"Code|Code Description|Aetna HMO|Cigna HMO|United Health Care|Humana |Anthem Blue Cross HMO ||"
"216|CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC|255016.46|377885.56|142473.80|229433.29|217839.94||"
"460|SPINAL FUSION EXCEPT CERVICAL W/O MCC |96114.98|142423.99|53697.97|86472.76|76841.65||"
"470|MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|49443.55|73265.87|27623.36|44483.39|43327.15||"
"473|CERVICAL SPINAL FUSION W/O CC/MCC|64654.73|95805.92|36121.61|58168.58|41305.06||"
"743|UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|30532.71|45243.63|17058.16|27469.68|18207.46||"
"19120|""Removal of 1 or more breast growth| open procedure""|5506|4097|5202|3579|6809.86||"
"29826|Shaving of shoulder bone using an endoscope |5506|4097|851|3579|7039.05||"
"29881|Removal of one knee cartilage using an endoscope |6056|4780|5793|4249|7039.05||"
"42820|Removal of tonsils and adenoid glands patient younger than age 12 |5506|4097|5202|3579|12794.31||"
"43235|""Diagnostic examination of esophagus| stomach| and/or upper small bowel using an endoscope ""|3214|2497|2133|2181|2179.14||"
"43239|""Biopsy of the esophagus| stomach| and/or upper small bowel using an endoscope""|4468|3337|2133|2914|2179.14||"
"45378|Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk |4468|3337|2133|2914|2197.09||"
"45380|Biopsy of the large bowel using an endoscope (colonoscopy) |4468|3337|2133|2914|2836.82||"
"45385|Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare |4468|3337|2133|2914|2836.82||"
"45391|Ultrasound examination of large bowel using a flexible endoscope|4468|3337|2133|2914|2836.82||"
"47562|Removal of gallbladder using an endoscope|6408|17511|13851|3824|12537.76||"
"49505|Repair of groin hernia patient age 5 years or older|6056|4780|5793|4249|7515.84||"
"55700|Biopsy of prostate gland|4468|3337|2133|2914|4309.26||"
"55866|Surgical removal of prostate and surrounding lymph nodes using an endoscope |6408|6037|13851|3824|24745.48||"
"59025|Fetal test|4799|6037|851|2181|479.02||"
"59400|Obstetrical pre- and postpartum care and vaginal delivery |4627|4282.61|5277.51|5651.38|4399.25||"
"59510|Cesarean delivery with pre- and post-delivery care|4822|4754.18|5852.91|6273.66|4852.09||"
"59610|Routine obstetric care with vaginal delivery after prior cesarean delivery |4714|4508.46|5552.71|5949.4|4594.27||"
"62322|Injection of substance into spinal canal of lower back or sacrum|3214|2497|2984|3824|2191.12||"
"62323|Injection of substance into spinal canal of lower back or sacrum using imaging guidance|3214|2497|2984|3824|1662.42||"
"64447|Injection of anesthetic agent and/or steroid into thigh nerve (femoral nerve)|4799|2497|2984|3824|1662.42||"
"64450|Injection of anesthetic agent and/or steroid into other nerve or branch|3214|2497|2984|2181|1662.42||"
"64483|""Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance| single level""|3214|2497|2984|2181|2191.12||"
"64488|Injection of local anesthetic for abdominal wall pain control on both sides using imaging guidance|4468|2497|851|3824|714.16||"
"66821|Removal of recurring cataract in lens capsule using laser|4468|3337|2984|2914|1397.33||"
"66984|""Removal of cataract with insertion of lens| simple ""|6408|7822|5202|6828|5485.56||"
"70450|CT scan head or brain|524.00|168.32|376.71|499.00|264.31||"
"70486|CT scan of face|524.00|221.42|376.71|499.00|264.31||"
"70491|CT scan of neck with contrast|524.00|381.56|545.05|499.00|441.67||"
"70496|CT scan of blood vessel of head with contrast|524.00|472.27|646.10|499.00|441.67||"
"70498|CT scan of blood vessels of neck with contrast|524.00|470.63|646.10|499.00|441.67||"
"70551|MRI scan brain|789.00|360.33|674.78|763.00|589.05||"
"70553|MRI scan of brain before and after contrast|789.00|603.81|""1|031.73""|763.00|924.50||"
"71045|""X-ray of chest| 1 view""|46.12|24.56|122.00|552.30|218.46||"
"71046|""X-ray of chest| 2 views""|84.42|44.96|122.00|386.40|218.46||"
"71101|""X-ray of ribs on side of body| minimum of 3 views""|119.35|52.31|87.00|41.93|264.31||"
"71250|CT scan chest|524.00|297.41|376.71|499.00|264.31||"
"71260|CT scan chest with contrast|524.00|384.01|545.05|499.00|441.67||"
"71271|Low dose CT scan of chest for lung cancer screening|524.00|72.33|158.91|499.00|264.31||"
"71275|CT scan of blood vessels of chest with contrast|524.00|480.44|646.10|499.00|441.67||"
"72040|""X-ray of spine of neck| 2 or 3 views""|109.02|49.85|87.00|89.36|218.43||"
"72050|""X-ray of upper spine| 4 or 5 views""|147.36|67.82|144.75|51.77|264.31||"
"72070|""X-ray of middle spine| 2 views""|103.13|52.31|87.00|36.23|264.31||"
"72100|""X-ray of lower and sacral spine| 2 or 3 views""|47.36|54.76|87.00|38.81|264.31||"
"72110|""X-ray of lower and sacral spine| minimum of 4 views""|64.42|76.00|144.75|52.80|264.31||"
"72125|CT scan of upper spine|524.00|301.49|376.71|499.00|264.31||"
"72128|CT scan of middle spine without contrast|524.00|299.86|376.71|499.00|264.31||"
"72131|CT scan of lower spine|524.00|298.22|376.71|499.00|264.31||"
"72141|MRI scan of upper spinal canal|789.00|344.80|674.78|763.00|589.05||"
"72148|MRI scan of lower spinal canal|789.00|342.35|674.78|763.00|589.05||"
"72170|""X-ray of pelvis| 1 or 2 views""|89.84|472.01|87.00|73.64|264.31||"
"72192|CT scan of pelvis without contrast|524.00|""2|937.60""|376.71|499.00|264.31||"
"72193|CT scan pelvis with contrast|524.00|""3|213.00""|545.05|499.00|441.67||"
"72197|MRI scan of pelvis before and after contrast|789.00|902.02|""1|031.73""|763.00|924.50||"
"73030|""X-ray of shoulder| minimum of 2 views""|95.73|44.95|87.00|33.63|218.43||"
"73060|""X-ray of upper arm| minimum of 2 views""|92.79|47.40|87.00|32.60|218.43||"
"73080|""X-ray of elbow| minimum of 3 views""|113.46|51.48|87.00|39.84|218.43||"
"73090|""X-ray of forearm| 2 views""|89.84|40.05|87.00|31.58|218.43||"
"73110|""X-ray of wrist| minimum of 3 views""|132.63|61.29|87.00|46.58|218.43||"
"73130|""X-ray of hand| minimum of 3 views""|109.02|50.67|87.00|38.30|218.43||"
"73140|""X-ray of fingers| minimum of 2 views""|122.29|56.38|87.00|42.96|218.43||"
"73221|MRI scan of arm joint|789.00|388.11|674.78|763.00|589.05||"
"73502|""X-ray of hip with pelvis| 2-3 views""|129.04|388.62|119.43|355.60|218.43||"
"73522|""X-ray of both hips| 3-4 views""|144.41|662.77|197.79|463.40|264.31||"
"73552|""X-ray of femur| minimum 2 views""|98.30|633.77|119.43|443.10|218.43||"
"73560|""X-ray of knee| 1 or 2 views""|98.69|51.48|87.00|34.67|218.43||"
"73562|""X-ray of knee| 3 views""|126.73|596.70|87.00|44.51|218.43||"
"73564|""X-ray of knee| 4 or more views""|145.91|65.38|87.00|51.26|264.31||"
"73590|""X-ray of lower leg| 2 views""|86.90|46.58|87.00|30.53|218.43||"
"73610|""X-ray of ankle| minimum of 3 views""|113.46|52.31|87.00|39.84|218.43||"
"73630|""X-ray of foot| minimum of 3 views""|45.46|47.40|87.00|37.26|218.43||"
"73700|CT scan leg|524.00|298.22|376.71|499.00|264.31||"
"73721|MRI scan of leg joint|789.00|388.11|674.78|763.00|589.05||"
"74018|""X-ray of abdomen| 1 view""|78.31|41.70|122.00|436.80|218.43||"
"74019|""X-ray of abdomen| 2 views""|93.65|49.87|233.24|462.00|264.31||"
"74174|CT scan of abdominal and pelvic blood vessels with contrast|524.00|""4|375.80""|""1|141.34""|499.00|924.50||"
"74176|CT scan of abdomen and pelvis|524.00|""4|981.68""|380.78|499.00|589.05||"
"74177|CT scan of abdomen and pelvis with contrast|524.00|""5|569.97""|588.92|499.00|924.50||"
"74178|CT scan of abdomen and pelvis before and after contrast|524.00|""6|194.21""|656.55|499.00|924.50||"
"74181|MRI scan of abdomen without contrast|789.00|597.27|674.78|763.00|589.05||"
"74183|MRI scan of abdomen before and after contrast|789.00|904.47|""1|031.73""|763.00|924.50||"
"74230|Imaging for evaluation of swallowing function|293.35|232.87|173.07|103.05|441.67||"
"75574|CT scan of blood vessels and grafts of heart with contrast|524.00|""1|852.83""|528.69|499.00|441.67||"
"76536|Ultrasound of head and neck|423.12|205.08|188.85|148.64|264.31||"
"76642|""Ultrasound of one breast| limited""|236.22|576.81|180.05|527.80|218.43||"
"76700|""Ultrasound of abdomen| complete""|193.35|117.81|188.85|158.46|264.31||"
"76705|Limited ultrasound scan of abdomen|152.26|""1|183.46""|188.85|124.82|264.31||"
"76770|Ultrasound behind abdominal cavity|430.46|""1|473.39""|188.85|151.23|264.31||"
"76801|Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus|150.38|170.77|188.85|123.24|264.31||"
"76805|Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus|190.17|214.07|188.85|155.90|264.31||"
"76815|Limited ultrasound of pregnant uterus|113.08|120.93|119.74|92.69|264.31||"
"76817|Vaginal ultrasound of pregnant uterus|125.09|420.75|119.74|102.53|264.31||"
"76830|Ultrasound pelvis through vagina|78.95|203.45|188.85|64.71|264.31||"
"76856|Complete ultrasound scan of pelvis|174.39|175.67|188.85|142.94|264.31||"
"76857|Limited ultrasound scan of pelvis|145.95|53.93|119.74|119.63|264.31||"
"76870|Ultrasound scan of scrotum|415.73|83.34|188.85|146.04|264.31||"
"76937|Ultrasonic guidance for blood vessel access|94.28|664.79|372.00|33.12|68.30||"
"77065|Diagnostic mammography of one breast|116.00|216.52|186.29|297.50|33.41||"
"77066|Diagnostic mammography of both breasts|148.00|276.98|237.17|297.50|33.41||"
"77067|Screening mammography of both breasts|124.00|228.78|197.51|297.50|33.41||"
"77080|""Bone density measurement of the core or central skeleton (e.g.| hips| pelvis| spine)""|175.38|71.10|142.43|61.62|264.31||"
"77334|Design and construction of complex radiation treatment device|386.23|165.05|""1|084.50""|135.69|888.23||"
"77385|Delivery of simple high precision radiation treatment|""3|420.00""|""1|072.38""|""2|280.00""|""3|192.00""|""1|415.09""||"
"77386|Delivery of complex high precision radiation treatment|""3|420.00""|""1|072.38""|""2|280.00""|""3|192.00""|""1|415.09""||"
"77412|Delivery of complex radiation treatment|""1|040.94""|443.38|962.50|365.67|646.05||"
"78452|Nuclear medicine study of vessels of heart using drugs or exercise multiple studies|""1|844.30""|""5|446.80""|""1|522.51""|647.88|""3|413.52""||"
"80047|""Blood test| basic group of blood chemicals (Calcium| ionized)""|14.32|26.15|33.71|11.63|32.60||"
"80048|""Blood test| basic group of blood chemicals (Calcium| total)""|14.32|26.15|13.07|11.63|20.09||"
"80051|""Blood test panel for electrolytes (sodium potassium| chloride| carbon dioxide)""|11.80|22.06|10.83|9.64|16.64||"
"80053|""Blood test| comprehensive group of blood chemicals""|18.12|32.68|16.32|14.53|25.07||"
"80055|Obstetric blood test panel|73.72|149.51|59.05|60.43|113.51||"
"80061|""Blood test| lipids (cholesterol and triglycerides)""|29.49|62.09|20.68|18.42|31.79||"
"80069|Kidney function blood test panel|14.75|26.96|13.40|11.94|20.61||"
"80074|Acute hepatitis panel|83.00|175.66|73.52|65.47|113.08||"
"80076|Liver function blood test panel|13.91|25.33|12.62|11.23|19.40||"
"80202|Vancomycin (antibiotic) level|23.17|42.49|20.92|15.61|32.15||"
"80307|""Testing for presence of drug| by chemistry analyzers""|93.27|181.38|88.18|329.00|147.53||"
"81000|""Manual urinalysis test with examination using microscope| non-automated""|5.48|9.81|4.89|4.35|9.54||"
"81001|""Manual urinalysis test with examination using microscope| automated""|5.48|9.81|4.89|4.35|7.53||"
"81002|""Urinalysis| manual test""|4.21|8.17|3.94|3.52|8.26||"
"81003|Automated urinalysis test|3.79|7.36|3.47|3.09|5.34||"
"82010|""Ketone bodies analysis| quantitative""|13.91|25.33|12.62|11.23|19.40||"
"82043|Urine microalbumin (protein) level|9.69|17.98|8.94|7.95|13.72||"
"82247|""Bilirubin level| total""|8.43|15.53|7.76|6.90|11.92||"
"82248|""Bilirubin level| direct""|8.43|15.53|7.76|6.90|11.92||"
"82306|Vitamin D-3 level|50.56|92.33|45.70|40.70|70.28||"
"82330|""Calcium level| ionized""|23.17|42.49|21.09|18.79|32.48||"
"82533|""Cortisol (hormone) measurement| total""|27.80|50.65|25.17|22.41|38.70||"
"82550|""Creatine kinase (cardiac enzyme) level| total""|10.96|20.43|10.05|8.95|15.46||"
"82553|""Creatine kinase (cardiac enzyme) level| MB fraction only""|19.80|35.96|17.82|15.87|27.42||"
"82565|Blood creatinine level|8.85|16.34|7.91|7.04|12.16||"
"82570|Creatinine level to test for kidney function or muscle injury|8.85|16.34|7.99|7.11|12.30||"
"82607|Cyanocobalamin (vitamin B-12) level|25.71|47.39|23.27|20.72|35.80||"
"82728|Ferritin (blood protein) level|23.17|42.49|21.03|18.73|32.36||"
"82746|""Folic acid level| serum""|24.85|45.75|22.69|20.21|34.90||"
"82784|Gammaglobulin (immune system protein) measurement|16.01|29.41|14.35|12.78|22.08||"
"82803|Blood gases measurement|32.87|60.46|29.88|26.60|61.90||"
"82947|Blood glucose (sugar) level|6.75|12.26|6.05|5.39|9.33||"
"83036|Hemoglobin A1C level|16.43|30.23|14.98|13.34|23.05||"
"83540|Iron level|10.96|20.43|10.00|8.90|15.36||"
"83550|Iron binding capacity|14.75|26.96|13.49|12.02|20.75||"
"83605|Lactic acid level|18.12|33.50|16.49|14.68|27.47||"
"83615|Lactate dehydrogenase (enzyme) level|10.11|18.79|9.33|8.30|14.34||"
"83655|Lead level|20.64|37.58|18.68|16.64|28.75||"
"83690|Lipase (fat enzyme) level|11.80|21.24|10.63|9.47|16.36||"
"83735|Magnesium level|11.37|21.24|10.34|9.21|15.91||"
"83880|Natriuretic peptide (heart and blood vessel protein) level|57.72|106.21|52.41|46.66|93.21||"
"83970|Parathormone (parathyroid hormone) level|70.36|129.10|63.72|56.74|98.01||"
"84100|Phosphate level|8.00|14.71|7.33|6.52|11.25||"
"84112|Cervicovaginal secretion of placenta protein|109.54|200.99|100.15|88.54|232.93||"
"84132|Blood potassium level|8.00|14.71|7.09|6.32|11.30||"
"84145|Procalcitonin (hormone) level|45.51|83.33|30.67|36.82|64.63||"
"84153|""PSA (prostate specific antigen) measurement| total""|31.17|57.20|28.40|25.29|43.66||"
"84154|""PSA (prostate specific antigen) measurement| free""|31.17|57.20|28.40|25.29|43.66||"
"84155|""Total protein level| blood""|6.32|11.43|5.66|5.04|8.71||"
"84156|""Total protein level| urine""|6.32|11.43|5.66|5.04|8.71||"
"84157|""Total protein level| body fluid""|6.32|11.43|5.66|5.04|9.50||"
"84295|Blood sodium level|8.00|14.71|7.42|6.62|11.42||"
"84300|Urine sodium level|8.43|15.53|7.50|4.75|12.01||"
"84402|""Testosterone (hormone) level| free""|43.40|79.25|39.30|35.00|60.47||"
"84403|""Testosterone (hormone) level| total""|43.81|80.88|39.86|35.49|61.28||"
"84425|Vitamin B-1 (thiamine) level|36.23|66.18|32.78|29.19|50.40||"
"84436|""Thyroxine (thyroid chemical)| total""|11.80|21.24|10.62|9.44|16.31||"
"84439|""Thyroxine (thyroid chemical)| free""|15.16|27.77|13.92|12.40|21.42||"
"84443|""Blood test| thyroid stimulating hormone (TSH)""|28.65|52.29|25.93|23.10|39.89||"
"84480|""Thyroid hormone| T3 measurement| total""|24.01|44.12|21.89|17.53|33.67||"
"84481|""Thyroid hormone| T3 measurement| free""|28.65|53.11|26.15|23.29|40.22||"
"84484|""Troponin (protein) analysis| quantitative""|16.85|31.05|15.19|13.53|29.61||"
"84550|""Uric acid level| blood""|7.59|13.89|6.97|6.21|10.73||"
"84702|""Gonadotropin| chorionic (reproductive hormone) level""|25.71|47.39|23.24|8.82|35.73||"
"84703|Gonadotropin (reproductive hormone) analysis|12.64|23.69|11.59|8.82|17.85||"
"85007|Microscopic examination for white blood cells with manual cell count|5.89|10.62|5.31|4.73|9.02||"
"85014|Red blood cell concentration measurement|4.21|7.36|3.66|3.26|5.63||"
"85018|""Blood count| hemoglobin""|4.21|7.36|3.66|3.26|5.63||"
"85025|""Complete blood cell count (red cells| white blood cell| platelets)| automated test and automated differential white blood cell count""|11.70|24.51|12.00|10.69|18.45||"
"85027|""Complete blood cell count (red cells| white blood cell| platelets)| automated test""|10.96|20.43|9.99|8.89|15.36||"
"85045|""Red blood count| automated test""|6.75|12.26|6.18|5.50|9.47||"
"85305|Protein S (clotting inhibitor) level|19.80|35.96|17.90|15.95|27.56||"
"85347|""Coagulation time measurement| activated""|7.16|13.07|6.57|5.85|10.16||"
"85379|""Coagulation function measurement| D-dimer; quantitative""|17.28|31.86|15.71|13.99|24.17||"
"85384|Fibrinogen (factor 1) activity measurement|14.32|26.15|13.12|11.68|23.08||"
"85390|Coagulation function screening test with interpretation and report|8.85|16.34|7.98|7.10|36.75||"
"85397|Measurement of blood coagulation and fibrinolysis (clot dissolving) function|39.19|71.90|37.03|31.54|73.27||"
"85520|Heparin assay|22.33|40.85|20.21|18.00|31.08||"
"85576|Platelet aggregation function test|36.65|66.99|33.16|29.53|59.14||"
"85610|""Blood test| clotting time""|6.75|12.26|6.07|5.40|10.19||"
"85652|""Red blood cell sedimentation rate| to detect inflammation| automated""|4.64|8.17|4.17|3.71|6.41||"
"85730|""Coagulation assessment blood test| plasma or whole blood""|10.11|18.79|9.26|8.25|14.27||"
"86003|""Measurement of antibody (IgE) to allergic substance| crude allergen extract| each""|8.85|16.34|8.07|7.17|12.39||"
"86038|Screening test for autoimmune disorder|20.64|37.58|18.66|16.62|28.70||"
"86140|Measurement C-reactive protein for detection of infection or inflammation|8.85|16.34|7.99|7.11|12.30||"
"86160|""Measurement of complement (immune system proteins)| antigen|""|20.23|37.58|18.54|16.50|28.49||"
"86225|""Measurement of DNA antibody| native or double stranded""|23.17|43.30|21.21|18.88|32.62||"
"86235|""Measurement of antibody for assessment of autoimmune disorder| any method""|30.33|56.37|27.69|24.65|42.57||"
"86255|Screening test for antibody to noninfectious agent|20.64|37.58|18.61|16.57|28.61||"
"86300|""Immunologic analysis for detection of tumor antigen| quantitative; CA 15-3""|35.39|65.37|32.12|28.61|49.41||"
"86317|""Detection of infectious agent antibody| quantitative""|25.71|46.58|23.15|16.50|35.59||"
"86334|Immunologic analysis technique on serum (immunofixation)|37.92|69.45|34.48|30.71|53.04||"
"86431|Rheumatoid factor level|9.69|17.98|8.76|7.80|13.46||"
"86480|""Tuberculosis test| gamma interferon""|105.32|193.64|95.67|85.20|147.15||"
"86592|Syphilis detection test|7.16|13.07|6.59|5.87|10.14||"
"86704|Hepatitis B core antibody measurement|20.64|37.58|18.61|16.57|28.61||"
"86706|Hepatitis B surface antibody measurement|18.12|33.50|16.58|14.76|25.50||"
"86762|Analysis for antibody to Rubella (German measles virus)|24.44|44.94|22.22|16.00|34.16||"
"86780|""Analysis for antibody| Treponema pallidum""|22.33|41.67|20.96|18.20|31.43||"
"86787|Analysis for antibody to varicella-zoster virus (chicken pox)|21.91|40.03|19.89|17.71|30.58||"
"86803|Hepatitis C antibody measurement|24.44|44.94|22.03|19.62|33.88||"
"86850|Screening test for red blood cell antibodies|21.07|12.26|15.06|17.27|23.20||"
"86880|""Red blood cell antibody detection test| direct""|9.27|17.15|8.29|7.39|12.80||"
"86922|""Blood unit compatibility test| antiglobulin technique""|32.03|84.16|23.55|26.25|410.62||"
"86923|""Blood unit compatibility test| electronic""|24.01|62.92|15.06|19.68|410.62||"
"87015|Concentration of specimen for infectious agents|11.37|21.24|10.31|9.18|15.86||"
"87150|""Identification of organisms by genetic analysis| amplified probe technique""|59.83|109.48|55.54|26.97|83.31||"
"87340|Detection test by immunoassay technique for Hepatitis B surface antigen|17.69|31.86|15.94|14.20|24.53||"
"87389|Detection test by immunoassay technique for HIV-1 antigen and HIV-1 and HIV-2 antibodies|40.87|75.16|37.70|33.11|57.17||"
"87430|""Detection test by immunoassay technique for Streptococcus| group A (strep)""|20.23|37.58|18.52|16.49|39.91||"
"87481|""Detection test for candida species (yeast)| amplified probe technique""|59.83|109.48|54.18|26.97|83.31||"
"87491|""Detection test by nucleic acid for chlamydia trachomatis| amplified probe technique""|59.83|109.48|54.18|26.97|83.31||"
"87591|""Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria)| amplified probe technique""|59.83|109.48|54.18|26.97|83.31||"
"87624|""Detection test by nucleic acid for human papillomavirus (hpv)| high-risk types""|32.57|109.48|52.77|93.80|83.31||"
"87651|""Detection test by nucleic acid for Strep (Streptococcus| group A)| amplified probe technique""|59.83|109.48|54.18|26.97|83.31||"
"87661|""Detection test by nucleic acid for Trichomonas vaginalis (genital parasite)| amplified probe technique""|32.66|109.48|52.89|115.50|83.31||"
"87806|""Detection test by immunoassay with direct visual observation for HIV-1 antigen| with HIV-1 and HIV-2 antibodies""|39.98|75.16|36.21|171.50|77.80||"
"87880|""Detection test by immunoassay with direct visual observation for Streptococcus| group A (strep)""|20.23|37.58|18.52|16.49|39.25||"
"88175|""Pap test| automated thin layer preparation; automated system and manual rescreening""|45.08|82.52|40.89|36.38|63.18||"
"88341|""Special stained specimen slides to examine tissue| each additional procedure""|82.70|142.16|50.24|406.00|45.59||"
"88342|""Special stained specimen slides to examine tissue| initial procedure""|90.55|161.79|36.19|74.22|410.62||"
"90791|Psychiatric diagnostic evaluation|522|508.08|388.23|417.6|383.28||"
"90832|""Psychotherapy| 30 minutes""|217.50|211.70|161.76|174.00|383.28||"
"90834|""Psychotherapy| 45 minutes""|288.00|280.32|214.20|230.40|383.28||"
"90837|""Psychotherapy| 60 minutes""|288|280.32|214.20|230.40|383.28||"
"90846|""Family psychotherapy| 50 minutes""|355.5|346.02|264.40|284.40|383.28||"
"90847|""Family psychotherapy including patient| 50 minutes""|393.75|383.25|292.85|315.00|383.28||"
"90853|Group psychotherapy|269.25|686.93|200.25|215.40|214.27||"
"92507|""Treatment of speech| language| voice| communication| and/or hearing processing disorder""|457|369|165|225|47.08||"
"92523|Evaluation of speech sound production with evaluation of language comprehension and expression|457|369|165|225|60.36||"
"92526|Treatment of swallowing and/or oral feeding function|457|369|165|225|43.39||"
"92610|Evaluation of swallowing function|457|369|165|225|60.60||"
"92611|Evaluation of swallowing function image|457|369|165|225|72.39||"
"93005|Routine electrocardiogram (EKG) with tracing using at least 12 leads|363.75|354.05|142|291.00|147.03||"
"93017|Exercise or drug-induced heart stress test with electrocardiogram (ECG)|988.50|962.14|403|790.80|754.54||"
"93246|Heart rhythm recording of continous external EKG over 8-15 days|92.25|89.79|217|73.80|96.42||"
"93270|Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days|312.75|304.41|142|250.20|90.67||"
"93306|""Ultrasound examination of heart including color-depicted blood flow rate| direction| and valve function""|454.03|2292.2|1099|1884.00|1326.18||"
"93308|Follow-up or limited ultrasound examination of heart|256.67|1671.70|1099|1374.00|589.05||"
"93312|Insertion of probe in esophagus for heart ultrasound examination including interpretation and report|474.03|2467.40|1099|2028.00|1326.18||"
"93320|""Doppler ultrasound study of heart blood flow| valves| and chambers""|120.19|851.91|1099|700.20|91.73||"
"93321|""Ultrasound of heart blood flow| valves and chambers| follow-up""|65.92|725.62|1099|596.40|78.13||"
"93325|""Ultrasound of heart with color-depicted blood flow| rate and valve function""|74.02|940.97|1099|773.40|69.48||"
"93452|Insertion of catheter into left heart including imaging interpretation and supervision and injection|12266|12294|9655|14116|7565.20||"
"93458|Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection|12266|12294|9655|14116|7565.20||"
"93798|""Outpatient heart rehabilitation with electrocardiogram (ECG) monitoring| quality health care professional services""|294|286.16|217|235.20|317.65||"
"93880|Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck|546.88|375.04|501|975.60|589.05||"
"93970|Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers|551.52|375.04|501|1254.60|589.05||"
"93971|Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers|344.56|226.33|501|945.00|264.31||"
"93975|""Ultrasound scan of abdominal| pelvic| and/or scrotal arterial inflow and venous outflow""|752.56|517.2|501|1144.80|589.05||"
"94640|Inhalation treatment for airway obstruction or sputum production|363|369|173|225|512.74||"
"94668|Follow-up therapy service to facilitate lung function|291.75|369|173|225|307.08||"
"94761|Test to measure oxygen level in blood using ear or finger device multiple times|303.00|369|173|225|31.75||"
"95800|""Sleep study including heart rate| breathing| and sleep time""|1314|806.65|616.37|663|375.49||"
"95810|Sleep monitoring of patient (6 years or older) in sleep lab|2627|1799|3236|6730|2513.42||"
"95811|Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube|2627|1799|3236|6230|2513.42||"
"95816|""Measurement and recording of brain wave (EEG) activity| awake and drowsy""|1350|1314|1004.04|1080|754.54||"
"95940|""Continuous monitoring of nervous system during operation| each 15 minutes""|550.50|535.82|595|440.4|57.69||"
"96040|Counseling for genetic testing|643.50|626.34|176|514.8|67.44||"
"96365|""Infusion into a vein for therapy| prevention| or diagnosis| 1 hour or less""|561|546.04|350|448.8|515.25||"
"96401|Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle|198.43|418.29|2182|343.8|169.34||"
"96402|Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle|76.01|400.77|2182|329.4|169.34||"
"96413|""Administration of chemotherapy into vein| 1 hour or less""|351.33|867.24|2182|712.8|814.14||"
"96416|Administration of prolonged chemotherapy into vein|357.4|867.24|2182|712.8|814.14||"
"96523|Irrigation of implanted venous access drug delivery device|64.8|199.29|350|163.8|147.03||"
"97012|Application of mechanical traction|457|369|111|225|12.58||"
"97016|Application of blood vessel compression device|457|369|111|225|13.68||"
"97110|""Therapeutic exercise to develop strength| endurance| range of motion| and flexibility| each 15 minutes""|457|369|111|225|19.65||"
"97112|""Therapy procedure to re-educate brain-to-nerve-to-muscle function| each 15 minutes""|457|369|111|225|20.12||"
"97113|""Therapy procedure using water pool to exercises| each 15 minutes""|457|369|111|225|22.95||"
"97116|""Therapy procedure for walking training| each 15 minutes""|457|369|111|225|19.02||"
"97129|""Therapy procedure for a range of mental processes| initial 15 minutes""|457|369|111|225|13.60||"
"97140|""Therapy procedure using manual technique| each 15 minutes""|457|369|111|225|22.40||"
"97161|""Evaluation of physical therapy| typically 20 minutes""|457|369|111|225|44.25||"
"97162|""Evaluation of physical therapy| typically 30 minutes""|457|369|111|225|45.51||"
"97163|""Evaluation of physical therapy| typically 45 minutes""|457|369|111|225|51.64||"
"97164|""Re-evaluation for physical therapy| typically 20 minutes""|457|369|111|225|43.07||"
"97165|""Evaluation of occupational therapy| typically 30 minutes""|457|369|197|225|44.80||"
"97166|""Evaluation of occupational therapy| typically 45 minutes""|457|369|197|225|46.14||"
"97167|""Evaluation for occupational therapy| typically 1 hour""|457|369|197|225|55.02||"
"97530|""Therapeutic activities to improve function| with one-on-one contact between patient and provider| each 15 minutes""|457|369|111|225|20.04||"
"97535|""Training for self-care or home management| each 15 minutes""|457|369|111|225|27.12||"
"97542|""Evaluation for wheelchair| each 15 minutes""|457|369|111|225|13.36||"
"97605|""Therapy procedure using a special bandage and vacuum pump| surface area 50.0 sq cm or less""|4799|6037|946.03|3824|481.25||"
"C8929|""Transthoracic echocardiography with or without contrast|  complete| with doppler and with color flow""|1853.40|3874.84|1099|3184.80|1924.79||"
"G0103|Prostate cancer screening; prostate specific antigen test (PSA)|312.75|304.41|31.38|250.20|32.78||"
"G0277|""Hyperbaric oxygen under pressure| full body chamber| per 30 minute interval""|1864.5|369|4172|1491.60|185.6||"
"G0279|""Diagnostic digital breast tomosynthesis| unilateral or bilateral (List separately in addition to 77065 or 77066)""|147.75|58.01|99.47|118.20|15.48||"
"G0463|Hospital outpt clinic visit|315.00|306.60|234.28|444|317.78||"
"||||||||"
"|WMCG MD Rates|||||"
"Code|Code Description|Aetna HMO|Cigna HMO|United Health Care|Humana |Anthem Blue Cross HMO "
"59400|Obstetrical pre- and postpartum care and vaginal delivery |4627|4282.61|5277.51|5651.38|4399.25"
"59510|Cesarean delivery with pre- and post-delivery care|4822|4754.18|5852.91|6273.66|4852.09"
"59610|Routine obstetric care with vaginal delivery after prior cesarean delivery|4714|4508.46|5552.71|5949.4|4594.27"