POS | CPT | Description | MCR Allowed | Coins 20% | Comment |
Hospital | 43200 | ESPHGSC RGD/FLX DX +-COLLJ SPEC BR/WA SPX | $154.12 | $30.82 | |
Hospital | 43202 | ESPHGSC RGD/FLX W/BX 1/MLT | $201.91 | $40.38 | |
Hospital | 43235 | UPPER STOMACH-INTESTINE SCOPE FOR DIAGNOSIS | $216.25 | $43.25 | |
Hospital | 43239 | UPPER STOMACH-INTESTINE SCOPE FOR BIOPSY | $251.15 | $50.23 | |
Hospital | 43244 | UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARC | $233.67 | $46.73 | |
Hospital | 43245 | UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ | $148.87 | $29.77 | |
Hospital | 43246 | UPR GI NDSC DIRED PLMT PRQ GASTROSTOMY TUBE | $200.27 | $40.05 | |
Hospital | 43247 | STOMACH-INTESTINE SCOPE FOR FOREIGN BODY REMOVAL | $158.62 | $31.72 | |
Hospital | 43248 | UPR GI NDSC INSJ GD WIRE DILAT ESOPH > GD WIRE | $149.24 | $29.85 | |
Hospital | 43249 | UPR GI NDSC BALO DILAT ESOPH < 30 MM DIAM | $137.62 | $27.52 | |
Hospital | 43250 | UPR GI NDSC RMVL LES HOT BX/BIPOLAR CAUT | $149.64 | $29.93 | |
Hospital | 43251 | UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ | $172.38 | $34.48 | |
Hospital | 43255 | UPR GI NDSC CTRL BLD ANY METH | $223.14 | $44.63 | |
Hospital | 43260 | ERCP DX COLLJ SPEC BR/WA SPX | $274.63 | $54.93 | |
Hospital | 43261 | ERCP W/BX 1/MLT | $288.88 | $57.78 | |
Hospital | 43262 | ERCP W/SPHNCTROTOMY/PAPILLOTOMY | $338.80 | $67.76 | |
Hospital | 43271 | ERCP W/BALO DILAT AMPULLA BILIARY&/PNCRTC DUX | $339.02 | $67.80 | |
Hospital | 43760 | SURGICAL CHANGE OF STOMACH TUBE | $255.50 | $51.10 | |
Hospital | 44360 | SCOPE OF UPPER SMALL INTESTINE | $123.90 | $24.78 | |
Hospital | 44376 | ENTEROSCOPY > 2ND PRTN W/ILE +-COLLJ SPEC SPX | $241.07 | $48.21 | |
Hospital | 44378 | ENTEROSCOPY > 2ND PRTN ILE CTRL BLD | $326.38 | $65.28 | |
Hospital | 44388 | SCOPE OF COLON THRU OSTOMY FOR DIAGNOSIS | $251.02 | $50.20 | |
Hospital | 44389 | SCOPE OF COLON WITH BIOPSY THRU OSTOMY | $287.53 | $57.51 | |
Hospital | 45330 | DIAGNOSTIC SIGMOIDOSCOPY | $97.75 | $19.55 | |
Hospital | 45331 | SIGMOIDOSCOPY AND BIOPSY | $122.63 | $24.53 | |
Hospital | 45334 | SGMDSC FLX CTRL BLD | $129.06 | $25.81 | |
Hospital | 45338 | SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ | $277.71 | $55.54 | |
Hospital | 45339 | SGMDSC FLX ABLTJ LES | $241.69 | $48.34 | |
Hospital | 45378 | SCOPE OF COLON FOR DIAGNOSIS | $289.36 | $57.87 | |
Hospital | 45379 | COLSC FLX PROX SPLENIC FLXR RMVL FB | $367.68 | $73.54 | |
Hospital | 45380 | SCOPE OF COLON WITH BIOPSY | $346.29 | $69.26 | |
Hospital | 45381 | COLSC FLX PROX SPLENIC FLXR SBMCSL NJX | $335.83 | $67.17 | |
Hospital | 45382 | COLSC FLX PROX SPLENIC FLXR CTRL BLD | $453.60 | $90.72 | |
Hospital | 45384 | COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT | $344.18 | $68.84 | |
Hospital | 45385 | COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ | $391.52 | $78.30 | |
Hospital | 45386 | COLSC FLX PROX SPLENIC FLXR DILAT BALO 1+ STRIXS | $474.25 | $94.85 | |
Hospital | 46221 | HEMORRHOIDECTOMY SMPL LIGATURE | $178.28 | $35.66 | |
Hospital | 46500 | NJX SCLRSG SLN HEMORRHOIDS | $149.28 | $29.86 | |
Hospital | 46930 | Destruction of internal hemorrhoid(s) by therma | $142.76 | $28.55 | |
Hospital | 99223 | 1ST HOSP CARE PR D 70 MIN | $148.40 | $29.68 | |
Hospital | 99232 | SBSQ HOSP CARE PR D 25 MIN | $53.82 | $10.76 | |
Hospital | 99233 | SBSQ HOSP CARE PR D 35 MIN | $77.20 | $15.44 | |
Hospital | 99238 | HOSP DSCHRG D MGMT 30 MIN/< | $52.69 | $10.54 | |
Hospital | 99252 | Inpatient consultation low severity | $0.00 | Invalid CPT for the year 2010 | |
Hospital | 99253 | 1ST INPT CONSLTJ 55 MIN | $0.00 | Invalid CPT for the year 2010 | |
Hospital | 99254 | 1ST INPT CONSLTJ 80 MIN | $0.00 | Invalid CPT for the year 2010 | |
Hospital | 99283 | EMER DEPT MODERATE SEVERITY | $48.66 | $9.73 | |
Hospital | G0121 | Screening Colonoscopy (low risk) | $281.04 | $56.21 |
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