,,,,Charge by OR time,,,Aetna,,Cigna,BCBS,,,,,,,,,,,,,,,,,,, CPTCode,Description,descripition 2, Charge ,1st 15 minutes,each additionl minute, Disc Cash ,PPO,Advantage,,PPO,Blue Essentials,Blue Advantage,Min Neg Chg,Max Neg Chg,,,,,,,,,,,,,,, 10021,ED FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE,Emergency department," 1,926.75 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 119.12 , 107.43 , 82.58 , 82.58 ," 1,200.00 ",,,,,,,,,,,,,,, 10021,FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE,OR LEVEL 3,," 17,605.00 ", 219.52 , 746.14 ," 1,200.00 ", 314.08 ,, 119.12 , 107.43 , 82.58 , 82.58 ," 1,200.00 ",,,,,,,,,,,,,,, 10022,ED FINE NEEDLE ASPIRATION; WITH IMAGING GUIDANCE,Emergency department," 1,767.50 ",,,," 2,500.00 ",," 1,900.00 ", 152.57 , 137.59 , 105.77 , 105.77 ," 2,500.00 ",,,,,,,,,,,,,,, 10022,FINE NEEDLE ASPIRATION; WITH IMAGING GUIDANCE,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,500.00 ",," 1,900.00 ", 152.57 , 137.59 , 105.77 , 105.77 ," 2,500.00 ",,,,,,,,,,,,,,, 10060,"EDINCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE",Emergency department," 1,478.25 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 119.12 , 107.43 , 82.58 , 82.58 ," 1,200.00 ",,,,,,,,,,,,,,, 10060,PSU INCISION AND DRAINAGE OF ABSCESS (EG CARBUNCLE SUPPURATIVE HIDRADENITIS CUTANEOUS OR SUBCUTANEOUS ABSCESS CYST FURUNCLE OR PARONYCHIA); SIMPLE OR SINGLE,Post Surgery Unit, 704.43 ,,, 361.16 ," 1,200.00 ", 176.45 ,, 119.12 , 107.43 , 82.58 , 82.58 ," 1,200.00 ",,,,,,,,,,,,,,, 10060,"INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ," 1,200.00 ", 176.45 ,, 119.12 , 107.43 , 82.58 , 82.58 ," 1,200.00 ",,,,,,,,,,,,,,, 10061,"EDINCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE",Emergency department," 1,478.25 ",,, 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 183.67 , 165.64 , 127.33 , 127.33 ," 1,800.00 ",,,,,,,,,,,,,,, 10061,INCISION AND DRAINAGE OF ABSCESS (EG CARBUNCLE SUPPURATIVE HIDRADENITIS CUTANEOUS OR SUBCUTANEOUS ABSCESS CYST FURUNCLE OR PARONYCHIA); COMPLICATED OR MULTIPLE,OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 183.67 , 165.64 , 127.33 , 127.33 ," 1,800.00 ",,,,,,,,,,,,,,, 10080,ED INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE,Emergency department," 2,319.38 ",,," 1,297.94 "," 1,200.00 ", 579.34 ,, 218.29 , 196.86 , 151.33 , 151.33 ," 1,200.00 ",,,,,,,,,,,,,,, 10080,INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE,10080," 2,319.38 ",,," 1,297.94 ",,,,,,, - , - ,,,,,,,,,,,,,,, 10081,ED INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED,Emergency department," 3,503.75 ",,," 1,297.94 "," 1,200.00 ", 579.34 ,, 284.01 , 256.13 , 196.89 , 196.89 ," 1,200.00 ",,,,,,,,,,,,,,, 10120,EDINCISION AND REMOVAL OF FOREIGN BODY SUBCUTANEOUS TISSUES; SIMPLE,Emergency department," 1,954.25 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 177.21 , 159.82 , 122.85 , 122.85 ," 1,200.00 ",,,,,,,,,,,,,,, 10120,"INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 177.21 , 159.82 , 122.85 , 122.85 ," 1,200.00 ",,,,,,,,,,,,,,, 10121,"EDINCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED",Emergency department," 3,531.38 ",,," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 10121,INCISION AND REMOVAL OF FOREIGN BODY SUBCUTANEOUS TISSUES; COMPLICATED,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 10140,"EDINCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION",Emergency department," 2,473.24 ",,," 2,999.10 "," 1,200.00 "," 1,375.50 ",, 170.76 , 154.00 , 118.38 , 118.38 ," 1,375.50 ",,,,,,,,,,,,,,, 10140,"INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 ",, 170.76 , 154.00 , 118.38 , 118.38 ," 1,375.50 ",,,,,,,,,,,,,,, 10160,ED PUNCTURE ASPIRATION OF ABSCESS HEMATOMA BULLA OR CYST,Emergency department," 1,664.50 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 134.96 , 121.72 , 93.56 , 93.56 ," 1,200.00 ",,,,,,,,,,,,,,, 10160,PUNCTURE ASPIRATION OF ABSCESS,OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 134.96 , 121.72 , 93.56 , 93.56 ," 1,200.00 ",,,,,,,,,,,,,,, 10180,"INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11000,ED DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE,Emergency department, 906.20 ,,," 1,161.90 "," 1,200.00 ", 482.89 ,, 53.40 , 48.16 , 37.02 , 37.02 ," 1,200.00 ",,,,,,,,,,,,,,, 11000,EDDEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 1,200.00 ", 482.89 ,, 53.40 , 48.16 , 37.02 , 37.02 ," 1,200.00 ",,,,,,,,,,,,,,, 11001,DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 11004,"DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSUE INFECTION; EXTERNAL GENITALIA AND PERINEUM",OR LEVEL 1,," 12,325.60 ", 146.65 ,,,," 1,900.00 "," 1,108.11 ", 988.32 , 724.77 , 724.77 ," 1,900.00 ",,,,,,,,,,,,,,, 11005,"DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSUE INFECTION; ABDOMINAL WALL, WITH OR WITHOUT FASCIAL CLOSURE",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,503.16 "," 1,340.66 ", 983.15 , 983.15 ," 1,900.00 ",,,,,,,,,,,,,,, 11008,"REMOVAL OF PROSTHETIC MATERIAL OR MESH, ABDOMINAL WALL FOR INFECTION (EG, FOR CHRONIC OR RECURRENT MESH INFECTION OR NECROTIZING SOFT TISSUE INFECTION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,,,,, 528.49 , 471.36 , 345.66 , 345.66 , 528.49 ,,,,,,,,,,,,,,, 11010,ED DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES,Emergency department," 6,344.88 ",,," 1,297.94 "," 1,500.00 ", 579.34 ," 2,400.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 2,400.00 ",,,,,,,,,,,,,,, 11010,EDDEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISLOCATION(S); SKIN AND SUBCUTANEOUS TISSUES,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 2,400.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 2,400.00 ",,,,,,,,,,,,,,, 11011,ED DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG EXCISIONAL DEBRIDEMENT); SKIN SUBCUTANEOUS TISSUE MUSCLE FASCIA AND MUSCLE,Emergency department," 6,868.13 ",,," 1,297.94 "," 1,500.00 ", 579.34 ," 2,400.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 2,400.00 ",,,,,,,,,,,,,,, 11011,"DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISLOCATION(S); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 2,400.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 2,400.00 ",,,,,,,,,,,,,,, 11012,"DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISLOCATION(S); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11042,ED DEBRIDEMENT SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS IF PERFORMED); FIRST 20 SQ CM OR LESS,Emergency department," 1,502.88 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 11042,"DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 11043,"DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 11044,"DEBRIDEMENT; BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED) FIRST 20 SQ CM OR LESS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 11045,DEBRIDEMENT SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS IF PERFORMED); EACH ADDITIONAL 20 SQ CM OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 11046,DEBRIDEMENT MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS DERMIS AND SUBCUTANEOUS TISSUE IF PERFORMED); EACH ADDITIONAL 20 SQ CM OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 11047,"DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 11055,ED PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG CORN OR CALLUS); SINGLE LESION,Emergency department, 605.50 ,,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11104,"PUNCH BIOPSY OF THE SKIN (INCLUDING SIMPLE CLOSER, WHEN PERFORMED); SINGLE LESION",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 176.45 ,,,,, 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11111,ANESTHESIA,11111, 800.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 11200,ED REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS TAGS ANY AREA; UP TO AND INCLUDING 15 LESIONS,Emergency department," 1,119.50 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11200,"REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11201,"REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10 LESIONS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,,,," 1,900.00 ",,,," 1,900.00 "," 1,900.00 ",,,,,,,,,,,,,,, 11310,SHAVE SKIN LESION 0.5 CM/< 1ST,OR LEVEL 2,," 14,341.60 ",171.67, 361.16 ,, 176.45 ,, 137.31 , 123.83 , 95.19 , 95.19 , 176.45 ,,,,,,,,,,,,,,, 11400,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 149.63 , 134.95 , 103.73 , 103.73 ," 1,800.00 ",,,,,,,,,,,,,,, 11401,ED EXCISION BENIGN LESION INCLUDING MARGINS EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE) TRUNK ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM,Emergency department," 1,910.50 ",,, 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 164.30 , 148.18 , 113.90 , 113.90 ," 1,800.00 ",,,,,,,,,,,,,,, 11401,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 164.30 , 148.18 , 113.90 , 113.90 ," 1,800.00 ",,,,,,,,,,,,,,, 11402,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 180.73 , 162.99 , 125.29 , 125.29 ," 1,800.00 ",,,,,,,,,,,,,,, 11403,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 196.58 , 177.28 , 136.28 , 136.28 ," 1,800.00 ",,,,,,,,,,,,,,, 11404,ED EXCISION BENIGN LESION INCLUDING MARGINS EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE) TRUNK ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM,Emergency department," 2,473.24 ",,," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 11404,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 11406,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 11420,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 1,800.00 ", 137.90 , 124.36 , 95.60 , 95.60 ," 1,800.00 ",,,,,,,,,,,,,,, 11421,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 164.89 , 148.71 , 114.31 , 114.31 ," 1,800.00 ",,,,,,,,,,,,,,, 11422,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 ", 181.91 , 164.05 , 126.11 , 126.11 ," 1,800.00 ",,,,,,,,,,,,,,, 11423,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 ", 197.16 , 177.81 , 136.68 , 136.68 ," 1,800.00 ",,,,,,,,,,,,,,, 11424,ED EXCISION BENIGN LESION INCLUDING MARGINS EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE) SCALP NECK HANDS FEET GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM,Emergency department," 7,941.14 ",,," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 11424,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM",OR LEVEL 4,," 21,812.00 ", 260.12 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 11426,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11440,"EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 157.85 , 142.35 , 109.43 , 109.43 ," 1,800.00 ",,,,,,,,,,,,,,, 11441,"EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.6 TO 1.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 178.97 , 161.41 , 124.07 , 124.07 ," 1,800.00 ",,,,,,,,,,,,,,, 11442,"EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 1.1 TO 2.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 195.40 , 176.22 , 135.46 , 135.46 ," 1,800.00 ",,,,,,,,,,,,,,, 11443,"EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 ", 215.94 , 194.75 , 149.70 , 149.70 ," 1,800.00 ",,,,,,,,,,,,,,, 11444,"EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 3.1 TO 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 11446,"EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11450,"EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11451,"EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLEX REPAIR",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11470,"EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH SIMPLE OR INTERMEDIATE REPAIR",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11471,"EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH COMPLEX REPAIR",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11602,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 262.89 , 237.08 , 182.25 , 182.25 ," 1,800.00 ",,,,,,,,,,,,,,, 11603,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 284.60 , 256.66 , 197.30 , 197.30 ," 1,800.00 ",,,,,,,,,,,,,,, 11604,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 2,400.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 2,400.00 ",,,,,,,,,,,,,,, 11606,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 11622,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 266.99 , 240.79 , 185.09 , 185.09 ," 1,800.00 ",,,,,,,,,,,,,,, 11626,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11641,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.6 TO 1.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 251.74 , 227.03 , 174.52 , 174.52 ," 1,800.00 ",,,,,,,,,,,,,,, 11642,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 276.97 , 249.78 , 192.01 , 192.01 ," 1,800.00 ",,,,,,,,,,,,,,, 11644,"EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 3.1 TO 4.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 11720,ED DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE,Emergency department, 409.00 ,,, 114.96 ," 1,200.00 ", 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 ," 1,200.00 ",,,,,,,,,,,,,,, 11730,"ED AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE",Emergency department," 1,249.13 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11730,"AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11732,"ED AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",Emergency department, 689.04 ,,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 11732,AVULSION OF NAIL PLATE PARTIAL OR COMPLETE SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 11740,ED EVACUATION OF SUBUNGUAL HEMATOMA,Emergency department, 630.75 ,,, 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 11740,EVACUATION OF SUBUNGUAL HEMATOMA,OR LEVEL 1,," 12,325.60 ", 146.65 , 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 11750,ED EXCISION OF NAIL AND NAIL MATRIX PARTIAL OR COMPLETE (EG INGROWN OR DEFORMED NAIL) FOR PERMANENT REMOVAL;,Emergency department," 2,838.13 ",,, 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 156.68 , 141.30 , 108.62 , 108.62 ," 1,800.00 ",,,,,,,,,,,,,,, 11750,"EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), FOR PERMANENT REMOVAL;",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 156.68 , 141.30 , 108.62 , 108.62 ," 1,800.00 ",,,,,,,,,,,,,,, 11755,"BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL NAIL FOLDS) (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 137.31 , 123.83 , 95.19 , 95.19 ," 1,800.00 ",,,,,,,,,,,,,,, 11760,ED REPAIR OF NAIL BED,Emergency department," 3,008.88 ",,," 1,161.90 "," 1,200.00 ", 482.89 ,, 903.17 , 805.53 , 590.72 , 482.89 ," 1,200.00 ",,,,,,,,,,,,,,, 11760,REPAIR OF NAIL BED,OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,161.90 "," 1,200.00 ", 482.89 ,, 903.17 , 805.53 , 590.72 , 482.89 ," 1,200.00 ",,,,,,,,,,,,,,, 11762,RECONSTRUCTION OF NAIL BED WITH GRAFT,OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,451.72 "," 1,500.00 "," 1,548.96 ",, 279.90 , 252.43 , 194.04 , 194.04 ," 1,548.96 ",,,,,,,,,,,,,,, 11765,ED WEDGE EXCISION OF SKIN OF NAIL FOLD (EG FOR INGROWN TOENAIL),Emergency department," 2,131.63 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 574.98 , 512.82 , 376.07 , 314.08 ," 1,200.00 ",,,,,,,,,,,,,,, 11770,EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11771,ED EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE,Emergency department," 4,297.82 ",,," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11771,EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11772,EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11900,"INJECTION, INTRALESIONAL; UP TO AND INCLUDING 7 LESIONS",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11901,INJECT SKIN LESIONS >7 1ST,OR LEVEL 1,," 12,325.60 ",143.65, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 11960,"INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST, INCLUDING SUBSEQUENT EXPANSION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,506.08 "," 1,500.00 "," 2,766.13 "," 2,400.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 1,500.00 "," 5,014.39 ",,,,,,,,,,,,,,, 11970,REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 11971,REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OF PROSTHESIS,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,200.00 "," 2,378.29 "," 1,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 11981,"INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",OR LEVEL 2,," 14,341.60 ", 171.67 , 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 11982,"REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT",OR LEVEL 2,," 14,341.60 ", 171.67 , 755.14 ," 1,200.00 ", 348.16 ,, 610.52 , 544.52 , 399.31 , 348.16 ," 1,200.00 ",,,,,,,,,,,,,,, 12001,"ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS",Emergency department," 1,156.88 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 12001,"SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 12002,ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP NECK AXILLAE EXTERNAL GENITALIA TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM,Emergency department," 1,399.00 ",,, 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 12002,"SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 12004,ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP NECK AXILLAE EXTERNAL GENITALIA TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM,Emergency department," 1,641.13 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 12005,ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP NECK AXILLAE EXTERNAL GENITALIA TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM,Emergency department," 2,121.25 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12006,ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP NECK AXILLAE EXTERNAL GENITALIA TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM,Emergency department," 2,563.00 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12011,"EDSIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS",Emergency department," 1,411.63 ",,, 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 12011,"SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 12013,ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE EARS EYELIDS NOSE LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM,Emergency department," 1,543.75 ",,, 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 12014,"ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM",Emergency department," 1,543.75 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 12015,ED SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE EARS EYELIDS NOSE LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12.5 CM,Emergency department," 2,198.00 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 12016,SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE EARS EYELIDS NOSE LIPS AND/OR MUCOUS MEMBRANES; 12.6 CM TO 20.0 CM,Emergency department," 2,728.38 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12020,ED TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE,Emergency department," 3,603.25 ",,," 1,161.90 "," 1,200.00 ", 482.89 ," 1,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 1,800.00 ",,,,,,,,,,,,,,, 12020,TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 1,200.00 ", 482.89 ," 1,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 1,800.00 ",,,,,,,,,,,,,,, 12021,ED TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING,Emergency department," 2,177.00 ",,, 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 1,800.00 ",,,,,,,,,,,,,,, 12031,ED REPAIR INTERMEDIATE WOUNDS OF SCALP AXILLAE TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS,Emergency department," 3,054.88 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 262.89 , 237.08 , 182.25 , 182.25 ," 1,200.00 ",,,,,,,,,,,,,,, 12031,"LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 262.89 , 237.08 , 182.25 , 182.25 ," 1,200.00 ",,,,,,,,,,,,,,, 12032,"ED LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM",Emergency department," 3,902.38 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12032,"REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12034,ED REPAIR INTERMEDIATE WOUNDS OF SCALP AXILLAE TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM,Emergency department," 3,993.50 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12034,"LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12035,ED REPAIR INTERMEDIATE WOUNDS OF SCALP AXILLAE TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM,Emergency department," 4,970.13 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12041,ED REPAIR INTERMEDIATE WOUNDS OF NECK HANDS FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS,Emergency department," 3,102.00 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 256.43 , 231.26 , 177.77 , 177.77 ," 1,200.00 ",,,,,,,,,,,,,,, 12041,"LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 256.43 , 231.26 , 177.77 , 177.77 ," 1,200.00 ",,,,,,,,,,,,,,, 12042,ED REPAIR INTERMEDIATE WOUNDS OF NECK HANDS FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM,Emergency department," 3,689.13 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12042,"LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12044,ED REPAIR INTERMEDIATE WOUNDS OF NECK HANDS FEET AND/OR EXTERNAL GENITALIA; 7.6 CM TO 12.5 CM,Emergency department," 4,611.38 ",,," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 12044,"LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6 CM TO 12.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 12045,ED REPAIR INTERMEDIATE WOUNDS OF NECK HANDS FEET AND/OR EXTERNAL GENITALIA; 12.6 CM TO 20.0 CM,Emergency department," 5,150.25 ",,," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 12051,"EDREPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS",Emergency department," 3,314.50 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12051,"LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12052,ED REPAIR INTERMEDIATE WOUNDS OF FACE EARS EYELIDS NOSE LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM,Emergency department," 3,757.25 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12052,"LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12053,EDREPAIR INTERMEDIATE WOUNDS OF FACE EARS EYELIDS NOSE LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM,Emergency department," 4,437.25 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12053,"LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,200.00 ", 314.08 ,, 263.90 , 237.99 , 182.95 , 182.95 ," 1,200.00 ",,,,,,,,,,,,,,, 12054,ED REPAIR INTERMEDIATE WOUNDS OF FACE EARS EYELIDS NOSE LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12.5 CM,Emergency department," 4,733.50 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12055,"LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 12.6 CM TO 20.0 CM",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 12056,"LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 20.1 CM TO 30.0 CM",OR LEVEL 2,," 14,341.60 ", 171.67 , 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 13100,ED REPAIR COMPLEX TRUNK; 1.1 CM TO 2.5 CM,Emergency department," 4,275.88 ",,," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 13100,"REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 13101,ED REPAIR COMPLEX TRUNK; 2.6 CM TO 7.5 CM,Emergency department," 5,050.38 ",,," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13101,"REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13102,ED REPAIR COMPLEX TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),Emergency department," 1,555.63 ",,,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 13102,"REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 13120,ED REPAIR COMPLEX SCALP ARMS AND/OR LEGS; 1.1 CM TO 2.5 CM,Emergency department," 4,480.00 ",,," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 13121,REPAIR COMPLEX SCALP ARMS AND/OR LEGS; 2.6 CM TO 7.5 CM,Emergency department," 5,467.25 ",,," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13121,"REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13122,REPAIR COMPLEX SCALP ARMS AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),Emergency department," 1,704.38 ",,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 13131,ED REPAIR COMPLEX FOREHEAD CHEEKS CHIN MOUTH NECK AXILLAE GENITALIA HANDS AND/OR FEET; 1.1 CM TO 2.5 CM,Emergency department," 4,926.63 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 13131,"REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5 CM",OR LEVEL 2,," 14,341.60 ", 171.67 , 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 13132,ED REPAIR COMPLEX FOREHEAD CHEEKS CHIN MOUTH NECK AXILLAE GENITALIA HANDS AND/OR FEET; 2.6 CM TO 7.5 CM,Emergency department," 6,079.88 ",,," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13132,"REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13133,ED REPAIR COMPLEX FOREHEAD CHEEKS CHIN MOUTH NECK AXILLAE GENITALIA HANDS AND/OR FEET; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),Emergency department," 2,257.88 ",,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 13151,ED REPAIR COMPLEX EYELIDS NOSE EARS AND/OR LIPS; 1.1 CM TO 2.5 CM,Emergency department," 5,381.75 ",,," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13151,"REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13152,ED REPAIR COMPLEX EYELIDS NOSE EARS AND/OR LIPS; 2.6 CM TO 7.5 CM,Emergency department," 6,109.38 ",,," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13152,"REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,161.90 "," 2,000.00 ", 482.89 ," 2,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,800.00 ",,,,,,,,,,,,,,, 13153,ED REPAIR COMPLEX EYELIDS NOSE EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),Emergency department," 2,453.13 ",,,," 2,000.00 ",,,,,," 2,000.00 "," 2,000.00 ",,,,,,,,,,,,,,, 13153,"REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 2,000.00 ",,,,,," 2,000.00 "," 2,000.00 ",,,,,,,,,,,,,,, 13160,"SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 2,400.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 14000,ADJACENT TISSUE TRANSFER OR REARRANGEMENT TRUNK; DEFECT 10 SQ CM OR LESS,OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 2,400.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 14001,"ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 14020,"ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 14021,"ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 14040,"ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 2,400.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 14041,"ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 14060,"ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 14301,ADJACENT TISSUE TRANSFER OR REARRANGEMENT ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM,OR LEVEL 1,," 12,325.60 ", 146.65 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 3,600.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 14302,ADJACENT TISSUE TRANSFER OR REARRANGEMENT ANY AREA; EACH ADDITIONAL 30.0 SQ CM OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15002,"SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR 1% OF BODY AREA OF INFANTS AND CHILDREN",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 2,400.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 15003,"SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM OR EACH ADDITIONAL 1% OF BODY AR",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15004,"SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/O",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,161.90 "," 1,500.00 ", 482.89 ," 2,400.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 2,400.00 ",,,,,,,,,,,,,,, 15100,"SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 2,400.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 15101,"SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)89514",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,000.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,000.00 ",,,,,,,,,,,,,,, 15120,"SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,506.08 "," 1,500.00 "," 2,766.13 "," 2,400.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 1,500.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15157,TISSUE CULTURED EPIDERMAL AUTOGRAFT 1ST,OR LEVEL 2,," 14,341.60 ",171.67,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15240,"FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 15260,"FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; 20 SQ CM OR LESS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 2,400.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 15271,APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK ARMS LEGS TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA,OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 1,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 15272,APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK ARMS LEGS TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15273,APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK ARMS LEGS TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA OR 1% OF BODY AREA OF INFANTS AND CHILDREN,OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,506.08 "," 1,500.00 "," 2,766.13 "," 1,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 1,500.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15274,APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK ARMS LEGS TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; EACH ADDITIONAL 100 SQ CM WOUND SURFACE AREA OR PART THEREOF OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN OR PART THEREOF (,OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15275,"APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE DIGITS TOTAL WOUND SURFACE AREA UP TO 100 SQ CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 1,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 15276,"APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR PART THEREOF (LIST SEPA",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15277,APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE SCALP EYELIDS MOUTH NECK EARS ORBITS GENITALIA HANDS FEET AND/OR MULTIPLE DIGITS TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA OR 1% OF BODY AREA OF INFANTS AN,OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,500.00 "," 1,548.96 "," 1,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,500.00 "," 2,901.60 ",,,,,,,,,,,,,,, 15420,"XENOGRAFT SKIN (DERMAL), FOR TEMPORARY WOUND CLOSURE, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,500.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,500.00 ",,,,,,,,,,,,,,, 15576,"FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS, OR INTRAORAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 15620,DELAY FLAP F/C/C/N/AX/G/H/F 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 3,451.72 "," 2,200.00 "," 1,548.96 "," 3,300.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 3,300.00 ",,,,,,,,,,,,,,, 15734,MUSCLE-SKIN GRAFT TRUNK 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15738,"MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15757,FREE SKIN FLAP MICROVASC 1ST,OR LEVEL 2,," 14,341.60 ",171.67,," 2,000.00 ",," 1,900.00 "," 4,323.58 "," 3,856.17 "," 2,827.85 "," 1,900.00 "," 4,323.58 ",,,,,,,,,,,,,,, 15769,GRFG AUTOL SOFT TISS DIR EXC 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,506.08 ",,,,,,, - , - ,,,,,,,,,,,,,,, 15771,GRFG AUTOL FAT LIPO 50 CC/< 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,506.08 ",,,,,,, - , - ,,,,,,,,,,,,,,, 15772,EACH ADD'L 50CC INJECTATE 1ST,OR LEVEL 2,," 14,341.60 ",171.67,,,,,,,, - , - ,,,,,,,,,,,,,,, 15773,GRFG AUTOL FAT LIPO 25 CC/< 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 3,451.72 ",,,,,,, - , - ,,,,,,,,,,,,,,, 15777,IMPLANTATION OF BIOLOGIC IMPLANT (EG ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (IE BREAST TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 15820,"BLEPHAROPLASTY, LOWER EYELID;",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 15821,REVISION OF LOWER EYELID 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 15822,BLEPHAROPLASTY UPPER EYELID 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 15823,REVISION OF UPPER EYELID 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 3,451.72 "," 2,200.00 "," 1,548.96 "," 3,031.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 3,031.00 ",,,,,,,,,,,,,,, 15825,"RHYTIDECTOMY; NECK WITH PLATYSMAL TIGHTENING (PLATYSMAL FLAP, P-FLAP)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15828,"RHYTIDECTOMY; CHEEK, CHIN, AND NECK",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15830,"EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 11,886.30 "," 2,000.00 "," 4,915.21 "," 2,800.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,000.00 "," 8,901.98 ",,,,,,,,,,,,,,, 15832,"EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 15834,EXCISE EXCESSIVE SKIN HIP 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 15836,"EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ARM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 15838,EXCISE EXCESS SKIN FAT PAD 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,166.50 "," 1,500.00 "," 2,378.29 "," 1,900.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 15839,"EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 15847,"EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY), ABDOMEN (EG, ABDOMINOPLASTY) (INCLUDES UMBILICAL TRANSPOSITION AND FASCIAL PLICATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,000.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,000.00 ",,,,,,,,,,,,,,, 15850,"REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), SAME SURGEON",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ", 482.89 ," 1,800.00 ", 903.17 , 805.53 , 590.72 , 482.89 ," 1,800.00 ",,,,,,,,,,,,,,, 15851,"REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,451.72 "," 1,200.00 "," 1,548.96 "," 1,800.00 ", 110.32 , 99.49 , 76.48 , 76.48 ," 1,800.00 ",,,,,,,,,,,,,,, 15852,ED DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL),Emergency department, 790.83 ,,," 1,161.90 "," 1,200.00 ", 482.89 ,, 903.17 , 805.53 , 590.72 , 482.89 ," 1,200.00 ",,,,,,,,,,,,,,, 15860,"INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP OR GRAFT",OR LEVEL 1,," 12,325.60 ", 146.65 , 755.14 ," 1,200.00 ", 348.16 ,, 610.52 , 544.52 , 399.31 , 348.16 ," 1,200.00 ",,,,,,,,,,,,,,, 15876,SUCTION ASSISTED LIPECTOMY HEAD&NECK 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15877,SUCTION ASSISTED LIPECTOMY; TRUNK,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15878,SUCTION LIPECTOMY UPR EXTREM 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 15879,SUCTION LIPECTOMY LWR EXTREM 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 15934,"EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 16000,ED INITIAL TREATMENT FIRST DEGREE BURN WHEN NO MORE THAN LOCAL TREATMENT IS REQUIRED,Emergency department, 872.25 ,,, 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 16020,ED DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS INITIAL OR SUBSEQUENT; SMALL (LESS THAN 5% TOTAL BODY SURFACE AREA),Emergency department," 1,042.75 ",,, 361.16 ," 1,200.00 ", 176.45 ," 1,800.00 ", 312.56 , 278.77 , 204.43 , 176.45 ," 1,800.00 ",,,,,,,,,,,,,,, 16020,"DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL (LESS THAN 5% TOTAL BODY SURFACE AREA)",OR LEVEL 2,," 14,341.60 ", 171.67 , 361.16 ," 1,200.00 ", 176.45 ," 1,800.00 ", 312.56 , 278.77 , 204.43 , 176.45 ," 1,800.00 ",,,,,,,,,,,,,,, 16025,ED DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS INITIAL OR SUBSEQUENT; MEDIUM (EG WHOLE FACE OR WHOLE EXTREMITY OR 5% TO 10% TOTAL BODY SURFACE AREA),Emergency department," 1,875.75 ",,, 361.16 ," 1,500.00 ", 176.45 ," 2,400.00 ", 312.56 , 278.77 , 204.43 , 176.45 ," 2,400.00 ",,,,,,,,,,,,,,, 16025,"DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; MEDIUM (EG, WHOLE FACE OR WHOLE EXTREMITY, OR 5% TO 10% TOTAL BODY SURFACE AREA)",OR LEVEL 3,," 17,605.00 ", 219.52 , 361.16 ," 1,500.00 ", 176.45 ," 2,400.00 ", 312.56 , 278.77 , 204.43 , 176.45 ," 2,400.00 ",,,,,,,,,,,,,,, 16030,ED DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS INITIAL OR SUBSEQUENT; LARGE (EG MORE THAN 1 EXTREMITY OR GREATER THAN 10% TOTAL BODY SURFACE AREA),Emergency department," 2,337.50 ",,, 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 16030,"DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; LARGE (EG, MORE THAN ONE EXTREMITY, OR GREATER THAN 10% TOTAL BODY SURFACE AREA)",OR LEVEL 3,," 17,605.00 ", 219.52 , 746.14 ," 1,500.00 ", 314.08 ," 2,400.00 ", 574.98 , 512.82 , 376.07 , 314.08 ," 2,400.00 ",,,,,,,,,,,,,,, 17110,ED DESTRUCTION (EG LASER SURGERY ELECTROSURGERY CRYOSURGERY CHEMOSURGERY SURGICAL CURETTEMENT) OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS,Emergency department," 1,431.25 ",,, 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 17110,"DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS",OR LEVEL 2,," 14,341.60 ", 171.67 , 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 17111,"DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 15 OR MORE LESIONS",OR LEVEL 2,," 14,341.60 ", 171.67 , 361.16 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 17999,"UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE",OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ," 1,200.00 ", 176.45 ," 1,900.00 ", 312.56 , 278.77 , 204.43 , 176.45 ," 1,900.00 ",,,,,,,,,,,,,,, 19000,PUNCTURE ASPIRATION OF CYST OF BREAST;,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ," 1,800.00 ", 132.03 , 119.07 , 91.53 , 91.53 ," 1,800.00 ",,,,,,,,,,,,,,, 19020,"MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 19081,PSU BIOPSY BREAST WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG CLIP METALLIC PELLET) WHEN PERFORMED AND IMAGING OF THE BIOPSY SPECIMEN WHEN PERFORMED PERCUTANEOUS; FIRST LESION INCLUDING STEREOTACTIC GUIDANCE,Post Surgery Unit," 9,717.01 ",,," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,800.00 ",,,,,,,,,,,,,,, 19083,BIOPSY BREAST WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG CLIP METALLIC PELLET) WHEN PERFORMED AND IMAGING OF THE BIOPSY SPECIMEN WHEN PERFORMED PERCUTANEOUS; FIRST LESION INCLUDING ULTRASOUND GUIDANCE,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,800.00 ",,,,,,,,,,,,,,, 19100,BIOPSY OF BREAST; PERCUTANEOUS NEEDLE CORE NOT USING IMAGING GUIDANCE (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 19101,"BIOPSY OF BREAST; OPEN, INCISIONAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 1,500.00 "," 2,816.01 "," 2,400.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,500.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19120,"EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, ONE OR MORE LESIONS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 2,000.00 "," 2,816.01 "," 2,800.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,000.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19125,"EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, OPEN; SINGLE LESION",OR LEVEL 1,," 12,325.60 ", 146.65 ," 6,875.60 "," 2,000.00 "," 2,816.01 "," 2,800.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,000.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19260,EXCISION OF CHEST WALL TUMOR INCLUDING RIBS,OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,200.00 "," 2,378.29 "," 3,031.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 19285,PLACEMENT BREAST LOCALIZATION DEVICES 1S,OR LEVEL 1,," 12,325.60 ",143.65," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 1,800.00 ",,,,,,,,,,,,,,, 19300,MASTECTOMY FOR GYNECOMASTIA89713,OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 2,200.00 "," 2,816.01 "," 3,300.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19301,"MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,875.60 "," 2,000.00 "," 2,816.01 "," 2,800.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,000.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19302,"MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 11,886.30 "," 2,450.00 "," 4,915.21 "," 2,779.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,450.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19303,"MASTECTOMY, SIMPLE, COMPLETE89716",OR LEVEL 3,," 17,605.00 ", 219.52 ," 11,886.30 "," 2,200.00 "," 4,915.21 "," 3,300.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,200.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19305,MAST RADICAL 1ST,OR LEVEL 2,," 14,341.60 ",171.67,,,," 1,900.00 "," 2,159.80 "," 1,926.31 "," 1,412.63 "," 1,412.63 "," 2,159.80 ",,,,,,,,,,,,,,, 19307,"MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 11,886.30 "," 2,200.00 "," 4,915.21 "," 3,600.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,200.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19316,MASTOPEXY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 11,886.30 "," 2,200.00 "," 4,915.21 "," 3,300.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,200.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19318,REDUCTION MAMMAPLASTY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 11,886.30 "," 2,200.00 "," 4,915.21 "," 3,300.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,200.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19324,ENLARGE BREAST 1ST,OR LEVEL 3,," 17,605.00 ",219.62,," 2,200.00 "," 7,448.83 "," 3,300.00 "," 13,667.30 "," 12,189.75 "," 8,939.15 "," 2,200.00 "," 13,667.30 ",,,,,,,,,,,,,,, 19325,"MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 17,611.48 "," 3,200.00 "," 7,448.83 "," 3,600.00 "," 13,667.30 "," 12,189.75 "," 8,939.15 "," 3,200.00 "," 13,667.30 ",,,,,,,,,,,,,,, 19328,REMOVAL OF INTACT MAMMARY IMPLANT,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,875.60 "," 1,200.00 "," 2,816.01 "," 1,800.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19330,REMOVAL MAMMARY IMPLANT MATERIAL 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 6,875.60 "," 1,200.00 "," 2,816.01 "," 1,800.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19340,IMMEDIATE BREAST PROSTHESIS 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 11,886.30 "," 1,500.00 "," 4,915.21 "," 2,400.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 1,500.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19342,"DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 17,611.48 "," 2,000.00 "," 7,448.83 "," 2,800.00 "," 13,667.30 "," 12,189.75 "," 8,939.15 "," 2,000.00 "," 13,667.30 ",,,,,,,,,,,,,,, 19350,NIPPLE/AREOLA RECONSTRUCTION,OR LEVEL 1,," 12,325.60 ", 146.65 ," 6,875.60 "," 2,200.00 "," 2,816.01 "," 3,300.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19357,"BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING SUBSEQUENT EXPANSION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 33,367.54 "," 2,200.00 "," 12,127.14 "," 3,031.00 "," 21,068.82 "," 18,791.11 "," 13,780.15 "," 2,200.00 "," 21,068.82 ",,,,,,,,,,,,,,, 19361,BREAST RECONSTR W/LAT FLAP 1ST,OR LEVEL 2,," 14,341.60 ",171.67,,,," 1,900.00 "," 3,008.99 "," 2,683.69 "," 1,968.04 "," 1,900.00 "," 3,008.99 ",,,,,,,,,,,,,,, 19366,BREAST RECONSTRUCTION WITH OTHER TECHNIQUE,OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,200.00 "," 4,915.21 "," 3,031.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,200.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19370,"OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,875.60 "," 2,200.00 "," 2,816.01 "," 3,300.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19371,"PERIPROSTHETIC CAPSULECTOMY, BREAST",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,875.60 "," 2,200.00 "," 2,816.01 "," 3,300.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 2,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 19380,REVISION OF RECONSTRUCTED BREAST,OR LEVEL 4,," 21,812.00 ", 260.12 ," 11,886.30 "," 2,200.00 "," 4,915.21 "," 3,031.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 2,200.00 "," 8,901.98 ",,,,,,,,,,,,,,, 19499,ED UNLISTED PROCEDURE BREAST,Emergency department," 4,998.96 ",,," 6,875.60 "," 1,200.00 "," 2,816.01 "," 1,900.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,200.00 "," 5,046.50 ",,,,,,,,,,,,,,, 20100,EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); NECK,OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ,, 487.13 ," 1,800.00 ", 850.76 , 758.79 , 556.44 , 487.13 ," 1,800.00 ",,,,,,,,,,,,,,, 20102,EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,451.72 ",," 1,548.96 "," 1,900.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 20103,EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 ", 579.34 ," 1,800.00 "," 1,059.77 ", 945.20 , 693.15 , 579.34 ," 1,800.00 ",,,,,,,,,,,,,,, 20225,"BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 20240,"BIOPSY, BONE, OPEN; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS, TROCHANTER OF FEMUR)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 20501,ED INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM),Emergency department," 1,038.55 ",,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20520,REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 1,800.00 ", 216.53 , 195.27 , 150.11 , 150.11 ," 1,800.00 ",,,,,,,,,,,,,,, 20525,ED REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED,Emergency department," 6,240.52 ",,," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 20526,"INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 65.13 , 58.74 , 45.15 , 45.15 ," 1,800.00 ",,,,,,,,,,,,,,, 20550,ED INJECTION(S); SINGLE TENDON SHEATH OR LIGAMENT APONEUROSIS (EG PLANTAR FASCIA),Emergency department, 732.50 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 39.32 , 35.46 , 27.26 , 27.26 ," 1,800.00 ",,,,,,,,,,,,,,, 20550,"INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR FASCIA)",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 39.32 , 35.46 , 27.26 , 27.26 ," 1,800.00 ",,,,,,,,,,,,,,, 20551,ED INJECTION(S); SINGLE TENDON ORIGIN/INSERTION,Emergency department, 758.13 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 52.81 , 47.63 , 36.61 , 36.61 ," 1,800.00 ",,,,,,,,,,,,,,, 20551,INJECTION(S); SINGLE TENDON ORIGIN/INSERTION,OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 52.81 , 47.63 , 36.61 , 36.61 ," 1,800.00 ",,,,,,,,,,,,,,, 20552,ED INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S) 1 OR 2 MUSCLE(S),Emergency department, 698.50 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 49.29 , 44.45 , 34.17 , 34.17 ," 1,800.00 ",,,,,,,,,,,,,,, 20552,"INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), ONE OR TWO MUSCLE(S)",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 49.29 , 44.45 , 34.17 , 34.17 ," 1,800.00 ",,,,,,,,,,,,,,, 20553,ED INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S) 3 OR MORE MUSCLE(S),Emergency department, 813.75 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 57.51 , 51.86 , 39.87 , 39.87 ," 1,800.00 ",,,,,,,,,,,,,,, 20553,"INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), THREE OR MORE MUSCLE(S)",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 57.51 , 51.86 , 39.87 , 39.87 ," 1,800.00 ",,,,,,,,,,,,,,, 20555,PLACEMENT OF NEEDLES OR CATHETERS INTO MUSCLE AND/OR SOFT TISSUE FOR SUBSEQUENT INTERSTITIAL RADIOELEMENT APPLICATION (AT THE TIME OF OR SUBSEQUENT TO THE PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 3,600.00 "," 1,202.26 "," 1,084.24 ", 833.47 , 833.47 ," 3,600.00 ",,,,,,,,,,,,,,, 20600,"ED ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG, FINGERS, TOES)",Emergency department, 693.00 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 37.56 , 33.87 , 26.04 , 26.04 ," 1,800.00 ",,,,,,,,,,,,,,, 20600,"ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG, FINGERS, TOES)",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 37.56 , 33.87 , 26.04 , 26.04 ," 1,800.00 ",,,,,,,,,,,,,,, 20604,ARTHROCENTESIS ASPIRATION AND/OR INJECTION SMALL JOINT OR BURSA (EG FINGERS TOES); WITH ULTRASOUND GUIDANCE WITH PERMANENT RECORDING AND REPORTING,OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ,, 62.20 , 56.10 , 43.12 , 43.12 ," 1,200.00 ",,,,,,,,,,,,,,, 20605,"ED ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA)",Emergency department, 821.38 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 39.90 , 35.99 , 27.66 , 27.66 ," 1,800.00 ",,,,,,,,,,,,,,, 20605,ARTHROCENTESIS ASPIRATION AND/OR INJECTION INTERMEDIATE JOINT OR BURSA (EG TEMPOROMANDIBULAR ACROMIOCLAVICULAR WRIST ELBOW OR ANKLE OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE,OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 39.90 , 35.99 , 27.66 , 27.66 ," 1,800.00 ",,,,,,,,,,,,,,, 20606,ED ARTHROCENTESIS ASPIRATION AND/OR INJECTION INTERMEDIATE JOINT OR BURSA (EG TEMPOROMANDIBULAR ACROMIOCLAVICULAR WRIST ELBOW OR ANKLE OLECRANON BURSA); WITH ULTRASOUND GUIDANCE WITH PERMANENT RECORDING AND REPORTING,Emergency department," 1,014.38 ",,," 1,288.68 "," 1,200.00 ", 598.81 ,, 68.07 , 61.39 , 47.19 , 47.19 ," 1,200.00 ",,,,,,,,,,,,,,, 20610,"EDARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE JOINT, SUBACROMIAL BURSA)",Emergency department, 756.88 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 47.53 , 42.87 , 32.95 , 32.95 ," 1,800.00 ",,,,,,,,,,,,,,, 20610,"ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE JOINT, SUBACROMIAL BURSA)",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 47.53 , 42.87 , 32.95 , 32.95 ," 1,800.00 ",,,,,,,,,,,,,,, 20611,ED ARTHROCENTESIS ASPIRATION AND/OR INJECTION MAJOR JOINT OR BURSA (EG SHOULDER HIP KNEE SUBACROMIAL BURSA); WITH ULTRASOUND GUIDANCE WITH PERMANENT RECORDING AND REPORTING,Emergency department, 818.72 ,,, 543.78 ," 1,200.00 ", 247.48 ,, 78.04 , 70.38 , 54.10 , 54.10 ," 1,200.00 ",,,,,,,,,,,,,,, 20611,ARTHROCENTESIS ASPIRATION AND/OR INJECTION MAJOR JOINT OR BURSA (EG SHOULDER HIP KNEE SUBACROMIAL BURSA); WITH ULTRASOUND GUIDANCE WITH PERMANENT RECORDING AND REPORTING,OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ,, 78.04 , 70.38 , 54.10 , 54.10 ," 1,200.00 ",,,,,,,,,,,,,,, 20612,ED ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION,Emergency department, 762.13 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 54.57 , 49.22 , 37.83 , 37.83 ," 1,800.00 ",,,,,,,,,,,,,,, 20612,ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION,OR LEVEL 2,," 14,341.60 ", 171.67 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 54.57 , 49.22 , 37.83 , 37.83 ," 1,800.00 ",,,,,,,,,,,,,,, 20615,ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ,, 248.80 , 224.38 , 172.48 , 172.48 ," 1,200.00 ",,,,,,,,,,,,,,, 20660,"APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 1,900.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 20670,"REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 20680,"REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 20690,"APPLICATION OF A UNIPLANE (PINS OR WIRES IN ONE PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 20692,"APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM (EG, ILIZAROV, MONTICELLI TYPE)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 26,096.16 "," 2,000.00 "," 10,713.88 "," 2,800.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,000.00 "," 18,727.40 ",,,,,,,,,,,,,,, 20693,"ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN(S) OR WIRE(S) AND/OR NEW RING(S) OR BAR(S))",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 20694,"REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 20704,MANUAL PREPARATION AND INSERTION OF DRUG- DELIVERY DEVICES- INTRA-ARTICULAR,OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,,,,, - , - ,,,,,,,,,,,,,,, 20900,"BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 20902,"BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 20912,CARTILAGE GRAFT; NASAL SEPTUM,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 20926,"TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,200.00 "," 2,766.13 "," 3,300.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,200.00 "," 5,014.39 ",,,,,,,,,,,,,,, 20930,ALLOGRAFT FOR SPINE SURGERY ONLY; MORSELIZED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20931,ALLOGRAFT FOR SPINE SURGERY ONLY; STRUCTURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20936,"AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20937,AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (THROUGH SEPARATE SKIN OR FASCIAL INCISION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20938,"AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); STRUCTURAL, BICORTICAL OR TRICORTICAL (THROUGH SEPARATE SKIN OR FASCIAL INCISION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20939,BONE ASPIRATION FOR BONE GRAFTING - SPINE SURGERY ONLY,OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 20974,ELECTRICAL STIMULATION TO AID BONE HEALING; NONINVASIVE (NONOPERATIVE),OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,, 96.94 , 86.46 , 63.40 , 63.40 , 96.94 ,,,,,,,,,,,,,,, 20985,COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES; IMAGE-LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 21011,"EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 ",, 374.38 , 337.63 , 259.54 , 259.54 ," 1,375.50 ",,,,,,,,,,,,,,, 21012,"EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 2,400.00 ", 884.89 , 798.03 , 613.45 , 613.45 ," 2,400.00 ",,,,,,,,,,,,,,, 21013,EXCISION TUMOR SOFT TISSUE OF FACE AND SCALP SUBFASCIAL (EG SUBGALEAL INTRAMUSCULAR); LESS THAN 2 CM,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 2,400.00 ", 497.02 , 448.23 , 344.56 , 344.56 ," 2,400.00 ",,,,,,,,,,,,,,, 21014,"EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,200.00 "," 2,378.29 "," 2,400.00 "," 1,732.32 "," 1,562.27 "," 1,200.93 "," 1,200.00 "," 2,400.00 ",,,,,,,,,,,,,,, 21015,"RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP",OR LEVEL 5,," 23,543.80 ", 337.20 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21029,"REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 21120,RECONSTRUCTION OF CHIN 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21125,"AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21235,"GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21270,MALAR AUGMENTATION PROSTHETIC MATERIAL 1,OR LEVEL 2,," 14,341.60 ",171.67," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,031.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21310,ED CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION,Emergency department," 1,745.50 ",,,," 1,500.00 ", 225.09 ," 2,400.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 2,400.00 ",,,,,,,,,,,,,,, 21315,ED CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION,Emergency department," 3,690.38 ",,," 2,776.28 "," 1,500.00 "," 1,279.10 "," 2,400.00 "," 2,105.63 "," 1,878.00 "," 1,377.20 "," 1,279.10 "," 2,400.00 ",,,,,,,,,,,,,,, 21315,CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,776.28 "," 1,500.00 "," 1,279.10 "," 2,400.00 "," 2,105.63 "," 1,878.00 "," 1,377.20 "," 1,279.10 "," 2,400.00 ",,,,,,,,,,,,,,, 21320,CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 21325,ED OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED,Emergency department," 6,066.63 ",,," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 21337,"CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 21385,OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; TRANSANTRAL APPROACH (CALDWELL-LUC TYPE OPERATION),OR LEVEL 5,," 23,543.80 ", 337.20 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,600.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21390,"OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH, WITH ALLOPLASTIC OR OTHER IMPLANT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21406,OPN TX ORBIT FX W/O IMPLANT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,300.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21440,ED CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE),Emergency department," 7,607.13 ",,," 5,690.06 "," 2,000.00 "," 2,231.27 "," 2,800.00 ", 738.76 , 666.25 , 512.15 , 512.15 ," 2,800.00 ",,,,,,,,,,,,,,, 21451,EDCLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION,Emergency department," 9,887.50 ",,," 2,776.28 "," 2,200.00 "," 1,279.10 "," 3,300.00 "," 2,105.63 "," 1,878.00 "," 1,377.20 "," 1,279.10 "," 3,300.00 ",,,,,,,,,,,,,,, 21465,TREAT LOWER JAW FRACTURE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,300.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21470,"OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE BY MULTIPLE SURGICAL APPROACHES INCLUDING INTERNAL FIXATION, INTERDENTAL FIXATION, AND/OR WIRING OF DENTURES OR SPLINTS",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,031.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 21480,ED CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT,Emergency department," 1,281.13 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 21501,"ED INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;",Emergency department," 5,914.25 ",,," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21550,"BIOPSY, SOFT TISSUE OF NECK OR THORAX",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 21552,"EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21554,EXCISION TUMOR SOFT TISSUE OF NECK OR ANTERIOR THORAX SUBFASCIAL (EG INTRAMUSCULAR); 5 CM OR GREATER,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21555,"EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; SUBCUTANEOUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 21556,"EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; DEEP, SUBFASCIAL, INTRAMUSCULAR",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21557,RESECT NECK THORAX TUMOR<5CM 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,166.50 "," 1,500.00 "," 2,378.29 "," 1,900.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21558,RADICAL RESECTION OF TUMOR (EG SARCOMA) SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21705,ED DIVISION OF SCALENUS ANTICUS; WITH RESECTION OF CERVICAL RIB,Emergency department," 2,302.08 ",,,,,," 1,900.00 "," 1,031.10 ", 919.63 , 674.39 , 674.39 ," 1,900.00 ",,,,,,,,,,,,,,, 21812,ED OPEN TREATMENT OF RIB FRACTURES W/ INTERNAL FIXATION,Emergency department," 2,434.84 ",,," 13,229.26 "," 2,000.00 "," 2,623.34 "," 3,600.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 3,600.00 ",,,,,,,,,,,,,,, 21930,"EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 21931,"EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 2,000.00 "," 1,375.50 "," 3,600.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,600.00 ",,,,,,,,,,,,,,, 21932,"EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,779.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21933,"EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21935,RESECT BACK TUM < 5 CM 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 21936,RADICAL RESECTION OF TUMOR (EG SARCOMA) SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 22010,"INCISION AND DRAINAGE, OPEN, OF DEEP ABSCESS (SUBFASCIAL), POSTERIOR SPINE; CERVICAL, THORACIC, OR CERVICOTHORACIC",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 1,828.48 "," 1,630.81 "," 1,195.93 "," 1,195.93 "," 1,900.00 ",,,,,,,,,,,,,,, 22015,"INCISION AND DRAINAGE, OPEN, OF DEEP ABSCESS (SUBFASCIAL), POSTERIOR SPINE; LUMBAR, SACRAL, OR LUMBOSACRAL",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,813.89 "," 1,617.79 "," 1,186.38 "," 1,186.38 "," 1,900.00 ",,,,,,,,,,,,,,, 22206,"OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VERTEBRAL SEGMENT (EG, PEDICLE/VERTEBRAL BODY SUBTRACTION); THORACIC",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,,," 4,707.34 "," 4,198.44 "," 3,078.86 "," 3,078.86 "," 4,707.34 ",,,,,,,,,,,,,,, 22207,"OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VERTEBRAL SEGMENT (EG, PEDICLE/VERTEBRAL BODY SUBTRACTION); LUMBAR",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,," 1,900.00 "," 4,633.64 "," 4,132.71 "," 3,030.65 "," 1,900.00 "," 4,633.64 ",,,,,,,,,,,,,,, 22208,"OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, THREE COLUMNS, ONE VERTEBRAL SEGMENT (EG, PEDICLE/VERTEBRAL BODY SUBTRACTION); EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,,," 1,150.61 "," 1,026.22 ", 752.56 , 752.56 ," 1,150.61 ",,,,,,,,,,,,,,, 22212,"OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT; THORACIC",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,," 1,900.00 "," 2,861.58 "," 2,552.22 "," 1,871.63 "," 1,871.63 "," 2,861.58 ",,,,,,,,,,,,,,, 22216,"OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,," 1,900.00 ", 704.44 , 628.29 , 460.74 , 460.74 ," 1,900.00 ",,,,,,,,,,,,,,, 22511,PERQ LUMBOSACRAL INJECTION 1ST,OR LEVEL 6,," 25,897.20 ",438.29," 5,953.32 "," 3,200.00 "," 2,623.34 "," 3,600.00 "," 5,950.00 "," 5,355.00 "," 4,582.00 "," 2,623.34 "," 5,950.00 ",,,,,,,,,,,,,,, 22512,PERC VERTEBROPLASTY BONE BIOPSY 1ST,OR LEVEL 6,," 25,897.20 ",438.29,," 1,200.00 ",," 3,600.00 ",,,," 1,200.00 "," 3,600.00 ",,,,,,,,,,,,,,, 22513,PERCUTANEOUS VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG KYPHOPLASTY) 1 VERTEBRAL BODY UNILATERAL OR BILATERAL CANNULATION INCLUSIVE OF ALL IMAGING GUIDANCE; TH,OR LEVEL 5,," 23,543.80 ", 337.20 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 1,900.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,900.00 "," 10,371.88 ",,,,,,,,,,,,,,, 22514,PERCUTANEOUS VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG KYPHOPLASTY) 1 VERTEBRAL BODY UNILATERAL OR BILATERAL CANNULATION INCLUSIVE OF ALL IMAGING GUIDANCE; LU,OR LEVEL 5,," 23,543.80 ", 337.20 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 1,900.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,900.00 "," 10,371.88 ",,,,,,,,,,,,,,, 22515,PERCUTANEOUS VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG KYPHOPLASTY) 1 VERTEBRAL BODY UNILATERAL OR BILATERAL CANNULATION INCLUSIVE OF ALL IMAGING GUIDANCE; EA,OR LEVEL 5,," 23,543.80 ", 337.20 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22522,"PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,500.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,500.00 ",,,,,,,,,,,,,,, 22523,"PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); THORACIC",OR LEVEL 5,," 23,543.80 ", 337.20 ,," 2,500.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,500.00 ",,,,,,,,,,,,,,, 22532,"ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); THORACIC",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 3,458.46 "," 3,084.58 "," 2,262.02 "," 1,900.00 "," 3,458.46 ",,,,,,,,,,,,,,, 22534,"ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); THORACIC OR LUMBAR, EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 ", 699.13 , 623.55 , 457.27 , 457.27 ," 1,900.00 ",,,,,,,,,,,,,,, 22551,"ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2",OR LEVEL 6,," 25,897.20 ", 438.29 ," 26,096.16 "," 12,000.00 "," 10,713.88 "," 1,900.00 "," 24,200.00 "," 21,780.00 "," 16,940.00 "," 1,900.00 "," 24,200.00 ",,,,,,,,,,,,,,, 22552,"ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR SEPARATE PROCED",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22554,"ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); CERVICAL BELOW C2",OR LEVEL 6,," 25,897.20 ", 438.29 ," 26,096.16 "," 3,200.00 "," 10,713.88 "," 1,900.00 "," 22,000.00 "," 19,800.00 "," 15,400.00 "," 1,900.00 "," 22,000.00 ",,,,,,,,,,,,,,, 22556,"ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); THORACIC",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 3,218.13 "," 2,870.22 "," 2,104.83 "," 1,900.00 "," 3,218.13 ",,,,,,,,,,,,,,, 22558,"ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,957.19 "," 2,637.49 "," 1,934.16 "," 1,900.00 "," 2,957.19 ",,,,,,,,,,,,,,, 22585,"ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 ",,,," 1,900.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22600,"ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; CERVICAL BELOW C2 SEGMENT",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,486.46 "," 2,217.65 "," 1,626.28 "," 1,626.28 "," 2,486.46 ",,,,,,,,,,,,,,, 22610,"ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; THORACIC (WITH OR WITHOUT LATERAL TRANSVERSE TECHNIQUE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,437.32 "," 2,173.83 "," 1,594.14 "," 1,594.14 "," 2,437.32 ",,,,,,,,,,,,,,, 22612,"ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR (WITH OR WITHOUT LATERAL TRANSVERSE TECHNIQUE)",OR LEVEL 6,," 25,897.20 ", 438.29 ," 43,795.26 "," 2,450.00 "," 10,713.88 "," 1,900.00 "," 28,350.00 "," 25,515.00 "," 17,861.00 "," 1,900.00 "," 28,350.00 ",,,,,,,,,,,,,,, 22614,"ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22630,"ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; LUMBAR",OR LEVEL 6,," 25,897.20 ", 438.29 ," 43,795.26 ",,," 1,900.00 "," 28,350.00 "," 25,515.00 "," 17,861.00 "," 1,900.00 "," 28,350.00 ",,,,,,,,,,,,,,, 22632,"ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 ", 625.43 , 557.82 , 409.06 , 409.06 ," 1,900.00 ",,,,,,,,,,,,,,, 22633,"ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE AND SEGMENT; LUMBAR",OR LEVEL 7,," 31,076.64 ", 525.95 ," 43,795.26 ",,," 1,900.00 "," 3,576.64 "," 3,189.98 "," 2,339.32 "," 1,900.00 "," 3,576.64 ",,,,,,,,,,,,,,, 22634,"ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE AND SEGMENT; EACH ADDITIONAL INT",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,,, 962.72 , 858.64 , 629.67 , 629.67 , 962.72 ,,,,,,,,,,,,,,, 22802,"ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 7 TO 12 VERTEBRAL SEGMENTS",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 4,059.34 "," 3,620.50 "," 2,655.03 "," 1,900.00 "," 4,059.34 ",,,,,,,,,,,,,,, 22830,EXPLORATION OF SPINAL FUSION,OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 1,566.89 "," 1,397.50 "," 1,024.83 "," 1,024.83 "," 1,900.00 ",,,,,,,,,,,,,,, 22840,"POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22842,"POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22844,"POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 13 OR MORE VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 1,914.14 "," 1,707.21 "," 1,251.95 "," 1,251.95 "," 1,914.14 ",,,,,,,,,,,,,,, 22845,ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22846,ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 1,471.29 "," 1,312.23 ", 962.30 , 962.30 ," 1,900.00 ",,,,,,,,,,,,,,, 22847,ANTERIOR INSTRUMENTATION; 8 OR MORE VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 1,563.58 "," 1,394.55 "," 1,022.67 "," 1,022.67 "," 1,900.00 ",,,,,,,,,,,,,,, 22848,PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER THAN SACRUM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 ", 697.80 , 622.36 , 456.40 , 456.40 ," 1,900.00 ",,,,,,,,,,,,,,, 22849,REINSERTION OF SPINAL FIXATION DEVICE,OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,505.05 "," 2,234.23 "," 1,638.44 "," 1,638.44 "," 2,505.05 ",,,,,,,,,,,,,,, 22850,"REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 1,391.63 "," 1,241.18 ", 910.20 , 910.20 ," 1,900.00 ",,,,,,,,,,,,,,, 22852,REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION,OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 1,335.85 "," 1,191.43 ", 873.72 , 873.72 ," 1,900.00 ",,,,,,,,,,,,,,, 22853,"INSERTION OF INTERBODY BIOMECHANICAL DEVICE WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING, WHEN PERFORMED, TO INTERVERTEBRAL DISCH SPACE IN CONJUNTION WITH INTERBODY ARTHRODESIS, EACH INTERSPACE",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22854,"INSERTION OF INTERVERTEBRAL MIOMECHANICAL DEVICES, WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING, WHEN PERFORMED, TO VERTEBRAL CORPECTOMY DEFECT, IN CONJECTION WITH INTERBODY ARTHRODESIS, EACHT CONTIGUOUS DEFECT.",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22855,REMOVAL OF ANTERIOR INSTRUMENTATION,OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,135.23 "," 1,904.40 "," 1,396.56 "," 1,396.56 "," 2,135.23 ",,,,,,,,,,,,,,, 22856,TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC) ANTERIOR APPROACH INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE CERVICAL,OR LEVEL 6,," 25,897.20 ", 438.29 ," 43,795.26 "," 2,450.00 "," 15,402.46 "," 1,900.00 "," 28,436.35 "," 25,362.15 "," 18,598.91 "," 1,900.00 "," 28,436.35 ",,,,,,,,,,,,,,, 22857,"TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), LUMBAR, SINGLE INTERSPACE",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 3,260.61 "," 2,908.11 "," 2,132.61 "," 1,900.00 "," 3,260.61 ",,,,,,,,,,,,,,, 22858,TOT DISC ARTHROPLASTY ANTERIOR APPROACH,OR LEVEL 6,," 25,897.20 ",438.29,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 22861,REVISE CERV ARTIFIC DISC 1ST,OR LEVEL 6,," 25,897.20 ",438.29,,,," 1,900.00 "," 4,524.75 "," 4,035.59 "," 2,959.43 "," 1,900.00 "," 4,524.75 ",,,,,,,,,,,,,,, 22900,"EXCISION, ABDOMINAL WALL TUMOR, SUBFASCIAL (EG, DESMOID)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,166.50 "," 2,200.00 "," 2,378.29 "," 3,300.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 22901,EXCISION TUMOR SOFT TISSUE OF ABDOMINAL WALL SUBFASCIAL (EG INTRAMUSCULAR); 5 CM OR GREATER,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 22902,EXCISION TUMOR SOFT TISSUE OF ABDOMINAL WALL SUBCUTANEOUS; LESS THAN 3 CM,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,779.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,779.00 ",,,,,,,,,,,,,,, 22903,EXCISION TUMOR SOFT TISSUE OF ABDOMINAL WALL SUBCUTANEOUS; 3 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 22904,RADICAL RESECTION OF TUMOR (EG SARCOMA) SOFT TISSUE OF ABDOMINAL WALL; LESS THAN 5 CM,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,779.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 22905,RADICAL RESECTION OF TUMOR (EG SARCOMA) SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 23030,"INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,200.00 "," 2,378.29 "," 1,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 23071,"EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 2,000.00 "," 1,375.50 "," 3,600.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,600.00 ",,,,,,,,,,,,,,, 23073,EXCISION TUMOR SOFT TISSUE OF SHOULDER AREA SUBFASCIAL (EG INTRAMUSCULAR); 5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 23075,"EXCISION, SOFT TISSUE TUMOR, SHOULDER AREA; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 23120,CLAVICULECTOMY; PARTIAL,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 23130,ACROMIOPLASTY/ACROMIONECTOMY PRTL 1ST 15,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 23180,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), CLAVICLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 23182,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), SCAPULA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 23184,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), PROXIMAL HUMERUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23350,INJECTION FOR SHOULDER ARTHROPATHY (IMAGING ONLY),23350," 2,846.02 ",,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 23405,"TENOTOMY, SHOULDER AREA; SINGLE TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23410,"REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE",OR LEVEL 5,," 23,543.80 ", 337.20 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23412,REPAIR ROTATOR CUFF CHRONIC 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 13,229.26 "," 2,450.00 "," 5,699.59 "," 2,779.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23415,CORACOACROMIAL LGMNT REL W/WO ACROMIO 1,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23420,"RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)",OR LEVEL 5,," 23,543.80 ", 337.20 ," 13,229.26 "," 2,450.00 "," 5,699.59 "," 2,779.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23430,TENODESIS OF LONG TENDON OF BICEPS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23450,"CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23455,"CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,450.00 "," 5,699.59 "," 2,779.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23462,"CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,450.00 "," 5,699.59 "," 2,779.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23470,"ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY",OR LEVEL 5,," 23,543.80 ", 337.20 ," 26,096.16 "," 3,200.00 "," 10,713.88 "," 1,900.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 1,900.00 "," 18,727.40 ",,,,,,,,,,,,,,, 23472,"ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))",OR LEVEL 5,," 23,543.80 ", 337.20 ," 26,096.16 "," 12,000.00 ",," 1,900.00 "," 15,450.00 "," 13,905.00 "," 10,154.00 "," 1,900.00 "," 15,450.00 ",,,,,,,,,,,,,,, 23473,REVISION OF TOTAL SHOULDER ARTHROPLASTY INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT,OR LEVEL 5,," 23,543.80 ", 337.20 ," 26,096.16 "," 12,000.00 "," 10,713.88 "," 7,965.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 7,965.00 "," 18,727.40 ",,,,,,,,,,,,,,, 23485,REVISION OF COLLAR BONE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 26,096.16 "," 2,450.00 "," 10,713.88 "," 2,779.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,450.00 "," 18,727.40 ",,,,,,,,,,,,,,, 23500,ED CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION,Emergency department," 2,805.38 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 23505,ED CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION,Emergency department," 4,491.50 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 23515,"OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23550,"OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23552,TREAT CLAVICLE DISLOCATION 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23570,ED CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION,Emergency department," 2,962.38 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 23600,ED CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITHOUT MANIPULATION,Emergency department," 4,199.75 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 182.48 , 164.57 , 126.50 , 126.50 ," 1,800.00 ",,,,,,,,,,,,,,, 23605,CLSD TX PROXIMAL HUMERAL FRACT W/MANIP,,," 2,434.84 ",875.3," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 23615,"OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, INCLUDES REPAIR OF TUBEROSITY(S), WHEN PERFORMED;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 23630,"OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 23650,ED CLOSED TREATMENT OF SHOULDER DISLOCATION WITH MANIPULATION; WITHOUT ANESTHESIA,Emergency department," 4,029.75 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 23655,ED CLOSED TREATMENT OF SHOULDER DILOCATION W/ MANIPULATION; REQURING ANESTHESIA,Emergency department," 5,077.00 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 23655,"CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 23665,"CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROSITY, WITH MANIPULATION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 23700,"MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 23929,"UNLISTED PROCEDURE, SHOULDER",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ," 1,900.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,900.00 ",,,,,,,,,,,,,,, 23930,"INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 24066,"BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 24071,EXCISION TUMOR SOFT TISSUE OF UPPER ARM OR ELBOW AREA SUBCUTANEOUS; 3 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 24073,EXCISION TUMOR SOFT TISSUE OF UPPER ARM OR ELBOW AREA SUBFASCIAL (EG INTRAMUSCULAR); 5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 24075,"EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 24076,"EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 24079,RESECT ARM/ELBOW TUM 5 CM/> 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 24101,"ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF LOOSE OR FOREIGN BODY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 24102,"ARTHROTOMY, ELBOW; WITH SYNOVECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 24105,"EXCISION, OLECRANON BURSA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 24200,ED REMOVAL OF FOREIGN BODY UPPER ARM OR ELBOW AREA; SUBCUTANEOUS,Emergency department," 2,632.75 ",,," 2,999.10 ",," 1,375.50 "," 1,800.00 ", 226.50 , 204.27 , 157.02 , 157.02 ," 1,800.00 ",,,,,,,,,,,,,,, 24200,"REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 ",," 1,375.50 "," 1,800.00 ", 226.50 , 204.27 , 157.02 , 157.02 ," 1,800.00 ",,,,,,,,,,,,,,, 24341,"REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EXCLUDES ROTATOR CUFF)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24342,"REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT",OR LEVEL 5,," 23,543.80 ", 337.20 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24343,"REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 24345,"REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24357,"TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); PERCUTANEOUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 3,600.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 3,600.00 ",,,,,,,,,,,,,,, 24359,"TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN WITH TENDON REPAIR OR REATTACHMENT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 3,600.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 24495,DECOMPRESSION OF FOREARM 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24515,"OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE",OR LEVEL 4,," 21,812.00 ", 260.12 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 24530,ED CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE WITH OR WITHOUT INTERCONDYLAR EXTENSION; WITHOUT MANIPULATION,Emergency department," 4,858.50 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 24535,ED CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE WITH OR WITHOUT INTERCONDYLAR EXTENSION; WITH MANIPULATION WITH OR WITHOUT SKIN OR SKELETAL TRACTION,Emergency department," 7,807.50 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 24538,"PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTERCONDYLAR EXTENSION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24545,"OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; WITHOUT INTERCONDYLAR EXTENSION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 24546,"OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; WITH INTERCONDYLAR EXTENSION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 15,402.46 "," 3,031.00 "," 28,436.35 "," 25,362.15 "," 18,598.91 "," 2,200.00 "," 28,436.35 ",,,,,,,,,,,,,,, 24575,OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE MEDIAL OR LATERAL INCLUDES INTERNAL FIXATION WHEN PERFORMED,OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,000.00 "," 10,713.88 "," 2,800.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,000.00 "," 18,727.40 ",,,,,,,,,,,,,,, 24579,"OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 2,," 14,341.60 ", 171.67 ," 26,096.16 "," 2,000.00 "," 10,713.88 "," 2,800.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,000.00 "," 18,727.40 ",,,,,,,,,,,,,,, 24600,ED TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA,Emergency department," 4,675.00 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 24615,OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION,OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24640,ED CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD NURSEMAID ELBOW WITH MANIPULATION,Emergency department," 1,832.63 ",,, 414.02 ,, 225.09 ," 1,800.00 ", 88.61 , 79.91 , 61.43 , 61.43 ," 1,800.00 ",,,,,,,,,,,,,,, 24650,ED CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION,Emergency department," 3,363.50 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 24655,ED CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION,Emergency department," 5,597.13 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 24665,"OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RADIAL HEAD EXCISION, WHEN PERFORMED;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24666,TREAT RADIUS FRACTURE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 24670,ED CLOSED TREATMENT OF ULNAR FRACTURE PROXIMAL END (EG OLECRANON OR CORONOID PROCESS[ES]); WITHOUT MANIPULATION,Emergency department," 3,737.00 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 24675,ED CLOSED TREATMENT OF ULNAR FRACTURE PROXIMAL END (EG OLECRANON OR CORONOID PROCESS[ES]); WITH MANIPULATION,Emergency department," 5,817.25 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 24685,"OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 24999,"UNLISTED PROCEDURE, HUMERUS OR ELBOW",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ," 1,900.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,900.00 ",,,,,,,,,,,,,,, 25000,"INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAINS DISEASE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25020,"DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT; WITHOUT DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25025,"DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT; WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25028,"INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25071,EXCISION TUMOR SOFT TISSUE OF FOREARM AND/OR WRIST AREA SUBCUTANEOUS; 3 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 2,000.00 "," 1,375.50 "," 3,600.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,600.00 ",,,,,,,,,,,,,,, 25075,"EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 25076,"EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 2,000.00 "," 1,375.50 "," 2,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,800.00 ",,,,,,,,,,,,,,, 25078,RADICAL RESECTION OF TUMOR (EG SARCOMA) SOFT TISSUE OF FOREARM AND/OR WRIST AREA; 3 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 25101,EXPLORE/TREAT WRIST JOINT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25107,"ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OF TRIANGULAR CARTILAGE, COMPLEX",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25110,"EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25111,"EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25112,"EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 3,300.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 3,300.00 ",,,,,,,,,,,,,,, 25115,"RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 3,300.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 3,300.00 ",,,,,,,,,,,,,,, 25118,"SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 25210,CARPECTOMY; ONE BONE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25215,CARPECTOMY; ALL BONES OF PROXIMAL ROW,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25230,RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25240,"EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25260,"REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25270,"REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25290,"TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 ",,,,,,, - , - ,,,,,,,,,,,,,,, 25301,TENODESIS AT WRIST; EXTENSORS OF FINGERS,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25310,"TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25320,"CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL INSTABILITY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25337,"RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY BY SOFT TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON GRAFT OR WEAVE, OR TENODESIS) WITH OR WITHOUT OPEN REDUCTION OF DISTAL RADIOULNAR JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25360,OSTEOTOMY; ULNA,OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25400,"REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25441,ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS,OR LEVEL 1,," 12,325.60 ", 146.65 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 1,900.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 1,900.00 "," 18,727.40 ",,,,,,,,,,,,,,, 25445,ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25447,"ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25505,ED CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION,Emergency department," 6,412.00 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 25505,CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 25515,"OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25520,CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION OF DISTAL RADIOULNAR JOINT (GALEAZZI FRACTURE/DISLOCATION),OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 25525,"OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, AND CLOSED TREATMENT OF DISTAL RADIOULNAR JOINT DISLOCATION (GALEAZZI FRACTURE/ DISLOCATION), INCLUDES PERCUTANEOUS SKELETAL FIXATION, WHEN PERFORMED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25535,ED CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION,Emergency department," 6,233.13 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 25545,"OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED90447",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25560,ED CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION,Emergency department," 3,575.38 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 25560,CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION,OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 25565,ED CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION,Emergency department," 6,645.25 ",,," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 25565,CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 25574,"OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN PERFORMED; OF RADIUS OR ULNA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25575,"OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN PERFORMED; OF RADIUS AND ULNA90451",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25600,ED CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID WHEN PERFORMED; WITHOUT MANIPULATION,Emergency department," 4,218.13 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 25600,"CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITHOUT MANIPULATION",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 25605,ED CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID WHEN PERFORMED; WITH MANIPULATION,Emergency department," 6,988.25 ",,," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25605,"CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITH MANIPULATION90453",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 25606,PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25607,"OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WITH INTERNAL FIXATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25608,OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 2 FRAGMENTS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25609,OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 3 OR MORE FRAGMENTS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25622,ED CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION,Emergency department," 3,911.25 ",,, 414.02 ,, 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 , 225.09 ,,,,,,,,,,,,,,, 25628,"OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED90460",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25630,ED CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID [NAVICULAR]); WITHOUT MANIPULATION EACH BONE,Emergency department," 3,902.13 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 25635,ED CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID [NAVICULAR]); WITH MANIPULATION EACH BONE,Emergency department," 5,787.50 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 25652,OPEN TREATMENT OF ULNAR STYLOID FRACTURE,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 25660,ED CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION 1 OR MORE BONES WITH MANIPULATION,Emergency department," 5,204.75 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 25671,PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR DISLOCATION,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 25675,ED CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION,Emergency department," 5,653.00 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 26010,ED DRAINAGE OF FINGER ABSCESS; SIMPLE,Emergency department," 3,434.63 ",,, 361.16 ,, 176.45 ,, 143.46 , 129.37 , 99.45 , 99.45 , 176.45 ,,,,,,,,,,,,,,, 26010,DRAINAGE OF FINGER ABSCESS; SIMPLE,OR LEVEL 1,," 12,325.60 ", 146.65 , 361.16 ,, 176.45 ,, 143.46 , 129.37 , 99.45 , 99.45 , 176.45 ,,,,,,,,,,,,,,, 26011,ED DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG FELON),Emergency department," 5,047.63 ",,," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 26011,"DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 26020,"DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26040,"FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); PERCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 3,300.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 3,300.00 ",,,,,,,,,,,,,,, 26045,"FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26055,"TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26070,"ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; CARPOMETACARPAL JOINT",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26080,"ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT, EACH",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 3,300.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 3,300.00 ",,,,,,,,,,,,,,, 26111,EXCISION TUMOR OR VASCULAR MALFORMATION SOFT TISSUE OF HAND OR FINGER SUBCUTANEOUS; 1.5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 2,000.00 "," 1,375.50 "," 3,600.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,600.00 ",,,,,,,,,,,,,,, 26113,"EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 2,000.00 "," 1,375.50 "," 3,600.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,600.00 ",,,,,,,,,,,,,,, 26115,"EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 26116,"EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER; DEEP (SUBFASCIAL OR INTRAMUSCULAR)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 26117,"RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 26121,"FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26123,"FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT);",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26125,"FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT); EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,200.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,200.00 ",,,,,,,,,,,,,,, 26145,"SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM AND/OR FINGER, EACH TENDON",OR LEVEL 4,," 21,812.00 ", 260.12 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26160,ED EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG CYST MUCOUS CYST OR GANGLION) HAND OR FINGER,Emergency department," 2,434.84 ",,," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26160,"EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR FINGER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26200,EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26210,"EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR DISTAL PHALANX OF FINGER;",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26230,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); METACARPAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,450.00 "," 2,623.34 "," 2,779.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,450.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26236,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26320,REMOVAL OF IMPLANT FROM FINGER OR HAND,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 26340,"MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 26350,"REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); PRIMARY OR SECONDARY WITHOUT FREE GRAFT, EACH TENDON",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26352,"REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); SECONDARY WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26356,"REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); PRIMARY, WITHOUT FREE GRAFT, EACH TENDON",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26358,"REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); SECONDARY, WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26370,"REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON; PRIMARY, EACH TENDON",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26390,"EXCISION FLEXOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED TENDON GRAFT, HAND OR FINGER, EACH ROD",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 26410,"REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26418,"REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 3,300.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 3,300.00 ",,,,,,,,,,,,,,, 26426,"REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY); USING LOCAL TISSUE(S), INCLUDING LATERAL BAND(S), EACH FINGER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26428,"REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY); WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH FINGER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26432,"CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT PERCUTANEOUS PINNING (EG, MALLET FINGER)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26433,"REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITHOUT GRAFT (EG, MALLET FINGER)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26440,"TENOLYSIS, FLEXOR TENDON; PALM OR FINGER, EACH TENDON",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26445,"TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26450,ED TENOTOMY FLEXOR PALM OPEN EACH TENDON,Emergency department," 4,876.68 ",,," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26450,"TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26460,ED TENOTOMY EXTENSOR HAND OR FINGER OPEN EACH TENDON,Emergency department," 2,434.84 ",,," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26477,"SHORTENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 ",,,,,,, - , - ,,,,,,,,,,,,,,, 26480,"TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND; WITHOUT FREE GRAFT, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26492,"OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26508,"RELEASE OF THENAR MUSCLE(S) (EG, THUMB CONTRACTURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26520,"CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACH JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26525,"CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 26530,"ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26531,"ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,450.00 "," 5,699.59 "," 2,779.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 26535,"ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26536,"ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,031.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 26540,ED REPAIR OF COLLATERAL LIGAMENT METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT,Emergency department," 8,276.88 ",,," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26540,"REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26541,"RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,450.00 "," 2,623.34 "," 2,779.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,450.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26542,"RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH LOCAL TISSUE (EG, ADDUCTOR ADVANCEMENT)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26548,"REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26567,"OSTEOTOMY; PHALANX OF FINGER, EACH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26591,"REPAIR, INTRINSIC MUSCLES OF HAND, EACH MUSCLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 2,800.00 ",,,,,,,,,,,,,,, 26600,ED CLOSED TREATMENT OF METACARPAL FRACTURE SINGLE; WITHOUT MANIPULATION EACH BONE,Emergency department," 3,780.00 ",,, 414.02 ,, 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 , 225.09 ,,,,,,,,,,,,,,, 26605,ED CLOSED TREATMENT OF METACARPAL FRACTURE SINGLE; WITH MANIPULATION EACH BONE,Emergency department," 4,119.50 ",,, 414.02 ," 1,500.00 ", 225.09 ," 2,400.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 2,400.00 ",,,,,,,,,,,,,,, 26607,ED CLOSED TREATMENT OF METACARPAL FRACTURE WITH MANIPULATION WITH EXTERNAL FIXATION EACH BONE,Emergency department," 5,771.88 ",,," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,500.00 "," 2,623.34 ",,,,,,,,,,,,,,, 26607,"CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH EXTERNAL FIXATION, EACH BONE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,500.00 "," 2,623.34 ",,,,,,,,,,,,,,, 26608,"PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26615,"OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH BONE90627",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26641,ED CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION THUMB WITH MANIPULATION,Emergency department," 4,688.38 ",,, 414.02 ,, 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 , 225.09 ,,,,,,,,,,,,,,, 26645,"CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MANIPULATION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 26676,"PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULATION, EACH JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26700,ED CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION SINGLE WITH MANIPULATION; WITHOUT ANESTHESIA,Emergency department," 4,140.13 ",,, 414.02 ,, 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 , 225.09 ,,,,,,,,,,,,,,, 26705,ED CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION SINGLE WITH MANIPULATION; REQUIRING ANESTHESIA,Emergency department," 5,269.63 ",,," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26705,"CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING ANESTHESIA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26720,ED CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE PROXIMAL OR MIDDLE PHALANX FINGER OR THUMB; WITHOUT MANIPULATION EACH,Emergency department," 2,551.00 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 26725,ED CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE PROXIMAL OR MIDDLE PHALANX FINGER OR THUMB; WITH MANIPULATION WITH OR WITHOUT SKIN OR SKELETAL TRACTION EACH,Emergency department," 4,305.63 ",,, 414.02 ," 1,500.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,500.00 ",,,,,,,,,,,,,,, 26725,"CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION, EACH",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,500.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,500.00 ",,,,,,,,,,,,,,, 26727,"PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,450.00 "," 2,623.34 "," 2,779.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,450.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26735,"OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH90644",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26742,EDCLOSED TREATMENT OF ARTICULAR FRACTURE INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT; WITH MANIPULATION EACH,Emergency department," 4,671.00 ",,," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26742,"CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT; WITH MANIPULATION, EACH",OR LEVEL 4,," 21,812.00 ", 260.12 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 26746,"OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH90647",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26750,ED CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE FINGER OR THUMB; WITHOUT MANIPULATION EACH,Emergency department," 2,363.63 ",,, 414.02 ,, 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 , 225.09 ,,,,,,,,,,,,,,, 26755,ED CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE FINGER OR THUMB; WITH MANIPULATION EACH,Emergency department," 4,025.38 ",,, 414.02 ,, 225.09 ,, 397.57 , 354.59 , 260.03 , 225.09 , 397.57 ,,,,,,,,,,,,,,, 26755,"CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH MANIPULATION, EACH",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ,, 225.09 ,, 397.57 , 354.59 , 260.03 , 225.09 , 397.57 ,,,,,,,,,,,,,,, 26756,"PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, EACH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26765,"OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH90651",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26770,ED CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION SINGLE WITH MANIPULATION; WITHOUT ANESTHESIA,Emergency department," 3,541.00 ",,, 414.02 ,, 225.09 ,, 397.57 , 354.59 , 260.03 , 225.09 , 397.57 ,,,,,,,,,,,,,,, 26776,"PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26785,"OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, SINGLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26860,"ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26861,"ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH ADDITIONAL INTERPHALANGEAL JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 1,500.00 ",," 1,900.00 ",,,," 1,500.00 "," 1,900.00 ",,,,,,,,,,,,,,, 26951,"AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26952,"AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 26989,"UNLISTED PROCEDURE, HANDS OR FINGERS",OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ," 1,900.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,900.00 ",,,,,,,,,,,,,,, 26990,"INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27000,"TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 27006,"TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 1,900.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,900.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27025,"FASCIOTOMY, HIP OR THIGH, ANY TYPE",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 1,758.11 "," 1,568.04 "," 1,149.90 "," 1,149.90 "," 1,900.00 ",,,,,,,,,,,,,,, 27030,"ARTHROTOMY, HIP, WITH DRAINAGE (EG, INFECTION)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,000.00 ",," 1,900.00 "," 1,790.65 "," 1,597.07 "," 1,171.18 "," 1,171.18 "," 2,000.00 ",,,,,,,,,,,,,,, 27036,EXCISION OF HIP JOINT/MUSCLE 1ST,OR LEVEL 2,," 14,341.60 ",171.67,,,," 1,900.00 "," 1,934.06 "," 1,724.98 "," 1,264.98 "," 1,264.98 "," 1,934.06 ",,,,,,,,,,,,,,, 27043,EXCISION TUMOR SOFT TISSUE OF PELVIS AND HIP AREA SUBCUTANEOUS; 3 CM OR GREATER,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27047,"EXCISION, TUMOR, PELVIS AND HIP AREA; SUBCUTANEOUS TISSUE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 ",,,,,,, - , - ,,,,,,,,,,,,,,, 27090,REMOVAL OF HIP PROSTHESIS; (SEPARATE PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,586.15 "," 1,414.68 "," 1,037.43 "," 1,037.43 "," 1,900.00 ",,,,,,,,,,,,,,, 27093,INJ PROC FOR HIP ARTHROGRAPHY W/O ANES,OR LEVEL 1,," 12,325.60 ",143.65,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 27095,INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA,OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 27096,"INJECTION PROCEDURE FOR SACROILIAC JOINT, ARTHROGRAPHY AND/OR ANESTHETIC/STEROID",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,, 159.34 , 142.11 , 104.22 , 104.22 ," 1,200.00 ",,,,,,,,,,,,,,, 27125,"HEMIARTHROPLASTY, HIP, PARTIAL (EG, FEMORAL STEM PROSTHESIS, BIPOLAR ARTHROPLASTY)",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,," 1,900.00 "," 2,171.75 "," 1,936.97 "," 1,420.44 "," 1,420.44 "," 2,171.75 ",,,,,,,,,,,,,,, 27130,"ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT",OR LEVEL 6,," 25,897.20 ", 438.29 ," 26,096.16 "," 12,000.00 ",," 1,900.00 "," 18,900.00 "," 17,010.00 "," 14,553.00 "," 1,900.00 "," 18,900.00 ",,,,,,,,,,,,,,, 27132,"CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,," 1,900.00 "," 3,210.82 "," 2,863.71 "," 2,100.05 "," 1,900.00 "," 3,210.82 ",,,,,,,,,,,,,,, 27134,"REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 3,675.58 "," 3,278.22 "," 2,404.03 "," 1,900.00 "," 3,675.58 ",,,,,,,,,,,,,,, 27137,"REVISION OF TOTAL HIP ARTHROPLASTY; ACETABULAR COMPONENT ONLY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 2,823.75 "," 2,518.48 "," 1,846.88 "," 1,846.88 "," 2,823.75 ",,,,,,,,,,,,,,, 27138,"REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT ALLOGRAFT",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,934.62 "," 2,617.36 "," 1,919.40 "," 1,900.00 "," 2,934.62 ",,,,,,,,,,,,,,, 27202,OPEN TREATMENT OF COCCYGEAL FRACTURE,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27222,"CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,860.36 "," 1,659.24 "," 1,216.78 "," 1,216.78 "," 1,900.00 ",,,,,,,,,,,,,,, 27235,"PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 1,900.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,900.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27236,"OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR PROSTHETIC REPLACEMENT",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 2,290.60 "," 2,042.96 "," 1,498.17 "," 1,498.17 "," 2,290.60 ",,,,,,,,,,,,,,, 27240,"CLOSED TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 1,834.46 "," 1,636.14 "," 1,199.84 "," 1,199.84 "," 1,900.00 ",,,,,,,,,,,,,,, 27245,"TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 2,358.32 "," 2,103.37 "," 1,542.47 "," 1,542.47 "," 2,358.32 ",,,,,,,,,,,,,,, 27248,"OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,421.50 "," 1,267.83 ", 929.74 , 929.74 ," 1,900.00 ",,,,,,,,,,,,,,, 27250,ED CLOSED TREATMENT OF HIP DISLOCATION TRAUMATIC; WITHOUT ANESTHESIA,Emergency department," 2,277.25 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27279,ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION) WITH IMAGE GUIDANCE INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED AND PLACEMENT OF TRANSFIXING DEVICE,OR LEVEL 5,," 23,543.80 ", 337.20 ," 43,795.26 "," 2,200.00 "," 15,402.46 "," 1,900.00 "," 28,436.35 "," 25,362.15 "," 18,598.91 "," 1,900.00 "," 28,436.35 ",,,,,,,,,,,,,,, 27280,"ARTHRODESIS, SACROILIAC JOINT (INCLUDING OBTAINING GRAFT)",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,," 1,900.00 "," 2,604.63 "," 2,323.05 "," 1,703.57 "," 1,703.57 "," 2,604.63 ",,,,,,,,,,,,,,, 27301,"INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27306,"TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; SINGLE TENDON (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 2,800.00 ",,,,,,,,,,,,,,, 27307,"TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; MULTIPLE TENDONS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27310,"ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG, INFECTION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27323,BIOPSY SOFT TISS THIGH/KNEE SUPER 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 27327,"EXCISION, TUMOR, THIGH OR KNEE AREA; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 27328,"EXCISION, TUMOR, THIGH OR KNEE AREA; DEEP, SUBFASCIAL, OR INTRAMUSCULAR",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27329,RESECT THIGH/KNEE TUM < 5 CM 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,166.50 "," 2,200.00 "," 2,378.29 "," 3,300.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27331,"ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR REMOVAL OF LOOSE OR FOREIGN BODIES",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27337,"EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27339,EXCISION TUMOR SOFT TISSUE OF THIGH OR KNEE AREA SUBFASCIAL (EG INTRAMUSCULAR); 5 CM OR GREATER,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27345,"EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG, BAKER'S CYST)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27347,"EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27350,PATELLECTOMY OR HEMIPATELLECTOMY 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27355,EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27372,ED REMOVAL OF FOREIGN BODY DEEP THIGH REGION OR KNEE AREA,Emergency department," 7,813.38 ",,," 5,166.50 "," 2,450.00 "," 2,378.29 "," 2,779.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,378.29 "," 4,301.01 ",,,,,,,,,,,,,,, 27380,SUTURE OF INFRAPATELLAR TENDON; PRIMARY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,200.00 "," 5,699.59 "," 1,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27385,SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27390,"TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27403,"ARTHROTOMY WITH MENISCUS REPAIR, KNEE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27405,REPAIR OF KNEE LIGAMENT 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27420,REVISION OF UNSTABLE KNEECAP 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27422,"RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,450.00 "," 5,699.59 "," 2,779.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27425,LATERAL RETINACULAR RELEASE OPEN 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,450.00 "," 2,623.34 "," 2,779.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,450.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27446,"ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT",OR LEVEL 5,," 23,543.80 ", 337.20 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 1,900.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 1,900.00 "," 18,727.40 ",,,,,,,,,,,,,,, 27447,"ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)",OR LEVEL 5,," 23,543.80 ", 337.20 ," 26,096.16 "," 12,000.00 "," 10,713.88 "," 1,900.00 "," 18,900.00 "," 17,010.00 "," 14,553.00 "," 1,900.00 "," 18,900.00 ",,,,,,,,,,,,,,, 27470,REPAIR OF THIGH 1ST,OR LEVEL 3,," 17,605.00 ",219.62,,,," 1,900.00 "," 2,251.43 "," 2,008.03 "," 1,472.56 "," 1,472.56 "," 2,251.43 ",,,,,,,,,,,,,,, 27486,"REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; ONE COMPONENT",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,," 1,900.00 "," 2,695.60 "," 2,404.18 "," 1,763.07 "," 1,763.07 "," 2,695.60 ",,,,,,,,,,,,,,, 27487,"REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,," 1,900.00 "," 3,371.50 "," 3,007.01 "," 2,205.14 "," 1,900.00 "," 3,371.50 ",,,,,,,,,,,,,,, 27488,"REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH OR WITHOUT INSERTION OF SPACER, KNEE",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 2,300.55 "," 2,051.84 "," 1,504.68 "," 1,504.68 "," 2,300.55 ",,,,,,,,,,,,,,, 27500,ED CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITHOUT MANIPULATION,Emergency department," 6,548.88 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27502,ED CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITH MANIPULATION WITH OR WITHOUT SKIN OR SKELETAL TRACTION,Emergency department," 9,715.50 ",,," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 27507,"OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,200.00 ",," 1,900.00 "," 1,861.69 "," 1,660.43 "," 1,217.65 "," 1,217.65 "," 2,200.00 ",,,,,,,,,,,,,,, 27511,"OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERCONDYLAR EXTENSION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 ",," 1,900.00 "," 1,908.83 "," 1,702.47 "," 1,248.48 "," 1,248.48 "," 2,200.00 ",,,,,,,,,,,,,,, 27514,"OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,851.07 "," 1,650.96 "," 1,210.70 "," 1,210.70 "," 1,900.00 ",,,,,,,,,,,,,,, 27520,ED CLOSED TREATMENT OF PATELLAR FRACTURE WITHOUT MANIPULATION,Emergency department," 4,161.13 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27524,"OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE PATELLECTOMY AND SOFT TISSUE REPAIR",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27535,"OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,000.00 ",,," 1,716.95 "," 1,531.33 "," 1,122.98 "," 1,122.98 "," 2,000.00 ",,,,,,,,,,,,,,, 27536,"OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHOUT INTERNAL FIXATION",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,277.98 "," 2,031.71 "," 1,489.92 "," 1,489.92 "," 2,277.98 ",,,,,,,,,,,,,,, 27550,ED CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA,Emergency department," 6,347.38 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27560,ED CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA,Emergency department," 4,673.88 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27570,MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES),OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 27598,DISARTICULATION AT KNEE,OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 1,371.04 "," 1,222.82 ", 896.73 , 896.73 ," 1,371.04 ",,,,,,,,,,,,,,, 27599,"UNLISTED PROCEDURE, FEMUR OR KNEE",OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ,, 397.57 , 354.59 , 260.03 , 225.09 ," 1,200.00 ",,,,,,,,,,,,,,, 27600,DECOMPRESSION OF LOWER LEG 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27603,"INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 27605,"TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 27606,"TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27610,"ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27612,"ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON LENGTHENING",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27618,"EXCISION, TUMOR, LEG OR ANKLE AREA; SUBCUTANEOUS TISSUE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 27620,"ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF LOOSE OR FOREIGN BODY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27625,"ARTHROTOMY, WITH SYNOVECTOMY, ANKLE;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27630,"EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27635,"EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27640,PARTIAL REMOVAL OF TIBIA 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27641,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR EXOSTOSIS); FIBULA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27650,"REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27652,"REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27654,"REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27658,"REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,200.00 "," 2,623.34 "," 1,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27659,"REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27675,"REPAIR, DISLOCATING PERONEAL TENDONS; WITHOUT FIBULAR OSTEOTOMY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27676,"REPAIR, DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27680,"TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27681,"TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; MULTIPLE TENDONS (THROUGH SEPARATE INCISION(S))",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27685,"LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27686,"LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE TENDONS (THROUGH SAME INCISION), EACH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27687,"GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27690,"TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); SUPERFICIAL (EG, ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27691,"TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27692,TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); EACH ADDITIONAL TENDON (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,000.00 ",,,,,," 2,000.00 "," 2,000.00 ",,,,,,,,,,,,,,, 27694,"DECOMPRESSION FASCIOTOMY, LEG;ANTERIOR AND OR LATERAL, AND POSTERIOR COMPARTMENTS WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND OR NERVE",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,,,,, - , - ,,,,,,,,,,,,,,, 27695,"REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27696,"REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27698,"REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27702,ARTHROPLASTY ANKLE W/IMPLANT 1ST 15,OR LEVEL 5,," 23,543.80 ",337.2," 43,795.26 ",,," 1,900.00 "," 1,837.12 "," 1,638.52 "," 1,201.58 "," 1,201.58 "," 1,900.00 ",,,,,,,,,,,,,,, 27704,REMOVAL OF ANKLE IMPLANT,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27707,OSTEOTOMY; FIBULA,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 27725,"REPAIR OF NONUNION OR MALUNION, TIBIA; BY SYNOSTOSIS, WITH FIBULA, ANY METHOD",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 2,339.07 "," 2,086.19 "," 1,529.88 "," 1,529.88 "," 2,339.07 ",,,,,,,,,,,,,,, 27726,REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION,OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 3,600.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27750,ED CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT MANIPULATION,Emergency department," 4,441.63 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27752,ED CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH MANIPULATION WITH OR WITHOUT SKELETAL TRACTION,Emergency department," 6,843.13 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 27758,"OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE), WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE",OR LEVEL 4,," 21,812.00 ", 260.12 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 27759,"TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 27760,ED CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION,Emergency department," 4,306.50 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27766,"OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED90996",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27769,"OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 ",,,,,,, - , - ,,,,,,,,,,,,,,, 27780,ED CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION,Emergency department," 3,949.50 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27780,CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION,27780," 3,949.50 ",,, 414.02 ,,,,,,, - , - ,,,,,,,,,,,,,,, 27786,ED CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION,Emergency department," 4,077.50 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27792,"OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,800.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27808,CLOSED TREATMENT OF BIMALLEOLAR ANKLE FR,," 2,000.00 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27810,ED CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG LATERAL AND MEDIAL MALLEOLI OR LATERAL AND POSTERIOR MALLEOLI OR MEDIAL AND POSTERIOR MALLEOLI); WITH MANIPULATION,Emergency department," 6,016.00 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 27814,"OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI, OR MEDIAL AND POSTERIOR MALLEOLI), INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,800.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27816,CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION,OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27818,ED CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION,Emergency department," 6,194.75 ",,," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 27818,CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,200.00 "," 1,313.34 "," 1,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,200.00 "," 2,497.39 ",,,,,,,,,,,,,,, 27822,"OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27823,"OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27824,ED CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG PILON OR TIBIAL PLAFOND) WITH OR WITHOUT ANESTHESIA; WITHOUT MANIPULATION,Emergency department," 3,995.00 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27825,ED CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG PILON OR TIBIAL PLAFOND) WITH OR WITHOUT ANESTHESIA; WITH SKELETAL TRACTION AND/OR REQUIRING MANIPULATION,Emergency department," 6,901.63 ",,," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 27827,"OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH INTERNAL FIXATION, WHEN PERFORMED; OF TIBIA ONLY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 26,096.16 "," 2,000.00 "," 10,713.88 "," 2,800.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,000.00 "," 18,727.40 ",,,,,,,,,,,,,,, 27828,"OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH INTERNAL FIXATION, WHEN PERFORMED; OF BOTH TIBIA AND FIBULA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 27829,"OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 27840,ED CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA,Emergency department," 4,767.63 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 27870,"ARTHRODESIS, ANKLE, OPEN",OR LEVEL 4,," 21,812.00 ", 260.12 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 27880,"AMPUTATION, LEG, THROUGH TIBIA AND FIBULA;",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,756.13 "," 1,566.28 "," 1,148.60 "," 1,148.60 "," 1,900.00 ",,,,,,,,,,,,,,, 27886,"AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,260.16 "," 1,123.93 ", 824.22 , 824.22 ," 1,900.00 ",,,,,,,,,,,,,,, 27894,"DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S), WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 2,800.00 ",,,,,,,,,,,,,,, 27899,"UNLISTED PROCEDURE, LEG OR ANKLE",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ,, 397.57 , 354.59 , 260.03 , 225.09 ," 1,200.00 ",,,,,,,,,,,,,,, 28002,"INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; SINGLE BURSAL SPACE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 28003,"INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; MULTIPLE AREAS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28005,"INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), FOOT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28008,"FASCIOTOMY, FOOT AND/OR TOE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28035,"RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 "," 2,200.00 "," 1,631.48 "," 3,300.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,631.48 "," 3,300.00 ",,,,,,,,,,,,,,, 28039,EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBCUTANEOUS; 1.5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 1,200.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 28041,EXCISION TUMOR SOFT TISSUE OF FOOT OR TOE SUBFASCIAL (EG INTRAMUSCULAR); 1.5 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 28043,"EXCISION, TUMOR, FOOT; SUBCUTANEOUS TISSUE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 28045,"EXCISION, TUMOR, FOOT; DEEP, SUBFASCIAL, INTRAMUSCULAR",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 2,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 28047,RADICAL RESECTION OF TUMOR (EG SARCOMA) SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,166.50 "," 2,000.00 "," 2,378.29 "," 3,600.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 2,000.00 "," 4,301.01 ",,,,,,,,,,,,,,, 28052,ARTHROTOMY W/BIOPSY MTP JOINT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28055,"NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT91057",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 ",,,,,,, - , - ,,,,,,,,,,,,,,, 28060,"FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28062,"FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28080,"EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 28088,SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR,OR LEVEL 2,," 14,341.60 ",171.67," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,500.00 "," 2,623.34 ",,,,,,,,,,,,,,, 28090,"EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); FOOT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 28092,"EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); TOE(S), EACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,800.00 ",,,,,,,,,,,,,,, 28100,"EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28103,REMOVE/GRAFT FOOT LESION 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28104,"EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALCANEUS;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28107,"EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALCANEUS; WITH ALLOGRAFT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28108,"EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 28110,"OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28111,"OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28112,"OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28113,"OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28116,"OSTECTOMY, EXCISION OF TARSAL COALITION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28118,"OSTECTOMY, CALCANEUS;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28119,"OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28120,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,450.00 "," 2,623.34 "," 2,779.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,450.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28122,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28124,"PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,800.00 ", 494.09 , 445.59 , 342.53 , 342.53 ," 2,800.00 ",,,,,,,,,,,,,,, 28126,"RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 2,800.00 ",,,,,,,,,,,,,,, 28130,TALECTOMY (ASTRAGALECTOMY),OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28140,METATARSECTOMY,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28150,ED CLOSED TREATMENT OF FRACTURE PHALANX OR PHALANGES OTHER THAN GREAT TOE; WITHOUT MANIPULATION EACH,Emergency department," 1,596.75 ",,," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28160,PARTIAL REMOVAL OF TOE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28190,ED REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS,Emergency department," 3,353.00 ",,," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 309.83 , 279.42 , 214.79 , 214.79 ," 1,800.00 ",,,,,,,,,,,,,,, 28190,"REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,297.94 "," 1,500.00 ", 579.34 ," 1,800.00 ", 309.83 , 279.42 , 214.79 , 214.79 ," 1,800.00 ",,,,,,,,,,,,,,, 28192,ED REMOVAL OF FOREIGN BODY FOOT; DEEP,Emergency department," 6,147.00 ",,," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 28192,"REMOVAL OF FOREIGN BODY, FOOT; DEEP",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 28193,ED REMOVAL OF FOREIGN BODY FOOT; COMPLICATED,Emergency department," 6,147.00 ",,," 2,999.10 "," 2,200.00 "," 1,375.50 "," 3,300.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,300.00 ",,,,,,,,,,,,,,, 28193,"REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 2,200.00 "," 1,375.50 "," 3,300.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 3,300.00 ",,,,,,,,,,,,,,, 28200,"REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28202,"REPAIR, TENDON, FLEXOR, FOOT; SECONDARY WITH FREE GRAFT, EACH TENDON (INCLUDES OBTAINING GRAFT)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28208,"REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28220,"TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 1,900.00 ", 468.27 , 422.30 , 324.63 , 324.63 ," 1,900.00 ",,,,,,,,,,,,,,, 28230,"TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLE TENDON(S) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 1,900.00 ", 460.64 , 415.42 , 319.34 , 319.34 ," 1,900.00 ",,,,,,,,,,,,,,, 28232,"TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 1,500.00 "," 1,313.34 ",, 433.65 , 391.08 , 300.63 , 300.63 ," 1,500.00 ",,,,,,,,,,,,,,, 28234,"TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 1,500.00 "," 1,313.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 2,497.39 ",,,,,,,,,,,,,,, 28238,"RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28240,"TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28250,"DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLER STRIPPING) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28270,"CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28272,CAPSULOTOMY IPJ EA JOINT SEP PROC 1ST 30,OR LEVEL 3,," 17,605.00 ",219.62," 2,869.04 "," 1,500.00 "," 1,313.34 "," 1,900.00 ", 421.32 , 379.97 , 292.08 , 292.08 ," 1,900.00 ",,,,,,,,,,,,,,, 28280,"SYNDACTYLIZATION, TOES (EG, WEBBING OR KELIKIAN TYPE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28285,"CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28286,"CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE (EG, RUIZ-MORA TYPE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,633.43 "," 3,300.00 ",,,,,,,,,,,,,,, 28288,"OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSAL HEAD",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28289,"HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28291,HALLUX RIGIDUS CORRECTION W/ CHEILECTOMY AND IMPLANT,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 1,900.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,900.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28292,"CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; KELLER, MCBRIDE, OR MAYO TYPE PROCEDURE",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28295,BUNIONECTOMY W/PROXIMAL METARSAL OSTEOTO,OR LEVEL 4,," 21,812.00 ",260.12," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28296,"CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY (EG, MITCHELL, CHEVRON, OR CONCENTRIC TYPE PROCEDURES)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28297,"CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; LAPIDUS-TYPE PROCEDURE",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28298,"CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX OSTEOTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28299,"CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY DOUBLE OSTEOTOMY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,200.00 "," 2,623.34 "," 3,031.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28300,"OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28302,OSTEOTOMY; TALUS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28304,"OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 1,500.00 "," 5,699.59 "," 2,400.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 1,500.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28305,"OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) (EG, FOWLER TYPE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28306,"OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; FIRST METATARSAL",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28308,"OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28310,"OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE (SEPARATE PROCEDURE)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28312,"OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY TOE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28313,REPAIR DEFORMITY OF TOE 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28315,"SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 3,300.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28320,"REPAIR, NONUNION OR MALUNION; TARSAL BONES",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 28322,"REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRAFT)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28400,ED CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION,Emergency department," 3,241.63 ",,, 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 28400,CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION,OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ," 1,800.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,800.00 ",,,,,,,,,,,,,,, 28415,"OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,800.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28430,ED CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION,Emergency department," 3,046.00 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 28430,CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION,OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 28465,"OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH91162",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28470,ED CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION EACH,Emergency department," 2,854.38 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 28470,"CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH",OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 28476,"PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28485,"OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH91166",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28490,ED CLOSED TREATMENT OF FRACTURE GREAT TOE PHALANX OR PHALANGES; WITHOUT MANIPULATION,Emergency department," 1,898.63 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 169.59 , 152.94 , 117.57 , 117.57 ," 1,200.00 ",,,,,,,,,,,,,,, 28495,ED CLOSED TREATMENT OF FRACTURE GREAT TOE PHALANX OR PHALANGES; WITH MANIPULATION,Emergency department," 2,303.75 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 28495,"CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION",OR LEVEL 2,," 14,341.60 ", 171.67 , 414.02 ," 1,200.00 ", 225.09 ,, 182.48 , 164.57 , 126.50 , 126.50 ," 1,200.00 ",,,,,,,,,,,,,,, 28496,TREAT BIG TOE FRACTURE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28505,"OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION, WHEN PERFORMED91170",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28510,CLSD TX FRACT PHLNX/PHLNG WO/M,, 912.83 ,,, 414.02 ," 1,200.00 ", 225.09 ,, 133.20 , 120.13 , 92.34 , 92.34 ," 1,200.00 ",,,,,,,,,,,,,,, 28515,ED CLOSED TREATMENT OF FRACTURE PHALANX OR PHALANGES OTHER THAN GREAT TOE; WITH MANIPULATION EACH,Emergency department," 2,086.63 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 172.52 , 155.58 , 119.60 , 119.60 ," 1,200.00 ",,,,,,,,,,,,,,, 28525,"OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH91173",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28531,"OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28585,"OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED91183",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28606,TREAT FOOT DISLOCATION 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28615,"OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED91187",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 2,800.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28630,ED CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA,Emergency department," 2,025.88 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 150.22 , 135.48 , 104.14 , 104.14 ," 1,200.00 ",,,,,,,,,,,,,,, 28645,"OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED91191",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28660,ED CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA,Emergency department," 1,505.63 ",,, 414.02 ," 1,200.00 ", 225.09 ,, 110.91 , 100.02 , 76.89 , 76.89 ," 1,200.00 ",,,,,,,,,,,,,,, 28666,"PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28675,"OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 2,800.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28715,"LUMBAR,CERVICAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 28725,ARTHRODESIS; SUBTALAR,OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 28730,"ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 28735,"ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY (EG, FLATFOOT CORRECTION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,300.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 28737,"ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL NAVICULAR-CUNEIFORM (EG, MILLER TYPE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 26,096.16 "," 2,200.00 "," 10,713.88 "," 3,031.00 "," 18,727.40 "," 16,702.82 "," 12,248.73 "," 2,200.00 "," 18,727.40 ",,,,,,,,,,,,,,, 28740,"ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28750,"ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28755,"ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28760,"ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST METATARSAL NECK, GREAT TOE, INTERPHALANGEAL JOINT (EG, JONES TYPE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 3,300.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 28800,"AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,025.79 ", 914.89 , 670.92 , 670.92 ," 1,900.00 ",,,,,,,,,,,,,,, 28805,"AMPUTATION, FOOT; TRANSMETATARSAL",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 1,900.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,900.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28810,"AMPUTATION, METATARSAL, WITH TOE, SINGLE",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 1,500.00 "," 4,893.68 ",,,,,,,,,,,,,,, 28820,"AMPUTATION, TOE; METATARSOPHALANGEAL JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,500.00 "," 2,623.34 ",,,,,,,,,,,,,,, 28825,"AMPUTATION, TOE; INTERPHALANGEAL JOINT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 1,500.00 "," 2,623.34 "," 2,400.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,500.00 "," 2,623.34 ",,,,,,,,,,,,,,, 28899,"UNLISTED PROCEDURE, FOOT OR TOES",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ," 1,900.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 1,900.00 ",,,,,,,,,,,,,,, 29049,"ED APPLICATION, CAST; FIGURE-OF-EIGHT",Emergency department," 1,275.00 ",,, 479.82 ,, 235.58 ,, 104.45 , 94.20 , 72.41 , 72.41 , 235.58 ,,,,,,,,,,,,,,, 29065,APP CAST SHOULDER-HAND LONG ARM,, 801.13 ,,, 479.82 ,, 235.58 ,, 102.10 , 92.08 , 70.78 , 70.78 , 235.58 ,,,,,,,,,,,,,,, 29075,APP CAST ELBOW-FINGER SHORT ARM,, 904.15 ,,, 479.82 ,, 235.58 ,, 93.30 , 84.14 , 64.68 , 64.68 , 235.58 ,,,,,,,,,,,,,,, 29085,"ED APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLET)",Emergency department," 1,225.13 ",,, 291.52 ,, 134.62 ,, 101.52 , 91.55 , 70.38 , 70.38 , 134.62 ,,,,,,,,,,,,,,, 29086,APPLICATION CAST FINGER EG CONTRACTURE,," 1,303.90 ",,, 291.52 ,, 134.62 ,, 93.30 , 84.14 , 64.68 , 64.68 , 134.62 ,,,,,,,,,,,,,,, 29105,ED APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND),Emergency department," 1,455.35 ",,, 291.52 ,, 134.62 ,, 89.19 , 80.44 , 61.83 , 61.83 , 134.62 ,,,,,,,,,,,,,,, 29125,ED APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC,Emergency department, 842.50 ,,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 29125,APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC,OR LEVEL 1,," 12,325.60 ", 146.65 , 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 29126,ED APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC,Emergency department," 1,268.47 ",,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 29130,ED APPLICATION OF FINGER SPLINT; STATIC,Emergency department, 523.25 ,,, 232.22 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 29130,APPLICATION OF FINGER SPLINT; STATIC,OR LEVEL 1,," 12,325.60 ", 146.65 , 232.22 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 29131,APPLICATION OF FINGER SPLINT; DYNAMIC,Emergency department, 853.45 ,,, 114.96 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 29240,"ED STRAPPING; SHOULDER (EG, VELPEAU)",Emergency department, 943.15 ,,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 29260,ED STRAPPING; ELBOW OR WRIST,Emergency department, 842.88 ,,, 114.96 ,, 32.12 ,, 58.83 , 52.47 , 38.48 , 32.12 , 58.83 ,,,,,,,,,,,,,,, 29280,ED STRAPPING; HAND OR FINGER,Emergency department, 831.50 ,,, 114.96 ,, 32.12 ,, 58.83 , 52.47 , 38.48 , 32.12 , 58.83 ,,,,,,,,,,,,,,, 29345,APPLICATION LONG LEG CAST THIGH TO TOES,," 2,265.90 ",,, 479.82 ," 1,200.00 ", 235.58 ,, 132.03 , 119.07 , 91.53 , 91.53 ," 1,200.00 ",,,,,,,,,,,,,,, 29355,APPLICATION OF LONG LEG CAST,," 1,798.38 ",,, 479.82 ,, 235.58 ,, 130.86 , 118.01 , 90.72 , 90.72 , 235.58 ,,,,,,,,,,,,,,, 29365,APPLICATION CYLINDER CAST THIGH TO ANKLE,," 2,044.08 ",,, 479.82 ,, 235.58 ,, 124.99 , 112.72 , 86.65 , 86.65 , 235.58 ,,,,,,,,,,,,,,, 29405,APP SHORT LEG CAST BELOW KNEE TO TOES,," 1,346.38 ",,, 479.82 ,, 235.58 ,, 82.74 , 74.62 , 57.36 , 57.36 , 235.58 ,,,,,,,,,,,,,,, 29425,APPLY SHORT LEG CAST,," 1,304.22 ",,, 479.82 ,, 235.58 ,, 78.63 , 70.91 , 54.51 , 54.51 , 235.58 ,,,,,,,,,,,,,,, 29435,APP PATELLAR TENDON BEARING PTB CAST,," 1,915.55 ",,, 479.82 ,, 235.58 ,, 117.36 , 105.84 , 81.36 , 81.36 , 235.58 ,,,,,,,,,,,,,,, 29505,ED APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES),Emergency department," 1,379.13 ",,, 291.52 ,, 134.62 ,, 97.41 , 87.85 , 67.53 , 67.53 , 134.62 ,,,,,,,,,,,,,,, 29515,ED APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT),Emergency department, 927.75 ,,, 291.52 ,, 134.62 ,, 72.76 , 65.62 , 50.44 , 50.44 , 134.62 ,,,,,,,,,,,,,,, 29515,APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT),OR LEVEL 1,," 12,325.60 ", 146.65 , 291.52 ,, 134.62 ,, 72.76 , 65.62 , 50.44 , 50.44 , 134.62 ,,,,,,,,,,,,,,, 29520,ED STRAPPING; HIP,Emergency department, 790.55 ,,, 232.22 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 29530,ED STRAPPING; KNEE,Emergency department, 837.20 ,,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 29540,ED STRAPPING; ANKLE AND/OR FOOT,Emergency department, 614.73 ,,, 291.52 ,, 134.62 ,, 19.36 , 17.46 , 13.42 , 13.42 , 134.62 ,,,,,,,,,,,,,,, 29550,ED STRAPPING; TOES,Emergency department, 515.45 ,,, 114.96 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 29580,ED STRAPPING; UNNA BOOT,Emergency department, 676.88 ,,, 291.52 ,, 134.62 ,, 66.31 , 59.80 , 45.97 , 45.97 , 134.62 ,,,,,,,,,,,,,,, 29580,STRAPPING; UNNA BOOT,OR LEVEL 1,," 12,325.60 ", 146.65 , 291.52 ,, 134.62 ,, 66.31 , 59.80 , 45.97 , 45.97 , 134.62 ,,,,,,,,,,,,,,, 29700,ED REMOVAL OR BIVALVING; GAUNTLET BOOT OR BODY CAST,Emergency department, 850.63 ,,, 479.82 ,, 235.58 ,, 71.00 , 64.03 , 49.22 , 49.22 , 235.58 ,,,,,,,,,,,,,,, 29705,ED REMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST,Emergency department," 1,104.83 ",,, 479.82 ,, 235.58 ,, 59.27 , 53.45 , 41.09 , 41.09 , 235.58 ,,,,,,,,,,,,,,, 29730,WINDOWING CAST,," 1,075.58 ",,, 291.52 ,, 134.62 ,, 55.75 , 50.27 , 38.65 , 38.65 , 134.62 ,,,,,,,,,,,,,,, 29805,"ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29806,"ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 5,699.59 "," 10,371.88 ",,,,,,,,,,,,,,, 29807,"ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 29819,"ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29821,"ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29822,"ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29823,"ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29824,"ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUMFORD PROCEDURE)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29825,"ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOUT MANIPULATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29826,"ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, WITH OR WITHOUT CORACOACROMIAL RELEASE",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,000.00 ",," 7,965.00 ",,,," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29827,"ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 5,699.59 "," 10,371.88 ",,,,,,,,,,,,,,, 29828,"ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 29830,"ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29838,ARTHROSCOPY ELBOW DEBRIDE EXTENS 1ST 30,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29840,"ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29845,"ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29846,"ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR FIBROCARTILAGE AND/OR JOINT DEBRIDEMENT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29848,"ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,869.04 "," 2,000.00 "," 1,313.34 "," 7,965.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 7,965.00 ",,,,,,,,,,,,,,, 29850,"ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, WITH OR WITHOUT MANIPULATION; WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 7,965.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 7,965.00 ",,,,,,,,,,,,,,, 29851,"ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, WITH OR WITHOUT MANIPULATION; WITH INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,869.04 "," 2,200.00 "," 1,313.34 "," 7,965.00 "," 2,497.39 "," 2,227.40 "," 1,633.43 "," 1,313.34 "," 7,965.00 ",,,,,,,,,,,,,,, 29855,"ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED (INCLUDES ARTHROSCOPY)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 29860,"ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 29870,"ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29871,"ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29873,"ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29874,"ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHONDRITIS DISSECANS FRAGMENTATION, CHONDRAL FRAGMENTATION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29875,"ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29876,"ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, TWO OR MORE COMPARTMENTS (EG, MEDIAL OR LATERAL)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,200.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,200.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29877,"ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 4,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,623.34 "," 7,965.00 ",,,,,,,,,,,,,,, 29879,KNEE ARTHROSCOPY/SURGERY 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29880,"ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 4,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,623.34 "," 7,965.00 ",,,,,,,,,,,,,,, 29881,"ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 4,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,623.34 "," 7,965.00 ",,,,,,,,,,,,,,, 29882,"ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29884,"ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT MANIPULATION (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29885,KNEE ARTHROSCOPY/SURGERY 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 13,229.26 "," 2,000.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 29888,ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION,OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 5,699.59 "," 10,371.88 ",,,,,,,,,,,,,,, 29891,"ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING DRILLING OF THE DEFECT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29892,"ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR DOME FRACTURE, OR TIBIAL PLAFOND FRACTURE, WITH OR WITHOUT INTERNAL FIXATION (INCLUDES ARTHROSCOPY)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,229.26 "," 2,000.00 "," 5,699.59 "," 7,965.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,000.00 "," 10,371.88 ",,,,,,,,,,,,,,, 29893,ENDOSCOPIC PLANTAR FASCIOTOMY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 3,600.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 4,893.68 ",,,,,,,,,,,,,,, 29894,"ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29895,"ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29897,"ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29898,"ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29906,ARTHROSCOPY SUBTALAR JOINT W/DEBRIDE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 5,953.32 "," 2,000.00 "," 2,623.34 "," 7,965.00 "," 4,893.68 "," 4,364.63 "," 3,200.73 "," 2,000.00 "," 7,965.00 ",,,,,,,,,,,,,,, 29999,"UNLISTED PROCEDURE, ARTHROSCOPY",OR LEVEL 3,," 17,605.00 ", 219.52 , 414.02 ," 1,200.00 ", 225.09 ," 7,965.00 ", 397.57 , 354.59 , 260.03 , 225.09 ," 7,965.00 ",,,,,,,,,,,,,,, 30000,"DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH",OR LEVEL 1,," 12,325.60 ", 146.65 , 415.66 ," 1,200.00 ", 206.14 ,, 151.56 , 136.68 , 105.07 , 105.07 ," 1,200.00 ",,,,,,,,,,,,,,, 30020,"DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM",OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ," 1,200.00 ", 487.13 ,, 282.84 , 255.07 , 196.08 , 196.08 ," 1,200.00 ",,,,,,,,,,,,,,, 30100,"BIOPSY, INTRANASAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 "," 1,200.00 "," 1,279.10 "," 1,800.00 ", 167.82 , 151.35 , 116.34 , 116.34 ," 1,800.00 ",,,,,,,,,,,,,,, 30110,"EXCISION, NASAL POLYP(S), SIMPLE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 "," 1,200.00 "," 1,279.10 "," 1,900.00 ", 264.65 , 238.67 , 183.47 , 183.47 ," 1,900.00 ",,,,,,,,,,,,,,, 30115,"EXCISION, NASAL POLYP(S), EXTENSIVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30117,"EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,690.06 "," 2,000.00 "," 2,231.27 "," 2,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,000.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30130,"EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 2,000.00 "," 2,231.27 "," 2,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,000.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30140,"SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD91354",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30300,ED REMOVAL FOREIGN BODY INTRANASAL; OFFICE TYPE PROCEDURE,Emergency department," 3,088.00 ",,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 30310,"REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,690.06 "," 1,200.00 "," 2,231.27 "," 1,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30400,"RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,300.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 30410,"RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL AND ALAR CARTILAGES, AND/OR ELEVATION OF NASAL TIP",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,031.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 30420,"RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,031.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 30430,REVISION OF NOSE 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 10,679.34 "," 2,000.00 "," 4,424.23 "," 2,800.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,000.00 "," 8,026.76 ",,,,,,,,,,,,,,, 30450,"RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 30465,"REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 3,600.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 30520,"SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30560,LYSIS INTRANASAL SYNECHIA,OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ," 1,500.00 ", 487.13 ," 2,400.00 ", 850.76 , 758.79 , 556.44 , 487.13 ," 2,400.00 ",,,,,,,,,,,,,,, 30630,REPAIR NASAL SEPTAL PERFORATIONS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 2,450.00 "," 2,231.27 "," 2,779.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,231.27 "," 4,068.26 ",,,,,,,,,,,,,,, 30801,"CAUTERY AND/OR ABLATION, MUCOSA OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD; SUPERFICIAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,776.28 "," 1,200.00 "," 1,279.10 "," 1,800.00 "," 2,105.63 "," 1,878.00 "," 1,377.20 "," 1,200.00 "," 2,105.63 ",,,,,,,,,,,,,,, 30901,ED CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD,Emergency department," 1,229.50 ",,, 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 30903,ED CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD,Emergency department," 2,707.13 ",,, 232.22 ," 1,200.00 ", 106.48 ," 1,800.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 1,800.00 ",,,,,,,,,,,,,,, 30905,ED CONTROL NASAL HEMORRHAGE POSTERIOR WITH POSTERIOR NASAL PACKS AND/OR CAUTERY ANY METHOD; INITIAL,Emergency department," 3,366.50 ",,, 232.22 ," 1,200.00 ", 106.48 ," 1,800.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 1,800.00 ",,,,,,,,,,,,,,, 30905,"CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL",OR LEVEL 2,," 14,341.60 ", 171.67 , 232.22 ," 1,200.00 ", 106.48 ," 1,800.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 1,800.00 ",,,,,,,,,,,,,,, 30930,"FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC91428",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 30999,"UNLISTED PROCEDURE, NOSE",OR LEVEL 3,," 17,605.00 ", 219.52 , 415.66 ," 1,200.00 ", 206.14 ," 1,900.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,900.00 ",,,,,,,,,,,,,,, 31040,"PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 ",," 4,424.23 "," 1,900.00 "," 3,492.24 "," 3,149.45 "," 2,421.00 "," 1,900.00 "," 4,424.23 ",,,,,,,,,,,,,,, 31231,"NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 , 357.50 ," 1,500.00 ", 163.97 ,, 133.38 , 120.29 , 92.47 , 92.47 ," 1,500.00 ",,,,,,,,,,,,,,, 31233,"NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR MEATUS OR CANINE FOSSA PUNCTURE)",OR LEVEL 3,," 17,605.00 ", 219.52 , 754.28 ," 1,500.00 ", 386.50 ," 2,400.00 ", 694.62 , 619.53 , 454.32 , 386.50 ," 2,400.00 ",,,,,,,,,,,,,,, 31235,"NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SPHENOIDAL FACE OR CANNULATION OF OSTIUM)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,197.12 "," 1,500.00 "," 1,369.29 "," 1,800.00 "," 2,448.85 "," 2,184.11 "," 1,601.68 "," 1,369.29 "," 2,448.85 ",,,,,,,,,,,,,,, 31237,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,197.12 "," 1,500.00 "," 1,369.29 "," 2,400.00 "," 2,448.85 "," 2,184.11 "," 1,601.68 "," 1,369.29 "," 2,448.85 ",,,,,,,,,,,,,,, 31238,NASAL/SINUS ENDOSCOPY SURG 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 3,197.12 "," 1,500.00 "," 1,369.29 "," 1,800.00 "," 2,448.85 "," 2,184.11 "," 1,601.68 "," 1,369.29 "," 2,448.85 ",,,,,,,,,,,,,,, 31240,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,197.12 "," 1,500.00 "," 1,369.29 "," 2,400.00 "," 2,448.85 "," 2,184.11 "," 1,601.68 "," 1,369.29 "," 2,448.85 ",,,,,,,,,,,,,,, 31253,NSL/SINS NDSC TOTAL 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 12,374.16 "," 2,200.00 "," 5,147.57 "," 3,600.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,200.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31254,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL (ANTERIOR)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,200.00 "," 5,147.57 "," 2,800.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,200.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31255,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND POSTERIOR)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,200.00 "," 5,147.57 "," 3,031.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,200.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31256,"NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,667.30 "," 2,000.00 "," 2,740.66 "," 2,800.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 2,000.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31257,"NASAL ENDOSCOPY, SURGICAL; TOTAL, INCLUDING SPHENOIDOTOMY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 12,374.16 "," 2,200.00 "," 5,147.57 "," 3,600.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,200.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31259,"NASAL ENDOSCOPY, SURGICAL; TOTAL, INCLUDING SPHENOIDOTOMY WITH REMOVAL OF TISSUE FROM THE SPHENOID",OR LEVEL 4,," 21,812.00 ", 260.12 ," 12,374.16 "," 2,200.00 "," 5,147.57 "," 3,600.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,200.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31267,"NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 2,800.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,000.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31276,"NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT REMOVAL OF TISSUE FROM FRONTAL SINUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 2,800.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,000.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31287,NASAL/SINUS ENDOSCOPY SURG 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 12,374.16 "," 2,000.00 "," 5,147.57 "," 2,800.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,000.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31288,"NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 2,800.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,000.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31290,"NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; ETHMOID REGION",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,000.00 ",," 1,900.00 "," 2,171.09 "," 1,936.37 "," 1,420.01 "," 1,420.01 "," 2,171.09 ",,,,,,,,,,,,,,, 31291,"NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; SPHENOID REGION",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,000.00 ",," 1,900.00 "," 2,324.45 "," 2,073.16 "," 1,520.32 "," 1,520.32 "," 2,324.45 ",,,,,,,,,,,,,,, 31292,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL DECOMPRESSION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 1,900.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 1,900.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31293,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL ORBITAL WALL AND INFERIOR ORBITAL WALL DECOMPRESSION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 1,900.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 1,900.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31294,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH OPTIC NERVE DECOMPRESSION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 1,900.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 1,900.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31295,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF MAXILLARY SINUS OSTIUM (EG, BALLOON DILATION), TRANSNASAL OR VIA CANINE FOSSA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 3,600.00 "," 2,881.89 "," 2,599.00 "," 1,997.87 "," 1,997.87 "," 5,147.57 ",,,,,,,,,,,,,,, 31296,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF FRONTAL SINUS OSTIUM (EG, BALLOON DILATION)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 12,374.16 "," 6,500.00 "," 5,147.57 "," 3,600.00 "," 2,881.89 "," 2,599.00 "," 1,997.87 "," 1,997.87 "," 6,500.00 ",,,,,,,,,,,,,,, 31297,"NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF SPHENOID SINUS OSTIUM (EG, BALLOON DILATION)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 12,374.16 "," 2,000.00 "," 5,147.57 "," 3,600.00 "," 2,881.89 "," 2,599.00 "," 1,997.87 "," 1,997.87 "," 5,147.57 ",,,,,,,,,,,,,,, 31298,"NASAL ENDOSCOPY, WITH DILATION OF FRONTAL AND SPHENOIS SINUS OSTIA",OR LEVEL 4,," 21,812.00 ", 260.12 ," 12,374.16 "," 2,200.00 "," 5,147.57 "," 3,600.00 "," 8,998.71 "," 8,025.88 "," 5,885.65 "," 2,200.00 "," 8,998.71 ",,,,,,,,,,,,,,, 31299,"UNLISTED PROCEDURE, ACCESSORY SINUSES",OR LEVEL 2,," 14,341.60 ", 171.67 , 415.66 ,, 206.14 ," 1,900.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,900.00 ",,,,,,,,,,,,,,, 31500,ED INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,Emergency department," 1,373.00 ",,, 415.66 ," 1,200.00 ", 206.14 ," 1,800.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,800.00 ",,,,,,,,,,,,,,, 31502,ED TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT,Emergency department," 7,085.36 ",,, 415.66 ," 1,200.00 ", 206.14 ," 1,800.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,800.00 ",,,,,,,,,,,,,,, 31505,ED LARYNGOSCOPY INDIRECT; DIAGNOSTIC (SEPARATE PROCEDURE),Emergency department," 1,090.38 ",,, 357.50 ,, 163.97 ,, 96.24 , 86.79 , 66.72 , 66.72 , 163.97 ,,,,,,,,,,,,,,, 31505,"LARYNGOSCOPY, INDIRECT; DIAGNOSTIC (SEPARATE PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 , 357.50 ,, 163.97 ,, 96.24 , 86.79 , 66.72 , 66.72 , 163.97 ,,,,,,,,,,,,,,, 31510,"LARYNGOSCOPY, INDIRECT; WITH BIOPSY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,667.30 "," 1,500.00 "," 2,740.66 "," 2,400.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 1,500.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31530,ED LARYNGOSCOPY DIRECT OPERATIVE WITH FOREIGN BODY REMOVAL;,Emergency department," 2,539.58 ",,," 3,197.12 "," 1,500.00 "," 1,369.29 "," 2,400.00 "," 2,448.85 "," 2,184.11 "," 1,601.68 "," 1,369.29 "," 2,448.85 ",,,,,,,,,,,,,,, 31535,"LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,667.30 "," 1,500.00 "," 2,740.66 "," 2,400.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 1,500.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31536,"LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELESCOPE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,667.30 "," 2,000.00 "," 2,740.66 "," 2,800.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 2,000.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31540,"LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,667.30 "," 2,000.00 "," 2,740.66 "," 2,800.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 2,000.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31541,"LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE91519",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,667.30 "," 2,200.00 "," 2,740.66 "," 3,300.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 2,200.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31545,"LARYNGOSCOPY, DIRECT, OPERATIVE, WITH OPERATING MICROSCOPE OR TELESCOPE, WITH SUBMUCOSAL REMOVAL OF NON-NEOPLASTIC LESION(S) OF VOCAL CORD; RECONSTRUCTION WITH LOCAL TISSUE FLAP(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,667.30 "," 2,200.00 "," 2,740.66 "," 3,300.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 2,200.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31571,"LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE OR TELESCOPE91526",OR LEVEL 1,," 12,325.60 ", 146.65 ," 6,667.30 "," 1,500.00 "," 2,740.66 "," 2,400.00 "," 4,840.65 "," 4,317.34 "," 3,166.05 "," 1,500.00 "," 4,840.65 ",,,,,,,,,,,,,,, 31575,"LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC",OR LEVEL 2,," 14,341.60 ", 171.67 , 357.50 ," 1,500.00 ", 163.97 ,, 124.99 , 112.72 , 86.65 , 86.65 ," 1,500.00 ",,,,,,,,,,,,,,, 31577,ED LARYNGOSCOPY FLEXIBLE FIBEROPTIC; WITH REMOVAL OF FOREIGN BODY,Emergency department," 3,166.75 ",,, 754.28 ," 1,500.00 ", 386.50 ," 2,400.00 ", 694.62 , 619.53 , 454.32 , 386.50 ," 2,400.00 ",,,,,,,,,,,,,,, 31600,ED TRACHEOSTOMY PLANNED (SEPARATE PROCEDURE);,Emergency department," 4,347.38 ",,," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 31622,"BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; DIAGNOSTIC, WITH OR WITHOUT CELL WASHING (SEPARATE PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,197.12 "," 1,500.00 "," 1,369.29 "," 1,800.00 "," 2,448.85 "," 2,184.11 "," 1,601.68 "," 1,369.29 "," 2,448.85 ",,,,,,,,,,,,,,, 32550,ED INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF,Emergency department," 10,357.13 ",,," 7,083.86 "," 1,500.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 1,500.00 "," 5,385.65 ",,,,,,,,,,,,,,, 32551,ED TUBE THORACOSTOMY INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG WATER SEAL) WHEN PERFORMED OPEN (SEPARATE PROCEDURE),Emergency department," 2,214.00 ",,," 2,975.70 "," 1,500.00 "," 1,093.63 "," 1,800.00 "," 1,818.49 "," 1,621.90 "," 1,189.39 "," 1,093.63 "," 1,818.49 ",,,,,,,,,,,,,,, 32555,ASPIRATE PLEURA W/ IMAGING,OR LEVEL 1,," 12,325.60 ",143.65," 1,157.00 "," 1,200.00 ", 620.01 ," 1,800.00 "," 1,133.25 "," 1,010.74 ", 741.21 , 620.01 ," 1,800.00 ",,,,,,,,,,,,,,, 32556,INTRO & REMOVAL PROC ON THE LUNGS&PLEURA,," 3,579.81 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 1,800.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 33415,ED RESECTION OR INCISION OF SUBVALVULAR TISSUE FOR DISCRETE SUBVALVULAR AORTIC STENOSIS,Emergency department," 4,268.04 ",,,,,," 1,900.00 "," 3,899.32 "," 3,477.77 "," 2,550.37 "," 1,900.00 "," 3,899.32 ",,,,,,,,,,,,,,, 34718,ENDOVASCULAR REPAIR THE ILIAC ARTERY 1ST,OR LEVEL 4,," 21,812.00 ",260.12,,,,,,,, - , - ,,,,,,,,,,,,,,, 35206,"REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,957.94 "," 2,200.00 "," 2,641.52 "," 1,900.00 "," 4,611.57 "," 4,113.02 "," 3,016.22 "," 1,900.00 "," 4,611.57 ",,,,,,,,,,,,,,, 36000,"ED INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN",Emergency department, 321.44 ,,,," 2,500.00 ",," 1,900.00 ",,,," 1,900.00 "," 2,500.00 ",,,,,,,,,,,,,,, 36011,ED SELECTIVE CATHETER PLACEMENT VENOUS SYSTEM; FIRST ORDER BRANCH (EG RENAL VEIN JUGULAR VEIN),Emergency department, 527.22 ,,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 36145,INTRO NEEDLE FOR DIALYSIS CANNULA FISTUL,, 164.56 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 36415,COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE,36415, 132.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 36416,"COLLECTION OF CAPILLARY BLOOD SPECIMEN (EG, FINGER, HEEL, EAR STICK)",36416, 132.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 36430,"TRANSFUSION, BLOOD OR BLOOD COMPONENTS",36430, 685.24 ,,, 815.50 ," 1,200.00 ", 382.90 ," 1,800.00 ", 57.51 , 51.86 , 39.87 , 39.87 ," 1,800.00 ",,,,,,,,,,,,,,, 36468,NJX SCLRSNT SPIDER VEINS,," 2,651.17 ",,, 746.14 ," 1,200.00 ", 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 ," 1,200.00 ",,,,,,,,,,,,,,, 36470,INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN,36470, 698.31 ,,, 746.14 ," 1,200.00 ", 314.08 ,, 123.81 , 111.66 , 85.83 , 85.83 ," 1,200.00 ",,,,,,,,,,,,,,, 36471,"INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG",36471," 1,037.30 ",,, 746.14 ," 1,200.00 ", 314.08 ,, 213.01 , 192.10 , 147.67 , 147.67 ," 1,200.00 ",,,,,,,,,,,,,,, 36475,"ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED",36475," 18,140.33 ",,," 5,957.94 "," 2,000.00 "," 2,641.52 "," 3,600.00 "," 4,611.57 "," 4,113.02 "," 3,016.22 "," 2,000.00 "," 4,611.57 ",,,,,,,,,,,,,,, 36476,"ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; SECOND AND SUBSEQUENT VEINS TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ",36476," 5,354.13 ",,,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 36556,ED INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR OLDER,Emergency department," 3,014.13 ",,," 5,957.94 "," 1,200.00 "," 1,093.63 "," 1,800.00 "," 1,818.49 "," 1,621.90 "," 1,189.39 "," 1,093.63 "," 1,818.49 ",,,,,,,,,,,,,,, 36558,"INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,957.94 "," 1,500.00 "," 2,641.52 "," 2,400.00 "," 4,611.57 "," 4,113.02 "," 3,016.22 "," 1,500.00 "," 4,611.57 ",,,,,,,,,,,,,,, 36561,"INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,957.94 "," 2,000.00 "," 2,641.52 "," 2,800.00 "," 4,611.57 "," 4,113.02 "," 3,016.22 "," 2,000.00 "," 4,611.57 ",,,,,,,,,,,,,,, 36563,INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH SUBCUTANEOUS PUMP,OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,279.52 "," 2,000.00 "," 4,376.52 "," 2,800.00 "," 7,890.18 "," 7,037.18 "," 5,160.60 "," 2,000.00 "," 7,890.18 ",,,,,,,,,,,,,,, 36569,ED INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC) WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER,Emergency department," 3,169.88 ",,," 2,975.70 "," 1,200.00 "," 1,093.63 "," 1,800.00 "," 1,818.49 "," 1,621.90 "," 1,189.39 "," 1,093.63 "," 1,818.49 ",,,,,,,,,,,,,,, 36569,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER",36569," 3,169.88 ",,," 2,975.70 "," 1,200.00 "," 1,093.63 "," 1,800.00 "," 1,818.49 "," 1,621.90 "," 1,189.39 "," 1,093.63 "," 1,818.49 ",,,,,,,,,,,,,,, 36571,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,957.94 ",,,,,,, - , - ,,,,,,,,,,,,,,, 36573,INSERTION OFF PICC WO PORT OR PUMP OLDER THEN 5 YEARS,36573," 5,657.48 ",,," 2,975.70 "," 1,200.00 "," 1,093.63 "," 2,779.00 ",,,," 1,093.63 "," 2,779.00 ",,,,,,,,,,,,,,, 36573,"INSERTION OF PICC W/O SUBCUTANEOUS PORT OR PUMP, INCLUDING IMAGING GUIDANCE AND DOCUMENTATION & ALL ASSOCIATED RADIOLOGIC SUPERVISION AND INTERPRETATION TO PERFORM INSERTION, AGE 5 AND OLDER",Emergency department," 3,262.26 ",,," 2,975.70 "," 1,200.00 "," 1,093.63 "," 2,779.00 ",,,," 1,093.63 "," 2,779.00 ",,,,,,,,,,,,,,, 36576,"REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,975.70 "," 1,500.00 "," 1,093.63 "," 2,400.00 "," 1,818.49 "," 1,621.90 "," 1,189.39 "," 1,093.63 "," 2,400.00 ",,,,,,,,,,,,,,, 36589,"REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,157.00 "," 1,200.00 ", 620.01 ," 1,800.00 "," 1,133.25 "," 1,010.74 ", 741.21 , 620.01 ," 1,800.00 ",,,,,,,,,,,,,,, 36590,"REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 2,975.70 "," 1,200.00 ", 620.01 ," 1,800.00 "," 1,133.25 "," 1,010.74 ", 741.21 , 620.01 ," 1,800.00 ",,,,,,,,,,,,,,, 36591,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE9422794228,36591, 298.00 ,,, 232.22 ,, 106.48 ,, 105.04 , 105.04 , 105.04 , 105.04 , 106.48 ,,,,,,,,,,,,,,, 36598,"CONTRAST INJECTION(S) FOR RADIOLOGIC EVALUATION OF EXISTING CENTRAL VENOUS ACCESS DEVICE, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT",OR LEVEL 1,," 12,325.60 ", 146.65 , 413.14 ," 1,500.00 ", 187.18 ," 1,800.00 ", 139.07 , 125.42 , 96.41 , 96.41 ," 1,800.00 ",,,,,,,,,,,,,,, 36600,"ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS",36600, 552.97 ,,, 232.22 ," 2,500.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 2,500.00 ",,,,,,,,,,,,,,, 37191,INSERTION OF INTRAVASCULAR VENA CAVA FILTER ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS VESSEL SELECTION AND RADIOLOGICAL SUPERVISION AND INTERPRETATION INTRAPROCEDURAL ROADMAPPING AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY) WHEN PERFORMED,OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,279.52 "," 2,000.00 "," 4,376.52 "," 1,900.00 "," 7,890.18 "," 7,037.18 "," 5,160.60 "," 1,900.00 "," 7,890.18 ",,,,,,,,,,,,,,, 37195,ED THROMBOLYSIS CEREBRAL BY INTRAVENOUS INFUSION,Emergency department," 1,522.72 ",,, 665.24 ,, 288.38 ," 1,800.00 ", 550.50 , 490.99 , 360.06 , 288.38 ," 1,800.00 ",,,,,,,,,,,,,,, 37609,"LIGATION OR BIOPSY, TEMPORAL ARTERY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,500.00 "," 1,375.50 "," 2,400.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,375.50 "," 2,493.86 ",,,,,,,,,,,,,,, 37785,ED LIGATION DIVISION AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S) 1 LEG,Emergency department," 4,721.20 ",,," 5,957.94 "," 2,000.00 "," 2,641.52 "," 2,800.00 "," 4,611.57 "," 4,113.02 "," 3,016.22 "," 2,000.00 "," 4,611.57 ",,,,,,,,,,,,,,, 38120,"LAPAROSCOPY, SURGICAL, SPLENECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 3,031.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 38220,BONE MARROW; ASPIRATION ONLY,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 ", 203.03 , 183.10 , 140.75 , 140.75 ," 1,800.00 ",,,,,,,,,,,,,,, 38221,"BONE MARROW; BIOPSY, NEEDLE OR TROCAR",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 ", 175.45 , 158.23 , 121.63 , 121.63 ," 1,800.00 ",,,,,,,,,,,,,,, 38232,BONE MARROW HARVESTING FOR TRANSPLANTATION; AUTOLOGOUS,OR LEVEL 2,," 14,341.60 ", 171.67 ," 8,320.00 "," 2,000.00 "," 3,922.50 "," 3,600.00 "," 6,845.20 "," 6,105.18 "," 4,477.13 "," 2,000.00 "," 6,845.20 ",,,,,,,,,,,,,,, 38300,ED DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE,Emergency department," 3,662.25 ",,," 5,166.50 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 38500,"BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 1,500.00 "," 2,816.01 "," 2,400.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,500.00 "," 5,046.50 ",,,,,,,,,,,,,,, 38505,"BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 38510,"BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 1,500.00 "," 2,816.01 "," 2,400.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,500.00 "," 5,046.50 ",,,,,,,,,,,,,,, 38525,PSU BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN DEEP AXILLARY NODE(S),Post Surgery Unit," 20,996.37 ",,," 6,875.60 "," 1,500.00 "," 2,816.01 "," 2,400.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,500.00 "," 5,046.50 ",,,,,,,,,,,,,,, 38525,"BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 1,500.00 "," 2,816.01 "," 2,400.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,500.00 "," 5,046.50 ",,,,,,,,,,,,,,, 38530,"BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INTERNAL MAMMARY NODE(S)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,875.60 "," 1,500.00 "," 2,816.01 "," 2,400.00 "," 5,046.50 "," 4,500.94 "," 3,300.69 "," 1,500.00 "," 5,046.50 ",,,,,,,,,,,,,,, 38531,OPEN INGUINOFEMORAL NODES 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,875.60 "," 1,500.00 "," 2,816.01 "," 1,900.00 ",,,," 1,500.00 "," 2,816.01 ",,,,,,,,,,,,,,, 38542,"DISSECTION, DEEP JUGULAR NODE(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 1,500.00 "," 4,595.85 "," 2,400.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 1,500.00 "," 8,304.06 ",,,,,,,,,,,,,,, 38720,CERVICAL LYMPHADENECTOMY (COMPLETE),OR LEVEL 3,," 17,605.00 ", 219.52 ," 17,611.48 "," 2,200.00 "," 7,448.83 "," 1,900.00 "," 13,667.30 "," 12,189.75 "," 8,939.15 "," 1,900.00 "," 13,667.30 ",,,,,,,,,,,,,,, 38724,CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 2,200.00 ",,," 2,747.38 "," 2,450.37 "," 1,796.93 "," 1,796.93 "," 2,747.38 ",,,,,,,,,,,,,,, 38760,REMOVE GROIN LYMPH NODES 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 11,886.30 "," 1,500.00 "," 4,915.21 "," 2,400.00 "," 8,901.98 "," 7,939.60 "," 5,822.37 "," 1,500.00 "," 8,901.98 ",,,,,,,,,,,,,,, 38790,INJECTION PROCEDURE; LYMPHANGIOGRAPHY,OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",," 1,900.00 ",,,," 1,200.00 "," 1,900.00 ",,,,,,,,,,,,,,, 38792,INJECTION PROCEDURE; FOR IDENTIFICATION OF SENTINEL NODE,OR LEVEL 2,," 14,341.60 ", 171.67 , 777.36 ," 1,200.00 ", 353.49 ," 1,800.00 ", 646.46 , 576.58 , 422.82 , 353.49 ," 1,800.00 ",,,,,,,,,,,,,,, 38900,INTRAOPERATIVE IDENTIFICATION (EG MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTION OF NON-RADIOACTIVE DYE WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 40650,ED REPAIR LIP FULL THICKNESS; VERMILION ONLY,Emergency department," 5,802.00 ",,, 913.64 ," 2,000.00 ", 487.13 ," 2,800.00 ", 850.76 , 758.79 , 556.44 , 487.13 ," 2,800.00 ",,,,,,,,,,,,,,, 40650,"REPAIR LIP, FULL THICKNESS; VERMILION ONLY",OR LEVEL 1,," 12,325.60 ", 146.65 , 913.64 ," 2,000.00 ", 487.13 ," 2,800.00 ", 850.76 , 758.79 , 556.44 , 487.13 ," 2,800.00 ",,,,,,,,,,,,,,, 40800,ED DRAINAGE OF MOUTH LESION,Emergency department," 2,810.13 ",,," 1,297.94 ",, 579.34 ,, 275.21 , 248.19 , 190.79 , 190.79 , 579.34 ,,,,,,,,,,,,,,, 40804,ED REMOVAL OF EMBEDDED FOREIGN BODY VESTIBULE OF MOUTH; SIMPLE,Emergency department," 2,879.25 ",,," 1,651.02 ",, 761.55 ,," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,375.46 ",,,,,,,,,,,,,,, 40805,ED REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES,Emergency department," 3,275.00 ",,, 913.64 ," 1,500.00 ", 487.13 ," 2,400.00 ", 347.39 , 313.29 , 240.83 , 240.83 ," 2,400.00 ",,,,,,,,,,,,,,, 40808,"BIOPSY, VESTIBULE OF MOUTH",OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ," 1,200.00 ", 487.13 ,, 245.28 , 221.21 , 170.04 , 170.04 ," 1,200.00 ",,,,,,,,,,,,,,, 40810,"EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITHOUT REPAIR",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,200.00 "," 2,231.27 "," 1,900.00 ", 255.84 , 230.73 , 177.36 , 177.36 ," 2,231.27 ",,,,,,,,,,,,,,, 40812,"EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE REPAIR",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 "," 1,200.00 "," 2,231.27 "," 1,900.00 ", 325.67 , 293.71 , 225.77 , 225.77 ," 2,231.27 ",,,,,,,,,,,,,,, 41100,BIOPSY OF TONGUE; ANTERIOR TWO-THIRDS,OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ," 1,200.00 ", 487.13 ," 1,800.00 ", 187.78 , 169.34 , 130.18 , 130.18 ," 1,800.00 ",,,,,,,,,,,,,,, 41112,EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 41113,EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 41114,EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 41115,EXCISION OF LINGUAL FRENUM (FRENECTOMY),OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 "," 1,200.00 "," 1,279.10 "," 1,800.00 ", 292.23 , 263.54 , 202.59 , 202.59 ," 1,800.00 ",,,,,,,,,,,,,,, 41250,ED REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONGUE,Emergency department," 3,561.50 ",,, 755.14 ," 1,500.00 ", 106.48 ," 2,400.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 2,400.00 ",,,,,,,,,,,,,,, 41251,ED REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OF TONGUE,Emergency department," 3,904.50 ",,, 415.66 ," 1,500.00 ", 206.14 ," 2,400.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 2,400.00 ",,,,,,,,,,,,,,, 41252,ED REPAIR OF LACERATION OF TONGUE FLOOR OF MOUTH OVER 2.6 CM OR COMPLEX,Emergency department," 4,156.25 ",,, 415.66 ," 1,500.00 ", 206.14 ," 2,400.00 ", 850.76 , 758.79 , 556.44 , 206.14 ," 2,400.00 ",,,,,,,,,,,,,,, 41520,RECONSTRUCTION TONGUE FOLD 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 41800,ED DRAINAGE OF ABSCESS CYST HEMATOMA FROM DENTOALVEOLAR STRUCTURES,Emergency department," 3,661.13 ",,, 232.22 ," 1,200.00 ", 106.48 ," 1,800.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 1,800.00 ",,,,,,,,,,,,,,, 41800,"DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES",OR LEVEL 2,," 14,341.60 ", 171.67 , 232.22 ," 1,200.00 ", 106.48 ," 1,800.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 1,800.00 ",,,,,,,,,,,,,,, 41805,REMOVAL FOREIGN BODY GUM,," 2,077.10 ",,," 2,776.28 "," 1,200.00 "," 1,279.10 "," 1,800.00 ", 383.18 , 345.57 , 265.64 , 265.64 ," 1,800.00 ",,,,,,,,,,,,,,, 41826,"EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,200.00 "," 2,231.27 "," 1,900.00 ", 370.86 , 334.45 , 257.10 , 257.10 ," 2,231.27 ",,,,,,,,,,,,,,, 41899,"UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES",OR LEVEL 1,," 12,325.60 ", 146.65 , 415.66 ," 1,200.00 ", 206.14 ," 1,900.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,900.00 ",,,,,,,,,,,,,,, 42100,"BIOPSY OF PALATE, UVULA",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,776.28 "," 1,200.00 "," 1,279.10 "," 1,800.00 ", 159.61 , 143.94 , 110.65 , 110.65 ," 1,800.00 ",,,,,,,,,,,,,,, 42104,"EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 ", 247.04 , 222.79 , 171.26 , 171.26 ," 2,400.00 ",,,,,,,,,,,,,,, 42107,"EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,679.34 "," 1,500.00 "," 4,424.23 "," 2,400.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 1,500.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42145,"PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,031.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42180,"REPAIR, LACERATION OF PALATE; UP TO 2 CM",OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ," 1,200.00 ", 487.13 ," 1,800.00 ", 850.76 , 758.79 , 556.44 , 487.13 ," 1,800.00 ",,,,,,,,,,,,,,, 42410,"EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITHOUT NERVE DISSECTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,000.00 "," 4,424.23 "," 2,800.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,000.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42415,"EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND PRESERVATION OF FACIAL NERVE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42420,"EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH DISSECTION AND PRESERVATION OF FACIAL NERVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42440,EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND,OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,000.00 "," 4,424.23 "," 2,800.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,000.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42700,ED INCISION AND DRAINAGE ABSCESS; PERITONSILLAR,Emergency department," 2,515.75 ",,, 415.66 ," 1,200.00 ", 206.14 ," 1,800.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,800.00 ",,,,,,,,,,,,,,, 42700,INCISION AND DRAINAGE ABSCESS; PERITONSILLAR,OR LEVEL 2,," 14,341.60 ", 171.67 , 415.66 ," 1,200.00 ", 206.14 ," 1,800.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,800.00 ",,,,,,,,,,,,,,, 42720,"INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, INTRAORAL APPROACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,200.00 "," 2,231.27 "," 1,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42800,BIOPSY; OROPHARYNX,OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,776.28 "," 1,200.00 "," 2,231.27 "," 1,900.00 ", 166.65 , 150.29 , 115.53 , 115.53 ," 2,231.27 ",,,,,,,,,,,,,,, 42804,"BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,200.00 "," 2,231.27 "," 1,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42808,"EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42809,ED REMOVAL OF FOREIGN BODY FROM PHARYNX,Emergency department," 2,263.50 ",,, 755.14 ," 1,200.00 ", 348.16 ," 1,800.00 ", 610.52 , 544.52 , 399.31 , 348.16 ," 1,800.00 ",,,,,,,,,,,,,,, 42810,"EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS TISSUES",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 2,000.00 "," 2,231.27 "," 2,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,000.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42820,TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12,OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,000.00 "," 4,424.23 "," 2,800.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,000.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42821,TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,031.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42825,"TONSILLECTOMY, PRIMARY OR SECONDARY; YOUNGER THAN AGE 12",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,300.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42826,"TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42830,"ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42831,"ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42836,"ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 2,200.00 "," 2,231.27 "," 3,300.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42842,"RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; WITHOUT CLOSURE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 10,679.34 ",," 4,424.23 "," 1,900.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 1,900.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42870,"EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,000.00 "," 4,424.23 "," 2,800.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,000.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42890,LIMITED PHARYNGECTOMY,OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42950,RECONSTRUCTION OF THROAT 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 10,679.34 "," 1,500.00 "," 4,424.23 "," 2,400.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 1,500.00 "," 8,026.76 ",,,,,,,,,,,,,,, 42960,"CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); SIMPLE",OR LEVEL 2,," 14,341.60 ", 171.67 , 913.64 ," 1,200.00 ", 487.13 ," 1,800.00 ", 850.76 , 758.79 , 556.44 , 487.13 ," 1,800.00 ",,,,,,,,,,,,,,, 42962,"CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); WITH SECONDARY SURGICAL INTERVENTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 42971,"CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOMY); COMPLICATED, REQUIRING HOSPITALIZATION",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 ", 863.78 , 770.40 , 564.96 , 564.96 ," 1,900.00 ",,,,,,,,,,,,,,, 42999,"UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS",OR LEVEL 3,," 17,605.00 ", 219.52 , 415.66 ," 1,200.00 ", 206.14 ," 1,900.00 ", 330.23 , 294.53 , 215.99 , 206.14 ," 1,900.00 ",,,,,,,,,,,,,,, 43122,"PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL OR ABDOMINAL APPROACH, WITH OR WITHOUT PROXIMAL GASTRECTOMY; WITH ESOPHAGOGASTROSTOMY, WITH OR WITHOUT PYLOROPLASTY",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 4,915.82 "," 4,384.38 "," 3,215.21 "," 1,900.00 "," 4,915.82 ",,,,,,,,,,,,,,, 43130,"DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; CERVICAL APPROACH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 1,900.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 1,900.00 "," 8,026.76 ",,,,,,,,,,,,,,, 43191,"ESOPHAGOSCOPY, RIGID, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN BY BRUSHING OR WASHING WHEN PERFORMED",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,483.18 "," 1,200.00 "," 1,483.35 "," 2,800.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,200.00 "," 2,800.00 ",,,,,,,,,,,,,,, 43195,ESOPHAGOSCOPY RIGID TRANSORAL; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER),OR LEVEL 1,," 12,325.60 ", 146.65 ," 6,521.38 "," 1,500.00 "," 2,824.69 "," 3,031.00 "," 5,075.36 "," 4,526.68 "," 3,319.56 "," 1,500.00 "," 5,075.36 ",,,,,,,,,,,,,,, 43200,"ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,651.02 "," 1,200.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 43202,"ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,483.18 "," 1,200.00 "," 1,483.35 "," 1,800.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,200.00 "," 2,640.67 ",,,,,,,,,,,,,,, 43210,"ESOPHAGOGASTRODUODENOSCOPY FUNDOPLASTY, TRANSORAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,000.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,000.00 "," 14,051.53 ",,,,,,,,,,,,,,, 43214,ESOPHAGOSCOPY FLEXIBLE TRANSORAL; WITH DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) (INCLUDES FLUOROSCOPIC GUIDANCE WHEN PERFORMED),43214," 6,501.64 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 3,031.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 3,031.00 ",,,,,,,,,,,,,,, 43233,ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL; WITH DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) (INCLUDES FLUOROSCOPIC GUIDANCE WHEN PERFORMED),43233," 6,167.01 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 3,031.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 3,031.00 ",,,,,,,,,,,,,,, 43235,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",43235," 3,393.33 ",,," 1,651.02 "," 1,200.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 43238,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), ESOPHAGUS (INCLUDES ENDOSCOPIC ULTRASO",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,483.18 "," 1,500.00 "," 1,483.35 "," 2,400.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 43239,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE",43239," 4,576.25 ",,," 1,651.02 "," 1,500.00 ", 761.55 ," 2,400.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 2,400.00 ",,,,,,,,,,,,,,, 43244,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC VARICES",43244," 6,895.75 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 2,400.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 43247,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY",43247," 4,487.33 ",,," 1,651.02 "," 1,500.00 ", 761.55 ," 2,400.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 2,400.00 ",,,,,,,,,,,,,,, 43248,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OF ESOPHAGUS OVER GUIDE WIRE",43248," 7,645.50 ",,," 1,651.02 "," 1,500.00 ", 761.55 ," 2,400.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 2,400.00 ",,,,,,,,,,,,,,, 43249,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)",43249," 5,949.00 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 2,400.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 43250,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY",43250," 5,949.00 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 2,400.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 43251,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE",43251," 5,063.14 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 2,400.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 43255,"UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH CONTROL OF BLEEDING, ANY METHOD",43255," 5,949.00 ",,," 3,483.18 "," 1,500.00 "," 1,483.35 "," 2,400.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 43260,"ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",43260," 6,061.56 ",,," 6,521.38 "," 1,500.00 "," 2,824.69 "," 2,400.00 "," 5,075.36 "," 4,526.68 "," 3,319.56 "," 1,500.00 "," 5,075.36 ",,,,,,,,,,,,,,, 43262,ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,521.38 "," 1,500.00 "," 2,824.69 "," 2,400.00 "," 5,075.36 "," 4,526.68 "," 3,319.56 "," 1,500.00 "," 5,075.36 ",,,,,,,,,,,,,,, 43274,"ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; W/PLACEMENT OF ENDOSCOPIC STENT INTO BILIARY OR PANCREATIC DUCT, INCLUDING PRE AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED EACH STENT",OR LEVEL 1,," 12,325.60 ", 146.65 ," 10,481.44 "," 2,000.00 "," 4,496.07 "," 3,600.00 "," 7,943.20 "," 7,084.47 "," 5,195.28 "," 2,000.00 "," 7,943.20 ",,,,,,,,,,,,,,, 43275,ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF FOREIGN BODY(S) OR STENT(S) FROM BILIARY/PANCREATIC DUCT(S),OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,521.38 "," 2,000.00 "," 2,824.69 "," 3,600.00 "," 5,075.36 "," 4,526.68 "," 3,319.56 "," 2,000.00 "," 5,075.36 ",,,,,,,,,,,,,,, 43277,ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH TRANS-ENDOSCOPIC BALLOON DILATION OF BILIARY/PANCREATIC DUCT(S) OR OF AMPULLA (SPHINCTEROPLASTY) INCLUDING SPHINCTEROTOMY WHEN PERFORMED EACH DUCT,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,521.38 "," 2,000.00 "," 2,824.69 "," 3,600.00 "," 5,075.36 "," 4,526.68 "," 3,319.56 "," 2,000.00 "," 5,075.36 ",,,,,,,,,,,,,,, 43279,LAP MYOTOMY HELLER 1ST,OR LEVEL 3,," 17,605.00 ",219.62,,,," 1,900.00 "," 2,479.15 "," 2,211.13 "," 1,621.50 "," 1,621.50 "," 2,479.15 ",,,,,,,,,,,,,,, 43280,"LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 3,031.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 43281,"LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 1,900.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 1,900.00 "," 14,051.53 ",,,,,,,,,,,,,,, 43282,LAPAROSCOPY SURGICAL REPAIR OF PARAESOPHAGEAL HERNIA INCLUDES FUNDOPLASTY WHEN PERFORMED; WITH IMPLANTATION OF MESH,OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 1,900.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 1,900.00 "," 14,051.53 ",,,,,,,,,,,,,,, 43420,CLOSURE OF ESOPHAGOSTOMY OR FISTULA; CERVICAL APPROACH,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 1,900.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 43450,"DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,651.02 "," 1,200.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 43499,"UNLISTED PROCEDURE, ESOPHAGUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,651.02 "," 1,200.00 ", 761.55 ," 1,900.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,900.00 ",,,,,,,,,,,,,,, 43621,REMOVAL OF STOMACH 1ST,OR LEVEL 4,," 21,812.00 ",260.12,,,," 1,900.00 "," 4,365.41 "," 3,893.47 "," 2,855.21 "," 1,900.00 "," 4,365.41 ",,,,,,,,,,,,,,, 43632,REMOVAL OF STOMACH PARTIAL 1ST,OR LEVEL 4,," 21,812.00 ",260.12,,,," 1,900.00 "," 3,909.29 "," 3,486.66 "," 2,556.89 "," 1,900.00 "," 3,909.29 ",,,,,,,,,,,,,,, 43633,REMOVAL OF STOMACH PARTIAL 1ST,OR LEVEL 4,," 21,812.00 ",260.12,,,," 1,900.00 "," 3,695.50 "," 3,295.99 "," 2,417.06 "," 1,900.00 "," 3,695.50 ",,,,,,,,,,,,,,, 43644,"LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASS AND ROUX-EN-Y GASTROENTEROSTOMY (ROUX LIMB 150 CM OR LESS)",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 3,329.67 "," 2,969.70 "," 2,177.78 "," 1,900.00 "," 3,329.67 ",,,,,,,,,,,,,,, 43659,"UNLISTED LAPAROSCOPY PROCEDURE, STOMACH",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 "," 2,000.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 43752,NGT PLACEMENT,IP43752, 808.75 ,,, 755.14 ," 1,500.00 ", 348.16 ,, 610.52 , 544.52 , 399.31 , 348.16 ," 1,500.00 ",,,,,,,,,,,,,,, 43752,ED NASO- OR ORO-GASTRIC TUBE PLACEMENT REQUIRING PHYSICIAN'S SKILL AND FLUOROSCOPIC GUIDANCE (INCLUDES FLUOROSCOPY IMAGE DOCUMENTATION AND REPORT),Emergency department, 743.70 ,,, 755.14 ," 1,500.00 ", 348.16 ,, 610.52 , 544.52 , 399.31 , 348.16 ," 1,500.00 ",,,,,,,,,,,,,,, 43753,ED GASTRIC INTUBATION AND ASPIRATION(S) THERAPEUTIC NECESSITATING PHYSICIAN'S SKILL (EG FOR GASTROINTESTINAL HEMORRHAGE) INCLUDING LAVAGE IF PERFORMED,Emergency department, 464.62 ,,, 560.12 ," 1,200.00 ", 252.31 ," 1,800.00 ", 460.34 , 410.57 , 301.08 , 252.31 ," 1,800.00 ",,,,,,,,,,,,,,, 43760,ED CHANGE OF GASTROSTOMY TUBE PERCUTANEOUS WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE,Emergency department," 6,658.50 ",,,," 2,500.00 ",," 1,900.00 ", 424.63 , 378.72 , 277.73 , 277.73 ," 2,500.00 ",,,,,,,,,,,,,,, 43760,"CHANGE OF GASTROSTOMY TUBE, PERCUTANEOUS, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE92766",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 2,500.00 ",," 1,900.00 ", 424.63 , 378.72 , 277.73 , 277.73 ," 2,500.00 ",,,,,,,,,,,,,,, 43761,ED REPOSITIONING OF A NASO- OR ORO-GASTRIC FEEDING TUBE THROUGH THE DUODENUM FOR ENTERIC NUTRITION,Emergency department," 1,459.63 ",,, 429.74 ," 1,200.00 ", 231.42 ," 1,800.00 ", 424.63 , 378.72 , 277.73 , 231.42 ," 1,800.00 ",,,,,,,,,,,,,,, 43770,"LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; PLACEMENT OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE (EG, GASTRIC BAND AND SUBCUTANEOUS PORT COMPONENTS)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 18,174.60 "," 2,000.00 "," 7,741.63 "," 1,900.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 1,900.00 "," 14,051.53 ",,,,,,,,,,,,,,, 43771,"LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REVISION OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE COMPONENT ONLY",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,000.00 ",," 1,900.00 "," 2,452.60 "," 2,187.45 "," 1,604.13 "," 1,604.13 "," 2,452.60 ",,,,,,,,,,,,,,, 43773,"LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL AND REPLACEMENT OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE COMPONENT ONLY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 "," 2,000.00 "," 4,595.85 "," 1,900.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 1,900.00 "," 8,304.06 ",,,,,,,,,,,,,,, 43774,"LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE AND SUBCUTANEOUS PORT COMPONENTS",OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,521.38 "," 2,000.00 "," 2,824.69 "," 1,900.00 "," 5,075.36 "," 4,526.68 "," 3,319.56 "," 1,900.00 "," 5,075.36 ",,,,,,,,,,,,,,, 43775,"LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY)",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,," 1,900.00 "," 6,750.00 "," 6,075.00 "," 5,005.00 "," 1,900.00 "," 6,750.00 ",,,,,,,,,,,,,,, 43843,GASTROPLASTY W/O V-BAND 1ST,OR LEVEL 3,," 17,605.00 ",219.62,,,,," 2,464.55 "," 2,198.11 "," 1,611.95 "," 1,611.95 "," 2,464.55 ",,,,,,,,,,,,,,, 43999,"UNLISTED PROCEDURE, STOMACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,651.02 "," 1,200.00 ", 761.55 ,," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,375.46 ",,,,,,,,,,,,,,, 44005,ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,450.00 ",,," 2,106.69 "," 1,878.94 "," 1,377.89 "," 1,377.89 "," 2,450.00 ",,,,,,,,,,,,,,, 44050,"REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,450.00 ",,," 1,795.96 "," 1,601.80 "," 1,174.66 "," 1,174.66 "," 2,450.00 ",,,,,,,,,,,,,,, 44120,"ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,354.99 "," 2,100.40 "," 1,540.29 "," 1,540.29 "," 2,354.99 ",,,,,,,,,,,,,,, 44139,MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 ", 234.38 , 209.04 , 153.29 , 153.29 ," 1,900.00 ",,,,,,,,,,,,,,, 44140,"COLECTOMY, PARTIAL; WITH ANASTOMOSIS",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,580.73 "," 2,301.73 "," 1,687.94 "," 1,687.94 "," 2,580.73 ",,,,,,,,,,,,,,, 44143,"COLECTOMY, PARTIAL; WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (HARTMANN TYPE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 3,203.52 "," 2,857.19 "," 2,095.27 "," 2,095.27 "," 3,203.52 ",,,,,,,,,,,,,,, 44146,"COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS), WITH COLOSTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 4,079.25 "," 3,638.25 "," 2,668.05 "," 1,900.00 "," 4,079.25 ",,,,,,,,,,,,,,, 44160,"COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,388.87 "," 2,130.61 "," 1,562.45 "," 1,562.45 "," 2,388.87 ",,,,,,,,,,,,,,, 44180,"LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,000.00 "," 4,595.85 "," 3,031.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 44204,"LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 2,960.52 "," 2,640.46 "," 1,936.34 "," 1,900.00 "," 2,960.52 ",,,,,,,,,,,,,,, 44205,"LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,574.09 "," 2,295.81 "," 1,683.59 "," 1,683.59 "," 2,574.09 ",,,,,,,,,,,,,,, 44207,"LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS)",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 3,502.96 "," 3,124.26 "," 2,291.12 "," 1,900.00 "," 3,502.96 ",,,,,,,,,,,,,,, 44213,"LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,000.00 ",,, 363.17 , 323.91 , 237.54 , 237.54 ," 2,000.00 ",,,,,,,,,,,,,,, 44238,"UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 ",," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 4,595.85 "," 8,304.06 ",,,,,,,,,,,,,,, 44300,"PLACEMENT, ENTEROSTOMY OR CECOSTOMY, TUBE OPEN (EG, FOR FEEDING OR DECOMPRESSION) (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 1,620.01 "," 1,444.87 "," 1,059.57 "," 1,059.57 "," 1,620.01 ",,,,,,,,,,,,,,, 44322,"COLOSTOMY OR SKIN LEVEL CECOSTOMY; WITH MULTIPLE BIOPSIES (EG, FOR CONGENITAL MEGACOLON) (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 1,924.76 "," 1,716.68 "," 1,258.90 "," 1,258.90 "," 1,924.76 ",,,,,,,,,,,,,,, 44340,REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,506.08 "," 2,000.00 "," 2,766.13 "," 2,800.00 "," 5,014.39 "," 4,472.29 "," 3,279.68 "," 2,000.00 "," 5,014.39 ",,,,,,,,,,,,,,, 44388,"COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",44388," 5,496.91 ",,," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 44389,COLONOSCOPY STOMA W/BIOP SNG/MLT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 2,165.82 "," 1,200.00 ", 979.79 ," 1,800.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 1,800.00 ",,,,,,,,,,,,,,, 44604,"SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY OR RUPTURE (SINGLE OR MULTIPLE PERFORATIONS); WITHOUT COLOSTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 2,036.31 "," 1,816.17 "," 1,331.86 "," 1,331.86 "," 2,036.31 ",,,,,,,,,,,,,,, 44620,"CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE;",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 "," 1,669.14 "," 1,488.70 "," 1,091.71 "," 1,091.71 "," 1,900.00 ",,,,,,,,,,,,,,, 44950,APPENDECTOMY;,OR LEVEL 3,," 17,605.00 ", 219.52 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 1,900.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 1,900.00 "," 5,385.65 ",,,,,,,,,,,,,,, 44955,APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (NOT AS SEPARATE PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ,,,," 1,900.00 ",,,," 1,900.00 "," 1,900.00 ",,,,,,,,,,,,,,, 44960,APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS,OR LEVEL 2,," 14,341.60 ", 171.67 ,,,," 1,900.00 "," 1,680.43 "," 1,498.76 "," 1,099.09 "," 1,099.09 "," 1,900.00 ",,,,,,,,,,,,,,, 44970,"LAPAROSCOPY, SURGICAL, APPENDECTOMY",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 "," 2,000.00 "," 4,595.85 "," 3,300.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 45005,"INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,165.82 "," 1,500.00 ", 979.79 ," 2,400.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,400.00 ",,,,,,,,,,,,,,, 45100,"BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,138.94 "," 1,200.00 "," 2,334.58 "," 1,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 45171,"EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSCULARIS PROPRIA (IE, PARTIAL THICKNESS)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,200.00 "," 2,334.58 "," 3,031.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 45172,EXCISION OF RECTAL TUMOR TRANSANAL APPROACH; INCLUDING MUSCULARIS PROPRIA (IE FULL THICKNESS),OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 3,600.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 45300,"PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 ", 155.50 , 140.24 , 107.80 , 107.80 ," 1,800.00 ",,,,,,,,,,,,,,, 45330,"SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",45330," 3,174.25 ",,," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 ", 225.92 , 203.74 , 156.62 , 156.62 ," 1,800.00 ",,,,,,,,,,,,,,, 45331,"SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE",45331," 2,667.88 ",,," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 45332,"SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY",45332," 8,412.97 ",,," 2,165.82 "," 1,200.00 ", 979.79 ," 1,800.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 1,800.00 ",,,,,,,,,,,,,,, 45333,SIGMOIDOSCOPY & POLYPECTOMY 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 45335,"SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 45378,"COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE",45383," 6,122.00 ",,," 1,662.08 "," 1,500.00 ", 744.89 ," 2,400.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 2,400.00 ",,,,,,,,,,,,,,, 45378,"COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WITH OR WITHOUT COLON DECOMPRESSION (SEPARATE PROCEDURE)",45378," 3,174.25 ",,," 1,662.08 "," 1,500.00 ", 744.89 ," 2,400.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 2,400.00 ",,,,,,,,,,,,,,, 45380,"COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE",45380," 6,122.00 ",,," 2,165.82 "," 1,500.00 ", 979.79 ," 2,400.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,400.00 ",,,,,,,,,,,,,,, 45381," COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE",45381," 6,122.00 ",,," 2,165.82 "," 1,500.00 ", 979.79 ," 2,400.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,400.00 ",,,,,,,,,,,,,,, 45382,"COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)",45382," 6,122.00 ",,," 2,165.82 "," 1,500.00 ", 979.79 ," 2,400.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,400.00 ",,,,,,,,,,,,,,, 45384,"COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY",45384," 6,122.00 ",,," 2,165.82 "," 1,500.00 ", 979.79 ," 2,400.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,400.00 ",,,,,,,,,,,,,,, 45385,"COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE",45385," 6,122.00 ",,," 2,165.82 "," 1,500.00 ", 979.79 ," 2,400.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,400.00 ",,,,,,,,,,,,,,, 45390,COLONOSCOPY FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION,45390," 3,464.19 ",,," 5,138.94 "," 1,500.00 ", 979.79 ," 3,300.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 3,300.00 ",,,,,,,,,,,,,,, 45398,COLONOSCOPY FLEXIBLE; WITH BAND LIGATION(S) (EG HEMORRHOIDS),45398," 18,564.00 ",,," 2,165.82 "," 1,500.00 ", 979.79 ," 3,300.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 3,300.00 ",,,,,,,,,,,,,,, 45505,PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 45541,"PROCTOPEXY (EG, FOR PROLAPSE); PERINEAL APPROACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 ",," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 45560,REPAIR OF RECTOCELE (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 45562,"EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY;",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 2,142.54 "," 1,910.91 "," 1,401.34 "," 1,401.34 "," 2,142.54 ",,,,,,,,,,,,,,, 45990,"ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46020,PLACEMENT OF SETON,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46040,INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,165.82 "," 2,000.00 ", 979.79 ," 2,800.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 2,800.00 ",,,,,,,,,,,,,,, 46045,"INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, UNDER ANESTHESIA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46050,ED INCISION AND DRAINAGE PERIANAL ABSCESS SUPERFICIAL,Emergency department," 2,663.25 ",,," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 46050,"INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 46060,ED INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS WITH FISTULECTOMY OR FISTULOTOMY SUBMUSCULAR WITH OR WITHOUT PLACEMENT OF SETON,Emergency department," 6,871.38 ",,," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46060,"INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY OR FISTULOTOMY, SUBMUSCULAR, WITH OR WITHOUT PLACEMENT OF SETON",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46083,ED INCISION OF THROMBOSED HEMORRHOID EXTERNAL,Emergency department," 2,293.13 ",,, 429.74 ," 1,200.00 ", 231.42 ," 1,800.00 ", 194.90 , 175.77 , 135.11 , 135.11 ," 1,800.00 ",,,,,,,,,,,,,,, 46200,"FISSURECTOMY, WITH OR WITHOUT SPHINCTEROTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 2,400.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46220,EXCISE ANAL EXT TAG/PAPILLA 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 2,165.82 "," 1,200.00 ", 979.79 ," 1,800.00 "," 1,732.32 "," 1,545.04 "," 1,133.03 ", 979.79 ," 1,800.00 ",,,,,,,,,,,,,,, 46221,"HEMORRHOIDECTOMY, BY SIMPLE LIGATURE (EG, RUBBER BAND)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 ", 293.40 , 264.60 , 203.40 , 203.40 ," 1,800.00 ",,,,,,,,,,,,,,, 46250,"HEMORRHOIDECTOMY, EXTERNAL, COMPLETE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46255,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE;",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46257,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISSURECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46258,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISTULECTOMY, WITH OR WITHOUT FISSURECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46260,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE;",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46261,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISSURECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,200.00 "," 2,334.58 "," 3,300.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46262,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISTULECTOMY, WITH OR WITHOUT FISSURECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 2,200.00 "," 2,334.58 "," 3,300.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46270,SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46275,SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBMUSCULAR,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,138.94 "," 2,000.00 "," 2,334.58 "," 2,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,000.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46280,"SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); COMPLEX OR MULTIPLE, WITH OR WITHOUT PLACEMENT OF SETON",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,138.94 "," 2,200.00 "," 2,334.58 "," 3,300.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46285,SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,138.94 "," 1,200.00 "," 2,334.58 "," 1,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46320,ED EXCISION OF THROMBOSED HEMORRHOID EXTERNAL,Emergency department," 2,385.50 ",,," 2,165.82 "," 1,200.00 ", 979.79 ," 1,800.00 ", 198.34 , 178.87 , 137.50 , 137.50 ," 1,800.00 ",,,,,,,,,,,,,,, 46320,ENUCLEATION OR EXCISION OF EXTERNAL THROMBOTIC HEMORRHOID,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,165.82 "," 1,200.00 ", 979.79 ," 1,800.00 ", 198.34 , 178.87 , 137.50 , 137.50 ," 1,800.00 ",,,,,,,,,,,,,,, 46600,"ANOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 , 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 46608,ED ANOSCOPY; WITH REMOVAL OF FOREIGN BODY,Emergency department," 3,072.50 ",,," 1,662.08 "," 1,200.00 ", 744.89 ," 1,800.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 1,800.00 ",,,,,,,,,,,,,,, 46900,"DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL",OR LEVEL 2,," 14,341.60 ", 171.67 , 746.14 ," 1,200.00 ", 314.08 ," 1,800.00 ", 263.90 , 237.99 , 182.95 , 182.95 ," 1,800.00 ",,,,,,,,,,,,,,, 46922,"DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,200.00 "," 2,334.58 "," 1,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46924,DESTRUCTION ANAL LESION(S) 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,138.94 "," 1,200.00 "," 2,334.58 "," 1,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,200.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46945,LIGATION OF INTERNAL HEMORRHOIDS; SINGLE PROCEDURE,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 ",, 368.51 , 332.34 , 255.47 , 255.47 ," 2,334.58 ",,,,,,,,,,,,,,, 46946,LIGATION OF INTERNAL HEMORRHOIDS; MULTIPLE PROCEDURES,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,138.94 "," 1,500.00 "," 2,334.58 "," 1,800.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 1,500.00 "," 4,283.92 ",,,,,,,,,,,,,,, 46948,INT HRHC TRANAL DARTLZJ 2+ 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 5,138.94 ",,,,,,, - , - ,,,,,,,,,,,,,,, 47001,"BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 47100,"BIOPSY OF LIVER, WEDGE",OR LEVEL 1,," 12,325.60 ", 146.65 ,,,,," 1,621.34 "," 1,446.06 "," 1,060.44 "," 1,060.44 "," 1,621.34 ",,,,,,,,,,,,,,, 47122,EXTENSIVE REMOVAL OF LIVER 1ST,OR LEVEL 2,," 14,341.60 ",171.67,,,,," 6,575.68 "," 5,864.79 "," 4,300.85 "," 4,300.85 "," 6,575.68 ",,,,,,,,,,,,,,, 47379,"UNLISTED LAPAROSCOPIC PROCEDURE, LIVER",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,424.30 "," 2,200.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 47542,"BALLOON DILATION OF BILIARY DUCTS OR OF AMPULLA, PERCUTANEOUS, INCLUDING IMAGING GUIDANCE",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 47562,"LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 7,603.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 47563,"LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 5,000.00 "," 4,595.85 "," 7,603.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 4,595.85 "," 8,304.06 ",,,,,,,,,,,,,,, 47564,"LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,450.00 "," 4,595.85 "," 7,603.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,450.00 "," 8,304.06 ",,,,,,,,,,,,,,, 47579,"UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,424.30 "," 2,000.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 47600,CHOLECYSTECTOMY;,OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,200.00 ",,," 2,050.91 "," 1,829.19 "," 1,341.41 "," 1,341.41 "," 2,200.00 ",,,,,,,,,,,,,,, 47605,CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 ",,," 2,159.80 "," 1,926.31 "," 1,412.63 "," 1,412.63 "," 2,200.00 ",,,,,,,,,,,,,,, 47612,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY,OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,450.00 ",,," 2,446.63 "," 2,182.13 "," 1,600.23 "," 1,600.23 "," 2,450.00 ",,,,,,,,,,,,,,, 48550,"DONOR PANCREATECTOMY (INCLUDING COLD PRESERVATION), WITH OR WITHOUT DUODENAL SEGMENT FOR TRANSPLANTATION",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,," 2,511.02 "," 2,239.56 "," 1,642.35 "," 1,642.35 "," 2,511.02 ",,,,,,,,,,,,,,, 49000,"EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 ",,," 1,478.59 "," 1,318.75 ", 967.08 , 967.08 ," 2,200.00 ",,,,,,,,,,,,,,, 49010,"EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 2,200.00 ",,," 1,791.32 "," 1,597.66 "," 1,171.62 "," 1,171.62 "," 2,200.00 ",,,,,,,,,,,,,,, 49020,"DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF APPENDICEAL ABSCESS; OPEN",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 3,056.13 "," 2,725.73 "," 1,998.87 "," 1,998.87 "," 3,056.13 ",,,,,,,,,,,,,,, 49060,DRAINAGE OF RETROPERITONEAL ABSCESS; OPEN,OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,112.66 "," 1,884.27 "," 1,381.80 "," 1,381.80 "," 2,112.66 ",,,,,,,,,,,,,,, 49082,ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,651.02 "," 1,500.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 49083,ABDOMINAL PARACENTESIS W/ GUIDANCE,, 260.12 ,,," 1,651.02 "," 1,500.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 49084,PERITONEAL LAVAGE INCLUDING IMAGING GUIDANCE WHEN PERFORMED,OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,651.02 "," 1,500.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 49203,"EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1 OR MORE PERITONEAL, MESENTERIC, OR RETROPERITONEAL PRIMARY OR SECONDARY TUMORS; LARGEST TUMOR 5 CM DIAMETER OR LESS",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 2,301.22 "," 2,052.44 "," 1,505.12 "," 1,505.12 "," 2,301.22 ",,,,,,,,,,,,,,, 49255,"OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 1,520.42 "," 1,356.05 ", 994.44 , 994.44 ," 1,520.42 ",,,,,,,,,,,,,,, 49320,"LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",OR LEVEL 5,," 23,543.80 ", 337.20 ," 10,424.30 "," 2,000.00 "," 4,595.85 "," 2,800.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49321,"LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,300.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49322,"LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,300.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49324,"LAPAROSCOPY, SURGICAL; WITH INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER, PERMANENT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49329,"UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 1,200.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 1,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49422,REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,957.94 "," 1,200.00 "," 2,641.52 "," 1,800.00 "," 4,611.57 "," 4,113.02 "," 3,016.22 "," 1,200.00 "," 4,611.57 ",,,,,,,,,,,,,,, 49435,INSERTION OF SUBCUTANEOUS EXTENSION TO INTRAPERITONEAL CANNULA OR CATHETER WITH REMOTE CHEST EXIT SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 49440,"INSERTION OF GASTROSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,483.18 "," 1,500.00 "," 1,483.35 "," 1,800.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 49441,PLACE DUOD/JEJ TUBE PERC 1ST,OR LEVEL 1,," 12,325.60 ",143.65," 3,483.18 "," 1,500.00 "," 1,483.35 "," 1,800.00 "," 2,640.67 "," 2,355.19 "," 1,727.14 "," 1,483.35 "," 2,640.67 ",,,,,,,,,,,,,,, 49450,"ED REPLACEMENT OF GASTROSTOMY OR CECOSTOMY (OR OTHER COLONIC) TUBE, PERCUTANEOUS, UNDER FLOUROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION (S), IMAGE DOCUMENTATION AND REPORT",Emergency department," 4,048.00 ",,," 1,651.02 "," 1,200.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 49450,"REPLACEMENT OF GASTROSTOMY OR CECOSTOMY (OR OTHER COLONIC) TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,651.02 "," 1,200.00 ", 761.55 ," 1,800.00 "," 1,375.46 "," 1,226.76 ", 899.62 , 761.55 ," 1,800.00 ",,,,,,,,,,,,,,, 49505,"REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,300.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49507,"REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49520,"REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 2,779.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49521,"REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49540,REPAIR LUMBAR HERNIA 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 10,424.30 "," 1,500.00 "," 4,595.85 "," 2,400.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 1,500.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49550,"REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,031.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49557,REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED,OR LEVEL 3,," 17,605.00 ", 219.52 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49560,REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 2,947.32 "," 3,300.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49561,REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED,OR LEVEL 5,," 23,543.80 ", 337.20 ,," 2,200.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49565,REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 4,595.85 "," 3,300.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49566,REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED,OR LEVEL 5,," 23,543.80 ", 337.20 ,," 2,200.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49568,IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL OR VENTRAL HERNIA REPAIR OR MESH FOR CLOSURE OF DEBRIDEMENT FOR NECROTIZING SOFT TISSUE INFECTION (LIST SEPARATELY IN ADDITION TO CODE FOR THE INCISIONAL OR VENTRAL HERNIA REPAIR),OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,450.00 ",,,,,," 2,450.00 "," 2,450.00 ",,,,,,,,,,,,,,, 49572,"REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49585,"REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 2,947.32 "," 3,300.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49587,"REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 2,947.32 "," 3,600.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 49650,"LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,300.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49651,"LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 "," 2,450.00 "," 4,595.85 "," 2,779.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,450.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49652,"LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49653,"LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,200.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 49654,"LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 49655,"LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 49656,LAPAROSCOPY SURGICAL REPAIR RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION WHEN PERFORMED); REDUCIBLE,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 49657,LAPAROSCOPY SURGICAL REPAIR RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION WHEN PERFORMED); INCARCERATED OR STRANGULATED,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 49659,LAPARO PROC HERNIA REPAIR 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 10,424.30 "," 2,200.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 50386,"REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETHRAL APPROACH, WITHOUT USE OF CYSTOSCOPY, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,200.00 "," 1,739.75 "," 1,800.00 ", 973.48 , 877.93 , 674.87 , 674.87 ," 1,800.00 ",,,,,,,,,,,,,,, 50590,"LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE",50590," 16,471.31 ",,," 6,410.24 "," 3,200.00 "," 2,926.86 "," 3,500.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,926.86 "," 6,856.16 ",,,,,,,,,,,,,,, 51530,CYSTOTOMY; FOR EXCISION OF BLADDER TUMOR,OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 1,501.83 "," 1,339.47 ", 982.28 , 982.28 ," 1,501.83 ",,,,,,,,,,,,,,, 51585,"CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS TRANSPLANTATIONS; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 4,063.99 "," 3,624.64 "," 2,658.07 "," 2,658.07 "," 4,063.99 ",,,,,,,,,,,,,,, 51600,INJECTION PROCEDURE FOR CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY,OR LEVEL 1,," 12,325.60 ", 146.65 ,," 2,500.00 ",,,,,," 2,500.00 "," 2,500.00 ",,,,,,,,,,,,,,, 51700,ED BLADDER IRRIGATION SIMPLE LAVAGE AND/OR INSTILLATION,Emergency department," 1,039.75 ",,, 429.74 ," 1,200.00 ", 231.42 ,, 85.09 , 76.73 , 58.99 , 58.99 ," 1,200.00 ",,,,,,,,,,,,,,, 51701,"ED INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR RESIDUAL URINE)",Emergency department, 390.13 ,,, 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 51701,"INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR RESIDUAL URINE)",OR LEVEL 1,," 12,325.60 ", 146.65 , 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 51702,"ED INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)",Emergency department, 894.75 ,,, 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 51702,"INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)",OR LEVEL 3,," 17,605.00 ", 219.52 , 232.22 ," 1,200.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 1,200.00 ",,,,,,,,,,,,,,, 51703,ED INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG ALTERED ANATOMY FRACTURED CATHETER/BALLOON),Emergency department," 1,619.00 ",,, 290.86 ," 1,200.00 ", 135.95 ," 1,800.00 ", 115.75 , 104.38 , 80.24 , 80.24 ," 1,800.00 ",,,,,,,,,,,,,,, 51705,BED SIDE CHANGE OF CYSTOSTOMY TUBE; SIMPLE,51705, 712.30 ,,, 429.74 ," 1,200.00 ", 231.42 ," 1,800.00 ", 95.06 , 85.73 , 65.90 , 65.90 ," 1,800.00 ",,,,,,,,,,,,,,, 51715,ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 51798,ED MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND NON-IMAGING,Emergency department," 1,261.61 ",,, 114.96 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 51798,"MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING",51798," 1,261.61 ",,, 114.96 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 51798,PSU MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND NON-IMAGING,Post Surgery Unit," 1,261.61 ",,, 114.96 ,, 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 , 103.53 ,,,,,,,,,,,,,,, 51840,"ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ, BURCH); SIMPLE",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,450.00 ",,," 1,258.17 "," 1,122.15 ", 822.91 , 822.91 ," 2,450.00 ",,,,,,,,,,,,,,, 51841,"ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ, BURCH); COMPLICATED (EG, SECONDARY REPAIR)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,450.00 ",,," 1,469.97 "," 1,311.06 ", 961.44 , 961.44 ," 2,450.00 ",,,,,,,,,,,,,,, 51999,LAPAROSCOPY PROCEDURE BLADDER 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 10,424.30 "," 2,000.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 52000,CYSTOURETHROSCOPY (SEPARATE PROCEDURE),OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,250.68 "," 1,200.00 ", 562.25 ," 1,800.00 "," 1,046.36 ", 933.24 , 684.38 , 562.25 ," 1,800.00 ",,,,,,,,,,,,,,, 52001,CYSTOURETHROSCOPY WITH IRRIGATION AND EVACUATION OF MULTIPLE OBSTRUCTING CLOTS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52005,"CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52007,"CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BRUSH BIOPSY OF URETER AND/OR RENAL PELVIS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52010,"CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR DUCT RADIOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,250.68 "," 1,500.00 ", 562.25 ," 2,400.00 "," 1,046.36 ", 933.24 , 684.38 , 562.25 ," 2,400.00 ",,,,,,,,,,,,,,, 52204,"CYSTOURETHROSCOPY, WITH BIOPSY(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52214,"CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGONE, BLADDER NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL GLANDS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52224,"CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT OF MINOR (LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52234,"CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; SMALL BLADDER TUMOR(S) (0.5 UP TO 2.0 CM)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52235,"CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52240,"CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; LARGE BLADDER TUMOR(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 2,000.00 "," 4,020.54 "," 2,800.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,000.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52250,"CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT BIOPSY OR FULGURATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,200.00 "," 2,926.86 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52260,"CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION (SPINAL) ANESTHESIA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52265,"CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANESTHESIA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 1,800.00 ", 423.67 , 382.08 , 293.71 , 293.71 ," 1,800.00 ",,,,,,,,,,,,,,, 52275,"CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52276,CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,137.01 ",,,,,,,,,,,,,,, 52277,"CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52281,"CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52282,"CYSTOURETHROSCOPY, WITH INSERTION OF URETHRAL STENT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 3,600.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52283,"CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52285,"CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL OF THE FOLLOWING: URETHRAL MEATOTOMY, URETHRAL DILATION, INTERNAL URETHROTOMY, LYSIS OF URETHROVAGINAL SEPTAL FIBROSIS, LATERAL INCISIONS OF THE BLADDER NECK, AND FULGURATION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,250.68 "," 1,500.00 ", 562.25 ," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 ", 562.25 ," 3,137.01 ",,,,,,,,,,,,,,, 52287,CYSTOURETHROSCOPY WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 3,031.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52290,"CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52300,"CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52301,"CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52305,"CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 1,500.00 "," 4,020.54 "," 2,400.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 1,500.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52310,"CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); SIMPLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52315,"CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); COMPLICATED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52317,LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM),OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,410.24 "," 1,200.00 "," 2,926.86 "," 1,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,200.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52318,LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM),OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 1,500.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52320,CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS,OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,410.24 "," 2,200.00 "," 2,926.86 "," 3,031.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52325,"CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF URETERAL CALCULUS (EG, ULTRASONIC OR ELECTRO-HYDRAULIC TECHNIQUE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52327,CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTION OF IMPLANT MATERIAL,OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 1,500.00 "," 4,020.54 "," 2,400.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 1,500.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52330,"CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF URETERAL CALCULUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52332,"CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,500.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52334,"CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABLISH A PERCUTANEOUS NEPHROSTOMY, RETROGRADE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52341,"CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,137.01 ",,,,,,,,,,,,,,, 52342,"CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,000.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52343,"CYSTOURETHROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,137.01 ",,,,,,,,,,,,,,, 52344,"CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52345,"CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,000.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52346,"CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 2,000.00 "," 4,020.54 "," 2,800.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,000.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52351,"CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,137.01 ",,,,,,,,,,,,,,, 52352,"CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,200.00 "," 2,926.86 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52353,"CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED)",52353," 19,940.34 ",,," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52354,"CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION OF URETERAL OR RENAL PELVIC LESION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52355,"CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF URETERAL OR RENAL PELVIC TUMOR",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52356,"Cystouretrhoscopy, with ureteroscopy and/or pyeloscopy ; with lithotripsy including insertion of indwelling ureteral stent",52356," 11,814.00 ",,," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,600.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52400,"CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERIOR URETHRAL VALVES, OR CONGENITAL OBSTRUCTIVE HYPERTROPHIC MUCOSAL FOLDS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 2,000.00 "," 3,137.01 ",,,,,,,,,,,,,,, 52402,CYSTOURETHROSCOPY WITH TRANSURETHRAL RESECTION OR INCISION OF EJACULATORY DUCTS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52500,TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 52601,"TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,300.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52630,TRANSURETHRAL RESECTION; OF REGROWTH OF OBSTRUCTIVE TISSUE LONGER THAN ONE YEAR POSTOPERATIVE,OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,404.36 "," 1,500.00 "," 4,020.54 "," 2,400.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 1,500.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52647,"LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED IF PERFORMED)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,600.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 52648,"LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)9",OR LEVEL 4,," 21,812.00 ", 260.12 ," 9,404.36 "," 2,200.00 "," 4,020.54 "," 3,600.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 2,200.00 "," 6,856.16 ",,,,,,,,,,,,,,, 53020,"MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,200.00 "," 1,739.75 "," 1,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,200.00 "," 3,137.01 ",,,,,,,,,,,,,,, 53230,EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 9,404.36 "," 1,500.00 "," 4,020.54 "," 2,400.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 1,500.00 "," 6,856.16 ",,,,,,,,,,,,,,, 53265,EXCISION OR FULGURATION; URETHRAL CARUNCLE,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 53445,INSERT URO/VES NCK SPHINCTER 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 38,563.42 "," 1,200.00 "," 16,319.55 "," 1,800.00 "," 29,040.97 "," 25,901.40 "," 18,994.36 "," 1,200.00 "," 29,040.97 ",,,,,,,,,,,,,,, 53447,REMOVE/REPLACE UR SPHINCTER 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 38,563.42 "," 1,200.00 "," 16,319.55 "," 1,800.00 "," 29,040.97 "," 25,901.40 "," 18,994.36 "," 1,200.00 "," 29,040.97 ",,,,,,,,,,,,,,, 53600,"DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; INITIAL",OR LEVEL 3,," 17,605.00 ", 219.52 , 429.74 ," 1,200.00 ", 231.42 ," 1,800.00 ", 61.61 , 55.57 , 42.71 , 42.71 ," 1,800.00 ",,,,,,,,,,,,,,, 53605,"DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA",OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 53620,"DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; INITIAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,250.68 "," 1,200.00 ", 562.25 ,, 90.95 , 82.03 , 63.05 , 63.05 ," 1,200.00 ",,,,,,,,,,,,,,, 53852,"BIOPSY OR EXCISION OF LYMPH NODE (S); OPEN, INGUINOFEMORAL NODE (S)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 1,500.00 "," 2,926.86 ",," 2,529.66 "," 2,281.35 "," 1,753.69 "," 1,500.00 "," 2,926.86 ",,,,,,,,,,,,,,, 53899,"UNLISTED PROCEDURE, URINARY SYSTEM",OR LEVEL 3,," 17,605.00 ", 219.52 , 429.74 ," 1,200.00 ", 231.42 ,, 424.63 , 378.72 , 277.73 , 231.42 ," 1,200.00 ",,,,,,,,,,,,,,, 54001,"SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54050,"DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL",OR LEVEL 1,," 12,325.60 ", 146.65 , 746.14 ,, 314.08 ,, 574.98 , 512.82 , 376.07 , 314.08 , 574.98 ,,,,,,,,,,,,,,, 54057,"DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,200.00 "," 1,548.96 "," 1,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,200.00 "," 2,901.60 ",,,,,,,,,,,,,,, 54060,"DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,451.72 "," 1,200.00 "," 1,548.96 "," 1,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,200.00 "," 2,901.60 ",,,,,,,,,,,,,,, 54065,"DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 3,451.72 "," 1,200.00 "," 1,548.96 "," 1,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,200.00 "," 2,901.60 ",,,,,,,,,,,,,,, 54100,BIOPSY OF PENIS; (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 54120,AMPUTATION OF PENIS; PARTIAL,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 6,856.16 "," 6,114.95 "," 4,484.30 "," 1,500.00 "," 6,856.16 ",,,,,,,,,,,,,,, 54150,"CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,200.00 "," 1,739.75 "," 1,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,200.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54161,"CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54162,LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS,OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54164,FRENULOTOMY OF PENIS,OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54220,IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM,OR LEVEL 2,," 14,341.60 ", 171.67 , 429.74 ," 1,200.00 ", 231.42 ," 1,800.00 ", 424.63 , 378.72 , 277.73 , 231.42 ," 1,800.00 ",,,,,,,,,,,,,,, 54360,PENIS PLASTIC SURGERY 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 54400,INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID),OR LEVEL 5,," 23,543.80 ", 337.20 ," 24,056.14 "," 2,000.00 "," 16,319.55 "," 2,800.00 "," 29,040.97 "," 25,901.40 "," 18,994.36 "," 2,000.00 "," 29,040.97 ",,,,,,,,,,,,,,, 54401,INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF-CONTAINED),OR LEVEL 4,," 21,812.00 ", 260.12 ," 38,563.42 "," 2,000.00 "," 16,319.55 "," 2,800.00 "," 29,040.97 "," 25,901.40 "," 18,994.36 "," 2,000.00 "," 29,040.97 ",,,,,,,,,,,,,,, 54405,INSERT MULTI-COMP PENIS PROS 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 38,563.42 "," 2,000.00 "," 16,319.55 "," 2,800.00 "," 29,040.97 "," 25,901.40 "," 18,994.36 "," 2,000.00 "," 29,040.97 ",,,,,,,,,,,,,,, 54406,REMOVE MUTI-COMP PENIS PROS 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 54410,REMOVE/REPLACE PENIS PROSTH 1ST,OR LEVEL 3,," 17,605.00 ",219.62," 38,563.42 "," 2,000.00 "," 16,319.55 "," 2,800.00 "," 29,040.97 "," 25,901.40 "," 18,994.36 "," 2,000.00 "," 29,040.97 ",,,,,,,,,,,,,,, 54430,"CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 1,232.93 "," 1,099.64 ", 806.40 , 806.40 ," 1,232.93 ",,,,,,,,,,,,,,, 54450,ED FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING,Emergency department, 856.50 ,,, 429.74 ," 1,200.00 ", 231.42 ," 1,800.00 ", 424.63 , 378.72 , 277.73 , 231.42 ," 1,800.00 ",,,,,,,,,,,,,,, 54512,EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS,OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54520,"ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,739.75 "," 4,989.01 ",,,,,,,,,,,,,,, 54530,"ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,300.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 54550,EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA),OR LEVEL 2,," 14,341.60 ", 171.67 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,300.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 54620,FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 2,000.00 "," 2,926.86 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,000.00 "," 4,989.01 ",,,,,,,,,,,,,,, 54700,ED INCISION AND DRAINAGE OF EPIDIDYMIS TESTIS AND/OR SCROTAL SPACE (EG ABSCESS OR HEMATOMA),Emergency department," 3,289.32 ",,," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54700,"INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 54840,"EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 2,200.00 "," 1,739.75 "," 3,300.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,300.00 ",,,,,,,,,,,,,,, 54860,EPIDIDYMECTOMY; UNILATERAL,OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,137.01 ",,,,,,,,,,,,,,, 55040,EXCISION OF HYDROCELE; UNILATERAL,OR LEVEL 2,," 14,341.60 ", 171.67 ," 7,083.86 "," 2,000.00 "," 2,947.32 "," 2,800.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,000.00 "," 5,385.65 ",,,,,,,,,,,,,,, 55041,EXCISION OF HYDROCELE; BILATERAL,OR LEVEL 2,," 14,341.60 ", 171.67 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,031.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 55060,REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE),OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 2,200.00 "," 1,739.75 "," 3,300.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,739.75 "," 3,300.00 ",,,,,,,,,,,,,,, 55100,ED DRAINAGE OF SCROTAL WALL ABSCESS,Emergency department," 2,720.25 ",,," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 55100,DRAINAGE OF SCROTAL WALL ABSCESS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 55110,SCROTAL EXPLORATION,OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 1,500.00 "," 2,926.86 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 55150,RESECTION OF SCROTUM,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,200.00 "," 1,739.75 "," 1,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,200.00 "," 4,989.01 ",,,,,,,,,,,,,,, 55250,"VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 55400,VASOVASOSTOMY VASOVASORRHAPHY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 6,410.24 "," 1,200.00 "," 2,926.86 "," 1,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,200.00 "," 4,989.01 ",,,,,,,,,,,,,,, 55500,"EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 2,000.00 "," 1,739.75 "," 2,800.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,739.75 "," 4,989.01 ",,,,,,,,,,,,,,, 55520,EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 2,200.00 "," 1,739.75 "," 3,300.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 1,739.75 "," 4,989.01 ",,,,,,,,,,,,,,, 55530,EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,410.24 "," 2,200.00 "," 2,926.86 "," 3,300.00 "," 4,989.01 "," 4,449.65 "," 3,263.08 "," 2,200.00 "," 4,989.01 ",,,,,,,,,,,,,,, 55540,EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH HERNIA REPAIR,OR LEVEL 2,," 14,341.60 ", 171.67 ," 7,083.86 "," 2,200.00 "," 2,947.32 "," 3,031.00 "," 5,385.65 "," 4,803.41 "," 3,522.50 "," 2,200.00 "," 5,385.65 ",,,,,,,,,,,,,,, 55550,LAPARO LIGATE SPERMATIC VEIN 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 10,424.30 "," 2,450.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,450.00 "," 8,304.06 ",,,,,,,,,,,,,,, 55559,LAPARO PROC SPERMATIC CORD 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 10,424.30 "," 2,000.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 55700,"BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,709.76 "," 1,500.00 "," 1,739.75 "," 2,400.00 "," 3,137.01 "," 2,797.87 "," 2,051.77 "," 1,500.00 "," 3,137.01 ",,,,,,,,,,,,,,, 55899,"UNLISTED PROCEDURE, MALE GENITAL SYSTEM",OR LEVEL 2,," 14,341.60 ", 171.67 , 429.74 ," 1,500.00 ", 231.42 ,, 424.63 , 378.72 , 277.73 , 231.42 ," 1,500.00 ",,,,,,,,,,,,,,, 56405,ED INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS,Emergency department," 1,402.00 ",,, 583.92 ," 1,500.00 ", 273.00 ," 2,400.00 ", 83.33 , 75.15 , 57.77 , 57.77 ," 2,400.00 ",,,,,,,,,,,,,,, 56405,INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS,OR LEVEL 2,," 14,341.60 ", 171.67 , 583.92 ," 1,500.00 ", 273.00 ," 2,400.00 ", 83.33 , 75.15 , 57.77 , 57.77 ," 2,400.00 ",,,,,,,,,,,,,,, 56420,ED INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS,Emergency department," 1,564.38 ",,, 356.26 ," 1,200.00 ", 165.93 ," 1,800.00 ", 108.56 , 97.90 , 75.26 , 75.26 ," 1,800.00 ",,,,,,,,,,,,,,, 56420,INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS,OR LEVEL 2,," 14,341.60 ", 171.67 , 356.26 ," 1,200.00 ", 165.93 ," 1,800.00 ", 108.56 , 97.90 , 75.26 , 75.26 ," 1,800.00 ",,,,,,,,,,,,,,, 56440,MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 1,500.00 "," 2,361.27 "," 2,400.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,500.00 "," 4,204.62 ",,,,,,,,,,,,,,, 56501,"DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 3,451.72 "," 1,200.00 "," 1,548.96 ",, 115.60 , 104.25 , 80.14 , 80.14 ," 1,548.96 ",,,,,,,,,,,,,,, 56515,DESTROY VULVA LESION/S COMPL 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 3,451.72 "," 2,000.00 "," 1,548.96 "," 2,800.00 "," 2,901.60 "," 2,587.91 "," 1,897.80 "," 1,548.96 "," 2,901.60 ",,,,,,,,,,,,,,, 56620,VULVECTOMY SIMPLE; PARTIAL,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 56740,EXCISION OF BARTHOLIN'S GLAND OR CYST,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,000.00 "," 2,361.27 "," 2,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,000.00 "," 4,204.62 ",,,,,,,,,,,,,,, 56810,"PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57000,COLPOTOMY; WITH EXPLORATION,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,654.88 "," 1,200.00 "," 2,361.27 "," 1,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57135,EXCISION OF VAGINAL CYST OR TUMOR,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,654.88 "," 1,500.00 "," 2,361.27 "," 2,400.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,500.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57240,"ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,031.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 57250,"POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,031.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 57260,COMBINED ANTEROPOSTERIOR COLPORRHAPHY;,OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,031.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 57265,COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR,OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,450.00 "," 4,125.83 "," 2,779.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,450.00 "," 7,606.85 ",,,,,,,,,,,,,,, 57282,"COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 13,851.12 "," 2,200.00 "," 6,344.41 ",," 11,631.62 "," 10,374.14 "," 7,607.71 "," 2,200.00 "," 11,631.62 ",,,,,,,,,,,,,,, 57287,"REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 5,654.88 "," 2,200.00 "," 2,361.27 ",," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57288,"SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,031.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 57295,REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,654.88 "," 2,000.00 "," 2,361.27 "," 2,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,000.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57415,ED REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (OTHER THAN LOCAL),Emergency department," 4,170.94 ",,," 5,654.88 "," 1,500.00 "," 2,361.27 "," 2,400.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,500.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57420,"COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT;",OR LEVEL 3,," 17,605.00 ", 219.52 , 583.92 ," 1,200.00 ", 273.00 ," 1,800.00 ", 88.02 , 79.38 , 61.02 , 61.02 ," 1,800.00 ",,,,,,,,,,,,,,, 57425,"LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 18,174.60 "," 2,200.00 "," 7,741.63 ",," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 57452,COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;,OR LEVEL 1,," 12,325.60 ", 146.65 , 356.26 ," 1,500.00 ", 165.93 ," 1,800.00 ", 81.57 , 73.56 , 56.55 , 56.55 ," 1,800.00 ",,,,,,,,,,,,,,, 57461,COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX,OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,654.88 "," 2,000.00 "," 2,361.27 "," 2,400.00 ", 302.79 , 273.07 , 209.91 , 209.91 ," 2,400.00 ",,,,,,,,,,,,,,, 57505,ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE),OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,406.94 "," 1,200.00 ", 558.04 ," 1,800.00 ", 91.54 , 82.56 , 63.46 , 63.46 ," 1,800.00 ",,,,,,,,,,,,,,, 57510,CAUTERY OF CERVIX; ELECTRO OR THERMAL,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 1,500.00 "," 2,361.27 ",, 93.89 , 84.67 , 65.09 , 65.09 ," 2,361.27 ",,,,,,,,,,,,,,, 57520,"CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,654.88 "," 1,500.00 "," 2,361.27 "," 2,400.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,500.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57522,"CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,654.88 "," 1,500.00 "," 2,361.27 "," 2,400.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,500.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57530,"TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 9,270.22 "," 2,000.00 "," 2,361.27 "," 2,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,000.00 "," 4,204.62 ",,,,,,,,,,,,,,, 57558,DILATION AND CURETTAGE OF CERVICAL STUMP93872,OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,000.00 "," 2,361.27 "," 2,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,000.00 "," 4,204.62 ",,,,,,,,,,,,,,, 58100,"ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 , 356.26 ," 1,200.00 ", 165.93 ,, 79.80 , 71.97 , 55.32 , 55.32 ," 1,200.00 ",,,,,,,,,,,,,,, 58120,"DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 1,500.00 "," 2,361.27 "," 2,400.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,500.00 "," 4,204.62 ",,,,,,,,,,,,,,, 58140,"MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; ABDOMINAL APPROACH",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,450.00 ",,," 1,724.26 "," 1,537.85 "," 1,127.76 "," 1,127.76 "," 2,450.00 ",,,,,,,,,,,,,,, 58145,"MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH93880",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 58146,MYOMECTOMY ABDOM COMPLEX 1ST,OR LEVEL 3,," 17,605.00 ",219.62,,,,," 2,152.49 "," 1,919.79 "," 1,407.85 "," 1,407.85 "," 2,152.49 ",,,,,,,,,,,,,,, 58150,"TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S);",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,450.00 ",,," 1,922.11 "," 1,714.32 "," 1,257.17 "," 1,257.17 "," 2,450.00 ",,,,,,,,,,,,,,, 58180,"SUPRACERVICAL ABDOMINAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S)",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,450.00 ",,," 1,813.22 "," 1,617.20 "," 1,185.95 "," 1,185.95 "," 2,450.00 ",,,,,,,,,,,,,,, 58260,"VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,600.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58262,"VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,600.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58290,VAG HYST COMPLEX 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 13,851.12 "," 2,200.00 "," 6,344.41 ",," 11,631.62 "," 10,374.14 "," 7,607.71 "," 2,200.00 "," 11,631.62 ",,,,,,,,,,,,,,, 58300,INSERTION OF INTRAUTERINE DEVICE (IUD),OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,200.00 ",,, 102.25 , 91.20 , 66.88 , 66.88 ," 1,200.00 ",,,,,,,,,,,,,,, 58301,ED REMOVAL OF INTRAUTERINE DEVICE (IUD),Emergency department," 1,219.38 ",,, 583.92 ," 1,200.00 ", 165.93 ," 1,800.00 ", 75.11 , 67.74 , 52.07 , 52.07 ," 1,800.00 ",,,,,,,,,,,,,,, 58301,REMOVAL OF INTRAUTERINE DEVICE (IUD),OR LEVEL 1,," 12,325.60 ", 146.65 , 583.92 ," 1,200.00 ", 165.93 ," 1,800.00 ", 75.11 , 67.74 , 52.07 , 52.07 ," 1,800.00 ",,,,,,,,,,,,,,, 58340,CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SONOHYSTEROGRAPHY (SIS) OR HYSTEROSALPINGOGRAPHY,OR LEVEL 3,," 17,605.00 ", 219.52 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 58350,"CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,000.00 "," 4,125.83 "," 2,800.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,000.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58353,"ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 9,270.22 "," 2,450.00 "," 4,125.83 "," 2,779.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,450.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58541,"LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58542,"LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58543,"LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58544,"LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,200.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,200.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58545,"LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,450.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,450.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58550,"LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;93923",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,424.30 "," 2,450.00 "," 4,595.85 "," 3,600.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,450.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58552,"LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,450.00 "," 7,741.63 "," 3,031.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,450.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58553,"LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;",OR LEVEL 4,," 21,812.00 ", 260.12 ," 18,174.60 "," 2,450.00 "," 7,741.63 "," 3,031.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,450.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58554,"LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 18,174.60 "," 2,450.00 "," 7,741.63 "," 3,031.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,450.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58555,"HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 1,200.00 "," 2,361.27 "," 1,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 58558,"HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,000.00 "," 2,361.27 "," 2,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,000.00 "," 4,204.62 ",,,,,,,,,,,,,,, 58559,"HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 9,270.22 "," 1,500.00 "," 4,125.83 "," 2,400.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 1,500.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58560,HYSTEROSCOPY RESECT SEPTUM 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 9,270.22 "," 2,000.00 "," 4,125.83 "," 2,800.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,000.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58561,"HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 9,270.22 "," 2,000.00 "," 4,125.83 "," 2,800.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,000.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58562,"HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,000.00 "," 2,361.27 "," 2,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,000.00 "," 4,204.62 ",,,,,,,,,,,,,,, 58563,"HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 9,270.22 "," 2,200.00 "," 4,125.83 "," 3,600.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58565,"HYSTEROSCOPY, SURGICAL; WITH BILATERAL FALLOPIAN TUBE CANNULATION TO INDUCE OCCLUSION BY PLACEMENT OF PERMANENT IMPLANTS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,000.00 "," 4,125.83 "," 3,600.00 "," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,000.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58571,"LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 18,174.60 "," 2,450.00 "," 7,741.63 "," 3,600.00 "," 14,051.53 "," 12,532.44 "," 9,190.46 "," 2,450.00 "," 14,051.53 ",,,,,,,,,,,,,,, 58579,"UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS",OR LEVEL 3,," 17,605.00 ", 219.52 , 356.26 ," 2,000.00 ", 165.93 ,, 297.30 , 265.16 , 194.45 , 165.93 ," 2,000.00 ",,,,,,,,,,,,,,, 58660,"LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,031.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58661,"LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,031.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58662,"LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,031.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58670,"LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,000.00 "," 4,595.85 "," 2,800.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58671,"LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,000.00 "," 4,595.85 "," 2,800.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,000.00 "," 8,304.06 ",,,,,,,,,,,,,,, 58720,"SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)",OR LEVEL 4,," 21,812.00 ", 260.12 ,," 2,200.00 ",,," 1,394.94 "," 1,244.13 ", 912.36 , 912.36 ," 2,200.00 ",,,,,,,,,,,,,,, 58740,"LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,200.00 ",,," 1,675.79 "," 1,494.62 "," 1,096.05 "," 1,096.05 "," 2,200.00 ",,,,,,,,,,,,,,, 58925,"OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 9,270.22 "," 2,200.00 "," 4,125.83 ",," 7,606.85 "," 6,784.49 "," 4,975.29 "," 2,200.00 "," 7,606.85 ",,,,,,,,,,,,,,, 58940,REMOVAL OF OVARY(S) 1ST,OR LEVEL 2,," 14,341.60 ",171.67,," 2,200.00 ",,, 997.91 , 890.03 , 652.69 , 652.69 ," 2,200.00 ",,,,,,,,,,,,,,, 58950,"RESECTION (INITIAL) OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL SALPINGO-OOPHORECTOMY AND OMENTECTOMY;",OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 2,164.44 "," 1,930.45 "," 1,415.66 "," 1,415.66 "," 2,164.44 ",,,,,,,,,,,,,,, 58999,"UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)",OR LEVEL 2,," 14,341.60 ", 171.67 , 356.26 ," 1,200.00 ", 165.93 ,, 297.30 , 265.16 , 194.45 , 165.93 ," 1,200.00 ",,,,,,,,,,,,,,, 59025,ED FETAL NON-STRESS TEST,Emergency department, 456.63 ,,, 356.26 ,, 165.93 ,, 18.66 , 18.66 , 18.66 , 18.66 , 165.93 ,,,,,,,,,,,,,,, 59120,"SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, REQUIRING SALPINGECTOMY AND/OR OOPHORECTOMY, ABDOMINAL OR VAGINAL APPROACH",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 2,000.00 ",,," 1,515.78 "," 1,351.91 ", 991.40 , 991.40 ," 2,000.00 ",,,,,,,,,,,,,,, 59151,LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY,OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 59320,"CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 1,200.00 "," 2,361.27 "," 1,800.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 59325,CERCLAGE CERVIX DURING PREG ABD 1ST 30 M,OR LEVEL 2,," 14,341.60 ",171.67,," 2,200.00 ",,, 464.76 , 414.51 , 303.98 , 303.98 ," 2,200.00 ",,,,,,,,,,,,,,, 59409,EDVAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS);,Emergency department," 10,383.50 ",,," 5,654.88 "," 1,200.00 "," 2,361.27 ",," 4,204.62 "," 3,750.07 "," 2,750.05 "," 1,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 59812,"TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 59820,"TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 59821,"TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 59840,"INDUCED ABORTION, BY DILATION AND CURETTAGE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 59841,"INDUCED ABORTION, BY DILATION AND EVACUATION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,654.88 "," 2,200.00 "," 2,361.27 "," 3,031.00 "," 4,204.62 "," 3,750.07 "," 2,750.05 "," 2,200.00 "," 4,204.62 ",,,,,,,,,,,,,,, 60210,"PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 60212,"PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,200.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 60220,"TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 1,500.00 "," 4,595.85 "," 2,400.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 1,500.00 "," 8,304.06 ",,,,,,,,,,,,,,, 60240,"THYROIDECTOMY, TOTAL OR COMPLETE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,424.30 "," 2,450.00 "," 4,595.85 ",," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,450.00 "," 8,304.06 ",,,,,,,,,,,,,,, 60252,"THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 ",," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 60260,"THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS REMOVAL OF A PORTION OF THYROID",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,200.00 "," 4,424.23 ",," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 60280,EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;,OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,424.30 "," 2,200.00 "," 4,595.85 "," 3,300.00 "," 8,304.06 "," 7,406.32 "," 5,431.30 "," 2,200.00 "," 8,304.06 ",,,,,,,,,,,,,,, 60300,ASPIRATION AND/OR INJECTION THYROID CYST,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,297.94 "," 1,200.00 ", 579.34 ,, 133.79 , 120.66 , 92.75 , 92.75 ," 1,200.00 ",,,,,,,,,,,,,,, 60650,LAPAROSCOPY ADRENALECTOMY 1ST,OR LEVEL 2,," 14,341.60 ",171.67,," 2,200.00 ",,," 2,289.93 "," 2,042.37 "," 1,497.74 "," 1,497.74 "," 2,289.93 ",,,,,,,,,,,,,,, 61070,PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 61615,"RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN, FORAMEN MAGNUM, OR C1-C3 VERTEBRAL BODIES; EXTRADURAL",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,,," 5,425.07 "," 4,838.58 "," 3,548.29 "," 3,548.29 "," 5,425.07 ",,,,,,,,,,,,,,, 61782,TEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 62270,"ED SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC",Emergency department," 2,046.13 ",,," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62272,ED SPINAL PUNCTURE THERAPEUTIC FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER),Emergency department," 2,626.50 ",,," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62272,"SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER)",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62273,"INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",OR LEVEL 2,," 14,341.60 ", 171.67 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62284,"INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTED TOMOGRAPHY, SPINAL (OTHER THAN C1-C2 AND POSTERIOR FOSSA)",62284," 2,291.63 ",,,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 62287,"ASPIRATION OR DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISC, ANY METHOD, SINGLE OR MULTIPLE LEVELS, LUMBAR (EG, MANUAL OR AUTOMATED PERCUTANEOUS DISCECTOMY, PERCUTANEOUS LASER DISCECTOMY)94294",OR LEVEL 5,," 23,543.80 ", 337.20 ," 3,595.04 "," 2,200.00 "," 4,566.06 "," 3,600.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 2,200.00 "," 8,561.04 ",,,,,,,,,,,,,,, 62290,"INJECTION PROCEDURE FOR DISCOGRAPHY, EACH LEVEL; LUMBAR",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 62291,INJECT PROC DISCO EA LEVEL CERV/THOR 1S,OR LEVEL 1,," 12,325.60 ",143.65,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 62320,"ESI, Cervical,Thoracic w/o Imaging guidance ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62321,"ESI, Cervical, Thoracic w/ Imaging Guidance (Flouroscopy or CT) ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62322,"ESI, Lumbar, Sacral w/o Imaging guidance ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62323,"ESI, Lumbar, Sacral w/ Imaging Guidance (flouroscopy or CT) ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 62324,"ESI, Cervical, Thoracic w/ continious infusion w/o Imaging guidance ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 2,400.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 2,400.00 ",,,,,,,,,,,,,,, 62325,"ESI, Cervical, Thoracic w/ continious infusion ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 2,400.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 2,400.00 ",,,,,,,,,,,,,,, 62326,"ESI, Lumbar, Sacral w/ continious infusion w/o Imaging guidance ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 2,400.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 2,400.00 ",,,,,,,,,,,,,,, 62327,"ESI, Lumbar, Sacral w/ continious infusion w/ Guidance (flouroscopy or CT) ",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 2,400.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 2,400.00 ",,,,,,,,,,,,,,, 62328,UNDER INJ PROCEDURE ON THE SPINE 1ST,OR LEVEL 1,," 12,325.60 ",143.65," 1,288.68 ",,,,,,, - , - ,,,,,,,,,,,,,,, 62329,THER SPI PNXR CSF FLUOR/CT 1ST,OR LEVEL 1,," 12,325.60 ",143.65," 1,288.68 ",,,,,,, - , - ,,,,,,,,,,,,,,, 62350,"IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY",OR LEVEL 5,," 23,543.80 ", 337.20 ," 12,357.30 "," 1,500.00 "," 4,566.06 "," 2,400.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 1,500.00 "," 8,561.04 ",,,,,,,,,,,,,,, 62355,REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER,OR LEVEL 5,," 23,543.80 ", 337.20 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 62362,"IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING",OR LEVEL 4,," 21,812.00 ", 260.12 ," 33,876.92 "," 1,500.00 "," 16,067.39 "," 2,400.00 "," 30,415.48 "," 27,127.32 "," 19,893.37 "," 1,500.00 "," 30,415.48 ",,,,,,,,,,,,,,, 62365,"REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL OR EPIDURAL INFUSION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 12,357.30 "," 1,500.00 "," 4,566.06 "," 2,400.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 1,500.00 "," 8,561.04 ",,,,,,,,,,,,,,, 63012,"LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH DECOMPRESSION OF CAUDA EQUINA AND NERVE ROOTS FOR SPONDYLOLISTHESIS, LUMBAR (GILL TYPE PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 3,200.00 "," 5,699.59 "," 6,000.00 "," 11,250.00 "," 10,125.00 "," 7,088.00 "," 3,200.00 "," 11,250.00 ",,,,,,,,,,,,,,, 63020,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; ONE INTERSPACE, CERVICAL",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 3,200.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 3,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 63030,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; ONE INTERSPACE, LUMBAR (INCLUDING OPEN OR ENDOSCOPICALLY-ASSISTED APPROACH)",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 5,699.59 "," 10,371.88 ",,,,,,,,,,,,,,, 63035,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; EACH ADDITIONAL INTERSPACE, CERVICAL OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 2,200.00 ",," 6,000.00 ",,,," 2,200.00 "," 6,000.00 ",,,,,,,,,,,,,,, 63040,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; CERVICAL",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 63042,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; LUMBAR",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 3,200.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 3,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 63043,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; EACH ADDITIONAL CERVICAL INTERSPACE (LIST SEPARATELY IN ADD",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 6,000.00 ",,,," 1,200.00 "," 6,000.00 ",,,,,,,,,,,,,,, 63044,"LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; EACH ADDITIONAL LUMBAR INTERSPACE (LIST SEPARATELY IN ADDIT",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",," 6,000.00 ",,,," 1,200.00 "," 6,000.00 ",,,,,,,,,,,,,,, 63045,"LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; CERVICAL",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 2,200.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 63046,"LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; THORACIC",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 3,200.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 3,200.00 "," 10,371.88 ",,,,,,,,,,,,,,, 63047,LAMINECTOMY FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD CAUDA EQUINA AND/OR NERVE ROOT[S] [EG SPINAL OR LATERAL RECESS STENOSIS]) SINGLE VERTEBRAL SEGMENT; LUMBAR,OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 7,100.00 "," 5,699.59 "," 6,000.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 5,699.59 "," 10,371.88 ",,,,,,,,,,,,,,, 63048,"LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL SEGMENT, CERVICAL, THORACIC, OR L",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 2,200.00 ",," 6,000.00 ",,,," 2,200.00 "," 6,000.00 ",,,,,,,,,,,,,,, 63050,"LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE VERTEBRAL SEGMENTS;",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,," 3,055.46 "," 2,725.14 "," 1,998.44 "," 1,998.44 "," 3,055.46 ",,,,,,,,,,,,,,, 63051,"LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, TWO OR MORE VERTEBRAL SEGMENTS; WITH RECONSTRUCTION OF THE POSTERIOR BONY ELEMENTS (INCLUDING THE APPLICATION OF BRIDGING BONE GRAFT AND NON-SEGMENTAL FIXATION DEVICES (EG, WIRE, SUTURE, MINI",OR LEVEL 6,," 25,897.20 ", 438.29 ,,,,," 3,295.81 "," 2,939.51 "," 2,155.64 "," 2,155.64 "," 3,295.81 ",,,,,,,,,,,,,,, 63056,"TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISC), SINGLE SEGMENT; LUMBAR (INCLUDING TRANSFACET, OR LATERAL EXTRAFORAMINAL APPROACH) (EG, FAR LATERAL HERNIATED INTERVERTEBRAL DISC)",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 "," 2,450.00 "," 5,699.59 "," 3,600.00 "," 10,371.88 "," 9,250.59 "," 6,783.77 "," 2,450.00 "," 10,371.88 ",,,,,,,,,,,,,,, 63057,"TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISC), SINGLE SEGMENT; EACH ADDITIONAL SEGMENT, THORACIC OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 6,," 25,897.20 ", 438.29 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 63081,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); CERVICAL, SINGLE SEGMENT",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,," 3,394.73 "," 3,027.73 "," 2,220.34 "," 2,220.34 "," 3,394.73 ",,,,,,,,,,,,,,, 63082,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); CERVICAL, EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,, 517.20 , 461.29 , 338.28 , 338.28 , 517.20 ,,,,,,,,,,,,,,, 63087,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED THORACOLUMBAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC OR LUMBAR; SINGLE SEGMENT",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,," 4,664.18 "," 4,159.95 "," 3,050.63 "," 3,050.63 "," 4,664.18 ",,,,,,,,,,,,,,, 63088,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED THORACOLUMBAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC OR LUMBAR; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,, 478.71 , 426.95 , 313.10 , 313.10 , 478.71 ,,,,,,,,,,,,,,, 63090,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANSPERITONEAL OR RETROPERITONEAL APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC, LUMBAR, OR SACRAL; SINGLE SEGMENT",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,," 3,783.81 "," 3,374.75 "," 2,474.81 "," 2,474.81 "," 3,783.81 ",,,,,,,,,,,,,,, 63101,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EXTRACAVITARY APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S) (EG, FOR TUMOR OR RETROPULSED BONE FRAGMENTS); THORACIC, SINGLE SEGMENT",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,," 4,488.91 "," 4,003.63 "," 2,935.99 "," 2,935.99 "," 4,488.91 ",,,,,,,,,,,,,,, 63103,"VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, LATERAL EXTRACAVITARY APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S) (EG, FOR TUMOR OR RETROPULSED BONE FRAGMENTS); THORACIC OR LUMBAR, EACH ADDITIONAL SEGMENT (LIST S",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,,, 570.32 , 508.66 , 373.02 , 373.02 , 570.32 ,,,,,,,,,,,,,,, 63267,"LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN NEOPLASM, EXTRADURAL; LUMBAR",OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,229.26 ",,," 6,000.00 "," 2,642.48 "," 2,356.81 "," 1,728.33 "," 1,728.33 "," 6,000.00 ",,,,,,,,,,,,,,, 63277,"LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, LUMBAR",OR LEVEL 5,," 23,543.80 ", 337.20 ,,,," 6,000.00 "," 3,001.68 "," 2,677.17 "," 1,963.26 "," 1,963.26 "," 6,000.00 ",,,,,,,,,,,,,,, 63650,"PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL",OR LEVEL 4,," 21,812.00 ", 260.12 ," 13,207.70 "," 7,146.00 "," 5,979.53 "," 3,600.00 "," 11,202.88 "," 9,991.76 "," 7,327.29 "," 3,600.00 "," 11,202.88 ",,,,,,,,,,,,,,, 63655,"LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL",OR LEVEL 6,," 25,897.20 ", 438.29 ," 43,030.72 "," 20,000.00 "," 18,707.16 "," 6,000.00 "," 33,982.45 "," 30,308.67 "," 22,226.36 "," 6,000.00 "," 33,982.45 ",,,,,,,,,,,,,,, 63661,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S) INCLUDING FLUOROSCOPY WHEN PERFORMED,OR LEVEL 5,," 23,543.80 ", 337.20 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 2,779.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 2,979.43 ",,,,,,,,,,,,,,, 63662,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY INCLUDING FLUOROSCOPY WHEN PERFORMED,OR LEVEL 6,," 25,897.20 ", 438.29 ," 6,495.36 "," 1,200.00 "," 2,879.80 "," 2,779.00 "," 5,326.85 "," 4,750.98 "," 3,484.05 "," 1,200.00 "," 5,326.85 ",,,,,,,,,,,,,,, 63663,REVISION INCLUDING REPLACEMENT WHEN PERFORMED OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S) INCLUDING FLUOROSCOPY WHEN PERFORMED,OR LEVEL 6,," 25,897.20 ", 438.29 ," 13,207.70 "," 1,200.00 "," 5,979.53 "," 2,779.00 "," 11,202.88 "," 9,991.76 "," 7,327.29 "," 1,200.00 "," 11,202.88 ",,,,,,,,,,,,,,, 63664,REVISION INCLUDING REPLACEMENT WHEN PERFORMED OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY INCLUDING FLUOROSCOPY WHEN PERFORMED,OR LEVEL 5,," 23,543.80 ", 337.20 ," 23,905.18 "," 1,200.00 "," 18,707.16 "," 2,779.00 "," 33,982.45 "," 30,308.67 "," 22,226.36 "," 1,200.00 "," 33,982.45 ",,,,,,,,,,,,,,, 63685,"INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING",OR LEVEL 4,," 21,812.00 ", 260.12 ," 58,716.96 "," 26,000.00 "," 27,697.85 "," 2,400.00 "," 51,599.81 "," 46,021.45 "," 33,749.07 "," 2,400.00 "," 51,599.81 ",,,,,,,,,,,,,,, 63688,REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,OR LEVEL 4,," 21,812.00 ", 260.12 ," 6,495.36 "," 1,200.00 "," 2,879.80 "," 1,800.00 "," 5,326.85 "," 4,750.98 "," 3,484.05 "," 1,200.00 "," 5,326.85 ",,,,,,,,,,,,,,, 63706,REPAIR OF MYELOMENINGOCELE; LARGER THAN 5 CM DIAMETER,OR LEVEL 3,," 17,605.00 ", 219.52 ,,,,," 3,571.33 "," 3,185.24 "," 2,335.84 "," 2,335.84 "," 3,571.33 ",,,,,,,,,,,,,,, 63707,"REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, NOT REQUIRING LAMINECTOMY",OR LEVEL 2,," 14,341.60 ", 171.67 ,,,,," 1,780.03 "," 1,587.60 "," 1,164.24 "," 1,164.24 "," 1,780.03 ",,,,,,,,,,,,,,, 63709,"REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK OR PSEUDOMENINGOCELE, WITH LAMINECTOMY",OR LEVEL 4,," 21,812.00 ", 260.12 ,,,,," 2,120.64 "," 1,891.38 "," 1,387.01 "," 1,387.01 "," 2,120.64 ",,,,,,,,,,,,,,, 64400,ED INJECTION ANESTHETIC AGENT; TRIGEMINAL NERVE ANY DIVISION OR BRANCH,Emergency department," 1,578.25 ",,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 140.25 , 126.48 , 97.23 , 97.23 ," 1,800.00 ",,,,,,,,,,,,,,, 64400,"INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 140.25 , 126.48 , 97.23 , 97.23 ," 1,800.00 ",,,,,,,,,,,,,,, 64402,ED INJECTION ANESTHETIC AGENT; FACIAL NERVE,Emergency department," 1,561.63 ",,,," 1,200.00 ", 106.48 ," 1,800.00 ", 194.32 , 173.32 , 127.10 , 106.48 ," 1,800.00 ",,,,,,,,,,,,,,, 64405,ED INJECTION ANESTHETIC AGENT; GREATER OCCIPITAL NERVE,Emergency department," 1,315.22 ",,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 105.04 , 94.73 , 72.82 , 72.82 ," 1,800.00 ",,,,,,,,,,,,,,, 64405,"INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 105.04 , 94.73 , 72.82 , 72.82 ," 1,800.00 ",,,,,,,,,,,,,,, 64413,ED INJECTION ANESTHETIC AGENT; CERVICAL PLEXUS,Emergency department," 1,115.02 ",,,," 1,200.00 ", 598.81 ," 1,800.00 ", 118.53 , 106.90 , 82.17 , 82.17 ," 1,800.00 ",,,,,,,,,,,,,,, 64415,ED INJECTION ANESTHETIC AGENT; BRACHIAL PLEXUS SINGLE,Emergency department," 1,277.86 ",,," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64415,"INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, SINGLE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64417,"INJECTION, ANESTHETIC AGENT; AXILLARY NERVE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64418,PSU INJECTION ANESTHETIC AGENT; SUPRASCAPULAR NERVE,Post Surgery Unit," 1,112.00 ",,," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 ", 124.40 , 112.19 , 86.24 , 86.24 ," 1,800.00 ",,,,,,,,,,,,,,, 64418,"INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 ", 124.40 , 112.19 , 86.24 , 86.24 ," 1,800.00 ",,,,,,,,,,,,,,, 64420,INJECTION ANESTHETIC AGENT; INTERCOSTAL NERVE SINGLE,Post Surgery Unit," 2,554.75 ",,," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 64420,"INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 "," 1,005.25 ", 896.58 , 657.49 , 598.81 ," 1,800.00 ",,,,,,,,,,,,,,, 64421,"INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64425,"INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 ", 111.49 , 100.55 , 77.29 , 77.29 ," 1,800.00 ",,,,,,,,,,,,,,, 64430,ED INJECTION ANESTHETIC AGENT; PUDENDAL NERVE,Emergency department," 1,751.13 ",,," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64445,"INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, SINGLE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 ", 133.79 , 120.66 , 92.75 , 92.75 ," 1,800.00 ",,,,,,,,,,,,,,, 64447,"INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 ",, 598.81 ," 1,800.00 ", 107.97 , 97.37 , 74.85 , 74.85 ," 1,800.00 ",,,,,,,,,,,,,,, 64448,"INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) INCLUDING DAILY MANAGEMENT FOR ANESTHETIC AGENT ADMINISTRATION",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 ",, 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64450,ED INJECTION ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH,Emergency department," 1,267.97 ",,," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 ", 85.67 , 77.26 , 59.39 , 59.39 ," 1,800.00 ",,,,,,,,,,,,,,, 64450,"INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 "," 1,200.00 ", 598.81 ," 1,800.00 ", 85.67 , 77.26 , 59.39 , 59.39 ," 1,800.00 ",,,,,,,,,,,,,,, 64451,INJECTION IN NERVES INNERVATING THE SI JOIN WITH IMAGE GUIDANCE (FLUORO OR CT),OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 ",,,,,,, - , - ,,,,,,,,,,,,,,, 64454,"GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,288.68 ",,,,,,, - , - ,,,,,,,,,,,,,,, 64455,ED INJECTION(S) ANESTHETIC AGENT AND/OR STEROID PLANTAR COMMON DIGITAL NERVE(S) (EG MORTON'S NEUROMA),Emergency department, 693.00 ,,, 543.78 ," 1,200.00 ", 247.48 ,, 32.27 , 29.11 , 22.37 , 22.37 ," 1,200.00 ",,,,,,,,,,,,,,, 64455,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PLANTAR COMMON DIGITAL NERVE(S)",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ,, 32.27 , 29.11 , 22.37 , 22.37 ," 1,200.00 ",,,,,,,,,,,,,,, 64479,"INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR THORACIC, SINGLE LEVEL",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64480,"INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64483,"INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR SACRAL, SINGLE LEVEL",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64484,"INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64487,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK RECTUS SHEATH BLOCK) UNILATERAL; BY CONTINUOUS INFUSION(S) (INCLUDES IMAGING GUIDANCE WHEN PERFORMED),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,500.00 ",,,,,," 1,500.00 "," 1,500.00 ",,,,,,,,,,,,,,, 64488,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE WHEN PERFORMED),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,500.00 ",,,,,," 1,500.00 "," 1,500.00 ",,,,,,,,,,,,,,, 64489,TAP BLOCK BI BY INFUSION 1ST,OR LEVEL 1,," 12,325.60 ",143.65,," 1,500.00 ",,,,,," 1,500.00 "," 1,500.00 ",,,,,,,,,,,,,,, 64490,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64491,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64492,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64493,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64494,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCE",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64495,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO C",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64505,ED INJECTION ANESTHETIC AGENT; SPHENOPALATINE GANGLION,Emergency department, 693.00 ,,, 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 90.37 , 81.50 , 62.65 , 62.65 ," 1,800.00 ",,,,,,,,,,,,,,, 64505,"INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION",OR LEVEL 1,," 12,325.60 ", 146.65 , 543.78 ," 1,200.00 ", 247.48 ," 1,800.00 ", 90.37 , 81.50 , 62.65 , 62.65 ," 1,800.00 ",,,,,,,,,,,,,,, 64508,"INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 2,500.00 ",,, 11.74 , 10.58 , 8.14 , 8.14 ," 2,500.00 ",,,,,,,,,,,,,,, 64510,ED INJECTION ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC),Emergency department," 1,215.00 ",,," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64510,"INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64517,"INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,500.00 ", 764.84 ," 2,400.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 2,400.00 ",,,,,,,,,,,,,,, 64520,"INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64530,"INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING",OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 "," 1,243.53 "," 1,109.10 ", 813.34 , 764.84 ," 1,800.00 ",,,,,,,,,,,,,,, 64550,ED APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR,Emergency department, 525.10 ,,,,,,, 17.26 , 15.39 , 11.29 , 11.29 , 17.26 ,,,,,,,,,,,,,,, 64555,IMPLANT NEUROELECTRODES 1ST,OR LEVEL 5,," 23,543.80 ",337.2," 13,207.70 "," 1,200.00 "," 5,979.53 ",," 11,202.88 "," 9,991.76 "," 7,327.29 "," 1,200.00 "," 11,202.88 ",,,,,,,,,,,,,,, 64561,PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORAMINAL PLACEMENT),OR LEVEL 5,," 23,543.80 ", 337.20 ," 13,207.70 "," 2,000.00 "," 5,979.53 "," 2,800.00 "," 11,202.88 "," 9,991.76 "," 7,327.29 "," 2,000.00 "," 11,202.88 ",,,,,,,,,,,,,,, 64581,INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORAMINAL PLACEMENT),OR LEVEL 2,," 14,341.60 ", 171.67 ," 13,207.70 "," 2,000.00 "," 5,979.53 "," 2,800.00 "," 11,202.88 "," 9,991.76 "," 7,327.29 "," 2,000.00 "," 11,202.88 ",,,,,,,,,,,,,,, 64585,REVISE/REMOVE NEUROELECTRODE 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,495.36 "," 1,200.00 "," 2,879.80 "," 1,800.00 "," 5,326.85 "," 4,750.98 "," 3,484.05 "," 1,200.00 "," 5,326.85 ",,,,,,,,,,,,,,, 64590,"INSERTION OR REPLACEMENT OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING",OR LEVEL 4,," 21,812.00 ", 260.12 ," 43,030.72 "," 1,500.00 "," 18,707.16 "," 2,400.00 "," 33,982.45 "," 30,308.67 "," 22,226.36 "," 1,500.00 "," 33,982.45 ",,,,,,,,,,,,,,, 64595,REVISE/RMV PN/GASTR STIMUL 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 6,495.36 "," 1,200.00 "," 2,879.80 "," 1,800.00 "," 5,326.85 "," 4,750.98 "," 3,484.05 "," 1,200.00 "," 5,326.85 ",,,,,,,,,,,,,,, 64624,"DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 ",,,,,,, - , - ,,,,,,,,,,,,,,, 64625,"RFA OF SACROILIAC JOINT, W/ IMAGE GUIDANCE",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,595.04 ",,,,,,, - , - ,,,,,,,,,,,,,,, 64633,DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC SINGLE FACET JOINT,OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 1,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64634,DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64635,"DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT",OR LEVEL 1,," 12,325.60 ", 146.65 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 3,031.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 3,031.00 ",,,,,,,,,,,,,,, 64636,"DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64640,ED DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH,Emergency department," 1,600.65 ",,," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 ", 143.18 , 129.12 , 99.26 , 99.26 ," 1,800.00 ",,,,,,,,,,,,,,, 64640,DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH,OR LEVEL 1,," 12,325.60 ", 146.65 ," 1,704.36 "," 1,200.00 ", 764.84 ," 1,800.00 ", 143.18 , 129.12 , 99.26 , 99.26 ," 1,800.00 ",,,,,,,,,,,,,,, 64702,"NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 1,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64704,NEUROPLASTY; NERVE OF HAND OR FOOT,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 1,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64708,"NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; OTHER THAN SPECIFIED",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64712,"NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; SCIATIC NERVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64713,"NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; BRACHIAL PLEXUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64714,"NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64716,NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY),OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 2,000.00 "," 1,631.48 "," 2,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,631.48 "," 2,979.43 ",,,,,,,,,,,,,,, 64718,NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64719,NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64721,NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 2,100.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,631.48 "," 2,979.43 ",,,,,,,,,,,,,,, 64722,DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY),OR LEVEL 5,," 23,543.80 ", 337.20 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 1,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64726,DECOMPRESSION; PLANTAR DIGITAL NERVE,OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 1,200.00 "," 1,631.48 "," 1,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,200.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64727,"INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)",OR LEVEL 3,," 17,605.00 ", 219.52 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64772,"TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 "," 1,500.00 "," 1,631.48 "," 2,400.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,500.00 "," 2,979.43 ",,,,,,,,,,,,,,, 64776,"EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 "," 2,000.00 "," 1,631.48 "," 2,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,631.48 "," 2,979.43 ",,,,,,,,,,,,,,, 64778,"EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 2,," 14,341.60 ", 171.67 ,," 1,500.00 ",,,,,," 1,500.00 "," 1,500.00 ",,,,,,,,,,,,,,, 64782,"EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 "," 2,000.00 "," 1,631.48 "," 2,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,631.48 "," 2,979.43 ",,,,,,,,,,,,,,, 64784,"EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC",OR LEVEL 2,," 14,341.60 ", 171.67 ," 3,595.04 "," 2,000.00 "," 1,631.48 "," 2,800.00 "," 2,979.43 "," 2,657.33 "," 1,948.71 "," 1,631.48 "," 2,979.43 ",,,,,,,,,,,,,,, 64831,"SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 3,595.04 "," 2,200.00 "," 4,566.06 "," 3,300.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 2,200.00 "," 8,561.04 ",,,,,,,,,,,,,,, 64832,SUTURE DIGITAL NERVE HAND OR FOOT 1ST,OR LEVEL 2,," 14,341.60 ",171.67,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 64834,REPAIR OF HAND OR FOOT NERVE 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 12,357.30 "," 1,500.00 "," 4,566.06 "," 2,400.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 1,500.00 "," 8,561.04 ",,,,,,,,,,,,,,, 64836,SUTURE OF ONE NERVE; ULNAR MOTOR,OR LEVEL 2,," 14,341.60 ", 171.67 ," 12,357.30 "," 2,000.00 "," 4,566.06 "," 2,800.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 2,000.00 "," 8,561.04 ",,,,,,,,,,,,,,, 64910,"NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NERVE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 12,357.30 "," 1,500.00 "," 4,566.06 "," 3,031.00 "," 8,561.04 "," 7,635.52 "," 5,599.38 "," 1,500.00 "," 8,561.04 ",,,,,,,,,,,,,,, 64999,"UNLISTED PROCEDURE, NERVOUS SYSTEM",OR LEVEL 2,," 14,341.60 ", 171.67 , 543.78 ," 1,200.00 ", 247.48 ,, 452.70 , 403.76 , 296.09 , 247.48 ," 1,200.00 ",,,,,,,,,,,,,,, 65205,"EDREMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL",Emergency department, 723.25 ,,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 65210,ED REMOVAL OF FOREIGN BODY EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES CONCRETIONS) SUBCONJUNCTIVAL OR SCLERAL NONPERFORATING,Emergency department, 893.89 ,,, 755.14 ,, 348.16 ,, 610.52 , 544.52 , 399.31 , 348.16 , 610.52 ,,,,,,,,,,,,,,, 65220,ED REMOVAL OF FOREIGN BODY EXTERNAL EYE; CORNEAL WITHOUT SLIT LAMP,Emergency department, 744.13 ,,, 755.14 ,, 348.16 ,, 610.52 , 544.52 , 399.31 , 348.16 , 610.52 ,,,,,,,,,,,,,,, 65222,ED REMOVAL OF FOREIGN BODY EXTERNAL EYE; CORNEAL WITH SLIT LAMP,Emergency department, 876.00 ,,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 65235,EDREMOVAL OF FOREIGN BODY INTRAOCULAR; FROM ANTERIOR CHAMBER OF EYE OR LENS,Emergency department," 3,648.70 ",,," 4,318.88 "," 1,500.00 "," 1,917.16 "," 2,400.00 "," 3,554.02 "," 3,169.80 "," 2,324.52 "," 1,500.00 "," 3,554.02 ",,,,,,,,,,,,,,, 65426,EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT,OR LEVEL 2,," 14,341.60 ", 171.67 ," 4,228.44 "," 2,200.00 "," 1,812.68 "," 3,031.00 "," 3,351.00 "," 2,988.73 "," 2,191.73 "," 1,812.68 "," 3,351.00 ",,,,,,,,,,,,,,, 65435,ED REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION (ABRASION CURETTAGE),Emergency department," 1,549.14 ",,," 1,745.28 "," 1,200.00 ", 807.29 ," 1,800.00 ", 78.63 , 70.91 , 54.51 , 54.51 ," 1,800.00 ",,,,,,,,,,,,,,, 65436,"REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)",OR LEVEL 1,," 12,325.60 ", 146.65 ," 4,228.44 "," 1,200.00 "," 1,812.68 ",, 346.80 , 312.76 , 240.42 , 240.42 ," 1,812.68 ",,,,,,,,,,,,,,, 65779,"PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE; SINGLE LAYER, SUTURED",OR LEVEL 2,," 14,341.60 ", 171.67 ," 6,991.00 "," 1,200.00 "," 2,975.27 "," 2,400.00 "," 5,460.40 "," 4,870.09 "," 3,571.40 "," 1,200.00 "," 5,460.40 ",,,,,,,,,,,,,,, 66982,"EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUT",OR LEVEL 4,," 21,812.00 ", 260.12 ," 4,318.88 "," 2,450.00 "," 1,917.16 "," 2,832.00 "," 3,554.02 "," 3,169.80 "," 2,324.52 "," 1,917.16 "," 3,554.02 ",,,,,,,,,,,,,,, 66984,"EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION)",OR LEVEL 4,," 21,812.00 ", 260.12 ," 4,318.88 "," 2,450.00 "," 1,917.16 "," 2,832.00 "," 3,554.02 "," 3,169.80 "," 2,324.52 "," 1,917.16 "," 3,554.02 ",,,,,,,,,,,,,,, 66986,EXCHANGE OF INTRAOCULAR LENS,OR LEVEL 3,," 17,605.00 ", 219.52 ," 4,318.88 "," 2,450.00 "," 1,917.16 "," 2,779.00 "," 3,554.02 "," 3,169.80 "," 2,324.52 "," 1,917.16 "," 3,554.02 ",,,,,,,,,,,,,,, 67005,"REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL",OR LEVEL 3,," 17,605.00 ", 219.52 ," 4,318.88 "," 2,200.00 "," 1,917.16 "," 3,300.00 "," 3,554.02 "," 3,169.80 "," 2,324.52 "," 1,917.16 "," 3,554.02 ",,,,,,,,,,,,,,, 67560,REVISE EYE SOCKET IMPLANT 1ST,OR LEVEL 4,," 21,812.00 ",260.12," 6,991.00 "," 1,500.00 "," 2,975.27 "," 2,400.00 "," 5,460.40 "," 4,870.09 "," 3,571.40 "," 1,500.00 "," 5,460.40 ",,,,,,,,,,,,,,, 67700,ED BLEPHAROTOMY DRAINAGE OF ABSCESS EYELID,Emergency department," 3,516.38 ",,, 529.42 ," 1,200.00 ", 283.52 ," 1,800.00 ", 227.27 , 204.96 , 157.56 , 157.56 ," 1,800.00 ",,,,,,,,,,,,,,, 67900,REPAIR BROW DEFECT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 4,228.44 "," 2,200.00 "," 1,812.68 "," 3,300.00 "," 3,351.00 "," 2,988.73 "," 2,191.73 "," 1,812.68 "," 3,351.00 ",,,,,,,,,,,,,,, 67904,REPAIR EYELID DEFECT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 4,228.44 "," 2,200.00 "," 1,812.68 "," 3,300.00 "," 3,351.00 "," 2,988.73 "," 2,191.73 "," 1,812.68 "," 3,351.00 ",,,,,,,,,,,,,,, 67908,REPAIR EYELID DEFECT 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 4,228.44 "," 2,200.00 "," 1,812.68 "," 3,300.00 "," 3,351.00 "," 2,988.73 "," 2,191.73 "," 1,812.68 "," 3,351.00 ",,,,,,,,,,,,,,, 67917,"REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)",OR LEVEL 3,," 17,605.00 ", 219.52 ," 4,228.44 "," 2,200.00 "," 1,812.68 "," 3,300.00 "," 3,351.00 "," 2,988.73 "," 2,191.73 "," 1,812.68 "," 3,351.00 ",,,,,,,,,,,,,,, 67921,REPAIR ENTROPION SUTURE 1ST,OR LEVEL 2,," 14,341.60 ",171.67," 4,228.44 "," 2,000.00 "," 1,812.68 "," 2,800.00 "," 3,351.00 "," 2,988.73 "," 2,191.73 "," 1,812.68 "," 3,351.00 ",,,,,,,,,,,,,,, 67938,ED REMOVAL OF EMBEDDED FOREIGN BODY EYELID,Emergency department," 3,175.75 ",,, 529.42 ," 1,200.00 ", 283.52 ,, 227.27 , 204.96 , 157.56 , 157.56 ," 1,200.00 ",,,,,,,,,,,,,,, 69000,ED DRAINAGE EXTERNAL EAR ABSCESS OR HEMATOMA; SIMPLE,Emergency department," 2,460.13 ",,," 1,297.94 "," 1,200.00 ", 579.34 ,, 211.83 , 191.04 , 146.85 , 146.85 ," 1,200.00 ",,,,,,,,,,,,,,, 69000,"DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE",OR LEVEL 3,," 17,605.00 ", 219.52 ," 1,297.94 "," 1,200.00 ", 579.34 ,, 211.83 , 191.04 , 146.85 , 146.85 ," 1,200.00 ",,,,,,,,,,,,,,, 69005,ED DRAINAGE EXTERNAL EAR ABSCESS OR HEMATOMA; COMPLICATED,Emergency department," 2,800.63 ",,," 2,999.10 "," 1,200.00 "," 1,375.50 ",, 208.90 , 188.40 , 144.82 , 144.82 ," 1,375.50 ",,,,,,,,,,,,,,, 69105,BIOPSY EXTERNAL AUDITORY CANAL,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 ",," 1,279.10 ",, 173.69 , 156.64 , 120.41 , 120.41 ," 1,279.10 ",,,,,,,,,,,,,,, 69110,"EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,200.00 "," 2,378.29 "," 1,800.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,200.00 "," 4,301.01 ",,,,,,,,,,,,,,, 69145,"EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL",OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,166.50 "," 1,500.00 "," 2,378.29 "," 2,400.00 "," 4,301.01 "," 3,836.04 "," 2,813.09 "," 1,500.00 "," 4,301.01 ",,,,,,,,,,,,,,, 69200,ED REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA,Emergency department," 1,622.50 ",,, 232.22 ," 2,500.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 2,500.00 ",,,,,,,,,,,,,,, 69200,REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA,OR LEVEL 1,," 12,325.60 ", 146.65 , 232.22 ," 2,500.00 ", 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 ," 2,500.00 ",,,,,,,,,,,,,,, 69205,REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA,OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,999.10 "," 1,200.00 "," 1,375.50 "," 1,800.00 "," 2,493.86 "," 2,224.25 "," 1,631.12 "," 1,200.00 "," 2,493.86 ",,,,,,,,,,,,,,, 69209,ED REMOVE IMPACTED EAR WAX UNI,Emergency department, 341.75 ,,, 114.96 ," 1,200.00 ", 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 ," 1,200.00 ",,,,,,,,,,,,,,, 69209,REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNILATERAL,OR LEVEL 1,," 12,325.60 ", 146.65 , 114.96 ," 1,200.00 ", 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 ," 1,200.00 ",,,,,,,,,,,,,,, 69210,ED REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION UNILATERAL,Emergency department, 664.25 ,,, 114.96 ," 1,200.00 ", 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 ," 1,200.00 ",,,,,,,,,,,,,,, 69210,"REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS",OR LEVEL 1,," 12,325.60 ", 146.65 , 114.96 ," 1,200.00 ", 55.90 ,, 103.53 , 92.33 , 67.71 , 55.90 ," 1,200.00 ",,,,,,,,,,,,,,, 69220,ED DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE (EG ROUTINE CLEANING),Emergency department, 542.98 ,,, 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 69220,"DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE CLEANING)",OR LEVEL 3,," 17,605.00 ", 219.52 , 361.16 ,, 176.45 ,, 312.56 , 278.77 , 204.43 , 176.45 , 312.56 ,,,,,,,,,,,,,,, 69222,"DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN ROUTINE CLEANING)",OR LEVEL 3,," 17,605.00 ", 219.52 , 913.64 ," 1,500.00 ", 487.13 ,, 262.30 , 236.55 , 181.84 , 181.84 ," 1,500.00 ",,,,,,,,,,,,,,, 69300,"OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 5,690.06 "," 2,000.00 "," 2,231.27 "," 2,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,000.00 "," 4,068.26 ",,,,,,,,,,,,,,, 69421,MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,690.06 "," 2,000.00 "," 2,231.27 "," 2,800.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,000.00 "," 4,068.26 ",,,,,,,,,,,,,,, 69424,VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA,OR LEVEL 1,," 12,325.60 ", 146.65 ," 5,690.06 "," 1,200.00 "," 2,231.27 "," 1,800.00 ", 154.33 , 139.18 , 106.99 , 106.99 ," 2,231.27 ",,,,,,,,,,,,,,, 69436,"TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA",OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 "," 2,000.00 "," 1,279.10 "," 2,800.00 "," 2,105.63 "," 1,878.00 "," 1,377.20 "," 1,279.10 "," 2,800.00 ",,,,,,,,,,,,,,, 69540,EXCISION AURAL POLYP,OR LEVEL 2,," 14,341.60 ", 171.67 ," 2,776.28 "," 1,500.00 "," 1,279.10 ",, 259.37 , 233.91 , 179.81 , 179.81 ," 1,500.00 ",,,,,,,,,,,,,,, 69610,"TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH",OR LEVEL 3,," 17,605.00 ", 219.52 ," 2,776.28 "," 2,000.00 "," 2,231.27 ",, 335.65 , 302.70 , 232.69 , 232.69 ," 2,231.27 ",,,,,,,,,,,,,,, 69620,MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA),OR LEVEL 3,," 17,605.00 ", 219.52 ," 5,690.06 "," 1,500.00 "," 2,231.27 "," 2,400.00 "," 4,068.26 "," 3,628.45 "," 2,660.86 "," 1,500.00 "," 4,068.26 ",,,,,,,,,,,,,,, 69631,"TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION",OR LEVEL 4,," 21,812.00 ", 260.12 ," 10,679.34 "," 2,200.00 "," 4,424.23 "," 3,031.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,200.00 "," 8,026.76 ",,,,,,,,,,,,,,, 69635,"TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 69641,"TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION",OR LEVEL 3,," 17,605.00 ", 219.52 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 69642,"TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 69645,"TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITHOUT OSSICULAR CHAIN RECONSTRUCTION",OR LEVEL 2,," 14,341.60 ", 171.67 ," 10,679.34 "," 2,450.00 "," 4,424.23 "," 2,779.00 "," 8,026.76 "," 7,159.00 "," 5,249.94 "," 2,450.00 "," 8,026.76 ",,,,,,,,,,,,,,, 69799,"UNLISTED PROCEDURE, MIDDLE EAR",OR LEVEL 3,," 17,605.00 ", 219.52 , 415.66 ," 1,200.00 ", 206.14 ,, 330.23 , 294.53 , 215.99 , 206.14 ," 1,200.00 ",,,,,,,,,,,,,,, 69801,"LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE PROCEDURES OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); TRANSCANAL",OR LEVEL 1,," 12,325.60 ", 146.65 ," 2,776.28 "," 2,200.00 "," 1,279.10 "," 3,031.00 ", 185.43 , 167.23 , 128.55 , 128.55 ," 3,031.00 ",,,,,,,,,,,,,,, 69990,"MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",OR LEVEL 1,," 12,325.60 ", 146.65 ,," 1,200.00 ",,,,,," 1,200.00 "," 1,200.00 ",,,,,,,,,,,,,,, 70010,"MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION",70010," 13,053.45 ",,, 736.86 , 44.83 , 385.88 ,, 625.23 , 565.90 , 515.70 , 44.83 , 625.23 ,,,,,,,,,,,,,,, 70015,"CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION",70015," 13,053.45 ",,," 1,481.50 ", 83.57 , 691.75 ," 1,120.27 ", 934.18 , 845.53 , 770.52 , 83.57 ," 1,120.27 ",,,,,,,,,,,,,,, 70030,"RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY",70030," 2,019.18 ",,, 173.76 , 19.21 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 19.21 , 100.38 ,,,,,,,,,,,,,,, 70100,"RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS",70100," 1,261.61 ",,, 173.76 , 23.41 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 23.41 , 100.98 ,,,,,,,,,,,,,,, 70110,"RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS",70110," 2,019.18 ",,, 213.76 , 24.80 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 24.80 , 186.51 ,,,,,,,,,,,,,,, 70120,"RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE",70120," 1,261.61 ",,, 213.76 , 23.76 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 23.76 , 185.92 ,,,,,,,,,,,,,,, 70130,"RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE",70130," 2,019.18 ",,, 213.76 , 36.35 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 36.35 , 187.11 ,,,,,,,,,,,,,,, 70134,"RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE",70134," 2,019.18 ",,," 1,006.26 ", 32.15 , 497.49 , 378.97 , 318.26 , 288.06 , 262.51 , 32.15 , 497.49 ,,,,,,,,,,,,,,, 70140,"RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS",70140," 2,019.18 ",,, 173.76 , 18.86 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 18.86 , 100.38 ,,,,,,,,,,,,,,, 70150,"RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS",70150," 2,019.18 ",,, 213.76 , 27.60 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 27.60 , 186.51 ,,,,,,,,,,,,,,, 70160,"RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF THREE VIEWS",70160," 2,019.18 ",,, 173.76 , 23.76 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 23.76 , 100.98 ,,,,,,,,,,,,,,, 70170,"DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION",70170," 7,161.89 ",,, 467.04 , 225.56 , 230.56 , 382.53 , 318.26 , 288.06 , 262.51 , 225.56 , 382.53 ,,,,,,,,,,,,,,, 70190,RADIOLOGIC EXAMINATION; OPTIC FORAMINA,70190," 2,019.18 ",,, 173.76 , 24.11 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 24.11 , 100.98 ,,,,,,,,,,,,,,, 70200,"RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS",70200," 2,019.18 ",,, 213.76 , 27.60 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 27.60 , 186.51 ,,,,,,,,,,,,,,, 70210,"RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS",70210," 1,261.61 ",,, 173.76 , 20.60 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.60 , 100.98 ,,,,,,,,,,,,,,, 70220,"RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS",70220," 1,261.61 ",,, 173.76 , 24.46 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 24.46 , 100.98 ,,,,,,,,,,,,,,, 70240,"RADIOLOGIC EXAMINATION, SELLA TURCICA",70240," 1,261.61 ",,, 173.76 , 20.60 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.60 , 100.98 ,,,,,,,,,,,,,,, 70250,"RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS",70250, 662.36 ,,, 213.76 , 23.41 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 23.41 , 185.92 ,,,,,,,,,,,,,,, 70260,"RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS",70260," 1,261.61 ",,, 213.76 , 27.60 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 27.60 , 186.51 ,,,,,,,,,,,,,,, 70300,"RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW",70300," 1,261.61 ",,, 173.76 , 8.71 , 62.30 , 98.60 , 85.10 , 77.03 , 70.20 , 8.71 , 98.60 ,,,,,,,,,,,,,,, 70310,"RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS THAN FULL MOUTH",70310," 2,019.18 ",,, 467.04 , 28.66 , 230.56 , 378.97 , 318.26 , 288.06 , 262.51 , 28.66 , 378.97 ,,,,,,,,,,,,,,, 70320,"RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH",70320," 1,261.61 ",,, 467.04 , 39.84 , 230.56 , 380.16 , 318.26 , 288.06 , 262.51 , 39.84 , 380.16 ,,,,,,,,,,,,,,, 70328,"RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; UNILATERAL",70328," 1,261.61 ",,, 173.76 , 20.96 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.96 , 100.98 ,,,,,,,,,,,,,,, 70330,"RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; BILATERAL",70330," 1,261.61 ",,, 173.76 , 34.25 , 62.30 , 101.57 , 85.10 , 77.03 , 70.20 , 34.25 , 101.57 ,,,,,,,,,,,,,,, 70332,"TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",70332," 7,196.31 ",,, 467.04 , 43.00 , 230.56 , 380.16 , 318.26 , 288.06 , 262.51 , 43.00 , 380.16 ,,,,,,,,,,,,,,, 70336,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULAR JOINT(S)",70336," 6,535.88 ",,, 467.04 , 318.56 , 230.56 , 381.94 , 343.82 , 308.97 , 264.83 , 230.56 , 381.94 ,,,,,,,,,,,,,,, 70350,"CEPHALOGRAM, ORTHODONTIC",70350," 2,019.18 ",,, 173.76 , 9.42 , 62.30 , 98.60 , 85.10 , 77.03 , 70.20 , 9.42 , 98.60 ,,,,,,,,,,,,,,, 70355,ORTHOPANTOGRAM,70355," 1,261.61 ",,, 173.76 , 9.42 , 62.30 , 98.60 , 85.10 , 77.03 , 70.20 , 9.42 , 98.60 ,,,,,,,,,,,,,,, 70360,"RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE",70360," 2,019.18 ",,, 173.76 , 19.56 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 19.56 , 100.98 ,,,,,,,,,,,,,,, 70370,"RADIOLOGIC EXAMINATION; PHARYNX OR LARYNX, INCLUDING FLUOROSCOPY AND/OR MAGNIFICATION TECHNIQUE",70370," 3,390.01 ",,, 173.76 , 55.24 , 62.30 , 101.57 , 85.10 , 77.03 , 70.20 , 55.24 , 101.57 ,,,,,,,,,,,,,,, 70371,COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY CINE OR VIDEO RECORDING,70371," 3,390.01 ",,, 467.04 , 46.49 , 230.56 , 380.75 , 318.26 , 288.06 , 262.51 , 46.49 , 380.75 ,,,,,,,,,,,,,,, 70380,"RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS",70380," 1,261.61 ",,, 173.76 , 23.41 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 23.41 , 100.98 ,,,,,,,,,,,,,,, 70390,"SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",70390," 7,161.89 ",,, 467.04 , 74.12 , 230.56 , 381.34 , 318.26 , 288.06 , 262.51 , 74.12 , 381.34 ,,,,,,,,,,,,,,, 70450,"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL",70450," 4,514.09 ",,, 213.76 , 85.03 , 112.51 , 284.40 , 169.40 , 152.23 , 130.48 , 85.03 , 284.40 ,,,,,,,,,,,,,,, 70460,"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S)",70460," 5,119.55 ",,, 360.68 , 123.25 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 123.25 , 629.99 ,,,,,,,,,,,,,,, 70470,"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH & WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",70470," 6,101.33 ",,, 360.68 , 148.32 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 148.32 , 629.99 ,,,,,,,,,,,,,,, 70480,"COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL",70480," 4,776.56 ",,, 213.76 , 130.66 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 70481,"COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITH CONTRAST MATERIAL(S)",70481," 5,119.55 ",,, 360.68 , 239.56 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 70482,"COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",70482," 6,501.79 ",,, 360.68 , 264.59 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 70486,"COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL",70486," 4,885.73 ",,, 213.76 , 111.74 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 111.74 , 285.30 ,,,,,,,,,,,,,,, 70487,"COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S)",70487," 5,119.55 ",,, 360.68 , 129.01 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 129.01 , 629.99 ,,,,,,,,,,,,,,, 70488,"COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",70488," 6,249.52 ",,, 360.68 , 163.12 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 163.12 , 629.99 ,,,,,,,,,,,,,,, 70490,"COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL",70490," 5,140.30 ",,, 213.76 , 120.37 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 70491,"COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITH CONTRAST MATERIAL(S)",70491," 5,119.55 ",,, 360.68 , 155.30 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 155.30 , 629.99 ,,,,,,,,,,,,,,, 70492,"CT, SOFT TISSUE NECK, W/ WO",70492," 6,650.40 ",,, 360.68 , 189.83 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 189.83 , 630.89 ,,,,,,,,,,,,,,, 70496,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",70496," 7,000.13 ",,, 360.68 , 238.28 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 70498,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",70498," 7,009.88 ",,, 360.68 , 237.47 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 70540,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITHOUT CONTRAST MATERIAL(S)",70540," 6,086.21 ",,, 467.04 , 284.52 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 70542,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITH CONTRAST MATERIAL(S)",70542," 9,074.60 ",,, 736.86 , 335.86 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 335.86 ," 1,137.59 ",,,,,,,,,,,,,,, 70543,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",70543," 10,265.45 ",,, 736.86 , 414.90 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 70544,"MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S)",70544," 6,382.63 ",,, 467.04 , 319.06 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 70545,"MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S)",70545," 9,074.60 ",,, 736.86 , 346.73 , 385.88 , 629.99 , 374.06 , 336.14 , 288.12 , 288.12 , 629.99 ,,,,,,,,,,,,,,, 70546,"MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",70546," 10,265.45 ",,, 736.86 , 572.94 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,137.59 ",,,,,,,,,,,,,,, 70547,"MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S)",70547," 6,366.88 ",,, 467.04 , 319.06 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 70548,"MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S)",70548," 9,074.60 ",,, 736.86 , 346.73 , 385.88 , 629.99 , 374.06 , 336.14 , 288.12 , 288.12 , 629.99 ,,,,,,,,,,,,,,, 70549,"MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",70549," 10,265.45 ",,, 736.86 , 576.90 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,137.59 ",,,,,,,,,,,,,,, 70551,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL",70551," 6,086.21 ",,, 467.04 , 218.81 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 218.81 , 579.59 ,,,,,,,,,,,,,,, 70552,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST MATERIAL(S)",70552," 9,074.60 ",,, 736.86 , 323.00 , 385.88 , 629.99 , 374.06 , 336.14 , 288.12 , 288.12 , 629.99 ,,,,,,,,,,,,,,, 70553,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",70553," 10,265.45 ",,, 736.86 , 368.46 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 368.46 ," 1,137.59 ",,,,,,,,,,,,,,, 70554,"MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; INCLUDING TEST SELECTION AND ADMINISTRATION OF REPETITIVE BODY PART MOVEMENT AND/OR VISUAL STIMULATION, NOT REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMINISTRATION",70554," 7,090.88 ",,, 467.04 , 480.56 , 230.56 ,, 343.82 , 308.97 , 264.83 , 230.56 , 480.56 ,,,,,,,,,,,,,,, 70555,"MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI; REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMINISTRATION OF ENTIRE NEUROFUNCTIONAL TESTING",70555," 7,549.06 ",,, 467.04 , 855.36 , 230.56 ,, 189.08 , 169.92 , 145.65 , 145.65 , 855.36 ,,,,,,,,,,,,,,, 70557,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL BASE), DURING OPEN INTRACRANIAL PROCEDURE (EG, TO ASSESS FOR RESIDUAL TUMOR OR RESIDUAL VASCULAR MALFORMATION); WITHOUT CONTRAST MATERIAL",70557," 6,086.21 ",,," 1,006.26 ", 318.60 , 497.49 , 579.59 , 334.83 , 303.06 , 276.17 , 276.17 , 579.59 ,,,,,,,,,,,,,,, 70558,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL BASE), DURING OPEN INTRACRANIAL PROCEDURE (EG, TO ASSESS FOR RESIDUAL TUMOR OR RESIDUAL VASCULAR MALFORMATION); WITH CONTRAST MATERIAL(S)",70558," 9,074.60 ",,, 360.68 , 346.76 , 201.74 , 630.89 , 345.16 , 312.41 , 284.69 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 70559,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM AND SKULL BASE), DURING OPEN INTRACRANIAL PROCEDURE (EG, TO ASSESS FOR RESIDUAL TUMOR OR RESIDUAL VASCULAR MALFORMATION); WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) ",70559," 10,265.45 ",,, 360.68 , 346.76 , 201.74 , 630.89 , 345.16 , 312.41 , 284.69 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 71010,X RAY CHEST SINGLE VIEW FRONTAL,, 618.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71020,"RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL;",71020," 1,261.61 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71021,"RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE",71021," 1,261.61 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71022,"RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE PROJECTIONS",71022," 2,019.18 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71023,"RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH FLUOROSCOPY",71023," 2,019.18 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71030,"RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS;",71030," 2,019.18 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71034,"RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; WITH FLUOROSCOPY",71034," 3,390.01 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71035,"RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES)",71035," 1,261.61 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 71045,XRAY- CHEST; SINGLE VIEW,71045, 659.92 ,,, 173.76 , 12.56 , 62.30 , 99.20 , 85.10 , 77.03 , 70.20 , 12.56 , 99.20 ,,,,,,,,,,,,,,, 71046,"X-RAY, CHEST; 2 VIEWS",71046, 839.30 ,,, 173.76 , 19.21 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 19.21 , 100.38 ,,,,,,,,,,,,,,, 71047,"X-RAY, CHEST; 3 VIEWS",71047, 840.73 ,,, 173.76 , 24.46 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 24.46 , 100.98 ,,,,,,,,,,,,,,, 71048,"X-RAY, CHEST; 4 VIEWS",71048, 831.21 ,,, 213.76 , 25.15 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 25.15 , 186.51 ,,,,,,,,,,,,,,, 71100,"RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS",71100," 1,261.61 ",,, 173.76 , 21.66 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 21.66 , 100.98 ,,,,,,,,,,,,,,, 71101,"RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF THREE VIEWS",71101," 2,019.18 ",,, 213.76 , 24.11 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 24.11 , 185.92 ,,,,,,,,,,,,,,, 71110,"RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS",71110," 2,019.18 ",,, 213.76 , 24.80 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 24.80 , 186.51 ,,,,,,,,,,,,,,, 71111,"RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF FOUR VIEWS",71111," 2,019.18 ",,, 213.76 , 30.05 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 30.05 , 186.51 ,,,,,,,,,,,,,,, 71120,"RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS",71120," 2,019.18 ",,, 173.76 , 19.21 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 19.21 , 100.38 ,,,,,,,,,,,,,,, 71130,"RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS, MINIMUM OF THREE VIEWS",71130," 2,019.18 ",,, 173.76 , 24.46 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 24.46 , 100.98 ,,,,,,,,,,,,,,, 71250,"COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL",71250," 4,593.90 ",,, 213.76 , 121.20 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 71260,"COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)",71260," 6,089.75 ",,, 360.68 , 155.72 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 155.72 , 629.99 ,,,,,,,,,,,,,,, 71270,"COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",71270," 6,208.61 ",,, 360.68 , 192.71 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 192.71 , 630.89 ,,,,,,,,,,,,,,, 71271,"CT THORAX, LOW DOSE FOR LUNG CANCER SCREENING, WITHOUT CONTRAST",71271," 5,500.77 ",,, 213.76 ,,,,,,, - , - ,,,,,,,,,,,,,,, 71275,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",71275," 6,080.17 ",,, 360.68 , 242.40 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 71550,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S)",71550," 6,086.21 ",,, 467.04 , 318.60 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 71551,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITH CONTRAST MATERIAL(S)",71551," 9,074.60 ",,," 1,481.50 ", 518.15 , 691.75 ," 1,701.88 "," 1,009.18 ", 906.90 , 777.34 , 518.15 ," 1,701.88 ",,,,,,,,,,,,,,, 71552,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",71552," 10,382.68 ",,, 736.86 , 626.29 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 71555,"MAGNETIC RESONANCE ANGIOGRAPHY, CHEST (EXCLUDING MYOCARDIUM), WITH OR WITHOUT CONTRAST MATERIAL(S)",71555," 3,430.89 ",,,, 433.18 ,," 1,138.49 ", 465.82 , 418.60 , 358.80 , 358.80 ," 1,138.49 ",,,,,,,,,,,,,,, 72010,"RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL",72010," 3,390.01 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 72020,"RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL",72020," 2,019.18 ",,, 173.76 , 14.32 , 62.30 , 99.79 , 85.10 , 77.03 , 70.20 , 14.32 , 99.79 ,,,,,,,,,,,,,,, 72040,"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; TWO OR THREE VIEWS",72040," 2,019.18 ",,, 173.76 , 21.66 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 21.66 , 100.98 ,,,,,,,,,,,,,,, 72050,"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS",72050," 1,326.58 ",,, 213.76 , 29.00 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 29.00 , 186.51 ,,,,,,,,,,,,,,, 72052,"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSION STUDIES",72052," 2,019.18 ",,, 213.76 , 37.04 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 37.04 , 187.11 ,,,,,,,,,,,,,,, 72070,"RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS",72070," 2,019.18 ",,, 213.76 , 22.36 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 22.36 , 185.92 ,,,,,,,,,,,,,,, 72072,"RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS",72072," 2,019.18 ",,, 213.76 , 23.41 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 23.41 , 185.92 ,,,,,,,,,,,,,,, 72074,"RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS",72074," 2,019.18 ",,, 213.76 , 27.60 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 27.60 , 186.51 ,,,,,,,,,,,,,,, 72080,"RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR, TWO VIEWS",72080," 2,019.18 ",,, 173.76 , 22.01 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 22.01 , 100.98 ,,,,,,,,,,,,,,, 72082,XR EXAM ENTIRE SPI 2/3 VW,," 1,676.77 ",,, 213.76 , 45.44 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 45.44 , 187.70 ,,,,,,,,,,,,,,, 72100,"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS",72100," 2,019.18 ",,, 213.76 , 23.41 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 23.41 , 185.92 ,,,,,,,,,,,,,,, 72110,"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; MINIMUM OF FOUR VIEWS",72110," 2,019.18 ",,, 213.76 , 32.50 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 32.50 , 187.11 ,,,,,,,,,,,,,,, 72114,"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS",72114," 1,261.61 ",,, 213.76 , 44.39 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 44.39 , 187.11 ,,,,,,,,,,,,,,, 72120,"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS",72120," 13,053.45 ",,, 213.76 , 29.00 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 29.00 , 186.51 ,,,,,,,,,,,,,,, 72125,"COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL",72125," 8,000.07 ",,, 213.76 , 130.66 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 72126,"COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL",72126," 5,861.63 ",,, 736.86 , 193.52 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 193.52 ," 1,138.49 ",,,,,,,,,,,,,,, 72127,"COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",72127," 6,823.60 ",,, 360.68 , 239.96 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 72128,"COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL",72128," 6,342.97 ",,, 213.76 , 130.66 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 72129,"COMPUTED TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL",72129," 5,909.97 ",,, 360.68 , 194.76 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 194.76 , 630.89 ,,,,,,,,,,,,,,, 72130,"COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",72130," 6,658.61 ",,, 360.68 , 241.61 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 72131,"COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL",72131," 6,489.81 ",,, 213.76 , 130.66 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 72132,"COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL",72132," 5,947.41 ",,, 736.86 , 193.52 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 193.52 ," 1,138.49 ",,,,,,,,,,,,,,, 72133,"COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",72133," 7,366.48 ",,, 360.68 , 238.73 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 72141,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL",72141," 8,785.87 ",,, 467.04 , 209.92 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 209.92 , 579.59 ,,,,,,,,,,,,,,, 72142,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITH CONTRAST MATERIAL(S)",72142," 9,074.60 ",,, 736.86 , 330.91 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 330.91 ," 1,137.59 ",,,,,,,,,,,,,,, 72146,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL",72146," 3,208.54 ",,, 467.04 , 210.41 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 210.41 , 579.59 ,,,,,,,,,,,,,,, 72147,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITH CONTRAST MATERIAL(S)",72147," 9,074.60 ",,, 736.86 , 327.95 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 327.95 ," 1,137.59 ",,,,,,,,,,,,,,, 72148,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL",72148," 8,385.37 ",,, 467.04 , 209.92 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 209.92 , 579.59 ,,,,,,,,,,,,,,, 72149,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITH CONTRAST MATERIAL(S)",72149," 9,074.60 ",,, 736.86 , 324.98 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 324.98 ," 1,137.59 ",,,,,,,,,,,,,,, 72156,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; CERVICAL",72156," 10,265.45 ",,, 736.86 , 371.42 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 371.42 ," 1,137.59 ",,,,,,,,,,,,,,, 72157,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; THORACIC",72157," 10,265.45 ",,, 736.86 , 372.41 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 372.41 ," 1,137.59 ",,,,,,,,,,,,,,, 72158,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR",72158," 12,203.69 ",,, 736.86 , 369.94 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 369.94 ," 1,137.59 ",,,,,,,,,,,,,,, 72159,"MAGNETIC RESONANCE ANGIOGRAPHY, SPINAL CANAL AND CONTENTS, WITH OR WITHOUT CONTRAST MATERIAL(S)",72159," 4,609.07 ",,,, 347.22 ,, 630.89 , 345.16 , 312.41 , 284.69 , 284.69 , 630.89 ,,,,,,,,,,,,,,, 72170,"RADIOLOGIC EXAMINATION, PELVIS; ONE OR TWO VIEWS",72170," 1,453.48 ",,, 213.76 , 22.70 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 22.70 , 185.92 ,,,,,,,,,,,,,,, 72190,"RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS",72190," 1,261.61 ",,, 213.76 , 26.56 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 26.56 , 186.51 ,,,,,,,,,,,,,,, 72191,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",72191," 5,991.23 ",,, 360.68 , 250.20 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 72192,"COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL",72192," 4,701.87 ",,, 213.76 , 106.00 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 106.00 , 285.30 ,,,,,,,,,,,,,,, 72193,"COMPUTED TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S)",72193," 5,119.55 ",,, 360.68 , 194.35 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 194.35 , 630.89 ,,,,,,,,,,,,,,, 72194,"COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",72194," 6,484.06 ",,, 360.68 , 230.93 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 72195,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S)",72195," 8,079.63 ",,, 467.04 , 318.60 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 72196,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S)",72196," 9,074.60 ",,, 736.86 , 364.51 , 385.88 ," 1,137.59 ", 675.43 , 606.97 , 520.26 , 364.51 ," 1,137.59 ",,,,,,,,,,,,,,, 72197,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",72197," 10,265.45 ",,, 736.86 , 441.58 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 72198,"MAGNETIC RESONANCE ANGIOGRAPHY, PELVIS, WITH OR WITHOUT CONTRAST MATERIAL(S)",72198," 3,917.71 ",,,, 435.65 ,," 1,138.49 ", 468.48 , 421.00 , 360.86 , 360.86 ," 1,138.49 ",,,,,,,,,,,,,,, 72200,"RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS",72200," 1,261.61 ",,, 213.76 , 19.21 , 112.51 , 185.33 , 156.81 , 141.93 , 129.34 , 19.21 , 185.33 ,,,,,,,,,,,,,,, 72202,"RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS",72202," 1,261.61 ",,, 213.76 , 23.05 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 23.05 , 185.92 ,,,,,,,,,,,,,,, 72220,"RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS",72220," 1,261.61 ",,, 173.76 , 19.21 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 19.21 , 100.38 ,,,,,,,,,,,,,,, 72240,"MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",72240," 13,053.45 ",,," 1,481.50 ", 51.73 , 691.75 ," 1,117.30 ", 934.18 , 845.53 , 770.52 , 51.73 ," 1,117.30 ",,,,,,,,,,,,,,, 72255,"MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION",72255," 3,181.02 ",,," 1,481.50 ", 51.04 , 691.75 ," 1,117.30 ", 934.18 , 845.53 , 770.52 , 51.04 ," 1,117.30 ",,,,,,,,,,,,,,, 72265,"MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",72265," 7,196.31 ",,," 1,481.50 ", 49.99 , 691.75 ," 1,117.30 ", 934.18 , 845.53 , 770.52 , 49.99 ," 1,117.30 ",,,,,,,,,,,,,,, 72270,"MYELOGRAPHY, TWO OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/THORACIC, LUMBAR/CERVICAL, LUMBAR/THORACIC/CERVICAL), RADIOLOGICAL SUPERVISION AND INTERPRETATION",72270," 13,053.45 ",,," 1,481.50 ", 59.44 , 691.75 ," 1,118.49 ", 934.18 , 845.53 , 770.52 , 59.44 ," 1,118.49 ",,,,,,,,,,,,,,, 72275,"EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",72275," 2,409.53 ",,,, 75.52 ,,, 106.20 , 96.12 , 87.60 , 75.52 , 106.20 ,,,,,,,,,,,,,,, 72285,"DISCOGRAPHY, CERVICAL OR THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION",72285," 7,212.24 ",,," 3,595.04 ", 51.38 ," 1,631.48 "," 2,639.71 "," 2,206.39 "," 1,997.02 "," 1,819.87 ", 51.38 ," 2,639.71 ",,,,,,,,,,,,,,, 72291,"RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY OR VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION, PER VERTEBRAL BODY; UNDER FLUOROSCOPIC GUIDANCE",72291," 1,799.94 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 72295,"DISCOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION AND INTERPRETATION",72295," 7,212.24 ",,," 3,595.04 ", 53.14 ," 1,631.48 "," 2,640.30 "," 2,206.39 "," 1,997.02 "," 1,819.87 ", 53.14 ," 2,640.30 ",,,,,,,,,,,,,,, 73000,"RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE",73000," 2,019.18 ",,, 173.76 , 19.21 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 19.21 , 100.38 ,,,,,,,,,,,,,,, 73010,"RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE",73010," 1,261.61 ",,, 213.76 , 20.96 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 20.96 , 185.92 ,,,,,,,,,,,,,,, 73020,"RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW",73020," 1,261.61 ",,, 173.76 , 14.66 , 62.30 , 99.79 , 85.10 , 77.03 , 70.20 , 14.66 , 99.79 ,,,,,,,,,,,,,,, 73030,"RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS",73030," 1,261.61 ",,, 173.76 , 19.56 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 19.56 , 100.98 ,,,,,,,,,,,,,,, 73040,"RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",73040," 4,221.69 ",,, 736.86 , 72.72 , 385.88 , 749.62 , 625.23 , 565.90 , 515.70 , 72.72 , 749.62 ,,,,,,,,,,,,,,, 73050,"RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED DISTRACTION",73050," 2,019.18 ",,, 173.76 , 24.80 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 24.80 , 100.98 ,,,,,,,,,,,,,,, 73060,"RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS",73060," 1,261.61 ",,, 173.76 , 20.26 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.26 , 100.98 ,,,,,,,,,,,,,,, 73070,"RADIOLOGIC EXAMINATION, ELBOW; TWO VIEWS",73070," 1,261.61 ",,, 173.76 , 18.86 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 18.86 , 100.38 ,,,,,,,,,,,,,,, 73080,"RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREE VIEWS",73080," 1,171.94 ",,, 173.76 , 22.36 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 22.36 , 100.98 ,,,,,,,,,,,,,,, 73085,"RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",73085," 7,196.31 ",,, 736.86 , 66.07 , 385.88 , 749.03 , 625.23 , 565.90 , 515.70 , 66.07 , 749.03 ,,,,,,,,,,,,,,, 73090,"RADIOLOGIC EXAMINATION; FOREARM, TWO VIEWS",73090," 2,019.18 ",,, 173.76 , 17.11 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 17.11 , 100.38 ,,,,,,,,,,,,,,, 73092,"RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS",73092," 2,019.18 ",,, 213.76 , 18.86 , 112.51 , 185.33 , 156.81 , 141.93 , 129.34 , 18.86 , 185.33 ,,,,,,,,,,,,,,, 73100,"RADIOLOGIC EXAMINATION, WRIST; TWO VIEWS",73100," 1,261.61 ",,, 173.76 , 22.36 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 22.36 , 100.98 ,,,,,,,,,,,,,,, 73110,"RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREE VIEWS",73110," 1,368.00 ",,, 173.76 , 25.86 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 25.86 , 100.98 ,,,,,,,,,,,,,,, 73115,"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",73115," 1,643.39 ",,, 736.86 , 77.27 , 385.88 , 415.20 , 346.25 , 313.40 , 285.60 , 77.27 , 415.20 ,,,,,,,,,,,,,,, 73120,"RADIOLOGIC EXAMINATION, HAND; TWO VIEWS",73120," 1,641.81 ",,, 213.76 , 19.56 , 112.51 , 185.33 , 156.81 , 141.93 , 129.34 , 19.56 , 185.33 ,,,,,,,,,,,,,,, 73130,"RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS",73130," 2,019.18 ",,, 173.76 , 22.70 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 22.70 , 100.98 ,,,,,,,,,,,,,,, 73140,"RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS",73140," 1,641.81 ",,, 173.76 , 24.80 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 24.80 , 100.98 ,,,,,,,,,,,,,,, 73200,"COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL",73200," 3,344.18 ",,, 213.76 , 130.66 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 73201,"COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)",73201," 5,119.55 ",,, 736.86 , 190.64 , 385.88 , 630.89 , 374.06 , 336.14 , 288.12 , 190.64 , 630.89 ,,,,,,,,,,,,,,, 73202,"COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",73202," 6,043.61 ",,, 360.68 , 251.47 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 73206,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",73206," 7,114.54 ",,, 360.68 , 276.50 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 73218,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S)",73218," 7,490.16 ",,, 467.04 , 319.06 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 73219,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S)",73219," 9,187.56 ",,, 736.86 , 449.98 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 73220,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",73220," 10,265.45 ",,, 736.86 , 548.28 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 73221,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S)",73221," 6,086.21 ",,, 467.04 , 236.56 , 230.56 , 578.69 , 343.82 , 308.97 , 264.83 , 230.56 , 578.69 ,,,,,,,,,,,,,,, 73222,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)",73222," 9,074.60 ",,," 1,481.50 ", 416.38 , 691.75 ," 1,700.98 "," 1,009.18 ", 906.90 , 777.34 , 416.38 ," 1,700.98 ",,,,,,,,,,,,,,, 73223,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",73223," 10,265.45 ",,, 736.86 , 507.28 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 73225,"MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY, WITH OR WITHOUT CONTRAST MATERIAL(S)",73225," 7,709.00 ",,,, 347.22 ,, 630.89 , 372.87 , 335.08 , 287.21 , 287.21 , 630.89 ,,,,,,,,,,,,,,, 73501,"XRAY, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED, 1 VIEW",73501," 2,571.81 ",,, 173.76 , 20.26 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.26 , 100.98 ,,,,,,,,,,,,,,, 73502,"XRAY, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED, 2-3 VIEWS",73502," 1,154.99 ",,, 173.76 , 29.70 , 62.30 , 101.57 , 85.10 , 77.03 , 70.20 , 29.70 , 101.57 ,,,,,,,,,,,,,,, 73503,"XRAY HIP UNILATERAL , WITH PELVIS WHEN PERFORD; MIN 4 VIEWS",73503," 1,690.52 ",,, 213.76 , 36.70 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 36.70 , 187.11 ,,,,,,,,,,,,,,, 73520,X RAY EXAM HIPS BILATERAL MIN 2 VIEWS,, 665.84 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 73521,"XRAY, HIPS, BILATERAL, WITH PELVIS WHEN PERFORMED, 2 VIEWS",73521," 1,317.54 ",,, 213.76 , 25.86 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 25.86 , 186.51 ,,,,,,,,,,,,,,, 73522,"XRAY, HIPS, BILATERAL WITH PELVIS WHEN PERFORMED; 3-4 VIEWS",73522," 2,019.18 ",,, 213.76 , 33.20 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 33.20 , 187.11 ,,,,,,,,,,,,,,, 73523,"XRAY, HIPS, BILATERAL WITH PELVIS WHEN PERFORMED; MIN 5 VIEWS",73523," 2,939.07 ",,, 213.76 , 39.84 , 112.51 , 187.11 , 56.05 , 50.73 , 46.23 , 39.84 , 187.11 ,,,,,,,,,,,,,,, 73525,"RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",73525," 7,196.31 ",,, 736.86 , 73.07 , 385.88 , 749.62 , 625.23 , 565.90 , 515.70 , 73.07 , 749.62 ,,,,,,,,,,,,,,, 73550,"RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS",73550," 1,261.61 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 73551,XRAY OF FEMUR 1 VIEW,73551," 1,261.61 ",,, 173.76 , 19.21 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 19.21 , 100.38 ,,,,,,,,,,,,,,, 73552,"XRAY, FEMUR, 2 VIEWS",73552," 1,261.61 ",,, 173.76 , 23.05 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 23.05 , 100.98 ,,,,,,,,,,,,,,, 73560,"RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS",, 944.14 ,,, 173.76 , 22.36 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 22.36 , 100.98 ,,,,,,,,,,,,,,, 73562,"RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS",73562," 2,019.18 ",,, 173.76 , 25.86 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 25.86 , 100.98 ,,,,,,,,,,,,,,, 73564,"RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE VIEWS",73564," 2,019.18 ",,, 213.76 , 27.95 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 27.95 , 186.51 ,,,,,,,,,,,,,,, 73565,"RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR",73565," 7,196.31 ",,, 173.76 , 26.56 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 26.56 , 100.98 ,,,,,,,,,,,,,,, 73580,"RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",73580," 7,196.31 ",,, 736.86 , 87.06 , 385.88 , 750.21 , 625.23 , 565.90 , 515.70 , 87.06 , 750.21 ,,,,,,,,,,,,,,, 73590,"RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS",73590," 1,261.61 ",,, 173.76 , 19.91 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 19.91 , 100.98 ,,,,,,,,,,,,,,, 73592,"RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS",73592," 1,261.61 ",,, 173.76 , 18.86 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 18.86 , 100.38 ,,,,,,,,,,,,,,, 73600,"RADIOLOGIC EXAMINATION, ANKLE; TWO VIEWS",73600," 1,261.61 ",,, 173.76 , 20.96 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.96 , 100.98 ,,,,,,,,,,,,,,, 73610,"RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS",73610," 1,261.61 ",,, 173.76 , 22.36 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 22.36 , 100.98 ,,,,,,,,,,,,,,, 73615,"RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",73615," 1,589.45 ",,, 736.86 , 76.92 , 385.88 , 749.62 , 625.23 , 565.90 , 515.70 , 76.92 , 749.62 ,,,,,,,,,,,,,,, 73620,"RADIOLOGIC EXAMINATION, FOOT; TWO VIEWS",73620," 1,261.61 ",,, 173.76 , 18.16 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 18.16 , 100.38 ,,,,,,,,,,,,,,, 73630,"RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF THREE VIEWS",73630," 1,008.78 ",,, 173.76 , 20.60 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 20.60 , 100.98 ,,,,,,,,,,,,,,, 73650,"RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS",73650," 2,019.18 ",,, 173.76 , 18.86 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 18.86 , 100.38 ,,,,,,,,,,,,,,, 73660,X RAY TOE(S) MINIMUM OF 2 VIEWS,, 944.14 ,,, 173.76 , 21.31 , 62.30 , 100.98 , 85.10 , 77.03 , 70.20 , 21.31 , 100.98 ,,,,,,,,,,,,,,, 73700,"COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL",73700," 4,308.73 ",,, 213.76 , 130.66 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 112.51 , 285.30 ,,,,,,,,,,,,,,, 73701,"COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)",73701," 5,119.55 ",,, 360.68 , 194.35 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 194.35 , 630.89 ,,,,,,,,,,,,,,, 73702,"COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",73702," 6,407.70 ",,, 360.68 , 247.78 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 73706,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",73706," 5,991.23 ",,, 360.68 , 288.40 , 201.74 , 629.09 , 374.06 , 336.14 , 288.12 , 201.74 , 629.09 ,,,,,,,,,,,,,,, 73718,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S)",73718," 6,916.44 ",,, 467.04 , 318.60 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 73719,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH CONTRAST MATERIAL(S)",73719," 9,074.60 ",,, 736.86 , 346.73 , 385.88 , 629.99 , 374.06 , 336.14 , 288.12 , 288.12 , 629.99 ,,,,,,,,,,,,,,, 73720,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",73720," 10,265.45 ",,, 736.86 , 444.54 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 73721,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL",73721," 6,086.21 ",,, 467.04 , 236.56 , 230.56 , 578.69 , 343.82 , 308.97 , 264.83 , 230.56 , 578.69 ,,,,,,,,,,,,,,, 73722,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)",73722," 9,074.60 ",,," 1,481.50 ", 419.83 , 691.75 ," 1,700.98 "," 1,009.18 ", 906.90 , 777.34 , 419.83 ," 1,700.98 ",,,,,,,,,,,,,,, 73723,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",73723," 10,265.45 ",,, 736.86 , 506.78 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 73725,"MAGNETIC RESONANCE ANGIOGRAPHY, LOWER EXTREMITY, WITH OR WITHOUT CONTRAST MATERIAL(S)",73725," 4,874.98 ",,,, 434.65 ,," 1,138.49 ", 467.41 , 420.04 , 360.03 , 360.03 ," 1,138.49 ",,,,,,,,,,,,,,, 74000,"RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW",74000," 3,208.54 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74010,"RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR AND ADDITIONAL OBLIQUE AND CONE VIEWS",74010," 5,636.56 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74018,"X-RAY, ABDOMEN; 1 VIEW",74018, 994.92 ,,, 173.76 , 17.81 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 17.81 , 100.38 ,,,,,,,,,,,,,,, 74019,"X-RAY, ABDOMEN; 2 VIEW",74019, 729.95 ,,, 213.76 , 21.31 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 21.31 , 185.92 ,,,,,,,,,,,,,,, 74020,"RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDING DECUBITUS AND/OR ERECT VIEWS",74020," 8,388.89 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74021,"X-RAY, ABDOMEN; 3 VIEWS OR MORE",74021, 881.92 ,,, 213.76 , 24.80 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 24.80 , 186.51 ,,,,,,,,,,,,,,, 74022,"RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/OR DECUBITUS VIEWS, SINGLE VIEW CHEST",74022," 1,261.61 ",,, 213.76 , 27.95 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 27.95 , 186.51 ,,,,,,,,,,,,,,, 74150,"COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL",74150," 5,966.27 ",,, 213.76 , 104.35 , 112.51 , 285.30 , 169.40 , 152.23 , 130.48 , 104.35 , 285.30 ,,,,,,,,,,,,,,, 74160,"COMPUTED TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S)",74160," 6,581.44 ",,, 360.68 , 193.93 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 193.93 , 630.89 ,,,,,,,,,,,,,,, 74170,"COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS",74170," 7,261.96 ",,, 360.68 , 223.12 , 201.74 , 630.89 , 374.06 , 336.14 , 288.12 , 201.74 , 630.89 ,,,,,,,,,,,,,,, 74174,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN AND PELVIS, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",74174," 10,368.99 ",,, 736.86 , 288.42 , 385.88 , 629.99 , 372.87 , 335.08 , 287.21 , 287.21 , 629.99 ,,,,,,,,,,,,,,, 74175,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",74175," 6,042.92 ",,, 360.68 , 251.44 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 74176,"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL",74176," 10,697.15 ",,, 467.04 , 131.47 , 230.56 , 578.69 , 343.82 , 308.97 , 264.83 , 131.47 , 578.69 ,,,,,,,,,,,,,,, 74177,"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)",74177," 11,827.03 ",,, 736.86 , 255.58 , 385.88 , 630.89 , 374.06 , 336.14 , 288.12 , 255.58 , 630.89 ,,,,,,,,,,,,,,, 74178,"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL IN ONE OR BOTH BODY REGIONS, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS IN ONE OR BOTH BODY REGIONS",74178," 12,554.73 ",,, 736.86 , 288.42 , 385.88 , 629.99 , 374.06 , 336.14 , 288.12 , 288.12 , 629.99 ,,,,,,,,,,,,,,, 74181,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S)",74181," 6,668.26 ",,, 467.04 , 292.42 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 74182,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITH CONTRAST MATERIAL(S)",74182," 9,074.60 ",,, 736.86 , 413.90 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 74183,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY WITH CONTRAST MATERIAL(S) AND FURTHER SEQUENCES",74183," 10,265.45 ",,, 736.86 , 443.05 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 74185,"MAGNETIC RESONANCE ANGIOGRAPHY, ABDOMEN, WITH OR WITHOUT CONTRAST MATERIAL(S)",74185," 6,430.38 ",,,, 438.61 ,," 1,138.49 ", 471.66 , 423.86 , 363.31 , 363.31 ," 1,138.49 ",,,,,,,,,,,,,,, 74190,"PERITONEOGRAM (EG, AFTER INJECTION OF AIR OR CONTRAST), RADIOLOGICAL SUPERVISION AND INTERPRETATION",74190," 7,161.89 ",,," 1,006.26 ", 472.82 , 497.49 , 802.49 , 666.77 , 603.50 , 549.96 , 472.82 , 802.49 ,,,,,,,,,,,,,,, 74210,RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS,74210," 2,160.91 ",,, 360.68 , 59.08 , 201.74 , 414.61 , 346.25 , 313.40 , 285.60 , 59.08 , 414.61 ,,,,,,,,,,,,,,, 74220,RADIOLOGIC EXAMINATION; ESOPHAGUS,74220," 2,160.91 ",,, 360.68 , 64.33 , 201.74 , 414.61 , 346.25 , 313.40 , 285.60 , 64.33 , 414.61 ,,,,,,,,,,,,,,, 74230,"SWALLOWING FUNCTION, WITH CINERADIOGRAPHY/VIDEORADIOGRAPHY",74230," 2,160.91 ",,, 360.68 , 101.05 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 101.05 , 188.30 ,,,,,,,,,,,,,,, 74235,"REMOVAL OF FOREIGN BODY(S), ESOPHAGEAL, WITH USE OF BALLOON CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74235," 2,236.35 ",,,, 113.94 ,,, 86.53 , 78.32 , 71.37 , 71.37 , 113.94 ,,,,,,,,,,,,,,, 74240,"RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB",74240," 3,208.54 ",,, 360.68 , 76.92 , 201.74 , 415.20 , 346.25 , 313.40 , 285.60 , 76.92 , 415.20 ,,,,,,,,,,,,,,, 74241,"RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITH KUB",74241," 1,534.75 ",,,, 81.47 , 201.74 , 415.20 , 346.25 , 313.40 , 285.60 , 81.47 , 415.20 ,,,,,,,,,,,,,,, 74245,"RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS",74245," 3,208.54 ",,,, 123.43 , 230.56 , 382.53 , 162.25 , 146.85 , 133.83 , 123.43 , 382.53 ,,,,,,,,,,,,,,, 74246,"RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB",74246," 70,368.81 ",,, 360.68 , 90.55 , 201.74 , 415.20 , 346.25 , 313.40 , 285.60 , 90.55 , 415.20 ,,,,,,,,,,,,,,, 74247,"RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITH KUB",74247," 7,068.81 ",,,, 105.25 , 201.74 , 415.80 , 346.25 , 313.40 , 285.60 , 105.25 , 415.80 ,,,,,,,,,,,,,,, 74249,"RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH SMALL INTESTINE FOLLOW-THROUGH",74249," 3,208.54 ",,,, 135.67 , 201.74 , 415.80 , 190.77 , 172.67 , 157.35 , 135.67 , 415.80 ,,,,,,,,,,,,,,, 74250,"RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS;",74250," 2,160.91 ",,, 360.68 , 78.66 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 78.66 , 188.30 ,,,,,,,,,,,,,,, 74251,"RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS; VIA ENTEROCLYSIS TUBE",74251," 3,208.54 ",,, 360.68 , 111.54 , 230.56 , 188.89 , 162.74 , 147.30 , 134.23 , 111.54 , 230.56 ,,,,,,,,,,,,,,, 74260,"DUODENOGRAPHY, HYPOTONIC",74260," 2,160.91 ",,,, 111.54 , 112.51 , 188.89 , 156.81 , 141.93 , 129.34 , 111.54 , 188.89 ,,,,,,,,,,,,,,, 74270,"RADIOLOGIC EXAMINATION, COLON; BARIUM ENEMA, WITH OR WITHOUT KUB",74270," 3,208.54 ",,, 360.68 , 113.99 , 201.74 , 415.80 , 346.25 , 313.40 , 285.60 , 113.99 , 415.80 ,,,,,,,,,,,,,,, 74280,"RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFIC HIGH DENSITY BARIUM, WITH OR WITHOUT GLUCAGON",74280," 3,208.54 ",,, 360.68 , 161.21 , 201.74 , 416.39 , 226.67 , 205.16 , 186.96 , 161.21 , 416.39 ,,,,,,,,,,,,,,, 74283,"THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION OF INTUSSUSCEPTION OR OTHER INTRALUMINAL OBSTRUCTION (EG, MECONIUM ILEUS)",74283," 3,208.54 ",,, 360.68 , 105.25 , 201.74 , 415.80 , 147.99 , 133.94 , 122.06 , 105.25 , 415.80 ,,,,,,,,,,,,,,, 74290,"CHOLECYSTOGRAPHY, ORAL CONTRAST;",74290," 2,160.91 ",,, 360.68 , 52.79 , 201.74 , 414.01 , 346.25 , 313.40 , 285.60 , 52.79 , 414.01 ,,,,,,,,,,,,,,, 74300,"CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74300," 1,382.45 ",,,, 33.79 ,,, 25.56 , 23.14 , 21.09 , 21.09 , 33.79 ,,,,,,,,,,,,,,, 74301,"CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONAL SET INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",74301," 1,010.45 ",,,, 19.51 ,,, 14.75 , 13.35 , 12.17 , 12.17 , 19.51 ,,,,,,,,,,,,,,, 74305,"CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; THROUGH EXISTING CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74305," 7,161.89 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74327,"POSTOPERATIVE BILIARY DUCT CALCULUS REMOVAL, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE (EG, BURHENNE TECHNIQUE), RADIOLOGICAL SUPERVISION AND INTERPRETATION",74327," 2,432.72 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74328,"ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74328," 1,227.59 ",,,, 82.22 ,,, 49.66 , 44.95 , 40.96 , 40.96 , 82.22 ,,,,,,,,,,,,,,, 74329,"ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74329," 2,391.81 ",,,, 65.87 ,,, 50.16 , 45.40 , 41.37 , 41.37 , 65.87 ,,,,,,,,,,,,,,, 74330,"COMBINED ENDOSCOPIC CATHETERIZATION OF THE BILIARY AND PANCREATIC DUCTAL SYSTEMS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74330," 3,187.01 ",,,, 122.29 ,,, 63.92 , 57.86 , 52.73 , 52.73 , 122.29 ,,,,,,,,,,,,,,, 74340,"INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT), INCLUDING MULTIPLE FLUOROSCOPIES AND FILMS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74340," 1,904.99 ",,,, 80.47 ,,, 37.85 , 34.26 , 31.22 , 31.22 , 80.47 ,,,,,,,,,,,,,,, 74355,"PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74355," 2,507.72 ",,,, 105.58 ,,, 55.07 , 49.85 , 45.43 , 45.43 , 105.58 ,,,,,,,,,,,,,,, 74360,"INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL SUPERVISION AND INTERPRETATION",74360," 1,868.17 ",,,, 88.14 ,,, 39.33 , 35.60 , 32.44 , 32.44 , 88.14 ,,,,,,,,,,,,,,, 74363,"PERCUTANEOUS TRANSHEPATIC DILATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74363," 5,056.34 ",,,, 78.41 ,,, 59.50 , 53.85 , 49.08 , 49.08 , 78.41 ,,,,,,,,,,,,,,, 74400,"UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOGRAPHY",74400," 7,068.81 ",,, 360.68 , 83.92 , 201.74 , 415.20 , 118.00 , 106.80 , 97.33 , 83.92 , 415.20 ,,,,,,,,,,,,,,, 74410,"UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE;",74410," 5,636.56 ",,, 360.68 , 85.31 , 201.74 , 415.20 , 119.97 , 108.59 , 98.95 , 85.31 , 415.20 ,,,,,,,,,,,,,,, 74415,"UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH NEPHROTOMOGRAPHY",74415," 5,636.56 ",,, 360.68 , 110.15 , 201.74 , 415.80 , 154.88 , 140.18 , 127.75 , 110.15 , 415.80 ,,,,,,,,,,,,,,, 74420,"UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB",74420," 5,636.56 ",,, 736.86 , 443.45 , 385.88 , 752.59 , 623.45 , 564.29 , 514.23 , 385.88 , 752.59 ,,,,,,,,,,,,,,, 74425,"UROGRAPHY, ANTEGRADE (PYELOSTOGRAM, NEPHROSTOGRAM, LOOPOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION",74425," 5,636.56 ",,, 736.86 , 245.50 , 385.88 , 416.39 , 346.25 , 313.40 , 285.60 , 245.50 , 416.39 ,,,,,,,,,,,,,,, 74430,"CYSTOGRAPHY, MINIMUM OF 3 VIEWS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74430," 5,636.56 ",,, 736.86 , 21.66 , 385.88 , 410.45 , 346.25 , 313.40 , 285.60 , 21.66 , 410.45 ,,,,,,,,,,,,,,, 74440,"VASOGRAPHY, VESICULOGRAPHY, OR EPIDIDYMOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74440," 5,636.56 ",,, 467.04 , 61.18 , 230.56 , 381.34 , 318.26 , 288.06 , 262.51 , 61.18 , 381.34 ,,,,,,,,,,,,,,, 74445,"CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74445," 5,636.56 ",,, 213.76 , 111.19 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 111.19 , 188.30 ,,,,,,,,,,,,,,, 74450,"URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74450," 5,636.56 ",,, 467.04 , 225.56 , 230.56 , 382.53 , 318.26 , 288.06 , 262.51 , 225.56 , 382.53 ,,,,,,,,,,,,,,, 74455,"URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74455," 5,636.56 ",,, 467.04 , 65.03 , 230.56 , 381.34 , 318.26 , 288.06 , 262.51 , 65.03 , 381.34 ,,,,,,,,,,,,,,, 74470,"RADIOLOGIC EXAMINATION, RENAL CYST STUDY, TRANSLUMBAR, CONTRAST VISUALIZATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74470," 17,280.50 ",,," 1,006.26 ", 225.56 , 497.49 , 382.53 , 318.26 , 288.06 , 262.51 , 225.56 , 497.49 ,,,,,,,,,,,,,,, 74475,"INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74475," 26,072.69 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74480,"INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74480," 26,072.69 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 74485,"DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74485," 26,072.69 ",,," 3,709.76 ", 65.72 ," 1,739.75 "," 2,782.86 "," 2,323.08 "," 2,102.64 "," 1,916.12 ", 65.72 ," 2,782.86 ",,,,,,,,,,,,,,, 74710,"PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION",74710," 2,019.18 ",,, 173.76 , 18.86 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 18.86 , 100.38 ,,,,,,,,,,,,,,, 74740,"HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74740," 7,161.89 ",,, 467.04 , 54.89 , 230.56 , 380.75 , 318.26 , 288.06 , 262.51 , 54.89 , 380.75 ,,,,,,,,,,,,,,, 74742,"TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",74742," 1,970.45 ",,,, 56.80 ,,, 43.26 , 39.16 , 35.69 , 35.69 , 56.80 ,,,,,,,,,,,,,,, 74775,"PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATION OR EXTENT OF ANOMALIES)",74775," 5,636.56 ",,, 467.04 , 111.19 , 230.56 , 188.30 , 162.25 , 146.85 , 133.83 , 111.19 , 230.56 ,,,,,,,,,,,,,,, 75557,CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL;,75557," 6,086.21 ",,, 467.04 , 298.34 , 230.56 , 579.59 , 343.82 , 308.97 , 264.83 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 75559,CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL; WITH STRESS IMAGING,75559," 6,604.06 ",,," 1,006.26 ", 318.60 , 497.49 , 579.59 , 343.82 , 308.97 , 264.83 , 264.83 , 579.59 ,,,,,,,,,,,,,,, 75561,"CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES;",75561," 10,265.45 ",,, 736.86 , 427.74 , 385.88 ," 1,138.49 ", 675.43 , 606.97 , 520.26 , 385.88 ," 1,138.49 ",,,,,,,,,,,,,,, 75563,"CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; WITH STRESS IMAGING",75563," 24,236.48 ",,," 1,481.50 ", 516.17 , 691.75 ," 1,701.88 "," 1,009.18 ", 906.90 , 777.34 , 516.17 ," 1,701.88 ",,,,,,,,,,,,,,, 75571,CT OF HEART WO,," 1,281.12 ",,, 173.76 , 71.06 , 62.30 , 154.80 , 91.94 , 82.62 , 70.82 , 62.30 , 154.80 ,,,,,,,,,,,,,,, 75574,CTA COR W MORPH,," 2,164.08 ",,, 360.68 , 288.42 , 201.74 , 629.99 , 372.87 , 335.08 , 287.21 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 75600,"AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75600," 54,408.93 ",,," 5,957.94 ", 174.14 ," 2,641.52 "," 4,105.09 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 174.14 ," 4,105.09 ",,,,,,,,,,,,,,, 75605,"AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75605," 54,408.93 ",,," 10,279.52 ", 81.12 ," 4,376.52 "," 7,007.34 "," 5,843.00 "," 5,288.55 "," 4,819.40 ", 81.12 ," 7,007.34 ",,,,,,,,,,,,,,, 75625,"AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75625," 54,408.93 ",,," 5,957.94 ", 80.06 ," 2,641.52 "," 4,094.99 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 80.06 ," 4,094.99 ",,,,,,,,,,,,,,, 75630,"AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75630," 54,408.93 ",,," 5,957.94 ", 81.12 ," 2,641.52 "," 4,095.58 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 81.12 ," 4,095.58 ",,,,,,,,,,,,,,, 75635,"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWER EXTREMITY RUNOFF, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING",75635," 7,068.81 ",,, 360.68 , 288.42 , 201.74 , 629.99 , 374.06 , 336.14 , 288.12 , 201.74 , 629.99 ,,,,,,,,,,,,,,, 75658,"ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75658," 54,408.93 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 75705,"ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75705," 1,13,147.97 ",,," 10,279.52 ", 136.00 ," 4,376.52 "," 7,001.40 "," 5,843.00 "," 5,288.55 "," 4,819.40 ", 136.00 ," 7,001.40 ",,,,,,,,,,,,,,, 75710,"ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75710," 54,408.93 ",,," 5,957.94 ", 84.61 ," 2,641.52 "," 4,096.18 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 84.61 ," 4,096.18 ",,,,,,,,,,,,,,, 75716,"ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75716," 54,408.93 ",,," 5,957.94 ", 97.55 ," 2,641.52 "," 4,098.55 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 97.55 ," 4,098.55 ",,,,,,,,,,,,,,, 75726,"ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE (WITH OR WITHOUT FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION",75726," 1,13,147.96 ",,," 10,279.52 ", 92.65 ," 4,376.52 "," 7,010.90 "," 5,843.00 "," 5,288.55 "," 4,819.40 ", 92.65 ," 7,010.90 ",,,,,,,,,,,,,,, 75731,"ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75731," 54,408.93 ",,," 5,957.94 ", 113.27 ," 1,093.63 "," 1,004.44 ", 839.22 , 759.59 , 692.20 , 113.27 ," 1,093.63 ",,,,,,,,,,,,,,, 75733,"ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75733," 54,408.93 ",,," 5,957.94 ", 119.53 ," 2,641.52 "," 4,077.17 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 119.53 ," 4,077.17 ",,,,,,,,,,,,,,, 75736,"ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75736," 54,408.93 ",,," 10,279.52 ", 103.48 ," 4,376.52 "," 6,990.11 "," 5,843.00 "," 5,288.55 "," 4,819.40 ", 103.48 ," 6,990.11 ",,,,,,,,,,,,,,, 75741,"ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75741," 54,408.93 ",,," 5,957.94 ", 85.66 ," 2,641.52 "," 4,096.18 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 85.66 ," 4,096.18 ",,,,,,,,,,,,,,, 75743,"ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75743," 54,408.93 ",,," 5,957.94 ", 86.71 ," 2,641.52 "," 4,096.77 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 86.71 ," 4,096.77 ",,,,,,,,,,,,,,, 75746,"ANGIOGRAPHY, PULMONARY, BY NONSELECTIVE CATHETER OR VENOUS INJECTION, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75746," 17,584.80 ",,," 5,957.94 ", 94.73 ," 1,093.63 "," 1,610.32 "," 1,346.67 "," 1,218.88 "," 1,110.76 ", 94.73 ," 1,610.32 ",,,,,,,,,,,,,,, 75756,"ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75756," 17,584.80 ",,," 5,957.94 ", 113.96 ," 2,641.52 "," 4,087.86 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 113.96 ," 4,087.86 ",,,,,,,,,,,,,,, 75774,"ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED AFTER BASIC EXAMINATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",75774," 5,795.43 ",,,, 68.52 ,,, 96.37 , 87.22 , 79.48 , 68.52 , 96.37 ,,,,,,,,,,,,,,, 75801,"LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75801," 7,161.89 ",,," 1,157.00 ", 595.24 , 620.01 ," 1,010.38 ", 839.22 , 759.59 , 692.20 , 595.24 ," 1,010.38 ",,,,,,,,,,,,,,, 75803,"LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75803," 17,280.50 ",,," 2,975.70 ", 595.24 ," 1,093.63 "," 1,010.38 ", 839.22 , 759.59 , 692.20 , 595.24 ," 1,093.63 ",,,,,,,,,,,,,,, 75805,"LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75805," 17,280.50 ",,," 5,957.94 ", 955.13 ," 1,093.63 "," 1,621.60 "," 1,346.67 "," 1,218.88 "," 1,110.76 ", 955.13 ," 1,621.60 ",,,,,,,,,,,,,,, 75807,"LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75807," 17,280.50 ",,," 5,957.94 "," 2,421.60 "," 2,641.52 "," 4,112.22 "," 3,415.05 "," 3,091.00 "," 2,816.80 "," 2,421.60 "," 4,112.22 ",,,,,,,,,,,,,,, 75809,"SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT, INDWELLING INFUSION PUMP), RADIOLOGICAL SUPERVISION AND INTERPRETATION",75809," 2,019.18 ",,, 213.76 , 74.12 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 74.12 , 187.70 ,,,,,,,,,,,,,,, 75810,"SPLENOPORTOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75810," 54,408.93 ",,," 5,957.94 ", 955.13 ," 1,093.63 "," 1,621.60 "," 1,346.67 "," 1,218.88 "," 1,110.76 ", 955.13 ," 1,621.60 ",,,,,,,,,,,,,,, 75820,"VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75820," 17,584.80 ",,," 2,975.70 ", 79.72 , 620.01 ," 1,006.22 ", 839.22 , 759.59 , 692.20 , 79.72 ," 1,006.22 ",,,,,,,,,,,,,,, 75822,"VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75822," 17,280.50 ",,," 2,975.70 ", 82.51 ," 1,093.63 "," 1,615.07 "," 1,346.67 "," 1,218.88 "," 1,110.76 ", 82.51 ," 1,615.07 ",,,,,,,,,,,,,,, 75825,"VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75825," 54,408.93 ",,," 5,957.94 ", 77.62 ," 2,641.52 "," 4,094.40 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 77.62 ," 4,094.40 ",,,,,,,,,,,,,,, 75827,"VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75827," 17,584.80 ",,," 2,975.70 ", 81.47 , 620.01 ," 1,006.22 ", 839.22 , 759.59 , 692.20 , 81.47 ," 1,006.22 ",,,,,,,,,,,,,,, 75831,"VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75831," 54,408.93 ",,," 5,957.94 ", 83.92 ," 2,641.52 "," 4,096.18 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 83.92 ," 4,096.18 ",,,,,,,,,,,,,,, 75833,"VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75833," 54,408.93 ",,," 5,957.94 ", 91.93 ," 2,641.52 "," 4,081.92 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 91.93 ," 4,081.92 ",,,,,,,,,,,,,,, 75840,"VENOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75840," 54,408.93 ",,," 5,957.94 ", 89.86 ," 2,641.52 "," 4,097.37 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 89.86 ," 4,097.37 ",,,,,,,,,,,,,,, 75842,"VENOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75842," 54,408.93 ",,," 10,279.52 ", 101.38 ," 4,376.52 "," 6,988.93 "," 5,843.00 "," 5,288.55 "," 4,819.40 ", 101.38 ," 6,988.93 ",,,,,,,,,,,,,,, 75860,"VENOGRAPHY, VENOUS SINUS (EG, PETROSAL AND INFERIOR SAGITTAL) OR JUGULAR, CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75860," 17,584.80 ",,," 5,957.94 ", 87.06 ," 2,641.52 "," 4,096.77 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 87.06 ," 4,096.77 ",,,,,,,,,,,,,,, 75870,"VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75870," 7,161.89 ",,," 5,957.94 ", 89.86 ," 1,093.63 "," 1,006.82 ", 839.22 , 759.59 , 692.20 , 89.86 ," 1,093.63 ",,,,,,,,,,,,,,, 75872,"VENOGRAPHY, EPIDURAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75872," 17,584.80 ",,," 1,157.00 ", 89.86 , 620.01 ," 1,006.82 ", 839.22 , 759.59 , 692.20 , 89.86 ," 1,006.82 ",,,,,,,,,,,,,,, 75880,"VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75880," 17,584.80 ",,," 1,157.00 ", 89.51 , 620.01 ," 1,006.82 ", 839.22 , 759.59 , 692.20 , 89.51 ," 1,006.82 ",,,,,,,,,,,,,,, 75885,"PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75885," 54,408.93 ",,," 5,957.94 ", 87.06 ," 2,641.52 "," 4,096.77 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 87.06 ," 4,096.77 ",,,,,,,,,,,,,,, 75887,"PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75887," 17,584.80 ",,," 5,957.94 ", 87.41 ," 1,093.63 "," 1,615.66 "," 1,346.67 "," 1,218.88 "," 1,110.76 ", 87.41 ," 1,615.66 ",,,,,,,,,,,,,,, 75889,"HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75889," 54,408.93 ",,," 5,957.94 ", 87.76 ," 2,641.52 "," 4,096.77 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 87.76 ," 4,096.77 ",,,,,,,,,,,,,,, 75891,"HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75891," 54,408.93 ",,," 5,957.94 ", 88.10 ," 2,641.52 "," 4,096.77 "," 3,415.05 "," 3,091.00 "," 2,816.80 ", 88.10 ," 4,096.77 ",,,,,,,,,,,,,,, 75893,"VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR PARATHYROID HORMONE, RENIN), RADIOLOGICAL SUPERVISION AND INTERPRETATION",75893," 54,408.93 ",,," 10,279.52 ", 91.96 ," 4,376.52 "," 7,010.90 "," 5,843.00 "," 5,288.55 "," 4,819.40 ", 91.96 ," 7,010.90 ",,,,,,,,,,,,,,, 75894,"TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75894," 12,122.67 ",,,, 949.13 ,,, 100.79 , 91.23 , 83.13 , 83.13 , 949.13 ,,,,,,,,,,,,,,, 75896,"TRANSCATHETER THERAPY, INFUSION, ANY METHOD (EG, THROMBOLYSIS OTHER THAN CORONARY), RADIOLOGICAL SUPERVISION AND INTERPRETATION",75896," 8,679.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 75898,"ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION OR INFUSION",75898," 17,584.80 ",,," 5,957.94 ", 955.13 ," 1,093.63 "," 1,621.60 "," 1,346.67 "," 1,218.88 "," 1,110.76 ", 955.13 ," 1,621.60 ",,,,,,,,,,,,,,, 75901,"MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM CENTRAL VENOUS DEVICE VIA SEPARATE VENOUS ACCESS, RADIOLOGIC SUPERVISION AND INTERPRETATION",75901," 3,309.53 ",,,, 153.86 ,,, 216.34 , 195.81 , 178.44 , 153.86 , 216.34 ,,,,,,,,,,,,,,, 75902,"MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM CENTRAL VENOUS DEVICE THROUGH DEVICE LUMEN, RADIOLOGIC SUPERVISION AND INTERPRETATION",75902," 1,284.54 ",,,, 52.44 ,,, 73.75 , 66.75 , 60.83 , 52.44 , 73.75 ,,,,,,,,,,,,,,, 75945,"INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL VESSEL",75945," 4,029.43 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 75946,"INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NON-CORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",75946," 1,667.72 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 75970,"TRANSCATHETER BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75970," 7,843.60 ",,,, 398.26 ,,, 55.55 , 50.28 , 45.82 , 45.82 , 398.26 ,,,,,,,,,,,,,,, 75980,"PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE WITH CONTRAST MONITORING, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75980," 4,606.34 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 75982,"PERCUTANEOUS PLACEMENT OF DRAINAGE CATHETER FOR COMBINED INTERNAL AND EXTERNAL BILIARY DRAINAGE OR OF A DRAINAGE STENT FOR INTERNAL BILIARY DRAINAGE IN PATIENTS WITH AN INOPERABLE MECHANICAL BILIARY OBSTRUCTION, RADIOLOGICAL SUPERVISION AND INTERPRETATIO",75982," 4,778.16 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 75984,"CHANGE OF PERCUTANEOUS TUBE OR DRAINAGE CATHETER WITH CONTRAST MONITORING (EG, GENITOURINARY SYSTEM, ABSCESS), RADIOLOGICAL SUPERVISION AND INTERPRETATION",75984," 1,615.91 ",,,, 70.27 ,,, 98.83 , 89.45 , 81.52 , 70.27 , 98.83 ,,,,,,,,,,,,,,, 75989,"RADIOLOGICAL GUIDANCE (IE, FLUOROSCOPY, ULTRASOUND, OR COMPUTED TOMOGRAPHY), FOR PERCUTANEOUS DRAINAGE (EG, ABSCESS, SPECIMEN COLLECTION), WITH PLACEMENT OF CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION",75989," 3,182.71 ",,,, 73.12 ,,, 87.52 , 79.21 , 72.18 , 72.18 , 87.52 ,,,,,,,,,,,,,,, 76000,"FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR PHYSICIAN TIME, OTHER THAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY)",76000," 1,200.65 ",,, 467.04 , 38.45 , 230.56 , 380.16 , 54.09 , 48.96 , 44.61 , 38.45 , 380.16 ,,,,,,,,,,,,,,, 76001,"FLUOROSCOPY, PHYSICIAN TIME MORE THAN 1 HOUR, ASSISTING A NONRADIOLOGIC PHYSICIAN (EG, NEPHROSTOLITHOTOMY, ERCP, BRONCHOSCOPY, TRANSBRONCHIAL BIOPSY)",76001," 1,874.90 ",,,,,,, 51.62 , 46.72 , 42.58 , 42.58 , 51.62 ,,,,,,,,,,,,,,, 76010,"RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY, SINGLE VIEW, CHILD",76010, 645.09 ,,, 173.76 , 16.76 , 62.30 , 100.38 , 85.10 , 77.03 , 70.20 , 16.76 , 100.38 ,,,,,,,,,,,,,,, 76080,"RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS TRACT STUDY, RADIOLOGICAL SUPERVISION AND INTERPRETATION",76080," 7,161.89 ",,," 1,006.26 ", 28.31 , 497.49 , 378.37 , 318.26 , 288.06 , 262.51 , 28.31 , 497.49 ,,,,,,,,,,,,,,, 76098,"RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN",76098," 7,161.89 ",,," 1,006.26 ", 8.71 , 497.49 , 771.00 , 666.77 , 603.50 , 549.96 , 8.71 , 771.00 ,,,,,,,,,,,,,,, 76100,"RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), OTHER THAN WITH UROGRAPHY",76100," 2,019.18 ",,, 213.76 , 59.08 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 59.08 , 187.70 ,,,,,,,,,,,,,,, 76101,"RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID POLYTOMOGRAPHY), OTHER THAN WITH UROGRAPHY; UNILATERAL",76101," 7,161.89 ",,,, 76.92 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 76.92 , 188.30 ,,,,,,,,,,,,,,, 76102,"RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID POLYTOMOGRAPHY), OTHER THAN WITH UROGRAPHY; BILATERAL",76102," 7,161.89 ",,,, 111.17 , 112.51 , 187.70 , 162.25 , 146.85 , 133.83 , 111.17 , 187.70 ,,,,,,,,,,,,,,, 76120,"CINERADIOGRAPHY/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED",76120," 3,390.01 ",,, 213.76 , 73.76 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 73.76 , 187.70 ,,,,,,,,,,,,,,, 76125,CINERADIOGRAPHY/VIDEORADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),76125, 571.36 ,,,, 31.02 ,,, 19.67 , 17.81 , 16.23 , 16.23 , 31.02 ,,,,,,,,,,,,,,, 76140,"CONSULTATION ON X-RAY EXAMINATION MADE ELSEWHERE, WRITTEN REPORT",76140, 195.00 ,,,, 37.75 ,,, 22.62 , 20.47 , 18.66 , 18.66 , 37.75 ,,,,,,,,,,,,,,, 76376,"3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION",76376," 1,855.01 ",,,, 15.59 ,,, 20.19 , 18.14 , 15.55 , 15.55 , 20.19 ,,,,,,,,,,,,,,, 76377,"3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION",76377," 1,089.25 ",,,, 36.13 ,,, 46.74 , 42.00 , 36.00 , 36.00 , 46.74 ,,,,,,,,,,,,,,, 76380,"COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY",76380," 2,227.43 ",,, 173.76 , 71.06 , 62.30 , 154.80 , 91.94 , 82.62 , 70.82 , 62.30 , 154.80 ,,,,,,,,,,,,,,, 76390,MAGNETIC RESONANCE SPECTROSCOPY,76390," 5,758.61 ",,, 173.76 , 530.04 ,,, 527.57 , 477.51 , 435.15 , 435.15 , 530.04 ,,,,,,,,,,,,,,, 76497,"UNLISTED COMPUTED TOMOGRAPHY PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)",76497," 1,261.61 ",,, 173.76 , 71.06 , 62.30 , 154.80 , 85.10 , 77.03 , 70.20 , 62.30 , 154.80 ,,,,,,,,,,,,,,, 76498,"UNLISTED MAGNETIC RESONANCE PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)",76498," 6,086.21 ",,, 173.76 , 85.43 , 62.30 , 154.80 , 85.06 , 76.99 , 70.16 , 62.30 , 154.80 ,,,,,,,,,,,,,,, 76499,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,76499," 1,261.61 ",,, 173.76 ,, 62.30 ,, 85.10 , 77.03 , 70.20 , 62.30 , 85.10 ,,,,,,,,,,,,,,, 76506,"ECHOENCEPHALOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR DETERMINATION OF VENTRICULAR SIZE, DELINEATION OF CEREBRAL CONTENTS, AND DETECTION OF FLUID MASSES OR OTHER INTRACRANIAL ABNORMALITIES), INCLUDING A-MODE ENCEPHALOGRAPHY AS SECONDA",76506," 2,865.56 ",,, 213.76 , 84.96 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 84.96 , 188.30 ,,,,,,,,,,,,,,, 76510,"OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFORMED DURING THE SAME PATIENT ENCOUNTER",76510," 2,143.06 ",,, 232.22 , 64.68 , 106.48 , 172.26 , 143.90 , 130.25 , 118.70 , 64.68 , 172.26 ,,,,,,,,,,,,,,, 76511,"OPHTHALMIC ULTRASOUND, DIAGNOSTIC; QUANTITATIVE A-SCAN ONLY",76511," 2,865.56 ",,, 213.76 , 38.80 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 38.80 , 187.11 ,,,,,,,,,,,,,,, 76512,"OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN (WITH OR WITHOUT SUPERIMPOSED NON-QUANTITATIVE A-SCAN)",76512," 3,140.55 ",,, 213.76 , 31.80 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 31.80 , 186.51 ,,,,,,,,,,,,,,, 76513,"OPHTHALMIC ULTRASOUND, DIAGNOSTIC; ANTERIOR SEGMENT ULTRASOUND, IMMERSION (WATER BATH) B-SCAN OR HIGH RESOLUTION BIOMICROSCOPY",76513," 2,865.56 ",,, 213.76 , 59.44 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 59.44 , 187.70 ,,,,,,,,,,,,,,, 76514,"OPHTHALMIC ULTRASOUND, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL (DETERMINATION OF CORNEAL THICKNESS)",76514, 621.35 ,,, 49.92 , 5.57 , 17.17 , 27.32 , 23.93 , 21.66 , 19.74 , 5.57 , 27.32 ,,,,,,,,,,,,,,, 76516,"OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN;",76516," 1,948.41 ",,, 213.76 , 38.10 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 38.10 , 187.11 ,,,,,,,,,,,,,,, 76519,"OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATION",76519," 1,948.41 ",,, 213.76 , 42.65 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 42.65 , 187.11 ,,,,,,,,,,,,,,, 76529,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,76529," 2,865.56 ",,, 173.76 , 46.84 , 62.30 , 101.57 , 85.10 , 77.03 , 70.20 , 46.84 , 101.57 ,,,,,,,,,,,,,,, 76536,"ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), REAL TIME WITH IMAGE DOCUMENTATION",76536," 2,865.56 ",,, 213.76 , 88.10 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 88.10 , 188.30 ,,,,,,,,,,,,,,, 76604,"ULTRASOUND, CHEST (INCLUDES MEDIASTINUM), REAL TIME WITH IMAGE DOCUMENTATION",76604," 2,865.56 ",,, 213.76 , 61.88 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 61.88 , 187.70 ,,,,,,,,,,,,,,, 76641,ULTRASOUND BREAST UNILATERAL REAL TIME WITH IMAGE DOCUMENTATION INCLUDING AXILLA WHEN PERFORMED; COMPLETE,76641," 2,865.56 ",,, 213.76 , 70.62 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 70.62 , 187.70 ,,,,,,,,,,,,,,, 76642,ULTRASOUND BREAST UNILATERAL REAL TIME WITH IMAGE DOCUMENTATION INCLUDING AXILLA WHEN PERFORMED; LIMITED,76642," 1,941.41 ",,, 173.76 , 53.83 , 62.30 , 101.57 , 85.10 , 77.03 , 70.20 , 53.83 , 101.57 ,,,,,,,,,,,,,,, 76645,"ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), REAL TIME WITH IMAGE DOCUMENTATION",76645," 1,116.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 76700,"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE",76700," 2,865.56 ",,, 213.76 , 81.82 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 81.82 , 188.30 ,,,,,,,,,,,,,,, 76705,"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLLOW-UP)",76705," 1,594.29 ",,, 213.76 , 61.88 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 61.88 , 187.70 ,,,,,,,,,,,,,,, 76706,"ULTRASOUND, ABDOMINAL AORTA, REAL TIME W/ IMAGE DOCUMENTATION, SCREENING STUDY FOR ABDOMINAL AORTIC ANEURYSM (AAA)",76706, 617.72 ,,, 213.76 , 66.42 , 112.51 ,, 93.42 , 84.56 , 77.05 , 66.42 , 112.51 ,,,,,,,,,,,,,,, 76770,"ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE",76770," 2,865.56 ",,, 213.76 , 76.21 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 76.21 , 188.30 ,,,,,,,,,,,,,,, 76775,"ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), REAL TIME WITH IMAGE DOCUMENTATION; LIMITED",76775," 1,754.99 ",,, 213.76 , 29.00 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 29.00 , 186.51 ,,,,,,,,,,,,,,, 76776,"ULTRASOUND, TRANSPLANTED KIDNEY, REAL TIME AND DUPLEX DOPPLER WITH IMAGE DOCUMENTATION",76776," 2,865.56 ",,, 213.76 , 118.54 , 112.51 ,, 156.81 , 141.93 , 129.34 , 112.51 , 156.81 ,,,,,,,,,,,,,,, 76800,"ULTRASOUND, SPINAL CANAL AND CONTENTS",76800," 4,029.43 ",,, 213.76 , 85.66 , 112.51 , 188.30 , 156.81 , 141.93 , 129.34 , 85.66 , 188.30 ,,,,,,,,,,,,,,, 76801,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, FIRST TRIMESTER (< 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION",76801," 2,865.56 ",,, 213.76 , 73.42 , 112.51 , 187.70 , 103.26 , 93.46 , 85.17 , 73.42 , 187.70 ,,,,,,,,,,,,,,, 76802,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, FIRST TRIMESTER (< 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",76802," 1,070.57 ",,,, 22.38 ,,, 31.47 , 28.48 , 25.96 , 22.38 , 31.47 ,,,,,,,,,,,,,,, 76805,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, AFTER FIRST TRIMESTER (> OR = 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION",76805," 2,865.56 ",,, 213.76 , 91.61 , 112.51 , 188.30 , 128.82 , 116.60 , 106.25 , 91.61 , 188.30 ,,,,,,,,,,,,,,, 76810,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, AFTER FIRST TRIMESTER (> OR = 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",76810," 1,948.41 ",,,, 43.02 ,,, 60.47 , 54.73 , 49.88 , 43.02 , 60.47 ,,,,,,,,,,,,,,, 76811,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION PLUS DETAILED FETAL ANATOMIC EXAMINATION, TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION",76811," 2,865.56 ",,, 467.04 , 84.94 , 230.56 , 187.11 , 119.48 , 108.14 , 98.55 , 84.94 , 230.56 ,,,,,,,,,,,,,,, 76812,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION PLUS DETAILED FETAL ANATOMIC EXAMINATION, TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",76812," 1,182.27 ",,,, 112.24 ,,, 157.82 , 142.85 , 130.18 , 112.24 , 157.82 ,,,,,,,,,,,,,,, 76813,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINAL APPROACH; SINGLE OR FIRST GESTATION",76813," 2,865.56 ",,, 213.76 , 61.18 , 112.51 ,, 156.81 , 141.93 , 129.34 , 61.18 , 156.81 ,,,,,,,,,,,,,,, 76814,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",76814," 2,865.56 ",,,, 29.35 ,,, 41.31 , 37.39 , 34.07 , 29.35 , 41.31 ,,,,,,,,,,,,,,, 76815,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (EG, FETAL HEART BEAT, PLACENTAL LOCATION, FETAL POSITION AND/OR QUALITATIVE AMNIOTIC FLUID VOLUME), ONE OR MORE FETUSES",76815," 2,300.00 ",,, 213.76 , 51.73 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 51.73 , 187.70 ,,,,,,,,,,,,,,, 76816,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG, RE-EVALUATION OF FETAL SIZE BY MEASURING STANDARD GROWTH PARAMETERS AND AMNIOTIC FLUID VOLUME, RE-EVALUATION OF ORGAN SYSTEM(S) SUSPECTED OR CONFIRMED TO BE ABNORMAL ON A PRE",76816," 2,865.56 ",,, 213.76 , 71.68 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 71.68 , 187.70 ,,,,,,,,,,,,,,, 76817,"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, TRANSVAGINAL",76817," 2,865.56 ",,, 213.76 , 59.08 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 59.08 , 187.70 ,,,,,,,,,,,,,,, 76818,FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS TESTING,76818," 2,865.56 ",,, 213.76 , 68.84 , 112.51 , 187.11 , 96.86 , 87.67 , 79.89 , 68.84 , 187.11 ,,,,,,,,,,,,,,, 76819,FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING,76819," 2,865.56 ",,, 213.76 , 50.34 , 112.51 , 187.70 , 70.80 , 64.08 , 58.40 , 50.34 , 187.70 ,,,,,,,,,,,,,,, 76820,"DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY",76820," 1,948.41 ",,, 213.76 , 22.36 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 22.36 , 185.92 ,,,,,,,,,,,,,,, 76821,"DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY",76821," 1,948.41 ",,, 213.76 , 56.98 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 56.98 , 187.70 ,,,,,,,,,,,,,,, 76825,"ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING;",76825," 8,983.44 ",,," 1,006.26 ", 193.70 , 497.49 , 800.11 , 272.38 , 246.54 , 224.67 , 193.70 , 800.11 ,,,,,,,,,,,,,,, 76826,"ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY",76826," 8,983.44 ",,, 467.04 , 122.39 , 230.56 , 381.94 , 172.09 , 155.76 , 141.94 , 122.39 , 381.94 ,,,,,,,,,,,,,,, 76827,"DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE",76827," 1,948.41 ",,, 213.76 , 46.49 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 46.49 , 187.70 ,,,,,,,,,,,,,,, 76828,"DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY",76828," 1,948.41 ",,, 213.76 , 24.80 , 112.51 , 186.51 , 156.81 , 141.93 , 129.34 , 24.80 , 186.51 ,,,,,,,,,,,,,,, 76830,"ULTRASOUND, TRANSVAGINAL",76830," 1,248.19 ",,, 213.76 , 87.06 , 112.51 , 188.30 , 122.42 , 110.81 , 100.98 , 87.06 , 188.30 ,,,,,,,,,,,,,,, 76831,"SALINE INFUSION SONOHYSTEROGRAPHY (SIS), INCLUDING COLOR FLOW DOPPLER, WHEN PERFORMED",76831," 4,029.43 ",,, 467.04 , 82.51 , 230.56 , 381.94 , 318.26 , 288.06 , 262.51 , 82.51 , 381.94 ,,,,,,,,,,,,,,, 76856,"ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE",76856," 2,044.21 ",,, 213.76 , 75.52 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 75.52 , 187.70 ,,,,,,,,,,,,,,, 76857,"ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; LIMITED OR FOLLOW-UP (EG, FOR FOLLICLES)",76857," 2,550.43 ",,, 213.76 , 23.41 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 23.41 , 185.92 ,,,,,,,,,,,,,,, 76870,"ULTRASOUND, SCROTUM AND CONTENTS",76870," 1,589.75 ",,, 213.76 , 35.65 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 35.65 , 187.11 ,,,,,,,,,,,,,,, 76872,"ULTRASOUND, TRANSRECTAL;",76872," 2,865.56 ",,, 213.76 , 62.58 , 112.51 , 187.70 , 88.01 , 79.66 , 72.59 , 62.58 , 187.70 ,,,,,,,,,,,,,,, 76873,"ULTRASOUND, TRANSRECTAL; PROSTATE VOLUME STUDY FOR BRACHYTHERAPY TREATMENT PLANNING (SEPARATE PROCEDURE)",76873," 4,029.43 ",,, 213.76 , 94.75 , 112.51 , 188.30 , 133.25 , 120.60 , 109.90 , 94.75 , 188.30 ,,,,,,,,,,,,,,, 76880,"ULTRASOUND, EXTREMITY, NONVASCULAR, REAL TIME WITH IMAGE DOCUMENTATION",76880," 1,404.88 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 76881,"ULTRASOUND, EXTREMITY, NONVASCULAR, REAL-TIME WITH IMAGE DOCUMENTATION; COMPLETE",76881," 2,009.44 ",,, 213.76 , 69.58 , 112.51 , 187.70 , 97.85 , 88.56 , 80.70 , 69.58 , 187.70 ,,,,,,,,,,,,,,, 76882,ULTRASOUND EXTREMITY NONVASCULAR REAL-TIME WITH IMAGE DOCUMENTATION; LIMITED ANATOMIC SPECIFIC,76882," 1,520.97 ",,, 213.76 , 32.84 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 32.84 , 187.11 ,,,,,,,,,,,,,,, 76885,"ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC (REQUIRING PHYSICIAN MANIPULATION)",76885," 1,948.41 ",,, 173.76 , 60.48 , 62.30 , 102.17 , 85.10 , 77.03 , 70.20 , 60.48 , 102.17 ,,,,,,,,,,,,,,, 76886,"ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC (NOT REQUIRING PHYSICIAN MANIPULATION)",76886," 1,948.41 ",,, 173.76 , 60.48 , 62.30 , 102.17 , 85.10 , 77.03 , 70.20 , 60.48 , 102.17 ,,,,,,,,,,,,,,, 76930,"ULTRASONIC GUIDANCE FOR PERICARDIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION",76930," 1,564.08 ",,,, 55.75 ,,, 46.22 , 41.84 , 38.13 , 38.13 , 55.75 ,,,,,,,,,,,,,,, 76932,"ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY, IMAGING SUPERVISION AND INTERPRETATION",76932," 1,764.54 ",,,, 55.04 ,,, 45.73 , 41.39 , 37.72 , 37.72 , 55.04 ,,,,,,,,,,,,,,, 76936,"ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDOANEURYSM OR ARTERIOVENOUS FISTULAE (INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION AND IMAGING)",76936," 7,007.61 ",,, 560.12 , 173.42 , 252.31 , 408.67 , 243.87 , 220.73 , 201.15 , 173.42 , 408.67 ,,,,,,,,,,,,,,, 76937,"ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING ULTRASOUND EVALUATION OF POTENTIAL ACCESS SITES, DOCUMENTATION OF SELECTED VESSEL PATENCY, CONCURRENT REALTIME ULTRASOUND VISUALIZATION OF VASCULAR NEEDLE ENTRY, WITH PERMANENT RECORDING AND REPORTING (LI",76937," 2,671.18 ",,,, 16.79 ,,, 23.61 , 21.37 , 19.47 , 16.79 , 23.61 ,,,,,,,,,,,,,,, 76940,"ULTRASOUND GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLATION",76940," 2,065.90 ",,,, 62.71 ,,, 144.55 , 130.83 , 119.23 , 62.71 , 144.55 ,,,,,,,,,,,,,,, 76941,"ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL TRANSFUSION OR CORDOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION",76941," 1,718.17 ",,,, 57.49 ,,, 95.38 , 86.33 , 78.67 , 57.49 , 95.38 ,,,,,,,,,,,,,,, 76942,"ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION",76942," 2,589.00 ",,,, 27.25 ,,, 38.35 , 34.71 , 31.63 , 27.25 , 38.35 ,,,,,,,,,,,,,,, 76945,"ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, IMAGING SUPERVISION AND INTERPRETATION",76945," 1,373.18 ",,,, 59.92 ,,, 47.69 , 43.16 , 39.34 , 39.34 , 59.92 ,,,,,,,,,,,,,,, 76946,"ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION",76946," 1,396.36 ",,,, 12.91 ,,, 18.19 , 16.47 , 15.01 , 12.91 , 18.19 ,,,,,,,,,,,,,,, 76948,"ULTRASONIC GUIDANCE FOR ASPIRATION OF OVA, IMAGING SUPERVISION AND INTERPRETATION",76948, 676.36 ,,,, 36.35 ,,, 51.13 , 46.28 , 42.17 , 36.35 , 51.13 ,,,,,,,,,,,,,,, 76965,ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENT APPLICATION,76965," 2,514.43 ",,,, 24.11 ,,, 33.92 , 30.70 , 27.98 , 24.11 , 33.92 ,,,,,,,,,,,,,,, 76970,ULTRASOUND STUDY FOLLOW-UP (SPECIFY),76970," 1,948.41 ",,,, 72.72 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 72.72 , 187.70 ,,,,,,,,,,,,,,, 76975,"GASTROINTESTINAL ENDOSCOPIC ULTRASOUND, SUPERVISION AND INTERPRETATION",76975," 4,029.43 ",,, 467.04 , 225.56 , 230.56 , 382.53 , 318.26 , 288.06 , 262.51 , 225.56 , 382.53 ,,,,,,,,,,,,,,, 76977,"ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY METHOD",76977," 1,112.86 ",,, 213.76 , 4.52 , 112.51 , 174.63 , 6.40 , 5.79 , 5.28 , 4.52 , 174.63 ,,,,,,,,,,,,,,, 76981,"Ultrasound, elastography; parenchyma (e",," 1,657.08 ",,, 213.76 , 76.66 , 112.51 ,,,,, 76.66 , 112.51 ,,,,,,,,,,,,,,, 76998,"ULTRASONIC GUIDANCE, INTRAOPERATIVE",76998," 2,105.44 ",,,, 63.06 ,,, 89.00 , 80.55 , 73.40 , 63.06 , 89.00 ,,,,,,,,,,,,,,, 76999,"UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)",76999," 1,948.41 ",,, 173.76 ,, 62.30 ,, 85.10 , 77.03 , 70.20 , 62.30 , 85.10 ,,,,,,,,,,,,,,, 77001,"FLUOROSCOPIC GUIDANCE FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT, REPLACEMENT (CATHETER ONLY OR COMPLETE), OR REMOVAL (INCLUDES FLUOROSCOPIC GUIDANCE FOR VASCULAR ACCESS AND CATHETER MANIPULATION, ANY NECESSARY CONTRAST INJECTIONS THROUGH ACCESS SITE OR ",77001, 779.06 ,,,, 64.68 ,,, 90.95 , 82.32 , 75.02 , 64.68 , 90.95 ,,,,,,,,,,,,,,, 77002,"FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE)",77002," 1,302.27 ",,,, 65.38 ,,, 91.94 , 83.22 , 75.83 , 65.38 , 91.94 ,,,,,,,,,,,,,,, 77003,"FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL, TRANSFORAMINAL EPIDURAL, SUBARACHNOID, PARAVERTEBRAL FACET JOINT, PARAVERTEBRAL FACET JOINT NERVE, OR SACR",77003," 1,228.92 ",,,, 63.62 ,,, 89.49 , 81.00 , 73.81 , 63.62 , 89.49 ,,,,,,,,,,,,,,, 77011,COMPUTED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION,77011," 5,369.97 ",,,, 190.24 ,,, 227.64 , 206.04 , 187.76 , 187.76 , 227.64 ,,,,,,,,,,,,,,, 77012,"COMPUTED TOMOGRAPHY GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), RADIOLOGICAL SUPERVISION AND INTERPRETATION",77012," 6,808.32 ",,,, 78.05 ,,, 93.42 , 84.56 , 77.05 , 77.05 , 93.42 ,,,,,,,,,,,,,,, 77013,"COMPUTED TOMOGRAPHY GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLATION",77013," 5,240.43 ",,,, 398.75 ,,, 269.44 , 243.87 , 222.24 , 222.24 , 398.75 ,,,,,,,,,,,,,,, 77014,COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS,77014," 1,006.62 ",,,, 87.91 ,,, 105.22 , 95.23 , 86.78 , 86.78 , 105.22 ,,,,,,,,,,,,,,, 77021,"MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRATION, INJECTION, OR PLACEMENT OF LOCALIZATION DEVICE) RADIOLOGICAL SUPERVISION AND INTERPRETATION",77021," 2,082.12 ",,,, 443.09 ,,, 441.03 , 399.18 , 363.77 , 363.77 , 443.09 ,,,,,,,,,,,,,,, 77022,"MAGNETIC RESONANCE GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLATION",77022," 9,651.77 ",,,, 673.78 ,,, 302.39 , 273.69 , 249.41 , 249.41 , 673.78 ,,,,,,,,,,,,,,, 77048,MRI BREAST C-+ W/CAD UNI,," 9,327.96 ",,,, 403.98 ,,,,,, 403.98 , 403.98 ,,,,,,,,,,,,,,, 77049,MRI BREAST C-+ W/CAD BI,," 5,224.34 ",,,, 402.00 ,,,,,, 402.00 , 402.00 ,,,,,,,,,,,,,,, 77053,"MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION",77053," 7,161.89 ",,, 467.04 , 39.84 , 230.56 , 380.16 , 318.26 , 288.06 , 262.51 , 39.84 , 380.16 ,,,,,,,,,,,,,,, 77054,"MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND INTERPRETATION",77054," 7,161.89 ",,, 467.04 , 52.79 , 230.56 , 380.75 , 318.26 , 288.06 , 262.51 , 52.79 , 380.75 ,,,,,,,,,,,,,,, 77058,"MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UNILATERAL",77058," 5,597.70 ",,,,,," 1,138.49 ", 673.50 , 605.24 , 518.78 , 518.78 ," 1,138.49 ",,,,,,,,,,,,,,, 77059,"MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BILATERAL",77059," 1,979.99 ",,,,,," 1,138.49 ", 673.50 , 605.24 , 518.78 , 518.78 ," 1,138.49 ",,,,,,,,,,,,,,, 77061,TOMOSYNTHESIS UNILATER,, 656.76 ,,,, 73.31 ,,,,,, 73.31 , 73.31 ,,,,,,,,,,,,,,, 77062,DIAG TOMOSYNTESIS BILATERAL,, 656.76 ,,,, 109.24 ,,,,,, 109.24 , 109.24 ,,,,,,,,,,,,,,, 77063,TOMOSYNTHESIS,, 656.76 ,,,, 24.83 ,,, 34.91 , 31.60 , 28.79 , 24.83 , 34.91 ,,,,,,,,,,,,,,, 77065,DIAG MAMMO INCL CAD UNI,," 1,558.56 ",,,, 93.36 ,,, 131.27 , 118.82 , 108.28 , 93.36 , 131.27 ,,,,,,,,,,,,,,, 77066,DIAG MAM BIL,," 1,964.04 ",,,, 119.23 ,,, 167.66 , 151.75 , 138.29 , 119.23 , 167.66 ,,,,,,,,,,,,,,, 77067,SCR MAMMOGRAM BILATERAL,," 1,595.64 ",,,, 98.60 ,,, 138.66 , 125.50 , 114.37 , 98.60 , 138.66 ,,,,,,,,,,,,,,, 77071,"MANUAL APPLICATION OF STRESS PERFORMED BY PHYSICIAN FOR JOINT RADIOGRAPHY, INCLUDING CONTRALATERAL JOINT IF INDICATED",77071," 1,261.61 ",,, 173.76 , 47.84 , 62.30 ,, 85.10 , 77.03 , 70.20 , 47.84 , 85.10 ,,,,,,,,,,,,,,, 77072,BONE AGE STUDIES,77072," 2,494.75 ",,, 213.76 , 13.26 , 112.51 , 184.14 , 156.81 , 141.93 , 129.34 , 13.26 , 184.14 ,,,,,,,,,,,,,,, 77073,"BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM)",77073," 2,019.18 ",,, 213.76 , 21.31 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 21.31 , 185.92 ,,,,,,,,,,,,,,, 77074,"RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES)",77074," 2,019.18 ",,, 213.76 , 40.90 , 112.51 , 187.11 , 156.81 , 141.93 , 129.34 , 40.90 , 187.11 ,,,,,,,,,,,,,,, 77075,"RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON)",77075," 3,390.01 ",,, 213.76 , 59.44 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 59.44 , 187.70 ,,,,,,,,,,,,,,, 77076,"RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT",77076," 2,019.18 ",,, 213.76 , 59.78 , 112.51 , 187.70 , 156.81 , 141.93 , 129.34 , 59.78 , 187.70 ,,,,,,,,,,,,,,, 77077,"JOINT SURVEY, SINGLE VIEW, 2 OR MORE JOINTS (SPECIFY)",77077," 2,019.18 ",,, 213.76 , 20.60 , 112.51 , 185.92 , 156.81 , 141.93 , 129.34 , 20.60 , 185.92 ,,,,,,,,,,,,,,, 77078,"COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE)",77078," 1,261.61 ",,, 173.76 , 71.06 , 62.30 , 154.80 , 91.89 , 82.58 , 70.78 , 62.30 , 154.80 ,,,,,,,,,,,,,,, 77080,"DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE)",77080," 2,019.18 ",,, 213.76 , 31.45 , 112.51 , 186.51 , 44.25 , 40.05 , 36.50 , 31.45 , 186.51 ,,,,,,,,,,,,,,, 77081,"DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)",77081," 1,261.61 ",,, 173.76 , 17.11 , 62.30 , 100.38 , 24.10 , 21.81 , 19.88 , 17.11 , 100.38 ,,,,,,,,,,,,,,, 77084,"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW BLOOD SUPPLY",77084," 5,213.00 ",,, 467.04 , 318.60 , 230.56 , 579.59 , 362.24 , 325.53 , 279.03 , 230.56 , 579.59 ,,,,,,,,,,,,,,, 77261,THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE,77261," 1,164.54 ",,,, 66.67 ,,, 99.80 , 90.33 , 82.32 , 66.67 , 99.80 ,,,,,,,,,,,,,,, 77262,THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE,77262," 1,562.72 ",,,, 100.51 ,,, 150.45 , 136.18 , 124.10 , 100.51 , 150.45 ,,,,,,,,,,,,,,, 77263,THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX,77263," 1,217.72 ",,,, 155.66 ,,, 233.05 , 210.94 , 192.22 , 155.66 , 233.05 ,,,,,,,,,,,,,,, 77280,THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE,77280," 1,566.56 ",,, 266.76 , 227.53 , 123.77 ,, 341.23 , 308.85 , 281.45 , 123.77 , 341.23 ,,,,,,,,,,,,,,, 77285,THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; INTERMEDIATE,77285," 4,011.80 ",,, 717.44 , 375.07 , 321.82 ,, 562.48 , 509.11 , 463.94 , 321.82 , 562.48 ,,,,,,,,,,,,,,, 77290,THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; COMPLEX,77290," 3,146.63 ",,, 717.44 , 414.40 , 321.82 ,, 621.47 , 562.50 , 512.60 , 321.82 , 621.47 ,,,,,,,,,,,,,,, 77295,THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; 3-DIMENSIONAL,77295," 5,049.45 ",,," 2,681.34 ", 255.30 ," 1,191.92 ",, 383.01 , 346.67 , 315.91 , 255.30 ," 1,191.92 ",,,,,,,,,,,,,,, 77300,"BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS DEPTH DOSE CALCULATION, TDF, NSD, GAP CALCULATION, OFF AXIS FACTOR, TISSUE INHOMOGENEITY FACTORS, CALCULATION OF NON-IONIZING RADIATION SURFACE AND DEPTH DOSE, AS REQUIRED DURING COURSE OF TREATMENT, ON",77300, 645.50 ,,, 266.76 , 32.44 , 123.77 ,, 48.68 , 44.06 , 40.15 , 32.44 , 123.77 ,,,,,,,,,,,,,,, 77301,"INTENSITY MODULATED RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS FOR TARGET AND CRITICAL STRUCTURE PARTIAL TOLERANCE SPECIFICATIONS",77301," 5,049.46 ",,," 2,681.34 "," 1,464.05 "," 1,191.92 ",," 2,196.32 "," 1,987.91 "," 1,811.56 "," 1,191.92 "," 2,196.32 ",,,,,,,,,,,,,,, 77321,"SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMIBODY, TOTAL BODY",77321," 1,259.96 ",,, 717.44 , 41.62 , 321.82 ,, 62.44 , 56.52 , 51.51 , 41.62 , 321.82 ,,,,,,,,,,,,,,, 77331,"SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN",77331," 1,092.70 ",,, 266.76 , 18.01 , 123.77 ,, 27.04 , 24.48 , 22.31 , 18.01 , 123.77 ,,,,,,,,,,,,,,, 77332,"TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE (SIMPLE BLOCK, SIMPLE BOLUS)",77332," 1,622.72 ",,, 266.76 , 32.76 , 123.77 ,, 49.17 , 44.50 , 40.56 , 32.76 , 123.77 ,,,,,,,,,,,,,,, 77333,"TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE (MULTIPLE BLOCKS, STENTS, BITE BLOCKS, SPECIAL BOLUS)",77333," 2,092.53 ",,, 266.76 , 55.06 , 123.77 ,, 82.60 , 74.76 , 68.13 , 55.06 , 123.77 ,,,,,,,,,,,,,,, 77334,"TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL SHIELDS, COMPENSATORS, WEDGES, MOLDS OR CASTS)",77334," 2,517.88 ",,, 717.44 , 64.90 , 321.82 ,, 97.35 , 88.11 , 80.30 , 64.90 , 321.82 ,,,,,,,,,,,,,,, 77336,"CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDING ASSESSMENT OF TREATMENT PARAMETERS, QUALITY ASSURANCE OF DOSE DELIVERY, AND REVIEW OF PATIENT TREATMENT DOCUMENTATION IN SUPPORT OF THE RADIATION ONCOLOGIST, REPORTED PER WEEK OF THERAPY",77336, 666.91 ,,, 266.76 , 75.24 , 123.77 ,, 113.08 , 102.35 , 93.27 , 75.24 , 123.77 ,,,,,,,,,,,,,,, 77370,SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION,77370, 645.51 ,,, 266.76 , 115.78 , 123.77 ,, 174.06 , 157.54 , 143.57 , 115.78 , 174.06 ,,,,,,,,,,,,,,, 77371,"RADIATION TREATMENT DELIVERY, STEREOTACTIC RADIOSURGERY (SRS), COMPLETE COURSE OF TREATMENT OF CRANIAL LESION(S) CONSISTING OF 1 SESSION; MULTI-SOURCE COBALT 60 BASED",77371," 36,043.47 ",,," 15,381.14 "," 1,155.60 "," 7,644.24 ",," 1,486.82 "," 1,345.73 "," 1,226.36 "," 1,155.60 "," 7,644.24 ",,,,,,,,,,,,,,, 77372,"RADIATION TREATMENT DELIVERY, STEREOTACTIC RADIOSURGERY (SRS), COMPLETE COURSE OF TREATMENT OF CRANIAL LESION(S) CONSISTING OF 1 SESSION; LINEAR ACCELERATOR BASED",77372," 40,040.27 ",,," 15,381.14 "," 1,018.34 "," 7,644.24 ",," 1,527.63 "," 1,382.67 "," 1,260.02 "," 1,018.34 "," 7,644.24 ",,,,,,,,,,,,,,, 77373,"STEREOTACTIC BODY RADIATION THERAPY, TREATMENT DELIVERY, PER FRACTION TO 1 OR MORE LESIONS, INCLUDING IMAGE GUIDANCE, ENTIRE COURSE NOT TO EXCEED 5 FRACTIONS",77373," 24,375.75 ",,," 3,534.90 "," 1,295.30 "," 1,690.57 ",," 1,943.10 "," 1,758.72 "," 1,602.70 "," 1,295.30 "," 1,943.10 ",,,,,,,,,,,,,,, 77401,"RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE",77401," 1,122.27 ",,, 244.78 , 23.26 , 116.99 ,, 34.91 , 31.60 , 28.79 , 23.26 , 116.99 ,,,,,,,,,,,,,,, 77424,"INTRAOPERATIVE RADIATION TREATMENT DELIVERY, X-RAY, SINGLE TREATMENT SESSION",77424," 14,591.00 ",,," 15,381.14 ", 353.72 ," 7,644.24 ",, 329.42 , 298.16 , 271.71 , 271.71 ," 7,644.24 ",,,,,,,,,,,,,,, 78012,THYROID UPTAKE SINGLE OR MULTIPLE,," 4,664.16 ",,, 777.36 , 73.39 , 353.49 ,, 103.26 , 93.46 , 85.17 , 73.39 , 353.49 ,,,,,,,,,,,,,,, 78070,PARATHYROID IMAGING,78070," 7,068.81 ",,, 777.36 , 268.87 , 353.49 , 574.39 , 378.09 , 342.22 , 311.86 , 268.87 , 574.39 ,,,,,,,,,,,,,,, 78195,LYMPHATICS AND LYMPH NODES IMAGING,," 7,068.81 ",,," 1,009.00 ", 306.62 , 455.52 , 744.27 , 431.19 , 390.28 , 355.66 , 306.62 , 744.27 ,,,,,,,,,,,,,,, 78220,LIVER FUNCTION STUDY WITH SERIAL IMAGES,," 2,129.60 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 78226,"HEPATOBILIARY SYSTEM IMAGING, INCLUDING GALLBLADDER WHEN PRESENT;",78226," 7,068.81 ",,, 777.36 , 303.12 , 353.49 , 573.80 , 426.29 , 385.84 , 351.61 , 303.12 , 573.80 ,,,,,,,,,,,,,,, 78227,"HEPATOBILIARY SYSTEM IMAGING, INCLUDING GALLBLADDER WHEN PRESENT; WITH PHARMACOLOGIC INTERVENTION, INCLUDING QUANTITATIVE MEASUREMENT(S) WHEN PERFORMED",78227," 7,068.81 ",,," 1,009.00 ", 415.72 , 455.52 , 744.27 , 584.61 , 529.13 , 482.19 , 415.72 , 744.27 ,,,,,,,,,,,,,,, 78264,GASTRIC EMPTYING STUDY,78264," 2,836.40 ",,, 777.36 , 305.92 , 353.49 , 573.80 , 430.22 , 389.40 , 354.85 , 305.92 , 573.80 ,,,,,,,,,,,,,,, 78278,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,78278," 7,068.81 ",,, 777.36 , 309.07 , 353.49 , 573.80 , 434.65 , 393.40 , 358.50 , 309.07 , 573.80 ,,,,,,,,,,,,,,, 78290,NM MECKELS SCAN,," 7,068.81 ",,, 777.36 , 306.28 , 353.49 , 573.80 , 430.71 , 389.84 , 355.26 , 306.28 , 573.80 ,,,,,,,,,,,,,,, 78300,BONE AND/OR JOINT IMAGING; LIMITED AREA,78300," 7,068.81 ",,, 777.36 , 205.60 , 353.49 , 574.39 , 289.11 , 261.68 , 238.46 , 205.60 , 574.39 ,,,,,,,,,,,,,,, 78305,BONE AND/OR JOINT IMAGING; MULTIPLE AREAS,78305," 7,068.81 ",,, 777.36 , 247.54 , 353.49 , 574.39 , 348.10 , 315.07 , 287.12 , 247.54 , 574.39 ,,,,,,,,,,,,,,, 78306,BONE AND/OR JOINT IMAGING; WHOLE BODY,78306," 3,234.63 ",,, 777.36 , 268.87 , 353.49 , 574.39 , 378.09 , 342.22 , 311.86 , 268.87 , 574.39 ,,,,,,,,,,,,,,, 78315,BONE AND/OR JOINT IMAGING; THREE PHASE STUDY,78315," 3,939.54 ",,, 777.36 , 305.22 , 353.49 , 573.80 , 429.23 , 388.50 , 354.04 , 305.22 , 573.80 ,,,,,,,,,,,,,,, 78320,BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT),78320," 3,939.54 ",,,, 183.89 , 455.52 , 743.09 , 258.61 , 234.07 , 213.31 , 183.89 , 743.09 ,,,,,,,,,,,,,,, 78350,"BONE DENSITY (BONE MINERAL CONTENT) STUDY, ONE OR MORE SITES; SINGLE PHOTON ABSORPTIOMETRY",78350," 7,068.81 ",,,, 22.01 ,,, 30.98 , 28.04 , 25.55 , 22.01 , 30.98 ,,,,,,,,,,,,,,, 78351,BONE DENSITY BONE MINERAL CONTENT STUDY,, 628.30 ,,,, 10.52 ,,, 21.63 , 19.58 , 17.84 , 10.52 , 21.63 ,,,,,,,,,,,,,,, 78452,MYCARDIOL PERFUSION IMAGING TOMOGRAPHIC,," 15,927.24 ",,," 2,654.54 ", 407.29 ," 1,229.38 "," 1,974.43 ", 618.79 , 556.07 , 476.63 , 407.29 ," 1,974.43 ",,,,,,,,,,,,,,, 78491,"MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE STUDY AT REST OR STRESS",78491," 12,580.85 ",,," 2,978.70 "," 1,050.00 "," 1,375.54 "," 2,272.02 "," 2,031.66 "," 1,825.74 "," 1,564.92 "," 1,050.00 "," 2,272.02 ",,,,,,,,,,,,,,, 78492,"MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE STUDIES AT REST AND/OR STRESS",78492," 13,726.30 ",,," 2,978.70 "," 1,050.00 "," 1,375.54 "," 2,272.02 "," 2,031.66 "," 1,825.74 "," 1,564.92 "," 1,050.00 "," 2,272.02 ",,,,,,,,,,,,,,, 78608,PET BRAIN IMAGING,," 15,670.84 ",,," 2,978.70 "," 1,050.00 "," 1,375.54 "," 2,272.02 "," 2,031.66 "," 1,825.74 "," 1,564.92 "," 1,050.00 "," 2,272.02 ",,,,,,,,,,,,,,, 78814,PET LIMITED STUDY,," 15,819.47 ",,," 2,978.70 "," 1,050.00 "," 1,375.54 "," 2,272.02 "," 2,031.66 "," 1,825.74 "," 1,564.92 "," 1,050.00 "," 2,272.02 ",,,,,,,,,,,,,,, 78815,POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; SKULL BASE TO MID-THIGH,78815," 27,332.39 ",,," 2,978.70 "," 1,050.00 "," 1,375.54 "," 2,272.02 "," 2,031.66 "," 1,825.74 "," 1,564.92 "," 1,050.00 "," 2,272.02 ",,,,,,,,,,,,,,, 78816,POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; WHOLE BODY,78816," 27,332.39 ",,," 2,978.70 "," 1,050.00 "," 1,375.54 "," 2,272.02 "," 2,031.66 "," 1,825.74 "," 1,564.92 "," 1,050.00 "," 2,272.02 ",,,,,,,,,,,,,,, 80047,"BASIC METABOLIC PANEL (CALCIUM, IONIZED) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, IONIZED (82330) CARBON DIOXIDE (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) POTASSIUM (84132) SODIUM (84295) UREA NITROGEN (BUN) (84520)",80047, 334.45 ,,,, 11.04 ,,, 13.73 , 13.73 , 13.73 , 11.04 , 13.73 ,,,,,,,,,,,,,,, 80048,"LAB BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM (82310) CARBON DIOXIDE (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) POTASSIUM (84132) SODIUM (84295) UREA NITROGEN (BUN) (84520)",80048, 395.75 ,,,, 8.39 ,,, 10.44 , 10.44 , 10.44 , 8.39 , 10.44 ,,,,,,,,,,,,,,, 80050,"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BLOOD COUNT, COMPLETE (CBC), AUTOMATED AND AUTOMATED DIFFERENTIAL WBC COUNT (85025 OR 85027 AND 85004) OR BLOOD COUNT, COMPLETE (CBC), AUTOMATED (85027) AND",80050, 357.47 ,,,, 38.66 ,,, 35.17 , 35.17 , 35.17 , 35.17 , 38.66 ,,,,,,,,,,,,,,, 80051,ELECTROLYTE PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CARBON DIOXIDE (82374) CHLORIDE (82435) POTASSIUM (84132) SODIUM (84295),80051, 364.75 ,,,, 6.96 ,,, 8.66 , 8.66 , 8.66 , 6.96 , 8.66 ,,,,,,,,,,,,,,, 80053,"LAB COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCL FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (82247) CALCIUM (82310) CARBON DIOXIDE (BICARBONATE) (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) PHOSPHATASE, ALKALINE (84075) POTASSIUM (8",80053, 713.29 ,,,, 10.49 ,,, 13.04 , 13.04 , 13.04 , 10.49 , 13.04 ,,,,,,,,,,,,,,, 80061,"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DIRECT MEASUREMENT, HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) (83718) TRIGLYCERIDES (84478)",80061, 363.54 ,,,, 13.30 ,,, 16.53 , 16.53 , 16.53 , 13.30 , 16.53 ,,,,,,,,,,,,,,, 80074,"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBODY (86709) HEPATITIS B CORE ANTIBODY (HBCAB), IGM ANTIBODY (86705) HEPATITIS B SURFACE ANTIGEN (HBSAG) (87340) HEPATITIS C ANTIBODY (86803)",80074, 818.38 ,,,, 47.28 ,,, 58.81 , 58.81 , 58.81 , 47.28 , 58.81 ,,,,,,,,,,,,,,, 80076,"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (82247) BILIRUBIN, DIRECT (82248) PHOSPHATASE, ALKALINE (84075) PROTEIN, TOTAL (84155) TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460) TRANSFERASE, ASPARTATE A",80076, 374.00 ,,,, 8.11 ,,, 10.09 , 10.09 , 10.09 , 8.11 , 10.09 ,,,,,,,,,,,,,,, 80101,"DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (EG, IMMUNOASSAY, ENZYME ASSAY), EACH DRUG CLASS",80101, 246.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 80156,CARBAMAZEPINE; TOTAL,80156, 327.38 ,,,, 14.46 ,,, 17.98 , 17.98 , 17.98 , 14.46 , 17.98 ,,,,,,,,,,,,,,, 80162,DIGOXIN,80162, 228.13 ,,,, 13.18 ,,, 16.39 , 16.39 , 16.39 , 13.18 , 16.39 ,,,,,,,,,,,,,,, 80163,DIGOXIN; FREE,80163, 63.74 ,,,, 13.18 ,,, 16.39 , 16.39 , 16.39 , 13.18 , 16.39 ,,,,,,,,,,,,,,, 80164,DIPROPYLACETIC ACID (VALPROIC ACID),80164, 272.70 ,,,, 13.44 ,,, 16.72 , 16.72 , 16.72 , 13.44 , 16.72 ,,,,,,,,,,,,,,, 80165,VALPROIC ACID DIPROPYLACETIC ACID FREE,, 394.82 ,,,, 13.44 ,,, 16.72 , 16.72 , 16.72 , 13.44 , 16.72 ,,,,,,,,,,,,,,, 80170,GENTAMICIN,80170, 494.88 ,,,, 16.26 ,,, 20.22 , 20.22 , 20.22 , 16.26 , 20.22 ,,,,,,,,,,,,,,, 80173,HALOPERIDOL,, 292.95 ,,,, 14.46 ,,, 17.98 , 17.98 , 17.98 , 14.46 , 17.98 ,,,,,,,,,,,,,,, 80175,LAMOTRIGINE,80175, 45.45 ,,,, 13.15 ,,, 16.36 , 16.36 , 16.36 , 13.15 , 16.36 ,,,,,,,,,,,,,,, 80177,LEVETIRACETAM,80177, 77.45 ,,,, 13.15 ,,, 16.36 , 16.36 , 16.36 , 13.15 , 16.36 ,,,,,,,,,,,,,,, 80178,LITHIUM,, 129.16 ,,,, 6.56 ,,, 8.16 , 8.16 , 8.16 , 6.56 , 8.16 ,,,,,,,,,,,,,,, 80184,PHENOBARBITAL,, 196.75 ,,,, 12.30 ,,, 15.30 , 15.30 , 15.30 , 12.30 , 15.30 ,,,,,,,,,,,,,,, 80185,PHENYTOIN; TOTAL,80185, 243.10 ,,,, 13.15 ,,, 16.36 , 16.36 , 16.36 , 13.15 , 16.36 ,,,,,,,,,,,,,,, 80186,PHENYTOIN; FREE,80186, 283.20 ,,,, 13.66 ,,, 16.99 , 16.99 , 16.99 , 13.66 , 16.99 ,,,,,,,,,,,,,,, 80197,TACROLIMUS,, 459.20 ,,,, 13.63 ,,, 16.96 , 16.96 , 16.96 , 13.63 , 16.96 ,,,,,,,,,,,,,,, 80198,THEOPHYLLINE,80198, 459.20 ,,,, 14.04 ,,, 17.46 , 17.46 , 17.46 , 14.04 , 17.46 ,,,,,,,,,,,,,,, 80200,TOBRAMYCIN,," 1,635.59 ",,,, 16.01 ,,, 19.91 , 19.91 , 19.91 , 16.01 , 19.91 ,,,,,,,,,,,,,,, 80202,VANCOMYCIN,80202," 1,764.75 ",,,, 13.44 ,,, 16.72 , 16.72 , 16.72 , 13.44 , 16.72 ,,,,,,,,,,,,,,, 80299,"QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED",80299, 238.50 ,,,, 14.99 ,,, 18.64 , 18.64 , 18.64 , 14.99 , 18.64 ,,,,,,,,,,,,,,, 80300,DRUG SCREEN ANY NUMBER DRUG CLASSES,, 229.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 80305,"DRUG TEST, PRESUMPTIVE, ANY NUMBER DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES CAPABLE OF BEING READ BY DIRECT OPTICAL OBESERVATION ONLY.",80305, 238.50 ,,,, 10.82 ,,, 13.46 , 13.46 , 13.46 , 10.82 , 13.46 ,,,,,,,,,,,,,,, 80306,"DRUG TEST, READ BY INTSTRUMENT ASSISTED DIREC OPTICAL OBSERVATION INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DOS",80306, 56.00 ,,,, 14.44 ,,, 17.96 , 17.96 , 17.96 , 14.44 , 17.96 ,,,,,,,,,,,,,,, 80307,DRUG TEST PRSMV CHEM ANLYZR,, 122.04 ,,,, 57.76 ,,, 71.83 , 71.83 , 71.83 , 57.76 , 71.83 ,,,,,,,,,,,,,,, 80320,ALCOHOLS,80320, 110.39 ,,,, 0.01 ,,,,,, 0.01 , 0.01 ,,,,,,,,,,,,,,, 80323,ALKALOIDS NOT OTHERWISE SPECIFIED,, 45.00 ,,,, 0.01 ,,,,,, 0.01 , 0.01 ,,,,,,,,,,,,,,, 80329,"ANALGESICS, NON-OPIOID, 1 OR 2",80329, 127.38 ,,,, 0.01 ,,,,,, 0.01 , 0.01 ,,,,,,,,,,,,,,, 80330,ANALGESICS NON-OPIOID; 3-5,80330, 130.39 ,,,, 0.01 ,,,,,, 0.01 , 0.01 ,,,,,,,,,,,,,,, 80345,BARBITURATES,80345, 110.30 ,,,, 0.01 ,,,,,, 0.01 , 0.01 ,,,,,,,,,,,,,,, 80375,DRUG(S) OR SUBSTANCE(S) DEFINITIVE QUALITATIVE OR QUANTITATIVE NOT OTHERWISE SPECIFIED; 1-3,80375, 110.39 ,,,, 0.01 ,,,,,, 0.01 , 0.01 ,,,,,,,,,,,,,,, 81000,"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITH MICROSCOPY",81000, 168.37 ,,,, 3.23 ,,, 4.02 , 4.02 , 4.02 , 3.23 , 4.02 ,,,,,,,,,,,,,,, 81001,"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITH MICROSCOPY",81001, 111.73 ,,,, 3.16 ,,, 3.92 , 3.92 , 3.92 , 3.16 , 3.92 ,,,,,,,,,,,,,,, 81002,"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITHOUT MICROSCOPY",81002, 168.37 ,,,, 2.80 ,,, 3.48 , 3.48 , 3.48 , 2.80 , 3.48 ,,,,,,,,,,,,,,, 81003,"LAB URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITHOUT MICROSCOPY",81003, 168.37 ,,,, 2.23 ,,, 2.77 , 2.77 , 2.77 , 2.23 , 2.77 ,,,,,,,,,,,,,,, 81005,"LAB URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS",81005, 84.33 ,,,, 2.15 ,,, 2.67 , 2.67 , 2.67 , 2.15 , 2.67 ,,,,,,,,,,,,,,, 81015,URINALYSIS; MICROSCOPIC ONLY,81015, 124.12 ,,,, 3.02 ,,, 3.76 , 3.76 , 3.76 , 3.02 , 3.76 ,,,,,,,,,,,,,,, 81025,"LAB URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS",81025, 124.12 ,,,, 6.92 ,,, 8.61 , 8.61 , 8.61 , 6.92 , 8.61 ,,,,,,,,,,,,,,, 81250,G6PC (GLUCOSE-6-PHOSPHATASE CATALYTIC SUBUNIT) (EG GLYCOGEN STORAGE DISEASE TYPE 1A VON GIERKE DISEASE) GENE ANALYSIS COMMON VARIANTS (EG R83C Q347X),81250, 283.31 ,,,, 47.03 ,,, 58.49 , 58.49 , 58.49 , 47.03 , 58.49 ,,,,,,,,,,,,,,, 81375,HLA CLASS II TYPING LOW RESOLUTION (EG ANTIGEN EQUIVALENTS); HLA-DRB1/3/4/5 AND -DQB1,81375, 605.60 ,,,, 219.11 ,,, 272.52 , 272.52 , 272.52 , 219.11 , 272.52 ,,,,,,,,,,,,,,, 81400,MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 (EG IDENTIFICATION OF SINGLE GERMLINE VARIANT [EG SNP] BY TECHNIQUES SUCH AS RESTRICTION ENZYME DIGESTION OR MELT CURVE ANALYSIS) ACADM (ACYL-COA DEHYDROGENASE C-4 TO C-12 STRAIGHT CHAIN MCAD) (EG MEDIUM CHAIN ACYL D,81400, 144.10 ,,,, 51.42 ,,, 63.96 , 63.96 , 63.96 , 51.42 , 63.96 ,,,,,,,,,,,,,,, 81506,ENDOCRINOLOGY (TYPE 2 DIABETES) BIOCHEMICAL ASSAYS OF SEVEN ANALYTES (GLUCOSE HBA1C INSULIN HS-CRP ADIPONECTIN FERRITIN INTERLEUKIN 2-RECEPTOR ALPHA) UTILIZING SERUM OR PLASMA ALGORITHM REPORTING A RISK SCORE,81506, 299.85 ,,,, 65.15 ,,,,,, 65.15 , 65.15 ,,,,,,,,,,,,,,, 82009,"ACETONE OR OTHER KETONE BODIES, SERUM; QUALITATIVE",82009, 195.50 ,,,, 4.49 ,,, 5.58 , 5.58 , 5.58 , 4.49 , 5.58 ,,,,,,,,,,,,,,, 82010,"ACETONE OR OTHER KETONE BODIES, SERUM; QUANTITATIVE",82010, 125.88 ,,,, 8.11 ,,, 10.09 , 10.09 , 10.09 , 8.11 , 10.09 ,,,,,,,,,,,,,,, 82040,ALBUMIN; SERUM,82040, 130.25 ,,,, 4.91 ,,, 6.11 , 6.11 , 6.11 , 4.91 , 6.11 ,,,,,,,,,,,,,,, 82075,ALCOHOL (ETHANOL); BREATH,82075, 207.13 ,,,, 0.01 ,,, 30.00 , 30.00 , 30.00 , 0.01 , 30.00 ,,,,,,,,,,,,,,, 82140,AMMONIA,82140, 250.38 ,,,, 14.46 ,,, 17.99 , 17.99 , 17.99 , 14.46 , 17.99 ,,,,,,,,,,,,,,, 82150,AMYLASE,82150, 292.00 ,,,, 6.43 ,,, 8.00 , 8.00 , 8.00 , 6.43 , 8.00 ,,,,,,,,,,,,,,, 82190,"ATOMIC ABSORPTION SPECTROSCOPY, EACH ANALYTE",82190, 161.55 ,,,, 14.80 ,,, 18.41 , 18.41 , 18.41 , 14.80 , 18.41 ,,,,,,,,,,,,,,, 82239,BILE ACIDS; TOTAL,82239, 46.98 ,,,, 16.99 ,,, 21.14 , 21.14 , 21.14 , 16.99 , 21.14 ,,,,,,,,,,,,,,, 82247,BILIRUBIN; TOTAL,82247, 102.17 ,,,, 4.98 ,,, 6.19 , 6.19 , 6.19 , 4.98 , 6.19 ,,,,,,,,,,,,,,, 82248,BILIRUBIN; DIRECT,82248, 86.25 ,,,, 4.98 ,,, 6.19 , 6.19 , 6.19 , 4.98 , 6.19 ,,,,,,,,,,,,,,, 82270,"BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUTIVE COLLECTED SPECIMENS WITH SINGLE DETERMINATION, FOR COLORECTAL NEOPLASM SCREENING (IE, PATIENT WAS PROVIDED 3 CARDS OR SINGLE TRIPLE CARD FOR CONSECUTIVE COLLECTION)",82270, 198.98 ,,,, 3.52 ,,, 4.38 , 4.38 , 4.38 , 3.52 , 4.38 ,,,,,,,,,,,,,,, 82271,"LAB BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES",82271, 348.74 ,,,, 4.27 ,,, 5.32 , 5.32 , 5.32 , 4.27 , 5.32 ,,,,,,,,,,,,,,, 82272,"BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS, PERFORMED FOR OTHER THAN COLORECTAL NEOPLASM SCREENING",82272, 415.01 ,,,, 3.40 ,,, 4.23 , 4.23 , 4.23 , 3.40 , 4.23 ,,,,,,,,,,,,,,, 82274,"BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS",82274, 102.80 ,,,, 15.79 ,,, 19.64 , 19.64 , 19.64 , 15.79 , 19.64 ,,,,,,,,,,,,,,, 82306,CALCIFEDIOL (25-OH VITAMIN D-3),82306, 466.88 ,,,, 29.39 ,,, 36.55 , 36.55 , 36.55 , 29.39 , 36.55 ,,,,,,,,,,,,,,, 82310,CALCIUM; TOTAL,82310, 116.13 ,,,, 5.12 ,,, 6.37 , 6.37 , 6.37 , 5.12 , 6.37 ,,,,,,,,,,,,,,, 82330,CALCIUM; IONIZED,82330, 234.88 ,,,, 13.57 ,,, 16.88 , 16.88 , 16.88 , 13.57 , 16.88 ,,,,,,,,,,,,,,, 82355,CALCULUS; QUALITATIVE ANALYSIS,82355, 141.10 ,,,, 11.48 ,,, 14.29 , 14.29 , 14.29 , 11.48 , 14.29 ,,,,,,,,,,,,,,, 82374,CARBON DIOXIDE (BICARBONATE),82374, 101.41 ,,,, 4.85 ,,, 6.03 , 6.03 , 6.03 , 4.85 , 6.03 ,,,,,,,,,,,,,,, 82375,CARBON MONOXIDE (CARBOXYHEMOGLOBIN); QUANTITATIVE,82375, 99.68 ,,,, 12.23 ,,, 15.21 , 15.21 , 15.21 , 12.23 , 15.21 ,,,,,,,,,,,,,,, 82378,CARCINOEMBRYONIC ANTIGEN (CEA),82378, 326.00 ,,,, 18.82 ,,, 23.41 , 23.41 , 23.41 , 18.82 , 23.41 ,,,,,,,,,,,,,,, 82435,CHLORIDE; BLOOD,82435, 335.46 ,,,, 4.57 ,,, 5.68 , 5.68 , 5.68 , 4.57 , 5.68 ,,,,,,,,,,,,,,, 82465,"CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL",82465, 159.99 ,,,, 4.32 ,,, 5.37 , 5.37 , 5.37 , 4.32 , 5.37 ,,,,,,,,,,,,,,, 82491,"CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); SINGLE ANALYTE NOT ELSEWHERE SPECIFIED, SINGLE STATIONARY AND MOBILE PHASE",82491, 310.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 82497,COLLAGEN CROSS LINKS ANY METHOD ,82497, 231.08 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 82525,COPPER,82525, 213.25 ,,,, 12.31 ,,, 15.32 , 15.32 , 15.32 , 12.31 , 15.32 ,,,,,,,,,,,,,,, 82533,CORTISOL; TOTAL,82533, 280.13 ,,,, 16.18 ,,, 20.12 , 20.12 , 20.12 , 16.18 , 20.12 ,,,,,,,,,,,,,,, 82540,CREATINE,82540, 89.55 ,,,, 4.60 ,,, 5.72 , 5.72 , 5.72 , 4.60 , 5.72 ,,,,,,,,,,,,,,, 82541,"COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NOT ELSEWHERE SPECIFIED; QUALITATIVE, SINGLE STATIONARY AND MOBILE PHASE",82541, 158.33 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 82550,"CREATINE KINASE (CK), (CPK); TOTAL",82550, 310.20 ,,,, 6.47 ,,, 8.04 , 8.04 , 8.04 , 6.47 , 8.04 ,,,,,,,,,,,,,,, 82552,"CREATINE KINASE (CK), (CPK); ISOENZYMES",82552, 228.84 ,,,, 13.30 ,,, 16.53 , 16.53 , 16.53 , 13.30 , 16.53 ,,,,,,,,,,,,,,, 82553,"LAB CREATINE KINASE (CK), (CPK); MB FRACTION ONLY",82553, 344.40 ,,,, 11.46 ,,, 14.26 , 14.26 , 14.26 , 11.46 , 14.26 ,,,,,,,,,,,,,,, 82554,"CREATINE KINASE (CK), (CPK); ISOFORMS",82554, 267.72 ,,,, 11.78 ,,, 14.65 , 14.65 , 14.65 , 11.78 , 14.65 ,,,,,,,,,,,,,,, 82565,LAB CREATININE; BLOOD,82565, 191.34 ,,,, 5.09 ,,, 6.33 , 6.33 , 6.33 , 5.09 , 6.33 ,,,,,,,,,,,,,,, 82570,CREATININE; OTHER SOURCE,82570, 136.11 ,,,, 5.14 ,,, 6.39 , 6.39 , 6.39 , 5.14 , 6.39 ,,,,,,,,,,,,,,, 82575,CREATININE CLEARANCE,, 194.55 ,,,, 9.38 ,,, 11.67 , 11.67 , 11.67 , 9.38 , 11.67 ,,,,,,,,,,,,,,, 82607,CYANOCOBALAMIN (VITAMIN B-12);,82607, 280.50 ,,,, 14.96 ,,, 18.61 , 18.61 , 18.61 , 14.96 , 18.61 ,,,,,,,,,,,,,,, 82608,CYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY,82608, 428.61 ,,,, 14.22 ,,, 17.68 , 17.68 , 17.68 , 14.22 , 17.68 ,,,,,,,,,,,,,,, 82652,DIHYDROXYVITAMIN D 126,, 242.44 ,,,, 38.22 ,,, 47.53 , 47.53 , 47.53 , 38.22 , 47.53 ,,,,,,,,,,,,,,, 82657,"ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE SPECIFIED; NONRADIOACTIVE SUBSTRATE, EACH SPECIMEN",82657, 194.48 ,,,, 17.92 ,,, 22.29 , 22.29 , 22.29 , 17.92 , 22.29 ,,,,,,,,,,,,,,, 82670,ESTRADIOL,82670, 480.13 ,,,, 27.73 ,,, 34.49 , 34.49 , 34.49 , 27.73 , 34.49 ,,,,,,,,,,,,,,, 82672,ESTROGENS; TOTAL,82672, 127.42 ,,,, 21.53 ,,, 26.78 , 26.78 , 26.78 , 21.53 , 26.78 ,,,,,,,,,,,,,,, 82728,FERRITIN,82728, 403.25 ,,,, 13.54 ,,, 16.83 , 16.83 , 16.83 , 13.54 , 16.83 ,,,,,,,,,,,,,,, 82735,FLUORIDE,82735, 326.29 ,,,, 18.41 ,,, 22.89 , 22.89 , 22.89 , 18.41 , 22.89 ,,,,,,,,,,,,,,, 82746,FOLIC ACID; SERUM,82746, 252.63 ,,,, 14.59 ,,, 18.15 , 18.15 , 18.15 , 14.59 , 18.15 ,,,,,,,,,,,,,,, 82747,FOLIC ACID; RBC,82747, 297.13 ,,,, 17.18 ,,, 21.38 , 21.38 , 21.38 , 17.18 , 21.38 ,,,,,,,,,,,,,,, 82784,"GAMMAGLOBULIN; IGA, IGD, IGG, IGM, EACH",82784, 159.75 ,,,, 9.23 ,,, 11.48 , 11.48 , 11.48 , 9.23 , 11.48 ,,,,,,,,,,,,,,, 82800,"GASES, BLOOD, PH ONLY",82800, 170.67 ,,,, 8.84 ,,, 11.00 , 11.00 , 11.00 , 8.84 , 11.00 ,,,,,,,,,,,,,,, 82803,"GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION);",82803, 501.68 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 82805,"GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION); WITH O2 SATURATION, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY",82805, 170.67 ,,,, 63.34 ,,, 78.77 , 78.77 , 78.77 , 63.34 , 78.77 ,,,,,,,,,,,,,,, 82945,"GLUCOSE, BODY FLUID, OTHER THAN BLOOD",82945, 150.25 ,,,, 3.90 ,,, 4.85 , 4.85 , 4.85 , 3.90 , 4.85 ,,,,,,,,,,,,,,, 82947,"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)",82947, 144.23 ,,,, 3.90 ,,, 4.85 , 4.85 , 4.85 , 3.90 , 4.85 ,,,,,,,,,,,,,,, 82948,"GLUCOSE; BLOOD, REAGENT STRIP",82948, 101.27 ,,,, 4.06 ,,, 5.04 , 5.04 , 5.04 , 4.06 , 5.04 ,,,,,,,,,,,,,,, 82950,GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE),82950, 144.23 ,,,, 4.72 ,,, 5.86 , 5.86 , 5.86 , 4.72 , 5.86 ,,,,,,,,,,,,,,, 82962,"GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE",82962, 283.05 ,,,, 2.64 ,,, 3.28 , 3.28 , 3.28 , 2.64 , 3.28 ,,,,,,,,,,,,,,, 82977,"GLUTAMYLTRANSFERASE, GAMMA (GGT)",82977, 123.75 ,,,, 7.15 ,,, 8.89 , 8.89 , 8.89 , 7.15 , 8.89 ,,,,,,,,,,,,,,, 83001,GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH),83001, 319.25 ,,,, 18.44 ,,, 22.94 , 22.94 , 22.94 , 18.44 , 22.94 ,,,,,,,,,,,,,,, 83002,GONADOTROPIN; LUTEINIZING HORMONE (LH),83002, 318.52 ,,,, 18.38 ,,, 22.86 , 22.86 , 22.86 , 18.38 , 22.86 ,,,,,,,,,,,,,,, 83009,"HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)",83009," 1,157.38 ",,,, 66.86 ,,, 83.16 , 83.16 , 83.16 , 66.86 , 83.16 ,,,,,,,,,,,,,,, 83036,HEMOGLOBIN; GLYCOSYLATED (A1C),83036, 188.70 ,,,, 9.64 ,,, 11.99 , 11.99 , 11.99 , 9.64 , 11.99 ,,,,,,,,,,,,,,, 83516,"IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN, QUALITATIVE OR SEMIQUANTITATIVE; MULTIPLE STEP METHOD",83516, 254.78 ,,,, 11.45 ,,, 14.24 , 14.24 , 14.24 , 11.45 , 14.24 ,,,,,,,,,,,,,,, 83519,"IMMUNOASSAY, ANALYTE, QUANTITATIVE; BY RADIOPHARMACEUTICAL TECHNIQUE (EG, RIA)",83519, 232.13 ,,,, 14.80 ,,, 18.40 , 18.40 , 18.40 , 14.80 , 18.40 ,,,,,,,,,,,,,,, 83520,"IMMUNOASSAY, ANALYTE, QUANTITATIVE; NOT OTHERWISE SPECIFIED",83520, 222.50 ,,,, 13.88 ,,, 17.27 , 17.27 , 17.27 , 13.88 , 17.27 ,,,,,,,,,,,,,,, 83525,INSULIN; TOTAL,83525, 196.38 ,,,, 11.34 ,,, 14.11 , 14.11 , 14.11 , 11.34 , 14.11 ,,,,,,,,,,,,,,, 83540,IRON,83540, 200.81 ,,,, 6.42 ,,, 7.99 , 7.99 , 7.99 , 6.42 , 7.99 ,,,,,,,,,,,,,,, 83550,IRON BINDING CAPACITY,83550, 209.70 ,,,, 8.68 ,,, 10.79 , 10.79 , 10.79 , 8.68 , 10.79 ,,,,,,,,,,,,,,, 83605,LACTATE (LACTIC ACID),83605, 248.25 ,,,, 10.61 ,,, 13.19 , 13.19 , 13.19 , 10.61 , 13.19 ,,,,,,,,,,,,,,, 83615,"LACTATE DEHYDROGENASE (LD), (LDH);",83615, 206.38 ,,,, 5.99 ,,, 7.45 , 7.45 , 7.45 , 5.99 , 7.45 ,,,,,,,,,,,,,,, 83655,LEAD,83655, 379.60 ,,,, 12.02 ,,, 14.95 , 14.95 , 14.95 , 12.02 , 14.95 ,,,,,,,,,,,,,,, 83690,LIPASE,83690, 191.34 ,,,, 6.84 ,,, 8.51 , 8.51 , 8.51 , 6.84 , 8.51 ,,,,,,,,,,,,,,, 83718,"LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)",83718, 193.57 ,,,, 8.14 ,,, 10.12 , 10.12 , 10.12 , 8.14 , 10.12 ,,,,,,,,,,,,,,, 83735,MAGNESIUM,83735, 206.64 ,,,, 6.65 ,,, 8.27 , 8.27 , 8.27 , 6.65 , 8.27 ,,,,,,,,,,,,,,, 83874,MYOGLOBIN,83874, 225.01 ,,,, 12.83 ,,, 15.95 , 15.95 , 15.95 , 12.83 , 15.95 ,,,,,,,,,,,,,,, 83880,LAB NATRIURETIC PEPTIDE,83880, 583.25 ,,,, 33.68 ,,, 41.90 , 41.90 , 41.90 , 33.68 , 41.90 ,,,,,,,,,,,,,,, 83891,MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIED NUCLEIC ACID,83891, 225.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 83930,OSMOLALITY; BLOOD,83930, 159.23 ,,,, 6.56 ,,, 8.16 , 8.16 , 8.16 , 6.56 , 8.16 ,,,,,,,,,,,,,,, 83935,OSMOLALITY; URINE,83935, 169.53 ,,,, 6.77 ,,, 8.42 , 8.42 , 8.42 , 6.77 , 8.42 ,,,,,,,,,,,,,,, 83970,PARATHORMONE (PARATHYROID HORMONE),83970, 709.25 ,,,, 40.97 ,,, 50.96 , 50.96 , 50.96 , 40.97 , 50.96 ,,,,,,,,,,,,,,, 84022,PHENOTHIAZINE,84022, 111.87 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 84075,"PHOSPHATASE, ALKALINE;",84075, 88.88 ,,,, 5.14 ,,, 6.39 , 6.39 , 6.39 , 5.14 , 6.39 ,,,,,,,,,,,,,,, 84080,PHOSPHATASE ALKALINE ISOENZYMES,, 216.50 ,,,, 14.68 ,,, 18.25 , 18.25 , 18.25 , 14.68 , 18.25 ,,,,,,,,,,,,,,, 84100,PHOSPHORUS INORGANIC (PHOSPHATE);,84100, 174.74 ,,,, 4.70 ,,, 5.85 , 5.85 , 5.85 , 4.70 , 5.85 ,,,,,,,,,,,,,,, 84132,POTASSIUM; SERUM,84132, 170.74 ,,,, 4.57 ,,, 5.68 , 5.68 , 5.68 , 4.57 , 5.68 ,,,,,,,,,,,,,,, 84133,POTASSIUM; URINE,84133, 378.45 ,,,, 4.27 ,,, 5.32 , 5.32 , 5.32 , 4.27 , 5.32 ,,,,,,,,,,,,,,, 84134,PREALBUMIN,84134, 170.74 ,,,, 14.48 ,,, 18.01 , 18.01 , 18.01 , 14.48 , 18.01 ,,,,,,,,,,,,,,, 84144,PROGESTERONE,84144, 358.50 ,,,, 20.71 ,,, 25.76 , 25.76 , 25.76 , 20.71 , 25.76 ,,,,,,,,,,,,,,, 84145,PROCALCITONIN 48931,84145, 394.80 ,,,, 26.59 ,,, 33.08 , 33.08 , 33.08 , 26.59 , 33.08 ,,,,,,,,,,,,,,, 84146,PROLACTIN,84146, 754.31 ,,,, 19.24 ,,, 23.92 , 23.92 , 23.92 , 19.24 , 23.92 ,,,,,,,,,,,,,,, 84153,PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL,84153, 447.15 ,,,, 18.26 ,,, 22.71 , 22.71 , 22.71 , 18.26 , 22.71 ,,,,,,,,,,,,,,, 84154,PROSTATE SPECIFIC ANTIGEN (PSA); FREE,84154, 316.13 ,,,, 18.26 ,,, 22.71 , 22.71 , 22.71 , 18.26 , 22.71 ,,,,,,,,,,,,,,, 84155,"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM",84155, 63.00 ,,,, 3.65 ,,, 4.53 , 4.53 , 4.53 , 3.65 , 4.53 ,,,,,,,,,,,,,,, 84157,"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID, CEREBROSPINAL FLUID)",84157, 524.10 ,,,, 3.65 ,,, 4.53 , 4.53 , 4.53 , 3.65 , 4.53 ,,,,,,,,,,,,,,, 84166,PROTEIN ELECTROPHORETIC FRACTIONATION,, 754.31 ,,,, 17.70 ,,, 22.01 , 22.01 , 22.01 , 17.70 , 22.01 ,,,,,,,,,,,,,,, 84270,SEX HORMONE BINDING GLOBULIN (SHBG),84270, 84.93 ,,,, 21.58 ,,, 26.83 , 26.83 , 26.83 , 21.58 , 26.83 ,,,,,,,,,,,,,,, 84295,SODIUM; SERUM,84295, 92.45 ,,,, 4.78 ,,, 5.94 , 5.94 , 5.94 , 4.78 , 5.94 ,,,,,,,,,,,,,,, 84300,SODIUM; URINE,84300, 345.75 ,,,, 4.82 ,,, 6.00 , 6.00 , 6.00 , 4.82 , 6.00 ,,,,,,,,,,,,,,, 84402,TESTOSTERONE; FREE,84402, 437.50 ,,,, 25.28 ,,, 31.45 , 31.45 , 31.45 , 25.28 , 31.45 ,,,,,,,,,,,,,,, 84403,TESTOSTERONE; TOTAL,84403, 443.63 ,,,, 25.62 ,,, 31.87 , 31.87 , 31.87 , 25.62 , 31.87 ,,,,,,,,,,,,,,, 84425,THIAMINE VITAMIN B-1,, 254.76 ,,,, 21.07 ,,, 26.21 , 26.21 , 26.21 , 21.07 , 26.21 ,,,,,,,,,,,,,,, 84436,THYROXINE; TOTAL,84436, 210.00 ,,,, 6.82 ,,, 8.48 , 8.48 , 8.48 , 6.82 , 8.48 ,,,,,,,,,,,,,,, 84439,THYROXINE; FREE,84439, 209.70 ,,,, 8.95 ,,, 11.13 , 11.13 , 11.13 , 8.95 , 11.13 ,,,,,,,,,,,,,,, 84443,THYROID STIMULATING HORMONE (TSH),84443, 344.40 ,,,, 16.68 ,,, 20.75 , 20.75 , 20.75 , 16.68 , 20.75 ,,,,,,,,,,,,,,, 84446,TOCOPHEROL ALPHA (VITAMIN E),84446, 608.18 ,,,, 14.08 ,,, 17.51 , 17.51 , 17.51 , 14.08 , 17.51 ,,,,,,,,,,,,,,, 84450,TRANSFERASE; ASPARTATE AMINO (AST) (SGOT),84450, 195.82 ,,,, 5.14 ,,, 6.39 , 6.39 , 6.39 , 5.14 , 6.39 ,,,,,,,,,,,,,,, 84460,TRANSFERASE; ALANINE AMINO (ALT) (SGPT),84460, 175.31 ,,,, 5.26 ,,, 6.54 , 6.54 , 6.54 , 5.26 , 6.54 ,,,,,,,,,,,,,,, 84466,TRANSFERRIN,84466, 158.13 ,,,, 12.67 ,,, 15.76 , 15.76 , 15.76 , 12.67 , 15.76 ,,,,,,,,,,,,,,, 84478,TRIGLYCERIDES,84478, 250.00 ,,,, 5.70 ,,, 7.09 , 7.09 , 7.09 , 5.70 , 7.09 ,,,,,,,,,,,,,,, 84479,THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR),84479, 285.64 ,,,, 6.42 ,,, 7.98 , 7.98 , 7.98 , 6.42 , 7.98 ,,,,,,,,,,,,,,, 84480,TRIIODOTHYRONINE T3; TOTAL (TT-3),84480, 243.63 ,,,, 14.08 ,,, 17.51 , 17.51 , 17.51 , 14.08 , 17.51 ,,,,,,,,,,,,,,, 84481,TRIIODOTHYRONINE T3; FREE,84481, 291.13 ,,,, 16.82 ,,, 20.92 , 20.92 , 20.92 , 16.82 , 20.92 ,,,,,,,,,,,,,,, 84482,TRIIODOTHYRONINE T3; REVERSE,84482, 275.41 ,,,, 15.65 ,,, 19.46 , 19.46 , 19.46 , 15.65 , 19.46 ,,,,,,,,,,,,,,, 84484,"LAB TROPONIN, QUANTITATIVE",84484, 344.40 ,,,, 10.02 ,,, 12.47 , 12.47 , 12.47 , 10.02 , 12.47 ,,,,,,,,,,,,,,, 84485,TRYPSIN; DUODENAL FLUID,84485, 215.18 ,,,, 7.15 ,,, 8.89 , 8.89 , 8.89 , 7.15 , 8.89 ,,,,,,,,,,,,,,, 84512,"TROPONIN, QUALITATIVE",84512, 202.43 ,,,, 8.11 ,,, 10.09 , 10.09 , 10.09 , 8.11 , 10.09 ,,,,,,,,,,,,,,, 84520,UREA NITROGEN; QUANTITATIVE,84520, 166.86 ,,,, 3.92 ,,, 4.88 , 4.88 , 4.88 , 3.92 , 4.88 ,,,,,,,,,,,,,,, 84550,URIC ACID; BLOOD,84550, 318.02 ,,,, 4.49 ,,, 5.58 , 5.58 , 5.58 , 4.49 , 5.58 ,,,,,,,,,,,,,,, 84560,URIC ACID; OTHER SOURCE,84560, 179.54 ,,,, 4.72 ,,, 5.86 , 5.86 , 5.86 , 4.72 , 5.86 ,,,,,,,,,,,,,,, 84597,VITAMIN K,, 7.46 ,,,, 13.62 ,,, 16.94 , 16.94 , 16.94 , 13.62 , 16.94 ,,,,,,,,,,,,,,, 84600,"VOLATILES (EG, ACETIC ANHYDRIDE, CARBON TETRACHLORIDE, DICHLOROETHANE, DICHLOROMETHANE, DIETHYLETHER, ISOPROPYL ALCOHOL, METHANOL)",84600, 413.07 ,,,, 15.96 ,,, 19.85 , 19.85 , 19.85 , 15.96 , 19.85 ,,,,,,,,,,,,,,, 84630,ZINC,84630, 166.86 ,,,, 11.30 ,,, 14.06 , 14.06 , 14.06 , 11.30 , 14.06 ,,,,,,,,,,,,,,, 84681,C-PEPTIDE,84681, 357.63 ,,,, 20.66 ,,, 25.70 , 25.70 , 25.70 , 20.66 , 25.70 ,,,,,,,,,,,,,,, 84702,"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE",84702, 273.76 ,,,, 14.95 ,,, 18.59 , 18.59 , 18.59 , 14.95 , 18.59 ,,,,,,,,,,,,,,, 84703," GONADOTROPIN, CHORIONIC, (HCG); QUALITATIVE",84703, 278.58 ,,,, 7.46 ,,, 9.29 , 9.29 , 9.29 , 7.46 , 9.29 ,,,,,,,,,,,,,,, 84704,"GONADOTROPIN, CHORIONIC (HCG); FREE BETA CHAIN",84704, 248.58 ,,,, 14.95 ,,, 18.59 , 18.59 , 18.59 , 14.95 , 18.59 ,,,,,,,,,,,,,,, 85004,BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT,85004, 168.97 ,,,, 6.42 ,,, 7.98 , 7.98 , 7.98 , 6.42 , 7.98 ,,,,,,,,,,,,,,, 85007,BLOOD COUNT BLOOD SMEAR MICROSCOPIC EXAM,, 99.75 ,,,, 3.41 ,,, 4.24 , 4.24 , 4.24 , 3.41 , 4.24 ,,,,,,,,,,,,,,, 85014,BLOOD COUNT; HEMATOCRIT (HCT),85014, 133.62 ,,,, 2.35 ,,, 2.93 , 2.93 , 2.93 , 2.35 , 2.93 ,,,,,,,,,,,,,,, 85018,BLOOD COUNT; HEMOGLOBIN (HGB),85018, 133.62 ,,,, 2.35 ,,, 2.93 , 2.93 , 2.93 , 2.35 , 2.93 ,,,,,,,,,,,,,,, 85025,"LAB BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT",85025, 267.87 ,,,, 7.72 ,,, 9.59 , 9.59 , 9.59 , 7.72 , 9.59 ,,,,,,,,,,,,,,, 85027,"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)",85027, 194.40 ,,,, 6.42 ,,, 7.98 , 7.98 , 7.98 , 6.42 , 7.98 ,,,,,,,,,,,,,,, 85032,"BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH",85032, 199.84 ,,,, 4.27 ,,, 5.32 , 5.32 , 5.32 , 4.27 , 5.32 ,,,,,,,,,,,,,,, 85041,BLOOD COUNT RED BLOOD CELL RBC AUTOMATED,, 62.10 ,,,, 3.00 ,,, 3.73 , 3.73 , 3.73 , 3.00 , 3.73 ,,,,,,,,,,,,,,, 85044,"BLOOD COUNT; RETICULOCYTE, MANUAL",85044, 131.18 ,,,, 4.27 ,,, 5.32 , 5.32 , 5.32 , 4.27 , 5.32 ,,,,,,,,,,,,,,, 85045,"BLOOD COUNT; RETICULOCYTE, AUTOMATED",85045, 34.79 ,,,, 3.96 ,,, 4.93 , 4.93 , 4.93 , 3.96 , 4.93 ,,,,,,,,,,,,,,, 85048,"LAB BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED",85048, 267.75 ,,,, 2.52 ,,, 3.13 , 3.13 , 3.13 , 2.52 , 3.13 ,,,,,,,,,,,,,,, 85049,"BLOOD COUNT; PLATELET, AUTOMATED",85049, 123.62 ,,,, 4.45 ,,, 5.53 , 5.53 , 5.53 , 4.45 , 5.53 ,,,,,,,,,,,,,,, 85060,"BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT",85060, 133.62 ,,,, 20.86 ,,, 25.48 , 25.48 , 25.48 , 20.86 , 25.48 ,,,,,,,,,,,,,,, 85347,COAGULATION TIME; ACTIVATED,85347, 73.13 ,,,, 4.22 ,,, 5.26 , 5.26 , 5.26 , 4.22 , 5.26 ,,,,,,,,,,,,,,, 85378,"FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE",85378, 197.16 ,,,, 7.81 ,,, 9.72 , 9.72 , 9.72 , 7.81 , 9.72 ,,,,,,,,,,,,,,, 85379,"LAB FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE",85379, 413.72 ,,,, 10.10 ,,, 12.56 , 12.56 , 12.56 , 10.10 , 12.56 ,,,,,,,,,,,,,,, 85380,"FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FOR VENOUS THROMBOEMBOLISM), QUALITATIVE OR SEMIQUANTITATIVE",85380, 427.52 ,,,, 10.10 ,,, 12.56 , 12.56 , 12.56 , 10.10 , 12.56 ,,,,,,,,,,,,,,, 85384,FIBRINOGEN; ACTIVITY,85384, 227.52 ,,,, 8.44 ,,, 10.49 , 10.49 , 10.49 , 8.44 , 10.49 ,,,,,,,,,,,,,,, 85385,FIBRINOGEN; ANTIGEN,85385, 210.02 ,,,, 11.63 ,,, 14.46 , 14.46 , 14.46 , 11.63 , 14.46 ,,,,,,,,,,,,,,, 85397,COAGULATION AND FIBRINOLYSIS FUNCTIONAL ACTIVITY NOT OTHERWISE SPECIFIED (EG ADAMTS-13) EACH ANALYTE,85397, 50.00 ,,,, 24.82 ,,, 30.86 , 30.86 , 30.86 , 24.82 , 30.86 ,,,,,,,,,,,,,,, 85576,"PLATELET, AGGREGATION (IN VITRO), EACH AGENT",85576, 251.50 ,,,, 21.32 ,,, 26.52 , 26.52 , 26.52 , 21.32 , 26.52 ,,,,,,,,,,,,,,, 85610,LAB PROTHROMBIN TIME;,85610, 225.01 ,,,, 3.90 ,,, 4.85 , 4.85 , 4.85 , 3.90 , 4.85 ,,,,,,,,,,,,,,, 85651,SEDIMENTATION RATE ERYTHROCYTE NONAUTOMA,, 191.34 ,,,, 3.52 ,,, 4.38 , 4.38 , 4.38 , 3.52 , 4.38 ,,,,,,,,,,,,,,, 85652,"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED",85652, 122.39 ,,,, 2.68 ,,, 3.33 , 3.33 , 3.33 , 2.68 , 3.33 ,,,,,,,,,,,,,,, 85660,"SICKLING OF RBC, REDUCTION",85660, 115.72 ,,,, 5.47 ,,, 6.80 , 6.80 , 6.80 , 5.47 , 6.80 ,,,,,,,,,,,,,,, 85730,"LAB THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD",85730, 212.29 ,,,, 5.96 ,,, 7.42 , 7.42 , 7.42 , 5.96 , 7.42 ,,,,,,,,,,,,,,, 86000,"AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED FEVER, SCRUB TYPHUS), EACH ANTIGEN",86000, 120.00 ,,,, 6.94 ,,, 8.62 , 8.62 , 8.62 , 6.94 , 8.62 ,,,,,,,,,,,,,,, 86001,ALLERGEN SPECIFIC IGG QUANTITATIVE,, 65.05 ,,,, 6.29 ,,, 7.82 , 7.82 , 7.82 , 6.29 , 7.82 ,,,,,,,,,,,,,,, 86003,"ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN",86003, 82.13 ,,,, 5.17 ,,, 6.44 , 6.44 , 6.44 , 5.17 , 6.44 ,,,,,,,,,,,,,,, 86021,ANTIBODY IDENTIFICATION LEUKOCYTE ANTIB,, 309.75 ,,,, 14.95 ,,, 18.59 , 18.59 , 18.59 , 14.95 , 18.59 ,,,,,,,,,,,,,,, 86038,ANTINUCLEAR ANTIBODIES (ANA);,86038, 207.75 ,,,, 12.00 ,,, 14.92 , 14.92 , 14.92 , 12.00 , 14.92 ,,,,,,,,,,,,,,, 86039,ANTINUCLEAR ANTIBODIES (ANA); TITER,86039, 75.15 ,,,, 11.08 ,,, 13.78 , 13.78 , 13.78 , 11.08 , 13.78 ,,,,,,,,,,,,,,, 86140,C-REACTIVE PROTEIN;,86140, 160.75 ,,,, 5.14 ,,, 6.39 , 6.39 , 6.39 , 5.14 , 6.39 ,,,,,,,,,,,,,,, 86141,C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP),86141, 222.50 ,,,, 12.85 ,,, 15.98 , 15.98 , 15.98 , 12.85 , 15.98 ,,,,,,,,,,,,,,, 86162,COMPLEMENT; TOTAL HEMOLYTIC (CH50),86162, 322.88 ,,,, 20.17 ,,, 25.09 , 25.09 , 25.09 , 20.17 , 25.09 ,,,,,,,,,,,,,,, 86255,"FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY",86255, 445.50 ,,,, 11.96 ,,, 14.88 , 14.88 , 14.88 , 11.96 , 14.88 ,,,,,,,,,,,,,,, 86300,IMMUNOASSAY FOR TUMOR ANTIGEN,, 254.44 ,,,, 20.66 ,,, 25.70 , 25.70 , 25.70 , 20.66 , 25.70 ,,,,,,,,,,,,,,, 86304,"IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125",86304, 357.63 ,,,, 20.66 ,,, 25.70 , 25.70 , 25.70 , 20.66 , 25.70 ,,,,,,,,,,,,,,, 86308,LAB HETEROPHILE ANTIBODIES; SCREENING,86308, 182.00 ,,,, 5.14 ,,, 6.39 , 6.39 , 6.39 , 5.14 , 6.39 ,,,,,,,,,,,,,,, 86325,"IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH CONCENTRATION",86325, 244.90 ,,,, 22.20 ,,, 27.61 , 27.61 , 27.61 , 22.20 , 27.61 ,,,,,,,,,,,,,,, 86328,IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY (IES) SINGLE STREP (REAGANT STRIP),86328, 565.37 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 86329,IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED,, 565.37 ,,,, 13.94 ,,, 17.34 , 17.34 , 17.34 , 13.94 , 17.34 ,,,,,,,,,,,,,,, 86356,"MONONUCLEAR CELL ANTIGEN, QUANTITATIVE (EG, FLOW CYTOMETRY), NOT OTHERWISE SPECIFIED, EACH ANTIGEN",86356, 210.14 ,,,, 26.58 ,,, 33.06 , 33.06 , 33.06 , 26.58 , 33.06 ,,,,,,,,,,,,,,, 86360,TCELLS ABSOLUTE CD4&CD8 COUNT INCD RATIO,," 1,369.56 ",,,, 46.64 ,,, 58.01 , 58.01 , 58.01 , 46.64 , 58.01 ,,,,,,,,,,,,,,, 86376,"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH",86376, 249.88 ,,,, 14.44 ,,, 17.96 , 17.96 , 17.96 , 14.44 , 17.96 ,,,,,,,,,,,,,,, 86403,"PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY",86403, 175.13 ,,,, 10.12 ,,, 12.58 , 12.58 , 12.58 , 10.12 , 12.58 ,,,,,,,,,,,,,,, 86406,"PARTICLE AGGLUTINATION; TITER, EACH ANTIBODY",86406, 169.24 ,,,, 10.56 ,,, 13.13 , 13.13 , 13.13 , 10.56 , 13.13 ,,,,,,,,,,,,,,, 86413,SARS-COV2 ANTIBODY QUANTITATIVE,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 86430,RHEUMATOID FACTOR; QUALITATIVE,86430, 97.50 ,,,, 5.63 ,,, 7.00 , 7.00 , 7.00 , 5.63 , 7.00 ,,,,,,,,,,,,,,, 86431,RHEUMATOID FACTOR; QUANTITATIVE,86431, 106.82 ,,,, 5.63 ,,, 7.00 , 7.00 , 7.00 , 5.63 , 7.00 ,,,,,,,,,,,,,,, 86480,"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY MEASUREMENT OF GAMMA INTERFERON ANTIGEN RESPONSE",86480, 208.17 ,,,, 61.52 ,,, 76.52 , 76.52 , 76.52 , 61.52 , 76.52 ,,,,,,,,,,,,,,, 86481,TUBERCULOSIS TEST CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFERON-PRODUCING T-CELLS IN CELL SUSPENSION,86481, 208.17 ,,,, 80.40 ,,, 100.00 , 100.00 , 100.00 , 80.40 , 100.00 ,,,,,,,,,,,,,,, 86580,"SKIN TEST; TUBERCULOSIS, INTRADERMAL",86580, 101.88 ,,, 49.92 , 6.72 , 17.17 ,, 17.47 , 17.47 , 17.47 , 6.72 , 17.47 ,,,,,,,,,,,,,,, 86592,"SYPHILIS TEST; QUALITATIVE (EG, VDRL, RPR, ART)",86592, 73.38 ,,,, 4.24 ,,, 5.27 , 5.27 , 5.27 , 4.24 , 5.27 ,,,,,,,,,,,,,,, 86593,SYPHILIS TEST; QUANTITATIVE,86593, 75.63 ,,,, 4.37 ,,, 5.44 , 5.44 , 5.44 , 4.37 , 5.44 ,,,,,,,,,,,,,,, 86611,ANTIBODY; BARTONELLA,86611, 140.50 ,,,, 10.10 ,,, 12.56 , 12.56 , 12.56 , 10.10 , 12.56 ,,,,,,,,,,,,,,, 86617,"ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN BLOT OR IMMUNOBLOT)",86617, 74.38 ,,,, 15.38 ,,, 19.13 , 19.13 , 19.13 , 15.38 , 19.13 ,,,,,,,,,,,,,,, 86618,ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE),86618, 292.63 ,,,, 16.90 ,,, 21.02 , 21.02 , 21.02 , 16.90 , 21.02 ,,,,,,,,,,,,,,, 86631,ANTIBODY; CHLAMYDIA,86631, 170.75 ,,,, 11.74 ,,, 14.60 , 14.60 , 14.60 , 11.74 , 14.60 ,,,,,,,,,,,,,,, 86641,ANTIBODY; CRYPTOCOCCUS,86641, 170.75 ,,,, 14.30 ,,, 17.79 , 17.79 , 17.79 , 14.30 , 17.79 ,,,,,,,,,,,,,,, 86644,ANTIBODY; CYTOMEGALOVIRUS (CMV),86644, 347.38 ,,,, 14.29 ,,, 17.77 , 17.77 , 17.77 , 14.29 , 17.77 ,,,,,,,,,,,,,,, 86645,"ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM",86645, 130.00 ,,,, 16.73 ,,, 20.80 , 20.80 , 20.80 , 16.73 , 20.80 ,,,,,,,,,,,,,,, 86663,"ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)",86663, 322.12 ,,,, 13.02 ,,, 16.20 , 16.20 , 16.20 , 13.02 , 16.20 ,,,,,,,,,,,,,,, 86664,"ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)",86664, 300.00 ,,,, 15.18 ,,, 18.88 , 18.88 , 18.88 , 15.18 , 18.88 ,,,,,,,,,,,,,,, 86665,"ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)",86665, 322.12 ,,,, 18.01 ,,, 22.40 , 22.40 , 22.40 , 18.01 , 22.40 ,,,,,,,,,,,,,,, 86666,ANTIBODY; EHRLICHIA,86666, 157.46 ,,,, 10.10 ,,, 12.56 , 12.56 , 12.56 , 10.10 , 12.56 ,,,,,,,,,,,,,,, 86677,ANTIBODY; HELICOBACTER PYLORI,86677, 182.85 ,,,, 14.40 ,,, 17.91 , 17.91 , 17.91 , 14.40 , 17.91 ,,,,,,,,,,,,,,, 86689,"ANTIBODY; HTLV OR HIV ANTIBODY, CONFIRMATORY TEST (EG, WESTERN BLOT)",86689, 322.50 ,,,, 19.21 ,,, 23.90 , 23.90 , 23.90 , 19.21 , 23.90 ,,,,,,,,,,,,,,, 86694,"ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST",86694, 82.80 ,,,, 14.29 ,,, 17.77 , 17.77 , 17.77 , 14.29 , 17.77 ,,,,,,,,,,,,,,, 86695,"ANTIBODY; HERPES SIMPLEX, TYPE 1",86695, 225.00 ,,,, 13.09 ,,, 16.28 , 16.28 , 16.28 , 13.09 , 16.28 ,,,,,,,,,,,,,,, 86696,"ANTIBODY; HERPES SIMPLEX, TYPE 2",86696, 332.50 ,,,, 19.21 ,,, 23.90 , 23.90 , 23.90 , 19.21 , 23.90 ,,,,,,,,,,,,,,, 86701,ANTIBODY; HIV-1,86701, 189.80 ,,,, 8.82 ,,, 10.97 , 10.97 , 10.97 , 8.82 , 10.97 ,,,,,,,,,,,,,,, 86702,ANTIBODY; HIV-2,86702, 217.20 ,,,, 13.42 ,,, 16.69 , 16.69 , 16.69 , 13.42 , 16.69 ,,,,,,,,,,,,,,, 86703,"ANTIBODY; HIV-1 AND HIV-2, SINGLE ASSAY",86703, 228.00 ,,,, 13.61 ,,, 16.92 , 16.92 , 16.92 , 13.61 , 16.92 ,,,,,,,,,,,,,,, 86704,HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL,86704, 128.00 ,,,, 11.96 ,,, 14.88 , 14.88 , 14.88 , 11.96 , 14.88 ,,,,,,,,,,,,,,, 86705,HEPATITIS B CORE ANTIBODY HBCAB IGM ANTI,, 128.00 ,,,, 11.69 ,,, 14.54 , 14.54 , 14.54 , 11.69 , 14.54 ,,,,,,,,,,,,,,, 86706,HEPATITIS B SURFACE ANTIBODY (HBSAB),86706, 298.93 ,,,, 10.66 ,,, 13.26 , 13.26 , 13.26 , 10.66 , 13.26 ,,,,,,,,,,,,,,, 86707,HEPATITIS BE ANTIBODY (HBEAB),86707, 198.00 ,,,, 11.48 ,,, 14.28 , 14.28 , 14.28 , 11.48 , 14.28 ,,,,,,,,,,,,,,, 86708,HEPATITIS A ANTIBODY (HAAB); TOTAL,86708, 212.88 ,,,, 12.29 ,,, 15.29 , 15.29 , 15.29 , 12.29 , 15.29 ,,,,,,,,,,,,,,, 86709,HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY,86709, 208.00 ,,,, 11.17 ,,, 13.90 , 13.90 , 13.90 , 11.17 , 13.90 ,,,,,,,,,,,,,,, 86710,ANTIBODY; INFLUENZA VIRUS,86710, 232.88 ,,,, 13.45 ,,, 16.73 , 16.73 , 16.73 , 13.45 , 16.73 ,,,,,,,,,,,,,,, 86735,ANTIBODY; MUMPS,86735, 224.25 ,,,, 12.95 ,,, 16.11 , 16.11 , 16.11 , 12.95 , 16.11 ,,,,,,,,,,,,,,, 86738,ANTIBODY MYCOPLASMA,, 75.84 ,,,, 13.14 ,,, 16.34 , 16.34 , 16.34 , 13.14 , 16.34 ,,,,,,,,,,,,,,, 86747,ANTIBODY; PARVOVIRUS,86747, 158.75 ,,,, 14.93 ,,, 18.56 , 18.56 , 18.56 , 14.93 , 18.56 ,,,,,,,,,,,,,,, 86750,ANTIBODY; PLASMODIUM (MALARIA),86750, 167.81 ,,,, 13.09 ,,, 16.28 , 16.28 , 16.28 , 13.09 , 16.28 ,,,,,,,,,,,,,,, 86753,"ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED",86753, 309.66 ,,,, 12.29 ,,, 15.29 , 15.29 , 15.29 , 12.29 , 15.29 ,,,,,,,,,,,,,,, 86756,ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS,86756, 345.00 ,,,, 12.79 ,,, 15.91 , 15.91 , 15.91 , 12.79 , 15.91 ,,,,,,,,,,,,,,, 86757,ANTIBODY; RICKETTSIA,86757, 140.58 ,,,, 19.21 ,,, 23.90 , 23.90 , 23.90 , 19.21 , 23.90 ,,,,,,,,,,,,,,, 86759,ANTIBODY; ROTAVIRUS,86759, 226.63 ,,,, 14.65 ,,, 18.23 , 18.23 , 18.23 , 14.65 , 18.23 ,,,,,,,,,,,,,,, 86762,ANTIBODY; RUBELLA,86762, 247.38 ,,,, 14.29 ,,, 17.77 , 17.77 , 17.77 , 14.29 , 17.77 ,,,,,,,,,,,,,,, 86765,ANTIBODY; RUBEOLA,86765, 309.66 ,,,, 12.78 ,,, 15.90 , 15.90 , 15.90 , 12.78 , 15.90 ,,,,,,,,,,,,,,, 86769,ANITBODY; SEVERE ACUTE RESPITATORY SYNDROM CORONAVISRUS 2,86769, 601.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 86777,ANTIBODY; TOXOPLASMA,86777, 247.38 ,,,, 14.29 ,,, 17.77 , 17.77 , 17.77 , 14.29 , 17.77 ,,,,,,,,,,,,,,, 86780,ANTIBODY; TREPONEMA PALLIDUM,86780, 172.90 ,,,, 13.14 ,,, 16.34 , 16.34 , 16.34 , 13.14 , 16.34 ,,,,,,,,,,,,,,, 86787,ANTIBODY; VARICELLA-ZOSTER,86787, 172.90 ,,,, 12.78 ,,, 15.90 , 15.90 , 15.90 , 12.78 , 15.90 ,,,,,,,,,,,,,,, 86788,"ANTIBODY; WEST NILE VIRUS, IGM",86788, 318.75 ,,,, 16.73 ,,, 20.80 , 20.80 , 20.80 , 16.73 , 20.80 ,,,,,,,,,,,,,,, 86789,ANTIBODY; WEST NILE VIRUS,86789, 134.76 ,,,, 14.29 ,,, 17.77 , 17.77 , 17.77 , 14.29 , 17.77 ,,,,,,,,,,,,,,, 86790,"ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED",86790, 171.25 ,,,, 12.78 ,,, 15.90 , 15.90 , 15.90 , 12.78 , 15.90 ,,,,,,,,,,,,,,, 86800,THYROGLOBULIN ANTIBODY,86800, 128.00 ,,,, 15.79 ,,, 19.64 , 19.64 , 19.64 , 15.79 , 19.64 ,,,,,,,,,,,,,,, 86803,HEPATITIS C ANTIBODY;,86803, 245.25 ,,,, 14.16 ,,, 17.61 , 17.61 , 17.61 , 14.16 , 17.61 ,,,,,,,,,,,,,,, 86804,"HEPATITIS C ANTIBODY; CONFIRMATORY TEST (EG, IMMUNOBLOT)",86804, 266.25 ,,,, 15.38 ,,, 19.13 , 19.13 , 19.13 , 15.38 , 19.13 ,,,,,,,,,,,,,,, 86806,"LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION",86806, 130.56 ,,,, 47.23 ,,, 58.75 , 58.75 , 58.75 , 47.23 , 58.75 ,,,,,,,,,,,,,,, 86850,"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE",86850, 248.73 ,,, 100.28 , 7.86 , 50.98 ,, 44.70 , 44.70 , 44.70 , 7.86 , 50.98 ,,,,,,,,,,,,,,, 86880,"ANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM",86880, 218.73 ,,, 114.96 , 5.35 , 32.12 ,, 31.80 , 31.80 , 31.80 , 5.35 , 32.12 ,,,,,,,,,,,,,,, 86900,LAB BLOOD TYPING; ABO,86900, 307.75 ,,, 232.22 , 2.96 , 106.48 ,, 105.04 , 105.04 , 105.04 , 2.96 , 106.48 ,,,,,,,,,,,,,,, 86901,LAB BLOOD TYPING; RH (D),86901, 194.25 ,,, 67.92 , 2.96 , 32.12 ,, 31.80 , 31.80 , 31.80 , 2.96 , 32.12 ,,,,,,,,,,,,,,, 86904,"BLOOD TYPING; ANTIGEN SCREENING FOR COMPATIBLE UNIT USING PATIENT SERUM, PER UNIT SCREENED",86904, 194.25 ,,, 67.92 , 13.14 , 32.12 ,, 31.80 , 31.80 , 31.80 , 13.14 , 32.12 ,,,,,,,,,,,,,,, 86905,"BLOOD TYPING; RBC ANTIGENS, OTHER THAN ABO OR RH (D), EACH",86905, 234.25 ,,, 648.22 , 3.80 , 274.22 ,, 215.43 , 215.43 , 215.43 , 3.80 , 274.22 ,,,,,,,,,,,,,,, 86906,"BLOOD TYPING; RH PHENOTYPING, COMPLETE",86906, 194.25 ,,, 67.92 , 7.69 , 32.12 ,, 31.80 , 31.80 , 31.80 , 7.69 , 32.12 ,,,,,,,,,,,,,,, 86923,"COMPATIBILITY TEST EACH UNIT, ELECTRONIC",," 1,886.76 ",,, 314.50 , 24.02 , 144.73 ,, 129.18 , 129.18 , 129.18 , 24.02 , 144.73 ,,,,,,,,,,,,,,, 87015,CONCENTRATION INFECTIOUS AGENTS,, 49.52 ,,,, 6.62 ,,, 8.24 , 8.24 , 8.24 , 6.62 , 8.24 ,,,,,,,,,,,,,,, 87040,"LAB CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES (INCLUDES ANAEROBIC CULTURE, IF APPROPRIATE)",87040, 378.00 ,,,, 10.25 ,,, 12.74 , 12.74 , 12.74 , 10.25 , 12.74 ,,,,,,,,,,,,,,, 87045,"CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION (EG, KIA, LIA), SALMONELLA AND SHIGELLA SPECIES",87045, 336.74 ,,,, 9.37 ,,, 11.66 , 11.66 , 11.66 , 9.37 , 11.66 ,,,,,,,,,,,,,,, 87046,"CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, EACH PLATE",87046, 162.13 ,,,, 9.37 ,,, 11.66 , 11.66 , 11.66 , 9.37 , 11.66 ,,,,,,,,,,,,,,, 87070,"LAB CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES",87070, 301.00 ,,,, 8.56 ,,, 10.64 , 10.64 , 10.64 , 8.56 , 10.64 ,,,,,,,,,,,,,,, 87071,"CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL",87071, 224.75 ,,,, 9.37 ,,, 11.66 , 11.66 , 11.66 , 9.37 , 11.66 ,,,,,,,,,,,,,,, 87073,CULTURE BACTERIAL QUANTITATIVE ANAEROBIC,, 194.25 ,,,, 9.37 ,,, 11.66 , 11.66 , 11.66 , 9.37 , 11.66 ,,,,,,,,,,,,,,, 87075,"LAB CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES",87075, 375.02 ,,,, 9.40 ,,, 11.69 , 11.69 , 11.69 , 9.40 , 11.69 ,,,,,,,,,,,,,,, 87076,"LAB CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE",87076, 403.20 ,,,, 8.02 ,,, 9.97 , 9.97 , 9.97 , 8.02 , 9.97 ,,,,,,,,,,,,,,, 87077,"LAB CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE",87077, 222.30 ,,,, 8.02 ,,, 9.97 , 9.97 , 9.97 , 8.02 , 9.97 ,,,,,,,,,,,,,,, 87081,"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;",87081, 265.35 ,,,, 6.58 ,,, 8.18 , 8.18 , 8.18 , 6.58 , 8.18 ,,,,,,,,,,,,,,, 87086,"LAB CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE",87086, 252.91 ,,,, 8.00 ,,, 9.96 , 9.96 , 9.96 , 8.00 , 9.96 ,,,,,,,,,,,,,,, 87088,"LAB CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE",87088, 139.13 ,,,, 8.03 ,,, 9.99 , 9.99 , 9.99 , 8.03 , 9.99 ,,,,,,,,,,,,,,, 87101,CULTURE FUNGI MOLD YEAST SKIN HAIR NAIL,, 237.54 ,,,, 7.64 ,,, 9.51 , 9.51 , 9.51 , 7.64 , 9.51 ,,,,,,,,,,,,,,, 87102,"CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; OTHER SOURCE (EXCEPT BLOOD)",87102, 568.72 ,,,, 8.34 ,,, 10.38 , 10.38 , 10.38 , 8.34 , 10.38 ,,,,,,,,,,,,,,, 87110,CULTURE CHLAMYDIA ANY SOURCE,, 403.20 ,,,, 19.45 ,,, 24.19 , 24.19 , 24.19 , 19.45 , 24.19 ,,,,,,,,,,,,,,, 87116,"CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY SOURCE, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES",87116, 349.74 ,,,, 10.73 ,,, 13.34 , 13.34 , 13.34 , 10.73 , 13.34 ,,,,,,,,,,,,,,, 87140,"CULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM",87140, 239.74 ,,,, 5.53 ,,, 6.88 , 6.88 , 6.88 , 5.53 , 6.88 ,,,,,,,,,,,,,,, 87158,CULTURE TYPING OTHER METHODS,, 160.20 ,,,, 6.23 ,,, 7.74 , 7.74 , 7.74 , 6.23 , 7.74 ,,,,,,,,,,,,,,, 87164,DARK FIELD EXAM ANY SOURCE,, 124.52 ,,,, 10.66 ,,, 13.26 , 13.26 , 13.26 , 10.66 , 13.26 ,,,,,,,,,,,,,,, 87177,"OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION",87177, 150.25 ,,,, 8.83 ,,, 10.99 , 10.99 , 10.99 , 8.83 , 10.99 ,,,,,,,,,,,,,,, 87181,"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR DILUTION METHOD, PER AGENT (EG, ANTIBIOTIC GRADIENT STRIP)",87181, 84.94 ,,,, 4.72 ,,, 5.86 , 5.86 , 5.86 , 4.72 , 5.86 ,,,,,,,,,,,,,,, 87205,"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYPES",87205, 73.38 ,,,, 4.24 ,,, 5.27 , 5.27 , 5.27 , 4.24 , 5.27 ,,,,,,,,,,,,,,, 87206,"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STAIN FOR BACTERIA, FUNGI, PARASITES, VIRUSES OR CELL TYPES",87206, 110.85 ,,,, 5.35 ,,, 6.65 , 6.65 , 6.65 , 5.35 , 6.65 ,,,,,,,,,,,,,,, 87207,"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODIES OR PARASITES (EG, MALARIA, COCCIDIA, MICROSPORIDIA, TRYPANOSOMES, HERPES VIRUSES)",87207, 251.50 ,,,, 5.95 ,,, 7.40 , 7.40 , 7.40 , 5.95 , 7.40 ,,,,,,,,,,,,,,, 87210,"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG, SALINE, INDIA INK, KOH PREPS)",87210, 120.62 ,,,, 4.68 ,,, 5.82 , 5.82 , 5.82 , 4.68 , 5.82 ,,,,,,,,,,,,,,, 87230,"TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN)",87230, 339.25 ,,,, 19.60 ,,, 24.37 , 24.37 , 24.37 , 19.60 , 24.37 ,,,,,,,,,,,,,,, 87252,"VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOPATHIC EFFECT",87252, 447.88 ,,,, 25.87 ,,, 32.18 , 32.18 , 32.18 , 25.87 , 32.18 ,,,,,,,,,,,,,,, 87255,"VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER THAN BY CYTOPATHIC EFFECT (EG, VIRUS SPECIFIC ENZYMATIC ACTIVITY)",, 210.00 ,,,, 33.61 ,,, 41.81 , 41.81 , 41.81 , 33.61 , 41.81 ,,,,,,,,,,,,,,, 87270,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CHLAMYDIA TRACHOMATIS,87270, 349.35 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87271,"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CYTOMEGALOVIRUS, DIRECT FLUORESCENT ANTIBODY (DFA)",87271, 130.04 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87273,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE 2,87273, 99.56 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87274,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE 1,87274, 99.56 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87280,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RESPIRATORY SYNCYTIAL VIRUS,87280, 130.04 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87324,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; CLOSTRIDIUM DIFFICILE TOXIN(S)",87324, 310.50 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87327,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; CRYPTOCOCCUS NEOFORMANS",87327, 190.25 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87329,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; GIARDIA",87329, 210.50 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87340,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; HEPATITIS B SURFACE ANTIGEN (HBSAG)",87340, 210.50 ,,,, 10.25 ,,, 12.75 , 12.75 , 12.75 , 10.25 , 12.75 ,,,,,,,,,,,,,,, 87350,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; HEPATITIS BE ANTIGEN (HBEAG)",87350, 210.50 ,,,, 11.44 ,,, 14.23 , 14.23 , 14.23 , 11.44 , 14.23 ,,,,,,,,,,,,,,, 87389,INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE MULTIPLE-STEP METHOD; HIV-1 ANTIGEN(S) WITH HIV-1 AND HIV-2 ANTIBODIES SINGLE RESULT,87389, 195.51 ,,,, 23.90 ,,, 29.73 , 29.73 , 29.73 , 23.90 , 29.73 ,,,,,,,,,,,,,,, 87390,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; HIV-1",87390, 303.13 ,,,, 19.34 ,,, 24.06 , 24.06 , 24.06 , 19.34 , 24.06 ,,,,,,,,,,,,,,, 87400,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; INFLUENZA, A OR B, EACH",87400, 248.00 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87420,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; RESPIRATORY SYNCYTIAL VIRUS",87420, 206.13 ,,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87425,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; ROTAVIRUS",87425," 1,022.97 ",,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87426,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITIVE OR SERMEQUANTITITAVE",87426, 615.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 87430,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; STREPTOCOCCUS, GROUP A",87430, 307.21 ,,,, 13.51 ,,, 16.81 , 16.81 , 16.81 , 13.51 , 16.81 ,,,,,,,,,,,,,,, 87450,"INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE; SINGLE STEP METHOD, NOT OTHERWISE SPECIFIED, EACH ORGANISM",87450, 256.15 ,,,, 9.52 ,,, 11.84 , 11.84 , 11.84 , 9.52 , 11.84 ,,,,,,,,,,,,,,, 87480,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE",87480, 180.00 ,,,, 19.91 ,,, 24.76 , 24.76 , 24.76 , 19.91 , 24.76 ,,,,,,,,,,,,,,, 87486,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHNIQUE",87486, 175.45 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87490,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, DIRECT PROBE TECHNIQUE",87490, 180.00 ,,,, 19.91 ,,, 24.76 , 24.76 , 24.76 , 19.91 , 24.76 ,,,,,,,,,,,,,,, 87491,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",87491, 180.51 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87492,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, QUANTIFICATION",87492," 12,149.05 ",,,, 42.98 ,,, 53.47 , 53.47 , 53.47 , 42.98 , 53.47 ,,,,,,,,,,,,,,, 87493,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CLOSTRIDIUM DIFFICILE TOXIN GENE(S) AMPLIFIED PROBE TECHNIQUE,87493, 258.68 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87498,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); ENTEROVIRUS, AMPLIFIED PROBE TECHNIQUE",87498, 96.28 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87500,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (EG, ENTEROCOCCUS SPECIES VAN A, VAN B), AMPLIFIED PROBE TECHNIQUE",87500, 156.98 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87506,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GASTROINTESTINAL PATHOGEN (EG CLOSTRIDIUM DIFFICILE E. COLI SALMONELLA SHIGELLA NOROVIRUS GIARDIA) INCLUDES MULTIPLEX REVERSE TRANSCRIPTION WHEN PERFORMED AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE MU,87506, 858.54 ,,,, 211.85 ,,, 263.49 , 263.49 , 263.49 , 211.85 , 263.49 ,,,,,,,,,,,,,,, 87507,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GASTROINTESTINAL PATHOGEN (EG CLOSTRIDIUM DIFFICILE E. COLI SALMONELLA SHIGELLA NOROVIRUS GIARDIA) INCLUDES MULTIPLEX REVERSE TRANSCRIPTION WHEN PERFORMED AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE MU,87507," 1,143.42 ",,,, 413.70 ,,, 514.55 , 514.55 , 514.55 , 413.70 , 514.55 ,,,,,,,,,,,,,,, 87510,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQUE",87510," 1,750.95 ",,,, 19.91 ,,, 24.76 , 24.76 , 24.76 , 19.91 , 24.76 ,,,,,,,,,,,,,,, 87522,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION",87522, 583.80 ,,,, 42.52 ,,, 52.88 , 52.88 , 52.88 , 42.52 , 52.88 ,,,,,,,,,,,,,,, 87525,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, DIRECT PROBE TECHNIQUE",87525, 215.05 ,,,, 23.96 ,,, 29.80 , 29.80 , 29.80 , 23.96 , 29.80 ,,,,,,,,,,,,,,, 87528,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, DIRECT PROBE TECHNIQUE",87528," 1,022.97 ",,,, 19.91 ,,, 24.76 , 24.76 , 24.76 , 19.91 , 24.76 ,,,,,,,,,,,,,,, 87529,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHNIQUE",87529, 301.09 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87530,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, QUANTIFICATION",87530, 322.22 ,,,, 42.52 ,,, 52.88 , 52.88 , 52.88 , 42.52 , 52.88 ,,,,,,,,,,,,,,, 87536,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION",87536," 1,462.95 ",,,, 84.47 ,,, 105.06 , 105.06 , 105.06 , 84.47 , 105.06 ,,,,,,,,,,,,,,, 87581,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECHNIQUE",87581, 175.45 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87590,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, DIRECT PROBE TECHNIQUE",87590, 344.63 ,,,, 21.61 ,,, 26.88 , 26.88 , 26.88 , 21.61 , 26.88 ,,,,,,,,,,,,,,, 87591,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECHNIQUE",87591, 226.50 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87592,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, QUANTIFICATION",87592, 183.68 ,,,, 42.52 ,,, 52.88 , 52.88 , 52.88 , 42.52 , 52.88 ,,,,,,,,,,,,,,, 87593,MONKEY POX,, 256.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 87632,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG ADENOVIRUS INFLUENZA VIRUS CORONAVIRUS METAPNEUMOVIRUS PARAINFLUENZA VIRUS RESPIRATORY SYNCYTIAL VIRUS RHINOVIRUS) INCLUDES MULTIPLEX REVERSE TRANSCRIPTION WHEN PERFORMED AND ,87632, 585.54 ,,,, 211.85 ,,, 263.49 , 263.49 , 263.49 , 211.85 , 263.49 ,,,,,,,,,,,,,,, 87633,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG ADENOVIRUS INFLUENZA VIRUS CORONAVIRUS METAPNEUMOVIRUS PARAINFLUENZA VIRUS RESPIRATORY SYNCYTIAL VIRUS RHINOVIRUS) INCLUDES MULTIPLEX REVERSE TRANSCRIPTION WHEN PERFORMED AND ,87633," 8,575.80 ",,,, 413.70 ,,, 514.55 , 514.55 , 514.55 , 413.70 , 514.55 ,,,,,,,,,,,,,,, 87635,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA/RNA) SEVERE ACUTE COVID 2 - PROB TECHNIQUE,87635, 336.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 87636,INF AGENT DETECTION BY DNA/RNA SARSCOV3,, 250.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 87637,INF AGENT DETECT NA COVID 19/FLU/RESP SY,, 250.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 87660,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQUE",87660, 82.53 ,,,, 19.91 ,,, 24.76 , 24.76 , 24.76 , 19.91 , 24.76 ,,,,,,,,,,,,,,, 87661,INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECHNIQUE,87661, 136.12 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87798,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM",87798, 206.50 ,,,, 34.84 ,,, 43.33 , 43.33 , 43.33 , 34.84 , 43.33 ,,,,,,,,,,,,,,, 87800,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQUE",87800, 578.75 ,,,, 39.83 ,,, 49.53 , 49.53 , 49.53 , 39.83 , 49.53 ,,,,,,,,,,,,,,, 87801,"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECHNIQUE",87801, 225.67 ,,,, 69.67 ,,, 86.66 , 86.66 , 86.66 , 69.67 , 86.66 ,,,,,,,,,,,,,,, 87803,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; CLOSTRIDIUM DIFFICILE TOXIN A,87803, 180.16 ,,,, 12.86 ,,, 16.00 , 16.00 , 16.00 , 12.86 , 16.00 ,,,,,,,,,,,,,,, 87804,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA,87804, 221.95 ,,,, 13.31 ,,, 16.55 , 16.55 , 16.55 , 13.31 , 16.55 ,,,,,,,,,,,,,,, 87806,INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; HIV-1 ANTIGEN(S) WITH HIV-1 AND HIV-2 ANTIBODIES,87806, 99.09 ,,,, 26.35 ,,, 32.77 , 32.77 , 32.77 , 26.35 , 32.77 ,,,,,,,,,,,,,,, 87807,LAB INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; RESPIRATORY SYNCYTIAL VIRUS,87807," 2,895.60 ",,,, 11.90 ,,, 14.80 , 14.80 , 14.80 , 11.90 , 14.80 ,,,,,,,,,,,,,,, 87811,INF AGT ANT DCT IM W/DRCT OPTC OBS COV19,, 250.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 87850,INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; NEISSERIA GONORRHOEAE,87850, 677.02 ,,,, 19.75 ,,, 24.56 , 24.56 , 24.56 , 19.75 , 24.56 ,,,,,,,,,,,,,,, 87880,"LAB INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GROUP A",87880, 206.13 ,,,, 13.30 ,,, 16.53 , 16.53 , 16.53 , 13.30 , 16.53 ,,,,,,,,,,,,,,, 87901,INF AGENT HIV1 GENOTYPE,, 502.80 ,,,, 255.54 ,,, 317.84 , 317.84 , 317.84 , 255.54 , 317.84 ,,,,,,,,,,,,,,, 88161,"CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION",88161, 401.82 ,,, 49.92 , 33.37 , 32.12 ,, 31.80 , 31.80 , 31.80 , 31.80 , 33.37 ,,,,,,,,,,,,,,, 88184,FLOW CYTOMETRY CELL 1ST MARKER,, 185.41 ,,, 648.22 , 55.32 , 274.22 ,, 215.43 , 215.43 , 215.43 , 55.32 , 274.22 ,,,,,,,,,,,,,,, 88185,FLOW CYTOMETRY CELL EACH ADD MARKER,, 97.08 ,,,, 24.90 ,,, 30.51 , 30.51 , 30.51 , 24.90 , 30.51 ,,,,,,,,,,,,,,, 88233,TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; SKIN OR OTHER SOLID TISSUE BIOPSY,88233, 381.52 ,,,, 139.69 ,,, 173.74 , 173.74 , 173.74 , 139.69 , 173.74 ,,,,,,,,,,,,,,, 88300,"LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY",88300, 209.83 ,,, 49.92 , 9.94 , 17.17 ,, 17.47 , 17.47 , 17.47 , 9.94 , 17.47 ,,,,,,,,,,,,,,, 88302,"LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION APPENDIX, INCIDENTAL FALLOPIAN TUBE, STERILIZATION FINGERS/TOES, AMPUTATION, TRAUMATIC FORESKIN, NEWBORN HERNIA SAC, ANY LOCATION HYDROCELE SAC NERVE SKIN, PLASTIC REPAIR SYMPATHETIC GANGLI",88302, 392.17 ,,, 49.92 , 19.61 , 32.12 ,, 31.80 , 31.80 , 31.80 , 19.61 , 32.12 ,,,,,,,,,,,,,,, 88304,"LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION, INDUCED ABSCESS ANEURYSM - ARTERIAL/VENTRICULAR ANUS, TAG APPENDIX, OTHER THAN INCIDENTAL ARTERY, ATHEROMATOUS PLAQUE BARTHOLIN'S GLAND CYST BONE FRAGMENT(S), OTHER THAN PATHOLOG",88304, 454.73 ,,, 100.28 , 24.00 , 50.98 ,, 44.70 , 44.70 , 44.70 , 24.00 , 50.98 ,,,,,,,,,,,,,,, 88305,"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTERY, BIOPSY BONE MARROW, BIOPSY BONE EXOSTOSIS BRAIN/MENINGES, OTHER THAN FOR TUMOR RESECTION BREAST, BIOPSY, NOT REQUIRING MICROSCOPIC EVALUATION OF SURGIC",88305, 879.38 ,,, 100.28 , 24.59 , 50.98 ,, 44.70 , 44.70 , 44.70 , 24.59 , 50.98 ,,,,,,,,,,,,,,, 88307,"LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ADRENAL, RESECTION BONE - BIOPSY/CURETTINGS BONE FRAGMENT(S), PATHOLOGIC FRACTURE BRAIN, BIOPSY BRAIN/MENINGES, TUMOR RESECTION BREAST, EXCISION OF LESION, REQUIRING MICROSCOPIC EVALUATION O",88307, 848.86 ,,, 648.22 , 148.16 , 274.22 ,, 215.43 , 215.43 , 215.43 , 148.16 , 274.22 ,,,,,,,,,,,,,,, 88309,"LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION BONE RESECTION BREAST, MASTECTOMY - WITH REGIONAL LYMPH NODES COLON, SEGMENTAL RESECTION FOR TUMOR COLON, TOTAL RESECTION ESOPHAGUS, PARTIAL/TOTAL RESECTION EXTREMITY, DISARTICULATION FETUS",88309," 3,975.03 ",,," 1,553.02 ", 206.72 , 558.12 ,, 540.96 , 540.96 , 540.96 , 206.72 , 558.12 ,,,,,,,,,,,,,,, 88311,DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION),88311, 74.11 ,,,, 7.60 ,,, 9.33 , 9.33 , 9.33 , 7.60 , 9.33 ,,,,,,,,,,,,,,, 88312,"SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE); GROUP I FOR MICROORGANISMS (EG, GRIDLEY, ACID FAST, METHENAMINE SILVER), EACH",88312, 326.29 ,,, 100.28 , 57.97 , 50.98 ,, 44.70 , 44.70 , 44.70 , 44.70 , 57.97 ,,,,,,,,,,,,,,, 88313,"SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE); GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT IMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, EACH",88313, 351.89 ,,, 67.92 , 48.31 , 32.12 ,, 31.80 , 31.80 , 31.80 , 31.80 , 48.31 ,,,,,,,,,,,,,,, 88314,SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE); HISTOCHEMICAL STAINING WITH FROZEN SECTION(S),88314, 137.37 ,,,, 51.53 ,,, 63.16 , 63.16 , 63.16 , 51.53 , 63.16 ,,,,,,,,,,,,,,, 88329,PATHOLOGY CONSULTATION DURING SURGERY;,88329, 482.62 ,,, 67.92 , 31.12 , 32.12 ,, 31.80 , 31.80 , 31.80 , 31.12 , 32.12 ,,,,,,,,,,,,,,, 88331,"PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN SECTION(S), SINGLE SPECIMEN",88331, 413.75 ,,, 314.50 , 26.93 , 144.73 ,, 129.18 , 129.18 , 129.18 , 26.93 , 144.73 ,,,,,,,,,,,,,,, 88332,PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S),88332, 261.50 ,,,, 17.56 ,,, 21.53 , 21.53 , 21.53 , 17.56 , 21.53 ,,,,,,,,,,,,,,, 88333,PATH CONSUL DURING CYTOLOGIC EXAM,, 318.77 ,,," 1,553.02 ", 20.48 , 558.12 ,, 540.96 , 540.96 , 540.96 , 20.48 , 558.12 ,,,,,,,,,,,,,,, 88334,"PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREP, SQUASH PREP), INITIAL SITE",, 318.77 ,,,, 13.18 ,,, 16.15 , 16.15 , 16.15 , 13.18 , 16.15 ,,,,,,,,,,,,,,, 88341,"IMMUNOHISTOCHEMISTRY OR IMMONOCYTOCHEMISTRY, PER SPECIMAN;EACH ADDITIONAL SINGLE ANTIBODY STAIN PROCEDURE",88341, 608.28 ,,,, 52.73 ,,, 64.60 , 64.60 , 64.60 , 52.73 , 64.60 ,,,,,,,,,,,,,,, 88342,"IMMUNOHISTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY",88342, 608.28 ,,, 314.50 , 60.31 , 144.73 ,, 215.43 , 215.43 , 215.43 , 60.31 , 215.43 ,,,,,,,,,,,,,,, 88344,EACH MULTIPLEX ANTIBODY STAIN PROCEDURE,88344, 608.42 ,,, 648.22 , 111.86 , 274.22 ,, 215.43 , 215.43 , 215.43 , 111.86 , 274.22 ,,,,,,,,,,,,,,, 88618,CODE ADDED TO MTCH PAY MASTER7.25.2016LT,, 198.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 89050,"CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD;",89050, 47.89 ,,,, 4.69 ,,, 5.83 , 5.83 , 5.83 , 4.69 , 5.83 ,,,,,,,,,,,,,,, 89051,"LAB CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT",89051, 94.63 ,,,, 5.47 ,,, 6.80 , 6.80 , 6.80 , 5.47 , 6.80 ,,,,,,,,,,,,,,, 89055,"LEUKOCYTE ASSESSMENT, FECAL, QUALITATIVE OR SEMIQUANTITATIVE",89055, 229.00 ,,,, 4.24 ,,, 5.27 , 5.27 , 5.27 , 4.24 , 5.27 ,,,,,,,,,,,,,,, 89060,"CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS ANALYSIS, TISSUE OR ANY BODY FLUID (EXCEPT URINE)",89060, 122.88 ,,,, 7.10 ,,, 8.83 , 8.83 , 8.83 , 7.10 , 8.83 ,,,,,,,,,,,,,,, 89220,"SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE)",89220, 221.25 ,,, 314.50 , 13.45 , 144.73 ,, 129.18 , 129.18 , 129.18 , 13.45 , 144.73 ,,,,,,,,,,,,,,, 89240,UNLISTED MISCELLANEOUS PATHOLOGY TEST,89240, 153.65 ,,, 100.28 ,, 50.98 ,, 44.70 , 44.70 , 44.70 , 44.70 , 50.98 ,,,,,,,,,,,,,,, 90375,RABIES IMMUNE GLOBULIN FOR IM OR SUBQ,," 2,747.69 ",,, 672.40 ,, 307.02 ,,,,, 307.02 , 307.02 ,,,,,,,,,,,,,,, 90460,IMM ADMIN 18 YR/< OF AGE,, 352.70 ,,,,,,, 20.82 , 20.82 , 20.82 , 20.82 , 20.82 ,,,,,,,,,,,,,,, 90471,IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS INTRADERMAL SUBCUTANEOUS OR INTRAMUSCULAR INJECTIONS); 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID),90471, 324.00 ,,, 134.94 ,, 59.75 ,, 58.20 , 58.20 , 58.20 , 58.20 , 59.75 ,,,,,,,,,,,,,,, 90471,"ED IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJECTIONS); ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)",Emergency department, 115.20 ,,, 134.94 ,, 59.75 ,, 58.20 , 58.20 , 58.20 , 58.20 , 59.75 ,,,,,,,,,,,,,,, 90472,"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJECTIONS); EACH ADDITIONAL VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",90472, 157.75 ,,,,,,, 12.92 , 12.92 , 12.92 , 12.92 , 12.92 ,,,,,,,,,,,,,,, 90656,"INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS AND OLDER, FOR INTRAMUSCULAR USE",90656, 154.97 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90658,"INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE",90658, 256.53 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90660,"INFLUENZA VIRUS VACCINE, LIVE, FOR INTRANASAL USE",90660, 319.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90675,RABIES VACCINE FOR IM USE,," 1,571.85 ",,, 684.45 ,, 289.98 ,,,,, 289.98 , 289.98 ,,,,,,,,,,,,,,, 90700,DTAP VACCINE ADMINISTERED < 7 YEARS,," 4,991.02 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90707,"MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS USE",90707, 928.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90714,TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED PRESERVATIVE FREE WHEN ADMINISTERED TO INDIVIDUALS 7 YEARS OR OLDER FOR INTRAMUSCULAR USE,90714, 243.43 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90715,"TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINISTERED TO INDIVIDUALS 7 YEARS OR OLDER, FOR INTRAMUSCULAR USE",90715, 422.49 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90718,"TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED WHEN ADMINISTERED TO INDIVIDUALS 7 YEARS OR OLDER, FOR INTRAMUSCULAR USE",90718, 198.93 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90719,DIPHTHERIA TOXOID FOR INTRAMUSCULAR USE,," 4,991.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90723,"DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HEPATITIS B, AND POLIOVIRUS VACCINE, INACTIVATED (DTAP-HEPB-IPV), FOR INTRAMUSCULAR USE",90723," 1,167.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90744,ENGERIX-B (HEPATITS B VACCINE),, 301.82 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90746,"HEPATITIS B VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE",90746, 746.34 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90765,"RABIES VACCINE, FOR INTRAMUSCULAR USE",90675," 2,904.81 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 90997,HEMOPERFUSION,, 535.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 91300,SARSCOV2 VACCINE 300 MCG/0.3ML IM PFIZER,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 91301,SARSCOV2 VACC 100 MCG/0.5 ML IM MODERNA,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 91302,SARSCOV2 VACC 5X10^10 VP/.5 MLIM ASTRA Z,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 91303,SARSCOV2 VACCINE AD26 .5 ML IM J&J,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 92002,EYE EXAM NEW PATIENT,, 213.22 ,,, 241.72 ,, 115.85 ,, 113.69 , 113.69 , 113.69 , 113.69 , 115.85 ,,,,,,,,,,,,,,, 92100,SERIAL TONOMETRY EXAM,, 213.59 ,,,,,,, 34.81 , 34.81 , 34.81 , 34.81 , 34.81 ,,,,,,,,,,,,,,, 92230,FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT,92230, 527.22 ,,, 966.86 ,, 455.27 ,, 444.39 , 444.39 , 444.39 , 444.39 , 455.27 ,,,,,,,,,,,,,,, 92610,EVALUATE SWALLOWING FUNCTION,," 1,877.86 ",,,,,,, 73.93 , 73.93 , 73.93 , 73.93 , 73.93 ,,,,,,,,,,,,,,, 92950,"CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)",92950," 3,857.75 ",,, 560.12 ,, 252.31 ,, 460.34 , 410.57 , 301.08 , 252.31 , 460.34 ,,,,,,,,,,,,,,, 92953,TEMPORARY TRANSCUTANEOUS PACING,, 182.15 ,,," 1,176.28 ",, 526.49 ,, 948.42 , 845.89 , 620.32 , 526.49 , 948.42 ,,,,,,,,,,,,,,, 92960,CARDIOVERSION ELECTIVE ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL,92960," 3,368.78 ",,," 1,176.28 "," 2,500.00 ", 526.49 ,, 948.42 , 845.89 , 620.32 , 526.49 ," 2,500.00 ",,,,,,,,,,,,,,, 93000,"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT",93000, 324.50 ,,,,,,, 17.23 , 17.23 , 17.23 , 17.23 , 17.23 ,,,,,,,,,,,,,,, 93005,"EKG ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT",93005, 558.18 ,,, 114.96 ,, 55.90 ,, 55.96 , 55.96 , 55.96 , 55.90 , 55.96 ,,,,,,,,,,,,,,, 93010,"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY",93010, 558.18 ,,,,,,, 8.61 , 8.61 , 8.61 , 8.61 , 8.61 ,,,,,,,,,,,,,,, 93015,STRESS TEST,, 872.04 ,,,,,,, 72.50 , 72.50 , 72.50 , 72.50 , 72.50 ,,,,,,,,,,,,,,, 93018,STRESS TEST TREADMILL OR BICYCLE,, 170.76 ,,,,,,, 15.07 , 15.07 , 15.07 , 15.07 , 15.07 ,,,,,,,,,,,,,,, 93040,"RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION AND REPORT",93040, 221.95 ,,,,,,, 12.92 , 12.92 , 12.92 , 12.92 , 12.92 ,,,,,,,,,,,,,,, 93041,"RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT",93041, 191.34 ,,, 114.96 ,, 55.90 ,, 55.96 , 55.96 , 55.96 , 55.90 , 55.96 ,,,,,,,,,,,,,,, 93042,"RHYTHM ECG, ONE TO THREE LEADS; INTERPRETATION AND REPORT ONLY",93042, 109.10 ,,,,,,, 7.18 , 7.18 , 7.18 , 7.18 , 7.18 ,,,,,,,,,,,,,,, 93224,"ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; INCLUDES RECORDING, SCANNING ANALYSIS WITH REPORT, PHYSICIAN REVIEW AND INTERPRETATION",93224," 1,166.65 ",,,,,,, 92.59 , 92.59 , 92.59 , 92.59 , 92.59 ,,,,,,,,,,,,,,, 93229,"EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH ELECTROCARDIOGRAPHIC RECORDING, CONCURRENT COMPUTERIZED REAL TIME DATA ANALYSIS AND GREATER THAN 24 HOURS OF ACCESSIBLE ECG DATA STORAGE (RETRIEVABLE WITH QUERY) WITH ECG TRIGGERED AND PATIENT SELECT48456",93229," 5,985.35 ",,, 290.86 ,, 135.95 ,, 741.10 , 741.10 , 741.10 , 135.95 , 741.10 ,,,,,,,,,,,,,,, 93303,TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE,93303, 899.36 ,,," 1,006.26 ",, 497.49 ,, 180.88 , 180.88 , 180.88 , 180.88 , 497.49 ,,,,,,,,,,,,,,, 93306,ECG TRANSTHORACIC,," 6,036.00 ",,," 1,006.26 ",, 497.49 ,, 138.53 , 138.53 , 138.53 , 138.53 , 497.49 ,,,,,,,,,,,,,,, 93307,TTE W/O DOPPLER COMPLETE,," 6,229.58 ",,, 467.04 ,, 230.56 ,, 99.05 , 99.05 , 99.05 , 99.05 , 230.56 ,,,,,,,,,,,,,,, 93308,"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR LIMITED STUDY",93308, 899.36 ,,, 467.04 ,, 230.56 ,, 81.47 , 81.47 , 81.47 , 81.47 , 230.56 ,,,,,,,,,,,,,,, 93313,"ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY",93313, 899.36 ,,," 1,006.26 ",, 497.49 ,, 11.84 , 11.84 , 11.84 , 11.84 , 497.49 ,,,,,,,,,,,,,,, 93314,"ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); IMAGE ACQUISITION, INTERPRETATION AND REPORT ONLY",93314, 899.36 ,,,,,,, 150.01 , 150.01 , 150.01 , 150.01 , 150.01 ,,,,,,,,,,,,,,, 93320,DOPPLER IN ADDITION TO ECHO IMAGING COMP,," 3,608.75 ",,,,,,, 36.61 , 36.61 , 36.61 , 36.61 , 36.61 ,,,,,,,,,,,,,,, 93325,COLOR FLOW VELOCITY MAPPING,," 5,413.13 ",,,,,,, 22.97 , 22.97 , 22.97 , 22.97 , 22.97 ,,,,,,,,,,,,,,, 93351,ECHOCARDIOGRAPHY TRANSTHORACIC REAL-TIME WITH IMAGE DOCUMENTATION (2D) INCLUDES M-MODE RECORDING WHEN PERFORMED DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS WITH INTERPRETATION AND RE,93351, 899.36 ,,," 1,006.26 ",, 497.49 ,, 151.45 , 151.45 , 151.45 , 151.45 , 497.49 ,,,,,,,,,,,,,,, 93610,INTRA-ATRIAL PACING,93610," 10,012.80 ",,," 13,465.50 ",," 5,097.39 ",," 9,831.49 "," 8,768.63 "," 6,430.33 "," 5,097.39 "," 9,831.49 ",,,,,,,,,,,,,,, 93660,"EVALUATION OF CARDIOVASCULAR FUNCTION WITH TILT TABLE EVALUATION, WITH CONTINUOUS ECG MONITORING AND INTERMITTENT BLOOD PRESSURE MONITORING, WITH OR WITHOUT PHARMACOLOGICAL INTERVENTION",93660, 831.74 ,,, 966.86 ,, 455.27 ,, 444.39 , 444.39 , 444.39 , 444.39 , 455.27 ,,,,,,,,,,,,,,, 93875,N-INVAS PHYSIO STD XTRC ART COMPL BI STD,," 1,102.07 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 93880,DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY,93880," 2,019.18 ",,, 467.04 ,, 230.56 , 381.94 , 118.07 , 118.07 , 118.07 , 118.07 , 381.94 ,,,,,,,,,,,,,,, 93882,DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY,93882," 2,956.56 ",,, 213.76 ,, 112.51 , 188.30 , 107.67 , 107.67 , 107.67 , 107.67 , 188.30 ,,,,,,,,,,,,,,, 93886,TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY,93886," 2,865.56 ",,, 467.04 ,, 230.56 , 188.30 , 118.43 , 118.43 , 118.43 , 118.43 , 230.56 ,,,,,,,,,,,,,,, 93922,"NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, SINGLE LEVEL, BILATERAL (EG, ANKLE/BRACHIAL INDICES, DOPPLER WAVEFORM ANALYSIS, VOLUME PLETHYSMOGRAPHY, TRANSCUTANEOUS OXYGEN TENSION MEASUREMENT)",93922," 2,341.00 ",,, 232.22 ,,,,,,, - , - ,,,,,,,,,,,,,,, 93923,UPR/LXTR ART STDY 3+ LVLS,," 3,502.46 ",,, 290.86 ,, 135.95 ,, 117.00 , 117.00 , 117.00 , 117.00 , 135.95 ,,,,,,,,,,,,,,, 93924,LWR XTR VASC STDY BILAT,," 4,324.50 ",,, 560.12 ,, 135.95 ,, 148.58 , 148.58 , 148.58 , 135.95 , 148.58 ,,,,,,,,,,,,,,, 93925,DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY,93925," 2,865.56 ",,, 467.04 ,, 230.56 , 381.34 , 226.82 , 226.82 , 226.82 , 226.82 , 381.34 ,,,,,,,,,,,,,,, 93926,DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY,93926," 3,049.75 ",,, 213.76 ,, 112.51 , 187.70 , 118.43 , 118.43 , 118.43 , 112.51 , 187.70 ,,,,,,,,,,,,,,, 93930,DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY,93930, 512.26 ,,, 467.04 ,, 230.56 , 381.94 , 118.07 , 118.07 , 118.07 , 118.07 , 381.94 ,,,,,,,,,,,,,,, 93931,DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY,93931," 1,136.92 ",,, 213.76 ,,,,,,, - , - ,,,,,,,,,,,,,,, 93965,EXTR VEINS DOPPLER WAVEFORM ANALYSIS,," 2,314.88 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, 93970,DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY,93970," 2,196.14 ",,, 467.04 ,, 230.56 , 381.94 , 166.16 , 166.16 , 166.16 , 166.16 , 381.94 ,,,,,,,,,,,,,,, 93971,DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY,93971," 1,465.63 ",,, 213.76 ,, 112.51 , 188.30 , 100.49 , 100.49 , 100.49 , 100.49 , 188.30 ,,,,,,,,,,,,,,, 93975,"DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY",93975, 978.73 ,,, 467.04 ,, 230.56 , 381.34 , 230.76 , 230.76 , 230.76 , 230.56 , 381.34 ,,,,,,,,,,,,,,, 93976,"DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY",93976, 978.75 ,,, 213.76 ,,,,,,, - , - ,,,,,,,,,,,,,,, 93978,"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY",93978," 2,324.00 ",,, 467.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 93980,DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY,93980, 978.73 ,,, 213.76 ,,,,,,, - , - ,,,,,,,,,,,,,,, 94060,PULMONARY TESTING SPIROMETRY,, 587.75 ,,, 560.12 ,, 252.31 ,, 48.45 , 48.45 , 48.45 , 48.45 , 252.31 ,,,,,,,,,,,,,,, 94620,"PULMONARY STRESS TESTING; SIMPLE (EG, 6-MINUTE WALK TEST, PROLONGED EXERCISE TEST FOR BRONCHOSPASM WITH PRE- AND POST-SPIROMETRY AND OXIMETRY)",94620, 300.06 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 94621,"PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2 UPTAKE, AND ELECTROCARDIOGRAPHIC RECORDINGS)",94621, 464.62 ,,, 560.12 ,, 252.31 ,, 97.62 , 97.62 , 97.62 , 97.62 , 252.31 ,,,,,,,,,,,,,,, 94640,"RESP NEBULIZER UPDRAFT INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION OR FOR SPUTUM INDUCTION FOR DIAGNOSTIC PURPOSES (EG, WITH AN AEROSOL GENERATOR, METERED DOSE INHALER OR INTERMITTENT POSITIVE PRESSURE BREATHING [IPPB] DEVICE) PRESSURIZED OR NONPR",94640, 324.16 ,,, 383.00 ,, 191.60 ,, 186.38 , 186.38 , 186.38 , 186.38 , 191.60 ,,,,,,,,,,,,,,, 94644,CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUCTION; FIRST HOUR,94644, 587.75 ,,, 232.22 ,, 106.48 ,, 105.04 , 105.04 , 105.04 , 105.04 , 106.48 ,,,,,,,,,,,,,,, 94645,CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUCTION; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),94645, 187.13 ,,,,,,, 16.51 , 16.51 , 16.51 , 16.51 , 16.51 ,,,,,,,,,,,,,,, 94660,POS AIRWAY PRESSURE CPAP,, 939.40 ,,, 383.00 ,, 191.60 ,, 186.38 , 186.38 , 186.38 , 186.38 , 191.60 ,,,,,,,,,,,,,,, 94760,RESP NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; SINGLE DETERMINATION,94760, 178.25 ,,,,,,, 2.87 , 2.87 , 2.87 , 2.87 , 2.87 ,,,,,,,,,,,,,,, 94761,NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; MULTIPLE DETERMINATIONS (EG DURING EXERCISE),94761, 312.49 ,,,,,,, 4.67 , 4.67 , 4.67 , 4.67 , 4.67 ,,,,,,,,,,,,,,, 94762,NONINVASIVE EAR OR PULSE OXIMETRY,, 402.67 ,,, 290.86 ,, 135.95 ,, 136.32 , 136.32 , 136.32 , 135.95 , 136.32 ,,,,,,,,,,,,,,, 95812,ELECTROENCEPHALOGRAM EEG MONITOR4160 MIN,, 800.00 ,,, 560.12 ,, 252.31 ,, 269.52 , 269.52 , 269.52 , 252.31 , 269.52 ,,,,,,,,,,,,,,, 95813,ELECTROENCEPHALOGRAM EEG MONITOR >1HR,," 1,014.04 ",,, 560.12 ,, 252.31 ,, 324.43 , 324.43 , 324.43 , 252.31 , 324.43 ,,,,,,,,,,,,,,, 95861,NEEDLE ELECTROMYOGRAPHY TWO EXTREMITIES,," 1,897.10 ",,, 232.22 ,, 106.48 ,, 105.04 , 105.04 , 105.04 , 105.04 , 106.48 ,,,,,,,,,,,,,,, 95864,NEEDLE ELECTROMYOGRAPHY 4 EXTREMITIES,," 1,897.10 ",,, 290.86 ,, 135.95 ,, 144.99 , 144.99 , 144.99 , 135.95 , 144.99 ,,,,,,,,,,,,,,, 95868,NEEDLE ELECTROMYOGRAPHY CRANIAL NERVE,," 1,469.90 ",,, 560.12 ,, 135.95 ,, 73.57 , 73.57 , 73.57 , 73.57 , 135.95 ,,,,,,,,,,,,,,, 95907,NERVE CONDUCTION STUDIES 12 STUDIES,, 791.44 ,,, 290.86 ,, 135.95 ,, 44.86 , 44.86 , 44.86 , 44.86 , 135.95 ,,,,,,,,,,,,,,, 95908,NERVE CONDUCTION STUDIES 34 STUDIES,, 740.00 ,,, 560.12 ,, 252.31 ,, 59.93 , 59.93 , 59.93 , 59.93 , 252.31 ,,,,,,,,,,,,,,, 95929,CENTRAL MOTOR EVOKED POTENTIAL STUDY,," 2,200.00 ",,, 966.86 ,, 455.27 ,, 140.68 , 140.68 , 140.68 , 140.68 , 455.27 ,,,,,,,,,,,,,,, 95937,NEUROMUSCULAR JUNCTION TESTING,, 700.25 ,,, 290.86 ,, 135.95 ,, 48.45 , 48.45 , 48.45 , 48.45 , 135.95 ,,,,,,,,,,,,,,, 95938,SHORTLATENCY SOMATSNSRY EVOKED POT STUDY,," 2,770.48 ",,, 966.86 ,, 455.27 ,, 304.34 , 304.34 , 304.34 , 304.34 , 455.27 ,,,,,,,,,,,,,,, 95939,CENTRAL MOTOR EVOKED POTENTIAL STUDY,," 4,083.04 ",,," 1,868.76 ",, 912.79 ,, 394.06 , 394.06 , 394.06 , 394.06 , 912.79 ,,,,,,,,,,,,,,, 95940,CONT INTRAOP NEUROMONITORING OUTSIDE OR,, 369.33 ,,,,,,, 33.38 , 33.38 , 33.38 , 33.38 , 33.38 ,,,,,,,,,,,,,,, 95941,CONT INTRAOP NEUROMONITORING OUTSIDE OR,," 1,500.00 ",,,,,,, 184.47 , 184.47 , 184.47 , 184.47 , 184.47 ,,,,,,,,,,,,,,, 95955,EEG DURING NONINTRACRANIAL CAROTID SURG,," 2,500.00 ",,,,,,, 163.29 , 163.29 , 163.29 , 163.29 , 163.29 ,,,,,,,,,,,,,,, 95972,"ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATION, CYCLING, IMPEDANCE AND PATIENT COMPLIANCE MEASUREMENT",95972, 171.90 ,,, 199.62 ,, 117.54 ,, 42.71 , 42.71 , 42.71 , 42.71 , 117.54 ,,,,,,,,,,,,,,, 96360,"INTRAVENOUS INFUSION, HYDRATION; INITIAL, 31 MINUTES TO 1 HOUR48483",96360, 732.50 ,,, 413.14 ,, 187.18 ,, 47.37 , 47.37 , 47.37 , 47.37 , 187.18 ,,,,,,,,,,,,,,, 96361," INTRAVENOUS INFUSION, HYDRATION; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",96361, 345.40 ,,, 84.74 ,, 37.88 ,, 14.00 , 14.00 , 14.00 , 14.00 , 37.88 ,,,,,,,,,,,,,,, 96365," INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); INITIAL, UP TO 1 HOUR",96365, 945.63 ,,, 413.14 ,, 187.18 ,, 73.93 , 73.93 , 73.93 , 73.93 , 187.18 ,,,,,,,,,,,,,,, 96366," INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCE48486",96366, 324.50 ,,, 84.74 ,, 37.88 ,, 22.25 , 22.25 , 22.25 , 22.25 , 37.88 ,,,,,,,,,,,,,,, 96367,"INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); ADDITIONAL SEQUENTIAL INFUSION OF A NEW DRUG/SUBSTANCE, UP TO 1 HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",96367, 579.40 ,,, 134.94 ,, 59.75 ,, 31.94 , 31.94 , 31.94 , 31.94 , 59.75 ,,,,,,,,,,,,,,, 96368,"INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); CONCURRENT INFUSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCE48488",96368, 329.10 ,,,,,,, 21.17 , 21.17 , 21.17 , 21.17 , 21.17 ,,,,,,,,,,,,,,, 96371,SUBCUTANEOUS INFUSION FOR THERAPY OR PROPHYLAXIS (SPECIFY SUBSTANCE OR DRUG); ADDITIONAL PUMP SET-UP WITH ESTABLISHMENT OF NEW SUBCUTANEOUS INFUSION SITE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCE48491,96371, 242.20 ,,, 134.94 ,, 59.75 ,, 58.20 , 58.20 , 58.20 , 58.20 , 59.75 ,,,,,,,,,,,,,,, 96372,"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTRAMUSCULAR",96372, 324.00 ,,, 134.94 ,, 59.75 ,, 58.20 , 58.20 , 58.20 , 58.20 , 59.75 ,,,,,,,,,,,,,,, 96373,THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); INTRA-ARTERIAL,96373, 359.54 ,,, 413.14 ,, 187.18 ,, 19.38 , 19.38 , 19.38 , 19.38 , 187.18 ,,,,,,,,,,,,,,, 96374,"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); INTRAVENOUS PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG",96374, 719.75 ,,, 413.14 ,, 187.18 ,, 47.01 , 47.01 , 47.01 , 47.01 , 187.18 ,,,,,,,,,,,,,,, 96375,"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); EACH ADDITIONAL SEQUENTIAL INTRAVENOUS PUSH OF A NEW SUBSTANCE/DRUG (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",96375," 1,406.25 ",,, 84.74 ,, 37.88 ,, 18.30 , 18.30 , 18.30 , 18.30 , 37.88 ,,,,,,,,,,,,,,, 96376,"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); EACH ADDITIONAL SEQUENTIAL INTRAVENOUS PUSH OF THE SAME SUBSTANCE/DRUG PROVIDED IN A FACILITY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)",96376, 289.29 ,,,,,,, 22.97 , 22.97 , 22.97 , 22.97 , 22.97 ,,,,,,,,,,,,,,, 96379,INJ-UNLIST THERA PROPH/DX IV/IA NJX/NFS,, 279.04 ,,, 84.74 ,, 37.88 ,, 37.03 , 37.03 , 37.03 , 37.03 , 37.88 ,,,,,,,,,,,,,,, 96523,IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS,96523, 347.80 ,,, 114.96 ,, 55.90 ,, 55.96 , 55.96 , 55.96 , 55.90 , 55.96 ,,,,,,,,,,,,,,, 97001,PHYSICAL THERAPY EVALUATION,, 327.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 97002,PHYSICAL THERAPY REEVALUATION,, 190.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 97010,APP A MODALITY TO=>1 AREAS HOT/COLD PACK,, 48.00 ,,,,,,, 6.46 , 6.46 , 6.46 , 6.46 , 6.46 ,,,,,,,,,,,,,,, 97012,MECHANICAL TRACTION THERAPY,, 178.92 ,,,,,,, 15.07 , 15.07 , 15.07 , 15.07 , 15.07 ,,,,,,,,,,,,,,, 97014,unattended electrical stimulation,, 260.65 ,,,,,,, 15.79 , 15.79 , 15.79 , 15.79 , 15.79 ,,,,,,,,,,,,,,, 97016,VASOPNEUMATIC DEVICE THERAPY,, 192.00 ,,,,,,, 16.15 , 16.15 , 16.15 , 16.15 , 16.15 ,,,,,,,,,,,,,,, 97018,APP MODALITY =>ONE AREAS PARAFFIN BATH,, 96.00 ,,,,,,, 8.97 , 8.97 , 8.97 , 8.97 , 8.97 ,,,,,,,,,,,,,,, 97022,APP MODALITY TO 1 OR MORE AREA WHIRLPOOL,, 141.00 ,,,,,,, 19.38 , 19.38 , 19.38 , 19.38 , 19.38 ,,,,,,,,,,,,,,, 97026,infrared light therapy,, 79.20 ,,,,,,, 6.46 , 6.46 , 6.46 , 6.46 , 6.46 ,,,,,,,,,,,,,,, 97032,APP MODALITY =>1 AREAS ELEC STIM EA 15 M,, 119.40 ,,,,,,, 15.79 , 15.79 , 15.79 , 15.79 , 15.79 ,,,,,,,,,,,,,,, 97035,APP MOD TO 1 OR MORE AREAS US EA 15 MIN,, 236.60 ,,,,,,, 13.64 , 13.64 , 13.64 , 13.64 , 13.64 ,,,,,,,,,,,,,,, 97039,CRM SETUP TRAINING,97039, 150.00 ,,,,,,, 11.13 , 11.13 , 11.13 , 11.13 , 11.13 ,,,,,,,,,,,,,,, 97110,therapy procedure using exercise to devel,, 365.40 ,,,,,,, 31.22 , 31.22 , 31.22 , 31.22 , 31.22 ,,,,,,,,,,,,,,, 97112,NEUROMUSCULAR REEDUCATION,, 419.28 ,,,,,,, 35.53 , 35.53 , 35.53 , 35.53 , 35.53 ,,,,,,,,,,,,,,, 97113,aquatic physical therapy,, 456.36 ,,,,,,, 39.84 , 39.84 , 39.84 , 39.84 , 39.84 ,,,,,,,,,,,,,,, 97116,PT GAIT TRAINING,, 365.40 ,,,,,,, 30.86 , 30.86 , 30.86 , 30.86 , 30.86 ,,,,,,,,,,,,,,, 97124,PT STROKING COMPRESSION,, 373.44 ,,,,,,, 31.22 , 31.22 , 31.22 , 31.22 , 31.22 ,,,,,,,,,,,,,,, 97139,nlisted therapeutic procedure,, 250.00 ,,,,,,, 15.07 , 15.07 , 15.07 , 15.07 , 15.07 ,,,,,,,,,,,,,,, 97140,MANUAL THERAPY,, 340.80 ,,,,,,, 28.35 , 28.35 , 28.35 , 28.35 , 28.35 ,,,,,,,,,,,,,,, 97150,GROUP THERAPEUTIC PROCEDURES,, 312.00 ,,,,,,, 18.66 , 18.66 , 18.66 , 18.66 , 18.66 ,,,,,,,,,,,,,,, 97161,PT EVAL LOW COMPLEX 20 MIN,97161," 1,759.71 ",,,,,,, 85.42 , 85.42 , 85.42 , 85.42 , 85.42 ,,,,,,,,,,,,,,, 97162,PT EVAL MOD COMPL,," 1,246.08 ",,,,,,, 85.42 , 85.42 , 85.42 , 85.42 , 85.42 ,,,,,,,,,,,,,,, 97163,PT EVAL LOW HIGH,," 1,246.08 ",,,,,,, 85.42 , 85.42 , 85.42 , 85.42 , 85.42 ,,,,,,,,,,,,,,, 97164,PT RE- EVAL,, 864.36 ,,,,,,, 57.78 , 57.78 , 57.78 , 57.78 , 57.78 ,,,,,,,,,,,,,,, 97530,PT THERAPEUTIC ACT 1 ON 1,, 460.44 ,,,,,,, 41.27 , 41.27 , 41.27 , 41.27 , 41.27 ,,,,,,,,,,,,,,, 97535,PT SELF CARE/HOME MGMT TRAINING,, 406.68 ,,,,,,, 35.17 , 35.17 , 35.17 , 35.17 , 35.17 ,,,,,,,,,,,,,,, 97597,"REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESS",97597, 980.00 ,,, 361.16 ," 1,200.00 ", 176.45 ,, 24.40 , 24.40 , 24.40 , 24.40 ," 1,200.00 ",,,,,,,,,,,,,,, 97602,WOUND(S) CARE NON-SELECTIVE,, 240.00 ,,, 361.16 ,, 176.45 ,, 168.95 , 168.95 , 168.95 , 168.95 , 176.45 ,,,,,,,,,,,,,,, 97605,NEG PRESS WOUND TX < 50 CM,, 308.25 ,,, 361.16 ,, 176.45 ,, 168.95 , 168.95 , 168.95 , 168.95 , 176.45 ,,,,,,,,,,,,,,, 97802,"MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE PATIENT, EACH 15 MINUTES",97802, 755.01 ,,,,,,, 33.02 , 33.02 , 33.02 , 33.02 , 33.02 ,,,,,,,,,,,,,,, 98925,OSTEOPATH MANJ 1-2 REGIONS INVOLVED,, 129.36 ,,, 49.96 ,, 24.78 ,, 26.83 , 26.83 , 26.83 , 24.78 , 26.83 ,,,,,,,,,,,,,,, 98970,Qnhp ol dig assmt&mgmt 5-10,, 59.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99000,HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PHYSICIAN'S OFFICE TO A LABORATORY,99000, 23.51 ,,,,,,, 12.20 , 12.20 , 12.20 , 12.20 , 12.20 ,,,,,,,,,,,,,,, 99001,HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PATIENT IN OTHER THAN A PHYSICIAN'S OFFICE TO A LABORATORY (DISTANCE MAY BE INDICATED),99001, 53.58 ,,,,,,, 6.10 , 6.10 , 6.10 , 6.10 , 6.10 ,,,,,,,,,,,,,,, 99024,POSTOP FOLLOW-UP VISIT,, 417.84 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99053,PRO SVC PRV BTW 10 PM&8 AM AT 24-HR FAC,, 240.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070,CARDIAC MONITORING /TELEMETRY,, 351.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99072,ADD SUPPLIES MATERIAL&STAFF PHE INFEC DISEAS,99072, 80.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99080,MEDICAL RECORDS AND/OR REPORTS FORMS,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99143,"MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999) PROVIDED BY THE SAME PHYSICIAN PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO",99143, 512.43 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99144,"MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999) PROVIDED BY THE SAME PHYSICIAN PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO",99144, 421.63 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99145,"MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999) PROVIDED BY THE SAME PHYSICIAN PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO",99145, 115.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99151,MODERATE SEDATION SERVICES,, 575.53 ,,,,,,, 25.12 , 25.12 , 25.12 , 25.12 , 25.12 ,,,,,,,,,,,,,,, 99152,MODERATE SEDATION SAME PHYS QHP GREATER THAN 5 YRS ,99152, 624.10 ,,,,,,, 12.92 , 12.92 , 12.92 , 12.92 , 12.92 ,,,,,,,,,,,,,,, 99153,MOD SED SAME PHYS/QHP EA ,99153, 221.95 ,,,,,,, 11.13 , 11.13 , 11.13 , 11.13 , 11.13 ,,,,,,,,,,,,,,, 99156,MODERATE SEDATION INITIAL 15 MINUTES 5YRS AND OLDER ,99156, 273.06 ,,,,,,, 77.16 , 77.16 , 77.16 , 77.16 , 77.16 ,,,,,,,,,,,,,,, 99157,MODERATE SEDATION ADDITIONAL 15 MINUTES 5YRS AND OLDER ,99157, 293.74 ,,,,,,, 58.86 , 58.86 , 58.86 , 58.86 , 58.86 ,,,,,,,,,,,,,,, 99172,"VISUAL FUNCTION SCREENING, AUTOMATED OR SEMI-AUTOMATED BILATERAL QUANTITATIVE DETERMINATION OF VISUAL ACUITY, OCULAR ALIGNMENT, COLOR VISION BY PSEUDOISOCHROMATIC PLATES, AND FIELD OF VISION (MAY INCLUDE ALL OR SOME SCREENING OF THE DETERMINATION[S] FOR ",99172, 287.16 ,,,,,,, 47.73 , 47.73 , 47.73 , 47.73 , 47.73 ,,,,,,,,,,,,,,, 99173,"SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE, BILATERAL",99173, 382.66 ,,,,,,, 3.23 , 3.23 , 3.23 , 3.23 , 3.23 ,,,,,,,,,,,,,,, 99175,IPECAC OR SIMILAR ADMINISTRATION FOR INDIVIDUAL EMESIS AND CONTINUED OBSERVATION UNTIL STOMACH ADEQUATELY EMPTIED OF POISON,99175, 212.75 ,,,,,,, 26.20 , 26.20 , 26.20 , 26.20 , 26.20 ,,,,,,,,,,,,,,, 99195,PHLEBOTOMY,, 318.20 ,,, 232.22 ,, 106.48 ,, 194.32 , 173.32 , 127.10 , 106.48 , 194.32 ,,,,,,,,,,,,,,, 99202,Office or other outpatient visit for the,, 895.44 ,,,,,,, 51.32 , 51.32 , 51.32 , 51.32 , 51.32 ,,,,,,,,,,,,,,, 99203,Office or other outpatient visit 15-29mi,, 895.44 ,,,,,,, 77.88 , 77.88 , 77.88 , 77.88 , 77.88 ,,,,,,,,,,,,,,, 99204,Office or other outpatient visit 45-59mi,," 2,061.24 ",,,,,,, 131.35 , 131.35 , 131.35 , 131.35 , 131.35 ,,,,,,,,,,,,,,, 99205,Office or other outpatient visit 60-74mi,," 2,720.40 ",,,,,,, 171.55 , 171.55 , 171.55 , 171.55 , 171.55 ,,,,,,,,,,,,,,, 99211,ESTABLISHED PT SELF LIMITED/MINOR,, 286.20 ,,,,,,, 9.33 , 9.33 , 9.33 , 9.33 , 9.33 ,,,,,,,,,,,,,,, 99212,ESTABLISHED 10-9 MIN,, 699.48 ,,,,,,, 25.84 , 25.84 , 25.84 , 25.84 , 25.84 ,,,,,,,,,,,,,,, 99214,ESTABLISHED PT HI SEVERITY&URGENT EVAL,," 1,572.00 ",,,,,,, 79.67 , 79.67 , 79.67 , 79.67 , 79.67 ,,,,,,,,,,,,,,, 99217,OBSERVATION CARE DISCHARGE DAY MGMNT,, 262.15 ,,,,,,, 74.29 , 74.29 , 74.29 , 74.29 , 74.29 ,,,,,,,,,,,,,,, 99218,INITIAL OBSERVATION CARE LOW COMPLEXITY,, 358.89 ,,,,,,, 101.57 , 101.57 , 101.57 , 101.57 , 101.57 ,,,,,,,,,,,,,,, 99219,INITIAL OBSERVATION CARE MODCOMPLEX,, 488.85 ,,,,,,, 138.17 , 138.17 , 138.17 , 138.17 , 138.17 ,,,,,,,,,,,,,,, 99220,INITIAL OBSERVATION CARE HIGH COMPLEXITY,, 668.40 ,,,,,,, 189.13 , 189.13 , 189.13 , 189.13 , 189.13 ,,,,,,,,,,,,,,, 99234,OBSERVATION CARE SAME DAY LOW COMPLEXITY,, 479.78 ,,,,,,, 135.30 , 135.30 , 135.30 , 135.30 , 135.30 ,,,,,,,,,,,,,,, 99235,OBSERVATION CARE SAME DAY MOD COMPLEX,, 608.48 ,,,,,,, 171.91 , 171.91 , 171.91 , 171.91 , 171.91 ,,,,,,,,,,,,,,, 99236,OBSERVATION CARE SAME DAY HIGH COMPLEX,, 784.25 ,,,,,,, 221.79 , 221.79 , 221.79 , 221.79 , 221.79 ,,,,,,,,,,,,,,, 99281,"ED VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVI",Emergency department, 499.00 ,,, 150.18 , 270.00 , 69.73 , 485.00 , 180.00 , 162.00 , 126.00 , 69.73 , 485.00 ,,,,,,,,,,,,,,, 99282,"ED VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDICAL DECISION MAKING OF LOW COMPLEXITY. COUNSELING AND/OR COORDINATION OF",Emergency department, 842.00 ,,, 279.38 , 475.00 , 127.96 , 850.00 , 600.00 , 540.00 , 420.00 , 127.96 , 850.00 ,,,,,,,,,,,,,,, 99283,"ED VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. COUNSELING AND/OR COORDINAT",Emergency department," 1,879.14 ",,, 490.06 ," 1,050.00 ", 222.99 ," 1,173.00 ", 938.00 , 847.00 , 658.00 , 222.99 ," 1,173.00 ",,,,,,,,,,,,,,, 99284,"ED VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR",Emergency department," 2,689.00 ",,, 763.22 ," 1,900.00 ", 360.37 ," 2,000.00 "," 1,760.00 "," 1,580.00 "," 1,240.00 ", 360.37 ," 2,000.00 ",,,,,,,,,,,,,,, 99285,"ED VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS WITHIN THE CONSTRAINTS IMPOSED BY THE URGENCY OF THE PATIENT'S CLINICAL CONDITION AND/OR MENTAL STATUS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; A",Emergency department," 3,635.00 ",,," 1,096.22 "," 2,400.00 ", 525.30 ," 3,088.00 "," 3,160.00 "," 2,840.00 "," 2,200.00 ", 525.30 ," 3,160.00 ",,,,,,,,,,,,,,, 99291,CRITICAL CARE FIRST HOUR,," 5,312.00 ",,," 1,535.44 "," 2,400.00 ", 740.02 ," 3,088.00 "," 3,160.00 "," 2,840.00 "," 2,200.00 ", 740.02 ," 3,160.00 ",,,,,,,,,,,,,,, 99292,EDEMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDICAL DECISION MAKING OF LOW COMPLEXITY. COUNSELING AND,Emergency department," 1,800.00 ",,,," 2,400.00 ",," 3,088.00 ", 113.41 , 113.41 , 113.41 , 113.41 ," 3,088.00 ",,,,,,,,,,,,,,, 99383,INITIAL COMP PREVENTAT MED E&M AGE 5-11,, 457.43 ,,,,,,, 88.29 , 88.29 , 88.29 , 88.29 , 88.29 ,,,,,,,,,,,,,,, 99384,INITIAL COMP PREVENTAT MED E&M AGE 12-17,, 457.43 ,,,,,,, 103.72 , 103.72 , 103.72 , 103.72 , 103.72 ,,,,,,,,,,,,,,, 99385,INITIAL COMP PREVENTAT MED E&M AGE 18-39,, 559.08 ,,,,,,, 99.41 , 99.41 , 99.41 , 99.41 , 99.41 ,,,,,,,,,,,,,,, 0001A,PFIZER ADMIN 1,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0001A,ADM SARSCOV2 30 MCG/0.3 ML 1ST DS PFIZER,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0002A,PFIZER ADMIN 2,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0002A,ADM SARSCOV2 30 MCG/0.3 ML 2ND DS PFIZER,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0003A,PFIZER ADMIN 3,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0003A,ADM SARSCOV2 30 MCG/0.3 ML 2ND DS PFIZER,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0011A,MODERNA ADMIN 2,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0011A,ADM SARSCOV2 100 MCG/0.5ML 1ST DS MODRNA,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0012A,MODERNA ADMIN 3,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0012A,ADM SARSCOV2 100 MCG/0.5ML 2ND DS MODRNA,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0013A,MODERNA ADMIN 4,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0013A,ADM SARSCOV2 100 MCG/0.5ML 3RD DS MODRNA,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0021A,ASTRENECA ADMIN,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 0021A,ADM SARSCOV2 5X10^10VP/.5 ML 1ST ASTRZNC,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 0022A,ATRENECA ADMIN 3,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 0031A,JOHNSON ADMIN 2,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0031A,ADM SARSCOV2 VAC AS26 .5ML 1ST DOSE J&J,, 200.00 ,,, 83.04 ,,,,,,, - , - ,,,,,,,,,,,,,,, 0163T,TOTAL DISC ARTHROPLASTY ANTERIOR APPROAC,OR LEVEL 5,," 23,543.80 ",337.2,,,,," 5,753.09 "," 5,131.14 "," 3,762.83 "," 3,762.83 "," 5,753.09 ",,,,,,,,,,,,,,, 0202U,INFECT DIS PATH S22 TARGT INC SARS-COV-2,, 250.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 0240U,SARS-COV-2 NEC,0240U, 713.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 0241U,CEPHIED INFECT DIS RNA,, 350.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 0249T,LIGA HEMORRHOID VAS BUND INC US GUID 1ST,OR LEVEL 3,," 17,605.00 ",219.62,,," 2,334.58 "," 3,031.00 "," 4,283.92 "," 3,820.79 "," 2,801.91 "," 2,334.58 "," 4,283.92 ",,,,,,,,,,,,,,, 0627T,PERC LUMBAR INTRAVERTEBRAL DISC INJ PROC,OR LEVEL 3,," 17,605.00 ",219.62," 26,096.16 ",,,,,,, - , - ,,,,,,,,,,,,,,, 2010F,VITAL SIGNS RECORDED,, 3.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 2014F,MENTAL STATUS ASSESSED,, 3.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 20560GP,NEEDLE 1-2 MUSC,, 319.56 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 3028F,OXYGEN SATURATION RESULTS DOC & REVIEW,, 68.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 3028F,OXYGEN SATURATION RESULTS DOC & REVIEW,, 34.44 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 3293F,ABO AND RH BLOOD TYPING,, 214.29 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 36430BL,TRANSFUSION BLOOD OR BLOOD COMPONENTS,, 685.24 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 6020F,NPO CHALLENGE,, 9.79 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070ALFOR,ALLIGATOR FORCEPS,, 137.81 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070CAUT,CAUTERY MICRO-TEMP FINE TIP/BOVIE,, 51.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070COBAN,COBAN/CO-FLEX BANDAGE,, 11.81 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070CTINJ,CT INJECTOR KIT,, 87.94 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070EAR,EAR CURETTE/WIRE LOOP,, 39.38 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070EMES,EMESIS BASIN,, 19.69 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070ETT7.,ENDOTRACHEAL TUBE (ETT) 7.0,, 170.63 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, 99070WOCAT,WORD BARTHOLIN CATHETER,, 221.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A0396,ALS ESOPHAGEAL INTUB SUPPLS,, 38.27 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4206,SYRINGE WITH NEEDLE STERILE 1 CC/LESS EA,, 24.31 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4209,5+ CC STERILE SYRINGE&NEEDLE,, 45.92 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4213,20 PLUS CC SYRINGE ONLY,, 9.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4215,NEEDLE STERILE ANY SIZE EACH,, 16.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4217,STERILE WATER/SALINE 500 ML,, 34.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4217,STERILE WATER IRRIGATION 3000ML BAG,, 31.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4217,STERILE WATER IRRIGATION 500ML BTL,, 22.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4217,STERILE WATER IRRIG 1000ML POUR BOTTLE,, 16.23 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4218,STERILE SALINE/WATER MTR DS DISP 10ML,, 14.44 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4222,INFUSION SUPPLIES WITH PUMP,, 367.39 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4244,ALCOHOL OR PEROXIDE PER PINT,, 6.12 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4246,BETADINE/PHISOHEX SOLUTION,, 33.03 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4247,BETADINE/IODINE SWABS/WIPES,, 33.03 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4248,CHLORHEXIDINE ANTISEPT,, 19.69 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4250,URINE REAGENT STRIPS/TABLETS,, 6.49 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4253,BLOOD GLUCOSE/REAGENT STRIPS,, 4.18 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4311,INSERT TRY WO/DRN BG W/INDWLL CATH FOLEY,, 37.81 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4314,INSERT TRY W/DRN BG W/INDWLL CATH FOLEY,, 25.29 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4320,IRRIGATION TRAY,, 20.29 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4322,IRRIGATION SYRINGE,, 20.29 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4327,URINE CUP FEMALE COLLECT DEV CUP,, 4.59 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4331,EXTEN DRAIN TUBING ANY TYPE ANY LENGTH,, 9.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4332,LUBE STERILE PACKET,, 9.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4334,URINARY CATHETER ANCHORING DVC LEG STRAP,, 10.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4338,INDWELLING CATHETER LATEX,, 27.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4344,CATHETER - FOLEY 2 WAY SILICN,, 30.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4346,CATH INDW FOLEY 3 WAY,, 41.72 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4351,STRAIGHT TIP URINE CATHETER,, 14.92 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4353,INTERMITTENT URINARY CATH,, 30.61 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4355,BLADDER IRRIGATION TUBING,, 48.68 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4358,BAG - URINARY LEG OR ABDOMEN BAG,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4364,ADHESIVE LIQUID OR EQUAL ANY TYPE PER OZ,, 43.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4364SURG,SURGICEL,, 38.06 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4402,LUBRICANT PER OUNCE,, 5.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4450,TAPE NON-WATERPROOF,, 13.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4452,TAPE WATERPROOF,, 13.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4455,MINERAL OIL,, 46.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4550,LACERATION - SURGICAL KIT,, 35.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4556,ELECTRODES PAIR,, 97.51 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4565,SLINGS,, 191.34 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4566,SHOULD SLING/VEST/ABRESTRAIN,, 201.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4570,SPLINT,, 164.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4590,ORTHO GLASS 4 SPECIAL CASTING MATERIAL,, 164.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4606,OXYGEN PROBE USED W OXIMETER,, 166.84 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4615,CANNULA NASAL O2,, 7.66 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4628,OROPHARYNGEAL SUCTION CATH,, 13.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4629,TRACHEOSTOMY CARE KIT,, 7.56 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4641,RADIOPHARMACEUTICAL DIAGNOSTIC NOT OTHERWISE CLASSIFIED,A4641, 139.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4641TC,ORL- READYCAT/GASTROGRAFIN,, 139.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A46469SU11,,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A46492,,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649BAND,BANDAGE FABRIC STRIP 1X3 INCH,, 1.27 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649BAND2,BANDAGE FABRIC PATCH 2X3 INCH,, 1.27 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649BAND3,BANDAGE FABRIC PATCH 2X4 INCH,, 1.27 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649BLAD,SCALPEL SAFETY #11,, 13.13 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649BURR,OPTHALMIC/ EYE BURR,, 105.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT,IV CATHETER INTROCAN 24GX3/4,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT1,IV CATHETER INTROCAN SAFETY 20GX1,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT2,IV CATHETER INTROCAN SAFETY 18G,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT4,IV CATHETER INTROCAN SAFETY 16G,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT5,IV CATHETER INTROCAN 14G,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT6,SUCTION CATHETER KIT 14 FR,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT7,CATH KIT URETH FEMALE 8 FR,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CAT8,CATH KIT SOFT PEDIATRIC 5 R,, 170.77 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CCAT,CATHETER SET CVC 7.5 FR. 2 LUMEN,, 213.22 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CCAT2,CATH KIT CVC 7 FR. 3 LUMEN,, 213.22 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CHTU,CHEST TUBE TRAY CENTURION,, 669.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CHTU2,CHEST TUBE TRAY COOK 36 FR,, 669.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CRIC,CATH SET CRICOTHYROTOMY MELKER,, 114.68 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CUP,URINE SPECIMEN COLLECTION KIT,, 3.79 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649CUP2,URINE CUP CONTAIN SPEC W/LID UNWRAP,, 3.79 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649EXTS,EXTENSION SET IV ULTRA/RATE FLOW,, 5.44 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649ICE,ICE PACK,, 6.32 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649IV,IV START KIT,, 16.08 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649IV2,IV EXTENSION SET 0.22 MICRON FILTER,, 16.08 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649KATZ,EXTRACTOR KATZ FOREIGN BODY,, 178.98 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649LMBR,LUMBAR PUNCTURE TRAY ADULT 20X3 1/2,, 15.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649LMBR2,LUMBAR PUNCTURE TRAY PEDI 22GX1 1/2,, 15.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649NIT,SILVER NITRATE STICKS EACH,, 52.82 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649PAD,ALCOHOL PREP PAD LARGE,, 3.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649PAD2,ALCOHOL PREP PAD MEDIUM,, 3.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649PNEU,PNEUMOTHOR SET CATH PIGTAIL NDL 18G 14FR,, 388.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SPEC,SPECULA VAGINAL KLEENSPEC MEDIUM,, 177.82 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SPEC2,SPECULA VAGINAL KLEENSPEC SMALL,, 177.82 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SPEC3,EAR SPECULUM 4.25 MM,, 231.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SPEC4,EAR SPECULUM 2.75 MM,, 231.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649STAP,STAPLES,, 49.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649STERI,STERI STRIPS,, 11.81 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU10,SUTURE PROLENE 5-0 PS-3,, 51.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU11,SUTURE PROLENE 4-0 PS-2,, 63.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU12,SUTURE PROLENE 3-0 FS-1,, 51.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU13,SUTURE PROLENE 6-0 P-3,, 66.94 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU14,SUTURE PROLENE 5-0 P-3,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU15,SUTURE PROLENE 4-0 P-3,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU16,SUTURE ETHLON 3-0 PS-1,, 51.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU17,SUTURE VICRYL 5-0 P-3,, 60.38 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU18,SUTURE VICRYL 4-0 P-3,, 52.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU19,SUTURE VICRYL 5-O PS-3,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU2,SUTURE PLAIN GUT 5-0 PC-1,, 90.56 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU20,SUTURE VICRYL 3-0 PS-1,, 52.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU3,SUTURE SILK 0 2C-2,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU4,SUTURE ETHLON 6-0 P-1,, 57.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU5,SUTURE ETHLON 5-0 P-3,, 57.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU6,SUTURE ETHLON 4-0 P-3,, 51.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU7,SUTURE SILK 0 SH,, 24.94 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU8,SUTURE CHROMIC GUT 5-0 PS-5,, 90.56 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SU9,SUTURE ETHLON 4-0 PS-2,, 19.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649SUTUR,SUTURE VICRYL 6-0 P-3,, 52.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TCAT,CATHETER THORACIC CHEST TUBE 12 FR,, 16.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TCAT2,CATHETER THORACIC CHEST TUBE 36 FR,, 16.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TCAT3,CATHETER THORACIC CHEST TUBE 24 FR,, 16.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TCAT4,CATHETER THORACIC CHEST TUBE 16 FR,, 16.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TCAT6,CATHETER THORACIC CHEST TUBE 28 FR,, 16.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TOUR,TOURNIQUET,, 33.28 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TU,IV TUB INTERLINK SET BURETROL 150ML 120,, 58.62 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TU2,IV TUBING SECONDARY 15 DRP 40,, 58.62 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4649TU3,IV PUMP TUBING-CHECK VALVE W/3 SMAR,, 58.62 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4657,SYRINGE WITH OR WITHOUT NEEDLE,, 9.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4736,TOPICAL ANESTHETIC PER GRAM,, 5.71 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4927,GLOVES NON-STERILE,, 3.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A4930,GLOVES STERILE PER PAIR,, 4.59 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A5120,SWAB OR WIPE SKIN BARRIER,, 7.66 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6204,COMPOSITE DRESSING STERILE >16<=48 SQ IN,, 13.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6216,GAUZE - NON-STERILE GAUZE<=16 SQ IN,, 18.52 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6220,GZ N-IMPRG STRL PD>16SQ IN<48SQ IN W/ADH,, 4.57 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6222,GZ IMPRG W/OT H2ONS/HYDRGL STRL16SQ/48SQIN,, 8.02 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6250,SKIN SEAL PROTECT MOISTURIZER OINTMENT,, 44.93 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6257,TRANSPARENT FILM <= 16 SQ IN,, 11.49 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6260,WOUND CLEANSER,, 130.11 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6402,GAUZE 2X2 4X4,, 14.44 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6404,STERILE GAUZE > 48 SQ IN,, 15.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6407,IODOFORM PACKING STRIPS/GZ NON-IMPREG,, 37.89 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6410,STERILE EYE PAD OR STRIP,, 7.66 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6412,OCCLUSIVE EYE PATCH,, 28.14 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6413,ADHESIVE BANDAGE FIRST-AID,, 6.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6442,CONFORM BAND N/S W<3/YD,, 18.37 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6443,CONFORM BAND N/S W>=3<5/YD,, 4.83 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6446,CONFORM BAND S W>=3 <5/YD,, 18.37 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6448,LT COMPRES BAND <3/YD,, 15.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6449,ACE WRAP (LT COMPRES BAND >=3 <5/YD),, 22.31 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6450,ACE WRAP - LT COMPRES BAND >=5/YD,, 22.97 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6453,BANDAGE - SELF-ADHER BAND W <3O/YD,, 3.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6454,SELF-ADHER BAND W>=3 <5/YD,, 6.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A6457,TUBULAR DRESSING,, 53.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7000,CANISTER DISPOSABLE USED W/SUCTION PUMP,, 10.52 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7001,CANISTER NONDISPOSABLE USED W/SUCTN PMP,, 13.02 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7002,SUCTION TUBING USED W PUMP,, 122.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7003,NEBULIZER ADMINISTRATION SET,, 73.92 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7015,AEROSOL MASK USED WITH DME NEBULIZER,, 30.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7040,ONE WAY CHEST DRAIN VALVE,, 70.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A7041,WATER SEAL DRAIN CNTN&TUB IMPLNT CHST TB,, 177.86 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150,NON-PRESCRIPTION DRUGS,A9150, 9.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150ACET,ACETAMINOPHEN MAPAP TAB 500MG UD,, 7.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150ACETS,ACETAMINOPHEN/ TYLENOL ELIXIR 160MG,, 7.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150ASP,ASPIRIN TAB 324MG,, 9.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150BENA,BENADRYL / DIPHENHYDRAMINE 25MG PO,, 7.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150BENAE,BENADRYL / DIPHENYDRAMINE ELIXIR,, 7.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150FAMO,FAMOTIDINE/ PEPCID 20MG TABLET,, 16.96 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150IBUP,IBUPROFEN (MOTRIN) 200 MG TAB ORAL,, 7.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150IBUPS,IBUPROFEN CHILDRENS ELIXIR,, 10.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150MAL,MAALOX 30CC,, 9.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9150MOD,IMODIUM/ LOPERAMIDE PO,, 7.88 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9270,NON-COVERED ITEM OR SERVICE,, 1.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9273,HOT/COLD H2OBOT/CAP/COL/WRAP,, 16.84 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9500,TECHNETIUM TC-99M SESTAMIBI DIAGNOSTIC PER STUDY DOSE,A9500, 70.22 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9503,"TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES",A9503, 44.31 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9537,"TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES",A9537, 63.56 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9541,"TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES",A9541, 951.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9552,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",A9552," 3,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9560,"TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES",A9560," 1,105.90 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9579,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",A9579, 1.99 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, A9900,"MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS CODE",A9900, 45.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, B4081,ENTERAL NG TUBING W/ STYLET,, 32.81 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, B4102,EF ADULT FLUIDS AND ELECTRO,, 9.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, B4185,LIPID INTRALIPID FAT EMULSION 20% 100ML,, 140.31 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1627,BOSTON SCIENTIFIC STENT 6X26,," 3,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,AXLE 36MM LENGTH PLATE X 14MM PEEK,," 45,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,X-SPINE 36MM PLATE X 12MM PEEK INSERT,," 45,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,X-SPINE 55MM LENGTH PLATE X NO INSERT,," 45,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,X-SPINE 36MM L PLATE X 16MM PEEK INSERT,," 45,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE PROLIFT LATERAL 18X45XLG,," 37,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE PROLIFT LATERAL 18X50 LG,," 37,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE PROLIFT 15,," 32,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART 14 LARGE 10 CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART 14 MEDIUM 10 CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART 16 LARGE10 CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART LARGE 15 16MM CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART MEDIUM H1415 CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART USA 12 MEDIUM 15 CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SCARLET LUMBAR CAGE,," 30,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC KYPHOPAK,," 28,870.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED RADIAL HEAD SYSTEM,," 28,870.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ORTHOFIX 6MM POLYCARBONATE URETHANE TIT,," 26,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ORTHOFIX 6MM POLYCARBONATE URETHANE TITA,," 26,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SCIENCES CERVICAL HIVE C INTERBODY,," 22,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SCIENCES INTERBODY SPACER WITH NANO,," 22,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 4.5 VA -LCP CURVED PLATE,," 22,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 14 HOLE PLATE,," 21,565.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA MODULAR CENTERED EPIPHYSSI HA COAT,," 21,216.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZIMMER SCP KIT,," 21,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ORTHOFIX 6MM ML M6 DISCH,," 20,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ORTHOFIX POLYCARBONATE TITANIUM 6MM,," 20,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PEEK CAGE18MM,," 20,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION KYMPHOPLASTY KIT,," 20,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JJ 3.5 LCP MED PROXIMAL TIB PL,," 17,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,18MM X14MM XDEGREE 7X7MMX1,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,18MMX14MM X DEGREE 7X8MM X1,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION MEDICAL 16MM X16MMXDEGREE 7X6,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION MEDICAL 16MMX13MMX7X6,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION MEDICAL 7X16X13 LORDOTIC CAGE,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 10TI CANN TIB NAIL EX PROX BEND 420-,," 17,150.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE Z LINK CERVICAL SPACER 12X15,," 16,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED RADIAL HEAD,," 16,585.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7/3.5MM DISTAL TIBIA PL/,," 16,020.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5 LCP MED PROXIMAL TIBIAL PLATE 4H,," 16,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY ACETABULAR SHELL SECTOR 58MM,," 15,743.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY 3.5MM VA LCP PROX TIBIA PLATE SMAL,," 15,675.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES VA PROXIMAL TIBIA PLATE,," 15,675.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 LCP PROXIMAL HUMERUS PLATES,," 15,640.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT ACTISHIELD 4X4CM,," 15,301.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MERIT MEDICAL STABILI MX FRACTURE KIT,," 15,300.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE 8MM CERVICAL INTERBODY PLATE,," 15,200.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 8 TI CANN TIBIAL NAIL,," 15,075.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM MEDIAL DIATAL TIBIA,," 15,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JJ 2.7 3.5 VA LCP MED DISTAL TIBIA PLATE,," 15,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK CERVICAL 16.5MM X 14MM X 7MM,," 15,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK CERVICAL 16.5MMX 17MM X 8MM,," 15,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,HD LIFESCIENCES CERVICAL PLATE 2LEVLE 32,," 15,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MERIT STABILI MX FRACTURE KIT,," 15,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TRILLIANT ARSENAL LISFRANC PLATE,," 14,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 2.7 MEDL DSTL HUM PLATE,," 13,770.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J VA LAT HUM PLATE,," 13,770.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM VA LCP PROX TIBIA PLATES S,," 13,420.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED RT OLECRANOR PLATE,," 13,390.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE SI SCREW LAG 8X40MM,," 13,330.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE SI TRI FIN SCREW 12X40MM,," 13,330.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHROSURFACE HEMI IMPLANT 15MM ARTICULA,," 13,180.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM/3.5MM VA LCP POSTLAT,," 12,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM3.5MM VA LCP DSTL HUM,," 12,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT LAPIDUS LOCKING PLATE 0 DEGREES,," 12,670.45 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA LATERALIZED GLENOSPHERE 38MM,," 12,532.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,AXLE CROSS BAR PLATES 40MM,," 12,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"AXLE LOCKING PLATES 40MM, 10MM",," 12,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,S&N BONE ANCHORS,," 12,135.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,S&N TENDON ANCHOR,," 12,135.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY BIOLOX DELTA CERAMIC FEMORAL HEAD,," 11,904.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,X SPINE 6.5X40MM PEDICLE SCREW,," 11,904.30 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,X-SPINE 6.5X35MM PEDICLE SCREW,," 11,904.30 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3HOLE R OLECRENON PLATE,," 11,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,FEMORAL 44,," 11,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JRF VERSA GRAFT DIAMETER 4.0-5.0MM,," 11,625.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 14MM SINGLE LEVEL PLATE,," 11,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION CERVICAL PLATE 18MM,," 11,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED RIGHT CLAVICLE PLATE,," 11,410.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE SI TRI FIN SCREW 12X45MM,," 11,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE SI TRI FIN SCREW 12X55MM,," 11,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED NARROW LEFT DISTAL RADIUS PLATE,," 11,170.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA MODULAR HUMERAL STEM CMENTLESS,," 11,069.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY POLYETHYLENE ACETABULAR LINER,," 11,069.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 5HOLE OLECRANON PLATE LEFT,," 11,025.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX SUTURE ANCHOR 8X19.5MM,," 10,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 75MM CERVICAL PLATE,," 10,860.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 80MM PLATE,," 10,860.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC CERVICAL PLATE 77.5,," 10,860.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 6MM CERVICAL PEEK CAGE,," 10,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION CIF 12/14 09 CAGE,," 10,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION CIF 12X14 PEEK CAGE,," 10,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVIATION CIF 12/14 ODIG 07 CAGE,," 10,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 6 HOLE CLAVICLE PLATE,," 10,660.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 6 HOLE CLAVICLE PLATE ACUMED (RT),," 10,660.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER NARROW LOCK PLATE .0 L34MM 6HOLE,," 10,640.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,BIOCOMPOSITE PUCSHLOCK,," 10,375.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 3.5MM LCP SUPERIOR CLAVICL,," 10,275.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 52.5MM PLATE,," 10,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 60MM PLATE,," 10,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC PLATE 55MM.,," 10,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC PLATE 57.5,," 10,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC PLATE 62.5,," 10,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,METRONIC 65MM PLATE,," 10,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT 1-HOLE UNIVERSAL PLATE,," 10,134.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION MEDICAL 16X13XDEGREE 0X7MM,," 10,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PROVIDENCE CAVUX CARVICAL CARE-X,," 10,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LAPIDUS PLATING,," 9,816.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA VALEO II 6DEGREE 10X27X9MM,," 9,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,VALEO LL 12MM 18X55,," 9,687.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TIBIAL 45,," 9,616.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY VOLAR DISTAL PLATE,," 9,465.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4MM VA-LCP RADIUS PLATE 6H HD,," 9,200.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION MEDICAL 3 LEVEL 51MM CERVICAL,," 9,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX 5.5 CORK SCREW ANCHOR,," 8,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA XTEND CEMENTLESS METAGLENE,," 8,836.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED DISTAL ULNA LONG PLATE,," 8,720.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3HOLE R DISTAL ULNA PLATE,," 8,720.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 45MM PLATE,," 8,718.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 47.5MM PLATE,," 8,718.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC PLATE 40MM,," 8,718.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC PLATE 42.5MM,," 8,718.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX ACHILLES SPEEDBRIDGE 4.75X19.1MM,," 8,700.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX SPEED BRIDGE IMPLANT SYSTEM 4.75,," 8,700.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT LAPIDUS PLATE.,," 8,572.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX 3MM SUTURE ANCHOR,," 8,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER EASYCLIP 18-19-17,," 8,490.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4MM VA LCP 2-COLUMN VOLAR DIST,," 8,410.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER SLIM Y PLATE 3 SHAFT HOLES,," 8,380.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4 VA DISTAL RADIUS PLATE,," 8,365.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC LATERAL PORTS SPACER,," 8,225.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED LONG LEFT DISTAL ULNA PLATE,," 8,150.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX 3X14.5 SMALL JOINT,," 8,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CTL AMEDICA VALEO II PL CAGE 9MM 9X26,," 8,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC PLATE 25MM.,," 8,107.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JONES FRACTURE PLATE SM RIGHT,," 8,080.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE 6.5 AVATR SCREW 55MM,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE AVAR 6.5 X 50,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE AVATAR 6.5 45,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE AVATAR 7.5 45MM,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 29MM CERVICAL PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 48MM 3 LEVEL PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 51 31V1 PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 54MM 31V1 PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 72MM PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL EVOLUTION 34MM PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 32MM PLATE,," 8,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC 42.5MM PLATE,," 7,952.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX INTERNALBRACE LIGAMENT,," 7,680.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE POLYAXIAL SCREW 6.5 X 40,," 7,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION POLYAXIAL SCREW 6.5 X 35,," 7,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION POLYAXIAL SCREW 6.5 X 45,," 7,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVIATION POLYAXIAL SCREW 7.5X35,," 7,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,IMPLANT MEDIUM CANNULATED,," 7,516.60 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORUS SPINAL SYSTEM-X,," 7,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STIMULAN BEADS (L8699),," 7,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX DISTAL EXTREMITY INTERNAL BRACE,," 7,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"ARTHREX IB KIT, BC W/CC FT AND JUMPSTART",," 7,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX TIGHTROPE,," 7,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX ANCHOR PEEK 5.5X14.7MM CORKSCREW,," 7,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA HUMERAL PE CUP STANDARD,," 6,860.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER POLYAXIAL LOCKING PLATE TALO-NAV,," 6,828.60 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J TFNA FENESTRATED SCREW 80MM,," 6,525.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES TFNA FENESTRATED SCREW 90MM,," 6,525.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL MEDICAL INTERBODY FUSION DEVICE,," 6,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JRF VERSA GRAFT 4.5 X 250,," 6,450.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 8-HOLE CLAVICLE PLATE,," 6,005.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 2 LEVEL PLATE,," 6,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHTREX KNOTLESS TIGHTROPE SYNDESMOSIS,," 5,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4 HOLE DHSPLATE,," 5,835.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ALLIANCE SPINE CERVICAL PLATE 14X16X2,," 5,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK RB CANNULATED SCREW 5.5X40,," 5,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK RB CANNULATED SCREW 6.5X45,," 5,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CTL AMEDICA POLY-AXIAL SEMI CLOSED SCRE,," 5,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX IMPLANT SYSTEM ACUTE AC REPAIR,," 5,625.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX IMPL DELIVERY SYS DISTAL BICEPS,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 14X11X7 CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 14X11X7 CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 14X11X8 CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 16MM X13X6MM CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 16X13X7 CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 16X13X7MM 0DEGREE CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 16X13X8MM,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 8MM 16X13X7 CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL EVOLUTION 16X13X7MM 0 DEGREE CAGE,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION CERVICAL INTERBODY SYSTEM,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION TI3Z CERVICAL INTERBODY SYSTEM,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION TI3Z CERVICAL INTERBODY SYSTEM,," 5,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER MEDIUM HAMMERTOE IMPLANT,," 5,495.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER SMALL HAMMERTOE IMPLANT,," 5,495.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 1.5MM VAL STRAIGHT 12 HOLE PLATE,," 5,495.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX CPR MINI SCORPION DX,," 5,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHORAGE PLATE MTP V1 LEFT,," 5,183.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ACHOR LAPIDUS PLATE MM,," 5,180.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL GRAFT TECHNOLOGIES CORTICAL BLOCK,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX SPEEDBRIDGE KIT,," 4,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET FIXATION PLATE 2 HOLE,," 4,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES PLATE,," 4,840.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER CANNULATED COMPRESSION SCREW 4.0,," 4,770.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER CANNULATED COMPRESSION SCREW 5.0,," 4,770.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER JFX CANN 5.0 X 5.0MM SCREW,," 4,770.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X 40 SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X 50SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X35 SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X40 SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X40MM SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X45 SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 6.5X50 MM SCREW,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA MANOT ACDF CAGE TITATIUM SMAL,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA MONET ACIF CAGE,," 4,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.0MM STRAIGHT PLATE,," 4,655.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 2.0TI T-PL 2HOLE HEAD/8HOLE-SHAFT,," 4,595.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GRAFTON PLUS DBM 5CC,," 4,585.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 6 HOLE PLATE,," 4,415.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 4.5MM NARROW LCP PLATE 7HO,," 4,405.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER EASY CLIP,," 4,361.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR UTILITY PLATE STRAIGHT 4,," 4,317.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER CHANOR UTILITY PLATE STRAIGHT 3,," 4,317.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 8MM T PLATE,," 4,310.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 30MM ACUTRAK MINI SCREW,," 4,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,INTERBODY FUSION DEVICE 10MM,," 4,062.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,VALEO INTERBODY FUSION DEVICE 11MM,," 4,062.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER DISTAL LATERAL FIBULA PLATE 6 HO,," 3,955.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 40MM ACUTRAK 4.7,," 3,895.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.0MM STRUT PLATE 8 HOLE,," 3,880.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 28MM ACUTRAK MINI SCREW,," 3,855.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUTRACK MINI SCREW 20MM,," 3,855.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,4 HOLE STRAIGH PLATE,," 3,804.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,S&N HEALICOIL KNOTLESS,," 3,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 1.3MM STRAIGHT PLATE,," 3,695.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.0 MM TI LC-DCP PLATE 4HO,," 3,690.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 22MM ACUTRALE MINI SCREW,," 3,680.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACCUTRAK STANDARD SCREW 24,," 3,670.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY 9 HOLE 3.5MM LCP PLATE,," 3,515.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES DHE LAG SCREW 70MM,," 3,470.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,FIXATION PLATE MEDIUM 2HOLE 6MM,," 3,462.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET 2HOLE FIXATION HOLE,," 3,462.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET TI MED 8 DEP 7MM,," 3,462.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET TITANIUM CAGE MEDIUM 6MM,," 3,462.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET TITANIUM CAGE MEDIUM 7MM,," 3,462.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,45MM XPRESS CONTINOUS RADIUS ROD,," 3,375.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES MINI FRAG LOCKING PLATE,," 3,280.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 34MM STANDARD SCREW,," 3,265.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE ZV PRO 5.00 CC,," 3,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PROVIDENCE ALLY BONE SCREW,," 3,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL MEDICAL 3.5 X 12MM SCREW,," 3,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED PLACE .8MM 10HOLE,," 3,195.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES LCP PLATE 6 HOLE,," 3,035.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM LCP 8 HOLE PLACE,," 3,035.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.5MM ACUTRAK 4.7SCREW,," 3,030.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO 5.5MM X40MM,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II 5.5X50 MIS SCREW,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II 6.5 X 50MM MIS SCREW,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II 6.5X45 MIS SCREW,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II 6.5X45MM POLYAXIAL SCREW,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II MIS SCREW5.5 X 35MM,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA PICASSO II PERC POLYAXIAL 127,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL MEDICAL 6.5 X 40MM SCREW,," 2,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX SUTURE ANCHOR BIO-COMP PUSHLOCK,," 2,860.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 45 ACUTRACK 4.7 SCREW,," 2,830.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACCUTRAC 30MM SCREW,," 2,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 30MM ACUTRAK STANDARD SCREW,," 2,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUTRAC 28MM STANDARD SCREW,," 2,800.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 2.0 MM TI ELASTIC NAIL 440MM,," 2,765.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CAGE MEDIUM 6MM 8 DEGREES,," 2,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,FIXATION PLATE MEDIUM 2HOLE 7MM,," 2,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET FIXATION PLATE MED 2-HOLE 7MM,," 2,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET MEDIUM 7MM CAGE,," 2,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 98MM LCP PLATE,," 2,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER CALCANEUS MESH PLATE LARGE,," 2,721.85 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER CALCANEUS PLATE,," 2,721.85 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY 4.5 HEALIX ANCHOR,," 2,685.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"MEDARTIS 2X2 HOLE, TRAPEZOID PLATE",," 2,607.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 1.5 TI ELASTIC NAIL 300MM,," 2,605.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5MM LCP 6 HOLE PLATE,," 2,595.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 5.0 PERIPRO VAL SCREW SLF TPNG SD 12,," 2,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 7.3MM CANNULATED SCREW 32MM,," 2,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 70MM SCREW,," 2,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CANCELLEOUS CRUSHED 10CC BONE CHIPS,," 2,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZVPRO PUTTY 2.5CC,," 2,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX FIBERSTITCH IMPLANT ACL,," 2,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRESSION SCREW 0.4MM,," 2,472.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX TENODESIS SCREW BIOCOMPOSITE,," 2,465.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX 3MM SUTURE ANCHOR ..,," 2,430.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 5.0TI LCKNG SCREW T25 SD48 NAIL,," 2,420.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 5.0TI LCKNG SCREW T25 SD40 NAIL,," 2,420.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 4X12MM VARIABLE SCREWS,," 2,400.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVIATION SELF DRILLING VARIABLE SCREWS,," 2,400.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MINI QUICK ANCHOR 2.0,," 2,380.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRESSION SCREW 7.0MM,," 2,380.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRESSION SCREW 7MM X,," 2,380.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRESSION SCREW 7MMX4,," 2,380.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 5.0 MM CANNULATED VA LOCKING SCREW 7,," 2,365.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 5.0MM CANNULATED VA LOCKING SCREW 65,," 2,365.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0MM CANNULATED VA LOCKING S,," 2,365.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPR. SCR. 4.0MM L36MM,," 2,356.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRESSION SCREW 4.0MM,," 2,356.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX FIBERTAK SUTURE ANCHOR,," 2,325.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT SNAP OFF SCREW 2.0MMX12MM,," 2,288.20 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHROSURFACE HEMI 9.5 TAPER POST,," 2,265.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SCIENCES 4.0 X14 SD FIXED SCREW,," 2,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SCIENCES 4.0 X14MM SD VARIABLE SCRE,," 2,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI LOCK SCREW 2.4 X 12MM,," 2,230.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI LOCK SCREW 2.4 X 14MM,," 2,230.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI LOCK SCREW 2.4 X 16MM,," 2,230.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI LOCK SCREW 2.4 X 18MM,," 2,230.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI LOCK SCREW 2.4 X 20MM,," 2,230.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARHTREX TIGHTROPE,," 2,225.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 4.5 MM CANNULATED SCREW PA,," 2,225.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX SUTURE ANCHOR SWIVELOCK TENODES,," 2,175.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T6 2.0MM L8MM,," 2,160.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER DISTAL LATERAL FIBULA PLATE 4 HO,," 2,129.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX NANO CORKSCREW FT TI W 3-0FW,," 2,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER DISTAL LATERAL FIBULA PLATE 3 HO,," 2,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ONE THIRD TUBULAR PLATE 6 HOLE,," 2,025.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES TUBULOR PLATE 7 HOLE,," 2,005.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CTL MEDICAL 6.5X30 POLYAXIAL SCREW,," 2,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE PRE-BENT ROD 5.5 X 65,," 2,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION PRE BENT ROD 5.5 X 40,," 2,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION STRAIGHT ROD 5.5X80MM,," 2,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX CANULATED SCREW 32MM,," 2,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,S&N HEALICOIL 4.7MM,," 2,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARHTHEX MENISCAL CINCH II,," 1,975.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT HEADED SCREW 4.0MM X 30MM,," 1,945.65 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JJ 2.8 PERC DB LCP PLA,," 1,900.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.0MM CANNULATED SCREW 32MM,," 1,885.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ALLIANCE SPINE PROMOTE OSTEO PRO DBM 5CC,," 1,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX ANCHOR PEEK 4.75X19.1MM,," 1,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TRILLIANT 3.5 X 12MM ARSENAL LOCKING SCR,," 1,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TRILLIANT 3.5 X 14MM ARSENAL LOCKING SCR,," 1,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TRILLIANT 3.5 X 16MM ARSENAL LOCKING SCR,," 1,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRGHT 3.5 X 18 LOCKING SCREW,," 1,866.05 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT MEDICAL 3.5 X 14MM LOCKING SCREW,," 1,866.05 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT MEDICAL 3.5 X 16MM LOCKING SCREW,," 1,866.05 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX TIGHTROPE RT,," 1,850.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 2.5 X 10MM FORCE FIBER ANCHOR KI,," 1,849.60 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX WEDGED PROFILE PLATE,," 1,790.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 5.0 VA LOCKING SCREW SLF TPNG SD 36,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0 VA LOCKING SCRE 34,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0 VA LOCKING SCRE 70,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0 VA LOCKING SCRE SELF TAPP,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0 VA LOCKING SCREW 40,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0 VA LOCKING SCREW SELF TAP,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 5.0 VA LOCKING SCREWS 65,," 1,755.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,INOVASIS PREBENT ROD 5.5X115CM,," 1,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE ROD 5.5X90MM,," 1,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 2.5MM HEADLESS SCREW 18MM LENGTH,," 1,702.30 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,OSTEOSELECT BONE PUTTY 2.5CC,," 1,700.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,B.S. CLICK X ANCHOR,," 1,687.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX BIOCOMPOSITE INTER-FERENCE SCRW2,," 1,680.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1/3 TUBULAR 6 HOLE PLATE,," 1,670.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES ONE THIRD TUBULAR LCP PLATES WIT,," 1,670.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDTRONIC SCREWS 4.0 X 13,," 1,642.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY 1.8MM QUICK COUPLING 110MM,," 1,630.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,METRO 2.5 COUNTERSINK,," 1,624.35 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER CANNULATED COUNTERSINK 4.0MM,," 1,604.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE SCREW ST SPINE ZAVATION NS,," 1,600.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J L SCREW 12,," 1,550.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J L SCREW 14,," 1,550.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J L SCREW 16,," 1,550.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J VA L SCREW 10,," 1,550.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER COMPRESSION SCREW 4X40MM,," 1,540.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRES SCREW 4X34MM,," 1,540.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER HEADLESS COMPRESSION SCREW 4MM /,," 1,540.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY VARIABLE ANDLE LOCKING SCREW 36MM,," 1,525.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW,," 1,525.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T8 3.5 X 18MM,," 1,525.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5MM VARIABLE ANGLE LOCKING SCREW 75MM,," 1,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY 3.5MM VARIABLE ANDLE LOCKING SCREW,," 1,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 3.5MM VARIABLE ANGLE LCKNG,," 1,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES VA LOCKING SCREW 60MM,," 1,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES VA LOCKING SCREW 65MM,," 1,520.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"3,5MM CONICAL SCREW 70MM",," 1,510.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J VA-LCKNG SCREW SLF-TPNG T4 SD REC 9,," 1,510.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION 14MM SDF SCREWS,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION 14MM SPV SCREWS,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GENSPINE 4.0 16MM SELF DRILLING VARIABLE,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENT 70MM ROD,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 40MMROD,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 50MM ROD,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 60MM RODS,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 65MM ROD,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TRILLIANT 4.0 X 26MM TIGER SCREW,," 1,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JJ 3.5 LOCKING SCREW SLFTPNG,," 1,485.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,JJ 3.5 LOCKING SCREW SLFTPNG RECESS,," 1,485.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX 10X30MM BC IF SCREW VENTED,," 1,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"ARTHREX 8X20MM BC IF SCREW, VNETED",," 1,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX 9X20MM SCREW VENTED,," 1,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4MM VARIABLE ANGLE LOCKING SCR,," 1,470.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4X12MM LOCKING SCREW,," 1,470.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES VA LOCKING SCREW 16MMC,," 1,470.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"SYNTHES VA LOCKING SCREW 18,MM",," 1,470.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 1.5VA LKNG SCREW SLFTPNG T4 SD REC10,," 1,445.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA XTEND LOCKING METAGLENE SCREW,," 1,436.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1/3 TUBULAR LCP PLATE 8 HOLE (C1,," 1,435.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX CANN SCREW 3.75 X 34MM PARTIALLY,," 1,430.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX SUTURE ANCHOR 3.5X10MM,," 1,425.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT 4.0 COUNTERSINK,," 1,383.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM VA LCKNG SCREW,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM VA LCKNG SCREW SLF-T,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM VA LOCKING SCREW,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.7MM VA LOCKING SCREW SLF,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DUPUY 2.7MM LOCKING SCREW 26MM,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.7 LOCKING SCREW 22MM,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.7 VA LOCKING SCREW,," 1,370.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 2.5MM X20MM FIXOS CANNULATED SCR,," 1,353.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER FIX 2.5 LAG SCREW 18MM,," 1,353.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER S FIX SCREW 2.5LG 16MM,," 1,353.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER S-FIX SCREW 2.G LG 22MM,," 1,353.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER SNAP SCREW 2.0X12MM,," 1,353.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 5.5MM TITANIUM INTRALINE ANCHOR,," 1,350.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5 LCKNG SCREW SLF TPNG W/SD REC 55,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CLOCKING SCREW SLF-TAPPING 3,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 LOCKING SCREW 36MM,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM LOCKING SCREW 38MM,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM LOCKING SCREW SLF-TPNG W/S,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM LOCKING SLF-TPNG W/STARDRI,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES SYNTHES 3.9MM LOCKING SCREW 24MM,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYTHES 3.5 LOCKING SCREW SLF-TPNG W/STAR,," 1,315.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW 3.0 X 14 MM,," 1,304.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T8 30.X18MM,," 1,304.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 10MM X 3.5 LOCKING SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 16 SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 18 SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 2.7X20MM LCKNG SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.5X20MM LCKNG SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.5X22MM LCKNG SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.5X40MM LCKNG SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.0X14 LKNG HEXALOBE SCREW,," 1,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5MM VARIABLE ANGLE LOCKING SCREW 38MM,," 1,280.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 1.5 VA LCKNG SCREW SLF TPN,," 1,280.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.7MM/3.5MM FIBULA PLATE,," 1,261.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,EVOLUTION MEDICAL 3X5X12MM SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,IN2BONES ONE THRID TUBULAR PLATE 6HOLE,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 12MM SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 14 MM SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 14MM SCREWS,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENTS 16MM SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART 5.0 X 25MM SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINEART 5.0X30MM SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 16MM RESCUE SCREW,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 16MM SCREW VSD,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 4.0 X 14MM ST SCREWS,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX LASERJET WEDGED PLATE,," 1,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT 6.0 COUNTERSINK,," 1,226.90 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT LOCKING SCREW T8 3.5 X 22MM,," 1,220.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 12MM LOCKING SCREW,," 1,210.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 14MM LOCKING SCREW,," 1,210.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 18MM X 2.7MM LOCKING SCREW,," 1,210.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 8MM LOCKING SCREW,," 1,210.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DUPUY 2.7MM LOCKING SCREW 28MM,," 1,205.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER MICRO CANNULATED SCREW 2.0 X 14M,," 1,203.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARFERENCETHREX BIO-COMP INTERFERENCE SCR,," 1,175.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX BIO-COMP INTERSCREW W/DISP,," 1,175.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX BIOCOMPOSITE INTER-FERENCE SCREW,," 1,175.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX INTERFERENCE SCREW,," 1,175.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 12MM X 2.3MM SCREW,," 1,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 2.3X10MM LCKNG SCREW,," 1,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 2.3X8MM LCKNG SCREW,," 1,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ANIS MICRO 3.0 SCREW 16MM,," 1,136.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER MICRO CANNULATED SCREW 3.0 17MM,," 1,136.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.7MM VA LOCKING SCREW SLF-TPNG,," 1,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TRILLIANT 3.5 X 18MM ARSENAL SCREW,," 1,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LCKNG SCR. T10 FULL THR. 3.5MM L,," 1,095.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCR. T10 FULL THR. 3.5MM,," 1,095.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 14MM X 2.3 LOCKING SCREW,," 1,080.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 16MM23MM SCREW,," 1,080.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 2.3 X20 LOCKING SCREW,," 1,080.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 2.3X16MM LOCKING SCREW,," 1,080.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTH1.5 LOCKING SCREW 9MM,," 1,075.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5 LOCKING SCREW 8MM,," 1,075.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHESLOCKING SCREW 10MM,," 1,075.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 10X9MM LAG SCREW,," 1,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 11.5X6 LOCKING SCREW,," 1,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 11.5X8 LOCKING SCREW,," 1,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 11.5X11 LOCKING SCREW,," 1,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 11.5X12 LOCKING SCREW,," 1,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 1.5X10 LAG SCREW,," 1,055.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"ARTHREX SUTURE ANCHOR, CORKSCREW",," 1,050.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 3.5X16MM,," 1,004.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 3.5X20MM,," 1,004.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ZAVATION 4.0 X 14MM SD SCREWS,," 1,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX CANULATED SCREW 34MM,," 1,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PARAMETRICS 40M ROD,," 1,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PARAMETRICS 45M ROD,," 1,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORTEX 1.3 MM SCREW 10MM,, 995.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORTEX 1.3MM SCREW 11MM,, 995.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORTEX 1.3MM SCREW 9MM,, 995.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 5X150 APEX S/D HALF PIN 50THR,, 978.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,METRO HEADED SCREW 20MM,, 978.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 3.5 X 14MM,, 975.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDARTIS 1.5MM X 10MM CORTEX BONE SCREW,, 972.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.7MM T-PLATE,, 956.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY PINNACLE CANCELLOUS BONE SCREW 6.5,, 945.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI NON LOCK SCREW 2.4 X 14MM,, 944.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TI NON LOCK SCREW 2.4 X 16MM,, 944.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 3.0 MM ASNIS MICRO CANNULATED SC,, 926.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 3.0MM ASNIS MICRO CANULATED SCRE,, 926.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 2.0 MM ASNIS MICRO CANNULATED SC,, 918.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 2.0MM CANNULATED SCREW 16/7MM,, 918.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER SCREW 2.0MM ASNIS MICRO CANNULAT,, 918.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 3.0 MM CANNULATED SCREW 17/4MM,, 911.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER NON-LOCKING SCREW 3.0X16MM,, 900.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL MEDICAL 40MM STRAIGHT ROD,, 875.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES LCP PLATE 12 HOLES,, 875.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT 2.7 X 16MM NON-LOCKING SCREW,, 868.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT 2.7 X 20MM NON LOCKING SCREW,, 868.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,WRIGHT 2.7 X 22MM NON-LOCKING SCREW,, 868.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DELTA XTEND NON-LCKNG METAGLENE SCREW,, 854.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY 4.5X18 NON LOCKING SCREW,, 854.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PARAMETRICS 50 MM SCREW,, 850.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 VA LOCKING SCREW 70MM,, 825.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LCKING SCREW T10 FULL THREAD 3.5,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD 3.5MM/,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD3.5MM/L,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 3.5MM/32MM,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 FULL 3.5X20MM,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 FULL 3.5X26MM,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW T10 FULL THREAD 3.,, 820.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDARTIS GOLD CORTEX BONE SCREW 08MM,, 810.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDARTIS GOLD CORTEX BONE SCREW 09MM,, 810.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MEDARTIS 1.5X4MM CORTEX BONE SCREW,, 810.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 6.5MMX80MM CANNULATED SCREW,, 799.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKEING SCREW FULL THREAD 3.5MM,, 798.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 10X1.5 LAG SCREW,, 790.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 11.5X8 LAG SCREW,, 790.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.3X6MKM SCRW,, 770.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,.7M C BONE SCREW,, 770.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK PRE-BENT ROD 40MM,, 750.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CTL AMEDICA PICASSO II CURVED ROD 06.0XL,, 750.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.3MM X12MM SCREW,, 750.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.6X6MM SCREW,, 750.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA CURVED ROD .6X40MM,, 750.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ASNIS 2.0MM MICROCANNULATED SCREW 11/5MM,, 742.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ASNIS MICRO CANNULATED SCREW 2.0X18MM,, 742.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 40-20112 2.0MM ASNIS MICRO CANNU,, 742.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER MICRO CANNULATED SCREW 2.0 X 16M,, 742.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,23X24 LOCKING SCREW,, 740.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW 3.0X24MM,, 738.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3MMX10MM,, 737.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3MMX22MM,, 737.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 3.5 X22 SCREW,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3MMX12MM,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3X26MM,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3X28MM,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3X30MM,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHORAGE LCKG SCREW 3.5MM X12MM,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHORAGE STANDARDS SCREW 3X18,, 737.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR LOCKING SCREW 3MM X 20MM,, 735.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 6.5MMX70MM CANNULATED SCREW,, 727.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.7 X 6 LOCKING SCREW,, 696.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.7 X5 LOCKING SCREW,, 696.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER SELF DRILLING HALF PIN,, 694.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.7MM BISHELL PLATE,, 659.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED HEXALO0BE SCREW 3.5 X 10 MM,, 655.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED HEXALOB SCREW,, 655.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.5X20MM NL SCREW,, 655.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.0X16 HEXALOBE SCREW,, 655.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.0X14 HEXA SCREW,, 655.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 LOCKING SCREWS 54MM,, 629.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM LOCKING SCREWS 58MM,, 629.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES LOCKING SCREWS 10MM,, 629.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PROVIDENCE CERVICAL VISUALIZATION HARNES,, 625.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,10MM BONE SCREW,, 616.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 14MM NON LOCKING SCREW,, 610.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 16MM X 3.5MM NON LOCKING SCREW,, 610.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED 3.5 12 CORTICAL,, 610.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.3 X6MM SCREW,, 610.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,"2.4MM CORTEX SCREW, SELF TAPPING 14MM",, 605.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4 CORTEX SCREW 12MM,, 605.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4MM CORTEX SCREW SELF TAPPING,, 605.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4MM CORTEX SCREW SELF-TAPPING,, 605.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.4MM CORTEX SELF TAPPING SCREW,, 605.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,LIFE SPINE LOCKING CAP,, 600.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5 CORTEX SCREW 8MM,, 595.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5 CORTEX SCREW 9MM,, 595.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5MM CORTEX SCREW SLF-TPNG WITH,, 595.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW T10 FULL THREAD 3.5MM,, 585.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.0 CORTEX SCREW 10MM,, 585.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.0 CORTEX SCREW 9,, 585.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES SCREW 2.4 LOCKING 16MM,, 576.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES SCREW 811.96,, 570.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES TENSION WIRE LARGE,, 560.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK 3.5X14MM FIXED SCREW,, 550.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CORELINK 4.0X 14MM FIXED SCREW,, 550.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.7 X5 CORTEX SCREW,, 546.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.7 X8 NON-LOCKING SCREW,, 546.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKE LOCKING SCREW T6 2.0MM L12MM,, 540.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD 2.4/12,, 540.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD 2.4/14,, 540.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD 2.4/20,, 540.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD 2.7MM,, 540.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER LOCKING SCREW FULL THREAD 2.4/16,, 540.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 5 HOLE T PLATE,, 533.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,GEMINUS SCREW CORTICAL LOCKING 3.5MM X12,, 520.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHROSURFACE DISPOSABLE PIN,, 510.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 2.0MM CORTEX SCREW SLF TAPPING,, 510.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 2.0MM TI CORTEX SCREW 6MM,, 510.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 2.0MM TI CORTEX SCREW 10MM,, 510.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 3.5MMX22MM SCREW,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 3.5MMX24MM SCREW,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR STANDARD SCREW 3MM X 16MM,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR STANDARD SCREW 3MM X12MM,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR STANDARD SCREW 3MMX14MM,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR STANDARD SCREW 3X24MM,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHOR STANDARD SCREW 3X26MM,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHORAGE SCREW 3MM X30MM,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHORAGE STANDARD SCREW 3.5MMX2,, 506.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER EX CLIP 3MM POSITIONING PIN,, 502.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,IN2BONES AFX ;PW [RP CPRTOCA; SCREW 3.5X,, 500.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET SCREW VA 3.5X16,, 500.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINAL ELEMENT SET SCREWS,, 500.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SPINE ELEMENTS KWIRES,, 500.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA MONET SCREW FA SELF DRILLING,, 500.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2.7 X 16MM CORTEX SCREW,, 475.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER ANCHORAGE FIXATION PIN,, 460.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 2.0MM CORTEX SCREW SELF TA,, 450.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES DHS/DCS COMPRESSION SCREW 36MM,, 450.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ARTHREX CANCELLOUS SCREW LOW PROFILE,, 445.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II 6.0X85MM CURVED ROD,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II CURVED 50MM ROD,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II CURVED ROD 60MM,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO PRE BENT 75MM ROD,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO PRE BENT 80MM ROD,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL AMEDICA CURVED ROD .6MMX 45MM,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,TL MEDICAL 70MM CURVED ROD,, 437.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER KWIRE WITH STOP 1.5MM L150MM,, 434.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW T10 FULL THREAD 3.5MM,, 431.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKRE BONE SCREW 3.5/L32,, 431.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW FULL THREAD 2.4/14MM,, 420.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW FULL THREAD 2.4/18MM,, 420.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW T6 2.0MM L12MM,, 420.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW T8 FULL THREAD 2.7MM,, 420.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STYKER BONE SCREW FULL THREAD 2.4X24MM,, 420.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,S&N TAPERED 3.8,, 405.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET FA SELF DRILLING 3.52X14MM,, 375.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET FA SELF DRILLING 4.0X14MM,, 375.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET FIXED ANGLE 3.5X 14 MM SLF TGNG SC,, 375.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,MONET FIXED ANGLE SLF TAPPING SCREW 3.5X,, 375.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES MINI 1.5MM X 12MM CORTICAL SCREW,, 372.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.0 CANCELLOUS SCREW 14M,, 370.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.0 CANCELLOUS SCREW 18M,, 370.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.0 CANCELLOUS SCREW 20MM,, 370.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.00MM CNACLLOUS BONE SCREW FULL,, 370.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.0MM CANCELLOUS BONE 16MM,, 370.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES CANCELLOUS SCREW 60MM,, 370.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 4.5MM CORTEX SCREW 26MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 4.5MM CORTEX SCREW 30MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,DEPUY SYNTHES 4.5MM CORTEX SCREW 32MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 4.5MM CORTEX SCREW SELF TAPPING 50MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 4.5MM CORTEX SCREW SELF TAPPING 54MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,J&J 4.5MM CORTEX SCREW SELF TAPPING 70MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 28MM CORTEX SCREW,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.5X38MM CORTEX SCREW,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES JJ 4.5MM CORTEX SCREW,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES SCREW 4.5 CORTEX 5MM 36MM,, 365.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 14,, 360.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 6.5MM X 110MM SCREW,, 360.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 6.5MM X 50MM SCREW,, 360.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5 CORTEX SCREW 14MM,, 332.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5 X 10MM SCREWS,, 330.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.5 X 9MM SCREWS,, 330.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 2X9MM CORTEX SCREW,, 330.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 8X2MM SCREW,, 330.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 20MM CORTICAL SCREW 10MM,, 325.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5 CORTEX SCREW SLF TAPPING 30 MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5MM CORTEX SCREW 45MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5MM CORTEX SCREW 55MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,3.5MM CORTEX SCREW 60MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 12MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 16,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 18,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 20MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 28,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 36MM,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 X 24MM CORTEX SCREW,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM CORTEX SCREW SELF-TAPPING,, 320.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER BONE SCREW 3.5X 30MM,, 288.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 1.25MM THREADED GUIDE 150MM,, 280.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.2 X 4MM SCREW,, 259.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,STRYKER 1.2 X 5MM SCREW,, 259.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PARAMETRICS SET SCRE,, 250.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES LOCKING SCREWS 12MM,, 234.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,K-WIRE 1.1MM X102MM,, 230.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,K-WIRE 14MM X 102MM,, 230.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5 CORTEX SCREW 26MM,, 225.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.5MM CORTEX SCREW 34MM,, 225.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,S&N suture 38,, 200.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 3.9MM X 45MM COTEX SCREW,, 195.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,CTL MEDICAL SET SCREW,, 187.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,PICASSO II SET SCREW,, 187.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES CORTX SCREWS 13MM,, 134.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES SELF TAPPING SCREW 14MM,, 134.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,ACUMED GUIDEWIRE .062 L8699,, 120.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,SYNTHES 4.0MM CANCELLOUS BONE SCREW FULL,, 93.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1713,METRO 2.5 KWIRE,, 85.26 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1751,CATH INF INSERT PERIPH CENTRAL MIDLINE,, 112.12 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,STRYKER 4X8CM ALLOWRAP DS WET,," 24,320.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,LIFENET HEALTH DECELLULARIZED DERMIS 40X,," 17,485.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,MIMEDX AMNIOTIC MEMBRANE ALLOGRAFT 4X4CM,," 15,255.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,SPEEDGRAFT PRE-SUTURED DOUBLE STRAND,," 11,625.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,ALLOSOURCE ACHILLES TENDON GRAFT,," 11,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,BONE BANK ALLOGRAFT,," 7,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,STRYKER ALLOGRAFCT EVANS WEDGE 8X22X20MM,," 6,160.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,LIFENET HEALTH THERASKIN (ALLOGRAFT FOTE,," 5,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,HUMAN ALLOGRAFT TISSUE PER CC,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,SPINAL GRAFT SR CORTICAL 6X11X11MM,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,SPINAL GRAFT TECHNOLOGIES GRAFT,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,H100 DBM CRUSH MIX,," 3,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,H100 DBM CRUSH MIX ALLOGRAFT,," 1,050.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,MIMEDX EPIFIX 2.0 X3.0 CM PER CM,, 953.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1762,MIMED EPIFIX 4.0 X4.0 CM (CHARGED PER SQ,, 950.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1763,MIMEDX EPIFIX 6X10CM,," 21,975.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1763,MMEDIX EPXL AMNIOTIC MEMBRANE GRAFT,," 17,475.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1763,SPINAL GRAFT TECHNOLOGIES ALLOGRAFT 8X11,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1763,SPINAL GRAFT TECHNOLOGIES ALLOGRAFT 9X11,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1763,MIMEDX AMNIOFIX 4.0X10 CM,," 2,730.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1771,ADVANTAGE FIT URETHRAL SLING SYSTEM,," 9,014.70 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1771,ARIS TRANSOBTURATOR KIT,," 5,225.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,TOTAL SHOULDER 2,," 45,769.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,TOTAL HIP IMPLANT,," 28,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,KNEE TOTAL IMPLANT,," 25,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,PARTIAL HIP,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,PARTIAL HIP IMPLANT,," 17,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,ATTUNE TIBIAL INSERT ROTATING PLATFORM 1,," 12,740.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,ATTUNE TIBIAL INSERT ROTATING PLATFORM C,," 12,740.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,DEPUY ATTUNE TIBIAL INSERT SIZE 6 7MM RP,," 12,740.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,TIBIAL INSERT ROTATING PLATFORMS POSTERI,," 12,740.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,DEPUY SYNTHES FEMORAL 53M - 75MM M/L LAR,," 11,752.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1776,ZIMMER PROLONG HIGHLY CROSSLINKED POLYET,," 5,937.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1778,TRIAL LEAD KIT 70B,," 10,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1778,NEVRO BLUE PERC LEAD KIT,," 10,735.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1778,MEDTRONIC ELECTRONIC FOR SPINAL STIMULAT,," 7,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,BARD PHASIX ST 20X25M MESH,," 18,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,PHASIX ST MESH 11CM,," 10,911.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,B.S OBTRYX II HALO SYSTEM,," 8,162.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,BARD VENTRALIGHT MESH 6 X 8,," 8,058.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,PROCEED VENTRAL PATCH,," 6,713.05 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,CARDINAL HEALTH VENTRAL SMALL PATCH MESH,," 5,873.55 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,ETHICON MESH 30X30,," 5,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,VENTRALIGHT ST MESH WITH BALLOON POSITIO,," 5,700.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,OVITEX 1S 6X10CM,," 4,860.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,ETHICON MESH 3X6,," 4,237.15 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,BARD VENTRALIGHT BALLOON MES 7X9,," 3,901.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,BARD MESH SMALL PLUG,," 3,802.20 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,GORE BIO-A TISSUE REINFORCEMENT MESH,," 3,105.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,BARD MESH PLUG LARGE,," 3,091.95 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,DAVOL VENTRALIGHT ST ECHO 4X6' - MESH,," 2,822.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,ATRIUM MESH C-CUR FX,," 1,740.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,ETHICON MESH 12X12,," 1,463.55 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,CARDINAL PLUG PERFIX MED 1.3X1.55IN HERN,," 1,452.20 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,ETHICON MESH 6X6,, 644.70 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1781,PARIETENE MACROPOROUS MESH 11CM X 6 CM,, 501.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1787,MEDTRONIC CONTROLLER PAIN INTELLIS PAPER,," 11,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1787,NEVRO PATIENT REMOTE KIT,," 2,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1788,BARD POWER PORT 8F,," 2,635.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1820,MEDTRONIC INTELLIS ADAPTIVE STIM,," 1,02,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1820,B.S SPECTRA WAVEWRTIER GENERATOR,," 95,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1820,MEDTRONIC RECHARGER,," 8,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1822,NEVRO IPG2500,," 1,17,875.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1822,NEVRO IPG KIT 2000,," 1,11,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1822,NEVRO IPG KIT..,," 98,750.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1822,NEVRO BLUE LEAD KIT,," 10,850.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1822,NEVRO TRIAL LEAD KIT,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1889,MILD KIT -,," 14,975.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1897,BOSTON SCIENTIFIC INFINION 50CM 17 CONTA,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C1897,NEVRO TRIAL LEAD KIT..,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,ASCERTA 4.8X26 STENT,, 395.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,ASCERTA 7 X 26 URETERAL STENT,, 395.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,ASCERTA URETERAL STENT 6 X 26,, 395.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,BARD URETERAL STENT 7FRX 26CM,, 395.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,ASCERTA 6 X 28 URETERAL STENT,, 383.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,ASCERTA 6X22 URETERAL STENT,, 383.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,ASCERTA URETREAL STENT 6X24,, 383.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2617,B.S. STENT 6 X 24CM,, 383.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2625,INTERSECT PROPEL SINUS IMPLANT,," 4,356.80 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2625,INTERSECT PROPAL CONTOUR,," 4,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C2625,INSERSECT PROPEL MINI SINUS STENT,," 3,650.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C8905,MRI W/O FOL W/CONT BRST UNILAT,," 9,327.96 ",,, 736.86 ,, 385.88 ,, 625.23 , 565.90 , 515.70 , 385.88 , 625.23 ,,,,,,,,,,,,,,, C8908,MRI W/O FOL W/CONT BREAST BILAT,," 5,224.34 ",,, 736.86 ,, 385.88 ,, 625.23 , 565.90 , 515.70 , 385.88 , 625.23 ,,,,,,,,,,,,,,, C8957,"INTRAVENOUS INFUSION FOR THERAPY/DIAGNOSIS; INITIATION OF PROLONGED INFUSION (MORE THAN 8 HOURS), REQUIRING USE OF PORTABLE OR IMPLANTABLE PUMP",C8957, 866.80 ,,, 665.24 ,, 288.38 ,, 550.50 , 490.99 , 360.06 , 288.38 , 550.50 ,,,,,,,,,,,,,,, C9046,COCAINE HCL NASAL SOLUTION,C9046, 742.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9113,"INJECTION, PANTOPRAZOLE SODIUM, PER VIAL",C9113, 158.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9285,LIDOCAINE PATCH,C9285, 6.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9290,BUVICAINE LIPOSOME (EXPAREL) (PER MG),C9290, 82.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,TACTOSET BONE GRAFT,," 12,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,STRYKER VITOSS FOAM PACK 2.5CC,," 8,295.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,10CC DBM,," 7,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,LIFE SPINE OSTEO LINK DBM 10CC,," 7,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,STRYKER DBM PLUS PUTTY,," 5,850.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,5 CC PUTTY,," 5,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,PARAMETRICS 10 DBM,," 4,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,VENTRIS OSTECYTE ALLOGRAFT BONE MATRIX,," 4,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,VENTRIS OSTECYTE PRODUCT,," 3,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,XTANT OSTEOSELECT DBM PUTTY 5.0CC,," 3,081.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,MEDTRONIC BONE PUTTY,," 3,060.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,EVOLUTION BONE PUTTY,," 2,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,30 BONE CHIP,," 2,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,MEDTRONIC HYPHON XPEDE BONE CEMENT AND K,," 1,845.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,ORTHO BLAS II PUTTY 5CC,," 1,700.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,SMARTSET GHV CENTAMICIN ONE CEMENT 40G,," 1,622.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,MORPHEUS VALUM 12CC,," 1,260.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,EVOLUTION HGENN PUTTY 1CC,," 1,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9359,DEPUY BONE CEMENT 20 G,, 681.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9362,STRYKE BONE MATRIX 5CC,," 13,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9362,STRYKER 2.5CC BIO VIABLE BONE MATRIX,," 9,562.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, C9728,PLACE DEVICE/MARKER NON PRO 1ST,,," 14,341.60 ",171.67," 2,681.34 ",," 1,191.92 ",," 1,007.60 ", 908.70 , 698.52 , 698.52 ," 1,191.92 ",,,,,,,,,,,,,,, C9749,REPAIR NASAL STENOSIS W/ IMPLANT 1ST,,," 17,605.00 ",219.62,," 2,200.00 "," 4,424.23 ",," 4,068.26 "," 3,628.45 "," 2,660.86 "," 2,200.00 "," 4,424.23 ",,,,,,,,,,,,,,, C9803,"HOSPITAL OUTPATIENT CLINIC VISIT SPECIMEN COLLECTION FOR SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2, ANY SOURCE ",C9803, 648.64 ,,, 49.92 ,,,,,,, - , - ,,,,,,,,,,,,,,, E0114,CRUTCH UNDERARM PAIR NO WOOD,, 76.53 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, E0116,CRUTCH UNDERARM EACH NO WOOD,, 76.53 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, E0117,UNDERARM SPRINGASSIST CRUTCH,, 158.26 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, E0135,WALKER FOLDING ADJUST/FIXED,, 121.44 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, E0275,BED PAN STANDARD,, 15.31 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, E0352,DISPOSABLE PACK W/BOWEL SYST VAG SPEC,, 231.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, E0445,OXIMETER NON-INVASIVE,, 12.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G0008,ADMINISTRATION INFLUENZA VIRUS VACCINE,, 160.43 ,,, 84.74 ,, 37.88 ,, 23.69 , 23.69 , 23.69 , 23.69 , 37.88 ,,,,,,,,,,,,,,, G0009,ADMINSITRATION PNEUMOCOCCAL VACCINE,, 160.43 ,,, 84.74 ,, 37.88 ,, 47.73 , 47.73 , 47.73 , 37.88 , 47.73 ,,,,,,,,,,,,,,, G0010,ADMINSITRATION HEPATITIS B VACCINE,, 160.43 ,,, 84.74 ,, 37.88 ,, 51.68 , 51.68 , 51.68 , 37.88 , 51.68 ,,,,,,,,,,,,,,, G0105,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK99824,G0105," 3,174.25 ",,," 1,662.08 "," 1,500.00 ", 744.89 ," 2,400.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 2,400.00 ",,,,,,,,,,,,,,, G0121,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK99831,G0121," 3,174.25 ",,," 1,662.08 "," 1,500.00 ", 744.89 ," 2,400.00 "," 1,313.46 "," 1,171.47 ", 859.08 , 744.89 ," 2,400.00 ",,,,,,,,,,,,,,, G0168,DERMABOND - WOUND CLOSURE BY ADHESIVE,, 43.73 ,,,,,,, 53.78 , 47.97 , 35.17 , 35.17 , 53.78 ,,,,,,,,,,,,,,, G0168,WOUND CLOSURE BY ADHESIVE,, 1.15 ,,,,,,, 53.78 , 47.97 , 35.17 , 35.17 , 53.78 ,,,,,,,,,,,,,,, G0283,"Electrical stimulation (unattended), to",, 149.76 ,,,,,,, 15.07 , 15.07 , 15.07 , 15.07 , 15.07 ,,,,,,,,,,,,,,, G0297,CT LOW DOSE CHEST WO,G0297," 5,500.77 ",,,,, 62.30 ,, 259.11 , 234.52 , 213.72 , 62.30 , 259.11 ,,,,,,,,,,,,,,, G0378,"HOSPITAL OBSERVATION SERVICE, PER HOUR",G0378," 1,000.00 ",,,,,," 2,755.00 ", 126.69 , 126.69 , 126.69 , 126.69 ," 2,755.00 ",,,,,,,,,,,,,,, G0379,DIRECT ADMISSION PT FOR HOSP OBS CARE,, 196.63 ,,," 1,096.22 ",, 525.30 ," 2,755.00 ", 126.69 , 126.69 , 126.69 , 126.69 ," 2,755.00 ",,,,,,,,,,,,,,, G2023,SPECIMEN COLLECTION (COVID),, 33.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G2024,SPECIMEN COLLECTION COVID,, 35.46 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G8598,ASPIRIN TABLET 325 MG,, 9.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G8978,MOBILITY: WALKING & MOVING AROUND FUNCTIONAL LIMITATION CURRENT STATUS AT THERAPY EPISODE OUTSET AND AT REPORTING INTERVALS,G8978, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G8979,MOBILITY: WALKING & MOVING AROUND FUNCTIONAL LIMITATION PROJECTED GOAL STATUS AT THERAPY EPISODE OUTSET AT REPORTING INTERVALS AND AT DISCHARGE OR TO END REPORTING,G8979, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G8981,CHANGING & MAINTAINING BODY POSITION FUNCTIONAL LIMITATION CURRENT STATUS AT THERAPY EPISODE OUTSET AND AT REPORTING INTERVALS,G8981, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G8982,CHANGING & MAINTAINING BODY POSITION FUNCTIONAL LIMITATION PROJECTED GOAL STATUS AT THERAPY EPISODE OUTSET AT REPORTING INTERVALS AND AT DISCHARGE OR TO END REPORTING,G8982, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, G9315,DOC FIRST LINE AMOX,, 20.12 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0131,"ACETAMINOPHEN, 10 MG, INJECTION",J0131, 2.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0153,INJECTION ADENOSINE 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS),J0153, 77.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0171,"ADRENALIN, EPINEPHRINE, 0.1 MG, INJECTION",J0171, 24.05 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0282,"AMIODARONE HYDROCHLORIDE, 30 MG INJECTION",J0282, 17.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0290,"AMPICILLIN SODIUM, 500 MG, INJECTIOM",J0290, 57.05 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0295,"INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM",J0295, 336.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0330,"SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG, INJECTION",J0330, 226.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0360,"HYDRALAZINE HCL, UP TO 20 MG INJECTION",J0360, 226.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0456,"AZITHROMYCIN, 500 MG, INJECTION",J0456, 106.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0461,"ATROPINE SULFATE, 0.01 MG, INJECTION",J0461, 68.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0500,"INJECTION, DICYCLOMINE HCL, UP TO 20 MG",J0500, 300.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0520,BETHANECHOL 10MG TAB,, 1.72 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0561,"INJECTION, PENICILLIN G BENZATHINE, 100,000 UNITS",J0561, 72.80 ,,, 37.18 ,, 13.85 ,,,,, 13.85 , 13.85 ,,,,,,,,,,,,,,, J0571,BUPRENORPHRINE ORAL 1MG,J0571, 124.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0585,"BOTULINUM TOXIN TYPE A, PER UNIT",J0585, 28.95 ,,, 12.64 ,, 6.14 ,,,,, 6.14 , 6.14 ,,,,,,,,,,,,,,, J0595,"INJECTION, BUTORPHANOL TARTRATE, 1 MG",J0595, 21.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0610,"CALCIUM GLUCONATE, PER 10 ML, INJECTION",J0610, 190.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0612,CALCIUM GLUCONATE INJECTION,, 190.11 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0641,INJECTION LEVOLEUCOVORIN CALCIUM 0.5 MG,J0641, 21.80 ,,, 0.71 ,, 0.12 ,,,,, 0.12 , 0.12 ,,,,,,,,,,,,,,, J0690,"CEFAZOLIN SODIUM, 500 MG, INJECTION",J0690, 27.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0692,"INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG",J0692, 60.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0694,"CEFOXITIN SODIUM, 1 GM, INJECTION",J0694, 506.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0696,"CEFTRIAXONE SODIUM, PER 250 MG INJECTION",J0696, 174.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0698,"CEFOTAXIME SODIUM, PER GM, INJECTION,",J0698, 164.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0706,CAFFIENE CITRATE INJ 5MG,, 16.64 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0713,"CEFTAZIDIME, PER 500 MG, INJECTION",J0713, 12.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0735,CLONIDINE 0.1MG PATCH,, 37.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0744,"CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG, INJECTION",J0744, 187.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J0780,"INJECTION, PROCHLORPERAZINE, UP TO 10 MG",J0780, 24.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1020,"METHYLPREDNISOLONE ACETATE, 20 MG, INJECTION",J1020, 37.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1030,"METHYLPREDNISOLONE ACETATE, 40 MG INJECTION",J1030, 34.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1040,"METHYLPREDNISOLONE ACETATE, 80 MG INJECTION",J1040, 66.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1094,"DEXAMETHASONE ACETATE, 1 MG, INJECTION",J1094, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1100,"DEXAMETHASONE SODIUM PHOSPHATE, 1 MG, INJECTION",J1100, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1120,"ACETAZOLAMIDE SODIUM, UP TO 500 MG, INJECTION",J1120, 331.70 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1160,"DIGOXIN, UP TO 0.5 MG, INJECTION",J1160, 40.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1165,"PHENYTOIN SODIUM, PER 50 MG, INJECTION",J1165, 53.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1170,"HYDROMORPHONE, UP TO 4 MG, INJECTION",J1170, 53.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1200,"DIPHENHYDRAMINE HCL, UP TO 50 MG",J1200, 85.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1205,"INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG",J1205, 409.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1240,"INJECTION, DIMENHYDRINATE, UP TO 50 MG",J1240, 64.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1250,"DOBUTAMINE HYDROCHLORIDE, PER 250 MG, INJECTION",J1250, 38.94 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1265,"DOPAMINE HCL, 40 MG INJECTION",J1265, 4.68 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1335,"INJECTION, ERTAPENEM SODIUM, 500 MG",J1335, 707.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1410,"INJECTION, ESTROGEN CONJUGATED, PER 25 MG",J1410," 1,383.50 ",,, 711.56 ,, 308.91 ,,,,, 308.91 , 308.91 ,,,,,,,,,,,,,,, J1450,"FLUCONAZOLE, 200 MG, INJECTION",J1450, 96.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1460,"INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC",J1460, 71.70 ,,, 96.64 ,, 39.97 ,,,,, 39.97 , 39.97 ,,,,,,,,,,,,,,, J1580,"INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG",J1580, 71.70 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1610,"GLUCAGON HYDROCHLORIDE, PER 1 MG, INJECTION",J1610," 1,251.40 ",,, 380.52 ,, 219.92 ,,,,, 219.92 , 219.92 ,,,,,,,,,,,,,,, J1630,"HALOPERIDOL, UP TO 5 MG, INJECTION",J1630, 116.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1631,"HALOPERIDOL DECANOATE, PER 50 MG, INJECTION",J1631, 245.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1642,"HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS, INJECTION",J1642, 17.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1644,"HEPARIN SODIUM, PER 1000 UNITS, INJECTION",J1644, 25.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1645,"INJECTION, DALTEPARIN SODIUM, PER 2500 IU",J1645, 359.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1650,"ENOXAPARIN SODIUM, 10 MG, INJECTION",J1650, 42.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1670,"INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS",J1670, 753.00 ,,," 1,091.24 ",, 418.61 ,,,,, 418.61 , 418.61 ,,,,,,,,,,,,,,, J1700,HYDROCORTISONE CREAM 1% 1OZ,, 13.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1710,"HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG, INJECTION",J1710, 27.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1720,"HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG INJECTION",J1720, 60.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1741,IBUPROFEN 100MG IV,J1741, 118.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1790,"INJECTION, DROPERIDOL, UP TO 5 MG",J1790, 26.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1800,"INJECTION, PROPRANOLOL HCL, UP TO 1 MG",J1800, 67.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1810,"INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE",J1810, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1815,INJECTION INSULIN PER 5 UNITS,J1815, 40.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1815,"INJECTION, INTERFERON BETA-1A, 33 MCG",J1825, 6.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1817,INSULIN FOR ADMINISTRATION THROUGH DME (I.E. INSULIN PUMP) PER 50 UNITS,J1817," 1,230.90 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1885,"KETOROLAC TROMETHAMINE, PER 15 MG, INJECTION",J1885, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1930,INJECTION LANREOTIDE 1 MG,J1930, 225.50 ,,, 114.84 ,, 58.77 ,,,,, 58.77 , 58.77 ,,,,,,,,,,,,,,, J1940,"FUROSEMIDE, UP TO 20 MG INJECTION",J1940, 77.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1950,"INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG",J1950," 9,349.00 ",,," 2,961.77 ",," 1,188.99 ",,,,," 1,188.99 "," 1,188.99 ",,,,,,,,,,,,,,, J1953,INJECTION LEVETIRACETAM 10 MG,J1953, 77.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J1956,"LEVOFLOXACIN, 250 MG, INJECTION",J1956, 156.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2001,"LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG, INJECTION",J2001, 40.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2060,"LORAZEPAM, 2 MG INJECTION",J2060, 130.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2150,"MANNITOL, 25% IN 50 ML, INJECTION",J2150, 33.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2175,"MEPERIDINE HYDROCHLORIDE, PER 100 MG INJECTION",J2175, 35.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2185,"INJECTION, MEROPENEM, 100 MG",J2185, 5.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2250,"PROMETHAZINE HCL, UP TO 50 MG INJECTION",J2550, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2250,"MIDAZOLAM HYDROCHLORIDE, PER 1 MG INJECTION",J2250, 15.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2270,"MORPHINE SULFATE, UP TO 10 MG, INJECTION",J2270, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2274,MORPHINE SULFATE 10MG/ML,, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2274,MORPHINE 4MG/ML,, 9.83 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2275,MORPHINE PF 1MG/ML AMP,, 71.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2300,"NALBUPHINE HYDROCHLORIDE, PER 10 MG INJECTION",J2300, 65.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2310,"NALOXONE HYDROCHLORIDE, PER 1 MG INJECTION",J2310, 76.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2315,"INJECTION, NALTREXONE, DEPOT FORM, 1 MG",J2315, 17.90 ,,, 7.45 ,, 3.25 ,,,,, 3.25 , 3.25 ,,,,,,,,,,,,,,, J2358,OLANZAPINE 1 MG LONG-ACTING INJECTION,, 10.59 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2360,"INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG",J2360, 161.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2370,"PHENYLEPHRINE HCL, UP TO 1 ML, INJECTION",J2370, 107.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2405,"ONDANSETRON HYDROCHLORIDE, PER 1 MG, INJECTION",J2405, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2407,INJ PROPOFOL 10 MG,, 49.32 ,,, 53.33 ,, 23.66 ,,,,, 23.66 , 23.66 ,,,,,,,,,,,,,,, J2440,PAPAVERINE 30MG/ML 2ML VIAL,, 82.08 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2540,"INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS",J2540, 98.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2543,"PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS), INJECTION",J2543, 76.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2550,PHENERGAN PROMETHAZINE HCL INJ 50MG/<,, 28.16 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2590,"OXYTOCIN, UP TO 10 UNITS INJECTION",J2590, 42.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2597,DESMOPRESSIN 4MCG/ML AMP,, 279.27 ,,, 14.15 ,, 12.46 ,,,,, 12.46 , 12.46 ,,,,,,,,,,,,,,, J2650,"PREDNISOLONE ACETATE, UP TO 1 ML, INJECTION",J2650, 7.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2690,"PROCAINAMIDE HCL, UP TO 1 GM, INJECTION",J2690, 235.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2704,"INJECTION, PROPOFOL, 10MG",J2704, 49.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2710,"NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG, INJECTION",J2710, 492.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2730,"INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM",J2730, 39.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2765,"METOCLOPRAMIDE HCL, UP TO 10 MG, INJECTION",J2765, 175.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2770,QUINUPRISTIN/DALFOPRISTIN,, 870.62 ,,, 987.94 ,, 417.76 ,,,,, 417.76 , 417.76 ,,,,,,,,,,,,,,, J2780,"INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG",J2780, 30.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2785,INJECTION REGADENOSON .1MG,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2790,"INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG",J2790," 1,033.55 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2795,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",J2795, 12.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2800,"INJECTION, METHOCARBAMOL, UP TO 10 ML",J2800, 602.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2805,"INJECTION, SINCALIDE, 5 MICROGRAMS",J2805," 1,038.85 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2920,"METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG, INJECTION",J2920, 63.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2930,"METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG, INJECTION",J2930, 50.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J2997,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",J2997, 202.80 ,,, 175.13 ,, 87.75 ,,,,, 87.75 , 87.75 ,,,,,,,,,,,,,,, J3010,"FENTANYL CITRATE, 0.1 MG, INJECTION",J3010, 14.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3030,"INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)",J3030, 218.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3230,"INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG",J3230, 181.70 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3260,"TOBRAMYCIN SULFATE, UP TO 80 MG, INJECTION",J3260, 47.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3301,"TRIAMCINOLONE ACETONIDE, PER 10 MG, INJECTION(KENALOG 40MG/ML PRESERVATIVE FREE COMPOUNDED",J3301, 22.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3302,TRIAMCINALONE PRESER FREE 40MG/ML 1ML,, 196.70 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3302,TRIAMCINOLONE PF 40MG/ML 2ML VIAL,, 95.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3320,"INJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 GM",J3320, 114.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3360,"DIAZEPAM, UP TO 5 MG, INJECTION",J3360, 40.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3370,"VANCOMYCIN HCL, 500 MG, INJECTION",J3370, 300.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3410,"INJECTION, HYDROXYZINE HCL, UP TO 25 MG",J3410, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3411,"INJECTION, THIAMINE HCL, 100 MG",J3411, 80.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3420,"VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG, INJECTION",J3420, 117.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3430,"INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG",J3430, 62.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3475,"MAGNESIUM SULFATE, PER 500 MG, INJECTION",J3475, 51.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3480,"POTASSIUM CHLORIDE, PER 2 MEQ, INJECTION",J3480, 20.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3486,"INJECTION, ZIPRASIDONE MESYLATE, 10 MG",J3486, 119.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3489,233.02,J3489," 1,165.10 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,SEVOFLURANE NDC66794001525,J3490SEVO, 599.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX BRIDION SUGAMMADEZ 100MG/ML 2ML,J3490BRID, 476.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX LYRICA 75MGNDC00071101441,J3490LYR, 470.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX SCOPOLAMINE PATCH NDC10019055303,J3490SCOPO, 122.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX FENTANYL PATCH 50MCG,J3490PATCH, 74.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,GLYCOPYRROLATE 0.4MG/2ML; NDC-0143-9681-01,J3490-GLY, 67.20 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,VISCOUS XYLOCAINE,J3490LIDO, 66.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,"BACITRACIN 50,000 UNITS PER VIAL NDC-009-0233-01",J3490BACI, 39.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX NIMBEX 2MG/ML,J3490NIM, 39.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,ACTIVATED CHACOAL 25G,J3490CHAR, 38.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,UNCLASSIFIED DRUGS,J3490, 25.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,CALCIUM CHLORIDE / 100MG / ML 10ML,J3490CALC, 24.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,ROCURONIUM NDC CODE #00409-9558-05,J3490ROC, 23.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,ETOMIDATE 20MG/ 10ML,J3490ETO, 21.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX OXYCODONE 5MG NDC00406051262,J3490OXY, 18.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,CLONAZEPAM 1MG TAB NDC#00004-0058-01,J3490CLO, 16.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,DONNATOL 10 ML,J3490DON, 15.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,FLUMAZENIL VL 0.1MG/ML 5ML,J3490FLUM, 14.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,GLYCOROLATE (ROBINULO) .2ML/ML,J3490GLYCO, 13.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,LABETOLOL(TRANDATE) 5MG/ML NDC-17478-420-20,J3490LABE, 11.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,BUVICAINE / 0.5% 50ML,J3490BUP, 10.05 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,MAALOX 30CC,J3490MAAL, 9.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,CARDIZEM- DITIAZEM HYDROCHLORIDE 10MG,J3490CARD, 6.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX CELEBREX 200MG NDC690970472107,J3490CEL, 6.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX ZOLPIDEM (AMBIEN) 5MG PO NDC51079072420,J3490ZOL, 4.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX PEPCID 20MG PO NDC#716837855255,J3490PEP, 2.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,METOPROLOL(LOPRESSOR) 1MG/ML NDC-0143-9873-10,J3490METO, 1.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX ASPIRING 81MG NDC363739522107,J3490ASP, 1.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,BENZOIN TINCTURE / AMPULE,J3490BENZ, 1.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,CLONIDINE HCL 0.1MG TAB,J3490CLON, 0.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX TYLENOL 325MG NDC300450496607,J3490TYL, 0.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490,RX DOC Q LACE 100MG PO NDC306030150211,J3490DOC, 0.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3490VIT,MULTIVITAMIN INJ,, 9.73 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3535,DRUG ADMINISTERED THROUGH A METERED DOSE INHALER,J3535," 1,833.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3590,EVICEL,," 3,693.15 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J3590,"THROMBIN 5,000 UNITS W/DIL",, 300.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7030,"NORMAL SALINE SOLUTION, 1000 CC, INFUSION",J7030, 69.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7040,"NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT), INFUSION",J7040, 34.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7042,5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT),J7042, 34.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7050,NORMAL SALINE SOLUTION INFUS 250CC,, 34.26 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7050,SODIUM CHLORIDE 0.9% 250ML INJ,, 18.21 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7060,DEXTROSE 50% 25G/50ML : 50ML,, 77.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7060,5% DEXTROSE/WATER,, 34.67 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7060,DEXTROSE 5% 250ML,, 31.93 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7060,DEXTROSE 5% / WATER 500ML,, 19.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7070,"D5W, 1000 CC, INFUSION",J7070, 91.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7110,"INFUSION, DEXTRAN 75, 500 ML",J7110, 168.30 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7120,"RINGERS LACTATE INFUSION, UP TO 1000 CC",J7120, 118.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7121,DEXTROSE 5% IN LACTATED RINGERS 1000 ML,, 7.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7130,"HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL",J7130, 99.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7197,"ANTITHROMBIN III (HUMAN), PER I.U.",J7197, 0.10 ,,, 7.44 ,, 3.50 ,,,,, 3.50 , 3.50 ,,,,,,,,,,,,,,, J7402,"MOMETASON FUROATE SINUS IMPLANT, (SINUVA), 10 MICROGRAMS (FOR 1350MCG CHARGE 135 UNITS)",J7402, 50.85 ,,, 22.69 ,,,,,,, - , - ,,,,,,,,,,,,,,, J7460,FORMOTEROL COMP UNIT,, 33.66 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7510,"PREDNISOLONE ORAL, PER 5 MG",J7510, 9.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7512,"PREDNISON, IMMEDIATE RELEASE OR DELAYED RELEASE",J7512, 10.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7607,"LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAM",J7607, 24.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7609,"ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG",J7609, 191.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7610,"ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1 MG",J7610, 18.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7611,ALBUTEROL NON-COMP CON,, 18.52 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7612,LEVALBUTEROL NON-COMP CON,, 18.68 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7613,ALBUTEROL NON-COMP UNIT,, 18.52 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7614,LEVALBUTEROL INHALATION SOLUTION FDA-APPROVED FINAL PRODUCT NON-COMPOUNDED ADMINISTERED THROUGH DME UNIT DOSE 0.5 MG,J7614, 45.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7615,"LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG",J7615, 43.05 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7620,"ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME",J7620, 18.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7636,ATROPINE 5ML ABBOJECT 0.5MG/5ML,, 118.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7636,ATROPINE 0.4MG/ML SDV 1ML,, 17.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7637,"DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM",J7637, 35.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7638,"DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM",J7638, 35.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7640,"FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 12 MICROGRAMS",J7640, 34.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7643,GLYCOPYRROLATE 0.2MG/ML 1ML,, 43.72 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7644,"IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM",J7644, 40.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7645,"IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM",J7645, 50.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7699,"NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME",J7699, 10.75 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7799,SODIUM BICARBONATE 4.2% 5ML,, 362.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7799,SODIUM BICARBONATE 8.4% 50ML,, 44.67 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J7999,VASOPRESSIN 20U/ML,J7999," 1,034.25 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8498,"ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED",J8498, 40.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX TRADJENTA 5MG PO NDC 005970140-30,J8499TRADJ, 78.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,TRADJENTA 5MG,J8499TRAD, 77.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,JARDIANCE 10MG PO,J8499JAR, 50.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX PLAVIX - CLOPIDOGREL 75MG PO NDC 65862035730,J8499PLAV, 37.05 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX NEOSPORIN OINT 1GM NDC300810730877,J8499NEO, 32.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,GLYCOPYRRONUM NDC00143968125 .2MG,J8499GLYCO, 29.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,"PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS",J8499, 25.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,COLCHICINE .6MG PO,J8499COL, 23.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX HYDROCODONE / ACETAMINOPEHEN NDC5167531 325MG,J8499HYDRO, 18.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,LEVOTHYROXIN 175 MCG,J8499LEVO, 5.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,ZOFRAN PO 4MG,J8499ZOF, 5.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX ACETAMINOPHEN,J8499ACE, 4.45 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX METFORMEN 500MG PO NDC5107017220,J8499METF, 3.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX EFFEXOR (VENLAFAXINE) 150MG PO NDC00008083621,J8499EFFE, 3.55 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX VENLAFAXINE 75MG PO,J8499VENL, 3.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,OXCARBAZEPIN 300MG,J8499OXCA, 3.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,MAGNESIUM 250MG PO NDC043292557388,J8499MAG, 2.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,HYDROXYZ HCL 25MG,J8499HYDR, 2.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,PROPANOLOL 10MG,J8499PROP, 2.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX GABAPENTIN 100MG PO NDC67877022201,J8499GABA, 2.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,VALSART/HCTZ 80-12.5,J8499VALS2, 2.85 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,ZIPRASIDONE 20MG,J8499ZIPR, 2.70 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,QUETIAPINE 25MG,J8499QUET2, 1.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX LIPITOR 40MG PO NDC00378395277,J8499LIP, 1.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX POTASSIUM 20MEQ PO NDC62037099901,J8499POT, 1.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,BUMEX / BUMETANIDE 1MG PO NDC69538149001,J8499BUM, 1.40 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX TRAMADOL 50MG NDC63709067110,J8499TRAM, 1.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,POTASSIUM 500MG PO NDC00832532410,J8499POTA, 0.95 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX MOTRIN 200MG PO NDC305730160407,J8499MOT, 0.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8499,RX MOVANTIK 25MG PO 00310197030,J8499MOV, 0.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J8540,ORAL DEXAMETHASON .25MG,, 6.19 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, J9027,"INJECTION, CLOFARABINE, 1 MG",J9027, 304.85 ,,, 64.45 ,, 94.93 ,,,,, 94.93 , 94.93 ,,,,,,,,,,,,,,, L0120,CERV FLEXIBLE NON-ADJUSTABLE,, 420.93 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L0150,CERV SEMI-RIG ADJ MOLDED CHN,, 388.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L0172,CERV COL THERMPLAS FOAM 2 PI,, 253.02 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L0978,AXILLARY CRUTCH EXTENSION,, 353.96 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L1270,ABDOMINAL PAD,, 167.32 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L1830,KNEE - KO IMMOBILIZER CANVAS LONGIT,, 157.06 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L1902,ANKLE FOOT ORTHOSIS,, 191.08 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L1906,AFO MULTILIGAMENTUS ANKLE SU,, 215.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3260,SURGICAL SHOE/BOOT EACH,, 61.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3650,SHLDER FIG 8 ABDUCT RESTRAIN,, 329.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3660,SHLDER FIG 8 ABDUCT RESTRAIN,, 329.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3807,WRIST HAND FING ORTHOSIS W/O JNT PREFAB,, 175.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3906,SPLINT WRIST - HAND ORTHOSIS,, 601.35 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3908,WRIST COCK-UP NON-MOLDED,, 114.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3924,HFO WO/JOINTS,, 305.64 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L3999,UPPER LIMB ORTHOSIS NOS,, 229.60 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L4350,ANKLE CONTROL ORTHOSI PREFAB,, 507.64 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L4361,WALKING BOOT PNEUMATIC AND/OR VACUUM,, 330.08 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L4387,NON-PNEUM WALK BOOT PRE OTS,, 507.64 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8499,RX VALSARTAN 160MG NDC 65862-0572-90,J8499VALS, 6.10 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8499,RX QUETIAPINE 150MG ER PO NDC 68180-0613-07,J8499QUET, 6.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8499,RX ACETAZOLAMID 250MG NDC 23155-0288-01,J8499ACET, 4.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8600,MENTOR IMPLANT 380CC HIGH PROFILE,," 6,140.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8613,VENT TUBE GOOD T,, 190.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8613,OLYMPUS ARMSTRONG GROMMET TUBE,, 60.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8658,INTEGRA LIFESCIENCES FINGER IMPLANT,," 6,959.75 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,S&N WARTH DEL,," 23,115.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,CARTIVA 10MM CARTIVA IMPLANT (L8699),," 17,250.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,STRYKER EASYCLIP 20-20-20,," 11,580.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,VERTEFIX HV KYPHOPLASTY,," 10,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,INTEGRA SILICONE MCP SIZE 20,," 8,145.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,STRYKER 2.0 X 2.5MM NEUROFLEX,," 6,906.15 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,STRYKER EASYCLIP FIXATION DEVICE 20X16X1,," 5,505.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,STRYKER EASYCLICK FIXATION DEVICE 18-14-,," 4,361.50 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,MIMEDX AMNIO FILL 500MG (CHARGE 2 UNITS),," 2,625.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,SUPPLY/ACCESSORY/SERVICE,," 2,500.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,GORE SEAMGAURD BIOABSORBABLE STAPLE LINE,," 2,121.65 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,NEVRO LEAD ANCHOR KIT L8699,," 1,290.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,KYPHON HV-R BONE COMENT,," 1,155.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,S&N RG DIALIATE 5.5,," 1,125.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,LIFE SPINE KWIRE,," 1,000.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,STRYKER UNTRHEADED GUIDEWIRE 1.4MM X150M,, 871.50 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,ARTHREX .062 X12 GUIDEWIRE,, 225.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,ARTHREX .062 GUIDEWIRE 6,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,ARTHREX .062 GUIDEWIRE 7,, 200.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, L8699,STRYKER KWIRE 0.62,, 14.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, M0239,BAMLANIVIMAB ELI LILLY INFUSION,," 1,548.00 ",,,,,,,,,, - , - ,,,,,,,,,,,,,,, M0243,IV/SUBQ INJ CASIRIVIMAB&IMDEVIMAB,," 1,548.00 ",,, 901.00 ,,,,,,, - , - ,,,,,,,,,,,,,,, M0245,BAMLANIVIMAB&ETESEVIMAB ELI LILLYIV INF,," 1,548.00 ",,, 901.00 ,,,,,,, - , - ,,,,,,,,,,,,,,, P9010,"BLOOD (WHOLE), FOR TRANSFUSION, PER UNIT",P9010," 1,150.00 ",,, 455.22 ,, 111.18 ,,,,, 111.18 , 111.18 ,,,,,,,,,,,,,,, P9010,BLOOD PROCESSING AND STORAGE,BLOODSTORAGEPROC, 96.00 ,,, 455.22 ,, 111.18 ,,,,, 111.18 , 111.18 ,,,,,,,,,,,,,,, P9010BL,WHOLE BLOOD,, 230.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, P9046,ALBUMIN 25% 12.5GM/50ML,, 276.55 ,,, 42.46 ,, 20.98 ,,,,, 20.98 , 20.98 ,,,,,,,,,,,,,,, Q0144,"AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM",Q0144, 211.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0162,ONDANSETRON 1 MG ORAL FDA APPROVED PRESCRIPTION ANTI-EMETIC FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN,Q0162, 21.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0163,"DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN",Q0163, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0164,"PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN",Q0164, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0169,PROMETHAZINE 25MG/ML,, 28.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0169,PROMETHAZINE 25MG TAB,, 7.28 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0177,"HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN",Q0177, 7.25 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0239,BAMLANIVIMAB INJECTION 700 MG ELI LILLY,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0243,CASIRIVIMAB&IMDEVIMAB INJ REGEN 2400MG,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q0244,INJECTION CASIRIVIMAB&IMDEVIMAB 1200MG,, 0.01 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q2037,INFLUENZA VIRUS VACCINE,, 54.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q2038,FLUZONE VACC 3 YRS & > IM,, 75.90 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4012,CAST SUP SHORT ARM FIBERGLASS PEDS,, 100.00 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4018,CAST SUP LNG ARM SPLINT FBRG ADULT,, 267.38 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4020,CAST SUP LNG ARM FBRG PED,, 121.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4021,CAST SUP SHT ARM SPLINT PLST ADULT,, 164.22 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4022,CAST SUP SHT ARM SPLINT FBRG ADULT,, 156.15 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4024,CAST SHORT ARM SPLINT PED,, 100.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4038,CAST SUP SHRT LEG FIBERGLASS ADULT,, 114.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4042,CAST SUP LONG LEG FIBERGLASS ADULT 11YR+,, 148.05 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4044,CAST SUP LNG LEG FBRGL PED,, 121.80 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4046,CAST SUP SHT LEG SPLNT FBRGL ADULT,, 325.65 ,,,,,,,,,, - , - ,,,,,,,,,,,,,,, Q4047,CAST SUP SHRT LEG SPLINT PED 10YR/96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.",inpatient," 1,19,685.15 ",,,," 91,260.00 "," 1,05,301.35 "," 84,029.40 "," 1,78,399.65 "," 1,57,595.51 "," 1,22,592.58 "," 84,029.40 "," 1,78,399.65 ",,,,,,,,,,,,,,, 028,SPINAL PROCEDURES W MCC,inpatient," 1,27,119.44 ",,,," 35,100.00 "," 30,931.92 "," 32,319.00 "," 52,404.30 "," 46,293.15 "," 36,011.16 "," 30,931.92 "," 52,404.30 ",,,,,,,,,,,,,,, 029,SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS,inpatient," 1,18,474.43 ",,,," 17,160.00 "," 18,161.02 "," 15,800.40 "," 30,768.08 "," 27,180.04 "," 21,143.19 "," 15,800.40 "," 30,768.08 ",,,,,,,,,,,,,,, 030,SPINAL PROCEDURES W/O CC/MCC,inpatient," 1,05,144.73 ",,,," 8,970.00 "," 12,521.13 "," 8,259.30 "," 21,213.08 "," 18,739.30 "," 14,577.19 "," 8,259.30 "," 21,213.08 ",,,,,,,,,,,,,,, 041,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM,inpatient," 3,80,696.80 ",,,," 16,380.00 "," 13,572.57 "," 15,082.20 "," 22,994.40 "," 20,312.90 "," 15,801.28 "," 13,572.57 "," 22,994.40 ",,,,,,,,,,,,,,, 042,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC,inpatient," 1,77,167.18 ",,,," 9,750.00 "," 10,770.46 "," 8,977.50 "," 18,247.13 "," 16,119.23 "," 12,539.05 "," 8,977.50 "," 18,247.13 ",,,,,,,,,,,,,,, 071,NONSPECIFIC CEREBROVASCULAR DISORDERS W CC,inpatient," 31,421.24 ",,,," 12,870.00 "," 5,673.27 "," 9,091.50 "," 9,611.55 "," 8,490.70 "," 6,604.86 "," 5,673.27 "," 12,870.00 ",,,,,,,,,,,,,,, 074,CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC,inpatient," 28,369.44 ",,,," 11,310.00 "," 5,604.78 "," 7,989.50 "," 9,495.53 "," 8,388.20 "," 6,525.13 "," 5,604.78 "," 11,310.00 ",,,,,,,,,,,,,,, 096,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC,inpatient," 71,251.18 ",,,," 17,160.00 "," 12,148.78 "," 12,122.00 "," 20,582.25 "," 18,182.04 "," 14,143.70 "," 12,122.00 "," 20,582.25 ",,,,,,,,,,,,,,, 103,HEADACHES W/O MCC,inpatient," 39,715.05 ",,,," 8,970.00 "," 4,496.95 "," 6,336.50 "," 7,618.65 "," 6,730.20 "," 5,235.38 "," 4,496.95 "," 8,970.00 ",,,,,,,,,,,,,,, 134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC",inpatient," 63,823.00 ",,,," 17,897.00 "," 6,898.51 "," 8,705.00 "," 11,687.33 "," 10,324.40 "," 8,031.29 "," 6,898.51 "," 17,897.00 ",,,,,,,,,,,,,,, 153,OTITIS MEDIA & URI W/O MCC,inpatient," 42,732.12 ",,,," 9,360.00 "," 4,096.40 "," 6,612.00 "," 6,940.05 "," 6,130.73 "," 4,769.06 "," 4,096.40 "," 9,360.00 ",,,,,,,,,,,,,,, 155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC",inpatient," 26,742.36 ",,,," 11,310.00 "," 5,083.38 "," 7,989.50 "," 8,612.18 "," 7,607.86 "," 5,918.11 "," 5,083.38 "," 11,310.00 ",,,,,,,,,,,,,,, 175,PULMONARY EMBOLISM W MCC,inpatient," 27,937.63 ",,,," 16,770.00 "," 8,430.48 "," 11,846.50 "," 14,282.78 "," 12,617.18 "," 9,814.83 "," 8,430.48 "," 16,770.00 ",,,,,,,,,,,,,,, 177,RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC,inpatient," 49,634.45 ",,,," 21,450.00 "," 10,593.79 "," 15,152.50 "," 17,947.80 "," 15,854.81 "," 12,333.36 "," 10,593.79 "," 21,450.00 ",,,,,,,,,,,,,,, 189,PULMONARY EDEMA & RESPIRATORY FAILURE,inpatient," 36,226.37 ",,,," 14,820.00 "," 7,109.14 "," 10,469.00 "," 12,044.18 "," 10,639.64 "," 8,276.51 "," 7,109.14 "," 14,820.00 ",,,,,,,,,,,,,,, 190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC,inpatient," 68,640.80 ",,,," 14,820.00 "," 6,852.47 "," 10,469.00 "," 11,609.33 "," 10,255.50 "," 7,977.69 "," 6,852.47 "," 14,820.00 ",,,,,,,,,,,,,,, 194,SIMPLE PNEUMONIA & PLEURISY W CC,inpatient," 60,566.06 ",,,," 12,870.00 "," 5,180.64 "," 9,091.50 "," 8,776.95 "," 7,753.42 "," 6,031.34 "," 5,180.64 "," 12,870.00 ",,,,,,,,,,,,,,, 195,SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC,inpatient," 40,367.44 ",,,," 10,140.00 "," 3,952.53 "," 7,163.00 "," 6,696.30 "," 5,915.41 "," 4,601.56 "," 3,952.53 "," 10,140.00 ",,,,,,,,,,,,,,, 196,INTERSTITIAL LUNG DISEASE W MCC,inpatient," 45,686.00 ",,,," 18,720.00 "," 9,427.25 "," 13,224.00 "," 15,971.48 "," 14,108.96 "," 10,975.27 "," 9,427.25 "," 18,720.00 ",,,,,,,,,,,,,,, 198,INTERSTITIAL LUNG DISEASE W/O CC/MCC,inpatient," 23,473.77 ",,,," 9,750.00 "," 4,365.16 "," 6,887.50 "," 7,395.38 "," 6,532.96 "," 5,081.95 "," 4,365.16 "," 9,750.00 ",,,,,,,,,,,,,,, 202,BRONCHITIS & ASTHMA W CC/MCC,inpatient," 32,696.17 ",,,," 11,700.00 "," 5,410.27 "," 8,265.00 "," 9,165.98 "," 8,097.08 "," 6,298.67 "," 5,410.27 "," 11,700.00 ",,,,,,,,,,,,,,, 204,RESPIRATORY SIGNS & SYMPTOMS,inpatient," 14,328.81 ",,,," 8,580.00 "," 4,417.53 "," 6,061.00 "," 7,484.10 "," 6,611.34 "," 5,142.92 "," 4,417.53 "," 8,580.00 ",,,,,,,,,,,,,,, 205,OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC,inpatient," 74,504.30 ",,,," 15,600.00 "," 8,735.50 "," 11,020.00 "," 14,799.53 "," 13,073.67 "," 10,169.93 "," 8,735.50 "," 15,600.00 ",,,,,,,,,,,,,,, 240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC,inpatient," 1,06,850.50 ",,,," 27,300.00 "," 15,796.87 "," 25,137.00 "," 26,762.78 "," 23,641.82 "," 18,390.83 "," 15,796.87 "," 27,300.00 ",,,,,,,,,,,,,,, 264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,inpatient," 1,65,627.24 ",,,," 25,350.00 "," 18,177.71 "," 23,341.50 "," 30,796.35 "," 27,205.02 "," 21,162.62 "," 18,177.71 "," 30,796.35 ",,,,,,,,,,,,,,, 280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC",inpatient," 69,099.72 ",,,," 16,380.00 "," 9,536.59 "," 11,571.00 "," 16,156.73 "," 14,272.60 "," 11,102.57 "," 9,536.59 "," 16,380.00 ",,,,,,,,,,,,,,, 291,HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),inpatient," 47,831.08 ",,,," 15,990.00 "," 7,742.76 "," 11,295.50 "," 13,117.65 "," 11,587.93 "," 9,014.18 "," 7,742.76 "," 15,990.00 ",,,,,,,,,,,,,,, 292,HEART FAILURE & SHOCK W CC,inpatient," 22,796.28 ",,,," 12,870.00 "," 5,293.44 "," 9,091.50 "," 8,968.05 "," 7,922.24 "," 6,162.66 "," 5,293.44 "," 12,870.00 ",,,,,,,,,,,,,,, 293,HEART FAILURE & SHOCK W/O CC/MCC,inpatient," 10,353.48 ",,,," 9,360.00 "," 3,830.52 "," 6,612.00 "," 6,489.60 "," 5,732.81 "," 4,459.52 "," 3,830.52 "," 9,360.00 ",,,,,,,,,,,,,,, 299,PERIPHERAL VASCULAR DISORDERS W MCC,inpatient," 33,214.28 ",,,," 15,210.00 "," 8,347.04 "," 10,744.50 "," 14,141.40 "," 12,492.30 "," 9,717.68 "," 8,347.04 "," 15,210.00 ",,,,,,,,,,,,,,, 305,HYPERTENSION W/O MCC,inpatient," 26,526.73 ",,,," 8,580.00 "," 4,143.02 "," 6,061.00 "," 7,019.03 "," 6,200.50 "," 4,823.33 "," 4,143.02 "," 8,580.00 ",,,,,,,,,,,,,,, 315,OTHER CIRCULATORY SYSTEM DIAGNOSES W CC,inpatient," 35,057.11 ",,,," 10,920.00 "," 5,501.19 "," 7,714.00 "," 9,320.03 "," 8,233.17 "," 6,404.53 "," 5,501.19 "," 10,920.00 ",,,,,,,,,,,,,,, 327,"STOMACH, ESOPHAGEAL & DUODENAL PROC W CC",inpatient," 72,512.23 ",,,," 19,110.00 "," 14,297.12 "," 17,595.90 "," 24,221.93 "," 21,397.28 "," 16,644.81 "," 14,297.12 "," 24,221.93 ",,,,,,,,,,,,,,, 329,MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC,inpatient," 1,47,500.32 ",,,," 42,120.00 "," 28,732.94 "," 38,782.80 "," 48,678.83 "," 43,002.13 "," 33,451.09 "," 28,732.94 "," 48,678.83 ",,,,,,,,,,,,,,, 330,MAJOR SMALL & LARGE BOWEL PROCEDURES W CC,inpatient," 2,69,041.21 ",,,," 21,518.00 "," 14,521.57 "," 18,517.00 "," 24,602.18 "," 21,733.18 "," 16,906.11 "," 14,521.57 "," 24,602.18 ",,,,,,,,,,,,,,, 339,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC,inpatient," 1,04,564.49 ",,,," 16,770.00 "," 10,017.14 "," 15,441.30 "," 16,970.85 "," 14,991.79 "," 11,662.02 "," 10,017.14 "," 16,970.85 ",,,,,,,,,,,,,,, 340,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC,inpatient," 99,853.62 ",,,," 9,360.00 "," 6,835.78 "," 8,618.40 "," 11,581.05 "," 10,230.52 "," 7,958.26 "," 6,835.78 "," 11,581.05 ",,,,,,,,,,,,,,, 342,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC,inpatient," 1,12,186.14 ",,,," 10,530.00 "," 8,165.18 "," 9,695.70 "," 13,833.30 "," 12,220.12 "," 9,505.96 "," 8,165.18 "," 13,833.30 ",,,,,,,,,,,,,,, 343,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC,inpatient," 86,238.17 ",,,," 6,630.00 "," 6,245.89 "," 6,104.70 "," 10,581.68 "," 9,347.69 "," 7,271.51 "," 6,104.70 "," 10,581.68 ",,,,,,,,,,,,,,, 345,MINOR SMALL & LARGE BOWEL PROCEDURES W CC,inpatient," 80,105.51 ",,,," 17,940.00 "," 9,424.37 "," 16,518.60 "," 15,966.60 "," 14,104.65 "," 10,971.92 "," 9,424.37 "," 17,940.00 ",,,,,,,,,,,,,,, 346,MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC,inpatient," 79,844.52 ",,,," 12,480.00 "," 7,116.62 "," 11,491.20 "," 12,056.85 "," 10,650.84 "," 8,285.22 "," 7,116.62 "," 12,480.00 ",,,,,,,,,,,,,,, 347,ANAL & STOMAL PROCEDURES W MCC,inpatient," 1,21,910.80 ",,,," 22,230.00 "," 13,875.86 "," 20,468.70 "," 23,508.23 "," 20,766.80 "," 16,154.37 "," 13,875.86 "," 23,508.23 ",,,,,,,,,,,,,,, 355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC,inpatient," 86,055.16 ",,,," 9,750.00 "," 7,796.86 "," 8,977.50 "," 13,209.30 "," 11,668.89 "," 9,077.16 "," 7,796.86 "," 13,209.30 ",,,,,,,,,,,,,,, 356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC,inpatient," 1,83,515.89 ",,,," 30,420.00 "," 22,880.11 "," 28,009.80 "," 38,763.08 "," 34,242.70 "," 26,637.19 "," 22,880.11 "," 38,763.08 ",,,,,,,,,,,,,,, 357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC,inpatient," 2,39,348.59 ",,,," 18,330.00 "," 12,296.69 "," 16,877.70 "," 20,832.83 "," 18,403.40 "," 14,315.89 "," 12,296.69 "," 20,832.83 ",,,,,,,,,,,,,,, 358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC,inpatient," 92,117.75 ",,,," 10,920.00 "," 7,759.45 "," 10,054.80 "," 13,145.93 "," 11,612.91 "," 9,033.61 "," 7,759.45 "," 13,145.93 ",,,,,,,,,,,,,,, 371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC,inpatient," 44,570.37 ",,,," 21,060.00 "," 10,006.78 "," 14,877.00 "," 16,953.30 "," 14,976.28 "," 11,649.96 "," 10,006.78 "," 21,060.00 ",,,,,,,,,,,,,,, 372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC,inpatient," 53,287.46 ",,,," 15,600.00 "," 5,975.98 "," 11,020.00 "," 10,124.40 "," 8,943.74 "," 6,957.28 "," 5,975.98 "," 15,600.00 ",,,,,,,,,,,,,,, 378,G.I. HEMORRHAGE W CC,inpatient," 66,701.60 ",,,," 11,700.00 "," 5,699.17 "," 8,265.00 "," 9,655.43 "," 8,529.45 "," 6,635.01 "," 5,699.17 "," 11,700.00 ",,,,,,,,,,,,,,, 379,G.I. HEMORRHAGE W/O CC/MCC,inpatient," 51,198.90 ",,,," 8,190.00 "," 3,759.16 "," 5,785.50 "," 6,368.70 "," 5,626.01 "," 4,376.44 "," 3,759.16 "," 8,190.00 ",,,,,,,,,,,,,,, 387,INFLAMMATORY BOWEL DISEASE W/O CC/MCC,inpatient," 41,998.79 ",,,," 10,920.00 "," 4,009.50 "," 7,714.00 "," 6,792.83 "," 6,000.68 "," 4,667.89 "," 4,009.50 "," 10,920.00 ",,,,,,,,,,,,,,, 389,G.I. OBSTRUCTION W CC,inpatient," 40,633.01 ",,,," 12,870.00 "," 4,852.61 "," 9,091.50 "," 8,221.20 "," 7,262.48 "," 5,649.44 "," 4,852.61 "," 12,870.00 ",,,,,,,,,,,,,,, 390,G.I. OBSTRUCTION W/O CC/MCC,inpatient," 38,958.22 ",,,," 9,750.00 "," 3,401.20 "," 6,887.50 "," 5,762.25 "," 5,090.28 "," 3,959.70 "," 3,401.20 "," 9,750.00 ",,,,,,,,,,,,,,, 391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC",inpatient," 80,533.05 ",,,," 14,430.00 "," 7,029.72 "," 10,193.50 "," 11,909.63 "," 10,520.78 "," 8,184.05 "," 7,029.72 "," 14,430.00 ",,,,,,,,,,,,,,, 392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC",inpatient," 52,607.30 ",,,," 10,140.00 "," 4,347.32 "," 7,163.00 "," 7,365.15 "," 6,506.26 "," 5,061.18 "," 4,347.32 "," 10,140.00 ",,,,,,,,,,,,,,, 393,OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC,inpatient," 1,02,711.62 ",,,," 17,160.00 "," 9,395.60 "," 12,122.00 "," 15,917.85 "," 14,061.58 "," 10,938.42 "," 9,395.60 "," 17,160.00 ",,,,,,,,,,,,,,, 394,OTHER DIGESTIVE SYSTEM DIAGNOSES W CC,inpatient," 46,560.16 ",,,," 12,090.00 "," 5,416.02 "," 8,540.50 "," 9,175.73 "," 8,105.69 "," 6,305.37 "," 5,416.02 "," 12,090.00 ",,,,,,,,,,,,,,, 414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC,inpatient," 1,23,269.34 ",,,," 31,200.00 "," 20,586.75 "," 28,728.00 "," 34,877.70 "," 30,810.42 "," 23,967.24 "," 20,586.75 "," 34,877.70 ",,,,,,,,,,,,,,, 416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC,inpatient," 1,33,605.22 ",,,," 12,480.00 "," 8,017.28 "," 11,491.20 "," 13,582.73 "," 11,998.77 "," 9,333.77 "," 8,017.28 "," 13,582.73 ",,,,,,,,,,,,,,, 417,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC,inpatient," 1,12,094.22 ",,,," 20,666.00 "," 13,946.64 "," 17,934.00 "," 23,628.15 "," 20,872.74 "," 16,236.78 "," 13,946.64 "," 23,628.15 ",,,,,,,,,,,,,,, 418,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC,inpatient," 97,132.68 ",,,," 14,193.00 "," 9,577.45 "," 11,575.00 "," 16,225.95 "," 14,333.75 "," 11,150.14 "," 9,577.45 "," 16,225.95 ",,,,,,,,,,,,,,, 419,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC,inpatient," 1,17,983.48 ",,,," 11,123.00 "," 7,505.66 "," 9,789.00 "," 12,715.95 "," 11,233.07 "," 8,738.14 "," 7,505.66 "," 12,715.95 ",,,,,,,,,,,,,,, 438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC,inpatient," 72,757.72 ",,,," 17,940.00 "," 9,427.82 "," 12,673.00 "," 15,972.45 "," 14,109.82 "," 10,975.94 "," 9,427.82 "," 17,940.00 ",,,,,,,,,,,,,,, 439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC,inpatient," 61,408.68 ",,,," 12,480.00 "," 4,962.53 "," 8,816.00 "," 8,407.43 "," 7,426.99 "," 5,777.41 "," 4,962.53 "," 12,480.00 ",,,,,,,,,,,,,,, 440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC,inpatient," 52,588.14 ",,,," 9,750.00 "," 3,575.58 "," 6,887.50 "," 6,057.68 "," 5,351.26 "," 4,162.71 "," 3,575.58 "," 9,750.00 ",,,,,,,,,,,,,,, 454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC,inpatient," 4,11,294.98 ",,,," 50,000.00 "," 36,468.22 "," 14,364.00 "," 61,783.80 "," 54,578.86 "," 42,456.56 "," 14,364.00 "," 61,783.80 ",,,,,,,,,,,,,,, 455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC,inpatient," 3,49,741.52 ",,,," 50,000.00 "," 28,774.95 "," 9,336.60 "," 48,750.00 "," 43,065.00 "," 33,500.00 "," 9,336.60 "," 50,000.00 ",,,,,,,,,,,,,,, 460,SPINAL FUSION EXCEPT CERVICAL W/O MCC,inpatient," 2,13,364.50 ",,,," 37,000.00 "," 23,235.77 "," 26,367.00 "," 39,365.63 "," 34,774.99 "," 27,051.25 "," 23,235.77 "," 39,365.63 ",,,,,,,,,,,,,,, 462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC,inpatient," 2,27,264.80 ",,,," 23,388.00 "," 18,382.01 "," 24,633.00 "," 31,142.48 "," 27,510.78 "," 21,400.47 "," 18,382.01 "," 31,142.48 ",,,,,,,,,,,,,,, 465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC",inpatient," 1,71,725.19 ",,,," 12,952.00 "," 10,574.22 "," 9,695.70 "," 17,914.65 "," 15,825.53 "," 12,310.58 "," 9,695.70 "," 17,914.65 ",,,,,,,,,,,,,,, 467,REVISION OF HIP OR KNEE REPLACEMENT W CC,inpatient," 1,96,748.83 ",,,," 17,122.00 "," 19,972.12 "," 26,431.00 "," 33,836.40 "," 29,890.56 "," 23,251.68 "," 17,122.00 "," 33,836.40 ",,,,,,,,,,,,,,, 468,REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC,inpatient," 2,08,654.40 ",,,," 17,122.00 "," 16,064.48 "," 27,818.00 "," 27,216.15 "," 24,042.33 "," 18,702.38 "," 16,064.48 "," 27,818.00 ",,,,,,,,,,,,,,, 469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACEMENT,inpatient," 1,84,804.49 ",,,," 17,122.00 "," 18,267.49 "," 28,329.00 "," 30,948.45 "," 27,339.38 "," 21,267.14 "," 17,122.00 "," 30,948.45 ",,,,,,,,,,,,,,, 470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC,inpatient," 1,43,267.98 ",,,," 17,122.00 "," 11,451.28 "," 20,286.00 "," 19,400.55 "," 17,138.15 "," 13,331.66 "," 11,451.28 "," 20,286.00 ",,,,,,,,,,,,,,, 472,CERVICAL SPINAL FUSION W CC,inpatient," 1,67,666.51 ",,,," 18,000.00 "," 16,958.80 "," 24,254.00 "," 28,731.30 "," 25,380.79 "," 19,743.56 "," 16,958.80 "," 28,731.30 ",,,,,,,,,,,,,,, 473,CERVICAL SPINAL FUSION W/O CC/MCC,inpatient," 2,31,042.88 ",,,," 17,122.00 "," 13,656.02 "," 22,630.00 "," 23,135.78 "," 20,437.79 "," 15,898.43 "," 13,656.02 "," 23,135.78 ",,,,,,,,,,,,,,, 478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC,inpatient," 1,28,721.89 ",,,," 20,670.00 "," 13,116.77 "," 19,032.30 "," 22,222.20 "," 19,630.75 "," 15,270.64 "," 13,116.77 "," 22,222.20 ",,,,,,,,,,,,,,, 481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC,inpatient," 75,682.71 ",,,," 17,160.00 "," 11,868.52 "," 15,800.40 "," 20,107.43 "," 17,762.59 "," 13,817.41 "," 11,868.52 "," 20,107.43 ",,,,,,,,,,,,,,, 482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC,inpatient," 1,10,585.58 ",,,," 13,650.00 "," 9,579.18 "," 12,568.50 "," 16,228.88 "," 14,336.34 "," 11,152.15 "," 9,579.18 "," 16,228.88 ",,,,,,,,,,,,,,, 483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,inpatient," 1,72,679.67 ",,,," 16,208.00 "," 13,717.02 "," 5,745.60 "," 23,239.13 "," 20,529.09 "," 15,969.45 "," 5,745.60 "," 23,239.13 ",,,,,,,,,,,,,,, 486,KNEE PROCEDURES W PDX OF INFECTION W CC,inpatient," 1,46,455.25 ",,,," 20,670.00 "," 12,766.87 "," 19,032.30 "," 21,629.40 "," 19,107.08 "," 14,863.28 "," 12,766.87 "," 21,629.40 ",,,,,,,,,,,,,,, 487,KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC,inpatient," 1,15,279.86 ",,,," 14,430.00 "," 9,496.88 "," 13,286.70 "," 16,089.45 "," 14,213.17 "," 11,056.34 "," 9,496.88 "," 16,089.45 ",,,,,,,,,,,,,,, 493,"LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC",inpatient," 93,742.86 ",,,," 15,600.00 "," 12,926.28 "," 14,364.00 "," 21,899.48 "," 19,345.66 "," 15,048.87 "," 12,926.28 "," 21,899.48 ",,,,,,,,,,,,,,, 494,"LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC",inpatient," 1,16,895.67 ",,,," 10,530.00 "," 10,093.68 "," 9,695.70 "," 17,100.53 "," 15,106.34 "," 11,751.13 "," 9,695.70 "," 17,100.53 ",,,,,,,,,,,,,,, 502,SOFT TISSUE PROCEDURES W/O CC/MCC,inpatient," 1,35,370.03 ",,,," 9,750.00 "," 7,430.27 "," 8,977.50 "," 12,588.23 "," 11,120.24 "," 8,650.37 "," 7,430.27 "," 12,588.23 ",,,,,,,,,,,,,,, 504,FOOT PROCEDURES W CC,inpatient," 93,339.69 ",,,," 18,720.00 "," 9,953.26 "," 17,236.80 "," 16,862.63 "," 14,896.18 "," 11,587.65 "," 9,953.26 "," 18,720.00 ",,,,,,,,,,,,,,, 512,"SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC",inpatient," 1,11,167.41 ",,,," 8,580.00 "," 8,759.67 "," 7,900.20 "," 14,840.48 "," 13,109.85 "," 10,198.07 "," 7,900.20 "," 14,840.48 ",,,,,,,,,,,,,,, 513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC",inpatient," 57,566.71 ",,,," 15,990.00 "," 9,435.88 "," 14,723.10 "," 15,986.10 "," 14,121.87 "," 10,985.32 "," 9,435.88 "," 15,990.00 ",,,,,,,,,,,,,,, 514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC",inpatient," 63,473.59 ",,,," 8,970.00 "," 5,753.84 "," 8,259.30 "," 9,748.05 "," 8,611.28 "," 6,698.66 "," 5,753.84 "," 9,748.05 ",,,,,,,,,,,,,,, 515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC,inpatient," 2,48,474.81 ",,,," 24,960.00 "," 17,736.88 "," 22,982.40 "," 30,049.50 "," 26,545.27 "," 20,649.40 "," 17,736.88 "," 30,049.50 ",,,,,,,,,,,,,,, 516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC,inpatient," 1,46,345.35 ",,,," 14,820.00 "," 10,850.46 "," 13,645.80 "," 18,382.65 "," 16,238.95 "," 12,632.18 "," 10,850.46 "," 18,382.65 ",,,,,,,,,,,,,,, 517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC,inpatient," 1,64,867.08 ",,,," 8,580.00 "," 7,947.07 "," 7,900.20 "," 13,463.78 "," 11,893.69 "," 9,252.03 "," 7,900.20 "," 13,463.78 ",,,,,,,,,,,,,,, 519,BACK & NECK PROC EXC SPINAL FUSION W CC,inpatient," 1,53,353.39 ",,,," 12,662.00 "," 10,715.79 "," 15,287.00 "," 18,154.50 "," 16,037.41 "," 12,475.40 "," 10,715.79 "," 18,154.50 ",,,,,,,,,,,,,,, 520,BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC,inpatient," 1,32,934.05 ",,,," 12,662.00 "," 7,562.63 "," 10,762.00 "," 12,812.48 "," 11,318.34 "," 8,804.47 "," 7,562.63 "," 12,812.48 ",,,,,,,,,,,,,,, 536,FRACTURES OF HIP & PELVIS W/O MCC,inpatient," 59,711.27 ",,,," 11,310.00 "," 4,356.53 "," 7,989.50 "," 7,380.75 "," 6,520.04 "," 5,071.90 "," 4,356.53 "," 11,310.00 ",,,,,,,,,,,,,,, 540,OSTEOMYELITIS W CC,inpatient," 48,953.20 ",,,," 17,550.00 "," 7,463.65 "," 12,397.50 "," 12,644.78 "," 11,170.20 "," 8,689.23 "," 7,463.65 "," 17,550.00 ",,,,,,,,,,,,,,, 547,CONNECTIVE TISSUE DISORDERS W/O CC/MCC,inpatient," 21,578.56 ",,,," 10,530.00 "," 4,935.48 "," 7,438.50 "," 8,361.60 "," 7,386.51 "," 5,745.92 "," 4,935.48 "," 10,530.00 ",,,,,,,,,,,,,,, 552,MEDICAL BACK PROBLEMS W/O MCC,inpatient," 41,899.10 ",,,," 11,700.00 "," 5,185.25 "," 8,265.00 "," 8,784.75 "," 7,760.31 "," 6,036.70 "," 5,185.25 "," 11,700.00 ",,,,,,,,,,,,,,, 554,BONE DISEASES & ARTHROPATHIES W/O MCC,inpatient," 97,850.02 ",,,," 10,920.00 "," 4,355.95 "," 7,714.00 "," 7,379.78 "," 6,519.18 "," 5,071.23 "," 4,355.95 "," 10,920.00 ",,,,,,,,,,,,,,, 558,"TENDONITIS, MYOSITIS & BURSITIS W/O MCC",inpatient," 43,067.96 ",,,," 12,480.00 "," 4,969.43 "," 8,816.00 "," 8,419.13 "," 7,437.33 "," 5,785.45 "," 4,969.43 "," 12,480.00 ",,,,,,,,,,,,,,, 563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC",inpatient," 51,187.51 ",,,," 11,700.00 "," 4,823.26 "," 8,265.00 "," 8,171.48 "," 7,218.56 "," 5,615.27 "," 4,823.26 "," 11,700.00 ",,,,,,,,,,,,,,, 566,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC,inpatient," 21,088.17 ",,,," 10,140.00 "," 4,387.03 "," 7,163.00 "," 7,432.43 "," 6,565.69 "," 5,107.41 "," 4,387.03 "," 10,140.00 ",,,,,,,,,,,,,,, 571,SKIN DEBRIDEMENT W CC,inpatient," 84,812.00 ",,,," 20,280.00 "," 9,800.17 "," 18,673.20 "," 16,603.28 "," 14,667.08 "," 11,409.43 "," 9,800.17 "," 20,280.00 ",,,,,,,,,,,,,,, 572,SKIN DEBRIDEMENT W/O CC/MCC,inpatient," 1,60,505.91 ",,,," 13,260.00 "," 6,782.83 "," 12,209.40 "," 11,491.35 "," 10,151.28 "," 7,896.62 "," 6,782.83 "," 13,260.00 ",,,,,,,,,,,,,,, 577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC,inpatient," 1,46,294.75 ",,,," 18,330.00 "," 14,440.42 "," 16,877.70 "," 24,464.70 "," 21,611.74 "," 16,811.64 "," 14,440.42 "," 24,464.70 ",,,,,,,,,,,,,,, 579,"OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC",inpatient," 1,10,384.08 ",,,," 25,350.00 "," 16,101.31 "," 23,341.50 "," 27,278.55 "," 24,097.45 "," 18,745.26 "," 16,101.31 "," 27,278.55 ",,,,,,,,,,,,,,, 580,"OTHER SKIN, SUBCUT TISS & BREAST PROC W CC",inpatient," 1,22,985.89 ",,,," 15,990.00 "," 9,149.28 "," 14,723.10 "," 15,500.55 "," 13,692.95 "," 10,651.66 "," 9,149.28 "," 15,990.00 ",,,,,,,,,,,,,,, 581,"OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC",inpatient," 65,496.87 ",,,," 9,360.00 "," 7,115.47 "," 8,618.40 "," 12,054.90 "," 10,649.11 "," 8,283.88 "," 7,115.47 "," 12,054.90 ",,,,,,,,,,,,,,, 584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC",inpatient," 1,30,615.38 ",,,," 14,040.00 "," 10,769.89 "," 12,927.60 "," 18,246.15 "," 16,118.37 "," 12,538.38 "," 10,769.89 "," 18,246.15 ",,,,,,,,,,,,,,, 585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC",inpatient," 59,325.51 ",,,," 8,580.00 "," 9,010.59 "," 7,900.20 "," 15,265.58 "," 13,485.37 "," 10,490.19 "," 7,900.20 "," 15,265.58 ",,,,,,,,,,,,,,, 593,SKIN ULCERS W CC,inpatient," 57,866.90 ",,,," 16,380.00 "," 6,499.69 "," 11,571.00 "," 11,011.65 "," 9,727.52 "," 7,566.98 "," 6,499.69 "," 16,380.00 ",,,,,,,,,,,,,,, 594,SKIN ULCERS W/O CC/MCC,inpatient," 21,870.68 ",,,," 12,480.00 "," 4,662.69 "," 8,816.00 "," 7,899.45 "," 6,978.25 "," 5,428.34 "," 4,662.69 "," 12,480.00 ",,,,,,,,,,,,,,, 603,CELLULITIS W/O MCC,inpatient," 60,484.62 ",,,," 12,870.00 "," 4,878.51 "," 9,091.50 "," 8,265.08 "," 7,301.24 "," 5,679.59 "," 4,878.51 "," 12,870.00 ",,,,,,,,,,,,,,, 617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC",inpatient," 93,339.67 ",,,," 23,010.00 "," 11,933.55 "," 21,186.90 "," 20,217.60 "," 17,859.92 "," 13,893.12 "," 11,933.55 "," 23,010.00 ",,,,,,,,,,,,,,, 620,O.R. PROCEDURES FOR OBESITY W CC,inpatient," 1,24,423.15 ",,,," 15,432.00 "," 10,414.23 "," 13,579.00 "," 17,643.60 "," 15,586.08 "," 12,124.32 "," 10,414.23 "," 17,643.60 ",,,,,,,,,,,,,,, 621,O.R. PROCEDURES FOR OBESITY W/O CC/MCC,inpatient," 95,378.22 ",,,," 13,460.00 "," 9,083.10 "," 11,040.00 "," 15,388.43 "," 13,593.90 "," 10,574.61 "," 9,083.10 "," 15,388.43 ",,,,,,,,,,,,,,, 623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC",inpatient," 69,830.97 ",,,," 21,450.00 "," 11,068.00 "," 19,750.50 "," 18,751.20 "," 16,564.52 "," 12,885.44 "," 11,068.00 "," 21,450.00 ",,,,,,,,,,,,,,, 629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC",inpatient," 92,560.42 ",,,," 23,400.00 "," 13,459.20 "," 21,546.00 "," 22,802.33 "," 20,143.22 "," 15,669.29 "," 13,459.20 "," 23,400.00 ",,,,,,,,,,,,,,, 637,DIABETES W MCC,inpatient," 11,888.39 ",,,," 15,210.00 "," 7,949.37 "," 10,744.50 "," 13,467.68 "," 11,897.14 "," 9,254.71 "," 7,949.37 "," 15,210.00 ",,,,,,,,,,,,,,, 638,DIABETES W CC,inpatient," 34,849.32 ",,,," 11,310.00 "," 5,019.50 "," 7,989.50 "," 8,503.95 "," 7,512.26 "," 5,843.74 "," 5,019.50 "," 11,310.00 ",,,,,,,,,,,,,,, 640,"MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC",inpatient," 40,966.02 ",,,," 12,870.00 "," 6,849.59 "," 9,091.50 "," 11,604.45 "," 10,251.19 "," 7,974.34 "," 6,849.59 "," 12,870.00 ",,,,,,,,,,,,,,, 641,"MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC",inpatient," 62,552.78 ",,,," 10,140.00 "," 4,327.18 "," 7,163.00 "," 7,331.03 "," 6,476.11 "," 5,037.73 "," 4,327.18 "," 10,140.00 ",,,,,,,,,,,,,,, 642,INBORN AND OTHER DISORDERS OF METABOLISM,inpatient," 54,340.24 ",,,," 12,480.00 "," 7,271.43 "," 8,816.00 "," 12,319.13 "," 10,882.53 "," 8,465.45 "," 7,271.43 "," 12,480.00 ",,,,,,,,,,,,,,, 659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC,inpatient," 57,989.76 ",,,," 23,790.00 "," 15,694.43 "," 21,905.10 "," 26,589.23 "," 23,488.51 "," 18,271.57 "," 15,694.43 "," 26,589.23 ",,,,,,,,,,,,,,, 660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC,inpatient," 67,231.89 ",,,," 12,480.00 "," 8,330.92 "," 11,491.20 "," 14,114.10 "," 12,468.18 "," 9,698.92 "," 8,330.92 "," 14,114.10 ",,,,,,,,,,,,,,, 661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC,inpatient," 52,641.35 ",,,," 7,800.00 "," 6,173.95 "," 7,182.00 "," 10,459.80 "," 9,240.03 "," 7,187.76 "," 6,173.95 "," 10,459.80 ",,,,,,,,,,,,,,, 664,MINOR BLADDER PROCEDURES W/O CC/MCC,inpatient," 82,103.15 ",,,," 7,800.00 "," 6,823.69 "," 7,182.00 "," 11,560.58 "," 10,212.43 "," 7,944.19 "," 6,823.69 "," 11,560.58 ",,,,,,,,,,,,,,, 667,PROSTATECTOMY W/O CC/MCC,inpatient," 73,706.10 ",,,," 8,580.00 "," 6,217.69 "," 7,900.20 "," 10,533.90 "," 9,305.49 "," 7,238.68 "," 6,217.69 "," 10,533.90 ",,,,,,,,,,,,,,, 670,TRANSURETHRAL PROCEDURES W/O CC/MCC,inpatient," 68,634.87 ",,,," 8,190.00 "," 5,544.93 "," 7,541.10 "," 9,394.13 "," 8,298.63 "," 6,455.45 "," 5,544.93 "," 9,394.13 ",,,,,,,,,,,,,,, 682,RENAL FAILURE W MCC,inpatient," 21,287.12 ",,,," 17,550.00 "," 8,816.64 "," 12,397.50 "," 14,937.00 "," 13,195.12 "," 10,264.40 "," 8,816.64 "," 17,550.00 ",,,,,,,,,,,,,,, 683,RENAL FAILURE W CC,inpatient," 38,329.14 ",,,," 12,480.00 "," 5,288.84 "," 8,816.00 "," 8,960.25 "," 7,915.35 "," 6,157.30 "," 5,288.84 "," 12,480.00 ",,,,,,,,,,,,,,, 684,RENAL FAILURE W/O CC/MCC,inpatient," 45,252.45 ",,,," 8,970.00 "," 3,566.94 "," 6,336.50 "," 6,043.05 "," 5,338.34 "," 4,152.66 "," 3,566.94 "," 8,970.00 ",,,,,,,,,,,,,,, 689,KIDNEY & URINARY TRACT INFECTIONS W MCC,inpatient," 30,866.09 ",,,," 15,210.00 "," 6,397.25 "," 10,744.50 "," 10,838.10 "," 9,574.21 "," 7,447.72 "," 6,397.25 "," 15,210.00 ",,,,,,,,,,,,,,, 690,KIDNEY & URINARY TRACT INFECTIONS W/O MCC,inpatient," 57,128.05 ",,,," 11,700.00 "," 4,570.04 "," 8,265.00 "," 7,742.48 "," 6,839.58 "," 5,320.47 "," 4,570.04 "," 11,700.00 ",,,,,,,,,,,,,,, 697,URETHRAL STRICTURE,inpatient," 65,268.88 ",,,," 9,750.00 "," 5,524.79 "," 6,887.50 "," 9,360.00 "," 8,268.48 "," 6,432.00 "," 5,524.79 "," 9,750.00 ",,,,,,,,,,,,,,, 698,OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC,inpatient," 9,290.65 ",,,," 19,110.00 "," 9,294.88 "," 13,499.50 "," 15,747.23 "," 13,910.86 "," 10,821.17 "," 9,294.88 "," 19,110.00 ",,,,,,,,,,,,,,, 713,TRANSURETHRAL PROSTATECTOMY W CC/MCC,inpatient," 2,73,440.15 ",,,," 11,310.00 "," 8,421.85 "," 10,413.90 "," 14,268.15 "," 12,604.26 "," 9,804.78 "," 8,421.85 "," 14,268.15 ",,,,,,,,,,,,,,, 718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC,inpatient," 63,908.54 ",,,," 9,750.00 "," 7,093.60 "," 8,977.50 "," 12,017.85 "," 10,616.38 "," 8,258.42 "," 7,093.60 "," 12,017.85 ",,,,,,,,,,,,,,, 727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC,inpatient," 32,386.41 ",,,," 18,330.00 "," 8,275.68 "," 12,948.50 "," 14,020.50 "," 12,385.49 "," 9,634.60 "," 8,275.68 "," 18,330.00 ",,,,,,,,,,,,,,, 742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC,inpatient," 1,17,688.14 ",,,," 14,617.00 "," 9,864.05 "," 10,480.00 "," 16,711.50 "," 14,762.68 "," 11,483.80 "," 9,864.05 "," 16,711.50 ",,,,,,,,,,,,,,, 743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC,inpatient," 98,916.90 ",,,," 9,514.00 "," 6,420.27 "," 6,932.00 "," 10,877.10 "," 9,608.66 "," 7,474.52 "," 6,420.27 "," 10,877.10 ",,,,,,,,,,,,,,, 745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC",inpatient," 1,03,682.34 ",,,," 8,190.00 "," 6,154.39 "," 7,541.10 "," 10,426.65 "," 9,210.74 "," 7,164.98 "," 6,154.39 "," 10,426.65 ",,,,,,,,,,,,,,, 759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC",inpatient," 29,326.35 ",,,," 10,140.00 "," 4,090.07 "," 7,163.00 "," 6,929.33 "," 6,121.26 "," 4,761.69 "," 4,090.07 "," 10,140.00 ",,,,,,,,,,,,,,, 809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC,inpatient," 30,426.76 ",,,," 14,040.00 "," 6,931.89 "," 9,918.00 "," 11,743.88 "," 10,374.36 "," 8,070.15 "," 6,931.89 "," 14,040.00 ",,,,,,,,,,,,,,, 812,RED BLOOD CELL DISORDERS W/O MCC,inpatient," 27,286.10 ",,,," 10,530.00 "," 5,082.81 "," 7,438.50 "," 8,611.20 "," 7,607.00 "," 5,917.44 "," 5,082.81 "," 10,530.00 ",,,,,,,,,,,,,,, 845,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC,inpatient," 35,985.71 ",,,," 10,140.00 "," 4,984.97 "," 7,163.00 "," 8,445.45 "," 7,460.58 "," 5,803.54 "," 4,984.97 "," 10,140.00 ",,,,,,,,,,,,,,, 853,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC,inpatient," 1,20,586.64 ",,,," 38,610.00 "," 29,103.56 "," 35,550.90 "," 49,306.73 "," 43,556.80 "," 33,882.57 "," 29,103.56 "," 49,306.73 ",,,,,,,,,,,,,,, 854,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC,inpatient," 81,576.35 ",,,," 22,230.00 "," 12,677.09 "," 20,468.70 "," 21,477.30 "," 18,972.72 "," 14,758.76 "," 12,677.09 "," 22,230.00 ",,,,,,,,,,,,,,, 855,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC,inpatient," 36,156.94 ",,,," 14,040.00 "," 8,977.78 "," 12,927.60 "," 15,210.00 "," 13,436.28 "," 10,452.00 "," 8,977.78 "," 15,210.00 ",,,,,,,,,,,,,,, 856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC,inpatient," 1,85,634.40 ",,,," 34,710.00 "," 25,830.12 "," 31,959.90 "," 43,760.93 "," 38,657.73 "," 30,071.61 "," 25,830.12 "," 43,760.93 ",,,,,,,,,,,,,,, 857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC,inpatient," 1,17,637.69 ",,,," 21,060.00 "," 11,836.29 "," 19,391.40 "," 20,052.83 "," 17,714.36 "," 13,779.89 "," 11,836.29 "," 21,060.00 ",,,,,,,,,,,,,,, 858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC,inpatient," 1,01,609.38 ",,,," 14,430.00 "," 7,942.46 "," 13,286.70 "," 13,455.98 "," 11,886.80 "," 9,246.67 "," 7,942.46 "," 14,430.00 ",,,,,,,,,,,,,,, 863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC,inpatient," 71,123.16 ",,,," 13,650.00 "," 5,667.51 "," 9,642.50 "," 9,601.80 "," 8,482.08 "," 6,598.16 "," 5,667.51 "," 13,650.00 ",,,,,,,,,,,,,,, 864,FEVER AND INFLAMMATORY CONDITIONS,inpatient," 45,324.40 ",,,," 10,920.00 "," 4,974.04 "," 7,714.00 "," 8,426.93 "," 7,444.22 "," 5,790.81 "," 4,974.04 "," 10,920.00 ",,,,,,,,,,,,,,, 871,SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC,inpatient," 14,704.24 ",,,," 18,720.00 "," 10,683.56 "," 13,224.00 "," 18,099.90 "," 15,989.17 "," 12,437.88 "," 10,683.56 "," 18,720.00 ",,,,,,,,,,,,,,, 872,SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC,inpatient," 43,482.75 ",,,," 14,430.00 "," 6,059.43 "," 10,193.50 "," 10,265.78 "," 9,068.63 "," 7,054.43 "," 6,059.43 "," 14,430.00 ",,,,,,,,,,,,,,, 897,ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC,inpatient," 84,751.98 ",,,," 13,260.00 "," 4,723.70 "," 9,367.00 "," 8,002.80 "," 7,069.55 "," 5,499.36 "," 4,723.70 "," 13,260.00 ",,,,,,,,,,,,,,, 908,OTHER O.R. PROCEDURES FOR INJURIES W CC,inpatient," 1,04,744.80 ",,,," 15,600.00 "," 11,468.54 "," 14,364.00 "," 19,429.80 "," 17,163.99 "," 13,351.76 "," 11,468.54 "," 19,429.80 ",,,,,,,,,,,,,,, 909,OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC,inpatient," 1,46,725.41 ",,,," 9,750.00 "," 7,627.66 "," 8,977.50 "," 12,922.65 "," 11,415.67 "," 8,880.18 "," 7,627.66 "," 12,922.65 ",,,,,,,,,,,,,,, 914,TRAUMATIC INJURY W/O MCC,inpatient," 52,482.86 ",,,," 9,750.00 "," 4,821.53 "," 6,887.50 "," 8,168.55 "," 7,215.97 "," 5,613.26 "," 4,821.53 "," 9,750.00 ",,,,,,,,,,,,,,, 920,COMPLICATIONS OF TREATMENT W CC,inpatient," 65,623.37 ",,,," 11,310.00 "," 5,772.83 "," 7,989.50 "," 9,780.23 "," 8,639.70 "," 6,720.77 "," 5,772.83 "," 11,310.00 ",,,,,,,,,,,,,,, 921,COMPLICATIONS OF TREATMENT W/O CC/MCC,inpatient," 62,214.81 ",,,," 8,580.00 "," 4,066.48 "," 6,061.00 "," 6,889.35 "," 6,085.95 "," 4,734.22 "," 4,066.48 "," 8,580.00 ",,,,,,,,,,,,,,, 941,O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC,inpatient," 96,253.57 ",,,," 8,970.00 "," 10,654.79 "," 8,259.30 "," 18,051.15 "," 15,946.11 "," 12,404.38 "," 8,259.30 "," 18,051.15 ",,,,,,,,,,,,,,, 982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC,inpatient," 1,17,938.77 ",,,," 19,110.00 "," 14,116.41 "," 17,595.90 "," 23,915.78 "," 21,126.83 "," 16,434.43 "," 14,116.41 "," 23,915.78 ",,,,,,,,,,,,,,, 983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,inpatient," 96,278.76 ",,,," 9,750.00 "," 9,030.15 "," 8,977.50 "," 15,298.73 "," 13,514.66 "," 10,512.97 "," 8,977.50 "," 15,298.73 ",,,,,,,,,,,,,,, 988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC,inpatient," 1,04,598.24 ",,,," 17,160.00 "," 9,743.77 "," 15,800.40 "," 16,507.73 "," 14,582.67 "," 11,343.77 "," 9,743.77 "," 17,160.00 ",,,,,,,,,,,,,,, 989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,inpatient," 81,335.81 ",,,," 8,190.00 "," 5,989.22 "," 7,541.10 "," 10,146.83 "," 8,963.55 "," 6,972.69 "," 5,989.22 "," 10,146.83 ",,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 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