Medical Procedure Pricing - Patient Resources

Procedure Pricing Make a Payment Educational Resources Request Medical Records

Procedure Pricing

Revere Health believes all patients should have access to information that helps them make educated healthcare decisions, including information about the cost of care. That’s why we’ve created pricing charts that highlight the most common procedures in each specialty and what they cost at any Revere Health location.

The pricing information below* represents the “sticker price” of a particular procedure or service for someone without insurance. Uninsured patients are eligible to receive a 30% discount on the sticker price for prompt payment. Patients with health insurance will typically be charged an amount less than the sticker price (the exact cost varies based on individual insurance plans).

The average patient experience also results in some additional testing or services that could appear on your bill. We’re happy to discuss the specifics of your bill with you if you have any questions.

*These prices reflect our most current data and will be updated periodically.

Office Visits

There are several different levels of office visits, and the price for each level of office visit is the same across all Revere Health specialties. Without seeing you in the exam room first, however, it’s difficult to know exactly which level of service will apply to your office visit.

A Level 1 visit typically involves the evaluation of a single problem (such as an insect bite or sinus infection) with a straightforward diagnosis and treatment plan. A Level 5 visit involves a comprehensive evaluation of serious/worsening problems that require complex medical decision making. Your office visit could fit anywhere on this scale depending on your individual health situation.

New Patients		Established Patients
CPT Code	Price	CPT Code	Price
99201 (Level 1)	$75	99201 (Level 1)	$36
99202 (Level 2)	$127	99202 (Level 2)	$74
99203 (Level 3)	$183	99203 (Level 3)	$123
99204 (Level 4)	$280	99204 (Level 4)	$182
99205 (Level 5)	$353	99205 (Level 5)	$246

Other Office Visits

CPT Code

Code Description

Explanation

Price

99381

Init pm e/m new pat infant

Initial new patient preventive medicine evaluation in an infant younger than 1 year, including age- and gender-appropriate history and physical exam.

$164

99382

Init pm e/m new pat 1-4 yrs

Initial new patient preventive medicine evaluation in children ages 1 to 4, including age- and gender-appropriate history and physical exam.

$187

99383

Prev visit new age 5-11

New patient preventive medicine evaluation in children ages 5 to 11, including age- and gender-appropriate history and physical exam.

$179

99384

Prev visit new age 12-17

New patient preventive medicine evaluation in adolescents ages 12 to 17, including age- and gender-appropriate history and physical exam.

$214

99385

Prev visit new age 18-39

New patient preventive medicine evaluation in adults ages 18 to 39, including age- and gender-appropriate history and physical exam.

$211

99386

Prev visit new age 40-64

New patient preventive medicine evaluation in adults ages 40 to 64, including age- and gender-appropriate history and physical exam.

$267

99387

Init pm e/m new pat 65+ yrs

Initial new patient preventive medicine evaluation in adults over age 65, including age- and gender-appropriate history and physical exam.

$301

99391

Per pm reeval est pat infant

Established patient periodic preventive medicine examination in an infant younger than 1 year, including age- and gender-appropriate history and physical exam.

$142

99392

Prev visit est age 1-4

Established patient periodic preventive medicine examination in children ages 1 to 4, including age- and gender-appropriate history and physical exam.

$154

99393

Prev visit est age 5-11

Established patient periodic preventive medicine examination in children ages 5 to 11, including age- and gender-appropriate history and physical exam.

$153

99394

Prev visit est age 12-17

Established patient periodic preventive medicine examination in adolescents ages 12 to 17, including age- and gender-appropriate history and physical exam.

$187

99395

Prev visit est age 18-39

Established patient periodic preventive medicine examination in adults ages 18 to 39, including age- and gender-appropriate history and physical exam.

$170

99396

Prev visit est age 40-64

Established patient periodic preventive medicine examination in adults ages 40 to 64, including age- and gender-appropriate history and physical exam.

$202

99397

Per pm reeval est pat 65+ yr

Established patient periodic preventive medicine examination in adults over age 65, including age- and gender-appropriate history and physical exam.

$239

G0402

Initial preventive exam

A one-time appointment for patients new to Medicare to cover health history and create a prevention plan.

$311

G0438

Ppps, initial visit

The first yearly appointment to create a patient's personalized prevention plan.

$310

G0439

Ppps, subseq visit

Yearly follow-up appointments to discuss and adjust a patient's personalized prevention plan (initial appointment).

$206

Search by Specialty

Adult Medicine

CPT Code

Code Description

Explanation

Price

99232

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making.

$126

G0250

Md inr test revie inter mgmt

Physician review, interpretation and management of home INR testing (to monitor blood thinning medications)

$18

99231

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring low complexity medical decision making.

$69

99239

Hospital discharge day

Management of patient health on hospital discharge day.

$181

90662

Iiv no prsv increased ag im

Preservative-free, high-dose Fluzone vaccine.

$65

G0008

Admin influenza virus vac

Administration of influenza vaccine

$19

J1030

Methylprednisolone 40 mg inj

Injection typically used to treat pain and swelling.

99223

Initial hospital care

Initial evaluation of a patient in the hospital requiring complex medical decision making and a comprehensive exam.

$350

20610

Drain/inj joint/bursa w/o us

Fluid removal in a major joint without the use of ultrasound technology.

$162

90471

Immunization admin

A single immunization that does not involve face-to-face counseling.

$38

Allergy & Immunology

CPT Code

Code Description

Explanation

Price

95004

Percut allergy skin tests

Allergy test in which a drop of a possible allergen is pricked or scratched into the skin. Charge is per allergen.

$10

95165

Antigen therapy services

Preparation by an allergist of an immunotherapy injection.

$30

95117

Immunotherapy injections

Multiple immunotherapy injection. Does not include preparation of vial.

$32

95115

Immunotherapy one injection

Single immunotherapy injection. Does not include preparation of vial.

$25

95044

Allergy patch tests

Allergy test in which a patch with a possible allergen is placed onto the skin. Charge is per allergen.

$13

95024

Icut allergy test drug/bug

Allergy test in which the extract of a possible allergen (medication or insect venom) is injected into the skin. Charge is per allergen.

$17

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

95018

Perq&ic allg test drugs/biol

Skin allergy test to identify allergic reactions to medications or biologic agents used to treat or diagnose a disease.

$46

94010

Breathing capacity test

Non-invasive evaluation of how quickly and how much air you exhale.

$78

94060

Evaluation of wheezing

Breathing capacity test after receiving a medication that widens the air passages into the lungs.

$131

Cardiology

CPT Code

Code Description

Explanation

Price

9330626

Tte w/doppler complete

Physician interpretation of echocardiogram results

$164

93000

Electrocardiogram complete

Routine electrocardiogram (ECG or EKG) with interpretation.

$45

99232

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making.

$126

93306

Tte w/doppler complete

A procedure that uses high-frequency sound waves to evaluate blood flow through the heart.

$527

J2785

Regadenoson injection

Injection of regadenoson (brand name: Lexiscan) for nuclear cardiovascular stress testing.

$78

93018

Cardiovascular stress test

A test that monitors how the heart reacts to physical stress, typically using a treadmill or bicycle.

$36

93280

Pm device progr eval dual

In-person evaluation of an implanted monitoring device, such as pacemakers, loop recorders, etc.

$143

A9500

Tc99m sestamibi

An injected substance used for nuclear imaging.

$216

7845226

Ht muscle image spect mult

Physician interpretation of results from a myocardial perfusion imaging (MPI) test, which analyzes how the heart muscle functions.

$228

93227

Ecg monit/reprt up to 48 hrs

Electrocardiographic monitoring for 24 hours with physician review and interpretation

$63

Dermatology

CPT Code

Code Description

Explanation

Price

17003

Destruct premalg les 2-14

Destruction of 2-14 pre-cancerous skin abnormalities through laser surgery, electrosurgery, cryosurgery (freezing) or curettement (scraping).

$19

95044

Allergy patch tests

Allergy test in which a patch with a possible allergen is placed onto the skin. Charge is per allergen.

$13

17000

Destruct premalg lesion

Destruction of a single precancerous skin abnormality through laser surgery, electrosurgery, cryosurgery (freezing) or curettement (scraping).

$132

17110

Destruct b9 lesion 1-14

Destruction of 1 to 14 benign (non-cancerous) skin abnormalities other than skin tags or certain types of birthmarks.

$206

88305

Tissue exam by pathologist

Examination of sample tissue by a pathologist to diagnose or rule out certain conditions.

$160

11301

Shave skin lesion 0.6-1.0 cm

Shaving of abnormalities on the skin for cosmetic or treatment purposes under local anesthesia.

$226

8830526

Tissue exam by pathologist

Interpretation of results from a tissue exam.

$82

17311

Mohs 1 stage h/n/hf/g

A procedure that involves removing one layer of skin cancer at a time for immediate examination of cancer cells.

$1,250

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

17312

Mohs addl stage

Additional stages required for a procedure that involves removing one layer of skin cancer at a time for immediate examination of cancer cells.

$732

Endocrinology

CPT Code

Code Description

Explanation

Price

77080

Dxa bone density axial

A non-invasive imaging test that measures bone density in the axial skeleton, which includes, for example, the hips, pelvis and spine.

$179

95251

Cont gluc mntr analysis i&r

Analysis and interpretation of data from a continuous glucose monitor, a device that tracks your blood sugar.

$80

76536

Us exam of head and neck

Use of ultrasound technology to examine salivary glands, lymph nodes, lesions and the endocrine system.

$316

76942

Echo guide for biopsy

Use of ultrasound technology to guide the placement of a needle during a biopsy.

$362

95250

Cont gluc mntr phys/qhp eqp

Includes sensor placement, patient training, calibration, removal and downloading data from the monitor.

$317

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

J0834

Inj., cosyntropin, 0.25 mg

Injection of cosyntropin (brand name: Cortrosyn) to diagnose adrenal gland disorders.

$141

G0103

Psa screening

A blood test used to screen for prostate cancer.

$44

77081

Dxa bone density/peripheral

A non-invasive imaging test that measures bone density in the lower arm, wrist, finger or heel using a portable DEXA machine.

$92

ENT

CPT Code

Code Description

Explanation

Price

69210

Remove impacted ear wax uni

Removal of earwax buildup.

$104

31505

Diagnostic laryngoscopy

Diagnostic examination of voice box using an endoscope, an instrument used to look inside the body.

$183

92567

Tympanometry

A test used to diagnose and monitor conditions of the middle ear.

$33

J0696

Ceftriaxone sodium injection

Antibacterial injection used to treat infection.

$31

92504

Ear microscopy examination

Examination of the ear using a microscope.

$63

42826

Removal of tonsils

Surgical removal of tonsils.

$527

69436

Create eardrum opening

Surgical opening of the eardrum and insertion of a ventilating tube.

$357

30901

Control of nosebleed

Control of minor nosebleed that originates in the front of the nose (anterior).

$304

42820

Remove tonsils and adenoids

Surgical removal of tonsils and adenoids, a patch of tissue in the back of the throat.

$593

30520

Repair of nasal septum

A surgical procedure to correct a deviated septum, a condition in which the bone and cartilage that separates the nose is off center.

$1,398

Family Medicine

CPT Code

Code Description

Explanation

Price

J0897

Denosumab injection

Injection of denosumab (brand names: Prolia and Xgeva) to treat osteoporosis and high calcium levels and prevent fractures.

$22

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

99231

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring low complexity medical decision making.

$69

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

90471

Immunization admin

Administration of a single immunization that does not involve face-to-face counseling.

$38

J0696

Ceftriaxone sodium injection

Antibacterial injection used to treat infection.

$31

90460

Im admin 1st/only component

Administration of initial immunization with physician counsel for patients age 18 and younger.

$44

90461

Im admin each addl component

Administration of additional immunizations with physician counsel for patients age 18 and younger.

$22

90472

Immunization admin each add

Administration of additional immunizations that do not involve face-to-face counseling.

$20

J1885

Ketorolac tromethamine inj

Injection of a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of moderate to severe pain.

$16

87880

Strep a assay w/optic

A test that detects the presence of streptococcus bacteria using a throat swab.

$28

J1100

Dexamethasone sodium phos

Injection of dexamethasone, a steroid used to treat inflammation (swelling).

85651

Rbc sed rate nonautomated

A blood test that detects inflammatory activity in the body.

J7325

Synvisc or synvisc-one

An injection used to treat osteoarthritis pain.

$25

Gastroenterology

CPT Code

Code Description

Explanation

Price

45378

Diagnostic colonoscopy

A colonoscopy performed as the result of an abnormal test result, sign or symptom

$882

43239

Egd biopsy single/multiple

A procedure used to examine the esophagus, stomach and the upper part of the small intestine with the removal of tissues (biopsy) for testing.

$943

45380

Colonoscopy and biopsy

A procedure used to examine the colon with the removal of tissues (biopsy) for testing.

$1,122

45385

Colonoscopy w/lesion removal

A procedure used to examine the colon with the removal of polyps, tumors or other lesions.

$1,224

43235

Egd diagnostic brush wash

A procedure used to examine the esophagus, stomach and the upper part of the small intestine with specimen collection.

$708

43249

Esoph egd dilation <30 mm

A procedure to widen a narrowed esophagus, which often occurs as the result of acid reflux.

$2,872

99232

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making.

$126

99233

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring high-complexity medical decision making.

$180

99222

Initial hospital care

Initial evaluation of a patient in the hospital requiring moderately complex medical decision making and a comprehensive exam.

$237

G0121

Colon ca scrn not hi rsk ind

A colonoscopy for a low-risk individual without symptoms to screen for colorectal cancer and check for the presence of polyps.

$707

90471

Immunization admin

Administration of a single immunization that does not involve face-to-face counseling.

$38

Imaging

CPT Code

Code Description

Explanation

Price

72148TC

Mri lumbar spine w/o dye

MRI scan of the lower spinal canal without contrast material (a substance used to enhance visibility of the body's internal structures).

$739

73721TC

Mri jnt of lwr extre w/o dye

MRI scan of joints in the body's lower extremities (i.e., hip, knee, ankle, foot, etc.) without contrast material (a substance used to enhance visibility of the body's internal structures).

$799

73221TC

Mri joint upr extrem w/o dye

MRI scan of joint in the body's upper extremities (i.e., shoulder, elbow, wrist, etc.) without contrast material (a substance used to enhance visibility of the body's internal structures).

$781

72141TC

Mri neck spine w/o dye

MRI scan of the neck and upper spine without contrast material (a substance used to enhance visibility of the body's internal structures).

$720

74177TC

Ct abd & pelv w/contrast

CT scan of the abdomen and pelvis region with contrast material (a substance used to enhance visibility of the body's internal structures).

$610

70553TC

Mri brain stem w/o & w/dye

MRI scan of the brain and brain stem before and after contrast (a substance used to enhance visibility of the body's internal structures).

$1,543

71260TC

Ct thorax w/dye

CT scan of the thorax (the chest area) with contrast material (a substance used to enhance visibility of the body's internal structures).

$464

72146TC

Mri chest spine w/o dye

MRI scan of the thoracic (chest area) of the spine without contrast material (a substance used to enhance visibility of the body's internal structures).

$739

74176TC

Ct abd & pelvis w/o contrast

CT scan of the abdomen and pelvis region without contrast material (a substance used to enhance visibility of the body's internal structures).

$303

73700TC

Ct lower extremity w/o dye

CT scan of the lower extremity (leg) without contrast material (a substance used to enhance visibility of the body's internal structures).

$363

72195TC

Mri pelvis w/o dye

MRI scan of the pelvic without contrast material (a substance used to enhance visibility of the body's internal structures).

$822

74178TC

Ct abd & pelv 1/> regns

CT scan of the abdomen and pelvis before and after contrast (a substance used to enhance visibility of the body's internal structures).

$698

70551TC

Mri brain stem w/o dye

MRI scan of the brain, including the brain stem, without contrast (a substance used to enhance visibility of the body's internal structures).

$826

71250TC

Ct thorax w/o dye

CT scan of the thorax (the chest area) without contrast material (a substance used to enhance visibility of the body's internal structures).

$372

77290TC

Set radiation therapy field

Complex management of radiation therapy for three or more treatment areas.

$1,156

70450TC

Ct head/brain w/o dye

CT scan of head or brain without contrast material (a substance used to enhance visibility of the body's internal structures).

$288

73718TC

Mri lower extremity w/o dye

MRI scan of the lower extremity (leg) without contrast material (a substance used to enhance visibility of the body's internal structures).

$819

Internal Medicine

CPT Code

Code Description

Explanation

Price

J0897

Denosumab injection

Injection of denosumab (brand names: Prolia and Xgeva) to treat osteoporosis and high calcium levels and prevent fractures.

$22

99233

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring high-complexity medical decision making.

$180

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

J1050

Medroxyprogesterone acetate

An injection used as a contraceptive (birth control) or to treat kidney cancer, endometrial cancer and pain caused by endometriosis.

90662

Iiv no prsv increased ag im

Preservative-free, high-dose Fluzone vaccine.

$65

G0008

Admin influenza virus vac

Administration of influenza vaccine

$19

77080

Dxa bone density axial

A non-invasive imaging test that measures bone density in the axial skeleton, which includes, for example, the hips, pelvis and spine.

$179

J3420

Vitamin b12 injection

An Injection used to treat vitamin b-12 deficiency.

90471

Immunization admin

A single immunization that does not involve face-to-face counseling.

$38

94664

Evaluate pt use of inhaler

The demonstration and/or evaluation of patient use of an inhaler.

$37

9581126

Polysom 6/>yrs cpap 4/> parm

Physician interpretation of a polysomnogram (sleep study) of patients age 6 and older with CPAP machine assistance.

$373

94762

Measure blood oxygen level

Non-invasive overnight measurement of oxygen levels in the blood using an ear or finger device.

$53

90688

Iiv4 vaccine splt 0.5 ml im

A type of influenza (flu) vaccine designed to cause fewer reactions at the injection site (e.g., swelling, rash, etc.).

$22

99304

Nursing facility care init

Initial evaluation and management of a patient in a nursing facility requiring low-complexity medical decision making.

$156

Lab

CPT Code

Code Description

Explanation

Price

36415

Routine venipuncture

Insertion of needle into vein for collection of blood samples.

$10

85025

Complete cbc w/auto diff wbc

A blood test used to evaluate overall health.

$15

80053

Comprehen metabolic panel

A comprehensive panel that includes 14 blood tests, used for medical screening.

$22

80061

Lipid panel

A blood test that measures good and bad cholesterol and triglycerides (a type of fat in the blood).

$28

84443

Assay thyroid stim hormone

A blood test that measures the amount of thyroid-stimulating hormone (TSH) in the blood.

$35

84439

Assay of free thyroxine

A blood test that is used to help diagnose conditions of the thyroid.

$18

83036

Glycosylated hemoglobin test

A blood test that measures glycosylated hemoglobin; used to diagnose and monitor diabetes.

$20

81003

Urinalysis auto w/o scope

Analysis of urine sample to diagnose UTIs, kidney disorders, liver problems, etc.

82306

Vitamin d 25 hydroxy

A blood test that measures the amount of vitamin D in the body.

$62

80050

General health panel

A blood test that includes a complete blood count, a comprehensive metabolic panel and thyroid test.

$87

82570

Assay of urine creatinine

A laboratory test that measures the amount of creatinine (a chemical waste product) in the urine.

$10

82607

Vitamin b-12

A blood test that measures the amount of vitamin b-12 in the body.

$31

85610QW

Prothrombin time

Laboratory test that calculates the average time it takes for your blood to clot.

80048

Metabolic panel total ca

A blood test that measures blood sugar levels, electrolyte and fluid balance, and kidney function.

$18

84153

Assay of psa total

A blood test that is used to screen for prostate cancer by measuring total prostate specific antigen (PSA).

$38

83615

Lactate (ld) (ldh) enzyme

A blood test that measures lactate dehydrogenase in the body to looks for signs of damage to tissues in the body.

$12

82043

Ur albumin quantitative

A laboratory test that measures albumin levels, a protein found in the blood.

$13

87880

Strep a assay w/optic

A test that detects the presence of streptococcus bacteria using a throat swab.

$28

83540

Assay of iron

A blood test that measures iron levels in the blood to help diagnose anemia or other conditions.

$14

36416

Capillary blood draw

Sampling a small amount of blood from a puncture on the finger (finger prick), heel or earlobe.

82728

Assay of ferritin

A blood test that shows how much iron the body stores.

$28

83550

Iron binding test

A blood test that measures the blood's ability to attach itself to iron and transport it around the body.

$18

86140

C-reactive protein

A blood test that helps identify inflammation in the body.

$11

84403

Assay of total testosterone

A blood test that measures the amount of testosterone in the blood.

$54

81025

Urine pregnancy test

A laboratory test that evaluates the urine to look for signs of pregnancy.

$15

83735

Assay of magnesium

A blood test that measures the amount of magnesium in the blood.

$14

83970

Assay of parathormone

A blood test that measures the level of parathyroid hormone in the blood.

$86

85018

Hemoglobin

A blood test that measures the amount of hemoglobin (a protein that carries oxygen from your lungs to the rest of your body).

Nephrology

CPT Code

Code Description

Explanation

Price

J0885

Epoetin alfa, non-esrd

Injection of epoetin alfa (brand names: Procrit and Epogen) to treat anemia in patients chronic kidney disease (non-end stage).

$17

90960

Esrd srv 4 visits p mo 20+

Monthly services (four or more visits per month) for patients with end-stage renal disease, including dialysis.

$528

99233

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring high-complexity medical decision making.

$180

99232

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making.

$126

90935

Hemodialysis one evaluation

Hemodialysis with a single physician evaluation.

$137

90961

Esrd srv 2-3 vsts p mo 20+

Monthly services (two - three visits per month) for patients with end-stage renal disease, including dialysis.

$443

90966

Esrd home pt serv p mo 20+

Monthly home dialysis services.

$442

99223

Initial hospital care

Initial evaluation of a patient in the hospital requiring complex medical decision making and a comprehensive exam.

$350

90970

Esrd svc pr day pt 20+

Dialysis services per day (for less than full month service)/

$15

G0008

Admin influenza virus vac

Administration of influenza vaccine

$19

90653

Iiv adjuvant vaccine im

Influenza vaccine made from killed flu viruses.

$63

Neurology

CPT Code

Code Description

Explanation

Price

J0585

Injection,onabotulinumtoxina

Botox injection to treat muscle stiffness/spasm and migraines.

$10

95886

Musc test done w/n test comp

A test in which a needle is inserted directly into a muscle (needle EMG) and records the muscle's electrical activity.

$205

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

95923

Autonomic nrv syst funj test

A test that evaluates functions of the autonomic nervous system, which controls heart rate, body temperature, breathing rate, etc.

$284

J1885

Ketorolac tromethamine inj

Injection of a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of moderate to severe pain.

$16

64615

Chemodenerv musc migraine

An injection procedure for the purposes of treating chronic migraines.

$339

95913

Nrv cndj test 13/> studies

13 or more nerve conduction studies, which are used to evaluate the function of motor and sensory nerves.

$674

64405

N block inj occipital

An injection into the occipital nerves (located above the neck) to treat chronic headaches.

$284

9595126

Eeg monitoring/videorecord

Physician interpretation of results from an EEG Video Monitoring, a test used to diagnose non-epileptic seizures.

$728

OBG/YN

CPT Code

Code Description

Explanation

Price

90471

Immunization admin

A single immunization that does not involve face-to-face counseling.

$38

59025

Fetal non-stress test

A screening test used to evaluate fetal oxygen supply. movement and heart rate.

$95

76811

Ob us detailed sngl fetus

Real-time ultrasound of the uterus for a single fetus with evaluation of fetal anatomical development.

$508

76856

Us exam pelvic complete

Nonobstetric ultrasound of the pelvis (i.e., ultrasounds unrelated to pregnancy care)

$301

76816

Ob us follow-up per fetus

Follow-up ultrasound for re-evaluation of fetal size.

$317

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

58300

Insert intrauterine device

Insertion of an IUD, a small, contraceptive (birth control) device, into the uterus.

$176

59400

Obstetrical care

Routine care for pregnant women, including pre- and postpartum care and delivery.

$3,729

90715

Tdap vaccine 7 yrs/> im

A vaccine that prevents tetanus, diphtheria (bacterial infection of the nose and throat), and pertussis (whooping cough).

$55

58301

Remove intrauterine device

Removal of IUD, a small, contraceptive (birth control) device.

$190

76815

Ob us limited fetus(s)

Real-time ultrasound limited to the evaluation of the fetal heartbeat and position.

$233

90686

Iiv4 vacc no prsv 0.5 ml im

A type of preservative-free influenza (flu) vaccine designed to cause fewer reactions at the injection site (e.g., swelling, rash, etc.).

$28

Oncology

CPT Code

Code Description

Explanation

Price

J1439

Inj ferric carboxymaltos 1mg

Injection of ferric carboxymaltos (brand name: Injectafer) to treat iron deficiency anemia.

J1442

Inj filgrastim excl biosimil

Injection of filgrastim (brand name: Neupogen) to treat a lack of white blood cells caused by cancer, chemotherapy, bone marrow transplant and other conditions.

J0641

Levoleucovorin injection

Injection of levoleucovorin (brand names: Fusilev and Khapzory) to prevent the harmful effects of a cancer medicine called methotrexate.

J9306

Injection, pertuzumab, 1 mg

Injection of pertuzumab (brand name: Perjeta) to treat breast cancer that has spread to other parts of the body.

$20

J9263

Oxaliplatin

Injection of oxaliplatin (brand name: Eloxatin) to treat advanced colorectal cancer.

$20

J3380

Injection, vedolizumab

Injection of vedolizumab (brand name: Entyvio) to treat Crohn's disease and ulcerative colitis in patients that have not had success with other medicines.

$23

J0897

Denosumab injection

Injection of denosumab (brand names: Prolia and Xgeva) to treat osteoporosis and high calcium levels and prevent fractures.

$22

J9267

Paclitaxel injection

Injection of paclitaxel (brand names: Nov-Onxol, Onxol, Paclitaxel Novaplus, Taxol) to treat advanced ovarian, breast and other cancers.

J1756

Iron sucrose injection

Injection of iron sucrose (brand name: Venofer) to treat iron deficiency in patients with chronic kidney disease.

J9025

Azacitidine injection

Injection of azacitidine (brand name: Vidaza) to treat a group of blood and bone marrow disorders.

$12

J2323

Natalizumab injection

Injection of natalizumab (brand name: Tysabri) to treat relapsing forms of MS (multiple sclerosis).

$22

J1453

Fosaprepitant injection

Injection of fosaprepitant (brand name: Emend) to prevent nausea and vomiting caused by chemotherapy.

J1100

Dexamethasone sodium phos

Injection of dexamethasone, a steroid used to treat inflammation (swelling).

J9171

Docetaxel injection

Injection of docetaxel (brand names: Docefrez and Taxotere) to treat a variety of cancers.

$43

J9355

Trastuzumab injection

Injection of trastuzumab (brand names: Herceptin, Herzuma, Ogivri, Ontruzant) to treat breast cancer.

$145

J1745

Infliximab not biosimil 10mg

Injection of infliximab to treat Crohn's disease, ulcerative colitis, rheumatoid arthritis and other conditions.

$141

J0885

Epoetin alfa, non-esrd

Injection of epoetin alfa (brand names: Procrit and Epogen) to treat anemia in patients chronic kidney disease (non-end stage).

$17

J9299

Injection, nivolumab

Injection of nivolumab (brand name: Opdivo) to treat melanoma (skin cancer).

$33

J9176

Injection, elotuzumab, 1mg

Injection of elotuzumab (brand name: Empliciti) to treat multiple myeloma, a cancer in the blood cells.

Ophthalmology

CPT Code

Code Description

Explanation

Price

92015

Determine refractive state

Assessment of the eyes for prescription eyewear using a range of lens powers.

$118

92014

Eye exam&tx estab pt 1/>vst

Comprehensive eye and medical examination for an established patient.

$196

92004

Eye exam new patient

Comprehensive eye and medical examination for a new patient.

$245

92134

Cptr ophth dx img post segmt

Diagnostic imaging scan of the retina used to detect disease and assess eye health.

$89

92012

Eye exam establish patient

An eye and medical examination of a limited portion of the eye (does not include a complete visual examination).

$134

66984

Cataract surg w/iol 1 stage

Removal of cataract with the insertion of a prosthetic lens.

$1,408

92136

Ophthalmic biometry

A test that measures the shape and size of the eye.

$150

92133

Cmptr ophth img optic nerve

Diagnostic imaging scan of the optic nerve used to detect glaucoma.

$85

92083

Visual field examination(s)

An examination that measures the field of vision, including peripheral (side) vision, during daylight conditions.

$152

66821

After cataract laser surgery

A surgical procedure to treat haze that develops behind the lens after cataract surgery.

$681

Orthopedics

CPT Code

Code Description

Explanation

Price

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

20610

Drain/inj joint/bursa w/o us

Fluid removal in a major joint without the use of ultrasound technology.

$162

J0585

Injection,onabotulinumtoxina

Botox injection to treat muscle stiffness/spasm and migraines.

$10

J7325

Synvisc or synvisc-one

An injection used to treat osteoarthritis pain.

$25

73564

X-ray exam knee 4 or more

Complete X-ray examination of the knee with four or more views.

$114

73630

X-ray exam of foot

Complete X-ray examination of the foot with a minimum of three views.

$86

73030

X-ray exam of shoulder

Complete X-ray examination of the shoulder with a minimum of two views.

$83

73562

X-ray exam of knee 3

X-ray examination of the knee with three views.

$102

73140

X-ray exam of finger(s)

X-ray examination of one or more fingers with a minimum of two views.

$92

J0702

Betamethasone acet&sod phosp

Injection of betamethasone (brand name: Celestone Soluspan) to treat inflammation (swelling) and arthritis.

$11

J7323

Euflexxa inj per dose

Injection of Euflexxa to treat osteoarthritis pain.

$376

73100

X-ray exam of wrist

X-ray examination of the wrist with two views.

$88

73502

X-ray exam hip uni 2-3 views

X-ray examination of the hip and pelvis with two or three views.

$118

73610

X-ray exam of ankle

Complete X-ray examination of the ankle with a minimum of three views.

$92

72100

X-ray exam l-s spine 2/3 vws

X-ray examination of the lower spine with two or three views.

$100

20552

Inj trigger point 1/2 muscl

A procedure used to treat muscle pain (one to two muscles).

$120

20550

Inj tendon sheath/ligament

A procedure used to treat pain, caused by inflammation (swelling) or disease, in the structures surrounding tendons and joints.

$119

64483

Inj foramen epidural l/s

Epidural injection into the spine using the guidance of imaging technology

$709

73110

X-ray exam of wrist

Complete X-ray examination of the wrist with a minimum of three views.

$100

20600

Drain/inj joint/bursa w/o us

Fluid removal in a small joint (e.g., fingers or toes) without the use of ultrasound technology.

$112

Physical Therapy

CPT Code

Code Description

Explanation

Price

97110

Therapeutic exercises

Therapeutic physical therapy exercises in one or more areas.

$49

97010

Hot or cold packs therapy

Application of a hot or cold pack to one or more area.

$10

97140

Manual therapy 1/> regions

Therapeutic exercises in which a physical therapist manipulates and moves the muscles or joints.

$46

97530

Therapeutic activities

Physical therapy activities with direct, one-on-one patient contact.

$63

97161

Pt eval low complex 20 min

20-minute evaluation of physical therapy treatment for a patient with low complexity.

$135

97014

Electric stimulation therapy

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles.

$24

97022

Whirlpool therapy

A therapy that decreases pain and swelling, promotes wound healing and increases mobility.

$35

97113

Aquatic therapy/exercises

Exercises performed in water for physical rehabilitation.

$64

G0283

Elec stim other than wound

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles for therapy other than wound care.

$22

97162

Pt eval mod complex 30 min

30-minute evaluation of physical therapy treatment for a patient with moderate complexity.

$135

97035

Ultrasound therapy

A procedure in which a physical therapist uses ultrasound technology to reduce pain.

$22

97535

Self care mngment training

Self-care and home management training for patients who need help with activities of daily living.

$54

Radiation Oncology

CPT Code

Code Description

Explanation

Price

G6013

Radiation treatment delivery

The delivery of radiation treatment in three or more treatment areas.

$515

G6015

Radiation tx delivery imrt

A type of radiation therapy in which the intensity of the radiation beam is adapted to match the precise shape of a tumor and minimize tissue damage.

$881

G600226

Stereoscopic x-ray guidance

Interpretation of results from a stereoscopic X-ray, an imaging test that is used to identify the volume of radiation therapy needed.

$42

G6002

Stereoscopic x-ray guidance

An imaging test that is used to identify the volume of radiation therapy needed.

$190

77300

Radiation therapy dose plan

The measurement, calculation and assessment of radiation therapy doses.

$186

A9606

Radium ra223 dichloride ther

Injection of radium dichloride (brand name: Xofigo) to treat prostate cancer.

$182

77427

Radiation tx management x5

Management of five courses of radiation treatment.

$544

77336

Radiation physics consult

Consultation of radiation therapy including assessment of treatment and review of dose delivery.

$227

77334

Radiation treatment aid(s)

The design and construction of complex treatment devices that assist in radiation therapy.

$377

77417

Radiology port images(s)

X-ray images taken throughout radiation treatment to check the positioning of the radiation.

$45

Radiology

CPT Code

Code Description

Explanation

Price

77063

Breast tomosynthesis bi

A screening test used to detect breast cancer in women using radiographic (X-ray) technique.

$153

77067

Scr mammo bi incl cad

A screening test used to detect breast cancer in women using tomosynthesis, a method that produces high-definition, 3D images; often used in conjunction with a typical mammography.

$374

7706726

Scr mammo bi incl cad

Physician interpretation of the results from a 3D mammogram, a test used to detect breast cancer.

$110

7706326

Breast tomosynthesis bi

Physician interpretation of the results from a mammogram, a test used to detect breast cancer.

$86

7045026

Ct head/brain w/o dye

Physician interpretation of the results from a CT scan of head or brain without contrast material (a substance used to enhance visibility of the body's internal structures).

$123

7417726

Ct abd & pelv w/contrast

Physician interpretation of the results from a CT scan of the abdomen and pelvis region with contrast material (a substance used to enhance visibility of the body's internal structures).

$264

73721

Mri jnt of lwr extre w/o dye

MRI scan of joints in the body's lower extremities (i.e., hip, knee, ankle, foot, etc.) without contrast material (a substance used to enhance visibility of the body's internal structures).

$930

72148

Mri lumbar spine w/o dye

MRI scan of the lower spinal canal without contrast material (a substance used to enhance visibility of the body's internal structures).

$875

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

74177

Ct abd & pelv w/contrast

CT scan of the abdomen and pelvis region with contrast material (a substance used to enhance visibility of the body's internal structures).

$875

J1100

Dexamethasone sodium phos

Injection of dexamethasone, a steroid used to treat inflammation (swelling).

73221

Mri joint upr extrem w/o dye

MRI scan of joint in the body's upper extremities (i.e., shoulder, elbow, wrist, etc.) without contrast material (a substance used to enhance visibility of the body's internal structures).

$913

76705

Echo exam of abdomen

Real-time ultrasound exam of the abdomen to diagnose medical conditions.

$250

7685626

Us exam pelvic complete

Nonobstetric ultrasound of the pelvis (i.e., ultrasounds unrelated to pregnancy care)

$100

7417626

Ct abd & pelvis w/o contrast

Physician interpretation of the results from a CT scan of the abdomen and pelvis region without contrast material (a substance used to enhance visibility of the body's internal structures).

$252

70553

Mri brain stem w/o & w/dye

MRI scan of the brain and brain stem before and after contrast (a substance used to enhance visibility of the body's internal structures).

$1,696

A9579

Gad-base mr contrast nos,1ml

Injection of a contrast agent (a substance used to enhance visibility of the body's internal structures) to improve the quality of MRI images.

$11

77002

Needle localization by xray

The use of imaging technology to ensure precise placement of a needle for biopsy, injections, aspirations (removal of cells and fluids via suction), etc.

$278

Sleep

CPT Code

Code Description

Explanation

Price

95810TC

Polysom 6/> yrs 4/> param

A polysomnogram (sleep study) of patients age 6 and older that tracks four or more measures of sleep.

$1,139

95811TC

Polysom 6/>yrs cpap 4/> parm

A polysomnogram (sleep study) of patients age 6 and older with CPAP machine assistance that tracks four or more measures of sleep.

$1,250

95806TC

Sleep study unatt&resp efft

A polysomnogram (sleep study) conducted at home instead of at a sleep center.

$241

95805TC

Multiple sleep latency test

A test that measures alertness, how quickly you fall asleep and other measures of sleep to diagnose a sleep disorder.

$1,155

95807TC

Sleep study attended

A sleep study that also records breathing, heart rate and oxygen saturation, and is attended by a technologist.

$990

95808TC

Polysom any age 1-3> param

A polysomnogram (sleep study) of patients of any age that tracks one to three measures of sleep.

$1,355

Spine & Rehab

CPT Code

Code Description

Explanation

Price

97110

Therapeutic exercises

Therapeutic physical therapy exercises in one or more areas.

$49

97140

Manual therapy 1/> regions

Therapeutic exercises in which a physical therapist manipulates and moves the muscles or joints.

$46

G0283

Elec stim other than wound

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles for therapy other than wound care.

$22

97035

Ultrasound therapy

A procedure in which a physical therapist uses ultrasound technology to reduce pain.

$22

97014

Electric stimulation therapy

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles.

$24

97012

Mechanical traction therapy

A non-surgical procedure that treats lower back, neck, and radiating arm and leg pain.

$25

J0702

Betamethasone acet&sod phosp

Injection of betamethasone (brand name: Celestone Soluspan) to treat inflammation (swelling) and arthritis.

$11

J0586

Abobotulinumtoxina

Injection of abobotulinumtoxinA (brand name: Dysport) to treat muscle spasms.

$12

97162

Pt eval mod complex 30 min

30-minute evaluation of physical therapy treatment for a patient with moderate complexity.

$135

95911

Nrv cndj test 9-10 studies

Nine to 10 nerve conduction studies, which are used to evaluate the function of motor and sensory nerves.

$524

97010

Hot or cold packs therapy

Application of a hot or cold pack to one or more area.

$10

95886

Musc test done w/n test comp

A test in which a needle is inserted directly into a muscle (needle EMG) and records the muscle's electrical activity.

$205

97112

Neuromuscular reeducation

A therapeutic procedure to restore normal function of the nerves and muscles.

$56

62370

Anl sp inf pmp w/mdreprg&fil

Electronic analysis, reprogramming and refill of implanted pump used for epidural drug infusion.

$273

20552

Inj trigger point 1/2 muscl

A procedure used to treat muscle pain (one to two muscles).

$120

Surgery Center

CPT Code

Code Description

Explanation

Price

J0585

Injection,onabotulinumtoxina

Botox injection to treat muscle stiffness/spasm and migraines.

$10

43239

Egd biopsy single/multiple

A procedure used to examine the esophagus, stomach and the upper part of the small intestine with the removal of tissues (biopsy) for testing.

$943

45385

Colonoscopy w/lesion removal

A procedure used to examine the colon with the removal of polyps, tumors or other lesions.

$1,224

45380

Colonoscopy and biopsy

A procedure used to examine the colon with the removal of tissues (biopsy) for testing.

$1,122

43249

Esoph egd dilation <30 mm

A procedure to widen a narrowed esophagus, which often occurs as the result of acid reflux.

$2,872

45378

Diagnostic colonoscopy

A colonoscopy performed as the result of an abnormal test result, sign or symptom

$882

30140

Resect inferior turbinate

Partial or complete removal of the structures in your nose that cleans the air that passes through the nostrils into the lungs.

$825

69436

Create eardrum opening

Surgical opening of the eardrum and insertion of a ventilating tube.

$357

30520

Repair of nasal septum

A surgical procedure to correct a deviated septum, a condition in which the bone and cartilage that separates the nose is off center.

$1,398

29848

Wrist endoscopy/surgery

Surgical release of wrist ligament using an endoscope.

$1,134

29826

Shoulder arthroscopy/surgery

A minimally invasive procedure of the shoulder to treat shoulder impingement.

$1,473

19380

Revise breast reconstruction

Revision surgery after a breast reconstruction procedure

$1,768

29881

Knee arthroscopy/surgery

Minimally invasive knee surgery that involves shaving the meniscus and cartilage.

$1,363

42820

Remove tonsils and adenoids

Surgical removal of tonsils and adenoids, a patch of tissue in the back of the throat.

$593

Urgent Care

CPT Code

Code Description

Explanation

Price

J1885

Ketorolac tromethamine inj

Injection of a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of moderate to severe pain.

$16

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

J1100

Dexamethasone sodium phos

Injection of dexamethasone, a steroid used to treat inflammation (swelling).

J0696

Ceftriaxone sodium injection

Antibacterial injection used to treat infection.

$31

J2405

Ondansetron hcl injection

Injection of ondansetron (brand name: Zofran) to reduce nausea.

J0558

Peng benzathine/procaine inj

Injection of penicillin to treat moderate to severe bacterial infections.

$13

94640

Airway inhalation treatment

A procedure to treat the obstruction of airways or collect specimens for testing.

$47

J2550

Promethazine hcl injection

Injection of promethazine (brand names: Antinaus 50, Phenergan, Promacot, Prorex) to relieve or prevent allergic reactions.

93000

Electrocardiogram complete

Routine electrocardiogram (ECG or EKG) with interpretation.

$45

J3301

Triamcinolone acet inj nos

Injection of triamcinolone, a steroid that decreases inflammation (swelling).

90471

Immunization admin

A single immunization that does not involve face-to-face counseling.

$38

J7620

Albuterol ipratrop non-comp

Use of the medication albuterol ipratropium (brand name: DuoNeb) to treat wheezing and shortness of breath.

J1200

Diphenhydramine hcl injectio

Injection of diphenhydramine (brand name: Benadryl) to treat anaphylaxis (a life-threatening allergic reaction).

90715

Tdap vaccine 7 yrs/> im

A vaccine that prevents tetanus, diphtheria (bacterial infection of the nose and throat), and pertussis (whooping cough).

$55

A4565

Slings

A device to immobilize (support and keep still) injured parts of the body such as fractures or dislocations.

$19

12001

Rpr s/n/ax/gen/trnk 2.5cm/<

Treatment of a superficial (minor, occurring in the top layer of the skin) wound.

$267

J2300

Inj nalbuphine hydrochloride

An injection of nalbuphine hydrochloride (brand name: Nubain), which is a narcotic used to treat pain.

Urology

CPT Code

Code Description

Explanation

Price

J0585

Injection,onabotulinumtoxina

Botox injection to treat muscle stiffness/spasm and migraines.

$10

J9155

Degarelix injection

Injection of degarelix (brand name: Firmagon) to treat advanced prostate cancer.

51798

Us urine capacity measure

Measurement of bladder capacity (the maximum amount of urine the bladder can hold) using ultrasound technology.

$37

52000

Cystoscopy

Examination of the bladder and urethra using an endoscope, an instrument that allows a provider to look deep inside the body.

$434

J0696

Ceftriaxone sodium injection

Antibacterial injection used to treat infection.

$31

J3301

Triamcinolone acet inj nos

Steroid injection that decreases inflammation (swelling).

J0775

Collagenase, clost hist inj

Injection of collagenase (brand name: Xiaflex) to treat Peyronie's disease.

$52

J3480

Inj potassium chloride

Injection of potassium chloride used to treat low levels of potassium in the blood.

96372

Ther/proph/diag inj sc/im

Injections used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

$42

51741

Electro-uroflowmetry first

Electronic assessment of urine flow.

$211

52332

Cystoscopy and treatment

Examination of the bladder and urethra with the insertion of a stent, a tube that supports the urinary duct (ureter).

$1,277

A4358

Urinary leg or abdomen bag

A bag attached to the leg or abdomen that collects urine through a catheter, a thin tube that drains urine from the bladder.

$12

50590

Fragmenting of kidney stone

A procedure that uses shock wave to break up kidney stones into small pieces that can pass through the body.

$1,742

Wellness Center

CPT Code

Code Description

Explanation

Price

97803

Med nutrition indiv subseq

Reassessment of a nutrition therapy plan (used to manage chronic conditions through an individual nutrition plan).

$51

97802

Medical nutrition indiv in

Initial assessment and development of a nutrition therapy plan (used to manage chronic conditions through an individual nutrition plan).

$59

90471

Immunization admin

Administration of a single immunization that does not involve face-to-face counseling.

$38

90688

Iiv4 vaccine splt 0.5 ml im

A type of influenza (flu) vaccine designed to cause fewer reactions at the injection site (e.g., swelling, rash, etc.).

$22

7045026

Ct head/brain w/o dye

Physician interpretation of the results from a CT scan of head or brain without contrast material (a substance used to enhance visibility of the body's internal structures).

$123