Srv. Code Description Standard Fee 0101T EXTRA CORP SHOCKWV TX HI ENERGY $1,003.00 0102T EXTRACORP SHOCKWV TX ANESTH $1,003.00 0165T REVISE LUMB ARTIF DISC ADDL $1,394.00 0184T EXC RECTAL TUMOR ENDOSCOPIC $2,636.00 0190T PLACE INTRAOC RADIATION SRC $821.00 0191T INSERT ANT SEGMENT DRAIN INT $3,137.00 0249T LIGATION HEMORRHOID W/US $1,404.00 0295T EXT ECG > 48HR TO 21 DAY RCRD SCAN $358.00 0296T EXT ECG > 48HR TO 21 DAY RCRD W/CON $108.00 0297T EXT ECG > 48HR TO 21 DAY SCAN ANALY $160.00 0298T EXT ECG > 48HR TO 21 DAY REVIEW AND $89.00 0308T INSJ OCULAR TELESCOPE PROSTH $3,693.00 10021 Ine needle aspiration;W/O image gui $256.00 10022 Ine needle aspiration;W/image guid $236.00 10030 Placement of soft tissue localizati $656.00 10035 Placement of soft tissue localizati $0.00 10036 Each additional lesion (List separa $10,040.00 10040 ACNE SURGERY $323.00 10060 DRAIN SKIN ABSCESS, SIMPLE/SINGLE $351.00 10061 DRAIN SKIN ABSCESS, COMPLIC/MULT $654.00 10080 DRAINAGE OF PILONIDAL CYST, SIMPLE $379.00 10081 DRAINAGE OF PILONIDAL CYST, COMPLIC $624.00 10120 REMOVE SKIN FOREIGN BODY, SIMPLE $377.00 10121 REMOVE SKIN FOREIGN BODY, COMPLIC $685.00 10140 DRAINAGE OF SKIN LESION $433.00 10160 PUNCTURE DRAINAGE OF SKIN LESION $351.00 10180 DRAIN COMPL POSTOP WOUND INFECTION $680.00 11000 SURGICAL SKIN CLEANSING, UP TO 10% $101.00 11001 SURGICAL SKIN CLEANSING, ADD'L 10% $51.00 11004 0EB SKIN, SUBCU TISS, EXT GEN/PERI $2,207.00 11005 DEBRIMNT, ABD WALL, W/WO FAS CLOSUR $3,045.00 11006 DEBRMNT SKIN, EXT GENT, W/WO FAS CL $2,684.00 11008 REM PROSTH MAT/MESH, ABD WALL INFEC $1,073.00 11010 DEBRIDE SKIN/TISSUE, FX $1,053.00 11011 DEBRIDE SKIN/MUSCLE, FX $1,139.00 11012 DEBRIDE SKIN/MUSCLE/BONE, FX $1,631.00 11042 SURGICAL CLEANSING OF SKIN/TISSUE $225.00 11043 SURGICAL CLEANSING OF TISSUE/MUSCLE $576.00 11044 SURG CLEANSING, TISSUE/MUSCLE/BONE $864.00 11045 DEB SUBQ TISSUE ADD‐ON $96.00 11046 DEB MUSC/FASCIA ADD‐ON $210.00 11047 DEB BONE ADD‐ON $378.00 11055 PARING/CUT BENIGN SKIN LESION, 1 $56.00 11056 PARING/CUT BENIGN SKIN LESION, 2‐4 $79.00 11057 PARING/CUT BENIGN SKIN LESION, 4+ $103.00 11100 BIOPSY OF SKIN LESION $180.00 11101 BIOPSY, SKIN SUBQ/MUCOUS, EA ADD'L $93.00 11200 REMOVAL OF SKIN TAGS, UP TO 15 $269.00 11201 REMOVAL OF EACH ADD'L 10 SKIN TAGS $62.00 11300 SHAVE SKIN LESION, TRUNK/ARM/LEG $129.00 11301 SHAVE SKIN LESION, TRUNK/ARM/LEG $197.00 11302 SHAVE SKIN LESION, TRUNK/ARM/LEG $233.00 11303 SHAVE SKIN LESION, TRUNK/ARM/LEG $275.00 11305 SHAVE LESION, SCALP/NECK/HAND/FOOT $140.00 11306 SHAVE LESION, SCALP/NECK/HAND/FOOT $189.00 11307 SHAVE LESION, SCALP/NECK/HAND/FOOT $245.00 11308 SHAVE LESION, SCALP/NECK/HAND/FOOT $265.00 11310 SHAVE LESION, FACE/LID/EAR/NOSE/LIP $174.00 11311 SHAVE LESION, FACE/LID/EAR/NOSE/LIP $243.00 11312 SHAVE LESION, FACE/LID/EAR/NOSE/LIP $290.00 11313 SHAVE LESION, FACE/LID/EAR/NOSE/LIP $373.00 11400 REMOVE LESION, TRUNK/ARM/LEG $296.00 11401 REMOVE LESION, TRUNK/ARM/LEG $383.00 11402 REMOVE LESION, TRUNK/ARM/LEG $423.00 11403 REMOVE LESION, TRUNK/ARM/LEG $550.00 11404 REMOVE LESION, TRUNK/ARM/LEG $609.00 11406 REMOVE LESION, TRUNK/ARM/LEG $935.00 11420 REMOVE LESION, SCALP/NECK/HAND/FOOT $298.00 11421 REMOVE LESION, SCALP/NECK/HAND/FOOT $404.00 11422 REMOVE LESION, SCALP/NECK/HAND/FOOT $500.00 11423 REMOVE LESION, SCALP/NECK/HAND/FOOT $584.00 11424 REMOVE LESION, SCALP/NECK/HAND/FOOT $671.00 11426 REMOVE LESION, SCALP/NECK/HAND/FOOT $1,034.00 11440 REMOVE LESION,FACE/LID/EAR/NOSE/LIP $377.00 11441 REMOVE LESION,FACE/LID/EAR/NOSE/LIP $486.00 11442 REMOVE LESION,FACE/LID/EAR/NOSE/LIP $539.00 11443 REMOVE LESION,FACE/LID/EAR/NOSE/LIP $664.00 11444 REMOVE LESION,FACE/LID/EAR/NOSE/LIP $846.00 11446 REMOVE LESION,FACE/LID/EAR/NOSE/LIP $1,213.00 11450 REMOVE SWEAT GLAND LESION, AXILLARY $958.00 11451 REMOVE SWEAT GLAND LESION, AXILLARY $1,234.00 11462 REMOVE SWEAT GLAND LESION, INGUINAL $912.00 11463 REMOVE SWEAT GLAND LESION, INGUINAL $1,235.00 11470 REMOVE SWEAT GLAND LESION, PERIANAL $1,065.00 11471 REMOVE SWEAT GLAND LESION, PERIANAL $1,313.00 11600 EXC TR‐EXT MAL+MARG 0.5 < CM $439.00 11601 EXC TR‐EXT MAL+MARG 0.6‐1 CM $552.00 11602 EXC TR‐EXT MAL+MARG 1.1‐2 CM $606.00 11603 EXC TR‐EXT MAL+MARG 2.1‐3 CM $728.00 11604 EXC TR‐EXT MAL+MARG 3.1‐4 CM $805.00 11606 EXC TR‐EXT MAL+MARG > 4 CM $1,208.00 11620 EXC H‐F‐NK‐SP MAL+MARG 0.5 < $448.00 11621 EXC S/N/H/F/G MAL+MRG 0.6‐1 $558.00 11622 EXC S/N/H/F/G MAL+MRG 1.1‐2 $638.00 11623 REMOVE MALIG LESION, HEAD/HAND/FOOT $793.00 11624 EXC S/N/H/F/G MAL+MRG 3.1‐4 $900.00 11626 EXC S/N/H/F/G MAL+MRG > 4 CM $1,110.00 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< $463.00 11641 EXC F/E/E/N/L MAL+MRG 0.6‐1 $581.00 11642 EXC F/E/E/N/L MAL+MRG 1.1‐2 $687.00 11643 EXC F/E/E/N/L MAL+MRG 2.1‐3 $859.00 11644 EXC F/E/E/N/L MAL+MRG 3.1‐4 $1,066.00 11646 EXC F/E/E/N/L MAL+MRG > 4 CM $1,485.00 11719 TRIM NONDYSTROPHIC NAIL, ANY NUMBER $27.00 11720 DEBRIDE 1‐5 NAILS, ANY METHOD $51.00 11721 DEBRIDE 6+ NAILS, ANY METHOD $87.00 11730 REMOVAL OF SINGLE NAIL PLATE $179.00 11732 REMOVAL, EA ADD NAIL PLATE PRTL/CMP $71.00 11740 DRAIN BLOOD FROM UNDER NAIL $118.00 11750 PERMANENT REMOVAL OF NAIL BED $506.00 11755 BIOPSY OF NAIL UNIT, ANY METHOD $277.00 11760 REPAIR OF NAIL BED $427.00 11762 NAILBED RECONSTRUCTION W/GRAFT $661.00 11765 EXCISE SKIN WEDGE, INGROWN TOENAIL $336.00 11770 EXCISION OF PILONIDAL CYST OR SINUS $706.00 11771 REMOVE PILONIDAL CYST, EXTENSIVE $1,661.00 11772 REMOVE PILONIDAL CYST, COMPLEX $2,196.00 11900 INJECT SKIN LESIONS, 7 MAX $115.00 11901 INJECT SKIN LESIONS, 8 OR MORE $178.00 11920 FIX SKIN COLOR DEFECT, UP TO 6 SQCM $423.00 11921 FIX SKIN COLOR DEFECT, 6.1‐20 SQCM $502.00 11922 FIX SKIN COLOR DEFECT ADD'L 10 SQCM $110.00 11950 CONTOUR DEFECT THERAPY, 1CC OR LESS $182.00 11951 CONTOUR DEFECT THERAPY, 1.1‐5.0 CC $269.00 11952 CONTOUR DEFECT THERAPY, 5.1‐10.0 CC $358.00 11954 CONTOUR DEFECT THERAPY, OVER 10 CC $428.00 11960 INSERT TISSUE EXPANDER(S) $3,521.00 11970 REPLACE TISSUE EXPANDER $2,274.00 11971 REMOVE TISSUE EXPANDER(S) $1,185.00 11976 REMOVE CONTRACEPTIVE CAPSULES $341.00 11980 IMPLANT HORMONE PELLET(S) $203.00 11981 INSRT, NONBIOGRADBLE DRUG IMPLANT $310.00 11982 REMOVAL, NONBIOGRADBLE DRU IMPLANT $376.00 11983 REMOVL W INSERT, IMPLANT $638.00 12001 REPAIR SUPERFICIAL WOUNDS, TRUNK $162.00 12002 REPAIR SUPERFICIAL WOUNDS, TRUNK $213.00 12004 REPAIR SUPERFICIAL WOUNDS, TRUNK $268.00 12005 REPAIR SUPERFICIAL WOUNDS, TRUNK $349.00 12006 REPAIR SUPERFICIAL WOUNDS, TRUNK $430.00 12007 REPAIR SUPERFICIAL WOUNDS, TRUNK $548.00 12011 REPAIR SUPERFICIAL WOUNDS, FACE $203.00 12013 REPAIR SUPERFICIAL WOUNDS, FACE $213.00 12014 REPAIR SUPERFICIAL WOUNDS, FACE $274.00 12015 REPAIR SUPERFICIAL WOUNDS, FACE $345.00 12016 REPAIR SUPERFICIAL WOUNDS, FACE $473.00 12017 REPAIR SUPERFICIAL WOUNDS, FACE $572.00 12018 REPAIR SUPERFICIAL WOUNDS, FACE $696.00 12020 CLOSURE OF SPLIT WOUND, SIMPLE $739.00 12021 CLOSURE OF SPLIT WOUND, W/PACKING $530.00 12031 INTMD WND REPAIR S/A/T/EXT $569.00 12032 INTMD WND REPAIR S/A/T/EXT $724.00 12034 LAYER CLOSURE OF WOUNDS, TRUNK $771.00 12035 INTMD WND REPAIR S/A/T/EXT $901.00 12036 INTMD WND REPAIR S/A/T/EXTRUNK $1,054.00 12037 LAYER CLOSURE OF WOUNDS, TRUNK $1,234.00 12041 LAYER CLOSURE OF WOUNDS, HANDS/FEET $558.00 12042 LAYER CLOSURE OF WOUNDS, HANDS/FEET $745.00 12044 LAYER CLOSURE OF WOUNDS, HANDS/FEET $797.00 12045 LAYER CLOSURE OF WOUNDS, HANDS/FEET $1,008.00 12046 LAYER CLOSURE OF WOUNDS, HANDS/FEET $1,194.00 12047 LAYER CLOSURE OF WOUNDS, HANDS/FEET $1,314.00 12051 LAYER CLOSURE OF WOUNDS, FACE/EARS $638.00 12052 LAYER CLOSURE OF WOUNDS, FACE/EARS $757.00 12053 LAYER CLOSURE OF WOUNDS, FACE/EARS $809.00 12054 LAYER CLOSURE OF WOUNDS, FACE/EARS $827.00 12055 LAYER CLOSURE OF WOUNDS, FACE/EARS $1,142.00 12056 LAYER CLOSURE OF WOUNDS, FACE/EARS $1,414.00 12057 LAYER CLOSURE OF WOUNDS, FACE/EARS $1,540.00 13100 REPAIR COMPLEX WOUND, TRUNK $767.00 13101 REPAIR COMPLEX WOUND, TRUNK $945.00 13102 NULL $281.00 13120 REPAIR COMPLEX WOUND, SCALP/ARM/LEG $881.00 13121 REPAIR COMPLEX WOUND, SCALP/ARM/LEG $997.00 13122 NULL $321.00 13131 REPAIR COMPLEX WOUND,FACE/HAND/FOOT $930.00 13132 REPAIR COMPLEX WOUND,FACE/HAND/FOOT $1,173.00 13133 NULL $491.00 13151 REPAIR COMPLEX WOUND, NOSE/EAR/LIPS $1,071.00 13152 REPAIR COMPLEX WOUND, NOSE/EAR/LIPS $1,300.00 13153 NULL $531.00 13160 LATE CLOSURE OF WOUND, EXTENSIVE $3,039.00 14000 ADJACENT TISSUE TRANSFER, TRUNK $1,882.00 14001 ADJACENT TISSUE TRANSFER, TRUNK $2,458.00 14020 TISSUE TRANSFER, SCALP/ARMS/LEGS $2,119.00 14021 TISSUE TRANSFER, SCALP/ARMS/LEGS $2,680.00 14040 TISSUE TRANSFER, FACE/HANDS/FEET $2,351.00 14041 TISSUE TRANSFER, FACE/HANDS/FEET $2,895.00 14060 TISSUE TRANSFER, NOSE/EAR/LIDS/LIPS $2,502.00 14061 TISSUE TRANSFER, NOSE/EAR/LIDS/LIPS $3,098.00 14301 ADJACENT TISSUE TRANSFER, REARRANGE $3,303.00 14302 ADJACENT TISSUE, EACH ADDTNL 30.0SQ $836.00 14350 FILLETED FINGER/TOE FLAP W/PREP $2,545.00 15002 SRGCL PRP IST 100 SQCM/1% TRUNK/ARM $855.00 15003 SRGCL PRP +NL 100 SQCM/1% TRUNK/ARM $174.00 15004 SRGCL PRP IST 100 SQCM/1% FACE,HAND $1,000.00 15005 SRGCL PRP +NL 100 SQCM/1% FACE,HAND $345.00 15040 HARVST SKIN FOR TISSUE, 100 SQ CM $486.00 15050 SKIN PINCH GRAFT, UP TO 2 CM $1,655.00 15100 SKIN SPLIT GRAFT, TRUNK/ARMS/LEGS $2,704.00 15101 SKIN SPLIT GRAFT, TRUNK/ARMS/LEGS $426.00 15110 EPIDERMAL AUTOGRFT, TRNK ARM 100 SQ $2,594.00 15111 EPIDERMAL, AUTOGRFT ADDNL 100 SQ CM $403.00 15115 EPIDRMAL AUTOGRFT, FACE 100 SQ CM $2,653.00 15116 EPIDRML, AUTOGRT, ADDTIONL 100 SQCM $537.00 15120 SKIN SPLIT GRAFT, FACE/NECK/EARS $2,617.00 15121 SKIN SPLIT GRAFT, FACE/NECK/EARS $505.00 15130 DERMAL AUTOGRFT TRUNK LEG, 100 SQCM $2,128.00 15131 DERML AUTGRFT, ADDINL 100 SQ CM $342.00 15135 DERMAL AUTGRFT, FACE 100 SQCM $726.00 15136 DERMAL AUTGRFT, ADDTNAL 100 SQ CM $330.00 15150 CULT SKIN GRFT T/ARM/LEG $2,452.00 15151 CULT SKIN GRFT T/A/L ADDL $437.00 15152 CULT SKIN GRAFT T/A/L +% $544.00 15155 CULT SKIN GRAFT F/N/HF/G $2,456.00 15156 CULT SKIN GRFT F/N/HFG ADD $573.00 15157 TISSU CULT, FACE, ADDTIONL 100 SQCM $599.00 15200 SKIN FULL THICKNESS GRAFT, TRUNK $2,521.00 15201 SKIN FULL THICKNESS GRAFT, TRUNK $298.00 15220 SKIN FULL GRAFT, SCALP/ARMS/LEGS $2,297.00 15221 SKIN FULL GRAFT, SCALP/ARMS/LEGS $269.00 15240 SKIN FULL GRAFT, FACE/HANDS/FEET $2,989.00 15241 SKIN FULL GRAFT, FACE/HANDS/FEET $419.00 15260 SKIN FULL GRAFT, NOSE/EAR/LIDS/LIPS $3,190.00 15261 SKIN FULL GRAFT, NOSE/EAR/LIDS/LIPS $525.00 15271 SKIN SUB GRAFT TRNK/ARM/LEG $313.00 15272 SKIN SUB GRAFT T/A/L ADD‐ON $65.00 15273 SKIN SUB GRFT T/ARM/LG CHILD $766.00 15274 SKN SUB GRFT T/A/L CHILD ADD $177.00 15275 SKIN SUB GRAFT FACE/NK/HF/G $345.00 15276 SKIN SUB GRAFT F/N/HF/G ADDL $91.00 15277 SKN SUB GRFT F/N/HF/G CHILD $843.00 15278 SKN SUB GRFT F/N/HF/G CH ADD $218.00 15570 FORM SKIN PEDICLE, TRUNK $2,768.00 15572 FORM SKIN PEDICLE, SCALP/ARMS/LEGS $2,791.00 15574 FORM SKIN PEDICLE, FACE/HANDS/FEET $2,863.00 15576 FORM SKIN PEDICLE, NOSE/EAR/LID/LIP $2,490.00 15600 DELAY SKIN FLAP AT TRUNK $770.00 15610 DELAY SKIN FLAP AT SCALP/ARMS/LEGS $898.00 15620 DELAY FLAP AT FACE/NECK/HANDS/FEET $1,213.00 15630 DELAY FLAP AT NOSE/EARS/LIDS/LIPS $1,289.00 15650 TRANSFER OF SKIN PEDICLE FLAP $1,422.00 15731 FOREHEAD FLAP W PRSRVTN VASCLR PDCL $3,757.00 15732 MUSCLE‐SKIN FLAP, HEAD/NECK $4,121.00 15734 MUSCLE‐SKIN FLAP, TRUNK $5,011.00 15736 MUSCLE‐SKIN FLAP, ARM $4,293.00 15738 MUSCLE‐SKIN FLAP, LEG $4,648.00 15740 ISLAND PEDICLE FLAP $3,180.00 15750 NEUROVASCULAR PEDICLE FLAP $3,443.00 15756 MICROVASCULAR FREE MUSCLE FLAP $8,715.00 15757 MICROVASCULAR FREE SKIN FLAP $8,580.00 15758 MICROVASCULAR FREE FASCIAL FLAP $8,607.00 15760 COMPOSITE SKIN GRAFT $2,632.00 15770 DERMA‐FAT‐FASCIA GRAFT $2,507.00 15775 HAIR TRANSPLANT PUNCH GRAFTS, 1‐15 $823.00 15776 HAIR TRANSPLANT PUNCH GRAFTS, 16+ $1,335.00 15777 ACELLULAR DERM MATRIX IMPLT $811.00 15780 DERMABRASION, TOTAL FACE $2,331.00 15781 DERMABRASION, SEGMENTAL, FACE $1,618.00 15782 DERMABRASION, OTHER THAN FACE $1,655.00 15783 DERMABRASION, SUPERFICIAL, ANY SITE $1,338.00 15786 ABRASION TREATMENT, SINGLE LESION $495.00 15787 ABRASION TREAT EA ADD'L 4 LESIONS $62.00 15788 CHEMICAL PEEL, FACIAL, EPIDERMAL $914.00 15789 CHEMICAL PEEL, FACIAL, DERMAL $1,540.00 15792 CHEMICAL PEEL, NONFACIAL, EPIDERMAL $980.00 15793 CHEMICAL PEEL, NONFACIAL, DERMAL $1,362.00 15819 REVISION/RECONSTRUCTION OF NECK $2,731.00 15820 REVISE LOWER EYELID $1,818.00 15821 REVISE LOWER EYELID/FAT PAD HERNIA $1,958.00 15822 REVISE UPPER EYELID $1,412.00 15823 REVISE UPPER EYELID/EXCESS SKIN $1,946.00 15830 EXCSN, EXCSV SKIN & SUBCU TISU, ABD $4,417.00 15832 REMOVE EXCESSIVE SKIN/TISSUE, THIGH $3,439.00 15833 REMOVE EXCESSIVE SKIN/TISSUE, LEG $3,222.00 15834 REMOVE EXCESSIVE SKIN/TISSUE, HIP $3,315.00 15835 REMOVE EXCESS SKIN/TISSUE, BUTTOCK $3,480.00 15836 REMOVE EXCESSIVE SKIN/TISSUE, ARM $2,869.00 15837 REMOVE EXCESSIVE SKIN, FOREARM/HAND $2,543.00 15838 REMOVE EXCESS SKIN/TISSUE, FAT PAD $2,123.00 15839 REMOVE EXCESSIVE SKIN, OTHER AREA $2,764.00 15840 GRAFT FOR FACE NERVE PALSY, FASCIA $3,741.00 15841 GRAFT FOR FACE NERVE PALSY, MUSCLE $6,071.00 15842 GRAFT FOR FACE NERVE PALSY, MUSCLE $9,874.00 15845 MUSCLE TRANSFER/GRAFT, FACIAL PALSY $3,673.00 15847 EXC SKIN ABD ADD ON $1,005.00 15851 REMOVAL OF SUTURES, OTHER SURGEON $165.00 15852 DRESSING CHANGE W/ANESTHESIA $175.00 15860 TEST FOR BLOOD FLOW IN FLAP/GRAFT $418.00 15920 REMOVE TAILBONE ULCER W/SUTURE $2,299.00 15922 REMOVE TAILBONE ULCER W/CLOSURE $2,913.00 15931 REMOVE SACRAL PRESSURE ULCER $2,629.00 15933 REMOVE SACRAL PRESSURE ULCER/BONE $3,216.00 15934 REMOVE SACRAL PRESSURE ULCER $3,530.00 15935 REMOVE SACRAL PRESSURE ULCER/BONE $4,143.00 15936 REMOVE SACRAL PRESSURE ULCER $3,377.00 15937 REMOVE SACRAL PRESSURE ULCER/BONE $3,905.00 15940 REMOVE ISCHIAL PRESSURE ULCER $2,663.00 15941 REMOVE ISCHIAL PRESSURE ULCER/BONE $3,389.00 15944 REMOVE ISCHIAL PRESSURE ULCER $3,337.00 15945 REMOVE ISCHIAL PRESSURE ULCER/BONE $3,674.00 15946 REMOVE ISCHIAL PRESSURE ULCER/BONE $6,159.00 15950 REMOVE THIGH PRESSURE ULCER $2,247.00 15951 REMOVE THIGH PRESSURE ULCER/BONE $3,277.00 15952 REMOVE THIGH PRESSURE ULCER $3,366.00 15953 REMOVE THIGH PRESSURE ULCER/BONE $3,712.00 15956 REMOVE THIGH PRESSURE ULCER $4,351.00 15958 REMOVE THIGH PRESSURE ULCER/BONE $4,415.00 16000 LOCAL BURN TREATMENT, 1ST DEGREE $168.00 16020 BURN TREATMENT W/O ANESTH, SMALL $199.00 16025 BURN TREATMENT W/O ANESTH, MEDIUM $411.00 16030 BURN TREATMENT W/O ANESTH, LARGE $499.00 16035 REMOVAL OF BURN SCAB $718.00 16036 Escharottomy, each addition incisio $304.00 17000 DESTROY BENIGN/PREMALIG LESION, 1 $196.00 17003 DESTROY BENIGN/PREMALIG LESION,2‐14 $9.00 17004 DESTROY BENIGN/PREMALIG LESION, 15+ $369.00 17106 DESTROY VASCULAR SKIN LESIONS $1,018.00 17107 DESTROY VASCULAR SKIN LESIONS $1,280.00 17108 DESTROY VASCULAR SKIN LESIONS $1,951.00 17110 DESTROY FLAT WART, UP TO 14 LESIONS $256.00 17111 DESTROY FLAT WART, 15+ LESIONS $315.00 17250 CHEMICAL CAUTERY, GRANULATED TISSUE $136.00 17260 DESTROY MALIG LESION, TRUNK/ARM/LEG $259.00 17261 DESTROY MALIG LESION, TRUNK/ARM/LEG $338.00 17262 DESTROY MALIG LESION, TRUNK/ARM/LEG $431.00 17263 DESTROY MALIG LESION, TRUNK/ARM/LEG $479.00 17264 DESTROY MALIG LESION, TRUNK/ARM/LEG $511.00 17266 DESTROY MALIG LESION, TRUNK/ARM/LEG $596.00 17270 DESTROY MALIG LESION,NECK/HAND/FOOT $369.00 17271 DESTROY MALIG LESION,NECK/HAND/FOOT $410.00 17272 DESTROY MALIG LESION,NECK/HAND/FOOT $475.00 17273 DESTROY MALIG LESION,NECK/HAND/FOOT $535.00 17274 DESTROY MALIG LESION,NECK/HAND/FOOT $653.00 17276 DESTROY MALIG LESION,NECK/HAND/FOOT $784.00 17280 DESTROY MALIG LESION, FACE/EAR/NOSE $336.00 17281 DESTROY MALIG LESION, FACE/EAR/NOSE $462.00 17282 DESTROY MALIG LESION, FACE/EAR/NOSE $535.00 17283 DESTROY MALIG LESION, FACE/EAR/NOSE $666.00 17284 DESTROY MALIG LESION, FACE/EAR/NOSE $777.00 17286 DESTROY MALIG LESION, FACE/EAR/NOSE $1,045.00 17311 MOHS SURGRY HEAD/NECK/HANDS.IST STG $1,410.00 17312 MOHS HEAD/NECK/HANDS +NL STG‐IST ST $749.00 17313 MOHS trunk/arms/legs IST STG<=5 tsu $1,263.00 17314 MOH trnk/arm/leg +nl IST STG<=5 tsu $695.00 17315 MOHS EACH +NL BLCK +IST 5 TSU BLOCK $197.00 17340 CRYOTHERAPY OF SKIN $178.00 17360 CHEMICAL SKIN PEEL FOR ACNE $363.00 19000 PUNCTURE DRAINAGE OF BREAST CYST $161.00 19001 PUNCTURE DRAIN OF BREAST CYST, ADDL $80.00 19020 INCISION OF BREAST LESION, DEEP $1,165.00 19030 INJECTION FOR BREAST DUCT X‐RAY $279.00 19081 BX BREAST W DEVICE 1ST LESION STERO $621.00 19082 BX BREAST W DEVICE 1ST LESION ULTRA $310.00 19083 BX BREAST W DEVICE 1ST LESION ULTRA $579.00 19084 NEEDLE BIOPSY OF BREAST $290.00 19085 NEEDLE BIOPSY OF BREAST $679.00 19086 BX BREAST W DEVICE ADDL LESION MAGN $333.00 19100 NEEDLE BIOPSY OF BREAST $271.00 19101 SURGICAL BIOPSY OF BREAST $851.00 19105 ABLTN CRYO OF FIBROADNMA + USG EACH $705.00 19110 EXPLORATION OF NIPPLE $1,311.00 19112 REMOVAL OF BREAST DUCT FISTULA $1,191.00 19120 REMOVAL OF BREAST LESION $1,592.00 19125 EXCISE BREAST LESION (MARKER USED) $1,774.00 19126 EXCISE ADDL BRST LESN (MARK), ADD'L $632.00 19260 REMOVAL OF CHEST WALL TUMOR, RIBS $4,642.00 19271 REMOVE CHST WALL TUMOR/REVISE CHEST $6,267.00 19272 REMOVE CHST WALL TUMOR/REVISE CHEST $6,848.00 19281 PERQ DEVICE PLACEMT BREAST LOC 1ST $365.00 19282 PERQ BREST LOC DEVICE PLACMT 1ST LE $184.00 19283 PERQ BREST LOC DEVICE PLACMT 1ST LE $371.00 19284 PERQ BREAST LOC DEVICE PLACEMT EA $189.00 19285 PERQ BREST LOC DEVICE PLACMT 1ST LE $313.00 19286 DEL2014PLACE NEEDLE LOC WIRE, BREAS $158.00 19287 DEL2014PLACE NEEDLE LOC WIRE, BREAS $469.00 19288 PERQ BREAST LOC DEVICE PLACEMT ADD $232.00 19296 PLCMNT RADTHRY BALLON CATH IN BRST $819.00 19297 PLCMNT RADIOTHRPY WITH MASTECTOMY $371.00 19298 PLCMENT RADTHRP AFTER BRCHTHR CATH $1,209.00 19300 MASTECTOMY FOR GYNECOMASTIA $1,578.00 19301 MASTECTOMY PARTIAL $2,526.00 19302 MASTECTMY PARTIAL W AXLRY LYMPNCTMY $3,483.00 19303 MASTECTOMY SIMPLE COMPLETE $3,914.00 19304 MASTECTOMY SUBCUTANEOUS $2,207.00 19305 MASTECTMY RADCAL INCLDNG PCTRL MUSL $4,359.00 19306 MASTECTOMY RADCL URBAN TYPE OPERATN $4,648.00 19307 MASTCTMY MODIFIED RADICAL $4,631.00 19316 SUSPENSION OF BREAST $2,893.00 19318 REDUCTION OF BREAST $4,123.00 19324 ENLARGEMENT OF BREAST W/O IMPLANT $1,884.00 19325 ENLARGEMENT OF BREAST W/IMPLANT $2,386.00 19328 REMOVAL OF BREAST IMPLANT $1,855.00 19330 REMOVAL OF BREAST IMPLANT MATERIAL $2,376.00 19340 IMMEDIATE BREAST PROSTHESIS $3,754.00 19342 DELAYED BREAST PROSTHESIS $3,444.00 19350 NIPPLE/AREOLA RECONSTRUCTION $2,518.00 19355 CORRECTION OF INVERTED NIPPLES $2,214.00 19357 BREAST RECONSTRUCTION W/EXPANDER $5,623.00 19361 BREAST RECONSTRUCTION W/LD FLAP $5,898.00 19364 BREAST RECONSTRUCTION W/FREE FLAP $10,334.00 19366 BREAST RECONSTRUCTION $5,319.00 19367 BREAST RECONSTRUCTION W/TRAM $6,706.00 19368 BREAST RECON W/TRAM MICROVASC ANAST $8,254.00 19369 BREAST RECON W/TRAM, DOUBLE PEDICLE $7,683.00 19370 SURGERY OF BREAST CAPSULE $2,564.00 19371 REMOVAL OF BREAST CAPSULE $2,932.00 19380 REVISION OF BREAST RECONSTRUCTION $2,890.00 19396 DESIGN CUSTOM BREAST IMPLANT $523.00 20005 INCISION OF ABSCESS, DEEP/COMPLEX $872.00 20100 EXPLORE PENETRATING WOUND, NECK $2,329.00 20101 EXPLORE PENETRATING WOUND, CHEST $808.00 20102 EXPLORE PENETRATING WND, ABDMN/BACK $988.00 20103 EXPLORE PENETRATING WND, ARM/LEG $1,309.00 20150 EXCISION OF EPIPHYSEAL BAR $3,518.00 20200 MUSCLE BIOPSY, SUPERFICIAL $373.00 20205 MUSCLE BIOPSY, DEEP $614.00 20206 NEEDLE BIOPSY, MUSCLE $216.00 20220 BONE BIOPSY, TROCAR/NEEDLE,SUPERFIC $263.00 20225 BONE BIOPSY, TROCAR/NEEDLE, DEEP $396.00 20240 BONE BIOPSY, EXCISIONAL,SUPERFICIAL $793.00 20245 BONE BIOPSY, EXCISIONAL, DEEP $2,258.00 20250 OPEN BONE BIOPSY, THORACIC $1,525.00 20251 OPEN BONE BIOPSY, LUMBAR/CERVICAL $1,655.00 20500 SINUS TRACT INJECTION, THERAPEUTIC $305.00 20501 SINUS TRACT INJECTION FOR X‐RAY $137.00 20520 REMOVE OBJECT, MUSCLE/TENDON,SIMPLE $540.00 20525 REMOVE OBJECT, MUSCLE/TENDON, DEEP $937.00 20526 Injection, therapeutic, Carpal tunn $215.00 20527 INJ DUPUYTREN CORD W/ENZYME $250.00 20550 INJECT TENDON/LIGAMENT/GANGL CYST $152.00 20551 Injection(S);Tendon origin/insertio $154.00 20552 single or mutiple trigger pts $138.00 20553 Injection(s);Single or Mult trigger $157.00 20555 PLACE NDL MUSC/TIS FOR RT $1,208.00 20600 DRAIN/INJECT SMALL JOINT OR BURSA $128.00 20604 DRAIN/INJECT INTERMED JOINT/BURSA $167.00 20605 DRAIN/INJECT INTERMED JOINT/BURSA $136.00 20606 DRAIN/INJECT MAJOR JOINT OR BURSA $192.00 20610 DRAIN/INJECT MAJOR JOINT OR BURSA $171.00 20611 Aspiration &/or injection of gangli $228.00 20612 Aspiration &/or injection of gangli $153.00 20615 TREATMENT OF BONE CYST $601.00 20650 INSERT/REMOVE BONE WIRE/PIN $577.00 20660 APPLY/REMOVE BONE FIXATION DEVICE $993.00 20661 APPLY/REMOVE HEAD BRACE (HALO) $2,005.00 20662 APPLY/REMOVE PELVIC BRACE (HALO) $1,552.00 20663 APPLY/REMOVE THIGH BRACE (HALO) $1,775.00 20664 APPLY/REMOVE HALO, THIN SKULL $3,576.00 20665 REMOVE TONGS/HALO, OTHER PHYSICIAN $323.00 20670 REMOVE SUPERFICIAL SUPPORT IMPLANT $547.00 20680 REMOVAL OF DEEP SUPPORT IMPLANT $1,588.00 20690 APPLY BONE FIXATION DEVICE,UNIPLANE $2,252.00 20692 APPLY BONE FIXATION DEVICE, MULTI‐ $4,201.00 20693 ADJUST/REVISE BONE FIXATION DEVICE $1,667.00 20694 REMOVE BONE FIXATION DEVICE $1,273.00 20696 NULL $4,553.00 20697 NULL $7,987.00 20802 REPLANTATION OF ARM, COMPLETE $8,879.00 20805 REPLANTATION OF FOREARM, COMPLETE $12,563.00 20808 REPLANTATION OF HAND, COMPLETE $15,225.00 20816 REPLANTATION OF DIGIT, COMPLETE $7,898.00 20822 REPLANTATION OF DIGIT, COMPLETE $6,699.00 20824 REPLANTATION OF THUMB, COMPLETE $7,802.00 20827 REPLANTATION OF THUMB, COMPLETE $6,956.00 20838 REPLANTATION OF FOOT, COMPLETE $9,151.00 20900 REMOVE BONE FOR GRAFT, SMALL/MINOR $719.00 20902 REMOVE BONE FOR GRAFT, LARGE/MAJOR $1,096.00 20910 REMOVE RIB CARTILAGE FOR GRAFT $1,592.00 20912 NASAL SEPTUM CARTILAGE FOR GRAFT $1,788.00 20920 FASCIA LATA FOR GRAFT, BY STRIPPER $1,460.00 20922 FASCIA LATA FOR GRAFT, BY INCISION $1,928.00 20924 REMOVE TENDON FOR GRAFT $1,904.00 20926 REMOVE TISSUE FOR GRAFT $1,620.00 20931 ALLOGRAFT, SPINE SURG, STRUCTURAL $461.00 20937 AUTOGRAFT, SPINE SURG, MORSELIZED $665.00 20938 AUTOGRAFT, SPINE SURG, STRUCTURAL $748.00 20950 RECORD INTERCELLULAR FLUID PRESSURE $344.00 20955 MICROVASCULAR FIBULA BONE GRAFT $9,408.00 20956 MICROVASCULAR ILIAC CREST BONE GRFT $10,169.00 20957 MICROVASCULAR METATARSAL BONE GRAFT $9,294.00 20962 MICROVASC BONE GRFT OTH THAN FIBULA $7,989.00 20969 MICROVASC GRFT NOT ILIAC/MET/GRTTOE $10,358.00 20970 MICROVASC BONE‐SKIN GRFT ILIAC CRST $11,377.00 20972 MICROVASCULAR BONE‐SKIN GRAFT, TOE $8,555.00 20973 BONE‐SKIN GRAFT, GREAT TOE $9,898.00 20974 ELECTRICAL BONE STIMULATION $193.00 20975 ELECTR BONE STIMULATION, OPERATIVE $694.00 20979 NULL $119.00 20982 ABLATION BONE TUMOR(S) INC CT GUID $1,395.00 20983 CPTR‐ASST DIR MS PX $1,519.00 20985 CPTR‐ASST DIR MS PX $563.00 21010 INCISION OF TEMPOROMANDIBULAR JOINT $2,763.00 21011 EXCISION, TUMOR, SOFT TISSUE FACE $975.00 21012 EXC FACE LES SBQ 2 CM/> $1,287.00 21013 EXCISION, TUMOR SUBFACIAL LESS 2CM $1,507.00 21014 EXC FACE TUM DEEP 2 CM/> $1,968.00 21015 RADICAL RESECTION, FACE/SCALP TUMOR $2,677.00 21016 RESECT FACE TUM 2 CM/> $3,863.00 21025 REMOVAL OF LOWER JAW BONE $2,845.00 21026 REMOVAL OF FACIAL BONE(S) $1,879.00 21029 CONTOUR BENIGN FACE BONE LESION $2,385.00 21030 REMOVE BENIGN FACE BONE LESION $1,582.00 21031 REMOVE EXOSTOSIS OF LOWER JAW $1,118.00 21032 REMOVE EXOSTOSIS OF UPPER JAW $1,108.00 21034 EXCISE MAX/ZYGOMA MAL TUMOR $4,342.00 21040 REMOVE BENIGN LOWER JAW LESION $1,584.00 21044 REMOVE MALIGNANT LOWER JAW TUMOR $3,283.00 21045 RADICAL RESECTION, MALIG JAW TUMOR $4,607.00 21046 Excision of benign tumor or cyst $4,233.00 21047 Exc of Benign tumor; extra oral‐ost $4,983.00 21048 Exc.of benign tumor of Maxilla; $4,339.00 21049 Exc.of Benign tumor of Maxilla; ext $4,531.00 21050 REMOVAL OF TEMPOROMANDIBULAR JOINT $3,169.00 21060 REMOVAL OF JAW JOINT CARTILAGE $3,052.00 21070 REMOVAL OF CORONOID PROCESS $2,276.00 21073 MNPJ OF TMJ W/ANESTH $957.00 21076 PREP SURGERY OBTURATOR PROSTHESIS $3,188.00 21077 PREPARE ORBITAL PROSTHESIS $8,008.00 21079 PREPARE CLEFT PALATE PROSTHESIS $5,330.00 21080 PREPARE CLEFT PALATE PROSTHESIS $5,924.00 21081 PREPARE MANDIBLE PROSTHESIS $5,457.00 21082 PREPARE PALATAL PROSTHESIS $5,120.00 21083 PREPARE PALATAL PROSTHESIS $4,752.00 21084 PREPARE SPEECH AID PROSTHESIS $5,513.00 21085 PREPARE ORAL SURGICAL SPLINT $2,159.00 21086 PREPARE EAR PROSTHESIS $5,935.00 21087 PREPARE NASAL PROSTHESIS $5,921.00 21088 PREPARE FACIAL PROSTHESIS $3,485.00 21100 APPLY/REMOVE MAXILLOFACIAL FIXATION $1,954.00 21110 APPLY/REMOVE INTERDENTAL FIXATION $2,545.00 21116 INJECTION FOR JAW JOINT X‐RAY $162.00 21120 REVISE/AUGMENT CHIN $1,960.00 21121 REVISE CHIN, SLIDING OSTEOTOMY $2,548.00 21122 REVISE CHIN, SLIDING OSTEOTOMIES $2,465.00 21123 REVISE CHIN, SLIDING W/BONE GRAFTS $3,523.00 21125 AUGMENT LOWER JAW, W/PROSTHESIS $2,953.00 21127 AUGMENT LOWER JAW, W/BONE GRAFT $3,381.00 21137 REDUCE/CONTOUR FOREHEAD $2,911.00 21138 REDUCE/CONTOUR FOREHEAD, PROS/GRAFT $3,298.00 21139 REDUCE/CONTOUR FOREHEAD, SINUS WALL $3,804.00 21141 RECONSTRUCT MIDFACE, LEFORT I, 1PC $5,053.00 21142 RECONSTRUCT MIDFACE, LEFORT I, 2PC $5,309.00 21143 RECONSTRUCT MIDFACE, LEFORT I, 3+PC $5,319.00 21145 RECONSTRUCT MIDFACE, LEFORT I $5,991.00 21146 RECONSTRUCT MIDFACE, LEFORT I $6,392.00 21147 RECONSTRUCT MIDFACE, LEFORT I $6,584.00 21150 RECONSTRUCT MIDFACE, LEFORT II $6,393.00 21151 RECONSTRUCT MIDFACE, LEFORT II $7,535.00 21154 RECONSTRUCT MIDFACE, LEFORT III $7,999.00 21155 RECONSTRUCT MIDFACE, LEFORT III & I $7,927.00 21159 RECONSTRUCT MIDFACE, LEFORT III $9,279.00 21160 RECONSTRUCT MIDFACE, LEFORT III & I $11,975.00 21172 RECONSTRUCT ORBIT/FOREHEAD, PARTIAL $6,735.00 21175 RECONSTRUCT ORBIT/FOREHEAD, PARTIAL $8,614.00 21179 RECONSTRUCT ENTIRE ORBIT/FOREHEAD $5,709.00 21180 RECONSTRUCT ENTIRE ORBIT/FOREHEAD $5,722.00 21181 CONTOUR BENIGN CRANIAL BONE TUMOR $2,772.00 21182 RECONSTRUCT CRANIAL BONE, 0‐39 SQCM $7,303.00 21183 RECONSTRUCT CRANIAL BONE,40‐79 SQCM $8,738.00 21184 RECONSTRUCT CRANIAL BONE, 80+ SQCM $8,243.00 21188 RECONSTRUCT MIDFACE, NOT LEFORT $6,077.00 21193 RECONSTRUCT LOWER JAW BONE $4,778.00 21194 RECONSTRUCT LOWER JAW BONE W/GRAFT $5,399.00 21195 RECONSTRUCT LOWER JAW BONE $4,997.00 21196 RECONSTRUCT LOWER JAW BONE W/FIX $5,577.00 21198 REVISE LOWER JAW BONE $4,400.00 21199 Osteotomey, Mandible, segmental; $4,044.00 21206 REVISE UPPER JAW BONE $4,479.00 21208 AUGMENTATION OF FACIAL BONES $3,134.00 21209 REDUCTION OF FACIAL BONES $2,304.00 21210 FACE BONE GRAFT, NASAL/MAXILL/MALAR $3,283.00 21215 LOWER JAW BONE GRAFT $3,414.00 21230 GRAFT RIB CARTILAGE TO FACE/EAR/NOS $2,714.00 21235 GRAFT EAR CARTILAGE TO NOSE/EAR $2,117.00 21240 RECONSTRUCTION OF JAW JOINT $4,243.00 21242 RECONSTRUCT JAW JOINT W/ALLOGRAFT $3,886.00 21243 RECONSTRUCT JAW JOINT W/PROSTHESIS $6,429.00 21244 RECONSTRUCT LOWER JAW W/BONE PLATE $4,007.00 21245 PARTIAL RECONSTRUCTION OF JAW $3,306.00 21246 COMPLETE RECONSTRUCTION OF JAW $3,275.00 21247 RECONSTRUCT/GRAFT LOWER JAW BONE $5,854.00 21248 RECONSTRUCTION OF JAW, PARTIAL $3,436.00 21249 RECONSTRUCTION OF JAW, COMPLETE $4,890.00 21255 RECONSTRUCT ZYGOMATIC ARCH $5,227.00 21256 RECONSTRUCT ORBIT W/BONE GRAFTS $4,429.00 21260 REVISE EYE SOCKETS, EXTRACRANIAL $5,220.00 21261 REVISE EYE SOCKETS, INTRA/EXTRACRAN $7,958.00 21263 REVISE EYE SOCKETS,FOREHEAD ADVANCE $7,212.00 21267 REPOSITIONING OF EYE SOCKETS $6,098.00 21268 REPOSITIONING OF EYE SOCKETS $6,559.00 21270 AUGMENT CHEEK BONES W/PROSTHESIS $2,623.00 21275 FOLLOWUP REVISION, ORBIT‐FACE BONES $3,136.00 21280 REVISION OF EYELID, MEDIAL $2,159.00 21282 REVISION OF EYELID, LATERAL $1,418.00 21295 REVISE JAW MUSCLE/BONE, EXTRAORAL $751.00 21296 REVISE JAW MUSCLE/BONE, INTRAORAL $1,678.00 21310 TREAT NOSE FX W/O MANIPULATION $100.00 21315 TREAT NOSE FX W/O STABILIZATION $565.00 21320 TREAT NOSE FX W/STABILIZATION $504.00 21325 REPAIR NOSE FX, UNCOMPLICATED $1,767.00 21330 REPAIR NOSE FX, COMPLIC, W/FIXATION $2,115.00 21335 REPAIR NOSE/SEPTUM FRACTURE $2,708.00 21336 REPAIR NASAL SEPTAL FRACTURE $2,400.00 21337 TREAT NASAL SEPTAL FRACTURE $1,102.00 21338 REPAIR NASOETHMOID FX W/O FIXATION $2,748.00 21339 REPAIR NASOETHMOID FX W/FIXATION $3,093.00 21340 TREAT NASOETHMOID COMPLEX FX W/FIX $2,879.00 21343 REPAIR DEPRESSED FRONTAL SINUS FX $4,513.00 21344 REPAIR COMPLICATED FRONTAL SINUS FX $5,928.00 21345 TREAT NASOMAXILLARY COMPLEX FX $2,436.00 21346 REPAIR NASOMAXILLARY COMPLEX FX $3,382.00 21347 REPAIR NASOMAXILLARY COMPLEX FX $4,264.00 21348 REPAIR NASOMAXILLARY COMPLEX FX $4,532.00 21355 REPAIR CHEEK BONE FX W/MANIPULATION $1,194.00 21356 REPAIR DEPRESSED ZYGOMATIC ARCH FX $1,418.00 21360 REPAIR DEPRESSED MALAR FX $2,014.00 21365 REPAIR COMPLIC MALAR FX W/FIXATION $4,166.00 21366 REPAIR COMPLIC MALAR FX W/GRAFT $4,524.00 21385 REPAIR EYE SOCKET FX, TRANSANTRAL $2,526.00 21386 REPAIR EYE SOCKET FX, PERIORBITAL $2,600.00 21387 REPAIR EYE SOCKET FX, COMBINED $2,695.00 21390 REPAIR EYE SOCKET FX, PERIORBITAL $2,944.00 21395 REPAIR EYE SOCKET FX, PERIORBITAL $3,751.00 21400 TREAT EYE SOCKET FX W/O MANIPUL $583.00 21401 TREAT EYE SOCKET FX W/MANIPULATION $1,069.00 21406 REPAIR EYE SOCKET FX W/O IMPLANT $1,978.00 21407 REPAIR EYE SOCKET FX W/IMPLANT $2,396.00 21408 REPAIR EYE SOCKET FX W/BONE GRAFT $3,329.00 21421 TREAT MOUTH ROOF FX, W/FIXATION $2,398.00 21422 REPAIR MOUTH ROOF FRACTURE $2,527.00 21423 REPAIR MOUTH ROOF FX, COMPLICATED $3,070.00 21431 TREAT CRANIOFACIAL FX, W/FIXATION $2,774.00 21432 REPAIR CRANIOFACIAL FX, W/FIXATION $2,564.00 21433 REPAIR CRANIOFACIAL FX, COMPLICATED $6,503.00 21435 REPAIR COMPL CRANIOFACIAL FX W/FIX $4,786.00 21436 REPAIR/GRAFT COMPL CRANIOFACIAL FX $8,129.00 21440 TREAT DENTAL RIDGE FRACTURE $1,766.00 21445 REPAIR DENTAL RIDGE FRACTURE $2,368.00 21450 TREAT LOWER JAW FX W/O MANIPULATION $1,868.00 21451 TREAT LOWER JAW FX W/MANIPULATION $2,413.00 21452 TREAT LOWER JAW FX, W/EXT FIXATION $1,322.00 21453 TREAT LOWER JAW FX, W/INTERDENT FIX $2,949.00 21454 REPAIR LOWER JAW FX, W/EXT FIXATION $2,235.00 21461 REPAIR LOWER JAW FX, W/O FIXATION $3,540.00 21462 REPAIR LOWER JAW FX, W/INT FIXATION $3,947.00 21465 REPAIR MANDIBULAR CONDYLAR FX $3,614.00 21470 REPAIR MANDIBULAR FX, COMPLICATED $4,540.00 21480 RESET DISLOCATED JAW $119.00 21485 RESET DISLOCATED JAW, COMPLICATED $2,214.00 21490 REPAIR DISLOCATED JAW $3,453.00 21497 INTERDENTAL WIRING, OTHER THAN FX $2,305.00 21501 DRAIN NECK/CHEST ABSCESS/HEMATOMA $1,220.00 21502 DRAIN CHEST LESION, REMOVE PART RIB $2,057.00 21510 DRAIN BONE LESION, DEEP, THORAX $1,820.00 21550 BIOPSY OF NECK/CHEST $589.00 21552 EXC NECK LES SC 3 CM/> $1,718.00 21554 EXC NECK TUM DEEP 5 CM/> $2,805.00 21555 REMOVE LESION NECK/CHEST, SUBCUTAN $1,165.00 21556 REMOVE LESION NECK/CHEST, DEEP $2,010.00 21557 RADICAL RESECTION, NECK/CHEST TUMOR $3,654.00 21558 RESECT NECK TUM 5 CM/> $5,158.00 21600 PARTIAL REMOVAL OF RIB $2,129.00 21610 PARTIAL REMOVAL OF RIB $4,915.00 21615 REMOVAL OF CERVICAL RIB $2,405.00 21616 REMOVE RIB W/NERVE REMOVAL $3,149.00 21620 PARTIAL REMOVAL OF STERNUM $1,935.00 21627 STERNAL DEBRIDEMENT $2,070.00 21630 RADICAL STERNUM RESECTION $4,641.00 21632 RADICAL RESECTION, STERNUM/LYMPHS $4,681.00 21685 HYOID MYOTOMY AND SUSPENSION $3,732.00 21700 REVISE NECK MUSCLE W/O RIB RESECT $1,435.00 21705 REVISE NECK MUSCLE W/RIB RESECTION $2,179.00 21720 REVISE NECK MUSCLE, OPEN, W/O CAST $1,897.00 21725 REVISE NECK MUSCLE, OPEN, W/CAST $2,068.00 21740 RECONSTRUCT PECTUS EXCAVATUM $4,255.00 21742 RECONSTRUCTIVE REPAIR, PECTUS EXCAV $2,602.00 21743 RECONSTRUCTIVE REPAIR, PECTUS EXCAV $3,276.00 21750 REPAIR STERNUM SEPARATION $2,657.00 21811 TREAT STERNUM FRACTURE $2,381.00 21812 TREAT STERNUM FRACTURE $2,858.00 21813 OPEN TX RIB FX W/FIXJ THORACOSCOPIC $3,712.00 21820 TREAT STERNUM FRACTURE $537.00 21825 REPAIR STERNUM FRACTURE $2,084.00 21920 BIOPSY BACK/FLANK, SUPERFICIAL $599.00 21925 BIOPSY BACK/FLANK, DEEP $1,348.00 21930 REMOVE BACK/FLANK TUMOR $1,393.00 21931 EXCISION SOFT TISSUE BACK 3CM GREAT $1,811.00 21932 EXCISION SOFT TISSUE BACK LESS 5CM $2,553.00 21933 EXCISION SOFT TISSUE BACK 5CM GREAT $2,843.00 21935 RADICAL RESECTION, BACK/FLANK TUMOR $3,944.00 21936 RADICAL RESECTION BACK 5CM GREATER $5,435.00 22010 I&D, OPEN, ABSCESS POSTR SPINE $3,747.00 22015 I&D, OPEN DEEP ABSCESS, LUMBAR SPIN $3,604.00 22100 REMOVE PART OF NECK VERTEBRA $3,472.00 22101 REMOVE PART OF THORACIC VERTEBRA $3,364.00 22102 REMOVE PART OF LUMBAR VERTEBRA $3,014.00 22103 REMOVE ADD'L VERTEBRAL SEGMENT $553.00 22110 REMOVE PART OF NECK VERTEBRA $4,175.00 22112 REMOVE PART OF THORACIC VERTEBRA $4,054.00 22114 REMOVE PART OF LUMBAR VERTEBRA $3,793.00 22116 REMOVE ADD'L VERTEBRAL SEGMENT $574.00 22206 CUT CPINE 3 COL, THOR $9,701.00 22207 CUT SPINE 3 COL, LUMB $9,455.00 22208 CUT SPINE 3 COL, ADDL SEG $2,322.00 22210 REVISE CERVICAL SPINE, POSTERIOR $7,121.00 22212 REVISE THORACIC SPINE, POSTERIOR $5,805.00 22214 REVISE LUMBAR SPINE, POSTERIOR $5,832.00 22216 REVISE ADD'L VERTEBRAL SEGMENT $1,445.00 22220 REVISE CERVICAL SPINE, ANTERIOR $6,298.00 22222 REVISE THORACIC SPINE, ANTERIOR $5,958.00 22224 REVISE LUMBAR SPINE, ANTERIOR $6,158.00 22226 REVISE ADD'L VERTEBRAL SEGMENT $1,443.00 22310 TREAT SPINE BODY FRACTURE(S) $1,078.00 22315 TREAT SPINE FRACTURE/DISLOCATION $2,996.00 22318 NULL $6,769.00 22319 NULL $7,578.00 22325 REPAIR LUMBAR SPINE FX/DISLOCATION $5,728.00 22326 REPAIR NECK SPINE FX/DISLOCATION $6,028.00 22327 REPAIR THORACIC SPINE FX/DISLOC $6,020.00 22328 TREAT ADD'L FRACTURED VERTEBRAE $1,151.00 22505 MANIPULATE SPINE, ANESTHESIA NEEDED $485.00 22510 DEL2015Percu vertebroplsty,1, uni/b $1,664.00 22511 DEL2015Percu vertebroplsty,1, uni/b $1,565.00 22512 VERTEBROPLASTY EACH ADDL CERVICOTHO $785.00 22513 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI $2,057.00 22514 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI $1,916.00 22515 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI $877.00 22532 ARTH LATERAL EXTRA TECH MIN DISKECT $7,119.00 22533 ARTHRODESIS LAT EXTRA TECH LUMBAR $6,434.00 22534 ARTH LAT EXTRA TECH THORACIC/LUMBAR $1,440.00 22548 NECK SPINE FUSION (ATLAS‐AXIS) $8,254.00 22551 NECK SPINE FUSE&REMOV BEL C2 $6,941.00 22552 ADDL NECK SPINE FUSION $1,636.00 22554 NECK SPINE FUSION (CERV, BELOW C2) $5,031.00 22556 THORACIC SPINE FUSION W/RIB GRAFT $6,642.00 22558 LUMBAR SPINE FUSION W/BONE GRAFT $6,058.00 22585 SPINAL FUSION, EA ADD'L INTERSPACE $1,323.00 22586 SPINE/SKULL FUSION (OCCIPUT‐C2) $6,995.00 22590 SPINE/SKULL FUSION (OCCIPUT‐C2) $6,455.00 22595 NECK SPINE FUSION (C1‐C2) W/GRAFT $6,147.00 22600 NECK SPINE FUSION (CERV, BELOW C2) $5,196.00 22610 THORAX SPINE FUSION, POSTEROLATERAL $5,047.00 22612 LUMBAR SPINE FUSION, POSTEROLATERAL $6,294.00 22614 SPINE FUSION, EACH ADD'L VERTEBRA $1,586.00 22630 LUMBAR SPINE FUSION, POST INTERBODY $6,341.00 22632 SPINE FUSION, EACH ADD'L INTERSPACE $1,316.00 22633 LUMBAR SPINE FUSION COMBINED $7,409.00 22634 SPINE FUSION EXTRA SEGMENT $2,014.00 22800 SPINAL FUSION, 6 OR LESS VERT, POST $5,297.00 22802 SPINAL FUSION, 7‐12 VERT, POST $8,211.00 22804 SPINAL FUSION, POSTERIOR, 13+ VERT $9,517.00 22808 SPINAL FUSION, ANTERIOR, 2‐3 VERT $7,296.00 22810 SPINAL FUSION, 4‐7 VERT, ANTERIOR $8,008.00 22812 SPINAL FUSION, 8+ VERT, ANTERIOR $9,924.00 22818 KYPHECTOMY, 1‐2 SEGMENTS $8,339.00 22819 KYPHECTOMY, 3 OR MORE SEGMENTS $11,605.00 22830 EXPLORATION OF SPINAL FUSION $3,204.00 22840 INSERT SPINE FIXATION, POSTERIOR $3,077.00 22842 INSERT SPINE SEG FIX, POST, 3‐6 SEG $3,086.00 22843 INSERT SPINE SEG FIX, POST,7‐12 SEG $3,292.00 22844 INSERT SPINE SEG FIX, POST, 13+ SEG $3,909.00 22845 INSERT SPINE FIX DEV, ANT, 2‐3 SEG $2,990.00 22846 INSERT SPINE FIX DEV, ANT, 4‐7 SEG $3,104.00 22847 INSERT SPINE FIX DEV, ANT, 8+ SEG $3,361.00 22848 INSERT PELVIC FIXATION DEVICE $1,430.00 22849 REINSERT SPINAL FIXATION DEVICE $5,165.00 22850 REMOVE SPINE FIXATION DEVICE, POST $2,856.00 22852 REMOVE SPINE SEG FIXATION DEV, POST $2,732.00 22855 REMOVE SPINE FIXATION DEV, ANTERIOR $4,436.00 22856 NULL $6,492.00 22857 TOTL DISC ARTRPLSTY ANTR APRCH LUMB $8,090.00 22858 Insj biomchn dev ntrvrt d $2,049.00 22861 NULL $8,212.00 22862 REVSN TOTAL DISC ARTHRPLSTY LUMBR $8,093.00 22864 NULL $8,541.00 22865 REMOVAL TOTL DISC ARTHRPLSTY, LUMBR $7,857.00 22900 REMOVE ABDOMINAL WALL LESION $2,175.00 22901 EXC ABDL TUM DEEP 5 CM/> $2,566.00 22902 EXCISION ABD WALL LESS THAN 3CM $1,271.00 22903 EXC ABD LES SC 3 CM/> $1,693.00 22904 RADICAL RESECTION ABD WALL 5CM LESS $4,044.00 22905 RADICAL RESECTION ABD WALL 5CM GREA $5,133.00 23000 REMOVE CALCIUM DEPOSITS, OPEN $1,400.00 23020 RELEASE SHOULDER JOINT $2,604.00 23030 DRAIN SHOULDER LESION, DEEP $972.00 23031 DRAIN INFECTED SHOULDER BURSA $828.00 23035 DRAIN SHOULDER BONE LESION $2,560.00 23040 GLENOHUMERAL JOINT SURGERY $2,725.00 23044 ACROMIO/STERNOCLAVICULAR JOINT SURG $2,160.00 23065 BIOPSY SHOULDER TISSUE, SUPERFICIAL $626.00 23066 BIOPSY SHOULDER TISSUE, DEEP $1,352.00 23071 EXC SHOULDER LES SC 3 CM/> $1,614.00 23073 EXC SHOULDER TUM DEEP 5 CM/> $2,658.00 23075 REMOVE SUBCUTANEOUS SHOULDER LESION $1,245.00 23076 REMOVE DEEP SHOULDER LESION $2,065.00 23077 RADICAL RESECTION, SHOULDER TUMOR $4,398.00 23078 RESECT SHOULDER TUM 5 CM/> $5,507.00 23100 GLENOHUMERAL JT ARTHROTOMY W/BIOP $1,884.00 23101 SHOULDER JOINT ARTHROTOMY W/BIOPSY $1,722.00 23105 REMOVE GLENOHUMERAL JOINT LINING $2,411.00 23106 REMOVE COLLARBONE JOINT LINING $1,861.00 23107 EXPLORE/TREAT GLENOHUMERAL JOINT $2,488.00 23120 PARTIAL REMOVAL OF COLLARBONE $2,205.00 23125 REMOVAL OF COLLARBONE $2,693.00 23130 PARTIAL REMOVAL OF SHOULDER BONE $2,310.00 23140 REMOVE CLAVICLE/SCAPULA BONE LESION $2,025.00 23145 REMOVE CLAVICLE LESION W/AUTOGRAFT $2,638.00 23146 REMOVE CLAVICLE LESION W/ALLOGRAFT $2,345.00 23150 REMOVE HUMERUS LESION $2,476.00 23155 REMOVE HUMERUS LESION W/AUTOGRAFT $3,013.00 23156 REMOVE HUMERUS LESION W/ALLOGRAFT $2,557.00 23170 REMOVE CLAVICLE ABSCESS/LESION $2,105.00 23172 REMOVE SCAPULA ABSCESS/LESION $2,139.00 23174 REMOVE HUMERUS ABSCESS/LESION $2,836.00 23180 PARTIAL REMOVAL, CLAVICLE BONE $2,534.00 23182 PARTIAL REMOVAL, SCAPULA BONE $2,460.00 23184 PARTIAL REMOVAL, PROXIMAL HUMERUS $2,781.00 23190 PARTIAL REMOVAL, SCAPULA $2,149.00 23195 REMOVE HEAD OF HUMERUS $2,853.00 23200 RADICAL RESECTION, CLAVICLE TUMOR $5,704.00 23210 RADICAL RESECTION, SCAPULA TUMOR $6,765.00 23220 RADICAL RESECT, PROX HUMERUS TUMOR $7,386.00 23330 REMOVE SHOULDER FOREIGN BODY, SUBCU $561.00 23333 INJECTION FOR SHOULDER X‐RAY $1,697.00 23334 INJECTION FOR SHOULDER X‐RAY $4,093.00 23335 PROSTHESIS REMOVAL HUMERAL AND GLEN $4,872.00 23350 INJECTION FOR SHOULDER X‐RAY $183.00 23395 MUSCLE TRANSFER, SHOULDER/UPPER ARM $4,874.00 23397 MUSCLE TRANSFERS, SHOULDER/UPPERARM $4,339.00 23400 FIXATION OF SCAPULA $3,696.00 23405 TENOMYOTOMY, SHOULDER AREA, SINGLE $2,359.00 23406 TENOMYOTOMY, SHOULDER AREA, MULT $2,891.00 23410 REPAIR RUPTURED ROTATOR CUFF, ACUTE $3,115.00 23412 REPAIR RUPTURED ROTATOR CUFF, CHRON $3,229.00 23415 RELEASE SHOULDER LIGAMENT $2,641.00 23420 RECONSTRUCT SHOULDER CUFF AVULSION $3,674.00 23430 REPAIR BICEPS LONG TENDON RUPTURE $2,819.00 23440 REMOVE/TRANSPLNT LONG BICEPS TENDON $2,859.00 23450 REPAIR SHOULDER CAPSULE,PUTTI‐PLATT $3,584.00 23455 REPAIR SHOULDER CAPSULE, W/LABRAL $3,787.00 23460 REPAIR SHOULDER CAP W/BONE BLOCK $4,153.00 23462 REPAIR SHOULDER CAP W/CORACOID XFER $4,020.00 23465 REPAIR SHOULDER CAPSULE $4,208.00 23466 REPAIR SHLDR CAPSULE ANY MULTI‐DIR $4,229.00 23470 RECONSTRUCT SHOULDER JOINT, IMPLANT $4,567.00 23472 RECONSTRUCT/REPLACE SHOULDER JOINT $5,530.00 23473 REVISE CLAVICLE (COLLARBONE) $6,180.00 23474 REVISE CLAVICLE (COLLARBONE) $6,677.00 23480 REVISE CLAVICLE (COLLARBONE) $3,120.00 23485 REVISE CLAVICLE W/BONE GRAFT $3,619.00 23490 REINFORCE CLAVICLE $3,174.00 23491 REINFORCE PROXIMAL HUMERUS $3,852.00 23500 TREAT CLAVICLE FRACTURE $825.00 23505 TREAT CLAVICLE FX W/MANIPULATION $1,248.00 23515 REPAIR CLAVICLE FRACTURE $2,724.00 23520 TREAT CLAVICLE DISLOCATION $850.00 23525 TREAT CLAVICLE DISLOCATION, W/MANIP $1,302.00 23530 REPAIR CLAVICLE DISLOCATION $2,081.00 23532 REPAIR CLAVICLE DISLOCATION W/GRAFT $2,331.00 23540 TREAT CLAVICLE DISLOCATION $846.00 23545 TREAT CLAVICLE DISLOCATION W/MANIP $1,141.00 23550 REPAIR CLAVICLE DISLOCATION $2,121.00 23552 REPAIR CLAVICLE DISLOCATION W/GRAFT $2,473.00 23570 TREAT SCAPULAR FRACTURE $892.00 23575 TREAT SCAPULAR FX, W/MANIPULATION $1,407.00 23585 REPAIR SCAPULAR FRACTURE $3,716.00 23600 TREAT HUMERAL FRACTURE $1,146.00 23605 TREAT HUMERAL FX, W/MANIPULATION $1,591.00 23615 REPAIR HUMERAL FRACTURE $3,350.00 23616 REPAIR HUMERAL FX, W/PROSTHESIS $4,716.00 23620 TREAT GREAT HUMERAL TUBEROSITY FX $955.00 23625 TREAT GREAT HUMRL TUBER FX W/MANIP $1,319.00 23630 REPAIR GREAT HUMERAL TUBEROSITY FX $2,955.00 23650 TREAT SHOULDER DISLOCATION $1,060.00 23655 TREAT SHOULDER DISLOC W/ANESTHESIA $1,506.00 23660 REPAIR ACUTE SHOULDER DISLOCATION $2,193.00 23665 TREAT SHOULDER DISLOC W/FX W/MANIP $1,481.00 23670 REPAIR SHOULDER DISLOC W/GT FX $3,318.00 23675 TREAT SHOULDER DISLOC W/FX W/MANIP $1,883.00 23680 REPAIR SHOULDER DISLOCATION W/FX $3,515.00 23700 SHOULDER MANIPUL W/ANESTH/FIXATION $744.00 23800 FUSION OF SHOULDER JOINT $3,907.00 23802 FUSION OF SHOULDER JOINT W/GRAFT $4,784.00 23900 INTERTHORACOSCAPULAR AMPUTATION $5,289.00 23920 AMPUTATION AT SHOULDER JOINT $4,281.00 23921 SHOULDER AMPUTATION FOLLOWUP SURG $1,771.00 23930 DRAIN ARM/ELBOW ABSCESS/HEMATOMA $821.00 23931 DRAIN INFECTED ARM/ELBOW BURSA $599.00 23935 DRAIN ARM/ELBOW BONE LESION $1,907.00 24000 EXPLORATORY ELBOW SURGERY $1,794.00 24006 RELEASE ELBOW JOINT $2,661.00 24065 BIOPSY SFT TISS ARM/ELBOW, SUPERFIC $625.00 24066 BIOPSY SFT TISSUE ARM/ELBOW, DEEP $1,585.00 24071 EXC ARM/ELBOW LES SC 3 CM/> $1,557.00 24073 EX ARM/ELBOW TUM DEEP 5 CM/> $2,647.00 24075 REMOVE SUBCUTANEOUS ARM/ELBOW TUMOR $1,256.00 24076 REMOVE DEEP ARM/ELBOW TUMOR $2,068.00 24077 REMOVE TUMOR OF ARM/ELBOW $3,972.00 24079 RESECT ARM/ELBOW TUM 5 CM/> $5,067.00 24100 BIOPSY ELBOW JOINT LINING $1,580.00 24101 EXPLORE/TREAT ELBOW JOINT $1,885.00 24102 REMOVE ELBOW JOINT LINING $2,323.00 24105 REMOVE ELBOW BURSA $1,318.00 24110 REMOVE HUMERUS LESION $2,187.00 24115 REMOVE HUMERUS LESION W/AUTOGRAFT $2,802.00 24116 REMOVE HUMERUS LESION W/ALLOGRAFT $3,280.00 24120 REMOVE ELBOW LESION $1,991.00 24125 REMOVE ELBOW LESION W/AUTOGRAFT $2,300.00 24126 REMOVE ELBOW LESION W/ALLOGRAFT $2,463.00 24130 REMOVE HEAD OF RADIUS $1,915.00 24134 REMOVE SHAFT/DISTAL HUMERUS LESION $2,830.00 24136 REMOVE RADIAL HEAD/NECK LESION $2,329.00 24138 REMOVE ELBOW BONE LESION $2,544.00 24140 PARTIAL HUMERAL BONE REMOVAL $2,644.00 24145 PARTIAL RADIAL HEAD/NECK BONE REMVL $2,245.00 24147 PARTIAL OLECRANON PROCESS BONE REMV $2,347.00 24149 RADICAL RESECT/RELEASE ELBOW JOINT $4,433.00 24150 RADICAL RESECTION, HUMERUS TUMOR $5,948.00 24152 RADICAL RESECTION, RADIUS TUMOR $5,016.00 24155 REMOVE ELBOW JOINT $3,204.00 24160 REMOVE ELBOW JOINT IMPLANT $4,798.00 24164 REMOVE RADIUS HEAD IMPLANT $2,775.00 24200 REMOVE SUBCUTAN FOREIGN BODY, ARM $521.00 24201 REMOVE DEEP FOREIGN BODY, ARM $1,371.00 24220 INJECTION FOR ELBOW X‐RAY $250.00 24300 MANIPULATE ELBOW W/ANESTH $1,563.00 24301 MUSCLE/TENDON XFER, UPPER ARM/ELBOW $2,827.00 24305 LENGTHEN UPPER ARM TENDON EA TENDON $2,160.00 24310 REVISE UPPER ARM TENDON, EA TENDON $1,766.00 24320 REPAIR UPPER ARM TENDON W/MUSC XFER $2,969.00 24330 FLEXOR‐PLASTY, ELBOW (STEINDLER) $2,726.00 24331 FLEXOR‐PLASTY, ELBOW W/EXTENSOR ADV $2,989.00 24332 Tenolysis, triceps $2,319.00 24340 REPAIR BICEPS TENDON RUPTURE $2,311.00 24341 REPAIR TENDON/MUSCLE UPPERARM/ELBOW $2,816.00 24342 REINSERT RUPT BICEPS/TRICEPS TENDON $2,929.00 24343 Repair lateral collateral ligament $2,658.00 24344 Reconstruction lateral collateral $4,164.00 24345 Rep.Medial Collateral ligament $2,651.00 24346 Reconstruction medial collateral li $4,142.00 24357 REPAIR ELBOW, PERC $1,598.00 24358 REPAIR ELBOW W/DEB, OPEN $1,962.00 24359 REPAIR ELBOW DEB/ATTCH OPEN $2,481.00 24360 RECONSTRUCT ELBOW JOINT W/MEMBRANE $3,352.00 24361 RECONSTRUCT ELBOW W/HUMERAL REPLACE $3,792.00 24362 RECONSTRUCT ELBOW W/IMPLANT $4,038.00 24363 REPLACE TOTAL ELBOW JOINT $5,510.00 24365 RECONSTRUCT RADIUS HEAD $2,410.00 24366 RECONSTRUCT RADIUS HEAD W/IMPLANT $2,563.00 24370 REVISE HUMERUSes $5,925.00 24371 REVISE HUMERUSes $6,755.00 24400 REVISE HUMERUS $3,090.00 24410 REVISE HUMERUS W/REALIGN (SOFIELD) $4,026.00 24420 SHORTEN/LENGTHEN HUMERUS $3,688.00 24430 REPAIR HUMERUS NONUNION/MALUNION $4,002.00 24435 REPAIR HUMERUS NON/MALUNION W/GRAFT $4,078.00 24470 REVISION OF ELBOW JOINT $2,288.00 24495 DECOMPRESS FOREARM W/EXPLORATION $2,483.00 24498 PROPHYLACTIC TREAT, HUMERAL SHAFT $3,281.00 24500 TREAT HUMERAL SHAFT FRACTURE $1,215.00 24505 TREAT HUMERAL SHAFT FX W/MANIPUL $1,692.00 24515 REPAIR HUMERAL SHAFT FX W/PLATE $3,316.00 24516 REPAIR HUMERAL SHAFT FX W/IMPLANT $3,263.00 24530 TREAT HUMERAL FRACTURE $1,286.00 24535 TREAT HUMERAL FRACTURE W/MANIPUL $2,132.00 24538 SKELETAL FIXATION OF HUMERAL FX $2,816.00 24545 REPAIR HUMERUS FRACTURE $3,520.00 24546 REPAIR HUMERUS FX W/CONDYLAR EXTEN $3,937.00 24560 TREAT HUMERAL EPICONDYLAR FX $1,063.00 24565 TREAT HUMERAL EPICOND FX W/MANIPUL $1,832.00 24566 TREAT HUMERAL EPICOND FX W/FIXATION $2,717.00 24575 REPAIR HUMERAL EPICONDYLAR FX $2,756.00 24576 TREAT HUMERAL CONDYLAR FX $1,135.00 24577 TREAT HUMERAL CONDYLAR FX W/MANIP $1,876.00 24579 REPAIR HUMERAL CONDYLAR FRACTURE $3,161.00 24582 TREAT HUMERAL CONDYLAR FX W/FIX $3,039.00 24586 REPAIR ELBOW FRACTURE/DISLOCATION $4,101.00 24587 REPAIR ELBOW FX/DISLOCAT W/IMPLANT $4,082.00 24600 TREAT ELBOW DISLOCATION $1,230.00 24605 TREAT ELBOW DISLOCATION, W/ANESTH $1,769.00 24615 REPAIR ELBOW DISLOCATION $2,691.00 24620 TREAT ELBOW FX/DISLOC, MONTEGGIA $2,057.00 24635 REPAIR ELBOW FX/DISLOC, MONTEGGIA $2,541.00 24640 TREAT NURSEMAID ELBOW $341.00 24650 TREAT RADIUS FRACTURE $891.00 24655 TREAT RADIUS FX W/MANIPULATION $1,474.00 24665 REPAIR RADIUS HEAD/NECK FRACTURE $2,456.00 24666 REPAIR RADIUS HEAD/NECK FX W/PROSTH $2,767.00 24670 TREAT ULNAR FRACTURE $977.00 24675 TREAT ULNAR FX W/MANIPULATION $1,546.00 24685 REPAIR ULNAR FRACTURE $2,468.00 24800 FUSION OF ELBOW JOINT, LOCAL $3,151.00 24802 FUSION OF ELBOW JOINT, W/AUTOGRAFT $3,696.00 24900 AMPUTATE UPPER ARM, PRIMARY CLOSURE $2,775.00 24920 AMPUTATE UPPER ARM, OPEN, CIRCULAR $2,770.00 24925 UPPER ARM AMPUTATION FOLLOW‐UP SURG $2,083.00 24930 RE‐AMPUTATE UPPER ARM $2,925.00 24931 AMPUTATE UPPER ARM, W/IMPLANT $2,956.00 24935 REVISE UPPER ARM AMPUTATION $4,262.00 24940 REVISION OF UPPER ARM $2,286.00 25000 INCISION OF TENDON SHEATH, WRIST $1,261.00 25001 Inc,Flexor tendon sheath, wrist $1,278.00 25020 DECOMPRESSION OF FOREARM/WRIST $2,146.00 25023 DECOMPRESS FOREARM/WRIST W/DEBRIDE $4,142.00 25024 Decompressoin Fasciotomy, forearm.. $2,927.00 25025 Decomp. fasciotomoy, F/A &/or wrist $4,555.00 25028 DRAINAGE OF FOREARM/WRIST LESION $1,964.00 25031 INCISE/DRAIN FOREARM/WRIST BURSA $1,350.00 25035 INCISE/DRAIN BONE CORTEX FRARM/WRST $2,175.00 25040 EXPLORE/TREAT WRIST JOINT $2,110.00 25065 BIOPSY FOREARM SOFT TISSUE,SUPERFIC $607.00 25066 BIOPSY FOREARM SOFT TISSUE, DEEP $1,352.00 25071 EXC FOREARM LES SC 3 CM/> $1,625.00 25073 EXC FOREARM TUM DEEP 3 CM/> $2,013.00 25075 REMOVE SUBCUT FOREARM/WRIST LESION $1,200.00 25076 REMOVE DEEP FOREARM/WRIST LESION $1,946.00 25077 RADICAL RESECT TUMOR, FOREARM/WRIST $3,376.00 25078 RESECT FORARM/WRIST TUM 3CM> $4,442.00 25085 INCISION OF WRIST CAPSULE $1,686.00 25100 BIOPSY OF WRIST JOINT $1,299.00 25101 EXPLORE/TREAT WRIST JOINT $1,508.00 25105 REMOVE WRIST JOINT LINING $1,803.00 25107 REMOVE WRIST JOINT CARTILAGE $2,304.00 25109 EXCSN TENDN FORARM/WRIST FLXR/EXTNS $2,009.00 25110 REMOVE FOREARM/WRIST TENDON LESION $1,286.00 25111 REMOVE WRIST GANGLION $1,201.00 25112 RE‐REMOVE WRIST GANGLION $1,450.00 25115 REMOVE WRIST/FOREARM LESION,FLEXORS $2,844.00 25116 REMOVE WRIST/FOREARM LESION,EXTENSO $2,241.00 25118 REMOVE WRIST TENDON SHEATH $1,427.00 25119 REMOVE WRIST TEND SHEATH, PART ULNA $1,850.00 25120 REMOVAL OF FOREARM LESION $1,862.00 25125 REMOVE FOREARM LESION, W/AUTOGRAFT $2,193.00 25126 REMOVE FOREARM LESION, W/ALLOGRAFT $2,247.00 25130 REMOVAL OF WRIST LESION $1,664.00 25135 REMOVE WRIST LESION, W/AUTOGRAFT $2,089.00 25136 REMOVE WRIST LESION, W/ALLOGRAFT $1,849.00 25145 REMOVE FOREARM/WRIST BONE LESION $1,955.00 25150 PARTIAL REMOVAL OF ULNA $2,134.00 25151 PARTIAL REMOVAL OF RADIUS $2,203.00 25170 RADICAL RESECTION, FOREARM TUMOR $5,649.00 25210 REMOVAL OF WRIST BONE $1,817.00 25215 REMOVAL OF WRIST BONES $2,312.00 25230 REMOVAL OF RADIAL STYLOID $1,620.00 25240 REMOVAL OF DISTAL ULNA $1,593.00 25246 INJECTION FOR WRIST X‐RAY $272.00 25248 REMOVE OBJECT FROM FOREARM/WRIST $1,570.00 25250 REMOVE WRIST PROSTHESIS $1,945.00 25251 REMOVE WRIST PROSTHESIS,COMPLICATED $2,722.00 25259 MANIPULATION,WRIST,UNDER ANESTHESIA $1,550.00 25260 REPAIR FOREARM/WRIST TENDON/MUSCLE $2,362.00 25263 REPAIR FOREARM/WRIST TENDON/MUSCLE $2,326.00 25265 REPAIR FOREARM/WRIST TENDON/MUSCLE $2,828.00 25270 REPAIR FOREARM/WRIST TENDON/MUSCLE $1,828.00 25272 REPAIR FOREARM/WRIST TENDON/MUSCLE $2,074.00 25274 REPAIR FOREARM/WRIST TENDON/MUSCLE $2,489.00 25275 Repair,Tendon sheath,extensor,F/A $2,520.00 25280 LENGTH/SHORTEN FOREARM/WRIST TENDON $2,102.00 25290 INCISE WRIST/FOREARM TENDON $1,634.00 25295 RELEASE WRIST/FOREARM TENDON $1,960.00 25300 FUSE FINGER TENDONS AT WRIST, FLEX $2,554.00 25301 FUSE FINGER TENDONS AT WRIST,EXTENS $2,416.00 25310 TRANSPLANT FOREARM/WRIST TENDON $2,321.00 25312 TRANSPLANT/GRAFT FOREARM/WRIST TEND $2,680.00 25315 FLEXOR ORIGIN SLIDE, CEREBRAL PALSY $2,920.00 25316 REVISE PALSY FOREARM/WRIST TENDON $3,474.00 25320 REPAIR/REVISE WRIST JOINT $3,702.00 25332 ARTHROPLASTY, WRIST $3,160.00 25335 REALIGNMENT OF HAND $3,120.00 25337 RECONSTRUCT UNSTABLE RADIOULNAR JT $3,335.00 25350 REVISION OF RADIUS, DISTAL 1/3 $2,527.00 25355 REVISION OF RADIUS, MID/PROX 1/3 $2,841.00 25360 REVISION OF ULNA $2,457.00 25365 REVISION OF RADIUS AND ULNA $3,452.00 25370 REVISION OF RADIUS/ULNA, MULTIPLE $3,809.00 25375 REVISION OF RADIUS AND ULNA, MULT $3,622.00 25390 SHORTEN RADIUS/ULNA $2,889.00 25391 LENGTHEN RADIUS/ULNA W/AUTOGRAFT $3,788.00 25392 SHORTEN RADIUS AND ULNA $3,689.00 25393 LENGTHEN RADIUS AND ULNA $4,239.00 25394 Osteoplay, carpal bone, shortening $2,951.00 25400 REPAIR NONUNION, RADIUS/ULNA $3,028.00 25405 REPAIR/GRAFT NONUNION, RADIUS/ULNA $3,909.00 25415 REPAIR NONUNION, RADIUS & ULNA $3,652.00 25420 REPAIR/GRAFT NONUNION RADIUS & ULNA $4,429.00 25425 REPAIR/GRAFT RADIUS/ULNA DEFECT $3,663.00 25426 REPAIR/GRAFT RADIUS & ULNA DEFECT $4,281.00 25430 Insertion of vascular pedicle carpa $2,773.00 25431 Repair of nonunion of carpal bone $2,972.00 25440 REPAIR/GRAFT NONUNION, WRIST BONE $2,877.00 25441 RECONSTRUCT WRIST JOINT,DIST RADIUS $3,475.00 25442 RECONSTRUCT WRIST JOINT, DIST ULNA $3,019.00 25443 RECONSTRUCT WRIST JOINT, SCAPHOID $2,966.00 25444 RECONSTRUCT WRIST JOINT, LUNATE $3,137.00 25445 RECONSTRUCT WRIST JOINT, TRAPEZIUM $2,719.00 25446 TOTAL WRIST REPLACEMENT $4,398.00 25447 REPAIR/REVISE WRIST JOINT(S) $3,103.00 25449 REMOVE WRIST JOINT IMPLANT $3,881.00 25450 SURGERY TO STOP ARM GROWTH $2,234.00 25455 SURGERY TO STOP ARM GROWTH $2,402.00 25490 REINFORCE RADIUS $2,729.00 25491 REINFORCE ULNA $2,808.00 25492 REINFORCE RADIUS AND ULNA $3,437.00 25500 TREAT RADIUS FRACTURE $930.00 25505 TREAT RADIUS FRACTURE, W/MANIPUL $1,718.00 25515 REPAIR RADIUS FRACTURE $2,525.00 25520 TREAT RADIUS FX/DISLOC (GALEAZZI) $1,994.00 25525 REPAIR RADIUS FX/DISLOC (GALEAZZI) $2,960.00 25526 REPAIR RADIUS FX/DISLOC (GALEAZZI) $3,595.00 25530 TREAT ULNA FRACTURE $883.00 25535 TREAT ULNA FRACTURE, W/MANIPULATION $1,694.00 25545 REPAIR ULNA FRACTURE $2,345.00 25560 TREAT RADIUS & ULNA FRACTURES $929.00 25565 TREAT RADIUS & ULNA FX, W/MANIPUL $1,755.00 25574 REPAIR RADIUS/ULNA FX, W/FIXATION $2,537.00 25575 REPAIR RADIUS & ULNA FX, W/FIXATION $3,407.00 25600 TREAT RADIUS/ULNA FRACTURE $1,151.00 25605 TREAT RADIUS/ULNA FX,W/MANIPULATION $1,917.00 25606 PERCU SKLTL FXTN OF DISTL RADIAL FX $2,504.00 25607 OPEN TX OF DSTL EXTRA‐ARTICULAR FX $2,770.00 25608 OPN TX DISTL RADIAL FX W INT FXTN 2 $3,106.00 25609 OPN TX DISTL RADIAL FX W INT FXTN 3 $3,948.00 25622 TREAT NAVICULAR FRACTURE $1,026.00 25624 TREAT NAVICULAR FRACTURE, W/MANIPUL $1,623.00 25628 REPAIR NAVICULAR FRACTURE $2,709.00 25630 TREAT WRIST BONE FX, EACH BONE $1,041.00 25635 TREAT WRIST BONE FX, W/MANIPUL, EA $1,408.00 25645 REPAIR WRIST BONE FX, EACH BONE $2,143.00 25650 TREAT ULNAR STYLOID FRACTURE $1,112.00 25651 Percut.Skeletal Fix. Ulnar styloid $1,810.00 25652 Open Tx of ulnar styloid Fx $2,350.00 25660 TREAT WRIST DISLOCATION, W/MANIPUL $1,516.00 25670 REPAIR WRIST DISLOCATION $2,279.00 25671 Perc. Skel.Fix. of distal radioulna $1,999.00 25675 TREAT WRIST DISLOCATION, W/MANIPUL $1,462.00 25676 REPAIR WRIST DISLOCATION $2,357.00 25680 TREAT WRIST FX/DISLOCATION, W/MANIP $1,753.00 25685 REPAIR WRIST FRACTURE/DISLOCATION $2,774.00 25690 TREAT LUNATE DISLOCATION, W/MANIP $1,788.00 25695 REPAIR LUNATE DISLOCATION $2,400.00 25800 FUSION OF WRIST JOINT W/O GRAFT $2,748.00 25805 FUSE WRIST JOINT W/SLIDING GRAFT $3,206.00 25810 FUSE WRIST JOINT W/AUTOGRAFT $3,254.00 25820 FUSION OF WRIST BONES $2,302.00 25825 FUSION OF WRIST BONES W/AUTOGRAFT $2,832.00 25830 DISTAL RADIOULNAR JOINT FUSION $3,536.00 25900 AMPUTATION OF FOREARM $2,673.00 25905 AMPUTATION OF FOREARM (GUILLOTINE) $2,500.00 25907 FOLLOWUP AMPUTATION, FOREARM $2,224.00 25909 RE‐AMPUTATION OF FOREARM $2,599.00 25915 AMPUTATION OF FOREARM (KRUKENBERG) $4,455.00 25920 AMPUTATION OF HAND AT WRIST $2,630.00 25922 FOLLOWUP AMPUTATION, HAND AT WRIST $2,173.00 25924 RE‐AMPUTATION OF HAND AT WRIST $2,408.00 25927 AMPUTATION OF HAND $3,067.00 25929 FOLLOWUP AMPUTATION OF HAND $2,243.00 25931 RE‐AMPUTATION OF HAND $2,633.00 26010 DRAINAGE OF FINGER ABSCESS, SIMPLE $506.00 26011 DRAINAGE OF FINGER ABSCESS, COMPLIC $691.00 26020 DRAIN HAND/DIGIT TENDON SHEATH, EA $1,625.00 26025 DRAINAGE OF PALMER BURSA, SINGLE $1,584.00 26030 DRAINAGE OF PALMER BURSA, MULTIPLE $1,841.00 26034 INCISE BONE CORTEX, HAND OR FINGER $2,017.00 26035 DECOMPRESS HAND/DIGIT,INJECT INJURY $3,187.00 26037 DECOMPRESSION OF HAND $2,129.00 26040 RELEASE PALM CONTRACTURE, PERCUT $1,161.00 26045 RELEASE PALM CONTRACTURE, OPEN PRTL $1,763.00 26055 TENDON SHEATH INCISION, FINGER $1,159.00 26060 INCISION OF FINGER TENDON, PERCUTAN $988.00 26070 EXPLORE/TREAT HAND JOINT $1,166.00 26075 EXPLORE/TREAT FINGER JOINT $1,242.00 26080 EXPLORE/TREAT FINGER JOINT $1,459.00 26100 BIOPSY OF HAND JOINT LINING $1,253.00 26105 BIOPSY OF FINGER JOINT LINING $1,245.00 26110 BIOPSY OF FINGER JOINT LINING $1,199.00 26111 EXC HAND LES SC 1.5 CM/> $1,570.00 26113 EXC HAND TUM DEEP 1.5 CM/> $2,056.00 26115 REMOVAL OF HAND/FINGER LESION $1,247.00 26116 REMOVAL OF HAND/FINGER LESION, DEEP $1,977.00 26117 RADICAL RESECTION,HAND/FINGER TUMOR $2,817.00 26118 RADICAL RESEC HAND/FINGER 3CM GREAT $3,962.00 26121 RELEASE CONTRACTURE, PALM ONLY $2,241.00 26123 FASCIECTOMY, PRT PALMER, SNGL DIGIT $3,129.00 26125 FASCIECTOMY, PRT PALMAR EA ADD DIG $1,039.00 26130 REMOVE WRIST JOINT LINING $1,745.00 26135 REVISE FINGER JOINT, EACH $2,053.00 26140 REVISE FINGER JOINT, EACH $1,886.00 26145 EXCISE TENDON, PALM/FINGER, EA TEND $1,918.00 26160 REMOVE TENDON SHEATH LESION, HAND $1,247.00 26170 REMOVAL OF PALM TENDON, EACH $1,508.00 26180 REMOVAL OF FINGER TENDON, EA TENDON $1,648.00 26185 THUMB OR FINGER SESAMOIDECTOMY $2,014.00 26200 REMOVE HAND BONE LESION $1,684.00 26205 REMOVE HAND BONE LESION W/AUTOGRAFT $2,284.00 26210 REMOVE FINGER LESION $1,653.00 26215 REMOVE FINGER LESION W/ AUTOGRAFT $2,132.00 26230 PARTIAL REMOVAL OF HAND BONE $1,864.00 26235 PARTIAL REMOVAL OF FINGER BONE $1,845.00 26236 PARTIAL REMOVAL OF FINGER BONE $1,652.00 26250 RADICAL RESECTION, HAND $4,031.00 26260 RADICAL RESECTION, FINGER $2,994.00 26262 RADICAL RESECTION, FINGER $2,321.00 26320 REMOVE IMPLANT FROM HAND/FINGER $1,296.00 26340 MANIPULATE FINGER W/ANESTH $1,242.00 26341 MANIPULAT PALM CORD POST INJ $280.00 26350 REPAIR FINGER/HAND TENDON, EACH $2,615.00 26352 SECONDARY REP/GRFT HAND TENDON, EA $3,038.00 26356 REPAIR FINGER/HAND TENDON, EACH $3,913.00 26357 SECONDARY REP FNGR/HAND TENDON, EA $3,240.00 26358 SECOND REP FNGR/HAND TEND W/GRFT EA $3,605.00 26370 REPAIR PROFUNDUS TENDON, PRIMARY EA $2,783.00 26372 SECOND PROFUNDUS TENDON REP/GRFT EA $3,255.00 26373 SECONDARY PROFUNDUS TENDON REP, EA $3,130.00 26390 REVISE HAND/FINGER TENDON, EA $3,121.00 26392 REMOVE IMPLNT, INSERT GRAFT EA TEND $3,592.00 26410 REPAIR HAND TENDON, EACH $2,080.00 26412 REPAIR HAND TENDON W/FREE GRAFT, EA $2,508.00 26415 REMOVE HAND TENDON, ADD IMPLANT $2,836.00 26416 REMOVE HAND/FINGER TENDON IMPLANT $2,983.00 26418 REPAIR FINGER TENDON, EACH $2,119.00 26420 REPAIR FINGER TENDON W/GRAFT, EACH $2,599.00 26426 SECONDARY FINGER/HAND TENDON REP EA $1,875.00 26428 SECONDARY REP/GRFT FINGER TENDON EA $2,786.00 26432 REPAIR FINGER TENDON, CLOSED $1,831.00 26433 REPAIR FINGER TENDON W/O GRAFT $1,952.00 26434 REPAIR FINGER TENDON W/GRAFT $2,392.00 26437 REALIGNMENT OF HAND TENDONS, EACH $2,290.00 26440 RELEASE PALM/FINGER TENDON, EACH $2,268.00 26442 RELEASE PALM & FINGER TENDON, EACH $3,550.00 26445 RELEASE HAND/FINGER TENDON, EACH $2,113.00 26449 RELEASE FRARM/HAND TEND, COMPLEX EA $2,593.00 26450 INCISION PALM TENDON, OPEN, EACH $1,501.00 26455 INCISION FINGER TENDON, OPEN, EACH $1,473.00 26460 INCISE HAND/FINGER TENDON, OPEN, EA $1,449.00 26471 FINGER TENDON FUSION,PROXIMAL JOINT $2,249.00 26474 FINGER TENDON FUSION, DISTAL JOINT $2,224.00 26476 TENDON LENGTHENING, HAND/FINGER $2,111.00 26477 TENDON SHORTENING, HAND/FINGER $2,129.00 26478 TENDON LENGTHENING, HAND/FINGER $2,277.00 26479 TENDON SHORTENING, HAND/FINGER $2,234.00 26480 TRANSPLANT HAND TENDON, EACH $2,748.00 26483 TRANSPLANT/GRAFT HAND TENDON, EACH $3,104.00 26485 TRANSPLANT PALM TENDON, EACH $2,968.00 26489 TRANSPLANT/GRAFT PALM TENDON, EACH $3,336.00 26490 REVISE THUMB TENDON SUPERFICIALIS $2,889.00 26492 TENDON TRANSFER WITH GRAFT, THUMB $3,195.00 26494 HAND TENDON/MUSCLE TRANSFER, THUMB $2,909.00 26496 REVISE THUMB TENDON, OTHER METHODS $3,154.00 26497 TENDON TRANSFER, RING/SMALL FINGER $3,231.00 26498 TENDON TRANSFER, ALL FOUR FINGERS $4,280.00 26499 CORRECT CLAW FINGER, OTHER METHODS $3,092.00 26500 HAND TENDON RECONSTRUCTION $2,288.00 26502 HAND TENDON RECONSTRUCTION/GRAFT $2,543.00 26508 RELEASE THUMB MUSCLE CONTRACTURE $2,376.00 26510 THUMB TENDON TRANSFER $2,170.00 26516 FUSION OF KNUCKLE JOINT, 1 DIGIT $2,564.00 26517 FUSION OF KNUCKLE JOINTS, 2 DIGITS $3,058.00 26518 FUSION OF KNUCKLE JOINTS,3‐4 DIGITS $3,016.00 26520 RELEASE KNUCKLE CONTRACTURE, EACH $2,386.00 26525 RELEASE FINGER CONTRACTURE, EACH $2,389.00 26530 REVISION OF KNUCKLE JOINT, EACH $2,007.00 26531 REVISE KNUCKLE JOINT W/PROSTH, EACH $2,335.00 26535 REVISION OF FINGER JOINT, EACH $1,562.00 26536 REVISE FINGER JOINT W/PROSTH, EACH $2,610.00 26540 REPAIR HAND JOINT $2,412.00 26541 RECONSTRUCT HAND JOINT W/GRAFT $2,951.00 26542 RECON HAND JOINT W/GRAFT, LOCAL TIS $2,485.00 26545 RECONSTRUCT FINGER JOINT, EACH $2,530.00 26546 REPAIR NONUNION, METACARPAL/PHALYNX $3,660.00 26548 RECONSTRUCT FINGER JOINT, EACH $2,792.00 26550 CONSTRUCT THUMB REPLACEMENT $5,925.00 26551 MICROVASC TOE‐TO‐HAND TRANS GRT TOE $10,683.00 26553 MICROVASC TOE/HAND XFER NOT GRT SNG $12,438.00 26554 MICROVASC TOE/HAND XFER NOT GRT DBL $12,159.00 26555 POSITIONAL CHANGE OF FINGER $4,985.00 26556 MICROVASC FREE TOE JOINT TRANSFER $12,922.00 26560 REPAIR OF WEB FINGER W/FLAP $2,108.00 26561 REPAIR OF WEB FINGER W/FLAP/GRAFT $3,425.00 26562 REPAIR OF WEB FINGER, COMPLEX $5,039.00 26565 CORRECT METACARPAL DEFORMITY, EACH $2,487.00 26567 CORRECT FINGER DEFORMITY, EACH $2,500.00 26568 LENGTHEN METACARPAL/FINGER $3,341.00 26580 REPAIR CLEFT HAND $5,500.00 26587 RECONSTRUCT EXTRA FINGER $3,666.00 26590 REPAIR FINGER DEFORMITY $5,091.00 26591 REPAIR INTRINSIC MUSCLES, HAND, EA $1,593.00 26593 RELEASE INTRINSIC MUSCLES, HAND, EA $2,197.00 26596 EXCISE CONSTRICTING FINGER TISSUE $2,758.00 26600 TREAT METACARPAL FRACTURE, EACH $1,025.00 26605 TREAT METACARPAL FX, W/MANIPULATION $1,089.00 26607 TREAT METACARPAL FX, W/MANIP/FIXATN $1,701.00 26608 SKELETAL FIXATION OF METACARPAL FX $1,783.00 26615 REPAIR METACARPAL FRACTURE $2,162.00 26641 TREAT THUMB DISLOCATION $1,238.00 26645 TREAT THUMB FX/DISLOC (BENNETT) $1,450.00 26650 PIN THUMB FX/DISLOCATION (BENNETT) $1,788.00 26665 REPAIR THUMB FX/DISLOC (BENNETT) $2,391.00 26670 TREAT HAND DISLOCATION $1,135.00 26675 TREAT HAND DISLOCATION, W/ANESTH $1,558.00 26676 PIN HAND DISLOCATION $1,872.00 26685 REPAIR HAND DISLOCATION, SINGLE $2,160.00 26686 REPAIR HAND DISLOCATION, CMPLX/MULT $2,362.00 26700 TREAT KNUCKLE DISLOCATION, SINGLE $1,112.00 26705 TREAT KNUCKLE DISLOCATION, W/ANESTH $1,423.00 26706 PIN KNUCKLE DISLOCATION, SINGLE $1,645.00 26715 REPAIR KNUCKLE DISLOCATION, SINGLE $2,140.00 26720 TREAT FINGER FRACTURE, EACH $680.00 26725 TREAT FINGER FRACTURE,W/MANIP,EACH $1,127.00 26727 PIN FINGER FRACTURE, EACH $1,754.00 26735 REPAIR FINGER FRACTURE, EACH $2,238.00 26740 TREAT FINGER FRACTURE, EACH $801.00 26742 TREAT FINGER FRACTURE, W/MANIP, EA $1,243.00 26746 REPAIR FINGER FRACTURE, EACH $2,783.00 26750 TREAT DISTAL FINGER FRACTURE, EACH $678.00 26755 TREAT FINGER FRACTURE, W/MANIP, EA $1,006.00 26756 PIN DISTAL FINGER FRACTURE, EACH $1,557.00 26765 REPAIR DISTAL FINGER FRACTURE, EACH $1,875.00 26770 TREAT FINGER DISLOCATION, SINGLE $932.00 26775 TREAT FINGER DISLOCATION, W/MANIP $1,284.00 26776 PIN FINGER DISLOCATION, W/MANIP $1,654.00 26785 REPAIR FINGER DISLOCATION, SINGLE $2,052.00 26820 THUMB FUSION W/AUTOGRAFT $2,919.00 26841 FUSION OF THUMB $2,673.00 26842 FUSION OF THUMB W/AUTOGRAFT $2,898.00 26843 FUSION OF HAND JOINT/FINGERS $2,747.00 26844 FUSION/GRAFT OF HAND JOINT/FINGERS $2,975.00 26850 FUSION OF KNUCKLE $2,538.00 26852 FUSION OF KNUCKLE W/AUTOGRAFT $2,924.00 26860 FUSION OF FINGER JOINT $2,073.00 26861 FUSION OF ADDED FINGER JOINT $391.00 26862 FUSION OF FINGER JOINT W/AUTOGRAFT $2,669.00 26863 FUSION/GRAFT OF ADD'L FINGER JOINT $882.00 26910 AMPUTATION OF METACARPAL BONE $2,663.00 26951 AMPUTATION OF FINGER/THUMB $2,410.00 26952 AMPUTATION OF FINGER/THUMB W/FLAPS $2,372.00 26990 DRAIN PELVIS/HIP JOINT LESION $2,367.00 26991 DRAIN PELVIS/HIP JOINT BURSA $1,967.00 26992 INCISE BONE CORTEX PELVIS/HIP JOINT $3,619.00 27000 INCISION OF HIP TENDON, CLSD, PERCU $1,552.00 27001 INCISION OF HIP TENDON, OPEN $2,024.00 27003 INCISION OF HIP TENDON, NERVE(S) $2,253.00 27005 TENOTOMY, HIP FLEXOR(S), OPEN $2,733.00 27006 TENOTOMY, HIP FLEX/EXTEN, OPEN $2,775.00 27025 INCISION OF HIP/THIGH FASCIA $3,459.00 27027 NULL $3,418.00 27030 DRAINAGE OF HIP JOINT $3,551.00 27033 EXPLORE/REMOVE OBJECT, HIP JOINT $3,689.00 27035 DENERVATION OF HIP JOINT $4,338.00 27036 RELEASE OF HIP FLEXION CONTRACTURE $3,826.00 27040 BIOPSY PELVIS/HIP TISSUES, SUPERFIC $746.00 27041 BIOPSY PELVIS/HIP SFT TISSUE, DEEP $2,601.00 27043 EXCISION PELVIS AND HIP 3CM GREATER $1,813.00 27045 EXC HIP/PELV TUM DEEP 5 CM/> $2,868.00 27047 REMOVE HIP/PELVIS TUMOR, SUBCU TISS $1,383.00 27048 REMOVE HIP/PELVIS TUMOR, DEEP $2,343.00 27049 RADICAL RESECTION, HIP/PELVIS TUMOR $5,169.00 27050 BIOPSY OF SACROILIAC JOINT $1,458.00 27052 BIOPSY OF HIP JOINT $2,182.00 27054 REMOVAL OF HIP JOINT LINING $2,587.00 27057 NULL $3,865.00 27059 RESECT HIP/PELV TUM 5 CM/> $6,971.00 27060 REMOVAL OF ISCHIAL BURSA $1,750.00 27062 REMOVAL OF FEMUR BURSA/LESION $1,728.00 27065 REMOVAL OF HIP BONE LESION,SUPERFIC $1,928.00 27066 REMOVAL OF HIP BONE LESION, DEEP $3,065.00 27067 REMOVE HIP BONE LESION, W/AUTOGRAFT $3,874.00 27070 PARTIAL REMOVAL HIP BONE, SUPERFIC $3,204.00 27071 PARTIAL REMOVAL OF HIP BONE, DEEP $3,473.00 27075 RADICAL RESECTION OF HIP TUMOR $8,005.00 27076 RADICAL RESECTION OF HIP TUMOR $9,660.00 27077 RADICAL RESECTION OF HIP TUMOR $10,881.00 27078 RADICAL RESECTION OF HIP TUMOR $7,878.00 27080 REMOVAL OF TAIL BONE $1,960.00 27086 REMOVE PELVIS/HIP OBJECT, SUPERFIC $627.00 27087 REMOVE PELVIS/HIP OBJECT, DEEP $2,371.00 27090 REMOVAL OF HIP PROSTHESIS $3,146.00 27091 REMOVAL OF HIP PROSTHESIS, COMPLIC $6,080.00 27093 INJECTION FOR HIP X‐RAY $255.00 27095 INJECTION FOR HIP X‐RAY, W/ANESTH $303.00 27096 NULL $304.00 27097 REVISION, HAMSTRING, PROXIMAL $2,546.00 27098 TRANSFER HIP TENDON TO PELVIS $2,522.00 27100 TRANSFER OF ABDOMINAL MUSCLE TO HIP $3,089.00 27105 TRANSFER OF SPINAL MUSCLE TO HIP $3,295.00 27110 TRANSFER ILIOPSOAS MUSCLE TO HIP $3,673.00 27111 TRANSFER ILIOPSOAS MUSCLE TO HIP $3,422.00 27120 RECONSTRUCTION OF HIP SOCKET $4,959.00 27122 RECONSTRUCTION OF HIP SOCKET $4,176.00 27125 PARTIAL HIP REPLACEMENT & PROSTH $4,312.00 27130 TOTAL HIP REPLACEMENT & PROSTHESIS $5,157.00 27132 REVISE HIP SURGERY TO TOTAL REPLACE $6,371.00 27134 REVISION OF TOTAL HIP JOINT SURGERY $7,298.00 27137 REVISION OF TOTAL HIP JOINT SURGERY $5,606.00 27138 REVISION OF TOTAL HIP JOINT SURGERY $5,824.00 27140 TRANSPLANT THIGH BONE $3,386.00 27146 INCISION OF HIP BONE $4,911.00 27147 REVISION OF HIP BONE $5,619.00 27151 INCISION OF HIP BONES $6,052.00 27156 REVISION OF HIP BONES $6,563.00 27158 OSTEOTOMY, PELVIS, BILATERAL $5,503.00 27161 INCISION OF NECK OF FEMUR $4,613.00 27165 INCISION OF FEMUR W/FIXATION/CAST $5,219.00 27170 REPAIR/GRAFT FEMUR HEAD/NECK $4,472.00 27175 TREAT SLIPPED EPIPHYSIS W/TRACTION $2,538.00 27176 TREAT SLIPPED EPIPHYSIS W/PINNING $3,409.00 27177 REPAIR SLIPPED EPIPHYSIS, PIN/GRAFT $4,247.00 27178 REPAIR SLIPPED EPIPHYSIS, MANIP/PIN $3,493.00 27179 REVISE SLIPPED EPIPHYSIS/FEMUR NECK $3,717.00 27181 REPAIR SLIPPED EPIPHYSIS W/FIXATION $3,925.00 27185 REVISION OF FEMUR EPIPHYSIS $2,334.00 27187 REINFORCEMENT OF HIP BONES $3,765.00 27200 TREAT TAIL BONE FRACTURE $700.00 27202 REPAIR TAIL BONE FRACTURE $2,000.00 27220 TREAT HIP SOCKET FRACTURE(S) $1,986.00 27222 TREAT HIP SOCKET FRACTURE, W/MANIP $3,706.00 27226 REPAIR HIP WALL FRACTURE W/FIXATION $4,014.00 27227 REPAIR HIP FRACTURE(S), W/FIXATION $6,324.00 27228 REPAIR HIP FRACTURE(S), W/FIXATION $7,213.00 27230 TREAT THIGH FRACTURE $1,774.00 27232 TREAT THIGH FRACTURE W/MANIPULATION $2,845.00 27235 SKELETAL FIXATION OF THIGH FRACTURE $3,461.00 27236 REPAIR THIGH FRACTURE $4,551.00 27238 TREAT THIGH FRACTURE $1,733.00 27240 TREAT THIGH FRACTURE W/MANIPULATION $3,633.00 27244 REPAIR THIGH FRACTURE, W/IMPLANT $4,686.00 27245 REPAIR THIGH FRACTURE, W/IMPLANT $4,684.00 27246 TREAT THIGH FRACTURE $1,459.00 27248 REPAIR THIGH FRACTURE $2,819.00 27250 TREAT TRAUMATIC HIP DISLOCATION $675.00 27252 TREAT HIP DISLOCATION, W/ANESTHESIA $2,875.00 27253 REPAIR TRAUMATIC HIP DISLOCATION $3,572.00 27254 REPAIR TRAUMATIC HIP DISLOCATION $4,817.00 27256 TREAT SPONTANEOUS HIP DISLOCATION $871.00 27257 TREAT HIP DISLOC, W/MANIP & ANESTH $1,385.00 27258 REPAIR SPONTANEOUS HIP DISLOCATION $4,231.00 27259 REPAIR SPONTANEOUS HIP DISLOCATION $5,934.00 27265 TREAT POSTSURGERY HIP DISLOCATION $1,478.00 27266 TREAT POSTSURGERY HIP DISLOCATION $2,203.00 27267 CLTX THIGH FX $1,637.00 27268 CLTX THIGH FX W/MNPJ $2,009.00 27269 OPTX THIGH FX $4,722.00 27275 MANIPULATE HIP JOINT, GEN'L ANESTH $684.00 27279 FUSION/GRAFT OF SACROILIAC JOINT $2,712.00 27280 FUSION/GRAFT OF SACROILIAC JOINT $5,370.00 27282 FUSION/GRAFT OF PUBIC BONES $3,109.00 27284 FUSION/GRAFT OF HIP JOINT $5,906.00 27286 FUSION/GRAFT OF HIP JOINT $6,182.00 27290 HINDQUARTER AMPUTATION $6,150.00 27295 AMPUTATION OF LEG AT HIP $4,815.00 27301 DRAINAGE OF THIGH/KNEE LESION $1,907.00 27303 INCISE THIGH/KNEE BONE LESION, DEEP $2,411.00 27305 INCISION OF THIGH TENDON & FASCIA $1,811.00 27306 INCISE THIGH TENDON, PERCUTAN, SNGL $1,345.00 27307 INCISE THIGH TENDONS, PERCUT, MULT $1,744.00 27310 INCISE KNEE JOINT FOR INFECTION $2,769.00 27323 BIOPSY THIGH/KNEE TISSUE, SUPERFIC $668.00 27324 BIOPSY THIGH/KNEE SFT TISSUE, DEEP $1,521.00 27325 NEURECTOMY HAMSTRING MUSCLE $2,063.00 27326 NURECTOMY POPLITEAL (GASTROCNEMIUS) $1,975.00 27327 REMOVE SUBCUTANTEOUS THIGH TUMOR $1,196.00 27328 REMOVE DEEP/MUSCULAR THIGH TUMOR $2,372.00 27329 RADICAL RESECTION, THIGH/KNEE TUMOR $3,967.00 27330 BIOPSY OF KNEE JOINT LINING $1,582.00 27331 EXPLORATION/TREATMENT OF KNEE JOINT $1,793.00 27332 REMOVE KNEE CART, MED OR LATERAL $2,424.00 27333 REMOV KNEE CART, MED AND LATERAL $2,221.00 27334 REMOVE KNEE JNT LINING, ANT OR POST $2,584.00 27335 REMOVE KNEE JNT LINING ANT AND POST $2,888.00 27337 EXCISION THIGH KNEE AREA 3CM GREATE $1,607.00 27339 EXC THIGH/KNEE TUM DEP 5CM/> $2,890.00 27340 REMOVAL OF KNEECAP BURSA $1,405.00 27345 REMOVAL OF KNEE CYST $1,815.00 27347 REMOVE KNEE LESION $2,002.00 27350 REMOVAL OF KNEECAP $2,460.00 27355 REMOVAL OF FEMUR LESION $2,274.00 27356 REMOVE FEMUR LESION, W/ALLOGRAFT $2,786.00 27357 REMOVE FEMUR LESION, W/AUTOGRAFT $3,086.00 27358 REMOVE FEMUR LESION, W/FIXATION $1,061.00 27360 PARTIAL REMOVAL OF LEG BONE(S) $3,220.00 27364 RESECT THIGH/KNEE TUM 5 CM/> $5,991.00 27365 RADICAL TUMOR RESECTION, FEMUR/KNEE $7,902.00 27370 INJECTION FOR KNEE X‐RAY $185.00 27372 REMOVE DEEP THIGH/KNEE FOREIGN BODY $1,524.00 27380 REPAIR OF KNEECAP TENDON $2,241.00 27381 REPAIR/GRAFT OF KNEECAP TENDON $3,010.00 27385 REPAIR OF THIGH MUSCLE $2,167.00 27386 REPAIR/GRAFT OF THIGH MUSCLE $3,134.00 27390 INCISION OF THIGH TENDON, SINGLE $1,691.00 27391 INCISE THIGH TENDON, MULT, ONE LEG $2,186.00 27392 INCISE THIGH TENDON, MLT, BOTH LEGS $2,676.00 27393 LENGTHENING OF THIGH TENDON, SINGLE $1,909.00 27394 LENGTHEN THIGH TENDON, MLT, ONE LEG $2,370.00 27395 LENGTHEN THIGH TENDON MLT BOTH LEGS $3,340.00 27396 TRANSPL THIGH TENDON TO KNEE, SINGL $2,336.00 27397 TRANSPL THIGH TENDONS TO KNEE 1 LEG $3,433.00 27400 REVISE THIGH MUSCLES/TENDONS $2,635.00 27403 REPAIR OF KNEE CARTILAGE $2,421.00 27405 REPAIR OF KNEE LIGAMENT/CAPSULE $2,548.00 27407 REPAIR OF KNEE LIGAMENT/CAPSULE $2,943.00 27409 REPAIR OF KNEE LIGAMENTS $3,610.00 27412 AUTOLOGUS CHONDROCYTE IMPLANTATION $6,304.00 27415 OSTEOCHONDRAL ALLOGRAFT, KNEE OPEN $5,218.00 27416 OSTEOCHONDRAL KNEE AUTOGRAFT $3,717.00 27418 REVISION OF DEGENERATED KNEECAP $3,136.00 27420 REVISE RECURR DISLOCATING KNEECAP $2,817.00 27422 REVISE RECURR DISLOC KNCP W/REALIGN $2,806.00 27424 REVISE/REMOVE UNSTABLE KNEECAP $2,842.00 27425 RELEASE OF KNEE RETINACULUM $1,694.00 27427 RECONSTRUCTION OF KNEE LIGAMENTS $2,690.00 27428 RECONSTRUCTION OF KNEE LIGAMENTS $4,225.00 27429 RECONSTRUCTION OF KNEE LIGAMENTS $4,715.00 27430 REVISION OF THIGH MUSCLES $2,795.00 27435 RELEASE OF KNEE JOINT $3,047.00 27437 REVISION OF KNEECAP $2,506.00 27438 REVISION OF KNEECAP W/IMPLANT $3,182.00 27440 REVISION OF KNEE JOINT $3,035.00 27441 REVISION OF KNEE JOINT & LINING $3,124.00 27442 REVISION OF KNEE JOINT $3,294.00 27443 REVISION OF KNEE JOINT & LINING $3,056.00 27445 REVISE KNEE JOINT, HINGE PROSTHE $4,743.00 27446 REVISION OF KNEE JOINT, MED/LATERAL $4,406.00 27447 TOTAL KNEE REPLACEMENT $5,366.00 27448 INCISION OF THIGH BONE $2,942.00 27450 INCISION OF THIGH BONE W/FIXATION $3,830.00 27454 REALIGNMENT OF THIGH BONES $4,961.00 27455 REALIGNMENT OF KNEE $3,576.00 27457 REALIGNMENT OF KNEE $3,577.00 27465 SHORTENING OF THIGH BONE $4,690.00 27466 LENGTHENING OF THIGH BONE $4,469.00 27468 SHORTEN/LENGTHEN THIGH BONES $4,672.00 27470 REPAIR NON/MALUNION OF THIGH BONE $4,463.00 27472 REPAIR NON/MALUNION OF THIGH BONE $4,800.00 27475 SURGERY TO STOP LEG GROWTH, FEMUR $2,512.00 27477 SURGERY TO STOP LEG GROWTH, TIB/FIB $2,772.00 27479 SURGERY TO STOP LEG GROWTH $3,037.00 27485 SURGERY TO STOP LEG GROWTH $2,546.00 27486 REVISE KNEE JOINT REPLACEMENT $5,347.00 27487 REVISE KNEE JOINT REPLACEMENT $6,689.00 27488 REMOVAL OF KNEE PROSTHESIS $4,561.00 27495 REINFORCEMENT OF THIGH $4,288.00 27496 DECOMPRESS THIGH/KNEE, 1 COMPART $2,050.00 27497 DECOMPRESS THIGH/KNEE W/DEBRIDEMENT $2,182.00 27498 DECOMPRESS THIGH/KNEE, MULT COMPART $2,450.00 27499 DECOMPRESS THIGH/KNEE W/DEBRIDEMENT $2,638.00 27500 TREAT FEMUR SHAFT FRACTURE $1,810.00 27501 TREAT THIGH FRACTURE $1,887.00 27502 TREAT FEMUR SHAFT FX W/MANIPULATION $2,888.00 27503 TREAT THIGH FRACTURE W/MANIPULATION $3,044.00 27506 REPAIR FEMUR SHAFT FRACTURE $5,088.00 27507 REPAIR FEMUR SHAFT FX W/PLATE/SCREW $3,698.00 27508 TREAT FEMUR FRACTURE $1,858.00 27509 SKELETAL FIXATION OF THIGH FRACTURE $2,419.00 27510 TREAT FEMUR FX W/MANIPULATION $2,576.00 27511 REPAIR THIGH FRACTURE $3,793.00 27513 REPAIR THIGH FRACTURE $4,728.00 27514 REPAIR FEMUR FRACTURE $3,678.00 27516 TREAT THIGH GROWTH PLATE SEPARATION $1,802.00 27517 TREAT THIGH GROWTH PLATE, W/MANIPUL $2,569.00 27519 REPAIR THIGH GROWTH PLATE $3,400.00 27520 TREAT KNEECAP FRACTURE $1,098.00 27524 REPAIR KNEECAP FRACTURE W/FIXATION $2,851.00 27530 TREAT KNEE FRACTURE $1,048.00 27532 TREAT KNEE FRACTURE W/TRACTION $2,181.00 27535 REPAIR UNICONDYLAR KNEE FRACTURE $3,413.00 27536 REPAIR BICONDYLAR KNEE FRACTURE $4,526.00 27538 TREAT KNEE FRACTURE(S) $1,661.00 27540 REPAIR KNEE FRACTURE $3,065.00 27550 TREAT KNEE DISLOCATION $1,750.00 27552 TREAT KNEE DISLOCATION W/ANESTHESIA $2,364.00 27556 REPAIR KNEE DISLOCATION $3,325.00 27557 REPAIR KNEE DISLOCATION, LIGAMENTS $4,006.00 27558 REPAIR KNEE DISLOCATION, LIGAMENTS $4,528.00 27560 TREAT KNEECAP DISLOCATION $1,238.00 27562 TREAT KNEECAP DISLOCATION W/ANESTH $1,763.00 27566 REPAIR KNEECAP DISLOCATION $3,384.00 27570 MANIPULATE KNEE JOINT, GEN'L ANESTH $572.00 27580 FUSION OF KNEE $5,460.00 27590 AMPUTATE LEG AT THIGH $3,135.00 27591 AMPUTATE LEG AT THIGH, FIRST CAST $3,669.00 27592 AMPUTATE LEG AT THIGH, GUILLOTINE $2,652.00 27594 FOLLOWUP AMPUTATION, LEG AT THIGH $1,959.00 27596 RE‐AMPUTATION OF LEG AT THIGH $2,809.00 27598 AMPUTATE LOWER LEG AT KNEE $2,799.00 27600 DECOMPRESSION OF LOWER LEG $1,574.00 27601 DECOMPRESSION OF LOWER LEG $1,688.00 27602 DECOMPRESSION OF LOWER LEG $1,908.00 27603 DRAIN LOWER LEG ABSCESS/HEMATOMA $1,474.00 27604 DRAIN LOWER LEG/ANKLE BURSA $1,297.00 27605 INCISE ACHILL TEND, LOCAL ANES PERC $668.00 27606 INCISE ACHILL TEND, GENL ANES, PERC $1,060.00 27607 INCISION, LEG OR ANKLE $2,290.00 27610 EXPLORE/TREAT ANKLE JOINT $2,451.00 27612 INCISE ANKLE JOINT, RELEASE CAPSULE $2,057.00 27613 BIOPSY OF LOWER LEG TISSUE,SUPERFIC $600.00 27614 BIOPSY OF LOWER LEG TISSUE, DEEP $1,511.00 27615 RADICAL RESECTION, LOWER LEG TUMOR $3,902.00 27616 RADICAL RESECT LEG ANKLE 5CM GREAT $4,861.00 27618 REMOVE LOWER LEG TUMOR,SUBCUTANEOUS $1,162.00 27619 REMOVE LOWER LEG TUMOR, DEEP $1,750.00 27620 EXPLORE, TREAT ANKLE JOINT $1,695.00 27625 REMOVE ANKLE JOINT LINING $2,182.00 27626 REMOVE ANKLE JOINT TENDON SHEATH $2,301.00 27630 REMOVE LOWER LEG TENDON LESION $1,364.00 27632 EXC LEG/ANKLE LES SC 3 CM/> $1,582.00 27634 EXC LEG/ANKLE TUM DEP 5 CM/> $2,613.00 27635 REMOVE LOWER LEG BONE LESION $2,212.00 27637 REMOVE/GRAFT LOWER LEG BONE LESION $2,822.00 27638 REMOVE/GRAFT LOWER LEG BONE LESION $2,874.00 27640 PARTIAL REMOVAL OF TIBIA $3,145.00 27641 PARTIAL REMOVAL OF FIBULA $2,505.00 27645 RADICAL TUMOR RESECTION, TIBIA $6,772.00 27646 RADICAL RESECTION, FIBULA $5,884.00 27647 RADICAL RESECTION, ANKLE/HEEL $3,672.00 27648 INJECTION FOR ANKLE X‐RAY $195.00 27650 REPAIR RUPTURED ACHILLES TENDON $2,453.00 27652 REPAIR/GRAFT ACHILLES TENDON $2,518.00 27654 REPAIR, SECONDARY, ACHILLES TENDON $2,617.00 27656 REPAIR OF LEG FASCIA DEFECT $1,500.00 27658 REPAIR OF LEG FLEXOR TENDON, EACH $1,381.00 27659 FOLLOWUP REPAIR OF LEG TENDON, EACH $1,779.00 27664 REPAIR OF LEG EXTENSOR TENDON, EACH $1,342.00 27665 FOLLOWUP REPAIR OF LEG TENDON, EACH $1,527.00 27675 REPAIR LOWER LEG TENDON DISLOCATION $1,791.00 27676 REPAIR LOWER LEG TENDON DISLOCATION $2,249.00 27680 RELEASE OF LOWER LEG TENDON $1,605.00 27681 RELEASE OF LOWER LEG TENDONS $2,063.00 27685 LENGTHEN/SHORTEN LOWER LEG TENDON $1,713.00 27686 LENGT/SHORT LOWER LEG TENDONS, EACH $2,093.00 27687 REVISION OF CALF TENDON $1,683.00 27690 LOWER LEG TENDON TRANSFER, SUPERFIC $2,324.00 27691 LOWER LEG TENDON TRANSFER, DEEP $2,805.00 27692 ADDED LOWER LEG TENDON TRANSFER $395.00 27695 REPAIR OF DISRUPTED ANKLE LIGAMENT $1,761.00 27696 REPAIR OF DISRUPTED ANKLE LIGAMENTS $2,045.00 27698 FOLLOWUP REPAIR OF ANKLE LIGAMENT $2,385.00 27700 REVISION OF ANKLE JOINT $2,173.00 27702 RECONSTRUCT ANKLE JOINT W/IMPLANT $3,643.00 27703 REVISE ARTHROPLASTY, TOTAL ANKLE $4,175.00 27704 REMOVAL ANKLE IMPLANT $2,171.00 27705 INCISION OF TIBIA $2,865.00 27707 INCISION OF FIBULA $1,520.00 27709 INCISION OF TIBIA/FIBULA $4,423.00 27712 REALIGNMENT OF LOWER LEG $4,180.00 27715 LENGTHEN/SHORTEN LOWER LEG $4,077.00 27720 REPAIR TIBIA UNION W/O GRAFT $3,315.00 27722 REPAIR TIBIA UNION W/SLIDING GRAFT $3,334.00 27724 REPAIR TIBIA UNION W/AUTOGRAFT $4,810.00 27725 REPAIR TIBIA UNION BY SYNOSTOSIS $4,577.00 27726 REPAIR FIBULA NONUNION $3,673.00 27727 REPAIR CONGENITAL TIBIA DEFECT $3,950.00 27730 SURGERY TO STOP LEG GROWTH, TIBIA $2,158.00 27732 SURGERY TO STOP LEG GROWTH, FIBULA $1,585.00 27734 SURGERY TO STOP LEG GROWTH, TIB/FIB $2,491.00 27740 SURGERY TO STOP LEG GROWTH, TIB/FIB $2,690.00 27742 SURG TO STOP LEG GROWTH,FEM/TIB/FIB $2,883.00 27745 REINFORCEMENT OF TIBIA $2,860.00 27750 TREAT TIBIA SHAFT FRACTURE $1,187.00 27752 TREAT TIBIA SHAFT FX W/MANIPULATION $1,868.00 27756 SKELETAL FIXATION, TIBIA SHAFT FX $2,159.00 27758 REPAIR TIBIA SHAFT FRACTURE $3,379.00 27759 REPAIR TIBIA SHAFT FX W/IMPLANT $3,797.00 27760 TREAT ANKLE FRACTURE $1,129.00 27762 TREAT ANKLE FRACTURE W/MANIPULATION $1,613.00 27766 REPAIR ANKLE FRACTURE $2,308.00 27767 CLTX POST ANKLE/FX $1,051.00 27768 CLTX POST ANKLE FX W/MNPJ $1,659.00 27769 OPTX POST ANKLE FX $2,769.00 27780 TREAT FIBULA FRACTURE $1,038.00 27781 TREAT FIBULA FX W/MANIPULATION $1,463.00 27784 REPAIR FIBULA FRACTURE $2,711.00 27786 TREAT ANKLE FRACTURE $1,063.00 27788 TREAT ANKLE FRACTURE W/MANIPULATION $1,435.00 27792 REPAIR ANKLE FRACTURE $2,467.00 27808 TREAT ANKLE FRACTURE $1,117.00 27810 TREAT ANKLE FRACTURE W/MANIPULATION $1,580.00 27814 REPAIR ANKLE FRACTURE $2,922.00 27816 TREAT ANKLE FRACTURE $1,067.00 27818 TREAT ANKLE FRACTURE W/MANIPULATION $1,615.00 27822 REPAIR ANKLE FRACTURE $3,178.00 27823 REPAIR ANKLE FRACTURE W/FIXATION $3,612.00 27824 TREAT LOWER LEG FRACTURE $1,137.00 27825 TREAT LOWER LEG FX W/MANIP/TRACTION $1,856.00 27826 TREAT LOWER LEG FX W/FIXATION $3,140.00 27827 TREAT LOWER LEG FX W/FIXATION $4,092.00 27828 TREAT LOWER LEG FX W/FIXATION $4,911.00 27829 TREAT LOWER LEG JOINT DISLOCATION $2,579.00 27830 TREAT LOWER LEG JOINT DISLOCATION $1,335.00 27831 TREAT LOWER LEG JOINT DISLOCATION $1,480.00 27832 REPAIR LOWER LEG DISLOCATION $2,875.00 27840 TREAT ANKLE DISLOCATION $1,364.00 27842 TREAT ANKLE DISLOCATION W/ANESTH $1,866.00 27846 REPAIR ANKLE DISLOCATION $2,736.00 27848 REPAIR ANKLE DISLOCATION W/FIXATION $3,064.00 27860 MANIPULATE ANKLE JOINT, GENL ANESTH $655.00 27870 FUSION OF ANKLE JOINT $3,882.00 27871 FUSION OF TIBIOFIBULAR JOINT $2,578.00 27880 AMPUTATION OF LOWER LEG $3,582.00 27881 AMPUTATION OF LOWER LEG, FIRST CAST $3,365.00 27882 AMPUTATION OF LOWER LEG, GUILLOTINE $2,347.00 27884 FOLLOWUP AMPUTATION OF LOWER LEG $2,241.00 27886 RE‐AMPUTATION OF LOWER LEG $2,559.00 27888 AMPUTATION OF FOOT AT ANKLE $2,610.00 27889 AMPUTATION OF ANKLE $2,537.00 27892 DECOMPRESSION OF LEG FASCIA $2,097.00 27893 DECOMPRESSION OF LEG FASCIA $2,295.00 27894 DECOMPRESSION OF LEG FASCIA $3,263.00 28001 DRAIN FOOT BURSA, SINGLE SPACE $608.00 28002 DRAIN FOOT, MULTIPLE AREAS $1,150.00 28003 TREAT FOOT INFECTIONS $2,066.00 28005 DRAIN FOOT BONE LESION $2,095.00 28008 INCISION OF FOOT/TOE FASCIA $1,054.00 28010 INCISE TOE TENDON, SINGLE $753.00 28011 INCISE TOE TENDON, MULTIPLE $1,043.00 28020 EXPLORATION OF FOOT JOINT $1,335.00 28022 EXPLORATION OF FOOT JOINT $1,185.00 28024 EXPLORATION OF TOE JOINT $1,106.00 28035 DECOMPRESS POSTERIOR TIBIAL NERVE $1,297.00 28039 EXC FOOT/TOE TUM SC 1.5 CM/> $1,288.00 28041 EXC FOOT/TOE TUM DEP 1.5CM/> $1,692.00 28043 REMOVE FOOT TUMOR, SUBCUTANEOUS TIS $949.00 28045 REMOVE FOOT TUMOR, DEEP/MUSCL $1,254.00 28046 RADICAL RESECTION OF FOOT TUMOR $2,667.00 28047 RESECT FOOT/TOE TUMOR 3 CM/> $4,008.00 28050 BIOPSY, INTERTARSAL/TARSOMET JOINT $1,000.00 28052 BIOPSY, METATARSOPHALANGEAL JOINT $1,046.00 28054 BIOPSY, INTERPHALANGEAL JOINT $882.00 28055 NURECTMY INTRNSC MUSCULATR OF FOOT $1,344.00 28060 PARTIAL REMOVAL FOOT FASCIA $1,298.00 28062 RADICAL REMOVAL OF FOOT FASCIA $1,466.00 28070 REMOVAL OF FOOT JOINT LINING $1,303.00 28072 REMOVAL OF FOOT JOINT LINING $1,219.00 28080 REMOVE FOOT NERVE LESION (MORTON) $1,333.00 28086 REMOVE FOOT FLEXOR TENDON SHEATH $1,342.00 28088 REMOVE FOOT EXTENSOR TENDON SHEATH $1,035.00 28090 REMOVE FOOT TENDON LESION $1,121.00 28092 REMOVE TENDON LESION, TOE(S) $977.00 28100 REMOVAL OF ANKLE/HEEL LESION $1,525.00 28102 REMOVE ANKLE/HEEL LESION, AUTOGRAFT $2,291.00 28103 REMOVE ANKLE/HEEL LESION, ALLOGRAFT $1,398.00 28104 REMOVAL OF FOOT LESION $1,290.00 28106 REMOVE FOOT LESION W/AUTOGRAFT $1,684.00 28107 REMOVE FOOT LESION W/ALLOGRAFT $1,356.00 28108 REMOVAL OF TOE LESION(S) $1,041.00 28110 PARTIAL REMOVAL,5TH METATARSAL HEAD $1,051.00 28111 REMOVAL OF 1ST METATARSAL HEAD $1,191.00 28112 REMOVAL OF METATARSAL HEAD $1,143.00 28113 REMOVAL OF 5TH METATARSAL HEAD $1,543.00 28114 REMOVAL OF ALL METATARSAL HEADS $3,093.00 28116 REVISION OF FOOT BONES $2,077.00 28118 REMOVAL OF HEEL BONE $1,517.00 28119 REMOVAL OF HEEL SPUR $1,307.00 28120 PARTIAL REMOVAL OF ANKLE/HEEL BONE $1,838.00 28122 PARTIAL REMOVAL OF FOOT BONE $1,600.00 28124 PARTIAL REMOVAL OF TOE $1,187.00 28126 PARTIAL REMOVAL OF TOE, EACH $899.00 28130 REMOVAL OF ANKLE BONE $2,569.00 28140 REMOVAL OF METATARSAL BONE $1,623.00 28150 REMOVAL OF TOE, EACH $1,020.00 28153 PARTIAL REMOVAL OF TOE, EACH $953.00 28160 PARTIAL REMOVAL OF TOE $980.00 28171 RADICAL RESECTION OF FOOT TUMOR $3,002.00 28173 RADICAL RESECTION OF FOOT TUMOR $2,741.00 28175 RADICAL RESECTION OF TOE TUMOR $1,756.00 28190 REMOVE OBJECT FROM FOOT, SUBCUTAN $484.00 28192 REMOVE OBJECT FROM FOOT, DEEP $1,141.00 28193 REMOVE OBJECT FROM FOOT,COMPLICATED $1,328.00 28200 REPAIR OF FOOT FLEXOR TENDON $1,171.00 28202 FOLLOWUP REPAIR/GRAFT, FOOT TENDON $1,536.00 28208 REPAIR OF FOOT EXTENSOR TENDON $1,135.00 28210 FOLLOWUP REPAIR/GRAFT, FOOT TENDON $1,479.00 28220 RELEASE OF FOOT FLEXOR TENDON $1,085.00 28222 RELEASE OF FOOT FLEXOR TENDONS $1,249.00 28225 RELEASE OF FOOT EXTENSOR TENDON $940.00 28226 RELEASE OF FOOT EXTENSOR TENDONS $1,484.00 28230 INCISION OF FOOT FLEXOR TENDON(S) $1,021.00 28232 INCISION OF TOE FLEXOR TENDON $879.00 28234 INCISE FOOT/TOE EXTENSOR TENDON $957.00 28238 REVISION OF FOOT TENDON $1,769.00 28240 LENGTHEN/RELEASE BIG TOE $1,048.00 28250 REVISION OF FOOT FASCIA/MUSCLE $1,494.00 28260 RELEASE OF MIDFOOT JOINT $1,865.00 28261 LENGTHENING OF MIDFOOT TENDON $2,822.00 28262 REVISION OF FOOT AND ANKLE $4,511.00 28264 RELEASE OF MIDFOOT JOINT $2,899.00 28270 RELEASE OF FOOT JOINT CONTRACTURE $1,211.00 28272 RELEASE OF TOE JOINT CONTRACTURE $913.00 28280 WEBBING PROCEDURE ON TOES $1,275.00 28285 REPAIR OF HAMMERTOE, ONE TOE $1,368.00 28286 REPAIR, COCK‐UP 5TH TOE $1,076.00 28288 PARTIAL REMOVAL OF FOOT BONE $1,569.00 28289 BUNION SURGERY $2,000.00 28292 BUNION SURGERY, KELLER/MCBRIDE/MAYO $2,174.00 28296 BUNION SURGERY, INCISE METATARSAL $1,877.00 28297 BUNION SURGERY, LAPIDUS TYPE $2,126.00 28298 BUNION SURGERY, INCISE PHALANX $1,840.00 28299 BUNION SURGERY $2,447.00 28300 INCISION OF HEEL BONE $2,432.00 28302 INCISION OF ANKLE BONE $2,719.00 28304 INCISION OF TARSAL BONES $2,239.00 28305 INCISION/GRAFT OF TARSAL BONES $2,442.00 28306 INCISION OF 1ST METATARSAL $1,487.00 28307 INCISION/GRAFT OF 1ST METATARSAL $1,668.00 28308 INCISION OF METATARSAL, EACH $1,376.00 28309 INCISE METATARSAL, MULTIPLE $3,370.00 28310 REVISION OF GREAT TOE $1,301.00 28312 REVISION OF TOE $1,163.00 28313 REPAIR ANGULAR DEFORMITY OF TOE $1,320.00 28315 REMOVAL OF SESAMOID BONE, GREAT TOE $1,179.00 28320 REPAIR NON/MALUNION, TARSAL BONES $2,257.00 28322 REPAIR NON/MALUNION, METATARSALS $2,153.00 28340 RESECTION OF ENLARGED TOE TISSUE $1,471.00 28341 RESECTION OF ENLARGED TOE BONE $1,750.00 28344 REVISION OF EXTRA TOE(S) $1,166.00 28345 REVISION OF WEBBED TOE(S) $1,301.00 28360 REVISION OF CLEFT FOOT $3,842.00 28400 TREATMENT OF HEEL FRACTURE $845.00 28405 TREATMENT OF HEEL FX W/MANIPULATION $1,322.00 28406 SKELETAL FIXATION OF HEEL FRACTURE $1,961.00 28415 REPAIR OF HEEL FRACTURE $4,151.00 28420 REPAIR OF HEEL FRACTURE W/AUTOGRAFT $4,781.00 28430 TREATMENT OF ANKLE FRACTURE $783.00 28435 TREAT ANKLE FX W/MANIPULATION $1,050.00 28436 SKELETAL FIXATION OF ANKLE FRACTURE $1,696.00 28445 REPAIR OF ANKLE FRACTURE $3,993.00 28446 OSTEOCHONDRAL TALUS AUTOGRFT $4,602.00 28450 TREAT MIDFOOT FRACTURE, EACH $713.00 28455 TREAT MIDFOOT FX W/MANIPUL, EACH $953.00 28456 SKELETAL FIXATION, MIDFOOT FRACTURE $1,203.00 28465 REPAIR MIDFOOT FRACTURE, EACH $2,317.00 28470 TREAT METATARSAL FRACTURE $759.00 28475 TREAT METATARSAL FX W/MANIPULATION $837.00 28476 SKELETAL FIXATION, METATARSAL FX $1,314.00 28485 REPAIR METATARSAL FRACTURE $1,929.00 28490 TREAT GREAT TOE FRACTURE $462.00 28495 TREAT GREAT TOE FX W/MANIPULATION $547.00 28496 SKELETAL FIXATION, GREAT TOE FX $868.00 28505 REPAIR GREAT TOE FRACTURE $1,834.00 28510 TREATMENT OF TOE FRACTURE $444.00 28515 TREATMENT OF TOE FX W/MANIPULATION $521.00 28525 REPAIR OF TOE FRACTURE $1,460.00 28530 TREAT SESAMOID BONE FRACTURE $374.00 28531 REPAIR SESAMOID BONE FRACTURE $663.00 28540 TREAT FOOT DISLOCATION $681.00 28545 TREAT FOOT DISLOCATION W/ANESTHESIA $973.00 28546 SKELETAL FIXATION, FOOT DISLOCATION $1,238.00 28555 REPAIR FOOT DISLOCATION $2,499.00 28570 TREAT FOOT JOINT DISLOCATION $708.00 28575 TREAT FOOT JOINT DISLOC, W/ANESTH $1,248.00 28576 SKELETAL FIXATION,FOOT JOINT DISLOC $1,472.00 28585 REPAIR FOOT JOINT DISLOCATION $2,426.00 28600 TREAT FOOT JOINT DISLOCATION $695.00 28605 TREAT FOOT JOINT DISLOC, W/ANESTH $1,105.00 28606 SKELETAL FIXATION,FOOT JOINT DISLOC $1,478.00 28615 REPAIR FOOT JOINT DISLOCATION $2,954.00 28630 TREAT TOE DISLOCATION $402.00 28635 TREAT TOE DISLOCATION W/ANESTHESIA $477.00 28636 SKELETAL FIXATION, TOE DISLOCATION $655.00 28645 REPAIR TOE DISLOCATION $1,771.00 28660 TREAT TOE DISLOCATION $327.00 28665 TREAT TOE DISLOCATION W/ANESTHESIA $475.00 28666 SKELETAL FIXATION, TOE DISLOCATION $694.00 28675 REPAIR OF TOE DISLOCATION $1,518.00 28705 ARTHRODESIS, PANTALAR $4,674.00 28715 ARTHRODESIS, TRIPLE $3,519.00 28725 ARTHRODESIS, SUBTALAR $2,909.00 28730 FUSION OF MIDFOOT BONES $2,728.00 28735 FUSION OF MIDFOOT BONES W/OSTEOTOMY $2,892.00 28737 REVISION OF FOOT BONES/TENDONS $2,529.00 28740 FUSION OF MIDFOOT JOINT $2,302.00 28750 FUSION OF GREAT TOE JOINT $2,189.00 28755 FUSION OF GREAT TOE JOINT $1,207.00 28760 FUSION OF GREAT TOE JOINT $2,103.00 28800 AMPUTATION, FOOT, MIDTARSAL $2,007.00 28805 AMPUTATION, FOOT, TRANSMETATARSAL $2,733.00 28810 AMPUTATION OF TOE & METATARSAL $1,629.00 28820 AMPUTATION OF TOE $1,469.00 28825 PARTIAL AMPUTATION OF TOE $1,375.00 28890 EXTRACORPOR SHOCK WAVE PLANTAR FASC $808.00 29000 APPLICATION OF BODY CAST, HALO TYPE $693.00 29010 APPLY BODY CAST, RISSER JACKET $552.00 29015 APPLY BODY/HEAD CAST, RISSER JACKET $667.00 29035 APPLY BODY CAST, SHOULDER TO HIPS $443.00 29040 APPLY BODY CAST, SHOULDER TO HIPS $538.00 29044 APPLY BODY CAST, SHOULDER TO HIPS $556.00 29046 APPLY BODY CAST, SHOULDER TO HIPS $584.00 29049 APPLY SHOULDER CAST, FIGURE‐EIGHT $233.00 29055 APPLY SHOULDER CAST, SHOULDER SPICA $528.00 29058 APPLY SHOULDER CAST, VELPEAU $349.00 29065 APPLICATION OF LONG ARM CAST $258.00 29075 APPLICATION OF FOREARM CAST $234.00 29085 APPLICATION OF HAND/WRIST CAST $253.00 29086 APPLICATION,CAST;FINGER(eg.CONTRACT $189.00 29105 APPLICATION OF LONG ARM SPLINT $220.00 29125 APPLY FOREARM SPLINT, STATIC $146.00 29126 APPLY FOREARM SPLINT, DYNAMIC $178.00 29130 APPLY FINGER SPLINT, STATIC $105.00 29131 APPLY FINGER SPLINT, DYNAMIC $120.00 29200 STRAPPING OF CHEST $63.00 29240 STRAPPING OF SHOULDER $64.00 29260 STRAPPING OF ELBOW/WRIST $70.00 29280 STRAPPING OF HAND/FINGER $73.00 29305 APPLICATION OF HIP CAST $605.00 29325 APPLICATION OF HIP CASTS $679.00 29345 APPLICATION OF LONG LEG CAST $380.00 29355 APPLICATION OF LONG LEG CAST,WALKER $401.00 29358 APPLY LONG LEG CAST BRACE $396.00 29365 APPLY LONG LEG CAST, CYLINDER $330.00 29405 APPLY SHORT LEG CAST $222.00 29425 APPLY SHORT LEG CAST, WALKER $210.00 29435 APPLY SHORT LEG CAST (PTB) $310.00 29440 ADDITION OF WALKER TO CAST $102.00 29445 APPLY RIGID TOTAL CONTACT LEG CAST $379.00 29450 APPLICATION OF LEG CAST, CLUBFOOT $404.00 29505 APPLICATION OF LONG LEG SPLINT $184.00 29515 APPLICATION OF LOWER LEG SPLINT $181.00 29520 STRAPPING OF HIP $64.00 29530 STRAPPING OF KNEE $65.00 29540 STRAPPING OF ANKLE $64.00 29550 STRAPPING OF TOES $41.00 29580 APPLICATION OF PASTE BOOT $130.00 29581 APPL MULTI‐LYR VENOUS WND COMP, BK $43.00 29582 APPLY MULTLAY COMPRS UPR LEG $53.00 29583 APPLY MULTLAY COMPRS UPR ARM $38.00 29584 APPL MULTLAY COMPRS ARM/HAND $53.00 29700 REMOVE/REVISE CAST, BOOT/BODY $124.00 29705 REMOVE/REVISE CAST, FULL ARM/LEG $177.00 29710 REMOVE/REVISE CAST, SHOULDER/HIP $315.00 29720 REPAIR OF BODY CAST SPICA $169.00 29730 WINDOWING OF CAST $169.00 29740 WEDGING OF CAST $269.00 29750 WEDGING OF CLUBFOOT CAST $245.00 29800 JAW ARTHROSCOPY, DIAGNOSTIC $1,913.00 29804 JAW ARTHROSCOPY/SURGERY $2,427.00 29805 ARTHROSCOPY,SHO,DIAG,W/WO SINO BIOP $1,791.00 29806 ARTHROSCOPY,SHO,SURGICAL;CAPSULORRH $4,040.00 29807 ARTHROSCOPY,SHO,SURG;REP‐SLAP LESIO $3,944.00 29819 SHOULDER ARTHROSCOPY/REMOVE OBJECT $2,224.00 29820 SHOULDER ARTHROSCOPY/SYNOVECTOMY $2,006.00 29821 SHOULDER ARTHROSCOPY/SYNOVECTOMY $2,189.00 29822 SHOULDER ARTHROSCOPY/DEBRIDEMENT $2,123.00 29823 SHOULDER ARTHROSCOPY/DEBRIDEMENT $2,316.00 29824 ARTH,DIS CLAVICULECTOMY‐DIS ART SUR $2,497.00 29825 SHOULDER ARTHROSCOPY/SURGERY $2,164.00 29826 SHOULDER ARTHROSCOPY/DECOMPRESSION $672.00 29827 ARTH,DIS CLAV‐DIS ART SUR /W ROT CU $3,957.00 29828 ARTHOSCOPY BICEPS TENODESIS $3,422.00 29830 ELBOW ARTHROSCOPY, DIAGNOSTIC $1,705.00 29834 ELBOW ARTHROSCOPY/REMOVE OBJECT $1,818.00 29835 ELBOW ARTHROSCOPY/SYNOVECTOMY $1,918.00 29836 ELBOW ARTHROSCOPY/SYNOVECTOMY $2,127.00 29837 ELBOW ARTHROSCOPY/DEBRIDEMENT $1,963.00 29838 ELBOW ARTHROSCOPY/DEBRIDEMENT $2,208.00 29840 WRIST ARTHROSCOPY, DIAGNOSTIC $1,716.00 29843 WRIST ARTHROSCOPY/DRAIN INFECTION $1,836.00 29844 WRIST ARTHROSCOPY/SYNOVECTOMY $1,853.00 29845 WRIST ARTHROSCOPY/SYNOVECTOMY $2,150.00 29846 WRIST ARTHROSCOPY/SURGERY $1,948.00 29847 WRIST ARTHROSCOPY/INTERNAL FIXATION $1,987.00 29848 WRIST ENDOSCOPY/REL TRANS CARP LIG $1,923.00 29850 KNEE ARTHROSCOPY/SURGERY $2,334.00 29851 KNEE ARTHROSCOPY/SURGERY,W/FIXATION $3,397.00 29855 TIBIAL ARTHROSCOPY/SURGERY, UNICOND $2,964.00 29856 TIBIAL ARTHROSCOPY/SURGERY,BICONDYL $3,799.00 29860 HIP ARTHROSCOPY, DIAGNOSTIC $2,502.00 29861 HIP ARTHROSCOPY, SURG REM LB/FB $2,708.00 29862 HIP ARTHROSCOPY, SURG DEBRID/SHAVE $3,028.00 29863 HIP ARTHROSCOPY, SURG W/SYNOVECTOMY $3,031.00 29866 ARTHROSCOPY, KNEE SURGICAL $3,960.00 29867 ARTHROSCOPY KNEE, ALLOGRFT OSTEOCHR $4,811.00 29868 ARTHROSCOPY, KNEE MENISCAL TRANPLAN $6,108.00 29870 KNEE ARTHROSCOPY, DIAGNOSTIC $1,563.00 29871 KNEE ARTHROSCOPY/DRAIN INFECTION $1,954.00 29873 ARTH,KNEE,SURG;WITH LATERAL RELEASE $1,989.00 29874 KNEE ARTHROSCOPY/REMOVE OBJECT $2,034.00 29875 KNEE ARTHROSCOPY/SYNOVECTOMY, LTD $1,876.00 29876 KNEE ARTHROSCOPY/SYNOVECTOMY, MAJOR $2,502.00 29877 KNEE ARTHROSCOPY/DEBRIDEMENT $2,358.00 29879 KNEE ARTHROSCOPY/ARTHROPLASTY $2,511.00 29880 KNEE ARTHROSCOPY/MENISCECTOMY $2,128.00 29881 KNEE ARTHROSCOPY/MENISCECTOMY $2,052.00 29882 KNEE ARTHROSCOPY/MENISCUS REPAIR $2,665.00 29883 KNEE ARTHROSCOPY/MENISCUS REPAIR $3,196.00 29884 KNEE ARTHROSCOPY/RELEASE ADHESIONS $2,312.00 29885 KNEE ARTHROSCOPY/SURGERY $2,853.00 29886 KNEE ARTHROSCOPY/SURGERY $2,423.00 29887 KNEE ARTHROSCOPY/SURGERY $2,838.00 29888 KNEE ARTHROSCOPY/REPAIR LIGAMENT $3,745.00 29889 KNEE ARTHROSCOPY/REPAIR LIGAMENT $4,651.00 29891 ARTHROSCOPY, ANKLE, EXCISE DEFECT $2,528.00 29892 ARTHROSCOPY, ANKLE SURG $2,264.00 29893 ENDOSCOPIC PLANTAR FASCIOTOMY $1,535.00 29894 ANKLE ARTHROSCOPY/REMOVE OBJECT $1,866.00 29895 ANKLE ARTHROSCOPY/SYNOVECTOMY $1,767.00 29897 ANKLE ARTHROSCOPY/DEBRIDEMENT $1,893.00 29898 ANKLE ARTHROSCOPY/DEBRIDEMENT $2,102.00 29899 ARTH ANKLE,SURG;W/ANKLE ARTHRODESIS $3,908.00 29900 ARTH,METACARPOPHAL JT,DIAG,SYNO BIO $1,663.00 29901 ARTH METACARPOPHA JT,SURG;W/DEBRIME $2,020.00 29902 ART,METCARPHA JT,SUR;W/RED DIS COL $2,294.00 29904 SUBTALAR ARTHRO W/FB RMVL $2,428.00 29905 SUBTALAR ARTHRO W/EXC $2,604.00 29906 SUBTALAR ARTHRO W/DEB $2,736.00 29907 SUBTALAR ATHRO W/FUSION $3,338.00 29914 HIP ARTHRO W/FEMOROPLASTY $3,741.00 29915 HIP ARTHRO ACETABULOPLASTY $3,797.00 29916 HIP ARTHRO W/LABRAL REPAIR $3,803.00 30000 DRAINAGE OF NOSE ABSCESS/HEMATOMA $437.00 30020 DRAINAGE OF NASAL SEPTUM LESION $442.00 30100 INTRANASAL BIOPSY $255.00 30110 REMOVAL OF NOSE POLYP(S), SIMPLE $482.00 30115 REMOVAL OF NOSE POLYP(S), EXTENSIVE $1,600.00 30117 REMOVE INTRANASAL LESION $1,262.00 30118 REMOVE INTRANASAL LESION $2,846.00 30120 REMOVAL/ABRASION OF SKIN OF NOSE $1,627.00 30124 REMOVAL OF NOSE LESION, SIMPLE $1,057.00 30125 REMOVAL OF NOSE LESION, COMPLEX $2,251.00 30130 REMOVAL OF TURBINATE BONES $1,407.00 30140 RESECTION OF TURBINATE BONES $1,633.00 30150 PARTIAL REMOVAL OF NOSE $2,859.00 30160 REMOVAL OF NOSE $2,859.00 30200 INJECTION TREATMENT OF NOSE $220.00 30210 NASAL SINUS THERAPY $368.00 30220 INSERT NASAL SEPTAL BUTTON $463.00 30300 REMOVE OBJECT FROM NOSE $390.00 30310 REMOVE OBJECT FROM NOSE, GEN ANESTH $763.00 30320 INCISION/REMOVAL NASAL FOREIGN BODY $1,642.00 30400 RECONSTRUCTION OF NOSE $3,740.00 30410 RECONSTRUCTION OF NOSE, COMPLETE $4,554.00 30420 RECONSTRUCTION OF NOSE/SEPTUM $5,075.00 30430 FOLLOWUP REVISION OF NOSE, MINOR $3,576.00 30435 FOLLOWUP REVISION OF NOSE,INTERMED $4,104.00 30450 FOLLOWUP REVISION OF NOSE, MAJOR $5,523.00 30460 REVISE NOSE FOR CLEFT LIP/PALATE $2,904.00 30462 REVISE NOSE FOR CLEFT LIP/PALATE $5,814.00 30465 REPAIR NASAL VESTIBULAR STENOSIS $3,629.00 30520 REPAIR OF NASAL SEPTUM $2,304.00 30540 REPAIR NASAL DEFECT, INTRANASAL $2,564.00 30545 REPAIR NASAL DEFECT, TRANSPALATINE $3,258.00 30560 RELEASE OF NASAL ADHESIONS $509.00 30580 REPAIR UPPER JAW FISTULA $1,918.00 30600 REPAIR MOUTH/NOSE FISTULA $1,663.00 30620 RECONSTRUCT INNER NOSE $2,313.00 30630 REPAIR NASAL SEPTUM DEFECT $2,301.00 30801 CAUTERIZE INNER NOSE, SUPERFICIAL $504.00 30802 CAUTERIZE INNER NOSE, INTRAMURAL $704.00 30901 CONTROL OF NOSEBLEED, SIMPLE $210.00 30903 CONTROL OF NOSEBLEED, COMPLEX $298.00 30905 CONTROL OF NOSEBLEED, POSTERIOR $397.00 30906 REPEAT CONTROL OF NOSEBLEED, POSTER $509.00 30915 LIGATION OF NASAL SINUS ARTERY $2,128.00 30920 LIGATION OF UPPER JAW ARTERY $3,090.00 30930 THERAPEUTIC FRACTURE OF NOSE $455.00 31000 IRRIGATION OF MAXILLARY SINUS $392.00 31002 IRRIGATION OF SPHENOID SINUS $729.00 31020 EXPLORATION OF MAXILLARY SINUS $1,331.00 31030 EXPLORE MAXILLARY SINUS, RADICAL $1,967.00 31032 EXPLORE MAXIL SINUS, REMOVE POLYPS $2,129.00 31040 EXPLORATION BEHIND UPPER JAW $2,822.00 31050 EXPLORATION OF SPHENOID SINUS $1,805.00 31051 SPHENOID SINUS SURGERY $2,386.00 31070 EXPLORATION OF FRONTAL SINUS $1,627.00 31075 EXPLORATION OF FRONTAL SINUS $2,916.00 31080 REMOVE FRONTAL SINUS, OBLITERATIVE $3,826.00 31081 REMOVE FRONTAL SINUS, OBLITERATIVE $5,859.00 31084 REMOVE FRONTAL SINUS, OBLIT,W/FLAP $4,273.00 31085 REMOVE FRONTAL SINUS, OBLIT,W/FLAP $6,273.00 31086 REMOVE FRONTAL SINUS, NONOBLIT,FLAP $4,157.00 31087 REMOVE FRONTAL SINUS, NONOBLIT,FLAP $4,023.00 31090 EXPLORATION OF 3+ SINUSES, UNILAT $3,785.00 31200 REMOVAL OF ETHMOID SINUS,INTRANASAL $2,085.00 31201 REMOVAL OF ETHMOID SINUS,INTRANASAL $2,734.00 31205 REMOVAL OF ETHMOID SINUS,EXTRANASAL $3,293.00 31225 REMOVAL OF UPPER JAW $6,949.00 31230 REMOVE UPPER JAW, ORBITAL CONTENTS $7,725.00 31231 NASAL ENDOSCOPY, DIAGNOSTIC $240.00 31233 NASAL ENDOSCOPY, DX W/SINUSOSCOPY $507.00 31235 NASAL ENDOSCOPY, DX W/SINUSOSCOPY $600.00 31237 NASAL/SINUS ENDOSCOPY, SURGICAL $600.00 31238 NASAL/SINUS ENDOSCOPY, SURGICAL $628.00 31239 NASAL/SINUS ENDOSCOPY, SURGICAL $2,436.00 31240 NASAL/SINUS ENDOSCOPY, SURGICAL $599.00 31254 NASAL ENDOSCOPY, PART ETHMOIDECTOMY $1,014.00 31255 NASAL ENDOSCOPY,TOTAL ETHMOIDECTOMY $1,486.00 31256 NASAL ENDOSCOPY/EXPLOR MAXIL SINUS $735.00 31267 MAXIL SINUS ENDOSCOPY W/TISS REMOVE $1,181.00 31276 NASAL/SINUS ENDOSCOPY, SURGICAL $1,877.00 31287 NASAL/SINUS ENDOSCOPY, SURGICAL $862.00 31288 NASAL/SINUS ENDOSCOPY, SURGICAL $999.00 31290 NASAL/SINUS ENDOSCOPY, W/CSF LEAK $4,317.00 31291 NASAL/SINUS ENDOSCOPY, W/CSF LEAK $4,651.00 31292 NASAL/SINUS ENDOSCOPY, SURGICAL $3,717.00 31293 NASAL/SINUS ENDOSCOPY, SURGICAL $4,027.00 31294 NASAL/SINUS ENDOSCOPY, SURGICAL $4,604.00 31295 SINUS ENDO W/BALLOON DIL $610.00 31296 SINUS ENDO W/BALLOON DIL $732.00 31297 SINUS ENDO W/BALLOON DIL $597.00 31300 REMOVAL OF LARYNX TUMOR $4,869.00 31320 DIAGNOSTIC INCISION OF LARYNX $2,571.00 31360 REMOVAL OF LARYNX $7,872.00 31365 REMOVAL OF LARYNX, NECK DISSECTION $9,712.00 31367 PARTIAL REMOVAL OF LARYNX $8,334.00 31368 PART REMOV LARYNX, NECK DISSECTION $9,309.00 31370 PARTIAL REMOVAL OF LARYNX, HORIZ $7,862.00 31375 PARTIAL REMOVAL OF LARYNX, VERTICAL $7,432.00 31380 PARTIAL REMOVAL OF LARYNX, VERTICAL $7,343.00 31382 PARTIAL REMOVAL OF LARYNX, VERTICAL $8,089.00 31390 REMOVAL OF LARYNX & PHARYNX $10,827.00 31395 RECONSTRUCTION OF LARYNX & PHARYNX $11,444.00 31400 REVISION OF LARYNX $3,650.00 31420 REMOVAL OF EPIGLOTTIS $3,094.00 31500 INSERTION OF EMERGENCY AIRWAY $400.00 31502 CHANGE OF WINDPIPE AIRWAY $128.00 31505 LARYNGOSCOPY, DIAGNOSTIC $182.00 31510 LARYNGOSCOPY/BIOPSY $452.00 31511 LARYNGOSCOPY/REMOVAL OF OBJECT $485.00 31512 LARYNGOSCOPY/REMOVAL OF LESION $481.00 31513 LARYNGOSCOPY/INJECTION VOCAL CORD $492.00 31515 LARYNGOSCOPY FOR ASPIRATION $383.00 31520 DIAGNOSTIC LARYNGOSCOPY, NEWBORN $581.00 31525 DIAGNOSTIC LARYNGOSCOPY,NOT NEWBORN $599.00 31526 DIAGNOSTIC LARYNGOSCOPY/MICROSCOPE $588.00 31527 LARYNGOSCOPY/INSERTION OF OBTURATOR $727.00 31528 LARYNGOSCOPY/DILATION $541.00 31529 LARYNGOSCOPY/ADDED DILATATION $606.00 31530 OPERATIVE LARYNGOSCOPY/REMOV OBJECT $740.00 31531 OPERATIVE LARYNGOSCOPY/REMOV OBJECT $796.00 31535 OPERATIVE LARYNGOSCOPY/BIOPSY $710.00 31536 OPERATIVE LARYNGOSCOPY/BIOPSY $789.00 31540 OPERATIVE LARYNGOSCOPY/REMOVE TUMOR $906.00 31541 OPERATIVE LARYNGOSCOPY/REMOVE TUMOR $988.00 31545 LARYNGOSCOPY, DIRECT, W OPERA MSCOP $1,356.00 31546 LARYNGOSCOPY, GRAFT W RECONSTRUCTIO $2,070.00 31560 OPERATIVE LARYNGOSCOPY/ARYTENOIDECT $1,172.00 31561 OPERATIVE LARYNGOSCOPY/ARYTENOIDECT $1,285.00 31570 LARYNGOSCOPY WITH INJECTION $865.00 31571 LARYNGOSCOPY WITH INJECTION $937.00 31575 DIAGNOSTIC LARYNGOSCOPY $284.00 31576 LARYNGOSCOPY WITH BIOPSY $460.00 31577 LARYNGOSCOPY/REMOVE FOREIGN BODY $558.00 31578 LARYNGOSCOPY/REMOVE LARYNX LESION $643.00 31579 LARYNGOSCOPY/STROBOSCOPY $525.00 31580 REVISION OF LARYNX FOR WEB $4,534.00 31584 REPAIR OF LARYNX FRACTURE $5,631.00 31587 REVISION OF LARYNX, CRICOID SPLIT $3,718.00 31590 REINNERVATION OF LARYNX $3,334.00 31595 LARYNX NERVE SURGERY $2,839.00 31600 INCISION OF WINDPIPE, PLANNED $1,517.00 31601 INCISION OF WINDPIPE, PLANNED $930.00 31603 INCISION OF WINDPIPE, EMERGENCY $847.00 31605 INCISION OF WINDPIPE, EMERGENCY $699.00 31610 INCISION OF WINDPIPE, FENESTRATION $2,666.00 31611 SURGERY TO INSERT SPEECH PROSTHESIS $2,006.00 31612 PUNCTURE TRACHEA TO CLEAR WINDPIPE $183.00 31613 REPAIR WINDPIPE OPENING, SIMPLE $1,700.00 31614 REPAIR WINDPIPE OPENING, COMPLEX $2,813.00 31615 VISUALIZE WINDPIPE THRU EST OPENING $475.00 31622 BRONCHOSCOPY, DIAGNOSTIC $525.00 31623 BRONCHOSCOPY, W/BRUSHING $525.00 31624 BRONCHOSCOPY W/BRONCHIAL ALV LAVAGE $530.00 31625 ENDOSCPY W/BRONCHIAL BIOPSY $608.00 31626 BRONCH W/PLCMNT FIDUCIAL MARKER $770.00 31627 BRONCHO W/COMP‐ASSIT IMAGE GUIDED $353.00 31628 BRONCHOSCOPY/LUNG BIOPSY $671.00 31629 BRONCHOSCOPY/NEEDLE BIOPSY $716.00 31630 BRONCHOSCOPY/REPAIR TRACHEA/BRONCHI $735.00 31631 BRONCHOSCOPY/DILATION, INSERT STENT $852.00 31632 BRONCHOSCOPY RIGID/FLEX W/WO GUID $175.00 31633 BRONCHOSCOPY RIGID/FLEX W/WO GUID $226.00 31634 BRONCH W/BALLOON OCCLUSION $758.00 31635 BRONCHOSCOPY/REMOVE FOREIGN BODY $685.00 31636 BRONCOSCOPY RIGID, PLCMENT STENT $813.00 31637 BRONCOSCPY, RIGID, ADD MAJOR STENTS $263.00 31638 BRONCOSCPY, REVISION OF STENTS $931.00 31640 BRONCHOSCOPY/REMOVE TUMOR $933.00 31641 BRONCHOSCOPY/TREAT TUMOR/STRICTURE $940.00 31643 BRONCHOSCOPY W/CATHETER PLACEMENT $635.00 31645 BRONCHOSCOPY/CLEAR AIRWAYS $579.00 31646 BRONCHOSCOPY/RE‐CLEAR AIRWAYS $500.00 31647 with endobronchial ultrasound (EBUS $797.00 31648 INSERTION OF AIRWAY CATHETER $802.00 31649 BRNCHSC OCCLUSION&INSERT BRONCH VAL $252.00 31651 BRNCHSC REMOVAL BRONCHIAL VALVE EA $293.00 31652 with endobronchial ultrasound (EBUS $0.00 31653 with endobronchial ultrasound (EBUS $31,654.00 31654 with transendoscopic endobronchial $0.00 31660 INSERTION OF AIRWAY CATHETER $766.00 31661 BRONCHOSCOPIC THERMOPLASTY 2/> LOBE $809.00 31717 CATHETERIZATION/BRONCH BRUSH BIOPSY $385.00 31720 CLEAR AIRWAYS, NOSE/TRACHEA $183.00 31725 CLEAR AIRWAYS, TRACHEA‐BRONCHUS $322.00 31730 INTRODUCE WINDPIPE WIRE/STENT/TUBE $562.00 31750 REPAIR OF WINDPIPE, CERVICAL $5,287.00 31755 REPAIR OF WINDPIPE/FISTULIZATION $6,594.00 31760 REPAIR OF WINDPIPE, INTRATHORACIC $5,447.00 31766 RECONSTRUCTION OF WINDPIPE $6,997.00 31770 REPAIR/GRAFT OF BRONCHUS $5,248.00 31775 RECONSTRUCTION OF BRONCHUS $5,051.00 31780 RECONSTRUCTION OF WINDPIPE $4,481.00 31781 RECONSTRUCTION OF WINDPIPE $5,700.00 31785 REMOVE WINDPIPE LESION, CERVICAL $4,081.00 31786 REMOVE WINDPIPE LESION, THORACIC $5,600.00 31800 REPAIR WINDPIPE INJURY, CERVICAL $2,744.00 31805 REPAIR WINDPIPE INJURY, THORACIC $3,216.00 31820 CLOSURE OF WINDPIPE OPENING $1,225.00 31825 CLOSURE/REPAIR OF WINDPIPE OPENING $1,784.00 31830 REVISE WINDPIPE SCAR $1,289.00 32035 THORACOSTOMY W/RIB RESECTION $2,786.00 32036 PERCUT BX LUNG/MEDIASTINUM $3,010.00 32096 OPEN WEDGE/BX LUNG INFILTR $3,138.00 32097 OPEN WEDGE/BX LUNG NODULE $3,135.00 32098 OPEN BIOPSY OF LUNG PLEURA $2,975.00 32100 EXPLORATION/BIOPSY OF CHEST $3,152.00 32110 EXPLORATION/REPAIR OF CHEST $5,692.00 32120 EXPLORATION/REPAIR OF CHEST,POST‐OP $3,385.00 32124 EXPLORE CHEST, FREE ADHESIONS $3,605.00 32140 REMOVAL OF LUNG CYST(S) $3,896.00 32141 REMOVE/TREAT LUNG LESIONS $5,952.00 32150 REMOVE OBJECT FROM CHEST LINING $3,915.00 32151 REMOVE LUNG FOREIGN BODY $3,894.00 32160 OPEN CHEST HEART MASSAGE $3,056.00 32200 OPEN DRAINAGE OF LUNG ABSCESS/CYST $4,411.00 32215 TREAT CHEST LINING FOR PNEUMOTHORAX $3,075.00 32220 RELEASE OF LUNG $6,167.00 32225 PARTIAL RELEASE OF LUNG $3,873.00 32310 REMOVAL OF CHEST LINING $3,532.00 32320 RELEASE/REMOVE CHEST LINING $6,221.00 32400 NEEDLE BIOPSY OF CHEST LINING $314.00 32405 NEEDLE BIOPSY OF LUNG/MEDIASTINUM $374.00 32440 REMOVE LUNG PNEUMONECTOMY $6,109.00 32442 LUNG REMOVAL W/SLEEVE PNEUMONECTOMY $12,586.00 32445 REMOVAL OF LUNG, EXTRAPLEURAL $13,826.00 32480 LUNG LOBECTOMY $5,765.00 32482 LUNG BILOBECTOMY $6,160.00 32484 LUNG SEGMENTECTOMY $5,615.00 32486 LUNG SLEEVE LOBECTOMY $9,215.00 32488 LUNG COMPLETION PNEUMONECTOMY $9,339.00 32491 EXCISE EMPHYSEMATOUS LUNG, VOL RED $5,759.00 32501 RESECT/REPAIR LUNG W/LOBECTOMY $963.00 32503 RESECTION LUN TUMOR, W/O CHEST REC $7,064.00 32504 RESCTION LUNG TUMOR, W CHEST WALL R $8,061.00 32505 WEDGE RESECT OF LUNG INITIAL $3,633.00 32506 WEDGE RESECT OF LUNG ADD‐ON $617.00 32507 WEDGE RESECT OF LUNG DIAG $614.00 32540 REMOVE LUNG LESION (EMPYEMECTOMY) $6,783.00 32550 INSERT PLEURAL CATH $830.00 32551 INSERTION OF CHEST TUBE $656.00 32552 REM OF INDWELLING TUNNELED PLEURAL $597.00 32553 PLACE INTERSTITIAL DEV RAD THERAPY $700.00 32554 THORACENTESIS NEEDLE/CATH PLEURA W/ $324.00 32555 THORACENTESIS NEEDLE/CATH PLEURA W/ $404.00 32556 TREAT LUNG LINING CHEMICALLY $446.00 32557 TREAT LUNG LINING CHEMICALLY $555.00 32560 TREAT LUNG LINING CHEMICALLY $294.00 32561 DESTR INSTILL VIA CHEST TUBE $250.00 32562 DESTRUCT SUBSEQUENT DAY $229.00 32601 THORACOSCOPY, DX, LUNGS $1,201.00 32604 THORACOSCOPY WBX SAC $1,890.00 32606 THORACOSCOPY W/BX MED SPACE $1,808.00 32607 THORACOSCOPY W/BX INFILTRATE $1,205.00 32608 THORACOSCOPY W/BX NODULE $1,478.00 32609 THORACOSCOPY W/BX PLEURA $1,006.00 32650 THORACOSCOPY W/PLEURODESIS $2,585.00 32651 THORACOSCOPY REMOVE CORTEX $4,278.00 32652 THORACOSCOPY REM TOTL CORTEX $6,496.00 32653 THORACOSCOPY REMOV FB/FIBRIN $4,127.00 32654 THORACOSCOPY CONTRL BLEEDING $4,639.00 32655 THORACOSCOPY RESECT BULLAE $3,728.00 32656 THORACOSCOPY W/PLEURECTOMY $3,130.00 32658 THORACOSCOPY W/SAC FB REMOVE $2,785.00 32659 THORACOSCOPY W/SAC DRAINAGE $2,849.00 32661 THORACOSCOPY W/PERICARD EXC $3,132.00 32662 THORACOSCOPY W/MEDIAST EXC $3,479.00 32663 THORACOSCOPY W/LOBECTOMY $5,476.00 32664 THORACOSCOPY W/ TH NRV EXC $3,323.00 32665 THORACOSCOP W/ESOPH MUSC EXC $4,772.00 32666 THORACOSCOPY W/WEDGE RESECT $3,396.00 32667 THORACOSCOPY W/W RESECT ADDL $618.00 32668 THORACOSCOPY W/W RESECT DIAG $617.00 32669 THORACOSCOPY REMOVE SEGMENT $5,268.00 32670 THORACOSCOPY BILOBECTOMY $6,257.00 32671 THORACOSCOPY PNEUMONECTOMY $6,921.00 32672 THORACOSCOPY FOR LVRS $5,954.00 32673 THORACOSCOPY W/THYMUS RESECT $4,755.00 32674 THORACOSCOPY LYMPH NODE EXC $848.00 32701 REPAIR LUNG HERNIA $848.00 32800 REPAIR LUNG HERNIA $3,696.00 32810 CLOSE CHEST AFTER DRAINAGE $3,524.00 32815 CLOSE BRONCHIAL FISTULA $10,929.00 32820 RECONSTRUCT CHEST WALL AFTER INJURY $5,209.00 32851 LUNG TRANSPLANT, SINGLE $12,933.00 32852 LUNG TRANSPLANT, SINGLE W/BYPASS $14,165.00 32853 LUNG TRANSPLANT, DOUBLE $18,018.00 32854 LUNG TRANSPLANT, DOUBLE W/BYPASS $19,145.00 32855 CADAVER DONOR LUNG ALLOGRFT, BRONCH $793.00 32856 CADAVER DONOR, LUNG TRANSPLNT, BILA $957.00 32900 PARTIAL REMOVAL OF RIB(S) $5,454.00 32905 REVISE/REPAIR CHEST WALL $5,249.00 32906 REVISE/REPAIR CHEST, CLOSE FISTULA $6,489.00 32940 REVISION OF LUNG W/FILLING/PACKING $4,833.00 32960 THERAPEUTIC PNEUMOTHORAX $380.00 32997 NULL $1,258.00 32998 ABLTN TX RDCTN OF 1/>1 PULMONRY TMR $1,026.00 33010 DRAINAGE OF HEART SAC $467.00 33011 REPEAT DRAINAGE OF HEART SAC $471.00 33015 INCISION OF HEART SAC, TUBE $1,955.00 33020 INCISE HEART SAC, REMOVE OBJECT $3,426.00 33025 INCISION OF HEART SAC FOR DRAINAGE $3,112.00 33030 PARTIAL REMOVAL OF HEART SAC $7,836.00 33031 PARTIAL REMOVAL HEART SAC, W/BYPASS $9,657.00 33050 RESECT HEART SAC LESION $3,882.00 33120 REMOVAL OF INTRACARDIAC TUMOR $8,201.00 33130 REMOVAL OF EXTERNAL CARDIAC TUMOR $5,381.00 33140 TRANMYOCARDIAL LASER/ THORACOTOMY. $6,169.00 33141 TRANMYOCARDIAL LASER, W OPEN CARDIA $517.00 33202 INSRTN EPICARDIAL ELCTRD OPEN INCSN $3,035.00 33203 INSRTN EPICARDL ELCTRD ENDOSCPC APR $3,155.00 33206 INSERT HEART PM ATRIAL $1,791.00 33207 INSERT HEART PM VENTRICULAR $1,916.00 33208 INSRT HEART PM ATRIAL & VENT $2,075.00 33210 INSERT ELECTRD/PM CATH SNGL $697.00 33211 INSERT HEART ELECTRODE, DUAL CHAMBR $714.00 33212 INSERT PULSE GEN SNGL LEAD $1,295.00 33213 INSERT/REPLACE PULSE GEN ONLY, DUAL $1,351.00 33214 IMPLANTED PACEMAKER SYSTEM UPGRADE $1,898.00 33215 REPOSITIONING PREV IMPLAN PACEMAKER $1,204.00 33216 INSERT/REVISE ELECTRODE, SNGL CHMBR $1,484.00 33217 INSERT/REVISE ELECTRODE, DUAL CHMBR $1,457.00 33218 REPAIR PACEMAKER ELECTRODE, SNGL CH $1,555.00 33220 REPAIR PACEMAKER ELECTRODE, DUAL CH $1,557.00 33221 INSERT PULSE GEN MULT LEADS $1,448.00 33222 REVISE/RELOCATE PACEMAKER POCKET $1,350.00 33223 REVISE/RELOCATE PACEMAKER POCKET $1,630.00 33224 Insert of pacing electrode, cardiac $2,012.00 33225 Insert of pacing electrode, cardiac $1,829.00 33226 REPOS‐PREV PL IMPL CAR VEN SYS ELEC $1,926.00 33227 REMOVE&REPLACE PM GEN SINGL $1,361.00 33228 REMV&REPLC PM GEN DUAL LEAD $1,420.00 33229 REMV&REPLC PM GEN MULT LEADS $1,497.00 33230 INSRT PULSE GEN W/DUAL LEADS $1,544.00 33231 INSRT PULSE GEN W/MULT LEADS $1,605.00 33233 REMOVE PACEMAKER PULSE GEN ONLY $938.00 33234 REMOVE PACEMAKER ELECTRODE, SINGLE $1,929.00 33235 REMOVE PACEMAKER ELECTRODE, DUAL $2,514.00 33236 REMOVE ELECTRODE/THORACOTOMY, SNGL $3,055.00 33237 REMOVE ELECTRODE/THORACOTOMY, DUAL $3,279.00 33238 REMOVE ELECTRODE BY THORACOTOMY $3,622.00 33240 INSRT PULSE GEN W/SINGL LEAD $1,469.00 33241 REMOVE ICD PULSE GENERATOR ONLY $884.00 33243 REMOVE ICD PULSE GEN BY THORACOTOMY $5,333.00 33244 REMOVE ICD PULSE GENERATOR $3,380.00 33249 NSERT PACE‐DEFIB W/LEAD $3,607.00 33250 ABLATE HEART DYSRHYTHM FOCUS $5,744.00 33251 ABLATE HEART DYSRHYTHM FOCUS/BYPASS $6,331.00 33254 MODIFIED MAZE PROCEDURE $5,368.00 33255 MAZE PROCDR W/O CARDIOPULMNRY BYPAS $6,293.00 33256 MAZE PROCDR W CARDIOPLMNRY BYPASS $7,656.00 33257 ABLATE ATRIA, LMTD, ADD‐ON $2,265.00 33258 ABLATE ATRIA, X10SV, ADD‐ON $2,539.00 33259 ABLATE ATRIA W/BYPASS ADD‐ON $3,285.00 33261 ABLATE HEART DYSRHYTHM FOCUS/BYPASS $6,414.00 33262 REMV&REPLC CVD GEN SING LEAD $1,496.00 33263 REMV&REPLC CVD GEN DUAL LEAD $1,554.00 33264 REMV&REPLC CVD GEN MULT LEAD $1,621.00 33265 ENDSCPY MODFIED MAZE PRCDR W/O BYPS $5,296.00 33266 MAZE PROCEDURE W CARDIOPLMNRY BYPAS $7,222.00 33270 Tcat insj/rpl perm leadless pacema $2,300.00 33271 VALVOTOMY, MITRAL, CLOSED HEART $1,935.00 33272 RMVL OF SUBQ IMPLANTABLE DEFIBRILLA $1,367.00 33273 REPOS PREVIOUSLY IMPLANTED SUBQ IMP $1,509.00 33282 NULL $1,141.00 33284 NULL $824.00 33300 REPAIR HEART WOUND $9,592.00 33305 REPAIR HEART WOUND, W/BYPASS $16,071.00 33310 EXPLORATORY HEART SURGERY $4,604.00 33315 EXPLORATORY HEART SURGERY W/BYPASS $7,465.00 33320 AORTA SUTURE REPAIR W/O SHUNT $4,151.00 33321 AORTA SUTURE REPAIR W/SHUNT BYPASS $4,827.00 33322 AORTA SUTURE REPAIR W/BYPASS $5,429.00 33330 INSERT AORTA GRAFT W/O SHUNT/BYPASS $5,558.00 33335 INSERT AORTA GRAFT W/CARDIO BYPASS $7,272.00 33361 Valvuloplasty aortic valv $5,325.00 33362 REPLACE AORTIC VALVE OPENFEMORAL AR $5,826.00 33363 REPLACE AORTIC VALVE OPEN AXILLRY A $6,045.00 33364 REPLACE AORTIC VALVE OPEN ILIAC ART $6,345.00 33365 REPLACE AORTIC VALVE OPEN TRANSAORT $6,986.00 33366 TRANSCATHETER TRANSAPICAL REPLACEMT $7,566.00 33367 REPLACE AORTIC VALVE W/BYP PRQ ART/ $2,445.00 33368 REPLACE AORTIC VALVE W/BYP OPEN ART $2,945.00 33369 REPLACE AORTA VALVE W/BYP CNTRL ART $3,894.00 33404 CONSTRUCT HEART‐AORTA CONDUIT $6,904.00 33405 REPLACE AORTIC VALVE, W/BYPASS $8,870.00 33406 REPLACE AORTIC VALVE, W/BYPASS $11,257.00 33410 NULL $9,882.00 33411 REPLACEMENT OF AORTIC VALVE $13,123.00 33412 REPLACEMENT OF AORTIC VALVE (KONNO) $12,478.00 33413 REPLACEMENT OF AORTIC VALVE (ROSS) $12,782.00 33414 REPAIR AORTIC VALVE, PATCH ENLARGE $8,506.00 33415 REVISE SUBVALVULAR TISSUE $7,863.00 33416 REVISE VENTRICLE MUSCLE $7,951.00 33417 REPAIR AORTIC VALVE STRICTURE $6,578.00 33418 VALVOTOMY, MITRAL, CLOSED HEART $6,969.00 33419 TCAT MITRAL VALVE REPAIR ADDL PROST $1,632.00 33420 VALVOTOMY, MITRAL, CLOSED HEART $5,722.00 33422 VALVOTOMY, MITRAL, OPEN HEART $6,528.00 33425 RECONSTRUCT MITRAL VALVE W/BYPASS $10,696.00 33426 RECONSTRUCT MITRAL VALVE W/RING $9,305.00 33427 RECONSTRUCT MITRAL VALVE, RADICAL $9,551.00 33430 REPLACE MITRAL VALVE W/BYPASS $10,935.00 33460 VALVECTOMY, TRICUSPID, W/BYPASS $9,602.00 33463 REPAIR TRICUSPID VALVE $12,080.00 33464 REPAIR TRICUSPID VALVE, W/RING $9,527.00 33465 REPLACE TRICUSPID VALVE, W/BYPASS $10,776.00 33468 REPOSITION TRICUSPID VALVE $9,700.00 33470 VALVOTOMY, PULMONARY, CLOSED HEART $5,078.00 33471 VALVOTOMY, PULMONARY, CLOSED HEART $5,426.00 33474 VALVOTOMY, PULMONARY, OPEN HEART $8,611.00 33475 REPLACE PULMONARY VALVE $9,102.00 33476 RIGHT VENTRICULAR RESECTION $6,004.00 33477 Transcatheter pulmonary valve impla $33,478.00 33478 OUTFLOW TRACT AUGMENTATION (GUSSET) $6,204.00 33496 REPAIR PROSTH VALVE DYSFUNC $6,545.00 33500 REPAIR HEART VESSEL FISTULA/BYPASS $6,095.00 33501 REPAIR HEART VESSEL FISTULA $4,444.00 33502 REPAIR CORONARY ARTERY, LIGATION $5,028.00 33503 REPAIR CORONARY ARTERY, GRAFT $5,225.00 33504 REPAIR CORONARY ARTERY, GRAFT/BYPAS $5,780.00 33505 REPAIR CORONARY ARTERY (TAKEUCHI) $8,170.00 33506 REPAIR CORONARY ARTERY, TRANSLOCATE $8,132.00 33507 REPAIR ANOMALOUS, AORTIC ORIGIN $6,819.00 33508 Endoscopy, surg.incl video‐assisted $63.00 33510 CORONARY ARTERY BYPASS, SINGLE $7,546.00 33511 CORONARY ARTERIES BYPASS, TWO $8,296.00 33512 CORONARY ARTERIES BYPASS, THREE $9,433.00 33513 CORONARY ARTERIES BYPASS, FOUR $9,706.00 33514 CORONARY ARTERIES BYPASS, FIVE $10,202.00 33516 CORONARY ARTERIES BYPASS, SIX/MORE $10,721.00 33517 CABG, ARTERY‐VEIN, SINGLE $734.00 33518 CABG, ARTERY‐VEIN, TWO $1,614.00 33519 CABG, ARTERY‐VEIN, THREE $2,134.00 33521 CABG, ARTERY‐VEIN, FOUR $2,559.00 33522 CABG, ARTERY‐VEIN, FIVE $2,870.00 33523 CABG, ARTERY‐VEIN, SIX OR MORE $3,261.00 33530 CORONARY ARTERY BYPASS, REOPERATE $2,065.00 33533 CABG, ARTERIAL, SINGLE $7,299.00 33534 CABG, ARTERIAL, TWO $8,591.00 33535 CABG, ARTERIAL, THREE $9,576.00 33536 CABG, ARTERIAL, FOUR OR MORE $10,319.00 33542 REMOVAL OF HEART LESION $10,277.00 33545 REPAIR OF DAMAGED HEART SEPTUM $12,157.00 33548 SURG VENTRICUALR RESTORATION $11,575.00 33572 CORONARY ENDARTERECTOMY, OPEN $904.00 33600 CLOSURE OF ATRIOVENTRICULAR VALVE $6,783.00 33602 CLOSURE OF SEMILUNAR VALVE $6,583.00 33606 ANASTOMOSIS, PULMONARY ARTERY‐AORTA $7,330.00 33608 REPAIR CARDIAC ANOMALY W/CONDUIT $7,108.00 33610 REPAIR HEART ANOMALY BY ENLARGEMENT $7,010.00 33611 REPAIR DOUBLE OUTLET RT VENTRICLE $8,099.00 33612 REPAIR DOUBLE OUTLET RT VENTRICLE $7,927.00 33615 REPAIR HEART (SIMPLE FONTAN) $7,891.00 33617 REPAIR HEART (MODIFIED FONTAN) $8,552.00 33619 REPAIR SINGLE VENTRICAL (NORWOOD) $10,771.00 33620 APPLY R&L PULM ART BANDS $6,525.00 33621 TRANSTHOR CATH FOR STENT $3,674.00 33622 REDO COMPL CARDIAC ANOMALY $14,321.00 33641 REPAIR HEART SEPTUM DEFECT,W/BYPASS $6,481.00 33645 REVISE HEART VEINS $6,841.00 33647 REPAIR HEART SEPTUM DEFECTS $7,191.00 33660 REPAIR INCOMPLETE CARDIAC AV CANAL $6,949.00 33665 REPAIR INTERMED CARDIAC AV CANAL $7,573.00 33670 REPAIR COMPLETE CARDIAC AV CANAL $7,814.00 33675 CLOSURE OF MULTIPLE VSD $7,804.00 33676 CLSR MULT VSD W PLMNRY VALVOTOMY $8,406.00 33677 CLSR MULTI VSD W REMVL PULMNRY ARTR $8,734.00 33681 REPAIR HEART SEPTUM DEFECT $7,260.00 33684 REPAIR HEART SEPTUM DEFECT $7,838.00 33688 REPAIR HEART SEPTUM DEFECT $7,461.00 33690 REINFORCE PULMONARY ARTERY $4,726.00 33692 REPAIR TETRALOGY OF FALLOT $8,148.00 33694 REPAIR TETRALOGY OF FALLOT W/PATCH $8,099.00 33697 COMPLETE REPAIR TETRALOGY OF FALLOT $8,134.00 33702 REPAIR HEART FISTULA, W/BYPASS $6,103.00 33710 REPAIR HEART FISTULA/SEPTAL DEFECT $8,522.00 33720 REPAIR OF HEART ANEURYSM, W/BYPASS $6,105.00 33722 AORTA‐LEFT VENTRICLE TUNNEL REPAIR $6,424.00 33724 REPAIR OF Scimitar Syndrome $6,084.00 33726 REPAIR OF PULMONARY VENOUS STENOSIS $8,046.00 33730 REPAIR HEART‐VEIN DEFECT(S) $7,927.00 33732 REPAIR HEART‐VEIN DEFECT $6,550.00 33735 REVISION OF HEART CHAMBER, CLOSED $5,106.00 33736 REVISION OF HEART CHAMBER, W/BYPASS $5,545.00 33737 REVISION OF HEART CHAMBER, OPEN $5,321.00 33750 MAJOR VESSEL SHNT (BLALOCK‐TAUSSIG) $5,205.00 33755 MAJOR VESSEL SHUNT (WATERSON) $5,189.00 33762 MAJOR VESSEL SHUNT (POTTS‐SMITH) $5,276.00 33764 MAJOR VESSEL SHUNT, CENTRAL W/GRAFT $5,189.00 33766 MAJOR VESSEL SHUNT (CLASSIC GLENN) $5,258.00 33767 MAJOR VESSEL SHUNT (BIDIRECT GLENN) $5,615.00 33768 ANASTOMOSIS, CAVOPULMONARY, 2ND SVC $1,674.00 33770 REPAIR GREAT VESSEL TRANSPOSITION $8,813.00 33771 REPAIR GREAT VESSEL TRANSPOSITION $9,090.00 33774 REPAIR GREAT VESSELS DEFECT $7,105.00 33775 REPAIR GREAT VESSELS DEFECT $7,649.00 33776 REPAIR GREAT VESSELS/SEPTAL DEFECTS $8,080.00 33777 REPAIR GREAT VESSELS DEFECT $7,832.00 33778 REPAIR GREAT VESSELS DEFECT $9,743.00 33779 REPAIR GREAT VESSELS DEFECT $9,697.00 33780 REPAIR GREAT VESSELS/SEPTAL DEFECTS $9,380.00 33781 REPAIR GREAT VESSELS DEFECT $9,653.00 33782 0ORTIC ROOT TRANSLOC W/VENT SEPTAL $12,789.00 33783 AORTIC ROOT TRANS W/REIMPLANTATION $14,557.00 33786 REPAIR ARTERIAL TRUNK $9,006.00 33788 REVISE/REIMPLANT PULMONARY ARTERY $6,330.00 33800 AORTIC SUSPENSION $3,897.00 33802 DIVISION OF ABNORMAL VESSEL $4,270.00 33803 DIVIDE/RECONNECT ABNORMAL VESSEL $4,546.00 33813 REPAIR SEPTAL DEFECT $5,076.00 33814 REPAIR SEPTAL DEFECT, W/BYPASS $6,010.00 33820 REPAIR PATENT DUCTUS ARTERIOSUS $3,821.00 33822 REPAIR PATENT DUCTUS ARTERIOSUS $4,190.00 33824 REPAIR PATENT DUCTUS ARTERIOSUS $4,647.00 33840 REMOVE AORTA CONSTRICTION $4,884.00 33845 REPAIR AORTA CONSTRICTION, W/GRAFT $5,258.00 33851 REPAIR AORTA CONSTRICTION,W/GUSSET $5,015.00 33852 REPAIR SEPTAL DEFECT $5,517.00 33853 REPAIR SEPTAL DEFECT W/CP BYPASS $7,238.00 33860 ASCENDING AORTA GRAFT W/CP BYPASS $12,575.00 33863 ASCENDING AORTA GRAFT W/REPLACEMENT $12,338.00 33864 ASCENDING AORTIC GRAFT $12,629.00 33870 TRANSVERSE AORTIC ARCH GRAFT $9,848.00 33875 DESCENDING THORACIC AORTA GRAFT $10,785.00 33877 REPAIR AORTIC ANEURYSM W/GRAFT $14,337.00 33880 ENDOVASCULAR REPAIR, THORACIC AORTA $7,109.00 33881 ENDOVASC REPR, NOT COVR LT SUB ARTY $6,106.00 33883 PLCMNT PROSTHS ENDOVASC RPR DES AOR $4,405.00 33884 PLCMNT ADDTIONAL PROXIMAL EXTNSION $1,617.00 33886 PLCMNT DIST PROSTHESIS, DELAYED $3,809.00 33889 OPEN SUB‐CAR ARTRY TRANSPOSITION $3,130.00 33891 BYPASS GRFT, OTHER THAN VEIN, REPR $3,864.00 33910 PULMONARY ARTERY EMBOLECTOMY $10,285.00 33915 PULMONARY ARTERY EMBOLECTOMY $4,978.00 33916 PULMONARY ENDARTERECTOMY W/BYPASS $16,588.00 33917 REPAIR PULMONARY ARTERY STENOSIS $5,746.00 33920 REPAIR PULMONARY ATRESIA $7,496.00 33922 TRANSECT PULMONARY ARTERY W/BYPASS $5,479.00 33924 REMOVE PULMONARY ARTERY SHUNT $1,134.00 33925 REPIR PULMO ARTY ARBZTION, W/O BYPA $6,794.00 33926 REPR PUL ARTY ARBOZATION, W CAR BYP $10,068.00 33933 CADAVER DONOR, DISS ALLOGRT TRANSPL $1,177.00 33935 TRANSPLANTATION OF HEART/LUNG $19,546.00 33944 CADAVER DONOR HEART ALLOGRFT TRAPLA $1,177.00 33945 TRANSPLANTATION OF HEART $19,059.00 33946 DEL2015INFLATE MIDDLE EAR CANAL24HR $1,173.00 33947 DEL2015INFLATE MIDDLE EAR CANAL24HR $1,297.00 33948 ECMO/ECLS DAILY MANAGEMENT EACH DAY $920.00 33949 ECMO/ECLS DAILY MANAGEMENT EA DAY V $895.00 33951 ECMO/ECLS INSJ OF PRPH CANNULA BIRT $1,569.00 33952 ECMO/ECLS INSJ OF PRPH CANNULA 6 YR $1,690.00 33953 ECMO/ECLS INSJ OF PRPH CANNULA BIRT $1,752.00 33954 ECMO/ECLS INSJ OF PRPH CANNULA 6 YR $1,890.00 33955 ECMO/ECLS INSJ OF CENTRAL CANNULA B $3,124.00 33956 ECMO/ECLS INSJ OF CENTRAL CANNULA 6 $3,292.00 33957 ECMO/ECLS REPOS PERIPH CANNULA PERQ $694.00 33958 ECMO/ECLS REPOS PERPH CANNULA PRQ 6 $688.00 33959 ECMO/ECLS REPOS PERPH CANNULA OPEN $881.00 33962 INSER‐INTRA AOR BALL ASS DEV,PERCUT $930.00 33963 INSER‐INTRA AOR BALL ASS DEV,PERCUT $1,762.00 33964 ECMO/ECLS ECLS REPOS CENTRAL CNULA $1,846.00 33965 ECMO/ECLS RMVL OF PERPH CANNULA PER $694.00 33966 ECMO/ECLS RMVL OF PRPH CANNULA PRQ $921.00 33967 INSER‐INTRA AOR BALL ASS DEV,PERCUT $1,017.00 33968 NULL $130.00 33969 INSERT AORTIC CIRCULATION ASSIST $1,026.00 33970 INSERT AORTIC CIRCULATION ASSIST $1,392.00 33971 REMOVE AORTIC CIRCULATION ASSIST $2,767.00 33973 INSERT INTRA‐AORTIC BALLOON ASSIST $2,015.00 33974 REMOVE INTRA‐AORTIC BALLOON ASSIST $3,457.00 33975 IMPLANT VENTRICULAR ASSIST DEVICE $5,175.00 33976 IMPLANT VENTRICULAR ASSIST DEVICE $6,309.00 33977 REMOVE VENTRICULAR ASSIST DEVICE $4,440.00 33978 REMOVE VENTRICULAR ASSIST DEVICE $5,250.00 33979 INSER‐VEN ASS DEV,IMPL INTRACOR,SIN $7,694.00 33980 REM‐VEN ASS DEV,IMPL INTRACOR,SIN V $7,034.00 33981 REPLACE VAD PUMP EXT $3,301.00 33982 REPLACE VAD INTRA W/O BP $7,776.00 33983 REPLACE VAD INTRA W/BP $9,121.00 33984 CARDIAC SURGERY PROCEDURE NEC $1,119.00 33985 ENDOVAS GRFT PLCMNT, REPR ILIAC ART $1,935.00 33986 ECMO/ECLS RMVL OF CENTRAL CANNULA 6 $2,068.00 33987 ARTERY EXPOS/GRAFT ARTERY PERFUSION $816.00 33988 INSERT LEFT HEART VENT BY THORACIC $3,046.00 33989 RMVL LEFT HEART VENT BY THORACIC IN $1,965.00 33990 INSJ PERQ VAD W/IMAGING ARTERY ACCE $1,730.00 33991 INSJ PERQ VAD TRNSPTAL W/IMAGE ART& $2,518.00 33992 REMOVAL PERCUTANEOUS VAD DIFFERENT $814.00 33993 REPOSITION VAD W/IMAGING DIFFERENT $713.00 34001 REMOVAL OF ARTERY CLOT, NECK $3,862.00 34051 REMOVAL OF ARTERY CLOT, CHEST $3,890.00 34101 REMOVAL OF ARTERY CLOT, ARM $2,392.00 34111 REMOVAL OF ARTERY CLOT, ARM $2,381.00 34151 REMOVAL OF ARTERY CLOT, ABDOMEN $5,565.00 34201 REMOVAL OF ARTERY CLOT, LEG $4,107.00 34203 REMOVAL OF ARTERY CLOT, LEG $3,805.00 34401 REMOVAL OF VEIN CLOT, ABDOMEN $5,693.00 34421 REMOVAL OF VEIN CLOT, LEG $2,893.00 34451 REMOVAL OF VEIN CLOT, ABDOMEN/LEG $5,873.00 34471 REMOVAL OF VEIN CLOT, NECK $4,306.00 34490 REMOVAL OF VEIN CLOT, ARM $2,420.00 34501 REVISE FEMORAL VEIN VALVE $3,871.00 34502 RECONSTRUCT VENA CAVA $6,023.00 34510 TRANSPOSITION OF VEIN VALVE $4,712.00 34520 CROSS‐OVER VEIN GRAFT $3,989.00 34530 FUSION OF LEG VEINS $4,297.00 34701 Endovascular repair of i $4,729.00 34702 Endovascular repair of i $7,046.00 34703 Endovascular repair of i $5,375.00 34704 Endovascular repair of i $8,907.00 34705 Endovascular repair of i $5,879.00 34706 Endovasc rpr of infraren $8,847.00 34707 Endovascular repair of i $4,410.00 34708 Endovascular repair of i $7,087.00 34709 Placement of extension p $1,247.00 3470F RA DISEASE ACTIVITY, LOW $0.01 34710 Delayed placement of dis $3,083.00 34711 Delayed placement of dis $1,152.00 34712 Transcatheter delivery o $2,616.00 34713 Percutaneous access and $494.00 34714 Open femoral artery expo $1,034.00 34715 Open axillary/subclavian $1,149.00 34716 Open axillary/subclavian $1,433.00 34800 ENDOVASCULAR REPR INFRARENAL AAA $4,484.00 34802 REPAIR OF AAA, 1 DOCKING LIMB $4,942.00 34803 REPAIR OF AAA, 2 DOCKING LIMB $5,107.00 34804 REPAIR AAA, USING BIFURCATED PROSTH $4,939.00 34805 ENDOVASCULAR REPAIR INFRARENAL AB $4,751.00 34806 ANEURYSM PRESS SENSOR ADD‐ON $399.00 34808 ENDOVASC PLCMNT ILIAC ARTERY DEVICE $829.00 34812 OPEN FEMORAL ARTERY EXPOSURE $1,345.00 34813 PLACEMENT OF FEM‐FEM PROSTHETIC GRF $945.00 34820 OPEN ILIAC ARTRY FOR DELIVERY $1,961.00 34825 PLCMENT PROSTHESIS ENDOVASC REPAIR $2,747.00 34826 PLCMENT PROSTHESIS, ADDTINL VESSEL $817.00 34830 REPIR INFRARENAL ANEURYSM, TUBE $7,011.00 34831 REPAIR ANEURYSM, AORTO PROSTHESIS $7,592.00 34832 REPAIR, AORTIC ANEURY, BIFEMO PROS $7,488.00 34833 ILIIAC ARTERY EXPOSURE , PROSTHESIS $2,426.00 34834 BRACHIAL ARTERY EXPOSURE, PROSTHESI $1,085.00 34841 ENDOVASC VISCER AORTA REPIR FENEST1 $4,730.00 34842 ENDOVASC VISCER AORTA REPAIR FENST2 $5,291.00 34843 ENDOVASC VISCER AORTA REPAIR FENST3 $6,355.00 34844 ENDOVASC VISCER AORTA REPR FENEST4+ $7,440.00 34845 VISCER AND INFRARENAL ABDOM AORTA 1 $7,675.00 34846 VISCER AND INFRARENAL ABDOM AORTA 2 $8,756.00 34847 VISCER AND INFRARENAL ABDOM AORTA 3 $9,840.00 34848 VISCER AND INFRARENAL ABDOM AORTA 4 $10,925.00 34900 ENDOVAS GRFT PLCMNT, REPR ILIAC ART $3,552.00 35001 REPAIR ARTERY DEFECT, NECK $4,455.00 35002 REPAIR ARTERY RUPTURE, NECK $4,562.00 35005 REPAIR ARTERY DEFECT, BACK $4,346.00 35011 REPAIR ARTERY DEFECT, ARM $3,994.00 35013 REPAIR ARTERY RUPTURE, ARM $4,990.00 35021 REPAIR ARTERY DEFECT, CHEST $4,954.00 35022 REPAIR ARTERY RUPTURE, CHEST $5,416.00 35045 REPAIR ARM ARTERY DEFECT $3,937.00 35081 REPAIR ARTERY DEFECT, ABDOMEN AORTA $6,964.00 35082 REPAIR ARTERY RUPTURE, ABDOM AORTA $8,754.00 35091 REPAIR ARTERY DEFECT, ABDOMEN AORTA $7,162.00 35092 REPAIR ARTERY RUPTURE, ABDOM AORTA $10,354.00 35102 REPAIR ARTERY DEFECT, GROIN $7,544.00 35103 REPAIR ARTERY RUPTURE, GROIN $8,963.00 35111 REPAIR ARTERY DEFECT, SPLEEN $6,053.00 35112 REPAIR ARTERY RUPTURE, SPLEEN $7,260.00 35121 REPAIR ARTERY DEFECT, BELLY $6,553.00 35122 REPAIR ARTERY RUPTURE, BELLY $8,500.00 35131 REPAIR ARTERY DEFECT, GROIN $5,530.00 35132 REPAIR ARTERY RUPTURE, GROIN $6,487.00 35141 REPAIR ARTERY DEFECT, THIGH $4,411.00 35142 REPAIR ARTERY RUPTURE, THIGH $5,271.00 35151 REPAIR ARTERY DEFECT, KNEE $4,952.00 35152 REPAIR ARTERY RUPTURE, KNEE $5,587.00 35180 REPAIR CONGEN BLOOD VESSEL LESION $3,569.00 35182 REPAIR CONGEN BLOOD VESSEL LESION $7,055.00 35184 REPAIR CONGEN BLOOD VESSEL LESION $4,154.00 35188 REPAIR ACQUIRED BLOOD VESSEL LESION $4,456.00 35189 REPAIR ACQUIRED BLOOD VESSEL LESION $6,094.00 35190 REPAIR ACQUIRED BLOOD VESSEL LESION $3,020.00 35201 REPAIR BLOOD VESSEL, NECK $3,745.00 35206 REPAIR BLOOD VESSEL, UPPER EXTREM $3,066.00 35207 REPAIR BLOOD VESSEL, HAND/FINGER $2,859.00 35211 REPAIR BLOOD VESSEL, CHEST W/BYPASS $5,400.00 35216 REPAIR BLOOD VESSEL, CHEST $8,055.00 35221 REPAIR BLOOD VESSEL, BELLY $5,756.00 35226 REPAIR BLOOD VESSEL, LOWER EXTREM $3,307.00 35231 REPAIR/GRAFT BLOOD VESSEL, NECK $4,700.00 35236 REPAIR/GRAFT BLOOD VESSEL, UPP EXTR $3,876.00 35241 REPAIR/GRAFT BLOOD VESSEL, CHEST $5,408.00 35246 REPAIR/GRAFT BLOOD VESSEL, CHEST $6,187.00 35251 REPAIR/GRAFT BLOOD VESSEL, BELLY $6,744.00 35256 REPAIR/GRAFT BLOOD VESSEL, LOW EXTR $4,048.00 35261 REPAIR/GRAFT BLOOD VESSEL, NECK $4,211.00 35266 REPAIR/GRAFT BLOOD VESSEL, UPP EXTR $3,463.00 35271 REPAIR/GRAFT BLOOD VESSEL, CHEST $5,364.00 35276 REPAIR/GRAFT BLOOD VESSEL, CHEST $5,736.00 35281 REPAIR/GRAFT BLOOD VESSEL, BELLY $6,427.00 35286 REPAIR/GRAFT BLOOD VESSEL, LOW EXTR $3,721.00 35301 RECHANNEL ARTERY,CAROTID/VERT/SUBCL $4,514.00 35302 THRMBOENDARTRECTOMY(PATCH GRFT) SFA $4,485.00 35303 THRMBOENDARTRECTOMY(PATCH GRFT) PA $4,965.00 35304 THRMBOENDARTRECTMY TBIOPERONAL ARTR $5,116.00 35305 THRMBOENDARTRECTMY TBL/PERONAL ARTR $4,900.00 35306 THRMBENDARTRCTMY +NL TBL/PERNL ARTR $1,828.00 35311 RECHANNEL ARTERY, SUBCLAV/INNOMINAT $5,817.00 35321 RECHANNEL ARTERY, AXILLARY‐BRACHIAL $3,546.00 35331 RECHANNEL ARTERY, ABDOMINAL AORTA $5,774.00 35341 RECHANNEL ARTERY,MESEN/CELIAC/RENAL $5,447.00 35351 RECHANNEL ARTERY, ILIAC $5,106.00 35355 RECHANNEL ARTERY, ILIOFEMORAL $4,133.00 35361 RECHANNEL ARTERY, AORTOILIAC $6,136.00 35363 RECHANNEL ARTERY, AORTOFEMORAL $6,974.00 35371 RECHANNEL ARTERY, COMMON FEMORAL $3,266.00 35372 RECHANNEL ARTERY, DEEP FEMORAL $3,915.00 35390 REOPERATION, CAROTID $635.00 35400 ANGIOSCOPY DURING INTERVENTION $596.00 35500 HARVEST UPPER EXTREMITY VEIN, 1 SEG $1,272.00 35501 ARTERY BYPASS GRAFT, CAROTID $5,951.00 35506 ARTERY BYPASS GRAFT,CAROTID‐SUBCLAV $5,097.00 35508 ARTERY BYPASS GRAFT, CAROTID‐VERTEB $5,438.00 35509 ARTERY BYPASS GRAFT,CAROTID‐CAROTID $5,620.00 35510 BYPASS GRAFT VEIN CAROTID BRACHIAL $4,919.00 35511 ARTERY BYPASS GRAFT,SUBCLAV‐SUBCLAV $4,852.00 35512 BYPASS GRAFT VEIN SUBCLAV BRACHIAL $4,876.00 35515 ARTERY BYPASS GRAFT, SUBCLAV‐VERTEB $5,436.00 35516 ARTERY BYPASS GRAFT, SUBCLAV‐AXILLA $4,881.00 35518 ARTERY BYPASS GRAFT,AXILLARY‐AXILLA $4,681.00 35521 ARTERY BYPASS GRAFT, AXILLARY‐FEMOR $5,056.00 35522 BYPASS GRAFT VEIN AXILLARY BRACHIAL $4,814.00 35523 ARTERY BYPASS GRAFT $5,095.00 35525 BYPASS GRAFT VEIN BRACHIAL BRACHIAL $4,554.00 35526 ARTERY BYPASS GRAFT,AORTSUBCL/CAROT $6,737.00 35531 ARTERY BYPASS GRAFT,AORTCEL/AORTMES $8,062.00 35533 ARTERY BYPASS GRAFT, AXILL‐FEM‐FEM $5,957.00 35535 NULL $7,662.00 35536 ARTERY BYPASS GRAFT, SPLENORENAL $7,259.00 35537 BYPASS GRFT AUTOILIAC $8,761.00 35538 BYPASS GRAFT AORTOBI‐ILIAX $9,360.00 35539 BYPASS GRFT W VEIN AORTOFEMORAL $8,731.00 35540 BYPASS GRFT W VEIN AORTOBIFEMORAL $9,807.00 35556 ARTERY BYPASS GRAFT,FEMOR‐POPLITEAL $5,591.00 35558 ARTERY BYPASS GRAFT, FEMOR‐FEMORAL $4,909.00 35560 ARTERY BYPASS GRAFT, AORTORENAL $6,846.00 35563 ARTERY BYPASS GRAFT, ILIOILIAC $5,358.00 35565 ARTERY BYPASS GRAFT, ILIOFEMORAL $5,285.00 35566 ARTERY BYPASS GRAFT, DISTAL VESSELS $6,679.00 35570 NULL $6,078.00 35571 ARTERY BYPASS GRAFT, DISTAL VESSELS $5,314.00 35572 HARVEST OF FEMPOP VEIN, ONE SEGMENT $1,380.00 35583 VEIN BYPASS GRAFT,FEMORAL‐POPLITEAL $5,779.00 35585 VEIN BYPASS GRAFT, FEM‐TIBIAL/PERON $6,714.00 35587 VEIN BYPASS GRAFT, POPLIT‐TIB/PERON $5,447.00 35600 HARVEST OF UPPER EXTREMITY ARTERY $999.00 35601 ARTERY BYPASS GRAFT, CAROTID $5,597.00 35606 ARTERY BYPASS GRAFT,CAROTID‐SUBCLAV $4,685.00 35612 ARTERY BYPASS GRAFT,SUBCLAV‐SUBCLAV $4,288.00 35616 ARTERY BYPASS GRAFT, SUBCLAV‐AXILLA $4,411.00 35621 ARTERY BYPASS GRAFT, AXILL‐FEMORAL $4,388.00 35623 ARTERY BYPASS GRAFT, AXILL‐POPLIT $5,256.00 35626 ARTERY BYPASS GRAFT,AORTSUBCL/CAROT $6,250.00 35631 ARTERY BYPASS GRAFT,AORTCEL/MES/REN $7,394.00 35632 NULL $7,195.00 35633 NULL $7,996.00 35634 NULL $7,053.00 35636 ARTERY BYPASS GRAFT, SPLENORENAL $6,413.00 35637 BYPAS GRFT W OTHR THN VEIN AORTOILC $6,876.00 35638 BYPAS GRFT OTHR THAN VEN AORTOBI‐IL $7,041.00 35642 ARTERY BYPASS GRAFT, CAROTID‐VERTEB $4,078.00 35645 ARTERY BYPASS GRAFT, SUBCLAV‐VERTEB $4,056.00 35646 ARTERY BYPASS GRAFT, AORTOFEM‐BIFEM $6,853.00 35647 BYPASS GRAFT,OTH THAN VEIN;AORTOFEM $6,218.00 35650 ARTERY BYPASS GRAFT, AXILL‐AXILLARY $4,303.00 35654 ARTERY BYPASS GRAFT, AXILL‐FEM‐FEM $5,472.00 35656 ARTERY BYPASS GRAFT,FEMOR‐POPLITEAL $4,331.00 35661 ARTERY BYPASS GRAFT,FEMORAL‐FEMORAL $4,331.00 35663 ARTERY BYPASS GRAFT, ILIOILIAC $4,997.00 35665 ARTERY BYPASS GRAFT, ILIOFEMORAL $4,679.00 35666 BYPASS GRAFT, LEG ARTERIES $5,057.00 35671 BYPASS GRAFT, LEG ARTERIES $4,453.00 35681 BYPASS GRAFT COMPOSITE PROST & VEIN $319.00 35682 BYPASS GRAFT, AUTOGENOUS COMPOSITE $1,411.00 35683 BYPASS GRAFT, AUTOGENOUS COMPOSITE $1,649.00 35685 PLCMNT VEIN PATCH GRAFT, CONDUIT $795.00 35686 CREATION OF AV FISTULA LWR EXT SURG $647.00 35691 TRANSPOSE, VERTEBRAL‐CAROTID $3,815.00 35693 TRANSPOSE, VERTEBRAL‐SUBCLAVIAN $3,475.00 35694 TRANSPOSE, VERTEBRAL‐CAROTID $3,951.00 35695 TRANSPOSE, CAROTID‐SUBCLAVIAN $4,182.00 35697 REIMPLANT VISCERAL TO INFRARENAL AO $590.00 35700 REOPERATION, ARTERY BYPASS GRAFT $611.00 35701 EXPLORATION OF CAROTID ARTERY $2,192.00 35721 EXPLORATION OF FEMORAL ARTERY $1,805.00 35741 EXPLORATION OF POPLITEAL ARTERY $2,035.00 35761 EXPLORATION OF BLOOD VESSELS $1,523.00 35800 EXPLORE NECK VESSELS, POST‐OP $2,774.00 35820 EXPLORE CHEST VESSELS, POST‐OP $7,873.00 35840 EXPLORE ABDOMINAL VESSELS, POST‐OP $4,658.00 35860 EXPLORE EXTREMITY VESSELS, POST‐OP $3,339.00 35870 REPAIR VESSEL GRAFT DEFECT $4,958.00 35875 REMOVE CLOT IN GRAFT $2,372.00 35876 REMOVE CLOT IN GRAFT W/REVISION $3,767.00 35879 REVISION LOW EXT ART BYPASS, ANGIO $3,681.00 35881 REVISION LOW EXT BYPASS, W SEG VEIN $4,072.00 35883 RVSN FEMRL ANASTMSIS OF SYNTHC BYPS $4,827.00 35884 RVSN FMRL ANSTMSIS AUTOGENS VEN GRF $4,945.00 35901 EXCISE INFECTED GRAFT, NECK $1,878.00 35903 EXCISE INFECTED GRAFT, EXTREMITY $2,243.00 35905 EXCISE INFECTED GRAFT, THORAX $6,721.00 35907 EXCISE INFECTED GRAFT, ABDOMEN $7,643.00 36002 INJ PROCEDS PERC TREAT EXTR PSEUDOA $399.00 36005 INJECTION FOR VENOGRAPHY $183.00 36010 PLACE CATHETER IN VENA CAVA $464.00 36011 PLACE CATHETER IN VEIN $591.00 36012 PLACE CATHETER IN VEIN $652.00 36013 PLACE CATHETER IN ARTERY $466.00 36014 PLACE CATHETER IN ARTERY $556.00 36015 PLACE CATHETER IN ARTERY $628.00 36100 PLACE NEEDLE/CATHETER IN ARTERY $600.00 36120 PLACE NEEDLE/CATHETER IN ARTERY $385.00 36140 PLACE NEEDLE/CATHETER IN ARTERY $399.00 36160 PLACE NEEDLE/CATHETER IN AORTA $455.00 36200 PLACE NEEDLE/CATHETER IN AORTA $598.00 36215 PLACE CATHETER IN ARTERIES $883.00 36216 PLACE CATHETER IN ARTERIES $1,063.00 36217 PLACE CATHETER IN ARTERIES $1,262.00 36218 PLACE CATHETER IN ARTERIES $204.00 36221 PLACE CATHETER IN ARTERIES $837.00 36222 PLACE CATHETER IN ARTERIES $1,150.00 36223 SLCTV CATH CAROTID/INNOM ART ANGIO $1,257.00 36224 SLCTV CATH INTRNL CAROTID ART ANGIO $1,407.00 36225 SLCTV CATH SUBCLAVIAN ART ANGIO VER $1,232.00 36226 SLCTV CATH VERTEBRAL ART ANGIO VERT $1,413.00 36227 SLCTV CATH XTRNL CAROTID ANGIO XTRN $444.00 36228 SLCTV CATH INTRCRNL BRNCH ANGIO INT $910.00 36245 PLACE CATHETER IN ARTERIES $964.00 36246 INS CATH ABD/L‐EXT ART 2ND $1,039.00 36247 INS CATH ABD/L‐EXT ART 3RD $1,216.00 36248 INS CATH ABD/L‐EXT ART ADDL $184.00 36251 INS CATH REN ART 1ST UNILAT $1,089.00 36252 INS CATH REN ART 1ST BILAT $1,467.00 36253 INS CATH REN ART 2ND+ UNILAT $1,399.00 36254 INS CATH REN ART 2ND+ BILAT $1,703.00 36260 INSERTION OF ARTERY INFUSION PUMP $2,450.00 36261 REVISION OF ARTERY INFUSION PUMP $1,556.00 36262 REMOVAL OF ARTERY INFUSION PUMP $1,185.00 36400 DRAWING BLOOD, UNDER AGE 3 $74.00 36405 DRAWING BLOOD, UNDER AGE 3 $59.00 36406 DRAWING BLOOD, UNDER AGE 3 $30.00 36410 DRAWING BLOOD, OVER AGE 3 $34.00 36415 DRAWING BLOOD, ROUTINE % $15.00 36420 DRAWING BLOOD, CUTDOWN, UNDER AGE 1 $194.00 36425 DRAWING BLOOD, CUTDOWN, AGE 1+ $147.00 36430 BLOOD TRANSFUSION SERVICE $129.00 36440 BLOOD TRANSFUSION SERVICE, PUSH $213.00 36450 EXCHANGE TRANSFUSION SERV, NEWBORN $430.00 36455 EXCHANGE TRANSFUSION SERVICE $484.00 36460 TRANSFUSION SERVICE, FETAL $1,344.00 36470 INJECTION THERAPY OF VEIN $317.00 36471 INJECTION THERAPY OF VEINS $381.00 36475 ENDOVEN ABLATION THERPY, 1ST VEIN $1,092.00 36476 ENDOVEN ABLATION, 2ND VEIN TREATED $531.00 36478 ENDOVENSOUS ABLATION , LASER VEIN $1,080.00 36479 ENDOVENOUS ABLATION, LASER, 2ND VEI $527.00 36481 INSERTION OF CATHETER, PORTAL VEIN $1,267.00 36500 INSERTION OF CATHETER, VEIN $689.00 36510 INSERT CATHETER, UMBILICAL VEIN $200.00 36511 THERAPEUTIC APHERESIS;FOR WBC $343.00 36512 THERAPEUTIC APHERESIS;FOR RBC $334.00 36513 THERAPEUTIC APHERESIS;FOR PLATELETS $364.00 36514 THERAPEUTIC APHERESIS;PLASMA PHERES $336.00 36515 THER APH;W/EXTRACOR IMMU‐PLASM REIN $322.00 36516 THER AP;W/EXTRACOR SEL ABS/SEL FIL $272.00 36522 PHOTOPHERESIS $364.00 36555 INSERT NON TUNNEL CENT VENOUS CATH $420.00 36556 INSERT CENT VENOUS CATH 5 YEARS PLU $441.00 36557 INSERT VENOUS CATH UNDER 5 YEARS OL $1,281.00 36558 INSERT VENOUS CATH 5 YEARS OR OLDER $1,031.00 36560 INSERT VENOUS ACCESS DEVICE UNDER 5 $1,516.00 36561 INSERT VENOUS ACCESS DEVICE 5Y PLUS $1,345.00 36563 INSERT VENOUS ACCESS DEVICE W/PUMP $1,490.00 36565 INSERT VENOUS DEVICE $1,361.00 36566 INSERT VENOUS ACCESS DEVICE TWO SEP $1,482.00 36568 INSERT PERIPHERALLY VEN CATH UN 5Y $350.00 36569 INSERT PERIPH VENOUS CATH 5Y PLUS $330.00 36570 INSERT PERIP VENOUS DEVICE 5Y PLUS $1,142.00 36571 INSERT PERIP VENOUS DEVICE 5Y PLUS $1,238.00 36575 REPAIR VENOUS ACCESS CATH $130.00 36576 REPAIR VENOUS ACCESS DEVICE $757.00 36578 REPLACE CATH VENOUS ACCESS DEVICE $813.00 36580 REPLACE COMPLETE VENOUS CATH $245.00 36581 REPLACE COMPLETE VENOUS CATH $725.00 36582 REPLACE COMPLETE VENOUS ACCESS DEVI $1,162.00 36583 REPLACE COMPLETE VENOUS ACCESS $1,326.00 36584 REPLACE PERIPHERALLY INSERT $242.00 36585 REPLACE COMPLEE PERIPH CENT VENOUS $1,071.00 36589 REMOVAL CENTRAL CATH $514.00 36590 REMOVAL VENOUS DEVICE $781.00 36591 DRAW BLOOD OFF VENOUS DEVICE $87.00 36592 COLLECT BLOOD FROM PICC $100.00 36593 DECLOT VASCULAR DEVICE $116.00 36595 MECHANICL REMOVAL PREICATH OBSTR $674.00 36596 MECHANICAL REMOVAL INTRACATH $167.00 36597 REPOSIT OF PREV CEN VEN CATH $223.00 36598 CONTRAST INJECTION, EXIST CVAD $134.00 36600 WITHDRAW ARTERIAL BLOOD, DIAGNOSTIC $56.00 36620 INSERT ARTERY CATHETER THRU SKIN $182.00 36625 INSERT ARTERY CATHETER, CUTDOWN $393.00 36640 INSERT ARTERY CATHETER, CUTDOWN $478.00 36660 INSERT UMBILICAL ARTERY CATHETER $264.00 36680 INSERT NEEDLE INTO BONE CAVITY $218.00 36800 INSERT CANNULA, VEIN‐VEIN $581.00 36810 INSERT CANNULA, ARTERY‐VEIN, EXTERN $827.00 36815 INSERT CANNULA, ARTERY‐VEIN, EXTERN $575.00 36818 AV ANASTOMOSIS, UPPER ARM CEPH VEIN $2,756.00 36819 AV ANASTOMOSIS, UPPER ARM BAS VEIN $2,915.00 36820 ART‐VEN ANAS,OP;UPP ARM BAS VEIN TR $3,021.00 36821 ARTERY‐VEIN FUSION, DIRECT (CIMINO) $2,640.00 36823 INSERTION CANNULA, ISOL REG CHEMO $5,258.00 36825 ARTERY‐VEIN GRAFT, AUTOGENOUS $3,183.00 36830 ARTERY‐VEIN GRAFT, NONAUTOGENOUS $2,657.00 36831 REMOVE ARTERIOVENOUS FISTULA $2,456.00 36832 REVISE, ARTERIOVEN FISTULA W/O GRFT $3,013.00 36833 REVISE, ARTERIOVEN FISTULA W/GRAFT $3,232.00 36835 INSERT OF THOMAS SHUNT $1,940.00 36838 DIST REVASCULAR INTER $4,557.00 36860 EXTRN CANNULA DECLOT, W/O BALLOON $397.00 36861 EXTRN CANNULA DECLOT W/BALLOON CATH $561.00 36901 Intro cath dialysis circu $627.00 37140 SPLICE PORTAL/CAVAL VEINS $9,011.00 37145 SPLICE KIDNEY/LIVER VEINS $8,447.00 37160 SPLICE CAVAL/MESENTERIC VEINS $8,676.00 37180 SPLICE PROXIMAL SPLEEN/KIDNEY VEINS $7,789.00 37181 SPLICE DISTAL SPLEEN/KIDNEY VEINS $9,139.00 37182 Insert of transvenous intrahepatic $3,012.00 37183 Revision of transvenous intrahepat. $1,423.00 37184 PRIMARY PERCU TRANS MEC THRMBECTOMY $1,790.00 37185 PRIMARY MECANICAL THROMBECTOMY, II $657.00 37186 SEC PERCUT TRANSLUMINAL THROMBECTOM $970.00 37187 PERCU TRANSLUMIN MECH THROMBEC VEIN $1,549.00 37188 PERC TRANSLUM MECH THROMBE VEIN REP $1,102.00 37191 INS ENDOVAS VENA CAVA FILTR $896.00 37192 REDO ENDOVAS VENA CAVA FILTR $1,403.00 37193 REM ENDOVAS VENA CAVA FILTER $1,372.00 37195 THROMBOLYSIS, CEREBRAL, IV INFUSION $1,322.00 37197 PRQ TRANSCATHETER RTRVL INTRVAS FB $1,198.00 37200 TRANSCATHETER BIOPSY $795.00 37211 TRANCATH PLCMNT STENT CER ARTRY,DEP $1,526.00 37212 TRANCATH PLCMNT STENT CER ARTRY,DEP $1,337.00 37213 THROMBOLYSIS ART/VENOUS INFSN W/IMA $928.00 37214 CESSATION THROMBOLYTIC THRPY W/CATH $536.00 37215 TRANCATH PLCMNT STENT CER ARTRY,DEP $4,017.00 37217 ILIAC REVASCices $4,309.00 37218 ILIAC REVASCices $3,190.00 37220 ILIAC REVASC $1,632.00 37221 ILIAC REVASC W/STENT $2,003.00 37222 ILIAC REVASC ADD‐ON $738.00 37223 ILIAC REVASC W/STENT ADD‐ON $845.00 37224 FEM/POPL REVAS W/TLA $1,788.00 37225 FEM/POPL REVAS W/ATHER $2,442.00 37226 FEM/POPL REVASC W/STENT $2,113.00 37227 FEM/POPL REVASC STNT & ATHER $2,935.00 37228 TIB/PER REVASC W/TLA $2,191.00 37229 TIB/PER REVASC W/ATHER $2,845.00 37230 TIB/PER REVASC W/STENT $2,803.00 37231 TIB/PER REVASC STENT & ATHER $3,047.00 37232 TIB/PER REVASC ADD‐ON $796.00 37233 TIBPER REVASC W/ATHER ADD‐ON $1,299.00 37234 REVSC OPN/PRQ TIB/PERO STENT $1,121.00 37235 TIB/PER REVASC STNT & ATHER $1,585.00 37236 VASCULAR EMBOLIZATION OR OCCLUSION $1,737.00 37237 VASCULAR EMBOLIZATION OR OCCLUSION $832.00 37238 OPEN/PERQ PLCEMNT INTRAVASC SAME1ST $1,192.00 37239 OPEN/PERQ PLCEMNT INTRAVASC SAME EA $581.00 37241 VASCULAR EMBOLIZATION OR OCCLUSION $1,708.00 37242 VASCULAR EMBOLIZATION OR OCCLUSION $1,833.00 37243 VASCULAR EMBOLIZE/OCCLUDE ORGAN TUM $2,133.00 37244 VASCULAR EMBOLIZATION OR OCCLUSION $2,503.00 37252 Intravascular ultrasound (noncorona $37,253.00 37253 each additional noncoronary vessel $0.00 37500 Vascular endoscopy, surgical, w/lig $2,989.00 37565 LIGATION OF INTERNAL JUGULAR VEIN $2,783.00 37600 LIGATION OF EXTERNAL CAROTID ARTERY $2,746.00 37605 LIGATION OF INTERNAL CAROTID ARTERY $3,148.00 37606 LIGATION OF INTERNAL CAROTID ARTERY $2,264.00 37607 LIGATION OF ANGIOACCESS FISTULA $1,484.00 37609 LIGATION/BIOPSY OF TEMPORAL ARTERY $798.00 37615 LIGATION OF NECK ARTERY $1,965.00 37616 LIGATION OF CHEST ARTERY $4,312.00 37617 LIGATION OF ABDOMEN ARTERY $5,227.00 37618 LIGATION OF EXTREMITY ARTERY $1,499.00 37619 LIGATION OF INF VENA CAVA $6,433.00 37650 LIGATION OF FEMORAL VEIN $2,000.00 37660 LIGATION OF COMMON ILIAC VEINS $4,596.00 37700 REVISION OF LEG VEIN $980.00 37718 LIGAT, DIVI & STRIP SHOR SAPHE VEIN $1,724.00 37722 LIGA DIV & STRIP LONG SAPH VEIN $1,898.00 37735 REMOVAL OF LEG VEINS/ULCER $2,713.00 37760 REVISION OF LEG VEINS $2,435.00 37761 LIGATE LEG VEINS OPEN $2,172.00 37765 STAB PHLEBECTOMY OF VARICOSE VEINS $1,752.00 37766 STAB PHLEBECTOMY OF VARICOSE VEINS $2,141.00 37780 REVISION OF LEG VEIN $1,000.00 37785 FOLLOWUP SURGERY, VARICOSE VEINS $1,026.00 37788 REVASCULARIZE PENIS $4,910.00 37790 PENILE VENOUS OCCLUSIVE PROCEDURE $1,866.00 38100 REMOVAL OF SPLEEN, TOTAL $4,501.00 38101 REMOVAL OF SPLEEN, PARTIAL $4,501.00 38102 REMOVAL OF SPLEEN, TOTAL, EN BLOC $1,023.00 38115 REPAIR OF RUPTURED SPLEEN $4,908.00 38120 Laparoscopy, surgical, splenectomy $4,106.00 38200 INJECTION FOR SPLEEN X‐RAY $502.00 38205 Blood‐derived hemato..;allogenic $294.00 38206 Blood‐derived hematop; autologous $295.00 38220 BONE MARROW ASPIRATION $226.00 38221 BONE MARROW BIOPSY $265.00 38230 BONE MARROW HARVEST ALLOGEN $774.00 38232 BONE MARROW HARVEST AUTOLOG $767.00 38240 BONE MARROW/STEM CELL XPLANT, ALLOG $793.00 38241 BONE MARROW/STEMCELL XPLNT, AUTOLOG $594.00 38242 Bone marrow; allogeneic $416.00 38243 DRAIN LYMPH NODE LESION, SIMPLE $414.00 38300 DRAIN LYMPH NODE LESION, SIMPLE $702.00 38305 DRAIN LYMPH NODE LESION, EXTENSIVE $1,836.00 38308 LYMPH CHANNEL SURGERY $1,726.00 38380 THORACIC DUCT SURGERY, CERVICAL $2,123.00 38381 THORACIC DUCT SURGERY, THORACIC $3,125.00 38382 THORACIC DUCT SURGERY, ABDOMINAL $2,452.00 38500 BIOPSY/REMOVE LYMPH NODE(S) $983.00 38505 NEEDLE BIOPSY/REMOVE LYMPH NODE(S) $259.00 38510 BIOPSY/REMOVE LYMPH NODE(S), NECK $1,606.00 38520 BIOPSY/REMOVE LYMPH NODE(S), NECK $1,782.00 38525 BIOPSY/REMOVE LYMPH NODE(S), ARMPIT $1,695.00 38530 BIOPSY/REMOVE LYMPH NODE(S),MAMMARY $2,112.00 38542 EXPLORE DEEP NODE(S), NECK $1,959.00 38550 REMOVE NECK/ARMPIT LESION, SIMPLE $1,959.00 38555 REMOVE NECK/ARMPIT LESION, COMPLEX $3,904.00 38562 REMOVE PELVIC LYMPH NODES $2,671.00 38564 REMOVE ABDOMEN LYMPH NODES $2,716.00 38570 NULL $1,904.00 38571 LAP SURG; W/ BIL TOT PELV LYMPADEN $2,764.00 38572 NULL $3,550.00 38700 REMOVAL OF NECK LYMPH NODES $3,020.00 38720 REMOVAL OF NECK LYMPH NODES $5,079.00 38724 REMOVAL OF NECK LYMPH NODES $5,451.00 38740 REMOVE ARMPIT LYMPH NODES, SUPERFIC $2,697.00 38745 REMOVE ARMPIT LYMPH NODES, COMPLETE $3,405.00 38746 REMOVE THORACIC LYMPH NODES $845.00 38747 REMOVE ABDOMINAL LYMPH NODES $1,045.00 38760 REMOVAL OF GROIN LYMPH NODES $3,248.00 38765 REMOVAL OF GROIN LYMPH NODES $4,966.00 38770 REMOVAL OF PELVIS LYMPH NODES $3,008.00 38780 REMOVAL OF ABDOMEN LYMPH NODES $3,823.00 38790 INJECTION FOR LYMPHATIC X‐RAY $313.00 38792 RA TRACER ID OF SENTINL NODE $148.00 38794 ACCESS THORACIC LYMPH DUCT, CANNULA $1,087.00 38900 IO MAP OF SENT LYMPH NODE $542.00 39000 EXPLORATION OF CHEST, CERVICAL $1,922.00 39010 EXPLORATION OF CHEST, TRANSTHORACIC $3,066.00 39200 RESECT MEDIASTINAL CYST $3,441.00 39220 RESECT MEDIASTINAL TUMOR $4,422.00 39401 Mediastinoscopy;includes biopsy(ies $808.00 39402 with lymph node biopsy(ies) (eg, lu $1,056.00 39501 REPAIR DIAPHRAGM LACERATION $3,289.00 39503 REPAIR DIAPHRAGM HERNIA, NEWBORN $24,099.00 39540 REPAIR TRAUMATIC DIAPHRAGM HERNIA $3,362.00 39541 REPAIR TRAUMATIC DIAPHRAGM HERNIA $3,679.00 39545 REVISION OF DIAPHRAGM, EVENTRATION $3,480.00 39560 NULL $3,089.00 39561 NULL $4,810.00 40490 BIOPSY OF LIP $272.00 40500 LIP SHAVE, VERMILION $1,370.00 40510 PARTIAL EXCISION OF LIP, WEDGE $1,346.00 40520 PARTIAL EXCISION OF LIP, V‐EXCISION $1,352.00 40525 RECONSTRUCT LIP W/LOCAL FLAP $2,077.00 40527 RECONSTRUCT LIP W/CROSS LIP FLAP $2,312.00 40530 PARTIAL REMOVAL OF LIP $1,522.00 40650 REPAIR LIP VERMILION $1,123.00 40652 REPAIR LIP, UP TO 1/2 $1,321.00 40654 REPAIR LIP, OVER 1/2 OR COMPLEX $1,601.00 40700 REPAIR CLEFT LIP/NASAL DEFORMITY $3,462.00 40701 REPAIR CLEFT LIP/NASAL DEFORMITY $4,075.00 40702 REPAIR CLEFT LIP/NASAL DEFORMITY $3,317.00 40720 REPAIR CLEFT LIP/NASAL DEFORMITY $3,853.00 40761 REPAIR CLEFT LIP/NASAL DEFORMITY $4,076.00 40800 DRAINAGE OF MOUTH LESION, SIMPLE $503.00 40801 DRAIN MOUTH LESION, COMPLICATED $851.00 40804 REMOVE FOREIGN BODY, MOUTH, SIMPLE $443.00 40805 REMOVE FOREIGN BODY, MOUTH, COMPL $811.00 40806 INCISION OF LIP FOLD $120.00 40808 BIOPSY OF MOUTH $414.00 40810 EXCISION OF MOUTH LESION $486.00 40812 EXCISE/REPAIR MOUTH LESION, SIMPLE $756.00 40814 EXCISE/REPAIR MOUTH LESION, COMPLX $1,169.00 40816 EXCISE/REPAIR MOUTH LESION, COMPLX $1,210.00 40818 EXCISE ORAL MUCOSA FOR GRAFT, DONOR $1,026.00 40819 EXCISE LIP OR CHEEK FOLD $922.00 40820 TREATMENT OF MOUTH LESION/SCAR $655.00 40830 REPAIR MOUTH LACERATION $625.00 40831 REPAIR MOUTH LACERATION $854.00 40840 RECONSTRUCTION OF ANTERIOR MOUTH $2,383.00 40842 RECONSTRUCTION OF POSTERIOR MOUTH $2,270.00 40843 RECONSTRUCTION OF POSTERIOR MOUTH $3,235.00 40844 RECONSTRUCTION OF MOUTH $3,936.00 40845 RECONSTRUCTION OF MOUTH, COMPLEX $4,614.00 41000 DRAIN MOUTH LESION, LINGUAL $428.00 41005 DRAIN MOUTH LESION,SUBLING,SUPERFIC $474.00 41006 DRAIN MOUTH LESION, SUBLING, DEEP $954.00 41007 DRAIN MOUTH LESION, SUBMENTAL SPACE $917.00 41008 DRAIN MOUTH LESION, SUBMANDIB SPACE $1,032.00 41009 DRAIN MOUTH LESION,MASTICATOR SPACE $1,119.00 41010 INCISION OF TONGUE FOLD $410.00 41015 DRAIN MOUTH LESION, SUBLINGUAL $1,342.00 41016 DRAIN MOUTH LESION, SUBMENTAL $1,347.00 41017 DRAIN MOUTH LESION, SUBMANDIBULAR $1,354.00 41018 DRAIN MOUTH LESION,MASTICATOR SPACE $1,583.00 41019 PLACE NEEDLES H&N FOR RT $1,677.00 41100 BIOPSY OF ANTERIOR TONGUE $409.00 41105 BIOPSY OF POSTERIOR TONGUE $424.00 41108 BIOPSY OF FLOOR OF MOUTH $345.00 41110 EXCISION OF TONGUE LESION $499.00 41112 EXCISION OF TONGUE LESION W/CLOSURE $967.00 41113 EXCISION OF TONGUE LESION W/CLOSURE $1,071.00 41114 EXCISION OF TONGUE LESION W/CLOSURE $2,410.00 41115 EXCISION OF TONGUE FOLD $584.00 41116 EXCISION OF MOUTH FLOOR LESION $840.00 41120 PARTIAL REMOVAL OF TONGUE $4,109.00 41130 PARTIAL REMOVAL OF TONGUE $5,048.00 41135 PARTIAL REMOVAL OF TONGUE,NECK SURG $8,270.00 41140 REMOVAL OF TONGUE $8,335.00 41145 TONGUE REMOVAL, NECK SURGERY $10,615.00 41150 TONGUE REMOVAL, MOUTH, JAW SURGERY $8,395.00 41153 TONGUE REMOVAL, MOUTH, NECK SURGERY $9,135.00 41155 TONGUE REMOVAL, JAW, NECK SURGERY $11,469.00 41250 REPAIR TONGUE/MOUTH LACERATION $577.00 41251 REPAIR TONGUE/MOUTH LACERATION $693.00 41252 REPAIR TONGUE/MOUTH LACERATION $795.00 41500 FIXATION OF TONGUE, MECHANICAL $1,709.00 41510 SUTURE TONGUE TO LIP $1,626.00 41512 NULL $2,514.00 41520 RECONSTRUCT TONGUE FOLD $991.00 41530 NULL $12,738.00 41800 DRAINAGE OF GUM LESION $556.00 41805 REMOVE FOREIGN BODY FROM GUM $668.00 41806 REMOVE FOREIGN BODY FROM JAWBONE $1,000.00 41822 REMOVE FIBROUS LESIONS FROM GUM $701.00 41823 REMOVE BONY LESIONS FROM GUM $1,243.00 41825 REMOVAL OF GUM LESION, NO REPAIR $468.00 41826 REMOVE GUM LESION, SIMPLE REPAIR $817.00 41827 REMOVE GUM LESION, COMPLEX REPAIR $1,176.00 41828 EXCISE HYPERPLASTIC ALVEOLAR MUCOSA $819.00 41830 REMOVAL OF GUM TISSUE $1,097.00 41872 GINGIVOPLASTY, EACH QUADRANT $980.00 41874 ALVEOLOPLASTY, EACH QUADRANT $986.00 42000 DRAINAGE OF MOUTH ROOF LESION $393.00 42100 BIOPSY OF ROOF OF MOUTH $417.00 42104 REMOVE MOUTH ROOF LESION,NO CLOSURE $530.00 42106 REMOVE MOUTH ROOF LESION W/CLOSURE $683.00 42107 REMOVE MOUTH ROOF LESION,FLAP CLOSE $1,320.00 42120 REMOVE LESION/PART REMOVAL PALATE $3,867.00 42140 REMOVAL OF UVULA $586.00 42145 REVISION OF PALATE, PHARYNX/UVULA $2,645.00 42160 TREAT MOUTH ROOF LESION $558.00 42180 REPAIR MOUTH ROOF LACERATION $694.00 42182 REPAIR MOUTH ROOF LACERATION $964.00 42200 RECONSTRUCT CLEFT PALATE $3,193.00 42205 RECONSTRUCT CLEFT PALATE $3,325.00 42210 RECONSTRUCT/GRAFT CLEFT PALATE $3,933.00 42215 RECONSTRUCT CLEFT PALATE $2,620.00 42220 RECONSTRUCT CLEFT PALATE W/LENGTHEN $1,861.00 42225 RECONSTRUCT CLEFT PALATE W/FLAP $3,306.00 42226 LENGTHENING OF PALATE, PHARYNG FLAP $3,382.00 42227 LENGTHENING OF PALATE, ISLAND FLAP $3,228.00 42235 REPAIR ANTERIOR PALATE, VOMER FLAP $2,761.00 42260 REPAIR NOSE TO LIP FISTULA $2,497.00 42280 PREPARATION OF PALATE MOLD $421.00 42281 INSERTION OF PALATE PROSTHESIS $569.00 42300 DRAINAGE OF SALIVARY GLAND ABSCESS $576.00 42305 DRAINAGE OF SALIVARY GLAND ABSCESS $1,627.00 42310 DRAINAGE OF SALIVARY GLAND ABSCESS $465.00 42320 DRAINAGE OF SALIVARY GLAND ABSCESS $661.00 42330 REMOVAL OF SALIVARY STONE, SIMPLE $622.00 42335 REMOVAL OF SALIVARY STONE, COMPLIC $975.00 42340 REMOVAL OF SALIVARY STONE, COMPLIC $1,262.00 42400 NEEDLE BIOPSY OF SALIVARY GLAND $204.00 42405 BIOPSY OF SALIVARY GLAND $850.00 42408 REMOVAL OF SALIVARY CYST $1,225.00 42409 DRAINAGE OF SALIVARY CYST $832.00 42410 REMOVAL OF PAROTID GLAND/TUMOR $2,349.00 42415 REMOVAL OF PAROTID GLAND/TUMOR $3,959.00 42420 REMOVAL OF PAROTID GLAND/TUMOR $4,448.00 42425 REMOVAL OF PAROTID GLAND/TUMOR $3,136.00 42426 REMOVAL OF PAROTID GLAND/TUMOR $5,058.00 42440 REMOVAL OF SUBMAXILLARY GLAND $1,549.00 42450 REMOVAL OF SUBLINGUAL GLAND $1,351.00 42500 REPAIR SALIVARY DUCT, SIMPLE $1,293.00 42505 REPAIR SALIVARY DUCT, COMPLICATED $1,708.00 42507 PAROTID DUCT DIVERSION (WILKE) $1,948.00 42509 DIVERT PAROTID DUCT, REMOVE GLANDS $3,231.00 42510 PAROTID DUCT DIVERSION, W/LIGATION $2,423.00 42550 INJECTION FOR SALIVARY GLAND X‐RAY $228.00 42600 CLOSURE OF SALIVARY FISTULA $1,307.00 42650 DILATE SALIVARY DUCT $220.00 42660 DILATE/CATHETERIZE SALIVARY DUCT $356.00 42665 LIGATION OF SALIVARY DUCT $772.00 42700 DRAINAGE OF TONSIL ABSCESS $510.00 42720 DRAINAGE OF THROAT ABSCESS $1,474.00 42725 DRAINAGE OF THROAT ABSCESS $3,084.00 42800 BIOPSY OF THROAT, OROPHARYNX $421.00 42804 BIOPSY OF UPPER NOSE/THROAT $426.00 42806 BIOPSY OF UPPER NOSE/THROAT $497.00 42808 REMOVAL OF PHARYNX LESION $610.00 42809 REMOVE PHARYNX FOREIGN BODY $459.00 42810 EXCISION OF NECK CYST, SUPERFICIAL $1,087.00 42815 EXCISION OF NECK CYST, DEEP $2,104.00 42820 REMOVE TONSILS & ADENOIDS, UNDER 12 $1,089.00 42821 REMOVE TONSILS & ADENOIDS, AGE 12+ $1,131.00 42825 REMOVAL OF TONSILS, UNDER AGE 12 $985.00 42826 REMOVAL OF TONSILS, AGE 12+ $944.00 42830 REMOVAL OF ADENOIDS, UNDER AGE 12 $778.00 42831 REMOVAL OF ADENOIDS, AGE 12+ $842.00 42835 REMOVAL OF ADENOIDS, UNDER AGE 12 $722.00 42836 REMOVAL OF ADENOIDS, AGE 12+ $904.00 42842 EXTENSIVE SURGERY OF THROAT/TONSILS $3,856.00 42844 EXTENSIVE SURGERY OF THROAT/TONSILS $5,278.00 42845 EXTENSIVE SURGERY OF THROAT/TONSILS $8,494.00 42860 REMOVAL OF TONSIL TAGS $707.00 42870 REMOVAL OF LINGUAL TONSIL $2,276.00 42890 PARTIAL REMOVAL OF PHARYNX $5,446.00 42892 REVISE PHARYNGEAL WALLS,DIRECT CLOS $7,203.00 42894 REVISE PHARYNGEAL WALLS, FLAP CLOSE $9,031.00 42900 REPAIR PHARYNX WOUND $1,264.00 42950 RECONSTRUCTION OF THROAT $3,113.00 42953 REPAIR THROAT AND ESOPHAGUS $3,753.00 42955 SURGICAL OPENING OF PHARYNX $2,936.00 42960 CONTROL THROAT BLEEDING, SIMPLE $639.00 42961 CONTROL THROAT BLEEDING, COMPLIC $1,594.00 42962 CONTROL THROAT BLEEDING, ADDED SURG $1,946.00 42970 CONTROL NOSE/THROAT BLEEDING,SIMPLE $1,502.00 42971 CONTROL NOSE/THROAT BLEEDING, COMPL $1,717.00 42972 CONTROL NOSE/THROAT BLEEDING $1,919.00 43020 INCISE ESOPHAGUS, REMOVE OBJECT $2,039.00 43030 THROAT MUSCLE SURGERY $1,956.00 43045 INCISE ESOPHAGUS, REMOVE OBJECT $5,113.00 43100 REMOVE ESOPHAGUS LESION, CERVICAL $2,342.00 43101 REMOVE ESOPHAGUS LESION, THORACIC $3,979.00 43107 TOTAL ESOPHAGUS REMOVAL $10,014.00 43108 REMOVE ESOPHAGUS W/BOWEL RECONSTRCT $17,802.00 43112 REMOVE ESOPHAGUS W/THORACOTOMY $10,583.00 43113 REMOVE ESOPHAGUS W/BOWEL RECONSTRCT $17,685.00 43116 PARTIAL ESOPHAGUS REMOVAL, CERVICAL $18,827.00 43117 PARTIAL ESOPHAGUS REMOVAL, DISTAL $9,690.00 43118 PARTIAL ESOPHAGUS REMOVAL, DISTAL $14,471.00 43121 PARTIAL ESOPHAGUS REMOVAL, DISTAL $11,296.00 43122 PARTIAL ESOPHAGUS REMOVAL, ABDOMEN $10,052.00 43123 PARTIAL ESOPHAGUS REMOVAL, ABDOMEN $18,548.00 43124 REMOVE ESOPHAGUS W/O RECONSTRUCTION $14,982.00 43130 REMOVAL OF ESOPHAGUS POUCH,CERVICAL $2,985.00 43135 REMOVAL OF ESOPHAGUS POUCH,THORACIC $5,799.00 43180 ESOPHAGUS ENDOSCOPY, DIAGNOSTIC $2,059.00 43191 ESOPHAGUS ENDOSCOPY, DIAGNOSTIC $578.00 43192 ESOPHAGOSCOPY RIGID TRANSORAL INJ $637.00 43193 ESOPHAGOSCOPY RIGID TRANSORAL BIOPS $637.00 43194 ESOPHAGOSCPY RIG TRANSORL RMV FORGN $732.00 43195 ESOPHAGOSCOPY RIGID TRANSORAL BALLO $691.00 43196 ESOPHAGOSCOPY RIG TRANSORAL GUIDE W $743.00 43197 ESOPHAGOSCOPY FLEXIBLE TRANSNASAL $311.00 43198 ESOPHAGOSCPY FLEXBLE TRANSNASAL BPS $374.00 43200 ESOPHAGUS ENDOSCOPY, DIAGNOSTIC $353.00 43201 ESOPHAGOSC,RIGID/FLEX;W/SUBMUC INJ $409.00 43202 ESOPHAGUS ENDOSCOPY W/BIOPSY $410.00 43204 ESOPHAGUS ENDOSCOPY/INJECT VARICES $783.00 43205 ESOPHAGUS ENDOSCOPY W/LIGATION $781.00 43206 with esophagogastric fundoplasty, p $529.00 43210 with esophagogastric fundoplasty, p $0.00 43211 ESOPHAGUS ENDOSCOPY/REMOVE OBJECT $903.00 43212 ESOPHAGUS ENDOSCOPY/REMOVE OBJECT $748.00 43213 ESOPHAGOSCPY RETROGRADE DILATE BALN $990.00 43214 ESOPHAGOSCPY DILATE ESOPHAGUS BALLN $740.00 43215 ESOPHAGUS ENDOSCOPY/REMOVE OBJECT $561.00 43216 ESOPHAGUS ENDOSCOPY/REMOVE LESION $521.00 43217 ESOPHAGUS ENDOSCOPY/REMOVE LESION $629.00 43220 ESOPHAGUS ENDOSCOPY/DILATION $466.00 43226 ESOPHAGUS ENDOSCOPY/INSERT WIRE $516.00 43227 ESOPHAGUS ENDOSCOPY, BLEED CONTROL $643.00 43229 Esophagoscopy w/Endosc US exam $763.00 43231 Esophagoscopy w/Endosc US exam $620.00 43232 Esophagoscopy w/transendoscopic US $758.00 43233 **DNU**UPPER GI ENDOSCOPY/EXAM $878.00 43235 UPPER GI ENDOSCOPY/DIAGNOSTIC $481.00 43236 UGI ENDSCOPY W DIRCTD SUBMUCSL INJ $541.00 43237 UPPER GASTRO ENDOSCOPY $814.00 43238 UPPER GASTRO ENDOSCOPY $1,016.00 43239 UPPER GI ENDOSCOPY, W/BIOPSY $542.00 43240 Upper GI endosc. w/transmural drain $1,496.00 43241 UPPER GI ENDOSCOPY,PLACE TUBE/CATH $557.00 43242 UGI ENDOSC‐ESO,STO;ULT INT‐MUR FNA $1,467.00 43243 UPPER GI ENDOSCOPY/INJECT VARICES $928.00 43244 UPPER GI ENDOSCOPY W/LIGATION $1,024.00 43245 UPPER GI ENDOSCOPY, W/DILATION $687.00 43246 UPPER GI ENDOSCOPY, W/GASTRIC TUBE $875.00 43247 UPPER GI ENDOSCOPY, REMOVE OBJECT $689.00 43248 UPPER GI ENDOSCOPY W/GUIDE WIRE $644.00 43249 UPPER GI ENDOSCOPY W/ESOPHAG DILATE $597.00 43250 UPPER GI ENDOSCOPY W/LESION REMOVAL $666.00 43251 UPPER GI ENDOSCOPY W/LESION REMOVAL $758.00 43252 UPPER GI ENDOSCOPY, BLEED CONTROL $654.00 43253 UPPER GI ENDOSCOPY, BLEED CONTROL $1,002.00 43254 EDG TRANSORAL ENDOSCPIC MUCOSAL RES $1,036.00 43255 UPPER GI ENDOSCOPY, BLEED CONTROL $772.00 43257 UGI ENDOSCPY W DELVRY OF THRML ENRG $1,120.00 43259 UPPER GI ENDOSCOPY W/ULTRASOUND $1,052.00 43260 ENDOSCOPY, ERCP, DIAGNOSTIC $1,231.00 43261 ENDOSCOPY, ERCP, W/BIOPSY $1,291.00 43262 ENDOSCOPY, ERCP, REPAIR SPHINCTER $1,482.00 43263 ENDOSCOPY, ERCP, SPHINCTER OF ODDI $1,463.00 43264 ENDOSCOPY, ERCP, W/STONE REMOVAL $1,777.00 43265 ENDOSCOPY, ERCP, STONE LITHOTRIPSY $1,993.00 43266 DEL2014ENDOSCOPY, ERCP, W/DRAIN INS $874.00 43270 DEL2014ENDOSCOPY, ERCP, W/BALLOON D $893.00 43273 NULL $449.00 43274 ERCP STENT PLACEMENT BILIARY/PANCRE $1,754.00 43275 ERCP REMOVE FOREIGN BODY/STENT BILI $1,436.00 43276 ERCP BILIARY/PANC DUCT STENT EXCHAN $1,828.00 43277 NULLcal Services $1,440.00 43278 NULLcal Services $1,642.00 43279 NULL $5,057.00 43280 NULL $4,223.00 43281 LAPAROSCOPY SX REPAIR PARAES HERNIA $6,042.00 43282 LAPAROSCOPY WITH IMPLANTATION MESH $6,791.00 43283 LAP ESOPH LENGTHENING $624.00 43300 REVISION OF ESOPHAGUS $2,310.00 43305 REVISE ESOPHAGUS, REPAIR FISTULA $4,124.00 43310 REVISION OF ESOPHAGUS $5,841.00 43312 REVISE ESOPHAGUS, REPAIR FISTULA $6,339.00 43313 ESOPHGPLSTY CNGNTL DFCT W/O RPR TEF $10,860.00 43314 ESOPHGOPLSTY CNGNTL DFCT W RPR TEF $11,852.00 43320 FUSE ESOPHAGUS & STOMACH $5,448.00 43325 REVISE ESOPHAGUS & STOMACH, W/PATCH $5,226.00 43327 ESOPH FUNDOPLASTY LAP $3,202.00 43328 ESOPH FUNDOPLASTY THOR $4,444.00 43330 REPAIR ESOPHAGUS (HELLER TYPE) $5,189.00 43331 REPAIR OF ESOPHAGUS $5,258.00 43332 TRANSAB ESOPH HIAT HERN RPR $4,539.00 43333 TRANSAB ESOPH HIAT HERN RPR $4,949.00 43334 TRANSTHOR DIAPHRAG HERN RPR $4,910.00 43335 TRANSTHOR DIAPHRAG HERN RPR $5,267.00 43336 THORABD DIAPHR HERN REPAIR $5,911.00 43337 THORABD DIAPHR HERN REPAIR $6,390.00 43338 ESOPH LENGTHENING $458.00 43340 FUSE ESOPHAGUS & INTESTINE $5,329.00 43341 FUSE ESOPHAGUS & INTESTINE $5,516.00 43351 SURGICAL OPENING OF ESOPHAGUS $4,981.00 43352 SURGICAL OPENING OF ESOPHAGUS $4,181.00 43360 GI REPAIR W/PREV ESOPHAGUS REMOVAL $9,254.00 43361 GI REPAIR W/PREV ESOPHAGUS REMOVAL $10,008.00 43400 LIGATION OF ESOPHAGUS VEINS $5,521.00 43401 ESOPHAGUS SURGERY FOR VARICES $6,113.00 43405 LIGATION/STAPLING GI JUNCTION $5,724.00 43410 SUTURE ESOPHAGUS WOUND, CERVICAL $4,101.00 43415 SUTURE ESOPHAGUS WOUND, THORACIC $10,076.00 43420 REPAIR ESOPHAGUS OPENING, CERVICAL $3,799.00 43425 REPAIR ESOPHAGUS OPENING, THORACIC $5,595.00 43450 DILATE ESOPHAGUS, UNGUIDED $317.00 43453 DILATE ESOPHAGUS, GUIDEWIRE $341.00 43460 ESOPHAGOGASTRIC TAMPONADE W/BALLOON $798.00 43496 MICROVASCULAR FREE JEJUNUM TRANSFER $6,506.00 43500 GASTROTOMY, REMOVE FOREIGN OBJECT $3,040.00 43501 GASTROTOMY, SUTURE BLEEDING ULCER $5,244.00 43502 GASTROTOMY, REPAIR ESOPHAGUS LACER $5,951.00 43510 GASTROTOMY W/ESOPHAGEAL DILATION $3,683.00 43520 PYLOROMYOTOMY (FREDET‐RAMSTEDT) $2,678.00 43605 BIOPSY OF STOMACH, BY LAPAROTOMY $3,253.00 43610 REMOVE BENIGN STOMACH ULCER/TUMOR $3,818.00 43611 REMOVE MALIGNANT STOMACH TUMOR $4,772.00 43620 REMOVE STOMACH, TOTAL $7,627.00 43621 REMOVE STOMACH, TOTAL, W/ROUX‐EN‐Y $8,891.00 43622 REMOVE STOMACH, TOTAL, W/POUCH $9,092.00 43631 REMOVE STOMACH, PARTIAL $5,657.00 43632 REMOVE STOMACH, PARTIAL $7,949.00 43633 REMOVE STOMACH, PARTIAL W/ROUX‐EN‐Y $7,507.00 43634 REMOVE STOMACH, PARTIAL, W/POUCH $8,265.00 43635 VAGOTOMY PERFORM W/PRT STOMACH REMV $442.00 43640 VAGOTOMY/PYLORUS REPAIR, TRUNCAL $4,598.00 43641 VAGOTOMY/PYLORUS REPAIR, PARIETAL $4,598.00 43644 LAPRSCPY, SURG, R‐EN‐Y GASTROENTERY $6,767.00 43645 LAPROSCY W GASTRIC BYPASS $ RECONST $7,241.00 43647 LAP IMPL ELECTRODE, ANTRUM $3,294.00 43648 LAP REVISE/REMV ELTRD ANTRUM $3,294.00 43651 LAPROSCOPY, TRANSECTION VAGUS NERVE $2,525.00 43652 LAPROSCPY, TRANSECTION VAGUS NERVE $2,990.00 43653 LAPROSCPY, GASTROSTOMY, W/O G‐TUBE $2,224.00 43752 NASOGASTRIC TUBE PLCMNT, W FLURO GU $148.00 43753 TX GASTRO INTUB W/ASP $80.00 43754 DX GASTR INTUB W/ASP SPEC $119.00 43755 DX GASTR INTUB W/ASP SPECS $236.00 43756 DX DUOD INTUB W/ASP SPEC $190.00 43757 DX DUOD INTUB W/ASP SPECS $287.00 43760 CHANGE GASTROSTOMY TUBE $175.00 43761 REPOSITION GASTROSTOMY TUBE $373.00 43770 LAPARSCPY, GASTR PLCMNT GASTIC BAND $4,363.00 43771 LAPARSCPY, REVISION OF GASTRIC BAND $4,968.00 43772 LAPROSCPY, REMOVAL OF ADJ GASTR BAN $3,693.00 43773 LAPROSCPY, REM&REPLCMNT GASTIC BAND $4,936.00 43774 LAPSCPY, REMOVL GAST BAND & PORTS $3,739.00 43775 LAP LONGITUDINAL GASTRECTOMY $4,611.00 43800 RECONSTRUCTION OF PYLORUS $3,622.00 43810 FUSION OF STOMACH AND BOWEL $3,969.00 43820 FUSION OF STOMACH AND BOWEL $5,233.00 43825 FUSION OF STOMACH AND BOWEL $5,103.00 43830 PLACE TEMPORARY GASTROSTOMY TUBE $2,715.00 43831 PLACE GASTROSTOMY TUBE, NEWBORN $2,266.00 43832 PLACE PERMANENT GASTROSTOMY TUBE $4,047.00 43840 REPAIR STOMACH LESION $5,301.00 43843 GASTRIC REVISION FOR OBESITY $4,989.00 43845 GASTRIC RESTRICTIVE PROCD, W GASTRE $7,676.00 43846 GASTRIC REVISION FOR OBESITY $6,294.00 43847 GASTRIC BYPASS FOR OBESITY $6,878.00 43848 GASTRIC BYPASS REVISION $7,515.00 43850 REVISE STOMACH‐BOWEL FUSION $6,281.00 43855 REVISE STOMACH‐BOWEL FUSION $6,315.00 43860 REVISE STOMACH‐BOWEL FUSION $6,380.00 43865 REVISE STOMACH‐BOWEL FUSION $6,653.00 43870 REPAIR STOMACH OPENING $2,764.00 43880 REPAIR STOMACH‐BOWEL FISTULA $6,234.00 43881 IMPL REDO ELECTRO, ANTRUM $2,928.00 43882 REVISE REMOVE ELECTRD ANTRUM $2,928.00 43886 GASTRIC RESTRICTIVE PROC, REVIS POR $1,396.00 43887 GATRIC RSTRICTIVE, REMOVAL PORT $1,252.00 43888 GATRIC RESTRICTIVE, REMOV &REPL POR $1,773.00 44005 FREEING OF BOWEL ADHESION $4,260.00 44010 INCISION OF DUODENUM $3,324.00 44015 TUBE JEJUNOSTOMY FOR FEEDING $559.00 44020 INCISION OF SMALL BOWEL $3,797.00 44021 DECOMPRESSION OF SMALL BOWEL $3,784.00 44025 INCISION OF COLON $3,829.00 44050 REDUCTION OF BOWEL OBSTRUCTION $3,646.00 44055 CORRECTION OF MALROTATION OF BOWEL $5,806.00 44100 BIOPSY OF BOWEL $405.00 44110 REMOVAL OF BOWEL LESION(S) $3,310.00 44111 REMOVAL OF BOWEL LESION(S) $3,812.00 44120 REMOVAL OF SMALL INTESTINE W/FUSION $4,766.00 44121 REMOVAL OF SMALL INTESTINE, EA ADDL $948.00 44125 REMOVAL OF SMALL INTESTINE $4,587.00 44126 ENTERECTOMY, RESEC OF SMALL INTESIN $9,659.00 44127 ENTERECTOMY, RESC SMALL INTES, TAPR $11,032.00 44128 ENTERECTOMY, ADDTINAL RESECT & ANAS $964.00 44130 BOWEL TO BOWEL FUSION $5,104.00 44137 REMOVAL OF TRANPLNTED INTES ALLOGRA $4,526.00 44139 MOBILIZATION OF SPLENIC FLEXURE $473.00 44140 PARTIAL REMOVAL OF COLON, W/FUSION $5,217.00 44141 PARTIAL REMOVAL OF COLON/COLOSTOMY $7,097.00 44143 PARTIAL REMOVAL OF COLON/COLOSTOMY $6,476.00 44144 PARTIAL REMOVAL OF COLON $6,892.00 44145 PARTIAL REMOVAL OF COLON/COLOSTOMY $6,417.00 44146 PARTIAL REMOVAL OF COLON/COLOSTOMY $8,179.00 44147 PARTIAL REMOVAL OF COLON $7,561.00 44150 REMOVAL OF COLON/ILEOSTOMY $7,240.00 44151 REMOVAL OF COLON/ILEOSTOMY $8,314.00 44155 REMOVAL OF COLON/PROCTECTOMY $8,003.00 44156 REMOVAL OF COLON/PROCTECT/ILEOSTOMY $8,929.00 44157 COLECTMY W PROCTECTOMY W IA ANSTMSS $8,318.00 44158 COLECTMY W PROCTECTOM W IAA W ILEAL $8,212.00 44160 REMOVAL OF COLON/ILEOCOLOSTOMY $4,823.00 44180 LAPAROSCOPY, ENTEROLYSIS $3,568.00 44186 LAPAROSCOPY, JEJUNOSTOMY, SURGICAL $2,542.00 44187 LAPAROSCOPY, SURG, ILEOSTOMY $4,240.00 44188 LAPAROSCOPY, SURG, COLOSTOMY SKIN $4,732.00 44202 LAPAROSCOPY, SURG, ENTEROSTOMY, $5,399.00 44203 LAPAROSCOPY, ENTERECTOMY, ADDTINAL $941.00 44204 LAPAROSCOPY, SURG, COLECTOMY $5,950.00 44205 LAPAROSCOPY, COLECTOMY, PARTIAL $5,168.00 44206 LAPAROSCOPY, COLECTOMY, PARTIAL $6,794.00 44207 LAPAROSCOPY, COLECTOMY, PART W ANAS $7,005.00 44208 LAP,SURG;COL,PAR W/ANA,COLPR,COLSTO $7,635.00 44210 LAP,SUR;COL,TOT ABD W/O PROT,W/ILEO $6,815.00 44211 LAP,SUR;COL,TOT,ABD,W/PRO,ILE ANAST $8,314.00 44212 LAPRSCOPY, COLECTOMY, ABDOMINAL $7,782.00 44213 LAPROSCPY, MOBILIZATION $727.00 44227 LAPROSCPY, CLOSURE ENTEROSTOMY $6,473.00 44300 OPEN BOWEL TO SKIN, TUBE $3,278.00 44310 ILEOSTOMY/JEJUNOSTOMY, NON‐TUBE $4,033.00 44312 REVISION OF ILEOSTOMY, SIMPLE $2,249.00 44314 REVISION OF ILEOSTOMY, COMPLICATED $3,844.00 44316 CONSTRUCT BOWEL POUCH $5,546.00 44320 COLOSTOMY $4,656.00 44322 COLOSTOMY/BIOPSIES $3,872.00 44340 REVISION OF COLOSTOMY, SIMPLE $2,414.00 44345 REVISION OF COLOSTOMY, COMPLICATED $4,060.00 44346 REVISION OF COLOSTOMY/HERNIA REPAIR $4,567.00 44360 SMALL BOWEL ENDOSCOPY/DIAGNOSTIC $560.00 44361 SMALL BOWEL ENDOSCOPY/BIOPSY $616.00 44363 SMALL BOWEL ENDOSCOPY/REMOVE OBJECT $740.00 44364 SMALL BOWEL ENDOSCOPY/REMOVE LESION $785.00 44365 SMALL BOWEL ENDOSCOPY/REMOVE LESION $698.00 44366 SMALL BOWEL ENDOSCOPY FOR BLEEDING $921.00 44369 SMALL BOWEL ENDOSCOPY/REMOVE LESION $943.00 44370 SMALL INTSTNL ENDO W TRNSENDO STENT $1,026.00 44372 SMALL BOWEL ENDOSCOPY/PLACE TUBE $926.00 44373 SMALL BOWEL ENDOSCOPY/REPLACE TUBE $746.00 44376 SMALL BOWEL ENDOSCOPY/DIAGNOSTIC $1,088.00 44377 SMALL BOWEL ENDOSCOPY/BIOPSY $1,148.00 44378 SMALL BOWEL ENDOSCOPY/BLEED CONTROL $1,467.00 44379 INT ENDOSC,ENTEROSC ‐DEO,ILE;CON BL $1,559.00 44380 SMALL BOWEL ENDOSCOPY, THRU STOMA $232.00 44381 SMALL BOWEL ENDOSCOPY, THRU STOMA $44,383.00 44382 SMALL BOWEL ENDOSCOPY, THRU STOMA $295.00 44384 ENDOSCOPY OF BOWEL POUCH/DIAGNOSTIC $44,386.00 44385 ENDOSCOPY OF BOWEL POUCH/DIAGNOSTIC $288.00 44386 ENDOSCOPY OF BOWEL POUCH/BIOPSY $353.00 44388 COLONOSCOPY, DIAGNOSTIC $615.00 44389 COLONOSCOPY, W/BIOPSY $669.00 44390 COLONOSCOPY, W/FOREIGN BODY REMOVAL $810.00 44391 COLONOSCOPY, W/BLEEDING CONTROL $888.00 44392 COLONOSCOPY, REMOVE LESION, CAUTERY $772.00 44394 COLONOSCOPY, REMOVE LESION, W/SNARE $874.00 44401 INTRODUCE GI TUBE (MILLER‐ABBOTT) $44,602.00 44402 LIVER SURGERY PROCEDURE NEC $0.00 44403 COLONOSCOPY STOMA W/ENDOSCOPIC MUCO $0.00 44404 COLONOSCOPY STOMA W/SUBMUCOSAL INJE $0.00 44405 COLONOSCOPY STOMA W/BALLOON DILATIO $0.00 44406 COLONOSCOPY STOMA W/ENDOSCOPIC ULTR $0.00 44407 COLONOSCOPY STOMA W/US GID NDL ASPI $0.00 44408 COLONOSCOPY THROUGH STOMA WITH DECO $0.00 44500 INTRODUCE GI TUBE (MILLER‐ABBOTT) $88.00 44602 SUTURE, SMALL INTESTINE, ONE PERF $5,507.00 44603 SUTURE, SMALL INTESTINE, MULT PERFS $6,301.00 44604 SUTURE, LARGE INTESTINE $4,110.00 44605 SUTURE, LARGE INTESTINE W/COLOSTOMY $5,072.00 44615 INTESTINAL STRICTUROPLASTY $4,182.00 44620 CLOSE ENTEROSTOMY $3,352.00 44625 CLOSE ENTEROSTOMY, W/RESEC $3,911.00 44626 CLOSE ENTEROSTOMY, W/RESEC COLORECT $6,229.00 44640 REPAIR BOWEL‐SKIN FISTULA $5,438.00 44650 REPAIR BOWEL FISTULA $5,617.00 44660 REPAIR BOWEL‐BLADDER FISTULA $5,031.00 44661 REPAIR BOWEL‐BLADDER FISTULA $5,966.00 44680 SURGICAL REVISION OF BOWEL $4,145.00 44700 EXCLUSION, SMALL BOWEL FROM PELVIS $3,896.00 44701 INTRAOPERATIVE COLONIC LAVAGE $656.00 44715 BKBEN STD PREP CADAVER INTES SMA/MV $1,096.00 44720 BKBEN RECON CADAVER INT VEN ANAS EA $1,084.00 44721 BKBEN RECON CADAVER INT ART ANAS EA $1,518.00 44800 REMOVAL OF BOWEL POUCH $2,954.00 44820 REMOVAL OF MESENTERY LESION $3,252.00 44850 REPAIR OF MESENTERY $2,920.00 44900 DRAINAGE OF APPENDIX ABSCESS, OPEN $3,001.00 44950 REMOVAL OF APPENDIX $2,505.00 44955 APPENDECTOMY W/OTHER PROCEDURE $327.00 44960 REMOVAL OF RUPTURED APPENDIX $3,410.00 44970 Laparoscopic Appendix $2,339.00 45000 DRAINAGE OF PELVIC ABSCESS $1,605.00 45005 DRAINAGE OF RECTAL ABSCESS $617.00 45020 DRAINAGE OF RECTAL ABSCESS, DEEP $2,191.00 45100 BIOPSY OF RECTUM $1,136.00 45108 REMOVAL OF ANORECTAL LESION $1,415.00 45110 REMOVAL OF RECTUM/COLOSTOMY $7,077.00 45111 PARTIAL REMOVAL OF RECTUM $4,176.00 45112 REMOVAL OF RECTUM (PULL‐THROUGH) $7,159.00 45113 PARTIAL REMOVAL OF RECTUM $7,314.00 45114 PARTIAL REMOVAL OF RECTUM W/FUSION $7,110.00 45116 PARTIAL REMOVAL OF RECTUM W/FUSION $6,405.00 45119 PROCTECTOMY, COMB PULL‐THRU W/RESV $7,399.00 45120 REMOVAL OF RECTUM (PULL THROUGH) $5,811.00 45121 REMOVAL OF RECTUM AND COLON $6,775.00 45123 PARTIAL REMOVAL OF RECTUM $4,248.00 45126 REMOVE ORGANS FOR COLORECTAL MALIG $10,631.00 45130 EXCISION OF RECTAL PROLAPSE, FUSION $4,113.00 45135 EXCISION OF RECTAL PROLAPSE, FUSION $5,331.00 45136 EXCISION‐ILEOANAL RESERV W/ILEOSTOM $6,762.00 45150 REMOVAL OF RECTAL STRICTURE $1,453.00 45160 REMOVAL OF RECTAL TUMOR $3,981.00 45171 EXCISION OR RECTAL TUMOR, TRANSANAL $2,291.00 45172 EXC RECTAL TUMOR INC MUSCUL PROPRIA $3,067.00 45190 DESTROY RECTAL TUMOR, ANY METHOD $2,621.00 45300 PROCTOSIGMOIDOSCOPY/DIAGNOSTIC $203.00 45303 PROCTOSIGMOIDOSCOPY/DILATION $351.00 45305 PROCTOSIGMOIDOSCOPY/BIOPSY $299.00 45307 PROCTOSIGMOIDOSCOPY/REMOVE OBJECT $415.00 45308 PROCTOSIGMOIDOSCOPY/REMOVE LESION $345.00 45309 PROCTOSIGMOIDOSCOPY/REMOVE LESION $369.00 45315 PROCTOSIGMOIDOSCOPY/REMOVE LESIONS $378.00 45317 PROCTOSIGMOIDOSCOPY/BLEEDING CONTRL $442.00 45320 PROCTOSIGMOIDOSCOPY/REMOVE TUMOR $430.00 45321 PROCTOSIGMOIDOSCOPY/DECOMPRESSION $411.00 45327 PRO‐SIG‐SCOP,RIGID W/TRANSEND ST PL $474.00 45330 SIGMOIDOSCOPY/DIAGNOSTIC $210.00 45331 SIGMOIDOSCOPY/BIOPSY $269.00 45332 SIGMOIDOSCOPY/REMOVE FOREIGN BODY $418.00 45333 SIGMOIDOSCOPY/REMOVE LESION $375.00 45334 SIGMOIDOSCOPY W/BLEEDING CONTROL $462.00 45335 SIGMOIDOSC,FLEX;W/SUBMUC INJ,ANY SU $270.00 45337 SIGMOIDOSCOPY/DECOMPRESSION $514.00 45338 SIGMOIDOSCOPY/REMOVE LESION W/SNARE $473.00 45340 SIGMOIDOSC,FLEX;W/DIL‐BALLO,1/MOR S $314.00 45341 SIGMOIDOSC,FLEX;W/ENDOSCOP US EXAM $560.00 45342 SIGMOIDOSC,FLEX;TRANSEND US‐GUI FNA $852.00 45346 SIGMOIDOSCOPY FLX ABLATION TUMOR PO $604.00 45347 DEL2015RADIATION THERAPY DOSE PLAN, $45,378.00 45349 SGMDSC FLX WITH ENDOSCOPIC MUCOSAL $0.00 45350 SIGMOIDOSCOPY FLX WITH WITH BAND LI $0.00 45378 COLONOSCOPY, DIAGNOSTIC $718.00 45379 COLONOSCOPY/REMOVE FOREIGN BODY $922.00 45380 COLONOSCOPY/BIOPSY $775.00 45381 COLONOSCPY FLXBL W DIRECTD SUMU INJ $773.00 45382 COLONOSCOPY, W/BLEEDING CONTROL $994.00 45384 COLONOSCOPY/REMOVE LESION W/CAUTERY $886.00 45385 COLONOSCOPY/REMOVE LESION W/SNARE $978.00 45386 COLNSCPY FLXBL PRXML TO SF W DILTN $820.00 45388 COLONOSCOPY FLEXIBLE, W ENDOSCOP US $45,392.00 45389 COLONOSCOPY FLX WITH ENDOSCOPIC STE $0.00 45390 COLONOSCOPY FLX W/ENDOSCOPIC MUCOSA $0.00 45391 COLONOSCOPY FLEXIBLE, W ENDOSCOP US $1,052.00 45392 COLONOSCOPY FLEXIBLE, W/ TRANSENDO $1,359.00 45393 LAPARSCO SURG PROTECTOM W/COLOSTOMY $45,397.00 45395 LAPARSCO SURG PROTECTOM W/COLOSTOMY $7,533.00 45397 LAPAROSC SURG PROTECTOM W/ENTEROSTO $8,162.00 45398 LAPAROSCO SURG PROCTOPEXY $45,402.00 45400 LAPAROSCO SURG PROCTOPEXY $4,316.00 45402 LAPAROSCO SURG PROCTOPEX W/SIGM RES $5,772.00 45500 REPAIR RECTAL/ANAL STRICTURE $1,939.00 45505 REPAIR RECTAL MEMBRANE PROLAPSE $2,253.00 45520 TREATMENT OF RECTAL PROLAPSE $149.00 45540 CORRECT RECTAL PROLAPSE $4,020.00 45541 CORRECT RECTAL PROLAPSE $3,617.00 45550 REPAIR RECTUM, REMOVE SIGMOID $5,542.00 45560 REPAIR RECTOCELE $2,532.00 45562 EXPLORE/REPAIR/DRAIN RECTAL INJURY $4,301.00 45563 EXPLORE/REPAIR/DRAIN RECTAL INJURY $6,435.00 45800 REPAIR RECTAL‐BLADDER FISTULA $4,568.00 45805 REPAIR RECTUM FISTULA, W/COLOSTOMY $5,716.00 45820 REPAIR RECTAL‐URETHRA FISTULA $4,436.00 45825 REPAIR RECTUM FISTULA, W/COLOSTOMY $5,131.00 45900 REDUCTION OF RECTAL PROLAPSE $772.00 45905 DILATION OF ANAL SPHINCTER $643.00 45910 DILATION OF RECTAL NARROWING $733.00 45915 REMOVE RECTAL OBSTRUCTION $846.00 45990 ANORECTAL EXAM,SURG,REQ ANESTH DIAG $409.00 46020 PLACMENT OF SETON $888.00 46030 REMOVAL OF RECTAL MARKER $340.00 46040 DRAINAGE OF RECTAL ABSCESS $1,580.00 46045 DRAINAGE OF RECTAL ABSCESS $1,656.00 46050 DRAINAGE OF ANAL ABSCESS $367.00 46060 DRAINAGE OF RECTAL ABSCESS $1,808.00 46070 INCISION OF ANAL SEPTUM, INFANT $854.00 46080 INCISION OF ANAL SPHINCTER $609.00 46083 INCISION OF EXTERNAL HEMORRHOID $398.00 46200 REMOVAL OF ANAL FISSURE $1,225.00 46220 REMOVAL OF ANAL TAG $449.00 46221 LIGATION OF HEMORRHOID(S) $709.00 46230 REMOVAL OF ANAL TAGS $651.00 46250 REMOVAL OF EXTERNAL HEMORRHOIDS $1,202.00 46255 REMOVAL OF HEMORRHOIDS, SIMPLE $1,348.00 46257 REMOVAL OF HEMORRHOIDS & FISSURE $1,600.00 46258 REMOVAL OF HEMORRHOIDS & FISTULA $1,806.00 46260 REMOVAL OF HEMORRHOIDS, COMPLEX $1,812.00 46261 REMOVAL OF HEMORRHOIDS & FISSURE $1,975.00 46262 REMOVAL OF HEMORRHOIDS & FISTULA $2,084.00 46270 REMOVE ANAL FISTULA, SUBCUTANEOUS $1,493.00 46275 REMOVE ANAL FISTULA, SUBMUSCULAR $1,560.00 46280 REMOVE ANAL FISTULA, COMPLEX/MULT $1,769.00 46285 REMOVE ANAL FISTULA, SECOND STAGE $1,551.00 46288 CLOSE ANAL FISSURE W/RECTAL ADVANCE $2,077.00 46320 REMOVE HEMORRHOID CLOT $418.00 46500 INJECT HEMORRHOIDS W/SCLEROSING $460.00 46505 CHEMODENERVATION ON INTER ANAL SPHI $900.00 46600 ANOSCOPY, DIAGNOSTIC $153.00 46601 ANOSCOPY, W/DILATION $46,606.00 46604 ANOSCOPY, W/DILATION $250.00 46606 ANOSCOPY, W/BIOPSY $286.00 46607 ANOSCOPY, W/FOREIGN BODY REMOVAL $456.87 46608 ANOSCOPY, W/FOREIGN BODY REMOVAL $308.00 46610 ANOSCOPY, REMOVE LESION $310.00 46611 ANOSCOPY, REMOVE LESION, W/SNARE $306.00 46612 ANOSCOPY, REMOVE LESIONS $359.00 46614 ANOSCOPY, W/BLEEDING CONTROL $243.00 46615 ANOSCOPY, REMOVE LESION $352.00 46700 REPAIR OF ANAL STRICTURE, ADULT $2,462.00 46705 REPAIR OF ANAL STRICTURE, INFANT $1,855.00 46706 REPAIR OF ANAL FISTULA W/FIBRIN GLU $616.00 46707 REPAIR OF ANORECTAL FISTULA W/PLUG $1,816.00 46710 REP ILEOANAL FIST/SIN T/PERIN APPRO $4,019.00 46712 REP ILEOAN FIST/SIN T/PERI T/ABD AP $8,047.00 46715 REPAIR, LOW IMPERFORATE ANUS $2,101.00 46716 REPAIR, LOW IMPERFORATE ANUS $4,107.00 46730 REPAIR, HIGH IMPERFORATE ANUS $6,751.00 46735 REPAIR, HIGH IMPERFORATE ANUS $7,817.00 46740 REPAIR, HIGH IMPERFORATE ANUS $8,379.00 46742 REPAIR, HIGH IMPERFORATE ANUS $9,311.00 46744 REPAIR, CLOACAL ANOMALY $13,806.00 46746 REPAIR, CLOACAL ANOMALY $13,537.00 46748 REPAIR, CLOACAL ANOMALY $14,702.00 46750 REPAIR OF ANAL SPHINCTER, ADULT $2,806.00 46751 REPAIR OF ANAL SPHINCTER, CHILD $2,208.00 46753 RECONSTRUCT ANUS W/GRAFT $2,372.00 46754 REMOVAL OF SUTURE FROM ANUS $842.00 46760 REVISION OF ANAL SPHINCTER, ADULT $4,050.00 46761 REVISION OF ANAL SPHINCTER, ADULT $3,439.00 46762 REVISION OF ANAL SPHINCTER, ADULT $3,455.00 46900 CHEM DESTRUCTION OF ANAL LESION(S) $510.00 46910 ELECTR DESTRUCTION, ANAL LESION(S) $505.00 46916 CRYOSURG REMOVAL OF ANAL LESION(S) $530.00 46917 LASER DESTRUCTION OF ANAL LESION(S) $487.00 46922 SURGICAL REMOVAL OF ANAL LESION(S) $513.00 46924 DESTRUCTION OF ANAL LESION(S) $687.00 46930 NULL $544.00 46940 TREATMENT OF ANAL FISSURE $548.00 46942 RETREATMENT OF ANAL FISSURE $489.00 46945 LIGATION OF INTERNAL HEMORRHOIDS $850.00 46946 LIGATION OF INTERNAL HEMORRHOIDS $846.00 46947 HEMORRHOIDOPEXY BY STAPLING $1,466.00 47000 NEEDLE BIOPSY OF LIVER $372.00 47001 NEEDLE BIOPSY OF LIVER W/OTHER PROC $408.00 47010 HEPATOTOMY, OPEN DRAIN, 1/2 STAGES $4,674.00 47015 INJECT/ASPIRATE LIVER CYST/ABSCESS $4,427.00 47100 WEDGE BIOPSY OF LIVER $3,278.00 47120 PARTIAL REMOVAL OF LIVER/LOBE $9,099.00 47122 EXTENSIVE REMOVAL OF LIVER $13,461.00 47125 REMOVAL OF PARTIAL LIVER, LEFT LOBE $12,016.00 47130 REMOVAL OF PARTIAL LIVER,RIGHT LOBE $12,910.00 47135 LIVER TRANSPLANT, ORTHOTOPIC $20,979.00 47140 DONOR HEPATECTOMY LIV DONOR LAT SEG $13,992.00 47141 DONOR HEPATECTOMY W/PREP AND MAIN $16,729.00 47142 DONOR HEPATECTOMY W/PREP AND MAIN $18,449.00 47143 BKBEN ST PREP CADAVER W/O TRISEG SP $1,392.00 47144 BKBEN STD PREP CADAVER W/TRISEG SPT $1,392.00 47145 BKBEN STD PREP CADAVER W/ LOBE SPLT $1,392.00 47146 BKBEN RECON CADAVER VENOUS ASAS EAC $1,297.00 47147 BKBEN RECON CADAVER ARTER ANAS EACH $1,505.00 47300 SURGERY FOR LIVER ABSCESS/CYST $4,403.00 47350 REPAIR LIVER WOUND, SIMPLE $5,328.00 47360 REPAIR LIVER WOUND, COMPLEX $7,238.00 47361 REPAIR LIVER WOUND, EXPLORATION $11,758.00 47362 REPAIR LIVER WOUND, RE‐EXPLORATION $5,663.00 47370 LAPAROSC,SUR,ABL‐1/MOR LIVER TUM;RF $4,867.00 47371 LAPROSC,SUR,ABL‐1‐MOR LIV TUM;CRYOS $4,465.00 47380 ABL,OP,1‐MORE LIVER TUMOR;RAD‐FREQU $5,604.00 47381 ABLATION,OP‐1‐MOR LIV TUM;CRYOSURGI $5,284.00 47382 ABLATION‐1‐MOR LIVER TUM,PERCUT,RF $2,782.00 47383 LIVER SURGERY PROCEDURE NEC $1,826.00 47400 INCISION OF LIVER DUCT $8,396.00 47420 INCISION OF BILE DUCT $5,234.00 47425 INCISION OF BILE DUCT/SPHINCTER $5,279.00 47460 INCISION OF BILE DUCT SPHINCTER $4,879.00 47480 INCISION OF GALLBLADDER $3,394.00 47490 INCISION OF GALLBLADDER $1,209.00 47531 Injection procedure for cholangiogr $47,532.00 47532 new access (eg, percutaneous transh $0.00 47533 Placement of biliary drainage cathe $47,534.00 47534 internal‐external $0.00 47535 Conversion of external biliary drai $47,536.00 47536 Exchange of biliary drainage cathet $0.00 47537 Removal of biliary drainage cathete $47,538.00 47538 Placement of stent(s) into a bile d $0.00 47539 new access, without placement of se $47,540.00 47540 new access, with placement of separ $0.00 47541 Placement of access through the bil $47,542.00 47542 Balloon dilation of biliary duct(s) $0.00 47543 Endoluminal biopsy(ies) of biliary $47,544.00 47544 Removal of calculi/debris from bili $0.00 47550 BILE DUCT ENDOSCOPY $651.00 47552 BILIARY ENDOSCOPY THRU SKIN, DIAG $1,129.00 47553 BILIARY ENDOSCOPY THRU SKIN, BIOPSY $1,108.00 47554 BILIARY ENDOSCOPY THRU SKIN, STONE $1,781.00 47555 BILIARY ENDOSCOPY THRU SKIN, DILATE $1,326.00 47556 BILIARY ENDOSCOPY THRU SKIN, DILATE $1,509.00 47562 LAPAROSCOPY SURGICAL W/CHOLECYSTEC $2,566.00 47563 NULL $2,784.00 47564 NULL $4,340.00 47570 NULL $2,981.00 47600 REMOVE GALLBLADDER $4,159.00 47605 REMOVE GALLBLADDER, W/XRAY EXAM $4,383.00 47610 REMOVE GALLBLADDER, EXPLORE DUCT $4,896.00 47612 REMOVE GALLBLADDER, EXPLORE DUCT $4,960.00 47620 REMOVE GALLBLADDER, EXPLORE DUCT $5,379.00 47700 EXPLORE BILE DUCTS FOR ATRESIA $4,028.00 47701 BILE DUCT REVISION (KASAI) $6,516.00 47711 EXCISE BILE DUCT TUMOR,EXTRAHEPATIC $6,067.00 47712 EXCISE BILE DUCT TUMOR,INTRAHEPATIC $7,753.00 47715 EXCISE BILE DUCT CYST $5,207.00 47720 FUSE GALLBLADDER/BOWEL, DIRECT $4,487.00 47721 FUSE UPPER GI STRUCTURES $5,303.00 47740 FUSE GALLBLADDER/BOWEL, ROUX‐EN‐Y $5,060.00 47741 FUSE GALLBLADDER/BOWEL, ROUX‐EN‐Y $5,727.00 47760 FUSE BILE DUCTS/BOWEL $8,834.00 47765 FUSE LIVER DUCTS/BOWEL $11,860.00 47780 FUSE BILE DUCTS/BOWEL, ROUX‐EN‐Y $9,657.00 47785 FUSE BILE DUCTS/BOWEL, ROUX‐EN‐Y $12,707.00 47800 RECONSTRUCT BILE DUCTS W/FUSION $6,147.00 47801 PLACE BILE DUCT SUPPORT STENT $3,706.00 47802 U‐TUBE HEPATICOENTEROSTOMY $5,863.00 47900 SUTURE BILE DUCT INJURY $5,340.00 48000 DRAIN PLACEMENT, ACUTE PANCREATITIS $7,287.00 48001 DRAIN PLACEMENT, ACUTE PANCREATITIS $8,921.00 48020 REMOVE PANCREATIC STONE $4,565.00 48100 BIOPSY OF PANCREAS, OPEN $3,445.00 48102 BIOPSY OF PANCREAS, NEEDLE $876.00 48105 RESCTN/DEBRDMNT NCRTZNG PNCREATITIS $11,131.00 48120 REMOVE PANCREATIC LESION $4,318.00 48140 PARTIAL REMOVAL OF PANCREAS $6,102.00 48145 PARTIAL REMOVAL OF PANCREAS $6,353.00 48146 PANCREATECTOMY (CHILD PROCEDURE) $7,326.00 48148 EXCISION OF AMPULLA OF VATER $4,857.00 48150 REMOVE PANCREAS, PARTIAL (WHIPPLE) $12,179.00 48152 REMOVE PANCREAS, PARTIAL (WHIPPLE) $11,219.00 48153 REMOVE PANCREAS, PARTIAL (WHIPPLE) $12,102.00 48154 REMOVE PANCREAS, PARTIAL (WHIPPLE) $11,381.00 48155 REMOVAL OF PANCREAS, TOTAL $7,111.00 48400 INJECTION, INTRAOP PANCREATOGRAPHY $393.00 48500 MARSUPIALIZE PANCREATIC CYST $4,327.00 48510 DRAIN PANCREATIC PSEUDOCYST, OPEN $4,233.00 48520 FUSE PANCREAS CYST/BOWEL, DIRECT $4,263.00 48540 FUSE PANCREAS CYST/BOWEL, ROUX‐EN‐Y $5,076.00 48545 PANCREATORRHAPHY FOR TRAUMA $5,196.00 48547 DUODENAL EXCLUSION, PANCREAS TRAUMA $6,990.00 48548 PANCREATICOJEJUNOSTOMY S2S ANSTMSIS $6,494.00 48551 BKBEN STD PREP CADAVER PANCRE ARTER $647.00 48552 BKBEN RECON OF CADAVER PANCR VEN AN $915.00 48554 TRANSPLANT PANCREATIC ALLOGRAFT $9,915.00 48556 REMOVE TRANSPLNT PANCREAS ALLOGRAFT $4,932.00 49000 EXPLORATION OF ABDOMEN $2,990.00 49002 REOPENING OF ABDOMEN $4,066.00 49010 EXPLORATION BEHIND ABDOMEN $3,612.00 49020 DRAINAGE OF PERITONEAL ABSCESS, OPN $6,180.00 49040 DRAIN ABDOMINAL ABSCESS, OPEN $3,879.00 49060 DRAINAGE, ABDOMINAL ABSCESS, OPEN $4,260.00 49062 DRAIN ABDOMINAL LYMPHOCELE, OPEN $2,840.00 49082 ABD PARACENTESIS $275.00 49083 ABD PARACENTESIS W/IMAGING $394.00 49084 PERITONEAL LAVAGE $421.00 49180 NEEDLE BIOPSY OF ABDOMINAL MASS $308.00 49185 Sclerotherapy of a fluid collection $49,200.00 49203 EXC ABD TUM 5 CM OR LESS $4,624.00 49204 EXC ABD TUM OVER 5 CM $5,920.00 49205 EXC ABD TUM OVER 10 CM $6,817.00 49215 EXCISION OF SACRAL SPINE TUMOR $8,567.00 49220 MULTIPLE SURGERY OF ABDOMEN $3,479.00 49250 REMOVAL OF UMBILICUS $2,271.00 49255 REMOVAL OF OMENTUM $3,051.00 49320 NULL $1,245.00 49321 NULL $1,329.00 49322 LAPAROSCOPY ASPIRATION $1,399.00 49323 NULL $2,434.00 49324 LAP SURGCL W INSRTN INTRPRTNL CATH $1,514.00 49325 LAP SURGCL W RVSN PRVSLY PLCED CATH $1,615.00 49326 LAPAROSCOPY SURGICAL W OMENTOPEXY $744.00 49327 LAP INS DEVICE FOR RT $516.00 49400 INJECT AIR/CONTRAST INTO ABDOMEN $344.00 49402 REMOVAL OF PERITONEAL FOREIGN BODY $3,329.00 49405 IMG‐GUIDE FLUID COLLXN DRAINAGE CAT $763.00 49406 IMG‐GUIDE FLUID COLLXN DRAINAG PERT $763.00 49407 IMG FLUID COLLXN DRAINAG CATH TRANS $828.00 49411 PLCMNT INTERSTITAL DEVICE RAD THERP $714.00 49412 INS DEVICE FOR RT GUIDE OPEN $327.00 49418 INSERT TUN IP CATH PERC $797.00 49419 INS‐INTRAPER CANN/CATH W/SUBDUT,PER $1,701.00 49421 INSERT PERMANENT ABDOMINAL DRAIN $900.00 49422 REMOVE PERMANENT ABDOMINAL DRAIN $1,476.00 49423 EXCHANGE PREV DRAINAGE CATHETER $260.00 49424 CONTRAST INJECT VIA PREV CATHETER $138.00 49425 INSERT PERITONEAL‐VENOUS SHUNT $2,809.00 49426 REVISE PERITONEAL‐VENOUS SHUNT $2,361.00 49427 INJECTION FOR ABDOMINAL SHUNT $171.00 49428 LIGATION OF PERITONEAL‐VENOUS SHUNT $1,684.00 49429 REMOVAL OF PERITONEAL‐VENOUS SHUNT $1,791.00 49435 INSRT SUBCU EXTNSN INTRAPERTNL CATH $473.00 49436 DELYD CRTN EXIT SITE INTRPRTNL CATH $724.00 49440 PLACE GASTROSTOMY TUBE PERC $805.00 49441 PLACE DUOD/JEJ TUBE PERC $949.00 49442 PLACE CECOSTOMY TUBE PERC $804.00 49446 CHANGE G‐TUBE TO G‐J PERC $587.00 49450 REPLACE G/C TUBE PERC $243.00 49451 REPLACE DUOD/JEJ TUBE PERC $330.00 49452 REPLACE G‐J TUBE PERC $504.00 49460 FIX G/COLON TUBE W/DEVICE $176.00 49465 FLUORO EXAM OF G/COLON TUBE $111.00 49491 REP,ING HER,PRETERM,50WK PO‐CON;RED $3,098.00 49492 REP,ING HER,PRETERM,50WK,INCARCERAT $3,740.00 49495 REPAIR INGUINAL HERNIA, UNDER 6 MO $1,449.00 49496 REPAIR INGUINAL HERNIA, UNDER 6 MO $2,395.00 49500 REPAIR INGUINAL HERNIA, UNDER AGE 5 $1,408.00 49501 REPAIR INGUINAL HERNIA, UNDER AGE 5 $2,220.00 49505 REPAIR INGUINAL HERNIA, AGE 5+ $2,021.00 49507 REPAIR INGUINAL HERNIA, AGE 5+ $2,273.00 49520 REPAIR RECURRENT INGUINAL HERNIA $2,458.00 49521 REPAIR RECURRENT INGUINAL HERNIA $2,786.00 49525 REPAIR SLIDING HERNIA $2,224.00 49540 REPAIR LUMBAR HERNIA $2,603.00 49550 REPAIR INITIAL FEMORAL HERNIA $2,234.00 49553 REPAIR INITIAL FEMORAL HERNIA $2,453.00 49555 REPAIR RECURRENT FEMORAL HERNIA $2,324.00 49557 REPAIR RECURRENT FEMORAL HERNIA $2,818.00 49560 REP INITIAL INCISION/VENTRAL HERNIA $2,866.00 49561 REP INITL INCISION/VENTRAL HERNIA $3,622.00 49565 REP RECURRENT INCISION/VENT HERNIA $2,982.00 49566 REP RECURRENT INCISION/VENT HERNIA $3,654.00 49568 REP INCISION/VENTRAL HERNIA W/MESH $1,047.00 49570 REPAIR EPIGASTRIC HERNIA $1,611.00 49572 REPAIR EPIGASTRIC HERNIA $2,002.00 49580 REPAIR UMBILICAL HERNIA, UNDER 5 YR $1,288.00 49582 REPAIR UMBILICAL HERNIA, UNDER 5 YR $1,879.00 49585 REPAIR UMBILICAL HERNIA, AGE 5+ YR $1,722.00 49587 REPAIR UMBILICAL HERNIA, AGE 5+ YR $1,844.00 49590 REPAIR SPIGELIAN HERNIA $2,222.00 49600 REPAIR UMBILICAL LESION, SMALL $2,682.00 49605 REPAIR UMBILICAL LESION, LARGE $19,424.00 49606 REPAIR UMBILICAL LESION, W/PROSTH $4,328.00 49610 REPAIR UMBILICAL LESION, 1ST STAGE $2,687.00 49611 REPAIR UMBILICAL LESION, 2ND STAGE $2,362.00 49650 NULL $1,660.00 49651 NULL $2,158.00 49652 LAP VENT/ABD HERNIA REPAIR $2,895.00 49653 NULL $3,612.00 49654 NULL $3,292.00 49655 NULL $4,021.00 49656 NULL $3,578.00 49657 NULL $5,143.00 49900 FOLLOWUP REPAIR OF ABDOMINAL WALL $3,147.00 49904 OMENTAL FLAP,EXTRA‐ABDOMINAL $5,476.00 49905 CREATE OMENTAL FLAP $1,368.00 50010 EXPLORATION OF KIDNEY $2,776.00 50020 DRAINAGE OF KIDNEY ABSCESS, OPEN $3,709.00 50040 DRAINAGE OF KIDNEY $3,366.00 50045 EXPLORATION OF KIDNEY $3,557.00 50060 REMOVAL OF KIDNEY STONE $4,161.00 50065 FOLLOWUP KIDNEY SURGERY FOR STONE $4,390.00 50070 KIDNEY SURGERY, CONGENITAL DEFECT $4,306.00 50075 REMOVAL OF LARGE STONE FROM KIDNEY $5,292.00 50080 REMOVAL OF KIDNEY STONE, UP TO 2CM $3,161.00 50081 REMOVAL OF KIDNEY STONE, OVER 2CM $4,638.00 50100 REVISE KIDNEY BLOOD VESSELS $3,963.00 50120 EXPLORATION OF RENAL PELVIS $3,450.00 50125 EXPLORE AND DRAIN RENAL PELVIS $3,805.00 50130 REMOVAL OF STONE FROM RENAL PELVIS $3,751.00 50135 EXPLORATION OF RENAL PELVIS, COMPL $4,176.00 50200 NEEDLE BIOPSY OF KIDNEY $516.00 50205 BIOPSY OF KIDNEY $2,910.00 50220 REMOVAL OF KIDNEY $3,864.00 50225 REMOVAL OF KIDNEY, COMPLICATED $4,417.00 50230 REMOVAL OF KIDNEY, RADICAL, W/LYMPH $4,675.00 50234 REMOVE KIDNEY/URETER, SAME INCISION $4,737.00 50236 REMOVE KIDNEY/URETER,SEPAR INCISION $5,342.00 50240 PARTIAL REMOVAL OF KIDNEY $4,819.00 50250 ABL,OPE,1/MOR REN MASS LES,CRYOSURG $4,419.00 50280 REMOVAL OF KIDNEY CYST(S) $3,487.00 50290 REMOVAL OF KIDNEY CYST $3,265.00 50320 REMOVAL OF DONOR KIDNEY,OPEN LIVING $5,577.00 50323 BKBEN STD PREP CADAVER RENAL $594.00 50325 BKBEN STD PREP LIVING DONOR RENAL $594.00 50327 BKBEN RECON CADAV/LIV DONOR VEN ANA $845.00 50328 BKBEN RECON CADA/LIV DON REN ART AN $742.00 50329 BKBEN RECON CADA/LIV DON REN URETER $685.00 50340 REMOVAL OF KIDNEY FROM RECIPIENT $3,620.00 50360 ALLOTRANSPLANT KIDN W/O RECPT NEPRE $9,398.00 50365 REMOVAL & TRANSPLANTATION OF KIDNEY $10,927.00 50370 REMOVE TRANSPLANTED RENAL ALLOGRAFT $4,635.00 50380 REIMPLANTATION OF KIDNEY $7,732.00 50382 REM/REPL INTER URET ST PERC APP S&I $976.00 50384 REMOV INTER URETER ST PERCU APP S&I $887.00 50385 CHANGE STENT VIA TRANSURETH $842.00 50386 REMOVE STENT VIA TRANSURETH $643.00 50387 REM/REPL EXTR T/NEPH URET ST S&I $350.00 50389 REM NEPHROST TUBE REQ FLURO GUID $195.00 50390 NEEDLE DRAINAGE OF KIDNEY LESION $348.00 50391 INSTI THERAP AGT REN PELV &/OR URET $354.00 50395 CREATE PASSAGE TO KIDNEY THRU SKIN $647.00 50396 MEASURE KIDNEY PRESSURE THRU TUBE $426.00 50400 REVISION OF KIDNEY/URETER, SIMPLE $4,222.00 50405 REVISION OF KIDNEY/URETER, COMPLIC $5,081.00 50430 Injection procedure for antegrade n $50,431.00 50431 existing accesss $0.00 50432 Placement of nephrostomy catheter, $500.00 50433 Placement of nephroureteral cathete $624.00 50434 Convert nephrostomy catheter to nep $50,435.00 50435 Exchange nephrostomy catheter, perc $367.00 50500 REPAIR OF KIDNEY WOUND $4,948.00 50520 REPAIR OF KIDNEY‐SKIN FISTULA $4,325.00 50525 REPAIR OF RENAL‐ABDOMEN FISTULA $5,417.00 50526 REPAIR OF RENAL‐ABDOMEN FISTULA $5,479.00 50540 REVISION OF HORSESHOE KIDNEY $4,233.00 50541 NULL $3,346.00 50542 Laprscpy,surg,ablation renal mass $4,243.00 50543 Laprscpy,surg,partial nephrectomy $5,404.00 50544 NULL $4,520.00 50545 Laprscpy,surg,radial nephrectomy $4,873.00 50546 NULL $4,399.00 50547 LAPAROSCOPY, SURG DON NEPHRECTOMY $6,183.00 50548 NULL $4,900.00 50551 KIDNEY ENDOSCOPY $1,072.00 50553 KIDNEY ENDOSCOPY/CATHETERIZATION $1,129.00 50555 KIDNEY ENDOSCOPY/BIOPSY $1,236.00 50557 KIDNEY ENDOSCOPY/TREATMENT $1,260.00 50561 KIDNEY ENDOSCOPY/REMOVE OBJECT $1,438.00 50562 Renal endscp via stomy w rsecn tumo $2,113.00 50570 KIDNEY ENDOSCOPY $1,788.00 50572 KIDNEY ENDOSCOPY/CATHETERIZATION $1,934.00 50574 KIDNEY ENDOSCOPY/BIOPSY $2,056.00 50575 KIDNEY ENDOSCOPY/ENDOPYELOTOMY $2,597.00 50576 KIDNEY ENDOSCOPY/TREATMENT $2,058.00 50580 KIDNEY ENDOSCOPY/REMOVE OBJECT $2,217.00 50590 FRAGMENT KIDNEY STONE BY SHOCK WAVE $2,066.00 50592 ABLAT 1& MORE REN TUMR PERCU UNILAT $1,305.00 50593 PERC CRYO ABLATE RENAL TUM $1,730.00 50600 EXPLORATION/DRAINAGE OF URETER $3,452.00 50605 INSERT URETERAL SUPPORT $3,738.00 50606 Endoluminal biopsy of ureter and/or $50,610.00 50610 REMOVE URETER STONE FROM UPPER 1/3 $3,594.00 50620 REMOVE URETER STONE FROM MIDDLE 1/3 $3,307.00 50630 REMOVE URETER STONE FROM LOWER 1/3 $3,242.00 50650 REMOVAL OF URETER, BLADDER CUFF $3,772.00 50660 REMOVAL OF URETER $4,194.00 50684 INJECTION FOR URETER X‐RAY $184.00 50686 MEASURE URETER PRESSURE $322.00 50688 CHANGE OF URETER TUBE $290.00 50690 INJECTION FOR URETER X‐RAY $255.00 50693 Placement of ureteral stent, percut $50,694.00 50694 new access, without separate nephro $0.00 50695 new access, with separate nephrosto $50,700.00 50700 REVISION OF URETER $3,401.00 50705 Ureteral embolization or occlusion, $50,706.00 50706 Balloon dilation, ureteral strictur $0.00 50715 RELEASE OF URETER $4,620.00 50722 RELEASE OF URETER FOR OVARIAN VEINS $3,808.00 50725 RELEASE/REVISE URETER W/FUSION $4,160.00 50727 REVISION OF URETER‐SKIN FUSION $1,856.00 50728 REVISION OF URETER‐SKIN FUSION $2,551.00 50740 FUSION OF URETER AND KIDNEY $4,783.00 50750 FUSION OF URETER AND KIDNEY $4,190.00 50760 FUSION OF URETERS $4,196.00 50770 SPLICING OF URETERS $4,196.00 50780 FUSION OF URETER AND BLADDER $4,076.00 50782 FUSION OF DUPL URETER TO BLADDER $4,154.00 50783 FUSION OF URETER AND BLADDER $4,134.00 50785 FUSION OF URETER AND BLADDER $4,428.00 50800 FUSION OF URETER AND BOWEL $3,374.00 50810 FUSION OF URETER AND BOWEL $4,847.00 50815 CREATION OF URINE SHUNT TO BOWEL $4,457.00 50820 CONSTRUCTION OF BOWEL BLADDER $4,802.00 50825 CONSTRUCTION OF BOWEL BLADDER $6,045.00 50830 REVISION OF URINE FLOW $6,604.00 50840 REPLACE URETER BY BOWEL SEGMENT $4,484.00 50845 CUTANEOUS APPENDICO‐VESICOSTOMY $4,547.00 50860 TRANSPLANT URETER TO SKIN $3,435.00 50900 REPAIR OF URETER $3,179.00 50920 REPAIR OF URETER‐SKIN FISTULA $3,200.00 50930 REPAIR OF URETER‐BOWEL FISTULA $4,494.00 50940 RELEASE OF URETER $3,216.00 50945 NULL $3,529.00 50947 LAPROSCOPY, SURG, URETEROLITHOTOMY $5,064.00 50948 LAPROSCPY, URETEROLITHO W STENT $4,643.00 50951 URETER ENDOSCOPY $1,116.00 50953 URETER ENDOSCOPY/CATHETERIZATION $1,181.00 50955 URETER ENDOSCOPY/BIOPSY $1,282.00 50957 URETER ENDOSCOPY/TREATMENT $1,290.00 50961 URETER ENDOSCOPY/REMOVE OBJECT $1,155.00 50970 URETER ENDOSCOPY $1,354.00 50972 URETER ENDOSCOPY/CATHETERIZATION $1,328.00 50974 URETER ENDOSCOPY/BIOPSY $1,721.00 50976 URETER ENDOSCOPY/TREATMENT $1,691.00 50980 URETER ENDOSCOPY/REMOVE OBJECT $1,287.00 51020 BLADDER SURGERY, W/FULGURAT/TRACER $1,710.00 51030 BLADDER SURGERY, W/CRYOSURGERY $1,727.00 51040 SURGICAL DRAINAGE OF BLADDER $1,054.00 51045 INSERT BLADDER DRAIN $1,823.00 51050 REMOVAL OF BLADDER STONE $1,718.00 51060 REMOVAL OF URETER STONE $2,120.00 51065 REMOVAL OF URETER STONE $2,103.00 51080 DRAINAGE OF BLADDER ABSCESS $1,495.00 51100 DRAIN BLADDER BY NEEDLE $143.00 51101 DRAIN BLADDER BY TROCAR/CATH $190.00 51102 DRAIN BL W/CATH INSERTION $526.00 51500 REMOVAL OF BLADDER CYST $2,328.00 51520 REMOVAL OF BLADDER LESION $2,188.00 51525 REMOVAL OF BLADDER DIVERTICULUM $3,129.00 51530 REMOVAL OF BLADDER TUMOR $2,948.00 51535 REPAIR/REMOVE URETEROCELE $2,833.00 51550 PARTIAL REMOVAL OF BLADDER, SIMPLE $3,544.00 51555 PARTIAL REMOVAL OF BLADDER, COMPLIC $4,643.00 51565 REVISE BLADDER & URETER(S) $4,756.00 51570 REMOVAL OF BLADDER $5,388.00 51575 REMOVAL OF BLADDER AND NODES $6,630.00 51580 REMOVE BLADDER, REVISE TRACT $6,885.00 51585 REMOVAL OF BLADDER & NODES $7,664.00 51590 REMOVE BLADDER,REVISE URINARY TRACT $7,045.00 51595 REMOVE BLADDER,REVISE URINARY TRACT $7,955.00 51596 REMOVE BLADDER,CREATE BLADDER POUCH $8,547.00 51597 REMOVAL OF PELVIC STRUCTURES $8,389.00 51600 INJECTION FOR BLADDER X‐RAY $161.00 51605 PREPARATION FOR BLADDER X‐RAY $139.00 51610 INJECTION FOR BLADDER X‐RAY $233.00 51700 IRRIGATION OF BLADDER, SIMPLE $163.00 51701 INSRTN NON‐INDWELLING BLADER CATHTR $102.00 51702 INSRTION TEMP INDWLNG BLADER CATHTR $111.00 51703 INSERTION TEMP INDWELLING CATH, COM $295.00 51705 CHANGE OF BLADDER TUBE, SIMPLE $189.00 51710 CHANGE OF BLADDER TUBE, COMPLICATED $291.00 51715 ENDOSCOPIC INJECT, IMPLANT MATERIAL $727.00 51720 TREATMENT OF BLADDER LESION $290.00 51725 SIMPLE CYSTOMETROGRAM $0.00 51726 COMPLEX CYSTOMETROGRAM $0.00 51727 URODYNAMICS WITH URETHRAL PRESSURE $0.00 51728 URODYNAMIC W/VOIDING PRESSURE STUDY $0.00 51729 URODYNAMIC W/VOIDING PRESSURE STUDY $0.00 51736 URINE FLOW MEASUREMENT, SIMPLE $0.00 51741 URINE FLOW MEASUREMENT, COMPLEX $0.00 51784 EMG STUDY, ANAL/URETHRAL SPHINCTER $0.00 51785 ANAL/URINARY MUSCLE STUDY, NEEDLE $0.00 51792 URINARY REFLEX STUDY $0.00 51797 INTRA‐ABDOM VOIDING PRESSURE TEST $0.00 51798 MEASURMNT OF POST VOIDING URINE $72.00 51800 REVISION OF BLADDER/URETHRA $3,788.00 51820 REVISION OF URINARY TRACT $4,114.00 51840 ATTACH BLADDER/URETHRA, SIMPLE $2,394.00 51841 ATTACH BLADDER/URETHRA, COMPLICATED $2,847.00 51845 REPAIR OF BLADDER NECK $2,138.00 51860 REPAIR OF BLADDER WOUND, SIMPLE $2,767.00 51865 REPAIR OF BLADDER WOUND,COMPLICATED $3,289.00 51880 REPAIR OF BLADDER OPENING $1,722.00 51900 REPAIR OF BLADDER‐VAGINA FISTULA $3,057.00 51920 REPAIR OF BLADDER‐UTERUS FISTULA $3,357.00 51925 REPAIR BLADDER FISTULA/HYSTERECTOMY $4,233.00 51940 CORRECTION OF BLADDER DEFECT $6,092.00 51960 REVISE BLADDER & BOWEL, W/FUSION $5,083.00 51980 CONSTRUCT BLADDER OPENING TO SKIN $2,590.00 51990 NULL $2,726.00 51992 NULL $3,071.00 52000 CYSTOSCOPY $459.00 52001 CYSTOURETHROSCOPY $1,046.00 52005 CYSTOSCOPY/URETERAL CATHETER $485.00 52007 CYSTOSCOPY/BIOPSY $603.00 52010 CYSTOSCOPY/EJACULAT DUCT CATHETER $612.00 52204 CYSTOSCOPY/BIOPSY $516.00 52214 CYSTOSCOPY/TREATMENT $641.00 52224 CYSTOSCOPY/TREAT MINOR LESION(S) $740.00 52234 CYSTOSCOPY/TREAT SML BLADDER TUMOR $896.00 52235 CYSTOSCOPY/TREAT MED BLADDER TUMOR $1,051.00 52240 CYSTOSCOPY/TREAT LGE BLADDER TUMOR $1,711.00 52250 CYSTOSCOPY/RADIOTRACER $874.00 52260 CYSTOSCOPY/DILATE BLADDER $766.00 52265 CYSTOSCOPY/DILATE BLADDER $594.00 52270 CYSTOSCOPY/REVISE FEMALE URETHRA $660.00 52275 CYSTOSCOPY/REVISE MALE URETHRA $904.00 52276 CYSTOSCOPY/URETHRA SURGERY $964.00 52277 CYSTOSCOPY/SPHINCTER SURGERY $1,177.00 52281 CYSTOSCOPY/TREATMENT OF STRICTURE $554.00 52282 CYSTOSCOPY W/INSERTION OF STENT $1,227.00 52283 CYSTOSCOPY/STEROID INJECTION $733.00 52285 CYSTOSCOPY/TREATMENT $714.00 52287 CYSTOSCOPY/URETERAL MEATOTOMY $615.00 52290 CYSTOSCOPY/URETERAL MEATOTOMY $888.00 52300 CYSTOSCOPY, ORTHOTOPIC URETEROCELE $1,022.00 52301 CYSTOSCOPY, ECTOPIC URETEROCELE $1,055.00 52305 CYSTOSCOPY/TREAT BLADDER LESION $1,016.00 52310 CYSTOSCOPY/REMOVE OBJECT, SIMPLE $553.00 52315 CYSTOSCOPY/REMOVE OBJECT, COMPLIC $999.00 52317 REMOVE SMALL BLADDER STONE, SIMPLE $1,265.00 52318 REMOVE LARGE BLADDER STONE, COMPLIC $1,724.00 52320 CYSTOSCOPY/STONE REMOVAL $897.00 52325 CYSTOSCOPY/STONE FRAGMENTATION $1,170.00 52327 CYSTOSCOPY W/MATERIAL INJECTION $952.00 52330 CYSTOSCOPY/MANIPULATION $959.00 52332 CYSTOSCOPY/INSERTION OF STENT $567.00 52334 CREATION OF PASSAGE TO KIDNEY $934.00 52341 CUSTOURETHROSCOPY, TRTMNT URT STRIC $1,035.00 52342 CYSTOURETSCPY, TRTMNT URETRPEL STRI $1,125.00 52343 CYSTOURSCPY, TRTMNT INTRARENAL STRI $1,252.00 52344 CYSURSCPY W URESCPY, TRTMNT URE STR $1,347.00 52345 CYSTOURSCPY, TRTMNT URETRPEL STRICT $1,437.00 52346 CYSTOURSCPY, TRTMNT INTRARENA STRIC $1,622.00 52351 CYSTOURETHSCPY W URETRSCPY, DIAGNOS $1,102.00 52352 CYSTOYRSCPY, REMOVAL CALCULUS $1,289.00 52353 CYCTOURETHROSCPY, LITHOTRIPSY $1,440.00 52354 CYSTOURTHSCPY, W BIOPSY & FULGRATIO $1,517.00 52355 CYSTOURTHSCPY, RESCT PELVIC TUMOR $1,700.00 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWEL $1,513.00 52400 CYSTOURTSCPY, INCISION URETHR VALVE $1,738.00 52402 CYSTOURETHROSCOPOY WITH T/URETH RES $970.00 52441 INCISION OF PROSTATE $835.00 52442 INCISION OF PROSTATE $221.00 52450 INCISION OF PROSTATE $1,711.00 52500 REVISION OF BLADDER NECK $1,776.00 52601 REMOVAL OF PROSTATE (TURP) $3,075.00 52630 REMOVE PROSTATE TISSUE REGROWTH $1,455.00 52640 RELIEVE BLADDER NECK CONTRACTURE $1,147.00 52647 PROSTATE LASER SURGERY, NON‐CONTACT $2,354.00 52648 PROSTATE LASER SURGERY, CONTACT $2,511.00 52649 PROSTATE LASER ENUCLEATION $2,991.00 52700 DRAINAGE OF PROSTATE ABSCESS $1,603.00 53000 INCISION OF PENDULOUS URETHRA $539.00 53010 INCISION OF PERINEAL URETHRA $1,077.00 53020 INCISION OF URINARY MEATUS $353.00 53025 INCISION OF URINARY MEATUS, INFANT $265.00 53040 DRAINAGE OF DEEP URETHRA ABSCESS $1,425.00 53060 DRAINAGE OF URETHRA ABSCESS/CYST $598.00 53080 DRAINAGE OF URINARY LEAKAGE,UNCOMPL $1,528.00 53085 DRAINAGE OF URINARY LEAKAGE, COMPL $2,436.00 53200 BIOPSY OF URETHRA $519.00 53210 REMOVAL OF FEMALE URETHRA $2,799.00 53215 REMOVAL OF MALE URETHRA $3,382.00 53220 DESTRUCTION OF URETHRA LESION $1,661.00 53230 REMOVAL OF URETHRA LESION, FEMALE $2,202.00 53235 REMOVAL OF URETHRA LESION, MALE $2,299.00 53240 SURGERY FOR URETHRA POUCH $1,563.00 53250 REMOVAL OF URETHRAL GLAND $1,536.00 53260 DESTRUCTION OF URETHRAL POLYP(S) $659.00 53265 DESTRUCTION OF URETHRAL CARUNCLE $677.00 53270 REMOVAL OF URETHRAL GLANDS $681.00 53275 REPAIR OF URETHRA PROLAPSE $954.00 53400 REVISION OF URETHRA, 1ST STAGE $2,917.00 53405 REVISION OF URETHRA, 2ND STAGE $3,173.00 53410 RECONSTRUCTION OF URETHRA $3,554.00 53415 RECONSTRUCTION OF URETHRA $4,107.00 53420 RECONSTRUCTION OF URETHRA, STAGE 1 $3,108.00 53425 RECONSTRUCTION OF URETHRA, STAGE 2 $3,402.00 53430 RECONSTRUCTION OF FEMALE URETHRA $3,507.00 53431 URETHROPPLASTY W TUBLIZTION POS URE $4,218.00 53440 CORRECT BLADDER FUNCTION, MALE $2,734.00 53442 REMOVAL OF PERINEAL PROSTHESIS $2,845.00 53444 INSERTION ON TANDEM CUFF $2,877.00 53445 CORRECT URINE FLOW CONTROL $2,737.00 53446 REM INFLAT URETHA SPHINCTER, CUFF $2,337.00 53447 REMOVE/REVISE ARTIFICIAL SPHINCTER $2,937.00 53448 REM & REPLC INFLAT URETHRA DEBRIDMN $4,688.00 53449 CORRECT ARTIFICIAL SPHINCTER $2,223.00 53450 REVISION OF URINARY MEATUS $1,491.00 53460 REVISION OF URINARY MEATUS $1,664.00 53500 URETHROLYSIS TRANSVAGINAL $2,725.00 53502 REPAIR OF FEMALE URETHRA INJURY $1,769.00 53505 REPAIR OF MALE URETHRA INJURY $1,776.00 53510 REPAIR OF MALE URETHRA INJURY $2,297.00 53515 REPAIR OF MALE URETHRA INJURY $2,889.00 53520 REPAIR OF MALE URETHRA DEFECT $2,023.00 53600 DILATE MALE URETHRA STRICTURE $231.00 53601 RE‐DILATE MALE URETHRA STRICTURE $195.00 53605 DILATE MALE URETHRA STRICTURE $235.00 53620 DILATE MALE URETHRA STRICTURE $317.00 53621 DILATE MALE URETHRA STRICTURE $263.00 53660 DILATION OF FEMALE URETHRA $152.00 53661 RE‐DILATE FEMALE URETHRA $147.00 53665 DILATION OF FEMALE URETHRA $141.00 53850 DESTROY PROSTATE TISSUE, MICROWAVE $2,209.00 53852 DESTROY PROSTATE TISSUE, RADIOFREQ $2,263.00 53855 INSERTION OF TEMP PROSTATIC URETHRA $300.00 53860 TRANSURETHRAL RF TREATMENT $825.00 54000 SLITTING OF PREPUCE, NEWBORN $394.00 54001 SLITTING OF PREPUCE $503.00 54015 DRAINAGE OF DEEP PENIS LESION $1,132.00 54050 CHEMICAL DESTRUCTION, PENIS LESION $387.00 54055 ELECTRO‐DESTRUCTION, PENIS LESION $340.00 54056 CRYOSURGERY, PENIS LESION(S) $410.00 54057 LASER SURGERY, PENIS LESION(S) $347.00 54060 REMOVAL OF PENIS LESION(S) $476.00 54065 DESTRUCTION, PENIS LESION,EXTENSIVE $638.00 54100 BIOPSY OF PENIS, SKIN $465.00 54105 BIOPSY OF PENIS, DEEP $776.00 54110 REMOVE PENIS LESION $2,308.00 54111 REMOVE PENIS LESION, W/GRAFT TO 5CM $2,907.00 54112 REMOVE PENIS LESION, W/GRAFT 5CM+ $3,420.00 54115 REMOVE OBJECT FROM PENIS TISSUE $1,548.00 54120 PARTIAL REMOVAL OF PENIS $2,297.00 54125 REMOVAL OF PENIS $2,958.00 54130 RADICAL REMOVAL OF PENIS AND NODES $4,318.00 54135 RADICAL REMOVAL OF PENIS AND NODES $5,412.00 54150 CIRCUMCISION, NEWBORN $356.00 54160 CIRCUMCISION, SURGICAL, NEWBORN $532.00 54161 CIRCUMCISION, SURGICAL, NOT NEWBORN $717.00 54162 LYSIS PENILE POST CIRCUMCISION ADHE $726.00 54163 REPAIR INCOMPLETE CIRCUMCISION. $798.00 54164 FRENULOTOMY PENIS $705.00 54200 INJECTION TREATMENT OF PENIS LESION $305.00 54205 INJECTION TREATMENT OF PENIS LESION $1,937.00 54220 IRRIGATION TREATMENT, PENIS LESION $491.00 54230 INJECTION FOR PENIS X‐RAY $290.00 54231 DYNAMIC CAVERNOSOMETRY $423.00 54235 INJECTION OF PENIS $267.00 54240 PENIS PRESSURE STUDY $0.00 54250 TEST PENILE ERECTION/RIGIDITY $0.00 54300 CORRECTION OF CHORDEE $2,329.00 54304 REVISE PENIS FOR CHORDEE/HYPOSPADIA $2,726.00 54308 REVISE URETHRA, REPAIR HYPOSPADIAS $2,599.00 54312 REVISE URETHRA, REPAIR HYPOSPADIAS $3,170.00 54316 REVISE URETHRA, REPAIR HYPOSPADIAS $3,865.00 54318 REVISE URETHRA, REPAIR HYPOSPADIAS $2,757.00 54322 HYPOSPADIAS REPAIR W/MEATUS ADVANCE $2,777.00 54324 HYPOSPADIAS REPAIR W/SKIN FLAPS $3,627.00 54326 HYPOSPADIAS REPAIR W/SKIN FLAPS $3,436.00 54328 REVISION OF PENIS AND URETHRA $3,415.00 54332 REVISION OF PENIS AND URETHRA $3,939.00 54336 REVISION OF PENIS AND URETHRA $4,607.00 54340 FOLLOWUP HYPOSPADIAS SURGERY $2,073.00 54344 FOLLOWUP HYPOSPADIAS SURGERY $3,979.00 54348 FOLLOWUP HYPOSPADIAS SURGERY $3,684.00 54352 RECONSTRUCTION OF PENIS AND URETHRA $5,146.00 54360 CORRECTION OF PENIS ANGULATION $2,618.00 54380 REPAIR EPISPADIAS, PENIS $3,081.00 54385 REPAIR EPISPADIAS, PENIS $3,597.00 54390 REPAIR EPISPADIAS, PENIS & BLADDER $4,802.00 54400 INSERT SEMI‐RIGID PROSTHESIS, PENIS $1,927.00 54401 INSERT SELF‐CONTD PROSTHESIS, PENIS $2,393.00 54405 INSERT MULTI‐COMP PROSTHESIS, PENIS $2,936.00 54406 REMOVAL COMPONENT INFLAT PENILE PRO $2,656.00 54408 REPR COMPNT, INFLAT PENILE PROSTHES $2,872.00 54410 REMOVAL COMPONT, INFLAT PENILE PROS $3,123.00 54411 REM INFTBLE PENILE PROS, INFCT FLD $3,724.00 54415 RMVL NON‐INFLAT PENILE PROS SAME SE $1,923.00 54416 REMVL NON‐INFLAT, PENILE PROS SESS $2,581.00 54417 REM NONINFLAT /INFL PEN PROS INF FL $3,261.00 54420 REVISION OF PENIS W/VEIN SHUNT $2,562.00 54430 REVISION OF PENIS W/VEIN SHUNT $2,327.00 54435 CREATE PENIS FISTULA $1,512.00 54437 Repair of traumatic corporeal tear( $1,656.00 54438 Replantation, penis, complete amput $54,440.00 54450 FORESKIN MANIPULATION/STRETCHING $210.00 54500 NEEDLE BIOPSY OF TESTIS $270.00 54505 BIOPSY OF TESTIS $765.00 54512 EXC EXTRAPARENCHYMALLESION TESTIS $1,969.00 54520 REMOVAL OF TESTIS, SIMPLE $1,195.00 54522 ORCHIECTOMY, PARTIAL $2,318.00 54530 RADICAL REMOVAL OF TESTIS/TUMOR $1,843.00 54535 RADICAL REMOVAL OF TESTIS/TUMOR $2,701.00 54550 EXPLORATION FOR UNDESCENDED TESTIS $1,799.00 54560 EXPLORATION FOR UNDESCENDED TESTIS $2,498.00 54600 REDUCTION OF TESTIS TORSION $1,659.00 54620 FIXATION OF CONTRALATERAL TESTIS $1,098.00 54640 ORCHIOPEXY, INGUINAL APPROACH $1,760.00 54650 ORCHIOPEXY (FOWLER‐STEPHENS) $2,575.00 54660 INSERTION OF TESTIS PROSTHESIS $1,301.00 54670 REPAIR OF TESTIS INJURY $1,470.00 54680 RELOCATION OF TESTIS(ES) TO THIGH $2,882.00 54690 NULL $2,860.00 54692 NULL $3,324.00 54700 DRAINAGE OF SCROTUM $788.00 54800 NEEDLE BIOPSY OF EPIDIDYMIS $465.00 54830 REMOVAL OF EPIDIDYMIS LESION $1,361.00 54840 REMOVAL OF SPERMATOCELE $1,171.00 54860 REMOVAL OF EPIDIDYMIS, UNILATERAL $1,525.00 54861 REMOVAL OF EPIDIDYMIS, BILATERAL $2,060.00 54865 EXPLORATION OF EPIDIDYMIS W/W/O BX $1,306.00 54900 FUSION OF SPERMATIC DUCTS, UNILAT $3,102.00 54901 FUSION OF SPERMATIC DUCTS, BILAT $4,090.00 55000 PUNCTURE DRAINAGE OF HYDROCELE $311.00 55040 REMOVAL OF HYDROCELE, UNILATERAL $1,238.00 55041 REMOVAL OF HYDROCELE, BILATERAL $1,859.00 55060 REPAIR OF HYDROCELE $1,392.00 55100 DRAINAGE OF SCROTUM ABSCESS $612.00 55110 EXPLORATION OF SCROTUM $1,418.00 55120 REMOVAL OF SCROTUM FOREIGN BODY $1,304.00 55150 REMOVAL OF SCROTUM $1,799.00 55175 REVISION OF SCROTUM, SIMPLE $1,320.00 55180 REVISION OF SCROTUM, COMPLICATED $2,529.00 55200 INCISION OF SPERM DUCT $1,014.00 55250 VASECTOMY $829.00 55300 INCISION OF SPERM DUCT FOR X‐RAY $681.00 55400 REPAIR OF SPERM DUCT $1,882.00 55450 LIGATION OF SPERM DUCT $935.00 55500 REMOVAL OF HYDROCELE $1,474.00 55520 REMOVAL OF SPERM CORD LESION $1,744.00 55530 REVISION OF SPERMATIC CORD VEINS $1,283.00 55535 REVISION OF SPERMATIC CORD VEINS $1,566.00 55540 REPAIR SPERM CORD VEINS & HERNIA $2,085.00 55550 NULL $1,564.00 55600 INCISION OF SPERM DUCT POUCH $1,534.00 55605 INCISION OF SPERM DUCT POUCH, COMPL $2,024.00 55650 REMOVAL OF SPERM DUCT POUCH $2,615.00 55680 REMOVAL OF SPERM POUCH CYST $1,302.00 55700 NEEDLE/PUNCH BIOPSY OF PROSTATE $507.00 55705 BIOPSY OF PROSTATE $969.00 55706 NULL $1,360.00 55720 DRAINAGE OF PROSTATE ABSCESS,SIMPLE $1,648.00 55725 DRAINAGE OF PROSTATE ABSCESS, COMPL $2,158.00 55801 REMOVAL OF PROSTATE, PERINEAL $4,020.00 55810 RADICAL REMOVAL OF PROSTATE $4,817.00 55812 RADICAL REMOVAL, PROSTATE W/BIOPSY $5,847.00 55815 RADICAL REMOVAL OF PROSTATE/NODES $6,453.00 55821 REMOVAL OF PROSTATE, SUPRAPUBIC $3,177.00 55831 REMOVAL OF PROSTATE, RETROPUBIC $3,436.00 55840 RADICAL PROSTATE REMOVAL $4,660.00 55842 RADICAL PROSTATE REMOVAL, W/BIOPSY $4,991.00 55845 RADICAL PROSTATE REMOVAL, W/NODES $5,697.00 55860 EXPOSE PROSTATE FOR RADIOACTIVE SUB $3,183.00 55862 EXPOSE PROSTATE FOR RADIOACTIVE SUB $4,246.00 55865 EXPOSE PROSTATE FOR RADIOACTIVE SUB $4,846.00 55866 LAPRSCPY, SURG PROSTECTRMY, RETRPUB $6,053.00 55870 ELECTROEJACULATION $519.00 55873 CRYOSURG ABLATION PROSTATE $2,800.00 55875 TRANSPRNL PLCMNT NEDLE/CATH PROSTAT $2,765.00 55876 PLCMNT INTRSTL DEVICE RADIATION TX $364.00 55920 PLACE NEEDLES PELVIC FOR RT $1,615.00 56405 DRAINAGE OF VULVA/PERINEUM ABSCESS $393.00 56420 DRAINAGE OF VULVA GLAND ABSCESS $331.00 56440 REPAIR OF VULVA LESION $668.00 56441 LYSIS OF LABIAL LESIONS $501.00 56442 HYMENOTOMY SIMPLE INCISION $176.00 56501 DESTRUCTION, VULVA LESION(S),SIMPLE $417.00 56515 DESTRUCTION, VULVA LESION(S),EXTENS $738.00 56605 BIOPSY OF VULVA/PERINEUM, 1 LESION $219.00 56606 BIOPSY, VULVA/PERINEUM, EA ADDL LES $109.00 56620 REMOVAL OF VULVA, PARTIAL $1,948.00 56625 REMOVAL OF VULVA, COMPLETE $2,372.00 56630 RADICAL REMOVAL OF VULVA, PARTIAL $3,528.00 56631 RADICAL REMOVAL OF VULVA, PARTIAL $4,523.00 56632 RADICAL REMOVAL OF VULVA, PARTIAL $5,235.00 56633 RADICAL REMOVAL OF VULVA, COMPLETE $4,631.00 56634 RADICAL REMOVAL OF VULVA, COMPLETE $5,074.00 56637 RADICAL REMOVAL OF VULVA, COMPLETE $5,771.00 56640 RADICAL REMOVAL OF VULVA & NODES $5,853.00 56700 PARTIAL REMOVAL/REVISION OF HYMEN $685.00 56740 REMOVE VULVA GLAND/LESION $1,103.00 56800 REPAIR OF VAGINA $874.00 56805 REVISION OF CLITORIS $4,268.00 56810 REPAIR/REVISION OF PERINEUM $945.00 56820 COLPSCPY OF VULVA $322.00 56821 COLPSCPY VULVA, WITH BIOPSY $425.00 57000 EXPLORATION OF VAGINA $691.00 57010 DRAINAGE OF PELVIC ABSCESS $1,591.00 57020 DRAINAGE OF PELVIC FLUID $292.00 57022 I&D VAGINAL HEMATOMA;OBSTRETICAL PP $631.00 57023 I&D VAGINAL HEMATOMA, NON‐OBSTRETIC $1,136.00 57061 DESTRUCTION OF VAGINA LESION(S) $358.00 57065 DESTRUCTION OF VAGINA LESION(S) $643.00 57100 BIOPSY OF VAGINA, SIMPLE $246.00 57105 BIOPSY OF VAGINA, EXTENSIVE $464.00 57106 VAGINECTOMY, PARTIAL $1,835.00 57107 VAGINECTOMY, PARTIAL, RADICAL $5,469.00 57109 VAGINECTOMY, PARTL, RADCL W/BIOPSY $6,689.00 57110 VAGINECTOMY, COMPLETE $3,280.00 57111 VAGINECTOMY, COMPLETE, RADICAL $5,878.00 57112 VAGINECTOMY, COMP RADICAL W/BIOPSY $7,121.00 57120 CLOSURE OF VAGINA $1,862.00 57130 REMOVAL OF VAGINAL SEPTUM $573.00 57135 REMOVAL OF VAGINAL LESION $631.00 57150 TREATMENT OF VAGINAL INFECTION $103.00 57155 INSERTION UTERINE TANDEM, BRACHTHRP $1,038.00 57156 INS VAG BRACHYTX DEVICE $519.00 57160 FIT/INSRT PESSARY/OTH SUPPORT DEV $168.00 57170 FITTING OF DIAPHRAGM/CERVICAL CAP $175.00 57180 TREATMENT OF VAGINAL BLEEDING $381.00 57200 REPAIR OF VAGINA INJURY $1,107.00 57210 REPAIR VAGINA/PERINEUM INJURY $1,333.00 57220 REVISION OF URETHRAL SPHINCTER $1,166.00 57230 REPAIR OF URETHROCELE $1,445.00 57240 REPAIR BLADDER & VAGINA, CYSTOCELE $2,418.00 57250 REPAIR RECTUM & VAGINA, RECTOCELE $2,466.00 57260 REPAIR OF VAGINA $3,039.00 57265 EXTENSIVE REPAIR OF VAGINA $3,326.00 57267 INS PROSTH,REP PELV FLR DEF EAC SIT $926.00 57268 REPAIR OF BOWEL BULGE $1,758.00 57270 REPAIR OF BOWEL POUCH $2,919.00 57280 SUSPENSION OF VAGINA $3,463.00 57282 COLPOPEXY,VAGINAL;EXTRA‐PERITO APPR $1,817.00 57283 COLPOPEXY,VAGINAL;INTRA‐PERITO APPR $2,518.00 57284 REPAIR PARAVAGINAL DEFECT $2,955.00 57285 REPAIR PARAVAG DEFECT, VAG $2,442.00 57287 REMVL SLING FOR STRESS INCONTINENCE $2,455.00 57288 REPAIR BLADDER DEFECT $2,580.00 57289 REPAIR BLADDER AND VAGINA $2,643.00 57291 CONSTRUCTION OF VAGINA $2,282.00 57292 CONSTRUCTION OF VAGINA WITH GRAFT $2,989.00 57295 REVIS OF PROSTH VAGIN GRFT VAG APPR $1,733.00 57296 RVSN PROSTHETC VAG GRAFT OPN ABDMNL $3,476.00 57300 REPAIR RECTUM‐VAGINA FISTULA $2,085.00 57305 REPAIR RECTUM‐VAGINA FISTULA $3,523.00 57307 FISTULA REPAIR AND COLOSTOMY $4,171.00 57308 REPAIR RECTOVAGIN FISTULA, TRANSPER $2,431.00 57310 REPAIR URETHRA‐VAGINA FISTULA $1,673.00 57311 REPAIR URETHRA‐VAGINA FISTULA $1,916.00 57320 REPAIR BLADDER‐VAGINA FISTULA $1,943.00 57330 REPAIR BLADDER‐VAGINA FISTULA $2,677.00 57335 REVISE VAGINA FOR INTERSEX STATE $4,107.00 57400 DILATION OF VAGINA, W/ANESTHESIA $496.00 57410 PELVIC EXAMINATION W/ANESTHESIA $394.00 57415 REMOVE OBJECT FROM VAGINA, W/ANESTH $580.00 57420 COLPOSCOPY VAGINA, WITH CERVIX $339.00 57421 COLPOSCOPY VAG W/CERVIX W/BX $461.00 57423 REPAIR PARAVAG DEFECT, LAP $3,355.00 57425 LAPAROSCOPY SURGICAL COLPOPEXY $3,524.00 57426 REVISION OF PROSTHETIC VAGINAL GRAF $3,097.00 57452 VAGINOSCOPY $337.00 57454 VAGINOSCOPY W/CERVICAL BIOPSY $491.00 57455 COLPOSCOPY CERVIX, W BIOPSY CERVIX $401.00 57456 COLPOSCPY CERVIX, WITH ENDCERV CURR $373.00 57460 VAGINOSCOPY WITH LEEP $590.00 57461 COLPSCPY CERV, LOOP ELCTRDE CONIZTN $680.00 57500 BIOPSY/REMOVAL OF CERVIX LESION $276.00 57505 SCRAPING OF CERVICAL CANAL LINING $337.00 57510 ELECTRO‐/THERMOCAUTERY OF CERVIX $418.00 57511 CRYOCAUTERY OF CERVIX $476.00 57513 LASER SURGERY OF CERVIX $491.00 57520 REMOVAL OF CERVIX CONE $1,009.00 57522 REMOVE CERVIX CONE W/LOOP ELECTRODE $884.00 57530 REMOVAL OF CERVIX $1,269.00 57531 TRACHELECTOMY, RADICAL $7,025.00 57540 REMOVAL OF CERVIX STUMP $2,850.00 57545 REMOVE CERVIX STUMP, REPAIR PELVIS $3,117.00 57550 REMOVAL OF CERVIX STUMP $1,493.00 57555 REMOVE CERVIX STUMP, REPAIR VAGINA $2,197.00 57556 REMOVE CERVIX STUMP, REPAIR BOWEL $2,061.00 57558 DILATION AND CURETAGE CERVICAL STMP $408.00 57700 REVISION OF CERVIX $1,167.00 57720 REVISION OF CERVIX $1,122.00 57800 DILATION OF CERVIX CANAL $177.00 58100 BIOPSY OF UTERUS LINING $317.00 58110 ENDOMET SAMPL PERFORMED W/COLOSCOPY $147.00 58120 DILATION AND CURETTAGE (D&C) $797.00 58140 REMOVAL OF FIBROID UTERUS TUMOR $3,375.00 58145 REMOVAL OF FIBROID UTERUS TUMOR $1,997.00 58146 MYOMECTMY, EXCI FIBROID UTRS, $4,226.00 58150 TOTAL HYSTERECTOMY $3,730.00 58152 TOTAL HYSTERECTOMY, W/SUSPENSION $4,563.00 58180 PARTIAL HYSTERECTOMY $3,510.00 58200 TOTAL HYSTERECTOMY $5,166.00 58210 RADICAL HYSTERECTOMY $7,025.00 58240 REMOVE PELVIS CONTENTS FOR TUMOR $11,042.00 58260 VAGINAL HYSTERECTOMY $3,027.00 58262 VAGINAL HYSTERECTOMY, W/TUBE/OVARY $3,376.00 58263 VAGINAL HYSTERECTOMY, W/TUBE/OVARY $3,625.00 58267 VAGINAL HYSTERECTOMY, W/SUSPENSION $3,864.00 58270 VAGINAL HYSTERECTOMY, HERNIA REPAIR $3,227.00 58275 VAGINAL HYSTERECTOMY, REVISE VAGINA $3,604.00 58280 VAGINAL HYSTERECTOMY, REVISE VAGINA $3,849.00 58285 RADICAL VAGINAL HYSTERECTOMY $4,927.00 58290 VAG HYSTERECTMY FOR UTERUS > 250 GM $4,214.00 58291 VAG HYSTRCTMY UTRS>250G W RMVL TUBE $4,563.00 58292 VAG HYSTRCTM UTRS>250G W RPR ENTRCL $4,812.00 58293 VAG HYSTRCTMY W COLPO‐URTHROCYSTPXY $5,006.00 58294 VAG HYSTRCTMY UTRS>250G W RPR ENTRC $4,464.00 58301 REMOVE INTRAUTERINE DEVICE (IUD) $243.00 58321 ARTIFICIAL INSEMINATION $176.00 58322 ARTIFICIAL INSEMINATION $210.00 58323 SPERM WASHING FOR ARTIFICIAL INSEM $42.00 58340 CATH/INTRO FOR UTERUS/OVIDUCT X‐RAY $211.00 58345 REOPEN OVIDUCT W/CATHETER $1,019.00 58346 INSERT HEYMAN CAPSULE FOR BRACHYTHR $1,578.00 58350 CHROMOTUBATION OF OVIDUCT $283.00 58353 ENDOMETRIAL ABLTION, THERMAL $789.00 58356 ENDOMET CRYOABL W/ US GUID,ENDM CUR $1,245.00 58400 SUSPENSION OF UTERUS $1,591.00 58410 SUSPENSION OF UTERUS, EXCISE NERVES $2,991.00 58520 REPAIR OF RUPTURED UTERUS $3,255.00 58540 REVISION OF UTERUS $3,326.00 58541 LAP SURGCL SUPRACRVCL HYSTRCTMY $3,158.00 58542 LAP SURGCL HYSTRCTMY W RMVL TUBE $3,533.00 58543 LAP SURGCL HYSTRCTMY UTERUS > 250G $3,587.00 58544 LAPSRGCL HYSTRCTMY>250G W RMVL TUBE $3,897.00 58545 LAPRSCPY, SURG MYOECTMY, 1‐4 INTRAM $3,296.00 58546 LAPRSCPY SURG, MYOMECTMY, >5 MYOMAS $4,125.00 58548 LAP SURGCL W RADCL HYSTERCTOMY $7,253.00 58550 NULL $3,234.00 58552 LAPSCPY SURG, VAG HYSTRETMY,REM TUB $3,602.00 58553 LAP SURW VAG HYSTREMY, UTRS 250GMS $4,158.00 58554 LAP SUG, VAG HYSTREMY, REMOVAL TUBE $4,857.00 58555 NULL $682.00 58558 HYSTEROSCOPY BIOPSY $963.00 58559 NULL $1,253.00 58560 NULL $1,417.00 58561 NULL $2,003.00 58562 NULL $1,043.00 58563 HYSTEROSCOPY ABLATION $1,227.00 58565 HYSTEROSCOY, SURG; W/ BIL FALLO TUB $1,557.00 58570 TLH, UTERUS 250 G OR LESS $3,402.00 58571 TLH W/T/O 250 G OR LESS $3,811.00 58572 TLH, UTERUS OVER 250 G $4,239.00 58573 TLH W/T/O UTERUS OVER 250 G $4,882.00 58600 LIGATE/CUT OVIDUCT(S) $1,336.00 58605 LIGATE/CUT OVIDUCT(S), POSTPARTUM $1,203.00 58611 LIGATE/CUT OVIDUCT(S) AT SURGERY $284.00 58615 OCCLUDE OVIDUCT(S) $892.00 58660 NULL $2,464.00 58661 NULL $2,376.00 58662 NULL $2,583.00 58670 LAPAROSCOPY TUBAL CAUTERY $1,338.00 58671 NULL $1,339.00 58672 NULL $2,692.00 58673 NULL $2,925.00 58700 REMOVAL OF OVIDUCT $2,888.00 58720 REMOVAL OF OVARY/OVIDUCT(S) $2,732.00 58740 LYSIS OF OVARY/OVIDUCT ADHESIONS $3,244.00 58750 FUSION OF OVIDUCT(S) $3,745.00 58752 IMPLANT OVIDUCT(S) IN UTERUS $3,411.00 58760 REMOVE TUBAL OBSTRUCTION $2,998.00 58770 CREATE NEW TUBAL OPENING $3,550.00 58800 DRAINAGE OF OVARIAN CYST(S) $1,072.00 58805 DRAINAGE OF OVARIAN CYST(S) $1,481.00 58820 DRAIN OVARIAN ABSCESS, VAG APP, OPN $1,141.00 58822 DRAIN OVARIAN ABSCESS, ABDOM APPRO $2,863.00 58825 TRANSPOSITION OF OVARY(S) $2,539.00 58900 BIOPSY OF OVARY(S) $1,733.00 58920 PARTIAL REMOVAL OF OVARY(S) $2,929.00 58925 REMOVAL OF OVARIAN CYST(S) $2,749.00 58940 REMOVAL OF OVARY(S) $1,961.00 58943 REMOVAL OF OVARY(S) FOR TUMOR $4,465.00 58950 REMOVAL OF OVARIAN TUMOR $4,295.00 58951 REMOVE OVARIAN TUMOR W/HYSTERECTOMY $5,524.00 58952 REMOVE OVARIAN TUMOR W/DISSECTION $6,259.00 58953 BSO W OMENTECTMY, TAH & RAD DISSECT $7,740.00 58954 TAH‐BSO W OMENTEMY, W LYMADECTMY $8,422.00 58956 BILAT SALPINGO‐OOPHORECTOMY FOR MAL $5,236.00 58957 TUMR DBLKNG OVARY, TUBL W OMNCTMY $6,063.00 58958 TUMR DBLKNG OVRY W PLVC LYMPADNCTMY $6,635.00 58960 EXPLORE ABDOMEN FOR OVARIAN TUMOR $3,708.00 58970 PUNCTURE RETRIEVAL OF OOCYTE $721.00 58976 TRANSFER OF GAMETE/ZYGOTE $797.00 59000 AMNIOCENTESIS $317.00 59001 AMINOCENTESIS, THERA AMNIOTIC FLUID $708.00 59012 FETAL CORD PUNCTURE $800.00 59015 CHORION SAMPLING $518.00 59020 FETAL CONTRACTION STRESS TEST $0.00 59025 FETAL NON‐STRESS TEST $0.00 59030 FETAL SCALP BLOOD SAMPLING $362.00 59050 FETAL MONITOR, SUPERVISE/REPORT $200.00 59051 FETAL MONITOR, REPORT ONLY $166.00 59070 TRANSABDOMINAL AMINO INC GUID $1,160.00 59072 FETAL UMBILICAL CORD INC GUIDENCE $2,002.00 59074 FETAL FLUID DRAINAGE $1,141.00 59076 FETAL SHUNT PLACEMENT INC GUIDENCE $2,010.00 59100 REMOVAL OF UTERUS LESION $3,178.00 59120 TREAT ECTOPIC PREGNANCY, TUBE/OVARY $3,101.00 59121 TREAT ECTOPIC PREGNANCY, TUBE/OVARY $3,115.00 59130 TREAT ECTOPIC PREGNANCY, ABDOMINAL $3,643.00 59135 TREAT ECTOPIC PREGNANCY,INTERSTICES $2,959.00 59136 TREAT ECTOPIC PREG, INTERSTITIAL $3,365.00 59140 TREAT ECTOPIC PREGNANCY, CERVICAL $1,497.00 59150 TREAT ECTOPIC PREGNANCY/LAPAROSCOPY $3,017.00 59151 TREAT ECTOPIC PREGNANCY/LAPAROSCOPY $2,920.00 59160 D&C AFTER DELIVERY $678.00 59200 INSERT CERVICAL DILATOR $174.00 59300 EPISIOTOMY/VAGINAL REPAIR BY OTHER $583.00 59320 REVISION OF CERVIX DURING PREGNANCY $597.00 59325 REVISION OF CERVIX DURING PREGNANCY $955.00 59350 REPAIR OF UTERUS RUPTURE $1,072.00 59400 ROUTINE OBSTETRIC CARE $8,091.00 59409 VAGINAL DELIVERY ONLY $3,178.00 59410 VAGINAL DELIVERY & POSTPARTUM CARE $4,056.00 59412 ANTEPARTUM MANIPULATION $407.00 59414 DELIVERY OF PLACENTA $363.00 59425 ANTEPARTUM CARE ONLY, 4‐6 VISITS $1,384.00 59426 ANTEPARTUM CARE ONLY, 7+ VISITS $2,435.00 59430 CARE AFTER DELIVERY $540.00 59510 ROUTINE CARE AND CESAREAN DELIVERY $9,036.00 59514 CESAREAN DELIVERY ONLY $3,597.00 59515 CESAREAN DELIVERY ONLY W/POSTPARTUM $4,953.00 59525 REMOVE UTERUS AFTER CESAREAN DELIV $1,895.00 59610 VBAC DELIV, ROUTINE OBSTETRIC CARE $8,572.00 59612 VBAC, VAGINAL DELIVERY ONLY $3,618.00 59614 VBAC DELIVERY W/POSTPARTUM CARE $4,496.00 59618 ATTEMPTED VBAC DEL, ROUTINE OBSTET $9,170.00 59620 ATTEMPTED VBAC, CESAREAN DELIV ONLY $3,678.00 59622 ATTEMPT VBAC DELIV W/POSTPART CARE $5,101.00 59812 TREATMENT OF INCOMPLETE ABORTION $1,151.00 59820 TREAT MISSED ABORTION, 1ST TRIMEST $1,380.00 59821 TREAT MISSED ABORTION, 2ND TRIMEST $1,388.00 59830 TREAT SEPTIC ABORTION $1,703.00 59840 ABORTION, INDUCED BY D&C $811.00 59841 ABORTION, INDUCED BY D&E $1,412.00 59850 ABORTION, INDUCED BY INJECTION $1,243.00 59851 ABORTION, BY INJECTION W/D&C/D&E $1,512.00 59852 ABORTION, BY INJECT W/HYSTEROTOMY $1,801.00 59855 ABORTION, BY SUPPOSITORY $1,623.00 59856 ABORTION, BY SUPPOSITORY W/D&C/D&E $1,911.00 59857 ABORTION, SUPPOSITORY W/HYSTEROTOMY $1,842.00 59866 MULTIFETAL PREGNANCY REDUCTION $771.00 59870 EVACUATE MOLE OF UTERUS $1,835.00 59871 REMOVE CERCLAGE SUTURE W/ANESTHESIA $522.00 60000 DRAIN INFECTED THYROID/TONGUE CYST $571.00 60100 NEEDLE BIOPSY OF THYROID GLAND $285.00 60200 REMOVAL OF THYROID LESION $2,502.00 60210 PARTIAL REMOVAL OF THYROID LOBE $2,700.00 60212 PARTIAL REMOVAL OF THYROID LOBE $3,841.00 60220 REMOVAL OF THYROID LOBE, TOTAL $2,687.00 60225 REMOVAL OF THYROID LOBE, TOTAL $3,554.00 60240 REMOVAL OF THYROID GLAND $3,513.00 60252 REMOVAL OF THYROID FOR TUMOR $5,049.00 60254 RADICAL THYROID SURGERY FOR TUMOR $6,357.00 60260 FOLLOWUP THYROID SURGERY $4,160.00 60270 REMOVAL OF THYROID GLAND $5,235.00 60271 REMOVAL OF THYROID GLAND $4,029.00 60280 REMOVE THYROID DUCT LESION $1,659.00 60281 RE‐REMOVE THYROID DUCT LESION $2,190.00 60300 ASPIR/INJ THYROID CYST $182.00 60500 EXPLORE PARATHYROID GLANDS $3,703.00 60502 RE‐EXPLORE PARATHYROIDS $4,949.00 60505 EXPLORE PARATHYROIDS/MEDIASTINUM $5,291.00 60512 PARATHYROID AUTOTRANSPLANTATION $940.00 60520 REMOVAL OF THYMUS GLAND $4,046.00 60521 REMOVAL OF THYMUS GLAND $4,368.00 60522 REMOVAL OF THYMUS GLAND $5,285.00 60540 EXPLORE/REMOVE ADRENAL GLAND $4,035.00 60545 EXPLORE/REMOVE ADRENAL GLAND/TUMOR $4,632.00 60600 REMOVE CAROTID BODY TUMOR $5,380.00 60605 REMOVE CAROTID BODY TUMOR/ARTERY $6,666.00 60650 LAPSCPY SURG W ADRENECTMY $4,569.00 61000 REMOVE BRAIN CAVITY FLUID, INFANT $481.00 61001 REMOVE BRAIN CAVITY FLUID, INFANT $413.00 61020 REMOVAL OF BRAIN CAVITY FLUID $504.00 61026 INJECTION INTO BRAIN CAVITY $461.00 61050 REMOVAL OF BRAIN CANAL FLUID $374.00 61055 INJECTION INTO BRAIN CANAL $473.00 61070 BRAIN CANAL SHUNT FOR DRAIN/INJECT $310.00 61105 DRILL SKULL FOR EXAMINATION $1,868.00 61107 DRILL SKULL FOR IMPLANT OF DEVICE $1,339.00 61108 DRILL SKULL FOR REMOVAL OF HEMATOMA $3,747.00 61120 PIERCE SKULL FOR EXAMINATION $3,094.00 61140 PIERCE SKULL FOR BIOPSY $5,273.00 61150 PIERCE SKULL FOR DRAINAGE $5,588.00 61151 RE‐PIERCE SKULL FOR DRAINAGE $4,180.00 61154 PIERCE SKULL TO REMOVE HEMATOMA $5,284.00 61156 PIERCE SKULL TO DRAIN LESION $5,209.00 61210 PIERCE SKULL TO IMPLANT DEVICE $1,573.00 61215 INSERT BRAIN‐FLUID DEVICE $2,083.00 61250 PIERCE SKULL, EXPLORATORY $3,282.00 61253 PIERCE SKULL, EXPLORATORY $3,050.00 61304 OPEN SKULL FOR EXPLORATION $6,877.00 61305 OPEN SKULL FOR EXPLORATION $8,411.00 61312 OPEN SKULL FOR REMOVAL OF HEMATOMA $8,734.00 61313 OPEN SKULL FOR REMOVAL OF HEMATOMA $8,312.00 61314 OPEN SKULL FOR REMOVAL OF HEMATOMA $7,613.00 61315 OPEN SKULL FOR REMOVAL OF HEMATOMA $8,675.00 61316 INCISION & PLCMNT OF RANL BONE GRFT $375.00 61320 OPEN SKULL FOR DRAINAGE OF ABSCESS $7,963.00 61321 OPEN SKULL FOR DRAINAGE OF ABSCESS $8,781.00 61322 CRAINECTOMY, DECOMPRESSIVE W/O LOBE $9,988.00 61323 CRANIECTMY DECOMPRESSVE, W LOBECTOM $10,157.00 61330 DECOMPRESSION OF EYE SOCKET $7,041.00 61332 EXPLORATION/BIOPSY OF EYE SOCKET $7,862.00 61333 EXPLORE EYE SOCKET, REMOVE LESION $8,040.00 61340 RELIEVE CRANIAL PRESSURE $5,906.00 61343 INCISE SKULL TO RELIEVE PRESSURE $9,195.00 61345 RELIEVE CRANIAL PRESSURE $8,530.00 61450 INCISION OF SKULL FOR SURGERY $8,082.00 61458 EXPLORE/DECOMPRESS CRANIAL NERVES $8,411.00 61460 REMOVE CRANIAL NERVE(S) $8,912.00 61480 REMOVE MIDBRAIN NERVE FIBER TRACT $5,996.00 61500 REMOVAL OF SKULL LESION $5,337.00 61501 REMOVAL OF INFECTED SKULL BONE $4,636.00 61510 REMOVE SUPRATENTORIAL BRAIN TUMOR $9,137.00 61512 REMOVAL OF BRAIN LINING TUMOR $10,684.00 61514 REMOVE SUPRATENTORIAL BRAIN ABSCESS $7,933.00 61516 REMOVE SUPRATENTORIAL BRAIN CYST $7,739.00 61517 IMPLNTATION BRAIN INTRACAVTY AGENT $375.00 61518 REMOVAL OF BRAIN TUMOR $11,547.00 61519 REMOVAL OF BRAIN LINING TUMOR $12,266.00 61520 REMOVE CEREBELLUM‐BRAIN STEM TUMOR $15,658.00 61521 REMOVAL OF BRAIN MIDLINE TUMOR $13,225.00 61522 REMOVAL OF BRAIN ABSCESS $9,083.00 61524 REMOVAL OF BRAIN CYST $8,690.00 61526 INCISE BONE FLAP,REMOVE BRAIN TUMOR $15,520.00 61530 INCISE BONE FLAP,REMOVE BRAIN TUMOR $13,080.00 61531 IMPLANT BRAIN ELECTRODES THRU HOLES $5,077.00 61533 INCISE SKULL, INSERT ELECTRODES $6,367.00 61534 REMOVAL OF EPILEPTIC LESION $6,738.00 61535 REMOVAL OF BRAIN ELECTRODES $4,135.00 61536 REMOVAL OF EPILEPTIC LESION $10,948.00 61537 CRANIOTOMY W ELEVAT BONE FLAP $10,348.00 61538 REMOVAL OF TEMPORAL LOBE $11,311.00 61539 REMOVE PART OR ALL OF BRAIN LOBE $9,827.00 61540 CRAINOTOMY W ELEVAT OF BONE FLAP $9,248.00 61541 INCISION OF BRAIN TISSUE $9,101.00 61543 REMOVAL OF BRAIN TISSUE $8,717.00 61544 REMOVAL/COAGULATION OF BRAIN LESION $8,056.00 61545 REMOVAL OF BRAIN TUMOR $13,510.00 61546 REMOVAL OF PITUITARY GLAND OR TUMOR $9,782.00 61548 REMOVAL OF PITUITARY GLAND OR TUMOR $6,442.00 61550 REOPEN SKULL SUTURE $3,595.00 61552 REOPEN SKULL SUTURES $4,372.00 61556 INCISE SKULL, REOPEN SUTURE(S) $6,462.00 61557 INCISE SKULL, REOPEN SUTURE(S) $6,562.00 61558 REOPEN SKULL SUTURES, EXTENSIVE $7,934.00 61559 REOPEN SKULL SUTURES, W/BONE GRAFTS $8,160.00 61563 REMOVAL OF BENIGN SKULL TUMOR $7,924.00 61564 REMOVAL OF BENIGN SKULL TUMOR $9,395.00 61566 CRANIOTOMY W ELEVAT OF BONE FLAP $9,440.00 61567 CRAINIOTOMY WITH ELEVAT BONE FLAP $10,859.00 61570 REMOVE BRAIN FOREIGN BODY $7,821.00 61571 TREAT BRAIN WOUND, REMOVE OBJECT $8,349.00 61575 SKULL BASE/BRAIN STEM SURGERY $9,174.00 61576 SKULL BASE/BRAIN STEM SURGERY $13,937.00 61580 CRANIOFACIAL APPROACH, EXTRADURAL $9,775.00 61581 CRANIOFACIAL APPROACH, EXTRADURAL $9,967.00 61582 CRANIOFACIAL APPROACH, EXTRADURAL $11,759.00 61583 CRANIOFACIAL APPROACH, INTRADURAL $11,960.00 61584 ORBITOCRANIAL APPROACH $11,795.00 61585 ORBITOCRANIAL APPROACH, W/EXENTER $13,479.00 61586 RESECT, NASOPHARYNX W/O BONE GRAFT $9,876.00 61590 INFRATEMPORAL APPROACH $11,668.00 61591 INFRATEMPORAL APPROACH $12,067.00 61592 ORBITOCRANIAL ZYGOMATIC APPROACH $13,097.00 61595 TRANSTEMPORAL APPROACH $9,220.00 61596 TRANSCOCHLEAR APPROACH $9,086.00 61597 TRANSCONDYLAR APPROACH $11,544.00 61598 TRANSPETROSAL APPROACH $11,782.00 61600 EXCISE CRANIAL LESION, EXTRADURAL $8,288.00 61601 EXCISE CRANIAL LESION, INTRADURAL $9,938.00 61605 EXCISE CRANIAL LESION, EXTRADURAL $8,220.00 61606 EXCISE CRANIAL LESION, INTRADURAL $12,218.00 61607 EXCISE CRANIAL LESION, EXTRADURAL $10,966.00 61608 EXCISE CRANIAL LESION, INTRADURAL $13,463.00 61610 TRANSECT CAROTID ARTERY IN SINUS $6,727.00 61611 TRANSECT ARTERY IN PETROUS CANAL $1,440.00 61612 TRANSECT ARTERY IN PETROUS CANAL $5,415.00 61613 REMOVE CAROTID ANEURYSM IN SINUS $13,270.00 61615 EXCISE SKULL LESION, EXTRADURAL $8,543.00 61616 EXCISE SKULL LESION, INTRADURAL $13,653.00 61618 SECONDARY REPAIR OF DURA CSF LEAK $5,289.00 61619 SECONDARY REPAIR OF DURA CSF LEAK $5,747.00 61623 ENDOVASC BALLON OCCLSION, HEAD $2,246.00 61624 CATHETER OCCLUSION/EMBOLIZATION,CNS $4,525.00 61626 CATHETER OCCLUSION/EMBOLIZATION $3,228.00 61630 BALLO ANGIOPL INTRACRAN PERCUTA $5,263.00 61635 T/CATH PLACMT INTRAVASC ST INTRACRA $5,592.00 61645 Percutaneous arterial transluminal $0.00 61650 Endovascular intracranial prolonged $61,651.00 61651 each additional vascular territory $0.00 61680 REPAIR INTRACRANIAL VESSEL DEFECT $9,375.00 61682 REPAIR INTRACRANIAL VESSEL DEFECT $17,514.00 61684 REPAIR INTRACRANIAL VESSEL DEFECT $12,075.00 61686 REPAIR INTRACRANIAL VESSEL DEFECT $18,933.00 61690 REPAIR INTRACRANIAL VESSEL DEFECT $9,069.00 61692 REPAIR INTRACRANIAL VESSEL DEFECT $15,345.00 61697 SURGERY COMPLEX INTRACRANIAL, CAROT $17,822.00 61698 SURG CMPLX INTRACRNL ANEU, VERBASIL $19,607.00 61700 REPAIR INTRACRANIAL ANEURYSM $14,286.00 61702 REPAIR INTRACRANIAL ANEURYSM $16,942.00 61703 CLAMP NECK ARTERY FOR ANEURYSM $5,728.00 61705 REVISION OF CIRCULATION TO HEAD $10,658.00 61708 REVISION OF CIRCULATION TO HEAD $7,896.00 61710 REVISION OF CIRCULATION TO HEAD $9,126.00 61711 FUSION OF SKULL ARTERIES $10,878.00 61720 STEREOTACTIC SURGERY $5,354.00 61735 STEREOTACTIC SURGERY $6,610.00 61750 STEREOTACTIC BIOPSY/SURGERY $5,905.00 61751 STEREOTACTIC BIOPSY W/CAT SCAN $5,794.00 61760 IMPLANT ELECTRODES, STEREOTACTIC $6,681.00 61770 INSERT CATHETER, STEREOTACTIC $6,813.00 61781 SCAN PROC CRANIAL INTRA $997.00 61782 SCAN PROC CRANIAL EXTRA $715.00 61783 SCAN PROC SPINAL $968.00 61790 TREAT TRIGEMINAL NERVE/STEREOTACTIC $3,678.00 61791 TREAT TRIGEMINAL TRACT/STEREOTACTIS $4,408.00 61796 NULL $4,251.00 61797 NULL $944.00 61798 NULL $5,808.00 61799 NULL $1,299.00 61800 NULL $652.00 61850 IMPLANT NEUROELECTRODES, CORTEX $4,126.00 61860 IMPLANT NEUROELECTRODES, CEREBRUM $6,618.00 61863 TWIST DRILL BURR HOLE CRANIOTOMY $6,281.00 61864 TWIST DRILL BURR HOLE CRAINIOTOMY $1,215.00 61867 TWIST DRILL BURR HOLE CRAINIOTOMY $9,570.00 61868 TWIST DRILL BURR HOLE CRANIOTOMY $2,126.00 61870 IMPLANT NEUROELECTRODES, CEREBELLUM $4,677.00 61880 REVISE/REMOVE NEUROELECTRODES $2,349.00 61885 INS/REPL CRAN NEUROSTIM GEN; 1 ELEC $2,095.00 61886 NULL $3,461.00 61888 REVISE/REMOVE NEURORECEIVER $1,639.00 62000 REPAIR OF CLOSED SKULL FRACTURE $4,328.00 62005 REPAIR OF SKULL FRACTURE $5,154.00 62010 TREATMENT OF HEAD INJURY $6,398.00 62100 REPAIR OF BRAIN FLUID LEAKAGE $6,555.00 62115 REPAIR SKULL DEFECT $4,850.00 62117 REPAIR/RECONSTRUCT SKULL FOR DEFECT $6,063.00 62120 REPAIR SKULL CAVITY LESION, VAULT $6,250.00 62121 REPAIR SKULL CAVITY LESION, BASE $6,468.00 62140 REPAIR OF SKULL DEFECT, UP TO 5CM $4,235.00 62141 REPAIR OF SKULL DEFECT, 5CM+ $4,671.00 62142 REMOVAL OF SKULL PLATE/BONE FLAP $3,660.00 62143 REPLACE SKULL PLATE/BONE FLAP $4,306.00 62145 REPAIR OF SKULL AND BRAIN $5,859.00 62146 REPAIR SKULL W/AUTOGRAFT, UP TO 5CM $5,190.00 62147 REPAIR SKULL W/AUTOGRAFT, 5CM+ $5,806.00 62148 INC & RETVAL CRANIAL BONE, CRAIPLST $544.00 62160 NEUROENDOSCOPY, INTRACRANIAL CATH $814.00 62161 NEUROENDOSCOPY, INTRACRNI, DISS ADH $6,368.00 62162 NEUROENDO, INTRACRN, FENETRTION CAT $7,940.00 62163 NEUROENDO, INTRACRNIL, RETRIVAL FB $4,633.00 62164 NEUROENDO, INTRACRNL, EXC BRAIN TUM $8,699.00 62165 NEUROENDO INTRACRNL, EXC PIT TUMOR $6,237.00 62180 CREATE BRAIN CAVITY SHUNT $6,683.00 62190 CREATE BRAIN CAVITY SHUNT $3,618.00 62192 CREATE BRAIN CAVITY SHUNT $4,044.00 62194 REPLACE/IRRIGATE INTRACRAN CATHETER $1,898.00 62200 CREATE BRAIN CAVITY SHUNT $5,779.00 62201 CREATE BRAIN CAV SHUNT,STEREOTACTIC $5,045.00 62220 CREATE BRAIN CAVITY SHUNT $4,273.00 62223 CREATE BRAIN CAVITY SHUNT $4,325.00 62225 REPLACE/IRRIGATE VENTRICLE CATHETER $2,160.00 62230 REPLACE/REVISE CSF SHUNT/VALVE/CATH $3,490.00 62252 REPROGRAM OF PROGRAMMABLE CFS $0.00 62256 REMOVAL OF CSF SHUNT SYSTEM $2,465.00 62258 REPLACEMENT OF CSF SHUNT SYSTEM $4,673.00 62263 NULL $1,226.00 62264 PERCU LYSIS ADHESIONS W INJECT,1DAY $857.00 62267 NULL $575.00 62268 DRAINAGE OF SPINAL CORD LESION $1,011.00 62269 NEEDLE BIOPSY OF SPINAL CORD $1,070.00 62270 DIAGNOSTIC SPINAL FLUID TAP, LUMBAR $289.00 62272 SPINAL FLUID TAP FOR DRAINAGE $323.00 62273 INJECT/TREAT LUMBAR SPINE LESION $409.00 62280 INJECT/TREAT SPINAL CORD LESION $593.00 62281 INJECT/TREAT SPINAL CORD LESION $578.00 62282 INJECT/TREAT SPINAL CANAL LESION $535.00 62284 INJECTION FOR MYELOGRAM/CAT SCAN $312.00 62287 PERCUTANEOUS DISCECTOMY, LUMBAR $2,077.00 62290 INJECT FOR SPINE DISK X‐RAY, LUMBAR $626.00 62291 INJECT FOR SPINE DISK X‐RAY, NECK $616.00 62292 INJECTION INTO DISK LESION, LUMBAR $2,096.00 62294 INJECTION INTO SPINAL ARTERY $2,825.00 62304 MYELOGRAPHY VIA LUMBAR INJECT RS&I $437.00 62305 MYELOGRAPHY VIA LUMBAR INJECTION RS $454.00 62350 IMPLANT SPINAL CANAL CATHETER $1,526.00 62351 IMPLANT SPINAL CANAL CATH W/LAMINEC $3,471.00 62355 REMOVE SPINAL CANAL CATHETER $1,032.00 62360 IMPLANT SPINAL INFUSION PUMP $1,202.00 62361 IMPLANT/REPLACE SPINE INFUSION PUMP $1,388.00 62362 IMPLANT/REPLACE SPINE INFUSION PUMP $1,492.00 62365 REMOVE SPINAL INFUSION PUMP $1,150.00 62367 ANALYZE SPINAL INFUSION PUMP PRGM $92.00 62368 ANALYZE SP INF PUMP W/REPROG $128.00 62369 ANAL SP INF PMP W/REPRG&FILL $130.00 62370 ANL SP INF PMP W/MDREPRG&FIL $169.00 63001 REMOVE NECK SPINE LAMINA, 1‐2 SEGS $5,101.00 63003 REMOVE THORACIC SPINE LAMINA, 1‐2 $5,041.00 63005 REMOVE LUMBAR SPINE LAMINA, 1‐2 $4,795.00 63011 REMOVE SACRAL SPINE LAMINA, 1‐2 $4,323.00 63012 REMOVAL OF SPINE LAMINA (GILL TYPE) $4,812.00 63015 REMOVE NECK SPINE LAMINA, 3+ SEGS $6,113.00 63016 REMOVE THORACIC SPINE LAMINA, 3+ $6,191.00 63017 REMOVE LUMBAR SPINE LAMINA, 3+ SEGS $5,123.00 63020 NECK SPINE DISK SURGERY/DECOMPRESS $4,676.00 63030 LOW BACK DISK SURGERY/DECOMPRESS $3,871.00 63035 ADDED SPINE DISK SURGERY/DECOMPRESS $775.00 63040 NECK SPINE DISK SURGERY, RE‐EXPLORE $5,602.00 63042 LOW BACK DISK SURGERY, RE‐EXPLORE $5,153.00 63043 LAMINOTOMY, EACH ADDL CERV INTERSPC $1,201.00 63044 LAMINOTOMY, ADDTN LUMBAR INTERSPACE $1,092.00 63045 REMOVE NECK SPINE LAMINA, 1 SEG $5,258.00 63046 REMOVE THORACIC SPINE LAMINA, 1 SEG $4,908.00 63047 REMOVE LUMBAR SPINE LAMINA, 1 SEG $4,419.00 63048 REMOVE ADDED SPINE LAMINA, 1 SEG $859.00 63050 LAMINOPLASTY CERV W/DECOMP SPIN COR $5,964.00 63051 LAMINOPLASTY CERV W/RECON POST ELMT $6,856.00 63055 DECOMPRESS THORACIC SPINAL CORD SEG $6,690.00 63056 DECOMPRESS LUMBAR SPINAL CORD SEG $5,962.00 63057 DECOMPRESS ADDED SPINAL CORD SEGMNT $1,299.00 63064 DECOMPRESS THORACIC SPINAL CORD SEG $7,184.00 63066 DECOMPRESS ADDED SPINAL CORD SEGMNT $887.00 63075 REMOVE NECK SPINE DISK, SINGLE $5,470.00 63076 REMOVE ADDED NECK SPINE DISK $1,009.00 63077 REMOVE THORACIC SPINE DISK, SINGLE $5,980.00 63078 REMOVE ADDED THORACIC SPINE DISK $765.00 63081 REMOVE VERTEBRAL BODY, NECK, SINGLE $7,089.00 63082 REMOVE ADDED VERTEBRAL SEG, NECK $1,085.00 63085 REMOVE VERTEBR BODY, THORAX, SINGLE $7,674.00 63086 REMOVE ADDED VERTEBRAL SEG, THORAX $769.00 63087 REMOVE VERTEBRAL BODY, LOW BACK $9,639.00 63088 REMOVE ADDED VERTEBR SEG, LOW BACK $1,043.00 63090 REMOVE VERTEBRAL BODY, LOW BACK $7,634.00 63091 REMOVE ADDED VERTEBR SEG, LOW BACK $693.00 63101 VERTEBRAL CORPECTOMY $9,429.00 63102 VERTEBRAL CORPECTOMY $9,098.00 63103 VERTEBRAL CORPECTOMY $1,188.00 63170 INCISE SPINAL CORD TRACT(S) $6,720.00 63172 INCISE SPINAL COLUMN, DRAIN LESION $5,712.00 63173 INCISE SPINAL COLUMN, DRAIN LESION $7,166.00 63180 REVISE SPINAL CORD LIGAMENTS, 1‐2 $6,263.00 63182 REVISE SPINAL CORD LIGAMENTS, 3+ $5,810.00 63185 INCISE SPINAL COLUMN/NERVE ROOT(S) $4,548.00 63190 INCISE SPINAL COLUMN/NERVE ROOTS $4,922.00 63191 INCISE SPINAL COLUMN/NERVE $5,582.00 63194 INCISE SPINAL COLUMN & CORD, NECK $6,734.00 63195 INCISE SPINAL COLUMN & CORD, THORAX $6,493.00 63196 INCISE SPINAL COLUMN & CORD, NECK $5,238.00 63197 INCISE SPINAL COLUMN & CORD, THORAX $7,229.00 63198 INCISE SPINAL COLUMN & CORD, NECK $6,167.00 63199 INCISE SPINAL COLUMN & CORD, THORAX $6,472.00 63200 RELEASE LUMBAR SPINAL CORD $6,378.00 63250 REVISE SPINAL CORD VESSELS, NECK $11,503.00 63251 REVISE SPINAL CORD VESSELS, THORAX $12,822.00 63252 REVISE SPINAL CORD VESSELS,LOW BACK $12,801.00 63265 REMOVE INTRASPINAL LESION, CERVICAL $6,906.00 63266 REMOVE INTRASPINAL LESION, THORACIC $7,090.00 63267 REMOVE INTRASPINAL LESION, LUMBAR $5,572.00 63268 REMOVE INTRASPINAL LESION, SACRAL $5,961.00 63270 REMOVE INTRASPINAL LESION, CERVICAL $8,759.00 63271 REMOVE INTRASPINAL LESION, THORACIC $8,614.00 63272 REMOVE INTRASPINAL LESION, TRUNK $7,780.00 63273 REMOVE INTRASPINAL LESION, SACRAL $7,811.00 63275 BIOPSY/REMOVE SPINAL TUMOR, NECK $7,447.00 63276 BIOPSY/REMOVE SPINAL TUMOR, THORAX $7,379.00 63277 BIOPSY/REMOVE SPINAL TUMOR, LUMBAR $6,316.00 63278 BIOPSY/REMOVE SPINAL TUMOR, SACRAL $6,702.00 63280 BIOPSY/REMOVE SPINAL TUMOR, NECK $8,825.00 63281 BIOPSY/REMOVE SPINAL TUMOR, THORAX $8,695.00 63282 BIOPSY/REMOVE SPINAL TUMOR, LUMBAR $8,163.00 63283 BIOPSY/REMOVE SPINAL TUMOR, SACRAL $7,880.00 63285 BIOPSY/REMOVE SPINAL TUMOR, NECK $11,046.00 63286 BIOPSY/REMOVE SPINAL TUMOR, THORAX $10,839.00 63287 BIOPSY/REMOVE SPINAL TUMOR, TRUNK $11,652.00 63290 BIOPSY/REMOVE SPINAL TUMOR,COMBINED $11,498.00 63295 OSTEOPLASTIC RECON DORS SPINAL ELMT $1,420.00 63300 REMOVE VERTEBR SEG FOR SPINE TUMOR $7,554.00 63301 REMOVE VERTEBR SEG FOR SPINE TUMOR $9,279.00 63302 REMOVE VERTEBR SEG FOR SPINE TUMOR $9,111.00 63303 REMOVE VERTEBR SEG FOR SPINE TUMOR $9,723.00 63304 REMOVE VERTEBR SEG FOR SPINE TUMOR $9,742.00 63305 REMOVE VERTEBR SEG FOR SPINE TUMOR $10,031.00 63306 REMOVE VERTEBR SEG FOR SPINE TUMOR $9,194.00 63307 REMOVE VERTEBR SEG FOR SPINE TUMOR $9,348.00 63308 REMOVE VERTEBR SEG FOR SPINE TUMOR $1,345.00 63600 CREATE SPINAL CORD LESION/STEREOTAX $3,294.00 63610 STIMULATE SPINAL CORD/STEREOTAXIS $2,262.00 63615 BIOPSY/REMOVE SPINAL CORD LESION $4,690.00 63620 NULL $4,679.00 63621 NULL $1,085.00 63650 IMPLANT EPIDURAL NEUROELECTRODES $1,496.00 63655 IMPLANT EPIDURAL NEUROELECTRODES $3,330.00 63661 REMOVAL OF SPINAL NEUROSTIMULATOR $1,197.00 63662 REM OF SPINAL NEUROSTIM ELECTRODE $3,358.00 63663 REVISION INC REPLCMNT SPINAL NEURO $1,668.00 63664 REVISION INCL REPLMNT SPINAL NEUROS $3,456.00 63685 INS/REPL NEUROSTIMULATOR SP PUL GEN $1,414.00 63688 REVISE/REMOVE SPINAL NEURORECEIVER $1,421.00 63700 REPAIR SPINAL HERNIA, LESS THAN 5CM $4,797.00 63702 REPAIR SPINAL HERNIA, MORE THAN 5CM $5,277.00 63704 REPAIR SPINAL HERNIA, LESS THAN 5CM $6,937.00 63706 REPAIR SPINAL HERNIA, MORE THAN 5CM $6,835.00 63707 REPAIR SPINAL FLUID LEAKAGE $3,682.00 63709 REPAIR SPINAL FLUID LEAK,W/LAMINECT $4,412.00 63710 GRAFT REPAIR OF SPINE $4,329.00 63740 CREATE SPINAL SHUNT, W/LAMINECTOMY $3,867.00 63741 CREATE SPINAL SHUNT THRU SKIN $2,739.00 63744 REVISE/REPLACE SPINAL SHUNT $2,746.00 63746 REMOVAL OF SPINAL SHUNT SYSTEM $2,492.00 64400 INJECT NERVE BLOCK, TRIGEMINAL $269.00 64402 INJECT NERVE BLOCK, FACIAL $300.00 64405 INJECT NERVE BLOCK, GRTR OCCIPITAL $240.00 64408 INJECT NERVE BLOCK, VAGUS $266.00 64410 INJECT NERVE BLOCK, PHRENIC $247.00 64413 INJECT NERVE BLOCK, CERVICAL PLEXUS $299.00 64415 INJECT NERVE BLOCK, BRACHIAL PLEXUS $230.00 64416 INJ, ANES AGNT, TRIGEM, BRACH PLEX $277.00 64417 INJECT NERVE BLOCK, AXILLARY $254.00 64418 INJECT NERVE BLOCK, SUPRASCAPULAR $276.00 64420 INJECT NERVE BLOCK, INTERCOSTAL $246.00 64421 INJECT NERVE BLOCK, INTERCOSTALS $329.00 64425 INJECT NERVE BLOCK, ILIOINGUINAL $337.00 64430 INJECT NERVE BLOCK, PUDENDAL $297.00 64435 INJECT NERVE BLOCK, UTERINE $303.00 64445 INJECT NERVE BLOCK, SCIATIC $261.00 64446 INJ ANESTH, SCIATIC NERVE, TRIGEMNL $278.00 64447 INJ, ANES AGNT, TRIGEM, FEMORAL NER $233.00 64448 INJ ANES AGNT, TRIGEM, FEM NERV CON $250.00 64449 ANES AGENT LUMBAR PLEX POST INJ $300.00 64450 INJECT NERVE BLOCK, PERIPHERAL $165.00 64455 NULL $123.00 64461 Paravertebral block (PVB) (paraspin $64,462.00 64462 second and any additional injection $0.00 64463 continuous infusion by catheter (in $64,470.00 64479 NULL $476.00 64480 NULL $227.00 64483 NULL $406.00 64484 NULL $186.00 64486 INJECT DX OR THERAPEUTIC AGENT $227.00 64487 INJECT DX OR THERAPEUTIC AGENT $267.00 64488 TAP BLOCK BILATERAL BY INJECTION(S) $288.00 64489 TAP BLOCK BILATERAL BY CONTINUOUS I $324.00 64490 INJECT DX OR THERAPEUTIC AGENT $384.00 64491 INJECT DX OR THERA AGENT SECOND LVL $216.00 64492 INJECT DX OR THERAP AGENT 3&ADD LVL $219.00 64493 INJECT DX OR THERAP AGENT PARAVERTE $330.00 64494 INJECT DX THERAP PARAVERTE SEC LVL $187.00 64495 INJECT DX THERA PARAVERTE 3&ADD LVL $190.00 64505 INJECT NERVE BLOCK, SPHEN GANGLION $317.00 64508 INJECT NERVE BLOCK, CAROTID SINUS $270.00 64510 INJECT NERVE BLOCK,CERV SYMPATHETIC $265.00 64517 ANES AGENT SUPE HUPOGASTRIC PLEXUS $437.00 64520 INJECT NERVE BLOCK,VERT SYMPATHETIC $292.00 64530 INJECT NERVE BLOCK, CELIAC PLEXUS $331.00 64550 APPLY SURFACE NEUROELECTRODE $30.00 64553 IMPLANT NEUROELECTRODES, CRANIAL $563.00 64555 IMPLANT NEUROELECTRODES, PERIPHERAL $557.00 64561 PERCU IMPLANT NEURO ELECTR, SACRAL $1,100.00 64565 IMPLANT NEUROELECTRODES, NEUROMUSC $484.00 64566 NEUROELTRD STIM POST TIBIAL $111.00 64568 INC FOR VAGUS N ELECT IMPL $2,632.00 64569 REVISE/REPL VAGUS N ELTRD $3,154.00 64570 REMOVE VAGUS N ELTRD $2,622.00 64575 IMPLANT NEUROELECTRODES, PERIPHERAL $1,209.00 64580 IMPLANT NEUROELECTRODES, NEUROMUSC $1,167.00 64581 INCSN IMPLNTN NEUROSTMLTR ELCTRD SN $2,415.00 64585 REVISE/REMOVE PERIPH NEUROELECTRODE $525.00 64590 INS/REPL PERIPHER NEUROSTIM PULSGEN $589.00 64595 REVISE/REMOVE PERIPH NEURORECEIVER $465.00 64600 DESTRUCTION OF TRIGEMINAL NERVE $828.00 64605 DESTRUCTION OF TRIGEMINAL NERVE $1,686.00 64610 DESTRUCTION OF TRIGEMINAL NERVE $1,984.00 64611 CHEMODENERV SALIV GLANDS $406.00 64612 DESTRUCTION OF FACE MUSCLE NERVE $446.00 64615 DESTRUCTION OF INTERCOSTAL NERVE $502.00 64616 DESTRUCTION OF INTERCOSTAL NERVE $437.00 64617 CHEMODENERVATION MSCLE LARYNX UNILT $497.00 64620 DESTRUCTION OF INTERCOSTAL NERVE $616.00 64630 DESTRUCTION OF PUDENDAL NERVE $717.00 64632 NULL $243.00 64633 DESTROY CERV/THOR FACET JNT $816.00 64634 DESTROY C/TH FACET JNT ADDL $246.00 64635 DESTROY LUMB/SAC FACET JNT $804.00 64636 DESTROY L/S FACET JNT ADDL $214.00 64640 DESTROY PERIPHERAL NERVE OR BRANCH $336.00 64642 CHEMODENERVTION 1 EXTREMTY 1‐4 MSCL $419.00 64643 CHEMODENERVTION 1 EXTRMITY 5 OR MOR $279.00 64644 CHEMODENERVTION 1 EXTRMITY 5 OR MOR $458.00 64645 CHEMODENER OF ECCRINE GLDS,BOTH AXI $323.00 64646 CHEMODENER OF ECCRINE GLDS,BOTH AXI $454.00 64647 CHEMODENERVATION OF TRUNK 6 OR MOR $531.00 64650 CHEMODENER OF ECCRINE GLDS,BOTH AXI $159.00 64653 CHEMODENER OF ENDO GLD,OTH AREA/DAY $215.00 64680 DESTRUCTION OF CELIAC PLEXUS $602.00 64681 DEST BY NEUROLYTIC AGENT HYPO PLEX $677.00 64702 REVISION OF DIGITAL NERVE(S) $1,865.00 64704 REVISION OF HAND/FOOT NERVE $1,156.00 64708 REVISION OF ARM/LEG NERVE $1,873.00 64712 REVISION OF SCIATIC NERVE $2,169.00 64713 REVISION OF ARM NERVE(S) $2,742.00 64714 REVISION OF LOW BACK NERVE(S) $2,364.00 64716 REVISION OF CRANIAL NERVE $2,013.00 64718 REVISION OF ULNAR NERVE AT ELBOW $2,237.00 64719 REVISION OF ULNAR NERVE AT WRIST $1,510.00 64721 CARPAL TUNNEL SURGERY $1,611.00 64722 RELIEVE PRESSURE ON NERVE(S) $1,397.00 64726 RELIEVE PRESSURE ON FOOT/TOE NERVE $988.00 64727 REVISION OF INTERNAL NERVE(S) $708.00 64732 SEVER SUPRAORBITAL NERVE $1,605.00 64734 SEVER INFRAORBITAL NERVE $1,550.00 64736 SEVER MENTAL NERVE $1,673.00 64738 SEVER INFERIOR ALVEOLAR NERVE $1,825.00 64740 SEVER LINGUAL NERVE $1,699.00 64742 SEVER FACIAL NERVE $1,809.00 64744 SEVER GREATER OCCIPITAL NERVE $2,005.00 64746 SEVER PHRENIC NERVE $1,754.00 64755 SEVER STOMACH NERVES $3,598.00 64760 SEVER VAGUS NERVE, ABDOMINAL $1,936.00 64763 SEVER EXTRAPELVIC OBTURATOR NERVE $1,964.00 64766 SEVER INTRAPELVIC OBTURATOR NERVE $2,231.00 64771 SEVER EXTRADURAL CRANIAL NERVE $2,248.00 64772 SEVER EXTRADURAL SPINAL NERVE $2,134.00 64774 REMOVAL OF SKIN NERVE LESION $1,571.00 64776 REMOVAL OF NERVE LESION, SAME DIGIT $1,453.00 64778 REMOVAL OF NERVE LESION,ADDED DIGIT $631.00 64782 REMOVAL OF HAND/FOOT NERVE LESION $1,666.00 64783 REMOVE ADD'L HAND/FOOT NERVE LESION $827.00 64784 REMOVE MAJOR PERIPH NERVE LESION $2,751.00 64786 REMOVAL OF SCIATIC NERVE LESION $4,091.00 64787 IMPLANT NERVE END INTO BONE/MUSCLE $909.00 64788 REMOVAL OF SKIN NERVE LESION $1,525.00 64790 REMOVE MAJOR PERIPH NERVE LESION $3,272.00 64792 REMOVAL OF EXTENSIVE NERVE LESION $4,974.00 64795 BIOPSY OF NERVE $757.00 64802 REMOVE SYMPATHETIC NERVES, NECK $2,447.00 64804 REMOVE SYMPATHETIC NERVES, BACK $4,007.00 64809 REMOVE SYMPATHETIC NERVES, LOW BACK $4,118.00 64818 REMOVE SYMPATHETIC NERVES, LUMBAR $2,338.00 64820 REMOVE SYMPATHETIC NERVES, EA DIGIT $2,699.00 64821 SYMPATHECTOMY, RADIAL ARTERIES $2,565.00 64822 SYMPATHECTOMY, ULNAR ARTERY $2,565.00 64823 SYMPATHECTOMY, SUPERFICIAL PALMAR $2,920.00 64831 REPAIR OF DIGIT NERVE $2,576.00 64832 REPAIR OF ADDED DIGIT NERVE $1,278.00 64834 REPAIR HAND/FOOT NERVE, COM SENSORY $2,784.00 64835 REPAIR HAND/FOOT NERVE, MED MOTOR $3,066.00 64836 REPAIR HAND/FOOT NERVE, ULNAR MOTOR $3,078.00 64837 REPAIR OF ADDED NERVE, HAND/FOOT $1,395.00 64840 REPAIR OF POSTERIOR TIBIAL NERVE $4,003.00 64856 REPAIR/TRANSPOSE MAJOR PERIPH NERVE $3,859.00 64857 REPAIR OF MAJOR PERIPHERAL NERVE $3,987.00 64858 REPAIR OF SCIATIC NERVE $4,266.00 64859 REPAIR ADDED MAJOR PERIPHERAL NERVE $948.00 64861 REPAIR OF BRACHIAL PLEXUS $5,075.00 64862 REPAIR OF LUMBAR PLEXUS $6,411.00 64864 REPAIR OF EXTRACRANIAL FACIAL NERVE $3,286.00 64865 REPAIR OF INTRACRANIAL FACIAL NERVE $4,229.00 64866 FUSION OF FACIAL/SPINAL ACCES NERVE $4,288.00 64868 FUSION OF FACIAL/TONGUE NERVE $3,794.00 64872 FOLLOWUP REPAIR OF NERVE $456.00 64874 REPAIR & REVISE NERVE, EXTENSIVE $652.00 64876 REPAIR NERVE, SHORTEN ARM/LEG BONE $671.00 64885 NERVE GRAFT, HEAD/NECK, SINGLE $4,316.00 64886 NERVE GRAFT, HEAD/NECK, SINGLE,4CM+ $4,867.00 64890 NERVE GRAFT, HAND/FOOT, SINGLE $4,088.00 64891 NERVE GRAFT, HAND/FOOT, SINGLE,4CM+ $4,381.00 64892 NERVE GRAFT, ARM/LEG, SINGLE $3,946.00 64893 NERVE GRAFT, ARM/LEG, SINGLE, 4CM+ $4,259.00 64895 NERVE GRAFT, HAND/FOOT, CABLE $5,090.00 64896 NERVE GRAFT, HAND/FOOT, CABLE, 4CM+ $6,015.00 64897 NERVE GRAFT, ARM/LEG, CABLE $4,780.00 64898 NERVE GRAFT, ARM/LEG, CABLE, 4CM+ $5,222.00 64901 ADDITIONAL NERVE GRAFT, SINGLE $2,193.00 64902 ADDITIONAL NERVE GRAFT, CABLE $2,534.00 64905 NERVE PEDICLE TRANSFER, 1ST STAGE $3,875.00 64907 NERVE PEDICLE TRANSFER, 2ND STAGE $5,493.00 64910 NERVE RPR W SYNTHTC CONDUT EACH NRV $3,102.00 64911 NERV RPR W AUTOGENS VEIN GRFT $3,788.00 65091 REMOVE/REVISE EYE CONTENTS $2,408.00 65093 REMOVAL OF EYE CONTENTS, W/IMPLANT $2,376.00 65101 REMOVAL OF EYE $2,790.00 65103 REMOVE EYE, INSERT IMPLANT $2,913.00 65105 REMOVE EYE, ATTACH IMPLANT $3,217.00 65110 REMOVAL OF EYE $4,448.00 65112 REMOVE EYE, REVISE SOCKET BONE $5,160.00 65114 REMOVE EYE, REVISE SOCKET $5,413.00 65125 REVISION OF OCULAR IMPLANT $1,047.00 65130 FOLLOWUP INSERTION, OCULAR IMPLANT $2,772.00 65135 FOLLOWUP INSERTION, OCULAR IMPLANT $2,812.00 65140 FOLLOWUP ATTACHMNT, OCULAR IMPLANT $2,942.00 65150 REINSERT OCULAR IMPLANT $2,037.00 65155 REINSERT/REINFORCE OCULAR IMPLANT $3,207.00 65175 REMOVAL OF OCULAR IMPLANT $2,393.00 65205 REMOVE OBJECT FROM EXTERNAL EYE $154.00 65210 REMOVE OBJECT FROM EXTERNAL EYE $187.00 65220 REMOVE OBJECT FROM EXTERNAL EYE $152.00 65222 REMOVE OBJECT FROM EXTERNAL EYE $183.00 65235 REMOVE OBJECT FROM INTERNAL EYE $2,598.00 65260 REMOVE OBJECT FROM INTERNAL EYE $3,410.00 65265 REMOVE OBJECT FROM INTERNAL EYE $4,173.00 65270 REPAIR OF EYE WOUND, CONJUNCTIVA $499.00 65272 REPAIR OF EYE WOUND, CONJUNCTIVA $1,248.00 65273 REPAIR OF EYE WOUND, CONJUNCTIVA $1,353.00 65275 REPAIR OF EYE WOUND, CORNEA $1,641.00 65280 REPAIR OF EYE WOUND, CORNEA/SCLERA $2,571.00 65285 REPAIR OF EYE WOUND, CORNEA/SCLERA $4,187.00 65286 REPAIR EYE WOUND, APPLY TISSUE GLUE $1,760.00 65290 REPAIR OF EYE SOCKET WOUND $1,872.00 65400 REMOVAL OF CORNEA LESION $2,147.00 65410 BIOPSY OF CORNEA $371.00 65420 REMOVE/TRANSFER PTERYGIUM $1,348.00 65426 REMOVE/TRANSFER PTERYGIUM, W/GRAFT $1,703.00 65430 SCRAPE CORNEA FOR SMEAR $366.00 65435 CURETTE/TREAT CORNEA $246.00 65436 CURETTE CORNEA, APPLY CHELAT AGENT $1,322.00 65450 DESTRUCTION OF CORNEAL LESION $1,150.00 65600 MULTIPLE PUNCTURES, ANTERIOR CORNEA $1,225.00 65710 CORNEAL TRANSPLANT, LAMELLAR $4,057.00 65730 CORNEAL TRANSPLANT, PENETRATING $4,502.00 65750 CORNEAL TRANSPLANT, APHAKIA $4,504.00 65755 CORNEAL TRANSPLANT, PSEUDOPHAKIA $4,505.00 65756 NULL $4,198.00 65757 PREP CORNEAL ENDO ALLOGRAFT $445.00 65770 REVISION OF CORNEA W/IMPLANT $5,988.00 65772 CORRECT ASTIGMATISM DUE TO SURGERY $1,447.00 65775 CORRECT ASTIGMATISM DUE TO SURGERY $1,961.00 65778 COVER EYE W/MEMBRANE $206.00 65779 COVER EYE W/MEMBRANE STENT $537.00 65780 OCULAR SURFACE RECON AMNIOTIC MEM $3,248.00 65781 OCULAR SURFACE RECON IIMBAL STEM $4,730.00 65782 OCULAR SURFACE REC STEM CELL ALLO $4,404.00 65785 Implantation of intrastromal cornea $65,800.00 65800 DRAINAGE OF EYE FLUID $323.00 65810 DRAINAGE OF EYE FLUID $1,713.00 65815 DRAINAGE OF EYE FLUID/BLOOD $1,700.00 65820 RELIEVE INNER EYE PRESSURE $2,667.00 65850 INCISION OF EYE $3,166.00 65855 LASER SURGERY OF EYE $858.00 65860 SEVER INNER EYE ADHESIONS, LASER $898.00 65865 SEVER INNER EYE ADHESIONS,IRIS‐CORN $1,683.00 65870 SEVER INNER EYE ADHESIONS, ANTERIOR $2,221.00 65875 SEVER INNER EYE ADHESIONS,POSTERIOR $2,312.00 65880 SEVER INNER EYE ADHESIONS,CORN‐VITR $2,352.00 65900 REMOVAL OF EYE LESION $3,408.00 65920 REMOVE IMPLANT FROM ANTERIOR EYE $2,878.00 65930 REMOVE BLOOD CLOT FROM ANTERIOR EYE $2,402.00 66020 INJECT/TREAT EYE W/ AIR/LIQUID $469.00 66030 INJECT/TREAT EYE W/MEDICATION $396.00 66130 REMOVAL OF SCLERAL LESION $2,018.00 66150 INCISION OF EYE FOR GLAUCOMA $3,121.00 66155 INCISION OF EYE FOR GLAUCOMA $3,118.00 66160 INCISION OF EYE FOR GLAUCOMA $3,511.00 66170 INCISION OF EYE FOR GLAUCOMA $4,380.00 66172 INCISION OF EYE FOR GLAUCOMA $5,522.00 66174 TRANSLUM DIL EYE CANAL $3,573.00 66175 TRNSLUM DIL EYE CANAL W/STNT $4,211.00 66179 IMPLANT EYE FLUID SHUNT $3,827.00 66180 IMPLANT EYE FLUID SHUNT $4,260.00 66183 REVISE EYE FLUID SHUNT $3,661.00 66184 REVISE EYE FLUID SHUNT $2,793.00 66185 REVISE EYE FLUID SHUNT $3,006.00 66220 REPAIR OF SCLERAL LESION $2,731.00 66225 REPAIR/GRAFT SCLERAL LESION $3,563.00 66250 FOLLOWUP SURGERY OF ANTERIOR EYE $1,982.00 66500 INCISION OF IRIS $1,263.00 66505 INCISION OF IRIS W/TRANSFIXION $1,385.00 66600 REMOVAL OF IRIS, LESION $2,961.00 66605 REMOVAL OF IRIS, CILIARY BODY $3,749.00 66625 REMOVAL OF PERIPH IRIS FOR GLAUCOMA $1,575.00 66630 REMOVAL OF IRIS SECTOR FOR GLAUCOMA $2,133.00 66635 REMOVAL OF IRIS, 'OPTICAL' $2,043.00 66680 REPAIR IRIS & CILIARY BODY, $1,989.00 66682 REPAIR IRIS & CILIARY BODY $2,423.00 66700 DESTROY CILIARY BODY, DIATHERMY $1,397.00 66710 DEST CILIA BODY,CYCLOPHOTOCOAG T/SC $1,395.00 66711 DES CILIA BODY CYCLOPHOTOCOAG ENDOS $2,284.00 66720 DESTROY CILIARY BODY, CRYOSURGERY $1,512.00 66740 DESTROY CILIARY BODY, CYCLODIALYSIS $1,397.00 66761 LASER REVISION OF IRIS $840.00 66762 REVISE IRIS BY PHOTOCOAGULATION $1,517.00 66770 REMOVAL OF INNER EYE LESION $1,720.00 66820 RUPTURING OF SECONDARY CATARACT $1,462.00 66821 LASERING OF SECONDARY CATARACT $1,111.00 66825 REPOSITION INTRAOCULAR LENS IMPLANT $2,774.00 66830 REMOVAL OF SECONDARY CATARACT $2,526.00 66840 LENS EXTRACTION BY ASPIRATION $2,662.00 66850 LENS EXTRACTION, PHACOFRAGMENTATION $2,914.00 66852 LENS EXTRACTION, PARS PLANA $3,184.00 66920 INTRACAPSULAR LENS EXTRACTION $2,676.00 66930 INTRACAPSULAR LENS EXTRACTION $3,040.00 66940 EXTRACAPSULAR LENS EXTRACTION $2,932.00 66982 EXTRACAP CATRCT REMO W IOLP $3,639.00 66983 REMOVE CATARACT, INSERT LENS PROSTH $2,629.00 66984 REMOVE CATARACT, INSERT LENS PROSTH $2,630.00 66985 INSERTION OF LENS PROSTHESIS $2,814.00 66986 EXCHANGE LENS PROSTHESIS $3,315.00 66990 USE OF OPHTHALMIC ENDOSCOPE $319.00 67005 PARTIAL REMOVAL OF EYE FLUID $1,818.00 67010 PARTIAL REMOVAL OF EYE FLUID $1,995.00 67015 DRAINAGE OF EYE FLUID, PARS PLANA $2,131.00 67025 INJECT EYE FLUID REPLACEMENT $2,249.00 67027 IMPLANT EYE DRUG DELV SYST $3,213.00 67028 INJECTION OF EYE DRUG $355.00 67030 INCISION OF INNER EYE STRANDS $1,897.00 67031 LASER SURGERY OF INNER EYE STRANDS $1,270.00 67036 REMOVAL OF INNER EYE FLUID $3,521.00 67039 VITRECTOMY/LASER COAGULATION $4,657.00 67040 VITRECTOMY/LASER COAGULATION $5,212.00 67041 VIT FOR MACULAR PUCKER $4,868.00 67042 VIT FOR MACULAR HOLE $5,564.00 67043 VIT FOR MEMBRANE DISSECT $6,019.00 67101 REPAIR DETACHED RETINA, HEAT/COLD $2,394.00 67105 REPAIR DETACHED RETINA, COAGULATION $2,286.00 67107 REPAIR DETACHED RETINA,SCLER BUCKLE $4,587.00 67108 REPAIR DETACHED RETINA, VITRECTOMY $5,897.00 67110 REPAIR DETACHED RETINA, INJECTION $2,483.00 67113 REPAIR RETINAL DETACH, CPLX $6,413.00 67115 RELEASE ENCIRCLING MATERIAL $1,822.00 67120 REMOVE EXTRAOC EYE IMPLANT MATERIAL $1,985.00 67121 REMOVE INTRAOC EYE IMPLANT MATERIAL $3,427.00 67141 RETINA TREATMENT, HEAT/COLD $1,736.00 67145 RETINA TREATMENT, PHOTOCOAGULATION $1,771.00 67208 TREAT LOCALIZED RETINA LESION $2,055.00 67210 TREAT LOCALIZED RETINA LESION $1,778.00 67218 TREAT LOCALIZED RETINA LESION $4,895.00 67220 TREAT LOCALIZED CHOROID LESION $1,778.00 67221 DEST LOCALIZED LESION, PHOTODYNAMIC $754.00 67225 DESTRUCTION LESION, PHOTOCOAG 2 EYE $98.00 67227 TREAT EXTENSIVE RETINA LESION $911.00 67228 TREAT EXTENSIVE RETINA LESION $1,089.00 67229 NULL $4,003.00 67250 REINFORCE EYE WALL $2,921.00 67255 REINFORCE/GRAFT EYE WALL $3,198.00 67311 REVISE HORIZONTAL EYE MUSCLE $2,243.00 67312 REVISE TWO HORIZONTAL EYE MUSCLES $2,727.00 67314 REVISE VERTICAL EYE MUSCLE $2,524.00 67316 REVISE TWO VERTICAL EYE MUSCLES $3,065.00 67318 REVISE OBLIQUE EYE MUSCLE(S) $2,501.00 67320 EXTRAOCULAR EYE MUSCLE TRANSFER $1,140.00 67331 EYE MUSCLE SURGERY FOLLOWUP $1,158.00 67332 EYE MUSCLE SURGERY FOR SCARRING $1,258.00 67334 REVISE EYE MUSCLE W/SUTURE $1,066.00 67335 EYE SUTURE(S) DURING SURGERY $563.00 67340 EXPLORE/REPAIR DETACHED EYE MUSCLE $1,267.00 67343 RELEASE EYE SCAR TISSUE $2,492.00 67345 DESTRUCTION OF EYE MUSCLE NERVE $799.00 67346 BX OF EXTRAOCULAR ADNEXA $755.00 67400 EXPLORE/BIOPSY EYE SOCKET $3,506.00 67405 EXPLORE/DRAIN EYE SOCKET $2,881.00 67412 EXPLORE EYE SOCKET, REMOVE LESION $3,199.00 67413 EXPLORE EYE SOCKET, REMOVE OBJECT $3,232.00 67414 EXPLORE/DECOMPRESS EYESOCKET $4,827.00 67415 NEEDLE BIOPSY OF EYE $385.00 67420 REMOVE EYE SOCKET LESION $6,146.00 67430 REMOVE OBJECT FROM EYE SOCKET $4,421.00 67440 DRAIN EYE SOCKET $4,398.00 67445 DECOMPRESS EYE SOCKET $5,346.00 67450 EXPLORE/BIOPSY EYE SOCKET $4,544.00 67500 INJECT MEDICATION IN EYE SOCKET $253.00 67505 INJECT ALCOHOL IN EYE SOCKET $287.00 67515 INJECTION INTO TENON'S CAPSULE $315.00 67550 INSERT EYE SOCKET IMPLANT $3,644.00 67560 REVISE/REMOVE EYE SOCKET IMPLANT $3,598.00 67570 DECOMPRESS OPTIC NERVE $4,774.00 67700 DRAINAGE OF EYELID ABSCESS $416.00 67710 SEVER EYELID SEAMS $348.00 67715 INCISE EYELID FOLD $391.00 67800 REMOVAL OF CHALAZION $367.00 67801 REMOVAL OF CHALAZIONS, SAME LID $474.00 67805 REMOVAL OF CHALAZIONS, DIFFER LIDS $585.00 67808 REMOVE CHALAZION, HOSP/ANESTHESIA $1,400.00 67810 BIOPSY OF EYELID $262.00 67820 CORRECT INVERSION OF EYELASHES $188.00 67825 CORRECT INVERSION OF EYELASHES $432.00 67830 CORRECT INVERSION OF EYELASHES $494.00 67835 CORRECT INVERSION OF EYELASHES $1,677.00 67840 REMOVAL OF EYELID LESION $564.00 67850 DESTROY EYELID MARGIN LESION $493.00 67875 CLOSE EYELID BY SUTURE $347.00 67880 REVISION OF EYELID $1,313.00 67882 REVISE EYELID,TRANSFER TARSAL PLATE $1,681.00 67900 REPAIR DROOPING EYEBROW $1,822.00 67901 REPAIR DROOPING EYELID $2,055.00 67902 REPAIR DROOPING EYELID $2,760.00 67903 REPAIR DROOPING EYELID $1,723.00 67904 REPAIR DROOPING EYELID $2,127.00 67906 REPAIR DROOPING EYELID $1,802.00 67908 REPAIR DROOPING EYELID $1,512.00 67909 RE‐REPAIR EYELID DEFECT $1,565.00 67911 REVISE RETRACTED EYELID $2,132.00 67912 CORRECT LAGOPHTHALMOS W IMPLANT $1,766.00 67914 SUTURE REPAIR OF ECTROPION $1,171.00 67915 CAUTERIZATION OF ECTROPION $709.00 67916 EYELID SURGERY FOR ECTROPION $1,539.00 67917 EYELID SURGERY FOR ECTROPION $1,633.00 67921 SUTURE REPAIR OF ENTROPION $1,110.00 67922 CAUTERIZATION OF ENTROPION $708.00 67923 EYELID SURGERY FOR ENTROPION $1,534.00 67924 EYELID SURGERY FOR ENTROPION $1,632.00 67930 REPAIR EYELID WOUND, PARTIAL $851.00 67935 REPAIR EYELID WOUND, FULL THICKNESS $1,581.00 67938 REMOVE EMBEDDED OBJECT FROM EYELID $412.00 67950 REVISION OF EYELID CANTHUS $1,656.00 67961 REVISION OF UP TO 1/4 OF EYELID $1,620.00 67966 REVISION OF MORE THAN 1/4 OF EYELID $2,340.00 67971 RECONSTRUCT EYELID, TRANSFER FLAP $2,764.00 67973 RECONSTRUCT EYELID, TRANSFER FLAP $3,563.00 67974 RECONSTRUCT EYELID, TRANSFER FLAP $3,559.00 67975 RECONSTRUCT EYELID, TRANSFER FLAP $2,613.00 68020 INCISE/DRAIN EYELID LINING CYST $392.00 68040 TREATMENT OF EYELID LINING LESION $178.00 68100 BIOPSY OF EYELID LINING $346.00 68110 REMOVE EYELID LINING LESION $529.00 68115 REMOVE EYELID LINING LESION $655.00 68130 REMOVE EYELID LINING LESION, SCLERA $1,467.00 68135 DESTROY EYELID LINING LESION $538.00 68200 TREAT EYELID LINING BY INJECTION $124.00 68320 REVISION/GRAFT OF EYELID LINING $1,922.00 68325 REVISION/GRAFT OF EYELID LINING $2,511.00 68326 REVISION/GRAFT OF EYELID LINING $2,463.00 68328 REVISION/GRAFT OF EYELID LINING $2,702.00 68330 REVISE EYELID LINING $1,643.00 68335 REVISE/GRAFT EYELID LINING $2,473.00 68340 SEPARATE EYELID ADHESIONS $1,423.00 68360 PARTIAL REVISION OF EYELID LINING $1,472.00 68362 REVISION OF EYELID LINING, W/FLAP $2,509.00 68371 HARVEST CONJUNCT ALLOGRAFT LIVE DON $1,470.00 68400 INCISION/DRAINAGE OF TEAR GLAND $469.00 68420 INCISION/DRAINAGE OF TEAR SAC $600.00 68440 INCISION OF TEAR DUCT OPENING $355.00 68500 REMOVAL OF TEAR GLAND $3,814.00 68505 PARTIAL REMOVAL OF TEAR GLAND $3,703.00 68510 BIOPSY OF TEAR GLAND $1,035.00 68520 REMOVAL OF TEAR SAC $2,507.00 68525 BIOPSY OF TEAR SAC $1,019.00 68530 REMOVAL OF OBJECT FROM TEAR DUCT(S) $915.00 68540 REMOVAL OF TEAR GLAND TUMOR $3,392.00 68550 REMOVAL OF TEAR GLAND TUMOR $4,154.00 68700 REVISION OF TEAR DUCTS $2,302.00 68705 REVISION OF TEAR DUCT OPENING $593.00 68720 CREATION OF TEAR SAC DRAIN $2,831.00 68745 CREATION OF TEAR DUCT DRAIN $2,902.00 68750 CREATE TEAR DUCT DRAIN, W/TUBE $2,991.00 68760 CLOSE TEAR DUCT OPENING $521.00 68761 PLUG TEAR DUCT OPENING $423.00 68770 CLOSE TEAR SYSTEM FISTULA $2,400.00 68801 DILATION OF LACRIMAL PUNCTUM $311.00 68810 PROBE NASOLACRIMAL DUCT $543.00 68811 PROBE NASOLACRIMAL DUCT W/ANESTH $783.00 68815 PROBE NASOLACRIMAL DUCT W/TUBE $792.00 68816 PROBE NL DUCT W/BALLOON $725.00 68840 EXPLORATION OF TEAR DUCTS $417.00 68850 INJECTION FOR TEAR SAC X‐RAY $200.00 69000 DRAIN EXTERNAL EAR LESION, SIMPLE $438.00 69005 DRAIN EXTERNAL EAR LESION, COMPLIC $584.00 69020 DRAIN OUTER EAR CANAL LESION $529.00 69100 BIOPSY OF EXTERNAL EAR $181.00 69105 BIOPSY OF EXTERNAL EAR CANAL $237.00 69110 PARTIAL REMOVAL EXTERNAL EAR $1,210.00 69120 REMOVAL OF EXTERNAL EAR $1,506.00 69140 REMOVE BONY EAR CANAL LESION(S) $3,269.00 69145 REMOVE EAR CANAL LESION(S) $931.00 69150 EXTENSIVE EAR CANAL SURGERY $3,910.00 69155 EXTENSIVE EAR/NECK SURGERY $6,219.00 69200 REMOVE OBJECT FROM OUTER EAR CANAL $174.00 69205 REMOVE OBJECT FROM OUTER EAR CANAL $378.00 69209 Removal impacted cerumen using irri $48.00 69210 REMOVE IMPACTED EAR WAX $119.00 69220 SURGICAL CLEANSING, MASTOID CAVITY $193.00 69222 SURGICAL CLEANSING, MASTOID CAVITY $510.00 69300 REVISE PROTRUDING EXTERNAL EAR $1,772.00 69310 REBUILD OUTER EAR CANAL $4,079.00 69320 RECONSTRUCT ABSENT OUTER EAR CANAL $5,785.00 69420 INCISION OF EARDRUM $449.00 69421 INCISION OF EARDRUM, GEN'L ANESTH $555.00 69424 REMOVE VENTILATING TUBE, OTHER PHYS $232.00 69433 CREATE EARDRUM OPENING,LOCAL ANESTH $495.00 69436 CREATE EARDRUM OPENING,GEN'L ANESTH $597.00 69440 EXPLORATION OF MIDDLE EAR $2,573.00 69450 REVISION OF EARDRUM $2,034.00 69501 REMOVE MASTOID STRUCTURES, SIMPLE $2,738.00 69502 REMOVE MASTOID STRUCTURES, COMPLETE $3,629.00 69505 MODIFIED RADICAL SURGERY, MASTOID $4,489.00 69511 RADICAL MASTOID SURGERY $4,582.00 69530 RADICAL REMOVAL,MASTOID/PETROUS APX $6,178.00 69535 PARTIAL REMOVAL OF TEMPORAL BONE $10,063.00 69540 REMOVAL OF EAR POLYP $474.00 69550 REMOVAL OF EAR LESION, TRANSCANAL $3,885.00 69552 REMOVAL OF EAR LESION, TRANSMASTOID $5,831.00 69554 REMOVAL OF EAR LESION, EXTENDED $9,093.00 69601 MASTOID SURGERY REVISION, COMPLETE $3,901.00 69602 MASTOID SURG REVISION, MOD RADICAL $4,058.00 69603 MASTOID SURGERY REVISION, RADICAL $4,766.00 69604 MASTOID SURG REVISION,TYMPANOPLASTY $4,148.00 69605 MASTOID SURGERY REVISION/APICECTOMY $5,823.00 69610 REPAIR OF EARDRUM $1,083.00 69620 REVISION OF EARDRUM $1,826.00 69631 REVISE EARDRUM STRUCTURES $3,300.00 69632 REBUILD EARDRUM STRUCTURES $4,015.00 69633 REBUILD EARDRUM STRUCTURES W/PROSTH $3,903.00 69635 REVISE EARDRUM STRUCTURES $4,627.00 69636 REBUILD EARDRUM STRUCTURES $5,158.00 69637 REBUILD EARDRUM STRUCTURES W/PROSTH $5,130.00 69641 REVISE MIDDLE EAR & MASTOID $3,884.00 69642 RECONSTRUCT MIDDLE EAR & MASTOID $4,982.00 69643 RECONSTRUCT MIDDLE EAR & MASTOID $4,569.00 69644 RECONSTRUCT MIDDLE EAR & MASTOID $5,514.00 69645 RADICAL MIDDLE EAR & MASTOID SURG $5,429.00 69646 RADICAL MIDDLE EAR & MASTOID SURG $5,763.00 69650 RELEASE OF MIDDLE EAR BONE $3,004.00 69660 REVISION OF MIDDLE EAR BONE $3,460.00 69661 REVISION OF MIDDLE EAR BONE $4,512.00 69662 REVISION OF MIDDLE EAR BONE SURGERY $4,328.00 69666 REPAIR MIDDLE EAR FISTULA $3,016.00 69667 REPAIR MIDDLE EAR FISTULA $3,017.00 69670 REMOVE MASTOID AIR CELLS $3,540.00 69676 REMOVE MIDDLE EAR NERVE $3,100.00 69700 CLOSE MASTOID FISTULA $2,557.00 69711 REMOVE/REPAIR HEARING AID $3,221.00 69714 IMPLANT OSSEINTE TEMPORAL BONE W MA $4,025.00 69715 IMPLANT TEMPORAL BONE, WITH MASTOID $4,956.00 69717 RPLCMNT OSSEINTEG IMPLNT, W/O MASTO $4,222.00 69718 RPLCMNT OSSEINT IMPLNT, W MASTOECTM $5,006.00 69720 DECOMPRESS FACIAL NERVE $4,595.00 69725 DECOMPRESS FACIAL NERVE $7,012.00 69740 REPAIR FACIAL NERVE $4,353.00 69745 REPAIR FACIAL NERVE $5,452.00 69801 TRANSCANAL INCISION OF INNER EAR $469.00 69805 INNER EAR FLUID SAC SURGERY $3,931.00 69806 INNER EAR FLUID SAC SURGERY W/SHUNT $3,526.00 69820 ESTABLISH INNER EAR WINDOW $3,197.00 69840 REVISE INNER EAR WINDOW $3,343.00 69905 REMOVE INNER EAR $3,423.00 69910 REMOVE INNER EAR, MASTOID $3,794.00 69915 SEVER INNER EAR NERVE $5,738.00 69930 IMPLANT COCHLEAR DEVICE $4,568.00 69950 SEVER INNER EAR NERVE, TRANSCRANIAL $6,647.00 69955 REPAIR/DECOMPRESS FACIAL NERVE $7,447.00 69960 DECOMPRESS INNER EAR CANAL $7,134.00 69970 REMOVE TEMPORAL BONE TUMOR $8,013.00 69990 OPERATING MICROSCOPE $925.00 70010 CONTRAST X‐RAY OF BRAIN $329.00 70015 CONTRAST X‐RAY OF BRAIN $0.00 70030 X‐RAY EXAM OF EYE FOR FOREIGN BODY $0.00 70100 X‐RAY EXAM OF JAW, PARTIAL $0.00 70110 X‐RAY EXAM OF JAW, COMPLETE $0.00 70120 X‐RAY EXAM OF MASTOIDS, PARTIAL $0.00 70130 X‐RAY EXAM OF MASTOIDS, COMPLETE $0.00 70134 X‐RAY EXAM OF MIDDLE EAR, COMPLETE $0.00 70140 X‐RAY EXAM OF FACIAL BONES, PARTIAL $0.00 70150 X‐RAY EXAM OF FACIAL BONES,COMPLETE $0.00 70160 X‐RAY EXAM OF NASAL BONES, COMPLETE $0.00 70170 X‐RAY EXAM OF TEAR DUCT $0.00 70190 X‐RAY EXAM OF EYE SOCKETS $0.00 70200 X‐RAY EXAM OF EYE SOCKETS, COMPLETE $0.00 70210 X‐RAY EXAM OF SINUSES $0.00 70220 X‐RAY EXAM OF SINUSES, COMPLETE $0.00 70240 X‐RAY EXAM PITUITARY SADDLE $0.00 70250 X‐RAY EXAM OF SKULL, PARTIAL $0.00 70260 X‐RAY EXAM OF SKULL, COMPLETE $0.00 70300 X‐RAY EXAM OF TEETH, SINGLE VIEW $0.00 70310 X‐RAY EXAM OF TEETH, PARTIAL $0.00 70320 FULL MOUTH X‐RAY OF TEETH $0.00 70328 X‐RAY EXAM OF JAW JOINT $0.00 70330 X‐RAY EXAM OF JAW JOINTS $0.00 70332 X‐RAY EXAM OF JAW JOINT $0.00 70336 MRI OF JAW JOINT $0.00 70350 X‐RAY HEAD FOR ORTHODONTIA $0.00 70355 PANORAMIC X‐RAY OF JAWS $0.00 70360 X‐RAY EXAM OF NECK TISSUE $0.00 70370 THROAT X‐RAY/FLUOROSCOPY $0.00 70371 SPEECH EVALUATION, COMPLEX $0.00 70380 X‐RAY EXAM OF SALIVARY GLAND $0.00 70390 X‐RAY EXAM OF SALIVARY DUCT $0.00 70450 CAT SCAN OF HEAD/BRAIN $0.00 70460 CONTRAST CAT SCAN OF HEAD/BRAIN $0.00 70470 CAT SCANS OF HEAD/BRAIN $0.00 70480 CAT SCAN OF SKULL $0.00 70481 CONTRAST CAT SCAN OF SKULL $0.00 70482 CAT SCANS OF SKULL $0.00 70486 CAT SCAN OF FACE, JAW $0.00 70487 CONTRAST CAT SCAN OF FACE, JAW $0.00 70488 CAT SCANS OF FACE, JAW $0.00 70490 CAT SCAN OF NECK TISSUE $0.00 70491 CONTRAST CAT SCAN OF NECK TISSUE $0.00 70492 CAT SCANS OF NECK TISSUE $0.00 70496 CT Scan head w contrast, w/o contra $0.00 70498 CTA neck w contrats, w/o contrast $0.00 70540 MRI OF ORBIT, FACE, NECK $0.00 70542 MRI face, neck, obit w/o conrast $0.00 70543 MRI orbit, face, neck, w contrast $0.00 70544 MRA head, w/o contrast $0.00 70545 MRA head, w contrast $0.00 70546 MRA head, w/o contrast & w contrast $0.00 70547 MRA NECK, w/o contrast $0.00 70548 MRA NECK, w contrast $0.00 70549 MRA NECK, w/o contrats & w contrast $0.00 70551 MRI OF BRAIN $0.00 70552 CONTRAST MRI OF BRAIN $0.00 70553 MRI OF BRAIN AND FURTHER SEQUENCES $0.00 70554 MRI BRAIN NOT RQRNG MD/PSYCHOLOGIST $0.00 70555 MRI BRAIN RQRNG MD/PSYCHOLOGIST $0.00 70557 MRI brain, w/o contrast $0.00 70558 MRI brain w contrast $0.00 70559 MRIBrain w/o contrast & w contrast $0.00 71010 CHEST X‐RAY, SINGLE VIEW, FRONTAL $0.00 71015 CHEST X‐RAY, STEREO, FRONTAL $0.00 71020 CHEST X‐RAY, TWO VIEWS $0.00 71021 CHEST X‐RAY, TWO VIEWS $0.00 71022 CHEST X‐RAY, TWO VIEWS $0.00 71023 CHEST X‐RAY/FLUOROSCOPY, TWO VIEWS $0.00 71030 CHEST X‐RAY, COMPLETE $0.00 71034 CHEST X‐RAY/FLUOROSCOPY, COMPLETE $0.00 71035 CHEST X‐RAY, SPECIAL VIEWS $0.00 71100 X‐RAY EXAM OF RIBS, ONE SIDE $0.00 71101 X‐RAY EXAM OF RIBS, CHEST, ONE SIDE $0.00 71110 X‐RAY EXAM OF RIBS, BOTH SIDES $0.00 71111 X‐RAY EXAM OF RIBS,CHEST,BOTH SIDES $0.00 71120 X‐RAY EXAM OF BREASTBONE, 2+ VIEWS $0.00 71130 X‐RAY EXAM OF STERNOCLAV JOINT(S) $0.00 71250 CAT SCAN OF CHEST $0.00 71260 CONTRAST CAT SCAN OF CHEST $0.00 71270 CAT SCANS OF CHEST $0.00 71275 CTA chest w/o contrast & w contrast $0.00 71550 MRI OF CHEST $0.00 71551 MRA Chest, w contrast $0.00 71552 MRA chest, w/o contrast & w contras $0.00 71555 MRA OF CHEST (EXCLUDE MYOCARDIUM) $0.00 72020 X‐RAY EXAM OF SPINE, SINGLE VIEW $0.00 72040 X‐RAY EXAM OF NECK SPINE $0.00 72050 X‐RAY EXAM OF NECK SPINE, 4+ VIEWS $0.00 72052 X‐RAY EXAM OF NECK SPINE, COMPLETE $0.00 72070 X‐RAY EXAM OF THORACIC SPINE $0.00 72072 X‐RAY EXAM OF THORACIC SPINE $0.00 72074 X‐RAY OF THORACIC SPINE, COMPLETE $0.00 72080 X‐RAY EXAM OF TRUNK SPINE $0.00 72081 Radiologic examination, spine, enti $0.00 72082 2 or 3 views $0.00 72083 4 or 5 views $0.00 72084 minimum of 6 views $0.00 72100 X‐RAY EXAM OF LOWER SPINE $0.00 72110 X‐RAY EXAM OF LOWER SPINE, COMPLETE $0.00 72114 X‐RAY EXAM OF LOWER SPINE, COMPLETE $0.00 72120 X‐RAY EXAM OF LOWER SPINE, BENDING $0.00 72125 CAT SCAN OF NECK SPINE $0.00 72126 CONTRAST CAT SCAN OF CERVICAL SPINE $0.00 72127 CAT SCAN OF CERVICAL SPINE $0.00 72128 CAT SCAN OF THORACIC SPINE $0.00 72129 CONTRAST CAT SCAN OF THORACIC SPINE $0.00 72130 CAT SCAN, THORACIC SPINE $0.00 72131 CAT SCAN OF LOWER SPINE $0.00 72132 CONTRAST CAT SCAN OF LUMBAR SPINE $0.00 72133 CAT SCAN OF LUMBAR SPINE $0.00 72141 MRI OF CERVICAL SPINE $0.00 72142 CONTRAST MRI OF CERVICAL SPINE $0.00 72146 MRI OF THORACIC SPINE $0.00 72147 CONTRAST MRI OF THORACIC SPINE $0.00 72148 MRI OF LUMBAR SPINE $0.00 72149 CONTRAST MRI OF LUMBAR SPINE $0.00 72156 MRI OF CERVICAL SPINE $0.00 72157 MRI OF THORACIC SPINE $0.00 72158 MRI OF LUMBAR SPINE $0.00 72159 MRA OF SPINAL CANAL/CONTENTS $0.00 72170 X‐RAY EXAM OF PELVIS $0.00 72190 X‐RAY EXAM OF PELVIS, COMPLETE $0.00 72191 CTA pelvis, w/o contrast w contrast $0.00 72192 CAT SCAN OF PELVIS $0.00 72193 CONTRAST CAT SCAN OF PELVIS $0.00 72194 CAT SCANS OF PELVIS $0.00 72195 MRI PELVIS, W/O CONTRAST $0.00 72196 MRI OF PELVIS $0.00 72197 MRI PELVIS, W CONTRAST MATERIAL $0.00 72198 MRA OF PELVIS $0.00 72200 X‐RAY EXAM OF SACROILIAC JOINTS $0.00 72202 X‐RAY EXAM OF SACROILIAC JOINTS $0.00 72220 X‐RAY EXAM OF TAILBONE, 2+ VIEWS $0.00 72240 MYELOGRAM OF NECK SPINE $0.00 72255 MYELOGRAM OF THORACIC SPINE $0.00 72265 MYELOGRAM OF LOWER SPINE $0.00 72270 MYELOGRAM OF TOTAL SPINE $0.00 72275 NULL $0.00 72285 X‐RAY OF NECK SPINE DISK $0.00 72295 X‐RAY OF LOWER SPINE DISK $0.00 73000 X‐RAY EXAM OF COLLARBONE, COMPLETE $0.00 73010 X‐RAY OF SHOULDER BLADE, COMPLETE $0.00 73020 X‐RAY EXAM OF SHOULDER, ONE VIEW $0.00 73030 X‐RAY EXAM OF SHOULDER, COMPLETE $0.00 73040 CONTRAST X‐RAY OF SHOULDER JOINT $0.00 73050 X‐RAY EXAM OF SHOULDER JOINTS $0.00 73060 X‐RAY EXAM OF HUMERUS, 2+ VIEWS $0.00 73070 X‐RAY EXAM OF ELBOW $0.00 73080 X‐RAY EXAM OF ELBOW, COMPLETE $0.00 73085 CONTRAST X‐RAY OF ELBOW JOINT $0.00 73090 X‐RAY EXAM OF FOREARM $0.00 73092 X‐RAY EXAM OF ARM, INFANT, 2+ VIEWS $0.00 73100 X‐RAY EXAM OF WRIST $0.00 73110 X‐RAY EXAM OF WRIST, COMPLETE $0.00 73115 CONTRAST X‐RAY OF WRIST JOINT $0.00 73120 X‐RAY EXAM OF HAND, 2 VIEWS $0.00 73130 X‐RAY EXAM OF HAND, 3+ VIEWS $0.00 73140 X‐RAY EXAM OF FINGER(S), 2+ VIEWS $0.00 73200 CAT SCAN OF ARM $0.00 73201 CONTRAST CAT SCAN OF ARM $0.00 73202 CAT SCANS OF ARM $0.00 73206 CTA UPPPER EXTMY, W/CON, W.O CONTR $0.00 73218 MRI UPPER EXTRMTY, OTHER THAN JNYT $0.00 73219 MRI UPPER EXTRMT, W CONTRAST $0.00 73220 MRI OF ARM/HAND $0.00 73221 MRI OF ARM/HAND JOINT $0.00 73222 MRI ANY JNT UPPR EXTRMTY, W CONTRST $0.00 73223 MRI, ANY JOINT UPPER EXTRMT, W/W/O $0.00 73225 MRA OF UPPER EXTREMITY $0.00 73501 Radiologic examination, hip, unilat $0.00 73502 2‐3 views $0.00 73503 minimum of 4 views $0.00 73521 Radiologic examination, hips, bilat $0.00 73522 3‐4 views $0.00 73523 minimum of 5 views $0.00 73525 CONTRAST X‐RAY OF HIP JOINT $0.00 73551 Radiologic examination, femur;1 vie $0.00 73552 minimum 2 views $0.00 73560 X‐RAY EXAM OF KNEE, 1 OR 2 VIEWS $0.00 73562 X‐RAY EXAM OF KNEE, 3 VIEWS $0.00 73564 X‐RAY EXAM OF KNEE, 4+ VIEWS $0.00 73565 X‐RAY EXAM OF BOTH KNEES, STANDING $0.00 73580 CONTRAST X‐RAY OF KNEE JOINT $0.00 73590 X‐RAY EXAM OF LOWER LEG $0.00 73592 X‐RAY EXAM OF LEG, INFANT, 2+ VIEWS $0.00 73600 X‐RAY EXAM OF ANKLE $0.00 73610 X‐RAY EXAM OF ANKLE, COMPLETE $0.00 73615 CONTRAST X‐RAY OF ANKLE JOINT $0.00 73620 X‐RAY EXAM OF FOOT $0.00 73630 X‐RAY EXAM OF FOOT, COMPLETE $0.00 73650 X‐RAY EXAM OF HEEL, 2+ VIEWS $0.00 73660 X‐RAY EXAM OF TOE(S), 2+ VIEWS $0.00 73700 CAT SCAN OF LEG $0.00 73701 CONTRAST CAT SCAN OF LEG $0.00 73702 CAT SCANS OF LEG $0.00 73706 CTA LOWER EXTRMTY W/O& W CONTRAST $0.00 73718 MRI LOWER EXTRMTY, OTHER THAN JNT $0.00 73719 MRI LOWER EXTRMTY, W CONTRAST $0.00 73720 MRI OF LEG/FOOT $0.00 73721 MRI OF LEG/FOOT JOINT $0.00 73722 MRI JOINT LOWER EXTRMTY W CONTRAST $0.00 73723 MRI LOWER EXTRMTY W&W/O CONTRAST $0.00 73725 MRA OF LOWER EXTREMITY $0.00 74000 RADIO EXAM, ABDOMEN, SINGLE AP VIEW $0.00 74010 X‐RAY EXAM OF ABDOMEN $0.00 74020 X‐RAY EXAM OF ABDOMEN, COMPLETE $0.00 74022 X‐RAY EXAM SERIES, ABDOMEN $0.00 74150 CAT SCAN OF ABDOMEN $0.00 74160 CONTRAST CAT SCAN OF ABDOMEN $0.00 74170 CAT SCANS OF ABDOMEN $0.00 74174 CT ANGIO ABD&PELV W/O&W/DYE $0.00 74175 CTA ABDOMEN, W/WO CONTRAST $0.00 74176 CT ABD & PELVIS W/O CONTRAST $0.00 74177 CT ABDOMEN&PELVIS W/CONTRAST $0.00 74178 CT ABD&PELV 1+ SECTION/REGNS $0.00 74181 MRI OF ABDOMEN $0.00 74182 MRI ABDOMEN, W/O CONTRAST $0.00 74183 MRI ABDOMEN, W/O & W CONTRAST $0.00 74185 MRA OF ABDOMEN $0.00 74190 X‐RAY EXAM OF PERITONEUM $0.00 74210 X‐RAY EXAM OF THROAT $0.00 74220 X‐RAY EXAM OF ESOPHAGUS $0.00 74230 CINEMA X‐RAY OF THROAT/ESOPHAGUS $0.00 74235 X‐RAY, REMOVE OBJECT FROM ESOPHAGUS $0.00 74240 X‐RAY EXAM OF UPPER GI TRACT $0.00 74241 X‐RAY EXAM OF UPPER GI TRACT, W/KUB $0.00 74245 X‐RAY EXAM UPPER GI TRACT, SM BOWEL $0.00 74246 CONTRAST X‐RAY OF UPPER GI TRACT $0.00 74247 CONTRAST X‐RAY OF UPPER GI TRACT $0.00 74249 CONTRAST X‐RAY OF UPPER GI TRACT $0.00 74250 X‐RAY EXAM OF SMALL BOWEL $0.00 74251 X‐RAY EXAM OF SMALL BOWEL $0.00 74260 X‐RAY EXAM OF SMALL BOWEL,HYPOTONIC $0.00 74261 CT COLONOGRAPHY W/O CONTRAST $0.00 74262 CT COLONOGRAPHY W/CONTRAST $0.00 74270 CONTRAST X‐RAY OF COLON, BARIUM $0.00 74280 CONTRAST X‐RAY OF COLON, AIR/BARIUM $0.00 74283 THERAPEUTIC ENEMA, CONTRAST OR AIR $0.00 74290 CONTRAST X‐RAY, GALLBLADDER $0.00 74300 BILE DUCT/PANCREAS X‐RAY, DURING OP $0.00 74301 BILE DUCT/PANCREAS X‐RAY, ADD'L $0.00 74328 X‐RAY FOR BILE DUCT ENDOSCOPY $0.00 74329 X‐RAY FOR PANCREAS ENDOSCOPY $0.00 74330 X‐RAY, BILE DUCT/PANCREAS ENDOSCOPY $0.00 74340 X‐RAY FOR INSERTION OF GI TUBE $0.00 74355 X‐RAY FOR INTESTINAL TUBE INSERTION $0.00 74360 X‐RAY FOR DILATION OF GI TRACT $0.00 74363 X‐RAY FOR DILATION OF BILE DUCT(S) $0.00 74400 X‐RAY OF URINARY TRACT $0.00 74410 CONTRAST X‐RAY OF URINARY TRACT $0.00 74415 CONTRAST X‐RAY OF URINARY TRACT $0.00 74420 X‐RAY OF URINARY TRACT $0.00 74425 X‐RAY OF URINARY TRACT $0.00 74430 X‐RAY OF BLADDER, MINIMUM 3 VIEWS $0.00 74440 X‐RAY EXAM OF MALE GENITAL TRACT $0.00 74445 X‐RAY EXAM OF PENIS $0.00 74450 X‐RAY EXAM OF URETHRA/BLADDER $0.00 74455 VOIDING X‐RAY EXAM, URETHRA/BLADDER $0.00 74470 X‐RAY EXAM OF KIDNEY LESION $0.00 74485 X‐RAY FOR DILATION OF GU TRACT $0.00 74710 X‐RAY FOR MEASUREMENT OF PELVIS $0.00 74712 Magnetic resonance (eg, proton) ima $0.00 74713 each additional gestation (List sep $0.00 74740 X‐RAY EXAM OF FEMALE GENITAL TRACT $0.00 74742 X‐RAY GUIDE FOR OVIDUCT CATHETER $0.00 74775 X‐RAY EXAM OF PERINEUM $0.00 75557 CARDIAC MRI FOR MORPH $0.00 75559 CARDIAC MRI W/STRESS IMG $0.00 75561 CARDIAC MRI FOR MORPH W/DYE $0.00 75563 CARD MRI W/STRESS IMG & DYE $0.00 75565 CARDIAC MRI VELOCITY FLOW $0.00 75571 CT HEART W/O CONTRAST $0.00 75572 CT HEART W/CONTRAST EVAL CARD STRUC $0.00 75573 CT HEART W/CONTRAST,CONGEN HRT DIS $0.00 75574 CTA HEART,CORONARY ARTERIES W/CONT $0.00 75600 50RAY OF THORACIC AORTA $0.00 75605 XRAY, THORACIC AORTA W/SERIALOGRAPH $0.00 75625 X‐RAY OF ABDOMINAL AORTA $0.00 75630 X‐RAY ABDOMINAL AORTA, LEG ARTERIES $0.00 75635 CTA ABDOMINAL AORTA & BIL ILEOFE RU $0.00 75658 X‐RAY EXAM OF ARM ARTERIES $0.00 75705 X‐RAY EXAM OF SPINAL ARTERIES $0.00 75710 X‐RAY EXAM OF ARM/LEG ARTERY $0.00 75716 X‐RAY EXAM OF ARM/LEG ARTERIES $0.00 75726 X‐RAY EXAM OF VISCERAL ARTERIES $0.00 75731 X‐RAY EXAM OF ADRENAL ARTERY $0.00 75733 X‐RAY EXAM OF ADRENAL ARTERIES $0.00 75736 X‐RAY EXAM OF PELVIC ARTERIES $0.00 75741 X‐RAY EXAM OF LUNG ARTERY $0.00 75743 X‐RAY EXAM OF LUNG ARTERIES $202.41 75746 X‐RAY EXAM OF LUNG ARTERIES $0.00 75756 X‐RAY EXAM OF BREAST ARTERIES $0.00 75774 X‐RAY OF ARTERIES, ADD'L VESSEL(S) $0.00 75801 X‐RAY EXAM OF ARM/LEG LYMPH VESSEL $0.00 75803 X‐RAY EXAM OF ARM/LEG LYMPH VESSELS $0.00 75805 X‐RAY EXAM OF TRUNK LYMPH VESSEL $0.00 75807 X‐RAY EXAM OF TRUNK LYMPH VESSELS $0.00 75809 X‐RAY EXAM OF NONVASCULAR SHUNT $0.00 75810 X‐RAY EXAM OF SPLEEN/LIVER VEINS $0.00 75820 X‐RAY EXAM OF ARM/LEG VEINS $0.00 75822 X‐RAY EXAM OF ARMS/LEGS VEINS $0.00 75825 X‐RAY EXAM OF TRUNK VEINS $0.00 75827 X‐RAY EXAM OF CHEST VEINS $0.00 75831 X‐RAY EXAM OF KIDNEY VEINS $0.00 75833 X‐RAY EXAM OF KIDNEY VEINS $0.00 75840 X‐RAY EXAM OF ADRENAL VEINS $0.00 75842 X‐RAY EXAM OF ADRENAL VEINS $0.00 75860 X‐RAY EXAM OF NECK VEINS $0.00 75870 X‐RAY EXAM OF SKULL VEINS $0.00 75872 X‐RAY EXAM OF SKULL VEINS $0.00 75880 X‐RAY EXAM OF EYE SOCKET VEINS $0.00 75885 X‐RAY EXAM OF LIVER VEINS $0.00 75887 X‐RAY EXAM OF LIVER VEINS $0.00 75889 X‐RAY EXAM OF LIVER VEINS $0.00 75891 X‐RAY EXAM OF LIVER VEINS $0.00 75893 X‐RAY FOR VENOUS SAMPLE BY CATHETER $0.00 75894 X‐RAY FOR CATHETER EMBOLIZE THERAPY $0.00 75898 FOLLOWUP ANGIOGRAM THRU CATHETER $0.00 75901 MECH REMVL PERICATH OBSTRTVE MATERL $0.00 75902 MEC REMVL INTRALUMNL THRU cvd $0.00 75952 ENDOVASC REPAIR OF AAA $0.00 75953 PLCMNT OF PRXML DEP REPR AAA DISSEC $0.00 75956 ENDOVAS REP DES T‐AOR,INV SUBCL ART $0.00 75957 ENDOVAS REP D‐AOR,NOT INV SUBCL ART $0.00 75958 PLAC PROX EXT PROST E/VAS REP DES T $0.00 75959 PLAC DIS EXT PROS E/VAS REP DESC TH $0.00 75970 X‐RAY FOR TRANSCATHETER BIOPSY $0.00 75984 X‐RAY FOR DRAINAGE CATHETER CHANGE $0.00 75989 X‐RAY GUIDE FOR DRAINAGE/SPECIMEN $0.00 76000 FLUOROSCOPE EXAM $0.00 76001 FLUOROSCOPE EXAM, EXTENSIVE $0.00 76010 X‐RAY FOR OBJECT, NOSE TO RECTUM $0.00 76080 X‐RAY EXAM ABSCESS/FISTULA/SINUS $0.00 76098 X‐RAY EXAM OF SURGICAL SPECIMEN $0.00 76100 X‐RAY EXAM OF BODY SECTION $0.00 76101 COMPLEX MOTION BODY SECTION X‐RAY $0.00 76102 COMPLEX MOTION BODY SECTION X‐RAYS $0.00 76120 CINEMATIC X‐RAYS $0.00 76125 CINEMATIC X‐RAYS W/ROUTINE EXAM $0.00 76376 3‐D CT/MRI REQ IMG PROCE INDEP W/ST $0.00 76377 3‐D CT/MRI N/REQ ING PROC INDP W/ST $0.00 76380 CAT SCAN FOLLOWUP STUDY, LIMITED $0.00 76506 ECHO EXAM OF HEAD/BRAIN $0.00 76510 OPTHALM U/S DIAG; B&A SCAN SAME ENC $0.00 76511 ECHO EXAM OF EYE (1D) $0.00 76512 ECHO EXAM OF EYE (2D) $325.95 76513 ECHO EXAM OF EYE, WATER BATH (2D) $0.00 76514 OPHTH SONO CORNEAL PACHYMETRY UN/BI $55.02 76516 ECHO EXAM OF EYE (1D) $0.00 76519 ECHO EXAM OF EYE, CALC LENS POWER $300.48 76529 ECHO EXAM OF EYE FOR FOREIGN BODY $0.00 76536 ECHO EXAM OF HEAD AND NECK TISSUES $0.00 76604 ECHO EXAM OF CHEST $0.00 76641 US BREAST UNI REAL TIME WITH IMAGE $0.00 76642 US BREAST UNI REAL TIME WITH IMAGE $0.00 76700 ECHO EXAM OF ABDOMEN, COMPLETE $0.00 76705 ECHO EXAM OF ABDOMEN, LIMITED $0.00 76770 ECHO EXAM, RETROPERITONEUM,COMPLETE $0.00 76775 ECHO EXAM, RETROPERITONEUM,LIMITED $0.00 76776 US TRANSPLNTD KIDNEY DUPLX & DOPPLR $0.00 76800 ECHO EXAM SPINAL CANAL AND CORD $0.00 76801 U/S PREGNANT UTERUS. FIRST TRIMESTE $0.00 76802 U/S PRGNT UTERUS, EACH GESTATION $0.00 76805 ECHO EXAM OF PREG UTERUS, COMPLETE $0.00 76810 ECHO EXAM OF PREG UTERUS, COMPLETE $0.00 76811 U/S PREGNT UTERUS, FET& MAT EVALTIO $0.00 76812 U/S PREGNT UTERUS, EACH ADD GESTION $0.00 76813 US PREG UTRS IST TRMST TRNSABD/VAGN $0.00 76814 US PREG UTRS IST TRMST EACH +NL GES $0.00 76815 ECHO EXAM OF PREG UTERUS, LIMITED $0.00 76816 ECHO EXAM FOLLOWUP OR REPEAT $0.00 76817 US PRGNANT UTERUS TRANSVAGINAL $0.00 76818 ECHO EXAM, FETAL PROFILE $0.00 76819 FETAL BIOPHYSL PROF, NONSTRESS TST $0.00 76820 DOPP VELOCIMETRY FETAL; UMBL ARTERY $0.00 76821 DOPP VELOCIMETRY FETAL MID CEREB AR $0.00 76825 ECHO EXAM OF FETAL HEART $0.00 76826 ECHO RE‐EXAM OF FETAL HEART $0.00 76827 DOPPLER ECHO EXAM OF FETAL HEART $0.00 76828 DOPPLER ECHO RE‐EXAM OF FETAL HEART $0.00 76830 TRANSVAGINAL ECHO EXAM $0.00 76831 UTERUS ECHO EXAM $0.00 76856 ECHO EXAM OF PELVIS, COMPLETE $0.00 76857 ECHO EXAM OF PELVIS, LIMITED $0.00 76870 ECHO EXAM OF SCROTUM AND TESTES $0.00 76872 ECHO EXAM OF PROSTATE $0.00 76873 NULL $0.00 76881 US XTR NON‐VASC COMPLETE $0.00 76882 US XTR NON‐VASC LMTD $0.00 76885 ECHO EXAM, INFANT HIPS, DYNAMIC $0.00 76886 ECHO EXAM, INFANT HIPS, LIMITED $0.00 76932 ULTRASOUND GUIDE FOR HEART BIOPSY $0.00 76936 ULTRASOUND GUIDE FOR ARTERY REPAIR $0.00 76937 ULTRA GUID VASCULAR ACCESS $37.50 76940 ULTRASOUND GUID MON VISCERAL ABLAT $0.00 76941 ULTRASOUND GUIDE, FETAL TRANSFUSION $0.00 76942 ULTRASOUND GUIDE FOR NEEDLE BIOPSY $0.00 76945 CHORIONIC VILLUS SAMPLING GUIDANCE $0.00 76946 ULTRASOUND GUIDE FOR AMNIOCENTESIS $0.00 76948 ULTRASOUND GUIDE FOR OVA ASPIRATION $0.00 76965 ULTRASOUND GUIDE FOR RADIOTHERAPY $0.00 76970 ULTRASOUND FOLLOWUP $0.00 76975 GI ENDOSCOPIC ULTRASOUND $0.00 76977 ULTRASOUND BONE DENSITY, PERIPHERAL $0.00 76998 ULTRASONIC GUIDANCE INTRAOPERATIVE $0.00 77001 FLRSCPIC GUIDANCE CVAD PLACMNT S&I $0.00 77002 FLRSCPC GUIDANCE NEEDL PLACEMENT $0.00 77003 FLRSCPC GUDNC & LOCLZTN DX/TX INJC $0.00 77011 CT GUIDANCE FOR STEREOTACTC LOCLZTN $0.00 77012 CT GUDNCE FOR NEEDLE PLCMENT S&I $0.00 77013 CT GUDNCE FOR MONTRNG TISSUE ABLTN $0.00 77014 CT GUDNCE FOR PLCMNT RADTN TX FIELD $0.00 77021 MR GUIDNCE FOR NEEDLE PLCMNT S&I $0.00 77022 MR GUDNCE FOR PARNCHYML TISSU ABLTN $0.00 77053 MAMMARY DUCTOGRAM OR GLACTOGRM SNGL $0.00 77054 MAMRY DUCTOGRM/GLCTOGRAM MULTPL DCT $0.00 77058 MRI BREAST W/O AND/OR W CNTRST UNIL $0.00 77059 MRI BREAST W/O OR W CONTRST BILATRL $0.00 77063 SCREENING DIGITAL BREAST TOMOSYNTHE $0.00 77071 MANUL APPLCTN STRES BY MD JOINT XRY $185.00 77072 BONE AGE STUDIES $0.00 77073 BONE LENGTH STUDIES $0.00 77074 RADIOLOGICAL EXM OSSEUS SURVY LIMTD $0.00 77075 RADIOLOGIC EXAM OSSEOUS SRVY COMPLT $0.00 77076 RADIOLOGICAL EXAM OSSEUS SRVY INFNT $0.00 77077 JOINT SURVY SINGL VIEW 2/MORE JOINT $0.00 77078 CT BONE MINERAL DENSITY STUDY AXIAL $0.00 77080 DXA BONE DENSITY STUDY 1>MORE AXIAL $0.00 77081 DXA APPENDICULAR SKLTN $0.00 77084 MRI BONE MARROW BLOOD SUPPLY $0.00 77085 DXA BONE DENSITY STUDY AXIAL SKELET $0.00 77086 VERTEBRAL FRACTURE ASSESSMENT VIA D $0.00 77261 RADIATION THERAPY PLANNING, SIMPLE $263.00 77262 RADIATION THERAPY PLANNING,INTERMED $395.00 77263 RADIATION THERAPY PLANNING, COMPLEX $578.00 77280 SET RADIATION THERAPY FIELD, SIMPLE $0.00 77285 SET RADIATION THERAPY FIELD, INTERM $0.00 77290 SET RADIATION THERAPY FIELD,COMPLEX $0.00 77293 RESPIRATORY MOTION MANAGEMENT SIMU $0.00 77295 SET RADIATION THERAPY FIELD, 3D $0.00 77300 RADIATION THERAPY DOSE PLAN $0.00 77301 INTENSITY MODULATED RAD PLAN $0.00 77306 TELETHX ISODOSE PLN SMPL W/DOSIMETR $0.00 77307 TELETHX ISODOSE PLN CPLX W/BASIC DO $0.00 77316 BRACHYTX ISODOSE PLN SMPL W/DOSIMET $0.00 77317 BRACHYTX ISODOSE PLN INTERMED W/DOS $0.00 77318 BRACHYTX ISODOSE PLN CPLX W/DOSIMET $0.00 77321 SPECIAL RADIATION THERAPY PORT PLAN $0.00 77331 SPECIAL RADIATION DOSIMETRY $0.00 77332 RADIATION TREATMENT AID(S), SIMPLE $0.00 77333 RADIATION TREATMENT AID(S),INTERMED $0.00 77334 RADIATION TREATMENT AID(S), COMPLEX $0.00 77336 CONT'D MEDICAL PHYSICS CONSULT $298.00 77338 MLC DEVICE FOR IMRT, DESIGN & CONST $0.00 77370 SPECIAL RADIATION PHYSICS CONSULT $460.00 77372 RADTN TX DLVRY SRS LINEAR ACCLRTR $3,948.00 77373 STEREOTACTIC BODY RADIATION TX $5,805.00 77401 RADIATION TREATMENT DELIVERY $89.00 77417 RADIOLOGY PORT FILM(S) $52.00 77427 Radiation treatment mngmnt 5 trtmnt $647.00 77431 RADIATION THERAPY MANAGEMENT $356.00 77432 STEREOTACTIC RADIATION TREATMENT $1,458.00 77435 STEROTACTIC BODY RADIATION TX $2,198.00 77469 IO RADIATION TX MANAGEMENT $1,122.00 77470 SPECIAL RADIATION TREATMENT $0.00 77600 HYPERTHERMIA TREATMENT, SUPERFICIAL $0.00 77605 HYPERTHERMIA TREATMENT, DEEP $0.00 77610 HYPERTHERMIA TREATMENT BY PROBE $0.00 77615 HYPERTHERMIA TREATMENT BY PROBE $0.00 77620 HYPERTHERMIA TREATMENT BY PROBE $0.00 77750 INFUSION RADIOELMTS SOL 3‐MTHS F/U $0.00 77761 IMPLANT INTRACAVITARY RADIOELEMENT $0.00 77762 IMPLANT INTRACAVITARY RADIOELEMENT $0.00 77763 IMPLANT INTRACAVITARY RADIOELEMENT $0.00 77767 Remote afterloading high dose rate $0.00 77768 lesion diameter over 2.0 cm and 2 o $0.00 77770 Remote afterloading high dose rate $0.00 77771 2‐12 channels $0.00 77772 over 12 channels $0.00 77778 IMPLANT INTERSTITIAL RADIOELEMENT $0.00 77789 RADIOELEMENT SURFACE APPLICATION $0.00 77790 RADIOELEMENT HANDLING $0.00 78012 THYROID UPTAKE SINGLE/MULTIPLE QUAN $0.00 78013 THYROID IMAGING WITH VASCULAR FLOW $0.00 78014 THYROID UPTAKE W/BLOOD FLOW SNGLE/M $0.00 78015 NUCLEAR SCAN OF THYROID FOR TUMOR $0.00 78016 EXTENSIVE THYROID SCAN FOR TUMOR $0.00 78018 WHOLE BODY NUCLEAR SCANS, THYROID $0.00 78020 CARCINOMA METAST UPTAKE, THYROID $0.00 78070 NUCLEAR SCAN OF PARATHYROID $0.00 78071 PARATHYROID PLANAR IMAGING W/WO SUB $0.00 78072 PARATHYROID IMAGING W/TOMOGRAPHIC S $0.00 78075 NUCLEAR SCAN OF ADRENAL GLAND(S) $0.00 78102 NUCLEAR SCAN, BONE MARROW, LIMITED $0.00 78103 NUCLEAR SCANS OF BONE MARROW $0.00 78104 NUCLEAR SCAN, BONE MARROW, COMPLETE $0.00 78110 NUCLEAR EXAM OF PLASMA VOLUME $0.00 78111 NUCLEAR EXAMS OF PLASMA VOLUME $0.00 78120 NUCLEAR EXAM OF RBC VOLUME $0.00 78121 NUCLEAR EXAMS OF RBC VOLUME $0.00 78122 NUCLEAR EXAM, WHOLE BLOOD VOLUME $0.00 78130 RED CELL SURVIVAL EXAM $0.00 78135 RED CELL SURVIVAL EXAM $0.00 78140 NUCLEAR EXAM OF RED BLOOD CELLS $0.00 78185 10CLEAR SCAN OF SPLEEN $0.00 78190 NUCLEAR EXAM OF PLATELET SURVIVAL $0.00 78191 NUCLEAR EXAM OF PLATELET SURVIVAL $0.00 78195 NUCLEAR SCAN OF LYMPH SYSTEM $0.00 78201 NUCLEAR SCAN OF LIVER, STATIC $0.00 78202 NUCLEAR SCAN OF LIVER/BLOOD FLOW $0.00 78205 NUCLEAR SCAN OF LIVER (3D) $0.00 78206 NUCLEAR SCAN, LIVER, W/VASC FLOW $0.00 78215 NUCLEAR SCAN OF LIVER & SPLEEN $0.00 78216 NUCLEAR SCAN OF LIVER & SPLEEN $0.00 78226 HEPATOBILIARY SYSTEM IMAGING $0.00 78227 HEPATOBIL SYST IMAGE W/DRUG $0.00 78230 NUCLEAR SCAN OF SALIVARY GLAND $0.00 78231 NUCLEAR SCANS OF SALIVARY GLAND $0.00 78232 NUCLEAR EXAM, SALIVARY GLAND FUNCT $0.00 78258 NUCLEAR IMAGING OF ESOPHAGUS $0.00 78261 NUCLEAR SCAN OF GASTRIC MUCOSA $0.00 78262 NUCLEAR EXAM OF GULLET REFLUX $0.00 78264 NUCLEAR EXAM OF STOMACH EMPTYING $0.00 78265 Gastric emptying imaging study (eg, $0.00 78266 Gastric emptying imaging study (eg, $0.00 78267 UREA BREATH TEST,C‐14 ACQ FOR ANAL $33.00 78268 Urea breath test, C‐14 (isotopic) $286.00 78270 NUCLEAR EXAMS, VIT B‐12 ABSORPTION $0.00 78271 NUCLEAR EXAMS, VIT B‐12 ABSORPTION $0.00 78272 NUCLEAR EXAMS, VIT B‐12 ABSORPTION $0.00 78278 NUCLEAR SCAN FOR GI BLOOD LOSS $0.00 78282 NUCLEAR EXAM OF GI PROTEIN LOSS $0.00 78290 NUCLEAR SCAN OF BOWEL $0.00 78291 TEST ABDOMINAL VENOUS DRAIN $0.00 78300 NUCLEAR SCAN OF BONE, LIMITED $0.00 78305 NUCLEAR SCAN OF BONES, MULTIPLE $0.00 78306 NUCLEAR SCAN OF SKELETON $0.00 78315 NUCLEAR SCAN OF BONE, 3‐PHASE $0.00 78320 NUCLEAR SCAN OF BONE (3D) $0.00 78414 NUCLEAR EXAM OF HEART CIRCULATION $0.00 78428 NUCLEAR EXAM OF HEART SHUNT $0.00 78445 NUCLEAR SCAN, BLOOD FLOW, NON‐CARD $0.00 78451 MYOCARDIAL PERFUSION IMAGING $0.00 78452 MULTIPLE STUDIES AT REST AND STRESS $0.00 78453 MYOCARDIAL PERFUSION IMAG PLANAR $0.00 78454 HT MUSC IMAGE, PLANAR, MULT $0.00 78456 NULL $0.00 78457 NUCLEAR SCAN VEIN CLOT, ONE SIDE $0.00 78458 NUCLEAR SCAN VEIN CLOT, BOTH SIDES $0.00 78459 MYOCARDIAL PET METABOLIC EVALUATION $0.00 78466 NUCLEAR SCAN OF HEART MUSCLE $0.00 78468 NUCLEAR SCAN OF HEART MUSCLE $0.00 78469 NUCLEAR SCAN OF HEART MUSCLE (3D) $0.00 78472 NUCLEAR SCAN, CARDIAC BLOOD POOL $0.00 78473 NUCLEAR SCAN, CARDIAC MUGA $0.00 78481 NUCLEAR SCAN, CARDIAC BLOOD POOL $0.00 78483 NUCLEAR SCANS, CARDIAC BLOOD POOL $0.00 78491 MYOCARDIAL PET, SINGLE $0.00 78492 MYOCARDIAL PET, MULTIPLE $0.00 78494 NUCLEAR BLOOD POOL IMAGING $0.00 78496 NUCLEAR BLOOD POOL IMAGING, SINGLE $0.00 78579 LUNG VENTILATION IMAGING $0.00 78580 NUCLEAR SCAN OF LUNG, PARTICULATE $0.00 78582 LUNG VENTILAT&PERFUS IMAGING $0.00 78597 LUNG PERFUSION DIFFERENTIAL $0.00 78598 LUNG PERF&VENTILAT DIFERENTL $0.00 78600 BRAIN IMAGING, LIMITED, STATIC $0.00 78601 BRAIN IMAGING, LIMITED W/BLOOD FLOW $0.00 78605 BRAIN IMAGING, COMPLETE, STATIC $0.00 78606 BRAIN IMAGING, COMPLETE W/BLOOD FLW $0.00 78607 BRAIN IMAGING, COMPLETE, (SPECT) $0.00 78608 BRAIN IMAGING, PET, METABOLIC EVAL $0.00 78610 NUCLEAR SCAN OF BRAIN/BLOOD FLOW $0.00 78630 CEREBROSPINAL FLUID FLOW SCAN $0.00 78635 CEREBROSPINAL FLUID FLOW SCAN $0.00 78645 CEREBROSPINAL FLUID FLOW SCAN $0.00 78647 CEREBROSPINAL FLUID FLOW SCAN $0.00 78650 CEREBROSPINAL FLUID FLOW SCAN $0.00 78660 NUCLEAR EXAM OF TEAR FLOW $0.00 78700 NUCLEAR SCAN OF KIDNEY $0.00 78701 NUCLEAR SCAN OF KIDNEY/BLOOD FLOW $0.00 78707 KIDNEY IMAGE, SINGL W/O DRUG INTERV $0.00 78708 KIDNEY IMAGE, SINGL W/DRUG INTERV $0.00 78709 KIDNEY IMAGE, MULT W/& W/O DRUG INT $0.00 78710 NUCLEAR SCAN OF KIDNEY (SPECT) $0.00 78725 NUCLEAR EXAM OF KIDNEY $0.00 78730 NUCLEAR EXAM OF BLADDER $0.00 78740 NUCLEAR EXAM OF URETER $0.00 78761 NUCLEAR SCAN OF TESTES/BLOOD FLOW $0.00 78800 NUCLEAR EXAM OF TUMOR, LIMITED $0.00 78801 NUCLEAR EXAM OF TUMORS $0.00 78802 NUCLEAR EXAM OF TUMORS, WHOLE BODY $0.00 78803 NUCLEAR SCAN OF TUMOR (SPECT) $0.00 78804 RADIOPHARM LOCAL TUMOR/WHOLE BODY $0.00 78805 NUCLEAR EXAM OF ABSCESS, LIMITED $0.00 78806 NUCLEAR EXAM OF ABSCESS, WHOLE BODY $0.00 78807 NUCLEAR LOCALIZATION OF ABSCESS $0.00 78808 Iv inj ra drug dx study $171.00 78811 TUMOR IMG, PET; LTD AREA CHT,HED,NK $0.00 78812 TUMOR IMG, PET; SKULL BASE‐MID THIG $0.00 78813 TUMOR IMG, PET; WHOLE BODY $0.00 78814 TUMOR IMG,PET W/ CT; LTD AREA $0.00 78815 TUMOR IMG, PET W/CT; SKULL‐MIDTHIGH $0.00 78816 TUMOR IMG, PET W/CT; WHOLE BODY $0.00 79005 RADIOPHARMACEUTICAL THERP, ORAL ADM $0.00 79101 RADIOPHARMACEUTICAL THERP, IV ADM $0.00 79200 INTRACAVITARY RADIOTHERAPY $0.00 79300 INTERSTITIAL RADIOTHERAPY $0.00 79403 MONOCLONAL ANTIBODY BY INTRAVENOUS $0.00 79440 INTRA‐ARTICULAR RADIOTHERAPY $0.00 79445 RADIOTHERAPY INTRA‐ARTERIAL ADM $0.00 80047 METABOLIC PANEL IONIZED CA $27.00 80048 Basic metabolic panel % $27.00 80051 ELECTROLYTE PANEL % $23.00 80053 Comprehensive metabolic panel % $41.00 80055 OBSTETRIC PROFILE % $0.00 80061 LIPID PROFILE % $57.00 80069 Renal function panel $34.00 80074 Acute hepatitis panel $202.00 80076 Hepatic function panel % $27.00 80081 Obstetric panel (includes HIV test $0.00 80150 ASSAY, AMIKACIN % $64.00 80155 DRUG SCREEN QUANTITATIVE CAFFEINE $58.00 80156 ASSAY, CARBAMAZEPINE % $50.00 80157 Carbamazepine; free $56.00 80158 ASSAY, CYCLOSPORINE % $77.00 80159 DRUG SCREEN QUANTITATIVE CLOZAPINE $76.00 80162 ASSAY, DIGOXIN % $56.00 80163 DRUG SCREEN QUANTITATIVE DIGOXIN FR $54.00 80164 ASSAY, DIPROPYLACETIC ACID % $58.00 80165 DRUG SCREEN QUANT DIPROPYLACETIC AC $55.00 80168 ASSAY, ETHOSUXIMIDE % $69.00 80169 DRUG SCREEN QUANTITATIVE EVEROLIMUS $56.00 80170 ASSAY, GENTAMICIN % $70.00 80171 DRUG SCREEN QUANTITATIVE GABAPENTIN $54.00 80173 Haloperidol $50.00 80175 DRUG SCREEN QUANTITATIVE LAMOTRIGIN $54.00 80176 ASSAY, LIDOCAINE % $62.00 80177 DRUG SCREEN QUANTITATIVE LEVETIRACE $54.00 80178 ASSAY, LITHIUM % $28.00 80180 DRUG SCREEN QUANTITATIVE MYCOPHENOL $74.00 80183 DRUG SCREEN QUANTITATIVE OXCARBAZEP $54.00 80184 ASSAY, PHENOBARBITAL % $49.00 80185 ASSAY, PHENYTOIN, TOTAL % $56.00 80186 ASSAY, PHENYTOIN, FREE % $50.00 80188 ASSAY, PRIMIDONE % $71.00 80190 ASSAY, PROCAINAMIDE % $71.00 80192 ASSAY, PROCAINAMIDE METABOLITES % $71.00 80194 ASSAY, QUINIDINE % $62.00 80195 SIROLIMUS $58.00 80197 ASSAY, TACROLIMUS % $58.00 80198 ASSAY, THEOPHYLLINE % $60.00 80199 DRUG SCREEN QUANTITATIVE TIAGABINE $74.00 80200 ASSAY, TOBRAMYCIN % $68.00 80201 ASSAY, TOPIRAMATE % $51.00 80202 ASSAY, VANCOMYCIN % $58.00 80203 DRUG SCREEN QUANTITATIVE ZONISAMIDE $54.00 80299 QUANTITATIVE ASSAY, DRUG NEC % $58.00 80400 ACTH STIMULATION PANEL % $139.00 80402 ACTH STIMULATION PANEL % $369.00 80406 ACTH STIMULATION PANEL % $333.00 80408 ALDOSTERONE SUPPRESSION EVAL PANEL% $533.00 80410 CALCITONIN STIMULULATION PANEL % $341.00 80412 CRH STIMULATION PANEL % $1,401.00 80414 CGS PANEL, TESTOSTERONE RESPONSE % $219.00 80415 CGS PANEL, ESTRADIOL RESPONSE % $237.00 80416 RENAL VEIN RENIN STIMULATION PANEL% $561.00 80417 PERIPHERAL VEIN RENIN STIMUL PANEL% $187.00 80418 PITUITARY EVALUATION PANEL % $2,463.00 80420 DEXAMETHASONE SUPPRESSION PANEL % $306.00 80422 GLUCAGON TOLERANCE PANEL % $196.00 80424 GLUCAGON TOLERANCE PANEL % $146.00 80426 GONADOTROPIN RELEASE HORMONE PANEL% $631.00 80428 GROWTH HORMONE STIMULATION PANEL % $283.00 80430 GROWTH HORMONE SUPPRESSION PANEL % $333.00 80432 INSULIN SUPPRESSION PANEL % $574.00 80434 INSULIN TOLERANCE PANEL % $430.00 80435 INSULIN TOLERANCE PANEL % $438.00 80436 METYRAPONE PANEL % $387.00 80438 TRH STIMULATION PANEL, ONE HOUR % $214.00 80439 TSH STIMULATION PANEL, TWO HOUR % $286.00 80500 LAB PATHOLOGY CONSULTATION,LIMITED% $67.00 80502 LAB PATHOLOGY CONSULT,COMPREHENSIV% $236.00 81000 URINALYSIS, NON‐AUTOMATED, W/SCOPE% $13.00 81001 URINALYSIS, AUTOMATED W/MICROSCOPY% $13.00 81002 URINALYSIS, NON‐AUTOMATED, W/SCOPE% $11.00 81003 URINALYSIS, AUTOMATED, W/O SCOPE % $10.00 81005 URINALYSIS % $9.00 81007 URINE SCREEN FOR BACTERIA % $11.00 81015 MICROSCOPIC EXAMINATION OF URINE % $13.00 81020 URINALYSIS, TWO/THREE GLASS TEST % $12.00 81025 URINE PREGNANCY TEST % $27.00 81050 URINALYSIS, VOLUME MEASURE % $13.00 81161 DMD DUPLICATION/DELETION ANALYSIS $0.00 81162 full sequence analysis and full dup $0.00 81170 ABL1 (ABL proto‐oncogene 1, non‐rec $0.00 81206 BCR/ABL1 GENE MAJOR BP $670.00 81207 BCR/ABL1 GENE MINOR BP $592.00 81208 BCR/ABL1 GENE OTHER BP $657.00 81210 BRAF GENE $537.00 81211 BRCA1&2 SEQ & COM DUP/DEL $6,541.00 81212 BRCA1&2 185&5385&6174 VAR $529.00 81213 BRCA1&2 UNCOM DUP/DEL VAR $1,746.00 81214 BRCA1 FULL SEQ & COM DUP/DEL $4,308.00 81215 BRCA1 GENE KNOWN FAM VARIANT $279.00 81217 BRCA2 GENE KNOWN FAM VARIANT $279.00 81218 CEBPA (CCAAT/enhancer binding prote $0.00 81219 CALR (calreticulin) (eg, myeloproli $0.00 81225 CYP2C19 GENE COM VARIANTS $874.00 81226 CYP2D6 GENE COM VARIANTS $1,353.00 81227 CYP2C9 GENE COM VARIANTS $524.00 81235 EGFR GENE ANALYSIS COMMON VARIANTS $989.00 81240 F2 GENE $201.00 81241 F5 GENE $250.00 81245 FLT3 GENE $497.00 81246 FLT3 GENE ANLYS TYROSINE KINASE DOM $0.00 81256 HFE GENE $267.00 81261 IGH GENE REARRANGE AMP METH $809.00 81262 IGH GENE REARRANG DIR PROBE $178.00 81263 IGH VARI REGIONAL MUTATION $1,204.00 81264 IGK REARRANGEABN CLONAL POP $610.00 81265 STR MARKERS SPECIMEN ANAL $879.00 81267 CHIMERISM ANAL NO CELL SELEC $848.00 81268 CHIMERISM ANAL W/CELL SELECT $1,066.00 81270 JAK2 GENE $375.00 81272 KIT (v‐kit Hardy‐Zuckerman 4 feline $0.00 81273 KIT (v‐kit Hardy‐Zuckerman 4 feline $0.00 81275 KRAS GENE $592.00 81276 additional variant(s) (eg, codon 61 $0.00 81287 MGMT METHYLATION ANALYSIS $0.00 81288 MLH1 GENE ANALYSIS PROMOTER METHYLA $0.00 81291 MTHFR GENE $178.00 81292 MLH1 GENE FULL SEQ $1,936.00 81293 MLH1 GENE KNOWN VARIANTS $776.00 81295 MSH2 GENE FULL SEQ $454.00 81296 MSH2 GENE KNOWN VARIANTS $388.00 81298 MSH6 GENE FULL SEQ $862.00 81299 MSH6 GENE KNOWN VARIANTS $483.00 81301 MICROSATELLITE INSTABILITY $1,183.00 81310 NPM1 GENE $740.00 81311 NRAS (neuroblastoma RAS viral [v‐ra $0.00 81313 PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN $0.00 81314 PDGFRA (platelet‐derived growth fac $0.00 81315 PML/RARALPHA COM BREAKPOINTS $847.00 81316 PML/RARALPHA 1 BREAKPOINT $1,292.00 81317 PMS2 GENE FULL SEQ ANALYSIS $2,340.00 81318 PMS2 KNOWN FAMILIAL VARIANTS $553.00 81319 PMS2 GENE DUP/DELET VARIANTS $664.00 81321 PTEN GENE ANALYSIS FULL SEQUENCE AN $1,799.00 81322 PTEN GENE ANALYSIS KNOWN FAMILIAL V $175.00 81323 PTEN GENE ANALYSIS DUPLICATION/DELE $262.00 81332 SERPINA1 GENE $178.00 81340 TRB@ GENE REARRANGE AMPLIFY $854.00 81341 TRB@ GENE REARRANGE DIRPROBE $203.00 81342 TRG GENE REARRANGEMENT ANAL $823.00 81370 HLA I & II TYPING LR $1,643.00 81371 HLA I & II TYPE VERIFY LR $984.00 81372 HLA I TYPING COMPLETE LR $903.00 81373 HLA I TYPING 1 LOCUS LR $455.00 81374 HLA I TYPING 1 ANTIGEN LR $297.00 81375 HLA II TYPING AG EQUIV LR $902.00 81376 HLA II TYPING 1 LOCUS LR $499.00 81377 HLA II TYPE 1 AG EQUIV LR $375.00 81378 HLA I & II TYPING HR $1,412.00 81379 HLA I TYPING COMPLETE HR $1,371.00 81380 HLA I TYPING 1 LOCUS HR $724.00 81381 HLA I TYPING 1 ALLELE HR $387.00 81382 HLA II TYPING 1 LOC HR $505.00 81383 HLA II TYPING 1 ALLELE HR $446.00 81435 HEREDITARY COLON CA GENOMIC SEQ ANA $0.00 81436 HEREDITARY COLON CA SYND DUP/DEL AN $0.00 81445 TARGETED GENOMIC SEQ ANALYS DNA ANA $0.00 81450 GENOMIC SEQ ANALYS DNA&RNA ANALYS 5 $0.00 81519 ONCOLOGY BREAST MRNA GENE EXPRESSIO $0.00 81528 Oncology (colorectal) screening, qu $0.00 81535 Oncology (gynecologic), live tumor $0.00 81536 each additional single drug or drug $0.00 82009 TEST FOR ACETONE % $19.00 82010 ACETONE ASSAY % $35.00 82013 ACETYLCHOLINESTERASE ASSAY % $47.00 82016 ACYLCARNITINES, QUAL, EACH SPECIME% $46.00 82017 ACYLCARNITINES, QUAN, EACH SPECIME% $61.00 82024 ACTH RADIOIMMUNE ASSAY % $164.00 82030 ASSAY, CYCLIC ADENOSINE % $110.00 82040 ASSAY, SERUM ALBUMIN % $21.00 82042 TEST FOR URINE ALBUMIN % $12.00 82043 TEST FOR MICROALBUMIN % $25.00 82044 MICROALBUMIN, SEMIQUANTITATIVE % $13.00 82045 ALBMIN; ISCHEMIA MODIFIED $144.00 82075 ASSAY, BREATH ETHANOL % $42.00 82085 ASSAY, BLOOD ALDOLASE % $41.00 82088 ASSAY, BLOOD ALDOSTERONE % $173.00 82103 ALPHA‐1‐ANTITRYPSIN, TOTAL % $57.00 82104 ALPHA‐1‐ANTITRYPSIN, PHENOTYPE % $61.00 82105 ALPHA‐FETOPROTEIN, SERUM % $71.00 82106 ALPHA‐FETOPROTEIN, AMNIOTIC FLUID % $71.00 82107 Alpha‐fetoprotein (AFP); AFP‐L3 fra $267.00 82108 ASSAY, BLOOD ALUMINUM % $108.00 82120 Amines, vaginal fluid, qualitative $16.00 82127 TEST FOR AMINO ACIDS, QUAL, EA SPE% $46.00 82128 TEST FOR AMINO ACIDS, QUAL, MULT % $46.00 82131 AMINO ACIDS ANALYSIS % $72.00 82135 ASSAY, AMINOLEVULINIC ACID % $70.00 82136 AMINO ACIDS ANAL, 2‐5 AMINO ACIDS % $61.00 82139 AMINO ACIDS ANAL, 6+ AMINO ACIDS % $61.00 82140 ASSAY, BLOOD AMMONIA % $62.00 82143 AMNIOTIC FLUID SCAN % $29.00 82150 ASSAY, SERUM AMYLASE % $28.00 82154 ANDROSTANEDIOL GLUCURONIDE % $123.00 82157 ASSAY, ANDROSTENEDIONE % $124.00 82160 ASSAY, ANDROSTERONE % $106.00 82163 ASSAY, ANGIOTENSIN II % $87.00 82164 ANGIOTENSIN I ENZYME TEST % $62.00 82172 APOLIPOPROTEIN IMMUNOASSAY % $66.00 82175 ASSAY, ARSENIC % $81.00 82180 ASSAY, VITAMIN C % $39.00 82190 ATOMIC ABSORPTION TEST % $23.00 82232 ASSAY, SERUM PROTEIN % $69.00 82239 ASSAY, BILE ACIDS, TOTAL % $60.00 82240 ASSAY, BILE ACIDS IN BLOOD % $60.00 82247 ASSAY BLOOD BILIRUBIN, TOTAL % $21.00 82248 ASSAY BLOOD BILIRUBIN, DIRECT % $21.00 82252 FECAL BILIRUBIN TEST, QUALITATIVE % $19.00 82261 ASSAY BIOTINIDASE, EACH SPECIMEN % $61.00 82270 BLOOD, OCCULT, FECES, 1‐3 DETERMIN% $14.00 82271 BLOOD,OCCULT‐PEROX ACT QUAL,OT SOUR $14.00 82272 BLD,OCCULT‐PEROX,QUAL,FEC.‐SIN SPEC $14.00 82274 Blood oclt(fec hb dtr)1‐3 simul dt% $68.00 82286 ASSAY, BRADYKININ % $29.00 82300 ASSAY CADMIUM IN URINE % $62.00 82306 ASSAY, VITAMIN D (CALCIFEDIOL) % $126.00 82308 ASSAY, CALCITONIN % $114.00 82310 ASSAY CALCIUM IN BLOOD, TOTAL % $22.00 82330 ASSAY IONIZED CALCIUM IN BLOOD % $30.00 82331 CALCIUM INFUSION TEST % $22.00 82340 ASSAY CALCIUM IN URINE, TIMED % $26.00 82355 CALCULUS (STONE) TEST % $49.00 82360 CALCULUS (STONE) ASSAY, CHEMICAL % $55.00 82365 CALCULUS (STONE) ASSAY, INFRARED % $55.00 82370 X‐RAY ASSAY FOR CALCULUS (STONE) % $52.00 82373 Carbohydrate deficient transferrin $77.00 82374 ASSAY BLOOD CARBON DIOXIDE % $21.00 82375 ASSAY BLOOD CARBON MONOXIDE % $52.00 82376 TEST FOR CARBON MONOXIDE % $25.00 82378 ASSAY, CARCINOEMBRYONIC ANTIGEN % $81.00 82379 ASSAY, CARNITINE, QUAN, EACH SPEC % $61.00 82380 ASSAY, BLOOD CAROTENE % $39.00 82382 ASSAY, URINE CATECHOLAMINES % $73.00 82383 ASSAY, BLOOD CATECHOLAMINES % $73.00 82384 ASSAY, THREE CATECHOLAMINES % $73.00 82387 ASSAY, CATHEPSIN‐D % $73.00 82390 ASSAY, BLOOD CERULOPLASMIN % $32.00 82397 ASSAY, CHEMILUMINESCENCE % $45.00 82415 ASSAY, BLOOD CHLORAMPHENICOL % $50.00 82435 ASSAY, BLOOD CHLORIDES % $20.00 82436 ASSAY, URINE CHLORIDES % $10.00 82438 ASSAY, CHLORIDES, OTHER SOURCES % $10.00 82441 SCREEN FOR CHLOROHYDROCARBONS % $26.00 82465 ASSAY, SERUM CHOLESTEROL % $18.00 82480 ASSAY, SERUM CHOLINESTERASE % $33.00 82482 ASSAY, RBC CHOLINESTERASE % $33.00 82485 ASSAY, CHONDROITIN SULFATE % $61.00 82495 ASSAY, URINE CHROMIUM % $86.00 82507 ASSAY, CITRATE % $118.00 82523 ASSAY, COLLAGEN CROSS LINKS % $79.00 82525 ASSAY, BLOOD COPPER % $53.00 82528 ASSAY, CORTICOSTERONE % $96.00 82530 ASSAY, FREE CORTISOL % $71.00 82533 ASSAY, PLASMA CORTISOL % $69.00 82540 ASSAY, BLOOD CREATINE % $20.00 82542 COLUMN CHROMATOGRAPHY, QUAN, SINGL% $77.00 82550 ASSAY CPK IN BLOOD % $28.00 82552 ASSAY CPK ISOENZYMES IN BLOOD % $37.00 82553 ASSAY CREATINE, MB FRACTION % $26.00 82554 ASSAY CREATINE, ISOFORMS % $26.00 82565 ASSAY, BLOOD CREATININE % $22.00 82570 ASSAY, CREATININE, OTHER SOURCES % $22.00 82575 CREATININE CLEARANCE TEST % $40.00 82585 ASSAY, BLOOD CRYOFIBRINOGEN % $22.00 82595 ASSAY, BLOOD CRYOGLOBULIN % $28.00 82600 ASSAY, BLOOD CYANIDE % $82.00 82607 ASSAY, VITAMIN B‐12 % $64.00 82608 ASSAY B‐12 BINDING CAPACITY % $61.00 82610 CYSTATIN C $48.00 82615 TEST FOR URINE CYSTINES % $35.00 82626 ASSAY, DEHYDROEPIANDROSTERONE % $107.00 82627 ASSAY, DEHYDROEPIANDROSTERONE‐S % $94.00 82633 ASSAY, DESOXYCORTICOSTERONE % $132.00 82634 ASSAY, DEOXYCORTISOL % $124.00 82638 ASSAY, DIBUCAINE NUMBER % $52.00 82652 ASSAY, DIHYDROXYVITAMIN D % $164.00 82656 ELASTASE,PANCRE FECAL,QUAL/SEM‐QUAN $37.00 82657 ENZYME CELL ACTIVITY, NONRADIOACTI% $77.00 82658 ENZYME CELL ACTIVITY, RADIOACTIVE % $77.00 82664 ELECTROPHORETIC TEST NEC % $126.00 82668 ERYTHROPOIETIN BIOASSAY % $80.00 82670 ASSAY, ESTRADIOL % $119.00 82671 ASSAY, ESTROGENS % $137.00 82672 ASSAY, ESTROGEN % $92.00 82677 ASSAY, ESTRIOL % $103.00 82679 ASSAY, ESTRONE % $106.00 82693 ASSAY, ETHYLENE GLYCOL % $63.00 82696 ASSAY, ETIOCHOLANOLONE % $100.00 82705 TEST FOR FATS/LIPIDS IN FECES % $22.00 82710 ASSAY, FATS/LIPIDS IN FECES % $71.00 82715 ASSAY FECAL FAT DIFFERENTIAL % $73.00 82725 ASSAY, BLOOD FATTY ACIDS % $57.00 82726 FATTY ACIDS, VERY LONG CHAIN % $77.00 82728 ASSAY, FERRITIN % $58.00 82731 FETAL FIBRONECTIN, SEMI‐QUAN % $267.00 82735 ASSAY, BLOOD FLUORIDE % $79.00 82746 ASSAY, BLOOD FOLIC ACID % $62.00 82747 RBC FOLIC ACID ASSAY % $49.00 82757 ASSAY SEMEN FRUCTOSE % $74.00 82759 RBC GALACTOKINASE ASSAY % $91.00 82760 ASSAY, BLOOD GALACTOSE % $48.00 82775 ASSAY, GALACTOSE TRANSFERASE % $90.00 82776 GALACTOSE TRANSFERASE SCREEN % $36.00 82777 GALECTIN 3 $90.00 82784 ASSAY, GAMMAGLOBULIN A/D/G/M % $40.00 82785 ASSAY, GAMMAGLOBULIN E % $70.00 82787 ASSAY, IMMUNOGLOBULIN SUBCLASSES % $18.00 82800 ASSAY, BLOOD PH % $36.00 82803 ASSAY, BLOOD GASES: PH/PO2/PCO2/ET% $82.00 82805 ASSAY, BLOOD GASES: W/O2 SATURATIO% $121.00 82810 ASSAY, BLOOD GASES: O2 SATURAT ONL% $37.00 82820 ASSAY, HEMOGLOBIN‐OXYGEN AFFINITY % $42.00 82930 GASTRIC ANALY W/PH EA SPEC $23.00 82938 SERUM GASTRIN TEST % $75.00 82941 ASSAY OF GASTRIN % $75.00 82943 ASSAY OF GLUCAGON % $61.00 82945 Glucose, body fluid, other than blo $17.00 82946 GLUCAGON TOLERANCE TEST % $64.00 82947 ASSAY BODY FLUID, GLUCOSE % $17.00 82948 STICK ASSAY OF BLOOD GLUCOSE % $13.00 82950 GLUCOSE TEST % $20.00 82951 GLUCOSE TOLERANCE TEST (GTT) % $55.00 82952 GTT‐ADDED SAMPLES % $12.00 82955 ASSAY, G6PD ENZYME % $41.00 82960 SCREEN FOR G6PD ENZYME % $25.00 82962 GLUCOSE BLOOD TEST % $9.00 82963 ASSAY, GLUCOSIDASE % $91.00 82965 ASSAY, BLOOD GDH ENZYME % $30.00 82977 ASSAY, GGT ENZYME % $31.00 82978 ASSAY, GLUTATHIONE % $61.00 82979 ASSAY, RBC GLUTATHIONE ENZYME % $29.00 82985 GLYCOPROTEIN ELECTROPHORESIS % $64.00 83001 ASSAY, PITUITARY GONADOTROPIN % $79.00 83002 ASSAY, PITUITARY GONADOTROPINS % $79.00 83003 ASSAY, GROWTH HORMONE % $71.00 83006 GROWTH STIMULATION EXPRESSED GENE 2 $90.00 83009 HYDROXYPROGESTERONE, 17‐d % $286.00 83010 ASSAY, HAPTOGLOBIN % $53.00 83012 ASSAY, HAPTOGLOBIN PHENOTYPES % $73.00 83013 H. PYLORI BREATH TEST ANALYSIS % $286.00 83014 H. PYLORI, ADMIN DRUG % $33.00 83015 HEAVY METAL SCREENING % $80.00 83018 CHROMATOGRAPH ASSAY, HEAVY METALS % $93.00 83020 ASSAY HEMOGLOBIN, ELECTROPHORESIS % $0.00 83021 ASSAY HEMOGLOBIN, CHROMOTOGRAPHY % $77.00 83026 ASSAY HEMOGLOBIN, COPPER SULFATE % $10.00 83030 FETAL HEMOGLOBIN ASSAY % $15.00 83033 FETAL FECAL HEMOGLOBIN TEST % $15.00 83036 GLYCOSYLATED HEMOGLOBIN ASSAY % $41.00 83037 Hb GLYCOSYLATED DEV CLE FDA HOM USE $41.00 83045 BLOOD METHEMOGLOBIN TEST % $15.00 83050 BLOOD METHEMOGLOBIN ASSAY % $15.00 83051 ASSAY, PLASMA HEMOGLOBIN % $15.00 83060 BLOOD SULFHEMOGLOBIN ASSAY % $15.00 83065 HEMOGLOBIN HEAT ASSAY % $15.00 83068 HEMOGLOBIN STABILITY SCREEN % $15.00 83069 ASSAY, URINE HEMOGLOBIN % $15.00 83070 URINE HEMOSIDERIN TEST % $20.00 83080 ASSAY, B‐HEXOSAMINIDASE, EACH % $61.00 83088 ASSAY, HISTAMINE % $125.00 83090 Homocystine $72.00 83150 ASSAY, HVA % $25.00 83491 ASSAY, CORTICOSTEROIDS % $74.00 83497 ASSAY, 5‐HIAA % $55.00 83498 ASSAY, PROGESTERONE % $115.00 83499 ASSAY, PROGESTERONE % $107.00 83500 ASSAY, URINE HYDROXYPROLINE, FREE % $96.00 83505 ASSAY, URINE HYDROXYPROLINE, TOTAL% $103.00 83516 IMMUNOASSAY, ANALYTE (NON‐INFECT) % $37.00 83518 IMMUNOASSAY, ANALYTE (NOT ANTIBODY% $25.00 83519 IMMUNOASSAY, ANALYTE, RIA TECHNIQU% $57.00 83520 IMMUNOASSAY, ANALYTE NOS % $55.00 83525 ASSAY, INSULIN, TOTAL % $49.00 83527 ASSAY, INSULIN, FREE % $55.00 83528 ASSAY INTRINSIC FACTOR LEVEL % $68.00 83540 ASSAY, SERUM IRON % $28.00 83550 SERUM IRON BINDING TEST % $37.00 83570 UV‐ASSAY, BLOOD IDH ENZYME % $38.00 83582 ASSAY URINE 17‐KETOGENIC STEROIDS % $60.00 83586 ASSAY BLOOD 17‐KETOSTEROIDS % $40.00 83593 CHROMATOGRAPH KETOSTEROIDS % $37.00 83605 LACTIC ACID ASSAY % $37.00 83615 UV‐ASSAY, BLOOD LDH ENZYME % $26.00 83625 ASSAY, BLOOD LDH ENZYMES % $37.00 83630 LACTOFERRIN, FECAL; QUALITATIVE $83.00 83631 LACTOFERRIN,FECAL; QUANTITATIVE $83.00 83632 ASSAY, PLACENTAL LACTOGEN % $86.00 83633 TEST URINE FOR LACTOSE % $23.00 83655 ASSAY BLOOD FOR LEAD % $51.00 83661 ASSAY AMNIOTIC L/S RATIO % $93.00 83662 L/S RATIO, FOAM STABILITY TEST % $80.00 83663 Fetal lung maturity ass; flu polari $80.00 83664 Fetal lung maturity ass;lam body de $80.00 83670 UV‐ASSAY, BLOOD LAP ENZYME % $30.00 83690 ASSAY, BLOOD LIPASE % $25.00 83695 LIPOPROTEIN (a) $55.00 83698 Lipoprotein‐associated phospholipas $144.00 83700 LIPOPRO BLD ELECTROPHORE SEP & QUAN $48.00 83701 LIPOPROT BLD FRACT/QUANT INCL SUBCL $62.00 83704 LIPOPRO BLD QUANT PARTICL NO/SUBCLA $86.00 83718 BLOOD LIPOPROTEIN ASSAY, HDL % $35.00 83719 BLOOD LIPOPROTEIN ASSAY, VLDL % $49.00 83721 BLOOD LIPOPROTEIN ASSAY, LDL % $41.00 83727 ASSAY, LRH HORMONE % $73.00 83735 ASSAY, BLOOD MAGNESIUM % $28.00 83775 UV‐ASSAY OF MD ENZYME % $31.00 83785 ASSAY, MANGANESE % $104.00 83789 MASS SPECTROMETRY, QUAN, EACH SPEC% $77.00 83825 ASSAY, BLOOD MERCURY % $69.00 83835 ASSAY, URINE METANEPHRINES % $72.00 83857 ASSAY, METHEMALBUMIN % $37.00 83861 MICROFLUID ANALY TEARS $70.00 83864 BLOOD MUCOPOLYSACCHARIDES ASSAY % $68.00 83872 ASSAY, SYNOVIAL FLUID MUCIN % $18.00 83873 ASSAY, CSF PROTEIN % $73.00 83874 MYOGLOBIN ELECTROPHORESIS % $51.00 83876 Assay, myeloperoxidase $144.00 83880 Natriuretic peptide % $144.00 83883 NEPHELOMETRY, EACH ANALYTE NEC % $48.00 83885 ASSAY URINE FOR NICKEL % $87.00 83915 ASSAY, NUCLEOTIDASE % $47.00 83916 ELECTROPHORESIS, CSF GLOBULIN % $85.00 83918 ASSAY, ORGANIC ACIDS, QUAN % $70.00 83919 ASSAY, ORGANIC ACIDS, QUAL % $70.00 83921 Organic acid, single, quantitative $70.00 83930 ASSAY, BLOOD OSMOLALITY % $28.00 83935 ASSAY, URINE OSMOLALITY % $29.00 83937 ASSAY, OSTEOCALCIN % $127.00 83945 ASSAY, URINE OXALATE % $47.00 83950 Oncoprotein her‐2/neu $267.00 83951 Oncoprotein, dcp $267.00 83970 ASSAY, PARATHORMONE % $175.00 83986 ASSAY, BODY FLUID ACIDITY % $14.00 83987 EXHALED BREATH CONDENSATE $67.00 83992 ASSAY, PHENCYCLIDINE % $62.00 83993 ASSAY FOR CALPROTECTION FECAL $83.00 84030 ASSAY, BLOOD PKU % $23.00 84035 TEST FOR BLOOD PHENYLKETONES % $16.00 84060 ASSAY, BLOOD ACID PHOSPHATASE % $31.00 84061 ASSAY PHOSPHATASE, FORENSIC EXAM % $34.00 84066 ASSAY PROSTATE PHOSPHATASE % $41.00 84075 ASSAY ALKALINE PHOSPHATASE % $22.00 84078 ASSAY ALKALINE PHOSPHATASE % $31.00 84080 ASSAY ALKALINE PHOSPHATASES % $37.00 84081 AMNIOTIC FLUID ENZYME TEST % $70.00 84085 ASSAY, RBC PG6D ENZYME % $29.00 84087 ASSAY, PHOSPHOHEXOSE ENZYMES % $38.00 84100 ASSAY, BLOOD PHOSPHORUS % $20.00 84105 ASSAY, URINE PHOSPHORUS % $22.00 84106 TEST URINE FOR PORPHOBILINOGEN % $18.00 84110 ASSAY, URINE PORPHOBILINOGEN % $36.00 84112 PLACENTA ALPHA MICRO IG C/V $267.00 84119 TEST URINE FOR PORPHYRINS % $37.00 84120 ASSAY, URINE PORPHYRINS % $54.00 84126 ASSAY, FECES PORPHYRINS % $108.00 84132 ASSAY, BLOOD POTASSIUM % $20.00 84133 ASSAY, URINE POTASSIUM % $18.00 84134 ASSAY, PREALBUMIN % $24.00 84135 ASSAY, PREGNANEDIOL % $81.00 84138 ASSAY, PREGNANETRIOL % $80.00 84140 ASSAY, PREGNENOLONE % $88.00 84143 ASSAY, 17‐HYDROXYPREGNENOLONE % $97.00 84144 ASSAY, PROGESTERONE % $89.00 84145 PROCALCITONIN (PCT) $114.00 84146 ASSAY, PROLACTIN % $82.00 84150 ASSAY, PROSTAGLANDIN, EACH % $106.00 84152 PSA; COMPLEXED (DIRECT MEASUREMENT) $78.00 84153 ASSAY, PSA, TOTAL % $78.00 84154 ASSAY, PSA, FREE % $78.00 84155 ASSAY SERUM PROTEIN, TOTAL % $16.00 84156 PROTEIN TOTAL EXCEPT BY REFRACTOME% $16.00 84157 Protein,tot,except by refrac;oth so $16.00 84160 ASSAY SERUM PROTEIN, REFRACTOMETRI% $22.00 84163 PREG‐ASSOC PLASMA PROTEIN‐A(PAPP‐A) $64.00 84165 ASSAY SERUM PROTEIN,ELECTROPHORETI% $0.00 84166 ASSAY OTH FLUID PROTEIN ELECTROPHO% $0.00 84181 WESTERN BLOT TEST % $0.00 84182 WESTERN BLOT W/IMMUNOLOGIC PROBE % $0.00 84202 ASSAY, RBC PROTOPORPHYRIN % $42.00 84203 TEST FOR RBC PROTOPORPHYRIN % $36.00 84206 ASSAY, PROINSULIN % $76.00 84207 ASSAY, VITAMIN B‐6 % $119.00 84210 ASSAY, BLOOD PYRUVATE % $46.00 84220 ASSAY, RBC PYRUVIC KINASE % $40.00 84228 ASSAY, QUININE % $49.00 84233 ASSAY, ESTROGEN % $267.00 84234 ASSAY, PROGESTERONE % $276.00 84235 ASSAY, ENDOCRINE HORMONE % $222.00 84238 ASSAY, NON‐ENDOCRINE RECEPTOR % $155.00 84244 ASSAY OF RENIN % $93.00 84252 ASSAY, VITAMIN B‐2 % $86.00 84255 ASSAY, SELENIUM % $108.00 84260 ASSAY, BLOOD SEROTONIN % $73.00 84270 ASSAY, SEX HORMONE GLOBULIN (SHBG)% $92.00 84275 ASSAY, BLOOD SIALIC ACID % $57.00 84285 ASSAY, SILICA % $100.00 84295 ASSAY, BLOOD SODIUM % $20.00 84300 ASSAY, URINE SODIUM % $21.00 84302 Sodium; other source $21.00 84305 ASSAY, SOMATOMEDIN % $90.00 84307 ASSAY, SOMATOSTATIN % $78.00 84311 SPECTROPHOTOMETRY, ANALYTE NEC % $30.00 84315 ASSAY BODY FLUID SPECIFIC GRAVITY % $11.00 84375 CHROMATOGRAM ASSAY, SUGARS % $83.00 84376 SUGARS, SINGLE QUAL, EACH SPECIMEN% $23.00 84377 SUGARS, MULT QUAL, EACH SPECIMEN % $23.00 84378 SUGARS, SINGLE QUAN, EACH SPECIMEN% $49.00 84379 SUGARS, MULT QUAN, EACH SPECIMEN % $49.00 84392 ASSAY, URINE SULFATE % $20.00 84402 ASSAY, FREE TESTOSTERONE % $108.00 84403 ASSAY, BLOOD TESTOSTERONE % $110.00 84425 ASSAY, VITAMIN B‐1 % $90.00 84430 ASSAY, BLOOD THIOCYANATE % $49.00 84431 THROMBOXANE, URINE $71.00 84432 ASSAY, THYROGLOBULIN % $68.00 84436 ASSAY, TRUE THYROXINE % $29.00 84437 ASSAY, NEONATAL THYROXINE % $28.00 84439 ASSAY, FREE THYROXINE % $38.00 84442 ASSAY THYROID ACTIVITY (TBG) % $63.00 84443 ASSAY THYROID STIMULATING HORMONE % $71.00 84445 ASSAY, TSI % $216.00 84446 ASSAY, VITAMIN E % $60.00 84449 ASSAY, TRANSCORTIN % $76.00 84450 UV‐ASSAY, TRANSAMINASE (SGOT) % $22.00 84460 UV‐ASSAY, TRANSAMINASE (SGPT) % $23.00 84466 ASSAY, TRANSFERRIN % $54.00 84478 ASSAY, BLOOD TRIGLYCERIDES % $24.00 84479 ASSAY, THYROID HORMONE (T‐3 OR T‐4% $28.00 84480 ASSAY, TOTAL TRIIDOTHYRONINE (TT‐3% $60.00 84481 ASSAY, FREE TRIIDOTHYRONINE (TT‐3)% $72.00 84482 ASSAY, REV TRIIDOTHYRONINE (TT‐3) % $33.00 84484 ASSAY, TROPONIN, QUANTITATIVE % $26.00 84485 ASSAY, DUODENAL FLUID TRYPSIN % $32.00 84488 TEST FECES FOR TRYPSIN % $31.00 84490 ASSAY FECES FOR TRYPSIN % $32.00 84510 ASSAY, BLOOD TYROSINE % $44.00 84512 ASSAY, TROPONIN, QUALITATIVE % $33.00 84520 ASSAY, BUN % $17.00 84525 STICK‐ASSAY, BUN % $16.00 84540 ASSAY, URINE UREA‐N % $20.00 84545 UREA‐N CLEARANCE TEST % $28.00 84550 ASSAY, URIC ACID, BLOOD % $19.00 84560 ASSAY, URIC ACID, OTHER SOURCES % $20.00 84577 ASSAY, FECES UROBILINOGEN % $53.00 84578 TEST FOR URINE UROBILINOGEN % $14.00 84580 ASSAY, URINE UROBILINOGEN % $19.00 84583 ASSAY, URINE UROBILINOGEN % $19.00 84585 ASSAY, URINE VMA % $66.00 84586 ASSAY, VIP % $150.00 84588 ASSAY, VASOPRESSIN % $144.00 84590 ASSAY, BLOOD VITAMIN‐A % $49.00 84591 Vitamin, not otherwise specified $49.00 84597 ASSAY, VITAMIN‐K % $58.00 84600 ASSAY FOR VOLATILES % $64.00 84620 XYLOSE TOLERANCE TEST % $47.00 84630 ASSAY, BLOOD ZINC % $31.00 84681 ASSAY, C‐PEPTIDE % $88.00 84702 CHORIONIC GONADOTROPIN TEST % $64.00 84703 CHORIONIC GONADOTROPIN ASSAY % $32.00 84704 HCG, FREE BETACHAIN TEST $64.00 84830 OVULATION TESTS % $43.00 85002 BLEEDING TIME TEST % $19.00 85004 Blood count;auto differntial wbc co $25.00 85007 DIFFERENTIAL WBC COUNT % $15.00 85008 NONDIFFERENTIAL WBC COUNT % $15.00 85009 DIFFERENTIAL WBC COUNT, BUFFY COAT% $16.00 85013 SPUN MICROHEMATOCRIT BLOOD COUNT % $10.00 85014 HEMATOCRIT BLOOD COUNT % $10.00 85018 HEMOGLOBIN COUNT, COLORIMETRIC % $10.00 85025 AUTOMATED HEMOGRAM (CBC) % $33.00 85027 AUTOMATED HEMOGRAM & PLATELET COUN% $25.00 85032 Blood count;manual cell count each $18.00 85041 RED BLOOD CELL (RBC) COUNT % $13.00 85044 RETICULOCYTE COUNT, MANUAL % $18.00 85045 RETICULOCYTE COUNT, FLOW CYTOMETRY% $17.00 85046 RETICULOCYTE COUNT,HEMOGLOBIN CONT $24.00 85048 WHITE BLOOD CELL (WBC) COUNT % $11.00 85049 Blood count; platelet automated $19.00 85055 RETICULATED PLATELET ASSAY % $114.00 85060 BLOOD SMEAR INTERPRETATION % $86.00 85097 BONE MARROW INTERPRETATION % $173.00 85130 CHROMOGENIC SUBSTRATE ASSAY % $32.00 85170 BLOOD CLOT RETRACTION TEST % $15.00 85175 CLOT LYSIS TIME TEST, WHL BLD DILU% $19.00 85210 BLOOD CLOT FACTOR II TEST % $55.00 85220 BLOOD CLOT FACTOR V TEST % $75.00 85230 BLOOD CLOT FACTOR VII TEST % $76.00 85240 BLOOD CLOT FACTOR VIII TEST,1 STAG% $37.00 85244 BLOOD CLOT FACTOR VIII TEST % $37.00 85245 BLOOD CLOT FACTOR VIII ASSAY (VW) % $37.00 85246 BLOOD CLOT FACTOR VIII ASSAY (VW) % $37.00 85247 BLOOD CLOT FACTOR VIII ASSAY (VW) % $37.00 85250 BLOOD CLOT FACTOR IX TEST % $79.00 85260 BLOOD CLOT FACTOR X TEST % $76.00 85270 BLOOD CLOT FACTOR XI TEST (PTA) % $76.00 85280 BLOOD CLOT FACTOR XII TEST % $79.00 85290 BLOOD CLOT FACTOR XIII TEST % $31.00 85291 BLOOD CLOT FACTOR XIII TEST % $31.00 85292 BLOOD CLOT FACTOR ASSAY (FLETCHER)% $80.00 85293 BLOOD CLOT FACTOR ASSAY(FITZGERALD% $80.00 85300 ANTITHROMBIN III TEST % $37.00 85301 ANTITHROMBIN III, ANTIGEN ASSAY % $46.00 85302 BLOOD CLOT INHIBITOR ASSAY, PROT C% $51.00 85303 BLOOD CLOT INHIBITOR TEST,PROTEIN % $59.00 85305 BLOOD CLOT INHIBITOR ASSAY, PROT S% $49.00 85306 BLOOD CLOT INHIBITOR TEST,PROTEIN % $61.00 85307 Activated protein c (apc)resist ass $61.00 85335 FACTOR INHIBITOR TEST % $47.00 85337 THROMBOMODULIN TEST % $44.00 85345 COAGULATION TIME TEST, LEE & WHITE% $18.00 85347 COAGULATION TIME TEST, ACTIVATED % $18.00 85348 COAGULATION TIME TEST % $16.00 85360 EUGLOBULIN LYSIS TEST % $26.00 85362 ASSAY, FIBRIN DEGRADATION PRODUCTS% $29.00 85366 FIBRINOGEN TEST % $37.00 85370 FIBRINOGEN ASSAY % $34.00 85378 ASSAY, FIBRIN DEGRADATION PRODUCTS% $30.00 85379 ASSAY, FIBRIN DEGRADATION PRODUCTS% $34.00 85380 fibrin degra pro d‐dimer;ultrasen q $34.00 85384 FIBRINOGEN ACTIVITY % $36.00 85385 FIBRINOGEN ANTIGEN % $36.00 85390 FIBRINOLYSINS/COAGULOPATHY SCREEN % $0.00 85396 COAGULATION/FIBRINOLYSIS WHOLE BLO% $72.00 85397 Clotting funct activity $37.00 85400 FIBRINOLYTIC PLASMIN % $38.00 85410 FIBRINOLYTIC ANTIPLASMIN % $33.00 85415 FIBRINOLYTIC PLASMINOGEN ACTIVATOR% $36.00 85420 FIBRINOLYTIC PLASMINOGEN % $26.00 85421 FIBRINOLYTIC PLASMINOGEN, ANTIGENI% $43.00 85441 HEINZ BODIES, DIRECT % $18.00 85445 HEINZ BODIES, INDUCED % $29.00 85460 FETAL HEMOGLOBIN (KLEIHAUER) % $33.00 85461 FETAL HEMOGLOBIN, ROSETTE % $28.00 85475 ACID HEMOLYSIN % $38.00 85520 HEPARIN ASSAY % $56.00 85525 HEPARIN NEUTRALIZATION TEST % $50.00 85530 HEPARIN‐PROTAMINE TOLERANCE TEST % $54.00 85536 Iron stain, peripheral blood $25.00 85540 WBC ALKALINE PHOSPHATASE COUNT % $37.00 85547 RBC MECHANICAL FRAGILITY COUNT % $28.00 85549 SERUM MURAMIDASE COUNT % $80.00 85555 RBC OSMOTIC FRAGILITY, UNINCUBATED% $28.00 85557 RBC OSMOTIC FRAGILITY, INCUBATED % $37.00 85576 BLOOD PLATELET AGGREGATION,IN VITR% $0.00 85597 PLATELET NEUTRALIZATION % $57.00 85598 HEXAGNAL PHOSPH PLTLT NEUTRL $57.00 85610 PROTHROMBIN TIME % $17.00 85611 PROTHROMBIN TEST % $17.00 85612 VIPER VENOM PROTHROMBIN TIME % $25.00 85613 VIPER VENOM PROTHROMB TIME, DILUTE% $25.00 85635 REPTILASE TEST % $42.00 85651 RBC SEDIMENTATION RATE, NON‐AUTO % $15.00 85652 RBC SEDIMENTATION RATE, AUTOMATED % $11.00 85660 RBC SICKLE CELL TEST, SLIDE % $17.00 85670 THROMBIN TIME, PLASMA % $25.00 85675 THROMBIN TIME, TITER % $29.00 85705 THROMBOPLASTIN INHIBITION, TISSUE % $25.00 85730 THROMBOPLASTIN TIME, PARTIAL % $26.00 85732 THROMBOPLASTIN TIME, PARTIAL, SUBS% $28.00 85810 VISCOSITY EXAMINATION % $50.00 86000 AGGLUTININS, FEBRILE, EACH ANTIGEN% $30.00 86001 Allerg sp igg quan/semiquan;each al $21.00 86003 ALLERGEN SPECIFIC IGE, QUANTITATIV% $21.00 86005 ALLERGEN SPECIFIC IGE, QUALITATIVE% $34.00 86021 WBC ANTIBODY IDENTIFICATION % $64.00 86022 PLATELET ANTIBODY IDENTIFICATION % $78.00 86023 IMMUNOGLOBULIN ASSAY % $53.00 86038 ASSAY, ANTINUCLEAR ANTIBODIES % $51.00 86039 ANTINUCLEAR ANTIBODIES TITER % $47.00 86060 ANTISTREPTOLYSIN O TITER % $31.00 86063 ANTISTREPTOLYSIN O SCREEN % $22.00 86077 PHYSICIAN BLOOD BANK SERVICE % $181.00 86078 PHYSICIAN BLOOD BANK SERVICE % $181.00 86079 PHYSICIAN BLOOD BANK SERVICE % $179.00 86140 C‐REACTIVE PROTEIN % $22.00 86141 C‐reactive protein; high sensitivi% $55.00 86146 Beta 2 glycoprotein i antibody,each $25.00 86147 CARDIOLIPIN ANTIBODY % $25.00 86148 ANTI‐PHOSPHATIDYLSERINE ANTIBODY % $68.00 86152 CELL ENUMERATION IMMUNE SELECTJ & I $1,004.00 86155 CHEMOTAXIS ASSAY % $68.00 86156 COLD AGGLUTININ SCREEN % $25.00 86157 COLD AGGLUTININ TITER % $25.00 86160 COMPLEMENT, ANTIGEN % $51.00 86161 COMPLEMENT/FUNCTIONAL ACTIVITY % $51.00 86162 COMPLEMENT, TOTAL (CH50) % $86.00 86171 COMPLEMENT FIXATION TEST, EACH % $43.00 86185 COUNTERIMMUNOELECTROPHORESIS, EACH% $37.00 86200 CYCLIC CITRULLINATED PEPTIDE,ANTIBO $55.00 86215 DEOXYRIBONUCLEASE, ANTIBODY % $56.00 86225 DNA ANTIBODY, NATIVE/DOUBLE STRAND% $58.00 86226 DNA ANTIBODY, SINGLE STRAND % $51.00 86235 NUCLEAR ANTIGEN ANTIBODY, EACH % $76.00 86243 FC RECEPTOR ASSAY % $87.00 86255 FLUOR ANTIBODY SCRN, NON‐INFECT, E% $0.00 86256 FLUORESCENT ANTIBODY TITER, EACH % $0.00 86277 ASSAY, GROWTH HORMONE ANTIBODY % $52.00 86280 HEMAGGLUTINATION INHIBITION TEST % $35.00 86294 Immunoassay‐tumor antig,qual/semiqu $69.00 86300 Immunoassay‐tumor antig,quan;ca15‐3 $88.00 86301 Immunoassay‐tumor antig,quan;ca19‐9 $88.00 86304 Immunoassay‐tumor antig,quan;ca 125 $88.00 86305 HUMAN EPIDIDYMIS PROTEIN 4 $88.00 86308 HETEROPHILE ANTIBODY SCREEN % $22.00 86309 HETEROPHILE ANTIBODY TITER % $28.00 86310 HETEROPHILE ANTIBODY TITERS % $30.00 86316 IMMUNOASSAY, TUMOR ANTIGEN, EACH % $88.00 86317 IMMUNOASSAY, INFECT AGENT ANTIBODY% $64.00 86318 IMMUNOASSAY, INFECT AGENT ANTIBODY% $55.00 86320 SERUM IMMUNOELECTROPHORESIS % $0.00 86325 IMMUNOELECTROPHORESIS, OTHER FLUID% $0.00 86327 IMMUNOELECTROPHORESIS ASSAY (2‐D) % $0.00 86329 IMMUNODIFFUSION, EACH % $60.00 86331 IMMUNODIFFUSION, GEL (OUCHTERLONY)% $51.00 86332 ASSAY, C1Q PRECIPITIN % $104.00 86334 IMMUNOFIXATION ELECTROPHORESIS SERU $0.00 86335 IMMUNOFIXATION ELECTROPHORESIS; OT% $0.00 86336 Inhibin a $66.00 86337 ASSAY, INSULIN ANTIBODIES % $91.00 86340 INTRINSIC FACTOR ANTIBODY % $64.00 86341 ISLET CELL ANTIBODY % $84.00 86343 LEUKOCYTE HISTAMINE RELEASE % $27.00 86344 LEUKOCYTE PHAGOCYTOSIS % $34.00 86352 CELL FUNCTION ASSAY W/STIM $577.00 86353 LYMPHOCYTE TRANSFORMATION % $208.00 86355 B Cells, total count $160.00 86356 MONONUCLEAR CELL ANTIGEN $114.00 86357 NATURAL KILLER CELLS, TOTAL COUNT $160.00 86359 T CELLS, TOTAL COUNT % $160.00 86360 T CELLS, ABSOLUTE CD4 & CD8 COUNT % $192.00 86361 T CELLS, ABSOLUTE CD4 COUNT % $114.00 86367 STEM CELLS(i.e.) total count $160.00 86376 ASSAY, MICROSOMAL ANTIBODIES % $62.00 86378 MIGRATION INHIBITORY FACTOR TEST % $56.00 86382 VIRAL NEUTRALIZATION TEST % $72.00 86384 NITROBLUE TETRAZOLIUM DYE TEST % $41.00 86386 NUCLEAR MATRIX PROTEIN 22 $68.00 86403 PARTICLE AGGLUTINATION, SCREEN % $43.00 86406 PARTICLE AGGLUTINATION TITER, EACH% $25.00 86430 RHEUMATOID FACTOR TEST % $24.00 86431 RHEUMATOID FACTOR ASSAY % $24.00 86480 TB TEST,CELL MED IMMU MEAS/GIA RESP $263.00 86481 TB AG RESPONSE T‐CELL SUSP $318.00 86485 CANDIDA SKIN TEST % $54.00 86486 SKIN TEST, NOS ANTIGEN $21.00 86490 COCCIDIOIDOMYCOSIS SKIN TEST % $257.00 86510 HISTOPLASMOSIS SKIN TEST % $24.00 86580 TB INTRADERMAL TEST % $30.00 86590 STREPTOKINASE, ANTIBODY % $47.00 86592 SYPHILIS TEST % $18.00 86593 SYPHILIS ASSAY % $19.00 86602 ANTIBODY, ACTINOMYCES % $25.00 86603 ANTIBODY, ADENOVIRUS % $25.00 86606 ANTIBODY, ASPIRGILLUS % $25.00 86609 ANTIBODY, BACTERIUM % $25.00 86611 Antibody; bartonella $25.00 86612 ANTIBODY, BLASTOMYCES % $25.00 86615 ANTIBODY, BORDETELLA % $25.00 86617 LYME DISEASE CONFIRMATION TEST % $66.00 86618 ANTIBODY, LYME DISEASE % $72.00 86619 ANTIBODY, BORRELIA % $57.00 86622 ANTIBODY, BRUCELLA % $25.00 86625 ANTIBODY, CAMPYLOBACTER % $25.00 86628 ANTIBODY, CANDIDA % $25.00 86631 ANTIBODY, CHLAMYDIA % $25.00 86632 ANTIBODY, CHLAMYDIA, IGM % $25.00 86635 ANTIBODY, COCCIDIOIDES % $25.00 86638 ANTIBODY, Q FEVER % $25.00 86641 ANTIBODY, CRYPTOCOCCUS % $25.00 86644 ANTIBODY, CMV % $61.00 86645 ANTIBODY, CMV, IGM % $25.00 86648 ANTIBODY, DIPHTHERIA % $25.00 86651 ANTIBODY, ENCEPHALITIS, CALIFORNIA% $25.00 86652 ANTIBODY, ENCEPHALITIS, E EQUINE % $25.00 86653 ANTIBODY, ENCEPHALITIS, ST LOUIS % $25.00 86654 ANTIBODY, ENCEPHALITIS, W EQUINE % $25.00 86658 ANTIBODY, ENTEROVIRUS % $25.00 86663 ANTIBODY, EPSTEIN‐BARR (EA) % $56.00 86664 ANTIBODY, EPSTEIN‐BARR (EBNA) % $65.00 86665 ANTIBODY, EPSTEIN‐BARR (VCA) % $77.00 86666 Antibody; ehrlichia $25.00 86668 FRANCISELLA TULARENSIS % $44.00 86671 ANTIBODY, FUNGUS % $22.00 86674 ANTIBODY, GIARDIA LAMBLIA % $63.00 86677 ANTIBODY, HELICOBACTER PYLORI % $25.00 86682 ANTIBODY, HELMINTH % $25.00 86684 HEMOPHILUS INFLUENZA % $67.00 86687 ANTIBODY, HTLV‐I % $36.00 86688 ANTIBODY, HTLV‐II % $60.00 86689 HTLV/HIV ANTIBODY CONFIRMATORY TES% $82.00 86692 HEPATITIS, DELTA AGENT % $73.00 86694 ANTIBODY, HERPES SIMPLEX % $61.00 86695 ANTIBODY, HERPES SIMPLEX, TYPE I % $56.00 86696 Antibody; herpes simplex, type 2 $82.00 86698 ANTIBODY, HISTOPLASMA % $48.00 86701 ANTIBODY, HIV‐1 % $38.00 86702 ANTIBODY, HIV‐2 % $57.00 86703 HIV‐1/HIV‐2, SINGLE ASSAY % $58.00 86704 HEPATITIS B CORE ANTIBODY IGG & IG% $51.00 86705 HEP B CORE ANTIBODY, IGM ANTIBODY % $50.00 86706 HEPATITIS B SURFACE ANTIBODY % $46.00 86707 HEPATITIS BE ANTIBODY % $49.00 86708 HEPATITIS A ANTIBODY, IGG & IGM % $53.00 86709 HEP A ANTIBODY, IGM ANTIBODY % $48.00 86710 ANTIBODY, INFLUENZA VIRUS % $58.00 86711 ANTIBODY JOHN CUNNINGHAM VIRUS $59.00 86713 ANTIBODY, LEGIONELLA % $65.00 86717 ANTIBODY, LEISHMANIA % $25.00 86720 ANTIBODY, LEPTOSPIRA % $25.00 86723 ANTIBODY, LISTERIA MONOCYTOGENES % $25.00 86727 LYMPHOCYTIC CHORIOMENINGITIS % $25.00 86729 ANTIBODY, LYMPHOGRANULOMA VENEREUM% $25.00 86732 ANTIBODY, MUCORMYCOSIS % $25.00 86735 ANTIBODY, MUMPS % $25.00 86738 ANTIBODY, MYCOPLASMA % $56.00 86741 ANTIBODY, NEISSERIA MENINGITIDIS % $25.00 86744 ANTIBODY, NOCARDIA % $25.00 86747 ANTIBODY, PARVOVIRUS % $64.00 86750 ANTIBODY, MALARIA % $56.00 86753 ANTIBODY, PROTOZOA % $25.00 86756 ANTIBODY, RESPIRATORY VIRUS % $25.00 86757 Antibody; rickettsia $82.00 86759 ANTIBODY, ROTAVIRUS % $56.00 86762 ANTIBODY, RUBELLA % $61.00 86765 ANTIBODY, RUBEOLA % $55.00 86768 ANTIBODY, SALMONELLA % $35.00 86771 ANTIBODY, SHIGELLA % $25.00 86774 ANTIBODY, TETANUS % $63.00 86777 ANTIBODY, TOXOPLASMA % $61.00 86778 ANTIBODY, TOXOPLASMA, IGM % $54.00 86780 TREPONEMA PALLIDUM $56.00 86784 ANTIBODY, TRICHINELLA % $25.00 86787 ANTIBODY, VARICELLA‐ZOSTER % $25.00 86788 Antibody; West Nile virus, IgM $25.00 86789 Antibody; West Nile virus $61.00 86790 ANTIBODY, VIRUS % $25.00 86793 ANTIBODY, YERSINIA % $25.00 86800 ANTIBODY, THYROGLOBULIN % $68.00 86803 ANTIBODY, HEPATITIS C % $61.00 86804 ANTIBODY, HEPATITIS C, CONFIRM TES% $66.00 86805 LYMPHOCYTOTOXICITY ASSAY W/TITRAT % $222.00 86806 LYMPHOCYTOTOXICITY ASSAY W/O TITRA% $202.00 86807 CYTOTOXIC ANTIBODY SCREENING, STD % $168.00 86808 CYTOTOXIC ANTIBODY SCREENING, QUIC% $126.00 86812 HLA TYPING, A, B OR C, SNGL ANTIGE% $110.00 86813 HLA TYPING, A, B OR C, MULT ANTIGE% $246.00 86816 HLA TYPING, DR/DQ, SINGLE % $118.00 86817 HLA TYPING, DR/DQ, MULTIPLE % $274.00 86821 LYMPHOCYTE CULTURE, MIXED (MLC) % $240.00 86822 LYMPHOCYTE CULTURE, PRIMED (PLC) % $155.00 86825 HLA X‐MATCH, NON‐CYTOTOXIC $341.00 86826 HLA X‐MATCH, NON‐CYT ADD‐ON $114.00 86828 ANTIBODY HLA CLASS I & CLASS II ANT $163.00 86829 ANTIBODY HLA CLASS I OR CLASS II AN $122.00 86830 ANTIBODY HLA CLASS I PHENOTYPE PANE $252.00 86831 ANTIBODY HLA CLASS II PHENOTYPE PAN $216.00 86832 ANTIBODY HLA CLASS I HIGH DEFINITIO $397.00 86833 ANTIBODY HLA CLASS II HIGH DEFINITI $361.00 86834 ANTIBODY HLA CLASS I SEMIQUANTITATI $1,118.00 86835 ANTIBODY HLA CLASS II SEMIQUANTITAT $1,010.00 86850 RBC ANTIBODY SCREEN, EACH % $0.00 86880 COOMBS TEST, DIRECT % $23.00 86885 COOMBS TEST, INDIRECT, QUALITATIVE% $24.00 86886 COOMBS TEST, INDIRECT % $22.00 86900 BLOOD TYPING, ABO ONLY % $13.00 86901 BLOOD TYPING, RH (D) % $13.00 86902 BLOOD TYPE ANTIGEN DONOR EA $16.00 86904 BLOOD TYPING, ANTIGEN SCREENING % $40.00 86905 BLOOD TYPING, RBC ANTIGENS % $16.00 86906 BLOOD TYPING, RH PHENOTYPING % $33.00 86940 HEMOLYSINS AND AGGLUTININS, AUTO % $35.00 86941 HEMOLYSINS/AGGLUTININS, INCUBATED % $51.00 87003 SM ANIMAL INOCULATION, DISSECTION % $72.00 87015 SPECIMEN CONCENTRATION % $28.00 87040 BLOOD CULTURE FOR BACTERIA % $37.00 87045 STOOL CULTURE FOR BACTERIA % $40.00 87046 CULTR BACTER STOOL AEROBIC ADD PATH $40.00 87070 CULTURE SPECIMEN FOR BACTERIA % $37.00 87071 Cult,bact;quan,aerobic/w iso‐presum $40.00 87073 Cult,bact;quan,anar/w isola presump $40.00 87075 CULTURE SPECIMEN,ANAEROBIC BACTERI% $40.00 87076 IDENTIFICATION, ANAEROBIC BACTERIA% $34.00 87077 Culture, bacterial; aerobic isolate $34.00 87081 BACTERIA CULTURE SCREEN % $28.00 87084 CULTURE SPECIMEN BY KIT, COLONY ES% $37.00 87086 URINE BACTERIA CULTURE, BY COUNT % $34.00 87088 URINE BACTERIA CULTURE, BY IDENT % $34.00 87101 SKIN FUNGUS CULTURE, ISOLATION % $33.00 87102 FUNGUS ISOLATION CULTURE % $36.00 87103 BLOOD FUNGUS CULTURE, ISOLATION % $38.00 87106 FUNGUS IDENTIFICATION CULTURE % $44.00 87107 Cult,fungi,defin iden,each org;mold $44.00 87109 MYCOPLASMA CULTURE % $62.00 87110 CHLAMYDIA CULTURE % $37.00 87116 MYCOBACTERIA CULTURE, ISOLATION % $46.00 87118 MYCOBACTERIA IDENTIFICATION CULTUR% $47.00 87140 CULTURE TYPING, FLUORESCENT METHOD% $24.00 87143 CULTURE TYPING, GLC METHOD % $19.00 87147 CULTURE TYPING, SEROLOGIC METHOD % $22.00 87149 Cult,typing;identif‐nuclic acid pro $85.00 87150 DNA/RNA, AMPLIFIED PROBE $149.00 87152 Cult,typing;identif‐pulse field gel $22.00 87153 DNA/RNA SEQUENCING $490.00 87158 CULTURE TYPING % $22.00 87164 DARK FIELD EXAMINATION,W/COLLECTIO% $0.00 87166 DARK FIELD EXAMINATION, W/O COLLEC% $48.00 87168 Macroscopic examination; arthropod $18.00 87169 Macroscopic examination; parasite $18.00 87172 PINWORM EXAM % $18.00 87176 ENDOTOXIN, BACTERIAL,HOMOGENIZATIO% $25.00 87177 OVA AND PARASITES SMEARS % $38.00 87181 ANTIBIOTIC SENSITIVITY, AGAR % $20.00 87184 ANTIBIOTIC SENSITIVITY, DISK % $25.00 87185 Suscep stu,antimicrobial ag;enz det $20.00 87186 ANTIBIOTIC SENSITIVITY, MIC % $25.00 87187 ANTIBIOTIC SENSITIVITY, MBC % $44.00 87188 ANTIBIOTIC SENSITIVITY, MACROTUBE % $25.00 87190 TB ANTIBIOTIC SENSITIVITY % $24.00 87197 BACTERICIDAL LEVEL, SERUM % $64.00 87205 SMEAR, STAIN & INTERPRET, ROUTINE % $18.00 87206 SMEAR, STAIN & INTERP, FLUORESCENT% $23.00 87207 SMEAR, STAIN & INTERPRET, SPECIAL % $0.00 87209 SMEAR PR SOUR W/INTPRET;CMPX SPE ST $76.00 87210 SMEAR, STAIN & INTERPRET, WET % $18.00 87220 TISSUE EXAM FOR FUNGI % $18.00 87230 ASSAY, TOXIN OR ANTITOXIN % $37.00 87250 VIRUS INOCULATION, TEST, SM ANIMAL% $83.00 87252 VIRUS INOCULATION FOR TEST, TISSUE% $111.00 87253 VIRUS INOCULATION FOR TEST, TISSUE% $86.00 87254 Virus iso;centrifuge enhan techniqu $83.00 87255 Virus iso;incl ident‐non‐immu metho $144.00 87260 INFEC ANTIGEN, ADENOVIRUS % $37.00 87265 INFEC ANTIGEN, BORDETELLA PERT/PAR% $37.00 87267 Inf ag ant det immflu tech;entv dfa $37.00 87269 INFECTIOUS ANTIGEN DET IMMUNO TECH% $37.00 87270 INFEC ANTIGEN, CHLAMYDIA TRACHOMAT% $37.00 87271 Infec ag ant det;cytomegalovir dfa $37.00 87272 INFEC ANTIGEN CRYPTOSPORIDUM/GIARD% $37.00 87273 Infec ag ant det;herpes simp vir 2 $37.00 87274 INFEC ANTIGEN, HERPES SIMPLX VIRUS% $37.00 87275 Infec ag ant det immflu;influen b v $37.00 87276 INFEC ANTIGEN, INFLUENZA A VIRUS % $37.00 87277 Infec ag ant det immflu,legionella $37.00 87278 INFEC ANTIGEN,LEGIONELLA PNEUMOPHI% $37.00 87279 Infec ag ant det;parainfl vir,each $37.00 87280 INFEC ANTIGEN, RESP SYNCYTIAL VIRU% $37.00 87281 Infec ag ant det immflu;pneomo cari $37.00 87283 Infec ag ant det immflu tec;rubeola $37.00 87285 INFEC ANTIGEN, TREPONEMA PALLIDUM % $37.00 87290 INFEC ANTIGEN, VARICELLA ZOSER VIR% $37.00 87299 INFEC ANTIGEN, NOS % $37.00 87300 Infec ag ant det;polyvalent mul org $37.00 87301 INFCT ANTIGEN,ADENOVIRUS TYPE 40/4% $37.00 87305 Infec ag ant det;mult step;aspergil $37.00 87320 INFCT ANTIGEN, CHLAMYDIA TRACHOMAT% $37.00 87324 INFCT ANTIGEN, CLOSTRIDIUM DIF TX % $37.00 87327 Infec ag ant det;mul step;cryptoc n $37.00 87328 INFCT ANTIGEN CRYPTOSPORIDUM/GIARD% $37.00 87329 INFECT ANTIGEN ENZYME IMMUN TECH % $37.00 87332 INFCT ANTIGEN, CYTOMEGALOVIRUS % $37.00 87335 INFCT ANTIGEN ESCHERICHIA COLI 015% $37.00 87336 Infec ag ant det;mul step;entameoba $37.00 87337 Infec ag ant det enz imm;entamoeba $37.00 87338 Infec ag ant det enz imm;helicobact $61.00 87339 Infec ag ant det;halicabacter pylor $37.00 87340 INFCT ANTIGEN, HEPATITIS B SURFACE% $44.00 87341 Infec ag ant det;hbsag neutralizatn $44.00 87350 INFCT ANTIGEN, HEPATITIS BE (HBSAG% $49.00 87380 INFCT ANTIGEN, HEPATIS DELTA AGENT% $70.00 87385 INFCT ANTIGEN, HISTOPLASMA CAPSULA% $37.00 87389 HIV‐1 AG W/HIV‐1 & HIV‐2 AB $102.00 87390 INFCT ANTIGEN, HIV‐1 % $75.00 87391 INFCT ANTIGEN, HIV‐2 % $75.00 87400 Infec ag ant det;influenza a/b,each $37.00 87420 INFCT ANTIGEN, RESP SYNCYTIAL VIRU% $37.00 87425 INFCT ANTIGEN, ROTAVIRUS % $37.00 87427 Infec ag ant det; shiga‐like toxin $37.00 87430 INFCT ANTIGEN, STREPTOC GROUP A % $37.00 87449 INFCT ANTIGEN, MULT STEP NOS % $37.00 87450 INFCT ANTIGEN, SINGLE STEP NOS % $25.00 87451 Infec ag ant det;polyvalent‐mul org $25.00 87470 INFCT ANTIGN, BARTONELLA DIRECT PR% $85.00 87471 INFCT ANTIGN, BARTONELLA AMPL PROB% $149.00 87472 INFCT ANTIGN, BARTONELLA, QUANTIF % $182.00 87475 INFCT ANTIGN, BORRELIA, DIRECT PRO% $85.00 87476 INFCT ANTIGN, BORRELIA, AMPL PROBE% $149.00 87477 INFCT ANTIGN, BORRELIA, QUANTIF % $182.00 87480 INFCT ANTIGN, CANDIDA, DIRECT PROB% $85.00 87481 INFCT ANTIGN, CANDIDA, AMPL PROBE % $149.00 87482 INFCT ANTIGN, CANDIDA, QUANT % $177.00 87485 INFCT ANTIGN, CHLAMYDIA PNEU DIREC% $85.00 87486 INFCT ANTIGN, CHLAMYDIA PNEU, AMPL% $149.00 87487 INFCT ANTIGN, CHLAMYDIA PNEU, QUAN% $182.00 87490 INFCT ANTIGN, CHLAMYDIA TRAC DIREC% $85.00 87491 INFCT ANTIGN, CHLAMYDIA TRAC, AMPL% $149.00 87492 INFCT ANTIGN, CHLAMYDIA TRAC, QUAN% $149.00 87493 C DIFF AMPLIFIED PROBE $149.00 87495 INFCT ANTIGN, CYTOMEGALOVIRUS, DIR% $85.00 87496 INFCT ANTIGN, CYTOMEGALOVIRUS, AMP% $149.00 87497 INFCT ANTIGN, CYTOMEGALOVIRUS, QUA% $182.00 87498 Infec ag detect‐nucleic acid;entero $149.00 87500 VANOMYCIN, DNA, AMP PROBE $149.00 87501 INFLUENZA DNA AMP PROB 1+ $218.00 87502 INFLUENZA DNA AMP PROBE $362.00 87503 INFLUENZA DNA AMP PROB ADDL $88.00 87505 NFCT AGENT DNA/RNA GASTROINTESTINAL $524.00 87506 IADNA‐DNA/RNA GI PTHGN MULTIPLEX PR $872.00 87507 IADNA‐DNA/RNA GI PTHGN MULTIPLEX PR $1,703.00 87510 INFCT ANTIGN, GARDNERELLA VAG, DIR% $85.00 87511 INFCT ANTIGN, GARDNERELLA VAG, AMP% $149.00 87512 INFCT ANTIGN, GARDNERELLA VAG, QUA% $177.00 87515 INFCT ANTIGN, HEPATITIS B, DIRECT % $85.00 87516 INFCT ANTIGN, HEPATITIS B, AMPL % $149.00 87517 INFCT ANTIGN, HEPATITIS B, QUAN % $182.00 87520 INFCT ANTIGN, HEPATITIS C, DIRECT % $85.00 87521 INFCT ANTIGN, HEPATITIS C, AMPL % $149.00 87522 INFCT ANTIGN, HEPATITIS C, QUAN % $182.00 87525 INFCT ANTIGN, HEPATITIS G, DIRECT % $85.00 87526 INFCT ANTIGN, HEPATITIS G, AMPL % $149.00 87527 INFCT ANTIGN, HEPATITIS G, QUAN % $177.00 87528 INFCT ANTIGN, HERPES SIMPLEX, DIRC% $85.00 87529 INFCT ANTIGN, HERPES SIMPLEX, AMPL% $149.00 87530 INFCT ANTIGN, HERPES SIMPLEX, QUAN% $182.00 87531 INFCT ANTIGN, HERPES V‐6, DIRECT % $85.00 87532 INFCT ANTIGN, HERPES V‐6, AMPL % $149.00 87533 INFCT ANTIGN, HERPES V‐6, QUAN % $177.00 87534 INFCT ANTIGN, HIV‐1, DIRECT PROBE % $85.00 87535 INFCT ANTIGN, HIV‐1, AMPL PROBE % $149.00 87536 INFCT ANTIGN, HIV‐1, QUANTIFICATIO% $362.00 87537 INFCT ANTIGN, HIV‐2, DIRECT PROBE % $85.00 87538 INFCT ANTIGN, HIV‐2, AMPL PROBE % $149.00 87539 INFCT ANTIGN, HIV‐2, QUANTIFICATIO% $182.00 87540 INFCT ANTIGN, LEGIONELLA PNEU DIRC% $85.00 87541 INFCT ANTIGN, LEGIONELLA PNEU, AMP% $149.00 87542 INFCT ANTIGN, LEGIONELLA PNEU, QUA% $177.00 87550 INFCT ANTIGN, MICROBAC SPEC, DIREC% $85.00 87551 INFCT ANTIGN, MICROBAC SPEC, AMPL % $149.00 87552 INFCT ANTIGN, MICROBAC SPEC, QUAN % $182.00 87555 INFCT ANTIGN, MICROBAC TB, DIRECT % $85.00 87556 INFCT ANTIGN, MICROBAC TB, AMPL % $149.00 87557 INFCT ANTIGN, MICROBAC TB, QUANTIF% $182.00 87560 INFCT ANTIGN, MICROBAC AVIUM DIREC% $85.00 87561 INFCT ANTIGN, MICROBAC AVIUM, AMPL% $149.00 87562 INFCT ANTIGN, MICROBAC AVIUM, QUAN% $182.00 87580 INFCT ANTIGN, MYCOPLASMA PNEU, DIR% $85.00 87581 INFCT ANTIGN, MYCOPLASMA PNEU, AMP% $149.00 87582 INFCT ANTIGN, MYCOPLASMA PNEU, QUA% $177.00 87590 INFCT ANTIGN, NEISSERIA GON, DIREC% $85.00 87591 INFCT ANTIGN, NEISSERIA GON, AMPL % $149.00 87592 INFCT ANTIGN, NEISSERIA GON, QUAN % $182.00 87623 IADNA HUMAN PAPILLOMAVIRUS LOW‐RISK $143.00 87624 IADNA HUMAN PAPILLOMAVIRUS HIGH‐RIS $143.00 87625 IADNA HUMAN PAPILLOMAVIRUS TYPES 99 $143.00 87631 IADNA RESPIRATRY PROBE & REV TRNSCR $529.00 87632 IADNA RESPIRATRY PROBE & REV TRNSCR $880.00 87633 IADNA RESPIRATRY PROBE & REV TRNSCR $1,719.00 87640 infec ag det‐nuc acid;staphyloccus $149.00 87641 infec ad det‐nuc acid;staphy aureus $149.00 87650 INFCT ANTIGN, STREPTOCOCCUS A, DIR% $85.00 87651 INFECT ANTIGN, STREPTOCOCCUS A AMP% $149.00 87652 INFECT ANTIGN, STREPTOCOCCUS A QUA% $177.00 87653 infec ag det‐nuc acid;strep,gr B,am $149.00 87660 INFECT NUCLEIC ACID TRICH VAGINALI% $85.00 87661 IADNA TRICHOMONAS VAGINALIS AMPLIFI $143.00 87797 INFECT ANTIGN, NOS, DIRECT % $85.00 87798 INFCT ANTIGN, NOS, AMPLIFIED % $149.00 87799 INFCT ANTIGN, NOS, QUANTIFICATION % $182.00 87800 infec ag det‐nuc acid;direct probe $170.00 87801 infec ag det‐nuc acid;amplified pro $298.00 87802 infec ag anti/w dir op obs;strep B $37.00 87803 infec ag anti det op obs;clostri di $37.00 87804 infec ag anti det dir op obs;influ% $37.00 87806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV $98.00 87807 INF AGENT ANTIGEN DET RESP SYNC VIR $37.00 87808 inf ag anti det dir op ob;trich vag $37.00 87809 Adenovirus assay w/optic $37.00 87810 INFCTS ANTIGN, CHLAMYDIA TRACHOMAT% $37.00 87850 INFCTS ANTIGN, NEISSERIA GONORRH % $37.00 87880 INFCTS ANTIGN, STREPTOCOCCUS GRP A% $37.00 87899 INFCTS ANTIGN, NOS % $37.00 87900 INFEC AGNT DRUG SUSP PHENOTYPE PRED $554.00 87901 infec ag geno‐nuc acid,hiv 1,rev tr $1,094.00 87902 infec ag geno ana nuc acid;hep c vi $1,094.00 87903 infec ag phen ana nuc ac;1st 10 drg $2,076.00 87904 IAP ANA‐NU ACID W/DRTC ANA,EACH ADD $111.00 87905 Sialidase enzyme assay $52.00 87906 GENOTYPE DNA HIV REVERSE T $547.00 87910 NFCT AGT GENOTYPE NUCLEIC ACID CYTO $1,062.00 87912 NFCT AGENT GENOTYPE HEPATITIS B VIR $1,062.00 88104 MICROSCOPIC EXAM OF CELLS, SMEARS % $0.00 88106 MICROSCOPIC EXAM OF CELLS, FILTER % $0.00 88108 MICROSCOPIC CELL EXAM (SACCOMANNO)% $0.00 88112 CYTOPATHOLOGY CELL ENHANCEMENT % $0.00 88120 CYTP URNE 3‐5 PROBES EA SPEC $0.00 88121 CYTP URINE 3‐5 PROBES CMPTR $0.00 88125 FORENSIC CYTOPATHOLOGY % $0.00 88130 SEX CHROMATIN IDENTIFICATION, % $64.00 88140 SEX CHROMATIN IDENTIFICATION % $34.00 88141 CYTOPATH, CERV/VAG, PHY INTERP % $114.00 88142 CYTOPATH, CERV/VAG, MANUAL SCREEN % $86.00 88143 CYTOPATH, CERV/VAG MANUAL RE‐SCREE% $86.00 88147 CYTOPATH SMEAR, C/VAG, AUTO % $45.00 88148 CYTOPATH SMEAR, C/VAG, AUTO/RESCRN% $45.00 88150 CYTOPATH, CERV/VAG, MANUAL SCREEN % $45.00 88152 CYTOPATH, CERV/VAG, SCREEN&RESCREE% $45.00 88153 CYTOPATH, C/VAG, MAN SCRN & RESCRN% $45.00 88154 CYTOPATH C/VAG MAN SCREN/COMP RESC% $45.00 88155 CYTOPATHOLOGY, HORMONAL EVALUATION% $25.00 88160 CYTOPATHOLOGY, SCREEN/INTERPRET % $0.00 88161 CYTOPATHOLOGY,PREP/SCREEN/INTERPRE% $0.00 88162 CYTOPATHOLOGY, EXTENSIVE STUDY % $0.00 88164 CYTOPATH, C/VAG BETHESDA, MANUAL % $45.00 88165 CYTOPATH, C/VAG BETHESDA, SRN&RESC% $45.00 88166 CTYOPATH, C/VAG BETHESDA AUTO REDO% $45.00 88167 CYTOPATH, C/VAG BETHESDA, SELECT % $45.00 88172 EVALUATION OF SMEAR % $0.00 88173 INTERPRETATION OF SMEAR % $0.00 88174 Cytopath cerv/vagi;screen auto sys $90.00 88175 CYTOPATH,CER/VAG W/SCR‐AUTO & MAN% $102.00 88177 CYTP C/V AUTO THIN LYR ADDL $0.00 88182 CELL MARKER STUDY, CELL CYCLE/DNA % $0.00 88184 FLOW CYTOMETRY, TC 1ST MARKER $323.00 88185 FLOW CYTOMETRY TC EACH ADD MARKER $197.00 88187 FLOW CYTOMETRY INTERPRET 2‐8 MARKER $249.00 88188 FLOW CYTOMETRY INTERPRET;9‐15 MARKE $318.00 88189 FLOW CYTOMETRY, INTERPRET; >=16 MAR $386.00 88230 TISS CULT, NON‐NEOPLASTIC, LYMPHOC% $87.00 88233 TISS CULT, NON‐NEOPLASTIC, BIOPSY % $109.00 88235 TISS CULT, NON‐NEOPLASTIC, AMNIOTI% $109.00 88237 TISS CULT, NEOPLASTIC, MARROW/CELL% $109.00 88239 TISS CULT, NEOPLASTIC, SOLID TUMOR% $87.00 88240 CRYOPRESRV CELLS, EACH CELL LINE % $43.00 88241 THAW/EXPAND FRZN CELLS EA ALIQUOT % $43.00 88245 CHROMOSOME ANALYSIS, 20‐25 CELLS % $331.00 88248 CHROMOSOME ANALYSIS, 50‐100 CELLS % $736.00 88249 CHROMOSOME ANALYSIS, 100 CELLS % $736.00 88261 CHROMOSOME ANALYSIS, 5 CELLS % $751.00 88262 CHROMOSOME COUNT, 15‐20 CELLS % $530.00 88263 CHROMOSOME ANALYSIS, 45 CELLS % $639.00 88264 CHROMOSOME ANALYSIS, 20‐25 CELLS % $530.00 88267 CHROMOSOME ANALYSIS, PLACENTA % $764.00 88269 CHROMOSOME ANALYSIS, AMNIOTIC FLUI% $515.00 88271 MOLECULAR CYTOGENICS, DNA PROBE, E% $77.00 88272 MOLECULAR CYTOGENICS, IN SITU 3‐5 % $92.00 88273 MOLECULAR CYTOGENICS, IN SITU 10‐3% $123.00 88274 MOLECULAR CYTOGENICS, IN SITU 25‐9% $148.00 88275 MOLECULAR CYTOGENICS INSITU 100‐30% $171.00 88280 CHROMOSOME KARYOTYPE STUDY % $107.00 88283 CHROMOSOME BANDING STUDY % $222.00 88285 CHROMOSOME COUNT, ADD'L CELLS % $81.00 88289 CHROMOSOME STUDY, ADD'L HIGH RES % $146.00 88291 CYTOGENETICS/MOLECULAR INTERP/REPT% $110.00 88300 TISSUE EXAM BY PATHOLOGIST, LEVEL % $0.00 88302 TISSUE EXAM BY PATHOLOGIST, LVL II% $0.00 88304 TISSUE EXAM BY PATHOLOGIST, LVL II% $0.00 88305 TISSUE EXAM BY PATHOLOGIST, LVL IV% $0.00 88307 TISSUE EXAM BY PATHOLOGIST, LEVEL % $0.00 88309 TISSUE EXAM BY PATHOLOGIST, LVL VI% $0.00 88311 DECALCIFICATION OF TISSUE % $0.00 88312 SPECIAL STAINS, GROUP I % $0.00 88313 SPECIAL STAINS, GROUP II % $0.00 88314 HISTOCHEMICAL STAIN % $0.00 88319 ENZYME CONSTITUENT HISTOCHEMISTRY % $0.00 88321 MICROSLIDE CONSULTATION % $298.00 88323 MICROSLIDE PREPARATION/CONSULTATIO% $0.00 88325 COMPREHENSIVE REVIEW OF DATA % $470.00 88329 PATHOLOGY CONSULTATION IN SURGERY % $130.00 88331 PATHOLOGY CONSULTATION IN SURGERY % $0.00 88332 PATHOLOGY CONSULTATION IN SURGERY % $0.00 88333 PATH CONS SURG CYTOLOG EXAM INI SIT $0.00 88334 PATH CONS SURG CYTOLO EXAM ADD SITE $0.00 88341 IMHISTOCHEM/CYTCHM EA ADDL ANTIBDY% $0.00 88342 IMMUNOCYTOCHEMISTRY, EACH % $0.00 88344 IMHISTOCHEM/CYTCHM EA MULTIPLEX ANT $0.00 88346 IMMUNOFLUORESCENT STUDY, DIRECT % $0.00 88348 ELECTRON MICROSCOPY, DIAGNOSTIC % $0.00 88350 each additional single antibody sta $0.00 88355 ANALYSIS, SKELETAL MUSCLE % $0.00 88356 ANALYSIS, NERVE % $0.00 88358 ANALYSIS, TUMOR % $0.00 88360 MORPHOMET STUD, TUMR CHEM, MANUAL % $0.00 88361 MORPHOM STUD, TUMR CHEM, COMP ASSTD $0.00 88362 NERVE TEASING PREPARATIONS % $0.00 88363 XM ARCHIVE TISSUE MOLEC ANAL $68.00 88364 IN SITU HYBRIDIZATION EA ADDL PROBE $0.00 88365 IN SITU HYRIDIZATION EACH PROBE $0.00 88366 IN SITU HYBRIDIZATION EA MULTIPLEX $0.00 88367 MORPHOMET STUD IN SITU HYBRID,COMP $0.00 88368 MORPHOMET STUD IN SITY HYBRID, MANU $0.00 88369 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL P $0.00 88371 PROTEIN ANALYSIS/WESTERN BLOT % $0.00 88372 PROTEIN ANALYSIS W/IMMUNOL PROBE % $0.00 88373 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR $0.00 88374 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR $0.00 88375 OPTICAL ENDOMICROSCOPIC IMAGE INTER $171.00 88377 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL E $0.00 88380 MICRODISSECTION, LASER $0.00 88381 MICRODISSECTION, MANUAL $0.00 88387 MACROSCOPIC EXAM DISSEC & PREP TISS $0.00 88388 MACRO EXAM DISSEC CONJ W/TOUCH IMPR $0.00 88720 Bilirubin total transcut $21.00 88738 HGB QUANT TRANSCUTANEOUS $21.00 88740 Transcutaneous carboxyhb $21.00 88741 Transcutaneous methb $21.00 89049 CHCT FOR MLG HYPERTHERMIA SUS I&R $229.00 89050 BODY FLUID CELL COUNT % $18.00 89051 BODY FLUID CELL/DIFFERENTIAL COUNT% $18.00 89055 Leukocyte assessment fecal, qualita $18.00 89060 EXAM, SYNOVIAL FLUID CRYSTALS % $0.00 89125 SPECIMEN FAT STAIN % $18.00 89160 EXAMINE FECES FOR MEAT FIBERS % $16.00 89190 NASAL SMEAR FOR EOSINOPHILS % $20.00 89220 SPUTUM OBTAINING SPECIMEN % $65.00 89230 SWEAT COLL BY IONTOPHORESIS % $21.00 89300 SEMEN ANALYSIS, PRESENCE/MOTILITY % $38.00 89310 SEMEN ANALYSIS, MOTILITY & COUNT % $37.00 89320 SEMEN ANALYSIS, COMPLETE % $51.00 89321 Semen ana, presence/motality‐sperm $51.00 89322 SEMEN ANAL, STRICT CRITERIA $66.00 89325 SPERM ANTIBODY TEST % $45.00 89329 SPERM EVAL, HAMSTER PENETRATION % $89.00 89330 SPERM EVAL, CERVICAL MUCUS TEST % $42.00 89331 RETROGRADE EJACULATION ANAL $83.00 90371 HBIG, HUMAN, INTRAMUSCULAR $350.00 90375 RIG, HUMAN, INTRAMUSC AND/OR SUBCUT $856.00 90376 RIG‐HT, HUMAN INTRAMUSC AND/OR SUBC $788.00 90585 BCG VAC FOR TB, LIVE, PERCUTANEOUS $371.00 90586 BCG VAC, BLADDER CANCER, INTRAVESIC $371.00 90630 INFLUENZA VACC IIV4 SPLIT VIRUS PRS $0.00 90747 HEP B VAC DIAL/IMMUNOSUP, INTRAMUSC $0.01 90785 PSYCHOTHERAPY COMPLEX INTERACTIVE $47.00 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION $424.00 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDIC $474.00 90832 PSYCHOTHERAPY PATIENT &/ FAMILY 30 $210.00 90833 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVC $218.00 90834 PSYCHOTHERAPY PATIENT &/ FAMILY 45 $280.00 90836 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVC $278.00 90837 PSYCHOTHERAPY PATIENT &/ FAMILY 60 $420.00 90838 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVC $368.00 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 $439.00 90840 PSYCHOTHERAPY FOR CRISIS EACH ADDL $209.00 90845 PSYCHOANALYSIS $304.00 90846 FAMILY PSYCHOTHERAPY, W/O PATIENT $340.00 90847 FAMILY PSYCHOTHERAPY, W/PT PRESENT $352.00 90849 MULT‐FAMILY PSYCHOTHERAPY, GROUP $105.00 90853 PSYCHOTHERAPY, GROUP (NO MULTI‐FAM) $84.00 90865 NARCOSYNTHESIS FOR DX & THERAPY $434.00 90867 TCRANIAL MAGN STIM TX PLAN $1,311.00 90868 TCRANIAL MAGN STIM TX DELI $652.00 90869 TCRAN MAGN STIM REDETEMINE $1,641.00 90870 ELECTROCONVULSIVE THERAPY (ECT) $372.00 90880 HYPNOTHERAPY $313.00 90901 BIOFEEDBACK TRAINING $68.00 90911 BIOFEEDBACK TRAINING $155.00 90935 HEMODIALYSIS, ONE EVALUATION $249.00 90937 HEMODIALYSIS, REPEATED EVALUATION $358.00 90945 DIALYSIS, ONE EVALUATION $298.00 90947 DIALYSIS, REPEATED EVALUATION $428.00 90951 Esrd serv, 4 visits p mo, <2 $3,278.00 90954 Esrd serv, 4 vsts p mo, 2‐11 $2,819.00 90955 Esrd srv 2‐3 vsts p mo, 2‐11 $1,579.00 90956 Esrd srv, 1 visit p mo, 2‐11 $1,102.00 90957 Esrd srv, 4 vsts p mo, 12‐19 $2,229.00 90958 Esrd srv 2‐3 vsts p mo 12‐19 $1,507.00 90959 Esrd serv, 1 vst p mo, 12‐19 $1,025.00 90960 Esrd srv, 4 visits p mo, 20+ $983.00 90961 Esrd srv, 2‐3 vsts p mo, 20+ $828.00 90962 Esrd serv, 1 visit p mo, 20+ $640.00 90963 Esrd home pt, serv p mo, <2 $1,879.00 90964 Esrd home pt serv p mo, 2‐11 $1,646.00 90965 Esrd home pt serv p mo 12‐19 $1,565.00 90966 Esrd home pt, serv p mo, 20+ $824.00 90967 Esrd home pt serv p day, <2 $62.00 90968 Esrd home pt srv p day, 2‐11 $54.00 90969 Esrd home pt srv p day 12‐19 $53.00 90970 Esrd home pt serv p day, 20+ $27.00 90997 HEMOPERFUSION $323.00 91010 ESOPHAGUS MOTILITY STUDY $0.00 91013 ESOPHGL MOTIL W/STIM/PERFUS $0.00 91020 GASTRIC MOTILITY STUDY $0.00 91022 DEODENAL MOTILITY(MANOMETRIC) STUDY $0.00 91030 ACID PERFUSION TEST OF ESOPHAGUS $0.00 91034 ESOPHAG,GER TEST; W NASAL CATH S&I $0.00 91035 ESOPHAG GER TEST; W/TELEMETRY ELEC $0.00 91037 EFT GERT W/NASAL CATH ELECTRODE S&I $0.00 91038 EFT GERT W/NAS CATH ELEC PL;PROLONG $0.00 91040 ESOPHAG BALLOON DISTENS PROVOC STUD $0.00 91065 BREATH HYDROGEN TEST $0.00 91110 GASTRO TRACT IMAG INTRA $0.00 91111 GI TRACT IMAGING INTRALUMNL ESOPHGS $0.00 91112 GI TRANSIT & PRES MEAS WIRELESS CAP $0.00 91117 COLON MOTILITY 6 HR STUDY $552.00 91120 GASTRIC MOTILITY STUDIES $0.00 91122 ANAL PRESSURE RECORDING $0.00 91132 ELECTROGASTROGRPHY, DGNSTC TRSCUTNS $0.00 91133 ELCTROGSTRGRPHY DGNSTC TRNSCU W PT $0.00 91200 LIVER ELASTOGRAPHY W/O IMAG W/I&R $0.00 92002 INTERMEDIATE EYE EXAM, NEW PATIENT $163.00 92004 COMPREHENSIVE EYE EXAM, NEW PATIENT $342.00 92012 INTERMED EYE EXAM, ESTAB PATIENT $182.00 92014 COMP EYE EXAMINATION, ESTAB PATIENT $275.00 92018 COMPLETE EYE EXAM/TREATMENT, ANESTH $513.00 92019 LIMITED EYE EXAM/TREATMENT, ANESTH $247.00 92020 GONIOSCOPY $71.00 92025 COMPUTERIZED CORNEAL TOPOGRAPHY $0.00 92060 SPECIAL EYE EVALUATION,SENSORIMOTOR $0.00 92065 ORTHOPTIC/PLEOPTIC TRAINING $0.00 92071 CONTACT LENS FITTING FOR TX $115.00 92072 FIT CONTAC LENS FOR MANAGMNT $352.00 92081 VISUAL FIELD EXAM(S), LIMITED $0.00 92082 VISUAL FIELD EXAM(S), INTERMEDIATE $0.00 92083 VISUAL FIELD EXAM(S), EXTENDED $0.00 92100 SERIAL TONOMETRY EVALUATION(S) $116.00 92132 CMPTR OPHTH DX IMG ANT SEGMT $0.00 92133 CMPTR OPHTH IMG OPTIC NERVE $154.44 92134 CPTR OPHTH DX IMG POST SEGMT $158.34 92136 OPTHALMIC BIO W/INTRAOCULAR LENS PO $0.00 92145 CORNEA HYSTERESIS DETERMIN IMPULSE $0.00 92225 EXTENDED OPHTHALMOSCOPY, INITIAL $72.00 92226 EXTENDED OPHTHALMOSCOPY, SUBSEQUENT $65.00 92227 REMOTE DX RETINAL IMAGING $54.00 92228 REMOTE RETINAL IMAGING MGMT $0.00 92230 FLUORESCEIN ANGIOSCOPY $116.00 92235 FLUORESCEIN ANGIOSCOPY, MULTIFRAME $389.25 92240 ANGIOGRAPHY, INDOCYANINE‐GREEN $0.00 92250 FUNDUS PHOTOGRAPHY $282.75 92260 OPHTHALMODYNAMOMETRY $38.00 92265 EYE MUSCLE EVALUATION, NEEDLE $0.00 92270 ELECTRO‐OCULOGRAPHY $0.00 92275 ELECTRORETINOGRAPHY $0.00 92283 COLOR VISION EYE EXAM, EXTENDED $0.00 92284 DARK ADAPTATION EYE EXAM $0.00 92285 EXTERNAL EYE PHOTOGRAPHY $0.00 92286 INTERNAL EYE PHOTOGRAPHY $0.00 92287 INTERNAL EYE PHOTOGRAPHY $0.00 92311 FIT CONTACT LENS FOR APHAKIA $191.00 92312 FIT CONTACT LENSES FOR APHAKIA $216.00 92313 CONTACT LENS FITTING, CORNEOSCLERAL $161.00 92315 PRESCRIBE CONTACT LENS FOR APHAKIA $75.00 92316 PRESCRIBE CONTACT LENSES, APHAKIA $111.00 92317 PRESCRIBE CORNEOSCLERA CONTACT LENS $76.00 92325 MODIFY CONTACT LENS $157.00 92326 REPLACE CONTACT LENS $134.00 92502 EAR & THROAT EXAM, GEN'L ANESTHESIA $345.00 92504 EAR MICROSCOPY EXAM $33.00 92507 SPEECH/HEARING THERAPY, INDIVIDUAL $275.00 92508 SPEECH/HEARING THERAPY, GROUP $81.00 92511 NASOPHARYNGOSCOPY W/ENDOSCOPY $139.00 92512 NASAL FUNCTION STUDIES $101.00 92516 FACIAL NERVE FUNCTION TEST $81.00 92520 LARYNGEAL FUNCTION STUDIES $147.00 92521 EVALUATION OF SPEECH FLUENCY (STUTT $384.00 92522 EVALUATION OF SPEECH SOUND PRODUCTI $320.00 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE $672.00 92524 BEHAVIORAL & QUALIT ANALYSIS VOICE $310.00 92526 SWALLOWING/ORAL FUNCTION TREATMENT $300.00 92537 Caloric vestibular test with record $0.00 92538 monothermal (ie, one irrigation in $0.00 92540 BASIC VESTIBULAR EVA INC SPONT NYST $0.00 92541 SPONTANEOUS NYSTAGMUS TEST $0.00 92542 POSITIONAL NYSTAGMUS TEST $0.00 92544 3PTOKINETIC NYSTAGMUS TEST $0.00 92545 OSCILLATING TRACKING TEST $0.00 92546 SINUSOIDAL ROTATIONAL TEST $0.00 92547 VERTICAL ELECTRODES $24.00 92548 POSTUROGRAPHY, COMPUTERIZED DYNAMIC $0.00 92550 TYMPANOMETRY AND REFLEX THRESHOLD $74.00 92552 PURE TONE AUDIOMETRY, AIR $118.00 92553 AUDIOMETRY, AIR & BONE $143.00 92555 SPEECH THRESHOLD AUDIOMETRY $89.00 92556 SPEECH AUDIOMETRY, W/SPEECH RECOG $140.00 92557 COMPREHENSIVE HEARING TEST $114.00 92561 BEKESY AUDIOMETRY, DIAGNOSIS $144.00 92562 LOUDNESS BALANCE TEST $178.00 92563 TONE DECAY HEARING TEST $120.00 92564 SISI HEARING TEST $109.00 92565 STENGER TEST, PURE TONE $65.00 92567 TYMPANOMETRY $38.00 92568 ACOUSTIC REFLEX TESTING $54.00 92570 ACOUSTIC IMMITTANCE TEST INC TYMPAN $104.00 92571 FILTERED SPEECH HEARING TEST $104.00 92572 STAGGERED SPONDAIC WORD TEST $201.00 92575 SENSORINEURAL ACUITY TEST $288.00 92576 SYNTHETIC SENTENCE TEST $132.00 92577 STENGER SPEECH TEST $71.00 92579 VISUAL REINFORCEMENT AUDIOMETRY $131.00 92582 CONDITIONING PLAY AUDIOMETRY $274.00 92583 SELECT PICTURE AUDIOMETRY $197.00 92584 ELECTROCOCHLEOGRAPHY $271.00 92585 AUDITORY EVOKED POTENTIAL,comprehen $0.00 92586 AUDITORY EVOKED POTENTIALS, LIMITED $326.00 92587 EVOKED AUDITORY EXAM, LIMITED $0.00 92588 EVOKED AUDITORY TST COMPLETE $0.00 92596 EAR PROTECTOR EVALUATION $165.00 92597 ORAL SPEECH DEVICE EVALUATION $283.00 92601 DIAG ANA COCH IMPL,UNDER 7 YR;W/PRO $416.00 92602 DIAG ANA COCH IMPL UNDER 7YRS;REPRO $239.00 92603 DIAG ANA COCH IMPL 7YRS/OLDER W/PRO $422.00 92604 DIAG ANA COCH IMPL,7YRS/OLDER;REPRO $233.00 92607 EVAL SPEECH GEN AUG‐COMM DEV,1ST Hr $490.00 92608 EVAL SPEECH GEN‐COMM DEV,ADD 30 MIN $186.00 92609 THERAPEUTIC SER‐SPEECH GEN DEVICE $387.00 92610 EVAL‐ORAL PHARYNGEAL SWALLOW FUNC. $251.00 92611 MOT FLUO EVAL‐SWALLOW FUNC‐RECORDIN $337.00 92612 FLEX FIB ENDOSC EVAL‐SWA;VID RECORD $238.00 92613 FLEX FIB ENDOSC EVAL‐SWAL;INT‐REPO $136.00 92614 FLEX FIB ENDOSC EV‐LAR SEN TEST;REC $237.00 92615 FLEX FIB ENDOSC,LAR SEN TEST;REPORT $117.00 92616 FLX FIB ENDSC‐SWAL,LAR SEN TEST;REC $354.00 92617 FLX FIB ENDSC‐SWAL LAR SEN TEST,REP $146.00 92620 EVAL CENTR AUDIT FUN W/REP INIT 60M $284.00 92621 EVAL CENTR AUDIT FUN W/REP ;EAC 15M $65.00 92625 ASSESS TINNITUS $215.00 92626 EVAL AUDIT REHAB STATUS FIRST HOUR $261.00 92627 EVAL AUDIT REHAB STAT EAC ADD 15MIN $62.00 92640 DX ANLYSIS W PROGRMNG AUDTORY BRNST $330.00 92920 PRQ TRLUML CORONARY ANGIOPLASTY ONE $2,135.00 92924 PRQ TRLUML CORONARY ANGIO/ATHERECT $2,536.00 92928 PRQ TRLUML CORONARY STENT W/ANGIO O $2,372.00 92933 PRQ TRLUML CORONRY STENT/ATH/ANGIO $2,653.00 92937 PRQ TRLUML CORONARY BYP GRFT REVASC $2,371.00 92941 PRQ TRLUML CORONRY TOT OCCLUS REVAS $2,659.00 92943 PRQ TRLUML CORONRY CHRONIC OCCLUS R $2,657.00 92950 HEART/LUNG RESUSCITATION (CPR) $661.00 92953 TEMPORARY EXTERNAL PACING $40.00 92960 HEART ELECTROCONVERSION, EXTERNAL $429.00 92961 NULL $1,005.00 92970 CARDIOASSIST, INTERNAL $704.00 92971 CARDIOASSIST, EXTERNAL $394.00 92973 PERCU TRNSLMNL CORNARY THROMBECTOMY $692.00 92974 TRANCATH PLAC RAD DEL DEV‐BRACHYTHE $631.00 92975 DISSOLVE HEART VESSEL CLOT $1,525.00 92977 DISSOLVE HEART VESSEL CLOT $463.00 92978 ULTRASND, INTRAVAS, HEART, INT VESL $0.00 92979 ULTRASOUND, INTRAVASC, HEART ADD'L $0.00 92986 REVISION OF AORTIC VALVE, BALLOON $5,195.00 92987 REVISION OF MITRAL VALVE, BALLOON $5,347.00 92990 REVISION OF PULMONARY VALVE,BALLOON $4,229.00 92992 REVISE HEART CHAMBER (RASHKIND) $2,078.00 92993 REVISE HEART CHAMBER (PARK) $2,078.00 92997 ANGPLSTY, PERCUT TRANS PUL, 1ST VSL $2,570.00 92998 ANGPLSTY, PERCUT TRANS PUL, ADD'L $1,260.00 93000 ELECTROCARDIOGRAM, COMPLETE (ECG) $67.00 93005 ELECTROCARDIOGRAM, TRACING ONLY $39.00 93010 ELECTROCARDIOGRAM REPORT $29.00 93015 CARDIOVASCULAR STRESS TEST $310.00 93016 CARDIOVASCULAR STRESS TEST $76.00 93017 CARDIOVASCULAR STRESS TEST TRACING $145.00 93018 CARDIOVASCULAR STRESS TEST REPORT $50.00 93024 CARDIAC DRUG STRESS TEST $0.00 93025 MICROVOLT T‐WAVE‐ASSESSMENT VEN ARR $0.00 93040 RHYTHM ECG WITH REPORT $46.00 93041 RHYTHM ECG, TRACING ONLY $23.00 93042 RHYTHM ECG, REPORT ONLY $24.00 93050 Arterial pressure waveform analysis $0.00 93224 ECG MONITOR/24 HRS, COMPLETE $352.00 93225 ECG MONITOR/24 HRS, RECORDING $107.00 93226 ECG MONITOR/24 HRS, ANALYSIS/REPORT $157.00 93227 ECG MONITOR/24 HRS, REVIEW/INTERP $90.00 93228 Remote 30 day ecg rev/report $90.00 93229 REMOTE 30 DAY ECG TECH SUPP $2,676.00 93260 PRGRMG DEV EVAL IMPLANTABLE SUBQ LE $0.00 93261 INTERROGATION EVAL F2F IMPLANT SUBQ $0.00 93268 ECG RECORDING, XMIT/REVIEW/INTRPRET $858.00 93270 ECG RECORDING, RECORDING ONLY $45.00 93271 ECG RECORDING, MONITORING/ANALYSIS $732.00 93272 ECG RECORDING, PHYS INTERPRETATION $87.00 93278 SIGNAL‐AVERAGED ECG $0.00 93279 Pm device progr eval, sngl $0.00 93280 Pm device progr eval, dual $0.00 93281 Pm device progr eval, multi $0.00 93282 Icd device prog eval, 1 sngl $0.00 93283 Icd device progr eval, dual $0.00 93284 Icd device progr eval, mult $0.00 93285 Ilr device eval progr $0.00 93286 Pre‐op pm device eval $0.00 93287 Pre‐op icd device eval $0.00 93288 Pm device eval in person $0.00 93289 Icd device interrogate $0.00 93290 Icm device eval $0.00 93291 Ilr device interrogate $0.00 93292 Wcd device interrogate $0.00 93293 Pm phone r‐strip device eval $0.00 93294 Pm device interrogate remote $118.00 93295 Icd device interrogat remote $235.00 93296 Pm/icd remote tech serv $108.00 93297 Icm device interrogat remote $92.00 93298 Ilr device interrogat remote $92.00 93299 ICM/ILR REMOTE TECH SERV $816.00 93303 ECG, TRANSTHORACIC, COMPLETE $0.00 93304 ECG, TRANSTHORACIC FOLLOWUP/LIMITED $0.00 93306 Tte w/doppler, complete $0.00 93307 ECG, TRANSTHORACIC, HEART, COMPLETE $0.00 93308 ECG, TRANSTHORACIC, HEART, LIMITED $0.00 93312 ECG, TRANSESOPHAGEAL, HEART, COMPL $0.00 93313 ECG, TRANSESOPHAGEAL HEART, LIMITED $143.00 93314 ECG, TRANSESOPHAGEAL HEART RPT ONLY $0.00 93315 ECG, TRANSESOPHAGEAL, CONG HEART $0.00 93316 ECG, TRANSESOPHAGEAL, CNG HRT PROBE $145.00 93317 ECG, TRANSESOPHAGEAL, CNG HRT RPRT $0.00 93318 EKG,TEE‐ASSESS CARDIAC PUMP FUNC $0.00 93320 DOPPLER ECHO EXAM OF HEART, COMPL $0.00 93321 DOPPLER ECHO EXAM OF HEART, LIMITED $0.00 93325 DOPPLER COLOR FLOW MAPPING $0.00 93350 ECHO EXAM OF HEART/ECG MONITORING $0.00 93351 Stress tte complete $0.00 93352 Admin ecg contrast agent $125.00 93355 ECHO TEE GUID TCAT ICAR/VESSEL STRU $788.00 93451 RIGHT HEART CATH $900.00 93452 LEFT HRT CATH W/VENTRCLGRPHY $0.00 93453 R&L HRT CATH W/VENTRICLGRPHY $0.00 93454 CORONARY ARTERY ANGIO S&I $0.00 93455 CORONARY ART/GRFT ANGIO S&I $0.00 93456 R HRT CORONARY ARTERY ANGIO $0.00 93457 R HRT ART/GRFT ANGIO $0.00 93458 L HRT ARTERY/VENTRICLE ANGIO $0.00 93459 L HRT ART/GRFT ANGIO $0.00 93460 R&L HRT ART/VENTRICLE ANGIO $0.00 93461 R&L HRT ART/VENTRICLE ANGIO $0.00 93462 L HRT CATH TRNSPTL PUNCTURE $816.00 93463 DRUG ADMIN & HEMODYNMIC MEAS $386.00 93464 EXERCISE W/HEMODYNAMIC MEAS $0.00 93503 PLACE FLOW DIRECTED HEART CATHETER $457.00 93505 BIOPSY OF HEART LINING $0.00 93530 CATHETERIZATION, RIGHT HEAR $0.00 93531 CATHZATION, COMB RIGHT/LEFT HEART $0.00 93532 CATHZATION, COMB RIGHT/LFT HEART $0.00 93533 CATHZATION, COMB RIGHT/LEFT HEART $0.00 93561 CARDIAC OUTPUT MEASUREMENT $0.00 93562 CARD OUTPUT MEASURE SUBSQ $0.00 93563 INJECT CONGENITAL CARD CATH $224.00 93564 INJECT HRT CONGNTL ART/GRFT $239.00 93565 INJECT L VENTR/ATRIAL ANGIO $176.00 93566 INJECT R VENTR/ATRIAL ANGIO $179.00 93567 INJECT SUPRVLV AORTOGRAPHY $204.00 93568 INJECT PULM ART HRT CATH $183.00 93571 DOPPLER INTRAVASC, INITIAL VESSEL $0.00 93572 DOPPLER INTRAVASC, EA ADD'L VESSEL $0.00 93580 PERCUT TRANCATH CLOS‐CONG INTERATRI $3,800.00 93581 PERC TRCATH CL‐CONG VEN SEP DEF‐IMP $5,230.00 93582 PERCUTAN TRANSCATH CLOSURE PAT DUCT $2,598.00 93583 PERCUTANEOUS TRANSCATHETER SEPTAL R $2,935.00 93600 BUNDLE OF HIS RECORDING $0.00 93602 INTRA‐ATRIAL RECORDING $0.00 93603 RIGHT VENTRICULAR RECORDING $0.00 93609 MAPPING OF TACHYCARDIA SITE(S) $0.00 93610 INTRA‐ATRIAL PACING $0.00 93612 INTRAVENTRICULAR PACING $0.00 93613 INTRACARDIAC ELECTROPHYSIO 3‐D MPNG $1,550.00 93615 ESOPHAGEAL RECORDING OF ELECTROGRAM $0.00 93616 ESOPHAGEAL RECORDING W/PACING $0.00 93618 HEART RHYTHM PACING $0.00 93619 ELECTROPHYS EVALUATION, W/O ARRHYTH $0.00 93620 ELECTROPHYS EVALUATION W/ARRYTHMIA $0.00 93621 ELECTROPHYS EVALUATION, LFT ATRIAL $0.00 93622 ELECTROPHYS EVALUATION, LEFT VENTRL $0.00 93623 STIMULATION AND PACING OF HEART $0.00 93624 ELECTROPHYSIOLOGIC FOLLOWUP STUDY $0.00 93631 OPERATIVE HEART PACING & MAPPING $0.00 93640 ELECTROPHYSIOLOGY EVALUATION $0.00 93641 ELECTROPHYSIOLOGY EVALUATION $0.00 93642 ELECTROPHYSIOLOGY EVALUATION $0.00 93644 EPHYS EVAL SUBQ IMPLANTABLE DEFIBRI $0.00 93650 ABLATE HEART DYSRHYTHM FOCUS $2,352.00 93653 EPHYS EVAL W/ ABLATION SUPRAVENT AR $3,311.00 93654 EPHYS EVAL W/ ABLATION VENTRICULAR $4,412.00 93655 ICAR CATHETER ABLATION ARRHYTHMIA A $1,655.00 93656 EPHYS EVL TRNSPTL TX ATRIAL FIB ISO $4,414.00 93657 ABLATE L/R ATRIAL FIBRIL W/ ISOLATE $1,656.00 93660 TILT TABLE EVALUATION $0.00 93662 INTRACARDIAC EKG‐THER/DIAG INT,S&I $0.00 93701 BIOIMPEDANCE, THORACIC; ELECTRICAL $94.00 93702 BIS EXTRACELLULAR FLUID ALYS LYMPHE $397.00 93724 ANALYSIS OF PACEMAKER SYSTEM $0.00 93745 INITI SETUP & PRGRAM CARDIO‐DEFIBRI $0.00 93750 INTERROG OF VENTICULAR ASSIT DEVICE $166.00 93784 AMBULATORY BP MONITORING, 24+ HRS $208.00 93786 AMBULATORY BP RECORDING, 24+ HRS $115.00 93788 AMBULATORY BP ANALYSIS, 24+ HRS $32.00 93790 REVIEW/REPORT BP RECORDING $63.00 93797 CARDIAC REHABILITATION $30.00 93798 CARDIAC REHAB W/ECG MONITORING $49.00 93880 EXTRACRANIAL ARTERIES STUDY, COMPL $0.00 93882 EXTRACRANIAL ARTERIES STUDY, LTD $0.00 93886 INTRACRANIAL ARTERIES STUDY, COMPL $0.00 93888 INTRACRANIAL ARTERIES STUDY, LTD $0.00 93890 T/CRANIAL DOPP STU INTRACRA ART COM $0.00 93892 T/CRAN DOPP STU EBOLI DET W/O IVINJ $0.00 93893 T/CRAN DOPP STU EMBOL DET W/IV INJ $0.00 93922 PHYSIOLOGIC EXTREMITY STUDY $0.00 93923 PHYSIOLOGIC EXTREMITY STUDY $0.00 93924 PHYSIOLOGIC EXTREMITY STUDY $0.00 93925 LOWER EXTREMITY ARTERY STUDY, COMPL $0.00 93926 LOWER EXTREMITY ARTERY STUDY, LTD $0.00 93930 UPPER EXTREMITY ARTERY STUDY, COMPL $118.00 93931 UPPER EXTREMITY ARTERY STUDY, LTD $73.00 93970 EXTREMITY VEINS STUDY, COMPLETE $0.00 93971 EXTREMITY VEINS STUDY, LIMITED $0.00 93975 VISCERAL VASCULAR STUDY, COMPLETE $0.00 93976 VISCERAL VASCULAR STUDY, LIMITED $0.00 93978 VISCERAL VASCULAR STUDY, COMPLETE $0.00 93979 VISCERAL VASCULAR STUDY, LIMITED $0.00 93980 PENILE VASCULAR STUDY, COMPLETE $0.00 93981 PENILE VASCULAR STUDY, LIMITED $0.00 93982 ANEURYSM PRESSURE SENS STUDY $158.00 93990 DUPLEX SCAN, HEMODIALYSIS ACCESS $0.00 94002 VENTILATION ASSIST AND MANAGEMENT $325.00 94003 VENTILATN A&M HOSPITAL IP/OBSRVTN $235.00 94004 VENTILATR A&M NURSNG FACILTY PERDAY $171.00 94010 BREATHING CAPACITY TEST $0.00 94011 MEASUREMENT OF SPIROMETIC EXPITRATO $357.00 94012 MEASUR SPIROMETIC BEFORE AND AFTER $551.00 94013 MEASUREMENT OF LUNG VOLUME $128.00 94014 SPIROMETRY, PAT RECORDED, PHYS REV $201.00 94015 SPIROMETRY, PATIENT RECORDED $114.00 94016 SPIROMETRY, PT RECORDED PHY REVIEW $87.00 94060 EVALATION OF WHEEZING $0.00 94070 EVALUATION OF WHEEZING, PROLONGED $0.00 94200 LUNG FUNCTION TEST (MBC/MVV) $0.00 94250 EXPIRED GAS COLLECTION $0.00 94375 RESPIRATORY FLOW VOLUME LOOP $0.00 94400 CO2 BREATHING RESPONSE CURVE $0.00 94450 HYPOXIA RESPONSE CURVE $0.00 94452 HAST WITH PHYS INTERPRET AND REPORT $0.00 94453 HAST W/PHYS I & R WITH SUPPL O2 TIT $0.00 94610 INTRAPULMNRY SURFCTANT ADMIN BY MD $207.00 94618 Pulmonary stress testing $121.00 94620 PULMONARY STRESS TESTING, SIMPLE $0.00 94621 PULMONARY STRESS TESTING, COMPLEX $0.00 94640 AIRWAY INHALATION TREATMENT $71.00 94642 AEROSOL INHALATION TREATMENT $224.00 94644 CONTNS INHLTN TX W AROSOL MEDICATN $171.00 94645 CONT TX AROSOL MDCTN 4 AIRWAY OBS $55.00 94660 POSITIVE AIRWAY PRESSURE (CPAP) $133.00 94662 NEGATIVE PRESSURE VENTILATION (CNP) $138.00 94664 AEROSOL/VAPOR INHALATIONS, INITIAL $68.00 94667 CHEST WALL MANIPULATION, INITIAL $98.00 94668 CHEST WALL MANIPULATION, ADDED $109.00 94669 MECHANICAL CHEST WALL OSCILLATION L $123.00 94680 EXHALED AIR ANALYSIS, O2 $0.00 94681 EXHALED AIR ANALYSIS, O2, CO2 $0.00 94690 EXHALED AIR ANALYSIS, REST,INDIRECT $0.00 94726 PULM FUNCT TST PLETHYSMOGRAP $0.00 94727 PULM FUNCTION TEST BY GAS $0.00 94728 PULM FUNCT TEST OSCILLOMETRY $0.00 94729 C02/MEMBANE DIFFUSE CAPACITY $0.00 94750 PULMONARY COMPLIANCE STUDY $0.00 94760 MEASURE BLOOD OXYGEN LEVEL, SINGLE $13.00 94761 MEASURE BLOOD OXYGEN LEVEL,MULTIPLE $19.00 94762 MEASURE BLOOD OXYGEN LEVEL,OVERNITE $92.00 94770 EXHALED CARBON DIOXIDE TEST $55.00 94774 PED HOME APNEA REC, COMPL $1,109.00 94775 PED HOME APNEA REC, HK‐UP $175.00 94776 PED HOME APNEA REC, DOWNLD $830.00 94777 PED HOME APNEA REC, REPORT $104.00 94780 CAR SEAT/BED TEST 60 MIN $80.00 94781 CAR SEAT/BED TEST + 30 MIN $29.00 95004 ALLERGY SKIN TESTS, PERCUTANEOUS $26.00 95012 NITRIC OXIDE EXPIRED GAS DETERMINA $76.00 95017 ALLG TSTG PERQ & IC VENOMS IMMED RE $13.00 95018 ALLG TEST PERQ & IC DRUG/BIOL IMMED $25.00 95024 ALLERGY SKIN TESTS, INTRADERMAL $5.00 95027 SKIN END POINT TITRATION $19.00 95028 ALLERGY SKIN TESTS, INTRADERMAL $53.00 95044 ALLERGY PATCH TESTS $23.00 95052 PHOTOSENSITIVITY PATCH TESTS $26.00 95056 PHOTOSENSITIVITY TESTS $172.00 95060 EYE ALLERGY TESTS $130.00 95065 NOSE ALLERGY TEST $100.00 95070 BRONCHIAL ALLERGY TESTS $125.00 95071 BRONCHIAL ALLERGY TESTS $248.00 95076 INGESTION CHALLENGE TEST INITIAL 12 $250.00 95079 INGESTION CHALLENGE TEST EACH ADDL $228.00 95144 ANTIGEN THERAPY SERVICES, $12.00 95145 ANTIGEN THERAPY SERVICES, INS VENOM $12.00 95146 ANTIGEN THERAPY SERVICES, INS VENOM $12.00 95147 ANTIGEN THERAPY SERVICES, INS VENOM $12.00 95148 ANTIGEN THERAPY SERVICES, INS VENOM $12.00 95149 ANTIGEN THERAPY SERVICES, INS VENOM $12.00 95165 ANTIGEN THERAPY SERVICES $12.00 95170 ANTIGEN THERAPY SERV, BITING INSECT $12.00 95180 RAPID DESENSITIZATION, EACH HOUR $346.00 95250 amb.gl.mont,subcut‐72 hr;sensor pla $605.00 95251 amb.gl.mont,subcut‐72hr;phy int‐rep $150.00 95782 POLYSOM <6 YRS SLEEP STAGE 4/> ADDL $0.00 95783 POLYSOM <6 YRS SLEEP W/CPAP/BILVL V $0.00 95800 SLP STDY UNATTENDED $0.00 95801 SLP STDY UNATND W/ANAL $0.00 95803 ACTIGRAPHY TESTING $0.00 95805 MULTIPLE SLEEP LATENCY TEST $0.00 95806 SLEEP STUDY, UNATTENDED $0.00 95807 SLEEP STUDY, ATTENDED $0.00 95808 POLYSOMNOGRAPHY, 1‐3 ADD'L PARAMS $0.00 95810 POLYSOMNOGRAPHY, 4+ ADD'L PARAMS $0.00 95811 POLYSONOGRPH 4+ ADD'L PARAMS W/CPAP $0.00 95812 EEG MONITORING, UP TO 1 HOUR $0.00 95813 EEG MONITORING, GREATER THAN 1 HOUR $0.00 95816 ELECTROENCEPHALOGRAM (EEG) $0.00 95819 ELECTROENCEPHALOGRAM (EEG) $0.00 95822 SLEEP EEG $0.00 95824 CEREBRAL DEATH EVALUATION EEG $0.00 95827 NIGHT EEG $0.00 95829 ELECTROCORTICOGRAM DURING SURGERY $0.00 95830 INSERTION OF ELECTRODES FOR EEG $326.00 95831 MANUAL MUSCLE TESTING, TRUNK/LIMB $54.00 95832 MANUAL MUSCLE TESTING, HAND $58.00 95833 MANUAL MUSCLE TESTING, BODY $73.00 95834 MANUAL MUSCLE TESTING, BODY $109.00 95851 RANGE OF MOTION TEST, TRUNK/LIMB $27.00 95852 RANGE OF MOTION TEST, HAND $21.00 95857 TENSILON TEST $104.00 95860 MUSCLE TEST, ONE LIMB $0.00 95861 MUSCLE TEST, TWO LIMBS $0.00 95863 MUSCLE TEST, THREE LIMBS $0.00 95864 MUSCLE TEST, FOUR LIMBS $0.00 95865 needle electromyography;larynx $0.00 95866 needle electromyography;hemidiaphra $0.00 95867 MUSCLE TEST, HEAD/NECK, ONE SIDE $0.00 95868 MUSCLE TEST, HEAD/NECK, BOTH SIDES $0.00 95869 MUSCLE TEST, LMTD, THORAC PARASPINE $0.00 95870 MUSCLE TEST, LMTD, OTH THAN PARASPI $0.00 95872 MUSCLE TEST, ONE FIBER $0.00 95873 electric stimul‐guid w/chemodenerva $0.00 95874 needl electromyogr‐guid w/chemodene $0.00 95875 LIMB EXERCISE TEST W/EMG, LACTIC $0.00 95885 MUSC TST DONE W/NERV TST LIM $0.00 95886 MUSC TEST DONE W/N TEST COMP $0.00 95887 MUSC TST DONE W/N TST NONEXT $0.00 95905 MOTOR AND SENSORY NERVE COND PRECON $0.00 95907 MOTOR &/SENS 1‐2 NRV CNDJ PRECONF E $0.00 95908 MOTOR &/SENS 3‐4 NRV CNDJ PRECONF E $0.00 95909 MOTOR &/SENS 5‐6 NRV CNDJ PRECONF E $0.00 95910 MOTOR &/SENS 7‐8 NRV CNDJ PRECONF E $0.00 95911 MOTOR &/SENS 9‐10 NRV CNDJ PRECONF $0.00 95912 MOTOR &/SENS 11‐12 NRV CNDJ PRECONF $0.00 95913 MOTOR &/SENS 13/> NRV CNDJ PRECONF $0.00 95921 AUTONOMIC NERV SYS TEST CARDIOVAGAL $0.00 95922 AUTONOMIC NERV SYS TEST, VASOMOTOR $0.00 95923 AUTONOMIC NERV SYS TEST, SUDOMOTOR $0.00 95924 TSTG ANS FUNCJ PARASYMP&SYMP W/5 MI $0.00 95925 SOMATOSENSORY TESTING, UPPER LIMBS $0.00 95926 SOMATOSENSORY TESTING, LOWER LIMBS $0.00 95927 SOMATOSENSORY TESTING, TRUNK/HEAD $0.00 95928 CENT MOTOR EVOK POT STUD UPP LIMB $0.00 95929 CENTR EVOK POT STUD LOWER LIMBS $0.00 95930 VISUAL EVOKED POTENTIAL (VEP) TEST $0.00 95933 BLINK REFLEX TEST $0.00 95937 NEUROMUSCULAR JUNCTION TEST $0.00 95938 SOMATOSENSORY TESTING $0.00 95939 C MOTOR EVOKED UPR&LWR LIMBS $0.00 95940 IONM 1 ON 1 IN OR W/ATTENDANCE EACH $116.00 95943 PARASYMP & SYMP NRV FUNCJ HRT RATE $0.00 95950 AMBULATORY EEG MONITORING $0.00 95951 EEG MONITORING/VIDEORECORDING $0.00 95953 EEG MONITORING/COMPUTER RECORDING $0.00 95954 EEG MONITORING W/DRUGS $0.00 95955 EEG MONITORING DURING SURGERY $0.00 95956 EEG MONITORING BY CABLE/RADIO $0.00 95957 EEG DIGITAL ANALYSIS $0.00 95958 EEG MONITORING/FUNCTION TEST $0.00 95961 ELECTRODE STIMULATION OF BRAIN $0.00 95962 ELECTRODE STIMULATION OF BRAIN $0.00 95965 MEG RECORDNG & ANLYSIS SPNTNS BRAIN $0.00 95966 MEG FOR EVOKED MAGNTC FIELD SNGL MO $0.00 95967 MEG RCDNG & ANLYSIS FOR EVKD MAG $0.00 95970 NEUROSTIM ANALYSIS, W/O REPROGRAM $85.00 95971 NEUROSTIM ANALYSIS, SIMPLE $145.00 95972 NEUROSTIM ANALYSIS, COMPLEX, 1ST HR $149.00 95974 NEUROSTIM, CRANIAL, COMPLEX, 1ST HR $584.00 95975 NEUROSTIM, CRAN, CMPLX, EA ADD'L HR $329.00 95978 ELEC ANALY NEUROSTIM PLSGEN 1ST HR $691.00 95979 ELEC ANALY NEUROSTIM PLSGEN ADD 30M $319.00 95980 IO ANAL GAST N‐STIM INIT $176.00 95981 IO ANAL GAST N‐STIM SUBSQ $65.00 95982 IO GA N‐STIM SUBSQ W/REPROG $133.00 95990 REFIL PUMP/RES DRG DEL,SPINE/BRAIN $352.00 95991 REFILLING AND MAIN IMPLANT PUMP $140.00 95992 CANALITH REPOSITIONING PROC $129.00 96000 COMP CMPUTR MOTION ANLYSIS, VT & 3D $332.00 96001 MOTION ANLYSIS VT & 3D DURNG WALKNG $381.00 96002 DYN SURF EMG‐WALK/FUNC ACT,1‐12 MUS $77.00 96003 DYN FINE WIRE EMG,WALK/FUN ACT,1MUS $68.00 96004 PHYSN RVW INTRPRTN OF MOTION ANLYS $411.00 96101 PSYCO TEST/HR PHYSCIAN/PSYCO TIME $266.00 96102 PSYCHO TEST/HR TECHN TIME $80.00 96103 PSYCHO TEST ADM COMP W/QUAL HLTHCAR $94.00 96105 ASSESSMENT OF APHASIA $371.00 96111 DEVELOPMENTAL TESTING, EXTENDED $419.00 96116 NEUROBEHA STAT EXAM/HR PSY/PHYS TIM $298.00 96118 NEUROPSYCHO TEST/HR PSYC/PHYS TIME $263.00 96119 NEUROPSYC TEST/HR TECH TIME $80.00 96120 NEUROPSYC TEST ADM COMP W/QUAL HLTH $92.00 96125 COGNITIVE TEST BY HC PRO $408.00 96127 BEHAV ASSMT W/SCORE & DOCD/STAND IN $21.00 96150 HEALTH & BHVR ASMNT EACH 15 M F2F $71.00 96151 HEALTH & BHVR ASMNT REASSESSMENT $68.00 96152 HELTH & BHVR INTRVNTN EACH 15M INDV $66.00 96153 HEALTH & BHVR INTRVNTN 15M GROUP $16.00 96154 HLTH & BHVR INTRVNTN 15M FAMLY W PT $64.00 96360 Hydration iv infusion, init $211.00 96361 Hydrate iv infusion, add‐on $55.00 96365 Ther/proph/diag iv inf, init $272.00 96366 Ther/proph/diag iv inf addon $76.00 96367 Tx/proph/dg addl seq iv inf $115.00 96368 Ther/diag concurrent inf $73.00 96369 Sc ther infusion, up to 1 hr $769.00 96370 Sc ther infusion, addl hr $60.00 96371 Sc ther infusion, reset pump $369.00 96372 Ther/proph/diag inj, sc/im $91.00 96373 Ther/proph/diag inj, ia $70.00 96374 Ther/proph/diag inj, iv push $209.00 96375 Tx/pro/dx inj new drug addon $81.00 96401 CHEMO ADM SUBC/IM NON HORM ANTI‐NEO $274.00 96402 CHEM ADM SUB/IM HORM ANTI‐NEOPLASTI $120.00 96405 CHEMOTHERAPY ADMIN, UP TO 7 LESIONS $105.00 96406 CHEMOTHERAPY ADMIN, 8+ LESIONS $163.00 96409 CHEM ADM IV PUSH TEC INIT SUB/DRG $0.00 96411 CHEM IV PUSH TECH EAC ADD SUB/DRG $0.00 96413 CHEM ADM IV INFUS TECH UPTO 1HR $0.00 96415 CHEM ADM IV INFUS EAC ADD 1‐8 HRS $0.00 96416 CHEM ADM IV INFUS TEC > 8HRS $519.00 96417 CHEM ADM IV INFU ADD SEQ INF UP 1HR $256.00 96420 IA CHEMOTHERAPY, PUSH TECHNIQUE $390.00 96422 IA CHEMOTHERAPY, INFUSION METHOD $629.00 96423 IA CHEMOTHERAPY, INFUSION METHOD $289.00 96425 IA CHEMOTHERAPY, INFUSION METHOD $674.00 96440 PLEURAL CAVITY CHEMOTHERAPY $540.00 96446 CHEMOTX ADMN PRTL CAVITY $129.00 96450 CNS CHEMOTHERAPY $0.00 96521 REFIL AND MAINTE PORTABLE PUMP $510.00 96522 REFIL & MAINT IMPL PUMP/RESERV SYST $419.00 96523 IRRIG IMPL VENOUS ACC DEV DRG DELV $91.00 96542 CHEMOTHERAPY INJECTION $149.00 96567 PHOTODYN THER‐DIST MAL LES;EACH SES $524.00 96570 NULL $217.00 96571 NULL $96.00 96900 ULTRAVIOLET LIGHT THERAPY $81.00 96904 WHOLE BODY INTGMNTRY PHOTOGRAPHY $265.00 96910 ULTRAVIOLET LIGHT THERAPY W/UV‐B $277.00 96912 ULTRAVIOLET LIGHT THERAPY W/PUVA $355.00 96913 ULTRAVIOLET LIGHT THERAPY,EXTENSIVE $500.00 96920 LASER TX‐INF SKIN DIS;WITHIN 250 SQ $233.00 96921 LASER TX INF SKIN DIS;250‐500 SQ CM $263.00 96922 LASER TX INF SKIN DIS;OVER 500 SQCM $426.00 97012 MECHANICAL TRACTION THERAPY $55.00 97016 VASOPNEUMATIC DEVICE THERAPY $69.00 97018 PARAFFIN BATH THERAPY $40.00 97022 WHIRLPOOL THERAPY $84.00 97024 DIATHERMY TREATMENT $23.00 97026 INFRARED THERAPY $22.00 97028 PHYSICAL THERAPY, UV LIGHT $27.00 97032 ELECTRICAL STIMULATION, EA 15 MINS $67.00 97033 IONTOPHORESIS, EACH 15 MINUTES $116.00 97034 CONTRAST BATHS, EACH 15 MINUTES $64.00 97035 ULTRASOUND, EACH 15 MINUTES $44.00 97036 HUBBARD TANK, EACH 15 MINUTES $117.00 97110 PHYSICAL THERAPY EXERCISES $112.00 97112 NEUROMUSCULAR REEDUCATION $118.00 97113 AQUATIC THERAPY W/EXERCISES $151.00 97116 GAIT TRAINING THERAPY $98.00 97124 MASSAGE THERAPY $91.00 97140 MANUAL THERAPY 1+ REGIONS, EA 15 MN $103.00 97150 GROUP THERAPEUTIC PROCEDURE(S) $68.00 97530 THERAPEUTIC ACTIVITIES (ONE ON ONE) $121.00 97532 DVLPMNT COGNTV SKIL DIRECT EACH 15M $91.00 97533 SENSORY INTERGRATIVE TECHNIQUES $100.00 97535 SELF CARE MANAGEMENT TRAINING $123.00 97537 COMMUNITY/WORK REINTEGRATION TRNG $105.00 97542 WHEELCHAIR MANAGEMENT TRAINING $107.00 97597 REM DEVITA TISS WOUND TSA <=20 SQCM $79.00 97598 REM DEVITA TISS WOUND TSA > 20 SQCM $37.00 97605 ‐VE PRESS WOUND THERAP TSA <=50SQCM $85.00 97606 ‐VE PRES WOUND THERAP TSA >50 SQCM $92.00 97607 NEG PRESSURE WOUND THERAPY NON DME $0.00 97608 NEG PRESSURE WOUND THERAPY NON DME $0.00 97610 LOW FREQUENCY NON‐THERMAL ULTRASOUN $53.00 97750 PHYSICAL PERFORMANCE TEST,EA 15 MIN $116.00 97755 ASSISTIVE TECH $124.00 97760 ortho man & tr;U.E,L.E,Tr‐EACH 15 m $135.00 97761 prosth train;U.E & L.E‐each 15 MIN $116.00 97762 CHKOUT‐ORTH/PROSTH USE,ESTB PT,15 M $174.00 97802 MEDICAL NUTRTN TX INTL ASMNT INDVID $112.00 97803 MEDICAL NUTRTN TX RE‐ASSMNT & INTRV $96.00 97804 MEDICAL NUTRITION TX GROUP EACH 30M $53.00 98925 OSTEOPATHIC MANIP, 1‐2 BODY REGIONS $82.00 98926 OSTEOPATHIC MANIP, 3‐4 BODY REGIONS $124.00 98927 OSTEOPATHIC MANIP, 5‐6 BODY REGIONS $163.00 98928 OSTEOPATHIC MANIP, 7‐8 BODY REGIONS $205.00 98929 OSTEOPATHIC MANIP, 9‐10 BODY REGION $246.00 98940 CMT, SPINAL, 1‐2 REGIONS $77.00 98941 CMT, SPINAL, 3‐4 REGIONS $117.00 98942 CMT, SPINAL, 5 REGIONS $158.00 99170 NULL $310.00 99175 INDUCTION OF VOMITING $70.00 99183 HYPERBARIC OXYGEN THERAPY $760.00 99184 INITIAT SELECTIVE HEAD/BODY HYPOTHE $793.00 99195 PHLEBOTOMY $375.00 99201 OFFICE/OUTPATIENT VISIT, NEW, MIN $94.00 99202 OFFICE/OUTPATIENT VISIT, NEW, LOW $177.00 99203 OFFICE/OUTPATIENT VISIT, NEW, MOD $273.00 99204 OFFICE/OUTPATIENT VISIT, NEW, MOD $458.00 99205 OFFICE/OUTPATIENT VISIT, NEW, HIGH $595.00 99211 OFFICE/OUTPATIENT VISIT, EST, MIN $32.00 99212 OFFICE/OUTPATIENT VISIT, EST, LOW $88.00 99213 OFFICE/OUTPATIENT VISIT, EST, MOD $178.00 99214 OFFICE/OUTPATIENT VISIT, EST, MOD $272.00 99215 OFFICE/OUTPATIENT VISIT, EST, HIGH $386.00 99217 OBSERVATION CARE DISCHARGE DAY MGT $254.00 99218 INITIAL OBSERVATION CARE, LOW $348.00 99219 INITIAL OBSERVATION CARE, MODERATE $470.00 99220 INITIAL OBSERVATION CARE, HIGH $641.00 99221 INITIAL HOSPITAL CARE, LOW $358.00 99222 INITIAL HOSPITAL CARE, MODERATE $478.00 99223 INITIAL HOSPITAL CARE, HIGH $705.00 99224 SUBSEQUENT OBSERVATION CARE $139.00 99225 SUBSEQUENT OBSERVATION CARE $252.00 99226 SUBSEQUENT OBSERVATION CARE $363.00 99231 FOLLOWUP HOSPITAL CARE, BRIEF $137.00 99232 FOLLOWUP HOSPITAL CARE, MODERATE $249.00 99233 FOLLOWUP HOSPITAL CARE, EXTENSIVE $361.00 99234 OBSERV OR INPATIENT HOSP CARE, LOW $466.00 99235 OBSERV OR INPATIENT HOSP CARE, MOD $586.00 99236 OBSERV OR INPATIENT HOSP CARE, HIGH $754.00 99238 HOSPITAL DISCHARGE DAY CARE $251.00 99239 HOSPITAL DISCHARGE DAY CARE,30+ MIN $372.00 99281 EMERGENCY DEPT VISIT, MINOR $74.00 99282 EMERGENCY DEPT VISIT, LOW‐MODERATE $145.00 99283 EMERGENCY DEPT VISIT, MODERATE $217.00 99284 EMERGENCY DEPT VISIT, HIGH $411.00 99285 EMERGENCY DEPT VISIT, HIGH $608.00 99291 CRITICAL CARE, FIRST HOUR $783.00 99292 CRITICAL CARE, ADD'L 30 MIN $392.00 99304 INIT. NURS CARE, LOW SEVERITY $320.00 99305 INIT. NURS FACLTY, MOD SEVERITY $456.00 99306 INIT. NURS FACLTY CARE, HIGH SEVERY $575.00 99307 SUBSEQNT NURS FACLTY, RECOVERING $156.00 99308 SUBSQNT NURS FACLTY, COMPL MINOR $242.00 99309 SUBSQNT NURS FACLTY, COMPL NEW PRBS $317.00 99310 SUBSQNT NURS FACLTY, IMM PHY ATTENT $472.00 99315 NURSING FACIL DISCH, 30 MIN OR LESS $254.00 99316 NURSING FACIL DISCH, 31+ MIN $368.00 99318 E/M, NURSI ASSMNT, STABLE RECOVERIN $333.00 99324 DOMICILIARY, REST HO/CUSTDIAL SERV $192.00 99325 DOMICILRY/REST HME, NEW PAT, MOD SE $279.00 99326 DOMCILRY/REST HME, MOD‐HIGH‐SEVERTY $481.00 99327 DOMICLRY/REST HME, NEW PAT, HIGH SE $642.00 99328 DOMICLRY/REST HME E/M NEW PAT, $750.00 99334 DOMILRY, EST PAT, $210.00 99335 DOMICLRY, ESTB PAT, LOW‐MOD SEVERIT $330.00 99336 DOMICLRY, ESTB PAT, MOD‐HIGH‐SEVER $466.00 99337 DOMICLRY, ESTB PAT, 60 MIN, HI SEVR $668.00 99341 HOME VISIT, NEW PATIENT, LOW $191.00 99342 HOME VISIT, NEW PATIENT, MODERATE $274.00 99343 HOME VISIT, NEW PATIENT, MOD‐HIGH $449.00 99344 HOME VISIT, NEW PATIENT, HIGH $632.00 99345 HOME VISIT, NEW PATIENT, EMERGENCY $767.00 99347 HOME VISIT, EST PATIENT, MINOR $193.00 99348 HOME VISIT, EST PATIENT, LOW TO MOD $292.00 99349 HOME VISIT, EST PT, MOD‐HIGH 40 MIN $445.00 99350 HOME VISIT, EST PT, MOD‐HIGH 60 MIN $618.00 99354 PROLONGED SERVICE, OFFICE, 1ST HR $323.00 99355 PROLONGED SERV, OFFICE, ADD'L 30MIN $312.00 99356 PROLONGED SERV, INPATIENT, 1ST HR $318.00 99357 PROLONGED SERV, INPATIENT, ADD'L 30 $316.00 99358 PROLONGED SERV, W/O CONTACT, 1ST HR $390.00 99359 PROLONGED SERV, W/O CONTACT, ADD'L $187.00 99391 PREVENTIVE CHECKUP, EST, INFANT & $299.00 99406 BEHAV CHNG SMOKING 3‐10 MIN $43.00 99407 BEHAV CHNG SMOKING < 10 MIN $90.00 99415 Placement of soft tissue localizati $0.00 99416 Each additional 30 minutes (List s $0.00 99460 Init nb em per day, hosp $333.00 99461 Init nb em per day, non‐fac $218.00 99462 Sbsq nb em per day, hosp $144.00 99463 Same day nb discharge $414.00 99464 Attendance at delivery $248.00 99465 Nb resuscitation $529.00 99466 Ped crit care transport $942.00 99467 Ped crit care transport addl $416.00 99468 Neonate crit care, initial $3,250.00 99469 Neonate crit care, subsq $1,375.00 99471 Ped critical care, initial $3,115.00 99472 Ped critical care, subsq $1,427.00 99475 Ped crit care age 2‐5, init $2,009.00 99476 Ped crit care age 2‐5, subsq $1,210.00 99477 INIT DAY HOSP NEONATE CARE $1,232.00 99478 Ic, lbw inf < 1500 gm subsq $473.00 99479 Ic lbw inf 1500‐2500 g subsq $431.00 99480 Ic inf pbw 2501‐5000 g subsq $412.00 99490 CHRON CARE MANAGEMENT SRVC 20 MIN P $108.00 99495 TRANSITIONAL CARE MANAGE SERVICE 14 $381.00 99496 TRANSITIONAL CARE MANAGE SERVICE 7 $552.00 99497 ADVANCE CARE PLANNING FIRST 30 MINS $0.00 99498 ADVANCE CARE PLANNING EA ADDL 30 MI $0.00 0075T,26 PERQ STENT / CHEST VERT ART $2,818.00 0075T,TC PERQ STENT / CHEST VERT ART $0.00 0076T,26 S&I STENT CHEST VERT ART $966.00 0076T,TC S&I STENT CHEST VERT ART $0.00 44388,53 COLONOSCOPY, DIAGNOSTIC $45,378.00 45378,53 COLONOSCOPY, DIAGNOSTIC $359.00 51725,26 SIMPLE CYSTOMETROGRAM $272.00 51725,TC SIMPLE CYSTOMETROGRAM $0.00 51726,26 COMPLEX CYSTOMETROGRAM $303.00 51726,TC COMPLEX CYSTOMETROGRAM $0.00 51727,26 URODYNAMICS WITH URETHRAL PRESSURE $381.00 51727,TC URODYNAMICS WITH URETHRAL PRESSURE $0.00 51728,26 URODYNAMIC W/VOIDING PRESSURE STUDY $371.00 51728,TC URODYNAMIC W/VOIDING PRESSURE STUDY $0.00 51729,26 URODYNAMIC W/VOIDING PRESSURE STUDY $450.00 51729,TC URODYNAMIC W/VOIDING PRESSURE STUDY $0.00 51736,26 URINE FLOW MEASUREMENT, SIMPLE $35.00 51736,TC URINE FLOW MEASUREMENT, SIMPLE $0.00 51741,26 URINE FLOW MEASUREMENT, COMPLEX $42.00 51741,TC URINE FLOW MEASUREMENT, COMPLEX $0.00 51784,26 EMG STUDY, ANAL/URETHRAL SPHINCTER $273.00 51784,TC EMG STUDY, ANAL/URETHRAL SPHINCTER $0.00 51785,26 ANAL/URINARY MUSCLE STUDY, NEEDLE $342.00 51785,TC ANAL/URINARY MUSCLE STUDY, NEEDLE $0.00 51792,26 URINARY REFLEX STUDY $198.00 51792,TC URINARY REFLEX STUDY $0.00 51797,26 INTRA‐ABDOM VOIDING PRESSURE TEST $143.00 51797,TC INTRA‐ABDOM VOIDING PRESSURE TEST $0.00 54240,26 PENIS PRESSURE STUDY $245.00 54240,TC PENIS PRESSURE STUDY $0.00 54250,26 TEST PENILE ERECTION/RIGIDITY $390.00 54250,TC TEST PENILE ERECTION/RIGIDITY $0.00 59020,26 FETAL CONTRACTION STRESS TEST $144.00 59020,TC FETAL CONTRACTION STRESS TEST $0.00 59025,26 FETAL NON‐STRESS TEST $115.00 59025,TC FETAL NON‐STRESS TEST $0.00 62252,26 REPROGRAM OF PROGRAMMABLE CFS $195.00 62252,TC REPROGRAM OF PROGRAMMABLE CFS $0.00 70010,26 CONTRAST X‐RAY OF BRAIN $329.00 70015,26 CONTRAST X‐RAY OF BRAIN $223.00 70015,TC CONTRAST X‐RAY OF BRAIN $0.00 70030,26 X‐RAY EXAM OF EYE FOR FOREIGN BODY $29.00 70030,TC X‐RAY EXAM OF EYE FOR FOREIGN BODY $0.00 70100,26 X‐RAY EXAM OF JAW, PARTIAL $32.00 70100,TC X‐RAY EXAM OF JAW, PARTIAL $0.00 70110,26 X‐RAY EXAM OF JAW, COMPLETE $43.00 70110,TC X‐RAY EXAM OF JAW, COMPLETE $0.00 70120,26 X‐RAY EXAM OF MASTOIDS, PARTIAL $32.00 70120,TC X‐RAY EXAM OF MASTOIDS, PARTIAL $0.00 70130,26 X‐RAY EXAM OF MASTOIDS, COMPLETE $60.00 70130,TC X‐RAY EXAM OF MASTOIDS, COMPLETE $0.00 70134,26 X‐RAY EXAM OF MIDDLE EAR, COMPLETE $61.00 70134,TC X‐RAY EXAM OF MIDDLE EAR, COMPLETE $0.00 70140,26 X‐RAY EXAM OF FACIAL BONES, PARTIAL $37.00 70140,TC X‐RAY EXAM OF FACIAL BONES, PARTIAL $0.00 70150,26 X‐RAY EXAM OF FACIAL BONES,COMPLETE $46.00 70150,TC X‐RAY EXAM OF FACIAL BONES,COMPLETE $0.00 70160,26 X‐RAY EXAM OF NASAL BONES, COMPLETE $31.00 70160,TC X‐RAY EXAM OF NASAL BONES, COMPLETE $0.00 70170,26 X‐RAY EXAM OF TEAR DUCT $54.00 70170,TC X‐RAY EXAM OF TEAR DUCT $0.00 70190,26 X‐RAY EXAM OF EYE SOCKETS $39.00 70190,TC X‐RAY EXAM OF EYE SOCKETS $0.00 70200,26 X‐RAY EXAM OF EYE SOCKETS, COMPLETE $48.00 70200,TC X‐RAY EXAM OF EYE SOCKETS, COMPLETE $0.00 70210,26 X‐RAY EXAM OF SINUSES $31.00 70210,TC X‐RAY EXAM OF SINUSES $0.00 70220,26 X‐RAY EXAM OF SINUSES, COMPLETE $43.00 70220,TC X‐RAY EXAM OF SINUSES, COMPLETE $0.00 70240,26 X‐RAY EXAM PITUITARY SADDLE $34.00 70240,TC X‐RAY EXAM PITUITARY SADDLE $0.00 70250,26 X‐RAY EXAM OF SKULL, PARTIAL $44.00 70250,TC X‐RAY EXAM OF SKULL, PARTIAL $0.00 70260,26 X‐RAY EXAM OF SKULL, COMPLETE $61.00 70260,TC X‐RAY EXAM OF SKULL, COMPLETE $0.00 70300,26 X‐RAY EXAM OF TEETH, SINGLE VIEW $21.00 70300,TC X‐RAY EXAM OF TEETH, SINGLE VIEW $0.00 70310,26 X‐RAY EXAM OF TEETH, PARTIAL $28.00 70310,TC X‐RAY EXAM OF TEETH, PARTIAL $0.00 70320,26 FULL MOUTH X‐RAY OF TEETH $41.00 70320,TC FULL MOUTH X‐RAY OF TEETH $0.00 70328,26 X‐RAY EXAM OF JAW JOINT $33.00 70328,TC X‐RAY EXAM OF JAW JOINT $0.00 70330,26 X‐RAY EXAM OF JAW JOINTS $44.00 70330,TC X‐RAY EXAM OF JAW JOINTS $0.00 70332,26 X‐RAY EXAM OF JAW JOINT $110.00 70332,TC X‐RAY EXAM OF JAW JOINT $0.00 70336,26 MRI OF JAW JOINT $255.00 70336,TC MRI OF JAW JOINT $0.00 70350,26 X‐RAY HEAD FOR ORTHODONTIA $37.00 70350,TC X‐RAY HEAD FOR ORTHODONTIA $0.00 70355,26 PANORAMIC X‐RAY OF JAWS $40.00 70355,TC PANORAMIC X‐RAY OF JAWS $0.00 70360,26 X‐RAY EXAM OF NECK TISSUE $29.00 70360,TC X‐RAY EXAM OF NECK TISSUE $0.00 70370,26 THROAT X‐RAY/FLUOROSCOPY $56.00 70370,TC THROAT X‐RAY/FLUOROSCOPY $0.00 70371,26 SPEECH EVALUATION, COMPLEX $149.00 70371,TC SPEECH EVALUATION, COMPLEX $0.00 70380,26 X‐RAY EXAM OF SALIVARY GLAND $32.00 70380,TC X‐RAY EXAM OF SALIVARY GLAND $0.00 70390,26 X‐RAY EXAM OF SALIVARY DUCT $67.00 70390,TC X‐RAY EXAM OF SALIVARY DUCT $0.00 70450,26 CAT SCAN OF HEAD/BRAIN $149.00 70450,TC CAT SCAN OF HEAD/BRAIN $0.00 70460,26 CONTRAST CAT SCAN OF HEAD/BRAIN $196.00 70460,TC CONTRAST CAT SCAN OF HEAD/BRAIN $0.00 70470,26 CAT SCANS OF HEAD/BRAIN $222.00 70470,TC CAT SCANS OF HEAD/BRAIN $0.00 70480,26 CAT SCAN OF SKULL $223.00 70480,TC CAT SCAN OF SKULL $0.00 70481,26 CONTRAST CAT SCAN OF SKULL $240.00 70481,TC CONTRAST CAT SCAN OF SKULL $0.00 70482,26 CAT SCANS OF SKULL $251.00 70482,TC CAT SCANS OF SKULL $0.00 70486,26 CAT SCAN OF FACE, JAW $194.00 70486,TC CAT SCAN OF FACE, JAW $0.00 70487,26 CONTRAST CAT SCAN OF FACE, JAW $223.00 70487,TC CONTRAST CAT SCAN OF FACE, JAW $0.00 70488,26 CAT SCANS OF FACE, JAW $243.00 70488,TC CAT SCANS OF FACE, JAW $0.00 70490,26 CAT SCAN OF NECK TISSUE $223.00 70490,TC CAT SCAN OF NECK TISSUE $0.00 70491,26 CONTRAST CAT SCAN OF NECK TISSUE $242.00 70491,TC CONTRAST CAT SCAN OF NECK TISSUE $0.00 70492,26 CAT SCANS OF NECK TISSUE $252.00 70492,TC CAT SCANS OF NECK TISSUE $0.00 70496,26 CT Scan head w contrast, w/o contra $304.00 70496,TC CT Scan head w contrast, w/o contra $0.00 70498,26 CTA neck w contrats, w/o contrast $304.00 70498,TC CTA neck w contrats, w/o contrast $0.00 70540,26 MRI OF ORBIT, FACE, NECK $234.00 70540,TC MRI OF ORBIT, FACE, NECK $0.00 70542,26 MRI face, neck, obit w/o conrast $281.00 70542,TC MRI face, neck, obit w/o conrast $0.00 70543,26 MRI orbit, face, neck, w contrast $373.00 70543,TC MRI orbit, face, neck, w contrast $0.00 70544,26 MRA head, w/o contrast $210.00 70544,TC MRA head, w/o contrast $0.00 70545,26 MRA head, w contrast $209.00 70545,TC MRA head, w contrast $0.00 70546,26 MRA head, w/o contrast & w contrast $313.00 70546,TC MRA head, w/o contrast & w contrast $0.00 70547,26 MRA NECK, w/o contrast $210.00 70547,TC MRA NECK, w/o contrast $0.00 70548,26 MRA NECK, w contrast $210.00 70548,TC MRA NECK, w contrast $0.00 70549,26 MRA NECK, w/o contrats & w contrast $313.00 70549,TC MRA NECK, w/o contrats & w contrast $0.00 70551,26 MRI OF BRAIN $257.00 70551,TC MRI OF BRAIN $0.00 70552,26 CONTRAST MRI OF BRAIN $309.00 70552,TC CONTRAST MRI OF BRAIN $0.00 70553,26 MRI OF BRAIN AND FURTHER SEQUENCES $399.00 70553,TC MRI OF BRAIN AND FURTHER SEQUENCES $0.00 70554,26 MRI BRAIN NOT RQRNG MD/PSYCHOLOGIST $371.00 70554,TC MRI BRAIN NOT RQRNG MD/PSYCHOLOGIST $0.00 70555,26 MRI BRAIN RQRNG MD/PSYCHOLOGIST $452.00 70555,TC MRI BRAIN RQRNG MD/PSYCHOLOGIST $0.00 70557,26 MRI BRAIN DUR INTRACRANIAL WO CONT $662.00 70557,TC MRI brain, w/o contrast $0.00 70558,26 MRI BRAIN DUR OPEN PROCEDURE W/CON $571.00 70558,TC MRI brain w contrast $0.00 70559,26 MRI BRAIN WO CONT FOLLOWED BY CONT $572.00 70559,TC MRIBrain w/o contrast & w contrast $0.00 71010,26 CHEST X‐RAY, SINGLE VIEW, FRONTAL $32.00 71010,TC CHEST X‐RAY, SINGLE VIEW, FRONTAL $0.00 71015,26 CHEST X‐RAY, STEREO, FRONTAL $38.00 71015,TC CHEST X‐RAY, STEREO, FRONTAL $0.00 71020,26 CHEST X‐RAY, TWO VIEWS $38.00 71020,TC CHEST X‐RAY, TWO VIEWS $0.00 71021,26 CHEST X‐RAY, TWO VIEWS $47.00 71021,TC CHEST X‐RAY, TWO VIEWS $0.00 71022,26 CHEST X‐RAY, TWO VIEWS $57.00 71022,TC CHEST X‐RAY, TWO VIEWS $0.00 71023,26 CHEST X‐RAY/FLUOROSCOPY, TWO VIEWS $66.00 71023,TC CHEST X‐RAY/FLUOROSCOPY, TWO VIEWS $0.00 71030,26 CHEST X‐RAY, COMPLETE $55.00 71030,TC CHEST X‐RAY, COMPLETE $0.00 71034,26 CHEST X‐RAY/FLUOROSCOPY, COMPLETE $83.00 71034,TC CHEST X‐RAY/FLUOROSCOPY, COMPLETE $0.00 71035,26 CHEST X‐RAY, SPECIAL VIEWS $32.00 71035,TC CHEST X‐RAY, SPECIAL VIEWS $0.00 71045,26 Radiologic exam chest single view $32.00 71046,26 Radiologic exam chest 2 views $37.00 71100,26 X‐RAY EXAM OF RIBS, ONE SIDE $39.00 71100,TC X‐RAY EXAM OF RIBS, ONE SIDE $0.00 71101,26 X‐RAY EXAM OF RIBS, CHEST, ONE SIDE $48.00 71101,TC X‐RAY EXAM OF RIBS, CHEST, ONE SIDE $0.00 71110,26 X‐RAY EXAM OF RIBS, BOTH SIDES $47.00 71110,TC X‐RAY EXAM OF RIBS, BOTH SIDES $0.00 71111,26 X‐RAY EXAM OF RIBS,CHEST,BOTH SIDES $58.00 71111,TC X‐RAY EXAM OF RIBS,CHEST,BOTH SIDES $0.00 71120,26 X‐RAY EXAM OF BREASTBONE, 2+ VIEWS $35.00 71120,TC X‐RAY EXAM OF BREASTBONE, 2+ VIEWS $0.00 71130,26 X‐RAY EXAM OF STERNOCLAV JOINT(S) $39.00 71130,TC X‐RAY EXAM OF STERNOCLAV JOINT(S) $0.00 71250,26 CAT SCAN OF CHEST $178.00 71250,TC CAT SCAN OF CHEST $0.00 71260,26 CONTRAST CAT SCAN OF CHEST $217.00 71260,TC CONTRAST CAT SCAN OF CHEST $0.00 71270,26 CAT SCANS OF CHEST $240.00 71270,TC CAT SCANS OF CHEST $0.00 71275,26 CTA chest w/o contrast & w contrast $329.00 71275,TC CTA chest w/o contrast & w contrast $0.00 71550,26 MRI OF CHEST $253.00 71550,TC MRI OF CHEST $0.00 71551,26 MRA Chest, w contrast $300.00 71551,TC MRA Chest, w contrast $0.00 71552,26 MRA chest, w/o contrast & w contras $394.00 71552,TC MRA chest, w/o contrast & w contras $0.00 71555,26 MRA OF CHEST (EXCLUDE MYOCARDIUM) $309.00 71555,TC MRA OF CHEST (EXCLUDE MYOCARDIUM) $0.00 72020,26 X‐RAY EXAM OF SPINE, SINGLE VIEW $27.00 72020,TC X‐RAY EXAM OF SPINE, SINGLE VIEW $0.00 72040,26 X‐RAY EXAM OF NECK SPINE $42.00 72040,TC X‐RAY EXAM OF NECK SPINE $0.00 72050,26 X‐RAY EXAM OF NECK SPINE, 4+ VIEWS $56.00 72050,TC X‐RAY EXAM OF NECK SPINE, 4+ VIEWS $0.00 72052,26 X‐RAY EXAM OF NECK SPINE, COMPLETE $65.00 72052,TC X‐RAY EXAM OF NECK SPINE, COMPLETE $0.00 72070,26 X‐RAY EXAM OF THORACIC SPINE $39.00 72070,TC X‐RAY EXAM OF THORACIC SPINE $0.00 72072,26 X‐RAY EXAM OF THORACIC SPINE $38.00 72072,TC X‐RAY EXAM OF THORACIC SPINE $0.00 72074,26 X‐RAY OF THORACIC SPINE, COMPLETE $38.00 72074,TC X‐RAY OF THORACIC SPINE, COMPLETE $0.00 72080,26 X‐RAY EXAM OF TRUNK SPINE $42.00 72080,TC X‐RAY EXAM OF TRUNK SPINE $0.00 72081,26 Radiologic examination, spine, enti $0.00 72081,TC Radiologic examination, spine, enti $0.00 72082,26 2 or 3 views $56.00 72082,TC 2 or 3 views $0.00 72083,26 4 or 5 views $0.00 72083,TC 4 or 5 views $0.00 72084,26 minimum of 6 views $0.00 72084,TC minimum of 6 views $0.00 72100,26 X‐RAY EXAM OF LOWER SPINE $42.00 72100,TC X‐RAY EXAM OF LOWER SPINE $0.00 72110,26 X‐RAY EXAM OF LOWER SPINE, COMPLETE $56.00 72110,TC X‐RAY EXAM OF LOWER SPINE, COMPLETE $0.00 72114,26 X‐RAY EXAM OF LOWER SPINE, COMPLETE $61.00 72114,TC X‐RAY EXAM OF LOWER SPINE, COMPLETE $0.00 72120,26 X‐RAY EXAM OF LOWER SPINE, BENDING $42.00 72120,TC X‐RAY EXAM OF LOWER SPINE, BENDING $0.00 72125,26 CAT SCAN OF NECK SPINE $186.00 72125,TC CAT SCAN OF NECK SPINE $0.00 72126,26 CONTRAST CAT SCAN OF CERVICAL SPINE $212.00 72126,TC CONTRAST CAT SCAN OF CERVICAL SPINE $0.00 72127,26 CAT SCAN OF CERVICAL SPINE $220.00 72127,TC CAT SCAN OF CERVICAL SPINE $0.00 72128,26 CAT SCAN OF THORACIC SPINE $175.00 72128,TC CAT SCAN OF THORACIC SPINE $0.00 72129,26 CONTRAST CAT SCAN OF THORACIC SPINE $212.00 72129,TC CONTRAST CAT SCAN OF THORACIC SPINE $0.00 72130,26 CAT SCAN, THORACIC SPINE $220.00 72130,TC CAT SCAN, THORACIC SPINE $0.00 72131,26 CAT SCAN OF LOWER SPINE $175.00 72131,TC CAT SCAN OF LOWER SPINE $0.00 72132,26 CONTRAST CAT SCAN OF LUMBAR SPINE $212.00 72132,TC CONTRAST CAT SCAN OF LUMBAR SPINE $0.00 72133,26 CAT SCAN OF LUMBAR SPINE $221.00 72133,TC CAT SCAN OF LUMBAR SPINE $0.00 72141,26 MRI OF CERVICAL SPINE $260.00 72141,TC MRI OF CERVICAL SPINE $0.00 72142,26 CONTRAST MRI OF CERVICAL SPINE $313.00 72142,TC CONTRAST MRI OF CERVICAL SPINE $0.00 72146,26 MRI OF THORACIC SPINE $260.00 72146,TC MRI OF THORACIC SPINE $0.00 72147,26 CONTRAST MRI OF THORACIC SPINE $312.00 72147,TC CONTRAST MRI OF THORACIC SPINE $0.00 72148,26 MRI OF LUMBAR SPINE $259.00 72148,TC MRI OF LUMBAR SPINE $0.00 72149,26 CONTRAST MRI OF LUMBAR SPINE $313.00 72149,TC CONTRAST MRI OF LUMBAR SPINE $0.00 72156,26 MRI OF CERVICAL SPINE $418.00 72156,TC MRI OF CERVICAL SPINE $0.00 72157,26 MRI OF THORACIC SPINE $418.00 72157,TC MRI OF THORACIC SPINE $0.00 72158,26 MRI OF LUMBAR SPINE $399.00 72158,TC MRI OF LUMBAR SPINE $0.00 72159,26 MRA OF SPINAL CANAL/CONTENTS $314.00 72159,tc MRA OF SPINAL CANAL/CONTENTS $0.00 72170,26 X‐RAY EXAM OF PELVIS $34.00 72170,TC X‐RAY EXAM OF PELVIS $0.00 72190,26 X‐RAY EXAM OF PELVIS, COMPLETE $41.00 72190,TC X‐RAY EXAM OF PELVIS, COMPLETE $0.00 72191,26 CTA pelvis, w/o contrast w contrast $315.00 72191,TC CTA pelvis, w/o contrast w contrast $0.00 72192,26 CAT SCAN OF PELVIS $190.00 72192,TC CAT SCAN OF PELVIS $0.00 72193,26 CONTRAST CAT SCAN OF PELVIS $203.00 72193,TC CONTRAST CAT SCAN OF PELVIS $0.00 72194,26 CAT SCANS OF PELVIS $212.00 72194,TC CAT SCANS OF PELVIS $0.00 72195,26 MRI PELVIS, W/O CONTRAST $254.00 72195,TC MRI PELVIS, W/O CONTRAST $0.00 72196,26 MRI OF PELVIS $303.00 72196,TC MRI OF PELVIS $0.00 72197,26 MRI PELVIS, W CONTRAST MATERIAL $394.00 72197,TC MRI PELVIS, W CONTRAST MATERIAL $0.00 72198,26 MRA OF PELVIS $310.00 72198,TC MRA OF PELVIS $0.00 72200,26 X‐RAY EXAM OF SACROILIAC JOINTS $31.00 72200,TC X‐RAY EXAM OF SACROILIAC JOINTS $0.00 72202,26 X‐RAY EXAM OF SACROILIAC JOINTS $33.00 72202,TC X‐RAY EXAM OF SACROILIAC JOINTS $0.00 72220,26 X‐RAY EXAM OF TAILBONE, 2+ VIEWS $31.00 72220,TC X‐RAY EXAM OF TAILBONE, 2+ VIEWS $0.00 72240,26 MYELOGRAM OF NECK SPINE $158.00 72240,TC MYELOGRAM OF NECK SPINE $0.00 72255,26 MYELOGRAM OF THORACIC SPINE $162.00 72255,TC MYELOGRAM OF THORACIC SPINE $0.00 72265,26 MYELOGRAM OF LOWER SPINE $145.00 72265,TC MYELOGRAM OF LOWER SPINE $0.00 72270,26 MYELOGRAM OF TOTAL SPINE $233.00 72270,TC MYELOGRAM OF TOTAL SPINE $0.00 72275,26 NULL $136.00 72275,TC NULL $0.00 72285,26 X‐RAY OF NECK SPINE DISK $212.00 72285,TC X‐RAY OF NECK SPINE DISK $0.00 72295,26 X‐RAY OF LOWER SPINE DISK $153.00 72295,TC X‐RAY OF LOWER SPINE DISK $0.00 73000,26 X‐RAY EXAM OF COLLARBONE, COMPLETE $29.00 73000,TC X‐RAY EXAM OF COLLARBONE, COMPLETE $0.00 73010,26 X‐RAY OF SHOULDER BLADE, COMPLETE $35.00 73010,TC X‐RAY OF SHOULDER BLADE, COMPLETE $0.00 73020,26 X‐RAY EXAM OF SHOULDER, ONE VIEW $27.00 73020,TC X‐RAY EXAM OF SHOULDER, ONE VIEW $0.00 73030,26 X‐RAY EXAM OF SHOULDER, COMPLETE $37.00 73030,TC X‐RAY EXAM OF SHOULDER, COMPLETE $0.00 73040,26 CONTRAST X‐RAY OF SHOULDER JOINT $96.00 73040,TC CONTRAST X‐RAY OF SHOULDER JOINT $0.00 73050,26 X‐RAY EXAM OF SHOULDER JOINTS $40.00 73050,TC X‐RAY EXAM OF SHOULDER JOINTS $0.00 73060,26 X‐RAY EXAM OF HUMERUS, 2+ VIEWS $30.00 73060,TC X‐RAY EXAM OF HUMERUS, 2+ VIEWS $0.00 73070,26 X‐RAY EXAM OF ELBOW $28.00 73070,TC X‐RAY EXAM OF ELBOW $0.00 73080,26 X‐RAY EXAM OF ELBOW, COMPLETE $31.00 73080,TC X‐RAY EXAM OF ELBOW, COMPLETE $0.00 73085,26 CONTRAST X‐RAY OF ELBOW JOINT $101.00 73085,TC CONTRAST X‐RAY OF ELBOW JOINT $0.00 73090,26 X‐RAY EXAM OF FOREARM $29.00 73090,TC X‐RAY EXAM OF FOREARM $0.00 73092,26 X‐RAY EXAM OF ARM, INFANT, 2+ VIEWS $28.00 73092,TC X‐RAY EXAM OF ARM, INFANT, 2+ VIEWS $0.00 73100,26 X‐RAY EXAM OF WRIST $33.00 73100,TC X‐RAY EXAM OF WRIST $0.00 73110,26 X‐RAY EXAM OF WRIST, COMPLETE $31.00 73110,TC X‐RAY EXAM OF WRIST, COMPLETE $0.00 73115,26 CONTRAST X‐RAY OF WRIST JOINT $100.00 73115,TC CONTRAST X‐RAY OF WRIST JOINT $0.00 73120,26 X‐RAY EXAM OF HAND, 2 VIEWS $29.00 73120,TC X‐RAY EXAM OF HAND, 2 VIEWS $0.00 73130,26 X‐RAY EXAM OF HAND, 3+ VIEWS $31.00 73130,TC X‐RAY EXAM OF HAND, 3+ VIEWS $0.00 73140,26 X‐RAY EXAM OF FINGER(S), 2+ VIEWS $25.00 73140,TC X‐RAY EXAM OF FINGER(S), 2+ VIEWS $0.00 73200,26 CAT SCAN OF ARM $175.00 73200,TC CAT SCAN OF ARM $0.00 73201,26 CONTRAST CAT SCAN OF ARM $203.00 73201,TC CONTRAST CAT SCAN OF ARM $0.00 73202,26 CAT SCANS OF ARM $212.00 73202,TC CAT SCANS OF ARM $0.00 73206,26 CTA UPPPER EXTMY, W/CON, W.O CONTR $312.00 73206,TC CTA UPPPER EXTMY, W/CON, W.O CONTR $0.00 73218,26 MRI UPPER EXTRMTY, OTHER THAN JNYT $236.00 73218,TC MRI UPPER EXTRMTY, OTHER THAN JNYT $0.00 73219,26 MRI UPPER EXTRMT, W CONTRAST $283.00 73219,TC MRI UPPER EXTRMT, W CONTRAST $0.00 73220,26 MRI OF ARM/HAND $374.00 73220,TC MRI OF ARM/HAND $0.00 73221,26 MRI OF ARM/HAND JOINT $238.00 73221,TC MRI OF ARM/HAND JOINT $0.00 73222,26 MRI ANY JNT UPPR EXTRMTY, W CONTRST $283.00 73222,TC MRI ANY JNT UPPR EXTRMTY, W CONTRST $0.00 73223,26 MRI, ANY JOINT UPPER EXTRMT, W/W/O $374.00 73223,TC MRI, ANY JOINT UPPER EXTRMT, W/W/O $0.00 73225,26 MRA OF UPPER EXTREMITY $297.00 73225,TC MRA OF UPPER EXTREMITY $0.00 73501,26 Radiologic examination, hip, unilat $33.00 73501,TC Radiologic examination, hip, unilat $0.00 73502,26 2‐3 views $39.00 73502,TC 2‐3 views $0.00 73503,26 minimum of 4 views $0.00 73503,TC minimum of 4 views $0.00 73521,26 Radiologic examination, hips, bilat $40.00 73521,TC Radiologic examination, hips, bilat $0.00 73522,26 3‐4 views $53.00 73522,TC 3‐4 views $0.00 73523,26 minimum of 5 views $0.00 73523,TC minimum of 5 views $0.00 73525,26 CONTRAST X‐RAY OF HIP JOINT $101.00 73525,TC CONTRAST X‐RAY OF HIP JOINT $0.00 73551,26 Radiologic examination, femur;1 vie $0.00 73551,TC Radiologic examination, femur;1 vie $0.00 73552,26 minimum 2 views $33.00 73552,TC minimum 2 views $0.00 73560,26 X‐RAY EXAM OF KNEE, 1 OR 2 VIEWS $34.00 73560,TC X‐RAY EXAM OF KNEE, 1 OR 2 VIEWS $0.00 73562,26 X‐RAY EXAM OF KNEE, 3 VIEWS $37.00 73562,TC X‐RAY EXAM OF KNEE, 3 VIEWS $0.00 73564,26 X‐RAY EXAM OF KNEE, 4+ VIEWS $42.00 73564,TC X‐RAY EXAM OF KNEE, 4+ VIEWS $0.00 73565,26 X‐RAY EXAM OF BOTH KNEES, STANDING $35.00 73565,TC X‐RAY EXAM OF BOTH KNEES, STANDING $0.00 73580,26 CONTRAST X‐RAY OF KNEE JOINT $102.00 73580,TC CONTRAST X‐RAY OF KNEE JOINT $0.00 73590,26 X‐RAY EXAM OF LOWER LEG $30.00 73590,TC X‐RAY EXAM OF LOWER LEG $0.00 73592,26 X‐RAY EXAM OF LEG, INFANT, 2+ VIEWS $28.00 73592,TC X‐RAY EXAM OF LEG, INFANT, 2+ VIEWS $0.00 73600,26 X‐RAY EXAM OF ANKLE $29.00 73600,TC X‐RAY EXAM OF ANKLE $0.00 73610,26 X‐RAY EXAM OF ANKLE, COMPLETE $31.00 73610,TC X‐RAY EXAM OF ANKLE, COMPLETE $0.00 73615,26 CONTRAST X‐RAY OF ANKLE JOINT $100.00 73615,TC CONTRAST X‐RAY OF ANKLE JOINT $0.00 73620,26 X‐RAY EXAM OF FOOT $27.00 73620,TC X‐RAY EXAM OF FOOT $0.00 73630,26 X‐RAY EXAM OF FOOT, COMPLETE $29.00 73630,TC X‐RAY EXAM OF FOOT, COMPLETE $0.00 73650,26 X‐RAY EXAM OF HEEL, 2+ VIEWS $28.00 73650,TC X‐RAY EXAM OF HEEL, 2+ VIEWS $0.00 73660,26 X‐RAY EXAM OF TOE(S), 2+ VIEWS $23.00 73660,TC X‐RAY EXAM OF TOE(S), 2+ VIEWS $0.00 73700,26 CAT SCAN OF LEG $175.00 73700,TC CAT SCAN OF LEG $0.00 73701,26 CONTRAST CAT SCAN OF LEG $203.00 73701,TC CONTRAST CAT SCAN OF LEG $0.00 73702,26 CAT SCANS OF LEG $211.00 73702,TC CAT SCANS OF LEG $0.00 73706,26 CTA LOWER EXTRMTY W/O& W CONTRAST $329.00 73706,TC CTA LOWER EXTRMTY W/O& W CONTRAST $0.00 73718,26 MRI LOWER EXTRMTY, OTHER THAN JNT $236.00 73718,TC MRI LOWER EXTRMTY, OTHER THAN JNT $0.00 73719,26 MRI LOWER EXTRMTY, W CONTRAST $281.00 73719,TC MRI LOWER EXTRMTY, W CONTRAST $0.00 73720,26 MRI OF LEG/FOOT $374.00 73720,TC MRI OF LEG/FOOT $0.00 73721,26 MRI OF LEG/FOOT JOINT $238.00 73721,TC MRI OF LEG/FOOT JOINT $0.00 73722,26 MRI JOINT LOWER EXTRMTY W CONTRAST $283.00 73722,TC MRI JOINT LOWER EXTRMTY W CONTRAST $0.00 73723,26 MRI LOWER EXTRMTY W&W/O CONTRAST $374.00 73723,TC MRI LOWER EXTRMTY W&W/O CONTRAST $0.00 73725,26 MRA OF LOWER EXTREMITY $313.00 73725,TC MRA OF LOWER EXTREMITY $0.00 74000,26 X‐RAY EXAM OF ABDOMEN, SINGLE VIEW $32.00 74000,TC X‐RAY EXAM OF ABDOMEN, SINGLE VIEW $0.00 74010,26 X‐RAY EXAM OF ABDOMEN $40.00 74010,TC X‐RAY EXAM OF ABDOMEN $0.00 74018,26 Radiologic exam abdomen 1 view $32.00 74020,26 X‐RAY EXAM OF ABDOMEN, COMPLETE $48.00 74020,TC X‐RAY EXAM OF ABDOMEN, COMPLETE $0.00 74021,26 Radiologic exam abdomen 3+ views $48.00 74022,26 X‐RAY EXAM SERIES, ABDOMEN $56.00 74022,TC X‐RAY EXAM SERIES, ABDOMEN $0.00 74150,26 CAT SCAN OF ABDOMEN $207.00 74150,TC CAT SCAN OF ABDOMEN $0.00 74160,26 CONTRAST CAT SCAN OF ABDOMEN $222.00 74160,TC CONTRAST CAT SCAN OF ABDOMEN $0.00 74170,26 CAT SCANS OF ABDOMEN $244.00 74170,TC CAT SCANS OF ABDOMEN $0.00 74174,26 NULL $381.00 74174,TC NULL $0.00 74175,26 CTA ABDOMEN, W/WO CONTRAST $325.00 74175,TC CTA ABDOMEN, W/WO CONTRAST $0.00 74176,26 CT ABD & PELVIS W/O CONTRAST $304.00 74176,TC CT ABD & PELVIS W/O CONTRAST $0.00 74177,26 CT ABDOMEN&PELVIS W/CONTRAST $317.00 74177,TC CT ABDOMEN&PELVIS W/CONTRAST $0.00 74178,26 CT ABD&PELV 1+ SECTION/REGNS $349.00 74178,TC CT ABD&PELV 1+ SECTION/REGNS $0.00 74181,26 MRI OF ABDOMEN $253.00 74181,TC MRI OF ABDOMEN $0.00 74182,26 MRI ABDOMEN, W/O CONTRAST $301.00 74182,TC MRI ABDOMEN, W/O CONTRAST $0.00 74183,26 MRI ABDOMEN, W/O & W CONTRAST $394.00 74183,TC MRI ABDOMEN, W/O & W CONTRAST $0.00 74185,26 MRA OF ABDOMEN $310.00 74185,TC MRA OF ABDOMEN $0.00 74190,26 X‐RAY EXAM OF PERITONEUM $83.00 74190,TC X‐RAY EXAM OF PERITONEUM $0.00 74210,26 X‐RAY EXAM OF THROAT $62.00 74210,TC X‐RAY EXAM OF THROAT $0.00 74220,26 X‐RAY EXAM OF ESOPHAGUS $81.00 74220,TC X‐RAY EXAM OF ESOPHAGUS $0.00 74230,26 CINEMA X‐RAY OF THROAT/ESOPHAGUS $93.00 74230,TC CINEMA X‐RAY OF THROAT/ESOPHAGUS $0.00 74235,26 X‐RAY, REMOVE OBJECT FROM ESOPHAGUS $235.00 74235,TC X‐RAY, REMOVE OBJECT FROM ESOPHAGUS $0.00 74240,26 X‐RAY EXAM OF UPPER GI TRACT $121.00 74240,TC X‐RAY EXAM OF UPPER GI TRACT $0.00 74241,26 X‐RAY EXAM OF UPPER GI TRACT, W/KUB $121.00 74241,TC X‐RAY EXAM OF UPPER GI TRACT, W/KUB $0.00 74245,26 X‐RAY EXAM UPPER GI TRACT, SM BOWEL $158.00 74245,TC X‐RAY EXAM UPPER GI TRACT, SM BOWEL $0.00 74246,26 CONTRAST X‐RAY OF UPPER GI TRACT $121.00 74246,TC CONTRAST X‐RAY OF UPPER GI TRACT $0.00 74247,26 CONTRAST X‐RAY OF UPPER GI TRACT $121.00 74247,TC CONTRAST X‐RAY OF UPPER GI TRACT $0.00 74249,26 CONTRAST X‐RAY OF UPPER GI TRACT $158.00 74249,TC CONTRAST X‐RAY OF UPPER GI TRACT $0.00 74250,26 X‐RAY EXAM OF SMALL BOWEL $82.00 74250,TC X‐RAY EXAM OF SMALL BOWEL $0.00 74251,26 X‐RAY EXAM OF SMALL BOWEL $121.00 74251,TC X‐RAY EXAM OF SMALL BOWEL $0.00 74260,26 X‐RAY EXAM OF SMALL BOWEL,HYPOTONIC $88.00 74260,TC X‐RAY EXAM OF SMALL BOWEL,HYPOTONIC $0.00 74261,26 CT COLONGRAPHY W/O CONTRAST $420.00 74261,TC CT COLONOGRAPHY W/O CONTRAST $0.00 74262,26 CT COLONOGRAPHY W/CONTRAST $435.00 74262,TC CT COLONOGRAPHY W/CONTRAST $0.00 74270,26 CONTRAST X‐RAY OF COLON, BARIUM $121.00 74270,TC CONTRAST X‐RAY OF COLON, BARIUM $0.00 74280,26 CONTRAST X‐RAY OF COLON, AIR/BARIUM $174.00 74280,TC CONTRAST X‐RAY OF COLON, AIR/BARIUM $0.00 74283,26 THERAPEUTIC ENEMA, CONTRAST OR AIR $356.00 74283,TC THERAPEUTIC ENEMA, CONTRAST OR AIR $0.00 74290,26 CONTRAST X‐RAY, GALLBLADDER $56.00 74290,TC CONTRAST X‐RAY, GALLBLADDER $0.00 74300,26 BILE DUCT/PANCREAS X‐RAY, DURING OP $64.00 74300,TC BILE DUCT/PANCREAS X‐RAY, DURING OP $0.00 74301,26 BILE DUCT/PANCREAS X‐RAY, ADD'L $39.00 74301,TC BILE DUCT/PANCREAS X‐RAY, ADD'L $0.00 74328,26 X‐RAY FOR BILE DUCT ENDOSCOPY $124.00 74328,TC X‐RAY FOR BILE DUCT ENDOSCOPY $0.00 74329,26 X‐RAY FOR PANCREAS ENDOSCOPY $125.00 74329,TC X‐RAY FOR PANCREAS ENDOSCOPY $0.00 74330,26 X‐RAY, BILE DUCT/PANCREAS ENDOSCOPY $161.00 74330,TC X‐RAY, BILE DUCT/PANCREAS ENDOSCOPY $0.00 74340,26 X‐RAY FOR INSERTION OF GI TUBE $95.00 74340,TC X‐RAY FOR INSERTION OF GI TUBE $0.00 74355,26 X‐RAY FOR INTESTINAL TUBE INSERTION $137.00 74355,TC X‐RAY FOR INTESTINAL TUBE INSERTION $0.00 74360,26 X‐RAY FOR DILATION OF GI TRACT $100.00 74360,TC X‐RAY FOR DILATION OF GI TRACT $0.00 74363,26 X‐RAY FOR DILATION OF BILE DUCT(S) $154.00 74363,TC X‐RAY FOR DILATION OF BILE DUCT(S) $0.00 74400,26 X‐RAY OF URINARY TRACT $86.00 74400,TC X‐RAY OF URINARY TRACT $0.00 74410,26 CONTRAST X‐RAY OF URINARY TRACT $84.00 74410,TC CONTRAST X‐RAY OF URINARY TRACT $0.00 74415,26 CONTRAST X‐RAY OF URINARY TRACT $86.00 74415,TC CONTRAST X‐RAY OF URINARY TRACT $0.00 74420,26 X‐RAY OF URINARY TRACT $63.00 74420,TC X‐RAY OF URINARY TRACT $0.00 74425,26 X‐RAY OF URINARY TRACT $62.00 74425,TC X‐RAY OF URINARY TRACT $0.00 74430,26 X‐RAY OF BLADDER, MINIMUM 3 VIEWS $56.00 74430,TC X‐RAY OF BLADDER, MINIMUM 3 VIEWS $0.00 74440,26 X‐RAY EXAM OF MALE GENITAL TRACT $66.00 74440,TC X‐RAY EXAM OF MALE GENITAL TRACT $0.00 74445,26 X‐RAY EXAM OF PENIS $199.00 74445,TC X‐RAY EXAM OF PENIS $0.00 74450,26 X‐RAY EXAM OF URETHRA/BLADDER $59.00 74450,TC X‐RAY EXAM OF URETHRA/BLADDER $0.00 74455,26 VOIDING X‐RAY EXAM, URETHRA/BLADDER $57.00 74455,TC VOIDING X‐RAY EXAM, URETHRA/BLADDER $0.00 74470,26 X‐RAY EXAM OF KIDNEY LESION $92.00 74470,TC X‐RAY EXAM OF KIDNEY LESION $0.00 74485,26 X‐RAY FOR DILATION OF GU TRACT $90.00 74485,TC X‐RAY FOR DILATION OF GU TRACT $0.00 74710,26 X‐RAY FOR MEASUREMENT OF PELVIS $60.00 74710,TC X‐RAY FOR MEASUREMENT OF PELVIS $0.00 74712,26 Magnetic resonance (eg, proton) ima $0.00 74712,TC Magnetic resonance (eg, proton) ima $0.00 74713,26 each additional gestation (List sep $278.00 74713,TC each additional gestation (List sep $0.00 74740,26 X‐RAY EXAM OF FEMALE GENITAL TRACT $66.00 74740,TC X‐RAY EXAM OF FEMALE GENITAL TRACT $0.00 74742,26 X‐RAY GUIDE FOR OVIDUCT CATHETER $108.00 74742,TC X‐RAY GUIDE FOR OVIDUCT CATHETER $0.00 74775,26 X‐RAY EXAM OF PERINEUM $109.00 74775,TC X‐RAY EXAM OF PERINEUM $0.00 75557,26 CARDIAC MRI FOR MORPH $398.00 75557,TC CARDIAC MRI FOR MORPH $0.00 75559,26 CARDIAC MRI W/STRESS IMG $489.00 75559,TC CARDIAC MRI W/STRESS IMG $0.00 75561,26 CARDIAC MRI FOR MORPH W/DYE $440.00 75561,TC CARDIAC MRI FOR MORPH W/DYE $0.00 75563,26 CARD MRI W/STRESS IMG & DYE $502.00 75563,TC CARD MRI W/STRESS IMG & DYE $0.00 75565,26 CARDIAC MRI FOR VELOCITY FLOW $42.00 75565,TC CARDIAC MRI FOR VELOCITY FLOW $0.00 75571,26 CT HEART W/O CONTRAST $100.00 75571,TC CT HEART W/O CONTRAST $0.00 75572,26 CT CARDIAC W/CONTRAST EVAL STRUCTUR $300.00 75572,TC CT HEART W/CONTRAST EVAL CARD STRUC $0.00 75573,26 CT HEART W/CONTRAST CONGEN HRT DIS $436.00 75573,TC CT HEART W/CONTRAST CONGEN HRT DIS $0.00 75574,26 CTA HEART,CORONARY ARTERIES W/CONT $409.00 75574,TC CTA HEART,CORONARY ARTERIES W/CONT $0.00 75600,26 50RAY OF THORACIC AORTA $86.00 75600,TC 50RAY OF THORACIC AORTA $0.00 75605,26 XRAY, THORACIC AORTA W/SERIALOGRAPH $197.00 75605,TC XRAY, THORACIC AORTA W/SERIALOGRAPH $0.00 75625,26 X‐RAY OF ABDOMINAL AORTA $201.00 75625,TC X‐RAY OF ABDOMINAL AORTA $0.00 75630,26 X‐RAY ABDOMINAL AORTA, LEG ARTERIES $314.00 75630,TC X‐RAY ABDOMINAL AORTA, LEG ARTERIES $0.00 75635,26 CTA ABDOMINAL AORTA & BIL ILEOFE RU $415.00 75635,TC CTA ABDOMINAL AORTA & BIL ILEOFE RU $0.00 75658,26 X‐RAY EXAM OF ARM ARTERIES $230.00 75658,TC X‐RAY EXAM OF ARM ARTERIES $0.00 75705,26 X‐RAY EXAM OF SPINAL ARTERIES $417.00 75705,TC X‐RAY EXAM OF SPINAL ARTERIES $0.00 75710,26 X‐RAY EXAM OF ARM/LEG ARTERY $203.00 75710,TC X‐RAY EXAM OF ARM/LEG ARTERY $0.00 75716,26 X‐RAY EXAM OF ARM/LEG ARTERIES $231.00 75716,TC X‐RAY EXAM OF ARM/LEG ARTERIES $0.00 75726,26 X‐RAY EXAM OF VISCERAL ARTERIES $194.00 75726,TC X‐RAY EXAM OF VISCERAL ARTERIES $0.00 75731,26 X‐RAY EXAM OF ADRENAL ARTERY $198.00 75731,TC X‐RAY EXAM OF ADRENAL ARTERY $0.00 75733,26 X‐RAY EXAM OF ADRENAL ARTERIES $218.00 75733,TC X‐RAY EXAM OF ADRENAL ARTERIES $0.00 75736,26 X‐RAY EXAM OF PELVIC ARTERIES $196.00 75736,TC X‐RAY EXAM OF PELVIC ARTERIES $0.00 75741,26 X‐RAY EXAM OF LUNG ARTERY $221.00 75741,TC X‐RAY EXAM OF LUNG ARTERY $0.00 75743,26 X‐RAY EXAM OF LUNG ARTERIES $282.00 75743,TC X‐RAY EXAM OF LUNG ARTERIES $0.00 75746,26 X‐RAY EXAM OF LUNG ARTERIES $195.00 75746,TC X‐RAY EXAM OF LUNG ARTERIES $0.00 75756,26 X‐RAY EXAM OF BREAST ARTERIES $213.00 75756,TC X‐RAY EXAM OF BREAST ARTERIES $0.00 75774,26 X‐RAY OF ARTERIES, ADD'L VESSEL(S) $62.00 75774,TC X‐RAY OF ARTERIES, ADD'L VESSEL(S) $0.00 75791,26 ANGIOGRAPHY, ARTERIO SHUNT COMPL $315.00 75791,TC ANGIOGRAPHY, ARTERIO SHUNT COMPL $0.00 75801,26 X‐RAY EXAM OF ARM/LEG LYMPH VESSEL $169.00 75801,TC X‐RAY EXAM OF ARM/LEG LYMPH VESSEL $0.00 75803,26 X‐RAY EXAM OF ARM/LEG LYMPH VESSELS $207.00 75803,TC X‐RAY EXAM OF ARM/LEG LYMPH VESSELS $0.00 75805,26 X‐RAY EXAM OF TRUNK LYMPH VESSEL $144.00 75805,TC X‐RAY EXAM OF TRUNK LYMPH VESSEL $0.00 75807,26 X‐RAY EXAM OF TRUNK LYMPH VESSELS $207.00 75807,TC X‐RAY EXAM OF TRUNK LYMPH VESSELS $0.00 75809,26 X‐RAY EXAM OF NONVASCULAR SHUNT $83.00 75809,TC X‐RAY EXAM OF NONVASCULAR SHUNT $0.00 75810,26 X‐RAY EXAM OF SPLEEN/LIVER VEINS $203.00 75810,TC X‐RAY EXAM OF SPLEEN/LIVER VEINS $0.00 75820,26 X‐RAY EXAM OF ARM/LEG VEINS $123.00 75820,TC X‐RAY EXAM OF ARM/LEG VEINS $0.00 75822,26 X‐RAY EXAM OF ARMS/LEGS VEINS $185.00 75822,TC X‐RAY EXAM OF ARMS/LEGS VEINS $0.00 75825,26 X‐RAY EXAM OF TRUNK VEINS $203.00 75825,TC X‐RAY EXAM OF TRUNK VEINS $0.00 75827,26 X‐RAY EXAM OF CHEST VEINS $204.00 75827,TC X‐RAY EXAM OF CHEST VEINS $0.00 75831,26 X‐RAY EXAM OF KIDNEY VEINS $219.00 75831,TC X‐RAY EXAM OF KIDNEY VEINS $0.00 75833,26 X‐RAY EXAM OF KIDNEY VEINS $261.00 75833,TC X‐RAY EXAM OF KIDNEY VEINS $0.00 75840,26 X‐RAY EXAM OF ADRENAL VEINS $228.00 75840,TC X‐RAY EXAM OF ADRENAL VEINS $0.00 75842,26 X‐RAY EXAM OF ADRENAL VEINS $258.00 75842,TC X‐RAY EXAM OF ADRENAL VEINS $0.00 75860,26 X‐RAY EXAM OF NECK VEINS $196.00 75860,TC X‐RAY EXAM OF NECK VEINS $0.00 75870,26 X‐RAY EXAM OF SKULL VEINS $198.00 75870,TC X‐RAY EXAM OF SKULL VEINS $0.00 75872,26 X‐RAY EXAM OF SKULL VEINS $203.00 75872,TC X‐RAY EXAM OF SKULL VEINS $0.00 75880,26 X‐RAY EXAM OF EYE SOCKET VEINS $126.00 75880,TC X‐RAY EXAM OF EYE SOCKET VEINS $0.00 75885,26 X‐RAY EXAM OF LIVER VEINS $242.00 75885,TC X‐RAY EXAM OF LIVER VEINS $0.00 75887,26 X‐RAY EXAM OF LIVER VEINS $242.00 75887,TC X‐RAY EXAM OF LIVER VEINS $0.00 75889,26 X‐RAY EXAM OF LIVER VEINS $192.00 75889,TC X‐RAY EXAM OF LIVER VEINS $0.00 75891,26 X‐RAY EXAM OF LIVER VEINS $194.00 75891,TC X‐RAY EXAM OF LIVER VEINS $0.00 75893,26 X‐RAY FOR VENOUS SAMPLE BY CATHETER $94.00 75893,TC X‐RAY FOR VENOUS SAMPLE BY CATHETER $0.00 75894,26 X‐RAY FOR CATHETER EMBOLIZE THERAPY $238.00 75894,TC X‐RAY FOR CATHETER EMBOLIZE THERAPY $0.00 75898,26 FOLLOWUP ANGIOGRAM THRU CATHETER $302.00 75898,TC FOLLOWUP ANGIOGRAM THRU CATHETER $0.00 75901,26 MECH REMVL PERICATH OBSTRTVE MATERL $83.00 75901,TC MECH REMVL PERICATH OBSTRTVE MATERL $0.00 75902,26 MEC REMVL INTRALUMNL THRU cvd $67.00 75902,TC MEC REMVL INTRALUMNL THRU cvd $0.00 75952,26 ENDOVASC REPAIR OF AAA $836.00 75952,TC ENDOVASC REPAIR OF AAA $0.00 75953,26 PLCMNT OF PRXML DEP REPR AAA DISSEC $254.00 75953,TC PLCMNT OF PRXML DEP REPR AAA DISSEC $0.00 75954,26 ENDVASC REPR ILIAC ARTRY ANEURYSM $427.00 75954,TC ENDVASC REPR ILIAC ARTRY ANEURYSM $0.00 75956,26 ENDOVAS REP DES T‐AOR,INV SUBCL ART $1,310.00 75956,TC ENDOVAS REP DES T‐AOR,INV SUBCL ART $0.00 75957,26 ENDOVAS REP D‐AOR,NOT INV SUBCL ART $1,127.00 75957,TC ENDOVAS REP D‐AOR,NOT INV SUBCL ART $0.00 75958,26 PLAC PROX EXT PROST E/VAS REP DES T $748.00 75958,TC PLAC PROX EXT PROST E/VAS REP DES T $0.00 75959,26 PLAC DIS EXT PROS E/VAS REP DESC TH $664.00 75959,TC PLAC DIS EXT PROS E/VAS REP DESC TH $0.00 75962,26 BALLOON ANGIOPLASTY, PERIPH ARTERY $96.00 75962,TC BALLOON ANGIOPLASTY, PERIPH ARTERY $0.00 75964,26 BALLOON ANGIOPLASTY, PERIPH ARTERY $65.00 75964,TC BALLOON ANGIOPLASTY, PERIPH ARTERY $0.00 75966,26 BALLOON ANGIOPLASTY,VISCERAL ARTERY $229.00 75966,TC BALLOON ANGIOPLASTY,VISCERAL ARTERY $0.00 75968,26 BALLOON ANGIOPLASTY,VISCERAL ARTERY $63.00 75968,TC BALLOON ANGIOPLASTY,VISCERAL ARTERY $0.00 75970,26 X‐RAY FOR TRANSCATHETER BIOPSY $142.00 75970,TC X‐RAY FOR TRANSCATHETER BIOPSY $0.00 75978,26 X‐RAY FOR BALLOON ANGIOPLASTY, VEIN $96.00 75978,TC X‐RAY FOR BALLOON ANGIOPLASTY, VEIN $0.00 75984,26 X‐RAY FOR DRAINAGE CATHETER CHANGE $122.00 75984,TC X‐RAY FOR DRAINAGE CATHETER CHANGE $0.00 75989,26 X‐RAY GUIDE FOR DRAINAGE/SPECIMEN $204.00 75989,TC X‐RAY GUIDE FOR DRAINAGE/SPECIMEN $0.00 76000,26 FLUOROSCOPE EXAM $32.00 76000,TC FLUOROSCOPE EXAM $0.00 76001,26 FLUOROSCOPE EXAM, EXTENSIVE $129.00 76001,TC FLUOROSCOPE EXAM, EXTENSIVE $0.00 76010,26 X‐RAY FOR OBJECT, NOSE TO RECTUM $32.00 76010,TC X‐RAY FOR OBJECT, NOSE TO RECTUM $0.00 76080,26 X‐RAY EXAM ABSCESS/FISTULA/SINUS $91.00 76080,TC X‐RAY EXAM ABSCESS/FISTULA/SINUS $0.00 76098,26 X‐RAY EXAM OF SURGICAL SPECIMEN $28.00 76098,TC X‐RAY EXAM OF SURGICAL SPECIMEN $0.00 76100,26 X‐RAY EXAM OF BODY SECTION $112.00 76100,TC X‐RAY EXAM OF BODY SECTION $0.00 76101,26 COMPLEX MOTION BODY SECTION X‐RAY $128.00 76101,TC COMPLEX MOTION BODY SECTION X‐RAY $0.00 76102,26 COMPLEX MOTION BODY SECTION X‐RAYS $132.00 76102,TC COMPLEX MOTION BODY SECTION X‐RAYS $0.00 76120,26 CINEMATIC X‐RAYS $68.00 76120,TC CINEMATIC X‐RAYS $0.00 76125,26 CINEMATIC X‐RAYS W/ROUTINE EXAM $52.00 76125,TC CINEMATIC X‐RAYS W/ROUTINE EXAM $0.00 76376,26 3‐D CT/MRI REQ IMG PROCE INDEP W/ST $34.00 76376,TC 3‐D CT/MRI REQ IMG PROCE INDEP W/ST $0.00 76377,26 3‐D CT/MRI N/REQ ING PROC INDP W/ST $138.00 76377,TC 3‐D CT/MRI N/REQ ING PROC INDP W/ST $0.00 76380,26 CAT SCAN FOLLOWUP STUDY, LIMITED $171.00 76380,TC CAT SCAN FOLLOWUP STUDY, LIMITED $0.00 76506,26 ECHO EXAM OF HEAD/BRAIN $114.00 76506,TC ECHO EXAM OF HEAD/BRAIN $0.00 76510,26 OPTHALM U/S DIAG; B&A SCAN SAME ENC $350.00 76510,TC OPTHALM U/S DIAG; B&A SCAN SAME ENC $0.00 76511,26 ECHO EXAM OF EYE (1D) $182.00 76511,TC ECHO EXAM OF EYE (1D) $0.00 76512,26 ECHO EXAM OF EYE (2D) $187.00 76512,TC ECHO EXAM OF EYE (2D) $0.00 76513,26 ECHO EXAM OF EYE, WATER BATH (2D) $123.00 76513,TC ECHO EXAM OF EYE, WATER BATH (2D) $0.00 76514,26 OPHTH SONO CORNEAL PACHYMETRY UN/BI $34.00 76514,TC OPHTH SONO CORNEAL PACHYMETRY UN/BI $0.00 76516,26 ECHO EXAM OF EYE (1D) $106.00 76516,TC ECHO EXAM OF EYE (1D) $0.00 76519,26 ECHO EXAM OF EYE, CALC LENS POWER $111.00 76519,TC ECHO EXAM OF EYE, CALC LENS POWER $0.00 76529,26 ECHO EXAM OF EYE FOR FOREIGN BODY $116.00 76529,TC ECHO EXAM OF EYE FOR FOREIGN BODY $0.00 76536,26 ECHO EXAM OF HEAD AND NECK TISSUES $97.00 76536,TC ECHO EXAM OF HEAD AND NECK TISSUES $0.00 76604,26 ECHO EXAM OF CHEST $94.00 76604,TC ECHO EXAM OF CHEST $0.00 76641,26 US BREAST UNI REAL TIME WITH IMAGE $127.00 76641,TC US BREAST UNI REAL TIME WITH IMAGE $0.00 76642,26 US BREAST UNI REAL TIME WITH IMAGE $118.00 76642,TC US BREAST UNI REAL TIME WITH IMAGE $0.00 76700,26 ECHO EXAM OF ABDOMEN, COMPLETE $139.00 76700,TC ECHO EXAM OF ABDOMEN, COMPLETE $0.00 76705,26 ECHO EXAM OF ABDOMEN, LIMITED $102.00 76705,TC ECHO EXAM OF ABDOMEN, LIMITED $0.00 76770,26 ECHO EXAM, RETROPERITONEUM,COMPLETE $128.00 76770,TC ECHO EXAM, RETROPERITONEUM,COMPLETE $0.00 76775,26 ECHO EXAM, RETROPERITONEUM,LIMITED $100.00 76775,TC ECHO EXAM, RETROPERITONEUM,LIMITED $0.00 76776,26 US TRANSPLNTD KIDNEY DUPLX & DOPPLR $131.00 76776,TC US TRANSPLNTD KIDNEY DUPLX & DOPPLR $0.00 76800,26 ECHO EXAM SPINAL CANAL AND CORD $221.00 76800,TC ECHO EXAM SPINAL CANAL AND CORD $0.00 76801,26 U/S PREGNANT UTERUS. FIRST TRIMESTE $175.00 76801,TC U/S PREGNANT UTERUS. FIRST TRIMESTE $0.00 76802,26 U/S PRGNT UTERUS, EACH GESTATION $149.00 76802,TC U/S PRGNT UTERUS, EACH GESTATION $0.00 76805,26 ECHO EXAM OF PREG UTERUS, COMPLETE $177.00 76805,TC ECHO EXAM OF PREG UTERUS, COMPLETE $0.00 76810,26 ECHO EXAM OF PREG UTERUS, COMPLETE $176.00 76810,TC ECHO EXAM OF PREG UTERUS, COMPLETE $0.00 76811,26 U/S PREGNT UTERUS, FET& MAT EVALTIO $348.00 76811,TC U/S PREGNT UTERUS, FET& MAT EVALTIO $0.00 76812,26 U/S PREGNT UTERUS, EACH ADD GESTION $327.00 76812,TC U/S PREGNT UTERUS, EACH ADD GESTION $0.00 76813,26 US PREG UTRS IST TRMST TRNSABD/VAGN $216.00 76813,TC US PREG UTRS IST TRMST TRNSABD/VAGN $0.00 76814,26 US PREG UTRS IST TRMST EACH +NL GES $183.00 76814,TC US PREG UTRS IST TRMST EACH +NL GES $0.00 76815,26 ECHO EXAM OF PREG UTERUS, LIMITED $114.00 76815,TC ECHO EXAM OF PREG UTERUS, LIMITED $0.00 76816,26 ECHO EXAM FOLLOWUP OR REPEAT $155.00 76816,TC ECHO EXAM FOLLOWUP OR REPEAT $0.00 76817,26 US PRGNANT UTERUS TRANSVAGINAL $134.00 76817,TC US PRGNANT UTERUS TRANSVAGINAL $0.00 76818,26 ECHO EXAM, FETAL PROFILE $193.00 76818,TC ECHO EXAM, FETAL PROFILE $0.00 76819,26 FETAL BIOPHYSL PROF, NONSTRESS TST $140.00 76819,TC FETAL BIOPHYSL PROF, NONSTRESS TST $0.00 76820,26 DOPP VELOCIMETRY FETAL; UMBL ARTERY $90.00 76820,TC DOPP VELOCIMETRY FETAL; UMBL ARTERY $0.00 76821,26 DOPP VELOCIMETRY FETAL MID CEREB AR $128.00 76821,TC DOPP VELOCIMETRY FETAL MID CEREB AR $0.00 76825,26 ECHO EXAM OF FETAL HEART $292.00 76825,TC ECHO EXAM OF FETAL HEART $0.00 76826,26 ECHO RE‐EXAM OF FETAL HEART $143.00 76826,TC ECHO RE‐EXAM OF FETAL HEART $0.00 76827,26 DOPPLER ECHO EXAM OF FETAL HEART $100.00 76827,TC DOPPLER ECHO EXAM OF FETAL HEART $0.00 76828,26 DOPPLER ECHO RE‐EXAM OF FETAL HEART $100.00 76828,TC DOPPLER ECHO RE‐EXAM OF FETAL HEART $0.00 76830,26 TRANSVAGINAL ECHO EXAM $121.00 76830,TC TRANSVAGINAL ECHO EXAM $0.00 76831,26 UTERUS ECHO EXAM $129.00 76831,TC UTERUS ECHO EXAM $0.00 76856,26 ECHO EXAM OF PELVIS, COMPLETE $120.00 76856,TC ECHO EXAM OF PELVIS, COMPLETE $0.00 76857,26 ECHO EXAM OF PELVIS, LIMITED $87.00 76857,TC ECHO EXAM OF PELVIS, LIMITED $0.00 76870,26 ECHO EXAM OF SCROTUM AND TESTES $111.00 76870,TC ECHO EXAM OF SCROTUM AND TESTES $0.00 76872,26 ECHO EXAM OF PROSTATE $117.00 76872,TC ECHO EXAM OF PROSTATE $0.00 76873,26 NULL $267.00 76873,TC NULL $0.00 76881,26 US XTR NON‐VASC COMPLETE $109.00 76881,TC US XTR NON‐VASC COMPLETE $0.00 76882,26 US XTR NON‐VASC LMTD $86.00 76882,TC US XTR NON‐VASC LMTD $0.00 76885,26 ECHO EXAM, INFANT HIPS, DYNAMIC $129.00 76885,TC ECHO EXAM, INFANT HIPS, DYNAMIC $0.00 76886,26 ECHO EXAM, INFANT HIPS, LIMITED $105.00 76886,TC ECHO EXAM, INFANT HIPS, LIMITED $0.00 76930,26 ULTRASOUND GUIDE FOR HEART SAC TAP $112.00 76932,26 ULTRASOUND GUIDE FOR HEART BIOPSY $113.00 76932,TC ULTRASOUND GUIDE FOR HEART BIOPSY $0.00 76936,26 ULTRASOUND GUIDE FOR ARTERY REPAIR $358.00 76936,TC ULTRASOUND GUIDE FOR ARTERY REPAIR $0.00 76937,26 ULTRA GUID VASCULAR ACCESS $53.00 76937,TC ULTRA GUID VASCULAR ACCESS $0.00 76940,26 ULTRASOUND GUID MON VISCERAL ABLAT $374.00 76940,TC ULTRASOUND GUID MON VISCERAL ABLAT $0.00 76941,26 ULTRASOUND GUIDE, FETAL TRANSFUSION $244.00 76941,TC ULTRASOUND GUIDE, FETAL TRANSFUSION $0.00 76942,26 ULTRASOUND GUIDE FOR NEEDLE BIOPSY $116.00 76942,TC ULTRASOUND GUIDE FOR NEEDLE BIOPSY $0.00 76945,26 CHORIONIC VILLUS SAMPLING GUIDANCE $123.00 76945,TC CHORIONIC VILLUS SAMPLING GUIDANCE $0.00 76946,26 ULTRASOUND GUIDE FOR AMNIOCENTESIS $69.00 76946,TC ULTRASOUND GUIDE FOR AMNIOCENTESIS $0.00 76948,26 ULTRASOUND GUIDE FOR OVA ASPIRATION $73.00 76948,TC ULTRASOUND GUIDE FOR OVA ASPIRATION $0.00 76965,26 ULTRASOUND GUIDE FOR RADIOTHERAPY $230.00 76965,TC ULTRASOUND GUIDE FOR RADIOTHERAPY $0.00 76970,26 ULTRASOUND FOLLOWUP $71.00 76970,TC ULTRASOUND FOLLOWUP $0.00 76975,26 GI ENDOSCOPIC ULTRASOUND $151.00 76975,TC GI ENDOSCOPIC ULTRASOUND $0.00 76977,26 ULTRASOUND BONE DENSITY, PERIPHERAL $11.00 76977,TC ULTRASOUND BONE DENSITY, PERIPHERAL $0.00 76998,26 ULTRASONIC GUIDANCE INTRAOPERATIVE $238.00 76998,TC ULTRASONIC GUIDANCE INTRAOPERATIVE $0.00 77001,26 FLRSCPIC GUIDANCE CVAD PLACMNT S&I $67.00 77001,TC FLRSCPIC GUIDANCE CVAD PLACMNT S&I $0.00 77002,26 0LRSCPC GUIDANCE NEEDL PLACEMENT $99.00 77002,TC FLRSCPC GUIDANCE NEEDL PLACEMENT $0.00 77003,26 FLRSCPC GUDNC & LOCLZTN DX/TX INJC $104.00 77003,TC FLRSCPC GUDNC & LOCLZTN DX/TX INJC $0.00 77011,26 CT GUIDANCE FOR STEREOTACTC LOCLZTN $218.00 77011,TC CT GUIDANCE FOR STEREOTACTC LOCLZTN $0.00 77012,26 CT GUDNCE FOR NEEDLE PLCMENT S&I $200.00 77012,TC CT GUDNCE FOR NEEDLE PLCMENT S&I $0.00 77013,26 CT GUDNCE FOR MONTRNG TISSUE ABLTN $695.00 77013,TC CT GUDNCE FOR MONTRNG TISSUE ABLTN $0.00 77014,26 CT GUDNCE FOR PLCMNT RADTN TX FIELD $150.00 77014,TC CT GUDNCE FOR PLCMNT RADTN TX FIELD $0.00 77021,26 MR GUIDNCE FOR NEEDLE PLCMNT S&I $262.00 77021,TC MR GUIDNCE FOR NEEDLE PLCMNT S&I $0.00 77022,26 MR GUDNCE FOR PARNCHYML TISSU ABLTN $738.00 77022,TC MR GUDNCE FOR PARNCHYML TISSU ABLTN $0.00 77051,26 CAD DIAGNOSTIC MAMMOGRAPHY $11.00 77051,TC CAD DIAGNOSTIC MAMMOGRAPHY $0.00 77052,26 CAD SCREENING MAMMOGRAPHY $11.00 77052,TC CAD SCREENING MAMMOGRAPHY $0.00 77053,26 MAMMARY DUCTOGRAM OR GLACTOGRM SNGL $62.00 77053,TC MAMMARY DUCTOGRAM OR GLACTOGRM SNGL $0.00 77054,26 MAMRY DUCTOGRM/GLCTOGRAM MULTPL DCT $80.00 77054,TC MAMRY DUCTOGRM/GLCTOGRAM MULTPL DCT $0.00 77055,26 MAMMOGRAPHAY UNILATERAL $122.00 77055,TC MAMMOGRAPHAY UNILATERAL $0.00 77056,26 MAMMOGRAPHY BILATERAL $151.00 77056,TC MAMMOGRAPHY BILATERAL $0.00 77057,26 SCRENG MAMMOGRAPHY BILATERAL $122.00 77057,TC SCRENG MAMMOGRAPHY BILATERAL $0.00 77058,26 MRI BREAST W/O AND/OR W CNTRST UNIL $282.00 77058,TC MRI BREAST W/O AND/OR W CNTRST UNIL $0.00 77059,26 MRI BREAST W/O OR W CONTRST BILATRL $282.00 77059,TC MRI BREAST W/O OR W CONTRST BILATRL $0.00 77063,26 SCREENING DIGITAL BREAST TOMOSYNTHE $197.00 77063,TC SCREENING DIGITAL BREAST TOMOSYNTHE $0.00 77072,26 BONE AGE STUDIES $33.00 77072,TC BONE AGE STUDIES $0.00 77073,26 BONE LENGTH STUDIES $54.00 77073,TC BONE LENGTH STUDIES $0.00 77074,26 RADIOLOGICAL EXM OSSEUS SURVY LIMTD $80.00 77074,TC RADIOLOGICAL EXM OSSEUS SURVY LIMTD $0.00 77075,26 RADIOLOGIC EXAM OSSEOUS SRVY COMPLT $94.00 77075,TC RADIOLOGIC EXAM OSSEOUS SRVY COMPLT $0.00 77076,26 RADIOLOGICAL EXAM OSSEUS SRVY INFNT $122.00 77076,TC RADIOLOGICAL EXAM OSSEUS SRVY INFNT $0.00 77077,26 JOINT SURVY SINGL VIEW 2/MORE JOINT $60.00 77077,TC JOINT SURVY SINGL VIEW 2/MORE JOINT $0.00 77078,26 CT BONE MINERAL DENSITY STUDY AXIAL $42.00 77078,TC CT BONE MINERAL DENSITY STUDY AXIAL $0.00 77080,26 DXA BONE DENSITY STUDY 1>MORE AXIAL $35.00 77080,TC DXA BONE DENSITY STUDY 1>MORE AXIAL $0.00 77081,26 DXA APPENDICULAR SKLTN $38.00 77081,TC DXA APPENDICULAR SKLTN $0.00 77084,26 MRI BONE MARROW BLOOD SUPPLY $279.00 77084,TC MRI BONE MARROW BLOOD SUPPLY $0.00 77085,26 DXA BONE DENSITY STUDY AXIAL SKELET $54.00 77085,TC DXA BONE DENSITY STUDY AXIAL SKELET $0.00 77086,26 VERTEBRAL FRACTURE ASSESSMENT VIA D $31.00 77086,TC VERTEBRAL FRACTURE ASSESSMENT VIA D $0.00 77280,26 SET RADIATION THERAPY FIELD, SIMPLE $123.00 77280,TC SET RADIATION THERAPY FIELD, SIMPLE $0.00 77285,26 SET RADIATION THERAPY FIELD, INTERM $187.00 77285,TC SET RADIATION THERAPY FIELD, INTERM $0.00 77290,26 SET RADIATION THERAPY FIELD,COMPLEX $278.00 77290,TC SET RADIATION THERAPY FIELD,COMPLEX $0.00 77293,26 RESPIRATORY MOTION MANAGEMENT SIMU $355.00 77293,TC RESPIRATORY MOTION MANAGEMENT SIMU $0.00 77295,26 SET RADIATION THERAPY FIELD, 3D $757.00 77295,TC SET RADIATION THERAPY FIELD, 3D $0.00 77300,26 RADIATION THERAPY DOSE PLAN $111.00 77300,TC RADIATION THERAPY DOSE PLAN $0.00 77301,26 INTENSITY MODULATED RAD PLAN $1,412.00 77301,TC INTENSITY MODULATED RAD PLAN $0.00 77306,26 TELETHX ISODOSE PLN SMPL W/DOSIMETR $248.00 77306,TC TELETHX ISODOSE PLN SMPL W/DOSIMETR $0.00 77307,26 TELETHX ISODOSE PLN CPLX W/BASIC DO $512.00 77307,TC TELETHX ISODOSE PLN CPLX W/BASIC DO $0.00 77316,26 BRACHYTX ISODOSE PLN SMPL W/DOSIMET $248.00 77316,TC BRACHYTX ISODOSE PLN SMPL W/DOSIMET $0.00 77317,26 BRACHYTX ISODOSE PLN INTERMED W/DOS $325.00 77317,TC BRACHYTX ISODOSE PLN INTERMED W/DOS $0.00 77318,26 BRACHYTX ISODOSE PLN CPLX W/DOSIMET $512.00 77318,TC BRACHYTX ISODOSE PLN CPLX W/DOSIMET $0.00 77321,26 SPECIAL RADIATION THERAPY PORT PLAN $168.00 77321,TC SPECIAL RADIATION THERAPY PORT PLAN $0.00 77331,26 SPECIAL RADIATION DOSIMETRY $154.00 77331,TC SPECIAL RADIATION DOSIMETRY $0.00 77332,26 RADIATION TREATMENT AID(S), SIMPLE $97.00 77332,TC RADIATION TREATMENT AID(S), SIMPLE $0.00 77333,26 RADIATION TREATMENT AID(S),INTERMED $149.00 77333,TC RADIATION TREATMENT AID(S),INTERMED $0.00 77334,26 RADIATION TREATMENT AID(S), COMPLEX $219.00 77334,TC RADIATION TREATMENT AID(S), COMPLEX $0.00 77338,26 ANGIOGRAPHY, ARTERIO SHUNT COMPL $757.00 77338,TC ANGIOGRAPHY, ARTERIO SHUNT COMPL $0.00 77470,26 SPECIAL RADIATION TREATMENT $369.00 77470,TC SPECIAL RADIATION TREATMENT $0.00 77600,26 HYPERTHERMIA TREATMENT, SUPERFICIAL $283.00 77600,TC HYPERTHERMIA TREATMENT, SUPERFICIAL $0.00 77605,26 HYPERTHERMIA TREATMENT, DEEP $431.00 77605,TC HYPERTHERMIA TREATMENT, DEEP $0.00 77610,26 HYPERTHERMIA TREATMENT BY PROBE $323.00 77610,TC HYPERTHERMIA TREATMENT BY PROBE $0.00 77615,26 HYPERTHERMIA TREATMENT BY PROBE $368.00 77615,TC HYPERTHERMIA TREATMENT BY PROBE $0.00 77620,26 HYPERTHERMIA TREATMENT BY PROBE $276.00 77620,TC HYPERTHERMIA TREATMENT BY PROBE $0.00 77750,26 INFUSION OF RADIOACTIVE SOLUTION $882.00 77750,TC INFUSION OF RADIOACTIVE SOLUTION $0.00 77761,26 IMPLANT INTRACAVITARY RADIOELEMENT $675.00 77761,TC IMPLANT INTRACAVITARY RADIOELEMENT $0.00 77762,26 IMPLANT INTRACAVITARY RADIOELEMENT $1,017.00 77762,TC IMPLANT INTRACAVITARY RADIOELEMENT $0.00 77763,26 IMPLANT INTRACAVITARY RADIOELEMENT $1,531.00 77763,TC IMPLANT INTRACAVITARY RADIOELEMENT $0.00 77767,26 Remote afterloading high dose rate $163.00 77767,TC Remote afterloading high dose rate $0.00 77768,26 lesion diameter over 2.0 cm and 2 o $219.00 77768,TC lesion diameter over 2.0 cm and 2 o $0.00 77770,26 Remote afterloading high dose rate $303.00 77770,TC Remote afterloading high dose rate $0.00 77771,26 2‐12 channels $592.00 77771,TC 2‐12 channels $0.00 77772,26 over 12 channels $838.00 77772,TC over 12 channels $0.00 77778,26 IMPLANT INTERSTITIAL RADIOELEMENT $1,971.00 77778,TC IMPLANT INTERSTITIAL RADIOELEMENT $0.00 77789,26 RADIOELEMENT SURFACE APPLICATION $204.00 77789,TC RADIOELEMENT SURFACE APPLICATION $0.00 78012,26 THYROID UPTAKE SINGLE/MULTIPLE QUAN $33.00 78012,TC THYROID UPTAKE SINGLE/MULTIPLE QUAN $0.00 78013,26 THYROID IMAGING WITH VASCULAR FLOW $63.00 78013,TC THYROID IMAGING WITH VASCULAR FLOW $0.00 78014,26 THYROID UPTAKE W/BLOOD FLOW SNGLE/M $85.00 78014,TC THYROID UPTAKE W/BLOOD FLOW SNGLE/M $0.00 78015,26 NUCLEAR SCAN OF THYROID FOR TUMOR $113.00 78015,TC NUCLEAR SCAN OF THYROID FOR TUMOR $0.00 78016,26 EXTENSIVE THYROID SCAN FOR TUMOR $117.00 78016,TC EXTENSIVE THYROID SCAN FOR TUMOR $0.00 78018,26 WHOLE BODY NUCLEAR SCANS, THYROID $143.00 78018,TC WHOLE BODY NUCLEAR SCANS, THYROID $0.00 78020,26 CARCINOMA METAST UPTAKE, THYROID $94.00 78020,TC CARCINOMA METAST UPTAKE, THYROID $0.00 78070,26 NUCLEAR SCAN OF PARATHYROID $134.00 78070,TC NUCLEAR SCAN OF PARATHYROID $0.00 78071,26 PARATHYROID PLANAR IMAGING W/WO SUB $202.00 78071,TC PARATHYROID PLANAR IMAGING W/WO SUB $0.00 78072,26 PARATHYROID IMAGING W/TOMOGRAPHIC S $266.00 78072,TC PARATHYROID IMAGING W/TOMOGRAPHIC S $0.00 78075,26 NUCLEAR SCAN OF ADRENAL GLAND(S) $120.00 78075,TC NUCLEAR SCAN OF ADRENAL GLAND(S) $0.00 78102,26 NUCLEAR SCAN, BONE MARROW, LIMITED $92.00 78102,TC NUCLEAR SCAN, BONE MARROW, LIMITED $0.00 78103,26 NUCLEAR SCANS OF BONE MARROW $125.00 78103,TC NUCLEAR SCANS OF BONE MARROW $0.00 78104,26 NUCLEAR SCAN, BONE MARROW, COMPLETE $132.00 78104,TC NUCLEAR SCAN, BONE MARROW, COMPLETE $0.00 78110,26 NUCLEAR EXAM OF PLASMA VOLUME $33.00 78110,TC NUCLEAR EXAM OF PLASMA VOLUME $0.00 78111,26 NUCLEAR EXAMS OF PLASMA VOLUME $38.00 78111,TC NUCLEAR EXAMS OF PLASMA VOLUME $0.00 78120,26 NUCLEAR EXAM OF RBC VOLUME $40.00 78120,TC NUCLEAR EXAM OF RBC VOLUME $0.00 78121,26 NUCLEAR EXAMS OF RBC VOLUME $56.00 78121,TC NUCLEAR EXAMS OF RBC VOLUME $0.00 78122,26 NUCLEAR EXAM, WHOLE BLOOD VOLUME $74.00 78122,TC NUCLEAR EXAM, WHOLE BLOOD VOLUME $0.00 78130,26 RED CELL SURVIVAL EXAM $107.00 78130,TC RED CELL SURVIVAL EXAM $0.00 78135,26 RED CELL SURVIVAL EXAM $111.00 78135,TC RED CELL SURVIVAL EXAM $0.00 78140,26 NUCLEAR EXAM OF RED BLOOD CELLS $107.00 78140,TC NUCLEAR EXAM OF RED BLOOD CELLS $0.00 78185,26 10CLEAR SCAN OF SPLEEN $69.00 78185,TC 10CLEAR SCAN OF SPLEEN $0.00 78190,26 NUCLEAR EXAM OF PLATELET SURVIVAL $185.00 78190,TC NUCLEAR EXAM OF PLATELET SURVIVAL $0.00 78191,26 NUCLEAR EXAM OF PLATELET SURVIVAL $107.00 78191,TC NUCLEAR EXAM OF PLATELET SURVIVAL $0.00 78195,26 NUCLEAR SCAN OF LYMPH SYSTEM $205.00 78195,TC NUCLEAR SCAN OF LYMPH SYSTEM $0.00 78201,26 NUCLEAR SCAN OF LIVER, STATIC $74.00 78201,TC NUCLEAR SCAN OF LIVER, STATIC $0.00 78202,26 NUCLEAR SCAN OF LIVER/BLOOD FLOW $82.00 78202,TC NUCLEAR SCAN OF LIVER/BLOOD FLOW $0.00 78205,26 NUCLEAR SCAN OF LIVER (3D) $116.00 78205,TC NUCLEAR SCAN OF LIVER (3D) $0.00 78206,26 NUCLEAR SCAN, LIVER, W/VASC FLOW $161.00 78206,TC NUCLEAR SCAN, LIVER, W/VASC FLOW $0.00 78215,26 NUCLEAR SCAN OF LIVER & SPLEEN $84.00 78215,TC NUCLEAR SCAN OF LIVER & SPLEEN $0.00 78216,26 NUCLEAR SCAN OF LIVER & SPLEEN $95.00 78216,TC NUCLEAR SCAN OF LIVER & SPLEEN $0.00 78226,26 NULL $126.00 78226,TC NULL $0.00 78227,26 NULL $155.00 78227,TC NULL $0.00 78230,26 NUCLEAR SCAN OF SALIVARY GLAND $74.00 78230,TC NUCLEAR SCAN OF SALIVARY GLAND $0.00 78231,26 NUCLEAR SCANS OF SALIVARY GLAND $92.00 78231,TC NUCLEAR SCANS OF SALIVARY GLAND $0.00 78232,26 NUCLEAR EXAM, SALIVARY GLAND FUNCT $69.00 78232,TC NUCLEAR EXAM, SALIVARY GLAND FUNCT $0.00 78258,26 NUCLEAR IMAGING OF ESOPHAGUS $126.00 78258,TC NUCLEAR IMAGING OF ESOPHAGUS $0.00 78261,26 NUCLEAR SCAN OF GASTRIC MUCOSA $119.00 78261,TC NUCLEAR SCAN OF GASTRIC MUCOSA $0.00 78262,26 NUCLEAR EXAM OF GULLET REFLUX $113.00 78262,TC NUCLEAR EXAM OF GULLET REFLUX $0.00 78264,26 NUCLEAR EXAM OF STOMACH EMPTYING $134.00 78264,TC NUCLEAR EXAM OF STOMACH EMPTYING $0.00 78265,26 Gastric emptying imaging study (eg, $144.00 78265,TC Gastric emptying imaging study (eg, $0.00 78266,26 Gastric emptying imaging study (eg, $159.00 78266,TC Gastric emptying imaging study (eg, $0.00 78270,26 NUCLEAR EXAMS, VIT B‐12 ABSORPTION $37.00 78270,TC NUCLEAR EXAMS, VIT B‐12 ABSORPTION $0.00 78271,26 NUCLEAR EXAMS, VIT B‐12 ABSORPTION $35.00 78271,TC NUCLEAR EXAMS, VIT B‐12 ABSORPTION $0.00 78272,26 NUCLEAR EXAMS, VIT B‐12 ABSORPTION $47.00 78272,TC NUCLEAR EXAMS, VIT B‐12 ABSORPTION $0.00 78278,26 NUCLEAR SCAN FOR GI BLOOD LOSS $169.00 78278,TC NUCLEAR SCAN FOR GI BLOOD LOSS $0.00 78282,26 NUCLEAR EXAM OF GI PROTEIN LOSS $67.00 78282,TC NUCLEAR EXAM OF GI PROTEIN LOSS $0.00 78290,26 NUCLEAR SCAN OF BOWEL $117.00 78290,TC NUCLEAR SCAN OF BOWEL $0.00 78291,26 TEST ABDOMINAL VENOUS DRAIN $145.00 78291,TC TEST ABDOMINAL VENOUS DRAIN $0.00 78300,26 NUCLEAR SCAN OF BONE, LIMITED $109.00 78300,TC NUCLEAR SCAN OF BONE, LIMITED $0.00 78305,26 NUCLEAR SCAN OF BONES, MULTIPLE $143.00 78305,TC NUCLEAR SCAN OF BONES, MULTIPLE $0.00 78306,26 NUCLEAR SCAN OF SKELETON $147.00 78306,TC NUCLEAR SCAN OF SKELETON $0.00 78315,26 NUCLEAR SCAN OF BONE, 3‐PHASE $173.00 78315,TC NUCLEAR SCAN OF BONE, 3‐PHASE $0.00 78320,26 NUCLEAR SCAN OF BONE (3D) $173.00 78320,TC NUCLEAR SCAN OF BONE (3D) $0.00 78414,26 NUCLEAR EXAM OF HEART CIRCULATION $77.00 78414,TC NUCLEAR EXAM OF HEART CIRCULATION $0.00 78428,26 NUCLEAR EXAM OF HEART SHUNT $129.00 78428,TC NUCLEAR EXAM OF HEART SHUNT $0.00 78445,26 NUCLEAR SCAN, BLOOD FLOW, NON‐CARD $79.00 78445,TC NUCLEAR SCAN, BLOOD FLOW, NON‐CARD $0.00 78451,26 MYOCARDIAL PERFUSION IMAGING $230.00 78451,TC MYOCARDIAL PERFUSION IMAGING $0.00 78452,26 MULTIPLE STUDIES AT REST AND STRESS $270.00 78452,TC MULTIPLE STUDIES AT REST AND STRESS $0.00 78453,26 MYOCARDIAL PERFUSION IMAG PLANAR $170.00 78453,TC NULL $0.00 78454,26 NULL $231.00 78454,TC MYOCARDIAL PERFUSION IMAG PLANAR $0.00 78456,26 NULL $166.00 78456,TC NULL $0.00 78457,26 NUCLEAR SCAN VEIN CLOT, ONE SIDE $136.00 78457,TC NUCLEAR SCAN VEIN CLOT, ONE SIDE $0.00 78458,26 NUCLEAR SCAN VEIN CLOT, BOTH SIDES $139.00 78458,TC NUCLEAR SCAN VEIN CLOT, BOTH SIDES $0.00 78459,26 MYOCARDIAL PET METABOLIC EVALUATION $248.00 78459,TC MYOCARDIAL PET METABOLIC EVALUATION $0.00 78466,26 NUCLEAR SCAN OF HEART MUSCLE $120.00 78466,TC NUCLEAR SCAN OF HEART MUSCLE $0.00 78468,26 NUCLEAR SCAN OF HEART MUSCLE $133.00 78468,TC NUCLEAR SCAN OF HEART MUSCLE $0.00 78469,26 NUCLEAR SCAN OF HEART MUSCLE (3D) $156.00 78469,TC NUCLEAR SCAN OF HEART MUSCLE (3D) $0.00 78472,26 NUCLEAR SCAN, CARDIAC BLOOD POOL $165.00 78472,TC NUCLEAR SCAN, CARDIAC BLOOD POOL $0.00 78473,26 NUCLEAR SCAN, CARDIAC MUGA $243.00 78473,TC NUCLEAR SCAN, CARDIAC MUGA $0.00 78481,26 NUCLEAR SCAN, CARDIAC BLOOD POOL $162.00 78481,TC NUCLEAR SCAN, CARDIAC BLOOD POOL $0.00 78483,26 NUCLEAR SCANS, CARDIAC BLOOD POOL $243.00 78483,TC NUCLEAR SCANS, CARDIAC BLOOD POOL $0.00 78491,26 MYOCARDIAL PET, SINGLE $251.00 78491,TC MYOCARDIAL PET, SINGLE $0.00 78492,26 MYOCARDIAL PET, MULTIPLE $310.00 78492,TC MYOCARDIAL PET, MULTIPLE $0.00 78494,26 NUCLEAR BLOOD POOL IMAGING $199.00 78494,TC NUCLEAR BLOOD POOL IMAGING $0.00 78496,26 NUCLEAR BLOOD POOL IMAGING, SINGLE $83.00 78496,TC NUCLEAR BLOOD POOL IMAGING, SINGLE $0.00 78579,26 NULL $82.00 78579,TC NULL $0.00 78580,26 NUCLEAR SCAN OF LUNG, PARTICULATE $126.00 78580,TC NUCLEAR SCAN OF LUNG, PARTICULATE $0.00 78582,26 NULL $183.00 78582,TC NULL $0.00 78597,26 NULL $121.00 78597,TC NULL $0.00 78598,26 NULL $143.00 78598,TC NULL $0.00 78600,26 BRAIN IMAGING, LIMITED, STATIC $79.00 78600,TC BRAIN IMAGING, LIMITED, STATIC $0.00 78601,26 BRAIN IMAGING, LIMITED W/BLOOD FLOW $87.00 78601,TC BRAIN IMAGING, LIMITED W/BLOOD FLOW $0.00 78605,26 BRAIN IMAGING, COMPLETE, STATIC $93.00 78605,TC BRAIN IMAGING, COMPLETE, STATIC $0.00 78606,26 BRAIN IMAGING, COMPLETE W/BLOOD FLW $108.00 78606,TC BRAIN IMAGING, COMPLETE W/BLOOD FLW $0.00 78607,26 BRAIN IMAGING, COMPLETE, (SPECT) $203.00 78607,TC BRAIN IMAGING, COMPLETE, (SPECT) $0.00 78608,26 BRAIN IMAGING, PET, METABOLIC EVAL $252.00 78608,TC BRAIN IMAGING, PET, METABOLIC EVAL $0.00 78610,26 NUCLEAR SCAN OF BRAIN/BLOOD FLOW $53.00 78610,TC NUCLEAR SCAN OF BRAIN/BLOOD FLOW $0.00 78630,26 CEREBROSPINAL FLUID FLOW SCAN $117.00 78630,TC CEREBROSPINAL FLUID FLOW SCAN $0.00 78635,26 CEREBROSPINAL FLUID FLOW SCAN $106.00 78635,TC CEREBROSPINAL FLUID FLOW SCAN $0.00 78645,26 CEREBROSPINAL FLUID FLOW SCAN $96.00 78645,TC CEREBROSPINAL FLUID FLOW SCAN $0.00 78647,26 CEREBROSPINAL FLUID FLOW SCAN $156.00 78647,TC CEREBROSPINAL FLUID FLOW SCAN $0.00 78650,26 CEREBROSPINAL FLUID FLOW SCAN $104.00 78650,TC CEREBROSPINAL FLUID FLOW SCAN $0.00 78660,26 NUCLEAR EXAM OF TEAR FLOW $93.00 78660,TC NUCLEAR EXAM OF TEAR FLOW $0.00 78700,26 NUCLEAR SCAN OF KIDNEY $76.00 78700,TC NUCLEAR SCAN OF KIDNEY $0.00 78701,26 NUCLEAR SCAN OF KIDNEY/BLOOD FLOW $83.00 78701,TC NUCLEAR SCAN OF KIDNEY/BLOOD FLOW $0.00 78707,26 KIDNEY IMAGE, SINGL W/O DRUG INTERV $161.00 78707,TC KIDNEY IMAGE, SINGL W/O DRUG INTERV $0.00 78708,26 KIDNEY IMAGE, SINGL W/DRUG INTERV $203.00 78708,TC KIDNEY IMAGE, SINGL W/DRUG INTERV $0.00 78709,26 KIDNEY IMAGE, MULT W/& W/O DRUG INT $236.00 78709,TC KIDNEY IMAGE, MULT W/& W/O DRUG INT $0.00 78710,26 NUCLEAR SCAN OF KIDNEY (SPECT) $105.00 78710,TC NUCLEAR SCAN OF KIDNEY (SPECT) $0.00 78725,26 NUCLEAR EXAM OF KIDNEY $63.00 78725,TC NUCLEAR EXAM OF KIDNEY $0.00 78730,26 NUCLEAR EXAM OF BLADDER $27.00 78730,TC NUCLEAR EXAM OF BLADDER $0.00 78740,26 NUCLEAR EXAM OF URETER $95.00 78740,TC NUCLEAR EXAM OF URETER $0.00 78761,26 NUCLEAR SCAN OF TESTES/BLOOD FLOW $124.00 78761,TC NUCLEAR SCAN OF TESTES/BLOOD FLOW $0.00 78800,26 NUCLEAR EXAM OF TUMOR, LIMITED $120.00 78800,TC NUCLEAR EXAM OF TUMOR, LIMITED $0.00 78801,26 NUCLEAR EXAM OF TUMORS $142.00 78801,TC NUCLEAR EXAM OF TUMORS $0.00 78802,26 NUCLEAR EXAM OF TUMORS, WHOLE BODY $144.00 78802,TC NUCLEAR EXAM OF TUMORS, WHOLE BODY $0.00 78803,26 NUCLEAR SCAN OF TUMOR (SPECT) $179.00 78803,TC NUCLEAR SCAN OF TUMOR (SPECT) $0.00 78804,26 RADIOPHARM LOCAL TUMOR/WHOLE BODY $179.00 78804,TC RADIOPHARM LOCAL TUMOR/WHOLE BODY $0.00 78805,26 NUCLEAR EXAM OF ABSCESS, LIMITED $124.00 78805,TC NUCLEAR EXAM OF ABSCESS, LIMITED $0.00 78806,26 NUCLEAR EXAM OF ABSCESS, WHOLE BODY $144.00 78806,TC NUCLEAR EXAM OF ABSCESS, WHOLE BODY $0.00 78807,26 NUCLEAR LOCALIZATION OF ABSCESS $177.00 78807,TC NUCLEAR LOCALIZATION OF ABSCESS $0.00 78811,26 TUMOR IMG, PET; LTD AREA CHT,HED,NK $278.00 78811,TC TUMOR IMG, PET; LTD AREA CHT,HED,NK $0.00 78812,26 TUMOR IMG, PET; SKULL BASE‐MID THIG $330.00 78812,TC TUMOR IMG, PET; SKULL BASE‐MID THIG $0.00 78813,26 TUMOR IMG, PET; WHOLE BODY $348.00 78813,TC TUMOR IMG, PET; WHOLE BODY $0.00 78814,26 TUMOR IMG,PET W/ CT; LTD AREA $384.00 78814,TC TUMOR IMG,PET W/ CT; LTD AREA $0.00 78815,26 TUMOR IMG, PET W/CT; SKULL‐MIDTHIGH $423.00 78815,TC TUMOR IMG, PET W/CT; SKULL‐MIDTHIGH $0.00 78816,26 TUMOR IMG, PET W/CT; WHOLE BODY $426.00 78816,TC TUMOR IMG, PET W/CT; WHOLE BODY $0.00 79005,26 RADIOPHARMACEUTICAL THERP, ORAL ADM $302.00 79005,TC RADIOPHARMACEUTICAL THERP, ORAL ADM $0.00 79101,26 RADIOPHARMACEUTICAL THERP, IV ADM $332.00 79101,TC RADIOPHARMACEUTICAL THERP, IV ADM $0.00 79200,26 INTRACAVITARY RADIOTHERAPY $350.00 79200,TC INTRACAVITARY RADIOTHERAPY $0.00 79300,26 INTERSTITIAL RADIOTHERAPY $283.00 79300,TC INTERSTITIAL RADIOTHERAPY $0.00 79403,26 MONOCLONAL ANTIBODY BY INTRAVENOUS $383.00 79403,TC MONOCLONAL ANTIBODY BY INTRAVENOUS $0.00 79440,26 INTRA‐ARTICULAR RADIOTHERAPY $330.00 79440,TC INTRA‐ARTICULAR RADIOTHERAPY $0.00 79445,26 RADIOTHERAPY INTRA‐ARTERIAL ADM $403.00 79445,TC RADIOTHERAPY INTRA‐ARTERIAL ADM $0.00 80047,QW METABOLIC PANEL IONIZED CA $27.00 80048,QW Basic metabolic panel $27.00 80051,QW ELECTROLYTE PANEL % $23.00 80053,QW Comprehensive metabolic panel $41.00 80061,QW LIPID PROFILE % $57.00 80069,QW Renal function panel $34.00 80178,QW ASSAY, LITHIUM % $28.00 81003,QW URINALYSIS, AUTOMATED, W/O SCOPE % $10.00 81007,QW URINE SCREEN FOR BACTERIA % $11.00 82010,QW ACETONE ASSAY % $35.00 82040,QW ASSAY, SERUM ALBUMIN % $21.00 82042,QW TEST FOR URINE ALBUMIN % $12.00 82043,QW TEST FOR MICROALBUMIN % $25.00 82044,QW MICROALBUMIN, SEMIQUANTITATIVE % $13.00 82120,QW Amines, vaginal fluid, qualitative $16.00 82150,QW ASSAY, SERUM AMYLASE % $28.00 82247,QW ASSAY BLOOD BILIRUBIN, TOTAL % $21.00 82271,QW BLOOD,OCCULT‐PEROX ACT QUAL,OT SOUR $14.00 82272,QW BLD,OCCULT‐PEROX,QUAL,FEC.‐SIN SPEC $14.00 82274,QW Blood oclt(fec hb dtr)1‐3 simul dtr $68.00 82310,QW ASSAY CALCIUM IN BLOOD, TOTAL % $22.00 82330,QW ASSAY IONIZED CALCIUM IN BLOOD % $30.00 82374,QW ASSAY BLOOD CARBON DIOXIDE % $21.00 82435,QW ASSAY, BLOOD CHLORIDES % $20.00 82465,QW ASSAY, SERUM CHOLESTEROL % $18.00 82523,QW ASSAY, COLLAGEN CROSS LINKS % $79.00 82550,QW ASSAY CPK IN BLOOD % $28.00 82565,QW ASSAY, BLOOD CREATININE % $22.00 82570,QW ASSAY, CREATININE, OTHER SOURCES % $22.00 82679,QW ASSAY, ESTRONE % $106.00 82947,QW ASSAY BODY FLUID, GLUCOSE % $17.00 82950,QW GLUCOSE TEST % $20.00 82951,QW GLUCOSE TOLERANCE TEST (GTT) % $55.00 82952,QW GTT‐ADDED SAMPLES % $12.00 82977,QW ASSAY, GGT ENZYME % $31.00 82985,QW GLYCOPROTEIN ELECTROPHORESIS % $64.00 83001,QW ASSAY, PITUITARY GONADOTROPIN % $79.00 83002,QW ASSAY, PITUITARY GONADOTROPINS % $79.00 83020,26 ASSAY HEMOGLOBIN, ELECTROPHORESIS % $68.00 83036,QW GLYCOSYLATED HEMOGLOBIN ASSAY % $41.00 83037,QW Hb GLYCOSYLATED DEV CLE FDA HOM USE $41.00 83516,QW IMMUNOASSAY, ANALYTE (NON‐INFECT) % $36.00 83518,QW IMMUNOASSAY, ANALYTE (NOT ANTIBODY% $25.00 83520,QW IMMUNOASSAY, ANALYTE NOS % $55.00 83605,QW LACTIC ACID ASSAY % $37.00 83655,QW ASSAY BLOOD FOR LEAD % $51.00 83718,QW BLOOD LIPOPROTEIN ASSAY, HDL % $35.00 83721,QW BLOOD LIPOPROTEIN ASSAY, LDL % $41.00 83861,QW MICROFLUID ANALY TEARS $68.00 83880,QW Natriuretic peptide $144.00 83986,QW ASSAY, BODY FLUID ACIDITY % $14.00 84075,QW ASSAY ALKALINE PHOSPHATASE % $22.00 84132,QW ASSAY, BLOOD POTASSIUM % $20.00 84155,QW ASSAY SERUM PROTEIN, TOTAL % $16.00 84157,QW Protein,tot,except by refrac;oth so $16.00 84165,26 ASSAY SERUM PROTEIN,ELECTROPHORETI% $68.00 84166,26 PROTEIN E‐PHORESIS/URINE/CSF % $68.00 84181,26 WESTERN BLOT TEST % $68.00 84182,26 WESTERN BLOT W/IMMUNOLOGIC PROBE % $66.00 84295,QW ASSAY, BLOOD SODIUM % $20.00 84443,QW ASSAY THYROID STIMULATING HORMONE % $71.00 84450,QW UV‐ASSAY, TRANSAMINASE (SGOT) % $22.00 84460,QW UV‐ASSAY, TRANSAMINASE (SGPT) % $23.00 84478,QW ASSAY, BLOOD TRIGLYCERIDES % $24.00 84520,QW ASSAY, BUN % $17.00 84550,QW ASSAY, URIC ACID, BLOOD % $19.00 84703,QW CHORIONIC GONADOTROPIN ASSAY % $32.00 85014,QW HEMATOCRIT BLOOD COUNT % $10.00 85018,QW HEMOGLOBIN COUNT, COLORIMETRIC % $10.00 85390,26 FIBRINOLYSINS/COAGULOPATHY SCREEN % $68.00 85576,26 BLOOD PLATELET AGGREGATION,IN VITR% $68.00 85576,QW BLOOD PLATELET AGGREGATION,IN VITR% $91.00 85610,QW PROTHROMBIN TIME % $17.00 86153,26 CELL ENUMERATION IMMUNE SELECTJ & I $117.00 86255,26 FLUOR ANTIBODY SCRN, NON‐INFECT, E% $68.00 86256,26 FLUORESCENT ANTIBODY TITER, EACH % $63.00 86294,QW Immunoassay‐tumor antig,qual/semiqu $69.00 86308,QW HETEROPHILE ANTIBODY SCREEN % $22.00 86318,QW IMMUNOASSAY, INFECT AGENT ANTIBODY% $55.00 86320,26 SERUM IMMUNOELECTROPHORESIS % $62.00 86325,26 IMMUNOELECTROPHORESIS, OTHER FLUID% $62.00 86327,26 IMMUNOELECTROPHORESIS ASSAY (2‐D) % $77.00 86334,26 IMMUNOFIXATION ELECTROPHORESIS % $66.00 86335,26 IMMUNFIX E‐PHORSIS/URINE/CSF $68.00 86386,QW NUCLEAR MATRIX PROTEIN 22 $65.00 86618,QW ANTIBODY, LYME DISEASE % $72.00 86701,QW ANTIBODY, HIV‐1 % $38.00 86780,QW TREPONEMA PALLIDUM $0.00 86803,QW ANTIBODY, HEPATITIS C $58.00 87077,QW Culture, bacterial; aerobic isolate $34.00 87164,26 DARK FIELD EXAMINATION,W/COLLECTIO% $66.00 87207,26 SMEAR, STAIN & INTERPRET, SPECIAL % $68.00 87210,QW SMEAR, STAIN & INTERPRET, WET % $18.00 87389,QW HIV‐1 AG W/HIV‐1 & HIV‐2 AB $0.00 87449,QW INFCT ANTIGEN, MULT STEP NOS % $37.00 87502,QW INFLUENZA DNA AMP PROBE $0.00 87650,QW INFCT ANTIGN, STREPTOCOCCUS A, DIR% $0.00 87651,QW INFECT ANTIGN, STREPTOCOCCUS A AMP% $0.00 87804,QW infec ag anti det dir op obs;influe $37.00 87806,QW IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV $0.00 87807,QW INF AGENT ANTIGEN DET RESP SYNC VIR $37.00 87808,QW inf ag anti det dir op ob;trich vag $37.00 87809,QW Adenovirus assay w/optic $37.00 87880,QW INFCTS ANTIGN, STREPTOCOCCUS GRP A% $37.00 87899,QW INFCTS ANTIGN, NOS % $37.00 87905,QW Sialidase enzyme assay $52.00 88104,26 MICROSCOPIC EXAM OF CELLS, SMEARS % $100.00 88104,TC MICROSCOPIC EXAM OF CELLS, SMEARS % $0.00 88106,26 MICROSCOPIC EXAM OF CELLS, FILTER % $69.00 88106,TC MICROSCOPIC EXAM OF CELLS, FILTER % $0.00 88108,26 MICROSCOPIC CELL EXAM (SACCOMANNO)% $79.00 88108,TC MICROSCOPIC CELL EXAM (SACCOMANNO)% $0.00 88112,26 CYTOPATHOLOGY CELL ENHANCEMENT % $193.00 88112,TC CYTOPATHOLOGY CELL ENHANCEMENT $0.00 88120,26 CYTP URNE 3‐5 PROBES EA SPEC $200.00 88120,TC CYTP URNE 3‐5 PROBES EA SPEC $0.00 88121,26 CYTP URINE 3‐5 PROBES CMPTR $173.00 88121,TC CYTP URINE 3‐5 PROBES CMPTR $0.00 88125,26 FORENSIC CYTOPATHOLOGY % $48.00 88125,TC FORENSIC CYTOPATHOLOGY % $0.00 88160,26 CYTOPATHOLOGY, SCREEN/INTERPRET % $91.00 88160,TC CYTOPATHOLOGY, SCREEN/INTERPRET % $0.00 88161,26 CYTOPATHOLOGY,PREP/SCREEN/INTERPRE% $87.00 88161,TC CYTOPATHOLOGY,PREP/SCREEN/INTERPRE% $0.00 88162,26 CYTOPATHOLOGY, EXTENSIVE STUDY % $138.00 88162,TC CYTOPATHOLOGY, EXTENSIVE STUDY % $0.00 88172,26 EVALUATION OF SMEAR % $128.00 88172,TC EVALUATION OF SMEAR % $0.00 88173,26 INTERPRETATION OF SMEAR % $248.00 88173,TC INTERPRETATION OF SMEAR % $0.00 88177,26 CYTP C/V AUTO THIN LYR ADDL $78.00 88177,TC CYTP C/V AUTO THIN LYR ADDL $0.00 88182,26 CELL MARKER STUDY, CELL CYCLE/DNA % $124.00 88182,TC CELL MARKER STUDY, CELL CYCLE/DNA % $0.00 88300,26 TISSUE EXAM BY PATHOLOGIST, LEVEL % $17.00 88300,TC TISSUE EXAM BY PATHOLOGIST, LEVEL % $0.00 88302,26 TISSUE EXAM BY PATHOLOGIST, LVL II% $26.00 88302,TC TISSUE EXAM BY PATHOLOGIST, LVL II% $0.00 88304,26 TISSUE EXAM BY PATHOLOGIST, LVL II% $40.00 88304,TC TISSUE EXAM BY PATHOLOGIST, LVL II% $0.00 88305,26 TISSUE EXAM BY PATHOLOGIST, LVL IV% $133.00 88305,TC TISSUE EXAM BY PATHOLOGIST, LVL IV% $0.00 88307,26 TISSUE EXAM BY PATHOLOGIST, LEVEL % $293.00 88307,TC TISSUE EXAM BY PATHOLOGIST, LEVEL % $0.00 88309,26 TISSUE EXAM BY PATHOLOGIST, LVL VI% $520.00 88309,TC TISSUE EXAM BY PATHOLOGIST, LVL VI% $0.00 88311,26 DECALCIFICATION OF TISSUE % $45.00 88311,TC DECALCIFICATION OF TISSUE % $0.00 88312,26 SPECIAL STAINS, GROUP I % $94.00 88312,TC SPECIAL STAINS, GROUP I % $0.00 88313,26 SPECIAL STAINS, GROUP II % $42.00 88313,TC SPECIAL STAINS, GROUP II % $0.00 88314,26 HISTOCHEMICAL STAIN % $78.00 88314,TC HISTOCHEMICAL STAIN % $0.00 88319,26 ENZYME CONSTITUENT HISTOCHEMISTRY % $96.00 88319,TC ENZYME CONSTITUENT HISTOCHEMISTRY % $0.00 88323,26 MICROSLIDE PREPARATION/CONSULTATIO% $297.00 88323,TC MICROSLIDE PREPARATION/CONSULTATIO% $0.00 88331,26 PATHOLOGY CONSULTATION IN SURGERY % $220.00 88331,TC PATHOLOGY CONSULTATION IN SURGERY % $0.00 88332,26 PATHOLOGY CONSULTATION IN SURGERY % $108.00 88332,TC PATHOLOGY CONSULTATION IN SURGERY % $0.00 88333,26 PATH CONS SURG CYTOLOG EXAM INI SIT $221.00 88333,TC PATH CONS SURG CYTOLOG EXAM INI SIT $0.00 88334,26 PATH CONS SURG CYTOLO EXAM ADD SITE $136.00 88334,TC PATH CONS SURG CYTOLO EXAM ADD SITE $0.00 88341,26 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY $93.00 88341,TC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY $0.00 88342,26 IMMUNOCYTOCHEMISTRY, EACH % $140.00 88342,TC IMMUNOCYTOCHEMISTRY, EACH % $0.00 88344,26 IMHISTOCHEM/CYTCHM EA MULTIPLEX ANT $137.00 88344,TC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANT $0.00 88346,26 IMMUNOFLUORESCENT STUDY, DIRECT % $142.00 88346,TC IMMUNOFLUORESCENT STUDY, DIRECT % $0.00 88348,26 ELECTRON MICROSCOPY, DIAGNOSTIC % $264.00 88348,TC ELECTRON MICROSCOPY, DIAGNOSTIC % $0.00 88350,26 each additional single antibody sta $0.00 88350,TC each additional single antibody sta $0.00 88355,26 ANALYSIS, SKELETAL MUSCLE % $278.00 88355,TC ANALYSIS, SKELETAL MUSCLE % $0.00 88356,26 ANALYSIS, NERVE % $442.00 88356,TC ANALYSIS, NERVE % $0.00 88358,26 ANALYSIS, TUMOR % $153.00 88358,TC ANALYSIS, TUMOR % $0.00 88360,26 MORPHOMET STUD, TUMR CHEM, MANUAL % $188.00 88360,TC MORPHOMET STUD, TUMR CHEM, MANUAL $0.00 88361,26 MORPHOM STUD, TUMR CHEM, COMP ASSTD $203.00 88361,TC MORPHOM STUD, TUMR CHEM, COMP ASSTD $0.00 88362,26 NERVE TEASING PREPARATIONS % $381.00 88362,TC NERVE TEASING PREPARATIONS % $0.00 88364,26 IN SITU HYBRIDIZATION EA ADDL PROBE $118.00 88364,TC IN SITU HYBRIDIZATION EA ADDL PROBE $0.00 88365,26 TISSUE HYBRIDIZATION % $200.00 88365,TC TISSUE HYBRIDIZATION % $0.00 88366,26 IN SITU HYBRIDIZATION EA MULTIPLEX $217.00 88366,TC IN SITU HYBRIDIZATION EA MULTIPLEX $0.00 88367,26 MORPHOMET STUD IN SITU HYBRID,COMP $208.00 88367,TC MORPHOMET STUD IN SITU HYBRID,COMP $0.00 88368,26 MORPHOMET STUD IN SITY HYBRID, MANU $214.00 88368,TC MORPHOMET STUD IN SITY HYBRID, MANU $0.00 88369,26 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL P $105.00 88369,TC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL P $0.00 88371,26 PROTEIN ANALYSIS/WESTERN BLOT % $66.00 88372,26 PROTEIN ANALYSIS W/IMMUNOL PROBE % $66.00 88373,26 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR $71.00 88373,TC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR $0.00 88374,26 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR $153.00 88374,TC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR $0.00 88377,26 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL E $219.00 88377,TC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL E $0.00 88380,26 MICRODISSECTION, LASER $267.00 88380,TC MICRODISSECTION, LASER $0.00 88381,26 MICRODISSECTION, MANUAL $182.00 88381,TC MICRODISSECTION, MANUAL $0.00 88387,26 MACROSCOPIC EXAM DISSEC & PREP TISS $112.00 88387,TC MACROSCOPIC EXAM DISSEC & PREP TISS $0.00 88388,26 MACRO EXAM DISSEC CONJ W/TOUCH IMPR $84.00 88388,TC MACRO EXAM DISSEC CONJ W/TOUCH IMPR $0.00 89060,26 EXAM, SYNOVIAL FLUID CRYSTALS % $66.00 89300,QW SEMEN ANALYSIS, PRESENCE/MOTILITY % $38.00 89321,QW Semen ana, presence/motality‐sperm $51.00 91010,26 ESOPHAGUS MOTILITY STUDY $234.00 91010,TC ESOPHAGUS MOTILITY STUDY $0.00 91013,26 ESOPHGL MOTIL W/STIM/PERFUS $33.00 91013,TC ESOPHGL MOTIL W/STIM/PERFUS $0.00 91020,26 GASTRIC MOTILITY STUDY $262.00 91020,TC GASTRIC MOTILITY STUDY $0.00 91022,26 DEODENAL MOTILITY(MANOMETRIC) STUDY $258.00 91022,TC DEODENAL MOTILITY(MANOMETRIC) STUDY $0.00 91030,26 ACID PERFUSION TEST OF ESOPHAGUS $165.00 91030,TC ACID PERFUSION TEST OF ESOPHAGUS $0.00 91034,26 ESOPHAG,GER TEST; W NASAL CATH S&I $180.00 91034,TC ESOPHAG,GER TEST; W NASAL CATH S&I $0.00 91035,26 ESOPHAG GER TEST; W/TELEMETRY ELEC $296.00 91035,TC ESOPHAG GER TEST; W/TELEMETRY ELEC $0.00 91037,26 EFT GERT W/NASAL CATH ELECTRODE S&I $180.00 91037,TC EFT GERT W/NASAL CATH ELECTRODE S&I $0.00 91038,26 EFT GERT W/NAS CATH ELEC PL;PROLONG $199.00 91038,TC EFT GERT W/NAS CATH ELEC PL;PROLONG $0.00 91040,26 ESOPHAG BALLOON DISTENS PROVOC STUD $171.00 91040,TC ESOPHAG BALLOON DISTENS PROVOC STUD $0.00 91065,26 BREATH HYDROGEN TEST $36.00 91065,TC BREATH HYDROGEN TEST $0.00 91110,26 GASTRO TRACT IMAG INTRA $658.00 91110,TC GASTRO TRACT IMAG INTRA $0.00 91111,26 GI TRACT IMAGING INTRALUMNL ESOPHGS $181.00 91111,TC GI TRACT IMAGING INTRALUMNL ESOPHGS $0.00 91112,26 GI TRANSIT & PRES MEAS WIRELESS CAP $380.00 91112,TC GI TRANSIT & PRES MEAS WIRELESS CAP $0.00 91120,26 GASTRIC MOTILITY STUDIES $177.00 91120,TC GASTRIC MOTILITY STUDIES $0.00 91122,26 ANAL PRESSURE RECORDING $317.00 91122,TC ANAL PRESSURE RECORDING $0.00 91132,26 ELECTROGASTROGRPHY, DGNSTC TRSCUTNS $102.00 91132,tc ELECTROGASTROGRPHY, DGNSTC TRSCUTNS $0.00 91133,26 ELCTROGSTRGRPHY DGNSTC TRNSCU W PT $123.00 91133,tc ELCTROGSTRGRPHY DGNSTC TRNSCU W PT $0.00 91200,26 LIVER ELASTOGRAPHY W/O IMAG W/I&R $45.00 91200,TC LIVER ELASTOGRAPHY W/O IMAG W/I&R $0.00 92025,26 COMPUTERIZED CORNEAL TOPOGRAPHY $69.00 92025,TC COMPUTERIZED CORNEAL TOPOGRAPHY $0.00 92060,26 SPECIAL EYE EVALUATION,SENSORIMOTOR $134.00 92060,TC SPECIAL EYE EVALUATION,SENSORIMOTOR $0.00 92065,26 ORTHOPTIC/PLEOPTIC TRAINING $61.00 92065,TC ORTHOPTIC/PLEOPTIC TRAINING $0.00 92081,26 VISUAL FIELD EXAM(S), LIMITED $59.00 92081,TC VISUAL FIELD EXAM(S), LIMITED $0.00 92082,26 VISUAL FIELD EXAM(S), INTERMEDIATE $80.00 92082,TC VISUAL FIELD EXAM(S), INTERMEDIATE $0.00 92083,26 VISUAL FIELD EXAM(S), EXTENDED $99.00 92083,TC VISUAL FIELD EXAM(S), EXTENDED $0.00 92132,26 CMPTR OPHTH DX IMG ANT SEGMT $70.00 92132,TC CMPTR OPHTH DX IMG ANT SEGMT $0.00 92133,26 CMPTR OPHTH IMG OPTIC NERVE $99.00 92133,TC CMPTR OPHTH IMG OPTIC NERVE $0.00 92134,26 CPTR OPHTH DX IMG POST SEGMT $103.00 92134,TC CPTR OPHTH DX IMG POST SEGMT $0.00 92136,26 OPTHALMIC BIO W/INTRAOCULAR LENS PO $107.00 92136,TC OPTHALMIC BIO W/INTRAOCULAR LENS PO $0.00 92145,26 CORNEA HYSTERESIS DETERMIN IMPULSE $29.00 92145,TC CORNEA HYSTERESIS DETERMIN IMPULSE $0.00 92228,26 REMOTE RETINAL IMAGING MGMT $74.00 92228,TC REMOTE RETINAL IMAGING MGMT $0.00 92235,26 FLUORESCEIN ANGIOSCOPY, MULTIFRAME $164.00 92235,TC FLUORESCEIN ANGIOSCOPY, MULTIFRAME $0.00 92240,26 ANGIOGRAPHY, INDOCYANINE‐GREEN $221.00 92240,TC ANGIOGRAPHY, INDOCYANINE‐GREEN $0.00 92250,26 FUNDUS PHOTOGRAPHY $82.00 92250,TC FUNDUS PHOTOGRAPHY $0.00 92265,26 EYE MUSCLE EVALUATION, NEEDLE $148.00 92265,TC EYE MUSCLE EVALUATION, NEEDLE $0.00 92270,26 ELECTRO‐OCULOGRAPHY $141.00 92270,TC ELECTRO‐OCULOGRAPHY $0.00 92275,26 ELECTRORETINOGRAPHY $204.00 92275,TC ELECTRORETINOGRAPHY $0.00 92283,26 COLOR VISION EYE EXAM, EXTENDED $33.00 92283,TC COLOR VISION EYE EXAM, EXTENDED $0.00 92284,26 DARK ADAPTATION EYE EXAM $42.00 92284,TC DARK ADAPTATION EYE EXAM $0.00 92285,26 EXTERNAL EYE PHOTOGRAPHY $13.00 92285,TC EXTERNAL EYE PHOTOGRAPHY $0.00 92286,26 INTERNAL EYE PHOTOGRAPHY $117.00 92286,TC INTERNAL EYE PHOTOGRAPHY $0.00 92287,26 INTERNAL EYE PHOTOGRAPHY $158.00 92287,TC INTERNAL EYE PHOTOGRAPHY $0.00 92537,26 Caloric vestibular test with record $0.00 92537,TC Caloric vestibular test with record $0.00 92538,26 monothermal (ie, one irrigation in $0.00 92538,TC monothermal (ie, one irrigation in $0.00 92540,26 BASIC VESTIBULAR EVA INC SPONT NYST $271.00 92540,TC BASIC VESTIBULAR EVA INC SPONT NYST $0.00 92541,26 SPONTANEOUS NYSTAGMUS TEST $71.00 92541,TC SPONTANEOUS NYSTAGMUS TEST $0.00 92542,26 POSITIONAL NYSTAGMUS TEST $86.00 92542,TC POSITIONAL NYSTAGMUS TEST $0.00 92544,26 3PTOKINETIC NYSTAGMUS TEST $48.00 92544,TC 3PTOKINETIC NYSTAGMUS TEST $0.00 92545,26 OSCILLATING TRACKING TEST $45.00 92545,TC OSCILLATING TRACKING TEST $0.00 92546,26 SINUSOIDAL ROTATIONAL TEST $52.00 92546,TC SINUSOIDAL ROTATIONAL TEST $0.00 92548,26 POSTUROGRAPHY, COMPUTERIZED DYNAMIC $90.00 92548,TC POSTUROGRAPHY, COMPUTERIZED DYNAMIC $0.00 92585,26 AUDITORY EVOKED POTENTIAL $92.00 92585,TC AUDITORY EVOKED POTENTIAL $0.00 92587,26 EVOKED AUDITORY EXAM, LIMITED $66.00 92587,TC EVOKED AUDITORY EXAM, LIMITED $0.00 92588,26 EVOKED AUDITORY EXAM, COMPREHENSIVE $100.00 92588,TC EVOKED AUDITORY EXAM, COMPREHENSIVE $0.00 92978,26 ULTRASND, INTRAVAS, HEART, INT VESL $368.00 92978,TC ULTRASND, INTRAVAS, HEART, INT VESL $0.00 92979,26 ULTRASOUND, INTRAVASC, HEART ADD'L $294.00 92979,TC ULTRASOUND, INTRAVASC, HEART ADD'L $0.00 93024,26 CARDIAC DRUG STRESS TEST $194.00 93024,TC CARDIAC DRUG STRESS TEST $0.00 93025,26 MICROVOLT T‐WAVE‐ASSESSMENT VEN ARR $125.00 93025,TC MICROVOLT T‐WAVE‐ASSESSMENT VEN ARR $0.00 93050,26 Arterial pressure waveform analysis $0.00 93050,TC Arterial pressure waveform analysis $0.00 93260,26 PRGRMG DEV EVAL IMPLANTABLE SUBQ LE $153.00 93260,TC PRGRMG DEV EVAL IMPLANTABLE SUBQ LE $0.00 93261,26 INTERROGATION EVAL F2F IMPLANT SUBQ $131.00 93261,TC INTERROGATION EVAL F2F IMPLANT SUBQ $0.00 93278,26 SIGNAL‐AVERAGED ECG $42.00 93278,TC SIGNAL‐AVERAGED ECG $0.00 93279,26 Pm device progr eval, sngl $110.00 93279,TC Pm device progr eval, sngl $0.00 93280,26 Pm device progr eval, dual $131.00 93280,TC Pm device progr eval, dual $0.00 93281,26 Pm device progr eval, multi $152.00 93281,TC Pm device progr eval, multi $0.00 93282,26 Icd device prog eval, 1 sngl $144.00 93282,TC Icd device prog eval, 1 sngl $0.00 93283,26 Icd device progr eval, dual $196.00 93283,TC Icd device progr eval, dual $0.00 93284,26 Icd device progr eval, mult $215.00 93284,TC Icd device progr eval, mult $0.00 93285,26 Ilr device eval progr $89.00 93285,TC Ilr device eval progr $0.00 93286,26 Pre‐op pm device eval $52.00 93286,TC Pre‐op pm device eval $0.00 93287,26 Pre‐op icd device eval $79.00 93287,TC Pre‐op icd device eval $0.00 93288,26 Pm device eval in person $73.00 93288,TC Pm device eval in person $0.00 93289,26 Icd device interrogate $155.00 93289,TC Icd device interrogate $0.00 93290,26 Icm device eval $74.00 93290,TC Icm device eval $0.00 93291,26 Ilr device interrogate $74.00 93291,TC Ilr device interrogate $0.00 93292,26 Wcd device interrogate $74.00 93292,TC Wcd device interrogate $0.00 93293,26 Pm phone r‐strip device eval $54.00 93293,TC Pm phone r‐strip device eval $0.00 93303,26 ECG, TRANSTHORACIC, COMPLETE $218.00 93303,TC ECG, TRANSTHORACIC, COMPLETE $0.00 93304,26 ECG, TRANSTHORACIC FOLLOWUP/LIMITED $125.00 93304,TC ECG, TRANSTHORACIC FOLLOWUP/LIMITED $0.00 93306,26 Tte w/doppler, complete $216.00 93306,TC Tte w/doppler, complete $0.00 93307,26 ECG, TRANSTHORACIC, HEART, COMPLETE $153.00 93307,TC ECG, TRANSTHORACIC, HEART, COMPLETE $0.00 93308,26 ECG, TRANSTHORACIC, HEART, LIMITED $88.00 93308,TC ECG, TRANSTHORACIC, HEART, LIMITED $0.00 93312,26 ECG, TRANSESOPHAGEAL, HEART, COMPL $413.00 93312,TC ECG, TRANSESOPHAGEAL, HEART, COMPL $0.00 93314,26 ECG, TRANSESOPHAGEAL HEART RPT ONLY $366.00 93314,TC ECG, TRANSESOPHAGEAL HEART RPT ONLY $0.00 93315,26 ECG, TRANSESOPHAGEAL, CONG HEART $485.00 93315,TC ECG, TRANSESOPHAGEAL, CONG HEART $0.00 93317,26 ECG, TRANSESOPHAGEAL, CNG HRT RPRT $375.00 93317,TC ECG, TRANSESOPHAGEAL, CNG HRT RPRT $0.00 93318,26 EKG,TEE‐ASSESS CARDIAC PUMP FUNC $406.00 93318,TC EKG,TEE‐ASSESS CARDIAC PUMP FUNC $0.00 93320,26 DOPPLER ECHO EXAM OF HEART, COMPL $62.00 93320,TC DOPPLER ECHO EXAM OF HEART, COMPL $0.00 93321,26 DOPPLER ECHO EXAM OF HEART, LIMITED $26.00 93321,TC DOPPLER ECHO EXAM OF HEART, LIMITED $0.00 93325,26 DOPPLER COLOR FLOW MAPPING $13.00 93325,TC DOPPLER COLOR FLOW MAPPING $0.00 93350,26 ECHO EXAM OF HEART/ECG MONITORING $242.00 93350,TC ECHO EXAM OF HEART/ECG MONITORING $0.00 93351,26 Stress tte complete $290.00 93351,TC Stress tte complete $0.00 93451,26 RIGHT HEART CATH $166.00 93451,TC RIGHT HEART CATH $734.00 93452,26 LEFT HRT CATH W/VENTRCLGRPHY $961.00 93452,TC LEFT HRT CATH W/VENTRCLGRPHY $0.00 93453,26 R&L HRT CATH W/VENTRICLGRPHY $1,278.00 93453,TC R&L HRT CATH W/VENTRICLGRPHY $0.00 93454,26 CORONARY ARTERY ANGIO S&I $980.00 93454,TC CORONARY ARTERY ANGIO S&I $0.00 93455,26 CORONARY ART/GRFT ANGIO S&I $1,132.00 93455,TC CORONARY ART/GRFT ANGIO S&I $0.00 93456,26 R HRT CORONARY ARTERY ANGIO $1,256.00 93456,TC R HRT CORONARY ARTERY ANGIO $0.00 93457,26 R HRT ART/GRFT ANGIO $1,410.00 93457,TC R HRT ART/GRFT ANGIO $0.00 93458,26 L HRT ARTERY/VENTRICLE ANGIO $1,198.00 93458,TC L HRT ARTERY/VENTRICLE ANGIO $0.00 93459,26 L HRT ART/GRFT ANGIO $1,350.00 93459,TC L HRT ART/GRFT ANGIO $0.00 93460,26 R&L HRT ART/VENTRICLE ANGIO $1,504.00 93460,TC R&L HRT ART/VENTRICLE ANGIO $0.00 93461,26 R&L HRT ART/VENTRICLE ANGIO $1,660.00 93461,TC R&L HRT ART/VENTRICLE ANGIO $0.00 93464,26 EXERCISE W/HEMODYNAMIC MEAS $348.00 93464,TC EXERCISE W/HEMODYNAMIC MEAS $0.00 93505,26 BIOPSY OF HEART LINING $891.00 93505,TC BIOPSY OF HEART LINING $0.00 93530,26 CATHETERIZATION, RIGHT HEART $838.00 93530,TC CATHETERIZATION, RIGHT HEART $0.00 93531,26 CATHZATION, COMB RIGHT/LEFT HEART $1,652.00 93531,TC CATHZATION, COMB RIGHT/LEFT HEART $0.00 93532,26 CATHZATION, COMB RIGHT/LFT HEART $2,054.00 93532,TC CATHZATION, COMB RIGHT/LFT HEART $0.00 93533,26 CATHZATION, COMB RIGHT/LEFT HEART $1,367.00 93533,TC CATHZATION, COMB RIGHT/LEFT HEART $0.00 93561,26 CARDIAC OUTPUT MEASUREMENT $91.00 93561,TC CARDIAC OUTPUT MEASUREMENT $0.00 93562,26 ADDED CARDIAC OUTPUT MEASUREMENT $28.00 93562,TC ADDED CARDIAC OUTPUT MEASUREMENT $0.00 93571,26 DOPPLER INTRAVASC, INITIAL VESSEL $367.00 93571,TC DOPPLER INTRAVASC, INITIAL VESSEL $0.00 93572,26 DOPPLER INTRAVASC, EA ADD'L VESSEL $294.00 93572,TC DOPPLER INTRAVASC, EA ADD'L VESSEL $0.00 93600,26 BUNDLE OF HIS RECORDING $453.00 93600,TC BUNDLE OF HIS RECORDING $0.00 93602,26 INTRA‐ATRIAL RECORDING $443.00 93602,TC INTRA‐ATRIAL RECORDING $0.00 93603,26 RIGHT VENTRICULAR RECORDING $443.00 93603,TC RIGHT VENTRICULAR RECORDING $0.00 93609,26 MAPPING OF TACHYCARDIA SITE(S) $1,062.00 93609,TC MAPPING OF TACHYCARDIA SITE(S) $0.00 93610,26 INTRA‐ATRIAL PACING $630.00 93610,TC INTRA‐ATRIAL PACING $0.00 93612,26 INTRAVENTRICULAR PACING $624.00 93612,TC INTRAVENTRICULAR PACING $0.00 93615,26 ESOPHAGEAL RECORDING OF ELECTROGRAM $181.00 93615,TC ESOPHAGEAL RECORDING OF ELECTROGRAM $0.00 93616,26 ESOPHAGEAL RECORDING W/PACING $223.00 93616,TC ESOPHAGEAL RECORDING W/PACING $0.00 93618,26 HEART RHYTHM PACING $907.00 93618,TC HEART RHYTHM PACING $0.00 93619,26 ELECTROPHYS EVALUATION, W/O ARRHYTH $1,549.00 93619,TC ELECTROPHYS EVALUATION, W/O ARRHYTH $0.00 93620,26 ELECTROPHYS EVALUATION W/ARRYTHMIA $2,457.00 93620,TC ELECTROPHYS EVALUATION W/ARRYTHMIA $0.00 93621,26 ELECTROPHYS EVALUATION, LFT ATRIAL $449.00 93621,TC ELECTROPHYS EVALUATION, LFT ATRIAL $0.00 93622,26 ELECTROPHYS EVALUATION, LEFT VENTRL $655.00 93622,TC ELECTROPHYS EVALUATION, LEFT VENTRL $0.00 93623,26 STIMULATION AND PACING OF HEART $609.00 93623,tc STIMULATION AND PACING OF HEART $0.00 93624,26 ELECTROPHYSIOLOGIC FOLLOWUP STUDY $1,008.00 93624,TC ELECTROPHYSIOLOGIC FOLLOWUP STUDY $0.00 93631,26 OPERATIVE HEART PACING & MAPPING $1,535.00 93631,TC OPERATIVE HEART PACING & MAPPING $0.00 93640,26 ELECTROPHYSIOLOGY EVALUATION $738.00 93640,TC ELECTROPHYSIOLOGY EVALUATION $0.00 93641,26 ELECTROPHYSIOLOGY EVALUATION $1,253.00 93641,TC ELECTROPHYSIOLOGY EVALUATION $0.00 93642,26 ELECTROPHYSIOLOGY EVALUATION $1,041.00 93642,TC ELECTROPHYSIOLOGY EVALUATION $0.00 93644,26 EPHYS EVAL SUBQ IMPLANTABLE DEFIBRI $591.00 93644,TC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRI $0.00 93660,26 TILT TABLE EVALUATION $321.00 93660,tc TILT TABLE EVALUATION $0.00 93662,26 INTRACARDIAC EKG‐THER/DIAG INT,S&I $498.00 93662,TC INTRACARDIAC EKG‐THER/DIAG INT,S&I $0.00 93724,26 ANALYSIS OF PACEMAKER SYSTEM $826.00 93724,TC ANALYSIS OF PACEMAKER SYSTEM $0.00 93745,26 INITI SETUP & PRGRAM CARDIO‐DEFIBRI $177.00 93745,TC INITI SETUP & PRGRAM CARDIO‐DEFIBRI $0.00 93880,26 EXTRACRANIAL ARTERIES STUDY, COMPL $142.00 93880,TC EXTRACRANIAL ARTERIES STUDY, COMPL $0.00 93882,26 EXTRACRANIAL ARTERIES STUDY, LTD $92.00 93882,TC EXTRACRANIAL ARTERIES STUDY, LTD $0.00 93886,26 INTRACRANIAL ARTERIES STUDY, COMPL $167.00 93886,TC INTRACRANIAL ARTERIES STUDY, COMPL $0.00 93888,26 INTRACRANIAL ARTERIES STUDY, LTD $108.00 93888,TC INTRACRANIAL ARTERIES STUDY, LTD $0.00 93890,26 T/CRANIAL DOPP STU INTRACRA ART COM $180.00 93890,TC T/CRANIAL DOPP STU INTRACRA ART COM $0.00 93892,26 T/CRAN DOPP STU EBOLI DET W/O IVINJ $218.00 93892,TC T/CRAN DOPP STU EBOLI DET W/O IVINJ $0.00 93893,26 T/CRAN DOPP STU EMBOL DET W/IV INJ $209.00 93893,TC T/CRAN DOPP STU EMBOL DET W/IV INJ $0.00 93922,26 PHYSIOLOGIC EXTREMITY STUDY $46.00 93922,TC PHYSIOLOGIC EXTREMITY STUDY $0.00 93923,26 PHYSIOLOGIC EXTREMITY STUDY $81.00 93923,TC PHYSIOLOGIC EXTREMITY STUDY $0.00 93924,26 PHYSIOLOGIC EXTREMITY STUDY $89.00 93924,TC PHYSIOLOGIC EXTREMITY STUDY $0.00 93925,26 LOWER EXTREMITY ARTERY STUDY, COMPL $138.00 93925,TC LOWER EXTREMITY ARTERY STUDY, COMPL $0.00 93926,26 LOWER EXTREMITY ARTERY STUDY, LTD $88.00 93926,TC LOWER EXTREMITY ARTERY STUDY, LTD $0.00 93930,26 UPPER EXTREMITY ARTERY STUDY, COMPL $143.00 93930,TC UPPER EXTREMITY ARTERY STUDY, COMPL $0.00 93931,26 UPPER EXTREMITY ARTERY STUDY, LTD $89.00 93931,TC UPPER EXTREMITY ARTERY STUDY, LTD $0.00 93965,26 EXTREMITY VEINS STUDY $62.00 93965,TC EXTREMITY VEINS STUDY $0.00 93970,26 EXTREMITY VEINS STUDY, COMPLETE $123.00 93970,TC EXTREMITY VEINS STUDY, COMPLETE $0.00 93971,26 EXTREMITY VEINS STUDY, LIMITED $80.00 93971,TC EXTREMITY VEINS STUDY, LIMITED $0.00 93975,26 VISCERAL VASCULAR STUDY, COMPLETE $308.00 93975,TC VISCERAL VASCULAR STUDY, COMPLETE $0.00 93976,26 VISCERAL VASCULAR STUDY, LIMITED $208.00 93976,TC VISCERAL VASCULAR STUDY, LIMITED $0.00 93978,26 VISCERAL VASCULAR STUDY, COMPLETE $144.00 93978,TC VISCERAL VASCULAR STUDY, COMPLETE $0.00 93979,26 VISCERAL VASCULAR STUDY, LIMITED $90.00 93979,TC VISCERAL VASCULAR STUDY, LIMITED $0.00 93980,26 PENILE VASCULAR STUDY, COMPLETE $212.00 93980,TC PENILE VASCULAR STUDY, COMPLETE $0.00 93981,26 PENILE VASCULAR STUDY, LIMITED $80.00 93981,TC PENILE VASCULAR STUDY, LIMITED $0.00 93990,26 DUPLEX SCAN, HEMODIALYSIS ACCESS $92.00 93990,TC DUPLEX SCAN, HEMODIALYSIS ACCESS $0.00 94010,26 BREATHING CAPACITY TEST $29.00 94010,TC BREATHING CAPACITY TEST $0.00 94060,26 EVALUATION OF WHEEZING $44.00 94060,TC EVALUATION OF WHEEZING $0.00 94070,26 EVALUATION OF WHEEZING, PROLONGED $99.00 94070,TC EVALUATION OF WHEEZING, PROLONGED $0.00 94200,26 LUNG FUNCTION TEST (MBC/MVV) $20.00 94200,TC LUNG FUNCTION TEST (MBC/MVV) $0.00 94250,26 EXPIRED GAS COLLECTION $20.00 94250,TC EXPIRED GAS COLLECTION $0.00 94375,26 RESPIRATORY FLOW VOLUME LOOP $50.00 94375,TC RESPIRATORY FLOW VOLUME LOOP $0.00 94400,26 CO2 BREATHING RESPONSE CURVE $68.00 94400,TC CO2 BREATHING RESPONSE CURVE $0.00 94450,26 HYPOXIA RESPONSE CURVE $69.00 94450,TC HYPOXIA RESPONSE CURVE $0.00 94452,26 HAST WITH PHYS INTERPRET AND REPORT $49.00 94452,TC HAST WITH PHYS INTERPRET AND REPORT $0.00 94453,26 HAST W/PHYS I & R WITH SUPPL O2 TIT $65.00 94453,TC HAST W/PHYS I & R WITH SUPPL O2 TIT $0.00 94618,26 Pulmonary stress testing $78.00 94618,TC Pulmonary stress testing $43.00 94620,26 PULMONARY STRESS TESTING, SIMPLE $105.00 94620,TC PULMONARY STRESS TESTING, SIMPLE $0.00 94621,26 PULMONARY STRESS TESTING, COMPLEX $236.00 94621,TC PULMONARY STRESS TESTING, COMPLEX $0.00 94680,26 EXHALED AIR ANALYSIS, O2 $43.00 94680,TC EXHALED AIR ANALYSIS, O2 $0.00 94681,26 EXHALED AIR ANALYSIS, O2, CO2 $34.00 94681,TC EXHALED AIR ANALYSIS, O2, CO2 $0.00 94690,26 EXHALED AIR ANALYSIS, REST,INDIRECT $14.00 94690,TC EXHALED AIR ANALYSIS, REST,INDIRECT $0.00 94726,26 NULL $43.00 94726,TC NULL $0.00 94727,26 NULL $43.00 94727,TC NULL $0.00 94728,26 NULL $43.00 94728,TC NULL $0.00 94729,26 NULL $32.00 94729,TC NULL $0.00 94750,26 PULMONARY COMPLIANCE STUDY $39.00 94750,TC PULMONARY COMPLIANCE STUDY $0.00 95782,26 POLYSOM <6 YRS SLEEP STAGE 4/> ADDL $443.00 95782,TC POLYSOM <6 YRS SLEEP STAGE 4/> ADDL $0.00 95783,26 POLYSOM <6 YRS SLEEP W/CPAP/BILVL V $482.00 95783,TC POLYSOM <6 YRS SLEEP W/CPAP/BILVL V $0.00 95800,26 SLP STDY UNATTENDED $177.00 95800,TC SLP STDY UNATTENDED $0.00 95801,26 SLP STDY UNATND W/ANAL $170.00 95801,TC SLP STDY UNATND W/ANAL $0.00 95803,26 ACTIGRAPHY TESTING $150.00 95803,TC ACTIGRAPHY TESTING $0.00 95805,26 MULTIPLE SLEEP LATENCY TEST $203.00 95805,TC MULTIPLE SLEEP LATENCY TEST $0.00 95806,26 SLEEP STUDY, UNATTENDED $208.00 95806,TC SLEEP STUDY, UNATTENDED $0.00 95807,26 SLEEP STUDY, ATTENDED $214.00 95807,TC SLEEP STUDY, ATTENDED $0.00 95808,26 POLYSOMNOGRAPHY, 1‐3 ADD'L PARAMS $303.00 95808,TC POLYSOMNOGRAPHY, 1‐3 ADD'L PARAMS $0.00 95810,26 POLYSOMNOGRAPHY, 4+ ADD'L PARAMS $417.00 95810,TC POLYSOMNOGRAPHY, 4+ ADD'L PARAMS $0.00 95811,26 POLYSONOGRPH 4+ ADD'L PARAMS W/CPAP $435.00 95811,TC POLYSONOGRPH 4+ ADD'L PARAMS W/CPAP $0.00 95812,26 EEG MONITORING, UP TO 1 HOUR $201.00 95812,TC EEG MONITORING, UP TO 1 HOUR $0.00 95813,26 EEG MONITORING, GREATER THAN 1 HOUR $320.00 95813,TC EEG MONITORING, GREATER THAN 1 HOUR $0.00 95816,26 ELECTROENCEPHALOGRAM (EEG) $201.00 95816,TC ELECTROENCEPHALOGRAM (EEG) $0.00 95819,26 ELECTROENCEPHALOGRAM (EEG) $201.00 95819,TC ELECTROENCEPHALOGRAM (EEG) $0.00 95822,26 SLEEP EEG $201.00 95822,TC SLEEP EEG $0.00 95824,26 CEREBRAL DEATH EVALUATION EEG $139.00 95824,TC CEREBRAL DEATH EVALUATION EEG $0.00 95827,26 NIGHT EEG $199.00 95827,TC NIGHT EEG $0.00 95829,26 ELECTROCORTICOGRAM DURING SURGERY $1,193.00 95829,TC ELECTROCORTICOGRAM DURING SURGERY $0.00 95860,26 MUSCLE TEST, ONE LIMB $178.00 95860,TC MUSCLE TEST, ONE LIMB $0.00 95861,26 MUSCLE TEST, TWO LIMBS $289.00 95861,TC MUSCLE TEST, TWO LIMBS $0.00 95863,26 MUSCLE TEST, THREE LIMBS $346.00 95863,TC MUSCLE TEST, THREE LIMBS $0.00 95864,26 MUSCLE TEST, FOUR LIMBS $380.00 95864,TC MUSCLE TEST, FOUR LIMBS $0.00 95865,26 needle electromyography;larynx $297.00 95865,TC needle electromyography;larynx $0.00 95866,26 needle electromyography;hemidiaphra $232.00 95866,TC needle electromyography;hemidiaphra $0.00 95867,26 MUSCLE TEST, HEAD/NECK, ONE SIDE $145.00 95867,TC MUSCLE TEST, HEAD/NECK, ONE SIDE $0.00 95868,26 MUSCLE TEST, HEAD/NECK, BOTH SIDES $221.00 95868,TC MUSCLE TEST, HEAD/NECK, BOTH SIDES $0.00 95869,26 MUSCLE TEST, LMTD, THORAC PARASPINE $70.00 95869,TC MUSCLE TEST, LMTD, THORAC PARASPINE $0.00 95870,26 MUSCLE TEST, LMTD, OTH THAN PARASPI $68.00 95870,TC MUSCLE TEST, LMTD, OTH THAN PARASPI $0.00 95872,26 MUSCLE TEST, ONE FIBER $534.00 95872,TC MUSCLE TEST, ONE FIBER $0.00 95873,26 electric stimul‐guid w/chemodenerva $70.00 95873,TC electric stimul‐guid w/chemodenerva $0.00 95874,26 needl electromyogr‐guid w/chemoden $70.00 95874,TC needl electromyogr‐guid w/chemoden $0.00 95875,26 LIMB EXERCISE TEST W/EMG, LACTIC $206.00 95875,TC LIMB EXERCISE TEST W/EMG, LACTIC $0.00 95885,26 NULL $66.00 95885,TC NULL $0.00 95886,26 NULL $161.00 95886,TC NULL $0.00 95887,26 MUSC TST DONE W/N TST NONEXT $132.00 95887,tc MUSC TST DONE W/N TST NONEXT $0.00 95905,26 MOTOR AND SENSORY NERVE COND PRECON $11.00 95905,TC MOTOR AND SENSORY NERVE COND PRECON $0.00 95907,26 MOTOR &/SENS 1‐2 NRV CNDJ PRECONF E $185.00 95907,TC MOTOR &/SENS 1‐2 NRV CNDJ PRECONF E $0.00 95908,26 MOTOR &/SENS 3‐4 NRV CNDJ PRECONF E $231.00 95908,TC MOTOR &/SENS 3‐4 NRV CNDJ PRECONF E $0.00 95909,26 MOTOR &/SENS 5‐6 NRV CNDJ PRECONF E $277.00 95909,TC MOTOR &/SENS 5‐6 NRV CNDJ PRECONF E $0.00 95910,26 MOTOR &/SENS 7‐8 NRV CNDJ PRECONF E $372.00 95910,TC MOTOR &/SENS 7‐8 NRV CNDJ PRECONF E $0.00 95911,26 MOTOR &/SENS 9‐10 NRV CNDJ PRECONF $464.00 95911,TC MOTOR &/SENS 9‐10 NRV CNDJ PRECONF $0.00 95912,26 MOTOR &/SENS 11‐12 NRV CNDJ PRECONF $551.00 95912,TC MOTOR &/SENS 11‐12 NRV CNDJ PRECONF $0.00 95913,26 MOTOR &/SENS 13/> NRV CNDJ PRECONF $652.00 95913,TC MOTOR &/SENS 13/> NRV CNDJ PRECONF $0.00 95921,26 AUTONOMIC NERV SYS TEST CARDIOVAGAL $156.00 95921,TC AUTONOMIC NERV SYS TEST CARDIOVAGAL $0.00 95922,26 AUTONOMIC NERV SYS TEST, VASOMOTOR $168.00 95922,TC AUTONOMIC NERV SYS TEST, VASOMOTOR $0.00 95923,26 AUTONOMIC NERV SYS TEST, SUDOMOTOR $162.00 95923,TC AUTONOMIC NERV SYS TEST, SUDOMOTOR $0.00 95924,26 TSTG ANS FUNCJ PARASYMP&SYMP W/5 MI $311.00 95924,TC TSTG ANS FUNCJ PARASYMP&SYMP W/5 MI $0.00 95925,26 SOMATOSENSORY TESTING, UPPER LIMBS $98.00 95925,TC SOMATOSENSORY TESTING, UPPER LIMBS $0.00 95926,26 SOMATOSENSORY TESTING, LOWER LIMBS $95.00 95926,TC SOMATOSENSORY TESTING, LOWER LIMBS $0.00 95927,26 SOMATOSENSORY TESTING, TRUNK/HEAD $95.00 95927,TC SOMATOSENSORY TESTING, TRUNK/HEAD $0.00 95928,26 CENT MOTOR EVOK POT STUD UPP LIMB $278.00 95928,TC CENT MOTOR EVOK POT STUD UPP LIMB $0.00 95929,26 CENTR EVOK POT STUD LOWER LIMBS $283.00 95929,TC CENTR EVOK POT STUD LOWER LIMBS $0.00 95930,26 VISUAL EVOKED POTENTIAL (VEP) TEST $64.00 95930,TC VISUAL EVOKED POTENTIAL (VEP) TEST $0.00 95933,26 BLINK REFLEX TEST $108.00 95933,TC BLINK REFLEX TEST $0.00 95937,26 NEUROMUSCULAR JUNCTION TEST $120.00 95937,TC NEUROMUSCULAR JUNCTION TEST $0.00 95938,26 NULL $160.00 95938,TC NULL $0.00 95939,26 NULL $416.00 95939,TC NULL $0.00 95943,26 PARASYMP & SYMP NRV FUNCJ HRT RATE $303.00 95943,TC PARASYMP & SYMP NRV FUNCJ HRT RATE $0.00 95950,26 AMBULATORY EEG MONITORING $278.00 95950,TC AMBULATORY EEG MONITORING $0.00 95951,26 EEG MONITORING/VIDEORECORDING $1,128.00 95951,TC EEG MONITORING/VIDEORECORDING $0.00 95953,26 EEG MONITORING/COMPUTER RECORDING $572.00 95953,TC EEG MONITORING/COMPUTER RECORDING $0.00 95954,26 EEG MONITORING W/DRUGS $432.00 95954,TC EEG MONITORING W/DRUGS $0.00 95955,26 EEG MONITORING DURING SURGERY $189.00 95955,TC EEG MONITORING DURING SURGERY $0.00 95956,26 EEG MONITORING BY CABLE/RADIO $666.00 95956,TC EEG MONITORING BY CABLE/RADIO $0.00 95957,26 EEG DIGITAL ANALYSIS $366.00 95957,TC EEG DIGITAL ANALYSIS $0.00 95958,26 EEG MONITORING/FUNCTION TEST $794.00 95958,TC EEG MONITORING/FUNCTION TEST $0.00 95961,26 ELECTRODE STIMULATION OF BRAIN $579.00 95961,TC ELECTRODE STIMULATION OF BRAIN $0.00 95962,26 ELECTRODE STIMULATION OF BRAIN $610.00 95962,TC ELECTRODE STIMULATION OF BRAIN $0.00 95965,26 MEG RECORDNG & ANLYSIS SPNTNS BRAIN $1,477.00 95965,TC MEG RECORDNG & ANLYSIS SPNTNS BRAIN $0.00 95966,26 MEG FOR EVOKED MAGNTC FIELD SNGL MO $750.00 95966,TC MEG FOR EVOKED MAGNTC FIELD SNGL MO $0.00 95967,26 MEG RCDNG & ANLYSIS FOR EVKD MAG $660.00 95967,TC MEG RCDNG & ANLYSIS FOR EVKD MAG $0.00 96020,26 NEUROFUNCTION TESTING AND ADMINSTRN $588.00 A0425 GROUND MILEAGE, PER STATUTE MILE $22.00 A0426 AMBULANCE SERVICE, ADVANCED LIFE SU $933.00 A0427 AMBULANCE SERVICE, ADVANCED LIFE SU $1,477.00 A0428 AMBULANCE SERVICE, BASIC LIFE SUPRT $777.00 A0429 AMBULANCE SERVICE, BASIC LIFE SUPRT $1,244.00 A0430 AMBULANCE SERVICE, CONVENTIONAL AIR $9,966.00 A0431 AMBULANCE SERVICE, CONVENTIONAL AIR $11,586.00 A0432 PARAMEDIC INTERCEPT (PI), RURAL, TR $1,360.00 A0433 ADVANCED LIFE SUPRT, LEVEL 2 (ALS 2 $2,138.00 A0434 SPEC CARE TRNSPRT (SCT) $2,527.00 A0435 FIXED WING AIR MILEAGE, PER STATUTE $26.00 A0436 ROTARY WING AIR MILEAGE, PER STATUT $68.00 A4216 STERILE WATER/SALINE, 10ML $1.00 A4217 STERILE WATER/SALINE, 500ML $9.00 A4217,AU STERILE WATER/SALINE, 500ML $9.00 A4221 SUPPLIES FOR MAINT OF DRUG INF CATH $75.00 A4222 INFUSION SUPPLIES WITH PUMP $156.00 A4233,NU Alkalin batt for glucose mon $3.00 A4233,NUKL Alkalin batt for glucose mon $2.00 A4234,NU J‐cell batt for glucose mon $12.00 A4234,NUKL J‐cell batt for glucose mon $10.00 A4235,NU Lithium batt for glucose mon $8.00 A4235,NUKL Lithium batt for glucose mon $7.00 A4236,NU Silvr oxide batt glucose mon $5.00 A4236,NUKL Silvr oxide batt glucose mon $5.00 A4253,NU BLOOD GLUCOSE TEST OR REAGENT STRIP $120.00 A4253,NUKL BLOOD GLUCOSE TEST OR REAGENT STRIP $106.00 A4255 PLATFORMS FOR HOME BLOOD GLUCOSE MO $13.00 A4256 NORMAL, LOW & HIGH CALIBRATOR SOL / $32.00 A4256,KL NORMAL, LOW & HIGH CALIBRATOR SOL / $28.00 A4257 REPLACEMENT LENS SHIELD CARTRIDGE F $42.00 A4258 SPRING‐POWERED DEVICE FOR LANCET, E $59.00 A4258,KL SPRING‐POWERED DEVICE FOR LANCET, E $52.00 A4259 LANCETS, PER BOX OF 100 $39.00 A4259,KL LANCETS, PER BOX OF 100 $35.00 A4265 PARAFFIN, PER POUND $11.00 A4280 ADH SKIN SUPRT ATTACH FOR USE W/ EX $18.00 A4310 INSERTION TRAY W/O DRAINAGE BAG & W $26.00 A4311 INSERT TRAY W/O DRAINAGE BAG W/INDW $45.00 A4312 INSERTION TRAY W/O DRAINAGE BAG W/I $51.00 A4313 INSERTION TRAY W/O DRAINAGE BAG W/I $62.00 A4314 INSERTION TRAY W/DRAINAGE BAG WINDW $81.00 A4315 INSERTION TRAY W/DRAINAGE BAG W/IND $88.00 A4316 INSERTION TRAY W/DRAINAGE BAG W/IND $95.00 A4320 IRRIGATION TRAY W/ BULB OR PISTON S $16.00 A4322 IRRIGATION SYRINGE, BULB OR PISTON, $10.00 A4326 MALE EXT CATH SPEC TYPE, EG; INFLA $31.00 A4327 FEMALE EXT URIN COLLECTION DEVICE; $141.00 A4328 FEMALE EXT URIN COLLECTION DEVICE; $35.00 A4330 PERIANAL FECAL COLLECTION POUCH W/ $20.00 A4331 EXT DRAINAGE TUBING, W/CONNECTOR/AD $11.00 A4332 LUBE STERILE PACKET $1.00 A4333 URIN CATH ANCHORING DEVICE, ADH SKI $7.00 A4334 URIN CATH ANCHORING DEVICE, LEG STR $16.00 A4336 URETHRAL INSERT $5.00 A4338 INDWELLING CATH; FOLEY TYPE, 2‐WAY $35.00 A4340 INDWELLING CATH; SPEC TYPE, EG; COU $106.00 A4344 INDWELLING CATH, FOLEY TYPE, TWO‐WA $53.00 A4346 INDWELLING CATH; FOLEY TYPE, THREE $59.00 A4349 DISPOSABLE MALE EXTERNAL CAT $7.00 A4351 INTERMITTENT URIN CATH; STRAIGHT TI $5.00 A4352 INTERMITTENT URIN CATH; COUDE (CURV $21.00 A4353 INTERMITTENT URIN CATH, W/ INSERTIO $23.00 A4354 INSERTION TRAY W/ DRAINAGE BAG BUT $33.00 A4355 IRRIGATION TUBING SET FOR CONT BLAD $30.00 A4356 EXT URETHRAL CLAMP OR COMPRESSION D $129.00 A4357 BEDSIDE DRAINAGE BAG, DAY OR NIGHT, $32.00 A4358 URIN DRAINAGE BAG, LEG OR ABDOMEN, $21.00 A4360 DISPOSABLE EXT URETHRAL DEV $1.00 A4361 OSTOMY FACEPLATE, EA $52.00 A4362 SKIN BARRIER; SOLID, 4 X 4 OR EQUIV $12.00 A4363 Ostomy clamp, replacement $7.00 A4364 ADH, LIQUID OR =, ANY TYPE, PER OZ $10.00 A4366 OSTOMY VENT ANY TYPE EACH $4.00 A4367 OSTOMY BELT, EA $23.00 A4368 OSTOMY FILTER, ANY TYPE, EA $1.00 A4369 OSTOMY SKIN BARRIER, LIQUID (SPRAY, $8.00 A4371 OSTOMY SKIN BARRIER, POWDER, PER OZ $12.00 A4372 Skin barrier solid 4x4 equiv $14.00 A4373 OSTOMY SKIN BARRIER, W/FLANGE (SOLI $21.00 A4375 OSTOMY POUCH, DRAINABLE, W/ FACEPLA $57.00 A4376 OSTOMY POUCH, DRAINABLE, W/ FACEPLA $158.00 A4377 OSTOMY POUCH, DRAINABLE, FOR USE ON $14.00 A4378 OSTOMY POUCH, DRAINABLE, FOR USE ON $102.00 A4379 OSTOMY POUCH, URIN, W/ FACEPLATE AT $50.00 A4380 OSTOMY POUCH, URIN, W/ FACEPLATE AT $124.00 A4381 OSTOMY POUCH, URIN, FOR USE ON FACE $15.00 A4382 OSTOMY POUCH, URIN, FOR USE ON FACE $82.00 A4383 OSTOMY POUCH, URIN, FOR USE ON FACE $94.00 A4384 OSTOMY FACEPLATE EQUIVALENT, SILICO $32.00 A4385 OSTOMY SKIN BARRIER, SOLID 4X4 OR E $17.00 A4387 OSTOMY POUCH, CLOSED, W/ BARRIER AT $7.00 A4388 OSTOMY POUCH, DRAINABLE, W/ EXT WEA $15.00 A4389 OSTOMY POUCH, DRAINABLE, W/ BARRIER $21.00 A4390 OSTOMY POUCH, DRAINABLE, W/ EXT WEA $32.00 A4391 OSTOMY POUCH, URIN, W/ EXT WEAR BAR $24.00 A4392 OSTOMY POUCH, URIN, W/ ST&ARD WEAR $27.00 A4393 OSTOMY POUCH, URIN, W/ EXT WEAR BAR $30.00 A4394 OSTOMY DEODORANT FOR USE IN OSTOMY $9.00 A4395 OSTOMY DEODORANT FOR USE IN OSTOMY $1.00 A4396 OSTOMY BELT W/ PERISTOMAL HERNIA SU $135.00 A4397 IRRIGATION SUPPLY; SLEEVE, EA $14.00 A4398 OSTOMY IRRIGATION SUPPLY; BAG, EA $46.00 A4399 OSTOMY IRRIGATION SUPPLY; CONE/CATH $41.00 A4400 OSTOMY IRRIGATION SET $138.00 A4402 LUBRICANT, PER OUNCE $5.00 A4404 OSTOMY RING, EA $6.00 A4405 OSTOMY SKIN BARRIER, NON‐PECTIN BAS $11.00 A4406 OSTOMY SKIN BARRIER, PECTIN‐BASED, $19.00 A4407 EXT WEAR OST SKN BARR <=4SQ $29.00 A4408 EXT WEAR OST SKN BARR >4SQ $33.00 A4409 Ost skn barr convex <=4 sq i $21.00 A4410 Ost skn barr extnd >4 sq $30.00 A4411 Ost skn barr extnd =4sq $17.00 A4412 Ost pouch drain high output $9.00 A4413 OSTOMY POUCH, DRAINABLE, HIGH OUTPU $18.00 A4414 Ost sknbar w/o conv<=4 sq in $16.00 A4415 Ost skn barr w/o conv >4 sqi $20.00 A4416 OSTOMY POUCH CLOSED W BARRIER $9.00 A4417 OSTOMY POUCH WITH BUILT IN CONVEX $12.00 A4418 OSTOMY POUCH W/O BARRIER $6.00 A4419 OSTOMY POUCH CLOSED $6.00 A4422 OSTOMY ABS MAT (SHEET/PAD/CRYSTAL P $1.00 A4423 OSTOMY POUCH W FILTER $6.00 A4424 OSTOMY POUCH DRAIN $16.00 A4425 OSTOMY DRAIN NON LOCKING $12.00 A4426 OSTOMY DRAIN WITH LOCKING $9.00 A4427 OSTOMY DRAIN LOCKING W FILTER $9.00 A4428 OSTOMY URINARY W EXTENDED WEAR BARR $22.00 A4429 OSTOMY URINARY W BARR WITH BUILT IN $27.00 A4430 OSTOMY POUCH URINARY W/EXT BARR $28.00 A4431 OSTOMY URIN W/BARR W/FACET TYPE TAP $21.00 A4432 PSTOMY URIN W/NON LOCK FAUCET TAP $12.00 A4433 OSTOMY URIN BARRIER W/LOCK 2 PIECE $11.00 A4434 OSTOMY URIN BARR LOCK W/VALVE $13.00 A4435 1PC OST PCH DRAIN HGH OUTPUT $19.00 A4450,AU TAPE, NON‐WATERPROOF, PER 18 SQUARE $1.00 A4450,AV TAPE, NON‐WATERPROOF, PER 18 SQUARE $1.00 A4450,AW TAPE, NON‐WATERPROOF, PER 18 SQUARE $1.00 A4452,AU TAPE, WATERPROOF, PER 18 SQUARE IN $1.00 A4452,AV TAPE, WATERPROOF, PER 18 SQUARE IN $1.00 A4452,AW TAPE, WATERPROOF, PER 18 SQUARE IN $1.00 A4455 ADH REMOVER OR SOLVENT (FOR TAPE, C $4.00 A4456 ADHESIVE REMOVER, WIPES $1.00 A4461 Surgicl dress hold non‐reuse $11.00 A4463 Surgical dress holder reuse $44.00 A4481 TRACHEOSTOMA FILTER, ANY TYPE, ANY $1.00 A4556 ELECTRODES, (E.G., APNEA MONITOR), $40.00 A4557 LEAD WIRES, (E.G., APNEA MONITOR), $63.00 A4558 CONDUCTIVE PASTE OR GEL $15.00 A4559 Coupling gel or paste $1.00 A4561 PESSARY, RUBBER, ANY TYPE $66.00 A4562 PESSARY, NON RUBBER, ANY TYPE $165.00 A4565 SLINGS $26.00 A4595 ELEC STIMULATOR SUPPLIES, 2 LEAD, P $96.00 A4602,NU REPLACE LITHIUM BATTERY 1.5V $0.00 A4604,NU Tubing W/ heating element $192.00 A4605,NU TRACH SUCTION CATH CLOSE SYS $55.00 A4608 TRANSTRACHEAL OXYGEN CATH, EA $167.00 A4614 PEAK EXPIRATORY FLOW RATE METER, H& $79.00 A4615 Cannula nasal $2.00 A4616 Tubing (oxygen) per foot $1.00 A4617 Mouth piece $10.00 A4618,NU BREATHING CIRCUITS $30.00 A4618,RR BREATHING CIRCUITS $3.00 A4618,UE BREATHING CIRCUITS $22.00 A4619,NU FACE TENT $6.00 A4620 Variable concentration mask $2.00 A4623 TRACHEOSTOMY, INNER CANNULA (REPLAC $22.00 A4624,NU TRACHEAL SUCTION CATH, ANY TYPE OTH $7.00 A4625 TRACHEOSTOMY CARE KIT FOR NEW TRACH $23.00 A4626 TRACHEOSTOMY CLEANING BRUSH, EA $11.00 A4628,NU OROPHARYNGEAL SUCTION CATH, EA $12.00 A4629 TRACHEOSTOMY CARE KIT FOR ESTABLISH $15.00 A4630,NU Repl bat t.e.n.s. own by pt $18.00 A4633,NU REPLACEMENT BULB/LAMP FOR UV LIGHT $137.00 A4635,NU UNDERARM PAD, CRUTCH, REPLACEMENT, $17.00 A4635,RR UNDERARM PAD, CRUTCH, REPLACEMENT, $2.00 A4635,UE UNDERARM PAD, CRUTCH, REPLACEMENT, $11.00 A4636,NU REPLACEMENT, H&GRIP, CANE, CRUTCH, $12.00 A4636,NUKE REPLACEMENT, H&GRIP, CANE, CRUTCH, $14.00 A4636,RR REPLACEMENT, H&GRIP, CANE, CRUTCH, $1.00 A4636,RRKE REPLACEMENT, H&GRIP, CANE, CRUTCH, $1.00 A4636,UE REPLACEMENT, H&GRIP, CANE, CRUTCH, $9.00 A4636,UEKE REPLACEMENT, H&GRIP, CANE, CRUTCH, $10.00 A4637,NU REPLACEMENT, TIP, CANE, CRUTCH, WAL $5.00 A4637,NUKE REPLACEMENT, TIP, CANE, CRUTCH, WAL $6.00 A4637,RR REPLACEMENT, TIP, CANE, CRUTCH, WAL $1.00 A4637,RRKE REPLACEMENT, TIP, CANE, CRUTCH, WAL $1.00 A4637,UE REPLACEMENT, TIP, CANE, CRUTCH, WAL $4.00 A4637,UEKE REPLACEMENT, TIP, CANE, CRUTCH, WAL $5.00 A4639,RR REPLACEMENT PAD FOR INFRARED HEATIN $96.00 A4640,NU REPLACEMENT PAD FOR USE W/ MEDICAL $185.00 A4640,RR REPLACEMENT PAD FOR USE W/ MEDICAL $19.00 A4640,UE REPLACEMENT PAD FOR USE W/ MEDICAL $135.00 A5051 OSTOMY POUCH, CLOSED; W/ BARRIER AT $7.00 A5052 OSTOMY POUCH, CLOSED; W/O BARRIER A $5.00 A5053 OSTOMY POUCH, CLOSED; FOR USE ON FA $5.00 A5054 OSTOMY POUCH, CLOSED; FOR USE ON BA $6.00 A5055 STOMA CAP $5.00 A5056 1 PC OST POUCH W FILTER $16.00 A5057 1 PC OST POU W BUILT‐IN CONV $32.00 A5061 OSTOMY POUCH, DRAINABLE; W/ BARRIER $12.00 A5062 OSTOMY POUCH, DRAINABLE; W/O BARRIE $7.00 A5063 OSTOMY POUCH, DRAINABLE; FOR USE ON $9.00 A5071 OSTOMY POUCH, URIN; W/ BARRIER ATTA $20.00 A5072 OSTOMY POUCH, URIN; W/O BARRIER ATT $12.00 A5073 OSTOMY POUCH, URIN; FOR USE ON BARR $10.00 A5081 CONTINENT DEVICE; PLUG FOR CONTINEN $11.00 A5082 CONTINENT DEVICE; CATH FOR CONTINEN $34.00 A5083 Stoma absorptive cover $2.00 A5093 OSTOMY ACCESSORY; CONVEX INSERT $6.00 A5102 BEDSIDE DRAINAGE BOTTLE W/ OR W/O T $75.00 A5105 Urinary suspensory $136.00 A5112 URIN LEG BAG, LATEX $102.00 A5113 LEG STRAP; LATEX, REPLACEMENT ONLY, $16.00 A5114 LEG STRAP; FOAM OR FABRIC, REPLACE $30.00 A5120,AU Skin barrier, wipe or swab $1.00 A5120,AV Skin barrier, wipe or swab $1.00 A5121 SKIN BARRIER; SOLID, 6 X 6 OR EQUIV $21.00 A5122 SKIN BARRIER; SOLID, 8 X 8 OR EQUIV $38.00 A5126 ADH OR NON‐ADH; DISK OR FOAM PAD $4.00 A5131 APPLIANCE CLEANER, INCONTINENCE & O $53.00 A5200 PERCUTANEOUS CATH/TUBE ANCHORING DE $38.00 A5500 FOR DIAB ONLY, FITTING (INCL FOLLOW $212.00 A5501 FOR DIAB ONLY, FITTING (INCL F‐UP), $635.00 A5503 FOR DIAB ONLY, MOD (INCL FITTING) O $104.00 A5504 FOR DIAB ONLY, MOD (INCL FITTING) O $104.00 A5505 FOR DIAB ONLY, MOD (INCL FITTING) O $104.00 A5506 FOR DIAB ONLY, MOD (INCL FITTING) O $104.00 A5507 FOR DIAB ONLY, NOT OTHWISE SPECIFIE $104.00 A5512 Multi den insert direct form $86.00 A5513 Multi den insert custom mold $129.00 A6010 COLLAGEN BASED WOUND FILLER, DRY FO $103.00 A6011 COLLAGEN BASED WOUND FILLER, GEL/PA $8.00 A6021 COLLAGEN DRSG, PAD SIZE 16 SQ. IN. $0.00 A6022 COLLAGEN DRSG, PAD SIZE > 16 SQ. IN $0.00 A6023 COLLAGEN DRSG, PAD SIZE > 48 SQ. IN $634.00 A6024 COLLAGEN DRSG WOUND FILLER, PER 6 I $21.00 A6154 WOUND POUCH, EA $48.00 A6196 ALGINATE OR OTH FIBER GELLING DRSG, $24.00 A6197 ALGINATE OR OTH FIBER GELLING DRSG, $55.00 A6199 ALGINATE OR OTH FIBER GELLING DRSG, $18.00 A6203 COMPOSITE DRSG, PAD SIZE 16 SQ. IN. $11.00 A6204 COMPOSITE DRSG, PAD SIZE > 16 SQ. I $21.00 A6207 CONTACT LAYER, > 16 SQ. IN. BUT < O $24.00 A6209 FOAM DRSG, WOUND COVER, PAD SIZE 16 $25.00 A6210 FOAM DRSG, WOUND COVER, PAD SIZE > $66.00 A6211 FOAM DRSG, WOUND COVER, PAD SIZE > $98.00 A6212 FOAM DRSG, WOUND COVER, PAD SIZE 16 $32.00 A6214 FOAM DRSG, WOUND COVER, PAD SIZE > $34.00 A6216 GAUZE, NON‐IMPREGNATED, NON‐STERILE $1.00 A6219 GAUZE, NON‐IMPREG, PAD SIZE 16 SQ. $3.00 A6220 GAUZE, NON‐IMPREG, PAD SIZE > 16 SQ $9.00 A6222 GAUZE, IMPREG W/OTH THAN WATER, NOR $7.00 A6223 GAUZE, IMPREG W/OTH THAN WATER, NOR $8.00 A6224 GAUZE, IMPREG W/OTH THAN WATER, NOR $12.00 A6229 GAUZE, IMPREG, WATER OR NORM SALINE $12.00 A6231 GAUZE, IMPREG, HYDROGEL, FOR DIRECT $16.00 A6232 GAUZE, IMPREG, HYDROGEL, FOR DIRECT $23.00 A6233 GAUZE, IMPREG, HYDROGEL FOR DIRECT $64.00 A6234 HYDROCOLLOID DRSG, WOUND COVER, PAD $22.00 A6235 HYDROCOLLOID DRSG, WOUND COVER, PAD $56.00 A6236 HYDROCOLLOID DRSG, WOUND COVER, PAD $91.00 A6237 HYDROCOLLOID DRSG, WOUND COVER, PAD $26.00 A6238 HYDROCOLLOID DRSG, WOUND COVER, PAD $76.00 A6240 HYDROCOLLOID DRSG, WOUND FILLER, PA $41.00 A6241 HYDROCOLLOID DRSG, WOUND FILLER, DR $9.00 A6242 HYDROGEL DRSG, WOUND COVER, PAD SIZ $20.00 A6243 HYDROGEL DRSG, WOUND COVER, PAD SIZ $41.00 A6244 HYDROGEL DRSG, WOUND COVER, PAD SIZ $131.00 A6245 HYDROGEL DRSG, WOUND COVER, PAD SIZ $24.00 A6246 HYDROGEL DRSG, WOUND COVER, PAD SIZ $33.00 A6247 HYDROGEL DRSG, WOUND COVER, PAD SIZ $79.00 A6248 HYDROGEL DRSG, WOUND FILLER, GEL, P $54.00 A6251 SPEC ABSORB DRSG, WOUND COVER, PAD $7.00 A6252 SPEC ABSORB DRSG, WOUND COVER, PAD $11.00 A6253 SPEC ABSORB DRSG, WOUND COVER, PAD $21.00 A6254 SPEC ABSORB DRSG, WOUND COVER, PAD $4.00 A6255 SPEC ABSORB DRSG, WOUND COVER, PAD $10.00 A6257 TRANSPARENT FILM, 16 SQ. IN. OR LES $5.00 A6258 TRANSPARENT FILM, > 16 SQ. IN. BUT $14.00 A6259 TRANSPARENT FILM, > 48 SQ. IN., EA $36.00 A6266 GAUZE, IMPREGNATED, OTHER THAN WATE $6.00 A6402 GAUZE, NON‐IMPREGNATED, STERILE, PA $1.00 A6403 GAUZE, NON‐IMPREG, STERILE, PAD SIZ $1.00 A6407 PACKING STRPS NON IMPREGNATED TO 2 $6.00 A6410 EYE PAD, STERILE, EA $1.00 A6441 PAD BAND W>=3 <5/YD $2.00 A6442 CONFORM BAND N/S W<3/YD $1.00 A6443 CONFORM BAND N/S W>=3<5/YD $1.00 A6444 CONFORM BAND N/S W>=5/YD $2.00 A6445 CONFORM BAND S W <3/YD $1.00 A6446 CONFORM BAND S W>=3 <5/YD $1.00 A6447 CONFORM BAND S W >=5/YD $2.00 A6448 LT COMPRES BAND <3/YD $4.00 A6449 LT COMPRES BAND >=3 <5/YD $6.00 A6452 HIGH COMPRES BAND W>=3<5YD $20.00 A6453 SELF‐ADHER BAND W <3/YD $2.00 A6454 SELF‐ADHER BAND W>=3 <5/YD $3.00 A6455 SELF‐ADHER BAND >=5/YD $5.00 A6456 ZINC PASTE BAND W >=3<5/YD $4.00 A6457 Tubular dressing $4.00 A6531,AW Compression stocking BK30‐40 $144.00 A6532,AW Compression stocking BK40‐50 $203.00 A6545,AW GRAD COMP NON‐ELASTIC BK $284.00 A6550 DRESSING SET FOR NEGATIVE PRESS $79.00 A7000,NU CANISTER, DISPOSABLE, USED W/ SUCTI $24.00 A7000,NUKE CANISTER, DISPOSABLE, USED W/ SUCTI $28.00 A7001,NU CANISTER, NON‐DISPOSABLE, USED W/ S $99.00 A7002,NU TUBING, USED W/ SUCTION PUMP, EA $12.00 A7003,NU ADMIN SET, W/ SMALL VOLUME NONFILTE $9.00 A7004,NU SMALL VOLUME NONFILTERED PNEUMATIC $5.00 A7005,NU ADMIN SET, W/ SMALL VOLUME NONFILTE $93.00 A7006,NU ADMIN SET, W/ SMALL VOLUME FILTERED $27.00 A7007,NU LARGE VOLUME NEBULIZER, DISPOSABLE, $13.00 A7008,NU LARGE VOLUME NEBULIZER, DISPOSABLE, $37.00 A7009,NU RESV BOTTLE, NON‐DISPOSABLE, USED W $126.00 A7010,NU CORRUGATED TUBING, DISPOSABLE, USED $78.00 A7012,NU WATER COLLECTION DEVICE, USED W/ LA $12.00 A7013,NU FILTER, DISPOSABLE, USED W/ AEROSOL $3.00 A7014,NU FILTER, NONDISPOSABLE, USED W/ AERO $13.00 A7015,NU AEROSOL MASK, USED W/ DME NEBULIZER $5.00 A7016,NU DOME & MOUTHPIECE, USED W/ SMALL VO $22.00 A7017,NU NEBULIZER, DURABLE, GLASS OR AUTOCL $446.00 A7017,RR NEBULIZER, DURABLE, GLASS OR AUTOCL $45.00 A7017,UE NEBULIZER, DURABLE, GLASS OR AUTOCL $335.00 A7018 WATER, DISTILLED, USED W/ LARGE VOL $1.00 A7020,NU INTERFACE, COUGH STIM DEVICE $46.00 A7025,RR HIGH FREQUENCY CHEST WALL OSCILLATI $145.00 A7026,NU HIGH FREQUENCY CHEST WALL OSCILLATI $96.00 A7027,NU Combination oral/nasal mask $597.00 A7028,NU Repl oral cushion combo mask $165.00 A7029,NU Repl nasal pillow comb mask $67.00 A7030,NU FULL FACE MASK USED W/ POSITIVE AIR $541.00 A7031,NU FACE MASK INTERFACE, REPLACEMENT FO $200.00 A7032,NU Replacement nasal cushion $116.00 A7033,NU Replacement nasal pillows $82.00 A7034,NU NASAL INTERFACE (MASK OR CANNULA TY $338.00 A7035,NU HEADGEAR USED W/ POSITIVE AIRWAY PR $102.00 A7036,NU CHINSTRAP USED W/ POSITIVE AIRWAY P $52.00 A7037,NU TUBING USED W/ POSITIVE AIRWAY PRES $113.00 A7038,NU FILTER, DISPOSABLE, USED W/ POSITIV $13.00 A7039,NU FILTER, NON DISPOSABLE, USED W/ POS $44.00 A7040 ONE WAY CHEST DRAIN VALVE $131.00 A7041 WATER SEAL DRAIN CONTAINER $247.00 A7044,NU ORAL INTERFACE USED W/ POSITIVE AIR $347.00 A7045,NU REPL EXHALATION PORT FOR PAP $56.00 A7045,RR REPL EXHALATION PORT FOR PAP $6.00 A7045,UE REPL EXHALATION PORT FOR PAP $42.00 A7046,NU WATER CHAMBER FOR HUMIDIFIER W POS $56.00 A7047,NU RESP SUCTION ORAL INTERFACE $403.00 A7048 VACUUM DRAIN BOTTLE/TUBE KIT $137.00 A7501 TRACHEOSTOMA VALVE, INCL DIAPHRAGM, $350.00 A7502 REPLACEMENT DIAPHRAGM/FACEPLATE FOR $166.00 A7503 FILTER HOLDER OR FILTER CAP, REUSAB $38.00 A7504 FILTER FOR USE IN A TRACHEOSTOMA HE $2.00 A7505 HOUSING, REUSABLE W/O ADH, FOR USE $16.00 A7506 ADH DISC FOR USE IN A HEAT & MOISTU $1.00 A7507 FILTER HOLDER & INT FILTER W/O ADH, $8.00 A7508 HOUSING & INT ADH, FOR USE IN A TRA $10.00 A7509 FILTER HOLDER & INT FILTER HOUSING, $5.00 A7520 TRACHEOSTOMY/LARYNGECTOMY TUBE $158.00 A7521 TRACHEOSTOMY/LARYNGECTOMY TUBE $157.00 A7522 TRACHEOSTOMY/LARYNGECTOMY TUBE $150.00 A7524 TRACHEOSTOMA STENT/STUD/BUTTON $258.00 A7525 TRACHEOSTOMY MASK $7.00 A7526 TRACHEOSTOMY TUBE COLLAR HOLDER $11.00 A7527 TRACH/LARYN TUBE PLUG/STOP $12.00 A8000,NU Soft protect helmet prefab $511.00 A8000,RR Soft protect helmet prefab $51.00 A8000,UE Soft protect helmet prefab $383.00 A8001,NU Hard protect helmet prefab $511.00 A8001,RR Hard protect helmet prefab $51.00 A8001,UE Hard protect helmet prefab $383.00 A9500 Tc99m sestamibi $503.00 A9502 Tc99m tetrofosmin $396.00 A9503 Tc99m medronate $65.00 A9505 TL201 thallium $175.00 A9512 Tc99m pertechnetate $0.00 A9516 Iodine I‐123 sod iodide mic $399.00 A9537 Tc99m mebrofenin $190.00 A9538 Tc99m pyrophosphate $78.00 A9552 F18 fdg $1,357.00 A9560 Tc99m labeled rbc $321.00 A9561 Tc99m oxidronate $166.00 A9575 INJ GADOTERATE MEGLUMI 0.1ML $1.00 A9576 INJ GADOTERIDOL PER ML $6.00 A9577 INJ GADOBENATE DIMEGLUMINE PER ML $7.00 A9578 INJ GADOBENATE DIMEGLUMINE PER ML $7.00 A9579 INJ GADOLINIUM BASED NOS PER ML $6.00 A9581 GADOXETATE DISODIUM INJ $42.00 A9583 GADOFOSVESET TRISODIUM INJ $44.00 A9585 GADOBUTROL INJECTION $1.00 ATP02 NULL $22.00 ATP03 NULL $23.00 ATP04 NULL $23.00 ATP05 NULL $23.00 ATP06 NULL $23.00 ATP07 NULL $27.00 ATP08 NULL $27.00 ATP09 NULL $27.00 ATP10 NULL $34.00 ATP11 NULL $34.00 ATP12 NULL $34.00 ATP16 NULL $41.00 ATP18 NULL $45.00 ATP19 NULL $47.00 ATP20 NULL $48.00 ATP21 NULL $50.00 ATP22 NULL $52.00 ATP23 NULL $52.00 B4034 Enter feed supkit syr by day $19.00 B4035 ENTERAL FEEDING SUPPLY KIT; PUMP F $36.00 B4036 ENTERAL FEEDING SUPPLY KIT; GRAVITY $25.00 B4081 NASOGASTRIC TUBING W/ STYLET $66.00 B4082 NASOGASTRIC TUBING W/O STYLET $49.00 B4083 STOMACH TUBE ‐ LEVINE TYPE $8.00 B4087 Gastro/jejuno tube, std $110.00 B4088 Gastro/jejuno tube, low‐pro $110.00 B4149 EF blenderized foods $5.00 B4150 EF COMPLET W/INTACT NUTRIENT $2.00 B4152 EF CALORIE DENSE>/=1.5KCAL $2.00 B4153 EF HYDROLYZED/AMINO ACIDS $6.00 B4154 EF SPEC METABOLIC NONINHERIT $4.00 B4155 EF INCOMPLETE/MODULAR $3.00 B4164 PARENTERAL NUTR SOL: CARBS (DEXTRO $59.00 B4168 PARENTERAL NUTR SOL; AMINO ACID, 3. $86.00 B4176 PARENTERAL NUTR SOL; AMINO ACID, 7% $166.00 B4178 PARENTERAL NUTR SOL: AMINO ACID, > $199.00 B4180 PARENTERAL NUTR SOL; CARBS (DEXTROS $84.00 B4185 Parenteral sol 10 gm lipids $39.00 B4189 PARENTERAL NUTR SOL; COMPOUNDED AMI $615.00 B4193 PARENTERAL NUTR SOL; COMPOUNDED AMI $794.00 B4197 PARENTERAL NUTR SOL; COMPOUNDED AMI $967.00 B4199 PARENTERAL NUTR SOL; COMPOUNDED AMI $1,105.00 B4216 PARENTERAL NUTRITION; ADDITIVES (VI $27.00 B4220 PARENTERAL NUTRITION SUPPLY KIT; PR $28.00 B4222 PARENTERAL NUTRITION SUPPLY KIT; HO $34.00 B4224 PARENTERAL NUTRITION ADMIN KIT, PER $86.00 B5000 PARENTERAL NUTR SOL: COMPOUNDED AM $41.00 B5100 PARENTERAL NUTR SOL: COMPOUNDED AMI $16.00 B9000,NU ENTERAL NUTRITION INF PUMP ‐ W/O AL $3,770.00 B9000,RR ENTERAL NUTRITION INF PUMP ‐ W/O AL $346.00 B9000,UE ENTERAL NUTRITION INF PUMP ‐ W/O AL $2,827.00 B9002,NU ENTERAL NUTRITION INF PUMP ‐ W/ ALA $3,770.00 B9002,RR ENTERAL NUTRITION INF PUMP ‐ W/ ALA $365.00 B9002,UE ENTERAL NUTRITION INF PUMP ‐ W/ ALA $2,827.00 B9004,NU PARENTERAL NUTRITION INF PUMP, PORT $8,725.00 B9004,RR PARENTERAL NUTRITION INF PUMP, PORT $1,381.00 B9004,UE PARENTERAL NUTRITION INF PUMP, PORT $6,543.00 B9006,NU PARENTERAL NUTRITION INF PUMP, STAT $8,725.00 B9006,RR PARENTERAL NUTRITION INF PUMP, STAT $1,381.00 B9006,UE PARENTERAL NUTRITION INF PUMP, STAT $6,543.00 E0100,NU CANE, INCL CANES OF ALL MATL, ADJ O $70.00 E0100,RR CANE, INCL CANES OF ALL MATL, ADJ O $20.00 E0100,UE CANE, INCL CANES OF ALL MATL, ADJ O $56.00 E0105,NU CANE, QUAD OR THREE PRONG, INCL CAN $164.00 E0105,RR CANE, QUAD OR THREE PRONG, INCL CAN $30.00 E0105,UE CANE, QUAD OR THREE PRONG, INCL CAN $126.00 E0110,NU CRUTCHES, FOREARM, INCL CRUTCHES OF $258.00 E0110,RR CRUTCHES, FOREARM, INCL CRUTCHES OF $45.00 E0110,UE CRUTCHES, FOREARM, INCL CRUTCHES OF $194.00 E0111,NU CRUTCH FOREARM, INCL CRUTCHES OF VA $169.00 E0111,RR CRUTCH FOREARM, INCL CRUTCHES OF VA $24.00 E0111,UE CRUTCH FOREARM, INCL CRUTCHES OF VA $126.00 E0112,NU CRUTCHES UNDERARM, WOOD, ADJ OR FIX $123.00 E0112,RR CRUTCHES UNDERARM, WOOD, ADJ OR FIX $28.00 E0112,UE CRUTCHES UNDERARM, WOOD, ADJ OR FIX $94.00 E0113,NU CRUTCH UNDERARM, WOOD, ADJ OR FIXED $70.00 E0113,RR CRUTCH UNDERARM, WOOD, ADJ OR FIXED $17.00 E0113,UE CRUTCH UNDERARM, WOOD, ADJ OR FIXED $53.00 E0114,NU CRUTCHES UNDERARM, OTHER THAN WOOD, $146.00 E0114,RR CRUTCHES UNDERARM, OTHER THAN WOOD, $26.00 E0114,UE CRUTCHES UNDERARM, OTHER THAN WOOD, $111.00 E0116,NU Crutch underarm EA. no wood $79.00 E0116,RR Crutch underarm EA. no wood $18.00 E0116,UE Crutch underarm EA. no wood $59.00 E0117,RR CRUTCH, UNDERARM, ARTICULATING, SPR $64.00 E0130,NU WALKER, RIGID (PICKUP), ADJ OR FIXE $197.00 E0130,RR WALKER, RIGID (PICKUP), ADJ OR FIXE $41.00 E0130,UE WALKER, RIGID (PICKUP), ADJ OR FIXE $157.00 E0135,NU WALKER, FOLDING (PICKUP), ADJ OR FI $241.00 E0135,RR WALKER, FOLDING (PICKUP), ADJ OR FI $48.00 E0135,UE WALKER, FOLDING (PICKUP), ADJ OR FI $185.00 E0140,NU WALDER W/TRUNK SUPPORT $1,035.00 E0140,RR WALDER W/TRUNK SUPPORT $104.00 E0140,UE WALDER W/TRUNK SUPPORT $776.00 E0141,NU RIGID WALKER, WHEELED, W/O SEAT $331.00 E0141,RR RIGID WALKER, WHEELED, W/O SEAT $55.00 E0141,UE RIGID WALKER, WHEELED, W/O SEAT $248.00 E0143,NU FOLDING WALKER, WHEELED, W/O SEAT $345.00 E0143,RR FOLDING WALKER, WHEELED, W/O SEAT $62.00 E0143,UE FOLDING WALKER, WHEELED, W/O SEAT $258.00 E0144,RR Enclosed walker w rear seat $91.00 E0147,NU HEAVY DUTY, MULT BREAKING SYS, VARI $1,650.00 E0147,RR HEAVY DUTY, MULT BREAKING SYS, VARI $165.00 E0147,UE HEAVY DUTY, MULT BREAKING SYS, VARI $1,237.00 E0148,NU WALKER, HEAVY DUTY, W/O WHEELS, RIG $365.00 E0148,RR WALKER, HEAVY DUTY, W/O WHEELS, RIG $37.00 E0148,UE WALKER, HEAVY DUTY, W/O WHEELS, RIG $273.00 E0149,NU WALKER, HEAVY DUTY, WHEELED, RIGID $641.00 E0149,RR WALKER, HEAVY DUTY, WHEELED, RIGID $64.00 E0149,UE WALKER, HEAVY DUTY, WHEELED, RIGID $480.00 E0153,NU PLATFORM ATTACH, FOREARM CRUTCH, EA $231.00 E0153,RR PLATFORM ATTACH, FOREARM CRUTCH, EA $24.00 E0153,UE PLATFORM ATTACH, FOREARM CRUTCH, EA $173.00 E0154,NU PLATFORM ATTACH, WALKER, EA $181.00 E0154,RR PLATFORM ATTACH, WALKER, EA $21.00 E0154,UE PLATFORM ATTACH, WALKER, EA $141.00 E0155,NU WHEEL ATTACH, RIGID PICK‐UP WALKER, $77.00 E0155,RR WHEEL ATTACH, RIGID PICK‐UP WALKER, $9.00 E0155,UE WHEEL ATTACH, RIGID PICK‐UP WALKER, $59.00 E0156,NU SEAT ATTACH, WALKER $76.00 E0156,RR SEAT ATTACH, WALKER $10.00 E0156,UE SEAT ATTACH, WALKER $57.00 E0157,NU CRUTCH ATTACH, WALKER, EA $206.00 E0157,RR CRUTCH ATTACH, WALKER, EA $22.00 E0157,UE CRUTCH ATTACH, WALKER, EA $154.00 E0158,NU LEG EXTS FOR WALKER, PER SET OF FOU $78.00 E0158,RR LEG EXTS FOR WALKER, PER SET OF FOU $9.00 E0158,UE LEG EXTS FOR WALKER, PER SET OF FOU $59.00 E0159,NU BRAKE ATTACH FOR WHEELED WALKER, RE $51.00 E0159,RR BRAKE ATTACH FOR WHEELED WALKER, RE $5.00 E0159,UE BRAKE ATTACH FOR WHEELED WALKER, RE $38.00 E0160,NU SITZ TYPE BATH OR EQUIP, PORT., USE $110.00 E0160,RR SITZ TYPE BATH OR EQUIP, PORT., USE $14.00 E0160,UE SITZ TYPE BATH OR EQUIP, PORT., USE $82.00 E0161,NU SITZ TYPE BATH OR EQUIP, PORT., USE $87.00 E0161,RR SITZ TYPE BATH OR EQUIP, PORT., USE $11.00 E0161,UE SITZ TYPE BATH OR EQUIP, PORT., USE $65.00 E0162,NU SITZ BATH CHAIR $485.00 E0162,RR SITZ BATH CHAIR $51.00 E0162,UE SITZ BATH CHAIR $376.00 E0163,NU COMMODE CHAIR, STATIONARY, W/ FIXED $367.00 E0163,RR COMMODE CHAIR, STATIONARY, W/ FIXED $69.00 E0163,UE COMMODE CHAIR, STATIONARY, W/ FIXED $283.00 E0165,RR COMMODE CHAIR, STATIONARY, W/ DETAC $62.00 E0167,NU PAIL OR PAN FOR USE W/ COMMODE CHAI $40.00 E0167,RR PAIL OR PAN FOR USE W/ COMMODE CHAI $4.00 E0167,UE PAIL OR PAN FOR USE W/ COMMODE CHAI $30.00 E0168,NU COMMODE CHAIR, EXTRA WIDE &/OR HEAV $503.00 E0168,RR COMMODE CHAIR, EXTRA WIDE &/OR HEAV $50.00 E0168,UE COMMODE CHAIR, EXTRA WIDE &/OR HEAV $377.00 E0170,RR Commode chair electric $535.00 E0171,RR Commode chair non‐electric $96.00 E0175,NU FOOT REST, FOR USE W/ COMMODE CHAIR $187.00 E0175,RR FOOT REST, FOR USE W/ COMMODE CHAIR $19.00 E0175,UE FOOT REST, FOR USE W/ COMMODE CHAIR $138.00 E0181,RR PRESS PAD, ALTERNATING W/ PUMP, HEA $87.00 E0182,RR PUMP FOR ALTERNATING PRESS PAD $75.00 E0184,NU DRY PRESS MATTRESS $648.00 E0184,RR DRY PRESS MATTRESS $82.00 E0184,UE DRY PRESS MATTRESS $497.00 E0185,NU GEL OR GEL‐LIKE PRESS PAD FOR MATTR $1,065.00 E0185,RR GEL OR GEL‐LIKE PRESS PAD FOR MATTR $150.00 E0185,UE GEL OR GEL‐LIKE PRESS PAD FOR MATTR $817.00 E0186,RR AIR PRESS MATTRESS $68.00 E0187,RR WATER PRESS MATTRESS $77.00 E0188,NU SYNTHETIC SHEEPSKIN PAD $75.00 E0188,RR SYNTHETIC SHEEPSKIN PAD $9.00 E0188,UE SYNTHETIC SHEEPSKIN PAD $56.00 E0189,NU LAMBSWOOL SHEEPSKIN PAD, ANY SIZE $147.00 E0189,RR LAMBSWOOL SHEEPSKIN PAD, ANY SIZE $16.00 E0189,UE LAMBSWOOL SHEEPSKIN PAD, ANY SIZE $110.00 E0191,NU HEEL OR ELBOW PROTECTOR, EA $28.00 E0191,RR HEEL OR ELBOW PROTECTOR, EA $3.00 E0191,UE HEEL OR ELBOW PROTECTOR, EA $21.00 E0193,RR POWERED AIR FLOTATION BED (LOW AIR $2,571.00 E0194,RR AIR FLUIDIZED BED $9,211.00 E0196,RR GEL PRESS MATTRESS $108.00 E0197,NU AIR PRESS PAD FOR MATTRESS, ST&ARD $627.00 E0197,RR AIR PRESS PAD FOR MATTRESS, ST&ARD $87.00 E0197,UE AIR PRESS PAD FOR MATTRESS, ST&ARD $551.00 E0198,RR WATER PRESS PAD FOR MATTRESS, ST&AR $64.00 E0199,NU DRY PRESS PAD FOR MATTRESS, ST&ARD $107.00 E0199,RR DRY PRESS PAD FOR MATTRESS, ST&ARD $11.00 E0199,UE DRY PRESS PAD FOR MATTRESS, ST&ARD $80.00 E0200,NU HEAT LAMP, W/O ST& (TABLE MODEL), I $264.00 E0200,RR HEAT LAMP, W/O ST& (TABLE MODEL), I $36.00 E0200,UE HEAT LAMP, W/O ST& (TABLE MODEL), I $198.00 E0202,RR PHOTOTHER (BILIRUBIN) LIGHT W/ PHOT $209.00 E0205,NU HEAT LAMP, W/ ST&, INCL BULB, OR IN $646.00 E0205,RR HEAT LAMP, W/ ST&, INCL BULB, OR IN $71.00 E0205,UE HEAT LAMP, W/ ST&, INCL BULB, OR IN $485.00 E0210,NU ELECTRIC HEAT PAD, ST&ARD $92.00 E0210,RR ELECTRIC HEAT PAD, ST&ARD $9.00 E0210,UE ELECTRIC HEAT PAD, ST&ARD $69.00 E0215,NU ELECTRIC HEAT PAD, MOIST $201.00 E0215,RR ELECTRIC HEAT PAD, MOIST $21.00 E0215,UE ELECTRIC HEAT PAD, MOIST $150.00 E0217,NU WATER CIRCULATING HEAT PAD W/ PUMP $1,405.00 E0217,RR WATER CIRCULATING HEAT PAD W/ PUMP $156.00 E0217,UE WATER CIRCULATING HEAT PAD W/ PUMP $1,054.00 E0225,NU HYDROCOLLATOR UNIT, INCL PADS $1,294.00 E0225,RR HYDROCOLLATOR UNIT, INCL PADS $128.00 E0225,UE HYDROCOLLATOR UNIT, INCL PADS $971.00 E0235,RR PARAFFIN BATH UNIT, PORT. (SEE MEDI $57.00 E0236,RR PUMP FOR WATER CIRCULATING PAD $128.00 E0239,NU HYDROCOLLATOR UNIT, PORT. $1,273.00 E0239,RR HYDROCOLLATOR UNIT, PORT. $127.00 E0239,UE HYDROCOLLATOR UNIT, PORT. $955.00 E0249,NU PAD FOR WATER CIRCULATING HEAT UNIT $282.00 E0249,RR PAD FOR WATER CIRCULATING HEAT UNIT $31.00 E0249,UE PAD FOR WATER CIRCULATING HEAT UNIT $211.00 E0250,RR HOSPITAL BED, FIXED HEIGHT, W/ ANY $238.00 E0251,RR HOSPITAL BED, FIXED HEIGHT, W/ ANY $194.00 E0255,RR HOSPITAL BED, VARIABLE HEIGHT, HI‐L $337.00 E0256,RR HOSPITAL BED, VARIABLE HEIGHT, HI‐L $239.00 E0260,RR HOSPITAL BED, SEMI‐ELECTRIC (HEAD & $403.00 E0261,RR HOSPITAL BED, SEMI‐ELECTRIC (HEAD & $393.00 E0265,RR HOSPITAL BED, TOTAL ELECTRIC (HEAD, $574.00 E0266,RR HOSPITAL BED, TOTAL ELECTRIC (HEAD, $510.00 E0271,NU MATTRESS, INNERSPRING $542.00 E0271,RR MATTRESS, INNERSPRING $56.00 E0271,UE MATTRESS, INNERSPRING $423.00 E0272,NU MATTRESS, FOAM RUBBER $494.00 E0272,RR MATTRESS, FOAM RUBBER $52.00 E0272,UE MATTRESS, FOAM RUBBER $368.00 E0275,NU BED PAN, ST&ARD, METAL OR PLAS $47.00 E0275,RR BED PAN, ST&ARD, METAL OR PLAS $5.00 E0275,UE BED PAN, ST&ARD, METAL OR PLAS $35.00 E0276,NU BED PAN, FRACTURE, METAL OR PLAS $44.00 E0276,RR BED PAN, FRACTURE, METAL OR PLAS $5.00 E0276,UE BED PAN, FRACTURE, METAL OR PLAS $35.00 E0277,RR POWERED PRESS‐REDUCING AIR MATTRESS $2,019.00 E0280,NU BED CRADLE, ANY TYPE $110.00 E0280,RR BED CRADLE, ANY TYPE $12.00 E0280,UE BED CRADLE, ANY TYPE $82.00 E0290,RR HOSPITAL BED, FIXED HEIGHT, W/O SID $211.00 E0291,RR HOSPITAL BED, FIXED HEIGHT, W/O SID $156.00 E0292,RR HOSPITAL BED, VARIABLE HEIGHT, HI‐L $241.00 E0293,RR HOSPITAL BED, VARIABLE HEIGHT, HI‐L $205.00 E0294,RR HOSPITAL BED, SEMI‐ELECTRIC (HEAD & $375.00 E0295,RR HOSPITAL BED, SEMI‐ELECTRIC (HEAD & $365.00 E0296,RR HOSPITAL BED, TOTAL ELECTRIC (HEAD, $471.00 E0297,RR HOSPITAL BED, TOTAL ELECTRIC (HEAD, $404.00 E0300,RR PEDIATRIC CRIB HOSP GRADE FULL ENCL $815.00 E0301,RR HOSPITAL BED HEAVY DUTY X WIDE $752.00 E0302,RR HOSP BED XTRA HEAVY DUTY X WIDE $2,053.00 E0303,RR HOSP BED HEAVY DUTY X WIDE $848.00 E0304,RR HOSP BED XTRA HEAVY DUTY X WIDE $2,212.00 E0305,RR BED SIDE RAILS, HALF LGTH $43.00 E0310,NU BED SIDE RAILS, FULL LGTH $474.00 E0310,RR BED SIDE RAILS, FULL LGTH $56.00 E0310,UE BED SIDE RAILS, FULL LGTH $358.00 E0316,RR SAFETY ENCLOSURE FRAME/CANOPY FOR U $606.00 E0325,NU URINAL; MALE, JUG‐TYPE, ANY MAT $29.00 E0325,RR URINAL; MALE, JUG‐TYPE, ANY MAT $4.00 E0325,UE URINAL; MALE, JUG‐TYPE, ANY MAT $19.00 E0326,NU URINAL; FEMALE, JUG‐TYPE, ANY MAT $32.00 E0326,RR URINAL; FEMALE, JUG‐TYPE, ANY MAT $3.00 E0326,UE URINAL; FEMALE, JUG‐TYPE, ANY MAT $24.00 E0371,RR NONPOWERED ADVANCED PRESS REDUCING $1,237.00 E0372,RR POWERED AIR OVERLAY FOR MATTRESS, S $1,501.00 E0373,RR NONPOWERED ADVANCED PRESS REDUCING $1,719.00 E0424,RR STATIONARY COMPRESSED GASEOUS OXYGE $543.00 E0431,RR PORT. GASEOUS OXYGEN SYS, RENTAL; I $91.00 E0433,RR PORTABLE LIQUID OXYGEN SYS $155.00 E0434,RR PORT. LIQ O2 SYS, RENTAL; INCL PORT $91.00 E0439,RR STATIONARY LIQ O2 SYS, RENTAL; INCL $543.00 E0441 OXY CONTENTS, GASEOUS (W/OWNED GASE $232.00 E0442 OXYGEN CONTENTS, LIQUID (FOR USE W/ $232.00 E0443 PORT. OXYGEN CONTENTS, GASEOUS (FOR $232.00 E0444 PORT. OXYGEN CONTENTS, LIQUID (FOR $232.00 E0462,RR ROCKING BED W/ OR W/O SIDE RAILS $825.00 E0465,RR Home ventilator, any type, used wit $0.00 E0466,RR Home ventilator, any type, used wit $0.00 E0470,RR RESP ASSIST DEVICE BI LEVEL PRESSRU $736.00 E0471,RR RESP ASSIST DEVICE BILEVEL PRESSURE $1,843.00 E0472,RR RESP ASSIST DEVICE BI LEVEL PRES $1,843.00 E0480,RR PERCUSSOR, ELECTRIC OR PNEUMATIC, H $124.00 E0482,RR COUGH STIMULATING DEVICE, ALTERNATI $1,388.00 E0483,RR HIGH FREQUENCY CHEST WALL OSCILLATI $3,540.00 E0484,NU OSCILLATORY POSITIVE EXPIRATORY PRE $123.00 E0484,RR OSCILLATORY POSITIVE EXPIRATORY PRE $12.00 E0484,UE OSCILLATORY POSITIVE EXPIRATORY PRE $92.00 E0500,RR IPPB MACHINE, ALL TYPES, W/ BUILT‐ $365.00 E0550,RR HUMIDIFIER, DURABLE FOR EXTENSIVE S $167.00 E0560,NU HUMIDIFIER, DURABLE FOR SUPPLEMENTA $492.00 E0560,RR HUMIDIFIER, DURABLE FOR SUPPLEMENTA $58.00 E0560,UE HUMIDIFIER, DURABLE FOR SUPPLEMENTA $369.00 E0561,NU HUMIDIFIER NON‐HEATED $307.00 E0561,RR HUMIDIFIER NON‐HEATED $31.00 E0561,UE HUMIDIFIER NON‐HEATED $230.00 E0562,NU HUM HEATED USED WITH POS $865.00 E0562,RR HUM HEATED USED WITH POS $86.00 E0562,UE HUM HEATED USED WITH POS $648.00 E0565,RR COMPRESSOR, AIR POWER SOURCE FOR EQ $203.00 E0570,RR NEBULIZER, W/ COMPRESSOR $54.00 E0572,RR AEROSOL COMPRESSOR, ADJ PRESS, LIGH $124.00 E0574,RR ULTRASONIC/ELECTRONIC AEROSOL GENER $131.00 E0575,RR NEBULIZER, ULTRASONIC, LARGE VOLUME $342.00 E0580,NU NEBULIZER, DURABLE, GLASS OR AUTOCL $385.00 E0580,RR NEBULIZER, DURABLE, GLASS OR AUTOCL $38.00 E0580,UE NEBULIZER, DURABLE, GLASS OR AUTOCL $288.00 E0585,RR NEBULIZER, W/ COMPRESSOR & HEATER $117.00 E0600,RR RESPIRATORY SUCTION PUMP, HOME MODE $152.00 E0601,RR CONT AIRWAY PRESS (CPAP) DEVICE $321.00 E0602,NU BREAST PUMP, MANUAL, ANY TYPE $98.00 E0602,RR BREAST PUMP, MANUAL, ANY TYPE $10.00 E0602,UE BREAST PUMP, MANUAL, ANY TYPE $74.00 E0605,NU VAPORIZER, ROOM TYPE $88.00 E0605,RR VAPORIZER, ROOM TYPE $10.00 E0605,UE VAPORIZER, ROOM TYPE $73.00 E0606,RR POSTURAL DRAINAGE BOARD $70.00 E0607,NU HOME BLOOD GLUCOSE MONITOR $222.00 E0607,RR HOME BLOOD GLUCOSE MONITOR $22.00 E0607,UE HOME BLOOD GLUCOSE MONITOR $167.00 E0610,NU PACEMAKER MONITOR, SELF‐CONTAINED, $792.00 E0610,RR PACEMAKER MONITOR, SELF‐CONTAINED, $84.00 E0610,UE PACEMAKER MONITOR, SELF‐CONTAINED, $594.00 E0615,NU PACEMAKER MONITOR, SELF CONTAINED, $1,456.00 E0615,RR PACEMAKER MONITOR, SELF CONTAINED, $166.00 E0615,UE PACEMAKER MONITOR, SELF CONTAINED, $1,080.00 E0617,RR EXT DEFIBRILLATOR W/ INT ELECTROCAR $1,012.00 E0617,RRKF EXT DEFIBRILLATOR W/ INT ELECTROCAR $1,124.00 E0618,RR APNEA MONITOR, W/O RECORDING FEATUR $934.00 E0620,RR SKIN PIERCING DEVICE FOR COLLECTION $291.00 E0621,NU SLING OR SEAT, PT LIFT, CANVAS OR N $272.00 E0621,RR SLING OR SEAT, PT LIFT, CANVAS OR N $26.00 E0621,UE SLING OR SEAT, PT LIFT, CANVAS OR N $205.00 E0627,NU SEAT LIFT MECHANISM INCORPORATED IN $1,096.00 E0627,RR SEAT LIFT MECHANISM INCORPORATED IN $110.00 E0627,UE SEAT LIFT MECHANISM INCORPORATED IN $822.00 E0628,NU SEPARATE SEAT LIFT MECHANISM FOR US $1,096.00 E0628,RR SEPARATE SEAT LIFT MECHANISM FOR US $110.00 E0628,UE SEPARATE SEAT LIFT MECHANISM FOR US $822.00 E0629,NU SEPARATE SEAT LIFT MECHANISM FOR US $936.00 E0629,RR SEPARATE SEAT LIFT MECHANISM FOR US $94.00 E0629,UE SEPARATE SEAT LIFT MECHANISM FOR US $702.00 E0630,RR Patient lift hydraulic $339.00 E0635,RR PT LIFT, ELECTRIC W/ SEAT OR SLING $382.00 E0636,RR MULTIPOSITIONAL PT SUPRT SYS, W/ IN $3,512.00 E0639,RR MOVEABLE PATIENT LIFT SYSTEM $0.00 E0640,RR FIXED PATIENT LIFT SYSTEM $0.00 E0650,NU PNEUMATIC COMPRESSOR, NON‐SEGMENTAL $2,169.00 E0650,RR PNEUMATIC COMPRESSOR, NON‐SEGMENTAL $261.00 E0650,UE PNEUMATIC COMPRESSOR, NON‐SEGMENTAL $1,637.00 E0651,NU PNEUMATIC COMPRESSOR, SEGMENTAL HOM $2,599.00 E0651,RR PNEUMATIC COMPRESSOR, SEGMENTAL HOM $292.00 E0651,UE PNEUMATIC COMPRESSOR, SEGMENTAL HOM $1,950.00 E0652,NU PNEUMATIC COMPRESSOR, SEGMENTAL HOM $16,749.00 E0652,RR PNEUMATIC COMPRESSOR, SEGMENTAL HOM $1,675.00 E0652,UE PNEUMATIC COMPRESSOR, SEGMENTAL HOM $11,917.00 E0655,NU NON‐SEGMENTAL PNEUMATIC APPLIANCE F $325.00 E0655,RR NON‐SEGMENTAL PNEUMATIC APPLIANCE F $42.00 E0655,UE NON‐SEGMENTAL PNEUMATIC APPLIANCE F $244.00 E0656,RR SEGMENTAL PNEUMATIC TRUNK $192.00 E0657,RR SEGMENTAL PNEUMATIC CHEST $181.00 E0660,NU NON‐SEGMENTAL PNEUMATIC APPLIANCE F $530.00 E0660,RR NON‐SEGMENTAL PNEUMATIC APPLIANCE F $53.00 E0660,UE NON‐SEGMENTAL PNEUMATIC APPLIANCE F $399.00 E0665,NU NON‐SEGMENTAL PNEUMATIC APPLIANCE F $456.00 E0665,RR NON‐SEGMENTAL PNEUMATIC APPLIANCE F $46.00 E0665,UE NON‐SEGMENTAL PNEUMATIC APPLIANCE F $343.00 E0666,NU NON‐SEGMENTAL PNEUMATIC APPLIANCE F $441.00 E0666,RR NON‐SEGMENTAL PNEUMATIC APPLIANCE F $43.00 E0666,UE NON‐SEGMENTAL PNEUMATIC APPLIANCE F $342.00 E0667,NU SEGMENTAL PNEUMATIC APPLIANCE FOR U $1,078.00 E0667,RR SEGMENTAL PNEUMATIC APPLIANCE FOR U $122.00 E0667,UE SEGMENTAL PNEUMATIC APPLIANCE FOR U $809.00 E0668,NU SEGMENTAL PNEUMATIC APPLIANCE FOR U $1,251.00 E0668,RR SEGMENTAL PNEUMATIC APPLIANCE FOR U $123.00 E0668,UE SEGMENTAL PNEUMATIC APPLIANCE FOR U $938.00 E0669,NU SEGMENTAL PNEUMATIC APPLIANCE FOR U $609.00 E0669,RR SEGMENTAL PNEUMATIC APPLIANCE FOR U $61.00 E0669,UE SEGMENTAL PNEUMATIC APPLIANCE FOR U $456.00 E0670,NU SEG PNEUM INT LEGS/TRUNK $4,186.00 E0670,RR SEG PNEUM INT LEGS/TRUNK $448.00 E0670,UE SEG PNEUM INT LEGS/TRUNK $3,139.00 E0671,NU SEGMENTAL GRADIENT PRESS PNEUMATIC $1,383.00 E0671,RR SEGMENTAL GRADIENT PRESS PNEUMATIC $138.00 E0671,UE SEGMENTAL GRADIENT PRESS PNEUMATIC $1,037.00 E0672,NU SEGMENTAL GRADIENT PRESS PNEUMATIC $1,075.00 E0672,RR SEGMENTAL GRADIENT PRESS PNEUMATIC $107.00 E0672,UE SEGMENTAL GRADIENT PRESS PNEUMATIC $806.00 E0673,NU SEGMENTAL GRADIENT PRESS PNEUMATIC $893.00 E0673,RR SEGMENTAL GRADIENT PRESS PNEUMATIC $89.00 E0673,UE SEGMENTAL GRADIENT PRESS PNEUMATIC $670.00 E0675,RR PNEU COMPRESS DEVICE HIGH PRESS $1,280.00 E0691,NU UV LIGHT THER SYS PANEL, INCL BULBS $2,992.00 E0691,RR UV LIGHT THER SYS PANEL, INCL BULBS $299.00 E0691,UE UV LIGHT THER SYS PANEL, INCL BULBS $2,244.00 E0692,NU UV LIGHT THER SYS PANEL, INCL BULBS $3,757.00 E0692,RR UV LIGHT THER SYS PANEL, INCL BULBS $376.00 E0692,UE UV LIGHT THER SYS PANEL, INCL BULBS $2,818.00 E0693,NU UV LIGHT THER SYS PANEL, INCL BULBS $4,632.00 E0693,RR UV LIGHT THER SYS PANEL, INCL BULBS $463.00 E0693,UE UV LIGHT THER SYS PANEL, INCL BULBS $3,474.00 E0694,NU UV MULTIDIRECTIONAL LIGHT THER SYS $14,742.00 E0694,RR UV MULTIDIRECTIONAL LIGHT THER SYS $1,474.00 E0694,UE UV MULTIDIRECTIONAL LIGHT THER SYS $11,057.00 E0705,NU Transfer device $175.00 E0705,RR Transfer device $18.00 E0705,UE Transfer device $134.00 E0720,NU TENS, TWO LEAD, LOCALIZED STIM $1,129.00 E0730,NU TRANSCUTANEOUS ELEC NERVE STIM DEVI $1,133.00 E0731,NU FORM FITTING CONDUCTIVE GARMENT FOR $1,010.00 E0740,RR INCONTINENCE TRTMT SYS, PELVIC FLOO $174.00 E0744,RR NEUROMUSCULAR STIMULATOR FOR SCOLIO $305.00 E0745,RR NEUROMUSCULAR STIMULATOR, ELECTRONI $296.00 E0747,NUKF OSTEOGENESIS STIMULATOR, ELEC, NON‐ $12,959.00 E0747,RRKF OSTEOGENESIS STIMULATOR, ELEC, NON‐ $1,296.00 E0747,UEKF OSTEOGENESIS STIMULATOR, ELEC, NON‐ $9,688.00 E0748,NUKF OSTEOGENESIS STIMULATOR, ELEC, NON‐ $12,955.00 E0748,RRKF OSTEOGENESIS STIMULATOR, ELEC, NON‐ $1,295.00 E0748,UEKF OSTEOGENESIS STIMULATOR, ELEC, NON‐ $9,717.00 E0749,RRKF OSTEOGENESIS STIMULATOR, ELEC, SURG $845.00 E0760,NUKF OSTOGENESIS STIMULATOR, LOW INTENSI $10,766.00 E0760,RRKF OSTOGENESIS STIMULATOR, LOW INTENSI $1,077.00 E0760,UEKF OSTOGENESIS STIMULATOR, LOW INTENSI $8,074.00 E0762,RR Trans elec jt stim dev sys $311.00 E0764,RRKF Functional neuromuscularstim $3,685.00 E0765,NU FDA APPROV NERVE STIMULATOR, W/ REP $280.00 E0765,RR FDA APPROV NERVE STIMULATOR, W/ REP $28.00 E0765,UE FDA APPROV NERVE STIMULATOR, W/ REP $210.00 E0776,NU IV POLE $405.00 E0776,NUBA IV POLE $314.00 E0776,NUKE IV POLE $364.00 E0776,RR IV POLE $53.00 E0776,RRBA IV POLE $79.00 E0776,RRKE IV POLE $92.00 E0776,UE IV POLE $298.00 E0776,UEBA IV POLE $235.00 E0776,UEKE IV POLE $273.00 E0779,RR AMBULATORY INF PUMP, MECH, REUSABLE $54.00 E0780,NU AMBULATORY INF PUMP, MECH, REUSABLE $35.00 E0781,RR AMBULATORY INF PUMP, SNG OR MULT CH $750.00 E0782,NUKF INF PUMP, IMPLANTABLE, NON‐PROGMABL $14,296.00 E0782,RRKF INF PUMP, IMPLANTABLE, NON‐PROGMABL $1,430.00 E0782,UEKF INF PUMP, IMPLANTABLE, NON‐PROGMABL $10,722.00 E0783,NUKF INF PUMP SYS, IMPLANTABLE, PROGMABL $27,261.00 E0783,RRKF INF PUMP SYS, IMPLANTABLE, PROGMABL $2,726.00 E0783,UEKF INF PUMP SYS, IMPLANTABLE, PROGMABL $20,446.00 E0784,RR EXT AMBULATORY INF PUMP, INSULIN $1,390.00 E0785,KF IMPLANTABLE INTRASPINAL (EPIDURAL/I $1,434.00 E0786,NUKF IMPLANTABLE PROGMABLE INF PUMP, REP $25,632.00 E0786,RRKF IMPLANTABLE PROGMABLE INF PUMP, REP $2,563.00 E0786,UEKF IMPLANTABLE PROGMABLE INF PUMP, REP $19,224.00 E0791,RR PARENTERAL INF PUMP, STATIONARY, SN $895.00 E0840,NU TRACTION FRAME, ATTACHED TO HEADBOA $244.00 E0840,RR TRACTION FRAME, ATTACHED TO HEADBOA $54.00 E0840,UE TRACTION FRAME, ATTACHED TO HEADBOA $183.00 E0849,RR CERVICAL PNEUM TRAC EQUIP $172.00 E0850,NU TRACTION ST&, FREE ST&ING, CERV TRA $350.00 E0850,RR TRACTION ST&, FREE ST&ING, CERV TRA $48.00 E0850,UE TRACTION ST&, FREE ST&ING, CERV TRA $262.00 E0855,RR CERV TRACTION EQUIP NOT REQUIRING A $167.00 E0856,RR Cervic collar w air bladder $51.00 E0860,NU TRACTION EQUIP, OVERDOOR, CERV $109.00 E0860,RR TRACTION EQUIP, OVERDOOR, CERV $18.00 E0860,UE TRACTION EQUIP, OVERDOOR, CERV $84.00 E0870,NU TRACTION FRAME, ATTACHED TO FOOTBOA $387.00 E0870,RR TRACTION FRAME, ATTACHED TO FOOTBOA $45.00 E0870,UE TRACTION FRAME, ATTACHED TO FOOTBOA $292.00 E0880,NU TRACTION ST&, FREE ST&ING, EXTREMIT $355.00 E0880,RR TRACTION ST&, FREE ST&ING, EXTREMIT $56.00 E0880,UE TRACTION ST&, FREE ST&ING, EXTREMIT $269.00 E0890,NU TRACTION FRAME, ATTACHED TO FOOTBOA $401.00 E0890,RR TRACTION FRAME, ATTACHED TO FOOTBOA $109.00 E0890,UE TRACTION FRAME, ATTACHED TO FOOTBOA $323.00 E0900,NU TRACTION ST&, FREE ST&ING, PELVIC T $420.00 E0900,RR TRACTION ST&, FREE ST&ING, PELVIC T $78.00 E0900,UE TRACTION ST&, FREE ST&ING, PELVIC T $315.00 E0910,RR TRAPEZE BARS, A/K/A PT HELPER, ATTA $57.00 E0911,RR HD trapeze bar attach to bed $143.00 E0912,RR HD trapeze bar free standing $329.00 E0920,RR FRACTURE FRAME, ATTACHED TO BED, IN $154.00 E0930,RR FRACTURE FRAME, FREE ST&ING, INCL W $135.00 E0935,RR Cont pas motion exercise dev $64.00 E0940,RR TRAPEZE BAR, FREE ST&ING, COMP W/ G $100.00 E0941,RR GRAVITY ASSISTED TRACTION DEVICE, A $145.00 E0942,NU CERV HEAD HARNESS/HALTER $56.00 E0942,RR CERV HEAD HARNESS/HALTER $7.00 E0942,UE CERV HEAD HARNESS/HALTER $42.00 E0944,NU PELVIC BELT/HARNESS/BOOT $130.00 E0944,RR PELVIC BELT/HARNESS/BOOT $13.00 E0944,UE PELVIC BELT/HARNESS/BOOT $97.00 E0945,NU EXTREMITY BELT/HARNESS $125.00 E0945,RR EXTREMITY BELT/HARNESS $13.00 E0945,UE EXTREMITY BELT/HARNESS $97.00 E0946,RR FRACTURE, FRAME, DUAL W/ CROSS BARS $178.00 E0947,NU FRACTURE FRAME, ATTACHS FOR COMPLEX $2,019.00 E0947,RR FRACTURE FRAME, ATTACHS FOR COMPLEX $209.00 E0947,UE FRACTURE FRAME, ATTACHS FOR COMPLEX $1,515.00 E0948,NU FRACTURE FRAME, ATTACHS FOR COMPLEX $1,953.00 E0948,RR FRACTURE FRAME, ATTACHS FOR COMPLEX $195.00 E0948,UE FRACTURE FRAME, ATTACHS FOR COMPLEX $1,378.00 E0950,NU TRAY $254.00 E0950,NUKE TRAY $294.00 E0950,RR TRAY $25.00 E0950,RRKE TRAY $29.00 E0950,UE TRAY $190.00 E0950,UEKE TRAY $221.00 E0951,NU LOOP HEEL $54.00 E0951,NUKE LOOP HEEL $63.00 E0951,RR LOOP HEEL $6.00 E0951,RRKE LOOP HEEL $7.00 E0951,UE LOOP HEEL $41.00 E0951,UEKE LOOP HEEL $47.00 E0952,NU TOE LOOP/HOLDER, EACH $54.00 E0952,NUKE TOE LOOP/HOLDER, EACH $63.00 E0952,RR TOE LOOP/HOLDER, EACH $6.00 E0952,RRKE TOE LOOP/HOLDER, EACH $7.00 E0952,UE TOE LOOP/HOLDER, EACH $41.00 E0952,UEKE TOE LOOP/HOLDER, EACH $47.00 E0955,NU WHEELCHAIR ACCESS HEADREST CUSHION $580.00 E0955,NUKE WHEELCHAIR ACCESS HEADREST CUSHION $673.00 E0955,RR WHEELCHAIR ACCESS HEADREST CUSHION $58.00 E0955,RRKE WHEELCHAIR ACCESS HEADREST CUSHION $67.00 E0955,UE WHEELCHAIR ACCESS HEADREST CUSHION $435.00 E0955,UEKE WHEELCHAIR ACCESS HEADREST CUSHION $505.00 E0956,NU WHEELCHAIR ONE ARM DRIVE ATTACH $283.00 E0956,NUKE WHEELCHAIR ONE ARM DRIVE ATTACH $328.00 E0956,RR WHEELCHAIR ONE ARM DRIVE ATTACH $28.00 E0956,RRKE WHEELCHAIR ONE ARM DRIVE ATTACH $33.00 E0956,UE WHEELCHAIR ONE ARM DRIVE ATTACH $212.00 E0956,UEKE WHEELCHAIR ONE ARM DRIVE ATTACH $246.00 E0957,NU WHEELCHAIR ACCESS MEDIAL THIGH SUPP $396.00 E0957,NUKE WHEELCHAIR ACCESS MEDIAL THIGH SUPP $459.00 E0957,RR WHEELCHAIR ACCESS MEDIAL THIGH SUPP $40.00 E0957,RRKE WHEELCHAIR ACCESS MEDIAL THIGH SUPP $46.00 E0957,UE WHEELCHAIR ACCESS MEDIAL THIGH SUPP $297.00 E0957,UEKE WHEELCHAIR ACCESS MEDIAL THIGH SUPP $344.00 E0958,RR MANUAL WHEELCHAIR ACCESS ONE ARM DR $144.00 E0959,NU AMPUTEE ADAPTER (DEVICE USED TO COM $143.00 E0959,RR AMPUTEE ADAPTER (DEVICE USED TO COM $14.00 E0959,UE AMPUTEE ADAPTER (DEVICE USED TO COM $111.00 E0960,NU WHEELCHAIR ACCESS SHOULDER HARNESS $261.00 E0960,NUKE WHEELCHAIR ACCESS SHOULDER HARNESS $303.00 E0960,RR WHEELCHAIR ACCESS SHOULDER HARNESS $26.00 E0960,RRKE WHEELCHAIR ACCESS SHOULDER HARNESS $30.00 E0960,UE WHEELCHAIR ACCESS SHOULDER HARNESS $196.00 E0960,UEKE WHEELCHAIR ACCESS SHOULDER HARNESS $227.00 E0961,NU BRAKE EXT, FOR WHEELCHR $84.00 E0961,RR BRAKE EXT, FOR WHEELCHR $9.00 E0961,UE BRAKE EXT, FOR WHEELCHR $42.00 E0966,NU HOOK ON HEAD REST EXT $238.00 E0966,RR HOOK ON HEAD REST EXT $23.00 E0966,UE HOOK ON HEAD REST EXT $178.00 E0967,NU WHEELCHAIR HAND RIMS $219.00 E0967,RR WHEELCHAIR HAND RIMS $22.00 E0967,UE WHEELCHAIR HAND RIMS $164.00 E0968,RR COMMODE SEAT, WHEELCHR $60.00 E0969,NU NARROWING DEVICE, WHEELCHR $490.00 E0969,RR NARROWING DEVICE, WHEELCHR $52.00 E0969,UE NARROWING DEVICE, WHEELCHR $384.00 E0971,NU Wheelchair anti‐tipping devi $144.00 E0971,RR Wheelchair anti‐tipping devi $14.00 E0971,UE Wheelchair anti‐tipping devi $108.00 E0973,NU ADJ HEIGHT DETACHABLE ARMS, DESK OR $293.00 E0973,NUKE ADJ HEIGHT DETACHABLE ARMS, DESK OR $340.00 E0973,RR ADJ HEIGHT DETACHABLE ARMS, DESK OR $28.00 E0973,RRKE ADJ HEIGHT DETACHABLE ARMS, DESK OR $33.00 E0973,UE ADJ HEIGHT DETACHABLE ARMS, DESK OR $247.00 E0973,UEKE ADJ HEIGHT DETACHABLE ARMS, DESK OR $287.00 E0974,NU MANUAL WHEELCHAIR ACCESSORY $242.00 E0974,RR MANUAL WHEELCHAIR ACCESSORY $25.00 E0974,UE 0 $188.00 E0978,NU W/C ACC,SAF BELT PELV STRAP $123.00 E0978,NUKE W/C ACC,SAF BELT PELV STRAP $142.00 E0978,RR W/C ACC,SAF BELT PELV STRAP $12.00 E0978,RRKE W/C ACC,SAF BELT PELV STRAP $14.00 E0978,UE W/C ACC,SAF BELT PELV STRAP $91.00 E0978,UEKE W/C ACC,SAF BELT PELV STRAP $105.00 E0980,NU SAFETY VEST, WHEELCHR $94.00 E0980,RR SAFETY VEST, WHEELCHR $9.00 E0980,UE SAFETY VEST, WHEELCHR $70.00 E0981,NU WHEELCHAIR ACCESS SEAT $127.00 E0981,NUKE WHEELCHAIR ACCESS SEAT $147.00 E0981,RR WHEELCHAIR ACCESS SEAT $13.00 E0981,RRKE WHEELCHAIR ACCESS SEAT $15.00 E0981,UE WHEELCHAIR ACCESS SEAT $95.00 E0981,UEKE WHEELCHAIR ACCESS SEAT $110.00 E0982,NU WHEELCHAIR ACCESS BACK $126.00 E0982,NUKE WHEELCHAIR ACCESS BACK $146.00 E0982,RR WHEELCHAIR ACCESS BACK $13.00 E0982,RRKE WHEELCHAIR ACCESS BACK $15.00 E0982,UE WHEELCHAIR ACCESS BACK $94.00 E0982,UEKE WHEELCHAIR ACCESS BACK $109.00 E0983,RR MANUAL WHEELCHAIR POWER ADD ON $809.00 E0984,RR MAN WHEELCHAIR POWER ADD ON $591.00 E0985,NU WHEELCHAIR ACCESS SEAT LIFT $675.00 E0985,RR WHEELCHAIR ACCESS SEAT LIFT $68.00 E0985,UE WHEELCHAIR ACCESS SEAT LIFT $507.00 E0986,RR MAN WHEELCHAIR PUSH RIM ACT POWER $1,620.00 E0988,RR NULL $958.00 E0990,NU ELEVATING LEG REST, EA $337.00 E0990,NUKE ELEVATING LEG REST, EA $391.00 E0990,RR ELEVATING LEG REST, EA $35.00 E0990,RRKE ELEVATING LEG REST, EA $41.00 E0990,UE ELEVATING LEG REST, EA $263.00 E0990,UEKE ELEVATING LEG REST, EA $305.00 E0992,NU SOLID SEAT INSERT $269.00 E0992,RR SOLID SEAT INSERT $27.00 E0992,UE SOLID SEAT INSERT $202.00 E0994,NU ARM REST, EA $50.00 E0994,RR ARM REST, EA $5.00 E0994,UE ARM REST, EA $37.00 E0995,NU CALF REST, EA $74.00 E0995,NUKE CALF REST, EA $86.00 E0995,RR CALF REST, EA $7.00 E0995,RRKE CALF REST, EA $9.00 E0995,UE CALF REST, EA $56.00 E0995,UEKE CALF REST, EA $65.00 E1002,RR WHEELCHAIR ACCESS POWER SEATING $1,163.00 E1002,RRKE WHEELCHAIR ACCESS POWER SEATING $1,350.00 E1003,RR WHEELCHAIR ACCESS POWER SEAT RECLIN $1,260.00 E1003,RRKE WHEELCHAIR ACCESS POWER SEAT RECLIN $1,462.00 E1004,RR WHEELCHAIR ACCESS POWER SEAT RECLIN $1,397.00 E1004,RRKE WHEELCHAIR ACCESS POWER SEAT RECLIN $1,621.00 E1005,RR WHEELCHAIR ACCESS POWER SEAT RECLIN $1,513.00 E1005,RRKE WHEELCHAIR ACCESS POWER SEAT RECLIN $1,755.00 E1006,RR WHEELCHAIR ACCESS RECLINE ONLY $1,853.00 E1006,RRKE WHEELCHAIR ACCESS RECLINE ONLY $2,150.00 E1007,RR WHEELCHAIR POWER SEAT TILT/RECLINE $2,509.00 E1007,RRKE WHEELCHAIR POWER SEAT TILT/RECLINE $2,911.00 E1008,RR WHEELCHAIR POWER SEAT TILT/RECLINE $2,509.00 E1008,RRKE WHEELCHAIR POWER SEAT TILT/RECLINE $2,911.00 E1010,RR WHEELCHAIR ADD TO POWER SEATING $328.00 E1010,RRKE WHEELCHAIR ADD TO POWER SEATING $381.00 E1012,RR Wheelchair accessory, addition to p $0.00 E1014,RR RECLINING BACK ADD PED W/C $122.00 E1015,NU SHOCK ABSORBER FOR MANUAL WHEELCHR, $382.00 E1015,RR SHOCK ABSORBER FOR MANUAL WHEELCHR, $38.00 E1015,UE SHOCK ABSORBER FOR MANUAL WHEELCHR, $286.00 E1016,NU SHOCK ABSORBER FOR POWER WHEELCHR, $377.00 E1016,NUKE SHOCK ABSORBER FOR POWER WHEELCHR, $437.00 E1016,RR SHOCK ABSORBER FOR POWER WHEELCHR, $38.00 E1016,RRKE SHOCK ABSORBER FOR POWER WHEELCHR, $44.00 E1016,UE SHOCK ABSORBER FOR POWER WHEELCHR, $283.00 E1016,UEKE SHOCK ABSORBER FOR POWER WHEELCHR, $328.00 E1020,NU RESIDUAL LIMB SUPRT SYS FOR WHEELCH $699.00 E1020,NUKE RESIDUAL LIMB SUPRT SYS FOR WHEELCH $811.00 E1020,RR RESIDUAL LIMB SUPRT SYS FOR WHEELCH $70.00 E1020,RRKE RESIDUAL LIMB SUPRT SYS FOR WHEELCH $81.00 E1020,UE RESIDUAL LIMB SUPRT SYS FOR WHEELCH $524.00 E1020,UEKE RESIDUAL LIMB SUPRT SYS FOR WHEELCH $608.00 E1028,NU WHEELCHAIR MANUAL SWINGWAY $593.00 E1028,NUKE WHEELCHAIR MANUAL SWINGWAY $688.00 E1028,RR WHEELCHAIR MANUAL SWINGWAY $59.00 E1028,RRKE WHEELCHAIR MANUAL SWINGWAY $69.00 E1028,UE WHEELCHAIR MANUAL SWINGWAY $445.00 E1028,UEKE WHEELCHAIR MANUAL SWINGWAY $516.00 E1029,RR WHEELCHAIR VENT TRAY FIXED $106.00 E1029,RRKE WHEELCHAIR VENT TRAY FIXED $123.00 E1030,RR WHEELCHAIR VENT TRAY GIMBALED $334.00 E1030,RRKE WHEELCHAIR VENT TRAY GIMBALED $388.00 E1031,RR 0 $143.00 E1035,RR MULTI‐POSITIONAL PT TRANSFER SYS, W $2,042.00 E1036,RR PATIENT TRANSFER SYSTEM >300 $2,863.00 E1037,RR TRNSPRT CHAIR, PEDIATRIC SIZE $361.00 E1038,RR Transport chair pt wt<=300lb $60.00 E1039,RR Transport chair pt wt >300lb $114.00 E1050,RR FULLY‐RECLINING WHEELCHR, FIXED FUL $338.00 E1060,RR FULLY‐RECLINING WHEELCHR, DETACHABL $367.00 E1070,RR FULLY‐RECLINING WHEELCHR, DETACHABL $346.00 E1083,RR HEMI‐WHEELCHR, FIXED FULL LGTH ARMS $262.00 E1084,RR HEMI‐WHEELCHR, DETACHABLE ARMS DESK $307.00 E1087,RR HIGH STRENGTH LIGHTWGT WHEELCHR, FI $421.00 E1088,RR HIGH STRENGTH LIGHTWGT WHEELCHR, DE $502.00 E1092,RR WIDE HEAVY DUTY WHEEL CHAIR, DETACH $428.00 E1093,RR WIDE HEAVY DUTY WHEELCHR, DETACHABL $368.00 E1100,RR SEMI‐RECLINING WHEELCHR, FIXED FULL $325.00 E1110,RR SEMI‐RECLINING WHEELCHR, DETACHABLE $322.00 E1150,RR WHEELCHR, DETACHABLE ARMS, DESK OR $272.00 E1160,RR WHEELCHR, FIXED FULL LGTH ARMS, SWI $208.00 E1161,RR MANUAL ADULT SIZE WHEELCHR, INCL TI $788.00 E1170,RR AMPUTEE WHEELCHR, FIXED FULL LGTH A $275.00 E1171,RR AMPUTEE WHEELCHR, FIXED FULL LGTH A $255.00 E1172,RR AMPUTEE WHEELCHR, DETACHABLE ARMS ( $326.00 E1180,RR AMPUTEE WHEELCHR, DETACHABLE ARMS ( $337.00 E1190,RR AMPUTEE WHEELCHR, DETACHABLE ARMS ( $390.00 E1195,RR HEAVY DUTY WHEELCHR, FIXED FULL LGT $418.00 E1200,RR AMPUTEE WHEELCHR, FIXED FULL LGTH A $290.00 E1221,RR WHEELCHR W/ FIXED ARM, FOOTRESTS $158.00 E1222,RR WHEELCHR W/ FIXED ARM, ELEVATING LE $226.00 E1223,RR WHEELCHR W/ DETACHABLE ARMS, FOOTRE $242.00 E1224,RR WHEELCHR W/ DETACHABLE ARMS, ELEVAT $230.00 E1225,RR MANUAL SEMI‐RECLINING BACK $151.00 E1226,NU MANUAL FULLY RECLINING BACK $1,817.00 E1226,RR MANUAL FULLY RECLINING BACK $187.00 E1226,UE MANUAL FULLY RECLINING BACK $1,363.00 E1227,NU SPECIAL HEIGHT ARMS FOR WHEELCHR $924.00 E1227,RR SPECIAL HEIGHT ARMS FOR WHEELCHR $92.00 E1227,UE SPECIAL HEIGHT ARMS FOR WHEELCHR $693.00 E1228,RR SPECIAL BACK HEIGHT FOR WHEELCHR $79.00 E1230,NU POWER OPERATED VEHICLE (THREE OR FO $7,531.00 E1230,RR POWER OPERATED VEHICLE (THREE OR FO $741.00 E1230,UE POWER OPERATED VEHICLE (THREE OR FO $5,956.00 E1232,RR WHEELCHR, PEDIATRIC SIZE, TILT‐IN‐S $712.00 E1233,RR WHEELCHR, PEDIATRIC SIZE, TILT‐IN‐S $738.00 E1234,RR WHEELCHR, PEDIATRIC SIZE, TILT‐IN‐S $642.00 E1235,RR WHEELCHR, PEDIATRIC SIZE, RIGID, AD $619.00 E1236,RR WHEELCHR, PEDIATRIC SIZE, FOLDING, $546.00 E1237,RR WHEELCHR, PEDIATRIC SIZE, RIGID, AD $550.00 E1238,RR WHEELCHR, PEDIATRIC SIZE, FOLDING, $546.00 E1240,RR LIGHTWGT WHEELCHR, DETACHABLE ARMS, $314.00 E1270,RR LIGHTWGT WHEELCHR, FIXED FULL LGTH $234.00 E1280,RR HEAVY DUTY WHEELCHR, DETACHABLE ARM $437.00 E1295,RR HEAVY DUTY WHEELCHR, FIXED FULL LGT $404.00 E1296,NU SPECIAL WHEELCHR SEAT HEIGHT FROM F $1,392.00 E1296,RR SPECIAL WHEELCHR SEAT HEIGHT FROM F $141.00 E1296,UE SPECIAL WHEELCHR SEAT HEIGHT FROM F $1,044.00 E1297,NU SPECIAL WHEELCHR SEAT DEPTH, BY UPH $296.00 E1297,RR SPECIAL WHEELCHR SEAT DEPTH, BY UPH $33.00 E1297,UE SPECIAL WHEELCHR SEAT DEPTH, BY UPH $222.00 E1298,NU SPECIAL WHEELCHR SEAT DEPTH &/OR WI $1,234.00 E1298,RR SPECIAL WHEELCHR SEAT DEPTH &/OR WI $123.00 E1298,UE SPECIAL WHEELCHR SEAT DEPTH &/OR WI $926.00 E1310,NU WHIRLPOOL, NON‐PORT. (BUILT‐IN TYPE $7,151.00 E1310,RR WHIRLPOOL, NON‐PORT. (BUILT‐IN TYPE $583.00 E1310,UE WHIRLPOOL, NON‐PORT. (BUILT‐IN TYPE $5,363.00 E1353 REGULATOR $94.00 E1355 ST&/RACK $71.00 E1372,NU IMMERSION EXT HEATER FOR NEBULIZER $543.00 E1372,RR IMMERSION EXT HEATER FOR NEBULIZER $67.00 E1372,UE IMMERSION EXT HEATER FOR NEBULIZER $402.00 E1390,RR OXYGEN CONCENTRATOR, CAPABLE OF DEL $543.00 E1391,RR OXYGEN CONCENTRATOR DUAL DELIVERY $543.00 E1392,RR Portable oxygen concentrator $155.00 E1405,RR OXYGEN & WATER VAPOR ENRICHING SYS $660.00 E1406,RR OXYGEN & WATER VAPOR ENRICHING SYS $596.00 E1700,RR JAW MOTION REHABILITATION SYS $115.00 E1701 REPLACEMENT CUSHIONS FOR JAW MOTION $35.00 E1702 REPLACEMENT MEASURING SCALES FOR JA $75.00 E1800,RR DYNAMIC ADJ ELBOW EXT/FLEXION DEVIC $347.00 E1801,RR SPS elbow device $416.00 E1802,RR DYNAMIC ADJ FOREARM PRONATION/SUPIN $1,088.00 E1805,RR DYNAMIC ADJ WRIST EXT / FLEXION DEV $387.00 E1806,RR SPS wrist device $342.00 E1810,RR DYNAMIC ADJ KNEE EXT / FLEXION DEVI $387.00 E1811,RR SPS knee device $433.00 E1812,RR Knee ext/flex w act res ctrl $286.00 E1815,RR DYNAMIC ADJ ANKLE EXT/FLEXION DEVIC $387.00 E1816,RR SPS ankle device $440.00 E1818,RR SPS forearm device $449.00 E1820,NU REPLACEMENT SOFT INTERFACE MAT, DYN $272.00 E1820,RR REPLACEMENT SOFT INTERFACE MAT, DYN $27.00 E1820,UE REPLACEMENT SOFT INTERFACE MAT, DYN $204.00 E1821,NU REPLACEMENT SOFT INTERFACE MAT/CUFF $350.00 E1821,RR REPLACEMENT SOFT INTERFACE MAT/CUFF $35.00 E1821,UE REPLACEMENT SOFT INTERFACE MAT/CUFF $263.00 E1825,RR DYNAMIC ADJ FINGER EXT/FLEXION DEVI $387.00 E1830,RR DYNAMIC ADJ TOE EXT/FLEXION DEVICE, $387.00 E1831,RR STATIC STR TOE DEV EXT/FLEX $212.00 E1840,RR DYNAMIC ADJ SHOULDER FLEXION / ABD $1,274.00 E1841,RR Static str shldr dev rom adj $1,508.00 E2000,RR GASTRIC SUCTION PUMP, HOME MODEL, P $167.00 E2100,NU BLOOD GLUCOSE MONITOR W/ INT VOICE $1,833.00 E2100,RR BLOOD GLUCOSE MONITOR W/ INT VOICE $214.00 E2100,UE BLOOD GLUCOSE MONITOR W/ INT VOICE $1,500.00 E2101,NU BLOOD GLUCOSE MONITOR W/ INT LANCIN $628.00 E2101,RR BLOOD GLUCOSE MONITOR W/ INT LANCIN $63.00 E2101,UE BLOOD GLUCOSE MONITOR W/ INT LANCIN $471.00 E2120,RR PULSE GEN SYS TYMPANIC TREAT IN EAR $944.00 E2201,NU MANUAL WHEELCHAIR SEAT FRAME 20‐24 $1,242.00 E2201,RR MANUAL WHEELCHAIR SEAT FRAME 20‐24 $124.00 E2201,UE MANUAL WHEELCHAIR SEAT FRAME 20‐24 $932.00 E2202,NU MANUAL WHEELCHAIR SEAT FRAME 24‐27 $1,578.00 E2202,RR MANUAL WHEELCHAIR SEAT FRAME 24‐27 $158.00 E2202,UE MANUAL WHEELCHAIR SEAT FRAME 24‐27 $1,184.00 E2203,NU MANUAL WHEELCHAIR SEAT FRAME D20‐22 $1,595.00 E2203,RR MANUAL WHEELCHAIR SEAT FRAME D20‐22 $159.00 E2203,UE MANUAL WHEELCHAIR SEAT FRAME D20‐22 $1,196.00 E2204,NU MAN WHEELCHAIR SEAT FRAM D 22‐25 $2,709.00 E2204,RR MAN WHEELCHAIR SEAT FRAM D 22‐25 $271.00 E2204,UE MAN WHEELCHAIR SEAT FRAM D 22‐25 $2,031.00 E2205,NU Manual wc accessory, handrim $109.00 E2205,RR Manual wc accessory, handrim $11.00 E2205,UE Manual wc accessory, handrim $82.00 E2206,NU COMPLETE WHEEL LOCK ASSEMBLY $135.00 E2206,RR COMPLETE WHEEL LOCK ASSEMBLY $14.00 E2206,UE COMPLETE WHEEL LOCK ASSEMBLY $102.00 E2207,NU Crutch and cane holder $144.00 E2207,RR Crutch and cane holder $14.00 E2207,UE Crutch and cane holder $108.00 E2208,NU Cylinder tank carrier $341.00 E2208,NUKE Cylinder tank carrier $396.00 E2208,RR Cylinder tank carrier $34.00 E2208,RRKE Cylinder tank carrier $40.00 E2208,UE Cylinder tank carrier $256.00 E2208,UEKE Cylinder tank carrier $297.00 E2209,NU Arm trough each $308.00 E2209,NUKE Arm trough each $357.00 E2209,RR Arm trough each $31.00 E2209,RRKE Arm trough each $36.00 E2209,UE Arm trough each $231.00 E2209,UEKE Arm trough each $268.00 E2210,NU Wheelchair bearings $19.00 E2210,NUKE Wheelchair bearings $22.00 E2210,RR Wheelchair bearings $2.00 E2210,RRKE Wheelchair bearings $2.00 E2210,UE Wheelchair bearings $14.00 E2210,UEKE Wheelchair bearings $16.00 E2211,NU Pneumatic propulsion tire $124.00 E2211,RR Pneumatic propulsion tire $12.00 E2211,UE Pneumatic propulsion tire $93.00 E2212,NU Pneumatic prop tire tube $20.00 E2212,RR Pneumatic prop tire tube $2.00 E2212,UE Pneumatic prop tire tube $15.00 E2213,NU Pneumatic prop tire insert $101.00 E2213,RR Pneumatic prop tire insert $10.00 E2213,UE Pneumatic prop tire insert $76.00 E2214,NU Pneumatic caster tire EA. $102.00 E2214,RR Pneumatic caster tire EA. $11.00 E2214,UE Pneumatic caster tire EA. $76.00 E2215,NU Pneumatic caster tire tube $32.00 E2215,RR Pneumatic caster tire tube $3.00 E2215,UE Pneumatic caster tire tube $24.00 E2219,NU Foam caster tire any size ea $139.00 E2219,RR Foam caster tire any size ea $16.00 E2219,UE Foam caster tire any size ea $105.00 E2220,NU Solid propulsion tire EA. $82.00 E2220,RR Solid propulsion tire EA. $8.00 E2220,UE Solid propulsion tire EA. $62.00 E2221,NU Solid caster tire EA. $85.00 E2221,RR Solid caster tire EA. $9.00 E2221,UE Solid caster tire EA. $64.00 E2222,NU Solid caster integrated whl $70.00 E2222,RR Solid caster integrated whl $7.00 E2222,UE Solid caster integrated whl $53.00 E2224,NU Propulsion whl excludes tire $286.00 E2224,RR Propulsion whl excludes tire $29.00 E2224,UE Propulsion whl excludes tire $214.00 E2225,NU Caster wheel excludes tire $58.00 E2225,RR Caster wheel excludes tire $6.00 E2225,UE Caster wheel excludes tire $43.00 E2226,NU Caster fork replacement only $126.00 E2226,RR Caster fork replacement only $13.00 E2226,UE Caster fork replacement only $95.00 E2227,RR Gear reduction drive wheel $599.00 E2228,NU Mwc acc, wheelchair brake $3,118.00 E2228,RR Mwc acc, wheelchair brake $312.00 E2228,UE Mwc acc, wheelchair brake $2,338.00 E2231,NU SOLID SEAT SUPPORT BASE $512.00 E2231,RR SOLID SEAT SUPPORT BASE $51.00 E2231,UE SOLID SEAT SUPPORT BASE $384.00 E2310,RR POWER WHEELCHAIR ELE CONN $336.00 E2310,RRKE POWER WHEELCHAIR ELE CONN $390.00 E2311,RR P WHEELCHAIR ELE CON $680.00 E2311,RRKE P WHEELCHAIR ELE CON $789.00 E2312,RR Mini‐prop remote joystick $646.00 E2312,RRKC Mini‐prop remote joystick $824.00 E2313,RR PWC harness, expand control $103.00 E2321,RR P WHEELCHAIR HAND CONTROL INTERFACE $456.00 E2321,RRKC P WHEELCHAIR HAND CONTROL INTERFACE $743.00 E2321,RRKE P WHEELCHAIR HAND CONTROL INTERFACE $529.00 E2322,RR P WHEELCHAIR HAND CONTROL INTERFACE $405.00 E2322,RRKC P WHEELCHAIR HAND CONTROL INTERFACE $787.00 E2322,RRKE P WHEELCHAIR HAND CONTROL INTERFACE $470.00 E2323,NU P WHEELCHAIR SPEC JOYSTICK HANDLE $199.00 E2323,NUKE P WHEELCHAIR SPEC JOYSTICK HANDLE $230.00 E2323,RR P WHEELCHAIR SPEC JOYSTICK HANDLE $20.00 E2323,RRKE P WHEELCHAIR SPEC JOYSTICK HANDLE $23.00 E2323,UE P WHEELCHAIR SPEC JOYSTICK HANDLE $149.00 E2323,UEKE P WHEELCHAIR SPEC JOYSTICK HANDLE $173.00 E2324,NU P WHEELCHAIR CHIN CUP FOR CHIN CONT $126.00 E2324,NUKE P WHEELCHAIR CHIN CUP FOR CHIN CONT $146.00 E2324,RR P WHEELCHAIR CHIN CUP FOR CHIN CONT $13.00 E2324,RRKE P WHEELCHAIR CHIN CUP FOR CHIN CONT $15.00 E2324,UE P WHEELCHAIR CHIN CUP FOR CHIN CONT $94.00 E2324,UEKE P WHEELCHAIR CHIN CUP FOR CHIN CONT $109.00 E2325,RR P WHEELCHAIR SIP AND PUFF INTERFACE $387.00 E2325,RRKE P WHEELCHAIR SIP AND PUFF INTERFACE $449.00 E2326,RR P WHEELCHAIR BREATH TUBE KIT $100.00 E2326,RRKE P WHEELCHAIR BREATH TUBE KIT $116.00 E2327,RR P WHEELCHAIR HEAD CONTROL INTERFACE $750.00 E2327,RRKC P WHEELCHAIR HEAD CONTROL INTERFACE $1,139.00 E2327,RRKE P WHEELCHAIR HEAD CONTROL INTERFACE $870.00 E2328,RR P WHEELCHAIR HEAD CONT OR EXTRE $1,422.00 E2328,RRKE P WHEELCHAIR HEAD CONT OR EXTRE $1,650.00 E2329,RR P WHEELCHAIR HEAD CONT INTERFACE $507.00 E2329,RRKE P WHEELCHAIR HEAD CONT INTERFACE $588.00 E2330,RR P WHEELCHAIR HEAD CONTROL INTERFACE $982.00 E2330,RRKE P WHEELCHAIR HEAD CONTROL INTERFACE $1,139.00 E2340,NU P WHEELCHAIR SEAT FRAME WID 20‐23 $1,193.00 E2340,RR P WHEELCHAIR SEAT FRAME WID 20‐23 $119.00 E2340,UE P WHEELCHAIR SEAT FRAME WID 20‐23 $895.00 E2341,NU P WHEELCHAIR SEAT FRAME WID 24‐27 $1,790.00 E2341,RR P WHEELCHAIR SEAT FRAME WID 24‐27 $179.00 E2341,UE P WHEELCHAIR SEAT FRAME WID 24‐27 $1,343.00 E2342,NU P WHEELCHAIR SEAT FRAME DEP 20‐21 $1,492.00 E2342,RR P WHEELCHAIR SEAT FRAME DEP 20‐21 $149.00 E2342,UE P WHEELCHAIR SEAT FRAME DEP 20‐21 $1,119.00 E2343,NU P WHEELCHAIR SEAT FRAME DEP 22‐25 $2,387.00 E2343,RR P WHEELCHAIR SEAT FRAME DEP 22‐25 $239.00 E2343,UE P WHEELCHAIR SEAT FRAME DEP 22‐25 $1,790.00 E2351,NU P WHEELCHAIR ELE INTERFACE SPEECH $1,978.00 E2351,NUKE P WHEELCHAIR ELE INTERFACE SPEECH $2,292.00 E2351,RR P WHEELCHAIR ELE INTERFACE SPEECH $201.00 E2351,RRKE P WHEELCHAIR ELE INTERFACE SPEECH $233.00 E2351,UE P WHEELCHAIR ELE INTERFACE SPEECH $1,484.00 E2351,UEKE P WHEELCHAIR ELE INTERFACE SPEECH $1,719.00 E2359,NU NULL $557.00 E2359,RR NULL $56.00 E2359,UE NULL $418.00 E2360,NU P WHEELCHAIR 22 NF NONSEALED BATT $374.00 E2360,RR P WHEELCHAIR 22 NF NONSEALED BATT $38.00 E2360,UE P WHEELCHAIR 22 NF NONSEALED BATT $281.00 E2361,NU P WHEELCHAIR 22NF SEALED LEAD A BAT $400.00 E2361,NUKE P WHEELCHAIR 22NF SEALED LEAD A BAT $464.00 E2361,RR P WHEELCHAIR 22NF SEALED LEAD A BAT $40.00 E2361,RRKE P WHEELCHAIR 22NF SEALED LEAD A BAT $46.00 E2361,UE P WHEELCHAIR 22NF SEALED LEAD A BAT $300.00 E2361,UEKE P WHEELCHAIR 22NF SEALED LEAD A BAT $348.00 E2362,NU P WHEELCHAIR G24 NON SEALED LEAD BA $306.00 E2362,RR P WHEELCHAIR G24 NON SEALED LEAD BA $31.00 E2362,UE P WHEELCHAIR G24 NON SEALED LEAD BA $230.00 E2363,NU P WHEELCHAIR 24 BATTERY $534.00 E2363,NUKE P WHEELCHAIR 24 BATTERY $619.00 E2363,RR P WHEELCHAIR 24 BATTERY $53.00 E2363,RRKE P WHEELCHAIR 24 BATTERY $62.00 E2363,UE P WHEELCHAIR 24 BATTERY $400.00 E2363,UEKE P WHEELCHAIR 24 BATTERY $465.00 E2364,NU POWER WHEELCHAIR BATTERY $374.00 E2364,RR POWER WHEELCHAIR BATTERY $38.00 E2364,UE POWER WHEELCHAIR BATTERY $281.00 E2365,NU POWER WHEELCHAIR BATTERY $322.00 E2365,NUKE POWER WHEELCHAIR BATTERY $373.00 E2365,RR POWER WHEELCHAIR BATTERY $32.00 E2365,RRKE POWER WHEELCHAIR BATTERY $37.00 E2365,UE POWER WHEELCHAIR BATTERY $242.00 E2365,UEKE POWER WHEELCHAIR BATTERY $280.00 E2366,NU P WHEELCHAIR BATTERY CHARGER $741.00 E2366,NUKE P WHEELCHAIR BATTERY CHARGER $860.00 E2366,RR P WHEELCHAIR BATTERY CHARGER $74.00 E2366,RRKE P WHEELCHAIR BATTERY CHARGER $86.00 E2366,UE P WHEELCHAIR BATTERY CHARGER $567.00 E2366,UEKE P WHEELCHAIR BATTERY CHARGER $658.00 E2367,NU POWER WHEELCHAIR BATTERY CHARGER $1,203.00 E2367,NUKE POWER WHEELCHAIR BATTERY CHARGER $1,395.00 E2367,RR POWER WHEELCHAIR BATTERY CHARGER $120.00 E2367,RRKE POWER WHEELCHAIR BATTERY CHARGER $140.00 E2367,UE POWER WHEELCHAIR BATTERY CHARGER $902.00 E2367,UEKE POWER WHEELCHAIR BATTERY CHARGER $1,047.00 E2368,NU POWER WC MOTOR REPLACEMENT $1,483.00 E2368,NUKE POWER WC MOTOR REPLACEMENT $1,720.00 E2368,RR POWER WC MOTOR REPLACEMENT $148.00 E2368,RRKE POWER WC MOTOR REPLACEMENT $172.00 E2368,UE POWER WC MOTOR REPLACEMENT $1,112.00 E2368,UEKE POWER WC MOTOR REPLACEMENT $1,290.00 E2369,NU PWR WC GEAR BOX REPLACEMENT $1,291.00 E2369,NUKE PWR WC GEAR BOX REPLACEMENT $1,498.00 E2369,RR PWR WC GEAR BOX REPLACEMENT $129.00 E2369,RRKE PWR WC GEAR BOX REPLACEMENT $150.00 E2369,UE PWR WC GEAR BOX REPLACEMENT $968.00 E2369,UEKE PWR WC GEAR BOX REPLACEMENT $1,124.00 E2370,NU PWR WC MOTOR/GEAR BOX COMBO $2,304.00 E2370,NUKE PWR WC MOTOR/GEAR BOX COMBO $2,673.00 E2370,RR PWR WC MOTOR/GEAR BOX COMBO $230.00 E2370,RRKE PWR WC MOTOR/GEAR BOX COMBO $267.00 E2370,UE PWR WC MOTOR/GEAR BOX COMBO $1,728.00 E2370,UEKE PWR WC MOTOR/GEAR BOX COMBO $2,005.00 E2371,NU Gr27 sealed leadacid battery $433.00 E2371,NUKE Gr27 sealed leadacid battery $502.00 E2371,RR Gr27 sealed leadacid battery $43.00 E2371,RRKE Gr27 sealed leadacid battery $50.00 E2371,UE Gr27 sealed leadacid battery $325.00 E2371,UEKE Gr27 sealed leadacid battery $376.00 E2373,RR Hand/chin ctrl spec joystick $225.00 E2373,RRKC Hand/chin ctrl spec joystick $347.00 E2373,RRKE Hand/chin ctrl spec joystick $403.00 E2374,RR Hand/chin ctrl std joystick $153.00 E2374,RRKE Hand/chin ctrl std joystick $178.00 E2375,NU Non‐expandable controller $2,458.00 E2375,NUKE Non‐expandable controller $2,852.00 E2375,RR Non‐expandable controller $246.00 E2375,RRKE Non‐expandable controller $285.00 E2375,UE Non‐expandable controller $1,844.00 E2375,UEKE Non‐expandable controller $2,139.00 E2376,RR Expandable controller, repl $385.00 E2376,RRKE Expandable controller, repl $447.00 E2377,RR Expandable controller, initl $139.00 E2377,RRKE Expandable controller, initl $162.00 E2378,RR PW ACTUATOR REPLACEMENT $170.00 E2381,NU Pneum drive wheel tire $219.00 E2381,NUKE Pneum drive wheel tire $254.00 E2381,RR Pneum drive wheel tire $22.00 E2381,RRKE Pneum drive wheel tire $25.00 E2381,UE Pneum drive wheel tire $164.00 E2381,UEKE Pneum drive wheel tire $190.00 E2382,NU Tube, pneum wheel drive tire $60.00 E2382,NUKE Tube, pneum wheel drive tire $69.00 E2382,RR Tube, pneum wheel drive tire $6.00 E2382,RRKE Tube, pneum wheel drive tire $7.00 E2382,UE Tube, pneum wheel drive tire $45.00 E2382,UEKE Tube, pneum wheel drive tire $52.00 E2383,NU Insert, pneum wheel drive $436.00 E2383,NUKE Insert, pneum wheel drive $506.00 E2383,RR Insert, pneum wheel drive $44.00 E2383,RRKE Insert, pneum wheel drive $51.00 E2383,UE Insert, pneum wheel drive $327.00 E2383,UEKE Insert, pneum wheel drive $379.00 E2384,NU Pneumatic caster tire $232.00 E2384,NUKE Pneumatic caster tire $269.00 E2384,RR Pneumatic caster tire $23.00 E2384,RRKE Pneumatic caster tire $27.00 E2384,UE Pneumatic caster tire $174.00 E2384,UEKE Pneumatic caster tire $202.00 E2385,NU Tube, pneumatic caster tire $142.00 E2385,NUKE Tube, pneumatic caster tire $165.00 E2385,RR Tube, pneumatic caster tire $14.00 E2385,RRKE Tube, pneumatic caster tire $16.00 E2385,UE Tube, pneumatic caster tire $107.00 E2385,UEKE Tube, pneumatic caster tire $124.00 E2386,NU Foam filled drive wheel tire $432.00 E2386,NUKE Foam filled drive wheel tire $501.00 E2386,RR Foam filled drive wheel tire $43.00 E2386,RRKE Foam filled drive wheel tire $50.00 E2386,UE Foam filled drive wheel tire $324.00 E2386,UEKE Foam filled drive wheel tire $376.00 E2387,NU Foam filled caster tire $194.00 E2387,NUKE Foam filled caster tire $225.00 E2387,RR Foam filled caster tire $19.00 E2387,RRKE Foam filled caster tire $22.00 E2387,UE Foam filled caster tire $145.00 E2387,UEKE Foam filled caster tire $169.00 E2388,NU Foam drive wheel tire $145.00 E2388,NUKE Foam drive wheel tire $168.00 E2388,RR Foam drive wheel tire $14.00 E2388,RRKE Foam drive wheel tire $17.00 E2388,UE Foam drive wheel tire $108.00 E2388,UEKE Foam drive wheel tire $126.00 E2389,NU Foam caster tire $79.00 E2389,NUKE Foam caster tire $91.00 E2389,RR Foam caster tire $8.00 E2389,RRKE Foam caster tire $9.00 E2389,UE Foam caster tire $59.00 E2389,UEKE Foam caster tire $68.00 E2390,NU Solid drive wheel tire $123.00 E2390,NUKE Solid drive wheel tire $143.00 E2390,RR Solid drive wheel tire $12.00 E2390,RRKE Solid drive wheel tire $14.00 E2390,UE Solid drive wheel tire $92.00 E2390,UEKE Solid drive wheel tire $107.00 E2391,NU Solid caster tire $59.00 E2391,NUKE Solid caster tire $68.00 E2391,RR Solid caster tire $6.00 E2391,RRKE Solid caster tire $7.00 E2391,UE Solid caster tire $44.00 E2391,UEKE Solid caster tire $51.00 E2392,NU Solid caster tire, integrate $155.00 E2392,NUKE Solid caster tire, integrate $179.00 E2392,RR Solid caster tire, integrate $16.00 E2392,RRKE Solid caster tire, integrate $18.00 E2392,UE Solid caster tire, integrate $116.00 E2392,UEKE Solid caster tire, integrate $135.00 E2394,NU Drive wheel excludes tire $220.00 E2394,NUKE Drive wheel excludes tire $256.00 E2394,RR Drive wheel excludes tire $22.00 E2394,RRKE Drive wheel excludes tire $26.00 E2394,UE Drive wheel excludes tire $165.00 E2394,UEKE Drive wheel excludes tire $192.00 E2395,NU Caster wheel excludes tire $157.00 E2395,NUKE Caster wheel excludes tire $182.00 E2395,RR Caster wheel excludes tire $16.00 E2395,RRKE Caster wheel excludes tire $18.00 E2395,UE Caster wheel excludes tire $117.00 E2395,UEKE Caster wheel excludes tire $136.00 E2396,NU Caster fork $165.00 E2396,NUKE Caster fork $191.00 E2396,RR Caster fork $17.00 E2396,RRKE Caster fork $20.00 E2396,UE Caster fork $124.00 E2396,UEKE Caster fork $143.00 E2397,NU Pwc acc, lith‐based battery $1,379.00 E2397,RR Pwc acc, lith‐based battery $138.00 E2397,UE Pwc acc, lith‐based battery $1,034.00 E2402,RR NEGATIVE PRESSURE WOUND PUMP $4,926.00 E2500,NU SPEECH GENERATING DEVICE DIG $1,297.00 E2500,RR SPEECH GENERATING DEVICE DIG $130.00 E2500,UE SPEECH GENERATING DEVICE DIG $973.00 E2502,NU SPEECH GENERATING DEVICE DIG SPEECH $3,966.00 E2502,RR SPEECH GENERATING DEVICE DIG SPEECH $398.00 E2502,UE SPEECH GENERATING DEVICE DIG SPEECH $2,974.00 E2504,NU SPEECH GEN DEVICE DIGIT SPEECH $5,232.00 E2504,RR SPEECH GEN DEVICE DIGIT SPEECH $525.00 E2504,UE SPEECH GEN DEVICE DIGIT SPEECH $3,924.00 E2506,NU SPEECH GENERATING DEVICE DIG $7,671.00 E2506,RR SPEECH GENERATING DEVICE DIG $770.00 E2506,UE SPEECH GENERATING DEVICE DIG $5,753.00 E2508,NU SPEECH GENERATING DEVICE SYNTHESIZE $11,862.00 E2508,RR SPEECH GENERATING DEVICE SYNTHESIZE $1,191.00 E2508,UE SPEECH GENERATING DEVICE SYNTHESIZE $8,896.00 E2510,NU SPEECH GENER DEVICE SYNTHESIZED $22,447.00 E2510,RR SPEECH GENER DEVICE SYNTHESIZED $2,254.00 E2510,UE SPEECH GENER DEVICE SYNTHESIZED $16,835.00 E2601,NU GEN W/C CUSHION WDTH < 22 IN $176.00 E2601,NUKE GEN W/C CUSHION WDTH < 22 IN $204.00 E2601,RR GEN W/C CUSHION WDTH < 22 IN $18.00 E2601,RRKE GEN W/C CUSHION WDTH < 22 IN $20.00 E2601,UE GEN W/C CUSHION WDTH < 22 IN $132.00 E2601,UEKE GEN W/C CUSHION WDTH < 22 IN $153.00 E2602,NU GEN W/C CUSHION WDTH >=22 IN $343.00 E2602,NUKE GEN W/C CUSHION WDTH >=22 IN $398.00 E2602,RR GEN W/C CUSHION WDTH >=22 IN $34.00 E2602,RRKE GEN W/C CUSHION WDTH >=22 IN $40.00 E2602,UE GEN W/C CUSHION WDTH >=22 IN $257.00 E2602,UEKE GEN W/C CUSHION WDTH >=22 IN $298.00 E2603,NU SKIN PROTECT WC CUS WD <22IN $435.00 E2603,NUKE SKIN PROTECT WC CUS WD <22IN $505.00 E2603,RR SKIN PROTECT WC CUS WD <22IN $44.00 E2603,RRKE SKIN PROTECT WC CUS WD <22IN $50.00 E2603,UE SKIN PROTECT WC CUS WD <22IN $326.00 E2603,UEKE SKIN PROTECT WC CUS WD <22IN $379.00 E2604,NU SKIN PROTECT WC CUS WD>=22IN $541.00 E2604,NUKE SKIN PROTECT WC CUS WD>=22IN $627.00 E2604,RR SKIN PROTECT WC CUS WD>=22IN $54.00 E2604,RRKE SKIN PROTECT WC CUS WD>=22IN $63.00 E2604,UE SKIN PROTECT WC CUS WD>=22IN $406.00 E2604,UEKE SKIN PROTECT WC CUS WD>=22IN $471.00 E2605,NU POSITION WC CUSH WDTH <22 IN $773.00 E2605,NUKE POSITION WC CUSH WDTH <22 IN $896.00 E2605,RR POSITION WC CUSH WDTH <22 IN $77.00 E2605,RRKE POSITION WC CUSH WDTH <22 IN $90.00 E2605,UE POSITION WC CUSH WDTH <22 IN $579.00 E2605,UEKE POSITION WC CUSH WDTH <22 IN $672.00 E2606,NU POSITION WC CUSH WDTH>=22 IN $1,205.00 E2606,NUKE POSITION WC CUSH WDTH>=22 IN $1,398.00 E2606,RR POSITION WC CUSH WDTH>=22 IN $121.00 E2606,RRKE POSITION WC CUSH WDTH>=22 IN $140.00 E2606,UE POSITION WC CUSH WDTH>=22 IN $904.00 E2606,UEKE POSITION WC CUSH WDTH>=22 IN $1,049.00 E2607,NU SKIN PRO/POS WC CUS WD <22IN $832.00 E2607,NUKE SKIN PRO/POS WC CUS WD <22IN $965.00 E2607,RR SKIN PRO/POS WC CUS WD <22IN $83.00 E2607,RRKE SKIN PRO/POS WC CUS WD <22IN $97.00 E2607,UE SKIN PRO/POS WC CUS WD <22IN $624.00 E2607,UEKE SKIN PRO/POS WC CUS WD <22IN $724.00 E2608,NU SKIN PRO/POS WC CUS WD>=22IN $999.00 E2608,NUKE SKIN PRO/POS WC CUS WD>=22IN $1,159.00 E2608,RR SKIN PRO/POS WC CUS WD>=22IN $100.00 E2608,RRKE SKIN PRO/POS WC CUS WD>=22IN $116.00 E2608,UE SKIN PRO/POS WC CUS WD>=22IN $749.00 E2608,UEKE SKIN PRO/POS WC CUS WD>=22IN $869.00 E2611,NU GEN USE BACK CUSH WDTH <22IN $896.00 E2611,NUKE GEN USE BACK CUSH WDTH <22IN $1,040.00 E2611,RR GEN USE BACK CUSH WDTH <22IN $90.00 E2611,RRKE GEN USE BACK CUSH WDTH <22IN $104.00 E2611,UE GEN USE BACK CUSH WDTH <22IN $672.00 E2611,UEKE GEN USE BACK CUSH WDTH <22IN $780.00 E2612,NU GEN USE BACK CUSH WDTH>=22IN $1,213.00 E2612,NUKE GEN USE BACK CUSH WDTH>=22IN $1,407.00 E2612,RR GEN USE BACK CUSH WDTH>=22IN $121.00 E2612,RRKE GEN USE BACK CUSH WDTH>=22IN $141.00 E2612,UE GEN USE BACK CUSH WDTH>=22IN $910.00 E2612,UEKE GEN USE BACK CUSH WDTH>=22IN $1,055.00 E2613,NU POSITION BACK CUSH WD <22IN $1,128.00 E2613,NUKE POSITION BACK CUSH WD <22IN $1,309.00 E2613,RR POSITION BACK CUSH WD <22IN $113.00 E2613,RRKE POSITION BACK CUSH WD <22IN $131.00 E2613,UE POSITION BACK CUSH WD <22IN $846.00 E2613,UEKE POSITION BACK CUSH WD <22IN $982.00 E2614,NU POSITION BACK CUSH WD>=22IN $1,561.00 E2614,NUKE POSITION BACK CUSH WD>=22IN $1,811.00 E2614,RR POSITION BACK CUSH WD>=22IN $156.00 E2614,RRKE POSITION BACK CUSH WD>=22IN $181.00 E2614,UE POSITION BACK CUSH WD>=22IN $1,171.00 E2614,UEKE POSITION BACK CUSH WD>=22IN $1,358.00 E2615,NU POS BACK POST/LAT WDTH <22IN $1,298.00 E2615,NUKE POS BACK POST/LAT WDTH <22IN $1,506.00 E2615,RR POS BACK POST/LAT WDTH <22IN $130.00 E2615,RRKE POS BACK POST/LAT WDTH <22IN $151.00 E2615,UE POS BACK POST/LAT WDTH <22IN $974.00 E2615,UEKE POS BACK POST/LAT WDTH <22IN $1,130.00 E2616,NU POS BACK POST/LAT WDTH>=22IN $1,747.00 E2616,NUKE POS BACK POST/LAT WDTH>=22IN $2,026.00 E2616,RR POS BACK POST/LAT WDTH>=22IN $175.00 E2616,RRKE POS BACK POST/LAT WDTH>=22IN $203.00 E2616,UE POS BACK POST/LAT WDTH>=22IN $1,310.00 E2616,UEKE POS BACK POST/LAT WDTH>=22IN $1,520.00 E2619,NU REPLACE COVER W/C SEAT CUSH $147.00 E2619,NUKE REPLACE COVER W/C SEAT CUSH $171.00 E2619,RR REPLACE COVER W/C SEAT CUSH $15.00 E2619,RRKE REPLACE COVER W/C SEAT CUSH $17.00 E2619,UE REPLACE COVER W/C SEAT CUSH $111.00 E2619,UEKE REPLACE COVER W/C SEAT CUSH $128.00 E2620,NU WC PLANAR BACK CUSH WD <22IN $1,572.00 E2620,NUKE WC PLANAR BACK CUSH WD <22IN $1,824.00 E2620,RR WC PLANAR BACK CUSH WD <22IN $157.00 E2620,RRKE WC PLANAR BACK CUSH WD <22IN $182.00 E2620,UE WC PLANAR BACK CUSH WD <22IN $1,179.00 E2620,UEKE WC PLANAR BACK CUSH WD <22IN $1,368.00 E2621,NU WC PLANAR BACK CUSH WD>=22IN $1,650.00 E2621,NUKE WC PLANAR BACK CUSH WD>=22IN $1,914.00 E2621,RR WC PLANAR BACK CUSH WD>=22IN $165.00 E2621,RRKE WC PLANAR BACK CUSH WD>=22IN $191.00 E2621,UE WC PLANAR BACK CUSH WD>=22IN $1,237.00 E2621,UEKE WC PLANAR BACK CUSH WD>=22IN $1,435.00 E2622,NU ADJ SKIN PRO W/C CUS WD<22IN $951.00 E2622,NUKE ADJ SKIN PRO W/C CUS WD<22IN $1,104.00 E2622,RR ADJ SKIN PRO W/C CUS WD<22IN $95.00 E2622,RRKE ADJ SKIN PRO W/C CUS WD<22IN $110.00 E2622,UE ADJ SKIN PRO W/C CUS WD<22IN $713.00 E2622,UEKE ADJ SKIN PRO W/C CUS WD<22IN $828.00 E2623,NU ADJ SKIN PRO WC CUS WD>=22IN $1,211.00 E2623,NUKE ADJ SKIN PRO WC CUS WD>=22IN $1,404.00 E2623,RR ADJ SKIN PRO WC CUS WD>=22IN $121.00 E2623,RRKE ADJ SKIN PRO WC CUS WD>=22IN $140.00 E2623,UE ADJ SKIN PRO WC CUS WD>=22IN $908.00 E2623,UEKE ADJ SKIN PRO WC CUS WD>=22IN $1,053.00 E2624,NU ADJ SKIN PRO/POS CUS<22IN $959.00 E2624,NUKE ADJ SKIN PRO/POS CUS<22IN $1,113.00 E2624,RR ADJ SKIN PRO/POS CUS<22IN $96.00 E2624,RRKE ADJ SKIN PRO/POS CUS<22IN $111.00 E2624,UE ADJ SKIN PRO/POS CUS<22IN $719.00 E2624,UEKE ADJ SKIN PRO/POS CUS<22IN $835.00 E2625,NU ADJ SKIN PRO/POS WC CUS>=22 $1,214.00 E2625,NUKE ADJ SKIN PRO/POS WC CUS>=22 $1,409.00 E2625,RR ADJ SKIN PRO/POS WC CUS>=22 $121.00 E2625,RRKE ADJ SKIN PRO/POS WC CUS>=22 $141.00 E2625,UE ADJ SKIN PRO/POS WC CUS>=22 $911.00 E2625,UEKE ADJ SKIN PRO/POS WC CUS>=22 $1,057.00 E2626,NU NULL $2,068.00 E2626,RR NULL $207.00 E2626,UE NULL $1,551.00 E2627,NU NULL $2,805.00 E2627,RR NULL $281.00 E2627,UE NULL $2,104.00 E2628,NU NULL $2,486.00 E2628,RR NULL $249.00 E2628,UE NULL $1,865.00 E2629,NU NULL $3,146.00 E2629,RR NULL $315.00 E2629,UE NULL $2,360.00 E2630,NU NULL $1,987.00 E2630,RR NULL $199.00 E2630,UE NULL $1,490.00 E2631,NU NULL $880.00 E2631,RR NULL $88.00 E2631,UE NULL $660.00 E2632,NU NULL $560.00 E2632,RR NULL $56.00 E2632,UE NULL $420.00 E2633,NU NULL $475.00 E2633,RR NULL $47.00 E2633,UE NULL $356.00 G0027 Semen analysis;presence &/OR motlty $15.00 G0101 CERVICAL OR VAGINAL CANCER SCREENIN $100.00 G0102 PROSTATE CANCER SCREENING $31.00 G0103 PROSTATE CANCER SCREENING $78.00 G0104 COLORECTAL CANCER SCREENING $210.00 G0105 COLORECTAL CANCER SCREENING $715.00 G0105,53 COLORECTAL CANCER SCREENING $359.00 G0106 COLORECTAL CANCER SCREENING $0.00 G0106,26 COLORECTAL CANCER SCREENING $171.00 G0106,TC COLORECTAL CANCER SCREENING $0.00 G0108 DIAB OUTPT SELF MGMNT TRAININ SVCS $183.00 G0109 DIAB OUTPT SELF MGMNT TRAININ SVC $55.00 G0117 GLAUCO SCR/HIGH RISK PAT‐OPTO/OPTHO $197.00 G0118 GLAUCO SCR/HIGH RISK PAT‐DIR SUPERV $162.00 G0120 COLORECTAL CANCER SCREENING $0.00 G0120,26 COLORECTAL CANCER SCREENING $183.00 G0120,TC COLORECTAL CANCER SCREENING $0.00 G0121 COLREC Ca Scr;COLSCO NO MEET HIG RI $718.00 G0121,53 COLREC Ca Scr;COLSCO NO MEET HIG RI $358.00 G0123 Scrning cytopathlgy, cervcl/vaginal $86.00 G0124 SCREENING CYTO CERV OR VAG $114.00 G0127 TRIMMING OF DYSTROPHIC NAILS $27.00 G0128 DIRECT (FACE 2 FACE W/PT) SKL NURS $35.00 G0130 SNG ENRGY X RAY ABSORPTIOMETRY,BONE $0.00 G0130,26 SNG ENERGY X RAY ABSORPTIOMETRY BON $39.00 G0130,TC SNG ENRGY X RAY ABSORBTIOMETRY BONE $0.00 G0141 SCREENIN CYTO SMEARS, CERV OR VAG $114.00 G0143 Scrning cytopathlgy, cervical/vagnl $86.00 G0144 Scrning cytopatholgy, cervical/vgnl $90.00 G0145 Scrning cytopathlgy, Cervical/VGNL $106.00 G0147 Scrng cytopathlgy smears, crvcl/vag $45.00 G0148 Scrng cytpathlgy smears, cervcl/vag $45.00 G0166 EXT COUNTERPULSATION, PER TRMNT SES $548.00 G0168 WOUND CLOSURE UTILIZING TISSUE ADH $102.00 G0179 PHY RE‐CERT‐MDR SER/RE‐CERT PERIOD $146.00 G0180 PHY CERT‐MDR SERVICES/CERT PERIOD $190.00 G0181 PHY SUP‐MED COV SER/PAR HOME HLT AG $377.00 G0182 PHY SUP OF PAT‐MDR APPR HOSPICE $378.00 G0186 DESTRUCTION OF LOCALIZED LESION $3,171.00 G0202 SCREENING MAMMOGRAPHY $0.00 G0202,26 SCREENING MAMMOGRAPHY $121.00 G0202,TC SCREENING MAMMOGRAPHY $0.00 G0204 DIAG MAMMOGRAPHY $0.00 G0204,26 DIAG MAMMOGRAPHY $151.00 G0204,TC DIAG MAMMOGRAPHY $0.00 G0206 DIAG MAMMOGRAPHY $0.00 G0206,26 DIAG MAMMOGRAPHY $121.00 G0206,TC DIAG MAMMOGRAPHY $0.00 G0237 THERAPEUTIC PROC TO INCR STRENTH $40.00 G0238 THERAPEUTIC PROC TO IMROV RESPIRAT $42.00 G0239 THERAPEUTIC PROC TO IMPROV RESPIRAT $49.00 G0245 INITIAL MD E&M OF A DIABETIC PT $150.00 G0246 FOLLOW UP MD E&M OF A DIABETIC PT $75.00 G0247 ROUTINE FOOT CARE BY MD OF DIABETIC $80.00 G0248 DEMONS AT INITIAL USE OF HOME INR $453.00 G0249 PROV OF TEST MATL & EQUI FOR HOME $417.00 G0250 MD REV, INTRPRTN & PT MNGMNT /HOME $32.00 G0268 REM IMPAC CERUM‐SAME DOS‐AUD FN TES $125.00 G0270 MED NUTRITION THER;REASSESSMENT $96.00 G0271 MED NUTRITION THER, REASSESSMENT $53.00 G0276 PILD/PLACEBO CONTROL CLIN TR $1,487.00 G0277 HBOT, FULL BODY CHAMBER, 30M $165.00 G0278 ILIAC ARTERY ANGIOGRAPHY $54.00 G0279 TOMOSYNTHESIS, MAMMO SCREEN $0.00 G0279,26 TOMOSYNTHESIS, MAMMO SCREEN $103.00 G0279,TC TOMOSYNTHESIS, MAMMO SCREEN $0.00 G0281 ELEC STIM(UNATTEND) TO 1 OR MORE AR $49.00 G0283 ELEC STIMUL‐1/MORE AREA OTH THAN WO $49.00 G0288 RECON CTA FOR SURG PLAN $228.00 G0289 ARTHSC,KNEE SURG/REM‐LOOSE,FOREI BO $334.00 G0306 COMPLETE CBC AUTO/ AUTO WBC DIFF CT $33.00 G0307 COMPLETE AUTO WITHOUT PLATELET CT $25.00 G0328 Colorectal CA scrng, fecal occult $68.00 G0328,QW Colorectal CA scrng, fecal occult $68.00 G0329 ELECTROMAGNETIC TX FOR ULCERS $36.00 G0339 IMAGE‐GUIDED ROBOTIC LINEAR ACCELER $15,311.00 G0340 IMAGE‐GUIDED ROBOTIC LINEAR ACCELER $11,924.00 G0341 PERCUTANEOUS ISLET CELLTRANS $1,352.00 G0342 LAPAROSCOPY ISLET CELL TRANS $2,587.00 G0343 LAPAROTOMY ISLET CELL TRANSPLANT $4,826.00 G0364 Bone marrow aspiration pefrmd w Bx $31.00 G0365 VESSEL MAPPING HEMO ACCESS $0.00 G0365,26 VESSEL MAPPING HEMO ACCESS $44.00 G0365,TC VESSEL MAPPING HEMO ACCESS $0.00 G0372 MD SERVICE REQUIRED FOR PMD $32.00 G0389,26 ULTRASOUND EXAM AAA SCREEN $102.00 G0389,TC ULTRASOUND EXAM AAA SCREEN $0.00 G0396 Alcohol/subs interv 15‐30mn $116.00 G0397 Alcohol/subs interv >30 min $238.00 G0398 NULL $0.00 G0398,26 (HST) with type II portable monitor $267.00 G0398,TC (HST) with type II portable monitor $0.00 G0399 NULL $0.00 g0399,26 (HST) with type III portable monito $249.00 G0399,TC (HST) with type III portable monito $0.00 G0400 NULL $0.00 G0400,26 (HST) with type IV portable monitor $224.00 G0400,TC (HST) with type IV portable monitor $0.00 G0402 INITIAL PREVENTIVE EXAM $439.00 G0403 EKG FOR INITIAL PREVENT EXAM $67.00 G0404 NULL $39.00 G0405 NULL $29.00 G0406 INPT/TELE FOLLOW UP 15 $135.00 G0407 INPT/TELE FOLLOW UP 25 $244.00 G0408 INPT/TELE FOLLOW UP 35 $351.00 G0409 NULL $70.00 G0412 NULL $2,721.00 G0413 NULL $4,069.00 G0414 NULL $3,619.00 G0415 NULL $5,222.00 G0416 NULL $0.00 g0416,26 NULL $623.00 G0416,TC Sat biopsy prostate 1‐20 spc $0.00 G0420 ED SVC CKD IND PER SESSION $378.00 G0421 ED SVC CKD GRP PER SESSION $87.00 G0422 INTENS CARDIAC REHAB W/EXERC $358.00 G0423 INTENS CARDIAC REHAB NO EXER $358.00 G0424 PULMONARY REHAB W/EXER $48.00 G0425 INPT TELEHEALTH CONSULT 30M $349.00 G0426 INPT TELEHEALTH CONSULT 50M $472.00 G0427 INPT TELEHEALTH CON 70/>M $696.00 G0429 DERMAL FILLER INJECTION(S) $260.00 G0432 EIA HIV‐1/HIV‐2 SCREEN $58.00 G0433 ELISA HIV‐1/HIV‐2 SCREEN $58.00 G0433,QW ELISA HIV‐1/HIV‐2 SCREEN $57.00 G0435 ORAL HIV‐1/HIV‐2 SCREEN $37.00 G0436 TOBACCO‐USE COUNSEL 3‐10 MIN $43.00 G0437 TOBACCO‐USE COUNSEL>10MIN $89.00 G0438 PPPS, INITIAL VISIT $600.00 G0439 PPPS, SUBSEQ VISIT $409.00 G0442 ANNUAL ALCOHOL SCREEN 15 MIN $33.00 G0443 BRIEF ALCOHOL MISUSE COUNSEL $82.00 G0444 DEPRESSION SCREEN ANNUAL $32.00 G0445 HIGH INTEN BEH COUNS STD 30M $82.00 G0446 INTENS BEHAVE THER CARDIO DX $82.00 G0447 BEHAVIOR COUNSEL OBESITY 15M $82.00 G0451 DEVLOPMENT TEST INTERPT&REP $36.00 G0452,26 MOLECULAR PATHOLOGY INTERPR $66.00 G0453 CONT INTRAOP NEURO MONITOR $116.00 G0454 MD DOCUMENT VISIT BY NPP $32.00 G0455 FECAL MICROBIOTA PREP INSTIL $268.00 G0459 TELEHEALTH INPT PHARM MGMT $138.00 G0460 AUTOLOGOUS PRP FOR ULCERS $0.00 G0471 Ven blood coll snf/hha $15.00 G0472 Hep C screen high risk/other $0.00 G0472,QW Hep C screen high risk/other $0.00 G0473 GROUP BEHAVE COUNS 2‐10 $40.00 G6001 ECHO GUIDANCE RADIOTHERAPY $0.00 G6001,26 ECHO GUIDANCE RADIOTHERAPY $101.00 G6001,TC ECHO GUIDANCE RADIOTHERAPY $0.00 G6002 STEREOSCOPIC X‐RAY GUIDANCE $0.00 G6002,26 STEREOSCOPIC X‐RAY GUIDANCE $69.00 G6002,TC STEREOSCOPIC X‐RAY GUIDANCE $0.00 G6003 RADIATION TREATMENT DELIVERY $684.00 G6004 RADIATION TREATMENT DELIVERY $530.00 G6005 RADIATION TREATMENT DELIVERY $528.00 G6006 RADIATION TREATMENT DELIVERY $527.00 G6007 RADIATION TREATMENT DELIVERY $1,100.00 G6008 RADIATION TREATMENT DELIVERY $732.00 G6009 RADIATION TREATMENT DELIVERY $724.00 G6010 RADIATION TREATMENT DELIVERY $723.00 G6011 RADIATION TREATMENT DELIVERY $1,175.00 G6012 RADIATION TREATMENT DELIVERY $965.00 G6013 RADIATION TREATMENT DELIVERY $966.00 G6014 RADIATION TREATMENT DELIVERY $966.00 G6015 RADIATION TX DELIVERY IMRT $1,278.00 G6016 DEL2015DELIVERY COMP IMRT $1,276.00 G6017 INTRAFRACTION TRACK MOTION $0.00 G9143 WARFARIN RESPON GENETIC TEST $513.00 G9157 TRANSESOPH DOPPL CARDIAC MON $337.00 G9187 BPCI HOME VISIT $164.00 J0129 INJ ABATACEPT 10 MG $0.00 J0130 INJ ABCIXIMAB 10 MG $0.00 J0132 INJ ACETYLCYSTEINE 100MG $0.00 J0133 INJ ACYCLOVIR 5 MG $0.00 J0135 INJ ADALIMUMAB 20 MG $0.00 J0153 ADENOSINE INJ 1MG $0.00 J0171 ADRENALIN EPINEPHRINE INJECT $0.00 J0178 AFLIBERCEPT INJECTION $0.00 J0180 Injection, agalsidase beta, 1 mg $0.00 J0202 Injection, alemtuzumab, 1 mg $0.00 J0207 INJ AMIFOSTINE 500 MG $0.00 J0220 INJ ALGLUCOSIDASE ALFA 10 MG $0.00 J0221 LUMIZYME INJECTION $0.00 J0256 INJ ALPHA 1 PROTEINASE INHIB/10 MG $0.00 J0257 GLASSIA INJECTION $0.00 J0278 Injection, amikacin sulfate, 100 mg $0.00 J0280 INJ AMINOPHYLLIN TO 250 MG $0.00 J0285 INJ AMPHOTERICIN B 50 MG $0.00 J0287 INJ AMPHOTERICIN B LIPID COMPLEX 10 $0.00 J0289 INJ AMPHOTERICIN B LIPOSOME $0.00 J0290 INJ AMPICILLIN SODIUM 500 MG $0.00 J0295 INJ AMPICILLIN SODIUM 1.5 GM $0.00 J0348 INJ ANADULAFUNGIN 1 MG $0.00 J0360 INJ HYDRALAZINE HCL TO 20 MG $0.00 J0400 Aripiprazole injection 0.25MG $0.00 J0401 INJ ARIPIPRAZOLE EXT REL 1MG $0.00 J0456 INJ AZITHROMYCIN 500 MG $0.00 J0461 ATROPINE SULFATE INJECTION $0.00 J0470 INJ DIMECAPROL PER 100 MG $0.00 J0475 INJ BACLOFEN 10 MG $0.00 J0476 INJ BACLOFEN 50 MCG IT TRIAL $0.00 J0480 INJ BASILIXIMAB 20MG $0.00 J0485 BELATACEPT INJECTION $0.00 J0490 BELIMUMAB INJECTION $0.00 J0500 INJ DICYCLOMINE HCL UP TO 20 MG $0.00 J0515 INJ BENZTROPINE MESYLATE, PER 1 MG $0.00 J0561 PENICILLIN G BENZATHINE INJ $0.00 J0583 BIVALIRUDIN 1 MG $0.00 J0586 ABOBOTULINUMTOXINA $0.00 J0587 Botulinum toxin type b, p 100 unit $0.00 J0588 INCOBOTULINUMTOXIN A $0.00 J0592 INJ BUPRENORPHINE HCL 0.1MG $0.00 J0594 INJ BUSULFAN 1MG $0.00 J0595 BUTORPHANOL TARTRATE 1MG $0.00 J0597 C‐1 ESTERASE, BERINERT $0.00 J0598 C1 ESTERASE INHIBITOR INJ $0.00 J0600 EDETATE CALCIUM DISODIUM TO 1000 MG $0.00 J0610 INJ CALCIUM GLUCONATE PER 10 ML $0.00 J0630 INJ CALCITONIN SALMON TO 400 UNITS $0.00 J0636 INJ CALCITRIOL 0.1MCG $0.00 J0637 Inj, caspofungin acetate, 5 mg $0.00 J0638 CANAKINUMAB INJECTION $0.00 J0640 INJ LEUCOVORIN CALCIUM PER 50 MG $0.00 J0641 LEVOLEUCOVORIN INJECTION $0.00 J0670 INJ MEPIVACAINE HCL, PER 10 ML $0.00 J0690 INJ CEFAZOLIN SODIUM 500 MG $0.00 J0692 Inj, cefepime hydrochloride, 500 mg $0.00 J0694 INJ CEFOXITIN SODIUM 1 GM $0.00 J0696 INJ CEFTRIAXONE SODIUM PER 250 MG $0.00 J0697 INJ STER CEFUROXIME SODIUM/750 MG $0.00 J0698 CEFOTAXIME SODIUM PER GM $0.00 J0702 BETAMETHASONE ACETATE‐NA PHOS/3 MG $0.00 J0712 CEFTAROLINE FOSAMIL INJ $0.00 J0713 INJECTION, CEFTAZIDIME, PER 500 MG $0.00 J0717 CERTOLIZUMAB PEGOL INJ 1MG $0.00 J0720 CHLORAMPHENICOL NA SUCCINATE‐1 GM $0.00 J0725 CHORIONIC GONADOTROPIN/1000 USP U $0.00 J0735 INS CLONIDINE HYDROCHLORIDE 1 MG $0.00 J0740 INJ CIDOFOVIR 375 MG $0.00 J0743 IMIPENEM‐CILASTATIN SODIUM/250MG $0.00 J0744 INJ CIPROFLOXACIN 200 MG $0.00 J0770 INJ COLISTIMETHATE SODIUM TO 150 MG $0.00 J0775 COLLAGENASE, CLOST HIST INJ $0.00 J0780 INJ PROCHLORPERAZINE TO 10 MG $0.00 J0795 INJ CORTICORELIN OVINE TRIFLUTATE 1 $0.00 J0840 CROTALIDAE POLY IMMUNE FAB $0.00 J0850 INJ CMV IMMUNE GLOBULIN IV/VIAL $0.00 J0875 Injection, dalbavancin, 5mg $0.00 J0878 Injection, daptomycin, 1 mg $0.00 J0881 Inj, darbepoetin alfa, 1 microgram $0.00 J0882 INJ DARBEPOEITIN ALFA 1 MCG $0.00 J0885 IJ, EPOETIN ALFA, 1000 UNITS $0.00 J0894 INJ DECITABINE 1 MG $0.00 J0895 DEFEROXAMINE MESYLATE 500 MG/5 CC $0.00 J0897 DENOSUMAB INJECTION $0.00 J1000 DEPO‐ESTRADIOL CYPIONATE TO 5 MG $0.00 J1020 METHYLPREDNISOLONE ACETATE‐20 MG $0.00 J1030 METHYLPREDNISOLONE ACETATE‐40 MG $0.00 J1071 INJ TESTOSTERONE CYPIONATE $0.00 J1110 INJ DIHYDROERGOTAMINE MESYLATE/1 MG $0.00 J1120 INJ ACETAZOLAMIDE SODIUM TO 500 MG $0.00 J1160 INJ DIGOXIN TO 0.5 MG $0.00 J1162 INJ DIGOXIN IMMUNE FAB OVINE $0.00 J1165 INJ PHENYTOIN SODIUM, PER 50 MG $0.00 J1170 INJ HYDROMORPHONE TO 4 MG $0.00 J1190 INJ DEXRAZOXANE HCL PER 250 MG $0.00 J1200 INJ DIPHENHYDRAMINE HCL TO 50 MG $0.00 J1205 CHLOROTHIAZIDE SODIUM, PER 500 MG $0.00 J1212 DMSO DIMETHYL SULFOXIDE 50%‐50 ML $0.00 J1230 INJ METHADONE HCL UP TO 10 MG $0.00 J1240 INJ DIMENHYDRINATE TO 50 MG $0.00 J1245 INJ DIPYRIDAMOLE PER 10MG $0.00 J1250 INJ, DOBUTAMINE HCL, PER 250 MG $0.00 J1260 INJ DOLASETRON MESYLATE 10 MG $0.00 J1265 INJ DOPAMINE HCL 40 MG $0.00 J1267 DORIPENEM INJECTION $0.00 J1270 INJ DOXERCALCIFEROL 1 MCG $0.00 J1290 ECALLANTIDE INJECTION $0.00 J1300 INJ ECULIZUMAB 10 MG $0.00 J1325 INJ EPOPROSTENOL 0.5 MG $0.00 J1335 ERTAPENEM SODIUM 500 MG $0.00 J1364 ERYTHROMYCIN LACTOBIONATE/500 MG $0.00 J1380 INJ ESTRADIOL VALERATE TO 10 MG $0.00 J1430 INJ ETHANOLAMINE OLEATE 100 MG $0.00 J1438 INJ ETANERCEPT 25 MG‐NOT SELF ADMIN $0.00 J1439 INJ FERRIC CARBOXYMALTOS 1MG $0.00 J1442 INJ, FILGRASTIM G‐CSF 1MCG $0.00 J1447 Injection, tbo‐filgrastim, 1 microg $0.00 J1450 INJ FLUCONAZOLE 200 MG $0.00 J1453 FOSAPREPITANT INJECTION $0.00 J1458 INJ GALSULFATE 1 MG $0.00 J1459 INJ IVIG PRIVIGEN 500 MG $0.00 J1460 INJ GAMMA GLOBULIN IM 1 CC $0.00 J1556 INJ, IMM GLOB BIVIGAM, 500MG $0.00 J1557 GAMMAPLEX INJECTION $0.00 J1559 HIZENTRA INJECTION $0.00 J1560 INJ GAMMA GLOBULIN IM OVER 10 CC $0.00 J1561 GAMUNEX/GAMUNEX C $0.00 J1566 INJ IMMUNE GLOBULIN IV 500 MG $0.00 J1568 INJ IMMUNE GLOBULIN IV LIQ 500 MG $0.00 J1569 INJ IMMUNE GLOBULIN IV GAMMAGARD LI $0.00 J1570 INJ GANCICLOVIR SODIUM 500 MG $0.00 J1571 INJ HEPATITIS B IMMUNE GLOBULIN 0.5 $0.00 J1572 INJ IMMUNE GLOBULIN IV 500 MG $0.00 J1575 Injection, immune globulin/hyaluron $0.00 J1580 INJ GARAMYCIN GENTAMICIN TO 80 MG $0.00 J1602 GOLIMUMAB FOR IV USE 1MG $0.00 J1610 INJ GLUCAGON HYDROCHLORIDE PER 1 MG $0.00 J1626 INJ GRANISETRON HCL 100 MCG $0.00 J1630 INJ HALOPERIDOL TO 5 MG $0.00 J1631 INJ HALOPERIDOL DECANOATE PER 50 MG $0.00 J1640 INJ HEMIN 1 MG $0.00 J1642 HEPARIN SODIUM‐HEP LOCK FLUSH‐10 U $0.00 J1644 INJ HEPARIN SODIUM PER 1000 UNITS $0.00 J1645 INJ DALTEPARIN SODIUM PER 2500 IU $0.00 J1650 INJ ENOXAPARIN SODIUM 10 MG $0.00 J1652 INJ FONDAPARINUX SODIUM 0.5 MG $0.00 J1670 TETANUS IMMUNE GLOBULIN HUMAN‐250 U $0.00 J1720 HYDROCORTISONE NA SUCCINATE‐100 MG $0.00 J1740 INJ IBANDRONATE SODIUM 1 MG $0.00 J1742 INJ IBUTILIDE FUMARATE 1 MG $0.00 J1743 INJ IDURSULFASE 1 MG $0.00 J1745 INJ INFLIXIMAB 10 MG $0.00 J1750 INJ IRON DEXTRAN 50 MG $0.00 J1756 Injection, iron sucrose, 1 mg $0.00 J1786 IMUGLUCERASE INJECTION $0.00 J1800 INJ PROPRANOLOL HCL TO 1 MG $0.00 J1817 INSULIN PUMP PER 50 UNITS $0.00 J1885 INJ KETOROLAC TROMETHAMINE PER 15MG $0.00 J1930 INJ PROPIOMAZINE TO 20 MG $0.00 J1931 Injection, laronidase, 0.1 mg $0.00 J1940 INJ FUROSEMIDE TO 20 MG $0.00 J1953 LEVETIRACETAM INJECTION $0.00 J1955 INJ LEVOCARNITINE PER 1 GM $0.00 J1956 INJ LEVOFLOXACIN 250 MG $0.00 J1980 INJ HYOSCYAMINE SULFATE TO .25 MG $0.00 J2010 INJ LINCOMYCIN HCL TO 300 MG $0.00 J2020 INJ LINEZOLID 200 MG $0.00 J2060 INJ LORAZEPAM 2MG $0.00 J2150 INJ MANNITOL 25% IN 50 ML $0.00 J2175 MEPERIDINE HYDROCHLORIDE/100 MG $0.00 J2185 MEROPENEM 100MG $0.00 J2210 METHYLERGONOVINE MALEATE TO 0.2 MG $0.00 J2248 INJ MICAFUNGIN SODIUM 1 MG $0.00 J2250 INJ, MIDAZOLAM HCL, PER 1 MG $0.00 J2270 INJ MORPHINE SULFATE TO 10 MG $0.00 J2274 IN MORPHINE PRESERVATIV FREE $0.00 J2278 INJ ZICONOTIDE 1 MCG $0.00 J2280 MOXIFLOXACIN 100MG $0.00 J2300 INJ, NALBUPHINE HCL, PER 10 MG $0.00 J2310 INJ, NALOXONE HCL, PER 1 MG $0.00 J2315 INJ NALTREXONE DEPOT FORM 1 MG $0.00 J2323 INJ NATALIZUMAB 1 MG $0.00 J2354 OCTREOTIDE NON DEPOT INTRAMUS 25MCG $0.00 J2355 INJ OPRELVEKIN 5 MG $0.00 J2358 OLANZAPINE LONG‐ACTING INJ $0.00 J2360 INJ ORPHENADRINE CITRATE UP TO 60MG $0.00 J2400 INJ CHLOROPROCAINE HCL, PER 30 ML $0.00 J2405 INJ ONDANSETRON HCL PER 1 MG $0.00 J2407 Injection, oritavancin, 10 mg $0.00 J2410 INJ OXYMORPHONE HCL TO 1 MG $0.00 J2425 INJ PALIFERMIN 50 MCG $0.00 J2426 PALIPERIDONE PALMITATE INJ $0.00 J2430 INJ PAMIDRONATE DISODIUM PER 30 MG $0.00 J2469 Injection, palonosetron hcl, 25 mcg $0.00 J2501 INJ PARACALCITOL 1 MCG $0.00 J2503 Injection, palonosetron hcl, 25 mcg $0.00 J2504 INJ PEGADEMASE BOVINE 25 IU $0.00 J2505 PEGFILGRASTIM 6MG $0.00 J2507 PEGLOTICASE INJECTION $0.00 J2510 PEN G PROCAINE AQUEOUS‐600,000 U $0.00 J2515 INJ PENTOBARBITAL SODIUM PER 50 MG $0.00 J2540 PEN G POTASSIUM‐600,000 U $0.00 J2543 INJ PIPERACILLIN NA/TAZOBACTAM NA $0.00 J2545 PENTAM ISETH INHAL SOLN/300 MG(DME) $0.00 J2550 INJ PROMETHAZINE HCL TO 50 MG $0.00 J2560 INJ PHENOBARBITAL SODIUM TO 120 MG $0.00 J2562 PLERIXAFOR INJECTION $0.00 J2597 INJ, DESMOPRESSIN ACETATE/1 MCG $0.00 J2675 INJ PROGESTERONE PER 50 MG $0.00 J2680 INJ FLUPHENAZINE DECANOATE TO 25 MG $0.00 J2690 INJ PROCAINAMIDE HCL TO 1 GM $0.00 J2700 INJ OXACILLIN SODIUM TO 250 MG $0.00 J2704 INJ, PROPOFOL, 10 MG $0.00 J2720 INJ PROTAMINE SULFATE PER 10 MG $0.00 J2724 INJ PROTEIN C CONCENTRATE IV HUMAN $0.00 J2760 INJ PHENTOLAMINE MESYLATE TO 5 MG $0.00 J2765 INJ METOCLOPRAMIDE HCL TO 10 MG $0.00 J2770 INJ QUINUPRISTIN/DALFOPRISTIN 500 M $0.00 J2778 INJ RANIMIZUBAB 0.1 MG $0.00 J2780 INJ RANITIDINE HYDROCHLORIDE 25 MG $0.00 J2783 RASBURICASE .5MG $0.00 J2785 REGADENOSON INJECTION $0.00 J2788 INJ RHO D IMMUNE GLOBULIN 50 MCG $0.00 J2790 RHO D IG HUMAN 1 DOSE PKG $0.00 J2791 INJ RHO IMMUNE GLOBULIN IM OR IV 10 $0.00 J2792 INJ RHO D IMMUNE GLOBULIN IV 100 IU $0.00 J2794 Inj, risperidone, long acting 0.5mg $0.00 J2795 INJ ROPIVACAINE HCL 1 MG $0.00 J2796 ROMIPLOSTIM INJECTION $0.00 J2800 INJ METHOCARBAMOL TO 10 ML $0.00 J2805 INJ SINCALIDE 5 MCG $0.00 J2810 INJ THEOPHYLLINE PER 40 MG $0.00 J2820 INJ SARGRAMOSTIN (GM‐CSF)/50MCG $0.00 J2850 INJ SECRETIN SYNTHETIC HUMAN 1 MCG $0.00 J2916 Inj, sodium ferric gluconate 12.5mg $0.00 J2930 METHYLPRED NA SUCCINATE TO 125MG $0.00 J2997 Inj, alteplase recombinant, 1 mg $0.00 J3000 INJ STREPTOMYCIN TO 1 GM $0.00 J3010 INJ FENTANYL CITRATE TO 2 ML $0.00 J3060 INJ, TALIGLUCERACE ALFA 10 U $0.00 J3070 INJ PENTAZOCINE HCL TO 30 MG $0.00 J3090 Injection, tedizolid phosphate, 1 m $0.00 J3095 TELEVANCIN INJECTION $0.00 J3101 TENECTEPLASE INJECTION $0.00 J3105 INJ TERBUTALINE SULFATE TO 1 MG $0.00 J3121 INJ TESTOSTERO ENANTHATE 1MG $0.00 J3230 INJ CHLORPROMAZINE HCL TO 50 MG $0.00 J3243 INJ TIGECYCLINE 1 MG $0.00 J3250 INJ TRIMETHOBENZAMIDE HCL TO 200 MG $0.00 J3260 INJ TOBRAMYCIN SULFATE TO 80 MG $0.00 J3262 TOCILIZUMAB INJECTION $0.00 J3285 INJ TREPROSTINIL 1 MG $0.00 J3300 TRIAMCINOLONE A INJ PRS‐FREE $0.00 J3303 TRIAMCINOLONE HEXACETONIDE/5 MG $0.00 J3315 Inj, triptorelin pamoate, 3.7 mg $0.00 J3357 USTEKINUMAB INJECTION $0.00 J3360 INJ DIAZEPAM TO 5 MG $0.00 J3370 INJ VANCOMYCIN HCL 500MG $0.00 J3380 Injection, vedolizumab, 1 mg $0.00 J3385 VELAGLUCERASE ALFA $0.00 J3396 Injection, verteporfin, 0.1 mg $0.00 J3410 INJ HYDROXYZINE HCL TO 25 MG $0.00 J3411 THIAMINE HCL 100MG $0.00 J3415 PYRIDOXINE HCL 100 MG $0.00 J3430 INJ PHYTONADIONE (VIT K) PER 1 MG $0.00 J3465 VORICONAZOLE 10 MG $0.00 J3471 INJ HYALURONIDASE OVINE 1 USP UNIT $0.00 J3473 INJ HYALURONIDASE RECOMBINANT 1 USP $0.00 J3475 INJ, MAGNESIUM SULFATE/500 MG $0.00 J3480 INJ, POTASSUIM CHLORIDE/2 MEQ $0.00 J3485 INJ ZIDOVUDINE 10 MG $0.00 J3486 ZIPRASIDONE MESYLATE 10MG $0.00 J7030 INFUS NORMAL SALINE SOLN 1000 CC $0.00 J7040 INFUS NS SOLN STER 500 ML $0.00 J7042 D5NS 500 ML = 1 UNIT $0.00 J7050 INFUS NORMAL SALINE SOLN 250 CC $0.00 J7060 5% DEXTROSE/WATER 500 ML = 1 UNIT $0.00 J7070 INFUSION D5W 1000 CC $0.00 J7120 RINGERS LACTATE INFUSION TO 1000 CC $0.00 J7180 FACTOR XIII ANTI‐HEM FACTOR $0.00 J7182 FACTOR VIII RECOMB NOVOEIGHT $0.00 J7183 WILATE INJECTION $0.00 J7185 XYNTHA INJ $0.00 J7186 ANTIHEMOPHILIC VIII/VWF COMP $0.00 J7187 INJ VON WILLEBRAND FACTOR COMPLEX $0.00 J7189 FACTOR 7A PER 1 MCG $0.00 J7190 FACT VIII(ANTI‐HEMOPHI HUMAN)PER IU $0.00 J7192 FACTOR VIII (ANTIHEMO RECOMB)PER IU $0.00 J7193 FACTOR 9 PER IU $0.00 J7194 FACTOR IX COMPLX PER IU $0.00 J7195 FACTOR 9 PER IU $0.00 J7197 ANTITHROMBIN III (HUMAN) PER IU $0.00 J7198 ANTI‐INHIBITOR PER I.U. $0.00 J7200 FACTOR IX RECOMBINAN RIXUBIS $0.00 J7201 FACTOR IX FC FUSION RECOMB $0.00 J7205 Injection, factor VIII Fc fusion (r $0.00 J7308 AMINOLEVULINIC ACID HCL 354 MG $0.00 J7311 FLUOCINOLONE ACETONIDE INTRAVITREAL $0.00 J7312 DEXAMETHASONE INTRA IMPLANT $0.00 J7313 Inj, fluocinolone acetonide, intrav $0.00 J7316 INJ, OCRIPLASMIN, 0.125 MG $0.00 J7321 HYALURONAN OR DERIVATIVE IA PER DOS $0.00 J7323 HYALURONAN OR DERIVATIVE EUFLEXXA I $0.00 J7325 SYNVISC OR SYNVISC‐ONE $0.00 J7327 MONOVISC INJ PER DOSE $0.00 J7336 CAPSAICIN 8% PATCH $0.00 J7500 AZATHIOPRINE ORAL 50 MG $0.00 J7502 CYCLOSPORINE ORAL 100 MG $0.00 J7504 LYMPH IG/ANTITHYMOCYTE GLOB 250 MG $0.00 J7507 TACROLIMUS ORAL PER 1 MG $0.00 J7508 TACROLIMUS EX REL ORAL 0.1MG $0.00 J7509 METHYLPREDNISOLONE PO/4 MG $0.00 J7510 PREDNISOLONE ORAL, PER 5 MG $0.00 J7511 LYMPHOCYTE IMMUNE GLOBULIN 25 MG $0.00 J7512 Prednisone, immediate release or d $0.00 J7515 CYCLOSPORINE ORAL 25 MG $0.00 J7516 CYCLOSPORIN PARENTERAL 250 MG $0.00 J7517 MYCOPHENOLATE MOFETIL ORAL 250 MG $0.00 J7518 MYCOPHENOLIC ACID ORAL 180 MG $0.00 J7520 SIROLIMUS ORAL 1 MG $0.00 J7525 TACROLIMUS PARENTERAL 5 MG $0.00 J7527 ORAL EVEROLIMUS $0.00 J7605 ARFORMOTEROL INHALATION SOL 15 MCG $0.00 J7606 FORMOTEROL FUMARATE, INH $0.00 J7608 ACETYLCYSTEINE INHAL SOL UD PER GM $0.00 J7611 ALBUTEROL, INHALATION SOLUTION $0.00 J7612 LEVALBUTEROL, INHALATION SOLUTION $0.00 J7626 BUDESONIDE, INHALATION SOL 0.5 MG $0.00 J7631 CROMOLYN NA INHAL SOL UD PER 10 MGS $0.00 J7639 DORNASE ALPHA INHAL SOL UD PER MG $0.00 J7644 IPRATROPIUM BROMIDE INHAL SOL UD/MG $0.00 J7674 METHACHOLINE CHLORIDE PER 1 MG $0.00 J7682 TOBRAMYCIN UD 300 MG INHAL SOL $0.00 J7686 TREPROSTINIL, NON‐COMP UNIT $0.00 J8501 APREPITANT, ORAL 5 MG $0.00 J8510 BUSULFAN ORAL 2 MG $0.00 J8520 TRIAMCINOLONE INHAL SOL/DME UD/MG $0.00 J8521 CAPECITABINE ORAL 500 MG $0.00 J8530 CYCLOPHOSPHAMIDE ORAL 25 MG $0.00 J8540 DEXAMETHASONE ORAL 0.25 MG $0.00 J8560 ETOPOSIDE ORAL 50 MG $0.00 J8600 MELPHALEN ORAL 2 MG $0.00 J8610 METHOTREXATE ORAL 2.5 MG $0.00 J8655 Netupitant 300 mg and palonosetron $0.00 J8700 TEMOZOLOMIDE ORAL 5 MG $0.00 J8705 TOPOTECAN ORAL $0.00 J9000 DOXORUBICIN HCL 10 MG $0.00 J9017 ARSENIC TRIOXIDE 1 MG $0.00 J9019 ERWINAZE INJECTION $0.00 J9025 INJ AZACITIDINE 1 MG $0.00 J9027 INJ CLOFARABINE 1 MG $0.00 J9031 BCG (INTRAVESICAL) PER INSTALLATION $0.00 J9032 Injection, belinostat, 10 mg $0.00 J9033 BENDAMUSTINE INJECTION $0.00 J9035 Injection, bevacizumab, 10 mg $0.00 J9040 BLEOMYCIN SULFATE 15 UNITS $0.00 J9041 Injection, bortezomib, 0.1 mg $0.00 J9042 BRENTUXIMAB VEDOTIN INJ $0.00 J9043 CABAZITAXEL INJECTION $0.00 J9045 CARBOPLATIN, 50 MG $0.00 J9047 INJECTION, CARFILZOMIB, 1 MG $0.00 J9050 CARMUSTINE, 100MG $0.00 J9055 Injection, cetuximab, 10 mg $0.00 J9060 CISPLATIN, POW/SOLN/10 MG $0.00 J9065 INJ CLADRIBINE PER 1 MG $0.00 J9070 CYCLOPHOSPHAMIDE 100MG $0.00 J9098 CYTARABINE LIPOSOME 10MG $0.00 J9100 CYTARABINE 100 MG $0.00 J9120 DACTINOMYCIN 0.5 MG $0.00 J9130 DACARBAZINE 100 MG $0.00 J9150 DAUNORUBICIN HCL 10 MG $0.00 J9155 DEGARELIX INJECTION $0.00 J9171 DOCETAXEL INJECTION $0.00 J9178 EPIRUBICINE HYDROCHLORIDE 50MG $0.00 J9179 ERIBULIN MESYLATE INJECTION $0.00 J9181 ETOPOSIDE, 10 MG $0.00 J9185 FLUDARABINE PHOSPHATE 50 MG $0.00 J9190 FLUOROURACIL 500 MG $0.00 J9200 FLOXURIDINE 500 MG $0.00 J9201 GEMCITABINE HCL 200 MG $0.00 J9202 GOSERELIN ACETATE IMPLANT/3.6 MG $0.00 J9206 IRINOTECAN 20 MG $0.00 J9207 IXABEPILONE INJECTION $0.00 J9208 IFOSFAMIDE INJECTION $0.00 J9209 MESNA, 200 MG $0.00 J9211 IDARUBICIN HYDROCHLORIDE, 5MG $0.00 J9214 INTERFERON,ALFA‐2B,RECOMB,1 MIL U $0.00 J9217 LEUPROLIDE ACET/DEPOT SUSP 7.5 MG $0.00 J9218 LEUPROLIDE ACETATE PER 1 MG $0.00 J9225 Histrelin implant, 50 mg $0.00 J9226 HISTRELIN IMPLANT 50 MG $0.00 J9228 IPILIMUMAB INJECTION $0.00 J9230 MECHLORETHAMINE HCL/10 MG $0.00 J9245 INJ MELPHALAN HYDROCHLORIDE 50 MG $0.00 J9250 METHOTREXATE SODIUM 5 MG $0.00 J9260 METHOTREXATE SODIUM 50 MG $0.00 J9261 INJ NELARABINE 50 MG $0.00 J9263 OXALIPLATINE .5MG $0.00 J9264 Inj, paclitaxel protein‐bound 1 mg $0.00 J9266 PEGASPARGASE, PER SINGLE DOSE VIAL $0.00 J9267 PACLITAXEL INJECTION $0.00 J9268 PENTOSTATIN PER 10 MG $0.00 J9271 Injection, pembrolizumab, 1 mg $0.00 J9280 MITOMYCIN 5 MG $0.00 J9293 MITOXANTRONE HCL/5 MG $0.00 J9299 Injection, nivolumab, 1 mg $0.00 J9301 OBINUTUZUMAB INJ $0.00 J9302 OFATUMUMAB INJECTION $0.00 J9303 INJ PANITUMUMAB 10 MG $0.00 J9305 Injection, pemetrexed, 10 mg $0.00 J9306 INJECTION, PERTUZUMAB, 1 MG $0.00 J9307 PRALATREXATE INJECTION $0.00 J9308 Injection, ramucirumab, 5 mg $0.00 J9310 RITUXIMAB 100 MG $0.00 J9315 ROMIDEPSIN INJECTION $0.00 J9320 STREPTOZOCIN 1 GM $0.00 J9328 TEMOZOLOMIDE INJECTION $0.00 J9330 TEMSIROLIMUS INJECTION $0.00 J9351 TOPOTECAN INJECTION $0.00 J9354 INJ, ADO‐TRASTUZUMAB EMT 1MG $0.00 J9355 TRASTUZUMAB 10 MG $0.00 J9357 VALRUBICIN INTRAVESICAL 200 MG $0.00 J9360 VINBLASTINE SULFATE 1 MG $0.00 J9370 VINCRISTINE SULFATE 1 MG $0.00 J9371 INJ, VINCRISTINE SUL LIP 1MG $0.00 J9390 VINORELBINE TARTRATE, PER 10 MG $0.00 J9395 FULVESTRANT 25MG $0.00 J9400 INJ, ZIV‐AFLIBERCEPT, 1MG $0.00 K0001,RR ST&ARD WHEELCHR $172.00 K0002,RR ST&ARD HEMI (LOW SEAT) WHEELCHR $271.00 K0003,RR LIGHTWGT WHEELCHR $267.00 K0004,RR HIGH STRENGTH, LIGHTWGT WHEELCHR $445.00 K0005,NU ULTRALIGHTWGT WHEELCHR $6,156.00 K0005,RR ULTRALIGHTWGT WHEELCHR $616.00 K0005,UE ULTRALIGHTWGT WHEELCHR $4,617.00 K0006,RR HEAVY DUTY WHEELCHR $418.00 K0007,RR EXTRA HEAVY DUTY WHEELCHR $584.00 K0009,RR OTHER MANUAL WHEELCHR/BASE $238.00 K0010,RR ST&ARD ‐ WGT FRAME MOTORIZED/POWER $1,206.00 K0011,RR ST&ARD ‐ WGT FRAME MOTORIZED/POWER $1,706.00 K0011,RRKF ST&ARD ‐ WGT FRAME MOTORIZED/POWER $1,894.00 K0012,RR LIGHTWGT PORT. MOTORIZED/POWER WHEE $1,049.00 K0015,NU DETACHABLE, NON‐ADJ HEIGHT ARMREST, $522.00 K0015,NUKE DETACHABLE, NON‐ADJ HEIGHT ARMREST, $605.00 K0015,RR DETACHABLE, NON‐ADJ HEIGHT ARMREST, $52.00 K0015,RRKE DETACHABLE, NON‐ADJ HEIGHT ARMREST, $61.00 K0015,UE DETACHABLE, NON‐ADJ HEIGHT ARMREST, $391.00 K0015,UEKE DETACHABLE, NON‐ADJ HEIGHT ARMREST, $454.00 K0017,NU DETACHABLE, ADJ HEIGHT ARMREST, BAS $147.00 K0017,NUKE DETACHABLE, ADJ HEIGHT ARMREST, BAS $170.00 K0017,RR DETACHABLE, ADJ HEIGHT ARMREST, BAS $15.00 K0017,RRKE DETACHABLE, ADJ HEIGHT ARMREST, BAS $17.00 K0017,UE DETACHABLE, ADJ HEIGHT ARMREST, BAS $110.00 K0017,UEKE DETACHABLE, ADJ HEIGHT ARMREST, BAS $128.00 K0018,NU DETACHABLE, ADJ HEIGHT ARMREST, UPP $82.00 K0018,NUKE DETACHABLE, ADJ HEIGHT ARMREST, UPP $95.00 K0018,RR DETACHABLE, ADJ HEIGHT ARMREST, UPP $8.00 K0018,RRKE DETACHABLE, ADJ HEIGHT ARMREST, UPP $9.00 K0018,UE DETACHABLE, ADJ HEIGHT ARMREST, UPP $61.00 K0018,UEKE DETACHABLE, ADJ HEIGHT ARMREST, UPP $71.00 K0019,NU ARM PAD, EA $47.00 K0019,NUKE ARM PAD, EA $54.00 K0019,RR ARM PAD, EA $5.00 K0019,RRKE ARM PAD, EA $5.00 K0019,UE ARM PAD, EA $35.00 K0019,UEKE ARM PAD, EA $41.00 K0020,NU FIXED, ADJ HEIGHT ARMREST, PAIR $133.00 K0020,NUKE FIXED, ADJ HEIGHT ARMREST, PAIR $155.00 K0020,RR FIXED, ADJ HEIGHT ARMREST, PAIR $13.00 K0020,RRKE FIXED, ADJ HEIGHT ARMREST, PAIR $16.00 K0020,UE FIXED, ADJ HEIGHT ARMREST, PAIR $100.00 K0020,UEKE FIXED, ADJ HEIGHT ARMREST, PAIR $116.00 K0037,NU HIGH MOUNT FLIP‐UP FOOTREST, EA $117.00 K0037,NUKE HIGH MOUNT FLIP‐UP FOOTREST, EA $136.00 K0037,RR HIGH MOUNT FLIP‐UP FOOTREST, EA $11.00 K0037,RRKE HIGH MOUNT FLIP‐UP FOOTREST, EA $13.00 K0037,UE HIGH MOUNT FLIP‐UP FOOTREST, EA $88.00 K0037,UEKE HIGH MOUNT FLIP‐UP FOOTREST, EA $102.00 K0038,NU LEG STRAP, EA $70.00 K0038,NUKE LEG STRAP, EA $81.00 K0038,RR LEG STRAP, EA $7.00 K0038,RRKE LEG STRAP, EA $8.00 k0038,ue LEG STRAP, EA $52.00 K0038,UEKE LEG STRAP, EA $61.00 K0039,NU LEG STRAP, H STYLE, EA $155.00 K0039,NUKE LEG STRAP, H STYLE, EA $179.00 K0039,RR LEG STRAP, H STYLE, EA $16.00 K0039,RRKE LEG STRAP, H STYLE, EA $18.00 K0039,UE LEG STRAP, H STYLE, EA $116.00 K0039,UEKE LEG STRAP, H STYLE, EA $135.00 K0040,NU ADJ ANGLE FOOTPLATE, EA $214.00 K0040,NUKE ADJ ANGLE FOOTPLATE, EA $249.00 K0040,RR ADJ ANGLE FOOTPLATE, EA $21.00 K0040,RRKE ADJ ANGLE FOOTPLATE, EA $25.00 K0040,UE ADJ ANGLE FOOTPLATE, EA $161.00 K0040,UEKE ADJ ANGLE FOOTPLATE, EA $186.00 K0041,NU LARGE SIZE FOOTPLATE, EA $152.00 K0041,NUKE LARGE SIZE FOOTPLATE, EA $176.00 K0041,RR LARGE SIZE FOOTPLATE, EA $15.00 K0041,RRKE LARGE SIZE FOOTPLATE, EA $18.00 K0041,UE LARGE SIZE FOOTPLATE, EA $114.00 K0041,UEKE LARGE SIZE FOOTPLATE, EA $132.00 K0042,NU ST&ARD SIZE FOOTPLATE, EA $105.00 K0042,NUKE ST&ARD SIZE FOOTPLATE, EA $121.00 K0042,RR ST&ARD SIZE FOOTPLATE, EA $10.00 K0042,RRKE ST&ARD SIZE FOOTPLATE, EA $12.00 K0042,UE ST&ARD SIZE FOOTPLATE, EA $78.00 K0042,UEKE ST&ARD SIZE FOOTPLATE, EA $91.00 K0043,NU FOOTREST, LOWER EXT TUBE, EA $56.00 K0043,NUKE FOOTREST, LOWER EXT TUBE, EA $65.00 K0043,RR FOOTREST, LOWER EXT TUBE, EA $6.00 K0043,RRKE FOOTREST, LOWER EXT TUBE, EA $7.00 K0043,UE FOOTREST, LOWER EXT TUBE, EA $42.00 K0043,UEKE FOOTREST, LOWER EXT TUBE, EA $49.00 K0044,NU FOOTREST, UPPER HANGER BRACKET, EA $48.00 K0044,NUKE FOOTREST, UPPER HANGER BRACKET, EA $55.00 K0044,RR FOOTREST, UPPER HANGER BRACKET, EA $5.00 K0044,RRKE FOOTREST, UPPER HANGER BRACKET, EA $6.00 K0044,UE FOOTREST, UPPER HANGER BRACKET, EA $36.00 K0044,UEKE FOOTREST, UPPER HANGER BRACKET, EA $42.00 K0045,NU FOOTREST, COMP ASSEMBLY $163.00 K0045,NUKE FOOTREST,COMP ASSEMBLY $189.00 K0045,RR FOOTREST, COMP ASSEMBLY $16.00 K0045,RRKE FOOTREST, COMP ASSEMBLY $19.00 K0045,UE FOOTREST, COMP ASSEMBLY $122.00 K0045,UEKE FOOTREST, COMP ASSEMBLY $141.00 K0046,NU ELEVATING LEGREST, LOWER EXT TUBE, $56.00 K0046,NUKE ELEVATING LEGREST, LOWER EXT TUBE, $65.00 K0046,RR ELEVATING LEGREST, LOWER EXT TUBE, $6.00 K0046,RRKE ELEVATING LEGREST, LOWER EXT TUBE, $7.00 K0046,UE ELEVATING LEGREST, LOWER EXT TUBE, $42.00 K0046,UEKE ELEVATING LEGREST, LOWER EXT TUBE, $49.00 K0047,NU ELEVATING LEGREST, UPPER HANGER BRA $219.00 K0047,NUKE ELEVATING LEGREST, UPPER HANGER BRA $255.00 K0047,RR ELEVATING LEGREST, UPPER HANGER BRA $22.00 K0047,RRKE ELEVATING LEGREST, UPPER HANGER BRA $26.00 K0047,UE ELEVATING LEGREST, UPPER HANGER BRA $165.00 K0047,UEKE ELEVATING LEGREST, UPPER HANGER BRA $191.00 K0050,NU RATCHET ASSEMBLY $93.00 K0050,NUKE RATCHET ASSEMBLY $108.00 K0050,RR RATCHET ASSEMBLY $9.00 K0050,RRKE RATCHET ASSEMBLY $11.00 K0050,UE RATCHET ASSEMBLY $70.00 K0050,UEKE RATCHET ASSEMBLY $81.00 K0051,NU CAM RELEASE ASSEMBLY, FOOTREST OR L $151.00 K0051,NUKE CAM RELEASE ASSEMBLY, FOOTREST OR L $175.00 K0051,RR CAM RELEASE ASSEMBLY, FOOTREST OR L $15.00 K0051,RRKE CAM RELEASE ASSEMBLY, FOOTREST OR L $18.00 K0051,UE CAM RELEASE ASSEMBLY, FOOTREST OR L $113.00 K0051,UEKE CAM RELEASE ASSEMBLY, FOOTREST OR L $131.00 K0052,NU SWINGAWAY, DETACHABLE FOOTRESTS, EA $265.00 K0052,NUKE SWINGAWAY, DETACHABLE FOOTRESTS, EA $308.00 K0052,RR SWINGAWAY, DETACHABLE FOOTRESTS, EA $27.00 K0052,RRKE SWINGAWAY, DETACHABLE FOOTRESTS, EA $31.00 K0052,UE SWINGAWAY, DETACHABLE FOOTRESTS, EA $199.00 K0052,UEKE SWINGAWAY, DETACHABLE FOOTRESTS, EA $231.00 K0053,NU ELEVATING FOOTRESTS, ARTICULATING ( $293.00 K0053,NUKE ELEVATING FOOTRESTS, ARTICULATING ( $340.00 K0053,RR ELEVATING FOOTRESTS, ARTICULATING ( $29.00 K0053,RRKE ELEVATING FOOTRESTS, ARTICULATING ( $34.00 K0053,UE ELEVATING FOOTRESTS, ARTICULATING ( $220.00 K0053,UEKE ELEVATING FOOTRESTS, ARTICULATING ( $255.00 K0056,NU 0 $317.00 K0056,RR 0 $32.00 K0056,UE 0 $238.00 K0065,NU SPOKE PROTECTORS, EA $148.00 K0065,RR SPOKE PROTECTORS, EA $15.00 K0065,UE SPOKE PROTECTORS, EA $111.00 K0069,NU REAR WHEEL ASSEMBLY, COMP, W/ SOLID $333.00 K0069,RR REAR WHEEL ASSEMBLY, COMP, W/ SOLID $33.00 K0069,UE REAR WHEEL ASSEMBLY, COMP, W/ SOLID $250.00 K0070,NU REAR WHEEL ASSEMBLY, COMP, W/ PNEUM $610.00 K0070,RR REAR WHEEL ASSEMBLY, COMP, W/ PNEUM $61.00 K0070,UE REAR WHEEL ASSEMBLY, COMP, W/ PNEUM $457.00 K0071,NU FRONT CASTER ASSEMBLY, COMP, W/ PNE $364.00 K0071,RR FRONT CASTER ASSEMBLY, COMP, W/ PNE $36.00 K0071,UE FRONT CASTER ASSEMBLY, COMP, W/ PNE $273.00 K0072,NU FRONT CASTER ASSEMBLY, COMP, W/ SEM $219.00 K0072,RR FRONT CASTER ASSEMBLY, COMP, W/ SEM $22.00 K0072,UE FRONT CASTER ASSEMBLY, COMP, W/ SEM $164.00 K0073,NU CASTER PIN LOCK,EA $116.00 K0073,RR CASTER PIN LOCK,EA $12.00 K0073,UE CASTER PIN LOCK,EA $87.00 K0077,NU FRONT CASTER ASSEMBLY, COMP, W/ SOL $196.00 K0077,RR FRONT CASTER ASSEMBLY, COMP, W/ SOL $20.00 K0077,UE FRONT CASTER ASSEMBLY, COMP, W/ SOL $147.00 K0098,NU Drive belt power wheelchair $78.00 K0098,NUKE Drive belt power wheelchair $91.00 K0098,RR Drive belt power wheelchair $8.00 K0098,RRKE Drive belt power wheelchair $9.00 K0098,UE Drive belt power wheelchair $59.00 K0098,UEKE Drive belt power wheelchair $68.00 K0105,NU IV HANGER, EA $331.00 K0105,RR IV HANGER, EA $33.00 K0105,UE IV HANGER, EA $248.00 K0195,RR ELEVATING LEG RESTS, PAIR (FOR USE $51.00 K0195,RRKE ELEVATING LEG RESTS, PAIR (FOR USE $60.00 K0455,RR INF PUMP USED FOR UNINTERRUPTED ADM $750.00 K0552 Supp FOR Ext DRUG Infus PUMP, SYRIN $9.00 K0601,NU REPLACEMENT BATTERY FOR Ext Infus P $4.00 K0602,NU REPLACEMENT BATTERY FOR Ext Infus P $21.00 K0603,NU REPLACEMENT BATTERY FOR Ext Infus P $2.00 K0604,NU REPLACEMENT BATTERY FOR Ext Infus P $20.00 K0605,NU REPLACEMENT BATTERY FOR Ext Infus P $49.00 K0606,RRKF Auto Ext DEFIBRILLATOR, W/INTEGRATE $8,385.00 K0607,RR REPLACEMENT BATTERY FOR AUTOMATED E $65.00 K0607,RRKF REPLACEMENT BATTERY FOR AUTOMATED E $72.00 K0608,NU REPLACEMENT GARMENT FOR USE W/AUTOM $404.00 K0608,NUKF REPLACEMENT GARMENT FOR USE W/AUTOM $448.00 K0608,RR REPLACEMENT GARMENT FOR USE W/AUTOM $40.00 K0608,RRKF REPLACEMENT GARMENT FOR USE W/AUTOM $45.00 K0608,UE REPLACEMENT GARMENT FOR USE W/AUTOM $303.00 K0608,UEKF REPLACEMENT GARMENT FOR USE W/AUTOM $336.00 K0609 REPLACEMENT ELECTRODES FOR USE W/AU $2,684.00 K0609,KF REPLACEMENT ELECTRODES FOR USE W/AU $2,980.00 K0672 REMOVABLE SOFT INTERFACE LE $238.00 K0730,RR Ctrl dose inh drug deliv sys $574.00 K0733,NU POWER WHEELCHAIR $87.00 K0733,NUKE POWER WHEELCHAIR $101.00 K0733,RR POWER WHEELCHAIR $9.00 K0733,RRKE POWER WHEELCHAIR $10.00 K0733,UE POWER WHEELCHAIR $65.00 K0733,UEKE POWER WHEELCHAIR $75.00 K0738,RR REPLACEMENT CIRCULAR SAW BLADE $155.00 K0800,NU POWER OPERATED VEHICLE $3,710.00 K0800,RR POWER OPERATED VEHICLE $371.00 K0800,UE POWER OPERATED VEHICLE $2,783.00 K0801,NU POV CAPACITY 301 TO 450 LBS $5,982.00 K0801,RR POV CAPACITY 301 TO 450 LBS $598.00 K0801,UE POV CAPACITY 301 TO 450 LBS $4,486.00 K0802,NU Gene, Locus, Description $6,769.00 K0802,RR Gene, Locus, Description $677.00 K0802,UE Gene, Locus, Description $5,077.00 K0806,NU POV,GROUP 2 $4,488.00 K0806,RR POV,GROUP 2 $449.00 K0806,UE POV,GROUP 2 $3,366.00 K0807,NU POV,GROUP 2 HEAVY DUTY $6,811.00 K0807,RR POV,GROUP 2 HEAVY DUTY $681.00 K0807,UE POV,GROUP 2 HEAVY DUTY $5,108.00 K0808,NU POV,CAPACITY 451 TO 600 LBS $10,538.00 K0808,RR POV,CAPACITY 451 TO 600 LBS $1,054.00 K0808,UE POV,CAPACITY 451 TO 600 LBS $7,903.00 K0813,RR POWER WHEELCHAIR GROUP 1 $1,039.00 K0814,RR POWERWHEELCHAIR,GROUP 1 $1,329.00 K0815,RR POWER WHEELCHAIR, SLING $1,514.00 K0816,RR POWER WHEELCHAIR CAPTAINS CHAIR $1,450.00 K0820,RR POWER WHEELCHAIR GROUP2 $1,109.00 K0821,RR PWC,GROUP 2,CAPTAINS CHAIR $1,424.00 K0822,RR CONTROLLER ARM BRACKET $1,721.00 K0823,RR POWER CHAIRS $1,732.00 K0824,RR PWC GP 2 HD SEAT/BACK $2,085.00 K0825,RR PWC 2 HEAVY DUTY $1,909.00 K0826,RR PWC GP2 VERY HEAVY DUTY $2,699.00 K0827,RR PWC GP2 VERY HEAVY DUTY CAPTAIN $2,295.00 K0828,RR PWC GP2 HD CAP CHAIR $2,974.00 K0829,RR PWC GP2 EXTRA $2,731.00 K0835,RR PWC GP2 STANDARD SINGLE POWER $1,747.00 K0836,RR PWC GP2 STANDARD $1,811.00 K0837,RR PWC GP2 HEAVY DUTY $2,085.00 K0838,RR PWC GP2 HD SINGLE POW OPT CAP $1,865.00 K0839,RR PWC GP2 VHD SING POW $2,699.00 K0840,RR PWC GP2 STD MULT POW $4,089.00 K0841,RR PWC $1,859.00 K0842,RR PWC GP2 STD MULT OPT $1,859.00 K0843,RR PWC GP2 HD MPO $2,238.00 K0848,RR PWC GP 3 STD $2,275.00 K0849,RR PWC GP3 STD CAPT CHAIR $2,187.00 K0850,RR PWC GP3 HD SEAT/BACK $2,639.00 K0851,RR PWC GP3 HD CAP CHAIR $2,537.00 K0852,RR PWC GP3 VHD SEAT/BACK $3,049.00 K0853,RR PWC GP3 VHD CAPT CHAIR $3,132.00 K0854,RR PWC GP3 XHD SEAT/BACK $4,149.00 K0855,RR PWC GP3 XHD CAP CHAIR $3,920.00 K0856,RR PWC GP3 STD SPO SLING $2,442.00 K0857,RR PWC GP3 STD SING POW OPT CAP $2,491.00 K0858,RR PWC GP3 HD SPO CAP 301 TO 450 LBS $3,030.00 K0859,RR PWC GP3 MUL POW OPT $2,889.00 K0860,RR PWC GP3 VHD SING POW OPT S/B $4,328.00 K0861,RR PWC GP3 STD MULT POW OPT S/B $2,446.00 K0861,RRKF PWC GP3 HD MULT POW $3,151.00 K0862,RR PWC GP3 VHD MULT POW OPT $3,030.00 K0863,RR PWC GP3 VHD MULT POW OPT S/B $4,328.00 K0864,RR PWC GP3 XHD MPO $5,151.00 L0112 CRAINAL CERVICAL ORTHOSIS CONGEN $3,923.00 L0113 CRANIAL CERVICAL TORTICOLLIS $799.00 L0120 CERV, FLEX, NON‐ADJ (FOAM COLLAR) $71.00 L0130 CERV, FLEX, THERMOPLAS COLLAR, MOLD $584.00 L0140 CERV, SEMI‐RIGID, ADJ (PLAS COLLAR) $172.00 L0150 CERV, SEMI‐RIGID, ADJ MOLDED CHIN C $332.00 L0160 CERV, SEMI‐RIGID, WIRE FRAME OCCIPI $450.00 L0170 CERV, COLLAR, MOLDED TO PT MODEL $1,732.00 L0172 CERV, COLLAR, SEMI‐RIGID THERMOPLAS $393.00 L0174 CERV, COLLAR, SEMI‐RIGID, THERMOPLA $738.00 L0180 CERV, MULT POST COLLAR, OCCIPITAL/M $1,089.00 L0190 CERV, MULT POST COLLAR, OCCIPITAL/M $1,458.00 L0200 CERV, MULT POST COLLAR, OCCIPITAL/M $1,404.00 L0220 THORACIC, RIB BELT, CUST FAB $414.00 L0450 TLSO, FLEX, PROVIDES TRUNK SUPRT, U $547.00 L0454 TLSO FLEX, PROVIDES TRUNK SUPRT, EX $972.00 L0455 TLSO FLEX TRNK SJ‐T9 PRE OTS $972.00 L0456 TLSO, FLEX, PROVIDES TRUNK SUPRT, T $2,787.00 L0457 TLSO FLEX TRNK SJ‐SS PRE OTS $2,787.00 L0458 TLSO, TRIPLANAR CTRL, MOD SEG SPINA $2,499.00 L0460 TLSO, TRIPLANAR CTRL, MOD SEG SPINA $2,813.00 L0462 TLSO, TRIPLANAR CTRL, MOD SEG SPINA $3,499.00 L0464 TLSO, TRIPLANAR CTRL, MOD SEG SPINA $4,166.00 L0466 TLSO, SAGITTAL CTRL, RIGID POST FRA $1,003.00 L0467 TLSO R FRAM SOFT PRE OTS $1,003.00 L0468 TLSO, SAGITTAL‐CORONAL CTRL, RIGID $1,231.00 L0469 TLSO RIG FRAM PELVIC PRE OTS $1,231.00 L0470 TLSO, TRIPLANAR CTRL, RIGID POST FR $1,996.00 L0472 TLSO, TRIPLANAR CTRL, HYPEREXT, RIG $1,300.00 L0480 TLSO, TRIPLANAR CTRL, ONE PIECE RIG $4,616.00 L0482 TLSO, TRIPLANAR CTRL, ONE PIECE RIG $5,144.00 L0484 TLSO, TRIPLANAR CTRL, TWO PIECE RIG $5,111.00 L0486 TLSO, TRIPLANAR CTRL, TWO PIECE RIG $5,434.00 L0488 TLSO, TRIPLANAR CTRL, ONE PIECE RIG $2,813.00 L0490 TLSO, SAGITTAL‐CORONAL CTRL, ONE PI $793.00 L0491 TLSO 2 piece rigid shell $2,152.00 L0492 TLSO 3 piece rigid shell $1,414.00 L0621 SIO flex pelvisacral prefab $260.00 L0622 SIO flex pelvisacral custom $694.00 L0625 LO flexibl L1‐below L5 pre $154.00 L0626 LO sag stays/panels pre‐fab $218.00 L0627 LO sagitt rigid panel prefab $1,152.00 L0628 LO flex w/o rigid stays pre $235.00 L0630 LSO post rigid panel pre $454.00 L0631 LSO sag‐coro rigid frame pre $2,877.00 L0633 LSO flexion control prefab $804.00 L0635 LSO sagit rigid panel prefab $2,732.00 L0636 LSO sagittal rigid panel cus $4,052.00 L0637 LSO sag‐coronal panel prefab $3,011.00 L0638 LSO sag‐coronal panel custom $3,696.00 L0639 LSO s/c shell/panel prefab $3,011.00 L0640 LSO s/c shell/panel custom $2,933.00 L0641 LO RIG POS PNL L1‐L5 PRE OTS $218.00 L0642 LO SAG RI AN/POS PNL PRE OTS $1,152.00 L0643 LSO SAG CTR RIGI POS PRE OTS $454.00 L0648 LSO SAG R AN/POS PNL PRE OTS $2,877.00 L0649 LSO SC R POS/LAT PNL PRE OTS $804.00 L0650 LSO SC R ANT/POS PNL PRE OTS $3,011.00 L0651 LSO SAG‐CO SHELL PNL PRE OTS $3,011.00 L0700 CERV‐THOR‐LUMBAR‐SACRAL‐ORTHOSES (C $5,428.00 L0710 CTLSO, ANT‐POST‐LAT‐CTRL, MOLDED TO $5,635.00 L0810 HALO PROC, CERV HALO INCORPORATED $7,033.00 L0820 HALO PROC, CERV HALO INCORPORATED $5,800.00 L0830 HALO PROC, CERV HALO INCORPORATED $8,419.00 L0859 MRI compatible system $3,271.00 L0861 ADD HALO PROCEDURE REPLACEMENT $604.00 L0970 TLSO, CORSET FRONT $318.00 L0972 LSO, CORSET FRONT $306.00 L0974 TLSO, FULL CORSET $481.00 L0976 LSO, FULL CORSET $429.00 L0978 AXILLARY CRUTCH EXT $517.00 L0980 PERONEAL STRAPS, PAIR $47.00 L0982 STOCKING SUPRTER GRIPS, SET OF FOUR $44.00 L0984 PROTECTIVE BODY SOCK, EA $176.00 L1000 CERV‐THORACIC‐LUMBAR‐SACRAL ORTHOSI $5,451.00 L1005 TENSION BASED SCOLIOSIS ORTHOSIS & $8,970.00 L1010 ADD TO CERV‐THORACIC‐LUMBAR‐SACRAL $180.00 L1020 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $232.00 L1025 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $446.00 L1030 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $171.00 L1040 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $209.00 L1050 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $224.00 L1060 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $257.00 L1070 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $242.00 L1080 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS $149.00 L1085 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $413.00 L1090 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $270.00 L1100 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $438.00 L1110 ADD TO CTLSO OR SCOLIOSIS ORTHOSIS, $686.00 L1120 ADD TO CTLSO, SCOLIOSIS ORTHOSIS, C $107.00 L1200 THORACIC‐LUMBAR‐SACRAL‐ORTHOSIS (TL $4,207.00 L1210 ADD TO TLSO, (LOW PROFILE), LAT THO $937.00 L1220 ADD TO TLSO, (LOW PROFILE), ANT THO $793.00 L1230 ADD TO TLSO, (LOW PROFILE), MILWAUK $2,035.00 L1240 ADD TO TLSO, (LOW PROFILE), LUMBAR $210.00 L1250 ADD TO TLSO, (LOW PROFILE), ANT ASI $194.00 L1260 ADD TO TLSO, (LOW PROFILE), ANT THO $203.00 L1270 ADD TO TLSO, (LOW PROFILE), ABDOMIN $208.00 L1280 ADD TO TLSO, (LOW PROFILE), RIB GUS $249.00 L1290 ADD TO TLSO, (LOW PROFILE), LAT TRO $211.00 L1300 OTHER SCOLIOSIS PROC, BODY JACKET M $5,980.00 L1310 OTHER SCOLIOSIS PROC, POST‐OPERATI $5,956.00 L1600 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $346.00 L1610 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $129.00 L1620 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $398.00 L1630 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $455.00 L1640 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $1,448.00 L1650 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $622.00 L1652 HIP ORTHOSIS, BILAT THIGH CUFFS W/ $999.00 L1660 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $459.00 L1680 HIP ORTHOSIS, ABD CTRL OF HIP JNTS, $3,271.00 L1685 HIP ORTHOSIS, ABD CTRL OF HIP JNT, $3,194.00 L1686 HIP ORTHOSIS, ABD CTRL OF HIP JNT, $3,266.00 L1690 COMBINATION, BILAT, LUMBO‐SACRAL, H $5,420.00 L1700 LEGG PERTHES ORTHOSIS, (TORONTO TYP $4,100.00 L1710 LEGG PERTHES ORTHOSIS, (NEWINGTON T $4,800.00 L1720 LEGG PERTHES ORTHOSIS, TRILAT, (TAC $3,538.00 L1730 LEGG PERTHES ORTHOSIS, (SCOTTISH RI $3,120.00 L1755 LEGG PERTHES ORTHOSIS, (PATTEN BOTT $4,375.00 L1810 KNEE ORTHOSIS, ELAST W/ JNTS, PREFA $288.00 L1812 KO ELASTIC W/JOINTS PRE OTS $288.00 L1820 KO ELAS W/ CONDYLE PADS & JO $395.00 L1830 KNEE ORTHOSIS, IMMOBILIZER, CANVAS $278.00 L1831 KNEE ORTHOSIS LOCKING KNEE JOINT $825.00 L1832 KO adj jnt pos rigid support $2,176.00 L1833 KO ADJ JNT POS R SUP PRE OTS $2,176.00 L1834 KNEE ORTHOSIS, W/O KNEE JNT, RIGID, $2,360.00 L1836 KNEE ORTHOSIS, RIGID, W/O JNT(S), I $374.00 L1840 KNEE ORTHOSIS, DEROTATION, MEDIAL‐L $2,778.00 L1843 KO single upright custom fit $2,515.00 L1844 Ko w/adj jt rot cntrl molded $4,390.00 L1845 Ko w/ adj flex/ext rotat cus $2,758.00 L1846 Ko w adj flex/ext rotat mold $3,619.00 L1847 KNEE ORTHOSIS, DOUBLE UPRIGHT W/ AD $1,612.00 L1848 KO DBL UPRIGHT W/AIR PRE OTS $1,612.00 L1850 KNEE ORTHOSIS, SWEDISH TYPE, PREFAB $849.00 L1860 KNEE ORTHOSIS, MOD OF SUPRACONDYLAR $3,509.00 L1900 ANKLE FOOT ORTHOSIS, SPRING WIRE, D $724.00 L1902 ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET $280.00 L1904 ANKLE FOOT ORTHOSIS, MOLDED ANKLE G $1,306.00 L1906 ANKLE FOOT ORTHOSIS, MULTILIGAMENTU $326.00 L1907 AFO SUPRAMALLEOLAR W/STRAPS $1,577.00 L1910 ANKLE FOOT ORTHOSIS, POST, SNG BAR, $893.00 L1920 ANKLE FOOT ORTHOSIS, SNG UPRIGHT W/ $1,004.00 L1930 ANKLE FOOT ORTHOSIS, PLAS OR OTHER $635.00 L1932 AFO RIG ANT TIB PREFAB TCF/= $2,501.00 L1940 ANKLE FOOT ORTHOSIS, PLAS OR OTHER $1,685.00 L1945 ANKLE FOOT ORTHOSIS, PLAS, RIGID AN $2,485.00 L1950 ANKLE FOOT ORTHOSIS, SPIRAL, (IRM T $2,666.00 L1951 ANKLE FOOT ORTHOSIS SPIRAL $2,354.00 L1960 ANKLE FOOT ORTHOSIS, POST SOLID ANK $1,984.00 L1970 ANKLE FOOT ORTHOSIS, PLAS W/ ANKLE $2,534.00 L1971 ANKLE FOOT ORTHOSIS $1,314.00 L1980 ANKLE FOOT ORTHOSIS, SNG UPRIGHT FR $1,106.00 L1990 ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT $1,427.00 L2000 KNEE ANKLE FOOT ORTHOSIS, SNG UPRIG $3,071.00 L2005 KAFO SNG/DBL MECHANICAL ACT $11,484.00 L2010 KNEE ANKLE FOOT ORTHOSIS, SNG UPRIG $3,310.00 L2020 KNEE ANKLE FOOT ORTHOSIS, DOUBLE UP $3,406.00 L2030 KNEE ANKLE FOOT ORTHOSIS, DOUBLE UP $3,492.00 L2034 KAFO pla sin up w/wo k/a cus $5,842.00 L2035 KAFO PLASTIC PEDIATRIC SIZE $494.00 L2036 Kafo plas doub free knee mol $6,642.00 L2037 Kafo plas sing free knee mol $5,877.00 L2038 Kafo w/o joint multi‐axis an $5,043.00 L2040 HIP KNEE ANKLE FOOT ORTHOSIS, TORSI $477.00 L2050 HIP KNEE ANKLE FOOT ORTH, TORSION C $1,311.00 L2060 HIP KNEE ANKLE FOOT ORTHOSIS, TORSI $1,650.00 L2070 HIP KNEE ANKLE FOOT ORTHOSIS, TORSI $363.00 L2080 HIP KNEE ANKLE FOOT ORTH, TORSION C $1,025.00 L2090 HIP KNEE ANKLE FOOT ORTHOSIS, TORSI $1,177.00 L2106 ANKLE FOOT ORTHOSIS, FRACTURE ORTHO $2,342.00 L2108 ANKLE FOOT ORTHOSIS, FRACTURE ORTHO $3,482.00 L2112 ANKLE FOOT ORTHOSIS, FRACTURE ORTHO $1,591.00 L2114 ANKLE FOOT ORTHOSIS, FRACTURE ORTH, $2,076.00 L2116 ANKLE FOOT ORTHOSIS, FRACTURE ORTHO $2,284.00 L2126 KNEE ANKLE FOOT ORTHOSIS, FRACTURE $4,287.00 L2128 KNEE ANKLE FOOT ORTHOSIS, FRACTURE $5,547.00 L2132 KAFO, FRACTURE ORTHOSIS, FEMORAL FR $2,888.00 L2134 KAFO, FRACTURE ORTHOSIS, FEMORAL FR $3,462.00 L2136 KAFO, FRACTURE ORTHOSIS, FEMORAL FR $4,234.00 L2180 ADD TO LOWER EXTREMITY FRACTURE ORT $314.00 L2182 ADD TO LOWER EXTREMITY FRACTURE ORT $246.00 L2184 ADD TO LOWER EXTREMITY FRACTURE ORT $333.00 L2186 ADD TO LOWER EXTREMITY FRACTURE ORT $444.00 L2188 ADD TO LOWER EXTREMITY FRACTURE ORT $1,072.00 L2190 ADD TO LOWER EXTREMITY FRACTURE ORT $252.00 L2192 ADD TO LOWER EXTREMITY FRACTURE ORT $1,222.00 L2200 ADD TO LOWER EXTREMITY, LIMITED ANK $132.00 L2210 ADD TO LOWER EXTREMITY, DORSIFLEXIO $197.00 L2220 ADD TO LOWER EXTREMITY, DORSIFLEXIO $249.00 L2230 ADD TO LOWER EXTREMITY, SPLIT FLAT $206.00 L2232 ROCKER BOTTOM, CONTACT AFO $279.00 L2240 ADD TO LOWER EXTREMITY, ROUND CALIP $225.00 L2250 ADD TO LOWER EXTREMITY, FOOT PLATE $954.00 L2260 ADD TO LOWER EXTREMITY, REINFORCED $718.00 L2265 ADD TO LOWER EXTREMITY, LONG TONGUE $316.00 L2270 ADD TO LOWER EXTREMITY, VARUS/VALG $147.00 L2275 ADD TO LOWER EXTREMITY, VARUS/VALGU $338.00 L2280 ADD TO LOWER EXTREMITY, MOLDED INN $1,402.00 L2300 ADD TO LOWER EXTREMITY, ABD BAR (B $964.00 L2310 ADD TO LOWER EXTREMITY, ABD BAR‐ST $330.00 L2320 NON‐MOLDED LACER $661.00 L2330 LACER MOLDED TO PATIENT MODE $1,406.00 L2335 ADD TO LOWER EXTREMITY, ANT SWING $610.00 L2340 ADD TO LOWER EXTREMITY, PRE‐TIBIAL $1,304.00 L2350 ADD TO LOWER EXTREMITY, PROS TYPE, $3,180.00 L2360 ADD TO LOWER EXTREMITY, EXT STEEL $185.00 L2370 ADD TO LOWER EXTREMITY, PATTEN BOTT $919.00 L2375 ADD TO LOWER EXTREMITY, TORSION CT $303.00 L2380 ADD TO LOWER EXTREMITY, TORSION CT $331.00 L2385 ADD TO LOWER EXTREMITY, STRAIGHT K $360.00 L2387 Add LE poly knee custom KAFO $444.00 L2390 ADD TO LOWER EXTREMITY, OFFSET KNE $313.00 L2395 ADD TO LOWER EXTREMITY, OFFSET KNE $420.00 L2397 ADD TO LOWER EXTREMITY ORTHOSIS, SU $317.00 L2405 Knee joint drop lock ea jnt $244.00 L2415 ADD TO KNEE LOCK W/ INT RELEASE MEC $340.00 L2425 ADD TO KNEE JNT, DISC OR DIAL LOCK $402.00 L2430 ADD TO KNEE JNT, RATCHET LOCK FOR A $402.00 L2492 ADD TO KNEE JNT, LIFT LOOP FOR DROP $312.00 L2500 ADD TO LOWER EXTREMITY, THIGH/WGT B $847.00 L2510 ADD TO LOWER EXTREMITY, THIGH/WGT B $2,270.00 L2520 ADD TO LOWER EXTREMITY, THIGH/WGT $1,524.00 L2525 ADD TO LOWER EXT, THIGH/WGT BEARING $3,767.00 L2526 ADD TO LOWER EXTREMITY, THIGH/WGT B $1,839.00 L2530 ADD TO LOWER EXTREMITY, THIGH‐WGT $822.00 L2540 ADD TO LOWER EXTREMITY, THIGH/WGT $1,160.00 L2550 ADD TO LOWER EXTREMITY, THIGH/WGT $937.00 L2570 ADD TO LOWER EXTREMITY, PELVIC CTRL $1,279.00 L2580 ADD TO LOWER EXTREMITY, PELVIC CTRL $1,430.00 L2600 ADD TO LOWER EXTREMITY, PELVIC CTRL $551.00 L2610 ADD TO LOWER EXTREMITY, PELVIC CTRL $761.00 L2620 ADD TO LOWER EXTREMITY, PELVIC CTRL $957.00 L2622 ADD TO LOWER EXTREMITY, PELVIC CTRL $823.00 L2624 ADD TO LOWER EXTREMITY, PELVIC CTRL $952.00 L2627 ADD TO LOWER EXTREMITY, PELVIC CTRL $5,600.00 L2628 ADD TO LOWER EXTREMITY, PELVIC CTRL $5,782.00 L2630 ADD TO LOWER EXTREMITY, PELVIC CTRL $810.00 L2640 ADD TO LOWER EXTREMITY, PELVIC CTRL $1,203.00 L2650 ADD TO LOWER EXTREMITY, PELVIC & TH $331.00 L2660 ADD TO LOWER EXTREMITY, THORACIC CT $500.00 L2670 ADD TO LOWER EXTREMITY, THORACIC CT $566.00 L2680 ADD TO LOWER EXTREMITY, THORACIC CT $526.00 L2750 ADD TO LOWER EXTREMITY ORTHOSIS, PL $264.00 L2755 CARBON GRAPHITE LAMINATION $366.00 L2760 ADD TO LOWER EXTREMITY ORTHOSIS, EX $201.00 L2768 ORTHOTIC SIDE BAR DISCONNECT DEVICE $365.00 L2780 ADD TO LOWER EXTREMITY ORTHOSIS, NO $219.00 L2785 ADD TO LOWER EXTREMITY ORTHOSIS, DR $100.00 L2795 ADD TO LOWER EXTREMITY ORTHOSIS, KN $256.00 L2800 KNEE CAP MEDIAL OR LATERAL P $286.00 L2810 ADD TO LOWER EXTREMITY ORTHOSIS, KN $210.00 L2820 ADD TO LOWER EXTREMITY ORTHOSIS, SO $268.00 L2830 ADD TO LOWER EXTREMITY ORTHOSIS, SO $311.00 L2840 ADD TO LOWER EXTREMITY ORTHOSIS, TI $139.00 L2850 ADD TO LOWER EXTREMITY ORTHOSIS, FE $178.00 L3000 FOOT, INSERT, REMOV, MOLDED TO PT M $880.00 L3001 FOOT, INSERT, REMOV, MOLDED TO PT M $371.00 L3002 FOOT, INSERT, REMOV, MOLDED TO PT M $453.00 L3003 FOOT, INSERT, REMOV, MOLDED TO PT M $488.00 L3010 FOOT, INSERT, REMOV, MOLDED TO PT M $488.00 L3020 FOOT, INSERT, REMOV, MOLDED TO PT M $556.00 L3030 FOOT, INSERT, REMOV, FORMED TO PT F $214.00 L3031 FOOT INSERT/PLATE REMOVABLE $343.00 L3040 FOOT, ARCH SUPRT, REMOV, PREMOLDED, $132.00 L3050 FOOT, ARCH SUPRT, REMOV, PREMOLDED, $132.00 L3060 FOOT, ARCH SUPRT, REMOV, PREMOLDED, $207.00 L3070 FOOT, ARCH SUPRT, NON‐REMOV ATTACHE $89.00 L3080 FOOT, ARCH SUPRT, NON‐REMOV ATTACHE $89.00 L3090 FOOT, ARCH SUPRT, NON‐REMOV ATTACHE $114.00 L3100 HALLUS‐VALGUS NIGHT DYNAMIC SPLINT $121.00 L3140 FOOT, ABD ROTATION BAR, INCL SHOES $250.00 L3150 FOOT, ABD ROTATATION BAR, W/O SHOES $228.00 L3170 Foot plastic heel stabilizer $143.00 L3224 ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, $174.00 L3225 ORTHOPEDIC FOOTWEAR, MAN'S SHOE, OX $195.00 L3300 LIFT, ELEVATION, HEEL, TAPERED TO M $146.00 L3310 LIFT, ELEVATION, HEEL & SOLE, NEOPR $228.00 L3330 LIFT, ELEVATION, METAL EXT (SKATE) $1,586.00 L3332 LIFT, ELEVATION, INSIDE SHOE, TAPER $207.00 L3334 LIFT, ELEVATION, HEEL, PER INCH $107.00 L3340 HEEL WEDGE, SACH $239.00 L3350 HEEL WEDGE $64.00 L3360 SOLE WEDGE, O/S SOLE $100.00 L3370 SOLE WEDGE, BETWEEN SOLE $139.00 L3380 CLUBFOOT WEDGE $139.00 L3390 OUTFLARE WEDGE $139.00 L3400 METATARSAL BAR WEDGE, ROCKER $114.00 L3410 METATARSAL BAR WEDGE, BETWEEN SOLE $260.00 L3420 FULL SOLE & HEEL WEDGE, BETWEEN SOL $153.00 L3430 HEEL, COUNTER, PLAS REINFORCED $449.00 L3440 HEEL, COUNTER, LEATHER REINFORCED $214.00 L3450 HEEL, SACH CUSHION TYPE $296.00 L3455 HEEL, NEW LEATHER, ST&ARD $114.00 L3460 HEEL, NEW RUBBER, ST&ARD $96.00 L3465 HEEL, THOMAS W/ WEDGE $164.00 L3470 HEEL, THOMAS EXT TO BALL $175.00 L3480 HEEL, PAD & DEPRESSION FOR SPUR $175.00 L3500 ORTHOPEDIC SHOE ADD, INSOLE, LEATHE $82.00 L3510 ORTHOPEDIC SHOE ADD, INSOLE, RUBBER $82.00 L3520 ORTHOPEDIC SHOE ADD, INSOLE, FELT C $89.00 L3530 ORTHOPEDIC SHOE ADD, SOLE, HALF $89.00 L3540 ORTHOPEDIC SHOE ADD, SOLE, FULL $143.00 L3550 ORTHOPEDIC SHOE ADD, TOE TAP ST&ARD $25.00 L3560 ORTHOPEDIC SHOE ADD, TOE TAP, HORSE $64.00 L3570 ORTHOPEDIC SHOE ADD, SPECIAL EXT TO $239.00 L3580 ORTHOPEDIC SHOE ADD, CONVERT INSTEP $182.00 L3590 ORTHOPEDIC SHOE ADD, CONVERT FIRM S $150.00 L3595 ORTHOPEDIC SHOE ADD, MARCH BAR $118.00 L3600 TRANSFER OF AN ORTHOSIS FROM ONE S $214.00 L3610 TRANSFER OF AN ORTHOSIS FROM ONE S $282.00 L3620 TRANSFER OF AN ORTHOSIS FROM ONE S $214.00 L3630 TRANSFER OF AN ORTHOSIS FROM ONE S $282.00 L3640 TRANSFER OF AN ORTHOSIS FROM ONE S $121.00 L3650 SHOULDER ORTHOSIS, FIG OF EIGHT DES $179.00 L3660 SHOULDER ORTHOSIS, FIG OF E $276.00 L3670 SHOULDER ORTHOSIS, ACROMIO/CLAVICUL $352.00 L3671 SO cap design w/o jnts CF $2,298.00 L3674 SO AIRPLANE W/WO JOINT CF $3,015.00 L3675 SHOULDER ORTHOSIS, VEST TYPE ABD RE $448.00 L3702 EO w/o joints CF $737.00 L3710 ELBOW ORTHOSIS, ELAST W/ METAL JNTS $339.00 L3720 ELBOW ORTHOSIS, DOUBLE UPRIGHT W/ F $2,291.00 L3730 ELBOW ORTHOSIS, DOUBLE UPRIGHT W/ F $3,089.00 L3740 ELBOW ORTHOSIS, DOUBLE UPRIGHT W/ F $3,464.00 L3760 ELBOW ORTHOSIS, W/ ADJ POSITION LOC $1,276.00 L3762 ELBOW ORTHOSIS, RIGID, W/O JNTS, IN $274.00 L3763 EWHO rigid w/o jnts CF $1,965.00 L3764 EWHO w/joint(s) CF $2,474.00 L3765 EWHFO rigid w/o jnts CF $3,271.00 L3766 EWHFO w/joint(s) CF $3,463.00 L3806 WHFO w/joint(s) custom fab $1,159.00 L3807 WRIST H& FINGER ORTHOSIS, W/O JNT(S $638.00 L3808 WHFO, rigid w/o joints $1,035.00 L3809 WHFO W/O JOINTS PRE OTS $638.00 L3900 WRIST H& FINGER ORTHOSIS, DYNAMIC F $3,400.00 L3901 WRIST H& FINGER ORTHOSIS, DYNAMIC F $4,671.00 L3904 WRIST H& FINGER ORTHOSIS, EXT POWER $7,694.00 L3905 WHO w/nontorsion jnt(s) CF $2,530.00 L3906 WHO w/o joints CF $1,073.00 L3908 WRST H& ORTHOSIS, WRIST EXT CTRL CO $210.00 L3912 H& FINGER ORTHOSIS, FLEXION GLOVE W $249.00 L3913 HFO w/o joints CF $691.00 L3915 WHO w nontor jnt(s) prefab $1,356.00 L3916 WHO NONTORSION JNTS PRE OTS $1,356.00 L3917 HAND ORTHOSIS METACARPAL FRACTURE $270.00 L3918 METACARP FX ORTHOSIS PRE OTS $270.00 L3919 HO w/o joints CF $691.00 L3921 HFO w/joint(s) CF $819.00 L3923 HFO w/o joints PF $229.00 L3924 HFO WITHOUT JOINTS PRE OTS $229.00 L3925 FO pip/dip with joint/spring $130.00 L3927 FO pip/dip w/o joint/spring $89.00 L3929 HFO nontorsion joint, prefab $205.00 L3930 HFO NONTORSION JNTS PRE OTS $205.00 L3931 WHFO nontorsion joint prefab $502.00 L3933 FO w/o joints CF $544.00 L3935 FO nontorsion joint CF $563.00 L3960 SHOULDER ELBOW WRIST H& ORTHOSIS, A $1,981.00 L3961 SEWHO cap design w/o jnts CF $4,285.00 L3962 SHOULDER ELBOW WRIST H& ORTHOSIS, A $1,885.00 L3967 SEWHO airplane w/o jnts CF $5,060.00 L3971 SEWHO cap design w/jnt(s) CF $4,803.00 L3973 SEWHO airplane w/jnt(s) CF $5,060.00 L3975 SEWHFO cap design w/o jnt CF $4,285.00 L3976 SEWHFO airplane w/o jnts CF $4,285.00 L3977 SEWHFO cap desgn w/jnt(s) CF $4,803.00 L3978 SEWHFO airplane w/jnt(s) CF $5,060.00 L3980 UPPER EXTREMITY FRACTURE ORTHOSIS, $929.00 L3981 UE FX ORTH SHOUL CAP FOREARM $2,567.00 L3982 UPPER EXTREMITY FRACTURE ORTHOSIS, $1,308.00 L3984 UPPER EXTREMITY FRACTURE ORTHOSIS, $967.00 L3995 ADD TO UPPER EXTREMITY ORTHOSIS, SO $115.00 L4000 REPLACE GIRDLE FOR SPINAL ORTHOSIS $3,423.00 L4010 REPLACE TRILAT SOCKET BRIM $2,125.00 L4020 REPLACE QUADRILAT SOCKET BRIM, MOLD $2,949.00 L4030 REPLACE QUADRILAT SOCKET BRIM, CUST $1,807.00 L4040 REPLACE MOLDED THIGH LACER $1,296.00 L4045 REPLACE NON‐MOLDED THIGH LAC $881.00 L4050 REPLACE MOLDED CALF LACER $1,478.00 L4055 REPLACE NON‐MOLDED CALF LACE $718.00 L4060 REPLACE HIGH ROLL CUFF $853.00 L4070 REPLACE PROXIMAL & DISTAL UPRIGHT F $756.00 L4080 REPLACE METAL B&S KAFO, PROXIMAL TH $278.00 L4090 REPLACE METAL B&S KAFO‐AFO, CALF OR $289.00 L4100 REPLACE LEATHER CUFF KAFO, PROXIMAL $348.00 L4110 REPLACE LEATHER CUFF KAFO‐AFO, CALF $300.00 L4130 REPLACE PRETIBIAL SHELL $1,332.00 L4350 PNEUMATIC ANKLE CTRL SPLINT, PREFAB $240.00 L4360 PNEUMATIC ANKLE FOOT ORTHOSIS, W/ O $771.00 L4361 PNEUMA/VAC WALK BOOT PRE OTS $771.00 L4370 PNEUMATIC FULL LEG SPLINT, PREFAB, $507.00 L4386 NON‐PNEUMATIC WALKING SPLINT, W/ OR $444.00 L4387 NON‐PNEUM WALK BOOT PRE OTS $444.00 L4392 REPLACEMENT, SOFT INTERFACE MAT, ST $66.00 L4394 REPLACE SOFT INTERFACE MAT, FOOT DR $48.00 L4396 STATIC ANKLE FOOT ORTHOSIS, INCL SO $470.00 L4397 STATIC OR DYNAMI AFO PRE OTS $470.00 L4398 FOOT DROP SPLINT, RECUMBENT POSITIO $217.00 L4631 AFO, WALK BOOT TYPE, CUS FAB $5,048.00 L5000 PARTIAL FOOT, SHOE INSERT W/ LONGIT $1,445.00 L5010 PARTIAL FOOT, MOLDED SOCKET, ANKLE $4,421.00 L5020 PARTIAL FOOT, MOLDED SOCKET, TIBIAL $5,669.00 L5050 ANKLE, SYMES, MOLDED SOCKET, SACH F $6,997.00 L5060 ANKLE, SYMES, METAL FRAME, MOLDED L $10,534.00 L5100 BEL KNEE, MOLDED SOCKET, SHIN, SACH $7,250.00 L5105 BEL KNEE, PLAS SOCKET, JNTS & THIGH $12,111.00 L5150 KNEE DISART (OR THRU KNEE), MOLDED $11,157.00 L5160 KNEE DISART (OR THRU KNEE), MOLDED $10,926.00 L5200 ABV KNEE, MOLDED SOCKET, SNG AXIS C $9,454.00 L5210 ABV KNEE, SHORT PROST, NO KNEE JNT $9,255.00 L5220 ABV KNEE, SHORT PROST, NO KNEE JNT $8,447.00 L5230 ABV KNEE, FOR PROXIMAL FEMORAL FOCA $10,882.00 L5250 HIP DISART, CANADIAN TYPE; MOLDED S $15,853.00 L5270 HIP DISART, TILT TABLE TYPE; MOLDED $14,712.00 L5280 HEMIPELVECTOMY, CANADIAN TYPE; MOLD $14,565.00 L5301 BEL KNEE, MOLDED SOCKET, SHIN, SACH $6,568.00 L5312 KNEE DISART, SACH FT, ENDO $9,599.00 L5321 ABV KNEE, MOLDED SOCKET, OPEN END, $9,401.00 L5331 HIP DISART, CANADIAN TYPE, MOLDED S $13,303.00 L5341 HEMIPELVECTOMY, CANADIAN, MOLDED SO $14,565.00 L5400 IMMED POST SURG OR EARLY FITTING, A $3,443.00 L5410 IMMED POST SURG OR EARLY FITTING, A $1,195.00 L5420 IMMED POST SURG OR EARLY FITTING, A $4,348.00 L5430 IMMED POST SURG OR EARLY FITTING, A $1,919.00 L5450 IMMED POST SURG OR EARLY FITTING, A $1,296.00 L5460 IMMED POST SURG OR EARLY FITTING, A $1,560.00 L5500 INITIAL, BEL KNEE 'PTB' TYPE SOCKET $3,674.00 L5505 INITIAL, ABV KNEE ‐ KNEE DISART, IS $4,975.00 L5510 PREP, BEL KNEE 'PTB' TYPE SOCKET, $4,164.00 L5520 PREP, BEL KNEE 'PTB' TYPE SOCKET, N $5,026.00 L5530 PREP, BEL KNEE 'PTB' TYPE SOCKET, N $4,941.00 L5535 PREP, BEL KNEE 'PTB' TYPE SOCKET, N $5,426.00 L5540 PREP, BEL KNEE 'PTB' TYPE SOCKET, N $5,177.00 L5560 PREP, ABV KNEE‐ KNEE DISART, ISCHIA $6,496.00 L5570 PREP, ABV KNEE ‐ KNEE DISART, ISCHI $6,543.00 L5580 PREP, ABV KNEE ‐ KNEE DISART ISCHIA $7,417.00 L5585 PREP, ABV KNEE ‐ KNEE DISART, ISCHI $7,319.00 L5590 PREP, ABV KNEE ‐ KNEE DISART ISCHIA $7,631.00 L5595 PREP, HIP DISART‐HEMIPELVECTOMY, PY $12,715.00 L5600 PREP, HIP DISART‐HEMIPELVECTOMY, PY $14,066.00 L5610 ADD TO LOWER EXTREMITY, ENDOSKELETA $5,922.00 L5611 ADD TO LOWER EXTREMITY, ENDOSKELETA $4,609.00 L5613 ADD TO LOWER EXTREMITY, ENDOSKELETA $7,010.00 L5614 ADD TO LOWER EXTREMITY, EXOSKELETAL $4,739.00 L5616 ADD TO LOWER EXTREMITY, ENDOSKELETA $3,885.00 L5617 ADD TO LOWER EXTREMITY, QUICK CHANG $1,603.00 L5618 ADD TO LOWER EXTREMITY, TEST SOCKET $848.00 L5620 ADD TO LOWER EXTREMITY, TEST SOCKET $941.00 L5622 ADD TO LOWER EXTREMITY, TEST SOCKET $1,383.00 L5624 ADD TO LOWER EXTREMITY, TEST SOCKET $1,202.00 L5626 ADD TO LOWER EXTREMITY, TEST SOCKET $1,364.00 L5628 ADD TO LOWER EXTREMITY, TEST SOCKET $1,426.00 L5629 ADD TO LOWER EXTREMITY, BEL KNEE, A $1,212.00 L5630 ADD TO LOWER EXTREMITY, SYMES TYPE, $1,297.00 L5631 ADD TO LOWER EXTREMITY, ABV KNEE OR $1,676.00 L5632 ADD TO LOWER EXTREMITY, SYMES TYPE, $692.00 L5634 ADD TO LOWER EXTREMITY, SYMES TYPE, $1,020.00 L5636 ADD TO LOWER EXTREMITY, SYMES TYPE $972.00 L5637 ADD TO LOWER EXTREMITY, BEL KNEE, T $1,054.00 L5638 ADD TO LOWER EXTREMITY, BEL KNEE, $1,675.00 L5639 ADD TO LOWER EXTREMITY, BEL KNEE, W $4,086.00 L5640 ADD TO LOWER EXTREMITY, KNEE DISAR $2,439.00 L5642 ADD TO LOWER EXTREMITY, ABV KNEE, $2,115.00 L5643 ADD TO LOWER EXTREMITY, HIP DISART $4,452.00 L5644 ADD TO LOWER EXTREMITY, ABV KNEE, $1,690.00 L5645 ADD TO LOWER EXTREMITY, BEL KNEE, $2,282.00 L5646 ADD TO LOWER EXTREMITY, BEL KNEE, $1,660.00 L5647 ADD TO LOWER EXTREMITY, BEL KNEE S $2,382.00 L5648 ADD TO LOWER EXTREMITY, ABV KNEE, $2,093.00 L5649 ADD TO LOWER EXTREMITY, ISCHIAL CO $5,446.00 L5650 ADDS TO LOWER EXTREMITY, TOTAL CONT $1,862.00 L5651 ADD TO LOWER EXTREMITY, ABV KNEE, $3,435.00 L5652 ADD TO LOWER EXTREMITY, SUCTION SU $1,247.00 L5653 ADD TO LOWER EXTREMITY, KNEE DISAR $1,665.00 L5654 ADD TO LOWER EXTREMITY, SOCKET INS $1,005.00 L5655 ADD TO LOWER EXTREMITY, SOCKET INS $976.00 L5656 ADD TO LOWER EXTREMITY, SOCKET INS $1,387.00 L5658 ADD TO LOWER EXTREMITY, SOCKET INS $1,120.00 L5661 ADD TO LOWER EXTREMITY, SOCKET INS $1,746.00 L5665 ADD TO LOWER EXTREMITY, SOCKET INS $1,465.00 L5666 ADD TO LOWER EXTREMITY, BEL KNEE, $225.00 L5668 ADD TO LOWER EXTREMITY, BEL KNEE, $301.00 L5670 ADD TO LOWER EXTREMITY, BEL KNEE, $803.00 L5671 ADD TO LOWER EXTREMITY, BEL KNEE / $1,423.00 L5672 ADD TO LOWER EXTREMITY, BEL KNEE, $853.00 L5673 ADD TO LOWER EXTREMITY $1,911.00 L5676 ADDS TO LOWER EXTREMITY, BEL KNEE, $1,037.00 L5677 ADDS TO LOWER EXTREMITY, BEL KNEE, $1,410.00 L5678 ADDS TO LOWER EXTREMITY, BEL KNEE, $114.00 L5679 ADD TO LOWER EXTREM $1,593.00 L5680 ADD TO LOWER EXTREMITY, BEL KNEE, $1,115.00 L5681 ADD TO LOWER EXTRREM $3,694.00 L5682 ADD TO LOWER EXTREMITY, BEL KNEE, $1,865.00 L5683 ADD TO LOWER EXTREM $3,694.00 L5684 ADD TO LOWER EXTREMITY, BEL KNEE, $141.00 L5685 BELOW KNEE SUS/SEAL SLEEVE $360.00 L5686 ADD TO LOWER EXTREMITY, BEL KNEE, $195.00 L5688 ADD TO LOWER EXTREMITY, BEL KNEE, $233.00 L5690 ADD TO LOWER EXTREMITY, BEL KNEE, $296.00 L5692 ADD TO LOWER EXTREMITY, ABV KNEE, $380.00 L5694 ADD TO LOWER EXTREMITY, ABV KNEE, $519.00 L5695 ADD TO LOWER EXTREMITY, ABV KNEE, P $543.00 L5696 ADD TO LOWER EXTREMITY, ABV KNEE O $575.00 L5697 ADD TO LOWER EXTREMITY, ABV KNEE O $230.00 L5698 ADD TO LOWER EXTREMITY, ABV KNEE O $375.00 L5699 ALL LOWER EXTREMITY PROSTHESES, SHO $544.00 L5700 REPLACEMENT, SOCKET, BEL KNEE, MOLD $7,979.00 L5701 REPLACEMENT, SOCKET, ABV KNEE/KNEE $9,899.00 L5702 REPLACEMENT, SOCKET, HIP DISART, IN $12,476.00 L5703 Symes ankle w/o (SACH) foot $6,654.00 L5704 CUST SHAPED PROTECTIVE COVER, BEL K $1,627.00 L5705 CUST SHAPED PROTECTIVE COVER, ABV K $2,983.00 L5706 CUST SHAPED PROTECTIVE COVER, KNEE $2,909.00 L5707 CUST SHAPED PROTECTIVE COVER, HIP D $3,909.00 L5710 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $1,083.00 L5711 ADDS EXOSKELETAL KNEE‐SHIN SYS, SNG $1,626.00 L5712 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $1,409.00 L5714 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $1,241.00 L5716 ADD, EXOSKELETAL KNEE‐SHIN SYS, PO $2,085.00 L5718 ADD, EXOSKELETAL KNEE‐SHIN SYS, PO $2,606.00 L5722 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $2,583.00 L5724 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $5,377.00 L5726 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $4,976.00 L5728 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $7,573.00 L5780 ADD, EXOSKELETAL KNEE‐SHIN SYS, SN $3,275.00 L5781 ADD TO LOWER LIMB PROST, VACUUM PUM $11,236.00 L5782 ADD TO LOWER LIMB PROST, VACUUM PUM $11,845.00 L5785 ADD, EXOSKELETAL SYS, BEL KNEE, ULT $1,486.00 L5790 ADD, EXOSKELETAL SYS, ABV KNEE, ULT $2,057.00 L5795 ADD, EXOSKELETAL SYS, HIP DISART, U $3,071.00 L5810 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $1,439.00 L5811 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $2,086.00 L5812 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $1,617.00 L5814 ADD, ENDOSKELETAL KNEE‐SHIN SYS, PO $10,429.00 L5816 ADD, ENDOSKELETAL KNEE‐SHIN SYS, PO $2,433.00 L5818 ADD, ENDOSKELETAL KNEE‐SHIN SYS, PO $2,944.00 L5822 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $6,040.00 L5824 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $5,431.00 L5826 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $8,919.00 L5828 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $9,871.00 L5830 ADD, ENDOSKELETAL KNEE‐SHIN SYS, SN $5,825.00 L5840 ADD, ENDOSKELETAL KNEE/SHIN SYS, 4‐ $10,145.00 L5845 ADD, ENDOSKELETAL, KNEE‐SHIN SYS, S $5,033.00 L5848 ADD TO ENDOSKELETAL, KNEE‐SHIN SYS, $3,020.00 L5850 ADD, ENDOSKELETAL SYS, ABV KNEE OR $383.00 L5855 ADD, ENDOSKELETAL SYS, HIP DISART, $883.00 L5856 ELEC KNEE‐SHIN SWING/STANCE $67,717.00 L5857 ELEC KNEE‐SHIN SWING ONLY $24,226.00 L5858 Stance phase only $52,189.00 L5859 KNEE‐SHIN PRO FLEX/EXT CONT $40,744.00 L5910 ADD, ENDOSKELETAL SYS, BEL KNEE, A $1,133.00 L5920 ADD, ENDOSKELETAL SYS, ABV KNEE OR $1,518.00 L5925 ADD, ENDOSKELETAL SYS, ABV KNEE, KN $961.00 L5930 ADD, ENDOSKELETAL SYS, HIGH ACTIVIT $9,642.00 L5940 ADD, ENDOSKELETAL SYS, BEL KNEE, U $1,559.00 L5950 ADD, ENDOSKELETAL SYS, ABV KNEE, U $2,527.00 L5960 ADD, ENDOSKELETAL SYS, HIP DISART, $3,661.00 L5961 ENDO POLY HIP, PNEU/HYD/ROT $12,383.00 L5962 ADD, ENDOSKELETAL SYS, BEL KNEE, FL $1,681.00 L5964 ADD, ENDOSKELETAL SYS, ABV KNEE, FL $2,916.00 L5966 ADD, ENDOSKELETAL SYS, HIP DISART, $3,756.00 L5968 ADD TO LOWER LIMB PROST, MULTIAXIAL $10,204.00 L5970 ALL LOWER EXTREMITY PROSTHESES, FOO $581.00 L5971 SACH foot, replacement $581.00 L5972 ALL LOWER EXTREMITY PROSTHESES, FLE $1,008.00 L5973 ANK‐FOOT SYS DORS‐PLANT FLEX $48,872.00 L5974 ALL LOWER EXTREMITY PROSTHESES, FOO $667.00 L5975 ALL LOWER EXTREMITY PROST, COMBINAT $1,302.00 L5976 ALL LOWER EXTREMITY PROSTHESES, ENE $2,021.00 L5978 ALL LOWER EXTREMITY PROSTHESES, FOO $835.00 L5979 ALL LOWER EXTREMITY PROST, MULTI‐AX $6,527.00 L5980 ALL LOWER EXTREMITY PROSTHESES, FLE $13,927.00 L5981 ALL LOWER EXTREMITY PROSTHESES, FLE $8,877.00 L5982 ALL EXOSKELETAL LOWER EXTREMITY PRO $1,654.00 L5984 ALL ENDOSKELETAL LOWER EXTREMITY PR $1,630.00 L5985 ALL ENDOSKELETAL LOWER EXTREMITY PR $809.00 L5986 ALL LOWER EXTREMITY PROSTHESES, MUL $1,813.00 L5987 ALL LOWER EXTREMITY PROST, SHANK FO $20,201.00 L5988 ADD TO LOWER LIMB PROST, VERTICAL S $5,610.00 L5990 ADD TO LOWER EXTREMITY PROST, USER $5,095.00 L6000 PART HAND THUMB REM $3,887.00 L6010 PART HAND LITTLE/RING $4,441.00 L6020 PART HAND NO FINGERS $3,943.00 L6026 PART HAND MYO EXCLU TERM DEV $11,259.00 L6050 WRIST DISART, MOLDED SOCKET, FLEX E $6,339.00 L6055 WRIST DISART, MOLDED SOCKET W/ EXP& $8,261.00 L6100 BEL ELBOW, MOLDED SOCKET, FLEX ELBO $7,340.00 L6110 BEL ELBOW, MOLDED SOCKET, (MUENSTER $7,786.00 L6120 BEL ELBOW, MOLDED DOUBLE WALL SPLIT $8,458.00 L6130 BEL ELBOW, MOLDED DOUBLE WALL SPLIT $9,154.00 L6200 ELBOW DISART, MOLDED SOCKET, O/S LO $7,804.00 L6205 ELBOW DISART, MOLDED SOCKET W/ EXP& $11,711.00 L6250 ABV ELBOW, MOLDED DOUBLE WALL SOCKE $8,095.00 L6300 SHOULDER DISART, MOLDED SOCKET, SHO $12,935.00 L6310 SHOULDER DISART, PASSIVE RESTORATIO $9,236.00 L6320 SHOULDER DISART, PASSIVE RESTORATIO $4,888.00 L6350 INTERSCAPULAR THORACIC, MOLDED SOCK $14,939.00 L6360 INTERSCAPULAR THORACIC, PASSIVE RES $9,111.00 L6370 INTERSCAPULAR THORACIC, PASSIVE RES $7,746.00 L6380 IMMED POST SURG OR EARLY FITTING, A $3,961.00 L6382 IMMED POST SURG OR EARLY FITTING, A $5,647.00 L6384 IMMED POST SURG OR EARLY FITTING, A $7,272.00 L6386 IMMED POST SURG OR EARLY FITTING, E $1,532.00 L6388 IMMED POST SURG OR EARLY FITTING, A $1,258.00 L6400 BEL ELBOW, MOLDED SOCKET, ENDOSKELE $7,725.00 L6450 ELBOW DISART, MOLDED SOCKET, ENDOSK $8,875.00 L6500 ABV ELBOW, MOLDED SOCKET, ENDOSKELE $9,146.00 L6550 SHOULDER DISART, MOLDED SOCKET, END $10,908.00 L6570 INTERSCAPULAR THORACIC, MOLDED SOCK $13,332.00 L6580 PREP, WRIST DISART OR BEL ELBOW, SN $4,482.00 L6582 PREP, WRIST DISART OR BEL ELBOW, SN $3,961.00 L6584 PREP, ELBOW DISART OR ABV ELBOW, SN $6,011.00 L6586 PREP, ELBOW DISART OR ABV ELBOW, SN $5,387.00 L6588 PREP, SHOULDER DISART OR INTERSCAPU $8,253.00 L6590 PREP, SHOULDER DISART OR INTERSCAPU $7,687.00 L6600 UPPER EXTREMITY ADDS, POLYCENTRIC H $715.00 L6605 UPPER EXTREMITY ADDS, SNG PIVOT HIN $706.00 L6610 UPPER EXTREMITY ADDS, FLEX METAL HI $476.00 L6611 Additional switch, ext power $1,156.00 L6615 UPPER EXTREMITY ADD, DISCONNECT LO $526.00 L6616 UPPER EXTREMITY ADD, ADDAL DISCONNE $216.00 L6620 UPPER EXTREMITY ADD, FLEXION‐FRICT $867.00 L6621 Flex/ext wrist w/wo friction $6,423.00 L6623 UPPER EXTREMITY ADD, SPRING ASSIST $1,835.00 L6624 Flex/ext/rotation wrist unit $10,576.00 L6625 UPPER EXTREMITY ADD, ROTATION WRIS $1,521.00 L6628 UPPER EXTREMITY ADD, QUICK DISCONN $1,370.00 L6629 UPPER EXTREMITY ADD, QUICK DISCONN $501.00 L6630 UPPER EXTREMITY ADD, STAINLESS STE $616.00 L6632 UPPER EXTREMITY ADD, LATEX SUSPENS $186.00 L6635 UPPER EXTREMITY ADD, LIFT ASSIST F $578.00 L6637 UPPER EXTREMITY ADD, NUDGE CTRL EL $1,050.00 L6638 UPPER EXTREMITY ADD TO PROST, ELECT $7,022.00 L6640 UPPER EXTREMITY ADDS, SHOULDER ABD $1,068.00 L6641 UPPER EXTREMITY ADD, EXCURSION AMP $612.00 L6642 UPPER EXTREMITY ADD, EXCURSION AMP $829.00 L6645 UPPER EXTREMITY ADD, SHOULDER FLEX $923.00 L6646 UPPER EXTREMITY ADD, SHOULDER JNT, $8,857.00 L6647 UPPER EXTREMITY ADD, SHOULDER LOCK $1,458.00 L6648 UPPER EXTREMITY ADD, SHOULDER LOCK $9,134.00 L6650 UPPER EXTREMITY ADD, SHOULDER UNIV $1,109.00 L6655 UPPER EXTREMITY ADD, ST&ARD CTRL C $229.00 L6660 UPPER EXTREMITY ADD, HEAVY DUTY CT $263.00 L6665 UPPER EXTREMITY ADD, TEFLON, OR =, $153.00 L6670 UPPER EXTREMITY ADD, HOOK TO H&, C $169.00 L6672 UPPER EXTREMITY ADD, HARNESS, CHES $586.00 L6675 UPPER EXTREMITY ADD, HARNESS, FIG $389.00 L6676 UPPER EXTREMITY ADD, HARNESS, FIG $417.00 L6677 UE triple control harness $833.00 L6680 UPPER EXTREMITY ADD, TEST SOCKET, $836.00 L6682 UPPER EXTREMITY ADD, TEST SOCKET, $897.00 L6684 UPPER EXTREMITY ADD, TEST SOCKET, $1,273.00 L6686 UPPER EXTREMITY ADD, SUCTION SOCKE $1,713.00 L6687 UPPER EXTREMITY ADD, FRAME TYPE SOC $1,679.00 L6688 UPPER EXTREMITY ADD, FRAME TYPE SOC $1,559.00 L6689 UPPER EXTREMITY ADD, FRAME TYPE SO $2,570.00 L6690 UPPER EXTREMITY ADD, FRAME TYPE SO $2,210.00 L6691 UPPER EXTREMITY ADD, REMOV INSERT, $1,054.00 L6692 UPPER EXTREMITY ADD, SILICONE GEL I $1,622.00 L6693 UPPER EXTREMITY ADD, LOCKING ELBOW, $7,972.00 L6694 ELBOW SOCKET INS USE W/LOCK $1,911.00 L6695 ELBOW SOCKET INS USE W/O LCK $1,593.00 L6696 CUS ELBO SKT IN FOR CON/ATYP $3,694.00 L6697 CUS ELBO SKT IN NOT CON/ATYP $3,694.00 L6698 BELOW/ABOVE ELBOW LOCK MECH $1,423.00 L6703 Term dev, passive hand mitt $1,240.00 L6704 Term dev, sport/rec/work att $1,678.00 L6706 Term dev mech hook vol open $998.00 L6707 Term dev mech hook vol close $3,921.00 L6708 Term dev mech hand vol open $2,628.00 L6709 Term dev mech hand vol close $3,518.00 L6711 PED TERM DEV, HOOK, VOL OPEN $1,888.00 L6712 PED TERM DEV, HOOK, VOL CLOS $3,476.00 L6713 PED TERM DEV, HAND, VOL OPEN $4,387.00 L6714 PED TERM DEV, HAND, VOL CLOS $3,716.00 L6715 TERM DEVICE, MULTI ART DIGIT $8,866.00 L6721 HOOK/HAND, HVY DTY, VOL OPEN $6,605.00 L6722 HOOK/HAND, HVY DTY, VOL CLOS $5,694.00 L6805 TERMINAL DEVICE, MODIFIER WRIST FLE $1,142.00 L6810 TERMINAL DEVICE, PINCHER TOOL, OTTO $534.00 L6880 ELEC HAND IND ART DIGITS $67,093.00 L6881 AUTOMATIC GRASP FEATURE, ADD TO UPP $11,480.00 L6882 MICROPROCESSOR CTRL FEATURE, ADD TO $8,708.00 L6883 Replc sockt below e/w disa $6,052.00 L6884 Replc sockt above elbow disa $6,656.00 L6885 Replc sockt shldr dis/interc $9,111.00 L6890 PREFAB GLOVE FOR TERM DEVICE $649.00 L6895 CUSTOM GLOVE FOR TERM DEVICE $1,597.00 L6900 H& RESTORATION (CASTS, SHADING & MS $5,077.00 L6905 H& RESTORATION (CASTS, SHADING & MS $5,017.00 L6910 H& RESTORATION (CASTS, SHADING & MS $5,216.00 L6915 H& RESTORATION (SHADING, & MSMTS IN $1,791.00 L6920 WRIST DISART, EXT POWER, SELF‐SUSPE $19,090.00 L6925 WRIST DISART, EXT POWER, SELF‐SUSPE $22,039.00 L6930 BEL ELBOW, EXT POWER, SELF‐SUSPENDE $19,208.00 L6935 BEL ELBOW, EXT POWER, SELF‐SUSPENDE $22,452.00 L6940 ELBOW DISART, EXT POWER, MOLDED INN $26,606.00 L6945 ELBOW DISART, EXT POWER, MOLDED INN $29,830.00 L6950 ABV ELBOW, EXT POWER, MOLDED INNER $28,526.00 L6955 ABV ELBOW, EXT POWER, MOLDED INNER $34,164.00 L6960 SHOULDER DISART, EXT POWER, MOLDED $34,457.00 L6965 SHOULDER DISART, EXT POWER, MOLDED $40,540.00 L6970 INTERSCAPULAR‐THORACIC, EXT POWER, $41,720.00 L6975 INTERSCAPULAR‐THORACIC, EXT POWER, $45,711.00 L7007 Adult electric hand $11,212.00 L7008 Pediatric electric hand $17,578.00 L7009 Adult electric hook $10,639.00 L7040 PREHENSILE ACTUATOR, HOSMER OR =, S $8,728.00 L7045 Pediatric electric hook $4,623.00 L7170 ELECTRONIC ELBOW, HOSMER OR =, SWIT $16,772.00 L7180 ELECTRONIC ELBOW SEQUENTIAL $1,028.27 L7181 ELECTRONIC ELBO SIMULTANEOUS $1,125.16 L7185 ELECTRONIC ELBOW, ADOLESCENT, VARIE $20,511.00 L7186 ELECTRONIC ELBOW, CHILD, VARIETY VI $31,248.00 L7190 ELECTRONIC ELBOW, ADOLESCENT, VARIE $28,812.00 L7191 ELECTRONIC ELBOW, CHILD, VARIETY VI $32,308.00 L7259 ELECTRONIC WRIST ROTATOR ANY $9,142.00 L7360 Six volt bat otto bock/eq ea $867.00 L7362 Battery chrgr six volt otto $799.00 L7364 Twelve volt battery utah/equ $1,520.00 L7366 Battery chrgr 12 volt utah/e $2,047.00 L7367 LITHIUM ION BATTERY, REPLACEMENT $1,093.00 L7368 LITHIUM ION BATTERY CHARGER $1,417.00 L7400 Add UE prost be/wd, ultlite $861.00 L7401 Add UE prost a/e ultlite mat $964.00 L7402 Add UE prost s/d ultlite mat $1,041.00 L7403 Add UE prost b/e acrylic $1,034.00 L7404 Add UE prost a/e acrylic $1,561.00 L7405 Add UE prost s/d acrylic $2,041.00 L8000 BREAST PROST, MASTECTOMY BRA $105.00 L8001 BREAST PROST, MASTECTOMY BRA, W/ IN $352.00 L8002 BREAST PROST, MASTECTOMY BRA, W/ IN $463.00 L8015 EXT BREAST PROST GARMENT, W/ MASTEC $168.00 L8020 BREAST PROST, MASTECTOMY FORM $686.00 L8030 BREAST PROST, SILICONE OR = $925.00 L8031 BREAST PROSTHESIS W ADHESIVE $925.00 L8032 REUSABLE NIPPLE PROSTHESIS $110.00 L8035 CUST BREAST PROST, POST MASTECTOMY, $10,288.00 L8040 NASAL PROST, PROV BY A NON‐MD $7,806.00 L8040,KM NASAL PROST, PROV BY A NON‐MD $7,415.00 L8040,KN NASAL PROST, PROV BY A NON‐MD $3,122.00 L8041 MIDFACIAL PROST, PROV BY A NON‐MD $9,408.00 L8041,KM MIDFACIAL PROST, PROV BY A NON‐MD $8,938.00 L8041,KN MIDFACIAL PROST, PROV BY A NON‐MD $3,763.00 L8042 ORBITAL PROST, PROV BY A NON‐MD $10,571.00 L8042,KM ORBITAL PROST, PROV BY A NON‐MD $10,043.00 L8042,KN ORBITAL PROST, PROV BY A NON‐MD $4,229.00 L8043 UPPER FACIAL PROST, PROV BY A NON‐M $11,840.00 L8043,KM UPPER FACIAL PROST, PROV BY A NON‐M $11,248.00 L8043,KN UPPER FACIAL PROST, PROV BY A NON‐M $4,736.00 L8044 HEMI‐FACIAL PROST, PROV BY A NON‐MD $13,108.00 L8044,KM HEMI‐FACIAL PROST, PROV BY A NON‐MD $12,453.00 L8044,KN HEMI‐FACIAL PROST, PROV BY A NON‐MD $5,243.00 L8045 AURICULAR PROST, PROV BY A NON‐MD $8,240.00 L8045,KM AURICULAR PROST, PROV BY A NON‐MD $7,828.00 L8045,KN AURICULAR PROST, PROV BY A NON‐MD $3,296.00 L8046 PARTIAL FACIAL PROST, PROV BY A NON $8,457.00 L8046,KM PARTIAL FACIAL PROST, PROV BY A NON $8,034.00 L8046,KN PARTIAL FACIAL PROST, PROV BY A NON $3,383.00 L8047 NASAL SEPTAL PROST, PROV BY A NON‐M $4,334.00 L8047,KM NASAL SEPTAL PROST, PROV BY A NON‐M $4,118.00 L8047,KN NASAL SEPTAL PROST, PROV BY A NON‐M $1,734.00 L8300 TRUSS, SNG W/ ST&ARD PAD $241.00 L8310 TRUSS, DOUBLE W/ ST&ARD PADS $505.00 L8320 TRUSS, ADD TO ST&ARD PAD, WATER PAD $153.00 L8330 TRUSS, ADD TO ST&ARD PAD, SCROTAL P $141.00 L8400 PROS SHEATH, BEL KNEE, EA $60.00 L8410 PROS SHEATH, ABV KNEE, EA $73.00 L8415 PROS SHEATH, UPPER LIMB, EA $69.00 L8417 PROS SHEATH/SOCK, INCL A GEL CUSHIO $211.00 L8420 PROS SOCK, MULT PLY, BEL KNEE, EA $65.00 L8430 PROS SOCK, MULT PLY, ABV KNEE, EA $75.00 L8435 PROS SOCK, MULT PLY, UPPER LIMB, E $63.00 L8440 PROS SHRINKER, BEL KNEE, EA $155.00 L8460 PROS SHRINKER, ABV KNEE, EA $191.00 L8465 PROS SHRINKER, UPPER LIMB, EA $140.00 L8470 PROS SOCK, SNG PLY, FITTING, BEL KN $19.00 L8480 PROS SOCK, SNG PLY, FITTING, ABV KN $26.00 L8485 PROS SOCK, SNG PLY, FITTING, UPPER $32.00 L8500 ARTIFICIAL LARYNX, ANY TYPE $2,174.00 L8501 TRACHEOSTOMY SPEAKING VALVE $346.00 L8507 TRACHEO‐ESOPHAGEAL VOICE PROST, PT $118.00 L8509 TRACHEO‐ESOPHAGEAL VOICE PROST, INS $307.00 L8510 VOICE AMPLIFIER $710.00 L8511 INSERT INDWELLING TRACHEOESOPHAGEAL $204.00 L8512 GELATIN CAP OR EQUIVALENT $6.00 L8513 CLEANING DEVICE USED W TRACHO $15.00 L8514 TRACHEOESOPHAGEAL PUNCTURE DILATOR $265.00 L8515 GEL CAP APP DEVICE FOR TRACH $177.00 L8600 IMPLANTABLE BREAST PROST, SILICONE $1,786.00 L8603 INJ BULKING AGENT, COLLAGEN IMPLANT $1,249.00 L8605 INJ BULKING AGENT ANAL CANAL $2,011.00 L8606 INJ BULKING AGENT, SYNTHETIC IMPLAN $615.00 L8607 Injectable bulking agent for vocal $0.00 L8609 Artificial cornea $18,296.00 L8610 OCULAR IMPLANT $1,983.00 L8612 AQUEOUS SHUNT $1,894.00 L8613 OSSICULA IMPLANT $959.00 L8614 COCHLEAR DEVICE/SYS $54,815.00 L8615 COCH IMPLANT HEADSET REPLACE $1,267.00 L8616 COCH IMPLANT MICROPHONE REPL $295.00 L8617 COCH IMPLANT TRANS COIL REPL $258.00 L8618 COCH IMPLANT TRAN CABLE REPL $74.00 L8619 COCHLEAR IMPLANT EXT SPEECH PROCESS $23,532.00 L8621 REPL ZINC AIR BATTERY $2.00 L8622 REPL ALKALINE BATTERY $1.00 L8623 Lith ion batt CID,non‐earlvl $182.00 L8624 Lith ion batt CID, ear level $453.00 L8627 CID EXT SPEECH PROCESS REPL $20,058.00 L8628 CID EXT CONTROLLER REPL $3,474.00 L8629 CID TRANSMIT COIL AND CABLE $503.00 L8630 METACARPOPHALANGEAL JNT IMPLANT $964.00 L8631 METACARPAL PHALANGAL JOINT REPLACE $6,209.00 L8641 METATARSAL JNT IMPLANT $1,001.00 L8642 HALLUX IMPLANT $878.00 L8658 INTERPHALANGEAL JNT IMPLANT $873.00 L8659 INTERPHALANGEAL FINGER JOINT REPLAC $5,419.00 L8670 VASC GRAFT MAT, SYNTHETIC, IMPLANT $1,592.00 L8679 IMP NEUROSTI PLS GN ANY TYPE $23,431.00 L8681 Pt prgrm for implt neurostim $4,114.00 L8682 Implt neurostim radiofq rec $16,741.00 L8683 Radiofq trsmtr for implt neu $14,736.00 L8684 Radiof trsmtr implt scrl neu $1,948.00 L8689 EXT. recharging system $4,844.00 L8690 Aud osseo dev, int/ext comp $13,359.00 L8691 Aud osseo dev ext snd proces $7,488.00 L8693 AUD OSSEO DEV, ABUTMENT $4,258.00 L8695 External recharg sys extern $47.00 L8696 EXT ANTENNA PHREN NERVE STIM $609.00 P2038 Mucoprotein, blood (seromucoid) $21.00 P3000 Screening pap smear. crvcl/vagnl $45.00 P3001 SCREENIN PAPANICOLAOU SMEAR $114.00 P9041 INFUSION ALBUMIN 50 ML $33.00 P9045 INFUSION ALBUMIN 250 ML $164.00 P9046 INFUSION ALBUMIN 20 ML $67.00 P9047 INFUSION ALBUMIN 50 ML $160.00 P9612 Catheterzatn for collectn of spcmn $9.00 P9615 Cath for spcmn colection multpl pat $9.00 Q0035 CARDIOKYMOGRAPHY $0.00 Q0035,26 CARDIOKYMOGRAPHY $31.00 Q0035,TC CARDIOKYMOGRAPHY $0.00 Q0091 PREPARING CERVICAL/VAG SMEAR TO LAB $71.00 Q0092 SET UP PORT X RAY EQUIPMENT $93.00 Q0111 WET MOUNTS, SPCMN VAG, CRVCL OR SKN $18.00 Q0112 All potassium hydroxide (koh) prep $18.00 Q0113 Pinworm examinations $23.00 Q0114 Fern test $30.00 Q0115 Post‐coital direct, qualitatve exam $42.00 Q0138 FERUMOXYTOL, NON‐ESRD $2.00 Q0139 FERUMOXYTOL, ESRD USE $2.00 Q0162 ONDANSETRON ORAL $1.00 Q0163 DIPHENHYDRAMINE HCL 50 MG ORAL $1.00 Q0164 PROCHLORPERAZINE MALEATE 5 MG ORAL $1.00 Q0166 GRANISETRON HCL 1 MG ORAL $12.00 Q0167 DRONABINOL 2.5 MG ORAL $21.00 Q0169 PROMETHAZINE HCL 12.5 MG ORAL $1.00 Q0180 DOLASETRON MESYLATE 100 MG ORAL $335.00 Q0478 POWER ADAPTER, COMBO VAD $516.00 Q0479 POWER MODULE COMBO VAD, REP $33,916.00 Q0480 Driver pneumatic vad, rep $2,529.11 Q0481 Microprcsr cu elec vad, rep $40,804.00 Q0482 Microprcsr cu combo vad, rep $12,781.00 Q0483 Monitor elec vad, rep $52,651.00 Q0484 Monitor elec or comb vad rep $10,225.00 Q0485 Monitor cable elec vad, rep $987.00 Q0486 Mon cable elec/pneum vad rep $822.00 Q0487 Leads any type vad, rep only $959.00 Q0489 Pwr pck base combo vad, rep $45,645.00 Q0490 Emr pwr source elec vad, rep $1,974.00 Q0491 Emr pwr source combo vad rep $3,104.00 Q0492 Emr pwr cbl elec vad, rep $250.00 Q0493 Emr pwr cbl combo vad, rep $712.00 Q0494 Emr hd pmp elec/combo, rep $603.00 Q0495 Charger elec/combo vad, rep $11,730.00 Q0496 Battery elec/combo vad, rep $4,210.00 Q0497 Bat clps elec/comb vad, rep $1,315.00 Q0498 Holster elec/combo vad, rep $1,442.00 Q0499 Belt/vest elec/combo vad rep $469.00 Q0500 Filters elec/combo vad, rep $86.00 Q0501 Shwr cov elec/combo vad, rep $1,434.00 Q0502 Mobility cart pneum vad, rep $1,826.00 Q0503 Battery pneum vad replacemnt $3,652.00 Q0504 Pwr adpt pneum vad, rep veh $1,927.00 Q0506 LITH‐ION BATT ELEC/PNEUM VAD $2,399.00 Q2035 AFLURIA VACC, 3 YRS & >, IM $39.00 Q2037 FLUVIRIN VACC, 3 YRS & >, IM $47.00 Q2038 FLUZONE VACC, 3 YRS & >, IM $40.00 Q2043 SIPULEUCEL‐T AUTO CD54+ $1,092.40 Q2050 DOXORUBICIN INJ 10MG $1,470.00 Q3027 INJ BETA INTERFERON IM 1 MCG $125.00 Q4001 CASTING SUPPLIES, BODY CAST ADULT, $146.00 Q4002 CAST SUPPLIES, BODY CAST ADULT, W/ $551.00 Q4003 CAST SUPPLIES, SHOULDER CAST, ADULT $105.00 Q4004 CAST SUPPLIES, SHOULDER CAST, ADULT $362.00 Q4005 CAST SUPPLIES, LONG ARM CAST, ADULT $39.00 Q4006 CAST SUPPLIES, LONG ARM CAST, ADULT $87.00 Q4007 CAST SUPPLIES, LONG ARM CAST, PEDIA $19.00 Q4008 CAST SUPPLIES, LONG ARM CAST, PEDIA $43.00 Q4009 CAST SUPPLIES, SHORT ARM CAST, ADUL $26.00 Q4010 CAST SUPPLIES, SHORT ARM CAST, ADUL $58.00 Q4011 CAST SUPPLIES, SHORT ARM CAST, PEDI $13.00 Q4012 CAST SUPPLIES, SHORT ARM CAST, PEDI $29.00 Q4013 CAST SUPPLIES, GAUNTLET CAST (INCL $47.00 Q4014 CAST SUPPLIES, GAUNTLET CAST (INCL $79.00 Q4015 CAST SUPPLIES, GAUNTLET CAST (INCL $23.00 Q4016 CAST SUPPLIES, GAUNTLET CAST (INCL $40.00 Q4017 CAST SUPPLIES, LONG ARM SPLINT, ADU $27.00 Q4018 CAST SUPPLIES, LONG ARM SPLINT, ADU $43.00 Q4019 CAST SUPPLIES, LONG ARM SPLINT, PED $14.00 Q4020 CAST SUPPLIES, LONG ARM SPLINT, PED $22.00 Q4021 CAST SUPPLIES, SHORT ARM SPLINT, AD $20.00 Q4022 CAST SUPPLIES, SHORT ARM SPLINT, AD $36.00 Q4023 CAST SUPPLIES, SHORT ARM SPLINT, PE $10.00 Q4024 CAST SUPPLIES, SHORT ARM SPLINT, PE $18.00 Q4025 CAST SUPPLIES, HIP SPICA (ONE OR BO $112.00 Q4026 CAST SUPPLIES, HIP SPICA (ONE OR BO $351.00 Q4027 CAST SUPPLIES, HIP SPICA (ONE OR BO $56.00 Q4028 CAST SUPPLIES, HIP SPICA (ONE OR BO $176.00 Q4029 CAST SUPPLIES, LONG LEG CAST, ADULT $86.00 Q4030 CAST SUPPLIES, LONG LEG CAST, ADULT $226.00 Q4031 CAST SUPPLIES, LONG LEG CAST, PEDIA $43.00 Q4032 CAST SUPPLIES, LONG LEG CAST, PEDIA $113.00 Q4033 CAST SUPPLIES, LONG LEG CYLINDER CA $80.00 Q4034 CAST SUPPLIES, LONG LEG CYLINDER CA $200.00 Q4035 CAST SUPPLIES, LONG LEG CYLINDER CA $40.00 Q4036 CAST SUPPLIES, LONG LEG CYLINDER CA $100.00 Q4037 CAST SUPPLIES, SHORT LEG CAST, ADUL $49.00 Q4038 CAST SUPPLIES, SHORT LEG CAST, ADUL $123.00 Q4039 CAST SUPPLIES, SHORT LEG CAST, PEDI $25.00 Q4040 CAST SUPPLIES, SHORT LEG CAST, PEDI $61.00 Q4041 CAST SUPPLIES, LONG LEG SPLINT, ADU $60.00 Q4042 CAST SUPPLIES, LONG LEG SPLINT, ADU $102.00 Q4043 CAST SUPPLIES, LONG LEG SPLINT, PED $30.00 Q4044 CAST SUPPLIES, LONG LEG SPLINT, PED $51.00 Q4045 CAST SUPPLIES, SHORT LEG SPLINT, AD $35.00 Q4046 CAST SUPPLIES, SHORT LEG SPLINT, AD $56.00 Q4047 CAST SUPPLIES, SHORT LEG SPLINT, PE $17.00 Q4048 CAST SUPPLIES, SHORT LEG SPLINT, PE $28.00 Q4049 FINGER SPLINT, STATIC $6.00 Q4074 ILOPROST NON‐COMP UNIT DOSE $335.00 Q4081 INJ EPOETIN ALFA 100 UNITS $4.00 Q4101 APLIGRAF SKIN SUB $119.00 Q4102 OASIS WOUND MATRIX SKIN SUB $32.00 Q4104 INTEGRA BMWD SKIN SUB $97.00 Q4105 INTEGRA DRT SKIN SUB $65.00 Q4106 DERMAGRAFT SKIN SUB $128.00 Q4107 GRAFTJACKET SKIN SUB $299.00 Q4108 INTEGRA MATRIX SKIN SUB $107.00 Q4110 PRIMATRIX SKIN SUB $113.00 Q4111 GAMMAGRAFT SKIN SUB $21.00 Q4112 CYMETRA ALLOGRAFT $1,067.00 Q4113 GRAFTJACKET EXPRESS ALLOGRAF $1,067.00 Q4114 INTEGRA FLOWABLE WOUND MATRI $4,733.00 Q4115 ALLOSKIN SKIN SUB $30.00 Q4116 ALLODERM SKIN SUB $98.00 Q4121 THERASKIN $115.00 Q4123 ALLOSKIN $67.00 Q4131 EPIFIX $0.00 Q5101 Inj filgrastim g‐csf biosim $0.00 Q9950 Injection, sulfur hexafluoride lipi $0.00 Q9956 INJ OCTAFLUOROPROPANE MICRO / ML $122.00 Q9957 INJ PERFLUTREN LIPID MICRO / ML $183.00 Q9958 HIGH OSMOLAR CONTR MAT 149 MG/ML IO $1.00 Q9960 HIGH OSMOLAR CONTR MAT 200‐249 MG / $1.00 Q9961 HIGH OSMOLAR CONTR MAT 250‐299 MG / $1.00 Q9963 HIGH OSMOLAR CONTR MAT 350‐399 MG/M $1.00 Q9965 LOW OSMOLAR CONTR MAT 100‐199 MG/ML $3.00 Q9966 LOW OSMOLAR CONTR MAT 200‐299 MG/ML $1.00 Q9967 LOW OSMOLAR CONTR MAT 300‐399 MG/ML $1.00 R0070 TRANSPRT OF PORT X RAY EQUIP & PER $648.00 R0075 TRNSPT OF PORT X RAY EQUIP & PERS $648.00 V2020 FRAMES, PURCHASES $179.00 V2100 SPHERE, SNG VISION, PLANO TO PLUS O $149.00 V2101 SPHERE, SNG VISION, +/‐ 4.12 TO +/‐ $157.00 V2102 SPHERE, SNG VISION, +/‐ 7.12 TO +/ $182.00 V2103 SPHEROCYL, SNG VISION, PLANO TO +/‐ $130.00 V2104 SPHEROCYL, SNG VISION, PLANO TO +/‐ $144.00 V2105 SPHEROCYL, SNG VISION, PLANO TO +/‐ $156.00 V2106 SPHEROCYL, SNG VISION, PLANO TO +/‐ $173.00 V2107 SPHEROCYL, SNG VISION, +/‐ 4.25 TO $165.00 V2108 SPHEROCYL, SNG VISION, +/‐ 4.25D TO $164.00 V2109 SPHEROCYL, SNG VISION, +/‐ 4.25 TO $183.00 V2110 SPHEROCYL, SNG VISION, +/‐ 4.25 TO $187.00 V2111 SPHEROCYL, SNG VISION, +/‐ 7.25 TO $195.00 V2112 SPHEROCYL, SNG VISION, +/‐ 7.25 TO $212.00 V2113 SPHEROCYL, SNG VISION, +/‐ 7.25 TO $233.00 V2114 SPHEROCYL, SNG VISION, SPHERE OVER $259.00 V2115 LENTICULAR, (MYODISC), PER LENS, SN $218.00 V2118 ANISEIKONIC LENS, SNG VISION $240.00 V2121 LENTICULAR LENS PER LENS SINGLE $241.00 V2200 SPHERE, BIFOCAL, PLANO TO +/‐ 4.00D $196.00 V2201 SPHERE, BIFOCAL, +/‐ 4.12 TO +/‐ 7. $212.00 V2202 SPHERE, BIFOCAL, +/‐ 7.12 TO +/‐ 20 $240.00 V2203 SPHEROCYL, BIFOCAL, PLANO TO +/‐ 4. $197.00 V2204 SPHEROCYL, BIFOCAL, PLANO TO +/‐ 4. $203.00 V2205 SPHEROCYL, BIFOCAL, PLANO TO +/‐ 4. $221.00 V2206 SPHEROCYL, BIFOCAL, PLANO TO +/‐ 4. $223.00 V2207 SPHEROCYL, BIFOCAL, +/‐ 4.25 TO +/‐ $205.00 V2208 SPHEROCYL, BIFOCAL, +/‐ 4.25 TO +/‐ $212.00 V2209 SPHEROCYL, BIFOCAL, +/‐ 4.25 TO +/‐ $216.00 V2210 SPHEROCYL, BIFOCAL, +/‐ 4.25 TO +/‐ $230.00 V2211 SPHEROCYL, BIFOCAL, +/‐ 7.25 TO +/‐ $239.00 V2212 SPHEROCYLINDER, BIFOCAL, +/‐ 7.25 T $243.00 V2213 SPHEROCYLINDER, BIFOCAL, +/‐ 7.25 T $252.00 V2214 SPHEROCYLINDER, BIFOCAL, SPHERE OVE $307.00 V2215 LENTICULAR (MYODISC), PER LENS, BIF $285.00 V2218 ANISEIKONIC, PER LENS, BIFOCAL $371.00 V2219 BIFOCAL SEG WIDTH OVER 28MM $160.00 V2220 BIFOCAL ADD OVER 3.25D $138.00 V2221 LENTICULAR LENS PER LENS BIFOCAL $277.00 V2300 SPHERE, TRI, PLANO TO +/‐ 4.00D, PE $241.00 V2301 SPHERE, TRI, +/‐ 4.12 TO +/‐ 7.00D, $233.00 V2302 SPHERE, TRI, +/‐ 7.12 TO +/‐ 20.00, $236.00 V2303 SPHEROCYLINDER, TRI, PLANO TO +/‐ $230.00 V2304 SPHEROCYLINDER, TRI, PLANO TO +/‐ 4 $248.00 V2305 SPHEROCYLINDER, TRI, PLANO TO +/‐ 4 $256.00 V2306 SPHEROCYLINDER, TRI, PLANO TO +/‐ 4 $263.00 V2307 SPHEROCYLINDER, TRI, +/‐ 4.25 TO +/ $253.00 V2308 SPHEROCYLINDER, TRI, +/‐ 4.25 TO +/ $254.00 V2309 SPHEROCYLINDER, TRI, +/‐ 4.25 TO +/ $261.00 V2310 SPHEROCYLINDER, TRI, +/‐ 4.25 TO +/ $265.00 V2311 SPHEROCYLINDER, TRI, +/‐ 7.25 TO +/ $256.00 V2312 SPHEROCYLINDER, TRI, +/‐ 7.25 TO +/ $257.00 V2313 SPHEROCYLINDER, TRI, +/‐ 7.25 ‐ +/‐ $290.00 V2314 SPHEROCYLINDER, TRI, SPHERE OVER +/ $331.00 V2315 LENTICULAR, (MYODISC), PER LENS, TR $412.00 V2318 ANISEIKONIC LENS, TRIFOCAL $559.00 V2319 TRIFOCAL SEG WIDTH OVER 28 MM $163.00 V2320 TRIFOCAL ADD OVER 3.25D $200.00 V2321 LENTICULAR ASPHERIC LENS TRIFOCAL $407.00 V2410 VARIABLE ASPHERICITY LENS, SNG VISI $316.00 V2430 VARIABLE ASPHERICITY LENS, BIFOCAL, $412.00 V2500 CONTACT LENS, PMMA, SPHERICAL, PER $310.00 V2501 CONTACT LENS, PMMA, TORIC OR PRISM $472.00 V2502 CONTACT LENS PMMA, BIFOCAL, PER LEN $582.00 V2503 CONTACT LENS, PMMA, COLOR VISION DE $536.00 V2510 CONTACT LENS, GAS PERMEABLE, SPHERI $361.00 V2511 CONTACT LENS, GAS PERMEABLE, TORIC, $608.00 V2512 CONTACT LENS, GAS PERMEABLE, BIFOCA $719.00 V2513 CONTACT LENS, GAS PERMEABLE, EXT WE $603.00 V2520 CONTACT LENS, HYDROPHILIC, SPHERICA $398.00 V2521 CONTACT LENS, HYDROPHILIC, TORIC, O $693.00 V2522 CONTACT LENS, HYDROPHILLIC, BIFOCAL $674.00 V2523 CONTACT LENS, HYDROPHILIC, EXT WEAR $537.00 V2530 CONTACT LENS, SCLERAL, GAS IMPERMEA $638.00 V2531 CONTACT LENS, SCLERAL, GAS PERMEABL $1,551.00 V2623 PROS EYE, PLAS, CUST $3,315.00 V2624 POLISHING/RESURFACING OF OCULAR PRO $174.00 V2625 ENLARGEMENT OF OCULAR PROST $1,059.00 V2626 REDUCTION OF OCULAR PROST $571.00 V2627 SCLERAL COVER SHELL $4,522.00 V2628 FABRICATION & FITTING OF OCULAR CON $884.00 V2630 ANT CHAMBER INTRAOCULAR LENS $340.00 V2631 IRIS SUPRTED INTRAOCULAR LENS $340.00 V2632 POST CHAMBER INTRAOCULAR LENS $340.00 V2700 BALANCE LENS, PER LENS $144.00 V2710 SLAB OFF PRISM, GLASS OR PLAS, PER $245.00 V2715 PRISM, PER LENS $44.00 V2718 PRESS‐ON LENS, FRESNELL PRISM, PER $101.00 V2730 SPECIAL BASE CURVE, GLASS OR PLAS, $60.00 V2744 TINT, PHOTOCHROMATIC, PER LENS $47.00 V2745 ADDITION TO LENS TINT $38.00 V2750 ANTI‐REFLECTIVE COATING, PER LENS $59.00 V2755 U‐V LENS, PER LENS $48.00 V2760 SCRATCH RESISTANT COATING, PER LENS $49.00 V2762 POLARIZATION $167.00 V2770 OCCLUDER LENS, PER LENS $72.00 V2780 OVERSIZE LENS, PER LENS $36.00 V2782 LENS INDEX $181.00 V2783 LENS INDEX $204.00 V2784 LENS POLYCARBONATE OR EQUAL $133.00