Common Medical Conditions Seen by This
Practice Related medical services provided
by a physician (CPT Code)
Current
Billed
Charge
Medicare
pays this
practice
0.81
Typical
charge in this
area, Reimb
by
Information on comparative
Commercial
quality is available:
Routine Exam
99396
Periodic Preventive Med, Established
Patient - Age 40-64 (99396)
$293.00
$0.00
$237.33
99392
Periodic Preventive Med, Established
Patient - Age 1-4 (99392)
$183.25
$0.00
$148.43
99395
Periodic Preventive Med, Established
Patient - Age 18-39 (99395)
$272.50
$0.00
$220.73
$246.50
$83.74
$199.67
$187.25
$0.00
$151.67
Screening Mammography Bilateral (77057)
77057
99393
Periodic Preventive Med, Established
Patient - Age 5-11 (99393)
Hyperlipidemia, other
Lipid Panel (80061)
80061
$199.25
$0.00
$161.39
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
99396
Periodic Preventive Med, Established
Patient - Age 40-64 (99396)
$293.00
$0.00
$237.33
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
$173.50
$0.00
$140.54
Comprehensive Metabolic Panel (80053)
80053
Hypertension
99214
Office Outpatient, Established Patient, 25
min (99214)
$256.25
$104.08
$207.56
99213
Office Outpatient, Established Patient, 15
min (99213)
$170.50
$70.48
$138.11
99396
Periodic Preventive Med, Established
Patient - Age 40-64 (99396)
$283.00
$0.00
$229.23
93306
Echo Tthrc R-T 2d -+M-Mode Compl
Spec&Color Dop (93306)
$3,301.25
$220.28
$2,674.01
$167.50
$0.00
$135.68
N/A
$40.18
N/A
Comprehensive Metabolic Panel (80053)
80053
Other Minor Orthopedic disorders-Back
Cmt Spi 3-4 Regions (98941)
98941
Cmt Spi 1-2 Regions (98940)
98940
N/A
$27.61
N/A
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
97110
Ther Px 1+ Areas Ea 15 min Ther Xerss
(97110)
$101.75
$31.56
$0.00
$4,095.00
$213.93
$3,316.95
$4,095.00
$213.93
$3,316.95
N/A
$40.18
N/A
MRI Spi Canal&Cnts Lmbr C-Matrl (72148)
72148
Joint degeneration, localized-back, w/o
surgery
MRI Spi Canal&Cnts Lmbr C-Matrl (72148)
72148
Cmt Spi 3-4 Regions (98941)
98941
Cmt Spi 1-2 Regions (98940)
98940
N/A
$27.61
N/A
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
97110
Ther Px 1+ Areas Ea 15 min Ther Xerss
(97110)
$101.75
$31.56
N/A
Isolated signs, symptoms & non-specific
diagnoses or conditions
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
$6,596.25
$363.27
$5,342.96
$246.50
$79.41
$199.67
$273.50
$26.74
$221.54
MRI Brn Brn Stem C-/C+ (70553)
70553
Screening Mammography Bilateral (77057)
77057
Radex Ch 2 Viwes Frnt&Lat (71020)
71020
Common Medical Conditions Seen by This
Practice Related medical services provided
by a physician (CPT Code)
Typical
charge in this
area, Reimb
by
Information on comparative
Commercial
quality is available:
Current
Billed
Charge
Medicare
pays this
practice
$265.00
$104.08
$214.65
$107.25
$0.00
$86.87
$176.50
$70.48
$142.97
$149.25
$0.00
$120.89
$199.25
$0.00
$161.39
$199.25
$0.00
$161.39
$265.00
$104.08
$214.65
Diabetes, w/o surgery
99214
Office Outpatient, Established Patient, 25
min (99214)
Hgb Glycosylated (83036)
83036
99213
Office Outpatient, Established Patient, 15
min (99213)
Albumin urine Microalbumin Quan (82043)
82043
Lipid Panel (80061)
80061
Obesity, w/o Surgery
Lipid Panel (80061)
80061
99214
9581126
Office Outpatient, Established Patient, 25
min (99214)
Polysm Sleep Staging 4/>Addl Param
W/Cpap Tx (95811)
$1,108.50
$124.99
$897.89
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99396
Periodic Preventive Med, Established
Patient - Age 40-64 (99396)
$293.00
$0.00
$237.33
$187.25
$0.00
$151.67
$265.00
$104.08
$214.65
Hypo-functioning thryroid gland, w/o
surgery
Thyroid Stimulating Hormone (84443)
84443
99214
9581126
Office Outpatient, Established Patient, 25
min (99214)
Polysm Sleep Staging 4/>Addl Param
W/Cpap Tx (95811)
$1,108.50
$124.99
$897.89
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99396
Periodic Preventive Med, Established
Patient - Age 40-64 (99396)
$293.00
$0.00
$237.33
Acne
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
99202
Office Outpatient, New Patient, 20 min
(99202)
$190.00
$71.98
$153.90
99212
Office Outpatient, Established Patient, 10
min (99212)
$111.00
$41.93
$89.91
99203
Office Outpatient, New Patient, 30 min
(99203)
$274.00
$104.48
$221.94
Acute bronchitis
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
Radex Ch 2 Viwes Frnt&Lat (71020)
71020
$273.50
$26.74
$221.54
99284
Emer Dept Hi Severity&Urgent Eval
(99284)
$505.75
$114.64
$409.66
94640
Press/N-Press Inhlj Tx F/Aao/Sptm Indctj
(94640)
$109.00
$17.64
$88.29
Acute Sinusitis, w/o Surgery
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
Ct Maxlfcl Area C-Matrl (70486)
70486
$423.75
$134.36
$343.24
99203
Office Outpatient, New Patient, 30 min
(99203)
$274.00
$104.48
$221.94
95165
Supvj Prepj&Prv Ags F/Allg Immntx 1/Mlt
Ags (95165)
$32.50
$12.27
$26.33
Common Medical Conditions Seen by This
Practice Related medical services provided
by a physician (CPT Code)
Current
Billed
Charge
Medicare
pays this
practice
Typical
charge in this
area, Reimb
by
Information on comparative
Commercial
quality is available:
Chronic Sinusitis, w/o Surgery
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
Ct Maxlfcl Area C-Matrl (70486)
70486
$423.75
$134.36
$343.24
95004
Percutaneous Tests with Allergenic
Extracts (95004)
$14.50
$6.03
$11.75
31231
Nasal Endoscopy Diagnostic Uni/Bi Spx
(31231)
$566.00
$204.00
$458.46
$176.50
$70.48
$142.97
$88.25
$0.00
$71.48
Tonsillitis, Adenoiditis or Pharyngitis, w/o
Surgery
99213
Office Outpatient, Established Patient, 15
min (99213)
Laadiadoo Streptococcus Grp (87880)
87880
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
87081
Cul Prsmptv Pthgnc Organisms Scr
(87081)
N/A
$0.00
N/A
99284
Emer Dept Hi Severity&Urgent Eval
(99284)
$505.75
$114.64
$409.66
Otitis media, w/o Surgery
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
99283
Emergency Dept, Moderate Severity
(99283)
$336.25
$60.12
$272.36
99212
Office Outpatient, Established Patient, 10
min (99212)
$111.00
$41.93
$89.91
$1,402.25
$156.61
$1,135.82
Tmpst Anes (69436)
69436
Otolaryngology Diseases Signs &
Symptoms
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
30901
Control Nasal Hemorrhage Anterior Simple
(30901)
$401.50
$92.20
$325.22
31238
Nsl/Sinus Ndsc Surg W/Ctrl Nsl Hemrrg
(31238)
$1,242.00
$250.76
$1,006.02
99283
Emergency Dept, Moderate Severity
(99283)
$336.25
$60.12
$272.36
$293.00
$0.00
$237.33
$68.35
$0.00
$55.36
$272.50
$0.00
$220.73
$22.00
$24.41
$17.82
$203.59
$0.00
$164.91
$293.00
$0.00
$237.33
Routine Inoculation
99396
Periodic Preventive Med, Established
Patient, Age 40-64 (99396)
Tdap Vaccine 7 Yr + Im (90715)
90715
99395
Periodic Preventive Med, Established
Patient, Age 18-39 (99395)
Imadm Prq Id Subq/lm Njxs 1 Vacc (90471)
90471
90649
Human Papilloma Virus Vaccine Quadriv 3
Dose Im (90649)
Contraceptive Management
99396
Periodic Preventive Med, Established
Patient, Age 40-64 (99396)
Insj Intrauterine Dev (58300)
58300
$570.75
$0.00
$462.31
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
$1,077.75
$118.23
$872.98
Us Trvg (76830)
76830
Common Medical Conditions Seen by This
Practice Related medical services provided
by a physician (CPT Code)
Typical
charge in this
area, Reimb
by
Information on comparative
Commercial
quality is available:
Current
Billed
Charge
Medicare
pays this
practice
$272.50
$0.00
$220.73
Contraceptive Management
99395
Periodic Preventive Med, Established
Patient, Age 18-39 (99395)
Insj Intrauterine Dev (58300)
58300
$570.75
$0.00
$462.31
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
$1,077.75
$118.23
$872.98
$2,035.25
$376.04
$1,648.55
$401.75
$57.71
$325.42
Us Trvg (76830)
76830
Gastroenterology Diseases Signs and
Symptoms
Scope of Colon for Diagnosis (45378)
45378
Ct Pelvis C+ Matrl (72193)
7219326
Ct Abd C+ Matrl (74160)
7416026
$529.75
$63.30
$429.10
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
Fungal Skin Infection
Debridement Nail Any Method 6/> (11721)
11721
$179.75
$43.48
$145.60
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$40.46
$142.97
11750
Excision Nail Matrix, Permanent Removal
(11750)
$892.00
$216.95
$722.52
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.12
$214.65
99212
Office Outpatient, Established Patient, 10
min (99212)
$111.00
$42.02
$89.91
Mood Disorder, Depressed
Ipi-ob-M/S Office 45-50 Min. MD (90834)
90806
$340.50
$83.82
$275.81
90801
Psychiatric Diagnosis Interview Xm MD
(90791)
$385.75
$128.51
$312.46
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
90862
Pharmacologic Mgmt Min Medical Psyctx
(90863)
$163.00
$0.00
$132.03
$203.25
$63.53
$164.63
$340.50
$83.82
$275.81
$385.75
$128.51
$312.46
Ipi-ob-M/S Office 20-30 Min MD (90832)
90805
Other Neuropsychological or Behavioral
Disorders
Ipi-ob-M/S Office 45-50 Min MD (90834)
90806
90801
Psychiatric Diagnosis Interview Xm MD
(90791)
Fam Psyctx W/Pt Present MD (90847)
90847
$352.25
$105.42
$285.32
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
Visual Disturbances , w/o Surgery
92014
Oph Medical Xm&Eval Compre,
Established Patient, 1+ Visits (92014)
$174.00
$120.23
$140.94
92004
Oph Medical Xm&Eval Compre, New
Patient, 1+ Visits (92004)
$214.75
$144.67
$173.95
Deter Refractive State (92015)
92015
$20.00
$0.00
$16.20
92012
Oph Medical Xm&Eval Intrm Established
Patient (92012)
$143.00
$82.78
$115.83
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
Common Medical Conditions Seen by This
Practice Related medical services provided
by a physician (CPT Code)
Typical
charge in this
area, Reimb
by
Information on comparative
Commercial
quality is available:
Current
Billed
Charge
Medicare
pays this
practice
$174.00
$120.23
$140.94
Cataract, w/o Surgery
92014
Oph Medical Xm&Eval Compre,
Established Patient, 1+ Visits (92014)
Deter Refractive State (92015)
92015
$20.00
$0.00
$16.20
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
92004
Oph Medical Xm&Eval Compre, New
Patient, 1+ Visits (92004)
$214.75
$144.67
$173.95
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
Inflammatory Eye Disease, w/o Surgery
92014
Oph Medical Xm&Eval Compre,
Established Patient, 1+ Visits (92014)
$174.00
$120.23
$140.94
99213
Office Outpatient, Established Patient, 15
min (99213)
$176.50
$70.48
$142.97
Deter Refractive State (92015)
92015
$20.00
$0.00
$16.20
99214
Office Outpatient, Established Patient, 25
min (99214)
$265.00
$104.08
$214.65
92004
Oph Medical Xm&Eval Compre, New
Patient, 1+ Visits (92004)
$214.75
$144.67
$173.95
Current Billed Charge: This is the standard amount the facility charges for a particular procedure as of today.
Medicare Payment: This is how much Medicare will pay this physician for the listed service, each time.
Typical Charge: This is the reimbursement amount Mayo Clinic Health System-Franciscan Healthcare La
Crosse receives from commercial insurance payers on each procedure based on the current billed charge.
WCHQ - Reporting
This will give comparative information but not necessarilyon the codes listed above.