Fee Index

This is simply a more comprehensive fee schedule from Multiplan; a sample PPO plan. The reimbursement rates are for the San Francisco Bay area and will vary for different regions of the country,but it gives ball park values for the services listed. Also note: These are the fees paid to doctors and outpatient service centers. Hospitals are reimbursed on a totally different schedule (often by a seperate division of the company). I don’t currently have access to that information. (See Figure Here)

Billing Code Service (Test or Procedure) Expected Reimbursemnt

00100 Anesthesia Salivary Glands With Biopsy $47

11100 Biopsy, Skin/Subcut/Mucous Membrane; Single $133

12001 Simple Repair, Head/Neck/Trunk/Extrem, 2.5CM $122

17110 Destroy Flat Wart/Molluscum, Up to 14 $144

20610 Arthrocentesis Major Joint/Bursa $97

22554 Arthrodesis W/Mim Diskectomy, Below C2 Spine $1,428

22612 Arthrodesis, Posterior, Lumbar $1,796

22842 Posterior Instrumentation, 3-6 Vert Segs $853

22845 Anterior Instrumentation, 2-3 Vert Segments $812

22851 Apply Spinal Prosthetic Device $454

27447 Arthroplasty Knee, Total Replacement $1,776

29881 Knee Arthroscopy/Meniscectomy, Medial or Lat $756

29888 Arthroscopic Aided Repair Ant Cruc Ligament $1,148

30520 Septoplasty/Submucous Resection $769

33533 Cabg, Arterial, Single Arterial Graft $2,169

36415 Collect Venous Blood, Venipuncture $3

36561 Insrt Tunnel Cntrl Cvad Port; 5 yr /> $1,602

43239 Upper GI Endoscopy/EGD/Biopsy $447

43644 Lap Gastr Rstrc;Gastr Byps&Rouxeny $1,890

43770 Lap, Place Gastr Adjust Band $1,230

44970 Laparoscopy, Appendectomy $661

45378 Colonoscopy, Diagnostic $504

45380 Colonoscopy, Biopsy $603

45385 Colonoscopy, Remove Lesion W/Snare $674

47562 Laproscopy, W/Cholecystectomy $825

47563 Laproscopy, W/Cholecystectomy W/Cholangiogrp $832

58150 Total Hysterectomy $1,132

58563 Hysteroscopy, W/Endometrial Ablation $2,430

59400 Routine Obstetric Care, Vaginal Delivery $2,119

59510 Routine Obstetric Care, Cesarean Delivery $2,356

62311 Inject, Spine, Lumbar/Sacral, Epidur/Subarchn $261

63030 Lumbar Disk Surgery/Decompression $1,092

63047 Remove Lamina/Decompress Lumbar Spine, 1 Seg $1,239

63075 Remove Cervical Disk, Single $1,532

64483 Inject Transforamin Epidural, Lumb/Sacr, Sngl $319

66984 Remove Cataract, Insert Lens, Extracapsular $883

70486 CT Scan, Maxillofacial, W/O Contrast $344

70551 MRI of Brain, Stem, W/O Contrast $578

70553 MRIs of Brain, Stem, W/O Foll By W/Contrast $902

71020 X-Ray, Chest, Two Views, Frontal/Lateral $42

71260 CT Scan, Thorax, W/Contrast $431

72100 X-Ray Exam Lower Spine, 2-3 Views $55

72141 MRI, Cervical Spine, W/O Contrast $584

72146 MRI, Thoracic Spine, W/O Contrast $584

72148 MRI, Lumbar Spine, W/O Contrast $577

72156 MRI, Cervical Spine, W/O Foll By W/Contrast $914

72158 MRI, Lumbar Spine, W/O Foll By W/Contrast $902

72192 CT Scan of Pelvis, W/O Contrast $335

72193 CT Scan of Pelvis, W/Contrast $408

72194 CT Scans of Pelvis, W/O Foll By W/Contrast $526

73221 MRI, Upper Extremity Joint, W/O Contrast $571

73721 MRI, Lower Extremity Joint, W/O Contrast $571

74150 CT Scan, Abdomen, W/O Contrast $339

74160 CT Scan, Abdomen, W/Contrast $463

74170 CT Scans, Abdomen W/O Foll By W/Contrast $561

76700 Ultrasound, Abdomen, B-Scan/Real Time, Compl $184

76805 Ultrasound OB >14 Wk Single Fetus $195

76811 UltrasoundOBDetailed, Single Fetus $253

76830 Ultrasound, Transvaginal $171

76856 Ultrasound, Pelvis, Complete $170

77059 MRI, Both Breasts $860

77080 DXA Bone Density, Axial $133

77301 Radiotherapy Plan, Intensity Modulated $2,881

77334 Radiation Treatment Aid, Complex $203

77418 RadiationTherapyDel, Intensity Modulated $746

77427 Radiation Treatment Management, 5 Treatments $209

80048 Metabolic Panel, Basic $12

80050 General Health Panel $56

80053 Metabolic Panel, Comprehensive $15

80055 Obstetric Panel $82

80061 Lipid Panel $19

80074 Hepatitis Panel, Acute $68

80076 Hepatitis Function Panel $12

80101 Drug Screen, Qualitative, Single Class $33

81001 Urinalysis, Automated W/Microscopy $4

82306 Assay, Vitamin D (Calcifediol) $42

82542 Assay, Column Chromatography, Quan, Single $26

82607 Assay, Vitamin B-12 $21

82728 Assay, Ferritin $19

83036 Glycosylated Hemoglobin Assay $14

83898 Molecular Diagnostics, W/Amplification, Each $24

83904 Molecule Mutation Scan By Sequence $24

83925 Assay,Opiates $28

83970 Assay,Parathormone $59

84153 Assay, PSA, Total $26

84403 Assay, Blood Testosterone $37

84436 Assay, True Thyroxine $10

84439 Assay, Free Thyroxine $13

84443 Assay, Thyroid Stimulating Hormone $24

84480 Assay, Total Tridothyronine (TT-3) $20

84481 Assay, Free Triodothyronine (FT-3) $24

84702 Chorionic Gonadotropin Test $21

85025 Blood Count, Complete CBC W/Auto Diff WBC $11

86003 Allergen Specific IGE, Quantitative $7

86141 C-Reactive Protein, High Sensitivity $18

86703 HIV-1/HIV-2, Single Assay $19

87086 Urine Bacteria Culture, By Count $11

87491 Infect Antigen, Nucleic Chlaymdia Trach, Ampl $50

87591 Infect Antigen, Nucleic, Neisseria Gon, Ampl $50

87621 Infect Antigen, Nucleic, Papillomavirus, Ampl $50

87880 Infect Antigen, Immuno, Strep, Group A $13

88112 Cytopath Cellr Enhance No Cerv/Vag $131

88142 Cytopath, Cervical/Vaginal, Manual Screen $29

88175 Cytopath, Cerv/Vag, In Fluid, Auto, Redo $38

88185 Flow Cytometry TC Only; Ea Add Mrkr $72

88189 Flow Cytometry Interp; 16/>Markers $117

88237 Tissue Culture, Bone Marrow $180

88305 Tissue Exam By Pathologist, Level IV $142

88312 Special Stains, Group I $146

88313 Special Stains, Group II $108

88342 Immunocytochemistry, Each $138

88361 Morphomtric Analy;Tumr IHC Quan/Semi $202

88367 Morphomtric Analy Hybrid Ea; Cmpt $350

88368 Morphomtric Analy Hybrid Ea; Mnl $297

90471 Immunization Admin, 1 Vaccine $31

90649 H Papilloma Vacc 3 Dose IM $140

90669 Pneum Vac, Polyvalent, Intramusc, Under 5 yrs $88

90716 Chicken Pox Immunization $81

90801 Psychiatric Diagnostic Interview Exam $183

90805 Psychother, Indiv, Insight, 20-30 Min W/E/M $85

90806 Psychother, Indiv, Insight, 45-50 Min $97

90807 Psychother, Indiv, Insight, 45-50 Min W/E/M $116

90808 Psychother, Indiv, Insight, 75-80 Min $142

90847 Psychotherapy, Family, (Conjoint) W/Pt Present $121

90862 Psychiatric Medication Management $70

92004 Comprehensive Eye Exam, New Patient $175

92012 Intermediate Eye Exam, Established Patient $101

92014 Comprehensive Eye Examin, Established Patient $146

92980 Place Intracoronary Stent, First Vessel $966

93000 Electrocardiogram (Routine ECG), Complete $26

93010 Electrocardiogram (Routine ECG), Report Only $10

93015 Cardiovascular Stress Test, Complete $123

93226 ECG Monitor/24 Hrs, Real Time, Computer Report $59

93271 PT Demand ECG Recording, Monitoring/Analysis $301

93306 TTE W/Doppler, Complete $317

93307 ECG, Transthoracic, Heart, Complete $200

93325 Doppler Color Flow Velocity Mapping $50

93880 Extracranial Arteries Study, Duplex, Complete $255

95004 Allergy Skin Tests, Percutaneous $9

95165 Antigen Therapy Services, Single/Mult Antigen $17

95810 Polysomnography, 4+ Additional Parameters $959

95811 Polysomnography, 4+ Add’l Parameter, W/CPAP $1,037

95903 Nerve Conduction Test Ea Nerve Motor W/F-Wave $91

95904 Nerve Conduction Test, Ea Nerve, Sensory $71

96372 Ther/Proph/Diag Inj, SC/IM $31

96413 Chemo, IV Infusion, 1 Hr $205

97001 Physical Therapy Evaluation $88

97010 Apply Modality, 1 or More Areas, Hot/Cold Pack $7

97012 Apply Modality, 1 or More Areas, Traction, Mech $19

97014 Apply Modality, 1 or More Areas, Elect Stim $18

97032 Apply Modality, Elec Stimulation, Ea 15 Min $22

97035 Apply Modality, Ultrasound, Ea 15 Min $14

97110 Tx Proc, 1+ Areas, Tx Exercise, Ea 15 Min $37

97112 Tx Pro, 1+ Areas, Neuro Reducate, Ea 15 Min $39

97140 Manual Therapy, 1+ Regions, Each 15 Min $34

97530 Therapeutic Activities, Direct PT, Ea 15 Min $41

98940 CMT, Spinal, 1-2 Regions $31

98941 CMT, Spinal, 3-4 Regions $42

98942 CMT, Spinal, 5 Regions $54

98943 CMT, Extraspinal, On or More Regions $29

99202 Office/Outpatient Visit, New, Expanded Prob $88

99203 Office/Outpatient Visit, New, Detailed $126

99204 Office/Outpatient Visit, New, Mod Complex $190

99205 Office/Outpatient Visit, New, High Complex $235

99211 Office/Outpatient Visit, Est, Minimal $26

99212 Office/Outpatient Visit, Est, Prob Foc $52

99213 Office/Outpatient Visit, Est, Exp Prob $85

99214 Office/Outpatient Visit, Est, Detailed $125

99215 Office/Outpatient Visit, Est, High Complex $167

99222 InitialHospitalCare, Mod Complex $151

99223 InitialHospitalCare, High Complex $222

99231 Subsequent Hospital Care, Low Complex $44

99232 Subsequent Hospital Care, Mod Complex $80

99233 Subsequent Hospital Care, High Complex $115

99238 Hospital Discharge Day Mgmt, <30 Min $81

99239 Hospital Discharge Day Mgmt, >30 Min $119

99242 Office Consultation, Exp Prob $105

99243 Office Consultation, Low Complex $143

99244 Office Consultation, Mod Complex $210

99245 Office Consultation, High Complex $255

99253 Initial Inpatient Consult, Low Complex $126

99254 Initial Inpatient Consult, Mod Complex $183

99255 Initial Inpatient Consult, High Complex $220

99282 Emergency Dept Visit, Low Complex $45

99283 Emergency Dept Visit, Exp Prob $68

99284 Emergency Dept Visit, Detailed $127

99285 Emergency Dept Visit, High Complex $187

99291 Critical Care, E&M, First 30-74 Min $313

99385 Preventive Checkup, New, 18-39 Yrs $136

99386 Preventive Checkup, New, 40-64 Yrs $157

99391 Preventive Checkup, Est, Infant $99

99392 Preventive Checkup, Est, 1-4 Yrs $109

99393 Preventive Checkup, Est, 5-11 Yrs $109

99395 Preventive Checkup, Est, 18-39 Yrs $119

99396 Preventive Checkup, Est, 40-64 Yrs $129

99468 Neonate Crit Care, Initial $1,015

99469 Neonate Crit Care, Subsq $450

99472 Ped Critical Care, Subsq $446

99479 IC LBW INF 1500-2500 G Subsq $145

99480 IC INF PBW 2501-5000 G Subsq $134

A4353 Intermittent Urinary Catheter $7

G0202 Screen Mammogram, Digital $191

G0283 Elec Stim Other Than Wound $16

J0256 Alpha 1-Proteinase, Per 500 mg, Inj $4

J0696 Ceftriaxone Sodium, Per 250 mg, Inj $1

J0878 Daptomycin Injection $.50

J1561 Immune Globulin, IV, 500 mg, Inject $38

J1562 Immune Globulin, IV, 5 gm, Inject $7

J1566 Immune Globulin, Powder $31

J1568 Inj IG Octogam IV Nonlyo 500 mg $36

J1569 Inj IG Gammagard IV Nonlyo 500 mg $39

J1745 Infliximab Injection $61

J2323 Injection Natalizumab 1 mg $10

J2469 Palonosetron HCL $19

J2505 Injection Pegfilgrastim 6 mg $2,544

J3487 Zoledronic Acid $223

J7187 Inj Vonwillbrnd FCT Complx Humn IU $1

J7192 Factor VIII Recombinant $1

J9035 Bevacizumab Injection $60

J9045 Carboplatin, 50 mg $4

J9055 Cetuximab Injection $50

J9201 Gemcitabine HCL, 200 mg $152

J9263 Injection Oxaliplatin 0.5 mg $9

J9265 Paclitaxel, 30 mg $7

J9310 Rituximab Cancer Treatment 100 mg $595

J9355 Trastuzumab $68

Q9967 Locm 300GC0399 mg/ml 1 conc per ml $.17

This fee schedule was sent to me by Multiplan. They are a PPO insurance (A prefered provider network, whatever that is) and this schedule was used for my example rates for private insurance. It’s a good representative of what most plans pay. I don’t know why they sent me this schedule but, without it, this website probably wouldn’t have been possible (See Figure Here)

The Medicare rates can be obtained from their website, which gives the reimbursement rate for each service for each region in theUS.

As I’ve said many times in this report, all of these rates vary substantially from plan to plan in order to confuse everyone but this was as close as I could ever come to real information so here it is.