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.