Medical Procedure Costs

99152

Mod sed same phys/qhp 5/>yrs

Other

$11

—

99153

Mod sed same phys/qhp ea

Other

$12

—

99155

Mod sed oth phys/qhp <5 yrs

Other

$82

—

99156

Mod sed oth phys/qhp 5/>yrs

Other

$71

—

99157

Mod sed other phys/qhp ea

Other

$54

—

99170

Anogenital exam child w imag

Other

$72

—

99175

Induction of vomiting

Other

$46

—

99183

Hyperbaric oxygen therapy

Other

$110

—

99184

Hypothermia ill neonate

Other

$184

—

99195

Phlebotomy

Other

$98

—

99202

Office o/p new sf 15 min

Evaluation & Management

$41

—

99203

Office o/p new low 30 min

Evaluation & Management

$71

—

99204

Office o/p new mod 45 min

Evaluation & Management

$117

—

99205

Office o/p new hi 60 min

Evaluation & Management

$160

—

99207001010

LOPROX 1% SHAMPOO

Prescription Drug - Brand

$6

—

99207013070

METROGEL-VAGINAL 0.75% GEL

Prescription Drug - Brand

$4

—

99207017105

MINITRAN 0.2 MG/HR PATCH

Prescription Drug - Brand

$4

—

99207026012

ALDARA 5% CREAM

Prescription Drug - Brand

$75

—

99207027028

ZYCLARA 3.75% CREAM

Prescription Drug - Brand

$36

—

99207027175

ZYCLARA 3.75% CREAM PUMP

Prescription Drug - Brand

$158

—

99207027675

ZYCLARA 2.5% CREAM PUMP

Prescription Drug - Brand

$158

—

99207030060

ZIANA GEL

Prescription Drug - Brand

$11

—

99207046330

SOLODYN ER 65 MG TABLET

Prescription Drug - Brand

$40

—

99207046430

SOLODYN ER 115 MG TABLET

Prescription Drug - Brand

$39

—

99207046530

SOLODYN ER 55 MG TABLET

Prescription Drug - Brand

$39

—

99207046630

SOLODYN ER 80 MG TABLET

Prescription Drug - Brand

$39

—

99207046730

SOLODYN ER 105 MG TABLET

Prescription Drug - Brand

$39

—

99207052560

VANOS 0.1% CREAM

Prescription Drug - Brand

$27

—

99207085060

LUZU 1% CREAM

Prescription Drug - Brand

$8

—

99211

Off/op est may x req phy/qhp

Evaluation & Management

$8

—

99212

Office o/p est sf 10 min

Evaluation & Management

$31

—

99213

Office o/p est low 20 min

Evaluation & Management

$57

—

99214

Office o/p est mod 30 min

Evaluation & Management

$85

—

99215

Office o/p est hi 40 min

Evaluation & Management

$126

—

99221

1st hosp ip/obs sf/low 40

Evaluation & Management

$74

—

99222

1st hosp ip/obs moderate 55

Evaluation & Management

$117

—

99223

1st hosp ip/obs high 75

Evaluation & Management

$156

—

99231

Sbsq hosp ip/obs sf/low 25

Evaluation & Management

$44

—

99232

Sbsq hosp ip/obs moderate 35

Evaluation & Management

$70

—

99233

Sbsq hosp ip/obs high 50

Evaluation & Management

$107

—

99234

Hosp ip/obs sm dt sf/low 45

Evaluation & Management

$88

—

99235

Hosp ip/obs same date mod 70

Evaluation & Management

$143

—

99236

Hosp ip/obs same date hi 85

Evaluation & Management

$190

—

99238

Hosp ip/obs dschrg mgmt 30/<

Evaluation & Management

$75

—

99239

Hosp ip/obs dschrg mgmt >30

Evaluation & Management

$107

—

99281

Emr dpt vst mayx req phy/qhp

Evaluation & Management

$11

—

99282

Emergency dept visit sf mdm

Evaluation & Management

$40

—

99283

Emergency dept visit low mdm

Evaluation & Management

$69

—

99284

Emergency dept visit mod mdm

Evaluation & Management

$118

—

99285

Emergency dept visit hi mdm

Evaluation & Management

$171

—

My Cost List