Medical Procedure Pricing - Patient Resources

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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.

Note: Drug/injection prices are listed per unit.

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

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 is a simple visit that may not require the presence of a physician. 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)	$82	99211 (Level 1)	$40
99202 (Level 2)	$138	99212 (Level 2)	$81
99203 (Level 3)	$197	99213 (Level 3)	$134
99204 (Level 4)	$300	99214 (Level 4)	$197
99205 (Level 5)	$377	99215 (Level 5)	$265

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.

$248

G0402

Initial preventive exam

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

$311

G0438

Ppps, initial visit

Initial Annual Wellness Visit, the first yearly appointment to create a patient's personalized prevention plan.

$312

G0439

Ppps, subseq visit

Subsequent Annual Wellness Visits, yearly follow-up appointments to discuss and adjust a patient's personalized prevention plan (initial appointment).

$210

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 (Level 2).

$134

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 (Level 1).

$73

99239

Hospital discharge day

Management of patient health on hospital discharge day.

$197

90662

Iiv no prsv increased ag im

Preservative-free, high-dose Fluzone (influenza) vaccine.

$68

G0008

Admin influenza virus vac

Administration of influenza (flu) vaccine

$19

J1030

Methylprednisolone 40 mg inj

Methylprednisolone injection (brand names: A-Methapred, Depo-Medrol, SoluMEDROL) 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 (Level 3).

$373

20610

Drain/inj joint/bursa w/o us

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

$153

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

Percutaneous (through the skin) 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.

$31

95117

Immunotherapy injections

Multiple immunotherapy injections. 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

Intradermal (between layers of skin) 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

Therapeutic, prophylactic and diagnostic injections and infusions 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.

$45

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

93000

Electrocardiogram complete

Routine electrocardiogram (ECG or EKG) with interpretation.

$45

93224

Ecg monit/reprt up to 48 hrs

Electrocardiographic monitoring for 24 hours using a holter monitor (with physician review and interpretation).

$285

93306

Tte w/doppler complete

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

$526

93880

Extracranial bilat study

Ultrasound scanning of blood flow in the extracranial arteries (outside the brain) on both sides of head and neck.

$551

93015

Cardiovascular stress test

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

$206

78452

Ht muscle image spect mult

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

$1,322

93970

Extremity study

Ultrasound study of the veins in the arms and legs to detect venous insufficiency or deep vein thrombosis (DVT).

$536

93923

Upr/lxtr art stdy 3+ lvls

Ultrasound study of the veins in the arms and legs (3 levels).

$400

93281

Pm device progr eval multi

Evaluation, testing and programming adjustment of pacemaker with physician analysis, review and report.

$165

93284

Prgrmg eval implantable dfb

Evaluation, testing and programming adjustment of defibrillator with physician analysis, review and report.

$219

Dermatology

CPT Code

Code Description

Explanation

Price

17003

Destruct premalg les 2-14

Destruction of 2-14 pre-cancerous skin lesions (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 lesion (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.

$197

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 skin lesions (abnormalities) on the skin for cosmetic or treatment purposes under local anesthesia.

$215

8830526

Tissue exam by pathologist

Interpretation of results from a pathologist tissue exam.

$82

17311

Mohs 1 stage h/n/hf/g

Mohs micrographic surgery, a procedure that involves removing one layer of skin cancer at a time for immediate examination of cancer cells.

$1,211

J3301

Triamcinolone acet inj nos

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

17312

Mohs addl stage

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

$716

Endocrinology

CPT Code

Code Description

Explanation

Price

77080

Dxa bone density axial

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

$222

95251

Cont gluc mntr analysis i&r

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

$79

76536

Us exam of head and neck

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

$315

76942

Echo guide for biopsy

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

$322

95250

Cont gluc mntr phys/qhp eqp

Continuous glucose monitoring, including sensor placement, patient training, calibration, removal and downloading data from the monitor.

$313

96372

Ther/proph/diag inj sc/im

Therapeutic, prophylactic and diagnostic injections and infusions 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

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

$88

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.

$187

92567

Tympanometry

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

$34

J0696

Ceftriaxone sodium injection

Antibacterial injection used to treat infection.

$31

92504

Ear microscopy examination

Examination of the ear using a microscope.

$61

42826

Removal of tonsils

Surgical removal of tonsils.

$527

69436

Create eardrum opening

Surgical opening of the eardrum and insertion of a ventilating tube, called a tympanostomy.

$1,179

30901

Control of nosebleed

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

$308

42820

Remove tonsils and adenoids

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

$2,180

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.

$1,401

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

Therapeutic, prophylactic and diagnostic injections and infusions 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 (Level 1).

$73

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.

$23

90472

Immunization admin each add

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

$23

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

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

$30

J1100

Dexamethasone sodium phos

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

85651

Rbc sed rate nonautomated

Red blood cell sedimentation test, 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

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

$1462

43239

Egd biopsy single/multiple

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

$999

45380

Colonoscopy and biopsy

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

$1,734

45385

Colonoscopy w/lesion removal

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

$ 2,058

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

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

$1,220

99232

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making (Level 2).

$134

99233

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring high-complexity medical decision making (Level 3).

$192

99222

Initial hospital care

Initial evaluation of a patient in the hospital requiring moderately complex medical decision making and a comprehensive exam (Level 2).

$253

G0121

Colon ca scrn not hi rsk ind

Screening colonoscopy, 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 (lower back) without contrast material (a substance used to enhance visibility of the body's internal structures).

$877

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).

$792

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).

$787

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).

$810

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).

$629

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).

$1,646

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).

$490

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).

$877

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).

$300

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).

$354

72195TC

Mri pelvis w/o dye

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

$801

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).

$714

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).

$843

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).

$405

77290TC

Set radiation therapy field

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

$1,114

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).

$320

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).

$798

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 (Level 3).

$192

96372

Ther/proph/diag inj sc/im

Therapeutic, prophylactic and diagnostic injections and infusions 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

Depo-Provera injection, 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 (influenza) vaccine.

$68

G0008

Admin influenza virus vac

Administration of influenza (flu) vaccine.

$19

77080

Dxa bone density axial

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

$222

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.

$55

90688

Iiv4 vaccine splt 0.5 ml im

Split virus influenza vaccine, 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.

$166

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

Complete blood count, A blood test used to evaluate overall health.

$16

80053

Comprehen metabolic panel

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

$23

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

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

$35

84439

Assay of free thyroxine

Free T4 test, a blood test that is used to help diagnose conditions of the thyroid.

$18

83036

Glycosylated hemoglobin test

A1c 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

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

$11

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

Basic metabolic panel, a blood test that measures blood sugar levels, electrolyte and fluid balance, and kidney function.

$18

84153

Assay of psa total

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

$38

83615

Lactate (ld) (ldh) enzyme

LDH test, 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

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

$30

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

Ferritin test, 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.

$16

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.

$524

99233

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring high-complexity medical decision making (Level 3).

$192

99232

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making (Level 2).

$134

90935

Hemodialysis one evaluation

Hemodialysis with a single physician evaluation.

$136

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.

$439

90966

Esrd home pt serv p mo 20+

Monthly home dialysis services.

$437

99223

Initial hospital care

Initial evaluation of a patient in the hospital requiring complex medical decision making and a comprehensive exam (Level 3).

$373

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

Inactivated influenza (flu) vaccine, a vaccine made from killed flu viruses.

$72

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

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

$207

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

Chemodenervation, an injection procedure for the purposes of treating chronic migraines.

$331

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

Occipital nerve block, an injection into the occipital nerves (located above the neck) to treat chronic headaches.

$254

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.

$93

76811

Ob us detailed sngl fetus

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

$489

76856

Us exam pelvic complete

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

$298

76816

Ob us follow-up per fetus

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

$309

96372

Ther/proph/diag inj sc/im

Therapeutic, prophylactic and diagnostic injections and infusions 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).

$56

58301

Remove intrauterine device

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

$197

76815

Ob us limited fetus(s)

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

$230

90686

Iiv4 vacc no prsv 0.5 ml im

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

$23

Oncology

CPT Code

Code Description

Explanation

Price

J1439

Inj ferric carboxymaltos 1mg

Injection of ferric carboxymaltose (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.

$26

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).

$37

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.

$87

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.

$1,318

92136

Ophthalmic biometry

Biometry eye test, a test that measures the shape and size of the eye.

$136

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.

$138

66821

After cataract laser surgery

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

$669

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.

$153

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.

$118

73630

X-ray exam of foot

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

$89

73030

X-ray exam of shoulder

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

$90

73562

X-ray exam of knee 3

X-ray examination of the knee with three views.

$106

73140

X-ray exam of finger(s)

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

$96

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.

$89

73502

X-ray exam hip uni 2-3 views

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

$122

73610

X-ray exam of ankle

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

$94

72100

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

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

$103

20552

Inj trigger point 1/2 muscl

Trigger point injection, a procedure used to treat muscle pain (one to two muscles).

$120

20550

Inj tendon sheath/ligament

Tendon sheath and ligament injection, a procedure used to treat pain, caused by inflammation (swelling) or disease, in the structures surrounding tendons and joints.

$116

64483

Inj foramen epidural l/s

Epidural injection into the spine using the guidance of imaging technology

$746

73110

X-ray exam of wrist

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

$105

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.

$109

Physical Therapy

CPT Code

Code Description

Explanation

Price

97110

Therapeutic exercises

Therapeutic physical therapy exercises in one or more areas.

$56

97010

Hot or cold packs therapy

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

$12

97140

Manual therapy 1/> regions

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

$51

97530

Therapeutic activities

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

$72

97161

Pt eval low complex 20 min

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

$154

97014

Electric stimulation therapy

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles (sometimes called E-stim)

$27

97022

Whirlpool therapy

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

$33

97113

Aquatic therapy/exercises

Exercises performed in water for physical rehabilitation.

$70

G0283

Elec stim other than wound

Non-wound care electrical Stimulation (E-stim), a therapy in which electrodes are applied to the skin, sending electric pulses to the muscles for therapy other than wound care.

$26

97162

Pt eval mod complex 30 min

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

$154

97035

Ultrasound therapy

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

$25

97535

Self care mngment training

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

$62

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

IMRT (intensity modulated radiation therapy), 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.

$183

A9606

Radium ra223 dichloride ther

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

$370

77427

Radiation tx management x5

Management of five courses of radiation treatment.

$540

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

Screening mammogram, a test used to detect breast cancer in women using radiographic (X-ray) technique.

$151

77067

Scr mammo bi incl cad

Screening 3D mammogram, a 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.

$372

7706726

Scr mammo bi incl cad

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

$109

7706326

Breast tomosynthesis bi

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

$85

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).

$121

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).

$919

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).

$981

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).

$888

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).

$914

76705

Echo exam of abdomen

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

$248

7685626

Us exam pelvic complete

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

$97

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).

$246

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).

$1,799

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.

$294

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.

$56

97140

Manual therapy 1/> regions

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

$51

G0283

Elec stim other than wound

Non-wound care electrical Stimulation (E-stim), a therapy in which electrodes are applied to the skin, sending electric pulses to the muscles for therapy other than wound care.

$26

97035

Ultrasound therapy

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

$25

97014

Electric stimulation therapy

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles (sometimes called E-stim)

$27

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.

$154

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.

$12

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.

$207

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

Trigger point injection, a procedure used to treat muscle pain (one to two muscles).

$120

Surgery Center

CPT Code

Code Description

Explanation

Price

43239

Egd biopsy single/multiple

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

$999

45385

Colonoscopy w/lesion removal

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

$ 2,058

45380

Colonoscopy and biopsy

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

$1,734

43249

Esoph egd dilation <30 mm

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

$1,220

45378

Diagnostic colonoscopy

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

$1462

30140

Resect inferior turbinate

Turbinate reduction surgery, the partial or complete removal of the structures in your nose that cleans the air that passes through the nostrils into the lungs.

$727

69436

Create eardrum opening

Surgical opening of the eardrum and insertion of a ventilating tube, called a tympanostomy.

$1,179

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.

$1,401

29848

Wrist endoscopy/surgery

Surgical release of wrist ligament using an endoscope.

$2,529

29826

Shoulder arthroscopy/surgery

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

$1,421

19380

Revise breast reconstruction

Revision surgery after a breast reconstruction procedure

$3,924

29881

Knee arthroscopy/surgery

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

$1,309

42820

Remove tonsils and adenoids

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

$2,180

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

Therapeutic, prophylactic and diagnostic injections and infusions 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.

$15

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

Nebulizer treatment, 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

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

$56

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.

$33

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.

$65

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

Therapeutic, prophylactic and diagnostic injections and infusions 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 (cystoscopy) with the insertion of a stent, a tube that supports the urinary duct (ureter).

$1,277

A4358

Urinary leg or abdomen bag

Urinary drainage 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 waves to break up kidney stones into small pieces that can pass through the body, called lithroscopy.

$1,742

Wellness Center

CPT Code

Code Description

Explanation

Price

97803

Med nutrition indiv subseq

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

$58

97802

Medical nutrition indiv in

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

$67

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

Split virus influenza vaccine, 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).

$121