAIL MATRIX PERMANENT REMOVAL |
| 11760 | $244.79 | HCPCS / CPT® | REPAIR NAIL BED |
| 11762 | $1150.00 | HCPCS / CPT® | Reconstruction of nail bed with graft |
| 11765 | $385.44 | HCPCS / CPT® | WEDGE EXCISION SKIN NAIL FOLD |
| 11771 | $335.28 | HCPCS / CPT® | EXCISION PILONIDAL CYST/SINUS EXTENSIVE |
| 12001 | $480.48 | HCPCS / CPT® | SIMPLE REPAIR SCALPNECKAXGENITTRUNK 2 5CM |
| 12002 | $487.08 | HCPCS / CPT® | SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM |
| 12004 | $561.00 | HCPCS / CPT® | SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM |
| 12005 | $744.48 | HCPCS / CPT® | SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM |
| 12011 | $724.88 | HCPCS / CPT® | SIMPLE REPAIR FACE/EAR/EYE/NOSE/LIP/MOUTH 2.5CM OR LESS |
| 12013 | $757.90 | HCPCS / CPT® | SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0CM |
| 12014 | $887.12 | HCPCS / CPT® | SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM |
| 12015 | $471.63 | HCPCS / CPT® | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm |
| 12020 | $363.00 | HCPCS / CPT® | TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE |
| 12031 | $570.24 | HCPCS / CPT® | REPAIR INTERMEDIATE SCALP/AXILLA/TRUNK/EXTREMITY 2.5 CM OR LESS |
| 12032 | $861.17 | HCPCS / CPT® | LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK/OR EXTREMITIES (EXCLUDING HANDS AND FEET);2.6CM TO 7.5 CM |
| 12034 | $799.92 | HCPCS / CPT® | REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM |
| 12036 | $2702.11 | HCPCS / CPT® | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm |
| 12041 | $592.68 | HCPCS / CPT® | REPAIR INTERMEDIATE N/H/F/XTRNL GENT LESS THAN 2.5CM |
| 12042 | $861.17 | HCPCS / CPT® | REPAIR (LACERATION)INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM |
| 12044 | $861.96 | HCPCS / CPT® | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM |
| 12051 | $671.88 | HCPCS / CPT® | REPAIR INTERMEDIATE FACE/EAR/EYE/NOSE/LIP/MOUTH&/MUC 2.5 CM OR LESS |
| 12052 | $801.24 | HCPCS / CPT® | REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 2.6-5.0 CM |
| 12053 | $1082.40 | HCPCS / CPT® | REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 5.1-7.5 CM |
| 12054 | $471.63 | HCPCS / CPT® | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm |
| 13101 | $1398.28 | HCPCS / CPT® | REPAIR COMPLEX TRUNK 2.6 CM-7.5 CM |
| 13120 | $859.32 | HCPCS / CPT® | REPAIR COMPLEX SCALP/ARM/LEG 1.1 CM-2.5 CM |
| 13121 | $1398.28 | HCPCS / CPT® | REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5 CM |
| 13122 | $601.00 | HCPCS / CPT® | REPAIR COMPLEX SCALP-ARM-LEG EA 5 CM |
| 13131 | $574.92 | HCPCS / CPT® | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1 CM-2.5 CM |
| 13132 | $1652.64 | HCPCS / CPT® | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6 CM-7.5 CM |
| 13133 | $2800.00 | HCPCS / CPT® | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA 5 CM |
| 13151 | $1193.28 | HCPCS / CPT® | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM |
| 13152 | $2071.08 | HCPCS / CPT® | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM |
| 13153 | $756.36 | HCPCS / CPT® | REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM/< |
| 16000 | $310.20 | HCPCS / CPT® | INITIAL TX 1ST DEGREE BURN LOCAL TX |
| 16020 | $304.92 | HCPCS / CPT® | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL |
| 16025 | $850.00 | HCPCS / CPT® | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM |
| 17999 | $196.88 | HCPCS / CPT® | UNLISTED PX SKIN MUC MEMBRANE &SUBQ TISSUE |
| 19020 | $11019.68 | HCPCS / CPT® | MASTOTOMY W/EXPL/DRAINAGE ABSCESS DEEP |
| 20520 | $1386.00 | HCPCS / CPT® | REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE |
| 20552 | $1406.52 | HCPCS / CPT® | INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES |
| 20600 | $826.55 | HCPCS / CPT® | ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA |
| 20605 | $269.40 | HCPCS / CPT® | ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA |
| 20610 | $950.00 | HCPCS / CPT® | ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA |
| 20612 | $175.00 | HCPCS / CPT® | ASPIRATE/INJ GANGLION CYST |
| 21310 | $653.59 | HCPCS / CPT® | CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION |
| 21315 | $3500.00 | HCPCS / CPT® | CLOSED TX NASAL FRACTURE W/O STABILIZATION |
| 21480 | $573.76 | HCPCS / CPT® | RESET DISLOCATED JAW |
| 21501 | $858.00 | HCPCS / CPT® | I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX |
| 21705 | $765.32 | HCPCS / CPT® | DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB |
| 21800 | $480.48 | HCPCS / CPT® | CLOSED TX RIB FRACTURE UNCOMPLICATED EACH |
| 21812 | $502.32 | HCPCS / CPT® | CLOSED TX RIB FRACTURE UNCOMPLICATED EACH |
| 21820 | $735.08 | HCPCS / CPT® | TREAT STERNUM FRACTURE |
| 23500 | $1066.87 | HCPCS / CPT® | CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION |
| 23540 | $900.00 | HCPCS / CPT® | Closed treatment of acromioclavicular dislocation; without manipulation |
| 23625 | $2253.73 | HCPCS / CPT® | CLTX GREATER HUMERAL TUBEROSITY FX W/ MNP |
| 23650 | $1224.52 | HCPCS / CPT® | CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES |
| 23655 | $1738.82 | HCPCS / CPT® | CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES |
| 23665 | $2500.00 | HCPCS / CPT® | CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROSITY |
| 23931 | $1834.80 | HCPCS / CPT® | INCISION&DRAINAGE UPPER ARM/ELBOW BURSA |
| 24201 | $7859.21 | HCPCS / CPT® | REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP |
| 24500 | $427.68 | HCPCS / CPT® | CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION |
| 24530 | $1824.53 | HCPCS / CPT® | CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX+-MNPJ |
| 24600 | $882.09 | HCPCS / CPT® | TREATMENT OF CLOSED ELBOW DISLOCATION WITHOUT ANESTHESIA |
| 24605 | $7146.58 | HCPCS / CPT® | TREATMENT ELBOW DISLOCATION |
| 24640 | $1200.00 | HCPCS / CPT® | CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MNPJ |
| 24650 | $1258.19 | HCPCS / CPT® | CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION |
| 24655 | $2500.00 | HCPCS / CPT® | CLOSED TX RADIAL HEAD/NECK FX W MANIPULATION |
| 24670 | $1500.00 | HCPCS / CPT® | CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MNPJ |
| 25505 | $2500.00 | HCPCS / CPT® | CLOSED TREATMENT OF RADIAL SHAFT FRACTURE WITH MANIPULATION |
| 25565 | $1740.35 | HCPCS / CPT® | CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ |
| 25600 | $1300.00 | HCPCS / CPT® | CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ |
| 25605 | $2612.82 | HCPCS / CPT® | CLTX DSTL RDL FX/EPIPHYSL SEP +-W/MNPJ |
| 25622 | $2712.30 | HCPCS / CPT® | CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ |
| 25635 | $1421.98 | HCPCS / CPT® | CLTX CARPL B1 FX W/MNPJ EA B1 |
| 25675 | $1836.78 | HCPCS / CPT® | CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION |
| 26010 | $390.32 | HCPCS / CPT® | DRAINAGE FINGER ABSCESS SIMPLE |
| 26011 | $3212.50 | HCPCS / CPT® | DRAINAGE OF FINGER ABCESS |
| 26600 | $1192.38 | HCPCS / CPT® | CLTX MTCRPL FX 1 W/O MNPJ EA B1 |
| 26605 | $1380.64 | HCPCS / CPT® | CLTX MTCRPL FX 1 W/MNPJ EA B1 |
| 26607 | $2190.36 | HCPCS / CPT® | CLTX MTCRPL FX W/MNPJ W/XTRNL FIXJ EA B1 |
| 26700 | $805.03 | HCPCS / CPT® | CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA |
| 26705 | $845.34 | HCPCS / CPT® | TREAT KNUCKLE DISLOCATION |
| 26720 | $823.49 | HCPCS / CPT® | CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITHOUT MANIPULATION, EACH |
| 26725 | $1348.50 | HCPCS / CPT® | CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITH MANIPULATION, EACH |
| 26750 | $805.03 | HCPCS / CPT® | CLTX DSTL PHLNGL FX FNGR/THMB W/O MNPJ EA |
| 26755 | $811.24 | HCPCS / CPT® | CLTX DSTL PHLNGL FX FNGR/THMB W/MNPJ EA |
| 26770 | $734.71 | HCPCS / CPT® | CLTX IPHAL JT DISLC 1 W/MNPJ W/O ANES |
| 26775 | $6572.12 | HCPCS / CPT® | CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIOPULATION; REQUIRING ANESTHESIA |
| 27372 | $459.20 | HCPCS / CPT® | REMOVAL FOREIGN BODY DEEP THIGH/KNEE |
| 27520 | $1579.63 | HCPCS / CPT® | CLOSED TX PATELLAR FRACTURE W/O MANIPULATION |
| 27550 | $1792.39 | HCPCS / CPT® | CLOSED TX KNEE DISLOCATION W/O ANESTHESIA |
| 27560 | $804.28 | HCPCS / CPT® | CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA |
| 27750 | $1424.77 | HCPCS / CPT® | CLTX TIBL SHFT FX W/O MNPJ |
| 27752 | $2580.68 | HCPCS / CPT® | CLTX TIBL SHFT FX W/MNPJ +-SKEL TRACJ |
| 27760 | $1510.75 | HCPCS / CPT® | CLTX MEDIAL MALLS FX W/O MNPJ |
| 27780 | $1750.00 | HCPCS / CPT® | CLOSED TREATMENT OF PROXIMAL FIBULA SHAFT FRACTURE WITHOUT MANIPULATION |
| 27786 | $1800.00 | HCPCS / CPT® | CLOSED TXT DISTAL FIBULAR FX LATERAL MALLEOLUS W/O MANIPULATION |
| 27788 | $2400.00 | HCPCS / CPT® | CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE LATERAL MALLEOLUS WITH MANIPULATION |
| 27808 | $1350.00 | HCPCS / CPT® | Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation |
| 27810 | $845.34 | HCPCS / CPT® | TREATMENT OF ANKLE FRACTURE |
| 27818 | $2500.00 | HCPCS / CPT® | Closed treatment of trimalleolar ankle fracture; with manipulation |
| 27824 | $845.34 | HCPCS / CPT® | CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MNPJ |
| 27840 | $499.28 | HCPCS / CPT® | CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA |
| 28190 | $976.56 | HCPCS / CPT® | REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS |
| 28192 | $5182.47 | HCPCS / CPT® | REMOVAL OF FOOT FOREIGN BODY |
| 28400 | $1250.00 | HCPCS / CPT® | CLOSED TREATMENT OF CALCANEAL FRACTURE WITHOUT MANIPULATION |
| 28430 | $853.02 | HCPCS / CPT® | CLOSED TX TALUS FRACTURE W/O MANIPULATION |
| 28450 | $800.00 | HCPCS / CPT® | Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each |
| 28470 | $1102.07 | HCPCS / CPT® | CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION |
| 28490 | $495.93 | HCPCS / CPT® | CLTX FX GRT TOE PHLX/PHLG W/O MNPJ |
| 28495 | $750.00 | HCPCS / CPT® | CLOSED TXT FX OF GREAT TOE PHLX/PHLG W/MANIPULATION |
| 28510 | $685.73 | HCPCS / CPT® | CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MNPJ |
| 28515 | $815.83 | HCPCS / CPT® | CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MNPJ |
| 28660 | $805.03 | HCPCS / CPT® | CLTX IPHAL JT DISLC W/O ANES |
| 29049 | $1425.00 | HCPCS / CPT® | APPLICATION OF FIGURE EIGHT SLING AND SWATHE |
| 29085 | $229.60 | HCPCS / CPT® | CAST HAND&LOWER FOREARM GAUNTLET |
| 29105 | $840.00 | HCPCS / CPT® | LONG ARM SPLINT SHOULDER HAND |
| 29125 | $229.60 | HCPCS / CPT® | SHORT ARM SPLINT FOREARM-HAND STATIC |
| 29126 | $229.60 | HCPCS / CPT® | SHORT ARM SPLINT DYNAMIC |
| 29130 | $229.60 | HCPCS / CPT® | FINGER SPLINT STATIC |
| 29240 | $507.63 | HCPCS / CPT® | STRAPPING; SHOULDER |
| 29260 | $341.11 | HCPCS / CPT® | STRAPPING; ELBOW OR WRIST |
| 29280 | $313.79 | HCPCS / CPT® | STRAPPING HAND/FINGER |
| 29505 | $229.60 | HCPCS / CPT® | LONG LEG SPLINT THIGH ANKLE/TOES |
| 29515 | $229.60 | HCPCS / CPT® | SHORT LEG SPLINT CALF FOOT |
| 29530 | $431.43 | HCPCS / CPT® | STRAPPING; KNEE |
| 29540 | $287.76 | HCPCS / CPT® | STRAPPING ANKLE &/FOOT |
| 29550 | $287.76 | HCPCS / CPT® | STRAPPING TOES |
| 29580 | $287.76 | HCPCS / CPT® | STRAPPING UNNA BOOT |
| 29700 | $166.84 | HCPCS / CPT® | REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST |
| 30300 | $650.53 | HCPCS / CPT® | REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE |
| 30901 | $375.00 | HCPCS / CPT® | CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE |
| 30903 | $238.91 | HCPCS / CPT® | CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX |
| 30905 | $650.00 | HCPCS / CPT® | CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD, INITIAL |
| 31500 | $1075.00 | HCPCS / CPT® | INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE |
| 31502 | $1167.33 | HCPCS / CPT® | TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT |
| 31505 | $198.60 | HCPCS / CPT® | LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX |
| 31515 | $9863.77 | HCPCS / CPT® | LARYNGOSCOPY +-TRACHEOSCOPY ASPIRATION |
| 31525 | $7689.00 | HCPCS / CPT® | LARYNGOSCOPY +-TRACHEOSCOPY DX EXCEPT NEWBORN |
| 31530 | $1995.14 | HCPCS / CPT® | LARYNGOSCOPY W/FOREIGN BODY REMOVAL |
| 32421 | $1518.00 | HCPCS / CPT® | THORACENTESIS PUNCTURE PLEURAL CAVITY ASPIRATION |
| 32551 | $2951.39 | HCPCS / CPT® | TUBE THORACOSTOMY INCLUDES WATER SEAL |
| 32554 | $1360.89 | HCPCS / CPT® | Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance |
| 33415 | $1285.75 | HCPCS / CPT® | RESCJ/INC SUBVALVULAR TISSUE |
| 36000 | $321.44 | HCPCS / CPT® | INTRO NDL/INTRACATH VEIN |
| 36415 | $350.00 | HCPCS / CPT® | VENIPUNCTURE |
| 36416 | $53.58 | HCPCS / CPT® | CAPILLARY COLLECTION BLOOD SPECIMEN (FINGERSTICK) |
| 36556 | $5850.00 | HCPCS / CPT® | INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR OLDER |
| 36558 | $2828.74 | HCPCS / CPT® | INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ PORT/PMP AGE 5 YR/> |
| 36571 | $2439.43 | HCPCS / CPT® | INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> |
| 36591 | $191.34 | HCPCS / CPT® | COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE |
| 36880 | $713.84 | HCPCS / CPT® | INTRAOSSEOUS LINE PLACEMENT |
| 37195 | $1500.00 | HCPCS / CPT® | Thrombolysis, cerebral, by intravenous infusion |
| 38300 | $396.83 | HCPCS / CPT® | DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL |
| 40650 | $3921.14 | HCPCS / CPT® | REPAIR LIP, FULL THICKNESS; VERMILLION ONLY |
| 41250 | $360.51 | HCPCS / CPT® | REPAIR TONGUE LACERATION |
| 41251 | $858.00 | HCPCS / CPT® | RPR LAC 2.5 CM/< PST ONE-3RD TONGUE |
| 41800 | $975.00 | HCPCS / CPT® | Drainage of abscess, cyst, hematoma from dentoalveolar structures |
| 42700 | $1758.80 | HCPCS / CPT® | I&D ABSC PRITONSILLAR |
| 42809 | $675.00 | HCPCS / CPT® | REMOVAL OF FB FROM PHARYNX |
| 43753 | $522.56 | HCPCS / CPT® | GASTRIC TUBE PLMT W/ASPIR & LAVAGE |
| 46040 | $1513.81 | HCPCS / CPT® | I&D ISCHIORCT&/PRIRCT ABSC SPX |
| 46050 | $2778.89 | HCPCS / CPT® | I&D PRIANAL ABSC SUPFC |
| 46083 | $1044.67 | HCPCS / CPT® | INC THROMBOSED HEMORRHOID XTRNL |
| 46320 | $802.06 | HCPCS / CPT® | ENCL/EXC XTRNL THROMBOTIC HEMORRHOID |
| 51700 | $126.74 | HCPCS / CPT® | BLDR IRRIGATION SMPL LVG&/INSTLJ |
| 51701 | $303.07 | HCPCS / CPT® | CATHETERIZATION, BLADDER |
| 51702 | $472.97 | HCPCS / CPT® | INSJ TEMP NDWELLG BLDR CATH SMPL |
| 51703 | $745.43 | HCPCS / CPT® | INSJ TEMP NDWELLG BLDR CATH COMP |
| 54220 | $840.13 | HCPCS / CPT® | Irrigation of corpora cavernosa for priapism |
| 54450 | $1533.31 | HCPCS / CPT® | FORESKN MNPJ W/LSS PREPUTIAL ADS&STRETCHING |
| 56405 | $786.15 | HCPCS / CPT® | I&D VULVA/PRNL ABSC |
| 56420 | $130.11 | HCPCS / CPT® | I&D OF BARTHOLIN’S GLAND ABSC |
| 57180 | $450.00 | HCPCS / CPT® | TREAT VAGINAL BLEEDING |
| 58301 | $652.08 | HCPCS / CPT® | Removal of intrauterine device (IUD) |
| 59025 | $750.00 | HCPCS / CPT® | FETAL NON-STRESS TEST |
| 59409 | $4478.89 | HCPCS / CPT® | VAG DLVR ONLY |
| 62270 | $3275.00 | HCPCS / CPT® | SPINAL TAP FLUID |
| 64400 | $1400.00 | HCPCS / CPT® | NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH |
| 64402 | $1350.00 | HCPCS / CPT® | NERVE BLOCK – ANESTHESIA FACIAL NERVE |
| 64450 | $750.00 | HCPCS / CPT® | NERVE BLOCK ANES OTHER PRPH NRV/BRANCH |
| 64640 | $1600.65 | HCPCS / CPT® | DSTRJ NULYT OTH PRPH NRV/BRANCH |
| 65205 | $321.44 | HCPCS / CPT® | RMVL FB XTRNL EYE |
| 65210 | $488.80 | HCPCS / CPT® | Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating |
| 65220 | $497.47 | HCPCS / CPT® | RMVL FB XTRNL EYE CRNL W/O SLIT LAMP |
| 65222 | $587.77 | HCPCS / CPT® | RMVL FB XTRNL EYE CRNL W/SLIT LAMP |
| 65435 | $726.00 | HCPCS / CPT® | RMVL CRNL EPITHE +-CHEMOCAUT |
| 67700 | $1014.82 | HCPCS / CPT® | BLEPHAROTOMY DRG ABSC EYELID |
| 69000 | $793.48 | HCPCS / CPT® | DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE |
| 69200 | $499.00 | HCPCS / CPT® | REMOVAL OF FOREIGN BODY OF EAR XTRNL AUD CANAL W/O ANES |
| 69205 | $535.73 | HCPCS / CPT® | RMVL FB XTRNL AUD CANAL ANES |
| 69209 | $150.00 | HCPCS / CPT® | REMOVE IMPACTED EAR WAX UNILATERAL |
| 69210 | $257.15 | HCPCS / CPT® | REMOVAL IMPACTED CERUMEN REQ INSTRUMENTATION; UNILATERAL |
| 69399 | $500.00 | HCPCS / CPT® | Procedure performed on external ear |
| 70030 | $345.00 | HCPCS / CPT® | RADEX EYE DETCJ FB |
| 70100 | $460.34 | HCPCS / CPT® | XRAY MANDIBLE LESS THAN 4 VIEWS |
| 70110 | $460.34 | HCPCS / CPT® | XRAY MANDIBLE 4 OR MORE VIEWS |
| 70150 | $655.12 | HCPCS / CPT® | RADEX FACIAL B1S COMPL MINIMUM 3 VIEWS |
| 70160 | $307.21 | HCPCS / CPT® | XRAY NASAL BONE MINIMUM OF 3 VIEWS |
| 70200 | $471.09 | HCPCS / CPT® | X-RAY EXAM OF EYE SOCKETS, MINIMUM OF 4 VIEWS |
| 70210 | $365.70 | HCPCS / CPT® | XRAY SINUSES PARANSL LESS THAN 3 VIEWS |
| 70220 | $645.93 | HCPCS / CPT® | XRAY SINUSES PARANASAL COMPLETE MINIMUM OF 3 VIEWS |
| 70250 | $496.66 | HCPCS / CPT® | XRAY SKULL LESS THAN 4 VIEWS |
| 70260 | $657.50 | HCPCS / CPT® | RADEX SKL COMPL MINIMUM 4 VIEWS |
| 70328 | $460.34 | HCPCS / CPT® | RADEX TMPRMAND JT OPN&CLSD MOUTH UNI |
| 70330 | $460.34 | HCPCS / CPT® | X-RAY EXAM OF JAW JOINT |
| 70350 | $336.74 | HCPCS / CPT® | CEPHALOGRAM ORTHODONTIC |
| 70360 | $895.13 | HCPCS / CPT® | RADEX OF NECK SOFT TISSUE |
| 70380 | $178.35 | HCPCS / CPT® | RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS |
| 70450 | $4986.50 | HCPCS / CPT® | CT HEAD-BRAIN WITHOUT CONTRAST |
| 70460 | $7356.03 | HCPCS / CPT® | CT HEAD-BRAIN WITH CONTRAST |
| 70470 | $11942.53 | HCPCS / CPT® | CT HEAD-BRAIN WITH & WITHOUT CONTRAST |
| 70480 | $1530.65 | HCPCS / CPT® | CT ORBIT SELLA/POST FOSSA/EAR C-MATRL |
| 70481 | $3116.56 | HCPCS / CPT® | CT ORBIT SELLA/POST FOSSA/EAR C+ MATRL |
| 70486 | $2519.04 | HCPCS / CPT® | CT SCAN MAXLFCL AREA C-MATRL – SINUS AREA |
| 70487 | $2142.91 | HCPCS / CPT® | CT MAXLFCL AREA C+ MATRL |
| 70488 | $2546.24 | HCPCS / CPT® | CT MAXLFCL AREA C-/C+ |
| 70490 | $1200.00 | HCPCS / CPT® | CT SOFT TISSUE NECK WITHOUT CONTRAST |
| 70491 | $2537.00 | HCPCS / CPT® | CT SOFT TISSUE NECK WITH CONTRAST |
| 70492 | $2600.00 | HCPCS / CPT® | CT SOFT TISSUE NECK WITH AND WITHOUT CONTRAST |
| 70496 | $6498.38 | HCPCS / CPT® | CTA HEAD WITH AND WITHOUT CONTRAST |
| 70498 | $2145.69 | HCPCS / CPT® | CTA NECK WITH AND WITHOUT CONTRAST |
| 70544 | $4132.75 | HCPCS / CPT® | MRA HEAD C-MATRL |
| 70547 | $3635.84 | HCPCS / CPT® | MRA NCK C-MATRL |
| 70551 | $3635.84 | HCPCS / CPT® | MRI BRN BRN STEM C-MATRL |
| 70553 | $4285.82 | HCPCS / CPT® | MRI BRN BRN STEM C-/C+ |
| 71010 | $391.71 | HCPCS / CPT® | XRAY CHEST ONE VIEW |
| 71020 | $609.62 | HCPCS / CPT® | XRAY CHEST 2 VIEW FRONTAL AND LATERAL |
| 71030 | $687.26 | HCPCS / CPT® | RADEX CH COMPL MINIMUM 4 VIEWS |
| 71045 | $665.91 | HCPCS / CPT® | XRAY CHEST ONE VIEW |
| 71046 | $786.65 | HCPCS / CPT® | XRAY CHEST 2 VIEW FRONTAL AND LATERAL |
| 71100 | $345.77 | HCPCS / CPT® | RADEX RIBS UNI 2 VIEWS |
| 71101 | $1175.95 | HCPCS / CPT® | RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS |
| 71110 | $668.90 | HCPCS / CPT® | RADEX RIBS BI 3 VIEWS |
| 71111 | $804.06 | HCPCS / CPT® | RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS |
| 71120 | $334.45 | HCPCS / CPT® | RADEX STERNUM MINIMUM 2 VIEWS |
| 71250 | $6893.53 | HCPCS / CPT® | CT THORAX C-MATRL |
| 71260 | $7794.08 | HCPCS / CPT® | CT THORAX C+ MATRL |
| 71270 | $7579.40 | HCPCS / CPT® | CT THORAX C-/C+ |
| 71275 | $9006.53 | HCPCS / CPT® | CTA CHEST WITH AND WITHOUT CONTRAST |
| 71550 | $3635.30 | HCPCS / CPT® | MRI CH C-MATRL |
| 72020 | $412.25 | HCPCS / CPT® | XRAY SPINE 1 VIEW SPECIFY LEVEL |
| 72040 | $879.98 | HCPCS / CPT® | XRAY CERVICAL 2 OR 3 VIEWS |
| 72050 | $642.87 | HCPCS / CPT® | XRAY CERVICAL 4 VIEWS |
| 72052 | $1102.07 | HCPCS / CPT® | XRAY CERVICAL 6 OR MORE VIEWS |
| 72069 | $962.31 | HCPCS / CPT® | XRAY SPINE THORACOLUMBAR STANDING SCOLIOSIS |
| 72070 | $898.07 | HCPCS / CPT® | XRAY THORACIC 2 VIEWS |
| 72072 | $1308.71 | HCPCS / CPT® | XRAY THORACIC 3 VIEWS |
| 72074 | $701.71 | HCPCS / CPT® | XRAY THORACIC 4 VIEWS |
| 72080 | $290.64 | HCPCS / CPT® | X RAY EXAM TRUNK SPINE 2VWS |
| 72100 | $1107.64 | HCPCS / CPT® | XRAY LUMBAR 2 OR 3 VIEWS |
| 72110 | $1040.84 | HCPCS / CPT® | XRAY LUMBAR 4 VIEWS |
| 72114 | $612.26 | HCPCS / CPT® | XRAY LUMBAR 6 OR MORE VIEWS |
| 72120 | $727.06 | HCPCS / CPT® | XRAY SPINE LUMBOSACRAL BENDING MINIMUM 4 VIEWS |
| 72125 | $5568.78 | HCPCS / CPT® | CT CERVICAL SPINE WITHOUT CONTRAST |
| 72126 | $7735.34 | HCPCS / CPT® | CT CERVICAL SPINE WITH CONTRAST |
| 72127 | $13268.78 | HCPCS / CPT® | CT CERVICAL SPINE W & WITHOUT CONTRAST |
| 72128 | $5152.70 | HCPCS / CPT® | CT THORACIC SPINE WITHOUT CONTRAST |
| 72129 | $7306.70 | HCPCS / CPT® | CT THORACIC SPINE WITH CONTRAST |
| 72131 | $6820.25 | HCPCS / CPT® | CT LUMBAR SPINE WITHOUT CONTRAST |
| 72132 | $8716.24 | HCPCS / CPT® | CT LUMBAR SPINE WITH CONTRAST |
| 72133 | $15524.87 | HCPCS / CPT® | CT LUMBAR SPINE WITH AND WITHOUT CONTRAST |
| 72141 | $2449.04 | HCPCS / CPT® | MRI SPI CANAL&CNTS CRV C-MATRL |
| 72146 | $3635.84 | HCPCS / CPT® | MRI SPI CANAL&CNTS THRC C-MATRL |
| 72148 | $3635.84 | HCPCS / CPT® | MRI SPI CANAL&CNTS LMBR C-MATRL |
| 72156 | $4285.82 | HCPCS / CPT® | MRI SPI CANAL&CNTS C-/C+ CRV |
| 72157 | $3635.84 | HCPCS / CPT® | MRI SPI CANAL&CNTS C-/C+ |
| 72158 | $3673.56 | HCPCS / CPT® | MRI SPI CANAL&CNTS C-/C+ LMBR |
| 72170 | $497.47 | HCPCS / CPT® | XRAY PELVIS 1 OR 2 VIEWS |
| 72190 | $569.55 | HCPCS / CPT® | XRAY PELVIS COMPLETE MINIMUM 3 VIEWS |
| 72191 | $1980.28 | HCPCS / CPT® | CTA PELVIS WITH & WITHOUT CONTRAST |
| 72192 | $3644.48 | HCPCS / CPT® | CT PELVIS WITHOUT CONTRAST |
| 72193 | $2404.50 | HCPCS / CPT® | CT PELVIS WITH CONTRAST |
| 72194 | $6622.05 | HCPCS / CPT® | CT PELVIS WITH & WITHOUT CONTRAST |
| 72195 | $3635.84 | HCPCS / CPT® | MRI PELVIS C-MATRL |
| 72196 | $4898.08 | HCPCS / CPT® | MRI PELVIS C+ MATRL |
| 72220 | $372.25 | HCPCS / CPT® | XRAY SACRUM & COCCYX MINIMUM 2 VIEWS |
| 73000 | $366.13 | HCPCS / CPT® | XRAY CLAVICLE COMPLETE |
| 73010 | $423.02 | HCPCS / CPT® | XRAY SCAPULA COMPLETE |
| 73020 | $303.29 | HCPCS / CPT® | XRAY SHOULDER 1 VIEW |
| 73030 | $911.18 | HCPCS / CPT® | XRAY SHOULDER 2 OR MORE VIEWS |
| 73040 | $2205.64 | HCPCS / CPT® | CONTRAST X RAY OF SHOULDER |
| 73050 | $486.75 | HCPCS / CPT® | RADEX ACROMCLAV JTS BI +-W8ED DISTRCJ |
| 73060 | $845.35 | HCPCS / CPT® | XRAY HUMERUS MINIMUM 2 VIEWS |
| 73070 | $843.21 | HCPCS / CPT® | XRAY ELBOW 2 VIEWS |
| 73080 | $1327.08 | HCPCS / CPT® | XRAY ELBOW COMPLETE MINIMUM 3 VIEWS |
| 73090 | $749.87 | HCPCS / CPT® | XRAY FOREARM 2 VIEWS |
| 73100 | $495.63 | HCPCS / CPT® | RADEX WRST 2 VIEWS |
| 73110 | $945.53 | HCPCS / CPT® | XRAY WRIST MINIMUM 3 VIEWS |
| 73120 | $422.12 | HCPCS / CPT® | RADEX HAND 2 VIEWS |
| 73130 | $1030.54 | HCPCS / CPT® | XRAY HAND MINIMUM 3 VIEWS |
| 73140 | $466.85 | HCPCS / CPT® | XRAY FINGER MINIMUM 2 VIEWS |
| 73200 | $1917.90 | HCPCS / CPT® | CT UPPER EXTREMITY WITHOUT MATERIAL |
| 73201 | $1188.00 | HCPCS / CPT® | CT UPPER EXTREMITY WITH CONTRAST |
| 73220 | $4285.82 | HCPCS / CPT® | MRI UXTR OTH/THN JT C-/C+ |
| 73221 | $3635.84 | HCPCS / CPT® | MRI ANY JT UXTR C-MATRL |
| 73501 | $250.00 | HCPCS / CPT® | Radiologic examination, hip, unilateral, with pelvis when performed; 1 view |
| 73502 | $764.56 | HCPCS / CPT® | XRAY HIP UNILATERAL 2-3 VIEWS |
| 73510 | $624.24 | HCPCS / CPT® | XRAY HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS |
| 73520 | $813.12 | HCPCS / CPT® | XRAY HIP BILATERAL 2 VIEWS ANTEROPOSTERIOR PELVIS |
| 73521 | $316.80 | HCPCS / CPT® | XRAY HIPS BILATERAL 2 VIEWS ANTEROPOSTERIOR PELVIS |
| 73522 | $421.54 | HCPCS / CPT® | XRAY HIPS BILATERAL 3-4 VIEWS ANTEROPOSTERIOR PELVIS |
| 73552 | $827.90 | HCPCS / CPT® | XRAY FEMUR 2 VIEWS |
| 73560 | $864.77 | HCPCS / CPT® | XRAY KNEE 1-2 VIEWS |
| 73562 | $997.35 | HCPCS / CPT® | XRAY KNEE 3 VIEWS |
| 73564 | $515.76 | HCPCS / CPT® | XRAY KNEE COMPLETE 4 OR MORE VIEWS |
| 73590 | $983.26 | HCPCS / CPT® | RADEX TIBFIB 2 VIEWS |
| 73592 | $391.47 | HCPCS / CPT® | RADEX LXTR INFT MINIMUM 2 VIEWS |
| 73600 | $307.21 | HCPCS / CPT® | RADEX ANKLE 2 VIEWS |
| 73610 | $964.53 | HCPCS / CPT® | RADEX ANKLE COMPL MINIMUM 3 VIEWS |
| 73620 | $775.35 | HCPCS / CPT® | RADEX FOOT 2 VIEWS |
| 73630 | $901.87 | HCPCS / CPT® | RADEX FOOT COMPL MINIMUM 3 VIEWS |
| 73650 | $420.93 | HCPCS / CPT® | RADEX CALCANEUS MINIMUM 2 VIEWS |
| 73652 | $294.49 | HCPCS / CPT® | RADEX KNE 3 VIEWS |
| 73660 | $306.13 | HCPCS / CPT® | RADEX TOE MINIMUM 2 VIEWS |
| 73700 | $1110.00 | HCPCS / CPT® | CT LOWER EXTREMITY WITHOUT CONTRAST |
| 73701 | $1500.00 | HCPCS / CPT® | CT LOWER EXTREMITY WITH CONTRAST |
| 73702 | $1750.00 | HCPCS / CPT® | CT LOWER EXTREMITY WITH & WITHOUT CONTRAST |
| 73721 | $3635.84 | HCPCS / CPT® | MRI ANY JT LXTR C-MATRL |
| 73722 | $4034.04 | HCPCS / CPT® | MRI ANY JT LXTR C+ MATRL |
| 73723 | $6622.05 | HCPCS / CPT® | MRI ANY JT LXTR C-/C+ |
| 73725 | $4898.08 | HCPCS / CPT® | MRA LXTR C+-MATRL |
| 74000 | $994.92 | HCPCS / CPT® | XRAY ABDOMEN – KUB 1 ANTEROPOSTERIOR VIEW |
| 74010 | $558.69 | HCPCS / CPT® | XRAY ABDOMEN AP, OBLIQUE & CONE VIEWS |
| 74018 | $450.00 | HCPCS / CPT® | XRAY ABDOMEN – 1 VIEW |
| 74019 | $725.00 | HCPCS / CPT® | XRAY ABDOMEN – 2 VIEWS |
| 74020 | $595.42 | HCPCS / CPT® | XRAY ABDOMEN COMPLETE WITH DECUBITUS & ERECT VIEWS |
| 74021 | $725.00 | HCPCS / CPT® | XRAY ABDOMEN – 3 VIEWS |
| 74022 | $747.59 | HCPCS / CPT® | XRAY ABDOMEN COMPLETE AAS WITH 1 VIEW CHEST |
| 74150 | $5711.02 | HCPCS / CPT® | CT ABD C-MATRL |
| 74160 | $3357.54 | HCPCS / CPT® | CT ABD C+ MATRL |
| 74170 | $3955.60 | HCPCS / CPT® | CT ABD C-/C+ |
| 74174 | $3916.22 | HCPCS / CPT® | CTA ABDOMEN PELVIS WITH AND WITHOUT CONTRAST |
| 74175 | $4239.61 | HCPCS / CPT® | CTA ABDOMEN WITH AND WITHOUT CONTRAST |
| 74176 | $5554.73 | HCPCS / CPT® | CT ABDOMEN & PELVIS W/O CONTRAST |
| 74177 | $7653.97 | HCPCS / CPT® | CT ABDOMEN & PELVIS WITH CONTRAST |
| 74178 | $12445.08 | HCPCS / CPT® | CT ABDOMEN & PELVIS WITH AND WITHOUT CONTRAST |
| 74181 | $3635.84 | HCPCS / CPT® | MRI ABD C-MATRL |
| 74183 | $4285.82 | HCPCS / CPT® | MRI ABD C-/C+ |
| 74241 | $1308.79 | HCPCS / CPT® | RADEX GI TRC UPR +-DLYD FLMS W/KUB |
| 74247 | $1323.71 | HCPCS / CPT® | RADEX GI UPR C+ +-GLUC +-DLYD FLMS W/KUB |
| 76010 | $342.86 | HCPCS / CPT® | RADEX FROM NOSE RECTUM FB 1 VIEW CHLD |
| 76376 | $841.86 | HCPCS / CPT® | 3D RNDR I&R CT MRI US/OTH X REQ POSTPCX |
| 76510 | $1120.47 | HCPCS / CPT® | Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter |
| 76536 | $1308.79 | HCPCS / CPT® | US SOFT TISSUE OF HEAD AND NECK |
| 76641 | $943.48 | HCPCS / CPT® | Ultrasound breast complete |
| 76642 | $3219.23 | HCPCS / CPT® | ULTRASOUND BREAST LIMITED |
| 76645 | $943.48 | HCPCS / CPT® | US BREAST R-T W/IMAGE DOCUMENTATION |
| 76700 | $1516.14 | HCPCS / CPT® | US ABDOMINAL COMPLETE |
| 76705 | $1347.51 | HCPCS / CPT® | US ABDOMINAL LIMITED |
| 76706 | $750.00 | HCPCS / CPT® | ULTRASOUND, ABDOMINAL AORTA, REAL TIME WITH IMAGE DOCUMENTATION, SCREENING STUDY FOR ABDOMINAL AORTIC ANEURYSM (AAA) |
| 76770 | $1093.06 | HCPCS / CPT® | US RETROPERITONEAL COMPLETE |
| 76775 | $983.77 | HCPCS / CPT® | US RETROPERITONEAL LIMITED |
| 76801 | $952.06 | HCPCS / CPT® | ULTRASOUND 14 WK TABDL 1/1ST GESTATION |
| 76805 | $1084.47 | HCPCS / CPT® | US PG UTER F&MAT AFTER 1ST TRI 1/1ST GESTATION |
| 76813 | $245.52 | HCPCS / CPT® | US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION |
| 76815 | $750.00 | HCPCS / CPT® | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED 1 OR MORE FETUSES |
| 76816 | $468.22 | HCPCS / CPT® | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION |
| 76817 | $789.51 | HCPCS / CPT® | US PG UTER R-T IMG TRVG |
| 76818 | $356.00 | HCPCS / CPT® | FTL BIOPHYSICAL PROFILE NON-STRS TSTG |
| 76825 | $1629.36 | HCPCS / CPT® | Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; |
| 76830 | $947.61 | HCPCS / CPT® | US TRVG |
| 76856 | $1100.54 | HCPCS / CPT® | US PELVIC NONOB REAL-TIME IMG COMPLETE |
| 76857 | $574.00 | HCPCS / CPT® | US PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 |
| 76870 | $1000.01 | HCPCS / CPT® | US SCROTUM&CNTS |
| 76880 | $1197.22 | HCPCS / CPT® | US EXTREMITY NON-VASC REAL-TIME IMG |
| 76881 | $636.17 | HCPCS / CPT® | US EXTREMITY NON-VASC REAL-TIME IMG COMPL |
| 76882 | $410.85 | HCPCS / CPT® | US EXTREMITY NON-VASC REAL-TIME IMG LMTD |
| 76942 | $375.00 | HCPCS / CPT® | Ultrasonic guidance for needle placement |
| 77072 | $409.64 | HCPCS / CPT® | X RAYS FOR BONE AGE |
| 77074 | $750.00 | HCPCS / CPT® | X-RAY BONE SURVEY limited |
| 77079 | $535.73 | HCPCS / CPT® | CT BONE MINERAL DENSITY STUDY 1+ SITS APPND |
| 78075 | $4745.02 | HCPCS / CPT® | ADRNL IMG CORTEX&/MEDULLA |
| 78223 | $3290.90 | HCPCS / CPT® | HIDA SCAN – HEPATBL DUX SYS IMG GLBLDR |
| 78306 | $1888.82 | HCPCS / CPT® | B1&/JT IMG WHBDY |
| 78315 | $1888.62 | HCPCS / CPT® | B1&/JT IMG 3 PHASE STD |
| 78320 | $1211.05 | HCPCS / CPT® | B1&/JT IMG TOMOG SPECT |
| 78472 | $2674.74 | HCPCS / CPT® | CARD BPI GTD =BRM PLNR 1 STD REST/STRS |
| 80047 | $334.45 | HCPCS / CPT® | BASIC METABOLIC PANEL CALCIUM IONIZED |
| 80048 | $353.58 | HCPCS / CPT® | BASIC METABOLIC PANEL CALCIUM TOTAL |
| 80051 | $364.75 | HCPCS / CPT® | ELECTROLYTE PANEL |
| 80053 | $1276.00 | HCPCS / CPT® | COMPRE METAB PANEL |
| 80061 | $363.54 | HCPCS / CPT® | LIPID PANEL |
| 80074 | $722.46 | HCPCS / CPT® | HEPATITIS PANEL |
| 80076 | $372.34 | HCPCS / CPT® | HEPATC FUNCJ PANEL |
| 80100 | $301.53 | HCPCS / CPT® | DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX |
| 80104 | $482.16 | HCPCS / CPT® | DRUG SCREEN, QUALITATIVE MULTIPLE DRUG CLASSES OTHER THAN CHROMATOGRAPHIC METHOD |
| 80158 | $243.52 | HCPCS / CPT® | Cyclosporine A Trough, Blood |
| 80164 | $202.84 | HCPCS / CPT® | DIPROPYLACETIC ACID |
| 80178 | $77.45 | HCPCS / CPT® | LITHIUM |
| 80185 | $115.44 | HCPCS / CPT® | PHENYTOIN TOT |
| 80197 | $459.20 | HCPCS / CPT® | TACROLIMUS |
| 80202 | $300.01 | HCPCS / CPT® | VANCOMYCIN |
| 80305 | $260.00 | HCPCS / CPT® | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only |
| 80306 | $275.00 | HCPCS / CPT® | UDS – DRUG SCREEN, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; READ BY INSTRUMENT ASSISTED DIRECT OPTICAL OBSERVATION (i.e. DIPSTICKS) |
| 80307 | $366.13 | HCPCS / CPT® | UDS – URINE DRUG SCREEN QUAL 1 DRUG CLASS METH EA DRUG CLASS |
| 80320 | $264.80 | HCPCS / CPT® | ALCOHOL, ETHYL SERUM OR PLASMA |
| 80329 | $289.29 | HCPCS / CPT® | ANALGESICS NON-OPIOID 1 OR 2 |
| 80435 | $585.00 | HCPCS / CPT® | Insulin tolerance panel; for growth hormone deficiency |
| 81000 | $168.37 | HCPCS / CPT® | URNLS DIP STICK/TABLET RGNT NON-AUTO MIC |
| 81001 | $111.73 | HCPCS / CPT® | URINALYSIS – URNLS DIP STICK/TABLET RGNT AUTO MIC |
| 81002 | $168.37 | HCPCS / CPT® | URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC |
| 81003 | $301.00 | HCPCS / CPT® | URINALYSIS DIP STICK/TABLET REAGENT AUTO W/O MIC |
| 81005 | $12.08 | HCPCS / CPT® | URNLS QUAL/SEMIQUAN XCPT IAS |
| 81020 | $20.55 | HCPCS / CPT® | URNLS 2/3 GLASS TST |
| 81025 | $124.12 | HCPCS / CPT® | URINE PREGNANCY TST VIS COLOR CMPRSN METHS |
| 81240 | $315.00 | HCPCS / CPT® | F2 (PROTHROMBIN, COAGULATION FACTOR II) GENE ANALYSIS, 20210G A VARIANT |
| 81241 | $380.00 | HCPCS / CPT® | F5 (COAGULATION FACTOR V) GENE ANALYSIS, LEIDEN VARIANT |
| 81291 | $250.00 | HCPCS / CPT® | MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C) |
| 82009 | $34.16 | HCPCS / CPT® | Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative |
| 82010 | $162.89 | HCPCS / CPT® | ACETONE/OTH KETONE BODIES SERUM QUAN |
| 82040 | $42.88 | HCPCS / CPT® | ASSAY OF SERUM ALBUMIN |
| 82075 | $132.09 | HCPCS / CPT® | ALCOHOL BRTH |
| 82103 | $250.00 | HCPCS / CPT® | Alpha-1-antitrypsin; total |
| 82105 | $131.67 | HCPCS / CPT® | ALPHA-FETOPROTEIN SERUM |
| 82140 | $275.00 | HCPCS / CPT® | AMMONIA ASSAY |
| 82150 | $275.52 | HCPCS / CPT® | AMYLASE |
| 82164 | $79.20 | HCPCS / CPT® | ANGIOTENSIN I-CONVERTING ENZYME |
| 82247 | $102.17 | HCPCS / CPT® | BILIRUBIN TOTAL |
| 82270 | $265.32 | HCPCS / CPT® | BLD OCLT PROXIDASE ACTV QUAL FECES 1 DETER |
| 82271 | $25.76 | HCPCS / CPT® | BLOOD, OCCULT, BY PEROXIDASE ACTIVITY EG, GUAIAC, QUALITATIVE OTHER SOURCES |
| 82272 | $153.06 | HCPCS / CPT® | BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC |
| 82274 | $102.80 | HCPCS / CPT® | BLD OCLT FECAL HGB DETER IA QUAL FECES 1-3 |
| 82306 | $36.63 | HCPCS / CPT® | Vitamin D 25 Hydroxy |
| 82310 | $116.13 | HCPCS / CPT® | ASSAY OF CALCIUM |
| 82330 | $125.00 | HCPCS / CPT® | IONIZED CALCIUM |
| 82374 | $550.84 | HCPCS / CPT® | ASSAY BLOOD CARBON DIOXIDE |
| 82376 | $33.40 | HCPCS / CPT® | CARBOXYHEMOGLOBIN QUALITATIVE |
| 82435 | $127.95 | HCPCS / CPT® | ASSAY OF BLOOD CHLORIDE |
| 82465 | $139.05 | HCPCS / CPT® | CHOLESTEROL SERUM/WHL BLD TOT |
| 82491 | $65.14 | HCPCS / CPT® | CHROM QUAN COLUMN 1 ANAL NES |
| 82533 | $150.00 | HCPCS / CPT® | CORTISOL; TOTAL |
| 82540 | $89.55 | HCPCS / CPT® | CREATINE |
| 82541 | $158.33 | HCPCS / CPT® | COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE |
| 82550 | $410.98 | HCPCS / CPT® | CREATINE KINASE TOT |
| 82553 | $603.75 | HCPCS / CPT® | CKMB – CREATINE KINASE MB FXJ ONLY |
| 82554 | $267.72 | HCPCS / CPT® | CREATINE KINASE ISOFORMS |
| 82565 | $191.34 | HCPCS / CPT® | CREATININE BLD |
| 82608 | $250.47 | HCPCS / CPT® | CYANOCOBALAMIN UNSAT BNDNG CAP |
| 82652 | $285.00 | HCPCS / CPT® | VIT D 1 25-DIHYDROXY |
| 82705 | $48.11 | HCPCS / CPT® | FAT/LIPIDS FECES QUAL |
| 82784 | $112.20 | HCPCS / CPT® | GAMMAGLOBULIN IGA IGD IGG IGM EACH |
| 82787 | $91.87 | HCPCS / CPT® | GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES |
| 82800 | $170.67 | HCPCS / CPT® | GASES BLD PH ONLY |
| 82803 | $501.68 | HCPCS / CPT® | GASES BLD PH CALCULATED O2 SATURATION |
| 82805 | $257.47 | HCPCS / CPT® | GASES BLD PH DIR MEAS XCPT PLS OXIMTRY |
| 82810 | $47.52 | HCPCS / CPT® | GASES BLD O2 SATURATION ONLY DIR MEAS |
| 82945 | $105.00 | HCPCS / CPT® | Glucose, body fluid, other than blood |
| 82947 | $144.23 | HCPCS / CPT® | GLUC QUAN BLD |
| 82948 | $101.27 | HCPCS / CPT® | GLUCOSE BLOOD REAGENT STRIP |
| 82962 | $90.31 | HCPCS / CPT® | GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE |
| 82969 | $165.83 | HCPCS / CPT® | Etiocholanolone |
| 82977 | $101.27 | HCPCS / CPT® | GGT – GLUTAMYLTRASE GAMMA |
| 82985 | $85.00 | HCPCS / CPT® | Glycated protein |
| 83036 | $84.38 | HCPCS / CPT® | HEMOGLOBIN GLYCOSYLATED (A1C) |
| 83090 | $125.00 | HCPCS / CPT® | HOMOCYSTEINE |
| 83516 | $65.00 | HCPCS / CPT® | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method |
| 83520 | $188.12 | HCPCS / CPT® | IMMUNOASSAY ANALYTE QUANTITATIVE NOS |
| 83540 | $165.00 | HCPCS / CPT® | ASSAY OF IRON |
| 83550 | $165.00 | HCPCS / CPT® | IRON BINDING TEST |
| 83605 | $116.13 | HCPCS / CPT® | LACTATE |
| 83615 | $53.95 | HCPCS / CPT® | LACTATE DEHYDROGENASE LD ISOENZYME PANEL |
| 83690 | $191.34 | HCPCS / CPT® | LIPASE |
| 83721 | $150.00 | HCPCS / CPT® | Lipoprotein, direct measurement; LDL cholesterol |
| 83735 | $206.64 | HCPCS / CPT® | MAGNESIUM |
| 83872 | $225.01 | HCPCS / CPT® | ASSAY SYNOVIAL FLUID MUCIN |
| 83874 | $414.00 | HCPCS / CPT® | MYOGLOBIN |
| 83880 | $420.93 | HCPCS / CPT® | BNP – B TYPE NATRIURETIC PEPTIDE |
| 84075 | $44.60 | HCPCS / CPT® | ASSAY ALKALINE PHOSPHATASE |
| 84132 | $170.74 | HCPCS / CPT® | POTASSIUM SERUM PLASMA/WHOLE BLOOD |
| 84144 | $199.32 | HCPCS / CPT® | PROGST |
| 84152 | $102.52 | HCPCS / CPT® | PRST8 SPEC AG CPLXED DIR MEAS |
| 84153 | $140.00 | HCPCS / CPT® | ASSAY OF PSA TOTAL |
| 84155 | $38.25 | HCPCS / CPT® | ASSAY OF PROTEIN SERUM |
| 84157 | $34.06 | HCPCS / CPT® | PROTEIN TOT XCPT REFRACTOMETRY OTH SRC |
| 84166 | $80.00 | HCPCS / CPT® | PROTEIN E-PHORESIS-URINE-CSF |
| 84295 | $133.80 | HCPCS / CPT® | ASSAY OF SERUM SODIUM |
| 84402 | $190.00 | HCPCS / CPT® | TESTOSTERONE FREE |
| 84403 | $195.00 | HCPCS / CPT® | TESTOSTERONE; TOTAL |
| 84410 | $395.00 | HCPCS / CPT® | TESTOSTERONE BIOAVAILABLE |
| 84436 | $220.00 | HCPCS / CPT® | THYROXINE TOT |
| 84439 | $210.00 | HCPCS / CPT® | THYROXINE FR |
| 84442 | $153.78 | HCPCS / CPT® | THYROXINE BINDING GLOBULIN TBG |
| 84443 | $345.00 | HCPCS / CPT® | TSH – THYR STIMULATING HORM |
| 84445 | $225.00 | HCPCS / CPT® | THYROID STIMULATING IMMUNE GLOBULINS TSI |
| 84450 | $195.82 | HCPCS / CPT® | TRANSFERASE (AST) (SGOT) |
| 84460 | $195.82 | HCPCS / CPT® | ALANINE AMINO (ALT) (SGPT) |
| 84479 | $285.64 | HCPCS / CPT® | THYR HORM UPTK/THYR HORM BNDNG RATIO |
| 84481 | $267.87 | HCPCS / CPT® | Triiodothyronine T3 |
| 84482 | $175.00 | HCPCS / CPT® | TRIIODOTHYRONINE T3 REVERSE |
| 84484 | $593.40 | HCPCS / CPT® | TROPONIN QUAN |
| 84512 | $202.43 | HCPCS / CPT® | TROPONIN QUAL |
| 84520 | $166.86 | HCPCS / CPT® | UREA N QUAN |
| 84550 | $197.45 | HCPCS / CPT® | URIC ACID BLD |
| 84560 | $179.54 | HCPCS / CPT® | URIC ACID OTH SRC |
| 84702 | $273.76 | HCPCS / CPT® | GONAD CHORNC QUAN |
| 84703 | $278.58 | HCPCS / CPT® | SERUM HCG – QUALITATIVE |
| 84704 | $130.35 | HCPCS / CPT® | GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN |
| 85014 | $133.62 | HCPCS / CPT® | BLD# HEMATOCRIT |
| 85018 | $133.62 | HCPCS / CPT® | BLD# HGB |
| 85025 | $503.25 | HCPCS / CPT® | CBC BLOOD COMPLETE AUTO WITH AUTO DIFFERENTIAL |
| 85027 | $194.40 | HCPCS / CPT® | BLD# COMPL AUTO HHRWP |
| 85032 | $199.84 | HCPCS / CPT® | BLD# MNL C-CNT RBC WBC/PLTLT EA |
| 85044 | $131.18 | HCPCS / CPT® | BLD# RETICULOCYTE MNL |
| 85046 | $42.19 | HCPCS / CPT® | Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF] |
| 85060 | $91.08 | HCPCS / CPT® | BLD SMR PRPH INTERPJ PHYS WRTTN REPRT |
| 85347 | $46.31 | HCPCS / CPT® | COAGJ TM ACTIVATED |
| 85378 | $197.16 | HCPCS / CPT® | D-DIMER – FIBRIN DGRADJ PRODUXS D-DIMER QUAL/SEMIQUAN |
| 85379 | $413.72 | HCPCS / CPT® | FIBRIN DGRADJ PRODUXS D-DIMER QUAN |
| 85380 | $427.52 | HCPCS / CPT® | FIBRIN DGRADJ PRODUXS D-DIMER ULTRSENS |
| 85415 | $91.08 | HCPCS / CPT® | FIBRINOLYTIC FACTORS AND INHIBITORS PLASMINOGEN ACTIVATOR |
| 85610 | $225.01 | HCPCS / CPT® | PT – PROTHROMBIN TIME |
| 85651 | $191.34 | HCPCS / CPT® | SEDIMENTATION RATE RBC NON-AUTO |
| 85652 | $122.39 | HCPCS / CPT® | SEDIMENTATION RATE RBC AUTO |
| 85730 | $212.29 | HCPCS / CPT® | THROMBOPLASTIN TM PRTL PLSM/WHL BLD |
| 86003 | $285.20 | HCPCS / CPT® | ALLERGEN SPECIFIC IGE |
| 86038 | $125.00 | HCPCS / CPT® | ANTINUCLEAR ANTIBODIES |
| 86039 | $75.15 | HCPCS / CPT® | ANA TITER |
| 86140 | $28.98 | HCPCS / CPT® | C-REACTIVE PROTEIN |
| 86148 | $135.00 | HCPCS / CPT® | ANTI-PHOSPHOLIPID ANTIBODY |
| 86304 | $212.96 | HCPCS / CPT® | IMMUNOASSAY TUMOR CA 125 |
| 86308 | $139.06 | HCPCS / CPT® | MONO – HTROPHL ANTIBODIES SCR |
| 86325 | $244.90 | HCPCS / CPT® | IMMUNOELECTROPHORESIS OTH FLUS CONCENTRATION |
| 86376 | $250.00 | HCPCS / CPT® | Microsomal antibodies (eg, thyroid or liver-kidney), each |
| 86403 | $174.85 | HCPCS / CPT® | PART AGGLUJ SCR EA ANTB |
| 86430 | $96.82 | HCPCS / CPT® | RHEUMATOID FACTOR QUAL |
| 86431 | $175.00 | HCPCS / CPT® | LUPUS PANEL |
| 86480 | $208.17 | HCPCS / CPT® | TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFER |
| 86486 | $19.80 | HCPCS / CPT® | SKIN TEST UNLISTED ANTIGEN EACH |
| 86580 | $22.97 | HCPCS / CPT® | SKN TST TUBERCULOSIS ID |
| 86592 | $50.00 | HCPCS / CPT® | RPR SYPHILIS TEST QUAL |
| 86593 | $90.00 | HCPCS / CPT® | SYPHILLIS TEST,NON-TREPONEMAL ANTIBODY, QUANTITATIVE |
| 86611 | $43.56 | HCPCS / CPT® | ANTB BARTONELLA |
| 86617 | $98.20 | HCPCS / CPT® | Lyme Disease Ab with Reflex to Blot |
| 86625 | $225.00 | HCPCS / CPT® | CAMPYLOBACTER ANTIBODY |
| 86631 | $170.75 | HCPCS / CPT® | ANTB CHLAMYDIA |
| 86641 | $225.00 | HCPCS / CPT® | Cryptococcus AG |
| 86663 | $322.12 | HCPCS / CPT® | ANTB EPSTEIN-BARR EB VIRUS EARLY AG EA |
| 86666 | $125.00 | HCPCS / CPT® | EHRLICHIA ANTIBODY |
| 86677 | $126.19 | HCPCS / CPT® | Antibody; Helicobacter pylori |
| 86689 | $281.64 | HCPCS / CPT® | ANTB HTLV/HIV ANTB CONFIRMATORY TST |
| 86694 | $82.80 | HCPCS / CPT® | ANTB HERPES SMPLX NON-SPEC TYP TST |
| 86695 | $150.00 | HCPCS / CPT® | ANTIBODY; HERPES SIMPLEX, TYPE 1 |
| 86696 | $150.00 | HCPCS / CPT® | ANTIBODY; HERPES SIMPLEX, TYPE 2 |
| 86701 | $189.80 | HCPCS / CPT® | ANTB HIV-1 |
| 86702 | $231.00 | HCPCS / CPT® | ANTB HIV-2 |
| 86703 | $75.24 | HCPCS / CPT® | ANTB HIV-1&HIV-2 1 ASSAY |
| 86710 | $187.51 | HCPCS / CPT® | ANTB INF VIRUS |
| 86747 | $175.00 | HCPCS / CPT® | PARVOVIRUS B19 |
| 86756 | $187.51 | HCPCS / CPT® | RSV ANTB |
| 86757 | $125.00 | HCPCS / CPT® | Antibody; Rickettsia |
| 86759 | $264.92 | HCPCS / CPT® | ANTB ROTAVIRUS |
| 86780 | $180.00 | HCPCS / CPT® | ANTIBODY; TREPONEMA PALLIDUM |
| 86787 | $172.90 | HCPCS / CPT® | ANTB VARICELLA-ZOSTER |
| 86789 | $134.57 | HCPCS / CPT® | ANTIBODY WEST NILE VIRUS |
| 86794 | $225.00 | HCPCS / CPT® | ZIKA VIRUS ANTIBODY (IGM) |
| 86800 | $225.00 | HCPCS / CPT® | THYROGLOBULIN ANTIBODY |
| 86803 | $140.69 | HCPCS / CPT® | Hepatitis C antibody |
| 86812 | $165.00 | HCPCS / CPT® | HLA B27 TYPING A B OR C |
| 86850 | $248.73 | HCPCS / CPT® | ANTB SCR RBC EA SERUM TQ |
| 86900 | $186.14 | HCPCS / CPT® | BLD TYPING ABO |
| 86901 | $112.96 | HCPCS / CPT® | BLD TYPING RH D |
| 86906 | $112.96 | HCPCS / CPT® | BLD TYPING RH PHEXYPING COMPL |
| 87040 | $345.00 | HCPCS / CPT® | BLOOD CULTURE – CUL BACT BLD AERC ISOL |
| 87045 | $336.74 | HCPCS / CPT® | CUL BACT STL AERC ISOL SALMONELLA&SHIGELLA |
| 87046 | $184.14 | HCPCS / CPT® | CUL BACT STL AERC ADDL PATHOGENS&ID EA |
| 87070 | $250.00 | HCPCS / CPT® | WOUND CULTURE – CULTURE BACTERIAL EXCPT URINE, BLOOD, STOOL AEROBIC ISOLATED |
| 87075 | $375.02 | HCPCS / CPT® | CUL BACT BLD ANAERC ISOL |
| 87077 | $73.33 | HCPCS / CPT® | CULTURE AEROBIC IDENTIFY |
| 87081 | $265.25 | HCPCS / CPT® | STREP CULTURE PRESUMPTIVE PATHOGENIC ORGANISMS SCREENING |
| 87086 | $265.00 | HCPCS / CPT® | CUL BACT QUAN COLONY CNT URINE |
| 87088 | $52.35 | HCPCS / CPT® | CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE |
| 87106 | $207.97 | HCPCS / CPT® | CUL FNGI DEFINITIVE ID EA ORGANISM YEAST |
| 87110 | $350.00 | HCPCS / CPT® | CUL CHLAMYDIA ANY SRC |
| 87177 | $120.00 | HCPCS / CPT® | OVA PARASITES DIRECT SMEARS CONCENTRATION&ID |
| 87205 | $191.40 | HCPCS / CPT® | SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL |
| 87207 | $191.43 | HCPCS / CPT® | SMR PRIM SRC SPEC STAIN BODIES/PARASITS |
| 87209 | $150.00 | HCPCS / CPT® | Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites |
| 87210 | $120.62 | HCPCS / CPT® | SMR PRIM SRC WET MOUNT NFCT AGT |
| 87230 | $175.00 | HCPCS / CPT® | TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE EG, CLOSTRIDIUM DIFFICILE TOXIN |
| 87252 | $86.57 | HCPCS / CPT® | Herpes simplex/Varicella |
| 87273 | $99.56 | HCPCS / CPT® | HERPES SIMPLEX 2 AG |
| 87274 | $99.56 | HCPCS / CPT® | Infectious agent antigen detection by |
| 87324 | $310.50 | HCPCS / CPT® | IAAD EIA CLOSTRIDIUM DIFFICILE TOXIN |
| 87329 | $180.00 | HCPCS / CPT® | IAA DETECTION BY IMMUNOASSAY,QUAL OR SEMIQUAL, GIARDIA |
| 87332 | $192.06 | HCPCS / CPT® | IAAD EIA CMV |
| 87389 | $270.00 | HCPCS / CPT® | Infectious agent antigen detection by enzyme immunoassay technique, HIV 1-2, multiple-step method; |
| 87390 | $163.88 | HCPCS / CPT® | IAAD EIA HIV-1 |
| 87400 | $228.07 | HCPCS / CPT® | INFLUENZA A OR B – IAAD EIA INF/B EA |
| 87420 | $129.18 | HCPCS / CPT® | IAAD EIA RSV |
| 87425 | $264.92 | HCPCS / CPT® | IAAD EIA ROTAVIRUS |
| 87430 | $307.21 | HCPCS / CPT® | IAAD EIA STREPTOCOCCUS GROUP A |
| 87491 | $240.00 | HCPCS / CPT® | INFECTIOUS AGENT DETECTION BY NUCLEIC ACID DNA OR RNA CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE |
| 87493 | $258.68 | HCPCS / CPT® | INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE |
| 87507 | $3500.00 | HCPCS / CPT® | IA DETECT BY NUCLEIC ACID GI PATHOGEN – DNA/RNA PROBE TQ 12-25 |
| 87528 | $315.09 | HCPCS / CPT® | IADNA HERPES SMPLX VIRUS DIR PRB |
| 87530 | $322.22 | HCPCS / CPT® | IADNA HERPES SOMPLX VIRUS QUANTIFICATION |
| 87591 | $240.00 | HCPCS / CPT® | INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE. AMPLIFIED PROBE TECHNIQUE |
| 87635 | $389.00 | HCPCS / CPT® | 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 |
| 87798 | $534.96 | HCPCS / CPT® | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified, Norovirus |
| 87804 | $225.00 | HCPCS / CPT® | INFLUENZA TEST; EACH A AND B |
| 87807 | $55.11 | HCPCS / CPT® | IAADIADOO RSV |
| 87808 | $47.52 | HCPCS / CPT® | Infectious agent antigen detection by immunoassay with direct optical observation; Trichomonas vaginalis |
| 87850 | $175.00 | HCPCS / CPT® | IAADIADOO NEISSERIA GONORRHOEAE |
| 87880 | $190.00 | HCPCS / CPT® | STREP TEST; RAPID |
| 89050 | $50.00 | HCPCS / CPT® | BODY FLUID CELL COUNT |
| 89051 | $51.15 | HCPCS / CPT® | C-CNT MISC BDY FLUS XCPT BLD DIFFIAL CNT |
| 89055 | $40.00 | HCPCS / CPT® | WBC ASSMT FECAL QUAL/SEMIQUAN |
| 89060 | $75.32 | HCPCS / CPT® | CRYSTAL ID LIGHT MIC ALYS TISSUE/ANY FLU |
| 89220 | $127.81 | HCPCS / CPT® | SPTM OBTG SPEC AERSL INDUCED SPX |
| 90470 | $79.20 | HCPCS / CPT® | H1N1 IMMUNIZATION ADMINISTRATION (INTRAMUSCULAR, INTRANASAL), INCLUDING COUNSELING WHEN PERFORMED |
| 90471 | $110.00 | HCPCS / CPT® | Immunization administration; 1 vaccine |
| 90472 | $5.75 | HCPCS / CPT® | IMADM PRQ ID SUBQ/IM NJXS EA VACC |
| 90658 | $177.10 | HCPCS / CPT® | INFLUENZA VIRUS VACCINE SPLIT VIRUS 3 YEARS + IM |
| 90660 | $91.84 | HCPCS / CPT® | INFLUENZA VIRUS VACCINE LIVE INTRANASAL |
| 90662 | $79.20 | HCPCS / CPT® | INFLUENZA VACCINE SPLT PRSRV FREE INC ANTIGEN IM |
| 90665 | $158.40 | HCPCS / CPT® | LYME DISEASE VACCINE ADULT IM |
| 90675 | $254.30 | HCPCS / CPT® | RABIES VACCINE INTRAMUSCULAR |
| 90703 | $198.93 | HCPCS / CPT® | TETANUS TOXOID ADSORBED INTRAMUSCULAR |
| 90707 | $249.11 | HCPCS / CPT® | MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ |
| 90714 | $188.48 | HCPCS / CPT® | TD VACCINE NO PRSV 7 IM |
| 90715 | $193.33 | HCPCS / CPT® | TDAP VACCINE 7 YR + IM |
| 90716 | $85.80 | HCPCS / CPT® | VARICELLA VIRUS VACCINE LIVE SUBQ |
| 90718 | $198.93 | HCPCS / CPT® | TD – TETANUS & DIPHTHERIA TOXOIDS ADSORBED 7 YR + IM |
| 90746 | $104.06 | HCPCS / CPT® | HEPATITIS B VACCINE ADULT DOSAGE INTRAMUSCULAR |
| 90885 | $580.00 | HCPCS / CPT® | Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes |
| 90997 | $535.73 | HCPCS / CPT® | HEMOPERFUSION |
| 92950 | $1280.09 | HCPCS / CPT® | CARDIOPULM RESUSCITATION |
| 92960 | $1427.56 | HCPCS / CPT® | CARDIOVERSION ELECTIVE ARRHYT XTRNL |
| 93000 | $324.50 | HCPCS / CPT® | ECG ROUTINE ECG W/LEAST 12 LDS W/I&R |
| 93005 | $343.56 | HCPCS / CPT® | Electrocardiogram, routine ECG with at least 12 leads |
| 93010 | $197.16 | HCPCS / CPT® | ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY EKG |
| 93041 | $191.34 | HCPCS / CPT® | Rhythm ECG, 1-3 leads |
| 93042 | $164.40 | HCPCS / CPT® | RHYTHM ECG, 1-3 LEADS; INTERPRETATION AND REPORT ONLY |
| 93224 | $194.55 | HCPCS / CPT® | WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I |
| 93303 | $2076.26 | HCPCS / CPT® | COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY |
| 93306 | $2969.08 | HCPCS / CPT® | ECHO TTHRC R-T 2D SPEC&COLOR DOP |
| 93307 | $1400.52 | HCPCS / CPT® | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography |
| 93308 | $1401.31 | HCPCS / CPT® | TTHRC R-T IMG 2D +-M-MODE REC F-UP/LMTD |
| 93312 | $1334.32 | HCPCS / CPT® | TEE R-T IMG 2D W/PRB IMG ACQUISJ I&R |
| 93313 | $3442.89 | HCPCS / CPT® | TEE R-T IMG 2D W/PROBE PLMT ONLY |
| 93320 | $449.33 | HCPCS / CPT® | DOPPLER ECHO COMPLETE |
| 93351 | $2046.33 | HCPCS / CPT® | ECHO TTHRC R-T 2D -+M-MODE REST&STRS CONT ECG |
| 93875 | $1102.07 | HCPCS / CPT® | N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD |
| 93880 | $1275.00 | HCPCS / CPT® | ULTRASOUND CAROTID DUPLEX SCAN COMPLETE BILATERAL STUDY |
| 93882 | $1184.72 | HCPCS / CPT® | DUP-SCAN XTRC ART UNI/LMTD STD |
| 93926 | $1151.05 | HCPCS / CPT® | DOPPLER – DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD |
| 93931 | $612.26 | HCPCS / CPT® | DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD |
| 93965 | $2369.45 | HCPCS / CPT® | N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD |
| 93970 | $1639.32 | HCPCS / CPT® | DUP-SCAN XTR VEINS COMPL BI STD |
| 93971 | $844.92 | HCPCS / CPT® | ULTRASOUND VENOUS DOPPLER UNILATERAL LIMITED STUDY DUPLEX SCAN |
| 93976 | $1100.00 | HCPCS / CPT® | ULTRASOUND PELVIC SCROTALCONTENTS AND OR RETROPERITONEAL; LIMITED STUDY |
| 93980 | $1021.28 | HCPCS / CPT® | PENILE VASCULAR STUDY |
| 94010 | $1387.50 | HCPCS / CPT® | SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY |
| 94150 | $158.40 | HCPCS / CPT® | VC TOT SPX |
| 94621 | $1349.73 | HCPCS / CPT® | PULM STRS TSTG CPLX |
| 94640 | $765.60 | HCPCS / CPT® | NEBULIZER TREATMENT AIRWAY INHALATION TREATMENT – PRESS/N-PRESS INHLJ TX F/AAO/SPTM INDCTJ |
| 94644 | $207.15 | HCPCS / CPT® | INHALATION TREATMENT – CONTINUOUS 1ST HR |
| 94645 | $125.00 | HCPCS / CPT® | Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour |
| 94660 | $1125.00 | HCPCS / CPT® | CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION CPAP, INITIATION AND MANAGEMENT |
| 94760 | $150.00 | HCPCS / CPT® | PULSE OXIMETRY – O2 SATURATION LEVELS – SINGLE |
| 94761 | $315.00 | HCPCS / CPT® | PULSE OXIMETRY – O2 SATURATION LEVELS – MULTIPLE |
| 96360 | $1050.00 | HCPCS / CPT® | IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR |
| 96361 | $306.13 | HCPCS / CPT® | IV INFUSION HYDRATION EACH ADDITIONAL HOUR |
| 96365 | $1050.00 | HCPCS / CPT® | IV INFUSION THERAPY 1ST HOUR |
| 96366 | $304.60 | HCPCS / CPT® | IV INFUSION THERAPY, EACH ADDL HOUR |
| 96367 | $344.40 | HCPCS / CPT® | IV INFUSION THERAPY, ADDL SEQUENTIAL INFUSION OF NEW MED 1ST HR |
| 96368 | $329.10 | HCPCS / CPT® | IV INFUSION THERAPY, CONCURRENT IV INFUSION OF DIFFERENT MED |
| 96372 | $217.29 | HCPCS / CPT® | INJECTION, INTRAMUSCULAR OR SUBCUTANEOUS |
| 96373 | $298.83 | HCPCS / CPT® | INJECTION, INTRA-ARTERIAL |
| 96374 | $1050.00 | HCPCS / CPT® | IV PUSH 1ST DRUG, THERAPEUTIC, DIAGNOSITIC MEDICATION |
| 96375 | $266.33 | HCPCS / CPT® | IV PUSH EACH ADD’L DRUG, THERAPEUTIC, DIAGNOSITIC, PROPHYLACTIC |
| 96376 | $289.29 | HCPCS / CPT® | IV PUSH EACH OF SAME DRUG, THERAPEUTIC, DIAGNOSITIC, PROPHYLACTIC |
| 96379 | $279.04 | HCPCS / CPT® | INJECTION – UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS |
| 97116 | $186.42 | HCPCS / CPT® | THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING) |
| 97597 | $150.00 | HCPCS / CPT® | REMOVAL DEVITALIZED TISSUE 20 CM OR LESS |
| 97760 | $250.00 | HCPCS / CPT® | ORTHOTIC TRAINING |
| 99000 | $25.74 | HCPCS / CPT® | HANDLING OR CONVEYANCE OF SPECIMEN FOR TRNSFR FROM OFFICE TO LAB |
| 99001 | $60.00 | HCPCS / CPT® | HANDLING OR CONVEYANCE OF SPECIMEN FOR TRNSFR FROM PT TO LAB |
| 99024 | $100.00 | HCPCS / CPT® | FOLLOW-UP VISIT |
| 99053 | $200.00 | HCPCS / CPT® | SERVICES PROVIDED BETWEEN 10 PM AND 8 AM AT A 24 HR FACILITY |
| 99070 | $69.18 | HCPCS / CPT® | SUPPLIES&MATERIALS PRV BY PHYS >&ABOVE |
| 99143 | $575.53 | HCPCS / CPT® | M-SEDATJ BY SM PHYS PERFRMG SVC < 5 YR |
| 99144 | $569.40 | HCPCS / CPT® | ANESTHESIA – M-SEDAJ BY SM PHYS PERFRMG SVC 5+ YR |
| 99145 | $221.95 | HCPCS / CPT® | M-SEDAJ BY SM PHYS PERFRMG SVC EA 15 MIN |
| 99148 | $191.27 | HCPCS / CPT® | M-SEDATION BY PHYS OTH/THN HC PROF PERFRMG < 5 |
| 99149 | $476.03 | HCPCS / CPT® | M-SEDATION BY PHYS OTH/THN HC PROF PERFRMG 5+ |
| 99150 | $413.94 | HCPCS / CPT® | MOD SED DIFF PHYS/QHP ADD ON |
| 99152 | $475.80 | HCPCS / CPT® | MOD SED SAME PHYS/QHP OVER 5 YRS OF AGE |
| 99153 | $563.49 | HCPCS / CPT® | MOD SED SAME PHYS/QHP EA |
| 99173 | $382.66 | HCPCS / CPT® | VISUAL ACUITY SCREENING |
| 99235 | $2226.40 | HCPCS / CPT® | EMERGENCY ROOM GENERAL CLASSIFICATION |
| 99244 | $401.28 | HCPCS / CPT® | OFFICE CONSLTJ 60 MIN |
| 99281 | $422.88 | HCPCS / CPT® | EVALUATION AND MANAGEMENT – LEVEL 1 |
| 99282 | $825.00 | HCPCS / CPT® | EVALUATION AND MANAGEMENT – LEVEL 2 |
| 99283 | $1336.04 | HCPCS / CPT® | EVALUATION AND MANAGEMENT – LEVEL 3 |
| 99284 | $2000.00 | HCPCS / CPT® | EVALUATION AND MANAGEMENT – LEVEL 4 |
| 99285 | $3500.00 | HCPCS / CPT® | EVALUATION AND MANAGEMENT – LEVEL 5 |
| 99291 | $4278.65 | HCPCS / CPT® | CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN |
| 99292 | $1023.04 | HCPCS / CPT® | CC E/M CRITICALLY ILL/INJURED EA 30 MIN |
| 99354 | $500.00 | HCPCS / CPT® | Prolonged E/M (beyond the typical service time of the primary procedure) in an outpatient setting requiring direct patient contact beyond the usual service; first hour |
| 99406 | $106.43 | HCPCS / CPT® | TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES |
| 999999 | $61.23 | HCPCS / CPT® | RETURN CHECK FEE |
| A0021 | $0.00 | HCPCS / CPT® | OUTSIDE STATE AMBULANCE SERV |
| A0080 | $0.00 | HCPCS / CPT® | NONINTEREST ESCORT IN NON ER |
| A0090 | $0.00 | HCPCS / CPT® | INTEREST ESCORT IN NON ER |
| A0100 | $0.00 | HCPCS / CPT® | NONEMERGENCY TRANSPORT TAXI |
| A0110 | $0.00 | HCPCS / CPT® | NONEMERGENCY TRANSPORT BUS |
| A0120 | $0.00 | HCPCS / CPT® | NONER TRANSPORT MINI-BUS |
| A0130 | $0.00 | HCPCS / CPT® | NONER TRANSPORT WHEELCH VAN |
| A0140 | $0.00 | HCPCS / CPT® | NONEMERGENCY TRANSPORT AIR |
| A0160 | $0.00 | HCPCS / CPT® | NONER TRANSPORT CASE WORKER |
| A0170 | $0.00 | HCPCS / CPT® | TRANSPORT PARKING FEES/TOLLS |
| A0180 | $0.00 | HCPCS / CPT® | NONER TRANSPORT LODGNG RECIP |
| A0190 | $0.00 | HCPCS / CPT® | NONER TRANSPORT MEALS RECIP |
| A0200 | $0.00 | HCPCS / CPT® | NONER TRANSPORT LODGNG ESCRT |
| A0210 | $0.00 | HCPCS / CPT® | NONER TRANSPORT MEALS ESCORT |
| A0225 | $0.00 | HCPCS / CPT® | NEONATAL EMERGENCY TRANSPORT |
| A0380 | $0.00 | HCPCS / CPT® | BASIC LIFE SUPPORT MILEAGE |
| A0382 | $0.00 | HCPCS / CPT® | BASIC SUPPORT ROUTINE SUPPLS |
| A0384 | $0.00 | HCPCS / CPT® | BLS DEFIBRILLATION SUPPLIES |
| A0390 | $0.00 | HCPCS / CPT® | ADVANCED LIFE SUPPORT MILEAG |
| A0392 | $0.00 | HCPCS / CPT® | ALS DEFIBRILLATION SUPPLIES |
| A0394 | $3.45 | HCPCS / CPT® | ALS IV DRUG THERAPY SUPPLIES |
| A0396 | $38.27 | HCPCS / CPT® | ALS ESOPHAGEAL INTUB SUPPLS |
| A0398 | $0.00 | HCPCS / CPT® | ALS ROUTINE DISPOSBLE SUPPLS |
| A0420 | $0.00 | HCPCS / CPT® | AMBULANCE WAITING 1/2 HR |
| A0422 | $0.00 | HCPCS / CPT® | AMBULANCE 02 LIFE SUSTAINING |
| A0424 | $0.00 | HCPCS / CPT® | EXTRA AMBULANCE ATTENDANT |
| A0425 | $0.00 | HCPCS / CPT® | GROUND MILEAGE |
| A0426 | $0.00 | HCPCS / CPT® | ALS 1 |
| A0427 | $0.00 | HCPCS / CPT® | ALS1-EMERGENCY |
| A0428 | $0.00 | HCPCS / CPT® | BLS |
| A0429 | $0.00 | HCPCS / CPT® | BLS-EMERGENCY |
| A0430 | $0.00 | HCPCS / CPT® | FIXED WING AIR TRANSPORT |
| A0431 | $0.00 | HCPCS / CPT® | ROTARY WING AIR TRANSPORT |
| A0432 | $0.00 | HCPCS / CPT® | PI VOLUNTEER AMBULANCE CO |
| A0433 | $0.00 | HCPCS / CPT® | ALS 2 |
| A0434 | $0.00 | HCPCS / CPT® | SPECIALTY CARE TRANSPORT |
| A0435 | $0.00 | HCPCS / CPT® | FIXED WING AIR MILEAGE |
| A0436 | $0.00 | HCPCS / CPT® | ROTARY WING AIR MILEAGE |
| A0888 | $0.00 | HCPCS / CPT® | NONCOVERED AMBULANCE MILEAGE |
| A0998 | $0.00 | HCPCS / CPT® | AMBULANCE RESPONSE/TREATMENT |
| A0999 | $0.00 | HCPCS / CPT® | UNLISTED AMBULANCE SERVICE |
| A4206 | $24.31 | HCPCS / CPT® | Syringe with needle, sterile, 1 cc or less, each |
| A4207 | $0.00 | HCPCS / CPT® | 2 CC STERILE SYRINGE&NEEDLE |
| A4208 | $41.18 | HCPCS / CPT® | 3 CC STERILE SYRINGE&NEEDLE |
| A4209 | $45.92 | HCPCS / CPT® | 5+ CC STERILE SYRINGE&NEEDLE |
| A4210 | $0.00 | HCPCS / CPT® | NONNEEDLE INJECTION DEVICE |
| A4211 | $0.00 | HCPCS / CPT® | SUPP FOR SELF-ADM INJECTIONS |
| A4212 | $0.00 | HCPCS / CPT® | NON CORING NEEDLE OR STYLET |
| A4213 | $9.15 | HCPCS / CPT® | 20+ CC SYRINGE ONLY |
| A4215 | $16.46 | HCPCS / CPT® | NEEDLE STERILE, ANY SIZE, EACH |
| A4216 | $4.59 | HCPCS / CPT® | STERILE WATER/SALINE, FLUSH 10 ML |
| A4217 | $34.90 | HCPCS / CPT® | STERILE WATER/SALINE, 500 ML |
| A4218 | $0.00 | HCPCS / CPT® | STERILE SALINE OR WATER |
| A4220 | $0.00 | HCPCS / CPT® | INFUSION PUMP REFILL KIT |
| A4221 | $185.08 | HCPCS / CPT® | MAINT DRUG INFUS CATH PER WK |
| A4222 | $367.39 | HCPCS / CPT® | INFUSION SUPPLIES WITH PUMP |
| A4223 | $0.00 | HCPCS / CPT® | INFUSION SUPPLIES W/O PUMP |
| A4224 | $0.00 | HCPCS / CPT® | SUPPLY INSULIN INF CATH/WK |
| A4225 | $0.00 | HCPCS / CPT® | SUP/EXT INSULIN INF PUMP SYR |
| A4230 | $0.00 | HCPCS / CPT® | INFUS INSULIN PUMP NON NEEDL |
| A4231 | $0.00 | HCPCS / CPT® | INFUSION INSULIN PUMP NEEDLE |
| A4232 | $0.00 | HCPCS / CPT® | SYRINGE W/NEEDLE INSULIN 3CC |
| A4233 | $0.00 | HCPCS / CPT® | ALKALIN BATT FOR GLUCOSE MON |
| A4234 | $0.00 | HCPCS / CPT® | J-CELL BATT FOR GLUCOSE MON |
| A4235 | $0.00 | HCPCS / CPT® | LITHIUM BATT FOR GLUCOSE MON |
| A4236 | $0.00 | HCPCS / CPT® | SILVR OXIDE BATT GLUCOSE MON |
| A4244 | $6.12 | HCPCS / CPT® | ALCOHOL OR PEROXIDE PER PINT |
| A4245 | $19.99 | HCPCS / CPT® | ALCOHOL WIPE |
| A4246 | $33.03 | HCPCS / CPT® | BETADINE/PHISOHEX SOLUTION |
| A4247 | $33.03 | HCPCS / CPT® | BETADINE/IODINE SWABS/WIPES |
| A4248 | $156.18 | HCPCS / CPT® | CHLORHEXIDINE ANTISEPT |
| A4250 | $10.00 | HCPCS / CPT® | URINE REAGENT STRIPS/TABLETS |
| A4252 | $10.00 | HCPCS / CPT® | GLUCOSE TEST STRIP – BLOOD KETONE TEST OR STRIP |
| A4253 | $0.00 | HCPCS / CPT® | BLOOD GLUCOSE/REAGENT STRIPS |
| A4255 | $0.00 | HCPCS / CPT® | GLUCOSE MONITOR PLATFORMS |
| A4256 | $0.00 | HCPCS / CPT® | CALIBRATOR SOLUTION/CHIPS |
| A4257 | $0.00 | HCPCS / CPT® | REPLACE LENSSHIELD CARTRIDGE |
| A4258 | $0.00 | HCPCS / CPT® | LANCET DEVICE EACH |
| A4259 | $0.00 | HCPCS / CPT® | LANCETS PER BOX |
| A4260 | $0.00 | HCPCS / CPT® | LEVONORGESTREL IMPLANT |
| A4261 | $0.00 | HCPCS / CPT® | CERVICAL CAP CONTRACEPTIVE |
| A4262 | $0.00 | HCPCS / CPT® | TEMPORARY TEAR DUCT PLUG |
| A4263 | $0.00 | HCPCS / CPT® | PERMANENT TEAR DUCT PLUG |
| A4264 | $0.00 | HCPCS / CPT® | INTRATUBAL OCCLUSION DEVICE |
| A4265 | $0.00 | HCPCS / CPT® | PARAFFIN |
| A4266 | $0.00 | HCPCS / CPT® | DIAPHRAGM |
| A4267 | $0.00 | HCPCS / CPT® | MALE CONDOM |
| A4268 | $0.00 | HCPCS / CPT® | FEMALE CONDOM |
| A4269 | $0.00 | HCPCS / CPT® | SPERMICIDE |
| A4270 | $0.00 | HCPCS / CPT® | DISPOSABLE ENDOSCOPE SHEATH |
| A4280 | $0.00 | HCPCS / CPT® | BRST PRSTHS ADHSV ATTCHMNT |
| A4281 | $0.00 | HCPCS / CPT® | REPLACEMENT BREASTPUMP TUBE |
| A4282 | $0.00 | HCPCS / CPT® | REPLACEMENT BREASTPUMP ADPT |
| A4283 | $0.00 | HCPCS / CPT® | REPLACEMENT BREASTPUMP CAP |
| A4284 | $0.00 | HCPCS / CPT® | REPLCMNT BREAST PUMP SHIELD |
| A4285 | $0.00 | HCPCS / CPT® | REPLCMNT BREAST PUMP BOTTLE |
| A4286 | $0.00 | HCPCS / CPT® | REPLCMNT BREASTPUMP LOK RING |
| A4290 | $0.00 | HCPCS / CPT® | SACRAL NERVE STIM TEST LEAD |
| A4300 | $55.83 | HCPCS / CPT® | IMPLANTABLE ACCESS CATHETER |
| A4301 | $0.00 | HCPCS / CPT® | IMPLANTABLE ACCESS SYST PERC |
| A4305 | $0.00 | HCPCS / CPT® | DRUG DELIVERY SYSTEM >=50 ML |
| A4306 | $0.00 | HCPCS / CPT® | DRUG DELIVERY SYSTEM <=50 ML |
| A4310 | $0.00 | HCPCS / CPT® | INSERT TRAY W/O BAG/CATH |
| A4311 | $45.92 | HCPCS / CPT® | CATHETER W/O BAG 2-WAY LATEX |
| A4312 | $0.00 | HCPCS / CPT® | CATH W/O BAG 2-WAY SILICONE |
| A4313 | $36.73 | HCPCS / CPT® | CATHETER W/BAG 3-WAY |
| A4314 | $16.84 | HCPCS / CPT® | CATH W/DRAINAGE 2-WAY LATEX |
| A4315 | $0.00 | HCPCS / CPT® | CATH W/DRAINAGE 2-WAY SILCNE |
| A4316 | $0.00 | HCPCS / CPT® | CATH W/DRAINAGE 3-WAY |
| A4320 | $20.29 | HCPCS / CPT® | IRRIGATION TRAY |
| A4321 | $0.00 | HCPCS / CPT® | CATH THERAPEUTIC IRRIG AGENT |
| A4322 | $20.29 | HCPCS / CPT® | IRRIGATION SYRINGE |
| A4326 | $11.49 | HCPCS / CPT® | MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH |
| A4327 | $4.59 | HCPCS / CPT® | URINE CUP FEMALE COLLECT DEV CUP |
| A4328 | $4.99 | HCPCS / CPT® | FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH |
| A4330 | $10.00 | HCPCS / CPT® | STOOL COLLECTION POUCH |
| A4331 | $0.00 | HCPCS / CPT® | EXTENSION DRAINAGE TUBING |
| A4332 | $9.19 | HCPCS / CPT® | LUBE STERILE PACKET |
| A4333 | $0.00 | HCPCS / CPT® | URINARY CATH ANCHOR DEVICE |
| A4334 | $0.00 | HCPCS / CPT® | URINARY CATH LEG STRAP |
| A4335 | $4.59 | HCPCS / CPT® | INCONTINENCE SUPPLY MISCELLANEOUS |
| A4336 | $0.00 | HCPCS / CPT® | URETHRAL INSERT |
| A4337 | $0.00 | HCPCS / CPT® | INCONTINENT RECTAL INSERT |
| A4338 | $15.31 | HCPCS / CPT® | INDWELLING CATHETER LATEX |
| A4340 | $0.00 | HCPCS / CPT® | INDWELLING CATHETER SPECIAL |
| A4344 | $16.84 | HCPCS / CPT® | CATHETER – FOLEY 2 WAY SILICN |
| A4346 | $0.00 | HCPCS / CPT® | CATH INDW FOLEY 3 WAY |
| A4349 | $0.00 | HCPCS / CPT® | DISPOSABLE MALE EXTERNAL CAT |
| A4351 | $14.92 | HCPCS / CPT® | STRAIGHT TIP URINE CATHETER |
| A4352 | $30.81 | HCPCS / CPT® | COUDE TIP URINARY CATHETER |
| A4353 | $30.61 | HCPCS / CPT® | INTERMITTENT URINARY CATH |
| A4354 | $81.71 | HCPCS / CPT® | CATH INSERTION TRAY W/BAG |
| A4355 | $0.00 | HCPCS / CPT® | BLADDER IRRIGATION TUBING |
| A4356 | $357.43 | HCPCS / CPT® | EXT URETH CLMP OR COMPR DVC |
| A4357 | $0.00 | HCPCS / CPT® | BEDSIDE DRAINAGE BAG |
| A4358 | $19.14 | HCPCS / CPT® | BAG – URINARY LEG OR ABDOMEN BAG |
| A4360 | $0.00 | HCPCS / CPT® | DISPOSABLE EXT URETHRAL DEV |
| A4361 | $0.00 | HCPCS / CPT® | OSTOMY FACE PLATE |
| A4362 | $0.00 | HCPCS / CPT® | SOLID SKIN BARRIER |
| A4363 | $0.00 | HCPCS / CPT® | OSTOMY CLAMP, REPLACEMENT |
| A4364 | $43.73 | HCPCS / CPT® | DERMABOND – ADHESIVE, LIQUID OR EQUAL PER OZ. |
| A4366 | $0.00 | HCPCS / CPT® | OSTOMY VENT |
| A4367 | $0.00 | HCPCS / CPT® | OSTOMY BELT |
| A4368 | $0.00 | HCPCS / CPT® | OSTOMY FILTER |
| A4369 | $0.00 | HCPCS / CPT® | SKIN BARRIER LIQUID PER OZ |
| A4371 | $0.00 | HCPCS / CPT® | SKIN BARRIER POWDER PER OZ |
| A4372 | $0.00 | HCPCS / CPT® | SKIN BARRIER SOLID 4X4 EQUIV |
| A4373 | $0.00 | HCPCS / CPT® | SKIN BARRIER WITH FLANGE |
| A4375 | $0.00 | HCPCS / CPT® | DRAINABLE PLASTIC PCH W FCPL |
| A4376 | $0.00 | HCPCS / CPT® | DRAINABLE RUBBER PCH W FCPLT |
| A4377 | $0.00 | HCPCS / CPT® | DRAINABLE PLSTIC PCH W/O FP |
| A4378 | $0.00 | HCPCS / CPT® | DRAINABLE RUBBER PCH W/O FP |
| A4379 | $0.00 | HCPCS / CPT® | URINARY PLASTIC POUCH W FCPL |
| A4380 | $0.00 | HCPCS / CPT® | URINARY RUBBER POUCH W FCPLT |
| A4381 | $0.00 | HCPCS / CPT® | URINARY PLASTIC POUCH W/O FP |
| A4382 | $0.00 | HCPCS / CPT® | URINARY HVY PLSTC PCH W/O FP |
| A4383 | $0.00 | HCPCS / CPT® | URINARY RUBBER POUCH W/O FP |
| A4384 | $0.00 | HCPCS / CPT® | OSTOMY FACEPLT/SILICONE RING |
| A4385 | $0.00 | HCPCS / CPT® | OST SKN BARRIER SLD EXT WEAR |
| A4387 | $0.00 | HCPCS / CPT® | OST CLSD POUCH W ATT ST BARR |
| A4388 | $0.00 | HCPCS / CPT® | DRAINABLE PCH W EX WEAR BARR |
| A4389 | $0.00 | HCPCS / CPT® | DRAINABLE PCH W ST WEAR BARR |
| A4390 | $0.00 | HCPCS / CPT® | DRAINABLE PCH EX WEAR CONVEX |
| A4391 | $0.00 | HCPCS / CPT® | URINARY POUCH W EX WEAR BARR |
| A4392 | $0.00 | HCPCS / CPT® | URINARY POUCH W ST WEAR BARR |
| A4393 | $0.00 | HCPCS / CPT® | URINE PCH W EX WEAR BAR CONV |
| A4394 | $0.00 | HCPCS / CPT® | OSTOMY POUCH LIQ DEODORANT |
| A4395 | $0.00 | HCPCS / CPT® | OSTOMY POUCH SOLID DEODORANT |
| A4396 | $0.00 | HCPCS / CPT® | PERISTOMAL HERNIA SUPPRT BLT |
| A4397 | $0.00 | HCPCS / CPT® | IRRIGATION SUPPLY SLEEVE |
| A4398 | $0.00 | HCPCS / CPT® | OSTOMY IRRIGATION BAG |
| A4399 | $0.00 | HCPCS / CPT® | OSTOMY IRRIG CONE/CATH W BRS |
| A4400 | $0.00 | HCPCS / CPT® | OSTOMY IRRIGATION SET |
| A4402 | $12.50 | HCPCS / CPT® | LUBRICANT PER OUNCE |
| A4404 | $0.00 | HCPCS / CPT® | OSTOMY RING EACH |
| A4405 | $0.00 | HCPCS / CPT® | NONPECTIN BASED OSTOMY PASTE |
| A4406 | $0.00 | HCPCS / CPT® | PECTIN BASED OSTOMY PASTE |
| A4407 | $0.00 | HCPCS / CPT® | EXT WEAR OST SKN BARR <=4SQ |
| A4408 | $0.00 | HCPCS / CPT® | EXT WEAR OST SKN BARR >4SQ |
| A4409 | $0.00 | HCPCS / CPT® | OST SKN BARR CONVEX <=4 SQ I |
| A4410 | $0.00 | HCPCS / CPT® | OST SKN BARR EXTND >4 SQ |
| A4411 | $0.00 | HCPCS / CPT® | OST SKN BARR EXTND =4SQ |
| A4412 | $0.00 | HCPCS / CPT® | OST POUCH DRAIN HIGH OUTPUT |
| A4413 | $0.00 | HCPCS / CPT® | 2 PC DRAINABLE OST POUCH |
| A4414 | $0.00 | HCPCS / CPT® | OST SKNBAR W/O CONV<=4 SQ IN |
| A4415 | $0.00 | HCPCS / CPT® | OST SKN BARR W/O CONV >4 SQI |
| A4416 | $0.00 | HCPCS / CPT® | OST PCH CLSD W BARRIER/FILTR |
| A4417 | $0.00 | HCPCS / CPT® | OST PCH W BAR/BLTINCONV/FLTR |
| A4418 | $0.00 | HCPCS / CPT® | OST PCH CLSD W/O BAR W FILTR |
| A4419 | $0.00 | HCPCS / CPT® | OST PCH FOR BAR W FLANGE/FLT |
| A4420 | $0.00 | HCPCS / CPT® | OST PCH CLSD FOR BAR W LK FL |
| A4421 | $0.00 | HCPCS / CPT® | OSTOMY SUPPLY MISC |
| A4422 | $0.00 | HCPCS / CPT® | OST POUCH ABSORBENT MATERIAL |
| A4423 | $0.00 | HCPCS / CPT® | OST PCH FOR BAR W LK FL/FLTR |
| A4424 | $0.00 | HCPCS / CPT® | OST PCH DRAIN W BAR & FILTER |
| A4425 | $0.00 | HCPCS / CPT® | OST PCH DRAIN FOR BARRIER FL |
| A4426 | $0.00 | HCPCS / CPT® | OST PCH DRAIN 2 PIECE SYSTEM |
| A4427 | $0.00 | HCPCS / CPT® | OST PCH DRAIN/BARR LK FLNG/F |
| A4428 | $0.00 | HCPCS / CPT® | URINE OST POUCH W FAUCET/TAP |
| A4429 | $0.00 | HCPCS / CPT® | URINE OST POUCH W BLTINCONV |
| A4430 | $0.00 | HCPCS / CPT® | OST URINE PCH W B/BLTIN CONV |
| A4431 | $0.00 | HCPCS / CPT® | OST PCH URINE W BARRIER/TAPV |
| A4432 | $0.00 | HCPCS / CPT® | OS PCH URINE W BAR/FANGE/TAP |
| A4433 | $0.00 | HCPCS / CPT® | URINE OST PCH BAR W LOCK FLN |
| A4434 | $0.00 | HCPCS / CPT® | OST PCH URINE W LOCK FLNG/FT |
| A4435 | $0.00 | HCPCS / CPT® | 1PC OST PCH DRAIN HGH OUTPUT |
| A4450 | $13.73 | HCPCS / CPT® | TAPE NON-WATERPROOF |
| A4452 | $13.73 | HCPCS / CPT® | TAPE WATERPROOF |
| A4455 | $0.00 | HCPCS / CPT® | ADHESIVE REMOVER PER OUNCE |
| A4456 | $0.00 | HCPCS / CPT® | ADHESIVE REMOVER, WIPES |
| A4458 | $0.00 | HCPCS / CPT® | REUSABLE ENEMA BAG |
| A4459 | $0.00 | HCPCS / CPT® | MANUAL PUMP ENEMA, REUSABLE |
| A4461 | $150.00 | HCPCS / CPT® | SURGICL DRESS HOLD NON-REUSE |
| A4463 | $0.00 | HCPCS / CPT® | SURGICAL DRESS HOLDER REUSE |
| A4465 | $0.00 | HCPCS / CPT® | NON-ELASTIC EXTREMITY BINDER |
| A4467 | $0.00 | HCPCS / CPT® | BELT STRAP SLEEV GRMNT COVER |
| A4470 | $0.00 | HCPCS / CPT® | GRAVLEE JET WASHER |
| A4480 | $0.00 | HCPCS / CPT® | VABRA ASPIRATOR |
| A4481 | $0.00 | HCPCS / CPT® | TRACHEOSTOMA FILTER |
| A4483 | $0.00 | HCPCS / CPT® | MOISTURE EXCHANGER |
| A4490 | $0.00 | HCPCS / CPT® | ABOVE KNEE SURGICAL STOCKING |
| A4495 | $0.00 | HCPCS / CPT® | THIGH LENGTH SURG STOCKING |
| A4500 | $0.00 | HCPCS / CPT® | BELOW KNEE SURGICAL STOCKING |
| A4510 | $0.00 | HCPCS / CPT® | FULL LENGTH SURG STOCKING |
| A4520 | $0.00 | HCPCS / CPT® | INCONTINENCE GARMENT ANYTYPE |
| A4550 | $535.73 | HCPCS / CPT® | PROCEDURE SUPPLY TRAY |
| A4550DRESS | $125.00 | HCPCS / CPT® | DRESSING TRAY |
| A4550SRKIT | $125.00 | HCPCS / CPT® | SUTURE REMOVAL KIT |
| A4553 | $0.00 | HCPCS / CPT® | NONDISP UNDERPADS, ALL SIZES |
| A4554 | $38.20 | HCPCS / CPT® | DISPOSABLE UNDERPADS – CHUCKS PAD – CHUX |
| A4555 | $0.00 | HCPCS / CPT® | CA TX E-STIM ELECTR/TRANSDUC |
| A4556 | $97.51 | HCPCS / CPT® | ELECTRODES PAIR |
| A4557 | $0.00 | HCPCS / CPT® | LEAD WIRES, PAIR |
| A4558 | $0.00 | HCPCS / CPT® | CONDUCTIVE GEL OR PASTE |
| A4559 | $0.00 | HCPCS / CPT® | COUPLING GEL OR PASTE |
| A4561 | $0.00 | HCPCS / CPT® | PESSARY RUBBER, ANY TYPE |
| A4562 | $0.00 | HCPCS / CPT® | PESSARY, NON RUBBER,ANY TYPE |
| A4565 | $191.34 | HCPCS / CPT® | SLINGS |
| A4566 | $201.77 | HCPCS / CPT® | SHOULD SLING/VEST/ABRESTRAIN |
| A4570 | $164.55 | HCPCS / CPT® | SPLINT |
| A4575 | $0.00 | HCPCS / CPT® | HYPERBARIC O2 CHAMBER DISPS |
| A4580 | $109.31 | HCPCS / CPT® | CAST SUPPLIES (PLASTER) |
| A4590 | $164.55 | HCPCS / CPT® | ORTHO GLASS 4″ SPECIAL CASTING MATERIAL |
| A4590 3 | $110.22 | HCPCS / CPT® | ORTHO GLASS 3″ SPECIAL CASTING MATERIAL |
| A4595 | $0.00 | HCPCS / CPT® | TENS SUPPL 2 LEAD PER MONTH |
| A4600 | $0.00 | HCPCS / CPT® | SLEEVE, INTER LIMB COMP DEV |
| A4601 | $0.00 | HCPCS / CPT® | LITH ION NON PROSTH RECHARGE |
| A4602 | $0.00 | HCPCS / CPT® | REPLACE LITHIUM BATTERY 1.5V |
| A4604 | $0.00 | HCPCS / CPT® | TUBING WITH HEATING ELEMENT |
| A4605 | $0.00 | HCPCS / CPT® | TRACH SUCTION CATH CLOSE SYS |
| A4606 | $166.84 | HCPCS / CPT® | OXYGEN PROBE USED W OXIMETER |
| A4608 | $0.00 | HCPCS / CPT® | TRANSTRACHEAL OXYGEN CATH |
| A4611 | $0.00 | HCPCS / CPT® | HEAVY DUTY BATTERY |
| A4612 | $0.00 | HCPCS / CPT® | BATTERY CABLES |
| A4613 | $0.00 | HCPCS / CPT® | BATTERY CHARGER |
| A4614 | $0.00 | HCPCS / CPT® | HAND-HELD PEFR METER |
| A4615 | $7.66 | HCPCS / CPT® | CANNULA NASAL O2 |
| A4616 | $3.45 | HCPCS / CPT® | TUBING (OXYGEN) PER FOOT |
| A4617 | $0.00 | HCPCS / CPT® | MOUTH PIECE |
| A4618 | $0.00 | HCPCS / CPT® | BREATHING CIRCUITS |
| A4619 | $0.00 | HCPCS / CPT® | FACE TENT |
| A4620 | $72.19 | HCPCS / CPT® | MASK – VARIABLE CONCENTRATION MASK – NON-REBREATHER MASK |
| A4623 | $0.00 | HCPCS / CPT® | TRACHEOSTOMY INNER CANNULA |
| A4624 | $0.00 | HCPCS / CPT® | TRACHEAL SUCTION TUBE |
| A4625 | $0.00 | HCPCS / CPT® | TRACH CARE KIT FOR NEW TRACH |
| A4626 | $0.00 | HCPCS / CPT® | TRACHEOSTOMY CLEANING BRUSH |
| A4627 | $0.00 | HCPCS / CPT® | SPACER BAG/RESERVOIR |
| A4628 | $0.00 | HCPCS / CPT® | OROPHARYNGEAL SUCTION CATH |
| A4629 | $0.00 | HCPCS / CPT® | TRACHEOSTOMY CARE KIT |
| A4630 | $0.00 | HCPCS / CPT® | REPL BAT T.E.N.S. OWN BY PT |
| A4633 | $0.00 | HCPCS / CPT® | UVL REPLACEMENT BULB |
| A4634 | $0.00 | HCPCS / CPT® | REPLACEMENT BULB TH LIGHTBOX |
| A4635 | $0.00 | HCPCS / CPT® | UNDERARM CRUTCH PAD |
| A4636 | $0.00 | HCPCS / CPT® | HANDGRIP FOR CANE ETC |
| A4637 | $0.00 | HCPCS / CPT® | REPL TIP CANE/CRUTCH/WALKER |
| A4638 | $0.00 | HCPCS / CPT® | REPL BATT PULSE GEN SYS |
| A4639 | $0.00 | HCPCS / CPT® | INFRARED HT SYS REPLCMNT PAD |
| A4640 | $0.00 | HCPCS / CPT® | ALTERNATING PRESSURE PAD |
| A4641 | $0.00 | HCPCS / CPT® | RADIOPHARM DX AGENT NOC |
| A4642 | $0.00 | HCPCS / CPT® | IN111 SATUMOMAB |
| A4648 | $0.00 | HCPCS / CPT® | IMPLANTABLE TISSUE MARKER |
| A4649 | $10.10 | HCPCS / CPT® | SURGICAL MISC |
| A4649 BAG | $28.84 | HCPCS / CPT® | BAG – NORMAL SALINE 100ML BAG |
| A4649 BAND | $1.27 | HCPCS / CPT® | BANDAID |
| A4649 BLAD | $6.32 | HCPCS / CPT® | SCAPLEL BLADE 11 |
| A4649 BOTT | $15.84 | HCPCS / CPT® | HYDROGEN PEROXIDE BOTTLE |
| A4649 BUDD | $11.34 | HCPCS / CPT® | BUDDY TAPE |
| A4649 CAT | $206.64 | HCPCS / CPT® | IV CATH ANY SIZE |
| A4649 CAU | $43.64 | HCPCS / CPT® | ELECTROCAUTERY MISC |
| A4649 CUP | $3.79 | HCPCS / CPT® | URINE SPEC CUP |
| A4649 DEC | $20.24 | HCPCS / CPT® | CO2 DETECTOR |
| A4649 ENEM | $41.78 | HCPCS / CPT® | FLEETS ENEMA |
| A4649 ICE | $6.32 | HCPCS / CPT® | ICE PACK |
| A4649 IRR | $16.77 | HCPCS / CPT® | IRRIGATION BOTTLE |
| A4649 IV | $16.08 | HCPCS / CPT® | IV START KIT |
| A4649 KATZ | $40.00 | HCPCS / CPT® | KATZ EXTRACTOR |
| A4649 LAMP | $225.01 | HCPCS / CPT® | WOODS LAMP |
| A4649 LITE | $46.31 | HCPCS / CPT® | LIGHT SOURCE |
| A4649 MASK | $12.65 | HCPCS / CPT® | ABUTER MASK |
| A4649 MON | $378.84 | HCPCS / CPT® | CARDIAC MONITOR |
| A4649 NACL | $13.20 | HCPCS / CPT® | SODIUM CHLORIDE BOTTLE 1000 ML |
| A4649 NIT | $52.82 | HCPCS / CPT® | SILVER NITRATE STICKS EACH |
| A4649 OXY | $28.16 | HCPCS / CPT® | OXYGEN MASK |
| A4649 SPEC | $231.60 | HCPCS / CPT® | SPECULUM |
| A4649 STAP | $76.53 | HCPCS / CPT® | STAPLE REPAIR KIT |
| A4649 TAM | $67.66 | HCPCS / CPT® | RAPID RHINO NASAL PACKING OR NASAL TAMPON |
| A4649 TON | $3.45 | HCPCS / CPT® | TONGUE DEPRESSOR |
| A4649 TOUR | $38.27 | HCPCS / CPT® | TOURNIQUETS |
| A4649 TU | $58.62 | HCPCS / CPT® | IV TUBING |
| A4649 VAG | $231.60 | HCPCS / CPT® | VAGINAL SPECULUM |
| A4649BASIN | $10.00 | HCPCS / CPT® | BASIN – EMESIS BASIN STERILE |
| A4649CAT | $206.64 | HCPCS / CPT® | IV CATH ANY SIZE |
| A4649FLUID | $10.00 | HCPCS / CPT® | PO FLUIDS MISCELLANEOUS |
| A4649FORCE | $25.00 | HCPCS / CPT® | FORCEPS |
| A4649STAPL | $236.89 | HCPCS / CPT® | SKIN STAPLER |
| A4649STR | $18.52 | HCPCS / CPT® | FLUOR-I-STRIP |
| A4649STRAI | $10.00 | HCPCS / CPT® | URINE STRAINER |
| A4649SURGI | $50.00 | HCPCS / CPT® | SURGICEL GEL FOAM |
| A4649SUTUR | $25.00 | HCPCS / CPT® | SUTURES |
| A4649SWAB | $5.00 | HCPCS / CPT® | SPECIMEN SWAB |
| A4649VBAG | $8.43 | HCPCS / CPT® | VOMIT BAG |
| A4649WICK | $40.00 | HCPCS / CPT® | EAR WICK |
| A4650 | $0.00 | HCPCS / CPT® | IMPLANT RADIATION DOSIMETER |
| A4651 | $0.00 | HCPCS / CPT® | CALIBRATED MICROCAP TUBE |
| A4652 | $0.00 | HCPCS / CPT® | MICROCAPILLARY TUBE SEALANT |
| A4653 | $0.00 | HCPCS / CPT® | PD CATHETER ANCHOR BELT |
| A4657 | $9.15 | HCPCS / CPT® | SYRINGE WITH OR WITHOUT NEEDLE |
| A4660 | $40.39 | HCPCS / CPT® | SPHYG/BP APP W CUFF AND STET |
| A4663 | $0.00 | HCPCS / CPT® | DIALYSIS BLOOD PRESSURE CUFF |
| A4670 | $46.84 | HCPCS / CPT® | AUTOMATIC BP MONITOR, DIAL |
| A4671 | $0.00 | HCPCS / CPT® | DISPOSABLE CYCLER SET |
| A4672 | $0.00 | HCPCS / CPT® | DRAINAGE EXT LINE, DIALYSIS |
| A4673 | $18.37 | HCPCS / CPT® | SALINE LOCK |
| A4674 | $0.00 | HCPCS / CPT® | CHEM/ANTISEPT SOLUTION, 8OZ |
| A4680 | $0.00 | HCPCS / CPT® | ACTIVATED CARBON FILTER, EA |
| A4690 | $0.00 | HCPCS / CPT® | DIALYZER, EACH |
| A4706 | $0.00 | HCPCS / CPT® | BICARBONATE CONC SOL PER GAL |
| A4707 | $0.00 | HCPCS / CPT® | BICARBONATE CONC POW PER PAC |
| A4708 | $0.00 | HCPCS / CPT® | ACETATE CONC SOL PER GALLON |
| A4709 | $0.00 | HCPCS / CPT® | ACID CONC SOL PER GALLON |
| A4714 | $0.00 | HCPCS / CPT® | TREATED WATER PER GALLON |
| A4719 | $0.00 | HCPCS / CPT® | Y SET TUBING |
| A4720 | $0.00 | HCPCS / CPT® | DIALYSAT SOL FLD VOL > 249CC |
| A4721 | $0.00 | HCPCS / CPT® | DIALYSAT SOL FLD VOL > 999CC |
| A4722 | $0.00 | HCPCS / CPT® | DIALYS SOL FLD VOL > 1999CC |
| A4723 | $0.00 | HCPCS / CPT® | DIALYS SOL FLD VOL > 2999CC |
| A4724 | $0.00 | HCPCS / CPT® | DIALYS SOL FLD VOL > 3999CC |
| A4725 | $0.00 | HCPCS / CPT® | DIALYS SOL FLD VOL > 4999CC |
| A4726 | $0.00 | HCPCS / CPT® | DIALYS SOL FLD VOL > 5999CC |
| A4728 | $0.00 | HCPCS / CPT® | DIALYSATE SOLUTION, NON-DEX |
| A4730 | $0.00 | HCPCS / CPT® | FISTULA CANNULATION SET, EA |
| A4736 | $0.00 | HCPCS / CPT® | TOPICAL ANESTHETIC, PER GRAM |
| A4737 | $0.00 | HCPCS / CPT® | INJ ANESTHETIC PER 10 ML |
| A4740 | $0.00 | HCPCS / CPT® | SHUNT ACCESSORY |
| A4750 | $0.00 | HCPCS / CPT® | ART OR VENOUS BLOOD TUBING |
| A4755 | $0.00 | HCPCS / CPT® | COMB ART/VENOUS BLOOD TUBING |
| A4760 | $0.00 | HCPCS / CPT® | DIALYSATE SOL TEST KIT, EACH |
| A4765 | $0.00 | HCPCS / CPT® | DIALYSATE CONC POW PER PACK |
| A4766 | $0.00 | HCPCS / CPT® | DIALYSATE CONC SOL ADD 10 ML |
| A4770 | $7.83 | HCPCS / CPT® | BLOOD COLLECTION TUBE/VACUUM |
| A4771 | $0.00 | HCPCS / CPT® | SERUM CLOTTING TIME TUBE |
| A4772 | $0.00 | HCPCS / CPT® | BLOOD GLUCOSE TEST STRIPS |
| A4773 | $0.00 | HCPCS / CPT® | OCCULT BLOOD TEST STRIPS |
| A4774 | $0.00 | HCPCS / CPT® | AMMONIA TEST STRIPS |
| A4802 | $0.00 | HCPCS / CPT® | PROTAMINE SULFATE PER 50 MG |
| A4860 | $0.00 | HCPCS / CPT® | DISPOSABLE CATHETER TIPS |
| A4870 | $0.00 | HCPCS / CPT® | PLUMB/ELEC WK HM HEMO EQUIP |
| A4890 | $0.00 | HCPCS / CPT® | REPAIR/MAINT CONT HEMO EQUIP |
| A4911 | $0.00 | HCPCS / CPT® | DRAIN BAG/BOTTLE |
| A4913 | $0.00 | HCPCS / CPT® | MISC DIALYSIS SUPPLIES NOC |
| A4918 | $0.00 | HCPCS / CPT® | VENOUS PRESSURE CLAMP |
| A4927 | $3.45 | HCPCS / CPT® | GLOVES NON-STERILE |
| A4928 | $0.00 | HCPCS / CPT® | SURGICAL MASK |
| A4929 | $9.81 | HCPCS / CPT® | TOURNIQUET FOR DIALYSIS, EA |
| A4930 | $4.59 | HCPCS / CPT® | GLOVES STERILE, PER PAIR |
| A4931 | $0.00 | HCPCS / CPT® | REUSABLE ORAL THERMOMETER |
| A4932 | $0.00 | HCPCS / CPT® | REUSABLE RECTAL THERMOMETER |
| A5051 | $0.00 | HCPCS / CPT® | POUCH CLSD W BARR ATTACHED |
| A5052 | $0.00 | HCPCS / CPT® | CLSD OSTOMY POUCH W/O BARR |
| A5053 | $0.00 | HCPCS / CPT® | CLSD OSTOMY POUCH FACEPLATE |
| A5054 | $0.00 | HCPCS / CPT® | CLSD OSTOMY POUCH W/FLANGE |
| A5055 | $0.00 | HCPCS / CPT® | STOMA CAP |
| A5056 | $0.00 | HCPCS / CPT® | 1 PC OST POUCH W FILTER |
| A5057 | $0.00 | HCPCS / CPT® | 1 PC OST POU W BUILT-IN CONV |
| A5061 | $0.00 | HCPCS / CPT® | POUCH DRAINABLE W BARRIER AT |
| A5062 | $0.00 | HCPCS / CPT® | DRNBLE OSTOMY POUCH W/O BARR |
| A5063 | $0.00 | HCPCS / CPT® | DRAIN OSTOMY POUCH W/FLANGE |
| A5071 | $0.00 | HCPCS / CPT® | URINARY POUCH W/BARRIER |
| A5072 | $0.00 | HCPCS / CPT® | URINARY POUCH W/O BARRIER |
| A5073 | $0.00 | HCPCS / CPT® | URINARY POUCH ON BARR W/FLNG |
| A5081 | $0.00 | HCPCS / CPT® | STOMA PLUG OR SEAL, ANY TYPE |
| A5082 | $0.00 | HCPCS / CPT® | CONTINENT STOMA CATHETER |
| A5083 | $0.00 | HCPCS / CPT® | STOMA ABSORPTIVE COVER |
| A5093 | $0.00 | HCPCS / CPT® | OSTOMY ACCESSORY CONVEX INSE |
| A5102 | $0.00 | HCPCS / CPT® | BEDSIDE DRAIN BTL W/WO TUBE |
| A5105 | $0.00 | HCPCS / CPT® | URINARY SUSPENSORY |
| A5112 | $0.00 | HCPCS / CPT® | URINARY LEG BAG |
| A5113 | $0.00 | HCPCS / CPT® | LATEX LEG STRAP |
| A5114 | $0.00 | HCPCS / CPT® | FOAM/FABRIC LEG STRAP |
| A5120 | $7.66 | HCPCS / CPT® | SWAB OR WIPE SKIN BARRIER |
| A5121 | $0.00 | HCPCS / CPT® | SOLID SKIN BARRIER 6X6 |
| A5122 | $0.00 | HCPCS / CPT® | SOLID SKIN BARRIER 8X8 |
| A5126 | $0.00 | HCPCS / CPT® | DISK/FOAM PAD +OR- ADHESIVE |
| A5131 | $0.00 | HCPCS / CPT® | APPLIANCE CLEANER |
| A5200 | $153.06 | HCPCS / CPT® | PERCUTANEOUS CATHETER ANCHOR |
| A5500 | $0.00 | HCPCS / CPT® | DIAB SHOE FOR DENSITY INSERT |
| A5501 | $0.00 | HCPCS / CPT® | DIABETIC CUSTOM MOLDED SHOE |
| A5503 | $0.00 | HCPCS / CPT® | DIABETIC SHOE W/ROLLER/ROCKR |
| A5504 | $0.00 | HCPCS / CPT® | DIABETIC SHOE WITH WEDGE |
| A5505 | $0.00 | HCPCS / CPT® | DIAB SHOE W/METATARSAL BAR |
| A5506 | $0.00 | HCPCS / CPT® | DIABETIC SHOE W/OFF SET HEEL |
| A5507 | $0.00 | HCPCS / CPT® | MODIFICATION DIABETIC SHOE |
| A5508 | $0.00 | HCPCS / CPT® | DIABETIC DELUXE SHOE |
| A5510 | $0.00 | HCPCS / CPT® | COMPRESSION FORM SHOE INSERT |
| A5512 | $0.00 | HCPCS / CPT® | MULTI DEN INSERT DIRECT FORM |
| A5513 | $0.00 | HCPCS / CPT® | MULTI DEN INSERT CUSTOM MOLD |
| A6000 | $23.12 | HCPCS / CPT® | NON-CONTACT WOUND WARMING WOUND COVER FOR USE WITH THE NON-CONTACT WOUND WARMING DEVICE AND WARMING CARD |
| A6010 | $0.00 | HCPCS / CPT® | COLLAGEN BASED WOUND FILLER |
| A6011 | $0.00 | HCPCS / CPT® | COLLAGEN GEL/PASTE WOUND FIL |
| A6021 | $22.90 | HCPCS / CPT® | COLLAGEN DRESSING <=16 SQ IN |
| A6022 | $0.00 | HCPCS / CPT® | COLLAGEN DRSG>16<=48 SQ IN |
| A6023 | $0.00 | HCPCS / CPT® | COLLAGEN DRESSING >48 SQ IN |
| A6024 | $0.00 | HCPCS / CPT® | COLLAGEN DSG WOUND FILLER |
| A6025 | $0.00 | HCPCS / CPT® | SILICONE GEL SHEET, EACH |
| A6154 | $0.00 | HCPCS / CPT® | WOUND POUCH EACH |
| A6196 | $0.00 | HCPCS / CPT® | ALGINATE DRESSING <=16 SQ IN |
| A6197 | $0.00 | HCPCS / CPT® | ALGINATE DRSG >16 <=48 SQ IN |
| A6198 | $18.52 | HCPCS / CPT® | ALGINATE DRESSING >48 SQ IN |
| A6199 | $0.00 | HCPCS / CPT® | ALGINATE DRSG WOUND FILLER |
| A6203 | $11.45 | HCPCS / CPT® | COMPOSITE DRSG 16 SQ IN |
| A6204 | $0.00 | HCPCS / CPT® | COMPOSITE DRSG >16<=48 SQ IN |
| A6205 | $27.55 | HCPCS / CPT® | COMPOSITE DRSG 48 SQ IN |
| A6206 | $0.00 | HCPCS / CPT® | CONTACT LAYER <= 16 SQ IN |
| A6207 | $0.00 | HCPCS / CPT® | CONTACT LAYER >16<= 48 SQ IN |
| A6208 | $0.00 | HCPCS / CPT® | CONTACT LAYER > 48 SQ IN |
| A6209 | $0.00 | HCPCS / CPT® | FOAM DRSG <=16 SQ IN W/O BDR |
| A6210 | $0.00 | HCPCS / CPT® | FOAM DRG >16<=48 SQ IN W/O B |
| A6211 | $40.49 | HCPCS / CPT® | FOAM DRG > 48 SQ IN W/O BRDR |
| A6212 | $0.00 | HCPCS / CPT® | FOAM DRG <=16 SQ IN W/BORDER |
| A6213 | $15.01 | HCPCS / CPT® | FOAM DRG >16<=48 SQ IN W/BDR |
| A6214 | $0.00 | HCPCS / CPT® | FOAM DRG > 48 SQ IN W/BORDER |
| A6215 | $0.00 | HCPCS / CPT® | FOAM DRESSING WOUND FILLER |
| A6216 | $18.52 | HCPCS / CPT® | GAUZE – NON-STERILE GAUZE – LESS THAN 16 SQ IN |
| A6217 | $18.52 | HCPCS / CPT® | GAUZE – NON-STERILE GAUZE>16 BUT <=48 SQ |
| A6218 | $18.52 | HCPCS / CPT® | GAUZE – NON-STERILE GAUZE > 48 SQ IN |
| A6219 | $18.52 | HCPCS / CPT® | GAUZE – STERILE GAUZE <= 16 SQ IN W/BORDER |
| A6220 | $0.00 | HCPCS / CPT® | GAUZE >16 <=48 SQ IN W/BORDR |
| A6221 | $0.00 | HCPCS / CPT® | GAUZE > 48 SQ IN W/BORDER |
| A6222 | $30.00 | HCPCS / CPT® | IODOFORM GAUZE 16 IN NO W/SAL W/O B |
| A6223 | $0.00 | HCPCS / CPT® | GAUZE >16<=48 NO W/SAL W/O B |
| A6224 | $24.74 | HCPCS / CPT® | GAUZE 48 IN NO WSAL WO B |
| A6228 | $0.00 | HCPCS / CPT® | GAUZE <= 16 SQ IN WATER/SAL |
| A6229 | $0.00 | HCPCS / CPT® | GAUZE >16<=48 SQ IN WATR/SAL |
| A6230 | $0.00 | HCPCS / CPT® | GAUZE > 48 SQ IN WATER/SALNE |
| A6231 | $92.45 | HCPCS / CPT® | GAUZE – KERLIX DRESSING LESS THAN 16 SQ IN |
| A6232 | $0.00 | HCPCS / CPT® | HYDROGEL DSG>16<=48 SQ IN |
| A6233 | $0.00 | HCPCS / CPT® | HYDROGEL DRESSING >48 SQ IN |
| A6234 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG <=16 W/O BDR |
| A6235 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG >16<=48 W/O B |
| A6236 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG > 48 IN W/O B |
| A6237 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG <=16 IN W/BDR |
| A6238 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG >16<=48 W/BDR |
| A6239 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG > 48 IN W/BDR |
| A6240 | $0.00 | HCPCS / CPT® | HYDROCOLLD DRG FILLER PASTE |
| A6241 | $0.00 | HCPCS / CPT® | HYDROCOLLOID DRG FILLER DRY |
| A6242 | $0.00 | HCPCS / CPT® | HYDROGEL DRG <=16 IN W/O BDR |
| A6243 | $0.00 | HCPCS / CPT® | HYDROGEL DRG >16<=48 W/O BDR |
| A6244 | $0.00 | HCPCS / CPT® | HYDROGEL DRG >48 IN W/O BDR |
| A6245 | $0.00 | HCPCS / CPT® | HYDROGEL DRG <= 16 IN W/BDR |
| A6246 | $0.00 | HCPCS / CPT® | HYDROGEL DRG >16<=48 IN W/B |
| A6247 | $0.00 | HCPCS / CPT® | HYDROGEL DRG > 48 SQ IN W/B |
| A6248 | $0.00 | HCPCS / CPT® | HYDROGEL DRSG GEL FILLER |
| A6250 | $44.93 | HCPCS / CPT® | SKIN SEAL PROTECT MOISTURIZER OINTMENT |
| A6251 | $10.00 | HCPCS / CPT® | ABSORPT DRG <=16 SQ IN W/O B |
| A6252 | $0.00 | HCPCS / CPT® | ABSORPT DRG >16 <=48 W/O BDR |
| A6253 | $0.00 | HCPCS / CPT® | ABSORPT DRG > 48 SQ IN W/O B |
| A6254 | $0.00 | HCPCS / CPT® | ABSORPT DRG <=16 SQ IN W/BDR |
| A6255 | $0.00 | HCPCS / CPT® | ABSORPT DRG >16<=48 IN W/BDR |
| A6256 | $0.00 | HCPCS / CPT® | ABSORPT DRG > 48 SQ IN W/BDR |
| A6257 | $11.49 | HCPCS / CPT® | TRANSPARENT FILM |
| A6258 | $31.13 | HCPCS / CPT® | TRANSPARENT FILM >16<=48 IN |
| A6259 | $0.00 | HCPCS / CPT® | TRANSPARENT FILM > 48 SQ IN |
| A6260 | $130.11 | HCPCS / CPT® | WOUND CLEANSER |
| A6261 | $0.00 | HCPCS / CPT® | WOUND FILLER GEL/PASTE /OZ |
| A6262 | $0.00 | HCPCS / CPT® | WOUND FILLER DRY FORM / GRAM |
| A6266 | $51.75 | HCPCS / CPT® | IMPREG GAUZE NO H20/SAL/YARD |
| A6402 | $5.45 | HCPCS / CPT® | STERILE GAUZE 16 SQ IN |
| A6403 | $0.00 | HCPCS / CPT® | STERILE GAUZE>16 <= 48 SQ IN |
| A6404 | $0.00 | HCPCS / CPT® | STERILE GAUZE > 48 SQ IN |
| A6407 | $40.00 | HCPCS / CPT® | STERI-STRIPS-IODOFORM-PACKING GAUZE |
| A6410 | $7.66 | HCPCS / CPT® | STERILE EYE PAD OR STRIP |
| A6411 | $0.00 | HCPCS / CPT® | NON-STERILE EYE PAD |
| A6412 | $0.00 | HCPCS / CPT® | OCCLUSIVE EYE PATCH |
| A6413 | $6.90 | HCPCS / CPT® | ADHESIVE BANDAGE, FIRST-AID |
| A6442 | $0.00 | HCPCS / CPT® | CONFORM BAND N/S W <3/YD |
| A6443 | $0.00 | HCPCS / CPT® | CONFORM BAND N/S W>=3 <5/YD |
| A6444 | $10.00 | HCPCS / CPT® | CONFORM BAND N/S W>=5/YD |
| A6445 | $5.31 | HCPCS / CPT® | CONFORM BAND S W <3″/YD |
| A6446 | $12.00 | HCPCS / CPT® | Conforming bandage |
| A6447 | $0.00 | HCPCS / CPT® | CONFORM BAND S W >=5/YD |
| A6448 | $15.01 | HCPCS / CPT® | LT COMPRES BAND <3Ö/YD |
| A6449 | $15.31 | HCPCS / CPT® | ACE WRAP (LT COMPRES BAND |
| A6450 | $22.97 | HCPCS / CPT® | ACE WRAP – LT COMPRES BAND >=5″/YD |
| A6451 | $0.00 | HCPCS / CPT® | MOD COMPRES BAND W>=3 <5/YD |
| A6452 | $0.00 | HCPCS / CPT® | HIGH COMPRES BAND W>=3 <5YD |
| A6453 | $5.45 | HCPCS / CPT® | BANDAGE – SELF-ADHER BAND W <3Ö/YD |
| A6454 | $15.00 | HCPCS / CPT® | SELF-ADHER BAND 3-5 YD |
| A6455 | $0.00 | HCPCS / CPT® | SELF-ADHER BAND >=5/YD |
| A6456 | $0.00 | HCPCS / CPT® | ZINC PASTE BAND W >=3 <5/YD |
| A6457 | $53.73 | HCPCS / CPT® | TUBULAR DRESSING |
| A6501 | $0.00 | HCPCS / CPT® | COMPRES BURNGARMENT BODYSUIT |
| A6502 | $0.00 | HCPCS / CPT® | COMPRES BURNGARMENT CHINSTRP |
| A6503 | $0.00 | HCPCS / CPT® | COMPRES BURNGARMENT FACEHOOD |
| A6504 | $0.00 | HCPCS / CPT® | CMPRSBURNGARMENT GLOVE-WRIST |
| A6505 | $0.00 | HCPCS / CPT® | CMPRSBURNGARMENT GLOVE-ELBOW |
| A6506 | $0.00 | HCPCS / CPT® | CMPRSBURNGRMNT GLOVE-AXILLA |
| A6507 | $0.00 | HCPCS / CPT® | CMPRS BURNGARMENT FOOT-KNEE |
| A6508 | $0.00 | HCPCS / CPT® | CMPRS BURNGARMENT FOOT-THIGH |
| A6509 | $0.00 | HCPCS / CPT® | COMPRES BURN GARMENT JACKET |
| A6510 | $0.00 | HCPCS / CPT® | COMPRES BURN GARMENT LEOTARD |
| A6511 | $0.00 | HCPCS / CPT® | COMPRES BURN GARMENT PANTY |
| A6512 | $0.00 | HCPCS / CPT® | COMPRES BURN GARMENT, NOC |
| A6513 | $0.00 | HCPCS / CPT® | COMPRESS BURN MASK FACE/NECK |
| A6530 | $0.00 | HCPCS / CPT® | COMPRESSION STOCKING BK18-30 |
| A6531 | $0.00 | HCPCS / CPT® | COMPRESSION STOCKING BK30-40 |
| A6532 | $0.00 | HCPCS / CPT® | COMPRESSION STOCKING BK40-50 |
| A6533 | $0.00 | HCPCS / CPT® | GC STOCKING THIGHLNGTH 18-30 |
| A6534 | $0.00 | HCPCS / CPT® | GC STOCKING THIGHLNGTH 30-40 |
| A6535 | $0.00 | HCPCS / CPT® | GC STOCKING THIGHLNGTH 40-50 |
| A6536 | $0.00 | HCPCS / CPT® | GC STOCKING FULL LNGTH 18-30 |
| A6537 | $0.00 | HCPCS / CPT® | GC STOCKING FULL LNGTH 30-40 |
| A6538 | $0.00 | HCPCS / CPT® | GC STOCKING FULL LNGTH 40-50 |
| A6539 | $0.00 | HCPCS / CPT® | GC STOCKING WAISTLNGTH 18-30 |
| A6540 | $0.00 | HCPCS / CPT® | GC STOCKING WAISTLNGTH 30-40 |
| A6541 | $0.00 | HCPCS / CPT® | GC STOCKING WAISTLNGTH 40-50 |
| A6544 | $0.00 | HCPCS / CPT® | GC STOCKING GARTER BELT |
| A6545 | $0.00 | HCPCS / CPT® | GRAD COMP NON-ELASTIC BK |
| A6549 | $0.00 | HCPCS / CPT® | G COMPRESSION STOCKING |
| A6550 | $0.00 | HCPCS / CPT® | NEG PRES WOUND THER DRSG SET |
| A7000 | $0.00 | HCPCS / CPT® | DISPOSABLE CANISTER FOR PUMP |
| A7001 | $13.02 | HCPCS / CPT® | CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH |
| A7002 | $122.75 | HCPCS / CPT® | SUCTION TUBING USED W PUMP |
| A7003 | $73.92 | HCPCS / CPT® | NEBULIZER ADMINISTRATION SET |
| A7004 | $0.00 | HCPCS / CPT® | DISPOSABLE NEBULIZER SML VOL |
| A7005 | $0.00 | HCPCS / CPT® | NONDISPOSABLE NEBULIZER SET |
| A7006 | $0.00 | HCPCS / CPT® | FILTERED NEBULIZER ADMIN SET |
| A7007 | $0.00 | HCPCS / CPT® | LG VOL NEBULIZER DISPOSABLE |
| A7008 | $0.00 | HCPCS / CPT® | DISPOSABLE NEBULIZER PREFILL |
| A7009 | $0.00 | HCPCS / CPT® | NEBULIZER RESERVOIR BOTTLE |
| A7010 | $40.00 | HCPCS / CPT® | DISPOSABLE CORRUGATED TUBING |
| A7012 | $0.00 | HCPCS / CPT® | NEBULIZER WATER COLLEC DEVIC |
| A7013 | $0.00 | HCPCS / CPT® | DISPOSABLE COMPRESSOR FILTER |
| A7014 | $0.00 | HCPCS / CPT® | COMPRESSOR NONDISPOS FILTER |
| A7015 | $73.92 | HCPCS / CPT® | NEBULIZER MASK USED W NEBULIZER |
| A7016 | $30.61 | HCPCS / CPT® | NEBULIZER DOME & MOUTHPIECE |
| A7017 | $73.92 | HCPCS / CPT® | NEBULIZER MASK NOT USED W OXYGEN |
| A7018 | $0.00 | HCPCS / CPT® | WATER DISTILLED W/NEBULIZER |
| A7020 | $0.00 | HCPCS / CPT® | INTERFACE, COUGH STIM DEVICE |
| A7025 | $0.00 | HCPCS / CPT® | REPLACE CHEST COMPRESS VEST |
| A7026 | $0.00 | HCPCS / CPT® | REPLACE CHST CMPRSS SYS HOSE |
| A7027 | $0.00 | HCPCS / CPT® | COMBINATION ORAL/NASAL MASK |
| A7028 | $0.00 | HCPCS / CPT® | REPL ORAL CUSHION COMBO MASK |
| A7029 | $0.00 | HCPCS / CPT® | REPL NASAL PILLOW COMB MASK |
| A7030 | $1161.86 | HCPCS / CPT® | CPAP FULL FACE MASK |
| A7031 | $0.00 | HCPCS / CPT® | REPLACEMENT FACEMASK INTERFA |
| A7032 | $0.00 | HCPCS / CPT® | REPLACEMENT NASAL CUSHION |
| A7033 | $0.00 | HCPCS / CPT® | REPLACEMENT NASAL PILLOWS |
| A7034 | $0.00 | HCPCS / CPT® | NASAL APPLICATION DEVICE |
| A7035 | $10.00 | HCPCS / CPT® | POS AIRWAY PRESS HEADGEAR |
| A7036 | $10.00 | HCPCS / CPT® | POS AIRWAY PRESS CHINSTRAP |
| A7037 | $10.00 | HCPCS / CPT® | POS AIRWAY PRESSURE TUBING |
| A7038 | $0.00 | HCPCS / CPT® | POS AIRWAY PRESSURE FILTER |
| A7039 | $0.00 | HCPCS / CPT® | FILTER, NON DISPOSABLE W PAP |
| A7040 | $0.00 | HCPCS / CPT® | ONE WAY CHEST DRAIN VALVE |
| A7041 | $0.00 | HCPCS / CPT® | WATER SEAL DRAIN CONTAINER |
| A7044 | $0.00 | HCPCS / CPT® | PAP ORAL INTERFACE |
| A7045 | $0.00 | HCPCS / CPT® | REPL EXHALATION PORT FOR PAP |
| A7046 | $0.00 | HCPCS / CPT® | REPL WATER CHAMBER, PAP DEV |
| A7047 | $0.00 | HCPCS / CPT® | RESP SUCTION ORAL INTERFACE |
| A7048 | $0.00 | HCPCS / CPT® | VACUUM DRAIN BOTTLE/TUBE KIT |
| A7501 | $0.00 | HCPCS / CPT® | TRACHEOSTOMA VALVE W DIAPHRA |
| A7502 | $0.00 | HCPCS / CPT® | REPLACEMENT DIAPHRAGM/FPLATE |
| A7503 | $0.00 | HCPCS / CPT® | HMES FILTER HOLDER OR CAP |
| A7504 | $0.00 | HCPCS / CPT® | TRACHEOSTOMA HMES FILTER |
| A7505 | $0.00 | HCPCS / CPT® | HMES OR TRACH VALVE HOUSING |
| A7506 | $0.00 | HCPCS / CPT® | HMES/TRACHVALVE ADHESIVEDISK |
| A7507 | $0.00 | HCPCS / CPT® | INTEGRATED FILTER & HOLDER |
| A7508 | $0.00 | HCPCS / CPT® | HOUSING & INTEGRATED ADHESIV |
| A7509 | $0.00 | HCPCS / CPT® | HEAT & MOISTURE EXCHANGE SYS |
| A7520 | $48.60 | HCPCS / CPT® | TRACH/LARYN TUBE NON-CUFFED |
| A7521 | $0.00 | HCPCS / CPT® | TRACH/LARYN TUBE CUFFED |
| A7522 | $0.00 | HCPCS / CPT® | TRACH/LARYN TUBE STAINLESS |
| A7523 | $0.00 | HCPCS / CPT® | TRACHEOSTOMY SHOWER PROTECT |
| A7524 | $0.00 | HCPCS / CPT® | TRACHEOSTOMA STENT/STUD/BTTN |
| A7525 | $0.00 | HCPCS / CPT® | TRACHEOSTOMY MASK |
| A7526 | $0.00 | HCPCS / CPT® | TRACHEOSTOMY TUBE COLLAR |
| A7527 | $0.00 | HCPCS / CPT® | TRACH/LARYN TUBE PLUG/STOP |
| A8000 | $0.00 | HCPCS / CPT® | SOFT PROTECT HELMET PREFAB |
| A8001 | $0.00 | HCPCS / CPT® | HARD PROTECT HELMET PREFAB |
| A8002 | $0.00 | HCPCS / CPT® | SOFT PROTECT HELMET CUSTOM |
| A8003 | $0.00 | HCPCS / CPT® | HARD PROTECT HELMET CUSTOM |
| A8004 | $0.00 | HCPCS / CPT® | REPL SOFT INTERFACE, HELMET |
| A9150 | $8.84 | HCPCS / CPT® | MISC/EXPER NON-PRESCRIPT DRU |
| A9150ACET3 | $15.00 | HCPCS / CPT® | ACETAMINOPHEN – TYLENOL; 325MG TAB PO |
| A9150ACET5 | $15.00 | HCPCS / CPT® | ACETAMINOPHEN – TYLENOL; 500MG TAB PO |
| A9150ACETP | $10.00 | HCPCS / CPT® | ACETAMINOPHEN-TYLENOL; 120 MG SUPPOSITORY |
| A9150ACETS | $10.00 | HCPCS / CPT® | ACETAMINOPHEN – TYLENOL; 160MG/5ML SUSP PO |
| A9150ASP3 | $10.00 | HCPCS / CPT® | ASPIRIN; 325MG TAB PO |
| A9150ASP81 | $10.00 | HCPCS / CPT® | ASPIRIN – ASA; 81MG PO |
| A9150BEN25 | $25.00 | HCPCS / CPT® | BENADRYL – DIPHENHYDRAMINE HCI; 25MG PO |
| A9150BENS | $40.00 | HCPCS / CPT® | Benadryl – Diphenhydramine; 12.5mg/5ml Susp PO |
| A9150CLARI | $10.00 | HCPCS / CPT® | CLARITIN-LORATADINE; 5MG TAB PO |
| A9150EXCED | $20.00 | HCPCS / CPT® | EXCEDRIN MIGRAINE-ACETAMINOPHEN, ASPIRIN, CAFFEINE; 250MG-250MG-65MG TAB PO |
| A9150IM | $25.00 | HCPCS / CPT® | IMMODIUM/LOPERAMIDE; PO |
| A9150IMOD | $15.00 | HCPCS / CPT® | IMODIUM; 4MG TAB PO |
| A9150MAG | $15.00 | HCPCS / CPT® | MAGNESIUM CITRATE; 150ML PO |
| A9150MOT2 | $10.00 | HCPCS / CPT® | Motrin/Ibuprofen, Tab 200mg |
| A9150MOT4 | $10.00 | HCPCS / CPT® | MOTRIN/IBUPROFEN; 400MG TAB PO |
| A9150MOTS | $15.00 | HCPCS / CPT® | IBUPROFEN – MOTRIN; 100MG/5ML SUSP PO |
| A9150NEOSY | $15.00 | HCPCS / CPT® | NEO-SYNEPHRINE – PHENYLEPHRINE HCl; NASAL SPRAY |
| A9150PEP | $25.00 | HCPCS / CPT® | PEPCID/FAMOTIDINE; 20MG PO |
| A9150PRILO | $25.00 | HCPCS / CPT® | PRILOSEC-OMEPRAZOLE; 20MG TAB PO |
| A9150SUDA | $10.00 | HCPCS / CPT® | SUDAFED |
| A9152 | $0.00 | HCPCS / CPT® | SINGLE VITAMIN NOS |
| A9153 | $0.00 | HCPCS / CPT® | MULTI-VITAMIN NOS |
| A9155 | $0.00 | HCPCS / CPT® | ARTIFICIAL SALIVA |
| A9180 | $0.00 | HCPCS / CPT® | LICE TREATMENT, TOPICAL |
| A9270 | $0.00 | HCPCS / CPT® | NON-COVERED ITEM OR SERVICE |
| A9272 | $0.00 | HCPCS / CPT® | DISP WOUND SUCT, DRSG/ACCESS |
| A9273 | $16.84 | HCPCS / CPT® | HOT/COLD H2OBOT/CAP/COL/WRAP |
| A9274 | $0.00 | HCPCS / CPT® | EXT AMB INSULIN DELIVERY SYS |
| A9275 | $0.00 | HCPCS / CPT® | DISP HOME GLUCOSE MONITOR |
| A9276 | $0.00 | HCPCS / CPT® | DISPOSABLE SENSOR, CGM SYS |
| A9277 | $0.00 | HCPCS / CPT® | EXTERNAL TRANSMITTER, CGM |
| A9278 | $0.00 | HCPCS / CPT® | EXTERNAL RECEIVER, CGM SYS |
| A9279 | $0.00 | HCPCS / CPT® | MONITORING FEATURE/DEVICENOC |
| A9280 | $0.00 | HCPCS / CPT® | ALERT DEVICE, NOC |
| A9281 | $0.00 | HCPCS / CPT® | REACHING/GRABBING DEVICE |
| A9282 | $0.00 | HCPCS / CPT® | WIG ANY TYPE |
| A9283 | $0.00 | HCPCS / CPT® | FOOT PRESS OFF LOAD SUPP DEV |
| A9284 | $0.00 | HCPCS / CPT® | NON-ELECTRONIC SPIROMETER |
| A9285 | $0.00 | HCPCS / CPT® | INVERSION EVERSION COR DEVIC |
| A9286 | $0.00 | HCPCS / CPT® | ANY HYGIENIC ITEM, DEVICE |
| A9300 | $0.00 | HCPCS / CPT® | EXERCISE EQUIPMENT |
| A9500 | $0.00 | HCPCS / CPT® | TC99M SESTAMIBI |
| A9501 | $0.00 | HCPCS / CPT® | TECHNETIUM TC-99M TEBOROXIME |
| A9502 | $0.00 | HCPCS / CPT® | TC99M TETROFOSMIN |
| A9503 | $0.00 | HCPCS / CPT® | TC99M MEDRONATE |
| A9504 | $0.00 | HCPCS / CPT® | TC99M APCITIDE |
| A9505 | $0.00 | HCPCS / CPT® | TL201 THALLIUM |
| A9507 | $0.00 | HCPCS / CPT® | IN111 CAPROMAB |
| A9508 | $0.00 | HCPCS / CPT® | I131 IODOBENGUATE, DX |
| A9509 | $0.00 | HCPCS / CPT® | IODINE I-123 SOD IODIDE MIL |
| A9510 | $0.00 | HCPCS / CPT® | TC99M DISOFENIN |
| A9512 | $0.00 | HCPCS / CPT® | TC99M PERTECHNETATE |
| A9515 | $0.00 | HCPCS / CPT® | CHOLINE C-11 |
| A9516 | $0.00 | HCPCS / CPT® | IODINE I-123 SOD IODIDE MIC |
| A9517 | $0.00 | HCPCS / CPT® | I131 IODIDE CAP, RX |
| A9520 | $0.00 | HCPCS / CPT® | TC99 TILMANOCEPT DIAG 0.5MCI |
| A9521 | $0.00 | HCPCS / CPT® | TC99M EXAMETAZIME |
| A9524 | $0.00 | HCPCS / CPT® | I131 SERUM ALBUMIN, DX |
| A9526 | $0.00 | HCPCS / CPT® | NITROGEN N-13 AMMONIA |
| A9527 | $0.00 | HCPCS / CPT® | IODINE I-125 SODIUM IODIDE |
| A9528 | $0.00 | HCPCS / CPT® | IODINE I-131 IODIDE CAP, DX |
| A9529 | $0.00 | HCPCS / CPT® | I131 IODIDE SOL, DX |
| A9530 | $0.00 | HCPCS / CPT® | I131 IODIDE SOL, RX |
| A9531 | $0.00 | HCPCS / CPT® | I131 MAX 100UCI |
| A9532 | $0.00 | HCPCS / CPT® | I125 SERUM ALBUMIN, DX |
| A9536 | $0.00 | HCPCS / CPT® | TC99M DEPREOTIDE |
| A9537 | $0.00 | HCPCS / CPT® | TC99M MEBROFENIN |
| A9538 | $0.00 | HCPCS / CPT® | TC99M PYROPHOSPHATE |
| A9539 | $0.00 | HCPCS / CPT® | TC99M PENTETATE |
| A9540 | $0.00 | HCPCS / CPT® | TC99M MAA |
| A9541 | $0.00 | HCPCS / CPT® | TC99M SULFUR COLLOID |
| A9542 | $0.00 | HCPCS / CPT® | IN111 IBRITUMOMAB, DX |
| A9543 | $0.00 | HCPCS / CPT® | Y90 IBRITUMOMAB, RX |
| A9546 | $0.00 | HCPCS / CPT® | CO57/58 |
| A9547 | $0.00 | HCPCS / CPT® | IN111 OXYQUINOLINE |
| A9548 | $0.00 | HCPCS / CPT® | IN111 PENTETATE |
| A9550 | $0.00 | HCPCS / CPT® | TC99M GLUCEPTATE |
| A9551 | $0.00 | HCPCS / CPT® | TC99M SUCCIMER |
| A9552 | $0.00 | HCPCS / CPT® | F18 FDG |
| A9553 | $0.00 | HCPCS / CPT® | CR51 CHROMATE |
| A9554 | $0.00 | HCPCS / CPT® | I125 IOTHALAMATE, DX |
| A9555 | $0.00 | HCPCS / CPT® | RB82 RUBIDIUM |
| A9556 | $0.00 | HCPCS / CPT® | GA67 GALLIUM |
| A9557 | $0.00 | HCPCS / CPT® | TC99M BICISATE |
| A9558 | $0.00 | HCPCS / CPT® | XE133 XENON 10MCI |
| A9559 | $0.00 | HCPCS / CPT® | CO57 CYANO |
| A9560 | $0.00 | HCPCS / CPT® | TC99M LABELED RBC |
| A9561 | $0.00 | HCPCS / CPT® | TC99M OXIDRONATE |
| A9562 | $0.00 | HCPCS / CPT® | TC99M MERTIATIDE |
| A9563 | $0.00 | HCPCS / CPT® | P32 NA PHOSPHATE |
| A9564 | $0.00 | HCPCS / CPT® | P32 CHROMIC PHOSPHATE |
| A9566 | $0.00 | HCPCS / CPT® | TC99M FANOLESOMAB |
| A9567 | $0.00 | HCPCS / CPT® | TECHNETIUM TC-99M AEROSOL |
| A9568 | $0.00 | HCPCS / CPT® | TECHNETIUM TC99M ARCITUMOMAB |
| A9569 | $0.00 | HCPCS / CPT® | TECHNETIUM TC-99M AUTO WBC |
| A9570 | $0.00 | HCPCS / CPT® | INDIUM IN-111 AUTO WBC |
| A9571 | $0.00 | HCPCS / CPT® | INDIUM IN-111 AUTO PLATELET |
| A9572 | $0.00 | HCPCS / CPT® | INDIUM IN-111 PENTETREOTIDE |
| A9575 | $0.00 | HCPCS / CPT® | INJ GADOTERATE MEGLUMI 0.1ML |
| A9576 | $0.00 | HCPCS / CPT® | INJ PROHANCE MULTIPACK |
| A9577 | $0.00 | HCPCS / CPT® | INJ MULTIHANCE |
| A9578 | $0.00 | HCPCS / CPT® | INJ MULTIHANCE MULTIPACK |
| A9579 | $20.63 | HCPCS / CPT® | GAD-BASE MR CONTRAST NOS,1ML |
| A9580 | $0.00 | HCPCS / CPT® | SODIUM FLUORIDE F-18 |
| A9581 | $0.00 | HCPCS / CPT® | GADOXETATE DISODIUM INJ |
| A9582 | $0.00 | HCPCS / CPT® | IODINE I-123 IOBENGUANE |
| A9583 | $0.00 | HCPCS / CPT® | GADOFOSVESET TRISODIUM INJ |
| A9584 | $0.00 | HCPCS / CPT® | IODINE I-123 IOFLUPANE |
| A9585 | $0.00 | HCPCS / CPT® | GADOBUTROL INJECTION |
| A9586 | $0.00 | HCPCS / CPT® | FLORBETAPIR F18 |
| A9587 | $0.00 | HCPCS / CPT® | GALLIUM GA-68 |
| A9588 | $0.00 | HCPCS / CPT® | FLUCICLOVINE F-18 |
| A9597 | $0.00 | HCPCS / CPT® | PET, DX, FOR TUMOR ID, NOC |
| A9598 | $0.00 | HCPCS / CPT® | PET DX FOR NON-TUMOR ID, NOC |
| A9599 | $0.00 | HCPCS / CPT® | RADIOPH DX B AMYLOID PET NOS |
| A9600 | $0.00 | HCPCS / CPT® | SR89 STRONTIUM |
| A9604 | $0.00 | HCPCS / CPT® | SM 153 LEXIDRONAM |
| A9606 | $0.00 | HCPCS / CPT® | RADIUM RA223 DICHLORIDE THER |
| A9698 | $0.00 | HCPCS / CPT® | NON-RAD CONTRAST MATERIALNOC |
| A9699 | $0.00 | HCPCS / CPT® | RADIOPHARM RX AGENT NOC |
| A9700 | $0.00 | HCPCS / CPT® | ECHOCARDIOGRAPHY CONTRAST |
| A9900 | $0.00 | HCPCS / CPT® | SUPPLY/ACCESSORY/SERVICE |
| A9901 | $0.00 | HCPCS / CPT® | DELIVERY/SET UP/DISPENSING |
| A9999 | $0.00 | HCPCS / CPT® | DME SUPPLY OR ACCESSORY, NOS |
| AMA | $0.00 | HCPCS / CPT® | PT LEFT AGAINST MEDICAL ADVICE |
| B4034 | $0.00 | HCPCS / CPT® | ENTER FEED SUPKIT SYR BY DAY |
| B4035 | $0.00 | HCPCS / CPT® | ENTERAL FEED SUPP PUMP PER D |
| B4036 | $0.00 | HCPCS / CPT® | ENTERAL FEED SUP KIT GRAV BY |
| B4081 | $0.00 | HCPCS / CPT® | ENTERAL NG TUBING W/ STYLET |
| B4082 | $25.00 | HCPCS / CPT® | ENTERAL NG TUBING W/O STYLET |
| B4083 | $0.00 | HCPCS / CPT® | ENTERAL STOMACH TUBE LEVINE |
| B4087 | $0.00 | HCPCS / CPT® | GASTRO/JEJUNO TUBE, STD |
| B4088 | $0.00 | HCPCS / CPT® | GASTRO/JEJUNO TUBE, LOW-PRO |
| B4100 | $0.00 | HCPCS / CPT® | FOOD THICKENER ORAL |
| B4102 | $0.00 | HCPCS / CPT® | EF ADULT FLUIDS AND ELECTRO |
| B4103 | $0.00 | HCPCS / CPT® | EF PED FLUID AND ELECTROLYTE |
| B4104 | $0.00 | HCPCS / CPT® | ADDITIVE FOR ENTERAL FORMULA |
| B4149 | $0.00 | HCPCS / CPT® | EF BLENDERIZED FOODS |
| B4150 | $0.00 | HCPCS / CPT® | EF COMPLET W/INTACT NUTRIENT |
| B4152 | $0.00 | HCPCS / CPT® | EF CALORIE DENSE>/=1.5KCAL |
| B4153 | $0.00 | HCPCS / CPT® | EF HYDROLYZED/AMINO ACIDS |
| B4154 | $0.00 | HCPCS / CPT® | EF SPEC METABOLIC NONINHERIT |
| B4155 | $0.00 | HCPCS / CPT® | EF INCOMPLETE/MODULAR |
| B4157 | $0.00 | HCPCS / CPT® | EF SPECIAL METABOLIC INHERIT |
| B4158 | $0.00 | HCPCS / CPT® | EF PED COMPLETE INTACT NUT |
| B4159 | $0.00 | HCPCS / CPT® | EF PED COMPLETE SOY BASED |
| B4160 | $0.00 | HCPCS / CPT® | EF PED CALORIC DENSE>/=0.7KC |
| B4161 | $0.00 | HCPCS / CPT® | EF PED HYDROLYZED/AMINO ACID |
| B4162 | $0.00 | HCPCS / CPT® | EF PED SPECMETABOLIC INHERIT |
| B4164 | $0.00 | HCPCS / CPT® | PARENTERAL 50% DEXTROSE SOLU |
| B4168 | $0.00 | HCPCS / CPT® | PARENTERAL SOL AMINO ACID 3. |
| B4172 | $0.00 | HCPCS / CPT® | PARENTERAL SOL AMINO ACID 5. |
| B4176 | $0.00 | HCPCS / CPT® | PARENTERAL SOL AMINO ACID 7- |
| B4178 | $0.00 | HCPCS / CPT® | PARENTERAL SOL AMINO ACID > |
| B4180 | $0.00 | HCPCS / CPT® | PARENTERAL SOL CARB > 50% |
| B4185 | $0.00 | HCPCS / CPT® | PARENTERAL SOL 10 GM LIPIDS |
| B4189 | $0.00 | HCPCS / CPT® | PARENTERAL SOL AMINO ACID & |
| B4193 | $0.00 | HCPCS / CPT® | PARENTERAL SOL 52-73 GM PROT |
| B4197 | $0.00 | HCPCS / CPT® | PARENTERAL SOL 74-100 GM PRO |
| B4199 | $0.00 | HCPCS / CPT® | PARENTERAL SOL > 100GM PROTE |
| B4216 | $0.00 | HCPCS / CPT® | PARENTERAL NUTRITION ADDITIV |
| B4220 | $0.00 | HCPCS / CPT® | PARENTERAL SUPPLY KIT PREMIX |
| B4222 | $0.00 | HCPCS / CPT® | PARENTERAL SUPPLY KIT HOMEMI |
| B4224 | $0.00 | HCPCS / CPT® | PARENTERAL ADMINISTRATION KI |
| B5000 | $0.00 | HCPCS / CPT® | PARENTERAL SOL RENAL-AMIROSY |
| B5100 | $0.00 | HCPCS / CPT® | PARENTERAL SOLUTION HEPATIC |
| B5200 | $0.00 | HCPCS / CPT® | PARENTERAL SOL HEPATIC FREAM |
| B9002 | $0.00 | HCPCS / CPT® | ENTER NUTR INF PUMP ANY TYPE |
| B9004 | $0.00 | HCPCS / CPT® | PARENTERAL INFUS PUMP PORTAB |
| B9006 | $0.00 | HCPCS / CPT® | PARENTERAL INFUS PUMP STATIO |
| B9998 | $0.00 | HCPCS / CPT® | ENTERAL SUPP NOT OTHERWISE C |
| B9999 | $0.00 | HCPCS / CPT® | PARENTERAL SUPP NOT OTHRWS C |
| C1713 | $0.00 | HCPCS / CPT® | ANCHOR/SCREW BN/BN,TIS/BN |
| C1714 | $0.00 | HCPCS / CPT® | CATH, TRANS ATHERECTOMY, DIR |
| C1715 | $0.00 | HCPCS / CPT® | BRACHYTHERAPY NEEDLE |
| C1716 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STR, GOLD-198 |
| C1717 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STR,HDR IR-192 |
| C1719 | $0.00 | HCPCS / CPT® | BRACHYTX, NS, NON-HDRIR-192 |
| C1721 | $0.00 | HCPCS / CPT® | AICD, DUAL CHAMBER |
| C1722 | $0.00 | HCPCS / CPT® | AICD, SINGLE CHAMBER |
| C1724 | $0.00 | HCPCS / CPT® | CATH, TRANS ATHEREC,ROTATION |
| C1725 | $0.00 | HCPCS / CPT® | CATH, TRANSLUMIN NON-LASER |
| C1726 | $0.00 | HCPCS / CPT® | CATH, BAL DIL, NON-VASCULAR |
| C1727 | $0.00 | HCPCS / CPT® | CATH, BAL TIS DIS, NON-VAS |
| C1728 | $0.00 | HCPCS / CPT® | CATH, BRACHYTX SEED ADM |
| C1729 | $0.00 | HCPCS / CPT® | CATH, DRAINAGE |
| C1730 | $0.00 | HCPCS / CPT® | CATH, EP, 19 OR FEW ELECT |
| C1731 | $0.00 | HCPCS / CPT® | CATH, EP, 20 OR MORE ELEC |
| C1732 | $0.00 | HCPCS / CPT® | CATH, EP, DIAG/ABL, 3D/VECT |
| C1733 | $0.00 | HCPCS / CPT® | CATH, EP, OTHR THAN COOL-TIP |
| C1749 | $0.00 | HCPCS / CPT® | ENDO, COLON, RETRO IMAGING |
| C1750 | $0.00 | HCPCS / CPT® | CATH, HEMODIALYSIS,LONG-TERM |
| C1751 | $0.00 | HCPCS / CPT® | CATH, INF, PER/CENT/MIDLINE |
| C1752 | $0.00 | HCPCS / CPT® | CATH,HEMODIALYSIS,SHORT-TERM |
| C1753 | $0.00 | HCPCS / CPT® | CATH, INTRAVAS ULTRASOUND |
| C1754 | $0.00 | HCPCS / CPT® | CATHETER, INTRADISCAL |
| C1755 | $0.00 | HCPCS / CPT® | CATHETER, INTRASPINAL |
| C1756 | $0.00 | HCPCS / CPT® | CATH, PACING, TRANSESOPH |
| C1757 | $0.00 | HCPCS / CPT® | CATH, THROMBECTOMY/EMBOLECT |
| C1758 | $0.00 | HCPCS / CPT® | CATHETER, URETERAL |
| C1759 | $0.00 | HCPCS / CPT® | CATH, INTRA ECHOCARDIOGRAPHY |
| C1760 | $0.00 | HCPCS / CPT® | CLOSURE DEV, VASC |
| C1762 | $0.00 | HCPCS / CPT® | CONN TISS, HUMAN(INC FASCIA) |
| C1763 | $0.00 | HCPCS / CPT® | CONN TISS, NON-HUMAN |
| C1764 | $0.00 | HCPCS / CPT® | EVENT RECORDER, CARDIAC |
| C1765 | $0.00 | HCPCS / CPT® | ADHESION BARRIER |
| C1766 | $0.00 | HCPCS / CPT® | INTRO/SHEATH,STRBLE,NON-PEEL |
| C1767 | $0.00 | HCPCS / CPT® | GENERATOR, NEURO NON-RECHARG |
| C1768 | $0.00 | HCPCS / CPT® | GRAFT, VASCULAR |
| C1769 | $0.00 | HCPCS / CPT® | GUIDE WIRE |
| C1770 | $0.00 | HCPCS / CPT® | IMAGING COIL, MR, INSERTABLE |
| C1771 | $0.00 | HCPCS / CPT® | REP DEV, URINARY, W/SLING |
| C1772 | $0.00 | HCPCS / CPT® | INFUSION PUMP, PROGRAMMABLE |
| C1773 | $0.00 | HCPCS / CPT® | RET DEV, INSERTABLE |
| C1776 | $0.00 | HCPCS / CPT® | JOINT DEVICE (IMPLANTABLE) |
| C1777 | $0.00 | HCPCS / CPT® | LEAD, AICD, ENDO SINGLE COIL |
| C1778 | $0.00 | HCPCS / CPT® | LEAD, NEUROSTIMULATOR |
| C1779 | $0.00 | HCPCS / CPT® | LEAD, PMKR, TRANSVENOUS VDD |
| C1780 | $0.00 | HCPCS / CPT® | LENS, INTRAOCULAR (NEW TECH) |
| C1781 | $0.00 | HCPCS / CPT® | MESH (IMPLANTABLE) |
| C1782 | $0.00 | HCPCS / CPT® | MORCELLATOR |
| C1783 | $0.00 | HCPCS / CPT® | OCULAR IMP, AQUEOUS DRAIN DE |
| C1784 | $0.00 | HCPCS / CPT® | OCULAR DEV, INTRAOP, DET RET |
| C1785 | $0.00 | HCPCS / CPT® | PMKR, DUAL, RATE-RESP |
| C1786 | $0.00 | HCPCS / CPT® | PMKR, SINGLE, RATE-RESP |
| C1787 | $0.00 | HCPCS / CPT® | PATIENT PROGR, NEUROSTIM |
| C1788 | $0.00 | HCPCS / CPT® | PORT, INDWELLING, IMP |
| C1789 | $0.00 | HCPCS / CPT® | PROSTHESIS, BREAST, IMP |
| C1813 | $0.00 | HCPCS / CPT® | PROSTHESIS, PENILE, INFLATAB |
| C1814 | $0.00 | HCPCS / CPT® | RETINAL TAMP, SILICONE OIL |
| C1815 | $0.00 | HCPCS / CPT® | PROS, URINARY SPH, IMP |
| C1816 | $0.00 | HCPCS / CPT® | RECEIVER/TRANSMITTER, NEURO |
| C1817 | $0.00 | HCPCS / CPT® | SEPTAL DEFECT IMP SYS |
| C1818 | $0.00 | HCPCS / CPT® | INTEGRATED KERATOPROSTHESIS |
| C1819 | $0.00 | HCPCS / CPT® | TISSUE LOCALIZATION-EXCISION |
| C1820 | $0.00 | HCPCS / CPT® | GENERATOR NEURO RECHG BAT SY |
| C1821 | $0.00 | HCPCS / CPT® | INTERSPINOUS IMPLANT |
| C1822 | $0.00 | HCPCS / CPT® | GEN, NEURO, HF, RECHG BAT |
| C1830 | $0.00 | HCPCS / CPT® | POWER BONE MARROW BX NEEDLE |
| C1840 | $0.00 | HCPCS / CPT® | TELESCOPIC INTRAOCULAR LENS |
| C1841 | $0.00 | HCPCS / CPT® | RETINAL PROSTH INT/EXT COMP |
| C1874 | $0.00 | HCPCS / CPT® | STENT, COATED/COV W/DEL SYS |
| C1875 | $0.00 | HCPCS / CPT® | STENT, COATED/COV W/O DEL SY |
| C1876 | $0.00 | HCPCS / CPT® | STENT, NON-COA/NON-COV W/DEL |
| C1877 | $0.00 | HCPCS / CPT® | STENT, NON-COAT/COV W/O DEL |
| C1878 | $0.00 | HCPCS / CPT® | MATRL FOR VOCAL CORD |
| C1880 | $0.00 | HCPCS / CPT® | VENA CAVA FILTER |
| C1881 | $0.00 | HCPCS / CPT® | DIALYSIS ACCESS SYSTEM |
| C1882 | $0.00 | HCPCS / CPT® | AICD, OTHER THAN SING/DUAL |
| C1883 | $0.00 | HCPCS / CPT® | ADAPT/EXT, PACING/NEURO LEAD |
| C1884 | $0.00 | HCPCS / CPT® | EMBOLIZATION PROTECT SYST |
| C1885 | $0.00 | HCPCS / CPT® | CATH, TRANSLUMIN ANGIO LASER |
| C1886 | $0.00 | HCPCS / CPT® | CATHETER, ABLATION |
| C1887 | $0.00 | HCPCS / CPT® | CATHETER, GUIDING |
| C1888 | $0.00 | HCPCS / CPT® | ENDOVAS NON-CARDIAC ABL CATH |
| C1889 | $0.00 | HCPCS / CPT® | IMPLANT/INSERT DEVICE, NOC |
| C1891 | $0.00 | HCPCS / CPT® | INFUSION PUMP,NON-PROG, PERM |
| C1892 | $0.00 | HCPCS / CPT® | INTRO/SHEATH,FIXED,PEEL-AWAY |
| C1893 | $0.00 | HCPCS / CPT® | INTRO/SHEATH, FIXED,NON-PEEL |
| C1894 | $0.00 | HCPCS / CPT® | INTRO/SHEATH, NON-LASER |
| C1895 | $0.00 | HCPCS / CPT® | LEAD, AICD, ENDO DUAL COIL |
| C1896 | $0.00 | HCPCS / CPT® | LEAD, AICD, NON SING/DUAL |
| C1897 | $0.00 | HCPCS / CPT® | LEAD, NEUROSTIM TEST KIT |
| C1898 | $0.00 | HCPCS / CPT® | LEAD, PMKR, OTHER THAN TRANS |
| C1899 | $0.00 | HCPCS / CPT® | LEAD, PMKR/AICD COMBINATION |
| C1900 | $0.00 | HCPCS / CPT® | LEAD, CORONARY VENOUS |
| C2613 | $0.00 | HCPCS / CPT® | LUNG BX PLUG W/DEL SYS |
| C2614 | $0.00 | HCPCS / CPT® | PROBE, PERC LUMB DISC |
| C2615 | $0.00 | HCPCS / CPT® | SEALANT, PULMONARY, LIQUID |
| C2616 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STR,YTTRIUM-90 |
| C2617 | $0.00 | HCPCS / CPT® | STENT, NON-COR, TEM W/O DEL |
| C2618 | $0.00 | HCPCS / CPT® | PROBE/NEEDLE, CRYO |
| C2619 | $0.00 | HCPCS / CPT® | PMKR, DUAL, NON RATE-RESP |
| C2620 | $0.00 | HCPCS / CPT® | PMKR, SINGLE, NON RATE-RESP |
| C2621 | $0.00 | HCPCS / CPT® | PMKR, OTHER THAN SING/DUAL |
| C2622 | $0.00 | HCPCS / CPT® | PROSTHESIS, PENILE, NON-INF |
| C2623 | $0.00 | HCPCS / CPT® | CATH, TRANSLUMIN, DRUG-COAT |
| C2624 | $0.00 | HCPCS / CPT® | WIRELESS PRESSURE SENSOR |
| C2625 | $0.00 | HCPCS / CPT® | STENT, NON-COR, TEM W/DEL SY |
| C2626 | $0.00 | HCPCS / CPT® | INFUSION PUMP, NON-PROG,TEMP |
| C2627 | $0.00 | HCPCS / CPT® | CATH, SUPRAPUBIC/CYSTOSCOPIC |
| C2628 | $0.00 | HCPCS / CPT® | CATHETER, OCCLUSION |
| C2629 | $0.00 | HCPCS / CPT® | INTRO/SHEATH, LASER |
| C2630 | $0.00 | HCPCS / CPT® | CATH, EP, COOL-TIP |
| C2631 | $0.00 | HCPCS / CPT® | REP DEV, URINARY, W/O SLING |
| C2634 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STR, HA, I-125 |
| C2635 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STR, HA, P-103 |
| C2636 | $0.00 | HCPCS / CPT® | BRACHY LINEAR, NON-STR,P-103 |
| C2637 | $0.00 | HCPCS / CPT® | BRACHY,NON-STR,YTTERBIUM-169 |
| C2638 | $0.00 | HCPCS / CPT® | BRACHYTX, STRANDED, I-125 |
| C2639 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STRANDED,I-125 |
| C2640 | $0.00 | HCPCS / CPT® | BRACHYTX, STRANDED, P-103 |
| C2641 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STRANDED,P-103 |
| C2642 | $0.00 | HCPCS / CPT® | BRACHYTX, STRANDED, C-131 |
| C2643 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STRANDED,C-131 |
| C2644 | $0.00 | HCPCS / CPT® | BRACHYTX CESIUM-131 CHLORIDE |
| C2645 | $0.00 | HCPCS / CPT® | BRACHYTX PLANAR, P-103 |
| C2698 | $0.00 | HCPCS / CPT® | BRACHYTX, STRANDED, NOS |
| C2699 | $0.00 | HCPCS / CPT® | BRACHYTX, NON-STRANDED, NOS |
| C5271 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5272 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5273 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5274 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5275 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5276 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5277 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C5278 | $0.00 | HCPCS / CPT® | LOW COST SKIN SUBSTITUTE APP |
| C8900 | $0.00 | HCPCS / CPT® | MRA W/CONT, ABD |
| C8901 | $0.00 | HCPCS / CPT® | MRA W/O CONT, ABD |
| C8902 | $0.00 | HCPCS / CPT® | MRA W/O FOL W/CONT, ABD |
| C8903 | $0.00 | HCPCS / CPT® | MRI W/CONT, BREAST, UNI |
| C8904 | $0.00 | HCPCS / CPT® | MRI W/O CONT, BREAST, UNI |
| C8905 | $0.00 | HCPCS / CPT® | MRI W/O FOL W/CONT, BRST, UN |
| C8906 | $0.00 | HCPCS / CPT® | MRI W/CONT, BREAST, BI |
| C8907 | $0.00 | HCPCS / CPT® | MRI W/O CONT, BREAST, BI |
| C8908 | $0.00 | HCPCS / CPT® | MRI W/O FOL W/CONT, BREAST, |
| C8909 | $0.00 | HCPCS / CPT® | MRA W/CONT, CHEST |
| C8910 | $0.00 | HCPCS / CPT® | MRA W/O CONT, CHEST |
| C8911 | $0.00 | HCPCS / CPT® | MRA W/O FOL W/CONT, CHEST |
| C8912 | $0.00 | HCPCS / CPT® | MRA W/CONT, LWR EXT |
| C8913 | $0.00 | HCPCS / CPT® | MRA W/O CONT, LWR EXT |
| C8914 | $0.00 | HCPCS / CPT® | MRA W/O FOL W/CONT, LWR EXT |
| C8918 | $0.00 | HCPCS / CPT® | MRA W/CONT, PELVIS |
| C8919 | $0.00 | HCPCS / CPT® | MRA W/O CONT, PELVIS |
| C8920 | $0.00 | HCPCS / CPT® | MRA W/O FOL W/CONT, PELVIS |
| C8921 | $0.00 | HCPCS / CPT® | TTE W OR W/O FOL W/CONT, COM |
| C8922 | $0.00 | HCPCS / CPT® | TTE W OR W/O FOL W/CONT, F/U |
| C8923 | $0.00 | HCPCS / CPT® | 2D TTE W OR W/O FOL W/CON,CO |
| C8924 | $0.00 | HCPCS / CPT® | 2D TTE W OR W/O FOL W/CON,FU |
| C8925 | $0.00 | HCPCS / CPT® | 2D TEE W OR W/O FOL W/CON,IN |
| C8926 | $0.00 | HCPCS / CPT® | TEE W OR W/O FOL W/CONT,CONG |
| C8927 | $0.00 | HCPCS / CPT® | TEE W OR W/O FOL W/CONT, MON |
| C8928 | $0.00 | HCPCS / CPT® | TTE W OR W/O FOL W/CON,STRES |
| C8929 | $0.00 | HCPCS / CPT® | TTE W OR WO FOL WCON,DOPPLER |
| C8930 | $0.00 | HCPCS / CPT® | TTE W OR W/O CONTR, CONT ECG |
| C8931 | $0.00 | HCPCS / CPT® | MRA, W/DYE, SPINAL CANAL |
| C8932 | $0.00 | HCPCS / CPT® | MRA, W/O DYE, SPINAL CANAL |
| C8933 | $0.00 | HCPCS / CPT® | MRA, W/O&W/DYE, SPINAL CANAL |
| C8934 | $0.00 | HCPCS / CPT® | MRA, W/DYE, UPPER EXTREMITY |
| C8935 | $0.00 | HCPCS / CPT® | MRA, W/O DYE, UPPER EXTR |
| C8936 | $0.00 | HCPCS / CPT® | MRA, W/O&W/DYE, UPPER EXTR |
| C8957 | $0.00 | HCPCS / CPT® | PROLONGED IV INF, REQ PUMP |
| C9113 | $0.00 | HCPCS / CPT® | INJ PANTOPRAZOLE SODIUM, VIA |
| C9132 | $0.00 | HCPCS / CPT® | KCENTRA, PER I.U. |
| C9140 | $0.00 | HCPCS / CPT® | AFSTYLA FACTOR VIII RECOMB |
| C9248 | $0.00 | HCPCS / CPT® | INJ, CLEVIDIPINE BUTYRATE |
| C9250 | $0.00 | HCPCS / CPT® | ARTISS FIBRIN SEALANT |
| C9254 | $0.00 | HCPCS / CPT® | INJECTION, LACOSAMIDE |
| C9257 | $0.00 | HCPCS / CPT® | BEVACIZUMAB INJECTION |
| C9275 | $0.00 | HCPCS / CPT® | HEXAMINOLEVULINATE HCL |
| C9285 | $101.03 | HCPCS / CPT® | PATCH, LIDOCAINE/TETRACAINE |
| C9290 | $0.00 | HCPCS / CPT® | INJ, BUPIVACAINE LIPOSOME |
| C9293 | $0.00 | HCPCS / CPT® | INJECTION, GLUCARPIDASE |
| C9352 | $0.00 | HCPCS / CPT® | NEURAGEN NERVE GUIDE, PER CM |
| C9353 | $0.00 | HCPCS / CPT® | NEURAWRAP NERVE PROTECTOR,CM |
| C9354 | $0.00 | HCPCS / CPT® | VERITAS COLLAGEN MATRIX, CM2 |
| C9355 | $0.00 | HCPCS / CPT® | NEUROMATRIX NERVE CUFF, CM |
| C9356 | $0.00 | HCPCS / CPT® | TENOGLIDE TENDON PROT, CM2 |
| C9358 | $0.00 | HCPCS / CPT® | SURGIMEND, FETAL |
| C9359 | $0.00 | HCPCS / CPT® | IMPLNT,BON VOID FILLER-PUTTY |
| C9360 | $0.00 | HCPCS / CPT® | SURGIMEND, NEONATAL |
| C9361 | $0.00 | HCPCS / CPT® | NEUROMEND NERVE WRAP |
| C9362 | $0.00 | HCPCS / CPT® | IMPLNT,BON VOID FILLER-STRIP |
| C9363 | $0.00 | HCPCS / CPT® | INTEGRA MESHED BIL WOUND MAT |
| C9364 | $0.00 | HCPCS / CPT® | PORCINE IMPLANT, PERMACOL |
| C9399 | $0.00 | HCPCS / CPT® | C9399 |
| C9447 | $0.00 | HCPCS / CPT® | INJ, PHENYLEPHRINE KETOROLAC |
| C9460 | $0.00 | HCPCS / CPT® | INJECTION, CANGRELOR |
| C9482 | $0.00 | HCPCS / CPT® | SOTALOL HYDROCHLORIDE IV |
| C9483 | $0.00 | HCPCS / CPT® | INJECTION, ATEZOLIZUMAB |
| C9497 | $0.00 | HCPCS / CPT® | LOXAPINE, INHALATION POWDER |
| C9600 | $0.00 | HCPCS / CPT® | PERC DRUG-EL COR STENT SING |
| C9601 | $0.00 | HCPCS / CPT® | PERC DRUG-EL COR STENT BRAN |
| C9602 | $0.00 | HCPCS / CPT® | PERC D-E COR STENT ATHER S |
| C9603 | $0.00 | HCPCS / CPT® | PERC D-E COR STENT ATHER BR |
| C9604 | $0.00 | HCPCS / CPT® | PERC D-E COR REVASC T CABG S |
| C9605 | $0.00 | HCPCS / CPT® | PERC D-E COR REVASC T CABG B |
| C9606 | $0.00 | HCPCS / CPT® | PERC D-E COR REVASC W AMI S |
| C9607 | $0.00 | HCPCS / CPT® | PERC D-E COR REVASC CHRO SIN |
| C9608 | $0.00 | HCPCS / CPT® | PERC D-E COR REVASC CHRO ADD |
| C9725 | $0.00 | HCPCS / CPT® | PLACE ENDORECTAL APP |
| C9726 | $0.00 | HCPCS / CPT® | RXT BREAST APPL PLACE/REMOV |
| C9727 | $0.00 | HCPCS / CPT® | INSERT PALATE IMPLANTS |
| C9728 | $0.00 | HCPCS / CPT® | PLACE DEVICE/MARKER, NON PRO |
| C9733 | $0.00 | HCPCS / CPT® | NON-OPHTHALMIC FVA |
| C9734 | $0.00 | HCPCS / CPT® | U/S TRTMT, NOT LEIOMYOMATA |
| C9739 | $0.00 | HCPCS / CPT® | CYSTOSCOPY PROSTATIC IMP 1-3 |
| C9740 | $0.00 | HCPCS / CPT® | CYSTO IMPL 4 OR MORE |
| C9741 | $0.00 | HCPCS / CPT® | IMPL PRESSURE SENSOR W/ANGIO |
| C9744 | $0.00 | HCPCS / CPT® | ABD US W/CONTRAST |
| C9898 | $0.00 | HCPCS / CPT® | INPNT STAY RADIOLABELED ITEM |
| C9899 | $0.00 | HCPCS / CPT® | INPT IMPLANT PROS DEV,NO COV |
| E0100 | $0.00 | HCPCS / CPT® | CANE ADJUST/FIXED WITH TIP |
| E0105 | $0.00 | HCPCS / CPT® | CANE ADJUST/FIXED QUAD/3 PRO |
| E0110 | $0.00 | HCPCS / CPT® | CRUTCH FOREARM PAIR |
| E0111 | $0.00 | HCPCS / CPT® | CRUTCH FOREARM EACH |
| E0112 | $0.00 | HCPCS / CPT® | CRUTCH UNDERARM PAIR WOOD |
| E0113 | $0.00 | HCPCS / CPT® | CRUTCH UNDERARM EACH WOOD |
| E0114 | $76.53 | HCPCS / CPT® | CRUTCH UNDERARM PAIR NO WOOD |
| E0116 | $76.53 | HCPCS / CPT® | CRUTCH UNDERARM EACH NO WOOD |
| E0117 | $0.00 | HCPCS / CPT® | UNDERARM SPRINGASSIST CRUTCH |
| E0118 | $0.00 | HCPCS / CPT® | CRUTCH SUBSTITUTE |
| E0130 | $0.00 | HCPCS / CPT® | WALKER RIGID ADJUST/FIXED HT |
| E0135 | $0.00 | HCPCS / CPT® | WALKER FOLDING ADJUST/FIXED |
| E0140 | $0.00 | HCPCS / CPT® | WALKER W TRUNK SUPPORT |
| E0141 | $0.00 | HCPCS / CPT® | RIGID WHEELED WALKER ADJ/FIX |
| E0143 | $0.00 | HCPCS / CPT® | WALKER FOLDING WHEELED W/O S |
| E0144 | $1879.66 | HCPCS / CPT® | ENCLOSED WALKER W REAR SEAT |
| E0147 | $0.00 | HCPCS / CPT® | WALKER VARIABLE WHEEL RESIST |
| E0148 | $0.00 | HCPCS / CPT® | HEAVYDUTY WALKER NO WHEELS |
| E0149 | $0.00 | HCPCS / CPT® | HEAVY DUTY WHEELED WALKER |
| E0153 | $0.00 | HCPCS / CPT® | FOREARM CRUTCH PLATFORM ATTA |
| E0154 | $0.00 | HCPCS / CPT® | WALKER PLATFORM ATTACHMENT |
| E0155 | $0.00 | HCPCS / CPT® | WALKER WHEEL ATTACHMENT,PAIR |
| E0156 | $0.00 | HCPCS / CPT® | WALKER SEAT ATTACHMENT |
| E0157 | $0.00 | HCPCS / CPT® | WALKER CRUTCH ATTACHMENT |
| E0158 | $0.00 | HCPCS / CPT® | WALKER LEG EXTENDERS SET OF4 |
| E0159 | $0.00 | HCPCS / CPT® | BRAKE FOR WHEELED WALKER |
| E0160 | $0.00 | HCPCS / CPT® | SITZ TYPE BATH OR EQUIPMENT |
| E0161 | $0.00 | HCPCS / CPT® | SITZ BATH/EQUIPMENT W/FAUCET |
| E0162 | $0.00 | HCPCS / CPT® | SITZ BATH CHAIR |
| E0163 | $0.00 | HCPCS / CPT® | COMMODE CHAIR WITH FIXED ARM |
| E0165 | $0.00 | HCPCS / CPT® | COMMODE CHAIR WITH DETACHARM |
| E0167 | $0.00 | HCPCS / CPT® | COMMODE CHAIR PAIL OR PAN |
| E0168 | $0.00 | HCPCS / CPT® | HEAVYDUTY/WIDE COMMODE CHAIR |
| E0170 | $0.00 | HCPCS / CPT® | COMMODE CHAIR ELECTRIC |
| E0171 | $0.00 | HCPCS / CPT® | COMMODE CHAIR NON-ELECTRIC |
| E0172 | $0.00 | HCPCS / CPT® | SEAT LIFT MECHANISM TOILET |
| E0175 | $0.00 | HCPCS / CPT® | COMMODE CHAIR FOOT REST |
| E0181 | $0.00 | HCPCS / CPT® | PRESS PAD ALTERNATING W/ PUM |
| E0182 | $0.00 | HCPCS / CPT® | REPLACE PUMP, ALT PRESS PAD |
| E0184 | $0.00 | HCPCS / CPT® | DRY PRESSURE MATTRESS |
| E0185 | $0.00 | HCPCS / CPT® | GEL PRESSURE MATTRESS PAD |
| E0186 | $0.00 | HCPCS / CPT® | AIR PRESSURE MATTRESS |
| E0187 | $0.00 | HCPCS / CPT® | WATER PRESSURE MATTRESS |
| E0188 | $0.00 | HCPCS / CPT® | SYNTHETIC SHEEPSKIN PAD |
| E0189 | $0.00 | HCPCS / CPT® | LAMBSWOOL SHEEPSKIN PAD |
| E0190 | $0.00 | HCPCS / CPT® | POSITIONING CUSHION |
| E0191 | $0.00 | HCPCS / CPT® | PROTECTOR HEEL OR ELBOW |
| E0193 | $0.00 | HCPCS / CPT® | POWERED AIR FLOTATION BED |
| E0194 | $0.00 | HCPCS / CPT® | AIR FLUIDIZED BED |
| E0196 | $0.00 | HCPCS / CPT® | GEL PRESSURE MATTRESS |
| E0197 | $0.00 | HCPCS / CPT® | AIR PRESSURE PAD FOR MATTRES |
| E0198 | $0.00 | HCPCS / CPT® | WATER PRESSURE PAD FOR MATTR |
| E0199 | $0.00 | HCPCS / CPT® | DRY PRESSURE PAD FOR MATTRES |
| E0200 | $0.00 | HCPCS / CPT® | HEAT LAMP WITHOUT STAND |
| E0202 | $0.00 | HCPCS / CPT® | PHOTOTHERAPY LIGHT W/ PHOTOM |
| E0203 | $0.00 | HCPCS / CPT® | THERAPEUTIC LIGHTBOX TABLETP |
| E0205 | $0.00 | HCPCS / CPT® | HEAT LAMP WITH STAND |
| E0210 | $0.00 | HCPCS / CPT® | ELECTRIC HEAT PAD STANDARD |
| E0215 | $0.00 | HCPCS / CPT® | ELECTRIC HEAT PAD MOIST |
| E0217 | $0.00 | HCPCS / CPT® | WATER CIRC HEAT PAD W PUMP |
| E0218 | $0.00 | HCPCS / CPT® | WATER CIRC COLD PAD W PUMP |
| E0220 | $45.92 | HCPCS / CPT® | HOT WATER BOTTLE |
| E0221 | $0.00 | HCPCS / CPT® | INFRARED HEATING PAD SYSTEM |
| E0225 | $0.00 | HCPCS / CPT® | HYDROCOLLATOR UNIT |
| E0230 | $14.52 | HCPCS / CPT® | ICE CAP OR COLLAR |
| E0231 | $0.00 | HCPCS / CPT® | WOUND WARMING DEVICE |
| E0232 | $0.00 | HCPCS / CPT® | WARMING CARD FOR NWT |
| E0235 | $0.00 | HCPCS / CPT® | PARAFFIN BATH UNIT PORTABLE |
| E0236 | $0.00 | HCPCS / CPT® | PUMP FOR WATER CIRCULATING P |
| E0239 | $0.00 | HCPCS / CPT® | HYDROCOLLATOR UNIT PORTABLE |
| E0240 | $0.00 | HCPCS / CPT® | BATH/SHOWER CHAIR |
| E0241 | $0.00 | HCPCS / CPT® | BATH TUB WALL RAIL |
| E0242 | $0.00 | HCPCS / CPT® | BATH TUB RAIL FLOOR |
| E0243 | $0.00 | HCPCS / CPT® | TOILET RAIL |
| E0244 | $0.00 | HCPCS / CPT® | TOILET SEAT RAISED |
| E0245 | $0.00 | HCPCS / CPT® | TUB STOOL OR BENCH |
| E0246 | $0.00 | HCPCS / CPT® | TRANSFER TUB RAIL ATTACHMENT |
| E0247 | $0.00 | HCPCS / CPT® | TRANS BENCH W/WO COMM OPEN |
| E0248 | $0.00 | HCPCS / CPT® | HDTRANS BENCH W/WO COMM OPEN |
| E0249 | $0.00 | HCPCS / CPT® | PAD WATER CIRCULATING HEAT U |
| E0250 | $0.00 | HCPCS / CPT® | HOSP BED FIXED HT W/ MATTRES |
| E0251 | $0.00 | HCPCS / CPT® | HOSP BED FIXD HT W/O MATTRES |
| E0255 | $0.00 | HCPCS / CPT® | HOSPITAL BED VAR HT W/ MATTR |
| E0256 | $0.00 | HCPCS / CPT® | HOSPITAL BED VAR HT W/O MATT |
| E0260 | $0.00 | HCPCS / CPT® | HOSP BED SEMI-ELECTR W/ MATT |
| E0261 | $0.00 | HCPCS / CPT® | HOSP BED SEMI-ELECTR W/O MAT |
| E0265 | $0.00 | HCPCS / CPT® | HOSP BED TOTAL ELECTR W/ MAT |
| E0266 | $0.00 | HCPCS / CPT® | HOSP BED TOTAL ELEC W/O MATT |
| E0270 | $0.00 | HCPCS / CPT® | HOSPITAL BED INSTITUTIONAL T |
| E0271 | $0.00 | HCPCS / CPT® | MATTRESS INNERSPRING |
| E0272 | $0.00 | HCPCS / CPT® | MATTRESS FOAM RUBBER |
| E0273 | $0.00 | HCPCS / CPT® | BED BOARD |
| E0274 | $0.00 | HCPCS / CPT® | OVER-BED TABLE |
| E0275 | $15.31 | HCPCS / CPT® | BED PAN STANDARD |
| E0276 | $0.00 | HCPCS / CPT® | BED PAN FRACTURE |
| E0277 | $0.00 | HCPCS / CPT® | POWERED PRES-REDU AIR MATTRS |
| E0280 | $0.00 | HCPCS / CPT® | BED CRADLE |
| E0290 | $0.00 | HCPCS / CPT® | HOSP BED FX HT W/O RAILS W/M |
| E0291 | $0.00 | HCPCS / CPT® | HOSP BED FX HT W/O RAIL W/O |
| E0292 | $0.00 | HCPCS / CPT® | HOSP BED VAR HT NO SR W/MATT |
| E0293 | $0.00 | HCPCS / CPT® | HOSP BED VAR HT NO SR NO MAT |
| E0294 | $0.00 | HCPCS / CPT® | HOSP BED SEMI-ELECT W/ MATTR |
| E0295 | $0.00 | HCPCS / CPT® | HOSP BED SEMI-ELECT W/O MATT |
| E0296 | $0.00 | HCPCS / CPT® | HOSP BED TOTAL ELECT W/ MATT |
| E0297 | $0.00 | HCPCS / CPT® | HOSP BED TOTAL ELECT W/O MAT |
| E0300 | $0.00 | HCPCS / CPT® | ENCLOSED PED CRIB HOSP GRADE |
| E0301 | $0.00 | HCPCS / CPT® | HD HOSP BED, 350-600 LBS |
| E0302 | $0.00 | HCPCS / CPT® | EX HD HOSP BED > 600 LBS |
| E0303 | $0.00 | HCPCS / CPT® | HOSP BED HVY DTY XTRA WIDE |
| E0304 | $0.00 | HCPCS / CPT® | HOSP BED XTRA HVY DTY X WIDE |
| E0305 | $0.00 | HCPCS / CPT® | RAILS BED SIDE HALF LENGTH |
| E0310 | $0.00 | HCPCS / CPT® | RAILS BED SIDE FULL LENGTH |
| E0315 | $0.00 | HCPCS / CPT® | BED ACCESSORY BRD/TBL/SUPPRT |
| E0316 | $0.00 | HCPCS / CPT® | BED SAFETY ENCLOSURE |
| E0325 | $8.43 | HCPCS / CPT® | URINAL MALE JUG-TYPE |
| E0326 | $0.00 | HCPCS / CPT® | URINAL FEMALE JUG-TYPE |
| E0328 | $0.00 | HCPCS / CPT® | PED HOSPITAL BED, MANUAL |
| E0329 | $0.00 | HCPCS / CPT® | PED HOSPITAL BED SEMI/ELECT |
| E0350 | $0.00 | HCPCS / CPT® | CONTROL UNIT BOWEL SYSTEM |
| E0352 | $231.60 | HCPCS / CPT® | DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM) |
| E0370 | $0.00 | HCPCS / CPT® | AIR ELEVATOR FOR HEEL |
| E0371 | $0.00 | HCPCS / CPT® | NONPOWER MATTRESS OVERLAY |
| E0372 | $0.00 | HCPCS / CPT® | POWERED AIR MATTRESS OVERLAY |
| E0373 | $0.00 | HCPCS / CPT® | NONPOWERED PRESSURE MATTRESS |
| E0424 | $0.00 | HCPCS / CPT® | STATIONARY COMPRESSED GAS 02 |
| E0425 | $0.00 | HCPCS / CPT® | GAS SYSTEM STATIONARY COMPRE |
| E0430 | $0.00 | HCPCS / CPT® | OXYGEN SYSTEM GAS PORTABLE |
| E0431 | $0.00 | HCPCS / CPT® | PORTABLE GASEOUS 02 |
| E0433 | $0.00 | HCPCS / CPT® | PORTABLE LIQUID OXYGEN SYS |
| E0434 | $0.00 | HCPCS / CPT® | PORTABLE LIQUID 02 |
| E0435 | $0.00 | HCPCS / CPT® | OXYGEN SYSTEM LIQUID PORTABL |
| E0439 | $0.00 | HCPCS / CPT® | STATIONARY LIQUID 02 |
| E0440 | $0.00 | HCPCS / CPT® | OXYGEN SYSTEM LIQUID STATION |
| E0441 | $0.00 | HCPCS / CPT® | STATIONARY O2 CONTENTS, GAS |
| E0442 | $0.00 | HCPCS / CPT® | STATIONARY O2 CONTENTS, LIQ |
| E0443 | $0.00 | HCPCS / CPT® | PORTABLE 02 CONTENTS, GAS |
| E0444 | $0.00 | HCPCS / CPT® | PORTABLE 02 CONTENTS, LIQUID |
| E0445 | $757.68 | HCPCS / CPT® | OXIMETER NON-INVASIVE |
| E0446 | $0.00 | HCPCS / CPT® | TOPICAL OX DELIVER SYS, NOS |
| E0455 | $0.00 | HCPCS / CPT® | OXYGEN TENT EXCL CROUP/PED T |
| E0457 | $0.00 | HCPCS / CPT® | CHEST SHELL |
| E0459 | $0.00 | HCPCS / CPT® | CHEST WRAP |
| E0462 | $0.00 | HCPCS / CPT® | ROCKING BED W/ OR W/O SIDE R |
| E0465 | $0.00 | HCPCS / CPT® | HOME VENT INVASIVE INTERFACE |
| E0466 | $0.00 | HCPCS / CPT® | HOME VENT NON-INVASIVE INTER |
| E0470 | $0.00 | HCPCS / CPT® | RAD W/O BACKUP NON-INV INTFC |
| E0471 | $0.00 | HCPCS / CPT® | RAD W/BACKUP NON INV INTRFC |
| E0472 | $0.00 | HCPCS / CPT® | RAD W BACKUP INVASIVE INTRFC |
| E0480 | $0.00 | HCPCS / CPT® | PERCUSSOR ELECT/PNEUM HOME M |
| E0481 | $0.00 | HCPCS / CPT® | INTRPULMNRY PERCUSS VENT SYS |
| E0482 | $0.00 | HCPCS / CPT® | COUGH STIMULATING DEVICE |
| E0483 | $0.00 | HCPCS / CPT® | CHEST COMPRESSION GEN SYSTEM |
| E0484 | $0.00 | HCPCS / CPT® | NON-ELEC OSCILLATORY PEP DVC |
| E0485 | $0.00 | HCPCS / CPT® | ORAL DEVICE/APPLIANCE PREFAB |
| E0486 | $0.00 | HCPCS / CPT® | ORAL DEVICE/APPLIANCE CUSFAB |
| E0487 | $0.00 | HCPCS / CPT® | ELECTRONIC SPIROMETER |
| E0500 | $0.00 | HCPCS / CPT® | IPPB ALL TYPES |
| E0550 | $0.00 | HCPCS / CPT® | HUMIDIF EXTENS SUPPLE W IPPB |
| E0555 | $0.00 | HCPCS / CPT® | HUMIDIFIER FOR USE W/ REGULA |
| E0560 | $0.00 | HCPCS / CPT® | HUMIDIFIER SUPPLEMENTAL W/ I |
| E0561 | $0.00 | HCPCS / CPT® | HUMIDIFIER NONHEATED W PAP |
| E0562 | $0.00 | HCPCS / CPT® | HUMIDIFIER HEATED USED W PAP |
| E0565 | $0.00 | HCPCS / CPT® | COMPRESSOR AIR POWER SOURCE |
| E0570 | $887.78 | HCPCS / CPT® | NEBULIZER WITH COMPRESSION |
| E0572 | $0.00 | HCPCS / CPT® | AEROSOL COMPRESSOR ADJUST PR |
| E0574 | $0.00 | HCPCS / CPT® | ULTRASONIC GENERATOR W SVNEB |
| E0575 | $0.00 | HCPCS / CPT® | NEBULIZER ULTRASONIC |
| E0580 | $382.66 | HCPCS / CPT® | NEBULIZER FOR USE W/ REGULAT |
| E0585 | $0.00 | HCPCS / CPT® | NEBULIZER W/ COMPRESSOR & HE |
| E0600 | $0.00 | HCPCS / CPT® | SUCTION PUMP PORTAB HOM MODL |
| E0601 | $0.00 | HCPCS / CPT® | CONT AIRWAY PRESSURE DEVICE |
| E0602 | $0.00 | HCPCS / CPT® | MANUAL BREAST PUMP |
| E0603 | $0.00 | HCPCS / CPT® | ELECTRIC BREAST PUMP |
| E0604 | $0.00 | HCPCS / CPT® | HOSP GRADE ELEC BREAST PUMP |
| E0605 | $0.00 | HCPCS / CPT® | VAPORIZER ROOM TYPE |
| E0606 | $0.00 | HCPCS / CPT® | DRAINAGE BOARD POSTURAL |
| E0607 | $0.00 | HCPCS / CPT® | BLOOD GLUCOSE MONITOR HOME |
| E0610 | $0.00 | HCPCS / CPT® | PACEMAKER MONITR AUDIBLE/VIS |
| E0615 | $0.00 | HCPCS / CPT® | PACEMAKER MONITR DIGITAL/VIS |
| E0616 | $0.00 | HCPCS / CPT® | CARDIAC EVENT RECORDER |
| E0617 | $0.00 | HCPCS / CPT® | AUTOMATIC EXT DEFIBRILLATOR |
| E0618 | $0.00 | HCPCS / CPT® | APNEA MONITOR |
| E0619 | $0.00 | HCPCS / CPT® | APNEA MONITOR W RECORDER |
| E0620 | $0.00 | HCPCS / CPT® | CAP BLD SKIN PIERCING LASER |
| E0621 | $0.00 | HCPCS / CPT® | PATIENT LIFT SLING OR SEAT |
| E0625 | $0.00 | HCPCS / CPT® | PATIENT LIFT BATHROOM OR TOI |
| E0627 | $0.00 | HCPCS / CPT® | SEAT LIFT MECH, ELECTRIC ANY |
| E0629 | $0.00 | HCPCS / CPT® | SEAT LIFT MECH, NON-ELECTRIC |
| E0630 | $0.00 | HCPCS / CPT® | PATIENT LIFT HYDRAULIC |
| E0635 | $0.00 | HCPCS / CPT® | PATIENT LIFT ELECTRIC |
| E0636 | $0.00 | HCPCS / CPT® | PT SUPPORT & POSITIONING SYS |
| E0637 | $0.00 | HCPCS / CPT® | COMBINATION SIT TO STAND SYS |
| E0638 | $0.00 | HCPCS / CPT® | STANDING FRAME SYS |
| E0639 | $0.00 | HCPCS / CPT® | MOVEABLE PATIENT LIFT SYSTEM |
| E0640 | $0.00 | HCPCS / CPT® | FIXED PATIENT LIFT SYSTEM |
| E0641 | $0.00 | HCPCS / CPT® | MULTI-POSITION STND FRAM SYS |
| E0642 | $0.00 | HCPCS / CPT® | DYNAMIC STANDING FRAME |
| E0650 | $0.00 | HCPCS / CPT® | PNEUMA COMPRESOR NON-SEGMENT |
| E0651 | $0.00 | HCPCS / CPT® | PNEUM COMPRESSOR SEGMENTAL |
| E0652 | $0.00 | HCPCS / CPT® | PNEUM COMPRES W/CAL PRESSURE |
| E0655 | $0.00 | HCPCS / CPT® | PNEUMATIC APPLIANCE HALF ARM |
| E0656 | $0.00 | HCPCS / CPT® | SEGMENTAL PNEUMATIC TRUNK |
| E0657 | $0.00 | HCPCS / CPT® | SEGMENTAL PNEUMATIC CHEST |
| E0660 | $0.00 | HCPCS / CPT® | PNEUMATIC APPLIANCE FULL LEG |
| E0665 | $0.00 | HCPCS / CPT® | PNEUMATIC APPLIANCE FULL ARM |
| E0666 | $0.00 | HCPCS / CPT® | PNEUMATIC APPLIANCE HALF LEG |
| E0667 | $0.00 | HCPCS / CPT® | SEG PNEUMATIC APPL FULL LEG |
| E0668 | $0.00 | HCPCS / CPT® | SEG PNEUMATIC APPL FULL ARM |
| E0669 | $0.00 | HCPCS / CPT® | SEG PNEUMATIC APPLI HALF LEG |
| E0670 | $0.00 | HCPCS / CPT® | SEG PNEUM INT LEGS/TRUNK |
| E0671 | $0.00 | HCPCS / CPT® | PRESSURE PNEUM APPL FULL LEG |
| E0672 | $0.00 | HCPCS / CPT® | PRESSURE PNEUM APPL FULL ARM |
| E0673 | $0.00 | HCPCS / CPT® | PRESSURE PNEUM APPL HALF LEG |
| E0675 | $0.00 | HCPCS / CPT® | PNEUMATIC COMPRESSION DEVICE |
| E0676 | $0.00 | HCPCS / CPT® | INTER LIMB COMPRESS DEV NOS |
| E0691 | $0.00 | HCPCS / CPT® | UVL PNL 2 SQ FT OR LESS |
| E0692 | $0.00 | HCPCS / CPT® | UVL SYS PANEL 4 FT |
| E0693 | $0.00 | HCPCS / CPT® | UVL SYS PANEL 6 FT |
| E0694 | $0.00 | HCPCS / CPT® | UVL MD CABINET SYS 6 FT |
| E0700 | $0.00 | HCPCS / CPT® | SAFETY EQUIPMENT |
| E0705 | $0.00 | HCPCS / CPT® | TRANSFER DEVICE |
| E0710 | $0.00 | HCPCS / CPT® | RESTRAINTS ANY TYPE |
| E0720 | $0.00 | HCPCS / CPT® | TENS TWO LEAD |
| E0730 | $0.00 | HCPCS / CPT® | TENS FOUR LEAD |
| E0731 | $0.00 | HCPCS / CPT® | CONDUCTIVE GARMENT FOR TENS/ |
| E0740 | $0.00 | HCPCS / CPT® | NON-IMPLANT PELV FLR E-STIM |
| E0744 | $0.00 | HCPCS / CPT® | NEUROMUSCULAR STIM FOR SCOLI |
| E0745 | $0.00 | HCPCS / CPT® | NEUROMUSCULAR STIM FOR SHOCK |
| E0746 | $0.00 | HCPCS / CPT® | ELECTROMYOGRAPH BIOFEEDBACK |
| E0747 | $0.00 | HCPCS / CPT® | ELEC OSTEOGEN STIM NOT SPINE |
| E0748 | $0.00 | HCPCS / CPT® | ELEC OSTEOGEN STIM SPINAL |
| E0749 | $0.00 | HCPCS / CPT® | ELEC OSTEOGEN STIM IMPLANTED |
| E0755 | $0.00 | HCPCS / CPT® | ELECTRONIC SALIVARY REFLEX S |
| E0760 | $0.00 | HCPCS / CPT® | OSTEOGEN ULTRASOUND STIMLTOR |
| E0761 | $0.00 | HCPCS / CPT® | NONTHERM ELECTROMGNTC DEVICE |
| E0762 | $0.00 | HCPCS / CPT® | TRANS ELEC JT STIM DEV SYS |
| E0764 | $0.00 | HCPCS / CPT® | FUNCTIONAL NEUROMUSCULARSTIM |
| E0765 | $0.00 | HCPCS / CPT® | NERVE STIMULATOR FOR TX N&V |
| E0766 | $0.00 | HCPCS / CPT® | ELEC STIM CANCER TREATMENT |
| E0769 | $0.00 | HCPCS / CPT® | ELECTRIC WOUND TREATMENT DEV |
| E0770 | $0.00 | HCPCS / CPT® | FUNCTIONAL ELECTRIC STIM NOS |
| E0776 | $0.00 | HCPCS / CPT® | IV POLE |
| E0779 | $0.00 | HCPCS / CPT® | AMB INFUSION PUMP MECHANICAL |
| E0780 | $0.00 | HCPCS / CPT® | MECH AMB INFUSION PUMP <8HRS |
| E0781 | $0.00 | HCPCS / CPT® | EXTERNAL AMBULATORY INFUS PU |
| E0782 | $0.00 | HCPCS / CPT® | NON-PROGRAMBLE INFUSION PUMP |
| E0783 | $0.00 | HCPCS / CPT® | PROGRAMMABLE INFUSION PUMP |
| E0784 | $0.00 | HCPCS / CPT® | EXT AMB INFUSN PUMP INSULIN |
| E0785 | $0.00 | HCPCS / CPT® | REPLACEMENT IMPL PUMP CATHET |
| E0786 | $0.00 | HCPCS / CPT® | IMPLANTABLE PUMP REPLACEMENT |
| E0791 | $0.00 | HCPCS / CPT® | PARENTERAL INFUSION PUMP STA |
| E0830 | $0.00 | HCPCS / CPT® | AMBULATORY TRACTION DEVICE |
| E0840 | $0.00 | HCPCS / CPT® | TRACT FRAME ATTACH HEADBOARD |
| E0849 | $0.00 | HCPCS / CPT® | CERVICAL PNEUM TRAC EQUIP |
| E0850 | $0.00 | HCPCS / CPT® | TRACTION STAND FREE STANDING |
| E0855 | $0.00 | HCPCS / CPT® | CERVICAL TRACTION EQUIPMENT |
| E0856 | $0.00 | HCPCS / CPT® | CERVIC COLLAR W AIR BLADDERS |
| E0860 | $0.00 | HCPCS / CPT® | TRACT EQUIP CERVICAL TRACT |
| E0870 | $0.00 | HCPCS / CPT® | TRACT FRAME ATTACH FOOTBOARD |
| E0880 | $0.00 | HCPCS / CPT® | TRAC STAND FREE STAND EXTREM |
| E0890 | $0.00 | HCPCS / CPT® | TRACTION FRAME ATTACH PELVIC |
| E0900 | $0.00 | HCPCS / CPT® | TRAC STAND FREE STAND PELVIC |
| E0910 | $0.00 | HCPCS / CPT® | TRAPEZE BAR ATTACHED TO BED |
| E0911 | $0.00 | HCPCS / CPT® | HD TRAPEZE BAR ATTACH TO BED |
| E0912 | $0.00 | HCPCS / CPT® | HD TRAPEZE BAR FREE STANDING |
| E0920 | $0.00 | HCPCS / CPT® | FRACTURE FRAME ATTACHED TO B |
| E0930 | $0.00 | HCPCS / CPT® | FRACTURE FRAME FREE STANDING |
| E0935 | $0.00 | HCPCS / CPT® | CONT PAS MOTION EXERCISE DEV |
| E0936 | $0.00 | HCPCS / CPT® | CPM DEVICE, OTHER THAN KNEE |
| E0940 | $0.00 | HCPCS / CPT® | TRAPEZE BAR FREE STANDING |
| E0941 | $0.00 | HCPCS / CPT® | GRAVITY ASSISTED TRACTION DE |
| E0942 | $0.00 | HCPCS / CPT® | CERVICAL HEAD HARNESS/HALTER |
| E0944 | $0.00 | HCPCS / CPT® | PELVIC BELT/HARNESS/BOOT |
| E0945 | $0.00 | HCPCS / CPT® | BELT/HARNESS EXTREMITY |
| E0946 | $0.00 | HCPCS / CPT® | FRACTURE FRAME DUAL W CROSS |
| E0947 | $0.00 | HCPCS / CPT® | FRACTURE FRAME ATTACHMNTS PE |
| E0948 | $0.00 | HCPCS / CPT® | FRACTURE FRAME ATTACHMNTS CE |
| E0950 | $0.00 | HCPCS / CPT® | TRAY |
| E0951 | $0.00 | HCPCS / CPT® | LOOP HEEL |
| E0952 | $0.00 | HCPCS / CPT® | TOE LOOP/HOLDER, EACH |
| E0955 | $0.00 | HCPCS / CPT® | CUSHIONED HEADREST |
| E0956 | $0.00 | HCPCS / CPT® | W/C LATERAL TRUNK/HIP SUPPOR |
| E0957 | $0.00 | HCPCS / CPT® | W/C MEDIAL THIGH SUPPORT |
| E0958 | $0.00 | HCPCS / CPT® | WHLCHR ATT- CONV 1 ARM DRIVE |
| E0959 | $0.00 | HCPCS / CPT® | AMPUTEE ADAPTER |
| E0960 | $0.00 | HCPCS / CPT® | W/C SHOULDER HARNESS/STRAPS |
| E0961 | $0.00 | HCPCS / CPT® | WHEELCHAIR BRAKE EXTENSION |
| E0966 | $0.00 | HCPCS / CPT® | WHEELCHAIR HEAD REST EXTENSI |
| E0967 | $0.00 | HCPCS / CPT® | MAN WC RIM/PROJECTION REP EA |
| E0968 | $0.00 | HCPCS / CPT® | WHEELCHAIR COMMODE SEAT |
| E0969 | $0.00 | HCPCS / CPT® | WHEELCHAIR NARROWING DEVICE |
| E0970 | $0.00 | HCPCS / CPT® | WHEELCHAIR NO. 2 FOOTPLATES |
| E0971 | $0.00 | HCPCS / CPT® | WHEELCHAIR ANTI-TIPPING DEVI |
| E0973 | $0.00 | HCPCS / CPT® | W/CH ACCESS DET ADJ ARMREST |
| E0974 | $0.00 | HCPCS / CPT® | W/CH ACCESS ANTI-ROLLBACK |
| E0978 | $0.00 | HCPCS / CPT® | W/C ACC,SAF BELT PELV STRAP |
| E0980 | $0.00 | HCPCS / CPT® | WHEELCHAIR SAFETY VEST |
| E0981 | $0.00 | HCPCS / CPT® | SEAT UPHOLSTERY, REPLACEMENT |
| E0982 | $0.00 | HCPCS / CPT® | BACK UPHOLSTERY, REPLACEMENT |
| E0983 | $0.00 | HCPCS / CPT® | ADD PWR JOYSTICK |
| E0984 | $0.00 | HCPCS / CPT® | ADD PWR TILLER |
| E0985 | $0.00 | HCPCS / CPT® | W/C SEAT LIFT MECHANISM |
| E0986 | $0.00 | HCPCS / CPT® | MAN W/C PUSH-RIM POWR SYSTEM |
| E0988 | $0.00 | HCPCS / CPT® | LEVER-ACTIVATED WHEEL DRIVE |
| E0990 | $0.00 | HCPCS / CPT® | WHEELCHAIR ELEVATING LEG RES |
| E0992 | $0.00 | HCPCS / CPT® | WHEELCHAIR SOLID SEAT INSERT |
| E0994 | $0.00 | HCPCS / CPT® | WHEELCHAIR ARM REST |
| E0995 | $0.00 | HCPCS / CPT® | WC CALF REST, PAD REPLACEMNT |
| E1002 | $0.00 | HCPCS / CPT® | PWR SEAT TILT |
| E1003 | $0.00 | HCPCS / CPT® | PWR SEAT RECLINE |
| E1004 | $0.00 | HCPCS / CPT® | PWR SEAT RECLINE MECH |
| E1005 | $0.00 | HCPCS / CPT® | PWR SEAT RECLINE PWR |
| E1006 | $0.00 | HCPCS / CPT® | PWR SEAT COMBO W/O SHEAR |
| E1007 | $0.00 | HCPCS / CPT® | PWR SEAT COMBO W/SHEAR |
| E1008 | $0.00 | HCPCS / CPT® | PWR SEAT COMBO PWR SHEAR |
| E1009 | $0.00 | HCPCS / CPT® | ADD MECH LEG ELEVATION |
| E1010 | $0.00 | HCPCS / CPT® | ADD PWR LEG ELEVATION |
| E1011 | $0.00 | HCPCS / CPT® | PED WC MODIFY WIDTH ADJUSTM |
| E1012 | $0.00 | HCPCS / CPT® | CTR MOUNT PWR ELEV LEG REST |
| E1014 | $0.00 | HCPCS / CPT® | RECLINING BACK ADD PED W/C |
| E1015 | $0.00 | HCPCS / CPT® | SHOCK ABSORBER FOR MAN W/C |
| E1016 | $0.00 | HCPCS / CPT® | SHOCK ABSORBER FOR POWER W/C |
| E1017 | $0.00 | HCPCS / CPT® | HD SHCK ABSRBR FOR HD MAN WC |
| E1018 | $0.00 | HCPCS / CPT® | HD SHCK ABSRBER FOR HD POWWC |
| E1020 | $0.00 | HCPCS / CPT® | RESIDUAL LIMB SUPPORT SYSTEM |
| E1028 | $0.00 | HCPCS / CPT® | W/C MANUAL SWINGAWAY |
| E1029 | $0.00 | HCPCS / CPT® | W/C VENT TRAY FIXED |
| E1030 | $0.00 | HCPCS / CPT® | W/C VENT TRAY GIMBALED |
| E1031 | $0.00 | HCPCS / CPT® | ROLLABOUT CHAIR WITH CASTERS |
| E1035 | $0.00 | HCPCS / CPT® | PATIENT TRANSFER SYSTEM <300 |
| E1036 | $0.00 | HCPCS / CPT® | PATIENT TRANSFER SYSTEM >300 |
| E1037 | $0.00 | HCPCS / CPT® | TRANSPORT CHAIR, PED SIZE |
| E1038 | $0.00 | HCPCS / CPT® | TRANSPORT CHAIR PT WT<=300LB |
| E1039 | $0.00 | HCPCS / CPT® | TRANSPORT CHAIR PT WT >300LB |
| E1050 | $0.00 | HCPCS / CPT® | WHELCHR FXD FULL LENGTH ARMS |
| E1060 | $0.00 | HCPCS / CPT® | WHEELCHAIR DETACHABLE ARMS |
| E1070 | $0.00 | HCPCS / CPT® | WHEELCHAIR DETACHABLE FOOT R |
| E1083 | $0.00 | HCPCS / CPT® | HEMI-WHEELCHAIR FIXED ARMS |
| E1084 | $0.00 | HCPCS / CPT® | HEMI-WHEELCHAIR DETACHABLE A |
| E1085 | $0.00 | HCPCS / CPT® | HEMI-WHEELCHAIR FIXED ARMS |
| E1086 | $0.00 | HCPCS / CPT® | HEMI-WHEELCHAIR DETACHABLE A |
| E1087 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWT FIXED ARM |
| E1088 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWEIGHT DET A |
| E1089 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWT FIXED ARM |
| E1090 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWEIGHT DET A |
| E1092 | $0.00 | HCPCS / CPT® | WHEELCHAIR WIDE W/ LEG RESTS |
| E1093 | $0.00 | HCPCS / CPT® | WHEELCHAIR WIDE W/ FOOT REST |
| E1100 | $0.00 | HCPCS / CPT® | WHCHR S-RECL FXD ARM LEG RES |
| E1110 | $0.00 | HCPCS / CPT® | WHEELCHAIR SEMI-RECL DETACH |
| E1130 | $0.00 | HCPCS / CPT® | WHLCHR STAND FXD ARM FT REST |
| E1140 | $0.00 | HCPCS / CPT® | WHEELCHAIR STANDARD DETACH A |
| E1150 | $0.00 | HCPCS / CPT® | WHEELCHAIR STANDARD W/ LEG R |
| E1160 | $0.00 | HCPCS / CPT® | WHEELCHAIR FIXED ARMS |
| E1161 | $0.00 | HCPCS / CPT® | MANUAL ADULT WC W TILTINSPAC |
| E1170 | $0.00 | HCPCS / CPT® | WHLCHR AMPU FXD ARM LEG REST |
| E1171 | $0.00 | HCPCS / CPT® | WHEELCHAIR AMPUTEE W/O LEG R |
| E1172 | $0.00 | HCPCS / CPT® | WHEELCHAIR AMPUTEE DETACH AR |
| E1180 | $0.00 | HCPCS / CPT® | WHEELCHAIR AMPUTEE W/ FOOT R |
| E1190 | $0.00 | HCPCS / CPT® | WHEELCHAIR AMPUTEE W/ LEG RE |
| E1195 | $0.00 | HCPCS / CPT® | WHEELCHAIR AMPUTEE HEAVY DUT |
| E1200 | $0.00 | HCPCS / CPT® | WHEELCHAIR AMPUTEE FIXED ARM |
| E1220 | $0.00 | HCPCS / CPT® | WHLCHR SPECIAL SIZE/CONSTRC |
| E1221 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SIZE W FOOT |
| E1222 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SIZE W/ LEG |
| E1223 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SIZE W FOOT |
| E1224 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SIZE W/ LEG |
| E1225 | $0.00 | HCPCS / CPT® | MANUAL SEMI-RECLINING BACK |
| E1226 | $0.00 | HCPCS / CPT® | MANUAL FULLY RECLINING BACK |
| E1227 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SZ SPEC HT A |
| E1228 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SZ SPEC HT B |
| E1229 | $0.00 | HCPCS / CPT® | PEDIATRIC WHEELCHAIR NOS |
| E1230 | $0.00 | HCPCS / CPT® | POWER OPERATED VEHICLE |
| E1231 | $0.00 | HCPCS / CPT® | RIGID PED W/C TILT-IN-SPACE |
| E1232 | $0.00 | HCPCS / CPT® | FOLDING PED WC TILT-IN-SPACE |
| E1233 | $0.00 | HCPCS / CPT® | RIG PED WC TLTNSPC W/O SEAT |
| E1234 | $0.00 | HCPCS / CPT® | FLD PED WC TLTNSPC W/O SEAT |
| E1235 | $0.00 | HCPCS / CPT® | RIGID PED WC ADJUSTABLE |
| E1236 | $0.00 | HCPCS / CPT® | FOLDING PED WC ADJUSTABLE |
| E1237 | $0.00 | HCPCS / CPT® | RGD PED WC ADJSTABL W/O SEAT |
| E1238 | $0.00 | HCPCS / CPT® | FLD PED WC ADJSTABL W/O SEAT |
| E1239 | $0.00 | HCPCS / CPT® | PED POWER WHEELCHAIR NOS |
| E1240 | $0.00 | HCPCS / CPT® | WHCHR LITWT DET ARM LEG REST |
| E1250 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWT FIXED ARM |
| E1260 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWT FOOT REST |
| E1270 | $0.00 | HCPCS / CPT® | WHEELCHAIR LIGHTWEIGHT LEG R |
| E1280 | $0.00 | HCPCS / CPT® | WHCHR H-DUTY DET ARM LEG RES |
| E1285 | $0.00 | HCPCS / CPT® | WHEELCHAIR HEAVY DUTY FIXED |
| E1290 | $0.00 | HCPCS / CPT® | WHEELCHAIR HVY DUTY DETACH A |
| E1295 | $0.00 | HCPCS / CPT® | WHEELCHAIR HEAVY DUTY FIXED |
| E1296 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPECIAL SEAT HEIG |
| E1297 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPECIAL SEAT DEPT |
| E1298 | $0.00 | HCPCS / CPT® | WHEELCHAIR SPEC SEAT DEPTH/W |
| E1300 | $0.00 | HCPCS / CPT® | WHIRLPOOL PORTABLE |
| E1310 | $0.00 | HCPCS / CPT® | WHIRLPOOL NON-PORTABLE |
| E1352 | $0.00 | HCPCS / CPT® | O2 FLOW REG POS INSPIR PRESS |
| E1353 | $0.00 | HCPCS / CPT® | OXYGEN SUPPLIES REGULATOR |
| E1354 | $0.00 | HCPCS / CPT® | WHEELED CART, PORT CYL/CONC |
| E1355 | $0.00 | HCPCS / CPT® | OXYGEN SUPPLIES STAND/RACK |
| E1356 | $0.00 | HCPCS / CPT® | BATT PACK/CART, PORT CONC |
| E1357 | $0.00 | HCPCS / CPT® | BATTERY CHARGER, PORT CONC |
| E1358 | $0.00 | HCPCS / CPT® | DC POWER ADAPTER, PORT CONC |
| E1372 | $0.00 | HCPCS / CPT® | OXY SUPPL HEATER FOR NEBULIZ |
| E1390 | $0.00 | HCPCS / CPT® | OXYGEN CONCENTRATOR |
| E1391 | $0.00 | HCPCS / CPT® | OXYGEN CONCENTRATOR, DUAL |
| E1392 | $0.00 | HCPCS / CPT® | PORTABLE OXYGEN CONCENTRATOR |
| E1399 | $0.00 | HCPCS / CPT® | DURABLE MEDICAL EQUIPMENT MI |
| E1405 | $0.00 | HCPCS / CPT® | O2/WATER VAPOR ENRICH W/HEAT |
| E1406 | $0.00 | HCPCS / CPT® | O2/WATER VAPOR ENRICH W/O HE |
| E1500 | $0.00 | HCPCS / CPT® | CENTRIFUGE |
| E1510 | $0.00 | HCPCS / CPT® | KIDNEY DIALYSATE DELIVRY SYS |
| E1520 | $0.00 | HCPCS / CPT® | HEPARIN INFUSION PUMP |
| E1530 | $0.00 | HCPCS / CPT® | REPLACEMENT AIR BUBBLE DETEC |
| E1540 | $0.00 | HCPCS / CPT® | REPLACEMENT PRESSURE ALARM |
| E1550 | $0.00 | HCPCS / CPT® | BATH CONDUCTIVITY METER |
| E1560 | $0.00 | HCPCS / CPT® | REPLACE BLOOD LEAK DETECTOR |
| E1570 | $0.00 | HCPCS / CPT® | ADJUSTABLE CHAIR FOR ESRD PT |
| E1575 | $0.00 | HCPCS / CPT® | TRANSDUCER PROTECT/FLD BAR |
| E1580 | $0.00 | HCPCS / CPT® | UNIPUNCTURE CONTROL SYSTEM |
| E1590 | $0.00 | HCPCS / CPT® | HEMODIALYSIS MACHINE |
| E1592 | $0.00 | HCPCS / CPT® | AUTO INTERM PERITONEAL DIALY |
| E1594 | $0.00 | HCPCS / CPT® | CYCLER DIALYSIS MACHINE |
| E1600 | $0.00 | HCPCS / CPT® | DELI/INSTALL CHRG HEMO EQUIP |
| E1610 | $0.00 | HCPCS / CPT® | REVERSE OSMOSIS H2O PURI SYS |
| E1615 | $0.00 | HCPCS / CPT® | DEIONIZER H2O PURI SYSTEM |
| E1620 | $0.00 | HCPCS / CPT® | REPLACEMENT BLOOD PUMP |
| E1625 | $0.00 | HCPCS / CPT® | WATER SOFTENING SYSTEM |
| E1630 | $0.00 | HCPCS / CPT® | RECIPROCATING PERITONEAL DIA |
| E1632 | $0.00 | HCPCS / CPT® | WEARABLE ARTIFICIAL KIDNEY |
| E1634 | $0.00 | HCPCS / CPT® | PERITONEAL DIALYSIS CLAMP |
| E1635 | $0.00 | HCPCS / CPT® | COMPACT TRAVEL HEMODIALYZER |
| E1636 | $0.00 | HCPCS / CPT® | SORBENT CARTRIDGES PER 10 |
| E1637 | $0.00 | HCPCS / CPT® | HEMOSTATS FOR DIALYSIS, EACH |
| E1639 | $0.00 | HCPCS / CPT® | DIALYSIS SCALE |
| E1699 | $0.00 | HCPCS / CPT® | DIALYSIS EQUIPMENT NOC |
| E1700 | $0.00 | HCPCS / CPT® | JAW MOTION REHAB SYSTEM |
| E1701 | $0.00 | HCPCS / CPT® | REPL CUSHIONS FOR JAW MOTION |
| E1702 | $0.00 | HCPCS / CPT® | REPL MEASR SCALES JAW MOTION |
| E1800 | $0.00 | HCPCS / CPT® | ADJUST ELBOW EXT/FLEX DEVICE |
| E1801 | $0.00 | HCPCS / CPT® | SPS ELBOW DEVICE |
| E1802 | $0.00 | HCPCS / CPT® | ADJST FOREARM PRO/SUP DEVICE |
| E1805 | $0.00 | HCPCS / CPT® | ADJUST WRIST EXT/FLEX DEVICE |
| E1806 | $0.00 | HCPCS / CPT® | SPS WRIST DEVICE |
| E1810 | $0.00 | HCPCS / CPT® | ADJUST KNEE EXT/FLEX DEVICE |
| E1811 | $0.00 | HCPCS / CPT® | SPS KNEE DEVICE |
| E1812 | $0.00 | HCPCS / CPT® | KNEE EXT/FLEX W ACT RES CTRL |
| E1815 | $0.00 | HCPCS / CPT® | ADJUST ANKLE EXT/FLEX DEVICE |
| E1816 | $0.00 | HCPCS / CPT® | SPS ANKLE DEVICE |
| E1818 | $0.00 | HCPCS / CPT® | SPS FOREARM DEVICE |
| E1820 | $0.00 | HCPCS / CPT® | SOFT INTERFACE MATERIAL |
| E1821 | $0.00 | HCPCS / CPT® | REPLACEMENT INTERFACE SPSD |
| E1825 | $0.00 | HCPCS / CPT® | ADJUST FINGER EXT/FLEX DEVC |
| E1830 | $0.00 | HCPCS / CPT® | ADJUST TOE EXT/FLEX DEVICE |
| E1831 | $0.00 | HCPCS / CPT® | STATIC STR TOE DEV EXT/FLEX |
| E1840 | $0.00 | HCPCS / CPT® | ADJ SHOULDER EXT/FLEX DEVICE |
| E1841 | $0.00 | HCPCS / CPT® | STATIC STR SHLDR DEV ROM ADJ |
| E1902 | $0.00 | HCPCS / CPT® | AAC NON-ELECTRONIC BOARD |
| E2000 | $0.00 | HCPCS / CPT® | GASTRIC SUCTION PUMP HME MDL |
| E2100 | $0.00 | HCPCS / CPT® | BLD GLUCOSE MONITOR W VOICE |
| E2101 | $0.00 | HCPCS / CPT® | BLD GLUCOSE MONITOR W LANCE |
| E2120 | $0.00 | HCPCS / CPT® | PULSE GEN SYS TX ENDOLYMP FL |
| E2201 | $0.00 | HCPCS / CPT® | MAN W/CH ACC SEAT W>=20 <24 |
| E2202 | $0.00 | HCPCS / CPT® | SEAT WIDTH 24-27 IN |
| E2203 | $0.00 | HCPCS / CPT® | FRAME DEPTH LESS THAN 22 IN |
| E2204 | $0.00 | HCPCS / CPT® | FRAME DEPTH 22 TO 25 IN |
| E2205 | $0.00 | HCPCS / CPT® | MANUAL WC ACCESSORY, HANDRIM |
| E2206 | $0.00 | HCPCS / CPT® | MAN WC WHL LOCK COMP REPL EA |
| E2207 | $0.00 | HCPCS / CPT® | CRUTCH AND CANE HOLDER |
| E2208 | $0.00 | HCPCS / CPT® | CYLINDER TANK CARRIER |
| E2209 | $0.00 | HCPCS / CPT® | ARM TROUGH EACH |
| E2210 | $0.00 | HCPCS / CPT® | WHEELCHAIR BEARINGS |
| E2211 | $0.00 | HCPCS / CPT® | PNEUMATIC PROPULSION TIRE |
| E2212 | $0.00 | HCPCS / CPT® | PNEUMATIC PROP TIRE TUBE |
| E2213 | $0.00 | HCPCS / CPT® | PNEUMATIC PROP TIRE INSERT |
| E2214 | $0.00 | HCPCS / CPT® | PNEUMATIC CASTER TIRE EACH |
| E2215 | $0.00 | HCPCS / CPT® | PNEUMATIC CASTER TIRE TUBE |
| E2216 | $0.00 | HCPCS / CPT® | FOAM FILLED PROPULSION TIRE |
| E2217 | $0.00 | HCPCS / CPT® | FOAM FILLED CASTER TIRE EACH |
| E2218 | $0.00 | HCPCS / CPT® | FOAM PROPULSION TIRE EACH |
| E2219 | $0.00 | HCPCS / CPT® | FOAM CASTER TIRE ANY SIZE EA |
| E2220 | $0.00 | HCPCS / CPT® | SOLID PROPULS TIRE, REPL, EA |
| E2221 | $0.00 | HCPCS / CPT® | SOLID CASTER TIRE REPL, EACH |
| E2222 | $0.00 | HCPCS / CPT® | SOLID CASTER INTEG WHL, REPL |
| E2224 | $0.00 | HCPCS / CPT® | PROPULSION WHL EXCL TIRE REP |
| E2225 | $0.00 | HCPCS / CPT® | CASTER WHEEL EXCLUDES TIRE |
| E2226 | $0.00 | HCPCS / CPT® | CASTER FORK REPLACEMENT ONLY |
| E2227 | $0.00 | HCPCS / CPT® | GEAR REDUCTION DRIVE WHEEL |
| E2228 | $0.00 | HCPCS / CPT® | MWC ACC, WHEELCHAIR BRAKE |
| E2230 | $0.00 | HCPCS / CPT® | MANUAL STANDING SYSTEM |
| E2231 | $0.00 | HCPCS / CPT® | SOLID SEAT SUPPORT BASE |
| E2291 | $0.00 | HCPCS / CPT® | PLANAR BACK FOR PED SIZE WC |
| E2292 | $0.00 | HCPCS / CPT® | PLANAR SEAT FOR PED SIZE WC |
| E2293 | $0.00 | HCPCS / CPT® | CONTOUR BACK FOR PED SIZE WC |
| E2294 | $0.00 | HCPCS / CPT® | CONTOUR SEAT FOR PED SIZE WC |
| E2295 | $0.00 | HCPCS / CPT® | PED DYNAMIC SEATING FRAME |
| E2300 | $0.00 | HCPCS / CPT® | PWR SEAT ELEVATION SYS |
| E2301 | $0.00 | HCPCS / CPT® | PWR STANDING |
| E2310 | $0.00 | HCPCS / CPT® | ELECTRO CONNECT BTW CONTROL |
| E2311 | $0.00 | HCPCS / CPT® | ELECTRO CONNECT BTW 2 SYS |
| E2312 | $0.00 | HCPCS / CPT® | MINI-PROP REMOTE JOYSTICK |
| E2313 | $0.00 | HCPCS / CPT® | PWC HARNESS, EXPAND CONTROL |
| E2321 | $0.00 | HCPCS / CPT® | HAND INTERFACE JOYSTICK |
| E2322 | $0.00 | HCPCS / CPT® | MULT MECH SWITCHES |
| E2323 | $0.00 | HCPCS / CPT® | SPECIAL JOYSTICK HANDLE |
| E2324 | $0.00 | HCPCS / CPT® | CHIN CUP INTERFACE |
| E2325 | $0.00 | HCPCS / CPT® | SIP AND PUFF INTERFACE |
| E2326 | $0.00 | HCPCS / CPT® | BREATH TUBE KIT |
| E2327 | $0.00 | HCPCS / CPT® | HEAD CONTROL INTERFACE MECH |
| E2328 | $0.00 | HCPCS / CPT® | HEAD/EXTREMITY CONTROL INTER |
| E2329 | $0.00 | HCPCS / CPT® | HEAD CONTROL NONPROPORTIONAL |
| E2330 | $0.00 | HCPCS / CPT® | HEAD CONTROL PROXIMITY SWITC |
| E2331 | $0.00 | HCPCS / CPT® | ATTENDANT CONTROL |
| E2340 | $0.00 | HCPCS / CPT® | W/C WDTH 20-23 IN SEAT FRAME |
| E2341 | $0.00 | HCPCS / CPT® | W/C WDTH 24-27 IN SEAT FRAME |
| E2342 | $0.00 | HCPCS / CPT® | W/C DPTH 20-21 IN SEAT FRAME |
| E2343 | $0.00 | HCPCS / CPT® | W/C DPTH 22-25 IN SEAT FRAME |
| E2351 | $0.00 | HCPCS / CPT® | ELECTRONIC SGD INTERFACE |
| E2358 | $0.00 | HCPCS / CPT® | GR 34 NONSEALED LEADACID |
| E2359 | $0.00 | HCPCS / CPT® | GR34 SEALED LEADACID BATTERY |
| E2360 | $0.00 | HCPCS / CPT® | 22NF NONSEALED LEADACID |
| E2361 | $0.00 | HCPCS / CPT® | 22NF SEALED LEADACID BATTERY |
| E2362 | $0.00 | HCPCS / CPT® | GR24 NONSEALED LEADACID |
| E2363 | $0.00 | HCPCS / CPT® | GR24 SEALED LEADACID BATTERY |
| E2364 | $0.00 | HCPCS / CPT® | U1NONSEALED LEADACID BATTERY |
| E2365 | $0.00 | HCPCS / CPT® | U1 SEALED LEADACID BATTERY |
| E2366 | $0.00 | HCPCS / CPT® | BATTERY CHARGER, SINGLE MODE |
| E2367 | $0.00 | HCPCS / CPT® | BATTERY CHARGER, DUAL MODE |
| E2368 | $0.00 | HCPCS / CPT® | PWR WC DRIVEWHEEL MOTOR REPL |
| E2369 | $0.00 | HCPCS / CPT® | PWR WC DRIVEWHEEL GEAR REPL |
| E2370 | $0.00 | HCPCS / CPT® | PWR WC DR WH MOTOR/GEAR COMB |
| E2371 | $0.00 | HCPCS / CPT® | GR27 SEALED LEADACID BATTERY |
| E2372 | $0.00 | HCPCS / CPT® | GR27 NON-SEALED LEADACID |
| E2373 | $0.00 | HCPCS / CPT® | HAND/CHIN CTRL SPEC JOYSTICK |
| E2374 | $0.00 | HCPCS / CPT® | HAND/CHIN CTRL STD JOYSTICK |
| E2375 | $0.00 | HCPCS / CPT® | NON-EXPANDABLE CONTROLLER |
| E2376 | $0.00 | HCPCS / CPT® | EXPANDABLE CONTROLLER, REPL |
| E2377 | $0.00 | HCPCS / CPT® | EXPANDABLE CONTROLLER, INITL |
| E2378 | $0.00 | HCPCS / CPT® | PW ACTUATOR REPLACEMENT |
| E2381 | $0.00 | HCPCS / CPT® | PNEUM DRIVE WHEEL TIRE |
| E2382 | $0.00 | HCPCS / CPT® | TUBE, PNEUM WHEEL DRIVE TIRE |
| E2383 | $0.00 | HCPCS / CPT® | INSERT, PNEUM WHEEL DRIVE |
| E2384 | $0.00 | HCPCS / CPT® | PNEUMATIC CASTER TIRE |
| E2385 | $0.00 | HCPCS / CPT® | TUBE, PNEUMATIC CASTER TIRE |
| E2386 | $0.00 | HCPCS / CPT® | FOAM FILLED DRIVE WHEEL TIRE |
| E2387 | $0.00 | HCPCS / CPT® | FOAM FILLED CASTER TIRE |
| E2388 | $0.00 | HCPCS / CPT® | FOAM DRIVE WHEEL TIRE |
| E2389 | $0.00 | HCPCS / CPT® | FOAM CASTER TIRE |
| E2390 | $0.00 | HCPCS / CPT® | SOLID DRIVE WHEEL TIRE |
| E2391 | $0.00 | HCPCS / CPT® | SOLID CASTER TIRE |
| E2392 | $0.00 | HCPCS / CPT® | SOLID CASTER TIRE, INTEGRATE |
| E2394 | $0.00 | HCPCS / CPT® | DRIVE WHEEL EXCLUDES TIRE |
| E2395 | $0.00 | HCPCS / CPT® | CASTER WHEEL EXCLUDES TIRE |
| E2396 | $0.00 | HCPCS / CPT® | CASTER FORK |
| E2397 | $0.00 | HCPCS / CPT® | PWC ACC, LITH-BASED BATTERY |
| E2402 | $0.00 | HCPCS / CPT® | NEG PRESS WOUND THERAPY PUMP |
| E2500 | $0.00 | HCPCS / CPT® | SGD DIGITIZED PRE-REC <=8MIN |
| E2502 | $0.00 | HCPCS / CPT® | SGD PREREC MSG >8MIN <=20MIN |
| E2504 | $0.00 | HCPCS / CPT® | SGD PREREC MSG>20MIN <=40MIN |
| E2506 | $0.00 | HCPCS / CPT® | SGD PREREC MSG > 40 MIN |
| E2508 | $0.00 | HCPCS / CPT® | SGD SPELLING PHYS CONTACT |
| E2510 | $0.00 | HCPCS / CPT® | SGD W MULTI METHODS MSG/ACCS |
| E2511 | $0.00 | HCPCS / CPT® | SGD SFTWRE PRGRM FOR PC/PDA |
| E2512 | $0.00 | HCPCS / CPT® | SGD ACCESSORY, MOUNTING SYS |
| E2599 | $0.00 | HCPCS / CPT® | SGD ACCESSORY NOC |
| E2601 | $0.00 | HCPCS / CPT® | GEN W/C CUSHION WDTH < 22 IN |
| E2602 | $0.00 | HCPCS / CPT® | GEN W/C CUSHION WDTH >=22 IN |
| E2603 | $0.00 | HCPCS / CPT® | SKIN PROTECT WC CUS WD <22IN |
| E2604 | $0.00 | HCPCS / CPT® | SKIN PROTECT WC CUS WD>=22IN |
| E2605 | $0.00 | HCPCS / CPT® | POSITION WC CUSH WDTH <22 IN |
| E2606 | $0.00 | HCPCS / CPT® | POSITION WC CUSH WDTH>=22 IN |
| E2607 | $0.00 | HCPCS / CPT® | SKIN PRO/POS WC CUS WD <22IN |
| E2608 | $0.00 | HCPCS / CPT® | SKIN PRO/POS WC CUS WD>=22IN |
| E2609 | $0.00 | HCPCS / CPT® | CUSTOM FABRICATE W/C CUSHION |
| E2610 | $0.00 | HCPCS / CPT® | POWERED W/C CUSHION |
| E2611 | $0.00 | HCPCS / CPT® | GEN USE BACK CUSH WDTH <22IN |
| E2612 | $0.00 | HCPCS / CPT® | GEN USE BACK CUSH WDTH>=22IN |
| E2613 | $0.00 | HCPCS / CPT® | POSITION BACK CUSH WD <22IN |
| E2614 | $0.00 | HCPCS / CPT® | POSITION BACK CUSH WD>=22IN |
| E2615 | $0.00 | HCPCS / CPT® | POS BACK POST/LAT WDTH <22IN |
| E2616 | $0.00 | HCPCS / CPT® | POS BACK POST/LAT WDTH>=22IN |
| E2617 | $0.00 | HCPCS / CPT® | CUSTOM FAB W/C BACK CUSHION |
| E2619 | $0.00 | HCPCS / CPT® | REPLACE COVER W/C SEAT CUSH |
| E2620 | $0.00 | HCPCS / CPT® | WC PLANAR BACK CUSH WD <22IN |
| E2621 | $0.00 | HCPCS / CPT® | WC PLANAR BACK CUSH WD>=22IN |
| E2622 | $0.00 | HCPCS / CPT® | ADJ SKIN PRO W/C CUS WD <22IN |
| E2623 | $0.00 | HCPCS / CPT® | ADJ SKIN PRO WC CUS WD>=22IN |
| E2624 | $0.00 | HCPCS / CPT® | ADJ SKIN PRO/POS CUS <22IN |
| E2625 | $0.00 | HCPCS / CPT® | ADJ SKIN PRO/POS WC CUS>=22 |
| E2626 | $0.00 | HCPCS / CPT® | SEO MOBILE ARM SUP ATT TO WC |
| E2627 | $0.00 | HCPCS / CPT® | ARM SUPP ATT TO WC RANCHO TY |
| E2628 | $0.00 | HCPCS / CPT® | MOBILE ARM SUPPORTS RECLININ |
| E2629 | $0.00 | HCPCS / CPT® | FRICTION DAMPENING ARM SUPP |
| E2630 | $0.00 | HCPCS / CPT® | MONOSUSPENSION ARM/HAND SUPP |
| E2631 | $0.00 | HCPCS / CPT® | ELEVAT PROXIMAL ARM SUPPORT |
| E2632 | $0.00 | HCPCS / CPT® | OFFSET/LAT ROCKER ARM W/ELA |
| E2633 | $0.00 | HCPCS / CPT® | MOBILE ARM SUPPORT SUPINATOR |
| E8000 | $0.00 | HCPCS / CPT® | POSTERIOR GAIT TRAINER |
| E8001 | $0.00 | HCPCS / CPT® | UPRIGHT GAIT TRAINER |
| E8002 | $0.00 | HCPCS / CPT® | ANTERIOR GAIT TRAINER |
| FEE | $46.20 | HCPCS / CPT® | RETURNED CHECK FEE |
| G0008 | $0.00 | HCPCS / CPT® | ADMIN INFLUENZA VIRUS VAC |
| G0009 | $0.00 | HCPCS / CPT® | ADMIN PNEUMOCOCCAL VACCINE |
| G0010 | $0.00 | HCPCS / CPT® | ADMIN HEPATITIS B VACCINE |
| G0027 | $0.00 | HCPCS / CPT® | SEMEN ANALYSIS |
| G0101 | $0.00 | HCPCS / CPT® | CA SCREEN;PELVIC/BREAST EXAM |
| G0102 | $0.00 | HCPCS / CPT® | PROSTATE CA SCREENING; DRE |
| G0103 | $0.00 | HCPCS / CPT® | PSA SCREENING |
| G0104 | $0.00 | HCPCS / CPT® | CA SCREEN;FLEXI SIGMOIDSCOPE |
| G0105 | $0.00 | HCPCS / CPT® | COLORECTAL SCRN; HI RISK IND |
| G0106 | $0.00 | HCPCS / CPT® | COLON CA SCREEN;BARIUM ENEMA |
| G0108 | $0.00 | HCPCS / CPT® | DIAB MANAGE TRN PER INDIV |
| G0109 | $0.00 | HCPCS / CPT® | DIAB MANAGE TRN IND/GROUP |
| G0117 | $0.00 | HCPCS / CPT® | GLAUCOMA SCRN HGH RISK DIREC |
| G0118 | $0.00 | HCPCS / CPT® | GLAUCOMA SCRN HGH RISK DIREC |
| G0120 | $0.00 | HCPCS / CPT® | COLON CA SCRN; BARIUM ENEMA |
| G0121 | $0.00 | HCPCS / CPT® | COLON CA SCRN NOT HI RSK IND |
| G0122 | $0.00 | HCPCS / CPT® | COLON CA SCRN; BARIUM ENEMA |
| G0123 | $0.00 | HCPCS / CPT® | SCREEN CERV/VAG THIN LAYER |
| G0124 | $0.00 | HCPCS / CPT® | SCREEN C/V THIN LAYER BY MD |
| G0127 | $0.00 | HCPCS / CPT® | TRIM NAIL(S) |
| G0128 | $0.00 | HCPCS / CPT® | CORF SKILLED NURSING SERVICE |
| G0129 | $0.00 | HCPCS / CPT® | PARTIAL HOSP PROG SERVICE |
| G0130 | $0.00 | HCPCS / CPT® | SINGLE ENERGY X-RAY STUDY |
| G0141 | $0.00 | HCPCS / CPT® | SCR C/V CYTO,AUTOSYS AND MD |
| G0143 | $0.00 | HCPCS / CPT® | SCR C/V CYTO,THINLAYER,RESCR |
| G0144 | $0.00 | HCPCS / CPT® | SCR C/V CYTO,THINLAYER,RESCR |
| G0145 | $0.00 | HCPCS / CPT® | SCR C/V CYTO,THINLAYER,RESCR |
| G0147 | $0.00 | HCPCS / CPT® | SCR C/V CYTO, AUTOMATED SYS |
| G0148 | $0.00 | HCPCS / CPT® | SCR C/V CYTO, AUTOSYS, RESCR |
| G0151 | $0.00 | HCPCS / CPT® | HHCP-SERV OF PT,EA 15 MIN |
| G0152 | $0.00 | HCPCS / CPT® | HHCP-SERV OF OT,EA 15 MIN |
| G0153 | $0.00 | HCPCS / CPT® | HHCP-SVS OF S/L PATH,EA 15MN |
| G0155 | $0.00 | HCPCS / CPT® | HHCP-SVS OF CSW,EA 15 MIN |
| G0156 | $0.00 | HCPCS / CPT® | HHCP-SVS OF AIDE,EA 15 MIN |
| G0157 | $0.00 | HCPCS / CPT® | HHC PT ASSISTANT EA 15 |
| G0158 | $0.00 | HCPCS / CPT® | HHC OT ASSISTANT EA 15 |
| G0159 | $0.00 | HCPCS / CPT® | HHC PT MAINT EA 15 MIN |
| G0160 | $0.00 | HCPCS / CPT® | HHC OCCUP THERAPY EA 15 |
| G0161 | $0.00 | HCPCS / CPT® | HHC SLP EA 15 MIN |
| G0162 | $0.00 | HCPCS / CPT® | HHC RN E&M PLAN SVS, 15 MIN |
| G0166 | $0.00 | HCPCS / CPT® | EXTRNL COUNTERPULSE, PER TX |
| G0168 | $43.73 | HCPCS / CPT® | DERMABOND – WOUND CLOSURE BY ADHESIVE |
| G0175 | $0.00 | HCPCS / CPT® | OPPS SERVICE,SCHED TEAM CONF |
| G0176 | $0.00 | HCPCS / CPT® | OPPS/PHP;ACTIVITY THERAPY |
| G0177 | $0.00 | HCPCS / CPT® | OPPS/PHP; TRAIN & EDUC SERV |
| G0179 | $0.00 | HCPCS / CPT® | MD RECERTIFICATION HHA PT |
| G0180 | $0.00 | HCPCS / CPT® | MD CERTIFICATION HHA PATIENT |
| G0181 | $0.00 | HCPCS / CPT® | HOME HEALTH CARE SUPERVISION |
| G0182 | $0.00 | HCPCS / CPT® | HOSPICE CARE SUPERVISION |
| G0186 | $0.00 | HCPCS / CPT® | DSTRY EYE LESN,FDR VSSL TECH |
| G0202 | $0.00 | HCPCS / CPT® | SCR MAMMO BI INCL CAD |
| G0204 | $0.00 | HCPCS / CPT® | DX MAMMO INCL CAD BI |
| G0206 | $0.00 | HCPCS / CPT® | DX MAMMO INCL CAD UNI |
| G0219 | $0.00 | HCPCS / CPT® | PET IMG WHOLBOD MELANO NONCO |
| G0235 | $0.00 | HCPCS / CPT® | PET NOT OTHERWISE SPECIFIED |
| G0237 | $0.00 | HCPCS / CPT® | THERAPEUTIC PROCD STRG ENDUR |
| G0238 | $0.00 | HCPCS / CPT® | OTH RESP PROC, INDIV |
| G0239 | $0.00 | HCPCS / CPT® | OTH RESP PROC, GROUP |
| G0245 | $0.00 | HCPCS / CPT® | INITIAL FOOT EXAM PT LOPS |
| G0246 | $0.00 | HCPCS / CPT® | FOLLOWUP EVAL OF FOOT PT LOP |
| G0247 | $0.00 | HCPCS / CPT® | ROUTINE FOOTCARE PT W LOPS |
| G0248 | $0.00 | HCPCS / CPT® | DEMONSTRATE USE HOME INR MON |
| G0249 | $0.00 | HCPCS / CPT® | PROVIDE INR TEST MATER/EQUIP |
| G0250 | $0.00 | HCPCS / CPT® | MD INR TEST REVIE INTER MGMT |
| G0252 | $0.00 | HCPCS / CPT® | PET IMAGING INITIAL DX |
| G0255 | $0.00 | HCPCS / CPT® | CURRENT PERCEP THRESHOLD TST |
| G0257 | $0.00 | HCPCS / CPT® | UNSCHED DIALYSIS ESRD PT HOS |
| G0259 | $0.00 | HCPCS / CPT® | INJECT FOR SACROILIAC JOINT |
| G0260 | $0.00 | HCPCS / CPT® | INJ FOR SACROILIAC JT ANESTH |
| G0268 | $248.89 | HCPCS / CPT® | REMOVAL OF IMPACTED WAX MD |
| G0269 | $0.00 | HCPCS / CPT® | OCCLUSIVE DEVICE IN VEIN ART |
| G0270 | $0.00 | HCPCS / CPT® | MNT SUBS TX FOR CHANGE DX |
| G0271 | $0.00 | HCPCS / CPT® | GROUP MNT 2 OR MORE 30 MINS |
| G0276 | $0.00 | HCPCS / CPT® | PILD/PLACEBO CONTROL CLIN TR |
| G0277 | $0.00 | HCPCS / CPT® | HBOT, FULL BODY CHAMBER, 30M |
| G0278 | $0.00 | HCPCS / CPT® | ILIAC ART ANGIO,CARDIAC CATH |
| G0279 | $0.00 | HCPCS / CPT® | TOMOSYNTHESIS, MAMMO |
| G0281 | $0.00 | HCPCS / CPT® | ELEC STIM UNATTEND FOR PRESS |
| G0282 | $0.00 | HCPCS / CPT® | ELECT STIM WOUND CARE NOT PD |
| G0283 | $0.00 | HCPCS / CPT® | ELEC STIM OTHER THAN WOUND |
| G0288 | $0.00 | HCPCS / CPT® | RECON, CTA FOR SURG PLAN |
| G0289 | $0.00 | HCPCS / CPT® | ARTHRO, LOOSE BODY + CHONDRO |
| G0293 | $0.00 | HCPCS / CPT® | NON-COV SURG PROC,CLIN TRIAL |
| G0294 | $0.00 | HCPCS / CPT® | NON-COV PROC, CLINICAL TRIAL |
| G0295 | $0.00 | HCPCS / CPT® | ELECTROMAGNETIC THERAPY ONC |
| G0296 | $0.00 | HCPCS / CPT® | VISIT TO DETERM LDCT ELIG |
| G0297 | $0.00 | HCPCS / CPT® | LDCT FOR LUNG CA SCREEN |
| G0299 | $0.00 | HCPCS / CPT® | HHS/HOSPICE OF RN EA 15 MIN |
| G0300 | $0.00 | HCPCS / CPT® | HHS/HOSPICE OF LPN EA 15 MIN |
| G0302 | $0.00 | HCPCS / CPT® | PRE-OP SERVICE LVRS COMPLETE |
| G0303 | $0.00 | HCPCS / CPT® | PRE-OP SERVICE LVRS 10-15DOS |
| G0304 | $0.00 | HCPCS / CPT® | PRE-OP SERVICE LVRS 1-9 DOS |
| G0305 | $0.00 | HCPCS / CPT® | POST OP SERVICE LVRS MIN 6 |
| G0306 | $0.00 | HCPCS / CPT® | CBC/DIFFWBC W/O PLATELET |
| G0307 | $0.00 | HCPCS / CPT® | CBC WITHOUT PLATELET |
| G0328 | $0.00 | HCPCS / CPT® | FECAL BLOOD SCRN IMMUNOASSAY |
| G0329 | $0.00 | HCPCS / CPT® | ELECTROMAGNTIC TX FOR ULCERS |
| G0333 | $0.00 | HCPCS / CPT® | DISPENSE FEE INITIAL 30 DAY |
| G0337 | $0.00 | HCPCS / CPT® | HOSPICE EVALUATION PREELECTI |
| G0339 | $0.00 | HCPCS / CPT® | ROBOT LIN-RADSURG COM, FIRST |
| G0340 | $0.00 | HCPCS / CPT® | ROBT LIN-RADSURG FRACTX 2-5 |
| G0341 | $0.00 | HCPCS / CPT® | PERCUTANEOUS ISLET CELLTRANS |
| G0342 | $0.00 | HCPCS / CPT® | LAPAROSCOPY ISLET CELL TRANS |
| G0343 | $0.00 | HCPCS / CPT® | LAPAROTOMY ISLET CELL TRANSP |
| G0364 | $0.00 | HCPCS / CPT® | BONE MARROW ASPIRATE &BIOPSY |
| G0365 | $0.00 | HCPCS / CPT® | VESSEL MAPPING HEMO ACCESS |
| G0372 | $0.00 | HCPCS / CPT® | MD SERVICE REQUIRED FOR PMD |
| G0378 | $1800.00 | HCPCS / CPT® | HOSPITAL OBSERVATION PER HR |
| G0379 | $1600.00 | HCPCS / CPT® | DIRECT REFERRAL TO OBSERVATION |
| G0380 | $0.00 | HCPCS / CPT® | LEV 1 HOSP TYPE B ED VISIT |
| G0381 | $0.00 | HCPCS / CPT® | LEV 2 HOSP TYPE B ED VISIT |
| G0382 | $0.00 | HCPCS / CPT® | LEV 3 HOSP TYPE B ED VISIT |
| G0383 | $0.00 | HCPCS / CPT® | LEV 4 HOSP TYPE B ED VISIT |
| G0384 | $0.00 | HCPCS / CPT® | LEV 5 HOSP TYPE B ED VISIT |
| G0390 | $0.00 | HCPCS / CPT® | TRAUMA RESPONS W/HOSP CRITI |
| G0396 | $0.00 | HCPCS / CPT® | ALCOHOL/SUBS INTERV 15-30MN |
| G0397 | $0.00 | HCPCS / CPT® | ALCOHOL/SUBS INTERV >30 MIN |
| G0398 | $0.00 | HCPCS / CPT® | HOME SLEEP TEST/TYPE 2 PORTA |
| G0399 | $0.00 | HCPCS / CPT® | HOME SLEEP TEST/TYPE 3 PORTA |
| G0400 | $0.00 | HCPCS / CPT® | HOME SLEEP TEST/TYPE 4 PORTA |
| G0402 | $0.00 | HCPCS / CPT® | INITIAL PREVENTIVE EXAM |
| G0403 | $0.00 | HCPCS / CPT® | EKG FOR INITIAL PREVENT EXAM |
| G0404 | $107.95 | HCPCS / CPT® | EKG TRACING FOR INITIAL PREV |
| G0405 | $0.00 | HCPCS / CPT® | EKG INTERPRET & REPORT PREVE |
| G0406 | $0.00 | HCPCS / CPT® | INPT/TELE FOLLOW UP 15 |
| G0407 | $0.00 | HCPCS / CPT® | INPT/TELE FOLLOW UP 25 |
| G0408 | $0.00 | HCPCS / CPT® | INPT/TELE FOLLOW UP 35 |
| G0409 | $0.00 | HCPCS / CPT® | CORF RELATED SERV 15 MINS EA |
| G0410 | $0.00 | HCPCS / CPT® | GRP PSYCH PARTIAL HOSP 45-50 |
| G0411 | $0.00 | HCPCS / CPT® | INTER ACTIVE GRP PSYCH PARTI |
| G0412 | $0.00 | HCPCS / CPT® | OPEN TX ILIAC SPINE UNI/BIL |
| G0413 | $0.00 | HCPCS / CPT® | PELVIC RING FRACTURE UNI/BIL |
| G0414 | $0.00 | HCPCS / CPT® | PELVIC RING FX TREAT INT FIX |
| G0415 | $0.00 | HCPCS / CPT® | OPEN TX POST PELVIC FXCTURE |
| G0416 | $0.00 | HCPCS / CPT® | PROSTATE BIOPSY, ANY MTHD |
| G0420 | $0.00 | HCPCS / CPT® | ED SVC CKD IND PER SESSION |
| G0421 | $0.00 | HCPCS / CPT® | ED SVC CKD GRP PER SESSION |
| G0422 | $0.00 | HCPCS / CPT® | INTENS CARDIAC REHAB W/EXERC |
| G0423 | $0.00 | HCPCS / CPT® | INTENS CARDIAC REHAB NO EXER |
| G0424 | $0.00 | HCPCS / CPT® | PULMONARY REHAB W EXER |
| G0425 | $0.00 | HCPCS / CPT® | INPT/ED TELECONSULT30 |
| G0426 | $0.00 | HCPCS / CPT® | INPT/ED TELECONSULT50 |
| G0427 | $0.00 | HCPCS / CPT® | INPT/ED TELECONSULT70 |
| G0428 | $0.00 | HCPCS / CPT® | COLLAGEN MENISCUS IMPLANT |
| G0429 | $0.00 | HCPCS / CPT® | DERMAL FILLER INJECTION(S) |
| G0431 | $366.13 | HCPCS / CPT® | UDS – URINE DRUG SCREEN QUAL 1 DRUG CLASS METH EA DRUG CLASS |
| G0432 | $0.00 | HCPCS / CPT® | EIA HIV-1/HIV-2 SCREEN |
| G0433 | $0.00 | HCPCS / CPT® | ELISA HIV-1/HIV-2 SCREEN |
| G0435 | $0.00 | HCPCS / CPT® | ORAL HIV-1/HIV-2 SCREEN |
| G0438 | $0.00 | HCPCS / CPT® | PPPS, INITIAL VISIT |
| G0439 | $0.00 | HCPCS / CPT® | PPPS, SUBSEQ VISIT |
| G0442 | $0.00 | HCPCS / CPT® | ANNUAL ALCOHOL SCREEN 15 MIN |
| G0443 | $0.00 | HCPCS / CPT® | BRIEF ALCOHOL MISUSE COUNSEL |
| G0444 | $0.00 | HCPCS / CPT® | DEPRESSION SCREEN ANNUAL |
| G0445 | $0.00 | HCPCS / CPT® | HIGH INTEN BEH COUNS STD 30M |
| G0446 | $0.00 | HCPCS / CPT® | INTENS BEHAVE THER CARDIO DX |
| G0447 | $0.00 | HCPCS / CPT® | BEHAVIOR COUNSEL OBESITY 15M |
| G0448 | $0.00 | HCPCS / CPT® | PLACE PERM PACING CARDIOVERT |
| G0451 | $0.00 | HCPCS / CPT® | DEVLOPMENT TEST INTERPT&REP |
| G0452 | $0.00 | HCPCS / CPT® | MOLECULAR PATHOLOGY INTERPR |
| G0453 | $0.00 | HCPCS / CPT® | CONT INTRAOP NEURO MONITOR |
| G0454 | $0.00 | HCPCS / CPT® | MD DOCUMENT VISIT BY NPP |
| G0455 | $0.00 | HCPCS / CPT® | FECAL MICROBIOTA PREP INSTIL |
| G0458 | $0.00 | HCPCS / CPT® | LDR PROSTATE BRACHY COMP RAT |
| G0459 | $0.00 | HCPCS / CPT® | TELEHEALTH INPT PHARM MGMT |
| G0460 | $0.00 | HCPCS / CPT® | AUTOLOGOUS PRP FOR ULCERS |
| G0463 | $0.00 | HCPCS / CPT® | HOSPITAL OUTPT CLINIC VISIT |
| G0466 | $0.00 | HCPCS / CPT® | FQHC VISIT NEW PATIENT |
| G0467 | $0.00 | HCPCS / CPT® | FQHC VISIT, ESTAB PT |
| G0468 | $0.00 | HCPCS / CPT® | FQHC VISIT, IPPE OR AWV |
| G0469 | $0.00 | HCPCS / CPT® | FQHC VISIT, MH NEW PT |
| G0470 | $0.00 | HCPCS / CPT® | FQHC VISIT, MH ESTAB PT |
| G0471 | $0.00 | HCPCS / CPT® | VEN BLOOD COLL SNF/HHA |
| G0472 | $0.00 | HCPCS / CPT® | HEP C SCREEN HIGH RISK/OTHER |
| G0473 | $0.00 | HCPCS / CPT® | GROUP BEHAVE COUNS 2-10 |
| G0475 | $0.00 | HCPCS / CPT® | HIV COMBINATION ASSAY |
| G0476 | $0.00 | HCPCS / CPT® | HPV COMBO ASSAY CA SCREEN |
| G0477 | $0.00 | HCPCS / CPT® | DRUG TEST PRESUMP OPTICAL |
| G0478 | $0.00 | HCPCS / CPT® | DRUG TEST PRESUMP OPT INST |
| G0479 | $366.13 | HCPCS / CPT® | UDS – URINE DRUG SCREEN QUAL 1 DRUG CLASS METH EA DRUG CLASS |
| G0480 | $264.80 | HCPCS / CPT® | Alcohol, Ethyl, Blood |
| G0481 | $0.00 | HCPCS / CPT® | DRUG TEST DEF 8-14 CLASSES |
| G0482 | $0.00 | HCPCS / CPT® | DRUG TEST DEF 15-21 CLASSES |
| G0483 | $0.00 | HCPCS / CPT® | DRUG TEST DEF 22+ CLASSES |
| G0490 | $0.00 | HCPCS / CPT® | HOME VISIT RN, LPN BY RHC/FQ |
| G0491 | $0.00 | HCPCS / CPT® | DIALYSIS ACU KIDNEY NO ESRD |
| G0492 | $0.00 | HCPCS / CPT® | MD/OTH EVAL ACUT KID NO ESRD |
| G0493 | $0.00 | HCPCS / CPT® | RN CARE EA 15 MIN HH/HOSPICE |
| G0494 | $0.00 | HCPCS / CPT® | LPN CARE EA 15MIN HH/HOSPICE |
| G0495 | $0.00 | HCPCS / CPT® | RN CARE TRAIN/EDU IN HH |
| G0496 | $0.00 | HCPCS / CPT® | LPN CARE TRAIN/EDU IN HH |
| G0498 | $0.00 | HCPCS / CPT® | CHEMO EXTEND IV INFUS W/PUMP |
| G0499 | $0.00 | HCPCS / CPT® | HEPB SCREEN HIGH RISK INDIV |
| G0500 | $0.00 | HCPCS / CPT® | MOD SEDAT ENDO SERVICE >5YRS |
| G0501 | $0.00 | HCPCS / CPT® | RESOURCE-INTEN SVC DURING OV |
| G0502 | $0.00 | HCPCS / CPT® | INIT PSYCH CARE MANAG, 70MIN |
| G0503 | $0.00 | HCPCS / CPT® | SUBSEQ PSYCH CARE MAN,60MI |
| G0504 | $0.00 | HCPCS / CPT® | INIT/SUB PSYCH CARE ADD 30 M |
| G0505 | $0.00 | HCPCS / CPT® | COG/FUNC ASSESSMENT OUTPT |
| G0506 | $0.00 | HCPCS / CPT® | COMP ASSES CARE PLAN CCM SVC |
| G0507 | $0.00 | HCPCS / CPT® | CARE MANAGE SERV MINIMUM 20 |
| G0508 | $0.00 | HCPCS / CPT® | CRIT CARE TELEHEA CONSULT 60 |
| G0509 | $0.00 | HCPCS / CPT® | CRIT CARE TELEHEA CONSULT 50 |
| G0913 | $0.00 | HCPCS / CPT® | IMPROVE VISUAL FUNCT |
| G0914 | $0.00 | HCPCS / CPT® | SURVEY NOT COMPLETE |
| G0915 | $0.00 | HCPCS / CPT® | NO IMPROVE VISUAL FUNCT |
| G0916 | $0.00 | HCPCS / CPT® | SATISFY WITH CARE |
| G0917 | $0.00 | HCPCS / CPT® | SATISFY SURVEY NOT COMPLETE |
| G0918 | $0.00 | HCPCS / CPT® | NO SATISFY WITH CARE |
| G6001 | $0.00 | HCPCS / CPT® | ECHO GUIDANCE RADIOTHERAPY |
| G6002 | $0.00 | HCPCS / CPT® | STEREOSCOPIC X-RAY GUIDANCE |
| G6003 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6004 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6005 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6006 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6007 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6008 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6009 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6010 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6011 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6012 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6013 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6014 | $0.00 | HCPCS / CPT® | RADIATION TREATMENT DELIVERY |
| G6015 | $0.00 | HCPCS / CPT® | RADIATION TX DELIVERY IMRT |
| G6016 | $0.00 | HCPCS / CPT® | DELIVERY COMP IMRT |
| G6017 | $0.00 | HCPCS / CPT® | INTRAFRACTION TRACK MOTION |
| G6038 | $126.72 | HCPCS / CPT® | SALICYLATE |
| G6039 | $258.83 | HCPCS / CPT® | ACETAMINOPHEN |
| G8395 | $0.00 | HCPCS / CPT® | LVEF>=40% DOC NORMAL OR MILD |
| G8396 | $0.00 | HCPCS / CPT® | LVEF NOT PERFORMED |
| G8397 | $0.00 | HCPCS / CPT® | DIL MACULA/FUNDUS EXAM/W DOC |
| G8398 | $0.00 | HCPCS / CPT® | DIL MACULAR/FUNDUS NOT PERFO |
| G8399 | $0.00 | HCPCS / CPT® | PT W/DXA RESULTS DOCUMENT |
| G8400 | $0.00 | HCPCS / CPT® | PT W/DXA NO RESULTS DOC |
| G8404 | $0.00 | HCPCS / CPT® | LOW EXTEMITY NEUR EXAM DOCUM |
| G8405 | $0.00 | HCPCS / CPT® | LOW EXTEMITY NEUR NOT PERFOR |
| G8410 | $0.00 | HCPCS / CPT® | EVAL ON FOOT DOCUMENTED |
| G8415 | $0.00 | HCPCS / CPT® | EVAL ON FOOT NOT PERFORMED |
| G8416 | $0.00 | HCPCS / CPT® | PT INELIG FOOTWEAR EVALUATIO |
| G8417 | $0.00 | HCPCS / CPT® | CALC BMI ABV UP PARAM F/U |
| G8418 | $0.00 | HCPCS / CPT® | CALC BMI BLW LOW PARAM F/U |
| G8419 | $0.00 | HCPCS / CPT® | CALC BMI OUT NRM PARAM NOF/U |
| G8420 | $0.00 | HCPCS / CPT® | CALC BMI NORM PARAMETERS |
| G8421 | $0.00 | HCPCS / CPT® | BMI NOT CALCULATED |
| G8422 | $0.00 | HCPCS / CPT® | PT INELIG BMI CALCULATION |
| G8427 | $0.00 | HCPCS / CPT® | DOCREV CUR MEDS BY ELIG CLIN |
| G8428 | $0.00 | HCPCS / CPT® | CUR MEDS NOT DOCUMENT |
| G8430 | $0.00 | HCPCS / CPT® | PT INELIG MED CHECK |
| G8431 | $0.00 | HCPCS / CPT® | POS CLIN DEPRES SCRN F/U DOC |
| G8432 | $0.00 | HCPCS / CPT® | DEP SCR NOT DOC, RNG |
| G8433 | $0.00 | HCPCS / CPT® | SCR DEP NOT DONE, DOC RSN |
| G8442 | $0.00 | HCPCS / CPT® | PT INELIG PAIN ASSESSMENT |
| G8450 | $0.00 | HCPCS / CPT® | BETA-BLOC RX PT W/ABN LVEF |
| G8451 | $0.00 | HCPCS / CPT® | PT W/ABN LVEF INELIG B-BLOC |
| G8452 | $0.00 | HCPCS / CPT® | PT W/ABN LVEF B-BLOC NO RX |
| G8465 | $0.00 | HCPCS / CPT® | HIGH RISK RECURRENCE PRO CA |
| G8473 | $0.00 | HCPCS / CPT® | ACE/ARB THXPY RX’D |
| G8474 | $0.00 | HCPCS / CPT® | ACE/ARB NOT RX’D; DOC REAS |
| G8475 | $0.00 | HCPCS / CPT® | ACE/ARB THXPY NOT RX’D |
| G8476 | $0.00 | HCPCS / CPT® | BP SYS <140 AND DIAS <90 |
| G8477 | $0.00 | HCPCS / CPT® | BP SYS>=140 AND/OR DIAS >=90 |
| G8478 | $0.00 | HCPCS / CPT® | BP NOT PERFORMED/DOC |
| G8482 | $0.00 | HCPCS / CPT® | FLU IMMUNIZE ORDER/ADMIN |
| G8483 | $0.00 | HCPCS / CPT® | FLU IMM NO ADMIN DOC REA |
| G8484 | $0.00 | HCPCS / CPT® | FLU IMMUNIZE NO ADMIN |
| G8506 | $0.00 | HCPCS / CPT® | PT REC ACE/ARB |
| G8509 | $0.00 | HCPCS / CPT® | POS PAIN ASSESS NO F/U DOC |
| G8510 | $0.00 | HCPCS / CPT® | SCR DEP NEG, NO PLAN REQD |
| G8511 | $0.00 | HCPCS / CPT® | SCR DEP POS, NO PLAN DOC RNG |
| G8535 | $0.00 | HCPCS / CPT® | PT INELIG NO ELD MAL SCRN |
| G8536 | $0.00 | HCPCS / CPT® | NO DOC ELDER MAL SCRN |
| G8539 | $0.00 | HCPCS / CPT® | DOC FUNCT AND CARE PLAN |
| G8540 | $0.00 | HCPCS / CPT® | PT INELIG FUNCT ASSESS |
| G8541 | $0.00 | HCPCS / CPT® | NO DOC CUR FUNCT ASSESS |
| G8542 | $0.00 | HCPCS / CPT® | DOC FUNCT NO DEFICIENCIES |
| G8543 | $0.00 | HCPCS / CPT® | CUR FUNCT ASSES; NO CARE PLN |
| G8559 | $0.00 | HCPCS / CPT® | PT REF DOC OTO EVAL |
| G8560 | $0.00 | HCPCS / CPT® | PT HX ACT DRAIN PREV 90 DAYS |
| G8561 | $0.00 | HCPCS / CPT® | PT INELIG FOR REF OTO EVAL |
| G8562 | $0.00 | HCPCS / CPT® | PT NO HX ACT DRAIN 90 D |
| G8563 | $0.00 | HCPCS / CPT® | PT NO REF OTO REAS NO SPEC |
| G8564 | $0.00 | HCPCS / CPT® | PT REF OTO EVAL |
| G8565 | $0.00 | HCPCS / CPT® | VER DOC HEAR LOSS |
| G8566 | $0.00 | HCPCS / CPT® | PT INELIG REF OTO EVAL |
| G8567 | $0.00 | HCPCS / CPT® | PT NO DOC HEAR LOSS |
| G8568 | $0.00 | HCPCS / CPT® | PT NO REF OTOLO NO SPEC |
| G8569 | $0.00 | HCPCS / CPT® | PROL INTUBATION REQ |
| G8570 | $0.00 | HCPCS / CPT® | NO PROL INTUB REQ |
| G8571 | $0.00 | HCPCS / CPT® | STER WD IFX 30 D POSTOP |
| G8572 | $0.00 | HCPCS / CPT® | NO STER WD IFX |
| G8573 | $0.00 | HCPCS / CPT® | STK CABG |
| G8574 | $0.00 | HCPCS / CPT® | NO STRK CABG |
| G8575 | $0.00 | HCPCS / CPT® | POSTOP REN FAIL |
| G8576 | $0.00 | HCPCS / CPT® | NO POSTOP REN FAIL |
| G8577 | $0.00 | HCPCS / CPT® | REOP REQ BLD GRFT OTH |
| G8578 | $0.00 | HCPCS / CPT® | NO REOP REQ BLD GRFT OTH |
| G8598 | $7.50 | HCPCS / CPT® | ASPIRIN OR ANOTHER ANTITHROMBOTIC THERAPY USED |
| G8599 | $0.00 | HCPCS / CPT® | NO ASA/ANTIPLAT THER USE RNG |
| G8600 | $0.00 | HCPCS / CPT® | TPA INITI W/IN 3 HRS |
| G8601 | $0.00 | HCPCS / CPT® | NO ELIG TPA INIT W/IN 3 HRS |
| G8602 | $0.00 | HCPCS / CPT® | NO TPA INIT W/IN 3 HRS |
| G8627 | $0.00 | HCPCS / CPT® | SURG PROC W/IN 30 DAYS |
| G8628 | $0.00 | HCPCS / CPT® | NO SURG PROC W/IN 30 DAYS |
| G8633 | $0.00 | HCPCS / CPT® | PHARM THER OSTEO RX |
| G8635 | $0.00 | HCPCS / CPT® | NO PHARM THER OSTEO RX |
| G8647 | $0.00 | HCPCS / CPT® | FUN STAT SCORE KNEE >= 0 |
| G8648 | $0.00 | HCPCS / CPT® | FUN STAT SCORE KNEE < 0 |
| G8649 | $0.00 | HCPCS / CPT® | RAFSCRS KNEE NO MSR, NO FOTO |
| G8650 | $0.00 | HCPCS / CPT® | FUN STAT SCORE KNEE NOT DONE |
| G8651 | $0.00 | HCPCS / CPT® | FUN STAT SCORE HIP >= 0 |
| G8652 | $0.00 | HCPCS / CPT® | FUN STAT SCORE HIP < 0 |
| G8653 | $0.00 | HCPCS / CPT® | RAFSCRS HIP, NO MSR, NO SURV |
| G8654 | $0.00 | HCPCS / CPT® | FUN STAT SCORE HIP NOT DONE |
| G8655 | $0.00 | HCPCS / CPT® | RAFSCRS FT ANK SCORE >=0 |
| G8656 | $0.00 | HCPCS / CPT® | RAFSCRS FT ANK SCORE < 0 |
| G8657 | $0.00 | HCPCS / CPT® | RAFSCRS FOOT, NO MSR/NO FOTO |
| G8658 | $0.00 | HCPCS / CPT® | RAFSCRS FOOT, NO MSR/NO SURV |
| G8659 | $0.00 | HCPCS / CPT® | RAFSCRS LUMB SCORE >= 0 |
| G8660 | $0.00 | HCPCS / CPT® | RAFSCRS LUMB SCORE < 0 |
| G8661 | $0.00 | HCPCS / CPT® | RAFSCRS LUM, NO MSR/NO FOTO |
| G8662 | $0.00 | HCPCS / CPT® | RAFSCRS LUM, NO MSR/NO SURV |
| G8663 | $0.00 | HCPCS / CPT® | FUN STAT SCORE SHDL >=0 |
| G8664 | $0.00 | HCPCS / CPT® | FUN STAT SCORE SHDL < 0 |
| G8665 | $0.00 | HCPCS / CPT® | RAFSCRS SHLDR, NO MSR/FOTO |
| G8666 | $0.00 | HCPCS / CPT® | FUN STAT SCORE SHDL NOT DONE |
| G8667 | $0.00 | HCPCS / CPT® | FUN STAT SCORE UE >=0 |
| G8668 | $0.00 | HCPCS / CPT® | FUN STAT SCORE UE < 0 |
| G8669 | $0.00 | HCPCS / CPT® | RAFSCRS HAND, NO MSR/SURV |
| G8670 | $0.00 | HCPCS / CPT® | FUN STAT SCORE UE NOT DONE |
| G8671 | $0.00 | HCPCS / CPT® | RAFSCRS NECK, SCORE >/=0 |
| G8672 | $0.00 | HCPCS / CPT® | RAFSCRS NECK, SCORE <0 |
| G8673 | $0.00 | HCPCS / CPT® | RAFSCRS NECK, NO MSR/NO FOTO |
| G8674 | $0.00 | HCPCS / CPT® | RAFSCRS NECK, NO MSR/NO FOTO |
| G8694 | $0.00 | HCPCS / CPT® | LVEF <40% |
| G8696 | $0.00 | HCPCS / CPT® | ANTITHROMB THX PRESC |
| G8697 | $0.00 | HCPCS / CPT® | ANTITHROMB NO PRESC DOC REAS |
| G8698 | $0.00 | HCPCS / CPT® | ANTITHROMB NO PRESC NO REAS |
| G8708 | $0.00 | HCPCS / CPT® | ANTIBIOTIC NOT PRES |
| G8709 | $0.00 | HCPCS / CPT® | MED REAS ANTIBIOTIC PRES |
| G8710 | $0.00 | HCPCS / CPT® | PT PRES ANTIBIOTIC |
| G8711 | $0.00 | HCPCS / CPT® | PRES ANTIBIOTIC |
| G8712 | $0.00 | HCPCS / CPT® | NOT PRES ANTIBIOTIC |
| G8721 | $0.00 | HCPCS / CPT® | PT, PN, HIST GRADE DOC |
| G8722 | $0.00 | HCPCS / CPT® | MED REAS PT, PN, NOT DOC |
| G8723 | $0.00 | HCPCS / CPT® | SPEC SIT NOT PRIM TUMOR |
| G8724 | $0.00 | HCPCS / CPT® | PT, PN, HIST GRADE NOT DOC |
| G8730 | $0.00 | HCPCS / CPT® | PAIN DOC POS AND PLAN |
| G8731 | $0.00 | HCPCS / CPT® | PAIN NEG NO PLAN |
| G8732 | $0.00 | HCPCS / CPT® | NO DOC OF PAIN |
| G8733 | $0.00 | HCPCS / CPT® | DOC POS ELDER MAL SCRN PLAN |
| G8734 | $0.00 | HCPCS / CPT® | DOC NEG ELDER MAL NO PLAN |
| G8735 | $0.00 | HCPCS / CPT® | ELD MAL SCRN POS NO PLAN |
| G8749 | $0.00 | HCPCS / CPT® | SIGNS OF MELANOMA ABSENT |
| G8752 | $0.00 | HCPCS / CPT® | SYS BP LESS 140 |
| G8753 | $0.00 | HCPCS / CPT® | SYS BP > OR = 140 |
| G8754 | $0.00 | HCPCS / CPT® | DIAS BP LESS 90 |
| G8755 | $0.00 | HCPCS / CPT® | DIAS BP > OR = 90 |
| G8756 | $0.00 | HCPCS / CPT® | NO BP MEASURE DOC |
| G8783 | $0.00 | HCPCS / CPT® | BP SCRN PERF REC INTERVAL |
| G8785 | $0.00 | HCPCS / CPT® | BP SCRN NO PERF AT INTERVAL |
| G8797 | $0.00 | HCPCS / CPT® | SPECIMEN SITE NOT ESOPHAGUS |
| G8798 | $0.00 | HCPCS / CPT® | SPECIMEN SITE NOT PROSTATE |
| G8806 | $0.00 | HCPCS / CPT® | TRANSAB OR TRANSVAG US |
| G8807 | $0.00 | HCPCS / CPT® | DOC REAS NO US |
| G8808 | $0.00 | HCPCS / CPT® | NO TRANSAB OR TRANSVAG US |
| G8809 | $0.00 | HCPCS / CPT® | RH-IMMUNOGLOBULIN ORDER |
| G8810 | $0.00 | HCPCS / CPT® | DOC REAS NO RH-IMMUNO |
| G8811 | $0.00 | HCPCS / CPT® | NO RH-IMMUNOGLOBULIN ORDER |
| G8815 | $0.00 | HCPCS / CPT® | DOC REAS NO STATIN THERAPY |
| G8816 | $0.00 | HCPCS / CPT® | STATIN MED PRES AT DISCH |
| G8817 | $0.00 | HCPCS / CPT® | DOC REAS NO STATIN MED DISCH |
| G8818 | $0.00 | HCPCS / CPT® | PT DISCH TO HOME BY DAY#7 |
| G8825 | $0.00 | HCPCS / CPT® | PT NOT DISCH TO HOME DAY#7 |
| G8826 | $0.00 | HCPCS / CPT® | PT DISCH HOME DAY #2 EVAR |
| G8833 | $0.00 | HCPCS / CPT® | PT NOT DISCH HOME DAY#2 EVAR |
| G8834 | $0.00 | HCPCS / CPT® | PT DISCH HOME DAY #2 CEA |
| G8838 | $0.00 | HCPCS / CPT® | NOT DISCH HOME BY DAY #2 |
| G8839 | $0.00 | HCPCS / CPT® | SLEEP APNEA ASSESS |
| G8840 | $0.00 | HCPCS / CPT® | DOC REAS NO SLEEP APNEA |
| G8841 | $0.00 | HCPCS / CPT® | NO SLEEP APNEA ASSESS |
| G8842 | $0.00 | HCPCS / CPT® | AHI OR RDI INITIAL DX |
| G8843 | $0.00 | HCPCS / CPT® | DOC REAS NO AHI OR RDI |
| G8844 | $0.00 | HCPCS / CPT® | NO AHI OR RDI INITIAL DX |
| G8845 | $0.00 | HCPCS / CPT® | POS AIRWAY PRESS PRESCRIBED |
| G8846 | $0.00 | HCPCS / CPT® | MOD OR SEVERE OSA |
| G8849 | $0.00 | HCPCS / CPT® | DOC REAS NO POS AIR PRESS |
| G8850 | $0.00 | HCPCS / CPT® | NO PAP PRESCRIBED |
| G8851 | $0.00 | HCPCS / CPT® | ADHERE POS AIR PRESS THERAPY |
| G8852 | $0.00 | HCPCS / CPT® | POS AIR PRESS PRESCRIBE |
| G8854 | $0.00 | HCPCS / CPT® | REAS NO ADHERE POS AIR PRES |
| G8855 | $0.00 | HCPCS / CPT® | POS AIR PRESS ADHERE NO PERF |
| G8856 | $0.00 | HCPCS / CPT® | REF FOR OTO EVAL |
| G8857 | $0.00 | HCPCS / CPT® | NO ELIG REF FOR OTO EVAL |
| G8858 | $0.00 | HCPCS / CPT® | NOT REF FOR OTO EVAL |
| G8861 | $0.00 | HCPCS / CPT® | DXA ORDERED FOR OSTEO |
| G8863 | $0.00 | HCPCS / CPT® | NO ASSESS BONE LOSS |
| G8864 | $0.00 | HCPCS / CPT® | PNEUMOCOCCAL VACCINE ADMIN |
| G8865 | $0.00 | HCPCS / CPT® | DOC MED REAS NO PNEUMOCOCCAL |
| G8866 | $0.00 | HCPCS / CPT® | DOC PT REAS NO PNEUMOCOCCAL |
| G8867 | $0.00 | HCPCS / CPT® | NO PNEUMOCOCCAL ADMIN |
| G8869 | $0.00 | HCPCS / CPT® | DOC IMMUN HEP B 1ST ANTITNF |
| G8872 | $0.00 | HCPCS / CPT® | INTRAOP IMAGE CONFIRM EXCISE |
| G8873 | $0.00 | HCPCS / CPT® | SPECIMEN NOT INTRAOP IMAGE |
| G8874 | $0.00 | HCPCS / CPT® | TISSUE NOT IMAGE INTRAOP |
| G8875 | $0.00 | HCPCS / CPT® | BREAST CANCER DX MIN INVSIVE |
| G8876 | $0.00 | HCPCS / CPT® | DOC REAS NO MIN INV DX |
| G8877 | $0.00 | HCPCS / CPT® | NO BRST CNCR DX MIN INVASIVE |
| G8878 | $0.00 | HCPCS / CPT® | SENT LYMPH NODE BIOPSY |
| G8879 | $0.00 | HCPCS / CPT® | NODE NEG INV BRST CNCR |
| G8880 | $0.00 | HCPCS / CPT® | DOC REAS NO LYMPH NODE BIOP |
| G8881 | $0.00 | HCPCS / CPT® | BRST CNCR STAGE > T1N0M0 |
| G8882 | $0.00 | HCPCS / CPT® | NO SENT LYMPH NODE BIOPSY |
| G8883 | $0.00 | HCPCS / CPT® | REV, COMM, TRACK, DOC BIOPSY |
| G8884 | $0.00 | HCPCS / CPT® | DOC REAS BIOPSY NOT REVIEW |
| G8885 | $0.00 | HCPCS / CPT® | NO REV, COMM, TRACK BIOPSY |
| G8895 | $9.90 | HCPCS / CPT® | ANTROM PRESCRIBE |
| G8907 | $0.00 | HCPCS / CPT® | PT DOC NO EVENTS ON DISCHARG |
| G8908 | $0.00 | HCPCS / CPT® | PT DOC W BURN PRIOR TO D/C |
| G8909 | $0.00 | HCPCS / CPT® | PT DOC NO BURN PRIOR TO D/C |
| G8910 | $0.00 | HCPCS / CPT® | PT DOC TO HAVE FALL IN ASC |
| G8911 | $0.00 | HCPCS / CPT® | PT DOC NO FALL IN ASC |
| G8912 | $0.00 | HCPCS / CPT® | PT DOC WITH WRONG EVENT |
| G8913 | $0.00 | HCPCS / CPT® | PT DOC NO WRONG EVENT |
| G8914 | $0.00 | HCPCS / CPT® | PT TRANS TO HOSP POST D/C |
| G8915 | $0.00 | HCPCS / CPT® | PT NOT TRANS TO HOSP AT D/C |
| G8916 | $0.00 | HCPCS / CPT® | PT W IV AB GIVEN ON TIME |
| G8917 | $0.00 | HCPCS / CPT® | PT W IV AB NOT GIVEN ON TIME |
| G8918 | $0.00 | HCPCS / CPT® | PT W/O PREOP ORDER IV AB PRO |
| G8923 | $0.00 | HCPCS / CPT® | LVEF < 40% OR LVSD |
| G8924 | $0.00 | HCPCS / CPT® | SPIR FEV1/FVC <70%,FEV <60% |
| G8925 | $0.00 | HCPCS / CPT® | SPIR FEV1/FVC>=60% & NO COPD |
| G8926 | $0.00 | HCPCS / CPT® | SPIRO NO PERF OR DOC |
| G8934 | $0.00 | HCPCS / CPT® | LVEF <40% OR DEP LV SYS FCN |
| G8935 | $0.00 | HCPCS / CPT® | RX ACE OR ARB THERAPY |
| G8936 | $0.00 | HCPCS / CPT® | PT NOT ELIGIBLE ACE/ARB |
| G8937 | $0.00 | HCPCS / CPT® | NO RX ACE/ARB THERAPY |
| G8938 | $0.00 | HCPCS / CPT® | BMI CALC, PT NO F/U PLAN ELG |
| G8939 | $0.00 | HCPCS / CPT® | PAIN ASSESS DOC, F/U NO DOC |
| G8941 | $0.00 | HCPCS / CPT® | NO DOC ELDER SCRN, PT NO EL |
| G8942 | $0.00 | HCPCS / CPT® | DOC FCN/CARE PLAN W/30 DAYS |
| G8944 | $0.00 | HCPCS / CPT® | AJCC MEL CNR STG 0 – IIC |
| G8946 | $0.00 | HCPCS / CPT® | MIBM BUT NO DX OF BREAST CA |
| G8947 | $0.00 | HCPCS / CPT® | 1 OR MORE NEUROPSYCH |
| G8950 | $0.00 | HCPCS / CPT® | PRE-HTN OR HTN DOC, F/U INDC |
| G8952 | $0.00 | HCPCS / CPT® | PRE-HTN/HTN, NO F/U, NOT GVN |
| G8955 | $0.00 | HCPCS / CPT® | MOST RECENT ASSESS VOL MGMT |
| G8956 | $0.00 | HCPCS / CPT® | PT RCV HEDIA OUTPT DYLS FAC |
| G8958 | $0.00 | HCPCS / CPT® | ASSESS VOL MGMT NOT DOC |
| G8959 | $0.00 | HCPCS / CPT® | CLIN TX MDD COMM TO TX CLIN |
| G8960 | $0.00 | HCPCS / CPT® | CLIN TX MDD NOT COMM |
| G8961 | $0.00 | HCPCS / CPT® | CSIT LOWRISK SURG PTS PREOP |
| G8962 | $0.00 | HCPCS / CPT® | CSIT ON PT ANY REAS 30 DAYS |
| G8963 | $0.00 | HCPCS / CPT® | CSI PER ASX PT W/PCI 2 YRS |
| G8964 | $0.00 | HCPCS / CPT® | CSI ANY OTHER THAN PCI 2 YR |
| G8965 | $0.00 | HCPCS / CPT® | CSIT PERF ON LOW CHD RSK |
| G8966 | $0.00 | HCPCS / CPT® | CSIT PERF SX OR HIGH CHD RSK |
| G8967 | $0.00 | HCPCS / CPT® | WRFRN OR ORAL ANTIGOAG PRES |
| G8968 | $0.00 | HCPCS / CPT® | DOC RSN NO WARF/ANTICOG PRES |
| G8969 | $0.00 | HCPCS / CPT® | PT RSN NO PRES WRFRN OR OTHR |
| G8970 | $0.00 | HCPCS / CPT® | NO RSK FAC OR 1 MOD RISK TE |
| G8971 | $0.00 | HCPCS / CPT® | WARFRN OR OTHR ANTCOG NO RX |
| G8972 | $0.00 | HCPCS / CPT® | 1>=RISK OR>= MOD RISK FOR TE |
| G8973 | $0.00 | HCPCS / CPT® | MST RCNT HBB < 10G/DL |
| G8974 | $0.00 | HCPCS / CPT® | HGB NOT DOC RNS NOT GVN |
| G8975 | $0.00 | HCPCS / CPT® | HGB <10G/DL, MED RSN |
| G8976 | $0.00 | HCPCS / CPT® | HGB >= 10 G/DL |
| G8978 | $0.00 | HCPCS / CPT® | MOBILITY CURRENT STATUS |
| G8979 | $0.00 | HCPCS / CPT® | MOBILITY GOAL STATUS |
| G8980 | $0.00 | HCPCS / CPT® | MOBILITY D/C STATUS |
| G8981 | $0.00 | HCPCS / CPT® | BODY POS CURRENT STATUS |
| G8982 | $0.00 | HCPCS / CPT® | BODY POS GOAL STATUS |
| G8983 | $0.00 | HCPCS / CPT® | BODY POS D/C STATUS |
| G8984 | $0.00 | HCPCS / CPT® | CARRY CURRENT STATUS |
| G8985 | $0.00 | HCPCS / CPT® | CARRY GOAL STATUS |
| G8986 | $0.00 | HCPCS / CPT® | CARRY D/C STATUS |
| G8987 | $0.00 | HCPCS / CPT® | SELF CARE CURRENT STATUS |
| G8988 | $0.00 | HCPCS / CPT® | SELF CARE GOAL STATUS |
| G8989 | $0.00 | HCPCS / CPT® | SELF CARE D/C STATUS |
| G8990 | $0.00 | HCPCS / CPT® | OTHER PT/OT CURRENT STATUS |
| G8991 | $0.00 | HCPCS / CPT® | OTHER PT/OT GOAL STATUS |
| G8992 | $0.00 | HCPCS / CPT® | OTHER PT/OT D/C STATUS |
| G8993 | $0.00 | HCPCS / CPT® | SUB PT/OT CURRENT STATUS |
| G8994 | $0.00 | HCPCS / CPT® | SUB PT/OT GOAL STATUS |
| G8995 | $0.00 | HCPCS / CPT® | SUB PT/OT D/C STATUS |
| G8996 | $0.00 | HCPCS / CPT® | SWALLOW CURRENT STATUS |
| G8997 | $0.00 | HCPCS / CPT® | SWALLOW GOAL STATUS |
| G8998 | $0.00 | HCPCS / CPT® | SWALLOW D/C STATUS |
| G8999 | $0.00 | HCPCS / CPT® | MOTOR SPEECH CURRENT STATUS |
| G9001 | $0.00 | HCPCS / CPT® | MCCD, INITIAL RATE |
| G9002 | $0.00 | HCPCS / CPT® | MCCD,MAINTENANCE RATE |
| G9003 | $0.00 | HCPCS / CPT® | MCCD, RISK ADJ HI, INITIAL |
| G9004 | $0.00 | HCPCS / CPT® | MCCD, RISK ADJ LO, INITIAL |
| G9005 | $0.00 | HCPCS / CPT® | MCCD, RISK ADJ, MAINTENANCE |
| G9006 | $0.00 | HCPCS / CPT® | MCCD, HOME MONITORING |
| G9007 | $0.00 | HCPCS / CPT® | MCCD, SCH TEAM CONF |
| G9008 | $0.00 | HCPCS / CPT® | MCCD,PHYS COOR-CARE OVRSGHT |
| G9009 | $0.00 | HCPCS / CPT® | MCCD, RISK ADJ, LEVEL 3 |
| G9010 | $0.00 | HCPCS / CPT® | MCCD, RISK ADJ, LEVEL 4 |
| G9011 | $0.00 | HCPCS / CPT® | MCCD, RISK ADJ, LEVEL 5 |
| G9012 | $0.00 | HCPCS / CPT® | OTHER SPECIFIED CASE MGMT |
| G9013 | $0.00 | HCPCS / CPT® | ESRD DEMO BUNDLE LEVEL I |
| G9014 | $0.00 | HCPCS / CPT® | ESRD DEMO BUNDLE-LEVEL II |
| G9016 | $0.00 | HCPCS / CPT® | DEMO-SMOKING CESSATION COUN |
| G9017 | $0.00 | HCPCS / CPT® | AMANTADINE HCL 100MG ORAL |
| G9018 | $0.00 | HCPCS / CPT® | ZANAMIVIR,INHALATION PWD 10M |
| G9019 | $0.00 | HCPCS / CPT® | OSELTAMIVIR PHOSPHATE 75MG |
| G9020 | $0.00 | HCPCS / CPT® | RIMANTADINE HCL 100MG ORAL |
| G9033 | $0.00 | HCPCS / CPT® | AMANTADINE HCL ORAL BRAND |
| G9034 | $0.00 | HCPCS / CPT® | ZANAMIVIR, INH PWDR, BRAND |
| G9035 | $0.00 | HCPCS / CPT® | OSELTAMIVIR PHOSP, BRAND |
| G9036 | $0.00 | HCPCS / CPT® | RIMANTADINE HCL, BRAND |
| G9050 | $0.00 | HCPCS / CPT® | ONCOLOGY WORK-UP EVALUATION |
| G9051 | $0.00 | HCPCS / CPT® | ONCOLOGY TX DECISION-MGMT |
| G9052 | $0.00 | HCPCS / CPT® | ONC SURVEILLANCE FOR DISEASE |
| G9053 | $0.00 | HCPCS / CPT® | ONC EXPECTANT MANAGEMENT PT |
| G9054 | $0.00 | HCPCS / CPT® | ONC SUPERVISION PALLIATIVE |
| G9055 | $0.00 | HCPCS / CPT® | ONC VISIT UNSPECIFIED NOS |
| G9056 | $0.00 | HCPCS / CPT® | ONC PRAC MGMT ADHERES GUIDE |
| G9057 | $0.00 | HCPCS / CPT® | ONC PRACT MGMT DIFFERS TRIAL |
| G9058 | $0.00 | HCPCS / CPT® | ONC PRAC MGMT DISAGREE W/GUI |
| G9059 | $0.00 | HCPCS / CPT® | ONC PRAC MGMT PT OPT ALTERNA |
| G9060 | $0.00 | HCPCS / CPT® | ONC PRAC MGMT DIF PT COMORB |
| G9061 | $0.00 | HCPCS / CPT® | ONC PRAC COND NOADD BY GUIDE |
| G9062 | $0.00 | HCPCS / CPT® | ONC PRAC GUIDE DIFFERS NOS |
| G9063 | $0.00 | HCPCS / CPT® | ONC DX NSCLC STGI NO PROGRES |
| G9064 | $0.00 | HCPCS / CPT® | ONC DX NSCLC STG2 NO PROGRES |
| G9065 | $0.00 | HCPCS / CPT® | ONC DX NSCLC STG3A NO PROGRE |
| G9066 | $0.00 | HCPCS / CPT® | ONC DX NSCLC STG3B-4 METASTA |
| G9067 | $0.00 | HCPCS / CPT® | ONC DX NSCLC DX UNKNOWN NOS |
| G9068 | $0.00 | HCPCS / CPT® | ONC DX SCLC/NSCLC LIMITED |
| G9069 | $0.00 | HCPCS / CPT® | ONC DX SCLC/NSCLC EXT AT DX |
| G9070 | $0.00 | HCPCS / CPT® | ONC DX SCLC/NSCLC EXT UNKNWN |
| G9071 | $0.00 | HCPCS / CPT® | ONC DX BRST STG1-2B HR,NOPRO |
| G9072 | $0.00 | HCPCS / CPT® | ONC DX BRST STG1-2 NOPROGRES |
| G9073 | $0.00 | HCPCS / CPT® | ONC DX BRST STG3-HR, NO PRO |
| G9074 | $0.00 | HCPCS / CPT® | ONC DX BRST STG3-NOPROGRESS |
| G9075 | $0.00 | HCPCS / CPT® | ONC DX BRST METASTIC/ RECUR |
| G9077 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE T1NO PROGRES |
| G9078 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE T2NO PROGRES |
| G9079 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE T3B-T4NOPROG |
| G9080 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE W/RISE PSA |
| G9083 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE UNKNWN NOS |
| G9084 | $0.00 | HCPCS / CPT® | ONC DX COLON T1-3,N1-2,NO PR |
| G9085 | $0.00 | HCPCS / CPT® | ONC DX COLON T4, N0 W/O PROG |
| G9086 | $0.00 | HCPCS / CPT® | ONC DX COLON T1-4 NO DX PROG |
| G9087 | $0.00 | HCPCS / CPT® | ONC DX COLON METAS EVID DX |
| G9088 | $0.00 | HCPCS / CPT® | ONC DX COLON METAS NOEVID DX |
| G9089 | $0.00 | HCPCS / CPT® | ONC DX COLON EXTENT UNKNOWN |
| G9090 | $0.00 | HCPCS / CPT® | ONC DX RECTAL T1-2 NO PROGR |
| G9091 | $0.00 | HCPCS / CPT® | ONC DX RECTAL T3 N0 NO PROG |
| G9092 | $0.00 | HCPCS / CPT® | ONC DX RECTAL T1-3,N1-2NOPRG |
| G9093 | $0.00 | HCPCS / CPT® | ONC DX RECTAL T4,N,M0 NO PRG |
| G9094 | $0.00 | HCPCS / CPT® | ONC DX RECTAL M1 W/METS PROG |
| G9095 | $0.00 | HCPCS / CPT® | ONC DX RECTAL EXTENT UNKNWN |
| G9096 | $0.00 | HCPCS / CPT® | ONC DX ESOPHAG T1-T3 NOPROG |
| G9097 | $0.00 | HCPCS / CPT® | ONC DX ESOPHAGEAL T4 NO PROG |
| G9098 | $0.00 | HCPCS / CPT® | ONC DX ESOPHAGEAL METS RECUR |
| G9099 | $0.00 | HCPCS / CPT® | ONC DX ESOPHAGEAL UNKNOWN |
| G9100 | $0.00 | HCPCS / CPT® | ONC DX GASTRIC NO RECURRENCE |
| G9101 | $0.00 | HCPCS / CPT® | ONC DX GASTRIC P R1-R2NOPROG |
| G9102 | $0.00 | HCPCS / CPT® | ONC DX GASTRIC UNRESECTABLE |
| G9103 | $0.00 | HCPCS / CPT® | ONC DX GASTRIC RECURRENT |
| G9104 | $0.00 | HCPCS / CPT® | ONC DX GASTRIC UNKNOWN NOS |
| G9105 | $0.00 | HCPCS / CPT® | ONC DX PANCREATC P R0 RES NO |
| G9106 | $0.00 | HCPCS / CPT® | ONC DX PANCREATC P R1/R2 NO |
| G9107 | $0.00 | HCPCS / CPT® | ONC DX PANCREATIC UNRESECTAB |
| G9108 | $0.00 | HCPCS / CPT® | ONC DX PANCREATIC UNKNWN NOS |
| G9109 | $0.00 | HCPCS / CPT® | ONC DX HEAD/NECK T1-T2NO PRG |
| G9110 | $0.00 | HCPCS / CPT® | ONC DX HEAD/NECK T3-4 NOPROG |
| G9111 | $0.00 | HCPCS / CPT® | ONC DX HEAD/NECK M1 METS REC |
| G9112 | $0.00 | HCPCS / CPT® | ONC DX HEAD/NECK EXT UNKNOWN |
| G9113 | $0.00 | HCPCS / CPT® | ONC DX OVARIAN STG1A-B NO PR |
| G9114 | $0.00 | HCPCS / CPT® | ONC DX OVARIAN STG1A-B OR 2 |
| G9115 | $0.00 | HCPCS / CPT® | ONC DX OVARIAN STG3/4 NOPROG |
| G9116 | $0.00 | HCPCS / CPT® | ONC DX OVARIAN RECURRENCE |
| G9117 | $0.00 | HCPCS / CPT® | ONC DX OVARIAN UNKNOWN NOS |
| G9123 | $0.00 | HCPCS / CPT® | ONC DX CML CHRONIC PHASE |
| G9124 | $0.00 | HCPCS / CPT® | ONC DX CML ACCELER PHASE |
| G9125 | $0.00 | HCPCS / CPT® | ONC DX CML BLAST PHASE |
| G9126 | $0.00 | HCPCS / CPT® | ONC DX CML REMISSION |
| G9128 | $0.00 | HCPCS / CPT® | ONC DX MULTI MYELOMA STAGE I |
| G9129 | $0.00 | HCPCS / CPT® | ONC DX MULT MYELOMA STG2 HIG |
| G9130 | $0.00 | HCPCS / CPT® | ONC DX MULTI MYELOMA UNKNOWN |
| G9131 | $0.00 | HCPCS / CPT® | ONC DX BRST UNKNOWN NOS |
| G9132 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE METS NO CAST |
| G9133 | $0.00 | HCPCS / CPT® | ONC DX PROSTATE CLINICAL MET |
| G9134 | $0.00 | HCPCS / CPT® | ONC NHLSTG 1-2 NO RELAP NO |
| G9135 | $0.00 | HCPCS / CPT® | ONC DX NHL STG 3-4 NOT RELAP |
| G9136 | $0.00 | HCPCS / CPT® | ONC DX NHL TRANS TO LG BCELL |
| G9137 | $0.00 | HCPCS / CPT® | ONC DX NHL RELAPSE/REFRACTOR |
| G9138 | $0.00 | HCPCS / CPT® | ONC DX NHL STG UNKNOWN |
| G9139 | $0.00 | HCPCS / CPT® | ONC DX CML DX STATUS UNKNOWN |
| G9140 | $0.00 | HCPCS / CPT® | FRONTIER EXTENDED STAY DEMO |
| G9143 | $0.00 | HCPCS / CPT® | WARFARIN RESPON GENETIC TEST |
| G9147 | $0.00 | HCPCS / CPT® | OUTPT IV INSULIN TX ANY MEA |
| G9148 | $0.00 | HCPCS / CPT® | MEDICAL HOME LEVEL 1 |
| G9149 | $0.00 | HCPCS / CPT® | MEDICAL HOME LEVEL II |
| G9150 | $0.00 | HCPCS / CPT® | MEDICAL HOME LEVEL III |
| G9151 | $0.00 | HCPCS / CPT® | MAPCP DEMO STATE |
| G9152 | $0.00 | HCPCS / CPT® | MAPCP DEMO COMMUNITY |
| G9153 | $0.00 | HCPCS / CPT® | MAPCP DEMO PHYSICIAN |
| G9156 | $0.00 | HCPCS / CPT® | EVALUATION FOR WHEELCHAIR |
| G9157 | $0.00 | HCPCS / CPT® | TRANSESOPH DOPPL CARDIAC MON |
| G9158 | $0.00 | HCPCS / CPT® | MOTOR SPEECH D/C STATUS |
| G9159 | $0.00 | HCPCS / CPT® | LANG COMP CURRENT STATUS |
| G9160 | $0.00 | HCPCS / CPT® | LANG COMP GOAL STATUS |
| G9161 | $0.00 | HCPCS / CPT® | LANG COMP D/C STATUS |
| G9162 | $0.00 | HCPCS / CPT® | LANG EXPRESS CURRENT STATUS |
| G9163 | $0.00 | HCPCS / CPT® | LANG EXPRESS GOAL STATUS |
| G9164 | $0.00 | HCPCS / CPT® | LANG EXPRESS D/C STATUS |
| G9165 | $0.00 | HCPCS / CPT® | ATTEN CURRENT STATUS |
| G9166 | $0.00 | HCPCS / CPT® | ATTEN GOAL STATUS |
| G9167 | $0.00 | HCPCS / CPT® | ATTEN D/C STATUS |
| G9168 | $0.00 | HCPCS / CPT® | MEMORY CURRENT STATUS |
| G9169 | $0.00 | HCPCS / CPT® | MEMORY GOAL STATUS |
| G9170 | $0.00 | HCPCS / CPT® | MEMORY D/C STATUS |
| G9171 | $0.00 | HCPCS / CPT® | VOICE CURRENT STATUS |
| G9172 | $0.00 | HCPCS / CPT® | VOICE GOAL STATUS |
| G9173 | $0.00 | HCPCS / CPT® | VOICE D/C STATUS |
| G9174 | $0.00 | HCPCS / CPT® | SPEECH LANG CURRENT STATUS |
| G9175 | $0.00 | HCPCS / CPT® | SPEECH LANG GOAL STATUS |
| G9176 | $0.00 | HCPCS / CPT® | SPEECH LANG D/C STATUS |
| G9186 | $0.00 | HCPCS / CPT® | MOTOR SPEECH GOAL STATUS |
| G9187 | $0.00 | HCPCS / CPT® | BPCI HOME VISIT |
| G9188 | $0.00 | HCPCS / CPT® | BETA NOT GIVEN NO REASON |
| G9189 | $0.00 | HCPCS / CPT® | BETA PRES OR ALREADY TAKING |
| G9190 | $0.00 | HCPCS / CPT® | MEDICAL REASON FOR NO BETA |
| G9191 | $0.00 | HCPCS / CPT® | PT REASON FOR NO BETA |
| G9192 | $0.00 | HCPCS / CPT® | SYSTEM REASON FOR NO BETA |
| G9196 | $0.00 | HCPCS / CPT® | MED REASON FOR NO CEPH |
| G9197 | $0.00 | HCPCS / CPT® | ORDER FOR CEPH |
| G9198 | $0.00 | HCPCS / CPT® | NO ORDER FOR CEPH NO REASON |
| G9212 | $0.00 | HCPCS / CPT® | DOC OF DSM-IV INIT EVAL |
| G9213 | $0.00 | HCPCS / CPT® | NO DOC OF DSM-IV |
| G9223 | $0.00 | HCPCS / CPT® | PJP PROPH ORDERED CD4 LOW |
| G9225 | $0.00 | HCPCS / CPT® | NORSN NO FOOT EXAM |
| G9226 | $0.00 | HCPCS / CPT® | 3 COMP FOOT EXAM COMPLETED |
| G9227 | $0.00 | HCPCS / CPT® | DOCRSN NO CARE PLAN |
| G9228 | $0.00 | HCPCS / CPT® | GC CHL SYP DOCUMENTED |
| G9229 | $0.00 | HCPCS / CPT® | PTRSN NO GC CHL SYP TEST |
| G9230 | $0.00 | HCPCS / CPT® | NORSN FOR GC CHL SYP TEST |
| G9231 | $0.00 | HCPCS / CPT® | DOC ESRD DIA TRANS PREG |
| G9232 | $0.00 | HCPCS / CPT® | PTRSN NO COMM COMORBID |
| G9239 | $0.00 | HCPCS / CPT® | DOC RSN HEMOD & CATH ACC |
| G9240 | $0.00 | HCPCS / CPT® | DOC PT W CATH MAINT DIA |
| G9241 | $0.00 | HCPCS / CPT® | DOC PT W OUT CATH MAINT DIA |
| G9242 | $0.00 | HCPCS / CPT® | DOC VIRAL LOAD >=200 |
| G9243 | $0.00 | HCPCS / CPT® | DOC VIRAL LOAD <200 |
| G9246 | $0.00 | HCPCS / CPT® | NO MED VISIT IN 24MO |
| G9247 | $0.00 | HCPCS / CPT® | 1 MED VISIT IN 24MO |
| G9250 | $0.00 | HCPCS / CPT® | DOC OF PAIN COMFORT 48HR |
| G9251 | $0.00 | HCPCS / CPT® | DOC NO PAIN COMFORT 48HR |
| G9254 | $0.00 | HCPCS / CPT® | DOC PT DISCHG >2D |
| G9255 | $0.00 | HCPCS / CPT® | DOC PT DISCHG <=2D |
| G9256 | $0.00 | HCPCS / CPT® | DOC DEATH AFTER CAS |
| G9257 | $0.00 | HCPCS / CPT® | DOC STROKE AFTER CAS |
| G9258 | $0.00 | HCPCS / CPT® | DOC STROKE AFTER CEA |
| G9259 | $0.00 | HCPCS / CPT® | DOC SURV NO STROKE AFTER CAS |
| G9260 | $0.00 | HCPCS / CPT® | DOC DEATH AFTER CEA |
| G9261 | $0.00 | HCPCS / CPT® | DOC SURV NO STROKE AFTER CEA |
| G9262 | $0.00 | HCPCS / CPT® | DOC DEATH IN HOSP AAA REPAIR |
| G9263 | $0.00 | HCPCS / CPT® | DOC SURV IN HOSP AAA REPAIR |
| G9264 | $0.00 | HCPCS / CPT® | DOC RSN HEMOD W/CATH >=90D |
| G9265 | $0.00 | HCPCS / CPT® | DOC CATH >90D FOR MAINT DIA |
| G9266 | $0.00 | HCPCS / CPT® | NORSN PT CATH >=90D |
| G9267 | $0.00 | HCPCS / CPT® | DOC COMP OR MORT W IN 30D |
| G9268 | $0.00 | HCPCS / CPT® | DOC COMP OR MORT W IN 90D |
| G9269 | $0.00 | HCPCS / CPT® | DOC NO COMP OR MORT W IN 30D |
| G9270 | $0.00 | HCPCS / CPT® | DOC NO COMP OR MORT W IN 90D |
| G9273 | $0.00 | HCPCS / CPT® | SYS <140 AND DIA <90 |
| G9274 | $0.00 | HCPCS / CPT® | BP OUT OF NRML LIMITS |
| G9275 | $0.00 | HCPCS / CPT® | DOC OF NON TOBACCO USER |
| G9276 | $0.00 | HCPCS / CPT® | DOC OF TOBACCO USER |
| G9277 | $0.00 | HCPCS / CPT® | DOC DAILY ASPIRIN OR CONTRA |
| G9278 | $0.00 | HCPCS / CPT® | DOC NO DAILY ASPIRIN |
| G9279 | $0.00 | HCPCS / CPT® | PNE SCRN DONE DOC VAC DONE |
| G9280 | $0.00 | HCPCS / CPT® | PNE NOT GIVEN NORSN |
| G9281 | $0.00 | HCPCS / CPT® | PNE SCRN DONE DOC NOT IND |
| G9282 | $0.00 | HCPCS / CPT® | DOC MEDRSN NO HISTO TYPE |
| G9283 | $0.00 | HCPCS / CPT® | HIST TYPE DOC ON REPORT |
| G9284 | $0.00 | HCPCS / CPT® | NO HIST TYPE DOC ON REPORT |
| G9285 | $0.00 | HCPCS / CPT® | SITE NOT SMALL CELL LUNG CA |
| G9286 | $0.00 | HCPCS / CPT® | ANTIBIO RX W IN 10D OF SYMPT |
| G9287 | $0.00 | HCPCS / CPT® | NO ANTIBIO W IN 10D OF SYMPT |
| G9288 | $0.00 | HCPCS / CPT® | DOC MEDRSN NO HIST TYPE RPT |
| G9289 | $0.00 | HCPCS / CPT® | DOC TYPE NSM LUNG CA |
| G9290 | $0.00 | HCPCS / CPT® | NO DOC TYPE NSM LUNG CA |
| G9291 | $0.00 | HCPCS / CPT® | NOT NSM LUNG CA |
| G9292 | $0.00 | HCPCS / CPT® | MEDRSN NO PT CATEGORY |
| G9293 | $0.00 | HCPCS / CPT® | NO PT CATEGORY ON REPORT |
| G9294 | $0.00 | HCPCS / CPT® | PT CAT AND THCK ON REPORT |
| G9295 | $0.00 | HCPCS / CPT® | NON CUTANEOUS LOC |
| G9296 | $0.00 | HCPCS / CPT® | DOC SHARE DEC PRIOR PROC |
| G9297 | $0.00 | HCPCS / CPT® | NO DOC SHARE DEC PRIOR PROC |
| G9298 | $0.00 | HCPCS / CPT® | EVAL RISK VTE CARD 30D PRIOR |
| G9299 | $0.00 | HCPCS / CPT® | NO EVAL RISKK VTE CARD PRIOR |
| G9300 | $0.00 | HCPCS / CPT® | DOC MEDRSN NO COMPL ANTIBIO |
| G9301 | $0.00 | HCPCS / CPT® | DOC COMPL INF ANTIBIO |
| G9302 | $0.00 | HCPCS / CPT® | NORSN INCOMP INF ANTIBIO |
| G9303 | $0.00 | HCPCS / CPT® | NORSN NO PROS INFO OP RPT |
| G9304 | $0.00 | HCPCS / CPT® | PROS INFO OP RPT |
| G9305 | $0.00 | HCPCS / CPT® | NO INTERV REQ FOR LEAK |
| G9306 | $0.00 | HCPCS / CPT® | INTERV REQ FOR LEAK |
| G9307 | $0.00 | HCPCS / CPT® | NO RET FOR SURG W IN 30D |
| G9308 | $0.00 | HCPCS / CPT® | UNPL RET OR W/COMPL W/IN 30D |
| G9309 | $0.00 | HCPCS / CPT® | NO UNPLND HOSP READM IN 30D |
| G9310 | $0.00 | HCPCS / CPT® | UNPLND HOSP READM IN 30D |
| G9311 | $0.00 | HCPCS / CPT® | NO SURG SITE INFECTION |
| G9312 | $0.00 | HCPCS / CPT® | SURGICAL SITE INFECTION |
| G9313 | $0.00 | HCPCS / CPT® | DOCRSN NOT FIRST LINE AMOX |
| G9314 | $0.00 | HCPCS / CPT® | NORSN NOT FIRST LINE AMOX |
| G9315 | $0.00 | HCPCS / CPT® | DOC FIRST LINE AMOX |
| G9316 | $0.00 | HCPCS / CPT® | DOC COMM RISK CALC |
| G9317 | $0.00 | HCPCS / CPT® | NO DOC COMM RISK CALC |
| G9318 | $0.00 | HCPCS / CPT® | IMAGE STD NOMENCLATURE |
| G9319 | $0.00 | HCPCS / CPT® | IMAGE NOT STD NOMENCLATURE |
| G9321 | $0.00 | HCPCS / CPT® | DOC COUNT OF CT IN 12MO |
| G9322 | $0.00 | HCPCS / CPT® | NO DOC COUNT OF CT IN 12MO |
| G9326 | $0.00 | HCPCS / CPT® | CT DONE NO RAD DS INDEX, NRG |
| G9327 | $0.00 | HCPCS / CPT® | CT DONE RAD DS INDEX |
| G9329 | $0.00 | HCPCS / CPT® | NORSN NO DICOM FORMAT DOC |
| G9340 | $0.00 | HCPCS / CPT® | DICOM FORMAT DOC ON RPT |
| G9341 | $0.00 | HCPCS / CPT® | SRCH FOR CT W IN 12 MOS |
| G9342 | $0.00 | HCPCS / CPT® | NO SRCH FOR CT IN 12MO NORSN |
| G9344 | $0.00 | HCPCS / CPT® | SYSRSN NO DICOM SRCH |
| G9345 | $0.00 | HCPCS / CPT® | FOLLOW UP PULM NOD |
| G9347 | $0.00 | HCPCS / CPT® | NO FOLLOW UP PULM NOD NORSN |
| G9348 | $0.00 | HCPCS / CPT® | DOCRSN NO SINUS CT DX |
| G9349 | $0.00 | HCPCS / CPT® | DOC SINUS CT 28D |
| G9350 | $0.00 | HCPCS / CPT® | NO DOC SINUS CT 28D OR DX |
| G9351 | $0.00 | HCPCS / CPT® | DOC >1 SINUS CT W 90D DX |
| G9352 | $0.00 | HCPCS / CPT® | NOT >1 SINUS CT W 90D DX |
| G9353 | $0.00 | HCPCS / CPT® | MEDRSN >1 SINUS CT W 90D DX |
| G9354 | $0.00 | HCPCS / CPT® | 1 OR NO CT SINUS W/IN 90D DX |
| G9355 | $0.00 | HCPCS / CPT® | NO EARLY IND/DELIVERY |
| G9356 | $0.00 | HCPCS / CPT® | EARLY IND/DELIVERY |
| G9357 | $0.00 | HCPCS / CPT® | PP EVAL/EDU PERF |
| G9358 | $0.00 | HCPCS / CPT® | PP EVAL/EDU NOT PERF |
| G9359 | $0.00 | HCPCS / CPT® | DOC OF NEG OR MAN POS TB SCN |
| G9360 | $0.00 | HCPCS / CPT® | NO DOC OF NEG OR MAN POS TB |
| G9361 | $0.00 | HCPCS / CPT® | DOC RSN ELECT C-SEC/INDUCT |
| G9364 | $0.00 | HCPCS / CPT® | SINUS CAUS BAC INX |
| G9365 | $0.00 | HCPCS / CPT® | 1HIGH RISK MED ORD |
| G9366 | $0.00 | HCPCS / CPT® | 1HIGH RISK NO ORD |
| G9367 | $0.00 | HCPCS / CPT® | 2HIGH RISK MED ORD |
| G9368 | $0.00 | HCPCS / CPT® | 2HIGH RISK NO ORD |
| G9380 | $0.00 | HCPCS / CPT® | OFF ASSIS EOL ISS |
| G9381 | $0.00 | HCPCS / CPT® | DOC MED REAS NO OFFER EOL |
| G9382 | $0.00 | HCPCS / CPT® | NO OFF ASSIS EOL |
| G9383 | $0.00 | HCPCS / CPT® | RECD SCRN HCV INFEC |
| G9384 | $0.00 | HCPCS / CPT® | DOC MED REAS |
©2025 Memorial Heights Emergency Center. All Rights Reserved.