CMS Shoppable Services
#
Code
Description
Available
1
90832
Psychotherapy, 30 minutes with patient
N/A
2
90834
Psychotherapy, 45 minutes with patient
N/A
3
90837
Psychotherapy, 60 minutes with patient
N/A
4
90846
Family psychotherapy
N/A
5
90847
Family psychotherapy including patient
N/A
6
90853
Group psychotherapy
N/A
7
99203
New patient ofice visit, complex
YES
8
99204
New patient office or other outpatient visit, typically 45 min
YES
9
99205
New patient ofice visit, comprehensive visit
YES
10
99243
Office visit consultation, complex
N/A
11
99244
Office consultation - new or established patient - 60 min
N/A
12
99385
Initial new patient preventative medicine evaluation (18-39 years)
YES
13
99386
Initial new patient preventative medicine evaluation (40-64 years)
YES
14
80048
Blood test, basic group of blood chemicals
YES
15
80053
Blood test, comprehensive group of blood chemicals
YES
16
80055
Obstetric panel (includes HIV testing)
N/A
17
80061
Blood test, lipids (cholesterol and triglycerides)
YES
18
80069
Kidney Function Blood Test Panel
YES
19
80076
Liver function blood test panel
YES
20
81000
Manual urinalysis test with examination using microscope
YES
21
81001
Urinalysis with Examination, using Microscope
YES
22
81002
Urinalysis, Manual Test
YES
23
81003
Urinalysis, Automated Test
YES
24
84153
PSA (prostate specific antigen) measurement
YES
25
84154
PSA Measurement; Free
YES
26
84443
Blood test, thyroid stimulating hormone (TSH)
YES
27
85025
Complete blood cell count - automated differential WBC count
YES
28
85027
Complete blood cell count - automated test with out Differential
YES
29
85610
Blood test, clotting time
YES
30
85730
Coagulation assessment blood test
YES
31
70450
CT Head Brain without Contrast
YES
32
70553
MRI Brain with and without Conrast
YES
33
72110
X-Ray Lower Sacral Spine, 4 or More Views
YES
34
72148
MRI Spine Lumbar without Contrast
YES
35
72193
CT Pelvis with Contrast
YES
36
73721
MRI Leg Joint without Contrast
YES
37
74177
CT Abdomen & Pelvis with Contrast
YES
38
76700
Ultrasound Abdomen - Complete
YES
39
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
YES
40
76830
Ultrasound Pelvis through Vagina
YES
41
77065
Diagnostic mammography, unilateral
YES
42
77066
Diagnostic mammography, bilateral
YES
43
77067
Screening Mammography, Bilateral, with CAD
YES
44
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
N/A
45
460
Spinal fusion other than the neck without major complications
N/A
46
470
Total Knee or Hip Replacement
YES
47
473
Cervical spinal fusion without complications
N/A
48
743
Uterus or Ovary Surgery Not Related to Cancer without complications
N/A
49
19120
Removal of 1 or more breast growth, open procedure
YES
50
29826
Shaving of shoulder bone using an endoscope
YES
51
29881
Removal of one knee cartilage using an endoscope
YES
52
42820
Removal of tonsils and adenoid glands patient younger than age 12
YES
53
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
YES
54
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
YES
55
45378
Colonscopy
YES
56
45380
Biopsy of Large Bowel, Using an Endoscope
YES
57
45385
Removal of Polyps in Large Bowel, Using an Endoscope
YES
58
45391
Ultrasound examination of lower large bowel using an endoscope
N/A
59
47562
Gallbladder Removal Using an Endoscope
YES
60
49505
Repair of groin hernia patient age 5 years or older
YES
61
55700
Biopsy of prostate gland
N/A
62
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
N/A
63
59400
Routine obstetric care for vaginal delivery, including pre and post
YES
64
59510
Routine obstetric care for cesarean delivery, including pre and post
YES
65
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
N/A
66
62322
Injection of substance into spinal canal or lower back using imaging
N/A
67
62323
Epidural Injection Thoracic
YES
68
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
YES
69
66821
Removal of recurring cataract in lens capsule using laser
N/A
70
66984
Removal of cataract with insertion of lens
N/A
71
93000
Routine electrocardiogram
N/A
72
93452
Insertion of catheter into left heart for diagnosis
N/A
73
95810
Sleep monitoring of patient (6 years or older) in sleep lab
N/A
74
97110
Physical Therapy Exercise, 15 Minutes
YES

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Disclaimer

This good faith 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 good faith 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 good faith 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 good faith ESTIMATE contact Customer Service at 435-587-1234.

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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