PHYSICIAN and OTHER PROFESSIONAL SERVICES RELATIVE VALUE UNITS (Rvus) by CPT/HCPCS CODE

Home , Adenoidectomy, Astragalectomy, Cervical canal, Coccygectomy, Endomicroscopy, Hymenotomy

TABLE G. — PHYSICIAN AND OTHER PROFESSIONAL SERVICES RELATIVE VALUE UNITS (RVUs) BY CPT/HCPCS CODE

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Non- Facility CPT/ Conversion Status/ Work Facility Total Practice Charge HCPCS Modifier 1 CPT/HCPCS Code Description Factor/GAAF Usage Expense Practice Expense Expense Methodology 3 Code Category Indicator 2 RVUs Expense RVUs RVUs RVUs

01996 DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN Anesthesia 2.62 Anesthesia 10021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE Surgery 1.27 0.55 2.78 RBRVS 10022 FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE Surgery 1.27 0.48 2.60 RBRVS 10030 IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE Surgery 3.00 1.17 18.76 RBRVS 10035 PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE Surgery 1.70 0.63 13.31 RBRVS 10036 PERQ SFT TISS LOC DEVICE PLMT ADD LES W/GDNCE Surgery 0.85 0.32 12.25 RBRVS 10040 ACNE SURGERY Surgery 1.21 1.14 1.50 RBRVS 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE Surgery 1.22 1.42 1.97 RBRVS 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE Surgery 2.45 2.38 3.10 RBRVS 10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE Surgery 1.22 1.55 3.68 RBRVS 10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED Surgery 2.50 2.01 4.76 RBRVS 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE Surgery 1.22 1.59 2.95 RBRVS 10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL Surgery 2.74 2.17 4.61 RBRVS 10140 I&D HEMATOMA SEROMA/FLUID COLLECTION Surgery 1.58 1.61 2.85 RBRVS 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST Surgery 1.25 1.33 2.28 RBRVS 10180 INCISION & DRAINAGE COMPLEX PO WOUND INFECTION Surgery 2.30 2.33 4.19 RBRVS 11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF Surgery 0.60 0.17 0.89 RBRVS 11001 DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF Surgery 0.30 0.08 0.27 RBRVS 11004 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR Surgery 10.80 3.91 3.91 RBRVS 11005 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL Surgery 14.24 5.21 5.21 RBRVS 11006 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL Surgery 13.10 4.68 4.68 RBRVS 11008 REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION Surgery 5.00 1.83 1.83 RBRVS 11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS Surgery 4.19 3.11 9.01 RBRVS 11011 DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC Surgery 4.94 2.68 9.10 RBRVS 11012 DBRDMT FX&/DISLC SUBQ T/M/F BONE Surgery 6.87 3.99 11.93 RBRVS 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< Surgery 1.01 0.64 2.18 RBRVS 11043 DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< Surgery 2.70 1.37 3.38 RBRVS 11044 DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< Surgery 4.10 1.91 4.19 RBRVS 11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM Surgery 0.50 0.18 0.60 RBRVS 11046 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM Surgery 1.03 0.40 0.87 RBRVS 11047 DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM Surgery 1.80 0.72 1.39 RBRVS 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 Surgery 0.35 0.09 0.98 RBRVS 11056 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 Surgery 0.50 0.12 1.12 RBRVS 11057 PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 Surgery 0.65 0.16 1.16 RBRVS 11100 BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION Surgery 0.81 0.48 2.01 RBRVS 11101 BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN Surgery 0.41 0.25 0.46 RBRVS 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 Surgery 0.82 1.17 1.57 RBRVS 11201 REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10 Surgery 0.29 0.15 0.21 RBRVS 11300 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< Surgery 0.60 0.33 2.07 RBRVS 11301 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM Surgery 0.90 0.52 2.37 RBRVS 11302 SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM Surgery 1.05 0.61 2.79 RBRVS 11303 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM Surgery 1.25 0.71 2.98 RBRVS 11305 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/< Surgery 0.80 0.25 1.92 RBRVS 11306 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM Surgery 0.96 0.42 2.37 RBRVS 11307 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM Surgery 1.20 0.56 2.71 RBRVS 11308 SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM Surgery 1.46 0.51 2.66 RBRVS 11310 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< Surgery 0.80 0.45 2.30 RBRVS 11311 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM Surgery 1.10 0.64 1.90 RBRVS 11312 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM Surgery 1.30 0.76 3.05 RBRVS 11313 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM Surgery 1.68 0.96 3.32 RBRVS 11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< Surgery 0.90 1.27 2.49 RBRVS 11401 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM Surgery 1.28 1.50 2.75 RBRVS 11402 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM Surgery 1.45 1.59 3.01 RBRVS 11403 EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM/< Surgery 1.84 2.07 3.27 RBRVS 11404 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM Surgery 2.11 2.16 3.66 RBRVS 11406 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM Surgery 3.52 2.85 4.66 RBRVS 11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< Surgery 1.03 1.18 2.32 RBRVS 11421 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM Surgery 1.47 1.48 2.78 RBRVS 11422 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM Surgery 1.68 1.95 3.04 RBRVS 11423 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM Surgery 2.06 2.13 3.34 RBRVS 11424 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM Surgery 2.48 2.27 3.72 RBRVS 11426 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM Surgery 4.09 3.05 4.62 RBRVS 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< Surgery 1.05 1.76 2.63 RBRVS 11441 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM Surgery 1.53 2.01 3.01 RBRVS 11442 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM Surgery 1.77 2.12 3.27 RBRVS 11443 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM Surgery 2.34 2.40 3.63 RBRVS 11444 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM Surgery 3.19 2.82 4.27 RBRVS 11446 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM Surgery 4.80 3.74 5.51 RBRVS 11450 EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR Surgery 3.22 3.31 6.94 RBRVS 11451 EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR Surgery 4.43 3.91 8.37 RBRVS 11462 EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR Surgery 3.00 3.24 6.88 RBRVS 11463 EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR Surgery 4.43 4.00 8.65 RBRVS 11470 EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR Surgery 3.74 3.52 7.15 RBRVS 11471 EXCISION H/P/P/U COMPLEX REPAIR Surgery 4.89 4.12 8.61 RBRVS 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< Surgery 1.63 1.56 3.57 RBRVS

NOTE: CPT Codes and descriptions only are copyright 2015 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 1, 2, 3 - See end of the table for notes regarding these fields. TABLE G. — PHYSICIAN AND OTHER PROFESSIONAL SERVICES RELATIVE VALUE UNITS (RVUs) BY CPT/HCPCS CODE

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11601 EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM Surgery 2.07 1.90 4.09 RBRVS 11602 EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM Surgery 2.27 2.09 4.40 RBRVS 11603 EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/< Surgery 2.82 2.37 4.76 RBRVS 11604 EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM Surgery 3.17 2.51 5.23 RBRVS 11606 EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM Surgery 5.02 3.28 6.87 RBRVS 11620 EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< Surgery 1.64 1.58 3.61 RBRVS 11621 EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM Surgery 2.08 1.92 4.11 RBRVS 11622 EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM Surgery 2.41 2.16 4.48 RBRVS 11623 EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/< Surgery 3.11 2.51 4.92 RBRVS 11624 EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM Surgery 3.62 2.70 5.39 RBRVS 11626 EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM Surgery 4.61 3.07 6.17 RBRVS 11640 EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/< Surgery 1.67 1.67 3.74 RBRVS 11641 EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM Surgery 2.17 1.99 4.23 RBRVS 11642 EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM Surgery 2.62 2.28 4.66 RBRVS 11643 EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM Surgery 3.42 2.68 5.11 RBRVS 11644 EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM Surgery 4.34 3.15 6.15 RBRVS 11646 EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM Surgery 6.26 4.09 7.35 RBRVS 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER Surgery 0.17 0.04 0.21 RBRVS 11720 DEBRIDEMENT NAIL ANY METHOD 1-5 Surgery 0.32 0.08 0.57 RBRVS 11721 DEBRIDEMENT NAIL ANY METHOD 6/> Surgery 0.54 0.13 0.69 RBRVS 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 Surgery 1.10 0.27 1.62 RBRVS 11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL Surgery 0.44 0.11 0.54 RBRVS 11740 EVACUATION SUBUNGUAL HEMATOMA Surgery 0.37 0.53 1.00 RBRVS 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL Surgery 2.50 2.26 3.62 RBRVS 11752 EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX Surgery 3.63 3.45 5.14 RBRVS 11755 BIOPSY NAIL UNIT SEPARATE PROCEDURE Surgery 1.31 0.81 2.36 RBRVS 11760 REPAIR NAIL BED Surgery 1.63 1.91 4.62 RBRVS 11762 RECONSTRUCTION NAIL BED W/GRAFT Surgery 2.94 2.08 4.77 RBRVS 11765 WEDGE EXCISION SKIN NAIL FOLD Surgery 1.22 1.37 3.42 RBRVS 11770 EXCISION PILONIDAL CYST/SINUS SIMPLE Surgery 2.66 2.09 4.63 RBRVS 11771 EXCISION PILONIDAL CYST/SINUS EXTENSIVE Surgery 6.09 5.00 8.86 RBRVS 11772 EXCISION PILONIDAL CYST/SINUS COMPLICATED Surgery 7.35 7.58 10.86 RBRVS 11900 INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS Surgery 0.52 0.31 0.98 RBRVS 11901 INJECTION INTRALESIONAL >7 LESIONS Surgery 0.80 0.48 1.07 RBRVS 11920 TATTOOING INCL MICROPIGMENTATION 6.0 CM/< Surgery 1.61 1.40 2.97 RBRVS 11921 TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM Surgery 1.93 1.61 3.36 RBRVS 11922 TATTOOING INCL MICROPIGMENTATION EA 20.0 CM Surgery 0.49 0.29 1.17 RBRVS 11950 SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/< Surgery 0.84 0.55 1.23 RBRVS 11951 SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC Surgery 1.19 0.75 1.61 RBRVS 11952 SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC Surgery 1.69 0.80 1.71 RBRVS 11954 SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC Surgery 1.85 1.15 2.34 RBRVS 11960 INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ Surgery 11.49 13.55 13.55 RBRVS 11970 REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS Surgery 8.01 8.04 8.04 RBRVS 11971 REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS Surgery 3.41 5.12 9.36 RBRVS 11976 REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES Surgery 1.78 0.70 2.05 RBRVS 11980 SUBCUTANEOUS HORMONE PELLET IMPLANTATION Surgery 1.10 0.39 1.44 RBRVS 11981 INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT Surgery 1.48 0.64 2.26 RBRVS 11982 REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT Surgery 1.78 0.80 2.45 RBRVS 11983 RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT Surgery 3.30 1.26 2.58 RBRVS 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< Surgery 0.84 0.32 1.58 RBRVS 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM Surgery 1.14 0.38 1.79 RBRVS 12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM Surgery 1.44 0.45 1.99 RBRVS 12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM Surgery 1.97 0.58 2.46 RBRVS 12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM Surgery 2.39 0.71 2.90 RBRVS 12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM Surgery 2.90 0.93 3.19 RBRVS 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< Surgery 1.07 0.36 1.88 RBRVS 12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM Surgery 1.22 0.39 2.01 RBRVS 12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM Surgery 1.57 0.46 2.22 RBRVS 12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM Surgery 1.98 0.55 2.59 RBRVS 12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM Surgery 2.68 0.74 2.96 RBRVS 12017 SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM Surgery 3.18 0.71 0.71 RBRVS 12018 SIMPLE REPAIR F/E/E/N/L/M >30.0 CM Surgery 3.61 0.79 0.79 RBRVS 12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE Surgery 2.67 2.33 4.87 RBRVS 12021 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING Surgery 1.89 1.78 2.45 RBRVS 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< Surgery 2.00 2.09 4.39 RBRVS 12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM Surgery 2.52 2.71 5.67 RBRVS 12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM Surgery 2.97 2.50 5.37 RBRVS 12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM Surgery 3.50 2.81 6.71 RBRVS 12036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM Surgery 4.23 2.99 6.86 RBRVS 12037 REPAIR INTERMEDIATE S/A/T/E >30.0 CM Surgery 5.00 3.50 7.69 RBRVS 12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< Surgery 2.10 2.09 4.42 RBRVS 12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM Surgery 2.79 2.56 4.97 RBRVS 12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM Surgery 3.19 2.52 6.49 RBRVS 12045 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM Surgery 3.75 3.45 7.08 RBRVS 12046 RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM Surgery 4.30 3.62 8.34 RBRVS

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12047 REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM Surgery 4.95 5.01 10.05 RBRVS 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< Surgery 2.33 2.25 4.61 RBRVS 12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM Surgery 2.87 2.57 5.02 RBRVS 12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM Surgery 3.17 2.61 6.12 RBRVS 12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM Surgery 3.50 2.51 6.36 RBRVS 12055 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM Surgery 4.50 3.45 8.25 RBRVS 12056 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM Surgery 5.30 3.83 7.93 RBRVS 12057 REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM Surgery 6.00 3.85 9.48 RBRVS 13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM Surgery 3.00 2.48 6.01 RBRVS 13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM Surgery 3.50 3.25 7.17 RBRVS 13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< Surgery 1.24 0.69 2.00 RBRVS 13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM Surgery 3.23 3.08 6.18 RBRVS 13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM Surgery 4.00 3.11 7.49 RBRVS 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< Surgery 1.44 0.79 2.11 RBRVS 13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM Surgery 3.73 2.92 6.62 RBRVS 13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM Surgery 4.78 3.56 8.01 RBRVS 13133 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< Surgery 2.19 1.26 2.55 RBRVS 13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM Surgery 4.34 3.27 6.97 RBRVS 13152 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM Surgery 5.34 3.88 8.23 RBRVS 13153 REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/< Surgery 2.38 1.33 2.76 RBRVS 13160 SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC Surgery 12.04 8.91 8.91 RBRVS 14000 ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/< Surgery 6.37 6.95 10.21 RBRVS 14001 ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM Surgery 8.78 8.44 12.38 RBRVS 14020 ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/< Surgery 7.22 7.93 11.39 RBRVS 14021 ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM Surgery 9.72 9.38 13.49 RBRVS 14040 ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/< Surgery 8.60 8.28 11.75 RBRVS 14041 ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM Surgery 10.83 9.89 14.34 RBRVS 14060 ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< Surgery 9.23 8.75 11.48 RBRVS 14061 ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM Surgery 11.48 10.71 15.63 RBRVS 14301 ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM Surgery 12.65 10.66 15.94 RBRVS 14302 ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/< Surgery 3.73 2.01 2.01 RBRVS 14350 FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE Surgery 11.05 7.59 7.59 RBRVS 15002 PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT Surgery 3.65 2.25 5.57 RBRVS 15003 PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT Surgery 0.80 0.37 1.21 RBRVS 15004 PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT Surgery 4.58 2.60 6.21 RBRVS 15005 PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT Surgery 1.60 0.74 1.67 RBRVS 15040 HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/< Surgery 2.00 1.29 4.83 RBRVS 15050 PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM Surgery 5.57 6.40 9.72 RBRVS 15100 SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD Surgery 9.90 8.78 12.66 RBRVS 15101 SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD Surgery 1.72 1.13 3.22 RBRVS 15110 EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD Surgery 10.97 7.51 10.43 RBRVS 15111 EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD Surgery 1.85 0.72 1.04 RBRVS 15115 EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/< Surgery 11.28 7.67 10.60 RBRVS 15116 EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM Surgery 2.50 1.46 1.88 RBRVS 15120 SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM//=100SCM ADL 100SQCM Surgery 0.80 0.36 1.06 RBRVS 15275 SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM Surgery 1.83 0.75 2.22 RBRVS 15276 SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM Surgery 0.50 0.16 0.42 RBRVS 15277 SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM Surgery 4.00 1.84 4.53 RBRVS 15278 SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM Surgery 1.00 0.46 1.23 RBRVS 15570 FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK Surgery 10.21 9.07 13.92 RBRVS 15572 FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS Surgery 10.12 9.58 13.40 RBRVS 15574 FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F Surgery 10.70 9.63 13.59 RBRVS

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15576 FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL Surgery 9.37 8.52 12.18 RBRVS 15600 DELAY FLAP/SECTIONING FLAP TRUNK Surgery 2.01 3.58 6.83 RBRVS 15610 DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS Surgery 2.52 3.97 7.15 RBRVS 15620 DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F Surgery 3.75 4.98 8.11 RBRVS 15630 DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS Surgery 4.08 5.22 8.34 RBRVS 15650 TRANSFER ANY PEDICLE FLAP ANY LOCATION Surgery 4.77 5.46 8.87 RBRVS 15731 FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE Surgery 14.38 12.35 15.55 RBRVS 15732 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NC Surgery 16.38 13.44 17.95 RBRVS 15734 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK Surgery 19.86 14.15 19.07 RBRVS 15736 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR Surgery 17.04 12.58 17.43 RBRVS 15738 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR Surgery 19.04 12.90 17.46 RBRVS 15740 FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY Surgery 11.80 10.93 15.41 RBRVS 15750 FLAP NEUROVASCULAR PEDICLE Surgery 12.96 11.20 11.20 RBRVS 15756 FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST Surgery 36.94 23.85 23.85 RBRVS 15757 FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS Surgery 37.15 23.31 23.31 RBRVS 15758 FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS Surgery 36.90 23.35 23.35 RBRVS 15760 GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA Surgery 9.86 9.08 13.00 RBRVS 15770 GRAFT DERMA-FAT-FASCIA Surgery 8.96 8.76 8.76 RBRVS 15775 PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS Surgery 3.95 1.93 4.06 RBRVS 15776 PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS Surgery 5.53 3.43 7.10 RBRVS 15777 IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT Surgery 3.65 1.83 1.83 RBRVS 15780 DERMABRASION TOTAL FACE Surgery 8.73 8.37 14.19 RBRVS 15781 DERMABRASION SEGMENTAL FACE Surgery 5.02 6.53 9.86 RBRVS 15782 DERMABRASION REGIONAL OTHER THAN FACE Surgery 4.44 7.68 12.98 RBRVS 15783 DERMABRASION SUPERFICIAL ANY SITE Surgery 4.41 5.67 8.71 RBRVS 15786 ABRASION 1 LESION Surgery 2.08 1.55 4.56 RBRVS 15787 ABRASION EACH ADDITIONAL 4 LESIONS OR LESS Surgery 0.33 0.14 1.03 RBRVS 15788 CHEMICAL PEEL FACIAL EPIDERMAL Surgery 2.09 4.65 10.65 RBRVS 15789 CHEMICAL PEEL FACIAL DERMAL Surgery 4.91 6.53 10.18 RBRVS 15792 CHEMICAL PEEL NONFACIAL EPIDERMAL Surgery 1.86 5.17 10.13 RBRVS 15793 CHEMICAL PEEL NONFACIAL DERMAL Surgery 3.96 5.95 9.44 RBRVS 15819 CERVICOPLASTY Surgery 10.65 10.21 10.21 RBRVS 15820 BLEPHAROPLASTY LOWER EYELID Surgery 6.27 7.78 9.46 RBRVS 15821 BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD Surgery 6.84 7.92 9.65 RBRVS 15822 BLEPHAROPLASTY UPPER EYELID Surgery 4.62 5.97 7.51 RBRVS 15823 BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN Surgery 6.81 8.05 9.81 RBRVS 15824 RHYTIDECTOMY FOREHEAD Surgery 15.47 13.13 13.13 ERBRVS 15825 RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING Surgery 17.41 14.77 14.77 ERBRVS 15826 RHYTIDECTOMY GLABELLAR FROWN LINES Surgery 12.57 10.67 10.67 ERBRVS 15828 RHYTIDECTOMY CHEEK CHIN & NECK Surgery 32.88 27.90 27.90 ERBRVS 15829 RHYTIDECTOMY SMAS FLAP Surgery 36.75 31.19 31.19 ERBRVS 15830 EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY Surgery 17.11 13.41 13.41 RBRVS 15832 EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH Surgery 12.85 11.14 11.14 RBRVS 15833 EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG Surgery 11.90 11.04 11.04 RBRVS 15834 EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP Surgery 12.17 11.19 11.19 RBRVS 15835 EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK Surgery 12.99 11.65 11.65 RBRVS 15836 EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM Surgery 10.61 10.18 10.18 RBRVS 15837 EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND Surgery 9.55 9.46 13.43 RBRVS 15838 EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD Surgery 8.25 6.89 6.89 RBRVS 15839 EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA Surgery 10.50 8.82 12.81 RBRVS 15840 GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT Surgery 14.99 11.63 11.63 RBRVS 15841 GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT Surgery 25.99 16.20 16.20 RBRVS 15842 GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG Surgery 41.01 23.25 23.25 RBRVS 15845 GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR Surgery 14.32 12.97 12.97 RBRVS 15847 EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN Surgery 9.18 FAIR Health 15850 REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON Surgery 0.78 0.30 1.63 RBRVS 15851 REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON Surgery 0.86 0.36 1.85 RBRVS 15852 DRESSING CHANGE UNDER ANESTHESIA Surgery 0.86 0.35 0.35 RBRVS 15860 IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT Surgery 1.95 0.90 0.90 RBRVS 15876 SUCTION ASSISTED LIPECTOMY HEAD & NECK Surgery 21.15 v3.16 15877 SUCTION ASSISTED LIPECTOMY TRUNK Surgery 11.22 v3.16 15878 SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY Surgery 13.00 v3.16 15879 SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY Surgery 3.25 v3.16 15920 EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR Surgery 8.29 7.17 7.17 RBRVS 15922 EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR Surgery 10.38 10.21 10.21 RBRVS 15931 EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE Surgery 10.07 7.40 7.40 RBRVS 15933 EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY Surgery 11.77 10.12 10.12 RBRVS 15934 EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR Surgery 13.68 10.21 10.21 RBRVS 15935 EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY Surgery 15.78 12.62 12.62 RBRVS 15936 EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR Surgery 13.16 9.67 9.67 RBRVS 15937 EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC Surgery 15.14 11.37 11.37 RBRVS 15940 EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE Surgery 10.20 7.76 7.76 RBRVS 15941 EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT Surgery 12.41 11.06 11.06 RBRVS 15944 EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE Surgery 12.44 11.00 11.00 RBRVS 15945 EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY Surgery 13.75 11.88 11.88 RBRVS

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15946 EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN Surgery 24.12 18.29 18.29 RBRVS 15950 EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR Surgery 8.03 7.18 7.18 RBRVS 15951 EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY Surgery 11.58 11.59 11.59 RBRVS 15952 EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE Surgery 12.31 11.46 11.46 RBRVS 15953 EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY Surgery 13.57 12.60 12.60 RBRVS 15956 EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN Surgery 16.79 13.01 13.01 RBRVS 15958 EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC Surgery 16.75 13.82 13.82 RBRVS 15999 UNLISTED PROCEDURE EXCISION PRESSURE ULCER Surgery 23.47 Unlisted 16000 INITIAL TX 1ST DEGREE BURN LOCAL TX Surgery 0.89 0.32 0.95 RBRVS 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL Surgery 0.71 0.75 1.52 RBRVS 16025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM Surgery 1.74 1.20 2.20 RBRVS 16030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE Surgery 2.08 1.37 2.77 RBRVS 16035 ESCHAROTOMY FIRST INCISION Surgery 3.74 1.32 1.32 RBRVS 16036 ESCHAROTOMY EACH ADDITIONAL INCISION Surgery 1.50 0.57 0.57 RBRVS 17000 DESTRUCTION PREMALIGNANT LESION 1ST Surgery 0.61 0.82 1.19 RBRVS 17003 DESTRUCTION PREMALIGNANT LESION 2-14 EA Surgery 0.04 0.02 0.11 RBRVS 17004 DESTRUCTION PREMALIGNANT LESION 15/> Surgery 1.37 1.29 2.69 RBRVS 17106 DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM Surgery 3.69 3.69 5.50 RBRVS 17107 DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM Surgery 4.79 4.40 6.77 RBRVS 17108 DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM Surgery 7.49 6.47 9.59 RBRVS 17110 DESTRUCTION BENIGN LESIONS UP TO 14 Surgery 0.70 1.20 2.35 RBRVS 17111 DESTRUCTION BENIGN LESIONS 15/> Surgery 0.97 1.35 2.62 RBRVS 17250 CHEMICAL CAUTERIZATION GRANULATION TISSUE Surgery 0.50 0.49 1.68 RBRVS 17260 DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/< Surgery 0.96 0.91 1.59 RBRVS 17261 DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM Surgery 1.22 1.23 2.67 RBRVS 17262 DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM Surgery 1.63 1.48 3.09 RBRVS 17263 DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM Surgery 1.84 1.60 3.30 RBRVS 17264 DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM Surgery 1.99 1.68 3.53 RBRVS 17266 DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM Surgery 2.39 1.92 3.85 RBRVS 17270 DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/> Surgery 1.37 1.30 2.70 RBRVS 17271 DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM Surgery 1.54 1.42 2.86 RBRVS 17272 DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM Surgery 1.82 1.59 3.18 RBRVS 17273 DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM Surgery 2.10 1.75 3.48 RBRVS 17274 DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM Surgery 2.64 2.05 3.92 RBRVS 17276 DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM Surgery 3.25 2.37 4.32 RBRVS 17280 DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/< Surgery 1.22 1.21 2.59 RBRVS 17281 DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM Surgery 1.77 1.56 3.01 RBRVS 17282 DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM Surgery 2.09 1.75 3.39 RBRVS 17283 DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM Surgery 2.69 2.09 3.84 RBRVS 17284 DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM Surgery 3.20 2.38 4.25 RBRVS 17286 DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM Surgery 4.48 2.99 5.04 RBRVS 17311 MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS Surgery 6.20 3.75 11.59 RBRVS 17312 MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE Surgery 3.30 2.01 7.20 RBRVS 17313 MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS Surgery 5.56 3.37 11.11 RBRVS 17314 MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE Surgery 3.06 1.86 7.03 RBRVS 17315 MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE Surgery 0.87 0.53 1.27 RBRVS 17340 CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE Surgery 0.77 0.54 0.61 RBRVS 17360 CHEMICAL EXFOLIATION ACNE Surgery 1.46 1.15 1.98 RBRVS 17380 ELECTROLYSIS EPILATION EACH 30 MINUTES Surgery 0.90 FAIR Health 17999 UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE Surgery 1.44 Unlisted 19000 PUNCTURE ASPIRATION CYST BREAST Surgery 0.84 0.31 2.26 RBRVS 19001 PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST Surgery 0.42 0.16 0.30 RBRVS 19020 MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP Surgery 3.83 4.05 8.74 RBRVS 19030 INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM Surgery 1.53 0.57 3.02 RBRVS 19081 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID Surgery 3.29 1.22 15.24 RBRVS 19082 BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID Surgery 1.65 0.61 13.65 RBRVS 19083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID Surgery 3.10 1.15 14.81 RBRVS 19084 BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID Surgery 1.55 0.58 13.18 RBRVS 19085 BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID Surgery 3.64 1.35 24.67 RBRVS 19086 BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID Surgery 1.82 0.68 21.21 RBRVS 19100 BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX Surgery 1.27 0.46 2.74 RBRVS 19101 BIOPSY BREAST OPEN INCISIONAL Surgery 3.23 2.41 5.74 RBRVS 19105 ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA Surgery 3.69 1.69 66.64 RBRVS 19110 NIPPLE EXPLORATION Surgery 4.44 4.30 8.31 RBRVS 19112 EXCISION LACTIFEROUS DUCT FISTULA Surgery 3.81 4.23 8.41 RBRVS 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION Surgery 5.92 4.55 6.77 RBRVS 19125 EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES Surgery 6.69 4.89 7.35 RBRVS 19126 EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL Surgery 2.93 1.05 1.05 RBRVS 19260 EXCISION CHEST WALL TUMOR INCLUDING RIBS Surgery 17.78 12.74 12.74 RBRVS 19271 EXC CHEST TUMOR W/RCNSTJ W/O MEDSTNL LMPHADEC Surgery 22.19 19.53 19.53 RBRVS 19272 EXC CHEST TUMOR W/RCNSTJ W/MEDSTNL LMPHADEC Surgery 25.17 20.49 20.49 RBRVS 19281 PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE Surgery 2.00 0.75 4.61 RBRVS 19282 PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE Surgery 1.00 0.37 3.64 RBRVS 19283 PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE Surgery 2.00 0.76 5.56 RBRVS 19284 PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC Surgery 1.00 0.38 4.61 RBRVS

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19285 PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG Surgery 1.70 0.65 10.78 RBRVS 19286 PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE Surgery 0.85 0.32 9.79 RBRVS 19287 PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID Surgery 2.55 0.97 21.71 RBRVS 19288 PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID Surgery 1.28 0.49 18.40 RBRVS 19296 PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST Surgery 3.63 1.62 106.48 RBRVS 19297 PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST Surgery 1.72 0.62 0.62 RBRVS 19298 PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST Surgery 6.00 2.53 22.81 RBRVS 19300 MASTECTOMY GYNECOMASTIA Surgery 5.31 5.33 8.43 RBRVS 19301 MASTECTOMY PARTIAL Surgery 10.13 6.25 6.25 RBRVS 19302 MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY Surgery 13.99 8.58 8.58 RBRVS 19303 MASTECTOMY SIMPLE COMPLETE Surgery 15.85 9.47 9.47 RBRVS 19304 MASTECTOMY SUBCUTANEOUS Surgery 7.95 6.70 6.70 RBRVS 19305 MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES Surgery 17.46 10.87 10.87 RBRVS 19306 MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES Surgery 18.13 11.95 11.95 RBRVS 19307 MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN Surgery 18.23 11.86 11.86 RBRVS 19316 MASTOPEXY Surgery 11.09 9.00 9.00 RBRVS 19318 REDUCTION MAMMAPLASTY Surgery 16.03 12.87 12.87 RBRVS 19324 MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT Surgery 6.80 5.64 5.64 RBRVS 19325 MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT Surgery 8.64 8.31 8.31 RBRVS 19328 REMOVAL INTACT MAMMARY IMPLANT Surgery 6.48 6.55 6.55 RBRVS 19330 REMOVAL MAMMARY IMPLANT MATERIAL Surgery 8.54 8.11 8.11 RBRVS 19340 IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ Surgery 13.99 12.39 12.39 RBRVS 19342 DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ Surgery 12.63 11.71 11.71 RBRVS 19350 NIPPLE/AREOLA RECONSTRUCTION Surgery 9.11 8.62 12.79 RBRVS 19355 CORRECTION INVERTED NIPPLES Surgery 8.52 5.85 9.50 RBRVS 19357 BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ Surgery 18.50 21.47 21.47 RBRVS 19361 BRST RCNSTJ W/LATSMS D/SI FLAP WO PRSTHC IMPL Surgery 23.36 17.86 17.86 RBRVS 19364 BREAST RECONSTRUCTION FREE FLAP Surgery 42.58 29.37 29.37 RBRVS 19366 BREAST RECONSTRUCTION OTHER TECHNIQUE Surgery 21.84 14.55 14.55 RBRVS 19367 BREAST RECONSTRUCTION TRAM FLAP 1 PEDICLE Surgery 26.80 20.15 20.15 RBRVS 19368 BREAST RECONSTRUCTION TRAM 1 PEDCL MVASC ANAST Surgery 33.90 23.63 23.63 RBRVS 19369 BREAST RECONSTRUCTION TRAM FLAP DOUBLE PEDICLE Surgery 31.31 22.10 22.10 RBRVS 19370 OPEN PERIPROSTHETIC CAPSULOTOMY BREAST Surgery 9.17 8.90 8.90 RBRVS 19371 PERIPROSTHETIC CAPSULECTOMY BREAST Surgery 10.62 10.02 10.02 RBRVS 19380 REVISION RECONSTRUCTED BREAST Surgery 10.41 9.95 9.95 RBRVS 19396 PREPARATION MOULAGE CUSTOM BREAST IMPLANT Surgery 2.17 1.66 5.76 RBRVS 19499 UNLISTED PROCEDURE BREAST Surgery 6.33 Unlisted 20005 I&D SOFT TISSUE ABSCESS SUBFASC Surgery 3.58 2.56 4.63 RBRVS 20100 EXPLORATION PENETRATING WOUND SPX NECK Surgery 10.38 5.04 5.04 RBRVS 20101 EXPLORATION PENETRATING WOUND SPX CHEST Surgery 3.23 2.03 8.86 RBRVS 20102 EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK Surgery 3.98 2.49 9.10 RBRVS 20103 EXPLORATION PENETRATING WOUND SPX EXTREMITY Surgery 5.34 3.71 10.30 RBRVS 20150 EXCISION EPIPHYSEAL BAR Surgery 14.75 10.26 10.26 RBRVS 20200 BIOPSY MUSCLE SUPERFICIAL Surgery 1.46 0.93 4.08 RBRVS 20205 BIOPSY MUSCLE DEEP Surgery 2.35 1.52 5.25 RBRVS 20206 BIOPSY MUSCLE PERCUTANEOUS NEEDLE Surgery 0.99 0.62 5.62 RBRVS 20220 BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL Surgery 1.27 0.71 3.40 RBRVS 20225 BIOPSY BONE TROCAR/NEEDLE DEEP Surgery 1.87 1.08 12.86 RBRVS 20240 BIOPSY BONE OPEN SUPERFICIAL Surgery 3.28 2.46 2.46 RBRVS 20245 BIOPSY BONE OPEN DEEP Surgery 8.95 7.21 7.21 RBRVS 20250 BIOPSY VERTEBRAL BODY OPEN THORACIC Surgery 5.19 4.71 4.71 RBRVS 20251 BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL Surgery 5.72 4.88 4.88 RBRVS 20500 INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC Surgery 1.28 1.02 1.56 RBRVS 20501 INJECTION SINUS TRACT DIAGNOSTIC Surgery 0.76 0.27 2.53 RBRVS 20520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE Surgery 1.90 2.03 3.61 RBRVS 20525 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP Surgery 3.54 2.98 9.50 RBRVS 20526 INJECTION THERAPEUTIC CARPAL TUNNEL Surgery 0.94 0.56 1.10 RBRVS 20527 INJECTION ENZYME PALMAR FASCIAL CORD Surgery 1.00 0.73 1.22 RBRVS 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS Surgery 0.75 0.36 0.84 RBRVS 20551 INJECTION SINGLE TENDON ORIGIN/INSERTION Surgery 0.75 0.39 0.88 RBRVS 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES Surgery 0.66 0.36 0.84 RBRVS 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES Surgery 0.75 0.41 0.99 RBRVS 20555 PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT Surgery 6.00 2.80 2.80 RBRVS 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US Surgery 0.66 0.29 0.62 RBRVS 20604 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT Surgery 0.89 0.33 1.06 RBRVS 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US Surgery 0.68 0.31 0.66 RBRVS 20606 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US Surgery 1.00 0.39 1.15 RBRVS 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US Surgery 0.79 0.42 0.81 RBRVS 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US Surgery 1.10 0.51 1.35 RBRVS 20612 ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ Surgery 0.70 0.41 0.94 RBRVS 20615 ASPIRATION & INJECTION TREATMENT BONE CYST Surgery 2.33 2.09 4.38 RBRVS 20650 INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX Surgery 2.28 1.89 3.28 RBRVS 20660 APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX Surgery 4.00 1.86 1.86 RBRVS 20661 APPLICATION HALO CRANIAL INCLUDING REMOVAL Surgery 5.26 7.47 7.47 RBRVS 20662 APPLICATION HALO PELVIC INCLUDING REMOVAL Surgery 6.38 5.63 5.63 RBRVS

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20663 APPLICATION HALO FEMORAL INCLUDING REMOVAL Surgery 5.74 4.77 4.77 RBRVS 20664 APPL HALO 6/> PINS THIN SKULL OSTEOLOGY Surgery 10.06 11.17 11.17 RBRVS 20665 REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL Surgery 1.36 1.10 1.51 RBRVS 20670 REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE Surgery 1.79 2.16 8.74 RBRVS 20680 REMOVAL IMPLANT DEEP Surgery 5.96 5.19 10.68 RBRVS 20690 APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM Surgery 8.78 6.63 6.63 RBRVS 20692 APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM Surgery 16.27 13.04 13.04 RBRVS 20693 ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES Surgery 6.06 5.76 5.76 RBRVS 20694 REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES Surgery 4.28 4.62 7.07 RBRVS 20696 XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ Surgery 17.56 13.80 13.80 RBRVS 20697 XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT Surgery a 59.97 59.97 RBRVS 20802 REPLANTATION ARM COMPLETE AMPUTATION Surgery 42.62 28.24 28.24 RBRVS 20805 REPLANTATION FOREARM COMPLETE AMPUTATION Surgery 51.46 35.17 35.17 RBRVS 20808 REPLANTATION HAND COMPLETE AMPUTATION Surgery 63.09 41.68 41.68 RBRVS 20816 RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP Surgery 31.95 23.18 23.18 RBRVS 20822 RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP Surgery 26.66 20.58 20.58 RBRVS 20824 RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION Surgery 31.95 21.27 21.27 RBRVS 20827 RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION Surgery 27.48 21.06 21.06 RBRVS 20838 REPLANTATION FOOT COMPLETE AMPUTATION Surgery 42.88 17.73 17.73 RBRVS 20900 BONE GRAFT ANY DONOR AREA MINOR/SMALL Surgery 3.00 1.94 8.43 RBRVS 20902 BONE GRAFT ANY DONOR AREA MAJOR/LARGE Surgery 4.58 2.82 2.82 RBRVS 20910 CARTILAGE GRAFT COSTOCHONDRAL Surgery 5.53 6.65 6.65 RBRVS 20912 CARTILAGE GRAFT NASAL SEPTUM Surgery 6.54 6.22 6.22 RBRVS 20920 FASCIA LATA GRAFT BY STRIPPER Surgery 5.51 4.99 4.99 RBRVS 20922 FASCIA LATA GRAFT INCISION & AREA EXPOSURE Surgery 6.93 5.79 8.76 RBRVS 20924 TENDON GRAFT FROM A DISTANCE Surgery 6.68 6.65 6.65 RBRVS 20926 TISSUE GRAFTS OTHER Surgery 5.79 5.49 5.49 RBRVS 20930 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED Surgery 4.23 FAIR Health 20931 ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL Surgery 1.81 0.87 0.87 RBRVS 20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION Surgery 5.22 FAIR Health 20937 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION Surgery 2.79 1.38 1.38 RBRVS 20938 AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC Surgery 3.02 1.46 1.46 RBRVS 20950 MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME Surgery 1.26 1.12 5.53 RBRVS 20955 BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA Surgery 40.26 25.85 25.85 RBRVS 20956 BONE GRAFT MICROVASCULAR ANAST ILIAC CREST Surgery 41.18 26.93 26.93 RBRVS 20957 BONE GRAFT MICROVASCULAR ANAST METATARSAL Surgery 42.61 14.96 14.96 RBRVS 20962 BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR Surgery 39.21 16.31 16.31 RBRVS 20969 FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE Surgery 45.43 27.08 27.08 RBRVS 20970 FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST Surgery 44.58 29.08 29.08 RBRVS 20972 FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL Surgery 44.51 18.34 18.34 RBRVS 20973 FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE Surgery 47.27 22.35 22.35 RBRVS 20974 ELECTRICAL STIMULATION BONE HEALING NONINVASIVE Surgery 0.62 0.69 1.43 RBRVS 20975 ELECTRICAL STIMULATION BONE HEALING INVASIVE Surgery 2.60 1.91 1.91 RBRVS 20979 LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE Surgery 0.62 0.23 0.78 RBRVS 20982 ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE Surgery 7.27 2.90 98.06 RBRVS 20983 ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD Surgery 7.13 3.44 188.26 RBRVS 20985 CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS Surgery 2.50 1.26 1.26 RBRVS 20999 UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL Surgery 1.58 Unlisted 21010 ARTHROTOMY TEMPOROMANDIBULAR JOINT Surgery 11.04 9.03 9.03 RBRVS 21011 EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM Surgery 2.99 3.90 6.41 RBRVS 21012 EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/> Surgery 4.45 4.37 4.37 RBRVS 21013 EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM Surgery 5.42 5.16 8.46 RBRVS 21014 EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/> Surgery 7.13 6.49 6.49 RBRVS 21015 RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM Surgery 9.89 8.63 8.63 RBRVS 21016 RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/> Surgery 15.26 11.38 11.38 RBRVS 21025 EXCISION BONE MANDIBLE Surgery 10.03 10.12 14.08 RBRVS 21026 EXCISION FACIAL BONE Surgery 5.70 7.82 11.20 RBRVS 21029 REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE Surgery 8.39 8.64 12.26 RBRVS 21030 EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG Surgery 4.91 6.37 9.25 RBRVS 21031 EXCISION TORUS MANDIBULARIS Surgery 3.30 4.71 7.56 RBRVS 21032 EXCISION MAXILLARY TORUS PALATINUS Surgery 3.34 4.57 7.67 RBRVS 21034 EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA Surgery 17.38 13.47 17.96 RBRVS 21040 EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT Surgery 4.91 6.41 9.38 RBRVS 21044 EXCISION MALIGNANT TUMOR MANDIBLE Surgery 12.80 10.61 10.61 RBRVS 21045 EXCISION MALIGNANT TUMOR MANDIBLE RADICAL Surgery 18.37 14.17 14.17 RBRVS 21046 EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT Surgery 14.21 15.86 15.86 RBRVS 21047 EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB Surgery 20.07 14.93 14.93 RBRVS 21048 EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT Surgery 14.71 16.16 16.16 RBRVS 21049 EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC Surgery 19.32 12.84 12.84 RBRVS 21050 CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX Surgery 11.76 10.55 10.55 RBRVS 21060 MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX Surgery 11.07 10.52 10.52 RBRVS 21070 CORONOIDECTOMY SEPARATE PROCEDURE Surgery 8.62 7.73 7.73 RBRVS 21073 MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA Surgery 3.45 3.32 7.35 RBRVS 21076 IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES Surgery 13.40 8.77 13.43 RBRVS 21077 IMPRESSION & PREPARATION ORBITAL PROSTHESIS Surgery 33.70 22.28 33.67 RBRVS

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21079 IMPRESSION & PREPARATION INTERIM OBTURATOR PROST Surgery 22.31 14.76 23.06 RBRVS 21080 IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES Surgery 25.06 16.12 25.81 RBRVS 21081 IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES Surgery 22.85 15.13 24.20 RBRVS 21082 IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES Surgery 20.84 14.99 23.87 RBRVS 21083 IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS Surgery 19.27 14.01 23.42 RBRVS 21084 IMPRESSION & PREPARATION SPEECH AID PROSTHESIS Surgery 22.48 15.99 26.29 RBRVS 21085 IMPRESSION & PREPARATION ORAL SURGICAL SPLINT Surgery 8.99 6.06 11.57 RBRVS 21086 IMPRESSION & PREPARATION AURICULAR PROSTHESIS Surgery 24.88 16.40 25.22 RBRVS 21087 IMPRESSION & PREPARATION NASAL PROSTHESIS Surgery 24.88 16.40 25.22 RBRVS 21088 IMPRESSION & PREPARATION FACIAL PROSTHESIS Surgery 37.96 v3.16 21089 UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE Surgery 44.76 Unlisted 21100 APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX Surgery 4.73 9.35 27.44 RBRVS 21110 APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC Surgery 5.99 12.56 16.36 RBRVS 21116 INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY Surgery 0.81 0.36 3.31 RBRVS 21120 GENIOPLASTY AUGMENTATION Surgery 5.10 7.85 11.29 RBRVS 21121 GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE Surgery 7.81 10.13 13.95 RBRVS 21122 GENIOPLASTY 2/> SLIDING OSTEOTOMIES Surgery 8.71 9.10 9.10 RBRVS 21123 GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS Surgery 11.34 10.09 10.09 RBRVS 21125 AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL Surgery 10.80 8.54 77.34 RBRVS 21127 AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL Surgery 12.44 11.05 109.94 RBRVS 21137 REDUCTION FOREHEAD CONTOURING ONLY Surgery 10.24 7.25 7.25 RBRVS 21138 RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT Surgery 12.87 11.49 11.49 RBRVS 21139 RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL Surgery 15.02 14.81 14.81 RBRVS 21141 RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT Surgery 19.57 16.12 16.12 RBRVS 21142 RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT Surgery 20.28 18.00 18.00 RBRVS 21143 RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT Surgery 21.05 17.47 17.47 RBRVS 21145 RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS Surgery 23.94 19.28 19.28 RBRVS 21146 RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS Surgery 24.87 20.16 20.16 RBRVS 21147 RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS Surgery 26.47 21.08 21.08 RBRVS 21150 RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION Surgery 25.96 18.71 18.71 RBRVS 21151 RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS Surgery 29.02 25.40 25.40 RBRVS 21154 RCNSTJ MIDFACE LEFORT III W/O LEFORT I Surgery 31.29 27.23 27.23 RBRVS 21155 RCNSTJ MIDFACE LEFORT III W/LEFORT I Surgery 35.22 30.05 30.05 RBRVS 21159 RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I Surgery 43.14 23.25 23.25 RBRVS 21160 RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I Surgery 47.19 24.80 24.80 RBRVS 21172 RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD Surgery 28.20 20.65 20.65 RBRVS 21175 RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD Surgery 33.56 18.87 18.87 RBRVS 21179 RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC Surgery 22.65 13.38 13.38 RBRVS 21180 RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT Surgery 25.58 14.77 14.77 RBRVS 21181 RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC Surgery 10.28 9.25 9.25 RBRVS 21182 RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM Surgery 32.58 17.82 17.82 RBRVS 21183 RCNSTJ ORBIT/FHD/NASETHMD EXC BONE GRF>40 <80 Surgery 35.70 25.84 25.84 RBRVS 21184 RCNSTJ ORBIT/FHD/NASETHMD EXC BONE TUM GRF>80SQ Surgery 38.62 24.25 24.25 RBRVS 21188 RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS Surgery 23.15 18.54 18.54 RBRVS 21193 RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF Surgery 18.90 12.58 12.58 RBRVS 21194 RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT Surgery 21.82 17.76 17.76 RBRVS 21195 RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD Surgery 19.16 16.33 16.33 RBRVS 21196 RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI Surgery 20.83 18.77 18.77 RBRVS 21198 OSTEOTOMY MANDIBLE SEGMENTAL Surgery 15.71 15.46 15.46 RBRVS 21199 OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT Surgery 16.73 9.79 9.79 RBRVS 21206 OSTEOTOMY MAXILLA SEGMENTAL Surgery 15.59 17.51 17.51 RBRVS 21208 OSTEOPLASTY FACIAL BONES AUGMENTATION Surgery 11.42 11.06 41.53 RBRVS 21209 OSTEOPLASTY FACIAL BONES REDUCTION Surgery 7.82 8.79 14.27 RBRVS 21210 GRAFT BONE NASAL/MAXILLARY/MALAR AREAS Surgery 11.69 11.55 52.45 RBRVS 21215 GRAFT BONE MANDIBLE Surgery 12.23 11.87 103.75 RBRVS 21230 GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR Surgery 11.17 8.88 8.88 RBRVS 21235 GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR Surgery 7.50 7.70 12.19 RBRVS 21240 ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT Surgery 16.07 13.68 13.68 RBRVS 21242 ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT Surgery 14.59 12.68 12.68 RBRVS 21243 ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT Surgery 24.53 20.61 20.61 RBRVS 21244 RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE Surgery 13.62 15.03 15.03 RBRVS 21245 RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL Surgery 13.12 10.41 16.72 RBRVS 21246 RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE Surgery 12.92 10.86 10.86 RBRVS 21247 RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS Surgery 24.37 16.01 16.01 RBRVS 21248 RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL Surgery 12.74 11.47 17.31 RBRVS 21249 RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE Surgery 18.77 15.61 22.25 RBRVS 21255 RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG Surgery 18.46 16.79 16.79 RBRVS 21256 RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS Surgery 17.66 15.38 15.38 RBRVS 21260 PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL Surgery 17.90 13.80 13.80 RBRVS 21261 PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR Surgery 34.07 22.04 22.04 RBRVS 21263 PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD Surgery 31.01 20.89 20.89 RBRVS 21267 ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL Surgery 20.69 23.03 23.03 RBRVS 21268 ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC Surgery 27.07 22.09 22.09 RBRVS 21270 MALAR AUGMENTATION PROSTHETIC MATERIAL Surgery 10.63 9.36 16.20 RBRVS 21275 SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ Surgery 11.76 10.30 10.30 RBRVS

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21280 MEDIAL CANTHOPEXY SEPARATE PROCEDURE Surgery 7.13 8.44 8.44 RBRVS 21282 LATERAL CANTHOPEXY Surgery 4.27 6.07 6.07 RBRVS 21295 REDUCTION MASSETER MUSCLE & BONE EXTRAORAL Surgery 1.90 3.23 3.23 RBRVS 21296 REDUCTION MASSETER MUSCLE & BONE INTRAORAL Surgery 4.78 6.57 6.57 RBRVS 21299 UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE Surgery 15.60 Unlisted 21310 CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION Surgery 0.58 0.12 3.10 RBRVS 21315 CLOSED TX NASAL FRACTURE W/O STABILIZATION Surgery 1.83 2.27 5.85 RBRVS 21320 CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION Surgery 1.88 1.73 5.17 RBRVS 21325 OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED Surgery 4.18 8.85 8.85 RBRVS 21330 OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI Surgery 5.79 9.70 9.70 RBRVS 21335 OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM Surgery 9.02 10.49 10.49 RBRVS 21336 OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION Surgery 6.77 10.71 10.71 RBRVS 21337 CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION Surgery 3.39 4.59 7.72 RBRVS 21338 OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION Surgery 6.87 13.58 13.58 RBRVS 21339 OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION Surgery 8.50 14.54 14.54 RBRVS 21340 PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE Surgery 11.49 10.63 10.63 RBRVS 21343 OPEN TX DEPRESSED FRONTAL SINUS FRACTURE Surgery 14.32 18.21 18.21 RBRVS 21344 OPEN TX COMPLICATED FRONTAL SINUS FRACTURE Surgery 21.57 15.32 15.32 RBRVS 21345 CLOSED TX NASOMAXILLARY COMPLEX FRACTURE Surgery 9.06 7.68 12.01 RBRVS 21346 OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ Surgery 11.45 12.88 12.88 RBRVS 21347 OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN Surgery 13.53 16.91 16.91 RBRVS 21348 OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT Surgery 17.52 14.27 14.27 RBRVS 21355 PERCUTANEOUS TX MALAR AREA FRACTURE Surgery 4.45 5.10 8.66 RBRVS 21356 OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE Surgery 4.83 5.29 8.81 RBRVS 21360 OPEN TX DEPRESSED MALAR FRACTURE Surgery 7.19 7.22 7.22 RBRVS 21365 OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG Surgery 16.77 12.60 12.60 RBRVS 21366 OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT Surgery 18.60 11.66 11.66 RBRVS 21385 OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL Surgery 9.57 8.65 8.65 RBRVS 21386 OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL Surgery 9.57 8.82 8.82 RBRVS 21387 OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR Surgery 10.11 8.87 8.87 RBRVS 21390 OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC Surgery 11.23 10.06 10.06 RBRVS 21395 OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF Surgery 14.70 11.80 11.80 RBRVS 21400 CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION Surgery 1.50 2.78 3.81 RBRVS 21401 CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION Surgery 3.68 4.52 9.81 RBRVS 21406 OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT Surgery 7.42 7.77 7.77 RBRVS 21407 OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT Surgery 9.02 8.29 8.29 RBRVS 21408 OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT Surgery 12.78 10.92 10.92 RBRVS 21421 CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT Surgery 6.02 13.01 17.18 RBRVS 21422 OPEN TREATMENT PALATAL/MAXILLARY FRACTURE Surgery 8.73 9.32 9.32 RBRVS 21423 OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR Surgery 10.85 10.11 10.11 RBRVS 21431 CLOSED TX CRANIOFACIAL SEPARATION Surgery 7.90 13.46 13.46 RBRVS 21432 OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ Surgery 8.82 8.33 8.33 RBRVS 21433 OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR Surgery 26.29 19.35 19.35 RBRVS 21435 OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX Surgery 20.26 13.11 13.11 RBRVS 21436 OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE Surgery 30.30 23.35 23.35 RBRVS 21440 CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX Surgery 3.44 9.52 12.66 RBRVS 21445 OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX Surgery 6.26 10.88 15.03 RBRVS 21450 CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION Surgery 3.71 10.07 13.69 RBRVS 21451 CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION Surgery 5.65 12.96 17.14 RBRVS 21452 PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ Surgery 2.40 7.00 13.77 RBRVS 21453 CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION Surgery 6.64 14.94 18.72 RBRVS 21454 OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION Surgery 7.36 7.99 7.99 RBRVS 21461 OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION Surgery 9.31 16.33 50.67 RBRVS 21462 OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION Surgery 11.01 17.44 52.59 RBRVS 21465 OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE Surgery 13.12 11.65 11.65 RBRVS 21470 OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION Surgery 17.54 14.49 14.49 RBRVS 21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ Surgery 0.61 0.22 2.12 RBRVS 21485 CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ Surgery 4.77 11.45 14.79 RBRVS 21490 OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION Surgery 12.95 11.49 11.49 RBRVS 21495 OPEN TREATMENT HYOID FRACTURE Surgery 6.79 11.11 11.11 RBRVS 21497 INTERDENTAL WIRING OTHER THAN FRACTURE Surgery 4.64 12.24 15.85 RBRVS 21499 UNLISTED MUSCULOSKELETAL PROCEDURE HEAD Surgery 15.60 Unlisted 21501 I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX Surgery 3.98 4.44 8.18 RBRVS 21502 I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI Surgery 7.55 5.28 5.28 RBRVS 21510 INCISION DEEP OPENING BONE CORTEX THORAX Surgery 6.20 5.01 5.01 RBRVS 21550 BIOPSY SOFT TISSUE NECK/THORAX Surgery 2.11 2.11 5.06 RBRVS 21552 EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> Surgery 6.49 4.91 4.91 RBRVS 21554 EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/> Surgery 11.13 7.63 7.63 RBRVS 21555 EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM Surgery 3.96 4.03 7.12 RBRVS 21556 EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM Surgery 7.66 6.11 6.11 RBRVS 21557 RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM Surgery 14.75 9.97 9.97 RBRVS 21558 RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/> Surgery 21.58 12.83 12.83 RBRVS 21600 EXCISION RIB PARTIAL Surgery 7.26 7.26 7.26 RBRVS 21610 COSTOTRANSVERSECTOMY SEPARATE PROCEDURE Surgery 15.91 12.75 12.75 RBRVS 21615 EXCISION 1ST &/CERVICAL RIB Surgery 10.45 5.24 5.24 RBRVS

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21616 EXCISION 1ST &/CERVICAL RIB W/SYMPATHECTOMY Surgery 12.69 5.45 5.45 RBRVS 21620 OSTECTOMY STERNUM PARTIAL Surgery 7.28 5.66 5.66 RBRVS 21627 STERNAL DEBRIDEMENT Surgery 7.30 6.76 6.76 RBRVS 21630 RADICAL RESECTION STERNUM Surgery 19.18 12.27 12.27 RBRVS 21632 RADICAL RESECTION STERNUM W/MEDSTNL LMPHADEC Surgery 19.68 10.44 10.44 RBRVS 21685 HYOID MYOTOMY & SUSPENSION Surgery 15.26 11.13 11.13 RBRVS 21700 DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB Surgery 6.31 2.82 2.82 RBRVS 21705 DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB Surgery 9.92 3.59 3.59 RBRVS 21720 DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST Surgery 5.80 7.06 7.06 RBRVS 21725 DIVISION STERNOCLEIDOMASTOID OPEN W/CAST Surgery 7.19 6.87 6.87 RBRVS 21740 REPAIR PECTUS EXCAVATUM/CARINATUM OPEN Surgery 17.57 8.11 8.11 RBRVS 21742 REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC Surgery 30.52 FAIR Health 21743 REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC Surgery 40.16 FAIR Health 21750 CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX Surgery 11.40 5.79 5.79 RBRVS 21811 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS Surgery 10.79 4.37 4.37 RBRVS 21812 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS Surgery 13.00 5.16 5.16 RBRVS 21813 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS Surgery 17.61 7.13 7.13 RBRVS 21820 CLOSED TREATMENT STERNUM FRACTURE Surgery 1.36 2.55 2.45 RBRVS 21825 OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION Surgery 7.76 6.08 6.08 RBRVS 21899 UNLISTED PROCEDURE NECK/THORAX Surgery 11.40 Unlisted 21920 BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL Surgery 2.11 2.16 4.87 RBRVS 21925 BIOPSY SOFT TISSUE BACK/FLANK DEEP Surgery 4.63 4.61 7.19 RBRVS 21930 EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM Surgery 4.94 4.48 7.52 RBRVS 21931 EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> Surgery 6.88 5.09 5.09 RBRVS 21932 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM Surgery 9.82 7.02 7.02 RBRVS 21933 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/> Surgery 11.13 7.67 7.67 RBRVS 21935 RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM Surgery 15.72 10.45 10.45 RBRVS 21936 RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/> Surgery 22.55 13.28 13.28 RBRVS 22010 I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR Surgery 12.75 11.19 11.19 RBRVS 22015 I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC Surgery 12.64 10.30 10.30 RBRVS 22100 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV Surgery 11.00 11.49 11.49 RBRVS 22101 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC Surgery 11.08 10.38 10.38 RBRVS 22102 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR Surgery 11.08 9.48 9.48 RBRVS 22103 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA Surgery 2.34 1.13 1.13 RBRVS 22110 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV Surgery 14.00 12.05 12.05 RBRVS 22112 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC Surgery 14.07 12.93 12.93 RBRVS 22114 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR Surgery 14.07 11.73 11.73 RBRVS 22116 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA Surgery 2.32 1.12 1.12 RBRVS 22206 OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC Surgery 37.18 23.32 23.32 RBRVS 22207 OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR Surgery 36.68 23.07 23.07 RBRVS 22208 OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM Surgery 9.66 4.75 4.75 RBRVS 22210 OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV Surgery 25.38 18.83 18.83 RBRVS 22212 OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC Surgery 20.99 16.48 16.48 RBRVS 22214 OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR Surgery 21.02 16.49 16.49 RBRVS 22216 OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM Surgery 6.03 2.97 2.97 RBRVS 22220 OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV Surgery 22.94 17.04 17.04 RBRVS 22222 OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC Surgery 23.09 17.32 17.32 RBRVS 22224 OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR Surgery 23.09 17.11 17.11 RBRVS 22226 OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM Surgery 6.03 2.95 2.95 RBRVS 22305 CLOSED TX VERTEBRAL PROCESS FRACTURE Surgery 2.13 2.43 2.94 RBRVS 22310 CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING Surgery 3.89 3.42 4.11 RBRVS 22315 CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ Surgery 10.11 9.61 12.80 RBRVS 22318 OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT Surgery 22.72 16.52 16.52 RBRVS 22319 OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ Surgery 25.33 17.94 17.94 RBRVS 22325 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM Surgery 19.87 15.81 15.81 RBRVS 22326 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR Surgery 20.84 15.66 15.66 RBRVS 22327 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH Surgery 20.77 16.36 16.36 RBRVS 22328 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA Surgery 4.60 2.22 2.22 RBRVS 22505 MANIPULATION SPINE REQUIRING ANESTHESIA Surgery 1.87 1.58 1.58 RBRVS 22510 PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC Surgery 8.15 3.92 40.91 RBRVS 22511 PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL Surgery 7.58 3.74 41.07 RBRVS 22512 VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL Surgery 4.00 1.50 23.25 RBRVS 22513 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION Surgery 8.90 4.98 197.92 RBRVS 22514 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR Surgery 8.24 4.71 197.62 RBRVS 22515 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH Surgery 4.00 1.75 121.04 RBRVS 22526 PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL Surgery 6.10 3.16 60.84 RBRVS 22527 PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL Surgery 3.03 1.16 52.83 RBRVS 22532 ARTHRODESIS LATERAL EXTRACAVITARY THORACIC Surgery 25.99 17.97 17.97 RBRVS 22533 ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR Surgery 24.79 17.15 17.15 RBRVS 22534 ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR Surgery 5.99 2.91 2.91 RBRVS 22548 ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD Surgery 27.06 19.50 19.50 RBRVS 22551 ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 Surgery 25.00 16.83 16.83 RBRVS 22552 ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC Surgery 6.50 3.12 3.12 RBRVS 22554 ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2 Surgery 17.69 13.38 13.38 RBRVS 22556 ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC Surgery 24.70 16.64 16.64 RBRVS

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22558 ARTHRODESIS ANTERIOR INTERBODY LUMBAR Surgery 23.53 15.16 15.16 RBRVS 22585 ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC Surgery 5.52 2.57 2.57 RBRVS 22586 ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5-S1 Surgery 28.12 18.93 18.93 RBRVS 22590 ARTHRODESIS POSTERIOR CRANIOCERVICAL Surgery 21.76 16.56 16.56 RBRVS 22595 ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2 Surgery 20.64 16.06 16.06 RBRVS 22600 ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM Surgery 17.40 14.38 14.38 RBRVS 22610 ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC Surgery 17.28 14.15 14.15 RBRVS 22612 ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR Surgery 23.53 16.19 16.19 RBRVS 22614 ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL Surgery 6.43 3.12 3.12 RBRVS 22630 ARTHRODESIS POSTERIOR INTERBODY LUMBAR Surgery 22.09 16.29 16.29 RBRVS 22632 ARTHRODESIS POSTERIOR INTERBODY EA ADDL Surgery 5.22 2.52 2.52 RBRVS 22633 ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR Surgery 27.75 18.07 18.07 RBRVS 22634 ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG Surgery 8.16 3.93 3.93 RBRVS 22800 ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG Surgery 19.50 14.67 14.67 RBRVS 22802 ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG Surgery 32.11 20.88 20.88 RBRVS 22804 ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG Surgery 37.50 23.44 23.44 RBRVS 22808 ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG Surgery 27.51 18.16 18.16 RBRVS 22810 ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG Surgery 31.50 18.84 18.84 RBRVS 22812 ARTHRODESIS POSTERIOR SPINAL DFRM 8/> VRT SEG Surgery 34.25 22.75 22.75 RBRVS 22818 KYPHECTOMY SINGLE OR TWO SEGMENTS Surgery 34.33 21.54 21.54 RBRVS 22819 KYPHECTOMY 3 OR MORE SEGMENTS Surgery 39.38 25.26 25.26 RBRVS 22830 EXPLORATION SPINAL FUSION Surgery 11.22 9.27 9.27 RBRVS 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION Surgery 12.52 6.06 6.06 RBRVS 22841 INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS Surgery 15.20 FAIR Health 22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG Surgery 12.56 6.08 6.08 RBRVS 22843 POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG Surgery 13.44 6.52 6.52 RBRVS 22844 POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE Surgery 16.42 8.06 8.06 RBRVS 22845 ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS Surgery 11.94 5.71 5.71 RBRVS 22846 ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS Surgery 12.40 5.94 5.94 RBRVS 22847 ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS Surgery 13.78 6.70 6.70 RBRVS 22848 PELVIC FIXATION OTHER THAN SACRUM Surgery 5.99 2.96 2.96 RBRVS 22849 REINSERTION SPINAL FIXATION DEVICE Surgery 19.17 13.21 13.21 RBRVS 22850 REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION Surgery 9.82 8.39 8.39 RBRVS 22851 APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE Surgery 6.70 3.22 3.22 RBRVS 22852 REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION Surgery 9.37 8.14 8.14 RBRVS 22855 REMOVAL ANTERIOR INSTRUMENTATION Surgery 15.86 11.55 11.55 RBRVS 22856 TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV Surgery 24.05 15.25 15.25 RBRVS 22857 TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC LMBR Surgery 27.13 18.73 18.73 RBRVS 22858 TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL Surgery 8.40 3.62 3.62 RBRVS 22861 REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV Surgery 33.36 15.58 15.58 RBRVS 22862 REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR Surgery 32.63 15.81 15.81 RBRVS 22864 RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL Surgery 29.40 19.61 19.61 RBRVS 22865 RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR Surgery 31.75 21.07 21.07 RBRVS 22899 UNLISTED PROCEDURE SPINE Surgery 18.34 Unlisted 22900 EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM Surgery 8.32 6.03 6.03 RBRVS 22901 EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/> Surgery 10.11 6.73 6.73 RBRVS 22902 EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM Surgery 4.42 4.09 7.13 RBRVS 22903 EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> Surgery 6.39 4.78 4.78 RBRVS 22904 RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM Surgery 16.69 9.94 9.94 RBRVS 22905 RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/> Surgery 21.58 11.97 11.97 RBRVS 22999 UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM Surgery 11.17 Unlisted 23000 REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN Surgery 4.48 5.29 11.38 RBRVS 23020 CAPSULAR CONTRACTURE RELEASE Surgery 9.36 8.60 8.60 RBRVS 23030 I&D SHOULDER DEEP ABSCESS/HEMATOMA Surgery 3.47 3.17 8.43 RBRVS 23031 I&D SHOULDER INFECTED BURSA Surgery 2.79 3.00 8.88 RBRVS 23035 INCISION BONE CORTEX SHOULDER AREA Surgery 9.16 8.56 8.56 RBRVS 23040 ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB Surgery 9.75 8.97 8.97 RBRVS 23044 ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB Surgery 7.59 7.27 7.27 RBRVS 23065 BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL Surgery 2.30 2.13 3.50 RBRVS 23066 BIOPSY SOFT TISSUE SHOULDER DEEP Surgery 4.30 5.03 10.69 RBRVS 23071 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> Surgery 5.91 4.82 4.82 RBRVS 23073 EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/> Surgery 10.13 7.64 7.64 RBRVS 23075 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM Surgery 4.21 4.24 8.25 RBRVS 23076 EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM Surgery 7.41 6.47 6.47 RBRVS 23077 RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM Surgery 17.66 11.40 11.40 RBRVS 23078 RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/> Surgery 22.55 13.89 13.89 RBRVS 23100 ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY Surgery 6.20 6.89 6.89 RBRVS 23101 ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG Surgery 5.72 5.99 5.99 RBRVS 23105 ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY Surgery 8.48 8.14 8.14 RBRVS 23106 ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX Surgery 6.13 6.86 6.86 RBRVS 23107 ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB Surgery 8.87 8.33 8.33 RBRVS 23120 CLAVICULECTOMY PARTIAL Surgery 7.39 7.93 7.93 RBRVS 23125 CLAVICULECTOMY TOTAL Surgery 9.64 8.78 8.78 RBRVS 23130 PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE Surgery 7.77 8.16 8.16 RBRVS 23140 EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA Surgery 7.12 6.56 6.56 RBRVS

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23145 EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT Surgery 9.40 8.66 8.66 RBRVS 23146 EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT Surgery 8.08 8.11 8.11 RBRVS 23150 EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS Surgery 8.91 8.29 8.29 RBRVS 23155 EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT Surgery 10.86 9.72 9.72 RBRVS 23156 EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT Surgery 9.11 8.51 8.51 RBRVS 23170 SEQUESTRECTOMY CLAVICLE Surgery 7.21 7.40 7.40 RBRVS 23172 SEQUESTRECTOMY SCAPULA Surgery 7.31 7.45 7.45 RBRVS 23174 SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK Surgery 10.05 9.68 9.68 RBRVS 23180 PARTIAL EXCISION BONE CLAVICLE Surgery 8.99 8.32 8.32 RBRVS 23182 PARTIAL EXCISION BONE SCAPULA Surgery 8.61 8.56 8.56 RBRVS 23184 PARTIAL EXCISION BONE PROXIMAL HUMERUS Surgery 9.90 9.24 9.24 RBRVS 23190 OSTECTOMY SCAPULA PARTIAL Surgery 7.47 7.42 7.42 RBRVS 23195 RESECTION HUMERAL HEAD Surgery 10.36 9.26 9.26 RBRVS 23200 RADICAL RESECTION TUMOR CLAVICLE Surgery 22.71 16.39 16.39 RBRVS 23210 RADICAL RESECTION TUMOR SCAPULA Surgery 27.21 18.66 18.66 RBRVS 23220 RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS Surgery 30.21 19.99 19.99 RBRVS 23330 REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS Surgery 1.90 2.10 4.58 RBRVS 23333 REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM Surgery 6.00 5.92 5.92 RBRVS 23334 PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT Surgery 15.50 12.36 12.36 RBRVS 23335 PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT Surgery 19.00 14.08 14.08 RBRVS 23350 INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG Surgery 1.00 0.38 2.63 RBRVS 23395 MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE Surgery 18.54 14.86 14.86 RBRVS 23397 MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE Surgery 16.76 12.70 12.70 RBRVS 23400 SCAPULOPEXY Surgery 13.87 11.23 11.23 RBRVS 23405 TENOTOMY SHOULDER AREA 1 TENDON Surgery 8.54 7.77 7.77 RBRVS 23406 TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION Surgery 11.01 9.02 9.02 RBRVS 23410 OPEN REPAIR OF ROTATOR CUFF ACUTE Surgery 11.39 9.98 9.98 RBRVS 23412 OPEN REPAIR OF ROTATOR CUFF CHRONIC Surgery 11.93 10.23 10.23 RBRVS 23415 CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY Surgery 9.23 8.93 8.93 RBRVS 23420 RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC Surgery 13.54 11.64 11.64 RBRVS 23430 TENODESIS LONG TENDON BICEPS Surgery 10.17 9.32 9.32 RBRVS 23440 RESECTION/TRANSPLANTATION LONG TENDON BICEPS Surgery 10.64 9.01 9.01 RBRVS 23450 CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON Surgery 13.70 10.81 10.81 RBRVS 23455 CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR Surgery 14.67 11.27 11.27 RBRVS 23460 CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK Surgery 15.82 12.33 12.33 RBRVS 23462 CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR Surgery 15.72 11.72 11.72 RBRVS 23465 CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK Surgery 16.30 12.63 12.63 RBRVS 23466 CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS Surgery 15.80 13.27 13.27 RBRVS 23470 ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY Surgery 17.89 13.27 13.27 RBRVS 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER Surgery 22.13 15.60 15.60 RBRVS 23473 REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT Surgery 25.00 17.06 17.06 RBRVS 23474 REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT Surgery 27.21 18.24 18.24 RBRVS 23480 OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION Surgery 11.54 9.72 9.72 RBRVS 23485 OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL Surgery 13.91 10.77 10.77 RBRVS 23490 PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE Surgery 12.16 10.16 10.16 RBRVS 23491 PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS Surgery 14.54 11.62 11.62 RBRVS 23500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION Surgery 2.21 3.71 3.61 RBRVS 23505 CLSD TX CLAVICULAR FRACTURE W/MANIPULATION Surgery 3.83 4.93 5.50 RBRVS 23515 OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION Surgery 9.69 9.09 9.09 RBRVS 23520 CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION Surgery 2.29 3.93 3.84 RBRVS 23525 CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION Surgery 3.79 5.60 6.42 RBRVS 23530 OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC Surgery 7.48 7.43 7.43 RBRVS 23532 OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF Surgery 8.20 8.05 8.05 RBRVS 23540 CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION Surgery 2.36 3.74 3.64 RBRVS 23545 CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION Surgery 3.43 4.80 5.69 RBRVS 23550 OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC Surgery 7.59 7.24 7.24 RBRVS 23552 OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF Surgery 8.82 8.24 8.24 RBRVS 23570 CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION Surgery 2.36 4.00 3.80 RBRVS 23575 CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION Surgery 4.23 5.64 6.36 RBRVS 23585 OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD Surgery 14.23 11.19 11.19 RBRVS 23600 CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION Surgery 3.00 5.19 5.73 RBRVS 23605 CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ Surgery 5.06 6.10 7.21 RBRVS 23615 OPEN TREATMENT PROXIMAL HUMERAL FRACTURE Surgery 12.30 10.71 10.71 RBRVS 23616 OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT Surgery 18.37 13.78 13.78 RBRVS 23620 CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ Surgery 2.55 4.28 4.65 RBRVS 23625 CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION Surgery 4.10 5.21 5.95 RBRVS 23630 OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE Surgery 10.57 9.81 9.81 RBRVS 23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES Surgery 3.53 4.10 4.84 RBRVS 23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES Surgery 4.76 5.79 5.79 RBRVS 23660 OPEN TX ACUTE SHOULDER DISLOCATION Surgery 7.66 7.49 7.49 RBRVS 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ Surgery 4.66 5.74 6.57 RBRVS 23670 OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX Surgery 12.28 10.52 10.52 RBRVS 23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ Surgery 6.27 6.89 8.30 RBRVS 23680 OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE Surgery 13.15 10.96 10.96 RBRVS 23700 MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS Surgery 2.57 2.57 2.57 RBRVS

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23800 ARTHRODESIS GLENOHUMERAL JOINT Surgery 14.73 11.78 11.78 RBRVS 23802 ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT Surgery 18.42 14.82 14.82 RBRVS 23900 INTERTHORACOSCAPULAR AMPUTATION Surgery 20.72 15.08 15.08 RBRVS 23920 DISARTICULATION SHOULDER Surgery 16.23 12.93 12.93 RBRVS 23921 DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION Surgery 5.72 6.51 6.51 RBRVS 23929 UNLISTED PROCEDURE SHOULDER Surgery 16.31 Unlisted 23930 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA Surgery 2.99 2.57 6.40 RBRVS 23931 INCISION&DRAINAGE UPPER ARM/ELBOW BURSA Surgery 1.84 2.41 5.99 RBRVS 23935 INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW Surgery 6.38 6.88 6.88 RBRVS 24000 ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB Surgery 6.08 6.43 6.43 RBRVS 24006 ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX Surgery 9.74 8.88 8.88 RBRVS 24065 BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL Surgery 2.13 2.35 4.82 RBRVS 24066 BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP Surgery 5.35 5.40 11.32 RBRVS 24071 EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> Surgery 5.70 4.69 4.69 RBRVS 24073 EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/> Surgery 10.13 7.73 7.73 RBRVS 24075 EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM Surgery 4.24 4.31 8.86 RBRVS 24076 EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM Surgery 7.41 6.59 6.59 RBRVS 24077 RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM Surgery 15.72 10.66 10.66 RBRVS 24079 RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/> Surgery 20.61 13.24 13.24 RBRVS 24100 ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY Surgery 5.07 5.87 5.87 RBRVS 24101 ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB Surgery 6.30 6.82 6.82 RBRVS 24102 ARTHROTOMY ELBOW W/SYNOVECTOMY Surgery 8.26 7.81 7.81 RBRVS 24105 EXCISION OLECRANON BURSA Surgery 3.78 5.48 5.48 RBRVS 24110 EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS Surgery 7.58 7.74 7.74 RBRVS 24115 EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT Surgery 10.12 9.02 9.02 RBRVS 24116 EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT Surgery 12.23 10.07 10.07 RBRVS 24120 EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN Surgery 6.82 7.01 7.01 RBRVS 24125 EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT Surgery 8.14 8.02 8.02 RBRVS 24126 EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT Surgery 8.62 8.26 8.26 RBRVS 24130 EXCISION RADIAL HEAD Surgery 6.42 6.86 6.86 RBRVS 24134 SEQUESTRECTOMY SHAFT/DISTAL HUMERUS Surgery 10.22 9.19 9.19 RBRVS 24136 SEQUESTRECTOMY RADIAL HEAD OR NECK Surgery 8.40 6.24 6.24 RBRVS 24138 SEQUESTRECTOMY OLECRANON PROCESS Surgery 8.50 9.15 9.15 RBRVS 24140 PARTIAL EXCISION BONE HUMERUS Surgery 9.55 8.77 8.77 RBRVS 24145 PARTIAL EXCISION BONE RADIAL HEAD/NECK Surgery 7.81 7.59 7.59 RBRVS 24147 PARTIAL EXCISION BONE OLECRANON PROCESS Surgery 7.84 8.48 8.48 RBRVS 24149 RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT Surgery 16.22 14.48 14.48 RBRVS 24150 RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS Surgery 23.46 16.66 16.66 RBRVS 24152 RADICAL RESECTION TUMOR RADIAL HEAD/NECK Surgery 19.99 14.92 14.92 RBRVS 24155 RESECTION ELBOW JOINT ARTHRECTOMY Surgery 12.09 9.99 9.99 RBRVS 24160 PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS Surgery 18.63 14.11 14.11 RBRVS 24164 PROSTHESIS REMOVAL RADIAL HEAD Surgery 10.00 8.97 8.97 RBRVS 24200 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS Surgery 1.81 1.91 3.79 RBRVS 24201 REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP Surgery 4.70 4.84 10.26 RBRVS 24220 INJECTION ELBOW ARTHROGRAPHY Surgery 1.31 0.54 3.12 RBRVS 24300 MANIPULATION ELBOW UNDER ANESTHESIA Surgery 4.04 7.15 7.15 RBRVS 24301 MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE Surgery 10.38 9.16 9.16 RBRVS 24305 TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON Surgery 7.62 7.53 7.53 RBRVS 24310 TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON Surgery 6.12 6.33 6.33 RBRVS 24320 TENOPLASTY ELBOW TO SHOULDER SINGLE Surgery 10.86 9.37 9.37 RBRVS 24330 FLEXOR-PLASTY ELBOW Surgery 9.79 8.85 8.85 RBRVS 24331 FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT Surgery 10.95 9.42 9.42 RBRVS 24332 TENOLYSIS TRICEPS Surgery 7.91 8.07 8.07 RBRVS 24340 TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE Surgery 8.08 7.91 7.91 RBRVS 24341 REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA Surgery 9.49 10.07 10.07 RBRVS 24342 RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF Surgery 10.86 9.35 9.35 RBRVS 24343 REPAIR LATERAL COLLATERAL LIGAMENT ELBOW Surgery 9.16 9.35 9.35 RBRVS 24344 RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT Surgery 15.21 13.29 13.29 RBRVS 24345 REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW Surgery 9.16 9.31 9.31 RBRVS 24346 RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF Surgery 15.21 13.29 13.29 RBRVS 24357 TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS Surgery 5.44 6.01 6.01 RBRVS 24358 TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN Surgery 6.66 7.07 7.07 RBRVS 24359 TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR Surgery 8.98 8.25 8.25 RBRVS 24360 ARTHROPLASTY ELBOW W/MEMBRANE Surgery 12.67 10.62 10.62 RBRVS 24361 ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT Surgery 14.41 11.60 11.60 RBRVS 24362 ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ Surgery 15.32 12.06 12.06 RBRVS 24363 ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM Surgery 22.00 15.78 15.78 RBRVS 24365 ARTHROPLASTY RADIAL HEAD Surgery 8.62 7.99 7.99 RBRVS 24366 ARTHROPLASTY RADIAL HEAD W/IMPLANT Surgery 9.36 8.39 8.39 RBRVS 24370 REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT Surgery 23.55 16.70 16.70 RBRVS 24371 REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT Surgery 27.50 18.62 18.62 RBRVS 24400 OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION Surgery 11.33 9.94 9.94 RBRVS 24410 MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT Surgery 15.11 12.23 12.23 RBRVS 24420 OSTEOPLASTY HUMERUS Surgery 13.73 12.03 12.03 RBRVS 24430 REPAIR NON/MALUNION HUMERUS W/O GRAFT Surgery 15.25 12.19 12.19 RBRVS

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24435 REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT Surgery 14.99 13.09 13.09 RBRVS 24470 HEMIEPIPHYSEAL ARREST Surgery 8.93 8.53 8.53 RBRVS 24495 DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL Surgery 8.41 5.05 5.05 RBRVS 24498 PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT Surgery 12.28 10.17 10.17 RBRVS 24500 CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION Surgery 3.41 5.25 6.17 RBRVS 24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ Surgery 5.39 6.47 7.82 RBRVS 24515 OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE Surgery 12.12 10.67 10.67 RBRVS 24516 TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE Surgery 12.19 10.12 10.12 RBRVS 24530 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ Surgery 3.69 5.42 6.44 RBRVS 24535 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ Surgery 7.11 7.70 9.04 RBRVS 24538 PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX Surgery 9.77 9.59 9.59 RBRVS 24545 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN Surgery 13.15 10.99 10.99 RBRVS 24546 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN Surgery 14.91 12.06 12.06 RBRVS 24560 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ Surgery 2.98 4.66 5.62 RBRVS 24565 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ Surgery 5.78 7.03 8.28 RBRVS 24566 PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ Surgery 9.06 9.67 9.67 RBRVS 24575 OPEN TX HUMERAL EPICONDYLAR FRACTURE Surgery 9.71 9.44 9.44 RBRVS 24576 CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ Surgery 3.06 5.10 6.09 RBRVS 24577 CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ Surgery 6.01 7.15 8.46 RBRVS 24579 OPEN TREATMENT HUMERAL CONDYLAR FRACTURE Surgery 11.44 10.33 10.33 RBRVS 24582 PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ Surgery 10.14 10.99 10.99 RBRVS 24586 OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO Surgery 15.78 12.34 12.34 RBRVS 24587 OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR Surgery 15.79 12.31 12.31 RBRVS 24600 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES Surgery 4.37 4.40 5.28 RBRVS 24605 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES Surgery 5.64 6.70 6.70 RBRVS 24615 OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION Surgery 9.83 8.67 8.67 RBRVS 24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ Surgery 7.22 7.07 7.07 RBRVS 24635 OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW Surgery 8.80 8.80 8.80 RBRVS 24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ Surgery 1.25 1.23 2.51 RBRVS 24650 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION Surgery 2.31 4.10 4.71 RBRVS 24655 CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION Surgery 4.62 5.83 6.94 RBRVS 24665 OPEN TX RADIAL HEAD/NECK FRACTURE Surgery 8.36 8.72 8.72 RBRVS 24666 OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC Surgery 9.86 9.29 9.29 RBRVS 24670 CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ Surgery 2.69 4.29 5.11 RBRVS 24675 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ Surgery 4.91 6.03 7.16 RBRVS 24685 OPEN TREATMENT ULNAR FRACTURE PROXIMAL END Surgery 8.37 8.76 8.76 RBRVS 24800 ARTHRODESIS ELBOW JOINT LOCAL Surgery 11.41 10.10 10.10 RBRVS 24802 ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT Surgery 14.32 11.57 11.57 RBRVS 24900 AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE Surgery 10.18 8.54 8.54 RBRVS 24920 AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR Surgery 10.13 8.87 8.87 RBRVS 24925 AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ Surgery 7.30 5.84 5.84 RBRVS 24930 AMPUTATION ARM THRU HUMERUS RE-AMPUTATION Surgery 10.83 9.23 9.23 RBRVS 24931 AMPUTATION ARM THRU HUMERUS W/IMPLANT Surgery 13.44 7.74 7.74 RBRVS 24935 STUMP ELONGATION UPPER EXTREMITY Surgery 16.45 5.72 5.72 RBRVS 24940 CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE Surgery 14.69 12.46 12.46 ERBRVS 24999 UNLISTED PROCEDURE HUMERUS/ELBOW Surgery 14.00 Unlisted 25000 INCISION EXTENSOR TENDON SHEATH WRIST Surgery 3.55 5.38 5.38 RBRVS 25001 INCISION FLEXOR TENDON SHEATH WRIST Surgery 3.79 5.34 5.34 RBRVS 25020 DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT Surgery 6.06 9.19 9.19 RBRVS 25023 DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT Surgery 13.83 15.09 15.09 RBRVS 25024 DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB Surgery 10.79 9.42 9.42 RBRVS 25025 DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT Surgery 17.94 13.73 13.73 RBRVS 25028 I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA Surgery 5.39 8.49 8.49 RBRVS 25031 INCISION & DRAINAGE FOREARM&/WRIST BURSA Surgery 4.26 5.31 5.31 RBRVS 25035 INCISION DEEP BONE CORTEX FOREARM&/WRIST Surgery 7.65 7.59 7.59 RBRVS 25040 ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB Surgery 7.50 7.24 7.24 RBRVS 25065 BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL Surgery 2.04 2.35 4.89 RBRVS 25066 BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP Surgery 4.27 5.19 5.19 RBRVS 25071 EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/> Surgery 5.91 5.05 5.05 RBRVS 25073 EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/> Surgery 7.13 6.73 6.73 RBRVS 25075 EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM Surgery 3.96 4.28 8.85 RBRVS 25076 EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM Surgery 6.74 6.74 6.74 RBRVS 25077 RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM Surgery 12.93 9.84 9.84 RBRVS 25078 RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/> Surgery 17.69 12.15 12.15 RBRVS 25085 CAPSULOTOMY WRIST Surgery 5.64 6.12 6.12 RBRVS 25100 ARTHROTOMY WRIST JOINT WITH BIOPSY Surgery 4.02 5.06 5.06 RBRVS 25101 ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB Surgery 4.83 5.80 5.80 RBRVS 25105 ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY Surgery 6.02 6.67 6.67 RBRVS 25107 ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE Surgery 7.70 8.54 8.54 RBRVS 25109 EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA Surgery 6.94 7.22 7.22 RBRVS 25110 EXCISION LESION TENDON SHEATH FOREARM&/WRIST Surgery 4.04 4.92 4.92 RBRVS 25111 EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY Surgery 3.53 4.93 4.93 RBRVS 25112 EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT Surgery 4.67 5.46 5.46 RBRVS 25115 RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS Surgery 10.09 9.79 9.79 RBRVS 25116 RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS Surgery 7.56 8.23 8.23 RBRVS

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25118 SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT Surgery 4.51 5.54 5.54 RBRVS 25119 SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA Surgery 6.21 6.79 6.79 RBRVS 25120 EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA Surgery 6.27 6.77 6.77 RBRVS 25125 EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT Surgery 7.67 7.93 7.93 RBRVS 25126 EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT Surgery 7.74 7.82 7.82 RBRVS 25130 EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES Surgery 5.43 6.34 6.34 RBRVS 25135 EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT Surgery 7.08 7.48 7.48 RBRVS 25136 EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT Surgery 6.14 6.74 6.74 RBRVS 25145 SEQUESTRECTOMY FOREARM &/WRIST Surgery 6.54 6.95 6.95 RBRVS 25150 PARTIAL EXCISION BONE ULNA Surgery 7.38 7.38 7.38 RBRVS 25151 PARTIAL EXCISION BONE RADIUS Surgery 7.68 7.59 7.59 RBRVS 25170 RADICAL RESECTION TUMOR RADIUS OR ULNA Surgery 22.21 15.91 15.91 RBRVS 25210 CARPECTOMY 1 BONE Surgery 6.12 6.73 6.73 RBRVS 25215 CARPECTOMY ALL BONES PROXIMAL ROW Surgery 8.14 8.07 8.07 RBRVS 25230 RADICAL STYLOIDECTOMY SEPARATE PROCEDURE Surgery 5.37 6.01 6.01 RBRVS 25240 EXCISION DISTAL ULNA PARTIAL/COMPLETE Surgery 5.31 5.98 5.98 RBRVS 25246 INJECTION WRIST ARTHROGRAPHY Surgery 1.45 0.58 3.02 RBRVS 25248 EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST Surgery 5.31 5.45 5.45 RBRVS 25250 REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE Surgery 6.77 7.05 7.05 RBRVS 25251 REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST Surgery 9.82 8.85 8.85 RBRVS 25259 MANIPULATION WRIST UNDER ANESTHESIA Surgery 4.04 7.12 7.12 RBRVS 25260 RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU Surgery 8.04 8.52 8.52 RBRVS 25263 RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS Surgery 8.04 8.31 8.31 RBRVS 25265 RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA Surgery 10.10 9.35 9.35 RBRVS 25270 RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN Surgery 6.17 6.73 6.73 RBRVS 25272 RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU Surgery 7.21 7.21 7.21 RBRVS 25274 RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN Surgery 8.94 8.50 8.50 RBRVS 25275 RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT Surgery 8.96 8.63 8.63 RBRVS 25280 LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN Surgery 7.39 7.42 7.42 RBRVS 25290 TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA Surgery 5.43 6.05 6.05 RBRVS 25295 TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA Surgery 6.72 7.00 7.00 RBRVS 25300 TENODESIS WRIST FLEXORS FINGERS Surgery 9.02 8.80 8.80 RBRVS 25301 TENODESIS WRIST EXTENSORS FINGERS Surgery 8.59 8.24 8.24 RBRVS 25310 TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN Surgery 8.08 8.19 8.19 RBRVS 25312 TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR Surgery 9.82 8.95 8.95 RBRVS 25315 FLEXOR ORIGIN SLIDE FOREARM &/WRIST Surgery 10.68 9.30 9.30 RBRVS 25316 FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE Surgery 12.90 10.73 10.73 RBRVS 25320 CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS Surgery 12.75 13.17 13.17 RBRVS 25332 ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ Surgery 11.74 10.24 10.24 RBRVS 25335 CENTRALIZATION WRST ULNA Surgery 13.39 10.98 10.98 RBRVS 25337 RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ Surgery 11.73 11.59 11.59 RBRVS 25350 OSTEOTOMY RADIUS DISTAL THIRD Surgery 9.09 8.58 8.58 RBRVS 25355 OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD Surgery 10.53 9.35 9.35 RBRVS 25360 OSTEOTOMY ULNA Surgery 8.74 8.35 8.35 RBRVS 25365 OSTEOTOMY RADIUS & ULNA Surgery 12.91 10.75 10.75 RBRVS 25370 MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA Surgery 14.10 11.95 11.95 RBRVS 25375 MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA Surgery 13.55 11.07 11.07 RBRVS 25390 OSTEOPLASTY RADIUS/ULNA SHORTENING Surgery 10.70 9.42 9.42 RBRVS 25391 OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT Surgery 14.28 11.44 11.44 RBRVS 25392 OSTEOPLASTY RADIUS & ULNA SHORTENING Surgery 14.58 12.10 12.10 RBRVS 25393 OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF Surgery 16.56 13.21 13.21 RBRVS 25394 OSTEOPLASTY CARPAL BONE SHORTENING Surgery 10.85 9.77 9.77 RBRVS 25400 RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT Surgery 11.28 9.65 9.65 RBRVS 25405 RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT Surgery 15.01 11.89 11.89 RBRVS 25415 RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF Surgery 13.80 11.20 11.20 RBRVS 25420 RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT Surgery 17.04 13.10 13.10 RBRVS 25425 REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA Surgery 13.72 11.16 11.16 RBRVS 25426 REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA Surgery 16.45 12.54 12.54 RBRVS 25430 INSERTION VASCULAR PEDICLE CARPAL BONE Surgery 9.71 9.32 9.32 RBRVS 25431 REPAIR NONUNION CARPAL BONE EACH BONE Surgery 10.89 9.87 9.87 RBRVS 25440 RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC Surgery 10.68 9.41 9.41 RBRVS 25441 ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS Surgery 13.29 11.36 11.36 RBRVS 25442 ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA Surgery 11.12 9.99 9.99 RBRVS 25443 ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL Surgery 10.66 9.60 9.60 RBRVS 25444 ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE Surgery 11.42 9.98 9.98 RBRVS 25445 ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM Surgery 9.88 8.93 8.93 RBRVS 25446 ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS Surgery 17.30 13.20 13.20 RBRVS 25447 ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS Surgery 11.14 10.55 10.55 RBRVS 25449 REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT Surgery 14.94 12.01 12.01 RBRVS 25450 EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U Surgery 8.06 5.68 5.68 RBRVS 25455 EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA Surgery 9.71 6.54 6.54 RBRVS 25490 PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS Surgery 9.73 7.32 7.32 RBRVS 25491 PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA Surgery 10.15 9.04 9.04 RBRVS 25492 PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL Surgery 12.66 10.73 10.73 RBRVS 25500 CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION Surgery 2.60 4.06 4.70 RBRVS

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25505 CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION Surgery 5.45 6.70 7.89 RBRVS 25515 OPEN TREATMENT RADIAL SHAFT FRACTURE Surgery 8.80 8.70 8.70 RBRVS 25520 CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT Surgery 6.50 7.58 8.41 RBRVS 25525 OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE Surgery 10.55 9.93 9.93 RBRVS 25526 OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE Surgery 13.15 11.64 11.64 RBRVS 25530 CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION Surgery 2.24 4.09 4.81 RBRVS 25535 CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION Surgery 5.36 6.55 7.59 RBRVS 25545 OPEN TREATMENT OF ULNAR SHAFT FRACTURE Surgery 7.94 8.40 8.40 RBRVS 25560 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN Surgery 2.59 4.10 4.86 RBRVS 25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ Surgery 5.85 6.50 7.89 RBRVS 25574 OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA Surgery 8.80 8.81 8.81 RBRVS 25575 OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA Surgery 12.29 11.14 11.14 RBRVS 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ Surgery 2.78 5.54 6.05 RBRVS 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF Surgery 6.25 7.25 8.18 RBRVS 25606 PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP Surgery 8.31 9.03 9.03 RBRVS 25607 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP Surgery 9.56 9.66 9.66 RBRVS 25608 OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG Surgery 11.07 10.44 10.44 RBRVS 25609 OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG Surgery 14.38 12.93 12.93 RBRVS 25622 CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ Surgery 2.79 4.59 5.36 RBRVS 25624 CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ Surgery 4.77 6.70 7.92 RBRVS 25628 OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE Surgery 9.67 9.19 9.19 RBRVS 25630 CLTX CARPAL BONE FX W/O MANJ EACH BONE Surgery 3.03 4.41 5.12 RBRVS 25635 CLTX CARPAL BONE FX W/MANJ EACH BONE Surgery 4.61 5.77 7.16 RBRVS 25645 OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA Surgery 7.42 7.42 7.42 RBRVS 25650 CLOSED TREATMENT ULNAR STYLOID FRACTURE Surgery 3.23 4.75 5.31 RBRVS 25651 PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE Surgery 5.82 6.98 6.98 RBRVS 25652 OPEN TREATMENT ULNAR STYLOID FRACTURE Surgery 8.06 8.24 8.24 RBRVS 25660 CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ Surgery 4.98 5.87 5.87 RBRVS 25670 OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES Surgery 8.09 7.74 7.74 RBRVS 25671 PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION Surgery 6.46 7.41 7.41 RBRVS 25675 CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ Surgery 4.89 5.65 6.75 RBRVS 25676 OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC Surgery 8.29 8.06 8.06 RBRVS 25680 CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ Surgery 6.23 6.14 6.14 RBRVS 25685 OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC Surgery 10.09 9.00 9.00 RBRVS 25690 CLOSED TX LUNATE DISLOCATION W/MANIPULATION Surgery 5.72 6.88 6.88 RBRVS 25695 OPEN TREATMENT LUNATE DISLOCATION Surgery 8.51 7.94 7.94 RBRVS 25800 ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT Surgery 10.07 9.07 9.07 RBRVS 25805 ARTHRODESIS WRIST W/SLIDING GRAFT Surgery 11.73 10.15 10.15 RBRVS 25810 ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT Surgery 11.95 10.76 10.76 RBRVS 25820 ARTHRODESIS WRIST LIMITED W/O BONE GRAFT Surgery 7.64 8.58 8.58 RBRVS 25825 ARTHRODESIS WRIST LIMITED W/AUTOGRAFT Surgery 9.69 10.24 10.24 RBRVS 25830 ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE Surgery 10.88 14.18 14.18 RBRVS 25900 AMPUTATION FOREARM THROUGH RADIUS & ULNA Surgery 9.61 8.76 8.76 RBRVS 25905 AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR Surgery 9.59 8.61 8.61 RBRVS 25907 AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE Surgery 8.09 7.85 7.85 RBRVS 25909 AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION Surgery 9.31 8.47 8.47 RBRVS 25915 KRUKENBERG PROCEDURE Surgery 17.52 9.25 9.25 RBRVS 25920 DISARTICULATION THROUGH WRIST Surgery 9.03 9.13 9.13 RBRVS 25922 DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ Surgery 7.65 8.32 8.32 RBRVS 25924 DISARTICULATION THRU WRIST RE-AMPUTATION Surgery 8.81 8.91 8.91 RBRVS 25927 TRANSMETACARPAL AMPUTATION Surgery 9.09 12.28 12.28 RBRVS 25929 TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ Surgery 7.82 6.02 6.02 RBRVS 25931 TRANSMETACARPAL AMPUTATION RE-AMPUTATION Surgery 8.04 11.64 11.64 RBRVS 25999 UNLISTED PROCEDURE FOREARM/WRIST Surgery 16.21 Unlisted 26010 DRAINAGE FINGER ABSCESS SIMPLE Surgery 1.59 2.10 5.66 RBRVS 26011 DRAINAGE FINGER ABSCESS COMPLICATED Surgery 2.24 2.66 8.43 RBRVS 26020 DRAINAGE TENDON SHEATH DIGIT&/PALM EACH Surgery 5.08 6.36 6.36 RBRVS 26025 DRAINAGE OF PALMAR BURSA SINGLE BURSA Surgery 5.08 6.07 6.07 RBRVS 26030 DRAINAGE OF PALMAR BURSA MULTIPLE BURSA Surgery 6.25 6.70 6.70 RBRVS 26034 INCISION BONE CORTEX HAND/FINGER Surgery 6.63 7.52 7.52 RBRVS 26035 DECOMPRESSION FINGERS&/HAND INJECTION INJURY Surgery 11.37 10.93 10.93 RBRVS 26037 DECOMPRESSIVE FASCIOTOMY HAND Surgery 7.57 7.22 7.22 RBRVS 26040 FASCIOTOMY PALMAR PERCUTANEOUS Surgery 3.46 4.80 4.80 RBRVS 26045 FASCIOTOMY PALMAR OPEN PARTIAL Surgery 5.73 6.53 6.53 RBRVS 26055 TENDON SHEATH INCISION Surgery 3.11 5.15 12.16 RBRVS 26060 TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT Surgery 2.91 4.06 4.06 RBRVS 26070 ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT Surgery 3.81 4.56 4.56 RBRVS 26075 ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA Surgery 3.91 4.91 4.91 RBRVS 26080 ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA Surgery 4.47 5.84 5.84 RBRVS 26100 ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH Surgery 3.79 5.02 5.02 RBRVS 26105 ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH Surgery 3.83 5.04 5.04 RBRVS 26110 ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH Surgery 3.65 4.85 4.85 RBRVS 26111 EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/> Surgery 5.42 5.54 5.54 RBRVS 26113 EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/> Surgery 7.13 7.25 7.25 RBRVS 26115 EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM Surgery 3.96 4.81 9.65 RBRVS

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26116 EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM Surgery 6.74 7.09 7.09 RBRVS 26117 RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM Surgery 10.13 9.36 9.36 RBRVS 26118 RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/> Surgery 14.81 12.77 12.77 RBRVS 26121 FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT Surgery 7.73 7.92 7.92 RBRVS 26123 FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR Surgery 10.88 10.97 10.97 RBRVS 26125 FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR Surgery 4.60 2.47 2.47 RBRVS 26130 SYNOVECTOMY CARPOMETACARPAL JOINT Surgery 5.59 6.51 6.51 RBRVS 26135 SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD Surgery 7.13 7.31 7.31 RBRVS 26140 SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT Surgery 6.34 6.91 6.91 RBRVS 26145 SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN Surgery 6.49 6.94 6.94 RBRVS 26160 EXC LESION TDN SHTH/JT CAPSL HAND/FNGR Surgery 3.57 5.28 12.07 RBRVS 26170 EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH Surgery 4.91 5.83 5.83 RBRVS 26180 EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH Surgery 5.35 6.39 6.39 RBRVS 26185 SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE Surgery 6.52 7.97 7.97 RBRVS 26200 EXCISION/CURETTAGE CYST/TUMOR METACARPAL Surgery 5.65 6.14 6.14 RBRVS 26205 EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT Surgery 7.93 7.73 7.73 RBRVS 26210 EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER Surgery 5.32 6.33 6.33 RBRVS 26215 EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT Surgery 7.27 7.39 7.39 RBRVS 26230 PARTIAL EXCISION BONE METACARPAL Surgery 6.47 6.68 6.68 RBRVS 26235 PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER Surgery 6.33 6.63 6.63 RBRVS 26236 PARTIAL EXCISION DISTAL PHALANX FINGER Surgery 5.46 6.12 6.12 RBRVS 26250 RADICAL RESECTION TUMOR METACARPAL Surgery 15.21 13.13 13.13 RBRVS 26260 RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER Surgery 11.16 9.67 9.67 RBRVS 26262 RADICAL RESECTION TUMOR DISTAL PHALANX FINGER Surgery 8.29 8.23 8.23 RBRVS 26320 REMOVAL IMPLANT FROM FINGER/HAND Surgery 4.10 5.05 5.05 RBRVS 26340 MANIPULATION FINGER JOINT UNDER ANES EACH JOINT Surgery 2.80 6.18 6.18 RBRVS 26341 MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD Surgery 0.91 1.07 1.74 RBRVS 26350 RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON Surgery 6.21 12.67 12.67 RBRVS 26352 RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON Surgery 7.87 13.37 13.37 RBRVS 26356 RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON Surgery 10.62 18.31 18.31 RBRVS 26357 RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON Surgery 8.77 14.08 14.08 RBRVS 26358 RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON Surgery 9.36 14.53 14.53 RBRVS 26370 RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN Surgery 7.28 12.78 12.78 RBRVS 26372 RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA Surgery 9.01 14.20 14.20 RBRVS 26373 RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA Surgery 8.41 13.68 13.68 RBRVS 26390 EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F Surgery 9.43 12.34 12.34 RBRVS 26392 RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD Surgery 10.50 14.96 14.96 RBRVS 26410 REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH Surgery 4.77 10.20 10.20 RBRVS 26412 REPAIR EXTENSOR TENDON HAND W/GRAFT EACH Surgery 6.48 11.75 11.75 RBRVS 26415 EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA Surgery 8.51 10.16 10.16 RBRVS 26416 RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD Surgery 9.56 13.58 13.58 RBRVS 26418 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH Surgery 4.47 10.92 10.92 RBRVS 26420 REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH Surgery 6.94 11.72 11.72 RBRVS 26426 RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR Surgery 6.32 6.82 6.82 RBRVS 26428 RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER Surgery 7.40 12.27 12.27 RBRVS 26432 CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING Surgery 4.16 9.12 9.12 RBRVS 26433 REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF Surgery 4.70 9.37 9.37 RBRVS 26434 REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT Surgery 6.26 10.74 10.74 RBRVS 26437 REALIGNMENT EXTENSOR TENDON HAND EACH TENDON Surgery 5.99 10.43 10.43 RBRVS 26440 TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON Surgery 5.16 11.30 11.30 RBRVS 26442 TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO Surgery 9.75 15.66 15.66 RBRVS 26445 TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH Surgery 4.45 10.89 10.89 RBRVS 26449 TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA Surgery 8.59 9.76 9.76 RBRVS 26450 TENOTOMY FLEXOR PALM OPEN EACH TENDON Surgery 3.79 6.98 6.98 RBRVS 26455 TENOTOMY FLEXOR FINGER OPEN EACH TENDON Surgery 3.76 6.95 6.95 RBRVS 26460 TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON Surgery 3.58 6.81 6.81 RBRVS 26471 TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH Surgery 5.90 10.32 10.32 RBRVS 26474 TENODESIS DISTAL JOINT EACH Surgery 5.49 10.36 10.36 RBRVS 26476 LENGTHENING TENDON EXTENSOR HAND/FINGER EACH Surgery 5.35 10.04 10.04 RBRVS 26477 SHORTENING TENDON EXTENSOR HAND/FINGER EACH Surgery 5.32 10.05 10.05 RBRVS 26478 LENGTHENING TENDON FLEXOR HAND/FINGER EACH Surgery 5.97 10.35 10.35 RBRVS 26479 SHORTENING TENDON FLEXOR HAND/FINGER EACH Surgery 5.91 10.36 10.36 RBRVS 26480 TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN Surgery 6.90 13.06 13.06 RBRVS 26483 TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT Surgery 8.48 13.68 13.68 RBRVS 26485 TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH Surgery 7.89 13.43 13.43 RBRVS 26489 TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH Surgery 9.86 14.63 14.63 RBRVS 26490 OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN Surgery 8.60 12.18 12.18 RBRVS 26492 OPPONENSPLASTY TDN TR W/GRF EA TDN Surgery 9.84 13.15 13.15 RBRVS 26494 OPPONENSPLASTY HYPOTHENAR MUSC TR Surgery 8.66 11.86 11.86 RBRVS 26496 OPPONENSPLASTY OTHER METHODS Surgery 9.78 12.76 12.76 RBRVS 26497 TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR Surgery 9.76 12.77 12.77 RBRVS 26498 TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS Surgery 14.21 15.57 15.57 RBRVS 26499 CORRECTION CLAW FINGER OTHER METHODS Surgery 9.17 12.42 12.42 RBRVS 26500 RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX Surgery 6.13 10.29 10.29 RBRVS 26502 RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX Surgery 7.31 11.27 11.27 RBRVS

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26508 RELEASE THENAR MUSCLE Surgery 6.18 10.30 10.30 RBRVS 26510 CROSS INTRINSIC TRANSFER EACH TENDON Surgery 5.60 10.17 10.17 RBRVS 26516 CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT Surgery 7.32 11.12 11.12 RBRVS 26517 CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS Surgery 9.08 12.43 12.43 RBRVS 26518 CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS Surgery 9.27 12.48 12.48 RBRVS 26520 CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH Surgery 5.47 11.81 11.81 RBRVS 26525 CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH Surgery 5.50 11.79 11.79 RBRVS 26530 ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH Surgery 6.88 7.23 7.23 RBRVS 26531 ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT Surgery 8.13 8.24 8.24 RBRVS 26535 ARTHROPLASTY INTERPHALANGEAL JOINT EACH Surgery 5.41 5.74 5.74 RBRVS 26536 ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA Surgery 6.56 12.31 12.31 RBRVS 26540 RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT Surgery 6.60 10.68 10.68 RBRVS 26541 RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF Surgery 8.81 12.17 12.17 RBRVS 26542 RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS Surgery 6.95 10.93 10.93 RBRVS 26545 RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT Surgery 7.11 11.43 11.43 RBRVS 26546 RPR NON-UNION MTCRPL/PHALANX Surgery 10.83 15.31 15.31 RBRVS 26548 RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL Surgery 8.22 11.72 11.72 RBRVS 26550 POLLICIZATION DIGIT Surgery 21.68 20.77 20.77 RBRVS 26551 TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND Surgery 48.48 36.21 36.21 RBRVS 26553 TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1 Surgery 48.17 26.16 26.16 RBRVS 26554 TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2 Surgery 57.01 29.92 29.92 RBRVS 26555 TR FNGR AXH POS W/O MVASC ANAST Surgery 17.08 18.44 18.44 RBRVS 26556 TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS Surgery 49.75 20.95 20.95 RBRVS 26560 REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS Surgery 5.52 10.03 10.03 RBRVS 26561 REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT Surgery 11.10 13.30 13.30 RBRVS 26562 REPAIR SYNDACTYLY EACH SPACE COMPLEX Surgery 16.68 18.17 18.17 RBRVS 26565 OSTEOTOMY METACARPAL EACH Surgery 6.91 10.83 10.83 RBRVS 26567 OSTEOTOMY PHALANX FINGER EACH Surgery 6.99 10.88 10.88 RBRVS 26568 OSTEOPLASTY LENGTHENING METACARPAL/PHALANX Surgery 9.27 14.33 14.33 RBRVS 26580 REPAIR CLEFT HAND Surgery 19.75 19.30 19.30 RBRVS 26587 RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE Surgery 14.50 9.54 9.54 RBRVS 26590 REPAIR MACRODACTYLIA EACH DIGIT Surgery 18.67 17.62 17.62 RBRVS 26591 REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE Surgery 3.38 8.22 8.22 RBRVS 26593 RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE Surgery 5.50 10.39 10.39 RBRVS 26596 EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES Surgery 9.14 10.72 10.72 RBRVS 26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE Surgery 2.60 4.81 5.30 RBRVS 26605 CLTX METACARPAL FX W/MANIPULATION EACH BONE Surgery 3.03 4.76 5.58 RBRVS 26607 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE Surgery 5.48 6.48 6.48 RBRVS 26608 PRQ SKELETAL FIXJ METACARPAL FX EACH BONE Surgery 5.55 7.01 7.01 RBRVS 26615 OPEN TX METACARPAL FRACTURE SINGLE EA BONE Surgery 7.07 8.09 8.09 RBRVS 26641 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ Surgery 4.13 4.95 5.91 RBRVS 26645 CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ Surgery 4.58 5.70 6.70 RBRVS 26650 PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB Surgery 5.35 7.29 7.29 RBRVS 26665 OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB Surgery 7.94 8.56 8.56 RBRVS 26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES Surgery 3.83 4.27 5.14 RBRVS 26675 CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES Surgery 4.83 6.12 7.16 RBRVS 26676 PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT Surgery 5.74 7.47 7.47 RBRVS 26685 OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB Surgery 7.07 8.10 8.10 RBRVS 26686 OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ Surgery 8.17 8.06 8.06 RBRVS 26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES Surgery 3.83 4.15 4.72 RBRVS 26705 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES Surgery 4.38 5.59 6.58 RBRVS 26706 PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ Surgery 5.31 6.31 6.31 RBRVS 26715 OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION Surgery 7.03 8.05 8.05 RBRVS 26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA Surgery 1.76 3.18 3.57 RBRVS 26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA Surgery 3.48 4.54 5.48 RBRVS 26727 PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T Surgery 5.42 6.95 6.95 RBRVS 26735 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA Surgery 7.42 8.27 8.27 RBRVS 26740 CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ Surgery 2.07 3.68 4.08 RBRVS 26742 CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ Surgery 3.99 4.75 5.72 RBRVS 26746 OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA Surgery 9.80 9.63 9.63 RBRVS 26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA Surgery 1.80 3.15 3.14 RBRVS 26755 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA Surgery 3.23 3.99 5.16 RBRVS 26756 PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA Surgery 4.58 6.47 6.47 RBRVS 26765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH Surgery 5.86 7.37 7.37 RBRVS 26770 CLTX IPHAL JT DISLC W/MANJ W/O ANES Surgery 3.15 3.62 4.20 RBRVS 26775 CLTX IPHAL JT DISLC W/MANJ REQ ANES Surgery 3.90 5.29 6.32 RBRVS 26776 PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ Surgery 4.99 6.69 6.69 RBRVS 26785 OPEN TX INTERPHALANGEAL JOINT DISLOCATION Surgery 6.60 7.80 7.80 RBRVS 26820 FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT Surgery 8.45 12.11 12.11 RBRVS 26841 ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ Surgery 7.35 11.76 11.76 RBRVS 26842 ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT Surgery 8.49 12.03 12.03 RBRVS 26843 ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH Surgery 7.78 11.51 11.51 RBRVS 26844 ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT Surgery 8.98 12.38 12.38 RBRVS 26850 ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ Surgery 7.14 11.05 11.05 RBRVS 26852 ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT Surgery 8.71 12.12 12.12 RBRVS

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26860 ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ Surgery 4.88 10.09 10.09 RBRVS 26861 ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT Surgery 1.74 0.93 0.93 RBRVS 26862 ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT Surgery 7.56 11.52 11.52 RBRVS 26863 ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT Surgery 3.89 2.11 2.11 RBRVS 26910 AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER Surgery 7.79 10.91 10.91 RBRVS 26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR Surgery 6.04 11.18 11.18 RBRVS 26952 AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP Surgery 6.48 10.48 10.48 RBRVS 26989 UNLISTED PROCEDURE HANDS/FINGERS Surgery 10.96 Unlisted 26990 I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA Surgery 7.95 8.37 8.37 RBRVS 26991 I&D PELVIS/HIP JOINT AREA INFECTED BURSA Surgery 7.06 6.52 11.66 RBRVS 26992 INCISION BONE CORTEX PELVIS&/HIP JOINT Surgery 13.48 11.55 11.55 RBRVS 27000 TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX Surgery 5.74 5.20 5.20 RBRVS 27001 TENOTOMY ADDUCTOR HIP OPEN Surgery 7.14 6.93 6.93 RBRVS 27003 TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY Surgery 7.81 7.71 7.71 RBRVS 27005 TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE Surgery 10.07 8.80 8.80 RBRVS 27006 TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX Surgery 10.11 9.06 9.06 RBRVS 27025 FASCIOTOMY HIP/THIGH ANY TYPE Surgery 12.89 10.88 10.88 RBRVS 27027 DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI Surgery 13.04 10.01 10.01 RBRVS 27030 ARTHROTOMY HIP W/DRAINAGE Surgery 13.65 10.61 10.61 RBRVS 27033 ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY Surgery 14.11 11.04 11.04 RBRVS 27035 DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH Surgery 17.37 12.09 12.09 RBRVS 27036 CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC Surgery 14.38 11.89 11.89 RBRVS 27040 BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL Surgery 2.92 2.35 6.43 RBRVS 27041 BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM Surgery 10.18 7.66 7.66 RBRVS 27043 EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/> Surgery 6.88 5.07 5.07 RBRVS 27045 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/> Surgery 11.13 8.09 8.09 RBRVS 27047 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM Surgery 4.94 4.44 7.43 RBRVS 27048 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM Surgery 8.85 6.76 6.76 RBRVS 27049 RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM Surgery 21.55 12.59 12.59 RBRVS 27050 ARTHROTOMY W/BIOPSY SACROILIAC JOINT Surgery 4.74 5.81 5.81 RBRVS 27052 ARTHROTOMY W/BIOPSY HIP JOINT Surgery 7.42 7.71 7.71 RBRVS 27054 ARTHROTOMY W/SYNOVECTOMY HIP JOINT Surgery 9.21 8.64 8.64 RBRVS 27057 DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI Surgery 14.91 11.25 11.25 RBRVS 27059 RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/> Surgery 29.35 17.18 17.18 RBRVS 27060 EXCISION ISCHIAL BURSA Surgery 5.87 6.27 6.27 RBRVS 27062 EXCISION TROCHANTERIC BURSA/CALCIFICATION Surgery 5.75 6.18 6.18 RBRVS 27065 EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL Surgery 6.55 7.04 7.04 RBRVS 27066 EXCISION BONE CYST/BENIGN TUMOR DEEP Surgery 11.20 9.94 9.94 RBRVS 27067 EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC Surgery 14.72 12.04 12.04 RBRVS 27070 PARTIAL EXCISION SUPERFICIAL PELVIS Surgery 11.56 10.53 10.53 RBRVS 27071 PARTIAL EXCISION DEEP PELVIS Surgery 12.39 11.39 11.39 RBRVS 27075 RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL Surgery 32.71 21.33 21.33 RBRVS 27076 RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC Surgery 40.21 25.10 25.10 RBRVS 27077 RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL Surgery 45.21 27.63 27.63 RBRVS 27078 RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR Surgery 32.21 21.08 21.08 RBRVS 27080 COCCYGECTOMY PRIMARY Surgery 6.89 6.35 6.35 RBRVS 27086 RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS Surgery 1.92 2.52 6.11 RBRVS 27087 REMOVAL FOREIGN BODY PELVIS/HIP DEEP Surgery 8.83 7.39 7.39 RBRVS 27090 REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE Surgery 11.69 9.79 9.79 RBRVS 27091 RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA Surgery 24.35 16.92 16.92 RBRVS 27093 INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA Surgery 1.30 0.58 3.88 RBRVS 27095 INJECTION HIP ARTHROGRAPHY W/ANESTHESIA Surgery 1.50 0.70 5.18 RBRVS 27096 INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA Surgery 1.48 0.82 2.96 RBRVS 27097 RELEASE/RECESSION HAMSTRING PROXIMAL Surgery 9.27 8.44 8.44 RBRVS 27098 TRANSFER ADDUCTOR ISCHIUM Surgery 9.32 8.73 8.73 RBRVS 27100 TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF Surgery 11.35 10.07 10.07 RBRVS 27105 TR PARASPI MUSC HIP FASC/TDN XTN GRF Surgery 12.04 10.42 10.42 RBRVS 27110 TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR Surgery 13.77 11.29 11.29 RBRVS 27111 TRANSFER ILIOPSOAS FEMORAL NECK Surgery 12.60 10.70 10.70 RBRVS 27120 ACETABULOPLASTY Surgery 19.25 14.31 14.31 RBRVS 27122 ACETABULOPLASTY RESECTION FEMORAL HEAD Surgery 16.09 12.35 12.35 RBRVS 27125 HEMIARTHROPLASTY HIP PARTIAL Surgery 16.64 12.71 12.71 RBRVS 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT Surgery 20.72 14.36 14.36 RBRVS 27132 CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT Surgery 25.69 17.62 17.62 RBRVS 27134 REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT Surgery 30.28 19.14 19.14 RBRVS 27137 REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT Surgery 22.70 15.38 15.38 RBRVS 27138 REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT Surgery 23.70 15.84 15.84 RBRVS 27140 OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX Surgery 12.78 10.42 10.42 RBRVS 27146 OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE Surgery 18.92 14.16 14.16 RBRVS 27147 OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ Surgery 22.07 15.85 15.85 RBRVS 27151 OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT Surgery 24.12 16.89 16.89 RBRVS 27156 OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ Surgery 26.23 17.95 17.95 RBRVS 27158 OSTEOTOMY PELVIS BILATERAL Surgery 21.04 15.12 15.12 RBRVS 27161 OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE Surgery 17.89 13.60 13.60 RBRVS 27165 OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL Surgery 20.29 15.31 15.31 RBRVS

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27170 B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA Surgery 17.61 12.83 12.83 RBRVS 27175 TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION Surgery 9.38 7.90 7.90 RBRVS 27176 TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU Surgery 12.92 10.86 10.86 RBRVS 27177 OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT Surgery 16.09 12.72 12.72 RBRVS 27178 OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN Surgery 12.92 10.86 10.86 RBRVS 27179 OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX Surgery 13.97 11.28 11.28 RBRVS 27181 OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ Surgery 16.18 12.89 12.89 RBRVS 27185 EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR Surgery 9.79 6.34 6.34 RBRVS 27187 PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR Surgery 14.23 11.49 11.49 RBRVS 27193 CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MANJ Surgery 6.09 6.39 6.21 RBRVS 27194 CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/MANJ ANES Surgery 10.20 8.43 8.43 RBRVS 27200 CLOSED TREATMENT COCCYGEAL FRACTURE Surgery 1.92 3.12 2.90 RBRVS 27202 OPEN TREATMENT COCCYGEAL FRACTURE Surgery 7.31 6.51 6.51 RBRVS 27215 OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD Surgery 10.45 6.05 6.05 RBRVS 27216 PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS Surgery 15.73 8.71 8.71 RBRVS 27217 OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR Surgery 14.65 8.30 8.30 RBRVS 27218 OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD Surgery 20.93 10.67 10.67 RBRVS 27220 CLTX ACETABULUM HIP/SOCKT FX W/O MANJ Surgery 6.83 6.89 7.03 RBRVS 27222 CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ Surgery 14.11 11.21 11.21 RBRVS 27226 OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ Surgery 15.57 11.80 11.80 RBRVS 27227 OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT Surgery 25.41 17.43 17.43 RBRVS 27228 OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT Surgery 29.33 19.41 19.41 RBRVS 27230 CLTX FEM FX PROX END NCK W/O MANJ Surgery 5.81 6.56 6.66 RBRVS 27232 CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ Surgery 11.72 7.76 7.76 RBRVS 27235 PRQ SKEL FIXJ FEMORAL FX PROX END NECK Surgery 13.00 10.54 10.54 RBRVS 27236 OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT Surgery 17.61 13.38 13.38 RBRVS 27238 CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ Surgery 5.75 6.32 6.32 RBRVS 27240 CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ Surgery 13.81 10.99 10.99 RBRVS 27244 TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT Surgery 18.18 13.69 13.69 RBRVS 27245 TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW Surgery 18.18 13.69 13.69 RBRVS 27246 CLTX GREATER TROCHANTERIC FX W/O MANJ Surgery 4.83 5.29 5.25 RBRVS 27248 OPEN TREATMENT GREATER TROCHANTERIC FRACTURE Surgery 10.78 8.50 8.50 RBRVS 27250 CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA Surgery 3.82 0.78 0.78 RBRVS 27252 CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA Surgery 11.03 8.65 8.65 RBRVS 27253 OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ Surgery 13.58 10.79 10.79 RBRVS 27254 OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD Surgery 18.94 13.86 13.86 RBRVS 27256 TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES Surgery 4.28 1.77 3.64 RBRVS 27257 TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES Surgery 5.38 3.47 3.47 RBRVS 27258 OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM Surgery 16.18 12.51 12.51 RBRVS 27259 OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT Surgery 23.26 16.80 16.80 RBRVS 27265 CLTX POST HIP ARTHRP DISLC W/O ANES Surgery 5.24 5.28 5.28 RBRVS 27266 CLTX POST HIP ARTHRP DISLC REQ ANES Surgery 7.78 7.35 7.35 RBRVS 27267 CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ Surgery 5.50 5.84 5.84 RBRVS 27268 CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ Surgery 7.12 6.89 6.89 RBRVS 27269 OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD Surgery 18.89 13.22 13.22 RBRVS 27275 MANIPULATION HIP JOINT GENERAL ANESTHESIA Surgery 2.32 2.49 2.49 RBRVS 27279 ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS Surgery 9.03 5.88 5.88 RBRVS 27280 ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT Surgery 14.64 12.29 12.29 RBRVS 27282 ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT Surgery 11.85 7.16 7.16 RBRVS 27284 ARTHRODESIS HIP JOINT W/OBTAINING GRAFT Surgery 25.06 13.86 13.86 RBRVS 27286 ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT Surgery 25.17 17.42 17.42 RBRVS 27290 INTERPELVIABDOMINAL AMPUTATION Surgery 24.55 17.33 17.33 RBRVS 27295 DISARTICULATION HIP Surgery 19.66 12.56 12.56 RBRVS 27299 UNLISTED PROCEDURE PELVIS/HIP JOINT Surgery 13.90 Unlisted 27301 I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION Surgery 6.78 6.07 10.76 RBRVS 27303 INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE Surgery 8.63 7.94 7.94 RBRVS 27305 FASCIOTOMY ILIOTIBIAL OPEN Surgery 6.18 6.47 6.47 RBRVS 27306 TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX Surgery 4.74 4.88 4.88 RBRVS 27307 TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON Surgery 6.06 6.47 6.47 RBRVS 27310 ARTHRT KNE W/EXPL DRG/RMVL FB Surgery 10.00 9.02 9.02 RBRVS 27323 BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL Surgery 2.33 2.36 4.95 RBRVS 27324 BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP Surgery 5.04 5.22 5.22 RBRVS 27325 NEURECTOMY HAMSTRING MUSCLE Surgery 7.20 5.74 5.74 RBRVS 27326 NEURECTOMY POPLITEAL Surgery 6.47 6.95 6.95 RBRVS 27327 EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM Surgery 3.96 4.20 8.32 RBRVS 27328 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM Surgery 8.85 7.10 7.10 RBRVS 27329 RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM Surgery 15.72 10.78 10.78 RBRVS 27330 ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY Surgery 5.11 5.75 5.75 RBRVS 27331 ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB Surgery 6.02 6.43 6.43 RBRVS 27332 ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT Surgery 8.46 8.27 8.27 RBRVS 27333 ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT Surgery 7.55 7.72 7.72 RBRVS 27334 ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR Surgery 9.19 8.65 8.65 RBRVS 27335 ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA Surgery 10.55 9.33 9.33 RBRVS 27337 EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/> Surgery 5.91 4.78 4.78 RBRVS 27339 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/> Surgery 11.13 8.18 8.18 RBRVS

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27340 EXCISION PREPATELLAR BURSA Surgery 4.32 5.45 5.45 RBRVS 27345 EXCISION SYNOVIAL CYST POPLITEAL SPACE Surgery 6.09 6.51 6.51 RBRVS 27347 EXCISION LESION MENISCUS/CAPSULE KNEE Surgery 6.73 7.11 7.11 RBRVS 27350 PATELLECTOMY/HEMIPATELLECTOMY Surgery 8.66 8.34 8.34 RBRVS 27355 EXCISION/CURETTAGE CYST/TUMOR FEMUR Surgery 8.00 7.73 7.73 RBRVS 27356 EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT Surgery 10.09 9.07 9.07 RBRVS 27357 EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT Surgery 11.16 9.95 9.95 RBRVS 27358 EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION Surgery 4.73 2.39 2.39 RBRVS 27360 PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA Surgery 11.46 10.72 10.72 RBRVS 27364 RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/> Surgery 24.49 15.54 15.54 RBRVS 27365 RADICAL RESECTION TUMOR FEMOR OR KNEE Surgery 32.21 21.00 21.00 RBRVS 27370 INJECTION KNEE ARTHROGRAPHY Surgery 0.96 0.39 3.33 RBRVS 27372 REMOVAL FOREIGN BODY DEEP THIGH/KNEE Surgery 5.21 5.38 11.14 RBRVS 27380 SUTURE INFRAPATELLAR TENDON PRIMARY Surgery 7.45 8.11 8.11 RBRVS 27381 SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF Surgery 10.76 10.00 10.00 RBRVS 27385 SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY Surgery 6.93 8.20 8.20 RBRVS 27386 SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ Surgery 11.13 10.50 10.50 RBRVS 27390 TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON Surgery 5.53 6.20 6.20 RBRVS 27391 TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG Surgery 7.49 7.54 7.54 RBRVS 27392 TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI Surgery 9.63 8.88 8.88 RBRVS 27393 LENGTHENING HAMSTRING TENDON SINGLE Surgery 6.59 6.71 6.71 RBRVS 27394 LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG Surgery 8.79 8.18 8.18 RBRVS 27395 LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL Surgery 12.24 10.52 10.52 RBRVS 27396 TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON Surgery 8.15 7.87 7.87 RBRVS 27397 TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN Surgery 12.66 11.11 11.11 RBRVS 27400 TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR Surgery 9.33 8.73 8.73 RBRVS 27403 ARTHROTOMY W/MENISCUS REPAIR KNEE Surgery 8.62 8.06 8.06 RBRVS 27405 RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL Surgery 9.08 8.56 8.56 RBRVS 27407 REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT Surgery 10.85 9.71 9.71 RBRVS 27409 RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE Surgery 13.71 11.26 11.26 RBRVS 27412 AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE Surgery 24.74 17.94 17.94 RBRVS 27415 OSTEOCHONDRAL ALLOGRAFT KNEE OPEN Surgery 20.00 15.57 15.57 RBRVS 27416 OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY Surgery 14.16 11.18 11.18 RBRVS 27418 ANTERIOR TIBIAL TUBERCLEPLASTY Surgery 11.60 9.93 9.93 RBRVS 27420 RCNSTJ DISLOCATING PATELLA Surgery 10.26 9.00 9.00 RBRVS 27422 RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL Surgery 10.21 9.14 9.14 RBRVS 27424 RCNSTJ DISLC PATELLA W/PATELLECTOMY Surgery 10.24 9.19 9.19 RBRVS 27425 LATERAL RETINACULAR RELEASE OPEN Surgery 5.39 6.36 6.36 RBRVS 27427 LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR Surgery 9.79 8.80 8.80 RBRVS 27428 LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR Surgery 15.58 13.31 13.31 RBRVS 27429 LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR Surgery 17.54 14.92 14.92 RBRVS 27430 QUADRICEPSPLASTY Surgery 10.16 9.10 9.10 RBRVS 27435 CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE Surgery 10.88 10.17 10.17 RBRVS 27437 ARTHROPLASTY PATELLA W/O PROSTHESIS Surgery 8.93 8.25 8.25 RBRVS 27438 ARTHROPLASTY PATELLA W/PROSTHESIS Surgery 11.89 9.97 9.97 RBRVS 27440 ARTHROPLASTY KNEE TIBIAL PLATEAU Surgery 11.09 9.59 9.59 RBRVS 27441 ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT Surgery 11.54 9.82 9.82 RBRVS 27442 ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE Surgery 12.37 10.20 10.20 RBRVS 27443 ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL Surgery 11.41 9.75 9.75 RBRVS 27445 ARTHROPLASTY KNEE HINGE PROSTHESIS Surgery 18.66 13.72 13.72 RBRVS 27446 ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT Surgery 17.48 12.54 12.54 RBRVS 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS Surgery 20.72 14.35 14.35 RBRVS 27448 OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION Surgery 11.60 8.54 8.54 RBRVS 27450 OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION Surgery 14.61 11.56 11.56 RBRVS 27454 OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT Surgery 19.17 14.41 14.41 RBRVS 27455 OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL Surgery 13.36 11.03 11.03 RBRVS 27457 OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL Surgery 14.03 10.75 10.75 RBRVS 27465 OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876 Surgery 18.60 13.58 13.58 RBRVS 27466 OSTEOPLASTY FEMUR LENGTHENING Surgery 17.28 13.32 13.32 RBRVS 27468 OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR Surgery 19.97 14.69 14.69 RBRVS 27470 RPR NON/MAL FEMUR DSTL H/N W/O GRF Surgery 17.14 13.33 13.33 RBRVS 27472 RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE Surgery 18.72 14.01 14.01 RBRVS 27475 ARREST EPIPHYSEAL DISTAL FEMUR Surgery 8.93 8.27 8.27 RBRVS 27477 ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL Surgery 10.14 8.88 8.88 RBRVS 27479 ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB Surgery 13.16 10.65 10.65 RBRVS 27485 ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA Surgery 9.13 8.28 8.28 RBRVS 27486 REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT Surgery 21.12 15.33 15.33 RBRVS 27487 REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE Surgery 27.11 18.32 18.32 RBRVS 27488 RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER Surgery 17.60 13.54 13.54 RBRVS 27495 PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR Surgery 16.54 12.64 12.64 RBRVS 27496 DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT Surgery 6.78 7.44 7.44 RBRVS 27497 DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE Surgery 7.79 7.35 7.35 RBRVS 27498 DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS Surgery 8.66 8.39 8.39 RBRVS 27499 DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE Surgery 9.43 8.78 8.78 RBRVS 27500 CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION Surgery 6.30 6.26 7.36 RBRVS

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27501 CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ Surgery 6.45 6.56 6.69 RBRVS 27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ Surgery 11.36 8.54 8.54 RBRVS 27503 CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ Surgery 11.27 9.53 9.53 RBRVS 27506 OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW Surgery 19.65 15.01 15.01 RBRVS 27507 OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE Surgery 14.48 10.68 10.68 RBRVS 27508 CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ Surgery 6.20 6.76 7.65 RBRVS 27509 PRQ SKELETAL FIXJ FEMORAL FX DISTAL END Surgery 8.14 8.76 8.76 RBRVS 27510 CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ Surgery 9.80 7.99 7.99 RBRVS 27511 OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN Surgery 15.11 10.63 10.63 RBRVS 27513 OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN Surgery 19.25 12.71 12.71 RBRVS 27514 OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE Surgery 14.60 10.38 10.38 RBRVS 27516 CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ Surgery 5.59 6.94 7.83 RBRVS 27517 CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL Surgery 9.12 8.73 8.73 RBRVS 27519 OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION Surgery 13.25 9.74 9.74 RBRVS 27520 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION Surgery 3.04 4.81 5.62 RBRVS 27524 OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR Surgery 10.37 9.23 9.23 RBRVS 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION Surgery 2.65 4.83 5.46 RBRVS 27532 CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ Surgery 7.55 7.54 8.62 RBRVS 27535 OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR Surgery 13.41 9.77 9.77 RBRVS 27536 OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ Surgery 17.39 13.43 13.43 RBRVS 27538 CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN Surgery 5.09 6.63 7.49 RBRVS 27540 OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE Surgery 11.30 9.82 9.82 RBRVS 27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA Surgery 5.98 6.28 7.32 RBRVS 27552 CLOSED TX KNEE DISLOCATION W/ANESTHESIA Surgery 8.18 8.18 8.18 RBRVS 27556 OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR Surgery 13.00 9.61 9.61 RBRVS 27557 OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR Surgery 15.90 11.07 11.07 RBRVS 27558 OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION Surgery 18.39 12.33 12.33 RBRVS 27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA Surgery 3.99 4.80 5.60 RBRVS 27562 CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA Surgery 5.98 6.67 6.67 RBRVS 27566 OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY Surgery 12.71 10.40 10.40 RBRVS 27570 MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA Surgery 1.79 2.19 2.19 RBRVS 27580 ARTHRODESIS KNEE ANY TECHNIQUE Surgery 21.10 16.06 16.06 RBRVS 27590 AMPUTATION THIGH THROUGH FEMUR ANY LEVEL Surgery 13.47 6.87 6.87 RBRVS 27591 AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST Surgery 13.94 11.04 11.04 RBRVS 27592 AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR Surgery 10.98 6.46 6.46 RBRVS 27594 AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION Surgery 7.29 5.73 5.73 RBRVS 27596 AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION Surgery 11.29 7.08 7.08 RBRVS 27598 DISARTICULATION KNEE Surgery 11.22 7.15 7.15 RBRVS 27599 UNLISTED PROCEDURE FEMUR/KNEE Surgery 35.07 Unlisted 27600 DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY Surgery 6.03 4.66 4.66 RBRVS 27601 DCMPRN FASCT LEG POST COMPARTMENT ONLY Surgery 6.05 5.57 5.57 RBRVS 27602 DCMPRN FASCT LEG ANT&/LAT&PST CMPRT Surgery 7.82 4.66 4.66 RBRVS 27603 INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA Surgery 5.23 4.90 8.90 RBRVS 27604 INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA Surgery 4.59 4.49 8.65 RBRVS 27605 TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES Surgery 2.92 2.07 6.49 RBRVS 27606 TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES Surgery 4.18 3.32 3.32 RBRVS 27607 INCISION LEG/ANKLE Surgery 8.62 7.35 7.35 RBRVS 27610 ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB Surgery 9.13 7.97 7.97 RBRVS 27612 ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH Surgery 8.15 6.89 6.89 RBRVS 27613 BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL Surgery 2.22 2.13 4.62 RBRVS 27614 BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP Surgery 5.80 4.82 9.67 RBRVS 27615 RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM Surgery 15.72 10.52 10.52 RBRVS 27616 RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/> Surgery 19.63 12.86 12.86 RBRVS 27618 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM Surgery 3.96 4.08 8.13 RBRVS 27619 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM Surgery 6.91 5.54 5.54 RBRVS 27620 ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB Surgery 6.15 6.01 6.01 RBRVS 27625 ARTHROTOMY W/SYNOVECTOMY ANKLE Surgery 8.49 6.97 6.97 RBRVS 27626 ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY Surgery 9.10 7.21 7.21 RBRVS 27630 EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK Surgery 4.94 4.78 10.35 RBRVS 27632 EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/> Surgery 5.91 4.78 4.78 RBRVS 27634 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/> Surgery 10.13 7.58 7.58 RBRVS 27635 EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA Surgery 8.03 7.38 7.38 RBRVS 27637 EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT Surgery 10.31 9.56 9.56 RBRVS 27638 EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT Surgery 10.99 9.10 9.10 RBRVS 27640 PARTIAL EXCISION BONE TIBIA Surgery 12.24 9.57 9.57 RBRVS 27641 PARTIAL EXCISION BONE FIBULA Surgery 9.84 7.72 7.72 RBRVS 27645 RADICAL RESECTION OF TUMOR TIBIA Surgery 27.21 18.66 18.66 RBRVS 27646 RADICAL RESECTION TUMOR BONE FIBULA Surgery 23.21 16.65 16.65 RBRVS 27647 RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS Surgery 20.26 7.76 7.76 RBRVS 27648 INJECTION ANKLE ARTHROGRAPHY Surgery 0.96 0.42 3.54 RBRVS 27650 REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON Surgery 9.21 8.29 8.29 RBRVS 27652 RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT Surgery 10.78 7.50 7.50 RBRVS 27654 REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT Surgery 10.53 8.33 8.33 RBRVS 27656 REPAIR FASCIAL DEFECT LEG Surgery 4.71 5.70 12.52 RBRVS 27658 REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH Surgery 5.12 4.87 4.87 RBRVS

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27659 RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH Surgery 7.10 5.71 5.71 RBRVS 27664 RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH Surgery 4.73 4.98 4.98 RBRVS 27665 RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH Surgery 5.57 5.36 5.36 RBRVS 27675 RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY Surgery 7.35 5.57 5.57 RBRVS 27676 REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT Surgery 8.73 6.98 6.98 RBRVS 27680 TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH Surgery 5.88 5.52 5.52 RBRVS 27681 TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN Surgery 7.05 7.21 7.21 RBRVS 27685 LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX Surgery 6.69 5.74 11.44 RBRVS 27686 LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA Surgery 7.75 7.05 7.05 RBRVS 27687 GASTROCNEMIUS RECESSION Surgery 6.41 5.73 5.73 RBRVS 27690 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC Surgery 9.17 7.66 7.66 RBRVS 27691 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP Surgery 10.49 9.32 9.32 RBRVS 27692 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN Surgery 1.87 0.82 0.82 RBRVS 27695 RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL Surgery 6.70 6.00 6.00 RBRVS 27696 RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS Surgery 8.58 6.16 6.16 RBRVS 27698 REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL Surgery 9.61 7.31 7.31 RBRVS 27700 ARTHROPLASTY ANKLE Surgery 9.66 6.39 6.39 RBRVS 27702 ARTHROPLASTY ANKLE W/IMPLANT Surgery 14.42 10.89 10.89 RBRVS 27703 ARTHROPLASTY ANKLE REVISION TOTAL ANKLE Surgery 16.94 12.08 12.08 RBRVS 27704 REMOVAL ANKLE IMPLANT Surgery 7.81 7.31 7.31 RBRVS 27705 OSTEOTOMY TIBIA Surgery 10.86 8.80 8.80 RBRVS 27707 OSTEOTOMY FIBULA Surgery 4.78 5.87 5.87 RBRVS 27709 OSTEOTOMY TIBIA & FIBULA Surgery 17.48 12.90 12.90 RBRVS 27712 OSTEOT MLT W/RELIGNMT IMED ROD Surgery 15.87 12.74 12.74 RBRVS 27715 OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN Surgery 15.50 11.57 11.57 RBRVS 27720 REPAIR NONUNION/MALUNION TIBIA W/O GRAFT Surgery 12.36 10.43 10.43 RBRVS 27722 REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT Surgery 12.45 10.64 10.64 RBRVS 27724 RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT Surgery 19.31 13.41 13.41 RBRVS 27725 RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH Surgery 17.41 14.21 14.21 RBRVS 27726 REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION Surgery 14.34 10.69 10.69 RBRVS 27727 REPAIR CONGENITAL PSEUDARTHROSIS TIBIA Surgery 14.84 8.68 8.68 RBRVS 27730 ARREST EPIPHYSEAL OPEN DISTAL TIBIA Surgery 7.70 7.56 7.56 RBRVS 27732 ARREST EPIPHYSEAL OPEN DISTAL FIBULA Surgery 5.46 6.26 6.26 RBRVS 27734 ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA Surgery 8.83 8.22 8.22 RBRVS 27740 ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA Surgery 9.61 8.80 8.80 RBRVS 27742 ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR Surgery 10.63 9.58 9.58 RBRVS 27745 PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA Surgery 10.49 9.27 9.27 RBRVS 27750 CLTX TIBIAL SHAFT FX W/O MANIPULATION Surgery 3.37 5.08 5.89 RBRVS 27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ Surgery 6.27 6.69 7.87 RBRVS 27756 PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE Surgery 7.45 7.67 7.67 RBRVS 27758 OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE Surgery 12.54 10.63 10.63 RBRVS 27759 TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA Surgery 14.45 11.43 11.43 RBRVS 27760 CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION Surgery 3.21 4.92 5.76 RBRVS 27762 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ Surgery 5.47 5.91 7.11 RBRVS 27766 OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE Surgery 7.89 8.15 8.15 RBRVS 27767 CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ Surgery 2.64 4.97 4.93 RBRVS 27768 CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ Surgery 5.14 6.43 6.43 RBRVS 27769 OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE Surgery 10.14 8.65 8.65 RBRVS 27780 CLTX PROX FIBULA/SHFT FX W/O MANJ Surgery 2.83 4.59 5.39 RBRVS 27781 CLTX PROX FIBULA/SHFT FX W/MANJ Surgery 4.59 5.77 6.65 RBRVS 27784 OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE Surgery 9.67 9.03 9.03 RBRVS 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ Surgery 3.02 4.62 5.49 RBRVS 27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ Surgery 4.64 5.52 6.55 RBRVS 27792 OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS Surgery 8.75 8.36 8.36 RBRVS 27808 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ Surgery 3.03 5.00 5.96 RBRVS 27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ Surgery 5.32 5.86 7.09 RBRVS 27814 OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE Surgery 10.62 9.54 9.54 RBRVS 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION Surgery 3.07 4.61 5.56 RBRVS 27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION Surgery 5.69 5.72 7.14 RBRVS 27822 OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP Surgery 11.21 10.80 10.80 RBRVS 27823 OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP Surgery 13.16 11.81 11.81 RBRVS 27824 CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ Surgery 3.31 4.76 5.02 RBRVS 27825 CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ Surgery 6.69 6.22 7.66 RBRVS 27826 OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA Surgery 11.10 10.70 10.70 RBRVS 27827 OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY Surgery 14.79 13.44 13.44 RBRVS 27828 OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA Surgery 18.43 15.27 15.27 RBRVS 27829 OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION Surgery 8.80 9.20 9.20 RBRVS 27830 CLTX PROX TIBFIB JT DISLC W/O ANES Surgery 3.96 5.39 6.13 RBRVS 27831 CLTX PROX TIBFIB JT DISLC REQ ANES Surgery 4.73 5.77 5.77 RBRVS 27832 OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB Surgery 10.17 9.51 9.51 RBRVS 27840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA Surgery 4.77 4.97 4.97 RBRVS 27842 CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ Surgery 6.46 6.55 6.55 RBRVS 27846 OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ Surgery 10.28 8.86 8.86 RBRVS 27848 OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ Surgery 11.68 9.56 9.56 RBRVS 27860 MANIPULATION ANKLE UNDER GENERAL ANESTHESIA Surgery 2.39 2.20 2.20 RBRVS

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27870 ARTHRODESIS ANKLE OPEN Surgery 15.41 11.56 11.56 RBRVS 27871 ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL Surgery 9.54 8.40 8.40 RBRVS 27880 AMPUTATION LEG THROUGH TIBIA&FIBULA Surgery 15.37 8.00 8.00 RBRVS 27881 AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST Surgery 13.47 8.78 8.78 RBRVS 27882 AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR Surgery 9.79 5.52 5.52 RBRVS 27884 AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV Surgery 8.76 6.05 6.05 RBRVS 27886 AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION Surgery 10.02 6.92 6.92 RBRVS 27888 AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV Surgery 10.37 7.52 7.52 RBRVS 27889 ANKLE DISARTICULATION Surgery 10.86 5.55 5.55 RBRVS 27892 DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE Surgery 7.94 6.29 6.29 RBRVS 27893 DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV Surgery 7.90 8.01 8.01 RBRVS 27894 DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS Surgery 12.67 9.63 9.63 RBRVS 27899 UNLISTED PROCEDURE LEG/ANKLE Surgery 17.11 Unlisted 28001 INCISION&DRAINAGE BURSA FOOT Surgery 2.78 1.92 5.03 RBRVS 28002 I&D BELOW FASCIA FOOT 1 BURSAL SPACE Surgery 5.34 3.30 6.87 RBRVS 28003 I&D BELOW FASCIA FOOT MULTIPLE AREAS Surgery 9.06 6.23 10.32 RBRVS 28005 INCISION BONE CORTEX FOOT Surgery 9.44 6.29 6.29 RBRVS 28008 FASCIOTOMY FOOT&/TOE Surgery 4.59 3.45 7.49 RBRVS 28010 TENOTOMY PERCUTANEOUS TOE SINGLE TENDON Surgery 2.97 2.79 3.44 RBRVS 28011 TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON Surgery 4.28 3.56 4.56 RBRVS 28020 ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT Surgery 5.15 4.63 9.90 RBRVS 28022 ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT Surgery 4.81 4.04 8.82 RBRVS 28024 ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT Surgery 4.52 3.82 8.39 RBRVS 28035 RELEASE TARSAL TUNNEL Surgery 5.23 4.38 9.39 RBRVS 28039 EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/> Surgery 5.42 3.99 8.60 RBRVS 28041 EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/> Surgery 7.13 5.22 5.22 RBRVS 28043 EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM Surgery 3.96 3.22 7.21 RBRVS 28045 EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM Surgery 5.45 4.03 8.33 RBRVS 28046 RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM Surgery 12.38 7.20 7.20 RBRVS 28047 RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/> Surgery 17.45 10.62 10.62 RBRVS 28050 ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT Surgery 4.39 4.18 9.17 RBRVS 28052 ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT Surgery 4.06 3.64 8.33 RBRVS 28054 ARTHRTOMY W/BX INTERPHALANGEAL JOINT Surgery 3.57 2.95 7.00 RBRVS 28055 NEURECTOMY INTRINSIC MUSCULATURE OF FOOT Surgery 6.29 4.06 4.06 RBRVS 28060 FASCIECTOMY PLANTAR FASCIA PARTIAL SPX Surgery 5.40 4.29 9.00 RBRVS 28062 FASCIOTOMY PLANTAR FASCIA RADICAL SPX Surgery 6.69 4.38 9.55 RBRVS 28070 SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX Surgery 5.24 4.31 9.42 RBRVS 28072 SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH Surgery 4.72 4.36 9.57 RBRVS 28080 EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH Surgery 4.86 5.24 9.86 RBRVS 28086 SYNOVECTOMY TENDON SHEATH FOOT FLEXOR Surgery 4.92 4.81 10.29 RBRVS 28088 SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR Surgery 3.98 3.62 8.39 RBRVS 28090 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT Surgery 4.55 3.85 8.60 RBRVS 28092 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA Surgery 3.78 3.57 8.07 RBRVS 28100 EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS Surgery 5.83 5.33 11.03 RBRVS 28102 EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT Surgery 7.92 7.90 7.90 RBRVS 28103 EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT Surgery 6.67 4.09 4.09 RBRVS 28104 EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL Surgery 5.26 4.37 9.51 RBRVS 28106 EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT Surgery 7.35 4.44 4.44 RBRVS 28107 EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT Surgery 5.73 3.87 8.75 RBRVS 28108 EXC/CURTG CST/B9 TUM PHALANGES FOOT Surgery 4.30 3.63 8.11 RBRVS 28110 OSTECTOMY PRTL 5TH METAR HEAD SPX Surgery 4.22 3.68 8.76 RBRVS 28111 OSTECTOMY COMPLETE 1ST METATARSAL HEAD Surgery 5.15 3.68 8.58 RBRVS 28112 OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4 Surgery 4.63 3.90 9.07 RBRVS 28113 OSTECTOMY COMPLETE 5TH METATARSAL HEAD Surgery 6.11 5.58 10.46 RBRVS 28114 OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC Surgery 12.00 10.61 17.56 RBRVS 28116 OSTECTOMY TARSAL COALITION Surgery 9.14 6.31 11.70 RBRVS 28118 OSTECTOMY CALCANEUS Surgery 6.13 4.99 10.25 RBRVS 28119 OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS Surgery 5.56 4.28 9.09 RBRVS 28120 PARTIAL EXCISION BONE TALUS/CALCANEUS Surgery 7.31 6.05 11.27 RBRVS 28122 PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS Surgery 6.76 5.20 9.83 RBRVS 28124 PARTICAL EXCISION BONE PHALANX TOE Surgery 5.00 4.07 8.36 RBRVS 28126 RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH Surgery 3.64 3.17 7.46 RBRVS 28130 TALECTOMY ASTRAGALECTOMY Surgery 9.50 7.36 7.36 RBRVS 28140 METATARSECTOMY Surgery 7.14 4.61 9.17 RBRVS 28150 PHALANGECTOMY TOE EACH TOE Surgery 4.23 3.44 7.70 RBRVS 28153 RESECTION CONDYLE DISTAL END PHALANX EACH TOE Surgery 3.80 3.45 7.77 RBRVS 28160 HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE Surgery 3.88 3.53 7.95 RBRVS 28171 RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS Surgery 16.41 6.82 6.82 RBRVS 28173 RADICAL RESECTION TUMOR METATARSAL Surgery 14.16 6.49 6.49 RBRVS 28175 RADICAL RESECTION TUMOR PHALANX OR TOE Surgery 8.29 5.19 5.19 RBRVS 28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS Surgery 2.01 1.66 5.21 RBRVS 28192 REMOVAL FOREIGN BODY FOOT DEEP Surgery 4.78 3.77 8.32 RBRVS 28193 REMOVAL FOREIGN BODY FOOT COMPLICATED Surgery 5.90 4.21 8.97 RBRVS 28200 RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON Surgery 4.74 3.98 8.89 RBRVS 28202 RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON Surgery 7.07 4.50 9.44 RBRVS

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28208 REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON Surgery 4.51 3.98 8.73 RBRVS 28210 RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON Surgery 6.52 4.85 9.83 RBRVS 28220 TENOLYSIS FLEXOR FOOT SINGLE TENDON Surgery 4.67 3.61 7.96 RBRVS 28222 TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS Surgery 5.76 3.76 8.32 RBRVS 28225 TENOLYSIS EXTENSOR FOOT SINGLE TENDON Surgery 3.78 3.29 7.65 RBRVS 28226 TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON Surgery 4.67 3.40 7.72 RBRVS 28230 TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX Surgery 4.36 3.43 7.88 RBRVS 28232 TX OPEN TENDON FLEXOR TOE 1 TENDON SPX Surgery 3.51 3.17 7.37 RBRVS 28234 TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON Surgery 3.54 3.72 7.97 RBRVS 28238 RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR Surgery 7.96 5.32 10.74 RBRVS 28240 TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC Surgery 4.48 3.45 7.86 RBRVS 28250 DIVISION PLANTAR FASCIA & MUSCLE SPX Surgery 6.06 4.82 9.95 RBRVS 28260 CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX Surgery 8.19 5.58 10.71 RBRVS 28261 CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING Surgery 13.11 8.10 14.20 RBRVS 28262 CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH Surgery 17.21 13.40 21.72 RBRVS 28264 CAPSULOTOMY MIDTARSAL Surgery 10.65 7.13 12.95 RBRVS 28270 CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX Surgery 4.93 4.18 8.81 RBRVS 28272 CAPSULOTOMY IPHAL JOINT EACH JOINT SPX Surgery 3.92 3.11 7.19 RBRVS 28280 SYNDACTYLIZATION TOES Surgery 5.33 4.12 8.99 RBRVS 28285 CORRECTION HAMMERTOE Surgery 5.62 4.69 9.29 RBRVS 28286 CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE Surgery 4.70 3.51 7.93 RBRVS 28288 OSTC PRTL EXOSTC/CONDYLC METAR HEAD Surgery 6.02 5.67 10.76 RBRVS 28289 HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT Surgery 8.31 6.48 11.90 RBRVS 28290 CORRJ HALLUX VALGUS W/WO SESMDC SMPL EXOSTECTOMY Surgery 5.83 4.89 10.56 RBRVS 28292 KELLER/MCBRIDE/MAYO PROCEDURE Surgery 9.05 7.43 12.91 RBRVS 28293 CORRJ HALLUX VALGUS W/WO SESMDC RESCJ JT W/IMPLT Surgery 11.48 8.00 17.74 RBRVS 28294 CORRJ HALLUX VALGUS W/WO SESMDC W/TDN TRNSPLS Surgery 8.75 6.13 12.69 RBRVS 28296 CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT Surgery 8.35 5.89 11.48 RBRVS 28297 CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX Surgery 9.43 6.22 12.90 RBRVS 28298 CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT Surgery 8.13 5.54 11.80 RBRVS 28299 CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT Surgery 11.57 6.81 13.21 RBRVS 28300 OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION Surgery 9.73 7.56 7.56 RBRVS 28302 OSTEOTOMY TALUS Surgery 9.74 8.86 8.86 RBRVS 28304 OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS Surgery 9.41 6.83 13.25 RBRVS 28305 OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT Surgery 10.77 7.22 7.22 RBRVS 28306 OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR Surgery 6.00 4.85 10.97 RBRVS 28307 OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE Surgery 6.50 5.74 12.67 RBRVS 28308 OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA Surgery 5.48 4.75 10.25 RBRVS 28309 OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT Surgery 14.16 9.92 9.92 RBRVS 28310 OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE Surgery 5.57 4.18 9.71 RBRVS 28312 OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE Surgery 4.69 4.10 9.76 RBRVS 28313 RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY Surgery 5.15 4.51 9.49 RBRVS 28315 SESAMOIDECTOMY FIRST TOE SPX Surgery 5.00 3.89 8.47 RBRVS 28320 REPAIR NONUNION/MALUNION TARSAL BONES Surgery 9.37 6.83 6.83 RBRVS 28322 RPR NON/MALUNION METARSAL W/WO BONE GRAFT Surgery 8.53 6.85 13.00 RBRVS 28340 RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION Surgery 7.15 4.21 9.05 RBRVS 28341 RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION Surgery 8.72 4.80 10.03 RBRVS 28344 RECONSTRUCTION TOE POLYDACTYLY Surgery 4.40 5.06 10.68 RBRVS 28345 RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB Surgery 6.09 3.95 8.56 RBRVS 28360 RECONSTRUCTION CLEFT FOOT Surgery 14.92 7.55 7.55 RBRVS 28400 CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION Surgery 2.31 3.84 4.45 RBRVS 28405 CLOSED TX CALCANEAL FRACTURE W/MANIPULATION Surgery 4.74 4.89 5.94 RBRVS 28406 PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ Surgery 6.56 7.40 7.40 RBRVS 28415 OPEN TREATMENT CALCANEAL FRACTURE Surgery 16.19 12.92 12.92 RBRVS 28420 OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT Surgery 17.52 15.06 15.06 RBRVS 28430 CLOSED TX TALUS FRACTURE W/O MANIPULATION Surgery 2.22 3.46 4.22 RBRVS 28435 CLOSED TX TALUS FRACTURE W/MANIPULATION Surgery 3.54 4.04 5.00 RBRVS 28436 PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ Surgery 4.90 7.00 7.00 RBRVS 28445 OPEN TREATMENT TALUS FRACTURE Surgery 15.76 12.21 12.21 RBRVS 28446 OPEN OSTEOCHONDRAL AUTOGRAFT TALUS Surgery 17.71 13.98 13.98 RBRVS 28450 TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ Surgery 2.03 3.19 3.86 RBRVS 28455 TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ Surgery 3.24 3.81 4.65 RBRVS 28456 PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ Surgery 2.86 5.71 5.71 RBRVS 28465 OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA Surgery 8.80 7.66 7.66 RBRVS 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION Surgery 2.03 3.53 3.95 RBRVS 28475 CLTX METAR FX W/MANJ Surgery 3.01 3.15 3.97 RBRVS 28476 PRQ SKEL FIXJ METAR FX W/MANJ Surgery 3.60 5.88 5.88 RBRVS 28485 OPEN TREATMENT METATARSAL FRACTURE EACH Surgery 7.44 6.76 6.76 RBRVS 28490 CLTX FX GRT TOE PHLX/PHLG W/O MANJ Surgery 1.17 2.28 2.86 RBRVS 28495 CLTX FX GRT TOE PHLX/PHLG W/MANJ Surgery 1.68 2.48 3.29 RBRVS 28496 PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ Surgery 2.48 3.85 9.78 RBRVS 28505 OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES Surgery 7.44 6.14 11.09 RBRVS 28510 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ Surgery 1.17 2.16 2.25 RBRVS 28515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ Surgery 1.56 2.39 2.94 RBRVS 28525 OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE Surgery 5.62 5.06 9.88 RBRVS

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28530 CLOSED TREATMENT SESAMOID FRACTURE Surgery 1.11 1.72 2.09 RBRVS 28531 OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION Surgery 2.57 2.49 7.13 RBRVS 28540 CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES Surgery 2.19 2.64 3.17 RBRVS 28545 CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES Surgery 2.60 4.38 5.36 RBRVS 28546 PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ Surgery 3.40 5.65 12.55 RBRVS 28555 OPEN TREATMENT TARSAL BONE DISLOCATION Surgery 9.65 8.09 14.25 RBRVS 28570 CLOSED TX TALOTARSAL JOINT DISLC W/O ANES Surgery 1.76 2.12 2.79 RBRVS 28575 CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES Surgery 3.49 5.20 6.20 RBRVS 28576 PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ Surgery 4.60 5.83 5.83 RBRVS 28585 OPEN TREATMENT TALOTARSAL JOINT DISLOCATION Surgery 11.13 7.03 12.38 RBRVS 28600 CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES Surgery 2.02 3.07 3.92 RBRVS 28605 CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES Surgery 2.89 4.96 5.91 RBRVS 28606 PRQ SKEL FIXJ TARS JT DISLC W/MANJ Surgery 5.09 5.39 5.39 RBRVS 28615 OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION Surgery 10.70 10.22 10.22 RBRVS 28630 CLTX METATARSOPHLNGL JT DISLC W/O ANES Surgery 1.75 1.17 2.52 RBRVS 28635 CLTX METATARSOPHLNGL JT DISLC REQ ANES Surgery 1.96 1.57 2.78 RBRVS 28636 PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ Surgery 2.77 3.12 6.75 RBRVS 28645 OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION Surgery 7.44 5.66 10.64 RBRVS 28660 CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES Surgery 1.28 1.10 1.90 RBRVS 28665 CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES Surgery 1.97 1.60 2.26 RBRVS 28666 PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ Surgery 2.66 2.32 2.32 RBRVS 28675 OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION Surgery 5.62 5.59 10.68 RBRVS 28705 ARTHRODESIS PANTALAR Surgery 20.33 12.74 12.74 RBRVS 28715 ARTHRODESIS TRIPLE Surgery 13.42 11.33 11.33 RBRVS 28725 ARTHRODESIS SUBTALAR Surgery 11.22 9.36 9.36 RBRVS 28730 ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS Surgery 10.70 8.74 8.74 RBRVS 28735 ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT Surgery 12.23 8.59 8.59 RBRVS 28737 ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR Surgery 11.03 7.56 7.56 RBRVS 28740 ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT Surgery 9.29 7.39 13.89 RBRVS 28750 ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT Surgery 8.57 7.30 13.79 RBRVS 28755 ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT Surgery 4.88 4.08 9.27 RBRVS 28760 ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK Surgery 9.14 6.51 12.70 RBRVS 28800 AMPUTATION FOOT MIDTARSAL Surgery 8.79 5.76 5.76 RBRVS 28805 AMPUTATION FOOT TRANSMETARSAL Surgery 12.71 6.60 6.60 RBRVS 28810 AMPUTATION METATARSAL W/TOE SINGLE Surgery 6.64 4.72 4.72 RBRVS 28820 AMPUTATION TOE METATARSOPHALANGEAL JOINT Surgery 5.82 4.82 9.75 RBRVS 28825 AMPUTATION TOE INTERPHALANGEAL JOINT Surgery 5.37 4.63 9.54 RBRVS 28890 ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA Surgery 3.45 2.72 5.57 RBRVS 28899 UNLISTED PROCEDURE FOOT/TOES Surgery 10.83 Unlisted 29000 APPLICATION HALO TYPE BODY CAST Surgery 2.25 2.19 5.51 RBRVS 29010 APPLICATION RISSER JACKET LOCALIZER BODY ONLY Surgery 2.06 1.51 3.78 RBRVS 29015 APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD Surgery 2.41 2.16 5.00 RBRVS 29035 APPLICATION BODY CAST SHOULDER HIPS Surgery 1.77 1.70 4.26 RBRVS 29040 APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA Surgery 2.22 1.68 3.92 RBRVS 29044 APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH Surgery 2.12 2.32 5.22 RBRVS 29046 APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS Surgery 2.41 1.82 4.20 RBRVS 29049 APPLICATION CAST FIGURE-OF-8 Surgery 0.89 0.57 1.03 RBRVS 29055 APPLICATION CAST SHOULDER SPICA Surgery 1.78 1.86 4.23 RBRVS 29058 APPLICATION CAST PLASTER VELPEAU Surgery 1.31 1.16 1.99 RBRVS 29065 APPLICATION CAST SHOULDER HAND LONG ARM Surgery 0.87 0.94 1.73 RBRVS 29075 APPLICATION CAST ELBOW FINGER SHORT ARM Surgery 0.77 0.89 1.58 RBRVS 29085 APPLICATION CAST HAND & LOWER FOREARM GAUNTLET Surgery 0.87 0.93 1.72 RBRVS 29086 APPLICATION CAST FINGER Surgery 0.62 0.76 1.53 RBRVS 29105 APPLICATION LONG ARM SPLINT SHOULDER HAND Surgery 0.87 0.71 1.52 RBRVS 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC Surgery 0.50 0.56 1.27 RBRVS 29126 APPLICATION SHORT ARM SPLINT DYNAMIC Surgery 0.68 0.63 1.44 RBRVS 29130 APPLICATION FINGER SPLINT STATIC Surgery 0.50 0.25 0.60 RBRVS 29131 APPLICATION FINGER SPLINT DYNAMIC Surgery 0.55 0.33 0.84 RBRVS 29200 STRAPPING THORAX Surgery 0.39 0.11 0.44 RBRVS 29240 STRAPPING SHOULDER Surgery 0.39 0.12 0.41 RBRVS 29260 STRAPPING ELBOW/WRIST Surgery 0.39 0.13 0.40 RBRVS 29280 STRAPPING HAND/FINGER Surgery 0.39 0.14 0.41 RBRVS 29305 APPLICATION HIP SPICA CAST 1 LEG Surgery 2.03 2.16 4.64 RBRVS 29325 APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS Surgery 2.32 2.37 5.05 RBRVS 29345 APPLICATION LONG LEG CAST THIGH-TOE Surgery 1.40 1.25 2.25 RBRVS 29355 APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE Surgery 1.53 1.26 2.23 RBRVS 29358 APPLICATION LONG LEG CAST BRACE Surgery 1.43 1.28 2.89 RBRVS 29365 APPLICATION CYLINDER CAST THIGH ANKLE Surgery 1.18 1.12 2.12 RBRVS 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE Surgery 0.80 0.81 1.42 RBRVS 29425 APPLICATION SHORT LEG CAST WALKING/AMBULATORY Surgery 0.80 0.73 1.34 RBRVS 29435 APPLICATION PATELLAR TENDON BEARING CAST Surgery 1.18 1.02 2.00 RBRVS 29440 ADDING WALKER PREVIOUSLY APPLIED CAST Surgery 0.57 0.22 0.64 RBRVS 29445 APPLICATION RIGID TOTAL CONTACT LEG CAST Surgery 1.78 1.02 1.89 RBRVS 29450 APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG Surgery 2.08 0.97 1.85 RBRVS 29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES Surgery 0.69 0.64 1.59 RBRVS

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29515 APPLICATION SHORT LEG SPLINT CALF FOOT Surgery 0.73 0.60 1.23 RBRVS 29520 STRAPPING HIP Surgery 0.39 0.12 0.47 RBRVS 29530 STRAPPING KNEE Surgery 0.39 0.11 0.39 RBRVS 29540 STRAPPING ANKLE &/FOOT Surgery 0.39 0.10 0.32 RBRVS 29550 STRAPPING TOES Surgery 0.25 0.06 0.27 RBRVS 29580 STRAPPING UNNA BOOT Surgery 0.55 0.40 0.88 RBRVS 29581 APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT Surgery 0.25 0.10 1.49 RBRVS 29582 APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE Surgery 0.35 0.09 1.63 RBRVS 29583 APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM Surgery 0.25 0.06 0.98 RBRVS 29584 APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING Surgery 0.35 0.09 1.63 RBRVS 29700 REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST Surgery 0.57 0.30 1.09 RBRVS 29705 REMOVAL/BIVALVING FULL ARM/FULL LEG CAST Surgery 0.76 0.47 1.03 RBRVS 29710 RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET Surgery 1.34 0.81 1.94 RBRVS 29720 REPAIR SPICA BODY CAST/JACKET Surgery 0.68 0.46 1.62 RBRVS 29730 WINDOWING CAST Surgery 0.75 0.42 0.97 RBRVS 29740 WEDGING CAST EXCEPT CLUBFOOT CASTS Surgery 1.12 0.68 1.50 RBRVS 29750 WEDGING CLUBFOOT CAST Surgery 1.26 0.63 1.26 RBRVS 29799 UNLISTED PROCEDURE CASTING/STRAPPING Surgery 1.39 Unlisted 29800 ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX Surgery 6.84 6.93 6.93 RBRVS 29804 ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL Surgery 8.87 8.13 8.13 RBRVS 29805 ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX Surgery 6.03 6.32 6.32 RBRVS 29806 ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY Surgery 15.14 12.36 12.36 RBRVS 29807 ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION Surgery 14.67 12.19 12.19 RBRVS 29819 ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB Surgery 7.79 7.51 7.51 RBRVS 29820 ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL Surgery 7.21 6.90 6.90 RBRVS 29821 ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE Surgery 7.89 7.56 7.56 RBRVS 29822 ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED Surgery 7.60 7.42 7.42 RBRVS 29823 ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE Surgery 8.36 8.03 8.03 RBRVS 29824 ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY Surgery 8.98 8.71 8.71 RBRVS 29825 ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ Surgery 7.79 7.52 7.52 RBRVS 29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE Surgery 3.00 1.51 1.51 RBRVS 29827 ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR Surgery 15.59 12.24 12.24 RBRVS 29828 ARTHROSCOPY SHOULDER BICEPS TENODESIS Surgery 13.16 10.80 10.80 RBRVS 29830 ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX Surgery 5.88 6.05 6.05 RBRVS 29834 ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB Surgery 6.42 6.45 6.45 RBRVS 29835 ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL Surgery 6.62 6.50 6.50 RBRVS 29836 ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE Surgery 7.72 7.30 7.30 RBRVS 29837 ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED Surgery 7.01 6.85 6.85 RBRVS 29838 ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE Surgery 7.88 7.55 7.55 RBRVS 29840 ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX Surgery 5.68 6.16 6.16 RBRVS 29843 ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE Surgery 6.15 6.51 6.51 RBRVS 29844 ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL Surgery 6.51 6.60 6.60 RBRVS 29845 ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE Surgery 7.69 7.53 7.53 RBRVS 29846 ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT Surgery 6.89 6.82 6.82 RBRVS 29847 ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY Surgery 7.22 6.94 6.94 RBRVS 29848 NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM Surgery 6.39 7.05 7.05 RBRVS 29850 ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ Surgery 8.27 8.01 8.01 RBRVS 29851 ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ Surgery 13.26 10.90 10.90 RBRVS 29855 ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR Surgery 10.76 9.71 9.71 RBRVS 29856 ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR Surgery 14.28 11.53 11.53 RBRVS 29860 ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX Surgery 9.00 8.38 8.38 RBRVS 29861 ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB Surgery 10.10 8.78 8.78 RBRVS 29862 ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG Surgery 11.17 10.17 10.17 RBRVS 29863 ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY Surgery 11.17 10.11 10.11 RBRVS 29866 ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST Surgery 14.67 12.58 12.58 RBRVS 29867 ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT Surgery 18.39 14.76 14.76 RBRVS 29868 ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT Surgery 25.10 18.12 18.12 RBRVS 29870 ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX Surgery 5.19 5.62 10.52 RBRVS 29871 ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE Surgery 6.69 6.75 6.75 RBRVS 29873 ARTHROSCOPY KNEE LATERAL RELEASE Surgery 6.24 7.57 7.57 RBRVS 29874 ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY Surgery 7.19 6.86 6.86 RBRVS 29875 ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX Surgery 6.45 6.52 6.52 RBRVS 29876 ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS Surgery 8.87 8.27 8.27 RBRVS 29877 ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG Surgery 8.30 7.97 7.97 RBRVS 29879 ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX Surgery 8.99 8.33 8.33 RBRVS 29880 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING Surgery 7.39 7.35 7.35 RBRVS 29881 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG Surgery 7.03 7.18 7.18 RBRVS 29882 ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL Surgery 9.60 8.62 8.62 RBRVS 29883 ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL Surgery 11.77 10.16 10.16 RBRVS 29884 ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX Surgery 8.28 7.94 7.94 RBRVS 29885 ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG Surgery 10.21 9.39 9.39 RBRVS 29886 ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION Surgery 8.49 8.12 8.12 RBRVS 29887 ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ Surgery 10.16 9.35 9.35 RBRVS 29888 ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ Surgery 14.30 11.28 11.28 RBRVS 29889 ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ Surgery 17.41 14.32 14.32 RBRVS

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29891 ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT Surgery 9.67 8.32 8.32 RBRVS 29892 ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX Surgery 10.27 6.97 6.97 RBRVS 29893 ENDOSCOPIC PLANTAR FASCIOTOMY Surgery 6.32 5.50 10.83 RBRVS 29894 ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY Surgery 7.35 5.94 5.94 RBRVS 29895 ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL Surgery 7.13 5.73 5.73 RBRVS 29897 ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED Surgery 7.32 6.09 6.09 RBRVS 29898 ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE Surgery 8.49 6.55 6.55 RBRVS 29899 ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS Surgery 15.41 11.83 11.83 RBRVS 29900 ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY Surgery 5.88 5.73 5.73 RBRVS 29901 ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT Surgery 6.59 7.47 7.47 RBRVS 29902 ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM Surgery 7.16 5.80 5.80 RBRVS 29904 ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY Surgery 8.65 7.97 7.97 RBRVS 29905 ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY Surgery 9.18 8.84 8.84 RBRVS 29906 ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT Surgery 9.65 8.73 8.73 RBRVS 29907 ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS Surgery 12.18 10.59 10.59 RBRVS 29914 ARTHROSCOPY HIP W/FEMOROPLASTY Surgery 14.67 11.46 11.46 RBRVS 29915 ARTHROSCOPY HIP W/ACETABULOPLASTY Surgery 15.00 11.64 11.64 RBRVS 29916 ARTHROSCOPY HIP W/LABRAL REPAIR Surgery 15.00 11.72 11.72 RBRVS 29999 UNLISTED PROCEDURE ARTHROSCOPY Surgery 15.02 Unlisted 30000 DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH Surgery 1.48 1.69 4.86 RBRVS 30020 DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM Surgery 1.48 1.72 4.94 RBRVS 30100 BIOPSY INTRANASAL Surgery 0.94 0.91 2.96 RBRVS 30110 EXCISION NASAL POLYP SIMPLE Surgery 1.68 1.81 4.64 RBRVS 30115 EXCISION NASAL POLYP EXTENSIVE Surgery 4.44 7.23 7.23 RBRVS 30117 EXCISION/DESTRUCTION INTRANASAL LESION INT APPR Surgery 3.26 5.98 21.25 RBRVS 30118 EXCISION/DESTRUCTION INTRANASAL LESION XTRNL Surgery 9.92 10.49 10.49 RBRVS 30120 EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA Surgery 5.39 6.26 8.58 RBRVS 30124 EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS Surgery 3.20 4.46 4.46 RBRVS 30125 EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG Surgery 7.30 8.97 8.97 RBRVS 30130 EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE Surgery 3.47 6.90 6.90 RBRVS 30140 SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL Surgery 3.57 8.47 8.47 RBRVS 30150 RHINECTOMY PARTIAL Surgery 9.55 10.91 10.91 RBRVS 30160 RHINECTOMY TOTAL Surgery 9.99 10.60 10.60 RBRVS 30200 INJECTION TURBINATE THERAPEUTIC Surgery 0.78 0.82 2.35 RBRVS 30210 DISPLACEMENT THERAPY PROETZ TYPE Surgery 1.13 1.55 2.99 RBRVS 30220 INSERTION NASAL SEPTAL PROSTHESIS BUTTON Surgery 1.59 1.76 6.80 RBRVS 30300 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE Surgery 1.09 2.38 5.34 RBRVS 30310 REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES Surgery 2.01 3.54 3.54 RBRVS 30320 RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY Surgery 4.64 7.57 7.57 RBRVS 30400 RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI Surgery 10.86 16.22 16.22 RBRVS 30410 RHINP PRIM COMPLETE XTRNL PARTS Surgery 14.00 17.62 17.62 RBRVS 30420 RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR Surgery 16.90 19.74 19.74 RBRVS 30430 RHINOPLASTY SECONDARY MINOR REVISION Surgery 8.24 15.07 15.07 RBRVS 30435 RHINOPLASTY SECONDARY INTERMEDIATE REVISION Surgery 12.73 20.70 20.70 RBRVS 30450 RHINOPLASTY SECONDARY MAJOR REVISION Surgery 19.66 20.13 20.13 RBRVS 30460 RHINP DFRM W/COLUM LNGTH TIP ONLY Surgery 10.32 11.17 11.17 RBRVS 30462 RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT Surgery 20.28 16.71 16.71 RBRVS 30465 REPAIR NASAL VESTIBULAR STENOSIS Surgery 12.36 13.77 13.77 RBRVS 30520 SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF Surgery 7.01 9.74 9.74 RBRVS 30540 REPAIR CHOANAL ATRESIA INTRANASAL Surgery 7.92 10.53 10.53 RBRVS 30545 REPAIR CHOANAL ATRESIA TRANSPALATINE Surgery 11.62 11.95 11.95 RBRVS 30560 LYSIS INTRANASAL SYNECHIA Surgery 1.31 2.43 6.16 RBRVS 30580 REPAIR FISTULA OROMAXILLARY Surgery 6.88 6.67 10.70 RBRVS 30600 REPAIR FISTULA ORONASAL Surgery 6.16 5.18 9.24 RBRVS 30620 SEPTAL/OTHER INTRANASAL DERMATOPLASTY Surgery 6.16 10.75 10.75 RBRVS 30630 REPAIR NASAL SEPTAL PERFORATIONS Surgery 7.29 9.48 9.48 RBRVS 30801 ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC Surgery 1.14 2.61 5.22 RBRVS 30802 ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL Surgery 2.08 3.06 5.90 RBRVS 30901 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE Surgery 1.10 0.37 1.46 RBRVS 30903 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX Surgery 1.54 0.51 4.10 RBRVS 30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST Surgery 1.97 0.61 5.07 RBRVS 30906 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ Surgery 2.45 0.97 5.20 RBRVS 30915 LIGATION ARTERIES ETHMOIDAL Surgery 7.44 7.90 7.90 RBRVS 30920 LIGATION ARTERIES INT MAXILLARY TRANSANTRAL Surgery 11.14 11.05 11.05 RBRVS 30930 FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC Surgery 1.31 2.03 2.03 RBRVS 30999 UNLISTED PROCEDURE NOSE Surgery 12.04 Unlisted 31000 LAVAGE CANNULATION MAXILLARY SINUS Surgery 1.20 1.67 3.87 RBRVS 31002 LAVAGE CANNULATION SPHENOID SINUS Surgery 1.96 3.29 3.29 RBRVS 31020 SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL Surgery 3.07 6.77 10.36 RBRVS 31030 SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS Surgery 6.01 8.21 12.85 RBRVS 31032 SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS Surgery 6.69 8.71 8.71 RBRVS 31040 PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH Surgery 9.77 10.74 10.74 RBRVS 31050 SINUSOTOMY SPHENOID W/WO BIOPSY Surgery 5.37 7.66 7.66 RBRVS 31051 SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP Surgery 7.25 10.08 10.08 RBRVS 31070 SINUSOTOMY FRONTAL EXTERNAL SIMPLE Surgery 4.40 7.47 7.47 RBRVS

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31075 SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL Surgery 9.51 11.37 11.37 RBRVS 31080 SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC Surgery 12.74 14.77 14.77 RBRVS 31081 SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC Surgery 14.19 23.36 23.36 RBRVS 31084 SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC Surgery 14.95 15.73 15.73 RBRVS 31085 SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC Surgery 15.64 24.04 24.04 RBRVS 31086 SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC Surgery 14.36 15.49 15.49 RBRVS 31087 SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC Surgery 14.57 14.15 14.15 RBRVS 31090 SINUSOT UNI 3/> PARANSL SINUSES Surgery 11.17 16.37 16.37 RBRVS 31200 ETHMOIDECTOMY INTRANASAL ANTERIOR Surgery 5.14 10.59 10.59 RBRVS 31201 ETHMOIDECTOMY INTRANASAL TOTAL Surgery 8.60 11.26 11.26 RBRVS 31205 ETHMOIDECTOMY EXTRANASAL TOTAL Surgery 10.58 13.94 13.94 RBRVS 31225 MAXILLECTOMY W/O ORBITAL EXENTERATION Surgery 26.70 22.97 22.97 RBRVS 31230 MAXILLECTOMY W/ORBITAL EXENTERATION Surgery 30.82 24.03 24.03 RBRVS 31231 NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX Surgery 1.10 0.62 4.71 RBRVS 31233 NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY Surgery 2.18 1.44 4.99 RBRVS 31235 NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY Surgery 2.64 1.65 5.52 RBRVS 31237 NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX Surgery 2.60 1.67 4.40 RBRVS 31238 NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG Surgery 2.74 1.73 4.22 RBRVS 31239 NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY Surgery 9.04 7.54 7.54 RBRVS 31240 NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION Surgery 2.61 1.64 1.64 RBRVS 31254 NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL Surgery 4.64 2.55 2.55 RBRVS 31255 NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL Surgery 6.95 3.55 3.55 RBRVS 31256 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY Surgery 3.29 1.94 1.94 RBRVS 31267 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS Surgery 5.45 2.91 2.91 RBRVS 31276 NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION Surgery 8.84 4.39 4.39 RBRVS 31287 NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY Surgery 3.91 2.22 2.22 RBRVS 31288 NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS Surgery 4.57 2.51 2.51 RBRVS 31290 NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID Surgery 18.61 11.71 11.71 RBRVS 31291 NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID Surgery 19.56 12.40 12.40 RBRVS 31292 NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN Surgery 15.90 10.47 10.47 RBRVS 31293 NASAL/SINUS NDSC MEDIAL ORB&NF ORB WALL DCMPR Surgery 17.47 11.09 11.09 RBRVS 31294 NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN Surgery 20.31 12.35 12.35 RBRVS 31295 NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS Surgery 2.70 1.72 55.27 RBRVS 31296 NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS Surgery 3.29 1.98 55.42 RBRVS 31297 NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS Surgery 2.64 1.69 55.10 RBRVS 31299 UNLISTED PROCEDURE ACCESSORY SINUSES Surgery 5.64 Unlisted 31300 LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY Surgery 15.91 17.82 17.82 RBRVS 31320 LARYNGOTOMY THYROTOMY LARYNGOFISSURE DX Surgery 5.73 12.16 12.16 RBRVS 31360 LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION Surgery 29.91 25.27 25.27 RBRVS 31365 LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION Surgery 38.81 29.22 29.22 RBRVS 31367 LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ Surgery 30.57 28.12 28.12 RBRVS 31368 LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ Surgery 34.19 30.80 30.80 RBRVS 31370 PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL Surgery 27.57 27.71 27.71 RBRVS 31375 PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL Surgery 26.07 26.42 26.42 RBRVS 31380 PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL Surgery 25.57 26.19 26.19 RBRVS 31382 PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL Surgery 28.57 28.13 28.13 RBRVS 31390 PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ Surgery 42.51 33.02 33.02 RBRVS 31395 PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ Surgery 43.80 35.83 35.83 RBRVS 31400 ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH Surgery 11.60 15.27 15.27 RBRVS 31420 EPIGLOTTIDECTOMY Surgery 11.43 10.78 10.78 RBRVS 31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE Surgery 2.33 0.55 0.55 RBRVS 31502 TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT Surgery 0.65 0.28 0.28 RBRVS 31505 LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX Surgery 0.61 0.72 1.68 RBRVS 31510 LARYNGOSCOPY INDIRECT W/BIOPSY Surgery 1.92 1.33 3.85 RBRVS 31511 LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY Surgery 2.16 1.25 3.55 RBRVS 31512 LARYNGOSCOPY INDIRECT W/REMOVAL LESION Surgery 2.07 1.39 3.54 RBRVS 31513 LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION Surgery 2.10 1.41 1.41 RBRVS 31515 LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION Surgery 1.80 1.15 3.86 RBRVS 31520 LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN Surgery 2.56 1.61 1.61 RBRVS 31525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN Surgery 2.63 1.62 4.22 RBRVS 31526 LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE Surgery 2.57 1.61 1.61 RBRVS 31527 LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR Surgery 3.27 1.93 1.93 RBRVS 31528 LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN Surgery 2.37 1.47 1.47 RBRVS 31529 LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ Surgery 2.68 1.62 1.62 RBRVS 31530 LARYNGOSCOPY W/FOREIGN BODY REMOVAL Surgery 3.38 1.84 1.84 RBRVS 31531 LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE Surgery 3.58 2.07 2.07 RBRVS 31535 LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY Surgery 3.16 1.88 1.88 RBRVS 31536 LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE Surgery 3.55 2.05 2.05 RBRVS 31540 LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT Surgery 4.12 2.29 2.29 RBRVS 31541 LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP Surgery 4.52 2.49 2.49 RBRVS 31545 LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP Surgery 6.30 3.29 3.29 RBRVS 31546 LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT Surgery 9.73 4.82 4.82 RBRVS 31560 LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY Surgery 5.45 2.86 2.86 RBRVS 31561 LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE Surgery 5.99 3.09 3.09 RBRVS 31570 LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC Surgery 3.86 2.20 5.25 RBRVS

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31571 LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE Surgery 4.26 2.37 2.37 RBRVS 31575 LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC Surgery 1.10 0.95 2.01 RBRVS 31576 LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY Surgery 1.97 1.33 4.14 RBRVS 31577 LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY Surgery 2.47 1.52 4.09 RBRVS 31578 LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION Surgery 2.84 1.72 4.70 RBRVS 31579 LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY Surgery 2.26 1.49 3.43 RBRVS 31580 LARYNGOPLASTY LARYN WEB 2 STG W/KEEL INSJ&RMVL Surgery 14.66 18.16 18.16 RBRVS 31582 LARYNGP LARYN STENOSIS GRF/CORE MOLD W/TRACHT Surgery 23.22 27.68 27.68 RBRVS 31584 LARYNGOPLASTY W/OPEN REDUCTION FRACTURE Surgery 20.47 19.81 19.81 RBRVS 31587 LARYNGOPLASTY CRICOID SPLIT Surgery 15.27 11.21 11.21 RBRVS 31588 LARYNGOPLASTY NOT OTHERWISE SPECIFIED Surgery 14.99 15.48 15.48 RBRVS 31590 LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE Surgery 7.85 16.45 16.45 RBRVS 31595 SECTION RECURRENT LARYNGEAL NERVE THER UNI SPX Surgery 8.84 11.74 11.74 RBRVS 31599 UNLISTED PROCEDURE LARYNX Surgery 3.01 Unlisted 31600 TRACHEOSTOMY PLANNED SEPARATE PROCEDURE Surgery 7.17 2.97 2.97 RBRVS 31601 TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX Surgery 4.44 2.41 2.41 RBRVS 31603 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL Surgery 4.14 1.60 1.60 RBRVS 31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE Surgery 3.57 1.11 1.11 RBRVS 31610 TRACHEOSTOMY FENESTRATION W/SKIN FLAPS Surgery 9.38 9.66 9.66 RBRVS 31611 CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH Surgery 6.00 8.59 8.59 RBRVS 31612 TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX Surgery 0.91 0.33 1.34 RBRVS 31613 TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION Surgery 4.71 7.51 7.51 RBRVS 31614 TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION Surgery 8.63 11.74 11.74 RBRVS 31615 TRACHEOBRNCHSC THRU EST TRACHS INC Surgery 2.09 1.33 2.82 RBRVS 31622 BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX Surgery 2.78 1.11 5.83 RBRVS 31623 BRNCHSC BRUSHING/PROTECTED BRUSHINGS Surgery 2.88 1.09 6.29 RBRVS 31624 BRNCHSC W/BRNCL ALVEOLAR LAVAGE Surgery 2.88 1.13 5.79 RBRVS 31625 BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES Surgery 3.36 1.25 5.82 RBRVS 31626 BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT Surgery 4.16 1.47 21.27 RBRVS 31627 BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION Surgery 2.00 0.60 37.92 RBRVS 31628 BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE Surgery 3.80 1.37 6.49 RBRVS 31629 BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON Surgery 4.09 1.46 12.33 RBRVS 31630 BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX Surgery 3.81 1.51 1.51 RBRVS 31631 BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT Surgery 4.36 1.68 1.68 RBRVS 31632 BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE Surgery 1.03 0.31 0.93 RBRVS 31633 BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE Surgery 1.32 0.40 1.08 RBRVS 31634 BRONCHOSCOPY BALLOON OCCLUSION Surgery 4.00 1.50 49.01 RBRVS 31635 BRONCHOSCOPY W/REMOVAL FOREIGN BODY Surgery 3.67 1.38 5.90 RBRVS 31636 BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS Surgery 4.30 1.57 1.57 RBRVS 31637 BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED Surgery 1.58 0.44 0.44 RBRVS 31638 BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS Surgery 4.88 1.80 1.80 RBRVS 31640 BRONCHOSCOPY W/EXCISION TUMOR Surgery 4.93 1.81 1.81 RBRVS 31641 BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC Surgery 5.02 1.86 1.86 RBRVS 31643 BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL Surgery 3.49 1.29 1.29 RBRVS 31645 BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST Surgery 3.16 1.21 5.77 RBRVS 31646 BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ Surgery 2.72 1.06 5.31 RBRVS 31647 BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE Surgery 4.40 1.54 1.54 RBRVS 31648 BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL Surgery 4.20 1.34 1.34 RBRVS 31649 BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL Surgery 1.44 0.41 0.41 RBRVS 31651 BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE Surgery 1.58 0.44 0.44 RBRVS 31652 BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX Surgery 4.71 1.61 20.56 RBRVS 31653 BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX Surgery 5.21 1.76 21.62 RBRVS 31654 BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES Surgery 1.40 0.42 1.56 RBRVS 31660 BRONCHOSCOPIC THERMOPLASTY ONE LOBE Surgery 4.25 1.44 1.44 RBRVS 31661 BRONCHOSCOPIC THERMOPLASTY 2/> LOBES Surgery 4.50 1.45 1.45 RBRVS 31717 CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY Surgery 2.12 0.84 5.16 RBRVS 31720 CATHETER ASPIRATION NASOTRACHEAL SPX Surgery 1.06 0.32 0.32 RBRVS 31725 CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX Surgery 1.96 0.44 0.44 RBRVS 31730 TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER Surgery 2.85 0.94 31.53 RBRVS 31750 TRACHEOPLASTY CERVICAL Surgery 15.39 21.47 21.47 RBRVS 31755 TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG Surgery 17.54 29.18 29.18 RBRVS 31760 TRACHEOPLASTY INTRATHORACIC Surgery 23.48 10.91 10.91 RBRVS 31766 CARINAL RECONSTRUCTION Surgery 31.67 15.06 15.06 RBRVS 31770 BRONCHOPLASTY GRAFT REPAIR Surgery 23.54 9.71 9.71 RBRVS 31775 BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS Surgery 24.59 9.13 9.13 RBRVS 31780 EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICA Surgery 19.84 10.73 10.73 RBRVS 31781 EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC Surgery 24.85 9.63 9.63 RBRVS 31785 EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL Surgery 18.35 9.91 9.91 RBRVS 31786 EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC Surgery 25.42 14.35 14.35 RBRVS 31800 SUTURE TRACHEAL WOUND/INJURY CERVICAL Surgery 8.18 11.03 11.03 RBRVS 31805 SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC Surgery 13.42 7.13 7.13 RBRVS 31820 SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR Surgery 4.64 4.04 7.05 RBRVS 31825 SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR Surgery 7.07 5.67 9.13 RBRVS 31830 REVISION TRACHEOSTOMY SCAR Surgery 4.62 4.42 7.26 RBRVS 31899 UNLISTED PROCEDURE TRACHEA BRONCHI Surgery 4.03 Unlisted

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32035 THORACOSTOMY W/RIB RESECTION EMPYEMA Surgery 11.29 7.04 7.04 RBRVS 32036 THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA Surgery 12.30 7.44 7.44 RBRVS 32096 THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL Surgery 13.75 6.47 6.47 RBRVS 32097 THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL Surgery 13.75 6.48 6.48 RBRVS 32098 THORACOTOMY W/BIOPSY OF PLEURA Surgery 12.91 6.30 6.30 RBRVS 32100 THORACOTOMY WITH EXPLORATION Surgery 13.75 6.58 6.58 RBRVS 32110 THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR Surgery 25.28 11.41 11.41 RBRVS 32120 THORACOTOMY POSTOPERATIVE COMPLICATIONS Surgery 14.39 7.57 7.57 RBRVS 32124 THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS Surgery 15.45 7.90 7.90 RBRVS 32140 THORCOM W/REMOVAL OF CYST Surgery 16.66 8.32 8.32 RBRVS 32141 THORACOTOMY W/RESECTION BULLAE Surgery 27.18 10.90 10.90 RBRVS 32150 THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP Surgery 16.82 8.50 8.50 RBRVS 32151 THORCOM W/RMVL IPUL FB Surgery 16.94 8.40 8.40 RBRVS 32160 THORACOTOMY W/CARDIAC MASSAGE Surgery 13.10 6.83 6.83 RBRVS 32200 PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST Surgery 18.68 10.12 10.12 RBRVS 32215 PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX Surgery 13.05 7.08 7.08 RBRVS 32220 DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE Surgery 26.65 13.21 13.21 RBRVS 32225 DECORTICATION PULMONARY PARTIAL SEPARATE PROC Surgery 16.75 8.26 8.26 RBRVS 32310 PLEURECTOMY PARIETAL SEPARATE PROCEDURE Surgery 15.28 7.64 7.64 RBRVS 32320 DECORTICATION & PARIETAL PLEURECTOMY Surgery 27.25 12.90 12.90 RBRVS 32400 BIOPSY PLEURA PERCUTANEOUS NEEDLE Surgery 1.76 0.60 2.40 RBRVS 32405 BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE Surgery 1.93 0.90 10.68 RBRVS 32440 REMOVAL OF LUNG PNEUMONECTOMY Surgery 27.28 11.87 11.87 RBRVS 32442 REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA Surgery 56.47 19.63 19.63 RBRVS 32445 REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL Surgery 63.84 24.20 24.20 RBRVS 32480 RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT Surgery 25.82 11.17 11.17 RBRVS 32482 RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC Surgery 27.44 12.26 12.26 RBRVS 32484 RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY Surgery 25.38 10.49 10.49 RBRVS 32486 RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY Surgery 42.88 15.58 15.58 RBRVS 32488 RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC Surgery 42.99 17.01 17.01 RBRVS 32491 RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG Surgery 25.24 11.70 11.70 RBRVS 32501 RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY Surgery 4.68 1.37 1.37 RBRVS 32503 RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ Surgery 31.74 13.34 13.34 RBRVS 32504 RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ Surgery 36.54 15.14 15.14 RBRVS 32505 THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL Surgery 15.75 7.69 7.69 RBRVS 32506 THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL Surgery 3.00 0.88 0.88 RBRVS 32507 THORACOTOMY W/DX WEDGE RESEXN & ANTOM LUNG RESE Surgery 3.00 0.88 0.88 RBRVS 32540 EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY Surgery 30.35 12.96 12.96 RBRVS 32550 INSERTION INDWELLING TUNNELED PLEURAL CATHETER Surgery 4.17 1.64 17.47 RBRVS 32551 TUBE THORACOSTOMY INCLUDES WATER SEAL Surgery 3.29 1.09 1.09 RBRVS 32552 RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF Surgery 2.53 1.70 2.41 RBRVS 32553 PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT Surgery 3.80 1.47 12.67 RBRVS 32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING Surgery 1.82 0.57 3.70 RBRVS 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING Surgery 2.27 0.79 5.73 RBRVS 32556 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING Surgery 2.50 0.79 12.98 RBRVS 32557 PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING Surgery 3.12 1.05 11.10 RBRVS 32560 INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS Surgery 1.54 0.47 5.14 RBRVS 32561 INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY Surgery 1.39 0.43 1.10 RBRVS 32562 INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY Surgery 1.24 0.38 0.99 RBRVS 32601 THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX Surgery 5.50 2.25 2.25 RBRVS 32604 THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX Surgery 8.77 3.21 3.21 RBRVS 32606 THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX Surgery 8.39 3.15 3.15 RBRVS 32607 THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL Surgery 5.50 2.25 2.25 RBRVS 32608 THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL Surgery 6.84 2.62 2.62 RBRVS 32609 THORACOSCOPY WITH BIOPSYIES OF PLEURA Surgery 4.58 1.96 1.96 RBRVS 32650 THORACOSCOPY W/PLEURODESIS Surgery 10.83 6.02 6.02 RBRVS 32651 THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION Surgery 18.78 8.73 8.73 RBRVS 32652 THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS Surgery 29.13 12.38 12.38 RBRVS 32653 THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT Surgery 18.17 8.43 8.43 RBRVS 32654 THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE Surgery 20.52 8.77 8.77 RBRVS 32655 THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX Surgery 16.17 7.86 7.86 RBRVS 32656 THORACOSCOPY W/PARIETAL PLEURECTOMY Surgery 13.26 6.96 6.96 RBRVS 32658 THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC Surgery 11.71 6.31 6.31 RBRVS 32659 THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC Surgery 11.94 6.57 6.57 RBRVS 32661 THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS Surgery 13.33 6.78 6.78 RBRVS 32662 THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS Surgery 14.99 7.49 7.49 RBRVS 32663 THORACOSCOPY W/LOBECTOMY SINGLE LOBE Surgery 24.64 10.39 10.39 RBRVS 32664 THORACOSCOPY W/THORACIC SYMPATHECTOMY Surgery 14.28 7.05 7.05 RBRVS 32665 THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE Surgery 21.53 9.35 9.35 RBRVS 32666 THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT Surgery 14.50 7.44 7.44 RBRVS 32667 THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL Surgery 3.00 0.89 0.89 RBRVS 32668 THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN Surgery 3.00 0.88 0.88 RBRVS 32669 THORACOSCOPY W/SEGMENTECTOMY Surgery 23.53 10.10 10.10 RBRVS 32670 THORACOSCOPY W/BILOBECTOMY Surgery 28.52 11.58 11.58 RBRVS 32671 THORACOSCOPY W/PNEUMONECTOMY Surgery 31.92 12.43 12.43 RBRVS

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32672 THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL Surgery 27.00 11.03 11.03 RBRVS 32673 THORACOSCOPY RESEXN THYMUS UNI/BILATERAL Surgery 21.13 9.43 9.43 RBRVS 32674 THORCOSCPY W/MEDIASTINL & REGIONL LYMPHDENECTOMY Surgery 4.12 1.22 1.22 RBRVS 32701 THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE Surgery 4.18 1.21 1.21 RBRVS 32800 REPAIR LUNG HERNIA THROUGH CHEST WALL Surgery 15.71 8.27 8.27 RBRVS 32810 CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA Surgery 14.95 7.78 7.78 RBRVS 32815 OPEN CLOSURE MAJOR BRONCHIAL FISTULA Surgery 50.03 19.94 19.94 RBRVS 32820 MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC Surgery 22.51 12.86 12.86 RBRVS 32851 LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS Surgery 59.64 22.22 22.22 RBRVS 32852 LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS Surgery 65.50 23.89 23.89 RBRVS 32853 LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS Surgery 84.48 29.52 29.52 RBRVS 32854 LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS Surgery 90.00 31.13 31.13 RBRVS 32855 BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI Surgery 11.48 v3.16 32900 RESECTION RIBS EXTRAPLEURAL ALL STAGES Surgery 23.81 11.97 11.97 RBRVS 32905 THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL Surgery 23.29 10.18 10.18 RBRVS 32906 THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL Surgery 29.30 11.92 11.92 RBRVS 32940 PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX Surgery 21.34 9.62 9.62 RBRVS 32960 PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR Surgery 1.84 0.66 1.63 RBRVS 32997 TOTAL LUNG LAVAGE UNILATERAL Surgery 7.31 2.01 2.01 RBRVS 32998 ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI Surgery 5.68 2.04 77.76 RBRVS 32999 UNLISTED PROCEDURE LUNGS & PLEURA Surgery 3.34 Unlisted 33010 PERICARDIOCENTESIS INITIAL Surgery 2.24 0.77 0.77 RBRVS 33011 PERICARDIOCENTESIS SUBSEQUENT Surgery 2.24 0.76 0.76 RBRVS 33015 TUBE PERICARDIOSTOMY Surgery 8.52 4.50 4.50 RBRVS 33020 PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY Surgery 14.95 7.21 7.21 RBRVS 33025 CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX Surgery 13.70 6.35 6.35 RBRVS 33030 PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS Surgery 36.00 13.97 13.97 RBRVS 33031 PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS Surgery 45.00 16.50 16.50 RBRVS 33050 RESECTION PERICARDIAL CYST/TUMOR Surgery 16.97 8.23 8.23 RBRVS 33120 EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP Surgery 38.45 13.87 13.87 RBRVS 33130 RESECTION EXTERNAL CARDIAC TUMOR Surgery 24.17 10.44 10.44 RBRVS 33140 TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX Surgery 28.34 11.03 11.03 RBRVS 33141 TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX Surgery 2.54 0.72 0.72 RBRVS 33202 INSERTION EPICARDIAL ELECTRODE OPEN Surgery 13.20 6.22 6.22 RBRVS 33203 INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC Surgery 13.97 6.15 6.15 RBRVS 33206 INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL Surgery 7.39 4.31 4.31 RBRVS 33207 INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR Surgery 8.05 4.35 4.35 RBRVS 33208 INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT Surgery 8.77 4.64 4.64 RBRVS 33210 INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH Surgery 3.30 1.17 1.17 RBRVS 33211 INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX Surgery 3.39 1.16 1.16 RBRVS 33212 INS PM PLS GEN W/EXIST SINGLE LEAD Surgery 5.26 3.18 3.18 RBRVS 33213 INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS Surgery 5.53 3.27 3.27 RBRVS 33214 UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS Surgery 7.84 4.53 4.53 RBRVS 33215 RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE Surgery 4.92 2.92 2.92 RBRVS 33216 INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB Surgery 5.87 3.86 3.86 RBRVS 33217 INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB Surgery 5.84 3.68 3.68 RBRVS 33218 RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB Surgery 6.07 4.14 4.14 RBRVS 33220 RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB Surgery 6.15 4.03 4.03 RBRVS 33221 INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS Surgery 5.80 3.65 3.65 RBRVS 33222 RELOCATION OF SKIN POCKET FOR PACEMAKER Surgery 5.10 3.81 3.81 RBRVS 33223 RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR Surgery 6.55 4.10 4.10 RBRVS 33224 INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN Surgery 9.04 3.81 3.81 RBRVS 33225 INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN Surgery 8.33 3.32 3.32 RBRVS 33226 RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD Surgery 8.68 3.68 3.68 RBRVS 33227 REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD Surgery 5.50 3.38 3.38 RBRVS 33228 REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS Surgery 5.77 3.48 3.48 RBRVS 33229 REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD Surgery 6.04 3.68 3.68 RBRVS 33230 INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS Surgery 6.32 3.64 3.64 RBRVS 33231 INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS Surgery 6.59 3.92 3.92 RBRVS 33233 REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY Surgery 3.39 2.85 2.85 RBRVS 33234 RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR Surgery 7.91 4.66 4.66 RBRVS 33235 RMVL TRANSVNS PM ELTRD DUAL LEAD SYS Surgery 10.15 6.23 6.23 RBRVS 33236 RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS Surgery 12.73 6.99 6.99 RBRVS 33237 RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY Surgery 13.84 7.30 7.30 RBRVS 33238 RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY Surgery 15.40 8.36 8.36 RBRVS 33240 INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD Surgery 6.05 3.51 3.51 RBRVS 33241 REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY Surgery 3.29 2.56 2.56 RBRVS 33243 RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM Surgery 23.57 10.75 10.75 RBRVS 33244 RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ Surgery 13.99 7.98 7.98 RBRVS 33249 INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR Surgery 15.17 8.20 8.20 RBRVS 33250 ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS Surgery 25.90 10.93 10.93 RBRVS 33251 ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS Surgery 28.92 11.42 11.42 RBRVS 33254 ABLATION & RECONSTRUCTION ATRIA LIMITED Surgery 23.71 10.26 10.26 RBRVS 33255 ABLATION & RCNSTJ ATRIA EXTNSV W/O BYPASS Surgery 29.04 11.75 11.75 RBRVS 33256 ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS Surgery 34.90 13.55 13.55 RBRVS

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33257 ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE Surgery 9.63 5.10 5.10 RBRVS 33258 ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP Surgery 11.00 5.51 5.51 RBRVS 33259 ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS Surgery 14.14 7.18 7.18 RBRVS 33261 OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS Surgery 28.92 11.42 11.42 RBRVS 33262 RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD Surgery 6.06 3.68 3.68 RBRVS 33263 RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD Surgery 6.33 3.79 3.79 RBRVS 33264 RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD Surgery 6.60 3.94 3.94 RBRVS 33265 NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS Surgery 23.71 10.43 10.43 RBRVS 33266 NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS Surgery 33.04 13.10 13.10 RBRVS 33270 INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD Surgery 9.10 5.88 5.88 RBRVS 33271 INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE Surgery 7.50 5.14 5.14 RBRVS 33272 RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE Surgery 5.42 3.89 3.89 RBRVS 33273 REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB Surgery 6.50 3.63 3.63 RBRVS 33282 IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER Surgery 3.50 2.60 2.60 RBRVS 33284 RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER Surgery 3.00 2.43 2.43 RBRVS 33300 REPAIR CARDIAC WOUND W/O BYPASS Surgery 44.97 16.01 16.01 RBRVS 33305 REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS Surgery 76.93 25.03 25.03 RBRVS 33310 CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP Surgery 20.34 9.68 9.68 RBRVS 33315 CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP Surgery 35.00 12.76 12.76 RBRVS 33320 SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP Surgery 18.54 8.02 8.02 RBRVS 33321 SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS Surgery 20.81 9.32 9.32 RBRVS 33322 SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS Surgery 24.42 10.30 10.30 RBRVS 33330 INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS Surgery 25.29 10.42 10.42 RBRVS 33335 INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS Surgery 33.91 13.04 13.04 RBRVS 33361 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH Surgery 25.13 8.66 8.66 RBRVS 33362 REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH Surgery 27.52 9.28 9.28 RBRVS 33363 REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH Surgery 28.50 10.26 10.26 RBRVS 33364 REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH Surgery 30.00 10.00 10.00 RBRVS 33365 REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH Surgery 33.12 11.14 11.14 RBRVS 33366 TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE Surgery 35.88 11.87 11.87 RBRVS 33367 REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH Surgery 11.88 3.50 3.50 RBRVS 33368 REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH Surgery 14.39 4.00 4.00 RBRVS 33369 REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH Surgery 19.00 5.29 5.29 RBRVS 33400 VALVULOPLASTY AORTIC VALVE OPEN W/BYPASS Surgery 41.50 15.39 15.39 RBRVS 33401 VALVULOPLASTY AORTIC VALVE OPEN W/INFLOW OCCLUS Surgery 24.63 11.55 11.55 RBRVS 33403 VLVP AORTIC VALVE W/TRANSVENTR DILAT W/CARD BYP Surgery 25.61 11.46 11.46 RBRVS 33404 CONSTRUCTION APICAL-AORTIC CONDUIT Surgery 31.37 12.85 12.85 RBRVS 33405 RPLCMT PROST AORTIC VALVE XCP HOMOGRF/STENT Surgery 41.32 15.35 15.35 RBRVS 33406 RPLCMT AORTIC VALVE ALLOGRAFT VALVE FREEHAND Surgery 52.68 18.94 18.94 RBRVS 33410 RPLCMT AORTIC VALVE W/STENTLESS TISSUE VALVE Surgery 46.41 17.04 17.04 RBRVS 33411 RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS Surgery 62.07 21.52 21.52 RBRVS 33412 REPLACEMENT AORTIC VALVE KONNO PROCEDURE Surgery 59.00 19.53 19.53 RBRVS 33413 REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR Surgery 59.87 21.29 21.29 RBRVS 33414 RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC Surgery 39.37 13.79 13.79 RBRVS 33415 RESECTION/INCISION SUBVALVULAR TISSUE Surgery 37.27 13.65 13.65 RBRVS 33416 VENTRICULOMYOTOMY-MYECTOMY Surgery 36.56 14.22 14.22 RBRVS 33417 AORTOPLASTY SUPRAVALVULAR STENOSIS Surgery 29.33 12.14 12.14 RBRVS 33418 TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS Surgery 32.25 14.68 14.68 RBRVS 33419 TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS Surgery 7.93 3.03 3.03 RBRVS 33420 VALVOTOMY MITRAL VALVE CLOSED HEART Surgery 25.79 12.66 12.66 RBRVS 33422 VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS Surgery 29.73 11.97 11.97 RBRVS 33425 VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS Surgery 49.96 18.12 18.12 RBRVS 33426 VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING Surgery 43.28 16.18 16.18 RBRVS 33427 VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING Surgery 44.83 16.17 16.17 RBRVS 33430 REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP Surgery 50.93 18.94 18.94 RBRVS 33460 VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP Surgery 44.70 15.76 15.76 RBRVS 33463 VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION Surgery 57.08 20.04 20.04 RBRVS 33464 VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION Surgery 44.62 16.41 16.41 RBRVS 33465 REPLACEMENT TRICUSPID VALVE W/CARD BYPASS Surgery 50.72 18.04 18.04 RBRVS 33468 TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY Surgery 45.13 15.44 15.44 RBRVS 33470 VALVOTOMY PULMONARY VALVE CLSD HEART TRANSVENTR Surgery 21.54 9.27 9.27 RBRVS 33471 VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY Surgery 22.96 11.86 11.86 RBRVS 33474 VALVOTOMY PULMONARY VALVE OPEN HEART W/BYPASS Surgery 39.40 14.53 14.53 RBRVS 33475 REPLACEMENT PULMONARY VALVE Surgery 42.40 15.84 15.84 RBRVS 33476 R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY Surgery 26.57 11.65 11.65 RBRVS 33477 TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH Surgery 25.00 8.77 8.77 RBRVS 33478 OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ Surgery 27.54 11.56 11.56 RBRVS 33496 RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS Surgery 29.84 11.86 11.86 RBRVS 33500 RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS Surgery 27.94 11.14 11.14 RBRVS 33501 RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS Surgery 19.51 8.53 8.53 RBRVS 33502 RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION Surgery 21.85 10.05 10.05 RBRVS 33503 RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT Surgery 22.51 10.62 10.62 RBRVS 33504 RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP Surgery 25.46 11.03 11.03 RBRVS 33505 RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL Surgery 38.40 12.48 12.48 RBRVS 33506 RPR ANOM CORONARY ART FROM PULM ART TO AORTA Surgery 37.85 16.09 16.09 RBRVS

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33507 RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ Surgery 31.40 11.24 11.24 RBRVS 33508 NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG Surgery 0.31 0.09 0.09 RBRVS 33510 CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT Surgery 34.98 13.33 13.33 RBRVS 33511 CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS Surgery 38.45 14.64 14.64 RBRVS 33512 CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS Surgery 43.98 16.30 16.30 RBRVS 33513 CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS Surgery 45.37 16.59 16.59 RBRVS 33514 CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS Surgery 48.08 17.29 17.29 RBRVS 33516 CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT Surgery 49.76 18.37 18.37 RBRVS 33517 CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN Surgery 3.61 1.04 1.04 RBRVS 33518 CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN Surgery 7.93 2.28 2.28 RBRVS 33519 CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN Surgery 10.49 3.01 3.01 RBRVS 33521 CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN Surgery 12.59 3.58 3.58 RBRVS 33522 CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN Surgery 14.14 4.03 4.03 RBRVS 33523 CORONARY ARTERY BYP W/VEIN &ARTERY GRAFT 6 VEIN Surgery 16.08 4.52 4.52 RBRVS 33530 ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ Surgery 10.13 2.91 2.91 RBRVS 33533 CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT Surgery 33.75 12.99 12.99 RBRVS 33534 CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS Surgery 39.88 15.07 15.07 RBRVS 33535 CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS Surgery 44.75 16.56 16.56 RBRVS 33536 CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS Surgery 48.43 17.64 17.64 RBRVS 33542 MYOCARDIAL RESECTION Surgery 48.21 17.18 17.18 RBRVS 33545 RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT Surgery 57.06 19.53 19.53 RBRVS 33548 SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD Surgery 54.14 19.93 19.93 RBRVS 33572 CORONARY ENDARTERCOMY OPEN ANY METHOD Surgery 4.44 1.28 1.28 RBRVS 33600 CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH Surgery 30.31 12.80 12.80 RBRVS 33602 CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH Surgery 29.34 12.52 12.52 RBRVS 33606 ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX Surgery 31.53 15.34 15.34 RBRVS 33608 RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT Surgery 31.88 12.83 12.83 RBRVS 33610 RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT Surgery 31.40 13.12 13.12 RBRVS 33611 RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR Surgery 35.57 15.99 15.99 RBRVS 33612 RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ Surgery 36.57 13.01 13.01 RBRVS 33615 RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX Surgery 35.89 14.07 14.07 RBRVS 33617 RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX Surgery 39.09 14.50 14.50 RBRVS 33619 RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLAS Surgery 48.76 23.14 23.14 RBRVS 33620 APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND Surgery 30.00 6.87 6.87 RBRVS 33621 TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT Surgery 16.18 7.19 7.19 RBRVS 33622 RECONSTRUCTION COMPLEX CARDIAC ANOMALY Surgery 64.00 19.69 19.69 RBRVS 33641 RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH Surgery 29.58 11.24 11.24 RBRVS 33645 DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG Surgery 31.30 11.57 11.57 RBRVS 33647 RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS Surgery 33.00 12.01 12.01 RBRVS 33660 RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR Surgery 31.83 12.09 12.09 RBRVS 33665 RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR Surgery 34.85 12.53 12.53 RBRVS 33670 RPR COMPL AV CANAL W/WO PROSTC VALVE Surgery 36.63 12.51 12.51 RBRVS 33675 CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS Surgery 35.95 13.32 13.32 RBRVS 33676 CLOSURE MULTIPLE VSD W/RESECTION Surgery 36.95 16.55 16.55 RBRVS 33677 CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND Surgery 38.45 17.12 17.12 RBRVS 33681 CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH Surgery 32.34 13.56 13.56 RBRVS 33684 CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ Surgery 34.37 12.83 12.83 RBRVS 33688 CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET Surgery 34.75 11.80 11.80 RBRVS 33690 BANDING PULMONARY ARTERY Surgery 20.36 9.92 9.92 RBRVS 33692 COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA Surgery 36.15 15.61 15.61 RBRVS 33694 COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH Surgery 35.57 12.73 12.73 RBRVS 33697 COMPL RPR T-FALLOT W/PULM ATRESIA Surgery 37.57 14.66 14.66 RBRVS 33702 RPR SINUS VALSALVA FISTULA Surgery 27.24 11.18 11.18 RBRVS 33710 RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT Surgery 37.50 14.64 14.64 RBRVS 33720 RPR SINUS VALSALVA ANEURYSM Surgery 27.26 11.56 11.56 RBRVS 33722 CLOSURE AORTICO-LEFT VENTRICULAR TUNNEL Surgery 29.21 11.47 11.47 RBRVS 33724 REPAIR ISOLATED PARTIAL PULM VENOUS RETURN Surgery 27.63 10.55 10.55 RBRVS 33726 REPAIR PULMONARY VENOUS STENOSIS Surgery 37.12 13.66 13.66 RBRVS 33730 COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN Surgery 36.14 14.01 14.01 RBRVS 33732 RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB Surgery 28.96 12.41 12.41 RBRVS 33735 ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART Surgery 22.20 10.45 10.45 RBRVS 33736 ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS Surgery 24.32 10.71 10.71 RBRVS 33737 ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION Surgery 22.47 11.67 11.67 RBRVS 33750 SHUNT SUBCLAVIAN PULMONARY ARTERY Surgery 22.22 11.20 11.20 RBRVS 33755 SHUNT ASCENDING AORTA PULMONARY ARTERY Surgery 22.60 12.03 12.03 RBRVS 33762 SHUNT DESCENDING AORTA PULMONARY ARTERY Surgery 22.60 11.16 11.16 RBRVS 33764 SHUNT CENTRAL W/PROSTHETIC GRAFT Surgery 22.60 12.03 12.03 RBRVS 33766 SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG Surgery 23.57 11.69 11.69 RBRVS 33767 SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS Surgery 25.30 10.00 10.00 RBRVS 33768 ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA Surgery 8.00 3.06 3.06 RBRVS 33770 RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT Surgery 39.07 16.92 16.92 RBRVS 33771 RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT Surgery 40.63 17.03 17.03 RBRVS 33774 RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS Surgery 31.73 13.42 13.42 RBRVS 33775 RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND Surgery 32.99 15.88 15.88 RBRVS 33776 RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT Surgery 34.75 16.90 16.90 RBRVS

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33777 RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC Surgery 34.17 15.75 15.75 RBRVS 33778 RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ Surgery 42.75 19.30 19.30 RBRVS 33779 RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND Surgery 43.23 18.31 18.31 RBRVS 33780 RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT Surgery 43.90 18.76 18.76 RBRVS 33781 RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ Surgery 43.21 18.00 18.00 RBRVS 33782 A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ Surgery 60.08 20.30 20.30 RBRVS 33783 A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA Surgery 65.08 27.27 27.27 RBRVS 33786 TOTAL REPAIR TRUNCUS ARTERIOSUS Surgery 41.87 18.29 18.29 RBRVS 33788 REIMPLANTATION ANOMALOUS PULMONARY ARTERY Surgery 27.42 10.95 10.95 RBRVS 33800 AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX Surgery 17.28 8.93 8.93 RBRVS 33802 DIVISION ABERRANT VESSEL VASCULAR RING Surgery 18.37 10.56 10.56 RBRVS 33803 DIVISION ABERRANT VESSEL W/REANASTOMOSIS Surgery 20.31 10.00 10.00 RBRVS 33813 OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS Surgery 21.36 11.25 11.25 RBRVS 33814 OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS Surgery 26.57 11.71 11.71 RBRVS 33820 REPAIR PATENT DUCTUS ARTERIOSUS LIGATION Surgery 16.69 7.48 7.48 RBRVS 33822 RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR Surgery 17.71 9.21 9.21 RBRVS 33824 RPR PATENT DUXUS ARTERIOSUS DIV 18 YR & OLDER Surgery 20.23 9.21 9.21 RBRVS 33840 EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS Surgery 21.34 11.24 11.24 RBRVS 33845 EXCISION COARCTATION AORTA W/WO PDA W/GRAFT Surgery 22.93 10.33 10.33 RBRVS 33851 EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET Surgery 21.98 11.49 11.49 RBRVS 33852 RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS Surgery 24.41 10.40 10.40 RBRVS 33853 RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS Surgery 32.51 13.00 13.00 RBRVS 33860 ASCENDING AORTA GRF W/CARD BYP & VALVE SSP Surgery 59.46 20.52 20.52 RBRVS 33863 AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT Surgery 58.79 19.58 19.58 RBRVS 33864 ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL Surgery 60.08 20.16 20.16 RBRVS 33870 TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS Surgery 46.06 16.74 16.74 RBRVS 33875 DESCENDING THORACIC AORTA GRAFT W/WO BYPASS Surgery 50.72 17.53 17.53 RBRVS 33877 RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS Surgery 69.03 21.17 21.17 RBRVS 33880 EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH Surgery 34.58 10.57 10.57 RBRVS 33881 EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN Surgery 29.58 9.22 9.22 RBRVS 33883 PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN Surgery 21.09 7.17 7.17 RBRVS 33884 PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN Surgery 8.20 2.05 2.05 RBRVS 33886 PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA Surgery 18.09 6.21 6.21 RBRVS 33889 OPN SUBCLA CRTD ART TRPOS NCK INC ULAT Surgery 15.92 3.66 3.66 RBRVS 33891 BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC Surgery 20.00 3.91 3.91 RBRVS 33910 PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS Surgery 48.21 17.54 17.54 RBRVS 33915 PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS Surgery 24.95 6.51 6.51 RBRVS 33916 PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS Surgery 78.00 26.23 26.23 RBRVS 33917 RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT Surgery 25.30 11.34 11.34 RBRVS 33920 RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT Surgery 32.74 12.49 12.49 RBRVS 33922 TRANSECTION PULMONARY ARTERY W/CARD BYPASS Surgery 24.22 10.34 10.34 RBRVS 33924 LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART Surgery 5.49 1.54 1.54 RBRVS 33925 RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS Surgery 31.30 11.60 11.60 RBRVS 33926 RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS Surgery 44.73 18.70 18.70 RBRVS 33935 HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC Surgery 91.78 31.19 31.19 RBRVS 33940 DONOR CARDIECTOMY Surgery 39.56 v3.16 33944 BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT Surgery 27.63 v3.16 33945 HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY Surgery 89.50 31.28 31.28 RBRVS 33946 ECMO/ECLS INITIATION VENO-VENOUS Surgery 6.00 1.86 1.86 RBRVS 33947 ECMO/ECLS INITIATION VENO-ARTERIAL Surgery 6.63 2.05 2.05 RBRVS 33948 ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS Surgery 4.73 1.53 1.53 RBRVS 33949 ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL Surgery 4.60 1.49 1.49 RBRVS 33951 ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ Surgery 8.15 2.79 2.79 RBRVS 33952 ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ Surgery 8.15 2.50 2.50 RBRVS 33953 ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN Surgery 9.11 3.11 3.11 RBRVS 33954 ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN Surgery 9.11 2.78 2.78 RBRVS 33955 ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS Surgery 16.00 6.18 6.18 RBRVS 33956 ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER Surgery 16.00 4.78 4.78 RBRVS 33957 ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS Surgery 3.51 1.43 1.43 RBRVS 33958 ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER Surgery 3.51 1.24 1.24 RBRVS 33959 ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS Surgery 4.47 1.80 1.80 RBRVS 33962 ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER Surgery 4.47 1.35 1.35 RBRVS 33963 ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS Surgery 9.00 3.51 3.51 RBRVS 33964 ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER Surgery 9.50 3.22 3.22 RBRVS 33965 ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS Surgery 3.51 1.43 1.43 RBRVS 33966 ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER Surgery 4.50 1.36 1.36 RBRVS 33967 INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ Surgery 4.84 1.62 1.62 RBRVS 33968 REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ Surgery 0.64 0.21 0.21 RBRVS 33969 ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS Surgery 5.22 2.09 2.09 RBRVS 33970 INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN Surgery 6.74 2.08 2.08 RBRVS 33971 RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF Surgery 11.99 5.94 5.94 RBRVS 33973 INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA Surgery 9.75 3.12 3.12 RBRVS 33974 RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA Surgery 15.03 7.40 7.40 RBRVS 33975 INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE Surgery 25.00 7.50 7.50 RBRVS 33976 INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR Surgery 30.75 8.58 8.58 RBRVS

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33977 REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE Surgery 20.86 7.33 7.33 RBRVS 33978 REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR Surgery 25.00 8.19 8.19 RBRVS 33979 INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC Surgery 37.50 10.84 10.84 RBRVS 33980 RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC Surgery 33.50 10.79 10.79 RBRVS 33981 RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP Surgery 16.11 4.48 4.48 RBRVS 33982 PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS Surgery 37.86 10.55 10.55 RBRVS 33983 RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/BYPASS Surgery 44.54 12.81 12.81 RBRVS 33984 ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER Surgery 5.46 1.63 1.63 RBRVS 33985 ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS Surgery 9.89 3.84 3.84 RBRVS 33986 ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER Surgery 10.00 2.90 2.90 RBRVS 33987 ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS Surgery 4.04 1.13 1.13 RBRVS 33988 INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS Surgery 15.00 4.27 4.27 RBRVS 33989 RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS Surgery 9.50 2.76 2.76 RBRVS 33990 INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY Surgery 8.15 2.78 2.78 RBRVS 33991 INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS Surgery 11.88 3.86 3.86 RBRVS 33992 REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION Surgery 4.00 1.30 1.30 RBRVS 33993 REPOSITION VAD W/IMAGING DIFFERENT SESSION Surgery 3.51 1.19 1.19 RBRVS 33999 UNLISTED CARDIAC SURGERY Surgery 13.41 Unlisted 34001 EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART Surgery 17.88 7.03 7.03 RBRVS 34051 EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY Surgery 16.99 5.36 5.36 RBRVS 34101 EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART Surgery 10.93 4.31 4.31 RBRVS 34111 EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC Surgery 10.93 4.22 4.22 RBRVS 34151 EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART Surgery 26.52 8.79 8.79 RBRVS 34201 EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART Surgery 19.48 6.49 6.49 RBRVS 34203 EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC Surgery 17.86 6.17 6.17 RBRVS 34401 THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC Surgery 26.52 10.18 10.18 RBRVS 34421 THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC Surgery 13.37 5.04 5.04 RBRVS 34451 THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG Surgery 28.52 13.18 13.18 RBRVS 34471 THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC Surgery 21.11 5.88 5.88 RBRVS 34490 THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN Surgery 10.91 4.57 4.57 RBRVS 34501 VALVULOPLASTY FEMORAL VEIN Surgery 16.85 5.63 5.63 RBRVS 34502 RECONSTRUCTION VENA CAVA ANY METHOD Surgery 28.07 10.75 10.75 RBRVS 34510 VENOUS VALVE TRANSPOSITION ANY VEIN DONOR Surgery 19.91 10.14 10.14 RBRVS 34520 CROSS-OVER VEIN GRAFT VENOUS SYSTEM Surgery 19.18 5.60 5.60 RBRVS 34530 SAPHENOPOPLITEAL VEIN ANASTOMOSIS Surgery 17.93 10.10 10.10 RBRVS 34800 EVASC RPR AAA W/AORTO-AORTIC TUBE PROSTH Surgery 21.54 6.93 6.93 RBRVS 34802 EVASC RPR AAA W/MDLR BFRC PROSTH 1 LIMB Surgery 23.79 7.73 7.73 RBRVS 34803 EVASC RPR AAA W/MDLR BFRC PROSTH 2 LIMBS Surgery 24.82 7.65 7.65 RBRVS 34804 EVASC RPR AAA W/UNIBDY BFRC PROSTH Surgery 23.79 7.64 7.64 RBRVS 34805 EVASC RPR AAA AORTO-UNIILIAC/AORTO-UNIFEM PROSTH Surgery 22.67 7.40 7.40 RBRVS 34806 TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC Surgery 2.06 0.41 0.41 RBRVS 34808 EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE Surgery 4.12 1.03 1.03 RBRVS 34812 OPN FEM ART EXPOS DLVR EVASC PROSTH UNI Surgery 6.74 1.66 1.66 RBRVS 34813 PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR Surgery 4.79 1.10 1.10 RBRVS 34820 ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI Surgery 9.74 2.48 2.48 RBRVS 34825 PLMT XTN PROSTH EVASC RPR ARYSM/DSJ 1ST VSL Surgery 12.80 4.90 4.90 RBRVS 34826 PLMT XTN PROSTH EVASC RPR ARYSM/DSJ EA VSL Surgery 4.12 1.02 1.02 RBRVS 34830 OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH Surgery 35.23 8.75 8.75 RBRVS 34831 OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH Surgery 37.98 9.29 9.29 RBRVS 34832 OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH Surgery 37.98 9.29 9.29 RBRVS 34833 ILIAC ART EXPOS W/CRTJ CONDUIT UNI Surgery 11.98 3.27 3.27 RBRVS 34834 BRACH ART EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI Surgery 5.34 1.49 1.49 RBRVS 34841 ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT Surgery 15.50 v3.16 34842 ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT Surgery 31.00 v3.16 34843 ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT Surgery 46.50 v3.16 34844 ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT Surgery 62.00 v3.16 34845 VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS Surgery 21.51 v3.16 34846 VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS Surgery 43.03 v3.16 34847 VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS Surgery 64.54 v3.16 34848 VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS Surgery 86.05 v3.16 34900 EVASC RPR ILIAC ART ILIO-ILIAC PROSTHESIS Surgery 16.85 5.79 5.79 RBRVS 35001 DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY Surgery 20.81 7.69 7.69 RBRVS 35002 DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY Surgery 22.23 6.18 6.18 RBRVS 35005 DIR RPR ANEURYSM VERTEBRAL ARTERY Surgery 19.29 10.03 10.03 RBRVS 35011 DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION Surgery 18.58 6.67 6.67 RBRVS 35013 DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS Surgery 23.23 8.14 8.14 RBRVS 35021 DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY Surgery 22.17 9.65 9.65 RBRVS 35022 DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN Surgery 25.70 10.66 10.66 RBRVS 35045 DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY Surgery 18.01 7.23 7.23 RBRVS 35081 DIR RPR ANEURYSM ABDOMINAL AORTA Surgery 33.53 10.39 10.39 RBRVS 35082 DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA Surgery 42.09 13.04 13.04 RBRVS 35091 DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS Surgery 35.35 9.48 9.48 RBRVS 35092 DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS Surgery 50.97 14.42 14.42 RBRVS 35102 DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS Surgery 36.53 10.94 10.94 RBRVS 35103 DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS Surgery 43.62 12.94 12.94 RBRVS

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35111 DIR RPR ANEURYSM SPLENIC ARTERY Surgery 26.28 6.90 6.90 RBRVS 35112 DIR RPR RUPTD ANEURYSM SPLENIC ARTERY Surgery 32.57 14.79 14.79 RBRVS 35121 DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC Surgery 31.52 9.70 9.70 RBRVS 35122 DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN Surgery 37.89 16.67 16.67 RBRVS 35131 DIR RPR ANEURYSM & GRAFT ILIAC ARTERY Surgery 26.40 8.58 8.58 RBRVS 35132 DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY Surgery 32.57 8.22 8.22 RBRVS 35141 DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY Surgery 20.91 7.05 7.05 RBRVS 35142 DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART Surgery 25.16 8.05 8.05 RBRVS 35151 DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY Surgery 23.72 7.58 7.58 RBRVS 35152 DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY Surgery 27.66 7.25 7.25 RBRVS 35180 REPAIR CONGENITAL AV FISTULA HEAD & NECK Surgery 15.10 9.12 9.12 RBRVS 35182 RPR CONGENITAL AV FISTULA THORAX & ABDOMEN Surgery 31.71 8.67 8.67 RBRVS 35184 RPR CONGENITAL AV FISTULA EXTREMITIES Surgery 18.82 9.51 9.51 RBRVS 35188 RPR/TRAUMATIC AV FISTULA HEAD & NECK Surgery 18.00 8.96 8.96 RBRVS 35189 RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN Surgery 29.98 7.71 7.71 RBRVS 35190 RPR/TRAUMATIC AV FISTULA EXTREMITIES Surgery 13.42 5.85 5.85 RBRVS 35201 REPAIR BLOOD VESSEL DIRECT NECK Surgery 16.93 7.42 7.42 RBRVS 35206 REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY Surgery 13.84 5.83 5.83 RBRVS 35207 REPAIR BLOOD VESSEL DIRECT HAND FINGER Surgery 10.94 8.86 8.86 RBRVS 35211 RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS Surgery 24.58 10.10 10.10 RBRVS 35216 RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS Surgery 36.61 14.79 14.79 RBRVS 35221 RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL Surgery 26.62 9.88 9.88 RBRVS 35226 RPR BLOOD VESSEL DIRECT LOWER EXTREMITY Surgery 15.30 5.70 5.70 RBRVS 35231 REPAIR BLOOD VESSEL W/VEIN GRAFT NECK Surgery 21.16 10.77 10.77 RBRVS 35236 REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY Surgery 18.02 6.83 6.83 RBRVS 35241 RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP Surgery 25.58 10.47 10.47 RBRVS 35246 RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP Surgery 28.23 11.25 11.25 RBRVS 35251 REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL Surgery 31.91 10.94 10.94 RBRVS 35256 REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY Surgery 19.06 6.58 6.58 RBRVS 35261 REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK Surgery 18.96 8.16 8.16 RBRVS 35266 RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY Surgery 15.83 6.03 6.03 RBRVS 35271 RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP Surgery 24.58 10.03 10.03 RBRVS 35276 RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP Surgery 25.83 10.98 10.98 RBRVS 35281 RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL Surgery 30.06 10.72 10.72 RBRVS 35286 RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY Surgery 17.19 6.40 6.40 RBRVS 35301 TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC Surgery 21.16 7.37 7.37 RBRVS 35302 TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY Surgery 21.35 7.06 7.06 RBRVS 35303 TEAEC W/GRAFT POPLITEAL ARTERY Surgery 23.60 7.69 7.69 RBRVS 35304 TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY Surgery 24.60 7.74 7.74 RBRVS 35305 TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL Surgery 23.60 7.14 7.14 RBRVS 35306 TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART Surgery 9.25 1.82 1.82 RBRVS 35311 TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC Surgery 28.60 10.60 10.60 RBRVS 35321 TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL Surgery 16.59 5.82 5.82 RBRVS 35331 TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA Surgery 27.72 8.95 8.95 RBRVS 35341 TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL Surgery 26.21 7.93 7.93 RBRVS 35351 TEAEC W/WO PATCH GRAFT ILIAC Surgery 24.61 7.59 7.59 RBRVS 35355 TEAEC W/WO PATCH GRAFT ILIOFEMORAL Surgery 19.86 6.18 6.18 RBRVS 35361 TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC Surgery 30.24 7.77 7.77 RBRVS 35363 TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL Surgery 32.35 11.88 11.88 RBRVS 35371 TEAEC W/WO PATCH GRAFT COMMON FEMORAL Surgery 15.31 5.40 5.40 RBRVS 35372 TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL Surgery 18.58 6.16 6.16 RBRVS 35390 ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO Surgery 3.19 0.80 0.80 RBRVS 35400 ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ Surgery 3.00 0.71 0.71 RBRVS 35450 TRLUML BALOON ANGIOPL OPN RENAL/OTH VISCERAL ART Surgery 10.05 2.50 2.50 RBRVS 35452 TRLUML BALLOON ANGIOPLASTY OPEN AORTIC Surgery 6.90 1.58 1.58 RBRVS 35458 TRLUML BALO ANGIOP OPN BRCH/CPHLC TRNK/BRNCH EA Surgery 9.48 2.78 2.78 RBRVS 35460 TRLUML BALLOON ANGIOPLASTY OPEN VENOUS Surgery 6.03 1.84 1.84 RBRVS 35471 TRLUML BALLOON ANGIOP PRQ RENAL/VISCERAL ART Surgery 10.05 3.22 60.75 RBRVS 35472 TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS AORTIC Surgery 6.90 2.09 44.91 RBRVS 35475 TRLUML BALO ANGIOP PRQ BRCH/CPHLC TRNK/BRNCH EA Surgery 6.60 2.20 36.83 RBRVS 35476 TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS VENOUS Surgery 5.10 2.04 34.73 RBRVS 35500 HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX Surgery 6.44 1.52 1.52 RBRVS 35501 BYPASS W/VEIN COMMON-IPSILATERAL CAROTID Surgery 29.09 8.69 8.69 RBRVS 35506 BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID Surgery 25.33 6.51 6.51 RBRVS 35508 BYPASS W/VEIN CAROTID-VERTEBRAL Surgery 26.09 7.17 7.17 RBRVS 35509 BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID Surgery 28.09 7.25 7.25 RBRVS 35510 BYPASS W/VEIN CAROTID-BRACHIAL Surgery 24.39 6.36 6.36 RBRVS 35511 BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN Surgery 22.20 5.81 5.81 RBRVS 35512 BYPASS W/VEIN SUBCLAVIAN-BRACHIAL Surgery 23.89 11.25 11.25 RBRVS 35515 BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL Surgery 26.09 12.87 12.87 RBRVS 35516 BYPASS W/VEIN SUBCLAVIAN-AXILLARY Surgery 24.21 6.29 6.29 RBRVS 35518 BYPASS W/VEIN AXILLARY-AXILLARY Surgery 22.65 5.90 5.90 RBRVS 35521 BYPASS W/VEIN AXILLARY-FEMORAL Surgery 24.13 6.56 6.56 RBRVS 35522 BYPASS W/VEIN AXILLARY-BRACHIAL Surgery 23.15 7.37 7.37 RBRVS 35523 BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL Surgery 24.13 8.59 8.59 RBRVS

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35525 BYPASS W/VEIN BRACHIAL-BRACHIAL Surgery 21.69 7.35 7.35 RBRVS 35526 BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE Surgery 31.55 12.09 12.09 RBRVS 35531 BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC Surgery 39.11 11.55 11.55 RBRVS 35533 BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL Surgery 29.92 7.70 7.70 RBRVS 35535 BYPASS W/VEIN HEPATORENAL Surgery 38.13 9.35 9.35 RBRVS 35536 BYPASS W/VEIN SPLENORENAL Surgery 33.73 8.45 8.45 RBRVS 35537 BYPASS W/VEIN AORTOILIAC Surgery 41.88 18.21 18.21 RBRVS 35538 BYPASS W/VEIN AORTOBI-ILIAC Surgery 47.03 11.14 11.14 RBRVS 35539 BYPASS W/VEIN AORTOFEMORAL Surgery 44.11 10.55 10.55 RBRVS 35540 BYPASS W/VEIN AORTOBIFEMORAL Surgery 49.33 15.20 15.20 RBRVS 35556 BYPASS W/VEIN FEMORAL-POPLITEAL Surgery 26.75 8.58 8.58 RBRVS 35558 BYPASS W/VEIN FEMORAL-FEMORAL Surgery 23.13 8.00 8.00 RBRVS 35560 BYPASS W/VEIN AORTORENAL Surgery 34.03 8.51 8.51 RBRVS 35563 BYPASS W/VEIN ILIOILIAC Surgery 26.12 12.48 12.48 RBRVS 35565 BYPASS W/VEIN ILIOFEMORAL Surgery 25.13 8.42 8.42 RBRVS 35566 BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL Surgery 32.35 9.70 9.70 RBRVS 35570 BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL Surgery 29.15 8.97 8.97 RBRVS 35571 BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL Surgery 25.52 7.97 7.97 RBRVS 35572 HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX Surgery 6.81 1.82 1.82 RBRVS 35583 IN-SITU VEIN BYPASS FEMORAL-POPLITEAL Surgery 27.75 8.89 8.89 RBRVS 35585 IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART Surgery 32.35 9.96 9.96 RBRVS 35587 IN-SITU VEIN BYP POP-TIBL PRONEAL Surgery 26.21 8.39 8.39 RBRVS 35600 HARVEST UPPER EXTREMITY ARTERY 1 SEGMENT CABG Surgery 4.94 1.43 1.43 RBRVS 35601 BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID Surgery 27.09 8.21 8.21 RBRVS 35606 BYP OTH/THN VEIN CAROTID-SUBCLAVIAN Surgery 22.46 7.22 7.22 RBRVS 35612 BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN Surgery 20.35 5.81 5.81 RBRVS 35616 BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY Surgery 21.82 5.73 5.73 RBRVS 35621 BYP OTH/THN VEIN AXILLARY-FEMORAL Surgery 21.03 6.72 6.72 RBRVS 35623 BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL Surgery 25.92 6.92 6.92 RBRVS 35626 BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE Surgery 29.14 10.52 10.52 RBRVS 35631 BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL Surgery 36.03 10.48 10.48 RBRVS 35632 BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC Surgery 36.13 8.97 8.97 RBRVS 35633 BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC Surgery 39.11 11.38 11.38 RBRVS 35634 BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL Surgery 35.33 10.64 10.64 RBRVS 35636 BYP OTH/THN VEIN SPLENORENAL Surgery 31.75 8.06 8.06 RBRVS 35637 BYP OTH/THN VEIN AORTOILIAC Surgery 33.05 10.75 10.75 RBRVS 35638 BYP OTH/THN VEIN AORTOBI-ILIAC Surgery 33.60 10.86 10.86 RBRVS 35642 BYP OTH/THN VEIN CAROTID-VERTEBRAL Surgery 18.94 10.44 10.44 RBRVS 35645 BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL Surgery 18.43 5.26 5.26 RBRVS 35646 BYP OTH/THN VEIN AORTOBIFEMORAL Surgery 32.98 10.29 10.29 RBRVS 35647 BYP OTH/THN VEIN AORTOFEMORAL Surgery 29.73 9.39 9.39 RBRVS 35650 BYP OTH/THN VEIN AXILLARY-AXILLARY Surgery 20.16 7.36 7.36 RBRVS 35654 BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL Surgery 26.28 8.30 8.30 RBRVS 35656 BYP OTH/THN VEIN FEMORAL-POPLITEAL Surgery 20.47 6.94 6.94 RBRVS 35661 BYP OTH/THN VEIN FEMORAL-FEMORAL Surgery 20.35 7.12 7.12 RBRVS 35663 BYP OTH/THN VEIN ILIOILIAC Surgery 23.93 7.86 7.86 RBRVS 35665 BYP OTH/THN VEIN ILIOFEMORAL Surgery 22.35 7.27 7.27 RBRVS 35666 BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL Surgery 23.66 8.34 8.34 RBRVS 35671 BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART Surgery 20.77 7.60 7.60 RBRVS 35681 BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN Surgery 1.60 0.41 0.41 RBRVS 35682 BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS Surgery 7.19 1.64 1.64 RBRVS 35683 BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION Surgery 8.49 1.67 1.67 RBRVS 35685 PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT Surgery 4.04 0.91 0.91 RBRVS 35686 CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO Surgery 3.34 0.66 0.66 RBRVS 35691 TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART Surgery 18.41 5.26 5.26 RBRVS 35693 TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART Surgery 15.73 5.28 5.28 RBRVS 35694 TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART Surgery 19.28 5.43 5.43 RBRVS 35695 TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART Surgery 20.06 5.59 5.59 RBRVS 35697 RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART Surgery 3.00 0.68 0.68 RBRVS 35700 ROPRTJ > 1 MO AFTER ORIGINAL OPRATION Surgery 3.08 0.73 0.73 RBRVS 35701 EXPL N/FLWD SURG RPR W/WO LYSIS CAROTID ARTERY Surgery 9.19 5.56 5.56 RBRVS 35721 EXPL N/FLWD SURG RPR W/WO LYSIS FEMORAL ARTERY Surgery 7.72 3.96 3.96 RBRVS 35741 EXPL N/FLWD SURG RPR W/WO LYSIS POPLITEAL ARTERY Surgery 8.69 4.42 4.42 RBRVS 35761 EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY Surgery 5.93 4.26 4.26 RBRVS 35800 EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK Surgery 12.00 6.41 6.41 RBRVS 35820 EXPL PO HEMRRG THROMBOSIS/INFCTJ CH Surgery 36.89 13.32 13.32 RBRVS 35840 EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD Surgery 20.75 9.12 9.12 RBRVS 35860 EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR Surgery 15.25 5.96 5.96 RBRVS 35870 RPR GRF-ENTERIC FSTL Surgery 24.50 6.63 6.63 RBRVS 35875 THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL Surgery 10.72 4.34 4.34 RBRVS 35876 THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF Surgery 17.82 6.04 6.04 RBRVS 35879 REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP Surgery 17.41 5.87 5.87 RBRVS 35881 REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS Surgery 19.35 6.37 6.37 RBRVS 35883 REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT Surgery 23.15 7.32 7.32 RBRVS 35884 REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT Surgery 24.65 6.35 6.35 RBRVS

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35901 EXCISION INFECTED NECK GRAFT Surgery 8.38 4.20 4.20 RBRVS 35903 EXCISION INFECTED GRAFT EXTREMITY Surgery 9.53 4.93 4.93 RBRVS 35905 EXCISION INFECTED GRAFT THORAX Surgery 33.52 10.64 10.64 RBRVS 35907 EXCISION INFECTED GRAFT ABDOMEN Surgery 37.27 10.61 10.61 RBRVS 36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN Surgery 0.18 0.07 0.53 RBRVS 36002 INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM Surgery 1.96 0.86 2.41 RBRVS 36005 NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH Surgery 0.95 0.31 8.08 RBRVS 36010 INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA Surgery 2.43 0.74 11.43 RBRVS 36011 SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH Surgery 3.14 0.97 20.12 RBRVS 36012 SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC Surgery 3.51 1.07 20.53 RBRVS 36013 INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY Surgery 2.52 0.80 19.37 RBRVS 36014 SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY Surgery 3.02 0.99 19.71 RBRVS 36015 SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART Surgery 3.51 1.07 20.63 RBRVS 36100 INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY Surgery 3.02 0.82 10.30 RBRVS 36120 INTRO NEEDLE/INTRACATH RETROGRADE BRACHIAL ART Surgery 2.01 0.55 9.57 RBRVS 36140 INTRO NEEDLE/INTRACATH EXTREMITY ARTERY Surgery 2.01 0.59 10.03 RBRVS 36147 INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL Surgery 3.72 1.18 19.51 RBRVS 36148 INTRO NDL/CATH AV SHUNT ADDL ACCESS THER IVNTJ Surgery 1.00 0.30 6.31 RBRVS 36160 INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR Surgery 2.52 0.79 11.27 RBRVS 36200 INTRODUCTION CATHETER AORTA Surgery 3.02 0.82 14.12 RBRVS 36215 SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH Surgery 4.67 1.48 26.64 RBRVS 36216 SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH Surgery 5.27 1.69 27.04 RBRVS 36217 SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH Surgery 6.29 1.95 46.36 RBRVS 36218 SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH Surgery 1.01 0.33 4.05 RBRVS 36221 NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART Surgery 4.17 1.26 26.11 RBRVS 36222 SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART Surgery 5.53 1.87 29.31 RBRVS 36223 SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART Surgery 6.00 2.13 35.98 RBRVS 36224 SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART Surgery 6.50 2.58 45.91 RBRVS 36225 SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY Surgery 6.00 2.05 34.41 RBRVS 36226 SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY Surgery 6.50 2.55 44.68 RBRVS 36227 SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC Surgery 2.09 0.79 4.87 RBRVS 36228 SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT Surgery 4.25 1.61 30.62 RBRVS 36245 SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH Surgery 4.90 1.62 33.19 RBRVS 36246 SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH Surgery 5.27 1.57 19.11 RBRVS 36247 SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH Surgery 6.29 1.89 37.47 RBRVS 36248 SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH Surgery 1.01 0.31 3.22 RBRVS 36251 SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN Surgery 5.35 1.80 34.06 RBRVS 36252 SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL Surgery 6.99 2.42 35.46 RBRVS 36253 SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I Surgery 7.55 2.49 55.96 RBRVS 36254 SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I Surgery 8.15 2.78 52.82 RBRVS 36260 INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM Surgery 9.91 6.43 6.43 RBRVS 36261 REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP Surgery 5.63 3.52 3.52 RBRVS 36262 REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP Surgery 4.11 3.75 3.75 RBRVS 36299 UNLISTED PROCEDURE VASCULAR INJECTION Surgery 0.68 Unlisted 36400 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN Surgery 0.38 0.15 0.40 RBRVS 36405 VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN Surgery 0.31 0.13 0.42 RBRVS 36406 VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN Surgery 0.18 0.08 0.37 RBRVS 36410 VNPNXR 3 YEARS/> PHYS/QHP SKILL Surgery 0.18 0.07 0.28 RBRVS 36416 COLLECTION CAPILLARY BLOOD SPECIMEN Pathology 0.11 FAIR Health 36420 VENIPUNCTURE CUTDOWN UNDER AGE 1 YR Surgery 1.01 0.39 0.39 RBRVS 36425 VENIPUNCTURE CUTDOWN AGE 1 YR/> Surgery 0.76 0.29 0.29 RBRVS 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS Surgery 0.96 0.96 RBRVS 36440 PUSH TRANSFUSION BLOOD 2 YR/UNDER Surgery 1.03 0.35 0.35 RBRVS 36450 EXCHNG TRANSFUSION BLOOD NEWBORN Surgery 2.23 0.88 0.88 RBRVS 36455 EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN Surgery 2.43 0.71 0.71 RBRVS 36460 TRANSFUSION INTRAUTERINE FETAL Surgery 6.58 2.59 2.59 RBRVS 36468 1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK Surgery 2.24 5% Sample 36470 NJX SCLEROSING SOLUTION SINGLE VEIN Surgery 1.10 1.12 2.96 RBRVS 36471 NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG Surgery 1.65 0.96 3.04 RBRVS 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN Surgery 5.30 1.81 37.25 RBRVS 36476 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS Surgery 2.65 0.76 5.25 RBRVS 36478 ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN Surgery 5.30 1.81 27.81 RBRVS 36479 ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS Surgery 2.65 0.82 5.62 RBRVS 36481 PRQ PORTAL VEIN CATHETERIZATION ANY METHOD Surgery 6.98 2.55 50.94 RBRVS 36500 VEN CATHJ SLCTV ORGAN BLD SAMPLING Surgery 3.51 1.18 1.18 RBRVS 36510 CATHJ UMBILICAL VEIN DX/THER NB Surgery 1.09 0.43 1.40 RBRVS 36511 THERAPEUTIC APHERESIS WHITE BLOOD CELLS Surgery 1.74 0.74 0.74 RBRVS 36512 THERAPEUTIC APHERESIS RED BLOOD CELLS Surgery 1.74 0.84 0.84 RBRVS 36513 THERAPEUTIC APHERESIS PLATELETS Surgery 1.74 0.78 0.78 RBRVS 36514 THERAPEUTIC APHERESIS PLASMA PHERESIS Surgery 1.74 0.75 13.24 RBRVS 36515 THER APHERESIS W/XTRCORP IMMUNODSPTJ& PLSM RENFJ Surgery 1.74 0.69 56.31 RBRVS 36516 THER APHRS XTRCORP SLCTV ADSRPJ/FILTRJ & REINFSJ Surgery 1.22 0.49 57.27 RBRVS 36522 PHOTOPHERESIS EXTRACORPOREAL Surgery 1.67 1.12 37.66 RBRVS 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y Surgery 2.68 0.48 4.33 RBRVS 36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> Surgery 2.50 0.70 3.85 RBRVS

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36557 INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR Surgery 5.14 3.20 22.77 RBRVS 36558 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> Surgery 4.84 2.54 16.78 RBRVS 36560 INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR Surgery 6.29 3.35 23.62 RBRVS 36561 INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> Surgery 6.04 3.17 26.40 RBRVS 36563 INSJ TUNNELED CTR VAD W/SUBQ PUMP Surgery 6.24 3.42 30.43 RBRVS 36565 INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP Surgery 6.04 2.76 20.16 RBRVS 36566 INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT Surgery 6.54 3.38 149.61 RBRVS 36568 INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR Surgery 1.92 0.76 6.53 RBRVS 36569 INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/> Surgery 1.82 0.67 5.13 RBRVS 36570 INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR Surgery 5.36 3.12 28.13 RBRVS 36571 INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> Surgery 5.34 3.02 30.88 RBRVS 36575 RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP Surgery 0.67 0.26 3.97 RBRVS 36576 RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT Surgery 3.24 1.89 7.23 RBRVS 36578 RPLCMT CATH CTR VAD SUBQ PORT/PMP Surgery 3.54 2.23 10.80 RBRVS 36580 RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP Surgery 1.31 0.48 4.66 RBRVS 36581 RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP Surgery 3.48 1.78 17.93 RBRVS 36582 RPLCMT COMPL TUN CTR VAD W/SUBQ PORT Surgery 5.24 2.73 25.09 RBRVS 36583 RPLCMT COMPL TUN CTR VAD W/SUBQ PMP Surgery 5.29 3.26 32.37 RBRVS 36584 RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP Surgery 1.20 0.62 4.51 RBRVS 36585 RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT Surgery 4.84 2.65 27.40 RBRVS 36589 RMVL TUN CVC W/O SUBQ PORT/PMP Surgery 2.28 1.39 2.12 RBRVS 36590 RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ Surgery 3.35 1.98 4.42 RBRVS 36591 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE Surgery a 0.65 0.65 RBRVS 36592 COLLECT BLOOD FROM CATHETER VENOUS NOS Surgery a 0.73 0.73 RBRVS 36593 DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH Surgery a 0.86 0.86 RBRVS 36595 MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS Surgery 3.59 1.35 12.65 RBRVS 36596 MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN Surgery 0.75 0.45 2.95 RBRVS 36597 RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE Surgery 1.21 0.45 2.31 RBRVS 36598 CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT Surgery 0.74 0.26 2.33 RBRVS 36600 ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX Surgery 0.32 0.10 0.56 RBRVS 36620 ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ Surgery 1.15 0.22 0.22 RBRVS 36625 ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN Surgery 2.11 0.55 0.55 RBRVS 36640 ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN Surgery 2.10 1.19 1.19 RBRVS 36660 CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY Surgery 1.40 0.24 0.24 RBRVS 36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION Surgery 1.20 0.31 0.31 RBRVS 36800 INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN Surgery 2.43 0.79 0.79 RBRVS 36810 INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL Surgery 3.96 1.59 1.59 RBRVS 36815 INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR Surgery 2.62 0.80 0.80 RBRVS 36818 ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS Surgery 12.39 5.17 5.17 RBRVS 36819 ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS Surgery 13.29 5.28 5.28 RBRVS 36820 ARVEN ANAST OPN F/ARM VEIN TRPOS Surgery 13.07 5.39 5.39 RBRVS 36821 ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT Surgery 11.90 4.95 4.95 RBRVS 36823 INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL Surgery 22.98 11.85 11.85 RBRVS 36825 CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF Surgery 14.17 6.17 6.17 RBRVS 36830 CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF Surgery 12.03 4.90 4.90 RBRVS 36831 THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF Surgery 11.00 4.68 4.68 RBRVS 36832 REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF Surgery 13.50 5.72 5.72 RBRVS 36833 REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF Surgery 14.50 6.06 6.06 RBRVS 36835 INSERTION THOMAS SHUNT SEPARATE PROCEDURE Surgery 7.51 5.36 5.36 RBRVS 36838 DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS Surgery 21.69 7.11 7.11 RBRVS 36860 XTRNL CANNULA DECLTNG SPX W/O BALO CATH Surgery 2.01 1.02 3.75 RBRVS 36861 XTRNL CANNULA DECLTNG SPX W/BALO CATH Surgery 2.52 0.77 0.77 RBRVS 36870 THRMBC PRQ ARVEN FSTL AUTOG/NONAUTOG GRF Surgery 5.20 2.85 46.25 RBRVS 37140 VENOUS ANASTOMOSIS OPEN PORTOCAVAL Surgery 40.00 17.61 17.61 RBRVS 37145 VENOUS ANASTOMOSIS OPEN RENOPORTAL Surgery 37.00 16.44 16.44 RBRVS 37160 VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC Surgery 38.00 16.89 16.89 RBRVS 37180 VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL Surgery 36.50 16.32 16.32 RBRVS 37181 VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL Surgery 40.00 17.61 17.61 RBRVS 37182 INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT Surgery 16.97 5.78 5.78 RBRVS 37183 REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT Surgery 7.99 2.75 159.33 RBRVS 37184 PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST Surgery 8.66 3.03 54.29 RBRVS 37185 PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ Surgery 3.28 0.93 16.51 RBRVS 37186 SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL Surgery 4.92 1.38 33.35 RBRVS 37187 PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN Surgery 8.03 2.56 49.44 RBRVS 37188 PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX Surgery 5.71 1.99 43.60 RBRVS 37191 INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I Surgery 4.71 1.57 69.55 RBRVS 37192 REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS& Surgery 7.35 2.87 39.77 RBRVS 37193 RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I Surgery 7.35 2.29 37.23 RBRVS 37195 THROMBOLYSIS CEREBRAL IV INFUSION Surgery 7.04 FAIR Health 37197 PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING Surgery 6.29 1.97 36.02 RBRVS 37200 TRANSCATHETER BIOPSY Surgery 4.55 1.45 1.45 RBRVS 37211 THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX Surgery 8.00 2.29 2.29 RBRVS 37212 THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX Surgery 7.06 2.01 2.01 RBRVS 37213 THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX Surgery 5.00 1.51 1.51 RBRVS 37214 CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL Surgery 2.74 0.82 0.82 RBRVS

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37215 TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ Surgery 19.68 7.65 7.65 RBRVS 37216 TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ Surgery 30.15 FAIR Health 37217 TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE Surgery 20.38 7.67 7.67 RBRVS 37218 TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE Surgery 15.00 5.94 5.94 RBRVS 37220 REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL Surgery 8.15 2.33 80.02 RBRVS 37221 REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY Surgery 10.00 2.90 120.47 RBRVS 37222 REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL Surgery 3.73 0.97 20.69 RBRVS 37223 REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL Surgery 4.25 1.16 68.71 RBRVS 37224 REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI Surgery 9.00 2.61 98.23 RBRVS 37225 REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL Surgery 12.00 3.58 299.17 RBRVS 37226 REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL Surgery 10.49 3.07 245.30 RBRVS 37227 REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL Surgery 14.50 4.23 406.09 RBRVS 37228 REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI Surgery 11.00 3.11 141.81 RBRVS 37229 REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL Surgery 14.05 4.15 292.49 RBRVS 37230 REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL Surgery 13.80 4.15 219.91 RBRVS 37231 REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL Surgery 15.00 4.51 362.05 RBRVS 37232 REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL Surgery 4.00 1.12 29.77 RBRVS 37233 REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL Surgery 6.50 1.82 34.00 RBRVS 37234 REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL Surgery 5.50 1.67 103.68 RBRVS 37235 REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL Surgery 7.80 2.11 109.15 RBRVS 37236 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL Surgery 9.00 2.71 107.42 RBRVS 37237 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL Surgery 4.25 1.17 65.60 RBRVS 37238 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST Surgery 6.29 1.92 109.59 RBRVS 37239 OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL Surgery 2.97 0.82 54.14 RBRVS 37241 VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I Surgery 9.00 2.83 120.55 RBRVS 37242 VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I Surgery 10.05 3.13 208.96 RBRVS 37243 VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT Surgery 11.99 3.72 264.58 RBRVS 37244 VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE Surgery 14.00 4.33 178.83 RBRVS 37252 INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL Surgery 1.80 0.50 37.50 RBRVS 37253 INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL Surgery 1.44 0.39 4.40 RBRVS 37500 VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX Surgery 11.67 4.44 4.44 RBRVS 37501 UNLISTED VASCULAR ENDOSCOPY PROCEDURE Surgery 16.11 Unlisted 37565 LIGATION INTERNAL JUGULAR VEIN Surgery 12.05 7.55 7.55 RBRVS 37600 LIGATION EXTERNAL CAROTID ARTERY Surgery 12.42 5.81 5.81 RBRVS 37605 LIGATION INTERNAL/COMMON CAROTID ARTERY Surgery 14.28 5.60 5.60 RBRVS 37606 LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION Surgery 8.81 3.32 3.32 RBRVS 37607 LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA Surgery 6.25 3.37 3.37 RBRVS 37609 LIGATION/BIOPSY TEMPORAL ARTERY Surgery 3.05 2.35 5.23 RBRVS 37615 LIGATION MAJOR ARTERY NECK Surgery 7.80 5.77 5.77 RBRVS 37616 LIGATION MAJOR ARTERY CHEST Surgery 18.97 8.80 8.80 RBRVS 37617 LIGATION MAJOR ARTERY ABDOMEN Surgery 23.79 10.13 10.13 RBRVS 37618 LIGATION MAJOR ARTERY EXTREMITY Surgery 6.03 3.79 3.79 RBRVS 37619 INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I Surgery 30.00 10.96 10.96 RBRVS 37650 REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS& Surgery 8.49 3.12 3.12 RBRVS 37660 RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I Surgery 22.28 10.47 10.47 RBRVS 37700 LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ Surgery 3.82 2.63 2.63 RBRVS 37718 LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN Surgery 7.13 4.05 4.05 RBRVS 37722 LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW Surgery 8.16 3.96 3.96 RBRVS 37735 LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS Surgery 10.90 3.73 3.73 RBRVS 37760 LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG Surgery 10.78 4.76 4.76 RBRVS 37761 LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG Surgery 9.13 5.12 5.12 RBRVS 37765 STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS Surgery 7.71 3.86 9.57 RBRVS 37766 STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS Surgery 9.66 4.44 10.77 RBRVS 37780 LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX Surgery 3.93 2.71 2.71 RBRVS 37785 LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG Surgery 3.93 2.92 5.56 RBRVS 37788 PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT Surgery 23.33 10.34 10.34 RBRVS 37790 PENILE VENOUS OCCLUSIVE PROCEDURE Surgery 8.43 4.60 4.60 RBRVS 37799 UNLISTED PROCEDURE VASCULAR SURGERY Surgery 0.08 Unlisted 38100 SPLENECTOMY TOTAL SEPARATE PROCEDURE Surgery 19.55 9.32 9.32 RBRVS 38101 SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE Surgery 19.55 9.50 9.50 RBRVS 38102 SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX Surgery 4.79 1.74 1.74 RBRVS 38115 RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT Surgery 21.88 10.16 10.16 RBRVS 38120 LAPAROSCOPIC SURGICAL SPLENECTOMY Surgery 17.07 9.40 9.40 RBRVS 38129 UNLISTED LAPAROSCOPY PROCEDURE SPLEEN Surgery 26.47 Unlisted 38200 INJECTION PROCEDURE SPLENOPORTOGRAPY Surgery 2.64 0.99 0.99 RBRVS 38204 MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ Surgery 2.00 0.77 0.77 RBRVS 38205 BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC Surgery 1.50 0.76 0.76 RBRVS 38206 BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL Surgery 1.50 0.78 0.78 RBRVS 38207 TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR Surgery 0.89 0.34 0.34 RBRVS 38208 TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR Surgery 0.56 0.21 0.21 RBRVS 38209 TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR Surgery 0.24 0.09 0.09 RBRVS 38210 TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL Surgery 1.57 0.60 0.60 RBRVS 38211 TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ Surgery 1.42 0.54 0.54 RBRVS 38212 TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL Surgery 0.94 0.36 0.36 RBRVS 38213 TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ Surgery 0.24 0.09 0.09 RBRVS

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38214 TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ Surgery 0.81 0.31 0.31 RBRVS 38215 TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM Surgery 0.94 0.36 0.36 RBRVS 38220 MARROW ASPIRATION ONLY Surgery 1.08 0.55 3.45 RBRVS 38221 BONE MARROW BIOPSY NEEDLE/TROCAR Surgery 1.37 0.69 3.29 RBRVS 38230 BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC Surgery 3.50 1.76 1.76 RBRVS 38232 BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS Surgery 3.50 1.66 1.66 RBRVS 38240 TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR Surgery 4.00 2.16 2.16 RBRVS 38241 TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR Surgery 3.00 1.64 1.64 RBRVS 38242 ALLOGENEIC LYMPHOCYTE INFUSIONS Surgery 2.11 1.16 1.16 RBRVS 38243 TRNSPLJ HEMATOPOIETIC CELL BOOST Surgery 2.13 1.15 1.15 RBRVS 38300 DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL Surgery 2.36 2.48 5.02 RBRVS 38305 DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV Surgery 6.68 5.06 5.06 RBRVS 38308 LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS Surgery 6.81 4.46 4.46 RBRVS 38380 SUTR&/LIG THORACIC DUCT CERVICAL APPROACH Surgery 8.46 6.43 6.43 RBRVS 38381 SUTR&/LIG THORACIC DUCT THORACIC APPROACH Surgery 13.38 6.80 6.80 RBRVS 38382 SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH Surgery 10.65 6.44 6.44 RBRVS 38500 BX/EXC LYMPH NODE OPEN SUPERFICIAL Surgery 3.79 2.69 4.84 RBRVS 38505 BX/EXC LYMPH NODE NEEDLE SUPERFICIAL Surgery 1.14 0.81 2.37 RBRVS 38510 BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE Surgery 6.74 4.08 6.87 RBRVS 38520 BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD Surgery 7.03 4.88 4.88 RBRVS 38525 BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE Surgery 6.43 4.63 4.63 RBRVS 38530 BX/EXC LYMPH NODE OPEN INT MAMMARY NODE Surgery 8.34 5.61 5.61 RBRVS 38542 DISSECTION DEEP JUGULAR NODE Surgery 7.95 5.59 5.59 RBRVS 38550 EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ Surgery 7.11 5.84 5.84 RBRVS 38555 EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ Surgery 15.59 9.74 9.74 RBRVS 38562 LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC Surgery 11.06 7.07 7.07 RBRVS 38564 LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC Surgery 11.38 6.45 6.45 RBRVS 38570 LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT Surgery 9.34 4.58 4.58 RBRVS 38571 LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY Surgery 14.76 6.32 6.32 RBRVS 38572 LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1 Surgery 16.94 8.15 8.15 RBRVS 38589 UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM Surgery 21.08 Unlisted 38700 SUPRAHYOID LYMPHADENECTOMY Surgery 12.81 8.48 8.48 RBRVS 38720 CERVICAL LYMPHADENECTOMY Surgery 21.95 13.19 13.19 RBRVS 38724 CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ Surgery 23.95 14.34 14.34 RBRVS 38740 AXILLARY LYMPHADENECTOMY SUPERFICIAL Surgery 10.70 6.82 6.82 RBRVS 38745 AXILLARY LYMPHADENECTOMY COMPLETE Surgery 13.87 8.17 8.17 RBRVS 38746 THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC Surgery 4.12 1.21 1.21 RBRVS 38747 ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC Surgery 4.88 1.75 1.75 RBRVS 38760 INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX Surgery 13.62 7.71 7.71 RBRVS 38765 INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC Surgery 21.91 10.84 10.84 RBRVS 38770 PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR Surgery 14.06 7.08 7.08 RBRVS 38780 RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL Surgery 17.70 9.11 9.11 RBRVS 38790 INJECTION PROCEDURE LYMPHANGIOGRAPHY Surgery 1.29 0.90 0.90 RBRVS 38792 INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE Surgery 0.52 0.56 0.56 RBRVS 38794 CANNULATION THORACIC DUCT Surgery 4.62 3.62 3.62 RBRVS 38900 INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION Surgery 2.50 0.91 0.91 RBRVS 38999 UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM Surgery 3.12 Unlisted 39000 MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR Surgery 7.57 5.16 5.16 RBRVS 39010 MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR Surgery 13.19 6.68 6.68 RBRVS 39200 RESECTION OF MEDIASTINAL CYST Surgery 15.09 6.87 6.87 RBRVS 39220 RESECTION MEDIASTINAL TUMOR Surgery 19.55 9.18 9.18 RBRVS 39401 MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY Surgery 5.44 2.35 2.35 RBRVS 39402 MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES Surgery 7.25 2.88 2.88 RBRVS 39499 UNLISTED PROCEDURE MEDIASTINUM Surgery 19.87 Unlisted 39501 REPAIR LACERATION DIAPHRAGM ANY APPROACH Surgery 13.98 7.46 7.46 RBRVS 39503 RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ Surgery 108.91 43.40 43.40 RBRVS 39540 RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT Surgery 14.57 7.19 7.19 RBRVS 39541 RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC Surgery 15.75 7.98 7.98 RBRVS 39545 IMBRICATION DIAPHRAGM EVENTRATION Surgery 14.67 7.84 7.84 RBRVS 39560 RESCJ DIAPHRAGM W/SIMPLE REPAIR Surgery 13.06 7.05 7.05 RBRVS 39561 RESCJ DIAPHRAGM W/COMPLEX REPAIR Surgery 19.99 11.23 11.23 RBRVS 39599 UNLISTED PROCEDURE DIAPHRAGM Surgery 21.44 Unlisted 40490 BIOPSY OF LIP Surgery 1.22 0.73 2.30 RBRVS 40500 VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT Surgery 4.47 5.37 9.41 RBRVS 40510 EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR Surgery 4.82 4.74 8.38 RBRVS 40520 EXC LIP V-EXC W/PRIM DIR LINR CLSR Surgery 4.79 4.84 8.56 RBRVS 40525 EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP Surgery 7.72 6.98 6.98 RBRVS 40527 EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP Surgery 9.32 7.19 7.19 RBRVS 40530 RESCJ LIP > ONE-FOURTH W/O RCNSTJ Surgery 5.54 5.25 9.13 RBRVS 40650 RPR LIP FULL THICKNESS VERMILION ONLY Surgery 3.78 4.26 8.23 RBRVS 40652 RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT Surgery 4.43 5.15 9.06 RBRVS 40654 RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE Surgery 5.48 5.93 10.02 RBRVS 40700 PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI Surgery 14.17 12.52 12.52 RBRVS 40701 PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX Surgery 17.23 9.80 9.80 RBRVS 40702 PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS Surgery 14.27 9.90 9.90 RBRVS

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40720 PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL Surgery 14.72 12.51 12.51 RBRVS 40761 PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP Surgery 15.84 10.05 10.05 RBRVS 40799 UNLISTED PROCEDURE LIPS Surgery 3.47 Unlisted 40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL Surgery 1.23 2.45 4.75 RBRVS 40801 DRG ABSC CST HMTMA VESTIBULE MOUTH COMP Surgery 2.63 3.47 6.17 RBRVS 40804 RMVL EMBEDDED FB VESTIBULE MOUTH SMPL Surgery 1.30 2.35 4.68 RBRVS 40805 RMVL EMBEDDED FB VESTIBULE MOUTH COMP Surgery 2.79 3.60 6.17 RBRVS 40806 INCISION LABIAL FRENUM FRENOTOMY Surgery 0.31 0.61 2.77 RBRVS 40808 BIOPSY VESTIBULE MOUTH Surgery 1.01 2.02 4.27 RBRVS 40810 EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR Surgery 1.36 2.18 4.43 RBRVS 40812 EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR Surgery 2.37 3.06 5.67 RBRVS 40814 EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR Surgery 3.52 4.88 7.19 RBRVS 40816 EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC Surgery 3.77 4.91 7.36 RBRVS 40818 EXC MUCOSA VESTIBULE MOUTH AS DON GRF Surgery 2.83 4.80 7.29 RBRVS 40819 EXC FRENUM LABIAL/BUCCAL Surgery 2.51 4.08 6.25 RBRVS 40820 DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS Surgery 1.34 3.51 6.21 RBRVS 40830 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< Surgery 1.82 2.78 5.65 RBRVS 40831 CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL Surgery 2.57 3.59 6.84 RBRVS 40840 VESTIBULOPLASTY ANTERIOR Surgery 9.15 7.82 13.11 RBRVS 40842 VESTIBULOPLASTY POSTERIOR UNILATERAL Surgery 9.15 8.36 13.13 RBRVS 40843 VESTIBULOPLASTY POSTERIOR BILATERAL Surgery 12.79 10.19 16.70 RBRVS 40844 VESTIBULOPLASTY ENTIRE ARCH Surgery 16.80 11.30 18.23 RBRVS 40845 VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG Surgery 19.36 13.46 20.20 RBRVS 40899 UNLISTED PROCEDURE VESTIBULE MOUTH Surgery 5.47 Unlisted 41000 INTRAORAL I&D TONGUE/FLOOR LINGUAL Surgery 1.35 1.74 3.18 RBRVS 41005 INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC Surgery 1.31 2.16 5.09 RBRVS 41006 INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD Surgery 3.34 3.95 7.29 RBRVS 41007 INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE Surgery 3.20 3.88 7.27 RBRVS 41008 INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE Surgery 3.46 3.90 7.07 RBRVS 41009 INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE Surgery 3.71 4.27 7.43 RBRVS 41010 INCISION LINGUAL FRENUM FRENOTOMY Surgery 1.11 1.89 4.60 RBRVS 41015 XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL Surgery 4.08 5.52 8.46 RBRVS 41016 XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT Surgery 4.19 5.45 7.99 RBRVS 41017 XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB Surgery 4.19 5.51 8.16 RBRVS 41018 XTRORAL I&D FLOOR MASTICATOR SPACE Surgery 5.22 6.02 8.68 RBRVS 41019 PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT Surgery 8.84 3.84 3.84 RBRVS 41100 BIOPSY TONGUE ANTERIOR TWO-THIRDS Surgery 1.42 1.52 3.25 RBRVS 41105 BIOPSY TONGUE POSTERIOR ONE-THIRD Surgery 1.47 1.57 3.27 RBRVS 41108 BIOPSY FLOOR MOUTH Surgery 1.10 1.38 3.04 RBRVS 41110 EXCISION LESION TONGUE W/O CLOSURE Surgery 1.56 2.06 4.36 RBRVS 41112 EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS Surgery 2.83 4.14 6.49 RBRVS 41113 EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD Surgery 3.29 4.41 6.89 RBRVS 41114 EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP Surgery 8.82 8.38 8.38 RBRVS 41115 EXCISION LINGUAL FRENUM FRENECTOMY Surgery 1.79 2.20 5.11 RBRVS 41116 EXCISION LESION FLOOR MOUTH Surgery 2.52 3.53 6.73 RBRVS 41120 GLOSSECTOMY 2.6 CM/CPLX Surgery 3.02 2.63 5.67 RBRVS 41500 FIXJ TONGUE MECHANICAL OTHER/THAN SUTURE Surgery 3.80 8.92 8.92 RBRVS 41510 SUTURE TONGUE LIP MICROGNATHIA Surgery 3.51 7.84 7.84 RBRVS 41512 TONGUE BASE SUSPENSION PERMANENT SUTURE TQ Surgery 6.86 10.61 10.61 RBRVS 41520 FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY Surgery 2.83 4.28 7.04 RBRVS 41530 SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION Surgery 4.51 6.88 87.26 RBRVS 41599 UNLISTED PROCEDURE TONGUE FLOOR MOUTH Surgery 4.53 Unlisted 41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS Surgery 1.27 2.83 6.37 RBRVS 41805 RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS Surgery 1.34 3.46 5.68 RBRVS 41806 RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE Surgery 2.79 4.40 7.13 RBRVS 41820 GINGIVECTOMY EXC GINGIVA EACH QUADRANT Surgery 5.61 FAIR Health 41821 OPRCULECTOMY EXC PRICORONAL TISSUE Surgery 1.26 FAIR Health 41822 EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS Surgery 2.41 2.59 6.25 RBRVS 41823 EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS Surgery 3.77 5.31 8.85 RBRVS 41825 EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR Surgery 1.41 1.96 4.53 RBRVS 41826 EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR Surgery 2.41 3.45 6.41 RBRVS 41827 EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR Surgery 3.83 4.62 8.50 RBRVS 41828 EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC Surgery 3.14 2.67 5.34 RBRVS 41830 ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY Surgery 3.45 4.36 7.51 RBRVS 41850 DESTRUCTION LESION DENTOALVEOLAR STRUCTURES Surgery 2.80 FAIR Health

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41870 PERIODONTAL MUCOSAL GRAFTING Surgery 7.01 FAIR Health 41872 GINGIVOPLASTY EACH QUADRANT SPECIFY Surgery 3.01 4.17 7.41 RBRVS 41874 ALVEOLOPLASTY EACH QUADRANT SPECIFY Surgery 3.19 3.81 7.33 RBRVS 41899 UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES Surgery 10.06 Unlisted 42000 DRAINAGE ABSCESS PALATE UVULA Surgery 1.28 1.56 3.12 RBRVS 42100 BIOPSY PALATE UVULA Surgery 1.36 1.64 2.81 RBRVS 42104 EXC LESION PALATE UVULA W/O CLOSURE Surgery 1.69 2.12 4.31 RBRVS 42106 EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE Surgery 2.15 2.76 5.49 RBRVS 42107 EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE Surgery 4.56 4.83 8.13 RBRVS 42120 RESCJ PALATE/EXTENSIVE RESCJ LESION Surgery 11.86 15.27 15.27 RBRVS 42140 UVULECTOMY EXCISION UVULA Surgery 1.70 2.57 5.37 RBRVS 42145 PALATOPHARYNGOPLASTY Surgery 9.78 9.24 9.24 RBRVS 42160 DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM Surgery 1.85 2.18 4.62 RBRVS 42180 REPAIR LACERATION PALATE 2 CM/COMPLEX Surgery 3.87 3.01 4.83 RBRVS 42200 PALATOP CL PALATE SOFT&/HARD PALATE ONLY Surgery 12.53 10.27 10.27 RBRVS 42205 PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE Surgery 13.66 10.06 10.06 RBRVS 42210 PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE Surgery 15.03 13.73 13.73 RBRVS 42215 PALATOPLASTY CLEFT PALATE MAJOR REVJ Surgery 8.99 10.36 10.36 RBRVS 42220 PALATOPLASTY CLEFT PALATE SEC LNGTH PX Surgery 7.16 7.18 7.18 RBRVS 42225 PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP Surgery 9.77 14.28 14.28 RBRVS 42226 LENGTHENING PALATE & PHARYNGEAL FLAP Surgery 10.35 14.07 14.07 RBRVS 42227 LENGTHENING PALATE W/ISLAND FLAP Surgery 9.90 12.96 12.96 RBRVS 42235 REPAIR ANTERIOR PALATE W/VOMER FLAP Surgery 8.01 12.12 12.12 RBRVS 42260 REPAIR NASOLABIAL FISTULA Surgery 10.22 9.03 13.09 RBRVS 42280 MAXILLARY IMPRESJ PALATAL PROSTHESIS Surgery 1.59 1.40 2.94 RBRVS 42281 INSJ PIN-RETAINED PALATAL PROSTHESIS Surgery 1.98 2.13 3.66 RBRVS 42299 UNLISTED PROCEDURE PALATE UVULA Surgery 6.82 Unlisted 42300 DRAINAGE ABSCESS PAROTID SIMPLE Surgery 1.98 2.17 3.78 RBRVS 42305 DRAINAGE ABSCESS PAROTID COMPLICATED Surgery 6.31 5.24 5.24 RBRVS 42310 DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL Surgery 1.61 1.77 2.83 RBRVS 42320 DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL Surgery 2.40 2.36 4.47 RBRVS 42330 SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL Surgery 2.26 2.22 4.13 RBRVS 42335 SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL Surgery 3.41 3.56 6.94 RBRVS 42340 SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL Surgery 4.72 4.39 8.10 RBRVS 42400 BIOPSY SALIVARY GLAND NEEDLE Surgery 0.78 0.73 2.20 RBRVS 42405 BIOPSY SALIVARY GLAND INCISIONAL Surgery 3.34 2.75 4.80 RBRVS 42408 EXC SUBLINGUAL SALIVARY CYST RANULA Surgery 4.66 4.11 7.75 RBRVS 42409 MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA Surgery 2.91 3.12 6.31 RBRVS 42410 EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ Surgery 9.57 6.90 6.90 RBRVS 42415 EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR Surgery 17.16 10.86 10.86 RBRVS 42420 EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR Surgery 19.53 11.93 11.93 RBRVS 42425 EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL Surgery 13.42 8.80 8.80 RBRVS 42426 EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ Surgery 22.66 13.04 13.04 RBRVS 42440 EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND Surgery 6.14 4.88 4.88 RBRVS 42450 EXISION OF SUBLINGUAL GLAND Surgery 4.74 4.99 7.69 RBRVS 42500 PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM Surgery 4.42 4.86 7.48 RBRVS 42505 PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP Surgery 6.32 5.91 8.85 RBRVS 42507 PAROTID DUCT DIVERSION BILATERAL WILKE PX Surgery 6.25 7.70 7.70 RBRVS 42509 PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS Surgery 11.76 11.01 11.01 RBRVS 42510 PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS Surgery 8.35 8.64 8.64 RBRVS 42550 INJECTION PROCEDURE SIALOGRAPHY Surgery 1.25 0.47 2.51 RBRVS 42600 CLOSURE SALIVARY FISTULA Surgery 4.94 4.42 8.20 RBRVS 42650 DILATION SALIVARY DUCT Surgery 0.77 0.83 1.54 RBRVS 42660 DILAT&CATHJ SALIVARY DUCT W/WO INJECTION Surgery 1.13 1.13 2.21 RBRVS 42665 LIGATION SALIVARY DUCT INTRAORAL Surgery 2.63 2.97 6.00 RBRVS 42699 UNLISTED PX SALIVARY GLANDS/DUCTS Surgery 16.47 Unlisted 42700 I&D ABSCESS PERITONSILLAR Surgery 1.67 2.03 3.57 RBRVS 42720 I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL Surgery 6.31 4.13 5.90 RBRVS 42725 I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR Surgery 12.41 9.46 9.46 RBRVS 42800 BIOPSY OROPHARYNX Surgery 1.44 1.60 2.94 RBRVS 42804 BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE Surgery 1.29 1.81 4.16 RBRVS 42806 BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION Surgery 1.63 1.96 4.46 RBRVS 42808 EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD Surgery 2.35 2.02 3.86 RBRVS 42809 REMOVAL FOREIGN BODY PHARYNX Surgery 1.86 1.72 2.87 RBRVS 42810 EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS Surgery 3.38 4.51 7.36 RBRVS 42815 EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX Surgery 7.31 7.82 7.82 RBRVS 42820 TONSILLECTOMY & ADENOIDECTOMY Surgery 4.36 3.72 3.72 RBRVS 42825 TONSILLECTOMY ONE-HALF Surgery 3.45 3.32 3.32 RBRVS 42830 ADENOIDECTOMY PRIMARY Surgery 2.81 3.25 3.25 RBRVS 42835 ADENOIDECTOMY SECONDARY Surgery 3.26 3.24 3.24 RBRVS

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42842 RADICAL RESECTION TONSIL W/O CLOSURE Surgery 12.23 14.81 14.81 RBRVS 42844 RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP Surgery 17.78 19.30 19.30 RBRVS 42845 RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP Surgery 32.56 26.85 26.85 RBRVS 42860 EXCISION TONSIL TAGS Surgery 2.30 2.83 2.83 RBRVS 42870 EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX Surgery 5.52 10.45 10.45 RBRVS 42890 LIMITED PHARYNGECTOMY Surgery 19.13 18.92 18.92 RBRVS 42892 RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR Surgery 26.03 24.48 24.48 RBRVS 42894 RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS Surgery 33.92 29.40 29.40 RBRVS 42900 SUTURE PHARYNX WOUND/INJURY Surgery 5.29 3.75 3.75 RBRVS 42950 PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX Surgery 8.27 13.48 13.48 RBRVS 42953 PHARYNGOESOPHAGEAL REPAIR Surgery 9.45 16.75 16.75 RBRVS 42955 PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING Surgery 8.01 12.59 12.59 RBRVS 42960 CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE Surgery 2.38 2.22 2.22 RBRVS 42961 CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ Surgery 5.77 5.66 5.66 RBRVS 42962 CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ Surgery 7.40 6.54 6.54 RBRVS 42970 CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS Surgery 5.82 5.34 5.34 RBRVS 42971 CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION Surgery 6.60 5.69 5.69 RBRVS 42972 CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ Surgery 7.59 6.13 6.13 RBRVS 42999 UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS Surgery 6.77 Unlisted 43020 ESOPHAGOTOMY CERVICAL APPR W/RMVL FB Surgery 8.23 6.19 6.19 RBRVS 43030 CRICOPHARYNGEAL MYOTOMY Surgery 7.99 5.78 5.78 RBRVS 43045 ESOPHAGOTOMY THORACIC APPR W/RMVL FB Surgery 21.88 10.88 10.88 RBRVS 43100 EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR Surgery 9.66 7.09 7.09 RBRVS 43101 EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR Surgery 17.07 9.68 9.68 RBRVS 43107 TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY Surgery 44.18 19.83 19.83 RBRVS 43108 TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ Surgery 82.87 33.68 33.68 RBRVS 43112 TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY Surgery 47.48 19.76 19.76 RBRVS 43113 TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ Surgery 80.06 28.26 28.26 RBRVS 43116 PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF Surgery 92.99 44.92 44.92 RBRVS 43117 PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY Surgery 43.65 17.88 17.88 RBRVS 43118 PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ Surgery 67.07 28.05 28.05 RBRVS 43121 PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY Surgery 51.43 19.94 19.94 RBRVS 43122 PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL Surgery 44.18 19.87 19.87 RBRVS 43123 PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ Surgery 83.12 35.14 35.14 RBRVS 43124 TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY Surgery 69.09 25.89 25.89 RBRVS 43130 DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR Surgery 12.53 8.12 8.12 RBRVS 43135 DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR Surgery 26.17 10.99 10.99 RBRVS 43180 ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH Surgery 9.03 5.59 5.59 RBRVS 43191 ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH Surgery 2.49 1.61 1.61 RBRVS 43192 ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL Surgery 2.79 1.75 1.75 RBRVS 43193 ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY Surgery 2.79 1.74 1.74 RBRVS 43194 ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY Surgery 3.51 1.55 1.55 RBRVS 43195 ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION Surgery 3.07 1.88 1.88 RBRVS 43196 ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION Surgery 3.31 1.95 1.95 RBRVS 43197 ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC Surgery 1.52 0.66 3.65 RBRVS 43198 ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY Surgery 1.82 0.79 3.97 RBRVS 43200 ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC Surgery 1.52 0.98 5.99 RBRVS 43201 ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ Surgery 1.82 1.12 5.82 RBRVS 43202 ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY Surgery 1.82 1.12 8.29 RBRVS 43204 ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES Surgery 2.43 1.44 1.44 RBRVS 43205 ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES Surgery 2.54 1.46 1.46 RBRVS 43206 ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY Surgery 2.39 1.35 6.70 RBRVS 43210 EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY Surgery 7.75 3.67 3.67 RBRVS 43211 ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN Surgery 4.30 2.30 2.30 RBRVS 43212 ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT Surgery 3.50 1.66 1.66 RBRVS 43213 ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER Surgery 4.73 2.42 29.91 RBRVS 43214 ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM Surgery 3.50 1.86 1.86 RBRVS 43215 ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY Surgery 2.54 1.39 8.76 RBRVS 43216 ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS Surgery 2.40 1.43 9.29 RBRVS 43217 ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE Surgery 2.90 1.56 9.45 RBRVS 43220 ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM Surgery 2.10 1.25 30.07 RBRVS 43226 ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION Surgery 2.34 1.33 8.20 RBRVS 43227 ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL Surgery 2.99 1.61 16.37 RBRVS 43229 ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION Surgery 3.59 1.93 16.75 RBRVS 43231 ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM Surgery 2.90 1.63 8.27 RBRVS 43232 ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX Surgery 3.69 1.88 9.59 RBRVS 43233 EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER Surgery 4.17 2.15 2.15 RBRVS 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC Surgery 2.19 1.30 6.47 RBRVS 43236 ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION Surgery 2.49 1.45 8.35 RBRVS 43237 ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS Surgery 3.57 1.92 1.92 RBRVS 43238 EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS Surgery 4.26 2.24 2.24 RBRVS 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE Surgery 2.49 1.44 8.63 RBRVS 43240 EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST Surgery 7.25 3.58 3.58 RBRVS 43241 EGD INTRALUMINAL TUBE/CATHETER INSERTION Surgery 2.59 1.43 1.43 RBRVS 43242 EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY Surgery 4.83 2.53 2.53 RBRVS

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43243 EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES Surgery 4.37 2.24 2.24 RBRVS 43244 EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES Surgery 4.50 2.38 2.38 RBRVS 43245 EGD DILATION GASTRIC/DUODENAL STRICTURE Surgery 3.18 1.70 14.00 RBRVS 43246 EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE Surgery 3.66 1.86 1.86 RBRVS 43247 EGD FLEXIBLE FOREIGN BODY REMOVAL Surgery 3.21 1.75 8.01 RBRVS 43248 EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS Surgery 3.01 1.69 8.38 RBRVS 43249 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM Surgery 2.77 1.57 27.85 RBRVS 43250 EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS Surgery 3.07 1.65 9.56 RBRVS 43251 EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH Surgery 3.57 1.93 10.33 RBRVS 43252 EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY Surgery 3.06 1.67 7.05 RBRVS 43253 EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER Surgery 4.83 2.53 2.53 RBRVS 43254 EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION Surgery 4.97 2.55 2.55 RBRVS 43255 EGD TRANSORAL CONTROL BLEEDING ANY METHOD Surgery 3.66 1.99 8.22 RBRVS 43257 EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD Surgery 4.25 2.20 2.20 RBRVS 43259 EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM Surgery 4.14 2.21 2.21 RBRVS 43260 ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING Surgery 5.95 3.03 3.03 RBRVS 43261 ERCP W/BIOPSY SINGLE/MULTIPLE Surgery 6.25 3.15 3.15 RBRVS 43262 ERCP W/SPHINCTEROTOMY/PAPILLOTOMY Surgery 6.60 3.31 3.31 RBRVS 43263 ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI Surgery 6.60 3.32 3.32 RBRVS 43264 ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT Surgery 6.73 3.37 3.37 RBRVS 43265 ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD Surgery 8.03 3.95 3.95 RBRVS 43266 EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION Surgery 4.17 2.11 2.11 RBRVS 43270 EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE Surgery 4.26 2.25 16.87 RBRVS 43273 ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC Surgery 2.24 1.02 1.02 RBRVS 43274 ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT Surgery 8.58 4.20 4.20 RBRVS 43275 ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT Surgery 6.96 3.47 3.47 RBRVS 43276 ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE Surgery 8.94 4.36 4.36 RBRVS 43277 ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA Surgery 7.00 3.49 3.49 RBRVS 43278 ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE Surgery 8.02 3.95 3.95 RBRVS 43279 LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED Surgery 22.10 10.20 10.20 RBRVS 43280 LAPS SURG ESOPG/GSTR FUNDOPLASTY Surgery 18.10 9.01 9.01 RBRVS 43281 LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH Surgery 26.60 11.96 11.96 RBRVS 43282 LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH Surgery 30.10 13.22 13.22 RBRVS 43283 LAPS ESOPHAGEAL LENGTHENING ADDL Surgery 2.95 0.97 0.97 RBRVS 43289 UNLISTED LAPAROSCOPIC PROCEDURE ESOPHAGUS Surgery 32.30 Unlisted 43300 ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL Surgery 9.33 7.13 7.13 RBRVS 43305 ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL Surgery 18.10 10.87 10.87 RBRVS 43310 ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL Surgery 26.26 10.49 10.49 RBRVS 43312 ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL Surgery 29.25 10.49 10.49 RBRVS 43313 ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL Surgery 48.45 23.46 23.46 RBRVS 43314 ESPHGP CGEN DFCT THRC APPR W/RPR FSTL Surgery 53.43 24.09 24.09 RBRVS 43320 EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP Surgery 23.31 11.55 11.55 RBRVS 43325 ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH Surgery 22.60 11.07 11.07 RBRVS 43327 ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY Surgery 13.35 7.16 7.16 RBRVS 43328 ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY Surgery 19.91 8.34 8.34 RBRVS 43330 ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH Surgery 22.19 11.15 11.15 RBRVS 43331 ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH Surgery 23.06 10.62 10.62 RBRVS 43332 RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH Surgery 19.62 9.45 9.45 RBRVS 43333 LAPT RPR PARAESOPH HIATAL HERNIA W/MESH Surgery 21.46 10.17 10.17 RBRVS 43334 RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH Surgery 22.12 9.19 9.19 RBRVS 43335 RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH Surgery 23.97 9.50 9.50 RBRVS 43336 RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH Surgery 25.81 12.16 12.16 RBRVS 43337 RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH Surgery 27.65 13.18 13.18 RBRVS 43338 ESOPHAGUS LENGTHENING Surgery 2.21 0.66 0.66 RBRVS 43340 ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR Surgery 22.99 11.43 11.43 RBRVS 43341 ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR Surgery 24.23 12.94 12.94 RBRVS 43351 ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR Surgery 22.05 13.04 13.04 RBRVS 43352 ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR Surgery 17.81 9.12 9.12 RBRVS 43360 GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH Surgery 40.11 19.37 19.37 RBRVS 43361 GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT Surgery 45.68 17.96 17.96 RBRVS 43400 LIGATION DIRECT ESOPHAGEAL VARICES Surgery 25.60 12.36 12.36 RBRVS 43401 TRNSXJ ESOPH W/RPR ESOPHAGEAL VARICES Surgery 26.49 12.68 12.68 RBRVS 43405 LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J Surgery 24.73 14.00 14.00 RBRVS 43410 SUTR ESOPHGL WND/INJ CRV APPR Surgery 16.41 10.16 10.16 RBRVS 43415 SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR Surgery 44.88 19.37 19.37 RBRVS 43420 CLSR ESOPHAGOSTOMY/FSTL CRV APPR Surgery 16.78 10.26 10.26 RBRVS 43425 CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR Surgery 25.04 11.19 11.19 RBRVS 43450 DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS Surgery 1.38 0.95 4.53 RBRVS 43453 DILATION ESOPHAGUS GUIDE WIRE Surgery 1.51 1.00 26.19 RBRVS 43460 ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE Surgery 3.79 2.04 2.04 RBRVS 43496 FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS Surgery 3.93 v3.16 43499 UNLISTED PROCEDURE ESOPHAGUS Surgery 4.35 Unlisted 43500 GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL Surgery 12.79 7.02 7.02 RBRVS 43501 GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER Surgery 22.60 11.12 11.12 RBRVS 43502 GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC Surgery 25.69 12.34 12.34 RBRVS

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43510 GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE Surgery 15.14 8.60 8.60 RBRVS 43520 PYLOROMYOTOMY CUTTING PYLORIC MUSC Surgery 11.29 5.96 5.96 RBRVS 43605 BIOPSY STOMACH LAPAROTOMY Surgery 13.72 7.28 7.28 RBRVS 43610 EXC LOCAL ULCER/BENIGN TUMOR STOMACH Surgery 16.34 8.27 8.27 RBRVS 43611 EXC LOCAL MALIGNANT TUMOR STOMACH Surgery 20.38 10.24 10.24 RBRVS 43620 GSTRCT TOT W/ESOPHAGOENTEROSTOMY Surgery 34.04 15.02 15.02 RBRVS 43621 GSTRCT TOT W/ROUX-EN-Y RCNSTJ Surgery 39.53 16.97 16.97 RBRVS 43622 GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE Surgery 40.03 17.45 17.45 RBRVS 43631 GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY Surgery 24.51 11.74 11.74 RBRVS 43632 GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY Surgery 35.14 15.49 15.49 RBRVS 43633 GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ Surgery 33.14 14.75 14.75 RBRVS 43634 GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH Surgery 36.64 16.23 16.23 RBRVS 43635 VAGOTOMY PFRMD W/PRTL DSTL GSTRCT Surgery 2.06 0.73 0.73 RBRVS 43640 VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV Surgery 19.56 9.98 9.98 RBRVS 43641 VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL Surgery 19.81 10.25 10.25 RBRVS 43644 LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM Surgery 29.40 13.93 13.93 RBRVS 43645 LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ Surgery 31.53 14.73 14.73 RBRVS 43651 LAPS SURG TRNSXJ VAGUS NRV TRUNCAL Surgery 10.13 6.38 6.38 RBRVS 43652 LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV Surgery 12.13 7.09 7.09 RBRVS 43653 LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX Surgery 8.48 6.06 6.06 RBRVS 43659 UNLISTED LAPAROSCOPIC PROCEDURE STOMACH Surgery 43.33 Unlisted 43752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE Surgery 0.81 0.29 0.29 RBRVS 43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE Surgery 0.45 0.12 0.12 RBRVS 43754 GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN Surgery 0.45 0.53 3.21 RBRVS 43755 GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC Surgery 0.94 0.63 2.81 RBRVS 43756 DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN Surgery 0.77 0.63 5.01 RBRVS 43757 DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN Surgery 1.26 0.86 6.98 RBRVS 43760 CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GDNCE Surgery 0.90 0.34 12.94 RBRVS 43761 REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO Surgery 2.01 0.76 1.13 RBRVS 43770 LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE Surgery 18.00 10.15 10.15 RBRVS 43771 LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE Surgery 20.79 11.13 11.13 RBRVS 43772 LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE Surgery 15.70 8.19 8.19 RBRVS 43773 LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE Surgery 20.79 11.27 11.27 RBRVS 43774 LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT Surgery 15.76 8.34 8.34 RBRVS 43775 LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY Surgery 20.38 10.73 10.73 RBRVS 43800 PYLOROPLASTY Surgery 15.43 7.87 7.87 RBRVS 43810 GASTRODUODENOSTOMY Surgery 16.88 8.57 8.57 RBRVS 43820 GASTROJEJUNOSTOMY W/O VAGOTOMY Surgery 22.53 11.01 11.01 RBRVS 43825 GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE Surgery 21.76 10.94 10.94 RBRVS 43830 GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX Surgery 10.85 6.87 6.87 RBRVS 43831 GASTROSTOMY OPN NEONATAL FEEDING Surgery 8.49 6.67 6.67 RBRVS 43832 GASTROSTOMY OPN W/CONSTJ GSTR TUBE Surgery 17.34 8.82 8.82 RBRVS 43840 GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ Surgery 22.83 11.18 11.18 RBRVS 43842 GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY Surgery 21.03 10.53 10.53 RBRVS 43843 GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP Surgery 21.21 10.79 10.79 RBRVS 43845 GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM Surgery 33.30 15.73 15.73 RBRVS 43846 GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< Surgery 27.41 12.91 12.91 RBRVS 43847 GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ Surgery 30.28 14.70 14.70 RBRVS 43848 REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE Surgery 32.75 15.35 15.35 RBRVS 43850 REVJ GASTRODUOL ANAST W/RCNSTJ W/O VAGOTOMY Surgery 27.58 13.02 13.02 RBRVS 43855 REVJ GASTRODUOL ANAST W/RCNSTJ W/VGTMY Surgery 28.69 13.41 13.41 RBRVS 43860 REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY Surgery 27.89 13.07 13.07 RBRVS 43865 REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY Surgery 29.05 13.54 13.54 RBRVS 43870 CLOSURE GASTROSTOMY SURG Surgery 11.44 6.57 6.57 RBRVS 43880 CLOSURE GASTROCOLIC FISTULA Surgery 27.18 12.72 12.72 RBRVS 43886 GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY Surgery 4.64 4.70 4.70 RBRVS 43887 GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY Surgery 4.32 4.07 4.07 RBRVS 43888 GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT Surgery 6.44 5.32 5.32 RBRVS 43999 UNLISTED PROCEDURE STOMACH Surgery 4.16 Unlisted 44005 ENTEROLSS FRING INTSTINAL ADHESION SPX Surgery 18.46 8.99 8.99 RBRVS 44010 DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL Surgery 14.26 7.75 7.75 RBRVS 44015 TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD Surgery 2.62 0.90 0.90 RBRVS 44020 ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL Surgery 16.22 8.25 8.25 RBRVS 44021 ENTEROTOMY SM INT OTH/THN DUO DCMPRN Surgery 16.31 8.25 8.25 RBRVS 44025 COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL Surgery 16.51 8.38 8.38 RBRVS 44050 RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT Surgery 15.52 7.96 7.96 RBRVS 44055 CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS Surgery 25.63 11.71 11.71 RBRVS 44100 BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS Surgery 2.01 0.91 0.91 RBRVS 44110 EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM Surgery 14.04 7.45 7.45 RBRVS 44111 EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE Surgery 16.52 8.29 8.29 RBRVS 44120 ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST Surgery 20.82 9.83 9.83 RBRVS 44121 ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA Surgery 4.44 1.59 1.59 RBRVS 44125 ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY Surgery 20.03 9.73 9.73 RBRVS 44126 ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING Surgery 42.23 19.17 19.17 RBRVS 44127 ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING Surgery 49.30 21.60 21.60 RBRVS

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44128 ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS Surgery 4.44 1.59 1.59 RBRVS 44130 ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX Surgery 22.11 10.93 10.93 RBRVS 44139 MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT Surgery 2.23 0.80 0.80 RBRVS 44140 COLECTOMY PARTIAL W/ANASTOMOSIS Surgery 22.59 11.15 11.15 RBRVS 44141 COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY Surgery 29.91 16.22 16.22 RBRVS 44143 COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT Surgery 27.79 14.17 14.17 RBRVS 44144 COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA Surgery 29.91 14.62 14.62 RBRVS 44145 COLECTOMY PRTL W/COLOPROCTOSTOMY Surgery 28.58 13.40 13.40 RBRVS 44146 COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY Surgery 35.30 18.74 18.74 RBRVS 44147 COLECTOMY PRTL ABDOMINAL & TRANSANAL APPROACH Surgery 33.69 15.17 15.17 RBRVS 44150 COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS Surgery 30.18 17.45 17.45 RBRVS 44151 COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST Surgery 34.92 19.03 19.03 RBRVS 44155 COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY Surgery 34.42 19.05 19.05 RBRVS 44156 COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST Surgery 37.42 20.67 20.67 RBRVS 44157 COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST Surgery 35.70 18.97 18.97 RBRVS 44158 COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR Surgery 36.70 19.66 19.66 RBRVS 44160 COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS Surgery 20.89 10.43 10.43 RBRVS 44180 LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE Surgery 15.27 7.87 7.87 RBRVS 44186 LAPAROSCOPY SURGICAL JEJUNOSTOMY Surgery 10.38 6.05 6.05 RBRVS 44187 LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE Surgery 17.40 11.16 11.16 RBRVS 44188 LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY Surgery 19.35 12.02 12.02 RBRVS 44202 LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA Surgery 23.39 11.47 11.47 RBRVS 44203 LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS Surgery 4.44 1.59 1.59 RBRVS 44204 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS Surgery 26.42 12.59 12.59 RBRVS 44205 LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM Surgery 22.95 11.04 11.04 RBRVS 44206 LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM Surgery 29.79 14.64 14.64 RBRVS 44207 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST Surgery 31.92 14.51 14.51 RBRVS 44208 LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST Surgery 33.99 16.88 16.88 RBRVS 44210 LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS Surgery 30.09 15.87 15.87 RBRVS 44211 LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS Surgery 37.08 19.59 19.59 RBRVS 44212 LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY Surgery 34.58 18.66 18.66 RBRVS 44213 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY Surgery 3.50 1.27 1.27 RBRVS 44227 LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS Surgery 28.62 13.47 13.47 RBRVS 44238 UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM Surgery 39.01 Unlisted 44300 PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN Surgery 13.75 7.41 7.41 RBRVS 44310 ILEOSTOMY/JEJUNOSTOMY NON-TUBE Surgery 17.59 8.94 8.94 RBRVS 44312 REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX Surgery 9.43 5.86 5.86 RBRVS 44314 REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX Surgery 16.74 9.06 9.06 RBRVS 44316 CONTINENT ILEOSTOMY KOCK PROCEDURE SPX Surgery 23.59 11.72 11.72 RBRVS 44320 COLOSTOMY/SKIN LEVEL CECOSTOMY Surgery 19.91 10.50 10.50 RBRVS 44322 COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX Surgery 13.32 12.41 12.41 RBRVS 44340 REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX Surgery 9.28 6.75 6.75 RBRVS 44345 REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX Surgery 17.22 9.55 9.55 RBRVS 44346 REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX Surgery 19.63 10.46 10.46 RBRVS 44360 ENDOSCOPY UPPER SMALL INTESTINE Surgery 2.59 1.50 1.50 RBRVS 44361 ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY Surgery 2.87 1.63 1.63 RBRVS 44363 ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY Surgery 3.49 1.88 1.88 RBRVS 44364 ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE Surgery 3.73 2.02 2.02 RBRVS 44365 ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY Surgery 3.31 1.79 1.79 RBRVS 44366 ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING Surgery 4.40 2.33 2.33 RBRVS 44369 ENTEROSCOPY > 2ND PRTN ABLTJ LESION Surgery 4.51 2.38 2.38 RBRVS 44370 ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT Surgery 4.79 2.65 2.65 RBRVS 44372 ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE Surgery 4.40 2.26 2.26 RBRVS 44373 ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE Surgery 3.49 1.86 1.86 RBRVS 44376 ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX Surgery 5.25 2.63 2.63 RBRVS 44377 ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE Surgery 5.52 2.80 2.80 RBRVS 44378 ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING Surgery 7.12 3.54 3.54 RBRVS 44379 ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT Surgery 7.46 3.88 3.88 RBRVS 44380 ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD Surgery 0.97 0.71 5.16 RBRVS 44381 ILEOSCOPY STOMA W/BALLOON DILATION Surgery 1.48 0.94 26.70 RBRVS 44382 ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE Surgery 1.27 0.86 7.65 RBRVS 44384 ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT Surgery 2.95 1.29 1.29 RBRVS 44385 NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX Surgery 1.82 1.02 5.50 RBRVS 44386 NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE Surgery 2.12 1.23 7.67 RBRVS 44388 COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX Surgery 2.82 1.51 6.77 RBRVS 44389 COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE Surgery 3.13 1.69 7.66 RBRVS 44390 COLONOSCOPY STOMA W/RMVL FOREIGN BODY Surgery 3.82 2.08 8.84 RBRVS 44391 COLONOSCOPY STOMA CONTROL BLEEDING Surgery 4.31 2.25 9.25 RBRVS 44392 COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS Surgery 3.81 1.91 8.15 RBRVS 44394 COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE Surgery 4.42 2.24 9.04 RBRVS 44401 COLONOSCOPY STOMA ABLATION LESION Surgery 4.44 2.17 87.43 RBRVS 44402 COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT Surgery 4.80 2.36 2.36 RBRVS 44403 COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ Surgery 5.60 2.64 2.64 RBRVS 44404 COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION Surgery 3.12 1.62 8.53 RBRVS 44405 COLONOSCOPY STOMA W/BALLOON DILATION Surgery 3.33 1.71 13.55 RBRVS

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44406 COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM Surgery 4.20 2.07 2.07 RBRVS 44407 COLONOSCOPY STOMA W/US GID NDL ASPIR/BX Surgery 5.06 2.42 2.42 RBRVS 44408 COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION Surgery 4.24 2.09 2.09 RBRVS 44500 INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE Surgery 0.49 0.18 0.18 RBRVS 44602 ENTERORRHAPHY 1PERFORATION Surgery 24.72 10.51 10.51 RBRVS 44603 ENTERORRHAPHY MULTIPLE PERFORATIONS Surgery 28.16 12.45 12.45 RBRVS 44604 SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY Surgery 18.16 8.42 8.42 RBRVS 44605 SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY Surgery 22.08 10.83 10.83 RBRVS 44615 INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ Surgery 18.16 8.90 8.90 RBRVS 44620 CLOSURE ENTEROSTOMY LG/SMALL INTESTINE Surgery 14.43 7.67 7.67 RBRVS 44625 CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT Surgery 17.28 8.74 8.74 RBRVS 44626 CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS Surgery 27.90 12.42 12.42 RBRVS 44640 CLOSURE INTESTINAL CUTANEOUS FISTULA Surgery 24.20 11.13 11.13 RBRVS 44650 CLSR ENTEROENTERIC/ENTEROCOLIC FSTL Surgery 25.12 11.43 11.43 RBRVS 44660 CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ Surgery 23.91 10.53 10.53 RBRVS 44661 CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ Surgery 27.35 12.11 12.11 RBRVS 44680 INTESTINAL PLICATION SEPARATE PROCEDURE Surgery 17.96 8.89 8.89 RBRVS 44700 EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS Surgery 17.48 8.79 8.79 RBRVS 44701 INTRAOPERATIVE COLONIC LAVAGE Surgery 3.10 1.12 1.12 RBRVS 44705 PREPARE FECAL MICROBIOTA FOR INSTILLATION Surgery 0.90 FAIR Health 44720 BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA Surgery 5.00 1.79 1.79 RBRVS 44721 BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA Surgery 7.00 2.50 2.50 RBRVS 44799 UNLISTED PROCEDURE SMALL INTESTINE Surgery 29.76 Unlisted 44800 EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT Surgery 12.05 7.39 7.39 RBRVS 44820 EXCISION LESION MESENTERY SEPARATE PROCEDURE Surgery 13.73 7.53 7.53 RBRVS 44850 SUTURE MESENTERY SEPARATE PROCEDURE Surgery 12.11 6.86 6.86 RBRVS 44899 UNLISTED PX MECKEL'S DIVERTICULUM & MESENTERY Surgery 19.44 Unlisted 44900 INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN Surgery 12.57 6.84 6.84 RBRVS 44950 APPENDECTOMY Surgery 10.60 5.51 5.51 RBRVS 44955 APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX Surgery 1.53 0.57 0.57 RBRVS 44960 APPENDEC RPTD APPENDIX ABSC/PRITONITIS Surgery 14.50 7.39 7.39 RBRVS 44970 LAPAROSCOPIC APPENDECTOMY Surgery 9.45 5.71 5.71 RBRVS 44979 UNLISTED LAPAROSCOPY PROCEDURE APPENDIX Surgery 15.16 Unlisted 45000 TRANSRECTAL DRAINAGE OF PELVIC ABSCESS Surgery 6.30 4.72 4.72 RBRVS 45005 I&D SUBMUCOSAL ABSCESS RECTUM Surgery 2.02 2.18 5.31 RBRVS 45020 I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC Surgery 8.56 6.16 6.16 RBRVS 45100 BX ANORECTAL WALL ANAL APPROACH Surgery 4.04 3.85 3.85 RBRVS 45108 ANORECTAL MYOMECTOMY Surgery 5.12 4.30 4.30 RBRVS 45110 PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST Surgery 30.76 16.80 16.80 RBRVS 45111 PRCTECT PRTL RESCJ RECTUM TABDL APPR Surgery 18.01 9.77 9.77 RBRVS 45112 PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX Surgery 33.18 15.34 15.34 RBRVS 45113 PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR Surgery 33.22 16.98 16.98 RBRVS 45114 PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH Surgery 30.79 14.52 14.52 RBRVS 45116 PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY Surgery 27.72 13.41 13.41 RBRVS 45119 PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM Surgery 33.48 17.06 17.06 RBRVS 45120 PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS Surgery 26.40 13.36 13.36 RBRVS 45121 PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS Surgery 29.08 14.63 14.63 RBRVS 45123 PRCTECT PRTL W/O ANAST PRNL APPR Surgery 18.86 10.31 10.31 RBRVS 45126 PELVIC EXENTERATION COLORECTAL MALIGNANCY Surgery 49.10 22.88 22.88 RBRVS 45130 EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH Surgery 18.50 9.90 9.90 RBRVS 45135 EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH Surgery 22.36 12.16 12.16 RBRVS 45136 EXC ILEOANAL RSVR W/ILEOSTOMY Surgery 30.82 17.22 17.22 RBRVS 45150 DIVISION STRICTURE RECTUM Surgery 5.85 3.83 3.83 RBRVS 45160 EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL Surgery 16.33 9.36 9.36 RBRVS 45171 EXC RCT TUM NOT INCL MUSCULARIS PROPRIA Surgery 8.13 7.65 7.65 RBRVS 45172 EXC RCT TUM INCL MUSCULARIS PROPRIA Surgery 12.13 9.13 9.13 RBRVS 45190 DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH Surgery 10.42 7.83 7.83 RBRVS 45300 PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX Surgery 0.80 0.64 2.61 RBRVS 45303 PROCTOSGMDSC RIGID W/DILATION Surgery 1.50 0.90 25.79 RBRVS 45305 PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE Surgery 1.25 0.82 4.11 RBRVS 45307 PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY Surgery 1.70 0.98 4.40 RBRVS 45308 PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY Surgery 1.40 0.86 4.55 RBRVS 45309 PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ Surgery 1.50 0.90 4.61 RBRVS 45315 PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE Surgery 1.80 1.01 4.86 RBRVS 45317 PROCTOSGMDSC RIGID CONTROL BLEEDING Surgery 2.00 1.09 4.62 RBRVS 45320 PROCTOSGMDSC RIGID ABLATION LESION Surgery 1.78 1.00 4.80 RBRVS 45321 PROCTOSGMDSC RIGID DCMPRN VOLVULUS Surgery 1.75 1.02 1.02 RBRVS 45327 PROCTOSGMDSC RIGID TNDSC STENT PLMT Surgery 2.00 1.24 1.24 RBRVS 45330 SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD Surgery 0.96 0.72 2.80 RBRVS 45331 SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE Surgery 1.15 0.84 3.32 RBRVS 45332 SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY Surgery 1.79 1.10 6.24 RBRVS 45333 SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS Surgery 1.79 1.09 6.38 RBRVS 45334 SIGMOIDOSCOPY FLX CONTROL BLEEDING Surgery 2.10 1.23 14.94 RBRVS 45335 SGMDSC FLX DIRED SBMCSL NJX ANY SBST Surgery 1.46 0.96 6.14 RBRVS 45337 SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE Surgery 2.36 1.36 1.36 RBRVS

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45338 SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ Surgery 2.34 1.35 6.39 RBRVS 45340 SIGMOIDOSCOPY FLX TNDSC BALO DILAT Surgery 1.89 1.14 11.67 RBRVS 45341 SIGMOIDOSCOPY FLX NDSC US XM Surgery 2.60 1.49 1.49 RBRVS 45342 SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX Surgery 4.05 2.17 2.17 RBRVS 45346 SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES Surgery 2.91 1.55 85.33 RBRVS 45347 SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT Surgery 2.82 1.49 1.49 RBRVS 45349 SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION Surgery 3.62 1.83 1.83 RBRVS 45350 SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S) Surgery 1.78 1.06 14.54 RBRVS 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD Surgery 3.69 1.94 6.81 RBRVS 45379 COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S) Surgery 4.68 2.38 8.85 RBRVS 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE Surgery 4.43 2.31 8.09 RBRVS 45381 COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST Surgery 4.19 2.20 8.43 RBRVS 45382 COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD Surgery 5.68 2.89 10.62 RBRVS 45384 COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS Surgery 4.69 2.33 7.78 RBRVS 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ Surgery 5.30 2.69 8.79 RBRVS 45386 COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT Surgery 4.57 2.33 13.69 RBRVS 45388 COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES Surgery 4.98 2.42 87.40 RBRVS 45389 COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT Surgery 5.34 2.60 2.60 RBRVS 45390 COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION Surgery 6.14 2.87 2.87 RBRVS 45391 COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX Surgery 5.09 2.62 2.62 RBRVS 45392 COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL Surgery 6.54 3.25 3.25 RBRVS 45393 COLONOSCOPY FLEXIBLE WITH DECOMPRESSION Surgery 4.78 2.12 2.12 RBRVS 45395 LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY Surgery 33.00 18.38 18.38 RBRVS 45397 LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR Surgery 36.50 19.68 19.68 RBRVS 45398 COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) Surgery 4.30 2.11 15.86 RBRVS 45399 UNLISTED PROCEDURE COLON Surgery 7.01 Unlisted 45400 LAPAROSCOPY PROCTOPEXY PROLAPSE Surgery 19.44 10.25 10.25 RBRVS 45402 LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ Surgery 26.51 12.85 12.85 RBRVS 45499 UNLISTED LAPAROSCOPY PROCEDURE RECTUM Surgery 51.38 Unlisted 45500 PROCTOPLASTY STENOSIS Surgery 7.73 6.37 6.37 RBRVS 45505 PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE Surgery 8.36 7.22 7.22 RBRVS 45520 PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE Surgery 0.55 0.55 3.92 RBRVS 45540 PROCTOPEXY ABDOMINAL APPROACH Surgery 18.12 9.35 9.35 RBRVS 45541 PROCTOPEXY PERINEAL APPROACH Surgery 14.85 9.31 9.31 RBRVS 45550 PROCTOPEXY W/SIGMOID RESCJ ABDL APPR Surgery 24.80 13.08 13.08 RBRVS 45560 REPAIR RECTOCELE SEPARATE PROCEDURE Surgery 11.50 6.84 6.84 RBRVS 45562 EXPL RPR & PRESACRAL DRG RECTAL INJURY Surgery 17.98 10.82 10.82 RBRVS 45563 EXPL RPR & PRESACRAL DRG RECTAL INJ W/COLOSTOMY Surgery 26.38 15.04 15.04 RBRVS 45800 CLOSURE RECTOVESICAL FISTULA Surgery 20.31 10.65 10.65 RBRVS 45805 CLSR RECTOVESICAL FISTULA W/COLOSTOMY Surgery 23.32 13.45 13.45 RBRVS 45820 CLOSURE RECTOURETHRAL FISTULA Surgery 20.37 9.76 9.76 RBRVS 45825 CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY Surgery 24.17 14.39 14.39 RBRVS 45900 RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE Surgery 2.99 2.30 2.30 RBRVS 45905 DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL Surgery 2.35 2.10 2.10 RBRVS 45910 DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL Surgery 2.85 2.29 2.29 RBRVS 45915 RMVL FECAL IMPACTION/FB SPX UNDER ANES Surgery 3.19 2.87 5.81 RBRVS 45990 ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX Surgery 1.80 0.98 0.98 RBRVS 45999 UNLISTED PROCEDURE RECTUM Surgery 7.01 Unlisted 46020 PLACEMENT SETON Surgery 3.00 3.20 4.37 RBRVS 46030 REMOVAL ANAL SETON OTHER MARKER Surgery 1.26 1.12 2.50 RBRVS 46040 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX Surgery 5.37 5.45 8.87 RBRVS 46045 I&D INTRAMURAL IM/ABSC TRANSANAL ANES Surgery 5.87 5.44 5.44 RBRVS 46050 I&D PERIANAL ABSCESS SUPERFICIAL Surgery 1.24 1.34 4.29 RBRVS 46060 I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON Surgery 6.37 6.16 6.16 RBRVS 46070 INCISION ANAL SEPTUM INFANT Surgery 2.79 3.35 3.35 RBRVS 46080 SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX Surgery 2.52 1.57 4.06 RBRVS 46083 INCISION THROMBOSED HEMORRHOID EXTERNAL Surgery 1.45 1.37 3.33 RBRVS 46200 FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED Surgery 3.59 5.12 8.54 RBRVS 46220 EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS Surgery 1.61 1.52 3.99 RBRVS 46221 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS Surgery 2.36 2.80 5.00 RBRVS 46230 EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS Surgery 2.62 1.90 4.72 RBRVS 46250 HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP Surgery 4.25 3.96 8.17 RBRVS 46255 HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP Surgery 4.96 4.25 8.60 RBRVS 46257 HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO Surgery 5.76 5.27 5.27 RBRVS 46258 HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY Surgery 6.41 5.48 5.48 RBRVS 46260 HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO Surgery 6.73 5.65 5.65 RBRVS 46261 HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU Surgery 7.76 5.90 5.90 RBRVS 46262 HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY Surgery 7.91 6.61 6.61 RBRVS 46270 SURG TX ANAL FISTULA SUBQ Surgery 4.92 5.36 8.65 RBRVS 46275 SURG TX ANAL FISTULA INTERSPHINCTERIC Surgery 5.42 5.54 9.07 RBRVS 46280 TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON Surgery 6.39 6.03 6.03 RBRVS 46285 SURG TX ANAL FISTULA 2ND STAGE Surgery 5.42 5.53 8.96 RBRVS 46288 CLSR ANAL FSTL W/RCT ADVMNT FLAP Surgery 7.81 6.68 6.68 RBRVS 46320 EXC THROMBOSED HEMORRHOID XTRNL Surgery 1.64 1.26 3.31 RBRVS 46500 INJECTION SCLEROSING SOLUTION HEMORRHOIDS Surgery 1.69 1.77 4.89 RBRVS

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46505 CHEMODENERVATION INTERNAL ANAL SPHINCTER Surgery 3.18 3.13 4.42 RBRVS 46600 ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD Surgery 0.55 0.55 1.90 RBRVS 46601 ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT Surgery 1.60 0.98 2.18 RBRVS 46604 ANOSCOPY W/DILATION Surgery 1.03 0.73 16.67 RBRVS 46606 ANOSCOPY W/BX SINGLE/MULTIPLE Surgery 1.20 0.81 5.04 RBRVS 46607 ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX Surgery 2.20 1.23 3.03 RBRVS 46608 ANOSCOPY W/RMVL FOREIGN BODY Surgery 1.30 0.83 5.18 RBRVS 46610 ANOSCOPY W/RMVL LESION CAUTERY Surgery 1.28 0.81 4.91 RBRVS 46611 ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ Surgery 1.30 0.84 3.47 RBRVS 46612 ANOSC RMVL MULT TUMORS CAUTERY/SNARE Surgery 1.50 0.90 5.99 RBRVS 46614 ANOSCOPY CONTROL BLEEDING Surgery 1.00 0.72 2.53 RBRVS 46615 ANOSCOPY ABLATION LESION Surgery 1.50 0.91 2.35 RBRVS 46700 ANOPLASTY PLASTIC OPERATION STRICTURE ADULT Surgery 9.81 7.43 7.43 RBRVS 46705 ANOPLASTY PLASTIC OPERATION STRICTURE INFANT Surgery 7.43 5.97 5.97 RBRVS 46706 REPAIR ANAL FISTULA W/FIBRIN GLUE Surgery 2.44 2.05 2.05 RBRVS 46707 REPAIR ANORECTAL FISTULA PLUG Surgery 6.39 5.98 5.98 RBRVS 46710 RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR Surgery 17.14 10.79 10.79 RBRVS 46712 RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR Surgery 36.45 18.85 18.85 RBRVS 46715 RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK Surgery 7.62 6.16 6.16 RBRVS 46716 RPR LW IMPERFORATE ANUS W/TRPOS FISTULA Surgery 17.54 12.02 12.02 RBRVS 46730 RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR Surgery 30.65 18.72 18.72 RBRVS 46735 RPR HI IMPRF ANUS W/O FISTULA CMBN APPR Surgery 36.14 19.83 19.83 RBRVS 46740 RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR Surgery 33.90 19.98 19.98 RBRVS 46742 RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL Surgery 40.14 21.36 21.36 RBRVS 46744 RPR CLOACAL ANOMALY SACROPERINEAL Surgery 58.94 28.88 28.88 RBRVS 46746 RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL Surgery 65.44 27.74 27.74 RBRVS 46748 RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF Surgery 71.42 33.41 33.41 RBRVS 46750 SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT Surgery 12.15 7.82 7.82 RBRVS 46751 SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD Surgery 9.30 6.61 6.61 RBRVS 46753 GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE Surgery 8.89 6.57 6.57 RBRVS 46754 RMVL THIERSCH WIRE/SUTURE ANAL CANAL Surgery 3.01 3.33 5.26 RBRVS 46760 SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT Surgery 17.45 11.77 11.77 RBRVS 46761 SPHNCTROP ANAL LEVATOR MUSC IMBRCJ Surgery 15.29 9.20 9.20 RBRVS 46762 SPHNCTROP ANAL IMPLTJ ARTIF SPHNCTR Surgery 14.82 9.83 9.83 RBRVS 46900 DSTRJ LESION ANUS SIMPLE CHEMICAL Surgery 1.91 1.78 4.76 RBRVS 46910 DSTRJ LESION ANUS SMPL ELTRDSICCATION Surgery 1.91 1.62 5.08 RBRVS 46916 DSTRJ LESION ANUS SIMPLE CRYOSURGERY Surgery 1.91 1.96 4.37 RBRVS 46917 DSTRJ LESION ANUS SIMPLE LASER SURG Surgery 1.91 1.64 10.68 RBRVS 46922 DSTRJ LESION ANUS SIMPLE SURG EXCISION Surgery 1.91 1.65 5.37 RBRVS 46924 DSTRJ LESION ANUS EXTENSIVE Surgery 2.81 2.06 12.06 RBRVS 46930 DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY Surgery 1.61 2.43 4.07 RBRVS 46940 CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST Surgery 2.35 1.52 3.86 RBRVS 46942 CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ Surgery 2.07 1.43 3.84 RBRVS 46945 HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP Surgery 2.21 3.87 6.22 RBRVS 46946 HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP Surgery 2.63 3.41 5.92 RBRVS 46947 HEMORRHOIDOPEXY STAPLING Surgery 5.57 4.26 4.26 RBRVS 46999 UNLISTED PROCEDURE ANUS Surgery 6.26 Unlisted 47000 BIOPSY LIVER NEEDLE PERCUTANEOUS Surgery 1.90 0.91 8.26 RBRVS 47001 BX LVR NDL DONE PURPOSE TM OTH MAJOR PX Surgery 1.90 0.67 0.67 RBRVS 47010 HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES Surgery 19.40 10.99 10.99 RBRVS 47015 LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS Surgery 18.50 10.70 10.70 RBRVS 47100 BIOPSY LIVER WEDGE Surgery 12.91 8.53 8.53 RBRVS 47120 HEPATECTOMY RESCJ PARTIAL LOBECTOMY Surgery 39.01 19.24 19.24 RBRVS 47122 HEPATECTOMY RESCJ TRISEGMENTECTOMY Surgery 59.48 25.81 25.81 RBRVS 47125 HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY Surgery 53.04 23.44 23.44 RBRVS 47130 HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY Surgery 57.19 24.84 24.84 RBRVS 47135 LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE Surgery 83.64 38.24 38.24 RBRVS 47140 DONOR HEPATECTOMY LIVING DONOR SEG II & III Surgery 59.40 29.28 29.28 RBRVS 47141 DONOR HEPATECTOMY LIVING DONOR SEG II III & IV Surgery 71.50 34.89 34.89 RBRVS 47142 DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI Surgery 79.44 37.73 37.73 RBRVS 47143 BKBENCH PREP CADAVER DONOR Surgery 22.65 5% Sample 47146 BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA Surgery 6.00 2.14 2.14 RBRVS 47147 BKBENCH RCNSTJ LVR GRF ARTL ANAST EA Surgery 7.00 2.50 2.50 RBRVS 47300 MARSUPIALIZATION CST/ABSC LVR Surgery 18.14 10.42 10.42 RBRVS 47350 MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ Surgery 22.49 11.96 11.96 RBRVS 47360 MGMT LVR HEMRRG CPLX SUTR WND/INJ Surgery 31.31 15.30 15.30 RBRVS 47361 MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR Surgery 52.60 23.15 23.15 RBRVS 47362 MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING Surgery 23.54 12.80 12.80 RBRVS 47370 LAPS SURG ABLTJ 1/> LVR TUM RF Surgery 20.80 10.40 10.40 RBRVS 47371 LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG Surgery 20.80 10.59 10.59 RBRVS 47379 UNLIS LAPAROSCOPIC PROCEDURE LIVER Surgery 31.20 Unlisted 47380 ABLTJ OPN 1/> LVR TUM RF Surgery 24.56 11.58 11.58 RBRVS 47381 ABLTJ OPN 1/> LVR TUM CRYOSURG Surgery 24.88 11.60 11.60 RBRVS 47382 ABLTJ 1/> LVR TUM PRQ RF Surgery 15.22 5.73 125.69 RBRVS 47383 ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION Surgery 9.13 3.82 205.46 RBRVS

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47399 UNLISTED PROCEDURE LIVER Surgery 3.22 Unlisted 47400 HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1 Surgery 36.36 17.36 17.36 RBRVS 47420 CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP Surgery 22.03 11.63 11.63 RBRVS 47425 CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP Surgery 22.31 11.91 11.91 RBRVS 47460 TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS Surgery 20.52 11.27 11.27 RBRVS 47480 CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX Surgery 13.25 8.98 8.98 RBRVS 47490 CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT Surgery 4.76 4.39 4.39 RBRVS 47531 NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS Surgery 1.80 0.81 8.59 RBRVS 47532 NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS Surgery 4.25 1.57 18.54 RBRVS 47533 PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL Surgery 6.00 2.16 31.20 RBRVS 47534 PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT Surgery 8.03 2.78 37.74 RBRVS 47535 CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH Surgery 4.50 1.68 26.26 RBRVS 47536 EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I Surgery 2.88 1.14 19.98 RBRVS 47537 REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I Surgery 1.83 0.82 9.37 RBRVS 47538 PLMT BILE DUCT STENT PRQ EXISTING ACCESS Surgery 6.60 2.35 120.38 RBRVS 47539 PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH Surgery 9.00 3.09 129.63 RBRVS 47540 PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH Surgery 10.75 3.69 133.28 RBRVS 47541 PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW Surgery 5.61 2.01 27.29 RBRVS 47542 BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT Surgery 2.50 0.78 11.56 RBRVS 47543 ENDOLUMINAL BX BILIARY TREE PRQ ANY METH SNG/MLT Surgery 3.07 1.08 33.88 RBRVS 47544 REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I Surgery 4.29 1.40 18.30 RBRVS 47550 BILIARY NDSC INTRAOPERATIVE Surgery 3.02 1.08 1.08 RBRVS 47552 BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH Surgery 6.03 2.46 2.46 RBRVS 47553 BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE Surgery 6.34 2.08 2.08 RBRVS 47554 BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS Surgery 9.05 3.61 3.61 RBRVS 47555 BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT Surgery 7.55 2.45 2.45 RBRVS 47556 BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT Surgery 8.55 2.83 2.83 RBRVS 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY Surgery 10.47 6.09 6.09 RBRVS 47563 LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY Surgery 11.47 6.48 6.48 RBRVS 47564 LAPS SURG CHOLECSTC W/EXPL COMMON DUCT Surgery 18.00 9.94 9.94 RBRVS 47570 LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY Surgery 12.56 6.87 6.87 RBRVS 47579 UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT Surgery 16.56 Unlisted 47600 CHOLECYSTECTOMY Surgery 17.48 9.33 9.33 RBRVS 47605 CHOLECYSTECTOMY W/CHOLANGIOGRAPHY Surgery 18.48 9.67 9.67 RBRVS 47610 CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT Surgery 20.92 10.48 10.48 RBRVS 47612 CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY Surgery 21.21 10.56 10.56 RBRVS 47620 CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP Surgery 23.07 11.33 11.33 RBRVS 47700 EXPL CONGENITAL ATRESIA BILE DUCTS Surgery 16.50 9.98 9.98 RBRVS 47701 PORTOENETEROSTOMY Surgery 28.73 14.63 14.63 RBRVS 47711 EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC Surgery 25.90 12.98 12.98 RBRVS 47712 EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC Surgery 33.72 16.12 16.12 RBRVS 47715 EXCISION CHOLEDOCHAL CYST Surgery 21.55 11.79 11.79 RBRVS 47720 CHOLECYSTOENTEROSTOMY DIRECT Surgery 18.34 10.66 10.66 RBRVS 47721 CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY Surgery 21.99 11.95 11.95 RBRVS 47740 CHOLECYSTOENTEROSTOMY ROUX-EN-Y Surgery 21.23 11.68 11.68 RBRVS 47741 CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM Surgery 24.21 12.74 12.74 RBRVS 47760 ANAST XTRHEPATC BILIARY DUCTS & GI TRACT Surgery 38.32 17.99 17.99 RBRVS 47765 ANAST INTRAHEPATC DUCTS & GI TRACT Surgery 52.19 23.42 23.42 RBRVS 47780 ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI Surgery 42.32 19.27 19.27 RBRVS 47785 ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS & GI Surgery 56.19 24.62 24.62 RBRVS 47800 RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST Surgery 26.17 13.39 13.39 RBRVS 47801 PLACEMENT CHOLEDOCHAL STENT Surgery 17.60 8.93 8.93 RBRVS 47802 U-TUBE HEPATICOENTEROSTOMY Surgery 24.93 13.29 13.29 RBRVS 47900 SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY Surgery 22.44 12.02 12.02 RBRVS 47999 UNLISTED PROCEDURE BILIARY TRACT Surgery 16.56 Unlisted 48000 PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS Surgery 31.95 14.87 14.87 RBRVS 48001 PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY Surgery 39.69 17.75 17.75 RBRVS 48020 REMOVAL PANCREATIC CALCULUS Surgery 19.09 10.42 10.42 RBRVS 48100 BIOPSY PANCREAS OPEN Surgery 14.46 7.79 7.79 RBRVS 48102 BIOPSY PANCREA PERCUTANEOUS NEEDLE Surgery 4.70 1.90 10.08 RBRVS 48105 RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS Surgery 49.26 21.81 21.81 RBRVS 48120 EXCISION LESION PANCREAS Surgery 18.41 9.35 9.35 RBRVS 48140 PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY Surgery 26.32 12.74 12.74 RBRVS 48145 PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY Surgery 27.39 13.37 13.37 RBRVS 48146 PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX Surgery 30.60 16.49 16.49 RBRVS 48148 EXCISION AMPULLA VATER Surgery 20.39 10.87 10.87 RBRVS 48150 PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY Surgery 52.84 24.72 24.72 RBRVS 48152 PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY Surgery 48.65 23.34 23.34 RBRVS 48153 PNCRTECT W/PANCREATOJEJUNOSTOMY Surgery 52.79 24.39 24.39 RBRVS 48154 PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY Surgery 48.88 23.43 23.43 RBRVS 48155 PANCREATECTOMY TOTAL Surgery 29.45 16.09 16.09 RBRVS 48160 PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS Surgery 44.20 37.51 37.51 ERBRVS 48400 INJECTION INTRAOPERATIVE PANCREATOGRAPHY Surgery 1.95 0.70 0.70 RBRVS 48500 MARSUPIALIZATION PANCREATIC CYST Surgery 18.16 10.79 10.79 RBRVS 48510 EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN Surgery 17.19 10.45 10.45 RBRVS

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48520 INT ANAST PANCREATIC CYST GI TRACT DIRECT Surgery 18.15 9.36 9.36 RBRVS 48540 INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y Surgery 21.94 10.77 10.77 RBRVS 48545 PANCREATORRHAPHY INJURY Surgery 22.23 11.40 11.40 RBRVS 48547 DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ Surgery 30.38 14.32 14.32 RBRVS 48548 PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST Surgery 28.09 13.52 13.52 RBRVS 48552 BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA Surgery 4.30 1.54 1.54 RBRVS 48554 TRANSPLANTATION PANCREATIC ALLOGRAFT Surgery 37.80 27.32 27.32 RBRVS 48556 RMVL TRANSPLANTED PANCREATIC ALLOGRAFT Surgery 19.47 12.72 12.72 RBRVS 48999 UNLISTED PROCEDURE PANCREAS Surgery 57.44 Unlisted 49000 EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX Surgery 12.54 6.93 6.93 RBRVS 49002 REOPENING RECENT LAPAROTOMY Surgery 17.63 8.68 8.68 RBRVS 49010 EXPL RETROPERITONEUM W/WO BX SPX Surgery 16.06 7.44 7.44 RBRVS 49020 DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN Surgery 26.67 13.42 13.42 RBRVS 49040 DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN Surgery 16.52 8.68 8.68 RBRVS 49060 DRAINAGE OF RETROPERITONEAL ABSCESS OPEN Surgery 18.53 9.22 9.22 RBRVS 49062 DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN Surgery 12.22 6.48 6.48 RBRVS 49082 ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE Surgery 1.24 0.76 4.10 RBRVS 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE Surgery 2.00 0.97 6.15 RBRVS 49084 PERITONEAL LAVAGE W/WO IMAGING GUIDANCE Surgery 2.00 0.72 0.72 RBRVS 49180 BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE Surgery 1.73 0.60 2.78 RBRVS 49185 SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID Surgery 2.35 0.98 25.64 RBRVS 49203 EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/< Surgery 20.13 10.20 10.20 RBRVS 49204 EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM Surgery 26.13 12.56 12.56 RBRVS 49205 EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM Surgery 30.13 14.05 14.05 RBRVS 49215 EXC PRESAC/SACROCOCCYGEAL TUMOR Surgery 37.81 18.31 18.31 RBRVS 49220 STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA Surgery 15.79 8.53 8.53 RBRVS 49250 UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX Surgery 9.01 5.86 5.86 RBRVS 49255 OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX Surgery 12.56 7.56 7.56 RBRVS 49320 LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX Surgery 5.14 3.21 3.21 RBRVS 49321 LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE Surgery 5.44 3.36 3.36 RBRVS 49322 LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE Surgery 6.01 3.46 3.46 RBRVS 49323 LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY Surgery 10.23 6.13 6.13 RBRVS 49324 LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER Surgery 6.32 3.54 3.54 RBRVS 49325 LAPS W/REVISION INTRAPERITONEAL CATHETER Surgery 6.82 3.67 3.67 RBRVS 49326 LAPAROSCOPY W/OMENTOPEXY Surgery 3.50 1.18 1.18 RBRVS 49327 LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT Surgery 2.38 0.85 0.85 RBRVS 49329 UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM Surgery 8.80 Unlisted 49400 INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX Surgery 1.88 0.63 1.80 RBRVS 49402 REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY Surgery 14.09 7.45 7.45 RBRVS 49405 IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ Surgery 4.25 1.51 20.20 RBRVS 49406 IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ Surgery 4.25 1.52 20.23 RBRVS 49407 IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL Surgery 4.50 1.63 15.89 RBRVS 49411 INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT Surgery 3.82 1.55 11.43 RBRVS 49412 PLACEMENT INTRSTL DEV OPN W/IMG GUID 1/MLT Surgery 1.50 0.55 0.55 RBRVS 49418 INSJ INTRAPERITONEAL CATHETER W/IMG GUID Surgery 4.21 1.68 36.06 RBRVS 49419 INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT Surgery 7.08 4.40 4.40 RBRVS 49421 INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN Surgery 4.21 1.52 1.52 RBRVS 49422 REMOVAL TUNNELED INTRAPERITONEAL CATHETER Surgery 6.29 3.30 3.30 RBRVS 49423 EXCHNG ABSC/CST DRG CATH RAD GID SPX Surgery 1.46 0.50 14.01 RBRVS 49424 CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX Surgery 0.76 0.28 3.33 RBRVS 49425 INSERTION PERITONEAL-VENOUS SHUNT Surgery 12.22 6.48 6.48 RBRVS 49426 REVIS PERITONEAL-VENOUS SHUNT Surgery 10.41 4.91 4.91 RBRVS 49427 INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT Surgery 0.89 0.33 0.33 RBRVS 49428 LIGATION PERITONEAL-VENOUS SHUNT Surgery 6.87 5.64 5.64 RBRVS 49429 RMVL PERITONEAL-VENOUS SHUNT Surgery 7.44 4.05 4.05 RBRVS 49435 INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER Surgery 2.25 0.72 0.72 RBRVS 49436 DELAYED CREATION EXIT SITE EMBEDDED CATHETER Surgery 2.72 2.05 2.05 RBRVS 49440 INSERT GASTROSTOMY TUBE PERCUTANEOUS Surgery 4.18 1.85 24.97 RBRVS 49441 INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ Surgery 4.77 2.08 27.75 RBRVS 49442 INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS Surgery 4.00 2.09 23.16 RBRVS 49446 CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ Surgery 3.31 1.11 24.81 RBRVS 49450 REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS Surgery 1.36 0.46 17.47 RBRVS 49451 REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ Surgery 1.84 0.62 18.66 RBRVS 49452 REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS Surgery 2.86 0.95 22.45 RBRVS 49460 OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE Surgery 0.96 0.34 19.79 RBRVS 49465 CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE Surgery 0.62 0.23 3.95 RBRVS 49491 RPR 1ST INGUN HRNA PRETERM INFT RDC Surgery 12.53 6.05 6.05 RBRVS 49492 RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED Surgery 15.43 8.25 8.25 RBRVS 49495 RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC Surgery 6.20 4.15 4.15 RBRVS 49496 RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER Surgery 9.42 5.68 5.68 RBRVS 49500 RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE Surgery 5.84 4.62 4.62 RBRVS 49501 RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED Surgery 9.36 5.88 5.88 RBRVS 49505 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE Surgery 7.96 5.20 5.20 RBRVS 49507 RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED Surgery 9.09 5.68 5.68 RBRVS 49520 RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE Surgery 9.99 5.92 5.92 RBRVS

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49521 RPR RECRT INGUN HERNIA ANY AGE INCARCERATED Surgery 11.48 6.51 6.51 RBRVS 49525 RPR INGUN HERNIA SLIDING ANY AGE Surgery 8.93 5.53 5.53 RBRVS 49540 REPAIR LUMBAR HERNIA Surgery 10.74 6.18 6.18 RBRVS 49550 RPR 1ST FEM HRNA ANY AGE REDUCIBLE Surgery 8.99 5.52 5.52 RBRVS 49553 RPR 1ST FEM HERNIA ANY AGE INCARCERATED Surgery 9.92 5.98 5.98 RBRVS 49555 RPR RECRT FEM HERNIA REDUCIBLE Surgery 9.39 5.65 5.65 RBRVS 49557 RPR RECRT FEM HRNA INCARCERATED Surgery 11.62 6.59 6.59 RBRVS 49560 REPAIR FIRST ABDOMINAL WALL HERNIA Surgery 11.92 6.64 6.64 RBRVS 49561 RPR 1ST INCAL/VNT HERNIA INCARCERATED Surgery 15.38 7.94 7.94 RBRVS 49565 RPR RECRT INCAL/VNT HERNIA REDUCIBLE Surgery 12.37 6.98 6.98 RBRVS 49566 RPR RECRT INCAL/VNT HERNIA INCARCERATED Surgery 15.53 8.00 8.00 RBRVS 49568 IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE Surgery 4.88 1.75 1.75 RBRVS 49570 RPR EPIGASTRIC HERNIA REDUCIBLE SPX Surgery 6.05 4.52 4.52 RBRVS 49572 RPR EPIGASTRIC HERNIA INCARCERATED Surgery 7.87 5.17 5.17 RBRVS 49580 RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE Surgery 4.47 4.04 4.04 RBRVS 49582 RPR UMBILICAL HERNIA < 5 YRS INCARCERATED Surgery 7.13 5.08 5.08 RBRVS 49585 RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE Surgery 6.59 4.70 4.70 RBRVS 49587 RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED Surgery 7.08 4.98 4.98 RBRVS 49590 RPR SPIGELIAN HERNIA Surgery 8.90 5.54 5.54 RBRVS 49600 RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE Surgery 11.55 5.80 5.80 RBRVS 49605 RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH Surgery 87.09 35.18 35.18 RBRVS 49606 RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH Surgery 19.00 9.24 9.24 RBRVS 49610 RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG Surgery 10.91 6.35 6.35 RBRVS 49611 RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG Surgery 9.34 5.56 5.56 RBRVS 49650 LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA Surgery 6.36 4.50 4.50 RBRVS 49651 LAPS SURG RPR RECURRENT INGUINAL HERNIA Surgery 8.38 5.71 5.71 RBRVS 49652 LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE Surgery 11.92 6.80 6.80 RBRVS 49653 LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED Surgery 14.94 8.41 8.41 RBRVS 49654 LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE Surgery 13.76 7.48 7.48 RBRVS 49655 LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED Surgery 16.84 9.10 9.10 RBRVS 49656 LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE Surgery 15.08 7.95 7.95 RBRVS 49657 LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED Surgery 22.11 10.93 10.93 RBRVS 49659 UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY Surgery 10.86 Unlisted 49900 SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN Surgery 12.41 8.34 8.34 RBRVS 49904 OMENTAL FLAP EXTRA-ABDOMINAL Surgery 22.35 14.08 14.08 RBRVS 49905 OMENTAL FLAP INTRA-ABDOMINAL Surgery 6.54 2.34 2.34 RBRVS 49999 UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM Surgery 7.24 Unlisted 50010 RNL EXPL X NECESSITATING OTH SPEC PX Surgery 12.28 7.00 7.00 RBRVS 50020 DRAINAGE PERIRENAL/RENAL ABSCESS OPEN Surgery 18.08 8.95 8.95 RBRVS 50040 NEPHROSTOMY/NEPHROTOMY W/DRAINAGE Surgery 16.68 8.04 8.04 RBRVS 50045 NEPHROTOMY W/EXPLORATION Surgery 16.82 8.06 8.06 RBRVS 50060 NEPHROLITHOTOMY REMOVAL STAGE 1 Surgery 20.95 9.44 9.44 RBRVS 50065 NEPHROLITHOTOMY SECONDARY FOR CALCULUS Surgery 22.32 9.90 9.90 RBRVS 50070 NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY Surgery 21.85 9.74 9.74 RBRVS 50075 NEPHROLITHOTOMY RMVL LG STAGHORN STAGE 1 Surgery 27.09 11.74 11.74 RBRVS 50080 PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY 2 CM Surgery 23.50 10.52 10.52 RBRVS 50100 TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX Surgery 17.45 9.56 9.56 RBRVS 50120 PYELOTOMY W/EXPLORATION Surgery 17.21 8.12 8.12 RBRVS 50125 PYELOTOMY W/DRAINAGE PYELOSTOMY Surgery 17.82 8.40 8.40 RBRVS 50130 PYELOTOMY W/REMOVAL CALCULUS Surgery 18.82 8.74 8.74 RBRVS 50135 PYELOTOMY COMPLICATED Surgery 20.59 9.34 9.34 RBRVS 50200 RENAL BIOPSY PRQ TROCAR/NEEDLE Surgery 2.63 1.22 14.56 RBRVS 50205 RENAL BIOPSY SURG EXPOSURE KIDNEY Surgery 12.29 6.76 6.76 RBRVS 50220 NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ Surgery 18.68 8.85 8.85 RBRVS 50225 NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL Surgery 21.88 9.87 9.87 RBRVS 50230 NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD Surgery 23.81 10.17 10.17 RBRVS 50234 NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC Surgery 24.05 10.50 10.50 RBRVS 50236 NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPAR INCISN Surgery 26.94 12.11 12.11 RBRVS 50240 NEPHRECTOMY PARTIAL Surgery 24.21 11.02 11.02 RBRVS 50250 OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND Surgery 22.22 10.21 10.21 RBRVS 50280 EXCISION/UNROOFING CYST KIDNEY Surgery 17.09 8.25 8.25 RBRVS 50290 EXCISION PERINEPHRIC CYST Surgery 16.15 7.83 7.83 RBRVS 50300 DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL Surgery 23.05 v3.16 50320 DONOR NEPHRECTOMY OPEN LIVING DONOR Surgery 22.43 15.60 15.60 RBRVS 50323 BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT Surgery 8.69 5% Sample 50325 BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT Surgery 9.48 v3.16 50327 BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA Surgery 4.00 1.41 1.41 RBRVS 50328 BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA Surgery 3.50 1.24 1.24 RBRVS 50329 BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA Surgery 3.34 1.17 1.17 RBRVS 50340 RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE Surgery 14.04 9.96 9.96 RBRVS 50360 RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY Surgery 39.88 20.99 20.99 RBRVS 50365 RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY Surgery 46.13 25.83 25.83 RBRVS 50370 RMVL TRNSPLED RENAL ALLOGRAFT Surgery 18.88 11.59 11.59 RBRVS 50380 RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY Surgery 30.11 20.51 20.51 RBRVS

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50382 RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ Surgery 5.50 1.85 27.71 RBRVS 50384 REMOVAL INDWELLING URETERAL STENT PRQ Surgery 5.00 1.65 21.37 RBRVS 50385 REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL Surgery 4.44 1.83 27.54 RBRVS 50386 REMOVE INT DWELL URETERAL STENT TRANSURETHRAL Surgery 3.30 1.43 17.44 RBRVS 50387 RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH Surgery 2.00 0.65 13.27 RBRVS 50389 RMVL NFROS TUBE REQ FLUORO GUIDANCE Surgery 1.10 0.37 7.23 RBRVS 50390 ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ Surgery 1.96 0.66 0.66 RBRVS 50391 INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB Surgery 1.96 0.68 1.33 RBRVS 50395 INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT Surgery 3.37 1.47 1.47 RBRVS 50396 MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH Surgery 2.09 1.14 1.14 RBRVS 50400 PYELOPLASTY SIMPLE Surgery 21.27 9.56 9.56 RBRVS 50405 PYELOPLASTY COMPLICATED Surgery 25.86 11.38 11.38 RBRVS 50430 NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS Surgery 3.15 1.40 11.35 RBRVS 50431 NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS Surgery 1.10 0.72 3.39 RBRVS 50432 PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I Surgery 4.25 1.76 19.33 RBRVS 50433 PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I Surgery 5.30 2.11 26.47 RBRVS 50434 CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ Surgery 4.00 1.68 21.16 RBRVS 50435 EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I Surgery 1.82 0.95 11.41 RBRVS 50500 NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY Surgery 21.22 9.53 9.53 RBRVS 50520 CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA Surgery 18.88 8.76 8.76 RBRVS 50525 CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR Surgery 24.39 16.68 16.68 RBRVS 50526 CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR Surgery 26.31 12.80 12.80 RBRVS 50540 SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI Surgery 21.10 9.49 9.49 RBRVS 50541 LAPAROSCOPY SURG ABLATION RENAL CYSTS Surgery 16.86 7.62 7.62 RBRVS 50542 LAPS ABLTJ RENAL MASS LESION W/INTRAOP US Surgery 21.36 9.72 9.72 RBRVS 50543 LAPAROSCOPY SURG PARTIAL NEPHRECTOMY Surgery 27.41 12.23 12.23 RBRVS 50544 LAPAROSCOPY SURG PYELOPLASTY Surgery 23.37 9.78 9.78 RBRVS 50545 LAPAROSCOPY RADICAL NEPHRECTOMY Surgery 25.06 10.58 10.58 RBRVS 50546 LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT Surgery 21.87 10.03 10.03 RBRVS 50547 LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR Surgery 26.34 14.60 14.60 RBRVS 50548 LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY Surgery 25.36 10.48 10.48 RBRVS 50549 UNLISTED LAPAROSCOPY PROCEDURE RENAL Surgery 35.64 Unlisted 50551 RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION Surgery 5.59 2.28 4.07 RBRVS 50553 RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA Surgery 5.98 2.39 4.35 RBRVS 50555 RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY Surgery 6.52 2.60 4.54 RBRVS 50557 RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI Surgery 6.61 2.63 4.65 RBRVS 50561 RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS Surgery 7.58 2.92 5.15 RBRVS 50562 RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR Surgery 10.90 4.59 4.59 RBRVS 50570 RENAL NDSC NEPHROTOMY W/WO IRRIGATION Surgery 9.53 3.55 3.55 RBRVS 50572 RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER Surgery 10.33 3.82 3.82 RBRVS 50574 RENAL NDSC NEPHROTOMY W/BIOPSY Surgery 11.00 4.04 4.04 RBRVS 50575 RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY Surgery 13.96 5.04 5.04 RBRVS 50576 RNL NDSC NFROT FULGURATION &/INCISION W/WO BX Surgery 10.97 4.03 4.03 RBRVS 50580 RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS Surgery 11.84 4.33 4.33 RBRVS 50590 LITHOTRIPSY XTRCORP SHOCK WAVE Surgery 9.77 5.42 9.65 RBRVS 50592 ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY Surgery 6.80 3.08 81.86 RBRVS 50593 ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY Surgery 9.13 3.93 121.62 RBRVS 50600 URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE Surgery 17.17 7.88 7.88 RBRVS 50605 URETEROTOMY INSERTION INDWELLING STENT ALL TYPES Surgery 16.79 8.41 8.41 RBRVS 50606 ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC Surgery 3.16 1.05 11.48 RBRVS 50610 URTROLITHOTOMY UPPER ONE-THIRD URETER Surgery 17.25 7.97 7.97 RBRVS 50620 URTROLITHOTOMY MIDDLE ONE-THIRD URETER Surgery 16.43 7.70 7.70 RBRVS 50630 URTROLITHOTOMY LOWER ONE-THIRD URETER Surgery 16.21 7.62 7.62 RBRVS 50650 URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE Surgery 18.82 8.76 8.76 RBRVS 50660 URETERECTOMY TOT ECTOPIC URETER CMBN APPR Surgery 21.02 9.46 9.46 RBRVS 50684 INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH Surgery 0.76 0.61 2.18 RBRVS 50686 MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH Surgery 1.51 1.03 2.82 RBRVS 50688 CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL Surgery 1.20 0.99 0.99 RBRVS 50690 NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG Surgery 1.16 0.77 1.54 RBRVS 50693 PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT Surgery 4.21 1.74 25.43 RBRVS 50694 PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH Surgery 5.50 2.18 27.06 RBRVS 50695 PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH Surgery 7.05 2.68 32.63 RBRVS 50700 URETEROPLASTY PLASTIC OPERATION URETER Surgery 16.69 8.02 8.02 RBRVS 50705 URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I Surgery 4.03 1.34 43.86 RBRVS 50706 BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I Surgery 3.80 1.26 17.53 RBRVS 50715 URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS Surgery 20.64 10.66 10.66 RBRVS 50722 URETEROLYSIS FOR OVARIAN VEIN SYNDROME Surgery 17.95 9.42 9.42 RBRVS 50725 URTROLSS RETROCAVAL URTR W/REANAST Surgery 20.20 9.20 9.20 RBRVS 50727 REVJ URINARY-CUTANEOUS ANASTAMOSIS Surgery 8.28 5.26 5.26 RBRVS 50728 REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA Surgery 12.18 6.49 6.49 RBRVS 50740 EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR Surgery 20.07 10.50 10.50 RBRVS 50750 URETEROCALYCOSTOMY ANAST URETER RENAL CALYX Surgery 21.22 9.53 9.53 RBRVS 50760 URETEROURETEROSTOMY Surgery 20.07 9.43 9.43 RBRVS 50770 TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR Surgery 21.22 9.53 9.53 RBRVS 50780 URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER Surgery 19.95 9.29 9.29 RBRVS

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50782 URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR Surgery 19.66 10.35 10.35 RBRVS 50783 URETERONEOCYSTOSTOMY W/URETERAL TAILORING Surgery 20.70 9.36 9.36 RBRVS 50785 URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP Surgery 22.23 9.98 9.98 RBRVS 50800 URETEROENTEROSTOMY ANAST URETER INTESTINE Surgery 16.41 8.21 8.21 RBRVS 50810 URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO Surgery 22.61 12.38 12.38 RBRVS 50815 URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS Surgery 22.26 10.35 10.35 RBRVS 50820 URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS Surgery 24.07 10.85 10.85 RBRVS 50825 CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN Surgery 30.68 13.43 13.43 RBRVS 50830 URINARY UNIDIVERSION Surgery 33.77 14.23 14.23 RBRVS 50840 RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST Surgery 22.39 10.39 10.39 RBRVS 50845 CUTANANEOUS APPENDICO-VESICOSTOMY Surgery 22.46 10.87 10.87 RBRVS 50860 URETEROSTOMY TRANSPLANTATION URETER SKIN Surgery 17.08 8.15 8.15 RBRVS 50900 URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE Surgery 15.04 7.67 7.67 RBRVS 50920 CLOSURE URETEROCUTANEOUS FISTULA Surgery 15.81 7.72 7.72 RBRVS 50930 CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR Surgery 20.19 9.20 9.20 RBRVS 50940 DELIGATION URETER Surgery 15.93 7.76 7.76 RBRVS 50945 LAPAROSCOPY URTROLITHOTOMY Surgery 17.97 7.98 7.98 RBRVS 50947 LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT Surgery 25.78 11.15 11.15 RBRVS 50948 LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT Surgery 23.82 10.15 10.15 RBRVS 50949 UNLISTED LAPAROSCOPY PROCEDURE URETER Surgery 36.93 Unlisted 50951 URETERAL ENDOSCOPY VIA URETEROSTOMY Surgery 5.83 2.36 4.25 RBRVS 50953 URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER Surgery 6.23 2.49 4.45 RBRVS 50955 URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY Surgery 6.74 2.67 4.66 RBRVS 50957 URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY Surgery 6.78 2.69 4.74 RBRVS 50961 URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE Surgery 6.04 2.44 4.34 RBRVS 50970 URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING Surgery 7.13 2.76 2.76 RBRVS 50972 NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER Surgery 6.88 2.68 2.68 RBRVS 50974 URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX Surgery 9.16 3.43 3.43 RBRVS 50976 URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX Surgery 9.03 3.39 3.39 RBRVS 50980 NDSC URETEROTOMY RMVL FB/CALCULUS Surgery 6.84 2.67 2.67 RBRVS 51020 CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL Surgery 7.69 4.86 4.86 RBRVS 51030 CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES Surgery 7.81 4.80 4.80 RBRVS 51040 CYSTOSTOMY CYSTOTOMY W/DRAINAGE Surgery 4.49 3.28 3.28 RBRVS 51045 CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX Surgery 7.81 5.10 5.10 RBRVS 51050 CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS Surgery 7.97 4.67 4.67 RBRVS 51060 TRANSVESICAL URETROLITHOTOMY Surgery 9.95 5.59 5.59 RBRVS 51065 CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO Surgery 9.95 5.52 5.52 RBRVS 51080 DRG PRIVESICAL/PREVESICAL SPACE ABSC Surgery 6.71 4.24 4.24 RBRVS 51100 ASPIRATION BLADDER NEEDLE Surgery 0.78 0.26 0.90 RBRVS 51101 ASPIRATION BLADDER TROCAR/INTRACATHETER Surgery 1.02 0.36 2.41 RBRVS 51102 ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER Surgery 2.70 1.18 3.46 RBRVS 51500 EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR Surgery 11.05 5.96 5.96 RBRVS 51520 CYSTOTOMY SIMPLE EXCISION VESICAL NECK Surgery 10.21 5.68 5.68 RBRVS 51525 CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE Surgery 15.42 7.48 7.48 RBRVS 51530 CYSTOTOMY EXCISION BLADDER TUMOR Surgery 13.71 7.23 7.23 RBRVS 51535 CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE Surgery 13.90 6.91 6.91 RBRVS 51550 CYSTECTOMY PARTIAL SIMPLE Surgery 17.23 8.23 8.23 RBRVS 51555 CYSTECTOMY PARTIAL COMPLICATED Surgery 23.18 10.38 10.38 RBRVS 51565 CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST Surgery 23.68 10.76 10.76 RBRVS 51570 CYSTECTOMY COMPLETE SEPARATE PROCEDURE Surgery 27.46 11.84 11.84 RBRVS 51575 CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY Surgery 34.18 14.27 14.27 RBRVS 51580 CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES Surgery 35.37 15.13 15.13 RBRVS 51585 CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES Surgery 39.64 16.56 16.56 RBRVS 51590 CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST Surgery 36.33 15.04 15.04 RBRVS 51595 CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC Surgery 41.32 16.90 16.90 RBRVS 51596 CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR Surgery 44.26 18.30 18.30 RBRVS 51597 PELVIC EXENTERATION COMPLETE MALIGNANCY Surgery 42.86 17.99 17.99 RBRVS 51600 NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY Surgery 0.88 0.32 4.23 RBRVS 51605 NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY Surgery 0.64 0.39 0.39 RBRVS 51610 NJX RETROGRADE URETHROCSTOGRAPY Surgery 1.05 0.70 1.88 RBRVS 51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ Surgery 0.88 0.31 1.38 RBRVS 51701 INSJ NON-NDWELLG BLADDER CATHETER Surgery 0.50 0.24 0.99 RBRVS 51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE Surgery 0.50 0.31 1.43 RBRVS 51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED Surgery 1.47 0.71 2.05 RBRVS 51705 CHANGE CYSTOSTOMY TUBE SIMPLE Surgery 0.90 0.49 1.58 RBRVS 51710 CHANGE CYSTOSTOMY TUBE COMPLICATED Surgery 1.35 0.80 2.15 RBRVS 51715 NDSC NJX IMPLT MATRL URT&/BLDR NCK Surgery 3.73 1.60 4.10 RBRVS 51720 BLADDER INSTILLATION ANTICARCINOGENIC AGENT Surgery 1.50 0.64 1.44 RBRVS 51725 SIMPLE CYSTOMETROGRAM Surgery a 1.51 3.65 3.65 RBRVS 51725 26 SIMPLE CYSTOMETROGRAM Surgery 1.51 0.55 0.55 RBRVS 51725 TC SIMPLE CYSTOMETROGRAM Surgery a 3.10 3.10 RBRVS 51726 BLADDER PRESSURE MEASUREMENT DURING FILLING Surgery a 1.71 5.56 5.56 RBRVS 51726 26 BLADDER PRESSURE MEASUREMENT DURING FILLING Surgery 1.71 0.60 0.60 RBRVS 51726 TC BLADDER PRESSURE MEASUREMENT DURING FILLING Surgery a 4.96 4.96 RBRVS 51727 COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE Surgery a 2.11 6.49 6.49 RBRVS

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51727 26 COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE Surgery 2.11 0.78 0.78 RBRVS 51727 TC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE Surgery a 5.71 5.71 RBRVS 51728 COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES Surgery a 2.11 6.58 6.58 RBRVS 51728 26 COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES Surgery 2.11 0.72 0.72 RBRVS 51728 TC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES Surgery a 5.86 5.86 RBRVS 51729 COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL Surgery a 2.51 6.86 6.86 RBRVS 51729 26 COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL Surgery 2.51 0.91 0.91 RBRVS 51729 TC COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL Surgery a 5.95 5.95 RBRVS 51736 SIMPLE UROFLOMETRY Surgery a 0.17 0.25 0.25 RBRVS 51736 26 SIMPLE UROFLOMETRY Surgery 0.17 0.06 0.06 RBRVS 51736 TC SIMPLE UROFLOMETRY Surgery a 0.19 0.19 RBRVS 51741 COMPLEX UROFLOMETRY Surgery a 0.17 0.26 0.26 RBRVS 51741 26 COMPLEX UROFLOMETRY Surgery 0.17 0.06 0.06 RBRVS 51741 TC COMPLEX UROFLOMETRY Surgery a 0.20 0.20 RBRVS 51784 EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL Surgery a 1.53 3.76 3.76 RBRVS 51784 26 EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL Surgery 1.53 0.54 0.54 RBRVS 51784 TC EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL Surgery a 3.22 3.22 RBRVS 51785 NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ Surgery a 1.53 5.33 5.33 RBRVS 51785 26 NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ Surgery 1.53 0.62 0.62 RBRVS 51785 TC NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ Surgery a 4.71 4.71 RBRVS 51792 STIMULUS EVOKED RESPONSE Surgery a 1.10 4.75 4.75 RBRVS 51792 26 STIMULUS EVOKED RESPONSE Surgery 1.10 0.39 0.39 RBRVS 51792 TC STIMULUS EVOKED RESPONSE Surgery a 4.36 4.36 RBRVS 51797 VOID PRESSURE STUDIES INTRAABDOMINAL Surgery a 0.80 2.29 2.29 RBRVS 51797 26 VOID PRESSURE STUDIES INTRAABDOMINAL Surgery 0.80 0.28 0.28 RBRVS 51797 TC VOID PRESSURE STUDIES INTRAABDOMINAL Surgery a 2.01 2.01 RBRVS 51798 MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP Surgery a 0.52 0.52 RBRVS 51800 CSTOPLASTY/CSTOURTP PLSTC ANY Surgery 18.89 8.91 8.91 RBRVS 51820 CSTOURTP W/UNI/BI URTRONEOCSTOST Surgery 19.59 10.77 10.77 RBRVS 51840 ANT VESICOURETHROPEXY/URETHROPEXY SMPL Surgery 11.36 6.11 6.11 RBRVS 51841 ANT VESICOURETHROPEXY/URETHROPEXY COMP Surgery 13.68 7.01 7.01 RBRVS 51845 ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL Surgery 10.15 5.52 5.52 RBRVS 51860 CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE Surgery 12.60 6.93 6.93 RBRVS 51865 CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED Surgery 15.80 7.88 7.88 RBRVS 51880 CLOSURE CYSTOSTOMY SEPARATE PROCEDURE Surgery 7.87 4.54 4.54 RBRVS 51900 CLSR VESICOVAGINAL FISTUL AABDL APPROACH Surgery 14.63 7.64 7.64 RBRVS 51920 CLOSURE VESICOUTERINE FISTULA Surgery 13.41 6.98 6.98 RBRVS 51925 CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY Surgery 17.53 10.59 10.59 RBRVS 51940 CLOSURE EXSTROPHY BLADDER Surgery 30.66 13.06 13.06 RBRVS 51960 ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS Surgery 25.40 11.52 11.52 RBRVS 51980 CUTANEOUS VESICOSTOMY Surgery 12.57 6.48 6.48 RBRVS 51990 LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT Surgery 13.36 6.65 6.65 RBRVS 51992 LAPAROSCOPY SLING OPERATION STRESS INCONT Surgery 14.87 7.45 7.45 RBRVS 51999 UNLISTED LAPAROSCOPY PROCEDURE BLADDER Surgery 22.32 Unlisted 52000 CYSTOURETHROSCOPY Surgery 2.23 1.14 3.31 RBRVS 52001 CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS Surgery 5.44 2.23 4.52 RBRVS 52005 CYSTO BLADDER W/URETERAL CATHETERIZATION Surgery 2.37 1.19 4.87 RBRVS 52007 CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS Surgery 3.02 1.41 9.17 RBRVS 52010 CYSTO W/EJACULATORY DUCT CATHETERIZATION Surgery 3.02 1.41 7.01 RBRVS 52204 CYSTOURETHROSCOPY WITH BIOPSY Surgery 2.59 1.20 7.54 RBRVS 52214 CYSTO W/DESTRUCTION OF LESIONS Surgery 3.50 1.18 14.72 RBRVS 52224 CYSTO W/REMOVAL OF LESIONS SMALL Surgery 4.05 1.37 14.98 RBRVS 52234 CYSTO W/REMOVAL OF TUMORS SMALL Surgery 4.62 1.95 1.95 RBRVS 52235 CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM Surgery 5.44 2.26 2.26 RBRVS 52240 CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE Surgery 7.50 2.96 2.96 RBRVS 52250 CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG Surgery 4.49 1.91 1.91 RBRVS 52260 CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH Surgery 3.91 1.71 1.71 RBRVS 52265 CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA Surgery 2.94 1.40 7.07 RBRVS 52270 CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE Surgery 3.36 1.50 6.33 RBRVS 52275 CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE Surgery 4.69 1.95 8.36 RBRVS 52276 CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE Surgery 4.99 2.08 2.08 RBRVS 52277 CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER Surgery 6.16 2.47 2.47 RBRVS 52281 CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS Surgery 2.75 1.32 4.64 RBRVS 52282 CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT Surgery 6.39 2.58 2.58 RBRVS 52283 CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE Surgery 3.73 1.65 3.70 RBRVS 52285 CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME Surgery 3.60 1.63 3.91 RBRVS 52287 CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER Surgery 3.20 1.31 5.25 RBRVS 52290 CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI Surgery 4.58 1.94 1.94 RBRVS 52300 CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI Surgery 5.30 2.19 2.19 RBRVS 52301 CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI Surgery 5.50 2.25 2.25 RBRVS 52305 CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT Surgery 5.30 2.13 2.13 RBRVS 52310 CYSTO W/SIMPLE REMOVAL STONE & STENT Surgery 2.81 1.23 3.76 RBRVS 52315 CYSTO W/COMPLEX REMOVAL STONE & STENT Surgery 5.20 2.13 5.95 RBRVS 52317 LITHOLAPAXY SMPL/SM <2.5 CM Surgery 6.71 2.55 15.26 RBRVS 52318 LITHOLAPAXY COMP/LG > 2.5 CM Surgery 9.18 3.43 3.43 RBRVS

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52320 CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS Surgery 4.69 1.89 1.89 RBRVS 52325 CYSTO FRAGMENTATION URETERAL STONE Surgery 6.15 2.40 2.40 RBRVS 52327 CYSTO W/SUBURTRIC NJX IMPLT MATRL Surgery 5.18 1.79 1.79 RBRVS 52330 CYSTO MANJ W/O RMVL URETERAL STONE Surgery 5.03 2.01 8.38 RBRVS 52332 CYSTO W/INSERT URETERAL STENT Surgery 2.82 1.34 10.65 RBRVS 52334 CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR Surgery 4.82 2.02 2.02 RBRVS 52341 CYSTO W/TX URETERAL STRICTURE Surgery 5.35 2.23 2.23 RBRVS 52342 CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE Surgery 5.85 2.40 2.40 RBRVS 52343 CYSTO W/TX INTRA-RENAL STRICTURE Surgery 6.55 2.64 2.64 RBRVS 52344 CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE Surgery 7.05 2.80 2.80 RBRVS 52345 CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX Surgery 7.55 2.97 2.97 RBRVS 52346 CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE Surgery 8.58 3.32 3.32 RBRVS 52351 CYSTO W/URTROSCOPY&/PYELOSCOPY DX Surgery 5.75 2.33 2.33 RBRVS 52352 CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES Surgery 6.75 2.71 2.71 RBRVS 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY Surgery 7.50 2.96 2.96 RBRVS 52354 CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION Surgery 8.00 3.12 3.12 RBRVS 52355 CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR Surgery 9.00 3.44 3.44 RBRVS 52356 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT Surgery 8.00 3.09 3.09 RBRVS 52400 CYSTO INC FULG/RESCJ URTL VALVES/FOLDS Surgery 8.69 4.06 4.06 RBRVS 52402 CSTO W/TRURL RESCJ/INC EJACULATORY DUXS Surgery 5.27 1.83 1.83 RBRVS 52441 CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE Surgery 4.50 1.52 29.88 RBRVS 52442 CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL Surgery 1.20 0.41 25.35 RBRVS 52450 TRANSURETHRAL INCISION PROSTATE Surgery 7.78 4.81 4.81 RBRVS 52500 TRANSURETHRAL RESECTION PROSTATE Surgery 8.14 4.93 4.93 RBRVS 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE Surgery 15.26 7.30 7.30 RBRVS 52630 TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS Surgery 6.55 4.17 4.17 RBRVS 52640 TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE Surgery 4.79 3.69 3.69 RBRVS 52647 LASER COAGULATION OF PROSTATE FOR URINE FLOW Surgery 11.30 6.00 37.68 RBRVS 52648 LASER VAPORIZATION OF PROSTATE FOR URINE FLOW Surgery 12.15 6.29 38.21 RBRVS 52649 LASER ENUCLEATION PROSTATE W/MORCELLATION Surgery 14.56 7.43 7.43 RBRVS 52700 TRURL DRAINAGE PROSTATIC ABSCESS Surgery 7.49 4.30 4.30 RBRVS 53000 URTT/URTS XTRNL SPX PENDULOUS URETHRA Surgery 2.33 1.66 1.66 RBRVS 53010 URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA Surgery 4.45 3.49 3.49 RBRVS 53020 MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT Surgery 1.77 0.82 0.82 RBRVS 53025 MEATOTOMY CUTTING MEATUS SPX INFANT Surgery 1.13 0.71 0.71 RBRVS 53040 DRAINAGE DEEP PERIURETHRAL ABSCESS Surgery 6.55 3.96 3.96 RBRVS 53060 DRG OF SKENE'S GLAND ABSCESS OR CYST Surgery 2.68 1.73 2.25 RBRVS 53080 DRG PERINEAL URINARY XTRVASATION UNCOMP SPX Surgery 6.92 4.83 4.83 RBRVS 53085 DRG PERINEAL URINARY XTRVASATION COMPLIC Surgery 11.18 6.18 6.18 RBRVS 53200 BIOPSY URETHRA Surgery 2.59 1.19 1.57 RBRVS 53210 URETHRECTOMY TOT W/CYSTOST FEMALE Surgery 13.72 6.91 6.91 RBRVS 53215 URETHRECTOMY TOT W/CYSTOST MALE Surgery 16.85 7.90 7.90 RBRVS 53220 EXC/FULGURATION CARCINOMA URETHRA Surgery 7.63 4.51 4.51 RBRVS 53230 EXC URETHRAL DIVERTICULUM SPX FEMALE Surgery 10.44 5.76 5.76 RBRVS 53235 EXC URETHRAL DIVERTICULUM SPX MALE Surgery 10.99 5.92 5.92 RBRVS 53240 MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE Surgery 7.08 4.29 4.29 RBRVS 53250 EXCISION OF BULBOURETHRAL GLAND Surgery 6.52 4.08 4.08 RBRVS 53260 EXC/FULGURATION URETHRAL POLYP DSTL URETHRA Surgery 3.03 1.78 2.36 RBRVS 53265 EXC/FULGURATION URETHRAL CARUNCLE Surgery 3.17 1.81 2.69 RBRVS 53270 EXCISION OR FULGURATION SKENES GLANDS Surgery 3.14 1.78 2.38 RBRVS 53275 EXCISION/FULGURATION URETHRAL PROLAPSE Surgery 4.57 2.46 2.46 RBRVS 53400 URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX Surgery 14.13 7.25 7.25 RBRVS 53405 URETHROPLASTY 2ND STAGE W/URINARY DIVERSION Surgery 15.66 7.66 7.66 RBRVS 53410 URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA Surgery 17.68 8.45 8.45 RBRVS 53415 URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT Surgery 20.70 9.43 9.43 RBRVS 53420 URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE Surgery 15.17 7.27 7.27 RBRVS 53425 URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE Surgery 17.07 7.91 7.91 RBRVS 53430 URETHROPLASTY RCNSTJ FEMALE URETHRA Surgery 17.43 8.22 8.22 RBRVS 53431 URTP W/TUBULARIZATION POST URT&/LWR BLDR Surgery 21.18 9.59 9.59 RBRVS 53440 SLING OPRATION CORRJ MALE URINARY INCONTINENCE Surgery 13.36 6.75 6.75 RBRVS 53442 RMVL/REVJ SLING MALE URINARY INCONTINENCE Surgery 13.49 7.46 7.46 RBRVS 53444 INSERTION TANDEM CUFF Surgery 14.19 6.98 6.98 RBRVS 53445 INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER Surgery 13.00 7.14 7.14 RBRVS 53446 REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER Surgery 11.02 6.15 6.15 RBRVS 53447 RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC Surgery 14.28 7.32 7.32 RBRVS 53448 RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD Surgery 23.44 10.69 10.69 RBRVS 53449 RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER Surgery 10.56 5.79 5.79 RBRVS 53450 URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT Surgery 6.77 4.17 4.17 RBRVS 53460 URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM Surgery 7.75 4.50 4.50 RBRVS 53500 URETHROLSS TRVG SEC OPN W/CSTO Surgery 13.00 6.96 6.96 RBRVS 53502 URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE Surgery 8.26 4.76 4.76 RBRVS 53505 URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE Surgery 8.26 4.74 4.74 RBRVS 53510 URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL Surgery 10.96 5.91 5.91 RBRVS 53515 URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS Surgery 14.22 7.02 7.02 RBRVS 53520 CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX Surgery 9.48 5.41 5.41 RBRVS

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53600 DILAT URETHRAL STRIX DILATOR MALE 1ST Surgery 1.21 0.49 1.02 RBRVS 53601 DILAT URETHRAL STRIX DILATOR MALE SBSQ Surgery 0.98 0.45 1.21 RBRVS 53605 DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES Surgery 1.28 0.43 0.43 RBRVS 53620 DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST Surgery 1.62 0.71 1.50 RBRVS 53621 DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ Surgery 1.35 0.57 1.61 RBRVS 53660 DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI Surgery 0.71 0.41 1.21 RBRVS 53661 DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ Surgery 0.72 0.36 1.16 RBRVS 53665 DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES Surgery 0.76 0.27 0.27 RBRVS 53850 TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH Surgery 10.08 6.19 47.24 RBRVS 53852 TRURL DSTRJ PRSTATE TISS RF THERMOTH Surgery 10.83 5.81 41.85 RBRVS 53855 INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT Surgery 1.64 0.55 20.03 RBRVS 53860 TRURL RF FEMALE BLADDER NECK STRS URIN INCONT Surgery 3.97 2.05 39.72 RBRVS 53899 UNLISTED PROCEDURE URINARY SYSTEM Surgery 4.25 Unlisted 54000 SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN Surgery 1.59 1.33 2.44 RBRVS 54001 SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN Surgery 2.24 1.48 2.75 RBRVS 54015 I&D PENIS DEEP Surgery 5.36 2.83 2.83 RBRVS 54050 DSTRJ LESION PENIS SIMPLE CHEMICAL Surgery 1.29 1.57 2.31 RBRVS 54055 DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION Surgery 1.25 1.26 1.98 RBRVS 54056 DSTRJ LESION PENIS SIMPLE CRYOSURGERY Surgery 1.29 1.72 2.58 RBRVS 54057 DSTRJ LESION PENIS SIMPLE LASER Surgery 1.29 1.27 2.40 RBRVS 54060 DSTRJ LESION PENIS SIMPLE SURG EXCISION Surgery 1.98 1.52 2.88 RBRVS 54065 DSTRJ LESION PENIS EXTENSIVE Surgery 2.47 2.17 3.42 RBRVS 54100 BIOPSY PENIS SEPARATE PROCEDURE Surgery 1.90 1.47 3.49 RBRVS 54105 BIOPSY PENIS DEEP STRUCTURES Surgery 3.54 2.18 3.58 RBRVS 54110 EXCISION OF PENILE PLAQUE Surgery 10.92 5.76 5.76 RBRVS 54111 EXC PENILE PLAQUE GRAFT &/5 CM LENGTH Surgery 14.42 6.95 6.95 RBRVS 54112 EXC PENILE PLAQUE GRAFT > 5 CM LENGTH Surgery 16.98 8.04 8.04 RBRVS 54115 REMOVAL FOREIGN BODY DEEP PENILE TISSUE Surgery 6.95 4.42 5.18 RBRVS 54120 AMPUTATION PENIS PARTIAL Surgery 11.01 5.87 5.87 RBRVS 54125 AMPUTATION PENIS COMPLETE Surgery 14.56 7.10 7.10 RBRVS 54130 AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE Surgery 21.84 9.97 9.97 RBRVS 54135 AMPUTATION PENIS RADICAL W/LYMPH NODES Surgery 28.17 12.10 12.10 RBRVS 54150 CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK Surgery 1.90 0.68 2.26 RBRVS 54160 CIRCUMCISION NEONATE Surgery 2.53 1.32 3.42 RBRVS 54161 CIRCUMCISION AGE >28 DAYS Surgery 3.32 1.95 1.95 RBRVS 54162 LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS Surgery 3.32 2.02 3.60 RBRVS 54163 REPAIR INCOMPLETE CIRCUMCISION Surgery 3.32 2.57 2.57 RBRVS 54164 FRENULOTOMY PENIS Surgery 2.82 2.41 2.41 RBRVS 54200 INJECTION PEYRONIE DISEASE Surgery 1.11 1.17 1.81 RBRVS 54205 NJX PEYRONIE W/SURG EXPOS PLAQUE Surgery 8.97 5.29 5.29 RBRVS 54220 IRRIGATION CORPORA CAVERNOSA PRIAPISM Surgery 2.42 1.14 3.09 RBRVS 54230 INJECTION CORPORA CAVERNOSOGRAPY Surgery 1.34 0.81 1.27 RBRVS 54231 DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS Surgery 2.04 1.08 1.73 RBRVS 54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT Surgery 1.19 0.79 1.25 RBRVS 54240 PENILE PLETHYSMOGRAPHY Surgery a 1.31 1.41 1.41 RBRVS 54240 26 PENILE PLETHYSMOGRAPHY Surgery 1.31 0.43 0.43 RBRVS 54240 TC PENILE PLETHYSMOGRAPHY Surgery a 0.98 0.98 RBRVS 54250 NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST Surgery a 2.22 1.05 1.05 RBRVS 54250 26 NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST Surgery 2.22 0.75 0.75 RBRVS 54250 TC NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST Surgery a 0.30 0.30 RBRVS 54300 PENIS STRAIGHTENING CHORDEE Surgery 11.20 5.94 5.94 RBRVS 54304 PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR Surgery 13.28 6.76 6.76 RBRVS 54308 URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM Surgery 12.62 6.49 6.49 RBRVS 54312 URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM Surgery 14.51 7.35 7.35 RBRVS 54316 URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF Surgery 18.05 8.59 8.59 RBRVS 54318 URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS Surgery 12.43 7.34 7.34 RBRVS 54322 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT Surgery 13.98 6.87 6.87 RBRVS 54324 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS Surgery 17.55 8.31 8.31 RBRVS 54326 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS Surgery 17.02 8.24 8.24 RBRVS 54328 1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ Surgery 16.89 8.20 8.20 RBRVS 54332 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR Surgery 18.37 8.70 8.70 RBRVS 54336 1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP Surgery 21.62 10.11 10.11 RBRVS 54340 RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE Surgery 9.71 5.54 5.54 RBRVS 54344 RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP Surgery 17.06 8.25 8.25 RBRVS 54348 RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF Surgery 18.32 9.78 9.78 RBRVS 54352 RPR HYPOSPADIAS CRIPPLE W/DSJ & EXC & GRFS/FLAP Surgery 26.13 11.63 11.63 RBRVS 54360 PLASTIC RPR PENIS CORRECT ANGULATION Surgery 12.78 6.46 6.46 RBRVS 54380 PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR Surgery 14.18 7.17 7.17 RBRVS 54385 PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT Surgery 16.56 10.88 10.88 RBRVS 54390 PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER Surgery 22.77 11.55 11.55 RBRVS 54400 INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID Surgery 9.17 4.98 4.98 RBRVS 54401 INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED Surgery 10.44 7.17 7.17 RBRVS 54405 INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH Surgery 14.52 7.06 7.06 RBRVS 54406 RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH Surgery 12.89 6.62 6.62 RBRVS 54408 RPR COMPONENT INFLATABLE PENILE PROSTHESIS Surgery 13.91 7.21 7.21 RBRVS

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54410 RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS Surgery 15.18 7.79 7.79 RBRVS 54411 RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL Surgery 18.35 9.06 9.06 RBRVS 54415 RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT Surgery 8.88 5.27 5.27 RBRVS 54416 RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI Surgery 12.08 6.93 6.93 RBRVS 54417 RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD Surgery 16.10 7.90 7.90 RBRVS 54420 CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI Surgery 12.39 6.44 6.44 RBRVS 54430 CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI Surgery 11.06 6.06 6.06 RBRVS 54435 CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM Surgery 6.81 4.36 4.36 RBRVS 54437 REPAIR OF TRAUMATIC CORPOREAL TEAR(S) Surgery 11.50 6.64 6.64 RBRVS 54438 REPLANTATION PENIS COMP AMPUTATION W/URETH REP Surgery 24.50 11.63 11.63 RBRVS 54440 PLASTIC OPERATION PENIS INJURY Surgery 16.20 FAIR Health 54450 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING Surgery 1.12 0.41 0.75 RBRVS 54500 BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE Surgery 1.31 0.69 0.69 RBRVS 54505 BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE Surgery 3.50 2.13 2.13 RBRVS 54512 EXC XTRPARENCHYMAL LESION TESTIS Surgery 9.33 5.07 5.07 RBRVS 54520 ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH Surgery 5.30 3.39 3.39 RBRVS 54522 ORCHIECTOMY PARTIAL Surgery 10.25 5.53 5.53 RBRVS 54530 ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH Surgery 8.46 5.04 5.04 RBRVS 54535 ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL Surgery 13.19 6.69 6.69 RBRVS 54550 EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA Surgery 8.41 4.76 4.76 RBRVS 54560 EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL Surgery 12.10 6.98 6.98 RBRVS 54600 RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS Surgery 7.64 4.49 4.49 RBRVS 54620 FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE Surgery 5.21 2.82 2.82 RBRVS 54640 ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR Surgery 7.73 5.04 5.04 RBRVS 54650 ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS Surgery 12.39 6.64 6.64 RBRVS 54660 INSJ TESTICULAR PROSTH SEPARATE PROCEDURE Surgery 5.74 3.85 3.85 RBRVS 54670 SUTURE/REPAIR TESTICULAR INJURY Surgery 6.65 4.21 4.21 RBRVS 54680 TRANSPLANTATION TESTIS TO THIGH Surgery 14.04 6.98 6.98 RBRVS 54690 LAPAROSCOPY SURGICAL ORCHIECTOMY Surgery 11.70 5.86 5.86 RBRVS 54692 LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS Surgery 13.74 6.52 6.52 RBRVS 54699 UNLISTED LAPAROSCOPY PROCEDURE TESTIS Surgery 17.56 Unlisted 54700 I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE Surgery 3.47 2.24 2.24 RBRVS 54800 BIOPSY EPIDIDYMIS NEEDLE Surgery 2.33 1.03 1.03 RBRVS 54830 EXCISION LOCAL LESION EPIDIDYMIS Surgery 6.01 3.96 3.96 RBRVS 54840 EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY Surgery 5.27 3.33 3.33 RBRVS 54860 EPIDIDYMECTOMY UNILATERAL Surgery 6.95 4.27 4.27 RBRVS 54861 EPIDIDYMECTOMY BILATERAL Surgery 9.70 5.44 5.44 RBRVS 54865 EXPLORATION EPIDIDYMIS W/WO BIOPSY Surgery 5.77 3.86 3.86 RBRVS 54900 EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI Surgery 14.20 8.03 8.03 RBRVS 54901 EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI Surgery 19.10 10.16 10.16 RBRVS 55000 PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED Surgery 1.43 0.85 1.74 RBRVS 55040 EXCISION HYDROCELE UNILATERAL Surgery 5.45 3.58 3.58 RBRVS 55041 EXCISION HYDROCELE BILATERAL Surgery 8.54 5.09 5.09 RBRVS 55060 RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE Surgery 6.15 4.03 4.03 RBRVS 55100 DRAINAGE SCROTAL WALL ABSCESS Surgery 2.45 2.01 3.36 RBRVS 55110 SCROTAL EXPLORATION Surgery 6.33 4.01 4.01 RBRVS 55120 REMOVAL FOREIGN BODY SCROTUM Surgery 5.72 3.89 3.89 RBRVS 55150 RESECTION SCROTUM Surgery 8.14 5.02 5.02 RBRVS 55175 SCROTOPLASTY SIMPLE Surgery 5.87 3.85 3.85 RBRVS 55180 SCROTOPLASTY COMPLICATED Surgery 11.78 6.62 6.62 RBRVS 55200 VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX Surgery 4.55 2.94 7.31 RBRVS 55250 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS Surgery 3.37 2.77 7.14 RBRVS 55300 VASOTOMY VASOGRAMS UNI/BI Surgery 3.50 1.50 1.50 RBRVS 55400 VASOVASOSTOMY VASOVASORRHAPHY Surgery 8.61 4.72 4.72 RBRVS 55450 LIGATION PRQ VAS DEFERENS UNI/BI SPX Surgery 4.43 2.47 5.27 RBRVS 55500 EXC HYDROCELE SPRMATIC CORD UNI SPX Surgery 6.22 4.21 4.21 RBRVS 55520 EXC LESION SPERMATIC CORD SEPARATE PROCEDURE Surgery 6.66 4.90 4.90 RBRVS 55530 EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX Surgery 5.75 3.67 3.67 RBRVS 55535 EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL Surgery 7.19 4.34 4.34 RBRVS 55540 EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR Surgery 8.30 5.66 5.66 RBRVS 55550 LAPS LIGATION SPERMATIC VEINS VARICOCELE Surgery 7.20 4.27 4.27 RBRVS 55559 UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD Surgery 11.47 Unlisted 55600 VESICULOTOMY Surgery 7.01 4.28 4.28 RBRVS 55605 VESICULOTOMY COMPLICATED Surgery 8.76 5.79 5.79 RBRVS 55650 VESICULECTOMY ANY APPROACH Surgery 12.65 6.51 6.51 RBRVS 55680 EXCISION MULLERIAN DUCT CYST Surgery 5.67 4.01 4.01 RBRVS 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH Surgery 2.58 1.14 3.31 RBRVS 55705 BIOPSY PROSTATE INCISIONAL ANY APPROACH Surgery 4.61 2.52 2.52 RBRVS 55706 BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID Surgery 6.28 3.69 3.69 RBRVS 55720 PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE Surgery 7.73 4.36 4.36 RBRVS 55725 PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED Surgery 10.05 7.03 7.03 RBRVS 55801 PROSTATECTOMY PERINEAL SUBTOTAL Surgery 19.80 9.37 9.37 RBRVS 55810 PROSTATECTOMY PERINEAL RADICAL Surgery 24.29 10.66 10.66 RBRVS 55812 PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX Surgery 29.89 12.99 12.99 RBRVS 55815 PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC Surgery 32.95 14.02 14.02 RBRVS

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55821 PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES Surgery 15.76 7.55 7.55 RBRVS 55831 PROSTATECTOMY RETROPUBIC SUBTOTAL Surgery 17.19 8.03 8.03 RBRVS 55840 PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING Surgery 21.36 9.88 9.88 RBRVS 55842 PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX Surgery 21.36 9.87 9.87 RBRVS 55845 PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM Surgery 25.18 11.16 11.16 RBRVS 55860 EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST Surgery 15.84 7.51 7.51 RBRVS 55862 EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX Surgery 20.04 10.32 10.32 RBRVS 55865 EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH Surgery 24.57 10.99 10.99 RBRVS 55866 LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT Surgery 32.06 14.17 14.17 RBRVS 55870 ELECTROEJACULATION Surgery 2.58 1.22 2.14 RBRVS 55873 CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI Surgery 13.60 6.84 185.27 RBRVS 55875 TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ Surgery 13.46 6.96 6.96 RBRVS 55876 PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT Surgery 1.73 0.98 1.94 RBRVS 55899 UNLISTED PROCEDURE MALE GENITAL SYSTEM Surgery 5.36 Unlisted 55920 PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL Surgery 8.31 3.64 3.64 RBRVS 56405 I&D VULVA/PERINEAL ABSCESS Surgery 1.49 1.40 1.42 RBRVS 56420 I&D OF BARTHOLINS GLAND ABSCESS Surgery 1.44 0.97 1.83 RBRVS 56440 MARSUPIALIZATION BARTHOLINS GLAND CYST Surgery 2.89 1.93 1.93 RBRVS 56441 LYSIS LABIAL ADHESIONS Surgery 2.02 1.69 1.84 RBRVS 56442 HYMENOTOMY SIMPLE INCISION Surgery 0.68 0.60 0.60 RBRVS 56501 DESTRUCTION LESIONS VULVA SIMPLE Surgery 1.58 1.48 1.93 RBRVS 56515 DESTRUCTION LESIONS VULVA EXTENSIVE Surgery 3.08 2.22 2.92 RBRVS 56605 BIOPSY VULVA/PERINEUM 1 LESION SPX Surgery 1.10 0.48 1.09 RBRVS 56606 BIOPSY VULVA/PERINEUM EACH ADDL LESION Surgery 0.55 0.22 0.45 RBRVS 56620 VULVECTOMY SIMPLE PARTIAL Surgery 7.53 5.95 5.95 RBRVS 56625 VULVECTOMY SIMPLE COMPLETE Surgery 9.68 6.44 6.44 RBRVS 56630 VULVECTOMY RADICAL PARTIAL Surgery 14.80 8.76 8.76 RBRVS 56631 VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY Surgery 18.99 10.89 10.89 RBRVS 56632 VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY Surgery 21.86 13.12 13.12 RBRVS 56633 VULVECTOMY RADICAL COMPLETE Surgery 19.62 11.06 11.06 RBRVS 56634 VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY Surgery 20.66 11.94 11.94 RBRVS 56637 VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY Surgery 24.75 13.38 13.38 RBRVS 56640 VULVECTOMY RAD COMPL ILIAC & PELVIC LMPHADECTOMY Surgery 24.78 13.26 13.26 RBRVS 56700 PRTL HYMENECTOMY/REVJ HYMENAL RING Surgery 2.84 2.12 2.12 RBRVS 56740 EXC BARTHOLINS GLAND/CYST Surgery 4.88 2.97 2.97 RBRVS 56800 PLASTIC REPAIR INTROITUS Surgery 3.93 2.43 2.43 RBRVS 56805 CLITOROPLASTY INTERSEX STATE Surgery 19.88 10.12 10.12 RBRVS 56810 PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX Surgery 4.29 2.55 2.55 RBRVS 56820 COLPOSCOPY VULVA Surgery 1.50 0.74 1.45 RBRVS 56821 COLPOSCOPY VULVA W/BIOPSY Surgery 2.05 0.95 1.85 RBRVS 57000 COLPOTOMY W/EXPLORATION Surgery 3.02 1.86 1.86 RBRVS 57010 COLPOTOMY W/DRAINAGE PELVIC ABSCESS Surgery 6.84 4.61 4.61 RBRVS 57020 COLPOCENTESIS SEPARATE PROCEDURE Surgery 1.50 0.62 0.95 RBRVS 57022 I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM Surgery 2.73 1.71 1.71 RBRVS 57023 I&D VAGINAL HEMATOMA NON-OBSTETRICAL Surgery 5.18 3.00 3.00 RBRVS 57061 DESTRUCTION VAGINAL LESIONS SIMPLE Surgery 1.30 1.33 1.76 RBRVS 57065 DESTRUCTION VAGINAL LESIONS EXTENSIVE Surgery 2.66 1.91 2.49 RBRVS 57100 BIOPSY VAGINAL MUCOSA SIMPLE Surgery 1.20 0.53 1.15 RBRVS 57105 BIOPSY VAGINAL MUCOSA EXTENSIVE Surgery 1.74 1.60 1.87 RBRVS 57106 VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL Surgery 7.50 5.34 5.34 RBRVS 57107 VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T Surgery 24.56 12.55 12.55 RBRVS 57109 VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC Surgery 28.40 15.10 15.10 RBRVS 57110 VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL Surgery 15.48 8.01 8.01 RBRVS 57111 VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS Surgery 28.40 13.58 13.58 RBRVS 57112 VAGNC COMPL RMVL VAG WALL TOT PEL LMPHADEC BX Surgery 30.52 16.02 16.02 RBRVS 57120 COLPOCLEISIS LE FORT TYPE Surgery 8.28 5.15 5.15 RBRVS 57130 EXCISION VAGINAL SEPTUM Surgery 2.46 1.76 2.26 RBRVS 57135 EXCISION VAGINAL CYST/TUMOR Surgery 2.70 1.87 2.39 RBRVS 57150 IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE Surgery 0.55 0.21 0.67 RBRVS 57155 INSERTION UTERINE TANDEM&/VAGINAL OVOIDS Surgery 5.40 2.36 6.23 RBRVS 57156 INSERTION VAGINAL RADIATION DEVICE Surgery 2.69 1.25 2.67 RBRVS 57160 FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI Surgery 0.89 0.35 1.17 RBRVS 57170 DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS Surgery 0.91 0.36 0.70 RBRVS 57180 INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX Surgery 1.63 1.17 2.15 RBRVS 57200 COLPORRHAPHY SUTURE INJURY VAGINA Surgery 4.42 3.52 3.52 RBRVS 57210 COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU Surgery 5.71 3.98 3.98 RBRVS 57220 PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH Surgery 4.85 3.59 3.59 RBRVS 57230 PLASTIC REPAIR URETHROCELE Surgery 6.30 4.11 4.11 RBRVS 57240 ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE Surgery 11.50 6.18 6.18 RBRVS 57250 POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY Surgery 11.50 6.29 6.29 RBRVS 57260 COMBINED ANTEROPOSTERIOR COLPORRHAPHY Surgery 14.44 7.45 7.45 RBRVS 57265 CMBND ANTEROPOST COLPORRHAPHY W/ENTEROCELE RPR Surgery 15.94 8.02 8.02 RBRVS 57267 INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE Surgery 4.88 1.84 1.84 RBRVS 57268 REPAIR ENTEROCELE VAGINAL APPROACH SPX Surgery 7.57 5.18 5.18 RBRVS 57270 REPAIR ENTEROCELE ABDOMINAL APPROACH SPX Surgery 13.67 7.25 7.25 RBRVS

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57280 COLPOPEXY ABDOMINAL APPROACH Surgery 16.72 8.32 8.32 RBRVS 57282 COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH Surgery 7.97 5.27 5.27 RBRVS 57283 COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH Surgery 11.66 6.46 6.46 RBRVS 57284 PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR Surgery 14.33 7.12 7.12 RBRVS 57285 PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH Surgery 11.60 6.11 6.11 RBRVS 57287 RMVL/REVJ SLING STRESS INCONTINENCE Surgery 11.15 6.90 6.90 RBRVS 57288 SLING OPERATION STRESS INCONTINENCE Surgery 12.13 6.79 6.79 RBRVS 57289 PEREYRA PX W/ANTERIOR COLPORRHAPHY Surgery 12.80 6.67 6.67 RBRVS 57291 CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT Surgery 8.64 5.31 5.31 RBRVS 57292 CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT Surgery 14.01 7.43 7.43 RBRVS 57295 REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP Surgery 7.82 4.79 4.79 RBRVS 57296 REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR Surgery 16.56 7.98 7.98 RBRVS 57300 CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR Surgery 8.71 6.02 6.02 RBRVS 57305 CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH Surgery 15.35 8.56 8.56 RBRVS 57307 CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST Surgery 17.17 9.67 9.67 RBRVS 57308 CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ Surgery 10.59 6.24 6.24 RBRVS 57310 CLOSURE URETHROVAGINAL FISTULA Surgery 7.65 4.68 4.68 RBRVS 57311 CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL Surgery 8.91 5.11 5.11 RBRVS 57320 CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH Surgery 8.88 5.19 5.19 RBRVS 57330 CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR Surgery 13.21 6.52 6.52 RBRVS 57335 VAGINOPLASTY INTERSEX STATE Surgery 20.02 10.46 10.46 RBRVS 57400 DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL Surgery 2.27 1.23 1.23 RBRVS 57410 PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL Surgery 1.75 1.08 1.08 RBRVS 57415 REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL Surgery 2.49 1.76 1.76 RBRVS 57420 COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT Surgery 1.60 0.78 1.50 RBRVS 57421 COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX Surgery 2.20 1.02 1.95 RBRVS 57423 PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH Surgery 16.08 7.88 7.88 RBRVS 57425 LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX Surgery 17.03 8.43 8.43 RBRVS 57426 REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC Surgery 14.30 7.92 7.92 RBRVS 57452 COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA Surgery 1.50 0.93 1.39 RBRVS 57454 COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE Surgery 2.33 1.26 1.72 RBRVS 57455 COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX Surgery 1.99 0.91 1.81 RBRVS 57456 COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE Surgery 1.85 0.86 1.74 RBRVS 57460 COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX Surgery 2.83 1.45 4.81 RBRVS 57461 COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX Surgery 3.43 1.48 5.17 RBRVS 57500 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX Surgery 1.20 0.81 2.27 RBRVS 57505 ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE Surgery 1.19 1.27 1.54 RBRVS 57510 CAUTERY CERVIX ELECTRO/THERMAL Surgery 1.90 1.15 1.58 RBRVS 57511 CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT Surgery 1.95 1.56 1.92 RBRVS 57513 CAUTERY CERVIX LASER ABLATION Surgery 1.95 1.59 1.89 RBRVS 57520 CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER Surgery 4.11 3.12 3.99 RBRVS 57522 CONIZATION CERVIX W/WO D&C RPR ELTRD EXC Surgery 3.67 2.78 3.31 RBRVS 57530 TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX Surgery 5.27 3.86 3.86 RBRVS 57531 RAD TRACHELECTOMY W/BI PEL LMPHADEC Surgery 29.95 15.97 15.97 RBRVS 57540 EXCISION CERVICAL STUMP ABDOMINAL APPROACH Surgery 13.29 7.91 7.91 RBRVS 57545 EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR Surgery 14.10 7.47 7.47 RBRVS 57550 EXCISION CERVICAL STUMP VAGINAL APPROACH Surgery 6.34 4.41 4.41 RBRVS 57555 EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR Surgery 9.94 5.87 5.87 RBRVS 57556 EXC CRV STUMP VAG APPR W/RPR NTRCL Surgery 9.36 5.61 5.61 RBRVS 57558 DILATION & CURETTAGE CERVICAL STUMP Surgery 1.72 1.29 1.61 RBRVS 57700 CERCLAGE UTERINE CERVIX NONOBSTETRICAL Surgery 4.35 3.91 3.91 RBRVS 57720 TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG Surgery 4.61 3.53 3.53 RBRVS 57800 DILATION CERVICAL CANAL INSTRUMENTAL SPX Surgery 0.77 0.52 0.85 RBRVS 58100 ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX Surgery 1.53 0.77 1.37 RBRVS 58110 ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY Surgery 0.77 0.31 0.50 RBRVS 58120 DILATION & CURETTAGE DX&/THER NONOBSTETRIC Surgery 3.59 2.16 3.25 RBRVS 58140 MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR Surgery 15.79 8.21 8.21 RBRVS 58145 MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR Surgery 8.91 5.43 5.43 RBRVS 58146 MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA Surgery 20.34 9.84 9.84 RBRVS 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY Surgery 17.31 8.92 8.92 RBRVS 58152 TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY Surgery 21.86 10.79 10.79 RBRVS 58180 SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY Surgery 16.60 8.51 8.51 RBRVS 58200 TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM Surgery 23.10 11.67 11.67 RBRVS 58210 RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY Surgery 30.91 15.65 15.65 RBRVS 58240 PEL EXNTJ GYNECOLOGIC MAL Surgery 49.33 24.54 24.54 RBRVS 58260 VAGINAL HYSTERECTOMY UTERUS 250 GM/< Surgery 14.15 7.54 7.54 RBRVS 58262 VAG HYST 250 GM/< W/RMVL TUBE&/OVARY Surgery 15.94 8.23 8.23 RBRVS 58263 VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL Surgery 17.23 8.72 8.72 RBRVS 58267 VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY Surgery 18.36 9.24 9.24 RBRVS 58270 VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE Surgery 15.30 7.80 7.80 RBRVS 58275 VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY Surgery 17.03 8.78 8.78 RBRVS 58280 VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE Surgery 18.33 9.23 9.23 RBRVS 58285 VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION Surgery 23.38 12.11 12.11 RBRVS 58290 VAGINAL HYSTERECTOMY UTERUS > 250 GM Surgery 20.27 9.83 9.83 RBRVS 58291 VAG HYST > 250 GM RMVL TUBE&/OVARY Surgery 22.06 10.51 10.51 RBRVS

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58292 VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE Surgery 23.35 11.01 11.01 RBRVS 58293 VAG HYST >250 GM COLPOURTCSTOPEXY W/WO NDSC CTR Surgery 24.33 11.39 11.39 RBRVS 58294 VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE Surgery 21.55 10.31 10.31 RBRVS 58300 INSERTION INTRAUTERINE DEVICE IUD Surgery 1.01 0.39 0.91 RBRVS 58301 REMOVAL INTRAUTERINE DEVICE IUD Surgery 1.27 0.50 1.26 RBRVS 58321 ARTIFICIAL INSEMINATION INTRA-CERVICAL Surgery 0.92 0.36 1.13 RBRVS 58322 ARTIFICIAL INSEMINATION INTRA-UTERINE Surgery 1.10 0.43 1.19 RBRVS 58323 SPERM WASHING ARTIFICIAL INSEMINATION Surgery 0.23 0.09 0.18 RBRVS 58340 CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI Surgery 0.88 0.68 2.38 RBRVS 58345 TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING Surgery 4.70 2.64 2.64 RBRVS 58346 INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY Surgery 7.56 4.45 4.45 RBRVS 58350 CHROMOTUBATION OVIDUCT W/MATERIALS Surgery 1.06 1.04 1.54 RBRVS 58353 ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID Surgery 3.60 2.17 24.28 RBRVS 58356 ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR Surgery 6.41 2.62 45.73 RBRVS 58400 UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX Surgery 7.14 4.45 4.45 RBRVS 58410 UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY Surgery 13.80 7.29 7.29 RBRVS 58520 HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL Surgery 13.48 7.61 7.61 RBRVS 58540 HYSTEROPLASTY RPR UTERINE ANOMALY Surgery 15.71 8.11 8.11 RBRVS 58541 LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/< Surgery 12.29 6.56 6.56 RBRVS 58542 LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR Surgery 14.16 7.31 7.31 RBRVS 58543 LAPS SUPRACERVICAL HYSTERECTOMY >250 Surgery 14.39 7.37 7.37 RBRVS 58544 LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY Surgery 15.60 7.97 7.97 RBRVS 58545 LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/< Surgery 15.55 7.92 7.92 RBRVS 58546 LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS Surgery 19.94 9.49 9.49 RBRVS 58548 LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY Surgery 31.63 16.30 16.30 RBRVS 58550 LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/< Surgery 15.10 8.05 8.05 RBRVS 58552 LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES Surgery 16.91 8.81 8.81 RBRVS 58553 LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS Surgery 20.06 9.56 9.56 RBRVS 58554 LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR Surgery 23.11 11.29 11.29 RBRVS 58555 HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE Surgery 3.33 1.65 4.83 RBRVS 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C Surgery 4.74 2.24 5.88 RBRVS 58559 HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS Surgery 6.16 2.77 2.77 RBRVS 58560 HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM Surgery 6.99 3.12 3.12 RBRVS 58561 HYSTEROSCOPY REMOVAL LEIOMYOMATA Surgery 9.99 4.28 4.28 RBRVS 58562 HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY Surgery 5.20 2.39 5.78 RBRVS 58563 HYSTEROSCOPY ENDOMETRIAL ABLATION Surgery 6.16 2.79 39.91 RBRVS 58565 HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS Surgery 7.12 4.27 44.67 RBRVS 58570 LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< Surgery 13.36 7.04 7.04 RBRVS 58571 LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY Surgery 15.00 8.00 8.00 RBRVS 58572 LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM Surgery 17.71 8.82 8.82 RBRVS 58573 LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR Surgery 20.79 10.34 10.34 RBRVS 58578 UNLISTED LAPAROSCOPY PROCEDURE UTERUS Surgery 25.72 Unlisted 58579 UNLISTED HYSTEROSCOPY PROCEDURE UTERUS Surgery 8.93 Unlisted 58600 LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI Surgery 5.91 3.67 3.67 RBRVS 58605 LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX Surgery 5.28 3.40 3.40 RBRVS 58611 LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG Surgery 1.45 0.57 0.57 RBRVS 58615 OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR Surgery 3.94 2.49 2.49 RBRVS 58660 LAPAROSCOPY W/LYSIS OF ADHESIONS Surgery 11.59 5.95 5.95 RBRVS 58661 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES Surgery 11.35 5.48 5.48 RBRVS 58662 LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE Surgery 12.15 6.33 6.33 RBRVS 58670 LAPAROSCOPY FULGURATION OVIDUCTS Surgery 5.91 3.68 3.68 RBRVS 58671 LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS Surgery 5.91 3.68 3.68 RBRVS 58672 LAPAROSCOPY FIMBRIOPLASTY Surgery 12.91 6.34 6.34 RBRVS 58673 LAPAROSCOPY SALPINGOSTOMY Surgery 14.04 6.89 6.89 RBRVS 58679 UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY Surgery 16.83 Unlisted 58700 SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX Surgery 12.95 7.23 7.23 RBRVS 58720 SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX Surgery 12.16 6.79 6.79 RBRVS 58740 LYSIS OF ADHESIONS SALPINX/OVARY Surgery 14.90 7.97 7.97 RBRVS 58750 TUBOTUBAL ANASTATOMOSIS Surgery 15.64 8.32 8.32 RBRVS 58752 TUBOUTERINE IMPLANTATION Surgery 15.64 8.02 8.02 RBRVS 58760 FIMBRIOPLASTY Surgery 13.93 7.30 7.30 RBRVS 58770 SALPINGOSTOMY Surgery 14.77 7.57 7.57 RBRVS 58800 DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR Surgery 4.62 3.26 3.81 RBRVS 58805 DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL Surgery 6.42 4.24 4.24 RBRVS 58820 DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN Surgery 4.70 3.56 3.56 RBRVS 58822 DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH Surgery 11.81 6.57 6.57 RBRVS 58825 TRANSPOSITION OVARY Surgery 11.78 7.13 7.13 RBRVS 58900 BIOPSY OVARY UNI/BI SEPARATE PROCEDURE Surgery 6.59 4.30 4.30 RBRVS 58920 WEDGE RESCJ/BISCTJ OVARY UNI/BI Surgery 11.95 6.84 6.84 RBRVS 58925 OVARIAN CYSTECTOMY UNI/BI Surgery 12.43 6.89 6.89 RBRVS 58940 OOPHORECTOMY PARTIAL/TOTAL UNI/BI Surgery 8.22 5.33 5.33 RBRVS 58943 OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY Surgery 19.52 10.22 10.22 RBRVS 58950 RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO Surgery 18.37 10.23 10.23 RBRVS 58951 RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD Surgery 24.26 12.44 12.44 RBRVS 58952 RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING Surgery 27.29 14.20 14.20 RBRVS

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58953 BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION Surgery 34.13 17.13 17.13 RBRVS 58954 BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY Surgery 37.13 18.44 18.44 RBRVS 58956 BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC Surgery 22.80 12.22 12.22 RBRVS 58957 RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY Surgery 26.22 13.84 13.84 RBRVS 58958 RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC Surgery 29.22 14.93 14.93 RBRVS 58960 LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK Surgery 15.79 8.84 8.84 RBRVS 58970 FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD Surgery 3.52 1.75 2.35 RBRVS 58974 EMBRYO TRANSFER INTRAUTERINE Surgery 4.03 FAIR Health 58976 GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH Surgery 3.82 1.88 2.85 RBRVS 58999 UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL Surgery 3.39 Unlisted 59000 AMNIOCENTESIS DIAGNOSIC Maternity - Non-Deliveries 1.30 0.71 1.97 RBRVS 59001 AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID Maternity - Non-Deliveries 3.00 1.44 1.44 RBRVS 59012 CORDOCENTESIS INTRAUTERINE Maternity - Non-Deliveries 3.44 1.55 1.55 RBRVS 59015 CHORIONIC VILLUS SAMPLING Maternity - Non-Deliveries 2.20 1.07 1.72 RBRVS 59020 FETAL CONTRACTION STRESS TEST Maternity - Non-Deliveries a 0.66 1.21 1.21 RBRVS 59020 26 FETAL CONTRACTION STRESS TEST Maternity - Non-Deliveries 0.66 0.26 0.26 RBRVS 59020 TC FETAL CONTRACTION STRESS TEST Maternity - Non-Deliveries a 0.95 0.95 RBRVS 59025 FETAL NONSTRESS TEST Maternity - Non-Deliveries a 0.53 0.72 0.72 RBRVS 59025 26 FETAL NONSTRESS TEST Maternity - Non-Deliveries 0.53 0.21 0.21 RBRVS 59025 TC FETAL NONSTRESS TEST Maternity - Non-Deliveries a 0.51 0.51 RBRVS 59030 FETAL SCALP BLOOD SAMPLING Maternity - Non-Deliveries 1.99 0.76 0.76 RBRVS 59050 FETAL MONITORING LABOR PHYS WRITTEN REPORT Maternity - Non-Deliveries 0.89 0.35 0.35 RBRVS 59051 FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY Maternity - Non-Deliveries 0.74 0.29 0.29 RBRVS 59070 TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE Maternity - Non-Deliveries 5.24 2.42 5.19 RBRVS 59072 FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE Maternity - Non-Deliveries 8.99 3.83 3.83 RBRVS 59074 FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE Maternity - Non-Deliveries 5.24 2.43 4.71 RBRVS 59076 FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE Maternity - Non-Deliveries 8.99 3.83 3.83 RBRVS 59100 HYSTEROTOMY ABDOMINAL Maternity - Non-Deliveries 13.37 7.28 7.28 RBRVS 59120 TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR Maternity - Non-Deliveries 12.67 7.00 7.00 RBRVS 59121 TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY Maternity - Non-Deliveries 12.74 6.94 6.94 RBRVS 59130 TX ECTOPIC PREGNANCY ABDL PREGNANCY Maternity - Non-Deliveries 15.08 8.00 8.00 RBRVS 59135 TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST Maternity - Non-Deliveries 14.92 7.87 7.87 RBRVS 59136 TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER Maternity - Non-Deliveries 14.25 7.47 7.47 RBRVS 59140 TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION Maternity - Non-Deliveries 5.94 4.08 4.08 RBRVS 59150 LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY Maternity - Non-Deliveries 12.29 6.77 6.77 RBRVS 59151 LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY Maternity - Non-Deliveries 12.11 6.39 6.39 RBRVS 59160 CURETTAGE POSTPARTUM Maternity - Non-Deliveries 2.76 1.54 2.39 RBRVS 59200 INSERTION CERVICAL DILATOR SEPARATE PROCEDURE Maternity - Non-Deliveries 0.79 0.31 1.07 RBRVS 59300 EPISIOTOMY/VAG RPR OTH/THN ATTENDING Maternity - Non-Deliveries 2.41 1.28 2.53 RBRVS 59320 CERCLAGE CERVIX PREGNANCY VAGINAL Maternity - Non-Deliveries 2.48 1.30 1.30 RBRVS 59325 CERCLAGE CERVIX PREGNANCY ABDOMINAL Maternity - Non-Deliveries 4.06 1.93 1.93 RBRVS 59350 HYSTERORRHAPHY RUPTURED UTERUS Maternity - Non-Deliveries 4.94 1.95 1.95 RBRVS 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM Maternity - Normal Deliveries 32.16 20.21 20.21 RBRVS 59409 VAGINAL DELIVERY ONLY Maternity - Normal Deliveries 14.37 5.73 5.73 RBRVS 59410 VAGINAL DELIVERY ONLY W/POSTPARTUM CARE Maternity - Normal Deliveries 18.01 7.68 7.68 RBRVS 59412 EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS Maternity - Normal Deliveries 1.71 0.85 0.85 RBRVS 59414 DELIVERY PLACENTA SEPARATE PROCEDURE Maternity - Normal Deliveries 1.61 0.63 0.63 RBRVS 59425 ANTEPARTUM CARE ONLY 4-6 VISITS Maternity - Normal Deliveries 6.31 2.50 5.25 RBRVS 59426 ANTEPARTUM CARE ONLY 7/> VISITS Maternity - Normal Deliveries 11.16 4.42 9.64 RBRVS 59430 POSTPARTUM CARE ONLY SEPARATE PROCEDURE Maternity - Normal Deliveries 2.47 0.98 2.26 RBRVS 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM Maternity - Cesarean Deliveries 35.64 22.01 22.01 RBRVS 59514 CESAREAN DELIVERY ONLY Maternity - Cesarean Deliveries 16.13 6.40 6.40 RBRVS 59515 CESAREAN DELIVERY ONLY W/POSTPARTUM CARE Maternity - Cesarean Deliveries 21.47 9.58 9.58 RBRVS 59525 STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY Surgery 8.53 3.34 3.34 RBRVS 59610 ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB Maternity - Normal Deliveries 33.87 20.69 20.69 RBRVS 59612 VAGINAL DELIVERY AFTER CESAREAN DELIVERY Maternity - Normal Deliveries 16.09 6.31 6.31 RBRVS 59614 VAGINAL DELIVERY & POSTPARTUM CARE VBAC Maternity - Normal Deliveries 19.73 8.21 8.21 RBRVS 59618 ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC Maternity - Cesarean Deliveries 36.16 22.16 22.16 RBRVS 59620 CESAREAN DELIVERY ATTEMPTED VBAC Maternity - Cesarean Deliveries 16.66 6.54 6.54 RBRVS 59622 CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA Maternity - Cesarean Deliveries 22.00 9.82 9.82 RBRVS 59812 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL Maternity - Non-Deliveries 4.44 2.96 3.57 RBRVS 59820 TX MISSED ABORTION FIRST TRIMESTER SURGICAL Maternity - Non-Deliveries 4.84 4.16 4.81 RBRVS 59821 TX MISSED ABORTION SECOND TRIMESTER SURGICAL Maternity - Non-Deliveries 5.09 3.87 4.58 RBRVS 59830 TX SEPTIC ABORTION SURGICAL Maternity - Non-Deliveries 6.59 4.29 4.29 RBRVS 59840 INDUCED ABORTION DILATION AND CURETTAGE Maternity - Non-Deliveries 3.01 2.22 2.47 RBRVS 59841 INDUCED ABORTION DILATION & EVACUATION Maternity - Non-Deliveries 5.65 3.30 3.90 RBRVS 59850 INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ Maternity - Non-Deliveries 5.90 3.66 3.66 RBRVS 59851 INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C Maternity - Non-Deliveries 5.92 4.03 4.03 RBRVS 59852 INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM Maternity - Non-Deliveries 8.23 5.63 5.63 RBRVS 59855 INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS Maternity - Non-Deliveries 6.43 3.88 3.88 RBRVS 59856 INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC Maternity - Non-Deliveries 7.79 4.27 4.27 RBRVS 59857 INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT Maternity - Non-Deliveries 9.33 4.85 4.85 RBRVS 59866 MULTIFETAL PREGNANCY REDUCTION Maternity - Non-Deliveries 3.99 1.95 1.95 RBRVS 59870 UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE Maternity - Non-Deliveries 6.57 5.31 5.31 RBRVS 59871 REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA Maternity - Non-Deliveries 2.13 1.20 1.20 RBRVS

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59897 UNLISTED FETAL INVASIVE PX W/ULTRASOUND Maternity - Non-Deliveries 1.25 Unlisted 59898 UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELIVERY Maternity - Non-Deliveries 18.50 Unlisted 59899 UNLISTED PROCEDURE MATERNITY CARE & DELIVERY Maternity - Non-Deliveries 1.25 Unlisted 60000 I&D THYROGLOSSAL DUCT CYST INFECTED Surgery 1.81 2.04 2.48 RBRVS 60100 BIOPSY THYROID PERCUTANEOUS CORE NEEDLE Surgery 1.56 0.57 1.51 RBRVS 60200 EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS Surgery 10.02 7.14 7.14 RBRVS 60210 PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY Surgery 11.23 6.99 6.99 RBRVS 60212 PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC Surgery 16.43 9.53 9.53 RBRVS 60220 TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY Surgery 11.19 7.12 7.12 RBRVS 60225 TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC Surgery 14.79 9.25 9.25 RBRVS 60240 THYROIDECTOMY TOTAL/COMPLETE Surgery 15.04 8.54 8.54 RBRVS 60252 THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT Surgery 22.01 11.83 11.83 RBRVS 60254 THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT Surgery 28.42 14.80 14.80 RBRVS 60260 THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL Surgery 18.26 9.88 9.88 RBRVS 60270 THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC Surgery 23.20 11.77 11.77 RBRVS 60271 THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH Surgery 17.62 9.58 9.58 RBRVS 60280 EXCISION THYROGLOSSAL DUCT CYST/SINUS Surgery 6.16 5.63 5.63 RBRVS 60281 EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT Surgery 8.82 6.83 6.83 RBRVS 60300 ASPIRATION AND/OR INJECTION THYROID CYST Surgery 0.97 0.36 2.30 RBRVS 60500 PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS Surgery 15.60 9.05 9.05 RBRVS 60502 PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR Surgery 21.15 11.61 11.61 RBRVS 60505 PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC Surgery 23.06 12.69 12.69 RBRVS 60512 PARATHYROID AUTOTRANSPLANTATION ADD-ON Surgery 4.44 1.71 1.71 RBRVS 60520 THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX Surgery 17.16 9.21 9.21 RBRVS 60521 THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX Surgery 19.18 9.04 9.04 RBRVS 60522 THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX Surgery 23.48 10.65 10.65 RBRVS 60540 ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX Surgery 18.02 9.14 9.14 RBRVS 60545 ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR Surgery 20.93 10.15 10.15 RBRVS 60600 EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY Surgery 25.09 9.85 9.85 RBRVS 60605 EXC CAROTID BODY TUMOR W EXC CAROTID ARTERY Surgery 31.96 18.39 18.39 RBRVS 60650 LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL Surgery 20.73 9.58 9.58 RBRVS 60659 UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM Surgery 30.31 Unlisted 60699 UNLISTED PROCEDURE ENDOCRINE SYSTEM Surgery 18.31 Unlisted 61000 SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT Surgery 1.58 0.89 0.89 RBRVS 61001 SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ Surgery 1.49 0.76 0.76 RBRVS 61020 VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX Surgery 1.51 1.04 1.04 RBRVS 61026 VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ Surgery 1.69 1.02 1.02 RBRVS 61050 CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX Surgery 1.51 0.78 0.78 RBRVS 61055 CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION Surgery 2.10 1.05 1.05 RBRVS 61070 PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX Surgery 0.89 0.61 0.61 RBRVS 61105 TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE Surgery 5.45 5.91 5.91 RBRVS 61107 TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE Surgery 4.99 2.33 2.33 RBRVS 61108 TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA Surgery 11.64 10.39 10.39 RBRVS 61120 BURR HOLE VENTRICULAR PUNCTURE Surgery 9.60 8.43 8.43 RBRVS 61140 BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION Surgery 17.23 12.95 12.95 RBRVS 61150 BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST Surgery 18.90 13.26 13.26 RBRVS 61151 BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST Surgery 13.49 10.24 10.24 RBRVS 61154 BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL Surgery 17.07 13.39 13.39 RBRVS 61156 BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL Surgery 17.45 12.08 12.08 RBRVS 61210 BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE Surgery 5.83 2.73 2.73 RBRVS 61215 INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH Surgery 5.85 6.53 6.53 RBRVS 61250 BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG Surgery 11.49 9.32 9.32 RBRVS 61253 BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI Surgery 13.49 8.14 8.14 RBRVS 61304 CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL Surgery 23.41 15.59 15.59 RBRVS 61305 CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL Surgery 28.64 18.85 18.85 RBRVS 61312 CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL Surgery 30.17 18.93 18.93 RBRVS 61313 CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL Surgery 28.09 18.98 18.98 RBRVS 61314 CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL Surgery 25.90 17.43 17.43 RBRVS 61315 CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL Surgery 29.65 19.27 19.27 RBRVS 61316 INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF Surgery 1.39 0.65 0.65 RBRVS 61320 CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL Surgery 27.42 17.53 17.53 RBRVS 61321 CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL Surgery 30.53 19.74 19.74 RBRVS 61322 CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY Surgery 34.26 21.85 21.85 RBRVS 61323 CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY Surgery 35.06 21.14 21.14 RBRVS 61330 DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH Surgery 25.30 17.23 17.23 RBRVS 61332 EXPLORATION ORBIT TRANSCRANIAL APPROACH W/BIOPSY Surgery 28.60 20.63 20.63 RBRVS 61333 EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION Surgery 29.27 21.05 21.05 RBRVS 61340 SUBTEMPORAL CRANIAL DECOMPRESSION Surgery 20.11 14.23 14.23 RBRVS 61343 CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD Surgery 31.86 20.09 20.09 RBRVS 61345 OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA Surgery 29.23 18.93 18.93 RBRVS 61450 CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION Surgery 27.69 17.66 17.66 RBRVS 61458 CRNEC SOPL EXPL/DCMPRN CRNL NRV Surgery 28.84 18.64 18.64 RBRVS 61460 CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NR Surgery 30.24 19.40 19.40 RBRVS 61480 CRNEC SUBOCPTL MESENCEPHAL TRCOTOMY/PEDUNCULOTMY Surgery 28.05 17.67 17.67 RBRVS 61500 CRANIECTOMY W/EXCISION TUMOR/LESION SKULL Surgery 19.18 13.30 13.30 RBRVS

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61501 CRANIECTOMY OSTEOMYELITIS Surgery 16.35 12.24 12.24 RBRVS 61510 CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR Surgery 30.83 21.06 21.06 RBRVS 61512 CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR Surgery 37.14 22.99 22.99 RBRVS 61514 CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR Surgery 27.23 17.88 17.88 RBRVS 61516 CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR Surgery 26.58 17.58 17.58 RBRVS 61517 IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT Surgery 1.38 0.65 0.65 RBRVS 61518 CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA Surgery 39.89 25.25 25.25 RBRVS 61519 CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA Surgery 43.43 25.89 25.89 RBRVS 61520 CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM Surgery 57.09 32.34 32.34 RBRVS 61521 CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL Surgery 46.99 27.44 27.44 RBRVS 61522 CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS Surgery 31.54 20.01 20.01 RBRVS 61524 CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST Surgery 29.89 19.24 19.24 RBRVS 61526 CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM Surgery 54.08 31.47 31.47 RBRVS 61530 CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA Surgery 45.56 26.57 26.57 RBRVS 61531 SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING Surgery 16.41 12.82 12.82 RBRVS 61533 CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING Surgery 21.46 14.50 14.50 RBRVS 61534 CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY Surgery 23.01 16.01 16.01 RBRVS 61535 CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX Surgery 13.15 10.84 10.84 RBRVS 61536 CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY Surgery 37.72 22.90 22.90 RBRVS 61537 CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY Surgery 36.45 21.36 21.36 RBRVS 61538 CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY Surgery 39.45 23.15 23.15 RBRVS 61539 CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG Surgery 34.28 21.30 21.30 RBRVS 61540 CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG Surgery 31.43 20.05 20.05 RBRVS 61541 CRANIOTOMY TRANSECTION CORPUS CALLOSUM Surgery 30.94 19.73 19.73 RBRVS 61543 CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY Surgery 31.31 19.90 19.90 RBRVS 61544 CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS Surgery 27.36 17.50 17.50 RBRVS 61545 CRANIOTOMY EXCISION CRANIOPHARYNGIOMA Surgery 46.43 28.46 28.46 RBRVS 61546 CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR Surgery 33.44 20.90 20.90 RBRVS 61548 HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL Surgery 23.37 14.63 14.63 RBRVS 61550 CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE Surgery 15.59 9.95 9.95 RBRVS 61552 CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES Surgery 20.40 10.34 10.34 RBRVS 61556 CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP Surgery 24.09 16.23 16.23 RBRVS 61557 CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP Surgery 23.31 16.63 16.63 RBRVS 61558 XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS Surgery 26.50 11.61 11.61 RBRVS 61559 XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT Surgery 34.02 22.50 22.50 RBRVS 61563 EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN Surgery 28.44 18.26 18.26 RBRVS 61564 EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN Surgery 34.74 21.97 21.97 RBRVS 61566 CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY Surgery 32.45 20.53 20.53 RBRVS 61567 CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG Surgery 37.00 17.00 17.00 RBRVS 61570 CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN Surgery 26.51 17.66 17.66 RBRVS 61571 CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN Surgery 28.42 18.54 18.54 RBRVS 61575 TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES Surgery 36.56 22.35 22.35 RBRVS 61576 TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE Surgery 55.31 35.45 35.45 RBRVS 61580 CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ Surgery 34.51 29.56 29.56 RBRVS 61581 CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ Surgery 39.13 31.39 31.39 RBRVS 61582 CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT Surgery 35.14 38.53 38.53 RBRVS 61583 CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE Surgery 38.50 31.28 31.28 RBRVS 61584 ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ Surgery 37.70 31.14 31.14 RBRVS 61585 ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ Surgery 42.57 34.43 34.43 RBRVS 61586 BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT Surgery 27.48 31.94 31.94 RBRVS 61590 INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN Surgery 47.04 31.93 31.93 RBRVS 61591 INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI Surgery 47.02 32.27 32.27 RBRVS 61592 ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE Surgery 43.08 33.63 33.63 RBRVS 61595 TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV Surgery 33.74 26.64 26.64 RBRVS 61596 TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART Surgery 39.43 25.53 25.53 RBRVS 61597 TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL Surgery 40.82 27.14 27.14 RBRVS 61598 TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM Surgery 36.53 31.84 31.84 RBRVS 61600 RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL Surgery 30.01 24.92 24.92 RBRVS 61601 RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF Surgery 31.14 27.52 27.52 RBRVS 61605 RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL Surgery 32.57 24.89 24.89 RBRVS 61606 RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR Surgery 42.05 29.85 29.85 RBRVS 61607 RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL Surgery 40.93 26.93 26.93 RBRVS 61608 RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL Surgery 45.54 32.56 32.56 RBRVS 61610 TRNSXJ/LIG CAROTID ARTERY SINUS W/RPR ANAST/GRFT Surgery 29.63 13.16 13.16 RBRVS 61611 TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR Surgery 7.41 2.84 2.84 RBRVS 61612 TRNSXJ/LIG CRTD ART PETROUS CANAL RPR ANAST/GRF Surgery 27.84 10.60 10.60 RBRVS 61613 OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ Surgery 45.03 33.17 33.17 RBRVS 61615 RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL Surgery 35.77 28.61 28.61 RBRVS 61616 RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL Surgery 46.74 34.12 34.12 RBRVS 61618 SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT Surgery 18.69 12.87 12.87 RBRVS 61619 SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP Surgery 22.10 13.88 13.88 RBRVS 61623 EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK Surgery 9.95 3.97 3.97 RBRVS 61624 TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS Surgery 20.12 7.91 7.91 RBRVS 61626 TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS Surgery 16.60 5.82 5.82 RBRVS 61630 BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS Surgery 22.07 10.65 10.65 RBRVS

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61635 TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD Surgery 24.28 10.95 10.95 RBRVS 61640 BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL Surgery 12.32 4.68 4.68 RBRVS 61641 BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL Surgery 4.33 1.66 1.66 RBRVS 61642 BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL Surgery 8.66 3.29 3.29 RBRVS 61645 PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL Surgery 15.00 4.51 4.51 RBRVS 61650 EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST Surgery 10.00 3.24 3.24 RBRVS 61651 EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL Surgery 4.25 1.38 1.38 RBRVS 61680 INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL Surgery 32.55 20.72 20.72 RBRVS 61682 INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL Surgery 63.41 34.06 34.06 RBRVS 61684 INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL Surgery 41.64 25.20 25.20 RBRVS 61686 INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL Surgery 67.50 37.75 37.75 RBRVS 61690 INTRACRANIAL ARVEN MALFRMJ DURAL SMPL Surgery 31.34 20.26 20.26 RBRVS 61692 INTRACRANIAL ARVEN MALFRMJ DURAL CMPL Surgery 54.59 31.13 31.13 RBRVS 61697 COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION Surgery 63.40 35.57 35.57 RBRVS 61698 CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ Surgery 69.63 38.75 38.75 RBRVS 61700 SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION Surgery 50.62 29.49 29.49 RBRVS 61702 SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ Surgery 60.04 34.27 34.27 RBRVS 61703 ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART Surgery 18.80 13.50 13.50 RBRVS 61705 ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART Surgery 38.10 23.07 23.07 RBRVS 61708 ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS Surgery 37.20 22.65 22.65 RBRVS 61710 ARYSM VASC MALFRMJ IA EMBOLIZATION Surgery 31.29 19.34 19.34 RBRVS 61711 ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES Surgery 38.23 22.84 22.84 RBRVS 61720 CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS Surgery 17.62 12.55 12.55 RBRVS 61735 CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN Surgery 22.35 15.33 15.33 RBRVS 61750 STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES Surgery 19.83 13.40 13.40 RBRVS 61751 STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR Surgery 18.79 14.06 14.06 RBRVS 61760 STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING Surgery 22.39 15.01 15.01 RBRVS 61770 STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC Surgery 23.19 15.17 15.17 RBRVS 61781 STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL Surgery 3.75 1.75 1.75 RBRVS 61782 STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL Surgery 3.18 1.42 1.42 RBRVS 61783 STEREOTACTIC COMPUTER ASSISTED PX SPINAL Surgery 3.75 1.78 1.78 RBRVS 61790 CREATE LESION STRTCTC PRQ NEUROLYTIC GASSERIAN Surgery 11.60 9.47 9.47 RBRVS 61791 CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC Surgery 15.41 11.36 11.36 RBRVS 61796 STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES Surgery 13.93 10.25 10.25 RBRVS 61797 STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE Surgery 3.48 1.63 1.63 RBRVS 61798 STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES Surgery 19.85 12.95 12.95 RBRVS 61799 STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX Surgery 4.81 2.25 2.25 RBRVS 61800 APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY Surgery 2.25 1.40 1.40 RBRVS 61850 TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL Surgery 13.34 10.08 10.08 RBRVS 61860 CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL Surgery 22.26 14.73 14.73 RBRVS 61863 STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY Surgery 20.71 15.12 15.12 RBRVS 61864 STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY Surgery 4.49 2.11 2.11 RBRVS 61867 STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY Surgery 33.03 20.74 20.74 RBRVS 61868 STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY Surgery 7.91 3.67 3.67 RBRVS 61870 CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL Surgery 16.34 11.80 11.80 RBRVS 61880 REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS Surgery 6.95 6.97 6.97 RBRVS 61885 INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR Surgery 6.05 6.73 6.73 RBRVS 61886 INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS Surgery 9.93 10.84 10.84 RBRVS 61888 REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR Surgery 5.23 4.30 4.30 RBRVS 62000 ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL Surgery 13.93 10.66 10.66 RBRVS 62005 ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL Surgery 17.63 12.56 12.56 RBRVS 62010 ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN Surgery 21.43 14.90 14.90 RBRVS 62100 CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA Surgery 23.53 15.01 15.01 RBRVS 62115 RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY Surgery 22.91 13.55 13.55 RBRVS 62117 RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT Surgery 28.35 17.88 17.88 RBRVS 62120 RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY Surgery 24.59 19.82 19.82 RBRVS 62121 CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE Surgery 23.03 17.68 17.68 RBRVS 62140 CRANIOPLASTY SKULL DEFECT 5 CM DIAMETER Surgery 16.07 11.50 11.50 RBRVS 62142 RMVL BONE FLAP/PROSTHETIC PLATE SKULL Surgery 11.83 9.58 9.58 RBRVS 62143 RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL Surgery 14.15 10.86 10.86 RBRVS 62145 CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG Surgery 20.09 13.63 13.63 RBRVS 62146 CRANIOPLASTY W/AUTOGRAFT 5 CM DIAMETER Surgery 20.67 13.81 13.81 RBRVS 62148 INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT Surgery 2.00 0.94 0.94 RBRVS 62160 NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS Surgery 3.00 1.41 1.41 RBRVS 62161 NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS Surgery 21.23 14.81 14.81 RBRVS 62162 NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG Surgery 26.80 17.90 17.90 RBRVS 62163 NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY Surgery 16.53 12.72 12.72 RBRVS 62164 NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY Surgery 29.43 20.06 20.06 RBRVS 62165 NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID Surgery 23.23 14.76 14.76 RBRVS 62180 VENTRICULOCISTERNOSTOMY Surgery 22.58 15.33 15.33 RBRVS 62190 CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR Surgery 12.17 3.82 3.82 RBRVS 62192 CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH Surgery 13.35 10.18 10.18 RBRVS 62194 RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER Surgery 5.78 6.12 6.12 RBRVS

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62200 VENTRICULOCISTERNOSTOMY 3RD VENTRICLE Surgery 19.29 13.34 13.34 RBRVS 62201 VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC Surgery 16.04 12.77 12.77 RBRVS 62220 CRTJ SHUNT VENTRICULO-ATR-JUG-AUR Surgery 14.10 10.49 10.49 RBRVS 62223 CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS Surgery 14.05 11.34 11.34 RBRVS 62225 RPLCMT/IRRIGATION VENTRICULAR CATHETER Surgery 6.19 6.68 6.68 RBRVS 62230 RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS Surgery 11.43 8.87 8.87 RBRVS 62252 REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT Surgery a 0.74 1.45 1.45 RBRVS 62252 26 REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT Surgery 0.74 0.35 0.35 RBRVS 62252 TC REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT Surgery a 1.10 1.10 RBRVS 62256 RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT Surgery 7.38 7.25 7.25 RBRVS 62258 RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT Surgery 15.64 11.25 11.25 RBRVS 62263 PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS Surgery 5.00 4.18 12.60 RBRVS 62264 PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY Surgery 4.42 2.05 7.14 RBRVS 62267 PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS Surgery 3.00 1.34 3.83 RBRVS 62268 PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX Surgery 4.73 2.39 2.39 RBRVS 62269 BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE Surgery 5.01 2.30 2.30 RBRVS 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC Surgery 1.37 0.69 2.98 RBRVS 62272 SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID Surgery 1.35 0.78 4.09 RBRVS 62273 INJECTION EPIDURAL BLOOD/CLOT PATCH Surgery 2.15 0.94 2.60 RBRVS 62280 INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID Surgery 2.63 1.60 5.58 RBRVS 62281 INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC Surgery 2.66 1.43 3.67 RBRVS 62282 INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL Surgery 2.33 1.60 5.77 RBRVS 62284 INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR Surgery 1.54 0.78 3.49 RBRVS 62287 DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR Surgery 9.03 6.33 6.33 RBRVS 62290 INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR Surgery 3.00 1.68 6.23 RBRVS 62291 INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC Surgery 2.91 1.79 6.44 RBRVS 62292 INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC Surgery 9.24 6.76 6.76 RBRVS 62294 NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL Surgery 12.87 8.69 8.69 RBRVS 62302 MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL Radiology 2.29 1.05 4.39 RBRVS 62303 MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC Radiology 2.29 1.10 4.66 RBRVS 62304 MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL Radiology 2.25 1.03 4.34 RBRVS 62305 MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS Radiology 2.35 1.09 4.86 RBRVS 62310 NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC Surgery 1.91 1.06 4.76 RBRVS 62311 NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL Surgery 1.54 0.90 4.61 RBRVS 62318 NJXS INFUS/BOLUS DX/SBST EDRL/SUBARACH CRV/THRC Surgery 2.04 0.66 4.32 RBRVS 62319 NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL Surgery 1.87 0.73 2.74 RBRVS 62350 IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM Surgery 6.05 4.41 4.41 RBRVS 62351 IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM Surgery 11.66 9.91 9.91 RBRVS 62355 RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH Surgery 3.55 3.50 3.50 RBRVS 62360 IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR Surgery 4.33 3.61 3.61 RBRVS 62361 IMPLTJ/RPLCMT FS NON-PRGRBL PUMP Surgery 5.00 5.47 5.47 RBRVS 62362 IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP Surgery 5.60 4.37 4.37 RBRVS 62365 RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS Surgery 3.93 3.75 3.75 RBRVS 62367 ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL Surgery 0.48 0.20 0.64 RBRVS 62368 ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG Surgery 0.67 0.28 0.88 RBRVS 62369 ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL Surgery 0.67 0.29 2.70 RBRVS 62370 ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP Surgery 0.90 0.36 2.63 RBRVS 63001 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV Surgery 17.61 12.34 12.34 RBRVS 63003 LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC Surgery 17.74 12.34 12.34 RBRVS 63005 LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR Surgery 16.43 12.44 12.44 RBRVS 63011 LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL Surgery 15.91 11.61 11.61 RBRVS 63012 LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR Surgery 16.85 12.36 12.36 RBRVS 63015 LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL Surgery 20.85 14.92 14.92 RBRVS 63016 LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC Surgery 22.03 14.86 14.86 RBRVS 63017 LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR Surgery 17.33 13.12 13.12 RBRVS 63020 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC Surgery 16.20 12.49 12.49 RBRVS 63030 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR Surgery 13.18 10.95 10.95 RBRVS 63035 LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR Surgery 3.15 1.53 1.53 RBRVS 63040 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL Surgery 20.31 13.93 13.93 RBRVS 63042 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR Surgery 18.76 13.57 13.57 RBRVS 63043 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV Surgery 17.59 FAIR Health 63044 LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR Surgery 16.71 FAIR Health 63045 LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL Surgery 17.95 13.00 13.00 RBRVS 63046 LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC Surgery 17.25 12.52 12.52 RBRVS 63047 LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR Surgery 15.37 12.01 12.01 RBRVS 63048 LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR Surgery 3.47 1.68 1.68 RBRVS 63050 LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG Surgery 22.01 14.89 14.89 RBRVS 63051 LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ Surgery 25.51 16.73 16.73 RBRVS 63055 TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC Surgery 23.55 15.69 15.69 RBRVS 63056 TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR Surgery 21.86 14.66 14.66 RBRVS 63057 TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR Surgery 5.25 2.55 2.55 RBRVS 63064 COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG Surgery 26.22 16.86 16.86 RBRVS 63066 COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG Surgery 3.26 1.53 1.53 RBRVS 63075 DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC Surgery 19.60 13.71 13.71 RBRVS 63076 DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC Surgery 4.04 1.92 1.92 RBRVS

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63077 DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC Surgery 22.88 14.26 14.26 RBRVS 63078 DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC Surgery 3.28 1.59 1.59 RBRVS 63081 VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG Surgery 26.10 17.04 17.04 RBRVS 63082 VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG Surgery 4.36 2.10 2.10 RBRVS 63085 VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG Surgery 29.47 17.44 17.44 RBRVS 63086 VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG Surgery 3.19 1.45 1.45 RBRVS 63087 VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG Surgery 37.53 21.59 21.59 RBRVS 63088 VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG Surgery 4.32 2.03 2.03 RBRVS 63090 VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG Surgery 30.93 18.56 18.56 RBRVS 63091 VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG Surgery 3.03 1.45 1.45 RBRVS 63101 VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG Surgery 34.10 22.14 22.14 RBRVS 63102 VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG Surgery 34.10 22.02 22.02 RBRVS 63103 VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG Surgery 4.82 2.32 2.32 RBRVS 63170 LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR Surgery 22.21 15.60 15.60 RBRVS 63172 LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID Surgery 19.76 13.90 13.90 RBRVS 63173 LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL Surgery 24.31 16.57 16.57 RBRVS 63180 LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV 1/2 SEG Surgery 20.53 14.82 14.82 RBRVS 63182 LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV >2 SEG Surgery 22.82 15.87 15.87 RBRVS 63185 LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS Surgery 16.49 12.17 12.17 RBRVS 63190 LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS Surgery 18.89 13.15 13.15 RBRVS 63191 LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE Surgery 18.92 13.90 13.90 RBRVS 63194 LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL Surgery 22.10 15.88 15.88 RBRVS 63195 LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC Surgery 21.64 10.52 10.52 RBRVS 63196 LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACTS CRV Surgery 25.27 12.09 12.09 RBRVS 63197 LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACT THRC Surgery 24.08 16.46 16.46 RBRVS 63198 LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES CERVICAL Surgery 29.90 14.10 14.10 RBRVS 63199 LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES THORACIC Surgery 31.47 14.70 14.70 RBRVS 63200 LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR Surgery 21.44 15.19 15.19 RBRVS 63250 LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL Surgery 43.86 25.77 25.77 RBRVS 63251 LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC Surgery 44.64 26.61 26.61 RBRVS 63252 LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR Surgery 44.63 26.61 26.61 RBRVS 63265 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL Surgery 23.82 16.22 16.22 RBRVS 63266 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC Surgery 24.68 16.58 16.58 RBRVS 63267 LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR Surgery 19.45 13.99 13.99 RBRVS 63268 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL Surgery 20.02 14.14 14.14 RBRVS 63270 LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL Surgery 29.80 19.19 19.19 RBRVS 63271 LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC Surgery 29.92 19.18 19.18 RBRVS 63272 LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR Surgery 27.50 17.87 17.87 RBRVS 63273 LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL Surgery 26.47 17.64 17.64 RBRVS 63275 LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL Surgery 25.86 17.20 17.20 RBRVS 63276 LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC Surgery 25.69 17.09 17.09 RBRVS 63277 LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR Surgery 22.39 15.41 15.41 RBRVS 63278 LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL Surgery 22.12 15.60 15.60 RBRVS 63280 LAM BX/EXC ISPI NEO IDRL XMED CERVICAL Surgery 30.29 19.88 19.88 RBRVS 63281 LAM BX/EXC ISPI NEO IDRL XMED THORACIC Surgery 29.99 19.66 19.66 RBRVS 63282 LAM BX/EXC ISPI NEO IDRL XMED LUMBAR Surgery 28.15 18.77 18.77 RBRVS 63283 LAM BX/EXC ISPI NEO IDRL SACRAL Surgery 26.76 18.24 18.24 RBRVS 63285 LAM BX/EXC ISPI NEO IDRL IMED CERVICAL Surgery 38.05 23.52 23.52 RBRVS 63286 LAM BX/EXC ISPI NEO IDRL IMED THORACIC Surgery 37.62 23.27 23.27 RBRVS 63287 LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR Surgery 40.08 24.48 24.48 RBRVS 63290 LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL Surgery 40.82 24.83 24.83 RBRVS 63295 OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX Surgery 5.25 2.47 2.47 RBRVS 63300 VCRPEC LES 1 SGM XDRL CERVICAL Surgery 26.80 17.42 17.42 RBRVS 63301 VCRPEC LES 1 SGM XDRL THORACIC TTHRC Surgery 31.57 18.95 18.95 RBRVS 63302 VCRPEC LES 1 SEG XDRL THRC THORACOLMBR Surgery 31.15 20.30 20.30 RBRVS 63303 VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR Surgery 33.55 20.96 20.96 RBRVS 63304 VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL Surgery 33.85 21.57 21.57 RBRVS 63305 VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC Surgery 36.24 22.67 22.67 RBRVS 63306 VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR Surgery 35.55 14.25 14.25 RBRVS 63307 VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR Surgery 34.96 21.53 21.53 RBRVS 63308 VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG Surgery 5.24 2.46 2.46 RBRVS 63600 CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ Surgery 15.12 9.61 9.61 RBRVS 63610 STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG Surgery 8.72 1.83 1.83 RBRVS 63615 STRTCTC BX ASPIRAT/EXC LESION SPINAL CORD Surgery 17.32 12.02 12.02 RBRVS 63620 STEREOTACTIC RADIOSURGERY 1 SPINAL LESION Surgery 15.60 10.95 10.95 RBRVS 63621 STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION Surgery 4.00 1.88 1.88 RBRVS 63650 PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL Surgery 7.15 4.06 29.92 RBRVS 63655 LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL Surgery 10.92 9.53 9.53 RBRVS 63661 RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR Surgery 5.08 3.44 10.69 RBRVS 63662 RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR Surgery 11.00 9.69 9.69 RBRVS 63663 REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR Surgery 7.75 4.34 13.78 RBRVS 63664 REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR Surgery 11.52 9.73 9.73 RBRVS 63685 INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING Surgery 5.19 4.29 4.29 RBRVS 63688 REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR Surgery 5.30 4.28 4.28 RBRVS 63700 REPAIR MENINGOCELE < 5 CM DIAMETER Surgery 17.47 12.75 12.75 RBRVS

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63702 REPAIR MENINGOCELE > 5 CM DIAMETER Surgery 19.41 13.73 13.73 RBRVS 63704 REPAIR MYELOMENINGOCELE < 5 CM DIAMETER Surgery 22.43 15.99 15.99 RBRVS 63706 REPAIR MYELOMENINGOCELE > 5 CM DIAMETER Surgery 25.35 18.26 18.26 RBRVS 63707 RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM Surgery 12.65 10.17 10.17 RBRVS 63709 RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM Surgery 15.65 11.59 11.59 RBRVS 63710 DURAL GRAFT SPINAL Surgery 15.40 11.50 11.50 RBRVS 63740 CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM Surgery 12.63 10.23 10.23 RBRVS 63741 CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM Surgery 9.12 7.59 7.59 RBRVS 63744 RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT Surgery 8.94 7.56 7.56 RBRVS 63746 RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT Surgery 7.33 7.27 7.27 RBRVS 64400 NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH Surgery 1.11 0.71 2.30 RBRVS 64402 INJECTION ANESTHETIC AGENT FACIAL NERVE Surgery 1.25 0.73 2.19 RBRVS 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV Surgery 0.94 0.69 1.75 RBRVS 64408 INJECTION ANESTHETIC AGENT VAGUS NERVE Surgery 1.41 0.92 1.77 RBRVS 64410 INJECTION ANESTHETIC AGENT PHRENIC NERVE Surgery 1.43 0.43 1.88 RBRVS 64413 INJECTION ANESTHETIC AGENT CERVICAL PLEXUS Surgery 1.40 0.75 2.06 RBRVS 64415 SINGLE NERVE BLOCK INJECTION ARM NERVE Surgery 1.48 0.26 1.74 RBRVS 64416 INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH Surgery 1.81 0.31 0.31 RBRVS 64417 INJECTION ANESTHETIC AGENT AXILLARY NERVE Surgery 1.44 0.46 2.11 RBRVS 64418 INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE Surgery 1.32 0.74 2.70 RBRVS 64420 INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE Surgery 1.18 0.66 1.91 RBRVS 64421 MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES Surgery 1.68 0.80 2.43 RBRVS 64425 INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS Surgery 1.75 0.75 1.82 RBRVS 64430 INJECTION ANESTHETIC AGENT PUDENDAL NERVE Surgery 1.46 0.77 2.36 RBRVS 64435 INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE Surgery 1.45 0.77 2.22 RBRVS 64445 INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE Surgery 1.48 0.43 2.20 RBRVS 64446 INJECTION ANES SCIATIC NERVE CONT INFUSION CATH Surgery 1.81 0.32 0.32 RBRVS 64447 INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE Surgery 1.50 0.27 1.77 RBRVS 64448 INJECTION ANES FEMORAL NERVE CONT INFUSION CATH Surgery 1.63 0.28 0.28 RBRVS 64449 INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH Surgery 1.81 0.42 0.42 RBRVS 64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH Surgery 0.75 0.49 1.46 RBRVS 64455 NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE Surgery 0.75 0.19 0.55 RBRVS 64461 PVB THORACIC SINGLE INJECTION SITE W/IMG GID Surgery 1.75 0.59 2.34 RBRVS 64462 PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID Surgery 1.10 0.37 1.20 RBRVS 64463 PVB THORACIC CONT CATHETER INFUSION W/IMG GID Surgery 1.81 0.50 2.74 RBRVS 64479 NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL Surgery 2.29 1.32 4.20 RBRVS 64480 NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV Surgery 1.20 0.51 1.90 RBRVS 64483 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL Surgery 1.90 1.19 4.16 RBRVS 64484 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV Surgery 1.00 0.42 1.41 RBRVS 64486 TAP BLOCK UNILATERAL BY INJECTION(S) Surgery 1.27 0.44 2.16 RBRVS 64487 TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S) Surgery 1.48 0.49 2.72 RBRVS 64488 TAP BLOCK BILATERAL BY INJECTION(S) Surgery 1.60 0.55 2.62 RBRVS 64489 TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S) Surgery 1.80 0.60 4.08 RBRVS 64490 NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL Surgery 1.82 1.09 3.42 RBRVS 64491 NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL Surgery 1.16 0.48 1.42 RBRVS 64492 NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL Surgery 1.16 0.50 1.43 RBRVS 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL Surgery 1.52 0.97 3.24 RBRVS 64494 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL Surgery 1.00 0.41 1.38 RBRVS 64495 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL Surgery 1.00 0.43 1.39 RBRVS 64505 INJECTION ANES AGENT SPHENOPALATINE GANGLION Surgery 1.36 0.98 1.47 RBRVS 64508 INJECTION ANESTHETIC AGENT CAROTID SINUS SPX Surgery 1.12 0.72 0.41 RBRVS 64510 NJX ANES STELLATE GANGLION CRV SYMPATHETIC Surgery 1.22 0.80 2.30 RBRVS 64517 INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS Surgery 2.20 1.15 2.77 RBRVS 64520 INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC Surgery 1.35 0.86 3.81 RBRVS 64530 INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG Surgery 1.58 0.94 3.70 RBRVS 64550 APPLICATION SURFACE NEUROSTIMULATOR Surgery 0.18 0.06 0.26 RBRVS 64553 PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE Surgery 2.36 2.05 3.54 RBRVS 64555 PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV Surgery 2.32 1.88 3.48 RBRVS 64561 PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING Surgery 5.44 2.63 17.13 RBRVS 64565 PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR Surgery 1.81 1.77 3.36 RBRVS 64566 POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE Surgery 0.60 0.21 2.78 RBRVS 64568 INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER Surgery 9.00 7.32 7.32 RBRVS 64569 REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV Surgery 11.00 8.35 8.35 RBRVS 64570 REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO Surgery 9.10 7.47 7.47 RBRVS 64575 INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD Surgery 4.42 3.85 3.85 RBRVS 64580 INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR Surgery 4.19 3.50 3.50 RBRVS 64581 INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE Surgery 12.20 5.41 5.41 RBRVS 64585 REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE Surgery 2.11 1.75 4.60 RBRVS 64590 INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR Surgery 2.45 1.86 4.77 RBRVS 64595 REVISION/RMVL PERIPHERAL/GASTRIC NPGR Surgery 1.78 1.62 4.97 RBRVS 64600 DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH Surgery 3.49 2.20 6.80 RBRVS 64605 DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH Surgery 5.65 3.54 10.04 RBRVS 64610 DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR Surgery 7.20 4.55 11.27 RBRVS 64611 CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS Surgery 1.03 1.51 1.92 RBRVS 64612 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL Surgery 1.41 1.65 2.03 RBRVS

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64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE Surgery 1.85 1.12 1.68 RBRVS 64616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA Surgery 1.53 1.09 1.54 RBRVS 64617 CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG Surgery 1.90 1.12 3.23 RBRVS 64620 DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE Surgery 2.89 1.83 2.74 RBRVS 64630 DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE Surgery 3.05 2.06 3.16 RBRVS 64632 DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE Surgery 1.23 0.66 1.12 RBRVS 64633 DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA Surgery 3.84 2.38 7.70 RBRVS 64634 DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA Surgery 1.32 0.54 3.87 RBRVS 64635 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL Surgery 3.78 2.36 7.66 RBRVS 64636 DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL Surgery 1.16 0.48 3.59 RBRVS 64640 DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE Surgery 1.23 1.34 2.46 RBRVS 64642 CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE Surgery 1.65 1.10 2.01 RBRVS 64643 CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE Surgery 1.22 0.61 1.16 RBRVS 64644 CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES Surgery 1.82 1.18 2.39 RBRVS 64645 CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES Surgery 1.39 0.69 1.54 RBRVS 64646 CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES Surgery 1.80 1.17 2.15 RBRVS 64647 CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES Surgery 2.11 1.33 2.46 RBRVS 64650 CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE Surgery 0.70 0.38 1.40 RBRVS 64653 CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY Surgery 0.88 0.43 1.59 RBRVS 64680 DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS Surgery 2.67 1.89 5.97 RBRVS 64681 DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS Surgery 3.78 2.55 7.42 RBRVS 64702 NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT Surgery 6.26 6.98 6.98 RBRVS 64704 NEUROPLASTY NERVE HAND/FOOT Surgery 4.69 3.88 3.88 RBRVS 64708 NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC Surgery 6.36 6.76 6.76 RBRVS 64712 NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV Surgery 8.07 6.84 6.84 RBRVS 64713 NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS Surgery 11.40 7.29 7.29 RBRVS 64714 NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS Surgery 10.55 6.60 6.60 RBRVS 64716 NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE Surgery 6.99 7.24 7.24 RBRVS 64718 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW Surgery 7.26 8.26 8.26 RBRVS 64719 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST Surgery 4.97 5.52 5.52 RBRVS 64721 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE Surgery 4.97 6.24 6.33 RBRVS 64722 DECOMPRESSION UNSPECIFIED NERVE Surgery 4.82 4.89 4.89 RBRVS 64726 DECOMPRESSION PLANTAR DIGITAL NERVE Surgery 4.27 3.23 3.23 RBRVS 64727 INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE Surgery 3.10 1.58 1.58 RBRVS 64732 TRANSECTION/AVULSION SUPRAORBITAL NERVE Surgery 4.89 5.20 5.20 RBRVS 64734 TRANSECTION/AVULSION INFRAORBITAL NERVE Surgery 5.55 6.75 6.75 RBRVS 64736 TRANSECTION/AVULSION MENTAL NERVE Surgery 5.23 5.35 5.35 RBRVS 64738 TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO Surgery 6.36 5.82 5.82 RBRVS 64740 TRANSECTION/AVULSION LINGUAL NERVE Surgery 6.22 5.98 5.98 RBRVS 64742 TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL Surgery 6.85 5.30 5.30 RBRVS 64744 TRANSECTION/AVULSION GREATER OCCIPITAL NERVE Surgery 5.72 6.36 6.36 RBRVS 64746 TRANSECTION/AVULSION PHRENIC NERVE Surgery 6.56 4.38 4.38 RBRVS 64755 TRANSECTION/AVULSION VAGUS NERVES Surgery 15.05 7.93 7.93 RBRVS 64760 TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL Surgery 7.59 5.42 5.42 RBRVS 64763 TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY Surgery 7.56 5.31 5.31 RBRVS 64766 TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY Surgery 9.47 5.69 5.69 RBRVS 64771 TRANSECTION/AVULSION OTH CRANIAL NRV XDRL Surgery 8.15 7.63 7.63 RBRVS 64772 TRANSECTION/AVULSION OTH SPINAL NRV XDRL Surgery 7.84 6.81 6.81 RBRVS 64774 EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE Surgery 5.80 5.05 5.05 RBRVS 64776 EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT Surgery 5.60 4.76 4.76 RBRVS 64778 EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT Surgery 3.11 0.76 0.76 RBRVS 64782 EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE Surgery 6.86 5.16 5.16 RBRVS 64783 EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT Surgery 3.71 2.08 2.08 RBRVS 64784 EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC Surgery 10.62 8.49 8.49 RBRVS 64786 EXCISION NEUROMA SCIATIC NERVE Surgery 16.25 11.63 11.63 RBRVS 64787 IMPLANTATION NERVE END BONE/MUSCLE Surgery 4.29 2.12 2.12 RBRVS 64788 EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV Surgery 5.24 5.32 5.32 RBRVS 64790 EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV Surgery 12.10 9.11 9.11 RBRVS 64792 EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV Surgery 15.86 12.53 12.53 RBRVS 64795 BIOPSY NERVE Surgery 3.01 1.77 1.77 RBRVS 64802 SYMPATHECTOMY CERVICAL Surgery 10.37 7.96 7.96 RBRVS 64804 SYMPATHECTOMY CERVICOTHORACIC Surgery 15.91 7.41 7.41 RBRVS 64809 SYMPATHECTOMY THORACOLUMBAR Surgery 14.71 11.19 11.19 RBRVS 64818 SYMPATHECTOMY LUMBAR Surgery 11.34 3.68 3.68 RBRVS 64820 SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT Surgery 10.74 8.48 8.48 RBRVS 64821 SYMPATHECTOMY RADIAL ARTERY Surgery 9.33 8.94 8.94 RBRVS 64822 SYMPATHECTOMY ULNAR ARTERY Surgery 9.33 8.94 8.94 RBRVS 64823 SYMPATHECTOMY SUPERFICIAL PALMAR ARCH Surgery 10.94 9.50 9.50 RBRVS 64831 SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE Surgery 9.16 8.88 8.88 RBRVS 64832 SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV Surgery 5.65 3.12 3.12 RBRVS 64834 SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE Surgery 10.81 8.57 8.57 RBRVS 64835 SUTURE 1 NERVE MEDIAN MOTOR THENAR Surgery 11.73 9.36 9.36 RBRVS 64836 SUTURE 1 NERVE ULNAR MOTOR Surgery 11.73 9.88 9.88 RBRVS 64837 SUTURE EACH ADDITIONAL NERVE HAND/FOOT Surgery 6.25 3.67 3.67 RBRVS 64840 SUTURE POSTERIOR TIBIAL NERVE Surgery 14.02 11.52 11.52 RBRVS

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64856 SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS Surgery 15.07 11.20 11.20 RBRVS 64857 SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS Surgery 15.82 11.47 11.47 RBRVS 64858 SUTURE SCIATIC NERVE Surgery 17.82 12.54 12.54 RBRVS 64859 SUTURE EACH ADDITIONAL PERIPHERAL NERVE Surgery 4.25 2.39 2.39 RBRVS 64861 SUTURE BRACHIAL PLEXUS Surgery 20.89 12.18 12.18 RBRVS 64862 SUTURE LUMBAR PLEXUS Surgery 21.09 10.57 10.57 RBRVS 64864 SUTURE FACIAL NERVE EXTRACRANIAL Surgery 13.41 9.71 9.71 RBRVS 64865 SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT Surgery 16.09 13.53 13.53 RBRVS 64866 ANASTOMOSIS FACIAL-SPINAL ACCESSORY Surgery 16.83 13.86 13.86 RBRVS 64868 ANASTOMOSIS FACIAL HYPOGLOSSAL Surgery 14.90 12.20 12.20 RBRVS 64872 SUTURE NERVE REQ SECONDARY/DELAYED SUTURE Surgery 1.99 1.01 1.01 RBRVS 64874 SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE Surgery 2.98 1.33 1.33 RBRVS 64876 SUTURE NERVE REQ SHORTENING BONE EXTREMITY Surgery 3.37 1.29 1.29 RBRVS 64885 NERVE GRAFT HEAD/NECK 4 CM Surgery 20.82 13.54 13.54 RBRVS 64890 NERVE GRAFT 1 STRAND HAND/FOOT 4 CM Surgery 17.35 13.29 13.29 RBRVS 64892 NERVE GRAFT 1 STRAND ARM/LEG <4 CM Surgery 15.74 11.37 11.37 RBRVS 64893 NERVE GRAFT 1 STRAND ARM/LEG >4 CM Surgery 16.87 13.01 13.01 RBRVS 64895 NERVE GRAFT MLT STRANDS HAND/FOOT 4 CM Surgery 21.96 15.60 15.60 RBRVS 64897 NERVE GRAFT MLT STRANDS ARM/LEG 4 CM Surgery 20.97 15.16 15.16 RBRVS 64901 NERVE GRAFT EACH NERVE 1 STRAND Surgery 10.20 4.52 4.52 RBRVS 64902 NERVE GRAFT EACH NERVE MULTIPLE STRANDS Surgery 11.81 5.24 5.24 RBRVS 64905 NERVE PEDICLE TRANSFER FIRST STAGE Surgery 15.11 11.87 11.87 RBRVS 64907 NERVE PEDICAL TRANSFER SECOND STAGE Surgery 20.03 14.08 14.08 RBRVS 64910 NERVE REPAIR W/CONDUIT EACH NERVE Surgery 11.39 10.29 10.29 RBRVS 64911 NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE Surgery 14.39 12.41 12.41 RBRVS 64999 UNLISTED PROCEDURE NERVOUS SYSTEM Surgery 3.92 Unlisted 65091 EVISCERATION OCULAR CONTENTS W/O IMPLANT Surgery 7.26 10.13 10.13 RBRVS 65093 EVISCERATION OCULAR CONTENTS W/IMPLANT Surgery 7.04 10.15 10.15 RBRVS 65101 ENUCLEATION OF EYE W/O IMPLANT Surgery 8.30 11.92 11.92 RBRVS 65103 ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT Surgery 8.84 12.20 12.20 RBRVS 65105 ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT Surgery 9.93 13.31 13.31 RBRVS 65110 EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY Surgery 15.70 17.65 17.65 RBRVS 65112 EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE Surgery 18.51 20.15 20.15 RBRVS 65114 EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP Surgery 19.65 20.86 20.86 RBRVS 65125 MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX Surgery 3.27 4.75 9.38 RBRVS 65130 INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL Surgery 8.42 11.61 11.61 RBRVS 65135 INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED Surgery 8.60 11.72 11.72 RBRVS 65140 INSJ OC IMPLT AFTER ENCL MUSC ATTACHED Surgery 9.46 12.64 12.64 RBRVS 65150 REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT Surgery 6.43 9.39 9.39 RBRVS 65155 REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE Surgery 10.10 13.04 13.04 RBRVS 65175 REMOVAL OCULAR IMPLANT Surgery 7.40 10.61 10.61 RBRVS 65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL Surgery 0.71 0.50 0.83 RBRVS 65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR Surgery 0.84 0.62 1.05 RBRVS 65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP Surgery 0.71 0.41 0.85 RBRVS 65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP Surgery 0.84 0.59 1.00 RBRVS 65235 RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS Surgery 9.01 10.45 10.45 RBRVS 65260 RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE Surgery 12.54 13.62 13.62 RBRVS 65265 RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ Surgery 14.34 15.11 15.11 RBRVS 65270 RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR Surgery 1.95 1.89 5.43 RBRVS 65272 RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION Surgery 4.62 4.97 9.23 RBRVS 65273 RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION Surgery 5.16 5.23 5.23 RBRVS 65275 RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY Surgery 6.29 6.33 9.58 RBRVS 65280 RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS Surgery 9.10 9.25 9.25 RBRVS 65285 RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T Surgery 15.36 14.88 14.88 RBRVS 65286 RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA Surgery 6.63 6.92 12.77 RBRVS 65290 RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU Surgery 6.53 6.86 6.86 RBRVS 65400 EXCISION LESION CORNEA XCP PTERYGIUM Surgery 7.50 9.03 11.15 RBRVS 65410 BIOPSY CORNEA Surgery 1.47 1.39 2.47 RBRVS 65420 EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT Surgery 4.36 5.99 9.89 RBRVS 65426 EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG Surgery 6.05 7.05 11.92 RBRVS 65430 CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE Surgery 1.47 1.36 1.67 RBRVS 65435 RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION Surgery 0.92 0.99 1.27 RBRVS 65436 RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT Surgery 4.82 5.34 5.78 RBRVS 65450 DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION Surgery 3.47 5.36 5.46 RBRVS 65600 MULTIPLE PUNCTURES ANTERIOR CORNEA Surgery 4.20 5.23 6.64 RBRVS 65710 KERATOPLASTY ANTERIOR LAMELLAR Surgery 14.45 15.78 15.78 RBRVS 65730 KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA Surgery 16.35 17.16 17.16 RBRVS 65750 KERATOPLASTY PENETRAING APHAKIA Surgery 16.90 16.76 16.76 RBRVS 65755 KERATOPLASTY PENETRATING PSEUDOPHAKIA Surgery 16.79 16.69 16.69 RBRVS 65756 KERATOPLASTY ENDOTHELIAL Surgery 16.84 15.46 15.46 RBRVS 65757 BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT Surgery 6.23 5% Sample

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65760 KERATOMILEUSIS Surgery 18.46 FAIR Health 65765 KERATOPHAKIA Surgery 23.53 19.96 19.96 ERBRVS 65767 EPIKERATOPLASTY Surgery 21.91 18.59 18.59 ERBRVS 65770 KERATOPROSTHESIS Surgery 19.74 18.60 18.60 RBRVS 65771 RADIAL KERATOTOMY Surgery 10.15 FAIR Health 65772 CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM Surgery 5.09 6.04 7.29 RBRVS 65775 CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM Surgery 6.91 8.19 8.19 RBRVS 65778 PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES Surgery 1.19 0.73 37.66 RBRVS 65779 PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED Surgery 3.92 3.81 30.37 RBRVS 65780 OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE Surgery 10.73 13.63 13.63 RBRVS 65781 OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT Surgery 18.14 18.25 18.25 RBRVS 65782 OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT Surgery 15.43 15.99 15.99 RBRVS 65785 IMPLANTATION INTRASTROMAL CORNEAL RING SEGMENTS Surgery 5.39 4.91 53.80 RBRVS 65800 PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX Surgery 1.53 0.96 1.73 RBRVS 65810 PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX Surgery 5.82 6.91 6.91 RBRVS 65815 PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR IN Surgery 6.00 7.07 11.57 RBRVS 65820 GONIOTOMY Surgery 8.91 11.59 11.59 RBRVS 65850 TRABECULOTOMY AB EXTERNO Surgery 11.39 11.52 11.52 RBRVS 65855 TRABECULOPLASTY BY LASER SURGERY Surgery 3.99 4.13 5.27 RBRVS 65860 SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX Surgery 3.59 3.31 4.87 RBRVS 65865 SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE Surgery 5.77 7.18 7.18 RBRVS 65870 SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE Surgery 7.39 8.79 8.79 RBRVS 65875 SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE Surgery 7.81 9.43 9.43 RBRVS 65880 SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL Surgery 8.36 9.78 9.78 RBRVS 65900 RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE Surgery 12.51 13.82 13.82 RBRVS 65920 RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE Surgery 9.99 11.57 11.57 RBRVS 65930 RMVL BLOOD CLOT ANTERIOR SEGMENT EYE Surgery 8.39 9.03 9.03 RBRVS 66020 INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX Surgery 1.64 1.97 3.50 RBRVS 66030 INJX ANTERIOR CHAMBER EYE MEDICATION SPX Surgery 1.30 1.74 3.28 RBRVS 66130 EXCISION LESION SCLERA Surgery 7.83 7.71 11.26 RBRVS 66150 FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY Surgery 10.53 13.34 13.34 RBRVS 66155 FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC Surgery 10.52 13.47 13.47 RBRVS 66160 FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT Surgery 12.39 14.64 14.64 RBRVS 66170 FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO Surgery 15.02 17.82 17.82 RBRVS 66172 FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING Surgery 18.86 22.58 22.58 RBRVS 66174 TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT Surgery 12.85 13.01 13.01 RBRVS 66175 TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT Surgery 13.60 13.48 13.48 RBRVS 66179 AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT Surgery 14.00 15.46 15.46 RBRVS 66180 AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT Surgery 15.00 16.07 16.07 RBRVS 66183 INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR Surgery 13.20 14.97 14.97 RBRVS 66184 REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT Surgery 9.58 11.91 11.91 RBRVS 66185 REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT Surgery 10.58 12.54 12.54 RBRVS 66220 REPAIR SCLERAL STAPHYLOMA W/O GRAFT Surgery 9.21 11.13 11.13 RBRVS 66225 REPAIR SCLERAL STAPHYLOMA W/GRAFT Surgery 12.63 12.80 12.80 RBRVS 66250 REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT Surgery 7.10 8.15 13.53 RBRVS 66500 IRIDOTOMY STAB INC SPX XCP TRANSFIXION Surgery 3.83 5.89 5.89 RBRVS 66505 IRIDOTOMY STAB INC SPX TRANSFIXION Surgery 4.22 6.43 6.43 RBRVS 66600 IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES Surgery 10.12 12.67 12.67 RBRVS 66605 IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY Surgery 14.22 14.62 14.62 RBRVS 66625 IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX Surgery 5.30 6.45 6.45 RBRVS 66630 IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX Surgery 7.28 8.30 8.30 RBRVS 66635 IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX Surgery 7.37 8.36 8.36 RBRVS 66680 REPAIR IRIS CILIARY BODY Surgery 6.39 7.78 7.78 RBRVS 66682 SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE Surgery 7.33 10.15 10.15 RBRVS 66700 CILIARY BODY DESTRUCTION DIATHERMY Surgery 5.14 5.61 7.21 RBRVS 66710 CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL Surgery 5.14 5.61 6.92 RBRVS 66711 CILIARY BODY DSTRJ CYCLOPHOTOCOAG ENDOSCOPIC Surgery 7.93 9.65 9.65 RBRVS 66720 CILIARY BODY DESTRUCTION CRYOTHERAPY Surgery 5.00 6.63 8.06 RBRVS 66740 CILIARY BODY DESTRUCTION CYCLODIAL Surgery 5.14 5.60 6.84 RBRVS 66761 IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION Surgery 3.00 3.45 5.14 RBRVS 66762 IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS Surgery 5.38 6.28 7.65 RBRVS 66770 DSTRJ CYST/LESION IRIS/CILIARY BODY Surgery 6.13 7.11 8.35 RBRVS 66820 DISCISSION SECONDARY MEMBRANOUS CATARACT Surgery 4.01 6.81 6.81 RBRVS 66821 POST-CATARACT LASER SURGERY Surgery 3.42 5.12 5.64 RBRVS 66825 REPOSITIONING IO LENS PROSTHESIS REQ INC SPX Surgery 9.01 11.80 11.80 RBRVS 66830 RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ Surgery 9.47 9.98 9.98 RBRVS 66840 RMVL LENS MATERIAL ASPIR TQ 1/> STAGES Surgery 9.18 9.85 9.85 RBRVS 66850 RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR Surgery 10.55 11.09 11.09 RBRVS 66852 RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY Surgery 11.41 11.64 11.64 RBRVS 66920 RMVL LENS MATERIAL INTRACAPSULAR Surgery 10.13 10.46 10.46 RBRVS 66930 REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS Surgery 11.61 11.77 11.77 RBRVS 66940 REMOVAL LENS MATERIAL EXTRACAPSULAR Surgery 10.37 10.99 10.99 RBRVS 66982 XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG Surgery 11.08 10.61 10.61 RBRVS 66983 ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG Surgery 10.43 9.71 9.71 RBRVS 66984 CATARACT REMOVAL INSERTION OF LENS Surgery 8.52 8.97 8.97 RBRVS

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66985 INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL Surgery 9.98 11.07 11.07 RBRVS 66986 EXCHANGE INTRAOCULAR LENS Surgery 12.26 12.54 12.54 RBRVS 66990 USE OPHTHALMIC ENDOSCOPE Surgery 1.51 0.95 0.95 RBRVS 66999 UNLISTED PROCEDURE ANTERIOR SEGMENT EYE Surgery 17.49 Unlisted 67005 RMVL VITREOUS ANT APPR PARTIAL REMOVAL Surgery 5.89 7.04 7.04 RBRVS 67010 RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT Surgery 7.06 7.78 7.78 RBRVS 67015 ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL Surgery 7.14 8.75 8.75 RBRVS 67025 INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX Surgery 8.11 9.21 11.82 RBRVS 67027 IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS Surgery 11.62 11.63 11.63 RBRVS 67028 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX Surgery 1.44 1.29 1.34 RBRVS 67030 DISCISSION VITREOUS STRANS PARS PLANA APPROACH Surgery 6.11 8.49 8.49 RBRVS 67031 SEVERING VITREOUS STRANS LASER 1/> STAGES Surgery 4.47 5.28 6.18 RBRVS 67036 VITRECTOMY MECHANICAL PARS PLANA Surgery 12.13 12.48 12.48 RBRVS 67039 VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC Surgery 13.20 13.15 13.15 RBRVS 67040 VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC Surgery 14.50 13.96 13.96 RBRVS 67041 VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE Surgery 16.33 15.11 15.11 RBRVS 67042 VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA Surgery 16.33 15.11 15.11 RBRVS 67043 VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE Surgery 17.40 15.76 15.76 RBRVS 67101 RPR RETINAL DTCHMNT 1/>SES CRYOTX/DTHRM INCL DRG Surgery 8.80 9.62 12.70 RBRVS 67105 RPR RETINAL DTCHMNT 1/> SES PC INCL SUBRETI DRG Surgery 8.53 9.08 11.17 RBRVS 67107 REPAIR RETINAL DETACHMENT SCLERAL BUCKLING Surgery 16.71 16.44 16.44 RBRVS 67108 RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH Surgery 22.89 20.84 20.84 RBRVS 67110 RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS Surgery 10.25 10.91 13.56 RBRVS 67113 RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL Surgery 25.35 22.14 22.14 RBRVS 67115 RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT Surgery 6.11 7.57 7.57 RBRVS 67120 RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR Surgery 7.10 8.18 10.95 RBRVS 67121 RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR Surgery 12.25 12.56 12.56 RBRVS 67141 PROPH RTA DTCHMNT W/O DRG 1/> SESS CRTX DTHRM Surgery 6.15 7.20 8.21 RBRVS 67145 PROPH RTA DTCHMNT W/O DRG 1/> SESS Surgery 6.32 7.30 8.12 RBRVS 67208 DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM Surgery 7.65 8.13 8.73 RBRVS 67210 DSTRJ LOCLZD LESION RETINA 1/> SESS PC Surgery 6.36 7.33 7.83 RBRVS 67218 DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ Surgery 20.36 17.25 17.25 RBRVS 67220 DSTRJ LESION CHOROID PC 1/> SESS Surgery 6.36 7.33 8.29 RBRVS 67221 DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY Surgery 3.45 2.36 4.40 RBRVS 67225 DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION Surgery 0.47 0.29 0.34 RBRVS 67227 DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY Surgery 7.53 8.08 9.20 RBRVS 67228 TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION Surgery 13.82 11.97 13.46 RBRVS 67229 EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT Surgery 16.30 15.50 15.50 RBRVS 67250 SCLERAL REINFORCEMENT SPX W/O GRAFT Surgery 9.61 11.75 11.75 RBRVS 67255 SCLERAL REINFORCEMENT SPX W/GRAFT Surgery 8.38 10.33 10.33 RBRVS 67299 UNLISTED PROCEDURE POSTERIOR SEGMENT Surgery 2.78 Unlisted 67311 STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC Surgery 7.77 8.60 8.60 RBRVS 67312 STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC Surgery 9.66 9.76 9.76 RBRVS 67314 STRABISMUS RECESSION/RESCJ 1 VER MUSC Surgery 8.79 9.61 9.61 RBRVS 67316 STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC Surgery 10.93 10.95 10.95 RBRVS 67318 STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE Surgery 9.12 10.14 10.14 RBRVS 67320 TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC Surgery 5.40 3.36 3.36 RBRVS 67331 STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC Surgery 5.13 3.17 3.17 RBRVS 67332 STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY Surgery 5.56 3.45 3.45 RBRVS 67334 STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION Surgery 5.05 3.14 3.14 RBRVS 67335 PLACEMENT ADJUSTABLE SUTURE STRABISMUS Surgery 2.49 1.56 1.56 RBRVS 67340 STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC Surgery 6.00 3.73 3.73 RBRVS 67343 RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX Surgery 8.47 9.37 9.37 RBRVS 67345 CHEMODENERVATION EXTRAOCULAR MUSCLE Surgery 3.01 2.79 3.46 RBRVS 67346 BIOPSY EXTRAOCULAR MUSCLE Surgery 2.87 2.43 2.43 RBRVS 67399 UNLISTED PROCEDURE EXTRAOCULAR MUSCLE Surgery 16.37 Unlisted 67400 ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY Surgery 11.20 14.23 14.23 RBRVS 67405 ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY Surgery 9.20 12.44 12.44 RBRVS 67412 ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION Surgery 10.30 12.96 12.96 RBRVS 67413 ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY Surgery 10.24 13.13 13.13 RBRVS 67414 ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN Surgery 17.94 18.16 18.16 RBRVS 67415 FINE NEEDLE ASPIRATION ORBITAL CONTENTS Surgery 1.76 1.09 1.09 RBRVS 67420 ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION Surgery 21.87 21.99 21.99 RBRVS 67430 ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB Surgery 15.29 18.81 18.81 RBRVS 67440 ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG Surgery 14.84 18.14 18.14 RBRVS 67445 ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN Surgery 19.12 19.03 19.03 RBRVS 67450 ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX Surgery 15.41 18.74 18.74 RBRVS 67500 RETROBULBAR INJECTION MEDICATION SPX Surgery 1.44 0.50 0.67 RBRVS 67505 RETROBULBAR INJECTION ALCOHOL Surgery 1.27 0.95 1.16 RBRVS 67515 INJECTION MEDICATION/OTHER SUBST TENON CAPSULE Surgery 1.40 1.03 1.24 RBRVS 67550 ORBITAL IMPLANT INSERTION Surgery 11.77 14.54 14.54 RBRVS 67560 ORBITAL IMPLANT REMOVAL/REVISION Surgery 12.18 14.81 14.81 RBRVS 67570 OPTIC NERVE DECOMPRESSION Surgery 14.40 16.57 16.57 RBRVS 67599 UNLISTED PROCEDURE ORBIT Surgery 2.62 Unlisted 67700 BLEPHAROTOMY DRAINAGE ABSCESS EYELID Surgery 1.40 1.79 6.04 RBRVS

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67710 SEVERING TARSORRHAPHY Surgery 1.07 1.61 5.14 RBRVS 67715 CANTHOTOMY SEPARATE PROCEDURE Surgery 1.27 1.69 5.32 RBRVS 67800 EXCISION CHALAZION SINGLE Surgery 1.41 1.42 2.08 RBRVS 67801 EXCISION CHALAZION MULTIPLE SAME LID Surgery 1.91 1.74 2.53 RBRVS 67805 EXCISION CHALAZION MULTIPLE DIFFERENT LIDS Surgery 2.27 2.24 3.25 RBRVS 67808 EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT Surgery 4.60 5.46 5.46 RBRVS 67810 INCISIONAL BIOPSY EYELID SKIN & LID MARGIN Surgery 1.18 0.72 3.52 RBRVS 67820 CORRECTION TRICHIASIS EPILATION FORCEPS ONLY Surgery 0.71 0.76 0.66 RBRVS 67825 CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS Surgery 1.43 1.92 2.11 RBRVS 67830 CORRECTION TRICHIASIS INCCISION LID MARGIN Surgery 1.75 2.03 5.61 RBRVS 67835 CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF Surgery 5.70 6.30 6.30 RBRVS 67840 EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE Surgery 2.09 2.24 5.50 RBRVS 67850 DESTRUCTION LESION LID MARGIN ONE-FOURTH LID MARGIN Surgery 5.86 6.56 9.91 RBRVS 67966 EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN Surgery 8.97 8.95 12.02 RBRVS 67971 RCNSTJ EYELID FULL THICKNESS 1 CM Surgery 2.41 2.63 6.18 RBRVS 68130 EXCISION LESION CONJUNCTIVA ADJACENT SCLERA Surgery 5.10 6.18 9.72 RBRVS 68135 DESTRUCTION LESION CONJUNCTIVA Surgery 1.89 2.26 2.40 RBRVS 68200 SUBCONJUNCTIVAL INJECTION Surgery 0.49 0.46 0.64 RBRVS 68320 CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT Surgery 6.64 8.12 13.30 RBRVS 68325 CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT Surgery 8.63 9.36 9.36 RBRVS 68326 CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT Surgery 8.42 9.24 9.24 RBRVS 68328 CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT Surgery 9.45 9.84 9.84 RBRVS 68330 RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT Surgery 5.78 6.84 10.83 RBRVS 68335 RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB Surgery 8.46 9.26 9.26 RBRVS 68340 RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE Surgery 4.97 5.96 10.03 RBRVS 68360 CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX Surgery 5.17 6.09 9.42 RBRVS 68362 CONJUNCTIVAL FLAP TOTAL Surgery 8.61 9.35 9.35 RBRVS 68371 HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR Surgery 5.09 6.22 6.22 RBRVS 68399 UNLISTED PROCEDURE CONJUNCTIVA Surgery 1.11 Unlisted 68400 INCISION DRAINAGE LACRIMAL GLAND Surgery 1.74 1.89 6.15 RBRVS 68420 INCISION DRAINAGE LACRIMAL SAC Surgery 2.35 2.24 6.50 RBRVS 68440 SNIP INCISION LACRIMAL PUNCTUM Surgery 0.99 1.75 1.83 RBRVS 68500 EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL Surgery 12.77 13.88 13.88 RBRVS 68505 EXCISION LACRIMAL GLAND XCPT TUMOR PRTL Surgery 12.69 13.83 13.83 RBRVS 68510 BIOPSY LACRIMAL GLAND Surgery 4.60 3.36 7.66 RBRVS 68520 EXCISION LACRIMAL SAC Surgery 8.78 9.96 9.96 RBRVS 68525 BIOPSY LACRIMAL SAC Surgery 4.42 2.74 2.74 RBRVS 68530 RMVL FB/DACRYOLITH LACRIMAL PASSAGES Surgery 3.70 3.31 8.08 RBRVS 68540 EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH Surgery 12.18 13.21 13.21 RBRVS 68550 EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY Surgery 15.16 11.69 11.69 RBRVS

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68700 PLASTIC REPAIR CANALICULI Surgery 7.87 8.64 8.64 RBRVS 68705 CORRECTION EVERTED PUNCTUM CAUTERY Surgery 2.11 2.45 4.39 RBRVS 68720 DACRYOCSTORHINOSTOMY Surgery 9.96 10.66 10.66 RBRVS 68745 CONJUNCTIVORHINOSTOMY W/O TUBE Surgery 9.90 10.86 10.86 RBRVS 68750 CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT Surgery 10.10 11.36 11.36 RBRVS 68760 CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER Surgery 1.78 2.24 3.76 RBRVS 68761 CLSR LACRIMAL PUNCTUM PLUG EACH Surgery 1.41 1.87 2.67 RBRVS 68770 CLOSURE LACRIMAL FISTULA SPX Surgery 8.29 8.91 8.91 RBRVS 68801 DILATION LACRIMAL PUNCTUM W/WO IRRGATION Surgery 1.00 1.99 2.46 RBRVS 68810 PROBE NASOLACRIMAL DUCT W/WO IRRIGATION Surgery 2.15 3.01 4.51 RBRVS 68811 PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES Surgery 2.45 3.20 3.20 RBRVS 68815 PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT Surgery 3.30 3.72 9.11 RBRVS 68816 PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION Surgery 3.06 3.79 17.61 RBRVS 68840 PROBE LACRIMAL CANALICULI W/WO IRRIGATION Surgery 1.30 1.92 2.22 RBRVS 68850 INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY Surgery 0.80 0.72 0.86 RBRVS 68899 UNLISTED PROCEDURE LACRIMAL SYSTEM Surgery 4.07 Unlisted 69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE Surgery 1.50 1.72 3.63 RBRVS 69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX Surgery 2.16 2.05 3.65 RBRVS 69020 DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS Surgery 1.53 2.34 4.88 RBRVS 69090 EAR PIERCING Miscellaneous Medical 0.99 FAIR Health 69100 BIOPSY EXTERNAL EAR Surgery 0.81 0.49 1.94 RBRVS 69105 BIOPSY EXTERNAL AUDITORY CANAL Surgery 0.85 0.86 3.04 RBRVS 69110 EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR Surgery 3.53 5.21 9.01 RBRVS 69120 EXCISION EXTERNAL EAR COMPLETE AMPUTATION Surgery 4.14 6.85 6.85 RBRVS 69140 EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL Surgery 8.14 15.87 15.87 RBRVS 69145 EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL Surgery 2.70 4.06 8.26 RBRVS 69150 RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ Surgery 13.61 14.45 14.45 RBRVS 69155 RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ Surgery 23.35 21.17 21.17 RBRVS 69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES Surgery 0.77 0.79 2.63 RBRVS 69205 RMVL FB XTRNL AUDITORY CANAL ANES Surgery 1.21 1.54 1.54 RBRVS 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT Surgery 0.35 0.35 RBRVS 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT Surgery 0.61 0.26 0.72 RBRVS 69220 DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE Surgery 0.83 0.84 2.97 RBRVS 69222 DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX Surgery 1.45 2.27 4.60 RBRVS 69300 OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ Surgery 6.69 6.00 13.26 RBRVS 69310 RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX Surgery 10.97 18.71 18.71 RBRVS 69320 RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG Surgery 17.18 24.27 24.27 RBRVS 69399 UNLISTED PROCEDURE EXTERNAL EAR Surgery 1.32 Unlisted 69420 MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ Surgery 1.38 1.89 3.88 RBRVS 69421 MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES Surgery 1.78 2.25 2.25 RBRVS 69424 VENTILATING TUBE RMVL REQUIRING GENERAL ANES Surgery 0.85 0.82 2.69 RBRVS 69433 TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA Surgery 1.57 2.01 3.98 RBRVS 69436 TYMPANOSTOMY GENERAL ANESTHESIA Surgery 2.01 2.32 2.32 RBRVS 69440 MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC Surgery 7.71 10.97 10.97 RBRVS 69450 TYMPANOLYSIS TRANSCANAL Surgery 5.69 9.14 9.14 RBRVS 69501 TRANSMASTOID ANTROTOMY Surgery 9.21 10.50 10.50 RBRVS 69502 MASTOIDECTOMY COMPLETE Surgery 12.56 13.58 13.58 RBRVS 69505 MASTOIDECTOMY MODIFIED RADICAL Surgery 13.17 19.53 19.53 RBRVS 69511 MASTOIDECTOMY RADICAL Surgery 13.70 19.77 19.77 RBRVS 69530 PETROUS APICECTOMY RADICAL MASTOIDECTOMY Surgery 20.38 24.23 24.23 RBRVS 69535 RESCJ TEMPORAL BONE EXTERNAL APPROACH Surgery 37.42 33.92 33.92 RBRVS 69540 EXCISION AURAL POLYP Surgery 1.25 2.22 4.52 RBRVS 69550 EXCISION AURAL GLOMUS TUMOR TRANSCANAL Surgery 11.15 17.17 17.17 RBRVS 69552 EXCISION AURAL GLOMUS TUMOR TRANSMASTOID Surgery 19.81 22.48 22.48 RBRVS 69554 EXCISION AURAL GLOMUS TUMOR EXTENDED Surgery 35.97 31.40 31.40 RBRVS 69601 REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY Surgery 13.45 14.71 14.71 RBRVS 69602 REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC Surgery 13.76 15.56 15.56 RBRVS 69603 REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY Surgery 14.20 19.99 19.99 RBRVS 69604 REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY Surgery 14.20 15.73 15.73 RBRVS 69605 REVJ MASTOIDECTOMY W/APICECTOMY Surgery 18.69 23.47 23.47 RBRVS 69610 TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH Surgery 4.47 3.26 5.88 RBRVS 69620 MYRINGOPLASTY Surgery 6.03 7.16 12.97 RBRVS 69631 TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ Surgery 10.05 13.92 13.92 RBRVS 69632 TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ Surgery 12.96 16.14 16.14 RBRVS 69633 TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP Surgery 12.31 15.89 15.89 RBRVS 69635 TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ Surgery 13.51 19.91 19.91 RBRVS 69636 TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ Surgery 15.43 22.02 22.02 RBRVS 69637 TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP Surgery 15.32 22.48 22.48 RBRVS 69641 TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ Surgery 12.89 15.20 15.20 RBRVS 69642 TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ Surgery 17.06 18.94 18.94 RBRVS 69643 TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR Surgery 15.59 17.35 17.35 RBRVS 69644 TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR Surgery 17.23 22.86 22.86 RBRVS 69645 TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR Surgery 16.71 22.67 22.67 RBRVS 69646 TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR Surgery 18.37 23.37 23.37 RBRVS 69650 STAPES MOBILIZATION Surgery 9.80 11.89 11.89 RBRVS

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69660 STAPEDECTOMY/STAPEDOTOMY Surgery 12.03 12.93 12.93 RBRVS 69661 STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT Surgery 15.92 16.51 16.51 RBRVS 69662 REVISION STAPEDECTOMY/STAPEDOTOMY Surgery 15.60 15.51 15.51 RBRVS 69666 REPAIR OVAL WINDOW FISTULA Surgery 9.89 11.99 11.99 RBRVS 69667 REPAIR ROUND WINDOW FISTULA Surgery 9.90 11.96 11.96 RBRVS 69670 MASTOID OBLITERATION SEPARATE PROCEDURE Surgery 11.73 13.71 13.71 RBRVS 69676 TYMPANIC NEURECTOMY Surgery 9.69 12.80 12.80 RBRVS 69700 CLOSURE POSTAURICULAR FISTULA MASTOID SPX Surgery 8.37 10.12 10.12 RBRVS 69710 IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE Surgery 19.59 v3.16 69711 RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE Surgery 10.62 12.64 12.64 RBRVS 69714 IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID Surgery 14.45 14.46 14.46 RBRVS 69715 IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID Surgery 18.96 16.55 16.55 RBRVS 69717 RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY Surgery 15.43 14.85 14.85 RBRVS 69718 RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY Surgery 19.21 16.66 16.66 RBRVS 69720 DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION Surgery 14.71 17.67 17.67 RBRVS 69725 DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE Surgery 27.64 22.51 22.51 RBRVS 69740 SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE Surgery 16.27 14.99 14.99 RBRVS 69745 SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE Surgery 17.02 16.26 16.26 RBRVS 69799 UNLISTED PROCEDURE MIDDLE EAR Surgery 5.47 Unlisted 69801 LABYRINTHOTOMY TRANSCANAL Surgery 2.06 1.27 3.24 RBRVS 69805 ENDOLYMPHATIC SAC W/O SHUNT Surgery 14.71 13.51 13.51 RBRVS 69806 ENDOLYMPHATIC SAC SHUNT Surgery 12.63 12.76 12.76 RBRVS 69820 FENESTRATION SEMICIRCULAR CANAL Surgery 10.52 12.60 12.60 RBRVS 69840 REVISION FENESTRATION OPERATION Surgery 10.44 15.02 15.02 RBRVS 69905 LABYRINTHECTOMY TRANSCANAL Surgery 11.26 13.50 13.50 RBRVS 69910 LABYRINTHECTOMY W/MASTOIDECTOMY Surgery 13.91 13.35 13.35 RBRVS 69915 VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR Surgery 22.77 18.24 18.24 RBRVS 69930 COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY Surgery 17.73 14.98 14.98 RBRVS 69949 UNLISTED PROCEDURE INNER EAR Surgery 32.71 Unlisted 69950 VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH Surgery 27.63 19.74 19.74 RBRVS 69955 TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR Surgery 29.42 23.32 23.32 RBRVS 69960 DECOMPRESSION INTERNAL AUDITORY CANAL Surgery 29.42 21.80 21.80 RBRVS 69970 REMOVAL TUMOR TEMPORAL BONE Surgery 32.41 24.64 24.64 RBRVS 69979 UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA Surgery 52.74 Unlisted 69990 MICROSURG TQS REQ USE OPERATING MICROSCOPE Surgery 3.46 1.63 1.63 RBRVS 70010 MYELOGRAPY POST FOSSA RS&I Radiology a 1.19 0.60 0.60 RBRVS 70010 26 MYELOGRAPY POST FOSSA RS&I Radiology 0.31 0.16 0.16 ERBRVS 70010 TC MYELOGRAPY POST FOSSA RS&I Radiology a 0.88 0.44 0.44 ERBRVS 70015 CISTERNOGRAPHY POSITIVE CONTRAST RS&I Radiology a 1.19 3.07 3.07 RBRVS 70015 26 CISTERNOGRAPHY POSITIVE CONTRAST RS&I Radiology 1.19 0.45 0.45 RBRVS 70015 TC CISTERNOGRAPHY POSITIVE CONTRAST RS&I Radiology a 2.62 2.62 RBRVS 70030 RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY Radiology a 0.17 0.58 0.58 RBRVS 70030 26 RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY Radiology 0.17 0.06 0.06 RBRVS 70030 TC RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY Radiology a 0.52 0.52 RBRVS 70100 RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS Radiology a 0.18 0.72 0.72 RBRVS 70100 26 RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS Radiology 0.18 0.07 0.07 RBRVS 70100 TC RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS Radiology a 0.65 0.65 RBRVS 70110 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS Radiology a 0.25 0.79 0.79 RBRVS 70110 26 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS Radiology 0.25 0.10 0.10 RBRVS 70110 TC RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS Radiology a 0.69 0.69 RBRVS 70120 RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE Radiology a 0.18 0.75 0.75 RBRVS 70120 26 RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE Radiology 0.18 0.07 0.07 RBRVS 70120 TC RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE Radiology a 0.68 0.68 RBRVS 70130 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE Radiology a 0.34 1.16 1.16 RBRVS 70130 26 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE Radiology 0.34 0.13 0.13 RBRVS 70130 TC RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE Radiology a 1.03 1.03 RBRVS 70134 RADEX INTERNAL AUDITORY MEATI COMPLETE Radiology a 0.34 1.08 1.08 RBRVS 70134 26 RADEX INTERNAL AUDITORY MEATI COMPLETE Radiology 0.34 0.15 0.15 RBRVS 70134 TC RADEX INTERNAL AUDITORY MEATI COMPLETE Radiology a 0.93 0.93 RBRVS 70140 RADEX FACIAL BONES < 3 VIEWS Radiology a 0.19 0.62 0.62 RBRVS 70140 26 RADEX FACIAL BONES < 3 VIEWS Radiology 0.19 0.10 0.10 RBRVS 70140 TC RADEX FACIAL BONES < 3 VIEWS Radiology a 0.52 0.52 RBRVS 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS Radiology a 0.26 0.88 0.88 RBRVS 70150 26 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS Radiology 0.26 0.11 0.11 RBRVS 70150 TC RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS Radiology a 0.77 0.77 RBRVS 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS Radiology a 0.17 0.72 0.72 RBRVS 70160 26 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 70160 TC RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS Radiology a 0.65 0.65 RBRVS 70170 DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I Radiology a 1.03 Global/TC/26 70170 26 DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I Radiology 0.41 Global/TC/26 70170 TC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I Radiology a 0.62 Global/TC/26 70190 RADEX OPTIC FORAMINA Radiology a 0.21 0.75 0.75 RBRVS 70190 26 RADEX OPTIC FORAMINA Radiology 0.21 0.10 0.10 RBRVS 70190 TC RADEX OPTIC FORAMINA Radiology a 0.65 0.65 RBRVS 70200 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS Radiology a 0.28 0.88 0.88 RBRVS

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70200 26 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS Radiology 0.28 0.11 0.11 RBRVS 70200 TC RADEX ORBITS COMPLETE MINIMUM 4 VIEWS Radiology a 0.77 0.77 RBRVS 70210 RADEX SINUSES PARANASAL <3 VIEWS Radiology a 0.17 0.64 0.64 RBRVS 70210 26 RADEX SINUSES PARANASAL <3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 70210 TC RADEX SINUSES PARANASAL <3 VIEWS Radiology a 0.57 0.57 RBRVS 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS Radiology a 0.25 0.77 0.77 RBRVS 70220 26 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS Radiology 0.25 0.10 0.10 RBRVS 70220 TC RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS Radiology a 0.67 0.67 RBRVS 70240 RADIOLOGIC EXAMINATION SELLA TURCICA Radiology a 0.19 0.62 0.62 RBRVS 70240 26 RADIOLOGIC EXAMINATION SELLA TURCICA Radiology 0.19 0.08 0.08 RBRVS 70240 TC RADIOLOGIC EXAMINATION SELLA TURCICA Radiology a 0.54 0.54 RBRVS 70250 RADIOLOGIC EXAMINATION SKULL 4/> VIEWS Radiology a 0.24 0.74 0.74 RBRVS 70250 26 RADIOLOGIC EXAMINATION SKULL 4/> VIEWS Radiology 0.24 0.11 0.11 RBRVS 70250 TC RADIOLOGIC EXAMINATION SKULL 4/> VIEWS Radiology a 0.63 0.63 RBRVS 70260 RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS Radiology a 0.34 0.90 0.90 RBRVS 70260 26 RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS Radiology 0.34 0.14 0.14 RBRVS 70260 TC RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS Radiology a 0.76 0.76 RBRVS 70300 RADIOLOGIC EXAMINATION TEETH 1 VIEW Radiology a 0.10 0.30 0.30 RBRVS 70300 26 RADIOLOGIC EXAMINATION TEETH 1 VIEW Radiology 0.10 0.06 0.06 RBRVS 70300 TC RADIOLOGIC EXAMINATION TEETH 1 VIEW Radiology a 0.24 0.24 RBRVS 70310 RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH Radiology a 0.16 0.90 0.90 RBRVS 70310 26 RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH Radiology 0.16 0.07 0.07 RBRVS 70310 TC RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH Radiology a 0.83 0.83 RBRVS 70320 RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH Radiology a 0.22 1.24 1.24 RBRVS 70320 26 RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH Radiology 0.22 0.11 0.11 RBRVS 70320 TC RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH Radiology a 1.13 1.13 RBRVS 70328 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT Radiology a 0.18 0.67 0.67 RBRVS 70328 26 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT Radiology 0.18 0.08 0.08 RBRVS 70328 TC RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT Radiology a 0.59 0.59 RBRVS 70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT Radiology a 0.24 1.05 1.05 RBRVS 70330 26 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT Radiology 0.24 0.11 0.11 RBRVS 70330 TC RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT Radiology a 0.94 0.94 RBRVS 70332 TEMPOROMANDBLE JT ARTHROGRAPHY RS&I Radiology a 0.54 1.69 1.69 RBRVS 70332 26 TEMPOROMANDBLE JT ARTHROGRAPHY RS&I Radiology 0.54 0.31 0.31 RBRVS 70332 TC TEMPOROMANDBLE JT ARTHROGRAPHY RS&I Radiology a 1.38 1.38 RBRVS 70336 MRI TEMPOROMANDIBULAR JOINT Radiology a 1.48 7.41 7.41 RBRVS 70336 26 MRI TEMPOROMANDIBULAR JOINT Radiology 1.48 0.54 0.54 RBRVS 70336 TC MRI TEMPOROMANDIBULAR JOINT Radiology a 6.87 6.87 RBRVS 70350 CEPHALOGRAM ORTHODONTIC Radiology a 0.17 0.35 0.35 RBRVS 70350 26 CEPHALOGRAM ORTHODONTIC Radiology 0.17 0.10 0.10 RBRVS 70350 TC CEPHALOGRAM ORTHODONTIC Radiology a 0.25 0.25 RBRVS 70355 ORTHOPANTOGRAM Radiology a 0.20 0.34 0.34 RBRVS 70355 26 ORTHOPANTOGRAM Radiology 0.20 0.10 0.10 RBRVS 70355 TC ORTHOPANTOGRAM Radiology a 0.24 0.24 RBRVS 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE Radiology a 0.17 0.59 0.59 RBRVS 70360 26 RADIOLOGIC EXAMINATION NECK SOFT TISSUE Radiology 0.17 0.06 0.06 RBRVS 70360 TC RADIOLOGIC EXAMINATION NECK SOFT TISSUE Radiology a 0.53 0.53 RBRVS 70370 RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ Radiology a 0.32 1.90 1.90 RBRVS 70370 26 RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ Radiology 0.32 0.11 0.11 RBRVS 70370 TC RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ Radiology a 1.79 1.79 RBRVS 70371 CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC Radiology a 0.84 1.65 1.65 RBRVS 70371 26 CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC Radiology 0.84 0.33 0.33 RBRVS 70371 TC CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC Radiology a 1.32 1.32 RBRVS 70380 RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS Radiology a 0.17 0.81 0.81 RBRVS 70380 26 RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS Radiology 0.17 0.08 0.08 RBRVS 70380 TC RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS Radiology a 0.73 0.73 RBRVS 70390 SIALOGRAPHY RS&I Radiology a 0.38 2.22 2.22 RBRVS 70390 26 SIALOGRAPHY RS&I Radiology 0.38 0.14 0.14 RBRVS 70390 TC SIALOGRAPHY RS&I Radiology a 2.08 2.08 RBRVS 70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL Radiology a 0.85 2.35 2.35 RBRVS 70450 26 CT HEAD/BRAIN W/O CONTRAST MATERIAL Radiology 0.85 0.32 0.32 RBRVS 70450 TC CT HEAD/BRAIN W/O CONTRAST MATERIAL Radiology a 2.03 2.03 RBRVS 70460 CT HEAD/BRAIN W/CONTRAST MATERIAL Radiology a 1.13 3.34 3.34 RBRVS 70460 26 CT HEAD/BRAIN W/CONTRAST MATERIAL Radiology 1.13 0.42 0.42 RBRVS 70460 TC CT HEAD/BRAIN W/CONTRAST MATERIAL Radiology a 2.92 2.92 RBRVS 70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL Radiology a 1.27 4.03 4.03 RBRVS 70470 26 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL Radiology 1.27 0.48 0.48 RBRVS 70470 TC CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL Radiology a 3.55 3.55 RBRVS 70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL Radiology a 1.28 5.18 5.18 RBRVS 70480 26 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL Radiology 1.28 0.48 0.48 RBRVS 70480 TC CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL Radiology a 4.70 4.70 RBRVS 70481 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL Radiology a 1.38 6.26 6.26 RBRVS 70481 26 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL Radiology 1.38 0.51 0.51 RBRVS 70481 TC CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL Radiology a 5.75 5.75 RBRVS 70482 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR Radiology a 1.45 6.92 6.92 RBRVS

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70482 26 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR Radiology 1.45 0.54 0.54 RBRVS 70482 TC CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR Radiology a 6.38 6.38 RBRVS 70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL Radiology a 0.85 3.02 3.02 RBRVS 70486 26 CT MAXILLOFACIAL W/O CONTRAST MATERIAL Radiology 0.85 0.32 0.32 RBRVS 70486 TC CT MAXILLOFACIAL W/O CONTRAST MATERIAL Radiology a 2.70 2.70 RBRVS 70487 CT MAXILLOFACIAL W/CONTRAST MATERIAL Radiology a 1.13 3.52 3.52 RBRVS 70487 26 CT MAXILLOFACIAL W/CONTRAST MATERIAL Radiology 1.13 0.42 0.42 RBRVS 70487 TC CT MAXILLOFACIAL W/CONTRAST MATERIAL Radiology a 3.10 3.10 RBRVS 70488 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL Radiology a 1.27 4.40 4.40 RBRVS 70488 26 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL Radiology 1.27 0.47 0.47 RBRVS 70488 TC CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL Radiology a 3.93 3.93 RBRVS 70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL Radiology a 1.28 4.05 4.05 RBRVS 70490 26 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL Radiology 1.28 0.48 0.48 RBRVS 70490 TC CT SOFT TISSUE NECK W/O CONTRAST MATERIAL Radiology a 3.57 3.57 RBRVS 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL Radiology a 1.38 5.14 5.14 RBRVS 70491 26 CT SOFT TISSUE NECK W/CONTRAST MATERIAL Radiology 1.38 0.52 0.52 RBRVS 70491 TC CT SOFT TISSUE NECK W/CONTRAST MATERIAL Radiology a 4.62 4.62 RBRVS 70492 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL Radiology a 1.45 6.25 6.25 RBRVS 70492 26 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL Radiology 1.45 0.54 0.54 RBRVS 70492 TC CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL Radiology a 5.71 5.71 RBRVS 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology a 1.75 6.41 6.41 RBRVS 70496 26 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology 1.75 0.65 0.65 RBRVS 70496 TC CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology a 5.76 5.76 RBRVS 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Radiology a 1.75 6.36 6.36 RBRVS 70498 26 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Radiology 1.75 0.64 0.64 RBRVS 70498 TC CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Radiology a 5.72 5.72 RBRVS 70540 MRI ORBIT FACE &/NECK W/O CONTRAST Radiology a 1.35 8.60 8.60 RBRVS 70540 26 MRI ORBIT FACE &/NECK W/O CONTRAST Radiology 1.35 0.49 0.49 RBRVS 70540 TC MRI ORBIT FACE &/NECK W/O CONTRAST Radiology a 8.11 8.11 RBRVS 70542 MRI ORBIT FACE & NECK W/CONTRAST MATERIAL Radiology a 1.62 9.56 9.56 RBRVS 70542 26 MRI ORBIT FACE & NECK W/CONTRAST MATERIAL Radiology 1.62 0.60 0.60 RBRVS 70542 TC MRI ORBIT FACE & NECK W/CONTRAST MATERIAL Radiology a 8.96 8.96 RBRVS 70543 MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL Radiology a 2.15 11.51 11.51 RBRVS 70543 26 MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL Radiology 2.15 0.79 0.79 RBRVS 70543 TC MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL Radiology a 10.72 10.72 RBRVS 70544 MRA HEAD W/O CONTRST MATERIAL Radiology a 1.20 9.72 9.72 RBRVS 70544 26 MRA HEAD W/O CONTRST MATERIAL Radiology 1.20 0.45 0.45 RBRVS 70544 TC MRA HEAD W/O CONTRST MATERIAL Radiology a 9.27 9.27 RBRVS 70545 MRA HEAD W/CONTRAST MATERIAL Radiology a 1.20 9.55 9.55 RBRVS 70545 26 MRA HEAD W/CONTRAST MATERIAL Radiology 1.20 0.44 0.44 RBRVS 70545 TC MRA HEAD W/CONTRAST MATERIAL Radiology a 9.11 9.11 RBRVS 70546 MRA HEAD W/O & W/CONTRAST MATERIAL Radiology a 1.80 14.90 14.90 RBRVS 70546 26 MRA HEAD W/O & W/CONTRAST MATERIAL Radiology 1.80 0.67 0.67 RBRVS 70546 TC MRA HEAD W/O & W/CONTRAST MATERIAL Radiology a 14.23 14.23 RBRVS 70547 MRA NECK W/O CONTRST MATERIAL Radiology a 1.20 9.77 9.77 RBRVS 70547 26 MRA NECK W/O CONTRST MATERIAL Radiology 1.20 0.45 0.45 RBRVS 70547 TC MRA NECK W/O CONTRST MATERIAL Radiology a 9.32 9.32 RBRVS 70548 MRA NECK W/CONTRAST MATERIAL Radiology a 1.20 10.31 10.31 RBRVS 70548 26 MRA NECK W/CONTRAST MATERIAL Radiology 1.20 0.45 0.45 RBRVS 70548 TC MRA NECK W/CONTRAST MATERIAL Radiology a 9.86 9.86 RBRVS 70549 MRA NECK W/O &W/CONTRAST MATERIAL Radiology a 1.80 14.97 14.97 RBRVS 70549 26 MRA NECK W/O &W/CONTRAST MATERIAL Radiology 1.80 0.67 0.67 RBRVS 70549 TC MRA NECK W/O &W/CONTRAST MATERIAL Radiology a 14.30 14.30 RBRVS 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL Radiology a 1.48 4.88 4.88 RBRVS 70551 26 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL Radiology 1.48 0.55 0.55 RBRVS 70551 TC MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL Radiology a 4.33 4.33 RBRVS 70552 MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL Radiology a 1.78 7.07 7.07 RBRVS 70552 26 MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL Radiology 1.78 0.67 0.67 RBRVS 70552 TC MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL Radiology a 6.40 6.40 RBRVS 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL Radiology a 2.29 8.15 8.15 RBRVS 70553 26 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL Radiology 2.29 0.85 0.85 RBRVS 70553 TC MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL Radiology a 7.30 7.30 RBRVS 70554 MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION Radiology a 2.11 10.37 10.37 RBRVS 70554 26 MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION Radiology 2.11 0.80 0.80 RBRVS 70554 TC MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION Radiology a 9.57 9.57 RBRVS 70555 MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION Radiology a 21.35 Global/TC/26 70555 26 MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION Radiology 3.48 Global/TC/26 70555 TC MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION Radiology a 17.87 Global/TC/26 70557 MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL Radiology a 37.06 Global/TC/26 70557 26 MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL Radiology 3.99 Global/TC/26 70557 TC MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL Radiology a 33.07 Global/TC/26 70558 MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL Radiology a 40.63 Global/TC/26 70558 26 MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL Radiology 4.41 Global/TC/26 70558 TC MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL Radiology a 36.22 Global/TC/26 70559 MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST Radiology a 51.80 Global/TC/26

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70559 26 MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST Radiology 4.41 Global/TC/26 70559 TC MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST Radiology a 47.39 Global/TC/26 71010 RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL Radiology a 0.18 0.43 0.43 RBRVS 71010 26 RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL Radiology 0.18 0.07 0.07 RBRVS 71010 TC RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL Radiology a 0.36 0.36 RBRVS 71015 RADIOLOGIC EXAMINATION CHEST STERO FRONTAL Radiology a 0.21 0.54 0.54 RBRVS 71015 26 RADIOLOGIC EXAMINATION CHEST STERO FRONTAL Radiology 0.21 0.09 0.09 RBRVS 71015 TC RADIOLOGIC EXAMINATION CHEST STERO FRONTAL Radiology a 0.45 0.45 RBRVS 71020 RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL Radiology a 0.22 0.54 0.54 RBRVS 71020 26 RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL Radiology 0.22 0.08 0.08 RBRVS 71020 TC RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL Radiology a 0.46 0.46 RBRVS 71021 RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX Radiology a 0.27 0.66 0.66 RBRVS 71021 26 RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX Radiology 0.27 0.11 0.11 RBRVS 71021 TC RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX Radiology a 0.55 0.55 RBRVS 71022 RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ Radiology a 0.31 0.84 0.84 RBRVS 71022 26 RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ Radiology 0.31 0.15 0.15 RBRVS 71022 TC RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ Radiology a 0.69 0.69 RBRVS 71023 RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO Radiology a 0.38 1.36 1.36 RBRVS 71023 26 RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO Radiology 0.38 0.14 0.14 RBRVS 71023 TC RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO Radiology a 1.22 1.22 RBRVS 71030 RADEX CHEST COMPLETE MINIMUM 4 VIEWS Radiology a 0.31 0.83 0.83 RBRVS 71030 26 RADEX CHEST COMPLETE MINIMUM 4 VIEWS Radiology 0.31 0.12 0.12 RBRVS 71030 TC RADEX CHEST COMPLETE MINIMUM 4 VIEWS Radiology a 0.71 0.71 RBRVS 71034 RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO Radiology a 0.46 1.86 1.86 RBRVS 71034 26 RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO Radiology 0.46 0.17 0.17 RBRVS 71034 TC RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO Radiology a 1.69 1.69 RBRVS 71035 RADEX CHEST SPECIAL VIEWS Radiology a 0.18 0.71 0.71 RBRVS 71035 26 RADEX CHEST SPECIAL VIEWS Radiology 0.18 0.07 0.07 RBRVS 71035 TC RADEX CHEST SPECIAL VIEWS Radiology a 0.64 0.64 RBRVS 71100 RADEX RIBS UNILATERAL 2 VIEWS Radiology a 0.22 0.61 0.61 RBRVS 71100 26 RADEX RIBS UNILATERAL 2 VIEWS Radiology 0.22 0.09 0.09 RBRVS 71100 TC RADEX RIBS UNILATERAL 2 VIEWS Radiology a 0.52 0.52 RBRVS 71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS Radiology a 0.27 0.72 0.72 RBRVS 71101 26 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS Radiology 0.27 0.10 0.10 RBRVS 71101 TC RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS Radiology a 0.62 0.62 RBRVS 71110 RADEX RIBS BILATERAL 3 VIEWS Radiology a 0.27 0.75 0.75 RBRVS 71110 26 RADEX RIBS BILATERAL 3 VIEWS Radiology 0.27 0.11 0.11 RBRVS 71110 TC RADEX RIBS BILATERAL 3 VIEWS Radiology a 0.64 0.64 RBRVS 71111 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS Radiology a 0.32 0.98 0.98 RBRVS 71111 26 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS Radiology 0.32 0.13 0.13 RBRVS 71111 TC RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS Radiology a 0.85 0.85 RBRVS 71120 RADEX STERNUM MINIMUM 2 VIEWS Radiology a 0.20 0.60 0.60 RBRVS 71120 26 RADEX STERNUM MINIMUM 2 VIEWS Radiology 0.20 0.08 0.08 RBRVS 71120 TC RADEX STERNUM MINIMUM 2 VIEWS Radiology a 0.52 0.52 RBRVS 71130 RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS Radiology a 0.22 0.76 0.76 RBRVS 71130 26 RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS Radiology 0.22 0.09 0.09 RBRVS 71130 TC RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS Radiology a 0.67 0.67 RBRVS 71250 CT THORAX W/O CONTRAST MATERIAL Radiology a 1.02 3.96 3.96 RBRVS 71250 26 CT THORAX W/O CONTRAST MATERIAL Radiology 1.02 0.38 0.38 RBRVS 71250 TC CT THORAX W/O CONTRAST MATERIAL Radiology a 3.58 3.58 RBRVS 71260 CT THORAX W/CONTRAST MATERIAL Radiology a 1.24 5.11 5.11 RBRVS 71260 26 CT THORAX W/CONTRAST MATERIAL Radiology 1.24 0.47 0.47 RBRVS 71260 TC CT THORAX W/CONTRAST MATERIAL Radiology a 4.64 4.64 RBRVS 71270 CT THORAX W/O & W/CONTRAST MATERIAL Radiology a 1.38 6.24 6.24 RBRVS 71270 26 CT THORAX W/O & W/CONTRAST MATERIAL Radiology 1.38 0.51 0.51 RBRVS 71270 TC CT THORAX W/O & W/CONTRAST MATERIAL Radiology a 5.73 5.73 RBRVS 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Radiology a 1.82 6.47 6.47 RBRVS 71275 26 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Radiology 1.82 0.68 0.68 RBRVS 71275 TC CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Radiology a 5.79 5.79 RBRVS 71550 MRI CHEST W/O CONTRAST MATERIAL Radiology a 1.46 10.06 10.06 RBRVS 71550 26 MRI CHEST W/O CONTRAST MATERIAL Radiology 1.46 0.54 0.54 RBRVS 71550 TC MRI CHEST W/O CONTRAST MATERIAL Radiology a 9.52 9.52 RBRVS 71551 MRI CHEST W/CONTRAST MATERIAL Radiology a 1.73 10.97 10.97 RBRVS 71551 26 MRI CHEST W/CONTRAST MATERIAL Radiology 1.73 0.63 0.63 RBRVS 71551 TC MRI CHEST W/CONTRAST MATERIAL Radiology a 10.34 10.34 RBRVS 71552 MRI CHEST W/O & W/CONTRAST MATERIAL Radiology a 2.26 13.84 13.84 RBRVS 71552 26 MRI CHEST W/O & W/CONTRAST MATERIAL Radiology 2.26 0.84 0.84 RBRVS 71552 TC MRI CHEST W/O & W/CONTRAST MATERIAL Radiology a 13.00 13.00 RBRVS 71555 MRA CHEST W/O & W/CONTRAST MATERIAL Radiology a 1.81 9.23 9.23 RBRVS 71555 26 MRA CHEST W/O & W/CONTRAST MATERIAL Radiology 1.81 0.65 0.65 RBRVS 71555 TC MRA CHEST W/O & W/CONTRAST MATERIAL Radiology a 8.58 8.58 RBRVS 72020 RADEX SPINE 1 VIEW SPECIFY LEVEL Radiology a 0.15 0.44 0.44 RBRVS 72020 26 RADEX SPINE 1 VIEW SPECIFY LEVEL Radiology 0.15 0.06 0.06 RBRVS 72020 TC RADEX SPINE 1 VIEW SPECIFY LEVEL Radiology a 0.38 0.38 RBRVS 72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS Radiology a 0.22 0.68 0.68 RBRVS

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72040 26 RADEX SPINE CERVICAL 2 OR 3 VIEWS Radiology 0.22 0.09 0.09 RBRVS 72040 TC RADEX SPINE CERVICAL 2 OR 3 VIEWS Radiology a 0.59 0.59 RBRVS 72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS Radiology a 0.31 0.91 0.91 RBRVS 72050 26 RADEX SPINE CERVICAL 4 OR 5 VIEWS Radiology 0.31 0.12 0.12 RBRVS 72050 TC RADEX SPINE CERVICAL 4 OR 5 VIEWS Radiology a 0.79 0.79 RBRVS 72052 RADEX SPINE CERVICAL 6 OR MORE VIEWS Radiology a 0.36 1.17 1.17 RBRVS 72052 26 RADEX SPINE CERVICAL 6 OR MORE VIEWS Radiology 0.36 0.14 0.14 RBRVS 72052 TC RADEX SPINE CERVICAL 6 OR MORE VIEWS Radiology a 1.03 1.03 RBRVS 72070 RADEX SPINE THORACIC 2 VIEWS Radiology a 0.22 0.63 0.63 RBRVS 72070 26 RADEX SPINE THORACIC 2 VIEWS Radiology 0.22 0.09 0.09 RBRVS 72070 TC RADEX SPINE THORACIC 2 VIEWS Radiology a 0.54 0.54 RBRVS 72072 RADEX SPINE THORACIC 3 VIEWS Radiology a 0.22 0.72 0.72 RBRVS 72072 26 RADEX SPINE THORACIC 3 VIEWS Radiology 0.22 0.08 0.08 RBRVS 72072 TC RADEX SPINE THORACIC 3 VIEWS Radiology a 0.64 0.64 RBRVS 72074 RADEX SPINE THORACIC MINIMUM 4 VIEWS Radiology a 0.22 0.85 0.85 RBRVS 72074 26 RADEX SPINE THORACIC MINIMUM 4 VIEWS Radiology 0.22 0.08 0.08 RBRVS 72074 TC RADEX SPINE THORACIC MINIMUM 4 VIEWS Radiology a 0.77 0.77 RBRVS 72080 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS Radiology a 0.22 0.68 0.68 RBRVS 72080 26 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS Radiology 0.22 0.09 0.09 RBRVS 72080 TC RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS Radiology a 0.59 0.59 RBRVS 72081 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW Radiology a 0.26 0.80 0.80 RBRVS 72081 26 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW Radiology 0.26 0.10 0.10 RBRVS 72081 TC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW Radiology a 0.70 0.70 RBRVS 72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW Radiology a 0.31 1.41 1.41 RBRVS 72082 26 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW Radiology 0.31 0.13 0.13 RBRVS 72082 TC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW Radiology a 1.28 1.28 RBRVS 72083 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW Radiology a 0.35 1.52 1.52 RBRVS 72083 26 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW Radiology 0.35 0.13 0.13 RBRVS 72083 TC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW Radiology a 1.39 1.39 RBRVS 72084 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW Radiology a 0.41 1.82 1.82 RBRVS 72084 26 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW Radiology 0.41 0.15 0.15 RBRVS 72084 TC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW Radiology a 1.67 1.67 RBRVS 72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS Radiology a 0.22 0.73 0.73 RBRVS 72100 26 RADEX SPINE LUMBOSACRAL 2/3 VIEWS Radiology 0.22 0.09 0.09 RBRVS 72100 TC RADEX SPINE LUMBOSACRAL 2/3 VIEWS Radiology a 0.64 0.64 RBRVS 72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS Radiology a 0.31 1.02 1.02 RBRVS 72110 26 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS Radiology 0.31 0.12 0.12 RBRVS 72110 TC RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS Radiology a 0.90 0.90 RBRVS 72114 RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 Radiology a 0.32 1.39 1.39 RBRVS 72114 26 RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 Radiology 0.32 0.13 0.13 RBRVS 72114 TC RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 Radiology a 1.26 1.26 RBRVS 72120 RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS Radiology a 0.22 0.87 0.87 RBRVS 72120 26 RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS Radiology 0.22 0.09 0.09 RBRVS 72120 TC RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS Radiology a 0.78 0.78 RBRVS 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL Radiology a 1.07 4.03 4.03 RBRVS 72125 26 CT CERVICAL SPINE W/O CONTRAST MATERIAL Radiology 1.07 0.40 0.40 RBRVS 72125 TC CT CERVICAL SPINE W/O CONTRAST MATERIAL Radiology a 3.63 3.63 RBRVS 72126 CT CERVICAL SPINE W/CONTRAST MATERIAL Radiology a 1.22 5.12 5.12 RBRVS 72126 26 CT CERVICAL SPINE W/CONTRAST MATERIAL Radiology 1.22 0.45 0.45 RBRVS 72126 TC CT CERVICAL SPINE W/CONTRAST MATERIAL Radiology a 4.67 4.67 RBRVS 72127 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL Radiology a 1.27 6.23 6.23 RBRVS 72127 26 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL Radiology 1.27 0.47 0.47 RBRVS 72127 TC CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL Radiology a 5.76 5.76 RBRVS 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL Radiology a 1.00 3.98 3.98 RBRVS 72128 26 CT THORACIC SPINE W/O CONTRAST MATERIAL Radiology 1.00 0.37 0.37 RBRVS 72128 TC CT THORACIC SPINE W/O CONTRAST MATERIAL Radiology a 3.61 3.61 RBRVS 72129 CT THORACIC SPINE W/CONTRAST MATERIAL Radiology a 1.22 5.13 5.13 RBRVS 72129 26 CT THORACIC SPINE W/CONTRAST MATERIAL Radiology 1.22 0.45 0.45 RBRVS 72129 TC CT THORACIC SPINE W/CONTRAST MATERIAL Radiology a 4.68 4.68 RBRVS 72130 CT THORACIC SPINE W/O & W/CONTRAST MATERIAL Radiology a 1.27 6.24 6.24 RBRVS 72130 26 CT THORACIC SPINE W/O & W/CONTRAST MATERIAL Radiology 1.27 0.47 0.47 RBRVS 72130 TC CT THORACIC SPINE W/O & W/CONTRAST MATERIAL Radiology a 5.77 5.77 RBRVS 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL Radiology a 1.00 3.95 3.95 RBRVS 72131 26 CT LUMBAR SPINE W/O CONTRAST MATERIAL Radiology 1.00 0.37 0.37 RBRVS 72131 TC CT LUMBAR SPINE W/O CONTRAST MATERIAL Radiology a 3.58 3.58 RBRVS 72132 CT LUMBAR SPINE W/CONTRAST MATERIAL Radiology a 1.22 5.10 5.10 RBRVS 72132 26 CT LUMBAR SPINE W/CONTRAST MATERIAL Radiology 1.22 0.45 0.45 RBRVS 72132 TC CT LUMBAR SPINE W/CONTRAST MATERIAL Radiology a 4.65 4.65 RBRVS 72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL Radiology a 1.27 6.23 6.23 RBRVS 72133 26 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL Radiology 1.27 0.47 0.47 RBRVS 72133 TC CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL Radiology a 5.76 5.76 RBRVS 72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL Radiology a 1.48 4.69 4.69 RBRVS 72141 26 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL Radiology 1.48 0.55 0.55 RBRVS 72141 TC MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL Radiology a 4.14 4.14 RBRVS 72142 MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL Radiology a 1.78 7.18 7.18 RBRVS

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72142 26 MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL Radiology 1.78 0.67 0.67 RBRVS 72142 TC MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL Radiology a 6.51 6.51 RBRVS 72146 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL Radiology a 1.48 4.69 4.69 RBRVS 72146 26 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL Radiology 1.48 0.55 0.55 RBRVS 72146 TC MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL Radiology a 4.14 4.14 RBRVS 72147 MRI SPINAL CANAL THORACIC W/CONTRAST MATRL Radiology a 1.78 7.12 7.12 RBRVS 72147 26 MRI SPINAL CANAL THORACIC W/CONTRAST MATRL Radiology 1.78 0.67 0.67 RBRVS 72147 TC MRI SPINAL CANAL THORACIC W/CONTRAST MATRL Radiology a 6.45 6.45 RBRVS 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL Radiology a 1.48 4.66 4.66 RBRVS 72148 26 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL Radiology 1.48 0.56 0.56 RBRVS 72148 TC MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL Radiology a 4.10 4.10 RBRVS 72149 MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL Radiology a 1.78 7.07 7.07 RBRVS 72149 26 MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL Radiology 1.78 0.67 0.67 RBRVS 72149 TC MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL Radiology a 6.40 6.40 RBRVS 72156 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL Radiology a 2.29 8.21 8.21 RBRVS 72156 26 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL Radiology 2.29 0.85 0.85 RBRVS 72156 TC MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL Radiology a 7.36 7.36 RBRVS 72157 MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL Radiology a 2.29 8.22 8.22 RBRVS 72157 26 MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL Radiology 2.29 0.85 0.85 RBRVS 72157 TC MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL Radiology a 7.37 7.37 RBRVS 72158 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL Radiology a 2.29 8.16 8.16 RBRVS 72158 26 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL Radiology 2.29 0.85 0.85 RBRVS 72158 TC MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL Radiology a 7.31 7.31 RBRVS 72159 MRA SPINAL CANAL W/WO CONTRAST MATERIAL Radiology a 1.80 9.77 9.77 RBRVS 72159 26 MRA SPINAL CANAL W/WO CONTRAST MATERIAL Radiology 1.80 0.68 0.68 RBRVS 72159 TC MRA SPINAL CANAL W/WO CONTRAST MATERIAL Radiology a 9.09 9.09 RBRVS 72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS Radiology a 0.17 0.57 0.57 RBRVS 72170 26 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS Radiology 0.17 0.07 0.07 RBRVS 72170 TC RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS Radiology a 0.50 0.50 RBRVS 72190 RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS Radiology a 0.21 0.83 0.83 RBRVS 72190 26 RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS Radiology 0.21 0.09 0.09 RBRVS 72190 TC RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS Radiology a 0.74 0.74 RBRVS 72191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST Radiology a 1.81 6.60 6.60 RBRVS 72191 26 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST Radiology 1.81 0.66 0.66 RBRVS 72191 TC CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST Radiology a 5.94 5.94 RBRVS 72192 CT PELVIS W/O CONTRAST MATERIAL Radiology a 1.09 2.95 2.95 RBRVS 72192 26 CT PELVIS W/O CONTRAST MATERIAL Radiology 1.09 0.41 0.41 RBRVS 72192 TC CT PELVIS W/O CONTRAST MATERIAL Radiology a 2.54 2.54 RBRVS 72193 CT PELVIS W/CONTRAST MATERIAL Radiology a 1.16 5.09 5.09 RBRVS 72193 26 CT PELVIS W/CONTRAST MATERIAL Radiology 1.16 0.43 0.43 RBRVS 72193 TC CT PELVIS W/CONTRAST MATERIAL Radiology a 4.66 4.66 RBRVS 72194 CT PELVIS W/O & W/CONTRAST MATERIAL Radiology a 1.22 6.00 6.00 RBRVS 72194 26 CT PELVIS W/O & W/CONTRAST MATERIAL Radiology 1.22 0.45 0.45 RBRVS 72194 TC CT PELVIS W/O & W/CONTRAST MATERIAL Radiology a 5.55 5.55 RBRVS 72195 MRI PELVIS W/O CONTRAST MATERIAL Radiology a 1.46 8.98 8.98 RBRVS 72195 26 MRI PELVIS W/O CONTRAST MATERIAL Radiology 1.46 0.55 0.55 RBRVS 72195 TC MRI PELVIS W/O CONTRAST MATERIAL Radiology a 8.43 8.43 RBRVS 72196 MRI PELVIS W/CONTRAST MATERIAL Radiology a 1.73 9.68 9.68 RBRVS 72196 26 MRI PELVIS W/CONTRAST MATERIAL Radiology 1.73 0.65 0.65 RBRVS 72196 TC MRI PELVIS W/CONTRAST MATERIAL Radiology a 9.03 9.03 RBRVS 72197 MRI PELVIS W/O & W/CONTRAST MATERIAL Radiology a 2.26 11.77 11.77 RBRVS 72197 26 MRI PELVIS W/O & W/CONTRAST MATERIAL Radiology 2.26 0.84 0.84 RBRVS 72197 TC MRI PELVIS W/O & W/CONTRAST MATERIAL Radiology a 10.93 10.93 RBRVS 72198 MRA PELVIS W/WO CONTRAST MATERIAL Radiology a 1.80 9.35 9.35 RBRVS 72198 26 MRA PELVIS W/WO CONTRAST MATERIAL Radiology 1.80 0.65 0.65 RBRVS 72198 TC MRA PELVIS W/WO CONTRAST MATERIAL Radiology a 8.70 8.70 RBRVS 72200 RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS Radiology a 0.17 0.60 0.60 RBRVS 72200 26 RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 72200 TC RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS Radiology a 0.53 0.53 RBRVS 72202 RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS Radiology a 0.19 0.71 0.71 RBRVS 72202 26 RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS Radiology 0.19 0.07 0.07 RBRVS 72202 TC RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS Radiology a 0.64 0.64 RBRVS 72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS Radiology a 0.17 0.59 0.59 RBRVS 72220 26 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS Radiology 0.17 0.07 0.07 RBRVS 72220 TC RADEX SACRUM & COCCYX MINIMUM 2 VIEWS Radiology a 0.52 0.52 RBRVS 72240 MYELOGRAPHY CERVICAL RS&I Radiology a 0.91 1.78 1.78 RBRVS 72240 26 MYELOGRAPHY CERVICAL RS&I Radiology 0.91 0.34 0.34 RBRVS 72240 TC MYELOGRAPHY CERVICAL RS&I Radiology a 1.44 1.44 RBRVS 72255 MYELOGRAPHY THORACIC RS&I Radiology a 0.91 1.77 1.77 RBRVS 72255 26 MYELOGRAPHY THORACIC RS&I Radiology 0.91 0.35 0.35 RBRVS 72255 TC MYELOGRAPHY THORACIC RS&I Radiology a 1.42 1.42 RBRVS 72265 MYELOGRAPY LUMBOSACRAL RS&I Radiology a 0.83 1.69 1.69 RBRVS 72265 26 MYELOGRAPY LUMBOSACRAL RS&I Radiology 0.83 0.31 0.31 RBRVS 72265 TC MYELOGRAPY LUMBOSACRAL RS&I Radiology a 1.38 1.38 RBRVS 72270 MYELOGRAPY 2/MORE REGIONS RS&I Radiology a 1.33 2.16 2.16 RBRVS

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72270 26 MYELOGRAPY 2/MORE REGIONS RS&I Radiology 1.33 0.50 0.50 RBRVS 72270 TC MYELOGRAPY 2/MORE REGIONS RS&I Radiology a 1.66 1.66 RBRVS 72275 EPIDUROGRAPY RS&I Radiology a 0.76 2.43 2.43 RBRVS 72275 26 EPIDUROGRAPY RS&I Radiology 0.76 0.32 0.32 RBRVS 72275 TC EPIDUROGRAPY RS&I Radiology a 2.11 2.11 RBRVS 72285 DISKOGRAPY CERVICAL/THORACIC RS&I Radiology a 1.16 1.97 1.97 RBRVS 72285 26 DISKOGRAPY CERVICAL/THORACIC RS&I Radiology 1.16 0.51 0.51 RBRVS 72285 TC DISKOGRAPY CERVICAL/THORACIC RS&I Radiology a 1.46 1.46 RBRVS 72295 DISKOGRAPY LUMBAR RS&I Radiology a 0.83 1.87 1.87 RBRVS 72295 26 DISKOGRAPY LUMBAR RS&I Radiology 0.83 0.35 0.35 RBRVS 72295 TC DISKOGRAPY LUMBAR RS&I Radiology a 1.52 1.52 RBRVS 73000 RADEX CLAVICLE COMPLETE Radiology a 0.16 0.59 0.59 RBRVS 73000 26 RADEX CLAVICLE COMPLETE Radiology 0.16 0.07 0.07 RBRVS 73000 TC RADEX CLAVICLE COMPLETE Radiology a 0.52 0.52 RBRVS 73010 RADEX SCAPULA COMPLETE Radiology a 0.17 0.64 0.64 RBRVS 73010 26 RADEX SCAPULA COMPLETE Radiology 0.17 0.08 0.08 RBRVS 73010 TC RADEX SCAPULA COMPLETE Radiology a 0.56 0.56 RBRVS 73020 RADEX SHOULDER 1 VIEW Radiology a 0.15 0.47 0.47 RBRVS 73020 26 RADEX SHOULDER 1 VIEW Radiology 0.15 0.06 0.06 RBRVS 73020 TC RADEX SHOULDER 1 VIEW Radiology a 0.41 0.41 RBRVS 73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS Radiology a 0.18 0.60 0.60 RBRVS 73030 26 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS Radiology 0.18 0.08 0.08 RBRVS 73030 TC RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS Radiology a 0.52 0.52 RBRVS 73040 RADEX SHOULDER ARTHROGRAPHY RS&I Radiology a 0.54 2.23 2.23 RBRVS 73040 26 RADEX SHOULDER ARTHROGRAPHY RS&I Radiology 0.54 0.21 0.21 RBRVS 73040 TC RADEX SHOULDER ARTHROGRAPHY RS&I Radiology a 2.02 2.02 RBRVS 73050 RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ Radiology a 0.20 0.77 0.77 RBRVS 73050 26 RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ Radiology 0.20 0.09 0.09 RBRVS 73050 TC RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ Radiology a 0.68 0.68 RBRVS 73060 RADEX HUMERUS MINIMUM 2 VIEWS Radiology a 0.17 0.55 0.55 RBRVS 73060 26 RADEX HUMERUS MINIMUM 2 VIEWS Radiology 0.17 0.07 0.07 RBRVS 73060 TC RADEX HUMERUS MINIMUM 2 VIEWS Radiology a 0.48 0.48 RBRVS 73070 RADEX ELBOW 2 VIEWS Radiology a 0.15 0.59 0.59 RBRVS 73070 26 RADEX ELBOW 2 VIEWS Radiology 0.15 0.07 0.07 RBRVS 73070 TC RADEX ELBOW 2 VIEWS Radiology a 0.52 0.52 RBRVS 73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS Radiology a 0.17 0.68 0.68 RBRVS 73080 26 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 73080 TC RADEX ELBOW COMPLETE MINIMUM 3 VIEWS Radiology a 0.61 0.61 RBRVS 73085 RADEX ELBOW ARTHROGRAPHY RS&I Radiology a 0.54 2.18 2.18 RBRVS 73085 26 RADEX ELBOW ARTHROGRAPHY RS&I Radiology 0.54 0.24 0.24 RBRVS 73085 TC RADEX ELBOW ARTHROGRAPHY RS&I Radiology a 1.94 1.94 RBRVS 73090 RADEX FOREARM 2 VIEWS Radiology a 0.16 0.54 0.54 RBRVS 73090 26 RADEX FOREARM 2 VIEWS Radiology 0.16 0.07 0.07 RBRVS 73090 TC RADEX FOREARM 2 VIEWS Radiology a 0.47 0.47 RBRVS 73092 RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS Radiology a 0.16 0.58 0.58 RBRVS 73092 26 RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS Radiology 0.16 0.06 0.06 RBRVS 73092 TC RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS Radiology a 0.52 0.52 RBRVS 73100 RADEX WRIST 2 VIEWS Radiology a 0.16 0.63 0.63 RBRVS 73100 26 RADEX WRIST 2 VIEWS Radiology 0.16 0.07 0.07 RBRVS 73100 TC RADEX WRIST 2 VIEWS Radiology a 0.56 0.56 RBRVS 73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS Radiology a 0.17 0.79 0.79 RBRVS 73110 26 RADEX WRIST COMPLETE MINIMUM 3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 73110 TC RADEX WRIST COMPLETE MINIMUM 3 VIEWS Radiology a 0.72 0.72 RBRVS 73115 RADEX WRIST ARTHROGRAPHY RS&I Radiology a 0.54 2.41 2.41 RBRVS 73115 26 RADEX WRIST ARTHROGRAPHY RS&I Radiology 0.54 0.23 0.23 RBRVS 73115 TC RADEX WRIST ARTHROGRAPHY RS&I Radiology a 2.18 2.18 RBRVS 73120 RADEX HAND 2 VIEWS Radiology a 0.16 0.55 0.55 RBRVS 73120 26 RADEX HAND 2 VIEWS Radiology 0.16 0.07 0.07 RBRVS 73120 TC RADEX HAND 2 VIEWS Radiology a 0.48 0.48 RBRVS 73130 RADEX HAND MINIMUM 3 VIEWS Radiology a 0.17 0.66 0.66 RBRVS 73130 26 RADEX HAND MINIMUM 3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 73130 TC RADEX HAND MINIMUM 3 VIEWS Radiology a 0.59 0.59 RBRVS 73140 RADEX FINGR MINIMUM 2 VIEWS Radiology a 0.13 0.72 0.72 RBRVS 73140 26 RADEX FINGR MINIMUM 2 VIEWS Radiology 0.13 0.06 0.06 RBRVS 73140 TC RADEX FINGR MINIMUM 2 VIEWS Radiology a 0.66 0.66 RBRVS 73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL Radiology a 1.00 3.95 3.95 RBRVS 73200 26 CT UPPER EXTREMITY W/O CONTRAST MATERIAL Radiology 1.00 0.37 0.37 RBRVS 73200 TC CT UPPER EXTREMITY W/O CONTRAST MATERIAL Radiology a 3.58 3.58 RBRVS 73201 CT UPPER EXTREMITY W/CONTRAST MATERIAL Radiology a 1.16 5.00 5.00 RBRVS 73201 26 CT UPPER EXTREMITY W/CONTRAST MATERIAL Radiology 1.16 0.43 0.43 RBRVS 73201 TC CT UPPER EXTREMITY W/CONTRAST MATERIAL Radiology a 4.57 4.57 RBRVS 73202 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL Radiology a 1.22 6.49 6.49 RBRVS 73202 26 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL Radiology 1.22 0.45 0.45 RBRVS 73202 TC CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL Radiology a 6.04 6.04 RBRVS 73206 CT ANGIOGRAPHY UPPER EXTREMITY Radiology a 1.81 7.22 7.22 RBRVS

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73206 26 CT ANGIOGRAPHY UPPER EXTREMITY Radiology 1.81 0.65 0.65 RBRVS 73206 TC CT ANGIOGRAPHY UPPER EXTREMITY Radiology a 6.57 6.57 RBRVS 73218 MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL Radiology a 1.35 8.77 8.77 RBRVS 73218 26 MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL Radiology 1.35 0.50 0.50 RBRVS 73218 TC MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL Radiology a 8.27 8.27 RBRVS 73219 MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL Radiology a 1.62 9.57 9.57 RBRVS 73219 26 MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL Radiology 1.62 0.60 0.60 RBRVS 73219 TC MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL Radiology a 8.97 8.97 RBRVS 73220 MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS Radiology a 2.15 11.71 11.71 RBRVS 73220 26 MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS Radiology 2.15 0.80 0.80 RBRVS 73220 TC MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS Radiology a 10.91 10.91 RBRVS 73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL Radiology a 1.35 5.17 5.17 RBRVS 73221 26 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL Radiology 1.35 0.52 0.52 RBRVS 73221 TC MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL Radiology a 4.65 4.65 RBRVS 73222 MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL Radiology a 1.62 8.89 8.89 RBRVS 73222 26 MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL Radiology 1.62 0.61 0.61 RBRVS 73222 TC MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL Radiology a 8.28 8.28 RBRVS 73223 MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL Radiology a 2.15 10.86 10.86 RBRVS 73223 26 MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL Radiology 2.15 0.80 0.80 RBRVS 73223 TC MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL Radiology a 10.06 10.06 RBRVS 73225 MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL Radiology a 1.73 9.46 9.46 RBRVS 73225 26 MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL Radiology 1.73 0.59 0.59 RBRVS 73225 TC MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL Radiology a 8.87 8.87 RBRVS 73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW Radiology a 0.18 0.64 0.64 RBRVS 73501 26 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW Radiology 0.18 0.08 0.08 RBRVS 73501 TC RADEX HIP UNILATERAL WITH PELVIS 1 VIEW Radiology a 0.56 0.56 RBRVS 73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS Radiology a 0.22 0.92 0.92 RBRVS 73502 26 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS Radiology 0.22 0.09 0.09 RBRVS 73502 TC RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS Radiology a 0.83 0.83 RBRVS 73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS Radiology a 0.27 1.15 1.15 RBRVS 73503 26 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS Radiology 0.27 0.12 0.12 RBRVS 73503 TC RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS Radiology a 1.03 1.03 RBRVS 73521 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS Radiology a 0.22 0.88 0.88 RBRVS 73521 26 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS Radiology 0.22 0.10 0.10 RBRVS 73521 TC RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS Radiology a 0.78 0.78 RBRVS 73522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS Radiology a 0.29 1.05 1.05 RBRVS 73522 26 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS Radiology 0.29 0.12 0.12 RBRVS 73522 TC RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS Radiology a 0.93 0.93 RBRVS 73523 RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS Radiology a 0.31 1.25 1.25 RBRVS 73523 26 RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS Radiology 0.31 0.13 0.13 RBRVS 73523 TC RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS Radiology a 1.12 1.12 RBRVS 73525 RADEX HIP ARTHROGRAPHY RS&I Radiology a 0.54 2.26 2.26 RBRVS 73525 26 RADEX HIP ARTHROGRAPHY RS&I Radiology 0.54 0.24 0.24 RBRVS 73525 TC RADEX HIP ARTHROGRAPHY RS&I Radiology a 2.02 2.02 RBRVS 73551 RADIOLOGIC EXAMINATION FEMUR 1 VIEW Radiology a 0.16 0.60 0.60 RBRVS 73551 26 RADIOLOGIC EXAMINATION FEMUR 1 VIEW Radiology 0.16 0.07 0.07 RBRVS 73551 TC RADIOLOGIC EXAMINATION FEMUR 1 VIEW Radiology a 0.53 0.53 RBRVS 73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS Radiology a 0.18 0.71 0.71 RBRVS 73552 26 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS Radiology 0.18 0.08 0.08 RBRVS 73552 TC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS Radiology a 0.63 0.63 RBRVS 73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS Radiology a 0.17 0.62 0.62 RBRVS 73560 26 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS Radiology 0.17 0.08 0.08 RBRVS 73560 TC RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS Radiology a 0.54 0.54 RBRVS 73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS Radiology a 0.18 0.75 0.75 RBRVS 73562 26 RADIOLOGIC EXAMINATION KNEE 3 VIEWS Radiology 0.18 0.08 0.08 RBRVS 73562 TC RADIOLOGIC EXAMINATION KNEE 3 VIEWS Radiology a 0.67 0.67 RBRVS 73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS Radiology a 0.22 0.86 0.86 RBRVS 73564 26 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS Radiology 0.22 0.09 0.09 RBRVS 73564 TC RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS Radiology a 0.77 0.77 RBRVS 73565 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST Radiology a 0.17 0.72 0.72 RBRVS 73565 26 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST Radiology 0.17 0.08 0.08 RBRVS 73565 TC RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST Radiology a 0.64 0.64 RBRVS 73580 RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I Radiology a 0.54 2.64 2.64 RBRVS 73580 26 RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I Radiology 0.54 0.23 0.23 RBRVS 73580 TC RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I Radiology a 2.41 2.41 RBRVS 73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS Radiology a 0.17 0.55 0.55 RBRVS 73590 26 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS Radiology 0.17 0.07 0.07 RBRVS 73590 TC RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS Radiology a 0.48 0.48 RBRVS 73592 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS Radiology a 0.16 0.58 0.58 RBRVS 73592 26 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS Radiology 0.16 0.06 0.06 RBRVS 73592 TC RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS Radiology a 0.52 0.52 RBRVS 73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS Radiology a 0.16 0.58 0.58 RBRVS 73600 26 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS Radiology 0.16 0.07 0.07 RBRVS 73600 TC RADIOLOGIC EXAMINATION ANKLE 2 VIEWS Radiology a 0.51 0.51 RBRVS 73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS Radiology a 0.17 0.68 0.68 RBRVS

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73610 26 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS Radiology 0.17 0.07 0.07 RBRVS 73610 TC RADEX ANKLE COMPLETE MINIMUM 3 VIEWS Radiology a 0.61 0.61 RBRVS 73615 RADEX ANKLE ARTHROGRAPHY RS&I Radiology a 0.54 2.17 2.17 RBRVS 73615 26 RADEX ANKLE ARTHROGRAPHY RS&I Radiology 0.54 0.24 0.24 RBRVS 73615 TC RADEX ANKLE ARTHROGRAPHY RS&I Radiology a 1.93 1.93 RBRVS 73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS Radiology a 0.16 0.54 0.54 RBRVS 73620 26 RADIOLOGIC EXAMINATION FOOT 2 VIEWS Radiology 0.16 0.05 0.05 RBRVS 73620 TC RADIOLOGIC EXAMINATION FOOT 2 VIEWS Radiology a 0.49 0.49 RBRVS 73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS Radiology a 0.17 0.62 0.62 RBRVS 73630 26 RADEX FOOT COMPLETE MINIMUM 3 VIEWS Radiology 0.17 0.06 0.06 RBRVS 73630 TC RADEX FOOT COMPLETE MINIMUM 3 VIEWS Radiology a 0.56 0.56 RBRVS 73650 RADEX CALCANEUS MINIMUM 2 VIEWS Radiology a 0.16 0.57 0.57 RBRVS 73650 26 RADEX CALCANEUS MINIMUM 2 VIEWS Radiology 0.16 0.06 0.06 RBRVS 73650 TC RADEX CALCANEUS MINIMUM 2 VIEWS Radiology a 0.51 0.51 RBRVS 73660 RADEX TOE MINIMUM 2 VIEWS Radiology a 0.13 0.63 0.63 RBRVS 73660 26 RADEX TOE MINIMUM 2 VIEWS Radiology 0.13 0.05 0.05 RBRVS 73660 TC RADEX TOE MINIMUM 2 VIEWS Radiology a 0.58 0.58 RBRVS 73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL Radiology a 1.00 3.95 3.95 RBRVS 73700 26 CT LOWER EXTREMITY W/O CONTRAST MATERIAL Radiology 1.00 0.37 0.37 RBRVS 73700 TC CT LOWER EXTREMITY W/O CONTRAST MATERIAL Radiology a 3.58 3.58 RBRVS 73701 CT LOWER EXTREMITY W/CONTRAST MATERIAL Radiology a 1.16 5.09 5.09 RBRVS 73701 26 CT LOWER EXTREMITY W/CONTRAST MATERIAL Radiology 1.16 0.43 0.43 RBRVS 73701 TC CT LOWER EXTREMITY W/CONTRAST MATERIAL Radiology a 4.66 4.66 RBRVS 73702 CT LOWER EXTREMITY W/O & W/CONTRAST MATRL Radiology a 1.22 6.37 6.37 RBRVS 73702 26 CT LOWER EXTREMITY W/O & W/CONTRAST MATRL Radiology 1.22 0.44 0.44 RBRVS 73702 TC CT LOWER EXTREMITY W/O & W/CONTRAST MATRL Radiology a 5.93 5.93 RBRVS 73706 CT ANGIOGRAPHY LOWER EXTREMITY Radiology a 1.90 7.83 7.83 RBRVS 73706 26 CT ANGIOGRAPHY LOWER EXTREMITY Radiology 1.90 0.69 0.69 RBRVS 73706 TC CT ANGIOGRAPHY LOWER EXTREMITY Radiology a 7.14 7.14 RBRVS 73718 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL Radiology a 1.35 8.79 8.79 RBRVS 73718 26 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL Radiology 1.35 0.50 0.50 RBRVS 73718 TC MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL Radiology a 8.29 8.29 RBRVS 73719 MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL Radiology a 1.62 9.61 9.61 RBRVS 73719 26 MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL Radiology 1.62 0.60 0.60 RBRVS 73719 TC MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL Radiology a 9.01 9.01 RBRVS 73720 MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR Radiology a 2.15 11.80 11.80 RBRVS 73720 26 MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR Radiology 2.15 0.80 0.80 RBRVS 73720 TC MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR Radiology a 11.00 11.00 RBRVS 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL Radiology a 1.35 5.16 5.16 RBRVS 73721 26 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL Radiology 1.35 0.51 0.51 RBRVS 73721 TC MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL Radiology a 4.65 4.65 RBRVS 73722 MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL Radiology a 1.62 8.97 8.97 RBRVS 73722 26 MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL Radiology 1.62 0.61 0.61 RBRVS 73722 TC MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL Radiology a 8.36 8.36 RBRVS 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL Radiology a 2.15 10.92 10.92 RBRVS 73723 26 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL Radiology 2.15 0.80 0.80 RBRVS 73723 TC MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL Radiology a 10.12 10.12 RBRVS 73725 MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL Radiology a 1.82 9.36 9.36 RBRVS 73725 26 MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL Radiology 1.82 0.65 0.65 RBRVS 73725 TC MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL Radiology a 8.71 8.71 RBRVS 74000 RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW Radiology a 0.18 0.46 0.46 RBRVS 74000 26 RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW Radiology 0.18 0.07 0.07 RBRVS 74000 TC RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW Radiology a 0.39 0.39 RBRVS 74010 RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS Radiology a 0.23 0.73 0.73 RBRVS 74010 26 RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS Radiology 0.23 0.09 0.09 RBRVS 74010 TC RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS Radiology a 0.64 0.64 RBRVS 74020 RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS Radiology a 0.27 0.75 0.75 RBRVS 74020 26 RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS Radiology 0.27 0.10 0.10 RBRVS 74020 TC RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS Radiology a 0.65 0.65 RBRVS 74022 RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH Radiology a 0.32 0.89 0.89 RBRVS 74022 26 RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH Radiology 0.32 0.12 0.12 RBRVS 74022 TC RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH Radiology a 0.77 0.77 RBRVS 74150 CT ABDOMEN W/O CONTRAST MATERIAL Radiology a 1.19 2.94 2.94 RBRVS 74150 26 CT ABDOMEN W/O CONTRAST MATERIAL Radiology 1.19 0.44 0.44 RBRVS 74150 TC CT ABDOMEN W/O CONTRAST MATERIAL Radiology a 2.50 2.50 RBRVS 74160 CT ABDOMEN W/CONTRAST MATERIAL Radiology a 1.27 5.12 5.12 RBRVS 74160 26 CT ABDOMEN W/CONTRAST MATERIAL Radiology 1.27 0.48 0.48 RBRVS 74160 TC CT ABDOMEN W/CONTRAST MATERIAL Radiology a 4.64 4.64 RBRVS 74170 CT ABDOMEN W/O & W/CONTRAST MATERIAL Radiology a 1.40 5.87 5.87 RBRVS 74170 26 CT ABDOMEN W/O & W/CONTRAST MATERIAL Radiology 1.40 0.52 0.52 RBRVS 74170 TC CT ABDOMEN W/O & W/CONTRAST MATERIAL Radiology a 5.35 5.35 RBRVS 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG Radiology a 2.20 8.54 8.54 RBRVS 74174 26 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG Radiology 2.20 0.79 0.79 RBRVS 74174 TC CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG Radiology a 7.75 7.75 RBRVS 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST Radiology a 1.82 6.66 6.66 RBRVS

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74175 26 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST Radiology 1.82 0.66 0.66 RBRVS 74175 TC CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST Radiology a 6.00 6.00 RBRVS 74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL Radiology a 1.74 3.77 3.77 RBRVS 74176 26 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL Radiology 1.74 0.65 0.65 RBRVS 74176 TC CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL Radiology a 3.12 3.12 RBRVS 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL Radiology a 1.82 6.80 6.80 RBRVS 74177 26 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL Radiology 1.82 0.68 0.68 RBRVS 74177 TC CT ABDOMEN & PELVIS W/CONTRAST MATERIAL Radiology a 6.12 6.12 RBRVS 74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE Radiology a 2.01 7.76 7.76 RBRVS 74178 26 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE Radiology 2.01 0.75 0.75 RBRVS 74178 TC CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE Radiology a 7.01 7.01 RBRVS 74181 MRI ABDOMEN W/O CONTRAST MATERIAL Radiology a 1.46 7.78 7.78 RBRVS 74181 26 MRI ABDOMEN W/O CONTRAST MATERIAL Radiology 1.46 0.54 0.54 RBRVS 74181 TC MRI ABDOMEN W/O CONTRAST MATERIAL Radiology a 7.24 7.24 RBRVS 74182 MRI ABDOMEN W/CONTRAST MATERIAL Radiology a 1.73 10.90 10.90 RBRVS 74182 26 MRI ABDOMEN W/CONTRAST MATERIAL Radiology 1.73 0.64 0.64 RBRVS 74182 TC MRI ABDOMEN W/CONTRAST MATERIAL Radiology a 10.26 10.26 RBRVS 74183 MRI ABDOMEN W/O & W/CONTRAST MATERIAL Radiology a 2.26 11.80 11.80 RBRVS 74183 26 MRI ABDOMEN W/O & W/CONTRAST MATERIAL Radiology 2.26 0.84 0.84 RBRVS 74183 TC MRI ABDOMEN W/O & W/CONTRAST MATERIAL Radiology a 10.96 10.96 RBRVS 74185 MRA ABDOMEN W/WO CONTRAST MATERIAL Radiology a 1.80 9.38 9.38 RBRVS 74185 26 MRA ABDOMEN W/WO CONTRAST MATERIAL Radiology 1.80 0.65 0.65 RBRVS 74185 TC MRA ABDOMEN W/WO CONTRAST MATERIAL Radiology a 8.73 8.73 RBRVS 74190 PERITONEOGRAM RS&I Radiology a 1.37 Global/TC/26 74190 26 PERITONEOGRAM RS&I Radiology 0.64 Global/TC/26 74190 TC PERITONEOGRAM RS&I Radiology a 0.73 Global/TC/26 74210 RADEX PHARYNX&/CERVICAL ESOPHAGUS Radiology a 0.36 1.78 1.78 RBRVS 74210 26 RADEX PHARYNX&/CERVICAL ESOPHAGUS Radiology 0.36 0.13 0.13 RBRVS 74210 TC RADEX PHARYNX&/CERVICAL ESOPHAGUS Radiology a 1.65 1.65 RBRVS 74220 RADEX ESOPHAGUS Radiology a 0.46 1.98 1.98 RBRVS 74220 26 RADEX ESOPHAGUS Radiology 0.46 0.17 0.17 RBRVS 74220 TC RADEX ESOPHAGUS Radiology a 1.81 1.81 RBRVS 74230 SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG Radiology a 0.53 3.03 3.03 RBRVS 74230 26 SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG Radiology 0.53 0.20 0.20 RBRVS 74230 TC SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG Radiology a 2.83 2.83 RBRVS 74235 RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I Radiology a 4.99 Global/TC/26 74235 26 RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I Radiology 1.73 Global/TC/26 74235 TC RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I Radiology a 3.26 Global/TC/26 74240 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB Radiology a 0.69 2.44 2.44 RBRVS 74240 26 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB Radiology 0.69 0.26 0.26 RBRVS 74240 TC RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB Radiology a 2.18 2.18 RBRVS 74241 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB Radiology a 0.69 2.56 2.56 RBRVS 74241 26 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB Radiology 0.69 0.26 0.26 RBRVS 74241 TC RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB Radiology a 2.30 2.30 RBRVS 74245 RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES Radiology a 0.91 3.83 3.83 RBRVS 74245 26 RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES Radiology 0.91 0.34 0.34 RBRVS 74245 TC RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES Radiology a 3.49 3.49 RBRVS 74246 RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB Radiology a 0.69 2.83 2.83 RBRVS 74246 26 RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB Radiology 0.69 0.26 0.26 RBRVS 74246 TC RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB Radiology a 2.57 2.57 RBRVS 74247 RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB Radiology a 0.69 3.21 3.21 RBRVS 74247 26 RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB Radiology 0.69 0.26 0.26 RBRVS 74247 TC RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB Radiology a 2.95 2.95 RBRVS 74249 RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU Radiology a 0.91 4.17 4.17 RBRVS 74249 26 RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU Radiology 0.91 0.34 0.34 RBRVS 74249 TC RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU Radiology a 3.83 3.83 RBRVS 74250 RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES Radiology a 0.47 2.41 2.41 RBRVS 74250 26 RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES Radiology 0.47 0.18 0.18 RBRVS 74250 TC RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES Radiology a 2.23 2.23 RBRVS 74251 RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE Radiology a 0.69 10.99 10.99 RBRVS 74251 26 RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE Radiology 0.69 0.26 0.26 RBRVS 74251 TC RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE Radiology a 10.73 10.73 RBRVS 74260 DUODENOGRAPY HYPOTONIC Radiology a 0.50 9.26 9.26 RBRVS 74260 26 DUODENOGRAPY HYPOTONIC Radiology 0.50 0.19 0.19 RBRVS 74260 TC DUODENOGRAPY HYPOTONIC Radiology a 9.07 9.07 RBRVS 74261 CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST Radiology a 2.40 11.07 11.07 RBRVS 74261 26 CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST Radiology 2.40 0.90 0.90 RBRVS 74261 TC CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST Radiology a 10.17 10.17 RBRVS 74262 CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST Radiology a 2.50 12.57 12.57 RBRVS 74262 26 CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST Radiology 2.50 0.93 0.93 RBRVS 74262 TC CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST Radiology a 11.64 11.64 RBRVS 74263 CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING Radiology a 2.28 18.78 18.78 RBRVS 74263 26 CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING Radiology 2.28 0.87 0.87 RBRVS 74263 TC CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING Radiology a 17.91 17.91 RBRVS 74270 RADEX COLON BARIUM ENEMA W/WO KUB Radiology a 0.69 3.46 3.46 RBRVS

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74270 26 RADEX COLON BARIUM ENEMA W/WO KUB Radiology 0.69 0.26 0.26 RBRVS 74270 TC RADEX COLON BARIUM ENEMA W/WO KUB Radiology a 3.20 3.20 RBRVS 74280 RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON Radiology a 0.99 4.89 4.89 RBRVS 74280 26 RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON Radiology 0.99 0.37 0.37 RBRVS 74280 TC RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON Radiology a 4.52 4.52 RBRVS 74283 THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ Radiology a 2.02 3.61 3.61 RBRVS 74283 26 THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ Radiology 2.02 0.77 0.77 RBRVS 74283 TC THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ Radiology a 2.84 2.84 RBRVS 74290 CHOLECYSTOGRAPHY ORAL CONTRST Radiology a 0.32 1.61 1.61 RBRVS 74290 26 CHOLECYSTOGRAPHY ORAL CONTRST Radiology 0.32 0.12 0.12 RBRVS 74290 TC CHOLECYSTOGRAPHY ORAL CONTRST Radiology a 1.49 1.49 RBRVS 74300 CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I Radiology a 1.54 Global/TC/26 74300 26 CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I Radiology 0.49 Global/TC/26 74300 TC CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I Radiology a 1.05 Global/TC/26 74301 CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS Radiology a 1.05 Global/TC/26 74301 26 CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS Radiology 0.28 Global/TC/26 74301 TC CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS Radiology a 0.77 Global/TC/26 74328 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I Radiology a 3.66 Global/TC/26 74328 26 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I Radiology 0.98 Global/TC/26 74328 TC ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I Radiology a 2.68 Global/TC/26 74329 ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I Radiology a 2.98 Global/TC/26 74329 26 ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I Radiology 0.98 Global/TC/26 74329 TC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I Radiology a 2.00 Global/TC/26 74330 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I Radiology a 4.47 Global/TC/26 74330 26 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I Radiology 1.25 Global/TC/26 74330 TC CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I Radiology a 3.22 Global/TC/26 74340 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I Radiology a 2.17 Global/TC/26 74340 26 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I Radiology 0.74 Global/TC/26 74340 TC INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I Radiology a 1.43 Global/TC/26 74355 PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I Radiology a 0.76 3.17 3.17 ERBRVS 74355 26 PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I Radiology 0.76 0.29 0.29 RBRVS 74355 TC PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I Radiology a 2.88 2.88 ERBRVS 74360 INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I Radiology a 3.32 Global/TC/26 74360 26 INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I Radiology 0.76 Global/TC/26 74360 TC INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I Radiology a 2.56 Global/TC/26 74363 PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I Radiology a 3.17 Global/TC/26 74363 26 PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I Radiology 1.17 Global/TC/26 74363 TC PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I Radiology a 2.00 Global/TC/26 74400 UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY Radiology a 0.49 2.54 2.54 RBRVS 74400 26 UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY Radiology 0.49 0.18 0.18 RBRVS 74400 TC UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY Radiology a 2.36 2.36 RBRVS 74410 UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE Radiology a 0.49 2.47 2.47 RBRVS 74410 26 UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE Radiology 0.49 0.17 0.17 RBRVS 74410 TC UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE Radiology a 2.30 2.30 RBRVS 74415 UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO Radiology a 0.49 3.30 3.30 RBRVS 74415 26 UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO Radiology 0.49 0.18 0.18 RBRVS 74415 TC UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO Radiology a 3.12 3.12 RBRVS 74420 X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL Radiology a 2.53 Global/TC/26 74420 26 X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL Radiology 0.49 Global/TC/26 74420 TC X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL Radiology a 2.04 Global/TC/26 74425 UROGRAPHY ANTEGRADE RS&I Radiology a 1.83 Global/TC/26 74425 26 UROGRAPHY ANTEGRADE RS&I Radiology 0.48 Global/TC/26 74425 TC UROGRAPHY ANTEGRADE RS&I Radiology a 1.35 Global/TC/26 74430 CYSTOGRAPHY MINIMUM 3 VIEWS RS&I Radiology a 0.32 0.70 0.70 RBRVS 74430 26 CYSTOGRAPHY MINIMUM 3 VIEWS RS&I Radiology 0.32 0.12 0.12 RBRVS 74430 TC CYSTOGRAPHY MINIMUM 3 VIEWS RS&I Radiology a 0.58 0.58 RBRVS 74440 VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I Radiology a 0.38 1.83 1.83 RBRVS 74440 26 VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I Radiology 0.38 0.13 0.13 RBRVS 74440 TC VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I Radiology a 1.70 1.70 RBRVS 74445 CORPORA CAVERNOSOGRAPY RS&I Radiology a 2.95 Global/TC/26 74445 26 CORPORA CAVERNOSOGRAPY RS&I Radiology 1.54 Global/TC/26 74445 TC CORPORA CAVERNOSOGRAPY RS&I Radiology a 1.41 Global/TC/26 74450 URETHROCYSTOGRAPHY RETROGRADE RS&I Radiology a 2.06 Global/TC/26 74450 26 URETHROCYSTOGRAPHY RETROGRADE RS&I Radiology 0.45 Global/TC/26 74450 TC URETHROCYSTOGRAPHY RETROGRADE RS&I Radiology a 1.61 Global/TC/26 74455 URETHROCYSTOGRAPHY VOIDING RS&I Radiology a 0.33 1.93 1.93 RBRVS 74455 26 URETHROCYSTOGRAPHY VOIDING RS&I Radiology 0.33 0.12 0.12 RBRVS 74455 TC URETHROCYSTOGRAPHY VOIDING RS&I Radiology a 1.81 1.81 RBRVS 74470 RADEX RENAL CYST STUDY TRANSLUMBAR RS&I Radiology a 2.44 Global/TC/26 74470 26 RADEX RENAL CYST STUDY TRANSLUMBAR RS&I Radiology 0.70 Global/TC/26 74470 TC RADEX RENAL CYST STUDY TRANSLUMBAR RS&I Radiology a 1.74 Global/TC/26 74485 DILATION NEPHROSTOMY/URETER/URETHRA RS&I Radiology a 0.54 2.01 2.01 RBRVS 74485 26 DILATION NEPHROSTOMY/URETER/URETHRA RS&I Radiology 0.54 0.18 0.18 RBRVS 74485 TC DILATION NEPHROSTOMY/URETER/URETHRA RS&I Radiology a 1.83 1.83 RBRVS 74710 PELVIMETRY W/WOPLACENTAL LOCALIZATION Radiology a 0.34 0.75 0.75 RBRVS

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74710 26 PELVIMETRY W/WOPLACENTAL LOCALIZATION Radiology 0.34 0.14 0.14 RBRVS 74710 TC PELVIMETRY W/WOPLACENTAL LOCALIZATION Radiology a 0.61 0.61 RBRVS 74712 FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES Radiology a 3.00 10.34 10.34 RBRVS 74712 26 FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES Radiology 3.00 1.12 1.12 RBRVS 74712 TC FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES Radiology a 9.22 9.22 RBRVS 74713 FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES Radiology 1.78 4.61 4.61 RBRVS 74713 26 FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES Radiology 1.78 0.66 0.66 RBRVS 74713 TC FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES Radiology 3.95 3.95 RBRVS 74740 HYSTEROSALPINGOGRAPHY RS&I Radiology a 0.38 1.69 1.69 RBRVS 74740 26 HYSTEROSALPINGOGRAPHY RS&I Radiology 0.38 0.14 0.14 RBRVS 74740 TC HYSTEROSALPINGOGRAPHY RS&I Radiology a 1.55 1.55 RBRVS 74742 TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I Radiology a 3.06 Global/TC/26 74742 26 TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I Radiology 0.84 Global/TC/26 74742 TC TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I Radiology a 2.22 Global/TC/26 74775 PERINEOGRAM Radiology a 3.38 Global/TC/26 74775 26 PERINEOGRAM Radiology 0.85 Global/TC/26 74775 TC PERINEOGRAM Radiology a 2.53 Global/TC/26 75557 CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST Radiology a 2.35 6.44 6.44 RBRVS 75557 26 CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST Radiology 2.35 0.84 0.84 RBRVS 75557 TC CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST Radiology a 5.60 5.60 RBRVS 75559 CARDIAC MRI W/O CONTRAST W/STRESS IMAGING Radiology a 2.95 9.08 9.08 RBRVS 75559 26 CARDIAC MRI W/O CONTRAST W/STRESS IMAGING Radiology 2.95 1.00 1.00 RBRVS 75559 TC CARDIAC MRI W/O CONTRAST W/STRESS IMAGING Radiology a 8.08 8.08 RBRVS 75561 CARDIAC MRI W/WO CONTRAST & FURTHER SEQ Radiology a 2.60 9.15 9.15 RBRVS 75561 26 CARDIAC MRI W/WO CONTRAST & FURTHER SEQ Radiology 2.60 0.92 0.92 RBRVS 75561 TC CARDIAC MRI W/WO CONTRAST & FURTHER SEQ Radiology a 8.23 8.23 RBRVS 75563 CARDIAC MRI W/W/O CONTRAST W/STRESS Radiology a 3.00 10.96 10.96 RBRVS 75563 26 CARDIAC MRI W/W/O CONTRAST W/STRESS Radiology 3.00 1.06 1.06 RBRVS 75563 TC CARDIAC MRI W/W/O CONTRAST W/STRESS Radiology a 9.90 9.90 RBRVS 75565 CARDIAC MRI FOR VELOCITY FLOW MAPPING Radiology a 0.25 1.28 1.28 RBRVS 75565 26 CARDIAC MRI FOR VELOCITY FLOW MAPPING Radiology 0.25 0.09 0.09 RBRVS 75565 TC CARDIAC MRI FOR VELOCITY FLOW MAPPING Radiology a 1.19 1.19 RBRVS 75571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM Radiology a 0.58 2.20 2.20 RBRVS 75571 26 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM Radiology 0.58 0.21 0.21 RBRVS 75571 TC CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM Radiology a 1.99 1.99 RBRVS 75572 CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH Radiology a 1.75 6.12 6.12 RBRVS 75572 26 CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH Radiology 1.75 0.63 0.63 RBRVS 75572 TC CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH Radiology a 5.49 5.49 RBRVS 75573 CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D Radiology a 2.55 8.24 8.24 RBRVS 75573 26 CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D Radiology 2.55 0.90 0.90 RBRVS 75573 TC CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D Radiology a 7.34 7.34 RBRVS 75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST Radiology a 2.40 9.21 9.21 RBRVS 75574 26 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST Radiology 2.40 0.85 0.85 RBRVS 75574 TC CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST Radiology a 8.36 8.36 RBRVS 75600 AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I Radiology a 0.49 5.02 5.02 RBRVS 75600 26 AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I Radiology 0.49 0.15 0.15 RBRVS 75600 TC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I Radiology a 4.87 4.87 RBRVS 75605 AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I Radiology a 1.14 2.65 2.65 RBRVS 75605 26 AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I Radiology 1.14 0.35 0.35 RBRVS 75605 TC AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I Radiology a 2.30 2.30 RBRVS 75625 AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I Radiology a 1.14 2.61 2.61 RBRVS 75625 26 AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I Radiology 1.14 0.32 0.32 RBRVS 75625 TC AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I Radiology a 2.29 2.29 RBRVS 75630 AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I Radiology a 1.79 2.83 2.83 RBRVS 75630 26 AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I Radiology 1.79 0.54 0.54 RBRVS 75630 TC AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I Radiology a 2.29 2.29 RBRVS 75635 CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP Radiology a 2.40 8.08 8.08 RBRVS 75635 26 CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP Radiology 2.40 0.86 0.86 RBRVS 75635 TC CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP Radiology a 7.22 7.22 RBRVS 75658 ANIOGRAPHY BRACHIAL RETROGRADE RS&I Radiology a 1.31 3.16 3.16 RBRVS 75658 26 ANIOGRAPHY BRACHIAL RETROGRADE RS&I Radiology 1.31 0.35 0.35 RBRVS 75658 TC ANIOGRAPHY BRACHIAL RETROGRADE RS&I Radiology a 2.81 2.81 RBRVS 75705 ANGIOGRAPHY SPINAL SELECTIVE RS&I Radiology a 2.18 4.35 4.35 RBRVS 75705 26 ANGIOGRAPHY SPINAL SELECTIVE RS&I Radiology 2.18 0.77 0.77 RBRVS 75705 TC ANGIOGRAPHY SPINAL SELECTIVE RS&I Radiology a 3.58 3.58 RBRVS 75710 ANGIOGRAPHY EXTREMITY UNILATERAL RS&I Radiology a 1.14 3.30 3.30 RBRVS 75710 26 ANGIOGRAPHY EXTREMITY UNILATERAL RS&I Radiology 1.14 0.33 0.33 RBRVS 75710 TC ANGIOGRAPHY EXTREMITY UNILATERAL RS&I Radiology a 2.97 2.97 RBRVS 75716 ANGIOGRAPHY EXTREMITY BILATERAL RS&I Radiology a 1.31 3.77 3.77 RBRVS 75716 26 ANGIOGRAPHY EXTREMITY BILATERAL RS&I Radiology 1.31 0.38 0.38 RBRVS 75716 TC ANGIOGRAPHY EXTREMITY BILATERAL RS&I Radiology a 3.39 3.39 RBRVS 75726 ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I Radiology a 1.14 2.97 2.97 RBRVS 75726 26 ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I Radiology 1.14 0.36 0.36 RBRVS 75726 TC ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I Radiology a 2.61 2.61 RBRVS 75731 ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I Radiology a 1.14 3.60 3.60 RBRVS

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75731 26 ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I Radiology 1.14 0.43 0.43 RBRVS 75731 TC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I Radiology a 3.17 3.17 RBRVS 75733 ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I Radiology a 1.31 3.76 3.76 RBRVS 75733 26 ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I Radiology 1.31 0.45 0.45 RBRVS 75733 TC ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I Radiology a 3.31 3.31 RBRVS 75736 ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I Radiology a 1.14 3.25 3.25 RBRVS 75736 26 ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I Radiology 1.14 0.34 0.34 RBRVS 75736 TC ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I Radiology a 2.91 2.91 RBRVS 75741 ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I Radiology a 1.31 2.87 2.87 RBRVS 75741 26 ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I Radiology 1.31 0.42 0.42 RBRVS 75741 TC ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I Radiology a 2.45 2.45 RBRVS 75743 ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I Radiology a 1.66 3.01 3.01 RBRVS 75743 26 ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I Radiology 1.66 0.53 0.53 RBRVS 75743 TC ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I Radiology a 2.48 2.48 RBRVS 75746 ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I Radiology a 1.14 3.12 3.12 RBRVS 75746 26 ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I Radiology 1.14 0.40 0.40 RBRVS 75746 TC ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I Radiology a 2.72 2.72 RBRVS 75756 ANGIOGRAPHY INTERNAL MAMMARY RS&I Radiology a 1.14 3.41 3.41 RBRVS 75756 26 ANGIOGRAPHY INTERNAL MAMMARY RS&I Radiology 1.14 0.32 0.32 RBRVS 75756 TC ANGIOGRAPHY INTERNAL MAMMARY RS&I Radiology a 3.09 3.09 RBRVS 75774 ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I Radiology a 0.36 2.06 2.06 RBRVS 75774 26 ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I Radiology 0.36 0.11 0.11 RBRVS 75774 TC ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I Radiology a 1.95 1.95 RBRVS 75791 ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR RS&I Radiology a 1.71 7.16 7.16 RBRVS 75791 26 ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR RS&I Radiology 1.71 0.51 0.51 RBRVS 75791 TC ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR RS&I Radiology a 6.65 6.65 RBRVS 75801 LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I Radiology a 6.99 Global/TC/26 75801 26 LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I Radiology 1.10 Global/TC/26 75801 TC LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I Radiology a 5.89 Global/TC/26 75803 LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I Radiology a 1.17 6.24 6.24 ERBRVS 75803 26 LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I Radiology 1.17 0.44 0.44 RBRVS 75803 TC LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I Radiology a 5.80 5.80 ERBRVS 75805 LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I Radiology a 0.81 6.66 6.66 ERBRVS 75805 26 LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I Radiology 0.81 0.30 0.30 RBRVS 75805 TC LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I Radiology a 6.36 6.36 ERBRVS 75807 LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I Radiology a 8.11 Global/TC/26 75807 26 LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I Radiology 1.61 Global/TC/26 75807 TC LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I Radiology a 6.50 Global/TC/26 75809 SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I Radiology a 0.47 2.28 2.28 RBRVS 75809 26 SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I Radiology 0.47 0.18 0.18 RBRVS 75809 TC SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I Radiology a 2.10 2.10 RBRVS 75810 SPLENOPORTOGRAPY RS&I Radiology a 1.14 13.34 13.34 ERBRVS 75810 26 SPLENOPORTOGRAPY RS&I Radiology 1.14 0.43 0.43 RBRVS 75810 TC SPLENOPORTOGRAPY RS&I Radiology a 12.91 12.91 ERBRVS 75820 VENOGRAPHY EXTREMITY UNILATERAL RS&I Radiology a 0.70 2.47 2.47 RBRVS 75820 26 VENOGRAPHY EXTREMITY UNILATERAL RS&I Radiology 0.70 0.23 0.23 RBRVS 75820 TC VENOGRAPHY EXTREMITY UNILATERAL RS&I Radiology a 2.24 2.24 RBRVS 75822 VENOGRAPHY EXTREMITY BILATERAL RS&I Radiology a 1.06 2.71 2.71 RBRVS 75822 26 VENOGRAPHY EXTREMITY BILATERAL RS&I Radiology 1.06 0.34 0.34 RBRVS 75822 TC VENOGRAPHY EXTREMITY BILATERAL RS&I Radiology a 2.37 2.37 RBRVS 75825 VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I Radiology a 1.14 2.57 2.57 RBRVS 75825 26 VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I Radiology 1.14 0.34 0.34 RBRVS 75825 TC VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I Radiology a 2.23 2.23 RBRVS 75827 VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I Radiology a 1.14 2.62 2.62 RBRVS 75827 26 VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I Radiology 1.14 0.33 0.33 RBRVS 75827 TC VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I Radiology a 2.29 2.29 RBRVS 75831 VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I Radiology a 1.14 2.74 2.74 RBRVS 75831 26 VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I Radiology 1.14 0.34 0.34 RBRVS 75831 TC VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I Radiology a 2.40 2.40 RBRVS 75833 VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I Radiology a 1.49 2.94 2.94 RBRVS 75833 26 VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I Radiology 1.49 0.39 0.39 RBRVS 75833 TC VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I Radiology a 2.55 2.55 RBRVS 75840 VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I Radiology a 1.14 2.97 2.97 RBRVS 75840 26 VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I Radiology 1.14 0.43 0.43 RBRVS 75840 TC VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I Radiology a 2.54 2.54 RBRVS 75842 VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I Radiology a 1.49 3.49 3.49 RBRVS 75842 26 VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I Radiology 1.49 0.56 0.56 RBRVS 75842 TC VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I Radiology a 2.93 2.93 RBRVS 75860 VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I Radiology a 1.14 2.80 2.80 RBRVS 75860 26 VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I Radiology 1.14 0.36 0.36 RBRVS 75860 TC VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I Radiology a 2.44 2.44 RBRVS 75870 VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I Radiology a 1.14 2.96 2.96 RBRVS 75870 26 VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I Radiology 1.14 0.43 0.43 RBRVS 75870 TC VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I Radiology a 2.53 2.53 RBRVS 75872 VENOGRAPHY EPIDURAL RS&I Radiology a 1.14 2.98 2.98 RBRVS

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75872 26 VENOGRAPHY EPIDURAL RS&I Radiology 1.14 0.43 0.43 RBRVS 75872 TC VENOGRAPHY EPIDURAL RS&I Radiology a 2.55 2.55 RBRVS 75880 VENOGRAPHY ORBITAL RS&I Radiology a 0.70 3.37 3.37 RBRVS 75880 26 VENOGRAPHY ORBITAL RS&I Radiology 0.70 0.30 0.30 RBRVS 75880 TC VENOGRAPHY ORBITAL RS&I Radiology a 3.07 3.07 RBRVS 75885 PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I Radiology a 1.44 2.90 2.90 RBRVS 75885 26 PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I Radiology 1.44 0.44 0.44 RBRVS 75885 TC PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I Radiology a 2.46 2.46 RBRVS 75887 PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP Radiology a 1.44 2.96 2.96 RBRVS 75887 26 PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP Radiology 1.44 0.47 0.47 RBRVS 75887 TC PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP Radiology a 2.49 2.49 RBRVS 75889 HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I Radiology a 1.14 2.84 2.84 RBRVS 75889 26 HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I Radiology 1.14 0.36 0.36 RBRVS 75889 TC HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I Radiology a 2.48 2.48 RBRVS 75891 HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I Radiology a 1.14 2.89 2.89 RBRVS 75891 26 HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I Radiology 1.14 0.39 0.39 RBRVS 75891 TC HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I Radiology a 2.50 2.50 RBRVS 75893 VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS& Radiology a 0.54 2.76 2.76 RBRVS 75893 26 VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS& Radiology 0.54 0.20 0.20 RBRVS 75893 TC VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS& Radiology a 2.56 2.56 RBRVS 75894 TRANSCATHETER EMBOLIZATION ANY METH RS&I Radiology a 26.22 Global/TC/26 75894 26 TRANSCATHETER EMBOLIZATION ANY METH RS&I Radiology 1.73 Global/TC/26 75894 TC TRANSCATHETER EMBOLIZATION ANY METH RS&I Radiology a 24.49 Global/TC/26 75898 ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS Radiology a 3.57 Global/TC/26 75898 26 ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS Radiology 2.21 Global/TC/26 75898 TC ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS Radiology a 1.36 Global/TC/26 75901 MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I Radiology a 0.49 4.39 4.39 RBRVS 75901 26 MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I Radiology 0.49 0.15 0.15 RBRVS 75901 TC MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I Radiology a 4.24 4.24 RBRVS 75902 MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I Radiology a 0.39 1.58 1.58 RBRVS 75902 26 MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I Radiology 0.39 0.12 0.12 RBRVS 75902 TC MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I Radiology a 1.46 1.46 RBRVS 75952 EVASC RPR INFRARENAL AAA/DISSECTION RS&I Radiology 4.49 1.14 1.14 ERBRVS 75952 26 EVASC RPR INFRARENAL AAA/DISSECTION RS&I Radiology 4.49 1.14 1.14 RBRVS 75953 PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I Radiology 3.05 Global/TC/26 75953 26 PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I Radiology 1.70 Global/TC/26 75953 TC PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I Radiology 1.35 Global/TC/26 75954 EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I Radiology 2.25 0.58 0.58 ERBRVS 75954 26 EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I Radiology 2.25 0.58 0.58 RBRVS 75956 EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I Radiology 7.00 1.73 1.73 ERBRVS 75956 26 EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I Radiology 7.00 1.73 1.73 RBRVS 75957 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I Radiology 6.00 1.47 1.47 ERBRVS 75957 26 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I Radiology 6.00 1.47 1.47 RBRVS 75958 PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I Radiology 4.00 0.98 0.98 ERBRVS 75958 26 PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I Radiology 4.00 0.98 0.98 RBRVS 75959 PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I Radiology 3.50 0.70 0.70 ERBRVS 75959 26 PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I Radiology 3.50 0.70 0.70 RBRVS 75962 TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI Radiology a 0.54 3.30 3.30 RBRVS 75962 26 TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI Radiology 0.54 0.16 0.16 RBRVS 75962 TC TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI Radiology a 3.14 3.14 RBRVS 75964 TRLUML BALOON ANGIOP PERIPHER EA ADDL ART RS&I Radiology a 0.36 2.01 2.01 RBRVS 75964 26 TRLUML BALOON ANGIOP PERIPHER EA ADDL ART RS&I Radiology 0.36 0.09 0.09 RBRVS 75964 TC TRLUML BALOON ANGIOP PERIPHER EA ADDL ART RS&I Radiology a 1.92 1.92 RBRVS 75966 TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I Radiology a 1.31 3.37 3.37 RBRVS 75966 26 TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I Radiology 1.31 0.39 0.39 RBRVS 75966 TC TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I Radiology a 2.98 2.98 RBRVS 75968 TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I Radiology a 0.36 2.10 2.10 RBRVS 75968 26 TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I Radiology 0.36 0.12 0.12 RBRVS 75968 TC TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I Radiology a 1.98 1.98 RBRVS 75970 TRANSCATHETER BIOPSY RS&I Radiology a 13.79 Global/TC/26 75970 26 TRANSCATHETER BIOPSY RS&I Radiology 1.09 Global/TC/26 75970 TC TRANSCATHETER BIOPSY RS&I Radiology a 12.70 Global/TC/26 75978 TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I Radiology a 0.54 3.26 3.26 RBRVS 75978 26 TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I Radiology 0.54 0.16 0.16 RBRVS 75978 TC TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I Radiology a 3.10 3.10 RBRVS 75984 CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I Radiology a 0.72 2.22 2.22 RBRVS 75984 26 CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I Radiology 0.72 0.24 0.24 RBRVS 75984 TC CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I Radiology a 1.98 1.98 RBRVS 75989 RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I Radiology a 1.19 2.12 2.12 RBRVS 75989 26 RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I Radiology 1.19 0.40 0.40 RBRVS 75989 TC RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I Radiology a 1.72 1.72 RBRVS 76000 FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME Radiology a 0.17 1.12 1.12 RBRVS 76000 26 FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME Radiology 0.17 0.06 0.06 RBRVS 76000 TC FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME Radiology a 1.06 1.06 RBRVS 76001 FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME Radiology a 0.67 3.23 3.23 Global/TC/26

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76001 26 FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME Radiology 0.67 0.27 0.27 Global/TC/26 76001 TC FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME Radiology a 2.96 2.96 Global/TC/26 76010 RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD Radiology a 0.18 0.53 0.53 RBRVS 76010 26 RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD Radiology 0.18 0.07 0.07 RBRVS 76010 TC RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD Radiology a 0.46 0.46 RBRVS 76080 RADEX ABSCESS/FISTULA/SINUS TRACT RS&I Radiology a 0.54 0.97 0.97 RBRVS 76080 26 RADEX ABSCESS/FISTULA/SINUS TRACT RS&I Radiology 0.54 0.18 0.18 RBRVS 76080 TC RADEX ABSCESS/FISTULA/SINUS TRACT RS&I Radiology a 0.79 0.79 RBRVS 76098 RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN Radiology a 0.16 0.28 0.28 RBRVS 76098 26 RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN Radiology 0.16 0.06 0.06 RBRVS 76098 TC RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN Radiology a 0.22 0.22 RBRVS 76100 RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY Radiology a 0.58 1.96 1.96 RBRVS 76100 26 RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY Radiology 0.58 0.28 0.28 RBRVS 76100 TC RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY Radiology a 1.68 1.68 RBRVS 76101 RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI Radiology a 0.58 3.06 3.06 RBRVS 76101 26 RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI Radiology 0.58 0.35 0.35 RBRVS 76101 TC RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI Radiology a 2.71 2.71 RBRVS 76102 RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI Radiology a 0.58 4.22 4.22 RBRVS 76102 26 RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI Radiology 0.58 0.35 0.35 RBRVS 76102 TC RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI Radiology a 3.87 3.87 RBRVS 76120 CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC Radiology a 0.38 2.12 2.12 RBRVS 76120 26 CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC Radiology 0.38 0.15 0.15 RBRVS 76120 TC CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC Radiology a 1.97 1.97 RBRVS 76125 CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION Radiology a 1.16 Global/TC/26 76125 26 CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION Radiology 0.38 Global/TC/26 76125 TC CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION Radiology a 0.78 Global/TC/26 76140 CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT Radiology 0.75 5% Sample 76376 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION Radiology a 0.20 0.42 0.42 RBRVS 76376 26 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION Radiology 0.20 0.07 0.07 RBRVS 76376 TC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION Radiology a 0.35 0.35 RBRVS 76377 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION Radiology a 0.79 0.96 0.96 RBRVS 76377 26 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION Radiology 0.79 0.29 0.29 RBRVS 76377 TC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION Radiology a 0.67 0.67 RBRVS 76380 CT LIMITED/LOCALIZED FOLLOW UP STUDY Radiology a 0.98 3.07 3.07 RBRVS 76380 26 CT LIMITED/LOCALIZED FOLLOW UP STUDY Radiology 0.98 0.36 0.36 RBRVS 76380 TC CT LIMITED/LOCALIZED FOLLOW UP STUDY Radiology a 2.71 2.71 RBRVS 76390 MRI SPECTROSCOPY Radiology a 1.40 11.03 11.03 RBRVS 76390 26 MRI SPECTROSCOPY Radiology 1.40 0.54 0.54 RBRVS 76390 TC MRI SPECTROSCOPY Radiology a 10.49 10.49 RBRVS 76496 UNLISTED FLUOROSCOPIC PROCEDURE Radiology a 1.29 Unlisted 76496 26 UNLISTED FLUOROSCOPIC PROCEDURE Radiology 0.23 Unlisted 76496 TC UNLISTED FLUOROSCOPIC PROCEDURE Radiology a 1.06 Unlisted 76497 UNLISTED COMPUTED TOMOGRAPHY PROCEDURE Radiology a 4.98 Unlisted 76497 26 UNLISTED COMPUTED TOMOGRAPHY PROCEDURE Radiology 1.40 Unlisted 76497 TC UNLISTED COMPUTED TOMOGRAPHY PROCEDURE Radiology a 3.58 Unlisted 76498 UNLISTED MAGNETIC RESONANCE PROCEDURE Radiology a 6.51 Unlisted 76498 26 UNLISTED MAGNETIC RESONANCE PROCEDURE Radiology 1.41 Unlisted 76498 TC UNLISTED MAGNETIC RESONANCE PROCEDURE Radiology a 5.10 Unlisted 76499 UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE Radiology a 3.07 Unlisted 76499 26 UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE Radiology 0.81 Unlisted 76499 TC UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE Radiology a 2.26 Unlisted 76506 ECHOENCEPHALOGRAPHY REAL TIME IMAGING Radiology a 0.63 2.67 2.67 RBRVS 76506 26 ECHOENCEPHALOGRAPHY REAL TIME IMAGING Radiology 0.63 0.24 0.24 RBRVS 76506 TC ECHOENCEPHALOGRAPHY REAL TIME IMAGING Radiology a 2.43 2.43 RBRVS 76510 OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR Radiology a 1.55 3.23 3.23 RBRVS 76510 26 OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR Radiology 1.55 0.95 0.95 RBRVS 76510 TC OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR Radiology a 2.28 2.28 RBRVS 76511 OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY Radiology a 0.94 1.94 1.94 RBRVS 76511 26 OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY Radiology 0.94 0.56 0.56 RBRVS 76511 TC OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY Radiology a 1.38 1.38 RBRVS 76512 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN Radiology a 0.94 1.66 1.66 RBRVS 76512 26 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN Radiology 0.94 0.55 0.55 RBRVS 76512 TC OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN Radiology a 1.11 1.11 RBRVS 76513 OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM Radiology a 0.66 2.03 2.03 RBRVS 76513 26 OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM Radiology 0.66 0.35 0.35 RBRVS 76513 TC OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM Radiology a 1.68 1.68 RBRVS 76514 OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI Radiology a 0.17 0.24 0.24 RBRVS 76514 26 OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI Radiology 0.17 0.10 0.10 RBRVS 76514 TC OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI Radiology a 0.14 0.14 RBRVS 76516 OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN Radiology a 0.54 1.66 1.66 RBRVS 76516 26 OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN Radiology 0.54 0.33 0.33 RBRVS 76516 TC OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN Radiology a 1.33 1.33 RBRVS 76519 OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL Radiology a 0.54 1.82 1.82 RBRVS 76519 26 OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL Radiology 0.54 0.33 0.33 RBRVS 76519 TC OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL Radiology a 1.49 1.49 RBRVS

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76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION Radiology a 0.57 1.66 1.66 RBRVS 76529 26 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION Radiology 0.57 0.34 0.34 RBRVS 76529 TC OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION Radiology a 1.32 1.32 RBRVS 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM Radiology a 0.56 2.69 2.69 RBRVS 76536 26 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM Radiology 0.56 0.21 0.21 RBRVS 76536 TC US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM Radiology a 2.48 2.48 RBRVS 76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION Radiology a 0.55 1.90 1.90 RBRVS 76604 26 US CHEST REAL TIME W/IMAGE DOCUMENTATION Radiology 0.55 0.20 0.20 RBRVS 76604 TC US CHEST REAL TIME W/IMAGE DOCUMENTATION Radiology a 1.70 1.70 RBRVS 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE Radiology a 0.73 2.27 2.27 RBRVS 76641 26 US BREAST UNI REAL TIME WITH IMAGE COMPLETE Radiology 0.73 0.27 0.27 RBRVS 76641 TC US BREAST UNI REAL TIME WITH IMAGE COMPLETE Radiology a 2.00 2.00 RBRVS 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED Radiology a 0.68 1.78 1.78 RBRVS 76642 26 US BREAST UNI REAL TIME WITH IMAGE LIMITED Radiology 0.68 0.25 0.25 RBRVS 76642 TC US BREAST UNI REAL TIME WITH IMAGE LIMITED Radiology a 1.53 1.53 RBRVS 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION Radiology a 0.81 2.61 2.61 RBRVS 76700 26 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION Radiology 0.81 0.30 0.30 RBRVS 76700 TC US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION Radiology a 2.31 2.31 RBRVS 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED Radiology a 0.59 1.96 1.96 RBRVS 76705 26 US ABDOMINAL REAL TIME W/IMAGE LIMITED Radiology 0.59 0.22 0.22 RBRVS 76705 TC US ABDOMINAL REAL TIME W/IMAGE LIMITED Radiology a 1.74 1.74 RBRVS 76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE Radiology a 0.74 2.41 2.41 RBRVS 76770 26 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE Radiology 0.74 0.27 0.27 RBRVS 76770 TC US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE Radiology a 2.14 2.14 RBRVS 76775 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED Radiology a 0.58 1.01 1.01 RBRVS 76775 26 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED Radiology 0.58 0.21 0.21 RBRVS 76775 TC US RETROPERITONEAL REAL TIME W/IMAGE LIMITED Radiology a 0.80 0.80 RBRVS 76776 US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN Radiology a 0.76 3.61 3.61 RBRVS 76776 26 US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN Radiology 0.76 0.28 0.28 RBRVS 76776 TC US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN Radiology a 3.33 3.33 RBRVS 76800 ULTRASOUND SPINAL CANAL & CONTENTS Radiology a 1.13 2.71 2.71 RBRVS 76800 26 ULTRASOUND SPINAL CANAL & CONTENTS Radiology 1.13 0.44 0.44 RBRVS 76800 TC ULTRASOUND SPINAL CANAL & CONTENTS Radiology a 2.27 2.27 RBRVS 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT Radiology a 0.99 2.43 2.43 RBRVS 76801 26 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT Radiology 0.99 0.38 0.38 RBRVS 76801 TC US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT Radiology a 2.05 2.05 RBRVS 76802 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION Radiology a 0.83 0.95 0.95 RBRVS 76802 26 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION Radiology 0.83 0.32 0.32 RBRVS 76802 TC US PREG UTERUS 14 WK TRANSABDL EACH GESTATION Radiology a 0.63 0.63 RBRVS 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION Radiology a 0.99 2.95 2.95 RBRVS 76805 26 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION Radiology 0.99 0.38 0.38 RBRVS 76805 TC US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION Radiology a 2.57 2.57 RBRVS 76810 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO Radiology a 0.98 1.61 1.61 RBRVS 76810 26 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO Radiology 0.98 0.38 0.38 RBRVS 76810 TC US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO Radiology a 1.23 1.23 RBRVS 76811 US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION Radiology a 1.90 3.07 3.07 RBRVS 76811 26 US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION Radiology 1.90 0.74 0.74 RBRVS 76811 TC US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION Radiology a 2.33 2.33 RBRVS 76812 US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT Radiology a 1.78 3.89 3.89 RBRVS 76812 26 US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT Radiology 1.78 0.70 0.70 RBRVS 76812 TC US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT Radiology a 3.19 3.19 RBRVS 76813 US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION Radiology a 1.18 2.15 2.15 RBRVS 76813 26 US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION Radiology 1.18 0.46 0.46 RBRVS 76813 TC US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION Radiology a 1.69 1.69 RBRVS 76814 US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION Radiology a 0.99 1.23 1.23 RBRVS 76814 26 US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION Radiology 0.99 0.39 0.39 RBRVS 76814 TC US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION Radiology a 0.84 0.84 RBRVS 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES Radiology a 0.65 1.69 1.69 RBRVS 76815 26 US PREGNANT UTERUS LIMITED 1/> FETUSES Radiology 0.65 0.25 0.25 RBRVS 76815 TC US PREGNANT UTERUS LIMITED 1/> FETUSES Radiology a 1.44 1.44 RBRVS 76816 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS Radiology a 0.85 2.33 2.33 RBRVS 76816 26 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS Radiology 0.85 0.33 0.33 RBRVS 76816 TC US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS Radiology a 2.00 2.00 RBRVS 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG Radiology a 0.75 1.94 1.94 RBRVS 76817 26 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG Radiology 0.75 0.29 0.29 RBRVS 76817 TC US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG Radiology a 1.65 1.65 RBRVS 76818 FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING Radiology a 1.05 2.29 2.29 RBRVS 76818 26 FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING Radiology 1.05 0.41 0.41 RBRVS 76818 TC FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING Radiology a 1.88 1.88 RBRVS 76819 FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING Radiology a 0.77 1.68 1.68 RBRVS 76819 26 FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING Radiology 0.77 0.30 0.30 RBRVS 76819 TC FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING Radiology a 1.38 1.38 RBRVS 76820 DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY Radiology a 0.50 0.79 0.79 RBRVS 76820 26 DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY Radiology 0.50 0.19 0.19 RBRVS 76820 TC DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY Radiology a 0.60 0.60 RBRVS

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76821 DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART Radiology a 0.70 1.86 1.86 RBRVS 76821 26 DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART Radiology 0.70 0.27 0.27 RBRVS 76821 TC DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART Radiology a 1.59 1.59 RBRVS 76825 ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING Radiology a 1.67 6.02 6.02 RBRVS 76825 26 ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING Radiology 1.67 0.62 0.62 RBRVS 76825 TC ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING Radiology a 5.40 5.40 RBRVS 76826 ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD Radiology a 0.83 3.75 3.75 RBRVS 76826 26 ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD Radiology 0.83 0.31 0.31 RBRVS 76826 TC ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD Radiology a 3.44 3.44 RBRVS 76827 DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE Radiology a 0.58 1.53 1.53 RBRVS 76827 26 DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE Radiology 0.58 0.21 0.21 RBRVS 76827 TC DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE Radiology a 1.32 1.32 RBRVS 76828 DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT Radiology a 0.56 0.91 0.91 RBRVS 76828 26 DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT Radiology 0.56 0.21 0.21 RBRVS 76828 TC DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT Radiology a 0.70 0.70 RBRVS 76830 US TRANSVAGINAL Radiology a 0.69 2.71 2.71 RBRVS 76830 26 US TRANSVAGINAL Radiology 0.69 0.26 0.26 RBRVS 76830 TC US TRANSVAGINAL Radiology a 2.45 2.45 RBRVS 76831 SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER Radiology a 0.72 2.57 2.57 RBRVS 76831 26 SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER Radiology 0.72 0.28 0.28 RBRVS 76831 TC SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER Radiology a 2.29 2.29 RBRVS 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE Radiology a 0.69 2.37 2.37 RBRVS 76856 26 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE Radiology 0.69 0.25 0.25 RBRVS 76856 TC US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE Radiology a 2.12 2.12 RBRVS 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U Radiology a 0.50 0.81 0.81 RBRVS 76857 26 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U Radiology 0.50 0.18 0.18 RBRVS 76857 TC US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U Radiology a 0.63 0.63 RBRVS 76870 US SCROTUM & CONTENTS Radiology a 0.64 1.21 1.21 RBRVS 76870 26 US SCROTUM & CONTENTS Radiology 0.64 0.23 0.23 RBRVS 76870 TC US SCROTUM & CONTENTS Radiology a 0.98 0.98 RBRVS 76872 US TRANSRECTAL Radiology a 0.69 1.92 1.92 RBRVS 76872 26 US TRANSRECTAL Radiology 0.69 0.24 0.24 RBRVS 76872 TC US TRANSRECTAL Radiology a 1.68 1.68 RBRVS 76873 US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX Radiology a 1.55 3.08 3.08 RBRVS 76873 26 US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX Radiology 1.55 0.59 0.59 RBRVS 76873 TC US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX Radiology a 2.49 2.49 RBRVS 76881 US EXTREMITY NON-VASC REAL-TIME IMG COMPL Radiology a 0.63 2.62 2.62 RBRVS 76881 26 US EXTREMITY NON-VASC REAL-TIME IMG COMPL Radiology 0.63 0.24 0.24 RBRVS 76881 TC US EXTREMITY NON-VASC REAL-TIME IMG COMPL Radiology a 2.38 2.38 RBRVS 76882 US EXTREMITY NON-VASC REAL-TIME IMG LMTD Radiology a 0.49 0.49 0.49 RBRVS 76882 26 US EXTREMITY NON-VASC REAL-TIME IMG LMTD Radiology 0.49 0.18 0.18 RBRVS 76882 TC US EXTREMITY NON-VASC REAL-TIME IMG LMTD Radiology a 0.31 0.31 RBRVS 76885 US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ Radiology a 0.74 3.32 3.32 RBRVS 76885 26 US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ Radiology 0.74 0.28 0.28 RBRVS 76885 TC US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ Radiology a 3.04 3.04 RBRVS 76886 US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ Radiology a 0.62 2.34 2.34 RBRVS 76886 26 US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ Radiology 0.62 0.23 0.23 RBRVS 76886 TC US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ Radiology a 2.11 2.11 RBRVS 76930 US GUIDANCE PERICARDIOCENTESIS RS&I Radiology a 2.34 Global/TC/26 76930 26 US GUIDANCE PERICARDIOCENTESIS RS&I Radiology 0.90 Global/TC/26 76930 TC US GUIDANCE PERICARDIOCENTESIS RS&I Radiology a 1.44 Global/TC/26 76932 US ENDOMYOCARDIAL BIOPSY RS&I Radiology a 2.46 Global/TC/26 76932 26 US ENDOMYOCARDIAL BIOPSY RS&I Radiology 0.90 Global/TC/26 76932 TC US ENDOMYOCARDIAL BIOPSY RS&I Radiology a 1.56 Global/TC/26 76936 US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL Radiology a 1.99 5.42 5.42 RBRVS 76936 26 US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL Radiology 1.99 0.57 0.57 RBRVS 76936 TC US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL Radiology a 4.85 4.85 RBRVS 76937 US VASC ACCESS SITS VSL PATENCY NDL ENTRY Radiology a 0.30 0.57 0.57 RBRVS 76937 26 US VASC ACCESS SITS VSL PATENCY NDL ENTRY Radiology 0.30 0.09 0.09 RBRVS 76937 TC US VASC ACCESS SITS VSL PATENCY NDL ENTRY Radiology a 0.48 0.48 RBRVS 76940 US &MNTR PARENCHYMAL TISSUE ABLATION Radiology a 4.31 Global/TC/26 76940 26 US &MNTR PARENCHYMAL TISSUE ABLATION Radiology 2.69 Global/TC/26 76940 TC US &MNTR PARENCHYMAL TISSUE ABLATION Radiology a 1.62 Global/TC/26 76941 US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I Radiology a 2.78 Global/TC/26 76941 26 US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I Radiology 1.79 Global/TC/26 76941 TC US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I Radiology a 0.99 Global/TC/26 76942 US GUIDANCE NEEDLE PLACEMENT IMG S&I Radiology a 0.67 0.98 0.98 RBRVS 76942 26 US GUIDANCE NEEDLE PLACEMENT IMG S&I Radiology 0.67 0.23 0.23 RBRVS 76942 TC US GUIDANCE NEEDLE PLACEMENT IMG S&I Radiology a 0.75 0.75 RBRVS 76945 US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I Radiology a 2.62 Global/TC/26 76945 26 US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I Radiology 0.93 Global/TC/26 76945 TC US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I Radiology a 1.69 Global/TC/26 76946 US GUIDANCE AMNIOCENTESIS IMG S&I Radiology a 0.38 0.51 0.51 RBRVS 76946 26 US GUIDANCE AMNIOCENTESIS IMG S&I Radiology 0.38 0.15 0.15 RBRVS 76946 TC US GUIDANCE AMNIOCENTESIS IMG S&I Radiology a 0.36 0.36 RBRVS

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76948 US GUIDANCE ASPIRATION OVA IMG S&I Radiology a 0.67 1.37 1.37 RBRVS 76948 26 US GUIDANCE ASPIRATION OVA IMG S&I Radiology 0.67 0.26 0.26 RBRVS 76948 TC US GUIDANCE ASPIRATION OVA IMG S&I Radiology a 1.11 1.11 RBRVS 76965 US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION Radiology a 1.34 1.14 1.14 RBRVS 76965 26 US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION Radiology 1.34 0.49 0.49 RBRVS 76965 TC US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION Radiology a 0.65 0.65 RBRVS 76970 US STUDY FOLLOW UP Radiology a 0.40 2.17 2.17 RBRVS 76970 26 US STUDY FOLLOW UP Radiology 0.40 0.13 0.13 RBRVS 76970 TC US STUDY FOLLOW UP Radiology a 2.04 2.04 RBRVS 76975 GI ENDOSCOPIC US S&I Radiology a 4.35 Global/TC/26 76975 26 GI ENDOSCOPIC US S&I Radiology 1.15 Global/TC/26 76975 TC GI ENDOSCOPIC US S&I Radiology a 3.20 Global/TC/26 76977 US BONE DENSITY MEAS & INTERP PERIPH ANY METHO Radiology a 0.05 0.13 0.13 RBRVS 76977 26 US BONE DENSITY MEAS & INTERP PERIPH ANY METHO Radiology 0.05 0.02 0.02 RBRVS 76977 TC US BONE DENSITY MEAS & INTERP PERIPH ANY METHO Radiology a 0.11 0.11 RBRVS 76998 ULTRASONIC GUIDANCE INTRAOPERATIVE Radiology a 3.01 Global/TC/26 76998 26 ULTRASONIC GUIDANCE INTRAOPERATIVE Radiology 1.59 Global/TC/26 76998 TC ULTRASONIC GUIDANCE INTRAOPERATIVE Radiology a 1.42 Global/TC/26 76999 UNLISTED US PROCEDURE Radiology a 3.14 Unlisted 76999 26 UNLISTED US PROCEDURE Radiology 0.81 Unlisted 76999 TC UNLISTED US PROCEDURE Radiology a 2.33 Unlisted 77001 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT Radiology a 0.38 1.56 1.56 RBRVS 77001 26 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT Radiology 0.38 0.13 0.13 RBRVS 77001 TC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT Radiology a 1.43 1.43 RBRVS 77002 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT Radiology a 0.54 2.01 2.01 RBRVS 77002 26 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT Radiology 0.54 0.22 0.22 RBRVS 77002 TC FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT Radiology a 1.79 1.79 RBRVS 77003 FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER Radiology a 0.60 1.76 1.76 RBRVS 77003 26 FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER Radiology 0.60 0.23 0.23 RBRVS 77003 TC FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER Radiology a 1.53 1.53 RBRVS 77011 CT GUIDANCE STEREOTACTIC LOCALIZATION Radiology a 1.21 4.90 4.90 RBRVS 77011 26 CT GUIDANCE STEREOTACTIC LOCALIZATION Radiology 1.21 0.49 0.49 RBRVS 77011 TC CT GUIDANCE STEREOTACTIC LOCALIZATION Radiology a 4.41 4.41 RBRVS 77012 CT GUIDANCE NEEDLE PLACEMENT Radiology a 1.16 2.27 2.27 RBRVS 77012 26 CT GUIDANCE NEEDLE PLACEMENT Radiology 1.16 0.41 0.41 RBRVS 77012 TC CT GUIDANCE NEEDLE PLACEMENT Radiology a 1.86 1.86 RBRVS 77013 CT GUIDANCE &MONITORING VISC TISS ABLATION Radiology a 23.20 Global/TC/26 77013 26 CT GUIDANCE &MONITORING VISC TISS ABLATION Radiology 5.34 Global/TC/26 77013 TC CT GUIDANCE &MONITORING VISC TISS ABLATION Radiology a 17.86 Global/TC/26 77014 CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT Radiology a 0.85 2.38 2.38 RBRVS 77014 26 CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT Radiology 0.85 0.34 0.34 RBRVS 77014 TC CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT Radiology a 2.04 2.04 RBRVS 77021 MR GUIDANCE NEEDLE PLACEMENT Radiology a 1.50 9.95 9.95 RBRVS 77021 26 MR GUIDANCE NEEDLE PLACEMENT Radiology 1.50 0.56 0.56 RBRVS 77021 TC MR GUIDANCE NEEDLE PLACEMENT Radiology a 9.39 9.39 RBRVS 77022 MR GUIDANCE &MONITORING TISSUE ABLATION Radiology a 28.82 Global/TC/26 77022 26 MR GUIDANCE &MONITORING TISSUE ABLATION Radiology 5.80 Global/TC/26 77022 TC MR GUIDANCE &MONITORING TISSUE ABLATION Radiology a 23.02 Global/TC/26 77051 COMPUTER-AIDED DETECTION DX MAMMOGRAPHY Radiology 0.06 0.17 0.17 RBRVS 77051 26 COMPUTER-AIDED DETECTION DX MAMMOGRAPHY Radiology 0.06 0.02 0.02 RBRVS 77051 TC COMPUTER-AIDED DETECTION DX MAMMOGRAPHY Radiology 0.15 0.15 RBRVS 77052 COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY Radiology 0.06 0.17 0.17 RBRVS 77052 26 COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY Radiology 0.06 0.02 0.02 RBRVS 77052 TC COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY Radiology 0.15 0.15 RBRVS 77053 MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE Radiology a 0.36 1.24 1.24 RBRVS 77053 26 MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE Radiology 0.36 0.13 0.13 RBRVS 77053 TC MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE Radiology a 1.11 1.11 RBRVS 77054 MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE Radiology a 0.45 1.65 1.65 RBRVS 77054 26 MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE Radiology 0.45 0.17 0.17 RBRVS 77054 TC MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE Radiology a 1.48 1.48 RBRVS 77055 MAMMOGRAPHY UNILATERAL Radiology 0.70 1.77 1.77 RBRVS 77055 26 MAMMOGRAPHY UNILATERAL Radiology 0.70 0.26 0.26 RBRVS 77055 TC MAMMOGRAPHY UNILATERAL Radiology 1.51 1.51 RBRVS 77056 MAMMOGRAPHY BILATERAL Radiology 0.87 2.31 2.31 RBRVS 77056 26 MAMMOGRAPHY BILATERAL Radiology 0.87 0.32 0.32 RBRVS 77056 TC MAMMOGRAPHY BILATERAL Radiology 1.99 1.99 RBRVS 77057 SCREENING MAMMOGRAPHY BILATERAL Radiology 0.70 1.56 1.56 RBRVS 77057 26 SCREENING MAMMOGRAPHY BILATERAL Radiology 0.70 0.26 0.26 RBRVS 77057 TC SCREENING MAMMOGRAPHY BILATERAL Radiology 1.30 1.30 RBRVS 77058 MRI BREAST UNILATERAL Radiology a 1.63 13.43 13.43 RBRVS 77058 26 MRI BREAST UNILATERAL Radiology 1.63 0.60 0.60 RBRVS 77058 TC MRI BREAST UNILATERAL Radiology a 12.83 12.83 RBRVS 77059 MRI BREAST BILATERAL Radiology a 1.63 13.27 13.27 RBRVS 77059 26 MRI BREAST BILATERAL Radiology 1.63 0.60 0.60 RBRVS 77059 TC MRI BREAST BILATERAL Radiology a 12.67 12.67 RBRVS

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77061 DIGITAL BREAST TOMOSYNTHESIS UNILATERAL Radiology a 0.87 3.66 3.66 ERBRVS 77061 26 DIGITAL BREAST TOMOSYNTHESIS UNILATERAL Radiology 0.87 0.32 0.32 ERBRVS 77061 TC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL Radiology a 3.34 3.34 ERBRVS 77062 DIGITAL BREAST TOMOSYNTHESIS BILATERAL Radiology a 0.70 2.87 2.87 ERBRVS 77062 26 DIGITAL BREAST TOMOSYNTHESIS BILATERAL Radiology 0.70 0.25 0.25 ERBRVS 77062 TC DIGITAL BREAST TOMOSYNTHESIS BILATERAL Radiology a 2.62 2.62 ERBRVS 77063 SCREENING DIGITAL BREAST TOMOSYNTHESIS BI Radiology 0.60 0.93 0.93 RBRVS 77063 26 SCREENING DIGITAL BREAST TOMOSYNTHESIS BI Radiology 0.60 0.22 0.22 RBRVS 77063 TC SCREENING DIGITAL BREAST TOMOSYNTHESIS BI Radiology 0.71 0.71 RBRVS 77071 MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS Radiology 0.41 0.88 0.88 RBRVS 77072 BONE AGE STUDIES Radiology a 0.19 0.44 0.44 RBRVS 77072 26 BONE AGE STUDIES Radiology 0.19 0.07 0.07 RBRVS 77072 TC BONE AGE STUDIES Radiology a 0.37 0.37 RBRVS 77073 BONE LENGTH STUDIES Radiology a 0.27 0.71 0.71 RBRVS 77073 26 BONE LENGTH STUDIES Radiology 0.27 0.12 0.12 RBRVS 77073 TC BONE LENGTH STUDIES Radiology a 0.59 0.59 RBRVS 77074 RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED Radiology a 0.45 1.31 1.31 RBRVS 77074 26 RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED Radiology 0.45 0.17 0.17 RBRVS 77074 TC RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED Radiology a 1.14 1.14 RBRVS 77075 RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL Radiology a 0.54 1.86 1.86 RBRVS 77075 26 RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL Radiology 0.54 0.20 0.20 RBRVS 77075 TC RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL Radiology a 1.66 1.66 RBRVS 77076 RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT Radiology a 0.70 1.92 1.92 RBRVS 77076 26 RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT Radiology 0.70 0.26 0.26 RBRVS 77076 TC RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT Radiology a 1.66 1.66 RBRVS 77077 JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS Radiology a 0.31 0.70 0.70 RBRVS 77077 26 JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS Radiology 0.31 0.13 0.13 RBRVS 77077 TC JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS Radiology a 0.57 0.57 RBRVS 77078 CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE Radiology a 0.25 2.92 2.92 RBRVS 77078 26 CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE Radiology 0.25 0.09 0.09 RBRVS 77078 TC CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE Radiology a 2.83 2.83 RBRVS 77080 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL Radiology a 0.20 0.94 0.94 RBRVS 77080 26 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL Radiology 0.20 0.08 0.08 RBRVS 77080 TC DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL Radiology a 0.86 0.86 RBRVS 77081 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL Radiology a 0.22 0.55 0.55 RBRVS 77081 26 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL Radiology 0.22 0.08 0.08 RBRVS 77081 TC DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL Radiology a 0.47 0.47 RBRVS 77084 BONE MARROW BLOOD SUPPLY Radiology a 1.60 9.24 9.24 RBRVS 77084 26 BONE MARROW BLOOD SUPPLY Radiology 1.60 0.60 0.60 RBRVS 77084 TC BONE MARROW BLOOD SUPPLY Radiology a 8.64 8.64 RBRVS 77085 DXA BONE DENSITY STUDY AXIAL SKELETON Radiology a 0.30 1.26 1.26 RBRVS 77085 26 DXA BONE DENSITY STUDY AXIAL SKELETON Radiology 0.30 0.12 0.12 RBRVS 77085 TC DXA BONE DENSITY STUDY AXIAL SKELETON Radiology a 1.14 1.14 RBRVS 77086 VERTEBRAL FRACTURE ASSESSMENT VIA DXA Radiology a 0.17 0.81 0.81 RBRVS 77086 26 VERTEBRAL FRACTURE ASSESSMENT VIA DXA Radiology 0.17 0.07 0.07 RBRVS 77086 TC VERTEBRAL FRACTURE ASSESSMENT VIA DXA Radiology a 0.74 0.74 RBRVS 77261 THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE Radiology 1.39 0.65 0.65 RBRVS 77262 THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE Radiology 2.11 0.91 0.91 RBRVS 77263 THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX Radiology 3.14 1.26 1.26 RBRVS 77280 THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE Radiology a 0.70 6.85 6.85 RBRVS 77280 26 THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE Radiology 0.70 0.28 0.28 RBRVS 77280 TC THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE Radiology a 6.57 6.57 RBRVS 77285 THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED Radiology a 1.05 10.86 10.86 RBRVS 77285 26 THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED Radiology 1.05 0.43 0.43 RBRVS 77285 TC THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED Radiology a 10.43 10.43 RBRVS 77290 THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX Radiology a 1.56 12.66 12.66 RBRVS 77290 26 THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX Radiology 1.56 0.63 0.63 RBRVS 77290 TC THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX Radiology a 12.03 12.03 RBRVS 77293 RESPIRATORY MOTION MANAGEMENT SIMULATION Radiology 2.00 10.87 10.87 RBRVS 77293 26 RESPIRATORY MOTION MANAGEMENT SIMULATION Radiology 2.00 0.80 0.80 RBRVS 77293 TC RESPIRATORY MOTION MANAGEMENT SIMULATION Radiology 10.07 10.07 RBRVS 77295 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS Radiology a 4.29 9.13 9.13 RBRVS 77295 26 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS Radiology 4.29 1.72 1.72 RBRVS 77295 TC 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS Radiology a 7.41 7.41 RBRVS 77299 UNLIS PX THER RADIOL CLINICAL TX PLANNING Radiology a 13.42 Unlisted 77299 26 UNLIS PX THER RADIOL CLINICAL TX PLANNING Radiology 3.42 Unlisted 77299 TC UNLIS PX THER RADIOL CLINICAL TX PLANNING Radiology a 10.00 Unlisted 77300 BASIC RADIATION DOSIMETRY CALCULATION Radiology a 0.62 1.11 1.11 RBRVS 77300 26 BASIC RADIATION DOSIMETRY CALCULATION Radiology 0.62 0.25 0.25 RBRVS 77300 TC BASIC RADIATION DOSIMETRY CALCULATION Radiology a 0.86 0.86 RBRVS 77301 NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS Radiology a 7.99 45.65 45.66 RBRVS 77301 26 NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS Radiology 7.99 3.19 3.20 RBRVS 77301 TC NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS Radiology a 42.46 42.46 RBRVS 77306 TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION Radiology a 1.40 2.60 2.60 RBRVS 77306 26 TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION Radiology 1.40 0.56 0.56 RBRVS

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77306 TC TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION Radiology a 2.04 2.04 RBRVS 77307 TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY Radiology a 2.90 4.90 4.90 RBRVS 77307 26 TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY Radiology 2.90 1.17 1.17 RBRVS 77307 TC TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY Radiology a 3.73 3.73 RBRVS 77316 BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL Radiology a 1.40 3.73 3.73 RBRVS 77316 26 BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL Radiology 1.40 0.56 0.56 RBRVS 77316 TC BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL Radiology a 3.17 3.17 RBRVS 77317 BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL Radiology a 1.83 4.87 4.87 RBRVS 77317 26 BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL Radiology 1.83 0.74 0.74 RBRVS 77317 TC BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL Radiology a 4.13 4.13 RBRVS 77318 BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL Radiology a 2.90 6.78 6.78 RBRVS 77318 26 BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL Radiology 2.90 1.17 1.17 RBRVS 77318 TC BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL Radiology a 5.61 5.61 RBRVS 77321 SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY Radiology a 0.95 1.58 1.58 RBRVS 77321 26 SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY Radiology 0.95 0.38 0.38 RBRVS 77321 TC SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY Radiology a 1.20 1.20 RBRVS 77331 SPEC DOSIM ONLY PRESCRIBED TREATING PHYS Radiology a 0.87 0.87 0.87 RBRVS 77331 26 SPEC DOSIM ONLY PRESCRIBED TREATING PHYS Radiology 0.87 0.35 0.35 RBRVS 77331 TC SPEC DOSIM ONLY PRESCRIBED TREATING PHYS Radiology a 0.52 0.52 RBRVS 77332 TX DEVICES DESIGN & CONSTRUCTION SIMPLE Radiology a 0.54 1.74 1.74 RBRVS 77332 26 TX DEVICES DESIGN & CONSTRUCTION SIMPLE Radiology 0.54 0.23 0.23 RBRVS 77332 TC TX DEVICES DESIGN & CONSTRUCTION SIMPLE Radiology a 1.51 1.51 RBRVS 77333 TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE Radiology a 0.84 0.59 0.59 RBRVS 77333 26 TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE Radiology 0.84 0.34 0.34 RBRVS 77333 TC TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE Radiology a 0.25 0.25 RBRVS 77334 TX DEVICES DESIGN & CONSTRUCTION COMPLEX Radiology a 1.24 2.96 2.96 RBRVS 77334 26 TX DEVICES DESIGN & CONSTRUCTION COMPLEX Radiology 1.24 0.50 0.50 RBRVS 77334 TC TX DEVICES DESIGN & CONSTRUCTION COMPLEX Radiology a 2.46 2.46 RBRVS 77336 CONTINUING MEDICAL PHYSICS CONSLTJ PR WK Radiology a 2.13 2.13 RBRVS 77338 MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN Radiology a 4.29 9.60 9.60 RBRVS 77338 26 MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN Radiology 4.29 1.72 1.72 RBRVS 77338 TC MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN Radiology a 7.88 7.88 RBRVS 77370 SPEC MEDICAL RADJ PHYSICS CONSLTJ Radiology a 3.23 3.23 RBRVS 77371 RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT Radiology a 6.66 26.28 26.28 ERBRVS 77372 RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR Radiology a 29.67 29.67 RBRVS 77373 STEREOTACTIC BODY RADIATION DELIVERY Radiology a 37.68 37.68 RBRVS 77385 INTENSITY MODULATED RADIATION TX DLVR SIMPLE Radiology a 11.15 11.15 ERBRVS 77386 INTENSITY MODULATED RADIATION TX DLVR COMPLEX Radiology a 11.15 11.15 ERBRVS 77387 GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR Radiology 0.49 1.25 1.25 ERBRVS 77387 26 GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR Radiology 0.49 0.20 0.20 ERBRVS 77387 TC GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR Radiology 1.05 1.05 ERBRVS 77399 UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS Radiology a 2.13 Unlisted 77399 26 UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS Radiology 0.85 Unlisted 77399 TC UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS Radiology a 1.28 Unlisted 77401 RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA Radiology a 0.57 0.57 RBRVS 77402 RADIATION TREATMENT DELIVERY 1 MEV >= SIMPLE Radiology a 1.51 FAIR Health 77407 RADIATION TX DELIVERY 1 MEV >= INTERMEDIATE Radiology a 1.99 FAIR Health 77412 RADIATION TREATMENT DELIVERY 1 MEV >= COMPLEX Radiology a 2.30 FAIR Health 77417 THERAPEUTIC RADIOLOGY PORT IMAGES(S) Radiology a 0.29 0.29 RBRVS 77422 HIGH ENERGY NEUTRON RADJ TX DLVR 1 TX AREA Radiology a 0.93 0.93 RBRVS 77423 HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER Radiology a 1.81 1.81 RBRVS 77427 RADIATION TREATMENT MANAGEMENT 5 TREATMENTS Radiology 3.37 1.58 1.58 RBRVS 77431 RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY Radiology 1.81 0.91 0.91 RBRVS 77432 STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION Radiology 7.92 3.16 3.17 RBRVS 77435 STEREOTACTIC BODY RADIATION MANAGEMENT Radiology 11.87 4.86 4.87 RBRVS 77469 INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT Radiology 5.75 2.86 2.86 RBRVS 77470 SPECIAL TREATMENT PROCEDURE Radiology a 2.09 2.15 2.15 RBRVS 77470 26 SPECIAL TREATMENT PROCEDURE Radiology 2.09 0.84 0.84 RBRVS 77470 TC SPECIAL TREATMENT PROCEDURE Radiology a 1.31 1.31 RBRVS 77499 UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT Radiology a 4.95 Unlisted 77499 26 UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT Radiology 0.84 Unlisted 77499 TC UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT Radiology a 4.11 Unlisted 77520 PROTON TX DELIVERY SIMPLE W/O COMPENSATION Radiology a 17.30 v3.16 77522 PROTON TX DELIVERY SIMPLE W/COMPENSATION Radiology a 24.24 5% Sample 77523 PROTON TX DELIVERY INTERMEDIATE Radiology a 24.75 5% Sample 77525 PROTON TX DELIVERY COMPLEX Radiology a 25.94 5% Sample 77600 HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL Radiology a 1.56 9.63 9.63 RBRVS 77600 26 HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL Radiology 1.56 0.63 0.63 RBRVS 77600 TC HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL Radiology a 9.00 9.00 RBRVS 77605 HYPERTHERMIA EXTERNAL GENERATED DEEP Radiology a 2.09 19.16 19.16 RBRVS 77605 26 HYPERTHERMIA EXTERNAL GENERATED DEEP Radiology 2.09 0.82 0.82 RBRVS 77605 TC HYPERTHERMIA EXTERNAL GENERATED DEEP Radiology a 18.34 18.34 RBRVS 77610 HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS Radiology a 1.56 27.18 27.18 RBRVS 77610 26 HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS Radiology 1.56 0.56 0.56 RBRVS 77610 TC HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS Radiology a 26.62 26.62 RBRVS

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77615 HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS Radiology a 2.09 26.07 26.07 RBRVS 77615 26 HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS Radiology 2.09 0.84 0.84 RBRVS 77615 TC HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS Radiology a 25.23 25.23 RBRVS 77620 HYPERTHERMIA INTRACAVITARY PROBES Radiology a 1.56 11.11 11.11 RBRVS 77620 26 HYPERTHERMIA INTRACAVITARY PROBES Radiology 1.56 0.58 0.58 RBRVS 77620 TC HYPERTHERMIA INTRACAVITARY PROBES Radiology a 10.53 10.53 RBRVS 77750 NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE Radiology a 5.00 5.11 5.11 RBRVS 77750 26 NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE Radiology 5.00 2.01 2.01 RBRVS 77750 TC NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE Radiology a 3.10 3.10 RBRVS 77761 INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE Radiology a 3.85 6.79 6.79 RBRVS 77761 26 INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE Radiology 3.85 1.49 1.49 RBRVS 77761 TC INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE Radiology a 5.30 5.30 RBRVS 77762 INTRACAVITARY RADIATION SOURCE APPLIC INTERMED Radiology a 5.76 8.34 8.34 RBRVS 77762 26 INTRACAVITARY RADIATION SOURCE APPLIC INTERMED Radiology 5.76 2.24 2.24 RBRVS 77762 TC INTRACAVITARY RADIATION SOURCE APPLIC INTERMED Radiology a 6.10 6.10 RBRVS 77763 INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX Radiology a 8.66 11.32 11.33 RBRVS 77763 26 INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX Radiology 8.66 3.45 3.46 RBRVS 77763 TC INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX Radiology a 7.87 7.87 RBRVS 77767 HDR RDNCL SKN SURF BRACHYTX LES 2CM&2CHAN/MLT LES Radiology a 1.40 8.42 8.42 RBRVS 77768 26 HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES Radiology 1.40 0.58 0.58 RBRVS 77768 TC HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES Radiology a 7.84 7.84 RBRVS 77770 HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL Radiology a 1.95 6.98 6.98 RBRVS 77770 26 HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL Radiology 1.95 0.81 0.81 RBRVS 77770 TC HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL Radiology a 6.17 6.17 RBRVS 77771 HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL Radiology a 3.80 12.83 12.83 RBRVS 77771 26 HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL Radiology 3.80 1.59 1.59 RBRVS 77771 TC HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL Radiology a 11.24 11.24 RBRVS 77772 HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS Radiology a 5.40 19.97 19.97 RBRVS 77772 26 HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS Radiology 5.40 2.24 2.24 RBRVS 77772 TC HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS Radiology a 17.73 17.73 RBRVS 77778 INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX Radiology a 11.32 12.48 12.49 RBRVS 77778 26 INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX Radiology 11.32 4.48 4.49 RBRVS 77778 TC INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX Radiology a 8.00 8.00 RBRVS 77789 SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE Radiology a 1.14 2.14 2.14 RBRVS 77789 26 SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE Radiology 1.14 0.47 0.47 RBRVS 77789 TC SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE Radiology a 1.67 1.67 RBRVS 77790 SUPERVISION HANDLING LOADING RADIATION SOURCE Radiology a 1.05 1.60 1.60 RBRVS 77790 26 SUPERVISION HANDLING LOADING RADIATION SOURCE Radiology 1.05 0.41 0.41 RBRVS 77790 TC SUPERVISION HANDLING LOADING RADIATION SOURCE Radiology a 1.19 1.19 RBRVS 77799 UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY Radiology a 23.81 Unlisted 77799 26 UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY Radiology 10.78 Unlisted 77799 TC UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY Radiology a 13.02 Unlisted 78012 THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT Radiology a 0.19 2.09 2.09 RBRVS 78012 26 THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT Radiology 0.19 0.07 0.07 RBRVS 78012 TC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT Radiology a 2.02 2.02 RBRVS 78013 THYROID IMAGING WITH VASCULAR FLOW Radiology a 0.37 5.11 5.11 RBRVS 78013 26 THYROID IMAGING WITH VASCULAR FLOW Radiology 0.37 0.13 0.13 RBRVS 78013 TC THYROID IMAGING WITH VASCULAR FLOW Radiology a 4.98 4.98 RBRVS 78014 THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS Radiology a 0.50 6.44 6.44 RBRVS 78014 26 THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS Radiology 0.50 0.17 0.17 RBRVS 78014 TC THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS Radiology a 6.27 6.27 RBRVS 78015 THYROID CARCINOMA METASTASES IMG LMTD AREA Radiology a 0.67 5.67 5.67 RBRVS 78015 26 THYROID CARCINOMA METASTASES IMG LMTD AREA Radiology 0.67 0.23 0.23 RBRVS 78015 TC THYROID CARCINOMA METASTASES IMG LMTD AREA Radiology a 5.44 5.44 RBRVS 78016 THYROID CARCINOMA METASTASES IMG ADDL STUDY Radiology a 0.82 7.34 7.34 RBRVS 78016 26 THYROID CARCINOMA METASTASES IMG ADDL STUDY Radiology 0.82 0.15 0.15 RBRVS 78016 TC THYROID CARCINOMA METASTASES IMG ADDL STUDY Radiology a 7.19 7.19 RBRVS 78018 THYROID CARCINOMA METASTASES IMG WHOLE BODY Radiology a 0.86 8.12 8.12 RBRVS 78018 26 THYROID CARCINOMA METASTASES IMG WHOLE BODY Radiology 0.86 0.28 0.28 RBRVS 78018 TC THYROID CARCINOMA METASTASES IMG WHOLE BODY Radiology a 7.84 7.84 RBRVS 78020 THYROID CARCINOMA METASTASES UPTAKE Radiology a 0.60 1.78 1.78 RBRVS 78020 26 THYROID CARCINOMA METASTASES UPTAKE Radiology 0.60 0.17 0.17 RBRVS 78020 TC THYROID CARCINOMA METASTASES UPTAKE Radiology a 1.61 1.61 RBRVS 78070 PARATHYROID PLANAR IMAGING Radiology a 0.80 7.85 7.85 RBRVS 78070 26 PARATHYROID PLANAR IMAGING Radiology 0.80 0.28 0.28 RBRVS 78070 TC PARATHYROID PLANAR IMAGING Radiology a 7.57 7.57 RBRVS 78071 PARATHYROID PLANAR IMAGING W/WO SUBTRACTION Radiology a 1.20 9.10 9.10 RBRVS 78071 26 PARATHYROID PLANAR IMAGING W/WO SUBTRACTION Radiology 1.20 0.41 0.41 RBRVS 78071 TC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION Radiology a 8.69 8.69 RBRVS 78072 PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT Radiology a 1.60 10.18 10.18 RBRVS 78072 26 PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT Radiology 1.60 0.50 0.50 RBRVS 78072 TC PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT Radiology a 9.68 9.68 RBRVS

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78075 ADRENAL IMAGING CORTEX &/MEDULLA Radiology a 0.74 12.30 12.30 RBRVS 78075 26 ADRENAL IMAGING CORTEX &/MEDULLA Radiology 0.74 0.28 0.28 RBRVS 78075 TC ADRENAL IMAGING CORTEX &/MEDULLA Radiology a 12.02 12.02 RBRVS 78099 UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE Radiology a 6.94 Unlisted 78099 26 UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE Radiology 0.67 Unlisted 78099 TC UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE Radiology a 6.27 Unlisted 78102 BONE MARROW IMAGING LIMITED AREA Radiology a 0.55 4.32 4.32 RBRVS 78102 26 BONE MARROW IMAGING LIMITED AREA Radiology 0.55 0.18 0.18 RBRVS 78102 TC BONE MARROW IMAGING LIMITED AREA Radiology a 4.14 4.14 RBRVS 78103 BONE MARROW IMAGING MULTIPLE AREAS Radiology a 0.75 5.61 5.61 RBRVS 78103 26 BONE MARROW IMAGING MULTIPLE AREAS Radiology 0.75 0.24 0.24 RBRVS 78103 TC BONE MARROW IMAGING MULTIPLE AREAS Radiology a 5.37 5.37 RBRVS 78104 BONE MARROW IMAGING WHOLE BODY Radiology a 0.80 6.26 6.26 RBRVS 78104 26 BONE MARROW IMAGING WHOLE BODY Radiology 0.80 0.26 0.26 RBRVS 78104 TC BONE MARROW IMAGING WHOLE BODY Radiology a 6.00 6.00 RBRVS 78110 PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE Radiology a 0.19 2.76 2.76 RBRVS 78110 26 PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE Radiology 0.19 0.08 0.08 RBRVS 78110 TC PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE Radiology a 2.68 2.68 RBRVS 78111 PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES Radiology a 0.22 2.54 2.54 RBRVS 78111 26 PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES Radiology 0.22 0.08 0.08 RBRVS 78111 TC PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES Radiology a 2.46 2.46 RBRVS 78120 RED CELL VOLUME DETERMINATION SPX 1 SAMPLING Radiology a 0.23 2.46 2.46 RBRVS 78120 26 RED CELL VOLUME DETERMINATION SPX 1 SAMPLING Radiology 0.23 0.09 0.09 RBRVS 78120 TC RED CELL VOLUME DETERMINATION SPX 1 SAMPLING Radiology a 2.37 2.37 RBRVS 78121 RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS Radiology a 0.32 2.70 2.70 RBRVS 78121 26 RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS Radiology 0.32 0.12 0.12 RBRVS 78121 TC RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS Radiology a 2.58 2.58 RBRVS 78122 WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU Radiology a 0.45 2.30 2.30 RBRVS 78122 26 WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU Radiology 0.45 0.13 0.13 RBRVS 78122 TC WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU Radiology a 2.17 2.17 RBRVS 78130 RED CELL SURVIVAL STUDY Radiology a 0.61 3.90 3.90 RBRVS 78130 26 RED CELL SURVIVAL STUDY Radiology 0.61 0.20 0.20 RBRVS 78130 TC RED CELL SURVIVAL STUDY Radiology a 3.70 3.70 RBRVS 78135 RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS Radiology a 0.64 9.46 9.46 RBRVS 78135 26 RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS Radiology 0.64 0.24 0.24 RBRVS 78135 TC RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS Radiology a 9.22 9.22 RBRVS 78140 LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE Radiology a 0.61 3.28 3.28 RBRVS 78140 26 LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE Radiology 0.61 0.23 0.23 RBRVS 78140 TC LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE Radiology a 3.05 3.05 RBRVS 78185 SPLEEN IMAGING ONLY W/WO VASCULAR FLOW Radiology a 0.40 5.70 5.70 RBRVS 78185 26 SPLEEN IMAGING ONLY W/WO VASCULAR FLOW Radiology 0.40 0.15 0.15 RBRVS 78185 TC SPLEEN IMAGING ONLY W/WO VASCULAR FLOW Radiology a 5.55 5.55 RBRVS 78190 KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ Radiology a 1.09 10.23 10.23 RBRVS 78190 26 KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ Radiology 1.09 0.42 0.42 RBRVS 78190 TC KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ Radiology a 9.81 9.81 RBRVS 78191 PLATELET SURVIVAL STUDY Radiology a 0.61 4.14 4.14 RBRVS 78191 26 PLATELET SURVIVAL STUDY Radiology 0.61 0.23 0.23 RBRVS 78191 TC PLATELET SURVIVAL STUDY Radiology a 3.91 3.91 RBRVS 78195 LYMPHATICS & LYMPH NODES IMAGING Radiology a 1.20 9.03 9.03 RBRVS 78195 26 LYMPHATICS & LYMPH NODES IMAGING Radiology 1.20 0.41 0.41 RBRVS 78195 TC LYMPHATICS & LYMPH NODES IMAGING Radiology a 8.62 8.62 RBRVS 78199 UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED Radiology a 10.23 Unlisted 78199 26 UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED Radiology 1.61 Unlisted 78199 TC UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED Radiology a 8.62 Unlisted 78201 LIVER IMAGING STATIC ONLY Radiology a 0.44 4.96 4.96 RBRVS 78201 26 LIVER IMAGING STATIC ONLY Radiology 0.44 0.14 0.14 RBRVS 78201 TC LIVER IMAGING STATIC ONLY Radiology a 4.82 4.82 RBRVS 78202 LIVER IMAGING W/VASCULAR FLOW Radiology a 0.51 5.27 5.27 RBRVS 78202 26 LIVER IMAGING W/VASCULAR FLOW Radiology 0.51 0.15 0.15 RBRVS 78202 TC LIVER IMAGING W/VASCULAR FLOW Radiology a 5.12 5.12 RBRVS 78205 LIVER IMAGING SPECT Radiology a 0.71 5.33 5.33 RBRVS 78205 26 LIVER IMAGING SPECT Radiology 0.71 0.22 0.22 RBRVS 78205 TC LIVER IMAGING SPECT Radiology a 5.11 5.11 RBRVS 78206 LIVER IMAGING SPECT W/VASCULAR FLOW Radiology a 0.96 8.91 8.91 RBRVS 78206 26 LIVER IMAGING SPECT W/VASCULAR FLOW Radiology 0.96 0.32 0.32 RBRVS 78206 TC LIVER IMAGING SPECT W/VASCULAR FLOW Radiology a 8.59 8.59 RBRVS 78215 LIVER & SPLEEN IMAGING STATIC ONLY Radiology a 0.49 5.09 5.09 RBRVS 78215 26 LIVER & SPLEEN IMAGING STATIC ONLY Radiology 0.49 0.17 0.17 RBRVS 78215 TC LIVER & SPLEEN IMAGING STATIC ONLY Radiology a 4.92 4.92 RBRVS 78216 LIVER & SPLEEN IMAGING W/VASCULAR FLOW Radiology a 0.57 3.01 3.01 RBRVS 78216 26 LIVER & SPLEEN IMAGING W/VASCULAR FLOW Radiology 0.57 0.19 0.19 RBRVS 78216 TC LIVER & SPLEEN IMAGING W/VASCULAR FLOW Radiology a 2.82 2.82 RBRVS 78226 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER Radiology a 0.74 8.81 8.81 RBRVS 78226 26 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER Radiology 0.74 0.26 0.26 RBRVS 78226 TC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER Radiology a 8.55 8.55 RBRVS

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78227 HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ Radiology a 0.90 12.06 12.06 RBRVS 78227 26 HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ Radiology 0.90 0.32 0.32 RBRVS 78227 TC HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ Radiology a 11.74 11.74 RBRVS 78230 SALIVARY GLAND IMAGING Radiology a 0.45 4.53 4.53 RBRVS 78230 26 SALIVARY GLAND IMAGING Radiology 0.45 0.17 0.17 RBRVS 78230 TC SALIVARY GLAND IMAGING Radiology a 4.36 4.36 RBRVS 78231 SALIVARY GLAND IMAGING SERIAL IMAGES Radiology a 0.52 3.19 3.19 RBRVS 78231 26 SALIVARY GLAND IMAGING SERIAL IMAGES Radiology 0.52 0.20 0.20 RBRVS 78231 TC SALIVARY GLAND IMAGING SERIAL IMAGES Radiology a 2.99 2.99 RBRVS 78232 SALIVARY GLAND FUNCTION STUDY Radiology a 0.47 2.33 2.33 RBRVS 78232 26 SALIVARY GLAND FUNCTION STUDY Radiology 0.47 0.08 0.08 RBRVS 78232 TC SALIVARY GLAND FUNCTION STUDY Radiology a 2.25 2.25 RBRVS 78258 ESOPHAGEAL MOTILITY Radiology a 0.74 5.60 5.60 RBRVS 78258 26 ESOPHAGEAL MOTILITY Radiology 0.74 0.27 0.27 RBRVS 78258 TC ESOPHAGEAL MOTILITY Radiology a 5.33 5.33 RBRVS 78261 GASTRIC MUCOSA IMAGING Radiology a 0.69 6.58 6.58 RBRVS 78261 26 GASTRIC MUCOSA IMAGING Radiology 0.69 0.26 0.26 RBRVS 78261 TC GASTRIC MUCOSA IMAGING Radiology a 6.32 6.32 RBRVS 78262 GASTROESOPHAGEAL REFLUX STUDY Radiology a 0.68 6.34 6.34 RBRVS 78262 26 GASTROESOPHAGEAL REFLUX STUDY Radiology 0.68 0.24 0.24 RBRVS 78262 TC GASTROESOPHAGEAL REFLUX STUDY Radiology a 6.10 6.10 RBRVS 78264 GASTRIC EMPTYING IMAGING STUDY Radiology a 0.80 7.53 7.53 RBRVS 78264 26 GASTRIC EMPTYING IMAGING STUDY Radiology 0.80 0.28 0.28 RBRVS 78264 TC GASTRIC EMPTYING IMAGING STUDY Radiology a 7.25 7.25 RBRVS 78265 GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT Radiology a 0.98 10.52 10.52 RBRVS 78265 26 GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT Radiology 0.98 0.34 0.34 RBRVS 78265 TC GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT Radiology a 10.18 10.18 RBRVS 78266 GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY Radiology a 1.08 12.57 12.57 RBRVS 78266 26 GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY Radiology 1.08 0.38 0.38 RBRVS 78266 TC GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY Radiology a 12.19 12.19 RBRVS 78270 VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR Radiology a 0.20 2.71 2.71 RBRVS 78270 26 VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR Radiology 0.20 0.09 0.09 RBRVS 78270 TC VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR Radiology a 2.62 2.62 RBRVS 78271 VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR Radiology a 0.20 2.39 2.39 RBRVS 78271 26 VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR Radiology 0.20 0.08 0.08 RBRVS 78271 TC VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR Radiology a 2.31 2.31 RBRVS 78272 VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT Radiology a 0.27 2.51 2.51 RBRVS 78272 26 VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT Radiology 0.27 0.10 0.10 RBRVS 78272 TC VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT Radiology a 2.41 2.41 RBRVS 78278 ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING Radiology a 0.99 9.05 9.05 RBRVS 78278 26 ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING Radiology 0.99 0.35 0.35 RBRVS 78278 TC ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING Radiology a 8.70 8.70 RBRVS 78282 GASTROINTESTINAL PROTEIN LOSS Radiology a 0.38 1.71 1.71 ERBRVS 78282 26 GASTROINTESTINAL PROTEIN LOSS Radiology 0.38 0.14 0.14 RBRVS 78282 TC GASTROINTESTINAL PROTEIN LOSS Radiology a 1.57 1.57 ERBRVS 78290 INTESTINE IMAGING Radiology a 0.68 8.90 8.90 RBRVS 78290 26 INTESTINE IMAGING Radiology 0.68 0.24 0.24 RBRVS 78290 TC INTESTINE IMAGING Radiology a 8.66 8.66 RBRVS 78291 PERITONEAL-VENOUS SHUNT PATENCY TEST Radiology a 0.88 6.26 6.26 RBRVS 78291 26 PERITONEAL-VENOUS SHUNT PATENCY TEST Radiology 0.88 0.27 0.27 RBRVS 78291 TC PERITONEAL-VENOUS SHUNT PATENCY TEST Radiology a 5.99 5.99 RBRVS 78299 UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE Radiology a 8.33 Unlisted 78299 26 UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE Radiology 0.90 Unlisted 78299 TC UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE Radiology a 7.43 Unlisted 78300 BONE &/JOINT IMAGING LIMITED AREA Radiology a 0.62 4.55 4.55 RBRVS 78300 26 BONE &/JOINT IMAGING LIMITED AREA Radiology 0.62 0.23 0.23 RBRVS 78300 TC BONE &/JOINT IMAGING LIMITED AREA Radiology a 4.32 4.32 RBRVS 78305 BONE &/JOINT IMAGING MULTIPLE AREAS Radiology a 0.83 5.79 5.79 RBRVS 78305 26 BONE &/JOINT IMAGING MULTIPLE AREAS Radiology 0.83 0.29 0.29 RBRVS 78305 TC BONE &/JOINT IMAGING MULTIPLE AREAS Radiology a 5.50 5.50 RBRVS 78306 BONE &/JOINT IMAGING WHOLE BODY Radiology a 0.86 6.38 6.38 RBRVS 78306 26 BONE &/JOINT IMAGING WHOLE BODY Radiology 0.86 0.30 0.30 RBRVS 78306 TC BONE &/JOINT IMAGING WHOLE BODY Radiology a 6.08 6.08 RBRVS 78315 BONE &/JOINT IMAGING 3 PHASE STUDY Radiology a 1.02 8.97 8.97 RBRVS 78315 26 BONE &/JOINT IMAGING 3 PHASE STUDY Radiology 1.02 0.36 0.36 RBRVS 78315 TC BONE &/JOINT IMAGING 3 PHASE STUDY Radiology a 8.61 8.61 RBRVS 78320 BONE &/JOINT IMAGING TOMOGRAPHIC SPECT Radiology a 1.04 5.49 5.49 RBRVS 78320 26 BONE &/JOINT IMAGING TOMOGRAPHIC SPECT Radiology 1.04 0.34 0.34 RBRVS 78320 TC BONE &/JOINT IMAGING TOMOGRAPHIC SPECT Radiology a 5.15 5.15 RBRVS 78350 BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY Radiology a 0.22 0.69 0.69 RBRVS 78350 26 BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY Radiology 0.22 0.08 0.08 RBRVS 78350 TC BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY Radiology a 0.61 0.61 RBRVS 78351 BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETR Radiology 0.30 0.11 0.11 RBRVS 78399 UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE Radiology a 7.24 Unlisted 78399 26 UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE Radiology 1.16 Unlisted

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78399 TC UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE Radiology a 6.08 Unlisted 78414 CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM Radiology a 0.45 1.58 1.58 ERBRVS 78414 26 CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM Radiology 0.45 0.16 0.16 RBRVS 78414 TC CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM Radiology a 1.42 1.42 ERBRVS 78428 CARDIAC SHUNT DETECTION Radiology a 0.78 4.40 4.40 RBRVS 78428 26 CARDIAC SHUNT DETECTION Radiology 0.78 0.26 0.26 RBRVS 78428 TC CARDIAC SHUNT DETECTION Radiology a 4.14 4.14 RBRVS 78445 NONCARDIAC VASCULAR FLOW IMAGING Radiology a 0.49 4.67 4.67 RBRVS 78445 26 NONCARDIAC VASCULAR FLOW IMAGING Radiology 0.49 0.16 0.16 RBRVS 78445 TC NONCARDIAC VASCULAR FLOW IMAGING Radiology a 4.51 4.51 RBRVS 78451 MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS Radiology a 1.38 8.43 8.43 RBRVS 78451 26 MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS Radiology 1.38 0.47 0.47 RBRVS 78451 TC MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS Radiology a 7.96 7.96 RBRVS 78452 MYOCARDIAL SPECT MULTIPLE STUDIES Radiology a 1.62 11.98 11.98 RBRVS 78452 26 MYOCARDIAL SPECT MULTIPLE STUDIES Radiology 1.62 0.56 0.56 RBRVS 78452 TC MYOCARDIAL SPECT MULTIPLE STUDIES Radiology a 11.42 11.42 RBRVS 78453 MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS Radiology a 1.00 7.77 7.77 RBRVS 78453 26 MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS Radiology 1.00 0.36 0.36 RBRVS 78453 TC MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS Radiology a 7.41 7.41 RBRVS 78454 MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES Radiology a 1.34 11.21 11.21 RBRVS 78454 26 MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES Radiology 1.34 0.49 0.49 RBRVS 78454 TC MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES Radiology a 10.72 10.72 RBRVS 78456 ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE Radiology a 1.00 8.23 8.23 RBRVS 78456 26 ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE Radiology 1.00 0.35 0.35 RBRVS 78456 TC ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE Radiology a 7.88 7.88 RBRVS 78457 VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL Radiology a 0.77 4.25 4.25 RBRVS 78457 26 VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL Radiology 0.77 0.26 0.26 RBRVS 78457 TC VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL Radiology a 3.99 3.99 RBRVS 78458 VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL Radiology a 0.90 4.99 4.99 RBRVS 78458 26 VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL Radiology 0.90 0.34 0.34 RBRVS 78458 TC VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL Radiology a 4.65 4.65 RBRVS 78459 MYOCARDIAL IMAGING PET METABOLIC EVALUATION Radiology a 9.56 Global/TC/26 78459 26 MYOCARDIAL IMAGING PET METABOLIC EVALUATION Radiology 1.95 Global/TC/26 78459 TC MYOCARDIAL IMAGING PET METABOLIC EVALUATION Radiology a 7.61 Global/TC/26 78466 MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN Radiology a 0.69 4.91 4.91 RBRVS 78466 26 MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN Radiology 0.69 0.27 0.27 RBRVS 78466 TC MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN Radiology a 4.64 4.64 RBRVS 78468 MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ Radiology a 0.80 4.74 4.74 RBRVS 78468 26 MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ Radiology 0.80 0.27 0.27 RBRVS 78468 TC MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ Radiology a 4.47 4.47 RBRVS 78469 MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ Radiology a 0.92 5.62 5.62 RBRVS 78469 26 MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ Radiology 0.92 0.34 0.34 RBRVS 78469 TC MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ Radiology a 5.28 5.28 RBRVS 78472 CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS Radiology a 0.98 5.62 5.62 RBRVS 78472 26 CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS Radiology 0.98 0.34 0.34 RBRVS 78472 TC CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS Radiology a 5.28 5.28 RBRVS 78473 CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT Radiology a 1.47 6.82 6.82 RBRVS 78473 26 CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT Radiology 1.47 0.49 0.49 RBRVS 78473 TC CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT Radiology a 6.33 6.33 RBRVS 78481 CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT Radiology a 0.98 4.03 4.03 RBRVS 78481 26 CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT Radiology 0.98 0.34 0.34 RBRVS 78481 TC CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT Radiology a 3.69 3.69 RBRVS 78483 CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT Radiology a 1.47 5.35 5.35 RBRVS 78483 26 CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT Radiology 1.47 0.50 0.50 RBRVS 78483 TC CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT Radiology a 4.85 4.85 RBRVS 78491 MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS Radiology a 9.88 Global/TC/26 78491 26 MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS Radiology 1.96 Global/TC/26 78491 TC MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS Radiology a 7.92 Global/TC/26 78492 MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS Radiology a 12.51 Global/TC/26 78492 26 MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS Radiology 2.48 Global/TC/26 78492 TC MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS Radiology a 10.03 Global/TC/26 78494 CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT Radiology a 1.19 5.23 5.23 RBRVS 78494 26 CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT Radiology 1.19 0.41 0.41 RBRVS 78494 TC CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT Radiology a 4.82 4.82 RBRVS 78496 CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT Radiology a 0.50 0.75 0.75 RBRVS 78496 26 CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT Radiology 0.50 0.17 0.17 RBRVS 78496 TC CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT Radiology a 0.58 0.58 RBRVS 78499 UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE Radiology a 13.60 Unlisted 78499 26 UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE Radiology 2.18 Unlisted 78499 TC UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE Radiology a 11.42 Unlisted 78579 PULMONARY VENTILATION IMAGING Radiology a 0.49 4.83 4.83 RBRVS 78579 26 PULMONARY VENTILATION IMAGING Radiology 0.49 0.16 0.16 RBRVS 78579 TC PULMONARY VENTILATION IMAGING Radiology a 4.67 4.67 RBRVS 78580 PULMONARY PERFUSION IMAGING PARTICULATE Radiology a 0.74 6.13 6.13 RBRVS 78580 26 PULMONARY PERFUSION IMAGING PARTICULATE Radiology 0.74 0.26 0.26 RBRVS

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78580 TC PULMONARY PERFUSION IMAGING PARTICULATE Radiology a 5.87 5.87 RBRVS 78582 PULMONARY VENTILATION & PERFUSION IMAGING Radiology a 1.07 8.57 8.57 RBRVS 78582 26 PULMONARY VENTILATION & PERFUSION IMAGING Radiology 1.07 0.38 0.38 RBRVS 78582 TC PULMONARY VENTILATION & PERFUSION IMAGING Radiology a 8.19 8.19 RBRVS 78597 QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING Radiology a 0.75 5.05 5.05 RBRVS 78597 26 QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING Radiology 0.75 0.23 0.23 RBRVS 78597 TC QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING Radiology a 4.82 4.82 RBRVS 78598 QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN Radiology a 0.85 7.97 7.97 RBRVS 78598 26 QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN Radiology 0.85 0.29 0.29 RBRVS 78598 TC QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN Radiology a 7.68 7.68 RBRVS 78599 UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE Radiology a 9.64 Unlisted 78599 26 UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE Radiology 1.45 Unlisted 78599 TC UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE Radiology a 8.19 Unlisted 78600 BRAIN IMAGING <4 STATIC VIEWS Radiology a 0.44 4.86 4.86 RBRVS 78600 26 BRAIN IMAGING <4 STATIC VIEWS Radiology 0.44 0.17 0.17 RBRVS 78600 TC BRAIN IMAGING <4 STATIC VIEWS Radiology a 4.69 4.69 RBRVS 78601 BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW Radiology a 0.51 5.66 5.66 RBRVS 78601 26 BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW Radiology 0.51 0.17 0.17 RBRVS 78601 TC BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW Radiology a 5.49 5.49 RBRVS 78605 BRAIN IMAGING MINIMUM 4 STATIC VIEWS Radiology a 0.53 5.18 5.18 RBRVS 78605 26 BRAIN IMAGING MINIMUM 4 STATIC VIEWS Radiology 0.53 0.20 0.20 RBRVS 78605 TC BRAIN IMAGING MINIMUM 4 STATIC VIEWS Radiology a 4.98 4.98 RBRVS 78606 BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW Radiology a 0.64 8.96 8.96 RBRVS 78606 26 BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW Radiology 0.64 0.23 0.23 RBRVS 78606 TC BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW Radiology a 8.73 8.73 RBRVS 78607 BRAIN IMAGING TOMOGRAPHIC SPECT Radiology a 1.23 8.91 8.91 RBRVS 78607 26 BRAIN IMAGING TOMOGRAPHIC SPECT Radiology 1.23 0.40 0.40 RBRVS 78607 TC BRAIN IMAGING TOMOGRAPHIC SPECT Radiology a 8.51 8.51 RBRVS 78608 BRAIN IMAGING PET METABOLIC EVALUATION Radiology a 12.48 Global/TC/26 78608 26 BRAIN IMAGING PET METABOLIC EVALUATION Radiology 1.97 Global/TC/26 78608 TC BRAIN IMAGING PET METABOLIC EVALUATION Radiology a 10.51 Global/TC/26 78609 BRAIN IMAGING PET PERFUSION EVALUATION Radiology a 8.28 Global/TC/26 78609 26 BRAIN IMAGING PET PERFUSION EVALUATION Radiology 2.07 Global/TC/26 78609 TC BRAIN IMAGING PET PERFUSION EVALUATION Radiology a 6.21 Global/TC/26 78610 BRAIN IMAGING VASCULAR FLOW ONLY Radiology a 0.30 4.71 4.71 RBRVS 78610 26 BRAIN IMAGING VASCULAR FLOW ONLY Radiology 0.30 0.11 0.11 RBRVS 78610 TC BRAIN IMAGING VASCULAR FLOW ONLY Radiology a 4.60 4.60 RBRVS 78630 CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY Radiology a 0.68 9.10 9.10 RBRVS 78630 26 CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY Radiology 0.68 0.24 0.24 RBRVS 78630 TC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY Radiology a 8.86 8.86 RBRVS 78635 CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY Radiology a 0.61 9.20 9.20 RBRVS 78635 26 CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY Radiology 0.61 0.23 0.23 RBRVS 78635 TC CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY Radiology a 8.97 8.97 RBRVS 78645 CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ Radiology a 0.57 8.76 8.76 RBRVS 78645 26 CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ Radiology 0.57 0.19 0.19 RBRVS 78645 TC CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ Radiology a 8.57 8.57 RBRVS 78647 CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT Radiology a 0.90 9.24 9.24 RBRVS 78647 26 CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT Radiology 0.90 0.34 0.34 RBRVS 78647 TC CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT Radiology a 8.90 8.90 RBRVS 78650 CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO Radiology a 0.61 9.01 9.01 RBRVS 78650 26 CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO Radiology 0.61 0.21 0.21 RBRVS 78650 TC CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO Radiology a 8.80 8.80 RBRVS 78660 RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY Radiology a 0.53 4.55 4.55 RBRVS 78660 26 RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY Radiology 0.53 0.19 0.19 RBRVS 78660 TC RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY Radiology a 4.36 4.36 RBRVS 78699 UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE Radiology a 12.48 Unlisted 78699 26 UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE Radiology 1.97 Unlisted 78699 TC UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE Radiology a 10.51 Unlisted 78700 KIDNEY IMAGING MORPHOLOGY Radiology a 0.45 4.49 4.49 RBRVS 78700 26 KIDNEY IMAGING MORPHOLOGY Radiology 0.45 0.16 0.16 RBRVS 78700 TC KIDNEY IMAGING MORPHOLOGY Radiology a 4.33 4.33 RBRVS 78701 KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW Radiology a 0.49 5.56 5.56 RBRVS 78701 26 KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW Radiology 0.49 0.16 0.16 RBRVS 78701 TC KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW Radiology a 5.40 5.40 RBRVS 78707 KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX Radiology a 0.96 5.70 5.70 RBRVS 78707 26 KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX Radiology 0.96 0.32 0.32 RBRVS 78707 TC KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX Radiology a 5.38 5.38 RBRVS 78708 KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX Radiology a 1.21 3.73 3.73 RBRVS 78708 26 KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX Radiology 1.21 0.42 0.42 RBRVS 78708 TC KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX Radiology a 3.31 3.31 RBRVS 78709 KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE Radiology a 1.41 8.98 8.98 RBRVS 78709 26 KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE Radiology 1.41 0.46 0.46 RBRVS 78709 TC KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE Radiology a 8.52 8.52 RBRVS 78710 KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC Radiology a 0.66 5.03 5.03 RBRVS 78710 26 KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC Radiology 0.66 0.17 0.17 RBRVS

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78710 TC KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC Radiology a 4.86 4.86 RBRVS 78725 KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY Radiology a 0.38 2.71 2.71 RBRVS 78725 26 KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY Radiology 0.38 0.12 0.12 RBRVS 78725 TC KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY Radiology a 2.59 2.59 RBRVS 78730 URINARY BLADDER RESIDUAL STUDY Radiology a 0.15 2.05 2.05 RBRVS 78730 26 URINARY BLADDER RESIDUAL STUDY Radiology 0.15 0.06 0.06 RBRVS 78730 TC URINARY BLADDER RESIDUAL STUDY Radiology a 1.99 1.99 RBRVS 78740 URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM Radiology a 0.57 5.72 5.72 RBRVS 78740 26 URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM Radiology 0.57 0.20 0.20 RBRVS 78740 TC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM Radiology a 5.52 5.52 RBRVS 78761 TESTICULAR IMAGING WITH VASCULAR FLOW Radiology a 0.71 5.33 5.33 RBRVS 78761 26 TESTICULAR IMAGING WITH VASCULAR FLOW Radiology 0.71 0.27 0.27 RBRVS 78761 TC TESTICULAR IMAGING WITH VASCULAR FLOW Radiology a 5.06 5.06 RBRVS 78799 UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE Radiology a 4.94 Unlisted 78799 26 UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE Radiology 1.33 Unlisted 78799 TC UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE Radiology a 3.61 Unlisted 78800 RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA Radiology a 0.66 4.80 4.80 RBRVS 78800 26 RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA Radiology 0.66 0.24 0.24 RBRVS 78800 TC RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA Radiology a 4.56 4.56 RBRVS 78801 RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS Radiology a 0.79 6.68 6.68 RBRVS 78801 26 RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS Radiology 0.79 0.29 0.29 RBRVS 78801 TC RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS Radiology a 6.39 6.39 RBRVS 78802 RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY Radiology a 0.86 8.47 8.47 RBRVS 78802 26 RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY Radiology 0.86 0.29 0.29 RBRVS 78802 TC RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY Radiology a 8.18 8.18 RBRVS 78803 RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT Radiology a 1.09 8.71 8.71 RBRVS 78803 26 RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT Radiology 1.09 0.34 0.34 RBRVS 78803 TC RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT Radiology a 8.37 8.37 RBRVS 78804 RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY Radiology a 1.07 15.37 15.37 RBRVS 78804 26 RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY Radiology 1.07 0.36 0.36 RBRVS 78804 TC RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY Radiology a 15.01 15.01 RBRVS 78805 RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA Radiology a 0.73 4.48 4.48 RBRVS 78805 26 RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA Radiology 0.73 0.25 0.25 RBRVS 78805 TC RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA Radiology a 4.23 4.23 RBRVS 78806 RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY Radiology a 0.86 8.74 8.74 RBRVS 78806 26 RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY Radiology 0.86 0.29 0.29 RBRVS 78806 TC RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY Radiology a 8.45 8.45 RBRVS 78807 RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT Radiology a 1.09 8.74 8.74 RBRVS 78807 26 RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT Radiology 1.09 0.34 0.34 RBRVS 78807 TC RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT Radiology a 8.40 8.40 RBRVS 78808 NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS Radiology 0.18 1.06 1.06 RBRVS 78811 PET IMAGING LIMITED AREA CHEST HEAD/NECK Radiology a 16.87 Global/TC/26 78811 26 PET IMAGING LIMITED AREA CHEST HEAD/NECK Radiology 2.10 Global/TC/26 78811 TC PET IMAGING LIMITED AREA CHEST HEAD/NECK Radiology a 14.77 Global/TC/26 78812 PET IMAGING SKULL BASE TO MID-THIGH Radiology a 20.55 Global/TC/26 78812 26 PET IMAGING SKULL BASE TO MID-THIGH Radiology 2.58 Global/TC/26 78812 TC PET IMAGING SKULL BASE TO MID-THIGH Radiology a 17.97 Global/TC/26 78813 PET IMAGING WHOLE BODY Radiology a 21.34 Global/TC/26 78813 26 PET IMAGING WHOLE BODY Radiology 2.69 Global/TC/26 78813 TC PET IMAGING WHOLE BODY Radiology a 18.65 Global/TC/26 78814 PET IMAGING CT FOR ATTENUATION LIMITED AREA Radiology a 23.73 Global/TC/26 78814 26 PET IMAGING CT FOR ATTENUATION LIMITED AREA Radiology 2.98 Global/TC/26 78814 TC PET IMAGING CT FOR ATTENUATION LIMITED AREA Radiology a 20.75 Global/TC/26 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH Radiology a 25.82 Global/TC/26 78815 26 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH Radiology 3.28 Global/TC/26 78815 TC PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH Radiology a 22.54 Global/TC/26 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology a 26.30 Global/TC/26 78816 26 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology 3.31 Global/TC/26 78816 TC PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology a 22.99 Global/TC/26 78999 UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE Radiology a 25.82 Unlisted 78999 26 UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE Radiology 3.40 Unlisted 78999 TC UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE Radiology a 22.42 Unlisted 79005 RP THERAPY ORAL ADMINISTRATION Radiology a 1.80 1.98 1.98 RBRVS 79005 26 RP THERAPY ORAL ADMINISTRATION Radiology 1.80 0.61 0.61 RBRVS 79005 TC RP THERAPY ORAL ADMINISTRATION Radiology a 1.37 1.37 RBRVS 79101 RP THERAPY INTRAVENOUS ADMINISTRATION Radiology a 1.96 1.99 1.99 RBRVS 79101 26 RP THERAPY INTRAVENOUS ADMINISTRATION Radiology 1.96 0.65 0.65 RBRVS 79101 TC RP THERAPY INTRAVENOUS ADMINISTRATION Radiology a 1.34 1.34 RBRVS 79200 RP THERAPY INRACAVITARY ADMINISTRATION Radiology a 1.99 1.80 1.80 RBRVS 79200 26 RP THERAPY INRACAVITARY ADMINISTRATION Radiology 1.99 0.36 0.36 RBRVS 79200 TC RP THERAPY INRACAVITARY ADMINISTRATION Radiology a 1.44 1.44 RBRVS 79300 RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN Radiology a 1.60 1.68 1.68 ERBRVS 79300 26 RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN Radiology 1.60 0.38 0.38 RBRVS 79300 TC RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN Radiology a 1.30 1.30 ERBRVS 79403 RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS Radiology a 2.25 3.00 3.00 RBRVS

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79403 26 RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS Radiology 2.25 0.76 0.76 RBRVS 79403 TC RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS Radiology a 2.24 2.24 RBRVS 79440 RP THERAPY INTRA-ARTICULAR ADMINISTRATION Radiology a 1.99 1.55 1.55 RBRVS 79440 26 RP THERAPY INTRA-ARTICULAR ADMINISTRATION Radiology 1.99 0.43 0.43 RBRVS 79440 TC RP THERAPY INTRA-ARTICULAR ADMINISTRATION Radiology a 1.12 1.12 RBRVS 79445 RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN Radiology a 9.55 Global/TC/26 79445 26 RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN Radiology 3.16 Global/TC/26 79445 TC RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN Radiology a 6.39 Global/TC/26 79999 RP THERAPY UNLISTED PROCEDURE Radiology a 3.78 Unlisted 79999 26 RP THERAPY UNLISTED PROCEDURE Radiology 2.41 Unlisted 79999 TC RP THERAPY UNLISTED PROCEDURE Radiology a 1.37 Unlisted 80500 CLINICAL PATHOLOGY CONSULTATION LIMITED Pathology 0.37 0.17 0.26 RBRVS 80502 CLINICAL PATHOLOGY CONSULTATION COMPREHENSIVE Pathology 1.33 0.57 0.66 RBRVS 83020 26 HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS Pathology 0.37 0.14 0.14 RBRVS 84165 26 PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM Pathology 0.37 0.14 0.14 RBRVS 84166 26 PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI Pathology 0.37 0.14 0.14 RBRVS 84181 26 PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID Pathology 0.37 0.14 0.14 RBRVS 84182 26 PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL Pathology 0.37 0.14 0.14 RBRVS 85060 BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT Pathology 0.45 0.23 0.23 RBRVS 85097 BONE MARROW SMEAR INTERPRETATION Pathology 0.94 0.41 1.52 RBRVS 85390 26 FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR Pathology 0.37 0.14 0.14 RBRVS 85396 COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY Pathology 0.37 0.19 0.19 RBRVS 85576 26 PLATELET AGGREGATION IN VITRO EACH AGENT Pathology 0.37 0.14 0.14 RBRVS 86077 BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REP Pathology 0.94 0.48 0.59 RBRVS 86078 BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT Pathology 0.94 0.47 0.58 RBRVS 86079 BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT Pathology 0.94 0.45 0.55 RBRVS 86153 26 CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP Pathology 0.69 0.26 0.26 RBRVS 86255 26 FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY Pathology 0.37 0.14 0.14 RBRVS 86256 26 FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY Pathology 0.37 0.14 0.14 RBRVS 86320 26 IMMUNOELECTROPHORESIS SERUM Pathology 0.37 0.14 0.14 RBRVS 86325 26 IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION Pathology 0.37 0.14 0.14 RBRVS 86327 26 IMMUNOELECTROPHORESIS CROSSED Pathology 0.42 0.16 0.16 RBRVS 86334 26 IMMUNOFIXJ ELECTROPHORESIS SERUM Pathology 0.37 0.14 0.14 RBRVS 86335 26 IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS Pathology 0.37 0.14 0.14 RBRVS 86486 SKIN TEST UNLISTED ANTIGEN EACH Pathology a 0.13 0.13 RBRVS 86490 SKIN TEST COCCIDIOIDOMYCOSIS Pathology a 1.96 1.96 RBRVS 86510 SKIN TEST HISTOPLASMOSIS Pathology a 0.16 0.16 RBRVS 86580 SKIN TEST TUBERCULOSIS INTRADERMAL Pathology a 0.21 0.21 RBRVS 87164 26 DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION Pathology 0.37 0.14 0.14 RBRVS 87207 26 SMR PRIM SRC SPEC STAIN BODIES/PARASITS Pathology 0.37 0.14 0.14 RBRVS 88104 CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ Pathology a 0.56 1.52 1.52 RBRVS 88104 26 CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ Pathology 0.56 0.26 0.26 RBRVS 88104 TC CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ Pathology a 1.26 1.26 RBRVS 88106 CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ Pathology a 0.37 2.07 2.07 RBRVS 88106 26 CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ Pathology 0.37 0.18 0.18 RBRVS 88106 TC CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ Pathology a 1.89 1.89 RBRVS 88108 CYTP CONCENTRATION SMEARS & INTERPRETATION Pathology a 0.44 1.91 1.91 RBRVS 88108 26 CYTP CONCENTRATION SMEARS & INTERPRETATION Pathology 0.44 0.21 0.21 RBRVS 88108 TC CYTP CONCENTRATION SMEARS & INTERPRETATION Pathology a 1.70 1.70 RBRVS 88112 CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V Pathology a 0.56 1.23 1.23 RBRVS 88112 26 CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V Pathology 0.56 0.23 0.23 RBRVS 88112 TC CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V Pathology a 1.00 1.00 RBRVS 88120 CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL Pathology a 1.20 16.19 16.19 RBRVS 88120 26 CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL Pathology 1.20 0.43 0.43 RBRVS 88120 TC CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL Pathology a 15.76 15.76 RBRVS 88121 CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA Pathology a 1.00 14.47 14.47 RBRVS 88121 26 CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA Pathology 1.00 0.42 0.42 RBRVS 88121 TC CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA Pathology a 14.05 14.05 RBRVS 88125 CYTOPATHOLOGY FORENSIC Pathology a 0.26 0.45 0.45 RBRVS 88125 26 CYTOPATHOLOGY FORENSIC Pathology 0.26 0.13 0.13 RBRVS 88125 TC CYTOPATHOLOGY FORENSIC Pathology a 0.32 0.32 RBRVS 88141 CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN Pathology 0.42 0.47 0.47 RBRVS 88160 CYTP SMRS ANY OTH SRC SCR&INTERPJ Pathology a 0.50 1.36 1.36 RBRVS 88160 26 CYTP SMRS ANY OTH SRC SCR&INTERPJ Pathology 0.50 0.24 0.24 RBRVS 88160 TC CYTP SMRS ANY OTH SRC SCR&INTERPJ Pathology a 1.12 1.12 RBRVS 88161 CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ Pathology a 0.50 1.18 1.18 RBRVS 88161 26 CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ Pathology 0.50 0.21 0.21 RBRVS 88161 TC CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ Pathology a 0.97 0.97 RBRVS 88162 CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES Pathology a 0.76 2.01 2.01 RBRVS 88162 26 CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES Pathology 0.76 0.37 0.37 RBRVS 88162 TC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES Pathology a 1.64 1.64 RBRVS 88172 CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST Pathology a 0.69 0.88 0.88 RBRVS 88172 26 CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST Pathology 0.69 0.34 0.34 RBRVS 88172 TC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST Pathology a 0.54 0.54 RBRVS 88173 CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT Pathology a 1.39 2.82 2.82 RBRVS

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88173 26 CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT Pathology 1.39 0.62 0.62 RBRVS 88173 TC CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT Pathology a 2.20 2.20 RBRVS 88177 CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL Pathology a 0.42 0.42 0.42 RBRVS 88177 26 CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL Pathology 0.42 0.21 0.21 RBRVS 88177 TC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL Pathology a 0.21 0.21 RBRVS 88182 FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS Pathology a 0.77 2.23 2.23 RBRVS 88182 26 FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS Pathology 0.77 0.23 0.23 RBRVS 88182 TC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS Pathology a 2.00 2.00 RBRVS 88184 FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST Pathology a 2.62 2.62 RBRVS 88185 FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA Pathology a 1.59 1.59 RBRVS 88187 FLOW CYTOMETRY INTERPJ 2-8 MARKERS Pathology 1.36 0.60 0.60 RBRVS 88188 FLOW CYTOMETRY INTERPJ 9-15 MARKERS Pathology 1.69 0.79 0.79 RBRVS 88189 FLOW CYTOMETRY INTERPRETATION 16/> MARKERS Pathology 2.23 0.84 0.84 RBRVS 88291 CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP Pathology 0.52 0.35 0.35 RBRVS 88300 LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY Pathology a 0.08 0.33 0.33 RBRVS 88300 26 LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY Pathology 0.08 0.04 0.04 RBRVS 88300 TC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY Pathology a 0.29 0.29 RBRVS 88302 LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 0.13 0.75 0.75 RBRVS 88302 26 LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology 0.13 0.06 0.06 RBRVS 88302 TC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 0.69 0.69 RBRVS 88304 LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 0.22 1.04 1.04 RBRVS 88304 26 LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology 0.22 0.10 0.10 RBRVS 88304 TC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 0.94 0.94 RBRVS 88305 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 0.75 1.27 1.27 RBRVS 88305 26 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology 0.75 0.33 0.33 RBRVS 88305 TC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 0.94 0.94 RBRVS 88307 LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 1.59 6.93 6.93 RBRVS 88307 26 LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology 1.59 0.79 0.79 RBRVS 88307 TC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 6.14 6.14 RBRVS 88309 LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 2.80 10.12 10.12 RBRVS 88309 26 LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology 2.80 1.39 1.39 RBRVS 88309 TC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM Pathology a 8.73 8.73 RBRVS 88311 DECALCIFICATION PROCEDURE Pathology a 0.24 0.33 0.33 RBRVS 88311 26 DECALCIFICATION PROCEDURE Pathology 0.24 0.11 0.11 RBRVS 88311 TC DECALCIFICATION PROCEDURE Pathology a 0.22 0.22 RBRVS 88312 SPECIAL STAIN GROUP 1 MICROORGANISMS I&R Pathology a 0.54 2.17 2.17 RBRVS 88312 26 SPECIAL STAIN GROUP 1 MICROORGANISMS I&R Pathology 0.54 0.23 0.23 RBRVS 88312 TC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R Pathology a 1.94 1.94 RBRVS 88313 SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT Pathology a 0.24 1.64 1.64 RBRVS 88313 26 SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT Pathology 0.24 0.10 0.10 RBRVS 88313 TC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT Pathology a 1.54 1.54 RBRVS 88314 SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU Pathology a 0.45 1.62 1.62 RBRVS 88314 26 SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU Pathology 0.45 0.18 0.18 RBRVS 88314 TC SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU Pathology a 1.44 1.44 RBRVS 88319 SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS Pathology a 0.53 1.92 1.92 RBRVS 88319 26 SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS Pathology 0.53 0.24 0.24 RBRVS 88319 TC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS Pathology a 1.68 1.68 RBRVS 88321 CONSLTJ&REPRT SLIDES PREPARED ELSEWHERE Pathology 1.63 0.72 1.00 RBRVS 88323 CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES Pathology a 1.83 2.40 2.40 RBRVS 88323 26 CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES Pathology 1.83 0.65 0.65 RBRVS 88323 TC CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES Pathology a 1.75 1.75 RBRVS 88325 CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL Pathology 2.50 1.20 3.41 RBRVS 88329 PATHOLOGY CONSULTATION DURING SURGERY Pathology 0.67 0.33 0.95 RBRVS 88331 PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC Pathology a 1.19 1.68 1.68 RBRVS 88331 26 PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC Pathology 1.19 0.60 0.60 RBRVS 88331 TC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC Pathology a 1.08 1.08 RBRVS 88332 PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION Pathology a 0.59 0.66 0.66 RBRVS 88332 26 PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION Pathology 0.59 0.29 0.29 RBRVS 88332 TC PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION Pathology a 0.37 0.37 RBRVS 88333 PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE Pathology a 1.20 1.82 1.82 RBRVS 88333 26 PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE Pathology 1.20 0.59 0.59 RBRVS 88333 TC PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE Pathology a 1.23 1.23 RBRVS 88334 PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE Pathology a 0.73 1.11 1.11 RBRVS 88334 26 PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE Pathology 0.73 0.36 0.36 RBRVS 88334 TC PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE Pathology a 0.75 0.75 RBRVS 88341 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology a 0.42 1.45 1.45 RBRVS 88341 26 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology 0.42 0.18 0.18 RBRVS 88341 TC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology a 1.27 1.27 RBRVS 88342 IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE Pathology a 0.70 1.81 1.81 RBRVS 88342 26 IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE Pathology 0.70 0.31 0.31 RBRVS 88342 TC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE Pathology a 1.50 1.50 RBRVS 88344 IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE Pathology a 0.77 2.48 2.48 RBRVS 88344 26 IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE Pathology 0.77 0.34 0.34 RBRVS 88344 TC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE Pathology a 2.14 2.14 RBRVS 88346 IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN Pathology a 0.86 2.21 2.21 RBRVS

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88346 26 IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN Pathology 0.86 0.35 0.35 RBRVS 88346 TC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN Pathology a 1.86 1.86 RBRVS 88348 ELECTRON MICROSCOPY DIAGNOSTIC Pathology a 1.51 8.14 8.14 RBRVS 88348 26 ELECTRON MICROSCOPY DIAGNOSTIC Pathology 1.51 0.66 0.66 RBRVS 88348 TC ELECTRON MICROSCOPY DIAGNOSTIC Pathology a 7.48 7.48 RBRVS 88350 IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN Pathology 0.56 1.45 1.45 RBRVS 88350 26 IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN Pathology 0.56 0.23 0.23 RBRVS 88350 TC IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN Pathology 1.22 1.22 RBRVS 88355 MORPHOMETRIC ANALYSIS SKELETAL MUSCLE Pathology a 1.85 3.01 3.01 RBRVS 88355 26 MORPHOMETRIC ANALYSIS SKELETAL MUSCLE Pathology 1.85 0.47 0.47 RBRVS 88355 TC MORPHOMETRIC ANALYSIS SKELETAL MUSCLE Pathology a 2.54 2.54 RBRVS 88356 MORPHOMETRIC ANALYSIS NERVE Pathology a 2.80 2.91 2.91 RBRVS 88356 26 MORPHOMETRIC ANALYSIS NERVE Pathology 2.80 0.61 0.61 RBRVS 88356 TC MORPHOMETRIC ANALYSIS NERVE Pathology a 2.30 2.30 RBRVS 88358 MORPHOMETRIC ANALYSIS TUMOR Pathology a 0.95 1.39 1.39 RBRVS 88358 26 MORPHOMETRIC ANALYSIS TUMOR Pathology 0.95 0.31 0.31 RBRVS 88358 TC MORPHOMETRIC ANALYSIS TUMOR Pathology a 1.08 1.08 RBRVS 88360 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL Pathology a 1.10 2.68 2.68 RBRVS 88360 26 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL Pathology 1.10 0.44 0.44 RBRVS 88360 TC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL Pathology a 2.24 2.24 RBRVS 88361 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST Pathology a 1.18 3.54 3.54 RBRVS 88361 26 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST Pathology 1.18 0.49 0.49 RBRVS 88361 TC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST Pathology a 3.05 3.05 RBRVS 88362 NERVE TEASING PREPARATIONS Pathology a 2.17 5.95 5.95 RBRVS 88362 26 NERVE TEASING PREPARATIONS Pathology 2.17 0.87 0.87 RBRVS 88362 TC NERVE TEASING PREPARATIONS Pathology a 5.08 5.08 RBRVS 88363 EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI Pathology 0.37 0.16 0.25 RBRVS 88364 IN SITU HYBRIDIZATION EA ADDL PROBE STAIN Pathology a 0.53 2.17 2.17 RBRVS 88364 26 IN SITU HYBRIDIZATION EA ADDL PROBE STAIN Pathology 0.53 0.22 0.22 RBRVS 88364 TC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN Pathology a 1.95 1.95 RBRVS 88365 IN SITU HYBRIDIZATION 1ST PROBE STAIN Pathology a 0.88 3.48 3.48 RBRVS 88365 26 IN SITU HYBRIDIZATION 1ST PROBE STAIN Pathology 0.88 0.36 0.36 RBRVS 88365 TC IN SITU HYBRIDIZATION 1ST PROBE STAIN Pathology a 3.12 3.12 RBRVS 88366 IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN Pathology a 1.24 6.05 6.05 RBRVS 88366 26 IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN Pathology 1.24 0.53 0.53 RBRVS 88366 TC IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN Pathology a 5.52 5.52 RBRVS 88367 M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN Pathology a 0.73 2.25 2.25 RBRVS 88367 26 M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN Pathology 0.73 0.25 0.25 RBRVS 88367 TC M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN Pathology a 2.00 2.00 RBRVS 88368 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL Pathology a 0.88 2.14 2.14 RBRVS 88368 26 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL Pathology 0.88 0.26 0.26 RBRVS 88368 TC M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL Pathology a 1.88 1.88 RBRVS 88369 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH Pathology a 0.53 1.51 1.51 RBRVS 88369 26 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH Pathology 0.53 0.16 0.16 RBRVS 88369 TC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH Pathology a 1.35 1.35 RBRVS 88371 26 PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO Pathology 0.37 0.14 0.14 RBRVS 88372 26 PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA Pathology 0.37 0.14 0.14 RBRVS 88373 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH Pathology a 0.43 1.24 1.24 RBRVS 88373 26 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH Pathology 0.43 0.15 0.15 RBRVS 88373 TC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH Pathology a 1.09 1.09 RBRVS 88374 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB Pathology a 0.93 8.70 8.70 RBRVS 88374 26 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB Pathology 0.93 0.34 0.34 RBRVS 88374 TC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB Pathology a 8.36 8.36 RBRVS 88377 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB Pathology a 1.40 10.06 10.06 RBRVS 88377 26 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB Pathology 1.40 0.43 0.43 RBRVS 88377 TC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB Pathology a 9.63 9.63 RBRVS 88380 MICRODISSECTION PREP IDENTIFIED TARGET LASER Pathology a 1.14 2.55 2.55 RBRVS 88380 26 MICRODISSECTION PREP IDENTIFIED TARGET LASER Pathology 1.14 0.43 0.43 RBRVS 88380 TC MICRODISSECTION PREP IDENTIFIED TARGET LASER Pathology a 2.12 2.12 RBRVS 88381 MICRODISSECTION PREP IDENTIFIED TARGET MANUAL Pathology a 0.53 2.92 2.92 RBRVS 88381 26 MICRODISSECTION PREP IDENTIFIED TARGET MANUAL Pathology 0.53 0.19 0.19 RBRVS 88381 TC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL Pathology a 2.73 2.73 RBRVS 88387 MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA Pathology a 0.62 0.56 0.56 RBRVS 88387 26 MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA Pathology 0.62 0.29 0.29 RBRVS 88387 TC MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA Pathology a 0.27 0.27 RBRVS 88388 MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE Pathology a 0.45 0.49 0.49 RBRVS 88388 26 MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE Pathology 0.45 0.23 0.23 RBRVS 88388 TC MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE Pathology a 0.26 0.26 RBRVS 89049 CAFFEINE HALOTHANE CONTRACTURE TEST Pathology 1.40 0.24 5.24 RBRVS 89060 26 CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID Pathology 0.37 0.14 0.14 RBRVS 89220 SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX Pathology a 0.43 0.43 RBRVS 89230 SWEAT COLLECTION IONTOPHORESIS Pathology a 0.14 0.14 RBRVS 90281 IMMUNE GLOBULIN IG HUMAN IM USE Therapeutic Injections 0.35 v3.16 90283 IMMUNE GLOBULIN IGIV HUMAN IV USE Therapeutic Injections 0.95 v3.16 90284 IMMUNE GLOBULIN HUMAN SUBQ INFUSION 100 MG EA Therapeutic Injections 0.28 v3.16

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90287 BOTULINUM ANTITOXIN EQUINE ANY ROUTE Therapeutic Injections 0.16 v3.16 90296 DIPHTHERIA ANTITOXIN EQUINE ANY ROUTE Therapeutic Injections 0.45 v3.16 90371 HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM Therapeutic Injections 2.81 FAIR Health 90375 RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ Therapeutic Injections 3.25 FAIR Health 90376 RABIES IG HEAT-TREATED HUMAN IM/SUBQ Therapeutic Injections 3.25 FAIR Health 90378 RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E Therapeutic Injections 0.56 v3.16 90384 RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM Therapeutic Injections 2.07 FAIR Health 90385 RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM Therapeutic Injections 0.95 FAIR Health 90386 RHO(D) IMMUNE GLOBULIN HUMAN IV Therapeutic Injections 3.59 3.59 ERBRVS 90389 TETANUS IMMUNE GLOBULIN TIG HUMAN IM Therapeutic Injections 1.92 FAIR Health 90396 VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM Therapeutic Injections 2.13 FAIR Health 90399 UNLISTED IMMUNE GLOBULIN Therapeutic Injections 0.95 Unlisted 90460 IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX Immunizations 0.17 0.53 0.53 RBRVS 90461 IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT Immunizations 0.15 0.20 0.20 RBRVS 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE Immunizations 0.17 0.53 0.53 RBRVS 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE Immunizations 0.15 0.20 0.20 RBRVS 90473 IM ADM INTRANSL/ORAL 1 VACCINE Immunizations 0.17 0.53 0.53 RBRVS 90474 IM ADM INTRANSL/ORAL EA VACCINE Immunizations 0.15 0.20 0.20 RBRVS 90476 ADENOVIRUS VACCINE TYPE 4 LIVE ORAL Immunizations 0.35 v3.16 90477 ADENOVIRUS VACCINE TYPE 7 LIVE FOR ORAL Immunizations 0.25 v3.16 90581 ANTHRAX VACCINE SUBCUTANEOUS/IM USE Immunizations 3.99 3.99 ERBRVS 90585 BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ Immunizations 4.24 FAIR Health 90586 BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL Immunizations 6.49 FAIR Health 90620 MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM Immunizations 5.70 Other 90621 MENB RECOMBINANT LIPOPROTEIN VACCINE IM Immunizations 5.70 Other 90630 INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID Immunizations 0.51 v3.16 90632 HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE Immunizations 2.32 FAIR Health 90633 HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE Immunizations 1.13 FAIR Health 90634 HEPA VACCINE 3 DOSE SCHEDULE PED/ADOLESC IM USE Immunizations 1.19 FAIR Health 90636 HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM Immunizations 3.11 FAIR Health 90644 HIB-MENCY VACC 4 DOSE SCHEDULE 2-18 MONTHS IM Immunizations 0.90 FAIR Health 90647 HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE Immunizations 0.96 FAIR Health 90648 HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE Immunizations 0.90 FAIR Health 90649 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE Immunizations 4.29 FAIR Health 90650 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE Immunizations 2.14 v3.16 90651 9VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE Immunizations 4.29 v3.16 90653 IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE Immunizations 0.49 5% Sample 90654 INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID Immunizations 0.52 5% Sample 90655 IIV3 VACC PRESRV FREE CHILD 6-35 MONTHS IM USE Immunizations 0.51 FAIR Health 90656 IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE Immunizations 0.51 FAIR Health 90657 IIV3 VACCINE TO CHILD 6-35 MONTHS FOR IM USE Immunizations 0.52 FAIR Health 90658 IIV3 VACCINE 3 YRS & OLDER FOR IM USE Immunizations 0.52 FAIR Health 90660 LAIV3 VACCINE LIVE FOR INTRANASAL USE Immunizations 0.68 FAIR Health 90661 CCIIV3 VACCINE PRESERVATIVE FREE FOR IM USE Immunizations 0.29 5% Sample 90662 IIV VACCINE PRESERV FREE INCREASED AG COUNT IM Immunizations 0.58 5% Sample 90664 LAIV VACCINE PANDEMIC FORMULA FOR INTRANASAL USE Immunizations 0.58 v3.16 90666 INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM Immunizations 0.57 v3.16 90667 IIV VACCINE PANDEMIC ADJUVANT FOR IM USE Immunizations 0.45 v3.16 90668 IIV VACCINE PANDEMIC FOR INTRAMUSCULAR USE Immunizations 0.59 v3.16 90670 PCV13 VACCINE FOR INTRAMUSCULAR USE Immunizations 3.11 5% Sample 90672 LAIV4 VACCINE FOR INTRANASAL USE Immunizations 1.55 FAIR Health 90673 RIV3 VACCINE PRESERVATIVE FREE FOR IM USE Immunizations 1.00 1.00 v3.16 90675 RABIES VACCINE INTRAMUSCULAR Immunizations 6.44 FAIR Health 90676 RABIES VACCINE INTRADERMAL Immunizations 2.94 v3.16 90680 RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE Immunizations 2.54 FAIR Health 90681 RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE Immunizations 2.54 FAIR Health 90685 IIV4 PRESRV FREE VACC CHILD 6-35 MO FOR IM USE Immunizations 0.67 0.67 ERBRVS 90686 IIV4 VACC PRESRV FREE 3 YRS & OLDER IM USE Immunizations 0.44 5% Sample 90687 IIV4 VACCINE CHILD 6-35 MO FOR IM USE Immunizations 0.26 0.26 ERBRVS 90688 IIV4 VACCINE 3 YRS & OLDER FOR IM USE Immunizations 0.41 5% Sample 90690 TYPHOID VACCINE LIVE ORAL Immunizations 1.30 FAIR Health 90691 TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM Immunizations 1.85 FAIR Health 90696 DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE Immunizations 1.39 v3.16 90697 DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR Immunizations 3.04 Other 90698 DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE Immunizations 2.54 FAIR Health 90700 DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM Immunizations 0.85 FAIR Health 90702 DT VACCINE YOUNGER THAN 7 YRS FOR IM USE Immunizations 0.69 FAIR Health 90707 MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ Immunizations 1.69 FAIR Health 90710 MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ Immunizations 4.52 FAIR Health 90713 POLIOVIRUS VACCINE INACTIVATED SUBQ/IM Immunizations 0.96 FAIR Health 90714 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE Immunizations 0.71 5% Sample 90715 TDAP VACCINE 7 YRS/> IM Immunizations 0.76 FAIR Health 90716 VAR VACCINE LIVE FOR SUBCUTANEOUS USE Immunizations 2.48 FAIR Health 90717 YELLOW FEVER VACCINE LIVE SUBQ Immunizations 2.88 FAIR Health 90723 DTAP-HEPB-IPV VACCINE INTRAMUSCULAR Immunizations 2.48 FAIR Health

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90732 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE Immunizations 1.10 FAIR Health 90733 MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE Immunizations 3.39 FAIR Health 90734 MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE Immunizations 3.22 FAIR Health 90736 ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE Immunizations 5.42 FAIR Health 90738 JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM Immunizations 2.24 FAIR Health 90739 HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE Immunizations 3.88 v3.16 90740 HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM Immunizations 6.49 FAIR Health 90743 HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM Immunizations 1.69 FAIR Health 90744 HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM Immunizations 1.17 FAIR Health 90746 HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE Immunizations 2.29 FAIR Health 90747 HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM Immunizations 7.31 FAIR Health 90748 HIB-HEPB VACCINE FOR INTRAMUSCULAR USE Immunizations 1.89 FAIR Health 90749 UNLISTED VACCINE/TOXOID Immunizations 0.70 Unlisted 90785 PSYCHOTHERAPY COMPLEX INTERACTIVE OP Psych./Alc. & Drug Abuse 0.33 0.06 0.06 RBRVS 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION OP Psych./Alc. & Drug Abuse 3.00 0.46 0.57 RBRVS 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES OP Psych./Alc. & Drug Abuse 3.25 0.61 0.73 RBRVS 90832 PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES OP Psych./Alc. & Drug Abuse 1.50 0.22 0.24 RBRVS 90833 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN OP Psych./Alc. & Drug Abuse 1.50 0.27 0.29 RBRVS 90834 PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES OP Psych./Alc. & Drug Abuse 2.00 0.29 0.31 RBRVS 90836 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN OP Psych./Alc. & Drug Abuse 1.90 0.35 0.36 RBRVS 90837 PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES OP Psych./Alc. & Drug Abuse 3.00 0.44 0.46 RBRVS 90838 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN OP Psych./Alc. & Drug Abuse 2.50 0.46 0.48 RBRVS 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES OP Psych./Alc. & Drug Abuse 3.13 0.46 0.49 RBRVS 90840 PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES OP Psych./Alc. & Drug Abuse 1.50 0.22 0.23 RBRVS 90845 PSYCHOANALYSIS OP Psych./Alc. & Drug Abuse 2.10 0.37 0.38 RBRVS 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT OP Psych./Alc. & Drug Abuse 2.40 0.38 0.40 RBRVS 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT OP Psych./Alc. & Drug Abuse 2.50 0.38 0.40 RBRVS 90849 MULTIPLE FAMILY GROUP PSYCHOTHERAPY OP Psych./Alc. & Drug Abuse 0.59 0.27 0.37 RBRVS 90853 GROUP PSYCHOTHERAPY OP Psych./Alc. & Drug Abuse 0.59 0.10 0.11 RBRVS 90863 PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY OP Psych./Alc. & Drug Abuse 1.55 FAIR Health 90865 NARCOSYNTHESIS PSYC DX&THER PURPOSES OP Psych./Alc. & Drug Abuse 2.84 0.65 1.79 RBRVS 90867 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M OP Psych./Alc. & Drug Abuse 9.15 5% Sample 90868 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG OP Psych./Alc. & Drug Abuse 5.03 5% Sample 90869 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN OP Psych./Alc. & Drug Abuse 9.82 FAIR Health 90870 ELECTROCONVULSIVE THERAPY OP Psych./Alc. & Drug Abuse 2.50 0.52 2.40 RBRVS 90875 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN OP Psych./Alc. & Drug Abuse 1.20 0.46 0.46 RBRVS 90876 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN OP Psych./Alc. & Drug Abuse 1.90 0.73 1.03 RBRVS 90880 HYPNOTHERAPY OP Psych./Alc. & Drug Abuse 2.19 0.38 0.58 RBRVS 90882 ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT OP Psych./Alc. & Drug Abuse 2.11 FAIR Health 90885 PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES OP Psych./Alc. & Drug Abuse 0.97 0.37 0.37 RBRVS 90887 INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY OP Psych./Alc. & Drug Abuse 1.48 0.57 0.92 RBRVS 90889 PREP REPORT PT PSYCH STATUS AGENCY/PAYER OP Psych./Alc. & Drug Abuse 1.79 FAIR Health 90899 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE OP Psych./Alc. & Drug Abuse 1.74 Unlisted 90901 BIOFEEDBACK TRAINING ANY MODALITY Miscellaneous Medical 0.41 0.14 0.64 RBRVS 90911 BIOFDBK TRNG PERINL MUSC ANORECT/URO SPHX W/EMG Miscellaneous Medical 0.89 0.31 1.43 RBRVS 90935 HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION Miscellaneous Medical 1.48 0.48 0.48 RBRVS 90937 HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX Miscellaneous Medical 2.11 0.71 0.71 RBRVS 90940 HEMODIALYSIS ACCESS FLOW STUDY Miscellaneous Medical 1.33 FAIR Health 90945 DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL Miscellaneous Medical 1.56 0.77 0.77 RBRVS 90947 DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS Miscellaneous Medical 2.52 0.83 0.83 RBRVS 90951 ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS Miscellaneous Medical 18.46 6.94 6.95 RBRVS 90952 ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 VISITS Miscellaneous Medical 6.42 13.39 13.39 ERBRVS 90953 ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT Miscellaneous Medical 4.28 8.93 8.93 ERBRVS 90954 ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS Miscellaneous Medical 15.98 6.11 6.12 RBRVS 90955 ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS Miscellaneous Medical 8.79 3.60 3.61 RBRVS 90956 ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT Miscellaneous Medical 5.95 2.74 2.74 RBRVS 90957 ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS Miscellaneous Medical 12.52 4.91 4.92 RBRVS 90958 ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS Miscellaneous Medical 8.34 3.45 3.46 RBRVS 90959 ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT Miscellaneous Medical 5.50 2.53 2.53 RBRVS 90960 ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS Miscellaneous Medical 5.18 2.53 2.53 RBRVS 90961 ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS Miscellaneous Medical 4.26 2.22 2.22 RBRVS 90962 ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT Miscellaneous Medical 3.15 1.86 1.86 RBRVS 90963 ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD Miscellaneous Medical 10.56 4.19 4.20 RBRVS 90964 ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD Miscellaneous Medical 9.14 3.72 3.73 RBRVS 90965 ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD Miscellaneous Medical 8.69 3.58 3.59 RBRVS 90966 ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD Miscellaneous Medical 4.26 2.21 2.21 RBRVS 90967 ESRD RELATED SVC YR OLD Miscellaneous Medical 0.14 0.07 0.07 RBRVS 90989 DIALYSIS TRAINING PATIENT COMPLETED COURSE Miscellaneous Medical 8.29 FAIR Health 90993 DIALYSIS TRAINING PATIENT PER TRAINING SESSION Miscellaneous Medical 1.80 FAIR Health 90997 HEMOPERFUSION Miscellaneous Medical 1.84 0.72 0.72 RBRVS 90999 UNLISTED DIALYSIS PROCEDURE INPATIENT/OUTPATIENT Miscellaneous Medical 1.96 Unlisted 91010 ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT Miscellaneous Medical a 1.28 3.65 3.65 RBRVS

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91010 26 ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT Miscellaneous Medical 1.28 0.57 0.57 RBRVS 91010 TC ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT Miscellaneous Medical a 3.08 3.08 RBRVS 91013 ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION Miscellaneous Medical a 0.18 0.48 0.48 RBRVS 91013 26 ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION Miscellaneous Medical 0.18 0.08 0.08 RBRVS 91013 TC ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION Miscellaneous Medical a 0.40 0.40 RBRVS 91020 GASTRIC MOTILITY MANOMETRIC STUDIES Miscellaneous Medical a 1.44 5.12 5.12 RBRVS 91020 26 GASTRIC MOTILITY MANOMETRIC STUDIES Miscellaneous Medical 1.44 0.65 0.65 RBRVS 91020 TC GASTRIC MOTILITY MANOMETRIC STUDIES Miscellaneous Medical a 4.47 4.47 RBRVS 91022 DUODENAL MOTILITY MANOMETRIC STUDY Miscellaneous Medical a 1.44 3.32 3.32 RBRVS 91022 26 DUODENAL MOTILITY MANOMETRIC STUDY Miscellaneous Medical 1.44 0.66 0.66 RBRVS 91022 TC DUODENAL MOTILITY MANOMETRIC STUDY Miscellaneous Medical a 2.66 2.66 RBRVS 91030 ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS Miscellaneous Medical a 0.91 2.95 2.95 RBRVS 91030 26 ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS Miscellaneous Medical 0.91 0.42 0.42 RBRVS 91030 TC ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS Miscellaneous Medical a 2.53 2.53 RBRVS 91034 GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT Miscellaneous Medical a 0.97 4.30 4.30 RBRVS 91034 26 GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT Miscellaneous Medical 0.97 0.42 0.42 RBRVS 91034 TC GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT Miscellaneous Medical a 3.88 3.88 RBRVS 91035 GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD Miscellaneous Medical a 1.59 12.01 12.01 RBRVS 91035 26 GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD Miscellaneous Medical 1.59 0.70 0.70 RBRVS 91035 TC GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD Miscellaneous Medical a 11.31 11.31 RBRVS 91037 GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD Miscellaneous Medical a 0.97 3.54 3.54 RBRVS 91037 26 GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD Miscellaneous Medical 0.97 0.43 0.43 RBRVS 91037 TC GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD Miscellaneous Medical a 3.11 3.11 RBRVS 91038 ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG Miscellaneous Medical a 1.10 11.69 11.69 RBRVS 91038 26 ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG Miscellaneous Medical 1.10 0.49 0.49 RBRVS 91038 TC ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG Miscellaneous Medical a 11.20 11.20 RBRVS 91040 ESOPHGL BALO DISTENSION DX STD W/PROVOCATION Miscellaneous Medical a 0.97 11.44 11.44 RBRVS 91040 26 ESOPHGL BALO DISTENSION DX STD W/PROVOCATION Miscellaneous Medical 0.97 0.44 0.44 RBRVS 91040 TC ESOPHGL BALO DISTENSION DX STD W/PROVOCATION Miscellaneous Medical a 11.00 11.00 RBRVS 91065 BREATH HYDROGEN/METHANE TEST Miscellaneous Medical a 0.20 2.08 2.08 RBRVS 91065 26 BREATH HYDROGEN/METHANE TEST Miscellaneous Medical 0.20 0.09 0.09 RBRVS 91065 TC BREATH HYDROGEN/METHANE TEST Miscellaneous Medical a 1.99 1.99 RBRVS 91110 GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R Miscellaneous Medical a 3.64 21.50 21.50 RBRVS 91110 26 GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R Miscellaneous Medical 3.64 1.66 1.66 RBRVS 91110 TC GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R Miscellaneous Medical a 19.84 19.84 RBRVS 91111 GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R Miscellaneous Medical a 1.00 19.71 19.71 RBRVS 91111 26 GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R Miscellaneous Medical 1.00 0.45 0.45 RBRVS 91111 TC GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R Miscellaneous Medical a 19.26 19.26 RBRVS 91112 GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP Miscellaneous Medical a 2.10 28.58 28.58 RBRVS 91112 26 GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP Miscellaneous Medical 2.10 0.95 0.95 RBRVS 91112 TC GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP Miscellaneous Medical a 27.63 27.63 RBRVS 91117 COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R Miscellaneous Medical 2.45 1.40 1.40 RBRVS 91120 RECTAL SESATION TONE & COMPLIANCE TEST Miscellaneous Medical a 0.97 11.13 11.13 RBRVS 91120 26 RECTAL SESATION TONE & COMPLIANCE TEST Miscellaneous Medical 0.97 0.40 0.40 RBRVS 91120 TC RECTAL SESATION TONE & COMPLIANCE TEST Miscellaneous Medical a 10.73 10.73 RBRVS 91122 ANORECTAL MANOMETRY Miscellaneous Medical a 1.77 4.49 4.49 RBRVS 91122 26 ANORECTAL MANOMETRY Miscellaneous Medical 1.77 0.68 0.68 RBRVS 91122 TC ANORECTAL MANOMETRY Miscellaneous Medical a 3.81 3.81 RBRVS 91132 ELECTROGASTROGRAPHY DX TRANSCUTANEOUS Miscellaneous Medical a 0.52 3.67 3.67 RBRVS 91132 26 ELECTROGASTROGRAPHY DX TRANSCUTANEOUS Miscellaneous Medical 0.52 0.24 0.24 RBRVS 91132 TC ELECTROGASTROGRAPHY DX TRANSCUTANEOUS Miscellaneous Medical a 3.43 3.43 RBRVS 91133 ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG Miscellaneous Medical a 0.66 4.20 4.20 RBRVS 91133 26 ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG Miscellaneous Medical 0.66 0.30 0.30 RBRVS 91133 TC ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG Miscellaneous Medical a 3.90 3.90 RBRVS 91200 LIVER ELASTOGRAPHY W/O IMAG W/I&R Radiology a 0.30 0.69 0.69 RBRVS 91200 26 LIVER ELASTOGRAPHY W/O IMAG W/I&R Radiology 0.30 0.10 0.10 RBRVS 91200 TC LIVER ELASTOGRAPHY W/O IMAG W/I&R Radiology a 0.59 0.59 RBRVS 91299 UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE Miscellaneous Medical a 9.58 Unlisted 91299 26 UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE Miscellaneous Medical 3.05 Unlisted 91299 TC UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE Miscellaneous Medical a 6.53 Unlisted 92002 OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT Vision Exams 0.88 0.44 1.37 RBRVS 92004 OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST Vision Exams 1.82 0.93 2.29 RBRVS 92012 OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT Vision Exams 0.92 0.53 1.45 RBRVS 92014 OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/> Vision Exams 1.42 0.78 2.00 RBRVS 92015 DETERMINATION REFRACTIVE STATE Vision Exams 0.38 0.15 0.16 RBRVS 92018 OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL Miscellaneous Medical 2.50 1.50 1.50 RBRVS 92019 OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD Miscellaneous Medical 1.31 0.67 0.67 RBRVS 92020 GONIOSCOPY SEPARATE PROCEDURE Miscellaneous Medical 0.37 0.21 0.37 RBRVS 92025 COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI Miscellaneous Medical a 0.35 0.70 0.70 RBRVS 92025 26 COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI Miscellaneous Medical 0.35 0.21 0.21 RBRVS 92025 TC COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI Miscellaneous Medical a 0.49 0.49 RBRVS 92060 SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX Miscellaneous Medical a 0.69 1.12 1.12 RBRVS 92060 26 SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX Miscellaneous Medical 0.69 0.38 0.38 RBRVS 92060 TC SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX Miscellaneous Medical a 0.74 0.74 RBRVS 92065 ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ Miscellaneous Medical a 0.37 1.12 1.12 RBRVS

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92065 26 ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ Miscellaneous Medical 0.37 0.13 0.13 RBRVS 92065 TC ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ Miscellaneous Medical a 0.99 0.99 RBRVS 92071 FIT CONTACT LENS TX OCULAR SURFACE DISEASE Miscellaneous Medical 0.61 0.32 0.44 RBRVS 92072 FITTING CONTACT LENS FOR MNGT OF KERATOCONUS Miscellaneous Medical 1.97 0.87 1.76 RBRVS 92081 VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM Miscellaneous Medical a 0.30 0.64 0.64 RBRVS 92081 26 VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM Miscellaneous Medical 0.30 0.15 0.15 RBRVS 92081 TC VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM Miscellaneous Medical a 0.49 0.49 RBRVS 92082 VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM Miscellaneous Medical a 0.40 0.93 0.93 RBRVS 92082 26 VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM Miscellaneous Medical 0.40 0.20 0.20 RBRVS 92082 TC VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM Miscellaneous Medical a 0.73 0.73 RBRVS 92083 VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM Miscellaneous Medical a 0.50 1.29 1.29 RBRVS 92083 26 VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM Miscellaneous Medical 0.50 0.28 0.28 RBRVS 92083 TC VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM Miscellaneous Medical a 1.01 1.01 RBRVS 92100 SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES Miscellaneous Medical 0.61 0.33 1.63 RBRVS 92132 CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI Miscellaneous Medical a 0.35 0.61 0.61 RBRVS 92132 26 CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI Miscellaneous Medical 0.35 0.18 0.18 RBRVS 92132 TC CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI Miscellaneous Medical a 0.43 0.43 RBRVS 92133 COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE Miscellaneous Medical a 0.50 0.72 0.72 RBRVS 92133 26 COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE Miscellaneous Medical 0.50 0.28 0.28 RBRVS 92133 TC COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE Miscellaneous Medical a 0.44 0.44 RBRVS 92134 COMPUTERIZED OPHTHALMIC IMAGING RETINA Miscellaneous Medical a 0.50 0.75 0.75 RBRVS 92134 26 COMPUTERIZED OPHTHALMIC IMAGING RETINA Miscellaneous Medical 0.50 0.30 0.30 RBRVS 92134 TC COMPUTERIZED OPHTHALMIC IMAGING RETINA Miscellaneous Medical a 0.45 0.45 RBRVS 92136 OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL Miscellaneous Medical a 0.54 1.98 1.98 RBRVS 92136 26 OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL Miscellaneous Medical 0.54 0.33 0.33 RBRVS 92136 TC OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL Miscellaneous Medical a 1.65 1.65 RBRVS 92140 PROVOCATIVE TESTS GLAUCOMA I&R W/O TONOGRAPHY Miscellaneous Medical 0.50 0.23 1.25 RBRVS 92145 CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI Miscellaneous Medical a 0.17 0.25 0.25 RBRVS 92145 26 CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI Miscellaneous Medical 0.17 0.07 0.07 RBRVS 92145 TC CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI Miscellaneous Medical a 0.18 0.18 RBRVS 92225 OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST Miscellaneous Medical 0.38 0.21 0.37 RBRVS 92226 OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS Miscellaneous Medical 0.33 0.20 0.36 RBRVS 92227 REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/B Miscellaneous Medical a 0.40 0.40 RBRVS 92228 REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B Miscellaneous Medical a 0.37 0.61 0.61 RBRVS 92228 26 REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B Miscellaneous Medical 0.37 0.23 0.23 RBRVS 92228 TC REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B Miscellaneous Medical a 0.38 0.38 RBRVS 92230 FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT Miscellaneous Medical 0.60 0.31 1.00 RBRVS 92235 FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT Miscellaneous Medical a 0.81 2.26 2.26 RBRVS 92235 26 FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT Miscellaneous Medical 0.81 0.51 0.51 RBRVS 92235 TC FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT Miscellaneous Medical a 1.75 1.75 RBRVS 92240 INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR Miscellaneous Medical a 1.10 6.05 6.05 RBRVS 92240 26 INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR Miscellaneous Medical 1.10 0.69 0.69 RBRVS 92240 TC INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR Miscellaneous Medical a 5.36 5.36 RBRVS 92250 FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT Miscellaneous Medical a 0.44 1.76 1.76 RBRVS 92250 26 FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT Miscellaneous Medical 0.44 0.23 0.23 RBRVS 92250 TC FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT Miscellaneous Medical a 1.53 1.53 RBRVS 92260 OPHTHALMODYNAMOMETRY Miscellaneous Medical 0.20 0.10 0.31 RBRVS 92265 NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R Miscellaneous Medical a 0.81 1.59 1.59 RBRVS 92265 26 NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R Miscellaneous Medical 0.81 0.50 0.50 RBRVS 92265 TC NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R Miscellaneous Medical a 1.09 1.09 RBRVS 92270 ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT Miscellaneous Medical a 0.81 1.74 1.74 RBRVS 92270 26 ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT Miscellaneous Medical 0.81 0.33 0.33 RBRVS 92270 TC ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT Miscellaneous Medical a 1.41 1.41 RBRVS 92275 ELECTRORETINOGRAPY W/INTERPRETATION & REPORT Miscellaneous Medical a 1.01 3.09 3.09 RBRVS 92275 26 ELECTRORETINOGRAPY W/INTERPRETATION & REPORT Miscellaneous Medical 1.01 0.49 0.49 RBRVS 92275 TC ELECTRORETINOGRAPY W/INTERPRETATION & REPORT Miscellaneous Medical a 2.60 2.60 RBRVS 92283 COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV Miscellaneous Medical a 0.17 1.39 1.39 RBRVS 92283 26 COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV Miscellaneous Medical 0.17 0.09 0.09 RBRVS 92283 TC COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV Miscellaneous Medical a 1.30 1.30 RBRVS 92284 DARK ADAPTATION XM W/INTERPRETATION & REPORT Miscellaneous Medical a 0.24 1.50 1.50 RBRVS 92284 26 DARK ADAPTATION XM W/INTERPRETATION & REPORT Miscellaneous Medical 0.24 0.11 0.11 RBRVS 92284 TC DARK ADAPTATION XM W/INTERPRETATION & REPORT Miscellaneous Medical a 1.39 1.39 RBRVS 92285 XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE Miscellaneous Medical a 0.05 0.51 0.51 RBRVS 92285 26 XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE Miscellaneous Medical 0.05 0.03 0.03 RBRVS 92285 TC XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE Miscellaneous Medical a 0.48 0.48 RBRVS 92286 ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY Miscellaneous Medical a 0.40 0.66 0.66 RBRVS 92286 26 ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY Miscellaneous Medical 0.40 0.22 0.22 RBRVS 92286 TC ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY Miscellaneous Medical a 0.44 0.44 RBRVS 92287 ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R Miscellaneous Medical a 0.81 3.05 3.05 RBRVS 92287 26 ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R Miscellaneous Medical 0.81 0.50 0.50 RBRVS 92287 TC ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R Miscellaneous Medical a 2.55 2.55 RBRVS 92310 RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK Vision Exams 1.17 0.45 1.46 RBRVS 92311 RX&FITG CONTACT CORNEAL LENS APHAKIA 1 EYE Miscellaneous Medical 1.08 0.45 1.72 RBRVS 92312 RX&FITG CONTACT CORNEAL LENS APHAKIA BOTH EYES Miscellaneous Medical 1.26 0.52 2.01 RBRVS 92313 RX&FITG CORNEOSCLERAL LENS Miscellaneous Medical 0.92 0.39 1.79 RBRVS

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92314 RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA Vision Exams 0.69 0.26 1.52 RBRVS 92315 RX CONTACT CORNEAL LENS APHAKIA 1 EYE Miscellaneous Medical 0.45 0.15 1.59 RBRVS 92316 RX CONTACT CORNEAL LENS APHAKIA BOTH EYES Miscellaneous Medical 0.68 0.23 1.88 RBRVS 92317 RX CONTACT CORNEOSCLERAL LENS Miscellaneous Medical 0.45 0.16 1.68 RBRVS 92325 MODIFICAJ CONTACT LENX SPX SUPVJ ADAPTATION Miscellaneous Medical 1.18 1.18 RBRVS 92326 REPLACEMENT CONTACT LENS Miscellaneous Medical 0.98 0.98 RBRVS 92340 FITTING SPECTACLES XCPT APHAKIA MONOFOCAL Miscellaneous Medical 0.37 0.14 0.61 RBRVS 92341 FITTING SPECTACLES XCPT APHAKIA BIFOCAL Miscellaneous Medical 0.47 0.18 0.64 RBRVS 92342 FITTING SPECTACLES XCPT APHAKIA MULTIFOCAL Miscellaneous Medical 0.53 0.20 0.67 RBRVS 92352 FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL Miscellaneous Medical 0.37 0.14 0.75 RBRVS 92353 FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL Miscellaneous Medical 0.50 0.19 0.80 RBRVS 92354 FITTING SPECTACLE MOUNTED LW VIS AID 1 ELMNT Miscellaneous Medical 0.37 0.37 RBRVS 92355 FITTING SPECTACLE MOUNTED LW VIS AID TLSCP Miscellaneous Medical 0.58 0.58 RBRVS 92358 PROSTHESIS SERVICE APHAKIA TEMPORARY Miscellaneous Medical 0.31 0.31 RBRVS 92370 RPR&REFITG SPECTACLES EXCEPT APHAKIA Miscellaneous Medical 0.32 0.12 0.53 RBRVS 92371 RPR&REFITG SPECTACLE PROSTHESIS APHAKIA Miscellaneous Medical 0.32 0.32 RBRVS 92499 UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE Miscellaneous Medical a 1.22 Unlisted 92499 26 UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE Miscellaneous Medical 0.41 Unlisted 92499 TC UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE Miscellaneous Medical a 0.81 Unlisted 92502 OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA Miscellaneous Medical 1.51 1.14 1.14 RBRVS 92504 BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE Miscellaneous Medical 0.18 0.08 0.66 RBRVS 92507 TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND Hearing/Speech Exams 1.30 0.89 0.89 RBRVS 92508 TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV Hearing/Speech Exams 0.33 0.32 0.32 RBRVS 92511 NASOPHARYNGOSCOPY W/ENDOSCOPE SPX Miscellaneous Medical 0.61 0.73 3.20 RBRVS 92512 NASAL FUNCTION STUDIES Miscellaneous Medical 0.55 0.23 1.15 RBRVS 92516 FACIAL NERVE FUNCTION STUDIES Miscellaneous Medical 0.43 0.19 1.54 RBRVS 92520 LARYNGEAL FUNCTION STUDIES Miscellaneous Medical 0.75 0.37 1.32 RBRVS 92521 EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER) Hearing/Speech Exams 1.75 1.22 1.22 RBRVS 92522 EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE Hearing/Speech Exams 1.50 1.04 1.04 RBRVS 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION Hearing/Speech Exams 3.00 2.15 2.15 RBRVS 92524 BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE Hearing/Speech Exams 1.50 0.93 0.93 RBRVS 92526 TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING Miscellaneous Medical 1.34 1.04 1.04 RBRVS 92531 SPONTANEOUS NYSTAGMUS W/GAZE Miscellaneous Medical 0.43 FAIR Health 92532 POSITIONAL NYSTAGMUS TEST Miscellaneous Medical 0.50 FAIR Health 92533 CALORIC VESTIBULAR TEST EACH IRRIGATION Miscellaneous Medical 0.72 FAIR Health 92534 OPTOKINETIC NYSTAGMUS TEST Miscellaneous Medical 0.55 FAIR Health 92537 CALORIC VESTIBULAR TEST W/REC BI BITHERMAL Miscellaneous Medical a 0.60 0.51 0.51 RBRVS 92537 26 CALORIC VESTIBULAR TEST W/REC BI BITHERMAL Miscellaneous Medical 0.60 0.28 0.28 RBRVS 92537 TC CALORIC VESTIBULAR TEST W/REC BI BITHERMAL Miscellaneous Medical a 0.23 0.23 RBRVS 92538 CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL Miscellaneous Medical a 0.30 0.26 0.26 RBRVS 92538 26 CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL Miscellaneous Medical 0.30 0.14 0.14 RBRVS 92538 TC CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL Miscellaneous Medical a 0.12 0.12 RBRVS 92540 VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK Miscellaneous Medical a 1.50 1.32 1.32 RBRVS 92540 26 VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK Miscellaneous Medical 1.50 0.70 0.70 RBRVS 92540 TC VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK Miscellaneous Medical a 0.62 0.62 RBRVS 92541 SPONTANEOUS NYSTAGMUS TEST Miscellaneous Medical a 0.40 0.26 0.26 RBRVS 92541 26 SPONTANEOUS NYSTAGMUS TEST Miscellaneous Medical 0.40 0.18 0.18 RBRVS 92541 TC SPONTANEOUS NYSTAGMUS TEST Miscellaneous Medical a 0.08 0.08 RBRVS 92542 POSITIONAL NYSTAGMUS TEST Miscellaneous Medical a 0.48 0.28 0.28 RBRVS 92542 26 POSITIONAL NYSTAGMUS TEST Miscellaneous Medical 0.48 0.21 0.21 RBRVS 92542 TC POSITIONAL NYSTAGMUS TEST Miscellaneous Medical a 0.07 0.07 RBRVS 92544 OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC Miscellaneous Medical a 0.27 0.18 0.18 RBRVS 92544 26 OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC Miscellaneous Medical 0.27 0.12 0.12 RBRVS 92544 TC OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC Miscellaneous Medical a 0.06 0.06 RBRVS 92545 OSCILLATING TRACKING TEST W/RECORDING Miscellaneous Medical a 0.25 0.14 0.14 RBRVS 92545 26 OSCILLATING TRACKING TEST W/RECORDING Miscellaneous Medical 0.25 0.11 0.11 RBRVS 92545 TC OSCILLATING TRACKING TEST W/RECORDING Miscellaneous Medical a 0.03 0.03 RBRVS 92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING Miscellaneous Medical a 0.29 2.59 2.59 RBRVS 92546 26 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING Miscellaneous Medical 0.29 0.12 0.12 RBRVS 92546 TC SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING Miscellaneous Medical a 2.47 2.47 RBRVS 92547 USE VERTICAL ELECTRODES Miscellaneous Medical a 0.17 0.17 RBRVS 92548 COMPUTERIZED DYNAMIC POSTUROGRAPY Miscellaneous Medical a 0.50 2.38 2.38 RBRVS 92548 26 COMPUTERIZED DYNAMIC POSTUROGRAPY Miscellaneous Medical 0.50 0.22 0.22 RBRVS 92548 TC COMPUTERIZED DYNAMIC POSTUROGRAPY Miscellaneous Medical a 2.16 2.16 RBRVS 92550 TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS Hearing/Speech Exams 0.35 0.23 0.23 RBRVS 92551 SCREENING TEST PURE TONE AIR ONLY Hearing/Speech Exams 0.33 0.33 RBRVS 92552 PURE TONE AUDIOMETRY AIR ONLY Hearing/Speech Exams a 0.87 0.87 RBRVS 92553 PURE TONE AUDIOMETRY AIR & BONE Hearing/Speech Exams a 1.03 1.03 RBRVS 92555 SPEECH AUDIOMETRY THRESHOLD Hearing/Speech Exams a 0.64 0.64 RBRVS 92556 SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ Hearing/Speech Exams a 1.04 1.04 RBRVS 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ Hearing/Speech Exams 0.60 0.29 0.43 RBRVS 92558 EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS Hearing/Speech Exams 0.38 FAIR Health 92559 AUDIOMETRIC TESTING GROUPS Hearing/Speech Exams 0.80 FAIR Health 92560 BEKESY AUDIOMETRY SCREENING Hearing/Speech Exams 0.56 FAIR Health 92561 BEKESY AUDIOMETRY DIAGNOSTIC Hearing/Speech Exams a 1.05 1.05 RBRVS

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92562 LOUDNESS BALANCE BINAURAL/MONAURAL Hearing/Speech Exams a 1.29 1.29 RBRVS 92563 TONE DECAY TEST Hearing/Speech Exams a 0.86 0.86 RBRVS 92564 SHORT INCREMENT SENSITIVITY INDEX Hearing/Speech Exams a 0.79 0.79 RBRVS 92565 STENGER TEST PURE TONE Hearing/Speech Exams a 0.43 0.43 RBRVS 92567 TYMPANOMETRY Hearing/Speech Exams 0.20 0.10 0.20 RBRVS 92568 ACOUSTIC REFLEX THRESHOLD Hearing/Speech Exams 0.29 0.13 0.14 RBRVS 92570 ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY Hearing/Speech Exams 0.55 0.27 0.33 RBRVS 92571 FILTERED SPEECH TEST Hearing/Speech Exams a 0.76 0.76 RBRVS 92572 STAGGERED SPONDAIC WORD Hearing/Speech Exams a 0.87 0.87 RBRVS 92575 SENSORINEURAL ACUITY LEVEL Hearing/Speech Exams a 1.99 1.99 RBRVS 92576 SYNTHETIC SENTENCE IDENTIFICATION TEST Hearing/Speech Exams a 0.98 0.98 RBRVS 92577 STENGER TEST SPEECH Hearing/Speech Exams a 0.44 0.44 RBRVS 92579 VISUAL REINFORCEMENT AUDIOMETRY Hearing/Speech Exams 0.70 0.35 0.55 RBRVS 92582 CONDITIONING PLAY AUDIOMETRY Hearing/Speech Exams a 2.00 2.00 RBRVS 92583 SELECT PICTURE AUDIOMETRY Hearing/Speech Exams a 1.42 1.42 RBRVS 92584 ELECTROCOCHLEOGRAPHY Hearing/Speech Exams a 2.07 2.07 RBRVS 92585 AUDITORY EVOKED POTENTIALS COMPREHENSIVE Hearing/Speech Exams a 0.50 3.29 3.29 RBRVS 92585 26 AUDITORY EVOKED POTENTIALS COMPREHENSIVE Hearing/Speech Exams 0.50 0.24 0.24 RBRVS 92585 TC AUDITORY EVOKED POTENTIALS COMPREHENSIVE Hearing/Speech Exams a 3.05 3.05 RBRVS 92586 AUDITORY EVOKED POTENTIALS LIMITED Hearing/Speech Exams a 2.34 2.34 RBRVS 92587 DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD Hearing/Speech Exams a 0.35 0.24 0.24 RBRVS 92587 26 DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD Hearing/Speech Exams 0.35 0.16 0.16 RBRVS 92587 TC DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD Hearing/Speech Exams a 0.08 0.08 RBRVS 92588 DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL Hearing/Speech Exams a 0.55 0.36 0.36 RBRVS 92588 26 DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL Hearing/Speech Exams 0.55 0.26 0.26 RBRVS 92588 TC DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL Hearing/Speech Exams a 0.10 0.10 RBRVS 92590 HEARING AID EXAMINATION & SELECTION MONAURAL Hearing/Speech Exams 1.47 FAIR Health 92591 HEARING AID EXAMINATION & SELECTION BINAURAL Hearing/Speech Exams 1.87 FAIR Health 92592 HEARING AID CHECK MONAURAL Hearing/Speech Exams 0.59 FAIR Health 92593 HEARING AID CHECK BINAURAL Hearing/Speech Exams 0.96 FAIR Health 92594 ELECTROACOUS EVAL HEARING AID MONAURAL Hearing/Speech Exams 0.56 FAIR Health 92595 ELECTROACOUS EVAL HEARING AID BINAURAL Hearing/Speech Exams 1.20 FAIR Health 92596 EAR PROTECTOR ATTENUATION MEASUREMENTS Hearing/Speech Exams a 1.17 1.17 RBRVS 92597 EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC Hearing/Speech Exams 1.26 0.71 0.71 RBRVS 92601 ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG Miscellaneous Medical 2.30 0.88 1.42 RBRVS 92602 ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG Miscellaneous Medical 1.30 0.58 1.18 RBRVS 92603 ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG Miscellaneous Medical 2.25 1.11 1.87 RBRVS 92604 ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG Miscellaneous Medical 1.25 0.62 1.21 RBRVS 92605 EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR Miscellaneous Medical 1.75 0.67 0.78 RBRVS 92606 THER SVC N-SP-GENRATJ DEV PRGRMG&MODIFICAJ Miscellaneous Medical 1.40 0.54 0.87 RBRVS 92607 RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR Miscellaneous Medical 1.85 1.56 1.56 RBRVS 92608 RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN Miscellaneous Medical 0.70 0.78 0.78 RBRVS 92609 THER SP-GENRATJ DEV PRGRMG&MODIFICAJ Miscellaneous Medical 1.50 1.58 1.58 RBRVS 92610 EVAL ORAL&PHARYNGEAL SWLNG FUNCJ Miscellaneous Medical 1.30 0.70 1.04 RBRVS 92611 MOTION FLUOR EVAL SWLNG FUNCJ C/V REC Miscellaneous Medical 1.34 1.01 1.01 RBRVS 92612 FLX FIBOPT NDSC EVAL SWLNG C/V REC Miscellaneous Medical 1.27 0.59 3.54 RBRVS 92613 FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R Miscellaneous Medical 0.71 0.32 0.32 RBRVS 92614 FLX FIBOPT NDSC EVAL LARYN SENS C/V REC Miscellaneous Medical 1.27 0.57 2.73 RBRVS 92615 FLX FIBOPT NDSC EVAL LARYN SENS PHYS I&R Miscellaneous Medical 0.63 0.28 0.28 RBRVS 92616 FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC Miscellaneous Medical 1.88 0.87 3.81 RBRVS 92617 FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS PHYS I&R Miscellaneous Medical 0.79 0.35 0.35 RBRVS 92618 EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN Miscellaneous Medical 0.65 0.25 0.27 RBRVS 92620 EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN Miscellaneous Medical 1.50 0.78 1.10 RBRVS 92621 EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN Miscellaneous Medical 0.35 0.18 0.27 RBRVS 92625 ASSESSMENT TINNITUS Miscellaneous Medical 1.15 0.57 0.78 RBRVS 92626 EVALUATION AUDITORY REHAB STATUS 1ST HR Miscellaneous Medical 1.40 0.70 1.08 RBRVS 92627 EVALUATION AUDITORY REHAB STATUS EA 15 MIN Miscellaneous Medical 0.33 0.16 0.28 RBRVS 92630 AUDITORY REHABILITATION PRELINGUAL HEARING LOSS Miscellaneous Medical 1.18 v3.16 92633 AUDITORY REHABILITATION POSTLINGUAL HEARING LOSS Miscellaneous Medical 1.19 v3.16 92640 ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR Miscellaneous Medical 1.76 0.89 1.39 RBRVS 92700 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE Miscellaneous Medical 0.73 Unlisted 92920 PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH Surgery 10.10 3.45 3.45 RBRVS 92921 PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH Surgery 3.93 FAIR Health 92924 PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH Surgery 11.99 4.08 4.08 RBRVS 92928 PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH Surgery 11.21 3.81 3.81 RBRVS 92929 PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH Surgery 4.36 FAIR Health 92933 PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH Surgery 12.54 4.26 4.26 RBRVS 92934 PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH Surgery 5.40 FAIR Health 92937 PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL Surgery 11.20 3.81 3.81 RBRVS 92938 PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL Surgery 5.89 FAIR Health 92941 PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL Surgery 12.56 4.27 4.27 RBRVS 92943 PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL Surgery 12.56 4.27 4.27 RBRVS 92944 PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL Surgery 5.89 FAIR Health 92950 CARDIOPULMONARY RESUSCITATION Cardiovascular 4.00 0.97 4.25 RBRVS 92953 TEMPORARY TRANSCUTANEOUS PACING Cardiovascular 0.23 0.07 0.07 RBRVS

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92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL Cardiovascular 2.25 1.08 3.43 RBRVS 92961 CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX Cardiovascular 4.59 1.98 1.98 RBRVS 92970 CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL Cardiovascular 3.51 1.39 1.39 RBRVS 92971 CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL Cardiovascular 1.77 0.75 0.75 RBRVS 92973 PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY Surgery 3.28 1.13 1.13 RBRVS 92974 TCAT PLACEMENT RADJ DLVR DEV SBSQ C IV BRACHYTX Surgery 3.00 1.04 1.04 RBRVS 92975 THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH Cardiovascular 7.24 2.49 2.49 RBRVS 92977 THROMBOLYSIS CORONARY INTRAVENOUS INFUSION Cardiovascular 1.51 1.51 RBRVS 92978 INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE Cardiovascular a 7.45 Global/TC/26 92978 26 INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE Cardiovascular 2.42 Global/TC/26 92978 TC INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE Cardiovascular a 5.03 Global/TC/26 92979 INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL Cardiovascular a 3.99 Global/TC/26 92979 26 INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL Cardiovascular 1.94 Global/TC/26 92979 TC INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL Cardiovascular a 2.05 Global/TC/26 92986 PRQ BALLOON VALVULOPLASTY AORTIC VALVE Surgery 22.85 10.58 10.58 RBRVS 92987 PRQ BALLOON VALVULOPLASTY MITRAL VALVE Surgery 23.63 11.01 11.01 RBRVS 92990 PRQ BALLOON VALVULOPLASTY PULMONARY VALVE Surgery 18.27 8.99 8.99 RBRVS 92992 ATRIAL SEPTECT/SEPTOST TRANSVENOUS BALLOON Surgery 31.64 FAIR Health 92993 ATRIAL SEPTECT/SEPTOSTOMY BLADE METHOD Surgery 7.73 16.13 16.13 ERBRVS 92997 PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL Surgery 11.98 4.45 4.45 RBRVS 92998 PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL Surgery 5.99 2.04 2.04 RBRVS 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R Cardiovascular 0.17 0.29 0.29 RBRVS 93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R Cardiovascular a 0.23 0.23 RBRVS 93010 ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY Cardiovascular 0.17 0.06 0.06 RBRVS 93015 CV STRS TST XERS&/OR RX CONT ECG W/SI&R Cardiovascular 0.75 1.36 1.36 RBRVS 93016 CV STRS TST XERS&/OR RX CONT ECG W/O I&R Cardiovascular 0.45 0.16 0.16 RBRVS 93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY Cardiovascular a 1.10 1.10 RBRVS 93018 CV STRS TST XERS&/OR RX CONT ECG I&R ONLY Cardiovascular 0.30 0.10 0.10 RBRVS 93024 ERGONOVINE PROVOCATION TST Cardiovascular a 1.17 1.94 1.94 RBRVS 93024 26 ERGONOVINE PROVOCATION TST Cardiovascular 1.17 0.41 0.41 RBRVS 93024 TC ERGONOVINE PROVOCATION TST Cardiovascular a 1.53 1.53 RBRVS 93025 MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS Cardiovascular a 0.75 3.82 3.82 RBRVS 93025 26 MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS Cardiovascular 0.75 0.27 0.27 RBRVS 93025 TC MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS Cardiovascular a 3.55 3.55 RBRVS 93040 RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT Cardiovascular 0.15 0.19 0.19 RBRVS 93041 RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R Cardiovascular a 0.15 0.15 RBRVS 93042 RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON Cardiovascular 0.15 0.04 0.04 RBRVS 93050 ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE Cardiovascular a 0.17 0.31 0.31 RBRVS 93050 26 ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE Cardiovascular 0.17 0.07 0.07 RBRVS 93050 TC ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE Cardiovascular a 0.24 0.24 RBRVS 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I Cardiovascular 0.52 2.03 2.03 RBRVS 93225 XTRNL ECG & 48 HR RECORDING Cardiovascular a 0.75 0.75 RBRVS 93226 EXTERNAL ECG SCANNING ANALYSIS REPORT Cardiovascular a 1.06 1.06 RBRVS 93227 XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS Cardiovascular 0.52 0.22 0.22 RBRVS 93228 XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS Cardiovascular 0.52 0.19 0.19 RBRVS 93229 XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT Cardiovascular a 18.97 18.97 RBRVS 93260 PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM Cardiovascular a 0.85 1.00 1.00 RBRVS 93260 26 PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM Cardiovascular 0.85 0.38 0.38 RBRVS 93260 TC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM Cardiovascular a 0.62 0.62 RBRVS 93261 INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB Cardiovascular a 0.74 0.95 0.95 RBRVS 93261 26 INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB Cardiovascular 0.74 0.33 0.33 RBRVS 93261 TC INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB Cardiovascular a 0.62 0.62 RBRVS 93268 XTRNL PT ACTIV ECG TRANSMIS W/R&I

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93284 26 PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB Cardiovascular 1.25 0.48 0.48 RBRVS 93284 TC PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB Cardiovascular a 0.75 0.75 RBRVS 93285 PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM Cardiovascular a 0.52 0.64 0.64 RBRVS 93285 26 PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM Cardiovascular 0.52 0.20 0.20 RBRVS 93285 TC PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM Cardiovascular a 0.44 0.44 RBRVS 93286 PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM Cardiovascular a 0.30 0.45 0.45 RBRVS 93286 26 PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM Cardiovascular 0.30 0.12 0.12 RBRVS 93286 TC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM Cardiovascular a 0.33 0.33 RBRVS 93287 PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB Cardiovascular a 0.45 0.54 0.54 RBRVS 93287 26 PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB Cardiovascular 0.45 0.18 0.18 RBRVS 93287 TC PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB Cardiovascular a 0.36 0.36 RBRVS 93288 INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM Cardiovascular a 0.43 0.60 0.60 RBRVS 93288 26 INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM Cardiovascular 0.43 0.16 0.16 RBRVS 93288 TC INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM Cardiovascular a 0.44 0.44 RBRVS 93289 INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB Cardiovascular a 0.92 0.88 0.88 RBRVS 93289 26 INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB Cardiovascular 0.92 0.34 0.34 RBRVS 93289 TC INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB Cardiovascular a 0.54 0.54 RBRVS 93290 INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS Cardiovascular a 0.43 0.42 0.42 RBRVS 93290 26 INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS Cardiovascular 0.43 0.16 0.16 RBRVS 93290 TC INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS Cardiovascular a 0.26 0.26 RBRVS 93291 INTERROGATION EVALUATION IN PERSON ILR SYSTEM Cardiovascular a 0.43 0.56 0.56 RBRVS 93291 26 INTERROGATION EVALUATION IN PERSON ILR SYSTEM Cardiovascular 0.43 0.16 0.16 RBRVS 93291 TC INTERROGATION EVALUATION IN PERSON ILR SYSTEM Cardiovascular a 0.40 0.40 RBRVS 93292 INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR Cardiovascular a 0.43 0.46 0.46 RBRVS 93292 26 INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR Cardiovascular 0.43 0.16 0.16 RBRVS 93292 TC INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR Cardiovascular a 0.30 0.30 RBRVS 93293 TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL Cardiovascular a 0.32 1.17 1.17 RBRVS 93293 26 TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL Cardiovascular 0.32 0.11 0.11 RBRVS 93293 TC TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL Cardiovascular a 1.06 1.06 RBRVS 93294 INTERROGATION EVAL REMOTE

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93325 TC DOP ECHOCARD COLOR FLOW VELOCITY MAPPING Cardiovascular a 0.63 0.63 RBRVS 93350 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST Cardiovascular a 1.46 5.25 5.25 RBRVS 93350 26 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST Cardiovascular 1.46 0.51 0.51 RBRVS 93350 TC ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST Cardiovascular a 4.74 4.74 RBRVS 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG Cardiovascular a 1.75 5.79 5.79 RBRVS 93351 26 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG Cardiovascular 1.75 0.61 0.61 RBRVS 93351 TC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG Cardiovascular a 5.18 5.18 RBRVS 93352 USE OF ECHO CONTRAST AGENT DURING STRESS ECHO Cardiovascular 0.19 0.75 0.75 RBRVS 93355 ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN Cardiovascular 4.66 1.45 1.45 RBRVS 93451 RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT Surgery a 2.72 18.93 18.93 RBRVS 93451 26 RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT Surgery 2.72 0.93 0.93 RBRVS 93451 TC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT Surgery a 18.00 18.00 RBRVS 93452 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I Surgery a 4.75 19.38 19.38 RBRVS 93452 26 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I Surgery 4.75 1.66 1.66 RBRVS 93452 TC L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I Surgery a 17.72 17.72 RBRVS 93453 R & L HRT CATH W/NJX L VENTRICULOG IMG S&I Surgery a 6.24 24.77 24.77 RBRVS 93453 26 R & L HRT CATH W/NJX L VENTRICULOG IMG S&I Surgery 6.24 2.16 2.16 RBRVS 93453 TC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I Surgery a 22.61 22.61 RBRVS 93454 CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I Surgery a 4.79 19.62 19.62 RBRVS 93454 26 CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I Surgery 4.79 1.65 1.65 RBRVS 93454 TC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I Surgery a 17.97 17.97 RBRVS 93455 CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I Surgery a 5.54 22.88 22.88 RBRVS 93455 26 CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I Surgery 5.54 1.90 1.90 RBRVS 93455 TC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I Surgery a 20.98 20.98 RBRVS 93456 CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I Surgery a 6.15 24.36 24.36 RBRVS 93456 26 CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I Surgery 6.15 2.11 2.11 RBRVS 93456 TC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I Surgery a 22.25 22.25 RBRVS 93457 CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I Surgery a 6.89 27.58 27.58 RBRVS 93457 26 CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I Surgery 6.89 2.36 2.36 RBRVS 93457 TC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I Surgery a 25.22 25.22 RBRVS 93458 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I Surgery a 5.85 23.40 23.40 RBRVS 93458 26 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I Surgery 5.85 2.01 2.01 RBRVS 93458 TC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I Surgery a 21.39 21.39 RBRVS 93459 CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I Surgery a 6.60 25.69 25.69 RBRVS 93459 26 CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I Surgery 6.60 2.26 2.26 RBRVS 93459 TC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I Surgery a 23.43 23.43 RBRVS 93460 R & L HRT CATH WINJX HRT ART& L VENTR IMG Surgery a 7.35 27.25 27.25 RBRVS 93460 26 R & L HRT CATH WINJX HRT ART& L VENTR IMG Surgery 7.35 2.52 2.52 RBRVS 93460 TC R & L HRT CATH WINJX HRT ART& L VENTR IMG Surgery a 24.73 24.73 RBRVS 93461 R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I Surgery a 8.10 31.50 31.50 RBRVS 93461 26 R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I Surgery 8.10 2.78 2.78 RBRVS 93461 TC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I Surgery a 28.72 28.72 RBRVS 93462 LEFT HEART CATH BY TRANSEPTAL PUNCTURE Surgery 3.73 1.47 1.47 RBRVS 93463 MEDICATION ADMIN & HEMODYNAMIC MEASURMENT Surgery 2.00 0.68 0.68 RBRVS 93464 PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU Surgery a 1.80 5.88 5.88 RBRVS 93464 26 PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU Surgery 1.80 0.62 0.62 RBRVS 93464 TC PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU Surgery a 5.26 5.26 RBRVS 93503 INSERTION FLOW DIRECTED CATHETER FOR MONITORING Surgery 2.91 0.53 0.53 RBRVS 93505 ENDOMYOCARDIAL BIOPSY Surgery a 4.37 16.41 16.41 RBRVS 93505 26 ENDOMYOCARDIAL BIOPSY Surgery 4.37 1.50 1.50 RBRVS 93505 TC ENDOMYOCARDIAL BIOPSY Surgery a 14.91 14.91 RBRVS 93530 R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY Surgery a 34.17 Global/TC/26 93530 26 R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY Surgery 5.68 Global/TC/26 93530 TC R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY Surgery a 28.49 Global/TC/26 93531 CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA Surgery a 89.68 Global/TC/26 93531 26 CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA Surgery 11.18 Global/TC/26 93531 TC CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA Surgery a 78.50 Global/TC/26 93532 CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN Surgery a 96.16 Global/TC/26 93532 26 CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN Surgery 13.37 Global/TC/26 93532 TC CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN Surgery a 82.79 Global/TC/26 93533 CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN Surgery a 90.74 Global/TC/26 93533 26 CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN Surgery 8.97 Global/TC/26 93533 TC CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN Surgery a 81.77 Global/TC/26 93561 INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS Cardiovascular a 2.24 Global/TC/26 93561 26 INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS Cardiovascular 0.65 Global/TC/26 93561 TC INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS Cardiovascular a 1.59 Global/TC/26 93562 INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA Cardiovascular a 1.19 Global/TC/26 93562 26 INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA Cardiovascular 0.22 Global/TC/26 93562 TC INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA Cardiovascular a 0.97 Global/TC/26 93563 NJX SEL HRT ART CONGENITAL HRT CATH W/S&I Cardiovascular 1.11 0.38 0.38 RBRVS 93564 NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I Cardiovascular 1.13 0.39 0.39 RBRVS 93565 NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I Cardiovascular 0.86 0.31 0.31 RBRVS 93566 NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I Cardiovascular 0.86 0.29 3.80 RBRVS 93567 NJX SUPRAVALV AORTOG HRT CATH W/S&I Cardiovascular 0.97 0.33 2.83 RBRVS 93568 NJX PULMONARY ANGIO HRT CATH W/S&I Cardiovascular 0.88 0.30 3.29 RBRVS

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93571 IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL Cardiovascular a 8.26 Global/TC/26 93571 26 IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL Cardiovascular 2.42 Global/TC/26 93571 TC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL Cardiovascular a 5.84 Global/TC/26 93572 IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL Cardiovascular a 5.10 Global/TC/26 93572 26 IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL Cardiovascular 1.93 Global/TC/26 93572 TC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL Cardiovascular a 3.17 Global/TC/26 93580 PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT Surgery 17.97 6.47 6.47 RBRVS 93581 PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT Surgery 24.39 8.61 8.61 RBRVS 93582 PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS Surgery 12.56 4.25 4.25 RBRVS 93583 PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER Surgery 14.00 4.74 4.74 RBRVS 93600 BUNDLE OF HIS RECORDING Cardiovascular a 4.37 Global/TC/26 93600 26 BUNDLE OF HIS RECORDING Cardiovascular 2.99 Global/TC/26 93600 TC BUNDLE OF HIS RECORDING Cardiovascular a 1.38 Global/TC/26 93602 INTRA-ATRIAL RECORDING Cardiovascular a 4.07 Global/TC/26 93602 26 INTRA-ATRIAL RECORDING Cardiovascular 2.93 Global/TC/26 93602 TC INTRA-ATRIAL RECORDING Cardiovascular a 1.14 Global/TC/26 93603 RIGHT VENTRICULAR RECORDING Cardiovascular a 4.65 Global/TC/26 93603 26 RIGHT VENTRICULAR RECORDING Cardiovascular 2.93 Global/TC/26 93603 TC RIGHT VENTRICULAR RECORDING Cardiovascular a 1.72 Global/TC/26 93609 INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA Cardiovascular a 9.18 Global/TC/26 93609 26 INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA Cardiovascular 7.02 Global/TC/26 93609 TC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA Cardiovascular a 2.16 Global/TC/26 93610 INTRA-ATRIAL PACING Cardiovascular a 4.20 Global/TC/26 93610 26 INTRA-ATRIAL PACING Cardiovascular 4.14 Global/TC/26 93610 TC INTRA-ATRIAL PACING Cardiovascular a 0.06 Global/TC/26 93612 INTRAVENTRICULAR PACING Cardiovascular a 5.73 Global/TC/26 93612 26 INTRAVENTRICULAR PACING Cardiovascular 4.12 Global/TC/26 93612 TC INTRAVENTRICULAR PACING Cardiovascular a 1.61 Global/TC/26 93613 INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING Cardiovascular 6.99 2.90 2.90 RBRVS 93615 ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS Cardiovascular a 1.80 Global/TC/26 93615 26 ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS Cardiovascular 1.42 Global/TC/26 93615 TC ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS Cardiovascular a 0.38 Global/TC/26 93616 ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG Cardiovascular a 2.32 Global/TC/26 93616 26 ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG Cardiovascular 1.74 Global/TC/26 93616 TC ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG Cardiovascular a 0.58 Global/TC/26 93618 INDUCTION ARRHYTHMIA ELECTRICAL PACING Cardiovascular a 10.10 Global/TC/26 93618 26 INDUCTION ARRHYTHMIA ELECTRICAL PACING Cardiovascular 5.95 Global/TC/26 93618 TC INDUCTION ARRHYTHMIA ELECTRICAL PACING Cardiovascular a 4.15 Global/TC/26 93619 COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION Cardiovascular a 16.38 Global/TC/26 93619 26 COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION Cardiovascular 10.22 Global/TC/26 93619 TC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION Cardiovascular a 6.16 Global/TC/26 93620 COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION Cardiovascular a 19.45 Global/TC/26 93620 26 COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION Cardiovascular 16.23 Global/TC/26 93620 TC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION Cardiovascular a 3.22 Global/TC/26 93621 COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC Cardiovascular a 4.83 Global/TC/26 93621 26 COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC Cardiovascular 2.96 Global/TC/26 93621 TC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC Cardiovascular a 1.87 Global/TC/26 93622 COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC Cardiovascular a 5.75 Global/TC/26 93622 26 COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC Cardiovascular 4.31 Global/TC/26 93622 TC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC Cardiovascular a 1.44 Global/TC/26 93623 PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS Cardiovascular a 5.37 Global/TC/26 93623 26 PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS Cardiovascular 4.03 Global/TC/26 93623 TC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS Cardiovascular a 1.34 Global/TC/26 93624 ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT Cardiovascular a 7.96 Global/TC/26 93624 26 ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT Cardiovascular 6.43 Global/TC/26 93624 TC ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT Cardiovascular a 1.53 Global/TC/26 93631 INTRAOP EPICAR& ENDOCAR PACG& MAPG Cardiovascular a 13.14 Global/TC/26 93631 26 INTRAOP EPICAR& ENDOCAR PACG& MAPG Cardiovascular 9.96 Global/TC/26 93631 TC INTRAOP EPICAR& ENDOCAR PACG& MAPG Cardiovascular a 3.18 Global/TC/26 93640 EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE Cardiovascular a 11.86 Global/TC/26 93640 26 EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE Cardiovascular 4.85 Global/TC/26 93640 TC EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE Cardiovascular a 7.01 Global/TC/26 93641 EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN Cardiovascular a 13.77 Global/TC/26 93641 26 EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN Cardiovascular 8.27 Global/TC/26 93641 TC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN Cardiovascular a 5.50 Global/TC/26 93642 EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS Cardiovascular a 4.88 6.23 6.23 RBRVS 93642 26 EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS Cardiovascular 4.88 1.97 1.97 RBRVS 93642 TC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS Cardiovascular a 4.26 4.26 RBRVS 93644 EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR Cardiovascular a 3.29 4.49 4.49 RBRVS 93644 26 EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR Cardiovascular 3.29 1.52 1.52 RBRVS 93644 TC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR Cardiovascular a 2.97 2.97 RBRVS 93650 ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION Cardiovascular 10.49 4.59 4.59 RBRVS 93653 EPHYS EVAL W/ABLATION SUPRAVENT ARRHYTHMIA Cardiovascular 15.00 6.14 6.14 RBRVS 93654 EPHYS EVAL W/ABLATION VENTRICULAR TACHYCARDIA Cardiovascular 20.00 8.12 8.12 RBRVS 93655 ICAR CATHETER ABLATION ARRHYTHMIA ADD ON Cardiovascular 7.50 3.06 3.06 RBRVS

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93656 EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN Cardiovascular 20.02 8.24 8.24 RBRVS 93657 ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN Cardiovascular 7.50 3.05 3.05 RBRVS 93660 CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR Cardiovascular a 1.89 2.48 2.48 RBRVS 93660 26 CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR Cardiovascular 1.89 0.71 0.71 RBRVS 93660 TC CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR Cardiovascular a 1.77 1.77 RBRVS 93662 INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I Cardiovascular a 5.37 Global/TC/26 93662 26 INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I Cardiovascular 3.95 Global/TC/26 93662 TC INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I Cardiovascular a 1.42 Global/TC/26 93668 PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION Cardiovascular 0.53 0.53 RBRVS 93701 BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS Cardiovascular a 0.68 0.68 Global/TC/26 93701 26 BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS Cardiovascular 0.18 Global/TC/26 93701 TC BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS Cardiovascular a 0.50 Global/TC/26 93702 BIS EXTRACELLULAR FLUID ALYS LYMPHEDEMA ASSMNT Radiology a 3.19 3.19 RBRVS 93724 ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM Cardiovascular a 4.88 2.63 2.63 RBRVS 93724 26 ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM Cardiovascular 4.88 1.84 1.84 RBRVS 93724 TC ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM Cardiovascular a 0.79 0.79 RBRVS 93740 TEMPRATURE GRADIENT STUDY Cardiovascular a 0.16 0.06 0.06 Other 93740 26 TEMPRATURE GRADIENT STUDY Cardiovascular 0.18 Global/TC/26 93740 TC TEMPRATURE GRADIENT STUDY Cardiovascular a 0.04 Global/TC/26 93750 INTERROGATION VAD IN PRSON W/PHYS/QHP ANALYSIS Cardiovascular 0.92 0.30 0.56 RBRVS 93770 DERMINATION OF VENOUS PRESSUE Cardiovascular a 0.16 0.06 0.06 Other 93770 26 DERMINATION OF VENOUS PRESSUE Cardiovascular 0.20 Global/TC/26 93770 TC DERMINATION OF VENOUS PRESSUE Cardiovascular a 0.02 Global/TC/26 93784 AMBL BLD PRESS W/TAPE&/DISK 24/> HR ALYS I&R Cardiovascular 0.38 1.11 1.11 RBRVS 93786 BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL Cardiovascular a 0.83 0.83 RBRVS 93788 AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT Cardiovascular a 0.14 0.14 RBRVS 93790 AMBL BLD PRESS TAPE&/DISK 24/> HR REVIEW Cardiovascular 0.38 0.14 0.14 RBRVS 93797 OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR Cardiovascular 0.18 0.06 0.27 RBRVS 93798 OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING Cardiovascular 0.28 0.10 0.41 RBRVS 93799 UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE Cardiovascular a 0.46 Unlisted 93799 26 UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE Cardiovascular 0.11 Unlisted 93799 TC UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE Cardiovascular a 0.35 Unlisted 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY Miscellaneous Medical a 0.80 4.84 4.84 RBRVS 93880 26 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY Miscellaneous Medical 0.80 0.27 0.27 RBRVS 93880 TC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY Miscellaneous Medical a 4.57 4.57 RBRVS 93882 DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY Miscellaneous Medical a 0.50 3.08 3.08 RBRVS 93882 26 DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY Miscellaneous Medical 0.50 0.15 0.15 RBRVS 93882 TC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY Miscellaneous Medical a 2.93 2.93 RBRVS 93886 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL Miscellaneous Medical a 0.91 7.15 7.15 RBRVS 93886 26 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL Miscellaneous Medical 0.91 0.37 0.37 RBRVS 93886 TC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL Miscellaneous Medical a 6.78 6.78 RBRVS 93888 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD Miscellaneous Medical a 0.50 3.68 3.68 RBRVS 93888 26 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD Miscellaneous Medical 0.50 0.19 0.19 RBRVS 93888 TC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD Miscellaneous Medical a 3.49 3.49 RBRVS 93890 TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY Miscellaneous Medical a 1.00 7.16 7.16 RBRVS 93890 26 TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY Miscellaneous Medical 1.00 0.40 0.40 RBRVS 93890 TC TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY Miscellaneous Medical a 6.76 6.76 RBRVS 93892 TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT Miscellaneous Medical a 1.15 8.31 8.31 RBRVS 93892 26 TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT Miscellaneous Medical 1.15 0.47 0.47 RBRVS 93892 TC TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT Miscellaneous Medical a 7.84 7.84 RBRVS 93893 TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ Miscellaneous Medical a 1.15 8.56 8.56 RBRVS 93893 26 TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ Miscellaneous Medical 1.15 0.47 0.47 RBRVS 93893 TC TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ Miscellaneous Medical a 8.09 8.09 RBRVS 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL Miscellaneous Medical a 0.25 2.25 2.25 RBRVS 93922 26 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL Miscellaneous Medical 0.25 0.08 0.08 RBRVS 93922 TC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL Miscellaneous Medical a 2.17 2.17 RBRVS 93923 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS Miscellaneous Medical a 0.45 3.42 3.42 RBRVS 93923 26 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS Miscellaneous Medical 0.45 0.14 0.14 RBRVS 93923 TC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS Miscellaneous Medical a 3.28 3.28 RBRVS 93924 N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI Miscellaneous Medical a 0.50 4.33 4.33 RBRVS 93924 26 N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI Miscellaneous Medical 0.50 0.16 0.16 RBRVS 93924 TC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI Miscellaneous Medical a 4.17 4.17 RBRVS 93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY Miscellaneous Medical a 0.80 6.49 6.49 RBRVS 93925 26 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY Miscellaneous Medical 0.80 0.26 0.26 RBRVS 93925 TC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY Miscellaneous Medical a 6.23 6.23 RBRVS 93926 DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY Miscellaneous Medical a 0.50 3.76 3.76 RBRVS 93926 26 DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY Miscellaneous Medical 0.50 0.14 0.14 RBRVS 93926 TC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY Miscellaneous Medical a 3.62 3.62 RBRVS 93930 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY Miscellaneous Medical a 0.80 5.04 5.04 RBRVS 93930 26 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY Miscellaneous Medical 0.80 0.26 0.26 RBRVS 93930 TC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY Miscellaneous Medical a 4.78 4.78 RBRVS 93931 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY Miscellaneous Medical a 0.50 3.12 3.12 RBRVS 93931 26 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY Miscellaneous Medical 0.50 0.16 0.16 RBRVS 93931 TC DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY Miscellaneous Medical a 2.96 2.96 RBRVS 93965 N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD Miscellaneous Medical a 0.35 3.03 3.03 RBRVS

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93965 26 N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD Miscellaneous Medical 0.35 0.12 0.12 RBRVS 93965 TC N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD Miscellaneous Medical a 2.91 2.91 RBRVS 93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY Miscellaneous Medical a 0.70 4.80 4.80 RBRVS 93970 26 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY Miscellaneous Medical 0.70 0.23 0.23 RBRVS 93970 TC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY Miscellaneous Medical a 4.57 4.57 RBRVS 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY Miscellaneous Medical a 0.45 2.93 2.93 RBRVS 93971 26 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY Miscellaneous Medical 0.45 0.15 0.15 RBRVS 93971 TC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY Miscellaneous Medical a 2.78 2.78 RBRVS 93975 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM Miscellaneous Medical a 1.16 6.72 6.72 RBRVS 93975 26 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM Miscellaneous Medical 1.16 0.39 0.39 RBRVS 93975 TC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM Miscellaneous Medical a 6.33 6.33 RBRVS 93976 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT Miscellaneous Medical a 0.80 3.76 3.76 RBRVS 93976 26 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT Miscellaneous Medical 0.80 0.29 0.29 RBRVS 93976 TC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT Miscellaneous Medical a 3.47 3.47 RBRVS 93978 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE Miscellaneous Medical a 0.80 4.51 4.51 RBRVS 93978 26 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE Miscellaneous Medical 0.80 0.24 0.24 RBRVS 93978 TC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE Miscellaneous Medical a 4.27 4.27 RBRVS 93979 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD Miscellaneous Medical a 0.50 2.85 2.85 RBRVS 93979 26 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD Miscellaneous Medical 0.50 0.15 0.15 RBRVS 93979 TC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD Miscellaneous Medical a 2.70 2.70 RBRVS 93980 DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL Miscellaneous Medical a 1.25 2.09 2.09 RBRVS 93980 26 DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL Miscellaneous Medical 1.25 0.44 0.44 RBRVS 93980 TC DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL Miscellaneous Medical a 1.65 1.65 RBRVS 93981 DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD Miscellaneous Medical a 0.44 1.56 1.56 RBRVS 93981 26 DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD Miscellaneous Medical 0.44 0.14 0.14 RBRVS 93981 TC DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD Miscellaneous Medical a 1.42 1.42 RBRVS 93982 IMPLANT WIRELESS PRESS SENSOR STUDY ANEURYSM SAC Miscellaneous Medical 0.30 0.89 0.89 RBRVS 93990 DUPLEX SCAN HEMODIALYSIS ACCESS Miscellaneous Medical a 0.50 3.96 3.96 RBRVS 93990 26 DUPLEX SCAN HEMODIALYSIS ACCESS Miscellaneous Medical 0.50 0.13 0.13 RBRVS 93990 TC DUPLEX SCAN HEMODIALYSIS ACCESS Miscellaneous Medical a 3.83 3.83 RBRVS 93998 UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY Miscellaneous Medical 5.31 Unlisted 94002 VENTILATION ASSIST & MGMT INPATIENT 1ST DAY Miscellaneous Medical 1.99 0.48 0.48 RBRVS 94003 VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA Miscellaneous Medical 1.37 0.42 0.42 RBRVS 94004 VENTILATION ASSIST & MGMT NURSING FAC PR DAY Miscellaneous Medical 1.00 0.32 0.32 RBRVS 94005 HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/> Miscellaneous Medical 1.50 1.03 1.03 RBRVS 94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ Miscellaneous Medical a 0.17 0.83 0.83 RBRVS 94010 26 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ Miscellaneous Medical 0.17 0.06 0.06 RBRVS 94010 TC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ Miscellaneous Medical a 0.77 0.77 RBRVS 94011 MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y Miscellaneous Medical 2.00 0.72 0.72 RBRVS 94012 MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS Miscellaneous Medical 3.10 1.35 1.35 RBRVS 94013 MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS Miscellaneous Medical 0.66 0.18 0.18 RBRVS 94014 PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I Miscellaneous Medical 0.52 1.03 1.03 RBRVS 94015 PATIENT-INITIATED SPIROMETRIC RECORDING Miscellaneous Medical a 0.85 0.85 RBRVS 94016 PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY Miscellaneous Medical 0.52 0.18 0.18 RBRVS 94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN Miscellaneous Medical a 0.27 1.43 1.43 RBRVS 94060 26 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN Miscellaneous Medical 0.27 0.09 0.09 RBRVS 94060 TC BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN Miscellaneous Medical a 1.34 1.34 RBRVS 94070 BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT Miscellaneous Medical a 0.60 1.05 1.05 RBRVS 94070 26 BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT Miscellaneous Medical 0.60 0.19 0.19 RBRVS 94070 TC BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT Miscellaneous Medical a 0.86 0.86 RBRVS 94150 VITAL CAPACITY TOTAL SEPARATE PROCEDURE Miscellaneous Medical a 0.07 0.63 0.63 RBRVS 94150 26 VITAL CAPACITY TOTAL SEPARATE PROCEDURE Miscellaneous Medical 0.07 0.03 0.03 RBRVS 94150 TC VITAL CAPACITY TOTAL SEPARATE PROCEDURE Miscellaneous Medical a 0.60 0.60 RBRVS 94200 MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ Miscellaneous Medical a 0.11 0.59 0.59 RBRVS 94200 26 MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ Miscellaneous Medical 0.11 0.04 0.04 RBRVS 94200 TC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ Miscellaneous Medical a 0.55 0.55 RBRVS 94250 EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX Miscellaneous Medical a 0.11 0.61 0.61 RBRVS 94250 26 EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX Miscellaneous Medical 0.11 0.03 0.03 RBRVS 94250 TC EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX Miscellaneous Medical a 0.58 0.58 RBRVS 94375 RESPIRATORY FLOW VOLUME LOOP Miscellaneous Medical a 0.31 0.78 0.78 RBRVS 94375 26 RESPIRATORY FLOW VOLUME LOOP Miscellaneous Medical 0.31 0.10 0.10 RBRVS 94375 TC RESPIRATORY FLOW VOLUME LOOP Miscellaneous Medical a 0.68 0.68 RBRVS 94400 BREATHING RESPONSE TO CO2 Miscellaneous Medical a 0.40 1.18 1.18 RBRVS 94400 26 BREATHING RESPONSE TO CO2 Miscellaneous Medical 0.40 0.14 0.14 RBRVS 94400 TC BREATHING RESPONSE TO CO2 Miscellaneous Medical a 1.04 1.04 RBRVS 94450 BREATHING RESPONSE TO HYPOXIA Miscellaneous Medical a 0.40 1.46 1.46 RBRVS 94450 26 BREATHING RESPONSE TO HYPOXIA Miscellaneous Medical 0.40 0.14 0.14 RBRVS 94450 TC BREATHING RESPONSE TO HYPOXIA Miscellaneous Medical a 1.32 1.32 RBRVS 94452 HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT Miscellaneous Medical a 0.31 1.30 1.30 RBRVS 94452 26 HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT Miscellaneous Medical 0.31 0.09 0.09 RBRVS 94452 TC HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT Miscellaneous Medical a 1.21 1.21 RBRVS 94453 HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION Miscellaneous Medical a 0.40 1.83 1.83 RBRVS 94453 26 HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION Miscellaneous Medical 0.40 0.12 0.12 RBRVS 94453 TC HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION Miscellaneous Medical a 1.71 1.71 RBRVS 94610 INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP Miscellaneous Medical 1.16 0.35 0.35 RBRVS

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94620 PULMONARY STRESS TESTING SIMPLE Miscellaneous Medical a 0.64 0.91 0.91 RBRVS 94620 26 PULMONARY STRESS TESTING SIMPLE Miscellaneous Medical 0.64 0.20 0.20 RBRVS 94620 TC PULMONARY STRESS TESTING SIMPLE Miscellaneous Medical a 0.71 0.71 RBRVS 94621 PULMONARY STRESS TESTING COMPLEX Miscellaneous Medical a 1.42 3.14 3.14 RBRVS 94621 26 PULMONARY STRESS TESTING COMPLEX Miscellaneous Medical 1.42 0.48 0.48 RBRVS 94621 TC PULMONARY STRESS TESTING COMPLEX Miscellaneous Medical a 2.66 2.66 RBRVS 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT Miscellaneous Medical 0.51 0.51 RBRVS 94642 PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH Miscellaneous Medical 1.16 FAIR Health 94644 CONTINUOUS INHALATION TREATMENT 1ST HR Miscellaneous Medical 1.22 1.22 RBRVS 94645 CONTINUOUS INHALATION TREATMENT EA ADDL HR Miscellaneous Medical 0.38 0.38 RBRVS 94660 CPAP VENTILATION CPAP INITIATION&MGMT Miscellaneous Medical 0.76 0.26 0.96 RBRVS 94662 CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGM Miscellaneous Medical 0.76 0.14 0.14 RBRVS 94664 DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP Miscellaneous Medical 0.48 0.48 RBRVS 94667 MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL Miscellaneous Medical 0.72 0.72 RBRVS 94668 MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ Miscellaneous Medical 0.80 0.80 RBRVS 94669 MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION Miscellaneous Medical 0.98 0.98 RBRVS 94680 O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP Miscellaneous Medical a 0.26 1.34 1.34 RBRVS 94680 26 O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP Miscellaneous Medical 0.26 0.09 0.09 RBRVS 94680 TC O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP Miscellaneous Medical a 1.25 1.25 RBRVS 94681 O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC Miscellaneous Medical a 0.20 1.29 1.29 RBRVS 94681 26 O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC Miscellaneous Medical 0.20 0.07 0.07 RBRVS 94681 TC O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC Miscellaneous Medical a 1.22 1.22 RBRVS 94690 O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX Miscellaneous Medical a 0.07 1.31 1.31 RBRVS 94690 26 O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX Miscellaneous Medical 0.07 0.03 0.03 RBRVS 94690 TC O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX Miscellaneous Medical a 1.28 1.28 RBRVS 94726 PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST Miscellaneous Medical a 0.26 1.21 1.21 RBRVS 94726 26 PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST Miscellaneous Medical 0.26 0.08 0.08 RBRVS 94726 TC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST Miscellaneous Medical a 1.13 1.13 RBRVS 94727 GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V Miscellaneous Medical a 0.26 0.91 0.91 RBRVS 94727 26 GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V Miscellaneous Medical 0.26 0.08 0.08 RBRVS 94727 TC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V Miscellaneous Medical a 0.83 0.83 RBRVS 94728 AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY Miscellaneous Medical a 0.26 0.83 0.83 RBRVS 94728 26 AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY Miscellaneous Medical 0.26 0.08 0.08 RBRVS 94728 TC AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY Miscellaneous Medical a 0.75 0.75 RBRVS 94729 CO DIFFUSING CAPACITY Miscellaneous Medical a 0.19 1.33 1.33 RBRVS 94729 26 CO DIFFUSING CAPACITY Miscellaneous Medical 0.19 0.06 0.06 RBRVS 94729 TC CO DIFFUSING CAPACITY Miscellaneous Medical a 1.27 1.27 RBRVS 94750 PULMONARY COMPLIANCE STUDY Miscellaneous Medical a 0.23 2.04 2.04 RBRVS 94750 26 PULMONARY COMPLIANCE STUDY Miscellaneous Medical 0.23 0.08 0.08 RBRVS 94750 TC PULMONARY COMPLIANCE STUDY Miscellaneous Medical a 1.96 1.96 RBRVS 94760 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER Miscellaneous Medical a 0.08 0.08 RBRVS 94761 NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER Miscellaneous Medical a 0.13 0.13 RBRVS 94762 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR Miscellaneous Medical a 0.68 0.68 RBRVS 94770 CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER Miscellaneous Medical a 0.15 0.05 0.05 Other 94770 26 CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER Miscellaneous Medical 0.04 Global/TC/26 94770 TC CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER Miscellaneous Medical a 0.16 Global/TC/26 94772 CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT Miscellaneous Medical a 3.43 v3.16 94772 26 CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT Miscellaneous Medical 1.37 v3.16 94772 TC CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT Miscellaneous Medical a 2.06 v3.16 94774 PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R Miscellaneous Medical 2.71 v3.16 94776 PEDIATRIC APNEA MONITOR ANALYSES COMPUTER Miscellaneous Medical a 1.72 v3.16 94777 PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW Miscellaneous Medical 1.50 v3.16 94780 CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN Miscellaneous Medical 0.48 0.20 1.26 RBRVS 94781 CAR SEAT/BED TESTNG W/INTERP & REPORT ADDL 30MIN Miscellaneous Medical 0.17 0.07 0.47 RBRVS 94799 UNLISTED PULMONARY SERVICE/PROCEDURE Miscellaneous Medical a 1.46 Unlisted 94799 26 UNLISTED PULMONARY SERVICE/PROCEDURE Miscellaneous Medical 0.39 Unlisted 94799 TC UNLISTED PULMONARY SERVICE/PROCEDURE Miscellaneous Medical a 1.07 Unlisted 95004 PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS Allergy Testing 0.01 0.16 0.16 RBRVS 95012 NITRIC OXIDE EXPIRED GAS DETERMINATION Allergy Testing 0.54 0.54 RBRVS 95017 ALLG TSTG PERQ & IC VENOMS IMMED REACT W/I&R Allergy Testing 0.07 0.02 0.14 RBRVS 95018 ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R Allergy Testing 0.14 0.05 0.38 RBRVS 95024 INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS Allergy Testing 0.01 0.01 0.20 RBRVS 95027 INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE Allergy Testing 0.01 0.11 0.11 RBRVS 95028 IC TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING Allergy Testing a 0.37 0.37 RBRVS 95044 PATCH/APPLICATION TEST SPECIFY NUMBER TESTS Allergy Testing 0.15 0.15 RBRVS 95052 PHOTO PATCH TEST SPECIFY NUMBER TSTS Allergy Testing 0.18 0.18 RBRVS 95056 PHOTO TESTS Allergy Testing 1.24 1.24 RBRVS 95060 OPHTHALMIC MUCOUS MEMBRANE TESTS Allergy Testing a 0.98 0.98 RBRVS 95065 DIRECT NASAL MUCOUS MEMBRANE TEST Allergy Testing a 0.70 0.70 RBRVS 95070 INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL Allergy Testing a 0.84 0.84 RBRVS 95071 INHLJ BRNCL CHALLENGE TSTG W/AGS/GASES Allergy Testing a 0.97 0.97 RBRVS 95076 INGESTION CHALLENGE TEST INITIAL 120 MINUTES Allergy Testing 1.50 0.51 1.72 RBRVS 95079 INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES Allergy Testing 1.38 0.47 0.91 RBRVS 95115 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX Allergy Immunotherapy 0.24 0.24 RBRVS 95117 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS Allergy Immunotherapy 0.28 0.28 RBRVS

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95120 PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX Allergy Immunotherapy 0.28 FAIR Health 95125 PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX Allergy Immunotherapy 0.35 FAIR Health 95130 PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT Allergy Immunotherapy 0.49 FAIR Health 95131 PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT Allergy Immunotherapy 0.62 FAIR Health 95132 PROF SVCS ALLG IMMNTX W/PRV XTRC 3 STING INSECT Allergy Immunotherapy 0.75 FAIR Health 95133 PROF SVCS ALLG IMMNTX W/PRV XTRC 4 STING INSECT Allergy Immunotherapy 0.91 FAIR Health 95134 PROF SVCS ALLG IMMNTX W/PRV XTRC 5 STING INSECT Allergy Immunotherapy 1.09 FAIR Health 95144 PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO Allergy Immunotherapy 0.06 0.02 0.28 RBRVS 95145 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT Allergy Immunotherapy 0.06 0.02 0.55 RBRVS 95146 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT Allergy Immunotherapy 0.06 0.02 1.03 RBRVS 95147 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECT Allergy Immunotherapy 0.06 0.02 0.92 RBRVS 95148 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT Allergy Immunotherapy 0.06 0.02 1.41 RBRVS 95149 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT Allergy Immunotherapy 0.06 0.02 1.91 RBRVS 95165 PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN Allergy Immunotherapy 0.06 0.02 0.29 RBRVS 95170 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE Allergy Immunotherapy 0.06 0.02 0.20 RBRVS 95180 RAPID DESENSITIZATION PROCEDURE EACH HOUR Allergy Immunotherapy 2.01 0.78 1.69 RBRVS 95199 UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SRVC/PX Allergy Immunotherapy 0.28 Unlisted 95250 GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID Miscellaneous Medical a 4.42 4.42 RBRVS 95251 GLUC MNTR CONT REC FROM NTRSTL TISS FLU I&R Miscellaneous Medical 0.85 0.33 0.33 RBRVS 95782 POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND Miscellaneous Medical a 2.60 22.84 22.84 RBRVS 95782 26 POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND Miscellaneous Medical 2.60 0.74 0.74 RBRVS 95782 TC POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND Miscellaneous Medical a 22.10 22.10 RBRVS 95783 POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM Miscellaneous Medical a 2.83 31.95 31.95 RBRVS 95783 26 POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM Miscellaneous Medical 2.83 1.22 1.22 RBRVS 95783 TC POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM Miscellaneous Medical a 30.73 30.73 RBRVS 95800 SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME Miscellaneous Medical a 1.05 3.97 3.97 RBRVS 95800 26 SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME Miscellaneous Medical 1.05 0.38 0.38 RBRVS 95800 TC SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME Miscellaneous Medical a 3.59 3.59 RBRVS 95801 SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL Miscellaneous Medical a 1.00 1.54 1.54 RBRVS 95801 26 SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL Miscellaneous Medical 1.00 0.36 0.36 RBRVS 95801 TC SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL Miscellaneous Medical a 1.18 1.18 RBRVS 95803 ACTIGRAPHY TESTING RECORDING ANALYSIS I&R Miscellaneous Medical a 0.90 3.05 3.05 RBRVS 95803 26 ACTIGRAPHY TESTING RECORDING ANALYSIS I&R Miscellaneous Medical 0.90 0.29 0.29 RBRVS 95803 TC ACTIGRAPHY TESTING RECORDING ANALYSIS I&R Miscellaneous Medical a 2.76 2.76 RBRVS 95805 MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG Miscellaneous Medical a 1.20 10.52 10.52 RBRVS 95805 26 MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG Miscellaneous Medical 1.20 0.43 0.43 RBRVS 95805 TC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG Miscellaneous Medical a 10.09 10.09 RBRVS 95806 SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT Miscellaneous Medical a 1.25 3.44 3.44 RBRVS 95806 26 SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT Miscellaneous Medical 1.25 0.43 0.43 RBRVS 95806 TC SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT Miscellaneous Medical a 3.01 3.01 RBRVS 95807 SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN Miscellaneous Medical a 1.28 11.82 11.82 RBRVS 95807 26 SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN Miscellaneous Medical 1.28 0.43 0.43 RBRVS 95807 TC SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN Miscellaneous Medical a 11.39 11.39 RBRVS 95808 POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND Miscellaneous Medical a 1.74 15.12 15.12 RBRVS 95808 26 POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND Miscellaneous Medical 1.74 0.67 0.67 RBRVS 95808 TC POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND Miscellaneous Medical a 14.45 14.45 RBRVS 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND Miscellaneous Medical a 2.50 14.82 14.82 RBRVS 95810 26 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND Miscellaneous Medical 2.50 0.85 0.85 RBRVS 95810 TC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND Miscellaneous Medical a 13.97 13.97 RBRVS 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND Miscellaneous Medical a 2.60 15.59 15.59 RBRVS 95811 26 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND Miscellaneous Medical 2.60 0.88 0.88 RBRVS 95811 TC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND Miscellaneous Medical a 14.71 14.71 RBRVS 95812 ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN Miscellaneous Medical a 1.08 10.63 10.63 RBRVS 95812 26 ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN Miscellaneous Medical 1.08 0.50 0.50 RBRVS 95812 TC ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN Miscellaneous Medical a 10.13 10.13 RBRVS 95813 ELECTROENCEPHALOGRAM EXTND MNTR >1 HR Miscellaneous Medical a 1.73 12.25 12.25 RBRVS 95813 26 ELECTROENCEPHALOGRAM EXTND MNTR >1 HR Miscellaneous Medical 1.73 0.80 0.80 RBRVS 95813 TC ELECTROENCEPHALOGRAM EXTND MNTR >1 HR Miscellaneous Medical a 11.45 11.45 RBRVS 95816 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY Miscellaneous Medical a 1.08 8.96 8.96 RBRVS 95816 26 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY Miscellaneous Medical 1.08 0.50 0.50 RBRVS 95816 TC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY Miscellaneous Medical a 8.46 8.46 RBRVS 95819 ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP Miscellaneous Medical a 1.08 10.37 10.37 RBRVS 95819 26 ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP Miscellaneous Medical 1.08 0.50 0.50 RBRVS 95819 TC ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP Miscellaneous Medical a 9.87 9.87 RBRVS 95822 ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY Miscellaneous Medical a 1.08 9.27 9.27 RBRVS 95822 26 ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY Miscellaneous Medical 1.08 0.50 0.50 RBRVS 95822 TC ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY Miscellaneous Medical a 8.77 8.77 RBRVS 95824 ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY Miscellaneous Medical a 2.76 Global/TC/26 95824 26 ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY Miscellaneous Medical 1.08 Global/TC/26 95824 TC ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY Miscellaneous Medical a 1.68 Global/TC/26 95827 ELECTROENCEPHALOGRAM ALL NIGHT RECORDING Miscellaneous Medical a 1.08 20.87 20.87 RBRVS 95827 26 ELECTROENCEPHALOGRAM ALL NIGHT RECORDING Miscellaneous Medical 1.08 0.49 0.49 RBRVS 95827 TC ELECTROENCEPHALOGRAM ALL NIGHT RECORDING Miscellaneous Medical a 20.38 20.38 RBRVS 95829 ELECTROCORTICOGRAM SURGERY SPX Miscellaneous Medical 6.20 46.52 46.52 RBRVS 95829 26 ELECTROCORTICOGRAM SURGERY SPX Miscellaneous Medical 6.20 2.85 2.85 RBRVS

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95829 TC ELECTROCORTICOGRAM SURGERY SPX Miscellaneous Medical 43.67 43.67 RBRVS 95830 INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP Miscellaneous Medical 1.70 0.75 5.09 RBRVS 95831 MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK Miscellaneous Medical 0.28 0.12 0.56 RBRVS 95832 MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML SIDE Miscellaneous Medical 0.29 0.13 0.53 RBRVS 95833 MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX HANDS Miscellaneous Medical 0.47 0.12 0.57 RBRVS 95834 MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS Miscellaneous Medical 0.60 0.25 0.79 RBRVS 95851 ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI Miscellaneous Medical 0.16 0.05 0.35 RBRVS 95852 ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID Miscellaneous Medical 0.11 0.05 0.34 RBRVS 95857 CHOLINESTERASE INHIBITOR CHALLENGE TEST Miscellaneous Medical 0.53 0.27 0.96 RBRVS 95860 NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 0.96 2.46 2.46 RBRVS 95860 26 NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical 0.96 0.47 0.47 RBRVS 95860 TC NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 1.99 1.99 RBRVS 95861 NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 1.54 3.25 3.25 RBRVS 95861 26 NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical 1.54 0.72 0.72 RBRVS 95861 TC NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 2.53 2.53 RBRVS 95863 NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 1.87 4.04 4.04 RBRVS 95863 26 NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical 1.87 0.89 0.89 RBRVS 95863 TC NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 3.15 3.15 RBRVS 95864 NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 1.99 4.74 4.74 RBRVS 95864 26 NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical 1.99 0.95 0.95 RBRVS 95864 TC NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS Miscellaneous Medical a 3.79 3.79 RBRVS 95865 NEEDLE ELECTROMYOGRAPHY LARYNX Miscellaneous Medical a 1.57 2.40 2.40 RBRVS 95865 26 NEEDLE ELECTROMYOGRAPHY LARYNX Miscellaneous Medical 1.57 0.72 0.72 RBRVS 95865 TC NEEDLE ELECTROMYOGRAPHY LARYNX Miscellaneous Medical a 1.68 1.68 RBRVS 95866 NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM Miscellaneous Medical a 1.25 2.45 2.45 RBRVS 95866 26 NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM Miscellaneous Medical 1.25 0.62 0.62 RBRVS 95866 TC NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM Miscellaneous Medical a 1.83 1.83 RBRVS 95867 NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI Miscellaneous Medical a 0.79 1.80 1.80 RBRVS 95867 26 NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI Miscellaneous Medical 0.79 0.36 0.36 RBRVS 95867 TC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI Miscellaneous Medical a 1.44 1.44 RBRVS 95868 NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI Miscellaneous Medical a 1.18 2.48 2.48 RBRVS 95868 26 NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI Miscellaneous Medical 1.18 0.55 0.55 RBRVS 95868 TC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI Miscellaneous Medical a 1.93 1.93 RBRVS 95869 NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12 Miscellaneous Medical a 0.37 1.90 1.90 RBRVS 95869 26 NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12 Miscellaneous Medical 0.37 0.17 0.17 RBRVS 95869 TC NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12 Miscellaneous Medical a 1.73 1.73 RBRVS 95870 NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI Miscellaneous Medical a 0.37 2.10 2.10 RBRVS 95870 26 NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI Miscellaneous Medical 0.37 0.17 0.17 RBRVS 95870 TC NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI Miscellaneous Medical a 1.93 1.93 RBRVS 95872 NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER Miscellaneous Medical a 2.88 2.56 2.56 RBRVS 95872 26 NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER Miscellaneous Medical 2.88 1.35 1.35 RBRVS 95872 TC NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER Miscellaneous Medical a 1.21 1.21 RBRVS 95873 ELECTRICAL STIMULATION GUID W/CHEMODENERVATION Miscellaneous Medical a 0.37 1.72 1.72 RBRVS 95873 26 ELECTRICAL STIMULATION GUID W/CHEMODENERVATION Miscellaneous Medical 0.37 0.20 0.20 RBRVS 95873 TC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION Miscellaneous Medical a 1.52 1.52 RBRVS 95874 NEEDLE EMG GUID W/CHEMODENERVATION Miscellaneous Medical a 0.37 1.64 1.64 RBRVS 95874 26 NEEDLE EMG GUID W/CHEMODENERVATION Miscellaneous Medical 0.37 0.18 0.18 RBRVS 95874 TC NEEDLE EMG GUID W/CHEMODENERVATION Miscellaneous Medical a 1.46 1.46 RBRVS 95875 ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB Miscellaneous Medical a 1.10 2.25 2.25 RBRVS 95875 26 ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB Miscellaneous Medical 1.10 0.50 0.50 RBRVS 95875 TC ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB Miscellaneous Medical a 1.75 1.75 RBRVS 95885 NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED Miscellaneous Medical a 0.35 1.28 1.28 RBRVS 95885 26 NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED Miscellaneous Medical 0.35 0.17 0.17 RBRVS 95885 TC NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED Miscellaneous Medical a 1.11 1.11 RBRVS 95886 NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE Miscellaneous Medical a 0.86 1.67 1.67 RBRVS 95886 26 NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE Miscellaneous Medical 0.86 0.41 0.41 RBRVS 95886 TC NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE Miscellaneous Medical a 1.26 1.26 RBRVS 95887 NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION Miscellaneous Medical a 0.71 1.55 1.55 RBRVS 95887 26 NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION Miscellaneous Medical 0.71 0.34 0.34 RBRVS 95887 TC NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION Miscellaneous Medical a 1.21 1.21 RBRVS 95905 MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB Miscellaneous Medical a 0.05 1.95 1.95 RBRVS 95905 26 MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB Miscellaneous Medical 0.05 0.02 0.02 RBRVS 95905 TC MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB Miscellaneous Medical a 1.93 1.93 RBRVS 95907 NERVE CONDUCTION STUDIES 1-2 STUDIES Miscellaneous Medical a 1.00 1.69 1.69 RBRVS 95907 26 NERVE CONDUCTION STUDIES 1-2 STUDIES Miscellaneous Medical 1.00 0.47 0.47 RBRVS 95907 TC NERVE CONDUCTION STUDIES 1-2 STUDIES Miscellaneous Medical a 1.22 1.22 RBRVS 95908 NERVE CONDUCTION STUDIES 3-4 STUDIES Miscellaneous Medical a 1.25 2.21 2.21 RBRVS 95908 26 NERVE CONDUCTION STUDIES 3-4 STUDIES Miscellaneous Medical 1.25 0.61 0.61 RBRVS 95908 TC NERVE CONDUCTION STUDIES 3-4 STUDIES Miscellaneous Medical a 1.60 1.60 RBRVS 95909 NERVE CONDUCTION STUDIES 5-6 STUDIES Miscellaneous Medical a 1.50 2.60 2.60 RBRVS 95909 26 NERVE CONDUCTION STUDIES 5-6 STUDIES Miscellaneous Medical 1.50 0.72 0.72 RBRVS 95909 TC NERVE CONDUCTION STUDIES 5-6 STUDIES Miscellaneous Medical a 1.88 1.88 RBRVS 95910 NERVE CONDUCTION STUDIES 7-8 STUDIES Miscellaneous Medical a 2.00 3.44 3.44 RBRVS 95910 26 NERVE CONDUCTION STUDIES 7-8 STUDIES Miscellaneous Medical 2.00 0.96 0.96 RBRVS 95910 TC NERVE CONDUCTION STUDIES 7-8 STUDIES Miscellaneous Medical a 2.48 2.48 RBRVS

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95911 NERVE CONDUCTION STUDIES 9-10 STUDIES Miscellaneous Medical a 2.50 3.97 3.97 RBRVS 95911 26 NERVE CONDUCTION STUDIES 9-10 STUDIES Miscellaneous Medical 2.50 1.19 1.19 RBRVS 95911 TC NERVE CONDUCTION STUDIES 9-10 STUDIES Miscellaneous Medical a 2.78 2.78 RBRVS 95912 NERVE CONDUCTION STUDIES 11-12 STUDIES Miscellaneous Medical a 3.00 4.20 4.20 RBRVS 95912 26 NERVE CONDUCTION STUDIES 11-12 STUDIES Miscellaneous Medical 3.00 1.37 1.37 RBRVS 95912 TC NERVE CONDUCTION STUDIES 11-12 STUDIES Miscellaneous Medical a 2.83 2.83 RBRVS 95913 NERVE CONDUCTION STUDIES 13/> STUDIES Miscellaneous Medical a 3.56 4.60 4.60 RBRVS 95913 26 NERVE CONDUCTION STUDIES 13/> STUDIES Miscellaneous Medical 3.56 1.60 1.60 RBRVS 95913 TC NERVE CONDUCTION STUDIES 13/> STUDIES Miscellaneous Medical a 3.00 3.00 RBRVS 95921 TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP Miscellaneous Medical a 0.90 1.53 1.53 RBRVS 95921 26 TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP Miscellaneous Medical 0.90 0.36 0.36 RBRVS 95921 TC TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP Miscellaneous Medical a 1.17 1.17 RBRVS 95922 TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ Miscellaneous Medical a 0.96 1.83 1.83 RBRVS 95922 26 TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ Miscellaneous Medical 0.96 0.38 0.38 RBRVS 95922 TC TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ Miscellaneous Medical a 1.45 1.45 RBRVS 95923 TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION Miscellaneous Medical a 0.90 4.46 4.46 RBRVS 95923 26 TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION Miscellaneous Medical 0.90 0.37 0.37 RBRVS 95923 TC TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION Miscellaneous Medical a 4.09 4.09 RBRVS 95924 TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT Miscellaneous Medical a 1.73 2.52 2.52 RBRVS 95924 26 TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT Miscellaneous Medical 1.73 0.72 0.72 RBRVS 95924 TC TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT Miscellaneous Medical a 1.80 1.80 RBRVS 95925 SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS Miscellaneous Medical a 0.54 3.84 3.84 RBRVS 95925 26 SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS Miscellaneous Medical 0.54 0.23 0.23 RBRVS 95925 TC SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS Miscellaneous Medical a 3.61 3.61 RBRVS 95926 SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS Miscellaneous Medical a 0.54 3.48 3.48 RBRVS 95926 26 SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS Miscellaneous Medical 0.54 0.21 0.21 RBRVS 95926 TC SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS Miscellaneous Medical a 3.27 3.27 RBRVS 95927 SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD Miscellaneous Medical a 0.54 3.72 3.72 RBRVS 95927 26 SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD Miscellaneous Medical 0.54 0.22 0.22 RBRVS 95927 TC SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD Miscellaneous Medical a 3.50 3.50 RBRVS 95928 CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS Miscellaneous Medical a 1.50 5.71 5.71 RBRVS 95928 26 CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS Miscellaneous Medical 1.50 0.70 0.70 RBRVS 95928 TC CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS Miscellaneous Medical a 5.01 5.01 RBRVS 95929 CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS Miscellaneous Medical a 1.50 5.75 5.75 RBRVS 95929 26 CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS Miscellaneous Medical 1.50 0.70 0.70 RBRVS 95929 TC CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS Miscellaneous Medical a 5.05 5.05 RBRVS 95930 VISUAL EP TSTG CNS CHECKERBOARD/FLASH Miscellaneous Medical a 0.35 3.24 3.24 RBRVS 95930 26 VISUAL EP TSTG CNS CHECKERBOARD/FLASH Miscellaneous Medical 0.35 0.16 0.16 RBRVS 95930 TC VISUAL EP TSTG CNS CHECKERBOARD/FLASH Miscellaneous Medical a 3.08 3.08 RBRVS 95933 ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST Miscellaneous Medical a 0.59 1.74 1.74 RBRVS 95933 26 ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST Miscellaneous Medical 0.59 0.27 0.27 RBRVS 95933 TC ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST Miscellaneous Medical a 1.47 1.47 RBRVS 95937 NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH Miscellaneous Medical a 0.65 1.65 1.65 RBRVS 95937 26 NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH Miscellaneous Medical 0.65 0.30 0.30 RBRVS 95937 TC NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH Miscellaneous Medical a 1.35 1.35 RBRVS 95938 SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB Miscellaneous Medical a 0.86 8.70 8.70 RBRVS 95938 26 SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB Miscellaneous Medical 0.86 0.40 0.40 RBRVS 95938 TC SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB Miscellaneous Medical a 8.30 8.30 RBRVS 95939 CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI Miscellaneous Medical a 2.25 11.73 11.73 RBRVS 95939 26 CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI Miscellaneous Medical 2.25 1.03 1.03 RBRVS 95939 TC CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI Miscellaneous Medical a 10.70 10.70 RBRVS 95940 IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES Miscellaneous Medical 0.60 0.28 0.28 RBRVS 95941 IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR Miscellaneous Medical 1.65 FAIR Health 95943 PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY Miscellaneous Medical 4.17 5% Sample 95950 MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG Miscellaneous Medical a 1.51 7.66 7.66 RBRVS 95950 26 MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG Miscellaneous Medical 1.51 0.68 0.68 RBRVS 95950 TC MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG Miscellaneous Medical a 6.98 6.98 RBRVS 95951 LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO Miscellaneous Medical a 15.63 Global/TC/26 95951 26 LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO Miscellaneous Medical 8.76 Global/TC/26 95951 TC LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO Miscellaneous Medical a 6.87 Global/TC/26 95953 LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG Miscellaneous Medical a 3.08 8.53 8.53 RBRVS 95953 26 LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG Miscellaneous Medical 3.08 1.40 1.40 RBRVS 95953 TC LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG Miscellaneous Medical a 7.13 7.13 RBRVS 95954 RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE Miscellaneous Medical a 2.45 10.33 10.33 RBRVS 95954 26 RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE Miscellaneous Medical 2.45 0.97 0.97 RBRVS 95954 TC RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE Miscellaneous Medical a 9.36 9.36 RBRVS 95955 EEG NONINTRACRANIAL SURGERY Miscellaneous Medical a 1.01 4.95 4.95 RBRVS 95955 26 EEG NONINTRACRANIAL SURGERY Miscellaneous Medical 1.01 0.46 0.46 RBRVS 95955 TC EEG NONINTRACRANIAL SURGERY Miscellaneous Medical a 4.49 4.49 RBRVS 95956 MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR Miscellaneous Medical a 3.61 43.04 43.04 RBRVS 95956 26 MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR Miscellaneous Medical 3.61 1.64 1.64 RBRVS 95956 TC MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR Miscellaneous Medical a 41.40 41.40 RBRVS 95957 DIGITAL ANALYSIS ELECTROENCEPHALOGRAM Miscellaneous Medical a 1.98 6.81 6.81 RBRVS 95957 26 DIGITAL ANALYSIS ELECTROENCEPHALOGRAM Miscellaneous Medical 1.98 0.90 0.90 RBRVS 95957 TC DIGITAL ANALYSIS ELECTROENCEPHALOGRAM Miscellaneous Medical a 5.91 5.91 RBRVS

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95958 WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG Miscellaneous Medical a 4.24 11.87 11.87 RBRVS 95958 26 WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG Miscellaneous Medical 4.24 1.89 1.89 RBRVS 95958 TC WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG Miscellaneous Medical a 9.98 9.98 RBRVS 95961 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR Miscellaneous Medical a 2.97 5.04 5.04 RBRVS 95961 26 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR Miscellaneous Medical 2.97 1.34 1.34 RBRVS 95961 TC FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR Miscellaneous Medical a 3.70 3.70 RBRVS 95962 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR Miscellaneous Medical a 3.21 3.92 3.92 RBRVS 95962 26 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR Miscellaneous Medical 3.21 1.47 1.47 RBRVS 95962 TC FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR Miscellaneous Medical a 2.45 2.45 RBRVS 95965 MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY Miscellaneous Medical a 7.99 50.19 50.20 ERBRVS 95965 26 MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY Miscellaneous Medical 7.99 3.56 3.57 RBRVS 95965 TC MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY Miscellaneous Medical a 46.63 46.63 ERBRVS 95966 MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY Miscellaneous Medical a 3.99 25.33 25.33 ERBRVS 95966 26 MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY Miscellaneous Medical 3.99 1.85 1.85 RBRVS 95966 TC MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY Miscellaneous Medical a 23.48 23.48 ERBRVS 95967 MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL Miscellaneous Medical a 3.49 22.18 22.18 ERBRVS 95967 26 MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL Miscellaneous Medical 3.49 1.62 1.62 RBRVS 95967 TC MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL Miscellaneous Medical a 20.56 20.56 ERBRVS 95970 ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM Miscellaneous Medical 0.45 0.19 1.40 RBRVS 95971 ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG Miscellaneous Medical 0.78 0.31 0.78 RBRVS 95972 ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH W/PRGRMG Miscellaneous Medical 0.80 0.31 0.69 RBRVS 95974 ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR Miscellaneous Medical 3.00 1.37 2.59 RBRVS 95975 ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN Miscellaneous Medical 1.70 0.79 1.31 RBRVS 95978 ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR Miscellaneous Medical 3.50 1.62 3.20 RBRVS 95979 ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN Miscellaneous Medical 1.64 0.76 1.28 RBRVS 95980 ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG Miscellaneous Medical 0.80 0.35 0.35 RBRVS 95981 ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG Miscellaneous Medical 0.30 0.17 0.57 RBRVS 95982 ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG Miscellaneous Medical 0.65 0.31 0.76 RBRVS 95990 REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN Miscellaneous Medical 2.51 2.51 RBRVS 95991 RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP Miscellaneous Medical 0.77 0.30 2.59 RBRVS 95992 CANALITH REPOSITIONING PROCEDURE Miscellaneous Medical 0.75 0.27 0.42 RBRVS 95999 UNLIS NEUROLOGICAL/NEUROMUSCULAR DX PX Miscellaneous Medical 1.06 Unlisted 96000 COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS Miscellaneous Medical 1.80 0.78 0.78 RBRVS 96001 COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG Miscellaneous Medical 2.15 0.56 0.56 RBRVS 96002 DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC Miscellaneous Medical 0.41 0.18 0.18 RBRVS 96003 DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC Miscellaneous Medical 0.37 0.16 0.16 RBRVS 96004 PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR Miscellaneous Medical 2.14 1.02 1.02 RBRVS 96020 26 TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP Miscellaneous Medical 3.43 1.07 1.07 RBRVS 96040 MEDICAL GENETICS COUNSELING EACH 30 MINUTES Miscellaneous Medical 1.30 1.30 RBRVS 96101 PSYCHOLOGICAL TESTING PR HR WITH PATIENT OP Psych./Alc. & Drug Abuse 1.86 0.30 0.32 RBRVS 96102 PSYCHOLOGICAL TESTING ADMN BY TECH PR HR OP Psych./Alc. & Drug Abuse 0.50 0.12 1.26 RBRVS 96103 PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R OP Psych./Alc. & Drug Abuse 0.51 0.21 0.23 RBRVS 96105 ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR OP Psych./Alc. & Drug Abuse 1.75 1.11 1.11 RBRVS 96110 DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM OP Psych./Alc. & Drug Abuse 0.26 0.26 RBRVS 96111 DEVELOPMENTAL TESTING W/INTERP & REPORT OP Psych./Alc. & Drug Abuse 2.60 0.70 0.89 RBRVS 96116 NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ OP Psych./Alc. & Drug Abuse 1.86 0.49 0.66 RBRVS 96118 NUROPSYC TESTING PR HR W/PT & INTERPJ TIME OP Psych./Alc. & Drug Abuse 1.86 0.29 0.82 RBRVS 96119 NEUROPSYC TSTG W/PROF I&R ADMN BY TECH PR HR OP Psych./Alc. & Drug Abuse 0.55 0.10 1.71 RBRVS 96120 NEUROPSYCHOLOG TESTING COMPUTER W/PROF I&R OP Psych./Alc. & Drug Abuse 0.51 0.19 0.81 RBRVS 96125 STANDARDIZED COGNITIVE PERFORMANCE TESTING OP Psych./Alc. & Drug Abuse 1.70 1.51 1.51 RBRVS 96127 BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT OP Psych./Alc. & Drug Abuse a 0.14 0.14 RBRVS 96150 HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT OP Psych./Alc. & Drug Abuse 0.50 0.08 0.09 RBRVS 96151 HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT OP Psych./Alc. & Drug Abuse 0.48 0.07 0.08 RBRVS 96152 HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV OP Psych./Alc. & Drug Abuse 0.46 0.07 0.08 RBRVS 96153 HLTH&BEHAVIOR IVNTJ EA 15 MIN GRP 2/>PTS OP Psych./Alc. & Drug Abuse 0.10 0.01 0.02 RBRVS 96154 HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/PT OP Psych./Alc. & Drug Abuse 0.45 0.07 0.08 RBRVS 96155 HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/O PT OP Psych./Alc. & Drug Abuse 0.44 0.17 0.17 RBRVS 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR Therapeutic Injections 0.17 1.42 1.42 RBRVS 96361 IV INFUSION HYDRATION EACH ADDITIONAL HOUR Therapeutic Injections 0.09 0.33 0.33 RBRVS 96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR Therapeutic Injections 0.21 1.71 1.71 RBRVS 96366 IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR Therapeutic Injections 0.18 0.34 0.34 RBRVS 96367 IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR Therapeutic Injections 0.19 0.65 0.65 RBRVS 96368 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS Therapeutic Injections 0.17 0.40 0.40 RBRVS 96369 SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP Therapeutic Injections 0.21 5.24 5.24 RBRVS 96370 SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR Therapeutic Injections 0.18 0.24 0.24 RBRVS 96371 SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE Therapeutic Injections 2.52 2.52 RBRVS 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM Therapeutic Injections 0.17 0.53 0.53 RBRVS 96373 THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL Therapeutic Injections 0.17 0.37 0.37 RBRVS 96374 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG Therapeutic Injections 0.18 1.39 1.39 RBRVS 96375 THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG Therapeutic Injections 0.10 0.52 0.52 RBRVS 96376 THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC Therapeutic Injections 0.38 FAIR Health 96379 UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS Therapeutic Injections 0.70 Unlisted 96401 CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO Miscellaneous Medical 0.21 1.85 1.85 RBRVS 96402 CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO Miscellaneous Medical 0.19 0.71 0.71 RBRVS 96405 CHEMOTHERAPY ADMINISTRATION INTRALESIONAL

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96406 CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7 Miscellaneous Medical 0.80 0.47 2.50 RBRVS 96409 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG Miscellaneous Medical 0.24 2.81 2.81 RBRVS 96411 CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG Miscellaneous Medical 0.20 1.51 1.51 RBRVS 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG Miscellaneous Medical 0.28 3.45 3.45 RBRVS 96415 CHEMOTHERAPY ADMN IV INFUSION TQ EA HR Miscellaneous Medical 0.19 0.59 0.59 RBRVS 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP Miscellaneous Medical 0.21 3.66 3.66 RBRVS 96417 CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR Miscellaneous Medical 0.21 1.52 1.52 RBRVS 96420 CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ Miscellaneous Medical 0.17 2.69 2.69 RBRVS 96422 CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS 8 HR PRTBLE IMPLTBL PMP Miscellaneous Medical 0.17 4.78 4.78 RBRVS 96440 CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS Miscellaneous Medical 2.37 1.08 21.29 RBRVS 96446 CHEMOTX ADMN PRTL CAVITY PORT/CATH Miscellaneous Medical 0.37 0.18 5.01 RBRVS 96450 CHEMOTX ADMN CNS REQ SPINAL PUNCTURE Miscellaneous Medical 1.53 0.64 3.48 RBRVS 96521 REFILLING & MAINTENANCE PORTABLE PUMP Miscellaneous Medical 0.21 3.60 3.60 RBRVS 96522 REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC Miscellaneous Medical 0.21 2.92 2.92 RBRVS 96523 IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST Miscellaneous Medical 0.04 0.65 0.65 RBRVS 96542 CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT Miscellaneous Medical 0.75 0.39 2.57 RBRVS 96549 UNLISTED CHEMOTHERAPY PROCEDURE Miscellaneous Medical 0.69 Unlisted 96567 PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX Miscellaneous Medical 3.78 3.78 RBRVS 96570 PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN Miscellaneous Medical 1.10 0.34 0.34 RBRVS 96571 PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN Miscellaneous Medical 0.55 0.16 0.16 RBRVS 96900 ACTINOTHERAPY ULTRAVIOLET LIGHT Miscellaneous Medical 0.57 0.57 RBRVS 96902 MCRSCP XM HAIR PLUCK/CLIP FOR CNTS/STRUCT ABNORM Miscellaneous Medical 0.41 0.16 0.18 RBRVS 96904 WHOLE BODY INTEGUMENTARY PHOTOGRAPHY Miscellaneous Medical 1.76 1.76 RBRVS 96910 PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB Miscellaneous Medical 2.00 2.00 RBRVS 96912 PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA Miscellaneous Medical 2.57 2.57 RBRVS 96913 PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION Miscellaneous Medical 3.61 3.61 RBRVS 96920 LASER SKIN DISEASE PSORIASIS TOT AREA <250 SQ CM Miscellaneous Medical 1.15 0.70 3.18 RBRVS 96921 LASER SKIN DISEASE PSORIASIS 250-500 SQ CM Miscellaneous Medical 1.30 0.79 3.48 RBRVS 96922 LASER SKIN DISEASE PSORIASIS >500 SQ CM Miscellaneous Medical 2.10 1.27 4.49 RBRVS 96999 UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PROCED Miscellaneous Medical 2.00 Unlisted 97001 PHYSICAL THERAPY EVALUATION Physical Medicine 1.20 0.87 0.87 RBRVS 97002 PHYSICAL THERAPY RE-EVALUATION Physical Medicine 0.60 0.56 0.56 RBRVS 97003 OCCUPATIONAL THERAPY EVALUATION Physical Medicine 1.20 1.14 1.14 RBRVS 97004 OCCUPATIONAL THERAPY RE-EVALUATION Physical Medicine 0.60 0.86 0.86 RBRVS 97005 ATHLETIC TRAINING EVALUATION Physical Medicine 1.66 FAIR Health 97006 ATHLETIC TRAINING RE-EVALUATION Physical Medicine 0.83 FAIR Health 97010 APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS Physical Medicine 0.06 0.10 0.10 RBRVS 97012 APPL MODALITY 1/> AREAS TRACTION MECHANICAL Physical Medicine 0.25 0.19 0.19 RBRVS 97014 APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED Physical Medicine 0.18 0.26 0.26 RBRVS 97016 APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES Physical Medicine 0.18 0.35 0.35 RBRVS 97018 APPL MODALITY 1/> AREAS PARAFFIN BATH Physical Medicine 0.06 0.24 0.24 RBRVS 97022 APPLICATION MODALITY 1/> AREAS WHIRLPOOL Physical Medicine 0.17 0.48 0.48 RBRVS 97024 APPLICATION MODALITY 1/> AREAS DIATHERMY Physical Medicine 0.06 0.11 0.11 RBRVS 97026 APPLICATION MODALITY 1/> AREAS INFRARED Physical Medicine 0.06 0.10 0.10 RBRVS 97028 APPL MODALITY 1/> AREAS ULTRAVIOLET Physical Medicine 0.08 0.12 0.12 RBRVS 97032 APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN Physical Medicine 0.25 0.28 0.28 RBRVS 97033 APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN Physical Medicine 0.26 0.65 0.65 RBRVS 97034 APPL MODALITY 1/> AREAS CONTRAST BATHS EA 15 MIN Physical Medicine 0.21 0.29 0.29 RBRVS 97035 APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN Physical Medicine 0.21 0.14 0.14 RBRVS 97036 APPL MODALITY 1/> AREAS HUBBARD TANK EA 15 MIN Physical Medicine 0.28 0.64 0.64 RBRVS 97039 UNLIST MODALITY SPEC TYPE&TIME CONSTANT ATTEND Physical Medicine 0.35 Unlisted 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES Physical Medicine 0.45 0.44 0.44 RBRVS 97112 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA Physical Medicine 0.45 0.48 0.48 RBRVS 97113 THER PX 1/> AREAS EACH 15 MIN AQUA THER W/XERSS Physical Medicine 0.44 0.76 0.76 RBRVS 97116 THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR Physical Medicine 0.40 0.39 0.39 RBRVS 97124 THER PX 1/> AREAS EACH 15 MINUTES MASSAGE Physical Medicine 0.35 0.38 0.38 RBRVS 97139 UNLISTED THERAPEUTIC PROCEDURE SPECIFY Physical Medicine 0.89 Unlisted 97140 MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES Physical Medicine 0.43 0.40 0.40 RBRVS 97150 THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS Physical Medicine 0.29 0.19 0.19 RBRVS 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN Physical Medicine 0.44 0.53 0.53 RBRVS 97532 DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES Physical Medicine 0.44 0.30 0.30 RBRVS 97533 SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES Physical Medicine 0.44 0.37 0.37 RBRVS 97535 SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES Physical Medicine 0.45 0.52 0.52 RBRVS 97537 COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN Physical Medicine 0.45 0.39 0.39 RBRVS 97542 WHEELCHAIR MGMT EA 15 MIN Physical Medicine 0.45 0.40 0.40 RBRVS 97545 WORK HARDENING/CONDITIONING 1ST 2 HR Physical Medicine 3.01 FAIR Health 97546 WORK HARDENING/CONDITIONING EACH HOUR Physical Medicine 1.20 FAIR Health 97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/< Miscellaneous Medical 0.51 0.13 1.60 RBRVS 97598 DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM Miscellaneous Medical 0.24 0.06 0.44 RBRVS 97602 RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS Miscellaneous Medical 0.90 FAIR Health 97605 NEGATIVE PRESSURE WOUND THERAPY DME 50 SQ CM Miscellaneous Medical 0.60 0.15 0.75 RBRVS 97610 LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY Physical Medicine 0.35 0.09 3.01 RBRVS

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97750 PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN Physical Medicine 0.45 0.46 0.46 RBRVS 97755 ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN Physical Medicine 0.62 0.37 0.37 RBRVS 97760 ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15 Physical Medicine 0.45 0.60 0.60 RBRVS 97761 PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M Physical Medicine 0.45 0.46 0.46 RBRVS 97762 CHECKOUT ORTHOTIC/PROSTHETIC ESTAB PT EA 15 MIN Physical Medicine 0.25 1.09 1.09 RBRVS 97799 UNLISTED PHYSICAL MEDICINE/REHAB SERVICE/PROC Physical Medicine 0.89 Unlisted 97802 MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI Miscellaneous Medical 0.53 0.37 0.43 RBRVS 97803 MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M Miscellaneous Medical 0.45 0.31 0.38 RBRVS 97804 MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI Miscellaneous Medical 0.25 0.17 0.19 RBRVS 97810 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN Miscellaneous Medical 0.60 0.23 0.39 RBRVS 97811 ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN Miscellaneous Medical 0.50 0.19 0.24 RBRVS 97813 ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN Miscellaneous Medical 0.65 0.25 0.41 RBRVS 97814 ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ Miscellaneous Medical 0.55 0.21 0.29 RBRVS 98925 OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS Physical Medicine 0.46 0.19 0.40 RBRVS 98926 OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS Physical Medicine 0.71 0.27 0.54 RBRVS 98927 OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS Physical Medicine 0.96 0.34 0.67 RBRVS 98928 OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS Physical Medicine 1.21 0.43 0.79 RBRVS 98929 OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS Physical Medicine 1.46 0.51 0.93 RBRVS 98940 CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS Chiropractor 0.46 0.16 0.32 RBRVS 98941 CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS Chiropractor 0.71 0.25 0.42 RBRVS 98942 CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS Chiropractor 0.96 0.33 0.51 RBRVS 98943 CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION Chiropractor 0.46 0.18 0.28 RBRVS 98960 EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT Miscellaneous Medical 0.77 0.77 RBRVS 98961 EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS Miscellaneous Medical 0.37 0.37 RBRVS 98962 EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS Miscellaneous Medical 0.27 0.27 RBRVS 98966 NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN Office/Home/Urgent Care Visits 0.25 0.10 0.13 RBRVS 98967 NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN Office/Home/Urgent Care Visits 0.50 0.19 0.23 RBRVS 98968 NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN Office/Home/Urgent Care Visits 0.75 0.29 0.33 RBRVS 98969 NONPHYSICIAN ONLINE ASSESSMENT AND MANAGEMENT Office/Home/Urgent Care Visits 0.69 FAIR Health 99000 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB Miscellaneous Medical 0.16 FAIR Health 99001 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB Miscellaneous Medical 0.19 FAIR Health 99002 HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP Miscellaneous Medical 0.21 FAIR Health 99024 POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX Miscellaneous Medical 0.69 5% Sample 99026 HOSPITAL MANDATED CALL SERVICE IN-HOSPITAL EA HR Miscellaneous Medical 0.89 v3.16 99027 HOSPITAL MANDATED CALL SVC OUT-OF-HOSPITAL EA HR Miscellaneous Medical 0.19 v3.16 99050 SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS Office/Home/Urgent Care Visits 0.89 FAIR Health 99051 SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS Office/Home/Urgent Care Visits 0.60 5% Sample 99053 SERVICES PROVIDED BTW 10 PM&8 AM AT 24-HR FACI Office/Home/Urgent Care Visits 1.10 5% Sample 99056 SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT Office/Home/Urgent Care Visits 0.85 FAIR Health 99058 SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS Office/Home/Urgent Care Visits 1.06 FAIR Health 99060 SVC PRV EMER OUT OFFICE DISRUPTS OFFICE SVC Office/Home/Urgent Care Visits 1.18 FAIR Health 99070 SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP Miscellaneous Medical 0.35 5% Sample 99071 EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST Miscellaneous Medical 0.10 5% Sample 99075 MEDICAL TESTIMONY Miscellaneous Medical 1.91 v3.16 99078 PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING Miscellaneous Medical 0.42 5% Sample 99080 SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG Miscellaneous Medical 0.35 5% Sample 99082 UNUSUAL TRAVEL Miscellaneous Medical 0.37 5% Sample 99090 ANALYSIS CLINICAL DATA STORED IN COMPUTERS Miscellaneous Medical 0.80 5% Sample 99091 COLLJ&INTERPJ PHYS/QHP PHYSIO COMPUTR DATA 30 MI Miscellaneous Medical 1.10 0.42 0.42 RBRVS 99100 ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/< Miscellaneous Medical 0.94 5% Sample 99116 ANES COMPLICJ UTILIZATION TOTAL BODY HYPOTHERMIA Miscellaneous Medical 3.18 v3.16 99135 ANES COMPLICJ UTILIZATION CONTROLLED HYPOTENSION Miscellaneous Medical 4.76 5% Sample 99140 ANES COMPLICJ EMERGENCY CONDITIONS SPECIFY Miscellaneous Medical 1.72 5% Sample 99143 MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN Miscellaneous Medical 1.32 FAIR Health 99144 MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN Miscellaneous Medical 1.10 FAIR Health 99145 MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN Miscellaneous Medical 0.44 FAIR Health 99148 MOD SEDATJ DIFF PHYS/QHP <5 YRS INIT 30 MIN Miscellaneous Medical 1.21 FAIR Health 99149 MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN Miscellaneous Medical 0.99 FAIR Health 99150 MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN Miscellaneous Medical 0.44 FAIR Health 99170 ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG Miscellaneous Medical 1.75 0.44 2.66 RBRVS 99172 VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM Vision Exams a 1.02 FAIR Health 99172 26 VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM Vision Exams 0.20 FAIR Health 99172 TC VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM Vision Exams a 0.82 FAIR Health 99173 SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT Vision Exams 0.08 0.08 RBRVS 99174 INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT Vision Exams a 0.77 Global/TC/26 99174 26 INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT Vision Exams 0.38 Global/TC/26 99174 TC INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT Vision Exams a 0.39 Global/TC/26 99175 IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED Miscellaneous Medical 0.47 0.47 RBRVS 99183 PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION Miscellaneous Medical 2.11 0.78 0.78 RBRVS 99184 INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE Inpatient Visits 4.50 1.72 1.72 RBRVS 99188 APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP Miscellaneous Medical 0.36 v3.16 99190 ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH EA HR Miscellaneous Medical 10.98 FAIR Health 99191 ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 45 MI Miscellaneous Medical 7.68 FAIR Health 99192 ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 30 MI Miscellaneous Medical 5.49 FAIR Health 99195 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE Miscellaneous Medical 2.77 2.77 RBRVS

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99199 UNLISTED SPECIAL SERVICE PROCEDURE/REPORT Miscellaneous Medical 2.77 Unlisted 99201 OFFICE OUTPATIENT NEW 10 MINUTES Office/Home/Urgent Care Visits 0.48 0.23 0.71 RBRVS 99202 OFFICE OUTPATIENT NEW 20 MINUTES Office/Home/Urgent Care Visits 0.93 0.41 1.10 RBRVS 99203 OFFICE OUTPATIENT NEW 30 MINUTES Office/Home/Urgent Care Visits 1.42 0.60 1.48 RBRVS 99204 OFFICE OUTPATIENT NEW 45 MINUTES Office/Home/Urgent Care Visits 2.43 1.02 1.99 RBRVS 99205 OFFICE OUTPATIENT NEW 60 MINUTES Office/Home/Urgent Care Visits 3.17 1.31 2.37 RBRVS 99211 OFFICE OUTPATIENT VISIT 5 MINUTES Office/Home/Urgent Care Visits 0.18 0.07 0.37 RBRVS 99212 OFFICE OUTPATIENT VISIT 10 MINUTES Office/Home/Urgent Care Visits 0.48 0.20 0.71 RBRVS 99213 OFFICE OUTPATIENT VISIT 15 MINUTES Office/Home/Urgent Care Visits 0.97 0.40 1.01 RBRVS 99214 OFFICE OUTPATIENT VISIT 25 MINUTES Office/Home/Urgent Care Visits 1.50 0.61 1.43 RBRVS 99215 OFFICE OUTPATIENT VISIT 40 MINUTES Office/Home/Urgent Care Visits 2.11 0.87 1.82 RBRVS 99217 OBSERVATION CARE DISCHARGE MANAGEMENT Inpatient Visits 1.28 0.68 0.68 RBRVS 99218 INITIAL OBSERVATION CARE/DAY 30 MINUTES Inpatient Visits 1.92 0.75 0.75 RBRVS 99219 INITIAL OBSERVATION CARE/DAY 50 MINUTES Inpatient Visits 2.60 1.05 1.05 RBRVS 99220 INITIAL OBSERVATION CARE/DAY 70 MINUTES Inpatient Visits 3.56 1.43 1.43 RBRVS 99221 INITIAL HOSPITAL CARE/DAY 30 MINUTES Inpatient Visits 1.92 0.76 0.76 RBRVS 99222 INITIAL HOSPITAL CARE/DAY 50 MINUTES Inpatient Visits 2.61 1.05 1.05 RBRVS 99223 INITIAL HOSPITAL CARE/DAY 70 MINUTES Inpatient Visits 3.86 1.57 1.57 RBRVS 99224 SBSQ OBSERVATION CARE/DAY 15 MINUTES Inpatient Visits 0.76 0.30 0.30 RBRVS 99225 SBSQ OBSERVATION CARE/DAY 25 MINUTES Inpatient Visits 1.39 0.57 0.57 RBRVS 99226 SBSQ OBSERVATION CARE/DAY 35 MINUTES Inpatient Visits 2.00 0.83 0.83 RBRVS 99231 SBSQ HOSPITAL CARE/DAY 15 MINUTES Inpatient Visits 0.76 0.29 0.29 RBRVS 99232 SBSQ HOSPITAL CARE/DAY 25 MINUTES Inpatient Visits 1.39 0.56 0.56 RBRVS 99233 SBSQ HOSPITAL CARE/DAY 35 MINUTES Inpatient Visits 2.00 0.80 0.80 RBRVS 99234 OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES Inpatient Visits 2.56 1.01 1.01 RBRVS 99235 OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES Inpatient Visits 3.24 1.30 1.30 RBRVS 99236 OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES Inpatient Visits 4.20 1.65 1.65 RBRVS 99238 HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/< Inpatient Visits 1.28 0.69 0.69 RBRVS 99239 HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN Inpatient Visits 1.90 1.01 1.01 RBRVS 99241 OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN Consults 0.64 0.24 0.66 RBRVS 99242 OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN Consults 1.34 0.51 1.10 RBRVS 99243 OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN Consults 1.88 0.71 1.46 RBRVS 99244 OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN Consults 3.02 1.14 1.96 RBRVS 99245 OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN Consults 3.77 1.38 2.30 RBRVS 99251 INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN Consults 1.00 0.32 0.32 RBRVS 99252 INITIAL INPATIENT CONSULT NEW/ESTAB PT 40 MIN Consults 1.50 0.52 0.52 RBRVS 99253 INITIAL INPATIENT CONSULT NEW/ESTAB PT 55 MIN Consults 2.27 0.84 0.84 RBRVS 99254 INITIAL INPATIENT CONSULT NEW/ESTAB PT 80 MIN Consults 3.29 1.23 1.23 RBRVS 99255 INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN Consults 4.00 1.44 1.44 RBRVS 99281 EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB Emergency Room Visits 0.45 0.11 0.11 RBRVS 99282 EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY Emergency Room Visits 0.88 0.21 0.21 RBRVS 99283 EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY Emergency Room Visits 1.34 0.29 0.29 RBRVS 99284 EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY Emergency Room Visits 2.56 0.53 0.53 RBRVS 99285 EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ Emergency Room Visits 3.80 0.75 0.75 RBRVS 99288 PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS Emergency Room Visits 1.10 5% Sample 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN Inpatient Visits 4.50 1.43 2.87 RBRVS 99292 CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN Inpatient Visits 2.25 0.72 1.02 RBRVS 99304 INITIAL NURSING FACILITY CARE/DAY 25 MINUTES Inpatient Visits 1.64 0.83 0.83 RBRVS 99305 INITIAL NURSING FACILITY CARE/DAY 35 MINUTES Inpatient Visits 2.35 1.18 1.18 RBRVS 99306 INITIAL NURSING FACILITY CARE/DAY 45 MINUTES Inpatient Visits 3.06 1.44 1.44 RBRVS 99307 SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN Inpatient Visits 0.76 0.45 0.45 RBRVS 99308 SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN Inpatient Visits 1.16 0.71 0.71 RBRVS 99309 SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN Inpatient Visits 1.55 0.92 0.92 RBRVS 99310 SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN Inpatient Visits 2.35 1.31 1.31 RBRVS 99315 NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES Inpatient Visits 1.28 0.70 0.70 RBRVS 99316 NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES Inpatient Visits 1.90 0.95 0.95 RBRVS 99318 E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN Inpatient Visits 1.71 0.89 0.89 RBRVS 99324 DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN Office/Home/Urgent Care Visits 1.01 0.48 0.48 RBRVS 99325 DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN Office/Home/Urgent Care Visits 1.52 0.64 0.64 RBRVS 99326 DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES Office/Home/Urgent Care Visits 2.63 1.12 1.12 RBRVS 99327 DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN Office/Home/Urgent Care Visits 3.46 1.55 1.55 RBRVS 99328 DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES Office/Home/Urgent Care Visits 4.09 1.76 1.76 RBRVS 99334 DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES Office/Home/Urgent Care Visits 1.07 0.56 0.56 RBRVS 99335 DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES Office/Home/Urgent Care Visits 1.72 0.85 0.85 RBRVS 99336 DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES Office/Home/Urgent Care Visits 2.46 1.17 1.17 RBRVS 99337 DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES Office/Home/Urgent Care Visits 3.58 1.62 1.62 RBRVS 99339 INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-29 MIN Office/Home/Urgent Care Visits 1.25 0.86 0.86 RBRVS 99340 INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/> Office/Home/Urgent Care Visits 1.80 1.15 1.15 RBRVS 99341 HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES Office/Home/Urgent Care Visits 1.01 0.47 0.47 RBRVS 99342 HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES Office/Home/Urgent Care Visits 1.52 0.61 0.61 RBRVS 99343 HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES Office/Home/Urgent Care Visits 2.53 0.95 0.95 RBRVS 99344 HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES Office/Home/Urgent Care Visits 3.38 1.52 1.52 RBRVS 99345 HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN Office/Home/Urgent Care Visits 4.09 1.84 1.84 RBRVS 99347 HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES Office/Home/Urgent Care Visits 1.00 0.50 0.50 RBRVS 99348 HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES Office/Home/Urgent Care Visits 1.56 0.70 0.70 RBRVS

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99349 HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES Office/Home/Urgent Care Visits 2.33 1.12 1.12 RBRVS 99350 HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS Office/Home/Urgent Care Visits 3.28 1.49 1.49 RBRVS 99354 PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR Office/Home/Urgent Care Visits 1.77 0.72 0.92 RBRVS 99355 PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30 Office/Home/Urgent Care Visits 1.77 0.63 0.84 RBRVS 99356 PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR Inpatient Visits 1.71 0.77 0.77 RBRVS 99357 PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN Inpatient Visits 1.71 0.75 0.75 RBRVS 99358 PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR Office/Home/Urgent Care Visits 2.10 0.84 0.84 RBRVS 99359 PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES Office/Home/Urgent Care Visits 1.00 0.42 0.42 RBRVS 99360 PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES Miscellaneous Medical 1.20 0.46 0.46 RBRVS 99363 ANTICOAGULANT MGMT OUTPATIENT INIT 90 DAYS Miscellaneous Medical 1.65 0.63 1.84 RBRVS 99364 ANTICOAGULANT MGMT OUTPATIENT EA SBSQ 90 DAYS Miscellaneous Medical 0.63 0.24 0.55 RBRVS 99366 TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN Office/Home/Urgent Care Visits 0.82 0.31 0.34 RBRVS 99367 TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN Office/Home/Urgent Care Visits 1.10 0.42 0.42 RBRVS 99368 TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN Office/Home/Urgent Care Visits 0.72 0.28 0.28 RBRVS 99374 SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES Office/Home/Urgent Care Visits 1.10 0.42 0.80 RBRVS 99375 SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/> Office/Home/Urgent Care Visits 1.73 0.66 1.12 RBRVS 99377 SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN Office/Home/Urgent Care Visits 1.10 0.42 0.80 RBRVS 99378 SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/> Office/Home/Urgent Care Visits 1.73 0.66 1.12 RBRVS 99379 SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN Office/Home/Urgent Care Visits 1.10 0.42 0.80 RBRVS 99380 SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/> Office/Home/Urgent Care Visits 1.73 0.66 1.12 RBRVS 99381 INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR Well Baby Exams 1.50 0.57 1.52 RBRVS 99382 INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS Well Baby Exams 1.60 0.61 1.55 RBRVS 99383 INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS Physical Exams 1.70 0.65 1.58 RBRVS 99384 INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR Physical Exams 2.00 0.77 1.70 RBRVS 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS Physical Exams 1.92 0.73 1.67 RBRVS 99386 INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS Physical Exams 2.33 0.89 1.82 RBRVS 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> Physical Exams 2.50 0.96 2.00 RBRVS 99391 PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y Well Baby Exams 1.37 0.52 1.34 RBRVS 99392 PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS Well Baby Exams 1.50 0.57 1.39 RBRVS 99393 PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS Physical Exams 1.50 0.57 1.38 RBRVS 99394 PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS Physical Exams 1.70 0.65 1.46 RBRVS 99395 PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS Physical Exams 1.75 0.67 1.48 RBRVS 99396 PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS Physical Exams 1.90 0.73 1.54 RBRVS 99397 PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER Physical Exams 2.00 0.77 1.71 RBRVS 99401 PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN Physical Exams 0.48 0.18 0.51 RBRVS 99402 PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN Physical Exams 0.98 0.37 0.70 RBRVS 99403 PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN Physical Exams 1.46 0.56 0.88 RBRVS 99404 PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN Physical Exams 1.95 0.75 1.07 RBRVS 99406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES Miscellaneous Medical 0.24 0.09 0.14 RBRVS 99407 TOBACCO USE CESSATION INTENSIVE >10 MINUTES Miscellaneous Medical 0.50 0.19 0.24 RBRVS 99408 ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN OP Psych./Alc. & Drug Abuse 0.65 0.25 0.30 RBRVS 99409 ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN OP Psych./Alc. & Drug Abuse 1.30 0.50 0.55 RBRVS 99411 PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M Physical Exams 0.15 0.06 0.30 RBRVS 99412 PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M Physical Exams 0.25 0.10 0.34 RBRVS 99415 PROLNG CLINCL STAFF SVC DURING O/P E/M 1ST HR Office/Home/Urgent Care Visits 0.24 0.24 RBRVS 99416 PROLNG CLINCL STAFF SVC DURING O/P E/M EA 30 MIN Office/Home/Urgent Care Visits 0.01 0.01 RBRVS 99420 ADMN & INTERPJ HEALTH RISK ASSESSMENT INSTRUMENT Physical Exams 0.30 0.30 RBRVS 99429 UNLISTED PREVENTIVE MEDICINE SERVICE Physical Exams 1.62 Unlisted 99441 PHYS/QHP TELEPHONE EVALUATION 5-10 MIN Office/Home/Urgent Care Visits 0.25 0.10 0.13 RBRVS 99442 PHYS/QHP TELEPHONE EVALUATION 11-20 MIN Office/Home/Urgent Care Visits 0.50 0.19 0.23 RBRVS 99443 PHYS/QHP TELEPHONE EVALUATION 21-30 MIN Office/Home/Urgent Care Visits 0.75 0.29 0.33 RBRVS 99444 PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE Office/Home/Urgent Care Visits 0.78 FAIR Health 99446 INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10 Office/Home/Urgent Care Visits 0.60 v3.16 99447 INTERPROF PHONE/INTERNET ASSESS/MANAGE 11-20 Office/Home/Urgent Care Visits 1.37 v3.16 99448 INTERPROF PHONE/INTERNET ASSESS/MANAGE 21-30 Office/Home/Urgent Care Visits 2.01 v3.16 99449 INTERPROF PHONE/INTERNET ASSESS/MANAGE 31/> Office/Home/Urgent Care Visits 2.66 v3.16 99450 BASIC LIFE AND/OR DISABILITY EXAMINATION Miscellaneous Medical 1.09 v3.16 99455 WORK RELATED/MED DBLT XM TREATING PHYS Miscellaneous Medical 1.74 5% Sample 99456 WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS Miscellaneous Medical 5.02 v3.16 99460 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB Inpatient Visits 1.92 0.77 0.77 RBRVS 99461 1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER Well Baby Exams 1.26 0.44 1.20 RBRVS 99462 SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN Inpatient Visits 0.84 0.29 0.29 RBRVS 99463 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT Inpatient Visits 2.13 1.10 1.10 RBRVS 99464 ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN Inpatient Visits 1.50 0.51 0.51 RBRVS 99465 DELIVERY/BIRTHING ROOM RESUSCITATION Inpatient Visits 2.93 1.15 1.15 RBRVS 99466 CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN Inpatient Visits 4.79 1.83 1.83 RBRVS 99467 CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN Inpatient Visits 2.40 0.92 0.92 RBRVS 99468 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/< Inpatient Visits 18.46 6.30 6.30 RBRVS 99469 SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/< Inpatient Visits 7.99 2.74 2.74 RBRVS 99471 INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS Inpatient Visits 15.98 7.13 7.13 RBRVS 99472 SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO Inpatient Visits 7.99 2.94 2.94 RBRVS 99475 INITIAL PED CRITICAL CARE 2 THRU 5 YEARS Inpatient Visits 11.25 4.18 4.18 RBRVS 99476 SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS Inpatient Visits 6.75 2.55 2.55 RBRVS 99477 INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL Inpatient Visits 7.00 2.68 2.68 RBRVS 99478 SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS Inpatient Visits 2.75 1.05 1.05 RBRVS

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99479 SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS Inpatient Visits 2.50 0.86 0.86 RBRVS 99480 SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS Inpatient Visits 2.40 0.82 0.82 RBRVS 99485 SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN Inpatient Visits 1.50 0.57 0.57 RBRVS 99486 SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN Inpatient Visits 1.30 0.50 0.50 RBRVS 99487 CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MO Inpatient Visits 2.24 FAIR Health 99489 CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH Inpatient Visits 0.71 5% Sample 99490 CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH Inpatient Visits 0.61 0.26 0.54 RBRVS 99495 TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE Inpatient Visits 2.11 0.88 2.38 RBRVS 99496 TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE Inpatient Visits 3.05 1.27 3.26 RBRVS 99497 ADVANCE CARE PLANNING FIRST 30 MINS Miscellaneous Medical 1.50 0.62 0.80 RBRVS 99498 ADVANCE CARE PLANNING EA ADDL 30 MINS Miscellaneous Medical 1.40 0.58 0.59 RBRVS 99499 UNLISTED EVALUATION AND MANAGEMENT SERVICE Office/Home/Urgent Care Visits 1.96 Unlisted 99500 HOME VISIT PRENATAL MONITORING & ASSESSMENT Miscellaneous Medical 1.66 v3.16 99501 HOME VISIT POSTNATAL ASSMT&F-UP CARE Miscellaneous Medical 1.21 v3.16 99502 HOME VISIT NEWBORN CARE & ASSESSMENT Miscellaneous Medical 1.21 v3.16 99503 HOME VISIT RESPIRATORY THERAPY CARE Miscellaneous Medical 1.02 v3.16 99504 HOME VISIT MECHANICAL VENTILATION CARE Miscellaneous Medical 0.52 v3.16 99505 HOME VISIT STOMA CARE&MAINT CLST&CSTOST Miscellaneous Medical 0.73 v3.16 99506 HOME VISIT INTRAMUSCULAR INJECTIONS Miscellaneous Medical 1.18 v3.16 99507 HOME VISIT CARE&MAINT CATH Miscellaneous Medical 0.88 v3.16 99509 HOME VISIT ASSISTANCE DAILY LIV&PRSONAL CARE Miscellaneous Medical 0.27 v3.16 99510 HOME VISIT INDIV FAM/MARRIAGE COUNSELING Miscellaneous Medical 1.27 v3.16 99511 HOME VISIT FECAL IMPACTION MGMT&ENEMA ADMN Miscellaneous Medical 0.99 v3.16 99512 HOME VISIT HEMODIALYSIS Miscellaneous Medical 5.35 v3.16 99600 UNLISTED HOME VISIT SERVICE/PROCEDURE Miscellaneous Medical 0.27 Unlisted 99601 HOME NFS/SPECTY DRUG ADMN PR VST CHEST RADIOGRAPH CONCURRENT W/INTERPRETATION Radiology 0.22 5% Sample 0191T ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT Surgery 24.14 5% Sample 0198T MEAS OCULAR BLOOD FLOW REPEAT IO PRES SAMP W/I&R Radiology 0.86 5% Sample 0201T PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS Radiology 21.00 5% Sample 0206T CPTR DBS ALYS MLT CYCLS CAR ELEC DTA 2/> ECG LDS Miscellaneous Medical a 3.24 v3.16 0213T NJX DX/THER PARAVER FCT JT W/US CER/THOR 1 LVL Surgery 2.80 5% Sample 0214T NJX DX/THER PARAVER FCT JT W/US CER/THOR 2ND LVL Surgery 1.68 5% Sample 0216T NJX DX/THER PARAVER FCT JT W/US LUMB/SAC 1 LVL Surgery 3.57 v3.16 0217T NJX DX/THER PARAVER FCT JT W/US LUMB/SAC LVL 2 Surgery 2.66 v3.16 0228T NJX ANES/STEROID TFRML EDRL W/US CER/THOR 1 LVL Surgery 7.09 v3.16 0229T NJX ANES/STERD TFRML EDRL W/US CER/THOR EA ADDL Surgery 3.53 v3.16 0230T NJX ANES/STEROID TFRML EDRL W/US LUM/SAC 1 LVL Surgery 6.90 v3.16 0231T NJX ANES/STEROID TFRML EDRL W/US LUM/SAC EA ADDL Surgery 3.48 v3.16 0232T NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION Miscellaneous Medical 9.03 5% Sample 0234T TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA Surgery 5.53 2.54 2.54 v3.16 0235T TRLUML PERIPHERAL ATHERECTOMY VISCERAL ARTERY EA Surgery 5.53 2.54 2.54 v3.16 0236T TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA Surgery 7.60 3.18 3.18 v3.16 0237T TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL Surgery 10.42 4.80 4.80 v3.16 0238T TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA Surgery 11.08 5% Sample 0275T PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR Surgery 43.13 5% Sample 0281T PERC TRANSCTH CLOSR LT ATRIAL APPNDGE IMPLNT S&I Surgery 39.21 5% Sample 0290T CORNEA INCISNS RECIPIENT CORNEA W/LASR KERTPLSTY Surgery 3.36 5% Sample

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0291T INTRAV OPTCL CHERNCE TMGRPHY W/S&I INTL VESL Miscellaneous Medical 6.73 5% Sample 0295T EXT ECG > 48HR TO 21 DAY RCRD SCAN ANLYS REP R&I Cardiovascular 3.59 5% Sample 0296T EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD Cardiovascular 0.85 5% Sample 0297T EXT ECG > 48HR TO 21 DAY SCAN ANALYSIS W/REPORT Cardiovascular 1.97 5% Sample 0298T EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN Cardiovascular 1.05 5% Sample 0330T TEAR FILM IMAGING UNILATERAL OR BILATERAL W/I&R Miscellaneous Medical 1.64 v3.16 0331T MYOCRD SYMPATHETIC INNERVAJ IMG PLNR QUAL&QUANT Radiology 3.78 v3.16 0332T MYOCRD SYMP INNERVAJ IMG PLNR QUAL&QUANT W/SPECT Radiology 5.25 v3.16 0333T VISUAL EVOKED POTENTIAL ACUITY SCREENING AUTO Miscellaneous Medical 3.72 v3.16 0375T TOTAL DISC ARTHRP ANT APPR W/DISCECTOMY CRV 3+ Surgery 10.08 4.20 4.20 v3.16 0387T TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR Surgery 160.64 Other 0388T TRANSCATH REMOVAL LEADLESS PM VENTRICULAR Surgery 66.58 Other 0389T PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM Cardiovascular 1.10 Other 0391T INTERROG DEVICE EVAL IN PERSON LEADLESS PM SYST Cardiovascular 1.10 Other 0392T LAPS ESOPHGL SPHINCTER AUGMENT PROC PLACE DEVICE Surgery 125.39 Other 0393T ESOPHGL SPHINCTER AUGMENT DEVICE REMOVAL Surgery 84.07 Other 0394T HDR ELECTRONIC BRACHYTHERAPY SKIN SURFACE Radiology 21.54 Other 0395T HDR ELECTRONIC BRACHYTHERAPY NTRSTL/INTRCAV Radiology 21.54 Other C8908 MRI W/O FOL W/CONT, BREAST, Radiology 16.38 v3.16 C9734 U/S TRTMT, NOT LEIOMYOMATA Miscellaneous Medical 133.08 v3.16 G0008 ADMIN INFLUENZA VIRUS VAC Immunizations 0.60 FAIR Health G0009 ADMIN PNEUMOCOCCAL VACCINE Immunizations 0.54 FAIR Health G0010 ADMIN HEPATITIS B VACCINE Immunizations 0.54 FAIR Health G0101 CA SCREEN;PELVIC/BREAST EXAM Physical Exams 0.45 0.29 0.58 RBRVS G0102 PROSTATE CA SCREENING; DRE Physical Exams 0.17 0.07 0.37 RBRVS G0104 CA SCREEN;FLEXI SIGMOIDSCOPE Surgery 0.96 0.72 2.80 RBRVS G0105 COLORECTAL SCRN; HI RISK IND Surgery 3.69 1.94 6.81 RBRVS G0106 COLON CA SCREEN;BARIUM ENEMA Radiology a 0.99 4.89 4.89 RBRVS G0106 26 COLON CA SCREEN;BARIUM ENEMA Radiology 0.99 0.37 0.37 RBRVS G0106 TC COLON CA SCREEN;BARIUM ENEMA Radiology a 4.52 4.52 RBRVS G0108 DIAB MANAGE TRN PER INDIV Miscellaneous Medical 0.90 0.55 0.55 RBRVS G0109 DIAB MANAGE TRN IND/GROUP Miscellaneous Medical 0.25 0.14 0.14 RBRVS G0117 GLAUCOMA SCRN HGH RISK DIREC Miscellaneous Medical 0.45 1.06 1.06 RBRVS G0118 GLAUCOMA SCRN HGH RISK DIREC Miscellaneous Medical 0.17 1.09 1.09 RBRVS G0120 COLON CA SCRN; BARIUM ENEMA Radiology a 0.99 4.89 4.89 RBRVS G0120 26 COLON CA SCRN; BARIUM ENEMA Radiology 0.99 0.37 0.37 RBRVS G0120 TC COLON CA SCRN; BARIUM ENEMA Radiology a 4.52 4.52 RBRVS G0121 COLON CA SCRN NOT HI RSK IND Surgery 3.69 1.94 6.81 RBRVS G0122 COLON CA SCRN; BARIUM ENEMA Radiology 0.99 6.47 6.47 RBRVS G0122 26 COLON CA SCRN; BARIUM ENEMA Radiology 0.99 0.38 0.38 RBRVS G0122 TC COLON CA SCRN; BARIUM ENEMA Radiology 6.09 6.09 RBRVS G0124 SCREEN C/V THIN LAYER BY MD Pathology 0.42 0.47 0.47 RBRVS G0127 TRIM NAIL(S) Surgery 0.17 0.04 0.47 RBRVS G0128 CORF SKILLED NURSING SERVICE Miscellaneous Medical a 0.21 0.21 RBRVS G0130 SINGLE ENERGY X-RAY STUDY Radiology a 0.22 0.73 0.73 RBRVS G0130 26 SINGLE ENERGY X-RAY STUDY Radiology 0.22 0.09 0.09 RBRVS G0130 TC SINGLE ENERGY X-RAY STUDY Radiology a 0.64 0.64 RBRVS G0141 SCR C/V CYTO,AUTOSYS AND MD Pathology 0.42 0.47 0.47 RBRVS G0151 HHCP-SERV OF PT,EA 15 MIN Miscellaneous Medical 0.17 v3.16 G0152 HHCP-SERV OF OT,EA 15 MIN Miscellaneous Medical 0.28 v3.16 G0153 HHCP-SVS OF S/L PATH,EA 15MN Miscellaneous Medical 0.24 v3.16 G0155 HHCP-SVS OF CSW,EA 15 MIN Miscellaneous Medical 0.77 v3.16 G0156 HHCP-SVS OF AIDE,EA 15 MIN Miscellaneous Medical 0.18 v3.16 G0157 HHC PT ASSISTANT EA 15 Miscellaneous Medical 0.17 v3.16 G0158 HHC OT ASSISTANT EA 15 Miscellaneous Medical 0.28 v3.16 G0159 HHC PT MAINT EA 15 MIN Miscellaneous Medical 0.17 v3.16 G0160 HHC OCCUP THERAPY EA 15 Miscellaneous Medical 0.28 v3.16 G0161 HHC SLP EA 15 MIN Miscellaneous Medical 0.24 v3.16 G0162 HHC RN E&M PLAN SVS, 15 MIN Miscellaneous Medical 0.33 v3.16 G0163 HHC LPN/RN OBS/ASSES EA 15 Miscellaneous Medical 0.33 v3.16 G0164 HHC LIS NURSE TRAIN EA 15 Miscellaneous Medical 0.33 v3.16 G0166 EXTRNL COUNTERPULSE, PER TX Miscellaneous Medical 0.07 3.76 3.76 RBRVS G0168 WOUND CLOSURE BY ADHESIVE Surgery 0.45 0.29 2.39 RBRVS G0175 OPPS SERVICE,SCHED TEAM CONF Miscellaneous Medical 0.17 v3.16 G0176 OPPS/PHP;ACTIVITY THERAPY OP Psych./Alc. & Drug Abuse 2.15 5% Sample G0177 OPPS/PHP; TRAIN & EDUC SERV OP Psych./Alc. & Drug Abuse 0.88 5% Sample G0179 MD RECERTIFICATION HHA PT Office/Home/Urgent Care Visits 0.45 0.68 0.68 RBRVS G0180 MD CERTIFICATION HHA PATIENT Office/Home/Urgent Care Visits 0.67 0.79 0.79 RBRVS G0181 HOME HEALTH CARE SUPERVISION Office/Home/Urgent Care Visits 1.73 1.19 1.19 RBRVS G0182 HOSPICE CARE SUPERVISION Office/Home/Urgent Care Visits 1.73 1.22 1.22 RBRVS G0186 DSTRY EYE LESN,FDR VSSL TECH Miscellaneous Medical 9.21 v3.16 G0202 SCREENINGMAMMOGRAPHYDIGITAL Radiology 0.70 3.02 3.02 RBRVS G0202 26 SCREENINGMAMMOGRAPHYDIGITAL Radiology 0.70 0.25 0.25 RBRVS G0202 TC SCREENINGMAMMOGRAPHYDIGITAL Radiology 2.77 2.77 RBRVS G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL Radiology a 0.87 3.66 3.66 RBRVS

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G0204 26 DIAGNOSTICMAMMOGRAPHYDIGITAL Radiology 0.87 0.32 0.32 RBRVS G0204 TC DIAGNOSTICMAMMOGRAPHYDIGITAL Radiology a 3.34 3.34 RBRVS G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL Radiology a 0.70 2.87 2.87 RBRVS G0206 26 DIAGNOSTICMAMMOGRAPHYDIGITAL Radiology 0.70 0.25 0.25 RBRVS G0206 TC DIAGNOSTICMAMMOGRAPHYDIGITAL Radiology a 2.62 2.62 RBRVS G0219 PET IMG WHOLBOD MELANO NONCO Radiology a 28.08 v3.16 G0219 26 PET IMG WHOLBOD MELANO NONCO Radiology 1.96 v3.16 G0219 TC PET IMG WHOLBOD MELANO NONCO Radiology a 26.12 v3.16 G0235 PET NOT OTHERWISE SPECIFIED Radiology a 28.08 Unlisted G0235 26 PET NOT OTHERWISE SPECIFIED Radiology 1.96 Unlisted G0235 TC PET NOT OTHERWISE SPECIFIED Radiology a 26.12 Unlisted G0237 THERAPEUTIC PROCD STRG ENDUR Miscellaneous Medical 0.28 0.28 RBRVS G0238 OTH RESP PROC, INDIV Miscellaneous Medical 0.29 0.29 RBRVS G0239 OTH RESP PROC, GROUP Miscellaneous Medical 0.36 0.36 RBRVS G0245 INITIAL FOOT EXAM PT LOPS Office/Home/Urgent Care Visits 0.88 0.28 0.92 RBRVS G0246 FOLLOWUP EVAL OF FOOT PT LOP Office/Home/Urgent Care Visits 0.45 0.13 0.60 RBRVS G0247 ROUTINE FOOTCARE PT W LOPS Office/Home/Urgent Care Visits 0.50 0.13 1.52 RBRVS G0248 DEMONSTRATE USE HOME INR MON Miscellaneous Medical a 3.12 3.12 RBRVS G0249 PROVIDE INR TEST MATER/EQUIP Miscellaneous Medical a 3.12 3.12 RBRVS G0250 MD INR TEST REVIE INTER MGMT Cardiovascular 0.18 0.07 0.07 RBRVS G0252 PET IMAGING INITIAL DX Radiology 1.50 0.57 0.57 ERBRVS G0252 26 PET IMAGING INITIAL DX Radiology 1.50 0.57 0.57 RBRVS G0255 CURRENT PERCEP THRESHOLD TST Miscellaneous Medical 1.14 v3.16 G0255 26 CURRENT PERCEP THRESHOLD TST Miscellaneous Medical 0.34 v3.16 G0255 TC CURRENT PERCEP THRESHOLD TST Miscellaneous Medical 0.80 v3.16 G0257 UNSCHED DIALYSIS ESRD PT HOS Miscellaneous Medical 7.20 v3.16 G0259 INJECT FOR SACROILIAC JOINT Surgery 4.77 v3.16 G0260 INJ FOR SACROILIAC JT ANESTH Surgery 16.80 5% Sample G0268 REMOVAL OF IMPACTED WAX MD Miscellaneous Medical 0.61 0.27 0.81 RBRVS G0269 OCCLUSIVE DEVICE IN VEIN ART Surgery 2.80 5% Sample G0270 MNT SUBS TX FOR CHANGE DX Miscellaneous Medical 0.45 0.31 0.38 RBRVS G0271 GROUP MNT 2 OR MORE 30 MINS Miscellaneous Medical 0.25 0.17 0.19 RBRVS G0276 PILD/PLACEBO CONTROL CLIN TR Miscellaneous Medical 7.17 3.03 3.03 RBRVS G0277 HBOT, FULL BODY CHAMBER, 30M Miscellaneous Medical a 1.30 1.30 RBRVS G0278 ILIAC ART ANGIO,CARDIAC CATH Radiology 0.25 0.09 0.09 RBRVS G0279 TOMOSYNTHESIS, MAMMO Radiology 0.60 0.93 0.93 RBRVS G0279 26 TOMOSYNTHESIS, MAMMO Radiology 0.60 0.22 0.22 RBRVS G0279 TC TOMOSYNTHESIS, MAMMO Radiology 0.71 0.71 RBRVS G0281 ELEC STIM UNATTEND FOR PRESS Physical Medicine 0.18 0.20 0.20 RBRVS G0282 ELECT STIM WOUND CARE NOT PD Physical Medicine 0.41 v3.16 G0283 ELEC STIM OTHER THAN WOUND Physical Medicine 0.18 0.20 0.20 RBRVS G0288 RECON, CTA FOR SURG PLAN Radiology a 0.91 0.91 RBRVS G0289 ARTHRO, LOOSE BODY + CHONDRO Surgery 1.48 0.75 0.75 RBRVS G0293 NON-COV SURG PROC,CLIN TRIAL Miscellaneous Medical 0.24 v3.16 G0295 ELECTROMAGNETIC THERAPY ONC Physical Medicine 0.43 v3.16 G0296 VISIT TO DETERM LDCT ELIG Radiology 1.02 0.45 0.45 RBRVS G0297 LDCT FOR LUNG CA SCREEN Surgery a 0.52 5.10 5.10 RBRVS G0297 26 LOW-DOSE COMPUTER TOMOGRAPHY Surgery 0.52 0.20 0.20 RBRVS G0297 TC LOW-DOSE COMPUTER TOMOGRAPHY Surgery a 4.90 4.90 RBRVS G0299 HHS/HOSPICE OF RN EA 15 MIN Surgery 0.26 Other G0300 HHS/HOSPICE OF LPN EA 15 MIN Surgery 0.26 Other G0329 ELECTROMAGNTIC TX FOR ULCERS Physical Medicine 0.06 0.21 0.21 RBRVS G0337 HOSPICE EVALUATION PREELECTI Office/Home/Urgent Care Visits 1.42 0.54 0.54 RBRVS G0339 ROBOT LIN-RADSURG COM, FIRST Surgery 112.02 5% Sample G0340 ROBT LIN-RADSURG FRACTX 2-5 Surgery 63.01 5% Sample G0341 PERCUTANEOUS ISLET CELLTRANS Surgery 6.98 3.12 58.83 RBRVS G0342 LAPAROSCOPY ISLET CELL TRANS Surgery 11.92 6.60 6.60 RBRVS G0343 LAPAROTOMY ISLET CELL TRANSP Surgery 19.85 11.08 11.08 RBRVS G0364 BONE MARROW ASPIRATE &BIOPSY Surgery 0.16 0.08 0.18 RBRVS G0365 VESSEL MAPPING HEMO ACCESS Miscellaneous Medical a 0.25 5.31 5.31 RBRVS G0365 26 VESSEL MAPPING HEMO ACCESS Miscellaneous Medical 0.25 0.07 0.07 RBRVS G0365 TC VESSEL MAPPING HEMO ACCESS Miscellaneous Medical a 5.24 5.24 RBRVS G0372 MD SERVICE REQUIRED FOR PMD Miscellaneous Medical 0.17 0.07 0.07 RBRVS G0378 HOSPITAL OBSERVATION PER HR Inpatient Visits 0.56 v3.16 G0382 LEV 3 HOSP TYPE B ED VISIT Emergency Room Visits 0.70 v3.16 G0389 ULTRASOUND EXAM AAA SCREEN Radiology a 0.58 2.64 2.64 RBRVS G0389 26 ULTRASOUND EXAM AAA SCREEN Radiology 0.58 0.21 0.21 RBRVS G0389 TC ULTRASOUND EXAM AAA SCREEN Radiology a 2.43 2.43 RBRVS G0396 ALCOHOL/SUBS INTERV 15-30MN OP Psych./Alc. & Drug Abuse 0.65 0.27 0.33 RBRVS G0397 ALCOHOL/SUBS INTERV >30 MIN OP Psych./Alc. & Drug Abuse 1.30 0.53 0.59 RBRVS G0398 HOME SLEEP TEST/TYPE 2 PORTA Miscellaneous Medical a 4.17 Global/TC/26 G0398 26 HOME SLEEP TEST/TYPE 2 PORTA Miscellaneous Medical 1.25 Global/TC/26 G0398 TC HOME SLEEP TEST/TYPE 2 PORTA Miscellaneous Medical a 2.91 Global/TC/26 G0399 HOME SLEEP TEST/TYPE 3 PORTA Miscellaneous Medical a 3.47 Global/TC/26 G0399 26 HOME SLEEP TEST/TYPE 3 PORTA Miscellaneous Medical 1.04 Global/TC/26

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G0399 TC HOME SLEEP TEST/TYPE 3 PORTA Miscellaneous Medical a 2.43 Global/TC/26 G0400 HOME SLEEP TEST/TYPE 4 PORTA Miscellaneous Medical a 2.78 Global/TC/26 G0400 26 HOME SLEEP TEST/TYPE 4 PORTA Miscellaneous Medical 0.84 Global/TC/26 G0400 TC HOME SLEEP TEST/TYPE 4 PORTA Miscellaneous Medical a 1.94 Global/TC/26 G0402 INITIAL PREVENTIVE EXAM Physical Exams 2.43 1.01 2.11 RBRVS G0403 EKG FOR INITIAL PREVENT EXAM Physical Exams 0.17 0.29 0.29 RBRVS G0404 EKG TRACING FOR INITIAL PREV Physical Exams a 0.23 0.23 RBRVS G0405 EKG INTERPRET & REPORT PREVE Physical Exams 0.17 0.06 0.06 RBRVS G0406 INPT/TELE FOLLOW UP 15 Consults 0.76 0.29 0.29 RBRVS G0407 INPT/TELE FOLLOW UP 25 Consults 1.39 0.56 0.56 RBRVS G0408 INPT/TELE FOLLOW UP 35 Consults 2.00 0.80 0.80 RBRVS G0409 CORF RELATED SERV 15 MINS EA OP Psych./Alc. & Drug Abuse 0.30 0.30 RBRVS G0410 GRP PSYCH PARTIAL HOSP 45-50 OP Psych./Alc. & Drug Abuse 1.13 5% Sample G0412 OPEN TX ILIAC SPINE UNI/BIL Surgery 10.45 8.37 8.37 RBRVS G0413 PELVIC RING FRACTURE UNI/BIL Surgery 15.73 11.86 11.86 RBRVS G0414 PELVIC RING FX TREAT INT FIX Surgery 14.65 10.88 10.88 RBRVS G0415 OPEN TX POST PELVIC FXCTURE Surgery 20.93 14.38 14.38 RBRVS G0416 PROSTATE BIOPSY ANY METH Pathology a 3.09 14.92 14.92 RBRVS G0416 26 PROSTATE BIOPSY, ANY MTHD Pathology 3.09 1.95 1.95 RBRVS G0416 TC PROSTATE BIOPSY, ANY MTHD Pathology a 12.97 12.97 RBRVS G0420 ED SVC CKD IND PER SESSION Miscellaneous Medical 2.12 0.80 0.80 RBRVS G0421 ED SVC CKD GRP PER SESSION Miscellaneous Medical 0.50 0.18 0.18 RBRVS G0422 INTENS CARDIAC REHAB W/EXERC Cardiovascular 1.56 1.25 1.25 RBRVS G0423 INTENS CARDIAC REHAB NO EXER Cardiovascular 1.56 1.25 1.25 RBRVS G0424 PULMONARY REHAB W EXER Miscellaneous Medical 0.28 0.09 0.55 RBRVS G0425 INPT/ED TELECONSULT30 Consults 1.92 0.76 0.76 RBRVS G0426 INPT/ED TELECONSULT50 Consults 2.61 1.05 1.05 RBRVS G0427 INPT/ED TELECONSULT70 Consults 3.86 1.57 1.57 RBRVS G0429 DERMAL FILLER INJECTION(S) Miscellaneous Medical 1.19 0.70 1.47 RBRVS G0436 TOBACCO-USE COUNSEL 3-10 MIN Miscellaneous Medical 0.24 0.09 0.15 RBRVS G0437 TOBACCO-USE COUNSEL>10MIN Miscellaneous Medical 0.50 0.20 0.26 RBRVS G0438 PPPS, INITIAL VISIT Office/Home/Urgent Care Visits 2.43 2.26 2.26 RBRVS G0439 PPPS, SUBSEQ VISIT Office/Home/Urgent Care Visits 1.50 1.68 1.68 RBRVS G0442 ANNUAL ALCOHOL SCREEN 15 MIN OP Psych./Alc. & Drug Abuse 0.18 0.08 0.32 RBRVS G0443 BRIEF ALCOHOL MISUSE COUNSEL OP Psych./Alc. & Drug Abuse 0.45 0.19 0.25 RBRVS G0444 DEPRESSION SCREEN ANNUAL OP Psych./Alc. & Drug Abuse 0.18 0.08 0.32 RBRVS G0445 HIGH INTEN BEH COUNS STD 30M OP Psych./Alc. & Drug Abuse 0.45 0.18 0.27 RBRVS G0446 INTENS BEHAVE THER CARDIO DX OP Psych./Alc. & Drug Abuse 0.45 0.19 0.25 RBRVS G0447 BEHAVIOR COUNSEL OBESITY 15M OP Psych./Alc. & Drug Abuse 0.45 0.19 0.25 RBRVS G0451 DEVLOPMENT TEST INTERPT&REP Pathology 0.26 0.26 RBRVS G0452 MOLECULAR PATHOLOGY INTERPR Pathology 0.37 0.14 0.14 Other G0452 26 MOLECULAR PATHOLOGY INTERPR Pathology 0.37 0.14 0.14 RBRVS G0453 CONT INTRAOP NEURO MONITOR Miscellaneous Medical 0.60 0.28 0.28 RBRVS G0454 MD DOCUMENT VISIT BY NPP Miscellaneous Medical 0.18 0.07 0.07 RBRVS G0455 FECAL MICROBIOTA PREP INSTIL Surgery 1.34 0.62 2.17 RBRVS G0459 TELEHEALTH INPT PHARM MGMT Miscellaneous Medical 0.95 0.17 0.17 RBRVS G0460 AUTOLOGOUS PRP FOR ULCERS Miscellaneous Medical 15.54 v3.16 G0464 COLOREC CA SCR, STO BAS DNA Surgery 7.07 FAIR Health G0473 GROUP BEHAVE COUNS 2-10 OP Psych./Alc. & Drug Abuse 0.23 0.09 0.11 RBRVS G6001 ECHO GUIDANCE RADIOTHERAPY Radiology a 0.58 0.83 0.83 RBRVS G6001 26 ECHO GUIDANCE RADIOTHERAPY Radiology 0.58 0.23 0.23 RBRVS G6001 TC ECHO GUIDANCE RADIOTHERAPY Radiology a 0.60 0.60 RBRVS G6002 STEREOSCOPIC X-RAY GUIDANCE Radiology a 0.39 1.68 1.68 RBRVS G6002 26 STEREOSCOPIC X-RAY GUIDANCE Radiology 0.39 0.16 0.16 RBRVS G6002 TC STEREOSCOPIC X-RAY GUIDANCE Radiology a 1.52 1.52 RBRVS G6003 RADIATION TREATMENT DELIVERY Radiology a 4.51 4.51 RBRVS G6004 RADIATION TREATMENT DELIVERY Radiology a 3.49 3.49 RBRVS G6005 RADIATION TREATMENT DELIVERY Radiology a 3.90 3.90 RBRVS G6006 RADIATION TREATMENT DELIVERY Radiology a 3.88 3.88 RBRVS G6007 RADIATION TREATMENT DELIVERY Radiology a 7.18 7.18 RBRVS G6008 RADIATION TREATMENT DELIVERY Radiology a 4.83 4.83 RBRVS G6009 RADIATION TREATMENT DELIVERY Radiology a 5.35 5.35 RBRVS G6010 RADIATION TREATMENT DELIVERY Radiology a 5.35 5.35 RBRVS G6011 RADIATION TREATMENT DELIVERY Radiology a 7.68 7.68 RBRVS G6012 RADIATION TREATMENT DELIVERY Radiology a 6.36 6.36 RBRVS G6013 RADIATION TREATMENT DELIVERY Radiology a 7.16 7.16 RBRVS G6014 RADIATION TREATMENT DELIVERY Radiology a 7.16 7.16 RBRVS G6015 RADIATION TX DELIVERY IMRT Radiology a 11.15 11.15 RBRVS G6016 DELIVERY COMP IMRT Radiology a 11.15 11.15 RBRVS G6017 INTRAFRACTION TRACK MOTION Radiology 2.18 v3.16 G9148 MEDICAL HOME LEVEL 1 Miscellaneous Medical 0.02 5% Sample G9149 MEDICAL HOME LEVEL II Miscellaneous Medical 0.02 5% Sample G9150 MEDICAL HOME LEVEL III Miscellaneous Medical 0.02 5% Sample G9152 MAPCP DEMO COMMUNITY Miscellaneous Medical 0.05 5% Sample G9153 MAPCP DEMO PHYSICIAN Miscellaneous Medical 0.02 5% Sample

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G9157 TRANSESOPH DOPPL CARDIAC MON Cardiovascular 2.20 0.37 0.37 RBRVS H0001 ALCOHOL AND/OR DRUG ASSESS OP Psych./Alc. & Drug Abuse 1.14 v3.16 H0002 ALCOHOL AND/OR DRUG SCREENIN OP Psych./Alc. & Drug Abuse 2.71 v3.16 H0003 ALCOHOL AND/OR DRUG SCREENIN OP Psych./Alc. & Drug Abuse 0.51 v3.16 H0004 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 0.47 5% Sample H0005 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 0.84 v3.16 H0006 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 0.60 v3.16 H0010 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 2.30 v3.16 H0011 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 7.96 v3.16 H0014 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 5.32 v3.16 H0015 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 3.15 5% Sample H0016 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 1.88 v3.16 H0017 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 3.07 v3.16 H0018 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 4.34 v3.16 H0019 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 2.07 v3.16 H0020 ALCOHOL AND/OR DRUG SERVICES OP Psych./Alc. & Drug Abuse 0.18 5% Sample H0022 ALCOHOL AND/OR DRUG INTERVEN OP Psych./Alc. & Drug Abuse 0.66 v3.16 H0024 ALCOHOL AND/OR DRUG PREVENTI OP Psych./Alc. & Drug Abuse 0.15 v3.16 H0025 ALCOHOL AND/OR DRUG PREVENTI OP Psych./Alc. & Drug Abuse 0.11 v3.16 H0031 MH HEALTH ASSESS BY NON-MD OP Psych./Alc. & Drug Abuse 1.33 v3.16 H0032 MH SVC PLAN DEV BY NON-MD OP Psych./Alc. & Drug Abuse 0.49 v3.16 H0033 ORAL MED ADM DIRECT OBSERVE OP Psych./Alc. & Drug Abuse 2.18 v3.16 H0034 MED TRNG & SUPPORT PER 15MIN OP Psych./Alc. & Drug Abuse 0.93 v3.16 H0035 MH PARTIAL HOSP TX UNDER 24H OP Psych./Alc. & Drug Abuse 2.52 5% Sample H0036 COMM PSY FACE-FACE PER 15MIN OP Psych./Alc. & Drug Abuse 0.19 v3.16 H0037 COMM PSY SUP TX PGM PER DIEM OP Psych./Alc. & Drug Abuse 2.21 v3.16 H0038 SELF-HELP/PEER SVC PER 15MIN OP Psych./Alc. & Drug Abuse 0.16 5% Sample H0039 ASSER COM TX FACE-FACE/15MIN OP Psych./Alc. & Drug Abuse 0.79 v3.16 H0040 ASSERT COMM TX PGM PER DIEM OP Psych./Alc. & Drug Abuse 1.35 v3.16 H0041 FOS C CHLD NON-THER PER DIEM OP Psych./Alc. & Drug Abuse 1.54 v3.16 H0043 SUPPORTED HOUSING, PER DIEM OP Psych./Alc. & Drug Abuse 0.56 v3.16 H0044 SUPPORTED HOUSING, PER MONTH OP Psych./Alc. & Drug Abuse 9.57 v3.16 H0045 RESPITE NOT-IN-HOME PER DIEM OP Psych./Alc. & Drug Abuse 2.29 v3.16 H0046 MENTAL HEALTH SERVICE, NOS OP Psych./Alc. & Drug Abuse 0.01 5% Sample H0047 ALCOHOL/DRUG ABUSE SVC NOS OP Psych./Alc. & Drug Abuse 0.90 v3.16 H0048 SPEC COLL NON-BLOOD:A/D TEST OP Psych./Alc. & Drug Abuse 0.17 v3.16 H0050 ALCOHOL/DRUG SERVICE 15 MIN OP Psych./Alc. & Drug Abuse 0.67 v3.16 H1000 PRENATAL CARE ATRISK ASSESSM OP Psych./Alc. & Drug Abuse 1.06 v3.16 H1001 ANTEPARTUM MANAGEMENT OP Psych./Alc. & Drug Abuse 2.30 v3.16 H1002 CARECOORDINATION PRENATAL OP Psych./Alc. & Drug Abuse 0.53 v3.16 H1003 PRENATAL AT RISK EDUCATION OP Psych./Alc. & Drug Abuse 0.28 v3.16 H1004 FOLLOW UP HOME VISIT/PRENTAL OP Psych./Alc. & Drug Abuse 0.87 v3.16 H1005 PRENATALCARE ENHANCED SRV PK OP Psych./Alc. & Drug Abuse 1.96 v3.16 H2000 COMP MULTIDISIPLN EVALUATION OP Psych./Alc. & Drug Abuse 1.94 v3.16 H2010 COMPREHENSIVE MED SVC 15 MIN OP Psych./Alc. & Drug Abuse 0.79 5% Sample H2011 CRISIS INTERVEN SVC, 15 MIN OP Psych./Alc. & Drug Abuse 1.17 5% Sample H2012 BEHAV HLTH DAY TREAT, PER HR OP Psych./Alc. & Drug Abuse 1.09 v3.16 H2013 PSYCH HLTH FAC SVC, PER DIEM OP Psych./Alc. & Drug Abuse 2.33 v3.16 H2014 SKILLS TRAIN AND DEV, 15 MIN OP Psych./Alc. & Drug Abuse 1.54 v3.16 H2015 COMP COMM SUPP SVC, 15 MIN OP Psych./Alc. & Drug Abuse 0.25 5% Sample H2017 PSYSOC REHAB SVC, PER 15 MIN OP Psych./Alc. & Drug Abuse 0.31 v3.16 H2018 PSYSOC REHAB SVC, PER DIEM OP Psych./Alc. & Drug Abuse 1.76 v3.16 H2019 THER BEHAV SVC, PER 15 MIN OP Psych./Alc. & Drug Abuse 0.23 v3.16 H2020 THER BEHAV SVC, PER DIEM OP Psych./Alc. & Drug Abuse 1.56 v3.16 H2021 COM WRAP-AROUND SV, 15 MIN OP Psych./Alc. & Drug Abuse 0.21 v3.16 H2022 COM WRAP-AROUND SV, PER DIEM OP Psych./Alc. & Drug Abuse 3.13 v3.16 H2023 SUPPORTED EMPLOY, PER 15 MIN OP Psych./Alc. & Drug Abuse 0.09 v3.16 H2024 SUPPORTED EMPLOY, PER DIEM OP Psych./Alc. & Drug Abuse 0.72 v3.16 H2026 SUPP MAINT EMPLOY, PER DIEM OP Psych./Alc. & Drug Abuse 0.63 v3.16 H2029 SEX OFFEND TX SVC, PER DIEM OP Psych./Alc. & Drug Abuse 1.20 v3.16 H2032 ACTIVITY THERAPY, PER 15 MIN OP Psych./Alc. & Drug Abuse 0.13 v3.16 H2033 MULTISYS THER/JUVENILE 15MIN OP Psych./Alc. & Drug Abuse 0.50 v3.16 H2035 A/D TX PROGRAM, PER HOUR OP Psych./Alc. & Drug Abuse 1.10 Other H2036 A/D TX PROGRAM, PER DIEM OP Psych./Alc. & Drug Abuse 1.36 v3.16 M0076 PROLOTHERAPY Miscellaneous Medical 1.04 5% Sample M0300 IV CHELATIONTHERAPY Cardiovascular 0.64 v3.16 P3001 SCREENING PAP SMEAR BY PHYS Pathology 0.42 0.47 0.47 RBRVS P9010 WHOLE BLOOD FOR TRANSFUSION Miscellaneous Medical 1.89 FAIR Health P9011 BLOOD SPLIT UNIT Miscellaneous Medical 2.70 FAIR Health P9012 CRYOPRECIPITATE EACH UNIT Miscellaneous Medical 0.55 v3.16 P9016 RBC LEUKOCYTES REDUCED Miscellaneous Medical 3.98 v3.16 P9017 PLASMA 1 DONOR FRZ W/IN 8 HR Miscellaneous Medical 0.10 5% Sample P9019 PLATELETS, EACH UNIT Miscellaneous Medical 0.87 v3.16 P9020 PLAELET RICH PLASMA UNIT Miscellaneous Medical 4.15 v3.16 P9021 RED BLOOD CELLS UNIT Miscellaneous Medical 2.50 v3.16

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P9022 WASHED RED BLOOD CELLS UNIT Miscellaneous Medical 1.30 v3.16 P9031 PLATELETS LEUKOCYTES REDUCED Miscellaneous Medical 1.95 v3.16 P9032 PLATELETS, IRRADIATED Miscellaneous Medical 1.38 v3.16 P9034 PLATELETS, PHERESIS Miscellaneous Medical 6.94 v3.16 P9035 PLATELET PHERES LEUKOREDUCED Miscellaneous Medical 12.13 5% Sample P9037 PLATE PHERES LEUKOREDU IRRAD Miscellaneous Medical 13.34 v3.16 P9040 RBC LEUKOREDUCED IRRADIATED Miscellaneous Medical 5.97 v3.16 P9041 ALBUMIN (HUMAN),5%, 50ML Miscellaneous Medical 0.64 FAIR Health P9043 PLASMA PROTEIN FRACT,5%,50ML Miscellaneous Medical 0.63 FAIR Health P9045 ALBUMIN (HUMAN), 5%, 250 ML Miscellaneous Medical 3.19 FAIR Health P9046 ALBUMIN (HUMAN), 25%, 20 ML Miscellaneous Medical 1.04 FAIR Health P9047 ALBUMIN (HUMAN), 25%, 50ML Miscellaneous Medical 2.60 FAIR Health P9048 PLASMAPROTEIN FRACT,5%,250ML Miscellaneous Medical 1.25 FAIR Health P9053 PLT, PHER, L/R CMV-NEG, IRR Miscellaneous Medical 14.03 v3.16 P9058 RBC, L/R, CMV-NEG, IRRAD Miscellaneous Medical 7.51 v3.16 P9059 PLASMA, FRZ BETWEEN 8-24HOUR Miscellaneous Medical 0.83 v3.16 P9070 PATHOGEN REDUCED PLASMA POOL Miscellaneous Medical 0.83 Other P9071 PATHOGEN REDUCED PLASMA SING Miscellaneous Medical 0.27 Other P9072 PATHOGEN REDUCED PLATELETS Miscellaneous Medical 13.34 Other Q0035 CARDIOKYMOGRAPHY Cardiovascular a 0.17 0.40 0.40 RBRVS Q0035 26 CARDIOKYMOGRAPHY Cardiovascular 0.17 0.07 0.07 RBRVS Q0035 TC CARDIOKYMOGRAPHY Cardiovascular a 0.33 0.33 RBRVS Q0081 INFUSION THER OTHER THAN CHE Therapeutic Injections 1.93 v3.16 Q0083 CHEMO BY OTHER THAN INFUSION Miscellaneous Medical 0.91 v3.16 Q0084 CHEMOTHERAPY BY INFUSION Miscellaneous Medical 1.18 FAIR Health Q0085 CHEMO BY BOTH INFUSION AND O Miscellaneous Medical 6.14 v3.16 Q0091 OBTAINING SCREEN PAP SMEAR Pathology 0.37 0.15 0.86 RBRVS Q0092 SET UP PORT XRAY EQUIPMENT Radiology a 0.70 0.70 RBRVS Q2026 RADIESSE INJECTION Miscellaneous Medical 5.21 5% Sample Q2028 INJ, SCULPTRA, 0.5MG Miscellaneous Medical 0.31 Other Q2035 AFLURIA VACC, 3 YRS & >, IM Immunizations 0.43 FAIR Health Q2036 FLULAVAL VACC, 3 YRS & >, IM Immunizations 0.42 5% Sample Q2037 FLUVIRIN VACC, 3 YRS & >, IM Immunizations 0.46 FAIR Health Q2038 FLUZONE VACC, 3 YRS & >, IM Immunizations 0.39 FAIR Health Q2039 NOS FLU VACC, 3 YRS & >, IM Immunizations 0.42 5% Sample Q3014 TELEHEALTH FACILITY FEE Miscellaneous Medical 0.35 5% Sample Q5001 HOSPICE OR HOME HLTH IN HOME Miscellaneous Medical 1.35 v3.16 Q5002 HOSPICE/HOME HLTH IN ASST LV Miscellaneous Medical 1.61 v3.16 Q5003 HOSPICE IN LT/NON-SKILLED NF Miscellaneous Medical 0.06 v3.16 Q5004 HOSPICE IN SNF Miscellaneous Medical 1.52 v3.16 Q5005 HOSPICE, INPATIENT HOSPITAL Miscellaneous Medical 5.03 v3.16 Q5006 HOSPICE IN HOSPICE FACILITY Miscellaneous Medical 6.27 v3.16 Q5010 HOSPICE HOME CARE IN HOSPICE Miscellaneous Medical 6.27 v3.16 R0070 TRANSPORT PORTABLE X-RAY Radiology a 1.56 FAIR Health R0075 TRANSPORT PORT X-RAY MULTIPL Radiology a 0.81 5% Sample R0076 TRANSPORT PORTABLE EKG Radiology 0.88 FAIR Health S0199 MED ABORTION INC ALL EX DRUG Maternity - Non-Deliveries 4.65 v3.16 S0201 PARTIAL HOSPITALIZATION SERV Miscellaneous Medical 0.48 v3.16 S0207 PARAMEDICINTERCEP NONHOSPALS Miscellaneous Medical 7.09 v3.16 S0208 PARAMED INTRCEPT NONVOL Miscellaneous Medical 4.56 v3.16 S0209 WC VAN MILEAGE PER MI Miscellaneous Medical 0.02 5% Sample S0220 MEDICAL CONFERENCE BY PHYSIC Office/Home/Urgent Care Visits 2.81 v3.16 S0221 MEDICAL CONFERENCE, 60 MIN Office/Home/Urgent Care Visits 1.42 0.44 1.10 v3.16 S0255 HOSPICE REFER VISIT NONMD Office/Home/Urgent Care Visits 0.48 0.11 0.36 v3.16 S0257 END OF LIFE COUNSELING Office/Home/Urgent Care Visits 0.38 5% Sample S0260 H&P FOR SURGERY Office/Home/Urgent Care Visits 3.45 v3.16 S0265 GENETIC COUNSEL 15 MINS Miscellaneous Medical 0.54 v3.16 S0280 MEDICAL HOME, INITIAL PLAN Miscellaneous Medical 0.41 5% Sample S0281 MEDICAL HOME, MAINTENANCE Miscellaneous Medical 0.43 5% Sample S0302 COMPLETED EPSDT Physical Exams 0.32 v3.16 S0315 DISEASE MANAGEMENT PROGRAM Miscellaneous Medical 1.12 v3.16 S0316 FOLLOW-UP/REASSESSMENT Miscellaneous Medical 0.83 v3.16 S0317 DISEASE MGMT PER DIEM Miscellaneous Medical 1.47 v3.16 S0390 ROUT FOOT CARE PER VISIT Miscellaneous Medical 0.49 v3.16 S0400 GLOBAL ESWL KIDNEY Surgery 9.64 6.13 17.10 v3.16 S0592 COMP CONT LENS EVAL Vision Exams 1.13 v3.16 S0601 SCREENING PROCTOSCOPY Surgery 0.55 0.38 1.37 v3.16 S0610 ANNUAL GYNECOLOGICAL EXAMINA Physical Exams 2.79 v3.16 S0612 ANNUAL GYNECOLOGICAL EXAMINA Physical Exams 1.95 v3.16 S0613 ANN BREAST EXAM Physical Exams 0.93 v3.16 S0618 AUDIOMETRY FOR HEARING AID Hearing/Speech Exams 1.20 v3.16 S0620 ROUTINE OPHTHALMOLOGICAL EXA Vision Exams 1.25 v3.16 S0621 ROUTINE OPHTHALMOLOGICAL EXA Vision Exams 1.40 v3.16 S0622 PHYS EXAM FOR COLLEGE Miscellaneous Medical 0.64 v3.16 S0630 REMOVAL OF SUTURES Miscellaneous Medical 0.63 5% Sample

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S0800 LASER IN SITU KERATOMILEUSIS Miscellaneous Medical 15.46 v3.16 S0810 PHOTOREFRACTIVE KERATECTOMY Miscellaneous Medical 16.09 v3.16 S0812 PHOTOTHERAP KERATECT Miscellaneous Medical 0.92 0.64 0.86 v3.16 S2053 TRANSPLANTATION OF SMALL INT Surgery 83.29 27.76 27.76 v3.16 S2054 TRANSPLANTATION OF MULTIVISC Surgery 61.68 22.96 22.96 v3.16 S2055 HARVESTING OF DONOR MULTIVIS Surgery 61.68 22.96 22.96 v3.16 S2060 LOBAR LUNG TRANSPLANTATION Surgery 40.94 20.19 20.19 v3.16 S2065 SIMULT PANC KIDN TRANS Surgery 61.68 22.96 22.96 v3.16 S2068 BREAST DIEP OR SIEA FLAP Surgery 211.74 v3.16 S2070 CYSTO LASER TX URETERAL CALC Surgery 6.87 3.46 3.46 v3.16 S2080 LAUP Surgery 9.63 7.49 7.49 v3.16 S2083 ADJUSTMENT GASTRIC BAND Surgery 1.96 5% Sample S2095 TRANSCATH EMBOLIZ MICROSPHER Surgery 18.11 6.24 6.24 v3.16 S2102 ISLET CELL TISSUE TRANSPLANT Surgery 48.84 v3.16 S2115 PERIACETABULAR OSTEOTOMY Surgery 21.87 12.02 12.02 v3.16 S2120 LOW DENSITY LIPOPROTEIN(LDL) Pathology 41.06 v3.16 S2140 CORD BLOOD HARVESTING Surgery 1.86 v3.16 S2142 CORD BLOOD-DERIVED STEM-CELL Surgery 1.62 v3.16 S2150 BMT HARV/TRANSPL 28D PKG Surgery 2.24 0.94 0.94 v3.16 S2202 ECHOSCLEROTHERAPY Miscellaneous Medical 1.09 0.64 2.41 v3.16 S2205 MINIMALLY INVASIVE DIRECT CO Surgery 33.64 12.57 12.57 v3.16 S2206 MINIMALLY INVASIVE DIRECT CO Surgery 39.77 14.75 14.75 v3.16 S2207 MINIMALLY INVASIVE DIRECT CO Surgery 34.87 12.92 12.92 v3.16 S2225 MYRINGOTOMY LASER-ASSIST Surgery 1.35 1.56 3.32 v3.16 S2230 IMPLANT SEMI-IMP HEAR Surgery 15.48 v3.16 S2235 IMPLANT AUDITORY BRAIN IMP Surgery 0.73 8.52 8.52 v3.16 S2260 INDUCED ABORTION 17-24 WEEKS Maternity - Non-Deliveries 5.90 2.46 2.46 v3.16 S2265 INDUCED ABORTION 25-28 WKS Maternity - Non-Deliveries 5.90 2.46 2.46 v3.16 S2266 INDUCED ABORTION 29-31 WKS Maternity - Non-Deliveries 5.90 2.46 2.46 v3.16 S2267 INDUCED ABORTION 32 OR MORE Maternity - Non-Deliveries 5.90 2.46 2.46 v3.16 S2300 ARTHROSCOPY, SHOULDER, SURGI Surgery 12.49 v3.16 S2340 CHEMODENERVATION OF ABDUCTOR Surgery 3.86 1.65 4.26 v3.16 S2341 CHEMODENERV ADDUCT VOCAL Surgery 3.86 1.65 4.26 v3.16 S2342 NASAL ENDOSCOP PO DEBRID Surgery 2.98 1.39 4.90 v3.16 S2348 DECOMPRESS DISC RF LUMBAR Surgery 8.88 4.30 4.30 v3.16 S2350 DISKECTOMY, ANTERIOR, WITH D Surgery 22.75 11.08 11.08 v3.16 S2351 DISKECTOMY, ANTERIOR, WITH D Surgery 3.28 1.21 1.21 v3.16 S2900 ROBOTIC SURGICAL SYSTEM Surgery 16.80 5% Sample S3005 EVAL SELF-ASSESS DEPRESSION OP Psych./Alc. & Drug Abuse 1.02 v3.16 S4005 INTERIM LABOR FACILITY GLOBA Maternity - Non-Deliveries 13.24 v3.16 S4011 IVF PACKAGE Miscellaneous Medical 66.38 v3.16 S4015 COMPLETE IVF NOS CASE RATE Miscellaneous Medical 71.73 v3.16 S4016 FROZEN IVF CASE RATE Miscellaneous Medical 20.87 v3.16 S4022 ASST OOCYTE FERT CASE RATE Miscellaneous Medical 14.68 v3.16 S4035 STIMULATED IUI CASE RATE Miscellaneous Medical 17.70 v3.16 S4040 MONIT STORE CRYO EMBRYO 30 D Miscellaneous Medical 0.78 v3.16 S4042 OVULATION MGMT PER CYCLE Miscellaneous Medical 3.70 v3.16 S4981 INSERT LEVONORGESTREL IUS Miscellaneous Medical 1.74 v3.16 S5035 HIT ROUTINE DEVICE MAINT Miscellaneous Medical 0.18 0.37 0.37 v3.16 S5100 ADULT DAYCARE SERVICES 15MIN Miscellaneous Medical 0.82 v3.16 S5102 ADULT DAY CARE PER DIEM Miscellaneous Medical 0.56 5% Sample S5105 CENTERBASED DAY CARE PERDIEM Miscellaneous Medical 0.64 v3.16 S5108 HOMECARE TRAIN PT 15 MIN Miscellaneous Medical 0.45 0.37 0.37 v3.16 S5109 HOMECARE TRAIN PT SESSION Miscellaneous Medical 1.08 v3.16 S5110 FAMILY HOMECARE TRAINING 15M Miscellaneous Medical 0.09 v3.16 S5111 FAMILY HOMECARE TRAIN/SESSIO Miscellaneous Medical 1.68 v3.16 S5115 NONFAMILY HOMECARE TRAIN/15M Miscellaneous Medical 1.68 v3.16 S5116 NONFAMILY HC TRAIN/SESSION Miscellaneous Medical 1.68 v3.16 S5126 ATTENDANT CARE SERVICE /DIEM Miscellaneous Medical 0.26 v3.16 S5136 ADULT COMPANIONCARE PER DIEM Miscellaneous Medical 0.58 v3.16 S5140 ADULT FOSTER CARE PER DIEM Miscellaneous Medical 0.51 v3.16 S5145 CHILD FOSTERCARE TH PER DIEM Miscellaneous Medical 1.07 v3.16 S5151 UNSKILLED RESPITECARE /DIEM Miscellaneous Medical 1.59 v3.16 S5161 EMER RSPNS SYS SERV PERMONTH Miscellaneous Medical 0.27 v3.16 S5180 HH RESPIRATORY THRPY IN EVAL Miscellaneous Medical 1.47 v3.16 S5181 HH RESPIRATORY THRPY NOS/DAY Miscellaneous Medical 1.47 v3.16 S5190 WELLNESS ASSESSMENT BY NONPH Miscellaneous Medical 0.42 v3.16 S5522 HIT PICC INSERT NO SUPP Miscellaneous Medical 1.45 v3.16 S5523 HIP MIDLINE CATH INSERT KIT Miscellaneous Medical 1.53 v3.16 S8030 TANTALUM RING APPLICATION Radiology 9.46 7.66 7.66 v3.16 S8032 LOW DOSE CT LUNG SCREENING Radiology 5.27 Other S8037 MRCP Radiology 7.77 v3.16 S8040 TOPOGRAPHIC BRAIN MAPPING Miscellaneous Medical 2.97 3.05 3.05 v3.16 S8080 SCINTIMAMMOGRAPHY Radiology 3.57 v3.16 S8085 FLUORINE-18 FLUORODEOXYGLUCO Radiology 2.91 v3.16

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S8092 ELECTRON BEAM COMPUTED TOMOG Radiology 2.28 v3.16 S8110 PEAK EXPIRATORY FLOW RATE (P Miscellaneous Medical 0.26 v3.16 S8930 AURICULAR ELECTROSTIMULATION Miscellaneous Medical 1.03 v3.16 S8940 HIPPOTHERAPY PER SESSION Physical Medicine 0.25 v3.16 S8948 LOW-LEVEL LASER TRMT 15 MIN Miscellaneous Medical 0.52 5% Sample S8950 COMPLEX LYMPHEDEMA THERAPY, Miscellaneous Medical 0.60 v3.16 S8990 PT OR MANIP FOR MAINT Physical Medicine 0.62 5% Sample S9024 PARANASAL SINUS ULTRASOUND Radiology 2.17 v3.16 S9034 ESWL FOR GALLSTONES Surgery 9.64 6.13 17.10 v3.16 S9083 URGENT CARE CENTER GLOBAL Office/Home/Urgent Care Visits 1.90 v3.16 S9088 SERVICES PROVIDED IN URGENT Office/Home/Urgent Care Visits 1.23 5% Sample S9090 VERTEBRAL AXIAL DECOMPRESSIO Miscellaneous Medical 0.66 5% Sample S9097 HOME VISIT WOUND CARE Miscellaneous Medical 1.15 v3.16 S9098 HOME PHOTOTHERAPY VISIT Miscellaneous Medical 1.89 v3.16 S9117 BACK SCHOOL VISIT Miscellaneous Medical 0.17 0.06 0.32 v3.16 S9122 HOME HEALTH AIDE OR CERTIFIE Miscellaneous Medical 0.26 v3.16 S9123 NURSING CARE IN HOME RN Miscellaneous Medical 0.76 v3.16 S9124 NURSING CARE, IN THE HOME; B Miscellaneous Medical 0.49 v3.16 S9125 RESPITE CARE, IN THE HOME, P Miscellaneous Medical 0.32 v3.16 S9126 HOSPICE CARE, IN THE HOME, P Miscellaneous Medical 1.38 v3.16 S9127 SOCIAL WORK VISIT, IN THE HO Miscellaneous Medical 1.64 v3.16 S9128 SPEECH THERAPY, IN THE HOME, Miscellaneous Medical 1.21 v3.16 S9129 OCCUPATIONAL THERAPY, IN THE Miscellaneous Medical 1.19 v3.16 S9131 PT IN THE HOME PER DIEM Miscellaneous Medical 1.20 v3.16 S9140 DIABETIC MANAGEMENT PROGRAM, Miscellaneous Medical 1.36 v3.16 S9141 DIABETIC MANAGEMENT PROGRAM, Miscellaneous Medical 0.59 0.59 v3.16 S9145 INSULIN PUMP INITIATION Miscellaneous Medical 3.81 v3.16 S9152 SPEECH THERAPY, RE-EVAL Hearing/Speech Exams 2.94 v3.16 S9401 ANTICOAG CLINIC PER SESSION Miscellaneous Medical 0.30 v3.16 S9430 PHARMACY COMP/DISP SERV Miscellaneous Medical 0.66 v3.16 S9436 LAMAZE CLASS Miscellaneous Medical 1.06 v3.16 S9441 ASTHMA EDUCATION Miscellaneous Medical 0.40 v3.16 S9442 BIRTHING CLASS Miscellaneous Medical 0.42 v3.16 S9443 LACTATION CLASS Miscellaneous Medical 0.48 v3.16 S9449 WEIGHT MGMT CLASS Miscellaneous Medical 0.39 v3.16 S9451 EXERCISE CLASS Miscellaneous Medical 0.24 v3.16 S9452 NUTRITION CLASS Miscellaneous Medical 0.12 v3.16 S9453 SMOKING CESSATION CLASS Miscellaneous Medical 1.53 v3.16 S9455 DIABETIC MANAGEMENT PROGRAM, Miscellaneous Medical 0.40 v3.16 S9460 DIABETIC MANAGEMENT PROGRAM, Miscellaneous Medical 0.69 v3.16 S9465 DIABETIC MANAGEMENT PROGRAM, Miscellaneous Medical 1.26 v3.16 S9470 NUTRITIONAL COUNSELING, DIET Miscellaneous Medical 0.96 v3.16 S9474 ENTEROSTOMAL THERAPY BY A RE Miscellaneous Medical 0.67 v3.16 S9475 AMBULATORY SETTING SUBSTANCE OP Psych./Alc. & Drug Abuse 1.79 v3.16 S9480 INTENSIVE OUTPATIENT PSYCHIA OP Psych./Alc. & Drug Abuse 2.14 5% Sample S9484 CRISIS INTERVENTION PER HOUR OP Psych./Alc. & Drug Abuse 0.31 5% Sample S9485 CRISIS INTERVENTION MENTAL H OP Psych./Alc. & Drug Abuse 4.63 v3.16 S9900 CHRISTIAN SCI PRACT VISIT Miscellaneous Medical 0.08 v3.16 S9970 HEALTH CLUB MEMBERSHIP YR Miscellaneous Medical 0.86 v3.16 S9981 MED RECORD COPY ADMIN Miscellaneous Medical 0.35 v3.16 S9986 NOT MEDICALLY NECESSARY SVC Miscellaneous Medical 5.94 5% Sample S9988 SERV PART OF PHASE I TRIAL Miscellaneous Medical 0.06 v3.16 S9990 SERVICES PROVIDED AS PART OF Miscellaneous Medical 1.04 v3.16 S9999 SALES TAX Miscellaneous Medical 0.46 5% Sample T1000 PRIVATE DUTY/INDEPENDENT NSG Office/Home/Urgent Care Visits 0.21 v3.16 T1001 NURSING ASSESSMENT/EVALUATN Office/Home/Urgent Care Visits 1.06 v3.16 T1002 RN SERVICES UP TO 15 MINUTES Office/Home/Urgent Care Visits 0.26 v3.16 T1003 LPN/LVN SERVICES UP TO 15MIN Office/Home/Urgent Care Visits 0.17 v3.16 T1004 NSG AIDE SERVICE UP TO 15MIN Office/Home/Urgent Care Visits 0.21 v3.16 T1005 RESPITE CARE SERVICE 15 MIN Office/Home/Urgent Care Visits 0.14 v3.16 T1006 FAMILY/COUPLE COUNSELING OP Psych./Alc. & Drug Abuse 0.47 v3.16 T1007 TREATMENT PLAN DEVELOPMENT OP Psych./Alc. & Drug Abuse 3.02 v3.16 T1009 CHILD SITTING SERVICES Miscellaneous Medical 0.06 v3.16 T1012 ALCOHOL/SUBSTANCE ABUSE SKIL OP Psych./Alc. & Drug Abuse 0.13 v3.16 T1013 SIGN LANG/ORAL INTERPRETER Miscellaneous Medical 0.31 5% Sample T1015 CLINIC SERVICE Office/Home/Urgent Care Visits 1.00 v3.16 T1016 CASE MANAGEMENT Office/Home/Urgent Care Visits 0.37 v3.16 T1019 PERSONAL CARE SER PER 15 MIN Office/Home/Urgent Care Visits 0.09 v3.16 T1020 PERSONAL CARE SER PER DIEM Office/Home/Urgent Care Visits 1.88 v3.16 T1021 HH AIDE OR CN AIDE PER VISIT Office/Home/Urgent Care Visits 0.79 v3.16 T1023 PROGRAM INTAKE ASSESSMENT Office/Home/Urgent Care Visits 0.82 v3.16 T1024 TEAM EVALUATION & MANAGEMENT Office/Home/Urgent Care Visits 0.32 v3.16 T1026 PED COMPR CARE PKG, PER HOUR Office/Home/Urgent Care Visits 0.81 v3.16 T1027 FAMILY TRAINING & COUNSELING OP Psych./Alc. & Drug Abuse 0.14 v3.16 T1028 HOME ENVIRONMENT ASSESSMENT OP Psych./Alc. & Drug Abuse 0.26 v3.16

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T1030 RN HOME CARE PER DIEM Office/Home/Urgent Care Visits 1.99 v3.16 T1031 LPN HOME CARE PER DIEM Office/Home/Urgent Care Visits 0.64 v3.16 T1502 MEDICATION ADMIN VISIT Office/Home/Urgent Care Visits 0.25 v3.16 T2001 N-ET; PATIENT ATTEND/ESCORT Miscellaneous Medical 0.18 v3.16 T2003 N-ET; ENCOUNTER/TRIP Miscellaneous Medical 0.50 v3.16 T2004 N-ET; COMMERC CARRIER PASS Miscellaneous Medical 0.07 v3.16 T2005 N-ET; STRETCHER VAN Miscellaneous Medical 0.13 v3.16 T2007 NON-EMER TRANSPORT WAIT TIME Miscellaneous Medical 0.26 v3.16 T2013 HABIL ED WAIVER PER HOUR Miscellaneous Medical 0.52 v3.16 T2014 HABIL PREVOC WAIVER, PER D Miscellaneous Medical 0.57 v3.16 T2016 HABIL RES WAIVER PER DIEM Miscellaneous Medical 1.82 v3.16 T2017 HABIL RES WAIVER 15 MIN Miscellaneous Medical 0.11 v3.16 T2018 HABIL SUP EMPL WAIVER/DIEM Miscellaneous Medical 1.82 v3.16 T2020 DAY HABIL WAIVER PER DIEM Miscellaneous Medical 1.05 v3.16 T2022 CASE MANAGEMENT, PER MONTH Miscellaneous Medical 0.63 v3.16 T2023 TARGETED CASE MGMT PER MONTH Miscellaneous Medical 1.51 v3.16 T2025 WAIVER SERVICE, NOS Miscellaneous Medical 0.18 v3.16 T2031 ASSIST LIVING WAIVER/DIEM Miscellaneous Medical 2.47 v3.16 T2032 RES CARE, NOS WAIVER/MONTH Miscellaneous Medical 2.48 v3.16 T2033 RES, NOS WAIVER PER DIEM Miscellaneous Medical 1.65 v3.16 T2040 FINANCIAL MGT WAIVER/15MIN Miscellaneous Medical 0.13 v3.16 T2042 HOSPICE ROUTINE HOME CARE Miscellaneous Medical 1.20 v3.16 T2043 HOSPICE CONTINUOUS HOME CARE Miscellaneous Medical 0.28 v3.16 T2045 HOSPICE GENERAL CARE Miscellaneous Medical 5.70 v3.16 T2046 HOSPICE LONG TERM CARE, R&B Miscellaneous Medical 1.37 v3.16 T2048 BH LTC RES R&B, PER DIEM Miscellaneous Medical 1.67 v3.16 T2049 N-ET; STRETCHER VAN, MILEAGE Miscellaneous Medical 0.10 v3.16 V5008 HEARING SCREENING Hearing/Speech Exams 1.18 FAIR Health V5010 ASSESSMENT FOR HEARING AID Hearing/Speech Exams 1.55 FAIR Health V5362 SPEECH SCREENING Hearing/Speech Exams 0.86 0.28 3.50 v3.16 V5363 LANGUAGE SCREENING Hearing/Speech Exams 0.86 0.28 3.50 v3.16 V5364 DYSPHAGIA SCREENING Hearing/Speech Exams 1.70 1.70 v3.16

1 Key to Modifier:

TC: Represents the technical component of a service or procedure 26: Represents the professional component of a service or procedure

2 Key to Status/Usage Indicator:

a: Cannot be billed by VA Hospital Outpatients and Provider-Based Clinics (because the service or a service component is separately priced as outpatient facility charges - see Table F)

3 Charge Methodology:

5% Sample: RVUs based on the Medicare 5% Sample Part B database. Anesthesia: Based on Anesthesia base RVUs. ERBRVS: RVUs based on Essential RBRVS RVUs. FAIR Health: Charge developed from FAIR Health database. Global/TC/26: RVUs were adjusted to ensure consistency between global, -26, and -TC services. RBRVS: Based on 10-1-2015 RBRVS fee schedule for 2015. Unlisted: Developed based on the weighted median of the total RVUs of CPT/HCPCS codes within the series in which the unliste d procedure occurs. v3.16: RVUs from v3.16 were adopted for v3.18. Other: RVUs based on methods not specified above, including crosswalks from similar code charges.