CMS Shoppable Services
#
Code
Description
Available
1
45380
Biopsy of Large Bowel, Using an Endoscope
NO
2
55700
Biopsy of prostate gland
NO
3
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
NO
4
80048
Blood test, basic group of blood chemicals
YES
5
85610
Blood test, clotting time
YES
6
80053
Blood test, comprehensive group of blood chemicals
YES
7
80061
Blood test, lipids (cholesterol and triglycerides)
YES
8
84443
Blood test, thyroid stimulating hormone (TSH)
YES
9
74177
CT Abdomen & Pelvis with Contrast
YES
10
70450
CT Head Brain without Contrast
YES
11
72193
CT Pelvis with Contrast
YES
12
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
NO
13
473
Cervical spinal fusion without complications
NO
14
85730
Coagulation assessment blood test
YES
15
45378
Colonscopy
NO
16
85025
Complete blood cell count - automated differential WBC count
YES
17
85027
Complete blood cell count - automated test with out Differential
YES
18
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
NO
19
77066
Diagnostic mammography, bilateral
NO
20
77065
Diagnostic mammography, unilateral
NO
21
62323
Epidural Injection Thoracic
YES
22
90846
Family psychotherapy
NO
23
90847
Family psychotherapy including patient
NO
24
47562
Gallbladder Removal Using an Endoscope
NO
25
90853
Group psychotherapy
NO
26
99385
Initial new patient preventative medicine evaluation (18-39 years)
NO
27
99386
Initial new patient preventative medicine evaluation (40-64 years)
NO
28
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
YES
29
62322
Injection of substance into spinal canal or lower back using imaging
NO
30
93452
Insertion of catheter into left heart for diagnosis
NO
31
80069
Kidney Function Blood Test Panel
YES
32
80076
Liver function blood test panel
YES
33
70553
MRI Brain with and without Conrast
YES
34
73721
MRI Leg Joint without Contrast
YES
35
72148
MRI Spine Lumbar without Contrast
YES
36
81000
Manual urinalysis test with examination using microscope
NO
37
99204
New patient office or other outpatient visit, typically 45 min
NO
38
99203
New patient ofice visit, complex
NO
39
99205
New patient ofice visit, comprehensive visit
NO
40
80055
Obstetric panel (includes HIV testing)
YES
41
99244
Office consultation - new or established patient - 60 min
NO
42
99243
Office visit consultation, complex
NO
43
84153
PSA (prostate specific antigen) measurement
YES
44
84154
PSA Measurement; Free
YES
45
97110
Physical Therapy Exercise, 15 Minutes
YES
46
90832
Psychotherapy, 30 minutes with patient
NO
47
90834
Psychotherapy, 45 minutes with patient
NO
48
90837
Psychotherapy, 60 minutes with patient
NO
49
19120
Removal of 1 or more breast growth, open procedure
NO
50
45385
Removal of Polyps in Large Bowel, Using an Endoscope
NO
51
66984
Removal of cataract with insertion of lens
YES
52
29881
Removal of one knee cartilage using an endoscope
YES
53
66821
Removal of recurring cataract in lens capsule using laser
NO
54
42820
Removal of tonsils and adenoid glands patient younger than age 12
NO
55
49505
Repair of groin hernia patient age 5 years or older
NO
56
93000
Routine electrocardiogram
NO
57
59510
Routine obstetric care for cesarean delivery, including pre and post
NO
58
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
NO
59
59400
Routine obstetric care for vaginal delivery, including pre and post
NO
60
77067
Screening Mammography, Bilateral, with CAD
NO
61
29826
Shaving of shoulder bone using an endoscope
NO
62
95810
Sleep monitoring of patient (6 years or older) in sleep lab
YES
63
460
Spinal fusion other than the neck without major complications
NO
64
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
NO
65
470
Total Knee or Hip Replacement
NO
66
76700
Ultrasound Abdomen - Complete
YES
67
76830
Ultrasound Pelvis through Vagina
YES
68
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
NO
69
45391
Ultrasound examination of lower large bowel using an endoscope
NO
70
81001
Urinalysis with Examination, using Microscope
YES
71
81003
Urinalysis, Automated Test
NO
72
81002
Urinalysis, Manual Test
NO
73
743
Uterus or Ovary Surgery Not Related to Cancer without complications
NO
74
72110
X-Ray Lower Sacral Spine, 4 or More Views
YES

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Disclaimer

This out-of-pocket ESTIMATE should not be relied on as the final out-of-pocket cost for services as your final cost will vary based upon your specific needs at the time of the service, including additional treatments or services deemed necessary by the physician and/or additional information provided by your insurer.

This out-of-pocket ESTIMATE does not include bills from medical specialists, including by not limited to: physician charges, anesthesiology charges, radiologist reading fees and pathologist fees. Charges from these medical specialists will be billed separately to you.

  • Pre-Procedure Office Visits
  • Post-Procedure Office Visits
  • Diagnostic Testing

If you have met all or part of your deductible or maximum out-of-pocket expenses, the actual amount you owe may be different.

The estimated cost is not a guarantee of insurance coverage. Please check with your insurance company if you need help understanding your benefits for the service chosen.

Final determination of eligibility and services covered are determined at the time the claim is processed by the insurance company. Any services determined non-covered by your plan are your responsibility to pay.

This out-of-pocket ESTIMATE is intended only for the use of the intended recipient. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of these documents is strictly forbidden.

To obtain a fully personalized out-of-pocket ESTIMATE contact Customer Service at 904-259-3151 ext. 2217.

The final price may be higher or lower based on actual services rendered at time of appointment. It is advised that you contact your health insurer for most accurate individual payment responsibilities and to confirm any applicable remaining deductible balances.

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