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Littleton Regional Healthcare Chargemaster Description Amount PROCEDURE ON SALIVARY GLANDS, INC BIOPS 94 Anes for reconstruction of eyelid 81 PROC ON EXT/MIDDLE/INNER/EAR INC BIOPSY 76 Anesthesia Ex/ Mdl /Inner Ear Otoscopy 81 ANESTHESIA FOR TYMPANOTOMY 94 PROCEDURES ON EYE NOS 76 ANESTHESIA FOR LENS SURGERY 76 ANESTHESIA FOR VITREORETINAL SURGERY 81 ANESTHESIA FOR OPHTHALMOSCOPY 81 PROCEDURES ON NOSE AND ACCESSORY SINUSES 94 ANESTH FOR RAD SURG NOSE/ACCESSORY SINUS 81 FOR BIOPSY SOFT TISSUE NOSE/ACCESS SINUS 76 FOR INTRAORAL PROC INCLUDING BIOPSY NOS 94 FOR PROC ON FACIAL BONES OR SKULL NOS 81 INTEGUMENTARY SYSTEM MUSCLES/NERVES HEAD 76 ESOPHA THYROID LARYNX TRACHEA LYMPH>AGE1 94 INTEGUMENTARY SYSTEM EXT ANT TRUNK PERIN 76 ANESTH RECONSTR BREAST EG MAMMOPLASTY 81 ANESTH RAD OR MOD PROC BREAST 76 ANESTH RAD/MOD BREAST INTERNAL MAM NODE 81 Cardioversion, Electrical, Elective 77 ANESTH PROC ON CLAVICLE/SCAPULA NOS 94 ANESTH RADICAL SURG CLAVICLE AND SCAPULA 81 ANESTHESIA FOR ALL PROC ON ESOPHAGUS 81 ANESTH CLOSED CHEST PROC INC BRONCH NOS 94 ANESTH FOR NEEDLE BIOPSY OF PLEURA 81 ANESTHESIA FOR PNEUMOCENTESIS 81 ANESTH FOR MEDIASTINOSCOPY/DIAG THORACOS 81 ANESTH MEDIASTINOSCOPY USING 1 LONG VENT 81 ANESTH PERMAN TRANSVENOUS PACEMAKER INS 76 ANESTH FOR ACCESS TO CENT. VENOUS CIRCUL 76 ANESTH TRANSVENOUS INS/REPLACE PACING CA 76 ANESTH THORACOTOMY PROCEDURES 81 ANESTHESIA FOR PROC IN LUMBAR REGION NOS 76 ANESTH FOR DIAG/THERAPEUTIC LUMBAR PUNCT 94 ANESTH EXTENSIVE SPINE /SPINAL CORD PROC 81 CT VIRTUAL COLONOSCOPY 1,914 ANESTH PROCEDURES UPPER ANT ABD WALL NOS 76 ANESTH PERCUTANEOUS LIVER BIOPSY 94 ANESTH PROC UPPER POST ABD WALL 81 ANES UPPER GI ENDO PROCEDURES SCOPE INTR 94 ANES ENDO RETROGRADE CHOLANGIOPANC GRAPH 94 ANESTH UPPER GASTROINTESTINAL ENDO PROC 76 ANESTH HERNIA REPAIRS UPPER ABD NOS 94 ANESTH LUMBAR/VENTRAL INCISIONAL HERNIAS 76 ANESTH TRANS ABD REP DIAPHRAGMATIC HERNI 81 Page 1 of 92 ANESTH ALL PROC MAJOR ABD BLOOD VESSELS 81 ANEST INTRAPERITONEAL PROC UPPER ABD INC 94 ANESTH PARTIAL HEPATECTOMY/LIVER HEMMORH 81 ANESTH PROC ON LOWER ANTERIOR ABD WALL 76 ANESTH FOR PANNICULECTOMY 76 ANESTH LOWER INTESTINAL ENDOSCOPIC PRO 94 Anes for lower intest endo proced scope 94 ANES FOR SCREENONG COLONOSCOPY 94 ANES COMBINED UPPER/LOWER GI ENDO PROC 94 ANESTH PROC LOWER POSTERIOR ABD WALL 76 ANESTH FOR HERNIA REP IN LOWER ABD INCL 76 ANESTH FOR VENTRAL AND INCISIONAL HERNIA 94 ANESTH INTRAPERITONEAL PROC LOWER ABD 94 ANESTH ABDOMINOPERINEAL RESECTION 94 ANESTH FOR RADICAL HYSTERECTOMY 94 ANESTH FOR PELVIC EXENTERATION 81 ANESTHESIA TUBAL LIGATION/TRANSECTION 76 ANEST EXTRAPERITONEAL PROC LOWER ABD 94 Renal procedure upper 1/3 Ureter 81 ANESTH FOR TOTAL CYSTECTOMY 81 ANESTH RADICAL PROSTATECTOMY SUPRA/RETRO 76 ANESTH FOR CYSTOLITHOTOMY 76 ANESTH FOR LITHOTRIPSY,EXTCORPOREAL SHO 76 ANESTH FOR LITHOTRIPSY EXTRACORPOREAL 76 ANESTHESIA FOR ANORECTAL PROCEDURE 94 ANESTHESIA FOR RADICAL PERINEAL PROCEDUR 81 ANESTH FOR PERINEAL PROSTATECTOMY 81 ANESTH TRANSURETHRAL PROC INC URETHROCYS 76 ANESTH TRANSURETHRAL RESECT BLADDER TUMO 76 ANESTH TRANSURETHRAL RESECT OF PROSTRATE 76 ANESTH FOR POST‐TRANSURETHRAL RESECT BLE 81 ANESTH PROC WITH FRAG/MANIP/REMOV/URETER 76 ANESTH PROC MALE GENITALIA NOS 76 ANESTH FOR VASECTOMY/UNILATERAL/BILATERA 81 ANESTH PROC UNDESCENDED TESTIS UNI/BI 81 Radical Orchiectomy Ingiunal Approach 94 ANESTH FOR ORCHIOPEXY, UNILATER/BILATER 94 ANESTH INSERTION OF PENILE PROSTHESIS 81 ANESTH VAG PROC BX OF LABIA/VAGINA/CERVI 94 ANESTH COLPOTOMY,COLPECTOMY, COLPORRHAP 76 ANESTH VAGINAL HYSTERECTOMY 94 ANESTH FOR CERVICAL CERCLAGE 81 ANESTH FOR CULDOSCOPY 81 ANESTH HYSTEROSCOPY AND/OR HYSTEROSALPIN 94 Bone Marrow Aspiration 81 Anesthesia Bony Pelvis Procedures 81 ANESTH FOR BODY CAST APPLICATION OR REV 81 Page 2 of 92 ANESTH CLOSED PROC SYMPHYSIS PUBIS/SACRO 81 ANESTHESIA,OPEN FX, PELVIS OR ACETABULU 81 ANESTH CLOSED PROCEDURES HIP JOINTS 94 ANESTH OPEN PROC INVOLVING HIP JOINT NOS 76 ANESTH TOTAL HIP ARTHROPLASTY 76 ANESTH REVISION OF TOTAL HIP ARTHROPLAST 76 ANESTH CLOSED PROCEDURES UPPER 2/3 FEMUR 76 ANESTH OPEN PROC INVOLV UPPER 2/3 FEMUR 76 ANESTH PROC ON NERVES/MUSCLES/TENDONS/FA 94 ANESTH ALL PROC INVOLV VEINS/UPPER LEG 81 ANESTH PROC INVOLV ARTERIES UPPER LEG 81 PROC NERVES/MUSCLES/TENDONS/FASCIA KNEE 94 ANES ALL CLOSED PROC ON LOWER 1/3 FEMUR 76 ANESTH ALL OPEN PROC LOWER 1/3 FEMUR 94 ANESTH CLOSED PROC ON KNEE JOINT 94 ANESTH DIAG ARTHROSCOPIC PROC KNEE JOINT 76 ANESTH CLOSED PROC UPPER INDS OF TIBIA/F 81 ANESTH OPEN PROC UPPER ENDS TIBIA/FIBULA 76 ANES OPEN/SURG ARTHRO PROC KNEE JT NOS 94 ANESTH TOTAL KNEE REPLACEMENT 76 ANESTH PROC VEINS OF KNEE/POPLITEAL AREA 81 ANESTH PROC ON VEINS OF KNEE POLITEAL AR 81 ANESTH CLOSED PROC LOWER LEG/ANKLE/FOOT 94 ANESTH ARTHRO PROC OF ANKLE/AND OR FOOT 94 ANESTH PROC NERV/MUSC/TEND/FASCIA LOW LE 94 ANESTH REPAIR RUPTURED ACHILLES TENDON 94 ANESTH OPEN PROC BONES LOWER LEG/ANK/FOO 94 ANESTH RAD RESECTION INC BELOW KNEE AMP 76 ANESTH OSTEOTOMY/OSTEOPLASTY TIBIA/FIBUL 76 ANESTH TOTAL ANKLE REPLACEMENT 81 CT CARDIAC CORONARIES/MORPHOLOGY 2,828 ANESTH LOWER LEG CAST APP/REMOVAL/REPAIR 81 ANESTH PROC LOWER LEG/INC BYPASS GRAFT N 81 ANESTH PROC ON VEINS OF LOWER LEG NOS 94 ANESTH PROC NER/MUSC/TEND/FAS/BURS/SHOUL 76 CLOSED PROC HUMERAL HEAD NECK STERNOCLAV 76 ANESTH DIAG ARTHROSCOPIC PROC SHLDER JT 81 OPEN/SURG PROC HUM HEAD/NECK/STERNOCLAVI 94 ANESTH RADICAL RESECTION, SHOULDER 81 ANESTH SHOULDER DISARTICULATION 76 ANESTH TOTAL SHOULDER REPLACEMENT 76 ANESTH PROC NERV/MUSC/TEND/FAS/UPPER ARM 94 ANESTH TENOTOMY ELBOW TO SHOULDER OPEN 76 ANESTHESIA FOR TENOPLATY ELBOW TO SHOULD 81 ANESTH TENODESIS RUPTURE LONG TENDON BIC 94 ANESTH CLOSED PROC HUMERUS AND ELBOW 81 ANES OPEN/SURG ARTRO PROC HUMERUS/ELBOW 76 Page 3 of 92 ANESTHESIA OSTEOTOMY OF HUMERUS 81 ANESTH REPAIR NONUNION/MALUNION HUMERUS 94 ANESTH FOR RADICAL PRECED HUMERUS/ELBOW 75 ANESTHESIA TOTAL ELBOW REPLACEMENT 81 ANESTH PROC ARTERIES UPPER ARM/ELBOW NOS 81 ANESTH PROC ON VEIN OF UPPER ARM/ELBOW 81 PROC NERV/MUSC/TEND/FAS/BURS/FOREARM WRI 76 ANESTH CLOSED PROC RADIUS/ULNA/WRIST/HAN 94 ANESTH FOR DIAG ARTHROSCOPIC PROC WRIST 81 ANESTH OPEN PROC RADIUS/ULNA/WRIST/HAND 76 ANESTH PROC ARTERIES FOREARM/WRIST/HAND 81 ANESTH PHLEBORRHAPHY FOREARM WRIST HAND0 81 ANESTH NON‐INVASIVE IMAGING/RADIATION TH 94 ANESTH FOR VAGINAL DELIVERY 76 ANESTH FOR CESAREAN DELIVERY ONLY 94 ANES CESAREAN HYSTER W/O LABOR ANALGESI 81 ANESTH FOR INCOMPLETE/MISSED ABORTION 94 NEURAXIAL ANALGESIA LABOR ENDING IN VAG 76 NEURAXIAL ANALGESIA/ANESTH FOR LABOR END 76 ANESTH CESAREAN/HYSTERECTOMY NEURAXIAL L 81 UNLISTED ANESTHESIA PROCEDURES 81 NJX PLATELET PLASMA 2,000 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE 351 FINE NEEDLE ASPIRATION W/IMAGE GUIDANCE 364 ACNE SURGERY 196 INCISION/DRAINAGE OF ABSCESS; SIMPLE, SINGLE 298 INCISION/DRAINAGE OF ABSCESS; COMPLICATED/MU 529 INCISION/DRAINAGE PILONIDAL CYST; SIMPLE 309 INCISION/DRAINAGE PILONIDAL CYST; COMPLICATED 712 REMOVE FOREIGN BODY 405 INCISION/REMOVAL FOREIGN BODY; COMPLICATED 396 INCISION & DRAINAGE OF HEMATOMA, SEROMA OR 655 PUNCTURE ASPIRATION OF ABSCESS HEMOTOMA BU 297 INCISION & DRAIN COMPLEX POSTOP WOUND INFEC 1,575 DEBRIDE OF EXTENSIVE ECZEMATOUS OR INFECTED S 183 DEBRIDE GENITALIA & PERINEUM 1,388 DEBRIDE OF SKIN, ABDOMINAL WALL W OR W/O FAS 1,900 DEBRIDE GENIT/PERINEUM/ABDOM WALL 1,749 REMOVE MESH FROM ABDOMINAL WALL FOR INFEC 602 DEBRIDE INCL REMOVE FOREIGN MAT AT SITE 668 DEBRIDE SKIN/MUSCLE, FX 1,276 DEBRIDE SKIN/MUSCLE/BONE, FX 1,610 DEBRIDGEMENT SKIN PARTIAL THICKNESS 111 DEBRIDE SKIN FULL THICKNESS 156 DEBRIDE SKIN/TISSUE 1st 20 SQ CM OR LESS 310 DEBRIDE SUB‐Q TISSUE MUSCLE 507 DEBRIDE SUB‐Q TISS MUSC BONE 693 Page 4 of 92 DEB SUBQ TISSUE ADD‐ON 92 DEB MUSC/FASCIA ADD‐ON 103 DEB BONE ADD‐ON 227 TRIM SKIN LESION 80 PARING CUTTING BENIGN 102 BIOPSY OF SKIN SINGLE LESION 157 BIOPSY OF SKIN EA ADDTL LESION 55 SKIN TAGS REMOVAL UP TO/INCLUDING 15 LESIONS 183 REMOVAL OF SKIN TAGS U 74 SHAVE TRUNK/EXT <.5CM 149 SHAVE TRUNK/EXT 0.6‐1.0CM 196 SHAVE TRUNK/EXT 1.1‐2.0CM 198 SHAVE TRUNK/EXT >2.0CM 237 SHAVE S/N/H/F/G <.5CM 129 SHAVE S/N/H/F/G .6 ‐ 1.0CM 190 SHAVE S/N/H/F/G 1.1 ‐ 2.0CM 203 SHAVE S/N/H/F/G >2.0CM 284 SHAVE FACE <.5 CM 175 SHAVE FACE .6 ‐ 1.0 CM 222 SHAVE FACE 1.1‐2 CM 284 SHAVE FACE >2 CM 352 EXCISION BENIGN LESION 445 EXCISION BENIGN LESION 0.6‐1.0 CM 345 EXCISION BENIGN LESION 1.1‐2.0 CM 377 EXCISION BENIGN LESION 2.1‐3.0 CM 422 EXCISION BENIGN LESION 3.1‐4.0 CM 472 EXCISION BENIGN LESION > 4.0 CM 588 EXCISION BENIGN LESION 651 EXCISION BENIGN LESION 704 EXCISION BENIGN LESION 693 EXCISN BEN LESION DIAM 2.1‐3.0CM 1,307 EXCISN BENLESION;DIAM 3.1‐4.0CM 1,305 EXCISN BEN LESION DIAM >4.0CM 1,751 EXCISION BENIGN LESION <0.5CM 324 EXCISION BENIGN LESION 0.6‐1.0CM 383 EXCISION BENIGN LESION 1.1‐2.0CM 422 EXCISION BENIGN LESION 2.1‐3.0CM 519 EXCISION BENIGN LESION 3.1‐4.0CM 575 EXCISION BENIGN LESION >4.0CM 739 EXCISION SKIN & SUBCUT TISSUE FOR HIDRADENITIS; 614 REMOVAL, SWEAT GLAND LESION 388 EXCISION FOR HIDRADENIS; SIMPLE OR INTERMEDIA 471 REMOVAL, SWEAT GLAND LESION 390 EXCISION FOR HIDRADENIS/PERIANAL/UMBILICAL; SI 554 EXCISION FOR HIDRADENIS/PERIANAL/UMBILICAL; C 772 EXCISION MAL LESION <=0.5CM 324 EXCISION MAL LESION 0.6‐1.0CM 448 Page 5 of 92 EXCISION MAL LESION 1.1‐2.0CM 472 EXCISION MAL LESION 2.1‐3.0CM 530 EXCISION MAL LESION 3.1‐4.0CM 563 EXCISION MAL LESION >4.0CM 750 EXCISION MAL LESION <=0.5CM 383 EXCISION MAL LESION 0.6‐1.0CM 367 EXCISION MAL LESION 1.1‐2.0CM 421 EXCISION MAL LESION 2.1‐3.0CM 588 EXCISION MAL LESION 3.1‐4.0CM 754 EXCISION MAL LESION >4.0CM 889 EXCISION MAL LESION <=0.5CM 409 EXCISION MAL LESION 0.6‐1.0CM
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