Provider Type 20 Physician, MD., Osteopathdhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources...Proc Code Description Mod Rate 11042 DEB SUBQ TISSUE 20 SQ CM/< 0001 61.54 11043

Note:

Proc Code Description Mod

01953 ANESTH BURN EACH 9 PERCENT 0001 21.12

01996 HOSP MANAGE CONT DRUG ADMIN 0001 63.36

10021 FNA W/O IMAGE 0001 70.92

10022 FNA W/IMAGE 0001 65.39

10030 Guide cathet fluid drainage 0001 154.73

10040 ACNE SURGERY 0001 87.47

10060 DRAINAGE OF SKIN ABSCESS 0001 95.60

10061 DRAINAGE OF SKIN ABSCESS 0001 178.04

10080 DRAINAGE OF PILONIDAL CYST 0001 103.29

10081 DRAINAGE OF PILONIDAL CYST 0001 172.45

10120 REMOVE FOREIGN BODY 0001 103.22

10121 REMOVE FOREIGN BODY 0001 185.58

10140 DRAINAGE OF HEMATOMA/FLUID 0001 118.06

10160 PUNCTURE DRAINAGE OF LESION 0001 95.62

10180 COMPLEX DRAINAGE WOUND 0001 178.97

11000 DEBRIDE INFECTED SKIN 0001 28.42

11001 DEBRIDE INFECTED SKIN ADD-ON 0001 14.22

11004 DEBRIDE GENITALIA & PERINEUM 0001 579.35

11005 DEBRIDE ABDOM WALL 0001 781.65

11006 DEBRIDE GENIT/PER/ABDOM WALL 0001 702.26

11008 REMOVE MESH FROM ABD WALL 0001 274.06

11010 DEBRIDE SKIN AT FX SITE 0001 278.30

11011 DEBRIDE SKIN MUSC AT FX SITE 0001 301.71

11012 DEB SKIN BONE AT FX SITE 0001 426.17

Rate

CPT codes, descriptions and other data only are copyright © 2008 American Medical Association. All

rights reserved. Applicable FARS/DFARS apply. CPT is a registered trademark ® of the American Medical

Association.Current Dental Terminology, fourth edition (CDT) (including procedure codes, definitions (descriptors) and

other data) is copyrighted by the American Dental Association. © 2008 American Dental Association. All

rights reserved. Applicable FARS/DFARS apply.

Provider Type 20 Physician, MD., OsteopathReimbursement Rates

Updated: July 1, 2015

The information contained in the schedule is made available to provide information and is not a

guarantee by the State or the Department or its employees as to the present accuracy of the

information contained herein. For example, coverage as well as an actual rate may have been revised or

updated and may no longer be the same as posted on the website.

Procedure codes with a rate of $0.00 are reimbursed at 62% of Usual and Customary charges unless

noted otherwise in Nevada Medicaid policy.

Proc Code Description Mod Rate

11042 DEB SUBQ TISSUE 20 SQ CM/< 0001 61.54

11043 DEB MUSC/FASCIA 20 SQ CM/< 0001 157.36

11044 DEB BONE 20 SQ CM/< 0001 234.59

11045 DEB SUBQ TISSUE ADD-ON 0001 27.63

11046 DEB MUSC/FASCIA ADD-ON 0001 56.21

11047 DEB BONE ADD-ON 0001 100.66

11055 TRIM SKIN LESION 0001 15.90

11056 TRIM SKIN LESIONS 2 TO 4 0001 22.47

11057 TRIM SKIN LESIONS OVER 4 0001 29.39

11100 BIOPSY SKIN LESION 0001 48.61

11101 BIOPSY SKIN ADD-ON 0001 24.46

11200 REMOVAL OF SKIN TAGS <W/15 0001 73.00

11201 REMOVE SKIN TAGS ADD-ON 0001 16.77

11300 SHAVE SKIN LESION 0.5 CM/< 0001 34.94

11301 SHAVE SKIN LESION 0.6-1.0 CM 0001 53.11


11303 SHAVE SKIN LESION >2.0 CM 0001 74.11









11400 EXC TR-EXT B9+MARG 0.5 CM< 0001 79.32

11401 EXC TR-EXT B9+MARG 0.6-1 CM 0001 103.18


11403 EXC TR-EXT B9+MARG 2.1-3CM/< 0001 146.50


11406 EXC TR-EXT B9+MARG >4.0 CM 0001 244.91

11420 EXC H-F-NK-SP B9+MARG 0.5/< 0001 81.23

11421 EXC H-F-NK-SP B9+MARG 0.6-1 0001 110.40

11422 EXC H-F-NK-SP B9+MARG 1.1-2 0001 134.86

11423 EXC H-F-NK-SP B9+MARG 2.1-3 0001 156.55

11424 EXC H-F-NK-SP B9+MARG 3.1-4 0001 178.52

11426 EXC H-F-NK-SP B9+MARG >4 CM 0001 273.01

11440 EXC FACE-MM B9+MARG 0.5 CM/< 0001 103.53

11441 EXC FACE-MM B9+MARG 0.6-1 CM 0001 131.15




11446 EXC FACE-MM B9+MARG >4 CM 0001 326.08

11450 REMOVAL SWEAT GLAND LESION 0001 250.45







11600 EXC TR-EXT MAL+MARG 0.5 CM/< 0001 119.51

11601 EXC TR-EXT MAL+MARG 0.6-1 CM 0001 148.23




11606 EXC TR-EXT MAL+MARG >4 CM 0001 319.34

11620 EXC H-F-NK-SP MAL+MARG 0.5/< 0001 121.29

11621 EXC S/N/H/F/G MAL+MRG 0.6-1 0001 148.93

11622 EXC S/N/H/F/G MAL+MRG 1.1-2 0001 170.68

11623 EXC S/N/H/F/G MAL+MRG 2.1-3 0001 211.61

11624 EXC S/N/H/F/G MAL+MRG 3.1-4 0001 239.93

11626 EXC S/N/H/F/G MAL+MRG >4 CM 0001 294.83

11640 EXC F/E/E/N/L MAL+MRG 0.5CM< 0001 125.18

11641 EXC F/E/E/N/L MAL+MRG 0.6-1 0001 155.98

11642 EXC F/E/E/N/L MAL+MRG 1.1-2 0001 183.25

11643 EXC F/E/E/N/L MAL+MRG 2.1-3 0001 230.87

11644 EXC F/E/E/N/L MAL+MRG 3.1-4 0001 285.84

11646 EXC F/E/E/N/L MAL+MRG >4 CM 0001 397.05

11719 TRIM NAIL(S) ANY NUMBER 0001 7.60

11720 DEBRIDE NAIL 1-5 0001 14.90

11721 DEBRIDE NAIL 6 OR MORE 0001 24.56

11730 REMOVAL OF NAIL PLATE 0001 50.53

11732 REMOVE NAIL PLATE ADD-ON 0001 20.06

11740 DRAIN BLOOD FROM UNDER NAIL 0001 32.76

11750 REMOVAL OF NAIL BED 0001 173.14

11752 REMOVE NAIL BED/TIP 0001 259.66

11755 BIOPSY NAIL UNIT 0001 78.21

11760 REPAIR OF NAIL BED 0001 133.87

11762 RECONSTRUCTION OF NAIL BED 0001 185.05

11765 EXCISION OF NAIL FOLD TOE 0001 93.04

11770 REMOVE PILONIDAL CYST SIMPLE 0001 183.77

11771 REMOVE PILONIDAL CYST EXTEN 0001 431.80

11772 REMOVE PILONIDAL CYST COMPL 0001 573.13

11900 INJECT SKIN LESIONS </W 7 0001 31.12

11901 INJECT SKIN LESIONS >7 0001 48.63

11950 TX CONTOUR DEFECTS 1 CC/< 0001 53.20

11951 TX CONTOUR DEFECTS 1.1-5.0CC 0001 76.48

11952 TX CONTOUR DEFECTS 5.1-10CC 0001 100.70

11954 TX CONTOUR DEFECTS >10.0 CC 0001 116.38

11960 INSERT TISSUE EXPANDER(S) 0001 934.51

11970 REPLACE TISSUE EXPANDER 0001 616.24

11971 REMOVE TISSUE EXPANDER(S) 0001 322.25

11976 REMOVE CONTRACEPTIVE CAPSULE 0001 97.05


11980 IMPLANT HORMONE PELLET(S) 0001 79.88

11981 INSERT DRUG IMPLANT DEVICE 0001 81.34

11982 REMOVE DRUG IMPLANT DEVICE 0001 97.30

11983 REMOVE/INSERT DRUG IMPLANT 0001 168.65

12001 RPR S/N/AX/GEN/TRNK 2.5CM/< 0001 45.00

12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM 0001 59.25

12004 RPR S/N/AX/GEN/TRK7.6-12.5CM 0001 73.87

12005 RPR S/N/A/GEN/TRK12.6-20.0CM 0001 99.98

12006 RPR S/N/A/GEN/TRK20.1-30.0CM 0001 121.24

12007 RPR S/N/AX/GEN/TRNK >30.0 CM 0001 150.62

12011 RPR F/E/E/N/L/M 2.5 CM/< 0001 56.15

12013 RPR F/E/E/N/L/M 2.6-5.0 CM 0001 62.72

12014 RPR F/E/E/N/L/M 5.1-7.5 CM 0001 79.77

12015 RPR F/E/E/N/L/M 7.6-12.5 CM 0001 99.25

12016 RPR FE/E/EN/L/M 12.6-20.0 CM 0001 134.79

12017 RPR FE/E/EN/L/M 20.1-30.0 CM 0001 154.16

12018 RPR F/E/E/N/L/M >30.0 CM 0001 174.32

12020 CLOSURE OF SPLIT WOUND 0001 190.75

12021 CLOSURE OF SPLIT WOUND 0001 141.38

12031 INTMD RPR S/A/T/EXT 2.5 CM/< 0001 152.69

12032 INTMD RPR S/A/T/EXT 2.6-7.5 0001 193.83

12034 INTMD RPR S/TR/EXT 7.6-12.5 0001 206.50

12035 INTMD RPR S/A/T/EXT 12.6-20 0001 242.75

12036 INTMD RPR S/A/T/EXT 20.1-30 0001 281.53

12037 INTMD RPR S/TR/EXT >30.0 CM 0001 329.21

12041 INTMD RPR N-HF/GENIT 2.5CM/< 0001 156.10

12042 INTMD RPR N-HF/GENIT2.6-7.5 0001 199.13

12044 INTMD RPR N-HF/GENIT7.6-12.5 0001 215.46

12045 INTMD RPR N-HF/GENIT12.6-20 0001 270.64

12046 INTMD RPR N-HF/GENIT20.1-30 0001 307.30

12047 INTMD RPR N-HF/GENIT >30.0CM 0001 342.23

12051 INTMD RPR FACE/MM 2.5 CM/< 0001 171.16

12052 INTMD RPR FACE/MM 2.6-5.0 CM 0001 202.59

12053 INTMD RPR FACE/MM 5.1-7.5 CM 0001 217.62

12054 INTMD RPR FACE/MM 7.6-12.5CM 0001 229.00

12055 INTMD RPR FACE/MM 12.6-20 CM 0001 304.25

12056 INTMD RPR FACE/MM 20.1-30.0 0001 378.07

12057 INTMD RPR FACE/MM >30.0 CM 0001 380.17

13100 CMPLX RPR TRUNK 1.1-2.5 CM 0001 205.67

13101 CMPLX RPR TRUNK 2.6-7.5 CM 0001 253.35

13102 CMPLX RPR TRUNK ADDL 5CM/< 0001 74.94

13120 CMPLX RPR S/A/L 1.1-2.5 CM 0001 236.18

13121 CMPLX RPR S/A/L 2.6-7.5 CM 0001 266.90

13122 CMPLX RPR S/A/L ADDL 5 CM/> 0001 86.11

13131 CMPLX RPR F/C/C/M/N/AX/G/H/F 0001 250.46




13151 CMPLX RPR E/N/E/L 1.1-2.5 CM 0001 287.17

13152 CMPLX RPR E/N/E/L 2.6-7.5 CM 0001 348.07

13153 CMPLX RPR E/N/E/L ADDL 5CM/< 0001 142.39

13160 LATE CLOSURE OF WOUND 0001 812.08

14000 TIS TRNFR TRUNK 10 SQ CM/< 0001 503.62

14001 TIS TRNFR TRUNK 10.1-30SQCM 0001 653.91

14020 TIS TRNFR S/A/L 10 SQ CM/< 0001 570.41

14021 TIS TRNFR S/A/L 10.1-30 SQCM 0001 718.98

14040 TIS TRNFR F/C/C/M/N/A/G/H/F 0001 634.12

14041 TIS TRNFR F/C/C/M/N/A/G/H/F 0001 777.02

14060 TIS TRNFR E/N/E/L 10 SQ CM/< 0001 675.50

14061 TIS TRNFR E/N/E/L10.1-30SQCM 0001 831.27

14301 TIS TRNFR ANY 30.1-60 SQ CM 0001 885.86

14302 TIS TRNFR ADDL 30 SQ CM/< 0001 222.91

14350 FILLETED FINGER/TOE FLAP 0001 710.79

15002 WOUND PREP TRK/ARM/LEG 0001 228.12

15003 WOUND PREP ADDL 100 CM 0001 45.82

15004 WOUND PREP F/N/HF/G 0001 273.12

15005 WND PREP F/N/HF/G ADDL CM 0001 92.01

15040 HARVEST CULTURED SKIN GRAFT 0001 127.99

15050 SKIN PINCH GRAFT 0001 447.97

15100 SKIN SPLT GRFT TRNK/ARM/LEG 0001 721.11

15101 SKIN SPLT GRFT T/A/L ADD-ON 0001 111.59

15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 0001 755.76

15111 EPIDRM AUTOGRFT T/A/L ADD-ON 0001 102.43

15115 EPIDRM A-GRFT FACE/NCK/HF/G 0001 760.07

15116 EPIDRM A-GRFT F/N/HF/G ADDL 0001 135.54

15120 SKN SPLT A-GRFT FAC/NCK/HF/G 0001 704.54

15121 SKN SPLT A-GRFT F/N/HF/G ADD 0001 132.65

15130 DERM AUTOGRAFT TRNK/ARM/LEG 0001 572.46

15131 DERM AUTOGRAFT T/A/L ADD-ON 0001 93.99

15135 DERM AUTOGRAFT FACE/NCK/HF/G 0001 751.60

15136 DERM AUTOGRAFT F/N/HF/G ADD 0001 85.38

15150 CULT SKIN GRFT T/ARM/LEG 0001 628.41

15151 CULT SKIN GRFT T/A/L ADDL 0001 109.41

15152 CULT SKIN GRAFT T/A/L +% 0001 141.28

15155 CULT SKIN GRAFT F/N/HF/G 0001 643.99

15156 CULT SKIN GRFT F/N/HFG ADD 0001 150.68

15157 CULT EPIDERM GRFT F/N/HFG +% 0001 151.39

15200 SKIN FULL GRAFT TRUNK 0001 676.40

15201 SKIN FULL GRAFT TRUNK ADD-ON 0001 80.59

15220 SKIN FULL GRAFT SCLP/ARM/LEG 0001 617.95

15221 SKIN FULL GRAFT ADD-ON 0001 72.52

15240 SKIN FULL GRFT FACE/GENIT/HF 0001 804.14



15260 SKIN FULL GRAFT EEN & LIPS 0001 861.95


15271 Skin sub graft trnk/arm/leg 0001 86.34

15272 SKIN SUB GRAFT T/A/L ADD-ON 0001 17.05

15273 Skin sub grft t/arm/lg child 0001 202.49

15274 SKN SUB GRFT T/A/L CHILD ADD 0001 43.94

15275 Skin sub graft face/nk/hf/g 0001 100.21

15276 SKIN SUB GRAFT F/N/HF/G ADDL 0001 25.03

15277 Skn sub grft f/n/hf/g child 0001 220.54

15278 SKN SUB GRFT F/N/HF/G CH ADD 0001 54.74

15570 SKIN PEDICLE FLAP TRUNK 0001 744.45

15572 SKIN PEDICLE FLAP ARMS/LEGS 0001 749.58

15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F 0001 773.29

15576 PEDICLE E/N/E/L/NTRORAL 0001 679.03

15600 DELAY FLAP TRUNK 0001 207.69

15610 DELAY FLAP ARMS/LEGS 0001 241.70

15620 DELAY FLAP F/C/C/N/AX/G/H/F 0001 328.03

15630 DELAY FLAP EYE/NOS/EAR/LIP 0001 347.96

15650 TRANSFER SKIN PEDICLE FLAP 0001 386.06

15731 FOREHEAD FLAP W/VASC PEDICLE 0001 1020.27

15732 MUSCLE-SKIN GRAFT HEAD/NECK 0001 1147.42

15734 MUSCLE-SKIN GRAFT TRUNK 0001 1331.00

15736 MUSCLE-SKIN GRAFT ARM 0001 1154.86

15738 MUSCLE-SKIN GRAFT LEG 0001 1252.48

15740 ISLAND PEDICLE FLAP GRAFT 0001 854.11

15750 NEUROVASCULAR PEDICLE FLAP 0001 919.29

15756 FREE MYO/SKIN FLAP MICROVASC 0001 2356.30

15757 FREE SKIN FLAP MICROVASC 0001 2323.21

15758 FREE FASCIAL FLAP MICROVASC 0001 2325.11

15760 COMPOSITE SKIN GRAFT 0001 714.82

15770 DERMA-FAT-FASCIA GRAFT 0001 683.17

15777 ACELLULAR DERM MATRIX IMPLT 0001 214.33

15786 ABRASION LESION SINGLE 0001 138.92

15787 ABRASION LESIONS ADD-ON 0001 17.77

15792 CHEMICAL PEEL NONFACIAL 0001 260.98

15793 CHEMICAL PEEL NONFACIAL 0001 363.84

15820 REVISION OF LOWER EYELID 0001 534.87

15821 REVISION OF LOWER EYELID 0001 567.00

15822 REVISION OF UPPER EYELID 0001 401.47

15823 REVISION OF UPPER EYELID 0001 567.31

15830 EXC SKIN ABD 0001 1181.00

15840 NERVE PALSY FASCIAL GRAFT 0001 1028.85

15841 NERVE PALSY MUSCLE GRAFT 0001 1609.83

15842 NERVE PALSY MICROSURG GRAFT 0001 2661.87

15845 SKIN AND MUSCLE REPAIR FACE 0001 1026.97

15847 EXC SKIN ABD ADD-ON 0001 412.57


15850 REMOVE SUTURES SAME SURGEON 0001 39.22

15851 REMOVE SUTURES DIFF SURGEON 0001 46.36

15852 DRESSING CHANGE NOT FOR BURN 0001 46.76

15860 TEST FOR BLOOD FLOW IN GRAFT 0001 111.94

15920 REMOVAL OF TAIL BONE ULCER 0001 608.79

15922 REMOVAL OF TAIL BONE ULCER 0001 791.10

15931 REMOVE SACRUM PRESSURE SORE 0001 684.75






15940 REMOVE HIP PRESSURE SORE 0001 702.46





15950 REMOVE THIGH PRESSURE SORE 0001 593.26






16000 INITIAL TREATMENT OF BURN(S) 0001 45.95

16020 DRESS/DEBRID P-THICK BURN S 0001 54.52

16025 DRESS/DEBRID P-THICK BURN M 0001 112.54

16030 DRESS/DEBRID P-THICK BURN L 0001 136.10

16035 INCISION OF BURN SCAB INITI 0001 198.83

16036 ESCHAROTOMY ADDL INCISION 0001 82.07

17000 DESTRUCT PREMALG LESION 0001 52.51

17003 DESTRUCT PREMALG LES 2-14 0001 2.45

17004 DESTROY PREMAL LESIONS 15/> 0001 99.06

17106 DESTRUCTION OF SKIN LESIONS 0001 271.65



17110 DESTRUCT B9 LESION 1-14 0001 68.86

17111 DESTRUCT LESION 15 OR MORE 0001 84.58

17250 CHEMICAL CAUTERY TISSUE 0001 37.26




















17311 MOHS 1 STAGE H/N/HF/G 0001 374.95

17312 MOHS ADDL STAGE 0001 198.98

17313 MOHS 1 STAGE T/A/L 0001 336.50

17314 MOHS ADDL STAGE T/A/L 0001 184.65

17315 MOHS SURG ADDL BLOCK 0001 52.09

17340 CRYOTHERAPY OF SKIN 0001 49.02

19000 DRAINAGE OF BREAST LESION 0001 43.88

19001 DRAIN BREAST LESION ADD-ON 0001 21.57

19020 INCISION OF BREAST LESION 0001 303.77

19030 INJECTION FOR BREAST X-RAY 0001 77.12

19081 Bx breast 1st lesion strtctc 0001 183.02

19082 Bx breast add lesion strtctc 0001 86.79

19083 Bx breast 1st lesion us imag 0001 171.39

19084 Bx breast add lesion us imag 0001 81.55

19085 Bx breast 1st lesion mr imag 0001 200.00

19086 Bx breast add lesion mr imag 0001 88.31

19100 BX BREAST PERCUT W/O IMAGE 0001 69.19

19101 BIOPSY OF BREAST OPEN 0001 219.59

19105 CRYOSURG ABLATE FA EACH 0001 189.90

19110 NIPPLE EXPLORATION 0001 339.52

19112 EXCISE BREAST DUCT FISTULA 0001 310.66

19120 REMOVAL OF BREAST LESION 0001 410.59

19125 EXCISION BREAST LESION 0001 455.77

19126 EXCISION ADDL BREAST LESION 0001 160.83

19260 REMOVAL OF CHEST WALL LESION 0001 1208.03

19271 REVISION OF CHEST WALL 0001 1626.86

19272 EXTENSIVE CHEST WALL SURGERY 0001 1817.52

19281 Perq device breast 1st imag 0001 101.85

19282 Perq device breast ea imag 0001 48.48

19283 Perq dev breast 1st strtctc 0001 102.93

19284 Perq dev breast add strtctc 0001 48.83

19285 Perq dev breast 1st us imag 0001 87.27

19286 Perq dev breast add us imag 0001 41.93

19287 Perq dev breast 1st mr guide 0001 142.77

19288 Perq dev breast add mr guide 0001 62.70

19296 PLACE PO BREAST CATH FOR RAD 0001 208.91


19297 PLACE BREAST CATH FOR RAD 0001 93.64

19298 PLACE BREAST RAD TUBE/CATHS 0001 322.73

19300 REMOVAL OF BREAST TISSUE 0001 410.06

19301 PARTIAL MASTECTOMY 0001 647.80

19302 P-MASTECTOMY W/LN REMOVAL 0001 891.99

19303 MAST SIMPLE COMPLETE 0001 1003.06

19304 MAST SUBQ 0001 568.06

19305 MAST RADICAL 0001 1123.49

19306 MAST RAD URBAN TYPE 0001 1191.07

19307 MAST MOD RAD 0001 1188.01

19316 SUSPENSION OF BREAST 0001 777.50

19318 REDUCTION OF LARGE BREAST 0001 1120.12

19324 ENLARGE BREAST 0001 487.24

19325 ENLARGE BREAST WITH IMPLANT 0001 652.99

19328 REMOVAL OF BREAST IMPLANT 0001 501.15

19330 REMOVAL OF IMPLANT MATERIAL 0001 640.56

19340 IMMEDIATE BREAST PROSTHESIS 0001 1018.34

19342 DELAYED BREAST PROSTHESIS 0001 935.58

19350 BREAST RECONSTRUCTION 0001 682.07

19355 CORRECT INVERTED NIPPLE(S) 0001 566.54


19361 BREAST RECONSTR W/LAT FLAP 0001 1601.69






19370 SURGERY OF BREAST CAPSULE 0001 694.56

19371 REMOVAL OF BREAST CAPSULE 0001 795.04

19380 REVISE BREAST RECONSTRUCTION 0001 783.15

19396 DESIGN CUSTOM BREAST IMPLANT 0001 149.72

20005 I&D ABSCESS SUBFASCIAL 0001 234.24

20100 EXPLORE WOUND NECK 0001 605.72

20101 EXPLORE WOUND CHEST 0001 207.42

20102 EXPLORE WOUND ABDOMEN 0001 255.06

20103 EXPLORE WOUND EXTREMITY 0001 350.18

20150 EXCISE EPIPHYSEAL BAR 0001 914.92

20200 MUSCLE BIOPSY 0001 95.54

20205 DEEP MUSCLE BIOPSY 0001 155.33

20206 NEEDLE BIOPSY MUSCLE 0001 59.75

20220 BONE BIOPSY TROCAR/NEEDLE 0001 72.89

20225 BONE BIOPSY TROCAR/NEEDLE 0001 111.12

20240 BONE BIOPSY EXCISIONAL 0001 220.33

20245 BONE BIOPSY EXCISIONAL 0001 623.63

20250 OPEN BONE BIOPSY 0001 389.62

20251 OPEN BONE BIOPSY 0001 423.99


20500 INJECTION OF SINUS TRACT 0001 84.36

20501 INJECT SINUS TRACT FOR X-RAY 0001 38.22

20520 REMOVAL OF FOREIGN BODY 0001 147.09


20526 THER INJECTION CARP TUNNEL 0001 56.66

20527 INJ DUPUYTREN CORD W/ENZYME 0001 65.19

20550 INJ TENDON SHEATH/LIGAMENT 0001 41.48

20551 INJ TENDON ORIGIN/INSERTION 0001 42.56

20552 INJ TRIGGER POINT 1/2 MUSCL 0001 38.04

20553 INJECT TRIGGER POINTS 3/> 0001 42.90

20555 Place ndl musc/tis for rt 0001 332.58

20600 DRAIN/INJ JOINT/BURSA W/O US 0001 35.53

20604 Drain/inj joint/bursa w/us 0001 44.80





20612 ASPIRATE/INJ GANGLION CYST 0001 41.58

20615 TREATMENT OF BONE CYST 0001 163.16

20650 INSERT AND REMOVE BONE PIN 0001 154.63

20660 APPLY REM FIXATION DEVICE 0001 243.31

20661 APPLICATION OF HEAD BRACE 0001 507.62

20662 APPLICATION OF PELVIS BRACE 0001 437.73

20663 APPLICATION OF THIGH BRACE 0001 452.02

20664 APPLICATION OF HALO 0001 873.71

20665 REMOVAL OF FIXATION DEVICE 0001 89.96

20670 REMOVAL OF SUPPORT IMPLANT 0001 148.01

20680 REMOVAL OF SUPPORT IMPLANT 0001 427.06

20690 APPLY BONE FIXATION DEVICE 0001 594.09

20692 APPLY BONE FIXATION DEVICE 0001 1122.31

20693 ADJUST BONE FIXATION DEVICE 0001 451.32

20694 REMOVE BONE FIXATION DEVICE 0001 339.17

20696 COMP MULTIPLANE EXT FIXATION 0001 1128.81

20697 COMP EXT FIXATE STRUT CHANGE 0001 1864.48

20802 REPLANTATION ARM COMPLETE 0001 2309.03

20805 REPLANT FOREARM COMPLETE 0001 3066.65

20808 REPLANTATION HAND COMPLETE 0001 3984.08

20816 REPLANTATION DIGIT COMPLETE 0001 1990.23

20822 REPLANTATION DIGIT COMPLETE 0001 1834.08

20824 REPLANTATION THUMB COMPLETE 0001 2148.50

20827 REPLANTATION THUMB COMPLETE 0001 1828.87

20838 REPLANTATION FOOT COMPLETE 0001 2604.41

20900 REMOVAL OF BONE FOR GRAFT 0001 192.55

20902 REMOVAL OF BONE FOR GRAFT 0001 288.17

20910 REMOVE CARTILAGE FOR GRAFT 0001 412.54

20912 REMOVE CARTILAGE FOR GRAFT 0001 485.48


20920 REMOVAL OF FASCIA FOR GRAFT 0001 397.10

20922 REMOVAL OF FASCIA FOR GRAFT 0001 502.12

20924 REMOVAL OF TENDON FOR GRAFT 0001 506.40

20926 REMOVAL OF TISSUE FOR GRAFT 0001 441.21

20930 SP BONE ALGRFT MORSEL ADD-ON 0001 95.56

20931 SP BONE ALGRFT STRUCT ADD-ON 0001 113.59

20936 SP BONE AGRFT LOCAL ADD-ON 0001 100.63

20937 SP BONE AGRFT MORSEL ADD-ON 0001 169.07

20938 SP BONE AGRFT STRUCT ADD-ON 0001 185.41

20950 FLUID PRESSURE MUSCLE 0001 91.42

20955 FIBULA BONE GRAFT MICROVASC 0001 2531.68

20956 ILIAC BONE GRAFT MICROVASC 0001 2660.26

20957 MT BONE GRAFT MICROVASC 0001 2292.26

20962 OTHER BONE GRAFT MICROVASC 0001 2199.34

20969 BONE/SKIN GRAFT MICROVASC 0001 2803.66

20970 BONE/SKIN GRAFT ILIAC CREST 0001 2878.50

20972 BONE/SKIN GRAFT METATARSAL 0001 2189.87

20973 BONE/SKIN GRAFT GREAT TOE 0001 2818.76

20974 ELECTRICAL BONE STIMULATION 0001 49.67

20975 ELECTRICAL BONE STIMULATION 0001 177.52

20979 US BONE STIMULATION 0001 32.75

20982 ABLATE BONE TUMOR(S) PERQ 0001 380.42

20983 Ablate bone tumor(s) perq 0001 397.62

20985 CPTR-ASST DIR MS PX 0001 148.10

21010 INCISION OF JAW JOINT 0001 750.81

21011 EXC FACE LES SC <2 CM 0001 257.00

21012 EXC FACE LES SBQ 2 CM/> 0001 335.20

21013 EXC FACE TUM DEEP < 2 CM 0001 397.84

21014 EXC FACE TUM DEEP 2 CM/> 0001 518.07

21015 RESECT FACE/SCALP TUM < 2 CM 0001 715.60

21016 RESECT FACE/SCALP TUM 2 CM/> 0001 1042.13

21025 EXCISION OF BONE LOWER JAW 0001 759.16

21026 EXCISION OF FACIAL BONE(S) 0001 505.05

21029 CONTOUR OF FACE BONE LESION 0001 657.33

21030 EXCISE MAX/ZYGOMA B9 TUMOR 0001 424.90

21031 REMOVE EXOSTOSIS MANDIBLE 0001 296.93

21032 REMOVE EXOSTOSIS MAXILLA 0001 294.00

21034 EXCISE MAX/ZYGOMA MAL TUMOR 0001 1169.56

21040 EXCISE MANDIBLE LESION 0001 425.60

21044 REMOVAL OF JAW BONE LESION 0001 888.91

21045 EXTENSIVE JAW SURGERY 0001 1235.02

21046 REMOVE MANDIBLE CYST COMPLEX 0001 1122.28

21047 EXCISE LWR JAW CYST W/REPAIR 0001 1314.24

21048 REMOVE MAXILLA CYST COMPLEX 0001 1152.72

21049 EXCIS UPPR JAW CYST W/REPAIR 0001 1224.19

21050 REMOVAL OF JAW JOINT 0001 873.04


21060 REMOVE JAW JOINT CARTILAGE 0001 838.12

21070 REMOVE CORONOID PROCESS 0001 618.63

21073 Mnpj of tmj w/anesth 0001 260.49

21076 PREPARE FACE/ORAL PROSTHESIS 0001 838.86












21100 MAXILLOFACIAL FIXATION 0001 383.01

21110 INTERDENTAL FIXATION 0001 682.14

21116 INJECTION JAW JOINT X-RAY 0001 42.76

21120 RECONSTRUCTION OF CHIN 0001 536.99




21125 AUGMENTATION LOWER JAW BONE 0001 816.02

21127 AUGMENTATION LOWER JAW BONE 0001 870.59

21137 REDUCTION OF FOREHEAD 0001 764.38



21141 LEFORT I-1 PIECE W/O GRAFT 0001 1383.70

21142 LEFORT I-2 PIECE W/O GRAFT 0001 1423.23

21143 LEFORT I-3/> PIECE W/O GRAFT 0001 1442.38

21145 LEFORT I-1 PIECE W/ GRAFT 0001 1516.36

21146 LEFORT I-2 PIECE W/ GRAFT 0001 1760.27

21147 LEFORT I-3/> PIECE W/ GRAFT 0001 1515.26

21150 LEFORT II ANTERIOR INTRUSION 0001 1812.33

21151 LEFORT II W/BONE GRAFTS 0001 2054.07

21154 LEFORT III W/O LEFORT I 0001 2237.04

21155 LEFORT III W/ LEFORT I 0001 2252.76

21159 LEFORT III W/FHDW/O LEFORT I 0001 2503.99

21160 LEFORT III W/FHD W/ LEFORT I 0001 2619.61

21172 RECONSTRUCT ORBIT/FOREHEAD 0001 1885.18

21175 RECONSTRUCT ORBIT/FOREHEAD 0001 2164.94

21179 RECONSTRUCT ENTIRE FOREHEAD 0001 1572.25

21180 RECONSTRUCT ENTIRE FOREHEAD 0001 1541.18

21181 CONTOUR CRANIAL BONE LESION 0001 727.23

21182 RECONSTRUCT CRANIAL BONE 0001 1927.27




21188 RECONSTRUCTION OF MIDFACE 0001 1582.46

21193 RECONST LWR JAW W/O GRAFT 0001 1310.93

21194 RECONST LWR JAW W/GRAFT 0001 1373.85

21195 RECONST LWR JAW W/O FIXATION 0001 1344.74

21196 RECONST LWR JAW W/FIXATION 0001 1491.76

21198 RECONSTR LWR JAW SEGMENT 0001 1173.98

21199 RECONSTR LWR JAW W/ADVANCE 0001 1057.18

21206 RECONSTRUCT UPPER JAW BONE 0001 1218.12

21208 AUGMENTATION OF FACIAL BONES 0001 869.99

21209 REDUCTION OF FACIAL BONES 0001 644.54

21210 FACE BONE GRAFT 0001 867.87

21215 LOWER JAW BONE GRAFT 0001 932.67

21230 RIB CARTILAGE GRAFT 0001 743.24

21235 EAR CARTILAGE GRAFT 0001 572.58

21240 RECONSTRUCTION OF JAW JOINT 0001 1111.69



21244 RECONSTRUCTION OF LOWER JAW 0001 1081.55

21245 RECONSTRUCTION OF JAW 0001 894.25


21247 RECONSTRUCT LOWER JAW BONE 0001 1599.49



21255 RECONSTRUCT LOWER JAW BONE 0001 1398.65

21256 RECONSTRUCTION OF ORBIT 0001 1239.11

21260 REVISE EYE SOCKETS 0001 1348.65





21270 AUGMENTATION CHEEK BONE 0001 737.70

21275 REVISION ORBITOFACIAL BONES 0001 851.50

21280 REVISION OF EYELID 0001 594.95


21295 REVISION OF JAW MUSCLE/BONE 0001 207.16

21296 REVISION OF JAW MUSCLE/BONE 0001 467.60

21310 CLOSED TX NOSE FX W/O MANJ 0001 27.83

21315 CLOSED TX NOSE FX W/O STABLJ 0001 154.03

21320 CLOSED TX NOSE FX W/ STABLJ 0001 136.31

21325 OPEN TX NOSE FX UNCOMPLICATD 0001 476.35

21330 OPEN TX NOSE FX W/SKELE FIXJ 0001 567.56

21335 OPEN TX NOSE & SEPTAL FX 0001 735.87

21336 OPEN TX SEPTAL FX W/WO STABJ 0001 652.23

21337 CLOSED TX SEPTAL&NOSE FX 0001 299.11

21338 OPEN NASOETHMOID FX W/O FIXJ 0001 727.49


21339 OPEN NASOETHMOID FX W/ FIXJ 0001 783.53

21340 PERQ TX NASOETHMOID FX 0001 754.75

21343 OPEN TX DPRSD FRONT SINUS FX 0001 1233.30

21344 OPEN TX COMPL FRONT SINUS FX 0001 1577.61

21345 CLOSED TX NOSE/JAW FX 0001 627.28

21346 OPN TX NASOMAX FX W/FIXJ 0001 917.47

21347 OPN TX NASOMAX FX MULTPLE 0001 1114.73

21348 OPN TX NASOMAX FX W/GRAFT 0001 1188.01

21355 PERQ TX MALAR FRACTURE 0001 324.16

21356 OPN TX DPRSD ZYGOMATIC ARCH 0001 380.80

21360 OPN TX DPRSD MALAR FRACTURE 0001 539.08

21365 OPN TX COMPLX MALAR FX 0001 1128.57

21366 OPN TX COMPLX MALAR W/GRFT 0001 1199.92

21385 OPN TX ORBIT FX TRANSANTRAL 0001 688.90

21386 OPN TX ORBIT FX PERIORBITAL 0001 708.33

21387 OPN TX ORBIT FX COMBINED 0001 742.66

21390 OPN TX ORBIT PERIORBTL IMPLT 0001 815.88

21395 OPN TX ORBIT PERIORBT W/GRFT 0001 990.80

21400 CLOSED TX ORBIT W/O MANIPULJ 0001 157.83

21401 CLOSED TX ORBIT W/MANIPULJ 0001 313.28

21406 OPN TX ORBIT FX W/O IMPLANT 0001 517.19

21407 OPN TX ORBIT FX W/IMPLANT 0001 662.89

21408 OPN TX ORBIT FX W/BONE GRFT 0001 916.78

21421 TREAT MOUTH ROOF FRACTURE 0001 658.38



21431 TREAT CRANIOFACIAL FRACTURE 0001 732.73





21440 TREAT DENTAL RIDGE FRACTURE 0001 483.45

21445 TREAT DENTAL RIDGE FRACTURE 0001 635.76

21450 TREAT LOWER JAW FRACTURE 0001 499.79









21480 RESET DISLOCATED JAW 0001 32.08

21485 RESET DISLOCATED JAW 0001 597.23

21490 REPAIR DISLOCATED JAW 0001 945.97

21495 TREAT HYOID BONE FRACTURE 0001 719.24


21497 INTERDENTAL WIRING 0001 625.25

21501 DRAIN NECK/CHEST LESION 0001 323.91

21502 DRAIN CHEST LESION 0001 533.86

21510 DRAINAGE OF BONE LESION 0001 447.77

21550 BIOPSY OF NECK/CHEST 0001 158.55

21552 EXC NECK LES SC 3 CM/> 0001 444.05

21554 EXC NECK TUM DEEP 5 CM/> 0001 728.42

21555 EXC NECK LES SC < 3 CM 0001 307.48

21556 EXC NECK TUM DEEP < 5 CM 0001 534.81

21557 RESECT NECK THORAX TUMOR<5CM 0001 964.60

21558 RESECT NECK TUMOR 5 CM/> 0001 1349.88

21600 PARTIAL REMOVAL OF RIB 0001 565.92

21610 PARTIAL REMOVAL OF RIB 0001 1206.90

21615 REMOVAL OF RIB 0001 636.96

21616 REMOVAL OF RIB AND NERVES 0001 858.59

21620 PARTIAL REMOVAL OF STERNUM 0001 512.47

21627 STERNAL DEBRIDEMENT 0001 547.31

21630 EXTENSIVE STERNUM SURGERY 0001 1225.33

21632 EXTENSIVE STERNUM SURGERY 0001 1225.93

21685 HYOID MYOTOMY & SUSPENSION 0001 1009.28

21700 REVISION OF NECK MUSCLE 0001 374.02

21705 REVISION OF NECK MUSCLE/RIB 0001 558.39



21740 RECONSTRUCTION OF STERNUM 0001 1023.76

21742 REPAIR STERN/NUSS W/O SCOPE 0001 890.88

21743 REPAIR STERNUM/NUSS W/SCOPE 0001 1172.51

21750 REPAIR OF STERNUM SEPARATION 0001 694.87

21805 TREATMENT OF RIB FRACTURE 0001 276.24

21811 Optx of rib fx w/fixj scope 0001 547.77

21812 Treatment of rib fracture 0001 651.41

21813 Treatment of rib fracture 0001 878.82

21820 TREAT STERNUM FRACTURE 0001 146.94

21825 TREAT STERNUM FRACTURE 0001 552.50

21899 NECK/CHEST SURGERY PROCEDURE 0001 0.00

21920 BIOPSY SOFT TISSUE OF BACK 0001 162.58

21925 BIOPSY SOFT TISSUE OF BACK 0001 353.89

21930 EXC BACK LES SC < 3 CM 0001 364.97

21931 EXC BACK LES SC 3 CM/> 0001 468.71

21932 EXC BACK TUM DEEP < 5 CM 0001 659.38

21933 EXC BACK TUM DEEP 5 CM/> 0001 734.26

21935 RESECT BACK TUM < 5 CM 0001 1028.51

21936 RESECT BACK TUM 5 CM/> 0001 1411.81

22010 I&D P-SPINE C/T/CERV-THOR 0001 955.12

22015 I&D ABSCESS P-SPINE L/S/LS 0001 902.91

22100 REMOVE PART OF NECK VERTEBRA 0001 883.35


22101 REMOVE PART THORAX VERTEBRA 0001 898.30

22102 REMOVE PART LUMBAR VERTEBRA 0001 822.13

22103 REMOVE EXTRA SPINE SEGMENT 0001 143.62

22110 REMOVE PART OF NECK VERTEBRA 0001 1094.73

22112 REMOVE PART THORAX VERTEBRA 0001 1080.61

22114 REMOVE PART LUMBAR VERTEBRA 0001 998.86

22116 REMOVE EXTRA SPINE SEGMENT 0001 141.07

22206 INCIS SPINE 3 COLUMN THORAC 0001 2369.69

22207 INCIS SPINE 3 COLUMN LUMBAR 0001 2408.98

22208 INCIS SPINE 3 COLUMN ADL SEG 0001 593.40

22210 INCIS 1 VERTEBRAL SEG CERV 0001 1782.58

22212 INCIS 1 VERTEBRAL SEG THORAC 0001 1481.00

22214 INCIS 1 VERTEBRAL SEG LUMBAR 0001 1492.34

22216 INCIS ADDL SPINE SEGMENT 0001 366.65

22220 INCIS W/DISCECTOMY CERVICAL 0001 1628.52

22222 INCIS W/DISCECTOMY THORACIC 0001 1570.14

22224 INCIS W/DISCECTOMY LUMBAR 0001 1597.77

22226 REVISE EXTRA SPINE SEGMENT 0001 368.21

22305 CLOSED TX SPINE PROCESS FX 0001 173.42

22310 CLOSED TX VERT FX W/O MANJ 0001 283.20

22315 CLOSED TX VERT FX W/MANJ 0001 777.76

22318 TREAT ODONTOID FX W/O GRAFT 0001 1645.77

22319 TREAT ODONTOID FX W/GRAFT 0001 1837.99

22325 TREAT SPINE FRACTURE 0001 1451.61

22326 TREAT NECK SPINE FRACTURE 0001 1498.24

22327 TREAT THORAX SPINE FRACTURE 0001 1496.86

22328 TREAT EACH ADD SPINE FX 0001 285.38

22505 MANIPULATION OF SPINE 0001 122.72

22510 Perq cervicothoracic inject 0001 442.43

22511 Perq lumbosacral injection 0001 414.68

22512 Vertebroplasty addl inject 0001 201.03

22513 Perq vertebral augmentation 0001 505.30



22526 IDET SINGLE LEVEL 0001 341.20

22527 IDET 1 OR MORE LEVELS 0001 153.53

22532 LAT THORAX SPINE FUSION 0001 1804.74

22533 LAT LUMBAR SPINE FUSION 0001 1688.24

22534 LAT THOR/LUMB ADDL SEG 0001 365.79

22548 NECK SPINE FUSION 0001 1974.80

22551 NECK SPINE FUSE&REMOV BEL C2 0001 1729.36

22552 ADDL NECK SPINE FUSION ARTHR 0001 397.84


22556 THORAX SPINE FUSION 0001 1680.57

22558 LUMBAR SPINE FUSION 0001 1550.74

22585 ADDITIONAL SPINAL FUSION 0001 338.29


22586 PRESCRL FUSE W/ INSTR L5-S1 0001 1889.92

22590 SPINE & SKULL SPINAL FUSION 0001 1592.25

22595 NECK SPINAL FUSION 0001 1515.95


22610 THORAX SPINE FUSION 0001 1271.14


22614 SPINE FUSION EXTRA SEGMENT 0001 395.08



22633 LUMBAR SPINE FUSION COMBINED 0001 1859.29


22800 POST FUSION </6 VERT SEG 0001 1368.74

22802 POST FUSION 7-12 VERT SEG 0001 2112.56

22804 POST FUSION 13/> VERT SEG 0001 2430.04

22808 ANT FUSION 2-3 VERT SEG 0001 1838.77

22810 ANT FUSION 4-7 VERT SEG 0001 2058.02

22812 ANT FUSION 8/> VERT SEG 0001 2258.51

22818 KYPHECTOMY 1-2 SEGMENTS 0001 2185.12

22819 KYPHECTOMY 3 OR MORE 0001 2763.16

22830 EXPLORATION OF SPINAL FUSION 0001 818.31

22840 INSERT SPINE FIXATION DEVICE 0001 770.60








22848 INSERT PELV FIXATION DEVICE 0001 360.79

22849 REINSERT SPINAL FIXATION 0001 1312.67

22850 REMOVE SPINE FIXATION DEVICE 0001 729.21

22851 APPLY SPINE PROSTH DEVICE 0001 412.75



22856 CERV ARTIFIC DISKECTOMY 0001 1673.17

22857 LUMBAR ARTIF DISKECTOMY 0001 1839.11

22858 Second level cer diskectomy 0001 670.62

22861 REVISE CERV ARTIFIC DISC 0001 2221.42

22862 REVISE LUMBAR ARTIF DISC 0001 2143.16

22864 REMOVE CERV ARTIF DISC 0001 1998.89

22865 REMOVE LUMB ARTIF DISC 0001 2061.56

22900 EXC ABDL TUM DEEP < 5 CM 0001 561.70

22901 EXC ABDL TUM DEEP 5 CM/> 0001 659.96

22902 EXC ABD LES SC < 3 CM 0001 323.03

22903 EXC ABD LES SC 3 CM/> 0001 431.56

22904 RADICAL RESECT ABD TUMOR<5CM 0001 1047.04


22905 RAD RESECT ABD TUMOR 5 CM/> 0001 1333.53

23000 REMOVAL OF CALCIUM DEPOSITS 0001 371.28

23020 RELEASE SHOULDER JOINT 0001 690.98

23030 DRAIN SHOULDER LESION 0001 255.79

23031 DRAIN SHOULDER BURSA 0001 219.81

23035 DRAIN SHOULDER BONE LESION 0001 685.60

23040 EXPLORATORY SHOULDER SURGERY 0001 720.62

23044 EXPLORATORY SHOULDER SURGERY 0001 568.42

23065 BIOPSY SHOULDER TISSUES 0001 167.66

23066 BIOPSY SHOULDER TISSUES 0001 356.13

23071 EXC SHOULDER LES SC 3 CM/> 0001 418.08

23073 EXC SHOULDER TUM DEEP 5 CM/> 0001 691.05

23075 EXC SHOULDER LES SC < 3 CM 0001 326.17

23076 EXC SHOULDER TUM DEEP < 5 CM 0001 538.97

23077 RESECT SHOULDER TUMOR < 5 CM 0001 1145.50

23078 RESECT SHOULDER TUMOR 5 CM/> 0001 1446.29

23100 BIOPSY OF SHOULDER JOINT 0001 500.86

23101 SHOULDER JOINT SURGERY 0001 456.34

23105 REMOVE SHOULDER JOINT LINING 0001 639.59

23106 INCISION OF COLLARBONE JOINT 0001 496.66

23107 EXPLORE TREAT SHOULDER JOINT 0001 663.02

23120 PARTIAL REMOVAL COLLAR BONE 0001 587.04

23125 REMOVAL OF COLLAR BONE 0001 709.30

23130 REMOVE SHOULDER BONE PART 0001 609.77

23140 REMOVAL OF BONE LESION 0001 530.02



23150 REMOVAL OF HUMERUS LESION 0001 660.79



23170 REMOVE COLLAR BONE LESION 0001 560.73

23172 REMOVE SHOULDER BLADE LESION 0001 567.44

23174 REMOVE HUMERUS LESION 0001 758.57

23180 REMOVE COLLAR BONE LESION 0001 667.26

23182 REMOVE SHOULDER BLADE LESION 0001 662.38


23190 PARTIAL REMOVAL OF SCAPULA 0001 571.13

23195 REMOVAL OF HEAD OF HUMERUS 0001 755.95

23200 RESECT CLAVICLE TUMOR 0001 1521.53

23210 RESECT SCAPULA TUMOR 0001 1788.71

23220 RESECT PROX HUMERUS TUMOR 0001 1961.56

23330 REMOVE SHOULDER FOREIGN BODY 0001 151.47

23333 Remove shoulder fb deep 0001 458.05

23334 Shoulder prosthesis removal 0001 1079.24

23335 Shoulder prosthesis removal 0001 1286.14

23350 INJECTION FOR SHOULDER X-RAY 0001 51.47


23395 MUSCLE TRANSFER SHOULDER/ARM 0001 1291.08

23397 MUSCLE TRANSFERS 0001 1144.18

23400 FIXATION OF SHOULDER BLADE 0001 972.95

23405 INCISION OF TENDON & MUSCLE 0001 630.86

23406 INCISE TENDON(S) & MUSCLE(S) 0001 773.66

23410 REPAIR ROTATOR CUFF ACUTE 0001 824.03

23412 REPAIR ROTATOR CUFF CHRONIC 0001 855.51

23415 RELEASE OF SHOULDER LIGAMENT 0001 697.70

23420 REPAIR OF SHOULDER 0001 972.32

23430 REPAIR BICEPS TENDON 0001 750.45

23440 REMOVE/TRANSPLANT TENDON 0001 758.38

23450 REPAIR SHOULDER CAPSULE 0001 950.23






23470 RECONSTRUCT SHOULDER JOINT 0001 1211.73

23472 RECONSTRUCT SHOULDER JOINT 0001 1469.19

23473 Revis reconst shoulder joint 0001 1637.93

23474 Revis reconst shoulder joint 0001 1770.40

23480 REVISION OF COLLAR BONE 0001 821.67

23485 REVISION OF COLLAR BONE 0001 958.12

23490 REINFORCE CLAVICLE 0001 863.87

23491 REINFORCE SHOULDER BONES 0001 1016.45

23500 TREAT CLAVICLE FRACTURE 0001 222.46



23520 TREAT CLAVICLE DISLOCATION 0001 233.85








23570 TREAT SHOULDER BLADE FX 0001 238.39

23575 TREAT SHOULDER BLADE FX 0001 374.55

23585 TREAT SCAPULA FRACTURE 0001 984.17

23600 TREAT HUMERUS FRACTURE 0001 308.17








23650 TREAT SHOULDER DISLOCATION 0001 287.51



23665 TREAT DISLOCATION/FRACTURE 0001 396.47




23700 FIXATION OF SHOULDER 0001 195.73

23800 FUSION OF SHOULDER JOINT 0001 1028.77

23802 FUSION OF SHOULDER JOINT 0001 1287.05

23900 AMPUTATION OF ARM & GIRDLE 0001 1392.78

23920 AMPUTATION AT SHOULDER JOINT 0001 1129.88

23921 AMPUTATION FOLLOW-UP SURGERY 0001 476.48

23930 DRAINAGE OF ARM LESION 0001 215.26

23931 DRAINAGE OF ARM BURSA 0001 160.92

23935 DRAIN ARM/ELBOW BONE LESION 0001 509.90

24000 EXPLORATORY ELBOW SURGERY 0001 477.65

24006 RELEASE ELBOW JOINT 0001 712.58

24065 BIOPSY ARM/ELBOW SOFT TISSUE 0001 167.92

24066 BIOPSY ARM/ELBOW SOFT TISSUE 0001 412.06

24071 EXC ARM/ELBOW LES SC 3 CM/> 0001 405.45

24073 EX ARM/ELBOW TUM DEEP 5 CM/> 0001 690.28

24075 EXC ARM/ELBOW LES SC < 3 CM 0001 329.32

24076 EX ARM/ELBOW TUM DEEP < 5 CM 0001 543.24

24077 RESECT ARM/ELBOW TUM < 5 CM 0001 1038.15

24079 RESECT ARM/ELBOW TUM 5 CM/> 0001 1329.20

24100 BIOPSY ELBOW JOINT LINING 0001 418.21

24101 EXPLORE/TREAT ELBOW JOINT 0001 499.94

24102 REMOVE ELBOW JOINT LINING 0001 616.46

24105 REMOVAL OF ELBOW BURSA 0001 349.71


24115 REMOVE/GRAFT BONE LESION 0001 738.01


24120 REMOVE ELBOW LESION 0001 528.91



24130 REMOVAL OF HEAD OF RADIUS 0001 507.60

24134 REMOVAL OF ARM BONE LESION 0001 747.54

24136 REMOVE RADIUS BONE LESION 0001 637.56

24138 REMOVE ELBOW BONE LESION 0001 674.74

24140 PARTIAL REMOVAL OF ARM BONE 0001 699.57

24145 PARTIAL REMOVAL OF RADIUS 0001 592.14

24147 PARTIAL REMOVAL OF ELBOW 0001 622.55

24149 RADICAL RESECTION OF ELBOW 0001 1175.48

24150 RESECT DISTAL HUMERUS TUMOR 0001 1562.42

24152 RESECT RADIUS TUMOR 0001 1381.63


24155 REMOVAL OF ELBOW JOINT 0001 854.98

24160 REMOVE ELBOW JOINT IMPLANT 0001 1263.78

24164 REMOVE RADIUS HEAD IMPLANT 0001 730.26

24200 REMOVAL OF ARM FOREIGN BODY 0001 139.38

24201 REMOVAL OF ARM FOREIGN BODY 0001 369.20

24220 INJECTION FOR ELBOW X-RAY 0001 68.51

24300 MANIPULATE ELBOW W/ANESTH 0001 412.78

24301 MUSCLE/TENDON TRANSFER 0001 754.12

24305 ARM TENDON LENGTHENING 0001 576.39

24310 REVISION OF ARM TENDON 0001 476.16

24320 REPAIR OF ARM TENDON 0001 781.80

24330 REVISION OF ARM MUSCLES 0001 718.05

24331 REVISION OF ARM MUSCLES 0001 787.41

24332 TENOLYSIS TRICEPS 0001 612.80

24340 REPAIR OF BICEPS TENDON 0001 616.13

24341 REPAIR ARM TENDON/MUSCLE 0001 749.35

24342 REPAIR OF RUPTURED TENDON 0001 778.44

24343 REPR ELBOW LAT LIGMNT W/TISS 0001 706.22

24344 RECONSTRUCT ELBOW LAT LIGMNT 0001 1100.92

24345 REPR ELBW MED LIGMNT W/TISSU 0001 702.27

24346 RECONSTRUCT ELBOW MED LIGMNT 0001 1100.92

24357 REPAIR ELBOW PERC 0001 440.90

24358 REPAIR ELBOW W/DEB OPEN 0001 523.40

24359 REPAIR ELBOW DEB/ATTCH OPEN 0001 660.59

24360 RECONSTRUCT ELBOW JOINT 0001 900.03



24363 REPLACE ELBOW JOINT 0001 1463.30

24365 RECONSTRUCT HEAD OF RADIUS 0001 639.39

24366 RECONSTRUCT HEAD OF RADIUS 0001 681.95

24370 Revise reconst elbow joint 0001 1548.55

24371 Revise reconst elbow joint 0001 1788.11

24400 REVISION OF HUMERUS 0001 819.78



24430 REPAIR OF HUMERUS 0001 1061.96

24435 REPAIR HUMERUS WITH GRAFT 0001 1082.15

24470 REVISION OF ELBOW JOINT 0001 585.80

24495 DECOMPRESSION OF FOREARM 0001 651.08

24498 REINFORCE HUMERUS 0001 869.75



















24586 TREAT ELBOW FRACTURE 0001 1088.45


24600 TREAT ELBOW DISLOCATION 0001 334.34






24650 TREAT RADIUS FRACTURE 0001 240.24




24670 TREAT ULNAR FRACTURE 0001 262.66



24800 FUSION OF ELBOW JOINT 0001 830.51

24802 FUSION/GRAFT OF ELBOW JOINT 0001 1003.52

24900 AMPUTATION OF UPPER ARM 0001 736.14

24920 AMPUTATION OF UPPER ARM 0001 732.97



24931 AMPUTATE UPPER ARM & IMPLANT 0001 769.65

24935 REVISION OF AMPUTATION 0001 1045.53

24940 REVISION OF UPPER ARM 0001 1143.92

25000 INCISION OF TENDON SHEATH 0001 334.91

25001 INCISE FLEXOR CARPI RADIALIS 0001 342.07

25020 DECOMPRESS FOREARM 1 SPACE 0001 572.64

25023 DECOMPRESS FOREARM 1 SPACE 0001 1104.79

25024 DECOMPRESS FOREARM 2 SPACES 0001 777.22

25025 DECOMPRESS FOREARM 2 SPACES 0001 1216.00

25028 DRAINAGE OF FOREARM LESION 0001 522.13

25031 DRAINAGE OF FOREARM BURSA 0001 363.73

25035 TREAT FOREARM BONE LESION 0001 580.50

25040 EXPLORE/TREAT WRIST JOINT 0001 561.17

25065 BIOPSY FOREARM SOFT TISSUES 0001 163.76


25066 BIOPSY FOREARM SOFT TISSUES 0001 356.49

25071 EXC FOREARM LES SC 3 CM/> 0001 424.47

25073 EXC FOREARM TUM DEEP 3 CM/> 0001 530.26

25075 EXC FOREARM LES SC < 3 CM 0001 316.42

25076 EXC FOREARM TUM DEEP < 3 CM 0001 516.83

25077 RESECT FOREARM/WRIST TUM<3CM 0001 885.42

25078 RESECT FORARM/WRIST TUM 3CM> 0001 1171.97

25085 INCISION OF WRIST CAPSULE 0001 449.97

25100 BIOPSY OF WRIST JOINT 0001 345.79

25101 EXPLORE/TREAT WRIST JOINT 0001 403.38

25105 REMOVE WRIST JOINT LINING 0001 482.31

25107 REMOVE WRIST JOINT CARTILAGE 0001 615.02

25109 EXCISE TENDON FOREARM/WRIST 0001 537.59

25110 REMOVE WRIST TENDON LESION 0001 339.59

25111 REMOVE WRIST TENDON LESION 0001 319.57

25112 REREMOVE WRIST TENDON LESION 0001 386.02

25115 REMOVE WRIST/FOREARM LESION 0001 757.50

25116 REMOVE WRIST/FOREARM LESION 0001 598.71

25118 EXCISE WRIST TENDON SHEATH 0001 379.75

25119 PARTIAL REMOVAL OF ULNA 0001 497.25

25120 REMOVAL OF FOREARM LESION 0001 497.05

25125 REMOVE/GRAFT FOREARM LESION 0001 592.70

25126 REMOVE/GRAFT FOREARM LESION 0001 596.90

25130 REMOVAL OF WRIST LESION 0001 446.95

25135 REMOVE & GRAFT WRIST LESION 0001 557.69

25136 REMOVE & GRAFT WRIST LESION 0001 493.05

25145 REMOVE FOREARM BONE LESION 0001 516.48



25170 RESECT RADIUS/ULNAR TUMOR 0001 1483.50

25210 REMOVAL OF WRIST BONE 0001 486.76

25215 REMOVAL OF WRIST BONES 0001 614.64



25246 INJECTION FOR WRIST X-RAY 0001 74.75

25248 REMOVE FOREARM FOREIGN BODY 0001 414.23

25250 REMOVAL OF WRIST PROSTHESIS 0001 533.00

25251 REMOVAL OF WRIST PROSTHESIS 0001 719.81

25259 MANIPULATE WRIST W/ANESTHES 0001 415.30

25260 REPAIR FOREARM TENDON/MUSCLE 0001 630.76






25275 REPAIR FOREARM TENDON SHEATH 0001 672.63


25280 REVISE WRIST/FOREARM TENDON 0001 561.23

25290 INCISE WRIST/FOREARM TENDON 0001 435.45

25295 RELEASE WRIST/FOREARM TENDON 0001 521.37

25300 FUSION OF TENDONS AT WRIST 0001 686.18

25301 FUSION OF TENDONS AT WRIST 0001 641.74

25310 TRANSPLANT FOREARM TENDON 0001 616.89

25312 TRANSPLANT FOREARM TENDON 0001 715.59

25315 REVISE PALSY HAND TENDON(S) 0001 770.93

25316 REVISE PALSY HAND TENDON(S) 0001 881.27

25320 REPAIR/REVISE WRIST JOINT 0001 984.25

25332 REVISE WRIST JOINT 0001 843.78

25335 REALIGNMENT OF HAND 0001 883.20

25337 RECONSTRUCT ULNA/RADIOULNAR 0001 884.45

25350 REVISION OF RADIUS 0001 672.85

25355 REVISION OF RADIUS 0001 766.48

25360 REVISION OF ULNA 0001 655.25

25365 REVISE RADIUS & ULNA 0001 915.87

25370 REVISE RADIUS OR ULNA 0001 1007.78

25375 REVISE RADIUS & ULNA 0001 891.88

25390 SHORTEN RADIUS OR ULNA 0001 766.93

25391 LENGTHEN RADIUS OR ULNA 0001 997.85

25392 SHORTEN RADIUS & ULNA 0001 1015.71

25393 LENGTHEN RADIUS & ULNA 0001 1132.64

25394 REPAIR CARPAL BONE SHORTEN 0001 784.69

25400 REPAIR RADIUS OR ULNA 0001 802.09

25405 REPAIR/GRAFT RADIUS OR ULNA 0001 1036.20

25415 REPAIR RADIUS & ULNA 0001 968.37

25420 REPAIR/GRAFT RADIUS & ULNA 0001 1170.34

25425 REPAIR/GRAFT RADIUS OR ULNA 0001 963.84

25426 REPAIR/GRAFT RADIUS & ULNA 0001 1125.60

25430 VASC GRAFT INTO CARPAL BONE 0001 706.22

25431 REPAIR NONUNION CARPAL BONE 0001 789.66

25440 REPAIR/GRAFT WRIST BONE 0001 766.98

25441 RECONSTRUCT WRIST JOINT 0001 917.24





25446 WRIST REPLACEMENT 0001 1169.49

25447 REPAIR WRIST JOINTS 0001 825.84

25449 REMOVE WRIST JOINT IMPLANT 0001 1040.99

25450 REVISION OF WRIST JOINT 0001 615.45

25455 REVISION OF WRIST JOINT 0001 680.90

25490 REINFORCE RADIUS 0001 695.13

25491 REINFORCE ULNA 0001 739.39

25492 REINFORCE RADIUS AND ULNA 0001 904.36


25500 TREAT FRACTURE OF RADIUS 0001 249.81






25530 TREAT FRACTURE OF ULNA 0001 236.76



25560 TREAT FRACTURE RADIUS & ULNA 0001 251.68



25575 TREAT FRACTURE RADIUS/ULNA 0001 901.94



25606 TREAT FX DISTAL RADIAL 0001 662.43

25607 TREAT FX RAD EXTRA-ARTICUL 0001 735.53

25608 TREAT FX RAD INTRA-ARTICUL 0001 824.37

25609 TREAT FX RADIAL 3+ FRAG 0001 1048.04

25622 TREAT WRIST BONE FRACTURE 0001 277.24







25651 PIN ULNAR STYLOID FRACTURE 0001 484.83

25652 TREAT FRACTURE ULNAR STYLOID 0001 622.09

25660 TREAT WRIST DISLOCATION 0001 404.18


25671 PIN RADIOULNAR DISLOCATION 0001 529.53



25680 TREAT WRIST FRACTURE 0001 471.83

25685 TREAT WRIST FRACTURE 0001 735.16



25800 FUSION OF WRIST JOINT 0001 730.98

25805 FUSION/GRAFT OF WRIST JOINT 0001 845.09

25810 FUSION/GRAFT OF WRIST JOINT 0001 867.00

25820 FUSION OF HAND BONES 0001 613.71

25825 FUSE HAND BONES WITH GRAFT 0001 756.26

25830 FUSION RADIOULNAR JNT/ULNA 0001 951.24

25900 AMPUTATION OF FOREARM 0001 708.15






25920 AMPUTATE HAND AT WRIST 0001 696.58

25922 AMPUTATE HAND AT WRIST 0001 490.56


25927 AMPUTATION OF HAND 0001 811.39



26010 DRAINAGE OF FINGER ABSCESS 0001 138.27

26011 DRAINAGE OF FINGER ABSCESS 0001 184.67

26020 DRAIN HAND TENDON SHEATH 0001 432.41

26025 DRAINAGE OF PALM BURSA 0001 419.81

26030 DRAINAGE OF PALM BURSAS 0001 492.40

26034 TREAT HAND BONE LESION 0001 534.54

26035 DECOMPRESS FINGERS/HAND 0001 866.81

26037 DECOMPRESS FINGERS/HAND 0001 567.29

26040 RELEASE PALM CONTRACTURE 0001 309.11


26055 INCISE FINGER TENDON SHEATH 0001 309.39

26060 INCISION OF FINGER TENDON 0001 264.48

26070 EXPLORE/TREAT HAND JOINT 0001 313.27

26075 EXPLORE/TREAT FINGER JOINT 0001 328.56

26080 EXPLORE/TREAT FINGER JOINT 0001 389.12

26100 BIOPSY HAND JOINT LINING 0001 334.27

26105 BIOPSY FINGER JOINT LINING 0001 333.52

26110 BIOPSY FINGER JOINT LINING 0001 320.01

26111 EXC HAND LES SC 1.5 CM/> 0001 416.09

26113 EXC HAND TUM DEEP 1.5 CM/> 0001 547.31

26115 EXC HAND LES SC < 1.5 CM 0001 331.77

26116 EXC HAND TUM DEEP < 1.5 CM 0001 525.32

26117 RAD RESECT HAND TUMOR < 3 CM 0001 746.02

26118 RAD RESECT HAND TUMOR 3 CM/> 0001 1055.93




26130 REMOVE WRIST JOINT LINING 0001 460.41

26135 REVISE FINGER JOINT EACH 0001 549.13

26140 REVISE FINGER JOINT EACH 0001 502.61

26145 TENDON EXCISION PALM/FINGER 0001 509.95

26160 REMOVE TENDON SHEATH LESION 0001 332.38

26170 REMOVAL OF PALM TENDON EACH 0001 404.95

26180 REMOVAL OF FINGER TENDON 0001 441.20

26185 REMOVE FINGER BONE 0001 550.98

26200 REMOVE HAND BONE LESION 0001 449.13


26210 REMOVAL OF FINGER LESION 0001 440.26


26215 REMOVE/GRAFT FINGER LESION 0001 563.17

26230 PARTIAL REMOVAL OF HAND BONE 0001 497.69

26235 PARTIAL REMOVAL FINGER BONE 0001 491.43

26236 PARTIAL REMOVAL FINGER BONE 0001 439.70

26250 EXTENSIVE HAND SURGERY 0001 1095.53

26260 RESECT PROX FINGER TUMOR 0001 818.30

26262 RESECT DISTAL FINGER TUMOR 0001 639.51

26320 REMOVAL OF IMPLANT FROM HAND 0001 344.80

26340 MANIPULATE FINGER W/ANESTH 0001 333.23

26341 MANIPULAT PALM CORD POST INJ 0001 73.59

26350 REPAIR FINGER/HAND TENDON 0001 700.66

26352 REPAIR/GRAFT HAND TENDON 0001 807.47







26390 REVISE HAND/FINGER TENDON 0001 827.39


26410 REPAIR HAND TENDON 0001 556.38


26415 EXCISION HAND/FINGER TENDON 0001 786.27

26416 GRAFT HAND OR FINGER TENDON 0001 750.35

26418 REPAIR FINGER TENDON 0001 569.41

26420 REPAIR/GRAFT FINGER TENDON 0001 701.52






26437 REALIGNMENT OF TENDONS 0001 611.51

26440 RELEASE PALM/FINGER TENDON 0001 608.14

26442 RELEASE PALM & FINGER TENDON 0001 951.18

26445 RELEASE HAND/FINGER TENDON 0001 566.88

26449 RELEASE FOREARM/HAND TENDON 0001 691.54

26450 INCISION OF PALM TENDON 0001 400.97

26455 INCISION OF FINGER TENDON 0001 397.81

26460 INCISE HAND/FINGER TENDON 0001 388.34

26471 FUSION OF FINGER TENDONS 0001 605.57

26474 FUSION OF FINGER TENDONS 0001 593.47

26476 TENDON LENGTHENING 0001 576.10

26477 TENDON SHORTENING 0001 574.31

26478 LENGTHENING OF HAND TENDON 0001 612.35

26479 SHORTENING OF HAND TENDON 0001 610.45

26480 TRANSPLANT HAND TENDON 0001 741.54


26483 TRANSPLANT/GRAFT HAND TENDON 0001 831.87

26485 TRANSPLANT PALM TENDON 0001 793.18

26489 TRANSPLANT/GRAFT PALM TENDON 0001 919.36

26490 REVISE THUMB TENDON 0001 783.04

26492 TENDON TRANSFER WITH GRAFT 0001 870.20

26494 HAND TENDON/MUSCLE TRANSFER 0001 790.11

26496 REVISE THUMB TENDON 0001 827.83

26497 FINGER TENDON TRANSFER 0001 855.97

26498 FINGER TENDON TRANSFER 0001 1132.20

26499 REVISION OF FINGER 0001 820.96

26500 HAND TENDON RECONSTRUCTION 0001 614.30

26502 HAND TENDON RECONSTRUCTION 0001 697.05

26508 RELEASE THUMB CONTRACTURE 0001 630.29

26510 THUMB TENDON TRANSFER 0001 588.80

26516 FUSION OF KNUCKLE JOINT 0001 689.19

26517 FUSION OF KNUCKLE JOINTS 0001 816.08

26518 FUSION OF KNUCKLE JOINTS 0001 824.02

26520 RELEASE KNUCKLE CONTRACTURE 0001 640.40

26525 RELEASE FINGER CONTRACTURE 0001 639.55

26530 REVISE KNUCKLE JOINT 0001 535.15

26531 REVISE KNUCKLE WITH IMPLANT 0001 621.10

26535 REVISE FINGER JOINT 0001 416.91

26536 REVISE/IMPLANT FINGER JOINT 0001 701.82

26540 REPAIR HAND JOINT 0001 647.98

26541 REPAIR HAND JOINT WITH GRAFT 0001 787.38

26542 REPAIR HAND JOINT WITH GRAFT 0001 671.15

26545 RECONSTRUCT FINGER JOINT 0001 682.01

26546 REPAIR NONUNION HAND 0001 977.75

26548 RECONSTRUCT FINGER JOINT 0001 752.16

26550 CONSTRUCT THUMB REPLACEMENT 0001 1632.20

26551 GREAT TOE-HAND TRANSFER 0001 2941.51

26553 SINGLE TRANSFER TOE-HAND 0001 3050.21

26554 DOUBLE TRANSFER TOE-HAND 0001 3163.56

26555 POSITIONAL CHANGE OF FINGER 0001 1364.14

26556 TOE JOINT TRANSFER 0001 2712.51

26560 REPAIR OF WEB FINGER 0001 564.35



26565 CORRECT METACARPAL FLAW 0001 672.12

26567 CORRECT FINGER DEFORMITY 0001 670.70

26568 LENGTHEN METACARPAL/FINGER 0001 890.45

26580 REPAIR HAND DEFORMITY 0001 1514.85

26587 RECONSTRUCT EXTRA FINGER 0001 939.72

26590 REPAIR FINGER DEFORMITY 0001 1398.03

26591 REPAIR MUSCLES OF HAND 0001 429.60

26593 RELEASE MUSCLES OF HAND 0001 587.82


26596 EXCISION CONSTRICTING TISSUE 0001 757.82

26600 TREAT METACARPAL FRACTURE 0001 277.15





26641 TREAT THUMB DISLOCATION 0001 339.38

26645 TREAT THUMB FRACTURE 0001 390.52



26670 TREAT HAND DISLOCATION 0001 307.53


26676 PIN HAND DISLOCATION 0001 499.63



26700 TREAT KNUCKLE DISLOCATION 0001 304.98


26706 PIN KNUCKLE DISLOCATION 0001 438.84


26720 TREAT FINGER FRACTURE EACH 0001 184.74









26756 PIN FINGER FRACTURE EACH 0001 416.28


26770 TREAT FINGER DISLOCATION 0001 255.79


26776 PIN FINGER DISLOCATION 0001 441.16


26820 THUMB FUSION WITH GRAFT 0001 778.59

26841 FUSION OF THUMB 0001 718.76

26842 THUMB FUSION WITH GRAFT 0001 778.16

26843 FUSION OF HAND JOINT 0001 729.70

26844 FUSION/GRAFT OF HAND JOINT 0001 806.89

26850 FUSION OF KNUCKLE 0001 681.20

26852 FUSION OF KNUCKLE WITH GRAFT 0001 781.74

26860 FUSION OF FINGER JOINT 0001 553.61

26861 FUSION OF FINGER JNT ADD-ON 0001 103.96

26862 FUSION/GRAFT OF FINGER JOINT 0001 712.49

26863 FUSE/GRAFT ADDED JOINT 0001 230.01

26910 AMPUTATE METACARPAL BONE 0001 708.43


26951 AMPUTATION OF FINGER/THUMB 0001 644.98

26952 AMPUTATION OF FINGER/THUMB 0001 637.48

26990 DRAINAGE OF PELVIS LESION 0001 623.55

26991 DRAINAGE OF PELVIS BURSA 0001 523.98


27000 INCISION OF HIP TENDON 0001 421.03




27006 INCISION OF HIP TENDONS 0001 737.26

27025 INCISION OF HIP/THIGH FASCIA 0001 919.89

27027 BUTTOCK FASCIOTOMY 0001 845.72

27030 DRAINAGE OF HIP JOINT 0001 919.37

27033 EXPLORATION OF HIP JOINT 0001 977.25

27035 DENERVATION OF HIP JOINT 0001 1180.23

27036 EXCISION OF HIP JOINT/MUSCLE 0001 1014.82

27040 BIOPSY OF SOFT TISSUES 0001 201.53

27041 BIOPSY OF SOFT TISSUES 0001 689.13

27043 EXC HIP PELVIS LES SC 3 CM/> 0001 467.27

27045 EXC HIP/PELV TUM DEEP 5 CM/> 0001 748.82

27047 EXC HIP/PELVIS LES SC < 3 CM 0001 363.17

27048 EXC HIP/PELV TUM DEEP < 5 CM 0001 609.72

27049 RESECT HIP/PELV TUM < 5 CM 0001 1367.59

27050 BIOPSY OF SACROILIAC JOINT 0001 401.80

27052 BIOPSY OF HIP JOINT 0001 578.75

27054 REMOVAL OF HIP JOINT LINING 0001 687.32

27057 BUTTOCK FASCIOTOMY W/DBRDMT 0001 948.80

27059 RESECT HIP/PELV TUM 5 CM/> 0001 1809.18

27060 REMOVAL OF ISCHIAL BURSA 0001 465.47

27062 REMOVE FEMUR LESION/BURSA 0001 456.29

27065 REMOVE HIP BONE LES SUPER 0001 513.95

27066 REMOVE HIP BONE LES DEEP 0001 815.01

27067 REMOVE/GRAFT HIP BONE LESION 0001 1036.65

27070 PART REMOVE HIP BONE SUPER 0001 853.61

27071 PART REMOVAL HIP BONE DEEP 0001 920.22

27075 RESECT HIP TUMOR 0001 2110.37

27076 RESECT HIP TUM INCL ACETABUL 0001 2536.41

27077 RESECT HIP TUM W/INNOM BONE 0001 2851.65

27078 RSECT HIP TUM INCL FEMUR 0001 2080.60

27080 REMOVAL OF TAIL BONE 0001 512.49

27086 REMOVE HIP FOREIGN BODY 0001 165.74

27087 REMOVE HIP FOREIGN BODY 0001 628.96

27090 REMOVAL OF HIP PROSTHESIS 0001 830.79

27091 REMOVAL OF HIP PROSTHESIS 0001 1608.82

27093 INJECTION FOR HIP X-RAY 0001 70.36

27095 INJECTION FOR HIP X-RAY 0001 82.27


27096 INJECT SACROILIAC JOINT 0001 84.73

27097 REVISION OF HIP TENDON 0001 682.56

27098 TRANSFER TENDON TO PELVIS 0001 694.72

27100 TRANSFER OF ABDOMINAL MUSCLE 0001 820.17

27105 TRANSFER OF SPINAL MUSCLE 0001 867.23

27110 TRANSFER OF ILIOPSOAS MUSCLE 0001 970.58

27111 TRANSFER OF ILIOPSOAS MUSCLE 0001 900.13

27120 RECONSTRUCTION OF HIP SOCKET 0001 1304.14

27122 RECONSTRUCTION OF HIP SOCKET 0001 1103.86

27125 PARTIAL HIP REPLACEMENT 0001 1139.32

27130 TOTAL HIP ARTHROPLASTY 0001 1366.90

27132 TOTAL HIP ARTHROPLASTY 0001 1688.66

27134 REVISE HIP JOINT REPLACEMENT 0001 1932.00



27140 TRANSPLANT FEMUR RIDGE 0001 896.31

27146 INCISION OF HIP BONE 0001 1289.93

27147 REVISION OF HIP BONE 0001 1475.44

27151 INCISION OF HIP BONES 0001 1597.69

27156 REVISION OF HIP BONES 0001 1722.30

27158 REVISION OF PELVIS 0001 1407.00

27161 INCISION OF NECK OF FEMUR 0001 1222.14

27165 INCISION/FIXATION OF FEMUR 0001 1385.14

27170 REPAIR/GRAFT FEMUR HEAD/NECK 0001 1182.38

27175 TREAT SLIPPED EPIPHYSIS 0001 590.14




27179 REVISE HEAD/NECK OF FEMUR 0001 978.17


27185 REVISION OF FEMUR EPIPHYSIS 0001 585.63

27187 REINFORCE HIP BONES 0001 996.45

27193 TREAT PELVIC RING FRACTURE 0001 478.41


27200 TREAT TAIL BONE FRACTURE 0001 187.70

27202 TREAT TAIL BONE FRACTURE 0001 534.05

27215 TREAT PELVIC FRACTURE(S) 0001 599.21




27220 TREAT HIP SOCKET FRACTURE 0001 526.81

27222 TREAT HIP SOCKET FRACTURE 0001 977.93

27226 TREAT HIP WALL FRACTURE 0001 1064.12

27227 TREAT HIP FRACTURE(S) 0001 1670.78

27228 TREAT HIP FRACTURE(S) 0001 1902.92

27230 TREAT THIGH FRACTURE 0001 472.35











27250 TREAT HIP DISLOCATION 0001 182.96










27267 Cltx thigh fx 0001 438.37

27268 Cltx thigh fx w/mnpj 0001 538.60

27269 Optx thigh fx 0001 1250.42

27275 MANIPULATION OF HIP JOINT 0001 181.65

27279 Arthrodesis sacroiliac joint 0001 560.88

27280 FUSION OF SACROILIAC JOINT 0001 1046.01

27282 FUSION OF PUBIC BONES 0001 855.66

27284 FUSION OF HIP JOINT 0001 1626.08

27286 FUSION OF HIP JOINT 0001 1660.02

27290 AMPUTATION OF LEG AT HIP 0001 1631.16

27295 AMPUTATION OF LEG AT HIP 0001 1270.71

27301 DRAIN THIGH/KNEE LESION 0001 495.73


27305 INCISE THIGH TENDON & FASCIA 0001 485.10

27306 INCISION OF THIGH TENDON 0001 370.56

27307 INCISION OF THIGH TENDONS 0001 480.26

27310 EXPLORATION OF KNEE JOINT 0001 733.15

27323 BIOPSY THIGH SOFT TISSUES 0001 178.43

27324 BIOPSY THIGH SOFT TISSUES 0001 395.70

27325 NEURECTOMY HAMSTRING 0001 557.52

27326 NEURECTOMY POPLITEAL 0001 513.72

27327 EXC THIGH/KNEE LES SC < 3 CM 0001 313.98

27328 EXC THIGH/KNEE TUM DEEP <5CM 0001 619.41

27329 RESECT THIGH/KNEE TUM < 5 CM 0001 1041.02

27330 BIOPSY KNEE JOINT LINING 0001 418.03

27331 EXPLORE/TREAT KNEE JOINT 0001 476.70

27332 REMOVAL OF KNEE CARTILAGE 0001 641.40


27333 REMOVAL OF KNEE CARTILAGE 0001 586.08

27334 REMOVE KNEE JOINT LINING 0001 685.93

27335 REMOVE KNEE JOINT LINING 0001 766.45

27337 EXC THIGH/KNEE LES SC 3 CM/> 0001 417.36

27339 EXC THIGH/KNEE TUM DEP 5CM/> 0001 749.90

27340 REMOVAL OF KNEECAP BURSA 0001 371.89

27345 REMOVAL OF KNEE CYST 0001 481.64

27347 REMOVE KNEE CYST 0001 529.84

27350 REMOVAL OF KNEECAP 0001 655.11

27355 REMOVE FEMUR LESION 0001 604.43

27356 REMOVE FEMUR LESION/GRAFT 0001 739.47

27357 REMOVE FEMUR LESION/GRAFT 0001 815.80

27358 REMOVE FEMUR LESION/FIXATION 0001 279.71

27360 PARTIAL REMOVAL LEG BONE(S) 0001 854.85

27364 RESECT THIGH/KNEE TUM 5 CM/> 0001 1568.28

27365 RESECT FEMUR/KNEE TUMOR 0001 2080.99

27370 INJECTION FOR KNEE X-RAY 0001 51.92


27380 REPAIR OF KNEECAP TENDON 0001 596.28

27381 REPAIR/GRAFT KNEECAP TENDON 0001 802.05

27385 REPAIR OF THIGH MUSCLE 0001 576.94

27386 REPAIR/GRAFT OF THIGH MUSCLE 0001 833.07

27390 INCISION OF THIGH TENDON 0001 448.36



27393 LENGTHENING OF THIGH TENDON 0001 509.94

27394 LENGTHENING OF THIGH TENDONS 0001 653.09

27395 LENGTHENING OF THIGH TENDONS 0001 879.52

27396 TRANSPLANT OF THIGH TENDON 0001 616.41

27397 TRANSPLANTS OF THIGH TENDONS 0001 917.64

27400 REVISE THIGH MUSCLES/TENDONS 0001 695.06

27403 REPAIR OF KNEE CARTILAGE 0001 641.86

27405 REPAIR OF KNEE LIGAMENT 0001 678.57

27407 REPAIR OF KNEE LIGAMENT 0001 793.31

27409 REPAIR OF KNEE LIGAMENTS 0001 967.09

27412 AUTOCHONDROCYTE IMPLANT KNEE 0001 1661.40

27415 OSTEOCHONDRAL KNEE ALLOGRAFT 0001 1379.46

27416 Osteochondral knee autograft 0001 982.92

27418 REPAIR DEGENERATED KNEECAP 0001 833.41

27420 REVISION OF UNSTABLE KNEECAP 0001 736.70

27422 REVISION OF UNSTABLE KNEECAP 0001 745.75

27424 REVISION/REMOVAL OF KNEECAP 0001 748.22

27425 LAT RETINACULAR RELEASE OPEN 0001 447.85

27427 RECONSTRUCTION KNEE 0001 716.97




27430 REVISION OF THIGH MUSCLES 0001 742.97

27435 INCISION OF KNEE JOINT 0001 812.66

27437 REVISE KNEECAP 0001 661.20

27438 REVISE KNEECAP WITH IMPLANT 0001 845.57

27440 REVISION OF KNEE JOINT 0001 798.66






27447 TOTAL KNEE ARTHROPLASTY 0001 1366.16

27448 INCISION OF THIGH 0001 810.13

27450 INCISION OF THIGH 0001 1017.09

27454 REALIGNMENT OF THIGH BONE 0001 1303.89

27455 REALIGNMENT OF KNEE 0001 944.27

27457 REALIGNMENT OF KNEE 0001 960.12

27465 SHORTENING OF THIGH BONE 0001 1258.12

27466 LENGTHENING OF THIGH BONE 0001 1183.25

27468 SHORTEN/LENGTHEN THIGHS 0001 1206.10

27470 REPAIR OF THIGH 0001 1182.74

27472 REPAIR/GRAFT OF THIGH 0001 1270.84

27475 SURGERY TO STOP LEG GROWTH 0001 662.64




27486 REVISE/REPLACE KNEE JOINT 0001 1417.63

27487 REVISE/REPLACE KNEE JOINT 0001 1773.06

27488 REMOVAL OF KNEE PROSTHESIS 0001 1208.96

27495 REINFORCE THIGH 0001 1133.35

27496 DECOMPRESSION OF THIGH/KNEE 0001 543.77




27500 TREATMENT OF THIGH FRACTURE 0001 479.49












27516 TREAT THIGH FX GROWTH PLATE 0001 476.99




27520 TREAT KNEECAP FRACTURE 0001 295.55

27524 TREAT KNEECAP FRACTURE 0001 754.86

27530 TREAT KNEE FRACTURE 0001 280.71




27538 TREAT KNEE FRACTURE(S) 0001 443.99


27550 TREAT KNEE DISLOCATION 0001 470.89





27560 TREAT KNEECAP DISLOCATION 0001 334.32



27570 FIXATION OF KNEE JOINT 0001 150.96

27580 FUSION OF KNEE 0001 1443.52

27590 AMPUTATE LEG AT THIGH 0001 817.50





27598 AMPUTATE LOWER LEG AT KNEE 0001 737.29

27599 LEG SURGERY PROCEDURE 0001 0.00

27600 DECOMPRESSION OF LOWER LEG 0001 417.59



27603 DRAIN LOWER LEG LESION 0001 390.27

27604 DRAIN LOWER LEG BURSA 0001 333.25

27605 INCISION OF ACHILLES TENDON 0001 185.86

27606 INCISION OF ACHILLES TENDON 0001 286.87

27607 TREAT LOWER LEG BONE LESION 0001 613.34

27610 EXPLORE/TREAT ANKLE JOINT 0001 657.01

27612 EXPLORATION OF ANKLE JOINT 0001 566.46

27613 BIOPSY LOWER LEG SOFT TISSUE 0001 163.40

27614 BIOPSY LOWER LEG SOFT TISSUE 0001 408.64

27615 RESECT LEG/ANKLE TUM < 5 CM 0001 1026.95

27616 RESECT LEG/ANKLE TUM 5 CM/> 0001 1270.24

27618 EXC LEG/ANKLE TUM < 3 CM 0001 306.32

27619 EXC LEG/ANKLE TUM DEEP <5 CM 0001 473.34

27620 EXPLORE/TREAT ANKLE JOINT 0001 456.85

27625 REMOVE ANKLE JOINT LINING 0001 581.45

27626 REMOVE ANKLE JOINT LINING 0001 628.51


27630 REMOVAL OF TENDON LESION 0001 369.59

27632 EXC LEG/ANKLE LES SC 3 CM/> 0001 413.63

27634 EXC LEG/ANKLE TUM DEP 5 CM/> 0001 683.46

27635 REMOVE LOWER LEG BONE LESION 0001 592.38

27637 REMOVE/GRAFT LEG BONE LESION 0001 755.65

27638 REMOVE/GRAFT LEG BONE LESION 0001 773.70

27640 PARTIAL REMOVAL OF TIBIA 0001 836.80

27641 PARTIAL REMOVAL OF FIBULA 0001 671.93

27645 RESECT TIBIA TUMOR 0001 1788.71

27646 RESECT FIBULA TUMOR 0001 1550.93

27647 RESECT TALUS/CALCANEUS TUM 0001 1041.50

27648 INJECTION FOR ANKLE X-RAY 0001 52.28

27650 REPAIR ACHILLES TENDON 0001 666.71

27652 REPAIR/GRAFT ACHILLES TENDON 0001 691.11

27654 REPAIR OF ACHILLES TENDON 0001 710.95

27656 REPAIR LEG FASCIA DEFECT 0001 396.07

27658 REPAIR OF LEG TENDON EACH 0001 375.72




27675 REPAIR LOWER LEG TENDONS 0001 487.28

27676 REPAIR LOWER LEG TENDONS 0001 618.02

27680 RELEASE OF LOWER LEG TENDON 0001 430.67

27681 RELEASE OF LOWER LEG TENDONS 0001 546.97

27685 REVISION OF LOWER LEG TENDON 0001 467.83

27686 REVISE LOWER LEG TENDONS 0001 554.84

27687 REVISION OF CALF TENDON 0001 457.00

27690 REVISE LOWER LEG TENDON 0001 634.51

27691 REVISE LOWER LEG TENDON 0001 757.16

27692 REVISE ADDITIONAL LEG TENDON 0001 106.65

27695 REPAIR OF ANKLE LIGAMENT 0001 481.74

27696 REPAIR OF ANKLE LIGAMENTS 0001 562.80

27698 REPAIR OF ANKLE LIGAMENT 0001 644.43

27700 REVISION OF ANKLE JOINT 0001 593.92

27702 RECONSTRUCT ANKLE JOINT 0001 976.81

27703 RECONSTRUCTION ANKLE JOINT 0001 1127.10

27704 REMOVAL OF ANKLE IMPLANT 0001 579.74

27705 INCISION OF TIBIA 0001 762.18

27707 INCISION OF FIBULA 0001 405.98

27709 INCISION OF TIBIA & FIBULA 0001 1174.56

27712 REALIGNMENT OF LOWER LEG 0001 1108.89

27715 REVISION OF LOWER LEG 0001 1074.30

27720 REPAIR OF TIBIA 0001 880.01

27722 REPAIR/GRAFT OF TIBIA 0001 891.75

27724 REPAIR/GRAFT OF TIBIA 0001 1276.02

27725 REPAIR OF LOWER LEG 0001 1224.34


27726 Repair fibula nonunion 0001 974.67

27727 REPAIR OF LOWER LEG 0001 922.31

27730 REPAIR OF TIBIA EPIPHYSIS 0001 586.56

27732 REPAIR OF FIBULA EPIPHYSIS 0001 383.13

27734 REPAIR LOWER LEG EPIPHYSES 0001 616.73

27740 REPAIR OF LEG EPIPHYSES 0001 621.03

27742 REPAIR OF LEG EPIPHYSES 0001 683.38

27745 REINFORCE TIBIA 0001 760.04

27750 TREATMENT OF TIBIA FRACTURE 0001 318.73





27760 CLTX MEDIAL ANKLE FX 0001 306.37

27762 CLTX MED ANKLE FX W/MNPJ 0001 437.94

27766 OPTX MEDIAL ANKLE FX 0001 612.04

27767 Cltx post ankle fx 0001 285.37

27768 Cltx post ankle fx w/mnpj 0001 440.72

27769 Optx post ankle fx 0001 732.59

27780 TREATMENT OF FIBULA FRACTURE 0001 279.69



27786 TREATMENT OF ANKLE FRACTURE 0001 287.26










27824 TREAT LOWER LEG FRACTURE 0001 305.86





27829 TREAT LOWER LEG JOINT 0001 689.32

27830 TREAT LOWER LEG DISLOCATION 0001 354.12



27840 TREAT ANKLE DISLOCATION 0001 371.41




27860 FIXATION OF ANKLE JOINT 0001 178.29


27870 FUSION OF ANKLE JOINT OPEN 0001 1041.31

27871 FUSION OF TIBIOFIBULAR JOINT 0001 691.82

27880 AMPUTATION OF LOWER LEG 0001 932.39





27888 AMPUTATION OF FOOT AT ANKLE 0001 680.02

27889 AMPUTATION OF FOOT AT ANKLE 0001 671.66

27892 DECOMPRESSION OF LEG 0001 558.67



28001 DRAINAGE OF BURSA OF FOOT 0001 169.41

28002 TREATMENT OF FOOT INFECTION 0001 322.94

28003 TREATMENT OF FOOT INFECTION 0001 573.95

28005 TREAT FOOT BONE LESION 0001 583.25

28008 INCISION OF FOOT FASCIA 0001 293.84

28010 INCISION OF TOE TENDON 0001 210.78

28011 INCISION OF TOE TENDONS 0001 291.68

28020 EXPLORATION OF FOOT JOINT 0001 363.98

28022 EXPLORATION OF FOOT JOINT 0001 326.25

28024 EXPLORATION OF TOE JOINT 0001 305.12

28035 DECOMPRESSION OF TIBIA NERVE 0001 359.85

28039 EXC FOOT/TOE TUM SC 1.5 CM/> 0001 351.78

28041 EXC FOOT/TOE TUM DEP 1.5CM/> 0001 461.70

28043 EXC FOOT/TOE TUM SC < 1.5 CM 0001 263.01

28045 EXC FOOT/TOE TUM DEEP <1.5CM 0001 350.33

28046 RESECT FOOT/TOE TUMOR < 3 CM 0001 738.70

28047 RESECT FOOT/TOE TUMOR 3 CM/> 0001 1028.61

28050 BIOPSY OF FOOT JOINT LINING 0001 282.68

28052 BIOPSY OF FOOT JOINT LINING 0001 283.11

28054 BIOPSY OF TOE JOINT LINING 0001 236.24

28055 NEURECTOMY FOOT 0001 377.81

28060 PARTIAL REMOVAL FOOT FASCIA 0001 357.21

28062 REMOVAL OF FOOT FASCIA 0001 408.06

28070 REMOVAL OF FOOT JOINT LINING 0001 355.74

28072 REMOVAL OF FOOT JOINT LINING 0001 336.00

28080 REMOVAL OF FOOT LESION 0001 367.79

28086 EXCISE FOOT TENDON SHEATH 0001 363.06

28088 EXCISE FOOT TENDON SHEATH 0001 295.55


28092 REMOVAL OF TOE LESIONS 0001 270.16

28100 REMOVAL OF ANKLE/HEEL LESION 0001 412.80

28102 REMOVE/GRAFT FOOT LESION 0001 573.13






28108 REMOVAL OF TOE LESIONS 0001 289.65

28110 PART REMOVAL OF METATARSAL 0001 289.85




28114 REMOVAL OF METATARSAL HEADS 0001 842.42

28116 REVISION OF FOOT 0001 565.37

28118 REMOVAL OF HEEL BONE 0001 411.87

28119 REMOVAL OF HEEL SPUR 0001 362.28

28120 PART REMOVAL OF ANKLE/HEEL 0001 502.06

28122 PARTIAL REMOVAL OF FOOT BONE 0001 442.25

28124 PARTIAL REMOVAL OF TOE 0001 330.80


28130 REMOVAL OF ANKLE BONE 0001 668.93

28140 REMOVAL OF METATARSAL 0001 444.37

28150 REMOVAL OF TOE 0001 282.31



28171 RESECT TARSAL TUMOR 0001 848.72

28173 RESECT METATARSAL TUMOR 0001 773.68

28175 RESECT PHALANX OF TOE TUMOR 0001 489.49

28190 REMOVAL OF FOOT FOREIGN BODY 0001 134.51



28200 REPAIR OF FOOT TENDON 0001 319.48

28202 REPAIR/GRAFT OF FOOT TENDON 0001 426.82

28208 REPAIR OF FOOT TENDON 0001 312.80

28210 REPAIR/GRAFT OF FOOT TENDON 0001 404.49

28220 RELEASE OF FOOT TENDON 0001 301.23

28222 RELEASE OF FOOT TENDONS 0001 351.09

28225 RELEASE OF FOOT TENDON 0001 259.32

28226 RELEASE OF FOOT TENDONS 0001 373.65

28230 INCISION OF FOOT TENDON(S) 0001 284.53

28232 INCISION OF TOE TENDON 0001 245.09

28234 INCISION OF FOOT TENDON 0001 264.79

28238 REVISION OF FOOT TENDON 0001 490.18

28240 RELEASE OF BIG TOE 0001 290.50

28250 REVISION OF FOOT FASCIA 0001 405.55

28260 RELEASE OF MIDFOOT JOINT 0001 511.60

28261 REVISION OF FOOT TENDON 0001 766.14

28262 REVISION OF FOOT AND ANKLE 0001 1175.87

28264 RELEASE OF MIDFOOT JOINT 0001 724.29

28270 RELEASE OF FOOT CONTRACTURE 0001 335.38

28272 RELEASE OF TOE JOINT EACH 0001 254.70


28280 FUSION OF TOES 0001 353.83

28285 REPAIR OF HAMMERTOE 0001 377.97

28286 REPAIR OF HAMMERTOE 0001 301.14

28288 PARTIAL REMOVAL OF FOOT BONE 0001 432.04

28289 REPAIR HALLUX RIGIDUS 0001 551.20

28290 CORRECTION OF BUNION 0001 395.80








28300 INCISION OF HEEL BONE 0001 659.46

28302 INCISION OF ANKLE BONE 0001 716.70

28304 INCISION OF MIDFOOT BONES 0001 599.42

28305 INCISE/GRAFT MIDFOOT BONES 0001 638.26

28306 INCISION OF METATARSAL 0001 407.56



28309 INCISION OF METATARSALS 0001 899.53

28310 REVISION OF BIG TOE 0001 356.18

28312 REVISION OF TOE 0001 321.82

28313 REPAIR DEFORMITY OF TOE 0001 363.30

28315 REMOVAL OF SESAMOID BONE 0001 325.18

28320 REPAIR OF FOOT BONES 0001 622.41

28322 REPAIR OF METATARSALS 0001 584.68

28340 RESECT ENLARGED TOE TISSUE 0001 413.95

28341 RESECT ENLARGED TOE 0001 493.14

28344 REPAIR EXTRA TOE(S) 0001 287.62

28345 REPAIR WEBBED TOE(S) 0001 365.11

28360 RECONSTRUCT CLEFT FOOT 0001 892.77

28400 TREATMENT OF HEEL FRACTURE 0001 229.38



28415 TREAT HEEL FRACTURE 0001 1116.05

28420 TREAT/GRAFT HEEL FRACTURE 0001 1259.00




28445 TREAT ANKLE FRACTURE 0001 1066.84

28446 Osteochondral talus autogrft 0001 1229.28

28450 TREAT MIDFOOT FRACTURE EACH 0001 193.89


28456 TREAT MIDFOOT FRACTURE 0001 320.26



28470 TREAT METATARSAL FRACTURE 0001 207.58




28490 TREAT BIG TOE FRACTURE 0001 125.57




28510 TREATMENT OF TOE FRACTURE 0001 120.51

28515 TREATMENT OF TOE FRACTURE 0001 142.48

28525 TREAT TOE FRACTURE 0001 403.40

28530 TREAT SESAMOID BONE FRACTURE 0001 102.27

28531 TREAT SESAMOID BONE FRACTURE 0001 193.95

28540 TREAT FOOT DISLOCATION 0001 184.83



28555 REPAIR FOOT DISLOCATION 0001 664.28









28630 TREAT TOE DISLOCATION 0001 109.91



28645 REPAIR TOE DISLOCATION 0001 485.67




28675 REPAIR OF TOE DISLOCATION 0001 404.19

28705 FUSION OF FOOT BONES 0001 1276.81





28737 REVISION OF FOOT BONES 0001 692.77


28750 FUSION OF BIG TOE JOINT 0001 598.61



28800 AMPUTATION OF MIDFOOT 0001 549.38

28805 AMPUTATION THRU METATARSAL 0001 750.39

28810 AMPUTATION TOE & METATARSAL 0001 440.38


28820 AMPUTATION OF TOE 0001 402.54

28825 PARTIAL AMPUTATION OF TOE 0001 377.00

28890 HI ENRGY ESWT PLANTAR FASCIA 0001 226.53

28899 FOOT/TOES SURGERY PROCEDURE 0001 0.00

29000 APPLICATION OF BODY CAST 0001 167.78







29049 APPLICATION OF FIGURE EIGHT 0001 70.47

29055 APPLICATION OF SHOULDER CAST 0001 138.77

29058 APPLICATION OF SHOULDER CAST 0001 94.20

29065 APPLICATION OF LONG ARM CAST 0001 68.67

29075 APPLICATION OF FOREARM CAST 0001 62.72

29085 APPLY HAND/WRIST CAST 0001 67.56

29086 APPLY FINGER CAST 0001 51.42

29105 APPLY LONG ARM SPLINT 0001 59.66

29125 APPLY FOREARM SPLINT 0001 39.79

29126 APPLY FOREARM SPLINT 0001 48.83

29130 APPLICATION OF FINGER SPLINT 0001 28.64

29131 APPLICATION OF FINGER SPLINT 0001 33.23

29200 STRAPPING OF CHEST 0001 39.46

29240 STRAPPING OF SHOULDER 0001 43.30

29260 STRAPPING OF ELBOW OR WRIST 0001 36.77

29280 STRAPPING OF HAND OR FINGER 0001 35.75

29305 APPLICATION OF HIP CAST 0001 159.56

29325 APPLICATION OF HIP CASTS 0001 179.24

29345 APPLICATION OF LONG LEG CAST 0001 102.00


29358 APPLY LONG LEG CAST BRACE 0001 104.85


29405 APPLY SHORT LEG CAST 0001 60.11



29440 ADDITION OF WALKER TO CAST 0001 30.33

29445 APPLY RIGID LEG CAST 0001 105.56

29450 APPLICATION OF LEG CAST 0001 111.79

29505 APPLICATION LONG LEG SPLINT 0001 50.26

29515 APPLICATION LOWER LEG SPLINT 0001 50.17

29520 STRAPPING OF HIP 0001 34.62

29530 STRAPPING OF KNEE 0001 36.73

29540 STRAPPING OF ANKLE AND/OR FT 0001 25.90

29550 STRAPPING OF TOES 0001 19.30

29580 APPLICATION OF PASTE BOOT 0001 35.73


29581 APPLY MULTLAY COMPRS LWR LEG 0001 12.48

29582 Apply multlay comprs upr leg 0001 15.53

29583 Apply multlay comprs upr arm 0001 11.04

29584 Appl multlay comprs arm/hand 0001 15.53

29700 REMOVAL/REVISION OF CAST 0001 33.95



29720 REPAIR OF BODY CAST 0001 43.82

29730 WINDOWING OF CAST 0001 45.13

29740 WEDGING OF CAST 0001 68.97

29750 WEDGING OF CLUBFOOT CAST 0001 66.34

29800 JAW ARTHROSCOPY/SURGERY 0001 523.20

29804 JAW ARTHROSCOPY/SURGERY 0001 659.10

29805 SHOULDER ARTHROSCOPY DX 0001 473.46

29806 SHOULDER ARTHROSCOPY/SURGERY 0001 1066.17










29827 ARTHROSCOP ROTATOR CUFF REPR 0001 1080.24

29828 Arthroscopy biceps tenodesis 0001 929.13

29830 ELBOW ARTHROSCOPY 0001 456.84

29834 ELBOW ARTHROSCOPY/SURGERY 0001 492.56





29840 WRIST ARTHROSCOPY 0001 453.54

29843 WRIST ARTHROSCOPY/SURGERY 0001 485.14





29848 WRIST ENDOSCOPY/SURGERY 0001 510.83

29850 KNEE ARTHROSCOPY/SURGERY 0001 625.54


29855 TIBIAL ARTHROSCOPY/SURGERY 0001 790.92

29856 TIBIAL ARTHROSCOPY/SURGERY 0001 1000.72

29860 HIP ARTHROSCOPY DX 0001 669.35

29861 HIP ARTHRO W/FB REMOVAL 0001 729.04

29862 HIP ARTHR0 W/DEBRIDEMENT 0001 820.79


29863 HIP ARTHR0 W/SYNOVECTOMY 0001 823.32

29866 AUTGRFT IMPLNT KNEE W/SCOPE 0001 1053.62

29867 ALLGRFT IMPLNT KNEE W/SCOPE 0001 1283.87

29868 MENISCAL TRNSPL KNEE W/SCPE 0001 1682.01

29870 KNEE ARTHROSCOPY DX 0001 414.42

29871 KNEE ARTHROSCOPY/DRAINAGE 0001 516.26

















29891 ANKLE ARTHROSCOPY/SURGERY 0001 690.88


29893 SCOPE PLANTAR FASCIOTOMY 0001 427.97






29900 MCP JOINT ARTHROSCOPY DX 0001 469.91

29901 MCP JOINT ARTHROSCOPY SURG 0001 534.36

29902 MCP JOINT ARTHROSCOPY SURG 0001 613.76

29904 Subtalar arthro w/fb rmvl 0001 639.69

29905 Subtalar arthro w/exc 0001 692.41

29906 Subtalar arthro w/deb 0001 729.02

29907 Subtalar arthro w/fusion 0001 879.63

29914 HIP ARTHRO W/FEMOROPLASTY ARTHR 0001 1015.92

29915 HIP ARTHRO ACETABULOPLASTY ARTHR 0001 1036.57

29916 HIP ARTHRO W/LABRAL REPAIR ARTHR 0001 1036.93

30000 DRAINAGE OF NOSE LESION 0001 120.44

30020 DRAINAGE OF NOSE LESION 0001 120.04

30100 INTRANASAL BIOPSY 0001 69.19

30110 REMOVAL OF NOSE POLYP(S) 0001 131.58

30115 REMOVAL OF NOSE POLYP(S) 0001 432.61

30117 REMOVAL OF INTRANASAL LESION 0001 339.73


30118 REMOVAL OF INTRANASAL LESION 0001 771.34

30120 REVISION OF NOSE 0001 438.14

30124 REMOVAL OF NOSE LESION 0001 287.78

30125 REMOVAL OF NOSE LESION 0001 611.44

30130 EXCISE INFERIOR TURBINATE 0001 382.12

30140 RESECT INFERIOR TURBINATE 0001 444.42

30150 PARTIAL REMOVAL OF NOSE 0001 775.44

30160 REMOVAL OF NOSE 0001 776.90

30200 INJECTION TREATMENT OF NOSE 0001 60.49

30210 NASAL SINUS THERAPY 0001 100.47

30220 INSERT NASAL SEPTAL BUTTON 0001 126.34

30300 REMOVE NASAL FOREIGN BODY 0001 127.83



30400 RECONSTRUCTION OF NOSE 0001 1014.61








30465 REPAIR NASAL STENOSIS 0001 988.75

30520 REPAIR OF NASAL SEPTUM 0001 628.43

30540 REPAIR NASAL DEFECT 0001 691.24

30545 REPAIR NASAL DEFECT 0001 920.69

30560 RELEASE OF NASAL ADHESIONS 0001 139.35

30580 REPAIR UPPER JAW FISTULA 0001 508.70

30600 REPAIR MOUTH/NOSE FISTULA 0001 442.74

30620 INTRANASAL RECONSTRUCTION 0001 630.32

30630 REPAIR NASAL SEPTUM DEFECT 0001 630.59

30801 ABLATE INF TURBINATE SUPERF 0001 138.51

30802 ABLATE INF TURBINATE SUBMUC 0001 191.95

30901 CONTROL OF NOSEBLEED 0001 56.76



30906 REPEAT CONTROL OF NOSEBLEED 0001 131.77

30915 LIGATION NASAL SINUS ARTERY 0001 580.41

30920 LIGATION UPPER JAW ARTERY 0001 839.73

30930 THER FX NASAL INF TURBINATE 0001 124.99

30999 NASAL SURGERY PROCEDURE 0001 0.00

31000 IRRIGATION MAXILLARY SINUS 0001 105.73

31002 IRRIGATION SPHENOID SINUS 0001 202.92

31020 EXPLORATION MAXILLARY SINUS 0001 360.50


31032 EXPLORE SINUS REMOVE POLYPS 0001 575.83


31040 EXPLORATION BEHIND UPPER JAW 0001 767.81

31050 EXPLORATION SPHENOID SINUS 0001 486.38

31051 SPHENOID SINUS SURGERY 0001 647.40

31070 EXPLORATION OF FRONTAL SINUS 0001 442.41

31075 EXPLORATION OF FRONTAL SINUS 0001 784.16

31080 REMOVAL OF FRONTAL SINUS 0001 1033.47






31090 EXPLORATION OF SINUSES 0001 1033.93

31200 REMOVAL OF ETHMOID SINUS 0001 577.73



31225 REMOVAL OF UPPER JAW 0001 1878.12

31230 REMOVAL OF UPPER JAW 0001 2080.57

31231 NASAL ENDOSCOPY DX 0001 64.59

31233 NASAL/SINUS ENDOSCOPY DX 0001 138.30

31235 NASAL/SINUS ENDOSCOPY DX 0001 163.02

31237 NASAL/SINUS ENDOSCOPY SURG 0001 162.73




31254 REVISION OF ETHMOID SINUS 0001 274.32



31267 ENDOSCOPY MAXILLARY SINUS 0001 318.59

31276 SINUS ENDOSCOPY SURGICAL 0001 507.00








31295 SINUS ENDO W/BALLOON DIL NASAL 0001 167.95



31299 SINUS SURGERY PROCEDURE 0001 0.00

31300 REMOVAL OF LARYNX LESION 0001 1264.92

31320 DIAGNOSTIC INCISION LARYNX 0001 661.36

31360 REMOVAL OF LARYNX 0001 2090.07

31365 REMOVAL OF LARYNX 0001 2583.71

31367 PARTIAL REMOVAL OF LARYNX 0001 2212.46







31390 REMOVAL OF LARYNX & PHARYNX 0001 2877.26

31395 RECONSTRUCT LARYNX & PHARYNX 0001 3016.36

31400 REVISION OF LARYNX 0001 1000.86

31420 REMOVAL OF EPIGLOTTIS 0001 838.86

31500 INSERT EMERGENCY AIRWAY 0001 110.42

31502 CHANGE OF WINDPIPE AIRWAY 0001 35.19

31505 DIAGNOSTIC LARYNGOSCOPY 0001 49.62

31510 LARYNGOSCOPY WITH BIOPSY 0001 122.21

31511 REMOVE FOREIGN BODY LARYNX 0001 131.19


31513 INJECTION INTO VOCAL CORD 0001 133.75

31515 LARYNGOSCOPY FOR ASPIRATION 0001 112.34

31520 DX LARYNGOSCOPY NEWBORN 0001 159.22

31525 DX LARYNGOSCOPY EXCL NB 0001 161.98

31526 DX LARYNGOSCOPY W/OPER SCOPE 0001 159.56

31527 LARYNGOSCOPY FOR TREATMENT 0001 197.53

31528 LARYNGOSCOPY AND DILATION 0001 146.61

31529 LARYNGOSCOPY AND DILATION 0001 164.04

31530 LARYNGOSCOPY W/FB REMOVAL 0001 199.89

31531 LARYNGOSCOPY W/FB & OP SCOPE 0001 214.98

31535 LARYNGOSCOPY W/BIOPSY 0001 191.63

31536 LARYNGOSCOPY W/BX & OP SCOPE 0001 213.24

31540 LARYNGOSCOPY W/EXC OF TUMOR 0001 245.01

31541 LARYNSCOP W/TUMR EXC + SCOPE 0001 267.34

31545 REMOVE VC LESION W/SCOPE 0001 367.48

31546 REMOVE VC LESION SCOPE/GRAFT 0001 557.97

31560 LARYNGOSCOP W/ARYTENOIDECTOM 0001 316.79

31561 LARYNSCOP REMVE CART + SCOP 0001 347.16

31570 LARYNGOSCOPE W/VC INJ 0001 232.20

31571 LARYNGOSCOP W/VC INJ + SCOPE 0001 252.67


31576 LARYNGOSCOPY WITH BIOPSY 0001 124.96

31577 REMOVE FOREIGN BODY LARYNX 0001 151.12





31584 TREAT LARYNX FRACTURE 0001 1514.27



31590 REINNERVATE LARYNX 0001 894.94

31595 LARYNX NERVE SURGERY 0001 767.30


31600 INCISION OF WINDPIPE 0001 398.62





31611 SURGERY/SPEECH PROSTHESIS 0001 544.97

31612 PUNCTURE/CLEAR WINDPIPE 0001 47.71

31613 REPAIR WINDPIPE OPENING 0001 459.66

31614 REPAIR WINDPIPE OPENING 0001 764.52

31615 VISUALIZATION OF WINDPIPE 0001 129.80

31620 ENDOBRONCHIAL US ADD-ON 0001 67.27

31622 DX BRONCHOSCOPE/WASH 0001 147.34

31623 DX BRONCHOSCOPE/BRUSH 0001 147.02

31624 DX BRONCHOSCOPE/LAVAGE 0001 148.09

31625 BRONCHOSCOPY W/BIOPSY(S) 0001 171.00

31626 BRONCHOSCOPY W/MARKERS 0001 206.51

31627 NAVIGATIONAL BRONCHOSCOPY 0001 94.57

31628 BRONCHOSCOPY/LUNG BX EACH 0001 189.92

31629 BRONCHOSCOPY/NEEDLE BX EACH 0001 204.53

31630 BRONCHOSCOPY DILATE/FX REPR 0001 202.06

31631 BRONCHOSCOPY DILATE W/STENT 0001 231.39

31632 BRONCHOSCOPY/LUNG BX ADDL 0001 48.85

31633 BRONCHOSCOPY/NEEDLE BX ADDL 0001 63.09

31634 BRONCH W/BALLOON OCCLUSION BRONC 0001 200.73

31635 BRONCHOSCOPY W/FB REMOVAL 0001 188.86

31636 BRONCHOSCOPY BRONCH STENTS 0001 223.19

31637 BRONCHOSCOPY STENT ADD-ON 0001 73.76

31638 BRONCHOSCOPY REVISE STENT 0001 256.37

31640 BRONCHOSCOPY W/TUMOR EXCISE 0001 256.62

31641 BRONCHOSCOPY TREAT BLOCKAGE 0001 259.60

31643 DIAG BRONCHOSCOPE/CATHETER 0001 176.47

31645 BRONCHOSCOPY CLEAR AIRWAYS 0001 161.99

31646 BRONCHOSCOPY RECLEAR AIRWAY 0001 140.49

31647 Bronchial valve init insert 0001 221.23

31648 BRONCHIAL VALVE REMOV INIT 0001 211.88

31649 BRONCHIAL VALVE REMOV ADDL 0001 68.26

31651 BRONCHIAL VALVE ADDL INSERT 0001 79.50

31660 Bronch thermoplsty 1 lobe 0001 211.42

31661 Bronch thermoplsty 2/> lobes 0001 222.87

31717 BRONCHIAL BRUSH BIOPSY 0001 108.74

31720 CLEARANCE OF AIRWAYS 0001 50.97

31725 CLEARANCE OF AIRWAYS 0001 91.51

31730 INTRO WINDPIPE WIRE/TUBE 0001 146.67

31750 REPAIR OF WINDPIPE 0001 1379.73




31766 RECONSTRUCTION OF WINDPIPE 0001 1800.84

31770 REPAIR/GRAFT OF BRONCHUS 0001 1349.04

31775 RECONSTRUCT BRONCHUS 0001 1375.92

31780 RECONSTRUCT WINDPIPE 0001 1187.92

31781 RECONSTRUCT WINDPIPE 0001 1555.05

31785 REMOVE WINDPIPE LESION 0001 1088.73

31786 REMOVE WINDPIPE LESION 0001 1461.26

31800 REPAIR OF WINDPIPE INJURY 0001 717.37

31805 REPAIR OF WINDPIPE INJURY 0001 826.20

31820 CLOSURE OF WINDPIPE LESION 0001 332.25

31825 REPAIR OF WINDPIPE DEFECT 0001 485.23

31830 REVISE WINDPIPE SCAR 0001 344.92

32035 THORACOSTOMY W/RIB RESECTION 0001 725.01

32036 THORACOSTOMY W/FLAP DRAINAGE 0001 787.97

32096 Open wedge/bx lung infiltr 0001 817.44

32097 Open wedge/bx lung nodule 0001 817.80

32098 Open biopsy of lung pleura 0001 771.96

32100 EXPLORATION OF CHEST 0001 827.15

32110 EXPLORE/REPAIR CHEST 0001 1473.71

32120 RE-EXPLORATION OF CHEST 0001 884.07

32124 EXPLORE CHEST FREE ADHESIONS 0001 941.82

32140 REMOVAL OF LUNG LESION(S) 0001 1005.67

32141 REMOVE/TREAT LUNG LESIONS 0001 1552.12

32150 REMOVAL OF LUNG LESION(S) 0001 1018.37

32151 REMOVE LUNG FOREIGN BODY 0001 1014.99

32160 OPEN CHEST HEART MASSAGE 0001 797.43

32200 DRAIN OPEN LUNG LESION 0001 1149.48

32215 TREAT CHEST LINING 0001 811.27

32220 RELEASE OF LUNG 0001 1608.92

32225 PARTIAL RELEASE OF LUNG 0001 1008.79

32310 REMOVAL OF CHEST LINING 0001 930.91

32320 FREE/REMOVE CHEST LINING 0001 1619.36

32400 NEEDLE BIOPSY CHEST LINING 0001 87.90

32405 PERCUT BX LUNG/MEDIASTINUM 0001 104.46

32440 REMOVE LUNG PNEUMONECTOMY 0001 1588.12

32442 SLEEVE PNEUMONECTOMY 0001 3259.02

32445 REMOVAL OF LUNG EXTRAPLEURAL 0001 3583.40

32480 PARTIAL REMOVAL OF LUNG 0001 1500.19

32482 BILOBECTOMY 0001 1606.96

32484 SEGMENTECTOMY 0001 1454.78

32486 SLEEVE LOBECTOMY 0001 2381.23

32488 COMPLETION PNEUMONECTOMY 0001 2434.83

32491 LUNG VOLUME REDUCTION 0001 1491.61

32501 REPAIR BRONCHUS ADD-ON 0001 248.51

32503 RESECT APICAL LUNG TUMOR 0001 1841.44

32504 RESECT APICAL LUNG TUM/CHEST 0001 2099.32


32505 Wedge resect of lung initial 0001 943.68

32506 Wedge resect of lung add-on 0001 159.76

32507 Wedge resect of lung diag 0001 159.76

32540 REMOVAL OF LUNG LESION 0001 1760.38

32550 Insert pleural cath 0001 226.15

32551 INSERTION OF CHEST TUBE 0001 179.37

32552 REMOVE LUNG CATHETER 0001 168.33

32553 INS MARK THOR FOR RT PERQ 0001 214.23

32554 Aspirate pleura w/o imaging 0001 90.28

32555 Aspirate pleura w/ imaging 0001 113.62

32556 Insert cath pleura w/o image 0001 124.72

32557 Insert cath pleura w/ image 0001 167.41

32560 TREAT PLEURODESIS W/AGENT 0001 79.48

32561 LYSE CHEST FIBRIN INIT DAY 0001 71.81

32562 LYSE CHEST FIBRIN SUBQ DAY 0001 64.17

32601 THORACOSCOPY DIAGNOSTIC 0001 313.38

32604 THORACOSCOPY WBX SAC 0001 487.82

32606 THORACOSCOPY W/BX MED SPACE 0001 468.60

32607 Thoracoscopy w/bx infiltrate 0001 313.74

32608 Thoracoscopy w/bx nodule 0001 385.07

32609 Thoracoscopy w/bx pleura 0001 265.96

32650 THORACOSCOPY W/PLEURODESIS 0001 674.71

32651 THORACOSCOPY REMOVE CORTEX 0001 1107.68

32652 THORACOSCOPY REM TOTL CORTEX 0001 1681.92

32653 THORACOSCOPY REMOV FB/FIBRIN 0001 1070.78

32654 THORACOSCOPY CONTRL BLEEDING 0001 1188.72

32655 THORACOSCOPY RESECT BULLAE 0001 968.32

32656 THORACOSCOPY W/PLEURECTOMY 0001 808.66

32658 THORACOSCOPY W/SAC FB REMOVE 0001 723.82

32659 THORACOSCOPY W/SAC DRAINAGE 0001 741.43

32661 THORACOSCOPY W/PERICARD EXC 0001 809.44

32662 THORACOSCOPY W/MEDIAST EXC 0001 906.48

32663 THORACOSCOPY W/LOBECTOMY 0001 1419.95

32664 THORACOSCOPY W/ TH NRV EXC 0001 860.14

32665 THORACOSCOP W/ESOPH MUSC EXC 0001 1234.17

32666 Thoracoscopy w/wedge resect 0001 882.77

32667 Thoracoscopy w/w resect addl 0001 160.12

32668 Thoracoscopy w/w resect diag 0001 160.16

32669 Thoracoscopy remove segment 0001 1364.46

32670 Thoracoscopy bilobectomy 0001 1619.96

32671 Thoracoscopy pneumonectomy 0001 1805.63

32672 Thoracoscopy for lvrs 0001 1548.43

32673 Thoracoscopy w/thymus resect 0001 1222.54

32674 Thoracoscopy lymph node exc 0001 218.81

32701 Thorax stereo rad targetw/tx 0001 223.86

32800 REPAIR LUNG HERNIA 0001 956.46


32810 CLOSE CHEST AFTER DRAINAGE 0001 914.47

32815 CLOSE BRONCHIAL FISTULA 0001 2853.60

32820 RECONSTRUCT INJURED CHEST 0001 1349.13

32900 REMOVAL OF RIB(S) 0001 1424.27

32905 REVISE & REPAIR CHEST WALL 0001 1354.78

32906 REVISE & REPAIR CHEST WALL 0001 1674.32

32940 REVISION OF LUNG 0001 1252.44

32960 THERAPEUTIC PNEUMOTHORAX 0001 104.31

32997 TOTAL LUNG LAVAGE 0001 354.67

32998 PERQ RF ABLATE TX PUL TUMOR 0001 288.92

32999 CHEST SURGERY PROCEDURE 0001 0.00

33010 DRAINAGE OF HEART SAC 0001 119.79

33011 REPEAT DRAINAGE OF HEART SAC 0001 121.65

33015 INCISION OF HEART SAC 0001 512.44



33030 PARTIAL REMOVAL OF HEART SAC 0001 2036.45

33031 PARTIAL REMOVAL OF HEART SAC 0001 2526.42

33050 RESECT HEART SAC LESION 0001 1014.94

33120 REMOVAL OF HEART LESION 0001 2140.76


33140 HEART REVASCULARIZE (TMR) 0001 1608.58

33141 HEART TMR W/OTHER PROCEDURE 0001 134.94

33202 INSERT EPICARD ELTRD OPEN 0001 786.75

33203 INSERT EPICARD ELTRD ENDO 0001 817.51

33206 INSERT HEART PM ATRIAL 0001 462.01

33207 INSERT HEART PM VENTRICULAR 0001 492.28

33208 INSRT HEART PM ATRIAL & VENT 0001 532.87

33210 INSERT ELECTRD/PM CATH SNGL 0001 180.04

33211 INSERT CARD ELECTRODES DUAL 0001 184.97

33212 INSERT PULSE GEN SNGL LEAD 0001 334.08

33213 INSERT PULSE GEN DUAL LEADS 0001 349.14

33214 UPGRADE OF PACEMAKER SYSTEM 0001 491.84

33215 REPOSITION PACING-DEFIB LEAD 0001 309.44

33216 INSERT 1 ELECTRODE PM-DEFIB 0001 382.35

33217 INSERT 2 ELECTRODE PM-DEFIB 0001 376.67

33218 REPAIR LEAD PACE-DEFIB ONE 0001 399.65

33220 REPAIR LEAD PACE-DEFIB DUAL 0001 402.39

33221 Insert pulse gen mult leads 0001 371.37

33222 RELOCATION POCKET PACEMAKER 0001 350.15

33223 RELOCATE POCKET FOR DEFIB 0001 421.28

33224 INSERT PACING LEAD & CONNECT 0001 514.88

33225 L VENTRIC PACING LEAD ADD-ON 0001 466.72

33226 REPOSITION L VENTRIC LEAD 0001 494.24

33227 Remove&replace pm gen singl 0001 352.09

33228 Remv&replc pm gen dual lead 0001 366.76


33229 Remv&replc pm gen mult leads 0001 385.04

33230 Insrt pulse gen w/dual leads 0001 400.07

33231 Insrt pulse gen w/mult leads 0001 412.60

33233 REMOVAL OF PM GENERATOR 0001 242.02

33234 REMOVAL OF PACEMAKER SYSTEM 0001 496.07

33235 REMOVAL PACEMAKER ELECTRODE 0001 647.56

33236 REMOVE ELECTRODE/THORACOTOMY 0001 800.94



33240 INSRT PULSE GEN W/SINGL LEAD 0001 379.99

33241 REMOVE PULSE GENERATOR 0001 227.81

33243 REMOVE ELTRD/THORACOTOMY 0001 1390.04

33244 REMOVE ELCTRD TRANSVENOUSLY 0001 869.93

33249 INSJ/RPLCMT DEFIB W/LEAD(S) 0001 925.58

33250 ABLATE HEART DYSRHYTHM FOCUS 0001 1499.64


33254 ABLATE ATRIA LMTD 0001 1393.24

33255 ABLATE ATRIA W/O BYPASS EXT 0001 1694.46

33256 ABLATE ATRIA W/BYPASS EXTEN 0001 2001.47

33257 ABLATE ATRIA LMTD ADD-ON 0001 594.77

33258 ABLATE ATRIA X10SV ADD-ON 0001 668.20

33259 Ablate atria w/bypass add-on 0001 864.11


33262 RMVL& REPLC PULSE GEN 1 LEAD 0001 385.72

33263 RMVL & RPLCMT DFB GEN 2 LEAD 0001 401.13

33264 RMVL & RPLCMT DFB GEN MLT LD 0001 417.97

33265 ABLATE ATRIA LMTD ENDO 0001 1390.63

33266 ABLATE ATRIA X10SV ENDO 0001 1886.90

33270 Ins/rep subq defibrillator 0001 648.01

33271 Insj subq impltbl dfb elctrd 0001 489.34

33272 Rmvl of subq defibrillator 0001 441.79

33273 Repos prev impltbl subq dfb 0001 393.15

33282 IMPLANT PAT-ACTIVE HT RECORD 0001 238.66

33284 REMOVE PAT-ACTIVE HT RECORD 0001 210.64

33300 REPAIR OF HEART WOUND 0001 2491.13

33305 REPAIR OF HEART WOUND 0001 4179.92

33310 EXPLORATORY HEART SURGERY 0001 1182.31

33315 EXPLORATORY HEART SURGERY 0001 1956.90

33320 REPAIR MAJOR BLOOD VESSEL(S) 0001 1084.05

33321 REPAIR MAJOR VESSEL 0001 1218.00

33322 REPAIR MAJOR BLOOD VESSEL(S) 0001 1416.26

33330 INSERT MAJOR VESSEL GRAFT 0001 1467.86

33335 INSERT MAJOR VESSEL GRAFT 0001 1920.10

33361 Replace aortic valve perq 0001 1369.99

33362 Replace aortic valve open 0001 1498.27





33366 Trcath replace aortic valve 0001 1948.05

33367 Replace aortic valve w/byp 0001 628.16



33400 REPAIR OF AORTIC VALVE 0001 2332.71

33401 VALVULOPLASTY OPEN 0001 1447.37

33403 VALVULOPLASTY W/CP BYPASS 0001 1518.74

33404 PREPARE HEART-AORTA CONDUIT 0001 1784.77

33405 REPLACEMENT OF AORTIC VALVE 0001 2320.89







33415 REVISION SUBVALVULAR TISSUE 0001 2068.54

33416 REVISE VENTRICLE MUSCLE 0001 2077.52


33418 Repair tcat mitral valve 0001 1815.44

33419 Repair tcat mitral valve 0001 566.53

33420 REVISION OF MITRAL VALVE 0001 1482.70


33425 REPAIR OF MITRAL VALVE 0001 2793.57



33430 REPLACEMENT OF MITRAL VALVE 0001 2861.53

33460 REVISION OF TRICUSPID VALVE 0001 2492.71

33463 VALVULOPLASTY TRICUSPID 0001 3158.72

33464 VALVULOPLASTY TRICUSPID 0001 2502.19

33465 REPLACE TRICUSPID VALVE 0001 2818.88

33468 REVISION OF TRICUSPID VALVE 0001 2506.51

33470 REVISION OF PULMONARY VALVE 0001 1312.10

33471 VALVOTOMY PULMONARY VALVE 0001 1416.25


33475 REPLACEMENT PULMONARY VALVE 0001 2398.33

33476 REVISION OF HEART CHAMBER 0001 1563.34


33496 REPAIR PROSTH VALVE CLOT 0001 1699.37

33500 REPAIR HEART VESSEL FISTULA 0001 1617.41

33501 REPAIR HEART VESSEL FISTULA 0001 1156.16

33502 CORONARY ARTERY CORRECTION 0001 1304.69

33503 CORONARY ARTERY GRAFT 0001 1337.04

33504 CORONARY ARTERY GRAFT 0001 1505.30

33505 REPAIR ARTERY W/TUNNEL 0001 2119.98


33506 REPAIR ARTERY TRANSLOCATION 0001 2089.60

33507 REPAIR ART INTRAMURAL 0001 1744.16

33508 ENDOSCOPIC VEIN HARVEST 0001 16.42

33510 CABG VEIN SINGLE 0001 1978.12

33511 CABG VEIN TWO 0001 2172.08

33512 CABG VEIN THREE 0001 2469.38

33513 CABG VEIN FOUR 0001 2540.69

33514 CABG VEIN FIVE 0001 2679.94

33516 CABG VEIN SIX OR MORE 0001 2789.30

33517 CABG ARTERY-VEIN SINGLE 0001 191.56

33518 CABG ARTERY-VEIN TWO 0001 421.66

33519 CABG ARTERY-VEIN THREE 0001 557.28

33521 CABG ARTERY-VEIN FOUR 0001 669.58

33522 CABG ARTERY-VEIN FIVE 0001 751.38

33523 CABG ART-VEIN SIX OR MORE 0001 851.96

33530 CORONARY ARTERY BYPASS/REOP 0001 537.66

33533 CABG ARTERIAL SINGLE 0001 1912.05

33534 CABG ARTERIAL TWO 0001 2247.56

33535 CABG ARTERIAL THREE 0001 2505.20

33536 CABG ARTERIAL FOUR OR MORE 0001 2689.61


33545 REPAIR OF HEART DAMAGE 0001 3159.28

33548 RESTORE/REMODEL VENTRICLE 0001 3040.90

33572 OPEN CORONARY ENDARTERECTOMY 0001 236.37

33600 CLOSURE OF VALVE 0001 1737.44

33602 CLOSURE OF VALVE 0001 1673.92

33606 ANASTOMOSIS/ARTERY-AORTA 0001 1784.15

33608 REPAIR ANOMALY W/CONDUIT 0001 1820.29

33610 REPAIR BY ENLARGEMENT 0001 1795.50

33611 REPAIR DOUBLE VENTRICLE 0001 1995.82

33612 REPAIR DOUBLE VENTRICLE 0001 2017.56

33615 REPAIR MODIFIED FONTAN 0001 2052.57

33617 REPAIR SINGLE VENTRICLE 0001 2188.70

33619 REPAIR SINGLE VENTRICLE 0001 2905.39

33620 APPLY R&L PULM ART BANDS APPLI 0001 1487.76

33621 TRANSTHOR CATH FOR STENT TRANS 0001 892.89

33622 REDO COMPL CARDIAC ANOMALY RECON 0001 3513.16

33641 REPAIR HEART SEPTUM DEFECT 0001 1671.72

33645 REVISION OF HEART VEINS 0001 1769.19

33647 REPAIR HEART SEPTUM DEFECTS 0001 1868.40

33660 REPAIR OF HEART DEFECTS 0001 1796.45


33670 REPAIR OF HEART CHAMBERS 0001 2028.80

33675 CLOSE MULT VSD 0001 2016.81

33676 CLOSE MULT VSD W/RESECTION 0001 2192.25

33677 CL MULT VSD W/REM PUL BAND 0001 2277.75





33690 REINFORCE PULMONARY ARTERY 0001 1213.25






33720 REPAIR OF HEART DEFECT 0001 1573.83

33722 REPAIR OF HEART DEFECT 0001 1670.17

33724 REPAIR VENOUS ANOMALY 0001 1566.10

33726 REPAIR PUL VENOUS STENOSIS 0001 2122.86

33730 REPAIR HEART-VEIN DEFECT(S) 0001 2049.60

33732 REPAIR HEART-VEIN DEFECT 0001 1779.32




33750 MAJOR VESSEL SHUNT 0001 1376.49



33764 MAJOR VESSEL SHUNT & GRAFT 0001 1323.07



33768 CAVOPULMONARY SHUNTING 0001 454.32

33770 REPAIR GREAT VESSELS DEFECT 0001 2270.96










33782 NIKAIDOH PROC 0001 3359.77

33783 NIKAIDOH PROC W/OSTIA IMPLT 0001 3749.28

33786 REPAIR ARTERIAL TRUNK 0001 2344.01

33788 REVISION OF PULMONARY ARTERY 0001 1575.09

33800 AORTIC SUSPENSION 0001 933.07

33802 REPAIR VESSEL DEFECT 0001 1113.60

33803 REPAIR VESSEL DEFECT 0001 1234.71

33813 REPAIR SEPTAL DEFECT 0001 1261.74


33820 REVISE MAJOR VESSEL 0001 996.06




33840 REMOVE AORTA CONSTRICTION 0001 1323.74





33860 ASCENDING AORTIC GRAFT 0001 3283.66



33870 TRANSVERSE AORTIC ARCH GRAFT 0001 2574.66

33875 THORACIC AORTIC GRAFT 0001 2813.57

33877 THORACOABDOMINAL GRAFT 0001 3728.48

33880 ENDOVASC TAA REPR INCL SUBCL 0001 1849.87

33881 ENDOVASC TAA REPR W/O SUBCL 0001 1591.48

33883 INSERT ENDOVASC PROSTH TAA 0001 1153.28

33884 ENDOVASC PROSTH TAA ADD-ON 0001 422.47

33886 ENDOVASC PROSTH DELAYED 0001 1003.73

33889 ARTERY TRANSPOSE/ENDOVAS TAA 0001 821.93

33891 CAR-CAR BP GRFT/ENDOVAS TAA 0001 1004.93

33910 REMOVE LUNG ARTERY EMBOLI 0001 2712.49

33915 REMOVE LUNG ARTERY EMBOLI 0001 1295.00

33916 SURGERY OF GREAT VESSEL 0001 4304.32

33917 REPAIR PULMONARY ARTERY 0001 1473.97

33920 REPAIR PULMONARY ATRESIA 0001 1859.06

33922 TRANSECT PULMONARY ARTERY 0001 1427.02

33924 REMOVE PULMONARY SHUNT 0001 288.99

33925 RPR PUL ART UNIFOCAL W/O CPB 0001 1738.54

33926 REPR PUL ART UNIFOCAL W/CPB 0001 2471.83

33946 Ecmo/ecls initiation venous 0001 319.77

33947 Ecmo/ecls initiation artery 0001 348.05

33948 Ecmo/ecls daily mgmt-venous 0001 243.56

33949 Ecmo/ecls daily mgmt artery 0001 237.69

33951 Ecmo/ecls insj prph cannula 0001 388.49




33955 Ecmo/ecls insj ctr cannula 0001 903.41

33956 Ecmo/ecls insj ctr cannula 0001 852.42

33957 Ecmo/ecls repos perph cnula 0001 306.30






33965 Ecmo/ecls rmvl perph cannula 0001 309.54

33966 Ecmo/ecls rmvl prph cannula 0001 340.75


33967 INSERT I-AORT PERCUT DEVICE 0001 262.20

33968 REMOVE AORTIC ASSIST DEVICE 0001 34.23

33969 Ecmo/ecls rmvl perph cannula 0001 348.70

33970 AORTIC CIRCULATION ASSIST 0001 361.15

33971 AORTIC CIRCULATION ASSIST 0001 723.39

33973 INSERT BALLOON DEVICE 0001 523.73

33974 REMOVE INTRA-AORTIC BALLOON 0001 909.74

33975 IMPLANT VENTRICULAR DEVICE 0001 1355.02

33976 IMPLANT VENTRICULAR DEVICE 0001 1650.40

33977 REMOVE VENTRICULAR DEVICE 0001 1152.71

33978 REMOVE VENTRICULAR DEVICE 0001 1375.66

33979 INSERT INTRACORPOREAL DEVICE 0001 1995.65

33980 REMOVE INTRACORPOREAL DEVICE 0001 1824.83

33981 REPLACE VAD PUMP EXT 0001 857.90

33982 REPLACE VAD INTRA W/O BP 0001 2002.67

33983 REPLACE VAD INTRA W/BP 0001 2360.03

33984 Ecmo/ecls rmvl prph cannula 0001 340.00

33985 Ecmo/ecls rmvl ctr cannula 0001 646.29

33986 Ecmo/ecls rmvl ctr cannula 0001 614.85

33987 Artery expos/graft artery 0001 261.06

33988 Insertion of left heart vent 0001 744.29

33989 Removal of left heart vent 0001 498.23

33990 Insert vad artery access 0001 442.99

33991 Insert vad art&vein access 0001 645.78

33992 Remove vad different session 0001 209.21

33993 Reposition vad diff session 0001 183.72

34001 REMOVAL OF ARTERY CLOT 0001 990.09



34111 REMOVAL OF ARM ARTERY CLOT 0001 620.60



34203 REMOVAL OF LEG ARTERY CLOT 0001 990.91

34401 REMOVAL OF VEIN CLOT 0001 1496.42





34501 REPAIR VALVE FEMORAL VEIN 0001 1019.88

34502 RECONSTRUCT VENA CAVA 0001 1557.15

34510 TRANSPOSITION OF VEIN VALVE 0001 1197.39

34520 CROSS-OVER VEIN GRAFT 0001 1030.16

34530 LEG VEIN FUSION 0001 1113.08

34800 ENDOVAS AAA REPR W/SM TUBE 0001 1160.14

34802 ENDOVAS AAA REPR W/2-P PART 0001 1281.83




34805 ENDOVAS AAA REPR W/LONG TUBE 0001 1231.02

34806 ANEURYSM PRESS SENSOR ADD-ON 0001 102.17

34808 ENDOVAS ILIAC A DEVICE ADDON 0001 211.52

34812 XPOSE FOR ENDOPROSTH FEMORL 0001 347.83

34813 FEMORAL ENDOVAS GRAFT ADD-ON 0001 244.73

34820 XPOSE FOR ENDOPROSTH ILIAC 0001 505.30

34825 ENDOVASC EXTEND PROSTH INIT 0001 718.22

34826 ENDOVASC EXTEN PROSTH ADDL 0001 210.77

34830 OPEN AORTIC TUBE PROSTH REPR 0001 1836.12

34831 OPEN AORTOILIAC PROSTH REPR 0001 1974.73

34832 OPEN AORTOFEMOR PROSTH REPR 0001 1974.73

34833 XPOSE FOR ENDOPROSTH ILIAC 0001 630.40

34834 XPOSE ENDOPROSTH BRACHIAL 0001 282.75

34839 Plnning pt spec fenest graft 0001 0.00

34841 Endovasc visc aorta 1 graft 0001 0.00




34845 Visc & infraren abd 1 prosth 0001 0.00



34848 Visc & infraren abd 4+ prost 0001 0.00

34900 ENDOVASC ILIAC REPR W/GRAFT 0001 917.91

35001 REPAIR DEFECT OF ARTERY 0001 1161.19

35002 REPAIR ARTERY RUPTURE NECK 0001 1163.84



35013 REPAIR ARTERY RUPTURE ARM 0001 1293.23


35022 REPAIR ARTERY RUPTURE CHEST 0001 1475.93

35045 REPAIR DEFECT OF ARM ARTERY 0001 1027.80


35082 REPAIR ARTERY RUPTURE AORTA 0001 2266.97






35112 REPAIR ARTERY RUPTURE SPLEEN 0001 1894.98


35122 REPAIR ARTERY RUPTURE BELLY 0001 2186.21


35132 REPAIR ARTERY RUPTURE GROIN 0001 1692.26


35142 REPAIR ARTERY RUPTURE THIGH 0001 1372.75



35152 REPAIR RUPTD POPLITEAL ART 0001 1456.01

35180 REPAIR BLOOD VESSEL LESION 0001 938.35

























35301 RECHANNELING OF ARTERY 0001 1172.57
















35390 REOPERATION CAROTID ADD-ON 0001 164.48

35400 ANGIOSCOPY 0001 153.61

35450 REPAIR ARTERIAL BLOCKAGE 0001 528.19




35460 REPAIR VENOUS BLOCKAGE 0001 320.38





35500 HARVEST VEIN FOR BYPASS 0001 330.70

35501 ART BYP GRFT IPSILAT CAROTID 0001 1549.84

35506 ART BYP GRFT SUBCLAV-CAROTID 0001 1329.05

35508 ART BYP GRFT CAROTID-VERTBRL 0001 1397.43

35509 ART BYP GRFT CONTRAL CAROTID 0001 1474.43

35510 ART BYP GRFT CAROTID-BRCHIAL 0001 1282.26

35511 ART BYP GRFT SUBCLAV-SUBCLAV 0001 1321.69

35512 ART BYP GRFT SUBCLAV-BRCHIAL 0001 1257.86

35515 ART BYP GRFT SUBCLAV-VERTBRL 0001 1385.38

35516 ART BYP GRFT SUBCLAV-AXILARY 0001 1272.10

35518 ART BYP GRFT AXILLARY-AXILRY 0001 1191.07

35521 ART BYP GRFT AXILL-FEMORAL 0001 1278.70

35522 ART BYP GRFT AXILL-BRACHIAL 0001 1259.25

35523 ART BYP GRFT BRCHL-ULNR-RDL 0001 1330.33

35525 ART BYP GRFT BRACHIAL-BRCHL 0001 1178.61

35526 ART BYP GRFT AOR/CAROT/INNOM 0001 1784.65

35531 ART BYP GRFT AORCEL/AORMESEN 0001 2095.25

35533 ART BYP GRFT AXILL/FEM/FEM 0001 1569.81

35535 ART BYP GRFT HEPATORENAL 0001 1754.81

35536 ART BYP GRFT SPLENORENAL 0001 1761.47

35537 ART BYP GRFT AORTOILIAC 0001 2173.05

35538 ART BYP GRFT AORTOBI-ILIAC 0001 2432.76

35539 ART BYP GRFT AORTOFEMORAL 0001 2285.47

35540 ART BYP GRFT AORTBIFEMORAL 0001 2534.05

35556 ART BYP GRFT FEM-POPLITEAL 0001 1457.68

35558 ART BYP GRFT FEM-FEMORAL 0001 1284.19

35560 ART BYP GRFT AORTORENAL 0001 1776.11

35563 ART BYP GRFT ILIOILIAC 0001 1378.50

35565 ART BYP GRFT ILIOFEMORAL 0001 1366.99

35566 ART BYP FEM-ANT-POST TIB/PRL 0001 1739.43

35570 ART BYP TIBIAL-TIB/PERONEAL 0001 1407.97

35571 ART BYP POP-TIBL-PRL-OTHER 0001 1383.40

35572 HARVEST FEMOROPOPLITEAL VEIN 0001 356.74

35583 VEIN BYP GRFT FEM-POPLITEAL 0001 1503.60

35585 VEIN BYP FEM-TIBIAL PERONEAL 0001 1743.58

35587 VEIN BYP POP-TIBL PERONEAL 0001 1423.33

35600 HARVEST ART FOR CABG ADD-ON 0001 263.66

35601 ART BYP COMMON IPSI CAROTID 0001 1457.75

35606 ART BYP CAROTID-SUBCLAVIAN 0001 1220.99


35612 ART BYP SUBCLAV-SUBCLAVIAN 0001 1088.82

35616 ART BYP SUBCLAV-AXILLARY 0001 1129.96

35621 ART BYP AXILLARY-FEMORAL 0001 1142.56

35623 ART BYP AXILLARY-POP-TIBIAL 0001 1368.01

35626 ART BYP AORSUBCL/CAROT/INNOM 0001 1632.80

35631 ART BYP AOR-CELIAC-MSN-RENAL 0001 1923.79

35632 ART BYP ILIO-CELIAC 0001 1666.70

35633 ART BYP ILIO-MESENTERIC 0001 1863.36

35634 ART BYP ILIORENAL 0001 1630.71

35636 ART BYP SPENORENAL 0001 1661.61

35637 ART BYP AORTOILIAC 0001 1798.72

35638 ART BYP AORTOBI-ILIAC 0001 1834.64

35642 ART BYP CAROTID-VERTEBRAL 0001 1028.34

35645 ART BYP SUBCLAV-VERTEBRL 0001 1080.11

35646 ART BYP AORTOBIFEMORAL 0001 1784.39

35647 ART BYP AORTOFEMORAL 0001 1619.01

35650 ART BYP AXILLARY-AXILLARY 0001 1116.77

35654 ART BYP AXILL-FEM-FEMORAL 0001 1425.75

35656 ART BYP FEMORAL-POPLITEAL 0001 1127.51

35661 ART BYP FEMORAL-FEMORAL 0001 1128.43

35663 ART BYP ILIOILIAC 0001 1305.55

35665 ART BYP ILIOFEMORAL 0001 1222.78

35666 ART BYP FEM-ANT-POST TIB/PRL 0001 1321.79

35671 ART BYP POP-TIBL-PRL-OTHER 0001 1167.29

35681 COMPOSITE BYP GRFT PROS&VEIN 0001 82.77

35682 COMPOSITE BYP GRFT 2 VEINS 0001 367.30

35683 COMPOSITE BYP GRFT 3/> SEGMT 0001 425.79

35685 BYPASS GRAFT PATENCY/PATCH 0001 207.05

35686 BYPASS GRAFT/AV FIST PATENCY 0001 166.39

35691 ART TRNSPOSJ VERTBRL CAROTID 0001 984.96

35693 ART TRNSPOSJ SUBCLAVIAN 0001 870.34

35694 ART TRNSPOSJ SUBCLAV CAROTID 0001 1028.22

35695 ART TRNSPOSJ CAROTID SUBCLAV 0001 1067.67

35697 REIMPLANT ARTERY EACH 0001 153.27

35700 REOPERATION BYPASS GRAFT 0001 158.54

35701 EXPLORATION CAROTID ARTERY 0001 583.94

35721 EXPLORATION FEMORAL ARTERY 0001 467.70

35741 EXPLORATION POPLITEAL ARTERY 0001 530.16

35761 EXPLORATION OF ARTERY/VEIN 0001 400.93

35800 EXPLORE NECK VESSELS 0001 735.12

35820 EXPLORE CHEST VESSELS 0001 2057.18

35840 EXPLORE ABDOMINAL VESSELS 0001 1204.84

35860 EXPLORE LIMB VESSELS 0001 870.78

35870 REPAIR VESSEL GRAFT DEFECT 0001 1296.83

35875 REMOVAL OF CLOT IN GRAFT 0001 615.24

35876 REMOVAL OF CLOT IN GRAFT 0001 980.52


35879 REVISE GRAFT W/VEIN 0001 961.76


35883 REVISE GRAFT W/NONAUTO GRAFT 0001 1256.15


35901 EXCISION GRAFT NECK 0001 489.04

35903 EXCISION GRAFT EXTREMITY 0001 585.00

35905 EXCISION GRAFT THORAX 0001 1750.26

35907 EXCISION GRAFT ABDOMEN 0001 1979.60

36000 PLACE NEEDLE IN VEIN 0001 9.77

36002 PSEUDOANEURYSM INJECTION TRT 0001 108.92

36005 INJECTION EXT VENOGRAPHY 0001 48.74

36010 PLACE CATHETER IN VEIN 0001 122.49



36013 PLACE CATHETER IN ARTERY 0001 132.20



36100 ESTABLISH ACCESS TO ARTERY 0001 161.81



36147 ACCESS AV DIAL GRFT FOR EVAL 0001 188.96

36148 ACCESS AV DIAL GRFT FOR PROC 0001 49.33

36160 ESTABLISH ACCESS TO AORTA 0001 129.92

36200 PLACE CATHETER IN AORTA 0001 154.86





36221 Place cath thoracic aorta 0001 217.41

36222 Place cath carotid/inom art 0001 295.60

36223 Place cath carotid/inom art 0001 318.91

36224 Place cath carotd art 0001 348.94

36225 Place cath subclavian art 0001 317.46

36226 Place cath vertebral art 0001 350.02

36227 Place cath xtrnl carotid 0001 110.89

36228 Place cath intracranial art 0001 225.25

36245 INS CATH ABD/L-EXT ART 1ST 0001 259.65

36246 INS CATH ABD/L-EXT ART 2ND 0001 272.74

36247 INS CATH ABD/L-EXT ART 3RD 0001 326.13

36248 INS CATH ABD/L-EXT ART ADDL 0001 51.90

36251 Ins cath ren art 1st unilat 0001 284.47

36252 Ins cath ren art 1st bilat 0001 372.43

36253 Ins cath ren art 2nd+ unilat 0001 398.89

36254 Ins cath ren art 2nd+ bilat 0001 432.79

36260 INSERTION OF INFUSION PUMP 0001 625.17

36261 REVISION OF INFUSION PUMP 0001 364.21


36262 REMOVAL OF INFUSION PUMP 0001 306.27

36400 BL DRAW < 3 YRS FEM/JUGULAR 0001 20.57

36405 BL DRAW <3 YRS SCALP VEIN 0001 17.11

36406 BL DRAW <3 YRS OTHER VEIN 0001 9.41

36410 NON-ROUTINE BL DRAW 3/> YRS 0001 9.77

36415 ROUTINE VENIPUNCTURE 0001 3.98

36416 CAPILLARY BLOOD DRAW 0001 4.34

36420 VEIN ACCESS CUTDOWN < 1 YR 0001 48.60

36425 VEIN ACCESS CUTDOWN > 1 YR 0001 40.44

36430 BLOOD TRANSFUSION SERVICE 0001 34.12

36440 BL PUSH TRANSFUSE 2 YR/< 0001 58.11

36450 BL EXCHANGE/TRANSFUSE NB 0001 107.39

36455 BL EXCHANGE/TRANSFUSE NON-NB 0001 112.45

36460 TRANSFUSION SERVICE FETAL 0001 368.34

36468 INJECTION(S) SPIDER VEINS 0001 25.70

36470 INJECTION THERAPY OF VEIN 0001 86.31

36471 INJECTION THERAPY OF VEINS 0001 102.73

36475 ENDOVENOUS RF 1ST VEIN 0001 361.65

36476 ENDOVENOUS RF VEIN ADD-ON 0001 177.39

36478 ENDOVENOUS LASER 1ST VEIN 0001 357.89

36479 ENDOVENOUS LASER VEIN ADDON 0001 176.19

36481 INSERTION OF CATHETER VEIN 0001 359.18



36511 APHERESIS WBC 0001 95.63

36512 APHERESIS RBC 0001 94.00

36513 APHERESIS PLATELETS 0001 100.07

36514 APHERESIS PLASMA 0001 94.91

36515 APHERESIS ADSORP/REINFUSE 0001 87.68

36516 APHERESIS SELECTIVE 0001 71.58

36522 PHOTOPHERESIS 0001 102.03

36555 INSERT NON-TUNNEL CV CATH 0001 117.51

36556 INSERT NON-TUNNEL CV CATH 0001 121.95

36557 INSERT TUNNELED CV CATH 0001 329.88







36568 INSERT PICC CATH 0001 98.73

36569 INSERT PICC CATH 0001 92.45

36570 INSERT PICVAD CATH 0001 311.95

36571 INSERT PICVAD CATH 0001 327.25

36575 REPAIR TUNNELED CV CATH 0001 35.92

36576 REPAIR TUNNELED CV CATH 0001 198.93


36578 REPLACE TUNNELED CV CATH 0001 219.15

36580 REPLACE CVAD CATH 0001 67.86




36584 REPLACE PICC CATH 0001 67.28

36585 REPLACE PICVAD CATH 0001 284.85

36589 REMOVAL TUNNELED CV CATH 0001 140.40

36590 REMOVAL TUNNELED CV CATH 0001 208.17

36591 Draw blood off venous device 0001 23.35

36592 Collect blood from picc 0001 26.22

36593 Declot vascular device 0001 30.89

36595 MECH REMOV TUNNELED CV CATH 0001 186.49

36596 MECH REMOV TUNNELED CV CATH 0001 45.83

36597 REPOSITION VENOUS CATHETER 0001 61.52

36598 INJ W/FLUOR EVAL CV DEVICE 0001 37.18

36600 WITHDRAWAL OF ARTERIAL BLOOD 0001 15.62

36620 INSERTION CATHETER ARTERY 0001 50.84




36680 INSERT NEEDLE BONE CAVITY 0001 60.27

36800 INSERTION OF CANNULA 0001 126.57



36818 AV FUSE UPPR ARM CEPHALIC 0001 687.76

36819 AV FUSE UPPR ARM BASILIC 0001 755.05

36820 AV FUSION/FOREARM VEIN 0001 825.49

36821 AV FUSION DIRECT ANY SITE 0001 711.16

36823 INSERTION OF CANNULA(S) 0001 1357.50

36825 ARTERY-VEIN AUTOGRAFT 0001 816.58

36830 ARTERY-VEIN NONAUTOGRAFT 0001 673.61

36831 OPEN THROMBECT AV FISTULA 0001 465.78

36832 AV FISTULA REVISION OPEN 0001 593.89

36833 AV FISTULA REVISION 0001 673.31

36835 ARTERY TO VEIN SHUNT 0001 512.67

36838 DIST REVAS LIGATION HEMO 0001 1183.10

36860 EXTERNAL CANNULA DECLOTTING 0001 114.87

36861 CANNULA DECLOTTING 0001 132.61

36870 PERCUT THROMBECT AV FISTULA 0001 305.38

37140 REVISION OF CIRCULATION 0001 2308.04




37181 SPLICE SPLEEN/KIDNEY VEINS 0001 2307.66

37182 INSERT HEPATIC SHUNT (TIPS) 0001 848.67


37183 REMOVE HEPATIC SHUNT (TIPS) 0001 399.08

37184 PRIM ART MECH THROMBECTOMY 0001 460.91

37185 PRIM ART M-THROMBECT ADD-ON 0001 169.48

37186 SEC ART M-THROMBECT ADD-ON 0001 256.45

37187 VENOUS MECH THROMBECTOMY 0001 410.45

37188 VENOUS M-THROMBECTOMY ADD-ON 0001 294.41

37191 Ins endovas vena cava filtr 0001 242.75

37192 Redo endovas vena cava filtr 0001 365.66

37193 Rem endovas vena cava filter 0001 373.91

37195 THROMBOLYTIC THERAPY STROKE 0001 304.44

37197 Remove intrvas foreign body 0001 306.80

37200 TRANSCATHETER BIOPSY 0001 223.92

37202 TRANSCATHETER THERAPY INFUSE 0001 306.45

37211 Thrombolytic art therapy 0001 407.72

37212 Thrombolytic venous therapy 0001 359.99

37213 Thromblytic art/ven therapy 0001 250.78

37214 CESSJ THERAPY CATH REMOVAL 0001 148.36

37215 TRANSCATH STENT CCA W/EPS 0001 1100.81

37216 TRANSCATH STENT CCA W/O EPS 0001 1019.39

37217 Stent placemt retro carotid 0001 1136.75

37218 Stent placemt ante carotid 0001 878.29

37220 ILIAC REVASC REVAS 0001 424.08

37221 ILIAC REVASC W/STENT REVAS 0001 516.55

37222 ILIAC REVASC ADD-ON 0001 190.82

37223 ILIAC REVASC W/STENT ADD-ON 0001 218.36

37224 FEM/POPL REVAS W/TLA REVAS 0001 469.06

37225 FEM/POPL REVAS W/ATHER REVAS 0001 633.14

37226 FEM/POPL REVASC W/STENT REVAS 0001 517.14

37227 FEM/POPL REVASC STNT & ATHER REVAS 0001 762.65

37228 TIB/PER REVASC W/TLA REVAS 0001 572.06

37229 TIB/PER REVASC W/ATHER REVAS 0001 740.37

37230 TIB/PER REVASC W/STENT REVAS 0001 716.87

37231 TIB/PER REVASC STENT & ATHER REVAS 0001 785.43

37232 TIB/PER REVASC ADD-ON 0001 207.29

37233 TIBPER REVASC W/ATHER ADD-ON 0001 338.99

37234 REVSC OPN/PRQ TIB/PERO STENT 0001 287.21

37235 TIB/PER REVASC STNT & ATHER 0001 416.97

37236 Open/perq place stent 1st 0001 469.58

37237 OPEN/PERQ PLACE STENT EA ADD 0001 219.43

37238 Open/perq place stent same 0001 329.00

37239 OPEN/PERQ PLACE STENT EA ADD 0001 153.14

37241 VASC EMBOLIZE/OCCLUDE VENOUS 0001 450.26

37242 Vasc embolize/occlude artery 0001 502.78

37243 Vasc embolize/occlude organ 0001 599.43

37244 Vasc embolize/occlude bleed 0001 699.19

37250 IV US FIRST VESSEL ADD-ON 0001 109.27


37251 IV US EACH ADD VESSEL ADD-ON 0001 81.65

37500 ENDOSCOPY LIGATE PERF VEINS 0001 777.91

37565 LIGATION OF NECK VEIN 0001 745.15

37600 LIGATION OF NECK ARTERY 0001 726.13



37607 LIGATION OF A-V FISTULA 0001 386.84

37609 TEMPORAL ARTERY PROCEDURE 0001 211.25


37616 LIGATION OF CHEST ARTERY 0001 1107.27

37617 LIGATION OF ABDOMEN ARTERY 0001 1353.51

37618 LIGATION OF EXTREMITY ARTERY 0001 395.77

37619 Ligation of inf vena cava 0001 1672.35

37650 REVISION OF MAJOR VEIN 0001 521.82

37660 REVISION OF MAJOR VEIN 0001 1152.62

37700 REVISE LEG VEIN 0001 257.56

37718 LIGATE/STRIP SHORT LEG VEIN 0001 446.60

37722 LIGATE/STRIP LONG LEG VEIN 0001 493.94

37735 REMOVAL OF LEG VEINS/LESION 0001 698.51

37760 LIGATE LEG VEINS RADICAL 0001 629.60

37761 LIGATE LEG VEINS OPEN 0001 564.57

37765 STAB PHLEB VEINS XTR 10-20 0001 460.97

37766 PHLEB VEINS - EXTREM 20+ 0001 566.92

37780 REVISION OF LEG VEIN 0001 262.42

37785 LIGATE/DIVIDE/EXCISE VEIN 0001 268.17

37788 REVASCULARIZATION PENIS 0001 1345.67

37790 PENILE VENOUS OCCLUSION 0001 481.71

37799 VASCULAR SURGERY PROCEDURE 0001 0.00

38100 REMOVAL OF SPLEEN TOTAL 0001 1150.76

38101 REMOVAL OF SPLEEN PARTIAL 0001 1159.87

38102 REMOVAL OF SPLEEN TOTAL 0001 261.79

38115 REPAIR OF RUPTURED SPLEEN 0001 1266.03

38120 LAPAROSCOPY SPLENECTOMY 0001 1051.11

38200 INJECTION FOR SPLEEN X-RAY 0001 133.00

38204 BL DONOR SEARCH MANAGEMENT 0001 100.67

38205 HARVEST ALLOGENEIC STEM CELL 0001 80.68

38206 HARVEST AUTO STEM CELLS 0001 82.17

38207 CRYOPRESERVE STEM CELLS 0001 44.40

38208 THAW PRESERVED STEM CELLS 0001 28.48

38209 WASH HARVEST STEM CELLS 0001 11.78

38210 T-CELL DEPLETION OF HARVEST 0001 78.79

38211 TUMOR CELL DEPLETE OF HARVST 0001 71.88

38212 RBC DEPLETION OF HARVEST 0001 46.83

38213 PLATELET DEPLETE OF HARVEST 0001 11.78

38214 VOLUME DEPLETE OF HARVEST 0001 40.60

38215 HARVEST STEM CELL CONCENTRTE 0001 46.83


38220 BONE MARROW ASPIRATION 0001 60.68

38221 BONE MARROW BIOPSY 0001 74.81

38230 BONE MARROW HARVEST ALLOGEN 0001 211.41

38232 Bone marrow harvest autolog 0001 209.61

38240 TRANSPLT ALLO HCT/DONOR 0001 224.34

38241 TRANSPLT AUTOL HCT/DONOR 0001 167.50

38242 TRANSPLT ALLO LYMPHOCYTES 0001 116.95

38243 Transplj hematopoietic boost 0001 117.99

38300 DRAINAGE LYMPH NODE LESION 0001 183.76

38305 DRAINAGE LYMPH NODE LESION 0001 477.53

38308 INCISION OF LYMPH CHANNELS 0001 448.44

38380 THORACIC DUCT PROCEDURE 0001 576.90



38500 BIOPSY/REMOVAL LYMPH NODES 0001 253.58

38505 NEEDLE BIOPSY LYMPH NODES 0001 72.06





38542 EXPLORE DEEP NODE(S) NECK 0001 524.03

38550 REMOVAL NECK/ARMPIT LESION 0001 506.50

38555 REMOVAL NECK/ARMPIT LESION 0001 1002.77

38562 REMOVAL PELVIC LYMPH NODES 0001 699.61

38564 REMOVAL ABDOMEN LYMPH NODES 0001 700.24

38570 LAPAROSCOPY LYMPH NODE BIOP 0001 531.60

38571 LAPAROSCOPY LYMPHADENECTOMY 0001 783.21

38572 LAPAROSCOPY LYMPHADENECTOMY 0001 956.69

38700 REMOVAL OF LYMPH NODES NECK 0001 814.56



38740 REMOVE ARMPIT LYMPH NODES 0001 691.81

38745 REMOVE ARMPIT LYMPH NODES 0001 873.85

38746 REMOVE THORACIC LYMPH NODES 0001 218.81

38747 REMOVE ABDOMINAL LYMPH NODES 0001 266.00

38760 REMOVE GROIN LYMPH NODES 0001 841.73

38765 REMOVE GROIN LYMPH NODES 0001 1287.07

38770 REMOVE PELVIS LYMPH NODES 0001 797.18

38780 REMOVE ABDOMEN LYMPH NODES 0001 1023.41

38790 INJECT FOR LYMPHATIC X-RAY 0001 84.56

38792 RA TRACER ID OF SENTINL NODE 0001 40.83

38794 ACCESS THORACIC LYMPH DUCT 0001 299.90

38900 IO MAP OF SENT LYMPH NODE INTRA 0001 137.40



39200 RESECT MEDIASTINAL CYST 0001 887.70


39220 RESECT MEDIASTINAL TUMOR 0001 1160.35

39400 MEDIASTINOSCOPY INCL BIOPSY 0001 514.01

39501 REPAIR DIAPHRAGM LACERATION 0001 853.18

39503 REPAIR OF DIAPHRAGM HERNIA 0001 6122.98



39545 REVISION OF DIAPHRAGM 0001 905.49

39560 RESECT DIAPHRAGM SIMPLE 0001 801.83

39561 RESECT DIAPHRAGM COMPLEX 0001 1251.35

40490 BIOPSY OF LIP 0001 73.81

40500 PARTIAL EXCISION OF LIP 0001 369.54



40525 RECONSTRUCT LIP WITH FLAP 0001 562.76

40527 RECONSTRUCT LIP WITH FLAP 0001 627.21

40530 PARTIAL REMOVAL OF LIP 0001 408.82

40650 REPAIR LIP 0001 304.35

40652 REPAIR LIP 0001 356.13

40654 REPAIR LIP 0001 430.96

40700 REPAIR CLEFT LIP/NASAL 0001 915.55





40800 DRAINAGE OF MOUTH LESION 0001 135.55


40804 REMOVAL FOREIGN BODY MOUTH 0001 137.18

40805 REMOVAL FOREIGN BODY MOUTH 0001 241.03

40806 INCISION OF LIP FOLD 0001 36.12

40808 BIOPSY OF MOUTH LESION 0001 110.71

40810 EXCISION OF MOUTH LESION 0001 131.36

40812 EXCISE/REPAIR MOUTH LESION 0001 202.26

40814 EXCISE/REPAIR MOUTH LESION 0001 314.24


40818 EXCISE ORAL MUCOSA FOR GRAFT 0001 280.49

40819 EXCISE LIP OR CHEEK FOLD 0001 242.96

40820 TREATMENT OF MOUTH LESION 0001 177.35

40830 REPAIR MOUTH LACERATION 0001 171.31

40831 REPAIR MOUTH LACERATION 0001 231.87

40840 RECONSTRUCTION OF MOUTH 0001 633.95












41010 INCISION OF TONGUE FOLD 0001 111.64





41019 Place needles h&n for rt 0001 465.36

41100 BIOPSY OF TONGUE 0001 110.82

41105 BIOPSY OF TONGUE 0001 114.32

41108 BIOPSY OF FLOOR OF MOUTH 0001 92.63

41110 EXCISION OF TONGUE LESION 0001 135.73




41115 EXCISION OF TONGUE FOLD 0001 156.51


41120 PARTIAL REMOVAL OF TONGUE 0001 1067.04

41130 PARTIAL REMOVAL OF TONGUE 0001 1319.53

41135 TONGUE AND NECK SURGERY 0001 2185.35

41140 REMOVAL OF TONGUE 0001 2205.38

41145 TONGUE REMOVAL NECK SURGERY 0001 2787.47

41150 TONGUE MOUTH JAW SURGERY 0001 2215.90

41153 TONGUE MOUTH NECK SURGERY 0001 2407.27

41155 TONGUE JAW & NECK SURGERY 0001 3032.81

41250 REPAIR TONGUE LACERATION 0001 158.52



41500 FIXATION OF TONGUE 0001 381.24

41510 TONGUE TO LIP SURGERY 0001 451.34

41512 TONGUE SUSPENSION 0001 634.12

41520 RECONSTRUCTION TONGUE FOLD 0001 263.94

41530 TONGUE BASE VOL REDUCTION 0001 412.67

41800 DRAINAGE OF GUM LESION 0001 151.70

41805 REMOVAL FOREIGN BODY GUM 0001 180.58

41806 REMOVAL FOREIGN BODY JAWBONE 0001 274.40

41820 EXCISION GUM EACH QUADRANT 0001 196.56

41821 EXCISION OF GUM FLAP 0001 44.52

41822 EXCISION OF GUM LESION 0001 188.18







41830 REMOVAL OF GUM TISSUE 0001 291.68

41850 TREATMENT OF GUM LESION 0001 98.46

41870 GUM GRAFT 0001 245.79

41872 REPAIR GUM 0001 265.82

41874 REPAIR TOOTH SOCKET 0001 260.83

42000 DRAINAGE MOUTH ROOF LESION 0001 105.62

42100 BIOPSY ROOF OF MOUTH 0001 112.33

42104 EXCISION LESION MOUTH ROOF 0001 143.05



42120 REMOVE PALATE/LESION 0001 1011.28

42140 EXCISION OF UVULA 0001 159.54

42145 REPAIR PALATE PHARYNX/UVULA 0001 717.29

42160 TREATMENT MOUTH ROOF LESION 0001 150.67

42180 REPAIR PALATE 0001 187.96

42182 REPAIR PALATE 0001 260.48

42200 RECONSTRUCT CLEFT PALATE 0001 865.07






42226 LENGTHENING OF PALATE 0001 908.79

42227 LENGTHENING OF PALATE 0001 852.45

42235 REPAIR PALATE 0001 747.82

42260 REPAIR NOSE TO LIP FISTULA 0001 670.26

42280 PREPARATION PALATE MOLD 0001 116.14

42281 INSERTION PALATE PROSTHESIS 0001 154.77

42300 DRAINAGE OF SALIVARY GLAND 0001 156.23




42330 REMOVAL OF SALIVARY STONE 0001 168.69



42400 BIOPSY OF SALIVARY GLAND 0001 56.15

42405 BIOPSY OF SALIVARY GLAND 0001 229.73

42408 EXCISION OF SALIVARY CYST 0001 332.45

42409 DRAINAGE OF SALIVARY CYST 0001 226.84

42410 EXCISE PAROTID GLAND/LESION 0001 632.19





42440 EXCISE SUBMAXILLARY GLAND 0001 418.78

42450 EXCISE SUBLINGUAL GLAND 0001 367.20


42500 REPAIR SALIVARY DUCT 0001 351.56

42505 REPAIR SALIVARY DUCT 0001 464.03

42507 PAROTID DUCT DIVERSION 0001 524.83



42550 INJECTION FOR SALIVARY X-RAY 0001 63.24

42600 CLOSURE OF SALIVARY FISTULA 0001 354.98

42650 DILATION OF SALIVARY DUCT 0001 60.51

42660 DILATION OF SALIVARY DUCT 0001 84.68

42665 LIGATION OF SALIVARY DUCT 0001 211.88

42699 SALIVARY SURGERY PROCEDURE 0001 0.00

42700 DRAINAGE OF TONSIL ABSCESS 0001 139.49

42720 DRAINAGE OF THROAT ABSCESS 0001 398.02

42725 DRAINAGE OF THROAT ABSCESS 0001 824.33

42800 BIOPSY OF THROAT 0001 115.09

42804 BIOPSY OF UPPER NOSE/THROAT 0001 115.65

42806 BIOPSY OF UPPER NOSE/THROAT 0001 134.88

42808 EXCISE PHARYNX LESION 0001 164.94

42809 REMOVE PHARYNX FOREIGN BODY 0001 135.27

42810 EXCISION OF NECK CYST 0001 296.44

42815 EXCISION OF NECK CYST 0001 569.91

42820 REMOVE TONSILS AND ADENOIDS 0001 295.09

42821 REMOVE TONSILS AND ADENOIDS 0001 306.73

42825 REMOVAL OF TONSILS 0001 266.79

42826 REMOVAL OF TONSILS 0001 256.13

42830 REMOVAL OF ADENOIDS 0001 212.21




42842 EXTENSIVE SURGERY OF THROAT 0001 1012.06



42860 EXCISION OF TONSIL TAGS 0001 192.67

42870 EXCISION OF LINGUAL TONSIL 0001 591.00

42890 PARTIAL REMOVAL OF PHARYNX 0001 1436.48

42892 REVISION OF PHARYNGEAL WALLS 0001 1907.14

42894 REVISION OF PHARYNGEAL WALLS 0001 2395.91

42900 REPAIR THROAT WOUND 0001 344.35

42950 RECONSTRUCTION OF THROAT 0001 809.63

42953 REPAIR THROAT ESOPHAGUS 0001 968.95

42955 SURGICAL OPENING OF THROAT 0001 767.21

42960 CONTROL THROAT BLEEDING 0001 173.51



42970 CONTROL NOSE/THROAT BLEEDING 0001 418.68




43020 INCISION OF ESOPHAGUS 0001 500.08

43030 THROAT MUSCLE SURGERY 0001 526.92

43045 INCISION OF ESOPHAGUS 0001 1320.22

43100 EXCISION OF ESOPHAGUS LESION 0001 636.71

43101 EXCISION OF ESOPHAGUS LESION 0001 1021.27

43107 REMOVAL OF ESOPHAGUS 0001 2566.87



43116 PARTIAL REMOVAL OF ESOPHAGUS 0001 5283.65







43130 REMOVAL OF ESOPHAGUS POUCH 0001 800.36

43135 REMOVAL OF ESOPHAGUS POUCH 0001 1512.32

43180 Esophagoscopy rigid trnso 0001 587.38

43191 Esophagoscopy rigid trnso dx 0001 127.38

43192 Esophagoscp rig trnso inject 0001 151.77

43193 Esophagoscp rig trnso biopsy 0001 180.67

43194 ESOPHAGOSCP RIG TRNSO REM FB 0001 163.44

43195 Esophagoscopy rigid balloon 0001 181.03

43196 Esophagoscp guide wire dilat 0001 198.61

43197 Esophagoscopy flex dx brush 0001 80.48

43198 ESOPHAGOSC FLEX TRNSN BIOPSY 0001 95.78

43200 ESOPHAGOSCOPY FLEXIBLE BRUSH 0001 94.91

43201 ESOPH SCOPE W/SUBMUCOUS INJ 0001 111.30

43202 ESOPHAGOSCOPY FLEX BIOPSY 0001 111.70

43204 ESOPH SCOPE W/SCLEROSIS INJ 0001 147.02

43205 ESOPHAGUS ENDOSCOPY/LIGATION 0001 151.82

43206 ESOPH OPTICAL ENDOMICROSCOPY 0001 145.19

43211 Esophagoscop mucosal resect 0001 246.74

43212 Esophagoscop stent placement 0001 194.74

43213 Esophagoscopy retro balloon 0001 274.33

43214 Esophagosc dilate balloon 30 0001 198.56

43215 ESOPHAGOSCOPY FLEX REMOVE FB 0001 150.08

43216 ESOPHAGOSCOPY LESION REMOVAL 0001 145.89

43217 ESOPHAGOSCOPY SNARE LES REMV 0001 173.94

43220 ESOPHAGOSCOPY BALLOON <30MM 0001 128.07

43226 ESOPH ENDOSCOPY DILATION 0001 141.00

43227 ESOPHAGOSCOPY CONTROL BLEED 0001 178.37

43229 Esophagoscopy lesion ablate 0001 209.87

43231 ESOPHAGOSCOP ULTRASOUND EXAM 0001 173.85

43232 ESOPHAGOSCOPY W/US NEEDLE BX 0001 206.98


43233 Egd balloon dil esoph30 mm/> 0001 235.55

43235 EGD DIAGNOSTIC BRUSH WASH 0001 133.02

43236 UPPR GI SCOPE W/SUBMUC INJ 0001 149.37

43237 ENDOSCOPIC US EXAM ESOPH 0001 210.13

43238 EGD US FINE NEEDLE BX/ASPIR 0001 239.77

43239 EGD BIOPSY SINGLE/MULTIPLE 0001 148.65

43240 EGD W/TRANSMURAL DRAIN CYST 0001 417.20

43241 EGD TUBE/CATH INSERTION 0001 153.87

43242 EGD US FINE NEEDLE BX/ASPIR 0001 273.33

43243 EGD INJECTION VARICES 0001 253.36

43244 EGD VARICES LIGATION 0001 262.46

43245 EGD DILATE STRICTURE 0001 188.16

43246 EGD PLACE GASTROSTOMY TUBE 0001 215.93

43247 EGD REMOVE FOREIGN BODY 0001 188.50

43248 EGD GUIDE WIRE INSERTION 0001 179.37

43249 ESOPH EGD DILATION <30 MM 0001 165.40

43250 EGD CAUTERY TUMOR POLYP 0001 182.26

43251 EGD REMOVE LESION SNARE 0001 210.85

43252 EGD OPTICAL ENDOMICROSCOPY 0001 181.45

43253 Egd us transmural injxn/mark 0001 273.33

43254 Egd endo mucosal resection 0001 283.82

43255 EGD CONTROL BLEEDING ANY 0001 216.07

43257 EGD W/THRML TXMNT GERD 0001 241.54

43259 EGD US EXAM DUODENUM/JEJUNUM 0001 242.57

43260 ERCP W/SPECIMEN COLLECTION 0001 343.82

43261 ENDO CHOLANGIOPANCREATOGRAPH 0001 360.57

43262 ENDO CHOLANGIOPANCREATOGRAPH 0001 380.50

43263 ERCP SPHINCTER PRESSURE MEAS 0001 380.88

43264 ERCP REMOVE DUCT CALCULI 0001 387.84

43265 ERCP LITHOTRIPSY CALCULI 0001 460.46

43266 Egd endoscopic stent place 0001 234.88

43270 Egd lesion ablation 0001 246.80

43273 ENDOSCOPIC PANCREATOSCOPY 0001 125.34

43274 Ercp duct stent placement 0001 485.95

43275 Ercp remove forgn body duct 0001 400.77

43276 Ercp stent exchange w/dilate 0001 505.47

43277 Ercp ea duct/ampulla dilate 0001 403.21

43278 Ercp lesion ablate w/dilate 0001 458.36

43279 LAP MYOTOMY HELLER 0001 1289.67

43280 LAPAROSCOPY FUNDOPLASTY 0001 1080.51

43281 LAP PARAESOPHAG HERN REPAIR 0001 1541.51

43282 LAP PARAESOPH HER RPR W/MESH 0001 1733.05

43283 LAP ESOPH LENGTHENING LAPAR 0001 156.79

43289 LAPAROSCOPE PROC ESOPH 0001 0.00

43300 REPAIR OF ESOPHAGUS 0001 625.40

43305 REPAIR ESOPHAGUS AND FISTULA 0001 1105.55


43310 REPAIR OF ESOPHAGUS 0001 1505.25

43312 REPAIR ESOPHAGUS AND FISTULA 0001 1621.26

43313 ESOPHAGOPLASTY CONGENITAL 0001 2915.89

43314 TRACHEO-ESOPHAGOPLASTY CONG 0001 2930.75

43320 FUSE ESOPHAGUS & STOMACH 0001 1391.31

43325 REVISE ESOPHAGUS & STOMACH 0001 1342.46

43327 ESOPH FUNDOPLASTY LAP ESOPH 0001 820.41

43328 ESOPH FUNDOPLASTY THOR ESOPH 0001 1167.41

43330 ESOPHAGOMYOTOMY ABDOMINAL 0001 1331.63

43331 ESOPHAGOMYOTOMY THORACIC 0001 1360.88

43332 TRANSAB ESOPH HIAT HERN RPR REPAI 0001 1161.22

43333 TRANSAB ESOPH HIAT HERN RPR REPAI 0001 1263.29

43334 TRANSTHOR DIAPHRAG HERN RPR REPAI 0001 1252.29

43335 TRANSTHOR DIAPHRAG HERN RPR REPAI 0001 1341.44

43336 THORABD DIAPHR HERN REPAIR REPAI 0001 1523.18

43337 THORABD DIAPHR HERN REPAIR REPAI 0001 1644.75

43338 ESOPH LENGTHENING ESOPH 0001 117.42

43340 FUSE ESOPHAGUS & INTESTINE 0001 1373.82

43341 FUSE ESOPHAGUS & INTESTINE 0001 1415.21

43351 SURGICAL OPENING ESOPHAGUS 0001 1335.76

43352 SURGICAL OPENING ESOPHAGUS 0001 1082.65

43360 GASTROINTESTINAL REPAIR 0001 2405.88

43361 GASTROINTESTINAL REPAIR 0001 2552.75

43400 LIGATE ESOPHAGUS VEINS 0001 1540.16

43401 ESOPHAGUS SURGERY FOR VEINS 0001 1560.01

43405 LIGATE/STAPLE ESOPHAGUS 0001 1459.58

43410 REPAIR ESOPHAGUS WOUND 0001 1063.49

43415 REPAIR ESOPHAGUS WOUND 0001 2606.43

43420 REPAIR ESOPHAGUS OPENING 0001 1031.60

43425 REPAIR ESOPHAGUS OPENING 0001 1447.64

43450 DILATE ESOPHAGUS 1/MULT PASS 0001 89.03

43453 DILATE ESOPHAGUS 0001 95.98

43460 PRESSURE TREATMENT ESOPHAGUS 0001 222.65

43496 FREE JEJUNUM FLAP MICROVASC 0001 5602.67

43500 SURGICAL OPENING OF STOMACH 0001 786.75

43501 SURGICAL REPAIR OF STOMACH 0001 1344.52

43502 SURGICAL REPAIR OF STOMACH 0001 1518.81

43510 SURGICAL OPENING OF STOMACH 0001 905.46

43520 INCISION OF PYLORIC MUSCLE 0001 687.54

43605 BIOPSY OF STOMACH 0001 829.82

43610 EXCISION OF STOMACH LESION 0001 979.32

43611 EXCISION OF STOMACH LESION 0001 1219.25

43620 REMOVAL OF STOMACH 0001 1959.22



43631 REMOVAL OF STOMACH PARTIAL 0001 1446.92






43640 VAGOTOMY & PYLORUS REPAIR 0001 1178.45

43641 VAGOTOMY & PYLORUS REPAIR 0001 1197.56

43644 LAP GASTRIC BYPASS/ROUX-EN-Y 0001 1728.69

43645 LAP GASTR BYPASS INCL SMLL I 0001 1848.09

43651 LAPAROSCOPY VAGUS NERVE 0001 652.85

43652 LAPAROSCOPY VAGUS NERVE 0001 762.27

43653 LAPAROSCOPY GASTROSTOMY 0001 572.34

43659 LAPAROSCOPE PROC STOM 0001 0.00

43752 NASAL/OROGASTRIC W/TUBE PLMT 0001 41.01

43753 TX GASTRO INTUB W/ASP 0001 20.76

43754 DX GASTR INTUB W/ASP SPEC 0001 33.35

43755 DX GASTR INTUB W/ASP SPECS GASTR 0001 58.01

43756 DX DUOD INTUB W/ASP SPEC DUODE 0001 51.09

43757 DX DUOD INTUB W/ASP SPECS DUODE 0001 77.17

43760 CHANGE GASTROSTOMY TUBE 0001 47.76

43761 REPOSITION GASTROSTOMY TUBE 0001 104.42

43770 LAP PLACE GASTR ADJ DEVICE 0001 1115.09

43771 LAP REVISE GASTR ADJ DEVICE 0001 1274.40

43772 LAP RMVL GASTR ADJ DEVICE 0001 952.32

43773 LAP REPLACE GASTR ADJ DEVICE 0001 1267.94

43774 LAP RMVL GASTR ADJ ALL PARTS 0001 959.39

43775 LAP SLEEVE GASTRECTOMY 0001 1318.38

43800 RECONSTRUCTION OF PYLORUS 0001 929.41

43810 FUSION OF STOMACH AND BOWEL 0001 1013.73



43830 PLACE GASTROSTOMY TUBE 0001 697.94



43840 REPAIR OF STOMACH LESION 0001 1355.66

43842 V-BAND GASTROPLASTY 0001 1149.05

43845 GASTROPLASTY DUODENAL SWITCH 0001 1954.15

43846 GASTRIC BYPASS FOR OBESITY 0001 1608.13

43850 REVISE STOMACH-BOWEL FUSION 0001 1622.30




43870 REPAIR STOMACH OPENING 0001 710.00

43880 REPAIR STOMACH-BOWEL FISTULA 0001 1595.09

43886 REVISE GASTRIC PORT OPEN 0001 363.67

43887 REMOVE GASTRIC PORT OPEN 0001 326.42

43888 CHANGE GASTRIC PORT OPEN 0001 460.09


44005 FREEING OF BOWEL ADHESION 0001 1091.32

44010 INCISION OF SMALL BOWEL 0001 871.44

44015 INSERT NEEDLE CATH BOWEL 0001 142.62

44020 EXPLORE SMALL INTESTINE 0001 969.74

44021 DECOMPRESS SMALL BOWEL 0001 980.06

44025 INCISION OF LARGE BOWEL 0001 988.65

44050 REDUCE BOWEL OBSTRUCTION 0001 933.79

44055 CORRECT MALROTATION OF BOWEL 0001 1492.98

44100 BIOPSY OF BOWEL 0001 112.80

44110 EXCISE INTESTINE LESION(S) 0001 851.55

44111 EXCISION OF BOWEL LESION(S) 0001 985.06

44120 REMOVAL OF SMALL INTESTINE 0001 1221.37



44126 ENTERECTOMY W/O TAPER CONG 0001 2457.33

44127 ENTERECTOMY W/TAPER CONG 0001 2840.74

44128 ENTERECTOMY CONG ADD-ON 0001 242.58

44130 BOWEL TO BOWEL FUSION 0001 1312.74

44137 REMOVE INTESTINAL ALLOGRAFT 0001 381.97

44139 MOBILIZATION OF COLON 0001 120.87

44140 PARTIAL REMOVAL OF COLON 0001 1340.00







44150 REMOVAL OF COLON 0001 1876.44

44151 REMOVAL OF COLON/ILEOSTOMY 0001 2150.38



44157 COLECTOMY W/ILEOANAL ANAST 0001 2184.07

44158 COLECTOMY W/NEO-RECTUM POUCH 0001 2251.52

44160 REMOVAL OF COLON 0001 1241.58

44180 LAP ENTEROLYSIS 0001 917.96

44186 LAP JEJUNOSTOMY 0001 651.40

44187 LAP ILEO/JEJUNO-STOMY 0001 1114.28

44188 LAP COLOSTOMY 0001 1231.50

44202 LAP ENTERECTOMY 0001 1386.64

44203 LAP RESECT S/INTESTINE ADDL 0001 241.86

44204 LAPARO PARTIAL COLECTOMY 0001 1543.27

44205 LAP COLECTOMY PART W/ILEUM 0001 1343.04

44206 LAP PART COLECTOMY W/STOMA 0001 1761.10

44207 L COLECTOMY/COLOPROCTOSTOMY 0001 1834.57

44208 L COLECTOMY/COLOPROCTOSTOMY 0001 1997.73

44210 LAPARO TOTAL PROCTOCOLECTOMY 0001 1808.95


44211 LAP COLECTOMY W/PROCTECTOMY 0001 2254.56

44212 LAPARO TOTAL PROCTOCOLECTOMY 0001 2082.04

44213 LAP MOBIL SPLENIC FL ADD-ON 0001 189.29

44227 LAP CLOSE ENTEROSTOMY 0001 1671.30

44300 OPEN BOWEL TO SKIN 0001 841.69

44310 ILEOSTOMY/JEJUNOSTOMY 0001 1046.32

44312 REVISION OF ILEOSTOMY 0001 590.18

44314 REVISION OF ILEOSTOMY 0001 1010.03

44316 DEVISE BOWEL POUCH 0001 1409.57

44320 COLOSTOMY 0001 1204.29

44322 COLOSTOMY WITH BIOPSIES 0001 1001.78

44340 REVISION OF COLOSTOMY 0001 626.28



44360 SMALL BOWEL ENDOSCOPY 0001 156.36

44361 SMALL BOWEL ENDOSCOPY/BIOPSY 0001 171.70






44370 SMALL BOWEL ENDOSCOPY/STENT 0001 284.25




44377 SMALL BOWEL ENDOSCOPY/BIOPSY 0001 319.03


44379 S BOWEL ENDOSCOPE W/STENT 0001 435.12

44380 SMALL BOWEL ENDOSCOPY BR/WA 0001 67.95

44381 Small bowel endoscopy br/wa 0001 72.44


44384 Small bowel endoscopy 0001 168.47

44385 ENDOSCOPY OF BOWEL POUCH 0001 108.03

44386 ENDOSCOPY BOWEL POUCH/BIOP 0001 128.43

44388 COLONOSCOPY THRU STOMA SPX 0001 166.83

44389 COLONOSCOPY WITH BIOPSY 0001 185.00

44390 COLONOSCOPY FOR FOREIGN BODY 0001 225.15

44391 COLONOSCOPY FOR BLEEDING 0001 250.96

44392 COLONOSCOPY & POLYPECTOMY 0001 220.61

44394 COLONOSCOPY W/SNARE 0001 256.57

44403 Colonoscopy w/resection 0001 176.39

44404 Colonoscopy w/injection 0001 176.39

44405 Colonoscopy w/dilation 0001 176.39

44406 Colonoscopy w/ultrasound 0001 176.39

44407 Colonoscopy w/ndl aspir/bx 0001 176.39

44408 Colonoscopy w/decompression 0001 176.39


44500 INTRO GASTROINTESTINAL TUBE 0001 24.66

44602 SUTURE SMALL INTESTINE 0001 1409.39

44603 SUTURE SMALL INTESTINE 0001 1616.01

44604 SUTURE LARGE INTESTINE 0001 1055.77

44605 REPAIR OF BOWEL LESION 0001 1306.33

44615 INTESTINAL STRICTUROPLASTY 0001 1076.61

44620 REPAIR BOWEL OPENING 0001 870.11



44640 REPAIR BOWEL-SKIN FISTULA 0001 1404.25

44650 REPAIR BOWEL FISTULA 0001 1451.67

44660 REPAIR BOWEL-BLADDER FISTULA 0001 1330.85

44661 REPAIR BOWEL-BLADDER FISTULA 0001 1553.92

44680 SURGICAL REVISION INTESTINE 0001 1069.26

44700 SUSPEND BOWEL W/PROSTHESIS 0001 1023.56

44701 INTRAOP COLON LAVAGE ADD-ON 0001 167.27

44800 EXCISION OF BOWEL POUCH 0001 762.51

44820 EXCISION OF MESENTERY LESION 0001 840.88

44850 REPAIR OF MESENTERY 0001 749.62

44899 BOWEL SURGERY PROCEDURE 0001 0.00

44900 DRAIN APPENDIX ABSCESS OPEN 0001 773.38

44950 APPENDECTOMY 0001 640.24

44955 APPENDECTOMY ADD-ON 0001 83.88

44960 APPENDECTOMY 0001 872.20

44970 LAPAROSCOPY APPENDECTOMY 0001 598.47

45000 DRAINAGE OF PELVIC ABSCESS 0001 427.20

45005 DRAINAGE OF RECTAL ABSCESS 0001 157.77

45020 DRAINAGE OF RECTAL ABSCESS 0001 570.80

45100 BIOPSY OF RECTUM 0001 301.48

45108 REMOVAL OF ANORECTAL LESION 0001 368.33

45110 REMOVAL OF RECTUM 0001 1861.97

45111 PARTIAL REMOVAL OF RECTUM 0001 1093.80


45113 PARTIAL PROCTECTOMY 0001 2005.32



45119 REMOVE RECTUM W/RESERVOIR 0001 1965.09


45121 REMOVAL OF RECTUM AND COLON 0001 1731.38

45123 PARTIAL PROCTECTOMY 0001 1126.79

45126 PELVIC EXENTERATION 0001 2883.76

45130 EXCISION OF RECTAL PROLAPSE 0001 1100.45

45135 EXCISION OF RECTAL PROLAPSE 0001 1372.21

45136 EXCISE ILEOANAL RESERVIOR 0001 1836.83

45150 EXCISION OF RECTAL STRICTURE 0001 396.71

45160 EXCISION OF RECTAL LESION 0001 1019.23


45171 EXC RECT TUM TRANSANAL PART 0001 604.06

45172 EXC RECT TUM TRANSANAL FULL 0001 818.38

45190 DESTRUCTION RECTAL TUMOR 0001 698.83

45300 PROCTOSIGMOIDOSCOPY DX 0001 54.37

45303 PROCTOSIGMOIDOSCOPY DILATE 0001 92.82

45305 PROCTOSIGMOIDOSCOPY W/BX 0001 79.95

45307 PROCTOSIGMOIDOSCOPY FB 0001 104.79

45308 PROCTOSIGMOIDOSCOPY REMOVAL 0001 88.34



45317 PROCTOSIGMOIDOSCOPY BLEED 0001 119.68

45320 PROCTOSIGMOIDOSCOPY ABLATE 0001 107.84

45321 PROCTOSIGMOIDOSCOPY VOLVUL 0001 108.65

45327 PROCTOSIGMOIDOSCOPY W/STENT 0001 121.97

45330 DIAGNOSTIC SIGMOIDOSCOPY 0001 63.45

45331 SIGMOIDOSCOPY AND BIOPSY 0001 75.73

45332 SIGMOIDOSCOPY W/FB REMOVAL 0001 111.73

45333 SIGMOIDOSCOPY & POLYPECTOMY 0001 110.66

45334 SIGMOIDOSCOPY FOR BLEEDING 0001 162.94

45335 SIGMOIDOSCOPY W/SUBMUC INJ 0001 92.49

45337 SIGMOIDOSCOPY & DECOMPRESS 0001 142.78

45338 SIGMOIDOSCOPY W/TUMR REMOVE 0001 141.33

45340 SIG W/TNDSC BALLOON DILATION 0001 116.23

45341 SIGMOIDOSCOPY W/ULTRASOUND 0001 156.34

45342 SIGMOIDOSCOPY W/US GUIDE BX 0001 237.70

45378 DIAGNOSTIC COLONOSCOPY 0001 216.45

45379 COLONOSCOPY W/FB REMOVAL 0001 271.59

45380 COLONOSCOPY AND BIOPSY 0001 258.31

45381 COLONOSCOPY SUBMUCOUS NJX 0001 245.04

45382 COLONOSCOPY W/CONTROL BLEED 0001 328.11

45384 COLONOSCOPY W/LESION REMOVAL 0001 270.51

45385 COLONOSCOPY W/LESION REMOVAL 0001 306.85

45386 COLONOSCOPY W/BALLOON DILAT 0001 265.68

45391 COLONOSCOPY W/ENDOSCOPE US 0001 293.83

45392 COLONOSCOPY W/ENDOSCOPIC FNB 0001 378.19

45395 LAP REMOVAL OF RECTUM 0001 1999.22

45397 LAP REMOVE RECTUM W/POUCH 0001 2167.33

45400 LAPAROSCOPIC PROC 0001 1160.50

45402 LAP PROCTOPEXY W/SIG RESECT 0001 1542.06

45500 REPAIR OF RECTUM 0001 532.86

45505 REPAIR OF RECTUM 0001 595.38

45520 TREATMENT OF RECTAL PROLAPSE 0001 41.12

45540 CORRECT RECTAL PROLAPSE 0001 1064.51

45541 CORRECT RECTAL PROLAPSE 0001 931.77

45550 REPAIR RECTUM/REMOVE SIGMOID 0001 1475.68

45560 REPAIR OF RECTOCELE 0001 701.05


45562 EXPLORATION/REPAIR OF RECTUM 0001 1119.78

45563 EXPLORATION/REPAIR OF RECTUM 0001 1641.68

45800 REPAIR RECT/BLADDER FISTULA 0001 1201.33

45805 REPAIR FISTULA W/COLOSTOMY 0001 1456.27

45820 REPAIR RECTOURETHRAL FISTULA 0001 1175.46

45825 REPAIR FISTULA W/COLOSTOMY 0001 1382.13

45900 REDUCTION OF RECTAL PROLAPSE 0001 204.77

45905 DILATION OF ANAL SPHINCTER 0001 169.42

45910 DILATION OF RECTAL NARROWING 0001 196.27

45915 REMOVE RECTAL OBSTRUCTION 0001 227.31

45990 SURG DX EXAM ANORECTAL 0001 107.80

46020 PLACEMENT OF SETON 0001 235.95

46030 REMOVAL OF RECTAL MARKER 0001 91.42

46040 INCISION OF RECTAL ABSCESS 0001 413.40


46050 INCISION OF ANAL ABSCESS 0001 98.65


46070 INCISION OF ANAL SEPTUM 0001 240.78

46080 INCISION OF ANAL SPHINCTER 0001 160.27

46083 INCISE EXTERNAL HEMORRHOID 0001 106.88

46200 REMOVAL OF ANAL FISSURE 0001 325.85

46220 EXCISE ANAL EXT TAG/PAPILLA 0001 119.98

46221 LIGATION OF HEMORRHOID(S) 0001 192.38

46230 REMOVAL OF ANAL TAGS 0001 174.43

46250 REMOVE EXT HEM GROUPS 2+ 0001 314.54

46255 REMOVE INT/EXT HEM 1 GROUP 0001 353.68

46257 REMOVE IN/EX HEM GRP & FISS 0001 421.00

46258 REMOVE IN/EX HEM GRP W/FISTU 0001 464.46

46260 REMOVE IN/EX HEM GROUPS 2+ 0001 474.82

46261 REMOVE IN/EX HEM GRPS & FISS 0001 525.92

46262 REMOVE IN/EX HEM GRPS W/FIST 0001 554.10

46270 REMOVE ANAL FIST SUBQ 0001 392.58

46275 REMOVE ANAL FIST INTER 0001 416.08

46280 REMOVE ANAL FIST COMPLEX 0001 471.63

46285 REMOVE ANAL FIST 2 STAGE 0001 415.23

46288 REPAIR ANAL FISTULA 0001 551.57

46320 REMOVAL OF HEMORRHOID CLOT 0001 112.03

46500 INJECTION INTO HEMORRHOID(S) 0001 130.95

46505 CHEMODENERVATION ANAL MUSC 0001 242.16

46600 DIAGNOSTIC ANOSCOPY SPX 0001 41.13

46604 ANOSCOPY AND DILATION 0001 66.94

46606 ANOSCOPY AND BIOPSY 0001 77.88

46607 Diagnostic anoscopy & biopsy 0001 0.00

46608 ANOSCOPY REMOVE FOR BODY 0001 80.95

46610 ANOSCOPY REMOVE LESION 0001 81.35

46611 ANOSCOPY 0001 82.73


46612 ANOSCOPY REMOVE LESIONS 0001 94.71

46614 ANOSCOPY CONTROL BLEEDING 0001 64.45

46615 ANOSCOPY 0001 94.31

46700 REPAIR OF ANAL STRICTURE 0001 657.56

46705 REPAIR OF ANAL STRICTURE 0001 483.41

46706 REPR OF ANAL FISTULA W/GLUE 0001 170.71

46707 REPAIR ANORECTAL FIST W/PLUG 0001 463.34

46710 REPR PER/VAG POUCH SNGL PROC 0001 1102.07

46712 REPR PER/VAG POUCH DBL PROC 0001 2042.06

46715 REP PERF ANOPER FISTU 0001 497.80

46716 REP PERF ANOPER/VESTIB FISTU 0001 1071.02

46730 CONSTRUCTION OF ABSENT ANUS 0001 1757.24



46742 REPAIR OF IMPERFORATED ANUS 0001 2441.39

46744 REPAIR OF CLOACAL ANOMALY 0001 3353.73



46750 REPAIR OF ANAL SPHINCTER 0001 766.56


46753 RECONSTRUCTION OF ANUS 0001 591.54

46754 REMOVAL OF SUTURE FROM ANUS 0001 227.83



46762 IMPLANT ARTIFICIAL SPHINCTER 0001 932.10

46900 DESTRUCTION ANAL LESION(S) 0001 138.82


46916 CRYOSURGERY ANAL LESION(S) 0001 142.71

46917 LASER SURGERY ANAL LESIONS 0001 134.92

46922 EXCISION OF ANAL LESION(S) 0001 136.02


46930 DESTROY INTERNAL HEMORRHOIDS 0001 148.27

46940 TREATMENT OF ANAL FISSURE 0001 147.45

46942 TREATMENT OF ANAL FISSURE 0001 133.55

46945 REMOVE BY LIGAT INT HEM GRP 0001 224.92

46946 REMOVE BY LIGAT INT HEM GRPS 0001 224.97

46947 HEMORRHOIDOPEXY BY STAPLING 0001 382.95

47000 NEEDLE BIOPSY OF LIVER 0001 104.55

47001 NEEDLE BIOPSY LIVER ADD-ON 0001 102.70

47010 OPEN DRAINAGE LIVER LESION 0001 1201.46

47015 INJECT/ASPIRATE LIVER CYST 0001 1146.33

47100 WEDGE BIOPSY OF LIVER 0001 841.78

47120 PARTIAL REMOVAL OF LIVER 0001 2320.17

47122 EXTENSIVE REMOVAL OF LIVER 0001 3416.26




47135 TRANSPLANTATION OF LIVER 0001 4876.53

47136 TRANSPLANTATION OF LIVER 0001 4179.17

47140 PARTIAL REMOVAL DONOR LIVER 0001 3554.68



47146 PREP DONOR LIVER/VENOUS 0001 327.90

47147 PREP DONOR LIVER/ARTERIAL 0001 382.43

47300 SURGERY FOR LIVER LESION 0001 1124.93

47350 REPAIR LIVER WOUND 0001 1367.20




47370 LAPARO ABLATE LIVER TUMOR RF 0001 1235.23

47371 LAPARO ABLATE LIVER CRYOSURG 0001 1223.76

47379 LAPAROSCOPE PROCEDURE LIVER 0001 0.00

47380 OPEN ABLATE LIVER TUMOR RF 0001 1435.99

47381 OPEN ABLATE LIVER TUMOR CRYO 0001 1448.23

47382 PERCUT ABLATE LIVER RF 0001 781.65

47383 Perq abltj lvr cryoablation 0001 503.87

47400 INCISION OF LIVER DUCT 0001 2145.71

47420 INCISION OF BILE DUCT 0001 1338.93

47425 INCISION OF BILE DUCT 0001 1362.25

47460 INCISE BILE DUCT SPHINCTER 0001 1264.00

47480 INCISION OF GALLBLADDER 0001 873.58

47490 INCISION OF GALLBLADDER 0001 335.59

47500 INJECTION FOR LIVER X-RAYS 0001 97.62

47505 INJECTION FOR LIVER X-RAYS 0001 37.86

47510 INSERT CATHETER BILE DUCT 0001 474.89

47511 INSERT BILE DUCT DRAIN 0001 581.16

47525 CHANGE BILE DUCT CATHETER 0001 85.00

47530 REVISE/REINSERT BILE TUBE 0001 352.89

47550 BILE DUCT ENDOSCOPY ADD-ON 0001 164.61

47552 BILIARY ENDO PERQ DX W/SPECI 0001 317.06

47553 BILIARY ENDOSCOPY THRU SKIN 0001 314.69




47560 LAPAROSCOPY W/CHOLANGIO 0001 266.74

47561 LAPARO W/CHOLANGIO/BIOPSY 0001 292.86

47562 LAPAROSCOPIC CHOLECYSTECTOMY 0001 655.52

47563 LAPARO CHOLECYSTECTOMY/GRAPH 0001 712.22

47564 LAPARO CHOLECYSTECTOMY/EXPLR 0001 1110.47

47570 LAPARO CHOLECYSTOENTEROSTOMY 0001 772.02

47600 REMOVAL OF GALLBLADDER 0001 1065.60






47630 REMOVE BILE DUCT STONE 0001 546.20

47700 EXPLORATION OF BILE DUCTS 0001 1049.15

47701 BILE DUCT REVISION 0001 1727.57

47711 EXCISION OF BILE DUCT TUMOR 0001 1555.78

47712 EXCISION OF BILE DUCT TUMOR 0001 1991.69

47715 EXCISION OF BILE DUCT CYST 0001 1326.05

47720 FUSE GALLBLADDER & BOWEL 0001 1149.05

47721 FUSE UPPER GI STRUCTURES 0001 1350.17



47760 FUSE BILE DUCTS AND BOWEL 0001 2248.30

47765 FUSE LIVER DUCTS & BOWEL 0001 3027.12



47800 RECONSTRUCTION OF BILE DUCTS 0001 1577.38

47801 PLACEMENT BILE DUCT SUPPORT 0001 1010.82

47802 FUSE LIVER DUCT & INTESTINE 0001 1521.04

47900 SUTURE BILE DUCT INJURY 0001 1367.69

48000 DRAINAGE OF ABDOMEN 0001 1848.16

48001 PLACEMENT OF DRAIN PANCREAS 0001 2300.62

48020 REMOVAL OF PANCREATIC STONE 0001 1173.50

48100 BIOPSY OF PANCREAS OPEN 0001 885.04

48102 NEEDLE BIOPSY PANCREAS 0001 244.14

48105 RESECT/DEBRIDE PANCREAS 0001 2838.67

48120 REMOVAL OF PANCREAS LESION 0001 1105.53

48140 PARTIAL REMOVAL OF PANCREAS 0001 1558.06


48146 PANCREATECTOMY 0001 1873.12

48148 REMOVAL OF PANCREATIC DUCT 0001 1244.08





48155 REMOVAL OF PANCREAS 0001 1812.34

48160 PANCREAS REMOVAL/TRANSPLANT 0001 2507.57

48400 INJECTION INTRAOP ADD-ON 0001 109.64

48500 SURGERY OF PANCREATIC CYST 0001 1147.57

48510 DRAIN PANCREATIC PSEUDOCYST 0001 1087.84

48520 FUSE PANCREAS CYST AND BOWEL 0001 1088.65

48540 FUSE PANCREAS CYST AND BOWEL 0001 1305.71

48545 PANCREATORRHAPHY 0001 1340.84

48547 DUODENAL EXCLUSION 0001 1785.82

48548 FUSE PANCREAS AND BOWEL 0001 1659.22

48999 PANCREAS SURGERY PROCEDURE 0001 0.00


49000 EXPLORATION OF ABDOMEN 0001 770.10

49002 REOPENING OF ABDOMEN 0001 1045.15

49010 EXPLORATION BEHIND ABDOMEN 0001 934.16

49020 DRAINAGE ABDOM ABSCESS OPEN 0001 1586.93

49040 DRAIN OPEN ABDOM ABSCESS 0001 998.26

49060 DRAIN OPEN RETROPERI ABSCESS 0001 1099.56

49062 DRAIN TO PERITONEAL CAVITY 0001 732.80

49082 Abd paracentesis 0001 74.03

49083 Abd paracentesis w/imaging 0001 109.36

49084 Peritoneal lavage 0001 100.74

49180 BIOPSY ABDOMINAL MASS 0001 86.48

49203 Exc abd tum 5 cm or less 0001 1195.40

49204 Exc abd tum over 5 cm 0001 1526.32

49205 Exc abd tum over 10 cm 0001 1754.31

49215 EXCISE SACRAL SPINE TUMOR 0001 2220.62

49220 MULTIPLE SURGERY ABDOMEN 0001 953.64

49250 EXCISION OF UMBILICUS 0001 582.55

49255 REMOVAL OF OMENTUM 0001 792.65

49320 DIAG LAPARO SEPARATE PROC 0001 328.00

49321 LAPAROSCOPY BIOPSY 0001 347.35

49322 LAPAROSCOPY ASPIRATION 0001 371.13

49323 LAPARO DRAIN LYMPHOCELE 0001 645.80

49324 LAP INSERT TUNNEL IP CATH 0001 391.31

49325 LAP REVISION PERM IP CATH 0001 419.36

49326 LAP W/OMENTOPEXY ADD-ON 0001 188.68

49327 LAP INS DEVICE FOR RT 0001 129.28

49329 LAPARO PROC ABDM/PER/OMENT 0001 0.00

49400 AIR INJECTION INTO ABDOMEN 0001 95.32

49402 REMOVE FOREIGN BODY ADBOMEN 0001 852.89

49405 Image cath fluid colxn visc 0001 213.65

49406 Image cath fluid peri/retro 0001 214.00

49407 Image cath fluid trns/vgnl 0001 227.96

49411 INS MARK ABD/PEL FOR RT PERQ 0001 198.57

49412 INS DEVICE FOR RT GUIDE OPEN PLACE 0001 81.41

49418 INSERT TUN IP CATH PERC INSER 0001 227.41

49419 INSERT TUN IP CATH W/PORT 0001 443.59

49421 INS TUN IP CATH FOR DIAL OPN 0001 229.18

49422 REMOVE TUNNELED IP CATH 0001 380.52

49423 EXCHANGE DRAINAGE CATHETER 0001 72.54

49424 ASSESS CYST CONTRAST INJECT 0001 38.93

49425 INSERT ABDOMEN-VENOUS DRAIN 0001 751.10

49426 REVISE ABDOMEN-VENOUS SHUNT 0001 617.35

49427 INJECTION ABDOMINAL SHUNT 0001 45.57

49428 LIGATION OF SHUNT 0001 430.76

49429 REMOVAL OF SHUNT 0001 457.55

49435 INSERT SUBQ EXTEN TO IP CATH 0001 119.41


49436 EMBEDDED IP CATH EXIT-SITE 0001 186.63

49440 Place gastrostomy tube perc 0001 226.86

49441 Place duod/jej tube perc 0001 257.48

49442 Place cecostomy tube perc 0001 222.69

49446 Change g-tube to g-j perc 0001 164.63

49450 Replace g/c tube perc 0001 67.34

49451 Replace duod/jej tube perc 0001 92.45

49452 Replace g-j tube perc 0001 142.04

49460 Fix g/colon tube w/device 0001 48.67

49465 FLUORO EXAM OF G/COLON TUBE 0001 30.90

49491 RPR HERN PREEMIE REDUC 0001 790.03

49492 RPR ING HERN PREMIE BLOCKED 0001 940.50

49495 RPR ING HERNIA BABY REDUC 0001 397.62

49496 RPR ING HERNIA BABY BLOCKED 0001 608.97

49500 RPR ING HERNIA INIT REDUCE 0001 379.13

49501 RPR ING HERNIA INIT BLOCKED 0001 602.26

49505 PRP I/HERN INIT REDUC >5 YR 0001 518.47

49507 PRP I/HERN INIT BLOCK >5 YR 0001 583.62

49520 REREPAIR ING HERNIA REDUCE 0001 628.94

49521 REREPAIR ING HERNIA BLOCKED 0001 712.53

49525 REPAIR ING HERNIA SLIDING 0001 570.52

49540 REPAIR LUMBAR HERNIA 0001 670.19

49550 RPR REM HERNIA INIT REDUCE 0001 572.62

49553 RPR FEM HERNIA INIT BLOCKED 0001 629.07

49555 REREPAIR FEM HERNIA REDUCE 0001 592.83

49557 REREPAIR FEM HERNIA BLOCKED 0001 720.24

49560 RPR VENTRAL HERN INIT REDUC 0001 734.46

49561 RPR VENTRAL HERN INIT BLOCK 0001 926.86

49565 REREPAIR VENTRL HERN REDUCE 0001 766.88

49566 REREPAIR VENTRL HERN BLOCK 0001 937.09

49568 HERNIA REPAIR W/MESH 0001 266.72

49570 RPR EPIGASTRIC HERN REDUCE 0001 415.77

49572 RPR EPIGASTRIC HERN BLOCKED 0001 513.95

49580 RPR UMBIL HERN REDUC < 5 YR 0001 331.96

49582 RPR UMBIL HERN BLOCK < 5 YR 0001 480.98

49585 RPR UMBIL HERN REDUC > 5 YR 0001 442.94

49587 RPR UMBIL HERN BLOCK > 5 YR 0001 474.19

49590 REPAIR SPIGELIAN HERNIA 0001 571.69

49600 REPAIR UMBILICAL LESION 0001 726.83





49650 LAP ING HERNIA REPAIR INIT 0001 427.14

49651 LAP ING HERNIA REPAIR RECUR 0001 555.60

49652 LAP VENT/ABD HERNIA REPAIR 0001 681.04


49653 LAP VENT/ABD HERN PROC COMP 0001 850.75

49654 LAP INC HERNIA REPAIR 0001 773.41

49655 LAP INC HERN REPAIR COMP 0001 944.41

49656 LAP INC HERNIA REPAIR RECUR 0001 839.74

49657 LAP INC HERN RECUR COMP 0001 1204.63

49659 LAPARO PROC HERNIA REPAIR 0001 0.00

49900 REPAIR OF ABDOMINAL WALL 0001 814.47

49904 OMENTAL FLAP EXTRA-ABDOM 0001 1449.77

49905 OMENTAL FLAP INTRA-ABDOM 0001 352.35

49906 FREE OMENTAL FLAP MICROVASC 0001 3585.61

49999 ABDOMEN SURGERY PROCEDURE 0001 0.00

50010 EXPLORATION OF KIDNEY 0001 737.32

50020 RENAL ABSCESS OPEN DRAIN 0001 1023.17

50040 DRAINAGE OF KIDNEY 0001 915.75


50060 REMOVAL OF KIDNEY STONE 0001 1124.93

50065 INCISION OF KIDNEY 0001 1194.13

50070 INCISION OF KIDNEY 0001 1170.86




50100 REVISE KIDNEY BLOOD VESSELS 0001 1074.32


50125 EXPLORE AND DRAIN KIDNEY 0001 970.06



50200 RENAL BIOPSY PERQ 0001 144.69

50205 RENAL BIOPSY OPEN 0001 751.25

50220 REMOVE KIDNEY OPEN 0001 1034.37

50225 REMOVAL KIDNEY OPEN COMPLEX 0001 1185.61

50230 REMOVAL KIDNEY OPEN RADICAL 0001 1265.83

50234 REMOVAL OF KIDNEY & URETER 0001 1285.12

50236 REMOVAL OF KIDNEY & URETER 0001 1447.81

50240 PARTIAL REMOVAL OF KIDNEY 0001 1308.12

50250 CRYOABLATE RENAL MASS OPEN 0001 1201.87

50280 REMOVAL OF KIDNEY LESION 0001 944.36

50290 REMOVAL OF KIDNEY LESION 0001 887.43

50300 REMOVE CADAVER DONOR KIDNEY 0001 1541.58

50320 REMOVE KIDNEY LIVING DONOR 0001 1420.15

50323 PREP CADAVER RENAL ALLOGRAFT 0001 0.00

50325 PREP DONOR RENAL GRAFT 0001 0.00

50327 PREP RENAL GRAFT/VENOUS 0001 214.78

50328 PREP RENAL GRAFT/ARTERIAL 0001 188.21

50329 PREP RENAL GRAFT/URETERAL 0001 173.47

50340 REMOVAL OF KIDNEY 0001 945.45

50360 TRANSPLANTATION OF KIDNEY 0001 2405.17


50365 TRANSPLANTATION OF KIDNEY 0001 2825.69

50370 REMOVE TRANSPLANTED KIDNEY 0001 1193.46

50380 REIMPLANTATION OF KIDNEY 0001 1994.82

50382 CHANGE URETER STENT PERCUT 0001 272.97

50384 REMOVE URETER STENT PERCUT 0001 249.77

50385 Change stent via transureth 0001 230.58

50386 Remove stent via transureth 0001 175.06

50387 CHANGE EXT/INT URETER STENT 0001 99.34

50389 REMOVE RENAL TUBE W/FLUORO 0001 54.88

50390 DRAINAGE OF KIDNEY LESION 0001 97.22

50391 INSTLL RX AGNT INTO RNAL TUB 0001 97.62

50392 INSERT KIDNEY DRAIN 0001 179.95

50393 INSERT URETERAL TUBE 0001 218.12

50394 INJECTION FOR KIDNEY X-RAY 0001 50.42

50395 CREATE PASSAGE TO KIDNEY 0001 180.35

50396 MEASURE KIDNEY PRESSURE 0001 118.56

50398 CHANGE KIDNEY TUBE 0001 72.90

50400 REVISION OF KIDNEY/URETER 0001 1143.17

50405 REVISION OF KIDNEY/URETER 0001 1378.12

50500 REPAIR OF KIDNEY WOUND 0001 1279.84

50520 CLOSE KIDNEY-SKIN FISTULA 0001 1073.52

50525 REPAIR RENAL-ABDOMEN FISTULA 0001 1469.04

50526 REPAIR RENAL-ABDOMEN FISTULA 0001 1423.96

50540 REVISION OF HORSESHOE KIDNEY 0001 1132.59

50541 LAPARO ABLATE RENAL CYST 0001 909.69

50542 LAPARO ABLATE RENAL MASS 0001 1152.34

50543 LAPARO PARTIAL NEPHRECTOMY 0001 1471.14

50544 LAPAROSCOPY PYELOPLASTY 0001 1230.86

50545 LAPARO RADICAL NEPHRECTOMY 0001 1326.18

50546 LAPAROSCOPIC NEPHRECTOMY 0001 1188.36

50548 LAPARO REMOVE W/URETER 0001 1330.93

50551 KIDNEY ENDOSCOPY 0001 291.51


50555 KIDNEY ENDOSCOPY & BIOPSY 0001 337.70

50557 KIDNEY ENDOSCOPY & TREATMENT 0001 341.86


50562 RENAL SCOPE W/TUMOR RESECT 0001 574.88



50574 KIDNEY ENDOSCOPY & BIOPSY 0001 559.65




50590 FRAGMENTING OF KIDNEY STONE 0001 561.34

50592 PERC RF ABLATE RENAL TUMOR 0001 364.85

50593 Perc cryo ablate renal tum 0001 482.65


50600 EXPLORATION OF URETER 0001 927.36

50605 INSERT URETERAL SUPPORT 0001 968.86

50610 REMOVAL OF URETER STONE 0001 933.68



50650 REMOVAL OF URETER 0001 1023.10

50660 REMOVAL OF URETER 0001 1129.15

50684 INJECTION FOR URETER X-RAY 0001 50.42

50686 MEASURE URETER PRESSURE 0001 93.81

50688 CHANGE OF URETER TUBE/STENT 0001 80.20

50690 INJECTION FOR URETER X-RAY 0001 70.57

50700 REVISION OF URETER 0001 917.76

50715 RELEASE OF URETER 0001 1197.21


50725 RELEASE/REVISE URETER 0001 1088.15

50727 REVISE URETER 0001 500.33

50728 REVISE URETER 0001 690.14

50740 FUSION OF URETER & KIDNEY 0001 1217.65

50750 FUSION OF URETER & KIDNEY 0001 1138.85

50760 FUSION OF URETERS 0001 1119.41

50770 SPLICING OF URETERS 0001 1138.85

50780 REIMPLANT URETER IN BLADDER 0001 1096.41




50800 IMPLANT URETER IN BOWEL 0001 915.60

50810 FUSION OF URETER & BOWEL 0001 1328.44

50815 URINE SHUNT TO INTESTINE 0001 1207.88

50820 CONSTRUCT BOWEL BLADDER 0001 1303.74

50825 CONSTRUCT BOWEL BLADDER 0001 1637.51

50830 REVISE URINE FLOW 0001 1780.69

50840 REPLACE URETER BY BOWEL 0001 1214.12

50845 APPENDICO-VESICOSTOMY 0001 1233.74

50860 TRANSPLANT URETER TO SKIN 0001 933.61

50900 REPAIR OF URETER 0001 840.84

50920 CLOSURE URETER/SKIN FISTULA 0001 870.77

50930 CLOSURE URETER/BOWEL FISTULA 0001 1223.55


50945 LAPAROSCOPY URETEROLITHOTOMY 0001 961.20

50947 LAPARO NEW URETER/BLADDER 0001 1370.01

50948 LAPARO NEW URETER/BLADDER 0001 1259.10

50951 ENDOSCOPY OF URETER 0001 303.31

50953 ENDOSCOPY OF URETER 0001 322.76

50955 URETER ENDOSCOPY & BIOPSY 0001 348.82

50957 URETER ENDOSCOPY & TREATMENT 0001 350.54



50970 URETER ENDOSCOPY 0001 366.46

50972 URETER ENDOSCOPY & CATHETER 0001 354.34

50974 URETER ENDOSCOPY & BIOPSY 0001 467.55



51020 INCISE & TREAT BLADDER 0001 465.06

51030 INCISE & TREAT BLADDER 0001 465.15

51040 INCISE & DRAIN BLADDER 0001 285.82

51045 INCISE BLADDER/DRAIN URETER 0001 487.56

51050 REMOVAL OF BLADDER STONE 0001 467.06


51065 REMOVE URETER CALCULUS 0001 571.83

51080 DRAINAGE OF BLADDER ABSCESS 0001 403.80

51100 Drain bladder by needle 0001 38.91

51101 Drain bladder by trocar/cath 0001 52.17

51102 Drain bl w/cath insertion 0001 144.89

51500 REMOVAL OF BLADDER CYST 0001 628.85

51520 REMOVAL OF BLADDER LESION 0001 586.81



51535 REPAIR OF URETER LESION 0001 769.09

51550 PARTIAL REMOVAL OF BLADDER 0001 958.23

51555 PARTIAL REMOVAL OF BLADDER 0001 1256.12

51565 REVISE BLADDER & URETER(S) 0001 1278.22

51570 REMOVAL OF BLADDER 0001 1461.50

51575 REMOVAL OF BLADDER & NODES 0001 1797.61

51580 REMOVE BLADDER/REVISE TRACT 0001 1872.42

51585 REMOVAL OF BLADDER & NODES 0001 2084.27



51596 REMOVE BLADDER/CREATE POUCH 0001 2322.91

51597 REMOVAL OF PELVIC STRUCTURES 0001 2273.74

51600 INJECTION FOR BLADDER X-RAY 0001 44.12

51605 PREPARATION FOR BLADDER XRAY 0001 37.68

51610 INJECTION FOR BLADDER X-RAY 0001 64.30

51700 IRRIGATION OF BLADDER 0001 44.12

51701 INSERT BLADDER CATHETER 0001 27.53

51702 INSERT TEMP BLADDER CATH 0001 30.04

51703 INSERT BLADDER CATH COMPLEX 0001 80.46

51705 CHANGE OF BLADDER TUBE 0001 51.64

51710 CHANGE OF BLADDER TUBE 0001 78.49

51715 ENDOSCOPIC INJECTION/IMPLANT 0001 198.44

51720 TREATMENT OF BLADDER LESION 0001 78.97

51725 SIMPLE CYSTOMETROGRAM TC 0001 109.52

51725 SIMPLE CYSTOMETROGRAM 26 0001 75.33

51725 SIMPLE CYSTOMETROGRAM 0001 184.85


51726 COMPLEX CYSTOMETROGRAM TC 0001 176.33

51726 COMPLEX CYSTOMETROGRAM 26 0001 84.69

51726 COMPLEX CYSTOMETROGRAM 0001 261.03

51727 CYSTOMETROGRAM W/UP TC 0001 203.23

51727 CYSTOMETROGRAM W/UP 26 0001 107.79

51727 CYSTOMETROGRAM W/UP 0001 311.02

51728 CYSTOMETROGRAM W/VP TC 0001 207.18

51728 CYSTOMETROGRAM W/VP 26 0001 104.49

51728 CYSTOMETROGRAM W/VP 0001 311.67

51729 CYSTOMETROGRAM W/VP&UP TC 0001 211.12

51729 CYSTOMETROGRAM W/VP&UP 26 0001 126.84

51729 CYSTOMETROGRAM W/VP&UP 0001 337.97

51736 URINE FLOW MEASUREMENT TC 0001 6.83

51736 URINE FLOW MEASUREMENT 26 0001 8.32

51736 URINE FLOW MEASUREMENT 0001 15.16

51741 ELECTRO-UROFLOWMETRY FIRST TC 0001 7.19

51741 ELECTRO-UROFLOWMETRY FIRST 26 0001 8.32

51741 ELECTRO-UROFLOWMETRY FIRST 0001 15.52

51784 ANAL/URINARY MUSCLE STUDY TC 0001 113.83

51784 ANAL/URINARY MUSCLE STUDY 26 0001 76.01

51784 ANAL/URINARY MUSCLE STUDY 0001 189.84

51785 ANAL/URINARY MUSCLE STUDY TC 0001 175.94

51785 ANAL/URINARY MUSCLE STUDY 26 0001 78.88

51785 ANAL/URINARY MUSCLE STUDY 0001 254.82

51792 URINARY REFLEX STUDY TC 0001 154.04

51792 URINARY REFLEX STUDY 26 0001 55.24

51792 URINARY REFLEX STUDY 0001 209.28

51797 INTRAABDOMINAL PRESSURE TEST TC 0001 71.10

51797 INTRAABDOMINAL PRESSURE TEST 26 0001 39.18

51797 INTRAABDOMINAL PRESSURE TEST 0001 110.29

51798 US URINE CAPACITY MEASURE 0001 19.04

51800 REVISION OF BLADDER/URETHRA 0001 1031.31

51820 REVISION OF URINARY TRACT 0001 1069.43

51840 ATTACH BLADDER/URETHRA 0001 660.58

51841 ATTACH BLADDER/URETHRA 0001 784.36

51845 REPAIR BLADDER NECK 0001 587.63

51860 REPAIR OF BLADDER WOUND 0001 745.79

51865 REPAIR OF BLADDER WOUND 0001 889.03

51880 REPAIR OF BLADDER OPENING 0001 467.60

51900 REPAIR BLADDER/VAGINA LESION 0001 821.04

51920 CLOSE BLADDER-UTERUS FISTULA 0001 800.07

51925 HYSTERECTOMY/BLADDER REPAIR 0001 1049.55

51940 CORRECTION OF BLADDER DEFECT 0001 1609.23

51960 REVISION OF BLADDER & BOWEL 0001 1377.41

51980 CONSTRUCT BLADDER OPENING 0001 704.57

51990 LAPARO URETHRAL SUSPENSION 0001 758.26


51992 LAPARO SLING OPERATION 0001 856.43

52000 CYSTOSCOPY 0001 125.18

52001 CYSTOSCOPY REMOVAL OF CLOTS 0001 284.23

52005 CYSTOSCOPY & URETER CATHETER 0001 132.12

52007 CYSTOSCOPY AND BIOPSY 0001 164.42

52010 CYSTOSCOPY & DUCT CATHETER 0001 164.42

52204 CYSTOSCOPY W/BIOPSY(S) 0001 140.37

52214 CYSTOSCOPY AND TREATMENT 0001 174.01





52250 CYSTOSCOPY AND RADIOTRACER 0001 237.37



52270 CYSTOSCOPY & REVISE URETHRA 0001 180.37

52275 CYSTOSCOPY & REVISE URETHRA 0001 245.62




52282 CYSTOSCOPY IMPLANT STENT 0001 333.30



52287 Cystoscopy chemodenervation 0001 167.74







52317 REMOVE BLADDER STONE 0001 343.49

52318 REMOVE BLADDER STONE 0001 467.87


52325 CYSTOSCOPY STONE REMOVAL 0001 316.78

52327 CYSTOSCOPY INJECT MATERIAL 0001 259.20



52334 CREATE PASSAGE TO KIDNEY 0001 253.69

52341 CYSTO W/URETER STRICTURE TX 0001 280.79

52342 CYSTO W/UP STRICTURE TX 0001 305.43

52343 CYSTO W/RENAL STRICTURE TX 0001 340.53

52344 CYSTO/URETERO STRICTURE TX 0001 365.18

52345 CYSTO/URETERO W/UP STRICTURE 0001 389.82

52346 CYSTOURETERO W/RENAL STRICT 0001 441.60

52351 CYSTOURETERO & OR PYELOSCOPE 0001 299.14

52352 CYSTOURETERO W/STONE REMOVE 0001 350.61


52353 CYSTOURETERO W/LITHOTRIPSY 0001 387.40

52354 CYSTOURETERO W/BIOPSY 0001 412.42

52355 CYSTOURETERO W/EXCISE TUMOR 0001 462.46

52356 Cysto/uretero w/lithotripsy 0001 411.34

52400 CYSTOURETERO W/CONGEN REPR 0001 472.29

52402 CYSTOURETHRO CUT EJACUL DUCT 0001 263.31

52441 Cystourethro w/implant 0001 234.99

52442 Cystourethro w/addl implant 0001 82.71

52450 INCISION OF PROSTATE 0001 464.49

52500 REVISION OF BLADDER NECK 0001 482.55

52601 PROSTATECTOMY (TURP) 0001 835.45

52630 REMOVE PROSTATE REGROWTH 0001 395.82

52640 RELIEVE BLADDER CONTRACTURE 0001 311.49

52647 LASER SURGERY OF PROSTATE 0001 639.56

52648 LASER SURGERY OF PROSTATE 0001 682.69

52649 PROSTATE LASER ENUCLEATION 0001 812.54

52700 DRAINAGE OF PROSTATE ABSCESS 0001 435.53

53000 INCISION OF URETHRA 0001 146.91




53040 DRAINAGE OF URETHRA ABSCESS 0001 388.28

53060 DRAINAGE OF URETHRA ABSCESS 0001 169.23

53080 DRAINAGE OF URINARY LEAKAGE 0001 415.30

53085 DRAINAGE OF URINARY LEAKAGE 0001 654.76

53200 BIOPSY OF URETHRA 0001 140.75

53210 REMOVAL OF URETHRA 0001 760.06

53215 REMOVAL OF URETHRA 0001 916.77

53220 TREATMENT OF URETHRA LESION 0001 447.85

53230 REMOVAL OF URETHRA LESION 0001 603.20

53235 REMOVAL OF URETHRA LESION 0001 624.62

53240 SURGERY FOR URETHRA POUCH 0001 419.69

53250 REMOVAL OF URETHRA GLAND 0001 419.47



53270 REMOVAL OF URETHRA GLAND 0001 189.36

53275 REPAIR OF URETHRA DEFECT 0001 259.48

53400 REVISE URETHRA STAGE 1 0001 792.52

53405 REVISE URETHRA STAGE 2 0001 862.75

53410 RECONSTRUCTION OF URETHRA 0001 967.80


53420 RECONSTRUCT URETHRA STAGE 1 0001 830.93

53425 RECONSTRUCT URETHRA STAGE 2 0001 925.02


53431 RECONSTRUCT URETHRA/BLADDER 0001 1139.28

53440 MALE SLING PROCEDURE 0001 743.83


53442 REMOVE/REVISE MALE SLING 0001 773.04

53444 INSERT TANDEM CUFF 0001 782.99

53445 INSERT URO/VES NCK SPHINCTER 0001 744.44

53446 REMOVE URO SPHINCTER 0001 634.67

53447 REMOVE/REPLACE UR SPHINCTER 0001 799.03

53448 REMOV/REPLC UR SPHINCTR COMP 0001 1264.03

53449 REPAIR URO SPHINCTER 0001 604.56

53450 REVISION OF URETHRA 0001 403.69


53500 URETHRLYS TRANSVAG W/ SCOPE 0001 745.89

53502 REPAIR OF URETHRA INJURY 0001 481.29




53520 REPAIR OF URETHRA DEFECT 0001 549.59

53600 DILATE URETHRA STRICTURE 0001 62.95





53660 DILATION OF URETHRA 0001 41.18



53850 PROSTATIC MICROWAVE THERMOTX 0001 600.33

53852 PROSTATIC RF THERMOTX 0001 614.86

53855 INSERT PROST URETHRAL STENT 0001 81.62

53860 TRANSURETHRAL RF TREATMENT TRANS 0001 234.04

54000 SLITTING OF PREPUCE 0001 106.45

54001 SLITTING OF PREPUCE 0001 137.73

54015 DRAIN PENIS LESION 0001 305.97

54050 DESTRUCTION PENIS LESION(S) 0001 103.80


54056 CRYOSURGERY PENIS LESION(S) 0001 110.66

54057 LASER SURG PENIS LESION(S) 0001 93.32

54060 EXCISION OF PENIS LESION(S) 0001 129.21


54100 BIOPSY OF PENIS 0001 124.37

54105 BIOPSY OF PENIS 0001 210.57

54110 TREATMENT OF PENIS LESION 0001 616.49

54111 TREAT PENIS LESION GRAFT 0001 790.87

54112 TREAT PENIS LESION GRAFT 0001 925.86


54120 PARTIAL REMOVAL OF PENIS 0001 624.63

54125 REMOVAL OF PENIS 0001 803.32

54130 REMOVE PENIS & NODES 0001 1178.78

54135 REMOVE PENIS & NODES 0001 1493.12


54150 CIRCUMCISION W/REGIONL BLOCK 0001 97.78

54160 CIRCUMCISION NEONATE 0001 142.24

54161 CIRCUM 28 DAYS OR OLDER 0001 194.82

54162 LYSIS PENIL CIRCUMIC LESION 0001 196.96

54163 REPAIR OF CIRCUMCISION 0001 216.34

54164 FRENULOTOMY OF PENIS 0001 192.06




54230 PREPARE PENIS STUDY 0001 78.51

54231 DYNAMIC CAVERNOSOMETRY 0001 115.06

54235 PENILE INJECTION 0001 73.04

54240 PENIS STUDY TC 0001 34.84

54240 PENIS STUDY 26 0001 63.43

54240 PENIS STUDY 0001 98.28

54250 PENIS STUDY TC 0001 10.78

54250 PENIS STUDY 26 0001 107.45

54250 PENIS STUDY 0001 118.23

54300 REVISION OF PENIS 0001 633.26









54328 REVISE PENIS/URETHRA 0001 928.18



54340 SECONDARY URETHRAL SURGERY 0001 562.85



54352 RECONSTRUCT URETHRA/PENIS 0001 1399.97

54360 PENIS PLASTIC SURGERY 0001 712.48

54380 REPAIR PENIS 0001 789.47

54385 REPAIR PENIS 0001 981.10

54390 REPAIR PENIS AND BLADDER 0001 1270.55

54400 INSERT SEMI-RIGID PROSTHESIS 0001 522.82

54401 INSERT SELF-CONTD PROSTHESIS 0001 648.93

54405 INSERT MULTI-COMP PENIS PROS 0001 798.98

54406 REMOVE MUTI-COMP PENIS PROS 0001 721.27

54408 REPAIR MULTI-COMP PENIS PROS 0001 780.99

54410 REMOVE/REPLACE PENIS PROSTH 0001 849.58

54411 REMOV/REPLC PENIS PROS COMP 0001 1013.35

54415 REMOVE SELF-CONTD PENIS PROS 0001 522.24


54416 REMV/REPL PENIS CONTAIN PROS 0001 702.17

54417 REMV/REPLC PENIS PROS COMPL 0001 888.24




54440 REPAIR OF PENIS 0001 623.36

54450 PREPUTIAL STRETCHING 0001 56.64

54500 BIOPSY OF TESTIS 0001 73.54

54505 BIOPSY OF TESTIS 0001 207.41

54512 EXCISE LESION TESTIS 0001 533.75

54520 REMOVAL OF TESTIS 0001 323.75

54522 ORCHIECTOMY PARTIAL 0001 596.11

54530 REMOVAL OF TESTIS 0001 500.77

54535 EXTENSIVE TESTIS SURGERY 0001 735.12

54550 EXPLORATION FOR TESTIS 0001 486.41

54560 EXPLORATION FOR TESTIS 0001 678.80

54600 REDUCE TESTIS TORSION 0001 447.83

54620 SUSPENSION OF TESTIS 0001 296.09

54640 SUSPENSION OF TESTIS 0001 474.11

54650 ORCHIOPEXY (FOWLER-STEPHENS) 0001 703.45

54660 REVISION OF TESTIS 0001 352.99

54670 REPAIR TESTIS INJURY 0001 400.67

54680 RELOCATION OF TESTIS(ES) 0001 777.50

54690 LAPAROSCOPY ORCHIECTOMY 0001 735.22

54692 LAPAROSCOPY ORCHIOPEXY 0001 788.03

54700 DRAINAGE OF SCROTUM 0001 211.49

54800 BIOPSY OF EPIDIDYMIS 0001 128.40

54830 REMOVE EPIDIDYMIS LESION 0001 369.15

54840 REMOVE EPIDIDYMIS LESION 0001 317.92

54860 REMOVAL OF EPIDIDYMIS 0001 414.19

54861 REMOVAL OF EPIDIDYMIS 0001 558.92

54865 EXPLORE EPIDIDYMIS 0001 355.13

54900 FUSION OF SPERMATIC DUCTS 0001 778.07

54901 FUSION OF SPERMATIC DUCTS 0001 1064.76

55000 DRAINAGE OF HYDROCELE 0001 83.77

55040 REMOVAL OF HYDROCELE 0001 336.04

55041 REMOVAL OF HYDROCELES 0001 505.35

55060 REPAIR OF HYDROCELE 0001 377.94

55100 DRAINAGE OF SCROTUM ABSCESS 0001 166.19

55110 EXPLORE SCROTUM 0001 384.81

55120 REMOVAL OF SCROTUM LESION 0001 355.65

55150 REMOVAL OF SCROTUM 0001 487.70

55175 REVISION OF SCROTUM 0001 359.30

55180 REVISION OF SCROTUM 0001 688.90

55200 INCISION OF SPERM DUCT 0001 277.09

55250 REMOVAL OF SPERM DUCT(S) 0001 225.23


55300 PREPARE SPERM DUCT X-RAY 0001 185.51

55400 REPAIR OF SPERM DUCT 0001 525.56

55450 LIGATION OF SPERM DUCT 0001 253.94

55500 REMOVAL OF HYDROCELE 0001 395.40

55520 REMOVAL OF SPERM CORD LESION 0001 452.49

55530 REVISE SPERMATIC CORD VEINS 0001 349.88

55535 REVISE SPERMATIC CORD VEINS 0001 425.25

55540 REVISE HERNIA & SPERM VEINS 0001 540.09

55550 LAPARO LIGATE SPERMATIC VEIN 0001 423.44

55600 INCISE SPERM DUCT POUCH 0001 416.95

55605 INCISE SPERM DUCT POUCH 0001 536.07

55650 REMOVE SPERM DUCT POUCH 0001 709.09

55680 REMOVE SPERM POUCH LESION 0001 342.35

55700 BIOPSY OF PROSTATE 0001 138.23

55705 BIOPSY OF PROSTATE 0001 262.64

55706 PROSTATE SATURATION SAMPLING 0001 362.95



55801 REMOVAL OF PROSTATE 0001 1080.23

55810 EXTENSIVE PROSTATE SURGERY 0001 1301.98








55860 SURGICAL EXPOSURE PROSTATE 0001 863.86



55866 LAPARO RADICAL PROSTATECTOMY 0001 1715.78

55870 ELECTROEJACULATION 0001 141.10

55873 CRYOABLATE PROSTATE 0001 756.77

55875 TRANSPERI NEEDLE PLACE PROS 0001 754.03

55876 PLACE RT DEVICE/MARKER PROS 0001 99.41

55920 Place needles pelvic for rt 0001 443.50

56405 I & D OF VULVA/PERINEUM 0001 110.08

56420 DRAINAGE OF GLAND ABSCESS 0001 92.54

56440 SURGERY FOR VULVA LESION 0001 185.09

56441 LYSIS OF LABIAL LESION(S) 0001 139.31

56442 HYMENOTOMY 0001 48.85

56501 DESTROY VULVA LESIONS SIM 0001 116.39

56515 DESTROY VULVA LESION/S COMPL 0001 201.99

56605 BIOPSY OF VULVA/PERINEUM 0001 61.11

56606 BIOPSY OF VULVA/PERINEUM 0001 29.64

56620 PARTIAL REMOVAL OF VULVA 0001 516.08


56625 COMPLETE REMOVAL OF VULVA 0001 619.00

56630 EXTENSIVE VULVA SURGERY 0001 912.78







56700 PARTIAL REMOVAL OF HYMEN 0001 189.83

56740 REMOVE VAGINA GLAND LESION 0001 302.27

56800 REPAIR OF VAGINA 0001 242.66

56805 REPAIR CLITORIS 0001 1164.40

56810 REPAIR OF PERINEUM 0001 262.55

56820 EXAM OF VULVA W/SCOPE 0001 87.08

56821 EXAM/BIOPSY OF VULVA W/SCOPE 0001 116.73

57000 EXPLORATION OF VAGINA 0001 191.69

57010 DRAINAGE OF PELVIC ABSCESS 0001 441.05

57020 DRAINAGE OF PELVIC FLUID 0001 83.13

57022 I & D VAGINAL HEMATOMA PP 0001 175.26

57023 I & D VAG HEMATOMA NON-OB 0001 315.08

57061 DESTROY VAG LESIONS SIMPLE 0001 99.58

57065 DESTROY VAG LESIONS COMPLEX 0001 174.29

57100 BIOPSY OF VAGINA 0001 67.06

57105 BIOPSY OF VAGINA 0001 126.90

57106 REMOVE VAGINA WALL PARTIAL 0001 490.91

57107 REMOVE VAGINA TISSUE PART 0001 1439.67

57109 VAGINECTOMY PARTIAL W/NODES 0001 1689.34

57110 REMOVE VAGINA WALL COMPLETE 0001 910.14

57111 REMOVE VAGINA TISSUE COMPL 0001 1630.82

57112 VAGINECTOMY W/NODES COMPL 0001 1709.42

57120 CLOSURE OF VAGINA 0001 517.01

57130 REMOVE VAGINA LESION 0001 160.96

57135 REMOVE VAGINA LESION 0001 174.22

57150 TREAT VAGINA INFECTION 0001 29.64

57155 INSERT UTERI TANDEM/OVOIDS 0001 285.65

57156 INS VAG BRACHYTX DEVICE INSER 0001 144.80

57160 INSERT PESSARY/OTHER DEVICE 0001 47.78

57170 FITTING OF DIAPHRAGM/CAP 0001 48.82

57180 TREAT VAGINAL BLEEDING 0001 106.97


57210 REPAIR VAGINA/PERINEUM 0001 370.54


57230 REPAIR OF URETHRAL LESION 0001 400.94

57240 REPAIR BLADDER & VAGINA 0001 673.12

57250 REPAIR RECTUM & VAGINA 0001 685.36



57265 EXTENSIVE REPAIR OF VAGINA 0001 924.70

57267 INSERT MESH/PELVIC FLR ADDON 0001 258.65

57268 REPAIR OF BOWEL BULGE 0001 488.29

57270 REPAIR OF BOWEL POUCH 0001 810.56

57280 SUSPENSION OF VAGINA 0001 964.25

57282 COLPOPEXY EXTRAPERITONEAL 0001 505.54

57283 COLPOPEXY INTRAPERITONEAL 0001 699.17

57284 REPAIR PARAVAG DEFECT OPEN 0001 823.93

57285 REPAIR PARAVAG DEFECT VAG 0001 680.04

57287 REVISE/REMOVE SLING REPAIR 0001 679.60

57288 REPAIR BLADDER DEFECT 0001 714.26

57289 REPAIR BLADDER & VAGINA 0001 719.98

57291 CONSTRUCTION OF VAGINA 0001 632.16

57292 CONSTRUCT VAGINA WITH GRAFT 0001 829.48

57295 REVISE VAG GRAFT VIA VAGINA 0001 482.41

57296 REVISE VAG GRAFT OPEN ABD 0001 964.50

57300 REPAIR RECTUM-VAGINA FISTULA 0001 564.60

57305 REPAIR RECTUM-VAGINA FISTULA 0001 937.95

57307 FISTULA REPAIR & COLOSTOMY 0001 1066.48

57308 FISTULA REPAIR TRANSPERINE 0001 674.00

57310 REPAIR URETHROVAGINAL LESION 0001 454.64

57311 REPAIR URETHROVAGINAL LESION 0001 517.52

57320 REPAIR BLADDER-VAGINA LESION 0001 529.74

57330 REPAIR BLADDER-VAGINA LESION 0001 729.70

57335 REPAIR VAGINA 0001 1139.39

57400 DILATION OF VAGINA 0001 135.77

57410 PELVIC EXAMINATION 0001 108.93

57415 REMOVE VAGINAL FOREIGN BODY 0001 160.84

57420 EXAM OF VAGINA W/SCOPE 0001 91.92

57421 EXAM/BIOPSY OF VAG W/SCOPE 0001 125.11

57423 REPAIR PARAVAG DEFECT LAP 0001 930.79

57425 LAPAROSCOPY SURG COLPOPEXY 0001 981.02

57426 REVISE PROSTH VAG GRAFT LAP 0001 859.21

57452 EXAM OF CERVIX W/SCOPE 0001 93.15

57454 BX/CURETT OF CERVIX W/SCOPE 0001 138.17

57455 BIOPSY OF CERVIX W/SCOPE 0001 112.87

57456 ENDOCERV CURETTAGE W/SCOPE 0001 105.20

57460 BX OF CERVIX W/SCOPE LEEP 0001 166.15

57461 CONZ OF CERVIX W/SCOPE LEEP 0001 191.43

57500 BIOPSY OF CERVIX 0001 77.11

57505 ENDOCERVICAL CURETTAGE 0001 92.93

57510 CAUTERIZATION OF CERVIX 0001 117.67

57511 CRYOCAUTERY OF CERVIX 0001 134.49

57513 LASER SURGERY OF CERVIX 0001 135.21

57520 CONIZATION OF CERVIX 0001 276.51

57522 CONIZATION OF CERVIX 0001 246.71


57530 REMOVAL OF CERVIX 0001 349.02

57531 REMOVAL OF CERVIX RADICAL 0001 1783.88

57540 REMOVAL OF RESIDUAL CERVIX 0001 790.76

57545 REMOVE CERVIX/REPAIR PELVIS 0001 834.36

57550 REMOVAL OF RESIDUAL CERVIX 0001 413.83

57555 REMOVE CERVIX/REPAIR VAGINA 0001 609.62

57556 REMOVE CERVIX REPAIR BOWEL 0001 573.37

57558 D&C OF CERVICAL STUMP 0001 115.45

57700 REVISION OF CERVIX 0001 314.56


57800 DILATION OF CERVICAL CANAL 0001 49.04

58100 BIOPSY OF UTERUS LINING 0001 89.54

58110 BX DONE W/COLPOSCOPY ADD-ON 0001 41.50

58120 DILATION AND CURETTAGE 0001 221.33

58140 MYOMECTOMY ABDOM METHOD 0001 933.98

58145 MYOMECTOMY VAG METHOD 0001 552.35

58146 MYOMECTOMY ABDOM COMPLEX 0001 1172.28

58150 TOTAL HYSTERECTOMY 0001 1016.87

58152 TOTAL HYSTERECTOMY 0001 1265.14

58180 PARTIAL HYSTERECTOMY 0001 973.78

58200 EXTENSIVE HYSTERECTOMY 0001 1348.56


58240 REMOVAL OF PELVIS CONTENTS 0001 2875.06

58260 VAGINAL HYSTERECTOMY 0001 839.71

58262 VAG HYST INCLUDING T/O 0001 936.74

58263 VAG HYST W/T/O & VAG REPAIR 0001 1005.83

58267 VAG HYST W/URINARY REPAIR 0001 1071.61

58270 VAG HYST W/ENTEROCELE REPAIR 0001 895.36

58275 HYSTERECTOMY/REVISE VAGINA 0001 999.36

58280 HYSTERECTOMY/REVISE VAGINA 0001 1068.02


58290 VAG HYST COMPLEX 0001 1169.16

58291 VAG HYST INCL T/O COMPLEX 0001 1265.83

58292 VAG HYST T/O & REPAIR COMPL 0001 1335.25

58293 VAG HYST W/URO REPAIR COMPL 0001 1389.04

58294 VAG HYST W/ENTEROCELE COMPL 0001 1238.28

58300 INSERT INTRAUTERINE DEVICE 0001 51.04

58301 REMOVE INTRAUTERINE DEVICE 0001 69.12

58340 CATHETER FOR HYSTEROGRAPHY 0001 58.17

58345 REOPEN FALLOPIAN TUBE 0001 282.78

58346 INSERT HEYMAN UTERI CAPSULE 0001 439.55

58350 REOPEN FALLOPIAN TUBE 0001 79.49

58353 ENDOMETR ABLATE THERMAL 0001 222.39

58356 ENDOMETRIAL CRYOABLATION 0001 351.59

58400 SUSPENSION OF UTERUS 0001 443.23

58410 SUSPENSION OF UTERUS 0001 816.17


58520 REPAIR OF RUPTURED UTERUS 0001 837.86

58540 REVISION OF UTERUS 0001 922.73

58541 LSH UTERUS 250 G OR LESS 0001 876.52

58542 LSH W/T/O UT 250 G OR LESS 0001 979.96

58543 LSH UTERUS ABOVE 250 G 0001 994.93

58544 LSH W/T/O UTERUS ABOVE 250 G 0001 1080.92

58545 LAPAROSCOPIC MYOMECTOMY 0001 910.14

58546 LAPARO-MYOMECTOMY COMPLEX 0001 1144.20

58548 LAP RADICAL HYST 0001 1862.01

58550 LAPARO-ASST VAG HYSTERECTOMY 0001 896.79

58552 LAPARO-VAG HYST INCL T/O 0001 996.66

58553 LAPARO-VAG HYST COMPLEX 0001 1153.34

58554 LAPARO-VAG HYST W/T/O COMPL 0001 1339.28

58555 HYSTEROSCOPY DX SEP PROC 0001 193.38

58558 HYSTEROSCOPY BIOPSY 0001 270.90

58559 HYSTEROSCOPY LYSIS 0001 347.68

58560 HYSTEROSCOPY RESECT SEPTUM 0001 393.06

58561 HYSTEROSCOPY REMOVE MYOMA 0001 556.05

58562 HYSTEROSCOPY REMOVE FB 0001 294.21

58563 HYSTEROSCOPY ABLATION 0001 348.04

58565 HYSTEROSCOPY STERILIZATION 0001 440.25

58570 TLH UTERUS 250 G OR LESS 0001 943.67

58571 Tlh w/t/o 250 g or less 0001 1056.87

58572 TLH UTERUS OVER 250 G 0001 1175.90

58573 Tlh w/t/o uterus over 250 g 0001 1354.65

58600 DIVISION OF FALLOPIAN TUBE 0001 370.35

58605 DIVISION OF FALLOPIAN TUBE 0001 333.94

58611 LIGATE OVIDUCT(S) ADD-ON 0001 78.88

58615 OCCLUDE FALLOPIAN TUBE(S) 0001 247.37

58660 LAPAROSCOPY LYSIS 0001 682.26

58661 LAPAROSCOPY REMOVE ADNEXA 0001 654.16

58662 LAPAROSCOPY EXCISE LESIONS 0001 716.11

58670 LAPAROSCOPY TUBAL CAUTERY 0001 370.71

58671 LAPAROSCOPY TUBAL BLOCK 0001 371.07

58672 LAPAROSCOPY FIMBRIOPLASTY 0001 746.85

58673 LAPAROSCOPY SALPINGOSTOMY 0001 811.85

58700 REMOVAL OF FALLOPIAN TUBE 0001 786.30

58720 REMOVAL OF OVARY/TUBE(S) 0001 736.70

58740 ADHESIOLYSIS TUBE OVARY 0001 887.94

58750 REPAIR OVIDUCT 0001 928.23

58752 REVISE OVARIAN TUBE(S) 0001 860.28

58760 FIMBRIOPLASTY 0001 822.09

58770 CREATE NEW TUBAL OPENING 0001 877.86

58800 DRAINAGE OF OVARIAN CYST(S) 0001 301.92

58805 DRAINAGE OF OVARIAN CYST(S) 0001 410.47

58820 DRAIN OVARY ABSCESS OPEN 0001 316.53


58822 DRAIN OVARY ABSCESS PERCUT 0001 749.45

58825 TRANSPOSITION OVARY(S) 0001 704.77

58900 BIOPSY OF OVARY(S) 0001 452.69

58920 PARTIAL REMOVAL OF OVARY(S) 0001 726.05

58925 REMOVAL OF OVARIAN CYST(S) 0001 751.41

58940 REMOVAL OF OVARY(S) 0001 527.12

58943 REMOVAL OF OVARY(S) 0001 1163.16

58950 RESECT OVARIAN MALIGNANCY 0001 1113.47



58953 TAH RAD DISSECT FOR DEBULK 0001 1994.43

58954 TAH RAD DEBULK/LYMPH REMOVE 0001 2162.79

58956 BSO OMENTECTOMY W/TAH 0001 1362.93

58957 RESECT RECURRENT GYN MAL 0001 1564.10

58958 RESECT RECUR GYN MAL W/LYM 0001 1714.63

58960 EXPLORATION OF ABDOMEN 0001 954.38

58999 GENITAL SURGERY PROCEDURE 0001 0.00

59000 AMNIOCENTESIS DIAGNOSTIC 0001 127.48

59001 AMNIOCENTESIS THERAPEUTIC 0001 184.78

59012 FETAL CORD PUNCTURE PRENATAL 0001 208.98

59015 CHORION BIOPSY 0001 159.30

59020 FETAL CONTRACT STRESS TEST TC 0001 33.76

59020 FETAL CONTRACT STRESS TEST 26 0001 37.46

59020 FETAL CONTRACT STRESS TEST 0001 71.23

59025 FETAL NON-STRESS TEST TC 0001 18.32

59025 FETAL NON-STRESS TEST 26 0001 29.73

59025 FETAL NON-STRESS TEST 0001 48.06

59030 FETAL SCALP BLOOD SAMPLE 0001 99.58

59050 FETAL MONITOR W/REPORT 0001 52.30

59051 FETAL MONITOR/INTERPRET ONLY 0001 43.53

59070 TRANSABDOM AMNIOINFUS W/US 0001 418.73

59072 UMBILICAL CORD OCCLUD W/US 0001 538.26

59074 FETAL FLUID DRAINAGE W/US 0001 397.90

59076 FETAL SHUNT PLACEMENT W/US 0001 540.42

59100 REMOVE UTERUS LESION 0001 856.17

59120 TREAT ECTOPIC PREGNANCY 0001 815.86








59160 D & C AFTER DELIVERY 0001 207.72

59200 INSERT CERVICAL DILATOR 0001 73.61

59300 EPISIOTOMY OR VAGINAL REPAIR 0001 196.34




59350 REPAIR OF UTERUS 0001 288.09

59400 OBSTETRICAL CARE 0001 2144.73



59412 ANTEPARTUM MANIPULATION 0001 106.47

59414 DELIVER PLACENTA 0001 94.40

59425 ANTEPARTUM CARE ONLY 0001 465.62

59426 ANTEPARTUM CARE ONLY 0001 832.98

59430 CARE AFTER DELIVERY 0001 188.31

59510 CESAREAN DELIVERY 0001 2371.93

59514 CESAREAN DELIVERY ONLY 0001 945.68

59515 CESAREAN DELIVERY 0001 1297.11

59525 REMOVE UTERUS AFTER CESAREAN 0001 499.71

59610 VBAC DELIVERY 0001 2249.19

59612 VBAC DELIVERY ONLY 0001 943.69

59614 VBAC CARE AFTER DELIVERY 0001 1173.20

59618 ATTEMPTED VBAC DELIVERY 0001 2404.43

59620 ATTEMPTED VBAC DELIVERY ONLY 0001 977.03

59622 ATTEMPTED VBAC AFTER CARE 0001 1332.81

59812 TREATMENT OF MISCARRIAGE 0001 324.63

59820 CARE OF MISCARRIAGE 0001 386.96

59821 TREATMENT OF MISCARRIAGE 0001 390.59

59830 TREAT UTERUS INFECTION 0001 447.06

59840 ABORTION 0001 219.50

59841 ABORTION 0001 390.88

59850 ABORTION 0001 343.13

59851 ABORTION 0001 408.10

59852 ABORTION 0001 502.87

59855 ABORTION 0001 425.74

59856 ABORTION 0001 499.99

59857 ABORTION 0001 513.88

59866 ABORTION (MPR) 0001 216.12

59870 EVACUATE MOLE OF UTERUS 0001 482.64

59871 REMOVE CERCLAGE SUTURE 0001 137.49

60000 DRAIN THYROID/TONGUE CYST 0001 156.13

60100 BIOPSY OF THYROID 0001 79.25

60200 REMOVE THYROID LESION 0001 663.40

60210 PARTIAL THYROID EXCISION 0001 709.19

60212 PARTIAL THYROID EXCISION 0001 1010.44

60220 PARTIAL REMOVAL OF THYROID 0001 712.64

60225 PARTIAL REMOVAL OF THYROID 0001 934.46

60240 REMOVAL OF THYROID 0001 923.41


60254 EXTENSIVE THYROID SURGERY 0001 1671.97


60260 REPEAT THYROID SURGERY 0001 1098.38



60280 REMOVE THYROID DUCT LESION 0001 446.78

60281 REMOVE THYROID DUCT LESION 0001 594.64

60300 Aspir/inj thyroid cyst 0001 50.11

60500 EXPLORE PARATHYROID GLANDS 0001 968.08

60502 RE-EXPLORE PARATHYROIDS 0001 1289.40

60505 EXPLORE PARATHYROID GLANDS 0001 1389.95

60512 AUTOTRANSPLANT PARATHYROID 0001 243.12

60520 REMOVAL OF THYMUS GLAND 0001 1042.82



60540 EXPLORE ADRENAL GLAND 0001 1054.16

60545 EXPLORE ADRENAL GLAND 0001 1212.91

60600 REMOVE CAROTID BODY LESION 0001 1434.20

60605 REMOVE CAROTID BODY LESION 0001 1581.82

60650 LAPAROSCOPY ADRENALECTOMY 0001 1187.51

61000 REMOVE CRANIAL CAVITY FLUID 0001 88.52

61001 REMOVE CRANIAL CAVITY FLUID 0001 109.10

61020 REMOVE BRAIN CAVITY FLUID 0001 106.50

61026 INJECTION INTO BRAIN CANAL 0001 107.75

61050 REMOVE BRAIN CANAL FLUID 0001 85.74

61055 INJECTION INTO BRAIN CANAL 0001 118.34

61070 BRAIN CANAL SHUNT PROCEDURE 0001 60.09

61105 TWIST DRILL HOLE 0001 467.16

61107 DRILL SKULL FOR IMPLANTATION 0001 318.40

61108 DRILL SKULL FOR DRAINAGE 0001 916.23

61120 BURR HOLE FOR PUNCTURE 0001 754.75

61140 PIERCE SKULL FOR BIOPSY 0001 1272.98

61150 PIERCE SKULL FOR DRAINAGE 0001 1365.83


61154 PIERCE SKULL & REMOVE CLOT 0001 1283.31


61210 PIERCE SKULL IMPLANT DEVICE 0001 371.94

61215 INSERT BRAIN-FLUID DEVICE 0001 509.40

61250 PIERCE SKULL & EXPLORE 0001 874.82

61253 PIERCE SKULL & EXPLORE 0001 824.71

61304 OPEN SKULL FOR EXPLORATION 0001 1653.91

61305 OPEN SKULL FOR EXPLORATION 0001 2026.33

61312 OPEN SKULL FOR DRAINAGE 0001 2099.78




61316 IMPLT CRAN BONE FLAP TO ABDO 0001 88.75




61322 DECOMPRESSIVE CRANIOTOMY 0001 2395.96

61323 DECOMPRESSIVE LOBECTOMY 0001 2404.18

61330 DECOMPRESS EYE SOCKET 0001 1874.63

61332 EXPLORE/BIOPSY EYE SOCKET 0001 2092.43

61333 EXPLORE ORBIT/REMOVE LESION 0001 2139.74

61340 SUBTEMPORAL DECOMPRESSION 0001 1458.44

61343 INCISE SKULL (PRESS RELIEF) 0001 2218.97

61345 RELIEVE CRANIAL PRESSURE 0001 2056.48

61450 INCISE SKULL FOR SURGERY 0001 1938.83

61458 INCISE SKULL FOR BRAIN WOUND 0001 2025.19



61500 REMOVAL OF SKULL LESION 0001 1344.97

61501 REMOVE INFECTED SKULL BONE 0001 1165.18

61510 REMOVAL OF BRAIN LESION 0001 2207.73

61512 REMOVE BRAIN LINING LESION 0001 2573.73

61514 REMOVAL OF BRAIN ABSCESS 0001 1925.30


61517 IMPLT BRAIN CHEMOTX ADD-ON 0001 88.05


61519 REMOVE BRAIN LINING LESION 0001 2977.00



61522 REMOVAL OF BRAIN ABSCESS 0001 2204.80




61531 IMPLANT BRAIN ELECTRODES 0001 1232.83



61535 REMOVE BRAIN ELECTRODES 0001 1008.49


61537 REMOVAL OF BRAIN TISSUE 0001 2485.50




61541 INCISION OF BRAIN TISSUE 0001 2166.04


61544 REMOVE & TREAT BRAIN LESION 0001 1918.06

61545 EXCISION OF BRAIN TUMOR 0001 3210.07

61546 REMOVAL OF PITUITARY GLAND 0001 2325.95

61548 REMOVAL OF PITUITARY GLAND 0001 1567.48

61550 RELEASE OF SKULL SEAMS 0001 881.56

61552 RELEASE OF SKULL SEAMS 0001 1119.64

61556 INCISE SKULL/SUTURES 0001 1718.15


61557 INCISE SKULL/SUTURES 0001 1694.68

61558 EXCISION OF SKULL/SUTURES 0001 1706.54

61559 EXCISION OF SKULL/SUTURES 0001 1751.08

61563 EXCISION OF SKULL TUMOR 0001 1996.06

61564 EXCISION OF SKULL TUMOR 0001 2425.59


61567 INCISION OF BRAIN TISSUE 0001 2584.07

61570 REMOVE FOREIGN BODY BRAIN 0001 1882.45

61571 INCISE SKULL FOR BRAIN WOUND 0001 2004.68

61575 SKULL BASE/BRAINSTEM SURGERY 0001 2433.07

61576 SKULL BASE/BRAINSTEM SURGERY 0001 3450.80

61580 CRANIOFACIAL APPROACH SKULL 0001 2502.86




61584 ORBITOCRANIAL APPROACH/SKULL 0001 2880.85


61586 RESECT NASOPHARYNX SKULL 0001 2471.18

61590 INFRATEMPORAL APPROACH/SKULL 0001 3075.14

61591 INFRATEMPORAL APPROACH/SKULL 0001 3127.03


61595 TRANSTEMPORAL APPROACH/SKULL 0001 2390.09

61596 TRANSCOCHLEAR APPROACH/SKULL 0001 2475.55

61597 TRANSCONDYLAR APPROACH/SKULL 0001 2875.56

61598 TRANSPETROSAL APPROACH/SKULL 0001 2861.44

61600 RESECT/EXCISE CRANIAL LESION 0001 2162.00






61610 TRANSECT ARTERY SINUS 0001 1776.32



61613 REMOVE ANEURYSM SINUS 0001 3310.90

61615 RESECT/EXCISE LESION SKULL 0001 2278.64

61616 RESECT/EXCISE LESION SKULL 0001 3355.05

61618 REPAIR DURA 0001 1315.31

61619 REPAIR DURA 0001 1493.11

61623 ENDOVASC TEMPORY VESSEL OCCL 0001 556.42

61624 TRANSCATH OCCLUSION CNS 0001 1110.78

61626 TRANSCATH OCCLUSION NON-CNS 0001 859.21

61630 INTRACRANIAL ANGIOPLASTY 0001 1279.50

61635 INTRACRAN ANGIOPLSTY W/STENT 0001 1395.88

61640 DILATE IC VASOSPASM INIT 0001 620.78

61641 DILATE IC VASOSPASM ADD-ON 0001 218.40


61642 DILATE IC VASOSPASM ADD-ON 0001 436.05

61680 INTRACRANIAL VESSEL SURGERY 0001 2272.12






61697 BRAIN ANEURYSM REPR COMPLX 0001 4258.37

61698 BRAIN ANEURYSM REPR COMPLX 0001 4674.04

61700 BRAIN ANEURYSM REPR SIMPLE 0001 3446.37

61702 INNER SKULL VESSEL SURGERY 0001 4060.39

61703 CLAMP NECK ARTERY 0001 1370.29

61705 REVISE CIRCULATION TO HEAD 0001 2624.34



61711 FUSION OF SKULL ARTERIES 0001 2629.56

61720 INCISE SKULL/BRAIN SURGERY 0001 1280.54

61735 INCISE SKULL/BRAIN SURGERY 0001 1602.87

61750 INCISE SKULL/BRAIN BIOPSY 0001 1418.10

61751 BRAIN BIOPSY W/CT/MR GUIDE 0001 1386.73


61770 INCISE SKULL FOR TREATMENT 0001 1632.13

61781 SCAN PROC CRANIAL INTRA STERE 0001 236.14

61782 SCAN PROC CRANIAL EXTRA STERE 0001 193.09

61783 SCAN PROC SPINAL STERE 0001 236.86

61790 TREAT TRIGEMINAL NERVE 0001 881.71

61791 TREAT TRIGEMINAL TRACT 0001 1121.84

61796 SRS CRANIAL LESION SIMPLE 0001 1011.59

61797 SRS CRAN LES SIMPLE ADDL 0001 219.60

61798 SRS CRANIAL LESION COMPLEX 0001 1381.38

61799 SRS CRAN LES COMPLEX ADDL 0001 302.61

61800 APPLY SRS HEADFRAME ADD-ON 0001 153.64

61850 IMPLANT NEUROELECTRODES 0001 990.33


61863 IMPLANT NEUROELECTRODE 0001 1516.52

61864 IMPLANT NEUROELECTRDE ADDL 0001 287.08

61867 IMPLANT NEUROELECTRODE 0001 2300.57

61868 IMPLANT NEUROELECTRDE ADDL 0001 505.49


61880 REVISE/REMOVE NEUROELECTRODE 0001 577.68

61885 INSRT/REDO NEUROSTIM 1 ARRAY 0001 523.03

61886 IMPLANT NEUROSTIM ARRAYS 0001 854.42

61888 REVISE/REMOVE NEURORECEIVER 0001 394.69

62000 TREAT SKULL FRACTURE 0001 1039.51

62005 TREAT SKULL FRACTURE 0001 1281.24

62010 TREATMENT OF HEAD INJURY 0001 1544.03


62100 REPAIR BRAIN FLUID LEAKAGE 0001 1623.17

62115 REDUCTION OF SKULL DEFECT 0001 1261.78

62117 REDUCTION OF SKULL DEFECT 0001 1567.95

62120 REPAIR SKULL CAVITY LESION 0001 1685.33

62121 INCISE SKULL REPAIR 0001 1722.68

62140 REPAIR OF SKULL DEFECT 0001 1047.62

62141 REPAIR OF SKULL DEFECT 0001 1152.78

62142 REMOVE SKULL PLATE/FLAP 0001 896.74

62143 REPLACE SKULL PLATE/FLAP 0001 1051.67

62145 REPAIR OF SKULL & BRAIN 0001 1435.84

62146 REPAIR OF SKULL WITH GRAFT 0001 1259.07

62147 REPAIR OF SKULL WITH GRAFT 0001 1468.48

62148 RETR BONE FLAP TO FIX SKULL 0001 127.85

62160 NEUROENDOSCOPY ADD-ON 0001 191.98

62161 DISSECT BRAIN W/SCOPE 0001 1530.65

62162 REMOVE COLLOID CYST W/SCOPE 0001 1905.43

62163 ZNEUROENDOSCOPY W/FB REMOVAL 0001 1234.10

62164 REMOVE BRAIN TUMOR W/SCOPE 0001 2106.88

62165 REMOVE PITUIT TUMOR W/SCOPE 0001 1561.12

62180 ESTABLISH BRAIN CAVITY SHUNT 0001 1614.45



62194 REPLACE/IRRIGATE CATHETER 0001 432.46


62201 BRAIN CAVITY SHUNT W/SCOPE 0001 1212.78



62225 REPLACE/IRRIGATE CATHETER 0001 528.37

62230 REPLACE/REVISE BRAIN SHUNT 0001 850.63

62252 CSF SHUNT REPROGRAM TC 0001 39.15

62252 CSF SHUNT REPROGRAM 26 0001 46.43

62252 CSF SHUNT REPROGRAM 0001 85.59

62256 REMOVE BRAIN CAVITY SHUNT 0001 605.92

62258 REPLACE BRAIN CAVITY SHUNT 0001 1136.53

62263 EPIDURAL LYSIS MULT SESSIONS 0001 353.03

62264 EPIDURAL LYSIS ON SINGLE DAY 0001 238.75

62267 INTERDISCAL PERQ ASPIR DX 0001 161.23

62268 DRAIN SPINAL CORD CYST 0001 262.42

62269 NEEDLE BIOPSY SPINAL CORD 0001 268.92

62270 SPINAL FLUID TAP DIAGNOSTIC 0001 79.37

62272 DRAIN CEREBRO SPINAL FLUID 0001 86.04

62273 INJECT EPIDURAL PATCH 0001 113.78

62280 TREAT SPINAL CORD LESION 0001 173.73

62281 TREAT SPINAL CORD LESION 0001 160.36

62282 TREAT SPINAL CANAL LESION 0001 145.57

62284 INJECTION FOR MYELOGRAM 0001 86.87


62287 PERCUTANEOUS DISKECTOMY 0001 564.62

62290 INJECT FOR SPINE DISK X-RAY 0001 174.87

62291 INJECT FOR SPINE DISK X-RAY 0001 171.03

62292 INJECTION INTO DISK LESION 0001 586.39

62294 INJECTION INTO SPINAL ARTERY 0001 717.69

62302 Myelography lumbar injection 0001 122.48




62310 INJECT SPINE CERV/THORACIC 0001 72.32

62311 INJECT SPINE LUMBAR/SACRAL 0001 70.89

62318 INJECT SPINE W/CATH CRV/THRC 0001 77.07

62319 INJECT SPINE W/CATH LMB/SCRL 0001 78.95

62350 IMPLANT SPINAL CANAL CATH 0001 404.97

62351 IMPLANT SPINAL CANAL CATH 0001 885.48

62355 REMOVE SPINAL CANAL CATHETER 0001 268.06

62360 INSERT SPINE INFUSION DEVICE 0001 314.84

62361 IMPLANT SPINE INFUSION PUMP 0001 351.85

62362 IMPLANT SPINE INFUSION PUMP 0001 389.41

62365 REMOVE SPINE INFUSION DEVICE 0001 294.90

62367 ANALYZE SPINE INFUS PUMP 0001 25.41

62368 ANALYZE SP INF PUMP W/REPROG 0001 34.38

62369 Anal sp inf pmp w/reprg&fill 0001 35.10

62370 ANL SP INF PMP W/MDREPRG&FIL 0001 46.20

63001 REMOVE SPINE LAMINA 1/2 CRVL 0001 1248.96

63003 REMOVE SPINE LAMINA 1/2 THRC 0001 1247.54

63005 REMOVE SPINE LAMINA 1/2 LMBR 0001 1194.45

63011 REMOVE SPINE LAMINA 1/2 SCRL 0001 1101.31

63012 REMOVE LAMINA/FACETS LUMBAR 0001 1203.77

63015 REMOVE SPINE LAMINA >2 CRVCL 0001 1498.35

63016 REMOVE SPINE LAMINA >2 THRC 0001 1530.62

63017 REMOVE SPINE LAMINA >2 LMBR 0001 1261.84

63020 NECK SPINE DISK SURGERY 0001 1182.27

63030 LOW BACK DISK SURGERY 0001 980.44

63035 SPINAL DISK SURGERY ADD-ON 0001 194.24

63040 LAMINOTOMY SINGLE CERVICAL 0001 1420.91

63042 LAMINOTOMY SINGLE LUMBAR 0001 1313.15

63043 LAMINOTOMY ADDL CERVICAL 0001 535.76

63044 LAMINOTOMY ADDL LUMBAR 0001 508.97

63045 REMOVE SPINE LAMINA 1 CRVL 0001 1285.38

63046 REMOVE SPINE LAMINA 1 THRC 0001 1223.21

63047 REMOVE SPINE LAMINA 1 LMBR 0001 1113.76

63048 REMOVE SPINAL LAMINA ADD-ON 0001 215.42

63050 CERVICAL LAMINOPLSTY 2/> SEG 0001 1575.65

63051 C-LAMINOPLASTY W/GRAFT/PLATE 0001 1731.09

63055 DECOMPRESS SPINAL CORD THRC 0001 1642.43


63056 DECOMPRESS SPINAL CORD LMBR 0001 1494.76

63057 DECOMPRESS SPINE CORD ADD-ON 0001 324.64

63064 DECOMPRESS SPINAL CORD THRC 0001 1789.15

63066 DECOMPRESS SPINE CORD ADD-ON 0001 208.89



63077 SPINE DISK SURGERY THORAX 0001 1508.49

63078 SPINE DISK SURGERY THORAX 0001 196.30

63081 REMOVE VERT BODY DCMPRN CRVL 0001 1788.21

63082 REMOVE VERTEBRAL BODY ADD-ON 0001 271.01

63085 REMOVE VERT BODY DCMPRN THRC 0001 1915.63


63087 REMOV VERTBR DCMPRN THRCLMBR 0001 2410.47


63090 REMOVE VERT BODY DCMPRN LMBR 0001 1982.09


63101 REMOVE VERT BODY DCMPRN THRC 0001 2341.47

63102 REMOVE VERT BODY DCMPRN LMBR 0001 2261.18


63170 INCISE SPINAL CORD TRACT(S) 0001 1605.93

63172 DRAINAGE OF SPINAL CYST 0001 1422.93

63173 DRAINAGE OF SPINAL CYST 0001 1741.25

63180 REVISE SPINAL CORD LIGAMENTS 0001 1498.47

63182 REVISE SPINAL CORD LIGAMENTS 0001 1476.63

63185 INCISE SPINE NRV HALF SEGMNT 0001 1210.48

63190 INCISE SPINE NRV >2 SEGMNTS 0001 1275.83

63191 INCISE SPINE ACCESSORY NERVE 0001 1280.24

63194 INCISE SPINE & CORD CERVICAL 0001 1255.64

63195 INCISE SPINE & CORD THORACIC 0001 1549.89

63196 INCISE SPINE&CORD 2 TRX CRVL 0001 1360.78

63197 INCISE SPINE&CORD 2 TRX THRC 0001 1554.09

63198 INCISE SPIN&CORD 2 STGS CRVL 0001 1602.35

63199 INCISE SPIN&CORD 2 STGS THRC 0001 1681.14

63200 RELEASE SPINAL CORD LUMBAR 0001 1553.89

63250 REVISE SPINAL CORD VSLS CRVL 0001 2992.81

63251 REVISE SPINAL CORD VSLS THRC 0001 3059.71

63252 REVISE SPINE CORD VSL THRLMB 0001 3059.01

63265 EXCISE INTRASPINL LESION CRV 0001 1686.80

63266 EXCISE INTRSPINL LESION THRC 0001 1741.04

63267 EXCISE INTRSPINL LESION LMBR 0001 1390.88

63268 EXCISE INTRSPINL LESION SCRL 0001 1467.88

63270 EXCISE INTRSPINL LESION CRVL 0001 2093.50

63271 EXCISE INTRSPINL LESION THRC 0001 2091.26

63272 EXCISE INTRSPINL LESION LMBR 0001 1923.66

63273 EXCISE INTRSPINL LESION SCRL 0001 1880.37

63275 BX/EXC XDRL SPINE LESN CRVL 0001 1820.01


63276 BX/EXC XDRL SPINE LESN THRC 0001 1802.55

63277 BX/EXC XDRL SPINE LESN LMBR 0001 1567.67

63278 BX/EXC XDRL SPINE LESN SCRL 0001 1602.09

63280 BX/EXC IDRL SPINE LESN CRVL 0001 2136.97

63281 BX/EXC IDRL SPINE LESN THRC 0001 2110.31

63282 BX/EXC IDRL SPINE LESN LMBR 0001 1994.73

63283 BX/EXC IDRL SPINE LESN SCRL 0001 1915.54

63285 BX/EXC IDRL IMED LESN CERVL 0001 2637.68

63286 BX/EXC IDRL IMED LESN THRC 0001 2597.12

63287 BX/EXC IDRL IMED LESN THRLMB 0001 2768.41

63290 BX/EXC XDRL/IDRL LSN ANY LVL 0001 2810.57

63295 REPAIR LAMINECTOMY DEFECT 0001 335.69

63300 REMOVE VERT XDRL BODY CRVCL 0001 1855.39

63301 REMOVE VERT XDRL BODY THRC 0001 2223.43

63302 REMOVE VERT XDRL BODY THRLMB 0001 2195.92

63303 REMOV VERT XDRL BDY LMBR/SAC 0001 2332.62

63304 REMOVE VERT IDRL BODY CRVCL 0001 2368.89

63305 REMOVE VERT IDRL BODY THRC 0001 2522.14

63306 REMOV VERT IDRL BDY THRCLMBR 0001 2184.80

63307 REMOV VERT IDRL BDY LMBR/SAC 0001 2426.80


63600 REMOVE SPINAL CORD LESION 0001 915.55

63610 STIMULATION OF SPINAL CORD 0001 388.67

63615 REMOVE LESION OF SPINAL CORD 0001 1247.50

63620 SRS SPINAL LESION 0001 1115.37

63621 SRS SPINAL LESION ADDL 0001 251.58



63661 REMOVE SPINE ELTRD PERQ ARAY 0001 322.17

63662 REMOVE SPINE ELTRD PLATE 0001 775.86

63663 REVISE SPINE ELTRD PERQ ARAY 0001 462.95

63664 REVISE SPINE ELTRD PLATE 0001 803.02

63685 INSRT/REDO SPINE N GENERATOR 0001 366.16

63688 REVISE/REMOVE NEURORECEIVER 0001 370.03

63700 REPAIR OF SPINAL HERNIATION 0001 1276.76




63707 REPAIR SPINAL FLUID LEAKAGE 0001 924.06

63709 REPAIR SPINAL FLUID LEAKAGE 0001 1112.67

63710 GRAFT REPAIR OF SPINE DEFECT 0001 1116.27

63740 INSTALL SPINAL SHUNT 0001 953.38

63741 INSTALL SPINAL SHUNT 0001 656.53

63744 REVISION OF SPINAL SHUNT 0001 690.30

63746 REMOVAL OF SPINAL SHUNT 0001 605.65

64400 N BLOCK INJ TRIGEMINAL 0001 69.34


64402 N BLOCK INJ FACIAL 0001 74.83

64405 N BLOCK INJ OCCIPITAL 0001 63.21

64408 N BLOCK INJ VAGUS 0001 73.43

64410 N BLOCK INJ PHRENIC 0001 76.20

64412 N BLOCK INJ SPINAL ACCESSOR 0001 73.20

64413 N BLOCK INJ CERVICAL PLEXUS 0001 81.05

64415 N BLOCK INJ BRACHIAL PLEXUS 0001 64.61

64416 N BLOCK CONT INFUSE B PLEX 0001 78.04

64417 N BLOCK INJ AXILLARY 0001 70.07

64418 N BLOCK INJ SUPRASCAPULAR 0001 75.32

64420 N BLOCK INJ INTERCOST SNG 0001 68.75

64421 N BLOCK INJ INTERCOST MLT 0001 94.54

64425 N BLOCK INJ ILIO-ING/HYPOGI 0001 94.77

64430 N BLOCK INJ PUDENDAL 0001 81.91

64435 N BLOCK INJ PARACERVICAL 0001 85.34

64445 N BLOCK INJ SCIATIC SNG 0001 71.86

64446 N BLK INJ SCIATIC CONT INF 0001 78.40

64447 N BLOCK INJ FEM SINGLE 0001 65.29

64448 N BLOCK INJ FEM CONT INF 0001 70.08

64449 N BLOCK INJ LUMBAR PLEXUS 0001 81.99

64450 N BLOCK OTHER PERIPHERAL 0001 45.76

64455 N BLOCK INJ PLANTAR DIGIT 0001 35.38

64479 INJ FORAMEN EPIDURAL C/T 0001 135.91

64480 INJ FORAMEN EPIDURAL ADD-ON 0001 65.95

64483 INJ FORAMEN EPIDURAL L/S 0001 113.45

64484 INJ FORAMEN EPIDURAL ADD-ON 0001 52.51

64486 Tap block unil by injection 0001 63.20

64487 Tap block uni by infusion 0001 72.52

64488 Tap block bi injection 0001 78.39

64489 Tap block bi by infusion 0001 87.38

64490 INJ PARAVERT F JNT C/T 1 LEV 0001 109.01



64493 INJ PARAVERT F JNT L/S 1 LEV 0001 92.22



64505 N BLOCK SPENOPALATINE GANGL 0001 86.00

64508 N BLOCK CAROTID SINUS S/P 0001 78.77

64510 N BLOCK STELLATE GANGLION 0001 74.05

64517 N BLOCK INJ HYPOGAS PLXS 0001 120.12

64520 N BLOCK LUMBAR/THORACIC 0001 80.65

64530 N BLOCK INJ CELIAC PELUS 0001 92.82

64550 APPLY NEUROSTIMULATOR 0001 9.02






64566 NEUROELTRD STIM POST TIBIAL POSTE 0001 29.86

64568 INC FOR VAGUS N ELECT IMPL INCIS 0001 614.97

64569 REVISE/REPL VAGUS N ELTRD REVIS 0001 785.77

64570 REMOVE VAGUS N ELTRD REMOV 0001 698.98




64585 REVISE/REMOVE NEUROELECTRODE 0001 143.78

64590 INSRT/REDO PN/GASTR STIMUL 0001 159.71

64595 REVISE/RMV PN/GASTR STIMUL 0001 126.35

64600 INJECTION TREATMENT OF NERVE 0001 215.29



64611 CHEMODENERV SALIV GLANDS CHEMO 0001 99.13

64612 DESTROY NERVE FACE MUSCLE 0001 124.20

64615 Chemodenerv musc migraine 0001 127.57

64616 Chemodenerv musc neck dyston 0001 108.17

64617 Chemodener muscle larynx emg 0001 113.96



64632 N BLOCK INJ COMMON DIGIT 0001 69.36

64633 Destroy cerv/thor facet jnt 0001 229.75

64634 DESTROY C/TH FACET JNT ADDL 0001 69.21

64635 Destroy lumb/sac facet jnt 0001 226.25

64636 DESTROY L/S FACET JNT ADDL 0001 60.49


64642 Chemodenerv 1 extremity 1-4 0001 107.38

64643 Chemodenerv 1 extrem 1-4 ea 0001 71.74

64644 Chemodenerv 1 extrem 5/> mus 0001 117.15

64645 Chemodenerv 1 extrem 5/> ea 0001 82.27

64646 Chemodenerv trunk musc 1-5 0001 116.11

64647 Chemodenerv trunk musc 6/> 0001 133.94

64650 CHEMODENERV ECCRINE GLANDS 0001 41.27

64653 CHEMODENERV ECCRINE GLANDS 0001 54.44



64702 REVISE FINGER/TOE NERVE 0001 497.59

64704 REVISE HAND/FOOT NERVE 0001 319.02

64708 REVISE ARM/LEG NERVE 0001 496.87

64712 REVISION OF SCIATIC NERVE 0001 563.66

64713 REVISION OF ARM NERVE(S) 0001 727.65

64714 REVISE LOW BACK NERVE(S) 0001 634.80

64716 REVISION OF CRANIAL NERVE 0001 542.69

64718 REVISE ULNAR NERVE AT ELBOW 0001 594.86

64719 REVISE ULNAR NERVE AT WRIST 0001 399.22


64721 CARPAL TUNNEL SURGERY 0001 426.60

64722 RELIEVE PRESSURE ON NERVE(S) 0001 368.82

64726 RELEASE FOOT/TOE NERVE 0001 271.77

64727 INTERNAL NERVE REVISION 0001 184.16

64732 INCISION OF BROW NERVE 0001 415.86

64734 INCISION OF CHEEK NERVE 0001 389.53

64736 INCISION OF CHIN NERVE 0001 440.57

64738 INCISION OF JAW NERVE 0001 486.54

64740 INCISION OF TONGUE NERVE 0001 461.70

64742 INCISION OF FACIAL NERVE 0001 505.88

64744 INCISE NERVE BACK OF HEAD 0001 496.30

64746 INCISE DIAPHRAGM NERVE 0001 435.74

64755 INCISION OF STOMACH NERVES 0001 914.85

64760 INCISION OF VAGUS NERVE 0001 511.53

64763 INCISE HIP/THIGH NERVE 0001 506.55

64766 INCISE HIP/THIGH NERVE 0001 560.38

64771 SEVER CRANIAL NERVE 0001 586.73

64772 INCISION OF SPINAL NERVE 0001 561.31

64774 REMOVE SKIN NERVE LESION 0001 418.00

64776 REMOVE DIGIT NERVE LESION 0001 392.52

64778 DIGIT NERVE SURGERY ADD-ON 0001 155.08

64782 REMOVE LIMB NERVE LESION 0001 451.36

64783 LIMB NERVE SURGERY ADD-ON 0001 216.90

64784 REMOVE NERVE LESION 0001 739.63

64786 REMOVE SCIATIC NERVE LESION 0001 1085.70

64787 IMPLANT NERVE END 0001 243.51

64788 REMOVE SKIN NERVE LESION 0001 398.97

64790 REMOVAL OF NERVE LESION 0001 829.02

64792 REMOVAL OF NERVE LESION 0001 1198.68

64795 BIOPSY OF NERVE 0001 195.47

64802 SYMPATHECTOMY CERVICAL 0001 677.41

64804 REMOVE SYMPATHETIC NERVES 0001 1030.61



64820 SYMPATHECTOMY DIGITAL ARTERY 0001 729.57



64823 SYMPATHECTOMY SUPFC PALMAR 0001 800.34

64831 REPAIR OF DIGIT NERVE 0001 686.76

64832 REPAIR NERVE ADD-ON 0001 339.95

64834 REPAIR OF HAND OR FOOT NERVE 0001 744.41



64837 REPAIR NERVE ADD-ON 0001 365.71

64840 REPAIR OF LEG NERVE 0001 927.85

64856 REPAIR/TRANSPOSE NERVE 0001 1014.00


64857 REPAIR ARM/LEG NERVE 0001 1061.56

64858 REPAIR SCIATIC NERVE 0001 1073.63

64859 NERVE SURGERY 0001 259.63

64861 REPAIR OF ARM NERVES 0001 1376.71

64862 REPAIR OF LOW BACK NERVES 0001 1371.41

64864 REPAIR OF FACIAL NERVE 0001 877.98

64865 REPAIR OF FACIAL NERVE 0001 1122.07

64866 FUSION OF FACIAL/OTHER NERVE 0001 1164.00

64868 FUSION OF FACIAL/OTHER NERVE 0001 1027.82

64872 SUBSEQUENT REPAIR OF NERVE 0001 119.57

64874 REPAIR & REVISE NERVE ADD-ON 0001 168.91

64876 REPAIR NERVE/SHORTEN BONE 0001 184.83

64885 NERVE GRAFT HEAD/NECK </4 CM 0001 1147.65

64886 NERVE GRAFT HEAD/NECK >4 CM 0001 1306.16

64890 NERVE GRAFT HAND/FOOT </4 CM 0001 1116.93

64891 NERVE GRAFT HAND/FOOT >4 CM 0001 1190.32

64892 NERVE GRAFT ARM/LEG <4 CM 0001 1086.48

64893 NERVE GRAFT ARM/LEG >4 CM 0001 1160.55

64895 NERVE GRAFT HAND/FOOT </4 CM 0001 1364.51

64896 NERVE GRAFT HAND/FOOT >4 CM 0001 1600.50

64897 NERVE GRAFT ARM/LEG </4 CM 0001 1316.50

64898 NERVE GRAFT ARM/LEG >4 CM 0001 1381.62

64901 NERVE GRAFT ADD-ON 0001 589.96

64902 NERVE GRAFT ADD-ON 0001 682.68

64905 NERVE PEDICLE TRANSFER 0001 1046.83

64907 NERVE PEDICLE TRANSFER 0001 1218.26

64910 NERVE REPAIR W/ALLOGRAFT 0001 827.56

64911 NEURORRAPHY W/VEIN AUTOGRAFT 0001 1036.08

64999 NERVOUS SYSTEM SURGERY 0001 0.00

65091 REVISE EYE 0001 663.36

65093 REVISE EYE WITH IMPLANT 0001 654.70

65101 REMOVAL OF EYE 0001 768.76

65103 REMOVE EYE/INSERT IMPLANT 0001 802.77

65105 REMOVE EYE/ATTACH IMPLANT 0001 886.57

65110 REMOVAL OF EYE 0001 1242.63

65112 REMOVE EYE/REVISE SOCKET 0001 1441.64

65114 REMOVE EYE/REVISE SOCKET 0001 1512.35

65125 REVISE OCULAR IMPLANT 0001 305.27

65130 INSERT OCULAR IMPLANT 0001 763.91

65135 INSERT OCULAR IMPLANT 0001 775.10

65140 ATTACH OCULAR IMPLANT 0001 820.51

65150 REVISE OCULAR IMPLANT 0001 572.73

65155 REINSERT OCULAR IMPLANT 0001 883.78

65175 REMOVAL OF OCULAR IMPLANT 0001 667.30

65205 REMOVE FOREIGN BODY FROM EYE 0001 45.90








65270 REPAIR OF EYE WOUND 0001 144.43







65290 REPAIR OF EYE SOCKET WOUND 0001 515.78

65400 REMOVAL OF EYE LESION 0001 616.99

65410 BIOPSY OF CORNEA 0001 111.28



65430 CORNEAL SMEAR 0001 107.17

65435 CURETTE/TREAT CORNEA 0001 72.53

65436 CURETTE/TREAT CORNEA 0001 386.77

65450 TREATMENT OF CORNEAL LESION 0001 328.33

65600 REVISION OF CORNEA 0001 352.32

65710 CORNEAL TRANSPLANT 0001 1131.42




65756 CORNEAL TRNSPL ENDOTHELIAL 0001 1174.92

65757 PREP CORNEAL ENDO ALLOGRAFT 0001 0.00



65767 CORNEAL TISSUE TRANSPLANT 0001 1394.78

65770 REVISE CORNEA WITH IMPLANT 0001 1599.25

65771 RADIAL KERATOTOMY 0001 759.47

65772 CORRECTION OF ASTIGMATISM 0001 413.96

65775 CORRECTION OF ASTIGMATISM 0001 547.50

65778 COVER EYE W/MEMBRANE 0001 73.87

65779 COVER EYE W/MEMBRANE SUTURE 0001 292.10

65780 OCULAR RECONST TRANSPLANT 0001 906.07



65800 DRAINAGE OF EYE 0001 94.85

65810 DRAINAGE OF EYE 0001 476.85

65815 DRAINAGE OF EYE 0001 496.99

65820 RELIEVE INNER EYE PRESSURE 0001 744.04

65850 INCISION OF EYE 0001 876.06

65855 LASER SURGERY OF EYE 0001 307.88


65860 INCISE INNER EYE ADHESIONS 0001 289.68





65900 REMOVE EYE LESION 0001 955.78

65920 REMOVE IMPLANT OF EYE 0001 803.49

65930 REMOVE BLOOD CLOT FROM EYE 0001 664.23

66020 INJECTION TREATMENT OF EYE 0001 130.38

66030 INJECTION TREATMENT OF EYE 0001 112.80

66130 REMOVE EYE LESION 0001 604.52

66150 GLAUCOMA SURGERY 0001 869.77




66172 INCISION OF EYE 0001 1541.97

66174 TRANSLUM DIL EYE CANAL TRANS 0001 988.39

66175 TRNSLUM DIL EYE CANAL W/STNT TRANS 0001 1125.34

66179 Aqueous shunt eye w/o graft 0001 1073.69

66180 AQUEOUS SHUNT EYE W/GRAFT 0001 1190.40

66183 Insert ant drainage device 0001 1071.83

66184 Revision of aqueous shunt 0001 784.00

66185 REVISE AQUEOUS SHUNT EYE 0001 780.48

66220 REPAIR EYE LESION 0001 761.08

66225 REPAIR/GRAFT EYE LESION 0001 981.61

66250 FOLLOW-UP SURGERY OF EYE 0001 586.03

66500 INCISION OF IRIS 0001 351.73

66505 INCISION OF IRIS 0001 385.54

66600 REMOVE IRIS AND LESION 0001 828.21

66605 REMOVAL OF IRIS 0001 1048.39

66625 REMOVAL OF IRIS 0001 438.83

66630 REMOVAL OF IRIS 0001 590.79

66635 REMOVAL OF IRIS 0001 570.77

66680 REPAIR IRIS & CILIARY BODY 0001 546.34

66682 REPAIR IRIS & CILIARY BODY 0001 667.22

66700 DESTRUCTION CILIARY BODY 0001 394.94

66710 CILIARY TRANSSLERAL THERAPY 0001 414.15

66711 CILIARY ENDOSCOPIC ABLATION 0001 638.02



66761 REVISION OF IRIS 0001 242.62

66762 REVISION OF IRIS 0001 433.59

66770 REMOVAL OF INNER EYE LESION 0001 479.88

66820 INCISION SECONDARY CATARACT 0001 404.85

66821 AFTER CATARACT LASER SURGERY 0001 319.90

66825 REPOSITION INTRAOCULAR LENS 0001 773.86


66830 REMOVAL OF LENS LESION 0001 707.18

66840 REMOVAL OF LENS MATERIAL 0001 733.34



66920 EXTRACTION OF LENS 0001 748.04



66982 CATARACT SURGERY COMPLEX 0001 822.32

66983 CATARACT SURG W/IOL 1 STAGE 0001 743.38

66984 CATARACT SURG W/IOL 1 STAGE 0001 661.23

66985 INSERT LENS PROSTHESIS 0001 785.91

66986 EXCHANGE LENS PROSTHESIS 0001 926.53

66990 OPHTHALMIC ENDOSCOPE ADD-ON 0001 89.67

66999 EYE SURGERY PROCEDURE 0001 0.00

67005 PARTIAL REMOVAL OF EYE FLUID 0001 499.33

67010 PARTIAL REMOVAL OF EYE FLUID 0001 555.96

67015 RELEASE OF EYE FLUID 0001 593.53

67025 REPLACE EYE FLUID 0001 659.29

67027 IMPLANT EYE DRUG SYSTEM 0001 888.99

67028 INJECTION EYE DRUG 0001 102.88

67030 INCISE INNER EYE STRANDS 0001 528.38

67031 LASER SURGERY EYE STRANDS 0001 363.65

67036 REMOVAL OF INNER EYE FLUID 0001 982.45

67039 LASER TREATMENT OF RETINA 0001 1287.96

67040 LASER TREATMENT OF RETINA 0001 1454.19

67041 Vit for macular pucker 0001 1358.90

67042 Vit for macular hole 0001 1553.19

67043 Vit for membrane dissect 0001 1665.33

67101 REPAIR DETACHED RETINA 0001 702.36





67112 REREPAIR DETACHED RETINA 0001 1359.71

67113 REPAIR RETINAL DETACH CPLX 0001 1790.02

67115 RELEASE ENCIRCLING MATERIAL 0001 508.54

67120 REMOVE EYE IMPLANT MATERIAL 0001 587.11

67121 REMOVE EYE IMPLANT MATERIAL 0001 948.02

67141 TREATMENT OF RETINA 0001 507.90

67145 TREATMENT OF RETINA 0001 509.35

67208 TREATMENT OF RETINAL LESION 0001 573.86



67220 TREATMENT OF CHOROID LESION 0001 521.23

67221 OCULAR PHOTODYNAMIC THER 0001 220.30

67225 EYE PHOTODYNAMIC THER ADD-ON 0001 27.91




67229 Tr retinal les preterm inf 0001 1099.75

67250 REINFORCE EYE WALL 0001 809.06

67255 REINFORCE/GRAFT EYE WALL 0001 881.18

67311 REVISE EYE MUSCLE 0001 621.26

67312 REVISE TWO EYE MUSCLES 0001 750.94

67314 REVISE EYE MUSCLE 0001 699.04

67316 REVISE TWO EYE MUSCLES 0001 844.16

67318 REVISE EYE MUSCLE(S) 0001 699.87

67320 REVISE EYE MUSCLE(S) ADD-ON 0001 319.22

67331 EYE SURGERY FOLLOW-UP ADD-ON 0001 321.25

67332 REREVISE EYE MUSCLES ADD-ON 0001 348.95

67334 REVISE EYE MUSCLE W/SUTURE 0001 298.99

67335 EYE SUTURE DURING SURGERY 0001 156.24

67340 REVISE EYE MUSCLE ADD-ON 0001 355.53

67343 RELEASE EYE TISSUE 0001 686.64

67345 DESTROY NERVE OF EYE MUSCLE 0001 231.35

67346 BIOPSY EYE MUSCLE 0001 207.22


67405 EXPLORE/DRAIN EYE SOCKET 0001 803.69

67412 EXPLORE/TREAT EYE SOCKET 0001 883.96


67414 EXPLR/DECOMPRESS EYE SOCKET 0001 1349.23

67415 ASPIRATION ORBITAL CONTENTS 0001 107.75



67440 EXPLORE/DRAIN EYE SOCKET 0001 1227.55

67445 EXPLR/DECOMPRESS EYE SOCKET 0001 1472.37


67500 INJECT/TREAT EYE SOCKET 0001 71.50



67550 INSERT EYE SOCKET IMPLANT 0001 1004.07

67560 REVISE EYE SOCKET IMPLANT 0001 1004.23

67570 DECOMPRESS OPTIC NERVE 0001 1278.73

67700 DRAINAGE OF EYELID ABSCESS 0001 119.88

67710 INCISION OF EYELID 0001 102.16

67715 INCISION OF EYELID FOLD 0001 113.71

67800 REMOVE EYELID LESION 0001 108.03

67801 REMOVE EYELID LESIONS 0001 140.72

67805 REMOVE EYELID LESIONS 0001 173.21

67808 REMOVE EYELID LESION(S) 0001 385.85

67810 BIOPSY EYELID & LID MARGIN 0001 72.09

67820 REVISE EYELASHES 0001 55.61





67840 REMOVE EYELID LESION 0001 163.69

67850 TREAT EYELID LESION 0001 136.51

67875 CLOSURE OF EYELID BY SUTURE 0001 101.68



67900 REPAIR BROW DEFECT 0001 529.16

67901 REPAIR EYELID DEFECT 0001 605.40






67909 REVISE EYELID DEFECT 0001 458.00

67911 REVISE EYELID DEFECT 0001 588.53

67912 CORRECTION EYELID W/IMPLANT 0001 500.79









67930 REPAIR EYELID WOUND 0001 252.28

67935 REPAIR EYELID WOUND 0001 464.36

67938 REMOVE EYELID FOREIGN BODY 0001 119.18




67971 RECONSTRUCTION OF EYELID 0001 761.50




68020 INCISE/DRAIN EYELID LINING 0001 113.69

68040 TREATMENT OF EYELID LESIONS 0001 55.43

68100 BIOPSY OF EYELID LINING 0001 100.18

68110 REMOVE EYELID LINING LESION 0001 155.57




68200 TREAT EYELID BY INJECTION 0001 36.22

68320 REVISE/GRAFT EYELID LINING 0001 564.78





68330 REVISE EYELID LINING 0001 483.90


68340 SEPARATE EYELID ADHESIONS 0001 419.43



68371 HARVEST EYE TISSUE ALOGRAFT 0001 409.50

68400 INCISE/DRAIN TEAR GLAND 0001 138.48

68420 INCISE/DRAIN TEAR SAC 0001 171.76

68440 INCISE TEAR DUCT OPENING 0001 102.99

68500 REMOVAL OF TEAR GLAND 0001 1043.25

68505 PARTIAL REMOVAL TEAR GLAND 0001 1020.27

68510 BIOPSY OF TEAR GLAND 0001 311.89

68520 REMOVAL OF TEAR SAC 0001 699.91

68525 BIOPSY OF TEAR SAC 0001 280.91

68530 CLEARANCE OF TEAR DUCT 0001 271.95

68540 REMOVE TEAR GLAND LESION 0001 947.50

68550 REMOVE TEAR GLAND LESION 0001 1160.94

68700 REPAIR TEAR DUCTS 0001 634.39

68705 REVISE TEAR DUCT OPENING 0001 174.17

68720 CREATE TEAR SAC DRAIN 0001 784.43

68745 CREATE TEAR DUCT DRAIN 0001 799.38

68750 CREATE TEAR DUCT DRAIN 0001 824.18

68760 CLOSE TEAR DUCT OPENING 0001 153.13

68761 CLOSE TEAR DUCT OPENING 0001 123.08

68770 CLOSE TEAR SYSTEM FISTULA 0001 661.41

68801 DILATE TEAR DUCT OPENING 0001 110.08

68810 PROBE NASOLACRIMAL DUCT 0001 194.53



68816 Probe nl duct w/balloon 0001 261.78

68840 EXPLORE/IRRIGATE TEAR DUCTS 0001 121.88

68850 INJECTION FOR TEAR SAC X-RAY 0001 55.02

69000 DRAIN EXTERNAL EAR LESION 0001 121.12

69005 DRAIN EXTERNAL EAR LESION 0001 158.80

69020 DRAIN OUTER EAR CANAL LESION 0001 144.36

69100 BIOPSY OF EXTERNAL EAR 0001 48.97

69105 BIOPSY OF EXTERNAL EAR CANAL 0001 64.31

69110 REMOVE EXTERNAL EAR PARTIAL 0001 326.52

69120 REMOVAL OF EXTERNAL EAR 0001 411.67

69140 REMOVE EAR CANAL LESION(S) 0001 888.34

69145 REMOVE EAR CANAL LESION(S) 0001 253.76

69150 EXTENSIVE EAR CANAL SURGERY 0001 1060.40

69155 EXTENSIVE EAR/NECK SURGERY 0001 1685.54

69200 CLEAR OUTER EAR CANAL 0001 58.72

69205 CLEAR OUTER EAR CANAL 0001 102.87


69210 REMOVE IMPACTED EAR WAX UNI 0001 33.11

69220 CLEAN OUT MASTOID CAVITY 0001 62.91

69222 CLEAN OUT MASTOID CAVITY 0001 138.73

69300 REVISE EXTERNAL EAR 0001 480.67

69310 REBUILD OUTER EAR CANAL 0001 1104.26

69320 REBUILD OUTER EAR CANAL 0001 1543.99

69420 INCISION OF EARDRUM 0001 122.34

69421 INCISION OF EARDRUM 0001 150.78

69424 REMOVE VENTILATING TUBE 0001 62.88

69433 CREATE EARDRUM OPENING 0001 134.99

69436 CREATE EARDRUM OPENING 0001 162.62

69440 EXPLORATION OF MIDDLE EAR 0001 701.27

69450 EARDRUM REVISION 0001 553.72

69501 MASTOIDECTOMY 0001 742.63

69502 MASTOIDECTOMY 0001 986.51

69505 REMOVE MASTOID STRUCTURES 0001 1217.70

69511 EXTENSIVE MASTOID SURGERY 0001 1246.99

69530 EXTENSIVE MASTOID SURGERY 0001 1669.51

69535 REMOVE PART OF TEMPORAL BONE 0001 2708.95

69540 REMOVE EAR LESION 0001 129.01




69601 MASTOID SURGERY REVISION 0001 1061.39





69610 REPAIR OF EARDRUM 0001 294.36

69620 REPAIR OF EARDRUM 0001 493.57

69631 REPAIR EARDRUM STRUCTURES 0001 898.52

69632 REBUILD EARDRUM STRUCTURES 0001 1095.23


69635 REPAIR EARDRUM STRUCTURES 0001 1246.93



69641 REVISE MIDDLE EAR & MASTOID 0001 1057.32






69650 RELEASE MIDDLE EAR BONE 0001 815.99

69660 REVISE MIDDLE EAR BONE 0001 939.49




69666 REPAIR MIDDLE EAR STRUCTURES 0001 820.89

69667 REPAIR MIDDLE EAR STRUCTURES 0001 822.31

69670 REMOVE MASTOID AIR CELLS 0001 957.92

69676 REMOVE MIDDLE EAR NERVE 0001 844.90

69700 CLOSE MASTOID FISTULA 0001 696.25

69710 IMPLANT/REPLACE HEARING AID 0001 2758.07

69711 REMOVE/REPAIR HEARING AID 0001 875.34

69714 IMPLANT TEMPLE BONE W/STIMUL 0001 1090.31

69715 TEMPLE BNE IMPLNT W/STIMULAT 0001 1344.70

69717 TEMPLE BONE IMPLANT REVISION 0001 1143.98

69718 REVISE TEMPLE BONE IMPLANT 0001 1358.65

69720 RELEASE FACIAL NERVE 0001 1211.60


69740 REPAIR FACIAL NERVE 0001 1182.48

69745 REPAIR FACIAL NERVE 0001 1258.10

69801 INCISE INNER EAR 0001 127.36

69805 EXPLORE INNER EAR 0001 1067.99

69806 EXPLORE INNER EAR 0001 960.07

69820 ESTABLISH INNER EAR WINDOW 0001 870.49

69840 REVISE INNER EAR WINDOW 0001 898.66

69905 REMOVE INNER EAR 0001 932.50

69910 REMOVE INNER EAR & MASTOID 0001 1031.24

69915 INCISE INNER EAR NERVE 0001 1558.36

69930 IMPLANT COCHLEAR DEVICE 0001 1239.36

69950 INCISE INNER EAR NERVE 0001 1801.37


69960 RELEASE INNER EAR CANAL 0001 1946.03

69970 REMOVE INNER EAR LESION 0001 2167.03

69990 MICROSURGERY ADD-ON 0001 218.56

70010 CONTRAST X-RAY OF BRAIN 0001 67.62

70015 CONTRAST X-RAY OF BRAIN TC 0001 99.03

70015 CONTRAST X-RAY OF BRAIN 26 0001 62.07

70015 CONTRAST X-RAY OF BRAIN 0001 161.11

70030 X-RAY EYE FOR FOREIGN BODY TC 0001 22.69

70030 X-RAY EYE FOR FOREIGN BODY 26 0001 8.76

70030 X-RAY EYE FOR FOREIGN BODY 0001 31.45

70100 X-RAY EXAM OF JAW <4VIEWS TC 0001 27.60

70100 X-RAY EXAM OF JAW <4VIEWS 26 0001 9.49

70100 X-RAY EXAM OF JAW <4VIEWS 0001 37.10

70110 X-RAY EXAM OF JAW 4/> VIEWS TC 0001 29.49

70110 X-RAY EXAM OF JAW 4/> VIEWS 26 0001 13.14

70110 X-RAY EXAM OF JAW 4/> VIEWS 0001 42.63

70120 X-RAY EXAM OF MASTOIDS TC 0001 29.11

70120 X-RAY EXAM OF MASTOIDS 26 0001 9.49

70120 X-RAY EXAM OF MASTOIDS 0001 38.61

70130 X-RAY EXAM OF MASTOIDS TC 0001 44.23


70130 X-RAY EXAM OF MASTOIDS 26 0001 17.50

70130 X-RAY EXAM OF MASTOIDS 0001 61.73

70134 X-RAY EXAM OF MIDDLE EAR TC 0001 40.45

70134 X-RAY EXAM OF MIDDLE EAR 26 0001 18.63

70134 X-RAY EXAM OF MIDDLE EAR 0001 59.09

70140 X-RAY EXAM OF FACIAL BONES TC 0001 21.56

70140 X-RAY EXAM OF FACIAL BONES 26 0001 10.61

70140 X-RAY EXAM OF FACIAL BONES 0001 32.17

70150 X-RAY EXAM OF FACIAL BONES TC 0001 32.14

70150 X-RAY EXAM OF FACIAL BONES 26 0001 13.49

70150 X-RAY EXAM OF FACIAL BONES 0001 45.64

70160 X-RAY EXAM OF NASAL BONES TC 0001 27.22

70160 X-RAY EXAM OF NASAL BONES 26 0001 9.13

70160 X-RAY EXAM OF NASAL BONES 0001 36.36

70170 X-RAY EXAM OF TEAR DUCT TC 0001 36.20

70170 X-RAY EXAM OF TEAR DUCT 26 0001 16.10

70170 X-RAY EXAM OF TEAR DUCT 0001 51.40

70190 X-RAY EXAM OF EYE SOCKETS TC 0001 27.60

70190 X-RAY EXAM OF EYE SOCKETS 26 0001 11.32

70190 X-RAY EXAM OF EYE SOCKETS 0001 38.93

70200 X-RAY EXAM OF EYE SOCKETS TC 0001 32.14

70200 X-RAY EXAM OF EYE SOCKETS 26 0001 14.59

70200 X-RAY EXAM OF EYE SOCKETS 0001 46.73

70210 X-RAY EXAM OF SINUSES TC 0001 23.82

70210 X-RAY EXAM OF SINUSES 26 0001 9.13

70210 X-RAY EXAM OF SINUSES 0001 32.96

70220 X-RAY EXAM OF SINUSES TC 0001 28.36

70220 X-RAY EXAM OF SINUSES 26 0001 13.14

70220 X-RAY EXAM OF SINUSES 0001 41.50

70240 X-RAY EXAM PITUITARY SADDLE TC 0001 22.69

70240 X-RAY EXAM PITUITARY SADDLE 26 0001 10.23

70240 X-RAY EXAM PITUITARY SADDLE 0001 32.92

70250 X-RAY EXAM OF SKULL TC 0001 26.85

70250 X-RAY EXAM OF SKULL 26 0001 13.15

70250 X-RAY EXAM OF SKULL 0001 40.01

70260 X-RAY EXAM OF SKULL TC 0001 32.89

70260 X-RAY EXAM OF SKULL 26 0001 17.87

70260 X-RAY EXAM OF SKULL 0001 50.77

70300 X-RAY EXAM OF TEETH TC 0001 9.84

70300 X-RAY EXAM OF TEETH 26 0001 6.25

70300 X-RAY EXAM OF TEETH 0001 16.09

70310 X-RAY EXAM OF TEETH TC 0001 32.52

70310 X-RAY EXAM OF TEETH 26 0001 8.40

70310 X-RAY EXAM OF TEETH 0001 40.92

70320 FULL MOUTH X-RAY OF TEETH TC 0001 44.23

70320 FULL MOUTH X-RAY OF TEETH 26 0001 12.44


70320 FULL MOUTH X-RAY OF TEETH 0001 56.67

70328 X-RAY EXAM OF JAW JOINT TC 0001 24.20

70328 X-RAY EXAM OF JAW JOINT 26 0001 9.87

70328 X-RAY EXAM OF JAW JOINT 0001 34.08

70330 X-RAY EXAM OF JAW JOINTS TC 0001 39.32

70330 X-RAY EXAM OF JAW JOINTS 26 0001 13.15

70330 X-RAY EXAM OF JAW JOINTS 0001 52.48

70332 X-RAY EXAM OF JAW JOINT TC 0001 56.33

70332 X-RAY EXAM OF JAW JOINT 26 0001 32.26

70332 X-RAY EXAM OF JAW JOINT 0001 88.59

70336 MAGNETIC IMAGE JAW JOINT TC 0001 266.45

70336 MAGNETIC IMAGE JAW JOINT 26 0001 76.27

70336 MAGNETIC IMAGE JAW JOINT 0001 342.73

70350 X-RAY HEAD FOR ORTHODONTIA TC 0001 12.49

70350 X-RAY HEAD FOR ORTHODONTIA 26 0001 10.27

70350 X-RAY HEAD FOR ORTHODONTIA 0001 22.76

70355 PANORAMIC X-RAY OF JAWS TC 0001 10.60

70355 PANORAMIC X-RAY OF JAWS 26 0001 11.34

70355 PANORAMIC X-RAY OF JAWS 0001 21.94

70360 X-RAY EXAM OF NECK TC 0001 22.31

70360 X-RAY EXAM OF NECK 26 0001 8.76

70360 X-RAY EXAM OF NECK 0001 31.07

70370 THROAT X-RAY & FLUOROSCOPY TC 0001 69.93

70370 THROAT X-RAY & FLUOROSCOPY 26 0001 16.02

70370 THROAT X-RAY & FLUOROSCOPY 0001 85.96

70371 SPEECH EVALUATION COMPLEX TC 0001 53.68

70371 SPEECH EVALUATION COMPLEX 26 0001 44.16

70371 SPEECH EVALUATION COMPLEX 0001 97.84

70373 CONTRAST X-RAY OF LARYNX TC 0001 69.55

70373 CONTRAST X-RAY OF LARYNX 26 0001 22.97

70373 CONTRAST X-RAY OF LARYNX 0001 92.53

70380 X-RAY EXAM OF SALIVARY GLAND TC 0001 31.38

70380 X-RAY EXAM OF SALIVARY GLAND 26 0001 9.51

70380 X-RAY EXAM OF SALIVARY GLAND 0001 40.90

70390 X-RAY EXAM OF SALIVARY DUCT TC 0001 88.07

70390 X-RAY EXAM OF SALIVARY DUCT 26 0001 20.10

70390 X-RAY EXAM OF SALIVARY DUCT 0001 108.18

70450 CT HEAD/BRAIN W/O DYE TC 0001 86.56

70450 CT HEAD/BRAIN W/O DYE 26 0001 43.78

70450 CT HEAD/BRAIN W/O DYE 0001 130.34

70460 CT HEAD/BRAIN W/DYE TC 0001 119.82

70460 CT HEAD/BRAIN W/DYE 26 0001 58.37

70460 CT HEAD/BRAIN W/DYE 0001 178.19

70470 CT HEAD/BRAIN W/O & W/DYE TC 0001 148.16

70470 CT HEAD/BRAIN W/O & W/DYE 26 0001 66.07

70470 CT HEAD/BRAIN W/O & W/DYE 0001 214.24


70480 CT ORBIT/EAR/FOSSA W/O DYE TC 0001 198.81

70480 CT ORBIT/EAR/FOSSA W/O DYE 26 0001 66.43

70480 CT ORBIT/EAR/FOSSA W/O DYE 0001 265.24

70481 CT ORBIT/EAR/FOSSA W/DYE TC 0001 237.35

70481 CT ORBIT/EAR/FOSSA W/DYE 26 0001 71.93

70481 CT ORBIT/EAR/FOSSA W/DYE 0001 309.29

70482 CT ORBIT/EAR/FOSSA W/O&W/DYE TC 0001 266.83

70482 CT ORBIT/EAR/FOSSA W/O&W/DYE 26 0001 75.19

70482 CT ORBIT/EAR/FOSSA W/O&W/DYE 0001 342.03

70486 CT MAXILLOFACIAL W/O DYE TC 0001 159.12

70486 CT MAXILLOFACIAL W/O DYE 26 0001 59.11

70486 CT MAXILLOFACIAL W/O DYE 0001 218.24

70487 CT MAXILLOFACIAL W/DYE TC 0001 196.92

70487 CT MAXILLOFACIAL W/DYE 26 0001 67.53

70487 CT MAXILLOFACIAL W/DYE 0001 264.45

70488 CT MAXILLOFACIAL W/O & W/DYE TC 0001 243.02

70488 CT MAXILLOFACIAL W/O & W/DYE 26 0001 73.74

70488 CT MAXILLOFACIAL W/O & W/DYE 0001 316.77

70490 CT SOFT TISSUE NECK W/O DYE TC 0001 149.30

70490 CT SOFT TISSUE NECK W/O DYE 26 0001 66.43

70490 CT SOFT TISSUE NECK W/O DYE 0001 215.73

70491 CT SOFT TISSUE NECK W/DYE TC 0001 187.47

70491 CT SOFT TISSUE NECK W/DYE 26 0001 71.53

70491 CT SOFT TISSUE NECK W/DYE 0001 259.00

70492 CT SFT TSUE NCK W/O & W/DYE TC 0001 232.82

70492 CT SFT TSUE NCK W/O & W/DYE 26 0001 75.19

70492 CT SFT TSUE NCK W/O & W/DYE 0001 308.02

70496 CT ANGIOGRAPHY HEAD TC 0001 381.72

70496 CT ANGIOGRAPHY HEAD 26 0001 90.90

70496 CT ANGIOGRAPHY HEAD 0001 472.63

70498 CT ANGIOGRAPHY NECK TC 0001 400.24

70498 CT ANGIOGRAPHY NECK 26 0001 90.52

70498 CT ANGIOGRAPHY NECK 0001 490.77

70540 MRI ORBIT/FACE/NECK W/O DYE TC 0001 312.56

70540 MRI ORBIT/FACE/NECK W/O DYE 26 0001 70.10

70540 MRI ORBIT/FACE/NECK W/O DYE 0001 382.66

70542 MRI ORBIT/FACE/NECK W/DYE TC 0001 352.62

70542 MRI ORBIT/FACE/NECK W/DYE 26 0001 84.35

70542 MRI ORBIT/FACE/NECK W/DYE 0001 436.98

70543 MRI ORBT/FAC/NCK W/O &W/DYE TC 0001 423.67

70543 MRI ORBT/FAC/NCK W/O &W/DYE 26 0001 110.93

70543 MRI ORBT/FAC/NCK W/O &W/DYE 0001 534.61

70544 MR ANGIOGRAPHY HEAD W/O DYE TC 0001 366.98

70544 MR ANGIOGRAPHY HEAD W/O DYE 26 0001 62.43

70544 MR ANGIOGRAPHY HEAD W/O DYE 0001 429.42

70545 MR ANGIOGRAPHY HEAD W/DYE TC 0001 360.94


70545 MR ANGIOGRAPHY HEAD W/DYE 26 0001 62.43

70545 MR ANGIOGRAPHY HEAD W/DYE 0001 423.37

70546 MR ANGIOGRAPH HEAD W/O&W/DYE TC 0001 551.79

70546 MR ANGIOGRAPH HEAD W/O&W/DYE 26 0001 93.85

70546 MR ANGIOGRAPH HEAD W/O&W/DYE 0001 645.64

70547 MR ANGIOGRAPHY NECK W/O DYE TC 0001 368.12

70547 MR ANGIOGRAPHY NECK W/O DYE 26 0001 62.43

70547 MR ANGIOGRAPHY NECK W/O DYE 0001 430.55

70548 MR ANGIOGRAPHY NECK W/DYE TC 0001 389.66

70548 MR ANGIOGRAPHY NECK W/DYE 26 0001 62.43

70548 MR ANGIOGRAPHY NECK W/DYE 0001 452.10

70549 MR ANGIOGRAPH NECK W/O&W/DYE TC 0001 556.33

70549 MR ANGIOGRAPH NECK W/O&W/DYE 26 0001 93.45

70549 MR ANGIOGRAPH NECK W/O&W/DYE 0001 649.78

70551 MRI BRAIN STEM W/O DYE TC 0001 181.80

70551 MRI BRAIN STEM W/O DYE 26 0001 76.65

70551 MRI BRAIN STEM W/O DYE 0001 258.45

70552 MRI BRAIN STEM W/DYE TC 0001 258.90

70552 MRI BRAIN STEM W/DYE 26 0001 93.13

70552 MRI BRAIN STEM W/DYE 0001 352.03

70553 MRI BRAIN STEM W/O & W/DYE TC 0001 295.93

70553 MRI BRAIN STEM W/O & W/DYE 26 0001 119.01

70553 MRI BRAIN STEM W/O & W/DYE 0001 414.95

71010 CHEST X-RAY 1 VIEW FRONTAL TC 0001 15.51

71010 CHEST X-RAY 1 VIEW FRONTAL 26 0001 9.49

71010 CHEST X-RAY 1 VIEW FRONTAL 0001 25.01

71015 CHEST X-RAY STEREO FRONTAL TC 0001 21.18

71015 CHEST X-RAY STEREO FRONTAL 26 0001 10.95

71015 CHEST X-RAY STEREO FRONTAL 0001 32.13

71020 CHEST X-RAY 2VW FRONTAL&LATL TC 0001 21.18

71020 CHEST X-RAY 2VW FRONTAL&LATL 26 0001 11.30

71020 CHEST X-RAY 2VW FRONTAL&LATL 0001 32.49

71021 CHEST X-RAY FRNT LAT LORDOTC TC 0001 25.71

71021 CHEST X-RAY FRNT LAT LORDOTC 26 0001 14.23

71021 CHEST X-RAY FRNT LAT LORDOTC 0001 39.95

71022 CHEST X-RAY FRNT LAT OBLIQUE TC 0001 32.52

71022 CHEST X-RAY FRNT LAT OBLIQUE 26 0001 17.18

71022 CHEST X-RAY FRNT LAT OBLIQUE 0001 49.70

71023 CHEST X-RAY AND FLUOROSCOPY TC 0001 51.03

71023 CHEST X-RAY AND FLUOROSCOPY 26 0001 19.31

71023 CHEST X-RAY AND FLUOROSCOPY 0001 70.35

71030 CHEST X-RAY 4/> VIEWS TC 0001 33.65

71030 CHEST X-RAY 4/> VIEWS 26 0001 15.66

71030 CHEST X-RAY 4/> VIEWS 0001 49.32

71034 CHEST X-RAY&FLUORO 4/> VIEWS TC 0001 69.55

71034 CHEST X-RAY&FLUORO 4/> VIEWS 26 0001 23.31


71034 CHEST X-RAY&FLUORO 4/> VIEWS 0001 92.87

71035 CHEST X-RAY SPECIAL VIEWS TC 0001 29.49

71035 CHEST X-RAY SPECIAL VIEWS 26 0001 9.49

71035 CHEST X-RAY SPECIAL VIEWS 0001 38.99

71100 X-RAY EXAM RIBS UNI 2 VIEWS TC 0001 23.45

71100 X-RAY EXAM RIBS UNI 2 VIEWS 26 0001 11.68

71100 X-RAY EXAM RIBS UNI 2 VIEWS 0001 35.13

71101 X-RAY EXAM UNILAT RIBS/CHEST TC 0001 28.74

71101 X-RAY EXAM UNILAT RIBS/CHEST 26 0001 13.85

71101 X-RAY EXAM UNILAT RIBS/CHEST 0001 42.59

71110 X-RAY EXAM RIBS BIL 3 VIEWS TC 0001 29.49

71110 X-RAY EXAM RIBS BIL 3 VIEWS 26 0001 14.23

71110 X-RAY EXAM RIBS BIL 3 VIEWS 0001 43.73

71111 X-RAY EXAM RIBS/CHEST4/> VWS TC 0001 40.45

71111 X-RAY EXAM RIBS/CHEST4/> VWS 26 0001 16.78

71111 X-RAY EXAM RIBS/CHEST4/> VWS 0001 57.24

71120 X-RAY EXAM BREASTBONE 2/>VWS TC 0001 23.45

71120 X-RAY EXAM BREASTBONE 2/>VWS 26 0001 10.59

71120 X-RAY EXAM BREASTBONE 2/>VWS 0001 34.04

71130 X-RAY STRENOCLAVIC JT 3/>VWS TC 0001 28.36

71130 X-RAY STRENOCLAVIC JT 3/>VWS 26 0001 11.68

71130 X-RAY STRENOCLAVIC JT 3/>VWS 0001 40.05

71250 CT THORAX W/O DYE TC 0001 149.30

71250 CT THORAX W/O DYE 26 0001 52.54

71250 CT THORAX W/O DYE 0001 201.84

71260 CT THORAX W/DYE TC 0001 188.22

71260 CT THORAX W/DYE 26 0001 64.62

71260 CT THORAX W/DYE 0001 252.85

71270 CT THORAX W/O & W/DYE TC 0001 233.95

71270 CT THORAX W/O & W/DYE 26 0001 71.15

71270 CT THORAX W/O & W/DYE 0001 305.11

71275 CT ANGIOGRAPHY CHEST TC 0001 294.80

71275 CT ANGIOGRAPHY CHEST 26 0001 99.66

71275 CT ANGIOGRAPHY CHEST 0001 394.47

71550 MRI CHEST W/O DYE TC 0001 365.09

71550 MRI CHEST W/O DYE 26 0001 75.55

71550 MRI CHEST W/O DYE 0001 440.65

71551 MRI CHEST W/DYE TC 0001 408.56

71551 MRI CHEST W/DYE 26 0001 89.81

71551 MRI CHEST W/DYE 0001 498.37

71552 MRI CHEST W/O & W/DYE TC 0001 510.22

71552 MRI CHEST W/O & W/DYE 26 0001 116.77

71552 MRI CHEST W/O & W/DYE 0001 626.99

71555 MRI ANGIO CHEST W OR W/O DYE TC 0001 345.82

71555 MRI ANGIO CHEST W OR W/O DYE 26 0001 93.43

71555 MRI ANGIO CHEST W OR W/O DYE 0001 439.26


72010 X-RAY EXAM SPINE AP&LAT TC 0001 60.10

72010 X-RAY EXAM SPINE AP&LAT 26 0001 24.50

72010 X-RAY EXAM SPINE AP&LAT 0001 84.61

72020 X-RAY EXAM OF SPINE 1 VIEW TC 0001 16.64

72020 X-RAY EXAM OF SPINE 1 VIEW 26 0001 8.04

72020 X-RAY EXAM OF SPINE 1 VIEW 0001 24.69

72040 X-RAY EXAM NECK SPINE 2-3 VW TC 0001 26.09

72040 X-RAY EXAM NECK SPINE 2-3 VW 26 0001 12.47

72040 X-RAY EXAM NECK SPINE 2-3 VW 0001 38.57

72050 X-RAY EXAM NECK SPINE 4/5VWS TC 0001 35.16

72050 X-RAY EXAM NECK SPINE 4/5VWS 26 0001 16.84

72050 X-RAY EXAM NECK SPINE 4/5VWS 0001 52.00

72052 X-RAY EXAM NECK SPINE 6/>VWS TC 0001 47.25

72052 X-RAY EXAM NECK SPINE 6/>VWS 26 0001 19.38

72052 X-RAY EXAM NECK SPINE 6/>VWS 0001 66.64

72069 X-RAY EXAM TRUNK SPINE STAND TC 0001 28.74

72069 X-RAY EXAM TRUNK SPINE STAND 26 0001 12.47

72069 X-RAY EXAM TRUNK SPINE STAND 0001 41.22

72070 X-RAY EXAM THORAC SPINE 2VWS TC 0001 24.20

72070 X-RAY EXAM THORAC SPINE 2VWS 26 0001 11.68

72070 X-RAY EXAM THORAC SPINE 2VWS 0001 35.89

72072 X-RAY EXAM THORAC SPINE 3VWS TC 0001 28.74

72072 X-RAY EXAM THORAC SPINE 3VWS 26 0001 11.30

72072 X-RAY EXAM THORAC SPINE 3VWS 0001 40.05

72074 X-RAY EXAM THORAC SPINE4/>VW TC 0001 36.29

72074 X-RAY EXAM THORAC SPINE4/>VW 26 0001 11.30

72074 X-RAY EXAM THORAC SPINE4/>VW 0001 47.60

72080 X-RAY EXAM TRUNK SPINE 2 VWS TC 0001 26.47

72080 X-RAY EXAM TRUNK SPINE 2 VWS 26 0001 12.47

72080 X-RAY EXAM TRUNK SPINE 2 VWS 0001 38.95

72090 X-RAY EXAM SCLOIOSIS ERECT TC 0001 39.70

72090 X-RAY EXAM SCLOIOSIS ERECT 26 0001 16.16

72090 X-RAY EXAM SCLOIOSIS ERECT 0001 55.86

72100 X-RAY EXAM L-S SPINE 2/3 VWS TC 0001 26.09

72100 X-RAY EXAM L-S SPINE 2/3 VWS 26 0001 12.47

72100 X-RAY EXAM L-S SPINE 2/3 VWS 0001 38.57

72110 X-RAY EXAM L-2 SPINE 4/>VWS TC 0001 35.92

72110 X-RAY EXAM L-2 SPINE 4/>VWS 26 0001 16.84

72110 X-RAY EXAM L-2 SPINE 4/>VWS 0001 52.76

72114 X-RAY EXAM L-S SPINE BENDING TC 0001 51.03

72114 X-RAY EXAM L-S SPINE BENDING 26 0001 17.97

72114 X-RAY EXAM L-S SPINE BENDING 0001 69.01

72120 X-RAY BEND ONLY L-S SPINE TC 0001 31.00

72120 X-RAY BEND ONLY L-S SPINE 26 0001 12.47

72120 X-RAY BEND ONLY L-S SPINE 0001 43.48

72125 CT NECK SPINE W/O DYE TC 0001 151.19


72125 CT NECK SPINE W/O DYE 26 0001 55.09

72125 CT NECK SPINE W/O DYE 0001 206.28

72126 CT NECK SPINE W/DYE TC 0001 189.36

72126 CT NECK SPINE W/DYE 26 0001 63.53

72126 CT NECK SPINE W/DYE 0001 252.89

72127 CT NECK SPINE W/O & W/DYE TC 0001 235.46

72127 CT NECK SPINE W/O & W/DYE 26 0001 65.70

72127 CT NECK SPINE W/O & W/DYE 0001 301.17

72128 CT CHEST SPINE W/O DYE TC 0001 150.43

72128 CT CHEST SPINE W/O DYE 26 0001 51.82

72128 CT CHEST SPINE W/O DYE 0001 202.25

72129 CT CHEST SPINE W/DYE TC 0001 189.36

72129 CT CHEST SPINE W/DYE 26 0001 63.53

72129 CT CHEST SPINE W/DYE 0001 252.89

72130 CT CHEST SPINE W/O & W/DYE TC 0001 238.87

72130 CT CHEST SPINE W/O & W/DYE 26 0001 65.70

72130 CT CHEST SPINE W/O & W/DYE 0001 304.57

72131 CT LUMBAR SPINE W/O DYE TC 0001 149.67

72131 CT LUMBAR SPINE W/O DYE 26 0001 51.82

72131 CT LUMBAR SPINE W/O DYE 0001 201.50

72132 CT LUMBAR SPINE W/DYE TC 0001 188.60

72132 CT LUMBAR SPINE W/DYE 26 0001 63.53

72132 CT LUMBAR SPINE W/DYE 0001 252.13

72133 CT LUMBAR SPINE W/O & W/DYE TC 0001 235.84

72133 CT LUMBAR SPINE W/O & W/DYE 26 0001 65.70

72133 CT LUMBAR SPINE W/O & W/DYE 0001 301.54

72141 MRI NECK SPINE W/O DYE TC 0001 179.15

72141 MRI NECK SPINE W/O DYE 26 0001 77.42

72141 MRI NECK SPINE W/O DYE 0001 256.58

72142 MRI NECK SPINE W/DYE TC 0001 260.41

72142 MRI NECK SPINE W/DYE 26 0001 92.73

72142 MRI NECK SPINE W/DYE 0001 353.15

72146 MRI CHEST SPINE W/O DYE TC 0001 179.15

72146 MRI CHEST SPINE W/O DYE 26 0001 77.42

72146 MRI CHEST SPINE W/O DYE 0001 256.58

72147 MRI CHEST SPINE W/DYE TC 0001 257.01

72147 MRI CHEST SPINE W/DYE 26 0001 92.73

72147 MRI CHEST SPINE W/DYE 0001 349.74

72148 MRI LUMBAR SPINE W/O DYE TC 0001 179.15

72148 MRI LUMBAR SPINE W/O DYE 26 0001 77.82

72148 MRI LUMBAR SPINE W/O DYE 0001 256.98

72149 MRI LUMBAR SPINE W/DYE TC 0001 255.49

72149 MRI LUMBAR SPINE W/DYE 26 0001 93.13

72149 MRI LUMBAR SPINE W/DYE 0001 348.63

72156 MRI NECK SPINE W/O & W/DYE TC 0001 296.31

72156 MRI NECK SPINE W/O & W/DYE 26 0001 119.01


72156 MRI NECK SPINE W/O & W/DYE 0001 415.33

72157 MRI CHEST SPINE W/O & W/DYE TC 0001 296.69

72157 MRI CHEST SPINE W/O & W/DYE 26 0001 119.01

72157 MRI CHEST SPINE W/O & W/DYE 0001 415.71

72158 MRI LUMBAR SPINE W/O & W/DYE TC 0001 294.42

72158 MRI LUMBAR SPINE W/O & W/DYE 26 0001 119.81

72158 MRI LUMBAR SPINE W/O & W/DYE 0001 414.23

72159 MR ANGIO SPINE W/O&W/DYE TC 0001 365.09

72159 MR ANGIO SPINE W/O&W/DYE 26 0001 92.64

72159 MR ANGIO SPINE W/O&W/DYE 0001 457.74

72170 X-RAY EXAM OF PELVIS TC 0001 21.18

72170 X-RAY EXAM OF PELVIS 26 0001 9.93

72170 X-RAY EXAM OF PELVIS 0001 31.11

72190 X-RAY EXAM OF PELVIS TC 0001 34.03

72190 X-RAY EXAM OF PELVIS 26 0001 12.12

72190 X-RAY EXAM OF PELVIS 0001 46.15

72191 CT ANGIOGRAPH PELV W/O&W/DYE TC 0001 316.72

72191 CT ANGIOGRAPH PELV W/O&W/DYE 26 0001 93.83

72191 CT ANGIOGRAPH PELV W/O&W/DYE 0001 410.55

72192 CT PELVIS W/O DYE TC 0001 102.81

72192 CT PELVIS W/O DYE 26 0001 56.18

72192 CT PELVIS W/O DYE 0001 159.00

72193 CT PELVIS W/DYE TC 0001 188.22

72193 CT PELVIS W/DYE 26 0001 60.62

72193 CT PELVIS W/DYE 0001 248.85

72194 CT PELVIS W/O & W/DYE TC 0001 228.28

72194 CT PELVIS W/O & W/DYE 26 0001 63.15

72194 CT PELVIS W/O & W/DYE 0001 291.44

72195 MRI PELVIS W/O DYE TC 0001 323.52

72195 MRI PELVIS W/O DYE 26 0001 76.72

72195 MRI PELVIS W/O DYE 0001 400.25

72196 MRI PELVIS W/DYE TC 0001 358.67

72196 MRI PELVIS W/DYE 26 0001 90.18

72196 MRI PELVIS W/DYE 0001 448.86

72197 MRI PELVIS W/O & W/DYE TC 0001 430.85

72197 MRI PELVIS W/O & W/DYE 26 0001 116.77

72197 MRI PELVIS W/O & W/DYE 0001 547.63

72198 MR ANGIO PELVIS W/O & W/DYE TC 0001 351.87

72198 MR ANGIO PELVIS W/O & W/DYE 26 0001 92.69

72198 MR ANGIO PELVIS W/O & W/DYE 0001 444.57

72200 X-RAY EXAM SI JOINTS TC 0001 22.69

72200 X-RAY EXAM SI JOINTS 26 0001 9.13

72200 X-RAY EXAM SI JOINTS 0001 31.83

72202 X-RAY EXAM SI JOINTS 3/> VWS TC 0001 27.60

72202 X-RAY EXAM SI JOINTS 3/> VWS 26 0001 9.85

72202 X-RAY EXAM SI JOINTS 3/> VWS 0001 37.46


72220 X-RAY EXAM SACRUM TAILBONE TC 0001 21.93

72220 X-RAY EXAM SACRUM TAILBONE 26 0001 9.13

72220 X-RAY EXAM SACRUM TAILBONE 0001 31.07

72240 MYELOGRAPHY NECK SPINE TC 0001 90.34

72240 MYELOGRAPHY NECK SPINE 26 0001 47.08

72240 MYELOGRAPHY NECK SPINE 0001 137.42

72255 MYELOGRAPHY THORACIC SPINE TC 0001 83.16

72255 MYELOGRAPHY THORACIC SPINE 26 0001 47.44

72255 MYELOGRAPHY THORACIC SPINE 0001 130.60

72265 MYELOGRAPHY L-S SPINE TC 0001 91.09

72265 MYELOGRAPHY L-S SPINE 26 0001 43.06

72265 MYELOGRAPHY L-S SPINE 0001 134.16

72270 MYELOGPHY 2/> SPINE REGIONS TC 0001 139.47

72270 MYELOGPHY 2/> SPINE REGIONS 26 0001 68.98

72270 MYELOGPHY 2/> SPINE REGIONS 0001 208.46

72275 EPIDUROGRAPHY TC 0001 82.02

72275 EPIDUROGRAPHY 26 0001 41.31

72275 EPIDUROGRAPHY 0001 123.34

72285 DISCOGRAPHY CERV/THOR SPINE TC 0001 57.84

72285 DISCOGRAPHY CERV/THOR SPINE 26 0001 63.23

72285 DISCOGRAPHY CERV/THOR SPINE 0001 121.07

72295 X-RAY OF LOWER SPINE DISK TC 0001 60.10

72295 X-RAY OF LOWER SPINE DISK 26 0001 44.95

72295 X-RAY OF LOWER SPINE DISK 0001 105.06

73000 X-RAY EXAM OF COLLAR BONE TC 0001 22.31

73000 X-RAY EXAM OF COLLAR BONE 26 0001 8.77

73000 X-RAY EXAM OF COLLAR BONE 0001 31.09

73010 X-RAY EXAM OF SHOULDER BLADE TC 0001 24.20

73010 X-RAY EXAM OF SHOULDER BLADE 26 0001 10.30

73010 X-RAY EXAM OF SHOULDER BLADE 0001 34.51

73020 X-RAY EXAM OF SHOULDER TC 0001 17.40

73020 X-RAY EXAM OF SHOULDER 26 0001 8.04

73020 X-RAY EXAM OF SHOULDER 0001 25.44

73030 X-RAY EXAM OF SHOULDER TC 0001 22.69

73030 X-RAY EXAM OF SHOULDER 26 0001 10.66

73030 X-RAY EXAM OF SHOULDER 0001 33.36

73040 CONTRAST X-RAY OF SHOULDER TC 0001 83.54

73040 CONTRAST X-RAY OF SHOULDER 26 0001 28.88

73040 CONTRAST X-RAY OF SHOULDER 0001 112.42

73050 X-RAY EXAM OF SHOULDERS TC 0001 31.00

73050 X-RAY EXAM OF SHOULDERS 26 0001 11.76

73050 X-RAY EXAM OF SHOULDERS 0001 42.77

73060 X-RAY EXAM OF HUMERUS TC 0001 21.93

73060 X-RAY EXAM OF HUMERUS 26 0001 9.13

73060 X-RAY EXAM OF HUMERUS 0001 31.07

73070 X-RAY EXAM OF ELBOW TC 0001 21.93


73070 X-RAY EXAM OF ELBOW 26 0001 8.42

73070 X-RAY EXAM OF ELBOW 0001 30.35

73080 X-RAY EXAM OF ELBOW TC 0001 26.85

73080 X-RAY EXAM OF ELBOW 26 0001 9.13

73080 X-RAY EXAM OF ELBOW 0001 35.98

73085 CONTRAST X-RAY OF ELBOW TC 0001 78.62

73085 CONTRAST X-RAY OF ELBOW 26 0001 30.00

73085 CONTRAST X-RAY OF ELBOW 0001 108.62

73090 X-RAY EXAM OF FOREARM TC 0001 21.18

73090 X-RAY EXAM OF FOREARM 26 0001 8.77

73090 X-RAY EXAM OF FOREARM 0001 29.96

73092 X-RAY EXAM OF ARM INFANT TC 0001 21.93

73092 X-RAY EXAM OF ARM INFANT 26 0001 8.40

73092 X-RAY EXAM OF ARM INFANT 0001 30.34

73100 X-RAY EXAM OF WRIST TC 0001 24.20

73100 X-RAY EXAM OF WRIST 26 0001 9.57

73100 X-RAY EXAM OF WRIST 0001 33.77

73110 X-RAY EXAM OF WRIST TC 0001 31.38

73110 X-RAY EXAM OF WRIST 26 0001 9.13

73110 X-RAY EXAM OF WRIST 0001 40.52

73115 CONTRAST X-RAY OF WRIST TC 0001 88.83

73115 CONTRAST X-RAY OF WRIST 26 0001 29.64

73115 CONTRAST X-RAY OF WRIST 0001 118.47

73120 X-RAY EXAM OF HAND TC 0001 20.80

73120 X-RAY EXAM OF HAND 26 0001 8.77

73120 X-RAY EXAM OF HAND 0001 29.58

73130 X-RAY EXAM OF HAND TC 0001 26.09

73130 X-RAY EXAM OF HAND 26 0001 9.13

73130 X-RAY EXAM OF HAND 0001 35.23

73140 X-RAY EXAM OF FINGER(S) TC 0001 28.36

73140 X-RAY EXAM OF FINGER(S) 26 0001 7.32

73140 X-RAY EXAM OF FINGER(S) 0001 35.68

73200 CT UPPER EXTREMITY W/O DYE TC 0001 149.30

73200 CT UPPER EXTREMITY W/O DYE 26 0001 52.61

73200 CT UPPER EXTREMITY W/O DYE 0001 201.91

73201 CT UPPER EXTREMITY W/DYE TC 0001 186.33

73201 CT UPPER EXTREMITY W/DYE 26 0001 60.62

73201 CT UPPER EXTREMITY W/DYE 0001 246.96

73202 CT UPPR EXTREMITY W/O&W/DYE TC 0001 252.09

73202 CT UPPR EXTREMITY W/O&W/DYE 26 0001 63.15

73202 CT UPPR EXTREMITY W/O&W/DYE 0001 315.25

73206 CT ANGIO UPR EXTRM W/O&W/DYE TC 0001 261.16

73206 CT ANGIO UPR EXTRM W/O&W/DYE 26 0001 92.64

73206 CT ANGIO UPR EXTRM W/O&W/DYE 0001 353.81

73218 MRI UPPER EXTREMITY W/O DYE TC 0001 318.99

73218 MRI UPPER EXTREMITY W/O DYE 26 0001 70.08


73218 MRI UPPER EXTREMITY W/O DYE 0001 389.07

73219 MRI UPPER EXTREMITY W/DYE TC 0001 357.54

73219 MRI UPPER EXTREMITY W/DYE 26 0001 84.73

73219 MRI UPPER EXTREMITY W/DYE 0001 442.27

73220 MRI UPPR EXTREMITY W/O&W/DYE TC 0001 430.85

73220 MRI UPPR EXTREMITY W/O&W/DYE 26 0001 111.31

73220 MRI UPPR EXTREMITY W/O&W/DYE 0001 542.17

73221 MRI JOINT UPR EXTREM W/O DYE TC 0001 197.29

73221 MRI JOINT UPR EXTREM W/O DYE 26 0001 71.64

73221 MRI JOINT UPR EXTREM W/O DYE 0001 268.94

73222 MRI JOINT UPR EXTREM W/DYE TC 0001 328.06

73222 MRI JOINT UPR EXTREM W/DYE 26 0001 84.73

73222 MRI JOINT UPR EXTREM W/DYE 0001 412.79

73223 MRI JOINT UPR EXTR W/O&W/DYE TC 0001 399.86

73223 MRI JOINT UPR EXTR W/O&W/DYE 26 0001 111.31

73223 MRI JOINT UPR EXTR W/O&W/DYE 0001 511.18

73225 MR ANGIO UPR EXTR W/O&W/DYE TC 0001 362.83

73225 MR ANGIO UPR EXTR W/O&W/DYE 26 0001 88.62

73225 MR ANGIO UPR EXTR W/O&W/DYE 0001 451.45

73500 X-RAY EXAM OF HIP TC 0001 19.29

73500 X-RAY EXAM OF HIP 26 0001 9.93

73500 X-RAY EXAM OF HIP 0001 29.22


73510 X-RAY EXAM OF HIP 26 0001 12.12

73510 X-RAY EXAM OF HIP 0001 42.37

73520 X-RAY EXAM OF HIPS TC 0001 29.87

73520 X-RAY EXAM OF HIPS 26 0001 14.67

73520 X-RAY EXAM OF HIPS 0001 44.54

73525 CONTRAST X-RAY OF HIP TC 0001 80.13

73525 CONTRAST X-RAY OF HIP 26 0001 30.02

73525 CONTRAST X-RAY OF HIP 0001 110.16


73530 X-RAY EXAM OF HIP 26 0001 15.74

73530 X-RAY EXAM OF HIP 0001 34.39

73540 X-RAY EXAM OF PELVIS & HIPS TC 0001 35.16

73540 X-RAY EXAM OF PELVIS & HIPS 26 0001 11.38

73540 X-RAY EXAM OF PELVIS & HIPS 0001 46.55

73550 X-RAY EXAM OF THIGH TC 0001 20.80

73550 X-RAY EXAM OF THIGH 26 0001 9.93

73550 X-RAY EXAM OF THIGH 0001 30.73

73560 X-RAY EXAM OF KNEE 1 OR 2 TC 0001 23.07

73560 X-RAY EXAM OF KNEE 1 OR 2 26 0001 9.93

73560 X-RAY EXAM OF KNEE 1 OR 2 0001 33.00

73562 X-RAY EXAM OF KNEE 3 TC 0001 29.49

73562 X-RAY EXAM OF KNEE 3 26 0001 10.66

73562 X-RAY EXAM OF KNEE 3 0001 40.16


73564 X-RAY EXAM KNEE 4 OR MORE TC 0001 34.03

73564 X-RAY EXAM KNEE 4 OR MORE 26 0001 12.47

73564 X-RAY EXAM KNEE 4 OR MORE 0001 46.51

73565 X-RAY EXAM OF KNEES TC 0001 27.98

73565 X-RAY EXAM OF KNEES 26 0001 10.30

73565 X-RAY EXAM OF KNEES 0001 38.29

73580 CONTRAST X-RAY OF KNEE JOINT TC 0001 105.08

73580 CONTRAST X-RAY OF KNEE JOINT 26 0001 30.41

73580 CONTRAST X-RAY OF KNEE JOINT 0001 135.50

73590 X-RAY EXAM OF LOWER LEG TC 0001 20.42

73590 X-RAY EXAM OF LOWER LEG 26 0001 9.13

73590 X-RAY EXAM OF LOWER LEG 0001 29.56

73592 X-RAY EXAM OF LEG INFANT TC 0001 21.93

73592 X-RAY EXAM OF LEG INFANT 26 0001 8.40

73592 X-RAY EXAM OF LEG INFANT 0001 30.34

73600 X-RAY EXAM OF ANKLE TC 0001 21.93

73600 X-RAY EXAM OF ANKLE 26 0001 8.77

73600 X-RAY EXAM OF ANKLE 0001 30.71

73610 X-RAY EXAM OF ANKLE TC 0001 26.85

73610 X-RAY EXAM OF ANKLE 26 0001 9.13

73610 X-RAY EXAM OF ANKLE 0001 35.98

73615 CONTRAST X-RAY OF ANKLE TC 0001 80.13

73615 CONTRAST X-RAY OF ANKLE 26 0001 30.02

73615 CONTRAST X-RAY OF ANKLE 0001 110.16

73620 X-RAY EXAM OF FOOT TC 0001 21.18

73620 X-RAY EXAM OF FOOT 26 0001 8.02

73620 X-RAY EXAM OF FOOT 0001 29.20

73630 X-RAY EXAM OF FOOT TC 0001 24.96

73630 X-RAY EXAM OF FOOT 26 0001 8.76

73630 X-RAY EXAM OF FOOT 0001 33.72

73650 X-RAY EXAM OF HEEL TC 0001 21.93

73650 X-RAY EXAM OF HEEL 26 0001 8.40

73650 X-RAY EXAM OF HEEL 0001 30.34

73660 X-RAY EXAM OF TOE(S) TC 0001 25.71

73660 X-RAY EXAM OF TOE(S) 26 0001 6.94

73660 X-RAY EXAM OF TOE(S) 0001 32.66

73700 CT LOWER EXTREMITY W/O DYE TC 0001 149.30

73700 CT LOWER EXTREMITY W/O DYE 26 0001 52.61

73700 CT LOWER EXTREMITY W/O DYE 0001 201.91

73701 CT LOWER EXTREMITY W/DYE TC 0001 189.36

73701 CT LOWER EXTREMITY W/DYE 26 0001 60.62

73701 CT LOWER EXTREMITY W/DYE 0001 249.98

73702 CT LWR EXTREMITY W/O&W/DYE TC 0001 249.45

73702 CT LWR EXTREMITY W/O&W/DYE 26 0001 63.15

73702 CT LWR EXTREMITY W/O&W/DYE 0001 312.60

73706 CT ANGIO LWR EXTR W/O&W/DYE TC 0001 295.56


73706 CT ANGIO LWR EXTR W/O&W/DYE 26 0001 98.19

73706 CT ANGIO LWR EXTR W/O&W/DYE 0001 393.75

73718 MRI LOWER EXTREMITY W/O DYE TC 0001 318.99

73718 MRI LOWER EXTREMITY W/O DYE 26 0001 70.10

73718 MRI LOWER EXTREMITY W/O DYE 0001 389.09

73719 MRI LOWER EXTREMITY W/DYE TC 0001 359.05

73719 MRI LOWER EXTREMITY W/DYE 26 0001 84.73

73719 MRI LOWER EXTREMITY W/DYE 0001 443.78

73720 MRI LWR EXTREMITY W/O&W/DYE TC 0001 434.26

73720 MRI LWR EXTREMITY W/O&W/DYE 26 0001 110.93

73720 MRI LWR EXTREMITY W/O&W/DYE 0001 545.19

73721 MRI JNT OF LWR EXTRE W/O DYE TC 0001 197.67

73721 MRI JNT OF LWR EXTRE W/O DYE 26 0001 71.64

73721 MRI JNT OF LWR EXTRE W/O DYE 0001 269.32

73722 MRI JOINT OF LWR EXTR W/DYE TC 0001 333.35

73722 MRI JOINT OF LWR EXTR W/DYE 26 0001 85.12

73722 MRI JOINT OF LWR EXTR W/DYE 0001 418.48

73723 MRI JOINT LWR EXTR W/O&W/DYE TC 0001 401.38

73723 MRI JOINT LWR EXTR W/O&W/DYE 26 0001 111.31

73723 MRI JOINT LWR EXTR W/O&W/DYE 0001 512.69

73725 MR ANG LWR EXT W OR W/O DYE TC 0001 351.87

73725 MR ANG LWR EXT W OR W/O DYE 26 0001 93.79

73725 MR ANG LWR EXT W OR W/O DYE 0001 445.66

74000 X-RAY EXAM OF ABDOMEN TC 0001 16.64

74000 X-RAY EXAM OF ABDOMEN 26 0001 9.49

74000 X-RAY EXAM OF ABDOMEN 0001 26.14







74022 X-RAY EXAM SERIES ABDOMEN TC 0001 35.92

74022 X-RAY EXAM SERIES ABDOMEN 26 0001 16.40

74022 X-RAY EXAM SERIES ABDOMEN 0001 52.32

74150 CT ABDOMEN W/O DYE TC 0001 100.54

74150 CT ABDOMEN W/O DYE 26 0001 62.07

74150 CT ABDOMEN W/O DYE 0001 162.62

74160 CT ABDOMEN W/DYE TC 0001 187.47

74160 CT ABDOMEN W/DYE 26 0001 66.07

74160 CT ABDOMEN W/DYE 0001 253.55

74170 CT ABDOMEN W/O & W/DYE TC 0001 220.35

74170 CT ABDOMEN W/O & W/DYE 26 0001 72.64

74170 CT ABDOMEN W/O & W/DYE 0001 293.00

74174 Ct angio abd&pelv w/o&w/dye TC 0001 460.71

74174 Ct angio abd&pelv w/o&w/dye 26 0001 113.90


74174 Ct angio abd&pelv w/o&w/dye 0001 574.61

74175 CT ANGIO ABDOM W/O & W/DYE TC 0001 309.92

74175 CT ANGIO ABDOM W/O & W/DYE 26 0001 98.57

74175 CT ANGIO ABDOM W/O & W/DYE 0001 408.49

74176 CT ABD & PELVIS W/O CONTRAST TC 0001 137.20

74176 CT ABD & PELVIS W/O CONTRAST 26 0001 90.54

74176 CT ABD & PELVIS W/O CONTRAST 0001 227.75

74177 CT ABD & PELV W/CONTRAST TC 0001 247.56

74177 CT ABD & PELV W/CONTRAST 26 0001 94.54

74177 CT ABD & PELV W/CONTRAST 0001 342.11

74178 CT ABD & PELV 1/> REGNS TC 0001 294.04

74178 CT ABD & PELV 1/> REGNS 26 0001 104.40

74178 CT ABD & PELV 1/> REGNS 0001 398.45

74181 MRI ABDOMEN W/O DYE TC 0001 280.82

74181 MRI ABDOMEN W/O DYE 26 0001 75.55

74181 MRI ABDOMEN W/O DYE 0001 356.37

74182 MRI ABDOMEN W/DYE TC 0001 401.75

74182 MRI ABDOMEN W/DYE 26 0001 89.81

74182 MRI ABDOMEN W/DYE 0001 491.56

74183 MRI ABDOMEN W/O & W/DYE TC 0001 432.74

74183 MRI ABDOMEN W/O & W/DYE 26 0001 116.77

74183 MRI ABDOMEN W/O & W/DYE 0001 549.51

74185 MRI ANGIO ABDOM W ORW/O DYE TC 0001 352.62

74185 MRI ANGIO ABDOM W ORW/O DYE 26 0001 93.07

74185 MRI ANGIO ABDOM W ORW/O DYE 0001 445.70

74190 X-RAY EXAM OF PERITONEUM TC 0001 49.23

74190 X-RAY EXAM OF PERITONEUM 26 0001 24.84

74190 X-RAY EXAM OF PERITONEUM 0001 73.84

74210 CONTRST X-RAY EXAM OF THROAT TC 0001 65.77

74210 CONTRST X-RAY EXAM OF THROAT 26 0001 18.21

74210 CONTRST X-RAY EXAM OF THROAT 0001 83.99

74220 CONTRAST X-RAY ESOPHAGUS TC 0001 74.09

74220 CONTRAST X-RAY ESOPHAGUS 26 0001 24.10

74220 CONTRAST X-RAY ESOPHAGUS 0001 98.20

74230 CINE/VID X-RAY THROAT/ESOPH TC 0001 70.31

74230 CINE/VID X-RAY THROAT/ESOPH 26 0001 27.75

74230 CINE/VID X-RAY THROAT/ESOPH 0001 98.06

74235 REMOVE ESOPHAGUS OBSTRUCTION TC 0001 98.82

74235 REMOVE ESOPHAGUS OBSTRUCTION 26 0001 59.86

74235 REMOVE ESOPHAGUS OBSTRUCTION 0001 159.64

74240 X-RAY UPPER GI DELAY W/O KUB TC 0001 86.56

74240 X-RAY UPPER GI DELAY W/O KUB 26 0001 36.15

74240 X-RAY UPPER GI DELAY W/O KUB 0001 122.71

74241 X-RAYUPPER GI DELAY W/KUB TC 0001 92.23

74241 X-RAYUPPER GI DELAY W/KUB 26 0001 35.38

74241 X-RAYUPPER GI DELAY W/KUB 0001 127.61


74245 X-RAY UPPER GI&SMALL INTEST TC 0001 144.01

74245 X-RAY UPPER GI&SMALL INTEST 26 0001 47.08

74245 X-RAY UPPER GI&SMALL INTEST 0001 191.09

74246 CONTRST X-RAY UPPR GI TRACT TC 0001 102.43

74246 CONTRST X-RAY UPPR GI TRACT 26 0001 35.77

74246 CONTRST X-RAY UPPR GI TRACT 0001 138.21







74250 X-RAY EXAM OF SMALL BOWEL TC 0001 91.85

74250 X-RAY EXAM OF SMALL BOWEL 26 0001 24.46

74250 X-RAY EXAM OF SMALL BOWEL 0001 116.32







74261 CT COLONOGRAPHY DX TC 0001 383.61

74261 CT COLONOGRAPHY DX 26 0001 124.05

74261 CT COLONOGRAPHY DX 0001 507.67

74262 CT COLONOGRAPHY DX W/DYE TC 0001 428.59

74262 CT COLONOGRAPHY DX W/DYE 26 0001 129.19

74262 CT COLONOGRAPHY DX W/DYE 0001 557.78

74270 CONTRAST X-RAY EXAM OF COLON TC 0001 133.42

74270 CONTRAST X-RAY EXAM OF COLON 26 0001 35.77

74270 CONTRAST X-RAY EXAM OF COLON 0001 169.20







74290 CONTRAST X-RAY GALLBLADDER TC 0001 58.59

74290 CONTRAST X-RAY GALLBLADDER 26 0001 16.40

74290 CONTRAST X-RAY GALLBLADDER 0001 75.00

74300 X-RAY BILE DUCTS/PANCREAS TC 0001 34.39

74300 X-RAY BILE DUCTS/PANCREAS 26 0001 19.01

74300 X-RAY BILE DUCTS/PANCREAS 0001 52.85

74301 X-RAYS AT SURGERY ADD-ON TC 0001 19.91

74301 X-RAYS AT SURGERY ADD-ON 26 0001 11.36

74301 X-RAYS AT SURGERY ADD-ON 0001 30.77

74305 X-RAY BILE DUCTS/PANCREAS TC 0001 29.68


74305 X-RAY BILE DUCTS/PANCREAS 26 0001 21.93

74305 X-RAY BILE DUCTS/PANCREAS 0001 51.40

74320 CONTRAST X-RAY OF BILE DUCTS TC 0001 76.36

74320 CONTRAST X-RAY OF BILE DUCTS 26 0001 27.35

74320 CONTRAST X-RAY OF BILE DUCTS 0001 103.71

74327 X-RAY BILE STONE REMOVAL TC 0001 110.75

74327 X-RAY BILE STONE REMOVAL 26 0001 38.53

74327 X-RAY BILE STONE REMOVAL 0001 149.28

74328 X-RAY BILE DUCT ENDOSCOPY TC 0001 118.73

74328 X-RAY BILE DUCT ENDOSCOPY 26 0001 37.28

74328 X-RAY BILE DUCT ENDOSCOPY 0001 154.93

74329 X-RAY FOR PANCREAS ENDOSCOPY TC 0001 118.73

74329 X-RAY FOR PANCREAS ENDOSCOPY 26 0001 37.66

74329 X-RAY FOR PANCREAS ENDOSCOPY 0001 154.93

74330 X-RAY BILE/PANC ENDOSCOPY TC 0001 118.73

74330 X-RAY BILE/PANC ENDOSCOPY 26 0001 48.27

74330 X-RAY BILE/PANC ENDOSCOPY 0001 165.07

74340 X-RAY GUIDE FOR GI TUBE TC 0001 98.82

74340 X-RAY GUIDE FOR GI TUBE 26 0001 28.50

74340 X-RAY GUIDE FOR GI TUBE 0001 126.70

74355 X-RAY GUIDE INTESTINAL TUBE TC 0001 98.82

74355 X-RAY GUIDE INTESTINAL TUBE 26 0001 40.23

74355 X-RAY GUIDE INTESTINAL TUBE 0001 137.56

74360 X-RAY GUIDE GI DILATION TC 0001 118.73

74360 X-RAY GUIDE GI DILATION 26 0001 29.26

74360 X-RAY GUIDE GI DILATION 0001 146.24

74363 X-RAY BILE DUCT DILATION TC 0001 229.50

74363 X-RAY BILE DUCT DILATION 26 0001 46.06

74363 X-RAY BILE DUCT DILATION 0001 275.12

74400 CONTRST X-RAY URINARY TRACT TC 0001 95.63

74400 CONTRST X-RAY URINARY TRACT 26 0001 25.56

74400 CONTRST X-RAY URINARY TRACT 0001 121.19













74430 CONTRAST X-RAY BLADDER TC 0001 27.60

74430 CONTRAST X-RAY BLADDER 0001 43.63


74440 X-RAY MALE GENITAL TRACT TC 0001 68.04

74440 X-RAY MALE GENITAL TRACT 26 0001 19.72

74440 X-RAY MALE GENITAL TRACT 0001 87.77

74445 X-RAY EXAM OF PENIS TC 0001 42.35

74445 X-RAY EXAM OF PENIS 26 0001 59.58

74445 X-RAY EXAM OF PENIS 0001 100.63

74450 X-RAY URETHRA/BLADDER TC 0001 55.38

74450 X-RAY URETHRA/BLADDER 26 0001 17.55

74450 X-RAY URETHRA/BLADDER 0001 72.76

74455 X-RAY URETHRA/BLADDER TC 0001 72.58

74455 X-RAY URETHRA/BLADDER 26 0001 16.76

74455 X-RAY URETHRA/BLADDER 0001 89.34

74470 X-RAY EXAM OF KIDNEY LESION TC 0001 47.06

74470 X-RAY EXAM OF KIDNEY LESION 26 0001 27.75

74470 X-RAY EXAM OF KIDNEY LESION 0001 74.57

74475 X-RAY CONTROL CATH INSERT TC 0001 75.22

74475 X-RAY CONTROL CATH INSERT 26 0001 27.73

74475 X-RAY CONTROL CATH INSERT 0001 102.96

74480 X-RAY CONTROL CATH INSERT TC 0001 75.22

74480 X-RAY CONTROL CATH INSERT 26 0001 27.73

74480 X-RAY CONTROL CATH INSERT 0001 102.96

74485 X-RAY GUIDE GU DILATION TC 0001 75.22

74485 X-RAY GUIDE GU DILATION 26 0001 27.35

74485 X-RAY GUIDE GU DILATION 0001 102.58

74710 X-RAY MEASUREMENT OF PELVIS TC 0001 21.93

74710 X-RAY MEASUREMENT OF PELVIS 26 0001 17.50

74710 X-RAY MEASUREMENT OF PELVIS 0001 39.44

74740 X-RAY FEMALE GENITAL TRACT TC 0001 63.13

74740 X-RAY FEMALE GENITAL TRACT 26 0001 19.31

74740 X-RAY FEMALE GENITAL TRACT 0001 82.44

74742 X-RAY FALLOPIAN TUBE TC 0001 118.73

74742 X-RAY FALLOPIAN TUBE 26 0001 32.54

74742 X-RAY FALLOPIAN TUBE 0001 150.59

74775 X-RAY EXAM OF PERINEUM TC 0001 55.38

74775 X-RAY EXAM OF PERINEUM 26 0001 32.52

74775 X-RAY EXAM OF PERINEUM 0001 87.96

75557 Cardiac mri for morph TC 0001 225.64

75557 Cardiac mri for morph 26 0001 119.97

75557 Cardiac mri for morph 0001 345.62

75559 Cardiac mri w/stress img TC 0001 319.36

75559 Cardiac mri w/stress img 26 0001 148.31

75559 Cardiac mri w/stress img 0001 467.68

75561 Cardiac mri for morph w/dye TC 0001 323.90

75561 Cardiac mri for morph w/dye 26 0001 132.36

75561 Cardiac mri for morph w/dye 0001 456.26

75563 Card mri w/stress img & dye TC 0001 386.64


75563 Card mri w/stress img & dye 26 0001 151.62

75563 Card mri w/stress img & dye 0001 538.26

75565 CARD MRI VELOC FLOW MAPPING TC 0001 46.12

75565 CARD MRI VELOC FLOW MAPPING 26 0001 12.76

75565 CARD MRI VELOC FLOW MAPPING 0001 58.88

75571 CT HRT W/O DYE W/CA TEST TC 0001 82.40

75571 CT HRT W/O DYE W/CA TEST 26 0001 28.75

75571 CT HRT W/O DYE W/CA TEST 0001 111.16

75572 CT HRT W/3D IMAGE TC 0001 215.06

75572 CT HRT W/3D IMAGE 26 0001 88.16

75572 CT HRT W/3D IMAGE 0001 303.22

75573 CT HRT W/3D IMAGE CONGEN TC 0001 287.62

75573 CT HRT W/3D IMAGE CONGEN 26 0001 128.62

75573 CT HRT W/3D IMAGE CONGEN 0001 416.24

75574 CT ANGIO HRT W/3D IMAGE TC 0001 321.25

75574 CT ANGIO HRT W/3D IMAGE 26 0001 121.35

75574 CT ANGIO HRT W/3D IMAGE 0001 442.61

75600 CONTRAST EXAM THORACIC AORTA TC 0001 198.05

75600 CONTRAST EXAM THORACIC AORTA 26 0001 24.80

75600 CONTRAST EXAM THORACIC AORTA 0001 222.86

75605 CONTRAST EXAM THORACIC AORTA TC 0001 102.43

75605 CONTRAST EXAM THORACIC AORTA 26 0001 57.26

75605 CONTRAST EXAM THORACIC AORTA 0001 159.69

75625 CONTRAST EXAM ABDOMINL AORTA TC 0001 101.68

75625 CONTRAST EXAM ABDOMINL AORTA 26 0001 57.69

75625 CONTRAST EXAM ABDOMINL AORTA 0001 159.37

75630 X-RAY AORTA LEG ARTERIES TC 0001 100.92

75630 X-RAY AORTA LEG ARTERIES 26 0001 89.31

75630 X-RAY AORTA LEG ARTERIES 0001 190.24

75635 CT ANGIO ABDOMINAL ARTERIES TC 0001 318.27

75635 CT ANGIO ABDOMINAL ARTERIES 26 0001 122.54

75635 CT ANGIO ABDOMINAL ARTERIES 0001 440.82

75658 ARTERY X-RAYS ARM TC 0001 121.33

75658 ARTERY X-RAYS ARM 26 0001 64.13

75658 ARTERY X-RAYS ARM 0001 185.46

75705 ARTERY X-RAYS SPINE TC 0001 147.78

75705 ARTERY X-RAYS SPINE 26 0001 111.56

75705 ARTERY X-RAYS SPINE 0001 259.34

75710 ARTERY X-RAYS ARM/LEG TC 0001 128.13

75710 ARTERY X-RAYS ARM/LEG 26 0001 56.08

75710 ARTERY X-RAYS ARM/LEG 0001 184.22

75716 ARTERY X-RAYS ARMS/LEGS TC 0001 154.62

75716 ARTERY X-RAYS ARMS/LEGS 26 0001 66.05

75716 ARTERY X-RAYS ARMS/LEGS 0001 220.68

75726 ARTERY X-RAYS ABDOMEN TC 0001 114.15

75726 ARTERY X-RAYS ABDOMEN 26 0001 58.03


75726 ARTERY X-RAYS ABDOMEN 0001 172.18

75731 ARTERY X-RAYS ADRENAL GLAND TC 0001 132.67

75731 ARTERY X-RAYS ADRENAL GLAND 26 0001 58.33

75731 ARTERY X-RAYS ADRENAL GLAND 0001 191.01

75733 ARTERY X-RAYS ADRENALS TC 0001 148.20

75733 ARTERY X-RAYS ADRENALS 26 0001 65.56

75733 ARTERY X-RAYS ADRENALS 0001 213.77

75736 ARTERY X-RAYS PELVIS TC 0001 125.11

75736 ARTERY X-RAYS PELVIS 26 0001 56.08

75736 ARTERY X-RAYS PELVIS 0001 181.20

75741 ARTERY X-RAYS LUNG TC 0001 103.94

75741 ARTERY X-RAYS LUNG 26 0001 66.39

75741 ARTERY X-RAYS LUNG 0001 170.34

75743 ARTERY X-RAYS LUNGS TC 0001 113.39

75743 ARTERY X-RAYS LUNGS 26 0001 83.52

75743 ARTERY X-RAYS LUNGS 0001 196.91

75746 ARTERY X-RAYS LUNG TC 0001 118.31

75746 ARTERY X-RAYS LUNG 26 0001 58.77

75746 ARTERY X-RAYS LUNG 0001 177.08

75756 ARTERY X-RAYS CHEST TC 0001 131.91

75756 ARTERY X-RAYS CHEST 26 0001 61.67

75756 ARTERY X-RAYS CHEST 0001 193.59

75774 ARTERY X-RAY EACH VESSEL TC 0001 85.80

75774 ARTERY X-RAY EACH VESSEL 26 0001 18.25

75774 ARTERY X-RAY EACH VESSEL 0001 104.06

75791 AV DIALYSIS SHUNT IMAGING TC 0001 261.54

75791 AV DIALYSIS SHUNT IMAGING 26 0001 84.93

75791 AV DIALYSIS SHUNT IMAGING 0001 346.48

75801 LYMPH VESSEL X-RAY ARM/LEG TC 0001 203.80

75801 LYMPH VESSEL X-RAY ARM/LEG 26 0001 46.74

75801 LYMPH VESSEL X-RAY ARM/LEG 0001 246.16

75803 LYMPH VESSEL X-RAY ARMS/LEGS TC 0001 203.80

75803 LYMPH VESSEL X-RAY ARMS/LEGS 26 0001 62.17

75803 LYMPH VESSEL X-RAY ARMS/LEGS 0001 263.89

75805 LYMPH VESSEL X-RAY TRUNK TC 0001 229.50

75805 LYMPH VESSEL X-RAY TRUNK 26 0001 43.15

75805 LYMPH VESSEL X-RAY TRUNK 0001 271.86

75807 LYMPH VESSEL X-RAY TRUNK TC 0001 229.50

75807 LYMPH VESSEL X-RAY TRUNK 26 0001 62.17

75807 LYMPH VESSEL X-RAY TRUNK 0001 289.60

75809 NONVASCULAR SHUNT X-RAY TC 0001 84.67

75809 NONVASCULAR SHUNT X-RAY 26 0001 24.84

75809 NONVASCULAR SHUNT X-RAY 0001 109.52

75810 VEIN X-RAY SPLEEN/LIVER TC 0001 473.49

75810 VEIN X-RAY SPLEEN/LIVER 26 0001 60.71

75810 VEIN X-RAY SPLEEN/LIVER 0001 532.50


75820 VEIN X-RAY ARM/LEG TC 0001 96.01

75820 VEIN X-RAY ARM/LEG 26 0001 35.75

75820 VEIN X-RAY ARM/LEG 0001 131.77

75822 VEIN X-RAY ARMS/LEGS TC 0001 109.99

75822 VEIN X-RAY ARMS/LEGS 26 0001 54.01

75822 VEIN X-RAY ARMS/LEGS 0001 164.01

75825 VEIN X-RAY TRUNK TC 0001 96.39

75825 VEIN X-RAY TRUNK 26 0001 57.27

75825 VEIN X-RAY TRUNK 0001 153.66

75827 VEIN X-RAY CHEST TC 0001 99.03

75827 VEIN X-RAY CHEST 26 0001 56.50

75827 VEIN X-RAY CHEST 0001 155.54

75831 VEIN X-RAY KIDNEY TC 0001 103.19

75831 VEIN X-RAY KIDNEY 26 0001 63.22

75831 VEIN X-RAY KIDNEY 0001 166.42

75833 VEIN X-RAY KIDNEYS TC 0001 116.42

75833 VEIN X-RAY KIDNEYS 26 0001 72.09

75833 VEIN X-RAY KIDNEYS 0001 188.51

75840 VEIN X-RAY ADRENAL GLAND TC 0001 106.59

75840 VEIN X-RAY ADRENAL GLAND 26 0001 65.87

75840 VEIN X-RAY ADRENAL GLAND 0001 172.46

75842 VEIN X-RAY ADRENAL GLANDS TC 0001 128.13

75842 VEIN X-RAY ADRENAL GLANDS 26 0001 77.38

75842 VEIN X-RAY ADRENAL GLANDS 0001 205.52

75860 VEIN X-RAY NECK TC 0001 103.57

75860 VEIN X-RAY NECK 26 0001 58.03

75860 VEIN X-RAY NECK 0001 161.60

75870 VEIN X-RAY SKULL TC 0001 105.83

75870 VEIN X-RAY SKULL 26 0001 59.52

75870 VEIN X-RAY SKULL 0001 165.36

75872 VEIN X-RAY SKULL EPIDURAL TC 0001 105.46

75872 VEIN X-RAY SKULL EPIDURAL 26 0001 53.10

75872 VEIN X-RAY SKULL EPIDURAL 0001 158.56

75880 VEIN X-RAY EYE SOCKET TC 0001 106.97

75880 VEIN X-RAY EYE SOCKET 26 0001 36.51

75880 VEIN X-RAY EYE SOCKET 0001 143.48

75885 VEIN X-RAY LIVER W/HEMODYNAM TC 0001 104.70

75885 VEIN X-RAY LIVER W/HEMODYNAM 26 0001 72.94

75885 VEIN X-RAY LIVER W/HEMODYNAM 0001 177.65

75887 VEIN X-RAY LIVER W/O HEMODYN TC 0001 104.70

75887 VEIN X-RAY LIVER W/O HEMODYN 26 0001 71.75

75887 VEIN X-RAY LIVER W/O HEMODYN 0001 176.46

75889 VEIN X-RAY LIVER W/HEMODYNAM TC 0001 105.46

75889 VEIN X-RAY LIVER W/HEMODYNAM 26 0001 58.01

75889 VEIN X-RAY LIVER W/HEMODYNAM 0001 163.47

75891 VEIN X-RAY LIVER TC 0001 105.83


75891 VEIN X-RAY LIVER 26 0001 58.77

75891 VEIN X-RAY LIVER 0001 164.61

75893 VENOUS SAMPLING BY CATHETER TC 0001 106.59

75893 VENOUS SAMPLING BY CATHETER 26 0001 27.31

75893 VENOUS SAMPLING BY CATHETER 0001 133.91

75894 X-RAYS TRANSCATH THERAPY TC 0001 907.89

75894 X-RAYS TRANSCATH THERAPY 26 0001 69.17

75894 X-RAYS TRANSCATH THERAPY 0001 975.95

75896 X-RAYS TRANSCATH THERAPY TC 0001 789.88

75896 X-RAYS TRANSCATH THERAPY 26 0001 68.41

75896 X-RAYS TRANSCATH THERAPY 0001 858.30

75898 FOLLOW-UP ANGIOGRAPHY TC 0001 39.82

75898 FOLLOW-UP ANGIOGRAPHY 26 0001 87.86

75898 FOLLOW-UP ANGIOGRAPHY 0001 125.61

75901 REMOVE CVA DEVICE OBSTRUCT TC 0001 163.28

75901 REMOVE CVA DEVICE OBSTRUCT 26 0001 24.80

75901 REMOVE CVA DEVICE OBSTRUCT 0001 188.09

75902 REMOVE CVA LUMEN OBSTRUCT TC 0001 59.35

75902 REMOVE CVA LUMEN OBSTRUCT 26 0001 20.10

75902 REMOVE CVA LUMEN OBSTRUCT 0001 79.45

75945 INTRAVASCULAR US TC 0001 171.58

75945 INTRAVASCULAR US 26 0001 20.48

75945 INTRAVASCULAR US 0001 192.94

75946 INTRAVASCULAR US ADD-ON TC 0001 86.88

75946 INTRAVASCULAR US ADD-ON 26 0001 20.89

75946 INTRAVASCULAR US ADD-ON 0001 107.87

75952 ENDOVASC REPAIR ABDOM AORTA TC 0001 2333.81

75952 ENDOVASC REPAIR ABDOM AORTA 26 0001 238.87

75952 ENDOVASC REPAIR ABDOM AORTA 0001 2593.00

75953 ABDOM ANEURYSM ENDOVAS RPR TC 0001 892.69

75953 ABDOM ANEURYSM ENDOVAS RPR 26 0001 72.68

75953 ABDOM ANEURYSM ENDOVAS RPR 0001 991.88

75954 ILIAC ANEURYSM ENDOVAS RPR TC 0001 875.61

75954 ILIAC ANEURYSM ENDOVAS RPR 26 0001 118.44

75954 ILIAC ANEURYSM ENDOVAS RPR 0001 973.05

75956 XRAY ENDOVASC THOR AO REPR 26 0001 374.51

75957 XRAY ENDOVASC THOR AO REPR 26 0001 320.48

75958 XRAY PLACE PROX EXT THOR AO 26 0001 213.29

75959 XRAY PLACE DIST EXT THOR AO 26 0001 190.09

75962 REPAIR ARTERIAL BLOCKAGE TC 0001 127.38

75962 REPAIR ARTERIAL BLOCKAGE 26 0001 26.97


75964 REPAIR ARTERY BLOCKAGE EACH TC 0001 80.51

75964 REPAIR ARTERY BLOCKAGE EACH 26 0001 18.65

75964 REPAIR ARTERY BLOCKAGE EACH 0001 99.17

75966 REPAIR ARTERIAL BLOCKAGE TC 0001 117.93


75966 REPAIR ARTERIAL BLOCKAGE 26 0001 64.86


75968 REPAIR ARTERY BLOCKAGE EACH TC 0001 74.84

75968 REPAIR ARTERY BLOCKAGE EACH 26 0001 17.84

75968 REPAIR ARTERY BLOCKAGE EACH 0001 92.68

75970 VASCULAR BIOPSY TC 0001 434.03

75970 VASCULAR BIOPSY 26 0001 42.74

75970 VASCULAR BIOPSY 0001 477.47

75978 REPAIR VENOUS BLOCKAGE TC 0001 125.49

75978 REPAIR VENOUS BLOCKAGE 26 0001 26.97


75980 CONTRAST XRAY EXAM BILE DUCT TC 0001 203.80

75980 CONTRAST XRAY EXAM BILE DUCT 26 0001 74.51

75980 CONTRAST XRAY EXAM BILE DUCT 0001 277.65

75982 CONTRAST XRAY EXAM BILE DUCT TC 0001 229.50

75982 CONTRAST XRAY EXAM BILE DUCT 26 0001 74.13

75982 CONTRAST XRAY EXAM BILE DUCT 0001 303.35

75984 XRAY CONTROL CATHETER CHANGE TC 0001 80.89

75984 XRAY CONTROL CATHETER CHANGE 26 0001 36.47

75984 XRAY CONTROL CATHETER CHANGE 0001 117.37

75989 ABSCESS DRAINAGE UNDER X-RAY TC 0001 71.44

75989 ABSCESS DRAINAGE UNDER X-RAY 26 0001 60.14

75989 ABSCESS DRAINAGE UNDER X-RAY 0001 131.59

76000 FLUOROSCOPE EXAMINATION TC 0001 44.99

76000 FLUOROSCOPE EXAMINATION 26 0001 8.76

76000 FLUOROSCOPE EXAMINATION 0001 53.75

76001 FLUOROSCOPE EXAM EXTENSIVE TC 0001 98.82

76001 FLUOROSCOPE EXAM EXTENSIVE 26 0001 37.40

76001 FLUOROSCOPE EXAM EXTENSIVE 0001 133.57

76010 X-RAY NOSE TO RECTUM TC 0001 19.67

76010 X-RAY NOSE TO RECTUM 26 0001 9.49

76010 X-RAY NOSE TO RECTUM 0001 29.16

76080 X-RAY EXAM OF FISTULA TC 0001 36.67

76080 X-RAY EXAM OF FISTULA 26 0001 27.35

76080 X-RAY EXAM OF FISTULA 0001 64.03

76098 X-RAY EXAM BREAST SPECIMEN TC 0001 11.73

76098 X-RAY EXAM BREAST SPECIMEN 26 0001 8.40

76098 X-RAY EXAM BREAST SPECIMEN 0001 20.13

76100 X-RAY EXAM OF BODY SECTION TC 0001 74.09

76100 X-RAY EXAM OF BODY SECTION 26 0001 32.98

76100 X-RAY EXAM OF BODY SECTION 0001 107.07

76101 COMPLEX BODY SECTION X-RAY TC 0001 122.09

76101 COMPLEX BODY SECTION X-RAY 26 0001 37.57

76101 COMPLEX BODY SECTION X-RAY 0001 159.66

76102 COMPLEX BODY SECTION X-RAYS TC 0001 175.75

76102 COMPLEX BODY SECTION X-RAYS 26 0001 38.36


76102 COMPLEX BODY SECTION X-RAYS 0001 214.12

76120 CINE/VIDEO X-RAYS TC 0001 78.25

76120 CINE/VIDEO X-RAYS 26 0001 20.48

76120 CINE/VIDEO X-RAYS 0001 98.73

76125 CINE/VIDEO X-RAYS ADD-ON TC 0001 29.68

76125 CINE/VIDEO X-RAYS ADD-ON 26 0001 15.02

76125 CINE/VIDEO X-RAYS ADD-ON 0001 43.44

76140 X-RAY CONSULTATION 0001 69.86

76376 3D RENDER W/INTRP POSTPROCES TC 0001 20.04

76376 3D RENDER W/INTRP POSTPROCES 26 0001 10.21

76376 3D RENDER W/INTRP POSTPROCES 0001 30.26

76377 3D RENDER W/INTRP POSTPROCES TC 0001 46.50

76377 3D RENDER W/INTRP POSTPROCES 26 0001 40.87

76377 3D RENDER W/INTRP POSTPROCES 0001 87.37

76380 CAT SCAN FOLLOW-UP STUDY TC 0001 109.24

76380 CAT SCAN FOLLOW-UP STUDY 26 0001 50.33

76380 CAT SCAN FOLLOW-UP STUDY 0001 159.57

76390 MR SPECTROSCOPY TC 0001 397.22

76390 MR SPECTROSCOPY 26 0001 72.59

76390 MR SPECTROSCOPY 0001 469.81

76497 CT PROCEDURE TC 0001 0.00

76497 CT PROCEDURE 26 0001 0.00

76497 CT PROCEDURE 0001 0.00

76499 RADIOGRAPHIC PROCEDURE TC 0001 0.00

76499 RADIOGRAPHIC PROCEDURE 26 0001 0.00

76499 RADIOGRAPHIC PROCEDURE 0001 0.00

76506 ECHO EXAM OF HEAD TC 0001 97.90

76506 ECHO EXAM OF HEAD 26 0001 32.86

76506 ECHO EXAM OF HEAD 0001 130.77

76510 OPHTH US B & QUANT A TC 0001 85.43

76510 OPHTH US B & QUANT A 26 0001 102.15

76510 OPHTH US B & QUANT A 0001 187.58

76511 OPHTH US QUANT A ONLY TC 0001 51.79

76511 OPHTH US QUANT A ONLY 26 0001 55.64

76511 OPHTH US QUANT A ONLY 0001 107.44

76512 OPHTH US B W/NON-QUANT A TC 0001 41.96

76512 OPHTH US B W/NON-QUANT A 26 0001 56.45

76512 OPHTH US B W/NON-QUANT A 0001 98.42

76513 ECHO EXAM OF EYE WATER BATH TC 0001 63.51

76513 ECHO EXAM OF EYE WATER BATH 26 0001 37.66

76513 ECHO EXAM OF EYE WATER BATH 0001 101.17

76514 ECHO EXAM OF EYE THICKNESS TC 0001 5.68

76514 ECHO EXAM OF EYE THICKNESS 26 0001 10.27

76514 ECHO EXAM OF EYE THICKNESS 0001 15.95

76516 ECHO EXAM OF EYE TC 0001 50.28

76516 ECHO EXAM OF EYE 26 0001 32.23


76516 ECHO EXAM OF EYE 0001 82.51


76519 ECHO EXAM OF EYE 26 0001 33.40

76519 ECHO EXAM OF EYE 0001 89.35


76529 ECHO EXAM OF EYE 26 0001 34.85

76529 ECHO EXAM OF EYE 0001 84.38

76536 US EXAM OF HEAD AND NECK TC 0001 100.17

76536 US EXAM OF HEAD AND NECK 26 0001 29.20

76536 US EXAM OF HEAD AND NECK 0001 129.37

76604 US EXAM CHEST TC 0001 65.40

76604 US EXAM CHEST 26 0001 28.09

76604 US EXAM CHEST 0001 93.49

76641 Ultrasound breast complete 26 0001 37.54

76641 Ultrasound breast complete 0001 112.77

76642 Ultrasound breast limited 26 0001 34.96

76642 Ultrasound breast limited 0001 92.46

76700 US EXAM ABDOM COMPLETE TC 0001 107.35

76700 US EXAM ABDOM COMPLETE 26 0001 41.96

76700 US EXAM ABDOM COMPLETE 0001 149.32

76705 ECHO EXAM OF ABDOMEN TC 0001 84.67

76705 ECHO EXAM OF ABDOMEN 26 0001 30.28

76705 ECHO EXAM OF ABDOMEN 0001 114.95

76770 US EXAM ABDO BACK WALL COMP TC 0001 102.43

76770 US EXAM ABDO BACK WALL COMP 26 0001 38.32

76770 US EXAM ABDO BACK WALL COMP 0001 140.76

76775 US EXAM ABDO BACK WALL LIM TC 0001 38.94

76775 US EXAM ABDO BACK WALL LIM 26 0001 29.92

76775 US EXAM ABDO BACK WALL LIM 0001 68.86

76776 US EXAM K TRANSPL W/DOPPLER TC 0001 124.35

76776 US EXAM K TRANSPL W/DOPPLER 26 0001 39.42

76776 US EXAM K TRANSPL W/DOPPLER 0001 163.77

76800 US EXAM SPINAL CANAL TC 0001 87.69

76800 US EXAM SPINAL CANAL 26 0001 58.35

76800 US EXAM SPINAL CANAL 0001 146.05

76801 OB US < 14 WKS SINGLE FETUS TC 0001 82.40

76801 OB US < 14 WKS SINGLE FETUS 26 0001 50.67

76801 OB US < 14 WKS SINGLE FETUS 0001 133.08

76802 OB US < 14 WKS ADDL FETUS TC 0001 27.22

76802 OB US < 14 WKS ADDL FETUS 26 0001 43.04

76802 OB US < 14 WKS ADDL FETUS 0001 70.27

76805 OB US >/= 14 WKS SNGL FETUS TC 0001 103.19

76805 OB US >/= 14 WKS SNGL FETUS 26 0001 51.05

76805 OB US >/= 14 WKS SNGL FETUS 0001 154.24

76810 OB US >/= 14 WKS ADDL FETUS TC 0001 51.03

76810 OB US >/= 14 WKS ADDL FETUS 26 0001 50.69


76810 OB US >/= 14 WKS ADDL FETUS 0001 101.73

76811 OB US DETAILED SNGL FETUS TC 0001 95.63

76811 OB US DETAILED SNGL FETUS 26 0001 98.45

76811 OB US DETAILED SNGL FETUS 0001 194.09

76812 OB US DETAILED ADDL FETUS TC 0001 128.13

76812 OB US DETAILED ADDL FETUS 26 0001 92.64

76812 OB US DETAILED ADDL FETUS 0001 220.78

76813 OB US NUCHAL MEAS 1 GEST TC 0001 65.77

76813 OB US NUCHAL MEAS 1 GEST 26 0001 61.28

76813 OB US NUCHAL MEAS 1 GEST 0001 127.06

76814 OB US NUCHAL MEAS ADD-ON TC 0001 31.76

76814 OB US NUCHAL MEAS ADD-ON 26 0001 51.42

76814 OB US NUCHAL MEAS ADD-ON 0001 83.19

76815 OB US LIMITED FETUS(S) TC 0001 61.99

76815 OB US LIMITED FETUS(S) 26 0001 33.15

76815 OB US LIMITED FETUS(S) 0001 95.15

76816 OB US FOLLOW-UP PER FETUS TC 0001 78.62

76816 OB US FOLLOW-UP PER FETUS 26 0001 44.14

76816 OB US FOLLOW-UP PER FETUS 0001 122.76

76817 TRANSVAGINAL US OBSTETRIC TC 0001 68.04

76817 TRANSVAGINAL US OBSTETRIC 26 0001 39.04

76817 TRANSVAGINAL US OBSTETRIC 0001 107.08

76818 FETAL BIOPHYS PROFILE W/NST TC 0001 73.71

76818 FETAL BIOPHYS PROFILE W/NST 26 0001 54.71

76818 FETAL BIOPHYS PROFILE W/NST 0001 128.42

76819 FETAL BIOPHYS PROFIL W/O NST TC 0001 54.06

76819 FETAL BIOPHYS PROFIL W/O NST 26 0001 40.13

76819 FETAL BIOPHYS PROFIL W/O NST 0001 94.20

76820 UMBILICAL ARTERY ECHO TC 0001 25.33

76820 UMBILICAL ARTERY ECHO 26 0001 25.88

76820 UMBILICAL ARTERY ECHO 0001 51.22

76821 MIDDLE CEREBRAL ARTERY ECHO TC 0001 62.37

76821 MIDDLE CEREBRAL ARTERY ECHO 26 0001 36.87

76821 MIDDLE CEREBRAL ARTERY ECHO 0001 99.24

76825 ECHO EXAM OF FETAL HEART TC 0001 203.72

76825 ECHO EXAM OF FETAL HEART 26 0001 85.27

76825 ECHO EXAM OF FETAL HEART 0001 289.00











76830 TRANSVAGINAL US NON-OB TC 0001 97.90

76830 TRANSVAGINAL US NON-OB 26 0001 35.75

76830 TRANSVAGINAL US NON-OB 0001 133.66

76831 ECHO EXAM UTERUS TC 0001 93.36

76831 ECHO EXAM UTERUS 26 0001 37.58

76831 ECHO EXAM UTERUS 0001 130.95

76856 US EXAM PELVIC COMPLETE TC 0001 96.01

76856 US EXAM PELVIC COMPLETE 26 0001 35.38

76856 US EXAM PELVIC COMPLETE 0001 131.39

76857 US EXAM PELVIC LIMITED TC 0001 37.05

76857 US EXAM PELVIC LIMITED 26 0001 19.72

76857 US EXAM PELVIC LIMITED 0001 56.78

76870 US EXAM SCROTUM TC 0001 44.61

76870 US EXAM SCROTUM 26 0001 33.22

76870 US EXAM SCROTUM 0001 77.84

76872 US TRANSRECTAL TC 0001 62.37

76872 US TRANSRECTAL 26 0001 35.39

76872 US TRANSRECTAL 0001 97.77

76873 ECHOGRAP TRANS R PROS STUDY TC 0001 99.41

76873 ECHOGRAP TRANS R PROS STUDY 26 0001 81.05

76873 ECHOGRAP TRANS R PROS STUDY 0001 180.46

76881 US XTR NON-VASC COMPLETE ULTRA TC 0001 92.61

76881 US XTR NON-VASC COMPLETE ULTRA 26 0001 32.86

76881 US XTR NON-VASC COMPLETE ULTRA 0001 125.48

76882 US XTR NON-VASC LMTD TC 0001 11.73

76882 US XTR NON-VASC LMTD 26 0001 25.58

76882 US XTR NON-VASC LMTD 0001 37.31

76885 US EXAM INFANT HIPS DYNAMIC TC 0001 119.06

76885 US EXAM INFANT HIPS DYNAMIC 26 0001 38.32

76885 US EXAM INFANT HIPS DYNAMIC 0001 157.39

76886 US EXAM INFANT HIPS STATIC TC 0001 81.65

76886 US EXAM INFANT HIPS STATIC 26 0001 31.32

76886 US EXAM INFANT HIPS STATIC 0001 112.97

76930 ECHO GUIDE CARDIOCENTESIS TC 0001 54.81

76930 ECHO GUIDE CARDIOCENTESIS 26 0001 33.11

76930 ECHO GUIDE CARDIOCENTESIS 0001 87.93

76932 ECHO GUIDE FOR HEART BIOPSY TC 0001 57.55

76932 ECHO GUIDE FOR HEART BIOPSY 26 0001 34.30

76932 ECHO GUIDE FOR HEART BIOPSY 0001 93.03

76936 ECHO GUIDE FOR ARTERY REPAIR TC 0001 185.96

76936 ECHO GUIDE FOR ARTERY REPAIR 26 0001 100.86

76936 ECHO GUIDE FOR ARTERY REPAIR 0001 286.82

76937 US GUIDE VASCULAR ACCESS TC 0001 22.31

76937 US GUIDE VASCULAR ACCESS 26 0001 15.72

76937 US GUIDE VASCULAR ACCESS 0001 38.04

76940 US GUIDE TISSUE ABLATION TC 0001 71.29


76940 US GUIDE TISSUE ABLATION 26 0001 108.89

76940 US GUIDE TISSUE ABLATION 0001 177.08

76941 ECHO GUIDE FOR TRANSFUSION TC 0001 57.55

76941 ECHO GUIDE FOR TRANSFUSION 26 0001 72.44

76941 ECHO GUIDE FOR TRANSFUSION 0001 128.87

76942 ECHO GUIDE FOR BIOPSY TC 0001 42.34

76942 ECHO GUIDE FOR BIOPSY 26 0001 34.68

76942 ECHO GUIDE FOR BIOPSY 0001 77.02

76945 ECHO GUIDE VILLUS SAMPLING TC 0001 57.55

76945 ECHO GUIDE VILLUS SAMPLING 26 0001 35.81

76945 ECHO GUIDE VILLUS SAMPLING 0001 92.31

76946 ECHO GUIDE FOR AMNIOCENTESIS TC 0001 14.00

76946 ECHO GUIDE FOR AMNIOCENTESIS 26 0001 19.69

76946 ECHO GUIDE FOR AMNIOCENTESIS 0001 33.69

76948 ECHO GUIDE OVA ASPIRATION TC 0001 14.00

76948 ECHO GUIDE OVA ASPIRATION 26 0001 20.48

76948 ECHO GUIDE OVA ASPIRATION 0001 34.48

76965 ECHO GUIDANCE RADIOTHERAPY TC 0001 24.96

76965 ECHO GUIDANCE RADIOTHERAPY 26 0001 69.74

76965 ECHO GUIDANCE RADIOTHERAPY 0001 94.70

76970 ULTRASOUND EXAM FOLLOW-UP TC 0001 79.00

76970 ULTRASOUND EXAM FOLLOW-UP 26 0001 21.22

76970 ULTRASOUND EXAM FOLLOW-UP 0001 100.22

76975 GI ENDOSCOPIC ULTRASOUND TC 0001 57.55

76975 GI ENDOSCOPIC ULTRASOUND 26 0001 45.06

76975 GI ENDOSCOPIC ULTRASOUND 0001 99.18

76977 US BONE DENSITY MEASURE TC 0001 4.55

76977 US BONE DENSITY MEASURE 26 0001 2.94

76977 US BONE DENSITY MEASURE 0001 7.49

76998 US GUIDE INTRAOP 26 0001 67.68

76999 ECHO EXAMINATION PROCEDURE TC 0001 0.00

76999 ECHO EXAMINATION PROCEDURE 0001 0.00

77001 FLUOROGUIDE FOR VEIN DEVICE TC 0001 63.88

77001 FLUOROGUIDE FOR VEIN DEVICE 26 0001 19.72

77001 FLUOROGUIDE FOR VEIN DEVICE 0001 83.61

77002 NEEDLE LOCALIZATION BY XRAY TC 0001 79.00

77002 NEEDLE LOCALIZATION BY XRAY 26 0001 28.86

77002 NEEDLE LOCALIZATION BY XRAY 0001 107.87

77003 FLUOROGUIDE FOR SPINE INJECT TC 0001 63.51

77003 FLUOROGUIDE FOR SPINE INJECT 26 0001 31.39

77003 FLUOROGUIDE FOR SPINE INJECT 0001 94.90

77011 CT SCAN FOR LOCALIZATION TC 0001 172.73

77011 CT SCAN FOR LOCALIZATION 26 0001 63.49

77011 CT SCAN FOR LOCALIZATION 0001 236.22

77012 CT SCAN FOR NEEDLE BIOPSY TC 0001 75.60

77012 CT SCAN FOR NEEDLE BIOPSY 26 0001 58.67


77012 CT SCAN FOR NEEDLE BIOPSY 0001 134.28

77013 CT GUIDE FOR TISSUE ABLATION TC 0001 428.10

77013 CT GUIDE FOR TISSUE ABLATION 26 0001 208.35

77013 CT GUIDE FOR TISSUE ABLATION 0001 652.83

77014 CT SCAN FOR THERAPY GUIDE TC 0001 84.29

77014 CT SCAN FOR THERAPY GUIDE 26 0001 44.91

77014 CT SCAN FOR THERAPY GUIDE 0001 129.21

77021 MR GUIDANCE FOR NEEDLE PLACE TC 0001 339.77

77021 MR GUIDANCE FOR NEEDLE PLACE 26 0001 78.93

77021 MR GUIDANCE FOR NEEDLE PLACE 0001 418.71

77022 MRI FOR TISSUE ABLATION TC 0001 739.86

77022 MRI FOR TISSUE ABLATION 26 0001 221.49

77022 MRI FOR TISSUE ABLATION 0001 799.67

77051 COMPUTER DX MAMMOGRAM ADD-ON TC 0001 7.57

77051 COMPUTER DX MAMMOGRAM ADD-ON 26 0001 3.30

77051 COMPUTER DX MAMMOGRAM ADD-ON 0001 10.88

77052 COMP SCREEN MAMMOGRAM ADD-ON TC 0001 7.57

77052 COMP SCREEN MAMMOGRAM ADD-ON 26 0001 3.30

77052 COMP SCREEN MAMMOGRAM ADD-ON 0001 10.88

77053 X-RAY OF MAMMARY DUCT TC 0001 44.61

77053 X-RAY OF MAMMARY DUCT 26 0001 18.21

77053 X-RAY OF MAMMARY DUCT 0001 62.83

77054 X-RAY OF MAMMARY DUCTS TC 0001 61.24

77054 X-RAY OF MAMMARY DUCTS 26 0001 23.75

77054 X-RAY OF MAMMARY DUCTS 0001 84.99

77055 MAMMOGRAM ONE BREAST TC 0001 57.46

77055 MAMMOGRAM ONE BREAST 26 0001 36.51

77055 MAMMOGRAM ONE BREAST 0001 93.97

77056 MAMMOGRAM BOTH BREASTS TC 0001 75.60

77056 MAMMOGRAM BOTH BREASTS 26 0001 45.27

77056 MAMMOGRAM BOTH BREASTS 0001 120.87

77057 MAMMOGRAM SCREENING TC 0001 49.52

77057 MAMMOGRAM SCREENING 26 0001 36.51

77057 MAMMOGRAM SCREENING 0001 86.04

77058 MRI ONE BREAST TC 0001 496.61

77058 MRI ONE BREAST 26 0001 84.71

77058 MRI ONE BREAST 0001 581.33

77059 MRI BOTH BREASTS TC 0001 494.35

77059 MRI BOTH BREASTS 26 0001 84.71

77059 MRI BOTH BREASTS 0001 579.06

77063 Breast tomosynthesis bi 26 0001 31.62

77063 Breast tomosynthesis bi 0001 58.64

77071 X-RAY STRESS VIEW 0001 53.75

77072 X-RAYS FOR BONE AGE TC 0001 15.13

77072 X-RAYS FOR BONE AGE 26 0001 9.85

77072 X-RAYS FOR BONE AGE 0001 24.99


77073 X-RAYS BONE LENGTH STUDIES TC 0001 24.58

77073 X-RAYS BONE LENGTH STUDIES 26 0001 15.80

77073 X-RAYS BONE LENGTH STUDIES 0001 40.38

77074 X-RAYS BONE SURVEY LIMITED TC 0001 51.79

77074 X-RAYS BONE SURVEY LIMITED 26 0001 23.75

77074 X-RAYS BONE SURVEY LIMITED 0001 75.54

77075 X-RAYS BONE SURVEY COMPLETE TC 0001 85.05

77075 X-RAYS BONE SURVEY COMPLETE 26 0001 28.11

77075 X-RAYS BONE SURVEY COMPLETE 0001 113.16

77076 X-RAYS BONE SURVEY INFANT TC 0001 77.11

77076 X-RAYS BONE SURVEY INFANT 26 0001 36.51

77076 X-RAYS BONE SURVEY INFANT 0001 113.62

77077 JOINT SURVEY SINGLE VIEW TC 0001 24.96

77077 JOINT SURVEY SINGLE VIEW 26 0001 17.61

77077 JOINT SURVEY SINGLE VIEW 0001 42.57

77078 CT BONE DENSITY AXIAL TC 0001 107.35

77078 CT BONE DENSITY AXIAL 26 0001 12.76

77078 CT BONE DENSITY AXIAL 0001 120.11

77080 DXA BONE DENSITY AXIAL TC 0001 41.21

77080 DXA BONE DENSITY AXIAL 26 0001 10.59

77080 DXA BONE DENSITY AXIAL 0001 51.80

77081 DXA BONE DENSITY/PERIPHERAL TC 0001 17.78

77081 DXA BONE DENSITY/PERIPHERAL 26 0001 11.30

77081 DXA BONE DENSITY/PERIPHERAL 0001 29.09

77084 MAGNETIC IMAGE BONE MARROW TC 0001 332.97

77084 MAGNETIC IMAGE BONE MARROW 26 0001 83.63

77084 MAGNETIC IMAGE BONE MARROW 0001 416.61

77085 Dxa bone density study 26 0001 15.83

77085 Dxa bone density study 0001 59.16

77086 Fracture assessment via dxa 0001 37.50

77261 RADIATION THERAPY PLANNING 0001 76.86



77280 SET RADIATION THERAPY FIELD TC 0001 248.31

77280 SET RADIATION THERAPY FIELD 26 0001 36.87

77280 SET RADIATION THERAPY FIELD 0001 285.19







77293 Respirator motion mgmt simul 26 0001 105.91

77293 Respirator motion mgmt simul 0001 452.49

77295 3-D RADIOTHERAPY PLAN TC 0001 276.71

77295 3-D RADIOTHERAPY PLAN 26 0001 227.16


77295 3-D RADIOTHERAPY PLAN 0001 503.88

77300 RADIATION THERAPY DOSE PLAN TC 0001 37.05

77300 RADIATION THERAPY DOSE PLAN 26 0001 32.87

77300 RADIATION THERAPY DOSE PLAN 0001 69.92

77301 RADIOTHERAPY DOSE PLAN IMRT TC 0001 1630.40

77301 RADIOTHERAPY DOSE PLAN IMRT 26 0001 422.91

77301 RADIOTHERAPY DOSE PLAN IMRT 0001 2053.31

77306 Telethx isodose plan simple 0001 149.65

77307 Telethx isodose plan cplx 26 0001 151.41

77307 Telethx isodose plan cplx 0001 291.55

77316 Brachytx isodose plan simple 0001 192.75

77317 Brachytx isodose intermed 0001 252.43

77318 Brachytx isodose complex 0001 363.39

77321 SPECIAL TELETX PORT PLAN TC 0001 44.99

77321 SPECIAL TELETX PORT PLAN 26 0001 50.01

77321 SPECIAL TELETX PORT PLAN 0001 95.00

77331 SPECIAL RADIATION DOSIMETRY TC 0001 19.67

77331 SPECIAL RADIATION DOSIMETRY 26 0001 46.01

77331 SPECIAL RADIATION DOSIMETRY 0001 65.68

77332 RADIATION TREATMENT AID(S) TC 0001 55.19

77332 RADIATION TREATMENT AID(S) 26 0001 28.86

77332 RADIATION TREATMENT AID(S) 0001 84.06







77336 RADIATION PHYSICS CONSULT 0001 79.00

77338 DESIGN MLC DEVICE FOR IMRT TC 0001 294.10

77338 DESIGN MLC DEVICE FOR IMRT 26 0001 227.56

77338 DESIGN MLC DEVICE FOR IMRT 0001 521.66

77370 RADIATION PHYSICS CONSULT 0001 121.01

77371 SRS MULTISOURCE 0001 1149.24

77372 SRS LINEAR BASED 0001 1102.89

77373 SBRT DELIVERY 0001 1320.61

77401 RADIATION TREATMENT DELIVERY 0001 21.18




77417 RADIOLOGY PORT FILM(S) 0001 14.75

77422 NEUTRON BEAM TX SIMPLE 0001 44.23

77423 NEUTRON BEAM TX COMPLEX 0001 52.55

77424 Io rad tx delivery by x-ray 0001 0.00

77425 Io rad tx deliver by elctrns 0001 0.00

77427 RADIATION TX MANAGEMENT X5 0001 190.48


77431 RADIATION THERAPY MANAGEMENT 0001 104.45

77432 STEREOTACTIC RADIATION TRMT 0001 428.39

77435 SBRT MANAGEMENT 0001 647.36

77469 Io radiation tx management 0001 320.40

77470 SPECIAL RADIATION TREATMENT TC 0001 49.14

77470 SPECIAL RADIATION TREATMENT 26 0001 110.65

77470 SPECIAL RADIATION TREATMENT 0001 159.80

77520 PROTON TRMT SIMPLE W/O COMP 0001 0.00

77522 PROTON TRMT SIMPLE W/COMP 0001 0.00

77523 PROTON TRMT INTERMEDIATE 0001 0.00

77525 PROTON TREATMENT COMPLEX 0001 0.00

77600 HYPERTHERMIA TREATMENT TC 0001 334.52

77600 HYPERTHERMIA TREATMENT 26 0001 82.52

77600 HYPERTHERMIA TREATMENT 0001 417.04













77750 INFUSE RADIOACTIVE MATERIALS TC 0001 115.70

77750 INFUSE RADIOACTIVE MATERIALS 26 0001 264.41

77750 INFUSE RADIOACTIVE MATERIALS 0001 380.11

77761 APPLY INTRCAV RADIAT SIMPLE TC 0001 199.62

77761 APPLY INTRCAV RADIAT SIMPLE 26 0001 201.90

77761 APPLY INTRCAV RADIAT SIMPLE 0001 401.52

77762 APPLY INTRCAV RADIAT INTERM TC 0001 226.47

77762 APPLY INTRCAV RADIAT INTERM 26 0001 303.83

77762 APPLY INTRCAV RADIAT INTERM 0001 530.30

77763 APPLY INTRCAV RADIAT COMPL TC 0001 293.02

77763 APPLY INTRCAV RADIAT COMPL 26 0001 458.33

77763 APPLY INTRCAV RADIAT COMPL 0001 751.35

77776 APPLY INTERSTIT RADIAT SIMPL TC 0001 198.88

77776 APPLY INTERSTIT RADIAT SIMPL 26 0001 251.48

77776 APPLY INTERSTIT RADIAT SIMPL 0001 450.36

77777 APPLY INTERSTIT RADIAT INTER TC 0001 203.41

77777 APPLY INTERSTIT RADIAT INTER 26 0001 402.05

77777 APPLY INTERSTIT RADIAT INTER 0001 605.47

77778 APPLY INTERSTIT RADIAT COMPL TC 0001 300.60

77778 APPLY INTERSTIT RADIAT COMPL 26 0001 598.21


77778 APPLY INTERSTIT RADIAT COMPL 0001 898.81

77785 HDR BRACHYTX 1 CHANNEL TC 0001 172.77

77785 HDR BRACHYTX 1 CHANNEL 26 0001 75.23

77785 HDR BRACHYTX 1 CHANNEL 0001 248.00

77786 HDR BRACHYTX 2-12 CHANNEL TC 0001 333.42

77786 HDR BRACHYTX 2-12 CHANNEL 26 0001 171.99

77786 HDR BRACHYTX 2-12 CHANNEL 0001 505.42

77787 HDR BRACHYTX OVER 12 CHAN TC 0001 546.25

77787 HDR BRACHYTX OVER 12 CHAN 26 0001 259.33

77787 HDR BRACHYTX OVER 12 CHAN 0001 805.59

77789 APPLY SURFACE RADIATION TC 0001 62.37

77789 APPLY SURFACE RADIATION 26 0001 60.24

77789 APPLY SURFACE RADIATION 0001 122.62

77790 RADIATION HANDLING TC 0001 44.61

77790 RADIATION HANDLING 26 0001 54.73

77790 RADIATION HANDLING 0001 99.34

78012 Thyroid uptake measurement TC 0001 72.95

78012 Thyroid uptake measurement 26 0001 9.47

78012 Thyroid uptake measurement 0001 82.43

78013 Thyroid imaging w/blood flow TC 0001 189.39

78013 Thyroid imaging w/blood flow 26 0001 18.57

78013 Thyroid imaging w/blood flow 0001 207.97

78014 Thyroid imaging w/blood flow TC 0001 226.43

78014 Thyroid imaging w/blood flow 26 0001 25.54

78014 Thyroid imaging w/blood flow 0001 251.98

78015 THYROID MET IMAGING TC 0001 199.22

78015 THYROID MET IMAGING 26 0001 34.30

78015 THYROID MET IMAGING 0001 233.52

78016 THYROID MET IMAGING/STUDIES TC 0001 264.98

78016 THYROID MET IMAGING/STUDIES 26 0001 35.88

78016 THYROID MET IMAGING/STUDIES 0001 300.86

78018 THYROID MET IMAGING BODY TC 0001 292.95

78018 THYROID MET IMAGING BODY 26 0001 42.62

78018 THYROID MET IMAGING BODY 0001 335.58

78020 THYROID MET UPTAKE TC 0001 59.35

78020 THYROID MET UPTAKE 26 0001 28.75

78020 THYROID MET UPTAKE 0001 88.10

78070 PARATHYROID PLANAR IMAGING TC 0001 278.96

78070 PARATHYROID PLANAR IMAGING 26 0001 40.47

78070 PARATHYROID PLANAR IMAGING 0001 319.44

78071 Parathyrd planar w/wo subtrj TC 0001 314.11

78071 Parathyrd planar w/wo subtrj 26 0001 60.52

78071 Parathyrd planar w/wo subtrj 0001 374.64

78072 Parathyrd planar w/spect&ct TC 0001 386.30

78072 Parathyrd planar w/spect&ct 26 0001 81.63

78072 Parathyrd planar w/spect&ct 0001 467.93


78075 ADRENAL CORTEX & MEDULLA IMG TC 0001 420.33

78075 ADRENAL CORTEX & MEDULLA IMG 26 0001 36.43

78075 ADRENAL CORTEX & MEDULLA IMG 0001 456.76

78102 BONE MARROW IMAGING LTD TC 0001 153.87

78102 BONE MARROW IMAGING LTD 26 0001 27.33

78102 BONE MARROW IMAGING LTD 0001 181.21

78103 BONE MARROW IMAGING MULT TC 0001 202.62

78103 BONE MARROW IMAGING MULT 26 0001 37.92

78103 BONE MARROW IMAGING MULT 0001 240.55

78104 BONE MARROW IMAGING BODY TC 0001 220.76

78104 BONE MARROW IMAGING BODY 26 0001 39.34

78104 BONE MARROW IMAGING BODY 0001 260.11

78110 PLASMA VOLUME SINGLE TC 0001 91.13

78110 PLASMA VOLUME SINGLE 26 0001 9.85

78110 PLASMA VOLUME SINGLE 0001 100.99

78111 PLASMA VOLUME MULTIPLE TC 0001 94.53

78111 PLASMA VOLUME MULTIPLE 26 0001 11.30

78111 PLASMA VOLUME MULTIPLE 0001 105.84

78120 RED CELL MASS SINGLE TC 0001 90.00

78120 RED CELL MASS SINGLE 26 0001 12.04

78120 RED CELL MASS SINGLE 0001 102.04

78121 RED CELL MASS MULTIPLE TC 0001 91.13

78121 RED CELL MASS MULTIPLE 26 0001 16.40

78121 RED CELL MASS MULTIPLE 0001 107.54

78122 BLOOD VOLUME TC 0001 83.20

78122 BLOOD VOLUME 26 0001 21.82

78122 BLOOD VOLUME 0001 105.02

78130 RED CELL SURVIVAL STUDY TC 0001 150.11

78130 RED CELL SURVIVAL STUDY 26 0001 32.15

78130 RED CELL SURVIVAL STUDY 0001 182.26

78135 RED CELL SURVIVAL KINETICS TC 0001 342.46

78135 RED CELL SURVIVAL KINETICS 26 0001 33.60

78135 RED CELL SURVIVAL KINETICS 0001 376.06

78140 RED CELL SEQUESTRATION TC 0001 113.05

78140 RED CELL SEQUESTRATION 26 0001 32.15

78140 RED CELL SEQUESTRATION 0001 145.20

78185 SPLEEN IMAGING TC 0001 205.65

78185 SPLEEN IMAGING 26 0001 20.40

78185 SPLEEN IMAGING 0001 226.05

78190 PLATELET SURVIVAL KINETICS TC 0001 368.53

78190 PLATELET SURVIVAL KINETICS 26 0001 56.54

78190 PLATELET SURVIVAL KINETICS 0001 425.08

78191 PLATELET SURVIVAL TC 0001 150.11

78191 PLATELET SURVIVAL 26 0001 32.15

78191 PLATELET SURVIVAL 0001 182.26

78195 LYMPH SYSTEM IMAGING TC 0001 321.29


78195 LYMPH SYSTEM IMAGING 26 0001 60.92

78195 LYMPH SYSTEM IMAGING 0001 382.22

78201 LIVER IMAGING TC 0001 178.43

78201 LIVER IMAGING 26 0001 22.27

78201 LIVER IMAGING 0001 200.71

78202 LIVER IMAGING WITH FLOW TC 0001 193.17

78202 LIVER IMAGING WITH FLOW 26 0001 24.35

78202 LIVER IMAGING WITH FLOW 0001 217.53

78205 LIVER IMAGING (3D) TC 0001 193.17

78205 LIVER IMAGING (3D) 26 0001 35.36

78205 LIVER IMAGING (3D) 0001 228.53

78206 LIVER IMAGE (3D) WITH FLOW TC 0001 316.00

78206 LIVER IMAGE (3D) WITH FLOW 26 0001 47.72

78206 LIVER IMAGE (3D) WITH FLOW 0001 363.73

78215 LIVER AND SPLEEN IMAGING TC 0001 183.73

78215 LIVER AND SPLEEN IMAGING 26 0001 25.18

78215 LIVER AND SPLEEN IMAGING 0001 208.91

78216 LIVER & SPLEEN IMAGE/FLOW TC 0001 103.23

78216 LIVER & SPLEEN IMAGE/FLOW 26 0001 28.05

78216 LIVER & SPLEEN IMAGE/FLOW 0001 131.28

78226 Hepatobiliary system imaging TC 0001 317.89

78226 Hepatobiliary system imaging 26 0001 37.94

78226 Hepatobiliary system imaging 0001 355.84

78227 Hepatobil syst image w/drug TC 0001 436.20

78227 Hepatobil syst image w/drug 26 0001 45.95

78227 Hepatobil syst image w/drug 0001 482.15

78230 SALIVARY GLAND IMAGING TC 0001 126.66

78230 SALIVARY GLAND IMAGING 26 0001 19.97

78230 SALIVARY GLAND IMAGING 0001 146.63

78231 SERIAL SALIVARY IMAGING TC 0001 111.92

78231 SERIAL SALIVARY IMAGING 26 0001 26.22

78231 SERIAL SALIVARY IMAGING 0001 138.14

78232 SALIVARY GLAND FUNCTION EXAM TC 0001 85.09

78232 SALIVARY GLAND FUNCTION EXAM 26 0001 21.06

78232 SALIVARY GLAND FUNCTION EXAM 0001 106.15

78258 ESOPHAGEAL MOTILITY STUDY TC 0001 199.60

78258 ESOPHAGEAL MOTILITY STUDY 26 0001 37.17

78258 ESOPHAGEAL MOTILITY STUDY 0001 236.77

78261 GASTRIC MUCOSA IMAGING TC 0001 235.12

78261 GASTRIC MUCOSA IMAGING 26 0001 36.15

78261 GASTRIC MUCOSA IMAGING 0001 271.28

78262 GASTROESOPHAGEAL REFLUX EXAM TC 0001 227.94

78262 GASTROESOPHAGEAL REFLUX EXAM 26 0001 33.47

78262 GASTROESOPHAGEAL REFLUX EXAM 0001 261.42

78264 GASTRIC EMPTYING STUDY TC 0001 268.00

78264 GASTRIC EMPTYING STUDY 26 0001 40.85


78264 GASTRIC EMPTYING STUDY 0001 308.86

78267 BREATH TST ATTAIN/ANAL C-14 0001 11.94

78268 BREATH TEST ANALYSIS C-14 0001 102.44

78270 VIT B-12 ABSORPTION EXAM TC 0001 85.80

78270 VIT B-12 ABSORPTION EXAM 26 0001 10.59

78270 VIT B-12 ABSORPTION EXAM 0001 96.40

78271 VIT B-12 ABSRP EXAM INT FAC TC 0001 85.80

78271 VIT B-12 ABSRP EXAM INT FAC 26 0001 10.59

78271 VIT B-12 ABSRP EXAM INT FAC 0001 96.40

78272 VIT B-12 ABSORP COMBINED TC 0001 95.29

78272 VIT B-12 ABSORP COMBINED 26 0001 14.23

78272 VIT B-12 ABSORP COMBINED 0001 109.53

78278 ACUTE GI BLOOD LOSS IMAGING TC 0001 323.94

78278 ACUTE GI BLOOD LOSS IMAGING 26 0001 50.33

78278 ACUTE GI BLOOD LOSS IMAGING 0001 374.27

78282 GI PROTEIN LOSS EXAM TC 0001 59.73

78282 GI PROTEIN LOSS EXAM 26 0001 20.10

78282 GI PROTEIN LOSS EXAM 0001 79.64

78290 MECKELS DIVERT EXAM TC 0001 323.94

78290 MECKELS DIVERT EXAM 26 0001 35.04

78290 MECKELS DIVERT EXAM 0001 358.98

78291 LEVEEN/SHUNT PATENCY EXAM TC 0001 224.92

78291 LEVEEN/SHUNT PATENCY EXAM 26 0001 44.12

78291 LEVEEN/SHUNT PATENCY EXAM 0001 269.04

78300 BONE IMAGING LIMITED AREA TC 0001 161.81

78300 BONE IMAGING LIMITED AREA 26 0001 32.11

78300 BONE IMAGING LIMITED AREA 0001 193.92

78305 BONE IMAGING MULTIPLE AREAS TC 0001 204.89

78305 BONE IMAGING MULTIPLE AREAS 26 0001 42.30

78305 BONE IMAGING MULTIPLE AREAS 0001 247.20

78306 BONE IMAGING WHOLE BODY TC 0001 225.30

78306 BONE IMAGING WHOLE BODY 26 0001 43.76

78306 BONE IMAGING WHOLE BODY 0001 269.06

78315 BONE IMAGING 3 PHASE TC 0001 321.67

78315 BONE IMAGING 3 PHASE 26 0001 51.78

78315 BONE IMAGING 3 PHASE 0001 373.46

78320 BONE IMAGING (3D) TC 0001 191.66

78320 BONE IMAGING (3D) 26 0001 51.74

78320 BONE IMAGING (3D) 0001 243.41

78350 BONE MINERAL SINGLE PHOTON TC 0001 23.07

78350 BONE MINERAL SINGLE PHOTON 26 0001 11.30

78350 BONE MINERAL SINGLE PHOTON 0001 34.38

78351 BONE MINERAL DUAL PHOTON 0001 15.68

78414 NON-IMAGING HEART FUNCTION TC 0001 54.30

78414 NON-IMAGING HEART FUNCTION 26 0001 23.37

78414 NON-IMAGING HEART FUNCTION 0001 77.46


78428 CARDIAC SHUNT IMAGING TC 0001 156.51

78428 CARDIAC SHUNT IMAGING 26 0001 38.98

78428 CARDIAC SHUNT IMAGING 0001 195.50

78445 VASCULAR FLOW IMAGING TC 0001 160.67

78445 VASCULAR FLOW IMAGING 26 0001 23.25

78445 VASCULAR FLOW IMAGING 0001 183.93

78451 HT MUSCLE IMAGE SPECT SING TC 0001 298.24

78451 HT MUSCLE IMAGE SPECT SING 26 0001 69.23

78451 HT MUSCLE IMAGE SPECT SING 0001 367.47

78452 HT MUSCLE IMAGE SPECT MULT TC 0001 429.02

78452 HT MUSCLE IMAGE SPECT MULT 26 0001 81.23

78452 HT MUSCLE IMAGE SPECT MULT 0001 510.26

78453 HT MUSCLE IMAGE PLANAR SING TC 0001 277.07

78453 HT MUSCLE IMAGE PLANAR SING 26 0001 51.44

78453 HT MUSCLE IMAGE PLANAR SING 0001 328.52

78454 HT MUSC IMAGE PLANAR MULT TC 0001 399.54

78454 HT MUSC IMAGE PLANAR MULT 26 0001 68.17

78454 HT MUSC IMAGE PLANAR MULT 0001 467.72

78456 ACUTE VENOUS THROMBUS IMAGE TC 0001 292.95

78456 ACUTE VENOUS THROMBUS IMAGE 26 0001 50.27

78456 ACUTE VENOUS THROMBUS IMAGE 0001 343.22

78457 VENOUS THROMBOSIS IMAGING TC 0001 169.36

78457 VENOUS THROMBOSIS IMAGING 26 0001 39.02

78457 VENOUS THROMBOSIS IMAGING 0001 208.39

78458 VEN THROMBOSIS IMAGES BILAT TC 0001 133.84

78458 VEN THROMBOSIS IMAGES BILAT 26 0001 39.54

78458 VEN THROMBOSIS IMAGES BILAT 0001 173.38

78459 HEART MUSCLE IMAGING (PET) TC 0001 183.17

78459 HEART MUSCLE IMAGING (PET) 26 0001 75.13

78459 HEART MUSCLE IMAGING (PET) 0001 261.72

78466 HEART INFARCT IMAGE TC 0001 159.92

78466 HEART INFARCT IMAGE 26 0001 35.75

78466 HEART INFARCT IMAGE 0001 195.67

78468 HEART INFARCT IMAGE (EF) TC 0001 170.12

78468 HEART INFARCT IMAGE (EF) 26 0001 40.45

78468 HEART INFARCT IMAGE (EF) 0001 210.58

78469 HEART INFARCT IMAGE (3D) TC 0001 194.31

78469 HEART INFARCT IMAGE (3D) 26 0001 47.02

78469 HEART INFARCT IMAGE (3D) 0001 241.34

78472 GATED HEART PLANAR SINGLE TC 0001 196.57

78472 GATED HEART PLANAR SINGLE 26 0001 49.19

78472 GATED HEART PLANAR SINGLE 0001 245.77

78473 GATED HEART MULTIPLE TC 0001 236.64

78473 GATED HEART MULTIPLE 26 0001 73.59

78473 GATED HEART MULTIPLE 0001 310.23

78481 HEART FIRST PASS SINGLE TC 0001 139.47


78481 HEART FIRST PASS SINGLE 26 0001 48.80

78481 HEART FIRST PASS SINGLE 0001 188.27

78483 HEART FIRST PASS MULTIPLE TC 0001 182.59

78483 HEART FIRST PASS MULTIPLE 26 0001 73.96

78483 HEART FIRST PASS MULTIPLE 0001 256.56

78491 HEART IMAGE (PET) SINGLE TC 0001 185.34

78491 HEART IMAGE (PET) SINGLE 26 0001 75.89

78491 HEART IMAGE (PET) SINGLE 0001 264.62

78492 HEART IMAGE (PET) MULTIPLE TC 0001 230.59

78492 HEART IMAGE (PET) MULTIPLE 26 0001 94.09

78492 HEART IMAGE (PET) MULTIPLE 0001 329.42

78494 HEART IMAGE SPECT TC 0001 182.59

78494 HEART IMAGE SPECT 26 0001 59.75

78494 HEART IMAGE SPECT 0001 242.34

78496 HEART FIRST PASS ADD-ON TC 0001 21.93

78496 HEART FIRST PASS ADD-ON 26 0001 25.12

78496 HEART FIRST PASS ADD-ON 0001 47.06

78579 Lung ventilation imaging TC 0001 175.39

78579 Lung ventilation imaging 26 0001 24.80

78579 Lung ventilation imaging 0001 200.20

78580 LUNG PERFUSION IMAGING TC 0001 218.87

78580 LUNG PERFUSION IMAGING 26 0001 37.55

78580 LUNG PERFUSION IMAGING 0001 256.42

78582 Lung ventilat&perfus imaging TC 0001 305.42

78582 Lung ventilat&perfus imaging 26 0001 54.33

78582 Lung ventilat&perfus imaging 0001 359.75

78597 Lung perfusion differential TC 0001 179.93

78597 Lung perfusion differential 26 0001 36.37

78597 Lung perfusion differential 0001 216.31

78598 Lung perf&ventilat diferentl TC 0001 287.28

78598 Lung perf&ventilat diferentl 26 0001 42.25

78598 Lung perf&ventilat diferentl 0001 329.53

78600 BRAIN IMAGE < 4 VIEWS TC 0001 174.28

78600 BRAIN IMAGE < 4 VIEWS 26 0001 22.22

78600 BRAIN IMAGE < 4 VIEWS 0001 196.50

78601 BRAIN IMAGE W/FLOW < 4 VIEWS TC 0001 206.02

78601 BRAIN IMAGE W/FLOW < 4 VIEWS 26 0001 26.28

78601 BRAIN IMAGE W/FLOW < 4 VIEWS 0001 232.30

78605 BRAIN IMAGE 4+ VIEWS TC 0001 184.86

78605 BRAIN IMAGE 4+ VIEWS 26 0001 27.75

78605 BRAIN IMAGE 4+ VIEWS 0001 212.61

78606 BRAIN IMAGE W/FLOW 4 + VIEWS TC 0001 322.05

78606 BRAIN IMAGE W/FLOW 4 + VIEWS 26 0001 31.66

78606 BRAIN IMAGE W/FLOW 4 + VIEWS 0001 353.71

78607 BRAIN IMAGING (3D) TC 0001 312.98

78607 BRAIN IMAGING (3D) 26 0001 60.45


78607 BRAIN IMAGING (3D) 0001 373.43

78608 BRAIN IMAGING (PET) TC 0001 1218.13

78608 BRAIN IMAGING (PET) 26 0001 75.91

78608 BRAIN IMAGING (PET) 0001 1740.13

78609 BRAIN IMAGING (PET) TC 0001 1425.19

78609 BRAIN IMAGING (PET) 26 0001 79.67

78609 BRAIN IMAGING (PET) 0001 79.67

78610 BRAIN FLOW IMAGING ONLY TC 0001 172.01

78610 BRAIN FLOW IMAGING ONLY 26 0001 15.31

78610 BRAIN FLOW IMAGING ONLY 0001 187.32

78630 CEREBROSPINAL FLUID SCAN TC 0001 328.09

78630 CEREBROSPINAL FLUID SCAN 26 0001 34.64

78630 CEREBROSPINAL FLUID SCAN 0001 362.74

78635 CSF VENTRICULOGRAPHY TC 0001 333.01

78635 CSF VENTRICULOGRAPHY 26 0001 30.96

78635 CSF VENTRICULOGRAPHY 0001 363.97

78645 CSF SHUNT EVALUATION TC 0001 318.65

78645 CSF SHUNT EVALUATION 26 0001 28.43

78645 CSF SHUNT EVALUATION 0001 347.08

78647 CEREBROSPINAL FLUID SCAN TC 0001 329.23

78647 CEREBROSPINAL FLUID SCAN 26 0001 46.72

78647 CEREBROSPINAL FLUID SCAN 0001 375.96

78650 CSF LEAKAGE IMAGING TC 0001 329.61

78650 CSF LEAKAGE IMAGING 26 0001 31.39

78650 CSF LEAKAGE IMAGING 0001 361.00

78660 NUCLEAR EXAM OF TEAR FLOW TC 0001 171.63

78660 NUCLEAR EXAM OF TEAR FLOW 26 0001 28.13

78660 NUCLEAR EXAM OF TEAR FLOW 0001 199.76

78700 KIDNEY IMAGING MORPHOL TC 0001 163.69

78700 KIDNEY IMAGING MORPHOL 26 0001 22.99

78700 KIDNEY IMAGING MORPHOL 0001 186.69

78701 KIDNEY IMAGING WITH FLOW TC 0001 204.51

78701 KIDNEY IMAGING WITH FLOW 26 0001 25.18

78701 KIDNEY IMAGING WITH FLOW 0001 229.70

78707 K FLOW/FUNCT IMAGE W/O DRUG TC 0001 199.60

78707 K FLOW/FUNCT IMAGE W/O DRUG 26 0001 48.10

78707 K FLOW/FUNCT IMAGE W/O DRUG 0001 247.70

78708 K FLOW/FUNCT IMAGE W/DRUG TC 0001 123.26

78708 K FLOW/FUNCT IMAGE W/DRUG 26 0001 60.86

78708 K FLOW/FUNCT IMAGE W/DRUG 0001 184.12

78709 K FLOW/FUNCT IMAGE MULTIPLE TC 0001 320.91

78709 K FLOW/FUNCT IMAGE MULTIPLE 26 0001 70.72

78709 K FLOW/FUNCT IMAGE MULTIPLE 0001 391.64

78710 KIDNEY IMAGING (3D) TC 0001 182.59

78710 KIDNEY IMAGING (3D) 26 0001 30.48

78710 KIDNEY IMAGING (3D) 0001 213.08


78725 KIDNEY FUNCTION STUDY TC 0001 97.93

78725 KIDNEY FUNCTION STUDY 26 0001 18.55

78725 KIDNEY FUNCTION STUDY 0001 116.49

78730 URINARY BLADDER RETENTION TC 0001 73.33

78730 URINARY BLADDER RETENTION 26 0001 8.04

78730 URINARY BLADDER RETENTION 0001 81.38

78740 URETERAL REFLUX STUDY TC 0001 207.16

78740 URETERAL REFLUX STUDY 26 0001 28.80

78740 URETERAL REFLUX STUDY 0001 235.97

78761 TESTICULAR IMAGING W/FLOW TC 0001 188.64

78761 TESTICULAR IMAGING W/FLOW 26 0001 36.87

78761 TESTICULAR IMAGING W/FLOW 0001 225.51

78800 TUMOR IMAGING LIMITED AREA TC 0001 169.74

78800 TUMOR IMAGING LIMITED AREA 26 0001 34.32

78800 TUMOR IMAGING LIMITED AREA 0001 204.06

78801 TUMOR IMAGING MULT AREAS TC 0001 227.94

78801 TUMOR IMAGING MULT AREAS 26 0001 40.49

78801 TUMOR IMAGING MULT AREAS 0001 268.44

78802 TUMOR IMAGING WHOLE BODY TC 0001 302.40

78802 TUMOR IMAGING WHOLE BODY 26 0001 43.00

78802 TUMOR IMAGING WHOLE BODY 0001 345.40

78803 TUMOR IMAGING (3D) TC 0001 310.33

78803 TUMOR IMAGING (3D) 26 0001 53.54

78803 TUMOR IMAGING (3D) 0001 363.87

78804 TUMOR IMAGING WHOLE BODY TC 0001 555.65

78804 TUMOR IMAGING WHOLE BODY 26 0001 53.57

78804 TUMOR IMAGING WHOLE BODY 0001 609.23

78805 ABSCESS IMAGING LTD AREA TC 0001 158.40

78805 ABSCESS IMAGING LTD AREA 26 0001 37.21

78805 ABSCESS IMAGING LTD AREA 0001 195.62

78806 ABSCESS IMAGING WHOLE BODY TC 0001 311.47

78806 ABSCESS IMAGING WHOLE BODY 26 0001 43.00

78806 ABSCESS IMAGING WHOLE BODY 0001 354.47

78807 NUCLEAR LOCALIZATION/ABSCESS TC 0001 309.20

78807 NUCLEAR LOCALIZATION/ABSCESS 26 0001 53.14

78807 NUCLEAR LOCALIZATION/ABSCESS 0001 362.34

78808 IV INJ RA DRUG DX STUDY 0001 49.59

78811 PET IMAGE LTD AREA TC 0001 608.94

78811 PET IMAGE LTD AREA 26 0001 82.74

78811 PET IMAGE LTD AREA 0001 690.65

78812 PET IMAGE SKULL-THIGH TC 0001 756.42

78812 PET IMAGE SKULL-THIGH 26 0001 99.34

78812 PET IMAGE SKULL-THIGH 0001 857.85

78813 PET IMAGE FULL BODY TC 0001 783.97

78813 PET IMAGE FULL BODY 26 0001 104.53

78813 PET IMAGE FULL BODY 0001 889.05


78814 PET IMAGE W/CT LMTD TC 0001 857.71

78814 PET IMAGE W/CT LMTD 26 0001 115.14

78814 PET IMAGE W/CT LMTD 0001 972.65

78815 PET IMAGE W/CT SKULL-THIGH TC 0001 947.84

78815 PET IMAGE W/CT SKULL-THIGH 26 0001 126.81

78815 PET IMAGE W/CT SKULL-THIGH 0001 1074.82

78816 PET IMAGE W/CT FULL BODY TC 0001 972.44

78816 PET IMAGE W/CT FULL BODY 26 0001 127.83

78816 PET IMAGE W/CT FULL BODY 0001 1102.71

78999 NUCLEAR DIAGNOSTIC EXAM TC 0001 0.00

78999 NUCLEAR DIAGNOSTIC EXAM 26 0001 0.00

78999 NUCLEAR DIAGNOSTIC EXAM 0001 0.00

79005 NUCLEAR RX ORAL ADMIN TC 0001 51.41

79005 NUCLEAR RX ORAL ADMIN 26 0001 90.37

79005 NUCLEAR RX ORAL ADMIN 0001 141.79

79101 NUCLEAR RX IV ADMIN TC 0001 52.17

79101 NUCLEAR RX IV ADMIN 26 0001 97.62

79101 NUCLEAR RX IV ADMIN 0001 149.79

79200 NUCLEAR RX INTRACAV ADMIN TC 0001 58.97

79200 NUCLEAR RX INTRACAV ADMIN 26 0001 105.95

79200 NUCLEAR RX INTRACAV ADMIN 0001 164.93

79300 NUCLR RX INTERSTIT COLLOID TC 0001 55.74

79300 NUCLR RX INTERSTIT COLLOID 26 0001 84.82

79300 NUCLR RX INTERSTIT COLLOID 0001 139.37

79403 HEMATOPOIETIC NUCLEAR TX TC 0001 85.84

79403 HEMATOPOIETIC NUCLEAR TX 26 0001 116.41

79403 HEMATOPOIETIC NUCLEAR TX 0001 202.25

79440 NUCLEAR RX INTRA-ARTICULAR TC 0001 50.28

79440 NUCLEAR RX INTRA-ARTICULAR 26 0001 101.30

79440 NUCLEAR RX INTRA-ARTICULAR 0001 151.59

79445 NUCLEAR RX INTRA-ARTERIAL TC 0001 104.92

79445 NUCLEAR RX INTRA-ARTERIAL 26 0001 121.18

79445 NUCLEAR RX INTRA-ARTERIAL 0001 227.68

80047 METABOLIC PANEL IONIZED CA 0001 10.96

80048 METABOLIC PANEL TOTAL CA 0001 10.96

80050 GENERAL HEALTH PANEL 0001 24.56

80051 ELECTROLYTE PANEL 0001 9.09

80053 COMPREHEN METABOLIC PANEL 0001 13.68

80055 OBSTETRIC PANEL 0001 49.38

80061 LIPID PANEL 0001 17.35

80069 RENAL FUNCTION PANEL 0001 11.25

80074 ACUTE HEPATITIS PANEL 0001 61.74

80076 HEPATIC FUNCTION PANEL 0001 10.58

80150 ASSAY OF AMIKACIN 0001 19.53

80156 ASSAY CARBAMAZEPINE TOTAL 0001 18.87

80157 ASSAY CARBAMAZEPINE FREE 0001 17.18


80158 ASSAY OF CYCLOSPORINE 0001 23.39

80162 ASSAY OF DIGOXIN TOTAL 0001 17.21

80164 ASSAY DIPROPYLACETIC ACD TOT 0001 17.56

80168 ASSAY OF ETHOSUXIMIDE 0001 21.18

80170 ASSAY OF GENTAMICIN 0001 21.24

80173 ASSAY OF HALOPERIDOL 0001 18.87

80176 ASSAY OF LIDOCAINE 0001 19.03

80178 ASSAY OF LITHIUM 0001 8.56

80184 ASSAY OF PHENOBARBITAL 0001 14.83

80185 ASSAY OF PHENYTOIN TOTAL 0001 17.18

80186 ASSAY OF PHENYTOIN FREE 0001 17.84

80188 ASSAY OF PRIMIDONE 0001 21.47

80190 ASSAY OF PROCAINAMIDE 0001 21.70

80192 ASSAY OF PROCAINAMIDE 0001 21.70

80194 ASSAY OF QUINIDINE 0001 18.92

80195 ASSAY OF SIROLIMUS 0001 17.79

80197 ASSAY OF TACROLIMUS 0001 17.79

80198 ASSAY OF THEOPHYLLINE 0001 18.33

80200 ASSAY OF TOBRAMYCIN 0001 20.89

80201 ASSAY OF TOPIRAMATE 0001 15.45

80202 ASSAY OF VANCOMYCIN 0001 17.56

80299 QUANTITATIVE ASSAY DRUG 0001 17.74

80400 ACTH STIMULATION PANEL 0001 42.27



80408 ALDOSTERONE SUPPRESSION EVAL 0001 162.64

80410 CALCITONIN STIMUL PANEL 0001 104.12

80412 CRH STIMULATION PANEL 0001 427.20

80414 TESTOSTERONE RESPONSE 0001 66.92

80415 ESTRADIOL RESPONSE PANEL 0001 72.42

80416 RENIN STIMULATION PANEL 0001 171.02

80417 RENIN STIMULATION PANEL 0001 57.00

80418 PITUITARY EVALUATION PANEL 0001 751.18

80420 DEXAMETHASONE PANEL 0001 93.37

80422 GLUCAGON TOLERANCE PANEL 0001 59.71

80424 GLUCAGON TOLERANCE PANEL 0001 65.44

80426 GONADOTROPIN HORMONE PANEL 0001 192.34

80428 GROWTH HORMONE PANEL 0001 86.45

80430 GROWTH HORMONE PANEL 0001 101.71

80432 INSULIN SUPPRESSION PANEL 0001 175.09

80434 INSULIN TOLERANCE PANEL 0001 131.12

80435 INSULIN TOLERANCE PANEL 0001 133.51

80436 METYRAPONE PANEL 0001 118.15

80438 TRH STIMULATION PANEL 0001 65.33

80439 TRH STIMULATION PANEL 0001 87.11

80500 LAB PATHOLOGY CONSULTATION 0001 20.55


80502 LAB PATHOLOGY CONSULTATION 0001 66.25

81000 URINALYSIS NONAUTO W/SCOPE 0001 4.10

81001 URINALYSIS AUTO W/SCOPE 0001 4.10

81002 URINALYSIS NONAUTO W/O SCOPE 0001 3.31

81003 URINALYSIS AUTO W/O SCOPE 0001 2.90

81005 URINALYSIS 0001 2.81

81007 URINE SCREEN FOR BACTERIA 0001 1.25

81015 MICROSCOPIC EXAM OF URINE 0001 3.94

81020 URINALYSIS GLASS TEST 0001 4.77

81025 URINE PREGNANCY TEST 0001 8.19

81050 URINALYSIS VOLUME MEASURE 0001 3.88

82009 TEST FOR ACETONE/KETONES 0001 5.85

82010 ACETONE ASSAY 0001 10.59

82013 ACETYLCHOLINESTERASE ASSAY 0001 14.47

82016 ACYLCARNITINES QUAL 0001 17.96

82017 ACYLCARNITINES QUANT 0001 21.85

82024 ASSAY OF ACTH 0001 50.06

82030 ASSAY OF ADP & AMP 0001 33.43

82040 ASSAY OF SERUM ALBUMIN 0001 6.41

82042 ASSAY OF URINE ALBUMIN 0001 6.70

82043 MICROALBUMIN QUANTITATIVE 0001 7.49

82044 MICROALBUMIN SEMIQUANT 0001 5.92

82045 ALBUMIN ISCHEMIA MODIFIED 0001 43.99

82075 ASSAY OF BREATH ETHANOL 0001 15.61

82085 ASSAY OF ALDOLASE 0001 12.57

82088 ASSAY OF ALDOSTERONE 0001 52.82

82103 ALPHA-1-ANTITRYPSIN TOTAL 0001 17.41

82104 ALPHA-1-ANTITRYPSIN PHENO 0001 18.74

82105 ALPHA-FETOPROTEIN SERUM 0001 21.69

82106 ALPHA-FETOPROTEIN AMNIOTIC 0001 21.69

82107 ALPHA-FETOPROTEIN L3 0001 48.15

82108 ASSAY OF ALUMINUM 0001 33.02

82120 AMINES VAGINAL FLUID QUAL 0001 4.88

82127 AMINO ACID SINGLE QUAL 0001 17.96

82128 AMINO ACIDS MULT QUAL 0001 17.96

82131 AMINO ACIDS SINGLE QUANT 0001 21.85

82135 ASSAY AMINOLEVULINIC ACID 0001 21.32

82136 AMINO ACIDS QUANT 2-5 0001 21.85

82139 AMINO ACIDS QUAN 6 OR MORE 0001 21.85

82140 ASSAY OF AMMONIA 0001 18.88

82143 AMNIOTIC FLUID SCAN 0001 8.90

82150 ASSAY OF AMYLASE 0001 8.39

82154 ANDROSTANEDIOL GLUCURONIDE 0001 37.37

82157 ASSAY OF ANDROSTENEDIONE 0001 37.94

82160 ASSAY OF ANDROSTERONE 0001 32.40

82163 ASSAY OF ANGIOTENSIN II 0001 26.59


82164 ANGIOTENSIN I ENZYME TEST 0001 18.92

82172 ASSAY OF APOLIPOPROTEIN 0001 20.08

82175 ASSAY OF ARSENIC 0001 24.59

82180 ASSAY OF ASCORBIC ACID 0001 12.80

82190 ATOMIC ABSORPTION 0001 19.32

82232 ASSAY OF BETA-2 PROTEIN 0001 20.96

82239 BILE ACIDS TOTAL 0001 22.20

82240 BILE ACIDS CHOLYLGLYCINE 0001 34.44

82247 BILIRUBIN TOTAL 0001 6.49

82248 BILIRUBIN DIRECT 0001 6.49

82252 FECAL BILIRUBIN TEST 0001 5.89

82261 ASSAY OF BIOTINIDASE 0001 21.85

82270 OCCULT BLOOD FECES 0001 4.21

82271 OCCULT BLOOD OTHER SOURCES 0001 4.21

82272 OCCULT BLD FECES 1-3 TESTS 0001 4.21

82274 ASSAY TEST FOR BLOOD FECAL 0001 20.61

82286 ASSAY OF BRADYKININ 0001 8.93

82300 ASSAY OF CADMIUM 0001 30.00

82306 VITAMIN D 25 HYDROXY 0001 37.99

82308 ASSAY OF CALCITONIN 0001 34.71

82310 ASSAY OF CALCIUM 0001 6.68

82330 ASSAY OF CALCIUM 0001 17.71

82331 CALCIUM INFUSION TEST 0001 6.70

82340 ASSAY OF CALCIUM IN URINE 0001 7.81

82355 CALCULUS ANALYSIS QUAL 0001 15.00

82360 CALCULUS ASSAY QUANT 0001 16.68

82365 CALCULUS SPECTROSCOPY 0001 16.71

82370 X-RAY ASSAY CALCULUS 0001 16.23

82373 ASSAY C-D TRANSFER MEASURE 0001 23.39

82374 ASSAY BLOOD CARBON DIOXIDE 0001 6.33

82375 ASSAY CARBOXYHB QUANT 0001 15.96

82376 ASSAY CARBOXYHB QUAL 0001 7.59

82378 CARCINOEMBRYONIC ANTIGEN 0001 24.58

82379 ASSAY OF CARNITINE 0001 21.85

82380 ASSAY OF CAROTENE 0001 11.95

82382 ASSAY URINE CATECHOLAMINES 0001 22.28

82383 ASSAY BLOOD CATECHOLAMINES 0001 32.48

82384 ASSAY THREE CATECHOLAMINES 0001 32.72

82387 ASSAY OF CATHEPSIN-D 0001 26.97

82390 ASSAY OF CERULOPLASMIN 0001 13.91

82397 CHEMILUMINESCENT ASSAY 0001 18.30

82415 ASSAY OF CHLORAMPHENICOL 0001 16.42

82435 ASSAY OF BLOOD CHLORIDE 0001 5.95

82436 ASSAY OF URINE CHLORIDE 0001 6.51

82438 ASSAY OTHER FLUID CHLORIDES 0001 6.33

82441 TEST FOR CHLOROHYDROCARBONS 0001 7.78


82465 ASSAY BLD/SERUM CHOLESTEROL 0001 5.63

82480 ASSAY SERUM CHOLINESTERASE 0001 10.21

82482 ASSAY RBC CHOLINESTERASE 0001 9.95

82485 ASSAY CHONDROITIN SULFATE 0001 26.76

82486 GAS/LIQUID CHROMATOGRAPHY 0001 23.39

82487 PAPER CHROMATOGRAPHY 0001 20.70

82488 PAPER CHROMATOGRAPHY 0001 27.69

82489 THIN LAYER CHROMATOGRAPHY 0001 23.96

82491 CHROMOTOGRAPHY QUANT SING 0001 23.39

82492 CHROMOTOGRAPHY QUANT MULT 0001 23.39

82495 ASSAY OF CHROMIUM 0001 26.28

82507 ASSAY OF CITRATE 0001 36.03

82523 COLLAGEN CROSSLINKS 0001 24.22

82525 ASSAY OF COPPER 0001 16.08

82528 ASSAY OF CORTICOSTERONE 0001 29.18

82530 CORTISOL FREE 0001 21.66

82533 TOTAL CORTISOL 0001 21.12

82540 ASSAY OF CREATINE 0001 6.00

82541 COLUMN CHROMOTOGRAPHY QUAL 0001 23.39

82542 COLUMN CHROMOTOGRAPHY QUANT 0001 23.39

82543 COLUMN CHROMOTOGRAPH/ISOTOPE 0001 23.39

82544 COLUMN CHROMOTOGRAPH/ISOTOPE 0001 23.39

82550 ASSAY OF CK (CPK) 0001 8.43

82552 ASSAY OF CPK IN BLOOD 0001 17.36

82553 CREATINE MB FRACTION 0001 14.96

82554 CREATINE ISOFORMS 0001 15.38

82565 ASSAY OF CREATININE 0001 6.64

82570 ASSAY OF URINE CREATININE 0001 6.70

82575 CREATININE CLEARANCE TEST 0001 12.24

82585 ASSAY OF CRYOFIBRINOGEN 0001 11.12

82595 ASSAY OF CRYOGLOBULIN 0001 8.38

82600 ASSAY OF CYANIDE 0001 25.13

82607 VITAMIN B-12 0001 19.53

82608 B-12 BINDING CAPACITY 0001 18.56

82610 Cystatin c 0001 17.61

82615 TEST FOR URINE CYSTINES 0001 10.58

82626 DEHYDROEPIANDROSTERONE 0001 32.75

82627 DEHYDROEPIANDROSTERONE 0001 28.81

82633 DESOXYCORTICOSTERONE 0001 40.14

82634 DEOXYCORTISOL 0001 37.94

82638 ASSAY OF DIBUCAINE NUMBER 0001 15.87

82652 VIT D 1 25-DIHYDROXY 0001 49.90

82656 PANCREATIC ELASTASE FECAL 0001 14.95

82657 ENZYME CELL ACTIVITY 0001 23.39

82658 ENZYME CELL ACTIVITY RA 0001 23.39

82664 ELECTROPHORETIC TEST 0001 44.52


82668 ASSAY OF ERYTHROPOIETIN 0001 24.36

82670 ASSAY OF ESTRADIOL 0001 36.21

82671 ASSAY OF ESTROGENS 0001 41.86

82672 ASSAY OF ESTROGEN 0001 28.12

82677 ASSAY OF ESTRIOL 0001 31.34

82679 ASSAY OF ESTRONE 0001 32.34

82693 ASSAY OF ETHYLENE GLYCOL 0001 19.30

82696 ASSAY OF ETIOCHOLANOLONE 0001 30.57

82705 FATS/LIPIDS FECES QUAL 0001 6.59

82710 FATS/LIPIDS FECES QUANT 0001 21.78

82715 ASSAY OF FECAL FAT 0001 22.30

82725 ASSAY OF BLOOD FATTY ACIDS 0001 17.25

82726 LONG CHAIN FATTY ACIDS 0001 23.39

82728 ASSAY OF FERRITIN 0001 17.66

82731 ASSAY OF FETAL FIBRONECTIN 0001 48.15

82735 ASSAY OF FLUORIDE 0001 24.02

82746 ASSAY OF FOLIC ACID SERUM 0001 19.05

82747 ASSAY OF FOLIC ACID RBC 0001 22.44

82759 ASSAY OF RBC GALACTOKINASE 0001 27.84

82760 ASSAY OF GALACTOSE 0001 14.50

82775 ASSAY GALACTOSE TRANSFERASE 0001 27.30

82776 GALACTOSE TRANSFERASE TEST 0001 10.86

82784 ASSAY IGA/IGD/IGG/IGM EACH 0001 8.67

82785 ASSAY OF IGE 0001 21.34

82787 IGG 1 2 3 OR 4 EACH 0001 10.39

82800 BLOOD PH 0001 10.96

82803 BLOOD GASES ANY COMBINATION 0001 25.08

82805 BLOOD GASES W/O2 SATURATION 0001 36.77

82810 BLOOD GASES O2 SAT ONLY 0001 11.31

82820 HEMOGLOBIN-OXYGEN AFFINITY 0001 12.29

82930 GASTRIC ANALY W/PH EA SPEC GASTR 0001 6.90

82938 GASTRIN TEST 0001 22.93

82941 ASSAY OF GASTRIN 0001 22.85

82943 ASSAY OF GLUCAGON 0001 18.51

82945 GLUCOSE OTHER FLUID 0001 5.09

82946 GLUCAGON TOLERANCE TEST 0001 19.53

82947 ASSAY GLUCOSE BLOOD QUANT 0001 5.09

82948 REAGENT STRIP/BLOOD GLUCOSE 0001 4.10

82950 GLUCOSE TEST 0001 6.15

82951 GLUCOSE TOLERANCE TEST (GTT) 0001 13.50

82952 GTT-ADDED SAMPLES 0001 5.08

82955 ASSAY OF G6PD ENZYME 0001 12.55

82960 TEST FOR G6PD ENZYME 0001 7.84

82962 GLUCOSE BLOOD TEST 0001 2.33

82963 ASSAY OF GLUCOSIDASE 0001 27.84

82965 ASSAY OF GDH ENZYME 0001 10.02


82977 ASSAY OF GGT 0001 9.32

82978 ASSAY OF GLUTATHIONE 0001 18.47

82979 ASSAY RBC GLUTATHIONE 0001 8.93

82985 ASSAY OF GLYCATED PROTEIN 0001 19.53

83001 ASSAY OF GONADOTROPIN (FSH) 0001 24.08

83002 ASSAY OF GONADOTROPIN (LH) 0001 23.99

83003 ASSAY GROWTH HORMONE (HGH) 0001 21.62

83009 H PYLORI (C-13) BLOOD 0001 87.29

83010 ASSAY OF HAPTOGLOBIN QUANT 0001 16.30

83012 ASSAY OF HAPTOGLOBINS 0001 22.28

83013 H PYLORI (C-13) BREATH 0001 87.29

83014 H PYLORI DRUG ADMIN 0001 10.19

83015 HEAVY METAL SCREEN 0001 24.40

83018 QUANTITATIVE SCREEN METALS 0001 28.46

83020 HEMOGLOBIN ELECTROPHORESIS 26 0001 18.76

83020 HEMOGLOBIN ELECTROPHORESIS 0001 16.68

83021 HEMOGLOBIN CHROMOTOGRAPHY 0001 23.39

83026 HEMOGLOBIN COPPER SULFATE 0001 3.06

83030 FETAL HEMOGLOBIN CHEMICAL 0001 10.71

83033 FETAL HEMOGLOBIN ASSAY QUAL 0001 7.72

83036 GLYCOSYLATED HEMOGLOBIN TEST 0001 12.57

83037 GLYCOSYLATED HB HOME DEVICE 0001 12.57

83045 BLOOD METHEMOGLOBIN TEST 0001 6.42

83050 BLOOD METHEMOGLOBIN ASSAY 0001 9.50

83051 ASSAY OF PLASMA HEMOGLOBIN 0001 9.48

83060 BLOOD SULFHEMOGLOBIN ASSAY 0001 10.71

83065 ASSAY OF HEMOGLOBIN HEAT 0001 8.93

83068 HEMOGLOBIN STABILITY SCREEN 0001 10.96

83069 ASSAY OF URINE HEMOGLOBIN 0001 5.12

83070 ASSAY OF HEMOSIDERIN QUAL 0001 6.15

83080 ASSAY OF B HEXOSAMINIDASE 0001 21.85

83088 ASSAY OF HISTAMINE 0001 38.27

83090 ASSAY OF HOMOCYSTINE 0001 21.85

83150 ASSAY OF HOMOVANILLIC ACID 0001 25.08

83491 ASSAY OF CORTICOSTEROIDS 17 0001 22.70

83497 ASSAY OF 5-HIAA 0001 16.71

83498 ASSAY OF PROGESTERONE 17-D 0001 35.21

83499 ASSAY OF PROGESTERONE 20- 0001 32.68

83500 ASSAY FREE HYDROXYPROLINE 0001 29.35

83505 ASSAY TOTAL HYDROXYPROLINE 0001 31.51

83516 IMMUNOASSAY NONANTIBODY 0001 14.95

83518 IMMUNOASSAY DIPSTICK 0001 10.98

83519 RIA NONANTIBODY 0001 17.50

83520 IMMUNOASSAY QUANT NOS NONAB 0001 16.77

83525 ASSAY OF INSULIN 0001 14.81

83527 ASSAY OF INSULIN 0001 16.78


83528 ASSAY OF INTRINSIC FACTOR 0001 20.61

83540 ASSAY OF IRON 0001 7.38

83550 IRON BINDING TEST 0001 9.07

83570 ASSAY OF IDH ENZYME 0001 11.46

83582 ASSAY OF KETOGENIC STEROIDS 0001 18.37

83586 ASSAY 17- KETOSTEROIDS 0001 16.59

83593 FRACTIONATION KETOSTEROIDS 0001 34.08

83605 ASSAY OF LACTIC ACID 0001 13.84

83615 LACTATE (LD) (LDH) ENZYME 0001 7.81

83625 ASSAY OF LDH ENZYMES 0001 16.58

83630 LACTOFERRIN FECAL (QUAL) 0001 25.44

83631 LACTOFERRIN FECAL (QUANT) 0001 25.44

83632 PLACENTAL LACTOGEN 0001 26.20

83633 TEST URINE FOR LACTOSE 0001 7.12

83655 ASSAY OF LEAD 0001 15.69

83661 L/S RATIO FETAL LUNG 0001 28.49

83662 FOAM STABILITY FETAL LUNG 0001 24.51

83663 FLUORO POLARIZE FETAL LUNG 0001 24.51

83664 LAMELLAR BDY FETAL LUNG 0001 24.51

83670 ASSAY OF LAP ENZYME 0001 11.86

83690 ASSAY OF LIPASE 0001 8.93

83695 ASSAY OF LIPOPROTEIN(A) 0001 16.77

83698 ASSAY LIPOPROTEIN PLA2 0001 43.99

83700 LIPOPRO BLD ELECTROPHORETIC 0001 14.59

83701 LIPOPROTEIN BLD HR FRACTION 0001 32.16

83704 LIPOPROTEIN BLD BY NMR 0001 40.88

83718 ASSAY OF LIPOPROTEIN 0001 10.61

83719 ASSAY OF BLOOD LIPOPROTEIN 0001 15.07

83721 ASSAY OF BLOOD LIPOPROTEIN 0001 12.36

83727 ASSAY OF LRH HORMONE 0001 22.28

83735 ASSAY OF MAGNESIUM 0001 8.68

83775 ASSAY MALATE DEHYDROGENASE 0001 9.55

83785 ASSAY OF MANGANESE 0001 31.87

83788 MASS SPECTROMETRY QUAL 0001 23.39

83789 MASS SPECTROMETRY QUANT 0001 23.39

83825 ASSAY OF MERCURY 0001 21.07

83835 ASSAY OF METANEPHRINES 0001 21.95

83857 ASSAY OF METHEMALBUMIN 0001 13.91

83861 MICROFLUID ANALY TEARS MICRO 0001 21.41

83864 MUCOPOLYSACCHARIDES 0001 25.81

83872 ASSAY SYNOVIAL FLUID MUCIN 0001 7.59

83873 ASSAY OF CSF PROTEIN 0001 22.29

83874 ASSAY OF MYOGLOBIN 0001 16.73

83876 ASSAY MYELOPEROXIDASE 0001 43.99

83880 ASSAY OF NATRIURETIC PEPTIDE 0001 43.99

83883 ASSAY NEPHELOMETRY NOT SPEC 0001 17.61


83885 ASSAY OF NICKEL 0001 31.75

83915 ASSAY OF NUCLEOTIDASE 0001 14.44

83916 OLIGOCLONAL BANDS 0001 26.05

83918 ORGANIC ACIDS TOTAL QUANT 0001 21.32

83919 ORGANIC ACIDS QUAL EACH 0001 21.32

83921 ORGANIC ACID SINGLE QUANT 0001 21.32

83930 ASSAY OF BLOOD OSMOLALITY 0001 8.56

83935 ASSAY OF URINE OSMOLALITY 0001 8.83

83937 ASSAY OF OSTEOCALCIN 0001 38.68

83945 ASSAY OF OXALATE 0001 16.68

83950 ONCOPROTEIN HER-2/NEU 0001 48.15

83951 ONCOPROTEIN DCP 0001 48.15

83970 ASSAY OF PARATHORMONE 0001 53.49

83986 ASSAY PH BODY FLUID NOS 0001 4.63

83992 ASSAY FOR PHENCYCLIDINE 0001 16.53

83993 Assay for calprotectin fecal 0001 25.44

84030 ASSAY OF BLOOD PKU 0001 7.12

84035 ASSAY OF PHENYLKETONES 0001 4.75

84060 ASSAY ACID PHOSPHATASE 0001 9.57

84061 PHOSPHATASE FORENSIC EXAM 0001 10.25

84066 ASSAY PROSTATE PHOSPHATASE 0001 12.52

84075 ASSAY ALKALINE PHOSPHATASE 0001 6.70

84078 ASSAY ALKALINE PHOSPHATASE 0001 8.67

84080 ASSAY ALKALINE PHOSPHATASES 0001 19.16

84081 ASSAY PHOSPHATIDYLGLYCEROL 0001 21.41

84085 ASSAY OF RBC PG6D ENZYME 0001 8.74

84087 ASSAY PHOSPHOHEXOSE ENZYMES 0001 13.38

84100 ASSAY OF PHOSPHORUS 0001 6.13

84105 ASSAY OF URINE PHOSPHORUS 0001 6.70

84106 TEST FOR PORPHOBILINOGEN 0001 5.54

84110 ASSAY OF PORPHOBILINOGEN 0001 10.93

84112 EVAL AMNIOTIC FLUID PROTEIN 0001 48.15

84119 TEST URINE FOR PORPHYRINS 0001 11.16

84120 ASSAY OF URINE PORPHYRINS 0001 19.06

84126 ASSAY OF FECES PORPHYRINS 0001 33.01

84132 ASSAY OF SERUM POTASSIUM 0001 5.95

84133 ASSAY OF URINE POTASSIUM 0001 5.57

84134 ASSAY OF PREALBUMIN 0001 18.89

84135 ASSAY OF PREGNANEDIOL 0001 24.79

84138 ASSAY OF PREGNANETRIOL 0001 24.53

84140 ASSAY OF PREGNENOLONE 0001 26.79

84143 ASSAY OF 17-HYDROXYPREGNENO 0001 29.57

84144 ASSAY OF PROGESTERONE 0001 27.03

84146 ASSAY OF PROLACTIN 0001 25.11

84150 ASSAY OF PROSTAGLANDIN 0001 32.34

84152 ASSAY OF PSA COMPLEXED 0001 23.83


84153 ASSAY OF PSA TOTAL 0001 23.83

84154 ASSAY OF PSA FREE 0001 23.83

84155 ASSAY OF PROTEIN SERUM 0001 4.75

84156 ASSAY OF PROTEIN URINE 0001 4.75

84157 ASSAY OF PROTEIN OTHER 0001 4.75

84160 ASSAY OF PROTEIN ANY SOURCE 0001 6.70

84163 PAPPA SERUM 0001 18.20

84165 PROTEIN E-PHORESIS SERUM 26 0001 18.76

84165 PROTEIN E-PHORESIS SERUM 0001 13.91

84166 PROTEIN E-PHORESIS/URINE/CSF 26 0001 18.76

84166 PROTEIN E-PHORESIS/URINE/CSF 0001 23.11

84181 WESTERN BLOT TEST 26 0001 18.76

84181 WESTERN BLOT TEST 0001 22.07

84182 PROTEIN WESTERN BLOT TEST 26 0001 18.76

84182 PROTEIN WESTERN BLOT TEST 0001 23.32

84202 ASSAY RBC PROTOPORPHYRIN 0001 18.59

84203 TEST RBC PROTOPORPHYRIN 0001 11.15

84206 ASSAY OF PROINSULIN 0001 23.08

84207 ASSAY OF VITAMIN B-6 0001 36.41

84210 ASSAY OF PYRUVATE 0001 14.06

84220 ASSAY OF PYRUVATE KINASE 0001 12.23

84228 ASSAY OF QUININE 0001 15.07

84233 ASSAY OF ESTROGEN 0001 48.15

84234 ASSAY OF PROGESTERONE 0001 40.60

84235 ASSAY OF ENDOCRINE HORMONE 0001 67.83

84238 ASSAY NONENDOCRINE RECEPTOR 0001 47.39

84244 ASSAY OF RENIN 0001 28.50


84255 ASSAY OF SELENIUM 0001 33.08

84260 ASSAY OF SEROTONIN 0001 40.14

84270 ASSAY OF SEX HORMONE GLOBUL 0001 28.16

84275 ASSAY OF SIALIC ACID 0001 17.41

84285 ASSAY OF SILICA 0001 30.51

84295 ASSAY OF SERUM SODIUM 0001 6.23

84300 ASSAY OF URINE SODIUM 0001 6.30

84302 ASSAY OF SWEAT SODIUM 0001 6.30

84305 ASSAY OF SOMATOMEDIN 0001 27.55

84307 ASSAY OF SOMATOSTATIN 0001 23.69

84311 SPECTROPHOTOMETRY 0001 9.06

84315 BODY FLUID SPECIFIC GRAVITY 0001 3.25

84375 CHROMATOGRAM ASSAY SUGARS 0001 25.41

84376 SUGARS SINGLE QUAL 0001 7.12

84377 SUGARS MULTIPLE QUAL 0001 7.12

84378 SUGARS SINGLE QUANT 0001 14.94

84379 SUGARS MULTIPLE QUANT 0001 14.94

84392 ASSAY OF URINE SULFATE 0001 6.15


84402 ASSAY OF FREE TESTOSTERONE 0001 33.00

84403 ASSAY OF TOTAL TESTOSTERONE 0001 33.45


84430 ASSAY OF THIOCYANATE 0001 15.07

84432 ASSAY OF THYROGLOBULIN 0001 20.81

84436 ASSAY OF TOTAL THYROXINE 0001 8.90

84437 ASSAY OF NEONATAL THYROXINE 0001 8.38

84439 ASSAY OF FREE THYROXINE 0001 11.68

84442 ASSAY OF THYROID ACTIVITY 0001 19.16

84443 ASSAY THYROID STIM HORMONE 0001 21.78

84445 ASSAY OF TSI GLOBULIN 0001 65.91

84446 ASSAY OF VITAMIN E 0001 18.37

84449 ASSAY OF TRANSCORTIN 0001 23.32

84450 TRANSFERASE (AST) (SGOT) 0001 6.70

84460 ALANINE AMINO (ALT) (SGPT) 0001 6.85

84466 ASSAY OF TRANSFERRIN 0001 16.54

84478 ASSAY OF TRIGLYCERIDES 0001 7.44

84479 ASSAY OF THYROID (T3 OR T4) 0001 8.38

84480 ASSAY TRIIODOTHYRONINE (T3) 0001 18.37

84481 FREE ASSAY (FT-3) 0001 21.95

84482 T3 REVERSE 0001 20.42

84484 ASSAY OF TROPONIN QUANT 0001 12.74

84485 ASSAY DUODENAL FLUID TRYPSIN 0001 9.73

84488 TEST FECES FOR TRYPSIN 0001 9.46

84490 ASSAY OF FECES FOR TRYPSIN 0001 9.85

84510 ASSAY OF TYROSINE 0001 13.48

84512 ASSAY OF TROPONIN QUAL 0001 9.98

84520 ASSAY OF UREA NITROGEN 0001 5.12

84525 UREA NITROGEN SEMI-QUANT 0001 4.88

84540 ASSAY OF URINE/UREA-N 0001 6.15

84545 UREA-N CLEARANCE TEST 0001 8.55

84550 ASSAY OF BLOOD/URIC ACID 0001 5.85

84560 ASSAY OF URINE/URIC ACID 0001 6.15

84577 ASSAY OF FECES/UROBILINOGEN 0001 16.17

84578 TEST URINE UROBILINOGEN 0001 4.20

84580 ASSAY OF URINE UROBILINOGEN 0001 9.19

84583 ASSAY OF URINE UROBILINOGEN 0001 6.51

84585 ASSAY OF URINE VMA 0001 20.08

84586 ASSAY OF VIP 0001 45.79

84588 ASSAY OF VASOPRESSIN 0001 43.99

84590 ASSAY OF VITAMIN A 0001 15.03

84591 ASSAY OF NOS VITAMIN 0001 15.03

84597 ASSAY OF VITAMIN K 0001 17.77

84600 ASSAY OF VOLATILES 0001 20.83

84620 XYLOSE TOLERANCE TEST 0001 15.35

84630 ASSAY OF ZINC 0001 14.75


84681 ASSAY OF C-PEPTIDE 0001 26.97

84702 CHORIONIC GONADOTROPIN TEST 0001 18.20

84703 CHORIONIC GONADOTROPIN ASSAY 0001 9.74

84704 HCG FREE BETACHAIN TEST 0001 18.20

84830 OVULATION TESTS 0001 12.99

85002 BLEEDING TIME TEST 0001 5.84

85004 AUTOMATED DIFF WBC COUNT 0001 8.38

85007 BL SMEAR W/DIFF WBC COUNT 0001 4.45

85008 BL SMEAR W/O DIFF WBC COUNT 0001 4.45

85009 MANUAL DIFF WBC COUNT B-COAT 0001 4.82

85013 SPUN MICROHEMATOCRIT 0001 3.06

85014 HEMATOCRIT 0001 3.06

85018 HEMOGLOBIN 0001 3.06

85025 COMPLETE CBC W/AUTO DIFF WBC 0001 10.07

85027 COMPLETE CBC AUTOMATED 0001 8.38

85032 MANUAL CELL COUNT EACH 0001 5.57

85041 AUTOMATED RBC COUNT 0001 3.90

85044 MANUAL RETICULOCYTE COUNT 0001 5.57

85045 AUTOMATED RETICULOCYTE COUNT 0001 5.17

85046 RETICYTE/HGB CONCENTRATE 0001 7.22

85048 AUTOMATED LEUKOCYTE COUNT 0001 3.28

85049 AUTOMATED PLATELET COUNT 0001 5.80

85055 RETICULATED PLATELET ASSAY 0001 23.45

85060 BLOOD SMEAR INTERPRETATION 0001 23.99

85097 BONE MARROW INTERPRETATION 0001 84.88

85130 CHROMOGENIC SUBSTRATE ASSAY 0001 15.40

85170 BLOOD CLOT RETRACTION 0001 4.69

85175 BLOOD CLOT LYSIS TIME 0001 5.89

85210 CLOT FACTOR II PROTHROM SPEC 0001 16.83

85220 BLOOC CLOT FACTOR V TEST 0001 22.86

85230 CLOT FACTOR VII PROCONVERTIN 0001 23.20

85240 CLOT FACTOR VIII AHG 1 STAGE 0001 23.20

85244 CLOT FACTOR VIII RELTD ANTGN 0001 26.45

85245 CLOT FACTOR VIII VW RISTOCTN 0001 29.73

85246 CLOT FACTOR VIII VW ANTIGEN 0001 29.73

85247 CLOT FACTOR VIII MULTIMETRIC 0001 29.73

85250 CLOT FACTOR IX PTC/CHRSTMAS 0001 24.67

85260 CLOT FACTOR X STUART-POWER 0001 23.20

85270 CLOT FACTOR XI PTA 0001 23.20

85280 CLOT FACTOR XII HAGEMAN 0001 25.08

85290 CLOT FACTOR XIII FIBRIN STAB 0001 21.18

85291 CLOT FACTOR XIII FIBRIN SCRN 0001 11.53

85292 CLOT FACTOR FLETCHER FACT 0001 24.54

85293 CLOT FACTOR WGHT KININOGEN 0001 24.54

85300 ANTITHROMBIN III ACTIVITY 0001 15.36

85301 ANTITHROMBIN III ANTIGEN 0001 14.01


85302 CLOT INHIBIT PROT C ANTIGEN 0001 15.58

85303 CLOT INHIBIT PROT C ACTIVITY 0001 17.92

85305 CLOT INHIBIT PROT S TOTAL 0001 15.03

85306 CLOT INHIBIT PROT S FREE 0001 19.86

85307 ASSAY ACTIVATED PROTEIN C 0001 19.86

85335 FACTOR INHIBITOR TEST 0001 16.68

85337 THROMBOMODULIN 0001 9.16

85345 COAGULATION TIME LEE & WHITE 0001 5.57

85347 COAGULATION TIME ACTIVATED 0001 5.51

85348 COAGULATION TIME OTR METHOD 0001 4.82

85360 EUGLOBULIN LYSIS 0001 10.88

85362 FIBRIN DEGRADATION PRODUCTS 0001 7.36

85366 FIBRINOGEN TEST 0001 10.86

85370 FIBRINOGEN TEST 0001 14.71

85378 FIBRIN DEGRADE SEMIQUANT 0001 9.24

85379 FIBRIN DEGRADATION QUANT 0001 13.19

85384 FIBRINOGEN ACTIVITY 0001 11.00

85385 FIBRINOGEN ANTIGEN 0001 11.00

85390 FIBRINOLYSINS SCREEN I&R 26 0001 18.76

85390 FIBRINOLYSINS SCREEN I&R 0001 6.69

85396 CLOTTING ASSAY WHOLE BLOOD 0001 19.83

85397 CLOTTING FUNCT ACTIVITY 0001 29.73

85400 FIBRINOLYTIC PLASMIN 0001 11.46

85410 FIBRINOLYTIC ANTIPLASMIN 0001 9.99

85415 FIBRINOLYTIC PLASMINOGEN 0001 22.28



85441 HEINZ BODIES DIRECT 0001 5.45

85445 HEINZ BODIES INDUCED 0001 8.83

85460 HEMOGLOBIN FETAL 0001 10.03

85461 HEMOGLOBIN FETAL 0001 8.59

85475 HEMOLYSIN ACID 0001 11.50

85520 HEPARIN ASSAY 0001 16.96

85525 HEPARIN NEUTRALIZATION 0001 15.35

85530 HEPARIN-PROTAMINE TOLERANCE 0001 18.37

85536 IRON STAIN PERIPHERAL BLOOD 0001 8.38

85540 WBC ALKALINE PHOSPHATASE 0001 11.15

85547 RBC MECHANICAL FRAGILITY 0001 11.15

85549 MURAMIDASE 0001 24.31

85555 RBC OSMOTIC FRAGILITY 0001 8.66

85557 RBC OSMOTIC FRAGILITY 0001 17.31

85576 BLOOD PLATELET AGGREGATION 26 0001 18.76

85576 BLOOD PLATELET AGGREGATION 0001 27.84

85597 PHOSPHOLIPID PLTLT NEUTRALIZ 0001 23.29

85598 HEXAGNAL PHOSPH PLTLT NEUTRL PHOSP 0001 23.29

85610 PROTHROMBIN TIME 0001 5.10


85611 PROTHROMBIN TEST 0001 5.11

85612 VIPER VENOM PROTHROMBIN TIME 0001 12.40

85613 RUSSELL VIPER VENOM DILUTED 0001 12.40

85635 REPTILASE TEST 0001 12.75

85651 RBC SED RATE NONAUTOMATED 0001 4.59

85652 RBC SED RATE AUTOMATED 0001 3.50

85660 RBC SICKLE CELL TEST 0001 7.15

85670 THROMBIN TIME PLASMA 0001 7.47

85675 THROMBIN TIME TITER 0001 8.87

85705 THROMBOPLASTIN INHIBITION 0001 12.47

85730 THROMBOPLASTIN TIME PARTIAL 0001 7.78

85732 THROMBOPLASTIN TIME PARTIAL 0001 8.38

85810 BLOOD VISCOSITY EXAMINATION 0001 15.12

86000 AGGLUTININS FEBRILE ANTIGEN 0001 9.04

86001 ALLERGEN SPECIFIC IGG 0001 6.76

86003 ALLERGEN SPECIFIC IGE 0001 6.76

86005 ALLERGEN SPECIFIC IGE 0001 10.33

86021 WBC ANTIBODY IDENTIFICATION 0001 14.69

86022 PLATELET ANTIBODIES 0001 23.80

86023 IMMUNOGLOBULIN ASSAY 0001 10.26

86038 ANTINUCLEAR ANTIBODIES 0001 15.66

86039 ANTINUCLEAR ANTIBODIES (ANA) 0001 14.46

86060 ANTISTREPTOLYSIN O TITER 0001 9.46

86063 ANTISTREPTOLYSIN O SCREEN 0001 7.47

86077 PHYS BLOOD BANK SERV XMATCH 0001 53.29

86078 PHYS BLOOD BANK SERV REACTJ 0001 53.29

86140 C-REACTIVE PROTEIN 0001 6.70

86141 C-REACTIVE PROTEIN HS 0001 16.77

86146 BETA-2 GLYCOPROTEIN ANTIBODY 0001 32.97

86147 CARDIOLIPIN ANTIBODY EA IG 0001 32.97

86148 ANTI-PHOSPHOLIPID ANTIBODY 0001 20.82

86155 CHEMOTAXIS ASSAY 0001 20.71

86156 COLD AGGLUTININ SCREEN 0001 8.68

86157 COLD AGGLUTININ TITER 0001 10.45

86160 COMPLEMENT ANTIGEN 0001 15.56

86161 COMPLEMENT/FUNCTION ACTIVITY 0001 15.56

86162 COMPLEMENT TOTAL (CH50) 0001 26.33

86171 COMPLEMENT FIXATION EACH 0001 12.97

86185 COUNTERIMMUNOELECTROPHORESIS 0001 11.59

86200 CCP ANTIBODY 0001 16.77

86215 DEOXYRIBONUCLEASE ANTIBODY 0001 17.17

86225 DNA ANTIBODY NATIVE 0001 17.80

86226 DNA ANTIBODY SINGLE STRAND 0001 15.69

86235 NUCLEAR ANTIGEN ANTIBODY 0001 21.69

86243 FC RECEPTOR 0001 26.59

86255 FLUORESCENT ANTIBODY SCREEN 26 0001 18.76


86255 FLUORESCENT ANTIBODY SCREEN 0001 15.61

86256 FLUORESCENT ANTIBODY TITER 26 0001 18.00

86256 FLUORESCENT ANTIBODY TITER 0001 15.61

86277 GROWTH HORMONE ANTIBODY 0001 20.39

86280 HEMAGGLUTINATION INHIBITION 0001 10.61

86294 IMMUNOASSAY TUMOR QUAL 0001 25.43

86300 IMMUNOASSAY TUMOR CA 15-3 0001 26.97

86301 IMMUNOASSAY TUMOR CA 19-9 0001 26.97

86304 IMMUNOASSAY TUMOR CA 125 0001 26.97

86308 HETEROPHILE ANTIBODY SCREEN 0001 6.70

86309 HETEROPHILE ANTIBODY TITER 0001 8.38

86310 HETEROPHILE ANTIBODY ABSRBJ 0001 9.55

86316 IMMUNOASSAY TUMOR OTHER 0001 26.97

86317 IMMUNOASSAY INFECTIOUS AGENT 0001 19.42

86318 IMMUNOASSAY INFECTIOUS AGENT 0001 16.77

86320 SERUM IMMUNOELECTROPHORESIS 26 0001 18.00

86320 SERUM IMMUNOELECTROPHORESIS 0001 29.05

86325 OTHER IMMUNOELECTROPHORESIS 26 0001 18.00

86325 OTHER IMMUNOELECTROPHORESIS 0001 28.98

86327 IMMUNOELECTROPHORESIS ASSAY 26 0001 21.18

86327 IMMUNOELECTROPHORESIS ASSAY 0001 29.40

86329 IMMUNODIFFUSION NES 0001 18.19

86331 IMMUNODIFFUSION OUCHTERLONY 0001 15.53

86332 IMMUNE COMPLEX ASSAY 0001 31.58

86334 IMMUNOFIX E-PHORESIS SERUM 26 0001 18.76

86334 IMMUNOFIX E-PHORESIS SERUM 0001 28.95

86335 IMMUNFIX E-PHORSIS/URINE/CSF 26 0001 18.76

86335 IMMUNFIX E-PHORSIS/URINE/CSF 0001 38.03

86336 INHIBIN A 0001 16.78

86337 INSULIN ANTIBODIES 0001 27.74

86340 INTRINSIC FACTOR ANTIBODY 0001 19.53

86341 ISLET CELL ANTIBODY 0001 25.64

86343 LEUKOCYTE HISTAMINE RELEASE 0001 16.15

86344 LEUKOCYTE PHAGOCYTOSIS 0001 10.35

86353 LYMPHOCYTE TRANSFORMATION 0001 63.54

86355 B CELLS TOTAL COUNT 0001 48.88

86356 Mononuclear cell antigen 0001 23.45

86357 NK CELLS TOTAL COUNT 0001 48.88

86359 T CELLS TOTAL COUNT 0001 48.88

86360 T CELL ABSOLUTE COUNT/RATIO 0001 60.89

86361 T CELL ABSOLUTE COUNT 0001 23.45

86367 STEM CELLS TOTAL COUNT 0001 48.88

86376 MICROSOMAL ANTIBODY EACH 0001 18.85

86378 MIGRATION INHIBITORY FACTOR 0001 25.51

86382 NEUTRALIZATION TEST VIRAL 0001 21.91

86384 NITROBLUE TETRAZOLIUM DYE 0001 14.75


86403 PARTICLE AGGLUT ANTBDY SCRN 0001 13.20

86406 PARTICLE AGGLUT ANTBDY TITR 0001 13.78

86430 RHEUMATOID FACTOR TEST QUAL 0001 7.35

86431 RHEUMATOID FACTOR QUANT 0001 7.35

86480 TB TEST CELL IMMUN MEASURE 0001 80.33

86481 TB AG RESPONSE T-CELL SUSP TUBER 0001 97.10

86485 SKIN TEST CANDIDA 0001 10.52

86490 COCCIDIOIDOMYCOSIS SKIN TEST 0001 5.04

86510 HISTOPLASMOSIS SKIN TEST 0001 6.48

86580 TB INTRADERMAL TEST 0001 7.91

86590 STREPTOKINASE ANTIBODY 0001 14.31

86592 SYPHILIS TEST NON-TREP QUAL 0001 5.52

86593 SYPHILIS TEST NON-TREP QUANT 0001 5.70

86602 ANTINOMYCES ANTIBODY 0001 13.19

86603 ADENOVIRUS ANTIBODY 0001 16.67

86606 ASPERGILLUS ANTIBODY 0001 19.51

86609 BACTERIUM ANTIBODY 0001 16.70

86611 BARTONELLA ANTIBODY 0001 13.19

86612 BLASTOMYCES ANTIBODY 0001 16.72

86615 BORDETELLA ANTIBODY 0001 17.10

86617 LYME DISEASE ANTIBODY 0001 20.07

86618 LYME DISEASE ANTIBODY 0001 22.07

86619 BORRELIA ANTIBODY 0001 17.33

86622 BRUCELLA ANTIBODY 0001 11.58

86625 CAMPYLOBACTER ANTIBODY 0001 17.00

86628 CANDIDA ANTIBODY 0001 15.56

86631 CHLAMYDIA ANTIBODY 0001 15.32

86632 CHLAMYDIA IGM ANTIBODY 0001 16.44

86635 COCCIDIOIDES ANTIBODY 0001 14.86

86638 Q FEVER ANTIBODY 0001 15.71

86641 CRYPTOCOCCUS ANTIBODY 0001 18.67

86644 CMV ANTIBODY 0001 18.65

86645 CMV ANTIBODY IGM 0001 21.83

86648 DIPHTHERIA ANTIBODY 0001 19.71

86651 ENCEPHALITIS CALIFORN ANTBDY 0001 17.10

86652 ENCEPHALTIS EAST EQNE ANBDY 0001 17.10

86653 ENCEPHALTIS ST LOUIS ANTBODY 0001 17.10

86654 ENCEPHALTIS WEST EQNE ANTBDY 0001 17.10

86658 ENTEROVIRUS ANTIBODY 0001 16.88

86663 EPSTEIN-BARR ANTIBODY 0001 17.00

86664 EPSTEIN-BARR NUCLEAR ANTIGEN 0001 19.82

86665 EPSTEIN-BARR CAPSID VCA 0001 23.51

86666 EHRLICHIA ANTIBODY 0001 13.19

86668 FRANCISELLA TULARENSIS 0001 13.48

86671 FUNGUS NES ANTIBODY 0001 15.88

86674 GIARDIA LAMBLIA ANTIBODY 0001 19.07


86677 HELICOBACTER PYLORI ANTIBODY 0001 18.81

86682 HELMINTH ANTIBODY 0001 16.86

86684 HEMOPHILUS INFLUENZA ANTIBDY 0001 20.52

86687 HTLV-I ANTIBODY 0001 10.87

86688 HTLV-II ANTIBODY 0001 18.15

86689 HTLV/HIV CONFIRMJ ANTIBODY 0001 25.08

86692 HEPATITIS DELTA AGENT ANTBDY 0001 22.23

86694 HERPES SIMPLEX NES ANTBDY 0001 18.65

86695 HERPES SIMPLEX TYPE 1 TEST 0001 17.10

86696 HERPES SIMPLEX TYPE 2 TEST 0001 25.08

86698 HISTOPLASMA ANTIBODY 0001 16.19

86701 HIV-1ANTIBODY 0001 11.51

86702 HIV-2 ANTIBODY 0001 17.51

86703 HIV-1/HIV-2 1 RESULT ANTBDY 0001 17.76

86704 HEP B CORE ANTIBODY TOTAL 0001 15.61

86705 HEP B CORE ANTIBODY IGM 0001 15.26

86706 HEP B SURFACE ANTIBODY 0001 13.91

86707 HEPATITIS BE ANTIBODY 0001 14.99

86708 HEPATITIS A TOTAL ANTIBODY 0001 16.05

86709 HEPATITIS A IGM ANTIBODY 0001 14.59

86710 INFLUENZA VIRUS ANTIBODY 0001 17.56

86713 LEGIONELLA ANTIBODY 0001 19.83

86717 LEISHMANIA ANTIBODY 0001 15.87

86720 LEPTOSPIRA ANTIBODY 0001 17.10

86723 LISTERIA MONOCYTOGENES 0001 17.10

86727 LYMPH CHORIOMENINGITIS AB 0001 16.67

86729 LYMPHO VENEREUM ANTIBODY 0001 15.48

86732 MUCORMYCOSIS ANTIBODY 0001 17.10

86735 MUMPS ANTIBODY 0001 16.91

86738 MYCOPLASMA ANTIBODY 0001 17.16

86741 NEISSERIA MENINGITIDIS 0001 17.10

86744 NOCARDIA ANTIBODY 0001 17.10

86747 PARVOVIRUS ANTIBODY 0001 19.48

86750 MALARIA ANTIBODY 0001 17.10

86753 PROTOZOA ANTIBODY NOS 0001 16.05

86756 RESPIRATORY VIRUS ANTIBODY 0001 16.70

86757 RICKETTSIA ANTIBODY 0001 25.08

86759 ROTAVIRUS ANTIBODY 0001 17.10

86762 RUBELLA ANTIBODY 0001 18.65

86765 RUBEOLA ANTIBODY 0001 16.70

86768 SALMONELLA ANTIBODY 0001 17.10

86771 SHIGELLA ANTIBODY 0001 17.10

86774 TETANUS ANTIBODY 0001 19.18

86777 TOXOPLASMA ANTIBODY 0001 18.65

86778 TOXOPLASMA ANTIBODY IGM 0001 18.66

86784 TRICHINELLA ANTIBODY 0001 16.28


86787 VARICELLA-ZOSTER ANTIBODY 0001 16.70

86788 WEST NILE VIRUS AB IGM 0001 21.83

86789 WEST NILE VIRUS ANTIBODY 0001 18.65

86790 VIRUS ANTIBODY NOS 0001 16.70

86793 YERSINIA ANTIBODY 0001 17.10

86800 THYROGLOBULIN ANTIBODY 0001 20.61

86803 HEPATITIS C AB TEST 0001 18.49

86804 HEP C AB TEST CONFIRM 0001 20.07

86805 LYMPHOCYTOTOXICITY ASSAY 0001 67.77

86806 LYMPHOCYTOTOXICITY ASSAY 0001 61.68

86807 CYTOTOXIC ANTIBODY SCREENING 0001 33.15

86808 CYTOTOXIC ANTIBODY SCREENING 0001 33.15

86812 HLA TYPING A B OR C 0001 33.44

86813 HLA TYPING A B OR C 0001 54.25

86816 HLA TYPING DR/DQ 0001 36.10

86817 HLA TYPING DR/DQ 0001 54.25

86821 LYMPHOCYTE CULTURE MIXED 0001 54.25

86822 LYMPHOCYTE CULTURE PRIMED 0001 47.38

86850 RBC ANTIBODY SCREEN 0001 12.36

86860 RBC ANTIBODY ELUTION 0001 30.90

86870 RBC ANTIBODY IDENTIFICATION 0001 25.75

86880 COOMBS TEST DIRECT 0001 6.97

86885 COOMBS TEST INDIRECT QUAL 0001 7.41

86886 COOMBS TEST INDIRECT TITER 0001 6.70

86890 AUTOLOGOUS BLOOD PROCESS 0001 51.50

86891 AUTOLOGOUS BLOOD OP SALVAGE 0001 111.33

86900 BLOOD TYPING SEROLOGIC ABO 0001 3.86

86901 BLOOD TYPING SEROLOGIC RH(D) 0001 3.86

86902 BLOOD TYPE ANTIGEN DONOR EA BLOOD 0001 4.95

86904 BLOOD TYPING PATIENT SERUM 0001 12.32

86905 BLOOD TYPING RBC ANTIGENS 0001 4.95

86906 BLD TYPING SEROLOGIC RH PHNT 0001 10.04

86920 COMPATIBILITY TEST SPIN 0001 20.60

86923 COMPATIBILITY TEST ELECTRIC 0001 19.50

86927 PLASMA FRESH FROZEN 0001 12.36

86930 FROZEN BLOOD PREP 0001 36.05

86931 FROZEN BLOOD THAW 0001 46.35

86932 FROZEN BLOOD FREEZE/THAW 0001 46.35

86940 HEMOLYSINS/AGGLUTININS AUTO 0001 10.63

86941 HEMOLYSINS/AGGLUTININS 0001 15.69

86945 BLOOD PRODUCT/IRRADIATION 0001 5.15

86950 LEUKACYTE TRANSFUSION 0001 48.89

86960 VOL REDUCTION OF BLOOD/PROD 0001 25.93

86965 POOLING BLOOD PLATELETS 0001 12.32

86970 RBC PRETX INCUBATJ W/CHEMICL 0001 6.18

86971 RBC PRETX INCUBATJ W/ENZYMES 0001 6.18


86972 RBC PRETX INCUBATJ W/DENSITY 0001 6.18

86975 RBC SERUM PRETX INCUBJ DRUGS 0001 6.18

86976 RBC SERUM PRETX ID DILUTION 0001 6.18

86977 RBC SERUM PRETX INCUBJ/INHIB 0001 6.18

86978 RBC PRETREATMENT SERUM 0001 6.18

86985 SPLIT BLOOD OR PRODUCTS 0001 5.15

87003 SMALL ANIMAL INOCULATION 0001 21.82

87015 SPECIMEN INFECT AGNT CONCNTJ 0001 8.65

87040 BLOOD CULTURE FOR BACTERIA 0001 13.38

87045 FECES CULTURE AEROBIC BACT 0001 12.23

87046 STOOL CULTR AEROBIC BACT EA 0001 12.23

87070 CULTURE OTHR SPECIMN AEROBIC 0001 11.16

87071 CULTURE AEROBIC QUANT OTHER 0001 12.23

87073 CULTURE BACTERIA ANAEROBIC 0001 12.23

87075 CULTR BACTERIA EXCEPT BLOOD 0001 12.26

87076 CULTURE ANAEROBE IDENT EACH 0001 10.47

87077 CULTURE AEROBIC IDENTIFY 0001 10.47

87081 CULTURE SCREEN ONLY 0001 8.59

87084 CULTURE OF SPECIMEN BY KIT 0001 11.16

87086 URINE CULTURE/COLONY COUNT 0001 10.45

87088 URINE BACTERIA CULTURE 0001 10.49

87101 SKIN FUNGI CULTURE 0001 9.99

87102 FUNGUS ISOLATION CULTURE 0001 10.88

87103 BLOOD FUNGUS CULTURE 0001 11.68

87106 FUNGI IDENTIFICATION YEAST 0001 13.38

87107 FUNGI IDENTIFICATION MOLD 0001 13.38

87109 MYCOPLASMA 0001 19.94

87110 CHLAMYDIA CULTURE 0001 25.39

87116 MYCOBACTERIA CULTURE 0001 14.00

87118 MYCOBACTERIC IDENTIFICATION 0001 14.18

87140 CULTURE TYPE IMMUNOFLUORESC 0001 7.22

87143 CULTURE TYPING GLC/HPLC 0001 16.23

87147 CULTURE TYPE IMMUNOLOGIC 0001 6.51

87149 DNA/RNA DIRECT PROBE 0001 25.99

87152 CULTURE TYPE PULSE FIELD GEL 0001 6.77

87158 CULTURE TYPING ADDED METHOD 0001 6.77

87164 DARK FIELD EXAMINATION 26 0001 18.76

87164 DARK FIELD EXAMINATION 0001 13.91

87166 DARK FIELD EXAMINATION 0001 14.63

87168 MACROSCOPIC EXAM ARTHROPOD 0001 5.52

87169 MACROSCOPIC EXAM PARASITE 0001 5.52

87172 PINWORM EXAM 0001 5.52

87176 TISSUE HOMOGENIZATION CULTR 0001 7.62

87177 OVA AND PARASITES SMEARS 0001 11.53

87181 MICROBE SUSCEPTIBLE DIFFUSE 0001 2.17

87184 MICROBE SUSCEPTIBLE DISK 0001 8.93


87185 MICROBE SUSCEPTIBLE ENZYME 0001 2.17

87186 MICROBE SUSCEPTIBLE MIC 0001 11.21

87187 MICROBE SUSCEPTIBLE MLC 0001 13.43

87188 MICROBE SUSCEPT MACROBROTH 0001 8.60

87190 MICROBE SUSCEPT MYCOBACTERI 0001 6.51

87197 BACTERICIDAL LEVEL SERUM 0001 19.47

87205 SMEAR GRAM STAIN 0001 5.52

87206 SMEAR FLUORESCENT/ACID STAI 0001 6.97

87207 SMEAR SPECIAL STAIN 26 0001 18.76

87207 SMEAR SPECIAL STAIN 0001 7.77

87209 SMEAR COMPLEX STAIN 0001 23.29

87210 SMEAR WET MOUNT SALINE/INK 0001 5.52

87220 TISSUE EXAM FOR FUNGI 0001 5.52

87230 ASSAY TOXIN OR ANTITOXIN 0001 25.59

87250 VIRUS INOCULATE EGGS/ANIMAL 0001 25.34

87252 VIRUS INOCULATION TISSUE 0001 33.78

87253 VIRUS INOCULATE TISSUE ADDL 0001 26.18

87254 VIRUS INOCULATION SHELL VIA 0001 25.34

87255 GENET VIRUS ISOLATE HSV 0001 43.89

87260 ADENOVIRUS AG IF 0001 15.54

87265 PERTUSSIS AG IF 0001 15.54

87269 GIARDIA AG IF 0001 15.54

87270 CHLAMYDIA TRACHOMATIS AG IF 0001 15.54

87271 CYTOMEGALOVIRUS DFA 0001 15.54

87272 CRYPTOSPORIDIUM AG IF 0001 15.54

87273 HERPES SIMPLEX 2 AG IF 0001 15.54

87274 HERPES SIMPLEX 1 AG IF 0001 15.54

87275 INFLUENZA B AG IF 0001 15.54

87276 INFLUENZA A AG IF 0001 15.54

87277 LEGIONELLA MICDADEI AG IF 0001 15.54

87278 LEGION PNEUMOPHILIA AG IF 0001 15.54

87279 PARAINFLUENZA AG IF 0001 15.54

87280 RESPIRATORY SYNCYTIAL AG IF 0001 15.54

87281 PNEUMOCYSTIS CARINII AG IF 0001 15.54

87283 RUBEOLA AG IF 0001 15.54

87285 TREPONEMA PALLIDUM AG IF 0001 15.54

87290 VARICELLA ZOSTER AG IF 0001 15.54

87299 ANTIBODY DETECTION NOS IF 0001 15.54

87300 AG DETECTION POLYVAL IF 0001 15.54

87301 ADENOVIRUS AG EIA 0001 15.54

87305 ASPERGILLUS AG EIA 0001 15.54

87320 CHYLMD TRACH AG EIA 0001 15.54

87324 CLOSTRIDIUM AG EIA 0001 15.54

87327 CRYPTOCOCCUS NEOFORM AG EIA 0001 15.54

87328 CRYPTOSPORIDIUM AG EIA 0001 15.54

87329 GIARDIA AG EIA 0001 15.54


87332 CYTOMEGALOVIRUS AG EIA 0001 15.54

87335 E COLI 0157 AG EIA 0001 15.54

87336 ENTAMOEB HIST DISPR AG EIA 0001 15.54

87337 ENTAMOEB HIST GROUP AG EIA 0001 15.54

87338 HPYLORI STOOL EIA 0001 15.55

87339 H PYLORI AG EIA 0001 15.54

87340 HEPATITIS B SURFACE AG EIA 0001 13.39

87341 HEPATITIS B SURFACE AG EIA 0001 13.39

87350 HEPATITIS BE AG EIA 0001 14.94

87380 HEPATITIS DELTA AG EIA 0001 21.27

87385 HISTOPLASMA CAPSUL AG EIA 0001 15.54

87390 HIV-1 AG EIA 0001 22.85

87391 HIV-2 AG EIA 0001 22.85

87400 INFLUENZA A/B AG EIA 0001 15.54

87420 RESP SYNCYTIAL AG EIA 0001 15.54

87425 ROTAVIRUS AG EIA 0001 15.54

87427 SHIGA-LIKE TOXIN AG EIA 0001 15.54

87430 STREP A AG EIA 0001 15.54

87449 AG DETECT NOS EIA MULT 0001 15.54

87450 AG DETECT NOS EIA SINGLE 0001 12.42

87451 AG DETECT POLYVAL EIA MULT 0001 12.42

87470 BARTONELLA DNA DIR PROBE 0001 25.99

87471 BARTONELLA DNA AMP PROBE 0001 45.47

87472 BARTONELLA DNA QUANT 0001 55.51

87475 LYME DIS DNA DIR PROBE 0001 25.99

87476 LYME DIS DNA AMP PROBE 0001 45.47

87477 LYME DIS DNA QUANT 0001 55.51

87480 CANDIDA DNA DIR PROBE 0001 25.99

87481 CANDIDA DNA AMP PROBE 0001 45.47

87482 CANDIDA DNA QUANT 0001 54.11

87485 CHYLMD PNEUM DNA DIR PROBE 0001 25.99

87486 CHYLMD PNEUM DNA AMP PROBE 0001 45.47

87487 CHYLMD PNEUM DNA QUANT 0001 55.51

87490 CHYLMD TRACH DNA DIR PROBE 0001 25.99

87491 CHYLMD TRACH DNA AMP PROBE 0001 45.47

87492 CHYLMD TRACH DNA QUANT 0001 45.30

87495 CYTOMEG DNA DIR PROBE 0001 25.99

87496 CYTOMEG DNA AMP PROBE 0001 45.47

87497 CYTOMEG DNA QUANT 0001 55.51

87498 ENTEROVIRUS PROBE&REVRS TRNS 0001 45.47

87500 VANOMYCIN DNA AMP PROBE 0001 45.47

87501 INFLUENZA DNA AMP PROB 1+ 0001 66.50

87502 INFLUENZA DNA AMP PROBE 0001 110.28

87503 INFLUENZA DNA AMP PROB ADDL INFEC 0001 26.91

87510 GARDNER VAG DNA DIR PROBE 0001 25.99

87511 GARDNER VAG DNA AMP PROBE 0001 45.47


87512 GARDNER VAG DNA QUANT 0001 54.11

87515 HEPATITIS B DNA DIR PROBE 0001 25.99

87516 HEPATITIS B DNA AMP PROBE 0001 45.47

87517 HEPATITIS B DNA QUANT 0001 55.51

87520 HEPATITIS C RNA DIR PROBE 0001 25.99

87521 HEPATITIS C PROBE&RVRS TRNSC 0001 45.47

87522 HEPATITIS C REVRS TRNSCRPJ 0001 55.51

87525 HEPATITIS G DNA DIR PROBE 0001 25.99

87526 HEPATITIS G DNA AMP PROBE 0001 45.47

87527 HEPATITIS G DNA QUANT 0001 54.11

87528 HSV DNA DIR PROBE 0001 25.99

87529 HSV DNA AMP PROBE 0001 45.47

87530 HSV DNA QUANT 0001 55.51

87531 HHV-6 DNA DIR PROBE 0001 25.99

87532 HHV-6 DNA AMP PROBE 0001 45.47

87533 HHV-6 DNA QUANT 0001 54.11

87534 HIV-1 DNA DIR PROBE 0001 25.99

87535 HIV-1 PROBE&REVERSE TRNSCRPJ 0001 45.47

87536 HIV-1 QUANT&REVRSE TRNSCRPJ 0001 110.28

87537 HIV-2 DNA DIR PROBE 0001 25.99

87538 HIV-2 PROBE&REVRSE TRNSCRIPJ 0001 45.47

87539 HIV-2 QUANT&REVRSE TRNSCRIPJ 0001 55.51

87540 LEGION PNEUMO DNA DIR PROB 0001 25.99

87541 LEGION PNEUMO DNA AMP PROB 0001 45.47

87542 LEGION PNEUMO DNA QUANT 0001 54.11

87550 MYCOBACTERIA DNA DIR PROBE 0001 25.99

87551 MYCOBACTERIA DNA AMP PROBE 0001 45.47

87552 MYCOBACTERIA DNA QUANT 0001 55.51

87555 M.TUBERCULO DNA DIR PROBE 0001 25.99

87556 M.TUBERCULO DNA AMP PROBE 0001 45.47

87557 M.TUBERCULO DNA QUANT 0001 55.51

87560 M.AVIUM-INTRA DNA DIR PROB 0001 25.99

87561 M.AVIUM-INTRA DNA AMP PROB 0001 45.47

87562 M.AVIUM-INTRA DNA QUANT 0001 55.51

87580 M.PNEUMON DNA DIR PROBE 0001 25.99

87581 M.PNEUMON DNA AMP PROBE 0001 45.47

87582 M.PNEUMON DNA QUANT 0001 54.11

87590 N.GONORRHOEAE DNA DIR PROB 0001 25.99

87591 N.GONORRHOEAE DNA AMP PROB 0001 45.47

87592 N.GONORRHOEAE DNA QUANT 0001 55.51

87623 HPV LOW-RISK TYPES 0001 24.53

87624 HPV HIGH-RISK TYPES 0001 24.53

87625 HPV TYPES 16 & 18 ONLY 0001 24.53

87640 STAPH A DNA AMP PROBE 0001 45.47

87641 MR-STAPH DNA AMP PROBE 0001 45.47

87650 STREP A DNA DIR PROBE 0001 25.99


87651 STREP A DNA AMP PROBE 0001 45.47

87652 STREP A DNA QUANT 0001 54.11

87653 STREP B DNA AMP PROBE 0001 45.47

87660 TRICHOMONAS VAGIN DIR PROBE 0001 25.99

87797 DETECT AGENT NOS DNA DIR 0001 25.99

87798 DETECT AGENT NOS DNA AMP 0001 45.47

87799 DETECT AGENT NOS DNA QUANT 0001 55.51

87800 DETECT AGNT MULT DNA DIREC 0001 51.98

87801 DETECT AGNT MULT DNA AMPLI 0001 90.97

87802 STREP B ASSAY W/OPTIC 0001 15.54

87803 CLOSTRIDIUM TOXIN A W/OPTIC 0001 15.54

87804 INFLUENZA ASSAY W/OPTIC 0001 15.54

87807 RSV ASSAY W/OPTIC 0001 15.54

87808 TRICHOMONAS ASSAY W/OPTIC 0001 15.54

87809 Adenovirus assay w/optic 0001 15.54

87810 CHYLMD TRACH ASSAY W/OPTIC 0001 15.54

87850 N. GONORRHOEAE ASSAY W/OPTIC 0001 15.54

87880 STREP A ASSAY W/OPTIC 0001 15.54

87899 AGENT NOS ASSAY W/OPTIC 0001 15.54

87900 PHENOTYPE INFECT AGENT DRUG 0001 168.92

87901 GENOTYPE DNA HIV REVERSE T 0001 333.65

87902 GENOTYPE DNA/RNA HEP C 0001 333.65

87903 PHENOTYPE DNA HIV W/CULTURE 0001 633.30

87904 PHENOTYPE DNA HIV W/CLT ADD 0001 33.78

87905 SIALIDASE ENZYME ASSAY 0001 15.83

87906 GENOTYPE DNA/RNA HIV 0001 166.83

88104 CYTOPATH FL NONGYN SMEARS TC 0001 44.89

88104 CYTOPATH FL NONGYN SMEARS 26 0001 28.42

88104 CYTOPATH FL NONGYN SMEARS 0001 73.32

88106 CYTOPATH FL NONGYN FILTER TC 0001 65.00

88106 CYTOPATH FL NONGYN FILTER 26 0001 19.08

88106 CYTOPATH FL NONGYN FILTER 0001 84.08

88108 CYTOPATH CONCENTRATE TECH TC 0001 56.02

88108 CYTOPATH CONCENTRATE TECH 26 0001 22.18

88108 CYTOPATH CONCENTRATE TECH 0001 78.21

88112 CYTOPATH CELL ENHANCE TECH TC 0001 34.84

88112 CYTOPATH CELL ENHANCE TECH 26 0001 27.35

88112 CYTOPATH CELL ENHANCE TECH 0001 62.19

88120 CYTP URNE 3-5 PROBES EA SPEC CYTOP TC 0001 560.86

88120 CYTP URNE 3-5 PROBES EA SPEC CYTOP 26 0001 57.08

88120 CYTP URNE 3-5 PROBES EA SPEC CYTOP 0001 617.95

88121 CYTP URINE 3-5 PROBES CMPTR CYTOP TC 0001 485.43

88121 CYTP URINE 3-5 PROBES CMPTR CYTOP 26 0001 49.19

88121 CYTP URINE 3-5 PROBES CMPTR CYTOP 0001 534.62

88125 FORENSIC CYTOPATHOLOGY TC 0001 8.99

88125 FORENSIC CYTOPATHOLOGY 26 0001 12.82


88125 FORENSIC CYTOPATHOLOGY 0001 21.81

88130 SEX CHROMATIN IDENTIFICATION 0001 19.51

88140 SEX CHROMATIN IDENTIFICATION 0001 10.36

88141 CYTOPATH C/V INTERPRET 0001 31.23

88142 CYTOPATH C/V THIN LAYER 0001 26.25

88143 CYTOPATH C/V THIN LAYER REDO 0001 26.25

88147 CYTOPATH C/V AUTOMATED 0001 14.75

88148 CYTOPATH C/V AUTO RESCREEN 0001 19.69

88150 CYTOPATH C/V MANUAL 0001 13.69

88152 CYTOPATH C/V AUTO REDO 0001 13.69

88153 CYTOPATH C/V REDO 0001 13.69

88154 CYTOPATH C/V SELECT 0001 13.69

88155 CYTOPATH C/V INDEX ADD-ON 0001 7.77

88160 CYTOPATH SMEAR OTHER SOURCE TC 0001 38.07

88160 CYTOPATH SMEAR OTHER SOURCE 26 0001 25.66

88160 CYTOPATH SMEAR OTHER SOURCE 0001 63.74







88164 CYTOPATH TBS C/V MANUAL 0001 13.69

88165 CYTOPATH TBS C/V REDO 0001 13.69

88166 CYTOPATH TBS C/V AUTO REDO 0001 13.69

88167 CYTOPATH TBS C/V SELECT 0001 13.69

88172 CYTP DX EVAL FNA 1ST EA SITE TC 0001 18.32

88172 CYTP DX EVAL FNA 1ST EA SITE 26 0001 35.01

88172 CYTP DX EVAL FNA 1ST EA SITE 0001 53.34

88173 CYTOPATH EVAL FNA REPORT TC 0001 75.05

88173 CYTOPATH EVAL FNA REPORT 26 0001 69.68

88173 CYTOPATH EVAL FNA REPORT 0001 144.73

88174 CYTOPATH C/V AUTO IN FLUID 0001 27.69

88175 CYTOPATH C/V AUTO FLUID REDO 0001 34.33

88177 CYTP FNA EVAL EA ADDL TC 0001 7.55

88177 CYTP FNA EVAL EA ADDL 26 0001 21.50

88177 CYTP FNA EVAL EA ADDL 0001 29.06

88182 CELL MARKER STUDY TC 0001 73.29

88182 CELL MARKER STUDY 26 0001 35.61

88182 CELL MARKER STUDY 0001 108.91

88184 FLOWCYTOMETRY/ TC 1 MARKER 0001 87.98

88185 FLOWCYTOMETRY/TC ADD-ON 0001 53.87

88187 FLOWCYTOMETRY/READ 2-8 0001 69.44

88188 FLOWCYTOMETRY/READ 9-15 0001 87.54

88189 FLOWCYTOMETRY/READ 16 & > 0001 107.03

88230 TISSUE CULTURE LYMPHOCYTE 0001 150.99


88233 TISSUE CULTURE SKIN/BIOPSY 0001 182.39

88235 TISSUE CULTURE PLACENTA 0001 190.85

88237 TISSUE CULTURE BONE MARROW 0001 163.70

88239 TISSUE CULTURE TUMOR 0001 191.19

88240 CELL CRYOPRESERVE/STORAGE 0001 13.09

88241 FROZEN CELL PREPARATION 0001 13.09

88245 CHROMOSOME ANALYSIS 20-25 0001 192.93


88249 CHROMOSOME ANALYSIS 100 0001 224.44





88267 CHROMOSOME ANALYS PLACENTA 0001 232.99

88269 CHROMOSOME ANALYS AMNIOTIC 0001 215.56

88271 CYTOGENETICS DNA PROBE 0001 27.75

88272 CYTOGENETICS 3-5 0001 34.70

88273 CYTOGENETICS 10-30 0001 41.64

88274 CYTOGENETICS 25-99 0001 45.11

88275 CYTOGENETICS 100-300 0001 52.05

88280 CHROMOSOME KARYOTYPE STUDY 0001 32.52

88283 CHROMOSOME BANDING STUDY 0001 64.94

88285 CHROMOSOME COUNT ADDITIONAL 0001 24.62

88289 CHROMOSOME STUDY ADDITIONAL 0001 18.54

88291 CYTO/MOLECULAR REPORT 0001 30.33

88300 SURGICAL PATH GROSS TC 0001 10.07

88300 SURGICAL PATH GROSS 26 0001 4.53

88300 SURGICAL PATH GROSS 0001 14.60

88302 TISSUE EXAM BY PATHOLOGIST TC 0001 22.99

88302 TISSUE EXAM BY PATHOLOGIST 26 0001 6.95

88302 TISSUE EXAM BY PATHOLOGIST 0001 29.95













88311 DECALCIFY TISSUE TC 0001 7.91

88311 DECALCIFY TISSUE 26 0001 12.14

88311 DECALCIFY TISSUE 0001 20.05


88312 SPECIAL STAINS GROUP 1 TC 0001 67.15

88312 SPECIAL STAINS GROUP 1 26 0001 26.67

88312 SPECIAL STAINS GROUP 1 0001 93.82

88313 SPECIAL STAINS GROUP 2 TC 0001 53.87

88313 SPECIAL STAINS GROUP 2 26 0001 11.78

88313 SPECIAL STAINS GROUP 2 0001 65.65

88314 HISTOCHEMICAL STAINS ADD-ON TC 0001 55.30

88314 HISTOCHEMICAL STAINS ADD-ON 26 0001 22.16

88314 HISTOCHEMICAL STAINS ADD-ON 0001 77.47

88319 ENZYME HISTOCHEMISTRY TC 0001 57.82

88319 ENZYME HISTOCHEMISTRY 26 0001 27.44

88319 ENZYME HISTOCHEMISTRY 0001 85.26

88321 MICROSLIDE CONSULTATION 0001 92.68

88323 MICROSLIDE CONSULTATION TC 0001 59.61

88323 MICROSLIDE CONSULTATION 26 0001 85.03

88323 MICROSLIDE CONSULTATION 0001 144.64

88325 COMPREHENSIVE REVIEW OF DATA 0001 208.86

88329 PATH CONSULT INTROP 0001 56.28

88331 PATH CONSULT INTRAOP 1 BLOC TC 0001 36.28

88331 PATH CONSULT INTRAOP 1 BLOC 26 0001 60.66

88331 PATH CONSULT INTRAOP 1 BLOC 0001 96.94

88332 PATH CONSULT INTRAOP ADDL TC 0001 12.58

88332 PATH CONSULT INTRAOP ADDL 26 0001 30.16

88332 PATH CONSULT INTRAOP ADDL 0001 42.75

88333 INTRAOP CYTO PATH CONSULT 1 TC 0001 40.94

88333 INTRAOP CYTO PATH CONSULT 1 26 0001 61.77

88333 INTRAOP CYTO PATH CONSULT 1 0001 102.72

88334 INTRAOP CYTO PATH CONSULT 2 TC 0001 25.86

88334 INTRAOP CYTO PATH CONSULT 2 26 0001 38.20

88334 INTRAOP CYTO PATH CONSULT 2 0001 64.07

88341 Immunohisto antibody slide 26 0001 22.48

88341 Immunohisto antibody slide 0001 70.77

88342 IMMUNOHISTOCHEMISTRY TC 0001 13.95

88342 IMMUNOHISTOCHEMISTRY 26 0001 55.80

88342 IMMUNOHISTOCHEMISTRY 0001 69.75

88344 Immunohisto antibody slide 0001 123.07

88346 IMMUNOFLUORESCENT STUDY TC 0001 63.56

88346 IMMUNOFLUORESCENT STUDY 26 0001 41.52

88346 IMMUNOFLUORESCENT STUDY 0001 105.08

88347 IMMUNOFLUORESCENT STUDY TC 0001 47.05

88347 IMMUNOFLUORESCENT STUDY 26 0001 40.44

88347 IMMUNOFLUORESCENT STUDY 0001 87.49

88348 ELECTRON MICROSCOPY TC 0001 627.37

88348 ELECTRON MICROSCOPY 26 0001 74.12

88348 ELECTRON MICROSCOPY 0001 701.50

88355 ANALYSIS SKELETAL MUSCLE TC 0001 91.93


88355 ANALYSIS SKELETAL MUSCLE 26 0001 81.42

88355 ANALYSIS SKELETAL MUSCLE 0001 173.35

88356 ANALYSIS NERVE TC 0001 146.19

88356 ANALYSIS NERVE 26 0001 128.95

88356 ANALYSIS NERVE 0001 275.15

88358 ANALYSIS TUMOR TC 0001 38.07

88358 ANALYSIS TUMOR 26 0001 43.90

88358 ANALYSIS TUMOR 0001 81.97

88360 TUMOR IMMUNOHISTOCHEM/MANUAL TC 0001 75.41

88360 TUMOR IMMUNOHISTOCHEM/MANUAL 26 0001 52.96

88360 TUMOR IMMUNOHISTOCHEM/MANUAL 0001 128.37

88361 TUMOR IMMUNOHISTOCHEM/COMPUT TC 0001 98.75

88361 TUMOR IMMUNOHISTOCHEM/COMPUT 26 0001 57.50

88361 TUMOR IMMUNOHISTOCHEM/COMPUT 0001 156.25

88362 NERVE TEASING PREPARATIONS TC 0001 195.02

88362 NERVE TEASING PREPARATIONS 26 0001 110.00

88362 NERVE TEASING PREPARATIONS 0001 305.02

88363 XM ARCHIVE TISSUE MOLEC ANAL EXAMI 0001 21.63

88364 Insitu hybridization (fish) 0001 102.55

88365 INSITU HYBRIDIZATION (FISH) TC 0001 117.42

88365 INSITU HYBRIDIZATION (FISH) 26 0001 58.16

88365 INSITU HYBRIDIZATION (FISH) 0001 175.58

88366 Insitu hybridization (fish) 0001 156.53

88367 INSITU HYBRIDIZATION AUTO TC 0001 193.53

88367 INSITU HYBRIDIZATION AUTO 26 0001 60.53

88367 INSITU HYBRIDIZATION AUTO 0001 254.06

88368 INSITU HYBRIDIZATION MANUAL TC 0001 168.04

88368 INSITU HYBRIDIZATION MANUAL 26 0001 62.48

88368 INSITU HYBRIDIZATION MANUAL 0001 230.52

88369 M/phmtrc alysishquant/semiq 0001 77.44

88371 PROTEIN WESTERN BLOT TISSUE 26 0001 18.76

88371 PROTEIN WESTERN BLOT TISSUE 0001 19.13

88372 PROTEIN ANALYSIS W/PROBE 26 0001 18.76

88372 PROTEIN ANALYSIS W/PROBE 0001 29.47

88373 M/phmtrc alys ishquant/semiq 0001 63.15


88375 Optical endomicroscpy interp 0001 0.00


88381 MICRODISSECTION MANUAL TC 0001 105.93

88381 MICRODISSECTION MANUAL 26 0001 53.17

88381 MICRODISSECTION MANUAL 0001 159.10

88387 TISS EXAM MOLECULAR STUDY TC 0001 6.48

88387 TISS EXAM MOLECULAR STUDY 26 0001 28.31

88387 TISS EXAM MOLECULAR STUDY 0001 34.79

88388 TISS EX MOLECUL STUDY ADD-ON TC 0001 8.99

88388 TISS EX MOLECUL STUDY ADD-ON 26 0001 23.24


88388 TISS EX MOLECUL STUDY ADD-ON 0001 32.23

88720 BILIRUBIN TOTAL TRANSCUT 0001 6.49

88740 TRANSCUTANEOUS CARBOXYHB 0001 6.49

88741 TRANSCUTANEOUS METHB 0001 6.49

89050 BODY FLUID CELL COUNT 0001 6.12

89051 BODY FLUID CELL COUNT 0001 7.13

89055 LEUKOCYTE ASSESSMENT FECAL 0001 5.52

89060 EXAM SYNOVIAL FLUID CRYSTALS 26 0001 18.76

89060 EXAM SYNOVIAL FLUID CRYSTALS 0001 9.27

89125 SPECIMEN FAT STAIN 0001 4.47

89160 EXAM FECES FOR MEAT FIBERS 0001 4.77

89190 NASAL SMEAR FOR EOSINOPHILS 0001 6.15

89220 SPUTUM SPECIMEN COLLECTION 0001 17.25

89230 COLLECT SWEAT FOR TEST 0001 5.04

89240 PATHOLOGY LAB PROCEDURE 0001 0.00

89310 SEMEN ANALYSIS W/COUNT 0001 11.15

90460 IM ADMIN 1ST/ONLY COMPONENT 0001 22.22

90471 IMMUNIZATION ADMIN 0001 22.22

90472 IMMUNIZATION ADMIN EACH ADD 0001 11.01

90473 IMMUNE ADMIN ORAL/NASAL 0001 22.22

90474 IMMUNE ADMIN ORAL/NASAL ADDL 0001 11.01

90476 ADENOVIRUS VACCINE TYPE 4 0001 0.00

90477 ADENOVIRUS VACCINE TYPE 7 0001 0.00

90581 ANTHRAX VACCINE SC OR IM 0001 113.17

90585 BCG VACCINE PERCUT 0001 161.54

90586 BCG VACCINE INTRAVESICAL 0001 148.66

90632 HEP A VACCINE ADULT IM 0001 56.31

90633 HEP A VACC PED/ADOL 2 DOSE 0001 27.39

90634 HEP A VACC PED/ADOL 3 DOSE 0001 27.39

90636 HEP A/HEP B VACC ADULT IM 0001 62.71

90645 HIB VACCINE HBOC IM 0001 22.46

90646 HIB VACCINE PRP-D IM 0001 18.94

90647 HIB VACCINE PRP-OMP IM 0001 20.92

90648 HIB VACCINE PRP-T IM 0001 21.10

90649 HPV VACCINE 4 VALENT IM 0001 124.80

90650 HPV VACCINE 2 VALENT IM 0001 124.80

90654 FLU VACC IIV3 NO PRESERV ID 0001 18.60

90655 FLU VAC NO PRSV 3 VAL 6-35 M 0001 17.46

90656 FLU VACCINE NO PRESERV 3 & > 0001 13.48

90657 FLU VACCINE 3 YRS IM 0001 7.03

90658 FLU VACCINE 3 YRS & > IM 0001 13.74

90660 FLU VACCINE NASAL 0001 9.34

90669 PNEUMOCOCCAL VACC 7 VAL IM 0001 16.30


90672 FLU VACCINE 4 VALENT NASAL 0001 9.34

90673 Flu vacc riv3 no preserv 0001 33.11


90675 RABIES VACCINE IM 0001 129.23

90676 RABIES VACCINE ID 0001 67.39

90680 ROTOVIRUS VACC 3 DOSE ORAL 0001 55.71

90681 ROTAVIRUS VACC 2 DOSE ORAL 0001 49.23

90685 FLU VAC NO PRSV 4 VAL 6-35 M 0001 15.15

90686 FLU VAC NO PRSV 4 VAL 3 YRS+ 0001 15.15

90687 FLU VACCINE 4 VAL 6-35 MO IM 0001 13.74

90688 FLU VACC 4 VAL 3 YRS PLUS IM 0001 13.74

90690 TYPHOID VACCINE ORAL 0001 27.08

90691 TYPHOID VACCINE IM 0001 37.85

90692 TYPHOID VACCINE H-P SC/ID 0001 2.09

90693 TYPHOID VACCINE AKD SC 0001 0.00

90696 DTAP-IPV VACC 4-6 YR IM 0001 0.00

90698 DTAP-HIB-IP VACCINE IM 0001 55.71

90700 DTAP VACCINE < 7 YRS IM 0001 12.75

90702 DT VACCINE < 7 YRS IM 0001 8.62

90703 TETANUS VACCINE IM 0001 7.69

90704 MUMPS VACCINE SC 0001 16.62

90705 MEASLES VACCINE SC 0001 12.92

90706 RUBELLA VACCINE SC 0001 14.77

90707 MMR VACCINE SC 0001 33.23

90708 MEASLES-RUBELLA VACCINE SC 0001 22.07

90710 MMRV VACCINE SC 0001 99.16

90712 ORAL POLIOVIRUS VACCINE 0001 17.85

90713 POLIOVIRUS IPV SC/IM 0001 9.96

90714 TD VACCINE NO PRSRV 7/> IM 0001 20.43

90715 TDAP VACCINE 7 YRS/> IM 0001 35.65

90716 CHICKEN POX VACCINE SC 0001 57.23

90717 YELLOW FEVER VACCINE SC 0001 52.92

90719 DIPHTHERIA VACCINE IM 0001 0.00

90720 DTP/HIB VACCINE IM 0001 34.77

90721 DTAP/HIB VACCINE IM 0001 23.40

90723 DTAP-HEP B-IPV VACCINE IM 0001 32.75

90725 CHOLERA VACCINE INJECTABLE 0001 8.65

90727 PLAGUE VACCINE IM 0001 0.00


90733 MENINGOCOCCAL VACCINE SC 0001 60.62

90734 MENINGOCOCCAL VACCINE IM 0001 70.57

90735 ENCEPHALITIS VACCINE SC 0001 71.69

90736 ZOSTER VACC SC 0001 117.01

90740 HEPB VACC ILL PAT 3 DOSE IM 0001 102.77

90743 HEP B VACC ADOL 2 DOSE IM 0001 22.46

90744 HEPB VACC PED/ADOL 3 DOSE IM 0001 22.46

90746 HEP B VACC ADULT 3 DOSE IM 0001 51.08

90747 HEPB VACC ILL PAT 4 DOSE IM 0001 102.77

90748 HEP B/HIB VACCINE IM 0001 45.54


90785 Psytx complex interactive 0001 12.32

90791 Psych diagnostic evaluation 0001 115.38

90792 Psych diag eval w/med srvcs 0001 124.29

90832 Psytx pt&/family 30 minutes 0001 55.77

90833 Psytx pt&/fam w/e&m 30 min 0001 57.05





90839 Psytx crisis initial 60 min 0001 115.49

90840 Psytx crisis ea addl 30 min 0001 55.45

90845 PSYCHOANALYSIS 0001 79.87

90847 FAMILY PSYTX W/PATIENT 0001 92.40

90853 GROUP PSYCHOTHERAPY 0001 22.84

90863 Pharmacologic mgmt w/psytx 0001 44.31

90867 TCRANIAL MAGN STIM TX PLAN 0001 353.92

90868 TCRANIAL MAGN STIM TX DELI 0001 172.76

90869 Tcran magn stim redetemine 0001 439.37

90870 ELECTROCONVULSIVE THERAPY 0001 156.04

90875 PSYCHOPHYSIOLOGICAL THERAPY 0001 54.37

90876 PSYCHOPHYSIOLOGICAL THERAPY 0001 94.70

90901 BIOFEEDBACK TRAIN ANY METH 0001 35.32

90911 BIOFEEDBACK PERI/URO/RECTAL 0001 75.42

90935 HEMODIALYSIS ONE EVALUATION 0001 63.54

90937 HEMODIALYSIS REPEATED EVAL 0001 91.14

90940 HEMODIALYSIS ACCESS STUDY 0001 70.97

90945 DIALYSIS ONE EVALUATION 0001 75.30

90947 DIALYSIS REPEATED EVAL 0001 108.83

90951 ESRD SERV 4 VISITS P MO <2YR 0001 816.70

90952 ESRD SERV 2-3 VSTS P MO <2YR 0001 617.16

90953 ESRD SERV 1 VISIT P MO <2YRS 0001 411.33

90954 ESRD SERV 4 VSTS P MO 2-11 0001 708.80

90955 ESRD SRV 2-3 VSTS P MO 2-11 0001 400.04

90956 ESRD SRV 1 VISIT P MO 2-11 0001 278.89

90957 ESRD SRV 4 VSTS P MO 12-19 0001 564.20

90958 ESRD SRV 2-3 VSTS P MO 12-19 0001 381.82

90959 ESRD SERV 1 VST P MO 12-19 0001 258.70

90960 ESRD SRV 4 VISITS P MO 20+ 0001 249.27

90961 ESRD SRV 2-3 VSTS P MO 20+ 0001 209.90

90962 ESRD SERV 1 VISIT P MO 20+ 0001 162.16

90963 ESRD HOME PT SERV P MO <2YRS 0001 478.25

90964 ESRD HOME PT SERV P MO 2-11 0001 416.86

90965 ESRD HOME PT SERV P MO 12-19 0001 395.39

90966 ESRD HOME PT SERV P MO 20+ 0001 209.58

90967 ESRD HOME PT SERV P DAY <2 0001 15.50

90968 ESRD HOME PT SRV P DAY 2-11 0001 13.33


90969 ESRD HOME PT SRV P DAY 12-19 0001 13.03

90970 ESRD HOME PT SERV P DAY 20+ 0001 6.85

90989 DIALYSIS TRAINING COMPLETE 0001 462.17

90993 DIALYSIS TRAINING INCOMPL 0001 78.16

90997 HEMOPERFUSION 0001 80.97

91010 ESOPHAGUS MOTILITY STUDY TC 0001 97.67

91010 ESOPHAGUS MOTILITY STUDY 26 0001 60.00

91010 ESOPHAGUS MOTILITY STUDY 0001 157.67

91013 ESOPHGL MOTIL W/STIM/PERFUS TC 0001 12.86

91013 ESOPHGL MOTIL W/STIM/PERFUS 26 0001 8.39

91013 ESOPHGL MOTIL W/STIM/PERFUS 0001 21.25

91020 GASTRIC MOTILITY STUDIES TC 0001 142.32

91020 GASTRIC MOTILITY STUDIES 26 0001 67.45

91020 GASTRIC MOTILITY STUDIES 0001 209.77

91022 DUODENAL MOTILITY STUDY TC 0001 83.85

91022 DUODENAL MOTILITY STUDY 26 0001 66.77

91022 DUODENAL MOTILITY STUDY 0001 150.63

91030 ACID PERFUSION OF ESOPHAGUS TC 0001 80.64

91030 ACID PERFUSION OF ESOPHAGUS 26 0001 42.57

91030 ACID PERFUSION OF ESOPHAGUS 0001 123.22

91034 GASTROESOPHAGEAL REFLUX TEST TC 0001 124.97

91034 GASTROESOPHAGEAL REFLUX TEST 26 0001 45.04

91034 GASTROESOPHAGEAL REFLUX TEST 0001 170.02

91035 G-ESOPH REFLX TST W/ELECTROD TC 0001 360.12

91035 G-ESOPH REFLX TST W/ELECTROD 26 0001 73.63

91035 G-ESOPH REFLX TST W/ELECTROD 0001 433.75

91037 ESOPH IMPED FUNCTION TEST TC 0001 98.95

91037 ESOPH IMPED FUNCTION TEST 26 0001 46.05

91037 ESOPH IMPED FUNCTION TEST 0001 145.01

91038 ESOPH IMPED FUNCT TEST > 1HR TC 0001 355.95

91038 ESOPH IMPED FUNCT TEST > 1HR 26 0001 51.27

91038 ESOPH IMPED FUNCT TEST > 1HR 0001 407.22

91040 ESOPH BALLOON DISTENSION TST TC 0001 316.43

91040 ESOPH BALLOON DISTENSION TST 26 0001 43.74

91040 ESOPH BALLOON DISTENSION TST 0001 360.18

91065 BREATH HYDROGEN/METHANE TEST TC 0001 64.90

91065 BREATH HYDROGEN/METHANE TEST 26 0001 9.32

91065 BREATH HYDROGEN/METHANE TEST 0001 74.23

91110 GI TRACT CAPSULE ENDOSCOPY TC 0001 631.25

91110 GI TRACT CAPSULE ENDOSCOPY 26 0001 169.97

91110 GI TRACT CAPSULE ENDOSCOPY 0001 801.22

91111 ESOPHAGEAL CAPSULE ENDOSCOPY TC 0001 611.97

91111 ESOPHAGEAL CAPSULE ENDOSCOPY 26 0001 46.60

91111 ESOPHAGEAL CAPSULE ENDOSCOPY 0001 658.58

91112 Gi wireless capsule measure TC 0001 869.29

91112 Gi wireless capsule measure 26 0001 98.20


91112 Gi wireless capsule measure 0001 967.49

91117 COLON MOTILITY 6 HR STUDY COLON 0001 132.42

91120 RECTAL SENSATION TEST TC 0001 314.83

91120 RECTAL SENSATION TEST 26 0001 45.11

91120 RECTAL SENSATION TEST 0001 359.94

91122 ANAL PRESSURE RECORD TC 0001 118.87

91122 ANAL PRESSURE RECORD 26 0001 79.16

91122 ANAL PRESSURE RECORD 0001 198.03

91200 Liver elastography 0001 32.31

92002 EYE EXAM NEW PATIENT 0001 73.19

92004 EYE EXAM NEW PATIENT 0001 132.74

92012 EYE EXAM ESTABLISH PATIENT 0001 76.65

92014 EYE EXAM&TX ESTAB PT 1/>VST 0001 110.90

92015 DETERMINE REFRACTIVE STATE 0001 17.73

92018 NEW EYE EXAM & TREATMENT 0001 131.04

92019 EYE EXAM & TREATMENT 0001 63.49

92020 SPECIAL EYE EVALUATION 0001 24.49

92025 CORNEAL TOPOGRAPHY TC 0001 16.07

92025 CORNEAL TOPOGRAPHY 26 0001 17.75

92025 CORNEAL TOPOGRAPHY 0001 33.82

92060 SPECIAL EYE EVALUATION TC 0001 23.78

92060 SPECIAL EYE EVALUATION 26 0001 34.57

92060 SPECIAL EYE EVALUATION 0001 58.35

92065 ORTHOPTIC/PLEOPTIC TRAINING TC 0001 31.81

92065 ORTHOPTIC/PLEOPTIC TRAINING 26 0001 15.79

92065 ORTHOPTIC/PLEOPTIC TRAINING 0001 47.60

92071 Contact lens fitting for tx 0001 33.73

92072 Fit contac lens for managmnt 0001 122.21

92081 VISUAL FIELD EXAMINATION(S) TC 0001 15.75

92081 VISUAL FIELD EXAMINATION(S) 26 0001 14.97

92081 VISUAL FIELD EXAMINATION(S) 0001 30.73







92100 SERIAL TONOMETRY EXAM(S) 0001 71.64

92132 CMPTR OPHTH DX IMG ANT SEGMT SCANN TC 0001 14.15

92132 CMPTR OPHTH DX IMG ANT SEGMT SCANN 26 0001 17.78

92132 CMPTR OPHTH DX IMG ANT SEGMT SCANN 0001 31.93

92133 CMPTR OPHTH IMG OPTIC NERVE SCANN TC 0001 14.47

92133 CMPTR OPHTH IMG OPTIC NERVE SCANN 26 0001 25.24

92133 CMPTR OPHTH IMG OPTIC NERVE SCANN 0001 39.71

92134 CPTR OPHTH DX IMG POST SEGMT SCANN TC 0001 14.47

92134 CPTR OPHTH DX IMG POST SEGMT SCANN 26 0001 26.20


92134 CPTR OPHTH DX IMG POST SEGMT SCANN 0001 40.68

92136 OPHTHALMIC BIOMETRY TC 0001 52.69

92136 OPHTHALMIC BIOMETRY 26 0001 27.71

92136 OPHTHALMIC BIOMETRY 0001 80.41

92140 GLAUCOMA PROVOCATIVE TESTS 0001 56.40

92145 Corneal hysteresis deter 0001 13.88

92225 SPECIAL EYE EXAM INITIAL 0001 24.47

92226 SPECIAL EYE EXAM SUBSEQUENT 0001 21.96

92227 REMOTE DX RETINAL IMAGING REMOT 0001 12.86

92228 REMOTE RETINAL IMAGING MGMT REMOT TC 0001 12.22

92228 REMOTE RETINAL IMAGING MGMT REMOT 26 0001 19.00

92228 REMOTE RETINAL IMAGING MGMT REMOT 0001 31.22

92230 EYE EXAM WITH PHOTOS 0001 52.72

92235 EYE EXAM WITH PHOTOS TC 0001 55.91

92235 EYE EXAM WITH PHOTOS 26 0001 42.08


92240 ICG ANGIOGRAPHY TC 0001 170.59

92240 ICG ANGIOGRAPHY 26 0001 57.02

92240 ICG ANGIOGRAPHY 0001 227.62

92250 EYE EXAM WITH PHOTOS TC 0001 49.16

92250 EYE EXAM WITH PHOTOS 26 0001 21.13


92260 OPHTHALMOSCOPY/DYNAMOMETRY 0001 16.71

92265 EYE MUSCLE EVALUATION TC 0001 31.49

92265 EYE MUSCLE EVALUATION 26 0001 36.59

92265 EYE MUSCLE EVALUATION 0001 68.08

92270 ELECTRO-OCULOGRAPHY TC 0001 44.02

92270 ELECTRO-OCULOGRAPHY 26 0001 36.30

92270 ELECTRO-OCULOGRAPHY 0001 80.32

92275 ELECTRORETINOGRAPHY TC 0001 89.96

92275 ELECTRORETINOGRAPHY 26 0001 52.37

92275 ELECTRORETINOGRAPHY 0001 142.33

92283 COLOR VISION EXAMINATION TC 0001 41.13

92283 COLOR VISION EXAMINATION 26 0001 8.40

92283 COLOR VISION EXAMINATION 0001 49.54

92284 DARK ADAPTATION EYE EXAM TC 0001 43.38

92284 DARK ADAPTATION EYE EXAM 26 0001 10.86

92284 DARK ADAPTATION EYE EXAM 0001 54.24

92285 EYE PHOTOGRAPHY TC 0001 15.75

92285 EYE PHOTOGRAPHY 26 0001 2.82

92285 EYE PHOTOGRAPHY 0001 18.58

92286 INTERNAL EYE PHOTOGRAPHY TC 0001 14.47

92286 INTERNAL EYE PHOTOGRAPHY 26 0001 19.59

92286 INTERNAL EYE PHOTOGRAPHY 0001 34.06

92287 INTERNAL EYE PHOTOGRAPHY 0001 123.05

92310 CONTACT LENS FITTING 0001 84.93





92314 PRESCRIPTION OF CONTACT LENS 0001 70.56

92315 RX CNTACT LENS APHAKIA 1 EYE 0001 65.82

92316 RX CNTACT LENS APHAKIA 2 EYE 0001 81.82

92317 RX CORNEOSCLERAL CNTACT LENS 0001 67.70

92325 MODIFICATION OF CONTACT LENS 0001 37.27

92326 REPLACEMENT OF CONTACT LENS 0001 32.13

92340 FIT SPECTACLES MONOFOCAL 0001 31.56

92341 FIT SPECTACLES BIFOCAL 0001 35.89

92342 FIT SPECTACLES MULTIFOCAL 0001 38.70

92352 FIT APHAKIA SPECTCL MONOFOCL 0001 36.06

92353 FIT APHAKIA SPECTCL MULTIFOC 0001 41.62

92354 FIT SPECTACLES SINGLE SYSTEM 0001 12.22

92355 FIT SPECTACLES COMPOUND LENS 0001 18.64

92358 APHAKIA PROSTH SERVICE TEMP 0001 10.29

92370 REPAIR & ADJUST SPECTACLES 0001 27.46

92371 REPAIR & ADJUST SPECTACLES 0001 10.29

92502 EAR AND THROAT EXAMINATION 0001 85.96

92504 EAR MICROSCOPY EXAMINATION 0001 27.02

92507 SPEECH/HEARING THERAPY 0001 70.25

92508 SPEECH/HEARING THERAPY 0001 20.67

92511 NASOPHARYNGOSCOPY 0001 123.04

92512 NASAL FUNCTION STUDIES 0001 54.39

92516 FACIAL NERVE FUNCTION TEST 0001 62.62

92520 LARYNGEAL FUNCTION STUDIES 0001 66.29

92521 Evaluation of speech fluency 0001 99.66

92522 Evaluate speech production 0001 80.78

92523 Speech sound lang comprehen 0001 168.00

92524 Behavral qualit analys voice 0001 84.39

92531 SPONTANEOUS NYSTAGMUS STUDY 0001 24.31

92532 POSITIONAL NYSTAGMUS TEST 0001 28.00

92533 CALORIC VESTIBULAR TEST 0001 44.62

92534 OPTOKINETIC NYSTAGMUS TEST 0001 19.69

92540 BASIC VESTIBULAR EVALUATION TC 0001 19.61

92540 BASIC VESTIBULAR EVALUATION 26 0001 69.87

92540 BASIC VESTIBULAR EVALUATION 0001 89.48

92541 SPONTANEOUS NYSTAGMUS TEST TC 0001 8.68

92541 SPONTANEOUS NYSTAGMUS TEST 26 0001 18.31

92541 SPONTANEOUS NYSTAGMUS TEST 0001 27.00

92542 POSITIONAL NYSTAGMUS TEST TC 0001 8.04

92542 POSITIONAL NYSTAGMUS TEST 26 0001 15.21

92542 POSITIONAL NYSTAGMUS TEST 0001 23.26

92543 CALORIC VESTIBULAR TEST TC 0001 9.33

92543 CALORIC VESTIBULAR TEST 26 0001 4.99


92543 CALORIC VESTIBULAR TEST 0001 14.32

92544 OPTOKINETIC NYSTAGMUS TEST TC 0001 9.01

92544 OPTOKINETIC NYSTAGMUS TEST 26 0001 12.11

92544 OPTOKINETIC NYSTAGMUS TEST 0001 21.12

92545 OSCILLATING TRACKING TEST TC 0001 7.72

92545 OSCILLATING TRACKING TEST 26 0001 10.55

92545 OSCILLATING TRACKING TEST 0001 18.28

92546 SINUSOIDAL ROTATIONAL TEST TC 0001 79.04

92546 SINUSOIDAL ROTATIONAL TEST 26 0001 13.35

92546 SINUSOIDAL ROTATIONAL TEST 0001 92.39

92547 SUPPLEMENTAL ELECTRICAL TEST 0001 5.47

92548 POSTUROGRAPHY TC 0001 70.36

92548 POSTUROGRAPHY 26 0001 22.64

92548 POSTUROGRAPHY 0001 93.01

92550 TYMPANOMETRY & REFLEX THRESH 0001 18.39

92551 PURE TONE HEARING TEST AIR 0001 10.61

92552 PURE TONE AUDIOMETRY AIR 0001 27.64

92553 AUDIOMETRY AIR & BONE 0001 33.10

92555 SPEECH THRESHOLD AUDIOMETRY 0001 20.57

92556 SPEECH AUDIOMETRY COMPLETE 0001 32.78

92557 COMPREHENSIVE HEARING TEST 0001 33.11

92559 GROUP AUDIOMETRIC TESTING 0001 27.69

92560 BEKESY AUDIOMETRY SCREEN 0001 16.62

92561 BEKESY AUDIOMETRY DIAGNOSIS 0001 33.74

92562 LOUDNESS BALANCE TEST 0001 41.45

92563 TONE DECAY HEARING TEST 0001 27.32

92564 SISI HEARING TEST 0001 25.39

92565 STENGER TEST PURE TONE 0001 14.79

92567 TYMPANOMETRY 0001 12.85

92568 ACOUSTIC REFL THRESHOLD TST 0001 13.67

92570 ACOUSTIC IMMITANCE TESTING 0001 28.37

92571 FILTERED SPEECH HEARING TEST 0001 24.10

92572 STAGGERED SPONDAIC WORD TEST 0001 45.95

92575 SENSORINEURAL ACUITY TEST 0001 67.15

92576 SYNTHETIC SENTENCE TEST 0001 31.17

92577 STENGER TEST SPEECH 0001 17.36

92579 VISUAL AUDIOMETRY (VRA) 0001 37.12

92582 CONDITIONING PLAY AUDIOMETRY 0001 61.37

92583 SELECT PICTURE AUDIOMETRY 0001 46.59

92584 ELECTROCOCHLEOGRAPHY 0001 63.30

92585 AUDITOR EVOKE POTENT COMPRE TC 0001 93.81

92585 AUDITOR EVOKE POTENT COMPRE 26 0001 23.28

92585 AUDITOR EVOKE POTENT COMPRE 0001 117.10

92586 AUDITOR EVOKE POTENT LIMIT 0001 75.50

92587 EVOKED AUDITORY TEST LIMITED TC 0001 2.58

92587 EVOKED AUDITORY TEST LIMITED 26 0001 16.81


92587 EVOKED AUDITORY TEST LIMITED 0001 19.40

92588 EVOKED AUDITORY TST COMPLETE TC 0001 3.54

92588 EVOKED AUDITORY TST COMPLETE 26 0001 25.79

92588 EVOKED AUDITORY TST COMPLETE 0001 29.33

92590 HEARING AID EXAM ONE EAR 0001 33.23

92591 HEARING AID EXAM BOTH EARS 0001 48.92

92592 HEARING AID CHECK ONE EAR 0001 15.08

92593 HEARING AID CHECK BOTH EARS 0001 21.54

92594 ELECTRO HEARNG AID TEST ONE 0001 16.00

92595 ELECTRO HEARNG AID TST BOTH 0001 24.31

92596 EAR PROTECTOR EVALUATION 0001 38.24

92597 ORAL SPEECH DEVICE EVAL 0001 63.89

92601 COCHLEAR IMPLT F/UP EXAM <7 0001 122.64

92602 REPROGRAM COCHLEAR IMPLT 7/> 0001 72.50

92603 COCHLEAR IMPLT F/UP EXAM 7/> 0001 129.78

92604 REPROGRAM COCHLEAR IMPLT 7/> 0001 78.33

92605 EX FOR NONSPEECH DEVICE RX 0001 81.75

92606 NON-SPEECH DEVICE SERVICE 0001 72.65

92607 EX FOR SPEECH DEVICE RX 1HR 0001 113.72

92608 EX FOR SPEECH DEVICE RX ADDL 0001 47.09

92609 USE OF SPEECH DEVICE SERVICE 0001 98.51

92610 EVALUATE SWALLOWING FUNCTION 0001 75.07

92611 MOTION FLUOROSCOPY/SWALLOW 0001 80.48

92612 ENDOSCOPY SWALLOW TST (FEES) 0001 158.64

92613 ENDOSCOPY SWALLOW TST (FEES) 0001 33.26

92614 LARYNGOSCOPIC SENSORY TEST 0001 133.90

92615 EVAL LARYNGOSCOPY SENSE TST 0001 29.85

92616 FEES W/LARYNGEAL SENSE TEST 0001 188.52

92617 INTERPRT FEES/LARYNGEAL TEST 0001 36.99

92620 AUDITORY FUNCTION 60 MIN 0001 82.77

92621 AUDITORY FUNCTION + 15 MIN 0001 19.67

92625 TINNITUS ASSESSMENT 0001 61.47

92920 Prq cardiac angioplast 1 art 0001 490.08

92921 Prq cardiac angio addl art 0001 0.00

92924 Prq card angio/athrect 1 art 0001 583.03

92925 Prq card angio/athrect addl 0001 0.00

92928 Prq card stent w/angio 1 vsl 0001 544.23

92929 Prq card stent w/angio addl 0001 0.00

92933 Prq card stent/ath/angio 0001 608.98

92934 Prq card stent/ath/angio 0001 0.00

92937 Prq revasc byp graft 1 vsl 0001 543.92

92938 Prq revasc byp graft addl 0001 0.00

92941 PRQ CARD REVASC MI 1 VSL 0001 610.25

92943 Prq card revasc chronic 1vsl 0001 610.25

92944 Prq card revasc chronic addl 0001 0.00

92950 HEART/LUNG RESUSCITATION CPR 0001 267.61


92953 TEMPORARY EXTERNAL PACING 0001 9.59

92960 CARDIOVERSION ELECTRIC EXT 0001 181.21

92961 CARDIOVERSION ELECTRIC INT 0001 215.09

92970 CARDIOASSIST INTERNAL 0001 154.89

92971 CARDIOASSIST EXTERNAL 0001 81.75

92973 PRQ CORONARY MECH THROMBECT 0001 159.19

92974 CATH PLACE CARDIO BRACHYTX 0001 145.42

92975 DISSOLVE CLOT HEART VESSEL 0001 351.23

92977 DISSOLVE CLOT HEART VESSEL 0001 113.76

92978 INTRAVASC US HEART ADD-ON TC 0001 145.85

92978 INTRAVASC US HEART ADD-ON 26 0001 78.48

92978 INTRAVASC US HEART ADD-ON 0001 228.01

92979 INTRAVASC US HEART ADD-ON TC 0001 73.85

92979 INTRAVASC US HEART ADD-ON 26 0001 63.32

92979 INTRAVASC US HEART ADD-ON 0001 138.47

92986 REVISION OF AORTIC VALVE 0001 1199.03





92997 PUL ART BALLOON REPR PERCUT 0001 586.90

92998 PUL ART BALLOON REPR PERCUT 0001 290.24

93000 ELECTROCARDIOGRAM COMPLETE 0001 14.85

93005 ELECTROCARDIOGRAM TRACING 0001 7.40

93010 ELECTROCARDIOGRAM REPORT 0001 7.44

93015 CARDIOVASCULAR STRESS TEST 0001 66.91




93024 CARDIAC DRUG STRESS TEST TC 0001 48.52

93024 CARDIAC DRUG STRESS TEST 26 0001 50.18

93024 CARDIAC DRUG STRESS TEST 0001 98.70

93025 MICROVOLT T-WAVE ASSESS 0001 146.27

93040 RHYTHM ECG WITH REPORT 0001 11.34

93041 RHYTHM ECG TRACING 0001 5.15

93042 RHYTHM ECG REPORT 0001 6.19

93224 ECG MONIT/REPRT UP TO 48 HRS 0001 81.43




93228 REMOTE 30 DAY ECG REV/REPORT 0001 22.96

93229 REMOTE 30 DAY ECG TECH SUPP 0001 600.09

93260 Prgrmg dev eval impltbl sys 0001 58.08

93261 Interrogate subq defib 0001 53.13

93268 ECG RECORD/REVIEW 0001 183.26

93270 REMOTE 30 DAY ECG REV/REPORT 0001 8.36


93271 ECG/MONITORING AND ANALYSIS 0001 152.92

93272 ECG/REVIEW INTERPRET ONLY 0001 21.96

93278 ECG/SIGNAL-AVERAGED TC 0001 16.07

93278 ECG/SIGNAL-AVERAGED 26 0001 10.84

93278 ECG/SIGNAL-AVERAGED 0001 26.92

93279 PM DEVICE PROGR EVAL SNGL TC 0001 15.43

93279 PM DEVICE PROGR EVAL SNGL 26 0001 28.53

93279 PM DEVICE PROGR EVAL SNGL 0001 43.96

93280 PM DEVICE PROGR EVAL DUAL TC 0001 17.68

93280 PM DEVICE PROGR EVAL DUAL 26 0001 33.79

93280 PM DEVICE PROGR EVAL DUAL 0001 51.48

93281 PM DEVICE PROGR EVAL MULTI TC 0001 20.57

93281 PM DEVICE PROGR EVAL MULTI 26 0001 39.36

93281 PM DEVICE PROGR EVAL MULTI 0001 59.94

93282 PRGRMG EVAL IMPLANTABLE DFB TC 0001 18.00

93282 PRGRMG EVAL IMPLANTABLE DFB 26 0001 37.19

93282 PRGRMG EVAL IMPLANTABLE DFB 0001 55.20







93285 ILR DEVICE EVAL PROGR TC 0001 14.15

93285 ILR DEVICE EVAL PROGR 26 0001 22.61

93285 ILR DEVICE EVAL PROGR 0001 36.76

93286 PERI-PX PACEMAKER DEVICE EVL TC 0001 10.61

93286 PERI-PX PACEMAKER DEVICE EVL 26 0001 13.33

93286 PERI-PX PACEMAKER DEVICE EVL 0001 23.95

93287 PERI-PX DEVICE EVAL & PRGR TC 0001 11.58

93287 PERI-PX DEVICE EVAL & PRGR 26 0001 19.83

93287 PERI-PX DEVICE EVAL & PRGR 0001 31.41

93288 PM DEVICE EVAL IN PERSON TC 0001 14.15

93288 PM DEVICE EVAL IN PERSON 26 0001 18.26

93288 PM DEVICE EVAL IN PERSON 0001 32.41

93289 INTERROG DEVICE EVAL HEART TC 0001 17.36

93289 INTERROG DEVICE EVAL HEART 26 0001 39.97

93289 INTERROG DEVICE EVAL HEART 0001 57.33

93290 ICM DEVICE EVAL TC 0001 8.36

93290 ICM DEVICE EVAL 26 0001 18.58

93290 ICM DEVICE EVAL 0001 26.95

93291 ILR DEVICE INTERROGATE TC 0001 13.18

93291 ILR DEVICE INTERROGATE 26 0001 18.58

93291 ILR DEVICE INTERROGATE 0001 31.76

93292 WCD DEVICE INTERROGATE TC 0001 9.65

93292 WCD DEVICE INTERROGATE 26 0001 18.26


93292 WCD DEVICE INTERROGATE 0001 27.91

93293 PM PHONE R-STRIP DEVICE EVAL TC 0001 33.74

93293 PM PHONE R-STRIP DEVICE EVAL 26 0001 13.94

93293 PM PHONE R-STRIP DEVICE EVAL 0001 47.69

93294 PM DEVICE INTERROGATE REMOTE 0001 29.51

93295 DEV INTERROG REMOTE 1/2/MLT 0001 58.72

93296 PM/ICD REMOTE TECH SERV 0001 23.14

93297 ICM DEVICE INTERROGAT REMOTE 0001 22.96

93298 ILR DEVICE INTERROGAT REMOTE 0001 23.28

93303 ECHO TRANSTHORACIC TC 0001 156.78

93303 ECHO TRANSTHORACIC 26 0001 55.74

93303 ECHO TRANSTHORACIC 0001 212.53

93304 ECHO TRANSTHORACIC TC 0001 108.91

93304 ECHO TRANSTHORACIC 26 0001 32.22

93304 ECHO TRANSTHORACIC 0001 141.13

93306 TTE W/DOPPLER COMPLETE TC 0001 147.78

93306 TTE W/DOPPLER COMPLETE 26 0001 55.74

93306 TTE W/DOPPLER COMPLETE 0001 203.53

93307 TTE W/O DOPPLER COMPLETE TC 0001 77.75

93307 TTE W/O DOPPLER COMPLETE 26 0001 39.65

93307 TTE W/O DOPPLER COMPLETE 0001 117.40

93308 TTE F-UP OR LMTD TC 0001 87.71

93308 TTE F-UP OR LMTD 26 0001 22.27

93308 TTE F-UP OR LMTD 0001 109.98

93312 ECHO TRANSESOPHAGEAL TC 0001 204.03

93312 ECHO TRANSESOPHAGEAL 26 0001 91.58

93312 ECHO TRANSESOPHAGEAL 0001 295.61












93318 ECHO TRANSESOPHAGEAL INTRAOP TC 0001 104.93

93318 ECHO TRANSESOPHAGEAL INTRAOP 26 0001 99.01

93318 ECHO TRANSESOPHAGEAL INTRAOP 0001 322.78

93320 DOPPLER ECHO EXAM HEART TC 0001 32.46

93320 DOPPLER ECHO EXAM HEART 26 0001 16.09

93320 DOPPLER ECHO EXAM HEART 0001 48.55

93321 DOPPLER ECHO EXAM HEART TC 0001 21.21

93321 DOPPLER ECHO EXAM HEART 26 0001 6.51


93321 DOPPLER ECHO EXAM HEART 0001 27.73

93325 DOPPLER COLOR FLOW ADD-ON TC 0001 20.25

93325 DOPPLER COLOR FLOW ADD-ON 26 0001 3.11

93325 DOPPLER COLOR FLOW ADD-ON 0001 23.36

93350 STRESS TTE ONLY TC 0001 152.28

93350 STRESS TTE ONLY 26 0001 62.56

93350 STRESS TTE ONLY 0001 214.85

93351 STRESS TTE COMPLETE 0001 249.74

93352 ADMIN ECG CONTRAST AGENT 0001 29.90

93355 Echo transesophageal (tee) 0001 198.21

93451 RIGHT HEART CATH RIGHT TC 0001 572.49

93451 RIGHT HEART CATH RIGHT 26 0001 131.97

93451 RIGHT HEART CATH RIGHT 0001 704.47

93452 LEFT HRT CATH W/VENTRCLGRPHY LEFT TC 0001 557.40

93452 LEFT HRT CATH W/VENTRCLGRPHY LEFT 26 0001 231.50

93452 LEFT HRT CATH W/VENTRCLGRPHY LEFT 0001 788.90

93453 R&L HRT CATH W/VENTRICLGRPHY COMBI TC 0001 718.67

93453 R&L HRT CATH W/VENTRICLGRPHY COMBI 26 0001 303.41

93453 R&L HRT CATH W/VENTRICLGRPHY COMBI 0001 1022.09

93454 CORONARY ARTERY ANGIO S&I CATHE TC 0001 570.89

93454 CORONARY ARTERY ANGIO S&I CATHE 26 0001 233.04

93454 CORONARY ARTERY ANGIO S&I CATHE 0001 803.94

93455 CORONARY ART/GRFT ANGIO S&I CATHE TC 0001 666.95

93455 CORONARY ART/GRFT ANGIO S&I CATHE 26 0001 268.99

93455 CORONARY ART/GRFT ANGIO S&I CATHE 0001 935.95

93456 R HRT CORONARY ARTERY ANGIO CATHE TC 0001 709.04

93456 R HRT CORONARY ARTERY ANGIO CATHE 26 0001 298.04

93456 R HRT CORONARY ARTERY ANGIO CATHE 0001 1007.08

93457 R HRT ART/GRFT ANGIO CATHE TC 0001 804.12

93457 R HRT ART/GRFT ANGIO CATHE 26 0001 334.34

93457 R HRT ART/GRFT ANGIO CATHE 0001 1138.47

93458 L HRT ARTERY/VENTRICLE ANGIO CATHE TC 0001 679.80

93458 L HRT ARTERY/VENTRICLE ANGIO CATHE 26 0001 284.33

93458 L HRT ARTERY/VENTRICLE ANGIO CATHE 0001 964.14

93459 L HRT ART/GRFT ANGIO CATHE TC 0001 744.37

93459 L HRT ART/GRFT ANGIO CATHE 26 0001 320.26

93459 L HRT ART/GRFT ANGIO CATHE 0001 1064.64

93460 R&L HRT ART/VENTRICLE ANGIO CATHE TC 0001 784.85

93460 R&L HRT ART/VENTRICLE ANGIO CATHE 26 0001 356.53

93460 R&L HRT ART/VENTRICLE ANGIO CATHE 0001 1141.39

93461 R&L HRT ART/VENTRICLE ANGIO CATHE TC 0001 912.72

93461 R&L HRT ART/VENTRICLE ANGIO CATHE 26 0001 393.47

93461 R&L HRT ART/VENTRICLE ANGIO CATHE 0001 1306.20

93462 L HRT CATH TRNSPTL PUNCTURE LEFT 0001 187.50

93463 DRUG ADMIN & HEMODYNMIC MEAS PHARM 0001 95.27


93464 EXERCISE W/HEMODYNAMIC MEAS PHYSI TC 0001 166.73

93464 EXERCISE W/HEMODYNAMIC MEAS PHYSI 26 0001 85.90

93464 EXERCISE W/HEMODYNAMIC MEAS PHYSI 0001 252.64

93503 INSERT/PLACE HEART CATHETER 0001 115.12

93505 BIOPSY OF HEART LINING TC 0001 471.30

93505 BIOPSY OF HEART LINING 26 0001 208.33

93505 BIOPSY OF HEART LINING 0001 679.64

93530 RT HEART CATH CONGENITAL TC 0001 543.71

93530 RT HEART CATH CONGENITAL 26 0001 205.17

93530 RT HEART CATH CONGENITAL 0001 734.48

93531 R & L HEART CATH CONGENITAL TC 0001 1553.27

93531 R & L HEART CATH CONGENITAL 26 0001 404.40

93531 R & L HEART CATH CONGENITAL 0001 1932.36







93561 CARDIAC OUTPUT MEASUREMENT TC 0001 18.15

93561 CARDIAC OUTPUT MEASUREMENT 26 0001 21.40

93561 CARDIAC OUTPUT MEASUREMENT 0001 39.39

93562 CARD OUTPUT MEASURE SUBSQ TC 0001 10.46

93562 CARD OUTPUT MEASURE SUBSQ 26 0001 6.82

93562 CARD OUTPUT MEASURE SUBSQ 0001 17.23

93563 INJECT CONGENITAL CARD CATH INJEC 0001 49.41

93564 INJECT HRT CONGNTL ART/GRFT INJEC 0001 50.67

93565 INJECT L VENTR/ATRIAL ANGIO INJEC 0001 38.54

93566 INJECT R VENTR/ATRIAL ANGIO INJEC 0001 153.55

93567 INJECT SUPRVLV AORTOGRAPHY INJEC 0001 126.06

93568 INJECT PULM ART HRT CATH INJEC 0001 137.13

93571 HEART FLOW RESERVE MEASURE TC 0001 145.85

93571 HEART FLOW RESERVE MEASURE 26 0001 78.48

93571 HEART FLOW RESERVE MEASURE 0001 228.93

93572 HEART FLOW RESERVE MEASURE TC 0001 73.85

93572 HEART FLOW RESERVE MEASURE 26 0001 63.66

93572 HEART FLOW RESERVE MEASURE 0001 141.23

93580 TRANSCATH CLOSURE OF ASD 0001 883.57

93581 TRANSCATH CLOSURE OF VSD 0001 1192.84

93582 Perq transcath closure pda 0001 608.95

93583 Perq transcath septal reduxn 0001 677.73

93600 BUNDLE OF HIS RECORDING TC 0001 63.39

93600 BUNDLE OF HIS RECORDING 26 0001 107.05

93600 BUNDLE OF HIS RECORDING 0001 161.23

93602 INTRA-ATRIAL RECORDING TC 0001 36.00

93602 INTRA-ATRIAL RECORDING 26 0001 105.77


93602 INTRA-ATRIAL RECORDING 0001 134.16

93603 RIGHT VENTRICULAR RECORDING TC 0001 54.46

93603 RIGHT VENTRICULAR RECORDING 26 0001 105.13

93603 RIGHT VENTRICULAR RECORDING 0001 151.70

93609 MAP TACHYCARDIA ADD-ON TC 0001 87.69

93609 MAP TACHYCARDIA ADD-ON 26 0001 250.43

93609 MAP TACHYCARDIA ADD-ON 0001 320.01

93610 INTRA-ATRIAL PACING TC 0001 44.31

93610 INTRA-ATRIAL PACING 26 0001 149.89

93610 INTRA-ATRIAL PACING 0001 183.39

93612 INTRAVENTRICULAR PACING TC 0001 52.31

93612 INTRAVENTRICULAR PACING 26 0001 148.60

93612 INTRAVENTRICULAR PACING 0001 191.39

93613 ELECTROPHYS MAP 3D ADD-ON 0001 352.19

93615 ESOPHAGEAL RECORDING TC 0001 10.46

93615 ESOPHAGEAL RECORDING 26 0001 46.63

93615 ESOPHAGEAL RECORDING 0001 53.54

93616 ESOPHAGEAL RECORDING TC 0001 10.46

93616 ESOPHAGEAL RECORDING 26 0001 57.47

93616 ESOPHAGEAL RECORDING 0001 74.77

93618 HEART RHYTHM PACING TC 0001 127.70

93618 HEART RHYTHM PACING 26 0001 214.76

93618 HEART RHYTHM PACING 0001 324.62

93619 ELECTROPHYSIOLOGY EVALUATION TC 0001 248.62

93619 ELECTROPHYSIOLOGY EVALUATION 26 0001 366.23

93619 ELECTROPHYSIOLOGY EVALUATION 0001 584.94










93623 STIMULATION PACING HEART TC 0001 105.85

93623 STIMULATION PACING HEART 26 0001 143.71

93623 STIMULATION PACING HEART 0001 235.70

93624 ELECTROPHYSIOLOGIC STUDY TC 0001 64.31

93624 ELECTROPHYSIOLOGIC STUDY 26 0001 235.90

93624 ELECTROPHYSIOLOGIC STUDY 0001 285.85

93631 HEART PACING MAPPING TC 0001 205.54

93631 HEART PACING MAPPING 26 0001 366.11

93631 HEART PACING MAPPING 0001 555.09

93640 EVALUATION HEART DEVICE TC 0001 230.78

93640 EVALUATION HEART DEVICE 26 0001 173.35


93640 EVALUATION HEART DEVICE 0001 392.93







93644 Electrophysiology evaluation 0001 276.27


93653 EP & ABLATE SUPRAVENT ARRHYT 0001 756.08

93654 EP & ABLATE VENTRIC TACHY 0001 1006.82

93655 Ablate arrhythmia add on 0001 377.87

93656 TX ATRIAL FIB PULM VEIN ISOL 0001 1008.08

93657 Tx l/r atrial fib addl 0001 378.21

93660 TILT TABLE EVALUATION TC 0001 55.91

93660 TILT TABLE EVALUATION 26 0001 82.77

93660 TILT TABLE EVALUATION 0001 138.68

93662 INTRACARDIAC ECG (ICE) TC 0001 111.70

93662 INTRACARDIAC ECG (ICE) 26 0001 127.72

93662 INTRACARDIAC ECG (ICE) 0001 248.01

93701 BIOIMPEDANCE CV ANALYSIS 0001 21.53

93702 Bis xtracell fluid analysis 0001 103.13

93724 ANALYZE PACEMAKER SYSTEM TC 0001 25.07

93724 ANALYZE PACEMAKER SYSTEM 26 0001 212.61

93724 ANALYZE PACEMAKER SYSTEM 0001 237.68

93740 TEMPERATURE GRADIENT STUDIES 0001 7.81

93745 SET-UP CARDIOVERT-DEFIBRILL 0001 0.00

93750 INTERROGATION VAD IN PERSON 0001 47.71

93770 MEASURE VENOUS PRESSURE 0001 7.81

93784 AMBULATORY BP MONITORING 0001 47.93

93786 AMBULATORY BP RECORDING 0001 26.67

93788 AMBULATORY BP ANALYSIS 0001 4.83

93790 REVIEW/REPORT BP RECORDING 0001 16.41

93799 CARDIOVASCULAR PROCEDURE TC 0001 0.00

93799 CARDIOVASCULAR PROCEDURE 26 0001 0.00

93799 CARDIOVASCULAR PROCEDURE 0001 0.00

93880 EXTRACRANIAL BILAT STUDY TC 0001 144.89

93880 EXTRACRANIAL BILAT STUDY 26 0001 26.38

93880 EXTRACRANIAL BILAT STUDY 0001 171.27

93882 EXTRACRANIAL UNI/LTD STUDY TC 0001 92.85

93882 EXTRACRANIAL UNI/LTD STUDY 26 0001 18.05

93882 EXTRACRANIAL UNI/LTD STUDY 0001 110.90

93886 INTRACRANIAL COMPLETE STUDY TC 0001 280.13

93886 INTRACRANIAL COMPLETE STUDY 26 0001 42.52

93886 INTRACRANIAL COMPLETE STUDY 0001 322.66

93888 INTRACRANIAL LIMITED STUDY TC 0001 160.95


93888 INTRACRANIAL LIMITED STUDY 26 0001 27.63

93888 INTRACRANIAL LIMITED STUDY 0001 188.59

93890 TCD VASOREACTIVITY STUDY TC 0001 214.92

93890 TCD VASOREACTIVITY STUDY 26 0001 44.67

93890 TCD VASOREACTIVITY STUDY 0001 259.60

93892 TCD EMBOLI DETECT W/O INJ TC 0001 250.58

93892 TCD EMBOLI DETECT W/O INJ 26 0001 51.83

93892 TCD EMBOLI DETECT W/O INJ 0001 302.41

93893 TCD EMBOLI DETECT W/INJ TC 0001 260.22

93893 TCD EMBOLI DETECT W/INJ 26 0001 52.15

93893 TCD EMBOLI DETECT W/INJ 0001 312.37

93922 UPR/L XTREMITY ART 2 LEVELS TC 0001 69.08

93922 UPR/L XTREMITY ART 2 LEVELS 26 0001 10.52

93922 UPR/L XTREMITY ART 2 LEVELS 0001 79.60

93923 UPR/LXTR ART STDY 3+ LVLS TC 0001 105.38

93923 UPR/LXTR ART STDY 3+ LVLS 26 0001 19.56

93923 UPR/LXTR ART STDY 3+ LVLS 0001 124.94

93924 LWR XTR VASC STDY BILAT TC 0001 135.25

93924 LWR XTR VASC STDY BILAT 26 0001 21.72

93924 LWR XTR VASC STDY BILAT 0001 156.98

93925 LOWER EXTREMITY STUDY TC 0001 186.04

93925 LOWER EXTREMITY STUDY 26 0001 35.07

93925 LOWER EXTREMITY STUDY 0001 221.12

93926 LOWER EXTREMITY STUDY TC 0001 104.74

93926 LOWER EXTREMITY STUDY 26 0001 22.08

93926 LOWER EXTREMITY STUDY 0001 126.82

93930 UPPER EXTREMITY STUDY TC 0001 186.65

93930 UPPER EXTREMITY STUDY 26 0001 20.18

93930 UPPER EXTREMITY STUDY 0001 206.84

93931 UPPER EXTREMITY STUDY TC 0001 127.86

93931 UPPER EXTREMITY STUDY 26 0001 13.67

93931 UPPER EXTREMITY STUDY 0001 141.54

93965 EXTREMITY STUDY TC 0001 93.17

93965 EXTREMITY STUDY 26 0001 15.53

93965 EXTREMITY STUDY 0001 108.70







93975 VASCULAR STUDY TC 0001 242.90

93975 VASCULAR STUDY 26 0001 78.84

93975 VASCULAR STUDY 0001 321.74


93976 VASCULAR STUDY 26 0001 53.39




93978 VASCULAR STUDY 26 0001 28.59



93979 VASCULAR STUDY 26 0001 18.93


93980 PENILE VASCULAR STUDY TC 0001 54.30

93980 PENILE VASCULAR STUDY 26 0001 54.59

93980 PENILE VASCULAR STUDY 0001 108.89

93981 PENILE VASCULAR STUDY TC 0001 47.23

93981 PENILE VASCULAR STUDY 26 0001 19.24

93981 PENILE VASCULAR STUDY 0001 66.47

93982 Aneurysm pressure sens study 0001 38.77

93990 DOPPLER FLOW TESTING TC 0001 164.16

93990 DOPPLER FLOW TESTING 26 0001 11.21

93990 DOPPLER FLOW TESTING 0001 175.38

94002 VENT MGMT INPAT INIT DAY 0001 81.77

94003 VENT MGMT INPAT SUBQ DAY 0001 58.94

94010 BREATHING CAPACITY TEST TC 0001 24.75

94010 BREATHING CAPACITY TEST 26 0001 7.44

94010 BREATHING CAPACITY TEST 0001 32.19

94011 SPIROMETRY UP TO 2 YRS OLD 0001 90.07

94012 SPIRMTRY W/BRNCHDIL INF-2 YR 0001 141.09

94013 MEAS LUNG VOL THRU 2 YRS 0001 27.88

94014 PATIENT RECORDED SPIROMETRY 0001 46.07

94015 PATIENT RECORDED SPIROMETRY 0001 24.10

94016 REVIEW PATIENT SPIROMETRY 0001 21.96

94060 EVALUATION OF WHEEZING TC 0001 42.74

94060 EVALUATION OF WHEEZING 26 0001 11.45

94060 EVALUATION OF WHEEZING 0001 54.19

94070 EVALUATION OF WHEEZING TC 0001 27.64

94070 EVALUATION OF WHEEZING 26 0001 25.40

94070 EVALUATION OF WHEEZING 0001 53.04

94150 VITAL CAPACITY TEST TC 0001 19.29

94150 VITAL CAPACITY TEST 26 0001 3.43

94150 VITAL CAPACITY TEST 0001 22.72

94200 LUNG FUNCTION TEST (MBC/MVV) TC 0001 17.04

94200 LUNG FUNCTION TEST (MBC/MVV) 26 0001 4.97

94200 LUNG FUNCTION TEST (MBC/MVV) 0001 22.01

94250 EXPIRED GAS COLLECTION TC 0001 18.64

94250 EXPIRED GAS COLLECTION 26 0001 4.97

94250 EXPIRED GAS COLLECTION 0001 23.62

94375 RESPIRATORY FLOW VOLUME LOOP TC 0001 21.86

94375 RESPIRATORY FLOW VOLUME LOOP 26 0001 12.99

94375 RESPIRATORY FLOW VOLUME LOOP 0001 34.85


94400 CO2 BREATHING RESPONSE CURVE TC 0001 32.78

94400 CO2 BREATHING RESPONSE CURVE 26 0001 17.02

94400 CO2 BREATHING RESPONSE CURVE 0001 49.80

94450 HYPOXIA RESPONSE CURVE TC 0001 43.38

94450 HYPOXIA RESPONSE CURVE 26 0001 17.34

94450 HYPOXIA RESPONSE CURVE 0001 60.73

94452 HAST W/REPORT TC 0001 38.88

94452 HAST W/REPORT 26 0001 12.67

94452 HAST W/REPORT 0001 51.56

94453 HAST W/OXYGEN TITRATE TC 0001 55.26

94453 HAST W/OXYGEN TITRATE 26 0001 16.38

94453 HAST W/OXYGEN TITRATE 0001 71.65

94610 SURFACTANT ADMIN THRU TUBE 0001 52.49

94620 PULMONARY STRESS TEST/SIMPLE TC 0001 22.50

94620 PULMONARY STRESS TEST/SIMPLE 26 0001 26.94

94620 PULMONARY STRESS TEST/SIMPLE 0001 49.44

94621 PULM STRESS TEST/COMPLEX TC 0001 84.82

94621 PULM STRESS TEST/COMPLEX 26 0001 60.70

94621 PULM STRESS TEST/COMPLEX 0001 145.53

94640 AIRWAY INHALATION TREATMENT 0001 16.39

94642 AEROSOL INHALATION TREATMENT 0001 64.92

94644 CBT 1ST HOUR 0001 39.52

94645 CBT EACH ADDL HOUR 0001 12.86

94660 POS AIRWAY PRESSURE CPAP 0001 55.68

94662 NEG PRESS VENTILATION CNP 0001 35.45

94664 EVALUATE PT USE OF INHALER 0001 15.43

94667 CHEST WALL MANIPULATION 0001 22.82

94668 CHEST WALL MANIPULATION 0001 26.35

94669 Mechanical chest wall oscill 0001 31.81

94680 EXHALED AIR ANALYSIS O2 TC 0001 40.49

94680 EXHALED AIR ANALYSIS O2 26 0001 11.15

94680 EXHALED AIR ANALYSIS O2 0001 51.64

94681 EXHALED AIR ANALYSIS O2/CO2 TC 0001 36.95

94681 EXHALED AIR ANALYSIS O2/CO2 26 0001 8.68

94681 EXHALED AIR ANALYSIS O2/CO2 0001 45.64

94690 EXHALED AIR ANALYSIS TC 0001 40.49

94690 EXHALED AIR ANALYSIS 26 0001 3.43

94690 EXHALED AIR ANALYSIS 0001 43.92

94726 Pulm funct tst plethysmograp TC 0001 36.65

94726 Pulm funct tst plethysmograp 26 0001 10.83

94726 Pulm funct tst plethysmograp 0001 47.48

94727 Pulm function test by gas TC 0001 26.67

94727 Pulm function test by gas 26 0001 10.83

94727 Pulm function test by gas 0001 37.51

94728 Pulm funct test oscillometry TC 0001 24.75

94728 Pulm funct test oscillometry 26 0001 11.15


94728 Pulm funct test oscillometry 0001 35.90

94729 CO/MEMBANE DIFFUSE CAPACITY TC 0001 40.49

94729 CO/MEMBANE DIFFUSE CAPACITY 26 0001 8.05

94729 CO/MEMBANE DIFFUSE CAPACITY 0001 48.54

94750 PULMONARY COMPLIANCE STUDY TC 0001 62.97

94750 PULMONARY COMPLIANCE STUDY 26 0001 9.91

94750 PULMONARY COMPLIANCE STUDY 0001 72.89

94760 MEASURE BLOOD OXYGEN LEVEL 0001 2.90



94770 EXHALED CARBON DIOXIDE TEST 0001 7.18

94774 PED HOME APNEA REC COMPL 0001 0.00

94775 PED HOME APNEA REC HK-UP 0001 0.00

94776 PED HOME APNEA REC DOWNLD 0001 0.00

94777 PED HOME APNEA REC REPORT 0001 0.00

94780 Car seat/bed test 60 min 0001 45.83

94781 Car seat/bed test + 30 min 0001 18.04

94799 PULMONARY SERVICE/PROCEDURE TC 0001 0.00

94799 PULMONARY SERVICE/PROCEDURE 26 0001 0.00

94799 PULMONARY SERVICE/PROCEDURE 0001 0.00

95004 PERCUT ALLERGY SKIN TESTS 0001 5.78

95012 EXHALED NITRIC OXIDE MEAS 0001 17.36

95017 Perq & icut allg test venoms 0001 7.28

95018 Perq&ic allg test drugs/biol 0001 17.77

95024 ICUT ALLERGY TEST DRUG/BUG 0001 7.06

95027 ICUT ALLERGY TITRATE-AIRBORN 0001 4.17

95028 ICUT ALLERGY TEST-DELAYED 0001 12.22

95044 ALLERGY PATCH TESTS 0001 4.83

95052 PHOTO PATCH TEST 0001 5.79

95056 PHOTOSENSITIVITY TESTS 0001 38.88

95060 EYE ALLERGY TESTS 0001 30.21

95065 NOSE ALLERGY TEST 0001 23.78

95070 BRONCHIAL ALLERGY TESTS 0001 26.35

95071 BRONCHIAL ALLERGY TESTS 0001 31.49

95076 Ingest challenge ini 120 min 0001 102.97

95079 Ingest challenge addl 60 min 0001 73.30

95115 IMMUNOTHERAPY ONE INJECTION 0001 8.04

95117 IMMUNOTHERAPY INJECTIONS 0001 9.33

95120 IMMUNOTHERAPY ONE INJECTION 0001 16.31

95125 IMMUNOTHERAPY 2/> INJECTIONS 0001 20.00

95130 IMMNTX 1 STING INSECT 0001 28.00

95131 IMMNTX 2 STING INSECTS 0001 35.69




95144 ANTIGEN THERAPY SERVICES 0001 11.16









95180 RAPID DESENSITIZATION 0001 118.23

95250 GLUCOSE MONITORING CONT 0001 141.04

95251 GLUC MONITOR CONT PHYS I&R 0001 38.17

95782 Polysom <6 yrs 4/> paramtrs 0001 916.52

95783 Polysom <6 yrs cpap/bilvl 0001 976.90

95800 SLP STDY UNATTENDED SLEEP TC 0001 113.73

95800 SLP STDY UNATTENDED SLEEP 26 0001 45.55

95800 SLP STDY UNATTENDED SLEEP 0001 159.29

95801 SLP STDY UNATND W/ANAL SLEEP TC 0001 41.13

95801 SLP STDY UNATND W/ANAL SLEEP 26 0001 42.75

95801 SLP STDY UNATND W/ANAL SLEEP 0001 83.88

95805 MULTIPLE SLEEP LATENCY TEST TC 0001 325.48

95805 MULTIPLE SLEEP LATENCY TEST 26 0001 52.05

95805 MULTIPLE SLEEP LATENCY TEST 0001 377.53

95806 SLEEP STUDY UNATT&RESP EFFT TC 0001 99.31

95806 SLEEP STUDY UNATT&RESP EFFT 26 0001 53.91

95806 SLEEP STUDY UNATT&RESP EFFT 0001 153.23

95807 SLEEP STUDY ATTENDED TC 0001 370.87

95807 SLEEP STUDY ATTENDED 26 0001 54.51

95807 SLEEP STUDY ATTENDED 0001 425.38

95808 POLYSOM ANY AGE 1-3> PARAM TC 0001 493.58

95808 POLYSOM ANY AGE 1-3> PARAM 26 0001 76.59

95808 POLYSOM ANY AGE 1-3> PARAM 0001 570.18

95810 POLYSOM 6/> YRS 4/> PARAM TC 0001 446.05

95810 POLYSOM 6/> YRS 4/> PARAM 26 0001 107.19

95810 POLYSOM 6/> YRS 4/> PARAM 0001 553.25

95811 POLYSOM 6/>YRS CPAP 4/> PARM TC 0001 468.86

95811 POLYSOM 6/>YRS CPAP 4/> PARM 26 0001 111.54

95811 POLYSOM 6/>YRS CPAP 4/> PARM 0001 580.41

95812 EEG 41-60 MINUTES TC 0001 337.02

95812 EEG 41-60 MINUTES 26 0001 50.32

95812 EEG 41-60 MINUTES 0001 387.35

95813 EEG OVER 1 HOUR TC 0001 371.73

95813 EEG OVER 1 HOUR 26 0001 80.78

95813 EEG OVER 1 HOUR 0001 452.52

95816 EEG AWAKE AND DROWSY TC 0001 265.71

95816 EEG AWAKE AND DROWSY 26 0001 50.66

95816 EEG AWAKE AND DROWSY 0001 316.37

95819 EEG AWAKE AND ASLEEP TC 0001 311.00


95819 EEG AWAKE AND ASLEEP 26 0001 50.32

95819 EEG AWAKE AND ASLEEP 0001 361.33

95822 EEG COMA OR SLEEP ONLY TC 0001 271.49

95822 EEG COMA OR SLEEP ONLY 26 0001 50.32

95822 EEG COMA OR SLEEP ONLY 0001 321.82

95824 EEG CEREBRAL DEATH ONLY TC 0001 52.62

95824 EEG CEREBRAL DEATH ONLY 26 0001 35.48

95824 EEG CEREBRAL DEATH ONLY 0001 87.69

95827 EEG ALL NIGHT RECORDING TC 0001 646.78

95827 EEG ALL NIGHT RECORDING 26 0001 50.66

95827 EEG ALL NIGHT RECORDING 0001 697.45

95829 SURGERY ELECTROCORTICOGRAM TC 0001 1370.49

95829 SURGERY ELECTROCORTICOGRAM 26 0001 285.58

95829 SURGERY ELECTROCORTICOGRAM 0001 1656.07

95830 INSERT ELECTRODES FOR EEG 0001 224.84

95857 CHOLINESTERASE CHALLENGE 0001 48.98

95860 MUSCLE TEST ONE LIMB TC 0001 62.33

95860 MUSCLE TEST ONE LIMB 26 0001 45.37

95860 MUSCLE TEST ONE LIMB 0001 107.70

95861 MUSCLE TEST 2 LIMBS TC 0001 76.47

95861 MUSCLE TEST 2 LIMBS 26 0001 72.39

95861 MUSCLE TEST 2 LIMBS 0001 148.86







95865 MUSCLE TEST LARYNX TC 0001 48.20

95865 MUSCLE TEST LARYNX 26 0001 72.33

95865 MUSCLE TEST LARYNX 0001 120.53

95866 MUSCLE TEST HEMIDIAPHRAGM TC 0001 57.51

95866 MUSCLE TEST HEMIDIAPHRAGM 26 0001 59.38

95866 MUSCLE TEST HEMIDIAPHRAGM 0001 116.89

95867 MUSCLE TEST CRAN NERV UNILAT TC 0001 45.95

95867 MUSCLE TEST CRAN NERV UNILAT 26 0001 36.97

95867 MUSCLE TEST CRAN NERV UNILAT 0001 82.92

95868 MUSCLE TEST CRAN NERVE BILAT TC 0001 60.40

95868 MUSCLE TEST CRAN NERVE BILAT 26 0001 54.98

95868 MUSCLE TEST CRAN NERVE BILAT 0001 115.39

95869 MUSCLE TEST THOR PARASPINAL TC 0001 50.12

95869 MUSCLE TEST THOR PARASPINAL 26 0001 17.07

95869 MUSCLE TEST THOR PARASPINAL 0001 67.20

95870 MUSCLE TEST NONPARASPINAL TC 0001 61.05

95870 MUSCLE TEST NONPARASPINAL 26 0001 17.39

95870 MUSCLE TEST NONPARASPINAL 0001 78.44


95872 MUSCLE TEST ONE FIBER TC 0001 43.70

95872 MUSCLE TEST ONE FIBER 26 0001 135.82

95872 MUSCLE TEST ONE FIBER 0001 179.52

95873 GUIDE NERV DESTR ELEC STIM TC 0001 48.52

95873 GUIDE NERV DESTR ELEC STIM 26 0001 18.03

95873 GUIDE NERV DESTR ELEC STIM 0001 66.56

95874 GUIDE NERV DESTR NEEDLE EMG TC 0001 46.91

95874 GUIDE NERV DESTR NEEDLE EMG 26 0001 17.39

95874 GUIDE NERV DESTR NEEDLE EMG 0001 64.31

95875 LIMB EXERCISE TEST TC 0001 61.05

95875 LIMB EXERCISE TEST 26 0001 51.59

95875 LIMB EXERCISE TEST 0001 112.64

95885 Musc tst done w/nerv tst lim TC 0001 35.67

95885 Musc tst done w/nerv tst lim 26 0001 16.46

95885 Musc tst done w/nerv tst lim 0001 52.13

95886 Musc test done w/n test comp TC 0001 40.49

95886 Musc test done w/n test comp 26 0001 40.71

95886 Musc test done w/n test comp 0001 81.20

95887 Musc tst done w/n tst nonext TC 0001 43.38

95887 Musc tst done w/n tst nonext 26 0001 33.23

95887 Musc tst done w/n tst nonext 0001 76.62

95905 MOTOR &/ SENS NRVE CNDJ TEST TC 0001 58.80

95905 MOTOR &/ SENS NRVE CNDJ TEST 26 0001 2.50

95905 MOTOR &/ SENS NRVE CNDJ TEST 0001 61.30

95907 NVR CNDJ TST 1-2 STUDIES 0001 83.90

95908 NRV CNDJ TST 3-4 STUDIES 0001 103.42

95909 NRV CNDJ TST 5-6 STUDIES 0001 124.56

95910 NRV CNDJ TEST 7-8 STUDIES 0001 163.62



95913 NRV CNDJ TEST 13/> STUDIES 0001 270.42

95921 AUTONOMIC NRV PARASYM INERVJ TC 0001 38.88

95921 AUTONOMIC NRV PARASYM INERVJ 26 0001 40.34

95921 AUTONOMIC NRV PARASYM INERVJ 0001 79.23

95922 AUTONOMIC NRV ADRENRG INERVJ TC 0001 51.73

95922 AUTONOMIC NRV ADRENRG INERVJ 26 0001 43.45

95922 AUTONOMIC NRV ADRENRG INERVJ 0001 95.19

95923 AUTONOMIC NRV SYST FUNJ TEST TC 0001 143.61

95923 AUTONOMIC NRV SYST FUNJ TEST 26 0001 40.98

95923 AUTONOMIC NRV SYST FUNJ TEST 0001 184.59

95924 Ans parasymp & symp w/tilt 0001 128.68

95925 SOMATOSENSORY TESTING TC 0001 131.08

95925 SOMATOSENSORY TESTING 26 0001 24.50

95925 SOMATOSENSORY TESTING 0001 155.58








95928 C MOTOR EVOKED UPPR LIMBS TC 0001 154.88

95928 C MOTOR EVOKED UPPR LIMBS 26 0001 70.56

95928 C MOTOR EVOKED UPPR LIMBS 0001 225.45

95929 C MOTOR EVOKED LWR LIMBS TC 0001 149.74

95929 C MOTOR EVOKED LWR LIMBS 26 0001 69.92

95929 C MOTOR EVOKED LWR LIMBS 0001 219.66

95930 VISUAL EVOKED POTENTIAL TEST TC 0001 103.45

95930 VISUAL EVOKED POTENTIAL TEST 26 0001 16.14

95930 VISUAL EVOKED POTENTIAL TEST 0001 119.60

95933 BLINK REFLEX TEST TC 0001 46.27

95933 BLINK REFLEX TEST 26 0001 27.66

95933 BLINK REFLEX TEST 0001 73.94

95937 NEUROMUSCULAR JUNCTION TEST TC 0001 41.45

95937 NEUROMUSCULAR JUNCTION TEST 26 0001 30.79

95937 NEUROMUSCULAR JUNCTION TEST 0001 72.25

95938 Somatosensory testing TC 0001 261.85

95938 Somatosensory testing 26 0001 40.41

95938 Somatosensory testing 0001 302.26

95939 C motor evoked upr&lwr limbs TC 0001 334.47

95939 C motor evoked upr&lwr limbs 26 0001 105.69

95939 C motor evoked upr&lwr limbs 0001 440.17

95940 Ionm in operatng room 15 min 0001 28.29

95941 Ionm remote/>1 pt or per hr 0001 0.00

95943 Parasymp&symp hrt rate test 0001 0.00

95950 AMBULATORY EEG MONITORING TC 0001 227.48

95950 AMBULATORY EEG MONITORING 26 0001 70.87

95950 AMBULATORY EEG MONITORING 0001 298.35

95951 EEG MONITORING/VIDEORECORD TC 0001 1196.95

95951 EEG MONITORING/VIDEORECORD 26 0001 287.70

95951 EEG MONITORING/VIDEORECORD 0001 1476.96

95953 EEG MONITORING/COMPUTER TC 0001 240.65

95953 EEG MONITORING/COMPUTER 26 0001 143.89

95953 EEG MONITORING/COMPUTER 0001 384.54

95954 EEG MONITORING/GIVING DRUGS TC 0001 283.71

95954 EEG MONITORING/GIVING DRUGS 26 0001 107.61

95954 EEG MONITORING/GIVING DRUGS 0001 391.33

95955 EEG DURING SURGERY TC 0001 157.10

95955 EEG DURING SURGERY 26 0001 47.23

95955 EEG DURING SURGERY 0001 204.33

95956 EEG MONITOR TECHNOL ATTENDED TC 0001 1323.10

95956 EEG MONITOR TECHNOL ATTENDED 26 0001 168.41

95956 EEG MONITOR TECHNOL ATTENDED 0001 1491.52


95957 EEG DIGITAL ANALYSIS TC 0001 301.01

95957 EEG DIGITAL ANALYSIS 26 0001 92.95

95957 EEG DIGITAL ANALYSIS 0001 393.97

95958 EEG MONITORING/FUNCTION TEST TC 0001 305.24

95958 EEG MONITORING/FUNCTION TEST 26 0001 197.34

95958 EEG MONITORING/FUNCTION TEST 0001 502.59

95961 ELECTRODE STIMULATION BRAIN TC 0001 115.02

95961 ELECTRODE STIMULATION BRAIN 26 0001 137.95

95961 ELECTRODE STIMULATION BRAIN 0001 252.97

95962 ELECTRODE STIM BRAIN ADD-ON TC 0001 73.25

95962 ELECTRODE STIM BRAIN ADD-ON 26 0001 148.80

95962 ELECTRODE STIM BRAIN ADD-ON 0001 222.06

95965 MEG SPONTANEOUS TC 0001 1433.27

95965 MEG SPONTANEOUS 26 0001 376.85

95965 MEG SPONTANEOUS 0001 1791.74

95966 MEG EVOKED SINGLE TC 0001 715.40

95966 MEG EVOKED SINGLE 26 0001 191.47

95966 MEG EVOKED SINGLE 0001 894.18

95967 MEG EVOKED EACH ADDL TC 0001 626.17

95967 MEG EVOKED EACH ADDL 26 0001 168.17

95967 MEG EVOKED EACH ADDL 0001 752.02

95970 ANALYZE NEUROSTIM NO PROG 0001 61.32

95971 ANALYZE NEUROSTIM SIMPLE 0001 53.43

95972 ANALYZE NEUROSTIM COMPLEX 0001 96.36

95973 ANALYZE NEUROSTIM COMPLEX 0001 55.79

95974 CRANIAL NEUROSTIM COMPLEX 0001 183.06

95975 CRANIAL NEUROSTIM COMPLEX 0001 97.60

95978 ANALYZE NEUROSTIM BRAIN/1H 0001 221.28

95979 ANALYZ NEUROSTIM BRAIN ADDON 0001 95.48

95980 IO ANAL GAST N-STIM INIT 0001 39.71

95981 Io anal gast n-stim subsq 0001 28.46

95982 Io ga n-stim subsq w/reprog 0001 45.59

95990 SPIN/BRAIN PUMP REFIL & MAIN 0001 83.24

95991 SPIN/BRAIN PUMP REFIL & MAIN 0001 108.35

95992 CANALITH REPOSITIONING PROC 0001 38.35

96000 MOTION ANALYSIS VIDEO/3D 0001 83.30

96001 MOTION TEST W/FT PRESS MEAS 0001 86.26

96002 DYNAMIC SURFACE EMG 0001 18.64

96003 DYNAMIC FINE WIRE EMG 0001 17.42

96004 PHYS REVIEW OF MOTION TESTS 0001 103.01

96020 FUNCTIONAL BRAIN MAPPING 26 0001 149.99

96101 PSYCHO TESTING BY PSYCH/PHYS 0001 69.65

96102 PSYCHO TESTING BY TECHNICIAN 0001 58.65

96103 PSYCHO TESTING ADMIN BY COMP 0001 24.26

96110 DEVELOPMENTAL SCREEN W/SCORE 0001 7.40

96111 DEVELOPMENTAL TEST EXTEND 0001 112.57


96116 NEUROBEHAVIORAL STATUS EXAM 0001 82.22

96118 NEUROPSYCH TST BY PSYCH/PHYS 0001 86.03

96119 NEUROPSYCH TESTING BY TEC 0001 72.03

96120 NEUROPSYCH TST ADMIN W/COMP 0001 42.25

96125 COGNITIVE TEST BY HC PRO 0001 75.73

96127 Brief emotional/behav assmt 0001 4.82

96150 ASSESS HLTH/BEHAVE INIT 0001 18.46

96151 ASSESS HLTH/BEHAVE SUBSEQ 0001 17.85

96152 INTERVENE HLTH/BEHAVE INDIV 0001 16.92

96153 INTERVENE HLTH/BEHAVE GROUP 0001 4.02

96154 INTERV HLTH/BEHAV FAM W/PT 0001 16.62

96360 HYDRATION IV INFUSION INIT 0001 50.84

96361 HYDRATE IV INFUSION ADD-ON 0001 13.35

96365 THER/PROPH/DIAG IV INF INIT 0001 61.38

96366 THER/PROPH/DIAG IV INF ADDON 0001 16.42

96367 TX/PROPH/DG ADDL SEQ IV INF 0001 26.68

96368 THER/DIAG CONCURRENT INF 0001 18.04

96369 SC THER INFUSION UP TO 1 HR 0001 174.45

96370 SC THER INFUSION ADDL HR 0001 13.53

96371 SC THER INFUSION RESET PUMP 0001 81.61

96372 THER/PROPH/DIAG INJ SC/IM 0001 22.22

96373 THER/PROPH/DIAG INJ IA 0001 17.08

96374 THER/PROPH/DIAG INJ IV PUSH 0001 50.18

96375 TX/PRO/DX INJ NEW DRUG ADDON 0001 19.76

96376 TX/PRO/DX INJ SAME DRUG ADON 0001 11.60

96401 CHEMO ANTI-NEOPL SQ/IM 0001 65.89

96402 CHEMO HORMON ANTINEOPL SQ/IM 0001 28.29

96405 CHEMO INTRALESIONAL UP TO 7 0001 72.11

96406 CHEMO INTRALESIONAL OVER 7 0001 100.58

96409 CHEMO IV PUSH SNGL DRUG 0001 97.34

96411 CHEMO IV PUSH ADDL DRUG 0001 54.65

96413 CHEMO IV INFUSION 1 HR 0001 119.12

96415 CHEMO IV INFUSION ADDL HR 0001 24.76

96416 CHEMO PROLONG INFUSE W/PUMP 0001 124.40

96417 CHEMO IV INFUS EACH ADDL SEQ 0001 55.27

96420 CHEMO IA PUSH TECNIQUE 0001 93.32

96422 CHEMO IA INFUSION UP TO 1 HR 0001 150.18

96423 CHEMO IA INFUSE EACH ADDL HR 0001 69.17

96425 CHEMOTHERAPY INFUSION METHOD 0001 161.78

96440 CHEMOTHERAPY INTRACAVITARY 0001 763.40

96446 CHEMOTX ADMN PRTL CAVITY CHEMO 0001 172.97

96450 CHEMOTHERAPY INTO CNS 0001 160.84

96521 REFILL/MAINT PORTABLE PUMP 0001 120.84

96522 REFILL/MAINT PUMP/RESVR SYST 0001 99.31

96523 IRRIG DRUG DELIVERY DEVICE 0001 22.11

96542 CHEMOTHERAPY INJECTION 0001 105.16


96567 PHOTODYNAMIC TX SKIN 0001 118.55

96570 PHOTODYNMC TX 30 MIN ADD-ON 0001 50.50

96571 PHOTODYNAMIC TX ADDL 15 MIN 0001 23.25

96900 ULTRAVIOLET LIGHT THERAPY 0001 18.32

96902 TRICHOGRAM 0001 19.29

96904 WHOLE BODY PHOTOGRAPHY 0001 60.08

96910 PHOTOCHEMOTHERAPY WITH UV-B 0001 62.33

96912 PHOTOCHEMOTHERAPY WITH UV-A 0001 80.32

96913 PHOTOCHEMOTHERAPY UV-A OR B 0001 113.09

96920 LASER TX SKIN < 250 SQ CM 0001 135.66

96921 LASER TX SKIN 250-500 SQ CM 0001 149.55

96922 LASER TX SKIN >500 SQ CM 0001 207.08

97001 PT EVALUATION 0001 66.20

97002 PT RE-EVALUATION 0001 37.28

97003 OT EVALUATION 0001 74.56

97004 OT RE-EVALUATION 0001 46.92

97010 HOT OR COLD PACKS THERAPY 0001 5.37

97022 WHIRLPOOL THERAPY 0001 20.93

97032 ELECTRICAL STIMULATION 0001 16.95

97035 ULTRASOUND THERAPY 0001 11.23

97110 THERAPEUTIC EXERCISES 0001 28.18

97112 NEUROMUSCULAR REEDUCATION 0001 29.47

97116 GAIT TRAINING THERAPY 0001 25.05

97150 GROUP THERAPEUTIC PROCEDURES 0001 15.27

97535 SELF CARE MNGMENT TRAINING 0001 30.75

97597 RMVL DEVITAL TIS 20 CM/< 0001 68.30

97598 RMVL DEVITAL TIS ADDL 20CM/< 0001 22.46

97602 WOUND(S) CARE NON-SELECTIVE 0001 14.46

97605 NEG PRESS WOUND TX </=50 CM 0001 37.77

97606 NEG PRESS WOUND TX >50 CM 0001 40.29

97607 Neg press wnd tx </=50 sq cm 0001 0.00

97610 Low frequency non-thermal us 0001 109.71

97760 ORTHOTIC MGMT AND TRAINING 0001 34.00

97761 PROSTHETIC TRAINING 0001 29.50

97762 C/O FOR ORTHOTIC/PROSTH USE 0001 42.65

98925 OSTEOPATH MANJ 1-2 REGIONS 0001 27.56





98940 CHIROPRACT MANJ 1-2 REGIONS 0001 24.63

98941 CHIROPRACT MANJ 3-4 REGIONS 0001 36.14

98942 CHIROPRACTIC MANJ 5 REGIONS 0001 46.65

98960 SELF-MGMT EDUC & TRAIN 1 PT 0001 24.75

98961 SELF-MGMT EDUC/TRAIN 2-4 PT 0001 11.90

98962 SELF-MGMT EDUC/TRAIN 5-8 PT 0001 8.68


99024 POSTOP FOLLOW-UP VISIT 0001 0.00

99050 MEDICAL SERVICES AFTER HRS 0001 15.08

99058 OFFICE EMERGENCY CARE 0001 19.69

99060 OUT OF OFFICE EMERG MED SERV 0001 19.69

99070 SPECIAL SUPPLIES PHYS/QHP 0001 15.50

99090 COMPUTER DATA ANALYSIS 0001 85.92

99143 MOD SEDAT PHYS/QHP <5 YRS 0001 45.82

99144 MOD SEDAT PHYS/QHP 5YRS/> 0001 38.23

99145 MOD SEDAT PHYS/QHP EA 15 MIN 0001 15.16

99148 MOD SED DIFF PHYS/QHP<5 YRS 0001 42.33

99149 MOD SED DIFF PHYS/QHP 5/>YRS 0001 34.12

99150 MOD SED DIFF PHYS/QHP ADD ON 0001 15.16

99170 ANOGENITAL EXAM CHILD W IMAG 0001 153.74

99175 INDUCTION OF VOMITING 0001 15.11

99183 HYPERBARIC OXYGEN THERAPY 0001 189.29

99188 App topical fluoride varnish 0001 12.30

99195 PHLEBOTOMY 0001 88.74

99199 SPECIAL SERVICE/PROC/REPORT 0001 0.00

99201 OFFICE/OUTPATIENT VISIT NEW 0001 40.38





99211 OFFICE/OUTPATIENT VISIT EST 0001 18.75





99217 OBSERVATION CARE DISCHARGE 0001 66.95

99218 INITIAL OBSERVATION CARE 0001 91.39



99221 INITIAL HOSPITAL CARE 0001 93.88



99224 SUBSEQUENT OBSERVATION CARE 0001 36.87



99231 SUBSEQUENT HOSPITAL CARE 0001 36.17



99234 OBSERV/HOSP SAME DATE 0001 124.80



99238 HOSPITAL DISCHARGE DAY 0001 66.93

99239 HOSPITAL DISCHARGE DAY 0001 98.91


99241 OFFICE CONSULTATION 0001 45.60





99251 INPATIENT CONSULTATION 0001 45.65





99281 EMERGENCY DEPT VISIT 0001 19.33





99291 CRITICAL CARE FIRST HOUR 0001 253.60

99292 CRITICAL CARE ADDL 30 MIN 0001 113.37

99304 NURSING FACILITY CARE INIT 0001 86.13



99307 NURSING FAC CARE SUBSEQ 0001 41.26




99315 NURSING FAC DISCHARGE DAY 0001 67.63

99316 NURSING FAC DISCHARGE DAY 0001 96.86

99318 ANNUAL NURSING FAC ASSESSMNT 0001 88.68

99324 DOMICIL/R-HOME VISIT NEW PAT 0001 51.42





99334 DOMICIL/R-HOME VISIT EST PAT 0001 56.07




99341 HOME VISIT NEW PATIENT 0001 51.08





99347 HOME VISIT EST PATIENT 0001 51.43




99354 PROLONGED SERVICE OFFICE 0001 92.34


99355 PROLONGED SERVICE OFFICE 0001 90.30

99356 PROLONGED SERVICE INPATIENT 0001 84.96

99357 PROLONGED SERVICE INPATIENT 0001 84.28

99360 PHYSICIAN STANDBY SERVICES 0001 57.22

99374 HOME HEALTH CARE SUPERVISION 0001 65.20

99375 HOME HEALTH CARE SUPERVISION 0001 97.85

99377 HOSPICE CARE SUPERVISION 0001 65.20

99378 HOSPICE CARE SUPERVISION 0001 97.85

99379 NURSING FAC CARE SUPERVISION 0001 65.20

99380 NURSING FAC CARE SUPERVISION 0001 97.85

99381 INIT PM E/M NEW PAT INFANT 0001 102.99

99382 INIT PM E/M NEW PAT 1-4 YRS 0001 107.22

99383 PREV VISIT NEW AGE 5-11 0001 111.83



99391 PER PM REEVAL EST PAT INFANT 0001 92.66

99392 PREV VISIT EST AGE 1-4 0001 98.91




99420 HEALTH RISK ASSESSMENT TEST 0001 10.22

99460 INIT NB EM PER DAY HOSP 0001 86.92

99461 INIT NB EM PER DAY NON-FAC 0001 91.47

99462 SBSQ NB EM PER DAY HOSP 0001 38.75

99463 SAME DAY NB DISCHARGE 0001 105.66

99464 ATTENDANCE AT DELIVERY 0001 65.19

99465 NB RESUSCITATION 0001 136.06

99466 PED CRIT CARE TRANSPORT 0001 244.32

99467 PED CRIT CARE TRANSPORT ADDL 0001 113.38

99468 NEONATE CRIT CARE INITIAL 0001 860.09

99469 NEONATE CRIT CARE SUBSQ 0001 363.97

99471 PED CRITICAL CARE INITIAL 0001 787.85

99472 PED CRITICAL CARE SUBSQ 0001 370.19

99475 PED CRIT CARE AGE 2-5 INIT 0001 531.45

99476 PED CRIT CARE AGE 2-5 SUBSQ 0001 321.40

99477 Init day hosp neonate care 0001 319.37

99478 IC LBW INF < 1500 GM SUBSQ 0001 126.79

99479 IC LBW INF 1500-2500 G SUBSQ 0001 114.94

99480 IC INF PBW 2501-5000 G SUBSQ 0001 110.69

99490 Chron care mgmt srvc 20 min 0001 39.47

99495 TRANS CARE MGMT 14 DAY DISCH 0001 152.32

99496 TRANS CARE MGMT 7 DAY DISCH 0001 215.07

A4206 1 CC STERILE SYRINGE&NEEDLE 0001 0.39



A4209 5+ CC STERILE SYRINGE&NEEDLE 0001 0.40


A4212 NON CORING NEEDLE OR STYLET 0001 6.71

A4213 20+ CC SYRINGE ONLY 0001 0.79

A4215 STERILE NEEDLE 0001 0.25

A4216 STERILE WATER/SALINE, 10 ML 0001 0.45

A4217 STERILE WATER/SALINE, 500 ML 0001 2.66

A4218 STERILE SALINE OR WATER 0001 4.75

A4220 INFUSION PUMP REFILL KIT 0001 32.52

A4221 MAINT DRUG INFUS CATH PER WK 0001 22.26

A4222 INFUSION SUPPLIES WITH PUMP 0001 44.17

A4231 INFUSION INSULIN PUMP NEEDLE 0001 5.10

A4244 ALCOHOL OR PEROXIDE PER PINT 0001 0.79

A4245 ALCOHOL WIPES PER BOX 0001 2.37

A4246 BETADINE/PHISOHEX SOLUTION 0001 2.77

A4247 BETADINE/IODINE SWABS/WIPES 0001 3.95

A4248 CHLORHEXIDINE ANTISEPT 0001 1.73

A4250 URINE REAGENT STRIPS/TABLETS 0001 0.13

A4253 BLOOD GLUCOSE/REAGENT STRIPS NU 0001 33.76

A4255 GLUCOSE MONITOR PLATFORMS 0001 4.11

A4256 CALIBRATOR SOLUTION/CHIPS 0001 9.72

A4257 REPLACE LENSSHIELD CARTRIDGE 0001 12.75

A4258 LANCET DEVICE EACH 0001 17.75

A4259 LANCETS PER BOX 0001 12.74

A4261 CERVICAL CAP CONTRACEPTIVE 0001 46.65

A4262 TEMPORARY TEAR DUCT PLUG 0001 0.39

A4263 PERMANENT TEAR DUCT PLUG 0001 31.96

A4264 INTRATUBAL OCCLUSION DEVICE 0001 1245.00

A4265 PARAFFIN 0001 3.39

A4266 DIAPHRAGM 0001 25.07

A4267 MALE CONDOM 0001 0.38

A4268 FEMALE CONDOM 0001 0.38

A4269 SPERMICIDE 0001 1.13

A4280 BRST PRSTHS ADHSV ATTCHMNT 0001 4.84

A4281 REPLACEMENT BREASTPUMP TUBE 0001 0.00

A4282 REPLACEMENT BREASTPUMP ADPT 0001 0.00

A4283 REPLACEMENT BREASTPUMP CAP 0001 0.00

A4284 REPLCMNT BREAST PUMP SHIELD 0001 0.00

A4285 REPLCMNT BREAST PUMP BOTTLE 0001 0.00

A4286 REPLCMNT BREASTPUMP LOK RING 0001 0.00

A4290 SACRAL NERVE STIM TEST LEAD 0001 104.86

A4300 CATH IMPL VASC ACCESS PORTAL 0001 0.00

A4301 IMPLANTABLE ACCESS SYST PERC 0001 0.00

A4306 DRUG DELIVERY SYSTEM <=50 ML 0001 18.54

A4310 INSERT TRAY W/O BAG/CATH 0001 7.72

A4311 CATHETER W/O BAG 2-WAY LATEX 0001 14.84

A4312 CATH W/O BAG 2-WAY SILICONE 0001 18.04

A4313 CATHETER W/BAG 3-WAY 0001 18.52


A4314 CATH W/DRAINAGE 2-WAY LATEX 0001 21.50

A4315 CATH W/DRAINAGE 2-WAY SILCNE 0001 26.39

A4316 CATH W/DRAINAGE 3-WAY 0001 28.40

A4320 IRRIGATION TRAY 0001 5.33

A4321 CATH THERAPEUTIC IRRIG AGENT 0001 0.00

A4322 IRRIGATION SYRINGE 0001 3.04

A4326 MALE EXTERNAL CATHETER 0001 10.79

A4327 FEM URINARY COLLECT DEV CUP 0001 42.27

A4328 FEM URINARY COLLECT POUCH 0001 10.45

A4330 STOOL COLLECTION POUCH 0001 7.15

A4331 EXTENSION DRAINAGE TUBING 0001 3.18

A4332 LUBE STERILE PACKET 0001 0.12

A4333 URINARY CATH ANCHOR DEVICE 0001 2.20

A4334 URINARY CATH LEG STRAP 0001 4.93

A4338 INDWELLING CATHETER LATEX 0001 12.26

A4340 INDWELLING CATHETER SPECIAL 0001 26.99

A4344 CATH INDW FOLEY 2 WAY SILICN 0001 16.02

A4346 CATH INDW FOLEY 3 WAY 0001 19.25

A4351 STRAIGHT TIP URINE CATHETER 0001 1.81

A4352 COUDE TIP URINARY CATHETER 0001 6.42

A4353 INTERMITTENT URINARY CATH 0001 7.00

A4354 CATH INSERTION TRAY W/BAG 0001 11.80

A4355 BLADDER IRRIGATION TUBING 0001 7.86

A4356 EXT URETH CLMP OR COMPR DVC 0001 39.33

A4357 BEDSIDE DRAINAGE BAG 0001 9.70

A4358 URINARY LEG OR ABDOMEN BAG 0001 6.63

A4361 OSTOMY FACE PLATE 0001 18.37

A4362 SOLID SKIN BARRIER 0001 3.46

A4363 OSTOMY CLAMP, REPLACEMENT 0001 2.20

A4364 ADHESIVE, LIQUID OR EQUAL 0001 2.93

A4366 OSTOMY VENT 0001 1.30

A4367 OSTOMY BELT 0001 7.35

A4368 OSTOMY FILTER 0001 0.26

A4369 SKIN BARRIER LIQUID PER OZ 0001 2.06

A4371 SKIN BARRIER POWDER PER OZ 0001 3.60

A4372 SKIN BARRIER SOLID 4X4 EQUIV 0001 4.18

A4373 SKIN BARRIER WITH FLANGE 0001 6.28

A4375 DRAINABLE PLASTIC PCH W FCPL 0001 17.18

A4376 DRAINABLE RUBBER PCH W FCPLT 0001 47.58

A4377 DRAINABLE PLSTIC PCH W/O FP 0001 4.29

A4378 DRAINABLE RUBBER PCH W/O FP 0001 30.75

A4379 URINARY PLASTIC POUCH W FCPL 0001 15.02

A4380 URINARY RUBBER POUCH W FCPLT 0001 37.33

A4381 URINARY PLASTIC POUCH W/O FP 0001 4.61

A4382 URINARY HVY PLSTC PCH W/O FP 0001 24.62

A4383 URINARY RUBBER POUCH W/O FP 0001 28.19


A4384 OSTOMY FACEPLT/SILICONE RING 0001 9.62

A4385 OST SKN BARRIER SLD EXT WEAR 0001 5.10

A4388 DRAINABLE PCH W EX WEAR BARR 0001 4.36

A4389 DRAINABLE PCH W ST WEAR BARR 0001 6.22

A4390 DRAINABLE PCH EX WEAR CONVEX 0001 9.61

A4391 URINARY POUCH W EX WEAR BARR 0001 7.07

A4392 URINARY POUCH W ST WEAR BARR 0001 8.18

A4393 URINE PCH W EX WEAR BAR CONV 0001 9.04

A4394 OSTOMY POUCH LIQ DEODORANT 0001 2.58

A4395 OSTOMY POUCH SOLID DEODORANT 0001 0.05

A4396 PERISTOMAL HERNIA SUPPRT BLT 0001 40.48

A4397 IRRIGATION SUPPLY SLEEVE 0001 4.07

A4398 OSTOMY IRRIGATION BAG 0001 13.81

A4399 OSTOMY IRRIG CONE/CATH W BRS 0001 12.26

A4400 OSTOMY IRRIGATION SET 0001 48.87

A4402 LUBRICANT PER OUNCE 0001 1.60

A4404 OSTOMY RING EACH 0001 1.63

A4405 NONPECTIN BASED OSTOMY PASTE 0001 3.40

A4406 PECTIN BASED OSTOMY PASTE 0001 5.74

A4407 EXT WEAR OST SKN BARR <=4SQ� 0001 8.76

A4408 EXT WEAR OST SKN BARR >4SQ� 0001 9.87

A4409 OST SKN BARR CONVEX <=4 SQ I 0001 6.22

A4410 OST SKN BARR EXTND >4 SQ 0001 9.04

A4411 OST SKN BARR EXTND =4SQ 0001 5.10

A4412 OST POUCH DRAIN HIGH OUTPUT 0001 2.70

A4413 2 PC DRAINABLE OST POUCH 0001 5.50

A4414 OST SKNBAR W/O CONV<=4 SQ IN 0001 4.93

A4415 OST SKN BARR W/O CONV >4 SQI 0001 6.00

A4416 OST PCH CLSD W BARRIER/FILTR 0001 2.75

A4417 OST PCH W BAR/BLTINCONV/FLTR 0001 3.72

A4418 OST PCH CLSD W/O BAR W FILTR 0001 1.81

A4419 OST PCH FOR BAR W FLANGE/FLT 0001 1.74

A4420 OST PCH CLSD FOR BAR W LK FL 0001 0.00

A4422 OST POUCH ABSORBENT MATERIAL 0001 0.12

A4423 OST PCH FOR BAR W LK FL/FLTR 0001 1.86

A4424 OST PCH DRAIN W BAR & FILTER 0001 4.75

A4425 OST PCH DRAIN FOR BARRIER FL 0001 3.58

A4426 OST PCH DRAIN 2 PIECE SYSTEM 0001 2.73

A4427 OST PCH DRAIN/BARR LK FLNG/F 0001 2.78

A4428 URINE OST POUCH W FAUCET/TAP 0001 6.51

A4429 URINE OST POUCH W BLTINCONV 0001 8.25

A4430 OST URINE PCH W B/BLTIN CONV 0001 8.52

A4431 OST PCH URINE W BARRIER/TAPV 0001 6.22

A4432 OS PCH URINE W BAR/FANGE/TAP 0001 3.59

A4433 URINE OST PCH BAR W LOCK FLN 0001 3.34

A4434 OST PCH URINE W LOCK FLNG/FT 0001 3.76


A4450 NON-WATERPROOF TAPE 0001 0.09

A4452 WATERPROOF TAPE 0001 0.36

A4455 ADHESIVE REMOVER PER OUNCE 0001 1.22

A4481 TRACHEOSTOMA FILTER 0001 0.38

A4483 MOISTURE EXCHANGER 0001 0.00

A4490 ABOVE KNEE SURGICAL STOCKING 0001 5.93

A4495 THIGH LENGTH SURG STOCKING 0001 5.93

A4500 BELOW KNEE SURGICAL STOCKING 0001 4.35

A4510 FULL LENGTH SURG STOCKING 0001 10.67

A4550 SURGICAL TRAYS 0001 34.14

A4556 ELECTRODES, PAIR 0001 12.14

A4557 LEAD WIRES, PAIR 0001 17.94

A4558 CONDUCTIVE GEL OR PASTE 0001 5.45

A4561 PESSARY RUBBER, ANY TYPE 0001 18.63

A4562 PESSARY, NON RUBBER,ANY TYPE 0001 46.38

A4565 SLINGS 0001 6.32

A4570 SPLINT 0001 20.13

A4580 CAST SUPPLIES (PLASTER) 0001 0.00

A4590 SPECIAL CASTING MATERIAL 0001 45.29

A4595 TENS SUPPL 2 LEAD PER MONTH 0001 28.35

A4604 TUBING WITH HEATING ELEMENT NU 0001 66.81

A4606 OXYGEN PROBE USED W OXIMETER 0001 0.00

A4608 TRANSTRACHEAL OXYGEN CATH 0001 58.15

A4612 BATTERY CABLES UE 0001 60.95

A4612 BATTERY CABLES RR 0001 8.14

A4612 BATTERY CABLES NU 0001 79.93

A4614 HAND-HELD PEFR METER 0001 23.78

A4617 MOUTH PIECE 0001 3.25

A4619 FACE TENT 0001 1.21

A4620 VARIABLE CONCENTRATION MASK 0001 2.37

A4623 TRACHEOSTOMY INNER CANNULA 0001 5.57

A4624 TRACHEAL SUCTION TUBE NU 0001 2.63

A4625 TRACH CARE KIT FOR NEW TRACH 0001 6.58

A4626 TRACHEOSTOMY CLEANING BRUSH 0001 2.78

A4627 SPACER BAG/RESERVOIR 0001 15.02

A4628 OROPHARYNGEAL SUCTION CATH NU 0001 3.65

A4629 TRACHEOSTOMY CARE KIT 0001 4.61

A4630 REPL BAT T.E.N.S. OWN BY PT NU 0001 6.19

A4633 UVL REPLACEMENT BULB NU 0001 41.04

A4634 REPLACEMENT BULB TH LIGHTBOX 0001 0.00

A4639 INFRARED HT SYS REPLCMNT PAD NU 0001 287.21

A4640 ALTERNATING PRESSURE PAD UE 0001 38.13

A4640 ALTERNATING PRESSURE PAD RR 0001 6.45

A4640 ALTERNATING PRESSURE PAD NU 0001 53.82

A4642 IN111 SATUMOMAB 0001 460.80

A4657 SYRINGE W/WO NEEDLE 0001 0.00


A4660 SPHYG/BP APP W CUFF AND STET 0001 50.00

A4670 AUTOMATIC BP MONITOR, DIAL 0001 50.00

A4673 EXT LINE W EASY LOCK CONNECT 0001 0.00

A4690 DIALYZER, EACH 0001 493.22

A4719 "Y SET" TUBING 0001 0.00

A4722 DIALYS SOL FLD VOL > 1999CC 0001 0.00



A4750 ART OR VENOUS BLOOD TUBING 0001 9.66

A4760 DIALYSATE SOL TEST KIT, EACH 0001 0.00

A4770 BLOOD COLLECTION TUBE/VACUUM 0001 0.00

A4860 DISPOSABLE CATHETER TIPS 0001 0.00

A4911 DRAIN BAG/BOTTLE 0001 0.00

A5051 POUCH CLSD W BARR ATTACHED 0001 2.07

A5052 CLSD OSTOMY POUCH W/O BARR 0001 1.49

A5053 CLSD OSTOMY POUCH FACEPLATE 0001 1.48

A5054 CLSD OSTOMY POUCH W/FLANGE 0001 1.79

A5055 STOMA CAP 0001 1.44

A5061 POUCH DRAINABLE W BARRIER AT 0001 3.52

A5062 DRNBLE OSTOMY POUCH W/O BARR 0001 2.09

A5063 DRAIN OSTOMY POUCH W/FLANGE 0001 2.17

A5071 URINARY POUCH W/BARRIER 0001 6.01

A5072 URINARY POUCH W/O BARRIER 0001 3.43

A5073 URINARY POUCH ON BARR W/FLNG 0001 3.18

A5081 STOMA PLUG OR SEAL, ANY TYPE 0001 2.81

A5082 CONTINENT STOMA CATHETER 0001 10.11

A5093 OSTOMY ACCESSORY CONVEX INSE 0001 1.95

A5102 BEDSIDE DRAIN BTL W/WO TUBE 0001 20.69

A5105 URINARY SUSPENSORY 0001 40.76

A5112 URINARY LEG BAG 0001 34.62

A5113 LATEX LEG STRAP 0001 4.70

A5114 FOAM/FABRIC LEG STRAP 0001 8.94

A5120 SKIN BARRIER, WIPE OR SWAB 0001 0.20

A5121 SOLID SKIN BARRIER 6X6 0001 6.72

A5122 SOLID SKIN BARRIER 8X8 0001 12.85

A5126 DISK/FOAM PAD +OR- ADHESIVE 0001 1.32

A5131 APPLIANCE CLEANER 0001 13.76

A5200 PERCUTANEOUS CATHETER ANCHOR 0001 11.29

A5500 DIAB SHOE FOR DENSITY INSERT 0001 59.36

A5501 DIABETIC CUSTOM MOLDED SHOE 0001 178.04

A5503 DIABETIC SHOE W/ROLLER/ROCKR 0001 26.40

A5504 DIABETIC SHOE WITH WEDGE 0001 26.40

A5505 DIAB SHOE W/METATARSAL BAR 0001 26.40

A5506 DIABETIC SHOE W/OFF SET HEEL 0001 26.40

A5507 MODIFICATION DIABETIC SHOE 0001 26.40

A5508 DIABETIC DELUXE SHOE 0001 0.00


A5510 COMPRESSION FORM SHOE INSERT 0001 0.00

A5512 MULTI DEN INSERT DIRECT FORM 0001 24.22

A5513 MULTI DEN INSERT CUSTOM MOLD 0001 36.14

A6010 COLLAGEN BASED WOUND FILLER 0001 30.96

A6011 COLLAGEN GEL/PASTE WOUND FIL 0001 2.28

A6021 COLLAGEN DRESSING <=16 SQ IN 0001 21.02

A6022 COLLAGEN DRSG>16<=48 SQ IN 0001 21.02

A6023 COLLAGEN DRESSING >48 SQ IN 0001 190.30

A6024 COLLAGEN DSG WOUND FILLER 0001 6.19

A6025 SILICONE GEL SHEET, EACH 0001 21.71

A6154 WOUND POUCH EACH 0001 14.36

A6196 ALGINATE DRESSING <=16 SQ IN 0001 7.35

A6197 ALGINATE DRSG >16 <=48 SQ IN 0001 16.44

A6198 ALGINATE DRESSING > 48 SQ IN 0001 0.00

A6199 ALGINATE DRSG WOUND FILLER 0001 5.29

A6203 COMPOSITE DRSG <= 16 SQ IN 0001 3.35

A6204 COMPOSITE DRSG >16<=48 SQ IN 0001 6.23

A6205 COMPOSITE DRSG > 48 SQ IN 0001 0.00

A6206 CONTACT LAYER <= 16 SQ IN 0001 3.34

A6207 CONTACT LAYER >16<= 48 SQ IN 0001 7.34

A6208 CONTACT LAYER > 48 SQ IN 0001 0.00

A6209 FOAM DRSG <=16 SQ IN W/O BDR 0001 7.48

A6210 FOAM DRG >16<=48 SQ IN W/O B 0001 19.92

A6211 FOAM DRG > 48 SQ IN W/O BRDR 0001 29.37

A6212 FOAM DRG <=16 SQ IN W/BORDER 0001 9.70

A6213 FOAM DRG >16<=48 SQ IN W/BDR 0001 15.97

A6214 FOAM DRG > 48 SQ IN W/BORDER 0001 10.29

A6216 NON-STERILE GAUZE<=16 SQ IN 0001 0.05

A6217 NON-STERILE GAUZE>16<=48 SQ 0001 0.00

A6218 NON-STERILE GAUZE > 48 SQ IN 0001 0.37

A6219 GAUZE <= 16 SQ IN W/BORDER 0001 0.95

A6220 GAUZE >16 <=48 SQ IN W/BORDR 0001 2.58

A6221 GAUZE > 48 SQ IN W/BORDER 0001 0.00

A6222 GAUZE <=16 IN NO W/SAL W/O B 0001 2.13

A6223 GAUZE >16<=48 NO W/SAL W/O B 0001 2.42

A6224 GAUZE > 48 IN NO W/SAL W/O B 0001 3.61

A6229 GAUZE >16<=48 SQ IN WATR/SAL 0001 3.61

A6231 HYDROGEL DSG<=16 SQ IN 0001 4.68

A6232 HYDROGEL DSG>16<=48 SQ IN 0001 6.88

A6233 HYDROGEL DRESSING >48 SQ IN 0001 19.19

A6234 HYDROCOLLD DRG <=16 W/O BDR 0001 6.54

A6235 HYDROCOLLD DRG >16<=48 W/O B 0001 16.82

A6236 HYDROCOLLD DRG > 48 IN W/O B 0001 27.25

A6237 HYDROCOLLD DRG <=16 IN W/BDR 0001 7.91

A6238 HYDROCOLLD DRG >16<=48 W/BDR 0001 22.79

A6240 HYDROCOLLD DRG FILLER PASTE 0001 12.24


A6241 HYDROCOLLOID DRG FILLER DRY 0001 2.57

A6242 HYDROGEL DRG <=16 IN W/O BDR 0001 6.07

A6243 HYDROGEL DRG >16<=48 W/O BDR 0001 12.31

A6244 HYDROGEL DRG >48 IN W/O BDR 0001 39.28

A6245 HYDROGEL DRG <= 16 IN W/BDR 0001 7.27

A6246 HYDROGEL DRG >16<=48 IN W/B 0001 9.92

A6247 HYDROGEL DRG > 48 SQ IN W/B 0001 23.78

A6248 HYDROGEL DRSG GEL FILLER 0001 16.24

A6250 SKIN SEAL PROTECT MOISTURIZR 0001 0.00

A6251 ABSORPT DRG <=16 SQ IN W/O B 0001 1.99

A6252 ABSORPT DRG >16 <=48 W/O BDR 0001 3.25

A6253 ABSORPT DRG > 48 SQ IN W/O B 0001 6.34

A6254 ABSORPT DRG <=16 SQ IN W/BDR 0001 1.21

A6255 ABSORPT DRG >16<=48 IN W/BDR 0001 3.03

A6256 ABSORPT DRG > 48 SQ IN W/BDR 0001 0.00

A6257 TRANSPARENT FILM <= 16 SQ IN 0001 1.53

A6258 TRANSPARENT FILM >16<=48 IN 0001 4.30

A6259 TRANSPARENT FILM > 48 SQ IN 0001 10.94

A6260 WOUND CLEANSER ANY TYPE/SIZE 0001 0.74

A6261 WOUND FILLER GEL/PASTE /OZ 0001 3.56

A6262 WOUND FILLER DRY FORM / GRAM 0001 0.74

A6266 IMPREG GAUZE NO H20/SAL/YARD 0001 1.92

A6402 STERILE GAUZE <= 16 SQ IN 0001 0.12

A6403 STERILE GAUZE>16 <= 48 SQ IN 0001 0.43

A6404 STERILE GAUZE > 48 SQ IN 0001 0.37

A6407 PACKING STRIPS, NON-IMPREG 0001 1.88

A6410 STERILE EYE PAD 0001 0.39

A6412 OCCLUSIVE EYE PATCH 0001 0.37

A6441 PAD BAND W>=3� <5�/YD 0001 0.67

A6442 CONFORM BAND N/S W<3�/YD 0001 0.17

A6443 CONFORM BAND N/S W>=3�<5�/YD 0001 0.29

A6444 CONFORM BAND N/S W>=5�/YD 0001 0.56

A6445 CONFORM BAND S W <3�/YD 0001 0.32

A6446 CONFORM BAND S W>=3� <5�/YD 0001 0.41

A6447 CONFORM BAND S W >=5�/YD 0001 0.67

A6448 LT COMPRES BAND <3�/YD 0001 1.16

A6449 LT COMPRES BAND >=3� <5�/YD 0001 1.75

A6450 LT COMPRES BAND >=5�/YD 0001 0.00

A6451 MOD COMPRES BAND W>=3�<5�/YD 0001 0.00

A6452 HIGH COMPRES BAND W>=3�<5�YD 0001 5.91

A6453 SELF-ADHER BAND W <3�/YD 0001 0.61

A6454 SELF-ADHER BAND W>=3� <5�/YD 0001 0.77

A6455 SELF-ADHER BAND >=5�/YD 0001 1.39

A6456 ZINC PASTE BAND W >=3> �� 0001 1.28

A6457 TUBULAR DRESSING 0001 1.14

A6503 COMPRES BURNGARMENT FACEHOOD 0001 0.00


A6504 CMPRSBURNGARMENT GLOVE-WRIST 0001 0.00

A6506 CMPRSBURNGRMNT GLOVE-AXILLA 0001 0.00

A6508 CMPRS BURNGARMENT FOOT-THIGH 0001 0.00

A6509 COMPRES BURN GARMENT JACKET 0001 0.00

A6511 COMPRES BURN GARMENT PANTY 0001 0.00

A6512 COMPRES BURN GARMENT, NOC 0001 0.00

A6530 COMPRESSION STOCKING BK18-30 0001 25.00



A6533 GC STOCKING THIGHLNGTH 18-30 0001 30.00



A6536 GC STOCKING FULL LNGTH 18-30 0001 40.00



A6539 GC STOCKING WAISTLNGTH 18-30 0001 80.00



A6544 GC STOCKING GARTER BELT 0001 14.00

A6549 G COMPRESSION STOCKING 0001 0.00

A6550 NEG PRES WOUND THER DRSG SET 0001 27.42

A7000 DISPOSABLE CANISTER FOR PUMP NU 0001 9.54

A7001 NONDISPOSABLE PUMP CANISTER NU 0001 33.08

A7002 TUBING USED W SUCTION PUMP NU 0001 3.83

A7003 NEBULIZER ADMINISTRATION SET NU 0001 2.74

A7004 DISPOSABLE NEBULIZER SML VOL NU 0001 1.80

A7005 NONDISPOSABLE NEBULIZER SET NU 0001 30.83

A7006 FILTERED NEBULIZER ADMIN SET NU 0001 9.54

A7007 LG VOL NEBULIZER DISPOSABLE NU 0001 4.61

A7008 DISPOSABLE NEBULIZER PREFILL NU 0001 11.00

A7009 NEBULIZER RESERVOIR BOTTLE NU 0001 42.04

A7010 DISPOSABLE CORRUGATED TUBING NU 0001 23.59

A7011 NONDISPOS CORRUGATED TUBING 0001 15.23

A7012 NEBULIZER WATER COLLEC DEVIC NU 0001 3.78

A7013 DISPOSABLE COMPRESSOR FILTER NU 0001 0.83

A7014 COMPRESSOR NONDISPOS FILTER NU 0001 4.49

A7015 AEROSOL MASK USED W NEBULIZE NU 0001 1.88

A7016 NEBULIZER DOME & MOUTHPIECE NU 0001 7.25

A7017 NEBULIZER NOT USED W OXYGEN UE 0001 100.52

A7017 NEBULIZER NOT USED W OXYGEN RR 0001 13.40

A7017 NEBULIZER NOT USED W OXYGEN NU 0001 134.04

A7018 WATER DISTILLED W/NEBULIZER 0001 0.38

A7020 INTERFACE, COUGH STIM DEVICE INTER 0001 2.75

A7025 REPLACE CHEST COMPRESS VEST NU 0001 434.94

A7026 REPLACE CHST CMPRSS SYS HOSE NU 0001 28.75

A7030 CPAP FULL FACE MASK NU 0001 188.64


A7031 REPLACEMENT FACEMASK INTERFA NU 0001 69.77

A7032 REPLACEMENT NASAL CUSHION NU 0001 40.53

A7033 REPLACEMENT NASAL PILLOWS NU 0001 28.41

A7034 NASAL APPLICATION DEVICE NU 0001 117.64

A7035 POS AIRWAY PRESS HEADGEAR NU 0001 39.75

A7036 POS AIRWAY PRESS CHINSTRAP NU 0001 18.20

A7037 POS AIRWAY PRESSURE TUBING NU 0001 41.02

A7038 POS AIRWAY PRESSURE FILTER NU 0001 5.39

A7039 FILTER, NON DISPOSABLE W PAP NU 0001 15.33

A7044 PAP ORAL INTERFACE NU 0001 120.91

A7046 REPL WATER CHAMBER, PAP DEV 0001 19.51

A7501 TRACHEOSTOMA VALVE W DIAPHRA 0001 105.03

A7502 REPLACEMENT DIAPHRAGM/FPLATE 0001 49.91

A7503 HMES FILTER HOLDER OR CAP 0001 11.33

A7504 TRACHEOSTOMA HMES FILTER 0001 0.67

A7505 HMES OR TRACH VALVE HOUSING 0001 4.68

A7506 HMES/TRACHVALVE ADHESIVEDISK 0001 0.33

A7507 INTEGRATED FILTER & HOLDER 0001 2.49

A7508 HOUSING & INTEGRATED ADHESIV 0001 2.87

A7509 HEAT & MOISTURE EXCHANGE SYS 0001 1.41

A7520 TRACH/LARYN TUBE NON-CUFFED 0001 47.48

A7521 TRACH/LARYN TUBE CUFFED 0001 47.05

A7522 TRACH/LARYN TUBE STAINLESS 0001 45.16

A7524 TRACHEOSTOMA STENT/STUD/BTTN 0001 77.40

A7525 TRACHEOSTOMY MASK 0001 2.07

A7526 TRACHEOSTOMY TUBE COLLAR 0001 3.37

A9150 MISC/EXPER NON-PRESCRIPT DRU 0001 0.00

A9270 NON-COVERED ITEM OR SERVICE 0001 0.00

A9300 EXERCISE EQUIPMENT 0001 0.00

A9500 TC99M SESTAMIBI 0001 81.54

A9501 Technetium TC-99m teboroxime 0001 52.55

A9502 TC99M TETROFOSMIN 0001 72.53

A9503 TC99M MEDRONATE 0001 24.99

A9504 TC99M APCITIDE 0001 24.55

A9505 TL201 THALLIUM 0001 26.76

A9507 IN111 CAPROMAB 0001 901.82

A9508 I131 IODOBENGUATE, DX 0001 20.39

A9509 Iodine I-123 sod iodide mil1 0001 113.90

A9510 TC99M DISOFENIN 0001 53.53

A9512 TC99M PERTECHNETATE 0001 6.28

A9516 IODINE I-123 SOD IODIDE MIC 0001 31.93

A9517 I131 IODIDE CAP, RX 0001 18.12

A9520 Tc99 tilmanocept diag 0.5mci 0001 0.00

A9521 TC99M EXAMETAZIME 0001 432.53

A9524 I131 SERUM ALBUMIN, DX 0001 74.41

A9526 NITROGEN N-13 AMMONIA 0001 164.35


A9527 IODINE I-125 SODIUM IODIDE 0001 11.01

A9528 IODINE I-131 IODIDE CAP, DX 0001 22.91

A9529 I131 IODIDE SOL, DX 0001 20.74

A9530 I131 IODIDE SOL, RX 0001 11.01

A9531 I131 MAX 100UCI 0001 5.61

A9532 I125 SERUM ALBUMIN, DX 0001 64.92

A9536 TC99M DEPREOTIDE 0001 44.35

A9537 TC99M MEBROFENIN 0001 36.19

A9538 TC99M PYROPHOSPHATE 0001 31.87

A9539 TC99M PENTETATE 0001 30.86

A9540 TC99M MAA 0001 24.89

A9541 TC99M SULFUR COLLOID 0001 39.38

A9542 IN111 IBRITUMOMAB, DX 0001 1353.40

A9543 Y90 IBRITUMOMAB, RX 0001 14338.22

A9544 I131 TOSITUMOMAB, DX 0001 1639.32

A9545 I131 TOSITUMOMAB, RX 0001 11436.22

A9546 CO57/58 0001 5.37

A9547 IN111 OXYQUINOLINE 0001 447.29

A9548 IN111 PENTETATE 0001 327.64

A9550 TC99M GLUCEPTATE 0001 38.58

A9551 TC99M SUCCIMER 0001 189.06

A9552 F18 FDG 0001 209.74

A9553 CR51 CHROMATE 0001 273.65

A9554 I125 IOTHALAMATE, DX 0001 50.60

A9555 RB82 RUBIDIUM 0001 176.51

A9556 GA67 GALLIUM 0001 23.27

A9557 TC99M BICISATE 0001 390.61

A9558 XE133 XENON 10MCI 0001 26.28

A9559 CO57 CYANO 0001 4.56

A9560 TC99M LABELED RBC 0001 64.19

A9561 TC99M OXIDRONATE 0001 26.03

A9562 TC99M MERTIATIDE 0001 121.43

A9563 P32 NA PHOSPHATE 0001 132.45

A9564 P32 CHROMIC PHOSPHATE 0001 608.98

A9566 TC99M FANOLESOMAB 0001 339.80

A9567 TECHNETIUM TC-99M AEROSOL 0001 33.67

A9568 TECHNETIUM TC99M ARCITUMOMAB 0001 18.87

A9569 Technetium TC-99m auto WBC 0001 517.30

A9570 Indium In-111 auto WBC 0001 525.12

A9571 Indium IN-111 auto platelet 0001 797.71

A9572 Indium In-111 pentetreotide 0001 690.43

A9576 Inj prohance multipack 0001 2.34

A9577 Inj multihance 0001 4.11

A9578 Inj multihance multipack 0001 3.97

A9579 Gad-base MR contrast NOS1ml 0001 3.81

A9580 SODIUM FLUORIDE F-18 0001 206.58


A9581 GADOXETATE DISODIUM INJ 0001 13.18

A9582 IODINE I-123 IOBENGUANE 0001 1270.11

A9583 GADOFOSVESET TRISODIUM INJ 0001 16.18

A9600 SR89 STRONTIUM 0001 787.40

A9604 SM 153 LEXIDRONAM 0001 3101.39

A9700 ECHOCARDIOGRAPHY CONTRAST 0001 33.81

A9900 SUPPLY/ACCESSORY/SERVICE 0001 0.00

A9901 DELIVERY/SET UP/DISPENSING 0001 0.00

A9999 DME SUPPLY OR ACCESSORY, NOS 0001 0.00

C1814 RETINAL TAMP, SILICONE OIL 0001 0.00

C1818 INTEGRATED KERATOPROSTHESIS 0001 0.00

C1819 TISSUE LOCALIZATION-EXCISION 0001 0.00

C1884 EMBOLIZATION PROTECT SYST 0001 0.00

C8918 MRA W/CONT, PELVIS 0001 0.00

C8919 MRA W/O CONT, PELVIS 0001 0.00

C8920 MRA W/O FOL W/CONT, PELVIS 0001 0.00

C8929 TTE W OR WO FOL WCON,DOPPLER 0001 0.00

C8930 TTE W OR W/O CONTR, CONT ECG 0001 0.00

C9716 RADIOFREQUENCY ENERGY TO ANU 0001 0.00

D0120 PERIODIC ORAL EVALUATION 0001 33.24

D0140 LIMIT ORAL EVAL PROBLM FOCUS 0001 33.24

D0145 ORAL EVALUATION PT < 3YRS 0001 20.50

D0150 COMPREHENSVE ORAL EVALUATION 0001 33.24

D0160 EXTENSV ORAL EVAL PROB FOCUS 0001 36.89

D0170 RE-EVAL,EST PT,PROBLEM FOCUS 0001 18.44

D0190 Screening of a patient 0001 14.34

D0191 Assessment of a patient 0001 10.24

D0210 INTRAOR COMPLETE FILM SERIES 0001 58.94

D0220 INTRAORAL PERIAPICAL FIRST 0001 18.86

D0230 INTRAORAL PERIAPICAL EA ADD 0001 5.89

D0240 INTRAORAL OCCLUSAL FILM 0001 14.14

D0270 DENTAL BITEWING SINGLE IMAGE 0001 11.79

D0272 DENTAL BITEWINGS TWO IMAGES 0001 21.21

D0273 BITEWINGS - THREE IMAGES 0001 16.40

D0274 BITEWINGS FOUR IMAGES 0001 23.57

D0277 VERT BITEWINGS 7 TO 8 IMAGES 0001 5.00

D0290 SKULL/FACIAL BONE IMAGE 0001 51.24

D0322 DENTAL TOMOGRAPHIC SURVEY 0001 153.99

D0330 PANORAMIC IMAGE 0001 41.24

D0340 CEPHALOMETRIC IMAGE 0001 40.99

D0350 ORAL/FACIAL PHOTO IMAGES 0001 20.50

D0364 Cone beam ct capt & interp 0001 172.19

D0365 Cone beam ct interprete man 0001 172.19

D0366 Cone beam ct interprete max 0001 172.19

D0367 Cone beam ct interp both jaw 0001 172.19

D0370 Max ultrasound capt & interp 0001 151.69


D0371 Sialoendoscopy capt & interp 0001 0.00

D0380 Cone beam ct capture limited 0001 137.34

D0381 Cone beam ct capt mandible 0001 137.34

D0382 Cone beam ct capt maxilla 0001 137.34

D0383 Cone beam ct both jaws 0001 137.34

D0386 Max ultrasound image capture 0001 81.99

D0391 Imterprete diagnostic image 0001 0.00

D0415 COLLECTION OF MICROORGANISMS 0001 34.85

D0416 VIRAL CULTURE 0001 34.85

D0460 PULP VITALITY TEST 0001 10.25

D0470 DIAGNOSTIC CASTS 0001 25.62

D0486 ACCESS OF TRANSEP CYTOL SAMP 0001 43.05

D0502 OTHER ORAL PATHOLOGY PROCEDU 0001 55.34

D0999 UNSPECIFIED DIAGNOSTIC PROCE 0001 0.00

D1110 DENTAL PROPHYLAXIS ADULT 0001 49.81

D1120 DENTAL PROPHYLAXIS CHILD 0001 57.28

D1206 TOPICAL FLUORIDE VARNISH 0001 53.30

D1208 TOPICAL APP FLUORID EX VRNSH 0001 10.24

D1351 DENTAL SEALANT PER TOOTH 0001 23.57

D1352 PREV RESIN REST, PERM TOOTH PREVE 0001 10.25

D1353 Sealant repair per tooth 0001 16.40

D1510 SPACE MAINTAINER FXD UNILAT 0001 139.09

D1515 FIXED BILAT SPACE MAINTAINER 0001 278.18

D1520 REMOVE UNILAT SPACE MAINTAIN 0001 102.49

D1525 REMOVE BILAT SPACE MAINTAIN 0001 143.50

D1550 RECEMENT SPACE MAINTAINER 0001 22.54

D1555 REMOVE FIX SPACE MAINTAINER 0001 22.54

D2140 AMALGAM ONE SURFACE PERMANEN 0001 64.83

D2150 AMALGAM TWO SURFACES PERMANE 0001 86.04

D2160 AMALGAM THREE SURFACES PERMA 0001 97.83

D2161 AMALGAM 4 OR > SURFACES PERM 0001 117.87

D2330 RESIN ONE SURFACE-ANTERIOR 0001 56.38

D2331 RESIN TWO SURFACES-ANTERIOR 0001 75.85

D2332 RESIN THREE SURFACES-ANTERIO 0001 83.03

D2335 RESIN 4/> SURF OR W INCIS AN 0001 94.30

D2390 ANT RESIN-BASED CMPST CROWN 0001 57.40

D2391 POST 1 SRFC RESINBASED CMPST 0001 43.05



D2394 POST >=4SRFC RESINBASE CMPST 0001 69.69

D2712 CROWN 3/4 RESIN-BASED COMPOS 0001 303.40

D2721 CROWN RESIN W/ BASE METAL 0001 307.50

D2740 CROWN PORCELAIN/CERAMIC SUBS 0001 450.99

D2751 CROWN PORCELAIN FUSED BASE M 0001 327.99

D2781 CROWN 3/4 CAST BASE METAL 0001 266.49

D2791 CROWN FULL CAST BASE METAL 0001 327.99


D2910 RECEMENT INLAY ONLAY OR PART 0001 30.74

D2915 RECEMENT CAST OR PREFAB POST 0001 34.02

D2920 RE-CEMENT OR RE-BOND CROWN 0001 30.74

D2921 Reattach tooth fragment 0001 41.00

D2930 PREFAB STNLSS STEEL CRWN PRI 0001 92.24

D2931 PREFAB STNLSS STEEL CROWN PE 0001 133.25

D2932 PREFABRICATED RESIN CROWN 0001 61.50

D2933 PREFAB STAINLESS STEEL CROWN 0001 112.74

D2940 PROTECTIVE RESTORATION 0001 30.74

D2950 CORE BUILD-UP INCL ANY PINS 0001 123.00

D2951 TOOTH PIN RETENTION 0001 20.50

D2952 POST AND CORE CAST + CROWN 0001 163.99

D2953 EACH ADDTNL CAST POST 0001 133.25

D2954 PREFAB POST/CORE + CROWN 0001 102.49

D2955 POST REMOVAL 0001 82.00

D2957 EACH ADDTNL PREFAB POST 0001 71.75

D2960 LAMINATE LABIAL VENEER 0001 123.00

D2961 LAB LABIAL VENEER RESIN 0001 205.00

D2962 LAB LABIAL VENEER PORCELAIN 0001 205.00

D2970 TEMPORARY CROWN �FRACTURED TOOTHÙ 0001 100.45

D2975 COPING 0001 166.05

D2980 CROWN REPAIR 0001 84.04

D2981 Inlay repair 0001 0.00

D2982 Onlay repair 0001 0.00

D2990 Resin infiltration of lesion 0001 0.00

D2999 DENTAL UNSPEC RESTORATIVE PR 0001 0.00

D3110 PULP CAP DIRECT 0001 25.62

D3120 PULP CAP INDIRECT 0001 20.50

D3220 THERAPEUTIC PULPOTOMY 0001 61.50

D3222 PART PULP FOR APEXOGENESIS 0001 65.59

D3230 PULPAL THERAPY ANTERIOR PRIM 0001 102.49

D3240 PULPAL THERAPY POSTERIOR PRI 0001 102.49

D3310 END THXPY, ANTERIOR TOOTH 0001 205.00

D3320 END THXPY, BICUSPID TOOTH 0001 246.00

D3330 END THXPY, MOLAR 0001 327.99

D3351 APEXIFICATION/RECALC INITIAL 0001 82.00

D3352 APEXIFICATION/RECALC INTERIM 0001 82.00

D3353 APEXIFICATION/RECALC FINAL 0001 163.99

D3355 Pulpal regeneration initial 0001 0.00

D3356 Pulpal regeneration interim 0001 0.00

D3357 Pulpal regeneration complete 0001 0.00

D3410 APICOECTOMY - ANTERIOR 0001 143.50

D3421 ROOT SURGERY BICUSPID 0001 153.74

D3425 ROOT SURGERY MOLAR 0001 163.99

D3426 ROOT SURGERY EA ADD ROOT 0001 61.50

D3430 RETROGRADE FILLING 0001 61.50


D3450 ROOT AMPUTATION 0001 102.49

D3460 ENDODONTIC ENDOSSEOUS IMPLAN 0001 317.75

D3920 TOOTH SPLITTING 0001 82.00

D3950 CANAL PREP/FITTING OF DOWEL 0001 61.50

D3999 ENDODONTIC PROCEDURE 0001 0.00

D4210 GINGIVECTOMY/PLASTY 4 OR MOR 0001 123.00

D4211 GINGIVECTOMY/PLASTY 1 TO 3 0001 40.99

D4212 Gingivectomy/plasty rest 0001 71.74

D4230 ANA CROWN EXP 4 OR> PER QUAD 0001 188.60

D4231 ANA CROWN EXP 1-3 PER QUAD 0001 166.05

D4240 GINGIVAL FLAP PROC W/ PLANIN 0001 123.00

D4241 GNGVL FLAP W ROOTPLAN 1-3 TH 0001 63.55

D4249 CROWN LENGTHEN HARD TISSUE 0001 209.10

D4260 OSSEOUS SURGERY 4 OR MORE 0001 205.00

D4261 OSSEOUS SURG 1 TO 3 TEETH 0001 163.99

D4263 BONE REPLCE GRAFT FIRST SITE 0001 194.75

D4264 BONE REPLCE GRAFT EACH ADD 0001 159.89

D4265 BIO MTRLS TO AID SOFT/OS REG 0001 96.35

D4266 GUIDED TISS REGEN RESORBLE 0001 284.95

D4267 GUIDED TISS REGEN NONRESORB 0001 327.99

D4270 PEDICLE SOFT TISSUE GRAFT PR 0001 123.00

D4273 SUBEPITHELIAL TISSUE GRAFT 0001 338.24

D4274 DISTAL/PROXIMAL WEDGE PROC 0001 209.10

D4277 Soft tissue graft firsttooth 0001 614.99

D4278 Soft tissue graft addl tooth 0001 204.99

D4320 PROVISION SPLNT INTRACORONAL 0001 20.50

D4321 PROVISIONAL SPLINT EXTRACORO 0001 20.50

D4341 PERIODONTAL SCALING & ROOT 0001 102.91

D4342 PERIODONTAL SCALING 1-3TEETH 0001 55.34

D4355 FULL MOUTH DEBRIDEMENT 0001 74.83

D4381 LOCALIZED DELIVERY ANTIMICRO 0001 69.69

D4910 PERIODONTAL MAINT PROCEDURES 0001 40.99

D4999 UNSPECIFIED PERIODONTAL PROC 0001 0.00

D5110 DENTURES COMPLETE MAXILLARY 0001 615.00

D5120 DENTURES COMPLETE MANDIBLE 0001 615.00

D5130 DENTURES IMMEDIAT MAXILLARY 0001 666.25

D5140 DENTURES IMMEDIAT MANDIBLE 0001 666.25

D5211 DENTURES MAXILL PART RESIN 0001 205.00

D5212 DENTURES MAND PART RESIN 0001 205.00

D5213 DENTURES MAXILL PART METAL 0001 615.00

D5214 DENTURES MANDIBL PART METAL 0001 615.00

D5281 REMOVABLE PARTIAL DENTURE 0001 410.00

D5410 DENTURES ADJUST CMPLT MAXIL 0001 40.99

D5411 DENTURES ADJUST CMPLT MAND 0001 40.99

D5421 DENTURES ADJUST PART MAXILL 0001 40.99

D5422 DENTURES ADJUST PART MANDBL 0001 40.99


D5510 DENTUR REPR BROKEN COMPL BAS 0001 61.50

D5520 REPLACE DENTURE TEETH COMPLT 0001 40.99

D5610 DENTURES REPAIR RESIN BASE 0001 61.50

D5620 REP PART DENTURE CAST FRAME 0001 123.00

D5630 REP PARTIAL DENTURE CLASP 0001 123.00

D5640 REPLACE PART DENTURE TEETH 0001 61.50

D5650 ADD TOOTH TO PARTIAL DENTURE 0001 61.50

D5660 ADD CLASP TO PARTIAL DENTURE 0001 102.49

D5670 REPLC TTH&ACRLC ON MTL FRMWK 0001 305.44

D5671 REPLC TTH&ACRLC MANDIBULAR 0001 305.44

D5730 DENTURE RELN CMPLT MAXIL CH 0001 123.00

D5731 DENTURE RELN CMPLT MAND CHR 0001 123.00

D5740 DENTURE RELN PART MAXIL CHR 0001 102.49

D5741 DENTURE RELN PART MAND CHR 0001 102.49

D5750 DENTURE RELN CMPLT MAX LAB 0001 189.62

D5751 DENTURE RELN CMPLT MAND LAB 0001 189.62

D5760 DENTURE RELN PART MAXIL LAB 0001 163.99

D5761 DENTURE RELN PART MAND LAB 0001 163.99

D5820 DENTURE INTERM PART MAXILL 0001 205.00

D5821 DENTURE INTERM PART MANDBL 0001 205.00

D5850 DENTURE TISS CONDITN MAXILL 0001 40.99

D5851 DENTURE TISS CONDTIN MANDBL 0001 40.99

D5862 PRECISION ATTACHMENT 0001 182.44

D5899 REMOVABLE PROSTHODONTIC PROC 0001 20.50

D5931 SURGICAL OBTURATOR 0001 656.00

D5932 POSTSURGICAL OBTURATOR 0001 1537.50

D5933 REFITTING OF OBTURATOR 0001 307.50

D5936 TEMP OBTURATOR PROSTHESIS 0001 563.74

D5983 RADIATION APPLICATOR 0001 0.00

D5984 RADIATION SHIELD 0001 0.00

D5985 RADIATION CONE LOCATOR 0001 573.99

D5988 SURGICAL SPLINT 0001 219.34

D5992 ADJUST MAX PROST APPLIANCE ADJUS 0001 82.00

D5993 MAIN/CLEAN MAX PROSTHESIS MAINT 0001 82.00

D5999 MAXILLOFACIAL PROSTHESIS 0001 0.00

D6930 RECEMENT/BOND PART DENTURE 0001 76.87

D7111 EXTRACTION CORONAL REMNANTS 0001 40.99

D7140 EXTRACTION ERUPTED TOOTH/EXR 0001 45.09

D7210 REM IMP TOOTH W MUCOPER FLP 0001 87.12

D7220 IMPACT TOOTH REMOV SOFT TISS 0001 128.12

D7230 IMPACT TOOTH REMOV PART BONY 0001 122.96

D7240 IMPACT TOOTH REMOV COMP BONY 0001 147.60

D7241 IMPACT TOOTH REM BONY W/COMP 0001 205.00

D7250 TOOTH ROOT REMOVAL 0001 82.00

D7251 CORONECTOMY CORON 0001 61.50

D7260 ORAL ANTRAL FISTULA CLOSURE 0001 246.00


D7261 PRIMARY CLOSURE SINUS PERF 0001 286.99

D7270 TOOTH REIMPLANTATION 0001 102.49

D7280 EXPOSURE IMPACT TOOTH ORTHOD 0001 123.00

D7283 PLACE DEVICE IMPACTED TOOTH 0001 49.20

D7285 BIOPSY OF ORAL TISSUE HARD 0001 92.24

D7286 BIOPSY OF ORAL TISSUE SOFT 0001 82.00

D7287 EXFOLIATIVE CYTOLOG COLLECT 0001 40.18

D7288 BRUSH BIOPSY 0001 47.56

D7290 REPOSITIONING OF TEETH 0001 246.00

D7291 TRANSSEPTAL FIBEROTOMY 0001 77.89

D7292 SCREW RETAINED PLATE 0001 727.75

D7293 TEMP ANCHORAGE DEV W FLAP 0001 533.00

D7294 TEMP ANCHORAGE DEV W/O FLAP 0001 395.64

D7295 BONE HARVEST,AUTO GRAFT PROC HARVE 0001 102.49

D7310 ALVEOPLASTY W/ EXTRACTION 0001 86.10

D7311 ALVEOLOPLASTY W/EXTRACT 1-3 0001 108.65

D7320 ALVEOPLASTY W/O EXTRACTION 0001 108.65

D7321 ALVEOLOPLASTY NOT W/EXTRACTS 0001 157.85

D7410 RAD EXC LESION UP TO 1.25 CM 0001 102.49

D7411 EXCISION BENIGN LESION>1.25C 0001 100.45

D7412 EXCISION BENIGN LESION COMPL 0001 139.39

D7440 MALIG TUMOR EXC TO 1.25 CM 0001 656.00

D7441 MALIG TUMOR > 1.25 CM 0001 327.99

D7450 REM ODONTOGEN CYST TO 1.25CM 0001 205.00

D7451 REM ODONTOGEN CYST > 1.25 CM 0001 327.99

D7460 REM NONODONTO CYST TO 1.25CM 0001 205.00

D7461 REM NONODONTO CYST > 1.25 CM 0001 327.99

D7465 LESION DESTRUCTION 0001 107.63

D7472 REMOVAL OF TORUS PALATINUS 0001 143.50

D7473 REMOVE TORUS MANDIBULARIS 0001 147.60

D7490 MAXILLA OR MANDIBLE RESECTIO 0001 4100.00

D7510 I&D ABSC INTRAORAL SOFT TISS 0001 82.00

D7511 INCISION/DRAIN ABSCESS INTRA 0001 90.61

D7520 I&D ABSCESS EXTRAORAL 0001 123.00

D7521 INCISION/DRAIN ABSCESS EXTRA 0001 145.96

D7530 REMOVAL FB SKIN/AREOLAR TISS 0001 86.10

D7540 REMOVAL OF FB REACTION 0001 123.00

D7550 REMOVAL OF SLOUGHED OFF BONE 0001 358.75

D7560 MAXILLARY SINUSOTOMY 0001 266.49

D7610 MAXILLA OPEN REDUCT SIMPLE 0001 820.00

D7620 CLSD REDUCT SIMPL MAXILLA FX 0001 717.50

D7630 OPEN RED SIMPL MANDIBLE FX 0001 922.49

D7640 CLSD RED SIMPL MANDIBLE FX 0001 820.00

D7650 OPEN RED SIMP MALAR/ZYGOM FX 0001 512.49

D7660 CLSD RED SIMP MALAR/ZYGOM FX 0001 410.00

D7670 CLOSD RDUCTN SPLINT ALVEOLUS 0001 410.00


D7671 ALVEOLUS OPEN REDUCTION 0001 779.00

D7680 REDUCT SIMPLE FACIAL BONE FX 0001 1025.00

D7710 MAXILLA OPEN REDUCT COMPOUND 0001 1025.00

D7720 CLSD REDUCT COMPD MAXILLA FX 0001 902.00

D7730 OPEN REDUCT COMPD MANDBLE FX 0001 1168.49

D7740 CLSD REDUCT COMPD MANDBLE FX 0001 922.49

D7750 OPEN RED COMP MALAR/ZYGMA FX 0001 645.75

D7760 CLSD RED COMP MALAR/ZYGMA FX 0001 533.00

D7770 OPEN REDUC COMPD ALVEOLUS FX 0001 533.00

D7771 ALVEOLUS CLSD REDUC STBLZ TE 0001 73.79

D7780 REDUCT COMPND FACIAL BONE FX 0001 2500.99

D7810 TMJ OPEN REDUCT-DISLOCATION 0001 1291.50

D7820 CLOSED TMP MANIPULATION 0001 194.75

D7840 REMOVAL OF TMJ CONDYLE 0001 1230.00

D7850 TMJ MENISCECTOMY 0001 615.00

D7852 TMJ REPAIR OF JOINT DISC 0001 737.99

D7854 TMJ EXCISN OF JOINT MEMBRANE 0001 573.99

D7858 TMJ RECONSTRUCTION 0001 2296.00

D7860 TMJ CUTTING INTO JOINT 0001 615.00

D7865 TMJ RESHAPING COMPONENTS 0001 1722.00

D7870 TMJ ASPIRATION JOINT FLUID 0001 82.00

D7872 TMJ DIAGNOSTIC ARTHROSCOPY 0001 533.00

D7873 TMJ ARTHROSCOPY LYSIS ADHESN 0001 584.24

D7874 TMJ ARTHROSCOPY DISC REPOSIT 0001 737.99

D7875 TMJ ARTHROSCOPY SYNOVECTOMY 0001 789.25

D7876 TMJ ARTHROSCOPY DISCECTOMY 0001 820.00

D7877 TMJ ARTHROSCOPY DEBRIDEMENT 0001 758.49

D7880 OCCLUSAL ORTHOTIC APPLIANCE 0001 291.09

D7910 DENT SUTUR RECENT WND TO 5CM 0001 26.64

D7911 DENTAL SUTURE WOUND TO 5 CM 0001 53.30

D7912 SUTURE COMPLICATE WND > 5 CM 0001 10.25

D7921 Collect & appl blood product 0001 71.74

D7940 RESHAPING BONE ORTHOGNATHIC 0001 1230.00

D7941 BONE CUTTING RAMUS CLOSED 0001 820.00

D7943 CUTTING RAMUS OPEN W/GRAFT 0001 1537.50

D7944 BONE CUTTING SEGMENTED 0001 1025.00

D7945 BONE CUTTING BODY MANDIBLE 0001 1025.00

D7946 RECONSTRUCTION MAXILLA TOTAL 0001 2562.49

D7947 RECONSTRUCT MAXILLA SEGMENT 0001 2562.49

D7948 RECONSTRUCT MIDFACE NO GRAFT 0001 2870.00

D7949 RECONSTRUCT MIDFACE W/GRAFT 0001 4182.00

D7951 SINUS AUG W BONE OR BONE SUB 0001 803.59

D7952 Sinus augmentation vertical 0001 0.00

D7953 BONE REPLACEMENT GRAFT 0001 440.74

D7955 REPAIR MAXILLOFACIAL DEFECTS 0001 922.49

D7960 FRENULECTOMY/FRENECTOMY 0001 123.00


D7963 FRENULOPLASTY 0001 145.54

D7970 EXCISION HYPERPLASTIC TISSUE 0001 246.00

D7971 EXCISION PERICORONAL GINGIVA 0001 123.00

D7980 SIALOLITHOTOMY 0001 246.00

D7981 EXCISION OF SALIVARY GLAND 0001 410.00

D7982 SIALODOCHOPLASTY 0001 584.24

D7983 CLOSURE OF SALIVARY FISTULA 0001 246.00

D7990 EMERGENCY TRACHEOTOMY 0001 512.49

D7991 DENTAL CORONOIDECTOMY 0001 820.00

D7996 IMPLANT MANDIBLE FOR AUGMENT 0001 0.00

D7998 INTRAORAL PLACE OF FIX DEV 0001 596.54

D7999 ORAL SURGERY PROCEDURE 0001 0.00

D8010 LIMITED DENTAL TX PRIMARY 0001 450.99

D8020 LIMITED DENTAL TX TRANSITION 0001 533.00

D8040 LIMITED DENTAL TX ADULT 0001 696.99

D8080 COMPRE DENTAL TX ADOLESCENT 0001 1865.49

D8090 COMPRE DENTAL TX ADULT 0001 1947.50

D8210 ORTHODONTIC REM APPLIANCE TX 0001 243.94

D8220 FIXED APPLIANCE THERAPY HABT 0001 293.15

D8660 PREORTHODONTIC TX VISIT 0001 49.20

D8670 PERIODIC ORTHODONTC TX VISIT 0001 79.94

D8680 ORTHODONTIC RETENTION 0001 117.87

D8691 REPAIR ORTHO APPLIANCE 0001 66.62

D8693 REBOND/RECEMENT RETAINERS 0001 69.69

D8999 ORTHODONTIC PROCEDURE 0001 0.00

D9110 TX DENTAL PAIN MINOR PROC 0001 40.99

D9120 FIX PARTIAL DENTURE SECTION 0001 71.75

D9210 DENT ANESTHESIA W/O SURGERY 0001 10.25

D9212 TRIGEMINAL BLOCK ANESTHESIA 0001 10.25

D9215 LOCAL ANESTHESIA 0001 6.15

D9220 GENERAL ANESTHESIA 0001 112.74

D9221 GENERAL ANESTHESIA EA AD 15M 0001 40.99

D9230 ANALGESIA 0001 18.44

D9241 INTRAVENOUS SEDATION 0001 123.00

D9242 IV SEDATION EA AD 15 M 0001 46.13

D9248 SEDATION (NON-IV) 0001 91.22

D9310 DENTAL CONSULTATION 0001 61.50

D9410 DENTAL HOUSE CALL 0001 61.50

D9420 HOSPITAL/ASC CALL 0001 40.99

D9440 OFFICE VISIT AFTER HOURS 0001 61.50

D9610 DENT THERAPEUTIC DRUG INJECT 0001 20.50

D9612 THERA PAR DRUGS 2 OR > ADMIN 0001 40.99

D9630 OTHER DRUGS/MEDICAMENTS 0001 10.25

D9930 TREATMENT OF COMPLICATIONS 0001 34.85

D9940 DENTAL OCCLUSAL GUARD 0001 205.00

D9942 REPAIR/RELINE OCCLUSAL GUARD 0001 70.52


D9950 OCCLUSION ANALYSIS 0001 168.09

D9951 LIMITED OCCLUSAL ADJUSTMENT 0001 10.25

D9952 COMPLETE OCCLUSAL ADJUSTMENT 0001 163.99

D9999 ADJUNCTIVE PROCEDURE 0001 0.00

E0110 CRUTCH FOREARM PAIR UE 0001 49.45

E0110 CRUTCH FOREARM PAIR RR 0001 15.99

E0110 CRUTCH FOREARM PAIR NU 0001 65.95

E0111 CRUTCH FOREARM EACH UE 0001 34.94

E0111 CRUTCH FOREARM EACH RR 0001 8.43

E0111 CRUTCH FOREARM EACH NU 0001 45.27

E0112 CRUTCH UNDERARM PAIR WOOD UE 0001 24.85

E0112 CRUTCH UNDERARM PAIR WOOD RR 0001 9.93

E0112 CRUTCH UNDERARM PAIR WOOD NU 0001 33.11

E0113 CRUTCH UNDERARM EACH WOOD UE 0001 13.48

E0113 CRUTCH UNDERARM EACH WOOD RR 0001 5.15

E0113 CRUTCH UNDERARM EACH WOOD NU 0001 17.96

E0114 CRUTCH UNDERARM PAIR NO WOOD UE 0001 30.32

E0114 CRUTCH UNDERARM PAIR NO WOOD RR 0001 8.57

E0114 CRUTCH UNDERARM PAIR NO WOOD NU 0001 40.11

E0116 CRUTCH UNDERARM EACH NO WOOD UE 0001 17.75

E0116 CRUTCH UNDERARM EACH NO WOOD RR 0001 5.40

E0116 CRUTCH UNDERARM EACH NO WOOD NU 0001 23.58

E0117 UNDERARM SPRINGASSIST CRUTCH UE 0001 144.55

E0117 UNDERARM SPRINGASSIST CRUTCH RR 0001 19.26

E0117 UNDERARM SPRINGASSIST CRUTCH NU 0001 192.71

E0118 CRUTCH SUBSTITUTE RR 0001 33.40

E0118 CRUTCH SUBSTITUTE NU 0001 334.00

E0140 WALKER W TRUNK SUPPORT UE 0001 270.54

E0140 WALKER W TRUNK SUPPORT RR 0001 36.08

E0140 WALKER W TRUNK SUPPORT NU 0001 360.71

E0300 ENCLOSED PED CRIB HOSP GRADE UE 0001 2128.96

E0300 ENCLOSED PED CRIB HOSP GRADE RR 0001 283.86

E0300 ENCLOSED PED CRIB HOSP GRADE NU 0001 2838.62

E0301 HD HOSP BED, 350-600 LBS RR 0001 256.30

E0302 EX HD HOSP BED > 600 LBS RR 0001 715.44

E0303 HOSP BED HVY DTY XTRA WIDE RR 0001 289.52

E0303 HOSP BED HVY DTY XTRA WIDE NU 0001 2895.20

E0304 HOSP BED XTRA HVY DTY X WIDE RR 0001 770.67

E0470 RAD W/O BACKUP NON-INV INTFC RR 0001 218.11

E0471 RAD W/BACKUP NON INV INTRFC RR 0001 642.17

E0471 RAD W/BACKUP NON INV INTRFC NU 0001 6421.70

E0472 RAD W BACKUP INVASIVE INTRFC RR 0001 642.17

E0561 HUMIDIFIER NONHEATED W PAP UE 0001 80.24

E0561 HUMIDIFIER NONHEATED W PAP RR 0001 10.69

E0561 HUMIDIFIER NONHEATED W PAP NU 0001 107.00

E0562 HUMIDIFIER HEATED USED W PAP UE 0001 225.91


E0562 HUMIDIFIER HEATED USED W PAP RR 0001 30.11

E0562 HUMIDIFIER HEATED USED W PAP NU 0001 301.22

E0637 COMBINATION SIT TO STAND SYS UE 0001 1578.72

E0637 COMBINATION SIT TO STAND SYS RR 0001 210.51

E0637 COMBINATION SIT TO STAND SYS NU 0001 2104.97

E0638 STANDING FRAME SYS UE 0001 640.18

E0638 STANDING FRAME SYS RR 0001 85.36

E0638 STANDING FRAME SYS NU 0001 853.57

E0675 PNEUMATIC COMPRESSION DEVICE RR 0001 321.99

E0955 CUSHIONED HEADREST UE 0001 151.63

E0955 CUSHIONED HEADREST RR 0001 20.23

E0955 CUSHIONED HEADREST NU 0001 202.18

E0956 W/C LATERAL TRUNK/HIP SUPPOR UE 0001 73.93

E0956 W/C LATERAL TRUNK/HIP SUPPOR RR 0001 9.87

E0956 W/C LATERAL TRUNK/HIP SUPPOR NU 0001 98.58

E0957 W/C MEDIAL THIGH SUPPORT UE 0001 103.45

E0957 W/C MEDIAL THIGH SUPPORT RR 0001 13.79

E0957 W/C MEDIAL THIGH SUPPORT NU 0001 137.93

E0960 W/C SHOULDER HARNESS/STRAPS UE 0001 68.24

E0960 W/C SHOULDER HARNESS/STRAPS RR 0001 9.10

E0960 W/C SHOULDER HARNESS/STRAPS NU 0001 90.98

E0981 SEAT UPHOLSTERY, REPLACEMENT UE 0001 34.12

E0981 SEAT UPHOLSTERY, REPLACEMENT RR 0001 4.80

E0981 SEAT UPHOLSTERY, REPLACEMENT NU 0001 45.51

E0982 BACK UPHOLSTERY, REPLACEMENT UE 0001 32.84

E0982 BACK UPHOLSTERY, REPLACEMENT RR 0001 5.15

E0982 BACK UPHOLSTERY, REPLACEMENT NU 0001 43.80

E0983 ADD PWR JOYSTICK RR 0001 238.05

E0984 ADD PWR TILLER UE 0001 1417.41

E0984 ADD PWR TILLER RR 0001 177.59

E0984 ADD PWR TILLER NU 0001 1889.92

E0985 W/C SEAT LIFT MECHANISM UE 0001 152.12

E0985 W/C SEAT LIFT MECHANISM RR 0001 20.30

E0985 W/C SEAT LIFT MECHANISM NU 0001 202.85

E0986 MAN W/C PUSH-RIM POWR SYSTEM UE 0001 3648.20

E0986 MAN W/C PUSH-RIM POWR SYSTEM RR 0001 486.43

E0986 MAN W/C PUSH-RIM POWR SYSTEM NU 0001 4864.24

E1002 PWR SEAT TILT UE 0001 3084.76

E1002 PWR SEAT TILT RR 0001 411.33

E1002 PWR SEAT TILT NU 0001 4113.02

E1003 PWR SEAT RECLINE UE 0001 3293.48

E1003 PWR SEAT RECLINE RR 0001 439.14

E1003 PWR SEAT RECLINE NU 0001 4391.30

E1004 PWR SEAT RECLINE MECH UE 0001 3651.77

E1004 PWR SEAT RECLINE MECH RR 0001 486.90

E1004 PWR SEAT RECLINE MECH NU 0001 4869.05


E1005 PWR SEAT RECLINE PWR UE 0001 3952.78

E1005 PWR SEAT RECLINE PWR RR 0001 527.03

E1005 PWR SEAT RECLINE PWR NU 0001 5270.36

E1006 PWR SEAT COMBO W/O SHEAR UE 0001 4841.78

E1006 PWR SEAT COMBO W/O SHEAR RR 0001 645.55

E1006 PWR SEAT COMBO W/O SHEAR NU 0001 6455.70

E1007 PWR SEAT COMBO W/SHEAR UE 0001 6555.94

E1007 PWR SEAT COMBO W/SHEAR RR 0001 874.13

E1007 PWR SEAT COMBO W/SHEAR NU 0001 8741.27

E1008 PWR SEAT COMBO PWR SHEAR UE 0001 6556.55

E1008 PWR SEAT COMBO PWR SHEAR RR 0001 874.20

E1008 PWR SEAT COMBO PWR SHEAR NU 0001 8742.05

E1009 ADD MECH LEG ELEVATION UE 0001 0.00

E1009 ADD MECH LEG ELEVATION RR 0001 0.00

E1009 ADD MECH LEG ELEVATION NU 0001 0.00

E1010 ADD PWR LEG ELEVATION UE 0001 863.51

E1010 ADD PWR LEG ELEVATION RR 0001 115.13

E1010 ADD PWR LEG ELEVATION NU 0001 1151.36

E1028 W/C MANUAL SWINGAWAY UE 0001 154.89

E1028 W/C MANUAL SWINGAWAY RR 0001 20.65

E1028 W/C MANUAL SWINGAWAY NU 0001 206.54

E1029 W/C VENT TRAY FIXED UE 0001 277.15

E1029 W/C VENT TRAY FIXED RR 0001 36.95

E1029 W/C VENT TRAY FIXED NU 0001 369.54

E1391 OXYGEN CONCENTRATOR, DUAL RR 0001 173.17

E2201 MAN W/CH ACC SEAT W>=20�<24� UE 0001 279.83

E2201 MAN W/CH ACC SEAT W>=20�<24� RR 0001 37.31

E2201 MAN W/CH ACC SEAT W>=20�<24� NU 0001 373.10

E2202 SEAT WIDTH 24-27 IN UE 0001 355.50

E2202 SEAT WIDTH 24-27 IN RR 0001 47.40

E2202 SEAT WIDTH 24-27 IN NU 0001 473.98

E2203 FRAME DEPTH LESS THAN 22 IN UE 0001 359.28

E2203 FRAME DEPTH LESS THAN 22 IN RR 0001 47.89

E2203 FRAME DEPTH LESS THAN 22 IN NU 0001 479.05

E2204 FRAME DEPTH 22 TO 25 IN UE 0001 610.05

E2204 FRAME DEPTH 22 TO 25 IN RR 0001 81.35

E2204 FRAME DEPTH 22 TO 25 IN NU 0001 813.40

E2310 ELECTRO CONNECT BTW CONTROL UE 0001 877.68

E2310 ELECTRO CONNECT BTW CONTROL RR 0001 117.02

E2310 ELECTRO CONNECT BTW CONTROL NU 0001 1170.24

E2311 ELECTRO CONNECT BTW 2 SYS UE 0001 1776.90

E2311 ELECTRO CONNECT BTW 2 SYS RR 0001 236.93

E2311 ELECTRO CONNECT BTW 2 SYS NU 0001 2369.20

E2321 HAND INTERFACE JOYSTICK UE 0001 1149.68

E2321 HAND INTERFACE JOYSTICK RR 0001 153.28

E2321 HAND INTERFACE JOYSTICK NU 0001 1532.90


E2322 MULT MECH SWITCHES UE 0001 1057.78

E2322 MULT MECH SWITCHES RR 0001 141.03

E2322 MULT MECH SWITCHES NU 0001 1410.36

E2323 SPECIAL JOYSTICK HANDLE UE 0001 48.48

E2323 SPECIAL JOYSTICK HANDLE RR 0001 6.47

E2323 SPECIAL JOYSTICK HANDLE NU 0001 64.64

E2324 CHIN CUP INTERFACE UE 0001 33.37

E2324 CHIN CUP INTERFACE RR 0001 4.45

E2324 CHIN CUP INTERFACE NU 0001 44.49

E2325 SIP AND PUFF INTERFACE UE 0001 1010.13

E2325 SIP AND PUFF INTERFACE RR 0001 134.70

E2325 SIP AND PUFF INTERFACE NU 0001 1346.83

E2326 BREATH TUBE KIT UE 0001 239.72

E2326 BREATH TUBE KIT RR 0001 31.96

E2326 BREATH TUBE KIT NU 0001 319.60

E2327 HEAD CONTROL INTERFACE MECH UE 0001 1729.58

E2327 HEAD CONTROL INTERFACE MECH RR 0001 230.62

E2327 HEAD CONTROL INTERFACE MECH NU 0001 2306.14

E2328 HEAD/EXTREMITY CONTROL INTER UE 0001 2908.01

E2328 HEAD/EXTREMITY CONTROL INTER RR 0001 387.74

E2328 HEAD/EXTREMITY CONTROL INTER NU 0001 3877.32

E2329 HEAD CONTROL NONPROPORTIONAL UE 0001 1297.72

E2329 HEAD CONTROL NONPROPORTIONAL RR 0001 173.04

E2329 HEAD CONTROL NONPROPORTIONAL NU 0001 1730.31

E2330 HEAD CONTROL PROXIMITY SWITC UE 0001 2499.96

E2330 HEAD CONTROL PROXIMITY SWITC RR 0001 333.32

E2330 HEAD CONTROL PROXIMITY SWITC NU 0001 3333.27

E2340 W/C WDTH 20-23 IN SEAT FRAME UE 0001 235.67

E2340 W/C WDTH 20-23 IN SEAT FRAME RR 0001 31.42

E2340 W/C WDTH 20-23 IN SEAT FRAME NU 0001 314.22

E2341 W/C WDTH 24-27 IN SEAT FRAME UE 0001 347.23

E2341 W/C WDTH 24-27 IN SEAT FRAME RR 0001 46.30

E2341 W/C WDTH 24-27 IN SEAT FRAME NU 0001 462.97

E2342 W/C DPTH 20-21 IN SEAT FRAME UE 0001 336.03

E2342 W/C DPTH 20-21 IN SEAT FRAME RR 0001 44.80

E2342 W/C DPTH 20-21 IN SEAT FRAME NU 0001 448.03

E2343 W/C DPTH 22-25 IN SEAT FRAME UE 0001 194.44

E2343 W/C DPTH 22-25 IN SEAT FRAME RR 0001 25.93

E2343 W/C DPTH 22-25 IN SEAT FRAME NU 0001 259.27

E2351 ELECTRONIC SGD INTERFACE UE 0001 523.96

E2351 ELECTRONIC SGD INTERFACE RR 0001 69.88

E2351 ELECTRONIC SGD INTERFACE NU 0001 698.63

E2360 22NF NONSEALED LEADACID UE 0001 84.26

E2360 22NF NONSEALED LEADACID RR 0001 11.29

E2360 22NF NONSEALED LEADACID NU 0001 112.34

E2361 22NF SEALED LEADACID BATTERY UE 0001 102.86


E2361 22NF SEALED LEADACID BATTERY RR 0001 13.72

E2361 22NF SEALED LEADACID BATTERY NU 0001 137.15

E2362 GR24 NONSEALED LEADACID UE 0001 67.82

E2362 GR24 NONSEALED LEADACID RR 0001 9.04

E2362 GR24 NONSEALED LEADACID NU 0001 90.44

E2363 GR24 SEALED LEADACID BATTERY UE 0001 137.17

E2363 GR24 SEALED LEADACID BATTERY RR 0001 18.30

E2363 GR24 SEALED LEADACID BATTERY NU 0001 182.89

E2364 U1NONSEALED LEADACID BATTERY UE 0001 84.26

E2364 U1NONSEALED LEADACID BATTERY RR 0001 11.29

E2364 U1NONSEALED LEADACID BATTERY NU 0001 112.34

E2365 U1 SEALED LEADACID BATTERY UE 0001 82.75

E2365 U1 SEALED LEADACID BATTERY RR 0001 11.03

E2365 U1 SEALED LEADACID BATTERY NU 0001 110.31

E2366 BATTERY CHARGER, SINGLE MODE UE 0001 168.06

E2366 BATTERY CHARGER, SINGLE MODE RR 0001 22.47

E2366 BATTERY CHARGER, SINGLE MODE NU 0001 224.08

E2367 BATTERY CHARGER, DUAL MODE UE 0001 314.31

E2367 BATTERY CHARGER, DUAL MODE RR 0001 41.91

E2367 BATTERY CHARGER, DUAL MODE NU 0001 419.08

E2402 NEG PRESS WOUND THERAPY PUMP RR 0001 1553.40

G0101 CA SCREEN;PELVIC/BREAST EXAM 0001 35.99

G0102 PROSTATE CA SCREENING; DRE 0001 16.42

G0108 DIAB MANAGE TRN PER INDIV 0001 30.89

G0109 DIAB MANAGE TRN IND/GROUP 0001 17.82

G0166 EXTRNL COUNTERPULSE, PER TX 0001 135.85

G0202 SCREENINGMAMMOGRAPHYDIGITAL TC 0001 103.63

G0202 SCREENINGMAMMOGRAPHYDIGITAL 26 0001 36.91

G0202 SCREENINGMAMMOGRAPHYDIGITAL 0001 140.54

G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL TC 0001 102.05

G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL 26 0001 45.76

G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL 0001 147.80

G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL TC 0001 82.67

G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL 26 0001 39.61

G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL 0001 119.58

G0235 PET NOT OTHERWISE SPECIFIED 0001 0.00

G0277 Hbot, full body chamber, 30m 0001 42.64

G0279 Tomosynthesis, mammo screen 26 0001 31.62

G0279 Tomosynthesis, mammo screen 0001 58.98

G0306 CBC/DIFFWBC W/O PLATELET 0001 5.68

G0307 CBC WITHOUT PLATELET 0001 4.72

G0364 BONE MARROW ASPIRATE &BIOPSY 0001 10.07

G0365 VESSEL MAPPING HEMO ACCESS TC 0001 163.17

G0365 VESSEL MAPPING HEMO ACCESS 26 0001 13.87

G0365 VESSEL MAPPING HEMO ACCESS 0001 177.04

G0372 MD SERVICE REQUIRED FOR PMD 0001 8.82


G0389 Ultrasound exam AAA screen TC 0001 63.94

G0389 Ultrasound exam AAA screen 26 0001 27.05

G0389 Ultrasound exam AAA screen 0001 90.99

G0398 HOME SLEEP TEST/TYPE 2 PORTA TC 0001 109.22

G0398 HOME SLEEP TEST/TYPE 2 PORTA 26 0001 53.80

G0398 HOME SLEEP TEST/TYPE 2 PORTA 0001 163.02







G0412 OPEN TX ILIAC SPINE UNI/BIL 0001 705.87

G0413 PELVIC RING FRACTURE UNI/BIL 0001 1028.00

G0414 PELVIC RING FX TREAT INT FIX 0001 972.03

G0415 OPEN TX POST PELVIC FXCTURE 0001 1329.79

G0416 PROSTATE BIOPSY, ANY MTHD TC 0001 462.65

G0416 PROSTATE BIOPSY, ANY MTHD 26 0001 189.08

G0416 PROSTATE BIOPSY, ANY MTHD 0001 651.73

G0432 EIA HIV-1/HIV-2 SCREEN INFEC 0001 9.64

G0433 ELISA HIV-1/HIV-2 SCREEN INFEC 0001 9.64

G0434 DRUG SCREEN MULTI DRUG CLASS DRUG 0001 10.23

G0435 ORAL HIV-1/HIV-2 SCREEN INFEC 0001 8.43

G0438 ANNUAL WELLNESS FIRST 0001 113.85

G0439 ANNUAL WELLNESS SUBSEQ 0001 68.62

G0442 Annual alcohol screen 15 min 0001 16.33

G0443 Brief alcohol misuse counsel 0001 23.44

G0444 Depression screen annual 0001 16.33

G0445 High inten beh couns STD 30m 0001 23.44

G0446 Intens behave ther cardio dx 0001 23.44

G0447 Behavior counsel obesity 15m 0001 23.44

G0452 Molecular pathology interpr 0001 0.00

G0453 Cont intraop neuro monitor 0001 28.55

G0454 MD document visit by NPP 0001 9.61

G6001 Echo guidance radiotherapy 26 0001 30.56

G6001 Echo guidance radiotherapy 0001 53.74

G6002 Stereoscopic x-ray guidance 26 0001 20.63

G6002 Stereoscopic x-ray guidance 0001 78.81

G6003 Radiation treatment delivery 0001 172.32













G6015 Radiation tx delivery imrt 0001 425.32

G6016 Delivery comp imrt 0001 425.32

G6017 Intrafraction track motion 0001 0.00

G6018 Ileoscopy w/stent 0001 168.47

G6019 Colonoscopy lesion removal 0001 277.25

G6020 Colonoscopy w/stent 0001 275.21

G6022 Sigmoidoscopy w/ablate tumr 0001 186.75

G6023 Sigmoidoscopy w/stent 0001 174.97

G6024 Lesion removal colonoscopy 0001 335.88

G6025 Colonoscopy w/stent 0001 346.47

G6027 Anoscopy hra w/spec collect 0001 0.00

G6028 Anoscopy hra w/biopsy 0001 0.00

H0004 ALCOHOL AND/OR DRUG SERVICES 0001 30.28

H2011 CRISIS INTERVEN SVC, 15 MIN 0001 21.71

J1050 Medroxyprogesterone acetate 0001 0.00

J1741 Ibuprofen injection 0001 0.00

J1930 LANREOTIDE INJECTION 0001 0.00

J3530 NASAL VACCINE INHALATION 0001 0.00

J3570 LAETRILE AMYGDALIN VIT B17 0001 0.00

J7315 OPHTHALMIC MITOMYCIN 0001 0.00

J7316 Inj ocriplasmin 0.125 mg 0001 0.00

J7508 Tacrolimus ex rel oral 0.1mg 0001 0.00

J7665 MANNITOL FOR INHALER 0001 0.00

K0601 REPL BATT SILVER OXIDE 1.5 V NU 0001 1.10

K0602 REPL BATT SILVER OXIDE 3 V NU 0001 6.36

K0603 REPL BATT ALKALINE 1.5 V NU 0001 0.57

K0604 REPL BATT LITHIUM 3.6 V NU 0001 6.09

K0605 REPL BATT LITHIUM 4.5 V NU 0001 14.60

K0730 CTRL DOSE INH DRUG DELIV SYS RR 0001 172.40

L0112 CRANIAL CERVICAL ORTHOSIS 0001 1099.77

L0113 CRANIAL CERVICAL TORTICOLLIS 0001 0.00

L0120 CERV FLEX N/ADJ FOAM PRE OTS 0001 26.63

L0130 FLEX THERMOPLASTIC COLLAR MO 0001 133.02

L0140 CERVICAL SEMI-RIGID ADJUSTAB 0001 48.19

L0150 CERV SEMI-RIG ADJ MOLDED CHN 0001 108.46

L0160 CERV SR WIRE OCC/MAN PRE OTS 0001 133.06

L0170 CERVICAL COLLAR MOLDED TO PT 0001 641.80

L0172 CERV COL SR FOAM 2PC PRE OTS 0001 119.82

L0174 CERV SR 2PC THOR EXT PRE OTS 0001 275.72

L0180 CER POST COL OCC/MAN SUP ADJ 0001 357.44

L0190 CERV COLLAR SUPP ADJ CERV BA 0001 497.18

L0200 CERV COL SUPP ADJ BAR & THOR 0001 518.30


L0220 THOR RIB BELT CUSTOM FABRICA 0001 92.19

L0450 TLSO FLEX TRUNK/THOR PRE OTS 0001 174.44

L0452 TLSO FLEX CUSTOM FAB THORACI 0001 330.85

L0454 TLSO TRNK SJ-T9 PRE CST 0001 350.83

L0456 TLSO FLEX TRNK SJ-SS PRE CST 0001 350.83

L0458 TLSO 2MOD SYMPHIS-XIPHO PRE 0001 547.13

L0460 TLSO 2 SHL SYMPHYS-STERN CST 0001 547.13

L0462 TLSO 3MOD SACRO-SCAP PRE 0001 547.13

L0464 TLSO 4MOD SACRO-SCAP PRE 0001 547.13

L0466 TLSO R FRAM SOFT ANT PRE CST 0001 374.99

L0468 TLSO RIG FRAM PELVIC PRE CST 0001 454.50

L0470 TLSO RIGID FRAME PRE SUBCLAV 0001 639.90

L0472 TLSO RIGID FRAME HYPEREX PRE 0001 405.83

L0480 TLSO RIGID PLASTIC CUSTOM FA 0001 1217.79

L0482 TLSO RIGID LINED CUSTOM FAB 0001 1388.76

L0484 TLSO RIGID PLASTIC CUST FAB 0001 1562.86

L0486 TLSO RIGIDLINED CUST FAB TWO 0001 1692.61

L0488 TLSO RIGID LINED PRE ONE PIE 0001 1212.41

L0490 TLSO RIGID PLASTIC PRE ONE 0001 1124.43

L0625 LO FLEX L1-BELOW L5 PRE OTS 0001 43.27

L0626 LO SAG RIG PNL STAYS PRE CST 0001 61.25

L0627 LO SAG RI AN/POS PNL PRE CST 0001 322.98

L0628 LSO FLEX NO RI STAYS PRE OTS 0001 65.92

L0630 LSO R POST PNL SJ-T9 PRE CST 0001 127.26

L0631 LSO SAG R AN/POS PNL PRE CST 0001 806.64

L0633 LSO SC R POS/LAT PNL PRE CST 0001 225.31

L0635 LSO SAGIT RIGID PANEL PREFAB 0001 960.72

L0636 LSO SAGITTAL RIGID PANEL CUS 0001 1422.21

L0637 LSO SC R ANT/POS PNL PRE CST 0001 991.52

L0638 LSO SAG-CORONAL PANEL CUSTOM 0001 1036.35

L0639 LSO S/C SHELL/PANEL PREFAB 0001 950.64

L0640 LSO S/C SHELL/PANEL CUSTOM 0001 822.21

L0700 CTLSO A-P-L CONTROL MOLDED 0001 2029.13

L0710 CTLSO A-P-L CONTROL W/ INTER 0001 2096.18

L0810 HALO CERVICAL INTO JCKT VEST 0001 2588.89

L0820 HALO CERVICAL INTO BODY JACK 0001 2040.86

L0830 HALO CERV INTO MILWAUKEE TYP 0001 3147.31

L0859 MRI COMPATIBLE SYSTEM 0001 917.03

L0861 HALO REPL LINER/INTERFACE 0001 169.36

L0970 TLSO CORSET FRONT 0001 114.71

L0972 LSO CORSET FRONT 0001 103.29

L0974 TLSO FULL CORSET 0001 173.70

L0976 LSO FULL CORSET 0001 122.61

L0978 AXILLARY CRUTCH EXTENSION 0001 193.20

L0980 PERONEAL STRAPS PAIR PRE OTS 0001 13.14

L0982 STOCKING SUP GRIPS 4 PRE OTS 0001 13.03


L0984 PROTECT BODY SOCK EA PRE OTS 0001 51.46

L1000 CTLSO MILWAUKE INITIAL MODEL 0001 2037.70

L1005 TENSION BASED SCOLIOSIS ORTH 0001 2514.93

L1010 CTLSO AXILLA SLING 0001 57.18

L1020 KYPHOSIS PAD 0001 86.75

L1025 KYPHOSIS PAD FLOATING 0001 116.87

L1030 LUMBAR BOLSTER PAD 0001 50.16

L1040 LUMBAR OR LUMBAR RIB PAD 0001 78.30

L1050 STERNAL PAD 0001 83.56

L1060 THORACIC PAD 0001 95.99

L1070 TRAPEZIUS SLING 0001 90.31

L1080 OUTRIGGER 0001 48.04

L1085 OUTRIGGER BIL W/ VERT EXTENS 0001 154.49

L1090 LUMBAR SLING 0001 92.00

L1100 RING FLANGE PLASTIC/LEATHER 0001 159.61

L1110 RING FLANGE PLAS/LEATHER MOL 0001 256.33

L1120 COVERS FOR UPRIGHT EACH 0001 39.86

L1200 FURNSH INITIAL ORTHOSIS ONLY 0001 1572.58

L1210 LATERAL THORACIC EXTENSION 0001 262.62

L1220 ANTERIOR THORACIC EXTENSION 0001 222.35

L1230 MILWAUKEE TYPE SUPERSTRUCTUR 0001 446.81

L1240 LUMBAR DEROTATION PAD 0001 77.93

L1250 ANTERIOR ASIS PAD 0001 61.81

L1260 ANTERIOR THORACIC DEROTATION 0001 67.60

L1270 ABDOMINAL PAD 0001 77.76

L1280 RIB GUSSET (ELASTIC) EACH 0001 86.58

L1290 LATERAL TROCHANTERIC PAD 0001 78.89

L1300 BODY JACKET MOLD TO PATIENT 0001 1676.57

L1310 POST-OPERATIVE BODY JACKET 0001 1575.53

L1499 SPINAL ORTHOSIS NOS 0001 1906.45

L1600 HO FLEX FREJKA W/COV PRE CST 0001 123.26

L1610 HO FREJKA COV ONLY PRE CST 0001 44.06

L1620 HO FLEX PAVLIK HARNS PRE CST 0001 125.04

L1630 ABDUCT CONTROL HIP SEMI-FLEX 0001 138.76

L1640 PELV BAND/SPREAD BAR THIGH C 0001 347.34

L1650 HO ABDUCTION HIP ADJUSTABLE 0001 203.36

L1652 HO BI THIGHCUFFS W SPRDR BAR 0001 280.10

L1660 HO ABDUCTION STATIC PLASTIC 0001 128.82

L1680 PELVIC & HIP CONTROL THIGH C 0001 1222.90

L1685 POST-OP HIP ABDUCT CUSTOM FA 0001 1193.85

L1686 HO POST-OP HIP ABDUCTION 0001 915.55

L1690 COMBINATION BILATERAL HO 0001 1519.45

L1700 LEG PERTHES ORTH TORONTO TYP 0001 1532.72

L1710 LEGG PERTHES ORTH NEWINGTON 0001 1794.22

L1720 LEGG PERTHES ORTHOSIS TRILAT 0001 1322.56

L1730 LEGG PERTHES ORTH SCOTTISH R 0001 1135.95


L1755 LEGG PERTHES PATTEN BOTTOM T 0001 1580.97

L1810 KO ELASTIC WITH JOINTS 0001 97.80

L1820 KO ELAS W/ CONDYLE PADS & JO 0001 119.08

L1830 KO IMMOB CANVAS LONG PRE OTS 0001 87.80

L1831 KNEE ORTH POS LOCKING JOINT 0001 231.26

L1832 KO ADJ JNT POS R SUP PRE CST 0001 546.47

L1834 KO W/0 JOINT RIGID MOLDED TO 0001 736.39

L1836 KO RIGID W/O JOINTS PRE OTS 0001 104.84

L1840 KO DEROT ANT CRUCIATE CUSTOM 0001 922.86

L1843 KO SINGLE UPRIGHT PRE CST 0001 705.03

L1844 KO W/ADJ JT ROT CNTRL MOLDED 0001 1595.91

L1845 KO DOUBLE UPRIGHT PRE CST 0001 615.27

L1846 KO W ADJ FLEX/EXT ROTAT MOLD 0001 1065.60

L1847 KO DBL UPRIGHT W/AIR PRE CST 0001 451.94

L1850 KO SWEDISH TYPE PRE OTS 0001 288.90

L1860 KO SUPRACONDYLAR SOCKET MOLD 0001 1077.00

L1900 AFO SPRNG WIR DRSFLX CALF BD 0001 229.71

L1902 AFO ANKLE GAUNTLET PRE OTS 0001 68.86

L1904 AFO MOLDED ANKLE GAUNTLET 0001 471.98

L1906 AFO MULTILIG ANK SUP PRE OTS 0001 120.70

L1907 AFO SUPRAMALLEOLAR CUSTOM 0001 442.14

L1910 AFO SING BAR CLASP ATTACH SH 0001 268.41

L1920 AFO SING UPRIGHT W/ ADJUST S 0001 274.43

L1930 AFO PLASTIC 0001 237.44

L1940 AFO MOLDED TO PATIENT PLASTI 0001 496.37

L1945 AFO MOLDED PLAS RIG ANT TIB 0001 929.10

L1950 AFO SPIRAL MOLDED TO PT PLAS 0001 747.58

L1951 AFO SPIRAL PREFABRICATED 0001 659.91

L1960 AFO POS SOLID ANK PLASTIC MO 0001 556.33

L1970 AFO PLASTIC MOLDED W/ANKLE J 0001 581.72

L1971 AFO W/ANKLE JOINT, PREFAB 0001 368.30

L1980 AFO SING SOLID STIRRUP CALF 0001 368.36

L1990 AFO DOUB SOLID STIRRUP CALF 0001 447.39

L2000 KAFO SING FRE STIRR THI/CALF 0001 1018.01

L2010 KAFO SNG SOLID STIRRUP W/O J 0001 928.01

L2020 KAFO DBL SOLID STIRRUP BAND/ 0001 1171.94

L2030 KAFO DBL SOLID STIRRUP W/O J 0001 1016.77

L2034 KAFO PLA SIN UP W/WO K/A CUS 0001 1574.25

L2035 KAFO PLASTIC PEDIATRIC SIZE 0001 136.11

L2036 KAFO PLAS DOUB FREE KNEE MOL 0001 1669.84

L2037 KAFO PLAS SING FREE KNEE MOL 0001 1671.72

L2038 KAFO W/O JOINT MULTI-AXIS AN 0001 1228.47

L2040 HKAFO TORSION BIL ROT STRAPS 0001 133.65

L2050 HKAFO TORSION CABLE HIP PELV 0001 478.11

L2060 HKAFO TORSION BALL BEARING J 0001 582.72

L2070 HKAFO TORSION UNILAT ROT STR 0001 111.60


L2080 HKAFO UNILAT TORSION CABLE 0001 361.00

L2090 HKAFO UNILAT TORSION BALL BR 0001 440.10

L2106 AFO TIB FX CAST PLASTER MOLD 0001 682.41

L2108 AFO TIB FX CAST MOLDED TO PT 0001 991.76

L2112 AFO TIBIAL FRACTURE SOFT 0001 432.04

L2114 AFO TIB FX SEMI-RIGID 0001 582.57

L2116 AFO TIBIAL FRACTURE RIGID 0001 714.52

L2126 KAFO FEM FX CAST THERMOPLAS 0001 1031.23

L2128 KAFO FEM FX CAST MOLDED TO P 0001 1619.84

L2132 KAFO FEMORAL FX CAST SOFT 0001 625.79

L2134 KAFO FEM FX CAST SEMI-RIGID 0001 970.73

L2136 KAFO FEMORAL FX CAST RIGID 0001 1186.95

L2180 PLAS SHOE INSERT W ANK JOINT 0001 117.53

L2182 DROP LOCK KNEE 0001 80.46

L2184 LIMITED MOTION KNEE JOINT 0001 93.25

L2186 ADJ MOTION KNEE JNT LERMAN T 0001 113.33

L2188 QUADRILATERAL BRIM 0001 225.44

L2190 WAIST BELT 0001 65.74

L2192 PELVIC BAND & BELT THIGH FLA 0001 357.87

L2200 LIMITED ANKLE MOTION EA JNT 0001 47.72

L2210 DORSIFLEXION ASSIST EACH JOI 0001 67.47

L2220 DORSI & PLANTAR FLEX ASS/RES 0001 82.19

L2230 SPLIT FLAT CALIPER STIRR & P 0001 77.01

L2240 ROUND CALIPER AND PLATE ATTA 0001 83.93

L2250 FOOT PLATE MOLDED STIRRUP AT 0001 356.64

L2260 REINFORCED SOLID STIRRUP 0001 201.20

L2265 LONG TONGUE STIRRUP 0001 118.20

L2270 VARUS/VALGUS STRAP PADDED/LI 0001 53.90

L2275 PLASTIC MOD LOW EXT PAD/LINE 0001 117.73

L2280 MOLDED INNER BOOT 0001 454.48

L2300 ABDUCTION BAR JOINTED ADJUST 0001 270.23

L2310 ABDUCTION BAR-STRAIGHT 0001 123.47

L2320 NON-MOLDED LACER 0001 206.50

L2330 LACER MOLDED TO PATIENT MODE 0001 394.10

L2335 ANTERIOR SWING BAND 0001 228.01

L2340 PRE-TIBIAL SHELL MOLDED TO P 0001 448.58

L2350 PROSTHETIC TYPE SOCKET MOLDE 0001 894.32

L2360 EXTENDED STEEL SHANK 0001 51.36

L2370 PATTEN BOTTOM 0001 257.65

L2375 TORSION ANK & HALF SOLID STI 0001 113.41

L2380 TORSION STRAIGHT KNEE JOINT 0001 123.56

L2385 STRAIGHT KNEE JOINT HEAVY DU 0001 134.43

L2387 ADD LE POLY KNEE CUSTOM KAFO 0001 166.10

L2390 OFFSET KNEE JOINT EACH 0001 109.86

L2395 OFFSET KNEE JOINT HEAVY DUTY 0001 143.93

L2397 SUSPENSION SLEEVE LOWER EXT 0001 99.48


L2405 KNEE JOINT DROP LOCK EA JNT 0001 68.50

L2415 KNEE JOINT CAM LOCK EACH JOI 0001 95.43

L2425 KNEE DISC/DIAL LOCK/ADJ FLEX 0001 112.64

L2430 KNEE JNT RATCHET LOCK EA JNT 0001 112.64

L2492 KNEE LIFT LOOP DROP LOCK RIN 0001 88.98

L2500 THI/GLUT/ISCHIA WGT BEARING 0001 316.63

L2510 TH/WGHT BEAR QUAD-LAT BRIM M 0001 729.05

L2520 TH/WGHT BEAR QUAD-LAT BRIM C 0001 462.37

L2525 TH/WGHT BEAR NAR M-L BRIM MO 0001 1142.09

L2526 TH/WGHT BEAR NAR M-L BRIM CU 0001 637.51

L2530 THIGH/WGHT BEAR LACER NON-MO 0001 235.82

L2540 THIGH/WGHT BEAR LACER MOLDED 0001 424.34

L2550 THIGH/WGHT BEAR HIGH ROLL CU 0001 288.26

L2570 HIP CLEVIS TYPE 2 POSIT JNT 0001 478.06

L2580 PELVIC CONTROL PELVIC SLING 0001 465.81

L2600 HIP CLEVIS/THRUST BEARING FR 0001 206.13

L2610 HIP CLEVIS/THRUST BEARING LO 0001 243.74

L2620 PELVIC CONTROL HIP HEAVY DUT 0001 268.36

L2622 HIP JOINT ADJUSTABLE FLEXION 0001 307.79

L2624 HIP ADJ FLEX EXT ABDUCT CONT 0001 332.36

L2627 PLASTIC MOLD RECIPRO HIP & C 0001 1290.44

L2628 METAL FRAME RECIPRO HIP & CA 0001 1261.16

L2630 PELVIC CONTROL BAND & BELT U 0001 248.53

L2640 PELVIC CONTROL BAND & BELT B 0001 337.29

L2650 PELV & THOR CONTROL GLUTEAL 0001 100.65

L2660 THORACIC CONTROL THORACIC BA 0001 187.06

L2670 THORAC CONT PARASPINAL UPRIG 0001 153.51

L2680 THORAC CONT LAT SUPPORT UPRI 0001 142.52

L2750 PLATING CHROME/NICKEL PR BAR 0001 62.92

L2755 CARBON GRAPHITE LAMINATION 0001 102.68

L2760 EXTENSION PER EXTENSION PER 0001 60.98

L2768 ORTHO SIDEBAR DISCONNECT 0001 102.38

L2780 NON-CORROSIVE FINISH 0001 67.92

L2785 DROP LOCK RETAINER EACH 0001 31.81

L2795 KNEE CONTROL FULL KNEECAP 0001 85.28

L2800 KNEE CAP MEDIAL OR LATERAL P 0001 107.06

L2810 KNEE CONTROL CONDYLAR PAD 0001 78.39

L2820 SOFT INTERFACE BELOW KNEE SE 0001 87.16

L2830 SOFT INTERFACE ABOVE KNEE SE 0001 94.30

L2840 TIBIAL LENGTH SOCK FX OR EQU 0001 32.89

L2850 FEMORAL LGTH SOCK FX OR EQUA 0001 56.34

L2999 LOWER EXTREMITY ORTHOSIS NOS 0001 0.00

L3140 ABDUCTION ROTATION BAR SHOE 0001 33.00

L3150 ABDUCT ROTATION BAR W/O SHOE 0001 33.00

L3160 SHOE STYLED POSITIONING DEV 0001 11.86

L3170 FOOT PLAS HEEL STABI PRE OTS 0001 39.99


L3260 AMBULATORY SURGICAL BOOT EAC 0001 15.42

L3265 PLASTAZOTE SANDAL EACH 0001 17.00

L3650 SO 8 ABD RESTRAINT PRE OTS 0001 58.25

L3660 SO 8 AB RSTR CAN/WEB PRE OTS 0001 89.62

L3670 SO ACRO/CLAV CAN WEB PRE OTS 0001 111.06

L3671 SO CAP DESIGN W/O JNTS CF 0001 644.37

L3674 SO AIRPLANE W/WO JOINT CF SHOUL 0001 949.77

L3675 SO VEST CANVAS/WEB PRE OTS 0001 125.49

L3677 SO HARD PLAS STABILI PRE CST 0001 67.87

L3702 EO W/O JOINTS CF 0001 206.49

L3710 EO ELAS W/METAL JNTS PRE OTS 0001 101.95

L3720 FOREARM/ARM CUFFS FREE MOTIO 0001 642.40

L3730 FOREARM/ARM CUFFS EXT/FLEX A 0001 885.36

L3740 CUFFS ADJ LOCK W/ ACTIVE CON 0001 1049.67

L3760 EO WITHJOINT, PREFABRICATED 0001 357.62

L3762 EO RIGID W/O JOINTS PRE OTS 0001 76.89

L3763 EWHO RIGID W/O JNTS CF 0001 916.94

L3764 EWHO W/JOINT(S) CF 0001 970.98

L3765 EWHFO RIGID W/O JNTS CF 0001 916.94

L3766 EWHFO W/JOINT(S) CF 0001 970.98

L3806 WHFO W/JOINT(S) CUSTOM FAB 0001 365.35

L3807 WHFO W/O JOINTS PRE CST 0001 178.81

L3808 WHFO RIGID W/O JOINTS 0001 365.79

L3900 HINGE EXTENSION/FLEX WRIST/F 0001 1166.95

L3901 HINGE EXT/FLEX WRIST FINGER 0001 1436.40

L3904 WHFO ELECTRIC CUSTOM FITTED 0001 2876.16

L3905 WHO W/NONTORSION JNT(S) CF 0001 709.19

L3906 WHO W/O JOINTS CF 0001 388.08

L3908 WHO COCK-UP NONMOLDE PRE OTS 0001 58.85

L3912 HFO FLEXION GLOVE PRE OTS 0001 93.14

L3913 HFO W/O JOINTS CF 0001 193.69

L3915 WHO NONTORSION JNTS PRE CST 0001 427.53

L3916 Who nontorsion jnts pre ots 0001 115.14

L3917 METACARP FX ORTHOSIS PRE CST 0001 75.54

L3918 Metacarp fx orthosis pre ots 0001 76.97

L3919 HO W/O JOINTS CF 0001 193.69

L3921 HFO W/JOINT(S) CF 0001 229.71

L3923 HFO WITHOUT JOINTS PRE CST 0001 27.82

L3924 Hfo without joints pre ots 0001 97.42

L3925 FO PIP DIP JNT/SPRNG PRE OTS 0001 50.31

L3927 FO PIP DIP NO JT SPR PRE OTS 0001 0.00

L3929 HFO NONTORSION JNTS PRE CST 0001 82.24

L3930 Hfo nontorsion jnts pre ots 0001 53.50

L3931 WHFO nontorsion joint prefab 0001 183.67

L3933 FO W/O JOINTS CF 0001 152.58

L3935 FO NONTORSION JOINT CF 0001 157.98


L3956 ADD JOINT UPPER EXT ORTHOSIS 0001 721.81

L3960 SEWHO AIRPLAN DESIG ABDU POS 0001 721.81

L3961 SEWHO CAP DESIGN W/O JNTS CF 0001 1201.47

L3962 SEWHO ERBS PALSEY DESIGN ABD 0001 704.68

L3967 SEWHO AIRPLANE W/O JNTS CF 0001 1595.45

L3971 SEWHO CAP DESIGN W/JNT(S) CF 0001 1514.45

L3973 SEWHO AIRPLANE W/JNT(S) CF 0001 1418.53

L3975 SEWHFO CAP DESIGN W/O JNT CF 0001 1201.47

L3976 SEWHFO AIRPLANE W/O JNTS CF 0001 1201.47

L3977 SEWHFO CAP DESGN W/JNT(S) CF 0001 1346.51

L3978 SEWHFO AIRPLANE W/JNT(S) CF 0001 1418.53

L3980 UP EXT FX ORTHOS HUMERAL NOS 0001 303.63

L3982 UPPER EXT FX ORTHOSIS RAD/UL 0001 366.65

L3984 UPPER EXT FX ORTHOSIS WRIST 0001 338.05

L3995 SOCK FRACTURE OR EQUAL EACH 0001 28.06

L3999 UPPER LIMB ORTHOSIS NOS 0001 1279.73

L4000 REPL GIRDLE MILWAUKEE ORTH 0001 8.00

L4010 REPLACE TRILATERAL SOCKET BR 0001 673.59

L4020 REPLACE QUADLAT SOCKET BRIM 0001 864.49

L4030 REPLACE SOCKET BRIM CUST FIT 0001 506.74

L4040 REPLACE MOLDED THIGH LACER 0001 409.70

L4045 REPLACE NON-MOLDED THIGH LAC 0001 329.24

L4050 REPLACE MOLDED CALF LACER 0001 414.36

L4055 REPLACE NON-MOLDED CALF LACE 0001 268.31

L4060 REPLACE HIGH ROLL CUFF 0001 318.97

L4070 REPLACE PROX & DIST UPRIGHT 0001 282.46

L4080 REPL MET BAND KAFO-AFO PROX 0001 86.99

L4090 REPL MET BAND KAFO-AFO CALF/ 0001 82.84

L4100 REPL LEATH CUFF KAFO PROX TH 0001 104.69

L4110 REPL LEATH CUFF KAFO-AFO CAL 0001 85.11

L4130 REPLACE PRETIBIAL SHELL 0001 497.96

L4205 ORTHO DVC REPAIR PER 15 MIN 0001 8.00

L4210 ORTH DEV REPAIR/REPL MINOR P 0001 8.00

L4350 ANKLE CONTROL ORTHO PRE OTS 0001 89.72

L4360 PNEUMAT WALKING BOOT PRE CST 0001 243.17

L4370 PNEUM FULL LEG SPLNT PRE OTS 0001 142.11

L4386 NON-PNEUM WALK BOOT PRE CST 0001 124.58

L4392 REPLACE AFO SOFT INTERFACE 0001 18.19

L4394 REPLACE FOOT DROP SPINT 0001 13.25

L4396 STATIC OR DYNAMI AFO PRE CST 0001 129.66

L4398 FOOT DROP SPLINT PRE OTS 0001 59.69

L4631 AFO, WALK BOOT TYPE, CUS FAB ANKLE 0001 1661.65

L5000 SHO INSERT W ARCH TOE FILLER 0001 481.95

L5010 MOLD SOCKET ANK HGT W/ TOE F 0001 1082.00

L5020 TIBIAL TUBERCLE HGT W/ TOE F 0001 2119.07

L5050 ANK SYMES MOLD SCKT SACH FT 0001 2135.36


L5060 SYMES MET FR LEATH SOCKET AR 0001 2953.39

L5100 MOLDED SOCKET SHIN SACH FOOT 0001 2156.06

L5105 PLAST SOCKET JTS/THGH LACER 0001 3714.66

L5150 MOLD SCKT EXT KNEE SHIN SACH 0001 3755.02

L5160 MOLD SOCKET BENT KNEE SHIN S 0001 4084.26

L5200 KNE SING AXIS FRIC SHIN SACH 0001 3218.43

L5210 NO KNEE/ANKLE JOINTS W/ FT B 0001 2374.61

L5220 NO KNEE JOINT WITH ARTIC ALI 0001 2949.37

L5230 FEM FOCAL DEFIC CONSTANT FRI 0001 4067.77

L5250 HIP CANAD SING AXI CONS FRIC 0001 5548.07

L5270 TILT TABLE LOCKING HIP SING 0001 5499.47

L5280 HEMIPELVECT CANAD SING AXIS 0001 5444.47

L5301 BK MOLD SOCKET SACH FT ENDO 0001 0.00

L5321 AK OPEN END SACH 0001 3514.44

L5331 HIP DISART CANADIAN SACH FT 0001 4670.41

L5341 HEMIPELVECTOMY CANADIAN SACH 0001 5404.15

L5400 POSTOP DRESS & 1 CAST CHG BK 0001 1272.55

L5410 POSTOP DSG BK EA ADD CAST CH 0001 335.08

L5420 POSTOP DSG & 1 CAST CHG AK/D 0001 1625.34

L5430 POSTOP DSG AK EA ADD CAST CH 0001 452.99

L5450 POSTOP APP NON-WGT BEAR DSG 0001 326.73

L5460 POSTOP APP NON-WGT BEAR DSG 0001 437.30

L5500 INIT BK PTB PLASTER DIRECT 0001 1367.68

L5505 INIT AK ISCHAL PLSTR DIRECT 0001 1859.84

L5510 PREP BK PTB PLASTER MOLDED 0001 1410.83

L5520 PERP BK PTB THERMOPLS DIRECT 0001 1536.75

L5530 PREP BK PTB THERMOPLS MOLDED 0001 1846.92

L5535 PREP BK PTB OPEN END SOCKET 0001 1813.31

L5540 PREP BK PTB LAMINATED SOCKET 0001 1934.10

L5560 PREP AK ISCHIAL PLAST MOLDED 0001 1885.32

L5570 PREP AK ISCHIAL DIRECT FORM 0001 2066.95

L5580 PREP AK ISCHIAL THERMO MOLD 0001 2508.74

L5585 PREP AK ISCHIAL OPEN END 0001 2221.79

L5590 PREP AK ISCHIAL LAMINATED 0001 2570.51

L5595 HIP DISARTIC SACH THERMOPLS 0001 4305.50

L5600 HIP DISART SACH LAMINAT MOLD 0001 4754.56

L5610 ABOVE KNEE HYDRACADENCE 0001 1965.23

L5611 AK 4 BAR LINK W/FRIC SWING 0001 1589.32

L5613 AK 4 BAR LING W/HYDRAUL SWIG 0001 2620.51

L5614 4-BAR LINK ABOVE KNEE W/SWNG 0001 1328.51

L5616 AK UNIV MULTIPLEX SYS FRICT 0001 1131.75

L5617 AK/BK SELF-ALIGNING UNIT EA 0001 440.50

L5618 TEST SOCKET SYMES 0001 231.58

L5620 TEST SOCKET BELOW KNEE 0001 234.56

L5622 TEST SOCKET KNEE DISARTICULA 0001 304.02

L5624 TEST SOCKET ABOVE KNEE 0001 333.46


L5626 TEST SOCKET HIP DISARTICULAT 0001 438.06

L5628 TEST SOCKET HEMIPELVECTOMY 0001 387.67

L5629 BELOW KNEE ACRYLIC SOCKET 0001 254.87

L5630 SYME TYP EXPANDABL WALL SCKT 0001 441.86

L5631 AK/KNEE DISARTIC ACRYLIC SOC 0001 352.37

L5632 SYMES TYPE PTB BRIM DESIGN S 0001 189.51

L5634 SYMES TYPE POSTER OPENING SO 0001 325.26

L5636 SYMES TYPE MEDIAL OPENING SO 0001 204.34

L5637 BELOW KNEE TOTAL CONTACT 0001 307.69

L5638 BELOW KNEE LEATHER SOCKET 0001 520.39

L5639 BELOW KNEE WOOD SOCKET 0001 1198.87

L5640 KNEE DISARTICULAT LEATHER SO 0001 622.22

L5642 ABOVE KNEE LEATHER SOCKET 0001 496.87

L5643 HIP FLEX INNER SOCKET EXT FR 0001 1248.22

L5644 ABOVE KNEE WOOD SOCKET 0001 473.68

L5645 BK FLEX INNER SOCKET EXT FRA 0001 724.32

L5646 BELOW KNEE CUSHION SOCKET 0001 439.41

L5647 BELOW KNEE SUCTION SOCKET 0001 850.58

L5648 ABOVE KNEE CUSHION SOCKET 0001 528.00

L5649 ISCH CONTAINMT/NARROW M-L SO 0001 1536.84

L5650 TOT CONTACT AK/KNEE DISART S 0001 522.01

L5651 AK FLEX INNER SOCKET EXT FRA 0001 963.10

L5652 SUCTION SUSP AK/KNEE DISART 0001 349.64

L5653 KNEE DISART EXPAND WALL SOCK 0001 522.47

L5654 SOCKET INSERT SYMES 0001 326.77

L5655 SOCKET INSERT BELOW KNEE 0001 283.62

L5656 SOCKET INSERT KNEE ARTICULAT 0001 396.66

L5658 SOCKET INSERT ABOVE KNEE 0001 301.88

L5661 MULTI-DUROMETER SYMES 0001 603.22

L5665 MULTI-DUROMETER BELOW KNEE 0001 547.51

L5666 BELOW KNEE CUFF SUSPENSION 0001 74.85

L5668 BK MOLDED DISTAL CUSHION 0001 107.98

L5670 BK MOLDED SUPRACONDYLAR SUSP 0001 290.15

L5671 BK/AK LOCKING MECHANISM 0001 531.87

L5672 BK REMOVABLE MEDIAL BRIM SUS 0001 252.77

L5673 SOCKET INSERT W LOCK MECH 0001 628.41

L5676 BK KNEE JOINTS SINGLE AXIS P 0001 387.48

L5677 BK KNEE JOINTS POLYCENTRIC P 0001 527.22

L5678 BK JOINT COVERS PAIR 0001 42.46

L5679 SOCKET INSERT W/O LOCK MECH 0001 523.67

L5680 BK THIGH LACER NON-MOLDED 0001 255.75

L5681 INTL CUSTM CONG/LATYP INSERT 0001 1035.59

L5682 BK THIGH LACER GLUT/ISCHIA M 0001 668.73

L5683 INITIAL CUSTOM SOCKET INSERT 0001 1035.59

L5684 BK FORK STRAP 0001 51.46

L5686 BK BACK CHECK 0001 49.79


L5688 BK WAIST BELT WEBBING 0001 65.31

L5690 BK WAIST BELT PADDED AND LIN 0001 104.63

L5692 AK PELVIC CONTROL BELT LIGHT 0001 142.08

L5694 AK PELVIC CONTROL BELT PAD/L 0001 193.98

L5695 AK SLEEVE SUSP NEOPRENE/EQUA 0001 174.38

L5696 AK/KNEE DISARTIC PELVIC JOIN 0001 197.84

L5697 AK/KNEE DISARTIC PELVIC BAND 0001 85.84

L5698 AK/KNEE DISARTIC SILESIAN BA 0001 110.02

L5699 SHOULDER HARNESS 0001 199.37

L5700 REPLACE SOCKET BELOW KNEE 0001 2928.30

L5701 REPLACE SOCKET ABOVE KNEE 0001 3635.72

L5702 REPLACE SOCKET HIP 0001 4645.70

L5703 SYMES ANKLE W/O (SACH) FOOT 0001 1930.50

L5704 CUSTOM SHAPE COVER BK 0001 489.05

L5705 CUSTOM SHAPE COVER AK 0001 802.86

L5706 CUSTOM SHAPE CVR KNEE DISART 0001 795.73

L5707 CUSTOM SHAPE CVR HIP DISART 0001 1131.18

L5710 KNE-SHIN EXO SNG AXI MNL LOC 0001 384.58

L5711 KNEE-SHIN EXO MNL LOCK ULTRA 0001 558.34

L5712 KNEE-SHIN EXO FRICT SWG & ST 0001 460.75

L5714 KNEE-SHIN EXO VARIABLE FRICT 0001 400.43

L5716 KNEE-SHIN EXO MECH STANCE PH 0001 779.34

L5718 KNEE-SHIN EXO FRCT SWG & STA 0001 974.09

L5722 KNEE-SHIN PNEUM SWG FRCT EXO 0001 870.17

L5724 KNEE-SHIN EXO FLUID SWING PH 0001 1546.65

L5726 KNEE-SHIN EXT JNTS FLD SWG E 0001 1581.69

L5728 KNEE-SHIN FLUID SWG & STANCE 0001 2544.37

L5780 KNEE-SHIN PNEUM/HYDRA PNEUM 0001 1224.24

L5781 LOWER LIMB PROS VACUUM PUMP 0001 3150.08

L5785 EXOSKELETAL BK ULTRALT MATER 0001 440.52

L5790 EXOSKELETAL AK ULTRA-LIGHT M 0001 709.25

L5795 EXOSKEL HIP ULTRA-LIGHT MATE 0001 894.98

L5810 ENDOSKEL KNEE-SHIN MNL LOCK 0001 520.60

L5811 ENDO KNEE-SHIN MNL LCK ULTRA 0001 779.85

L5812 ENDO KNEE-SHIN FRCT SWG & ST 0001 604.46

L5814 ENDO KNEE-SHIN HYDRAL SWG PH 0001 2923.91

L5816 ENDO KNEE-SHIN POLYC MCH STA 0001 909.37

L5818 ENDO KNEE-SHIN FRCT SWG & ST 0001 1026.87

L5822 ENDO KNEE-SHIN PNEUM SWG FRC 0001 1365.67

L5824 ENDO KNEE-SHIN FLUID SWING P 0001 1639.82

L5826 MINIATURE KNEE JOINT 0001 2458.64

L5828 ENDO KNEE-SHIN FLUID SWG/STA 0001 2933.64

L5830 ENDO KNEE-SHIN PNEUM/SWG PHA 0001 2029.01

L5840 MULTI-AXIAL KNEE/SHIN SYSTEM 0001 3236.89

L5845 KNEE-SHIN SYS STANCE FLEXION 0001 1411.11

L5848 KNEE-SHIN SYS HYDRAUL STANCE 0001 846.60


L5850 ENDO AK/HIP KNEE EXTENS ASSI 0001 102.59

L5855 MECH HIP EXTENSION ASSIST 0001 330.23

L5858 STANCE PHASE ONLY 0001 14631.97

L5910 ENDO BELOW KNEE ALIGNABLE SY 0001 290.45

L5920 ENDO AK/HIP ALIGNABLE SYSTEM 0001 425.51

L5925 ABOVE KNEE MANUAL LOCK 0001 349.76

L5930 HIGH ACTIVITY KNEE FRAME 0001 2649.95

L5940 ENDO BK ULTRA-LIGHT MATERIAL 0001 427.54

L5950 ENDO AK ULTRA-LIGHT MATERIAL 0001 623.94

L5960 ENDO HIP ULTRA-LIGHT MATERIA 0001 773.13

L5961 ENDO POLY HIP, PNEU/HYD/ROT ADDIT 0001 0.00

L5962 BELOW KNEE FLEX COVER SYSTEM 0001 628.52

L5964 ABOVE KNEE FLEX COVER SYSTEM 0001 904.80

L5966 HIP FLEXIBLE COVER SYSTEM 0001 1173.04

L5968 MULTIAXIAL ANKLE W DORSIFLEX 0001 2860.96

L5970 FOOT EXTERNAL KEEL SACH FOOT 0001 204.90

L5971 SACH FOOT, REPLACEMENT 0001 204.90

L5972 FLEXIBLE KEEL FOOT 0001 376.85

L5974 FOOT SINGLE AXIS ANKLE/FOOT 0001 249.17

L5975 COMBO ANKLE/FOOT PROSTHESIS 0001 364.98

L5976 ENERGY STORING FOOT 0001 598.83

L5978 FT PROSTH MULTIAXIAL ANKL/FT 0001 312.05

L5979 MULTI-AXIAL ANKLE/FT PROSTH 0001 2417.33

L5980 FLEX FOOT SYSTEM 0001 3384.57

L5981 FLEX-WALK SYS LOW EXT PROSTH 0001 2626.94

L5982 EXOSKELETAL AXIAL ROTATION U 0001 618.17

L5984 ENDOSKELETAL AXIAL ROTATION 0001 609.15

L5985 LWR EXT DYNAMIC PROSTH PYLON 0001 222.32

L5986 MULTI-AXIAL ROTATION UNIT 0001 677.59

L5987 SHANK FT W VERT LOAD PYLON 0001 5663.57

L5988 VERTICAL SHOCK REDUCING PYLO 0001 1572.78

L5990 USER ADJUSTABLE HEEL HEIGHT 0001 1428.31

L5999 LOWR EXTREMITY PROSTHES NOS 0001 1420.76

L6010 PART HAND LITTLE/RING 0001 1581.07

L6020 PART HAND NO FINGERS 0001 1474.10

L6050 WRST MLD SCK FLX HNG TRI PAD 0001 2024.81

L6055 WRST MOLD SOCK W/EXP INTERFA 0001 2596.73

L6100 ELB MOLD SOCK FLEX HINGE PAD 0001 1685.00

L6110 ELBOW MOLD SOCK SUSPENSION T 0001 2182.18

L6120 ELBOW MOLD DOUB SPLT SOC STE 0001 2477.81

L6130 ELBOW STUMP ACTIVATED LOCK H 0001 2768.09

L6200 ELBOW MOLD OUTSID LOCK HINGE 0001 2917.12

L6205 ELBOW MOLDED W/ EXPAND INTER 0001 3560.93

L6250 ELBOW INTER LOC ELBOW FORARM 0001 2871.42

L6300 SHLDER DISART INT LOCK ELBOW 0001 3983.78

L6310 SHOULDER PASSIVE RESTOR COMP 0001 3244.87


L6320 SHOULDER PASSIVE RESTOR CAP 0001 1827.35

L6350 THORACIC INTERN LOCK ELBOW 0001 4156.76

L6360 THORACIC PASSIVE RESTOR COMP 0001 3405.88

L6370 THORACIC PASSIVE RESTOR CAP 0001 2171.81

L6380 POSTOP DSG CAST CHG WRST/ELB 0001 1037.38

L6382 POSTOP DSG CAST CHG ELB DIS/ 0001 1305.03

L6384 POSTOP DSG CAST CHG SHLDER/T 0001 1692.25

L6386 POSTOP EA CAST CHG & REALIGN 0001 429.41

L6388 POSTOP APPLICAT RIGID DSG ON 0001 438.41

L6400 BELOW ELBOW PROSTH TISS SHAP 0001 2481.18

L6450 ELB DISART PROSTH TISS SHAP 0001 3024.44

L6500 ABOVE ELBOW PROSTH TISS SHAP 0001 2749.48

L6550 SHLDR DISAR PROSTH TISS SHAP 0001 4077.47

L6570 SCAP THORAC PROSTH TISS SHAP 0001 4680.15

L6580 WRIST/ELBOW BOWDEN CABLE MOL 0001 1433.23

L6582 WRIST/ELBOW BOWDEN CBL DIR F 0001 1103.75

L6584 ELBOW FAIR LEAD CABLE MOLDED 0001 1791.95

L6586 ELBOW FAIR LEAD CABLE DIR FO 0001 1524.30

L6588 SHDR FAIR LEAD CABLE MOLDED 0001 2593.27

L6590 SHDR FAIR LEAD CABLE DIRECT 0001 2278.38

L6600 POLYCENTRIC HINGE PAIR 0001 200.57

L6605 SINGLE PIVOT HINGE PAIR 0001 198.05

L6610 FLEXIBLE METAL HINGE PAIR 0001 178.02

L6611 ADDITIONAL SWITCH EXT POWER 0001 364.58

L6615 DISCONNECT LOCKING WRIST UNI 0001 146.93

L6616 DISCONNECT INSERT LOCKING WR 0001 52.02

L6620 FLEXION/EXTENSION WRIST UNIT 0001 306.47

L6621 FLEX/EXT WRIST W/WO FRICTION 0001 1800.78

L6623 SPRING-ASS ROT WRST W/ LATCH 0001 514.43

L6624 FLEX/EXT/ROTATION WRIST UNIT 0001 3334.81

L6625 ROTATION WRST W/ CABLE LOCK 0001 568.71

L6628 QUICK DISCONN HOOK ADAPTER O 0001 384.18

L6629 LAMINATION COLLAR W/ COUPLIN 0001 140.43

L6630 STAINLESS STEEL ANY WRIST 0001 172.84

L6632 LATEX SUSPENSION SLEEVE EACH 0001 52.10

L6635 LIFT ASSIST FOR ELBOW 0001 188.33

L6637 NUDGE CONTROL ELBOW LOCK 0001 343.89

L6638 ELEC LOCK ON MANUAL PW ELBOW 0001 1968.81

L6640 SHOULDER ABDUCTION JOINT PAI 0001 224.64

L6641 EXCURSION AMPLIFIER PULLEY T 0001 161.11

L6642 EXCURSION AMPLIFIER LEVER TY 0001 208.95

L6645 SHOULDER FLEXION-ABDUCTION J 0001 341.35

L6646 MULTIPO LOCKING SHOULDER JNT 0001 2483.11

L6647 SHOULDER LOCK ACTUATOR 0001 408.79

L6648 EXT PWRD SHLDER LOCK/UNLOCK 0001 2560.98

L6650 SHOULDER UNIVERSAL JOINT 0001 361.94


L6655 STANDARD CONTROL CABLE EXTRA 0001 80.32

L6660 HEAVY DUTY CONTROL CABLE 0001 98.15

L6665 TEFLON OR EQUAL CABLE LINING 0001 39.77

L6670 HOOK TO HAND CABLE ADAPTER 0001 51.28

L6672 HARNESS CHEST/SHLDER SADDLE 0001 180.30

L6675 HARNESS FIGURE OF 8 SING CON 0001 122.42

L6676 HARNESS FIGURE OF 8 DUAL CON 0001 129.68

L6677 UE TRIPLE CONTROL HARNESS 0001 233.54

L6680 TEST SOCK WRIST DISART/BEL E 0001 248.09

L6682 TEST SOCK ELBW DISART/ABOVE 0001 247.03

L6684 TEST SOCKET SHLDR DISART/THO 0001 372.73

L6686 SUCTION SOCKET 0001 631.27

L6687 FRAME TYP SOCKET BEL ELBOW/W 0001 467.87

L6688 FRAME TYP SOCK ABOVE ELB/DIS 0001 506.84

L6689 FRAME TYP SOCKET SHOULDER DI 0001 577.97

L6690 FRAME TYP SOCK INTERSCAP-THO 0001 669.54

L6691 REMOVABLE INSERT EACH 0001 368.41

L6692 SILICONE GEL INSERT OR EQUAL 0001 597.98

L6693 LOCKINGELBOW FOREARM CNTRBAL 0001 2235.13

L6703 TERM DEV PASSIVE HAND MITT 0001 300.62

L6704 TERM DEV SPORT/REC/WORK ATT 0001 653.14

L6706 TERM DEV MECH HOOK VOL OPEN 0001 360.99

L6707 TERM DEV MECH HOOK VOL CLOSE 0001 1378.40

L6708 TERM DEV MECH HAND VOL OPEN 0001 932.88

L6709 TERM DEV MECH HAND VOL CLOSE 0001 1351.18

L6711 PED TERM DEV, HOOK, VOL OPEN 0001 595.33

L6712 PED TERM DEV, HOOK, VOL CLOS 0001 1096.10

L6713 PED TERM DEV, HAND, VOL OPEN 0001 1383.40

L6714 PED TERM DEV, HAND, VOL CLOS 0001 1171.74

L6715 "Term device multi art digit" 0001 342.54

L6721 HOOK/HAND, HVY DTY, VOL OPEN 0001 2082.62

L6722 HOOK/HAND, HVY DTY, VOL CLOS 0001 1795.38

L6805 TERM DEV MODIFIER WRIST UNIT 0001 339.57

L6810 TERM DEV PRECISION PINCH DEV 0001 174.55

L6880 Elec hand ind art digits 0001 494.41

L6881 TERM DEV AUTO GRASP FEATURE 0001 3218.65

L6882 MICROPROCESSOR CONTROL UPLMB 0001 2441.49

L6883 REPLC SOCKT BELOW E/W DISA 0001 1378.59

L6884 REPLC SOCKT ABOVE ELBOW DISA 0001 2387.21

L6885 REPLC SOCKT SHLDR DIS/INTERC 0001 3405.88

L6890 PREFAB GLOVE FOR TERM DEVICE 0001 181.87

L6895 CUSTOM GLOVE FOR TERM DEVICE 0001 447.81

L6900 HAND RESTORAT THUMB/1 FINGER 0001 1608.83

L6905 HAND RESTORATION MULTIPLE FI 0001 1569.94

L6910 HAND RESTORATION NO FINGERS 0001 1529.45

L6915 HAND RESTORATION REPLACMNT G 0001 647.52


L7360 SIX VOLT BAT OTTO BOCK/EQ EA 0001 194.82

L7362 BATTERY CHRGR SIX VOLT OTTO 0001 207.03

L7364 TWELVE VOLT BATTERY UTAH/EQU 0001 380.92

L7366 BATTERY CHRGR 12 VOLT UTAH/E 0001 492.16

L7367 REPLACEMNT LITHIUM IONBATTER 0001 306.51

L7368 LITHIUM ION BATTERY CHARGER 0001 397.34

L7400 ADD UE PROST BE/WD, ULTLITE 0001 241.29

L7401 ADD UE PROST A/E ULTLITE MAT 0001 270.12

L7402 ADD UE PROST S/D ULTLITE MAT 0001 291.72

L7403 ADD UE PROST B/E ACRYLIC 0001 289.93

L7404 ADD UE PROST A/E ACRYLIC 0001 437.58

L7405 ADD UE PROST S/D ACRYLIC 0001 572.30

L7499 UPPER EXTREMITY PROSTHES NOS 0001 426.30

L7510 PROSTHETIC DEVICE REPAIR REP 0001 8.00

L7520 REPAIR PROSTHESIS PER 15 MIN 0001 8.00

L7600 PROSTHETIC DONNING SLEEVE 0001 0.00

L8000 MASTECTOMY BRA 0001 39.04

L8001 BREAST PROSTHESIS BRA & FORM 0001 98.74

L8002 BRST PRSTH BRA & BILAT FORM 0001 129.88

L8010 MASTECTOMY SLEEVE 0001 47.19

L8015 EXT BREASTPROSTHESIS GARMENT 0001 47.19

L8020 MASTECTOMY FORM 0001 167.64

L8030 BREAST PROSTHES W/O ADHESIVE 0001 306.28

L8035 CUSTOM BREAST PROSTHESIS 0001 2884.35

L8039 BREAST PROSTHESIS NOS 0001 0.00

L8040 NASAL PROSTHESIS 0001 2062.29

L8041 MIDFACIAL PROSTHESIS 0001 2485.87

L8042 ORBITAL PROSTHESIS 0001 2793.11

L8043 UPPER FACIAL PROSTHESIS 0001 3128.29

L8044 HEMI-FACIAL PROSTHESIS 0001 3463.45

L8045 AURICULAR PROSTHESIS 0001 2176.85

L8046 PARTIAL FACIAL PROSTHESIS 0001 2234.49

L8047 NASAL SEPTAL PROSTHESIS 0001 1145.16

L8049 REPAIR MAXILLOFACIAL PROSTH 0001 8.00

L8300 TRUSS SINGLE W/ STANDARD PAD 0001 90.20

L8310 TRUSS DOUBLE W/ STANDARD PAD 0001 142.41

L8320 TRUSS ADDITION TO STD PAD WA 0001 57.16

L8330 TRUSS ADD TO STD PAD SCROTAL 0001 52.79

L8400 SHEATH BELOW KNEE 0001 16.83

L8410 SHEATH ABOVE KNEE 0001 21.72

L8415 SHEATH UPPER LIMB 0001 19.20

L8417 PROS SHEATH/SOCK W GEL CUSHN 0001 59.20

L8420 PROSTHETIC SOCK MULTI PLY BK 0001 20.80

L8430 PROSTHETIC SOCK MULTI PLY AK 0001 22.32

L8435 PROS SOCK MULTI PLY UPPER LM 0001 20.72

L8440 SHRINKER BELOW KNEE 0001 44.72


L8460 SHRINKER ABOVE KNEE 0001 71.27

L8465 SHRINKER UPPER LIMB 0001 39.12

L8470 PROS SOCK SINGLE PLY BK 0001 7.14

L8480 PROS SOCK SINGLE PLY AK 0001 8.51

L8485 PROS SOCK SINGLE PLY UPPER L 0001 11.53

L8499 UNLISTED MISC PROSTHETIC SER 0001 0.00

L8500 ARTIFICIAL LARYNX 0001 529.27

L8501 TRACHEOSTOMY SPEAKING VALVE 0001 96.88

L8507 TRACH-ESOPH VOICE PROS PT IN 0001 32.98

L8509 TRACH-ESOPH VOICE PROS MD IN 0001 85.98

L8600 IMPLANT BREAST SILICONE/EQ 0001 545.82

L8603 COLLAGEN IMP URINARY 2.5 ML 0001 351.66

L8604 DEXTRANMER/HYALURONIC ACID 0001 0.00

L8606 SYNTHETIC IMPLNT URINARY 1ML 0001 182.61

L8610 OCULAR IMPLANT 0001 469.40

L8612 AQUEOUS SHUNT PROSTHESIS 0001 638.02

L8613 OSSICULAR IMPLANT 0001 236.84

L8614 COCHLEAR DEVICE 0001 15819.35

L8619 COCH IMP EXT PROC/CONTR RPLC 0001 6791.15

L8627 CID EXT SPEECH PROCESS REPL 0001 6487.90

L8628 CID EXT CONTROLLER REPL 0001 1150.21

L8629 CID TRANSMIT COIL AND CABLE 0001 0.00

L8630 METACARPOPHALANGEAL IMPLANT 0001 270.19

L8641 METATARSAL JOINT IMPLANT 0001 283.93

L8642 HALLUX IMPLANT 0001 277.80

L8658 INTERPHALANGEAL JOINT SPACER 0001 244.76

L8670 VASCULAR GRAFT, SYNTHETIC 0001 446.41

L8690 AUD OSSEO DEV INT/EXT COMP 0001 3748.14

L8691 OSSEOINTEGRATED SND PROC RPL 0001 2100.96

L8692 NON-OSSEOINTEGRATED SND PROC 0001 0.00

L8693 AUD OSSEO DEV, ABUTMENT AUDIT 0001 1341.32

L8695 EXTERNAL RECHARG SYS EXTERN 0001 13.67

L9900 O&P SUPPLY/ACCESSORY/SERVICE 0001 0.00

Q0081 INFUSION THER OTHER THAN CHE 0001 52.83

Q0084 CHEMOTHERAPY BY INFUSION 0001 166.41

Q0091 OBTAINING SCREEN PAP SMEAR 0001 19.74

Q2034 AGRIFLU VACCINE 0001 0.00

Q3001 BRACHYTHERAPY RADIOELEMENTS 0001 47.57

Q3014 TELEHEALTH FACILITY FEE 0001 24.24

Q4001 CAST SUP BODY CAST PLASTER 0001 161.73

Q4002 CAST SUP BODY CAST FIBERGLAS 0001 343.60

Q4003 CAST SUP SHOULDER CAST PLSTR 0001 87.70

Q4004 CAST SUP SHOULDER CAST FBRGL 0001 186.17

Q4005 CAST SUP LONG ARM ADULT PLST 0001 48.16

Q4006 CAST SUP LONG ARM ADULT FBRG 0001 102.43

Q4007 CAST SUP LONG ARM PED PLSTER 0001 24.08


Q4008 CAST SUP LONG ARM PED FBRGLS 0001 51.04

Q4009 CAST SUP SHT ARM ADULT PLSTR 0001 37.02

Q4010 CAST SUP SHT ARM ADULT FBRGL 0001 79.43

Q4011 CAST SUP SHT ARM PED PLASTER 0001 18.69

Q4012 CAST SUP SHT ARM PED FBRGLAS 0001 39.54

Q4013 CAST SUP GAUNTLET PLASTER 0001 34.86

Q4014 CAST SUP GAUNTLET FIBERGLASS 0001 74.76

Q4015 CAST SUP GAUNTLET PED PLSTER 0001 17.61

Q4016 CAST SUP GAUNTLET PED FBRGLS 0001 37.38

Q4017 CAST SUP LNG ARM SPLINT PLST 0001 30.55

Q4018 CAST SUP LNG ARM SPLINT FBRG 0001 65.05

Q4019 CAST SUP LNG ARM SPLNT PED P 0001 15.45

Q4020 CAST SUP LNG ARM SPLNT PED F 0001 32.71

Q4021 CAST SUP SHT ARM SPLINT PLST 0001 30.55

Q4022 CAST SUP SHT ARM SPLINT FBRG 0001 65.05

Q4023 CAST SUP SHT ARM SPLNT PED P 0001 15.45

Q4024 CAST SUP SHT ARM SPLNT PED F 0001 32.71

Q4025 CAST SUP HIP SPICA PLASTER 0001 135.86

Q4026 CAST SUP HIP SPICA FIBERGLAS 0001 288.97

Q4027 CAST SUP HIP SPICA PED PLSTR 0001 67.93

Q4028 CAST SUP HIP SPICA PED FBRGL 0001 144.48

Q4029 CAST SUP LONG LEG PLASTER 0001 66.85

Q4030 CAST SUP LONG LEG FIBERGLASS 0001 142.33

Q4031 CAST SUP LNG LEG PED PLASTER 0001 33.43

Q4032 CAST SUP LNG LEG PED FBRGLS 0001 71.16

Q4033 CAST SUP LNG LEG CYLINDER PL 0001 57.15

Q4034 CAST SUP LNG LEG CYLINDER FB 0001 121.12

Q4035 CAST SUP LNGLEG CYLNDR PED P 0001 28.39

Q4036 CAST SUP LNGLEG CYLNDR PED F 0001 60.38

Q4037 CAST SUP SHRT LEG PLASTER 0001 76.55

Q4038 CAST SUP SHRT LEG FIBERGLASS 0001 163.17

Q4039 CAST SUP SHRT LEG PED PLSTER 0001 38.10

Q4040 CAST SUP SHRT LEG PED FBRGLS 0001 81.59

Q4041 CAST SUP LNG LEG SPLNT PLSTR 0001 43.85

Q4042 CAST SUP LNG LEG SPLNT FBRGL 0001 93.09

Q4043 CAST SUP LNG LEG SPLNT PED P 0001 21.92

Q4044 CAST SUP LNG LEG SPLNT PED F 0001 46.72

Q4045 CAST SUP SHT LEG SPLNT PLSTR 0001 28.39

Q4046 CAST SUP SHT LEG SPLNT FBRGL 0001 60.38

Q4047 CAST SUP SHT LEG SPLNT PED P 0001 14.02

Q4048 CAST SUP SHT LEG SPLNT PED F 0001 30.19

Q4049 FINGER SPLINT, STATIC 0001 37.38

Q4050 CAST SUPPLIES UNLISTED 0001 0.00

Q4051 SPLINT SUPPLIES MISC 0001 0.00

Q4101 APLIGRAF 0001 31.39

Q4102 OASIS WOUND MATRIX 0001 4.35


Q4105 INTEGRA DRT 0001 11.87

Q4106 DERMAGRAFT 0001 38.45

Q4116 ALLODERM 0001 34.30

Q4141 Alloskin ac 1 cm 0001 0.00

Q9951 LOCM >= 400 MG/ML IODINE,1ML 0001 0.55

Q9953 INJ FE-BASED MR CONTRAST,1ML 0001 10.73

Q9954 ORAL MR CONTRAST, 100 ML 0001 10.35

Q9955 INJ PERFLEXANE LIP MICROS,ML 0001 55.27

Q9956 INJ OCTAFLUOROPROPANE MIC,ML 0001 47.89

Q9957 INJ PERFLUTREN LIP MICROS,ML 0001 81.10

Q9958 HOCM <=149 MG/ML IODINE, 1ML 0001 0.37

Q9959 HOCM 150-199MG/ML IODINE,1ML 0001 0.38





Q9964 HOCM>= 400MG/ML IODINE, 1ML 0001 0.72

Q9965 LOCM 100-199MG/ML IODINE,1ML 0001 1.74



S0199 MED ABORTION INC ALL EX DRUG 0001 270.00

S2118 TOTAL HIP RESURFACING 0001 0.00

S2225 MYRINGOTOMY LASER-ASSIST 0001 0.00

S2235 IMPLANT AUDITORY BRAIN IMP 0001 518.00

S3000 BILAT DIL RETINAL EXAM 0001 0.00

S9455 DIABETIC MANAGEMENT PROGRAM, 0001 32.60

S9465 DIABETIC MANAGEMENT PROGRAM, 0001 55.42

T2003 N-ET; ENCOUNTER/TRIP 0001 51.25

V2020 VISION SVCS FRAMES PURCHASES 0001 67.05

V2100 LENS SPHER SINGLE PLANO 4.00 0001 31.41

V2101 SINGLE VISN SPHERE 4.12-7.00 0001 42.10

V2102 SINGL VISN SPHERE 7.12-20.00 0001 51.06

V2103 SPHEROCYLINDR 4.00D/12-2.00D 0001 29.99

V2104 SPHEROCYLINDR 4.00D/2.12-4D 0001 31.73

V2105 SPHEROCYLINDER 4.00D/4.25-6D 0001 34.80

V2106 SPHEROCYLINDER 4.00D/>6.00D 0001 41.65

V2107 SPHEROCYLINDER 4.25D/12-2D 0001 44.81



V2110 SPHEROCYLINDER 4.25D/OVER 6D 0001 41.01

V2111 SPHEROCYLINDR 7.25D/.25-2.25 0001 48.35



V2114 SPHEROCYLINDER OVER 12.00D 0001 54.51

V2115 LENS LENTICULAR BIFOCAL 0001 75.95

V2116 NONASPHERIC LENS BIFOCAL 0001 70.32


V2117 ASPHERIC LENS BIFOCAL 0001 81.75

V2118 LENS ANISEIKONIC SINGLE 0001 75.83

V2121 LENTICULAR LENS, SINGLE 0001 80.96

V2199 LENS SINGLE VISION NOT OTH C 0001 0.00

V2200 LENS SPHER BIFOC PLANO 4.00D 0001 46.95

V2201 LENS SPHERE BIFOCAL 4.12-7.0 0001 57.14

V2202 LENS SPHERE BIFOCAL 7.12-20. 0001 52.73

V2203 LENS SPHCYL BIFOCAL 4.00D/.1 0001 51.06

V2204 LENS SPHCY BIFOCAL 4.00D/2.1 0001 51.82

V2205 LENS SPHCY BIFOCAL 4.00D/4.2 0001 51.18

V2206 LENS SPHCY BIFOCAL 4.00D/OVE 0001 57.49

V2207 LENS SPHCY BIFOCAL 4.25-7D/. 0001 55.83

V2208 LENS SPHCY BIFOCAL 4.25-7/2. 0001 61.50

V2209 LENS SPHCY BIFOCAL 4.25-7/4. 0001 57.70

V2210 LENS SPHCY BIFOCAL 4.25-7/OV 0001 61.54

V2211 LENS SPHCY BIFO 7.25-12/.25- 0001 74.75

V2212 LENS SPHCYL BIFO 7.25-12/2.2 0001 70.16

V2213 LENS SPHCYL BIFO 7.25-12/4.2 0001 65.35

V2214 LENS SPHCYL BIFOCAL OVER 12. 0001 73.91

V2215 LENS LENTICULAR BIFOCAL 0001 90.89

V2216 LENS LENTICULAR NONASPHERIC 0001 98.43

V2217 LENS LENTICULAR ASPHERIC BIF 0001 93.02

V2218 LENS ANISEIKONIC BIFOCAL 0001 87.26

V2219 LENS BIFOCAL SEG WIDTH OVER 0001 35.71

V2220 LENS BIFOCAL ADD OVER 3.25D 0001 33.75

V2221 LENTICULAR LENS, BIFOCAL 0001 94.45

V2299 LENS BIFOCAL SPECIALITY 0001 0.00

V2300 LENS SPHERE TRIFOCAL 4.00D 0001 58.10

V2301 LENS SPHERE TRIFOCAL 4.12-7. 0001 71.51

V2302 LENS SPHERE TRIFOCAL 7.12-20 0001 65.76

V2303 LENS SPHCY TRIFOCAL 4.0/.12- 0001 62.65

V2304 LENS SPHCY TRIFOCAL 4.0/2.25 0001 65.01

V2305 LENS SPHCY TRIFOCAL 4.0/4.25 0001 65.19

V2306 LENS SPHCYL TRIFOCAL 4.00/>6 0001 65.73

V2307 LENS SPHCY TRIFOCAL 4.25-7/. 0001 70.40

V2308 LENS SPHC TRIFOCAL 4.25-7/2. 0001 68.68

V2309 LENS SPHC TRIFOCAL 4.25-7/4. 0001 83.14

V2310 LENS SPHC TRIFOCAL 4.25-7/>6 0001 70.23

V2311 LENS SPHC TRIFO 7.25-12/.25- 0001 85.98

V2312 LENS SPHC TRIFO 7.25-12/2.25 0001 95.82

V2313 LENS SPHC TRIFO 7.25-12/4.25 0001 107.01

V2314 LENS SPHCYL TRIFOCAL OVER 12 0001 99.33

V2315 LENS LENTICULAR TRIFOCAL 0001 123.23

V2316 LENS LENTICULAR NONASPHERIC 0001 119.62

V2317 LENS LENTICULAR ASPHERIC TRI 0001 114.40

V2318 LENS ANISEIKONIC TRIFOCAL 0001 156.85


V2319 LENS TRIFOCAL SEG WIDTH > 28 0001 39.82

V2320 LENS TRIFOCAL ADD OVER 3.25D 0001 42.02

V2321 LENTICULAR LENS, TRIFOCAL 0001 116.92

V2399 LENS TRIFOCAL SPECIALITY 0001 0.00

V2410 LENS VARIAB ASPHERICITY SING 0001 95.88

V2430 LENS VARIABLE ASPHERICITY BI 0001 115.55

V2499 VARIABLE ASPHERICITY LENS 0001 0.00

V2500 CONTACT LENS PMMA SPHERICAL 0001 70.52

V2501 CNTCT LENS PMMA-TORIC/PRISM 0001 110.91

V2502 CONTACT LENS PMMA BIFOCAL 0001 162.28

V2503 CNTCT LENS PMMA COLOR VISION 0001 112.65

V2510 CNTCT GAS PERMEABLE SPHERICL 0001 94.80

V2511 CNTCT TORIC PRISM BALLAST 0001 153.22

V2512 CNTCT LENS GAS PERMBL BIFOCL 0001 177.88

V2513 CONTACT LENS EXTENDED WEAR 0001 163.20

V2520 CONTACT LENS HYDROPHILIC 0001 83.64

V2521 CNTCT LENS HYDROPHILIC TORIC 0001 145.61

V2522 CNTCT LENS HYDROPHIL BIFOCL 0001 188.95

V2523 CNTCT LENS HYDROPHIL EXTEND 0001 120.76

V2530 CONTACT LENS GAS IMPERMEABLE 0001 178.86

V2531 CONTACT LENS GAS PERMEABLE 0001 426.30

V2599 CONTACT LENS/ES OTHER TYPE 0001 0.00

V2600 HAND HELD LOW VISION AIDS 0001 0.00

V2610 SINGLE LENS SPECTACLE MOUNT 0001 0.00

V2615 TELESCOP/OTHR COMPOUND LENS 0001 0.00

V2630 ANTER CHAMBER INTRAOCUL LENS 0001 0.00

V2632 POST CHMBR INTRAOCULAR LENS 0001 0.00

V2700 BALANCE LENS 0001 46.85

V2710 GLASS/PLASTIC SLAB OFF PRISM 0001 64.93

V2715 PRISM LENS/ES 0001 12.43

V2718 FRESNELL PRISM PRESS-ON LENS 0001 30.53

V2730 SPECIAL BASE CURVE 0001 21.91

V2744 TINT PHOTOCHROMATIC LENS/ES 0001 13.16

V2745 TINT, ANY COLOR/SOLID/GRAD 0001 8.52

V2750 ANTI-REFLECTIVE COATING 0001 19.16

V2755 UV LENS/ES 0001 13.32

V2760 SCRATCH RESISTANT COATING 0001 17.13

V2762 POLARIZATION, ANY LENS 0001 46.92

V2770 OCCLUDER LENS/ES 0001 20.87

V2780 OVERSIZE LENS/ES 0001 13.40

V2781 PROGRESSIVE LENS PER LENS 0001 0.00

V2782 LENS, 1.54-1.65 P/1.60-1.79G 0001 50.68

V2783 LENS, >= 1.66 P/>=1.80 G 0001 57.14

V2784 LENS POLYCARB OR EQUAL 0001 37.16

V2785 CORNEAL TISSUE PROCESSING 0001 0.00

V2786 OCCUPATIONAL MULTIFOCAL LENS 0001 0.00


V2790 AMNIOTIC MEMBRANE 0001 0.00

V2797 VIS ITEM/SVC IN OTHER CODE 0001 0.00

V2799 MISC VISION ITEM OR SERVICE 0001 0.00

Documents

Provider Type 20 Physician, MD., Osteopathdhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources...Proc Code Description Mod Rate 11042 DEB SUBQ TISSUE 20 SQ CM/< 0001 61.54 11043