Medical Procedure Costs

90937

Hemodialysis repeated eval

Other

$89

—

90945

Dialysis one evaluation

Other

$77

—

90947

Dialysis repeated eval

Other

$106

—

90951

Esrd serv 4 visits p mo <2yr

Other

$1,184

—

90954

Esrd serv 4 vsts p mo 2-11

Other

$1,034

—

90955

Esrd srv 2-3 vsts p mo 2-11

Other

$538

—

90956

Esrd srv 1 visit p mo 2-11

Other

$367

—

90957

Esrd srv 4 vsts p mo 12-19

Other

$797

—

90958

Esrd srv 2-3 vsts p mo 12-19

Other

$519

—

90959

Esrd serv 1 vst p mo 12-19

Other

$339

—

90960

Esrd srv 4 visits p mo 20+

Other

$373

—

90961

Esrd srv 2-3 vsts p mo 20+

Other

$311

—

90962

Esrd serv 1 visit p mo 20+

Other

$215

—

90963

Esrd home pt serv p mo <2yrs

Other

$626

—

90964

Esrd home pt serv p mo 2-11

Other

$534

—

90965

Esrd home pt serv p mo 12-19

Other

$516

—

90966

Esrd home pt serv p mo 20+

Other

$310

—

90967

Esrd svc pr day pt <2

Other

$18

—

90968

Esrd svc pr day pt 2-11

Other

$18

—

90969

Esrd svc pr day pt 12-19

Other

$17

—

90970

Esrd svc pr day pt 20+

Other

$10

—

90997

Hemoperfusion

Other

$76

—

91010

Esophagus motility study

Gastroenterology

$246

—

91013

Esophgl motil w/stim/perfus

Gastroenterology

$28

—

91020

Gastric motility studies

Gastroenterology

$309

—

91022

Duodenal motility study

Gastroenterology

$194

—

91030

Acid perfusion of esophagus

Gastroenterology

$163

—

91034

Gastroesophageal reflux test

Gastroenterology

$202

—

91035

G-esoph reflx tst w/electrod

Gastroenterology

$502

—

91037

Esoph imped function test

Gastroenterology

$187

—

91038

Esoph imped funct test > 1hr

Gastroenterology

$446

—

91040

Esoph balloon distension tst

Gastroenterology

$577

—

91065

Breath hydrogen/methane test

Gastroenterology

$64

—

91110

Gi trc img intral esoph-ile

Gastroenterology

$802

—

91111

Gi trc img intral esophagus

Gastroenterology

$957

—

91112

Gi wireless capsule measure

Gastroenterology

$1,767

—

91113

Gi trc img intral colon i&r

Gastroenterology

$985

—

91117

Colon motility 6 hr study

Gastroenterology

$122

—

91124

Rct snsatn tone&cmplianc std

Gastroenterology

$769

—

91125

Anrct mano rct snsatn&balo

Gastroenterology

$347

—

91132

Electrogastrography

Gastroenterology

$486

—

91133

Electrogastrography w/test

Gastroenterology

$508

—

91200

Liver elastography

Gastroenterology

$34

—

92002

Intrm oph exam new patient

Ophthalmology

$38

—

92004

Compre oph exam new pt 1/>

Ophthalmology

$78

—

92012

Intrm oph exam est patient

Ophthalmology

$41

—

92014

Compre oph exam est pt 1/>

Ophthalmology

$62

—

92018

Compl oph exam general anes

Ophthalmology

$113

—

92019

Lmtd oph exam general anes

Ophthalmology

$59

—

92020

Gonioscopy

Ophthalmology

$16

—

My Cost List