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.