99381
INIT PM E/M NEW PAT INFANT
No
No
Yes
FLAT RC
No
86.72
N/A
2/1/2015
N/A
8
99382
INIT PM E/M NEW PAT 1-4 YRS
No
No
Yes
FLAT RC
No
93.36
N/A
2/1/2015
N/A
6
99383
PREV VISIT NEW AGE 5-11
No
No
Yes
FLAT RC
No
91.46
N/A
2/1/2015
N/A
6
99384
PREV VISIT NEW AGE 12-17
No
No
Yes
FLAT RC
No
99.37
N/A
2/1/2015
N/A
2
99385
PREV VISIT NEW AGE 18-39
No
No
Yes
FLAT RC
No
99.37
N/A
2/1/2015
N/A
1
99386
PREV VISIT NEW AGE 40-64
No
No
Yes
FLAT RC
No
117.1
N/A
2/1/2015
N/A
1
99387
INIT PM E/M NEW PAT 65+ YRS
No
No
Yes
FLAT RC
No
126.92
N/A
2/1/2015
N/A
1
99391
PER PM REEVAL EST PAT INFANT
No
No
Yes
FLAT RC
No
65.83
N/A
2/1/2015
N/A
8
99392
PREV VISIT EST AGE 1-4
No
No
Yes
FLAT RC
No
73.74
N/A
2/1/2015
N/A
6
99393
PREV VISIT EST AGE 5-11
No
No
Yes
FLAT RC
No
72.79
N/A
2/1/2015
N/A
6
99394
PREV VISIT EST AGE 12-17
No
No
Yes
FLAT RC
No
80.39
N/A
2/1/2015
N/A
2
99395
PREV VISIT EST AGE 18-39
No
No
Yes
FLAT RC
No
81.34
N/A
2/1/2015
N/A
1
99396
PREV VISIT EST AGE 40-64
No
No
Yes
FLAT RC
No
89.89
N/A
2/1/2015
N/A
1
99397
PER PM REEVAL EST PAT 65+ YR
No
No
Yes
FLAT RC
No
99.06
N/A
2/1/2015
N/A
1
93000
ELECTROCARDIOGRAM COMPLETE
No
No
Yes
FLAT RC
No
16.39
N/A
2/1/2015
N/A
1
93005
ELECTROCARDIOGRAM TRACING
No
No
Yes
FLAT RC
No
7.24
N/A
2/1/2015
N/A
1
93010
ELECTROCARDIOGRAM REPORT
No
No
Yes
FLAT RC
No
9.15
N/A
2/1/2015
N/A
1
EKG FOR INITIAL PREVENT EXAM
No
No
No
FLAT RC
N/A
16.39
N/A
N/A
N/A
1
EKG TRACING FOR INITIAL PREV
No
No
No
FLAT RC
N/A
7.24
N/A
N/A
N/A
1
EKG INTERPRET & REPORT PREVE
No
No
No
FLAT RC
N/A
9.15
N/A
N/A
N/A
1
80048
METABOLIC PANEL TOTAL CA
No
No
Yes
PC
Yes
8.46
N/A
N/A
1
80050
GENERAL HEALTH PANEL
No
No
Yes
PC
No
50.04
N/A
1/1/2014
N/A
1
80051
ELECTROLYTE PANEL
No
No
Yes
PC
Yes
7.01
N/A
N/A
1
80053
COMPREHEN METABOLIC PANEL
No
No
Yes
PC
Yes
10.56
N/A
N/A
1
82040
ASSAY OF SERUM ALBUMIN
No
No
Yes
PC
Yes
4.95
N/A
N/A
1
82247
BILIRUBIN TOTAL
No
No
Yes
PC
Yes
5.02
N/A
N/A
1
82310
ASSAY OF CALCIUM
No
No
Yes
PC
Yes
5.16
N/A
N/A
1
82374
ASSAY BLOOD CARBON DIOXIDE
No
No
Yes
PC
Yes
4.7
N/A
N/A
1
82435
ASSAY OF BLOOD CHLORIDE
No
No
Yes
PC
Yes
4.6
N/A
N/A
1
82550
ASSAY OF CK (CPK)
No
No
Yes
PC
Yes
6.51
N/A
N/A
1
82565
ASSAY OF CREATININE
No
No
Yes
PC
Yes
5.12
N/A
N/A
1
82977
ASSAY OF GGT
No
No
Yes
PC
Yes
7.2
N/A
N/A
1
84478
ASSAY OF TRIGLYCERIDES
No
No
Yes
PC
Yes
5.74
N/A
N/A
1
85004
AUTOMATED DIFF WBC COUNT
No
No
Yes
PC
Yes
6.47
N/A
N/A
1
85013
SPUN MICROHEMATOCRIT
No
No
Yes
PC
Yes
3.23
N/A
1/1/2014
N/A
1
85014
HEMATOCRIT
No
No
Yes
PC
Yes
2.37
N/A
N/A
1
85018
HEMOGLOBIN
No
No
Yes
PC
Yes
2.37
N/A
N/A
1
85025
COMPLETE CBC W/AUTO DIFF WBC
No
No
Yes
PC
Yes
7.77
N/A
N/A
1
85027
COMPLETE CBC AUTOMATED
No
No
Yes
PC
Yes
6.47
N/A
N/A
1
CBC/DIFFWBC W/O PLATELET
No
No
Yes
PC
Yes
7.77
N/A
N/A
1
CBC WITHOUT PLATELET
No
No
Yes
PC
Yes
6.47
N/A
N/A
1
81000
URINALYSIS NONAUTO W/SCOPE
No
No
Yes
PC
Yes
4.02
N/A
N/A
1
81001
URINALYSIS AUTO W/SCOPE
No
No
Yes
PC
Yes
3.17
N/A
N/A
1
81002
URINALYSIS NONAUTO W/O SCOPE
No
No
Yes
PC
Yes
3.48
N/A
N/A
1
81003
URINALYSIS AUTO W/O SCOPE
No
No
Yes
PC
Yes
2.25
N/A
N/A
1
80061
LIPID PANEL
No
No
Yes
PC
Yes
13.39
N/A
N/A
1
82465
ASSAY BLD/SERUM CHOLESTEROL
No
No
Yes
PC
Yes
4.35
N/A
N/A
1
83718
ASSAY OF LIPOPROTEIN
No
No
Yes
PC
Yes
8.19
N/A
N/A
1
83719
ASSAY OF BLOOD LIPOPROTEIN
No
No
Yes
PC
Yes
12.75
N/A
N/A
1
83721
ASSAY OF BLOOD LIPOPROTEIN
No
No
Yes
PC
Yes
10.5
N/A
N/A
1
84478
ASSAY OF TRIGLYCERIDES
No
No
Yes
PC
Yes
5.74
N/A
N/A
1
82947
ASSAY GLUCOSE BLOOD QUANT
No
No
Yes
PC
Yes
3.93
N/A
N/A
2
82950
GLUCOSE TEST
No
No
Yes
PC
Yes
4.75
N/A
N/A
2
82951
GLUCOSE TOLERANCE TEST (GTT)
No
No
Yes
PC
Yes
12.87
N/A
N/A
2
83036
GLYCOSYLATED HEMOGLOBIN TEST
No
No
Yes
PC
Yes
9.71
N/A
N/A
2
83037
GLYCOSYLATED HB HOME DEVICE
No
No
Yes
PC
Yes
9.71
N/A
N/A
2
86480
TB TEST CELL IMMUN MEASURE
No
No
Yes
PC
Yes
61.98
N/A
N/A
1
86481
TB AG RESPONSE T-CELL SUSP
No
No
Yes
PC
Yes
65.48
N/A
4/1/2015
N/A
1
86580
TB INTRADERMAL TEST
No
No
Yes
PC
No
3.89
N/A
2/1/2015
N/A
1
86631
CHLAMYDIA ANTIBODY
No
No
Yes
PC
Yes
11.82
N/A
N/A
1
age 11-64
86632
CHLAMYDIA IGM ANTIBODY
No
No
Yes
PC
Yes
12.68
N/A
N/A
1
age 11-64
87110
CHLAMYDIA CULTURE
No
No
Yes
PC
Yes
15.84
N/A
N/A
1
age 11-64
87270
CHLAMYDIA TRACHOMATIS AG IF
No
No
Yes
PC
Yes
11.98
N/A
N/A
1
age 11-64
87320
CHYLMD TRACH AG IA
No
No
Yes
PC
Yes
15
N/A
N/A
1
age 11-64
87490
CHYLMD TRACH DNA DIR PROBE
No
No
Yes
PC
Yes
22.75
N/A
N/A
1
age 11-64
87491
CHYLMD TRACH DNA AMP PROBE
No
No
Yes
PC
Yes
35.09
N/A
N/A
1
age 11-64
87492
CHYLMD TRACH DNA QUANT
No
No
Yes
PC
Yes
47.57
N/A
N/A
1
age 11-64
87810
CHYLMD TRACH ASSAY W/OPTIC
No
No
Yes
PC
Yes
16.32
N/A
4/1/2015
N/A
1
age 11-64
86689
HTLV/HIV CONFIRMJ ANTIBODY
No
No
Yes
PC
Yes
19.35
N/A
N/A
1
age 11-64
86701
HIV-1ANTIBODY
No
No
Yes
PC
Yes
8.89
N/A
N/A
1
age 11-64
86702
HIV-2 ANTIBODY
No
No
Yes
PC
Yes
13.52
N/A
N/A
1
age 11-64
86703
HIV-1/HIV-2 1 RESULT ANTBDY
No
No
Yes
PC
Yes
13.71
N/A
N/A
1
age 11-64
87389
HIV-1 AG W/HIV-1 & HIV-2 AB
No
No
Yes
PC
Yes
24.08
N/A
N/A
1
age 11-64
87390
HIV-1 AG IA
No
No
Yes
PC
Yes
24.01
N/A
N/A
1
age 11-64
87391
HIV-2 AG IA
No
No
Yes
PC
Yes
21.9
N/A
N/A
1
age 11-64
87806
HIV ANTIGEN W/HIV ANTIBODIES
No
No
Yes
PC
Yes
16.32
N/A
2/29/2016
N/A
1
age 11-64
86592
SYPHILIS TEST NON-TREP QUAL
No
No
Yes
PC
Yes
4.27
N/A
N/A
1
age 11-64
86593
SYPHILIS TEST NON-TREP QUANT
No
No
Yes
PC
Yes
4.4
N/A
N/A
1
age 11-64
86780
TREPONEMA PALLIDUM
No
No
Yes
PC
Yes
13.24
N/A
N/A
1
age 11-64
87590
N.GONORRHOEAE DNA DIR PROB
No
No
Yes
PC
Yes
26.88
N/A
N/A
1
age 11-64
87591
N.GONORRHOEAE DNA AMP PROB
No
No
Yes
PC
Yes
35.09
N/A
N/A
1
age 11-64
87592
N.GONORRHOEAE DNA QUANT
No
No
Yes
PC
Yes
42.84
N/A
N/A
1
age 11-64
87850
N. GONORRHOEAE ASSAY W/OPTIC
No
No
Yes
PC
Yes
16.32
N/A
4/1/2015
N/A
1
age 11-64
87340
HEPATITIS B SURFACE AG IA
No
No
Yes
PC
Yes
8.73
N/A
N/A
1
age 11-64
87341
HEPATITIS B SURFACE AG IA
No
No
Yes
PC
Yes
8.73
N/A
N/A
1
age 11-64
HEPB SCREEN HIGH RISK INDIV
No
No
Yes
PC
Yes
28.27
N/A
N/A
1
age 11-64
86803
HEPATITIS C AB TEST
No
No
Yes
PC
Yes
14.27
N/A
N/A
1
age 11-64
86804
HEP C AB TEST CONFIRM
No
No
Yes
PC
Yes
15.49
N/A
N/A
1
age 11-64
87520
HEPATITIS C RNA DIR PROBE
No
No
Yes
PC
Yes
27.29
N/A
4/1/2015
N/A
1
age 11-64
87521
HEPATITIS C PROBE&RVRS TRNSC
No
No
Yes
PC
Yes
35.09
N/A
N/A
1
age 11-64
87522
HEPATITIS C REVRS TRNSCRPJ
No
No
Yes
PC
Yes
42.84
N/A
N/A
1
age 11-64
HEP C SCREEN HIGH RISK/OTHER
No
No
Yes
PC
Yes
19.44
N/A
3/16/2016
N/A
1
age 11-64
82726
LONG CHAIN FATTY ACIDS
No
No
Yes
PC
Yes
19.75
N/A
N/A
1
birth to 60 days
84443
ASSAY THYROID STIM HORMONE
No
No
Yes
PC
Yes
16.8
N/A
N/A
1
birth to 30 days
84030
ASSAY OF BLOOD PKU
No
No
Yes
PC
Yes
5.5
N/A
N/A
1
birth to 30 days
83864
MUCOPOLYSACCHARIDES
No
No
Yes
PC
Yes
27.1
N/A
N/A
1
birth to 60 days
83020
HEMOGLOBIN ELECTROPHORESIS
No
No
Yes
PC
Yes
12.87
N/A
N/A
1
birth to 30 days
83021
HEMOGLOBIN CHROMOTOGRAPHY
No
No
Yes
PC
Yes
18.06
N/A
N/A
1
birth to 30 days
85660
RBC SICKLE CELL TEST
No
No
Yes
PC
Yes
5.51
N/A
N/A
1
birth to 30 days
85014
HEMATOCRIT
No
No
Yes
PC
Yes
2.37
N/A
N/A
2
4 months to 21yrs
85018
HEMOGLOBIN
No
No
Yes
PC
Yes
2.37
N/A
N/A
2
4 months to 21yrs
83026
HEMOGLOBIN COPPER SULFATE
No
No
Yes
PC
Yes
3.22
N/A
N/A
2
4 months to 21yrs
NEWBORN METABOLIC SCREENING
No
No
No
N/A
N/A
5.5
N/A
N/A
N/A
1
birth to 60 days
83655
ASSAY OF LEAD
No
No
Yes
PC
Yes
12.11
N/A
N/A
1
6 months to 6yrs
86580
TB INTRADERMAL TEST
No
No
Yes
PC
No
3.89
N/A
2/1/2015
N/A
1
1 month to 21 yrs
80061
LIPID PANEL
No
No
Yes
PC
Yes
13.39
N/A
N/A
1
9 yrs to 64yrs
92551
HEARING Loss Screening
No
No
Yes
FLAT RC
No
5.5
N/A
2/1/2015
N/A
1
birth to 21 yrs
99172
OCULAR FUNCTION SCREEN
No
No
Yes
PC
No
9.98
N/A
7/1/2014
N/A
1
birth to 5 yrs
99173
VISUAL ACUITY SCREEN
No
No
Yes
NONE
No
9.98
N/A
2/1/2015
N/A
1
birth to 21 yrs
96110
DEVELOPMENTAL SCREEN W/SCORE
No
No
Yes
FLAT RC
No
9.98
N/A
2/1/2015
N/A
2
birth to 36 months
84152
ASSAY OF PSA COMPLEXED
No
No
Yes
PC
Yes
18.39
N/A
N/A
1
men over 40
84153
ASSAY OF PSA TOTAL
No
No
Yes
PC
Yes
18.39
N/A
N/A
1
men over 40
84154
ASSAY OF PSA FREE
No
No
Yes
PC
Yes
18.39
N/A
N/A
1
men over 40
PROSTATE CA SCREENING; DRE
No
No
No
N/A
N/A
19.31
N/A
N/A
N/A
1
men over 40
PSA SCREENING
No
No
Yes
PC
Yes
19.31
N/A
N/A
1
men over 40
88142
CYTOPATH C/V THIN LAYER
No
No
Yes
PC
Yes
14.6
N/A
1/1/2013
N/A
1
88143
CYTOPATH C/V THIN LAYER REDO
No
No
Yes
PC
Yes
23.04
N/A
N/A
1
88147
CYTOPATH C/V AUTOMATED
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88148
CYTOPATH C/V AUTO RESCREEN
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88150
CYTOPATH C/V MANUAL
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88152
CYTOPATH C/V AUTO REDO
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88153
CYTOPATH C/V REDO
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88155
CYTOPATH C/V INDEX ADD-ON
No
No
Yes
PC
Yes
8.15
N/A
N/A
1
88164
CYTOPATH TBS C/V MANUAL
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88165
CYTOPATH TBS C/V REDO
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88166
CYTOPATH TBS C/V AUTO REDO
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88167
CYTOPATH TBS C/V SELECT
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
88174
CYTOPATH C/V AUTO IN FLUID
No
No
Yes
PC
Yes
25.37
N/A
N/A
1
88175
CYTOPATH C/V AUTO FLUID REDO
No
No
Yes
PC
Yes
14.76
N/A
1/1/2006
N/A
1
SCREEN CERV/VAG THIN LAYER
No
No
Yes
PC
Yes
14.6
N/A
9/1/2001
N/A
1
SCREEN C/V THIN LAYER BY MD
No
No
Yes
NONE
No
14.49
N/A
4/1/2015
N/A
1
SCR C/V CYTO,THINLAYER,RESCR
No
No
Yes
PC
Yes
14.49
N/A
9/1/2001
N/A
1
SCR C/V CYTO,THINLAYER,RESCR
No
No
No
N/A
N/A
14.49
N/A
N/A
N/A
1
SCR C/V CYTO,THINLAYER,RESCR
No
No
No
N/A
N/A
14.49
N/A
N/A
N/A
1
SCR C/V CYTO, AUTOMATED SYS
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
SCR C/V CYTO, AUTOSYS, RESCR
No
No
Yes
PC
Yes
14.49
N/A
N/A
1
OBTAINING SCREEN PAP SMEAR
No
No
Yes
PC
No
20.38
N/A
8/1/2015
N/A
1
77080
DXA BONE DENSITY AXIAL
No
No
Yes
PC
No
26.92
N/A
4/1/2015
N/A
1
at risk women
77081
DXA BONE DENSITY/PERIPHERAL
No
No
Yes
PC
No
11.56
N/A
4/1/2015
N/A
1
99202
Office o/p new sf 15-29 min
No
No
Yes
FLAT RC
No
74.06
N/A
2/1/2015
N/A
99203
Office o/p new low 30-44 min
No
No
Yes
FLAT RC
No
113.85
N/A
2/1/2015
N/A
99204
Office o/p new mod 45-59 min
No
No
Yes
FLAT RC
No
169.57
N/A
2/1/2015
N/A
99205
Office o/p new hi 60-74 min
No
No
Yes
FLAT RC
No
224.25
N/A
4/1/2015
N/A
99211
Off/op est may x req phy/qhp
No
No
Yes
FLAT RC
No
23.53
N/A
2/1/2015
N/A
99212
Office o/p est sf 10-19 min
No
No
Yes
FLAT RC
No
57.45
N/A
2/1/2015
N/A
99213
Office o/p est low 20-29 min
No
No
Yes
FLAT RC
No
92.05
N/A
2/1/2015
N/A
99214
Office o/p est mod 30-39 min
No
No
Yes
FLAT RC
No
129.77
N/A
2/1/2015
N/A
99215
Office o/p est hi 40-54 min
No
Yes
FLAT RC
No
183.07
N/A
4/1/2015
N/A