| EVALUATION & MANAGEMENT - MD | ||
| SERVICE CHARGE CODE | SERVICE DESCRIPTION | SERVICE CHARGE PRICE |
| MD99201 | OFFICE/OUTPATIENT VISIT, NEW | 55.74 |
| MD99202 | OFFICE/OUTPATIENT VISIT, NEW | 75.04 |
| MD99203 | OFFICE/OUTPATIENT VISIT, NEW | 101.84 |
| MD99204 | OFFICE/OUTPATIENT VISIT, NEW | 143.65 |
| MD99205 | OFFICE/OUTPATIENT VISIT, NEW | 187.60 |
| MD99211 | OFFICE/OUTPATIENT VISIT, EST | 32.16 |
| MD99212 | OFFICE/OUTPATIENT VISIT, EST | 48.24 |
| MD99213 | OFFICE/OUTPATIENT VISIT, EST | 64.32 |
| MD99214 | OFFICE/OUTPATIENT VISIT, EST | 91.12 |
| MD99215 | OFFICE/OUTPATIENT VISIT, EST | 134.00 |
| MD99217 | OBSERVATION CARE DISCHARGE | 101.84 |
| MD99218 | OBSERVATION CARE | 117.92 |
| MD99219 | OBSERVATION CARE | 167.23 |
| MD99220 | OBSERVATION CARE | 235.84 |
| MD99221 | INITIAL HOSPITAL CARE | 134.00 |
| MD99222 | INITIAL HOSPITAL CARE | 176.88 |
| MD99223 | INITIAL HOSPITAL CARE | 225.12 |
| MD99231 | SUBSEQUENT HOSPITAL CARE | 67.54 |
| MD99232 | SUBSEQUENT HOSPITAL CARE | 91.12 |
| MD99233 | SUBSEQUENT HOSPITAL CARE | 132.93 |
| MD99234 | OBSERV/HOSP SAME DATE | 187.60 |
| MD99235 | OBSERV/HOSP SAME DATE | 254.06 |
| MD99236 | OBSERV/HOSP SAME DATE | 308.74 |
| MD99238 | HOSPITAL DISCHARGE DAY | 107.20 |
| MD99239 | HOSPITAL DISCHARGE DAY | 198.32 |
| MD99241 | OFFICE CONSULTATION | 94.34 |
| MD99242 | OFFICE CONSULTATION | 126.50 |
| MD99243 | OFFICE CONSULTATION | 160.80 |
| MD99244 | OFFICE CONSULTATION | 214.40 |
| MD99245 | OFFICE CONSULTATION | 268.00 |
| MD99251 | INITIAL INPATIENT CONSULT | 107.20 |
| MD99252 | INITIAL INPATIENT CONSULT | 139.36 |
| MD99253 | INITIAL INPATIENT CONSULT | 172.59 |
| MD99254 | INITIAL INPATIENT CONSULT | 216.54 |
| MD99255 | INITIAL INPATIENT CONSULT | 278.72 |
| MD99261 | FOLLOW-UP INPATIENT CONSULT | 64.32 |
| MD99262 | FOLLOW-UP INPATIENT CONSULT | 91.12 |
| MD99263 | FOLLOW-UP INPATIENT CONSULT | 128.64 |
| MD99271 | CONFIRMATORY CONSULTATION | 96.48 |
| MD99272 | CONFIRMATORY CONSULTATION | 120.06 |
| MD99273 | CONFIRMATORY CONSULTATION | 146.86 |
| MD99274 | CONFIRMATORY CONSULTATION | 187.60 |
| MD99275 | CONFIRMATORY CONSULTATION | 241.20 |
| MD99281 | EMERGENCY DEPT VISIT | 68.61 |
| MD99282 | EMERGENCY DEPT VISIT | 91.12 |
| MD99283 | EMERGENCY DEPT VISIT | 131.86 |
| MD99284 | EMERGENCY DEPT VISIT | 187.60 |
| MD99285 | EMERGENCY DEPT VISIT | 254.06 |
| MD99288 | DIRECT ADVANCED LIFE SUPPORT | 160.80 |
| MD99291 | CRITICAL CARE, FIRST HOUR | 321.60 |
| MD99292 | CRITICAL CARE, ADDL 30 MIN | 160.80 |
| MD99295 | NEONATAL CRITICAL CARE | 1,045.20 |
| MD99296 | NEONATAL CRITICAL CARE | 594.96 |
| MD99298 | NEONATAL CRITICAL CARE | 221.90 |
| MD99301 | NURSING FACILITY CARE | 94.34 |
| MD99302 | NURSING FACILITY CARE | 129.71 |
| MD99303 | NURSING FACILITY CARE | 166.16 |
| MD99311 | NURSING FAC CARE, SUBSEQ | 58.96 |
| MD99312 | NURSING FAC CARE, SUBSEQ | 80.40 |
| MD99313 | NURSING FAC CARE, SUBSEQ | 96.48 |
| MD99315 | NURSING FAC DISCHARGE DAY | 107.20 |
| MD99316 | NURSING FAC DISCHARGE DAY | 127.57 |
| MD99321 | REST HOME VISIT, NEW PATIENT | 66.46 |
| MD99322 | REST HOME VISIT, NEW PATIENT | 91.12 |
| MD99323 | REST HOME VISIT, NEW PATIENT | 130.78 |
| MD99331 | REST HOME VISIT, EST PAT | 54.67 |
| MD99332 | REST HOME VISIT, EST PAT | 73.97 |
| MD99333 | REST HOME VISIT, EST PAT | 90.05 |
| MD99341 | HOME VISIT, NEW PATIENT | 85.76 |
| MD99342 | HOME VISIT, NEW PATIENT | 107.20 |
| MD99343 | HOME VISIT, NEW PATIENT | 151.15 |
| MD99344 | HOME VISIT, NEW PATIENT | 201.54 |
| MD99345 | HOME VISIT, NEW PATIENT | 242.27 |
| MD99347 | HOME VISIT, EST PATIENT | 72.90 |
| MD99348 | HOME VISIT, EST PATIENT | 96.48 |
| MD99349 | HOME VISIT, EST PATIENT | 121.14 |
| MD99350 | HOME VISIT, EST PATIENT | 182.24 |
| MD99354 | PROLONGED SERVICE, OFFICE | 160.80 |
| MD99355 | PROLONGED SERVICE, OFFICE | 107.20 |
| MD99356 | PROLONGED SERVICE, INPATIENT | 160.80 |
| MD99357 | PROLONGED SERVICE, INPATIENT | 107.20 |
| MD99358 | PROLONGED SERVICE, W/O CONTACT | 143.65 |
| MD99359 | PROLONGED SERVICE, W/O CONTACT | 91.12 |
| MD99360 | PHYSICIAN STANDBY SERVICES | 201.54 |
| MD99361 | PHYSICIAN/TEAM CONFERENCE | 95.41 |
| MD99362 | PHYSICIAN/TEAM CONFERENCE | 160.80 |
| MD99371 | PHYSICIAN PHONE CONSULTATION | 32.16 |
| MD99372 | PHYSICIAN PHONE CONSULTATION | 53.60 |
| MD99373 | PHYSICIAN PHONE CONSULTATION | 83.62 |
| MD99374 | HOME HEALTH CARE SUPERVISION | 70.75 |
| MD99375 | HOME HEALTH CARE SUPERVISION | 117.92 |
| MD99377 | HOSPICE CARE SUPERVISION | 87.90 |
| MD99378 | HOSPICE CARE SUPERVISION | 112.56 |
| MD99379 | NURSING FAC CARE SUPERVISION | 70.75 |
| MD99380 | NURSING FAC CARE SUPERVISION | 107.20 |
| MD99381 | PREV VISIT, NEW INFANT | 75.04 |
| MD99382 | PREV VISIT, NEW, AGE 1-4 | 80.40 |
| MD99383 | PREV VISIT, NEW, AGE 5-11 | 84.69 |
| MD99384 | PREV VISIT, NEW, AGE 12-17 | 102.91 |
| MD99385 | PREV VISIT, NEW, AGE 18-39 | 116.85 |
| MD99386 | PREV VISIT, NEW, AGE 40-64 | 136.14 |
| MD99387 | PREV VISIT, NEW, 65 & OVER | 153.30 |
| MD99391 | PREV VISIT, EST, INFANT | 64.32 |
| MD99392 | PREV VISIT, EST, AGE 1-4 | 64.32 |
| MD99393 | PREV VISIT, EST, AGE 5-11 | 69.68 |
| MD99394 | PREVENTIVE VISIT, EST, AGE 12-17 | 80.40 |
| MD99395 | PREV VISIT, EST, AGE 18-39 | 96.48 |
| MD99396 | PREV VISIT, EST, AGE 40-64 | 110.42 |
| MD99397 | PREV VISIT, EST, 65 & OVER | 115.78 |
| MD99401 | PREVENTIVE COUNSELING, INDIV | 47.17 |
| MD99402 | PREVENTIVE COUNSELING, INDIV | 77.18 |
| MD99403 | PREVENTIVE COUNSELING, INDIV | 128.64 |
| MD99404 | PREVENTIVE COUNSELING, INDIV | 164.02 |
| MD99411 | PREVENTIVE COUNSELING, GROUP | 61.10 |
| MD99412 | PREVENTIVE COUNSELING, GROUP | 87.90 |
| MD99420 | HEALTH RISK ASSESSMENT TEST | 120.06 |
| MD99429 | UNLISTED PREVENTIVE SERVICE | 0.00 |
| MD99431 | INITIAL CARE, NORMAL NEWBORN | 147.94 |
| MD99432 | NEWBORN CARE, NOT IN HOSP | 107.20 |
| MD99433 | NORMAL NEWBORN CARE/HOSPITAL | 69.68 |
| MD99435 | NEWBORN DISCHARGE DAY HOSP | 176.88 |
| MD99436 | ATTENDANCE, NB BIRTH | 201.54 |
| MD99440 | NEWBORN RESUSCITATION | 268.00 |
| MD99450 | LIFE/DISABILITY EVALUATION | 72.90 |
| MD99455 | DISABILITY EXAMINATION | 241.20 |
| MD99456 | DISABILITY EXAMINATION | 362.34 |
| MD99499 | UNLISTED E&M SERVICE | 0.00 |