| Pueblo-Canon City | Surgery | Debridement subcutaneous (under the skin) tissue - first 20 sq cm | Debridement, Subsequesnt Tissue 20 Sq Cm/ | 11042 | $96.10 | Per Service |
| Pueblo-Canon City | Surgery | Insertion of drug implant device | Insertion of Drug Implant Device | 11981 | $185.00 | Per Service |
| Pueblo-Canon City | Surgery | Tissue Transfer - additional 30 square cm | Tissue Transfer Additional 30 Square Cm | 14302 | $290.00 | Per Service |
| Pueblo-Canon City | Surgery | Descuction of up to 14 benign lesions | Destruction of benign Lesion 1-14 | 17110 | $145.50 | Per Service |
| Pueblo-Canon City | Surgery | Breast biopsy with placement of clip/metallic pellet - with ultrasound guidance | Biopsy Breast 1st Lesion Ultrasound Imaging | 19083 | $274.07 | Per Service |
| Pueblo-Canon City | Surgery | Large oint aspiration or injection (shoulder, knee, hip) without ultraound | Drain/Inj Joint/Bursa W/O Ultrasound | 20610 | $78.50 | Per Service |
| Pueblo-Canon City | Surgery | Large joint aspiration or injection (shoulder, knee, hip) with ultrasound | Drain/Inj Joint/Bursa W/Ultrasound | 20611 | $117.50 | Per Service |
| Pueblo-Canon City | Surgery | Insertion of mechanical disk spacer during spine surgery | Insertion of Biomechanical Device | 22853 | $332.00 | Per Service |
| Pueblo-Canon City | Surgery | Reduction of shoulder dislocation | Treat Shoulder Dislocation | 23650 | $411.00 | Per Service |
| Pueblo-Canon City | Surgery | Nonsurgical treatment of radius fracture at the wrist including ulna | Treat Fracture Radius/Ulna | 25600 | $430.00 | Per Service |
| Pueblo-Canon City | Surgery | Total Hip Arthroplasty (THA) | Total Hip Arthroplasty | 27130 | $1,781.50 | Per Service |
| Pueblo-Canon City | Surgery | Total Knee Arthroplasty (TKA) | Total Knee Arthroplasty | 27447 | $1,780.00 | Per Service |
| Pueblo-Canon City | Surgery | Arthroscopic shoulder surgery - decompression/repair of acromion/ligament release | Shoulder Arthroscopy/Surgery | 29826 | $231.50 | Per Service |
| Pueblo-Canon City | Surgery | Arthroscopic Cartilage Removal | Knee Arthroscopy/Surgery | 29881 | $710.50 | Per Service |
| Pueblo-Canon City | Surgery | Arthroscopic ACL Repair | Knee Arthroscopy/Surgery | 29888 | $1,291.50 | Per Service |
| Pueblo-Canon City | Surgery | Removal of inferior nasal turbinate | Resect Inferior Turbinate | 30140 | $356.00 | Per Service |
| Pueblo-Canon City | Surgery | Repair Of Nasal Septum | Repair Of Nasal Septum | 30520 | $794.00 | Per Service |
| Pueblo-Canon City | Surgery | Diagnostic scope of the nose - unilateral or bilateral | Nasal Endoscopy Dx | 31231 | $272.50 | Per Service |
| Pueblo-Canon City | Surgery | Sinus or Nasal surgery with biopsy or removal of polyps | Nasal/Sinus Endoscopy Surg | 31237 | $339.00 | Per Service |
| Pueblo-Canon City | Surgery | Scope of Larynx (voice box) | Diagnostic Laryngoscopy | 31575 | $146.00 | Per Service |
| Pueblo-Canon City | Surgery | Routine Venipuncture | Routine Venipuncture | 36415 | $4.00 | Per Service |
| Pueblo-Canon City | Surgery | Esophagus/Stomach/Intestine (EDG) with biopsy single/multiple | Esophagus Biopsy Single/Multiple | 43239 | $254.01 | Per Service |
| Pueblo-Canon City | Surgery | Diagnostic Colonoscopy | Diagnostic Colonoscopy | 45378 | $342.43 | Per Service |
| Pueblo-Canon City | Surgery | Colonoscopy with biopsy | Colonoscopy And Biopsy | 45380 | $406.76 | Per Service |
| Pueblo-Canon City | Surgery | Colonoscopy with lesion/polyp removal | Colonoscopy W/Lesion Removal | 45385 | $484.78 | Per Service |
| Pueblo-Canon City | Surgery | Diagnostic exam of the anus using an endoscope | Diagnostic Anoscopy Specimen | 46600 | $116.50 | Per Service |
| Pueblo-Canon City | Surgery | Circumcision - Clamp | Circumcision W/Regional Block | 54150 | $156.50 | Per Service |
| Pueblo-Canon City | Surgery | Cervical biopsy with scope | Bx/Curett Of Cervix W/Scope | 57454 | $196.00 | Per Service |
| Pueblo-Canon City | Surgery | Biopsy of Uterine Lining | Biopsy Of Uterus Lining | 58100 | $140.50 | Per Service |
| Pueblo-Canon City | Surgery | Insertion of an Intrauterine Device (IUD) | Insert Intrauterine Device | 58300 | $95.50 | Per Service |
| Pueblo-Canon City | Surgery | Removal of an Intrauterine Device (IUD) | Remove Intrauterine Device | 58301 | $123.00 | Per Service |
| Pueblo-Canon City | Surgery | Laparoscopic total hysterectomy for a uterus of 250g or less | Tlh W/T/O 250 G Or Less | 58571 | $1,161.50 | Per Service |
| Pueblo-Canon City | Surgery | Fetal Non Stress Test | Fetal Non-Stress Test | 59025 | $63.00 | Per Service |
| Pueblo-Canon City | Surgery |
Routine Vaginal Delivery Package - includes:
- Up to 13 prenatal visits (after initial visit)
- Routine prenatal urinalysis tests
- Labor, delivery
- Uncomplicated postpartum care
|
Obstetrical Care | 59400 | $2,727.50 | Per Service |
| Pueblo-Canon City | Surgery | Physician charges of antepartum care only | Antepartum Care Only | 59426 | $1,060.00 | Per Service |
| Pueblo-Canon City | Surgery | C-Section Delivery Package - includes:
- Up to 13 prenatal visits (after initial visit)
- Routine prenatal urinalysis tests
- Labor, delivery
- Uncomplicated postpartum care
|
Cesarean Delivery | 59510 | $3,025.50 | Per Service |
| Pueblo-Canon City | Surgery | C-Section - Delivery Only | Cesarean Delivery Only | 59514 | $1,200.50 | Per Service |
| Pueblo-Canon City | Surgery | Spinal injection - epidural with imaging - Lumbar/Sacrum single level | Injection transforminal Epidural Lumbar/Sacral | 64483 | $179.01 | Per Service |
| Pueblo-Canon City | Surgery | Spinal Facet Injection with imaging - Lumbar/Sacrum single level | Injection Paravertebral Facet Joint L/S 1 Lev | 64493 | $147.08 | Per Service |
| Pueblo-Canon City | Surgery | Bilateral Chemodenervation of Muscle(s) (eg: Botox for Migraines) | Chemodenervation of Muscle(s) for Migraine | 64615 | $192.50 | Per Service |
| Pueblo-Canon City | Radiology | Chest X-Ray - 2 view | Chest X-Ray 2 view Frontal&Lateral | 71020 | $36.00 | Per Service |
| Pueblo-Canon City | Radiology | X-Ray of Shoulder - complete | X-Ray Exam Of Shoulder | 73030 | $38.00 | Per Service |
| Pueblo-Canon City | Radiology | X-Ray of Wrist - complete | X-Ray Exam Of Wrist | 73110 | $45.50 | Per Service |
| Pueblo-Canon City | Radiology | X-Ray of Knee - 3 views | X-Ray Exam Of Knee 3 | 73562 | $46.50 | Per Service |
| Pueblo-Canon City | Radiology | X-Ray of Ankle - complete | X-Ray Exam Of Ankle | 73610 | $41.00 | Per Service |
| Pueblo-Canon City | Radiology | X-Ray of foot - complete | X-Ray Exam Of Foot | 73630 | $38.00 | Per Service |
| Pueblo-Canon City | Radiology | Ultrasound Breast Limited - Unilateral | Ultrasound Breast Limited | 76642 | $114.50 | Per Service |
| Pueblo-Canon City | Radiology | OB Ultrasound first trimester - Single Fetus | OB Ultrasound | 76801 | $161.00 | Per Service |
| Pueblo-Canon City | Radiology | OB Ultrasound after first trimester - Single Fetus | Ob Ultrasound >/= 14 Wks Single Fetus | 76805 | $185.50 | Per Service |
| Pueblo-Canon City | Radiology | OB Ultrasound Follow-Up Per Fetus | OB Ultrasound Follow-Up Per Fetus | 76816 | $151.00 | Per Service |
| Pueblo-Canon City | Radiology | Transvaginal ultrasound - obstetric | Transvaginal Ultrasound Obstetric | 76817 | $126.50 | Per Service |
| Pueblo-Canon City | Radiology | Transvaginal ultrasound - not obstetric | Transvaginal Ultrasound Non-Ob | 76830 | $159.00 | Per Service |
| Pueblo-Canon City | Radiology | 3D screening breast mammography - bilateral | Breast Tomosynthesis Biopsy | 77063 | $71.50 | Per Service |
| Pueblo-Canon City | Radiology | Screening Mammogram - Bilateral | Screening Mamm Bilat Incl Cad When Perf | 77067 | $175.00 | Per Service |
| Pueblo-Canon City | Lab Path | Automated Urinalysis without microscopy | Urinalysis Auto W/O Scope | 81003 | $3.50 | Per Service |
| Pueblo-Canon City | Lab Path | Influenze A or B Test | Influenza Assay W/Optic | 87804 | $21.00 | Per Service |
| Pueblo-Canon City | Lab Path | Strep A Test | Strep A Assay W/Optic | 87880 | $21.00 | Per Service |
| Pueblo-Canon City | Medicine | Immunization admistration with counseling - ages of 0-18 | Im Admin 1St/Only Component | 90460 | $26.50 | Per Service |
| Pueblo-Canon City | Medicine | Immunization administration with counseling - additional vaccines - ages of 0-18 | Im Admin Each Addl Component | 90461 | $16.50 | Per Service |
| Pueblo-Canon City | Medicine | Immunization administration - initial vaccine | Immunization Admin | 90471 | $26.50 | Per Service |
| Pueblo-Canon City | Medicine | Immunization administration - additional administration | Immunization Admin Each Add | 90472 | $16.50 | Per Service |
| Pueblo-Canon City | Medicine | HPV Vaccine | Vaccine 2/3 Dose Im | 90651 | $172.00 | Per Service |
| Pueblo-Canon City | Medicine | Pneumonia 13 Vaccine | Pcv13 Vaccine Im | 90670 | $234.24 | Per Service |
| Pueblo-Canon City | Medicine | Flu Vaccine - preservative free | Flu Vacinne 0.5 Ml Intramuscular | 90686 | $24.00 | Per Service |
| Pueblo-Canon City | Medicine | Flu Vaccine | Flu Vaccine Split 0.5 Ml Intramuscular | 90688 | $22.50 | Per Service |
| Pueblo-Canon City | Medicine | Tetanus Diptheria Vaccine administered to individuals 7 years or older | Tetanus Diptheria Vaccine 7 Yrs/> Intramuscular | 90715 | $38.00 | Per Service |
| Pueblo-Canon City | Medicine | Psychotherapy Evalutation - 30 Minutes | Psychotherapy Evalutation with E/M 30 Min | 90833 | $87.00 | Per Service |
| Pueblo-Canon City | Medicine | Psychotherapy Evaluation - 45 Minutes | Psychotherapy Evaluation with E/M 45 Minutes | 90834 | $111.50 | Per Service |
| Pueblo-Canon City | Medicine | Electroconvulsive Therapy | Electroconvulsive Therapy | 90870 | $171.70 | Per Service |
| Pueblo-Canon City | Medicine | Comprehensive Hearing Test | Comprehensive Hearing Test | 92557 | $49.00 | Per Service |
| Pueblo-Canon City | Medicine | Electrocardiogram (EKG) Complete | Electrocardiogram Complete | 93000 | $22.00 | Per Service |
| Pueblo-Canon City | Medicine | Electrocardiogram (EKG) Report | Electrocardiogram Report | 93010 | $11.00 | Per Service |
| Pueblo-Canon City | Medicine | Echocardiogram with Doppler Study | Transthoracic Echo w/Doppler Complete | 93306 | $271.00 | Per Service |
| Pueblo-Canon City | Medicine | Heart Stress Test Complete | Stress Test Complete | 93351 | $303.00 | Per Service |
| Pueblo-Canon City | Medicine | Heart Angiogram including Left Heart Catherization | L Hrt Artery/Ventricle Angio | 93458 | $1,315.50 | Per Service |
| Pueblo-Canon City | Medicine | Abdominal/Pelvic ultrasound study -arteries/veins - Limited | Vascular Study | 93976 | $197.00 | Per Service |
| Pueblo-Canon City | Medicine | Therapeutic Exercises, each 15 minutes | Therapeutic Exercises | 97110 | $40.00 | Per Service |
| Pueblo-Canon City | Medicine | Manual therapy for 1 or more regions, each 15 minutes | Manual Therapy 1/> Regions | 97140 | $36.00 | Per Service |
| Pueblo-Canon City | Medicine | Physical therapy evaluation - low complexity (about 20 Minutes) | Physical therapy Evaluation Low Complex 20 Min | 97161 | $108.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 2 office visit for a new patient | Office/Outpatient Visit New Patient | 99202 | $96.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 3 office visit for a new patient | Office/Outpatient Visit New Patient | 99203 | $139.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 4 office visit for a new patient | Office/Outpatient Visit New Patient | 99204 | $211.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 5 office visit for a new patient | Office/Outpatient Visit New Patient | 99205 | $266.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 2 office visit for an established patient | Office/Outpatient Visit Established Patient | 99212 | $56.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 3 office visit for an established patient | Office/Outpatient Visit Established Patient | 99213 | $94.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 4 office visit for an established patient | Office/Outpatient Visit Established Patient | 99214 | $138.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Level 5 office visit for an established patient | Office/Outpatient Visit Established Patient | 99215 | $186.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Initial preventative visit for a newpatient less than one year old | Init Preventative E/M New Patient Infant | 99381 | $142.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Initial preventative visit for a new patient between the ages 1-4 | Init Preventative E/M New Patient 1-4 Yrs | 99382 | $149.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Initial preventative visit for a new patient between the ages 5-11 | Previous Visit New Age 5-11 | 99383 | $154.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Initial preventative visit for a new patient between the ages 12-17 | Previous Visit New Age 12-17 | 99384 | $174.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Initial preventative visit for a new patient between the ages 18-39 | Prev Visit New Patient Age 18-39 | 99385 | $169.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Initial preventative visit for a new patient between the ages 40-64 | Prev Visit New Patient Age 40-64 | 99386 | $196.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established infant patient less than one year old | Preventive Visit Reevaluation Established Pat Infant | 99391 | $128.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established patient between the ages of 1-4 | Preventive Visit Established Patient Age 1-4 | 99392 | $136.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established patient between the ages of 5-11 | Preventive Med Visit Established Pateint Age 5-11 | 99393 | $136.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established patient between the ages of 12-17 | Preventive Visit Established Patient Age 12-17 | 99394 | $149.00 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established patient between the ages of 18-39 | Prev Visit Established Patient Age 18-39 | 99395 | $152.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established patient between the ages of 40-64 | Prev Visit Est Age 40-64 | 99396 | $162.50 | Per Service |
| Pueblo-Canon City | Evaluation and Mgmt | Preventive visit for an established patients ages 65 and over | Established Patient Reevaluation65+ Yr | 99397 | $175.00 | Per Service |
