Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
30000 $97.00
30020 $105.00
30100 $87.00
30110 $156.00
30115 $342.00
30117 $313.00
30118 $706.68
30120 $455.73
30124 $232.00
30125 $554.08
30130 $261.00
30140 $309.00
30150 $722.00
30160 $745.54
30200 $62.00
30210 $124.46
30220 $156.00
30300 $77.00
30310 $153.00
30320 $378.00
30400 $834.00
30410 $1,052.00
30420 $1,256.00
30430 $559.00
30435 $860.00
30450 $1,266.00
30460 $745.79
30462 $1,506.09
30465 $839.00
30520 $514.00
30540 $551.00
30545 $896.39
30560 $93.00
30580 $521.00
30600 $432.00
30620 $551.88
30630 $567.61
30801 $79.00
30802 $156.00
30901 $95.00
30903 $128.00
30905 $211.53
30906 $242.00
30915 $524.04
30920 $746.82
30930 $104.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
31000 $81.00
31002 $123.00
31020 $279.00
31030 $477.00
31032 $520.71
31040 $714.34
31050 $443.53
31051 $581.48
31070 $389.11
31075 $714.30
31080 $871.00
31081 $973.00
31084 $1,055.65
31085 $1,117.00
31086 $994.00
31087 $999.97
31090 $820.00
31200 $410.00
31201 $649.00
31205 $765.00
31225 $1,528.00
31230 $1,674.16
31231 $137.00
31233 $218.00
31235 $240.00
31237 $263.67
31238 $262.39
31239 $632.33
31240 $159.57
31254 $274.23
31255 $406.60
31256 $198.71
31267 $320.63
31276 $512.52
31287 $233.78
31288 $271.10
31290 $1,113.40
31291 $1,173.42
31292 $963.64
31293 $1,048.65
31294 $1,206.94
31295 $1,916.20
31296 $2,167.33
31297 $2,132.60
31300 $1,146.33
31320 $596.68
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
31360 $1,531.00
31365 $2,090.00
31367 $1,560.00
31368 $2,196.84
31370 $1,727.00
31375 $1,589.00
31380 $1,651.47
31382 $1,703.88
31390 $2,324.00
31395 $2,404.54
31400 $934.40
31420 $771.32
31500 $106.29
31502 $33.96
31505 $50.00
31510 $196.14
31511 $197.84
31512 $182.83
31513 $129.93
31515 $160.00
31520 $150.91
31525 $214.00
31526 $156.26
31527 $188.27
31528 $139.80
31529 $160.04
31530 $195.42
31531 $212.76
31535 $187.91
31536 $210.84
31540 $242.16
31541 $265.42
31545 $352.29
31546 $542.03
31560 $312.00
31561 $340.90
31570 $342.90
31571 $249.75
31575 $111.31
31576 $178.00
31577 $232.44
31578 $265.09
31579 $201.00
31580 $1,120.25
31582 $1,793.69
31584 $1,400.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
31587 $900.18
31588 $1,044.79
31590 $850.00
31595 $304.00
31600 $387.99
31601 $251.75
31603 $217.98
31605 $178.93
31610 $655.74
31611 $486.82
31612 $76.24
31613 $350.00
31614 $650.14
31615 $174.06
31620 $253.00
31622 $149.75
31623 $245.00
31624 $151.20
31625 $239.00
31626 $418.00
31627 $1,125.50
31628 $194.24
31629 $209.04
31630 $204.42
31631 $226.20
31632 $72.28
31633 $87.29
31634 $1,700.40
31635 $295.00
31636 $223.28
31637 $75.56
31638 $247.96
31640 $260.18
31641 $253.79
31643 $173.07
31645 $165.36
31646 $143.33
31647 $223.85
31648 $215.05
31649 $69.91
31651 $78.94
31660 $214.70
31661 $226.27
31717 $129.00
31720 $50.74
31725 $93.35
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
31730 $204.00
31750 $1,124.00
31755 $1,525.00
31760 $1,308.55
31766 $1,746.15
31770 $1,286.31
31775 $1,373.57
31780 $1,133.37
31781 $1,370.33
31785 $1,033.19
31786 $1,458.03
31800 $630.00
31805 $791.25
31820 $387.50
31825 $546.84
31830 $392.60
32035 $655.00
32036 $716.80
32096 $805.98
32097 $805.98
32098 $757.67
32100 $828.24
32110 $1,319.00
32120 $817.60
32124 $869.19
32140 $930.71
32141 $1,087.00
32150 $935.86
32151 $931.56
32160 $701.77
32200 $1,042.91
32215 $763.90
32220 $1,499.00
32225 $937.10
32310 $870.63
32320 $1,513.97
32400 $139.00
32405 $95.13
32440 $1,540.84
32442 $1,664.00
32445 $1,649.93
32480 $1,452.59
32482 $1,545.56
32484 $1,396.83
32486 $1,606.00
32488 $1,782.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
32491 $1,433.88
32501 $241.05
32503 $1,791.41
32504 $2,040.99
32505 $931.06
32506 $155.47
32507 $155.47
32540 $1,086.00
32550 $749.00
32551 $151.99
32552 $180.33
32553 $572.50
32554 $201.87
32555 $301.70
32556 $547.71
32557 $581.23
32560 $249.66
32561 $94.37
32562 $83.88
32601 $303.04
32604 $473.64
32606 $455.74
32607 $307.92
32608 $377.75
32609 $261.33
32650 $671.15
32651 $914.00
32652 $1,186.00
32653 $916.00
32654 $821.00
32655 $896.04
32656 $805.99
32658 $725.93
32659 $736.36
32661 $807.74
32662 $907.21
32663 $1,312.00
32664 $850.92
32665 $995.56
32666 $870.88
32667 $155.47
32668 $156.28
32669 $1,337.05
32670 $1,594.51
32671 $1,766.99
32672 $1,512.96
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
32673 $1,198.79
32674 $213.27
32701 $214.82
32800 $886.12
32810 $862.92
32815 $1,608.00
32820 $1,321.16
32850 $3,000.00
32851 $2,601.47
32852 $2,930.90
32853 $3,109.26
32854 $3,361.78
32855 $376.89
32856 $471.11
32900 $1,288.00
32905 $1,290.84
32906 $1,597.87
32940 $1,186.15
32960 $124.00
32997 $329.50
32998 $2,750.00
33010 $114.60
33011 $116.48
33015 $457.00
33020 $831.97
33025 $772.72
33030 $1,227.88
33031 $1,363.82
33050 $933.24
33120 $1,505.18
33130 $1,314.22
33140 $1,299.83
33141 $135.08
33202 $750.00
33203 $769.51
33206 $448.62
33207 $494.78
33208 $489.93
33210 $172.85
33211 $178.46
33212 $335.93
33213 $350.96
33214 $482.18
33215 $307.45
33216 $379.15
33217 $375.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
33218 $389.88
33220 $392.56
33221 $351.18
33222 $352.17
33223 $420.61
33224 $495.20
33225 $440.21
33226 $477.63
33227 $335.21
33228 $349.44
33229 $363.66
33230 $377.52
33231 $391.75
33233 $243.69
33234 $445.00
33235 $516.00
33236 $683.55
33237 $827.23
33238 $912.56
33240 $381.88
33241 $225.00
33243 $1,277.84
33244 $830.00
33249 $887.38
33250 $1,385.81
33251 $1,543.07
33254 $1,309.03
33255 $1,575.35
33256 $1,880.62
33257 $507.83
33258 $573.06
33259 $749.93
33261 $1,543.63
33262 $364.00
33263 $378.22
33264 $392.45
33265 $1,309.03
33266 $1,789.55
33282 $240.08
33284 $163.00
33300 $1,841.00
33305 $2,206.00
33310 $1,146.68
33315 $1,423.93
33320 $1,028.17
33321 $1,194.30
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
33322 $1,328.49
33330 $1,353.60
33332 $1,318.89
33335 $1,799.21
33361 $1,313.56
33362 $1,437.09
33363 $1,487.94
33364 $1,584.30
33365 $1,729.80
33366 $1,950.50
33367 $606.47
33368 $734.90
33369 $970.28
33400 $2,164.39
33401 $1,446.38
33403 $1,510.00
33404 $1,761.62
33405 $2,277.66
33406 $2,725.00
33410 $1,938.00
33411 $3,070.20
33412 $2,473.00
33413 $3,079.80
33414 $2,063.90
33415 $1,894.40
33416 $1,931.31
33417 $1,654.04
33420 $1,310.18
33422 $1,668.32
33425 $2,405.45
33426 $2,307.36
33427 $2,460.45
33430 $2,604.49
33460 $2,062.59
33463 $2,513.00
33464 $2,221.31
33465 $2,438.30
33468 $1,811.70
33470 $1,163.73
33471 $1,257.22
33472 $1,321.66
33474 $1,722.00
33475 $2,219.62
33476 $1,448.59
33478 $1,558.26
33496 $1,642.14
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
33500 $1,527.32
33501 $1,053.95
33502 $1,258.48
33503 $1,213.13
33504 $1,424.47
33505 $1,888.41
33506 $2,030.00
33507 $1,725.56
33508 $15.93
33510 $1,950.39
33511 $2,108.67
33512 $2,335.79
33513 $2,401.53
33514 $2,506.92
33516 $2,607.72
33517 $172.78
33518 $366.91
33519 $494.41
33521 $606.08
33522 $699.30
33523 $804.73
33530 $464.00
33533 $1,913.19
33534 $2,186.37
33535 $2,393.16
33536 $2,547.64
33542 $2,349.74
33545 $2,788.14
33548 $2,389.02
33572 $229.52
33600 $1,670.21
33602 $1,625.41
33606 $1,741.83
33608 $1,790.20
33610 $1,732.55
33611 $1,900.57
33612 $1,998.86
33615 $1,879.12
33617 $2,154.33
33619 $2,670.38
33620 $1,485.44
33621 $894.97
33622 $3,520.43
33641 $1,508.69
33645 $1,538.54
33647 $1,641.59
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
33660 $1,745.93
33665 $1,789.00
33670 $1,916.54
33675 $2,017.54
33676 $2,123.00
33677 $2,207.00
33681 $1,788.00
33684 $1,859.00
33688 $1,738.00
33690 $1,140.00
33692 $1,726.99
33694 $1,909.17
33697 $2,072.40
33702 $1,532.41
33710 $1,708.78
33720 $1,526.90
33722 $1,530.48
33724 $1,491.52
33726 $1,964.99
33730 $1,947.10
33732 $1,646.76
33735 $1,174.95
33736 $1,383.34
33737 $1,268.16
33750 $1,205.73
33755 $1,212.80
33762 $1,241.67
33764 $1,259.38
33766 $1,351.25
33767 $1,425.12
33768 $414.26
33770 $2,064.20
33771 $2,049.41
33774 $1,792.57
33775 $1,830.68
33776 $1,947.18
33777 $1,901.88
33778 $2,312.76
33779 $2,108.50
33780 $2,300.96
33781 $2,141.17
33782 $3,217.36
33783 $3,477.31
33786 $2,224.43
33788 $1,514.62
33800 $932.95
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
33802 $1,044.97
33803 $1,161.94
33813 $1,238.96
33814 $1,506.17
33820 $974.63
33822 $1,014.31
33824 $1,161.71
33840 $1,188.56
33845 $1,314.21
33851 $1,257.08
33852 $1,333.84
33853 $1,820.43
33860 $2,913.61
33863 $2,978.87
33864 $2,704.23
33870 $2,498.22
33875 $1,928.63
33877 $3,255.24
33880 $1,772.79
33881 $1,530.58
33883 $1,127.43
33884 $405.56
33886 $978.78
33889 $811.84
33891 $1,005.36
33910 $1,527.19
33915 $1,251.14
33916 $1,531.76
33917 $1,443.55
33920 $1,779.55
33922 $1,360.88
33924 $289.50
33925 $1,742.47
33926 $2,399.06
33930 $4,500.00
33933 $617.50
33935 $3,487.29
33940 $3,000.00
33944 $356.00
33945 $2,682.50
33960 $952.44
33961 $538.84
33967 $255.78
33968 $33.85
33970 $350.51
33971 $685.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
33973 $511.97
33974 $876.73
33975 $1,071.59
33976 $1,196.04
33977 $1,154.69
33978 $1,328.48
33979 $1,997.53
33980 $1,826.73
33981 $857.61
33982 $2,004.41
33983 $2,362.14
33990 $427.37
33991 $622.72
33992 $202.83
33993 $178.11
34001 $857.00
34051 $949.03
34101 $618.71
34111 $619.15
34151 $1,375.00
34201 $683.00
34203 $938.00
34401 $1,096.00
34421 $735.00
34451 $1,497.95
34471 $642.18
34490 $620.65
34501 $935.00
34502 $1,542.14
34510 $1,103.37
34520 $1,031.60
34530 $996.57
34800 $1,159.04
34802 $1,257.70
34803 $1,294.33
34804 $1,256.32
34805 $1,195.57
34808 $212.15
34812 $348.48
34813 $244.78
34820 $503.33
34825 $708.97
34826 $207.55
34830 $1,837.90
34831 $1,924.94
34832 $1,976.47
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
34833 $629.98
34834 $283.24
34900 $922.34
35001 $1,158.12
35002 $1,168.77
35005 $1,049.75
35011 $1,016.33
35013 $1,257.17
35021 $1,214.24
35022 $1,365.89
35045 $981.07
35081 $1,723.35
35082 $2,197.24
35091 $1,862.38
35092 $2,444.00
35102 $1,873.84
35103 $2,278.57
35111 $1,404.31
35112 $1,702.74
35121 $1,685.98
35122 $1,977.14
35131 $1,430.71
35132 $1,695.81
35141 $1,141.75
35142 $1,356.51
35151 $1,287.58
35152 $1,291.00
35180 $807.66
35182 $1,718.47
35184 $1,006.00
35188 $833.00
35189 $1,585.66
35190 $758.56
35201 $903.00
35206 $778.94
35207 $701.44
35211 $1,356.75
35216 $1,169.38
35221 $1,345.00
35226 $864.27
35231 $1,136.00
35236 $991.23
35241 $1,414.99
35246 $1,546.61
35251 $1,671.71
35256 $1,048.24
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
35261 $1,025.00
35266 $871.47
35271 $1,348.46
35276 $1,420.56
35281 $1,598.10
35286 $962.14
35301 $1,073.71
35302 $1,108.72
35303 $1,217.92
35304 $1,267.09
35305 $1,217.92
35306 $455.63
35311 $1,488.42
35321 $916.06
35331 $1,492.03
35341 $1,423.14
35351 $1,312.25
35355 $1,068.29
35361 $1,587.79
35363 $1,721.93
35371 $850.90
35372 $1,019.76
35390 $164.40
35400 $153.95
35450 $522.38
35452 $353.27
35458 $497.75
35460 $318.56
35471 $537.70
35472 $366.76
35475 $349.79
35476 $279.09
35500 $327.96
35501 $1,373.00
35506 $1,230.20
35508 $1,191.46
35509 $1,319.00
35510 $1,278.39
35511 $1,200.87
35512 $1,253.40
35515 $1,182.10
35516 $953.00
35518 $1,192.29
35521 $1,280.18
35522 $1,220.36
35523 $1,108.30
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
35525 $1,155.82
35526 $1,746.03
35531 $2,050.00
35533 $1,544.00
35535 $1,798.17
35536 $1,763.09
35537 $2,141.26
35538 $2,391.76
35539 $2,248.04
35540 $2,505.46
35556 $1,388.80
35558 $1,247.69
35560 $1,777.79
35563 $1,234.00
35565 $1,305.00
35566 $1,666.66
35570 $1,442.12
35571 $1,385.41
35572 $350.73
35583 $1,438.79
35585 $1,698.87
35587 $1,426.73
35600 $256.40
35601 $1,284.00
35606 $1,196.14
35612 $935.81
35616 $1,000.61
35621 $1,124.00
35623 $1,330.00
35626 $1,583.83
35631 $1,859.00
35632 $1,707.81
35633 $1,908.76
35634 $1,671.04
35636 $1,663.27
35637 $1,705.30
35638 $1,732.16
35642 $1,029.96
35645 $1,025.92
35646 $1,764.07
35647 $1,583.00
35650 $1,090.74
35654 $1,411.33
35656 $1,113.80
35661 $1,116.99
35663 $1,291.71
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
35665 $1,213.44
35666 $1,309.30
35671 $1,152.50
35681 $82.20
35682 $367.86
35683 $426.09
35685 $207.20
35686 $166.73
35691 $986.24
35693 $871.81
35694 $1,029.57
35695 $1,069.02
35697 $153.53
35700 $158.36
35701 $510.00
35721 $463.15
35741 $507.63
35761 $376.26
35800 $480.50
35820 $787.00
35840 $612.00
35860 $407.94
35870 $1,298.34
35875 $606.40
35876 $968.64
35879 $939.00
35881 $1,057.00
35883 $1,235.50
35884 $1,294.09
35901 $490.78
35903 $587.56
35905 $1,751.96
35907 $1,964.02
36000 $25.00
36002 $165.67
36005 $30.02
36010 $124.20
36011 $160.95
36012 $209.00
36013 $177.64
36014 $179.00
36015 $208.00
36100 $212.00
36120 $131.00
36140 $105.05
36147 $749.50
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
36148 $236.00
36160 $174.00
36200 $155.84
36215 $247.90
36216 $283.17
36217 $339.87
36218 $53.99
36221 $1,143.64
36222 $1,446.92
36223 $321.92
36224 $1,732.57
36225 $1,560.22
36226 $1,767.56
36227 $253.20
36228 $1,202.71
36245 $261.76
36246 $274.87
36247 $328.63
36248 $59.00
36251 $1,250.00
36252 $1,375.00
36253 $1,890.00
36254 $1,965.00
36260 $569.78
36261 $351.48
36262 $256.00
36400 $17.00
36405 $22.17
36406 $17.68
36410 $17.16
36415 $2.70
36416 $2.70
36420 $47.28
36425 $36.58
36430 $34.56
36440 $51.75
36450 $110.31
36455 $115.48
36460 $334.48
36468 $104.71
36469 $67.00
36470 $142.85
36471 $99.00
36475 $363.38
36476 $178.15
36478 $360.31
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
36479 $177.46
36481 $354.22
36500 $160.00
36510 $64.00
36511 $89.16
36512 $89.93
36513 $91.77
36514 $96.00
36515 $96.00
36516 $96.00
36522 $104.04
36555 $260.93
36556 $123.94
36557 $332.00
36558 $286.14
36560 $373.01
36561 $363.92
36563 $385.21
36565 $1,006.09
36566 $1,311.00
36568 $100.78
36569 $94.32
36570 $1,215.77
36571 $329.98
36575 $164.00
36576 $373.44
36578 $530.50
36580 $69.02
36581 $202.54
36582 $1,133.63
36583 $415.00
36584 $208.92
36585 $1,186.14
36589 $168.32
36590 $261.50
36591 $15.70
36592 $17.27
36593 $30.00
36595 $596.27
36596 $137.59
36597 $129.10
36598 $30.45
36600 $21.11
36620 $50.33
36625 $101.61
36640 $118.51
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
36660 $67.67
36680 $60.77
36800 $127.81
36810 $213.34
36815 $146.21
36818 $690.63
36819 $757.88
36820 $797.27
36821 $530.08
36822 $380.00
36823 $1,239.83
36825 $577.91
36830 $661.50
36831 $447.74
36832 $583.85
36833 $658.86
36835 $451.50
36838 $1,185.73
36860 $156.57
36861 $133.59
36870 $310.09
37140 $1,322.78
37145 $1,412.03
37160 $1,214.00
37180 $1,397.63
37181 $1,497.22
37182 $843.47
37183 $403.09
37184 $2,318.74
37185 $742.97
37186 $1,427.24
37187 $416.24
37188 $1,833.14
37191 $2,536.30
37192 $1,569.02
37193 $1,639.50
37195 $300.00
37197 $1,558.84
37200 $222.27
37202 $308.06
37211 $398.16
37212 $351.48
37213 $245.33
37214 $144.74
37215 $1,072.65
37216 $1,043.27
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
37217 $1,142.40
37220 $2,995.20
37221 $520.39
37222 $865.80
37223 $219.75
37224 $471.83
37225 $636.18
37226 $525.75
37227 $7,000.00
37228 $575.08
37229 $6,115.50
37230 $7,115.50
37231 $8,283.00
37232 $1,151.80
37233 $1,411.80
37234 $3,654.30
37235 $3,907.80
37236 $2,866.00
37237 $1,188.00
37238 $4,108.00
37239 $1,975.00
37241 $457.79
37242 $511.13
37243 $609.37
37244 $710.83
37250 $109.23
37251 $81.96
37500 $700.15
37565 $640.50
37600 $507.00
37605 $578.00
37606 $464.90
37607 $374.85
37609 $254.00
37615 $424.00
37616 $1,039.84
37617 $1,227.00
37618 $364.68
37619 $1,613.85
37650 $472.00
37660 $1,149.00
37700 $251.62
37718 $399.34
37722 $471.69
37735 $626.46
37760 $615.11
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
37761 $567.85
37765 $447.59
37766 $540.21
37780 $257.77
37785 $242.00
37788 $1,256.67
37790 $484.67
38100 $915.00
38101 $906.00
38102 $246.15
38115 $898.00
38120 $941.06
38200 $88.00
38205 $78.84
38206 $78.84
38220 $153.50
38221 $168.84
38230 $212.27
38232 $181.44
38240 $119.79
38241 $120.17
38242 $90.50
38243 $115.39
38300 $112.00
38305 $338.00
38308 $402.92
38380 $522.52
38381 $779.17
38382 $605.29
38500 $244.00
38505 $121.35
38510 $357.00
38520 $420.70
38525 $374.30
38530 $489.17
38542 $375.00
38550 $402.00
38555 $850.00
38562 $639.54
38564 $635.70
38570 $511.65
38571 $776.01
38572 $910.08
38700 $700.04
38720 $1,150.72
38724 $1,226.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 30000 - 39999
Effective Jan. 1, 2015
CPT Code Reimbursement
38740 $474.00
38745 $714.46
38746 $219.19
38747 $250.33
38760 $646.76
38765 $1,172.75
38770 $762.48
38780 $983.83
38790 $50.09
38792 $37.41
38794 $273.08
38900 $133.89
39000 $464.73
39010 $788.60
39200 $865.08
39220 $1,102.75
39400 $464.00
39501 $782.48
39503 $3,202.00
39540 $794.96
39541 $855.02
39545 $852.32
39560 $736.21
39561 $1,123.61
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans.
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