Code Procedure Cpt Price University Physicians Group

Home , Anal sphincterotomy, Bursectomy, Cervical canal, Corneal topography, Endomicroscopy, Hemipelvectomy

UNIVERSITY PHYSICIANS GROUP (UPG) PRICES OF PROVIDER SERVICES

CODE PROCEDURE MOD CPT PRICE

0001A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE 0001A $40.00

0002A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE 0002A $40.00

0011A IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE 0011A $40.00

0012A IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE 0012A $40.00

0021A IMM ADMN SARSCOV2 5X1010 VP/0.5 ML 1ST DOSE 0021A $40.00

0022A IMM ADMN SARSCOV2 5X1010 VP/0.5 ML 2ND DOSE 0022A $40.00

0031A IMM ADMN SARSCOV2 AD26 5X10^10 VP/0.5 ML 1 DOSE 0031A $40.00 0042T CEREBRAL PERFUS ANALYSIS, CT W/CONTRAST 0042T $954.00

0054T BONE SURGERY USING COMPUTER ASSIST, FLURO GUIDED 0054T $640.00

0055T BONE SURGERY USING COMPUTER ASSIST, CT/ MRI GUIDED 0055T $1,188.00 0071T U/S LEIOMYOMATA ABLATE <200 CC 0071T $2,500.00

0075T 0075T PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL 26 26 $2,208.00

0126T CAROTID INT-MEDIA THICKNESS EVAL FOR ATHERSCLER 0126T $55.00

0159T 0159T COMPUTER AIDED BREAST MRI 26 26 $314.00

PR RECTAL TUMOR EXCISION, TRANSANAL ENDOSCOPIC 0184T MICROSURGICAL, FULL THICK 0184T $2,315.00

0191T PR ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT 0191T $2,396.00 01967 ANESTH, NEURAXIAL LABOR, PLAN VAG DEL 01967 $2,500.00

01996 PR DAILY MGMT,EPIDUR/SUBARACH CONT DRUG ADM 01996 $285.00

PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> 0200T NDL 0200T $5,106.00 PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> 0201T NDLS 0201T $9,446.00

PR INJECT PLATELET RICH PLASMA W/IMG 0232T HARVEST/PREPARATOIN 0232T $1,509.00

0234T PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, RENAL ARTERY 0234T $2,012.00

PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, 0237T BRACHIOCEPHAL AND BRANCHES, EACH 0237T $1,868.00

PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, ILIAC ARTERY, 0238T EACH 0238T $1,877.00

0253T PR INSERT ANT SGM DRAINAGE DEV W/O RESERVR INT APPR 0253T $2,584.00

0254T PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI 0254T $3,412.00

0275T PR PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR 0275T $1,459.00

0281T PR PERC TRANSCTH CLOSR LT ATRIAL APPNDGE IMPLNT S&I 0281T $3,574.00

0296T PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD 0296T $135.00

0298T PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN 0298T $140.00 0346T PR ULTRASOUND ELASTOGRAPHY 0346T $276.00

0375T PR TOTAL DISC ARTHRP ANT APPR W/DISCECTOMY CRV 3+ 0375T $8,709.00

0376T PR ANT SEGMENT INSERT DRAIN W/O RESERVOIR EA ADDL 0376T $2,568.00

0379T PR VISUAL FIELD ASSESSMENT TECH SUPPORT W/INSTRUCT 0379T $109.00

0387T PR TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR 0387T $1,124.00

0389T PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM 0389T $115.00

0389T 0389T PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM 26 26 $115.00

0391T PR INTERROG DEVICE EVAL IN PERSON LEADLESS PM SYST 0391T $87.00

0397T PR ERCP WITH OPTICAL ENDOMICROSCOPY ADD ON 0397T $1,002.00 $15,604.0 0398T PR MRGFUS STEREOTACTIC ABLATION LESION INTRACRANIAL 0398T 0 0399T PR MYOCARDIAL STRAIN IMAGING QUAN ASSMT 0399T $513.00

0399T 0399T PR MYOCARDIAL STRAIN IMAGING QUAN ASSMT 26 26 $513.00

0438T PR TPRNL PLMT BIODEGRADABLE MATRL PERIPROSTATIC 0438T $764.00

0442T PR ABLTJ PERC CRYOABLTJ IMG GDN NRV PLEX/TRNCL NRV 0442T $450.00

0449T PR INSJ AQUEOUS DRAIN DEV W/O EO RSVR INITIAL DEV 0449T $2,222.00

0466T PR INSRT CH WALL RESPIR ELTRD/RA & CONJ PULSE GEN 0466T $1,235.00 0474T PR CYPASS GLAUCOMA IMPLANT 0474T $3,333.00

0482T 0482T PR ABSOLUTE QUAN MYOCARD BLD FLO PET STRESS & REST 26 26 $179.00

0483T PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH 0483T $5,681.00

0484T PR TMVI W/PROSTHETIC VALVE TRANSTHORACIC EXPOSURE 0484T $8,059.00

0494T PR PREP & CANNULJ CDVR DON LNG ORGN PRFUJ SYS 0494T $812.00

0495T PR INIT & MNTR CDVR DON LNG ORGN PRFUJ SYS 1ST 2 HR 0495T $7,000.00

0496T PR MNTR CDVR DON LNG ORGN PRFUJ SYS EA ADDL HR 0496T $3,500.00

0497T PR XTRNL PT ACT ECG W/O ATTN MNTR IN-OFFICE CONN 0497T $24.00

0498T PR XTRNL PT ACT ECG W/O ATTN MNTR R&I PR 30 DAYS 0498T $65.00

0499T PR CYSTO W/DIL & URTL RX DEL F/URTL STRIX/STENOSIS 0499T $1,024.00

0504T PR COR FFR CTA DATA REVIEW W/INTERPJ & FINAL REPORT 0504T $443.00

0507T 0507T PR NEAR INFRARED DUAL IMG MEIBOMIAN GLND UNI/BI I&R 26 26 $16.00

0514T PR INTRAOPERATIVE VISUAL AXIS ID USING PT FIXATION 0514T $184.00 0537T PR CAR-T THERAPY HRVG BLD DRV T LMPHCYT PR DAY 0537T $220.00

0540T PR CAR-T THERAPY AUTOLOGOUS CELL ADMINISTRATION 0540T $500.00

0545T PR TCAT TV ANN RCNSTJ W/IMPL ADJST ANN RCNSTJ DEV 0545T $7,329.00

0569T PR TTVR PERCUTANEOUS APPROACH INITIAL PROSTHESIS 0569T $5,396.00

0570T PR TTVR PERCUTANEOUS APPROACH EACH ADDL PROSTHESIS 0570T $1,242.00

0570T 0570T PR TTVR PERCUTANEOUS APPROACH EACH ADDL PROSTHESIS 26 26 $635.00

0571T PR INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE 0571T $1,581.00

0572T PR INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD 0572T $1,258.00

0573T PR RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD 0573T $1,058.00

0574T PR REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD 0574T $1,039.00

0581T PR ABLATION MAL BRST TUMOR PERQ CRTX UNILATERAL 0581T $763.00 0584T PR PERCUTANEOUS ISLET CELL TRANSPLANT 0584T $5,361.00 0585T PR LAPAROSCOPIC ISLET CELL TRANSPLANT 0585T $2,451.00 0586T PR OPEN ISLET CELL TRANSPLANT 0586T $4,045.00

0589T PR ELEC ALYS SMPL PRGRMG IINS PTN 1-3 PARAMETERS 0589T $129.00

0590T PR ELEC ALYS CPLX PRGRMG IINS PTN 4+ PARAMETERS 0590T $300.00

0600T PR IRE ABLATION 1+TUMORS PER ORGAN W/IMG GDN PERQ 0600T $2,386.00

10004 PR FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL 10004 $135.00

10005 PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 10005 $342.00

10006 PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL 10006 $155.00

10007 PR FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION 10007 $729.00 10008 PR FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL 10008 $411.00

10009 PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION 10009 $1,193.00

10010 PR FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL 10010 $719.00

10011 PR FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION 10011 $1,193.00

10012 PR FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL 10012 $719.00 10021 PR FINE NEEDLE ASP;W/O IMAGING GUIDANCE 10021 $357.00 10022 PR FINE NEEDLE ASP;W/IMAGING GUIDANCE 10022 $328.00

10030 PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE 10030 $1,938.00

10035 PR PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE 10035 $1,359.00 10040 PR ACNE SURGERY OF SKIN ABSCESS 10040 $276.82 10060 PR DRAIN SKIN ABSCESS SIMPLE 10060 $321.00 10061 PR DRAIN SKIN ABSCESS COMPLIC 10061 $556.00 10080 PR DRAIN PILONIDAL CYST SIMPL 10080 $558.00 10081 PR DRAIN PILONIDAL CYST COMPLIC 10081 $808.00 10120 PR REMOVE FOREIGN BODY SIMPLE 10120 $402.00 10121 PR REMOVE FOREIGN BODY COMPLIC 10121 $723.00 10140 PR DRAINAGE OF HEMATOMA/FLUID 10140 $452.00 10160 PR PUNCTURE DRAINAGE OF LESION 10160 $346.00 10180 PR COMPLEX DRAINAGE, WOUND 10180 $680.00

11000 PR DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA 11000 $150.00

11001 PR DEBRIDEMENT, INFECTED SKIN, EA ADD 10% BSA 11001 $63.00

11004 PR DEBRIDE NECROTIC SKIN/ TISSUE, GENIT & PERINM 11004 $1,554.00 11005 PR DEBRIDE NECROTIC SKIN/ TISSUE, ABD WALL 11005 $2,810.00

11006 PR DEBRIDE NECROT SKIN/ TISS, GENIT,PERI, ADB WALL 11006 $2,540.00 11008 REMOVE MESH FROM ABD WALL FOR INFECTION 11008 $745.00 11010 PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ 11010 $1,412.00

11011 PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/MUSCLE 11011 $1,676.00 11012 PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE 11012 $2,446.00

11042 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM 11042 $395.00

11043 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM 11043 $619.00

PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ 11044 CM 11044 $981.00

11045 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM 11045 $111.00

PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 11046 SQ CM 11046 $198.00

PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH 11047 ADD 20 SQ CM 11047 $329.00 11055 PR TRIM HYPERKERATOTIC SKIN LESION, ONE 11055 $166.00 11056 TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4 11056 $187.09 11057 TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4 11057 $226.00 11100 PR BIOPSY OF SKIN LESION 11100 $239.00 11101 PR BIOPSY, EACH ADDED LESION 11101 $74.00 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION 11102 $265.00

11103 PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11103 $141.00 11104 PR PUNCH BIOPSY SKIN SINGLE LESION 11104 $333.00

11105 PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION 11105 $161.00 11106 PR INCISIONAL BIOPSY SKIN SINGLE LESION 11106 $403.00

11107 PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11107 $190.00 11200 PR REMOVAL OF SKIN TAGS, UP TO 15 11200 $235.00 11201 PR REMOVAL OF SKIN TAGS, EACH ADD 10 11201 $56.00 11300 PR SHAV SKIN LES <5MM TRUNK,ARM,LEG 11300 $265.00 11301 PR SHAV SKIN LES 6-10MM TRUNK,ARM,LEG 11301 $322.00 11302 PR SHAV SKIN LES 11-20MM TRUNK,ARM,LEG 11302 $372.00 11303 PR SHAV SKIN LES >21MM TRUNK,ARM,LEG 11303 $409.00 11305 PR SHAV SKIN LES <5MM REMAINDR BODY 11305 $279.00 11306 PR SHAV SKIN LES 6-10MM REMAINDR BODY 11306 $326.00 11307 PR SHAV SKIN LES 11-20MM REMAINDR BODY 11307 $381.00 11308 PR SHAV SKIN LES >21MM REMAINDR BODY 11308 $407.00 11310 PR SHAV SKIN LES <5MM FACE,FACIAL 11310 $307.00 11311 PR SHAV SKIN LES 6-10MM FACE,FACIAL 11311 $364.00 11312 PR SHAV SKIN LES 11-20MM FACE,FACIAL 11312 $420.00 11313 PR SHAV SKIN LES >21MM FACE,FACIAL 11313 $468.68 11400 PR EXC SKIN BENIG <5MM TRUNK,ARM,LEG 11400 $333.00 11401 PR EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LEG 11401 $406.00 11402 PR EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LEG 11402 $450.00 11403 PR EXC SKIN BENIG 2.1-3CM TRUNK,ARM,LEG 11403 $520.00 11404 PR EXC SKIN BENIG 3.1-4CM TRUNK,ARM,LEG 11404 $591.00 11406 PR EXC SKIN BENIG >4CM TRUNK,ARM,LEG 11406 $845.00 11420 PR EXC SKIN BENIG <5MM REMAINDR BODY 11420 $336.00 11421 PR EXC SKIN BENIG 0.6-1CM REMAINDR BODY 11421 $423.00 11422 PR EXC SKIN BENIG 1.1-2CM REMAINDR BODY 11422 $476.00 11423 PR EXC SKIN BENIG 2.1-3CM REMAINDR BODY 11423 $541.00 11424 PR EXC SKIN BENIG 3.1-4CM REMAINDR BODY 11424 $625.00 11426 PR EXC SKIN BENIG >4CM REMAINDR BODY 11426 $897.00 11440 PR EXC SKIN BENIG <5MM FACE,FACIAL 11440 $370.00 11441 PR EXC SKIN BENIG 0.6-1CM FACE,FACIAL 11441 $455.00 11442 PR EXC SKIN BENIG 1.1-2CM FACE,FACIAL 11442 $506.00 11443 PR EXC SKIN BENIG 2.1-3CM FACE,FACIAL 11443 $601.00 11444 PR EXC SKIN BENIG 3.1-4CM FACE,FACIAL 11444 $1,086.00 11446 PR EXC SKIN BENIG >4CM FACE,FACIAL 11446 $1,038.00 11450 PR EXC SWEAT GLAND LESN AXILL,SIMPL 11450 $1,037.59 11451 PR EXC SWEAT GLAND LESN AXILL,COMPLX 11451 $1,292.45 11462 PR EXC SWEAT GLAND LESN INGUIN,SIMPL 11462 $1,009.91 11463 PR EXC SWEAT GLAND LESN INGUIN,COMPLX 11463 $1,315.36 11470 PR EXC SWEAT GLAND LESN PERINEAL,SIMPL 11470 $1,077.00 11471 PR EXC SWEAT GLAND LESN PERINEAL,COMPLX 11471 $1,329.00

PR ADVANCE CARE PLANNING DISCUSS DOCUMENTED IN 1158F MEDICAL RECORD 1158F $0.00 11600 PR EXC SKIN MALIG <5MM TRUNK,ARM,LEG 11600 $523.00 11601 PR EXC SKIN MALIG 0.6-1CM TRUNK,ARM,LEG 11601 $608.00 11602 PR EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LEG 11602 $654.00 11603 PR EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LEG 11603 $745.00 11604 PR EXC SKIN MALIG 3.1-4CM TRUNK,ARM,LEG 11604 $832.00 11606 PR EXC SKIN MALIG >4CM TRUNK,ARM,LEG 11606 $1,193.00 11620 PR EXC SKIN MALIG <5MM REMAINDR BODY 11620 $526.00 11621 PR EXC SKIN MALIG 0.6-1CM REMAINDR BODY 11621 $610.00 11622 PR EXC SKIN MALIG 1.1-2CM REMAINDR BODY 11622 $676.00 11623 PR EXC SKIN MALIG 2.1-3CM REMAINDR BODY 11623 $794.00 11624 PR EXC SKIN MALIG 3.1-4CM REMAINDR BODY 11624 $899.00 11626 PR EXC SKIN MALIG >4CM REMAINDR BODY 11626 $1,086.00 11640 PR EXC SKIN MALIG <5MM FACE,FACIAL 11640 $538.00 11641 PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL 11641 $632.00 11642 PR EXC SKIN MALIG 1.1-2CM FACE,FACIAL 11642 $717.00 11643 PR EXC SKIN MALIG 2.1-3CM FACE,FACIAL 11643 $844.00 11644 PR EXC SKIN MALIG 3.1-4CM FACE,FACIAL 11644 $1,189.00 11646 PR EXC SKIN MALIG >4CM FACE,FACIAL 11646 $1,357.00 11719 PR TRIM NAIL(S) 11719 $52.00 11720 PR DEBRIDEMENT OF NAIL(S), 1-5 11720 $87.00 11721 PR DEBRIDEMENT OF NAILS, 6 OR MORE 11721 $103.00 11730 PR REMOVAL OF NAIL PLATE 11730 $293.00 11732 PR REMOVE ADDITIONAL NAIL PLATE 11732 $89.00 11740 PR DRAIN BLOOD FROM UNDER NAIL 11740 $142.00 11750 PR REMOVAL OF NAIL BED 11750 $538.00 11752 PR REMOVE NAIL BED/FINGER TIP 11752 $680.00 11755 PR BIOPSY, NAIL UNIT (SEP PROC) 11755 $347.00 11760 PR RECONSTRUC OF NAIL BED 11760 $555.00 11762 PR RECONSTRUC OF NAIL BED W GRAFT 11762 $786.00 11765 PR EXCISION OF NAIL FOLD, TOE 11765 $447.00 11770 PR REMV PILONIDAL LESION SIMPLE 11770 $831.00 11771 PR REMV PILONIDAL LESION EXTENS 11771 $1,610.00 11772 PR REMV PILONIDAL LESION COMPLIC 11772 $1,951.00 11900 INJECTION INTO SKIN LESIONS, UP TO 7 11900 $146.00 11901 INJECTION INTO SKIN LESIONS, 8 OR MORE 11901 $184.00 11920 PR CORRECT SKIN COLR DEFCT <6SQ CM 11920 $495.00 11950 PR FILL CONTOUR DEFCT <1CC 11950 $195.00 11951 PR FILL CONTOUR DEFCT 1.1-5CC 11951 $251.00 11952 PR FILL CONTOUR DEFCT 5.1-10CC 11952 $341.00 11954 PR FILL CONTOUR DEFCT >10CC 11954 $605.00 11960 PR INSERT TISSUE EXPANDER(S) 11960 $3,447.00

11970 PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT 11970 $2,680.00

11971 PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT 11971 $1,283.00 11976 PR REMOVAL OF CONTRACEPTIVE CAPSUL 11976 $387.00 11980 PR IMPLANT,HORMONE,SUBCUTANEOUS 11980 $250.00 11981 PR INSERTION DRUG IMPLANT DEVICE 11981 $370.00 11982 PR REMOVAL DRUG IMPLANT DEVICE 11982 $415.00 11983 PR REMOVAL W/ REINSERT DRUG IMPLANT DEVICE 11983 $590.00 12001 PR REPR SUPERF WND BODY <2.5CM 12001 $282.00 12002 PR REPR SUP NPTERF WND BODY 2.6-7.5 12002 $300.00 12004 PR REPR SUPERF WND BODY 7.6-12.5 12004 $351.00 12005 PR REPR SUPERF WND BODY 12.6-20 12005 $538.00 12006 PR REPR SUPERF WND BODY 20.1-30 12006 $537.00 12007 PR REPR SUPERF WND BODY >30CM 12007 $608.00 12011 PR REPR SUPERF WND FACE <2.5CM 12011 $298.00 12013 PR REPR SUPERF WND FACE 2.6-5 12013 $327.00 12014 PR REPR SUPERF WND FACE 5.1-7.5 12014 $387.00 12015 PR REPR SUPERF WND FACE 7.6-12.5 12015 $598.00 12016 PR REPR SUPERF WND FACE 12.6-20 12016 $709.00 12017 PR REPR SUPERF WND FACE 20.1-30 12017 $424.00 12018 PR REPR SUPERF WND FACE >30CM 12018 $470.00 12020 PR CLOSURE SUPERF WND DEHIS SIMPLE 12020 $784.00 12021 PR CLOSURE SUPERF WND DEHIS W PACKING 12021 $457.00 12031 PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM 12031 $668.00 12032 PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM 12032 $800.00 12034 PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM 12034 $861.00 12035 PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM 12035 $1,028.00 12036 PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM 12036 $1,150.00 12037 PR LAYR CLOS WND TRUNK,ARM,LEG >30 CM 12037 $1,305.00 12041 PR LAYR CLOS WND REST BODY <2.5 CM 12041 $670.00 12042 PR LAYR CLOS WND REST BODY 2.6-7.5 CM 12042 $796.00 12044 PR LAYR CLOS WND REST BODY 7.6-12.5 CM 12044 $988.00 12045 PR LAYR CLOS WND REST BODY 12.6-20 CM 12045 $1,083.00 12046 PR LAYR CLOS WND REST BODY 20.1-30 CM 12046 $1,246.00 12047 PR LAYR CLOS WND REST BODY >30 CM 12047 $1,375.00 12051 PR LAYR CLOS WND FACE,FACIAL <2.5 CM 12051 $720.00 12052 PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM 12052 $808.00 12053 PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM 12053 $947.00 12054 PR LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM 12054 $999.00 12055 PR LAYR CLOS WND FACE,FACIAL 12.6-20 CM 12055 $1,805.00 12056 PR LAYR CLOS WND FACE,FACIAL 20.1-30 CM 12056 $1,422.00 12057 PR LAYR CLOS WND FACE,FACIAL >30 CM 12057 $1,506.00 13100 PR REPR CMPL WND TRUNK 1.1-2.5CM 13100 $906.00 13101 PR REPR CMPL WND TRUNK 2.6-7.5CM 13101 $1,063.00 13102 PR REP,SKIN,TRUNK,CMPLX,+5CM/< 13102 $400.00 13120 PR REPR CMPL WND SCALP,EXTR 1.1-2.5 13120 $945.00 13121 PR REPR CMPL WND SCALP,EXTR 2.6-7.5 13121 $1,140.00 13122 PR REP,SKIN,SCALP/EXTREM+5CM/< 13122 $600.00 13131 PR REPR CMPL WND HEAD,FAC,HAND 1.1-2.5 13131 $1,035.00 13132 PR REPR CMPL WND HEAD,FAC,HAND 2.6-7.5 13132 $1,315.00 13133 PR REP,FACE,GENITAL,HAND,FT+5CM/< 13133 $800.00 13151 PR REPR CMPL WND LID,NOS,EAR 1.1-2.5 13151 $1,130.00 13152 PR REPR CMPL WND LID,NOS,EAR 2.5-7.5 13152 $1,338.00 13153 PR REP,EYELID,NOSE,EAR,LIP+5CM 13153 $636.00 13160 PR SECD CLOS SURG WND EXTEN/COMPLIC 13160 $2,857.00 14000 PR ADJ TISS XFER TRUNK <10SQCM 14000 $1,666.00 14001 PR ADJ TISS XFER TRUNK 10.1-30 14001 $2,128.00 14020 PR ADJ TISS XFER SCALP,EXTREM <10SQCM 14020 $1,844.00 14021 PR ADJ TISS XFER SCALP,EXTREM 10.1-30 14021 $2,294.00 14040 PR ADJ TISS XFER HEAD,FAC,HAND <10SQCM 14040 $3,098.00 14041 PR ADJ TISS XFER HEAD,FAC,HAND 10.1-30 14041 $3,330.00 14060 PR ADJ TISS XFER LID,NOS,EAR <10SQCM 14060 $2,040.00 14061 PR ADJ TISS XFER LID,NOS,EAR 10.1-30 14061 $3,582.00 14301 PR ADJ TISS XFER ANY AREA,30.1-60 SQCM 14301 $3,832.00 14302 PR ADJ TISS XFER ANY AREA,EA ADD 30.0 SQCM 14302 $854.00 14350 PR FILLET FINGR/TOE FLAP W PREP 14350 $2,449.00 15002 PR WOUND PREP, PED, TRK/ARM/LG 1ST 100 CM 15002 $950.00

15003 PR WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM 15003 $425.00 15004 PR WND PREP PED, FACE/NCK/HND/FT/GEN 15004 $1,066.00

15005 PR WND PREP,PED, FACE/NCK/HND/FT/GEN ADD 100 CM 15005 $500.00 15040 PR SKIN GRAFT, HARVEST CULTURED TISSUE 15040 $696.00 15050 PR SKIN PINCH GRAFT PROCEDURE <2CM 15050 $1,562.00 15100 PR SPLIT GRFT TRUNK,ARM,LEG <100SQCM 15100 $2,314.00 15101 PR SPLIT GRFT,TRUNK,ARM,LEG EA 100SQCM 15101 $508.00 15120 PR SPLIT GRFT,HEAD,FAC,HAND,FEET <100SQCM 15120 $3,023.00

15121 PR SPLIT GRFT,HEAD,FAC,HAND,FEET EA 100SQCM 15121 $730.00 15200 PR FULL THICK GRFT TRUNK <20 SQCM 15200 $2,168.00 15201 PR FULL THICK GRFT TRUNK ADD 20 SQCM 15201 $386.00 15220 PR FULL THICK GRFT SCALP,ARM,LEG <20SQC 15220 $2,047.00 15221 PR FULL THICK GRFT SCALP,ARM ADD 20 SQCM 15221 $450.00 15240 PR FULL THICK GRFT HEAD,FAC,HAND <20SQC 15240 $3,321.00 15241 PR FULL THICK GRFT HEAD,FAC,HA ADD 20SQ 15241 $715.00 15260 PR FULL THICK GRFT NOS,EAR,LID <20SQCM 15260 $3,596.00 15261 PR FULL THICK GRFT NOS,EAR,LID ADD 20SQ 15261 $1,180.00

15271 PR APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM 15271 $400.00

15272 PR APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM 15272 $71.00

15273 PR APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM 15273 $1,001.00

15274 PR APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM 15274 $237.00

15275 PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM 15275 $418.00

15276 PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM 15276 $92.00

15277 PR SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM 15277 $912.00

15278 PR SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM 15278 $249.00 15570 PR FORM SKIN PEDICLE FLAP TRUNK 15570 $3,239.00 15572 PR FORM SKIN PEDICLE FLAP SCALP,ARM,LEG 15572 $3,152.00 15574 PR FORM SKIN PEDICLE FLAP FACE,GEN,HAND 15574 $1,950.00 15576 PR FORM SKIN PEDICLE FLAP LID,EAR,NOSE 15576 $2,205.00 15600 PR DELAY/SECTN FLAP TRUNK 15600 $895.00 15610 PR DELAY/SECTN FLAP SCALP,ARM,LEG 15610 $924.00 15620 PR DELAY/SECTN FLAP FACE,GENIT,HAND,FT 15620 $1,145.00 15630 PR DELAY/SECTN FLAP LID,NOS,EAR,LIP 15630 $1,196.00 15650 PR TRANSFER SKIN PEDICLE FLAP 15650 $1,270.00

15730 PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES 15730 $5,573.00 15731 PR FOREHEAD FLAP W/VASC PEDICLE 15731 $3,989.00 15732 PR MUSCLE-SKIN FLAP,HEAD/NECK 15732 $4,529.00

PR MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC 15733 PEDCL 15733 $3,801.00 15734 PR MUSCLE-SKIN FLAP,TRUNK 15734 $6,172.00 15736 PR MUSCLE-SKIN FLAP,ARM 15736 $4,609.00 15738 PR MUSCLE-SKIN FLAP,LEG 15738 $4,812.00

15740 PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY 15740 $3,589.00 15750 PR NEUROVASCULAR PEDICLE GRAFT 15750 $3,255.00 15756 PR FREE MUSC-SKIN FLAP W/MICROVASC ANAST 15756 $9,419.00 15757 PR FREE SKIN FLAP W MICROVASC ANAST 15757 $8,329.00 15758 PR FREE FASCIAL FLAP W MICROVASC ANAST 15758 $9,403.00 15760 PR COMPOSITE SKIN GRAFT 15760 $2,378.00

15769 PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC 15769 $1,291.00 15770 PR DERMA-FAT-FASCIA GRAFT 15770 $2,145.00

15771 PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS 15771 $1,476.00

15772 PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC 15772 $466.00

15773 PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS 15773 $1,489.00

15774 PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC 15774 $452.00

15777 PR IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT 15777 $566.00 15780 PR DERMABRAS RX SKIN TOTAL FACE 15780 $2,326.00 15781 PR DERMABRAS RX SKIN SGMENT FACE 15781 $1,460.00 15782 PR DERMABRAS RX SKIN REGIONAL 15782 $1,656.00 15783 PR DERMABRAS RX SKIN SUPERFICIAL 15783 $1,230.00 15786 PR ABRASION SINGLE LESION 15786 $636.00 15787 PR ABRASION, EACH ADDN 4 OR LESS 15787 $124.00 15788 PR CHEM PEEL, FACE, EPIDERM 15788 $803.00 15789 PR CHEM PEEL, FACE, DERMAL 15789 $1,431.00 15819 PR PLASTIC SURGERY, NECK 15819 $3,185.00 15820 PR REVISION OF LOWER EYELID 15820 $1,512.00 15821 PR REV LOWER EYELID EXTEN FAT PAD 15821 $1,623.00 15822 PR REVISION OF UPPER EYELID 15822 $1,203.00 15823 PR REV UPPER EYELID W EXCESS SKIN 15823 $1,624.00 15824 PR REMOVAL OF FOREHEAD WRINKLES 15824 $2,647.00 15825 PR REMOV NECK WRINKLES W PLTSY TIGHT 15825 $4,557.00 15828 PR REML OF CHEEK,CHIN,NECK WRINKLES 15828 $9,835.00 $10,991.0 15829 PR REMOVAL OF SKIN WRINKLES 15829 0 15830 PR EXCISE EXCESS SKIN TISSUE,ABDOMEN 15830 $4,198.00 15832 PR EXCISE EXCESS SKIN TISSUE,THIGH 15832 $3,284.00 15833 PR EXCISE EXCESS SKIN TISSUE,LEG 15833 $3,030.00 15834 PR EXCISE EXCESS SKIN TISSUE,HIP 15834 $3,146.00 15835 PR EXCISE EXCESS SKIN TISSUE,BUTTOCK 15835 $3,340.00 15836 PR EXCISE EXCESS SKIN TISSUE,ARM 15836 $2,819.00 15838 PR EXCISE EXCESS SKIN TISSUE,SUBMENTAL 15838 $1,630.00 15839 PR EXCISE EXCESS SKIN TISSUE,OTHER 15839 $3,144.00 15840 PR GRAFT FACE N PALSY,FREE FASCIA 15840 $3,594.00 15841 PR GRAFT FACE N PALSY,FREE MUSCLE 15841 $5,000.00 15845 PR GRAFT FACE N PALSY,REGN MUSC XFER 15845 $3,565.00

15847 PR EXCISE EXCESS SKIN TISSUE,ABDOMEN, ADD-ON 15847 $1,493.00 15850 PR REM SUTURES W ANESTH SAME SURGEON 15850 $240.00 15851 PR REM SUTURES W ANESTH OTHR SURGEON 15851 $895.00 15852 PR DRESSING CHANGE,NOT FOR BURN 15852 $125.00 15860 PR IV INJ TO TEST BLOOD FLOW IN FLAP/GRAFT 15860 $450.00 15876 PR SUCT ASSIS LIPECTOMY,HEAD/NECK 15876 $4,704.00 15877 PR SUCT ASSIS LIPECTOMY,TRUNK 15877 $2,335.00 15878 PR SUCT ASSIS LIPECTOMY,UP EXTREM 15878 $2,006.00 15879 PR SUCT ASSIS LIPECTOMY,LOW EXTREM 15879 $2,266.00 15920 PR EXC COCCYX/ULCER W SUTURE 15920 $1,592.00 15931 PR EXC SACR PRESS ULC W PRI SUTURE 15931 $2,476.00 15933 PR EXC SACR PRESS ULC BONE & SUTURE 15933 $3,055.00 15934 PR EXC SACR PRESS ULC W FLAP CLOS 15934 $3,374.00 15935 PR EXC SACR PRESS ULC BONE & FLAP CLO 15935 $2,910.00 15936 PR EXC SACR PRESS ULC W MUSC FLAP CLO 15936 $3,196.00 15937 PR EXC SACR PRESS ULC BONE/W MUSC FLAP 15937 $3,711.00 15940 PR EXC ISCH PRES ULC W PRIM CLOS 15940 $1,890.00 15941 PR EXC ISCH PRES ULC & BONE PRIM CLO 15941 $3,289.00 15944 PR EXC ISCH PRES ULC W FLAP CLOS 15944 $3,217.00 15946 PR EXC ISCH PRES ULC BONE MYOCUT FLAP 15946 $6,661.00 15950 PR EXC TROC PRES ULC W PRIM CLOS 15950 $1,640.00 15956 PR EXC TROC PRES ULC W MYOCUT FLAP 15956 $4,150.00 15958 PR EXC TROC PRES ULC BONE MYOCUT FLAP 15958 $3,596.00 16020 PR DRESS/DEBRID SMALL BURN NO ANES 16020 $219.00 16025 PR DRESS/DEBRID MED BURN NO ANESTH 16025 $370.00 16030 PR DRESS/DEBRID LARGE BURN NO ANESTH 16030 $466.00 16035 PR ESCHAROTOMY 16035 $895.00 16036 PR INCISION OF BURN SCAB, EACH ADDNTL 16036 $207.00 17000 PR DESTRUC PREMALIGNANT, FIRST LESION 17000 $187.00 17003 PR DESTRUC PREMALIGNANT,2-14 LESIONS 17003 $24.00 17004 PR DESTRUC PREMALIGNANT,15+ LESIONS 17004 $418.00 17106 PR DESTRUC CUT/VASC <10SQ CM 17106 $906.00 17107 PR DESTRUC CUT/VASC 10-50 SQ CM 17107 $1,132.09 17108 PR DESTRUC CUT/VASC >50 SQ CM 17108 $1,690.00 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 17110 $296.00 17111 DESTRUCTION BENIGN LESIONS 15 OR MORE 17111 $347.00

17250 PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE 17250 $226.00 17260 PR DESTR MALIG TRUNK,EXTREM <0.6 CM 17260 $256.00 17261 PR DESTR MALIG TRUNK,EXTREM 0.6-1 CM 17261 $385.00 17262 PR DESTR MALIG TRUNK,EXTREM 1.1-2 CM 17262 $467.00 17263 PR DESTR MALIG TRUNK,EXTREM 2.1-3 CM 17263 $508.00 17264 PR DESTR MALIG TRUNK,EXTREM 3.1-4 CM 17264 $544.00 17266 PR DESTR MALIG TRUNK,EXTREM >4.0 CM 17266 $621.00 17270 PR DESTR MALIG SCAL,NCK,HAND <0.6 CM 17270 $393.00 17271 PR DESTR MALIG SCAL,NCK,HAND 0.6-1 CM 17271 $433.00 17272 PR DESTR MALIG SCAL,NCK,HAND 1.1-2 CM 17272 $496.00 17273 PR DESTR MALIG SCAL,NCK,HAND 2.1-3 CM 17273 $552.00 17274 PR DESTR MALIG SCAL,NCK,HAND 3.1-4 CM 17274 $620.45 17276 PR DESTR MALIG SCAL,NCK,HAND >4 CM 17276 $752.00 17280 PR DESTR MALIG FACE,NOSE,LIP <0.6 CM 17280 $367.00 17281 PR DESTR MALIG FACE,NOSE,LIP 0.6-1 CM 17281 $472.00 17282 PR DESTR MALIG FACE,NOSE,LIP 1.1-2 CM 17282 $542.00 17283 PR DESTR MALIG FACE,NOSE,LIP 2.1-3 CM 17283 $647.00 17284 PR DESTR MALIG FACE,NOSE,LIP 3.1-4 CM 17284 $702.00 17286 PR DESTR MALIG FACE,NOSE,LIP >4CM 17286 $899.00

17311 PR MOHS, 1 STAGE, HEAD/NECK/HAND/FEET/GENTIAL 17311 $2,622.00

17312 PR MOHS, ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL 17312 $1,053.00 17313 PR MOHS, 1 STAGE, TRUNK/ARM/LEG 17313 $1,645.00 17314 PR MOHS, ADDL STAGE, TRUNK/ARM/LEG 17314 $1,006.00 17315 PR MOHS SURG, ADDL BLOCK 17315 $208.00 17340 PR CRYOTHERAPY ACNE 17340 $130.00 17380 PR HAIR REMOV ELECTROLYSIS EA 30 MIN 17380 $190.00 19000 PR PUNC/ASPIR BREAST CYST 19000 $300.00 19001 PR PUCT/ASPIR BREAST CYST,EACH ADDN 19001 $77.00 19020 PR EXPLO/DRAIN BREAST ABSCESS 19020 $1,261.00 19030 PR INJECT DUCTOGRAM/GALACTOGRAM 19030 $382.00 19081 PR BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE 19081 $1,891.00

19082 PR BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE 19082 $1,349.00

19083 PR BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE 19083 $1,654.00

19084 PR BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE 19084 $1,331.00

19085 PR BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE 19085 $2,505.00

19086 PR BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE 19086 $2,005.00 19100 PR BIOPSY OF BREAST, NEEDLE CORE 19100 $410.00 19101 PR BIOPSY OF BREAST, INCISIONAL 19101 $896.00 19110 PR NIPPLE EXPLORATION 19110 $1,305.00 19112 PR EXCISE BREAST DUCT FISTULA 19112 $880.00 19120 PR REMOVAL OF BREAST LESION 19120 $1,353.00 19125 PR EXCISE BREAST LES W XRAY MARKER 19125 $1,495.00 19126 PR EXCISE BREAST LES XRAY MARK ADDNL 19126 $436.00 19260 PR EXCIS CHEST WALL TUMOR/RIBS 19260 $3,164.00 19271 PR EXCIS CHEST WALL TUM W RECON 19271 $3,906.00 19272 PR EXTENSIVE CHEST WALL SURGERY 19272 $3,807.00

19281 PR PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE 19281 $603.00

19282 PR PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE 19282 $420.00

19283 PR PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID 19283 $685.00

19285 PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG 19285 $1,157.00

19286 PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE 19286 $971.00

19287 PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID 19287 $2,138.00

19288 PR PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID 19288 $1,752.00

19294 PR PREP TUMOR CAVITY IORT W/PARTIAL MASTECTOMY 19294 $448.00 19296 PR PLACE POSTOP BREAST CATH FOR RAD 19296 $9,315.00 19297 PR PLACE INTRAOP BREAST CATH FOR RAD 19297 $258.00 19300 PR MASTECTOMY FOR GYNECOMASTIA 19300 $1,400.00 19301 PR MASTECTOMY, PARTIAL 19301 $2,340.00

PR MASTECTOMY,PARTIAL, WITH AXILLARY 19302 LYMPHADENECTOMY 19302 $2,440.00 19303 PR MASTECTOMY, SIMPLE, COMPLETE 19303 $3,574.00 19304 PR MASTECTOMY, SUBCUTANEOUS 19304 $1,516.00 19305 PR MASTECTOMY, RADICAL 19305 $3,996.00 19307 PR MASTECTOMY, MODIFIED RADICAL 19307 $4,231.00 19316 PR SUSPENSION OF BREAST 19316 $2,758.00 19318 PR BREAST REDUCTION 19318 $3,931.00 19325 PR BREAST AUGMENTATION WITH IMPLANT 19325 $1,685.00 19328 PR REMOVAL INTACT BREAST IMPLANT 19328 $1,344.00

19330 PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS 19330 $1,670.00

19340 PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY 19340 $3,563.00

19342 PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY 19342 $3,301.00 19350 PR NIPPLE/AREOLA RECONSTRUCTION 19350 $2,153.00

19357 PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION 19357 $5,960.00

19361 PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP 19361 $6,430.00 $11,264.0 19364 PR BREAST RECONSTRUCTION W/FREE FLAP 19364 0 19366 PR BREAST RECONSTRUC W OTHR TECHNIQ 19366 $5,739.00

19367 PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP 19367 $7,300.00

19368 PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST 19368 $8,990.00 19370 PR REVISION PERI-IMPLANT CAPSULE BREAST 19370 $1,805.00

19371 PR PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE 19371 $2,807.00 19380 PR REVISION OF RECONSTRUCTED BREAST 19380 $2,770.00 20005 PR I&D SOFT TISSUE ABSCESS SUBFASCIAL 20005 $1,216.00 20100 PR EXPLORE WOUND,NECK 20100 $2,179.00 20101 PR EXPLORE WOUND,CHEST 20101 $1,277.00 20102 PR EXPLORE WOUND,ABDOMEN/FLANK/BACK 20102 $1,285.00 20103 PR EXPLORE WOUND,EXTREMITY 20103 $1,543.00 20150 PR EXCISION OF EPIPHYSEAL BAR 20150 $2,753.00 20200 PR MUSCLE BIOPSY 20200 $542.00 20205 PR DEEP MUSCLE BIOPSY 20205 $789.00 20206 PR NEEDLE BIOPSY,MUSCLE 20206 $635.00 20220 PR BONE BIOPSY,TROCAR/NEEDLE SUPERF 20220 $656.00 20225 PR BONE BIOPSY,TROCAR/NEEDLE DEEP 20225 $2,089.00 20240 PR BIOPSY BONE OPEN SUPERFICIAL 20240 $770.00 20245 PR BIOPSY BONE OPEN DEEP 20245 $1,501.00 20250 PR OPEN BONE BIOP VERT DORSAL 20250 $1,255.00 20251 PR OPEN BONE BIOP VERT LUMB/CERV 20251 $1,151.00 20500 PR INJECT SINUS TRACT THERAPEUTIC 20500 $260.00 20501 PR INJECT SINUS TRACT FOR DX W XRAY 20501 $312.00 20520 PR REMOVAL OF FOREIGN BODY 20520 $562.00 20525 PR REMOVAL OF FOREIGN BODY DEEP/COMPLIC 20525 $1,267.00 20526 PR INJECT CARPAL TUNNEL 20526 $247.00 20527 PR INJECTION ENZYME PALMAR FASCIAL CORD 20527 $227.00 20550 PR INJECT TENDON SHEATH/LIGAMENT 20550 $190.00 20551 PR INJECT TENDON ORIGIN/INSERT 20551 $187.00 20552 PR INJECT TRIGGER POINT, 1 OR 2 20552 $200.00 20553 PR INJECT TRIGGER POINTS, > 3 20553 $231.00

20560 PR NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES 20560 $72.00

20561 PR NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES 20561 $107.00

20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 20600 $135.00

20604 PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT 20604 $203.00

20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 20605 $141.00

20605 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 26 26 $474.00

20606 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US 20606 $224.00

20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 20610 $226.00

20611 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 20611 $250.00 20612 PR ASPIRAT/INJECTION GANGLION CYST(S) 20612 $184.00 20615 PR ASPIR/INJEC BONE CYST 20615 $662.00 20650 PR INSERT AND REMOVE BONE PIN 20650 $613.00 20660 PR APPLY/REMOVE CRANIAL FIX DEV 20660 $1,024.00 20661 PR APPLY/REMOVE HALO CRANIAL 20661 $1,344.00

20664 PR APPLY HALO 6/> PINS THIN SKULL OSTEOLOGY 20664 $3,106.00 20670 PR REMOVAL SUPERFICIAL IMPLANT 20670 $990.00 20680 PR REMOVAL DEEP IMPLANT 20680 $1,987.00 20690 PR APPLY BONE UNIPLANE,EXT FIX DEV 20690 $1,604.00 20692 PR APPLY BONE MULTIPLAN,EXT FIX DEV 20692 $4,015.00 20693 PR ADJUST EXTERN BONE FIX DEV W ANESTH 20693 $1,517.00 20694 PR REMOVE EXTERN BONE FIX DEV W ANESTH 20694 $1,432.00

20696 PR COMP ASSIST MULTIPLANE EXT FIXATION, INITIAL 20696 $4,289.00

20700 PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV 20700 $218.00 20701 PR REMOVAL DEEP DRUG DELIVERY DEVICE 20701 $163.00

20702 PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE 20702 $362.00

20703 PR REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE 20703 $260.00

20704 PR MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE 20704 $377.00

20705 PR REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE 20705 $310.00 $10,610.0 20816 PR REPLANTATION DIGIT MCP, COMPLETE 20816 0 20822 PR REPLANTATION DIGIT DISTAL, COMPLT 20822 $9,144.00 20824 PR REPLANTATION THUMB MCP, COMPLETE 20824 $7,949.00 20827 PR REPLANTATION THUMB DISTAL,COMPLETE 20827 $7,474.00 20900 PR REMV BONE FOR GRAFT MINOR 20900 $1,204.00 20902 PR REMV BONE FOR GRAFT MAJOR 20902 $1,917.00 20910 PR REMV CARTILAGE FOR GRAFT COSTOCH 20910 $1,145.00 20912 PR REMV CARTILAGE FOR GRAFT NASAL 20912 $1,269.00 20922 PR REMV FASCIA FOR GRAFT INCIS 20922 $1,599.00 20924 PR REMV TENDON FOR GRAFT 20924 $1,642.00 20926 PR REMV TISSUE FOR GRAFT OTHR 20926 $1,140.00

20930 PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED 20930 $624.00 20931 PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL 20931 $573.00

PR OSTEOARTICULAR ALLOGRAFT W/ARTICULAR SURF & 20932 BONE 20932 $2,684.00

20933 PR HEMICORTICAL INTERCALARY ALLOGRAFT PARTIAL 20933 $2,377.00 20934 PR INTERCALARY ALLOGRAFT COMPLETE 20934 $2,590.00

20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION 20936 $414.00

20937 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION 20937 $861.00

20938 AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INCISION 20938 $956.00

20939 PR BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY 20939 $350.00 20950 PR RECORD FLUID PRESSURE,MUSCLE 20950 $692.00 $10,198.0 20955 PR MICROVASCULAR FIBULA GRAFT 20955 0 $10,821.0 20956 PR MICROVASCULAR ILIAC CREST GRAFT 20956 0 $10,939.0 20962 PR MICROVASCULAR BONE GRAFT,OTHER 20962 0 $11,239.0 20969 PR BONE-SKIN GRAFT, MICROVASCULAR 20969 0 20975 PR ELECT BONE STIM INVASIVE 20975 $425.00

PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN 20982 DONE 20982 $9,739.00

PR ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN 20983 PRFMD 20983 $1,007.00

20985 PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS 20985 $640.00 21010 PR INCISION OF JAW JOINT 21010 $2,640.00

21011 PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM 21011 $964.00

21012 PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM 21012 $906.00

21013 PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL < 2CM 21013 $1,414.00

21014 PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2+CM 21014 $1,397.00

21015 PR RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM 21015 $1,793.00 21016 PR RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/> 21016 $3,623.00 21025 PR EXCISION OF BONE, LOWER JAW 21025 $3,095.00 21026 PR EXCISION OF FACIAL BONE(S) 21026 $1,571.00 21029 PR CONTOUR OF FACE BONE LESION 21029 $2,023.00 21030 PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOMA 21030 $1,320.00 21031 PR EXCISION,TORUS MANDIBULARIS 21031 $1,049.00 21032 PR EXCISION,MAXILLARY TORUS PALATINUS 21032 $1,090.00 21034 PR EXCISION,MALIG TUMOR, MAXILLA/ZYGOMA 21034 $4,033.00 21040 PR EXCISION,BENIGN TUMOR,MANDIBLE 21040 $1,044.00 21044 PR REMV MALIG JAW BONE LESION 21044 $2,669.00 21045 PR REMV MALIG JAW BONE RADICAL 21045 $3,708.00 21046 PR EXCISION,BEN TUMOR,MANDIBLE,INTRA-ORAL 21046 $3,928.00 21047 PR EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL 21047 $5,368.00 21048 PR EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL 21048 $4,018.00 21049 PR EXCISION,BEN TUMOR,MAXILLA,EXTRA-ORAL 21049 $4,299.00 21070 PR REMV CORONOID PROCESS 21070 $1,547.00 21079 PR PREP FACE/ORAL PROST TEMP OBTURATOR 21079 $3,412.00 21080 PR PREP FACE/ORAL PROST FINL OBTURATOR 21080 $5,000.00 21085 PR PREP FACE/ORAL PROST ORAL SPLINT 21085 $2,024.00 21086 PR PREP FACE/ORAL PROST AURICULAR 21086 $3,910.00 21089 PR PREP FACE/ORAL PROST UNLISTED 21089 $1,700.00 21110 PR INTERDENTAL FIXATION 21110 $2,138.00 21137 PR REDUC FOREHEAD,CONTOURING 21137 $2,690.00 21141 PR RECONST FACE,LEFORT I,1 PIECE 21141 $4,910.00 21142 PR RECONST FACE,LEFORT I,2 PIECES 21142 $5,866.00 21145 PR RECONST FACE,LEFORT I,1 PIECE+GRFT 21145 $6,576.00 21147 PR RECONST FACE,LEFORT I,3+PIECES+GRFT 21147 $7,229.00 21172 PR RECONST ORBIT/FOREHEAD 21172 $8,540.00 21175 PR RECONST ORBIT/FOREHEAD BIFRONTAL 21175 $9,075.00 21179 PR RECONST ENTIRE FOREHEAD+GRAFT 21179 $5,551.00 21180 PR RECONST ENTIRE FOREHEAD+AUTOGRFT 21180 $6,935.00 21181 PR CONTOUR CRANIAL BONE LESION 21181 $2,649.00 21188 PR RECONST MIDFACE 21188 $6,643.00 21193 PR RECONST MANDIBLE,C/L OSTEOTOMY 21193 $5,360.00 21194 PR RECONST MANDIBLE,C/L OSTEO+GRFT 21194 $6,028.00 21196 PR RECONST MANDIBLE,SAG SPLIT+FIXATN 21196 $6,790.00 21198 PR OSTEOTOMY, MANDIBLE 21198 $4,172.00 21199 PR RECONST MANDIBLE,GLOSSAL ADVANCEMT 21199 $3,605.00 21206 PR RECONST MAXILLA,SEGMENTAL 21206 $4,345.00 21208 PR AUGMENT FACIAL BONES 21208 $4,884.00 21209 PR REDUCTION OF FACIAL BONES 21209 $2,289.00 21210 PR NASAL,MAXILLA,MALAR BONE GRAFT 21210 $7,917.00 21215 PR MANDIBLE GRAFT 21215 $2,406.00 21230 PR RIB CARTILAGE GRAFT TO FACE 21230 $1,737.00 21235 PR EAR CARTILAGE GRAFT TO FACE 21235 $1,928.00 21240 PR ARTHROPLASTY TMJ 21240 $4,003.00 21247 PR RECONSTR MANDIB CONDYLE 21247 $6,681.00 21248 PR RECONSTR JAW,PART-ENDO IMPLNT 21248 $3,957.00 21267 PR REPOSITN ORBITS,EXTRACRAN 21267 $6,456.00 21270 PR AUGMENTATION CHEEK BONE 21270 $3,616.00 21280 PR REVISION OF EYELID,MEDIAL 21280 $1,440.00 21282 PR REVISION OF EYELID,LATERAL 21282 $2,415.00 21310 PR CLOSED RX NOSE FRACTURE 21310 $346.00 21315 PR CLOSED RX NOSE FRACTURE 21315 $729.00 21320 PR CLOSED RX NOSE FX W STABILIZATN 21320 $676.00 21325 PR OPEN RX NOSE FRACTURE 21325 $1,207.00 21330 PR OPEN RX NOSE FX COMPLICATED 21330 $1,785.00 21335 PR OPEN RX NOSE FX+OPEN FIX SEPTUM 21335 $1,846.00 21336 PR OPEN RX NASAL SEPTAL FRACTURE 21336 $1,633.00 21337 PR CLOSED RX NASAL SEPTAL FRACTURE 21337 $1,065.00 21338 PR REPAIR NASOETHMOID FRACTURE 21338 $2,431.00 21339 PR REPAIR NASOETHMOID FX+EXTERN FIXATN 21339 $2,291.00 21340 PR REPAIR NASOETHMOID COMPLEX FRACTURE 21340 $2,858.00 21343 PR OPEN RX DEPRES FRONTAL SINUS FRAC 21343 $4,631.00 21344 PR OPEN RX COMPLIC FRONT SINUS FRACT 21344 $5,647.00 21345 PR CLOSED RX NOSE/JAW FRAC+WIRES 21345 $2,140.00 21346 PR OPEN RX NOSE/JAW FRACT+WIRES 21346 $2,244.00 21347 PR OPEN RX NOSE/JAW FRACT/COMPLX 21347 $3,809.00 21348 PR OPEN RX NOSE/JAW FRACT+GRAFT 21348 $4,895.00 21355 PR CLOSED REPAIR CHEEK BONE FRAC 21355 $1,199.00 21356 PR OPEN RX DEPRESS ZYGOMA FRAC 21356 $1,318.00 21360 PR OPEN RX DEPRESS MALAR FRAC 21360 $1,908.00 21365 PR OPEN RX COMPLX CHEEK BONE FRAC 21365 $3,977.00 21385 PR REPAIR EYE BLOWOUT,TRANSANTRAL 21385 $1,945.00 21386 PR REPAIR EYE BLOWOUT,PERIORBITAL 21386 $1,834.00 21387 PR REPAIR EYE BLOWOUT,COMBINED 21387 $2,664.00 21390 PR REPAIR EYE BLOWOUT,PERIORB+IMPLNT 21390 $2,862.00 21401 PR CLOSED RX FX ORBIT W MANIPULATN 21401 $1,377.00 21406 PR OPEN RX FX ORBIT 21406 $1,470.00 21407 PR OPEN RX FX ORBIT W IMPLANT 21407 $1,721.00 21408 PR OPEN RX FX ORBIT W GRAFT 21408 $3,229.00 21421 PR CLOSED RX LEFORTE I+WIRES 21421 $1,773.00 21422 PR OPEN RX LEFORTE I 21422 $1,815.00 21423 PR OPEN RX LEFORTE I,COMPLICATED 21423 $3,801.00 21432 PR OPEN RX LEFORTE III+FIXATN 21432 $2,876.00 21433 PR OPEN RX LEFORTE III,COMPLICATED 21433 $7,134.00 21435 PR OPEN RX LEFORTE III,COMPL+FIXATN 21435 $5,737.00 21440 PR CLOSED RX DENTAL RIDGE FX 21440 $1,754.00 21445 PR OPEN RX DENTAL RIDGE FX 21445 $1,985.00 21451 PR CLOSED RX MANDIBLE FX+MANIPULATN 21451 $2,086.00 21452 PR PERCUT RX MANDIBLE FX EXT FIXATN 21452 $1,704.00 21453 PR CLOSED RX MANDIBLE FX+DENTAL FIX 21453 $2,455.00 21454 PR OPEN RX MANDIBLE FX+EXTERN FIX 21454 $1,468.00 21461 PR OPEN RX MANDIBLE FX 21461 $3,787.00 21462 PR OPEN RX MANDIBLE FX+DENTAL FIX 21462 $7,884.00 21470 PR OPEN RX MANDIBLE CONDYLE FX,COMPL 21470 $4,299.00 21480 PR REDUCE TEMPOROMANDIBL DISLOC 21480 $311.00 21485 PR REDUCE TEMPOROMANDIBL DISLOC,COMP 21485 $2,114.00 21501 PR I&D DEEP ABSC/HEMATOMA NECK/CHEST 21501 $1,251.00 21502 PR I&D DEEP ABSC NECK/CHST+RIB CUT 21502 $1,361.00 21550 PR BIOPSY SOFT TISSUE NECK/CHEST 21550 $699.00

21552 PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM 21552 $1,201.00

PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL 21554 5+CM 21554 $2,616.00

21555 PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM 21555 $1,143.00

PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL 21556 <5CM 21556 $1,418.00

21557 PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM 21557 $3,434.00

21558 PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/> 21558 $3,619.00 21600 PR PARTIAL REMOVAL OF RIB 21600 $1,485.00

21601 PR EXCISION CHEST WALL TUMOR INCLUDING RIBS 21601 $3,643.00 PR EXCISION CH WAL TUM W/RIB W/O MEDSTNL 21602 LYMPHADEC 21602 $6,518.00

21603 PR EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMPHADEC 21603 $7,211.00 21610 PR COSTOTRANSVERSECTOMY 21610 $5,956.00 21615 PR REMOVAL 1ST/CERVICAL RIB 21615 $1,975.00 21620 PR PARTIAL REMOVAL OF STERNUM 21620 $1,361.00 21627 PR STERNAL DEBRIDEMENT 21627 $1,739.00 21630 PR RADICAL RESECTN STERNUM 21630 $4,372.00 21632 PR RAD RESEC STERNUM+MEDIAST NODES 21632 $4,329.00 21685 PR HYOID MYOTOMY & SUSPENSION 21685 $3,482.00 21700 PR DIVIDE SCALENUS ANTICUS 21700 $1,370.00 21705 PR DIVIDE SCALENUS+RESECT CERV RIB 21705 $1,448.00 21720 PR DIVIDE STERNOMASTOID OPEN 21720 $1,866.00 21740 PR RECONST PECTUS EXCAV/CARIN,OPEN 21740 $3,728.00

21743 PR RECONST PECTUS EXCAV/CARIN W/ THORACOS 21743 $6,413.00

21750 PR CLOSE MED STERNOTOMY SEP, W/WO DEBRIDE 21750 $2,641.00

21811 PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS 21811 $2,131.00

21812 PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS 21812 $2,595.00 21820 PR CLOSED RX STERNUM FRACTURE 21820 $390.00 21825 PR OPEN RX STERNUM FRACTURE 21825 $1,594.00 21925 PR BIOPSY SOFT TISSUE BACK,DEEP 21925 $1,436.00

21930 PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM 21930 $2,195.00

21931 PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM 21931 $1,269.00

21932 PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 21932 $1,786.00

21933 PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM 21933 $2,644.00

21935 PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM 21935 $3,967.00

21936 PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/> 21936 $4,037.00 22010 PR I&D, POST SPINE, CERV/THOR/CERV-THOR 22010 $3,138.00 22015 PR I&D, POST SPINE, LUMB/SACR/LUMBOSAC 22015 $3,110.00 22100 PR REMV PART POST CERV VERT,1 LVL 22100 $4,644.00 22101 PR REMV PART POST THOR VERT,1 LVL 22101 $4,463.00 22102 PR REMV PART POST LUMB VERT,1 LVL 22102 $2,916.00 22103 PR REMV PART POST VERT,EA ADDN SGMT 22103 $715.00 22110 PR REMV PART CERV VERT BODY,1 LVL 22110 $5,341.00 22116 PR REMV PART VERT BODY,EA ADDN SGMT 22116 $360.00

$12,591.0 22206 PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC 22206 0

$12,327.0 22207 PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR 22207 0

22208 PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM 22208 $3,034.00 22210 PR OSTEOTOMY CERV SP,POST,1 LVL 22210 $9,178.00 22212 PR OSTEOTOMY THOR SP,POST,1 LVL 22212 $7,681.00 22214 PR OSTEOTOMY LUMB SP,POST,1 LVL 22214 $7,709.00 22216 PR OSTEOTOMY,POST,EA ADDN SGMT 22216 $1,873.00 22220 PR OSTEOTOMY CERV SP,ANT,REMV DISC 22220 $8,124.00 22222 PR OSTEOTOMY THOR SP,ANT,REMV DISC 22222 $5,136.00 22224 PR OSTEOTOMY LUMB SP,ANT,REMV DISC 22224 $8,048.00 22226 PR OSTEOTOMY,DISCECT,ANT,EA ADDNL SGMT 22226 $1,850.00 22305 PR CLOSED TREAT SPINE PROCESS FX 22305 $684.00 22310 PR CLOSED TREAT VERT BODY FRACT 22310 $979.00 22315 PR CLOSED TREAT VERT BODY FX,MANIPULATN 22315 $3,123.00 22318 PR ODONTOID FX,W/O GRAFT,OPEN 22318 $8,374.00 22319 PR ODONTOID,FX,GRAFTING,OPEN 22319 $9,273.00 22325 PR OPEN POST RX LUMB VERT FX,1 LVL 22325 $7,448.00 22326 PR OPEN POST RX CERV VERT FX,1 LVL 22326 $7,672.00 22327 PR OPEN POST RX THOR VERT FX,1 LVL 22327 $7,754.00 22328 PR OPEN POST REPAIR EA ADDN VERT FX 22328 $1,447.00

22510 PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC 22510 $2,170.00

22511 PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL 22511 $2,040.00

PR VERTEBROPLASTY EACH ADDL 22512 CERVICOTHOR/LUMBOSACRAL 22512 $1,035.00

22513 PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION 22513 $2,580.00 22514 PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR 22514 $2,410.00

22515 PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH 22515 $1,105.00 22532 PR LAT THORAX SPINE FUSION 22532 $9,236.00 22533 PR LAT LUMBAR SPINE FUSION 22533 $8,538.00 22534 PR LAT THOR/LUMB, ADDL SEG 22534 $1,859.00

PR ARTHRODESIS ANT INTERBODY INC DISCECTOMY, 22551 CERVICAL BELOW C2 22551 $8,750.00

PR ARTHRODESIS ANT INTERBODY INC DISCECTOMY, 22552 CERVICAL BELOW C2 EACH ADDL 22552 $2,045.00 22554 PR CERV SPINE FUSN,ANTER,BELOW C2 22554 $6,443.00 22556 PR THORAX SPINE FUSION,ANTER APPRCH 22556 $8,548.00 22558 PR LUMBAR SPINE FUSION,ANTER APPRCH 22558 $7,882.00 22585 PR SPINAL FUSION,ANT,EA ADNL LEVEL 22585 $1,687.00

22586 PR ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5/S1 22586 $7,759.00 22590 PR CRANIOCERV FUSN,POST TECHNIQUE 22590 $8,081.00 22595 PR CERV C1-2 FUSN,POSTER TECH 22595 $7,705.00 22600 PR CERV FUSN,BELOW C2,POST TECH 22600 $6,610.00

22610 PR ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC 22610 $6,503.00

22612 PR ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR 22612 $8,165.00 22614 PR SPINE FUSN,POST TECH,EA ADDNL SGMT 22614 $2,016.00 22630 PR LUMBAR SPINE FUSN,POST INTRBDY 22630 $8,076.00 22632 PR LUMB SP FUSN,POST INTERBDY,EA ADDNL 22632 $1,656.00

22633 PR ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR 22633 $9,518.00

22634 PR ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG 22634 $2,553.00 22800 PR SPINE FUSN,POSTER,UP TO 6 SGMTS 22800 $6,992.00 $10,843.0 22802 PR SPINE FUSION,POSTER,7-12 SGMTS 22802 0 $12,491.0 22804 PR SPINE FUSION,POSTER,13+ SGMTS 22804 0 22808 PR SPINE FUSION,ANTER,3 SGMTS 22808 $9,432.00 $10,425.0 22810 PR SPINE FUSION,ANTER,4-7 SGMTS 22810 0 22830 PR EXPLORATION OF SPINAL FUSION 22830 $4,199.00 22840 POSTERIOR NON-SEGMENTAL INSTRUMENTATION 22840 $3,913.00

22841 INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS 22841 $1,008.00

22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG 22842 $3,930.00

22843 POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG 22843 $4,200.00

22844 POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SEG 22844 $5,081.00

22845 ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS 22845 $3,749.00

22846 ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS 22846 $3,898.00

22847 ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS 22847 $2,868.00 22848 PELVIC FIXATION OTHER THAN SACRUM 22848 $1,858.00 22849 PR REINSERT SPINAL FIXATION 22849 $6,699.00 22850 PR REMOVE SPINE FIX DEV,HARRINGTON 22850 $3,745.00

22851 PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE 22851 $2,125.00 22852 PR REMOVE SPINE FIX DEV,POST SGMTAL 22852 $3,596.00

22853 PR INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD 22853 $1,086.00

22854 PR INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD 22854 $907.00 22855 PR REMOVE SPINE FIX DEV,ANTERIOR 22855 $5,697.00

22856 PR TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV 22856 $8,399.00

22858 PR TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL 22858 $2,633.00

22859 PR INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD 22859 $1,409.00

22867 PR INSJ STABLJ DEV W/DCMPRN LUMBAR SINGLE LEVEL 22867 $3,587.00

22868 PR INSJ STABLJ DEV W/DCMPRN LUMBAR SECOND LEVEL 22868 $641.00

22869 PR INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL 22869 $1,409.00 22870 PR INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL 22870 $374.00

22900 PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM 22900 $1,518.00

22901 PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM 22901 $2,390.00

22902 PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM 22902 $1,153.00

22903 PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM 22903 $1,185.00

22904 PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM 22904 $3,731.00

22905 PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/> 22905 $5,405.00 23030 PR INCIS/DRAIN SHLDR ABSC/HEMA,DEEP 23030 $1,209.00 23031 PR DRAIN INFECT SHOULDER BURSA 23031 $1,076.00 23035 PR DRAIN SHOULDER BONE LESION 23035 $2,436.00 23040 PR DEEP INCIS SHLDR BONE CORTEX 23040 $2,554.00 23044 PR EXPLOR/REMV INFECT GLENO-HUM JT 23044 $1,639.00 23065 PR EXPLOR INFECT A-C/S-C JT 23065 $654.00 23066 PR BIOPSY SHLDR SOFT TISSUES,SUPERFIC 23066 $1,514.00

23071 PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM 23071 $1,132.00

23073 PR EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5+CM 23073 $2,440.00

23075 PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM 23075 $1,340.00

23076 PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM 23076 $1,457.00

23077 PR RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM 23077 $3,877.00

23078 PR RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/> 23078 $3,875.00 23107 PR EXPLORE SHOULDER JOINT 23107 $1,861.00 23120 PR PARTIAL REMOVAL, CLAVICLE 23120 $1,807.00 23125 PR TOTAL REMOVAL OF CLAVICLE 23125 $1,908.00 23130 PR PARTIAL REMOVAL/REPAIR,ACROMION 23130 $1,946.00 23140 PR EXCIS/CURET BENIGN TUMR CLAV/SCAPULA 23140 $1,487.00 23146 PR EXCIS BENIGN TUMR CLAV/SCAP,ALLOGRFT 23146 $2,237.00 23150 PR EXCIS/CURET BENIGN TUMR PROX HUMERUS 23150 $2,058.00 23156 PR EXCIS BENIG TUMR PROX HUMER,AUTOGRFT 23156 $1,863.00 23170 PR SEQUESTRECTOMY, CLAVICLE 23170 $1,997.00 23174 PR SEQUESTRECTOMY,HUMER HEAD-SURG NECK 23174 $2,723.00 23180 PR PART EXCIS CLAVICLE 23180 $2,343.00 23182 PR PART EXCIS SCAPULA 23182 $2,370.00 23184 PR PART EXCIS PROX HUMERUS 23184 $2,655.00 23195 PR REMOVAL OF HEAD OF HUMERUS 23195 $2,692.00 23200 PR RAD RESECT CLAVICLE FOR TUMOR 23200 $6,214.00 23220 PR RAD RESECT PROX HUMERUS FOR TUMOR 23220 $7,000.00 23330 PR REMOVE SUBCUT SHOULDER FOREIGN BODY 23330 $772.00

23333 PR REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM 23333 $1,186.00

23334 PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT 23334 $3,736.00

PR PROSTHESIS REMOVAL HUMERAL AND GLENOID 23335 COMPONENT 23335 $4,545.00 23350 PR INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI 23350 $794.00 23395 PR MUSCLE TRANSFER,SHOULDER/ARM,SINGLE 23395 $4,545.00 23397 PR MUSCLE TRANSFER,SHLDR/ARM,MULTIPLE 23397 $4,062.00 23400 PR FIXATION OF SHOULDER BLADE 23400 $3,345.00 23405 PR INCISE TENDON/MUSCLE,SHLDR,SINGLE 23405 $1,665.00 23406 PR INCISE TENDON/MUSCLE,SHLDR,MULTIPLE 23406 $2,761.00 23410 PR REPAIR ROTATOR CUFF,ACUTE 23410 $2,923.00 23412 PR REPAIR ROTATOR CUFF,CHRONIC 23412 $3,109.00 23415 PR CORACO-ACROMIAL LIG RELEASE 23415 $2,506.00 23420 PR REPAIR COMPL ROTATOR CUFF AVULSN,CHR 23420 $3,433.00 23430 PR REPAIR BICEPS LONG TENDON 23430 $2,417.00 23440 PR REMV/TRANSPLANT LONG BICEPS TENDON 23440 $2,721.00 23450 PR REPAIR SHOULDER CAPSULE,ANTERIOR 23450 $3,374.00 23455 PR REPAIR SHOULDER CAPSULE,BANKART 23455 $3,340.00 23460 PR REPAIR SHLDR CAPSUL,ANT,BONE BLOCK 23460 $3,585.00 23462 PR REPAIR SHLDR CAPSU,ANT,CORACOID XFER 23462 $3,503.00 23465 PR REPAIR SHLDR CAPSU,POST,RECUR DISLOC 23465 $3,941.00 23466 PR REPAIR SHLDR CAPSU FOR INSTABILITY 23466 $3,992.00 23470 PR RECONSTRUCT PROX HUMERAL IMPLANT 23470 $3,929.00 23472 PR RECONSTR TOTAL SHOULDER IMPLANT 23472 $5,781.00

PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID 23473 COMPNT 23473 $6,601.00 PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID 23474 COMPNT 23474 $6,840.00 23480 PR OSTEOTOMY CLAVICLE 23480 $2,953.00 23485 PR OSTEOTOMY CLAVICLE W BONE GRAFT 23485 $3,124.00 23490 PR REINFORCE CLAVICLE 23490 $3,070.00 23491 PR REINFORCE PROX HUMERUS/HEAD 23491 $3,618.00 23500 PR CLOSED RX CLAVICLE FRACTURE 23500 $589.00 23505 PR CLOSED RX CLAVICLE FX,MANIPULATN 23505 $1,177.00

23515 OPEN TREATMENT CLAVICULAR FRACTURE INTERNAL FX 23515 $1,935.00 23525 PR CLOSED RX STERN-CLAV DISLOC,MANIP 23525 $1,153.00 23530 PR OPEN RX STERN-CLAV DISLOC 23530 $1,828.00 23532 PR OPEN RX STERN-CLAV DISLOC,FASC GRFT 23532 $2,223.00 23540 PR CLOSED RX A-C JT DISLOC 23540 $622.00 23545 PR CLOSED RX A-C JT DISLOC,MANIPULATN 23545 $1,010.00 23550 PR OPEN RX A-C JT DISLOC 23550 $2,099.00 23552 PR OPEN RX A-C JT DISLOC,FASCIAL GRFT 23552 $2,318.00 23570 PR CLOSED RX SCAPULA FX 23570 $766.00 23585 PR OPEN RX SCAPULA FRACTURE 23585 $2,635.00 23600 PR CLOSED RX PROX HUMERUS FRACTURE 23600 $1,119.00 23605 PR CLOSED RX PROX HUMERUS FX,MANIP 23605 $1,501.00 23615 OPEN TREATMENT PROX HUMERAL FRACTURE 23615 $2,398.00

23616 OPEN PROX HUMERAL FRACTURE PROSHETIC REPLACEMENT 23616 $4,421.00 23620 PR CLOSED RX GR TUBEROSITY HUM FX 23620 $979.00 23630 PR OPEN RX GR TUBEROSITY FX 23630 $2,095.00 23650 PR CLOSED RX SHLDR DISLOCATION 23650 $855.00 23655 PR CLOSED RX SHLDR DISLOC,ANESTHESIA 23655 $1,084.00 23660 PR OPEN RX ACUTE SHLDR DISLOC 23660 $1,909.00 23665 PR CLOSED RX SHLDR DISLOC,GR TUB FX 23665 $1,496.00 23670 PR OPEN RX SHLDR DISLOC,GR TUB FX 23670 $3,100.00 23675 PR CLOSED RX SHLDR DISLOC,PROX HUM FX 23675 $1,787.00 23700 PR MANIPULATN SHLDR JT W ANESTHESIA 23700 $641.00 23800 PR FUSION SHOULDER JOINT 23800 $3,298.00 23900 PR AMPUTATION OF ARM & GIRDLE 23900 $5,694.00 23920 PR AMPUTATION AT SHOULDER JOINT 23920 $4,035.00 23930 PR INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA 23930 $953.00 23931 PR INCIS/DRAIN ARM/ELBOW INFECT BURSA 23931 $1,010.00 23935 PR INCIS DEEP ARM/ELBOW BONE LESION 23935 $1,796.00 24000 PR EXPLORE/DRAIN ELBOW FOR INFECT 24000 $1,482.00 24006 PR ARTHROTOMY/CAPULE RELEASE ELBOW JT 24006 $2,266.00 24065 PR BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL 24065 $690.00 24066 PR BX ARM/ELBOW SOFT TISSUE,DEEP 24066 $1,664.00

24071 PR EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM 24071 $1,093.00

24073 PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5+CM 24073 $4,488.00

24075 PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM 24075 $1,386.00

24076 PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM 24076 $1,462.00

24077 PR RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM 24077 $3,239.00

24079 PR RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/> 24079 $4,968.00 24101 PR EXPLORE ELBOW JOINT 24101 $1,750.00 24102 PR EXPLOR ELBOW JT/REMOV SYNOVIUM 24102 $2,290.00 24105 PR REMOVAL OF ELBOW BURSA 24105 $1,046.00 24110 PR EXCIS/CURET BENIGN HUMERUS LESN 24110 $1,909.00 24116 PR EXCIS BENIGN HUMERUS LESN,ALLOGRFT 24116 $3,073.00 24120 PR EXCIS/CURET BENIGN ELBOW LESN 24120 $1,663.00 24130 PR REMOVAL OF HEAD OF RADIUS 24130 $1,619.00 24138 PR SEQUESTRECTOMY,OLECRANNON PROCESS 24138 $1,827.00 24140 PR PARTIAL REMOVAL HUMERUS 24140 $2,467.00 24147 PR PARTIAL REMOVAL OLECRANNON PROCESS 24147 $2,132.00 24149 PR RADICAL RESECT ELBOW, CONTRAC RELEAS 24149 $3,414.00 24150 PR RADICAL RESEC MID/DIST HUMERUS 24150 $5,495.00

PR PROSTHESIS REMOVAL HUMERAL AND ULNAR 24160 COMPONENTS 24160 $3,384.00 24164 PR PROSTHESIS REMOVAL RADIAL HEAD 24164 $2,585.00 24200 PR REMOVAL ARM/ELBOW F.B.,SUPERFICIAL 24200 $578.00 24201 PR REMOVAL ARM/ELBOW F.B.,DEEP 24201 $1,928.00 24220 PR INJECTION FOR ELBOW ARTHROGRAM 24220 $719.00 24300 PR MANIPULATE ELBOW W/ANESTH 24300 $1,141.00 24301 PR MUSC/TENDON XFER,ARM/ELBOW,SINGLE 24301 $2,655.00 24305 PR ARM/ELBOW TENDON LENGTHEN,SINGLE,EA 24305 $1,875.00 24310 PR TENOTOMY,ELBOW-SHLDR,SINGL,EACH 24310 $1,545.00 24320 PR TENOPLASTY,ELB-SHLDR,MUSC XFER,SINGL 24320 $2,782.00 24332 PR TENOLYSIS, TRICEPS 24332 $1,845.00 24340 PR REPAIR OF BICEPS TENDON AT ELBOW 24340 $1,969.00 24341 PR MUSC/TENDON REPAIR EACH; ARM/ELBOW 24341 $2,163.00 24342 PR REINSERT BI/TRICEPS TENDON,DISTAL 24342 $2,549.00 24343 PR REPR ELBOW LAT LIGMNT W/TISS 24343 $2,336.00 24344 PR RECONSTRUCT ELBOW LAT LIGMNT W/GRAFT 24344 $3,865.00 24345 PR REPR ELBW MED LIGMNT W/TISS 24345 $1,885.00 24346 PR RECONSTRUCT ELBOW MED LIGMNT W/GRAFT 24346 $3,890.00

24357 PR TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS 24357 $1,116.00

24358 PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE OPEN 24358 $1,575.00

24359 PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE REPAIR 24359 $1,934.00 24360 PR ARTHROPLASTY,ELBOW,W MEMBRANE 24360 $3,187.00 24363 PR ARTHROPLASTY,ELBOW,TOTAL PROSTH REPL 24363 $4,994.00 24365 PR RECONSTRUCT RADIAL HEAD 24365 $2,303.00 24366 PR RECONSTRUCT RADIAL HEAD W IMPLANT 24366 $2,212.00

24370 PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT 24370 $6,297.00

24371 PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT 24371 $7,339.00 24400 PR OSTEOTOMY HUMERUS 24400 $2,666.00 24430 PR REPAIR NON/MALUNION HUMERUS 24430 $3,020.00 24435 PR REPAIR NON/MALUNION HUMERUS,GRAFT 24435 $3,203.00 24495 PR DECOMPRESS FOREARM,BRACH ART EXPLOR 24495 $2,248.00 24498 PR REINFORCE HUMERUS 24498 $3,103.00 24500 PR CLOSED RX MID HUMERUS FRACTURE 24500 $1,116.00 24505 PR CLOSED RX MID HUMERUS FX,MANIPULATN 24505 $1,630.00 24515 PR OPEN FIXATN MID HUMERUS FRACTURE 24515 $2,804.00 24516 PR OPEN ROD FIXATN HUMERAL SHAFT FX 24516 $2,776.00 24530 PR CLOSED RX HUMERAL SUPRACONDYLAR FX 24530 $1,157.00 24535 PR CLOSED RX HUM SUPRACONDYLR FX,MANIPU 24535 $2,007.00 24538 PR PERCUT FIX HUM SUPRACONDYLAR FX 24538 $2,403.00

24545 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN 24545 $2,522.00

24546 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W XTN 24546 $3,620.00 24560 PR CLOSED RX HUMER EPICONDYLR FX 24560 $879.00 24565 PR CLOSED RX HUMER EPICONDYLR FX,MANIP 24565 $1,439.00 24566 PR PERCUT FIXATN HUMERAL EPICONDYLAR FX 24566 $2,539.00 24575 OPEN TX HUMERAL EPICONDYLAR FRACTURE 24575 $2,531.00 24576 PR CLOSED RX HUMER CONDYLR FX 24576 $1,012.00 24577 PR CLOSED RX HUMER CONDYLR FX,MANIP 24577 $1,752.00 24579 OPEN TX HUMERAL CONDYLAR FRACTURE 24579 $2,734.00 24582 PR PERCUT FIXATN HUMERAL CONDYLAR FX 24582 $2,323.00 24586 PR OPEN RX PERIARTIC FX/DISLOC ELBOW 24586 $3,837.00 24587 PR OPEN RX PERIARTIC FX ELBOW,IMPLNT 24587 $3,840.00 24600 PR CLOSED RX ELBOW DISLOCATION 24600 $1,276.00 24605 PR CLOSED RX ELBOW DISLOCATN,ANESTHESIA 24605 $1,412.00 24615 PR OPEN RX ELBOW DISLOCATION 24615 $2,289.00 24620 PR CLOSED RX MONTEGGIA FX/DISLOC ELBOW 24620 $1,737.00

24635 OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW 24635 $3,620.00 24640 PR CLOSED RX RADIAL HEAD DISLOC,CHILD 24640 $345.00 24650 PR CLOSED RX RADIAL HEAD/NECK FX 24650 $865.00 24655 PR CLOSED RX RADIAL HEAD/NECK FX,MANIP 24655 $1,452.00 24665 OPEN TX RADIAL HEAD/NECK FRACTURE 24665 $2,076.00

24666 OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC 24666 $2,393.00

24670 CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE 24670 $905.00

24675 CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION 24675 $1,229.00 24685 OPEN TX ULNAR FRACTURE PROX END 24685 $2,175.00 24800 PR FUSION OF ELBOW JOINT 24800 $2,958.00 24802 PR FUSION/GRAFT OF ELBOW JOINT 24802 $3,595.00 24900 PR AMPUTATN ARM,THRU HUMERUS,PRIM CLOS 24900 $2,635.00 24920 PR AMPUTATN ARM,THRU HUMERUS,CIRCULAR 24920 $2,551.00 24925 PR AMPUTATN ARM,THRU HUMER,SECOND CLOS 24925 $1,773.00 25000 PR INCIS TENDON SHEATH,RADIAL STYLOID 25000 $1,331.00 25001 PR INCIS FLEXOR TENDON SHEATH,WRIST 25001 $920.00 25020 PR DECOMP FOREARM,1 COMPART,W/O DEBRIDE 25020 $2,056.00 25023 PR DECOMPRESS FOREARM,EXCIS MUSC/NERV 25023 $4,302.00 25024 PR DECOMP FOREARM,2 COMPART,W/O DEBRIDE 25024 $2,268.00 25025 PR DECOMP FOREARM,2 COMPART,W/ DEBRIDE 25025 $4,328.00 25028 PR INCIS/DRAIN FOREARM DEEP ABSCESS 25028 $1,777.00 25035 PR INCIS FOREARM BONE LESION 25035 $1,567.00 25040 PR EXPLORE/TREAT WRIST JOINT 25040 $1,919.00 25065 PR BIOPSY FOREARM SOFT TISSUES,SUPERFIC 25065 $1,922.00 25066 PR BIOPSY FOREARM SOFT TISSUES,DEEP 25066 $1,468.00

25071 PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3+CM 25071 $1,141.00

25073 PR EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM 25073 $1,437.00

25075 PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM 25075 $1,353.00

25076 PR EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM 25076 $1,389.00

25077 PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM 25077 $2,389.00

25078 PR RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/> 25078 $3,133.00 25085 PR INCISION OF WRIST CAPSULE 25085 $1,583.00 25100 PR BIOPSY OF WRIST JOINT 25100 $1,246.00 25101 PR EXPLORE/TREAT WRIST JOINT 25101 $1,425.00 25105 PR EXPLOR WRIST JT/REMV SYNOVIUM 25105 $1,301.00 25107 PR REPAIR TRIANGULAR CART,WRIST JT 25107 $1,940.00 25109 PR EXCISE TENDON FOREARM/ WRIST 25109 $1,915.00 25110 PR EXCIS TENDON SHEATH LESN,WRIST/FORE 25110 $917.00 25111 PR EXCIS PRIMARY GANGLION WRIST 25111 $1,130.00 25112 PR EXCIS RECURRENT GANGLION WRIST 25112 $1,303.00 25115 PR RAD EXCIS WRIST SYNOV/TENDON,FLEXOR 25115 $3,016.00 25116 PR RAD EXCIS WRIST SYNOV/TENDON,EXTEN 25116 $2,664.00 25118 PR EXCIS SYNOV WRIST,EXTENS TENDON 25118 $1,421.00 25119 PR EXCIS SYNOV WRIST,PART REMV ULNA 25119 $1,331.00 25120 PR EXCIS/CURET BENIG BONE LES RAD/ULNA 25120 $2,390.00 25130 PR EXCIS BENIGN LESN CARPALS 25130 $1,591.00 25135 PR EXCIS BENIGN LESN CARPALS,AUTOGRFT 25135 $1,428.00 25136 PR EXCIS BENIGN LESN CARPALS,ALLOGRFT 25136 $1,287.00 25145 PR SEQUESTRECTOMY,FOREARM/WRIST 25145 $1,909.00 25150 PR PART REMOVAL BONE,ULNA 25150 $2,019.00 25151 PR PART REMOVAL BONE,RADIUS 25151 $2,647.00 25170 PR RAD RESEC TUMOR, FOREARM 25170 $5,222.00 25210 PR REMOVAL OF CARPAL BONE 25210 $1,685.00 25215 PR REMOVAL OF PROX ROW CARPAL BONES 25215 $2,227.00 25230 PR REMOVAL OF RADIAL STYLOID 25230 $1,528.00 25240 PR EXCIS DISTAL ULNA,PART/COMPLETE 25240 $1,602.00 25246 PR INJECTION FOR WRIST ARTHROGRAM 25246 $958.00 25248 PR REMOVE FOREARM/WRIST FOREIGN BODY 25248 $1,372.00 25250 PR REMOVAL WRIST PROSTHESIS 25250 $1,438.00 25259 PR MANIPULATE WRIST W/ANESTHES 25259 $1,479.00 25260 PR REPR FOREARM TEND/MUSC,FLEX,PRIM,EA 25260 $1,987.00 25263 PR REPR FOREARM TEND/MUSC,FLEX,SECON,EA 25263 $1,983.00 25265 PR REPR FOREARM TEND/FLEX,SECOND,GRFT 25265 $2,646.00 25270 PR REPR FOREARM TEND/MUSC,EXTEN,PRIM,EA 25270 $1,689.00 25272 PR REPR FOREARM TEND/MUSC,EXTEN,SECOND 25272 $1,499.00 25274 PR REPR FOREARM TEND/EXT,SECOND,GRAFT,EA 25274 $2,341.00 25275 PR REPR FOREARM EXT TEND SHEATH,GRAFT 25275 $2,122.00 25280 PR REVISE WRIST/FOREARM TENDON 25280 $1,518.00 25290 PR INCISE WRIST/FOREARM TENDON 25290 $1,541.00 25295 PR RELEASE WRIST/FOREARM TENDON 25295 $2,472.00 25300 PR FUSION TENDONS WRIST,FINGR FLEXORS 25300 $2,459.00 25301 PR FUSION TENDONS WRIST,FINGR EXTENSORS 25301 $2,189.00 25310 PR TRANSPLANT FOREARM/WRIST TENDON 25310 $2,796.00 25312 PR XPLANT FOREARM TENDON,W TENDON GRFT 25312 $1,929.00 25316 PR REVISE PALSY HAND TENDON(S),W XFER 25316 $3,254.00 25320 PR REVISE WRIST JOINT,CARPAL INSTABIL 25320 $3,523.00 25332 PR ARTHROPLASTY WRIST JT 25332 $2,724.00 25335 PR REALIGNMENT OF WRIST ON ULNA 25335 $3,346.00 25337 PR RECONSTRUCT ULNA/RADIOULNAR 25337 $3,185.00 25350 PR OSTEOTOMY RADIUS,DISTAL THIRD 25350 $2,411.00 25355 PR OSTEOTOMY RADIUS,PROX/MID THIRD 25355 $2,752.00 25360 PR OSTEOTOMY ULNA 25360 $2,109.00 25365 PR OSTEOTOMY RADIUS/ULNA 25365 $3,258.00 25375 PR OSTEOTOMY+ROD,RADIUS AND ULNA 25375 $3,394.00 25390 PR OSTEOPLASTY,RADIUS OR ULNA,SHORTEN 25390 $3,302.00 25394 PR OSTEOPLASTY,CARPAL BONE,SHORTEN 25394 $2,823.00 25400 PR REPAIR NONUNION RADIUS OR ULNA 25400 $3,451.00

25405 PR REPAIR NONUNION RADIUS OR ULNAW/GRAFT 25405 $4,198.00 25415 PR REPAIR NONUNION RADIUS AND ULNA 25415 $3,446.00

25420 PR REPAIR NONUNION RADIUS AND ULNA W/GRAFT 25420 $4,119.00 25430 PR INSERT VASC PEDICLE,CARPAL BONE (HARII) 25430 $2,588.00 25440 PR REPAIR NONUNION SCAPHOID CARPAL BONE 25440 $2,753.00 25442 PR RECONSTRUCT DIST ULNA W PROSTHESIS 25442 $2,883.00 25444 PR RECONSTRUCT LUNATE W PROSTHESIS 25444 $2,980.00 25445 PR RECONSTRUCT TRAPEZIUM W PROSTHESIS 25445 $1,846.00 25447 PR REPAIR INTERCARP/CARP-METACARP JT 25447 $2,964.00 25449 PR REMOVE WRIST JOINT IMPLANT 25449 $3,661.00 25450 PR EPIPHYSEAL ARREST DIST RAD OR ULNA 25450 $2,192.00 25455 PR EPIPHYSEAL ARREST DIST RAD & ULNA 25455 $2,622.00 25490 PR REINFORCE RADIUS 25490 $2,567.00 25500 PR CLOSED RX RADIAL SHAFT FX 25500 $834.00 25505 PR CLOSED RX RADIAL SHAFT FX,MANIPULATN 25505 $1,624.00 25515 OPEN TREATMENT RADIAL SHAFT FRACTURE 25515 $2,218.00 25520 PR CLOSED RX RADIAL SHAFT FX W/DISLOCATION 25520 $1,802.00

25525 OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE 25525 $2,777.00

25526 OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE 25526 $3,369.00 25530 PR CLOSED RX ULNA SHAFT FX 25530 $804.00 25535 PR CLOSED RX ULNA SHAFT FX,MANIPULATN 25535 $1,568.00 25545 OPEN TREATMENT OF ULNAR SHAFT FRACTURE 25545 $2,204.00 25560 PR CLOSED RX RAD/ULNA SHAFT FX 25560 $838.00 25565 PR CLOSED RX RAD/ULNA SHAFT FX,MANIP 25565 $1,701.00

25574 OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS OR ULNA 25574 $2,354.00

25575 OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS AND ULNA 25575 $3,227.00 25600 PR CLOSED RX DIST RAD/ULNA FX 25600 $921.00 25605 PR CLOSED RX DIST RAD/ULNA FX,MANIPUL 25605 $1,812.00 25606 PR PERCUT SKELETAL FIX, DISTAL RADIUS FX 25606 $2,112.00

25607 PR OPEN RX DISTAL RADIUS FX, EXTRA-ARTICULAR 25607 $2,599.00

25608 PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 2 FRAG 25608 $2,915.00

25609 PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG 25609 $3,754.00 25622 PR CLOSED RX NAVICULAR FX 25622 $939.00

25628 OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE 25628 $2,550.00 25630 PR CLOSED RX CARPAL FX 25630 $817.00 25635 PR CLOSED RX CARPAL FX,MAIPULATN 25635 $1,232.00 25645 PR OPEN RX CARPAL BONE FX,EACH BONE 25645 $1,531.00 25650 PR CLOSED RX ULNA STYLOID FX 25650 $1,023.00 25651 PR PERCUT SKELETAL FIX,ULNAR STYLOID FX 25651 $1,422.00 25652 PR OPEN RX ULNAR STYLOID FX 25652 $1,670.00 25660 PR CLOSED TREAT WRIST DISLOCATION 25660 $1,449.00 25670 PR OPEN REPAIR WRIST DISLOCATION 25670 $2,142.00 25671 PR PERCUT SKELETAL FIX,DIST RADIOULN DISLOC 25671 $1,425.00 25675 PR CLOSED RX RADIO-ULNA DISLOCATION 25675 $1,454.00 25676 PR OPEN RX RADIO-ULNA DISLOCATION 25676 $2,221.00 25680 PR CLOSED RX NAVIC/LUNATE FX/DISLOC 25680 $1,407.00 25685 PR OPEN RX NAVIC-PERILUNATE FX/DISLOC 25685 $2,631.00 25690 PR CLOSED RX LUNATE DISLOCATION 25690 $1,304.00 25695 PR OPEN REPAIR LUNATE DISLOCATION 25695 $1,705.00 25800 PR FUSION OF WRIST JOINT 25800 $2,501.00 25805 PR FUSION/SLIDING GRAFT WRIST JOINT 25805 $2,856.00 25810 PR FUSION/GRAFT WRIST JOINT 25810 $3,076.00 25820 PR FUSION INTERCARPAL 25820 $2,290.00 25825 PR FUSION/GRAFT INTERCARPAL 25825 $3,105.00 25830 PR FUSION RADIOULNAR JNT/ULNA RESEC 25830 $3,333.00 25900 PR AMPUTATION FOREARM 25900 $1,911.00 25905 PR AMPUTATION FOREARM,CIRCULAR 25905 $1,981.00 25920 PR AMPUTATE THRU WRIST 25920 $1,828.00 25927 PR AMPUTATION TRANSMETACARPAL 25927 $2,725.00 26010 PR DRAIN FINGER ABSCESS,SIMPLE 26010 $803.00 26011 PR DRAIN FINGER ABSCESS,COMPLICATED 26011 $1,162.00 26020 PR DRAIN HAND TENDON SHEATH 26020 $1,487.00 26025 PR DRAINAGE PALM BURSA,SINGLE 26025 $1,499.00 26030 PR DRAINAGE PALM BURSA,MULTIP/COMPLX 26030 $1,318.00 26034 PR INCIS DEEP FINGR/HAND BONE LESN 26034 $1,464.00 26035 PR DECOMPRESS FINGERS/HAND,INJECT INJ 26035 $3,073.00 26037 PR DECOMPRESS FASCIOTOMY FINGR/HAND 26037 $1,520.00 26040 PR RELEASE PALM CONTRACT,PERCUTANEOUS 26040 $839.00 26045 PR RELEASE PALM CONTRACT,OPEN,PARTIAL 26045 $1,259.00 26055 PR INCISE FINGER TENDON SHEATH 26055 $2,165.00 26075 PR EXPLORE & TREAT METACARPO-PHAL JT 26075 $1,047.00 26080 PR EXPLORE/TREAT INTERPHALANGEAL JT,EA 26080 $1,054.00 26105 PR BIOPSY SYNOVIUM MC-P JT 26105 $1,200.00 26110 PR BIOPSY SYNOVIUM I-P JT 26110 $1,136.00 26111 PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM 26111 $1,117.00

26113 PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5+CM 26113 $1,468.00

26115 PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM 26115 $1,562.00

26116 PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM 26116 $1,506.00

26118 PR RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/> 26118 $3,738.00 26121 PR PALMAR FASCIECTOMY 26121 $2,268.00 26123 PR PART PALMAR FASCIEC,OPEN 1 DIGIT 26123 $2,985.00 26125 PR PART PALMAR FASCIEC,OPEN ADDNL DIGIT 26125 $952.00 26130 PR EXCIS JT LINING,CARPOMETACARPAL JT 26130 $1,660.00 26135 PR EXCIS JT LINING,MC-P JT,EACH DIGIT 26135 $1,942.00 26140 PR EXCIS JT LINING,PROX I-P JT,EACH 26140 $1,700.00 26145 PR RAD EXCIS JT LINING,FLEXOR,EACH 26145 $1,624.00

26160 PR EXCIS TENDON SHEATH LESION, HAND/FINGER 26160 $2,001.00 26170 PR EXCIS PALM TENDON FLEXOR, EACH 26170 $1,091.00 26180 PR EXCIS FINGER TENDON FLEXOR, EACH 26180 $1,563.00 26200 PR EXCIS BENIGN BONE LESN,METACARPAL 26200 $1,212.00 26210 PR EXCIS BENIGN BONE LESN,PHALANX 26210 $1,384.00 26215 PR EXCIS/GRFT BENIGN LESN,PHALANX 26215 $1,451.00 26230 PR PART REMV BONE,METACARPAL 26230 $1,615.00 26235 PR PART REMV BONE,PROX/MID PHALANX 26235 $1,579.00 26236 PR PART REMV BONE,DISTAL PHALANX 26236 $1,390.00 26260 PR RAD RESEC PROX/MID PHALANX 26260 $2,866.00 26320 PR REMOVAL OF IMPLANT FROM HAND/FINGR 26320 $1,223.00 26340 PR MANIPULATE FINGER JT W/ ANESTH,EACH 26340 $934.00

26341 PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD 26341 $285.00

26350 PR REPAIR FLEXOR TENDON,HAND,W/O GRAFT,EA 26350 $1,950.00 26352 PR REPAIR FLEXOR TENDON,HAND,W/ GRAFT,EA 26352 $2,172.00 26356 PR REPAIR FLEX TENDON,ZONE 2,HAND 26356 $2,590.00

26357 PR REPAIR FLEX TENDON,ZONE 2,SECON,HAND,EA 26357 $3,170.00 26358 PR REPAIR FLEX TEND,ZONE 2,SEC,HAND,W/GRFT 26358 $3,507.00 26370 PR REPAIR PROFUNDUS TENDON,PRIMARY 26370 $2,135.00

26372 PR REPAIR PROFUNDUS TENDON,SECONDARY/GRFT 26372 $2,397.00 26373 PR REPAIR PROFUNDUS TENDON,SECONDARY 26373 $2,417.00

26390 PR EXCIS FLEX TEND HAND,IMPL ROD,DELAY GRFT 26390 $2,999.00 26392 PR REMOV ROD & INSERT FLEX TEND HAND GRFT 26392 $3,386.00 26410 PR REPAIR EXTEN TENDON,DORSUM HAND,EA 26410 $1,543.00 26412 PR REPAIR EXTEN TENDON,DORSUM HAND,GRFT 26412 $2,408.00 26415 PR EXCIS EXT TEND HAND,IMPL ROD,DELAY GRFT 26415 $2,385.00 26416 PR REMOV ROD & INSERT EX TEND HAND GRFT 26416 $2,225.00 26418 PR REPAIR EXTEN TENDON,DORSUM FINGR,EA 26418 $2,184.00 26420 PR REPAIR EXTEN TENDON,DORSUM FINGR,GRFT 26420 $2,702.00 26426 PR REPAIR EXT TEND,CENT SLIP,SEC 26426 $1,804.00 26428 PR REPAIR EXT TEND,CENT SLIP,SEC,W/ GRFT 26428 $2,061.00 26432 PR REPAIR EXTEN TENDON,DISTAL INSERT,CLOSE 26432 $1,876.00 26433 PR REPAIR EXTEN TENDON,DISTAL INSERT,OPEN 26433 $1,455.00 26437 PR REALIGNMENT OF TENDONS,HAND 26437 $2,291.00 26440 PR TENOLYSIS, FLEX TENDON,PALM/FINGER,EA 26440 $1,711.00 26442 PR TENOLYSIS FLEX TENDON,PALM & FINGER,EA 26442 $3,181.00 26445 PR TENOLYSIS EXT TENDON,HAND/FINGER,EA 26445 $2,316.00 26449 PR RELEASE FOREARM/HAND EXTEN TENDON 26449 $1,759.00 26450 PR TENOTOMY PALM FLEX,SINGLE,OPEN,EACH 26450 $1,447.00 26455 PR TENOTOMY FINGR FLEX,SINGLE,OPEN,EACH 26455 $1,434.00 26460 PR TENOTOMY HAND EXTEN,SINGLE,OPEN,EACH 26460 $1,386.00 26471 PR FUSION FINGER TENDONS,PIP JT STABIL 26471 $2,141.00 26474 PR FUSION FINGER TENDONS,DIP JT STABIL 26474 $1,555.00 26478 PR TENDON LENGTHENING,FLEX,HAND/FINGR 26478 $1,700.00 26479 PR TENDON SHORTENING,FLEX,HAND/FINGR 26479 $2,201.00 26480 PR TRANSPLANT HAND TENDON 26480 $2,867.00 26483 PR TRANSPLANT/GRAFT HAND TENDON 26483 $2,960.00 26485 PR TRANSPLANT PALM TENDON 26485 $2,183.00 26489 PR TRANSPLANT/GRAFT PALM TENDON 26489 $2,530.00 26490 PR REVISE THUMB TENDON 26490 $2,778.00 26492 PR THUMB TENDON TRANSFER,GRAFT 26492 $2,407.00 26496 PR REVISE THUMB TENDON,OTHR 26496 $3,020.00 26497 PR FINGER TENDON TRANSFER,4-5 FINGRS 26497 $2,251.00 26498 PR FINGER TENDON TRANSFER,2-5 FINGRS 26498 $4,232.00 26500 PR HAND TENDON PULLEY RECONSTRUCTION 26500 $1,701.00 26502 PR HAND TENDON PULLEY RECONST,GRAFT 26502 $1,943.00 26508 PR RELEASE THUMB CONTRACTURE 26508 $1,661.00 26516 PR FUSION MC-P JOINT,SINGLE 26516 $2,439.00 26518 PR FUSION MC-P JOINT,3-4 DIGITS 26518 $2,277.00 26520 PR RELEASE MC-P JT CONTRACTURE 26520 $1,781.00 26525 PR RELEASE I-P JT CONTRACTURE 26525 $2,559.00 26530 PR ARTHROPLASTY MC-P JT,SINGLE 26530 $1,835.00 26531 PR ARTHROPLASTY MC-P JT,IMPLANT 26531 $1,976.00 26535 PR ARTHROPLASTY I-P JT 26535 $1,430.00 26536 PR ARTHROPLASTY I-P JT,IMPLANT 26536 $1,940.00 26540 PR FIX COLLAT LIG,MC-P JT,I-P JT 26540 $1,880.00 26541 PR FIX COLLAT LIG,MC-P JT,GRAFT 26541 $2,176.00 26542 PR FIX COLLAT LIG,MC-P JT,LOCAL TISS 26542 $2,478.00 26545 PR FIX COLAT LIG,I-P JT,GRAFT,EACH 26545 $2,538.00 26546 PR FIX NONUNION METACARPAL/PHALANX 26546 $3,499.00 26548 PR FIX FINGER,VOLAR PLATE,I-P JT 26548 $2,070.00 26550 PR POLLICIZATION OF DIGIT 26550 $6,578.00 26560 PR REPAIR OF WEB FINGER,EACH 26560 $2,075.00 26561 PR REPAIR OF WEB FINGER,GRAFT 26561 $3,095.00 26562 PR REPAIR OF WEB FINGER,COMPLEX 26562 $5,291.00 26565 PR CORRECT METACARPAL DEFORM 26565 $1,849.00 26567 PR CORRECT FINGER DEFORMITY 26567 $1,860.00 26587 PR RECONST POLYDACT DIGIT,SOFT TIS & BONE 26587 $3,728.00 26591 PR REPAIR MUSCLES OF HAND 26591 $1,215.00 26593 PR RELEASE MUSCLES OF HAND 26593 $1,644.00 26596 PR EXCISION CONSTRICT FINGR TISSUE 26596 $2,096.00 26600 PR CLOSED RX METACARPAL FX 26600 $792.00 26605 PR CLOSED RX METACARPAL FX,MANIP 26605 $869.00

26607 PR CLOSED RX METACARP FX,W/MANIP,W/EXT FIX 26607 $1,629.00 26608 PR CLOSED RX METACARPAL FX,PERCUT 26608 $1,320.00

26615 OPEN TX METACARPAL FRACTURE SINGLE EA BONE 26615 $1,542.00 26641 PR TREAT THUMB DISLOC,MANIPULATN 26641 $1,025.00 26645 PR TREAT THUMB FX/DISLOC,MANIP 26645 $1,153.00

26650 PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB 26650 $1,345.00

26665 OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB 26665 $1,938.00 26670 PR CLOSED RX, CARPOMETACAR DISLOC,NON-THUMB 26670 $919.00 26675 PR CLOSED RX C-MC DISLOC,ANESTH 26675 $1,229.00

26676 PR PERCUT FIX CARPOMETACAR DISLOC,NON-THUMB 26676 $1,354.00

26685 OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB 26685 $1,760.00 26686 PR OPEN RX C-MC DISLOC,COMPLEX 26686 $2,104.00 26700 PR CLOSED RX MC-P DISLOC 26700 $1,081.00 26705 PR CLOSED RX MC-P DISLOC,ANESTH 26705 $1,451.00 26706 PR PERCUT RX MC-P DISLOC 26706 $1,184.00

26715 OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION 1 26715 $1,502.00 26720 PR CLOSE RX PROX/MID FING SHFT FX 26720 $711.00 26725 PR CLOSE RX PROX/MID FING SHFT FX,MANIP 26725 $1,219.00 26727 PR PERCUT RX PROX/MID FING SHFT FX 26727 $1,263.00

26735 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA 26735 $1,594.00 26740 PR CLOSE RX FINGR ARTICULAR FX 26740 $711.00 26742 PR CLOSE RX FINGR ARTICULAR FX,MANIP 26742 $996.00 26746 OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA 26746 $1,991.00 26750 PR CLOSE RX DIST FINGR FX 26750 $624.00 26755 PR CLOSE RX DIST FINGR FX,MANIPULATN 26755 $850.00 26756 PR PERCUT RX DIST FINGR FX 26756 $1,129.00 26765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH 26765 $1,343.00 26770 PR CLOSED RX IP JT DISLOCATION 26770 $753.00 26775 PR CLOSED RX IP JT DISLOCATION,ANESTH 26775 $1,238.00 26776 PR PERCUT RX IP JT DISLOCATION 26776 $1,196.00

26785 OPEN TX INTERPHALANGEAL JOINT DISLOCATION 1 26785 $1,463.00 26841 PR FUSION 1ST CARPOMETACARPAL JT 26841 $1,980.00 26843 PR FUSION 2-5 CARPOMETACARPAL JT 26843 $2,817.00 26850 PR FUSION MC-P JT 26850 $2,525.00 26852 PR FUSION MC-P JT,GRAFT 26852 $2,819.00 26860 PR FUSION FINGER JOINT 26860 $2,079.00 26861 PR FUSION FINGER JOINT,EACH ADDNL 26861 $692.00 26862 PR FUSION/GRAFT FINGER JT 26862 $2,529.00 26910 PR AMPUTATE METACARPAL+FINGER 26910 $1,969.00 26951 PR AMPUTATION FINGER/THUMB 26951 $1,949.00 26952 PR AMPUTATION FINGER/THUMB+FLAPS 26952 $1,761.00 26990 PR INCIS/DRAIN PELVIS/HIP,DEEP ABSCESS 26990 $1,990.00 26992 PR INCIS/DRAIN PELVIS/HIP,OPEN BONE 26992 $3,179.00 27000 PR INCIS HIP ADDUCTOR,SUBCUT,CLOSED 27000 $1,444.00 27001 PR INCIS HIP ADDUCTOR,SUBCUT,OPEN 27001 $1,741.00 27003 PR INCIS HIP ADDUC,OPEN,OBTUR NEUREC 27003 $1,840.00 27005 PR INCIS ILIOPSOAS,OPEN 27005 $2,340.00 27006 PR INCIS HIP ADDUCTORS,OPEN 27006 $2,599.00 27025 PR INCIS OF HIP/THIGH FASCIA 27025 $3,276.00 27030 PR DRAINAGE OF HIP JOINT 27030 $3,036.00 27033 PR EXPLORATION OF HIP JOINT 27033 $3,504.00 27035 PR DENERVATION OF HIP JOINT 27035 $4,105.00 27036 PR RELEASE HIP FLEXION CONTRACTURE 27036 $3,584.00 27040 PR BX SOFT TISSUES,PELV/HIP,SUPERFICL 27040 $1,214.00 27041 PR BX SOFT TISSUES,PELV/HIP,DEEP 27041 $1,878.00

27043 PR EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM 27043 $1,264.00

27045 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5+CM 27045 $2,656.00

27047 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM 27047 $1,533.00

27048 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM 27048 $1,641.00

27049 PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM 27049 $3,602.00 27050 PR OPEN BIOPSY SACROILIAC JOINT 27050 $1,163.00 27052 PR OPEN BIOPSY OF HIP JOINT 27052 $2,063.00

27059 PR RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/> 27059 $4,885.00 27060 PR REMOVAL OF ISCHIAL BURSA 27060 $1,248.00 27062 PR REMOVE TROCH BURSA/CALCIFICATN 27062 $1,219.00

27066 PR EXCISISON BONE CYST BENIGN TUMOR,PELVIS/HIP,DEEP 27066 $2,880.00 27071 PR PARTIAL EXCISION DEEP PELVIS 27071 $3,265.00 27075 PR RAD RESEC UNILAT ILEUM 27075 $8,193.00 27076 PR RAD RESEC ILIUM+ACETABULUM 27076 $8,981.00 27078 PR RAD RESEC ISCHIAL TUBER+GR TROCH 27078 $7,407.00 27080 PR REMOVAL OF COCCYX 27080 $2,185.00 27086 PR REMOVE PELV/HIP F.B.,SUBCUTANEOUS 27086 $818.00 27087 PR REMOVE PELV/HIP F.B.,DEEP 27087 $2,626.00 27090 PR REMOVAL OF HIP PROSTHESIS 27090 $2,647.00 27091 PR REMOVAL OF HIP PROSTHESIS,COMPLEX 27091 $5,547.00 27093 PR INJECTION HIP ARTHROGRAM 27093 $1,222.00 27095 PR INJECTION HIP ARTHROGRAM,ANESTH 27095 $1,524.00

27096 PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE 27096 $505.00 27097 PR HAMSTRING RECESSION,PROX 27097 $2,444.00 27120 PR RECONSTRUC HIP SOCKET 27120 $4,594.00 27122 PR RECONSTRUC HIP SOCKET,RESEC FEM HEAD 27122 $3,470.00 27125 PR PARTIAL HIP REPLACEMENT 27125 $3,378.00 27130 PR TOTAL HIP ARTHROPLASTY 27130 $5,757.00

27132 PR CONV PREV HIP SURG TO TOT HIP ARTHROPLAS 27132 $6,818.00 27134 PR REVISE TOTAL HIP REPLACEMENT 27134 $7,424.00 27137 PR REVISE ACETABULAR PART OF TOTAL HIP 27137 $5,909.00 27138 PR REVISE FEM PART OFTOTAL HIP 27138 $5,909.00 27146 PR OSTEOTOMY OF HIP BONE 27146 $4,552.00 27147 PR OSTEOTOMY HIP BONE,OPEN REDN HIP 27147 $6,003.00 27151 PR OSTEOTOMY HIP/FEMUR 27151 $6,535.00 27156 PR OSTEOTOMY HIP/FEMUR,OPEN REDN HIP 27156 $6,956.00 27158 PR OSTEOTOMY PELVIS BILAT 27158 $5,724.00 27161 PR OSTEOTOMY OF NECK OF FEMUR 27161 $4,309.00 27165 PR OSTEOTOMY/FIX INTER/SUBTROCH FEMUR 27165 $4,874.00 27170 PR BONE GRAFT FEMUR HEAD/NECK/RIDGE 27170 $3,670.00 27176 PR CLOSED RX SLIP FEM EPIPHYSIS,PINS 27176 $3,030.00 27177 PR OPEN RX SLIP EPIPHYSIS 27177 $3,475.00 27187 PR REINFORCE HIP BONES 27187 $3,333.00 27193 PR CLOSED RX PELVIC RING FX/SUBLUX 27193 $1,662.00 27194 PR CLOSED RX PELV RING FX/SUBLUX,MANIP 27194 $2,445.00 27197 PR CLSD TX PELVIC RING FX W/O MANIPULATION 27197 $343.00

27198 PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES 27198 $824.00 27215 PR OPEN FIX ILIAC FX,INTERN FIXATN 27215 $2,334.00 27216 PR PERCUT FIX POST PELV RING FX 27216 $3,357.00 27217 PR OPEN INTERN FIX ANTER PELV RING FX 27217 $3,252.00 27218 PR OPEN INTERN FIX POST PELV RING FX 27218 $4,894.00 27220 PR CLOSED RX ACETABULAR FX 27220 $1,891.00 27222 PR CLOSED RX ACETABULAR FX,MANIPULATN 27222 $3,019.00 27226 PR OPEN INTERN FIX ACETABULAR WALL FX 27226 $3,094.00 27227 PR OPEN INTERN FIX ACETABULAR FX 27227 $5,962.00 27228 PR OPEN INTERN FIX COMPLEX ACETABUL FX 27228 $6,879.00 27230 PR CLOSED RX PROX/NECK FEMUR FX 27230 $1,692.00 27235 PR PERCUT FIX PROX/NECK FEMUR FX 27235 $3,250.00 27236 PR FEMORAL FX, OPEN TX 27236 $3,562.00 27238 PR CLOSED RX INTER/SUBTROCH FEMUR FX 27238 $1,210.00 27240 PR CLOSED RX INTER/SUBTROCH FX,MANIP 27240 $3,431.00 27244 PR TREAT INTER/SUBTROCH FX,W/PLATE/SCREW 27244 $3,651.00 27245 PR OPEN FIX INTER/SUBTROCH FX,IMPLNT 27245 $5,226.00 27246 PR CLOSED RX GR TROCHANTERIC FX 27246 $1,365.00

27248 OPEN TREATMENT GREATER TROCHANTERIC FRACTURE 27248 $2,491.00 27250 PR CLOSED RX TRAUMATIC HIP DISLOCATN 27250 $1,172.00 27252 PR CLOSED RX TRAUMA HIP DISLOC,ANESTH 27252 $2,378.00 27253 PR OPEN RX TRAUMATIC HIP DISLOCATN 27253 $3,345.00 27254 PR OPEN RX HIP DISLOC/ACETABULAR FX 27254 $4,532.00 27256 PR CLOSED RX SPONTANEOUS HIP DISLOC 27256 $1,077.00 27257 PR CLOSED RX SPONT HIP DISLOC,ANESTH 27257 $973.00 27258 PR OPEN RX SPONTANEOUS HIP DISLOC 27258 $3,962.00 27259 PR OPEN RX SPONT HIP DISLOC,FEM SHORT 27259 $6,341.00 27265 PR CLOSED RX POST HIP ARTHRPLAS DISLOC 27265 $1,298.00 27266 PR CLOSED RX POST HIP FIX DISLOC,ANESTH 27266 $1,835.00

27267 PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANIP 27267 $1,258.00

27268 PR CLOSED TX FEMORAL FRACTURE PROX HEAD W MANIP 27268 $1,391.00

27269 PR OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD 27269 $4,437.00 27275 PR MANIPULATION HIP JOINT W ANESTHESIA 27275 $651.00

27279 PR ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS 27279 $2,360.00

27280 PR ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT 27280 $3,653.00 27282 PR FUSION OF PUBIC BONES 27282 $2,585.00 27290 PR HINDQUARTER AMPUTATION 27290 $5,809.00 27295 PR DISARTICULATION OF HIP 27295 $4,517.00 27301 PR INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP 27301 $1,815.00 27303 PR INCIS DEEP BONE LESN,FEMUR/KNEE 27303 $1,724.00 27305 PR FASCIOTOMY,ILIOTIBIAL,OPEN 27305 $1,697.00 27306 PR INCIS THIGH TENDON,ADDUC/HAMST,SINGL 27306 $1,244.00 27307 PR INCIS THIGH TENDON,ADDUC/HAMST,MULTI 27307 $1,500.00 27310 PR EXPLOR/DRAIN KNEE,INFECTN 27310 $2,245.00 27323 PR BX THIGH/KNEE SOFT TISSUES,SUPERF 27323 $682.00 27324 PR BX THIGH/KNEE SOFT TISSUES,DEEP 27324 $1,223.00

27327 PR EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM 27327 $1,299.00

27328 PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM 27328 $1,678.00

27329 PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM 27329 $3,680.00 27330 PR BIOPSY SYNOVIUM KNEE JOINT 27330 $1,480.00 27331 PR ARTHROTOMY/EXPLORE/TREAT KNEE JOINT 27331 $1,274.00 27332 PR EXCIS KNEE CARTILAGE,MEDIAL OR LAT 27332 $2,317.00 27334 PR RMV KNEE SYNOVIUM,ANT/POST 27334 $2,144.00 27335 PR REMV SYNOVIUM KNEE,ANTER & POST 27335 $2,714.00

27337 PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM 27337 $1,128.00

27339 PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+CM 27339 $2,034.00 27340 PR REMOVAL PREPATELLA BURSA 27340 $1,150.00 27345 PR REMOVAL SYNOVIAL CYST,KNEE 27345 $1,299.00 27347 PR REMOVE KNEE CYST/GANGLION 27347 $2,045.00 27350 PR PART/FULL REMOVAL OF KNEECAP 27350 $2,046.00 27355 PR REMV BENIGN FEMUR LESION 27355 $2,132.00 27356 PR REMV BENIGN FEMUR LESN/ALLOGRAFT 27356 $2,314.00 27357 PR REMV BENIGN FEMUR LESN/AUTOGRAFT 27357 $2,937.00 27358 PR REMV BENIGN FEMUR LESN/INTERN FIX 27358 $987.00 27360 PR PART REMV FEMUR/PROX TIB/FIB 27360 $2,710.00

27364 PR RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/> 27364 $4,211.00 27365 PR RAD RESEC TUMOR,FEMUR OR KNEE 27365 $7,410.00

27369 PR NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE 27369 $513.00 27370 PR INJECTION KNEE ARTHROGRAPHY 27370 $1,098.00 27372 PR REMV FOREIGN BODY,KNEE/THIGH,DEEP 27372 $1,607.00 27380 PR FIX INFRAPATELLA TENDON,PRIMARY 27380 $1,909.00 27381 PR FIX PATELLA TENDN,SECONDARY 27381 $2,581.00 27385 PR FIX QUAD/HAMSTR MUSC RUPT,PRIMARY 27385 $2,036.00 27386 PR FIX QUAD/HAMSTR MUSC RUPT,SECOND 27386 $2,951.00 27390 PR TENOTOMY,HAMSTR,KNEE-THIGH,SINGL 27390 $1,596.00 27391 PR TENOTOMY,UNI HAMSTR,KNEE-THIGH,MULTI 27391 $1,837.00 27392 PR TENOTOMY,BI HAMSTR,KNEE-THIGH,MULTI 27392 $2,252.00 27393 PR LENGTHEN HAMSTR TENDON,SINGLE 27393 $1,628.00 27394 PR LENGTHEN HAMSTR TENDON,MULTI,ONE LEG 27394 $2,102.00 27395 PR LENGTHEN HAMSTR TENDON,MULTI,2 LEGS 27395 $2,820.00 27396 PR XPLANT HAMSTR TENDON-PATELLA,SINGL 27396 $1,698.00 27400 PR TENDON/MUSC XFER,HAMSTR-FEMUR 27400 $1,868.00 27403 PR ARTHROTOMY,OPEN REPAIR MENISCUS 27403 $2,424.00 27405 PR REPAIR COLLAT LIGAMT/CAPSULE,KNEE 27405 $2,379.00 27407 PR REPAIR CRUCIATE LIGAMENT,KNEE 27407 $2,823.00 27412 PR AUTOCHONDROCYTE IMPLANT KNEE 27412 $6,139.00 27415 PR OSTEOCHONDRAL KNEE ALLOGRAFT 27415 $4,699.00 27416 PR OSTEOCHONDRAL KNEE AUTOGRAFT 27416 $2,888.00 27418 PR REPAIR ANTER TIBIAL TUBERCLE 27418 $3,182.00 27420 PR REVISION OF UNSTABLE PATELLA 27420 $2,515.00 27422 PR FIX UNSTABLE PATELLA,EXTEN REALIGN 27422 $2,606.00 27425 PR LATERAL RETINACULAR RELEASE OPEN 27425 $2,273.00 27427 PR LIGMT REVISION,KNEE,EXTRA-ARTIC 27427 $3,636.00 27428 PR LIGMT REVISION,KNEE,INTRA-ARTIC 27428 $3,983.00 27429 PR LIGMT REVISN,KNEE,INTRA/EXTRA-ART 27429 $4,242.00 27430 PR REVISION QUADRICEPS 27430 $2,354.00 27435 PR POST CAPSULAR RELEASE,KNEE 27435 $2,855.00 27438 PR ARTHROPLASTY PATELLA WITH IMPLANT 27438 $2,631.00 27445 PR PLASTY KNEE,CONSTRAINED PROSTHESIS 27445 $4,467.00 27446 PR PLASTY KNEE,MED OR LAT COMPARTMT 27446 $3,738.00 27447 PR TOTAL KNEE ARTHROPLASTY 27447 $5,696.00 27448 PR OSTEOTOMY FEMUR SHAFT/SUPRACONDY 27448 $2,632.00 27450 PR OSTEOTOMY FEMUR SHAFT,W FIXATN 27450 $3,289.00 27454 PR OSTEOTOMIES FEMUR SHAFT+INTRA ROD 27454 $4,033.00 27455 PR OSTEOTOMY PROX TIB,1 COMPARTMT 27498 $1,759.00 27500 PR CLOSED RX FEMUR SHAFT FX 27500 $1,700.00 27501 PR CLOSED RX CONDYLAR FX 27501 $1,817.00 27502 PR CLOSED RX FEMUR SHAFT FX+MANIP 27502 $2,500.00 27503 PR CLOSED RX CONDYLAR FX+MANIP 27503 $2,855.00 27506 PR OPEN RX FEMUR FX+INTRAMED ROD 27506 $4,032.00 27507 PR OPEN RX FEMUR FX+PLATE/SCREW 27507 $3,203.00 27508 PR CLOSED RX FEMUR,DISTAL 27508 $1,866.00 27509 PR PERCUT FIX DISTAL FEMUR 27509 $2,270.00 27510 PR CLOSED RX FEMUR,DISTAL+MANIP 27510 $2,178.00

OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O 27511 EXTENSION 27511 $3,314.00

OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W 27513 EXTENSION 27513 $4,247.00

27514 OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE 27514 $4,092.00 27517 PR CLOSED RX DIST FEM EPIPHYSIS+MANIP 27517 $1,861.00 27520 PR CLOSED RX PATELLA FX 27520 $1,047.00 27524 PR OPEN RX PATELLA FX 27524 $2,423.00 27530 PR CLOSED RX TIBIAL PLATEAU FX 27530 $1,258.00 27532 PR CLOSED RX TIB PLAT FX+MANIP 27532 $1,999.00

27535 OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR 27535 $2,874.00 27536 PR OPEN RX BILAT TIB PLAT FX 27536 $3,637.00 27538 PR CLOSED RX TIB TUBER FX 27538 $1,559.00

27540 OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE 27540 $3,023.00 27550 PR CLOSED RX KNEE DISLOCATN 27550 $1,402.00 27552 PR CLOSED RX KNEE DISLOC+ANESTH 27552 $1,966.00

27556 OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR 27556 $3,141.00 27560 PR CLOSED RX KNEECAP DISLOCATN 27560 $1,001.00 27562 PR CLOSED RX KNEECAP DISLOC+ANESTH 27562 $1,370.00 27570 PR MANIPULATN KNEE JT+ANESTHESIA 27570 $515.00 27580 PR FUSION OF KNEE 27580 $4,566.00 27590 PR AMPUTATE THIGH,THRU FEMUR 27590 $3,131.00 27592 PR AMPUTATE THIGH,OPEN CIRCULAR 27592 $2,440.00 27594 PR AMPUTATE THIGH,SECONDRY CLOSUR 27594 $1,449.00 27596 PR AMPUTATE THIGH,RE-AMPUTATN 27596 $2,374.00 27598 PR AMPUTATE LOWER LEG AT KNEE 27598 $2,547.00 27600 PR DECOMPRESS ANT/LAT LEG CMPART 27600 $1,378.00 27601 PR DECOMPRESS POST LEG COMPARTMT 27601 $1,200.00 27602 PR DECOMPRESS ANT/LAT+POST LEG CMPART 27602 $1,406.00 27603 PR DRAIN LOWER LEG DEEP ABSC/HEMATOMA 27603 $1,856.00 27605 PR INCIS ACHILLES TENDON+LOCAL ANESTH 27605 $1,487.00 27606 PR INCIS ACHILLES TENDON+GEN ANESTH 27606 $1,818.00 27607 PR DRAIN LEG/ANKLE BONE FOR INFECT 27607 $1,939.00 27610 PR EXPLORE/TREAT ANKLE JOINT 27610 $2,053.00 27612 PR EXPLORE/RELEASE POST CAP ANKLE JT 27612 $1,793.00 27613 PR BX LOW LEG SOFT TISSUE,SUPERFICIAL 27613 $673.00 27614 PR BX LOW LEG SOFT TISSUE,DEEP 27614 $1,868.00

27615 PR RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM 27615 $3,716.00

27616 PR RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/> 27616 $3,430.00

27618 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM 27618 $1,826.00

27619 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <3CM 27619 $1,660.00 27620 PR EXPLOR ANKLE JOINT 27620 $1,202.00 27625 PR EXPLOR ANKLE JT+SYNOVECTOMY 27625 $2,056.00 27626 PR EXPLOR ANKLE JT+TENOSYNOVECTOMY 27626 $1,624.00 27630 PR EXCIS LESN TENDON SHEALTH LEG/ANKLE 27630 $1,779.00

27632 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3+CM 27632 $1,422.00

27634 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM 27634 $2,335.00 27635 PR EXCIS BENIGN LESN,TIB/FIB 27635 $1,945.00 27637 PR EXCIS BENIGN LESN,TIB/FIB+AUTOGRFT 27637 $2,698.00 27638 PR EXCIS BENIGN LESN,TIB/FIB+ALLOGRFT 27638 $2,533.00 27640 PR PARTIAL REMOVAL OF TIBIA 27640 $2,940.00 27641 PR PARTIAL REMOVAL OF FIBULA 27641 $2,393.00 27645 PR RAD RESEC TUMOR,TIBIA 27645 $3,531.00 27648 PR INJECTION FOR ANKLE ARTHROGRAM 27648 $863.00 27650 PR REPAIR ACHILLES TENDON,PRIMARY 27650 $2,301.00 27654 PR REPAIR ACHILLES TENDON,SECONDARY 27654 $2,314.00 27656 PR REPAIR LEG FASCIA DEFECT 27656 $1,700.00 27658 PR REPAIR FLEX LEG TENDON,PRIM,EA 27658 $1,833.00 27659 PR REPAIR FLEX LEG TENDON,SECOND,EA 27659 $2,356.00 27664 PR REPAIR EXTEN LEG TENDN,PRIM,EACH 27664 $967.00 27665 PR REPAIR EXTEN LEG TENDN,SECOND,EA 27665 $2,123.00 27675 PR REPAIR PERONEAL TENDONS 27675 $1,733.00 27676 PR REPAIR PERONEAL TENDONS,FIB OSTEOTMY 27676 $2,027.00 27680 PR RELEASE TIB/FIB/ANKLE FLEX TENDON,EA 27680 $1,453.00 27681 PR RELEASE TIB/FIB/ANKL FLEX TENDON,MUL 27681 $1,948.00 27685 PR LENGTH/SHORT LEG/ANKL TENDON,SINGLE 27685 $1,920.00 27686 PR LENGTH/SHORT LEG/ANKL TENDON,MULTI 27686 $2,604.00 27687 PR GASTROCNEMIUS RECESSION 27687 $1,554.00 27690 PR XFER SINGLE SUPERFICI LOW LEG TENDON 27690 $2,032.00 27691 PR XFER SINGLE DEEP LOW LEG TENDON 27691 $2,653.00 27695 PR REPAIR 1 COLLAT ANKLE LIGMNT,PRIMARY 27695 $1,652.00 27696 PR REPAIR BOTH COLLAT ANKL LIGMT,PRIMRY 27696 $1,964.00 27698 PR REPAIR COLLAT ANKLE LIGMNT,SECONDARY 27698 $3,175.00 27700 PR ARTHROPLASTY ANKLE JOINT 27700 $1,648.00 27702 PR TOTAL ANKLE REPLACEMENT 27702 $3,541.00 27703 PR SECONDARY RECONSTRUCTION,ANKLE JOINT 27703 $3,622.00 27704 PR REMOVAL OF ANKLE IMPLANT 27704 $1,540.00 27705 PR OSTEOTOMY TIBIA 27705 $2,486.00 27707 PR OSTEOTOMY FIBULA 27707 $1,235.00 27709 PR OSTEOTOMY TIBIA & FIBULA 27709 $3,139.00 27712 PR OSTEOTOMIES TIB/FIB+INTRAMED ROD 27712 $3,946.00 27715 PR LENGTHENING TIBIA/FIBULA 27715 $3,727.00 27720 RPR NON/MALUNION TIBIA 27720 $3,100.00 27722 RPR NON/MALUNION TIBIA+SLIDING GRAFT 27722 $3,175.00 27724 RPR NON/MALUNION TIBIA+AUTOGRAFT 27724 $4,080.00

27726 PR RPR FIBULA NONUNION/MALUNION W INT FIXATION 27726 $2,748.00 27727 RPR CONGEN PSEUDOARTHROSIS TIBIA 27727 $3,723.00 27730 PR ARREST,EPIPHYSEAL,OPEN,DISTAL TIBIA 27730 $3,206.00 27732 PR STOP GROWTH DISTAL FIBULA EPIPHYSIS 27732 $1,316.00 27734 PR STOP GROWTH DISTAL TIB/FIB EPIPHYSES 27734 $1,967.00 27745 PR REINFORCE TIBIA 27745 $2,678.00 27750 PR CLOSED RX TIBIA SHAFT FX 27750 $1,112.00 27752 PR CLOSED RX TIBIA SHAFT FX,MANIPULATN 27752 $1,737.00 27756 PR PERCUT RX TIBIA SHAFT FX 27756 $2,063.00 27758 PR OPEN RX TIBIA SHAFT FX,SCREWS 27758 $2,779.00 27759 PR TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT 27759 $3,225.00 27760 PR CLOSED RX MED MALLEOLUS FX 27760 $1,071.00 27762 PR CLOSED RX MED MALLEOLUS FX,MANIP 27762 $1,619.00

27766 OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE 27766 $2,069.00

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O 27767 MANIP 27767 $773.00

27768 PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W MANIP 27768 $1,290.00

27769 PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE 27769 $2,057.00 27780 PR CLOSED RX PROX/SHAFT FIBULA FX 27780 $978.00 27781 PR CLOSED RX PROX/SHAFT FIB FX,MANIP 27781 $1,401.00

27784 OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE 27784 $1,910.00 27786 PR CLOSED RX DIST FIBULA FX 27786 $1,027.00 27788 PR CLOSED RX DIST FIBULA FX,MANIP 27788 $1,425.00

27792 OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS 27792 $1,937.00

27808 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 27808 $1,099.00

27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP 27810 $1,582.00

27814 OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE 27814 $2,569.00 27816 PR CLOSED RX TRIMALLEOLAR FX 27816 $872.00 27818 PR CLOSED RX TRIMALLEOLAR FX,MANIP 27818 $1,646.00

27822 OPEN TX TRIMALLEOLAR ANKLE FX W/O FIX PST LIP 27822 $2,848.00 27823 OPEN TX TRIMALLEOLAR ANKLE FX W FIX PST LIP 27823 $3,246.00 27824 PR CLOSED RX WEIGHT BEAR DIST TIBIA 27824 $1,093.00 27825 PR CLOSED RX WEIGHT BEAR DIST TIB,MANIP 27825 $1,885.00 27826 OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA 27826 $2,424.00 27827 OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY 27827 $3,560.00

27828 OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA 27828 $4,010.00

27829 OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION 27829 $1,881.00 27830 PR CLOSED RX PROX TIB/FIB DISLOC 27830 $1,035.00

27832 OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB 27832 $2,608.00 27840 PR CLOSED RX ANKLE DISLOCATN 27840 $1,115.00 27842 PR CLOSED RX ANKLE DISLOCATN,ANESTH 27842 $1,498.00 27846 PR OPEN RX ANKLE DISLOCATN 27846 $2,364.00 27848 PR OPEN RX ANKLE DISLOCATN+FIXATN 27848 $2,784.00 27860 PR MANIPULATION ANKLE JT W ANESTHESIA 27860 $579.00 27870 PR ARTHRODESIS,ANKLE,OPEN 27870 $3,269.00 27871 PR FUSION OF TIBIOFIBULAR JOINT 27871 $2,463.00 27880 PR AMPUTATION LOW LEG THRU TIB/FIB 27880 $2,578.00 27882 PR AMPUTATION LOW LEG,CIRCULAR 27882 $2,104.00 27884 PR AMPUTATION LOW LEG,SECOND CLOSURE 27884 $1,543.00 27886 PR RE-AMPUTATION LOWER LEG 27886 $2,149.00 27888 PR AMPUTATION ANKLE-TIB/FIB MALLEOLI 27888 $2,372.00 27889 PR ANKLE DISARTICULATION 27889 $2,316.00 27892 PR DECOMPRESS FASCIOTOMY LEG,ANT/LAT 27892 $1,971.00 27894 PR DECOMPRESS LEG,ANT/LAT & POST 27894 $3,041.00 28001 PR INCIS/DRAINAGE BURSA OF FOOT 28001 $1,002.00 28002 PR DEEP DISSEC FOOT INFEC,1 BURSA 28002 $1,536.00 28003 PR DEEP DISSEC FOOT INFEC,MULTIPLE 28003 $2,127.00 28005 PR DEEP INCIS FOOT BONE INFECTN 28005 $1,550.00 28008 PR INCISION OF FOOT/TOE FASCIA 28008 $1,164.00 28010 PR INCISION SUBCUT TOE TENDON 28010 $1,083.00 28011 PR INCISION SUBCUT TOE TENDON,>1 28011 $847.00 28020 PR EXPLOR TARSAL/TARSOMETATAR JT 28020 $1,444.00 28022 PR EXPLOR METATARSO-PHALANG JT 28022 $1,409.00 28024 PR EXPLOR INTERPHALANGEAL JT 28024 $1,228.00 28035 PR TARSAL TUNNEL RELEASE 28035 $1,515.00

28039 PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ 1.5+CM 28039 $1,332.00 28041 PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM 28041 $1,218.00

28043 PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM 28043 $1,056.00

28045 PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM 28045 $1,785.00

28046 PR RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM 28046 $2,579.00

28047 PR RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/> 28047 $3,760.00 28060 PR PART EXCIS PLANTAR FASCIA 28060 $1,524.00 28070 PR SYNOVECTOMY TARS/TARSOMETA JT,EA 28070 $1,925.00 28072 PR SYNOVECTOMY METATAR-PHAL JT,EA 28072 $1,310.00 28080 PR EXCIS INTERDIGITAL NEUROMA,EA 28080 $1,414.00 28086 PR SYNOVECTOMY FLEX TENDN SHEATH,FOOT 28086 $1,948.00 28090 PR EXCIS TENDN/CAPSULE LESN,FOOT 28090 $1,362.00 28092 PR EXCIS TENDN/CAPSULE LESN,TOES 28092 $1,290.00 28100 PR REMV TALUS/HEEL BENIGN BONE LESN 28100 $2,167.00 28102 PR REMV TALUS/HEEL BENIGN LESN,AUTOGRFT 28102 $1,634.00 28103 PR REMV TALUS/HEEL BENIGN LESN,ALLOGRFT 28103 $1,955.00

28104 PR REMV TARSAL/METATARSAL BENIGN BONE LESN 28104 $1,888.00 28106 PR REMV OTHR FOOT BENIGN LESN,AUTOGRFT 28106 $1,150.00 28107 PR REMV OTHR FOOT BENIGN LESN,ALLOGRFT 28107 $1,854.00 28108 PR REMV TOE BENIGN BONE LESN 28108 $1,254.00 28110 PR PART EXCIS 5TH METATARSAL HEAD 28110 $1,659.00 28111 PR FULL EXCIS 1ST METATARSAL HEAD 28111 $1,313.00 28112 PR FULL EXCIS 2,3 OR 4TH METATAR HEAD 28112 $1,457.00 28113 PR FULL EXCIS 5TH METATARSAL HEAD 28113 $1,578.00 28114 PR FULL EXCIS 2 - 5 METATARSAL HEADS 28114 $3,830.00 28116 PR EXCIS TARSAL COALITION 28116 $2,050.00 28118 PR REMOVAL OF HEEL BONE 28118 $1,719.00 28119 PR REMOVAL OF HEEL SPUR 28119 $1,407.00 28120 PR PART REMV TALUS OR CALCANEUS 28120 $1,826.00 28122 PR PART REMV OTHR TARSAL/METATARSAL 28122 $2,001.00 28124 PR PART REMV PHALANX OF TOE 28124 $1,428.00 28126 PR RESEC ONE TOE PHALANGEAL BASE,EA 28126 $1,055.00 28130 PR REMOVAL OF TALUS 28130 $1,853.00 28140 PR REMOVAL OF METATARSAL 28140 $1,986.00 28150 PR REMOVAL OF SINGLE TOE,EACH 28150 $1,519.00 28153 PR RESEC HEAD OF PHALANX,TOE 28153 $1,181.00 28160 PR RESEC TOE AT I-P JT,SINGLE,EA 28160 $1,228.00 28175 PR RAD RESEC PHALANX,TOE 28175 $1,271.00 28190 PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS 28190 $738.00 28192 PR REMV FOOT FOREIGN BODY,DEEP 28192 $1,258.00 28200 PR REPAIR FLEX FOOT TENDON,EA 28200 $1,379.00 28202 PR REPAIR/GRAFT FLEX FOOT TENDON 28202 $1,624.00 28208 PR REPAIR EXTEN LEG TENDON,PRIM,EA 28208 $1,321.00 28210 PR REPAIR/GRAFT EXTEN FOOT TENDON 28210 $1,587.00 28220 PR RELEASE FLEX FOOT TENDON,SINGLE 28220 $1,326.00 28222 PR RELEASE FLEX FOOT TENDON,MULTIPLE 28222 $1,834.00 28225 PR RELEASE EXTEN FOOT TENDON,SINGLE 28225 $1,123.00 28226 PR RELEASE EXTEN FOOT TENDONS,MULTIPL 28226 $1,648.00 28230 PR INCISION FLEX FOOT TENDON(S) 28230 $1,292.00 28232 PR INCISION FLEX TOE TENDON 28232 $1,177.00 28234 PR INCISION EXTEN FOOT/TOE TENDON 28234 $1,191.00 28238 PR RECONST POST TIB TEND,EXCIS ACC TAR NAV 28238 $2,397.00 28240 PR RELEASE OF BIG TOE TENDN 28240 $1,653.00 28250 PR DIVISN PLANTAR FASCIA/MUSCLE 28250 $1,642.00 28260 PR CAPSULOTOMY MIDFOOT JT,MED RELEASE 28260 $2,000.00 28261 PR CAPSULOTOMY MIDFOOT,TENDN LENGTH 28261 $3,580.00 28262 PR CAPSULOTOMY MIDFOOT,EXTENSIVE 28262 $4,011.00 28264 PR CAPSULOTOMY MIDTARSAL 28264 $2,717.00 28270 PR CAPSULOTOMY MT-P JT,FOOT,EACH 28270 $1,402.00 28272 PR CAPSULOTOMY I-P JT,FOOT,EA 28272 $1,170.00 28285 PR REPAIR OF HAMMERTOE,ONE 28285 $1,442.00 28288 PR PART REMV BONE METATARSAL HEAD,EA 28288 $1,637.00

28289 PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT 28289 $2,101.00

28291 PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT 28291 $2,610.00

28292 PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL 28292 $1,959.00

PR CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR 28295 OSTEOT 28295 $2,657.00

PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR 28296 OSTEOT 28296 $2,438.00 PR CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL 28297 CNF 28297 $2,820.00

PR CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX 28298 OSTEOT 28298 $2,264.00

28299 PR CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT 28299 $2,710.00 28300 PR OSTEOTOMY HEEL BONE 28300 $2,963.00 28302 PR OSTEOTOMY TALUS 28302 $2,952.00 28304 PR OSTEOTOMY MIDTARSAL BONES 28304 $2,282.00 28305 PR OSTEOTOMY MIDTARSAL,AUTOGRAFT 28305 $2,402.00 28306 PR OSTEOTOMY 1ST METATARSAL,BASE/SHAFT 28306 $1,715.00 28308 PR OSTEOTOMY METATARSAL (NOT 1ST) 28308 $1,530.00 28309 PR OSTEOTOMY METATARSALS,MULTIPLE 28309 $3,204.00 28310 PR OSTEOTOMY PROX PHALANX,1ST TOE 28310 $1,965.00 28312 PR OSTEOTOMY,ANY PHALANX,ANY TOE 28312 $1,350.00 28313 PR RECONSTRUC TOE DEFORM,SOFT TISSUE 28313 $1,500.00 28315 PR REMOV SESAMOID BONE,1ST TOE 28315 $1,404.00 28320 PR REPAIR NON/MALUNION TARSAL BONE(S) 28320 $2,135.00 28322 PR REPAIR NON/MALUNION METATARSAL 28322 $2,430.00 28341 PR RESECT ENLARGED TOE TISSUE/BONE 28341 $2,405.00 28344 PR REPAIR EXTRA TOE(S) 28344 $1,990.00 28345 PR REPAIR WEBBED TOE(S) 28345 $1,430.00 28400 PR CLOSED RX HEEL FX 28400 $832.00 28405 PR CLOSED RX HEEL FX,MANIPULATN 28405 $1,325.00 28406 PR PERCUT RX HEEL FX 28406 $1,731.00 28415 OPEN TREATMENT CALCANEAL FRACTURE 28415 $3,898.00

28420 OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT 28420 $4,515.00 28430 PR CLOSED RX TALUS FX 28430 $796.00 28435 PR CLOSED RX TALUS FX,MANIPULATN 28435 $1,034.00 28436 PR PERCUT RX TALUS FX 28436 $1,253.00 28445 OPEN TREATMENT TALUS FRACTURE 28445 $3,500.00 28446 PR OPEN OSTEOCHONDRAL AUTOGRAFT TALUS 28446 $3,556.00 28450 PR CLOSED RX TARSAL FX,EACH 28450 $769.00 28455 PR CLOSED RX TARSAL FX,MANIP,EACH 28455 $771.00 28456 PR PERCUT RX TARSAL FX,EACH 28456 $907.00

28465 OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA 28465 $1,770.00 28470 PR CLOSED RX METATARSAL FX 28470 $757.00 28475 PR CLOSED RX METATARSAL FX,MANIP 28475 $920.00 28476 PR PERCUT RX METATARSAL FX 28476 $1,091.00

28485 OPEN TREATMENT METATARSAL FRACTURE EACH 28485 $1,493.00 28490 PR CLOSED RX BIG TOE FRACTURE 28490 $425.00 28495 PR CLOSED RX BIG TOE FX,MANIP 28495 $530.00 28496 PR PERCUT BIG TOE FX 28496 $1,593.00

28505 OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES 28505 $1,781.00 28510 PR CLOSED RX TOE FX 28510 $397.00 28515 PR CLOSED RX TOE FX,MANIPULATN 28515 $435.00

28525 OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE 28525 $1,612.00 28540 PR CLOSED RX TARSAL DISLOCATION 28540 $639.00 28545 PR CLOSED RX TARSAL DISLOC,ANESTH 28545 $808.00 28546 PR PERCUT RX TARSAL DISLOCATION 28546 $1,559.00 28555 OPEN TREATMENT TARSAL BONE DISLOCATION 28555 $2,306.00 28570 PR CLOSED RX TALOTARSAL DISLOC 28570 $612.00 28575 PR CLOSED RX TALOTARSAL DISLOC,ANESTH 28575 $991.00 28576 PR PERCUT RX TALOTARSAL DISLOCATION 28576 $1,836.00

28585 OPEN TREATMENT TALOTARSAL JOINT DISLOCATION 28585 $2,323.00 28600 PR CLOSED RX TAR-METATAR DISLOCATION 28600 $671.00 28605 PR CLOSED RX TAR-METATAR DISLOC,ANESTH 28605 $893.00 28606 PR PERCUT RX TAR-METATAR FOOT DISLOC 28606 $2,661.00

28615 OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION 28615 $2,182.00 28630 PR CLOSED RX MT-PHAL TOE DISLOCATION 28630 $419.00 28635 PR CLOSED RX MT-PHAL TOE DISLOC,ANESTH 28635 $470.00 28636 PR PERCUT RX MT-PHAL TOE DISLOCATION 28636 $1,242.00

28645 OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION 28645 $2,346.00 28660 PR CLOSED RX I-P JT,TOE DISLOCATION 28660 $319.00 28665 PR CLOSED RX I-P JT,TOE DISLOC,ANESTH 28665 $474.00 28666 PR PERCUT RX I-P JT,TOE DISLOC 28666 $478.00

28675 OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION 28675 $2,056.00 28705 PR FUSION FOOT BONES,PANTALAR 28705 $5,070.00 28715 PR FUSION FOOT BONES,TRIPLE 28715 $3,060.00 28725 PR FUSION FOOT BONES,SUBTALAR 28725 $2,672.00 28730 PR FUSION FOOT BONES,MIDTARSAL,MULTI 28730 $2,571.00 28735 PR FUSION FOOT BONES,MIDTARSAL,OSTEOTMY 28735 $2,508.00

28737 PR FUSION W/TEND ADV,MIDTAR NAV-CUNEIFORM 28737 $2,217.00 28740 PR FUSION FOOT BONE,MIDTARSAL,1 JT 28740 $2,564.00 28750 PR FUSION BIG TOE,MT-P JT 28750 $2,630.00 28755 PR FUSION BIG TOE,I-P JOINT 28755 $1,512.00 28760 PR FUSION BIG TOE,I-P JT+TENDN XFER 28760 $2,100.00 28800 PR AMPUTATION FOOT,MIDTARSAL-CHOPART 28800 $1,574.00 28805 PR AMPUTATION FOOT,TRANSMETATARSAL 28805 $1,943.00 28810 PR AMPUTATION METATARSAL+TOE,SINGLE 28810 $1,281.00 28820 PR AMPUTATION TOE,MT-P JT 28820 $1,501.00 28825 PR AMPUTATION TOE,I-P JT 28825 $1,475.00 29010 PR APPLY BODY CAST,RISSER JACKET 29010 $711.00 29035 PR APPLY BODY CAST,SHLDR-HIP 29035 $1,728.00 29065 PR APPLY LONG ARM CAST 29065 $278.00 29075 PR APPLY FOREARM CAST 29075 $257.00 29085 PR APPLY HAND/WRIST CAST 29085 $274.00 29105 PR APPLY LONG ARM SPLINT 29105 $223.00 29125 PR APPLY FOREARM SPLINT,STATIC 29125 $170.00 29126 PR APPLY FOREARM SPLINT,DYNAMIC 29126 $203.00 29130 PR APPLY FINGER SPLINT,STATIC 29130 $110.00 29131 PR APPLY FINGER SPLINT,DYNAMIC 29131 $165.00 29200 PR STRAPPING OF CHEST 29200 $127.00 29240 PR STRAPPING OF SHOULDER 29240 $137.00 29260 PR STRAPPING OF ELBOW OR WRIST 29260 $124.00 29280 PR STRAPPING OF HAND OR FINGER 29280 $122.00 29305 PR APPLY OF HIP CAST,ONE LEG 29305 $650.00 29325 PR APPLY OF HIP CASTS,TWO LEGS 29325 $743.00 29345 PR APPLY LONG LEG CAST 29345 $407.00 29355 PR APPLY LONG LEG CAST,WALKER 29355 $376.00 29365 PR APPLY LONG LEG CAST,CYLINDER 29365 $438.00 29405 PR APPLY SHORT LEG CAST 29405 $266.00 29425 PR APPLY SHORT LEG CAST,WALKER 29425 $289.00 29445 PR APPLY RIGID LEG CAST 29445 $333.00 29450 PR APPLY OF CLUBFOOT CAST 29450 $461.00 29505 PR APPLY LONG LEG SPLINT 29505 $225.00 29515 PR APPLY LOWER LEG SPLINT 29515 $188.00 29520 PR STRAPPING OF HIP 29520 $179.00 29530 PR STRAPPING OF KNEE 29530 $126.00 29540 PR STRAPPING; ANKLE &/OR FOOT 29540 $96.00 29550 PR STRAPPING OF TOES 29550 $94.00 29580 PR APPLY OF PASTE BOOT 29580 $168.00

PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE 29581 FOOT 29581 $226.23

PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN 29582 DONE 29582 $178.00 29805 PR SHLDR ARTHROSCOP,DIAGNOSTIC 29805 $1,533.00 29806 PR SHLDR ARTHROSCOP,SURG,CAPSULORRHAPHY 29806 $3,387.00

29807 PR SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION 29807 $3,301.00

29819 PR SHLDR ARTHROSCOP,SURG,W/REMOVAL,LOOSE/FB 29819 $1,902.00 29820 PR SHLDR ARTHROSCOP,PART SYNOVECT 29820 $1,903.00

29822 PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2 29822 $1,862.00

29823 PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+ 29823 $2,034.00

29824 PR SHLDR ARTHROSCOP,SURG,DIS CLAVICULECTOMY 29824 $2,074.00 29825 PR SHLDR ARTHROSCOP,LYSE ADHESNS 29825 $1,920.00 29826 PR SHOULDER SCOPE BONE SHAVING 29826 $2,190.00

29827 PR SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR 29827 $3,551.00

29828 PR ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS 29828 $2,731.00 29834 PR ELBOW ARTHROSCOP,REMV LOOSE BODY 29834 $1,891.00 29835 PR ELBOW ARTHROSCOP,PART SYNOVECT 29835 $2,072.00 29836 PR ELBOW ARTHROSCOP,FULL SYNOVECT 29836 $1,569.00 29837 PR ELBOW ARTHROSCOP,PART DEBRIDE 29837 $1,891.00 29838 PR ELBOW ARTHROSCOP,EXTEN DEBRIDE 29838 $2,409.00 29840 PR WRIST ARTHROSCOP,DIAGNOSTIC 29840 $1,424.00 29844 PR WRIST ARTHROSCOP,PART SYNOVECT 29844 $1,813.00 29845 PR WRIST ARTHROSCOP,FULL SYNOVECT 29845 $2,072.00 29846 PR WRIST ARTHROSCOP,EXCIS TRIANG CART 29846 $1,943.00 29847 PR WRIST ARTHROSCOP,INTERN FIXATN 29847 $1,919.00 29848 PR WRIST ARTHROSCOP,RELEASE XVERS LIG 29848 $1,444.00 29850 PR KNEE SCOPE/SURG/INTERCOND FX AID 29850 $2,149.00 29851 PR KNEE SCOPE/SURG/INCOND FX AID+FIXAT 29851 $3,048.00 29855 PR TIBIAL SCOPE/SURG/FX AID,UNICONDYLR 29855 $2,733.00 29860 PR HIP ARTHROSCOPY, DX 29860 $1,792.00 29861 PR HIP SCOPE/REMOV LOOSE/FOREIGN BODY 29861 $2,190.00 29862 PR HIP SCOPE/REMV BODY,PLASTY/RESECTN 29862 $2,440.00 29863 PR HIP SCOPE/REMV BODY,SYNOVECTOMY 29863 $2,434.00 29866 PR KNEE SCOPE, AUTOGRAFT IMPANT 29866 $5,449.00 29867 PR KNEE SCOPE, ALLOGRAFT IMPANT 29867 $3,972.00 29868 PR KNEE SCOPE, MENISC TRANSPLANT 29868 $6,481.00 29870 PR KNEE SCOPE,DIAGNOSTIC 29870 $1,529.00 29871 PR KNEE SCOPE,CLEAN/DRAIN 29871 $1,636.00 29873 PR KNEE SCOPE, W/LATERAL RELEASE 29873 $1,646.00 29874 PR KNEE SCOPE,REMV LOOSE BODY 29874 $1,824.00 29875 PR KNEE SCOPE,PART SYNOVECT 29875 $1,800.00 29876 PR KNEE SCOPE,FULL SYNOVECT 29876 $2,148.00 29877 PR KNEE SCOPE,SHAVE ARTICULAR CART 29877 $1,920.00 29879 PR KNEE SCOPE,ABRASN ARTHROPLASTY 29879 $2,208.00

29880 PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING 29880 $2,640.00

29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG 29881 $2,184.00 29882 PR KNEE SCOPE,MED OR LAT MENIS REPAIR 29882 $2,364.00 29883 PR KNEE SCOPE,MED+LAT MENIS REPAIR 29883 $3,072.00 29884 PR KNEE SCOPE,LYSIS OF ADHESNS 29884 $1,847.00 29885 PR KNEE SCOPE,DRILL OSTE DISSEC+GRFT 29885 $2,650.00 29886 PR KNEE SCOPE,DRILL OSTEIT DISSEC 29886 $1,709.00 29887 PR KNEE SCOPE,DRILL OSTE DISS+INT FIX 29887 $2,681.00 29888 PR KNEE SCOPE,AID ANT CRUCIATE REPAIR 29888 $3,908.00 29889 PR KNEE SCOPE,AID POST CRUC REPAIR 29889 $3,864.00 29891 PR ANKLE SCOPE,EXCIS OSTEOCHON DEFCT 29891 $2,424.00 29892 PR ANKLE SCOPE,AID REPAIR FX,BONE DEFCT 29892 $2,348.00 29894 PR ANKLE SCOPE,REMVL LOOSE BODY 29894 $1,766.00 29895 PR ANKLE SCOPE,PART SYNOVECTOMY 29895 $1,848.00 29897 PR ANKLE SCOPE,PART DEBRIDEMENT 29897 $1,732.00 29898 PR ANKLE SCOPE,EXTENS DEBRIDEMNT 29898 $2,424.00 29899 PR ANKLE SCOPE,W/ANKLE ARTHRODESIS 29899 $3,685.00

PR ARTHROSCOPY SUBTALAR JOINT REMOVE 29904 LOOSE/FOREIGN BODY 29904 $2,225.00 29905 PR ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY 29905 $1,984.00

29906 PR ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT 29906 $2,478.00

29907 PR ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS 29907 $3,106.00 29914 PR ARTHROSCOPY HIP W/FEMOROPLASTY 29914 $4,023.00 29915 PR ARTHROSCOPY HIP W/ACETABULOPLASTY 29915 $4,023.00 29916 PR ARTHROSCOPY HIP W/LABRAL REPAIR 29916 $3,520.00 30020 PR DRAIN ABSCESS/HEMATOMA,NASAL SEPTUM 30020 $614.00 30100 PR INTRANASAL BIOPSY 30100 $388.00 30110 PR EXCISION NOSE POLYP(S),SIMPLE 30110 $467.00 30117 PR EXCIS/DEST INTRANAS LESION; INT APP 30117 $2,305.00 30118 PR EXCIS/DEST INTRANAS LESION; EXT APP 30118 $2,957.00 30120 PR EXCISION SKIN OF NOSE 30120 $2,000.00 30125 PR EXCIS NASAL DERMOID,COMPLX 30125 $1,520.00 30130 PR EXCISION TURBINATE 30130 $947.00 30140 PR EXCISION TURBINATE,SUBMUCOUS 30140 $1,101.00 30150 PR PARTIAL EXCISION OF NOSE 30150 $1,746.00 30160 PR EXCISION OF NOSE 30160 $2,979.00 30200 PR INJECTION INTO TURBINATE 30200 $313.00 30220 PR INSERT NASAL SEPTAL PROSTHESIS 30220 $797.00

3028F OXYGEN SATURATION RESULTS DOCUMENTED/REVIEWED 3028F $0.00 30300 PR REMOVE NASAL FOREIGN BODY 30300 $575.00 30310 PR REMV NASAL FOR BODY,GEN ANESTH 30310 $543.00 30400 PR RECONSTR NOSE 30400 $2,800.00 30410 PR RECONSTR NOSE,COMPLETE+EXTERNAL 30410 $4,454.00 30420 PR RECONSTR NOSE+MAJ SEPTAL REPAIR 30420 $3,449.00 30430 PR REVIS NOSE,SECONDARY,MINOR 30430 $2,524.00 30435 PR REVIS NOSE,SECONDARY,INTERMEDIATE 30435 $3,744.00 30450 PR REVIS NOSE,SECONDARY,MAJOR 30450 $4,873.00 30460 PR REVIS NOSE/CLEFT LIP/TIP 30460 $2,925.00 30462 PR REVIS NOSE/CLEFT LIP/TIP,SEPTUM 30462 $6,426.00 30465 PR REPAIR NASAL CAVITY STENOSIS 30465 $3,503.00

30468 PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT 30468 $440.00 30520 PR REPAIR OF NASAL SEPTUM 30520 $2,106.00 30540 PR REPAIR CHOANAL ATRESIA,INTRANASAL 30540 $1,824.00 30560 PR RELEASE OF NASAL ADHESIONS 30560 $565.00 30580 PR REPAIR ORO-MAXILLARY FISTULA 30580 $1,140.00 30600 PR REPAIR ORO-NASAL FISTULA 30600 $1,785.00 30620 PR INTRANASAL RECONSTRUCTION 30620 $1,971.00 30630 PR REPAIR NASAL SEPTUM PERFORATN 30630 $1,805.00 30802 PR CAUTER TURBINATE MUCOSA,INTRAMURAL 30802 $764.00 30901 PR CTRL NOSEBLEED,ANTER,SIMPLE 30901 $381.00 30903 PR CTRL NOSEBLEED,ANTER,COMPLEX 30903 $605.00 30905 PR CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT 30905 $898.00 30906 PR REPEAT CONTROL OF NOSEBLEED 30906 $584.00 30920 PR LIGATE INTERN MAXILL ARTERY 30920 $2,898.00 30930 PR THERAPEUTIC FRACTURE INFER TURBINATE 30930 $339.00 31000 PR IRRIGATION MAXILLARY SINUS 31000 $376.00

PR CAROTID IMG STUDY MEAS DISTAL INT CAROTID DIAM 3100F DOCUMENTED 3100F $0.00 31020 PR EXPLOR MAXILL SINUS,INTRANASAL 31020 $1,036.00 31030 PR EXPLOR MAXILL SINUS,RADICAL 31030 $1,741.00 31032 PR EXPLOR MAXILL SINUS,RMV POLYPS 31032 $1,945.00 31040 PR EXPLOR PTERYGOMAXILL FOSSA 31040 $3,039.00 31051 PR EXPLOR SPHENOID SINUS+RMV POLYPS 31051 $1,490.00 31070 PR EXPLOR FRONT SINUS,EXTERN,SIMPLE 31070 $1,561.00 31075 PR EXPLOR FRONT SINUS,TRANSORBIT,UNI 31075 $1,967.00 31080 PR OBLITER FRONT SINUS,BROW INCIS 31080 $3,878.00 31081 PR OBLITER FRONT SINUS,CORON INCIS 31081 $3,965.00 31085 PR OBLITER FRONT SINUS+FLAP,CORON INCI 31085 $4,557.00 31086 PR NONOBLIT FRONT SINUS+FLAP,BROW INCI 31086 $3,910.00 31201 PR REMOV ETHMOID SINUS,INTRANASAL,TOTL 31201 $1,854.00 31205 PR REMOV ETHMOID SINUS,EXTRANASAL,TOTL 31205 $2,266.00 31225 PR REMV UPPER JAW-MAXILLECTOMY 31225 $7,515.00 31230 PR REMV UPPER JAW+ORBIT EXENTERATN 31230 $8,248.00 31231 PR NASAL ENDOSCOPY,DX 31231 $528.00

31233 PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY 31233 $1,331.00

31235 PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY 31235 $665.00 31237 PR NASAL SCOPE,BX/RMV POLYP/DEBRID 31237 $1,280.00

31238 PR NASAL/SINUS SCOPY,W/CONTROL NASAL HEM 31238 $866.00 31239 PR NASAL/SINUS SCOPY,SURG TEAR DUCT 31239 $1,457.00 31240 PR NASAL/SINUS SCOPY,RMV CONCHA BULL 31240 $525.00

31241 PR NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY 31241 $1,155.00

31253 PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL 31253 $1,294.00

31254 PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY 31254 $1,204.00

31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY 31255 $2,344.00 31256 PR NASAL SCOPY,OPEN MAXILL SINUS 31256 $926.00

31257 PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY 31257 $1,152.00

PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS 31259 RMVL 31259 $1,221.00 31267 PR NASAL SCOPY,RMV TISS MAXILL SINUS 31267 $1,737.00

31276 PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS 31276 $3,500.00 31287 PR NASAL SCOPY,SPHENOIDOTOMY 31287 $1,379.00 31288 PR NASAL SCOPY,REMV TISS SPHENOID 31288 $1,379.00 31290 PR NASAL SCOPY,REPAIR CSF LEAK,ETHMOID 31290 $3,717.00 31291 PR NASAL SCOPY,REPR CSF LEAK,SPHENOID 31291 $3,885.00

PR NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL 31292 DCMPRN 31292 $4,200.00

PR NASAL/SINUS NDSC SURG MEDIAL&INF ORB WALL 31293 DCMPRN 31293 $3,782.00

31295 PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS 31295 $5,065.00

31296 PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS 31296 $5,166.00

31297 PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS 31297 $5,073.00

PR NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN 31298 SINUS 31298 $9,883.00 31299 PR SINUS SURGERY PROC UNLISTED 31299 $450.00 31300 PR REMOVAL OF LARYNX LESION 31300 $3,092.00 31360 PR REMOVAL OF LARYNX 31360 $3,645.00 31365 PR REMOVAL OF LARYNX+RAD TOTL NECK 31365 $5,375.00 31367 PR PART SUPRAGLOT REMV LARYNX 31367 $9,023.00 31368 PR PART SUPRAGLOT REMV LARYNX+RAD NECK 31368 $6,350.00 $11,598.0 31390 PR REMV LARYNX & PHARYNX 31390 0 31395 PR REMV LARYNX+PHARYNX W RECONSTRUC 31395 $5,672.00 31400 PR REVISION ARYTENOIDS 31400 $3,460.00 31420 PR REMOVAL OF EPIGLOTTIS 31420 $2,937.00 31500 PR INSERT EMERGENCY ENDOTRACH AIRWAY 31500 $396.00 31502 PR TRACH TUBE CHANGE 31502 $95.00 31505 PR LARYNGOSCOPY,INDIRECT,DX 31505 $231.00 31510 PR LARYNGOSCOPY,INDIRECT WITH BIOPSY 31510 $533.00 31515 PR LARYNGOSCOPY,DIRECT FOR ASPIRATION 31515 $929.00 31520 PR LARYNGOSCOPY,DIRECT,DIAGNOS,NEWBRN 31520 $778.00 31525 PR LARYNGOSCOPY,DIRECT,DIAGNOSTIC 31525 $734.00 31526 PR LARYNGOSCOPY,DIRECT,DX,OP MICROSCOP 31526 $437.00 31527 PR LARYNGOSCOPY,DIRECT,INSRT OBTURATOR 31527 $734.00 31528 PR LARYNGOSCOPY DIRECT,W/DILAT, INITIAL 31528 $460.00

31529 PR LARYNGOSCOPY DIRECT,W/DILAT, SUBSEQUENT 31529 $763.00 31530 PR LARYNGOSCOPY,DIRCT,OP,F.B. REMVL 31530 $763.00 31535 PR LARYNGOSCOPY,DIRCT,OP,BIOPSY 31535 $763.00 31536 PR LARYNGOSCOPY,DIRCT,OP SCOPE,BIOPSY 31536 $878.00 31540 PR LARYNGOSCOPY,DIRCT,OP,EXC TUMOR 31540 $923.00 31541 PR LARYNGOSCOPY,DIRCT,OP SCOP,EXC TUMR 31541 $1,439.00 31545 PR LARYNGOSCOPY,DIR,OP,EXC TUMR,LCL FLAP 31545 $923.00

31551 PR LARYNGOPLASTY LARYNGEAL STEN W/O STENT < 12 YRS 31551 $5,849.00

31552 PR LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS > 31552 $5,174.00

31553 PR LARYNGOPLASTY LARYNGEAL STEN W/STENT < 12 YRS 31553 $6,448.00

31554 PR LARYNGOPLASTY LARYNGEAL STEN W/STENT 12 YRS > 31554 $6,789.00 31560 PR LARYNGOSCOPY,DIRCT,OP,REMV ARYTENOD 31560 $2,128.00 31561 PR LARYNGOSCOPY,DIRCT,OP SCOP,REMV ARY 31561 $1,520.00 31570 PR LARYNGOSCOPY,DIRCT,INJ VOCAL CORD 31570 $929.00 31571 PR LARYNGOSCOPY,DIRECT,SCOPE,INJ CORDS 31571 $869.00

31572 PR LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI 31572 $1,250.00

31573 PR LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI 31573 $665.00 31574 PR LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI 31574 $2,577.00 31575 PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 31575 $325.00 31576 PR LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES) 31576 $495.00 31577 PR LARYNGOSCOPY FLX RMVL FOREIGN BODY(S) 31577 $540.00

31579 PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579 $498.00

31580 PR LARYNGOPLASTY LARYN WEB W/KEEL STENT INSERTION 31580 $4,417.00 31582 PR REVISION LARYNX,STENOSIS W GRFT 31582 $3,844.00

PR LARYNGOPLASTY W/OPEN REDUCTION FRACTURE 31584 W/TRACHS 31584 $3,844.00

31587 PR LARYNGOPLASTY CRICOID SPLIT W/O GRAFT PLACEMENT 31587 $3,844.00 31588 PR REVISION OF LARYNX, UNSPECIFIED 31588 $3,844.00 31590 PR REINNERVATE LARYNX W PEDICLE 31590 $2,415.00

31591 PR LARYNGOPLASTY MEDIALIZATION UNLIATERAL 31591 $3,672.00 31592 PR CRICOTRACHEAL RESECTION 31592 $6,934.00 31600 PR TRACHEOSTOMY, PLANNED 31600 $1,057.00 31601 TRACHEOSTOMY, <2 Y/O 31601 $797.00 31603 PR TRACHEOSTOMY,EMERG,XTRACH 31603 $911.00 31605 PR TRACHEOSTOMY,EMERG,CRICOTHYROID 31605 $863.00 31610 PR TRACHEOSTOMY,FENESTRATN+FLAPS 31610 $3,391.00 31611 PR CREATE T-E FISTULA+SPEECH PROSTHESIS 31611 $1,158.00 31612 PR PERCUT TRACH PUNCT/ASPIRATN 31612 $213.00 31613 PR TRACH REVISION,SIMPLE 31613 $1,160.00 31614 PR TRACH REVISION,COMPLEX 31614 $1,594.00 31615 PR TRACHEOBRNCHSC THRU EST TRACHS INC 31615 $480.00

31622 PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX 31622 $796.00 31623 PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS 31623 $853.00 31624 PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE 31624 $820.00

31625 PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES 31625 $826.00

PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED 31627 NAVIGATION 31627 $4,814.00

31628 PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE 31628 $969.00 31629 PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON 31629 $1,386.00 31630 PR BRONCHOSCOPY,TRACH/BRONCH DILATN 31630 $735.00 31631 PR BRONCHOSCOPY,TRACH DIL+STENT 31631 $611.00

PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH 31632 LOBE 31632 $175.00

PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA 31633 LOBE 31633 $214.00 31634 PR BRONCHOSCOPY BALLOON OCCLUSION 31634 $4,687.00 31635 PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY 31635 $830.00 31636 PR BRONCHOSCOPY, BRONCH STENTS 31636 $590.00 31637 PR BRONCHOSCOPY, STENT ADD-ON 31637 $207.00 31638 PR BRONCHOSCOPY, REVISE STENT 31638 $671.00 31640 PR BRONCHOSCOPY,EXCIS LESN 31640 $946.00 31641 PR BRONCHOSCOPY,RX STENOSIS 31641 $946.00

31645 PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST 31645 $847.00

31646 PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ 31646 $759.00

31647 PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE 31647 $540.00

31648 PR BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL 31648 $548.00

31649 PR BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL 31649 $179.00

31651 PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE 31651 $191.00

31652 PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX 31652 $2,301.00

31653 PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX 31653 $2,445.00

31654 PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES 31654 $351.00 31660 PR BRONCHOSCOPIC THERMOPLASTY ONE LOBE 31660 $526.00 31661 PR BRONCHOSCOPIC THERMOPLASTY 2/> LOBES 31661 $555.00 31720 PR CATHETER ASPIRATN,NASOTRACH 31720 $132.00 31730 PR INTRO WINDPIPE WIRE/TUBE 31730 $3,098.00 31750 PR REVISN TRACHEA,CERVICAL 31750 $4,960.00 31760 PR REVISN TRACHEA,INTRATHROACIC 31760 $5,645.00 31780 PR EXCIS TRACH STEN/RECONST,CERV 31780 $3,343.00 31785 PR EXCIS TRACH LESN,CERVICAL 31785 $3,398.00 31800 PR REPAIR TRACH WOUND/INJ,CERVICAL 31800 $1,896.00 31820 PR SURG CLOSURE TRACH/FISTULA 31820 $1,157.00 31825 PR SURG CLOSURE TRACH/FIST,PLAST REPR 31825 $1,602.00 31830 PR REVISE TRACHEOSTOMY SCAR 31830 $1,338.00 32035 PR THORACOSTOMY,RIB RESECT,EMPYEMA 32035 $1,956.00 32036 PR THORACOSTOMY,OPEN DRAIN/EMPYEMA 32036 $2,096.00

32096 PR THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL 32096 $2,865.00

PR THORACTOMY W/DX BX LUNG NODULE/MASS 32097 UNILATERAL 32097 $2,878.00 32098 PR THORACOTOMY W/BIOPSY OF PLEURA 32098 $2,045.00 32100 PR THORACOTOMY WITH EXPLORATION 32100 $3,279.00

32110 PR THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR 32110 $5,229.00

32120 PR THORACOTOMY POSTOPERATIVE COMPLICATIONS 32120 $3,099.00 32141 PR THORACOTOMY W/RESECTION BULLAE 32141 $4,101.00

32150 PR THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP 32150 $3,404.00 32151 PR THORCOM W/RMVL IPUL FB 32151 $3,406.00 32160 PR THORACOTOMY W/CARDIAC MASSAGE 32160 $2,139.00 32200 PR PNEUMONOSTOMY,OPEN DRAIN ABSC/CYST 32200 $4,060.00 32220 PR DECORTICATION,PULMONARY,TOTAL 32220 $5,507.00 32225 PR DECORTICATION,PULMONARY,PARTIAL 32225 $3,099.00 32310 PR REMOVAL PARIETAL PLEURA 32310 $2,986.00 32320 PR DECORTICATE/REMV PARIETAL PLEURA 32320 $5,478.00 32400 PR NEEDLE BIOPSY PLEURA 32400 $342.00

32405 PR BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE 32405 $1,095.00

32408 PR CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG 32408 $2,502.00 32440 PR REMOVAL OF LUNG PNEUMONECTOMY 32440 $5,524.00

PR REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT $12,579.0 32442 TRACHEA 32442 0

PR RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE 32480 LOBECT 32480 $5,325.00 32482 PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC 32482 $5,518.00

PR RMVL LUNG OTHER THAN PNEUMONECT 1 32484 SEGMENTECTOMY 32484 $4,691.00

PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE 32486 LOBECTOMY 32486 $9,583.00

32488 PR RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC 32488 $9,775.00

32491 PR RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG 32491 $5,300.00 32501 PR REPAIR BRONCHUS (ADD-ON) 32501 $656.00 32503 PR RESECT APICAL LUNG TUMOR 32503 $7,327.00

32504 PR RESECT APICAL LUNG TUM/ CHEST WALL RECONST 32504 $8,348.00

32505 PR THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL 32505 $2,505.00

PR THORACOTOMY W/THERAP WEDGE RESEXN ADDL 32506 IPSILATRL 32506 $421.00

PR THORACOTOMY W/DX WEDGE RESEXN &ANTOM LUNG 32507 RESEXN 32507 $421.00 32540 PR EXTRAPLEURAL REMV EMPYEMA 32540 $7,031.00

32550 PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER 32550 $1,515.00

32551 PR TUBE THORACOSTOMY INCLUDES WATER SEAL 32551 $501.00

PR REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER 32552 WITH CUFF 32552 $492.00

32554 PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING 32554 $1,384.00

32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING 32555 $1,404.00

32556 PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING 32556 $1,774.00

32557 PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING 32557 $2,706.00

32560 PR CHEMICAL PLEURODESIS FOR PERSISTENT PNEUMOTHORAX 32560 $612.00

32561 PR INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 1ST DAY 32561 $248.00 PR INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 32562 SUBSEQUENT 32562 $224.00

PR THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O 32601 BX 32601 $832.00 32606 PR THORACOSCOPY,DX MEDIAST W BX 32606 $1,246.00

32607 PR THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL 32607 $831.00

32608 PR THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL 32608 $1,021.00 32609 PR THORACOSCOPY WITH BIOPSYIES OF PLEURA 32609 $692.00 32650 PR THORACOSCOPY SURG W/PLEURODESIS 32650 $2,227.00 32651 PR THORACOSCOPY SURG PART PULM DECORT 32651 $2,946.00 32652 PR THORACOSCOPY SURG TOT PULM DECORT 32652 $4,636.00 32653 PR THORACOSCOPY SURG REMOV FB INTRAPLEU 32653 $2,856.00 32654 PR THORACOSCOPY SURG CTRL TRAUMA BLEED 32654 $3,126.00

PR THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL 32655 PX 32655 $2,612.00 32656 PR THORACOSCOPY SURG PART PLEURECTOMY 32656 $2,850.00 32658 PR THORACOSCOPY SURG EXC FB/CLOT PERICA 32658 $2,549.00 32659 PR THORACOSCOPY SURG PERICARD WINDOW 32659 $2,625.00 32661 PR THORACOSCOPY SURG EXC PERICARD MASS 32661 $2,847.00 32662 PR THORACOSCOPY SURG EXC MEDIAST MASS 32662 $3,240.00 32663 PR THORACOSCOPY W/LOBECTOMY SINGLE LOBE 32663 $5,036.00 32664 PR THORACOSCOPY SURG THOR SYMPATHECT 32664 $2,812.00 32665 PR THORACOSCOPY SURG ESOPHAGOMYOTOMY 32665 $5,027.00

PR THORACOSCOPY W/THERA WEDGE RESEXN INITIAL 32666 UNILAT 32666 $2,336.00

PR THORACOSCOPY W/THERA WEDGE RESEXN ADDL 32667 IPSILATRL 32667 $422.00

PR THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG 32668 RESEXN 32668 $422.00 32669 PR THORACOSCOPY W/SEGMENTECTOMY 32669 $3,616.00

PR THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG 32672 UNIL 32672 $4,100.00

32673 PR THORACOSCOPY RESEXN THYMUS UNI/BILATERAL 32673 $3,275.00

PR THORCOSCPY W/MEDIASTINL ®IONL 32674 LYMPHADENECTOMY 32674 $581.00 32800 PR REPAIR LUNG HERNIA 32800 $3,363.00 32810 PR CLOSE CHEST AFTER DRAINAGE 32810 $3,216.00 $11,491.0 32815 PR CLOSE BRONCHIAL FISTULA 32815 0 32850 PR DONOR PNEUMONECTOMY 32850 $7,200.00 32851 PR LUNG TRANSPLANT,SINGLE 32851 $8,833.00 32852 PR LUNG TRANSPLANT,SINGL W CP BYPASS 32852 $9,595.00 $12,380.0 32853 PR LUNG TRANSPLANT,DOUBLE 32853 0 $13,149.0 32854 PR LUNG TRANSPLANT,DBL W CP BYPASS 32854 0 32855 PR TRANSPLANT,PREP DONOR LUNG, SINGLE 32855 $711.00 32856 PR TRANSPLANT,PREP DONOR LUNG, DOUBLE 32856 $942.00 32900 PR REMOVAL OF RIB(S) 32900 $3,478.00 32906 PR THORACOPLASTY,CLOSE BP FISTULA 32906 $6,617.00

$15,761.0 32994 PR ABLATION THER 1+ PULM TUMORS PERQ CRYOABLATION 32994 0

PR ABLATION THER 1+ PULM TUMORS PERQ 32998 RADIOFREQUENCY 32998 $6,630.00 32999 PR CHEST SURGERY PROCEDURE UNLISTED 32999 $450.00 33010 PR PERICARDIOCENTESIS INITIAL 33010 $350.00 33015 PR INCIS HEART SAC TUBE 33015 $1,258.00

PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN 33016 PERFORMED 33016 $609.00

PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR 33017 ANOMALY 33017 $632.00

PR PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR 33018 ANOMALY 33018 $720.00

33019 PR PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT 33019 $585.00 33020 PR INCIS HEART SAC REMV CLOT/FB 33020 $2,661.00 33025 PR INCIS HEART SAC WINDW FOR DRAIN 33025 $2,580.00 33030 PR REMOV HEART SAC NO CP BYPASS 33030 $5,389.00 33031 PR REMOV HEART SAC W CP BYPASS 33031 $6,677.00 33050 PR RESECTION PERICARDIAL CYST/TUMOR 33050 $3,176.00 33120 PR REMOVAL HEART LESION INTERN 33120 $5,996.00 33130 PR REMOVAL HEART LESION EXTERN 33130 $5,618.00 33202 PR INSERT EPICARDIAL ELECTRODE, OPEN 33202 $3,025.00

33206 PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL 33206 $1,728.00

33207 PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR 33207 $1,297.00 PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD 33208 ATRIAL&VENT 33208 $1,409.00

33210 PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH 33210 $650.00

33211 PR INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX 33211 $472.00 33212 PR INS PM PLS GEN W/EXIST SINGLE LEAD 33212 $918.00

33213 PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS 33213 $1,005.00

33214 PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS 33214 $1,294.00

33215 PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE 33215 $773.00

33216 PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB 33216 $1,012.00

33217 PR INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB 33217 $990.00

33218 PR RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB 33218 $993.00

33220 PR RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB 33220 $995.00

33221 PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS 33221 $977.00

33222 PR RELOCATION OF SKIN POCKET FOR PACEMAKER 33222 $921.00

33223 PR RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR 33223 $1,107.00

33224 PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN 33224 $1,395.00

33225 PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN 33225 $1,272.00

33226 PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD 33226 $1,237.00

33227 PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD 33227 $816.00

33228 PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS 33228 $958.00

33229 PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD 33229 $886.00 33230 PR INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS 33230 $1,033.00

PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR 33233 ONLY 33233 $678.00

33234 PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR 33234 $1,313.00 33235 PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS 33235 $2,253.00 33237 PR REMV EPICARD SYST TWO LD/THORACOTMY 33237 $2,999.00

33241 PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY 33241 $578.00

33243 PR RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM 33243 $4,969.00

33244 PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ 33244 $3,032.00

33249 PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR 33249 $3,222.00

33255 PR ABLATE/ RECONSTUCT ATRIA, EXTENS, W/O BYPASS 33255 $6,685.00

33256 PR ABLATE/ RECONSTUCT ATRIA, EXTENS, W/ BYPASS 33256 $7,914.00

33257 PR ABLATE/ RECONSTUCT ATRIA, W OTHER PROCED LIMITED 33257 $1,565.00

PR ABLATE/ RECONSTUCT ATRIA, W OTHER PROCED EXTENS 33259 W/ BYPASS 33259 $2,271.00 33261 PR ABLAT VENTR DYSRHYTHM FOCUS 33261 $4,344.00

33262 PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD 33262 $1,071.00

33263 PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD 33263 $1,144.00

33264 PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD 33264 $1,161.00 33265 PR ENDO ABLATE/ RECONSTUCT ATRIA, LIMITED 33265 $5,543.00

33266 PR ENDO ABLATE/ RECONSTUCT ATRIA, EXTENS, W/O BYPASS 33266 $7,587.00

33270 PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD 33270 $1,581.00

33271 PR INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE 33271 $1,258.00 33272 PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE 33272 $1,058.00

33273 PR REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB 33273 $1,039.00

33274 PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG 33274 $1,281.00

33275 PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG 33275 $1,361.00

33282 PR IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER 33282 $2,000.00

33284 PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER 33284 $593.00

PR INSERTION SUBQ CARDIAC RHYTHM MONITOR 33285 W/PRGRMG 33285 $2,000.00

33286 PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR 33286 $343.00

33289 PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR 33289 $857.00 33300 PR REPAIR HEART WOUND 33300 $9,990.00 $16,879.0 33305 PR REPAIR HEART WND W CP BYPASS 33305 0 33315 PR EXPLOR HEART SURG WND W CP BYPASS 33315 $7,725.00 33322 PR REPR AO/GRT VESSEL W CP BYPASS 33322 $5,009.00

33340 PR PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT 33340 $2,917.00

33361 PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH 33361 $5,554.00

PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY 33362 APPROACH 33362 $6,060.00

33363 PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH 33363 $6,381.00

33364 PR REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH 33364 $6,615.00

33365 PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH 33365 $7,277.00

33366 PR TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE 33366 $7,870.00

PR REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS 33367 APPRCH 33367 $2,234.00 PR REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS 33368 APRCH 33368 $2,666.00

PR REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS 33369 APRCH 33369 $3,526.00

33390 PR VALVULOPLASTY AORTIC VALVE OPEN CARD BYP SIMPLE 33390 $7,949.00

PR VALVULOPLASTY AORTIC VALVE OPEN CARD BYP 33391 COMPLEX 33391 $9,419.00 33400 PR REPR AORT VALV W CP BYPASS 33400 $6,424.00 33403 PR REPR AORT VALV XVENT DIL W/CP BYPAS 33403 $5,678.00

PR RPLCMT PROST AORTIC VALVE OPEN XCP 33405 HOMOGRF/STENT 33405 $7,770.00

$11,848.0 33406 PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND 33406 0

PR MAMMO ASSESS CAT OF INCOMPLETE NEED ADD IMAGE 3340F DOCUMENTED 3340F $0.00

33411 PR REPLACE AORT VALV W ANNULUS ENLRGEMENT 33411 $9,070.00 $12,952.0 33412 PR REPLAC AO VALV XVENT AO ANNUL ENLG 33412 0

33413 PR REPL AORT VALVE,TRANSLOC AUTOL PULM VALV 33413 $9,386.00 33414 PR REPAIR LV OUTFLOW OBSTR PATCH ENLG 33414 $8,794.00 33415 PR REVIS SUBVALV TIS SVAS 33415 $6,385.00 33416 PR REVIS VENT MUSC FOR IHSS 33416 $6,942.00 33417 PR AORTOPLAS FOR SUPRAVALV STEN 33417 $4,598.00

33418 PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS 33418 $6,371.00

33419 PR TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS 33419 $1,344.00

3341F PR MAMMO ASSESS CAT OF NEGATIVE DOCUMENTED 3341F $0.00 33425 PR MITRALPLASTY W CP BYPASS 33425 $7,372.00 33426 PR MITRALPLASTY W PROSTHETIC RING 33426 $7,329.00 $10,180.0 33427 PR MITRALPLASTY W RADICAL RECONSTR 33427 0

3342F PR MAMMO ASSESS CAT OF BENIGN DOCUMENTED 3342F $0.00 $11,652.0 33430 PR REPLACEMENT OF MITRAL VALVE 33430 0 $14,142.0 33440 PR RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE 33440 0 33463 PR VALVULOPLAS TRICUS NO RING INSERT 33463 $8,332.00 33464 PR VALVULOPLAS TRICUS W RING INSERT 33464 $6,586.00 33465 PR REPLACE TRICUSPID W CP BYPASS 33465 $7,440.00 33471 PR PULM VALVOTOMY VIA PULM ART 33471 $4,265.00 33474 PR PULM VALVOTOMY W CP BYPASS 33474 $8,904.00 33475 PR REPLACEMENT, PULMONARY VALVE 33475 $6,292.00 33476 PR RV RESEC INFUND STEN 33476 $5,850.00

33477 PR TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH 33477 $5,383.00 33478 PR RV OUTFLOW TRACT AUGMENTATN 33478 $6,225.00

33502 PR REPR ANOMAL CORON ART PA ORIGIN BY LIGATN 33502 $3,437.00

33506 PR REPR ANOMAL COR ART PA ORIGIN TRANSLOCATION 33506 $8,213.00

33507 PR REPR INTRAMURAL COR ART TRANSLOC/ UNROOF 33507 $7,054.00

33508 PR ENDOSCOPY W/VIDEO-ASST VEIN HARVEST,CABG 33508 $350.00 33510 PR CABG, VEIN, SINGLE 33510 $6,571.00 33511 PR CABG, VEIN, TWO 33511 $6,827.00 33512 PR CABG, VEIN, THREE 33512 $7,188.00 33517 PR CABG, ARTERY-VEIN, SINGLE 33517 $524.00 33518 PR CABG, ARTERY-VEIN, TWO 33518 $1,152.00 33519 PR CABG, ARTERY-VEIN, THREE 33519 $1,963.00 33521 PR CABG, ARTERY-VEIN, FOUR 33521 $2,331.00 33530 CABG, REOPERATE >1 MON ORIG 33530 $1,895.00 33533 PR CABG, ARTERIAL, SINGLE 33533 $7,782.00 33534 PR CABG, ARTERIAL, TWO 33534 $9,042.00 $10,083.0 33535 PR CABG, ARTERIAL, THREE 33535 0 33542 PR MYOCARD RESECTN 33542 $7,091.00 $12,083.0 33548 PR RESTORE/REMODEL VENTRICLE 33548 0 33572 PR OPEN CORONARY ENDARTERECTOMY 33572 $623.00 33600 PR CLOSURE OF AV VALVE 33600 $7,029.00 33606 PR ANAST PULM ARTERY TO AORTA 33606 $7,231.00 33608 PR REPAIR ANOMALY W/CONDUIT 33608 $5,095.00 33610 PR REPAIR BY SURG ENLARGEMENT,VSD 33610 $7,260.00 33612 PR REPR DOUB VENT W RPR RV OUTFLOW 33612 $8,236.00 33615 PR REPR (SIMPLE FONTAN) 33615 $6,510.00 33617 PR REPR BY MODIFIED FONTAN 33617 $8,682.00 $10,622.0 33619 PR REPR HYPOPLAS LT HEART 33619 0

33620 PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BANDS 33620 $6,765.00

$14,172.0 33622 PR RECONSTRUCTION COMPLEX CARDIAC ANOMALY 33622 0 33641 PR REPR ASD W BYPASS 33641 $4,943.00 33645 PR REPR/CLOS SINUS VENOSUS 33645 $5,804.00 33647 PR REPR ASD & VSD 33647 $6,844.00 33660 PR REPR ASD OSTIUM PREMUM 33660 $6,949.00 33665 PR REPR INTERMED AV CANAL DEFECT 33665 $6,860.00 33670 PR REPR COMPL AV CANAL DEFECT 33670 $7,463.00 33675 PR CLOSE MULTIPLE VSD 33675 $8,072.00 33677 PR CLOSE MULTIPLE VSD, REMOVE PA BAND 33677 $7,982.00 33681 PR CLOSE SINGLE VSD 33681 $7,521.00 33684 PR CLOSE SINGLE VSD, WITH RESECTION 33684 $6,907.00 33688 PR CLOSE SINGLE VSD, REMOVE PA BAND 33688 $7,767.00 33690 PR BANDING PULM ARTERY 33690 $4,290.00 33692 PR REPR TET FALLOT WO PULM ARTRES 33692 $7,141.00 33694 PR REPR TET FALLOT X-ANNULAR PTCH 33694 $7,778.00 33697 PR REPR TET FALLOT W PULM ATRESIA 33697 $8,253.00 33710 PR REPR VALSALVA FISTULA & VSD 33710 $8,400.00 33720 PR REPR VALSALVA ANEURYSM 33720 $6,337.00 33724 PR REPAIR PULMONARY VENOUS ANOMALY 33724 $6,301.00 33726 PR REPAIR PULMONARY VENOUS STENOSIS 33726 $8,324.00

33730 PR REPRAIR ANOMAL PULMONARY VENOUS RETURN 33730 $7,656.00 33732 PR REPR COR TRIAT/SUPRAVALV MITR RING 33732 $5,420.00 33735 PR ATR SEPTEC/SEPTOSTOMY CLOSED 33735 $4,295.00 33737 PR ATR SEPTEC/SEPTOSTMY OPN INFLW OCCL 33737 $4,340.00

33741 PR TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD 33741 $1,983.00

33745 PR TIS CRTJ ST CONGENITAL CARDIAC ANOMAL 1ST SHUNT 33745 $2,789.00

33746 PR TIS CRTJ ST CONGENITAL CARDIAC ANOMAL EA ADDL 33746 $1,098.00 33750 PR SHUNT SUBCL TO PULM ART 33750 $5,075.00 33755 PR SHUNT ASC AORTA TO PUL ART 33755 $5,413.00 33764 PR SHUNT CENTRAL W PROSTH GRAFT 33764 $5,112.00 33766 PR SHUNT SVC TO PA, ONE LUNG 33766 $4,070.00 33767 PR SHUNT SVC TO PA, BOTH LUNGS 33767 $5,875.00 33768 PR ANAST SECONDARY SVC TO PA 33768 $1,136.00 33778 PR REPR XPOSTN GRT VES,AO-PUL ART RECON 33778 $9,007.00 33780 PR REPR XPTN GR VES,AP ART W CLOS VSD 33780 $9,520.00 33786 PR REPAIR TRUNCUS ARTERIOSUS 33786 $9,313.00 33788 PR REIMPLNT ANOMAL PULM ART 33788 $5,110.00 33800 PR AORTIC SUSPENSN FOR TRACH DECOMPRE 33800 $2,705.00 33802 PR DIVISN ABERRANT VESSEL 33802 $3,881.00 33803 PR DIVISN ABER VESS W REANAST 33803 $3,260.00 33814 PR OBLIT AO-PUL SEPTAL DFCT W CP BYPAS 33814 $6,181.00 33820 PR REPR PDA BY LIGATN 33820 $3,582.00 33822 REPR PDA BY DIVISION <18 Y/O 33822 $4,016.00 33840 PR EXCISN COARCT AORTA DRCT ANAST 33840 $5,086.00 33845 PR EXCISN COARCT AORTA W GRAFT 33845 $5,504.00 33852 PR REPR HYPOPLASTIC AORTIC ARCH 33852 $3,818.00 33853 PR REPR HYPOPLASTIC ARCH W CP BYPASS 33853 $7,512.00

$13,987.0 33858 PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION 33858 0

$10,042.0 33859 PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ 33859 0

$12,960.0 33860 PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION 33860 0

PR ASCEND AORTA GRAFT W ROOT REPLACMENT.VALVE 33863 CONDUIT/CORON RECONSTRUCT 33863 $9,772.00

PR ASCEND AORTA GRAFT W VALVE SPARING ANNULUS 33864 REMODEL 33864 $9,006.00

33866 PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS 33866 $3,766.00 33870 PR TRANSV AORTIC ARCH GRAFT W BYPASS 33870 $9,620.00

$13,446.0 33871 PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA 33871 0 33875 PR THORACIC AORTA GRAFT 33875 $7,447.00 33877 PR REPR THORACOABDOM AA W GRAFT 33877 $9,792.00 33880 PR ENDOVASC TAA REPR INCL SUBCL 33880 $4,848.00 33881 PR ENDOVASC TAA REPR W/O SUBCL 33881 $6,329.00 33883 PR INSERT ENDOVASC PROSTH, TAA 33883 $3,013.00 33884 PR ENDOVASC PROSTH, TAA, EA ADD 33884 $950.00

33886 PR ENDOVASC DIST EXTENS TAA PROSTH, DELAYED 33886 $3,400.00

33889 PR SUBCLAV TRANSPOS W/ ENDOVAS TAA REPAIR 33889 $2,138.00

33891 PR CAR-CAR BYPASS GRFT W/ ENDOVAS TAA REPAIR 33891 $2,614.00 $10,752.0 33910 PR REMOVE PUL ART EMBOLI W CP BYPASS 33910 0 $17,458.0 33916 PR PULM ENDARTERECTOMY 33916 0 33917 PR REPAIR PULMONARY ART STEN 33917 $5,981.00 33920 PR REPAIR PULM ART ATRESIA,CONDUIT 33920 $7,224.00 33922 PR TRANSECT PULMONARY ARTERY 33922 $4,375.00 33924 PR REMV SYS-PULM SHUNT W CONG HRT 33924 $772.00

$10,466.0 33926 PR REPAIR PUL ART UNIFOCAL ARBOR W/ CP BYPASS 33926 0

$10,629.0 33927 PR IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY 33927 0 33930 PR REMOVAL OF DONOR HEART/LUNG 33930 $5,251.00 33933 PR TRANSPLANT,PREP DONOR HEART/LUNG 33933 $8,373.00 33940 PR REMOVAL OF DONOR HEART 33940 $5,251.00 33944 PR TRANSPLANT,PREP DONOR HEART 33944 $1,643.00 $13,141.0 33945 PR TRANSPLANTATION OF HEART 33945 0 33946 PR ECMO/ECLS INITIATION VENO-VENOUS 33946 $834.00 33947 PR ECMO/ECLS INITIATION VENO-ARTERIAL 33947 $927.00

PR ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO- 33948 VENOUS 33948 $646.00

33949 PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL 33949 $627.00

33951 PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ 33951 $1,147.00

33952 PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ 33952 $1,215.00

33953 PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN 33953 $1,278.00

33954 PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN 33954 $1,287.00 33955 PR ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS 33955 $3,150.00

33956 PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER 33956 $2,977.00

33957 PR ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS 33957 $712.00

33958 PR ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER 33958 $695.00

33959 PR ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS 33959 $830.00

33962 PR ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER 33962 $791.00

33963 PR ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS 33963 $1,388.00

33964 PR ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER 33964 $1,406.00

33965 PR ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS 33965 $704.00

33966 PR ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER 33966 $786.00 33967 PR INSERT INTRA-AORTIC BALLOON ASST DEVICE 33967 $850.00 33968 PR RMV AORTIC BALLOON DEVICE 33968 $92.00

33969 PR ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS 33969 $845.00 33970 PR INSRT AORT BALLOON ASSIST FEM ART 33970 $1,166.00 33971 PR REMV AORTIC BALLOON ASSIST FEM ART 33971 $2,534.00 33973 PR INSRT AORTIC BALLOON THRU ASC AORT 33973 $1,286.00 33974 PR REMV AORTIC BALLOON FROM ASC AORT 33974 $3,184.00 33975 PR INSERT VENT ASST DEVICE,SINGLE VENTRICLE 33975 $4,034.00 33976 PR INSERT VENT ASST DEVICE,BIVENTRICULAR 33976 $4,576.00

33977 PR REMOVE VENT ASST DEVICE,SINGLE VENTRICLE 33977 $3,869.00 33978 PR REMOVE VENT ASST DEVICE,BIVENTRICULAR 33978 $4,911.00

33979 PR INSERT VENT ASST DEV,IMPLANT,SINGLE VENT 33979 $6,668.00

33980 PR REMOVE VENT ASST DEV,IMPLANT,SINGLE VENT 33980 $8,150.00

PR REPLACE EXTRACORP VENT ASST DEV,SINGLE/BIVENT, 33981 1/EACH PUMP 33981 $3,016.00 PR REPLACE VENT ASST DEV, IMPLANT INTRACORP, SINGLE 33982 VENT, W/O BYPASS 33982 $7,399.00

PR REPLACE VENT ASST DEV, IMPLANT INTRACORP, SINGLE 33983 VENT, W/ BYPASS 33983 $8,460.00

33984 PR ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER 33984 $827.00

33985 PR ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS 33985 $1,566.00

33986 PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER 33986 $2,074.00

33987 PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS 33987 $624.00

33988 PR INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS 33988 $2,637.00

33989 PR RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS 33989 $1,248.00

33990 PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY 33990 $1,148.00

33991 PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS 33991 $2,136.00

33992 PR REMOVAL PERQ LEFT HRT VAD ARTL/ARTL&VEN SEP INSJ 33992 $539.00

33993 PR REPOSITIONING PERQ R/L VAD W/IMG GDN SEP INSJ 33993 $470.00

33995 PR INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY 33995 $948.00

33997 PR REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ 33997 $421.00 33999 PR CARDIAC SURG PROCEDURE UNLIST 33999 $2,000.00 34001 PR REMV ART CLOT,NECK INCIS 34001 $3,458.00 34101 PR REMV ART CLOT AXILL-BRACH,ARM INCIS 34101 $1,619.00 34111 PR REMV ART CLOT ARM,ARM INCIS 34111 $2,158.00 34151 PR REMV ART CLOT VISC,ABD INCIS 34151 $5,168.00 34201 PR REMV ART CLOT ILIAC-POP,LEG INCIS 34201 $2,777.00 34203 PR REMV ART CLOT LOW LEG,LEG INCIS 34203 $3,079.00 34401 PR REMV VEIN CLOT CAVA-ILIAC,ABD INCIS 34401 $4,127.00 34471 PR REMV VEIN CLOT SUBCLAV,NECK INCIS 34471 $2,978.00 34490 PR REMV VEIN CLOT AXILL-SUBCL,ARM INCIS 34490 $2,185.00 34502 PR RECONSTRUCT, VENA CAVA 34502 $6,326.00 34701 PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT 34701 $5,143.00

34702 PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT 34702 $7,682.00 34703 PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT 34703 $5,795.00

34704 PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT 34704 $9,639.00 34705 PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT 34705 $6,384.00

34706 PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT 34706 $9,608.00 34707 PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT 34707 $4,796.00 34708 PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT 34708 $7,718.00

34709 PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR 34709 $878.00

34710 PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL 34710 $2,929.00

34711 PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL 34711 $809.00

34712 PR TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I 34712 $2,503.00

34713 PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT 34713 $339.00

34714 PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH 34714 $733.00

34715 PR OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI 34715 $790.00

34716 PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ 34716 $1,046.00

34717 PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI 34717 $1,205.00

34718 PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI 34718 $5,119.00 34800 PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH 34800 $3,789.00 34802 PR AAA REPAIR,MODULR BIFURCATED PROSTH 34802 $4,789.00 34803 PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK 34803 $4,884.00 34805 PR ENDOVASC ABDO REPAIR W/PROS 34805 $2,752.00 34808 PR AAA REPAIR,ILIAC ARTERY OCCLSN DEVICE 34808 $541.00

34812 PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI 34812 $830.00 34813 PR AAA REPAIR, FEMORAL-FEMORAL GRAFT 34813 $643.00 34820 PR OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI 34820 $1,200.00 34825 PR AAA REPR,1ST VESSEL,EXTENSION PROSTH 34825 $1,628.00 34826 PR AAA REPR,ADD VESSEL,EXTENSION PROSTH 34826 $500.00 34830 PR AAA+TRAUMA REPR,OPEN,TUBE PROSTH 34830 $4,281.00 34831 PR AAA+TRAUMA REPR, AORTO-BI-ILIAC PROS 34831 $7,939.00

34833 PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP 34833 $1,455.00

34834 PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI 34834 $1,166.00

34839 PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT 34839 $1,035.00

34842 PR ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT 34842 $5,096.00

34843 PR ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT 34843 $5,852.00

34844 PR ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT 34844 $8,743.00

34845 PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS 34845 $6,885.00

34846 PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS 34846 $4,565.00

34847 PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS 34847 $5,412.00

$11,282.0 34848 PR VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS 34848 0

PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC 34900 PROSTHESIS 34900 $3,224.00

35001 PR REPR ANEURYSM/GRFT INS,CAROTID/SUBCLAV 35001 $4,567.00 35011 PR REPR DFCT ART AXILLO-BRACH 35011 $3,258.00 35045 PR REPR ANEURYSM/GRFT INS,RADIAL/ULNAR 35045 $3,531.00

35081 PR REPR ANEURYSM/GRFT INS,ABDOMINAL AORTA 35081 $5,899.00 35082 PR REPR ART RUPTURE, ABD AORTA 35082 $8,983.00

35091 PR REPR ANEURYSM/GRFT INS,ABD AORT W/VISCER 35091 $7,346.00 $10,743.0 35092 PR REPR ART RUPTURE,AORTA/VISC 35092 0 35102 PR REPR ANEURYSM/GRFT INS,ABD AORT W/ILIAC 35102 $7,748.00 35103 PR REPR ART RUPTURE,AORTOILIAC 35103 $9,213.00

35121 PR REPR ANEUR/GRFT INS,HEP/CEL/REN/MESENTER 35121 $6,769.00 35131 PR REPR ANEURYSM/GRFT INS,ILIAC 35131 $5,713.00 35132 PR REPR ART RUPTURE,ILIAC 35132 $3,982.00

35141 PR REPR ANEURYSM/GRFT INS,COMMON FEMORAL 35141 $3,667.00 35142 PR REPR ART RUPTURE,FEMORAL 35142 $5,406.00 35151 PR REPR ANEURYSM/GRFT INS,POPLITEAL 35151 $4,737.00 35184 PR REPR CONG AV FIST,EXTREM 35184 $3,448.00 35189 PR REPR ACQ AV FIST,CHEST/ABD 35189 $6,221.00 35190 PR REPR ACQ AV FIST,EXTREM 35190 $2,411.00 35201 PR REPR BL VES DIRECT,NECK 35201 $2,968.00 35206 PR REPR BL VES DIRECT,UP EXTREM 35206 $2,814.00 35207 PR REPR BL VES DIRECT,HAND/FINGR 35207 $3,750.00 35211 PR REPR BL VES DIRECT,CHEST W BYPASS 35211 $3,748.00 35216 PR REPR BL VES DIRECT,CHEST 35216 $5,596.00 35221 PR REPR BL VES DIRECT,ABD 35221 $5,056.00 35226 PR REPR BL VES DIRECT,LOW EXTREM 35226 $2,972.00 35231 PR REPR BL VES VEIN GRFT,NECK 35231 $5,084.00 35236 PR REPR BL VES VEIN GRFT,UP EXTREM 35236 $4,650.00 35241 PR REPR BL VES VEIN GRFT,CHEST/W BYPAS 35241 $3,281.00 35246 PR REPR BL VES VEIN GRFT,CHEST 35246 $6,420.00 35251 PR REPR BL VES VEIN GRFT,ABD 35251 $7,136.00 35256 PR REPR BL VES VEIN GRFT,LOW EXTREM 35256 $3,664.00 35261 PR REPR BL VES GRAFT,NECK 35261 $3,239.00 35266 PR REPR BL VES GRAFT,UP EXTREM 35266 $3,102.00 35271 PR REPR BL VES GRAFT,CHEST W BYPASS 35271 $3,129.00 35276 PR REPR BL VES GRAFT,CHEST 35276 $5,596.00 35281 PR REPR BL VES GRAFT,ABDOMEN 35281 $5,763.00 35286 PR REPR BL VES GRAFT,LOW EXTREM 35286 $3,189.00 35301 PR THROMBOENDARTECTMY NECK,NECK INCIS 35301 $3,510.00

35302 PR THROMBOENDARTECTMY SUPERFICIAL FEM ARTERY 35302 $4,546.00 35303 PR THROMBOENDARTECTMY POPLITEAL ARTERY 35303 $5,292.00

35304 PR THROMBOENDARTECTMY TIBIOPERONEAL TRUNK ARTERY 35304 $3,452.00

35305 PR THROMBOENDARTECTMY TIBIAL/ PERON ARTERY, INITIAL 35305 $5,063.00 35306 PR THROMBOENDARTECTMY TIBIAL/ PERON ARTERY, ADD 35306 $1,244.00 35321 PR THROMBOENDARTECTMY AXILLARY-BRACH 35321 $2,926.00 35331 PR THROMBOENDARTECTMY ABD AORTA 35331 $5,486.00 35341 PR THROMBOENDARTECTMY VISCERAL 35341 $5,284.00 35351 PR THROMBOENDARTECTMY ILIAC 35351 $5,260.00 35355 PR THROMBOENDARTECTMY ILIOFEMORAL 35355 $3,706.00 35371 PR THROMBOENDARTECTMY FEMORAL COMMON 35371 $2,744.00 35372 PR THROMBOENDARTECTMY FEMORAL DEEP 35372 $3,312.00 35390 PR REOPER, CAROTID ENDARTEC>1 MON 35390 $433.00 35400 PR ANGIOSCOPY DURING RX INTERVENTN 35400 $403.00 35460 PR BALLN ANGIOPLASTY OPEN,VENOUS 35460 $794.00 $12,695.0 35471 PR BALLN ANGIOPLASTY PERC,VISCERAL 35471 0 35472 PR BALLN ANGIOPLASTY PERC,AORTIC 35472 $5,072.00 35475 PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH 35475 $5,657.00 35476 PR BALLN ANGIOPLASTY,PERC VENOUS 35476 $4,321.00 35500 PR HARVEST VEIN FOR BYPASS 35500 $866.00

35501 PR VEIN BYPASS GRAFT,CAROTID, COMMON-INT CAR ART 35501 $3,615.00

35506 PR VEIN BYPASS GRAFT,CAROT-SUBCL/ SUBCL-CAROTD 35506 $3,624.00 35510 PR ARTERY BYPASS GRAFT 35510 $5,025.00 35516 PR VEIN BYPASS GRAFT,SUBCL-AXILL 35516 $2,889.00 35522 PR ARTERY BYPASS GRAFT 35522 $4,959.00

35523 PR VEIN BYPASS GRAFT, BRACHIAL ULNAR OR RADIAL 35523 $5,227.00 35525 PR ARTERY BYPASS GRAFT 35525 $4,556.00 35531 PR VEIN BYPASS GRAFT,AORTO-MESEN 35531 $8,348.00 35537 PR VEIN BYPASS GRAFT,AORTOILIOFEMORAL 35537 $8,726.00 35556 PR VEIN BYPASS GRAFT,FEM-POP 35556 $5,745.00 35566 PR VEIN BYPASS GRAFT,FEM-TIBIAL 35566 $5,731.00 35571 PR VEIN BYPASS GRAFT,TIB-PERONEAL 35571 $5,283.00 35572 PR HARVEST FEMPOP VEIN,ONE SEGMENT 35572 $982.00 35583 PR VEIN IN SITU BYPASS GRAFT,FEM-POP 35583 $5,932.00

35600 HARVEST UPPER EXTREMITY ART 1 SEGMENT FOR CABG 35600 $693.00 35601 PR BYPASS GRAFT OTHR,CAROTID-INT CAROTID 35601 $3,787.00 35606 PR BYPASS GRAFT OTHR,CAROT-SUBCL 35606 $3,270.00 35612 PR BYPASS GRAFT OTHR,SUBCL-SUBCL 35612 $4,270.00 35616 PR BYPASS GRAFT OTHR,SUBCL-AXILL 35616 $4,512.00 35621 PR BYPASS GRAFT OTHR,AXILL-FEM 35621 $3,689.00

PR BYPASS GRAFT OTHR,AORTOSUBCLAVIAN/AORTOINNOMINATE/AORTOCAR 35626 OTID 35626 $5,739.00 35631 PR BYPASS GRAFT OTHR,AORTO-MESENTER 35631 $6,982.00 35632 PR BYPASS GRAFT OTHR,ILIO-CELIAC 35632 $6,493.00 35633 PR BYPASS GRAFT OTHR,ILIO-MESENTERIC 35633 $5,797.00 35637 PR BYPASS GRAFT OTHR,AORTOILIAC 35637 $4,491.00 35638 PR BYPASS GRAFT OTHR,AORTOBI-ILIAC 35638 $6,288.00 35646 PR BYPASS GRAFT OTHR,AORTOBIFEMORAL 35646 $6,550.00 35647 PR BYPASS GRAFT OTHR,AORTOFEMORAL 35647 $4,190.00 35654 PR BYPASS GRAFT OTHR,AXILL-FEM-FEM 35654 $5,201.00 35656 PR BYPASS GRAFT OTHR,FEM-POP 35656 $3,609.00 35661 PR BYPASS GRAFT OTHR,FEM-FEM 35661 $3,481.00 35663 PR BYPASS GRAFT OTHR,ILIOILIAC 35663 $5,147.00 35665 PR BYPASS GRAFT OTHR,ILIOFEMORAL 35665 $4,821.00 35666 PR BYPASS GRAFT OTHR,FEM-TIBIAL 35666 $5,195.00 35671 PR BYPASS GRAFT OTHR,POP-PERONEAL 35671 $4,581.00 35681 PR BYPASS GRAFT COMPOSITE/PROS+VEIN 35681 $220.00 35682 PR BYPASS GRAFT COMPOS/2 VEINS/2 LOCATN 35682 $959.00 35685 PR BYPASS GRAFT VEIN PATCH/CUFF,SYNTHETIC 35685 $539.00 35693 PR ART TRANSPOSITN,VERT-SUBCL 35693 $2,858.00 35694 PR ART TRANSPOSITN,SUBCL-CAROT 35694 $3,535.00 35695 PR ART TRANSPOSITN,CAROT-SUBCL 35695 $4,192.00 35697 PR REIMPLANT ARTERY EACH 35697 $391.00 35700 PR REOPERATION, BYPASS GRAFT 35700 $414.00 35701 PR EXPLORATION N/FLWD SURG NECK ARTERY 35701 $1,529.00

35702 PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY 35702 $1,057.00

35703 PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY 35703 $1,125.00 35721 PR EXPLORATION, FEMORAL ARTERY 35721 $1,119.00 35741 PR EXPLORATION POPLITEAL ARTERY 35741 $1,316.00 35761 PR EXPLORATION OF ARTERY/VEIN 35761 $895.00 35800 PR EXPLOR POSTOP BLEED,INFEC,CLOT-NECK 35800 $1,939.00 35820 PR EXPLOR POSTOP BLEED,INFEC,CLOT-CHST 35820 $6,564.00 35840 PR EXPLOR POSTOP BLEED,INFEC,CLOT-ABD 35840 $4,867.00 35860 PR EXPLOR POSTOP BLEED,INFEC,CLOT-EXTR 35860 $3,009.00 35875 PR REMOVAL OF CLOT IN GRAFT 35875 $2,107.00 35876 PR REMOVAL OF CLOT IN GRAFT 35876 $3,337.00 35879 PR REVISE GRAFT/VEIN PATCH ANGIO 35879 $3,321.00 35881 PR REVISE GRAFT/SEG VEIN INTERPOS 35881 $3,215.00

35883 PR REVISE FEMORAL GRAFT, NON-AUTOGENOUS GRAFT 35883 $5,133.00

35884 PR REVISE FEMORAL GRAFT, AUTOGENOUS GRAFT 35884 $5,091.00 35901 PR EXCISION, INFEC GRAFT, NECK 35901 $1,272.00 35903 PR EXCISION, INFEC GRAFT, EXTREMITY 35903 $1,594.00 35905 PR EXCISION, INFEC GRAFT, THORAX 35905 $6,868.00 35907 PR EXCISION, INFEC GRAFT, ABDOMEN 35907 $7,238.00 36000 PR PLACE NEEDLE IN VEIN 36000 $74.00 36002 PR INJECTION RX EXTREMITY PSEUDOANEURYSM 36002 $416.00 36005 PR INJECTION PROC,EXTREMITY,VENOGRAPHY 36005 $814.00

36010 PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA 36010 $1,958.00 36011 PR PLACE CATH IN VEIN,SELECT 36011 $2,569.00 36012 PR PLACE CATH IN VEIN,SUBSELECT 36012 $2,016.00 36013 PR PLACE CATH IN RT HRT,MAIN PULM ART 36013 $2,004.00 36014 PR PLACE CATH IN LT/RT PULM ART 36014 $2,019.00 36015 PR PLACE CATH IN SUBSEGMT PULM ART 36015 $2,287.00 36120 PR PLACE CATH BRACHIAL ART 36120 $1,120.00

36140 PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY 36140 $1,272.00

PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/ 36147 RAD EVAL 36147 $1,813.00

PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,ADDL ACCESS 36148 FOR THERAPY 36148 $657.00 36160 PR PLACE CATH AORTA VIA TRANSLUMBAR 36160 $1,389.00 36200 PR INTRODUCTION CATHETER AORTA 36200 $1,672.00 36215 PR PLACE CATH SELECTIVE ART,NECK 36215 $2,786.00 36216 PR PLACE CATH SUBSELECT ART,NECK 36216 $3,016.00 36217 PR PLACE CATH SUBSUBSELECT ART,NECK 36217 $5,259.00 36218 PR PLACE CATH ADDN SUBSELEC ART,NECK 36218 $512.00

PR NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL 36221 ART 36221 $540.00

36222 PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART 36222 $3,526.00 36223 PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART 36223 $3,843.00

36224 PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART 36224 $4,177.00

36225 PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY 36225 $3,813.00

36226 PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY 36226 $4,261.00

36227 PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC 36227 $613.00

36228 PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT 36228 $2,934.00

36245 PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH 36245 $3,197.00

36246 PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH 36246 $3,074.00

36247 PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH 36247 $4,866.00

36248 PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH 36248 $431.00

36251 PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN 36251 $3,573.00

36252 PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL 36252 $3,919.00

PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY 36253 ARTERY/S&I 36253 $5,467.00

PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY 36254 ARTERY/S&I 36254 $5,563.00

36400 PR VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN 36400 $75.00

36406 PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN 36406 $64.00 36410 PR VNPNXR 3 YEARS/> PHYS/QHP SKILL 36410 $46.00 36415 PR COLLECTION VENOUS BLOOD,VENIPUNCTURE 36415 $8.00 36416 PR COLLECTION CAPILLARY BLOOD SPECIMEN 36416 $11.00 36430 PR BLOOD TRANSFUSION SERVICE 36430 $89.00

PR PRTL EXCHANGE TRANSFUSE BLOOD/PLSM/CRYST 36456 NEWBORN 36456 $278.00 36460 PR TRANSFUSION FETAL,INTRAUTER 36460 $1,400.00 36465 PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN 36465 $4,060.00

36466 PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS 36466 $4,242.00

36468 PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK 36468 $137.00

36470 PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN 36470 $373.00

36471 PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS 36471 $436.00

36473 PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN 36473 $450.00

36474 PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS 36474 $226.00 36475 PR ENDOVENOUS RF, 1ST VEIN 36475 $4,147.00 36478 PR ENDOVENOUS LASER, 1ST VEIN 36478 $3,282.00

36479 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS 36479 $958.00

36481 PR PRQ PORTAL VEIN CATHETERIZATION ANY METHOD 36481 $4,963.00

36482 PR ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN 36482 $5,158.00

36483 PR ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN 36483 $368.00 36500 PR VENOUS SELECT SAMPLING W CATH 36500 $509.00 36510 PR CATH, VEIN UMBILICAL NEWBORN 36510 $232.00 36511 PR THER APHERESIS,WHITE BLOOD CELLS 36511 $232.00 36512 PR THER APHERESIS,RED BLOOD CELLS 36512 $280.00 36513 PR THER APHERESIS,PLATELETS 36513 $248.00 36514 PR THER APHERESIS,PLASMA PHERESIS 36514 $2,027.00 36522 PR PHOTOPHERESIS 36522 $6,263.00

36555 PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y 36555 $711.00 36556 PR INSERT NON-TUNNEL CV CATH 36556 $664.00

36557 PR INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR 36557 $2,201.00

36558 PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> 36558 $2,170.00 36560 PR INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR 36560 $3,168.00

36561 PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> 36561 $3,010.00

36565 PR INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP 36565 $2,379.00

36566 PR INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT 36566 $8,520.00 36568 PR INSERTION PICC W/O IMG GDN < 5 YR 36568 $798.00 36569 PR INSERT TUNNELED CV CATH 36569 $751.00 36571 PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> 36571 $3,251.00 36572 PR INSERTION PICC W/RS&I < 5 YR 36572 $1,073.00 36573 PR INSERTION PICC W/RS&I 5 YR/> 36573 $1,060.00 36575 PR REPAIR TUNNELED CV CATH 36575 $426.00

36576 PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576 $951.00 36578 PR RPLCMT CATH CTR VAD SUBQ PORT/PMP 36578 $1,278.00

36580 PR REPLACE NON-TUNNELED CENTRAL LINE, W/O PORT/PUMP 36580 $672.00

36581 PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP 36581 $2,134.00 36582 PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT 36582 $2,686.00

36584 PR REPLACE COMPLETE PICC W/O PORT/PUMP, SAME ACCESS 36584 $663.00 36585 PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT 36585 $2,767.00 36589 PR REMOVAL TUNNELED CV CATH 36589 $444.00

36590 PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 36590 $772.00

36593 PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH 36593 $67.00 36595 PR MECH REMOV TUNNELED CV CATH 36595 $1,701.00 36596 PR MECH REMOV TUNNELED CV CATH 36596 $368.00 36597 PR REPOSITION VENOUS CATHETER 36597 $395.00 36598 PR CONTRAST INJ CENT VEN CATH, INC FLOURO 36598 $292.00 36600 PR WITHDRAWAL OF ARTERIAL BLOOD 36600 $83.00 36620 PR INSERT CATH,ART,PERCUT,SHORTTERM 36620 $270.00 36625 PR INSERT CATH,ART,CUTDOWN,SHORTTERM 36625 $285.00 36660 PR CATH, UMBILICAL ARTERY 36660 $177.00 36680 PR INSERT NEEDLE,INTRAOSSEOUS INFUSN 36680 $188.00 36800 PR INSERT CANNULA,VEIN-VEIN 36800 $405.00 36815 PR INSERT CANNULA,ART-VEN REVISN 36815 $384.00

36818 PR AV ANAST,UP ARM CEPHALIC VEIN TRANSPOSIT 36818 $1,873.00 36819 PR AV ANAST,UP ARM BASILIC VEIN TRANSPOSIT 36819 $2,648.00 36820 PR AV ANAST,FOREARM VEIN TRANSPOSITION 36820 $2,636.00 36821 PR ANASTOMOSIS,AV,ANY SITE 36821 $1,799.00 36825 PR CREAT AV FISTULA,AUTOGENOUS GRAFT 36825 $2,152.00

36830 PR CREAT AV FISTULA,NON-AUTOGENOUS GRAFT 36830 $2,343.00 36831 PR THROMBECTOMY,AV FISTULA DIALYS GRFT 36831 $2,219.00 36832 PR REVISE AV FISTULA,W/O THROMBECTOMY 36832 $2,071.00 36833 PR AV FIST REVISE GRFT,W THROMBECTOMY 36833 $2,322.00 36838 PR DIST REVAS LIGATION, HEMO 36838 $4,708.00 36870 PR THROMBECTOMY,ARTERIOVENOUS FISTULA 36870 $4,878.00

36901 PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I 36901 $1,429.00

36902 PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP 36902 $624.00

36903 PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT 36903 $770.00

36904 PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH 36904 $887.00

36905 PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP 36905 $1,113.00

36906 PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT 36906 $1,299.00

36907 PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I 36907 $383.00

36908 PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR 36908 $486.00

36909 PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I 36909 $462.00 37140 PR VENOUS ANASTOMOSIS,OPEN,PORTOCAVAL 37140 $6,305.00 37180 PR SPLENORENAL PROX SHUNT 37180 $8,798.00

37182 PR INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT 37182 $3,470.00

37183 PR REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT 37183 $965.00 37184 PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST 37184 $6,625.00

37185 PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ 37185 $2,166.00

37186 PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL 37186 $4,003.00

37187 PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN 37187 $6,443.00 37188 PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX 37188 $5,558.00

37191 PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I 37191 $6,509.00

37192 PR REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I 37192 $3,917.00

37193 PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I 37193 $4,160.00

37197 PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING 37197 $3,777.00 37200 PR TRANSCATHETER BIOPSY 37200 $587.00

37211 PR THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX 37211 $1,045.00

37212 PR THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX 37212 $914.00

37213 PR THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX 37213 $630.00

37214 PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL 37214 $354.00

37215 PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ 37215 $3,586.00

37216 PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ 37216 $3,333.00

PR TCATH STENT PLACEMT RETROGRAD 37217 CAROTID/INNOMINATE 37217 $2,922.00

PR TCATH STENT PLACEMT ANTEGRADE 37218 CAROTID/INNOMINATE 37218 $3,034.00

37220 PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL 37220 $1,052.00

37221 PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY 37221 $1,285.00 37222 PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL 37222 $2,225.00

37223 PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL 37223 $543.00

37224 PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI 37224 $1,165.00

37225 PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL 37225 $1,570.00

37226 PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL 37226 $1,824.00

PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM 37227 VSL 37227 $2,646.00

37228 PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI 37228 $1,420.00

37229 PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL 37229 $2,568.00

37230 PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL 37230 $2,497.00

PR REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM 37231 VSL 37231 $1,955.00

37232 PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL 37232 $2,967.00

PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA 37233 VSL 37233 $3,702.00

37234 PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL 37234 $714.00

PR REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA 37235 VSL 37235 $1,556.00

37236 PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL 37236 $1,795.00

37237 PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL 37237 $546.00

37238 PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST 37238 $819.00

37239 PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL 37239 $381.00

37241 PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I 37241 $1,789.00 37242 PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I 37242 $1,773.00

37243 PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT 37243 $2,382.00

37244 PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE 37244 $2,778.00

37246 PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART 37246 $924.00

37247 PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART 37247 $458.00

37248 PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN 37248 $795.00

37249 PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN 37249 $390.00

37252 PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL 37252 $3,554.00

37253 PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL 37253 $530.00 37600 PR LIGATN NECK ARTERY, ECA 37600 $2,612.00 37607 PR LIGATN ANGIOACCESS AV FISTULA 37607 $1,012.00 37609 PR TEMPORAL ARTERY LIGATN OR BX 37609 $833.00 37615 PR LIGATN OF NECK ARTERY 37615 $1,361.00 37616 PR LIGATN OF CHEST ARTERY 37616 $3,879.00 37617 PR LIGATN OF ABDOMEN ARTERY 37617 $4,619.00 37618 PR LIGATN OF EXTREMITY ARTERY 37618 $1,031.00

37619 PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I 37619 $4,021.00 37650 PR LIGATN FEMORAL VEIN 37650 $1,251.00 37660 PR LIGATN COMMON ILIAC VEIN 37660 $5,412.00

37700 PR LIGATN LONG SAPHENOUS VEIN AT SEPH-FEM JUNC 37700 $673.00 37765 PR PHLEB VEINS - EXTREM - TO 20 37765 $1,645.00 37766 PR PHLEB VEINS - EXTREM 20+ 37766 $1,953.00 37785 PR REVISE SECONDARY VARICOSITY 37785 $913.00 38100 PR REMOVAL SPLEEN, TOTAL 38100 $3,128.00 38101 PR REMOVAL SPLEEN, PARTIAL 38101 $3,163.00 38102 PR REMOVAL SPLEEN, TOTAL W OTHR PROC 38102 $711.00 38115 PR REPAIR OF RUPTURED SPLEEN 38115 $3,463.00 38120 PR LAP,SPLENECTOMY 38120 $3,155.00 38200 PR INJECTION FOR SPLEEN X-RAY 38200 $359.00

38205 PR PROG CELL HARVEST,TRANSPLANT,ALLOGENIC 38205 $197.00

38206 PR PROG CELL HARVEST,TRANSPLANT,AUTOLOGOUS 38206 $198.00 38220 PR DIAGNOSTIC BONE MARROW ASPIRATIONS 38220 $445.00 38221 PR DIAGNOSTIC BONE MARROW BIOPSIES 38221 $421.00

38222 PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS 38222 $460.00

38230 PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC 38230 $1,500.00

PR BONE MARROW HARVEST TRANSPLANTATION 38232 AUTOLOGOUS 38232 $537.00

38240 PR TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR 38240 $500.00

PR TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER 38241 DONOR 38241 $500.00 38242 PR ALLOGENEIC LYMPHOCYTE INFUSIONS 38242 $304.00 38243 PR TRNSPLJ HEMATOPOIETIC CELL BOOST 38243 $304.00 38300 PR DRAINAGE LYMPH NODE,SIMPLE 38300 $800.00 38305 PR DRAINAGE LYMPH NODE,EXTENSIVE 38305 $988.00 38308 PR INCISION OF LYMPH CHANNELS 38308 $1,227.00 38380 PR LIGATN THOR DUCT,CERV APPROACH 38380 $1,580.00 38381 PR LIGATN THOR DUCT,THOR APPROACH 38381 $2,921.00 38500 PR BIOPSY/EXCISION, LYMPH NODE(S) 38500 $902.00 38505 PR NEEDLE BIOPSY, LYMPH NODE(S) 38505 $331.00 38510 PR BX/REMV,LYMPH NODE,DEEP CERV 38510 $1,407.00 38520 PR BX/REMV,LYMPH NODE,DEEP CERV/SCAL 38520 $1,252.00 38525 PR BX/REMV,LYMPH NODE,DEEP AXILL 38525 $1,183.00 38530 PR BX/REMV,LYMPH NODE,INTERN MAMM 38530 $1,522.00

38531 PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES 38531 $1,166.00 38542 PR EXPLORE DEEP NODE(S), NECK 38542 $1,440.00 38562 PR REMOVAL, PELVIC LYMPH NODES,STAGING 38562 $2,550.00 38564 PR REMOVAL, ABDOMEN LYMPH NODE,STAGING 38564 $2,543.00 38570 PR LAP,LYMPH NODE BX 38570 $1,378.00 38571 PR LAP,PELVIC LYMPHADENECTOMY 38571 $2,580.00 38572 PR LAP,PELVIC LYMPHADENECTOMY/BX 38572 $3,330.00 38573 PR LAPS W/BI TOT PEL LMPHADEC & OMNTC LYMPH BX 38573 $4,232.00 38700 PR REMOVAL NODES, NECK,SUPRAHYOID 38700 $2,685.00 38720 PR REMOVAL NODES, NECK,CERV CMPLT 38720 $3,588.00 38724 PR REMOVAL NODES, NECK,CERV MOD RAD 38724 $6,010.00 38740 PR REMOVE ARMPIT LYMPH NODES SUPERFIC 38740 $2,014.00 38745 PR REMOVE ARMPITS LYMPH NODES COMPLT 38745 $2,714.00 38746 PR REMOVE THOR LYMPH NODES RAD REGNL 38746 $658.00 38747 PR REMOVE ABD LYMPH NODES RAD REGNL 38747 $754.00 38760 PR REMOVE GROIN LYMPH NODES SUPERF 38760 $3,030.00 38765 PR REMOVE GROIN LYMPH NODES 38765 $3,983.00 38770 PR REMOVE PELVIS LYMPH NODES 38770 $2,920.00 38780 PR REMOVE ABD LYMPH NODES EXTENSIVE 38780 $3,977.00 38790 PR INJECTION FOR LYMPHATIC XRAY 38790 $776.00

38792 PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE 38792 $221.00 38794 PR ACCESS THORACIC LYMPH DUCT 38794 $794.00

PR INTRAOPERATIVE SENTINEL LYMPH NODE ID W DYE 38900 INJECTION 38900 $376.00 39000 PR MEDIASTINOTOMY, CERVICAL APPROACH 39000 $1,336.00

39010 PR MEDIASTINOTOMY, TRANSTHORACIC APPROACH 39010 $2,456.00 39200 PR RESECTION OF MEDIASTINAL CYST 39200 $3,120.00 39220 PR RESECTION MEDIASTINAL TUMOR 39220 $3,435.00

39401 PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY 39401 $832.00

39402 PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES 39402 $1,088.00 39501 PR REPAIR DIAPHRAGM LACERATION 39501 $2,693.00 $18,769.0 39503 PR REPAIR DIAPHR HERNIA,NEONATE 39503 0 39540 PR REPAIR DIAPHR HERNIA TRAUMA ACUTE 39540 $2,715.00 39541 PR REPAIR DIAPHR HERNIA TRAUMA CHR 39541 $2,873.00 39545 PR REVISION OF DIAPHRAGM 39545 $3,191.00 39560 PR RESECT DIAPHRAM,SIMPLE REPAIR 39560 $2,517.00 39561 PR RESECT DIAPHRAM,COMPLX REP 39561 $4,432.00 40490 PR BIOPSY OF LIP 40490 $338.00 40500 PR LIP SHAVE 40500 $1,280.00 40510 PR PARTIAL EXCIS LIP,WEDGE PRIM CLOS 40510 $1,520.00 40520 PR PARTIAL EXCIS LIP,V-EXC PRIM CLOS 40520 $1,251.00 40525 PR FULL THICK EXCIS LIP,RECON W FLAP 40525 $1,469.00 40527 PR FULL THICK EXCIS LIP,FIX W XFLAP 40527 $3,570.00 40530 PR PARTIAL REMOVAL OF LIP,>1/4 40530 $1,180.00 40650 PR REPAIR LIP,FULL THICK,VERMILION 40650 $1,167.00 40652 PR REPAIR LIP,<1/2 VERT HEIGHT 40652 $1,354.00 40654 PR REPAIR LIP,>1/2 VERT HEIGHT 40654 $2,128.00 40700 PR REPAIR CLEFT LIP/NASAL,UNILAT 40700 $3,619.00 40701 PR REPR CLEFT LIP,BILAT,1 STAGE 40701 $4,288.00 40702 PR REPR CLEFT LIP,BILAT,1OF2 STAGE 40702 $3,225.00 40720 PR REPR CLEFT LIP/NASAL,SECONDARY 40720 $3,697.00 40761 PR REPR CLEFT LIP/NASAL,XLIP PED GRFT 40761 $3,898.00 40800 PR DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL 40800 $555.00 40801 PR DRAIN MOUTH ABSC/CYST/HEMAT,COMPLX 40801 $806.00 40804 PR REMOVAL FOREIGN BODY,MOUTH,SIMPLE 40804 $533.00 40806 PR INCISION OF LIP FOLD 40806 $325.00 40808 PR BIOPSY OF MOUTH LESION 40808 $501.00 40810 PR EXCIS MOUTH MUCOSA/SUB,NO REPAIR 40810 $554.00 40812 PR EXCIS MOUTH MUCOSA/SUB,SIMPL REPAIR 40812 $775.00 40814 PR EXCIS MOUTH MUCOSA/SUB,COMPLX REPR 40814 $1,902.00 40816 PR EXCIS MOUTH COMPLEX,EXC THRU MUSCLE 40816 $1,031.00 40818 PR EXCISE ORAL MUCOSA FOR GRAFT 40818 $937.00 40819 PR EXCISE LIP OR CHEEK FOLD 40819 $691.00 40820 PR DESTRUC MOUTH LESION/SCAR 40820 $712.00 40830 PR REPAIR MOUTH LACERATION,<2.5CM 40830 $711.00 40831 PR REPAIR MOUTH LACERATION,>2.5CM 40831 $714.00 40840 PR RECONSTRUC MOUTH ANTERIOR 40840 $1,709.00 41005 PR I&D MOUTH/TONG INTRA,SUBLING,SUPERF 41005 $588.00 41007 PR I&D MOUTH/TONG INTRA,SUBMENTAL 41007 $977.00 41008 PR I&D MOUTH/TONG INTRA,SUBMANDIBULAR 41008 $979.00 41009 PR I&D MOUTH/TONG INTRA,MASTICATOR 41009 $1,054.00 41010 PR INCISION OF TONGUE FOLD 41010 $543.00 41015 PR I&D MOUTH/TONG EXTRA,SUBLING 41015 $1,171.00 41017 PR I&D MOUTH/TONG EXTRA,SUBMANDIBUL 41017 $1,144.00 41018 PR I&D MOUTH/TONG EXTRA,MASTICATOR 41018 $1,304.00 41100 PR BIOPSY TONGUE,ANTER 2/3 41100 $450.00 41105 PR BIOPSY TONGUE,POSTER 1/3 41105 $682.00 41108 PR BIOPSY OF FLOOR OF MOUTH 41108 $397.00 41110 PR EXCIS TONGUE LESN 41110 $569.00 41112 PR EXCIS TONGUE LESN,ANT 2/3+CLOS 41112 $899.00 41113 PR EXCIS TONGUE LESN,POST 1/3 41113 $983.00 41114 PR EXCIS TONGUE LESN,LOCAL FLAP 41114 $1,735.00 41115 PR EXCIS TONGUE FOLD 41115 $676.00 41116 PR EXCIS FLOOR MOUTH LESION 41116 $836.00 41120 PR PART REMOVAL TONGUE,<1/2 41120 $3,212.00 41130 PR PART REMOVAL TONGUE, 1/2 41130 $4,769.00 41135 PR PART EXC TONGUE,UNILAT RAD NECK 41135 $7,415.00 41140 PR REMOVAL OF TONGUE 41140 $9,029.00 41145 PR EXCIS TONGUE,UNILAT RAD NECK 41145 $9,540.00 41150 PR EXCIS TONGUE,MOUTH,JAW 41150 $7,569.00 41153 PR EXCIS TONGUE,MOUTH,NECK 41153 $4,344.00 41155 PR EXCIS TONGUE,MOUTH,JAW,RAD NECK 41155 $5,536.00 41250 PR REPAIR TONGUE LACER,<2.6CM 41250 $744.00 41251 PR REPAIR TONGUE LACER,POST 1/3 41251 $788.00 41252 PR REPAIR TONGUE LACER,2.6CM+/COMPLX 41252 $855.00 41500 PR FIXATION OF TONGUE,MECHANICAL 41500 $1,153.00 41800 PR DRAINAGE OF GUM LESION 41800 $781.00 41820 PR EXCISION, GUM, EACH QUADRANT 41820 $680.00 41822 PR EXCIS FIBROUS TUBER,DENTOALV 41822 $800.00 41823 PR EXCIS OSSEOUS TUBER,DENTOALV 41823 $833.00 41825 PR EXCIS DENTOALVEOLAR LESION 41825 $569.00 41826 PR EXCIS DENTOALV LESN,SIMPL REPR 41826 $801.00 41827 PR EXCIS DENTOALV LESN,COMPLX REP 41827 $2,007.00 41828 PR EXCISION OF GUM LESION 41828 $790.00 41830 PR REMOVAL OF GUM TISSUE 41830 $800.00 41850 PR TREATMENT OF GUM LESION 41850 $577.00 41870 PR GUM GRAFT 41870 $784.00 41874 PR REPAIR TOOTH SOCKET 41874 $1,014.00 42000 PR DRAINAGE ABSCESS PALATE/UVULA 42000 $496.00 42100 PR BIOPSY PALATE/UVULA 42100 $393.00 42104 PR EXCIS LESN,PALATE/UVULA 42104 $469.00 42106 PR EXCIS LESN,PALATE/UVULA-SIMPL CLOS 42106 $699.00 42107 PR EXCIS LESN,PALETE/UVULA-FLAP CLOS 42107 $1,239.00 42120 PR REMOVE PALATE/LESION 42120 $2,925.00 42140 PR EXCISION OF UVULA 42140 $518.00 42145 PR PALATOPHAYNGOPLASTY 42145 $2,128.00 42160 PR DESTRUC LESN PALATE/UVULA 42160 $622.00 42182 PR REPAIR PALATE LACER 2+CM OR COMPLX 42182 $826.00 42200 PR RECONST CLEFT PALATE,SOFT/HARD 42200 $3,393.00 42205 PR RECONST CLEFT PALATE,CLOS ALVE RDG 42205 $3,570.00 42210 PR RECONST CLEFT PALATE,BONE GRFT 42210 $4,020.00 42215 PR RECONST CLEFT PALATE,MAJOR REVIS 42215 $1,854.00 42220 PR RECONST CLEFT PALATE,LENGTHENING 42220 $1,517.00 42225 PR RECONST CLEFT PALATE,ATTACH PHAR 42225 $3,050.00 42226 PR LENGTHENING PALATE+PHARY FLAP 42226 $3,142.00 42235 PR REPAIR ANTER PALATE W VOMER FLAP 42235 $1,965.00 42281 PR INSERTION, PALATE PROSTHESIS 42281 $428.00 42300 PR DRAIN ABSCESS PAROTID,SIMPLE 42300 $441.00 42305 PR DRAIN ABSCESS PAROTID,COMPLIC 42305 $1,114.00 42330 PR REMOVAL SALIVARY STONE,UNCOMPLIC 42330 $649.00 42335 PR REMOVAL SUBMAND STONE,COMPLICATED 42335 $714.00 42340 PR REMOVAL PAROTID STONE 42340 $1,322.00 42400 PR BIOPSY SALIVARY GLAND,NEEDLE 42400 $269.00 42405 PR BIOPSY SALIVARY GLAND,INCISIONAL 42405 $802.00 42408 PR EXCISION SUBLING SALIVARY CYST 42408 $963.00 42409 PR DRAINAGE SUBLING SALIVARY CYST 42409 $847.00 42410 PR EXC PAROTD LESN,LATER LOBE 42410 $1,985.00 42415 PR EXC PAROTD,LAT LOBE,DISSECT 5TH NERV 42415 $4,226.00 42420 PR EXC PAROTD,TOTAL,DISSECT 5TH NERV 42420 $3,528.00 42425 PR EXC PAROTD,TOTAL,SACRIFICE 5TH NERV 42425 $2,556.00 42426 PR EXC PAROTD,TOTAL,UNILAT RAD NECK 42426 $4,851.00 42440 PR EXCISION SUBMAXILLARY GLAND 42440 $1,473.00 42450 PR EXCISION SUBLINGUAL GLAND 42450 $1,216.00 42500 PR REPAIR SALIVARY DUCT SIMPLE 42500 $1,103.00 42600 PR CLOSURE OF SALIVARY FISTULA 42600 $1,277.00 42650 PR DILATION OF SALIVARY DUCT 42650 $285.00 42700 PR INC/DRAIN PERITONSIL ABSCESS 42700 $509.00 42720 PR INC/DRAIN RETROPHARYNG ABSCESS,ORAL 42720 $1,153.00 42725 PR INC/DRAIN RETROPHARYNG ABSCESS,EXT 42725 $2,476.00 42800 PR BIOPSY OROPHARYNX 42800 $397.00 42804 PR BIOPSY NASOPHARYNX,SIMPLE 42804 $495.00 42808 PR EXCISE PHARYNX LESION 42808 $687.00 42809 PR REMOVE PHARYNX FOREIGN BODY 42809 $911.00 42810 PR EXCISION BRACH CLFT CYST,SUPERFICIAL 42810 $1,025.00 42815 PR EXCISION BRANC CLFT CYST,DEEP 42815 $1,474.00 42820 REMOVE TONSILS/ADENOIDS,<12 Y/O 42820 $776.00 42821 PR REMOVE TONSILS/ADENOIDS,12+ Y/O 42821 $744.00 42825 REMOVAL OF TONSILS,<12 Y/O 42825 $645.00 42826 PR REMOVAL OF TONSILS,12+ Y/O 42826 $744.00 42830 REMOVAL ADENOIDS,PRIMARY,<12 Y/O 42830 $528.00 42831 PR REMOVAL ADENOIDS,PRIMARY,12+ Y/O 42831 $599.00 42835 REMOVAL ADENOIDS,SECOND,<12 Y/O 42835 $423.00 42836 PR REMOVAL ADENOIDS,SECOND,12+ Y/O 42836 $537.00 42842 PR RAD RESEC TONSIL/PILLARS 42842 $3,605.00 42844 PR RAD RESEC TONSIL/PILLARS,CLOS LOCAL 42844 $5,010.00 42845 PR RAD RESEC TONSIL/PILLARS,CLOS FLAP 42845 $4,316.00 42860 PR EXCISION OF TONSIL TAGS 42860 $482.00 42870 PR EXCISION OF LINGUAL TONSIL 42870 $1,256.00 42890 PR PARTIAL REMOVAL OF PHARYNX 42890 $5,095.00 42894 PR RESEC PHARYN WALL,CLOS MYOCUT FLAP 42894 $5,774.00 42900 PR SUTURE INJURY/WND PHARYNX 42900 $891.00 42950 PR RECONSTRUCTION OF THROAT 42950 $2,210.00 42953 PR REPAIR THROAT, ESOPHAGUS 42953 $2,229.00 42960 PR CONTROL THROAT BLEED,SIMPLE 42960 $401.00 42961 PR CONTROL THROAT BLEED,COMPL IN HOSP 42961 $1,076.00 42962 PR CONTROL THROAT BLEED,SURG INTERVENTN 42962 $1,203.00 42972 PR CNTRL NASOPHARYNG BLEED,SURGERY 42972 $1,318.00 42999 PR THROAT SURGERY PROCEDURE UNLISTED 42999 $3,784.00 43030 PR CRICOPHAYNGEAL MYOTOMY 43030 $1,763.00 43045 PR INCIS ESOPHAGUS,FOREIGN BODY,THORAX 43045 $5,350.00 43101 PR EXCIS ESOPHAGUS LESN,THOR APPROACH 43101 $3,215.00 43107 PR REMOVAL ESOPHAGUS,NO THORACOTOMY 43107 $8,521.00

PR TOTAL ESOPHAGECTOMY W/THORCOM W/WO 43112 PYLORPLASTY 43112 $9,430.00 $20,582.0 43116 PR PART REMOV ESOPHAGUS,CERVICAL 43116 0 43117 PR PART REMOV ESOPHAGUS,LOWER 2/3 43117 $9,157.00

43118 PR PART RMV ESOPH,DIST 2/3,W/THOR,W/COL INT 43118 $9,617.00 $10,507.0 43122 PR PARI REMOV ESOPH,THORACOABDOM 43122 0

$15,000.0 43123 PR PART RMV ESOPH,THORACOABD APP,W/COL INT 43123 0 $15,528.0 43124 PR REMOVAL OF ESOPHAGUS,NO RECONSTRUC 43124 0 43130 PR REMOV ESOPHAG DIVERTIC,CERV APPRCH 43130 $2,674.00 43135 PR REMOV ESOPHAG DIVERTIC,THOR APPRCH 43135 $6,040.00

PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV 43180 ESOPH 43180 $1,461.00 43191 PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH 43191 $890.00

43192 PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL 43192 $435.00

43193 PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY 43193 $441.00

PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN 43194 BODY 43194 $517.00

43195 PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION 43195 $471.00

43197 PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC 43197 $475.00

43198 PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY 43198 $523.00

43200 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC 43200 $697.00

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS 43201 INJ 43201 $722.00

43202 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY 43202 $898.00

PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL 43205 VARICES 43205 $760.00

PR ESOPHAGOSCOPY TRANSORAL W/OPTICAL 43206 ENDOMICROSCOPY 43206 $713.00

43212 PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT 43212 $511.00

43213 PR ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER 43213 $2,919.00

43214 PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM 43214 $518.00

43215 PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY 43215 $403.00

43216 PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS 43216 $1,080.00

PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR 43217 SNARE 43217 $1,125.00

43220 PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM 43220 $470.00 43226 PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION 43226 $949.00

43229 PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION 43229 $1,761.00

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND 43231 EXAM 43231 $675.00

PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE 43232 ASPIRAT/BX 43232 $647.00

43233 PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER 43233 $617.00

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL 43235 DIAGNOSTIC 43235 $744.00

PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL 43236 INJECTION 43236 $992.00

PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ 43237 STRXRS 43237 $582.00

43238 PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS 43238 $725.00 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE 43239 $856.00

43240 PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST 43240 $995.00

43241 PR EGD INTRALUMINAL TUBE/CATHETER INSERTION 43241 $565.00

43242 PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY 43242 $1,045.00

43243 PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES 43243 $970.00

43244 PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES 43244 $920.00

43245 PR EGD DILATION GASTRIC/DUODENAL STRICTURE 43245 $729.00

43246 PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE 43246 $729.00 43247 PR EGD FLEXIBLE FOREIGN BODY REMOVAL 43247 $725.00

43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS 43248 $680.00

43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM 43249 $429.00 43250 PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS 43250 $465.00

43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH 43251 $795.00

43252 PR EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY 43252 $900.00

43253 PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER 43253 $683.00

43254 PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION 43254 $709.00

43255 PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD 43255 $925.00

PR EDG US EXAM SURGICAL ALTER STOM 43259 DUODENUM/JEJUNUM 43259 $825.00

43260 PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING 43260 $1,050.00 43261 PR ERCP W/BIOPSY SINGLE/MULTIPLE 43261 $1,150.00 43262 PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY 43262 $1,440.00

43264 PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT 43264 $1,650.00

43265 PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD 43265 $1,550.00

43266 PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION 43266 $587.00

43270 PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE 43270 $1,802.00

43273 PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC 43273 $316.00

43274 PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT 43274 $1,922.00

43275 PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT 43275 $1,002.00

43276 PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE 43276 $1,264.00

43277 PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA 43277 $1,008.00

PR ERCP TUMOR/POLYP/LESION ABLATION 43278 W/DILATION&WIRE 43278 $1,146.00 43279 PR LAP, ESOPHAGOMYOTOMY W FUNDOPLASTY 43279 $3,497.00 43280 PR LAP,ESOPHAGOGAST FUNDOPLASTY 43280 $3,289.00

PR LAP, REPAIR PARAESOPHAGEAL HERNIA, INCL 43281 FUNDOPLASTY W/O MESH 43281 $6,422.00

PR LAP, REPAIR PARAESOPHAGEAL HERNIA, INCL 43282 FUNDOPLASTY W/ MESH 43282 $4,714.00 43283 PR LAP ESOPHAGEAL LENGTHENING 43283 $429.00

43284 PR LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL 43284 $1,686.00

43285 PR REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE 43285 $1,706.00

$13,109.0 43286 PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ 43286 0

$14,972.0 43287 PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ 43287 0

$15,622.0 43288 PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ 43288 0 43300 PR ESOPHAGOPLASTY,CERV APPRCH 43300 $2,735.00 43305 PR REPAIR TRACHEOESOPHAGEAL FISTULA 43305 $2,913.00 43310 PR ESOPHAGOPLASTY,THORACIC APPRCH 43310 $6,055.00 43312 PR REPAIR TRACHEOESOPHAGEAL FISTULA 43312 $6,563.00

$10,954.0 43314 PR ESOPHAGOPLASTY CON DEF,W/REPAIR TE FIST 43314 0 43325 PR ESOPHAGOGASTRIC FUNDOPLASTY+PATCH 43325 $2,832.00

PR ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR 43327 COMPLETE; LAPAROTOMY 43327 $2,226.00

PR ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR 43328 COMPLETE; THORACOTOMY 43328 $4,016.00 43330 PR ESOPHAGOMYOTOMY,ABD APPRCH 43330 $3,757.00 43331 PR ESOPHAGOMYOTOMY,THORACIC APPRCH 43331 $5,475.00

PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,LAPAROTOMY, 43332 WO MESH 43332 $3,139.00

PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,LAPAROTOMY, 43333 W MESH 43333 $3,429.00

PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,THORACOTOMY, 43334 WO MESH 43334 $3,373.00

PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,THORACOTOMY, 43335 W MESH 43335 $5,471.00

PR REPAIR PARAESOPHAGEAL HIATAL 43336 HERNIA,THORACOABDOMINAL, WO MESH 43336 $6,142.00 43338 PR ESOPHAGUS LENGTHENING 43338 $334.00 43351 PR SURG OPENING,ESOPHAGUS,THOR APPRCH 43351 $2,877.00 43352 PR SURG OPENING,ESOPHAGUS,CERV APPRCH 43352 $3,813.00 43360 PR GI REPAIR PREV ESOPH RMVL 43360 $9,248.00

$11,004.0 43361 PR GI RECON,PRIOR ESOPHAGECT,W/COLON INTERP 43361 0 43400 PR LIGATE ESOPHAGUS VARICES 43400 $6,219.00 43410 PR SUTURE ESOPHAGUS WOUND,CERV APPRCH 43410 $2,735.00 $10,547.0 43415 PR SUTURE ESOPHAGUS WOUND,THOR APPRCH 43415 0 43420 PR REPAIR ESOPHAGUS OPENING,CERV APPRCH 43420 $3,006.00 43425 PR REPAIR ESOPHAGUS OPENING 43425 $5,932.00 43450 PR DILATE ESOPHAGUS 43450 $454.00 43453 PR DILATION ESOPHAGUS GUIDE WIRE 43453 $738.00 43460 PR ESOPHAGOGASTRIC TAMPONADE,BALLOON 43460 $600.00 43496 PR FREE JEJUNUM XFER,MICROVASC ANAST 43496 $8,135.00 43500 PR SURGICAL OPENING OF STOMACH 43500 $2,798.00 43520 PR INCISION OF PYLORIC MUSCLE 43520 $2,477.00 43605 PR BIOPSY OF STOMACH,BY LAPAROTOMY 43605 $2,952.00 43610 PR EXCIS STOMACH ULCER,LESN;LOCAL 43610 $3,537.00 43611 PR EXCIS STOAMCH MALIG 43611 $3,318.00 43621 PR REMOVAL STOMACH,ROUX-EN-Y 43621 $9,355.00 43622 PR REMOVAL STOMACH,FORM INTEST POUCH 43622 $9,450.00 43631 PR REMV STOMACH,PART,DISTAL,GASTRODUOD 43631 $5,698.00 43632 PR REMV STOMACH,PART,DISTAL,GASTROJEJUN 43632 $5,527.00 43633 PR REMV STOMACH,PART,DISTAL,ROUX-EN-Y 43633 $7,818.00 43640 PR VAGOTOMY/PYLOROPLASTY,SELECT 43640 $3,162.00 43641 PR VAGOTOMY/PYLOROPLASTY,HI SELECT 43641 $4,299.00 43644 PR LAP GASTRIC BYPASS/ROUX-EN-Y 43644 $7,198.00 43653 PR LAP,GASTROSTOMY,W/O TUBE CONSTR 43653 $1,557.00 43752 PR PLACEMENT NG/OG TUBE BY PHYSICIAN 43752 $114.00

43753 PR GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC 43753 $61.00

PR DUODENAL INTUBATION/ASPIRATION, DIAGNOSTIC, 1 43756 SPECIMEN 43756 $510.00

PR DUODENAL INTUBATION/ASPIRATION, DIAGNOSTIC, 43757 MULTIPLE SPECIMEN 43757 $781.00

43760 CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE 43760 $1,137.00 43761 PR REPOSITION GASTRIC FEEDING TUBE THRU DUODENUM 43761 $326.00

43762 PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 43762 $601.00

43763 PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC 43763 $845.00 43770 LAP, PLACE ADJUST GAST RESTRICT DEVICE 43770 $4,042.00 43771 LAP, REVISE ADJUST GAST RESTRICT DEVICE 43771 $5,294.00 43772 LAP, REMOVE ADJUST GAST RESTRICT DEVICE 43772 $2,585.00 43773 LAP, CHANGE ADJUST GAST RESTRICT DEVICE 43773 $5,262.00

43774 LAP, REMOVE ADJUST GAST RESTRICT DEVICE/PORT 43774 $2,609.00

43775 PR LAP, GAST RESTRICT PROC, LONGITUDINAL GASTRECTOMY 43775 $4,581.00 43800 PR RECONSTRUCTION OF PYLORUS 43800 $3,349.00 43820 PR GASTROJEJUNOSTOMY 43820 $3,649.00 43825 PR GASTROJEJUNOSTOMY+VAGOTOMY 43825 $5,428.00 43830 PR GASTROSTOMY,OPEN,W/O TUBE CNSTR 43830 $2,520.00 43831 PR PLACE GASTROSTOMY TUBE,NEONATE 43831 $1,632.00 43832 PR GASTROSTOMY,OPEN,W/TUBE CNSTR 43832 $3,733.00 43840 PR REPAIR PERF DUOD/GAST ULC-WND/INJ 43840 $5,550.00 43843 PR GASTROPLASTY,OBESITY,OTHER 43843 $5,277.00 43846 PR GASTRIC BYPASS,OBESE<150CM ROUX-EN-Y 43846 $6,608.00

REVISION GASTROPLASTY,OBESITY, NON-GAST RESTRICT 43848 DEVICE 43848 $7,859.00 43855 PR REVISE GASTRODUOD ANAST,W VAGOTOMY 43855 $7,008.00

43860 PR REVISE,GASTROJEJUN ANAST,W/O VAGOTOMY 43860 $6,727.00 43870 PR CLOSURE OF GASTROSTOMY,SURGICAL 43870 $2,572.00 43880 PR CLOSURE GASTROCOLIC FISTULA 43880 $5,184.00 43886 PR REVISE GASTRIC PORT, OPEN 43886 $986.00 43887 PR REMOVE GASTRIC PORT, OPEN 43887 $887.00 44005 PR FREEING BOWEL ADHESION,ENTEROLYSIS 44005 $3,950.00 44010 PR DUODENOTOMY FOR EXPLOR,BX,FB REMOV 44010 $3,078.00 44015 PR INSERT TUBE-BOWEL,ENTERAL ALIMENT 44015 $442.00

44020 PR ENTEROTOMY,NON-DUOD,EXPLOR/BX/FB REMOVAL 44020 $3,476.00 44021 PR ENTEROTOMY DECOMPRESS SMALL BOWEL 44021 $2,643.00 44025 PR INCIS COLON FOR EXPLOR,BX,FB REM 44025 $3,466.00 44050 PR REDUCE VOLVULUS,INTUSS,INTERN HERNIA 44050 $3,365.00 44055 PR CORRECT MALROTATION OF BOWEL 44055 $4,552.00

44110 PR EXCIS BOWEL LESION(S),SINGLE ENTEROTOMY 44110 $2,286.00

44111 PR EXCIS BOWEL LESION(S),MULT ENTEROTOMIES 44111 $2,740.00 44120 PR RESECT SMALL INTEST,SINGL RESEC/ANAS 44120 $5,040.00 44121 PR RESECT SMALL INTEST,EACH ADDNL 44121 $656.00 44125 PR RESECT SMALL INTEST W ENTEROSTOMY 44125 $4,860.00

$10,077.0 44126 PR RESECT SM INTEST,CONG ATRESIA,W/O TAPER 44126 0 44127 PR RESECT SM INTEST,CONG ATRESIA,W/TAPER 44127 $8,766.00 44130 PR BOWEL TO BOWEL ANASTOMOSIS 44130 $4,907.00 44139 PR MOBILIZE SPLENIC FLEX 44139 $330.00 44140 PR PART REMOVAL COLON W ANASTOMOSIS 44140 $5,530.00 44141 PR PART REMOVAL COLON W COLOSTOMY 44141 $7,510.00 44143 PR PART REMOVAL COLON W END COLOSTOMY 44143 $6,850.00

44144 PR PART REMOVAL COLON W OSTOMY/MUCOFIST 44144 $7,290.00

44145 PR PART REMOVAL COLON W COLOPROCTOSTOMY 44145 $6,820.00

44146 PR PART REMOVAL COLON W COLOPROC,COLOST 44146 $8,710.00 44147 PR PART REMOVAL COLON,ABD/TRANSANAL APP 44147 $7,936.00 44150 PR REMOVAL COLON/ILEOSTOMY 44150 $5,302.00 44155 PR REMOVAL COLON/PROCTECTOMY/ILEOSTOMY 44155 $6,072.00

44157 PR REMOVAL COLON/PROCTEC/ ILEOANAL ANAST 44157 $8,964.00

44158 PR REMOVAL COLON/PROCTEC/ILEOANAL ANAST POUCH 44158 $7,429.00

44160 PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY 44160 $5,110.00 44180 PR LAP, SURG ENTEROLYSIS 44180 $3,310.00 44186 PR LAP, SURG JEJUNOSTOMY 44186 $2,359.00 44187 PR LAP, SURG ILEO/JEJUNO-STOMY 44187 $3,544.00 44188 PR LAP, SURG COLOSTOMY 44188 $4,410.00 44202 PR LAP,SURG,ENTERECTOMY,RESECT & ANAST 44202 $4,612.00 44203 PR LAP,SURG,EA ADDL RESECT & ANAST 44203 $550.00 44204 PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAST 44204 $5,228.00 44205 PR LAP,SURG,COLECTOMY,W/REMVL TERM ILEUM 44205 $4,635.00

44206 PR LAP,SURG,COLECTOMY,W/END COLOST & CLOSUR 44206 $7,195.00 44207 PR LAP,SURG,COLECTOMY,W/ANAST 44207 $7,447.00

44208 PR LAP,SURG,COLECTOMY,W/ANAST,W/COLOSTOMY 44208 $6,647.00

44210 PR LAP,SURG,COLECTOMY,TOTAL,W/O PROCTECTOMY 44210 $5,876.00

44211 PR LAP,SURG,COLECTOMY,TOTAL,W/PROCTECTOMY 44211 $8,930.00

44212 PR LAP,SURG,COLECT,TOT,W/PROCTECT,W/ILEOST 44212 $6,826.00

44213 PR LAP, SURG MOBIL SPLENIC FL DUR PTL COLECTOMY 44213 $506.00

44227 PR LAP, SURG CLOSE ENTEROSTOMY RESECT ANAST 44227 $6,808.00

44300 PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN 44300 $3,033.00 44310 PR ILEOSTOMY/JEJUNOSTOMY,NONTUBE 44310 $3,760.00 44312 PR REVISION OF ILEOSTOMY,SIMPLE 44312 $1,604.00 44314 PR REVISION OF ILEOSTOMY,COMPLICATED 44314 $2,781.00 44320 PR COLOSTOMY 44320 $4,330.00 44322 PR COLOSTOMY,W/MULTIPLE BIOPSIES 44322 $3,581.00 44340 PR REVISION OF COLOSTOMY,SIMPLE 44340 $1,682.00 44345 PR REVISION OF COLOSTOMY,COMPLICATED 44345 $2,875.00 44346 PR REVIS COLOSTOMY,REPR PARACOLO HERNIA 44346 $3,200.00 44360 PR ENDOSCOPY UPPER SMALL INTESTINE 44360 $590.00

44361 PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY 44361 $660.00

44363 PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY 44363 $531.00

44364 PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE 44364 $550.00

44366 PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING 44366 $960.00 44369 PR ENTEROSCOPY > 2ND PRTN ABLTJ LESION 44369 $1,030.00

44372 PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE 44372 $975.00 44373 PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE 44373 $800.00

44376 PR ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX 44376 $850.00

44377 PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE 44377 $793.00

44378 PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING 44378 $1,018.00

44379 PR ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT 44379 $1,099.00

PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN 44380 PRFMD 44380 $536.00 44381 PR ILEOSCOPY STOMA W/BALLOON DILATION 44381 $464.00 44382 PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE 44382 $776.00

44384 PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT 44384 $587.00

44385 PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX 44385 $667.00

44386 PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE 44386 $849.00

44388 PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX 44388 $858.00

44389 PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE 44389 $971.00

44390 PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY 44390 $1,114.00 44391 PR COLONOSCOPY STOMA CONTROL BLEEDING 44391 $1,862.00

PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY 44392 FORCEPS 44392 $1,058.00

PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES 44394 SNARE 44394 $1,074.00 44401 PR COLONOSCOPY STOMA ABLATION LESION 44401 $1,156.00

PR COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL 44403 RESCJ 44403 $788.00

44404 PR COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION 44404 $1,000.00

44405 PR COLONOSCOPY STOMA W/BALLOON DILATION 44405 $1,491.00 PR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND 44406 EXAM 44406 $612.00

44500 PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE 44500 $58.00 44602 PR SUTURE SM INTEST,SINGLE PERF 44602 $5,746.00 44603 PR SUTURE SM INTEST,MULTPL PERF 44603 $4,391.00 44604 PR SUTURE LRG INTEST 44604 $2,930.00 44605 PR SUTURE LRG INTEST W COLOSTOMY 44605 $5,361.00 44615 PR INTESTINAL STRICTUROPLASTY 44615 $2,940.00 44620 PR CLOSE ENTEROSTOMY 44620 $2,343.00 44625 PR CLOSE ENTEROSTOMY,RESEC+ANAST 44625 $3,660.00

44626 PR CLOSE ENTEROSTOMY,RESEC+COLOREC ANAS 44626 $6,590.00 44640 PR REPAIR BOWEL-SKIN FISTULA 44640 $5,768.00 44650 PR REPAIR BOWEL-BOWEL FISTULA 44650 $4,868.00 44661 PR REPR BOW-BLAD FIST,W/INTEST/BLAD RESECT 44661 $5,057.00 44680 PR INTESTINAL PLICATION 44680 $3,794.00 44700 PR EXCLUSION,SMALL BOWEL FROM PELVIS 44700 $3,634.00 44701 PR INTRAOPERATIVE COLONIC LAVAGE 44701 $463.00

44705 PR PREPARE FECAL MICROBIOTA FOR INSTILLATION 44705 $310.00 44800 PR EXCISION MECKEL,OMPHALOMES DUCT 44800 $2,158.00 44820 PR EXCISION OF MESENTERY LESION 44820 $2,263.00 44850 PR SUTURE OF MESENTERY 44850 $2,044.00 44950 PR APPENDECTOMY 44950 $1,745.00 44955 PR APPENDECTOMY,W OTHR PROC 44955 $300.00 44960 PR APPENDECTOMY,RUPT APPENDX+ABSCESS 44960 $2,381.00 44970 PR LAP,APPENDECTOMY 44970 $1,629.00 45000 PR DRAINAGE OF PELVIC ABSCESS 45000 $1,172.00 45005 PR I&D RECTAL SUBMUCOSAL ABSCESS 45005 $781.00 45020 PR DRAINAGE OF DEEP RECTAL ABSCESS 45020 $1,544.00 45100 PR BIOPSY OF RECTUM 45100 $806.00 45110 PR PROCTECTOMY,AP RESECT+OSTOMY 45110 $7,586.00 45112 PR PROCTECTOMY,AP RESEC,PULL-THRU 45112 $7,686.00 45113 PR PROCTECTOMY,PART,ILEAL RESERV 45113 $7,793.00 45119 PR PROCTECTOMY,A-P PULLTHRU W/RESERVOIR 45119 $7,946.00 45120 PR PROCTECTOMY,COMPLT,PULL-THRU,ANAST 45120 $6,502.00 45121 PR PROCTECTOMY,COMPL,COLECTOMY,BX'S 45121 $5,676.00 45123 PR PROCTECTOMY,PART,NO ANAST,PERINEAL 45123 $3,032.00 $11,460.0 45126 PR PELVIC EXENTERATION 45126 0 45130 PR EXCIS RECTAL PROLAPSE,PERINEAL 45130 $2,992.00 45136 PR EXCIS,ILEOANAL RESERVOIR W/ILEOSTOMY 45136 $7,591.00 45160 PR EXCIS RECTAL LESION 45160 $3,708.00

45171 PR EXCIS RECTAL TUMOR, TRANSANAL, PARTIAL THICKNESS 45171 $1,630.00

45172 PR EXCIS RECTAL TUMOR, TRANSANAL, FULL THICKNESS 45172 $2,886.00 45300 PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS 45300 $231.00

45305 PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE 45305 $443.00

45307 PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY 45307 $593.00

45309 PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ 45309 $564.00 45317 PR PROCTOSGMDSC RIGID CONTROL BLEEDING 45317 $596.00

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF 45330 PFRMD 45330 $464.00 45331 PR SIGMOIDOSCOPY,BIOPSY 45331 $643.00 45332 PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY 45332 $755.00

PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX 45333 FORCEPS 45333 $877.00 45334 PR SIGMOIDOSCOPY FLX CONTROL BLEEDING 45334 $550.00 45335 PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST 45335 $706.00

45337 PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE 45337 $490.00

45338 PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ 45338 $788.00 45340 PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT 45340 $1,108.00 45341 PR SIGMOIDOSCOPY FLX NDSC US XM 45341 $585.00

45342 PR SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX 45342 $675.00

45346 PR SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES 45346 $443.00

45347 PR SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT 45347 $443.00

45349 PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION 45349 $443.00 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 45378 $961.00

45379 PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S) 45379 $1,226.00 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE 45380 $1,520.00

45381 PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST 45381 $1,122.00

45382 PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD 45382 $1,926.00

45384 PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS 45384 $1,136.00

45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 45385 $1,294.00

45386 PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT 45386 $1,743.00

45388 PR COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES 45388 $765.00

PR COLONOSCOPY FLX WITH ENDOSCOPIC STENT 45389 PLACEMENT 45389 $837.00

PR COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL 45390 RESECTION 45390 $893.00

45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX 45391 $730.00

45392 PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL 45392 $875.00

45393 PR COLONOSCOPY FLEXIBLE WITH DECOMPRESSION 45393 $1,071.00 45395 PR LAP, SURG PROCTECTOMY W COLOSTOMY 45395 $5,297.00 45397 PR LAP, SURG PROCTECTOMY W J-POUCH 45397 $8,800.00

45398 PR COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) 45398 $1,785.00 45400 PR LAP, SURG PROCTOPEXY 45400 $4,027.00 45500 PR REPAIR OF RECTUM,STENOSIS 45500 $1,067.00 45505 PR REPAIR OF RECTUM,PROLAPSE MUCOSA 45505 $1,606.00 45540 PR FIX RECTAL PROLAPSE,ABD APPRCH 45540 $3,908.00 45550 PR REPAIR RECTUM; REMOVE SIGMOID 45550 $4,847.00 45560 PR REPAIR OF RECTOCELE 45560 $2,454.00 45562 PR EXPLOR/REPAIR RECTUM INJURY 45562 $3,047.00 45563 PR EXPLOR/REPAIR RECTUM,INJ,COLOSTOMY 45563 $5,038.00 45800 PR CLOSE RECTUM-BLADDER FISTULA 45800 $5,089.00 45820 PR CLOSE RECTOURETHRAL FISTULA 45820 $5,215.00 45900 PR REDUCTION RECTAL PROLAPSE W ANESTHE 45900 $601.00 45905 PR DILATION ANAL SPHINCTER W ANESTH 45905 $1,203.00 45910 FL DILATION FOR RECTAL STRICTURE 45910 $1,629.00 45915 PR REMV RECTAL OBSTR:FECES/F.B. W ANEST 45915 $922.00 45990 PR SURG DIAGNOSTIC EXAM, ANORECTAL 45990 $286.00 46020 PR PLACEMENT,SETON 46020 $755.00 46030 PR REMOVAL OF RECTAL MARKER 46030 $385.00 46040 PR I&D PERIRECTAL ABSCESS 46040 $1,472.00 46045 PR I&D RECTAL WALL ABSCESS W ANESTH 46045 $1,179.00 46050 PR I&D PERIANAL ABSCESS,SUPERFICIAL 46050 $584.00 46060 PR I&D RECTAL ABSCESS + FISTULECTOMY 46060 $1,296.00 46080 PR ANAL SPHINCTEROTOMY 46080 $547.00 46083 PR INCISE EXTERNAL HEMORRHOID 46083 $515.00 46200 PR REMOVAL OF ANAL FISSURE 46200 $1,234.00

46220 PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS 46220 $609.00

46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS 46221 $735.00

46230 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 46230 $610.00

46250 PR HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GROUPS 46250 $1,269.00

46255 PR HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP 46255 $1,386.00

46260 PR HEMORRHOIDECTOMY,INT/EXT, 2+ COLUMNS/GROUPS 46260 $1,292.00 46270 PR REMOVAL ANAL FISTULA,SUBCUTANEOUS 46270 $1,403.00 46275 PR REMOVAL ANAL FISTULA,INTERSPNINCTERIC 46275 $1,478.00

PR REMOVAL ANAL FISTULA,TRANS/SUPRA/EXTRAPHINCT, +/- 46280 SETON 46280 $1,277.00 46285 PR REMOVAL ANAL FISTULA,SECOND STAGE 46285 $1,470.00 46288 PR REPAIR ANAL FISTULA,RECT ADV FLAP 46288 $1,485.00

46320 PR EXCISION THROMBOSED HEMORRHOID, EXTERNAL 46320 $527.00 46505 PR CHEMODENERVATION ANAL SPHINCTER 46505 $700.00

PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN 46600 PRFRMD 46600 $288.00 46601 PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT 46601 $382.00 46604 PR ANOSCOPY,W/DILATION 46604 $1,561.00 46606 PR ANOSCOPY AND BIOPSY 46606 $620.00

PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT 46607 W/BX 46607 $536.00 46608 PR ANOSCOPY,REMOVE FOREIGN BODY 46608 $716.00 46611 PR ANOSCOPY,REMOVE LESN,SNARE 46611 $409.00 46614 PR ANOSCOPY,W/CONTROL,BLEEDING 46614 $393.00 46615 PR ANOSCOPY,ABLATE LESION 46615 $429.00 46700 PR REPAIR ANAL STRICTURE,ADULT 46700 $1,767.00 46705 PR REPAIR ANAL STRICTURE,INFANT 46705 $1,522.00 46715 PR REPR LO IMPERF ANUS W FISTULA 46715 $1,489.00 46716 PR REPR LO IMPERF ANUS W TRANSPOSTN 46716 $3,301.00 46730 PR REPR HI IMPERF ANUS 46730 $7,436.00 46740 PR REPR HI IMPERF ANUS,W FISTULA 46740 $8,913.00 $10,134.0 46742 PR REPR HI IMPERF ANUS,FIST,COMBINED 46742 0 46750 PR REPAIR OF ANAL SPHINCTER,ADULT 46750 $2,691.00 46900 PR DESTRUCT,ANAL LESN(S),SIMPLE,CHEM 46900 $607.00 46910 PR ELECTRODESSICATN,ANAL LESN(S) 46910 $689.00 46916 PR CRYOSURGERY, ANAL LESION(S) 46916 $652.00 46917 PR LASER SURGERY, ANAL LESION(S) 46917 $1,143.00 46922 PR SURG EXCISION OF ANAL LESION(S) 46922 $782.00 46924 PR DESTRUCTION,ANAL LESION(S),EXTENSIVE 46924 $1,433.00 46930 PR DESTRUCT INTERNAL HEMORRHOID, THERMAL 46930 $536.00 46940 PR CAUTERY ANAL FISSURE,INITIAL 46940 $657.00

46945 PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN 46945 $897.00

46946 PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN 46946 $1,012.00

46948 PR INT HRHC TRANSANAL HROID DARTLZJ 2+ W/US GDN 46948 $1,132.00 47000 PR BIOPSY LIVER NEEDLE PERCUTANEOUS 47000 $884.00

47000 47000 PR BIOPSY LIVER NEEDLE PERCUTANEOUS 26 26 $537.00 47001 PR NEEDLE BIOPSY LIVER,W OTHR PROC 47001 $295.00 47010 PR DRAINAGE OF LIVER LESION, OPEN 47010 $3,282.00 47015 PR INJECT/ASPIRATE LIVER CYST/ABSCESS 47015 $4,155.00 47100 PR WEDGE BIOPSY OF LIVER 47100 $3,041.00 47120 PR RESEC LIVER,PART LOBECTOMY 47120 $9,478.00 $11,481.0 47122 PR RESEC LIVER,TRISEGMENTECTOMY 47122 0 47125 PR RESEC LIVER,TOTAL LT LOBECTOMY 47125 $8,362.00 $11,138.0 47130 PR RESEC LIVER,TOTAL RT LOBECTOMY 47130 0 47133 PR REMOVAL OF DONOR LIVER 47133 $5,566.00 $19,900.0 47135 PR TRANSPLANT LIVER,ALLOTRANSPLANT 47135 0 $17,584.0 47141 PR PARTIAL REMOVAL, DONOR LIVER, LEFT LOBE 47141 0 $14,000.0 47142 PR PARTIAL REMOVAL, DONOR LIVER, RIGHT LOBE 47142 0 47143 PR TRANSPLANT,PREP DONOR LIVER, WHOLE 47143 $1,600.00 47144 PR TRANSPLANT,PREP DONOR LIVER, 3-SEGMENT 47144 $1,600.00 47145 PR TRANSPLANT,PREP DONOR LIVER, LOBE SPLIT 47145 $1,600.00 47146 PR TRANSPLANT,PREP DONOR LIVER/VENOUS 47146 $892.00 47147 PR TRANSPLANT,PREP DONOR LIVER/ARTERIAL 47147 $1,040.00 47300 PR MARSUPIALIZE LIVER CYST/ABSCESS 47300 $4,029.00 47350 PR REPAIR BLEED LIVER/SUTURE WOUND 47350 $3,714.00 47360 PR REPR BLEED LIVER/COMPLX SUTURE WND 47360 $5,750.00 47361 PR EXPLOR LIVER WOUND,EXTENSIV DEBRIDE 47361 $9,752.00 47362 PR RE-EXPLORE LIVER WOUND,REMV PACKING 47362 $3,942.00 47370 PR LAP,ABLAT 1+ LIVER TUMOR(S),RADIOFREQ 47370 $5,145.00 47380 PR ABLAT,OPEN,1+ LIVER TUMOR(S),RADIOFREQ 47380 $4,912.00 47382 PR ABLTJ 1/> LVR TUM PRQ RF 47382 $2,613.00

$18,361.0 47383 PR ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION 47383 0 47400 PR INCISION OF LIVER DUCT/EXPLOR,DRAIN 47400 $8,649.00 47420 PR INCIS BILE DUCT/EXPL,DRAIN,REMV CALC 47420 $3,733.00

47490 PR CHOLECYSTOSTOMY,PERCUTANEOUS, COMPLETE 47490 $1,184.00 47525 PR CHANGE PERCUT BILE DUCT CATHETER 47525 $1,812.00

47531 PR NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS 47531 $946.00

47532 PR NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS 47532 $2,014.00

47533 PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL 47533 $3,394.00

47534 PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT 47534 $4,183.00 47535 PR CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH 47535 $2,805.00

47536 PR EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I 47536 $2,070.00

47537 PR REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I 47537 $1,024.00

47538 PR PLMT BILE DUCT STENT PRQ EXISTING ACCESS 47538 $3,500.00

47540 PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH 47540 $4,400.00

47541 PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW 47541 $3,082.00

47542 PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT 47542 $1,312.00

47543 PR ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT 47543 $3,374.00

47544 PR REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I 47544 $2,061.00 47550 PR BILE DUCT ENDOSCOPY,INTRAOPERATIVE 47550 $448.00

47552 PR BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH 47552 $775.00 47555 PR BILIARY ENDOSCOPY PERCUT,DIL STRICT 47555 $882.00 47562 PR LAP,CHOLECYSTECTOMY 47562 $2,083.00 47563 PR LAP,CHOLECYSTECTOMY/GRAPH 47563 $2,310.00 47564 PR LAP,CHOLECYSTECTOMY/EXPLORE 47564 $4,037.00 47600 PR REMOVAL GALLBLADDER 47600 $2,903.00 47605 PR REMV GALLBLADDER W CHOLANGIOGRAM 47605 $3,055.00 47610 PR REMV GALLBLADDER,EXPLOR COMMON DUCT 47610 $3,525.00 47612 PR REMV GB,W CHOLEDOCHOENTEROSTOMY 47612 $5,153.00 47701 PR BILE DUCT REVISION 47701 $7,085.00 47711 PR EXCIS BILE DUCT TUMOR,EXTRAHEPATIC 47711 $5,001.00 47712 PR EXCIS BILE DUCT TUMOR,INTRAHEPATIC 47712 $6,456.00 47715 PR EXCISION CHOLEDOCHAL CYST 47715 $3,619.00 47720 PR CHOLECYSTOENTEROSTOMY 47720 $4,124.00 47760 PR ANAST EXTRAHEP DUCT TO GI TRACT 47760 $6,117.00 $12,413.0 47765 PR ANAST INTRAHEP DUCT TO GI TRACT 47765 0 47780 PR ANAST,ROUX-EN-Y,EXTRAHEP TO GI TRCT 47780 $6,719.00 47785 PR ANAST,ROUX-EN-Y,INTRAHEP TO GI TRCT 47785 $8,832.00 47800 PR RECONSTR EXTRAHEP DUCTS,PLASTIC 47800 $6,413.00 47999 PR BILE TRACT SURG PROC, UNLISTED 47999 $615.00 48020 PR REMOVAL OF PANCREATIC STONE 48020 $3,202.00 48100 PR BIOPSY,PANCREAS,OPEN 48100 $2,444.00 48102 PR NEEDLE BIOPSY OF PANCREAS 48102 $1,147.00 48105 PR RESECT/DEBRIDE ACUTE NECROT PANCREAS 48105 $9,512.00 48120 PR EXCISION OF PANCREAS LESION 48120 $3,938.00 48140 PR PART REMV PANCREAS,DISTAL SUBTOTAL 48140 $4,928.00 $22,550.0 48145 PR PART REMV PANC,DIST+ANAST PANC-JEJU 48145 0 48148 PR EXCISION AMPULLA VATER 48148 $5,177.00 $10,227.0 48150 PR PART REMV PANC,PROX+REMV DUOD+ANAST 48150 0 $10,236.0 48153 PR PART REMV PANC,PROX+PART DUOD+ANAST 48153 0 48154 PR PART REMV PANC,PROX+PART REMV DUOD 48154 $7,898.00 48155 PR REMOVAL OF PANCREAS, TOTAL 48155 $5,669.00

$12,860.0 48160 PR PANCREATECTOMY,W/AUTOLOGOUS TRANSPLANT 48160 0 48500 PR MARSUPIALIZATION,CYST,PANCREAS 48500 $4,029.00 48510 PR EXTERN DRAIN PANC PSEUDOCYST,OPEN 48510 $3,924.00 48520 PR ANAST PANC CYST-BOWEL,DIRECT 48520 $3,902.00 48540 PR ANAST PANC CYST-BOWEL,ROUX-EN-Y 48540 $5,331.00 48545 PR PANCREATORRHAPHY,INJURY 48545 $5,464.00 48548 PR ANAST PANCREAS-JEJUNUM/SIDE-SIDE 48548 $6,781.00 48550 PR DONOR PANCREATECTOMY 48550 $5,251.00 48551 PR TRANSPLANT,PREP DONOR PANCREAS 48551 $615.00

48552 PR TRANSPLANT,PREP DONOR PANCREAS/VENOUS 48552 $674.00 48554 PR TRANSPLANT ALLOGRAFT PANCREAS 48554 $6,933.00 48556 PR REMOVAL ALLOGRAFT PANCREAS 48556 $4,555.00 49000 PR EXPLORATORY OF ABDOMEN 49000 $2,780.00 49002 PR REOPEN RECENT ABD EXPLORATORY 49002 $3,770.00 49010 PR EXPLORATORY RETROPERITONEAL 49010 $2,504.00

49013 PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA 49013 $1,132.00

49014 PR REEXPL PEL WND W/RMVL PREPERITONEAL PEL PACKING 49014 $936.00 49020 PR DRAIN ABD ABSCESS OPEN 49020 $4,978.00 49040 PR DRAIN SUBDIAPH/SUBPHR ABSCESS,OPEN 49040 $3,554.00 49060 PR DRAIN RETROPERITONEAL ABSCESS,OPEN 49060 $3,216.00 49062 PR DRAIN LYMPH-PERITONEAL CAVITY,OPEN 49062 $2,363.00 PR ABDOM PARACENTESIS DX/THER W/O IMAGING 49082 GUIDANCE 49082 $542.00

49083 PR ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE 49083 $798.00

49084 PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE 49084 $295.00 49180 PR PERCUT BIOPSY, ABDOMINAL MASS 49180 $412.00

49185 PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID 49185 $2,989.00

PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 49203 CM 49203 $4,930.00

PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5.1- 49204 10.0 CM 49204 $6,300.00

PR EXCISION/DESTRUCTION OPEN ABDOMINAL 49205 TUMORS >10.0 CM 49205 $7,292.00 49215 PR EXCISE PRESACRAL/SACRAL TUMOR 49215 $7,067.00 49250 PR EXCISION OF UMBILICUS 49250 $1,592.00 49255 PR REMOVAL OF OMENTUM 49255 $2,848.00 49320 PR LAP,DIAGNOSTIC ABDOMEN 49320 $889.00 49321 PR LAP,DX SURGICAL ABD W/BIOPSY 49321 $1,015.00 49322 PR LAP,ABDOMEN,ASPIRATE CYST 49322 $1,400.00 49323 PR LAP,ABDOMEN,DRAIN LYMPHOCELE 49323 $2,276.00

49324 PR LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER 49324 $1,056.00 49325 PR LAP REVISE INTRAPERITONEAL CATHETER 49325 $1,127.00 49326 PR LAP OMENTOPEXY ADD-ON 49326 $530.00 49400 PR AIR/CONTRAST INJECT INTO ABDOMEN 49400 $426.00 49402 PR REMOVE PERITONEAL FOREIGN BODY 49402 $2,838.00

49405 PR IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ 49405 $2,173.00

49406 PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ 49406 $497.00

PR IMAGE FLUID COLLXN DRAINAG CATH 49407 TRANSREC/VAGINAL 49407 $1,836.00

49411 PR INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT 49411 $1,278.00

49418 PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID 49418 $3,707.00 49419 PR INSERTION TUNNEL INTRAPERITONEAL CATH W SUBQ PORT 49419 $1,166.00

49421 PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN 49421 $877.00

49422 PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER 49422 $968.00 49423 PR DRAINAGE CATHETER EXCHANGE 49423 $1,349.00 49424 PR CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE 49424 $380.00 49425 PR INSERT ABDOMEN-VENOUS SHUNT 49425 $2,594.00 49429 PR REMOVAL OF ABD-VENOUS SHUNT 49429 $1,220.00

49435 PR INSERT SUBQ EXTENSION INTRAPERITONEAL CATH 49435 $326.00 49440 PR INSERT GASTROSTOMY TUBE PERCUTANEOUS 49440 $2,041.00

49441 PR INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ 49441 $2,416.00

PR INSERT CECOSTOMY/OTHER COLONIC TUBE 49442 PERCUTANEOUS 49442 $2,644.00

PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE 49446 PERQ 49446 $2,131.00

PR REPLACE GASTROSTOMY/CECOSTOMY TUBE 49450 PERCUTANEOUS 49450 $1,401.00

PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE 49451 PERCUTANEOUS 49451 $1,487.00

PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE 49452 PERCUTANEOUS 49452 $2,257.00

49460 PR OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE 49460 $1,482.00

PR CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC 49465 EVAL GI TUBE 49465 $312.00 49491 REPAIR ING HERNIA,PRETERM INFANT,REDUC 49491 $2,161.00 49495 REPAIR ING HERNIA,FULL/PRETERM INF,REDUC 49495 $1,108.00 49496 REPAIR ING HERNIA,<6MO,STRANG 49496 $1,665.00 49500 REPAIR ING HERNIA,6MO-5YR,REDUC 49500 $1,181.00 49501 PR REPAIR ING HERNIA,6MO-5YR,STRANG 49501 $1,642.00 49505 PR REPAIR ING HERNIA,5+Y/O,REDUCIBL 49505 $1,413.00 49507 PR REPAIR ING HERNIA,5+Y/O,STRANG 49507 $2,090.00 49520 PR REPAIR RECURR INGUIN HERN,REDUCIBL 49520 $1,757.00 49521 PR REPAIR RECURR INGUIN HERN,STRANG 49521 $2,269.00 49525 PR REPAIR SLIDING INGUINAL HERNIA 49525 $1,556.00 49540 PR REPAIR LUMBAR HERNIA 49540 $2,423.00 49550 PR REPAIR FEMORAL HERNIA,REDUCIBLE 49550 $1,598.00 49553 PR REPAIR FEMORAL HERNIA,STRANG 49553 $1,712.00 49557 PR REPAIR RECURR FEMORAL HERNIA,STRANG 49557 $2,602.00 49560 PR REPAIR INCISIONAL HERNIA,REDUCIBLE 49560 $2,660.00 49561 PR REPAIR INCISIONAL HERNIA,STRANG 49561 $2,673.00 49565 PR REPAIR RECURR INCIS HERNIA,REDUC 49565 $2,268.00 49566 PR REPAIR RECURR INCIS HERNIA,STRANG 49566 $2,701.00

49568 PR IMPLANT MESH HERNIA REPAIR/DEBRIDEMENT CLOSURE 49568 $727.00 49570 PR REPAIR EPIGASTRIC HERNIA,REDUC 49570 $1,129.00 49572 PR REPAIR EPIGASTRIC HERNIA,STRANG 49572 $1,403.00 49580 REPAIR UMBILICAL HERN,<5Y/O,REDUC 49580 $903.00 49582 REPAIR UMBILICAL HERN,<5Y/O,STRANG 49582 $1,283.00 49585 REPAIR UMBILICAL HERN,5+Y/O,REDUC 49585 $1,207.00 49587 REPAIR UMBILICAL HERN,5+Y/O,STRANG 49587 $1,291.00 49590 PR REPAIR SPIEGELIAN HERNIA 49590 $1,554.00 49600 PR REPAIR SMALL OMPHALOCELE 49600 $2,607.00 $20,206.0 49605 PR REPAIR LARGE OMPHALOCELE 49605 0 49606 PR REPAIR LARGE OMPHALOCELE,FINAL 49606 $3,593.00 49610 PR REPAIR OMPHALOCELE,FIRST STAGE 49610 $2,453.00 49650 PR LAP,INGUINAL HERNIA REPR,INITIAL 49650 $1,164.00 49651 PR LAP,INGUINAL HERNIA REPR,RECUR 49651 $1,516.00 49652 PR LAP, VENTRAL HERNIA REPAIR,REDUCIBLE 49652 $3,349.00 49653 PR LAP, VENTRAL HERNIA REPAIR,INCARCERATED 49653 $3,773.00 49654 PR LAP, INCISIONAL HERNIA REPAIR,REDUCIBLE 49654 $3,349.00

49655 PR LAP, INCISIONAL HERNIA REPAIR,INCARCERATED 49655 $3,773.00

49656 PR LAP, RECURRENT INCISIONAL HERNIA REPAIR,REDUCIBLE 49656 $3,555.00

49657 PR LAP, RECURRENT INCISIONAL HERNIA REPAIR,INCARCERATED 49657 $3,587.00 49900 PR SUTURE ABD WALL-DEHIS/EVISCER 49900 $2,940.00 49904 PR OMENTAL FLAP,EXTRA-ABDOMINAL 49904 $5,815.00 49905 PR OMENTAL FLAP,INTRA-ABDOMINAL 49905 $960.00 49906 PR FREE OMENTAL FLAP,MICROVASC ANAST 49906 $4,247.00 50060 PR REMOVAL OF KIDNEY STONE 50060 $3,439.00 50080 PR PERCUT REMV KID STONE,UP TO 2 CM 50080 $3,486.00 50081 PR PERCUT REMV KID STONE,2+ CM 50081 $5,317.00 50130 PR EXPLOR/REMV STONE,RENAL PELVIS 50130 $3,732.00 50200 PR RENAL BIOPSY PRQ TROCAR/NEEDLE 50200 $1,496.00 50205 PR BIOPSY OF KIDNEY,OPEN EXPOS 50205 $2,730.00 50220 PR REMV KIDNEY,W/RIB RESECTION 50220 $3,282.00 50225 PR REMV KIDNEY,COMPLICATED 50225 $4,861.00 50230 PR REMV KIDNEY,RADICAL 50230 $5,283.00 50234 PR REMV KIDNEY/URETER,SAME INCIS 50234 $5,272.00 50236 PR REMV KIDNEY/URETER,SEPAR INCIS 50236 $6,017.00 50240 PR PARTIAL REMOVAL OF KIDNEY 50240 $5,404.00 50280 PR EXCIS/UNROOF RENAL CYST 50280 $3,428.00 50300 PR RMV,DONOR KIDNEY,CADAVER 50300 $2,418.00 50320 PR RMV,KIDNEY,DONOR,LIVING 50320 $4,760.00 50323 PR TRANSPLANT,PREP CADAVER RENAL GRAFT 50323 $494.00 50325 PR TRANSPLANT,PREP LIVING RENAL GRAFT 50325 $509.00 50327 PR TRANSPLANT,PREP RENAL GRAFT/VENOUS 50327 $618.00 50328 PR TRANSPLANT,PREP RENAL GRAFT/ARTERIAL 50328 $515.00 50329 PR TRANSPLANT,PREP RENAL GRAFT/URETERAL 50329 $490.00 50340 PR REMOVAL OF RECIPIENT KIDNEY 50340 $2,709.00 50360 PR TRANSPLANTATION OF KIDNEY 50360 $7,189.00 $11,669.0 50365 PR TRANSPLANT KIDNEY+RECIP NEPHREC 50365 0 50370 PR REMOVE TRANSPLANTED KIDNEY 50370 $3,265.00 50380 PR REIMPLANTATION OF KIDNEY 50380 $7,809.00

50382 PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ 50382 $2,952.00 50384 PR REMOVAL INDWELLING URETERAL STENT PRQ 50384 $2,306.00

50385 PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL 50385 $2,984.00

50386 PR REMOVE INT DWELL URETERAL STENT TRANSURETHRAL 50386 $2,034.00

50387 PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH 50387 $1,664.00 50389 PR REMOVE RENAL TUBE W/FLUORO 50389 $748.00 50390 PR PERCUT DRAIN/INJECT RENAL CYST 50390 $258.00 50391 PR INSTLL RX AGNT INTO RNAL TUB 50391 $348.00 50395 PR PERCUT DILATN RENAL TRACT 50395 $430.00 50396 PR MEASURE KIDNEY PRESSURE THRU TUBE 50396 $301.00 50400 PR REVISION RENAL PELVIS,SIMPLE 50400 $3,621.00 50405 PR REVISION RENAL PELVIS,COMPLICATED 50405 $5,764.00 50430 PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS 50430 $1,323.00

PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG 50431 ACESS 50431 $720.00

50432 PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I 50432 $2,144.00

50433 PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I 50433 $2,886.00

PR CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH 50434 PRQ 50434 $2,285.00

PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID 50435 RS&I 50435 $1,199.00

50436 PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG 50436 $394.00

50437 PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS 50437 $679.00 50500 PR REPAIR OF KIDNEY WOUND 50500 $5,249.00 50520 PR CLOSE KIDNEY-SKIN FISTULA 50520 $3,689.00 50541 PR LAP,ABLATION OF RENAL CYSTS 50541 $3,246.00

PR LAP,ABLATION, RENAL MASS LESION(S), ULTRASOUND 50542 GUIDE 50542 $4,812.00 50543 PR LAP,PARTIAL NEPHRECTOMY 50543 $4,926.00 50544 PR LAP,PYELOPLASTY 50544 $5,037.00 50545 PR LAP, RADICAL NEPHRECTOMY 50545 $5,418.00 50546 PR NEPHRECTOMY 50546 $4,392.00 50547 PR LAP,DONOR KIDNEY REMOV,LIVING 50547 $6,600.00 50548 PR NEPHRECTOMY, W/PART. URETECTOMY 50548 $5,155.00 50551 PR RENAL ENDOSCOPY 50551 $884.00 50553 PR RENAL ENDOSCOPY,CATH URETER 50553 $1,065.00 50555 PR RENAL ENDOSCOPY,BIOPSY 50555 $1,060.00 50557 PR RENAL ENDOSCOPY,TREATMENT 50557 $1,069.00 50561 PR RENAL ENDOSCOPY,REMV FB/STONE 50561 $3,344.00 50562 PR RENAL SCOPE,W/RESECTION,TUMOR 50562 $1,808.00 50574 PR RENAL SCOPE,BIOPSY 50574 $901.00 50575 PR RENAL SCOPE,ENDOPYELOTOMY 50575 $3,509.00 50576 PR RENAL SCOPE,FULAUR/INCIS 50576 $1,975.00 50580 PR RENAL SCOPE,REMV FB/STONE 50580 $2,196.00 50590 PR FRAGMENT KIDNEY STONE/ ESWL 50590 $3,250.00 50592 PR ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY 50592 $1,200.00

50593 PR ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY 50593 $1,600.00 50605 PR URETEROTOMY TO INSERT STENT 50605 $3,299.00 50650 PR REMOVAL URETER,BLADDER CUFF 50650 $3,726.00 50660 PR REMOVAL URETER,TOTAL,ECTOPIC 50660 $4,701.00 50684 PR INJECT INDWELL CATH,URETER X-RAY 50684 $468.00 50686 PR MEASURE URETER PRESS,INDWELL CATH 50686 $391.00

50688 PR CHANGE OF URETEROSTOMY TUBE VIA ILEAL CONDUIT 50688 $238.00 50690 PR INJECT RETROGRADE/CONDUIT X-RAY 50690 $404.00

50693 PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT 50693 $2,686.00

50694 PR PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH 50694 $2,958.00

50695 PR PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH 50695 $3,580.00

50705 PR URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I 50705 $4,128.00

50706 PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I 50706 $1,942.00 50715 PR RELEASE URETER,RETROPER FIBROSIS 50715 $3,508.00 50727 PR REVISE URINARY-CUTAN ANAST 50727 $2,500.00 50728 PR REVISE URINARY-CUTAN ANAST+REPAIR 50728 $1,683.00 50740 PR ANASTOMOSE URETER/RENAL PELVIS 50740 $3,527.00 50750 PR ANASTOMOSE URETER/RENAL CALYX 50750 $4,759.00 50760 PR ANASTOMSIS OF URETER 50760 $4,661.00 50780 PR REIMPLANT URETER,SINGLE URETER 50780 $3,500.00 50782 PR REIMPLANT URETER,DUPLICATED URETER 50782 $4,238.00 50783 PR REIMPLANT URETER,EXTENSIVE TAILORING 50783 $4,636.00 50785 PR REIMPLANT URETER,VESICOPSOAS HITCH 50785 $4,907.00

50815 PR URETEROCOLON CONDUIT,W/BOWEL ANASTOMOSIS 50815 $5,014.00

50820 PR URETEROILEAL CONDUIT,W/BOWEL ANASTOMOSIS 50820 $5,351.00

50825 PR CONTINENT DIVERSION,W/BOWEL ANASTOMOSIS 50825 $7,150.00 50830 PR URINARY UN-DIVERSION 50830 $7,436.00 50845 PR APPENDICO-VESICOSTOMY 50845 $4,830.00 50860 PR TRANSPLANT URETER TO SKIN 50860 $3,478.00 50930 PR CLOSURE URETER/BOWEL FISTULA 50930 $4,443.00 50947 PR LAP,REIMPLANT URETER W/CYSTO,STENT 50947 $5,555.00 50948 PR LAP,REIMPLANT URETER W/O CYSTO,STENT 50948 $5,241.00 50957 PR URETER ENDOSCOPY,FULGUR/INCIS 50957 $1,104.00 50961 PR URETER ENDOSCOPY,REMV CALCULUS 50961 $1,016.00 50970 PR URETER ENDOSCOPY 50970 $985.00 51020 PR INCISE/FULGUR LESN BLADDER 51020 $1,238.00 51040 PR INCISE/DRAIN BLADDER 51040 $1,507.00 51050 PR OPEN BLADDER,REMV CALCULUS 51050 $2,003.00

51065 PR CYSTOTOMY,EXTRACT &/OR FRAG URETER CALC 51065 $1,486.00 51080 PR DRAIN PERI-BLADDER ABSCESS 51080 $1,098.00 51100 PR ASPIRATION BLADDER NEEDLE 51100 $191.00

51101 PR ASPIRATION BLADDER TROCAR/INTRACATHETER 51101 $311.00

51102 PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER 51102 $706.00 51500 PR REMOVAL URACHAL CYST 51500 $2,299.00 51525 PR CYSTOTOMY,EXCIS BLADDER TIC 51525 $3,074.00 51530 PR CYSTOTOMY,EXCIS BLADDER TUMOR 51530 $2,806.00 51550 PR PART REMV BLADDER,SIMPLE 51550 $2,820.00 51555 PR PART REMV BLADDER,COMPLICATED 51555 $5,181.00 51565 PR PART REMV BLADDER,REIMPLNT URETER 51565 $5,317.00 51575 PR REMV BLADDER/NODES 51575 $7,218.00

51590 PR CYSTECTOMY,ILEAL CONDUIT/SIGMOID BLADDER 51590 $7,700.00 51595 PR REMV BLADDER/NODES,ILEAL CONDUIT 51595 $8,907.00 51596 PR CYSTECTOMY,W/CONTINENT DIVERSION 51596 $9,456.00 51597 PR PELVIC EXENTERATION 51597 $9,196.00 51600 PR INJECTION FOR BLADDER X-RAY 51600 $493.00 51610 PR INJECT FOR RETROGRADE URETHOCYSTO 51610 $408.00 51700 PR IRRIGATION OF BLADDER 51700 $220.00

51701 PR INSERT,NON-INDWELLING BLADDER CATHETER 51701 $155.00 51702 PR INSERT,TEMP INDWELLING BLAD CATH,SIMPLE 51702 $204.00 51703 PR INSERT,TEMP INDWELLING BLAD CATH,COMP 51703 $353.00 51705 PR CHANGE OF BLADDER TUBE,SIMPLE 51705 $284.00 51710 PR CHANGE OF BLADDER TUBE,COMPLICATED 51710 $404.00 51715 PR ENDOSCOPIC INJECTION/IMPLANT 51715 $1,029.00 51720 PR INSTILL ANTICANCER AGENT IN BLADDER 51720 $285.00

51725 51725 PR SIMPLE CYSTOMETROGRAM 26 26 $197.00

51726 51726 PR COMPLEX CYSTOMETROGRAM 26 26 $250.00

51727 51727 PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE 26 26 $282.00

PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE 51728 51728 STUDIES 26 26 $690.00

PR COMPLEX CYSTOMETROGRAM W/VOID PRESS&URETHRAL 51729 51729 PROFILE 26 26 $340.00

51741 51741 PR ELECTRO-UROFLOWMETRY, FIRST 26 26 $165.00

51784 51784 PR ANAL/URINARY MUSCLE STUDY 26 26 $210.00

51785 51785 PR ANAL/URINARY MUSCLE STUDY,NEEDLE 26 26 $225.00

51797 51797 PR VOIDING PRESS STUDY INTRA-ABDOMINAL VOID 26 26 $233.00 51798 PR MEAS,POST-VOID RES,US,NON-IMAGING 51798 $42.00

51798 51798 PR MEAS,POST-VOID RES,US,NON-IMAGING 26 26 $48.00 51800 PR REVISION OF BLADDER/URETHRA 51800 $3,740.00 51820 PR REVISE BLAADER/URETHRA+URETER 51820 $3,895.00 51860 PR REPAIR BLADDER WOUND/INJ,SIMPLE 51860 $2,690.00 51865 PR REPAIR BLADDER WOUND/INJ,COMPLIC 51865 $3,240.00 51880 PR CLOSE CYSTOSTOMY 51880 $1,348.00 51900 PR CLOSE BLADDER/VAGINA FISTULA,ABDOM 51900 $2,997.00 51940 PR CLOSURE,BLADDER EXSTROPHY 51940 $6,779.00

51960 PR ENTEROCYSTOPLASTY,W/BOWEL ANASTOMOSIS 51960 $6,378.00 51980 PR CONSTRUCT BLADDER OPENING-CUTANEOUS 51980 $3,403.00 52000 PR CYSTOURETHROSCOPY 52000 $550.00

52001 PR CYSTOURETHROSCOPY W/IRRIG & EVAC CLOTS 52001 $933.00 52005 PR CYSTOURETHROSCOPY,URETER CATHETER 52005 $780.00 52007 PR CYSTOURETHROSCOPY,URETERAL BIOPSY 52007 $1,117.00 52204 PR CYSTOURETHROSCOPY,BIOPSIES 52204 $1,251.00 52214 PR CYSTOURETHROSCOPY,FULGURATN 52214 $3,067.00 52224 PR CYSTOURETHROSCOPY,FULGUR <.5CM LESN 52224 $2,903.00 52234 PR CYSTOURETHROSCOPY,FULGUR .5-2CM LESN 52234 $998.00 52235 PR CYSTOURETHROSCOPY,FULGUR 2-5CM LESN 52235 $845.00 52240 PR CYSTOURETHROSCOPY,FULGUR >5CM LESN 52240 $2,263.00 52260 PR CYSTOSCOPY,DIL BLADDER,GEN ANESTH 52260 $630.00 52265 PR CYSTOSCOPY,DIL BLADDER,LOCAL ANESTH 52265 $1,207.00 52270 PR CYSTOSCOPY,INTERN URETHROTOMY,FEMALE 52270 $897.00 52275 PR CYSTOSCOPY,INTERN URETHROTOMY,MALE 52275 $1,528.00 52276 PR CYSTOSCOPY,DIR VIS INT URETHROTOMY 52276 $1,140.00 52277 PR CYSTOSCOPY,RESEC EXTERN SPHINCTER 52277 $856.00 52281 PR CYSTOSCOPY,DIL URETHRAL STRICTURE 52281 $802.00

52287 PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER 52287 $860.00 52290 PR CYSTOSCOPY,URETERAL MEATOTOMY 52290 $625.00 52300 PR CYSTOSCOPY,RESECT ORTHO URETEROCELE 52300 $1,340.00 52301 PR CYSTOSCOPY,RESECT ECTOPIC URETEROCEL 52301 $725.00 52310 PR CYSTOSCOPY,REMV CALCULUS,SIMPLE 52310 $770.00 52315 PR CYSTOSCOPY,REMV CALCULUS,COMPLIC 52315 $1,114.00 52317 PR REMOVE BLADDER STONE,<2.5CM 52317 $2,655.00 52318 PR REMOVE BLADDER STONE,>2.5CM 52318 $2,186.00 52320 PR CYSTOSCOPY,REMV URETERAL STONE 52320 $636.00 52327 PR CYSTOSCOPY,INJECT IMPLNT MATERIAL 52327 $672.00 52330 PR CYSTOSCOPY,MANIPULATN 52330 $1,246.00 52332 PR CYSTOSCOPY,INSERT URETERAL STENT 52332 $1,270.00 52334 PR CYSTOSCOPY,GUIDE,PERCUT NEPHROS 52334 $641.00 52341 PR CYSTOSCOPY,TX URETERAL STRICTURE 52341 $752.00 52342 PR CYSTOSCOPY,TX URETEROPELVC STRICTURE 52342 $798.00 52343 PR CYSTOSCOPY,TX INTRARENAL STRICTURE 52343 $911.00 52344 PR CYSTO/URETEROSCOPY,TX URETER STRICT 52344 $963.00 52345 PR CYSTO/URETEROSCOPY,TX URET/PELV STRICT 52345 $1,015.00

52346 PR CYSTO/URETEROSCOPY,TX INTRARENAL STRICT 52346 $1,159.00 52351 PR CYSTO/URETERO/PYELOSCOPY, DX 52351 $794.00 52352 PR CYSTO/URETERO/PYELOSCOPY, CALCULUS TX 52352 $933.00

52353 PR CYSTO/URETERO/PYELOSCOPY W/LITHOTRIPSY 52353 $3,545.00 52354 PR CYSTO/URETERO/PYELOSC,BX &/OR FULG LESN 52354 $2,130.00

52355 PR CYSTO/URETERO/PYELOSCOPY,W/RESECT TUMOR 52355 $2,500.00

52356 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 52356 $1,116.00

52400 PR CYSTOSCOPY,RESEC CONGEN MUCOSAL FOLDS 52400 $1,199.00 52402 PR CYSTOSCOPY,RESEC EJACULATORY DUCT 52402 $677.00

52441 PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE 52441 $590.00

52442 PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL 52442 $197.00 52450 PR TRANSURETHRAL INCISION OF PROSTATE 52450 $2,420.00 52500 PR TRANSURETHRAL RESEC BLADDER NECK 52500 $1,863.00 52601 PR TRANSURETHRAL ELEC-SURG PROSTATECTOM 52601 $3,113.00 52630 PR REMV RESID OBSTRUC PROSTATE,>1 YR 52630 $2,916.00 52640 PR RELIEVE POSTOP BLADDER CONTRACTURE 52640 $1,646.00

52648 PR LASER VAPORIZATION SURGERY PROSTATE, COMPLETE 52648 $8,787.00

52649 PR LASER ENUCLEATION PROSTATE W MORCELLATION 52649 $2,903.00 52700 PR DRAINAGE OF PROSTATE ABSCESS 52700 $1,136.00 53000 PR INCISION OF URETHRA 53000 $381.00 53010 PR INCISION OF URETHRA,PERINEAL 53010 $1,730.00 53020 PR INCISION OF URETHRAL MEATUS 53020 $361.00 53025 PR INCISION OF URETHRAL MEATUS,INFANT 53025 $387.00 53040 PR DRAINAGE DEEP URETHRAL ABSCESS 53040 $1,191.00 53060 PR DRAINAGE SKENES GLAND ABSCESS 53060 $468.00 53200 PR BIOPSY OF URETHRA 53200 $420.00 53210 PR REMOVAL OF URETHRA,FEMALE 53210 $2,820.00 53215 PR REMOVAL OF URETHRA,MALE 53215 $2,782.00 53220 PR EXCIS CANCER URETHRA 53220 $1,255.00 53230 PR EXCIS URETHRAL TIC,FEMALE 53230 $2,190.00 53240 PR MARSUP URETHRAL TIC 53240 $1,130.00 53260 PR EXCIS URETHRAL POLYP(S) 53260 $530.00 53275 PR EXCIS URETHRAL PROLAPSE 53275 $673.00 53400 PR REVISE URETHRA, 1ST STAGE 53400 $2,329.00 53405 PR REVISE URETHRA, 2ND STAGE 53405 $3,713.00 53410 PR RECONSTRUC ANT MALE URETHRA 53410 $2,865.00 53415 PR RECONSTRUC PROSTATIC URETHRA 53415 $4,037.00 53420 PR RECONSTRUC PROS URETHRA,1ST STAGE 53420 $3,781.00 53425 PR RECONSTRUC PROS URETHRA,2ND STAGE 53425 $3,352.00 53430 PR RECONSTRUC FEMALE URETHRA 53430 $2,823.00 53431 PR URETHROPLASTY,W/TUBULARIZATION 53431 $4,745.00

53440 PR SLING OPERATION,CORRECTION,MALE INCONT 53440 $2,708.00 53442 PR REVISION OF SLING FOR MALE INCONT 53442 $2,827.00 53445 PR INSERT,INFLATABLE SPHINCTER 53445 $5,477.00 53446 PR REMOVAL,INFLATABLE SPHINCTER 53446 $2,027.00 53447 PR REMOVAL & REPLACE,INFLATABLE SPHINCTER 53447 $2,611.00 53449 PR REPAIR,INFLATABLE SPHINCTER DEVICE 53449 $2,209.00 53450 PR URETHRAL MEATAL REVISION 53450 $984.00 53460 PR URETHROPLASTY,EXCIS DIST URETHRA 53460 $1,153.00 53500 PR URETHRLYS, TRANSVAG W/ SCOPE 53500 $2,687.00 53502 PR REPAIR URETHRA INJURY,FEMALE 53502 $1,290.00 53505 PR REPAIR URETHRA INJURY,PENILE 53505 $1,241.00 53520 PR CLOSE URETHROSTOMY/FISTULA,MALE 53520 $1,643.00 53600 PR DIL URETHRA STRIC,MALE,INITIAL 53600 $210.00 53601 PR DIL URETHRA STRIC,MALE,SUBSEQ 53601 $208.00 53660 PR DIL URETHRA,FEMALE,INITIAL 53660 $181.00 53661 PR DIL URETHRA,FEMALE,SUBSEQUENT 53661 $180.00 53665 PR DIL URETHRA,GEN/SPINAL ANESTH 53665 $100.00

53854 PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY 53854 $4,690.00 54001 PR SLITTING OF PREPUCE 54001 $475.00 54050 PR DESTR PENIS LESN,SIMPL,CHEMICAL 54050 $340.77 54056 PR DESTR PENIS LESN,SIMPL,CRYOSURG 54056 $371.00 54057 PR DESTR PENIS LESN,SIMPL,LASER SURG 54057 $532.00 54060 PR DESTR PENIS LESN,SIMPL,SURG EXCIS 54060 $450.00 54065 PR DESTR PENIS LESN,EXTENSIVE 54065 $584.00 54100 PR BX,PENIS (SEPARATE PROCEDURE) 54100 $528.00 54105 PR BIOPSY OF PENIS,DEEP STRUCT 54105 $692.00 54110 PR EXCIS PENILE PLAQUE 54110 $2,555.00 54111 PR EXCIS PENILE PLAQUE,GRAFT <5CM 54111 $3,328.00 54115 PR REMV FOR.BODY DEEP PENILE TISS 54115 $1,129.00 54120 PR REMOVAL PENIS,PARTIAL 54120 $2,012.00 54125 PR REMOVAL PENIS,TOTAL 54125 $2,913.00 54130 PR REMOVAL PENIS,RADICAL+NODES 54130 $4,927.00 54150 PR CIRCUMCISION,CLAMP,NEWBORN W/ ANESTH 54150 $410.00 54160 PR CIRCUMCISION,OTHER,<28 D/O 54160 $577.00 54161 PR CIRCUMCISION,OTHER,28+ D/O 54161 $677.00 54162 PR LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS 54162 $670.00 54163 PR REPAIR,INCOMPLETE CIRCUMCISION 54163 $629.00 54164 PR FRENULOTOMY,PENIS 54164 $498.00 54200 PR INJECT PROC PENILE PLAQUE 54200 $267.00 54220 PR IRRIGAT CORPUS CAVERN,PRIAPISM 54220 $1,065.00 54230 PR INJECT CORPORA CAVERN XRAY 54230 $507.00 54235 PR INJECT CORPORA CAVERN,PHARM AGNT 54235 $248.00 54300 PR STRAIGHTEN PENIS 54300 $2,237.00 54304 PR HYPOSPADIUS REPAIR,1ST STAGE 54304 $2,695.00 54308 PR HYPOSPADIUS REPAIR,2ND STAGE,<3CM 54308 $3,993.00 54312 PR HYPOSPADIUS REPAIR,2ND STAGE,>3CM 54312 $4,662.00 54322 PR HYPOSPAD REPAIR,1 STAGE,DISTAL 54322 $2,436.00 54324 PR HYPOSPAD REPAIR,1 STAGE,DIST,PLASTY 54324 $3,142.00 54326 PR HYPOSPAD REPAIR,1 STAGE,DIST,PLASTY 54326 $4,411.00 54328 PR HYPOSPAD REPR,1 STAGE,DIST,EXTENSV 54328 $3,872.00 54332 PR HYPOSPAD REPR,1 STAGE,PROX,EXTENSV 54332 $3,872.00 54336 PR HYPOSPAD REPR,1 STAGE,PERINEAL,EXTEN 54336 $4,900.00 54340 PR REPAIR HYPOSPAD COMPLIC,SIMPLE 54340 $1,635.00 54344 PR REPAIR HYPOSPAD COMPLIC,MOBILIZ 54344 $3,279.00 54360 PR PENIS PLASTIC SURG,CORRECT ANGULATN 54360 $2,536.00 54380 PR REPAIR PENIS,EPISPADIUS 54380 $2,895.00 54400 PR INSERT SEMI-RIGID PENILE PROSTHESIS 54400 $1,397.00 54405 PR INSERT,INFLATABLE PENILE PROSTHESIS 54405 $3,708.00

54406 PR REMVL,INFLAT PENILE PROSTH W/O REPLACMT 54406 $2,614.00 54408 PR REPAIR,INFLATABLE PENILE PROSTHESIS 54408 $2,828.00 54410 PR REPLACE,INFLATABLE PENILE PROSTHESIS 54410 $2,602.00 54415 PR REMOVAL,PENILE PROSTHESIS W/O REPLACMT 54415 $1,551.00 54416 PR REPLACE,PENILE PROSTHESIS 54416 $2,555.00 54430 PR CORPORA CAVER-SPONGIOSA SHUNT 54430 $2,616.00 54435 PR CORPORA-GLANS FISTULIZATN 54435 $1,072.00 54437 PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S) 54437 $2,431.00 54440 PR REPAIR PENIS POST INJURY 54440 $2,411.00 54450 PR PREPUTIAL STRETCHING 54450 $250.00 54505 PR BIOPSY OF TESTIS,INCISIONAL 54505 $734.00 54512 PR EXCIS TESTIS EXTRAPARENCHYMAL LESION 54512 $1,271.00 54520 PR REMOVAL TESTIS,SIMPLE 54520 $1,186.00 54522 PR REMOVAL TESTIS, PARTIAL 54522 $2,127.00 54530 PR REMOVAL TESTIS,RADICAL 54530 $1,796.00 54550 PR EXPLORE UNDESC TESTIS,INGUIN/SCROTAL 54550 $1,628.00 54560 PR EXPLORE UNDESC TESTIS,ABDOMINAL 54560 $2,470.00 54600 PR REDUCE TESTIS TORSION 54600 $1,559.00 54620 PR FIXATN OF TESTIS OPP TORSN 54620 $1,134.00

54640 PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH 54640 $1,519.00 54650 PR ORCHIOPEXY,ABD APPRCH,ABD TESTIS 54650 $2,517.00 54660 PR INSERT TESTICULAR PROSTHESIS 54660 $919.00 54670 PR REPAIR TESTIS INJURY 54670 $1,047.00 54680 PR RELOCATION OF TESTIS(ES) 54680 $2,778.00 54690 PR LAP,ORCHIECTOMY 54690 $2,374.00 54692 PR LAP,ORCHIOPEXY 54692 $2,779.00 54700 PR INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM 54700 $576.00 54830 PR EXCIS EPIDIDYMIS LOCAL LESION 54830 $1,157.00 54840 PR EXCIS SPERMATOCELE 54840 $2,133.00 54900 PR ANAST EPIDIDYMIS-VAS DEFERENS,UNILAT 54900 $2,892.00 55000 PR DRAINAGE OF HYDROCELE,TUNICA 55000 $303.00 55040 PR REMOVAL OF HYDROCELE,TUNICA,UNILAT 55040 $1,163.00 55041 PR REMOVAL OF HYDROCELE,TUNICA,BILAT 55041 $2,048.00 55060 PR REPAIR OF HYDROCELE,TUNICA 55060 $1,375.00 55100 PR DRAINAGE SCROTAL WALL ABSCESS 55100 $599.00 55110 PR EXPLORE SCROTUM 55110 $1,235.00 55120 PR REMOVAL OF SCROTAL FOR.BODY 55120 $941.00 55150 PR REMOVAL OF SCROTUM 55150 $1,361.00 55175 PR REVISION OF SCROTUM,SIMPLE 55175 $1,467.00 55180 PR REVISION OF SCROTUM,COMPLICATED 55180 $2,000.00 55250 PR REMOVAL OF SPERM DUCT(S) 55250 $1,237.00 55400 PR REPAIR OF SPERM DUCT 55400 $5,200.00 55450 PR LIGATION OF SPERM DUCT 55450 $178.00 55500 PR REMV HYDROCELE,SPERM CORD,UNILAT 55500 $1,223.00 55520 PR REMOVAL OF SPERM CORD LESION 55520 $1,230.00 55530 PR EXCISE VARICOCELE 55530 $1,573.00 55550 PR LAP,LIGATION SPERMATIC VEINS 55550 $1,066.00 55600 PR INCISE SEMINAL VESICLE 55600 $1,092.00 55680 PR EXCISE MULLERIAN DUCT CYST 55680 $927.00 55700 PR BIOPSY OF PROSTATE,NEEDLE/PUNCH 55700 $625.00 55705 PR BIOPSY OF PROSTATE,INCISIONAL 55705 $944.00

55706 PR BIOPSY OF PROSTATE,NEEDLE,TRANSPERINEAL 55706 $944.00 55801 PR REMV PROSTATE,PERINEAL,SUBTOTAL 55801 $3,953.00 55810 PR REMV PROSTATE,PERINEAL,RADICAL 55810 $5,421.00 55821 PR REMV PROSTATE,SUPRAPUBIC,SUBTOTAL 55821 $3,127.00 55840 PR REMV PROSTATE,RETROPUB,RADICAL 55840 $5,432.00 55842 PR REMV PROSTATE,RETROPUB,RAD,LTD NODES 55842 $4,818.00 55845 PR REMV PROSTATE,RETROPUB,RAD,TOT NODES 55845 $6,883.00

PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL 55866 ROBOTIC 55866 $6,807.00 55873 PR CRYOSURG ABLATION OF PROSTATE 55873 $2,730.00

55874 PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX 55874 $9,491.00

55875 PR PERCUT/NEEDLE INSERT,PROSTATE,RADIOISOT 55875 $2,690.00

55875 55875 PR PERCUT/NEEDLE INSERT,PROSTATE,RADIOISOT 26 26 $2,690.00

55876 PR PLACE RADIOTHER DEVICE/MARKER, PROSTATE 55876 $552.00

55880 PR TRANSRECTAL ABLTJ MAL PRST8 TISSUE HIFU W/US 55880 $2,573.00

55920 PR PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL 55920 $1,065.00 56405 PR I&D OF VULVA/PERINEUM ABSCESS 56405 $344.00 56420 PR I&D BARTHOLIN GLAND ABSCESS 56420 $417.00 56440 PR MARSUP BARTHOLIN GLAND CYST 56440 $525.00 56441 PR LYSIS OF LABIAL LESION(S) 56441 $440.00 56442 PR HYMENOTOMY, SIMPLE INCISION 56442 $127.00 56501 PR DESTRUCTION,LESION(S),VULVA,SIMPLE 56501 $417.14 56515 PR DESTRUCTION,LESION(S),VULVA;EXTENSIVE 56515 $600.00 56605 PR BIOPSY VULVA/PERINEUM,ONE LESN 56605 $243.00 56606 PR BX,VULVA/PERINEUM,ADDL LESION 56606 $130.00 56620 PR PART SIMPLE REMV VULVA 56620 $1,575.00 56625 PR COMPLETE SIMPLE REMV VULVA 56625 $1,660.00 56630 PR VULVA RESECT,RADICAL,PARTIAL 56630 $3,390.00 56631 PR VULVA RESECT,RAD,PART,UNI NODES 56631 $4,290.00 56632 PR VULVA RESECT,RAD,PART,BILAT NODES 56632 $5,780.00 56633 PR VULVA RESECT,RAD,TOTAL 56633 $3,425.00 56634 PR VULVA RESECT,RAD,TOTAL,UNI NODES 56634 $5,380.00 56700 PR PARTIAL REMOVAL OF HYMEN 56700 $550.00 56740 PR EXCIS BARTHOLIN GLAND/CYST 56740 $800.00 56800 PR REPAIR OF VAGINA 56800 $615.00 56805 PR REPAIR CLITORIS 56805 $4,000.00 56810 PR REPAIR OF PERINEUM,NON OBSTETRICAL 56810 $900.00 56820 PR COLPOSCOPY,VULVA 56820 $300.00 56821 PR COLPOSCOPY,VULVA,W/BIOPSY(S) 56821 $390.00 57000 PR EXPLORATION OF VAGINA 57000 $520.00 57020 PR DRAINAGE OF PELVIC FLUID 57020 $250.00 57022 PR I&D VAGINAL HEMATOMA,OBSTET/POSTPART 57022 $500.00 57061 PR DESTRUCT,VAGINAL LESION(S),SIMPLE 57061 $378.00 57065 PR DESTRUCT,VAGINAL LESION(S),EXTENSIVE 57065 $530.00 57100 PR BIOPSY OF VAGINA,SIMPLE 57100 $240.00 57105 PR BIOPSY OF VAGINA,EXTENSIVE 57105 $380.00 57106 PR REMOVE VAGINA WALL, PARTIAL 57106 $1,387.00 57110 PR COMPLETE REMOVAL OF VAGINA WALL 57110 $3,300.00 57120 PR CLOSURE OF VAGINA 57120 $1,900.00 57130 PR EXCIS VAGINAL SEPTUM 57130 $480.00 57135 PR EXCIS VAGINAL CYST/TUMOR 57135 $520.00

57155 PR INSERTION UTERINE TANDEM&/VAGINAL OVOIDS 57155 $1,638.00 57156 PR INSERT VAGINAL RADIATION DEVICE 57156 $586.00 57160 PR FIT/INSERT INTRAVAG SUPPORT DEVICE 57160 $200.00 57170 PR FITTING OF DIAPHRAGM/CAP 57170 $221.00 57180 PR TREAT VAGINAL BLEEDING 57180 $390.00 57200 PR REPAIR OF VAGINA 57200 $800.00 57210 PR REPAIR VAGINA/PERINEUM 57210 $1,031.00 57220 PR REVISION OF URETHRA SPHINCTER 57220 $1,200.00 57230 PR REPAIR OF URETHROCELE 57230 $1,104.00

57240 PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO 57240 $2,130.00 57250 PR POST COLPORRHAPHY,RECTUM/VAGINA 57250 $2,130.00 57260 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO 57260 $2,720.00

PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL 57265 RPR 57265 $3,006.00 57267 PR INSERT MESH/PELVIC FLR ADDON 57267 $670.00 57280 PR SUSPENSION OF VAGINA,ABD APPRCH 57280 $3,410.00 57282 PR REPR VAGINAL PROLAPSE,SACROSP LIG 57282 $2,900.00 57283 PR REPR VAGINAL PROLAPSE,UTEROSACRAL 57283 $2,775.00

57285 PR PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH 57285 $2,366.00 57287 PR REMV/REVS SLING FOR STRES INCONTINENCE 57287 $2,490.00 57288 PR SLING OPER STRES INCONTINENCE 57288 $2,825.00 57291 PR CONSTRUCTION ARTIFIC VAGINA 57291 $3,639.00 57292 PR CONSTRUCT ARTIFIC VAGINA W GRAFT 57292 $2,850.00 57295 PR REVISION VAGINAL GRAFT, VAG APPROACH 57295 $2,900.00 57296 PR REVISION VAGINAL GRAFT, ABD APPROACH 57296 $3,356.00 57300 PR REPAIR RECTO-VAG FISTULA 57300 $1,675.00 57307 PR REPR REC-VAG FIST,ABD+COLOSTOMY 57307 $3,715.00 57310 PR CLOSE URETHROVAGINAL FISTULA 57310 $1,375.00 57311 PR CLOSE URETHROVAGINAL FIST+XPLANT 57311 $1,575.00 57320 PR CLOSE BLAD-VAG FISTULA,VAG APPRCH 57320 $2,471.00 57330 PR CLOSE BLAD-VAG FIST,XVESC+VAG APPRCH 57330 $2,736.00 57335 PR REVISE VAGINA FOR INTERSEC STATE 57335 $4,845.00 57400 PR DILATION OF VAGINA W ANESTH 57400 $350.00 57410 PR PELVIC EXAMINATION W ANESTH 57410 $375.00 57415 PR REMOVAL VAGINAL FOR.BODY W ANESTH 57415 $500.00 57420 PR COLPOSCOPY,ENTIRE VAGINA 57420 $337.00 57421 PR COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S) 57421 $420.00 57425 PR LAPAROSCOPY, SURG, COLPOPEXY 57425 $3,460.00

57426 PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC 57426 $3,025.00 57452 PR COLPOSCOPY,CERVIX W/ADJ VAGINA 57452 $290.00

57454 PR COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG 57454 $400.00 57455 PR COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX 57455 $380.00

57456 PR COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG 57456 $360.00 57460 PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX 57460 $740.00

57461 PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ 57461 $900.00

57465 PR COMPUTER-AIDED MAPG CERVIX UTERI DRG COLPOSCOPY 57465 $149.00

57500 PR BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION 57500 $340.00 57505 PR ENDOCERVICAL CURETTAGE 57505 $290.00 57510 PR CAUTERIZATION,CERVIX,ELECTRO/THERMAL 57510 $350.00 57511 PR CRYOCAUTERY OF CERVIX 57511 $350.00 57513 PR LASER SURGERY OF CERVIX 57513 $410.00 57520 PR CONIZATION CERVIX,KNIFE/LASER 57520 $825.00 57522 PR CONIZATION CERVIX,LOOP ELECTRD 57522 $700.00 57530 PR REMOVAL OF CERVIX 57530 $1,050.00 57540 PR REMV CERV STUMP,ABD APPRCH 57540 $2,750.00 57550 PR REMV CERV STUMP,VAG APPRCH 57550 $1,100.00 57555 PR REMV CERV STUMP,VAG,ANT/POST FIX 57555 $1,750.00 57558 PR D&C OF CERVIX STUMP 57558 $320.00 57700 PR REVISION OF CERVIX,NON OBSTETRICAL 57700 $950.00 57720 PR PLASTIC REPR CERVIX,VAG APPRCH 57720 $925.00 57800 PR DILATION OF CERVICAL CANAL 57800 $170.00 58100 PR BIOPSY OF UTERUS LINING 58100 $290.00 58110 PR ENDOMET BIOPSY DONE W/COLPOSCOPY 58110 $130.00 58120 PR DILATION/CURETTAGE,DIAGNOSTIC 58120 $690.00

58140 PR MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH 58140 $3,270.00 58145 PR EXCIS UTERINE FIBROID,VAG APPRCH 58145 $1,600.00

58146 PR MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH 58146 $4,650.00 58150 PR TOTAL ABDOM HYSTERECTOMY 58150 $3,630.00 58180 PR SUPRACERV ABD HYSTERECTOMY 58180 $3,420.00 58200 PR TOTAL ABD HYSTEREC+LTD NODES 58200 $5,640.00 58210 PR RADICAL ABD HYSTEREC+PELV NODES 58210 $7,590.00 $12,050.0 58240 PR PELVIC EXENTERATN,GYN MALIGNANCY 58240 0 58260 PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/< 58260 $2,930.00 58262 PR VAG HYST,RMV TUBE/OVARY 58262 $3,260.00 58263 PR VAG HYST,RMV TUBE/OVARY,FIX ENTEROCE 58263 $3,275.00 58267 PR VAG HYST,REV VAG/URETHRA 58267 $3,475.00 58270 PR VAG HYST,REV VAG/URETHR,FIX ENTEROCE 58270 $3,000.00 58275 PR VAG HYST, W/VAGINECTOMY 58275 $3,490.00 58290 PR VAG HYST,UTERUS >250 GMS 58290 $4,650.00

58291 PR VAG HYST,UTERUS >250 GMS,REM TUBE/OVARY 58291 $5,080.00 58300 PR INSERT INTRAUTERINE DEVICE 58300 $255.00 58301 PR REMOVE INTRAUTERINE DEVICE 58301 $271.00 58322 PR ARTIF INSEMINATION,INTRA-UTERINE 58322 $211.00 58340 PR CATH/INJECT HYSTEROSALPINGOGRAM 58340 $620.00 58345 PR REOPEN FALLOPIAN TUBE,TRANSCERV CATH 58345 $771.00 58350 PR REOPEN FALLOPIAN TUBE,CHROMOTUBATION 58350 $280.00 58353 PR ENDOMETRIAL ABLATION, THERMAL 58353 $2,520.00 58520 PR REPAIR RUPTURED UTERUS,NON OBSTECTR 58520 $2,850.00 58541 PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G 58541 $2,600.00

58542 PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G 58542 $2,920.00

58544 PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, >250G 58544 $3,200.00 58545 PR LAP,MYOMECTOMY 1-4,TOT WT 250 GMS 58545 $3,200.00 58546 PR LAP,MYOMECTOMY 5/>,TOTAL WT >250 GMS 58546 $2,950.00 58548 PR LAP, RADICAL HYST W/ TUBE&OV, NODE BX 58548 $7,820.00 58550 PR LAP,VAG HYST,UTERUS 250GMS/< 58550 $3,110.00 58552 PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH 58552 $3,500.00 58554 PR LAP,VAG HYST,UTERUS >250GMS,SALP-OOPH 58554 $5,360.00 58555 PR HYSTEROSCOPY,DX,SEP PROC 58555 $1,000.00 58558 PR HYSTEROSCOPY,W/ENDO BX 58558 $3,535.00 58559 PR HYSTEROSCOPY,LYSIS ADHESIONS 58559 $890.00 58560 PR HYSTEROSCOPY,RESECT SEPTUM 58560 $1,010.00 58561 PR HYSTEROSCOPY,RMV MYOMA 58561 $2,300.00 58562 PR HYSTEROSCOPY,RMV FB 58562 $1,090.00 58563 PR HYSTEROSCOPY,W/ENDOMETRIAL ABLATION 58563 $5,643.00 58565 PR HYSTEROSCOPY, STERILIZE W IMPLANTS 58565 $5,150.00

PR LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR 58570 LESS 58570 $2,825.00

PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM 58571 W TUBE/OVARY 58571 $3,220.00

PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250 58572 GRAM 58572 $3,660.00

PR LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250 GRAM 58573 W TUBE/OVARY 58573 $4,980.00

58575 PR LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC 58575 $7,750.00 58605 PR LIGATE FALLOPIAN TUBE,POSTPARTUM 58605 $1,225.00 58611 PR LIGATION,FALLOPIAN TUBE W/C-SECTION 58611 $600.00 58660 PR LAP,LYSIS OF ADHESIONS 58660 $2,400.00 58661 PR LAP,RMV ADNEXAL STRUCTURE 58661 $2,320.00 58662 PR LAP,FULGURATE/EXCISE LESIONS 58662 $2,520.00 58670 PR LAP,TUBAL CAUTERY 58670 $909.00 58671 PR LAP,TUBAL BLOCK BY DEVICE 58671 $1,225.00

58674 PR LAPS ABLTJ UTERINE FIBROIDS W/INTRAOP US GDN 58674 $2,918.00 58679 PR LAP,OVIDUCT/OVARY,UNLIST PROC 58679 $4,210.00 58700 PR REMOVAL OF FALLOPIAN TUBE 58700 $2,790.00 58720 PR REMOVAL OF OVARY/TUBE(S) 58720 $2,660.00 58740 PR LYSIS ADNEXAL ADHESIONS 58740 $3,110.00 58800 PR DRAIN OVARIAN CYST(S),VAG APPRCH 58800 $774.00 58805 PR DRAIN OVARIAN CYST(S),ABD APPRCH 58805 $1,128.00 58825 PR TRANSPOSITION, OVARY(S) 58825 $2,460.00 58900 PR BIOPSY OF OVARY(S) 58900 $1,200.00 58925 PR REMOVAL OF OVARIAN CYST(S) 58925 $2,680.00 58940 PR REMOVAL OF OVARY(S) 58940 $1,458.00 58943 PR OOPHORECTORMY FOR MALIG, W/BX 58943 $4,250.00 58950 PR RESEC OVAR MALIG+BILAT OVAR+OMENTUM 58950 $4,100.00 58951 PR RESEC OVAR MALIG+TAH+PELV NODES 58951 $5,990.00 58952 PR OOPH W/RADIC DISSECT FOR DEBULKING 58952 $6,790.00

58953 PR BIL SALP-OOPH W/OMENTECT,TAH,RAD DISSECT 58953 $8,370.00

58954 PR BIL SAL-OOPH W/OMENTECT,TAH,RAD DIS,LYMP 58954 $9,090.00 58956 PR BSO, OMENTECTOMY W/TAH 58956 $5,680.00 58957 PR RESECT RECURRENT GYN MALIG 58957 $6,570.00 59000 PR AMNIOCENTESIS,DIAGNOSTIC 59000 $340.00

59001 PR AMNIOCENTESIS,THER AMNIOTIC FLUID REDUCT 59001 $525.00 59012 PR FETAL CORD PUNCTURE,PRENATAL 59012 $850.00 59015 PR CHORION VILLUS BIOPSY 59015 $420.00 59025 PR FETAL NON-STRESS TEST 59025 $130.00

59025 59025 PR FETAL NON-STRESS TEST 26 26 $100.00 59051 PR FETAL MONITOR/INTERPRET ONLY 59051 $110.00 59120 PR TREAT ECTOPIC PREG,RMV TUBE/OVARY 59120 $2,860.00 59130 PR TREAT ECTOPIC PREG,ABD PREG 59130 $3,400.00 59150 PR RX ECTOP PREG BY LAPAROSCOPE 59150 $2,770.00 59151 PR RX ECTOP PREG BY SCOPE,RMV TUBE/OVRY 59151 $2,700.00 59160 PR D&C AFTER DELIVERY 59160 $625.00 59200 PR INSERT CERVICAL DILATOR 59200 $210.00 59300 PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING 59300 $520.00 59320 PR REVISION CERVIX W PREG,VAG APPRCH 59320 $850.00 59325 PR REVISION CERVIX W PREG,ABD APPRCH 59325 $900.00 59400 PR FULL ROUT OBSTE CARE,VAGINAL DELIV 59400 $5,730.00 59409 PR OBSTETRICAL CARE,VAG DELIV ONLY 59409 $2,900.00 59410 PR OBSTE CARE,VAG DELIV+POSTPARTUM 59410 $3,720.00 59412 PR ANTEPARTUM HEAD MANIPULATION 59412 $600.00 59414 PR DELIVER PLACENTA 59414 $600.00 59425 PR ANTEPARTUM CARE ONLY, 4-6 VISITS 59425 $1,300.00 59426 PR ANTEPARTUM CARE ONLY, >7 VISITS 59426 $2,930.00 59430 PR CARE AFTER DELIVERY ONLY 59430 $560.00 59510 PR FULL ROUT OBSTE CARE,CESAREAN DELIV 59510 $6,350.00 59514 PR CESAREAN DELIVERY ONLY 59514 $3,270.00 59515 PR CESAREAN DELIVERY+POSTPARTUM CARE 59515 $4,000.00 59525 PR REMOVE UTERUS AFTER CESAREAN 59525 $1,320.00 59610 PR ROUT OB CARE,VAG DELIV,PREV C-SEC 59610 $6,030.00 59612 PR VAG DELIV ONLY,PREV C-SECTN 59612 $3,270.00 59614 PR VAG DELIV+POSTPARTUM CARE,PREV C-SEC 59614 $3,900.00 59618 PR ROUT OB CARE,C-SEC,PREV C-SEC 59618 $6,440.00 59620 PR C-SEC ONLY,PREV C-SEC 59620 $3,360.00 59622 PR C-SEC+POSTPARTUM CARE,PREV C-SEC 59622 $4,200.00 59812 PR SURG RX INCOMPLETE ABORTN 59812 $930.00 59820 PR SURG RX MISSED ABORTN,1ST TRI 59820 $1,110.00 59821 PR SURG RX MISSED ABORTN,2ND TRI 59821 $1,110.00 59830 PR SURG RX SEPTIC ABORTN 59830 $1,104.00 59840 PR INDUCED ABORTN BY D&C 59840 $750.00 59841 PR INDUCED ABORTN BY DIL/EVAC 59841 $1,100.00 59855 PR INDUCED AB BY VAG SUPPOS 59855 $1,140.00 59870 PR EVACUATE MOLE OF UTERUS 59870 $2,000.00 59871 PR REMOVE CERCLAGE SUTURE 59871 $360.00 60100 PR BIOPSY OF THYROID,PERCUT 60100 $259.00 60200 PR REMOVE BENIGN THYROID LESION 60200 $2,342.00 60210 PR PARTIAL EXCISION THYROID,UNILAT 60210 $2,222.00 60212 PR PARTIAL EXCISION THYROID,BILAT 60212 $3,613.00 60220 PR THYROID LOBECTOMY,UNILAT 60220 $2,414.00 60225 PR THYR LOBECTOMY+PART REMOV CONTRA 60225 $2,755.00 60240 PR THYROIDECTOMY 60240 $3,224.00 60252 PR THYROIDECTOMY,MALIG,LTD NECK SURG 60252 $4,670.00 60254 PR THYROIDECTOMY W RAD NECK SURGERY 60254 $5,859.00 60260 PR THYROIDECTOMY POST PREV THYR SURG 60260 $3,881.00 60270 PR THYROIDECTOMY,SUBSTERNAL,TRANSTHOR APP 60270 $3,677.00 60271 PR THYROIDECTOMY=SUBSTERNAL,TRANSCERV 60271 $4,700.00 60280 PR EXCIS THYROID DUCT CYST/SINUS 60280 $1,529.00 60281 PR EXCIS THYROID DUCT CYST/SINUS,RECUR 60281 $1,559.00

60300 PR ASPIRATION AND/OR INJECTION THYROID CYST 60300 $302.00 60500 PR EXPLORE PARATHYROID GLANDS 60500 $3,096.00 60502 PR RE-EXPLORE PARATHYROIDS 60502 $4,417.00 60505 PR EXPLORE PARATHYROID+MEDIASTINUM 60505 $5,706.00 60512 PR AUTOTRANSPLANT, PARATHYROID 60512 $688.00 60520 PR THYMECTOMY,TRANSCERVICAL 60520 $3,436.00 60521 PR THYMECTOMY,TRANSTHORACIC 60521 $3,963.00 60522 PR THYMECTOMY,RADICAL MEDIAST DISSSEC 60522 $5,347.00 60540 PR EXCISE ADRENAL GLAND 60540 $3,172.00 60545 PR EXCISE ADRENAL+ADJ RETROPER TUMOR 60545 $3,758.00 60600 PR EXCISE CAROTID BODY LESION 60600 $5,647.00 60605 PR EXCISE CAROTID BODY+CAROTID ARTERY 60605 $4,491.00 60650 PR LAP,ADRENALECTOMY 60650 $3,635.00 61020 PR VENTRICULAR PUCTURE 61020 $325.00

61055 PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION 61055 $349.00 61070 PR BRAIN SHUNT TUBE/RESERV INJECTN 61070 $300.00 61107 PR TWIST HOLE SKULL,IMPLANT CATH/DEVICE 61107 $2,117.00 61140 PR BURR HOLE FOR BIOPSY 61140 $6,503.00 61150 PR BURR HOLE FOR DRAINAGE ABSC/CYST 61150 $7,081.00 61154 PR BURR HOLE EVAC SUBDUR/EXTRA HEMATOMA 61154 $6,351.00 61210 PR BURR HOLE IMPLANT CATH/DEVICE 61210 $2,419.00 61304 PR OPEN SKULL SUPRATENT EXPLORE 61304 $9,084.00 $10,053.0 61312 PR OPEN SKULL EVAC SUB/EXTRADUR BLOOD 61312 0 $10,176.0 61313 PR OPEN SKULL EVAC INTRACEREBR BLOOD 61313 0 61314 PR OPEN SKULL EVAC SUB/EXTRADUR BLOOD 61314 $9,622.00 $11,135.0 61315 PR OPEN SKULL EVAC INTRACEREBR BLOOD 61315 0 $10,095.0 61320 PR OPEN SKULL DRAIN SUPRATENT ABSC 61320 0 $10,963.0 61322 PR OPEN SKULL,DECOMPRES,W/DURAPLASTY 61322 0 $11,205.0 61323 PR OPEN SKULL,DECOMP,W/LOBECTOMY 61323 0 61330 PR DECOMPRESS ORBIT,TRANSCRANIAL 61330 $4,366.00 61340 PR SUBTEMPORAL CRANIAL DECOMPRESSION 61340 $7,509.00 $12,283.0 61343 PR SUBOCCIPT DECOMP MEDULLA/SP CRD 61343 0 $10,718.0 61345 PR CRANIAL DECOMPRESSN POST FOSSA 61345 0 $11,122.0 61458 PR CRANIECT EXPL/DECOM CRANIAL NER 61458 0 $11,389.0 61460 PR CRANIECT SECTN 1+ CRAN NERVES 61460 0 61500 PR CRANIECT EXCIS SKULL BONE LESN 61500 $7,491.00 $11,543.0 61510 PR EXCIS SUPRATENT BRAIN TUMOR 61510 0 $13,933.0 61512 PR EXCIS SUPRATENT MENINGIOMA 61512 0 $11,448.0 61516 PR EXCIS SUPRATENT BRAIN CYST 61516 0 $14,904.0 61518 PR EXCIS INFRATENT BRAIN TUMOR 61518 0 $16,293.0 61519 PR EXCIS INFRATENT MENINGIOMA 61519 0 $21,041.0 61520 PR EXCIS INFRATENT CP ANGLE TUMOR 61520 0 $17,519.0 61521 PR EXCIS INFRATENT MIDLINE TUMOR 61521 0 $11,355.0 61524 PR EXCIS INFRATENT BRAIN CYST 61524 0 $19,784.0 61526 PR EXCIS TRANSTEMP CP ANGLE TUMOR 61526 0 61531 PR SUBDUR IMPLNT ELECTR,BURR HOLE 61531 $6,039.00 61533 SUBDUR IMPLNT ELECTR, CRAN BONE FLAP 61533 $7,980.00 61534 PR EXCIS EPILEPTOGENIC FOCUS 61534 $7,707.00 61535 PR REMOVE BRAIN ELECTRODES 61535 $4,538.00 $11,168.0 61537 PR REMOVAL OF BRAIN TISSUE 61537 0 $16,348.0 61538 PR LOBECTOMY TEMPOR CORTICOGRAPHY 61538 0 $13,458.0 61540 PR REMOVAL OF BRAIN TISSUE 61540 0 61541 PR TRANSECT CORPUS CALLOSUM 61541 $7,241.00 $19,586.0 61545 PR EXCISION CRANIOPHARYNGIOMA 61545 0 $12,530.0 61546 PR EXCIS PITUITARY,INTRACRANIAL 61546 0 61548 PR EXCIS PITUITARY,TRANSNASAL/SEPTAL 61548 $9,020.00 61550 PR CRANIECTOMY SYNSOTOSIS,SINGLE SUT 61550 $7,275.00 61552 PR CRANIEC SYNOSTOSIS,MULTIP SUTURES 61552 $6,046.00 61557 PR OPEN FLAP SYNOSTOSIS,BIFRONTAL 61557 $8,762.00 61558 PR EXTENSIVE CRANIECTOMY SYNOSTOSIS 61558 $7,787.00 61559 PR EXTEN CRANIEC W RECONTOUR SYNOSTOSIS 61559 $9,409.00 $13,823.0 61566 PR REMOVAL OF BRAIN TISSUE 61566 0 $10,186.0 61580 PR CRANIOFACIAL APPROACH,EXTRADURAL 61580 0 $13,333.0 61581 PR CRANIOFACIAL APPROACH,EXTRADURAL+ 61581 0 $14,302.0 61583 PR CRANIOFACIAL APPROACH,INTRADURAL 61583 0 $13,610.0 61584 PR ORBITOCRANIAL APPROACH/SKULL 61584 0 61586 PR BICOR,XZYGOMA APPROACH ANT CRAN FOSS 61586 $9,223.00 $12,552.0 61590 PR INFRATEMPORAL APPROACH/PREAURICULAR 61590 0 $16,642.0 61591 PR INFRATEMPORAL APPROACH/POSTAURICULAR 61591 0 $15,518.0 61592 PR ORBITOCRANIAL APPROACH/ZYGOMATIC 61592 0 61595 PR TRANSTEMPORAL APPROACH/SKULL 61595 $6,044.00 $10,103.0 61600 PR RESECT BASE ANT CRAN FOSSA/EXTRADURL 61600 0 $11,002.0 61601 PR RESECT BASE ANT CRAN FOSSA/INTRADURL 61601 0 61605 PR RESECT INFRATEMP FOSSA/EXTRADURL 61605 $5,365.00 $17,964.0 61606 PR RESECT INFRATEMP FOSSA/INTRADURL 61606 0 $16,454.0 61608 PR RESECT PARASELLAR FOSSA/INTRADURL 61608 0 $11,400.0 61616 PR EXCIS BASE POST CRAN FOSSA/INTRADURL 61616 0 61618 PR SEC REPR,CSF LEAK/CRANIAL FOSSA 61618 $3,408.00 61619 PR REPAIR DURA POSTOP SK BASE-PEDICLE 61619 $5,742.00

61623 PR ENDOVASC TEMP BALLOON OCCLUS,HEAD/NCK 61623 $2,403.00

61624 PR PERM OCCLUSION/EMBOLIZATION,PERCUT,CNS 61624 $4,680.00 61626 PR PERCUT CATH OCCLUSN NON CNS LESN 61626 $2,744.00 61630 PR INTRACRANIAL BALLOON ANGIOPLASTY 61630 $5,604.00

61635 PR INTRACRANIAL BALLOON ANGIOPLSTY W/STENT 61635 $5,200.00

61640 PR BALLOON DILATION INTRACRANIAL VASOSPASM, INIT 61640 $2,383.00

61645 PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL 61645 $2,831.00

61650 PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST 61650 $2,402.00

PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 61651 ADDL 61651 $1,026.00 $12,672.0 61680 PR BRAIN AVM SURG,SUPRATENT,SIMPLE 61680 0 $23,372.0 61682 PR BRAIN AVM SURG,SUPRATENT,COMPLX 61682 0 $24,497.0 61686 PR BRAIN AVM SURG,INFRATENT,COMPLX 61686 0 $13,484.0 61690 PR BRAIN AVM SURG,DURAL,SIMPLE 61690 0 $19,670.0 61692 PR BRAIN AVM SURG,DURAL,COMPLX 61692 0 $19,317.0 61697 PR COMPLEX ANEURYSM SURG/CAROTID CIRC 61697 0 $27,954.0 61698 PR COMPLX ANEURYSM SURG/VERT-BASILAR CIRC 61698 0 $13,923.0 61700 PR ANEURYSM, INTRACRAN, SIMPLE SURG 61700 0 $10,655.0 61711 PR INTRA-EXTRACRANIAL ART ANASTOM 61711 0 61720 PR CREATE LESN GLOBUS/THAL STEREO 61720 $7,148.00 61735 PR CREATE LESN SUBCORTICAL STEREO 61735 $9,771.00 61750 PR STEREOTACTIC BRAIN BX,ASPIR,EXC 61750 $7,258.00 61751 PR STEREO BX/ASPIR/EXCIS,INTRACRANIAL LESN 61751 $7,410.00

61760 STEREO IMPLANT BRAIN ELECTRODES, SEIZURE MONITOR 61760 $8,741.00

61781 PR STEREOTACTIC COMP ASSIST PROC,CRANIAL,INTRADURAL 61781 $1,365.00

61782 PR STEREOTACTIC COMP ASSIST PROC,CRANIAL,EXTRADURAL 61782 $753.00 61783 PR STEREOTACTIC COMP ASSIST PROC,SPINAL 61783 $1,365.00 61791 PR STEREO TREAT TRIGEMINAL TRACT 61791 $4,513.00

61796 PR STEREOTACTIC RADIOSURGERY, CRANIAL,SIMPLE,SINGLE 61796 $6,600.00

61797 PR STEREOTACTIC RADIOSURGERY, CRANIAL,SIMPLE,EA ADD 61797 $6,600.00

61798 PR STEREOTACTIC RADIOSURGERY, CRANIAL,COMPLEX,SINGLE 61798 $9,900.00

61799 PR STEREOTACTIC RADIOSURGERY, CRANIAL,COMPLEX,EA ADD 61799 $9,900.00

61800 PR APPLY STEREOTACTIC HEADFRAME FOR RADIOSURGERY 61800 $2,000.00 61863 PR IMPLANT NEUROELECTRODE 61863 $6,229.00 61864 PR IMPLANT NEUROELECTRDE, ADD'L 61864 $1,733.00 61867 PR IMPLANT NEUROELECTRODE 61867 $9,357.00 61868 PR IMPLANT NEUROELECTRDE, ADDL 61868 $3,077.00 61880 PR REVISE/REMOVE INTRACRAN NEUROELEC 61880 $2,754.00 61885 PR IMP STIM,CRANIAL,SUBQ,1 ARRAY 61885 $2,472.00 61886 PR IMP STIM,CRANIAL,SUBQ,>1 ARRAY 61886 $3,170.00 62000 PR FIX SIMPL DEPRESS SKULL FX 62000 $3,534.00 62010 PR FIX DEPRESS SKULL FX,REPR DURA 62010 $8,104.00 62100 PR CRANIOTOMY,REPAIR,DURAL/CSF LEAK 62100 $6,670.00 62120 PR REPAIR ENCEPHALOCELE,VAULT 62120 $8,744.00 62121 PR REPAIR ENCEPHALOCELE,BASE 62121 $6,936.00 62140 PR REPAIR SKULL DEFECT,UP TO 5CM 62140 $5,629.00 62141 PR REPAIR SKULL DEFECT,>5CM 62141 $6,350.00 62142 PR REMOVE SKULL PLATE/FLAP 62142 $4,629.00 62143 PR REPLACE SKULL PLATE/FLAP 62143 $5,285.00 62146 PR REPAIR SKULL W GRAFT,UP TO 5CM 62146 $5,772.00 62147 PR REPAIR SKULL W GRAFT,>5CM 62147 $6,000.00

62160 PR NEUROENDOSCOP,PLACE/REPLACE VENTCATH 62160 $979.00

62161 PR NEUROENDOSCOP,DISS ADHESION/FENESTRATION 62161 $7,271.00

62162 PR NEUROENDOSCOP,W/FENESTRAT/EXCIS COLLOID 62162 $8,968.00 62163 PR NEUROENDOSCOP,W/RETRIEVAL, FB 62163 $7,547.00 $12,728.0 62164 PR NEUROENDOSCOP,W/EXCISE BRAIN TUMOR 62164 0

62165 PR NEUROENDOSCOP,EXC,PIT TUM,TRANSNAS/SPHEN 62165 $6,492.00 62192 PR CREATE SHUNT:SUBARCH/DUR-PLEURAL 62192 $5,272.00 62200 PR VENTRICULO-CISTERNOSTOMY,3RD VENT 62200 $4,835.00

62201 PR VENTRICULO-CISTERNOSTOMY,3RD VENT,STEREO 62201 $4,843.00 62220 PR CREATE SHUNT:VENTRIC-ATRIAL 62220 $6,214.00 62223 PR CREATE SHUNT:VENTRIC-PERITONEAL 62223 $5,508.00 62225 PR REPLACE/IRRIGATE VENTRIC CATH 62225 $2,331.00 62230 PR REPLACEMENT/REVISION,CSF SHUNT 62230 $4,350.00

62252 62252 PR REPROGRAMMING,PROGRAMMABLE CSF SHUNT 26 26 $263.00

62256 PR REMOVAL,COMPLETE CSF SHUNT,W/O REPLACE 62256 $2,940.00 62258 PR REMOVE & REPLACE CSF SHUNT 62258 $6,003.00 62267 PR PERCUT ASPIRATION VERTEBRAL DISC 62267 $570.00 62270 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE 62270 $417.00

62272 PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF 62272 $588.00 62273 PR INJ,LUMB EPIDUR,BLOOD/CLOT PATCH 62273 $457.00 62281 PR INJECT NEUROLYTIC,EPIDUR,CERV/THOR 62281 $610.00 62282 PR INJ,NEUROLYTIC,EPID/LUMB/CAUDAL 62282 $816.00

62284 PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR 62284 $552.00

62287 PR DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR 62287 $1,459.00 62290 PR INJECT DISCOGRAM,LUMBAR,EA LEVEL 62290 $829.00 62292 PR INJECT CHEMONUCLEOLYSIS 62292 $2,941.00 62294 PR INJECT SPINAL ARTERY,OCCLUDE AVM 62294 $4,844.00

62302 PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL 62302 $687.00

62303 PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC 62303 $700.00

62304 PR MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL 62304 $677.00

62305 PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS 62305 $737.00

62310 PR NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC 62310 $725.00

62311 PR NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL 62311 $614.00 62318 PR INJ/INFUS,CERV/THORAC,W/CATH 62318 $738.00

62319 PR NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL 62319 $563.00

62320 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN 62320 $436.00

62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 62321 $687.00

62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN 62322 $407.00

62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN 62323 $679.00

62324 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN 62324 $381.00

62325 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 62325 $647.00

62326 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN 62326 $401.00 62327 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN 62327 $573.00

62328 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT 62328 $661.00

62329 PR THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT 62329 $820.00 62350 PR IMP SPINAL CANAL CATH 62350 $2,460.00 62355 PR REMOVE SPINAL CANAL CATHETER 62355 $893.00

62362 INSERT/ REPLACE INFUSN PUMP,PROGRAMMABLE 62362 $2,600.00 62365 PR REMOVE INFUSN DEVICE/PUMP 62365 $2,023.00

62367 PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL 62367 $109.00 62368 PR ANALYZE INFUSN PUMP+REPROGRAM 62368 $165.00

62370 PR ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP 62370 $445.00

63001 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, CERVICAL 63001 $6,324.00

LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, 63003 THORACIC 63003 $6,332.00

63005 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, LUMBAR 63005 $6,102.00

63011 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, SACRAL 63011 $5,559.00 63012 PR LAMINECTOMY,FACETECTOMY,LUMBAR 63012 $6,121.00 63015 PR LAMINECTOMY,>2 SGMT,CERVICAL 63015 $7,571.00 63016 PR LAMINECTOMY,>2 SGMT,THORACIC 63016 $7,793.00 63017 PR LAMINECTOMY,>2 SGMT,LUMBAR 63017 $6,443.00

PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC 63020 CERVC 63020 $5,936.00

PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC 63030 LUMBR 63030 $4,986.00

63035 PR LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR 63035 $984.00 63040 PR LAMINOTOMY 63040 $7,093.00 63042 PR REDO EXCIS LUMBAR DISC 63042 $6,661.00 63043 PR REDO EXCIS CERV DISC, ADDN CERV INTERSPC 63043 $990.00

63044 PR REDO EXCIS CERV DISC, ADDN LUMB INTERSPC 63044 $990.00 63045 LAMINEC/FACETECT/FORAMIN,CERVICAL 1 SEG 63045 $6,588.00 63046 LAMINEC/FACETECT/FORAMIN,THORACIC 1 SEG 63046 $6,291.00 63047 LAMINEC/FACETECT/FORAMIN,LUMBAR 1 SEG 63047 $5,658.00 63048 PR LAMINEC/FACETECT/FORAMIN,EACH ADDNL 63048 $1,086.00 63050 PR C- LAMINOPLASTY, 2 OR MORE 63050 $5,090.00

63051 PR C-LAMINOPLASTY W/GRAFT/PLATE, 2 OR MORE 63051 $8,757.00 63055 PR XPEDICUL DECOMPRESS THROACIC CORD 63055 $8,325.00 63056 PR DECOMPRESS SPINAL CORD,1 SEG 63056 $7,636.00 63064 PR COSTOVERT DECOMPRESS THORACIC CORD 63064 $9,124.00

63066 PR COSTOVERT DECOMP THOR CORD,EACH ADDN 63066 $1,056.00 63075 PR DISK SURG,ANTER,CERVICAL,SINGLE LVL 63075 $6,933.00 63076 PR DISK SURG,ANTER,CERV,EA ADDNL LVL 63076 $1,267.00 63077 PR DISK SURG,THORAX,SINGLE LEVEL 63077 $7,739.00 63081 PR REMV VERT BODY,CERV,ONE SGMT 63081 $9,030.00 63082 PR REMV VERT BODY,CERV,EACH ADDNL SGMT 63082 $8,946.00 63085 PR REMV VERT BODY,THOR,ONE SGMT 63085 $9,880.00 63086 PR REMV VERT BODY,THOR,EACH ADDNL SGMT 63086 $975.00 $12,372.0 63087 PR REMV VERT BODY,LO THOR/LUMB,ONE 63087 0 63088 PR REMV VERT BODY,LO THOR/LUMB,EA ADDNL 63088 $1,330.00 $10,101.0 63090 PR REMV VERT BODY,LOWER,RETROPER,ONE 63090 0 63091 PR REMV VERT BODY,LOWR,RETROPER,EA ADDN 63091 $920.00 $11,911.0 63101 PR REMOVAL OF VERTEBRAL BODY 63101 0 $11,622.0 63102 PR REMOVAL OF VERTEBRAL BODY 63102 0 63103 PR REMOVE VERTEBRAL BODY ADD-ON 63103 $2,497.00 63170 PR INCISE SPINAL CORD TRACT(S) 63170 $8,155.00 63172 PR DRAIN INTRAMEDULLARY->SUBARACH 63172 $7,188.00 63173 PR DRAIN INTRAMEDULLARY->PERITONEAL 63173 $8,712.00 63185 PR INCISE SP COLUMN/NERVES,ONE/TWO LVL 63185 $5,884.00 63190 PR INCISE SP COLUMN/NERVES,>2 LVL 63190 $6,522.00 63191 PR INCISE SPINAL ACCESS NERVE 63191 $6,465.00 63194 PR INCIS 1 SPINOTHAL,CERV,1 STAGE 63194 $8,144.00 63195 PR INCIS 1 SPINOTHAL,THOR,1 STAGE 63195 $6,489.00 63200 PR RELEASE TETHERED SPINAL CORD,LUMBR 63200 $7,828.00 $15,227.0 63250 PR EXCIS/OCCLUD CORD AVM,CERVICAL 63250 0 $15,523.0 63251 PR EXCIS/OCCLUD CORD AVM,THORACIC 63251 0 $15,520.0 63252 PR EXCIS/OCCLUD CORD AVM,THORCOLUMBAR 63252 0 63265 PR EXCIS INTRASP LESN,XDURAL,CERVICAL 63265 $8,543.00 63266 PR EXCIS INTRASP LESN,XDURAL,THORACIC 63266 $8,803.00 63267 PR EXCIS INTRASP LESN,XDURAL,LUMBAR 63267 $7,030.00 63268 PR EXCIS INTRASP LESN,XDURAL,SACRAL 63268 $7,248.00 $10,599.0 63270 PR EXCIS INTRASP LESN,INTRADUR,CERV 63270 0 $10,579.0 63271 PR EXCIS INTRASP LESN,INTRADUR,THOR 63271 0 63272 PR EXCIS INTRASP LESN,INTRADUR,LUMB 63272 $9,662.00 63275 PR BX/EXCIS SPINAL TUMOR,XDURAL,CERV 63275 $9,223.00 63276 PR BX/EXCIS SPINAL TUMOR,XDURAL,THOR 63276 $9,151.00 63277 PR BX/EXCIS SPINAL TUMOR,XDURAL,LUMB 63277 $7,986.00 63278 PR BX/EXCIS SPINAL TUMOR,XDURAL,SACR 63278 $8,117.00 $10,823.0 63280 PR BX/EXCIS SPIN TUM,INDUR,XMED,CERV 63280 0 $10,698.0 63281 PR BX/EXCIS SPIN TUM,INDUR,XMED,THOR 63281 0 $10,092.0 63282 PR BX/EXCIS SPIN TUM,INDUR,XMED,LUMB 63282 0 63283 PR BX/EXCIS SPIN TUM,INDUR,XMED,SACR 63283 $9,629.00 $13,414.0 63285 PR BX/EXCIS SPIN TUM,INDUR,INMED,CERV 63285 0 $13,208.0 63286 PR BX/EXCIS SPIN TUM,INDUR,INMED,THOR 63286 0 $14,075.0 63287 PR BX/EXCIS SPIN TUM,INDUR,INMED,THLUM 63287 0 $14,270.0 63290 PR BX/EXCIS SPIN TUM,COMBINED,ANY LVL 63290 0 63300 PR REMV VERT,EXDUR,CERV TUMOR 63300 $9,408.00 $11,259.0 63301 PR REMV VERT,EXUDR,XTHOR,THOR TUMOR 63301 0 $10,979.0 63302 PR REMV VERT,EXDUR,THORLUM,THOR TUMOR 63302 0 $11,822.0 63303 PR REMV VERT,EXDUR,LUMB/SACR TUMOR 63303 0 $10,280.0 63305 PR REMV VERT,INDURAL,XTHOR,THOR TUMOR 63305 0 $11,110.0 63307 PR REMV VERT,INDURAL,LUMB/SACR TUMOR 63307 0 63308 PR REMV VERT,EACH ADDNL SEGMENT 63308 $1,658.00 63600 PR CREATE SP CORD LESN,STEREOTAC 63600 $4,568.00 63650 PR PERCUT IMPLNT NEUROELECT,EPIDURAL 63650 $4,089.00 63655 PR SURG IMPLNT NEUROELECT,EPIDURAL 63655 $4,257.00

PR REMOVE SPINAL NEUROSTIM ELECTRODE PERC ARRAY, INCL 63661 FLUORO 63661 $2,921.00

PR REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, 63662 INCL FLUORO 63662 $4,252.00 PR REVISION SPINAL NEUROSTIM ELECTRODE PERC ARRAY, 63663 INCL FLUORO 63663 $2,500.00

PR REVISION SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, 63664 INCL FLUORO 63664 $4,390.00 63685 PR IMPLANT NEUROSTIM/RECEIVER 63685 $1,853.00 63688 PR REVISE/REMOVE NEUROSTIM/RECEIVER 63688 $1,883.00 63704 PR REPR MYELOMENIGOCELE,<5CM DIA 63704 $7,451.00 63706 PR REPR MYELOMENIGOCELE,5+CM DIA 63706 $8,888.00

63707 PR REPR,DURAL/CSF LEAK,NOT REQ LAMINECTOMY 63707 $4,757.00 63709 PR REPR,DURAL/CSF LEAK,W/LAMINECTOMY 63709 $5,683.00 63710 PR DURAL GRAFT REPAIR,SPINE DEFECT 63710 $5,572.00 63740 PR INSTALL SPINAL SHUNT,LAMINECTOMY 63740 $4,983.00 63741 PR INSTALL SPINAL SHUNT,PERCUT 63741 $3,455.00 63744 PR REVISION OF SPINAL SHUNT 63744 $3,478.00 63746 PR REMOVAL OF SPINAL SHUNT 63746 $3,066.00

64400 PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH 64400 $345.00 64402 PR INJECT NERV BLCK,FACIAL NERV 64402 $318.00

64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE 64405 $285.00 64408 PR INJECTION AA&/STRD VAGUS NERVE 64408 $294.00 64413 PR INJECT NERV BLCK,CERV PLEXUS 64413 $332.00 64415 PR INJECTION AA&/STRD BRACHIAL PLEXUS 64415 $401.00

64416 PR INJECTION AA&/STRD BRACHIAL PLEXUS CONT NFS CATH 64416 $420.00 64417 PR INJECTION AA&/STRD AXILLARY NERVE 64417 $366.00

64418 PR INJECTION AA&/STRD SUPRASCAPULAR NERVE 64418 $380.00

64420 PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL 64420 $418.00

64421 PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL 64421 $634.00

64425 PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES 64425 $395.00 64430 PR INJECTION AA&/STRD PUDENDAL NERVE 64430 $413.00 64445 PR INJECTION AA&/STRD SCIATIC NERVE 64445 $400.00

64446 PR INJECTION AA&/STRD SCIATIC NERVE CONT NFS CATH 64446 $420.00 64447 PR INJECTION AA&/STRD FEMORAL NERVE 64447 $365.00

64448 PR INJECTION AA&/STRD FEMORAL NERVE CONT NFS CATH 64448 $400.00

64449 PR INJECTION AA&/STRD LUMBAR PLEXUS CONT NFS CATH 64449 $222.00

64450 PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH 64450 $310.00

64451 PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG 64451 $558.00

64454 PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG 64454 $564.00

64455 PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES 64455 $129.00

64461 PR PVB THORACIC SINGLE INJECTION SITE W/IMG GID 64461 $388.00

64462 PR PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID 64462 $220.00

64463 PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID 64463 $407.00

64479 PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL 64479 $677.00

64480 PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL 64480 $337.00

64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL 64483 $627.00

64484 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL 64484 $276.00 64486 PR TAP BLOCK UNILATERAL BY INJECTION(S) 64486 $325.00 64488 PR TAP BLOCK BILATERAL BY INJECTION(S) 64488 $402.00

PR INJ DX/THER AGNT PARAVERT FACET JOINT, 64490 CERV/THORAC, 1ST LEVEL 64490 $732.00

PR INJ DX/THER AGNT PARAVERT FACET JOINT, 64491 CERV/THORAC, 2ND LEVEL 64491 $298.00

PR INJ DX/THER AGNT PARAVERT FACET JOINT, 64492 CERV/THORAC, ADD LEVEL 64492 $298.00

PR INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 64493 1ST LEVEL 64493 $668.00

PR INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 64494 2ND LEVEL 64494 $264.00 PR INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 64495 ADD LEVEL 64495 $236.00 64505 PR INJECT NERV BLCK,SPHENOPALAT GANGLN 64505 $338.00 64510 PR INJECT NERV BLCK,STELLATE GANGLION 64510 $397.00 64520 PR INJECT NERV BLCK,PARAVERT SYMPATH 64520 $581.00 64530 PR INJECT NERV BLCK,CELIAC PLEXUS 64530 $592.00

64550 PR APPLICATION OF SURFACE NEUROSTIMULATOR 64550 $40.00

64555 PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV 64555 $3,939.00

64561 PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING 64561 $2,101.00

64566 PR POST TIBIAL NEUROSTIMULATION,PERC NEEDLE ELECTRODE 64566 $418.00

PR INCISION IMPLANT CRANIAL NERVE STIM ELECTRODE/PULSE 64568 GEN 64568 $1,650.00

PR REVISE/REPLACE CRANIAL NERVE STIM 64569 ELECTRODE/CONNECT PULSE GEN 64569 $4,713.00

PR REMOVE IMPLANT CRANIAL NERVE STIM ELECTRODE/PULSE 64570 GEN 64570 $3,134.00

64575 PR INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD 64575 $1,622.00

64581 PR INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE 64581 $2,390.00

64585 PR REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE 64585 $657.00 64590 PR IMPLANT GASTRIC NEUROSTIM/RECEIVER 64590 $800.00

64595 PR REVISE/REMOVE GASTRIC NEUROSTIM/RECEIVER 64595 $650.00 64600 PR INJECT TRIGEM NERV,1ST BRANCH 64600 $1,187.00 64610 PR INJECT 5TH N.-2,3 DIV,F.OVALE,XRAY 64610 $2,836.00

PR CHEMODENERVATION PAROTID/SUBMANDIBULAR 64611 SALIVARY GLANDS,BILATERAL 64611 $295.00

PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV 64612 UNIL 64612 $356.00

64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE 64615 $435.00 PR CHEMODENERVATION MUSCLE NECK UNILAT FOR 64616 DYSTONIA 64616 $356.00

64617 PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG 64617 $515.00

PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE 64624 W/IMG 64624 $1,078.00

64625 PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN 64625 $1,317.00 64630 PR DESTRUCT BY NEURO AGENT; PUDENDAL 64630 $677.00

64633 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA 64633 $1,329.00

64634 PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA 64634 $609.00

64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL 64635 $1,306.00

64636 PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL 64636 $548.00 64640 PR INJECT RX OTHER PERIPH NERVE 64640 $657.00

64642 PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE 64642 $391.00

64643 PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE 64643 $275.00

64644 PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES 64644 $456.00

64645 PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/< MUSCLES 64645 $313.00

64646 PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES 64646 $411.00

64647 PR CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES 64647 $475.00

64650 PR CHEMODENERV ECCRINE GLANDS BOTH AXILLAE 64650 $286.00

64653 PR CHEMODENERV ECCRINE GLANDS, NON-AXILLARY 64653 $356.00 64680 PR INJECT RX CELIAC PLEXUS NERVE 64680 $950.00 64681 PR INJECTION TREATMENT OF NERVE 64681 $1,312.00 64702 PR REVISE/REPAIR FINGER/TOE NERVE 64702 $1,350.00 64704 PR REVISE/REPAIR HAND/FOOT NERVE 64704 $1,430.00 64708 PR NEUROPLASTY OTHER ARM/LEG NERVE,OPEN 64708 $2,521.00 64712 PR NEUROPLASTY SCIATIC NERVE,OPEN 64712 $2,940.00 64713 PR NEUROPLASTY BRACHIAL PLEXUS,OPEN 64713 $3,889.00 64714 PR NEUROPLASTY LUMBAR PLEXUS,OPEN 64714 $2,517.00 64716 PR REVISION OF CRANIAL NERVE 64716 $1,380.00 64718 PR REVISE ULNAR NERVE AT ELBOW 64718 $2,990.00 64719 PR REVISE ULNAR NERVE AT WRIST 64719 $2,022.00 64721 PR REVISE MEDIAN N/CARPAL TUNNEL SURG 64721 $1,467.00 64722 PR RELIEVE PRESSURE ON NERVE(S) 64722 $964.00 64726 PR RELEASE FOOT/TOE NERVE 64726 $932.00 64727 PR INTERN NERVE REVIS,OPER MICROSCOPE 64727 $940.00 64734 PR TRANSECT INFRAORBITAL NERV 64734 $2,090.00 64742 PR TRANSECT OF FACIAL NERVE 64742 $1,309.00 64744 PR TRANSECT GREAT OCCIPITAL NERV 64744 $1,725.00

64755 PR TRANSECT VAGUS NERVES,PROXIMAL STOMACH 64755 $3,332.00 64763 PR TRANSECT OBTURATR,XTRAPELV,HIP/LEG 64763 $1,613.00 64771 PR TRANSECT OTHER CRAN N,EXTRADURAL 64771 $3,043.00 64772 PR TRANSECT OTHR SPINAL N,XTRADURAL 64772 $2,854.00 64774 PR EXCISE CUTANEOUS NEUROMA 64774 $2,098.00 64776 PR EXCISE DIGITAL NEUROMA 64776 $1,172.00 64782 PR EXCISE HAND/FOOT NEUROMA 64782 $1,223.00 64783 PR EXCISE HAND/FOOT NEUROMA,EACH ADDNL 64783 $790.00 64784 PR EXCISE MAJOR PERIPHERAL NEUROMA 64784 $3,697.00 64786 PR EXCISE SCIATIC NERVE NEUROMA 64786 $5,494.00 64787 PR IMPLANT NERVE END TO BONE/MUSC 64787 $1,078.00 64788 PR EXCISE CUTANEOUS NEUROFIBROMA 64788 $2,019.00 64790 PR EXCISE MAJOR PERIPH NEUROFIBROMA 64790 $4,284.00 64792 PR EXCISE NEUROFIBROMA EXTENSIVE 64792 $5,507.00 64795 PR BIOPSY OF NERVE 64795 $983.00 64804 PR SYMPATHECTOMY,CERVICOTHORACIC 64804 $4,267.00 64820 PR SYMPATHECTOMY,DIGITAL ARTERIES, EA 64820 $2,680.00 64821 PR SYMPATHECTOMY,RADIAL ARTERY 64821 $2,450.00 64822 PR SYMPATHECTOMY,ULNAR ARTERY 64822 $1,868.00

64823 PR SYMPATHECTOMY,SUPERFICIAL PALMAR ARCH 64823 $2,840.00 64831 PR REPAIR OF DIGIT NERVE 64831 $1,850.00 64832 PR REPAIR EACH ADDNL DIGIT NERVE 64832 $907.00

64834 SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE 64834 $2,661.00 64835 SUTURE 1 NERVE MEDIAN MOTOR THENAR 64835 $2,535.00 64836 SUTURE 1 NERVE ULNAR MOTOR 64836 $2,927.00 64837 PR REPAIR EACH ADDNL HAND/FOOT NERVE 64837 $1,075.00 64856 PR REPAIR/TRANSPOS MAJ PERIPH NERVE 64856 $3,071.00 64857 PR REPAIR MAJOR PERIPHERAL NERVE 64857 $3,290.00 64858 PR REPAIR SCIATIC NERVE 64858 $4,210.00 64859 PR REPAIR ADDNL MAJ PERIPH NERVE 64859 $674.00 64864 PR REPR FACIAL NERVE,EXTRACRANIAL 64864 $2,853.00 64865 PR REPR FACIAL NERVE,INFRATEMP 64865 $3,923.00 64866 PR ANAST FACIAL-SPINAL ACCESS 64866 $4,577.00 64868 PR ANAST FACIAL-HYPOGLOSSAL NERVE 64868 $3,513.00 64872 PR REPR NERVE,SECONDARY/DELAY 64872 $418.00 64874 PR REPR/TRANSPOSE NERVE,SECONDARY 64874 $425.00 64885 PR NERVE GRAFT,HEAD/NECK,ONE,=<4CM 64885 $3,478.00 64886 PR NERVE GRAFT,HEAD/NECK,ONE,>4CM 64886 $5,305.00 64890 PR NERVE GRAFT,HAND/FOOT,ONE,=<4CM 64890 $3,879.00 64893 PR NERVE GRAFT,ARM/LEG,ONE,>4CM 64893 $4,032.00 64896 PR NERV GRFT,HAND/FOOT,MULT,>4CM 64896 $5,889.00 64898 PR NERV GRFT,ARM/LEG,MULT,>4CM 64898 $5,990.00 64902 PR EA ADDNL NERVE GRAFT,MULTPL STRANDS 64902 $2,504.00 64905 PR NERVE PEDICLE XFER,FIRST STAGE 64905 $3,664.00 64910 PR NERVE REPAIR W/ALLOGRAFT OR SYNTH 64910 $2,906.00 64911 PR NEURORRAPHY W/VEIN AUTOGRAFT 64911 $3,682.00

64912 PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND 64912 $2,821.00

64913 PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND 64913 $572.00 65091 PR REMOVE OCULAR CONTENTS 65091 $1,909.00 65101 PR REMOVAL OF EYE 65101 $2,000.00 65103 PR REMOVE EYE W IMPLANT 65103 $2,070.00 65105 PR REMOVE EYE W MUSC TO IMPLANT 65105 $2,270.00 65110 PR REMOVAL OF ORBITAL CONTENTS 65110 $4,321.00 65205 PR REMV F.B.,EYE,SUPERF CONJUNC 65205 $145.00 65210 PR REMV F.B.,EYE,EMBED CONJUNC 65210 $179.00 65220 PR REMV F.B.,EYE,CORNEA,NO SLIT 65220 $229.00 65222 PR REMV F.B.,EYE,CORNEA,SLIT LAMP 65222 $180.00

65235 PR REMOVAL,FB,INTRAOCULAR,ANT CHAMBER/LENS 65235 $1,894.00 65260 PR REMV F.B.,EYE,POST SGMT,MAGNETIC 65260 $3,401.00 65265 PR REMV F.B.,EYE,POST SGMT,NONMAGNETIC 65265 $3,817.00 65270 PR REPAIR CONJUNC LACERATN 65270 $665.00 65272 PR REPAIR CONJUNC LAC,REARRANG,NO HOSP 65272 $1,438.00 65275 PR REPAIR CORNEA LAC,NONPERFORATING 65275 $1,543.00 65280 PR REPAIR CORNEA LAC,PERF,NO UVEAL 65280 $1,770.00 65285 PR REPAIR CORNEA LAC,PERF,RESEC UVEAL 65285 $2,960.00 65286 PR REPAIR CORNEA LAC,APPLY GLUE 65286 $1,857.00 65400 PR EXCIS CORNEA LESN 65400 $1,808.00 65410 PR BIOPSY OF CORNEA 65410 $380.00 65420 PR EXCIS PTERYGIUM 65420 $1,468.00 65426 PR EXCIS PTERYGIUM,W GRAFT 65426 $1,754.00 65430 PR CORNEAL SMEAR 65430 $306.00 65435 PR CURETTE/TREAT CORNEA 65435 $217.00 65436 PR CURETTE/TREAT CORNEA,APPLY CHELATE 65436 $1,021.00 65450 PR DESTR CORNEAL LESN,CRYO,PHOTO,THERM 65450 $861.00 65600 PR MULT PUNC ANTER CORNEA 65600 $1,091.00 65730 PR CORNEAL TRANSPLANT,PENETRATING 65730 $3,681.00 65750 PR CORNEAL TRANSPLANT,PENETRAT,APHAKIA 65750 $3,681.00 65755 PR CORNEAL TRANSPLANT,PEN,PSEUDOAPHAK 65755 $3,681.00 65756 PR CORNEAL TRANSPLANT,ENDOTHELIAL 65756 $3,400.00 65757 PR PREP CORNEAL ENDOTHEL ALLOGRAFT 65757 $1,072.00 65770 PR REVISE CORNEA WITH IMPLANT 65770 $4,100.00

PR PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O 65778 SUTURES 65778 $3,721.00

65779 PR PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED 65779 $3,207.00

PR OCULAR SURF RECONST, AMNIOTIC TRANSPLANT, MULTIPLE 65780 LAYERS 65780 $2,500.00

65800 PR PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX 65800 $316.00 65815 PR DRAIN ANT CHMBR,REMV BLOOD 65815 $1,697.00 65820 PR RELIEVE INNER EYE PRESSURE 65820 $2,069.00 65850 PR INCISION OF EYE 65850 $2,400.00 65855 PR TRABECULOPLASTY BY LASER SURGERY 65855 $854.00 65860 PR INCISE INNER EYE ADHESNS,LASER 65860 $817.00 65865 PR INCISE INNER EYE ADHESNS,INCISN 65865 $1,253.00 65875 PR INCISE POST SYNECHIAE,EYE 65875 $1,664.00

65920 PR REMVL,IMPLANT MATERIAL,ANT SEGMENT,EYE 65920 $2,084.00 66020 PR INJECTION,ANT CHAMBER,EYE,AIR/LIQUID 66020 $512.00 66030 PR INJECT ANTER CHMBR EYE,MEDICATN 66030 $458.00 66170 PR GLAUCOMA SURG,TRABECU AB EXTERNO 66170 $3,400.00 66172 PR GLAUCOMA SURG,TRAB AB EXT,PREV SCAR 66172 $4,100.00

66180 PR AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT 66180 $3,400.00

66183 PR INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR 66183 $3,588.00

66184 PR REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT 66184 $2,072.00

PR REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR 66185 W/GRAFT 66185 $2,400.00 66250 PR REVIS/REPAIR OP WOUND ANTER SGMT 66250 $1,989.00 66605 PR REMV IRIS,CYCLECTOMY 66605 $3,739.00 66625 PR REMV IRIS,PERIPH FOR GLAUCOMA 66625 $1,400.00 66680 PR REPAIR IRIS/CILIARY BODY 66680 $1,437.00 66682 PR SUTURE IRIS/CILIARY BODY 66682 $1,777.00 66710 PR DESTRUC,CILIARY BODY,CYCLOPHOTOCOAG 66710 $1,170.00

66711 PR ECP CILIARY BODY DSTRJ W/O RMVL CRYSTALLINE LENS 66711 $1,669.00

66761 PR IRIDOTOMY/IRIDECTOMY BY LASER, PER SESSION 66761 $900.00 66762 PR IRIDOPLASTY BY PHOTOCOAG 66762 $1,258.00 66821 PR DISCISSION,2ND CATARACT,LASER 66821 $876.00 66825 PR REPOSITION INTRAOCULAR LENS W INCIS 66825 $2,095.00 66840 PR REMV LENS MATERIAL,ASPIRATN 66840 $1,829.00 66850 PR REMV LENS MATERIAL,PHACOFRAGMT 66850 $2,300.00 66852 PR REMV LENS MATERIAL,PARS PLANAR APPRC 66852 $2,500.00 66940 PR EXTRACT LENS,EXTRACAPSULAR 66940 $2,453.00

66982 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP 66982 $2,800.00

66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP 66984 $2,100.00 66985 PR INSERT LENS PROSTHESIS ONLY 66985 $2,200.00 66986 PR EXCHANGE LENS PROSTHESIS 66986 $2,500.00

66987 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX W/ECP 66987 $3,080.00

66988 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/ECP 66988 $2,310.00 66990 PR OPHTHALMIC ENDOSCOPE USE 66990 $250.00 67005 PR PART REMV VITREOUS,ANT APPRCH 67005 $1,245.00 67010 PR SUBTOT REMV VITREOUS,MECH VIRECTOMY 67010 $1,427.00 67015 PR RELEAS VITREOUS,SUBRET/CHOROID FLUID 67015 $1,560.00 67025 PR REPLACE EYE FLUID 67025 $1,947.00 67028 PR INJECT INTRAVITREAL PHARMCOLOGIC 67028 $400.00 67036 PR VITRECTOMY,MECHANICAL 67036 $3,200.00 67039 PR VITRECTOMY,FOCAL LASER RX RETINA 67039 $3,400.00 67040 PR VITRECTOMY,PANRETINAL LASER RX 67040 $3,700.00

67041 PR VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE 67041 $3,800.00

67042 PR VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA 67042 $4,032.00

PR VITRECTOMY PARS PLANA REMOVE SUBRETINAL 67043 MEMBRANE 67043 $4,300.00

67101 PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX 67101 $2,100.00

67105 PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC 67105 $1,867.00

67107 PR REPAIR RETINAL DETACHMENT SCLERAL BUCKLING 67107 $3,600.00

67108 PR RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH 67108 $6,412.00 67110 PR REPAIR DETACD RETINA,INJECT AIR/GAS 67110 $2,400.00

67113 PR RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL 67113 $4,800.00 67115 PR RELEASE ENCIRCL MATERIAL,POST SGMT 67115 $1,313.00 67120 PR REMV POST EYE IMPLNT MATER,EXTRAOCUL 67120 $1,800.00 67121 PR REMV POST EYE IMPLNT MATER,INTRAOCUL 67121 $2,600.00 67141 PR PROPHYLAXIS RETINA DETACH,CRYO/DIATH 67141 $1,383.00 67145 PR PROPHYLAXIS RETINA DETACH,PHOTOCOAG 67145 $1,500.00 67208 PR DESTRUC RETINAL LESN,CRYOTHERAPY 67208 $1,583.00 67210 PR DESTRUC RETINAL LESN,PHOTOCOAG 67210 $1,365.00 67218 PR DESTRUC RETINAL LESN,RADN IMPLNT 67218 $3,670.00 67220 PR DEST,CHOROID LESION,PHOTOCOAG 67220 $1,700.00

67221 PR DEST,CHOROID LESN,PHOTODYNAMIC THERAPY 67221 $820.00

67227 PR DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY 67227 $1,473.00 PR TREATMENT EXTENSIVE RETINOPATHY 67228 PHOTOCOAGULATION 67228 $2,700.00

67229 PR TX EXTENSIVE RETINOPATHY, PRETERM INFANT 67229 $3,268.00 67255 PR REINFORCE SCLERA EYE W GRAFT 67255 $2,400.00 67311 PR STABISMUS SURG,ONE HORIZ MUSCLE 67311 $1,600.00 67312 PR STABISMUS SURG,TWO HORIZ MUSCLE 67312 $1,900.00 67314 PR STABISMUS SURG,ONE VERT MUSCLE 67314 $1,800.00 67316 PR STABISMUS SURG,2+ VERT MUSCLE 67316 $2,200.00 67318 PR STRABISMUS SURG,SUPER-OBLIQ MUSC 67318 $1,865.00 67320 PR TRANSPOSITION ANY EXTRAOCUL MUSC 67320 $848.00 67331 PR STRABISM SURG,PREV EYE SURG,NOT MUSC 67331 $806.00 67332 PR STRABISMUS SURG,SCAR EXTRAOCUL MUSC 67332 $920.00 67334 PR STRABISMUS SURG,POST FIXATN SUTURE 67334 $794.00 67335 PR STRABISMUS SURG,PLACE ADJUST SUTURE 67335 $430.00 67345 PR DESTROY NERVE OF EYE MUSCLE 67345 $700.00 67400 PR EXPLORE EYE SOCKET 67400 $2,700.00 67405 PR EXPLORE EYE SOCKET,DRAINAGE 67405 $2,232.00 67412 PR EXPLORE EYE SOCKET,REMV LESN 67412 $2,600.00 67413 PR EXPLORE EYE SOCKET,REMV F.B. 67413 $2,403.00 67414 PR EXPLORE EYE SOCKET,DECOMPRESS 67414 $3,686.00 67415 PR NEEDLE ASPIR ORBITAL CONTENTS 67415 $420.00 67420 PR LAT EXPLOR EYE SOCK,REMV LESN 67420 $4,430.00 67430 PR LAT EXPLOR EYE SOCK,REMV F.B. 67430 $4,486.00 67445 PR LAT EXPLOR EYE SOCK,DECOMPRESS 67445 $4,931.00 67500 PR RETROBULBAR INJECT,MEDICATN 67500 $204.00 67515 PR INJ,THER AGENT INTO TENON'S CAPSULE 67515 $260.00 67550 PR INSERT EYE SOCKET IMPLANT 67550 $3,414.00 67560 PR REVISE EYE SOCKET IMPLANT 67560 $3,501.00 67700 PR DRAINAGE OF EYELID ABSCESS 67700 $775.00 67710 PR INCISION OF EYELID 67710 $623.00 67715 PR INCISION OF EYELID FOLD 67715 $670.00 67800 PR EXCIS CHALAZION,SINGLE 67800 $339.00 67801 PR EXCIS CHALAZION,MULT,SAME LID 67801 $430.00 67805 PR EXCIS CHALAZION,MULT,BOTH LIDS 67805 $533.00 67808 PR EXCIS CHALAZION,GEN ANESTHESIA 67808 $971.00

67810 PR INCISIONAL BIOPSY EYELID SKIN & LID MARGIN 67810 $478.00 67820 PR REVISE EYELASHES,FORCEPS 67820 $130.00 67825 PR REVISE EYELASHES 67825 $352.00 67830 PR REVISE EYELASHES,INCIS LID MARGIN 67830 $746.00 67840 PR REMOVE EYELID LESN (NOT CHALAZION) 67840 $737.00 67850 PR DESTRUC EYELID LESN, <1 CM 67850 $570.00 67875 PR TEMP CLOSURE EYELID BY SUTURE 67875 $467.00 67880 PR REVISION OF EYELID 67880 $1,220.00 67882 PR REVISION EYELID,XPOSITN TARSAL PLATE 67882 $1,500.00 67900 PR REPAIR BROW PTOSIS 67900 $1,705.00 67901 PR FIX LID PTOSIS,FRONTALIS MUSC,SUT 67901 $2,061.00 67902 PR FIX LID PTOSIS,FRONT MUSC,FAS SLNG 67902 $1,909.00 67903 PR FIX LID PTOSIS,LEVATR RESEC,INTERN 67903 $1,583.00 67904 PR FIX LID PTOSIS,LEVATR RESEC,EXTERN 67904 $1,949.00 67911 PR CORRECT LID RETRACTN 67911 $1,520.00 67912 PR CORRECTION EYELID W/ IMPLANT 67912 $2,393.00 67914 PR FIX ECTROPION,SUTURE 67914 $1,272.00 67917 PR FIX ECTROPION,ENTENSV LID REPAIR 67917 $1,630.00 67921 PR FIX ENTROPION,SUTURE 67921 $1,246.00 67923 PR FIX ENTROPION,EXCIS TARSAL WEDGE 67923 $1,598.00 67924 PR FIX ENTROPION,EXTENSV LID REPAIR 67924 $1,702.00 67930 PR SUTURE EYELID WOUND,PARTIAL THICK 67930 $974.00 67935 PR SUTURE EYELID WOUND,FULL THICK 67935 $1,576.00 67938 PR REMOVE EYELID FOREIGN BODY,EMBEDDED 67938 $686.00 67950 PR CANTHOPLASTY 67950 $1,530.00 67961 PR REVISION OF EYELID,< 1/4 LID MARGIN 67961 $1,536.00 67966 PR REVISION OF EYELID,> 1/4 LID MARGIN 67966 $2,045.00 67971 PR RECONSTRUC EYELID,<2/3,ONE STAGE 67971 $2,548.00 67973 PR RECONSTRUC EYELID,TOT LOWER,1 STAGE 67973 $2,703.00 67974 PR RECONSTRUC EYELID,TOT UPPER,1 STAGE 67974 $3,271.00 67975 PR RECONSTRUC EYELID,SECOND STAGE 67975 $1,805.00 68020 PR INCISE/DRAIN CONJUNCTIVA 68020 $334.00 68100 PR BIOPSY OF CONJUNCTIVA 68100 $472.00 68110 PR EXCIS CONJUNC LESN,=<1 CM 68110 $618.00 68115 PR EXCIS CONJUNC LESN,>1 CM 68115 $856.00 68135 PR DESTRUC CONJUNC LESN 68135 $420.00 68200 PR SUBCONJUNCTIVAL INJECTN 68200 $111.00 68320 PR REVISE CONJUNC,CONJUNC GRFT 68320 $1,945.00 68326 PR REVISE CONJUNC,FIX CUL-DE-SAC+GRFT 68326 $1,697.00 68328 PR REVISE CONJUNC,FIX CUL-DE-SAC=BUCCAL 68328 $1,830.00 68330 PR REPAIR SYMBLEPHARON 68330 $1,708.00 68335 PR REPAIR SYMBLEPHARON+FREE GRFT 68335 $1,703.00 68340 PR DIVISION OF SYMBLEPHARON 68340 $1,531.00 68362 PR CONJUNC FLAP,TOTAL 68362 $1,725.00 68440 PR INCISE TEAR DUCT OPENING 68440 $280.00 68510 PR BIOPSY OF TEAR GLAND 68510 $1,203.00 68525 PR BIOPSY OF TEAR SAC 68525 $731.00 68550 PR REMV TEAR GLAND LESN,W OSTEOTOMY 68550 $4,255.00 68700 PR REPAIR TEAR DUCTS 68700 $1,600.00 68720 PR CREATE TEAR SAC-NASAL FISTULA 68720 $2,061.00 68750 PR CREATE CONJUNC-NASAL FISTULA+STENT 68750 $2,786.00 68760 PR CLOSE TEAR DUCT OPENING 68760 $566.00 68761 PR CLOSE TEAR DUCT OPENING BY PLUG,EA 68761 $401.00 68801 PR DILATION NASOLACRIMAL DUCT 68801 $310.00 68810 PR PROBE NASOLACRIMAL DUCT 68810 $620.00 68811 PR PROBE NASOLAC DUCT W GEN ANESTH 68811 $517.00 68815 PR PROBE NASOLAC DUCT,INSERT TUBE/STENT 68815 $1,095.00 68840 PR EXPLORE LACRIMAL CANALICULI 68840 $345.00 68850 PR INJECTION FOR TEAR SAC X-RAY 68850 $168.00 69000 PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE 69000 $498.00 69005 PR DRAIN EXT EAR ABSC/BLOOD,COMPLIC 69005 $455.00 69020 PR DRAIN EXT AUD CANAL ABSCESS 69020 $584.00 69090 PR PIERCE EARLOBES 69090 $79.00 69100 PR BIOPSY OF EXTERNAL EAR 69100 $262.00 69105 PR BIOPSY OF EXT AUDITORY CANAL 69105 $373.00 69110 PR REMOVAL EXTERNAL EAR,PARTIAL 69110 $1,226.00 69120 PR REMOVAL EXTERNAL EAR,TOTAL 69120 $882.00 69140 PR REMV EXT CANAL EXOSTOSIS 69140 $1,900.00 69145 PR REMV EXT CANAL SOFT TISSUE LESN 69145 $1,056.00 69150 PR RAD EXCIS EXT CANAL LESN 69150 $3,702.00 69155 PR RAD EXCIS EXT CANAL LESN+NECK DISSEC 69155 $4,500.00 69200 PR REMV EXT CANAL FOREIGN BODY 69200 $273.00 69205 PR REMV EXT CANAL F.B.,GEN ANESTH 69205 $359.00

69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 69209 $36.27

69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 69210 $127.00 69220 PR DEBRIDE MASTOID CAVITY,SIMPLE 69220 $287.00 69222 PR DEBRIDE MASTOID CAVITY,COMPLEX 69222 $589.00 69300 PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ 69300 $1,812.00 69310 PR RECONSTRUCTION,EXT AUDITORY CANAL 69310 $3,338.00 69320 PR REBUILD EXT AUD CANAL,CONG ANOMALY 69320 $7,500.00 69420 PR INCISION EARDRUM,ASPIR 69420 $915.00 69421 PR INCISION EARDRUM,ASPIR,GEN ANESTH 69421 $420.00 69424 PR VENT TUBE REMVL REQ GEN ANESTHESIA 69424 $271.00 69433 PR CREATE EARDRUM OPENING,LOCAL ANESTH 69433 $507.00 69436 PR CREATE EARDRUM OPENING,GEN ANESTH 69436 $519.00 69440 PR EXPLORATION OF MIDDLE EAR 69440 $2,358.00 69450 PR EARDRUM REVISION 69450 $1,445.00 69501 PR MASTOIDECTOMY,SIMPLE 69501 $1,920.00 69502 PR MASTOIDECTOMY,COMPLETE 69502 $3,450.00 69505 PR MASTOIDECTOMY,MOD RADICAL 69505 $3,161.00 69511 PR MASTOIDECTOMY,RADICAL 69511 $3,161.00 69530 PR MASTOIDECTOMY,RAD,PETR APICECTOMY 69530 $6,718.00 69535 PR RESECT TEMPORAL BONE,EXTERN APPRCH 69535 $9,487.00 69540 PR REMV AURAL POLYP 69540 $1,423.00 69550 PR REMV AURAL GLOMUS TUMOR,TRANSCANAL 69550 $3,640.00

69552 PR REMV AURAL GLOMUS TUMOR,TRANSMASTOID 69552 $4,468.00 69554 PR REMV AURAL GLOMUS,EXTRATEMPORAL 69554 $6,755.00 69601 PR MASTOIDECT REVISN W COMPLETE REMVAL 69601 $3,698.00 69602 PR MASTOID REVISN ->MOD RAD MASTOIDECT 69602 $3,861.00 69603 PR MASTOID REVISN ->RAD MASTOIDECTOMY 69603 $4,408.00 69604 PR MASTOID REVISN ->TYMPANOPLASTY 69604 $3,943.00 69610 PR REPAIR TYMPANIC MEMBRANE 69610 $936.00 69620 PR MYRINGOPLASTY 69620 $1,770.00 69631 PR TYMPANOPLASTY 69631 $5,000.00 69632 PR TYMPANOPLASTY,REBUILD OSSICUL CHAIN 69632 $3,079.00 69633 PR TYMPANOPLASTY,REBLD OSSIC CHAIN+PROS 69633 $6,500.00 69635 PR TYMPANOPLAS/ANTROTOMY 69635 $3,109.00 69636 PR TYMPANOPLAS/ANTROT,REBLD OSSIC CHAIN 69636 $4,875.00 69637 PR TYMPANOPLAS/ANTROT,REBLD OSSIC+PROST 69637 $3,821.00 69641 PR TYMPANOPLAS/MASTOIDECTOMY 69641 $3,500.00 69642 PR TYMPANOPLAS/MASTOIDEC,REBLD OSSICLES 69642 $3,858.00 69643 PR TYMPANOPLAS/MASTOIDEC,INTACT WALL 69643 $3,858.00 69644 PR TYMPANOPLAS/MASTOID,INTCT WALL,REBLD 69644 $3,914.00 69645 PR TYMPANOPLAS/MASTOIDEC,RADICAL/COMPLE 69645 $3,840.00 69646 PR TYMPANOPLAS/MASTOIDEC,RAD,REBLD OSSI 69646 $7,575.00 69650 PR STAPES MOBILIZATION 69650 $2,063.00 69660 PR STAPEDECTOMY 69660 $2,932.00 69661 PR STAPEDECTOMY,FOOTPLATE DRILL OUT 69661 $3,258.00 69662 PR REVISE STAPEDECTOMY/STAPEDOTOMY 69662 $4,056.00 69666 PR REPAIR OVAL WINDOW FISTULA 69666 $2,688.00 69667 PR REPAIR ROUND WINDOW FISTULA 69667 $2,688.00 69670 PR MASTOID OBLITERATION 69670 $3,320.00

PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE 69705 UNI 69705 $455.00

69706 PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI 69706 $636.00 69710 PR IMPLANT/REPLACE HEAR AID,TEMP BONE 69710 $2,655.00 69711 PR REMOVE/REPAIR HEAR AID,TEMP BONE 69711 $3,015.00 69714 PR IMPLNT,TEMPORAL BONE,W/EXTRN STIM 69714 $3,308.00

69717 PR REPLCE IMPLNT,TEMPORAL BONE,W/EXTRN STIM 69717 $3,527.00

69718 PR REPLCE IMPLNT,TEMPORAL BONE,REMV MASTOID 69718 $4,750.00 69720 PR RELEASE FACIAL NERVE,LAT TO GANGLION 69720 $4,300.00 69725 PR RELEASE FACIAL NERVE,MED TO GANGLION 69725 $7,618.00 69740 PR REPAIR FACIAL NERVE,LAT TO GANGLION 69740 $3,407.00

PR LABYRINTHOTOMY W PERFUSION VESTIBULOACTIVE 69801 DRUGS,TRANSCRANIAL 69801 $1,602.00 69805 PR ENDOLYMPH SAC OPERATN,NO SHUNT 69805 $3,263.00 69806 PR ENDOLYMPH SAC OP W SHUNT 69806 $3,263.00 69905 PR EXCIS LABYRINTH,TRANSCANAL 69905 $3,903.00 69910 PR EXCIS LABYRINTH W MASTOIDECTOMY 69910 $3,557.00 69915 PR INCISE VESTIBULAR NERVE,TRANSLABYR 69915 $6,177.00 69930 PR IMPLANT COCHLEAR DEVICE 69930 $4,468.00 69960 PR DECOMPRESS INTERN AUDITORY CANAL 69960 $7,714.00

69990 PR MICROSURG TECHNIQUES,REQ OPER MICROSCOPE 69990 $1,117.00

70015 70015 PR CISTERNOGRAPHY,POS CONTRAST 26 26 $206.00

70015 70015 PR CISTERNOGRAPHY,POS CONTRAST TC TC $287.00 70030 70030 PR X-RAY EYE FOR FOREIGN BODY 26 26 $30.00

70030 70030 PR X-RAY EYE FOR FOREIGN BODY TC TC $62.00 70100 CHG X-RAY JAW <4 VW 70100 $84.00

70100 70100 CHG X-RAY JAW <4 VW 26 26 $31.00

70100 70100 CHG X-RAY JAW <4 VW TC TC $76.00 70110 CHG X-RAY JAW 4+ VW 70110 $96.00

70110 70110 CHG X-RAY JAW 4+ VW 26 26 $43.00

70110 70110 CHG X-RAY JAW 4+ VW TC TC $82.00

70120 70120 CHG X-RAY MASTOIDS <3 VW 26 26 $31.00

70120 70120 CHG X-RAY MASTOIDS <3 VW TC TC $76.00

70130 70130 CHG X-RAY MASTOIDS 3+ VW TC TC $118.00

70134 70134 PR X-RAY MIDDLE EAR TC TC $108.00 70140 CHG X-RAY FACIAL BONES <3 VW 70140 $87.00

70140 70140 CHG X-RAY FACIAL BONES <3 VW 26 26 $34.00

70140 70140 CHG X-RAY FACIAL BONES <3 VW TC TC $58.00 70150 CHG X-RAY FACIAL BONES 3+ VW 70150 $127.00

70150 70150 CHG X-RAY FACIAL BONES 3+ VW 26 26 $38.00

70150 70150 CHG X-RAY FACIAL BONES 3+ VW TC TC $89.00 70160 PR X-RAY NASAL BONES 70160 $82.00

70160 70160 PR X-RAY NASAL BONES 26 26 $30.00

70160 70160 PR X-RAY NASAL BONES TC TC $76.00

70170 70170 PR X-RAY TEAR DUCT TC TC $99.00 70190 70190 PR X-RAY OPTIC FORAMEN 26 26 $36.00

70190 70190 PR X-RAY OPTIC FORAMEN TC TC $75.00 70200 CHG X-RAY ORBITS 70200 $106.00

70200 70200 CHG X-RAY ORBITS 26 26 $48.00

70200 70200 CHG X-RAY ORBITS TC TC $89.00

70210 70210 CHG X-RAY SINUSES <3 VW 26 26 $30.00

70210 70210 CHG X-RAY SINUSES <3 VW TC TC $61.00 70220 CHG X-RAY SINUSES 3+ VW 70220 $101.00

70220 70220 CHG X-RAY SINUSES 3+ VW 26 26 $32.00

70220 70220 CHG X-RAY SINUSES 3+ VW TC TC $70.00

70240 70240 PR X-RAY EXAM SELLA TC TC $65.00 70250 CHG X-RAY SKULL <4 VW 70250 $98.00

70250 70250 CHG X-RAY SKULL <4 VW 26 26 $29.00

70250 70250 CHG X-RAY SKULL <4 VW TC TC $70.00

PR PT INFO IN REMIND SYSTEM W/ TARGET DATE FOR NEXT 7025F MAMMO 7025F $0.00 70260 CHG X-RAY SKULL 4+ VW 70260 $115.00

70260 70260 CHG X-RAY SKULL 4+ VW 26 26 $58.00

70260 70260 CHG X-RAY SKULL 4+ VW TC TC $82.00 70300 PR X-RAY TEETH SINGLE 70300 $20.00

70300 70300 PR X-RAY TEETH SINGLE 26 26 $20.00

70300 70300 PR X-RAY TEETH SINGLE TC TC $23.00 70310 PR X-RAY TEETH PARTIAL 70310 $25.00 70310 70310 PR X-RAY TEETH PARTIAL TC TC $87.00

70320 70320 PR FULL MOUTH X-RAY OF TEETH TC TC $121.00 70328 PR X-RAY TMJ UNILAT 70328 $78.00

70328 70328 PR X-RAY TMJ UNILAT 26 26 $26.00

70328 70328 PR X-RAY TMJ UNILAT TC TC $67.00 70330 PR X-RAY TMJ BILAT 70330 $118.00

70330 70330 PR X-RAY TMJ BILAT 26 26 $35.00

70330 70330 PR X-RAY TMJ BILAT TC TC $108.00

70332 70332 PR X-RAY TMJ ARTHROGRAM 26 26 $184.00

70332 70332 PR X-RAY TMJ ARTHROGRAM TC TC $151.00

70336 70336 PR MRI, TMJ 26 26 $257.00

70336 70336 PR MRI, TMJ TC TC $644.00

70350 70350 PR X-RAY HEAD FOR ORTHODONTIA TC TC $23.00 70355 PR ORTHOPANTOGRAM 70355 $53.00

70355 70355 PR ORTHOPANTOGRAM 26 26 $35.00

70355 70355 PR ORTHOPANTOGRAM TC TC $24.00 70360 PR X-RAY NECK SOFT TISSUE 70360 $85.00

70360 70360 PR X-RAY NECK SOFT TISSUE 26 26 $26.00

70360 70360 PR X-RAY NECK SOFT TISSUE TC TC $59.00

70370 70370 PR THROAT X-RAY & FLUOROSCOPY TC TC $209.00 70371 PR SPEECH EVALUATION, COMPLEX 70371 $247.00

70371 70371 PR SPEECH EVALUATION, COMPLEX 26 26 $112.00 70371 70371 PR SPEECH EVALUATION, COMPLEX TC TC $178.00

70380 70380 PR X-RAY SALIVARY GLAND TC TC $76.00

70390 70390 PR X-RAY SIALOGRAM TC TC $258.00

70450 70450 PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL 26 26 $148.00

70450 70450 PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL TC TC $200.00

70460 70460 PR CT SCAN HEAD CONTRAST 26 26 $197.00

70460 70460 PR CT SCAN HEAD CONTRAST TC TC $293.00

70470 70470 PR CT SCAN HEAD COMBO 26 26 $221.00

70470 70470 PR CT SCAN HEAD COMBO TC TC $351.00

70480 70480 PR CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O 26 26 $222.00

70480 70480 PR CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O TC TC $375.00

70481 70481 PR CT SCAN SKULL CONTRAST 26 26 $239.00

70481 70481 PR CT SCAN SKULL CONTRAST TC TC $459.00

70482 70482 PR CT SCAN SKULL COMBO 26 26 $251.00

70482 70482 PR CT SCAN SKULL COMBO TC TC $507.00

70486 70486 PR CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST 26 26 $221.00

70486 70486 PR CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST TC TC $265.00

70487 70487 PR CT SCAN, FACE/JAW CONTRAST 26 26 $227.00

70487 70487 PR CT SCAN, FACE/JAW CONTRAST TC TC $304.00 70488 70488 PR CT SCANS FACE/JAW COMBO 26 26 $246.00

70488 70488 PR CT SCANS FACE/JAW COMBO TC TC $385.00

70490 70490 PR CT SCAN,SOFT TISSUE NECK,W/O CONTRAST 26 26 $222.00

70490 70490 PR CT SCAN,SOFT TISSUE NECK,W/O CONTRAST TC TC $275.00

70491 70491 PR CT NECK TISSUE CONTRAST 26 26 $239.00

70491 70491 PR CT NECK TISSUE CONTRAST TC TC $366.00

70492 70492 PR CT NECK TISSUE COMBO 26 26 $251.00

70492 70492 PR CT NECK TISSUE COMBO TC TC $448.00

70496 70496 PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS 26 26 $314.00

70496 70496 PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS TC TC $574.00

70498 70498 PR CT ANGIO,NECK COMBO,INCL IMAGE PROCESS 26 26 $314.00

70498 70498 PR CT ANGIO,NECK COMBO,INCL IMAGE PROCESS TC TC $574.00

70540 70540 PR MRI, FACE, NECK 26 26 $233.00

70540 70540 PR MRI, FACE, NECK TC TC $532.00

70542 70542 PR MRI, FACE, NECK W/CONTRAST 26 26 $280.00

70542 70542 PR MRI, FACE, NECK W/CONTRAST TC TC $627.00

70543 70543 PR MRI, FACE, NECK, COMBO 26 26 $371.00

70543 70543 PR MRI, FACE, NECK, COMBO TC TC $776.00

70544 70544 PR MR ANGIO, HEAD 26 26 $208.00 70544 70544 PR MR ANGIO, HEAD TC TC $509.00

70545 70545 PR MR ANGIO, HEAD W/CONTRAST 26 26 $208.00

70545 70545 PR MR ANGIO, HEAD W/CONTRAST TC TC $539.00

70546 70546 PR MR ANGIO, HEAD, COMBO 26 26 $312.00

70546 70546 PR MR ANGIO, HEAD, COMBO TC TC $817.00

70547 70547 PR MR ANGIO, NECK 26 26 $208.00

70547 70547 PR MR ANGIO, NECK TC TC $511.00

70548 70548 PR MR ANGIO, NECK W/CONTRAST 26 26 $209.00

70548 70548 PR MR ANGIO, NECK W/CONTRAST TC TC $549.00

70549 70549 PR MR ANGIO, NECK, COMBO 26 26 $312.00

70549 70549 PR MR ANGIO, NECK, COMBO TC TC $823.00

70551 70551 PR MRI BRAIN 26 26 $257.00

70551 70551 PR MRI BRAIN TC TC $408.00

70552 70552 PR MRI BRAIN CONTRAST 26 26 $311.00

70552 70552 PR MRI BRAIN CONTRAST TC TC $603.00

70553 70553 PR MRI BRAIN COMBO 26 26 $409.00

70553 70553 PR MRI BRAIN COMBO TC TC $687.00

70554 70554 PR FUNCTIONAL MRI BRAIN BY TECH 26 26 $293.00

70554 70554 PR FUNCTIONAL MRI BRAIN BY TECH TC TC $897.00 70555 70555 PR FUNCTIONAL MRI BRAIN BY PHYS/PSYCH 26 26 $414.00

70555 70555 PR FUNCTIONAL MRI BRAIN BY PHYS/PSYCH TC TC $1,485.00

70557 70557 PR MRI BRAIN W/O DYE 26 26 $448.00

70557 70557 PR MRI BRAIN W/O DYE TC TC $3,306.00

70558 70558 PR MRI BRAIN W/ DYE 26 26 $477.00

70558 70558 PR MRI BRAIN W/ DYE TC TC $3,480.00

70559 70559 PR MRI BRAIN W/O & W/ DYE 26 26 $457.00

70559 70559 PR MRI BRAIN W/O & W/ DYE TC TC $3,264.00 71010 PR CHEST X-RAY 1 VW 71010 $57.00

71010 71010 PR CHEST X-RAY 1 VW 26 26 $31.00 71020 CHG CHEST X-RAY 2 VW 71020 $77.00

71020 71020 CHG CHEST X-RAY 2 VW 26 26 $39.00

71021 71021 CHG CHEST X-RAY W APICAL LORD 26 26 $46.00

71022 71022 CHG CHEST X-RAY W OBLIQUES 26 26 $54.00

71023 71023 CHG CHEST X-RAY W FLUORO 26 26 $67.00

71030 71030 CHG CHEST X-RAY 4 VW 26 26 $51.00 71035 PR CHEST X-RAY SPEC VIEWS 71035 $86.00

71035 71035 PR CHEST X-RAY SPEC VIEWS 26 26 $31.00 71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW 71045 $71.00

71045 71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW 26 26 $26.00

71045 71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW TC TC $45.00 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS 71046 $90.00 71046 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS 26 26 $31.00

71046 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS TC TC $60.00 71047 CHG RADIOLOGIC EXAM CHEST 3 VIEWS 71047 $99.00

71047 71047 CHG RADIOLOGIC EXAM CHEST 3 VIEWS 26 26 $39.00

71047 71047 CHG RADIOLOGIC EXAM CHEST 3 VIEWS TC TC $76.00 71048 CHG RADIOLOGIC EXAM CHEST 4+ VIEWS 71048 $107.00

71048 71048 CHG RADIOLOGIC EXAM CHEST 4+ VIEWS 26 26 $45.00

71048 71048 CHG RADIOLOGIC EXAM CHEST 4+ VIEWS TC TC $79.00 71100 CHG X-RAY RIBS 2 VW UNILAT 71100 $74.00

71100 71100 CHG X-RAY RIBS 2 VW UNILAT 26 26 $39.00

71100 71100 CHG X-RAY RIBS 2 VW UNILAT TC TC $67.00 71101 CHG X-RAY RIBS, CHEST 3+ VW 71101 $89.00

71101 71101 CHG X-RAY RIBS, CHEST 3+ VW 26 26 $46.00

71101 71101 CHG X-RAY RIBS, CHEST 3+ VW TC TC $76.00

71110 71110 CHG X-RAY RIBS 3 VW BILAT 26 26 $46.00

71110 71110 CHG X-RAY RIBS 3 VW BILAT TC TC $78.00 71111 CHG X-RAY RIBS, CHEST 4+ VW 71111 $128.00

71111 71111 CHG X-RAY RIBS, CHEST 4+ VW 26 26 $55.00

71111 71111 CHG X-RAY RIBS, CHEST 4+ VW TC TC $96.00 71120 CHG X-RAY STERNUM 2+ VW 71120 $76.00

71120 71120 CHG X-RAY STERNUM 2+ VW 26 26 $35.00

71120 71120 CHG X-RAY STERNUM 2+ VW TC TC $62.00 71130 71130 CHG X-RAY STERNO-CLAVICLUAR JT 26 26 $39.00

71130 71130 CHG X-RAY STERNO-CLAVICLUAR JT TC TC $79.00

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O 71250 71250 CNTRST 26 26 $202.00

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O 71250 71250 CNTRST TC TC $275.00

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX 71260 71260 W/CONTRAST 26 26 $214.00

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX 71260 71260 W/CONTRAST TC TC $367.00

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C- 71270 71270 /C+ 26 26 $239.00

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C- 71270 71270 /C+ TC TC $448.00

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA 71271 71271 SCR C- 26 26 $148.00

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA 71271 71271 SCR C- TC TC $281.00

PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG 71275 71275 PROC 26 26 $343.00

PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG 71275 71275 PROC TC TC $582.00

71550 71550 PR MRI, CHEST 26 26 $251.00

71550 71550 PR MRI, CHEST TC TC $888.00

71551 71551 PR MRI, CHEST, W/CONTRAST 26 26 $298.00

71551 71551 PR MRI, CHEST, W/CONTRAST TC TC $965.00

71552 71552 PR MRI, CHEST, COMBO 26 26 $381.00

71552 71552 PR MRI, CHEST, COMBO TC TC $1,213.00

71555 71555 PR MR ANGIO CHEST (MRA) 26 26 $315.00 71555 71555 PR MR ANGIO CHEST (MRA) TC TC $809.00 72020 PR X-RAY SPINE ONE VIEW 72020 $67.00

72020 72020 PR X-RAY SPINE ONE VIEW 26 26 $26.00

72020 72020 PR X-RAY SPINE ONE VIEW TC TC $45.00 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS 72040 $92.00

72040 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS 26 26 $39.00

72040 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS TC TC $74.00 72050 CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS 72050 $133.00

72050 72050 CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS 26 26 $54.00

72050 72050 CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS TC TC $101.00 72052 CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS 72052 $150.00

72052 72052 CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS 26 26 $64.00

72052 72052 CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS TC TC $122.00 72070 CHG X-RAY THORACIC SPINE 2 VW 72070 $88.00

72070 72070 CHG X-RAY THORACIC SPINE 2 VW 26 26 $39.00

72070 72070 CHG X-RAY THORACIC SPINE 2 VW TC TC $59.00 72072 CHG X-RAY THORACIC SPINE+SWIM 3 VW 72072 $87.00

72072 72072 CHG X-RAY THORACIC SPINE+SWIM 3 VW 26 26 $39.00

72072 72072 CHG X-RAY THORACIC SPINE+SWIM 3 VW TC TC $74.00 72074 CHG X-RAY THORACIC SPINE 4 VW 72074 $107.00

72074 72074 CHG X-RAY THORACIC SPINE 4 VW 26 26 $39.00

72074 72074 CHG X-RAY THORACIC SPINE 4 VW TC TC $85.00

CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 72080 VIEWS 72080 $88.00 CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 72080 72080 VIEWS 26 26 $39.00

CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 72080 72080 VIEWS TC TC $64.00

72081 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW 72081 $98.00

72081 72081 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW 26 26 $38.00

72081 72081 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW TC TC $78.00

72082 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW 72082 $156.00

72082 72082 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW 26 26 $45.00

72082 72082 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW TC TC $141.00

72083 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW 72083 $169.00

72083 72083 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW 26 26 $51.00

72083 72083 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW TC TC $166.00

72084 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW 72084 $201.00

72084 72084 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW 26 26 $58.00

72084 72084 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW TC TC $199.00 72100 CHG X-RAY LUMBAR SPINE 2/3 VW 72100 $105.00

72100 72100 CHG X-RAY LUMBAR SPINE 2/3 VW 26 26 $39.00

72100 72100 CHG X-RAY LUMBAR SPINE 2/3 VW TC TC $74.00 72110 CHG X-RAY LUMBAR SPINE 4 VW 72110 $120.00

72110 72110 CHG X-RAY LUMBAR SPINE 4 VW 26 26 $54.00

72110 72110 CHG X-RAY LUMBAR SPINE 4 VW TC TC $97.00 72114 72114 PR RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 26 26 $64.00

72114 72114 PR RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 TC TC $122.00

72120 PR RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS 72120 $102.00

72120 72120 PR RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS 26 26 $32.00

72120 72120 PR RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS TC TC $78.00

72125 72125 PR CT SCAN,CERVICAL SPINE,W/O CONTRAST 26 26 $202.00

72125 72125 PR CT SCAN,CERVICAL SPINE,W/O CONTRAST TC TC $290.00

72126 72126 PR CT SCAN CERV SPINE CONTRAST 26 26 $211.00

72126 72126 PR CT SCAN CERV SPINE CONTRAST TC TC $369.00

72127 72127 PR CT SCAN CERV SP COMBO 26 26 $177.00

72127 72127 PR CT SCAN CERV SP COMBO TC TC $458.00

72128 72128 PR CT SCAN,THORACIC SPINE,W/O CONTRAST 26 26 $139.00

72128 72128 PR CT SCAN,THORACIC SPINE,W/O CONTRAST TC TC $290.00

72129 72129 PR CT SCAN DORSAL SP CONTRAST 26 26 $170.00

72129 72129 PR CT SCAN DORSAL SP CONTRAST TC TC $373.00

72130 72130 PR CT SCAN DORSAL SP COMBO 26 26 $177.00

72130 72130 PR CT SCAN DORSAL SP COMBO TC TC $459.00

72131 72131 PR CT SCAN,LUMBAR SPINE,W/O CONTRAST 26 26 $139.00

72131 72131 PR CT SCAN,LUMBAR SPINE,W/O CONTRAST TC TC $288.00 72132 72132 PR CT SCAN LUMBAR SP CONTRAST 26 26 $170.00

72132 72132 PR CT SCAN LUMBAR SP CONTRAST TC TC $370.00

72133 72133 PR CT SCAN LUMBAR SP COMBO 26 26 $176.00

72133 72133 PR CT SCAN LUMBAR SP COMBO TC TC $456.00

72141 72141 PR MRI, CERV SPINE 26 26 $207.00

72141 72141 PR MRI, CERV SPINE TC TC $392.00

72142 72142 PR MRI, CERV SPINE CONTRAST 26 26 $249.00

72142 72142 PR MRI, CERV SPINE CONTRAST TC TC $620.00

72146 72146 PR MRI, DORSAL SPINE 26 26 $207.00

72146 72146 PR MRI, DORSAL SPINE TC TC $392.00

72147 72147 PR MRI, DORSAL SPINE CONTRAST 26 26 $248.00

72147 72147 PR MRI, DORSAL SPINE CONTRAST TC TC $616.00

72148 72148 PR MRI, LUMBAR SPINE 26 26 $207.00

72148 72148 PR MRI, LUMBAR SPINE TC TC $393.00

72149 72149 PR MRI, LUMBAR SPINE CONTRAST 26 26 $248.00

72149 72149 PR MRI, LUMBAR SPINE CONTRAST TC TC $608.00

72156 72156 PR MRI, CERV SPINE COMBO 26 26 $318.00

72156 72156 PR MRI, CERV SPINE COMBO TC TC $695.00

72157 72157 PR MRI, DORSAL SPINE COMBO 26 26 $318.00 72157 72157 PR MRI, DORSAL SPINE COMBO TC TC $697.00

72158 72158 PR MRI, LUMBAR SPINE COMBO 26 26 $318.00

72158 72158 PR MRI, LUMBAR SPINE COMBO TC TC $693.00

72159 72159 PR MR ANGIO SPINE (MRA) 26 26 $251.00

72159 72159 PR MR ANGIO SPINE (MRA) TC TC $847.00 72170 CHG X-RAY PELVIS 1/2 VW 72170 $68.00

72170 72170 CHG X-RAY PELVIS 1/2 VW 26 26 $25.00

72170 72170 CHG X-RAY PELVIS 1/2 VW TC TC $54.00 72190 CHG X-RAY PELVIS 3+ VW 72190 $101.00

72190 72190 CHG X-RAY PELVIS 3+ VW 26 26 $36.00

72190 72190 CHG X-RAY PELVIS 3+ VW TC TC $77.00

72191 72191 PR CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC 26 26 $249.00

72191 72191 PR CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC TC TC $640.00

72192 72192 PR CT SCAN,PELVIS,W/O CONTRAST 26 26 $151.00

72192 72192 PR CT SCAN,PELVIS,W/O CONTRAST TC TC $250.00

72193 72193 PR CT SCAN OF PELVIS CONTRAST 26 26 $161.00

72193 72193 PR CT SCAN OF PELVIS CONTRAST TC TC $506.00

72194 72194 PR CT SCAN OF PELVIS COMBO 26 26 $170.00

72194 72194 PR CT SCAN OF PELVIS COMBO TC TC $580.00

72195 72195 PR MRI, PELVIS, W/O CONTRAST 26 26 $204.00 72195 72195 PR MRI, PELVIS, W/O CONTRAST TC TC $530.00

72196 72196 PR MRI, PELVIS W/CONTRAST 26 26 $241.00

72196 72196 PR MRI, PELVIS W/CONTRAST TC TC $615.00

72197 72197 PR MRI, PELVIS, COMBO 26 26 $304.00

72197 72197 PR MRI, PELVIS, COMBO TC TC $772.00

72198 72198 PR MR ANGIO PELVIS(MRA) 26 26 $247.00

72198 72198 PR MR ANGIO PELVIS(MRA) TC TC $816.00 72200 CHG X-RAY SACROILIAC JTS <3 VW 72200 $89.00

72200 72200 CHG X-RAY SACROILIAC JTS <3 VW 26 26 $25.00

72200 72200 CHG X-RAY SACROILIAC JTS <3 VW TC TC $64.00 72202 CHG X-RAY SACROILIAC JTS 3+ VW 72202 $105.00

72202 72202 CHG X-RAY SACROILIAC JTS 3+ VW 26 26 $33.00

72202 72202 CHG X-RAY SACROILIAC JTS 3+ VW TC TC $73.00 72220 CHG X-RAY SACRUM/COCCYX 2+ VW 72220 $70.00

72220 72220 CHG X-RAY SACRUM/COCCYX 2+ VW 26 26 $25.00

72220 72220 CHG X-RAY SACRUM/COCCYX 2+ VW TC TC $62.00

72240 72240 PR MYELOGRAPHY CERV SPINE 26 26 $128.00

72240 72240 PR MYELOGRAPHY CERV SPINE TC TC $183.00

72255 72255 PR MYELOGRAPHY THORAX SPINE TC TC $181.00

72265 72265 PR MYELOGRAPHY LUMBAR SPINE TC TC $175.00

72270 72270 CHG MYELOGRAPHY OF ENTIRE SPINE TC TC $211.00 72275 72275 PR EPIDUROGRAPHY,SUPERV/INTERPRET 26 26 $100.00

72275 72275 PR EPIDUROGRAPHY,SUPERV/INTERPRET TC TC $260.00

72285 72285 PR X-RAY,C/T,DISC,SUPERV/INTERPRET 26 26 $155.00

72285 72285 PR X-RAY,C/T,DISC,SUPERV/INTERPRET TC TC $176.00

72295 72295 PR DISCOGRAPHY LUMBAR SPINE TC TC $182.00 73000 PR X-RAY CLAVICLE 73000 $69.00

73000 73000 PR X-RAY CLAVICLE 26 26 $24.00

73000 73000 PR X-RAY CLAVICLE TC TC $63.00 73010 PR X-RAY SCAPULA 73010 $78.00

73010 73010 PR X-RAY SCAPULA 26 26 $26.00

73010 73010 PR X-RAY SCAPULA TC TC $51.00 73020 CHG X-RAY SHOULDER 1 VW 73020 $57.00

73020 73020 CHG X-RAY SHOULDER 1 VW 26 26 $22.00

73020 73020 CHG X-RAY SHOULDER 1 VW TC TC $38.00 73030 CHG X-RAY SHOULDER 2+ VW 73030 $72.00

73030 73030 CHG X-RAY SHOULDER 2+ VW 26 26 $27.00

73030 73030 CHG X-RAY SHOULDER 2+ VW TC TC $65.00

73040 73040 PR ARTHROGRAM OF SHOULDER 26 26 $77.00

73040 73040 PR ARTHROGRAM OF SHOULDER TC TC $264.00 73050 PR X-RAY AC JTS 73050 $98.00

73050 73050 PR X-RAY AC JTS 26 26 $28.00

73050 73050 PR X-RAY AC JTS TC TC $60.00 73060 CHG X-RAY HUMERUS 73060 $68.00

73060 73060 CHG X-RAY HUMERUS 26 26 $24.00

73060 73060 CHG X-RAY HUMERUS TC TC $63.00 73070 CHG X-RAY ELBOW 2 VW 73070 $79.00

73070 73070 CHG X-RAY ELBOW 2 VW 26 26 $24.00

73070 73070 CHG X-RAY ELBOW 2 VW TC TC $55.00 73080 CHG X-RAY ELBOW 3+ VW 73080 $79.00

73080 73080 CHG X-RAY ELBOW 3+ VW 26 26 $25.00

73080 73080 CHG X-RAY ELBOW 3+ VW TC TC $61.00

73085 73085 PR ARTHROGRAM OF ELBOW 26 26 $64.00

73085 73085 PR ARTHROGRAM OF ELBOW TC TC $230.00 73090 CHG X-RAY FOREARM 2 VW 73090 $76.00

73090 73090 CHG X-RAY FOREARM 2 VW 26 26 $24.00

73090 73090 CHG X-RAY FOREARM 2 VW TC TC $56.00 73092 CHG X-RAY ARM, INFANT 73092 $79.00

73092 73092 CHG X-RAY ARM, INFANT 26 26 $23.00

73092 73092 CHG X-RAY ARM, INFANT TC TC $61.00 73100 CHG X-RAY WRIST 2 VW 73100 $75.00

73100 73100 CHG X-RAY WRIST 2 VW 26 26 $24.00

73100 73100 CHG X-RAY WRIST 2 VW TC TC $67.00 73110 CHG X-RAY WRIST 3+ VW 73110 $107.00

73110 73110 CHG X-RAY WRIST 3+ VW 26 26 $25.00

73110 73110 CHG X-RAY WRIST 3+ VW TC TC $83.00 73115 73115 PR ARTHROGRAM OF WRIST 26 26 $64.00

73115 73115 PR ARTHROGRAM OF WRIST TC TC $278.00 73120 CHG X-RAY HAND 2 VW 73120 $84.00

73120 73120 CHG X-RAY HAND 2 VW 26 26 $24.00

73120 73120 CHG X-RAY HAND 2 VW TC TC $60.00 73130 CHG X-RAY HAND 3+ VW 73130 $96.00

73130 73130 CHG X-RAY HAND 3+ VW 26 26 $25.00

73130 73130 CHG X-RAY HAND 3+ VW TC TC $72.00 73140 CHG X-RAY EXAM OF FINGER(S) 73140 $82.00

73140 73140 CHG X-RAY EXAM OF FINGER(S) 26 26 $20.00

73140 73140 CHG X-RAY EXAM OF FINGER(S) TC TC $79.00

73200 73200 PR CT SCAN,UPPER EXTREMITY,W/O CONTRAST 26 26 $139.00

73200 73200 PR CT SCAN,UPPER EXTREMITY,W/O CONTRAST TC TC $353.00

73201 73201 PR CT SCAN OF ARM CONTRAST 26 26 $161.00

73201 73201 PR CT SCAN OF ARM CONTRAST TC TC $452.00

73202 73202 PR CT SCAN OF ARM COMBO 26 26 $170.00

73202 73202 PR CT SCAN OF ARM COMBO TC TC $596.00

73206 73206 PR CT ANGIO,UPPER EXTREM,COMBO 26 26 $249.00

73206 73206 PR CT ANGIO,UPPER EXTREM,COMBO TC TC $656.00

73218 73218 PR MRI, UPPER EXTREM 26 26 $188.00

73218 73218 PR MRI, UPPER EXTREM TC TC $784.00 73219 73219 PR MRI, UPPER EXTREM W/CONTRAST 26 26 $227.00

73219 73219 PR MRI, UPPER EXTREM W/CONTRAST TC TC $847.00

73220 73220 PR MRI UPPER EXTR, W/CONTRAST 26 26 $298.00

73220 73220 PR MRI UPPER EXTR, W/CONTRAST TC TC $1,021.00

73221 73221 PR MRI, JOINT UPPER EXTREM 26 26 $191.00

73221 73221 PR MRI, JOINT UPPER EXTREM TC TC $442.00

73222 73222 PR MRI, JOINT UPPER EXTREM W/CONTRAST 26 26 $227.00

73222 73222 PR MRI, JOINT UPPER EXTREM W/CONTRAST TC TC $780.00

73223 73223 PR MRI, JOINT UPPER EXTREM COMBO 26 26 $298.00

73223 73223 PR MRI, JOINT UPPER EXTREM COMBO TC TC $947.00

73225 73225 PR MR ANGIO UPPER EXTREM 26 26 $242.00

73225 73225 PR MR ANGIO UPPER EXTREM TC TC $847.00 73501 CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW 73501 $76.00

73501 73501 CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW 26 26 $27.00

73501 73501 CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW TC TC $61.00

73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS 73502 $104.00

73502 73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS 26 26 $32.00

73502 73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS TC TC $93.00

73503 CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 73503 $130.00

73503 73503 CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 26 26 $39.00 73503 73503 CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS TC TC $115.00 73521 CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS 73521 $105.00

73521 73521 CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS 26 26 $32.00

73521 73521 CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS TC TC $79.00

73522 CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS 73522 $123.00

73522 73522 CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS 26 26 $42.00

73522 73522 CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS TC TC $102.00

73523 CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS 73523 $143.00

73523 73523 CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS 26 26 $45.00

73523 73523 CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS TC TC $118.00

73525 73525 PR ARTHROGRAM OF HIP 26 26 $83.00

73525 73525 PR ARTHROGRAM OF HIP TC TC $269.00 73551 CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW 73551 $70.00

73551 73551 CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW 26 26 $24.00

73551 73551 CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW TC TC $57.00

73552 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS 73552 $82.00

73552 73552 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS 26 26 $26.00

73552 73552 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS TC TC $70.00 73560 CHG X-RAY KNEE 1 OR 2 VIEW 73560 $73.00

73560 73560 CHG X-RAY KNEE 1 OR 2 VIEW 26 26 $24.00

73560 73560 CHG X-RAY KNEE 1 OR 2 VIEW TC TC $69.00 73562 CHG X-RAY KNEE 3 VIEW 73562 $88.00

73562 73562 CHG X-RAY KNEE 3 VIEW 26 26 $27.00

73562 73562 CHG X-RAY KNEE 3 VIEW TC TC $82.00 73564 CHG X-RAY KNEE 4+ VIEW 73564 $106.00

73564 73564 CHG X-RAY KNEE 4+ VIEW 26 26 $32.00

73564 73564 CHG X-RAY KNEE 4+ VIEW TC TC $89.00 73565 PR X-RAY KNEE BILAT STANDING 73565 $84.00

73565 73565 PR X-RAY KNEE BILAT STANDING 26 26 $25.00

73565 73565 PR X-RAY KNEE BILAT STANDING TC TC $83.00

73580 73580 PR ARTHROGRAM OF KNEE JOINT 26 26 $64.00

73580 73580 PR ARTHROGRAM OF KNEE JOINT TC TC $301.00 73590 CHG X-RAY TIB + FIB, 2VW 73590 $72.00

73590 73590 CHG X-RAY TIB + FIB, 2VW 26 26 $23.00

73590 73590 CHG X-RAY TIB + FIB, 2VW TC TC $62.00 73592 CHG X-RAY LEG, INFANT 73592 $69.00

73592 73592 CHG X-RAY LEG, INFANT 26 26 $23.00

73592 73592 CHG X-RAY LEG, INFANT TC TC $61.00 73600 CHG X-RAY ANKLE 2 VW 73600 $68.00

73600 73600 CHG X-RAY ANKLE 2 VW 26 26 $24.00

73600 73600 CHG X-RAY ANKLE 2 VW TC TC $64.00 73610 CHG X-RAY ANKLE 3+ VW 73610 $81.00

73610 73610 CHG X-RAY ANKLE 3+ VW 26 26 $25.00

73610 73610 CHG X-RAY ANKLE 3+ VW TC TC $72.00 73615 73615 PR ARTHROGRAM OF ANKLE TC TC $277.00 73620 CHG X-RAY FOOT 2 VW 73620 $67.00

73620 73620 CHG X-RAY FOOT 2 VW 26 26 $22.00

73620 73620 CHG X-RAY FOOT 2 VW TC TC $55.00 73630 CHG X-RAY FOOT 3+ VW 73630 $77.00

73630 73630 CHG X-RAY FOOT 3+ VW 26 26 $24.00

73630 73630 CHG X-RAY FOOT 3+ VW TC TC $67.00 73650 CHG X-RAY HEEL 73650 $78.00

73650 73650 CHG X-RAY HEEL 26 26 $23.00

73650 73650 CHG X-RAY HEEL TC TC $55.00 73660 CHG X-RAY TOE(S) 73660 $68.00

73660 73660 CHG X-RAY TOE(S) 26 26 $19.00

73660 73660 CHG X-RAY TOE(S) TC TC $59.00

73700 73700 PR CT SCAN,LOWER EXTREMITY,W/O CONTRAST 26 26 $139.00

73700 73700 PR CT SCAN,LOWER EXTREMITY,W/O CONTRAST TC TC $288.00

73701 73701 PR CT SCAN OF LEG CONTRAST 26 26 $161.00

73701 73701 PR CT SCAN OF LEG CONTRAST TC TC $373.00

73702 73702 PR CT SCAN OF LEG COMBO 26 26 $169.00

73702 73702 PR CT SCAN OF LEG COMBO TC TC $474.00

73706 73706 PR CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC 26 26 $261.00

73706 73706 PR CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC TC TC $718.00 73718 73718 PR MRI, LOWER EXTREM 26 26 $187.00

73718 73718 PR MRI, LOWER EXTREM TC TC $523.00

73719 73719 PR MRI, LOWER EXTREM W/CONTRAST 26 26 $226.00

73719 73719 PR MRI, LOWER EXTREM W/CONTRAST TC TC $614.00

73720 73720 PR MRI, LOWER EXTR, W/O CONTRAST F/U BY CONTRAST 26 26 $297.00

73720 73720 PR MRI, LOWER EXTR, W/O CONTRAST F/U BY CONTRAST TC TC $778.00

73721 73721 PR MRI LOWER EXTREM JT, W/O CONTRAST 26 26 $188.00

73721 73721 PR MRI LOWER EXTREM JT, W/O CONTRAST TC TC $442.00

73722 73722 PR MRI, JOINT OF LEG W/CONTRAST 26 26 $227.00

73722 73722 PR MRI, JOINT OF LEG W/CONTRAST TC TC $782.00

73723 73723 PR MRI, JOINT OF LEG. COMBO 26 26 $298.00

73723 73723 PR MRI, JOINT OF LEG. COMBO TC TC $945.00

73725 73725 PR MR ANGIO LOWER EXTREM (MRA) 26 26 $250.00

73725 73725 PR MR ANGIO LOWER EXTREM (MRA) TC TC $815.00 74000 PR X-RAY ABDOMEN 1 VW 74000 $60.00

74000 74000 PR X-RAY ABDOMEN 1 VW 26 26 $22.00

74010 74010 PR X-RAY ABDOMEN 1+ VW 26 26 $28.00 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW 74018 $70.00

74018 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW 26 26 $26.00

74018 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW TC TC $55.00 74019 CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS 74019 $85.00 74019 74019 CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS 26 26 $33.00

74019 74019 CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS TC TC $67.00 74020 PR X-RAY ABDOMEN 2 VW 74020 $90.00

74020 74020 PR X-RAY ABDOMEN 2 VW 26 26 $32.00 74021 CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS 74021 $99.00

74021 74021 CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS 26 26 $38.00

74021 74021 CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS TC TC $78.00

74022 CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES 74022 $117.00

74022 74022 CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES 26 26 $45.00

74022 74022 CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES TC TC $89.00

74150 74150 PR CT SCAN,ABDOMEN,W/O CONTRAST 26 26 $166.00

74150 74150 PR CT SCAN,ABDOMEN,W/O CONTRAST TC TC $246.00

74160 74160 PR CT SCAN OF ABDOMEN CONTRAST 26 26 $177.00

74160 74160 PR CT SCAN OF ABDOMEN CONTRAST TC TC $504.00

74170 74170 PR CT SCAN OF ABDOMEN COMBO 26 26 $195.00

74170 74170 PR CT SCAN OF ABDOMEN COMBO TC TC $574.00

PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST 74174 74174 IMGES 26 26 $304.00

PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST 74174 74174 IMGES TC TC $812.00

74175 74175 PR CT ANGIO, ABD, COMBO,INCL IMAGE PROC 26 26 $252.00

74175 74175 PR CT ANGIO, ABD, COMBO,INCL IMAGE PROC TC TC $639.00 74176 74176 CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST 26 26 $242.00

74176 74176 CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST TC TC $310.00

74177 74177 PR CT SCAN,ABDOMEN AND PELVIS,W CONTRAST 26 26 $254.00

74177 74177 PR CT SCAN,ABDOMEN AND PELVIS,W CONTRAST TC TC $648.00

74178 74178 CHG CT SCAN,ABDOMENT AND PELVIS,COMBO 26 26 $278.00

74178 74178 CHG CT SCAN,ABDOMENT AND PELVIS,COMBO TC TC $735.00

74181 74181 PR MRI, ABDOMEN (MRI) 26 26 $204.00

74181 74181 PR MRI, ABDOMEN (MRI) TC TC $417.00

74182 74182 PR MRI, ABDOMEN W/CONTRAST 26 26 $241.00

74182 74182 PR MRI, ABDOMEN W/CONTRAST TC TC $728.00

74183 74183 PR MRI, ABDOMEN, COMBO 26 26 $304.00

74183 74183 PR MRI, ABDOMEN, COMBO TC TC $774.00

74185 74185 PR MR ANGIO ABDOMEN (MRA) 26 26 $248.00

74185 74185 PR MR ANGIO ABDOMEN (MRA) TC TC $820.00

74190 74190 PR X-RAY PERITONEUM 26 26 $65.00

74190 74190 PR X-RAY PERITONEUM TC TC $133.00

CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST 74210 74210 STUDY 26 26 $83.00

CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST 74210 74210 STUDY TC TC $180.00

CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST 74220 74220 STUDY 26 26 $86.00 CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST 74220 74220 STUDY TC TC $183.00

CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST 74221 74221 STUDY 26 26 $97.00

CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST 74221 74221 STUDY TC TC $203.00

CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST 74230 74230 STUDY 26 26 $74.00

CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST 74230 74230 STUDY TC TC $283.00

74235 74235 PR REMOVE ESOPHAGUS OBSTRUCTION TC TC $270.00

CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST 74240 74240 STUDY 26 26 $108.00

CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST 74240 74240 STUDY TC TC $221.00

CHG RADEX GI TRACT UPPER W/WO DELAYED IMAGES 74241 74241 W/KUB 26 26 $91.00

CHG RADEX GI TRACT UPR W/SM INT W/MULT SERIAL 74245 74245 IMAGES 26 26 $120.00

CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST 74246 74246 STUDY 26 26 $126.00

CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST 74246 74246 STUDY TC TC $257.00

CHG RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES 74247 74247 W/KUB 26 26 $91.00

CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH 74248 74248 STUDY 26 26 $97.00

CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH 74248 74248 STUDY TC TC $131.00

74249 74249 CHG X-RAY,UPPER GI TRACT W/CONT,SMALL INTEST 26 26 $120.00

CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST 74250 74250 STUDY 26 26 $109.00

CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST 74250 74250 STUDY TC TC $221.00

CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST 74251 74251 STUDY TC TC $944.00 CHG CT COLONOGRAPHY INC IMAGE PROCESS, 74261 74261 DIAGNOSTIC, W/O CONTRAST 26 26 $333.00

CHG CT COLONOGRAPHY INC IMAGE PROCESS, 74261 74261 DIAGNOSTIC, W/O CONTRAST TC TC $982.00

CHG CT COLONOGRAPHY INC IMAGE PROCESS, 74262 74262 DIAGNOSTIC, W/ CONTRAST 26 26 $347.00

CHG CT COLONOGRAPHY INC IMAGE PROCESS, 74262 74262 DIAGNOSTIC, W/ CONTRAST TC TC $1,044.00

74263 74263 CHG CT COLONOGRAPHY INC IMAGE PROCESS, SCREENING 26 26 $318.00

74263 74263 CHG CT COLONOGRAPHY INC IMAGE PROCESS, SCREENING TC TC $1,751.00

74270 74270 CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY 26 26 $144.00

74270 74270 CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY TC TC $281.00

74280 74280 CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY 26 26 $175.00

74280 74280 CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY TC TC $437.00

74283 74283 PR X-RAY B.E. REDUCTN INTUSS 26 26 $288.00

74283 74283 PR X-RAY B.E. REDUCTN INTUSS TC TC $415.00

74290 74290 PR X-RAY GALLBLADDER SINGLE DOSE TC TC $184.00

74300 74300 PR X-RAY OPER CHOLANGIOGRAM 26 26 $50.00

74300 74300 PR X-RAY OPER CHOLANGIOGRAM TC TC $89.00 74301 PR X-RAY OPER CHOLANGIO ADDNL SET 74301 $77.00

74301 74301 PR X-RAY OPER CHOLANGIO ADDNL SET 26 26 $27.00

74301 74301 PR X-RAY OPER CHOLANGIO ADDNL SET TC TC $89.00

74328 74328 PR X-RAY FOR BILE DUCT ENDOSCOPY 26 26 $99.00

74328 74328 PR X-RAY FOR BILE DUCT ENDOSCOPY TC TC $165.00 74329 74329 PR X-RAY FOR PANCREAS ENDOSCOPY 26 26 $99.00

74329 74329 PR X-RAY FOR PANCREAS ENDOSCOPY TC TC $132.00

74330 74330 PR X-RAY BILE/PANCREAS ENDOSCOPY 26 26 $128.00

74330 74330 PR X-RAY BILE/PANCREAS ENDOSCOPY TC TC $246.00

74340 74340 CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I 26 26 $76.00

74340 74340 CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I TC TC $195.00

74355 74355 PR X-RAY GUIDE ENTEROCLYSIS TUBE TC TC $250.00

74360 74360 PR X-RAY GUIDE, GI DILATION 26 26 $79.00

74360 74360 PR X-RAY GUIDE, GI DILATION TC TC $217.00

74363 74363 PR PERCUT TRANSHEPAT DILAT,BILE DUCT STRICT 26 26 $102.00

74363 74363 PR PERCUT TRANSHEPAT DILAT,BILE DUCT STRICT TC TC $197.00 74400 PR X-RAY IV PYELOGRAM (IVP) 74400 $276.00

74400 74400 PR X-RAY IV PYELOGRAM (IVP) 26 26 $68.00

74400 74400 PR X-RAY IV PYELOGRAM (IVP) TC TC $287.00

74410 74410 PR X-RAY IV PYELOGRAM+DRIP INFUSN TC TC $298.00

74415 74415 PR X-RAY IV PYELOGRAM+TOMOGRAPHY TC TC $352.00

74420 74420 PR X-RAY RETROGRADE PYELOGRAM 26 26 $71.00

74420 74420 PR X-RAY RETROGRADE PYELOGRAM TC TC $133.00

CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & 74425 74425 INTERPJ 26 26 $70.00

CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & 74425 74425 INTERPJ TC TC $292.00 74430 74430 X-RAY CYSTOGRAM, MIN 3 VIEW 26 26 $45.00

74430 74430 X-RAY CYSTOGRAM, MIN 3 VIEW TC TC $67.00

74440 74440 PR X-RAY VESICULOGM MALE GENL TRCT TC TC $206.00

74445 74445 PR X-RAY PENIS 26 26 $137.00

74445 74445 PR X-RAY PENIS TC TC $107.00

74450 74450 PR X-RAY URETHROCYSTOGRAM 26 26 $45.00

74450 74450 PR X-RAY URETHROCYSTOGRAM TC TC $151.00

74455 74455 PR X-RAY URETHROCYSTOGRAM+VOIDING 26 26 $45.00

74455 74455 PR X-RAY URETHROCYSTOGRAM+VOIDING TC TC $230.00

74470 74470 PR X-RAY RENAL CYST XLUMBAR+CONTRST TC TC $130.00

74485 74485 PR X-RAY GUIDE, GU DILATION 26 26 $107.00

74485 74485 PR X-RAY GUIDE, GU DILATION TC TC $205.00

74710 74710 PR X-RAY PELVIMETRY TC TC $62.00

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST 74712 74712 GES 26 26 $415.00

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST 74712 74712 GES TC TC $888.00

74713 74713 CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES TC TC $375.00

74740 74740 PR X-RAY HYSTEROSALPINGOGRAM 26 26 $53.00

74740 74740 PR X-RAY HYSTEROSALPINGOGRAM TC TC $202.00

74742 74742 PR X-RAY XCERV CATH FALLOPIAN TUBE 26 26 $86.00 74742 74742 PR X-RAY XCERV CATH FALLOPIAN TUBE TC TC $139.00

74775 74775 PR X-RAY PERINEOGRAM TC TC $151.00

CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O 75557 75557 CONTRAST 26 26 $321.00

CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O 75557 75557 CONTRAST TC TC $561.00

75559 75559 CHG CARDIAC MRI W/O CONTRAST W STRESS IMAGING 26 26 $395.00

75559 75559 CHG CARDIAC MRI W/O CONTRAST W STRESS IMAGING TC TC $830.00

75561 75561 CHG CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ 26 26 $353.00

75561 75561 CHG CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ TC TC $803.00

75563 75563 CHG CARDIAC MRI W/W/O CONTRAST W STRESS 26 26 $408.00

75563 75563 CHG CARDIAC MRI W/W/O CONTRAST W STRESS TC TC $962.00

75565 75565 CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING 26 26 $35.00

75565 75565 CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING TC TC $103.00

CHG CT HEART W/O CONTRAST QUANT EVAL CORONARY 75571 75571 CALCIUM 26 26 $75.00

CHG CT HEART W/O CONTRAST QUANT EVAL CORONARY 75571 75571 CALCIUM TC TC $197.00

75572 75572 CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH 26 26 $241.00

75572 75572 CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH TC TC $480.00

CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH, 75573 75573 CONGEN HEART DISEASE 26 26 $352.00

CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH, 75573 75573 CONGEN HEART DISEASE TC TC $630.00

PR CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D 75574 75574 POST 26 26 $328.00 PR CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D 75574 75574 POST TC TC $720.00

75600 75600 PR ANGIO AORTOGRAM THORACIC 26 26 $65.00

75600 75600 PR ANGIO AORTOGRAM THORACIC TC TC $484.00

75605 75605 PR ANGIO AORTOGRAM THOR SERIAL 26 26 $196.00

75605 75605 PR ANGIO AORTOGRAM THOR SERIAL TC TC $207.00

75625 75625 PR ANGIO AORTOGRAM ABD SERIAL 26 26 $195.00

75625 75625 PR ANGIO AORTOGRAM ABD SERIAL TC TC $189.00

75630 75630 PR ANGIO AORTOBIFEMORAL W CATH 26 26 $271.00

75630 75630 PR ANGIO AORTOBIFEMORAL W CATH TC TC $200.00

75635 75635 PR CT ANGIO AORTOBIFEMORAL, COMBO 26 26 $328.00

75635 75635 PR CT ANGIO AORTOBIFEMORAL, COMBO TC TC $894.00

75658 75658 PR ANGIO RETRO BRACHIAL ANGIO 26 26 $159.00

75705 75705 PR ANGIO SPINAL SELECTV 26 26 $324.00

75705 75705 PR ANGIO SPINAL SELECTV TC TC $370.00

75710 75710 PR ANGIO EXTREMITY UNILAT 26 26 $240.00

75710 75710 PR ANGIO EXTREMITY UNILAT TC TC $214.00

75716 75716 PR ANGIO EXTERMITY BILAT 26 26 $265.00

75716 75716 PR ANGIO EXTERMITY BILAT TC TC $219.00

75726 75726 PR ANGIO VISCERAL SELECTV/SUBSELEC 26 26 $272.00 75726 75726 PR ANGIO VISCERAL SELECTV/SUBSELEC TC TC $237.00

75731 75731 PR ANGIO ADRENAL UNILAT SELECT 26 26 $159.00

75731 75731 PR ANGIO ADRENAL UNILAT SELECT TC TC $292.00

75733 75733 PR ANGIO ADRENAL BILAT SELECT TC TC $310.00

75736 75736 PR ANGIO PELVIS 26 26 $151.00

75736 75736 PR ANGIO PELVIS TC TC $265.00

75741 75741 PR ANGIO PULMON UNILAT SELECT 26 26 $176.00

75741 75741 PR ANGIO PULMON UNILAT SELECT TC TC $220.00

75743 75743 PR ANGIO PULMON BILAT SELECT 26 26 $223.00

75743 75743 PR ANGIO PULMON BILAT SELECT TC TC $222.00

75746 75746 PR ANGIO PULMON BILAT NONSELEC 26 26 $154.00

75746 75746 PR ANGIO PULMON BILAT NONSELEC TC TC $245.00

75756 75756 PR ANGIO INTERN MAMMARY 26 26 $203.00

75756 75756 PR ANGIO INTERN MAMMARY TC TC $297.00

75774 75774 PR ANGIO EA ADDNL SELECTV VESSEL 26 26 $135.00

75774 75774 PR ANGIO EA ADDNL SELECTV VESSEL TC TC $163.00

75791 75791 CHG ANGIO AV SHUNT COMPLETE EVAL 26 26 $201.00

75801 75801 PR LYMPHANGIO EXTREM UNILAT 26 26 $121.00

75801 75801 PR LYMPHANGIO EXTREM UNILAT TC TC $560.00 75803 75803 PR LYMPHANGIO EXTREM BILAT 26 26 $163.00

75803 75803 PR LYMPHANGIO EXTREM BILAT TC TC $560.00

75805 75805 PR LYMPHANGIO ABD/PELV UNILAT 26 26 $109.00

75805 75805 PR LYMPHANGIO ABD/PELV UNILAT TC TC $631.00

75807 75807 PR LYMPHANGIO ABD/PELV BILAT 26 26 $155.00

75807 75807 PR LYMPHANGIO ABD/PELV BILAT TC TC $631.00

75809 75809 PR NONVASCULAR SHUNTOGRAM 26 26 $100.00

75809 75809 PR NONVASCULAR SHUNTOGRAM TC TC $186.00

75810 75810 PR VENOGRAM SPLENOPORTOGRAM 26 26 $151.00

75810 75810 PR VENOGRAM SPLENOPORTOGRAM TC TC $1,300.00

75820 75820 PR VENOGRAM EXTREM UNILAT 26 26 $96.00

75820 75820 PR VENOGRAM EXTREM UNILAT TC TC $202.00

75822 75822 PR VENOGRAM EXTREM BILAT 26 26 $144.00

75822 75822 PR VENOGRAM EXTREM BILAT TC TC $205.00

75825 75825 PR VENOGRAM INFER VENA CAVA 26 26 $154.00

75825 75825 PR VENOGRAM INFER VENA CAVA TC TC $194.00

75827 75827 PR VENOGRAM SUPER VENA CAVA 26 26 $155.00

75827 75827 PR VENOGRAM SUPER VENA CAVA TC TC $207.00

75831 75831 PR VENOGRAM RENAL UNILAT 26 26 $151.00 75831 75831 PR VENOGRAM RENAL UNILAT TC TC $212.00

75833 75833 PR VENOGRAM RENAL BILAT 26 26 $202.00

75833 75833 PR VENOGRAM RENAL BILAT TC TC $234.00

75840 75840 PR VENOGRAM ADRENAL UNILAT 26 26 $159.00

75840 75840 PR VENOGRAM ADRENAL UNILAT TC TC $230.00

75842 75842 PR VENOGRAM ADRENAL BILAT 26 26 $209.00

75842 75842 PR VENOGRAM ADRENAL BILAT TC TC $265.00

75860 75860 PR VENOGRAM SINUS/JUGULAR 26 26 $156.00

75860 75860 PR VENOGRAM SINUS/JUGULAR TC TC $225.00

75870 75870 PR VENOGRAM SUPER SAG SINUS 26 26 $136.00

75870 75870 PR VENOGRAM SUPER SAG SINUS TC TC $329.00

75872 75872 PR VENOGRAM EPIDURAL TC TC $230.00

75880 75880 PR VENOGRAM ORBITAL TC TC $230.00

75885 75885 PR PERCUT XHEPATIC PORTO+DYNAMIC 26 26 $189.00

75885 75885 PR PERCUT XHEPATIC PORTO+DYNAMIC TC TC $223.00

75887 75887 PR PERCUT XHEPATIC PORTOGRAM 26 26 $191.00

75887 75887 PR PERCUT XHEPATIC PORTOGRAM TC TC $224.00

75889 75889 PR VENOGRAM HEPATIC W HEMODYNAMICS 26 26 $150.00

75889 75889 PR VENOGRAM HEPATIC W HEMODYNAMICS TC TC $223.00 75891 PR VENOGRAM HEPATIC 75891 $377.00 75891 75891 PR VENOGRAM HEPATIC 26 26 $153.00

75891 75891 PR VENOGRAM HEPATIC TC TC $226.00

75893 75893 PR VENOUS SAMPLING BY CATHETER 26 26 $76.00

75893 75893 PR VENOUS SAMPLING BY CATHETER TC TC $243.00

75894 75894 PR TRANSCATHETER RX EMBOLIZATN 26 26 $200.00

75894 75894 PR TRANSCATHETER RX EMBOLIZATN TC TC $2,491.00

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN 75898 75898 THROMBYLSIS 26 26 $251.00

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN 75898 75898 THROMBYLSIS TC TC $111.00

75901 75901 PR REMOVE,OBST MATL,CVA DEV VIA SEP VEN ACC 26 26 $66.00

75901 75901 PR REMOVE,OBST MATL,CVA DEV VIA SEP VEN ACC TC TC $546.00

75902 75902 PR REMOVE,OBST MATL,CVA DEVICE VIA LUMEN 26 26 $53.00

75902 75902 PR REMOVE,OBST MATL,CVA DEVICE VIA LUMEN TC TC $187.00

75952 75952 PR ENDOVASC REPAIR AAA 26 26 $560.00

75953 75953 PR PLACEMNT,PROX/DIST EXT PROS, INFRARENAL 26 26 $162.00

CHG REPAIR,ILIAC ANRYSM/PSEUDO/AV MALF/TRAUMA W/ 75954 75954 ENDOPROSTHESIS 26 26 $260.00

75956 PR ENDOVASC REPAIR THOR AORTA INCL SUBCLAVIAN 75956 $855.00

75956 75956 PR ENDOVASC REPAIR THOR AORTA INCL SUBCLAVIAN 26 26 $959.00

75957 75957 PR ENDOVASC REPAIR THOR AORTA EXCL SUBCLAVIAN 26 26 $821.00

75958 75958 PR PROXIMAL EXTENS DURNG ENDOVASC REPR THOR AORTA 26 26 $544.00 75959 75959 PR DELAYED PROX EXTENS ENDOVASC REPR THOR AORTA 26 26 $479.00

75962 75962 PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI 26 26 $65.00

75966 75966 PR BALLOON ANGIOPLASTY VISCERAL 26 26 $159.00

75968 75968 PR BALLOON ANGIO ADDNL VISCERAL 26 26 $44.00

75970 75970 PR VASCULAR BIOPSY 26 26 $106.00

75970 75970 PR VASCULAR BIOPSY TC TC $1,094.00

75978 75978 PR BALLOON ANGIO VENOUS 26 26 $64.00

75984 75984 CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT 26 26 $97.00

75984 75984 CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT TC TC $177.00

75989 75989 PR RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE 26 26 $163.00

75989 75989 PR RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE TC TC $174.00

76000 76000 CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME 26 26 $121.00

76000 76000 CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME TC TC $73.00

76001 76001 CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME 26 26 $80.00

76010 76010 PR X-RAY NOSE-RECTUM CHILD F.B. 26 26 $26.00

76010 76010 PR X-RAY NOSE-RECTUM CHILD F.B. TC TC $54.00

76080 76080 PR X-RAY FISTULA,ABSCESS,SINUS TRACT 26 26 $73.00

76080 76080 PR X-RAY FISTULA,ABSCESS,SINUS TRACT TC TC $91.00

76098 76098 PR X-RAY EXAM, BREAST SPECIMEN 26 26 $45.00 76098 76098 PR X-RAY EXAM, BREAST SPECIMEN TC TC $75.00

76100 76100 PR X-RAY TOMOGRAM TC TC $183.00

76101 76101 PR COMPLEX TOMOGRAM UNILAT TC TC $195.00

76102 76102 PR COMPLEX TOMOGRAM BILAT TC TC $398.00

76120 76120 PR CINE/VIDEORADIOLOGY,EXC WHERE SPEC INCL 26 26 $47.00

76120 76120 PR CINE/VIDEORADIOLOGY,EXC WHERE SPEC INCL TC TC $247.00

76125 76125 PR CINE/VIDEORADIOGRAPHY W/ROUTINE EXAM TC TC $82.00 76140 PR X-RAY CONSULTATION 76140 $226.00

CHG MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS 76145 W/RPRT 76145 $2,201.00

CHG 3D RENDERING W/INTERP & POSTPROCESS 76376 SUPERVISION 76376 $162.00

CHG 3D RENDERING W/INTERP & POSTPROCESS 76376 76376 SUPERVISION 26 26 $28.00

CHG 3D RENDERING W/INTERP & POSTPROCESS 76376 76376 SUPERVISION TC TC $37.00

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK 76377 STATION 76377 $212.00

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK 76377 76377 STATION 26 26 $106.00

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK 76377 76377 STATION TC TC $89.00

76380 76380 PR CT SCAN,LIMITED/LOCALIZED F/U STUDY 26 26 $134.00

76380 76380 PR CT SCAN,LIMITED/LOCALIZED F/U STUDY TC TC $265.00

76390 76390 PR MRI SPECTROSCOPY 26 26 $196.00

76390 76390 PR MRI SPECTROSCOPY TC TC $976.00 76391 CHG MAGNETIC RESONANCE ELASTOGRAPHY 76391 $601.00 76391 76391 CHG MAGNETIC RESONANCE ELASTOGRAPHY 26 26 $155.00

76391 76391 CHG MAGNETIC RESONANCE ELASTOGRAPHY TC TC $486.00

76496 76496 CHG UNLISTED FLUOROSCOPIC PROCEDURE 26 26 $205.00

76496 76496 CHG UNLISTED FLUOROSCOPIC PROCEDURE TC TC $117.00

76497 76497 PR UNLISTED CT PROCEDURE 26 26 $150.00

76497 76497 PR UNLISTED CT PROCEDURE TC TC $225.00

76498 76498 PR UNLISTED MR PROCEDURE 26 26 $331.00

76498 76498 PR UNLISTED MR PROCEDURE TC TC $785.00

76499 76499 CHG UNLISTED DX RADIOGRAPHIC PROCEDURE 26 26 $100.00

76506 76506 US, HEAD, REAL TIME 26 26 $89.00

76506 76506 US, HEAD, REAL TIME TC TC $229.00

76510 76510 US, EYE, B-SCAN & QUANT A-SCAN TC TC $110.00

76511 76511 US, EYE A-SCAN 26 26 $138.00

76511 76511 US, EYE A-SCAN TC TC $72.00

76512 76512 US, EYE B-SCAN 26 26 $138.00

76512 76512 US, EYE B-SCAN TC TC $59.00

76513 76513 CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI 26 26 $95.00

76513 76513 CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI TC TC $176.00

76514 76514 US, EYE, FOR CORNEAL THICKNESS 26 26 $26.00 76514 76514 US, EYE, FOR CORNEAL THICKNESS TC TC $11.00 76516 US, EYE BIOMETRY 76516 $197.00

76516 76516 US, EYE BIOMETRY 26 26 $81.00

76516 76516 US, EYE BIOMETRY TC TC $70.00 76519 US, EYE BIOMETRY W LENS CALC 76519 $212.00

76519 76519 US, EYE BIOMETRY W LENS CALC 26 26 $82.00

76519 76519 US, EYE BIOMETRY W LENS CALC TC TC $98.00

76529 76529 US, EYE F.B. LOCALIZATION TC TC $140.00 76536 US, HEAD/NECK TISSUES,REAL TIME 76536 $320.00

76536 76536 US, HEAD/NECK TISSUES,REAL TIME 26 26 $79.00

76536 76536 US, HEAD/NECK TISSUES,REAL TIME TC TC $242.00

76604 76604 US, CHEST,REAL TIME 26 26 $81.00

76604 76604 US, CHEST,REAL TIME TC TC $138.00

76641 76641 CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE 26 26 $101.00

76641 76641 CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE TC TC $195.00

76642 76642 CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED 26 26 $94.00

76642 76642 CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED TC TC $148.00

76700 76700 US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE 26 26 $109.00

76700 76700 US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE TC TC $226.00 76705 US ABDOMEN LIMITED 76705 $270.00

76705 76705 US ABDOMEN LIMITED 26 26 $82.00 76705 76705 US ABDOMEN LIMITED TC TC $171.00

76706 CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA 76706 $239.00

76706 76706 CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA 26 26 $77.00

76706 76706 CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA TC TC $238.00 76770 PR US,RETROPERIT,REAL TIME,COMPLETE 76770 $321.00

76770 76770 PR US,RETROPERIT,REAL TIME,COMPLETE 26 26 $102.00

76770 76770 PR US,RETROPERIT,REAL TIME,COMPLETE TC TC $211.00 76775 US, RETROPERITNL ABD, LTD 76775 $259.00

76775 76775 US, RETROPERITNL ABD, LTD 26 26 $88.00

76775 76775 US, RETROPERITNL ABD, LTD TC TC $83.00

76776 76776 PR US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER 26 26 $107.00

76776 76776 PR US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER TC TC $325.00

76800 76800 US, SPINAL CANAL & CONTENTS 26 26 $163.00

76800 76800 US, SPINAL CANAL & CONTENTS TC TC $233.00 76801 US, OB < 14 WKS, SINGLE FETUS 76801 $310.00

76801 76801 US, OB < 14 WKS, SINGLE FETUS 26 26 $140.00

76801 76801 US, OB < 14 WKS, SINGLE FETUS TC TC $200.00 76802 US, OB < 14 WKS, ADD'L FETUS 76802 $163.00

76802 76802 US, OB < 14 WKS, ADD'L FETUS 26 26 $120.00

76802 76802 US, OB < 14 WKS, ADD'L FETUS TC TC $60.00 76805 US, OB >/= 14 WKS, SNGL FETUS 76805 $358.00

76805 76805 US, OB >/= 14 WKS, SNGL FETUS 26 26 $140.00 76805 76805 US, OB >/= 14 WKS, SNGL FETUS TC TC $249.00

76810 76810 US, OB >/= 14 WKS, ADDL FETUS 26 26 $145.00

76810 76810 US, OB >/= 14 WKS, ADDL FETUS TC TC $112.00 76811 PR US,PREG UTER,FET & MAT,+ DETL FET EXM 76811 $480.00

76811 76811 PR US,PREG UTER,FET & MAT,+ DETL FET EXM 26 26 $263.00

76811 76811 PR US,PREG UTER,FET & MAT,+ DETL FET EXM TC TC $228.00

76812 76812 PR US,PREG UTER,FET & MAT,+ DETL FET,ADDL 26 26 $250.00

76812 76812 PR US,PREG UTER,FET & MAT,+ DETL FET,ADDL TC TC $304.00

76813 PR US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON 76813 $303.00

76813 76813 PR US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON 26 26 $160.00

76813 76813 PR US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON TC TC $172.00

76814 PR US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST 76814 $202.00

76814 76814 PR US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST 26 26 $140.00

76814 76814 PR US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST TC TC $81.00

76815 CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES 76815 $219.00

76815 76815 CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES 26 26 $90.00

76815 76815 CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES TC TC $142.00 76816 PR US,PREGNANT UTERUS,F/U,TRANSABD APP 76816 $288.00

76816 76816 PR US,PREGNANT UTERUS,F/U,TRANSABD APP 26 26 $120.00

76816 76816 PR US,PREGNANT UTERUS,F/U,TRANSABD APP TC TC $195.00 76817 PR US,PREGNANT UTERUS,TRANSVAGINAL 76817 $247.00 76817 76817 PR US,PREGNANT UTERUS,TRANSVAGINAL 26 26 $110.00

76817 76817 PR US,PREGNANT UTERUS,TRANSVAGINAL TC TC $161.00 76818 PR FETAL BIOPHYSICAL PROFILE 76818 $305.00

76818 76818 PR FETAL BIOPHYSICAL PROFILE 26 26 $160.00

76818 76818 PR FETAL BIOPHYSICAL PROFILE TC TC $181.00 76819 PR FETAL BIOPHYS PROF,W/O NST 76819 $222.00

76819 76819 PR FETAL BIOPHYS PROF,W/O NST 26 26 $110.00

76819 76819 PR FETAL BIOPHYS PROF,W/O NST TC TC $133.00 76820 CHG US DOPPLER FETAL UMBILICAL ARTERY 76820 $118.00

76820 76820 CHG US DOPPLER FETAL UMBILICAL ARTERY 26 26 $70.00

76820 76820 CHG US DOPPLER FETAL UMBILICAL ARTERY TC TC $60.00

76821 76821 CHG US DOPPLER FETAL MID CEREBRAL ARTERY 26 26 $240.00

76821 76821 CHG US DOPPLER FETAL MID CEREBRAL ARTERY TC TC $154.00 76825 ECHOCARDIOGRAPHY FETAL,2D,COMPLT 76825 $691.00

76825 76825 ECHOCARDIOGRAPHY FETAL,2D,COMPLT 26 26 $210.00

76825 76825 ECHOCARDIOGRAPHY FETAL,2D,COMPLT TC TC $527.00 76826 ECHOCARDIOGRAPHY FETAL,2D,F/U,REPT 76826 $410.00

76826 76826 ECHOCARDIOGRAPHY FETAL,2D,F/U,REPT 26 26 $107.00

76826 76826 ECHOCARDIOGRAPHY FETAL,2D,F/U,REPT TC TC $335.00 76827 FETAL ECHOCARDIOGRAPHY DOPPLER,COMP 76827 $191.00

76827 76827 FETAL ECHOCARDIOGRAPHY DOPPLER,COMP 26 26 $86.00

76827 76827 FETAL ECHOCARDIOGRAPHY DOPPLER,COMP TC TC $124.00 76828 FETAL ECHO DOPPLER F/U 76828 $134.00 76828 76828 FETAL ECHO DOPPLER F/U 26 26 $75.00

76828 76828 FETAL ECHO DOPPLER F/U TC TC $67.00 76830 PR ECHOGRAPHY,TRANSVAGINAL 76830 $340.00

76830 76830 PR ECHOGRAPHY,TRANSVAGINAL 26 26 $100.00

76830 76830 PR ECHOGRAPHY,TRANSVAGINAL TC TC $244.00

76831 76831 PR SONO EXAM, HYSTEROSONOGRAPHY 26 26 $160.00

76831 76831 PR SONO EXAM, HYSTEROSONOGRAPHY TC TC $229.00

76856 PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE 76856 $303.00

76856 76856 PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE 26 26 $95.00

76856 76856 PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE TC TC $208.00

76857 76857 PR US,PELVIC (NONOBSTETRIC),REAL TIME,LIMITED 26 26 $70.00

76857 76857 PR US,PELVIC (NONOBSTETRIC),REAL TIME,LIMITED TC TC $66.00

76870 76870 PR ECHO,SCROTUM & CONTENTS 26 26 $89.00

76870 76870 PR ECHO,SCROTUM & CONTENTS TC TC $202.00 76872 PR ECHO,TRANSRECTAL 76872 $240.00

76872 76872 PR ECHO,TRANSRECTAL 26 26 $121.00

76872 76872 PR ECHO,TRANSRECTAL TC TC $396.00 76873 PR ECHO,TRANSRECTAL,PROSTATE VOL 76873 $195.00

76873 76873 PR ECHO,TRANSRECTAL,PROSTATE VOL 26 26 $195.00

76873 76873 PR ECHO,TRANSRECTAL,PROSTATE VOL TC TC $268.00

76881 76881 CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION 26 26 $88.00 76881 76881 CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION TC TC $128.00

76882 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG 76882 $158.00

76882 76882 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG 26 26 $68.00

76882 76882 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG TC TC $90.00

76885 76885 CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ 26 26 $103.00

76885 76885 CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ TC TC $294.00

76886 76886 CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ 26 26 $87.00

76886 76886 CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ TC TC $205.00

76930 76930 PR SONO GUIDE PERICARD TAP 26 26 $84.00

76932 76932 PR SONO GUIDE HEART BIOPSY 26 26 $93.00

76932 76932 PR SONO GUIDE HEART BIOPSY TC TC $159.00

76936 76936 PR US GUID,COMP REPAIR,PSEUDO-ANEUR/AV FIST 26 26 $244.00

76936 76936 PR US GUID,COMP REPAIR,PSEUDO-ANEUR/AV FIST TC TC $475.00 76937 PR US GUIDE, VASCULAR ACCESS 76937 $101.00

76937 76937 PR US GUIDE, VASCULAR ACCESS 26 26 $41.00

76937 76937 PR US GUIDE, VASCULAR ACCESS TC TC $63.00

76940 76940 PR US GUIDE, TISSUE ABLATION 26 26 $287.00

76940 76940 PR US GUIDE, TISSUE ABLATION TC TC $177.00

76941 76941 PR SONO GUIDE INTRAUTER XFUSN 26 26 $180.00

76941 76941 PR SONO GUIDE INTRAUTER XFUSN TC TC $158.00 76942 PR SONO GUIDE NEEDLE BIOPSY 76942 $487.00

76942 76942 PR SONO GUIDE NEEDLE BIOPSY 26 26 $100.00

76942 76942 PR SONO GUIDE NEEDLE BIOPSY TC TC $71.00

76945 76945 PR SONO GUIDE CHOR VILL SAMPLING 26 26 $100.00

76945 76945 PR SONO GUIDE CHOR VILL SAMPLING TC TC $158.00

76946 76946 PR SONO GUIDE AMNIOCENTESIS 26 26 $60.00

76946 76946 PR SONO GUIDE AMNIOCENTESIS TC TC $38.00

76948 76948 PR SONO GUIDE OVA ASPIRATION TC TC $122.00

76965 76965 PR SONO GUIDE RADIOELEMT APPLIC 26 26 $169.00

76965 76965 PR SONO GUIDE RADIOELEMT APPLIC TC TC $70.00 76975 PR GI ENDOSCOPIC ULTRASOUND 76975 $559.00

76975 76975 PR GI ENDOSCOPIC ULTRASOUND 26 26 $112.00

76975 76975 PR GI ENDOSCOPIC ULTRASOUND TC TC $159.00

76977 76977 PR SONO BONE DENSITY MEASURE,PERIPHERAL TC TC $12.00

76978 CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION 76978 $828.00

76978 76978 CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION 26 26 $224.00

76978 76978 CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION TC TC $677.00

CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL 76979 LES 76979 $562.00

CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL 76979 76979 LES 26 26 $114.00

CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL 76979 76979 LES TC TC $493.00 76981 CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA 76981 $274.00

76981 76981 CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA 26 26 $83.00

76981 76981 CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA TC TC $216.00

76982 CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION 76982 $246.00

76982 76982 CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION 26 26 $83.00

76982 76982 CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION TC TC $183.00

76983 CHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION 76983 $151.00

76983 76983 CHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION 26 26 $65.00

76983 76983 CHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION TC TC $97.00

76998 76998 PR ULTRASONIC GUIDANCE, INTRAOPERATIVE 26 26 $177.00

76998 76998 PR ULTRASONIC GUIDANCE, INTRAOPERATIVE TC TC $475.00

76999 76999 PR UNLISTED ULTRASOUND PROCEDURE 26 26 $3,500.00

PR FLUOROGUIDE CNTRL VEN 77001 77001 ACCESS,PLACE,REPLACE,REMOVE 26 26 $52.00

PR FLUOROGUIDE CNTRL VEN 77001 77001 ACCESS,PLACE,REPLACE,REMOVE TC TC $215.00

77002 CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON 77002 $239.00

77002 77002 CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON 26 26 $78.00

77002 77002 CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON TC TC $227.00

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER 77003 ADDON 77003 $145.00

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER 77003 77003 ADDON 26 26 $84.00 CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER 77003 77003 ADDON TC TC $196.00

77011 77011 PR CT GUIDANCE STEREOTACTIC LOCALIZATION 26 26 $177.00

77011 77011 PR CT GUIDANCE STEREOTACTIC LOCALIZATION TC TC $466.00

77012 77012 PR CT GUIDANCE NEEDLE PLACEMENT 26 26 $206.00

77012 77012 PR CT GUIDANCE NEEDLE PLACEMENT TC TC $212.00

77013 77013 PR CT GUIDANCE TISSUE ABLATION 26 26 $531.00

77013 77013 PR CT GUIDANCE TISSUE ABLATION TC TC $820.00

77014 77014 PR CT GUIDANCE PLACEMENT RAD THERAPY FIELDS 26 26 $152.00

77014 77014 PR CT GUIDANCE PLACEMENT RAD THERAPY FIELDS TC TC $213.00

77021 77021 PR MRI GUIDANCE NEEDLE PLACEMENT 26 26 $203.00

77021 77021 PR MRI GUIDANCE NEEDLE PLACEMENT TC TC $1,079.00

77022 77022 PR MRI GUIDANCE TISSUE ABLATION 26 26 $599.00

77022 77022 PR MRI GUIDANCE TISSUE ABLATION TC TC $1,158.00

77046 CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL 77046 $633.00

77046 77046 CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL 26 26 $202.00

77046 77046 CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL TC TC $474.00

77047 CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL 77047 $650.00

77047 77047 CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL 26 26 $222.00

77047 77047 CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL TC TC $471.00 CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD 77048 UNILATERAL 77048 $1,005.00

CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD 77048 77048 UNILATERAL 26 26 $291.00

CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD 77048 77048 UNILATERAL TC TC $779.00

CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD 77049 BILATERAL 77049 $1,027.00

CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD 77049 77049 BILATERAL 26 26 $319.00

CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD 77049 77049 BILATERAL TC TC $776.00

77051 77051 CHG COMPUTER-AIDED DETECTION DX MAMMOGRAPHY 26 26 $8.00

CHG COMPUTER-AIDED DETECTION SCREENING 77052 77052 MAMMOGRAPHY 26 26 $8.00

77053 77053 PR MAMMARY DUCTOGRAM, SINGLE 26 26 $50.00

77053 77053 PR MAMMARY DUCTOGRAM, SINGLE TC TC $107.00

77054 77054 PR MAMMARY DUCTOGRAM, MULTIPLE TC TC $140.00

77055 77055 PR MAMMOGRAPHY; UNILATERAL 26 26 $66.00

77056 77056 PR MAMMOGRAPHY; BILATERAL 26 26 $101.00

77057 77057 CHG SCREENING MAMMOGRAPHY BILATERAL 26 26 $81.00

77058 77058 PR MRI BREAST, W/WO CONTRAST, SINGLE 26 26 $189.00

77059 77059 PR MRI BREAST, W/WO CONTRAST, BILATERAL 26 26 $189.00

77061 77061 CHG DIGITAL BREAST TOMOSYNTHESIS UNILATERAL 26 26 $197.00

77061 77061 CHG DIGITAL BREAST TOMOSYNTHESIS UNILATERAL TC TC $325.00

77062 CHG DIGITAL BREAST TOMOSYNTHESIS BILATERAL 77062 $423.00 77062 77062 CHG DIGITAL BREAST TOMOSYNTHESIS BILATERAL 26 26 $222.00

77062 77062 CHG DIGITAL BREAST TOMOSYNTHESIS BILATERAL TC TC $396.00

77063 77063 CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI 26 26 $84.00

77063 77063 CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI TC TC $69.00

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ 77065 77065 UNI 26 26 $109.00

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ 77065 77065 UNI TC TC $257.00

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ 77066 77066 BI 26 26 $139.00

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ 77066 77066 BI TC TC $327.00

CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC 77067 77067 CAD 26 26 $108.00

CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC 77067 77067 CAD TC TC $271.00 77072 PR X-RAYS FOR BONE AGE 77072 $70.00

77072 77072 PR X-RAYS FOR BONE AGE 26 26 $27.00

77072 77072 PR X-RAYS FOR BONE AGE TC TC $44.00

77073 77073 PR X-RAYS, BONE LENGTH STUDIES 26 26 $39.00

77073 77073 PR X-RAYS, BONE LENGTH STUDIES TC TC $84.00

77074 77074 PR X-RAYS, BONE SURVEY, LIMITED 26 26 $62.00

77074 77074 PR X-RAYS, BONE SURVEY, LIMITED TC TC $112.00 77075 PR X-RAYS, BONE SURVEY COMPLETE 77075 $240.00

77075 77075 PR X-RAYS, BONE SURVEY COMPLETE 26 26 $78.00

77075 77075 PR X-RAYS, BONE SURVEY COMPLETE TC TC $185.00 77076 77076 PR X-RAYS, BONE SURVEY, INFANT 26 26 $97.00

77076 77076 PR X-RAYS, BONE SURVEY, INFANT TC TC $187.00 77077 PR JOINT SURVEY, SINGLE VIEW 77077 $97.00

77077 77077 PR JOINT SURVEY, SINGLE VIEW 26 26 $48.00

77077 77077 PR JOINT SURVEY, SINGLE VIEW TC TC $79.00

77078 77078 PR CT BONE DENS STUDY, 1+ SITE,AXIAL 26 26 $35.00

77078 77078 PR CT BONE DENS STUDY, 1+ SITE,AXIAL TC TC $281.00 77080 PR DEXA,BONE DENSITY,AXIAL SKELETON 77080 $309.00

77080 77080 PR DEXA,BONE DENSITY,AXIAL SKELETON 26 26 $28.00

77080 77080 PR DEXA,BONE DENSITY,AXIAL SKELETON TC TC $82.00 77081 PR DEXA,BONE DENSITY,APPENDICULR SKELTN 77081 $77.00

77081 77081 PR DEXA,BONE DENSITY,APPENDICULR SKELTN 26 26 $29.00

77081 77081 PR DEXA,BONE DENSITY,APPENDICULR SKELTN TC TC $61.00

77084 77084 PR MRI, BONE MARROW 26 26 $223.00

77084 77084 PR MRI, BONE MARROW TC TC $800.00

77085 77085 CHG DXA BONE DENSITY STUDY AXIAL SKELETON TC TC $106.00

77086 77086 CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA TC TC $72.00 77261 CHG RADIATION THERAPY PLAN SIMPLE 77261 $290.00 77262 CHG RADIATION THERAPY PLAN INTERM 77262 $286.00 77263 CHG RADIATION THERAPY PLAN COMPLEX 77263 $648.00

77280 77280 CHG SET RADN THERAPY FIELD SIMPLE 26 26 $190.00

77280 77280 CHG SET RADN THERAPY FIELD SIMPLE TC TC $663.00 77285 77285 CHG SET RADN THERAPY FIELD INTERME TC TC $1,051.00

77290 77290 CHG SET RADN THERAPY FIELD COMPLEX 26 26 $315.00

77290 77290 CHG SET RADN THERAPY FIELD COMPLEX TC TC $1,054.00

77293 77293 CHG RESPIRATORY MOTION MANAGEMENT SIMULATION 26 26 $257.00

77293 77293 CHG RESPIRATORY MOTION MANAGEMENT SIMULATION TC TC $953.00

77295 77295 CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS 26 26 $919.00

77295 77295 CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS TC TC $720.00

77300 77300 CHG RADIATION THERAPY,DOSIMETRY PLAN 26 26 $128.00

77300 77300 CHG RADIATION THERAPY,DOSIMETRY PLAN TC TC $93.00

77301 77301 CHG INTEN MOD RADIOTHER PLAN W/DOSE VOL HIST 26 26 $1,613.00

77301 77301 CHG INTEN MOD RADIOTHER PLAN W/DOSE VOL HIST TC TC $4,109.00

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY 77306 77306 CALCULATION 26 26 $177.00

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY 77306 77306 CALCULATION TC TC $208.00

77307 77307 CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY 26 26 $366.00

77307 77307 CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY TC TC $376.00

77316 77316 CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL 26 26 $177.00

77316 77316 CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL TC TC $405.00

77317 77317 CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL 26 26 $233.00

77317 77317 CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL TC TC $532.00 77318 77318 CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL 26 26 $367.00

77318 77318 CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL TC TC $719.00

77321 77321 CHG TELETHER ISO-PORT PLAN 26 26 $191.00

77321 77321 CHG TELETHER ISO-PORT PLAN TC TC $121.00

77331 77331 CHG SPECIAL RADIATION DOSIMETRY 26 26 $175.00

77331 77331 CHG SPECIAL RADIATION DOSIMETRY TC TC $52.00

77332 77332 CHG RADN TREATMENT AID(S) SIMPLE 26 26 $109.00

77332 77332 CHG RADN TREATMENT AID(S) SIMPLE TC TC $65.00

77333 77333 CHG RADN TREATMENT AID(S) INTERM 26 26 $169.00

77333 77333 CHG RADN TREATMENT AID(S) INTERM TC TC $238.00

77334 77334 CHG RADN TREATMENT AID(S) COMPLX 26 26 $250.00

77334 77334 CHG RADN TREATMENT AID(S) COMPLX TC TC $183.00

77338 77338 CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN 26 26 $870.00

77338 77338 CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN TC TC $718.00

77387 CHG GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR 77387 $187.00

77387 77387 CHG GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR 26 26 $60.00

77401 CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA 77401 $51.00 77427 CHG RADIATION,MANGEMENT,5 TX'S 77427 $668.00 77431 CHG RADIATION THERAPY MANAGEMENT 77431 $379.00

CHG STEREOTACTIC RADIATION TX MANAGEMENT CRANIAL 77432 LESION 77432 $2,640.00 77435 CHG RADN RX DELIV,BODY, MANAGEMENT, PER COURSE 77435 $2,444.00

77470 77470 PR SPECIAL TREATMENT PROCEDURE 26 26 $422.00

77470 77470 PR SPECIAL TREATMENT PROCEDURE TC TC $71.00

77600 77600 CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL TC TC $1,090.00

77605 77605 CHG HYPERTHERMIA EXTERNAL GENERATED DEEP TC TC $2,334.00

77610 77610 CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS TC TC $1,694.00

77615 77615 CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS TC TC $2,680.00

77620 77620 CHG HYPERTHERMIA RX INTRACAV PROBE TC TC $1,455.00

77750 77750 CHG INFUSE RADIOACTIVE MATERIALS TC TC $333.00

77761 77761 CHG INTRACAV RADIOELEM APPL SIMPLE TC TC $554.00

77762 77762 CHG INTRACAV RADIOELEM APPL INTERM TC TC $635.00

77763 77763 CHG INTRACAV RADIOELEM APPL COMPLX TC TC $820.00

77767 77767 CHG HDR RDNCL SKN SURF BRACHYTX LES

CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT 77768 77768 LES 26 26 $185.00

CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT 77768 77768 LES TC TC $788.00

77770 77770 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL 26 26 $255.00

77770 77770 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL TC TC $643.00

77771 77771 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL 26 26 $497.00 77771 77771 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL TC TC $1,033.00

77772 77772 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS 26 26 $705.00

77772 77772 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS TC TC $1,712.00

77778 77778 CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX 26 26 $2,253.00

77778 77778 CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX TC TC $1,086.00

CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE 77789 77789 SOURCE 26 26 $228.00

CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE 77789 77789 SOURCE TC TC $185.00

77799 77799 PR RADIUM/RADIOISOTOPE THERAPY UNLIST 26 26 $800.00

CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT 78012 78012 MEASUREMENT 26 26 $27.00

CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT 78012 78012 MEASUREMENT TC TC $202.00

78013 78013 CHG THYROID IMAGING WITH VASCULAR FLOW 26 26 $50.00

78013 78013 CHG THYROID IMAGING WITH VASCULAR FLOW TC TC $487.00

CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN 78014 78014 MEAS 26 26 $68.00

CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN 78014 78014 MEAS TC TC $604.00

78015 78015 PR THYROID MET IMAGING LTD 26 26 $92.00

78015 78015 PR THYROID MET IMAGING LTD TC TC $537.00

78016 78016 PR THYROID MET IMAGING ADDN LTD TC TC $696.00

78018 78018 PR THYROID MET IMAGING BODY 26 26 $109.00

78018 78018 PR THYROID MET IMAGING BODY TC TC $762.00 78020 78020 PR THYROID MET UPTAKE 26 26 $78.00

78020 78020 PR THYROID MET UPTAKE TC TC $155.00

78070 78070 CHG PARATHYROID PLANAR IMAGING 26 26 $108.00

78070 78070 CHG PARATHYROID PLANAR IMAGING TC TC $722.00

78071 78071 CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION 26 26 $163.00

78071 78071 CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION TC TC $828.00

78072 78072 CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT 26 26 $214.00

78072 78072 CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT TC TC $1,035.00

78075 78075 PR ADRENAL NUCLEAR IMAGING TC TC $1,058.00

78102 78102 PR BONE MARROW IMAGING, LTD 26 26 $74.00

78102 78102 PR BONE MARROW IMAGING, LTD TC TC $403.00

78103 78103 PR BONE MARROW IMAGING, MULT 26 26 $97.00

78103 78103 PR BONE MARROW IMAGING, MULT TC TC $510.00

78104 78104 PR BONE MARROW IMAGING, BODY TC TC $591.00

78110 78110 PR PLASMA VOLUME, SINGLE TC TC $173.00

78111 78111 PR PLASMA VOLUME, MULTIPLE TC TC $180.00

78120 78120 PR RED CELL MASS, SINGLE TC TC $173.00

78121 78121 PR RED CELL MASS, MULTIPLE TC TC $180.00

78122 78122 PR BLOOD VOLUME TC TC $211.00 78130 78130 CHG RED CELL SURVIVAL STUDY TC TC $280.00

78140 78140 PR RED CELL SEQUESTRATION TC TC $241.00

78185 78185 PR SPLEEN IMAGING TC TC $431.00

78191 78191 PR PLATELET SURVIVAL TC TC $280.00

78195 78195 PR LYMPHATICS & LYMPH GLANDS IMAGING 26 26 $162.00

78195 78195 PR LYMPHATICS & LYMPH GLANDS IMAGING TC TC $832.00

78201 78201 PR LIVER IMAGING 26 26 $59.00

78201 78201 PR LIVER IMAGING TC TC $476.00

78202 78202 PR LIVER IMAGING WITH FLOW 26 26 $67.00

78202 78202 PR LIVER IMAGING WITH FLOW TC TC $509.00

78205 78205 PR LIVER IMAGING (SPECT) 26 26 $89.00

78206 78206 PR LIVER IMAGE (3-D) W/FLOW 26 26 $123.00

78215 78215 PR LIVER AND SPLEEN IMAGING 26 26 $67.00

78215 78215 PR LIVER AND SPLEEN IMAGING TC TC $481.00

78216 78216 PR LIVER & SPLEEN IMAGE, FLOW TC TC $286.00

78226 78226 PR HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER 26 26 $101.00

78226 78226 PR HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER TC TC $817.00

78227 78227 PR HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ 26 26 $125.00

78227 78227 PR HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ TC TC $1,025.00 78230 78230 PR SALIVARY GLAND IMAGING TC TC $426.00

78231 78231 PR SERIAL SALIVARY IMAGING TC TC $235.00

78232 78232 PR SALIVARY GLAND FUNCTION EXAM TC TC $235.00

78258 78258 PR ESOPHAGEAL MOTILITY STUDY TC TC $509.00

78261 78261 PR GASTRIC MUCOSA IMAGING TC TC $491.00

78262 78262 PR GASTROESOPHAGEAL REFLUX EXAM TC TC $578.00

78264 78264 CHG GASTRIC EMPTYING IMAGING STUDY 26 26 $108.00

78264 78264 CHG GASTRIC EMPTYING IMAGING STUDY TC TC $824.00

78265 78265 CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT TC TC $968.00

CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT 78266 78266 DAY TC TC $1,067.00

78278 78278 PR ACUTE GI BLOOD LOSS IMAGING 26 26 $136.00

78278 78278 PR ACUTE GI BLOOD LOSS IMAGING TC TC $839.00

78282 78282 PR GI PROTEIN LOSS EXAM TC TC $259.00

78290 78290 PR BOWEL IMAGING 26 26 $92.00

78290 78290 PR BOWEL IMAGING TC TC $832.00

78291 78291 PR LEVEEN/SHUNT PATENCY EXAM TC TC $595.00

78300 78300 PR BONE IMAGING, LIMITED AREA 26 26 $87.00

78300 78300 PR BONE IMAGING, LIMITED AREA TC TC $556.00

78305 78305 PR BONE IMAGING, MULTIPLE AREAS 26 26 $109.00 78305 78305 PR BONE IMAGING, MULTIPLE AREAS TC TC $663.00

78306 78306 PR BONE IMAGING, WHOLE BODY 26 26 $113.00

78306 78306 PR BONE IMAGING, WHOLE BODY TC TC $725.00

78315 78315 CHG BONE IMAGING, 3 PHASE 26 26 $140.00

78315 78315 CHG BONE IMAGING, 3 PHASE TC TC $830.00

78320 78320 PR BONE IMAGING (SPECT) 26 26 $132.00 78350 CHG BONE MINERAL, SINGLE PHOTON 78350 $83.00

78350 78350 CHG BONE MINERAL, SINGLE PHOTON 26 26 $28.00

78350 78350 CHG BONE MINERAL, SINGLE PHOTON TC TC $59.00

78414 78414 PR NON-IMAGING HEART FUNCTION TC TC $478.00

78428 78428 PR CARDIAC SHUNT IMAGING TC TC $414.00

CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT 78429 78429 CT 26 26 $213.00

CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT 78429 78429 CT TC TC $3,166.00

78430 78430 CHG MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT 26 26 $221.00

78430 78430 CHG MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT TC TC $3,591.00

78431 78431 CHG MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT 26 26 $257.00

78431 78431 CHG MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT TC TC $3,591.00

78432 78432 CHG MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER 26 26 $273.00

78432 78432 CHG MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER TC TC $3,591.00

CHG MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT 78433 78433 CT 26 26 $299.00 CHG MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT 78433 78433 CT TC TC $3,591.00

78434 78434 CHG AQMBF PET REST AND PHARMACOLOGIC STRESS 26 26 $264.00

78434 78434 CHG AQMBF PET REST AND PHARMACOLOGIC STRESS TC TC $1,796.00

78445 78445 PR VASCULAR FLOW IMAGING,NONCARDIAC TC TC $478.00

MYOCARDIAL SPECT,SINGLE,REST OR STRESS,EF,WALL 78451 78451 MOTION 26 26 $186.00

MYOCARDIAL SPECT,SINGLE,REST OR STRESS,EF,WALL 78451 78451 MOTION TC TC $756.00

MYOCARDIAL SPECT MULTIPLE STUDIES,REST,STRESS,BLOOD 78452 78452 POOL IMAGING GTD 26 26 $220.00

MYOCARDIAL SPECT MULTIPLE STUDIES,REST,STRESS,BLOOD 78452 78452 POOL IMAGING GTD TC TC $1,095.00

78453 78453 MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS TC TC $709.00

78454 78454 MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES TC TC $1,030.00

78456 78456 PR IMAG,ACUTE VENOUS THRMBSIS,PEP TC TC $729.00

78457 78457 PR IMAG,ACUTE VENOUS THRMBSIS,UNILAT TC TC $388.00

78458 78458 PR VEN THROMBOSIS IMAGES, BILAT TC TC $449.00

78459 78459 CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY 26 26 $211.00

78459 78459 CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY TC TC $3,166.00

78466 78466 PR HEART INFARCT IMAGE TC TC $462.00

78468 78468 PR HEART INFARCT IMAGE W EF TC TC $432.00

78469 78469 PR HEART INFARCT IMAGE SPECT 26 26 $115.00 78469 78469 PR HEART INFARCT IMAGE SPECT TC TC $500.00

78472 78472 CARDIAC BLOOD POOL IMAGING, PLANAR,SINGLE 26 26 $134.00

78472 78472 CARDIAC BLOOD POOL IMAGING, PLANAR,SINGLE TC TC $503.00

78473 78473 CARDIAC BLOOD POOL IMAGING,MULTIPLE TC TC $612.00

78481 78481 PR HEART FIRST PASS SINGLE,PLANAR TC TC $358.00

78483 78483 PR HEART FIRST PASS MULTIPLE,PLANAR TC TC $476.00

78491 78491 CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS 26 26 $205.00

78491 78491 CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS TC TC $3,591.00

78492 78492 CHG MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS 26 26 $241.00

78492 78492 CHG MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS TC TC $3,591.00

78494 78494 PR HEART IMAGE, SPECT TC TC $472.00

78496 78496 PR HEART FIRST PASS ADD-ON TC TC $53.00

78579 78579 PR PULMONARY VENTILATION IMAGING 26 26 $67.00

78579 78579 PR PULMONARY VENTILATION IMAGING TC TC $458.00

78580 78580 PR PULMONARY PERFUSION IMAGING PARTICULATE 26 26 $101.00

78580 78580 PR PULMONARY PERFUSION IMAGING PARTICULATE TC TC $562.00

78582 78582 PR PULMONARY VENTILATION & PERFUSION IMAGING 26 26 $146.00

78582 78582 PR PULMONARY VENTILATION & PERFUSION IMAGING TC TC $788.00

78597 78597 PR QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING 26 26 $98.00 78597 78597 PR QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING TC TC $464.00

PR QUANT DIFF PULM PRFUSION & VENTLAJ W/WO 78598 78598 IMAGING 26 26 $109.00

PR QUANT DIFF PULM PRFUSION & VENTLAJ W/WO 78598 78598 IMAGING TC TC $738.00

78600 78600 BRAIN IMAGING < 4 STATIC VIEWS TC TC $454.00

78601 78601 BRAIN IMAGING < 4 STATIC VIEWS W VASCULAR FLOW TC TC $537.00

78605 78605 BRAIN IMAGING MIN 4 STATIC VIEWS TC TC $486.00

78606 78606 BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW 26 26 $88.00

78606 78606 BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW TC TC $838.00

78607 78607 BRAIN IMAGING TOMOGRAPHIC SPECT 26 26 $155.00

78608 78608 PR BRAIN IMAGING PET METABOLIC 26 26 $199.00

78608 78608 PR BRAIN IMAGING PET METABOLIC TC TC $3,591.00

78609 78609 PR BRAIN IMAGING PET PERFUSION 26 26 $252.00

78609 78609 PR BRAIN IMAGING PET PERFUSION TC TC $3,591.00

78610 78610 PR BRAIN FLOW IMAGING ONLY TC TC $445.00 78630 PR CSF FLUID SCAN CISTERNOGRAPHY 78630 $945.00

78630 78630 PR CSF FLUID SCAN CISTERNOGRAPHY 26 26 $93.00

78630 78630 PR CSF FLUID SCAN CISTERNOGRAPHY TC TC $852.00

78635 78635 PR CSF VENTRICULOGRAPHY TC TC $860.00

78645 78645 PR CSF SHUNT EVALUATION 26 26 $77.00

78645 78645 PR CSF SHUNT EVALUATION TC TC $832.00 78650 78650 PR CSF LEAKAGE DETECTION & LOCALIZATION TC TC $701.00

78660 78660 PR NUCLEAR TEAR FLOW TC TC $442.00

78700 78700 PR RENAL IMAGING, MORPHOLOGY TC TC $418.00

78701 78701 PR RENAL IMAGING, MORPH W/ FLOW TC TC $545.00

78707 78707 PR RENAL IMAGING, MORPH W/ FLOW/FUNC 26 26 $131.00

78707 78707 PR RENAL IMAGING, MORPH W/ FLOW/FUNC TC TC $522.00

PR RENAL IMAGING, MORPH W/ FLOW/FUNC, PHARM, 78708 78708 SINGLE 26 26 $164.00

PR RENAL IMAGING, MORPH W/ FLOW/FUNC, PHARM, 78708 78708 SINGLE TC TC $332.00

78709 78709 PR RENAL IMAGING, MORPH W/ FLOW/FUNC, PHARM, MULTI 26 26 $189.00

78709 78709 PR RENAL IMAGING, MORPH W/ FLOW/FUNC, PHARM, MULTI TC TC $839.00

78725 78725 PR RENAL FUNCTION STUDY TC TC $254.00

78730 78730 PR URINARY BLADDER RESIDUAL, ADD-ON TC TC $191.00 78740 PR URETERAL REFLUX STUDY 78740 $566.00

78740 78740 PR URETERAL REFLUX STUDY 26 26 $76.00

78740 78740 PR URETERAL REFLUX STUDY TC TC $532.00

78761 78761 PR TESTICULAR IMAGING & FLOW TC TC $494.00

78800 78800 CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING 26 26 $89.00

78800 78800 CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING TC TC $635.00

CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA 78801 78801 IMG>2+D 26 26 $105.00

CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA 78801 78801 IMG>2+D TC TC $695.00 CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY 78802 78802 IMAGING 26 26 $110.00

CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY 78802 78802 IMAGING TC TC $767.00

78803 78803 CHG RP LOCLZJ TUM SPECT 1 AREA SINGLE DAY IMAGING 26 26 $146.00

78803 78803 CHG RP LOCLZJ TUM SPECT 1 AREA SINGLE DAY IMAGING TC TC $942.00

78804 78804 CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING 26 26 $137.00

78804 78804 CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING TC TC $1,709.00

78805 78805 PR ABSCESS IMAGING, LTD AREA 26 26 $94.00

78806 78806 PR ABSCESS IMAGING, WHOLE BODY 26 26 $110.00

78807 78807 PR NUCLEAR LOCALIZATION/ABSCESS 26 26 $135.00

78811 78811 PET IMAGING LIMITED AREA CHEST HEAD/NECK TC TC $3,166.00

78812 78812 PET IMAGING SKULL BASE TO MID-THIGH TC TC $3,591.00

78813 78813 PET IMAGING WHOLE BODY TC TC $3,591.00

78814 78814 PET IMAGING CT FOR ATTENUATION LIMITED AREA 26 26 $295.00

78814 78814 PET IMAGING CT FOR ATTENUATION LIMITED AREA TC TC $3,591.00

78815 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH 26 26 $330.00

78815 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH TC TC $3,591.00

78816 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 26 26 $333.00

78816 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY TC TC $3,591.00

78830 78830 CHG RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING 26 26 $200.00 78830 78830 CHG RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING TC TC $1,082.00

CHG RP LOCLZJ TUM SPECT 2 AREA 1D IMG/1 AREA 78831 78831 IMG>2+D 26 26 $244.00

CHG RP LOCLZJ TUM SPECT 2 AREA 1D IMG/1 AREA 78831 78831 IMG>2+D TC TC $1,747.00

CHG RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR 78832 78832 IMG>2+D 26 26 $284.00

CHG RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR 78832 78832 IMG>2+D TC TC $2,306.00

78835 78835 CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA 26 26 $58.00

78835 78835 CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA TC TC $226.00

79005 79005 CHG NUC THERAPY INTRACAVITARY RADIOCOLLOID 26 26 $245.00

79005 79005 CHG NUC THERAPY INTRACAVITARY RADIOCOLLOID TC TC $139.00

79101 79101 CHG NUC THERAPY INTRA-ARTERIAL 26 26 $273.00

79101 79101 CHG NUC THERAPY INTRA-ARTERIAL TC TC $141.00

79200 79200 PR NUCLEAR THERAPY, INTRACAVITARY TC TC $147.00

79300 79300 PR NUCLEAR THERAPY, INTERSTITIAL TC TC $147.00

79403 79403 PR NUCLEAR THERAPY, MONOCLONAL AB 26 26 $303.00

79403 79403 PR NUCLEAR THERAPY, MONOCLONAL AB TC TC $225.00

79440 79440 PR NUCLEAR THERAPY, INTRA-ARTICULAR TC TC $110.00

79445 79445 PR NUCLEAR THERAPY, INTRA-ARTERIAL 26 26 $317.00

79445 79445 PR NUCLEAR THERAPY, INTRA-ARTERIAL TC TC $226.00 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL 80048 $29.00 80053 CHG METABOLIC PANEL,COMPREHENSIVE 80053 $36.00 80061 CHG LIPID PANEL 80061 $44.00 80360 CHG DRUG SCREENING METHYLPHENIDATE 80360 $60.00

CHG DRUG SCREENING OPIOIDS & OPIATE ANALOGS 80364 5/MORE 80364 $58.00 80500 CHG LAB PATHOLOGY CONSULT-LTD 80500 $100.00

80500 80500 CHG LAB PATHOLOGY CONSULT-LTD 26 26 $100.00 81000 CHG URINALYSIS, NONAUTO, W/SCOPE 81000 $19.00 81001 CHG URINALYSIS, AUTO, W/SCOPE 81001 $11.00 81002 CHG URINALYSIS NONAUTO W/O SCOPE 81002 $14.00 81003 CHG URINALYSIS, AUTO, W/O SCOPE 81003 $8.00 81025 CHG URINE PREGNANCY TEST 81025 $25.00 81120 CHG IDH1 COMMON VARIANTS 81120 $100.00 81121 CHG IDH2 COMMON VARIANTS 81121 $100.00

CHG BRCA1 BRCA2 GENE ANALYSIS FULL SEQUENCE 81163 ANALYSIS 81163 $100.00

81164 CHG BRCA1 BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS 81164 $100.00

81165 CHG BRCA1 GENE ANALYSIS FULL SEQUENCE ANALYSIS 81165 $100.00

81166 CHG BRCA1 GENE ANALYSIS FULL DUP/DEL ANALYSIS 81166 $100.00

81167 CHG BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS 81167 $100.00

81171 CHG AFF2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81171 $100.00

81172 CHG AFF2 GENE ANALYSIS CHARACTERIZATION OF ALLELES 81172 $100.00 81173 CHG AR GENE ANALYSIS FULL GENE SEQUENCE 81173 $100.00

81174 CHG AR GENE ANALYSIS KNOWN FAMILIAL VARIANT 81174 $100.00

81177 CHG ATN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81177 $100.00

CHG ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL 81178 ALLELES 81178 $100.00

CHG ATXN2 GENE ANALYSIS EVAL DETECT ABNORMAL 81179 ALLELES 81179 $100.00

CHG ATXN3 GENE ANALYSIS EVAL DETECT ABNORMAL 81180 ALLELES 81180 $100.00 CHG ATXN7 GENE ANALYSIS EVAL DETECT ABNORMAL 81181 ALLELES 81181 $100.00

81182 CHG ATXN8OS GENE ANALYSIS EVAL DETECT ABNOR ALLELES 81182 $100.00

81183 CHG ATXN10 GENE ANALYSIS EVAL DETC ABNORMAL ALLELES 81183 $100.00

81184 CHG CACNA1A GENE ANALYSIS EVAL DETECT ABNOR ALLELES 81184 $100.00

81185 CHG CACNA1A GENE ANALYSIS FULL GENE SEQUENCE 81185 $100.00

81186 CHG CACNA1A GENE ANALYSIS KNOWN FAMILIAL VARIANT 81186 $100.00

81187 CHG CNBP GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81187 $100.00

81188 CHG CSTB GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81188 $100.00

81189 CHG CSTB GENE ANALYSIS FULL GENE SEQUENCE 81189 $100.00

81190 CHG CSTB GENE ANALYSIS KNOWN FAMILIAL VARIANTS 81190 $100.00

81204 CHG AR GENE ANALYSIS CHARACTERIZATION OF ALLELES 81204 $100.00

81206 PR BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE 81206 $100.00 81210 CHG BRAF GENE ANALYSIS V600 VARIANT(S) 81210 $100.00

81215 PR BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT 81215 $939.00

PR CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP 81229 VAR 81229 $100.00 81233 CHG BTK GENE ANALYSIS COMMON VARIANTS 81233 $100.00

81234 CHG DMPK GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81234 $100.00 81235 CHG EGFR GENE ANALYSIS COMMON VARIANTS 81235 $348.00

81235 81235 CHG EGFR GENE ANALYSIS COMMON VARIANTS 26 26 $100.00

81236 CHG EZH2 GENE ANALYSIS FULL GENE SEQUENCE 81236 $100.00 81237 CHG EZH2 GENE ANALYSIS COMMON VARIANTS 81237 $100.00 81239 CHG DMPK GENE ANALYSIS CHARACTERIZATION OF ALLELES 81239 $100.00 81240 PR F2 GENE ANALYSIS 20210G >A VARIANT 81240 $100.00

81241 PR F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT 81241 $100.00

81243 PR FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES 81243 $100.00

81244 PR FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES 81244 $100.00

PR HFE HEMOCHROMATOSIS GENE ANAL COMMON 81256 VARIANTS 81256 $100.00 81260 PR IKBKAP GENE ANALYSIS COMMON VARIANTS 81260 $138.00

81261 PR IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED 81261 $100.00

81265 PR COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC 81265 $100.00

81267 PR CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION 81267 $100.00 81270 PR JAK2 GENE ANALYSIS P.VAL617PHE VARIANT 81270 $100.00

81271 CHG HTT GENE ANALYSIS DETECT ABNORMAL ALLELES 81271 $100.00

81274 CHG HTT GENE ANALYSIS CHARACTERIZATION ALLELES 81274 $100.00 81275 CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2 81275 $100.00

81276 CHG KRAS GENE ANALYSIS ADDITIONAL VARIANT(S) 81276 $468.00

81284 CHG FXN GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81284 $100.00

81285 CHG FXN GENE ANALYSIS CHARACTERIZATION ALLELES 81285 $100.00 81286 CHG FXN GENE ANALYSIS FULL GENE SEQUENCE 81286 $100.00 81287 CHG MGMT METHYLATION ANALYSIS 81287 $100.00

CHG MLH1 GENE ANALYSIS PROMOTER METHYLATION 81288 81288 ANALYSIS 26 26 $100.00

81289 CHG FXN GENE ANALYSIS KNOWN FAMILIAL VARIANTS 81289 $100.00

81301 PR MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF 81301 $100.00 81305 CHG MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT 81305 $100.00

81306 CHG NUDT15 GENE ANALYSIS COMMON VARIANTS 81306 $100.00

81310 PR NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS 81310 $597.00

81311 CHG NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 81311 $716.00

81312 CHG PABPN1 GENE ANALYSIS EVAL DETC ABNORMAL ALLELES 81312 $100.00

81320 CHG PLCG2 GENE ANALYSIS COMMON VARIANTS 81320 $100.00

CHG SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 81329 ALYS 81329 $100.00 81333 CHG TGFBI GENE ANALYSIS COMMON VARIANTS 81333 $100.00

81336 CHG SMN1 GENE ANALYSIS FULL GENE SEQUENCE 81336 $100.00

81337 CHG SMN1 GENE ANALYSIS KNOWN FAMILIAL SEQ VARIANTS 81337 $100.00

81340 PR TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD 81340 $100.00 81342 PR TRG@ GENE REARRANGEMENT ANALYSIS 81342 $100.00

CHG PPP2R2B GENE ANALYSIS EVAL DETC ABNORMAL 81343 ALLELES 81343 $100.00

81344 CHG TBP GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES 81344 $100.00

81345 CHG TERT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS 81345 $100.00

81403 CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 81403 $100.00

81404 81404 CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 26 26 $115.00

81406 CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 7 81406 $100.00

81443 CHG GENETIC TESTING FOR SEVERE INHERITED CONDITIONS 81443 $1,645.00

81445 CHG GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE 81445 $1,495.00 81445 81445 CHG GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE 26 26 $200.00

81450 CHG GEN SEQ ANALYS HEMATOLYMPHOID NEO 5-50 GENE 81450 $200.00

81450 81450 CHG GEN SEQ ANALYS HEMATOLYMPHOID NEO 5-50 GENE 26 26 $200.00

CHG GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 81455 51/> GEN 81455 $1,645.00

CHG GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 81455 81455 51/> GEN 26 26 $200.00

81479 CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE 81479 $100.00

BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL 82270 SCREEN 82270 $11.00

BLOOD OCCULT,BY PEROXID, FECES, 1-3 SIMULT, NON CA 82272 SCREEN 82272 $11.00

82656 PR PANCREATIC ELASTASE, FECAL, QUAL/SEMI-QUANT 82656 $40.00 82710 CHG FATS/LIPIDS, FECES, QUANTITATIVE 82710 $48.00 82962 CHG GLUCOSE BLOOD TEST 82962 $9.00

83020 83020 CHG HEMOGLOBIN ELECTROPHORESIS 26 26 $60.00 83036 PR GLYCOSYLATED HEMOGLOBIN TEST 83036 $32.00 83655 ASSAY OF LEAD 83655 $40.00 83986 CHG PH BODY FLUID NOS 83986 $10.00 83993 CHG ASSAY FOR CALPROTECTIN FECAL 83993 $67.00 84145 CHG ASSAY OF PROCALCITONIN 84145 $92.00

84165 84165 CHG PROTEIN E-PHORESIS, SERUM 26 26 $47.00 84166 PR PROTEIN E-PHORESIS/URINE/CSF 84166 $61.00

84166 84166 PR PROTEIN E-PHORESIS/URINE/CSF 26 26 $47.00 84403 ASSAY OF TOTAL TESTOSTERONE 84403 $85.00 85013 CHG MICROHEMATOCRIT,SPUN 85013 $8.00 85014 CHG HEMATOCRIT 85014 $8.00 85018 CHG HEMOGLOBIN 85018 $8.00 85025 CHG COMPLETE CBC & AUTO DIFF WBC 85025 $26.00 85060 PR BLOOD SMEAR INTERPRETATION 85060 $62.00 85097 PR BONE MARROW, SMEAR INTERPRETATION 85097 $231.00 85097 85097 PR BONE MARROW, SMEAR INTERPRETATION 26 26 $214.00

85390 85390 CHG FIBRINOLYSINS SCREEN 26 26 $60.00

85576 85576 CHG BLOOD PLATELET AGGREGATION 26 26 $62.00 85610 CHG PROTHROMBIN TIME 85610 $13.00 86077 CHG PHYS BLD BANK SERV,DIFF XMTCH 86077 $143.00 86078 CHG PHYS BLD BANK SERV,XFUSN RX 86078 $143.00 86079 CHG PHYS BLD BANK SERV,DEV STD 86079 $143.00 86308 CHG HETEROPHILE ANTIBODIES,SCREEN 86308 $17.00

86325 CHG IMMUNOELECTROPHOR,OTHER FLUIDS W/CONC 86325 $74.00

86325 86325 CHG IMMUNOELECTROPHOR,OTHER FLUIDS W/CONC 26 26 $64.00

86328 CHG IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19 86328 $46.00 86580 CHG TB INTRADERMAL TEST 86580 $21.00 86788 PR WEST NILE VIRUS AB, IGM 86788 $56.00 87210 CHG SMEAR,STAIN,WET MNT,INTERP 87210 $20.00 87220 CHG TISSUE EXAM BY KOH 87220 $20.00

87662 CHG IADNA DNA/RNA ZIKA VIRUS AMPLIFIED PROBE TQ 87662 $159.00 87804 CHG DETECT AGENT,IMMUN,DIR OBS,INFLUENZA 87804 $39.00 87807 PR DETECT AGENT,IMMUN,DIR OBS, RSV 87807 $41.00 87880 CHG STREP A ASSAY W/OPTIC 87880 $50.00 88020 CHG AUTOPSY COMPL,W/O CNS 88020 $1,696.00 88025 CHG AUTOPSY COMPL,W BRAIN 88025 $2,355.00 88028 CHG AUTOPSY COMPL,INFANT W BRAIN 88028 $2,355.00 88029 CHG AUTOPSY COMPL,NEWBORN W BRAIN 88029 $1,884.00 88037 CHG LTD AUTOPSY,SINGLE ORGAN 88037 $866.00 88099 CHG NECROPSY (AUTOPSY) UNLISTED 88099 $330.00

88104 88104 CHG CYTOPATH FLUIDS,SMEAR,INTERP 26 26 $75.00

88108 88108 CHG CYTOPATH FLUIDS,CONCENTRATN,INTERP 26 26 $84.00

88112 88112 CHG CYTOPATH, CELL ENHANCE TECH 26 26 $161.00 88141 CHG CYTOPATH CERV/VAG INTERPRET 88141 $82.00 88142 CHG CYTOPATH CERV/VAG THIN LAYER 88142 $70.00 88143 CHG CYTOPATH CERV/VAG THIN LAYER REDO 88143 $70.00

88160 88160 CHG CYTOPATH,OTHR SOURC,SCREEN,INTERP 26 26 $79.00

CHG EVALUATION OF FNA SMEAR TO DETERMINE ADEQUACY, 88172 88172 FIRST EVAL 26 26 $134.00

88173 88173 CHG INTERPRETATION OF FNA SMEAR 26 26 $250.00

88174 CHG CYTOPATH,CERV/VAG,AUTO THIN LAYER,INTERP 88174 $74.00

CHG EVALUATION OF FNA SMEAR TO DETERMINE ADEQUACY, 88177 88177 EA ADD EVAL 26 26 $58.00 88187 PR FLOWCYTOMETRY/READ, 2-8 MARKERS 88187 $175.00 88188 PR FLOWCYTOMETRY/READ, 9-15 MARKERS 88188 $220.00 88189 PR FLOWCYTOMETRY/READ, 16 & > MARKERS 88189 $278.00 88237 CHG TISSUE CULTURE, BONE MARROW 88237 $434.00 88261 CHG CHROMOSOME ANAL:5 CELLS,1 KARYOTYPE 88261 $607.00 88263 CHG CHROMOSOME ANAL:45 CELLS,MOSAICISM 88263 $493.00 88271 CHG CYTOGENETICS, DNA PROBE 88271 $74.00 88291 CHG CYTO/MOLECULAR REPORT 88291 $84.00

88300 88300 CHG SURG PATH,GROSS,LEVEL I 26 26 $39.00

88302 88302 CHG SURG PATH,LEVEL II 26 26 $60.00

88304 88304 CHG SURG PATH,LEVEL III 26 26 $94.00

88305 88305 CHG SURG PATH,LEVEL IV 26 26 $178.00 88307 CHG SURG PATH,LEVEL V 88307 $325.00

88307 88307 CHG SURG PATH,LEVEL V 26 26 $337.00

88309 88309 CHG SURG PATH,LEVEL VI 26 26 $462.00

88311 88311 CHG DECALCIFY TISSUE 26 26 $34.00

88312 PR SPECIAL STAIN GROUP 1 MICROORGANISMS I&R 88312 $60.00

88312 88312 PR SPECIAL STAIN GROUP 1 MICROORGANISMS I&R 26 26 $67.00 88313 PR SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS 88313 $70.00

88313 88313 PR SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS 26 26 $65.00

88314 88314 PR SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSUE 26 26 $158.00

88319 88319 PR SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS 26 26 $86.00 88321 CHG MICROSLIDE CONSULT 88321 $368.00 88323 CHG MICROSLIDE CONSULT W SLIDE PREP 88323 $368.00

88323 88323 CHG MICROSLIDE CONSULT W SLIDE PREP 26 26 $227.00 88325 CHG COMPREHENSIVE REVIEW OF DATA 88325 $468.00

88329 88329 CHG PATH CONSULT IN SURGERY GC GC $136.00

88331 88331 PR PATH CONSULT IN SURG,W FRZ SEC 26 26 $204.00

88332 88332 CHG PATH CONSULT IN SURG,W ADDN FRZ SEC 26 26 $135.00

88333 88333 PR INTRAOPERATIVE CYTO PATH CONSULT, INITIAL SITE 26 26 $165.00

88334 88334 CHG INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES 26 26 $101.00

88334 88334 CHG INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES GC GC $101.00

88341 CHG IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE 88341 $235.00

88341 88341 CHG IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE 26 26 $75.00

CHG IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN 88342 PROCEDURE 88342 $268.00

CHG IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN 88342 88342 PROCEDURE 26 26 $93.00

CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB 88346 88346 STAIN 26 26 $101.00

88348 88348 CHG ELECTRON MICROSCOPY,DIAGNOSTIC 26 26 $468.00

CHG IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB 88350 88350 STAIN 26 26 $76.00 CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY 88360 88360 MANUAL 26 26 $138.00

CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR 88361 88361 ASST 26 26 $142.00

88363 CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS 88363 $55.00

88364 88364 CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN 26 26 $91.00 88365 CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN 88365 $440.00

88365 88365 CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN 26 26 $144.00

88366 88366 CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN 26 26 $163.00

88367 CHG M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN 88367 $604.00

88367 88367 CHG M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN 26 26 $160.00

88368 CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL 88368 $149.00

88368 88368 CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL 26 26 $160.00

CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC 88369 88369 EACH 26 26 $85.00

CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH 88377 MULTIPRB 88377 $166.00

CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH 88377 88377 MULTIPRB 26 26 $169.00 88720 CHG BILIRUBIN TOTAL TRANSCUTANEOUS 88720 $18.00

89060 89060 CHG EXAM,SYNOVIAL FLUID CRYSTALS 26 26 $47.00 90389 PR TETANUS IG, IM 90389 $776.00

90460 PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX 90460 $21.00

90461 PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT 90461 $21.00

90471 PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID 90471 $21.00 90472 PR IMMUNIZ,ADMIN,EACH ADDL 90472 $21.00 90473 PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX 90473 $21.00

90474 PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL 90474 $21.00

PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC 90620 IM 90620 $675.00

90630 PR INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID 90630 $49.00

90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE 90632 $134.00

90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE 90633 $63.00 90636 PR HEPA/HEPB VACCINE ADULT IM 90636 $200.00

90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE 90647 $55.00 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 90648 $61.00

90649 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE 90649 $336.00

90650 PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE 90650 $164.00 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE 90651 $346.00

90655 PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE 90655 $51.00

90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE 90656 $35.00

90657 PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE 90657 $11.00

90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE 90658 $41.00 90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE 90660 $55.00

90662 PR IIV VACCINE PRESERV FREE INCREASED AG COUNT IM 90662 $50.00 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE 90670 $334.00 90672 PR LAIV4 VACCINE FOR INTRANASAL USE 90672 $56.00

90673 PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE 90673 $79.00 90675 PR RABIES VACCINE, IM 90675 $636.00

90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE 90680 $182.00 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE 90681 $230.00

90682 PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM 90682 $50.00

90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE 90685 $52.00

90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 90686 $20.00 90691 PR TYPHOID VACCINE, IM 90691 $186.00 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE 90696 $104.00

90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE 90698 $178.00 90700 DTAP IMMUNIZATION, IM, <7 YO 90700 $60.00

90702 PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE 90702 $80.00 90707 PR MMR VIRUS IMMUNIZATION, SUBCUT 90707 $132.00 90710 PR COMBINED VACCINE,MMR+VARICELLA,SUB-Q 90710 $378.00 90713 PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q 90713 $63.00

90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE 90714 $55.00 90715 PR TDAP VACCINE IM 90715 $91.00 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE 90716 $226.00 90717 PR YELLOW FEVER IMMUNIZATN,LIVE,SUB-Q 90717 $295.00 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR 90723 $153.00

90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE 90732 $166.00

90733 PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE 90733 $129.00

PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY 90734 IM USE 90734 $126.00

90736 PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE 90736 $414.00 90738 CHG JAPANESE ENCEPH VACC, INACTIVATED, IM 90738 $487.00

90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM 90744 $47.00

90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE 90746 $114.00

90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX 90750 $175.00 90785 PR PSYCHOTHERAPY COMPLEX INTERACTIVE 90785 $40.00 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION 90791 $399.00

90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES 90792 $361.00 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES 90832 $171.00

90833 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN 90833 $166.00 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES 90834 $227.00

90836 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN 90836 $214.00 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES 90837 $341.00

90838 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN 90838 $315.00

90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES 90839 $343.00

90840 PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES 90840 $183.00

90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS 90846 $256.00

90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS 90847 $286.00 90849 PR MULTIP FAMILY-GROUP PSYCHOTHERAPY 90849 $88.00 90853 PR GROUP PSYCHOTHERAPY 90853 $85.00

90867 PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&MNG 90867 $852.00

90868 PR THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNGT 90868 $463.00

90869 PR REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MNGT 90869 $1,053.00 90870 PR ELECTROCONVULSIVE THERAPY,1 SEIZ 90870 $410.00 90887 PR CONSULTATION WITH FAMILY 90887 $216.00 90899 PR PSYCHIATRIC SERVICE/THERAPY 90899 $400.00 90901 PR BIOFEEDBACK TRAINING,ANY MODALITY 90901 $101.00 90911 PR BIOFEEDBACK PERI/URO/RECTAL 90911 $230.00

90912 PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT 90912 $103.00

PR BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 MIN 90913 CNTCT 90913 $204.00 90935 PR HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION 90935 $225.00 90937 PR HEMODIALYSIS, REPEATED EVAL. 90937 $375.00

90945 PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL 90945 $210.00

90947 PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS 90947 $350.00

90953 PR ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT 90953 $1,216.00

90954 PR ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS 90954 $2,749.00

90956 PR ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT 90956 $798.00

90957 PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS 90957 $2,184.00

90958 PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS 90958 $1,058.00

90959 PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT 90959 $711.00

90960 PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS 90960 $700.00

90961 PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS 90961 $575.00

90962 PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT 90962 $430.00

90963 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, < 2 YR OLD 90963 $1,904.00

90964 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 2-11 YR OLD 90964 $1,189.00

PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 12-19 YR 90965 OLD 90965 $1,132.00

90966 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 20+ YR OLD 90966 $572.00 90967 PR ESRD SERVICES, PER DAY, < 2 YR OLD 90967 $48.00 90968 PR ESRD SERVICES, PER DAY, 2-11 YR OLD 90968 $39.00 90969 PR ESRD SERVICES, PER DAY, 12-19 YR OLD 90969 $38.00 90970 PR ESRD SERVICES, PER DAY,20+ YR OLD 90970 $20.00 90989 PR DIALYSIS TRAINING/COMPLETE 90989 $767.00 91010 91010 PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT 26 26 $300.00

91034 91034 PR GERD TST W/ NASAL PH ELECTROD 26 26 $128.00

91035 91035 PR GERD TST W/ MUCOS PH ELECTROD 26 26 $221.00

91038 91038 PR GERD TST W/ MUCOS IMPEDE ELECTROD,>1HR 26 26 $145.00

91065 91065 PR BREATH HYDROGEN/METHANE TEST 26 26 $60.00

91110 PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R 91110 $2,350.00

91110 91110 PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R 26 26 $540.00

91112 91112 PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP 26 26 $280.00

91122 91122 PR ANAL PRESSURE RECORD 26 26 $300.00

91200 91200 PR LIVER ELASTOGRAPHY W/O IMAG W/I&R 26 26 $38.00

91300 SARSCOV2 VACCINE DIL RECON 30 MCG/0.3 ML IM USE 91300 $0.00 91301 SARSCOV2 VACCINE 100 MCG/0.5 ML IM USE 91301 $0.00

91303 SARSCOV2 VACCINE AD26 5X10^10 VP/0.5ML IM USE 91303 $0.00 92002 PR EYE EXAM, NEW PATIENT,INTERMED 92002 $221.00 92004 PR EYE EXAM, NEW PATIENT,COMPREHESV 92004 $394.00 92012 PR EYE EXAM ESTABLISHED PT 92012 $232.00

92012 92012 PR EYE EXAM ESTABLISHED PT 26 26 $185.00 92014 PR EYE EXAM, EST PATIENT,COMPREHESV 92014 $331.00 92015 PR REFRACTION 92015 $54.00 92018 PR NEW EYE EXAM & TREATMENT 92018 $379.00 92019 PR EYE EXAM & TREATMENT 92019 $193.00 92020 PR SPECIAL EYE EVAL,GONIOSCOPY 92020 $73.00

92020 92020 PR SPECIAL EYE EVAL,GONIOSCOPY 26 26 $68.00

92025 92025 PR CORNEAL TOPOGRAPHY 26 26 $53.00 92060 92060 PR SPECIAL EYE EVAL,SENSORIMOTOR 26 26 $100.00

92071 PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE 92071 $99.00

92072 PR FITTING CONTACT LENS FOR MNGT OF KERATOCONUS 92072 $350.00

92081 92081 PR VISUAL FIELD EXAM,LIMITED 26 26 $43.00 92082 PR VISUAL FIELD EXAM,INTERMED 92082 $122.00

92082 92082 PR VISUAL FIELD EXAM,INTERMED 26 26 $57.00

92083 92083 PR VISUAL FIELD EXAM,EXTENDED 26 26 $73.00 92100 PR SERIAL TONOMETRY EXAM(S) 92100 $217.00

PR COMPUTERIZED OPHTHALMIC IMAGING ANTERIOR 92132 92132 SEGMENT 26 26 $50.00

92133 92133 PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE 26 26 $73.00

92134 PR COMPUTERIZED OPHTHALMIC IMAGING RETINA 92134 $261.00

92134 92134 PR COMPUTERIZED OPHTHALMIC IMAGING RETINA 26 26 $75.00

92136 PR OPHTHAL BIOMETRY,INTRAOC LENS POW CALC 92136 $225.00

92136 92136 PR OPHTHAL BIOMETRY,INTRAOC LENS POW CALC 26 26 $82.00

92201 PR OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI 92201 $67.00

PR OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R 92202 UNI/BI 92202 $41.00 92225 PR SPECIAL EYE EXAM, INITIAL 92225 $70.00 92226 PR SPECIAL EYE EXAM, SUBSEQUENT 92226 $70.00 92230 PR FLUORESCEIN ANGIOSCOPY 92230 $145.00

92235 92235 PR FLUORESCEIN ANGRPH W/MULTIFRAME I&R UNI/BI 26 26 $123.00

PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R 92240 92240 UNI/BI 26 26 $167.00

92242 PR FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI 92242 $575.00 92242 92242 PR FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI 26 26 $145.00

92250 92250 PR FUNDAL PHOTOGRAPHY 26 26 $63.00 92265 PR EYE MUSCLE EVALUATION 92265 $214.00

92265 92265 PR EYE MUSCLE EVALUATION 26 26 $123.00 92273 PR FULL FIELD ELECTRORETINOGRAPHY W/I&R 92273 $341.00

92273 92273 PR FULL FIELD ELECTRORETINOGRAPHY W/I&R 26 26 $98.00 92274 PR MULTIFOCAL ELECTRORETINOGRAPHY W/I&R 92274 $231.00

92274 92274 PR MULTIFOCAL ELECTRORETINOGRAPHY W/I&R 26 26 $87.00

92274 92274 PR MULTIFOCAL ELECTRORETINOGRAPHY W/I&R TC TC $146.00

92275 92275 PR ELECTRORETINOGRAPHY 26 26 $148.00

92283 92283 PR COLOR VISION EXAMINATION 26 26 $25.00

92285 92285 PR EYE PHOTOGRAPHY 26 26 $16.00

PR ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL 92286 92286 ANALY 26 26 $59.00 92310 PR CONTACT LENS FITTING,BILAT 92310 $75.00 92311 PR CONTACT LENS FIT,APHAKIA UNILAT 92311 $275.00 92312 PR CONTACT LENS FIT,APHAKIA BILAT 92312 $319.00 92313 PR CONTACT LENS FIT,CORNEOSCLERAL LENS 92313 $258.00 92502 PR EAR AND THROAT EXAMINATION 92502 $221.00 92504 PR EAR MICROSCOPY EXAMINATION 92504 $71.00 92507 PR SPEECH/HEARING THERAPY 92507 $205.00 92511 PR NASOPHARYNGOSCOPY 92511 $361.00 92516 PR FACIAL NERVE FUNCTION TEST 92516 $175.00 92517 PR CERVICAL VEMP TESTING W/I&R 92517 $222.00 92518 PR OCULAR VEMP TESTING W/I&R 92518 $207.00 92519 PR CERVICAL & OCULAR VEMP TESTING W/I&R 92519 $346.00

92521 PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER) 92521 $288.00

PR EVALUATION OF SPEECH SOUND PRODUCTION 92522 ARTICULATE 92522 $240.00 PR EVAL SPEECH SOUND PRODUCT LANGUAGE 92523 COMPREHENSION 92523 $502.00

92524 PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE 92524 $233.00 92526 PR ORAL FUNCTION THERAPY 92526 $224.00 92532 PR POSITIONAL NYSTAGMUS 92532 $61.00

92537 PR CALORIC VESTIBULAR TEST W/REC BI BITHERMAL 92537 $388.00

92537 92537 PR CALORIC VESTIBULAR TEST W/REC BI BITHERMAL 26 26 $128.00

92538 PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL 92538 $194.00

92538 92538 PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL 26 26 $64.00

PR VESTIBULAR EVAL NYSTAG FOVL&PERPH STIM OSCIL 92540 TRACKING 92540 $320.00

PR VESTIBULAR EVAL NYSTAG FOVL&PERPH STIM OSCIL 92540 92540 TRACKING 26 26 $320.00 92541 PR SPONTANEOUS NYSTAGMUS TEST 92541 $134.00

92541 92541 PR SPONTANEOUS NYSTAGMUS TEST 26 26 $48.00 92542 PR POSITIONAL NYSTAGMUS TEST 92542 $139.00

92542 92542 PR POSITIONAL NYSTAGMUS TEST 26 26 $64.00 92544 PR OPTOKINETIC NYSTAGMUS TEST 92544 $111.00

92544 92544 PR OPTOKINETIC NYSTAGMUS TEST 26 26 $38.00 92545 PR OSCILLATING TRACKING TEST 92545 $102.00

92545 92545 PR OSCILLATING TRACKING TEST 26 26 $30.00 92546 PR SINUSOIDAL ROTATIONAL TEST 92546 $197.00

92546 92546 PR SINUSOIDAL ROTATIONAL TEST 26 26 $119.00

92548 PR CDP-SOT 6 CONDITIONS W/INTERPRETATION & REPORT 92548 $250.00

92548 92548 PR CDP-SOT 6 CONDITIONS W/INTERPRETATION & REPORT 26 26 $66.00 92549 PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT 92549 $162.00 92549 92549 PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT 26 26 $115.00

92549 92549 PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT TC TC $47.00

92550 PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS 92550 $85.00 92551 PR PURE TONE HEARING TEST, AIR 92551 $31.00 92552 PR PURE TONE AUDIOMETRY, AIR 92552 $78.00 92553 PR AUDIOMETRY, AIR & BONE 92553 $93.00 92555 PR SPEECH THRESHOLD AUDIOMETRY 92555 $58.00 92556 PR SPEECH AUDIOMETRY, COMPLETE 92556 $95.00 92557 PR COMPREHENSIVE HEARING TEST 92557 $115.00

92558 PR EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS 92558 $26.00 92565 PR STENGER TEST, PURE TONE 92565 $35.00 92567 PR TYMPANOMETRY 92567 $49.00 92568 PR ACOUSTIC REFLEX TESTING 92568 $47.00 92575 PR SENSORINEURAL ACUITY TEST 92575 $178.00 92577 PR STENGER TEST, SPEECH 92577 $46.00 92579 PR VISUAL AUDIOMETRY (VRA) 92579 $107.00 92582 PR CONDITIONING PLAY AUDIOMETRY 92582 $167.00 92583 PR SELECT PICTURE AUDIOMETRY 92583 $200.00 92584 PR ELECTROCOCHLEOGRAPHY 92584 $190.00 92585 PR AUDITORY EVOKED POTENTIAL 92585 $294.00

92585 92585 PR AUDITORY EVOKED POTENTIAL 26 26 $294.00 92586 PR AUDITORY EVOKED POTENTIAL, LIMITED 92586 $339.00

92587 PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD 92587 $115.00

92587 92587 PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD 26 26 $65.00

PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX 92588 EVAL 92588 $163.00

PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX 92588 92588 EVAL 26 26 $95.00 92601 DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG 92601 $403.00 92602 DX ANAL COCHLEAR IMP,PT <7 YRS,REPROG 92602 $257.00 92603 PR DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG 92603 $343.00 92604 PR DX ANAL COCHLEAR IMP,PT >7 YRS,REPROG 92604 $204.00 92607 PR EVAL,SPEECH-GEN AUG/ALT COMM DEV,1ST HR 92607 $330.00

92608 PR EVAL,SPEECH-GEN AUG/ALT COMM DEV,ADDL 30 92608 $133.00

92610 PR EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION 92610 $222.00

92612 PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC 92612 $484.00

92613 PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R 92613 $145.00 92620 PR AUDITORY FUNCTION, 60 MIN 92620 $239.00

92621 PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN 92621 $57.00 92625 PR TINNITUS ASSESSMENT 92625 $165.00

92626 PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR 92626 $230.00

92627 PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15 92627 $70.00

92650 PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS 92650 $76.00

92651 PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R 92651 $234.00

92652 PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R 92652 $309.00

92653 PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT 92653 $228.00

92920 PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH 92920 $1,814.00

92921 PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH 92921 $493.00

PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE 92924 ART/BRNCH 92924 $2,156.00

PR PRQ TRLUML CORONARY STENT W/ANGIO ONE 92928 ART/BRNCH 92928 $2,013.00

PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL 92929 ART/BRNCH 92929 $775.00

PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL 92929 92929 ART/BRNCH 26 26 $548.00 PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE 92933 ART/BRNCH 92933 $2,253.00

PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL 92934 BRANCH 92934 $705.00

92937 PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL 92937 $2,012.00

92941 PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL 92941 $2,695.00

PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE 92943 VSL 92943 $2,257.00

PR PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL 92944 VSL 92944 $906.00 92950 PR HEART/LUNG RESUSCITATION (CPR) 92950 $853.00

92960 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL 92960 $672.00

92961 PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX 92961 $980.00 92970 PR CARDIOASSIST, INTERNAL 92970 $439.00

92978 92978 PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL 26 26 $243.00

92979 92979 PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL 26 26 $188.00 92986 PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE 92986 $5,512.00 92987 PR PRQ BALLOON VALVULOPLASTY MITRAL VALVE 92987 $5,689.00 92990 PR PERCUT PULMONARY VALVULOPLASTY 92990 $3,755.00 92992 PR ATRIAL SEPTOSTOMY,XVENOUS,BALLOON 92992 $4,000.00 92993 PR ATRIAL SEPTOSTOMY,XVENOUS,BLADE 92993 $4,500.00 92997 PR PUL ART BALLOON REPAIR,PERC,1ST VESL 92997 $3,200.00 92998 PR PUL ART BALLOON REPAIR,PERC,ADDN VES 92998 $1,600.00 93000 PR ELECTROCARDIOGRAM, COMPLETE 93000 $52.00 93005 PR ELECTROCARDIOGRAM, TRACING 93005 $34.00 93010 PR ELECTROCARDIOGRAM REPORT 93010 $30.00

93010 93010 PR ELECTROCARDIOGRAM REPORT 76 76 $30.00 93015 PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R 93015 $227.00

93016 PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R 93016 $125.00 93017 CARDIAC STRESS TEST 93017 $136.00 93018 PR CARDIAC STRESS TST,INTERP/REPT ONLY 93018 $120.00 93040 PR RHYTHM ECG WITH REPORT 93040 $31.00 93041 PR RHYTHM ECG, TRACING 93041 $14.00 93042 PR RHYTHM ECG, REPORT 93042 $25.00

93224 PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I 93224 $228.00 93225 PR EXT ECG RECORD CONTIN 48 HR, RECORD 93225 $92.00

PR EXT ECG RECORD CONTIN 48 HR, SCAN ANALYSIS W 93226 REPORT 93226 $97.00

93227 PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS 93227 $78.00

93228 PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS 93228 $64.00 93242 PR EXTERNAL ECG REC>48HR<7D RECORDING 93242 $40.00

93244 PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION 93244 $64.00 93246 PR EXTERNAL ECG REC>7D<15D RECORDING 93246 $40.00

93248 PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION 93248 $70.00

PR - PROGRAMMING - IMPLANTABLE SUBCUTANEOUS LEAD 93260 93260 DEFIBRILLATOR SYSTEM (93260) 26 26 $112.00

PR - INTERROGATION - IMPLANTABLE SUBCUTANEOUS LEAD 93261 93261 DEFIBRILLATOR SYSTEM (93261) 26 26 $107.00

93264 PR REMOTE MNTR WIRELESS P-ART PRS SNR UP TO 30 D 93264 $130.00

PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, 93270 RECORD 93270 $27.00

PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, 93271 TRANSMIT 93271 $454.00

93272 PR XTRNL PT ACTIVTD ECG DWNLD W/R&I

93279 PR - PROGRAMMING - PACEMAKER SINGLE LEAD (93279) 93279 $124.00

93279 93279 PR - PROGRAMMING - PACEMAKER SINGLE LEAD (93279) 26 26 $85.00

93280 PR - PROGRAMMING - PACEMAKER DUAL LEAD (93280) 93280 $145.00 93280 93280 PR - PROGRAMMING - PACEMAKER DUAL LEAD (93280) 26 26 $106.00 93281 PR - PROGRAMMING - PACEMAKER BIV (93281) 93281 $170.00

93281 93281 PR - PROGRAMMING - PACEMAKER BIV (93281) 26 26 $118.00 93282 PR - PROGRAMMING - ICD SINGLE LEAD (93282) 93282 $157.00

93282 93282 PR - PROGRAMMING - ICD SINGLE LEAD (93282) 26 26 $115.00 93283 PR - PROGRAMMING - ICD DUAL LEAD (93283) 93283 $204.00

93283 93283 PR - PROGRAMMING - ICD DUAL LEAD (93283) 26 26 $148.00 93284 PR - PROGRAMMING - ICD BIV (93284) 93284 $224.00

93284 93284 PR - PROGRAMMING - ICD BIV (93284) 26 26 $172.00

PR - PROGRAMMING - IMPLANTABLE LOOP RECORDER 93285 93285 (93285) 26 26 $72.00

PERI-PROCEDURAL DEVICE EVALUATION OF A PACEMAKER 93286 93286 (93286) 26 26 $37.00

93287 PERI-PROCEDURAL DEVICE EVALUATION OF AN ICD (93287) 93287 $57.00

93287 93287 PERI-PROCEDURAL DEVICE EVALUATION OF AN ICD (93287) 26 26 $55.00

PR - INTERROGATION IN PERSON PACEMAKER (ALL TYPES) 93288 93288 (93288) 26 26 $59.00

93289 PR - INTERROGATION IN PERSON ICD (ALL TYPES) (93289) 93289 $163.00

93289 93289 PR - INTERROGATION IN PERSON ICD (ALL TYPES) (93289) 26 26 $116.00

PR - INTERROGATION IN PERSON IMPANTABLE 93290 93290 CARDIOVASCULAR MONITOR (93290) 26 26 $52.00

PR - INTERROGATION IN PERSON IMPLANTABLE LOOP 93291 93291 RECORDER (93291) 26 26 $60.00

PR - INTERROGATION IN PERSON WEARABLE CARDIO- 93292 DEFIBRILLATOR (93292) 93292 $93.00

PR - INTERROGATION IN PERSON WEARABLE CARDIO- 93292 93292 DEFIBRILLATOR (93292) 26 26 $55.00

93293 93293 PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL 26 26 $42.00 93294 PR INTERROGATION EVAL REMOTE

93295 PR INTERROGATION EVAL REMOTE

93296 PR INTERROGATION REMOTE

93297 PR INTERROGATION EVAL REMOTE

93298 PR INTERROGATION EVALUATION REMOTE

PR INTERROG EVAL, REMOTE, UP TO 90 DAYS, CV MON/LOOP 93299 REC,TECH REVIEW 93299 $346.00 93303 PR ECHO XTHORACIC,CONG ANOM,COMPLETE 93303 $594.00

93303 93303 PR ECHO XTHORACIC,CONG ANOM,COMPLETE 26 26 $594.00 93304 PR ECHO XTHORACIC,CONG ANOM,LIMITED 93304 $388.00

93304 93304 PR ECHO XTHORACIC,CONG ANOM,LIMITED 26 26 $388.00

93306 PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER 93306 $567.00

93306 93306 PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER 26 26 $175.00

93307 PR ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER 93307 $326.00

93307 93307 PR ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER 26 26 $115.00 93308 PR ECHO HEART XTHORACIC,LIMITED 93308 $311.00

93308 93308 PR ECHO HEART XTHORACIC,LIMITED 26 26 $68.00

93312 93312 PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R 26 26 $350.00 93313 PR ECHO R-T 2D W/PROBE PLACEMENT ONLY 93313 $180.00

93314 PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY 93314 $271.00

93314 93314 PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY 26 26 $253.00

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG 93315 93315 I&R 26 26 $771.00 93316 PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY 93316 $104.00

93317 93317 PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT 26 26 $666.00

93318 93318 PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ 26 26 $294.00 93320 DOPPLER ECHO HEART,COMPLETE 93320 $184.00

93320 93320 DOPPLER ECHO HEART,COMPLETE 26 26 $103.00 93321 ECHO XTHORACIC, LIMITED, F/U, DOPPLER 93321 $91.00

93321 93321 ECHO XTHORACIC, LIMITED, F/U, DOPPLER 26 26 $58.00 93325 DOPPLER COLOR FLOW VELOCITY MAP 93325 $167.00

93325 93325 DOPPLER COLOR FLOW VELOCITY MAP 26 26 $115.00

93350 93350 93350 ECHO REST & STRESS W/PF 26 26 $188.00

PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT 93351 93351 ECG 26 26 $217.00 93352 93352 ECHO STRESS CONTRAST AGENT 93352 $85.00

93355 PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN 93355 $476.00

93355 93355 PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN 26 26 $476.00

PR MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD 93356 MECH 93356 $102.00

93451 93451 PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT 26 26 $354.00

93452 93452 PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I 26 26 $620.00

93453 93453 PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I 26 26 $813.00

93454 93454 PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I 26 26 $625.00

93455 93455 PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I 26 26 $722.00

93456 93456 PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I 26 26 $800.00 93457 93457 PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I 26 26 $897.00

93458 93458 PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I 26 26 $763.00

93459 93459 PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I 26 26 $859.00

93460 93460 PR R & L HRT CATH WINJX HRT ART& L VENTR IMG 26 26 $957.00

93461 93461 PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I 26 26 $1,055.00 93462 PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE 93462 $486.00

93463 PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT 93463 $259.00

93464 93464 PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU 26 26 $228.00 93503 PR INSERT/PLACE FLOW DIRECT CATH 93503 $900.00

93503 93503 PR INSERT/PLACE FLOW DIRECT CATH 26 26 $391.00

93505 93505 PR ENDOMYOCARDIAL BIOPSY 26 26 $1,050.00

93530 93530 PR R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY 26 26 $1,155.00

93531 93531 PR R/L RETRO HEART CATH, CONG HT ABNL 26 26 $1,680.00

93532 93532 PR R/L INTACT XSEPTAL HT CATH,CONGEN AB 26 26 $1,325.00

93533 93533 PR R/L OPEN XSEPTAL HRT CATH,CONGEN ABL 26 26 $910.00

93563 PR NJX SEL HRT ART CONGENITAL HRT CATH W/S&I 93563 $140.00

93565 PR NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I 93565 $109.00

93566 PR NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I 93566 $424.00 93567 PR NJX SUPRAVALV AORTOG HRT CATH W/S&I 93567 $349.00 93568 PR NJX PULMONARY ANGIO HRT CATH W/S&I 93568 $379.00

93571 93571 PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL 26 26 $243.00 93572 93572 PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL 26 26 $198.00

93580 PR PERC CLOS,CONG INTERATRIAL COMMUN W/IMPL 93580 $3,901.00 93581 PR PERC CLOSURE,CONG VSD W/IMPLANT 93581 $5,348.00

93582 PR PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS 93582 $2,358.00

93583 PR PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER 93583 $2,624.00

93590 PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE 93590 $4,982.00

93591 PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE 93591 $3,618.00

93592 PR PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV 93592 $1,139.00

93600 93600 PR BUNDLE OF HIS RECORDING 26 26 $380.00

93602 93602 PR INTRA-ATRIAL RECORDING 26 26 $325.00

93603 93603 PR RIGHT VENTRICULAR RECORDING 26 26 $293.00

93609 93609 PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA 26 26 $787.00

93610 93610 PR INTRA-ATRIAL PACING 26 26 $535.00

93612 93612 PR INTRAVENTRICULAR PACING 26 26 $419.00

93613 PR INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING 93613 $1,554.00

93619 PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION 93619 $1,793.00

93619 93619 PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION 26 26 $999.00

93620 PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION 93620 $2,813.00

93620 93620 PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION 26 26 $2,257.00

93621 PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC 93621 $990.00 93621 93621 PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC 26 26 $330.00

93622 PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC 93622 $587.00

93622 93622 PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC 26 26 $3,500.00

93623 93623 PR STIM/PACING HEART POST IV DRUG INFU 26 26 $408.00

PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC 93624 93624 W/ARRHYT 26 26 $1,600.00

93631 93631 PR HEART PACING, MAPPING 26 26 $1,007.00

93641 93641 PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN 26 26 $906.00

PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG 93642 93642 PARAMETERS 26 26 $776.50

93644 93644 PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR 26 26 $462.00

93650 PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION 93650 $2,120.00

93653 PR EPHYS EVAL W/ABLATION SUPRAVENT ARRHYTHMIA 93653 $2,980.00

93654 PR EPHYS EVAL W/ABLATION VENTRICULAR TACHYCARDIA 93654 $3,962.00

93655 PR ICAR CATHETER ABLATION ARRHYTHMIA ADD ON 93655 $1,062.00

93656 PR EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN 93656 $4,548.00

93657 PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN 93657 $1,062.00

93662 93662 PR INTRACARD ECHO, THER/DX INTERVENT 26 26 $443.00

93724 93724 PR ANALYZE PACER SYS 26 26 $658.00

93750 PR INTERROGATION VAD IN PRSON W/PHYS/QHP ANALYSIS 93750 $131.00

PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS 93784 I&R 93784 $135.00 93790 PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R 93790 $50.00

93792 PR PT/CAREGIVER TRAINJ FOR INITIATION HOME INR MNTR 93792 $138.00

93793 PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN 93793 $31.00

93880 93880 PR DUPLEX SCAN EXTRACRANIAL,BILAT 26 26 $106.00

93882 93882 PR DUPLEX SCAN EXTRACRANIAL,LIMITED 26 26 $68.00

93886 93886 PR TRANSCRAN DOPPLER INTRACRAN ART 26 26 $126.00

93895 93895 PR CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI 26 26 $102.00

93922 93922 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL 26 26 $34.00

93923 93923 PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS 26 26 $59.00

PR NON-INVASIVE LOWER EXTREM ART STRESS/REST, 93924 93924 COMPLETE,BILATERAL 26 26 $73.00

93925 93925 PR DUPLEX LO EXTREM ART BILAT 26 26 $104.00

93926 93926 PR DUPLEX LO EXTREM ART UNILAT/LTD 26 26 $65.00

93930 93930 PR DUPLEX UP EXTREM ART BILAT 26 26 $107.00

93931 93931 PR DUPLEX UP EXTREM ART UNILAT/LTD 26 26 $66.00 93970 PR DUPLEX EXTREM VENOUS,BILAT 93970 $514.00

93970 93970 PR DUPLEX EXTREM VENOUS,BILAT 26 26 $92.00 93971 PR DUPLEX EXTREM VENOUS,UNI OR LTD 93971 $321.00

93971 93971 PR DUPLEX EXTREM VENOUS,UNI OR LTD 26 26 $59.00

93975 93975 PR DUPLEX ABD/PEL VASC STUDY,COMPLETE 26 26 $215.00 93976 PR DUPLEX ABD/PEL VASC STUDY,LIMITD 93976 $501.00

93976 93976 PR DUPLEX ABD/PEL VASC STUDY,LIMITD 26 26 $141.00 93978 93978 PR DUPLEX LARGE VESSEL(S),COMPLETE 26 26 $105.00

93979 93979 PR DUPLEX LARGE VESSEL(S),LIMITED 26 26 $66.00

93980 93980 PR PENILE VASCULAR STUDY,COMPLETE 26 26 $210.00

93985 PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD 93985 $673.00

93985 93985 PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD 26 26 $103.00

93985 93985 PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD TC TC $575.00

93986 PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD 93986 $391.00

93986 93986 PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD 26 26 $67.00

93986 93986 PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD TC TC $328.00 93990 PR DUPLEX HEMODIALYSIS ACCESS 93990 $64.00

93990 93990 PR DUPLEX HEMODIALYSIS ACCESS 26 26 $67.00 94010 PR BREATHING CAPACITY TEST 94010 $86.00

94010 94010 PR BREATHING CAPACITY TEST 26 26 $31.00 94060 PR EVAL OF BRONCHOSPASM 94060 $152.00

94060 94060 PR EVAL OF BRONCHOSPASM 26 26 $48.00

94070 94070 PR EVAL OF BRONCHOSPASM,PROLONGED 26 26 $71.00 94150 PR VITAL CAPACITY TEST 94150 $56.00

94150 94150 PR VITAL CAPACITY TEST 26 26 $56.00 94200 PR LUNG FUNCTION TEST (MBC/MVV) 94200 $65.00

94375 94375 PR RESPIRATORY FLOW VOLUME LOOP 26 26 $41.00

94452 94452 PR HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT 26 26 $37.00

94453 94453 PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION 26 26 $48.00 94617 PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG 94617 $243.00

94617 94617 PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG 26 26 $86.00 94618 PR PULMONARY STRESS TESTING 94618 $88.00

94618 94618 PR PULMONARY STRESS TESTING 26 26 $59.00

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO 94619 /ECG 94619 $192.00

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO 94619 94619 /ECG 26 26 $60.00 94620 PR PULMONARY STRESS TESTING,SIMPLE 94620 $136.00

94620 94620 PR PULMONARY STRESS TESTING,SIMPLE 26 26 $100.00

94621 94621 PR CARDIOPULMONARY EXERCISE TESTING 26 26 $170.00

94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 94640 $46.00

94640 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 26 26 $46.00 94645 PR CONTINUOUS INHALATION TX, EACH ADD HR 94645 $37.00 94664 PR DEMO &/OR EVAL,PT USE,AEROSOL DEVICE 94664 $40.00 94690 PR EXHALED AIR ANALYSIS 94690 $129.00

94690 94690 PR EXHALED AIR ANALYSIS 26 26 $10.00

PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY 94726 94726 RESIST 26 26 $31.00

PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB 94727 94727 VENT&VOL 26 26 $31.00 94728 PR AIRWAY RESISTANCE BY OSCILLOMETRY 94728 $108.00

94729 94729 PR DIFFUSING CAPACITY 26 26 $25.00

94750 94750 PR PULMONARY COMPLIANCE STUDY 26 26 $30.00 94760 PR NONINVASV OXYGEN SATUR;SINGLE 94760 $8.00 94761 PR NONINVASV OXYGEN SATUR,MULTIPLE 94761 $13.00

94780 PR CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN 94780 $134.00 94781 PR CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN 94781 $53.00

95004 PR PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS 95004 $16.00 95012 PR NITRIC OXIDE EXPIRED GAS DETERMINATION 95012 $51.00

95017 PR ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R 95017 $227.00

95018 PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R 95018 $56.00

95024 PR INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS 95024 $19.00 95028 PR ALLERGY SKIN TESTS 95028 $31.00 95044 PR ALLERGY PATCH TESTS 95044 $17.00

95070 PR INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL 95070 $77.00

95076 PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES 95076 $314.00

95079 PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES 95079 $224.00 95115 PR IMMUNOTHERAPY, ONE INJECTION 95115 $26.00 95117 PR IMMUNOTHERAPY, 2+ INJECTIONS 95117 $32.00

95145 PR PROFES SVC,IMMUNOTHERAPY,1 INSECT VENOM 95145 $50.00 95148 PR ANTIGEN RX SERV,INSECT,4 VENOMS 95148 $231.00 95165 PR PROFES SVC,IMMUNOTHER,SINGLE/MULT AGS 95165 $39.00 95180 PR RAPID DESENSITIZATION PROC,EACH HOUR 95180 $361.00

PR CONT GLUC MONITORING PATIENT PROVIDED 95249 EQUIPTMENT 95249 $141.00

PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED 95250 EQUIPTMENT 95250 $410.00

95251 PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R 95251 $104.00 95717 PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO 95717 $314.00 95718 PR EEG PHYS/QHP 2-12 HR WITH VEEG 95718 $392.00

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO 95719 VID 95719 $471.00

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR 95720 W/VEEG 95720 $606.00 PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O 95721 VIDEO 95721 $606.00

95722 PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG 95722 $737.00

PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O 95723 VIDEO 95723 $745.00

95724 PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG 95724 $941.00

95725 PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID 95725 $847.00

95726 PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG 95726 $1,189.00

95782 95782 PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND 26 26 $315.00

95783 95783 PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM 26 26 $344.00

PR SLEEP STUDY, UNATTENDED, RECORD HEART RATE/O2 95800 95800 SAT/RESP ANAL/SLEEP TIME 26 26 $144.00

PR SLEEP STUDY, UNATTENDED, RECORD HEART RATE/O2 95801 95801 SAT/RESP ANALYSIS 26 26 $127.00

95803 95803 PR ACTIGRAPHY TESTING, 3-14 DAY 26 26 $111.00

95805 95805 PR MULTIPLE SLEEP LATENCY TEST 26 26 $216.00

PR SLEEP STUDY, UNATTENDED, SIMUL RECORD HR/O2 95806 95806 SAT/RESP FLOW/RESP EFF 26 26 $177.00

95808 95808 PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND 26 26 $290.00

95810 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND 26 26 $424.00

PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM 95811 95811 ATTND 26 26 $473.00

95812 95812 PR EEG,EXTENDED MONITORING,41-60 MINUTES 26 26 $146.00

95813 95813 PR EEG EXTENDED MONITORING 61-119 MINUTES 26 26 $232.00

95816 95816 PR EEG,W/AWAKE & DROWSY RECORD 26 26 $207.00 95819 95819 PR EEG,W/AWAKE & ASLEEP RECORD 26 26 $207.00

95822 95822 PR EEG,COMA/SLEEP RECORD ONLY 26 26 $150.00

95824 95824 PR EEG EVAL CEREBRAL DEATH 26 26 $101.00

95827 95827 PR EEG,ALL NIGHT RECORD 26 26 $125.00 95829 PR SURGERY ELECTROCORTICOGRAM 95829 $4,787.00

95829 95829 PR SURGERY ELECTROCORTICOGRAM 26 26 $750.00

95836 PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS 95836 $298.00

95860 95860 PR EMG, NEEDLE, ONE LIMB 26 26 $175.00

95861 95861 PR EMG, NEEDLE, TWO LIMBS 26 26 $235.00

95863 95863 PR EMG, NEEDLE, 3 LIMBS 26 26 $280.00 95865 PR EMG, NEEDLE, LARYNX 95865 $368.00 95866 PR EMG, NEEDLE, HEMIDIAPHRAGM 95866 $341.00

95866 95866 PR EMG, NEEDLE, HEMIDIAPHRAGM 26 26 $178.00

95867 95867 PR EMG,NEEDLE,CRANIAL NERVE SUPP MUS,UNILAT 26 26 $114.00

95869 PR EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12 95869 $237.00

95869 95869 PR EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12 26 26 $51.00

95870 95870 PR EMG,1 EXTREM,NONPARASPINAL 26 26 $70.00

95872 95872 PR EMG, NEEDLE, ONE FIBER 26 26 $363.33

95873 95873 PR ELECTRIC STIM GUIDANCE FOR CHEMODENERVATION 26 26 $54.00

95874 95874 PR NEEDLE EMG GUIDANCE FOR CHEMODENERVATION 26 26 $65.00

95885 95885 PR NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED 26 26 $137.00 95886 95886 PR NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE 26 26 $214.00

PR NEEDLE EMG NONEXTREMTY MSCLES W/NERVE 95887 95887 CONDUCTION 26 26 $191.00

95907 95907 PR MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB 26 26 $205.00

95908 95908 PR MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB 26 26 $258.00

95909 95909 PR MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB 26 26 $308.00

95910 95910 PR MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB 26 26 $412.00

95911 95911 PR MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB 26 26 $513.00

95912 95912 PR MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB 26 26 $617.00

95913 95913 PR MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB 26 26 $730.00

95925 95925 PR SOMATOSENSORY TEST,UPPER LIMBS 26 26 $80.00

95926 95926 PR SOMATOSENSORY TEST,LOWER LIMBS 26 26 $80.00

95930 95930 PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R 26 26 $50.00

95933 95933 PR BLINK REFLEX TEST 26 26 $80.00

95937 95937 PR NEUROMUSCULAR JUNCTION TEST 26 26 $115.00

95938 95938 PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS 26 26 $721.00

95950 95950 PR AMBULATORY EEG MONITORING 26 26 $205.00 95951 PR EEG MONITORING/VIDEORECORD 95951 $790.00

95951 95951 PR EEG MONITORING/VIDEORECORD 26 26 $939.00

PR EEG MONITORING/COMPUTER, EA 24 HOURS, 95953 95953 UNATTENDED 26 26 $399.00

95955 95955 PR EEG DURING SURGERY 26 26 $137.00 PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED 95956 BY TECH/NURSE 95956 $4,073.00

PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED 95956 95956 BY TECH/NURSE 26 26 $616.00

95958 95958 PR EEG MONITORING/FUNCTION TEST 26 26 $600.00

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT 95961 HR 95961 $768.00

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT 95961 95961 HR 26 26 $425.00

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL 95962 HR 95962 $659.00

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL 95962 95962 HR 26 26 $446.00

95970 PR ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM 95970 $180.00

95971 PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG 95971 $129.00 95972 PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG 95972 $300.00

95974 PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR 95974 $519.00

95975 PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN 95975 $283.00 95976 PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG 95976 $105.00 95977 PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG 95977 $139.00 95978 PR ANALYZE NEUROSTIM BRAIN, FIRST 1H 95978 $514.00

95979 PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN 95979 $240.00

95983 PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN 95983 $132.00

95984 PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN 95984 $115.00

95990 PR REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN 95990 $226.00

95991 PR RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP 95991 $315.00

95992 PR CANALITH REPOSITIONING PROCEDURE, PER DAY 95992 $122.00 96002 PR DYN SURF EMG,WALKING/FUNC ACT,1-12 MUS 96002 $56.00 96040 PR GENETIC COUNSELING, EACH 30 MIN 96040 $122.00 96101 PR PSYCHOLOGIC TESTING BY PSYCH/PHYS 96101 $300.00

96103 PR PSYCHOLOGIC TESTING ADMIN BY COMPUTER 96103 $158.00

PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD 96110 INSTRM 96110 $30.00

96111 PR DEVELOPMENTAL TESTING W/INTERP & REPORT 96111 $320.00

96112 PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR 96112 $363.00

96113 PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN 96113 $163.00

96116 PR NEUROBEHAVIORAL STATUS EXAM BY PSYCH/PHYS 96116 $250.00 96118 PR NEUROPSYCH TESTING BY PSYCH/PHYS 96118 $300.00 96119 PR NEUROPSYCH TESTING BY TECHNICIAN 96119 $201.00

96121 PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR 96121 $210.00

96127 PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT 96127 $16.00

96130 PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR 96130 $315.00

96131 PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR 96131 $243.00

96132 PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR 96132 $335.00

96133 PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR 96133 $255.00

96136 PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN 96136 $124.00

96137 PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN 96137 $111.00 96138 PR PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN 96138 $98.00

96139 PR PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN 96139 $98.00

96146 PR PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT 96146 $6.00 96150 PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT 96150 $64.00 96151 PR HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS 96151 $63.00 96152 PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV 96152 $60.00 96154 PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT 96154 $59.00 96155 PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT 96155 $59.00

96156 PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT 96156 $258.00

96158 PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN 96158 $176.00

96159 PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN 96159 $62.00

96160 PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM 96160 $12.00

96161 PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM 96161 $30.00

96164 PR HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN 96164 $26.00

96165 PR HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN 96165 $12.00

96167 PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN 96167 $183.00

96168 PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN 96168 $65.00

96170 PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN 96170 $206.00

96171 PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15 96171 $206.00 96360 PR IV INFUSION, HYDRATION, 31-60 MIN 96360 $130.00 96361 PR IV INFUSION, HYDRATION, EA ADD HOUR 96361 $110.00

PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST 96365 HOUR 96365 $159.00

PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD 96366 HOUR 96366 $53.00

96367 PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR 96367 $88.00

PR IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT 96368 INFUSION 96368 $51.00 96372 PR INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT 96372 $70.00

96373 PR INJECTION,THERAP/PROPH/DIAGNOST, INTRA-ARTERIAL 96373 $48.00

PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL 96374 DRUG 96374 $119.00

PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, 96375 NEW DRUG 96375 $55.00

96401 PR CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM 96401 $156.00 96402 PR CHEMOTHER HORMON ANTINEOPL SUB-Q/IM 96402 $106.00 96405 PR INTRALESIONAL CHEMO ADMIN,<8 LESN 96405 $417.00 96409 PR CHEMOTHER, IV PUSH, SNGL DRUG 96409 $298.00 96411 PR CHEMOTHER, IV PUSH,EA ADD DRUG 96411 $183.00 96413 PR CHEMOTHER, IV INFUSION, 1 HR 96413 $485.00 96415 PR CHEMOTHER, IV INFUSION, EA HR 96415 $149.00 96417 PR CHEMOTHER, IV INFUSE, EACH SEQU INFUS 96417 $218.00 96450 PR CHEMOTHER,CNS,W/LUMBAR PUNCTURE 96450 $1,291.00 96542 PR CHEMOTHER INJECT,SUBARACH/INTRAVENT 96542 $770.00

96573 PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP 96573 $484.00

96574 PR DEBRIDEMENT PRMLG HYPERKERATOTIC LES W/PDT 96574 $623.00 97010 PR HOT OR COLD PACKS THERAPY 97010 $16.00 97012 PR MECHANICAL TRACTION THERAPY 97012 $39.00 97014 PR ELECTRIC STIMULATION THERAPY 97014 $39.00 97016 PR VASOPNEUMATIC DEVICE THERAPY 97016 $46.00 97018 PR PARAFFIN BATH THERAPY 97018 $27.00 97022 PR WHIRLPOOL THERAPY 97022 $56.00 97032 PR ELECTRICAL STIMULATION 97032 $46.00 97034 PR CONTRAST BATH THERAPY 97034 $44.00 97035 PR ULTRASOUND THERAPY 97035 $35.00 97039 PR PHYSICAL THERAPY TREATMENT 97039 $32.00 97110 PR THERAPEUTIC EXERCISES 97110 $78.00

97112 PR NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN 97112 $89.00 97116 PR GAIT TRAINING THERAPY 97116 $77.00

97129 PR THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES 97129 $61.00 97130 PR THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES 97130 $59.00 97140 PR MANUAL THER TECH,1+REGIONS,EA 15 MIN 97140 $72.00 97150 PR GROUP THERAPEUTIC PROCEDURES 97150 $47.00

97161 PR PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS 97161 $215.00

97162 PR PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS 97162 $215.00

97163 PR PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS 97163 $215.00

97164 PR PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS 97164 $146.00

97165 PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS 97165 $231.00

97166 PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS 97166 $231.00

97167 PR OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS 97167 $231.00

97168 PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS 97168 $158.00

97530 PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 97530 $101.00

97533 PR SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES 97533 $108.00

97535 PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES 97535 $87.00

97542 PR WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN 97542 $84.00 97545 PR WORK HARDENING/CONDN,0-2 HR 97545 $394.00 97597 PR DEBRIDEMENT OPEN WOUND 20 SQ CM< 97597 $256.00

97598 PR DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM 97598 $122.00

97602 PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS 97602 $256.00

PR NEGATIVE PRESSURE WOUND THERAPY DME

97606 PR NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM 97606 $136.00 PR NEG PRESSURE WOUND THERAPY NON DME

97608 PR NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM 97608 $888.00 97750 PR PHYSICAL PERFORMANCE TEST 97750 $100.00

97760 PR ORTHOTICS MGMT & TRAINJ INITIAL ENCTR EA 15 MINS 97760 $121.00

97761 PR PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS 97761 $104.00

PR ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 97763 MIN 97763 $128.00 97802 PR MED NUTR THER, 1ST, INDIV, EA 15 MIN 97802 $88.00 97803 PR MED NUTR THER, SUBSQ, INDIV, EA 15 MIN 97803 $76.00 97804 PR MED NUTR THER, GROUP, EA 30 MIN 97804 $40.00 97810 PR ACUPUNCT W/O ELEC STIMUL 15 MIN 97810 $136.00 97813 PR ACUPUNCT W/ ELEC STIMUL 15 MIN 97813 $136.00 98925 PR OSTEOPATHIC MANIP,1-2 BODY REGN 98925 $83.00 98926 PR OSTEOPATHIC MANIP,3-4 BODY REGN 98926 $121.00 98927 PR OSTEOPATHIC MANIP,5-6 BODY REGN 98927 $157.00 98928 PR OSTEOPATHIC MANIP,7-8 BODY REGN 98928 $191.00 98929 PR OSTEOPATHIC MANIP,9-10 BODY REGN 98929 $229.00 98961 PR SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN 98961 $46.00

98967 PR NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN 98967 $70.00

98968 PR NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN 98968 $150.00

98970 PR QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MIN 98970 $206.00

98971 PR QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 11-20MIN 98971 $206.00

98972 PR QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MIN 98972 $206.00

99000 PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB 99000 $16.00 99024 PR POST-OP FOLLOW-UP VISIT 99024 $0.00 99050 PR MEDICAL SERVICES AFTER HRS 99050 $47.00 99053 PR MEDICAL SERVICES 10PM-8AM, 24 HR FAC 99053 $55.00 99058 PR EMERGENCY CARE DISRUPTING OFFICE 99058 $144.00 PR SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY 99070 PHYS/QHP 99070 $50.00 99080 PR SPECIAL REPORTS OR FORMS 99080 $49.00 99100 SPECIAL ANESTHESIA SERVICE 99100 $152.00 99140 PR EMERGENCY ANESTHESIA 99140 $304.00

99143 PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN 99143 $148.00

99144 PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN 99144 $135.00

99144 99144 PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN 26 26 $135.00

99145 PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN 99145 $63.00

99145 99145 PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN 26 26 $63.00

99148 PR MOD SEDATJ DIFF PHYS/QHP <5 YRS INIT 30 MIN 99148 $137.00

99149 PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN 99149 $128.00

99150 PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN 99150 $70.00

99151 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 99151 $196.00

99152 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 99152 $134.00

99153 PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 99153 $28.00

99155 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS 99155 $244.00

99156 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS 99156 $207.00

99157 PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS 99157 $169.00 99173 PR VISUAL SCREENING TEST, BILAT 99173 $72.00

99174 PR INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT 99174 $67.00

99177 PR INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS 99177 $13.00 99184 PR INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE 99184 $565.00

99188 PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP 99188 $49.00 99201 PR OFFICE OUTPATIENT NEW 10 MINUTES 99201 $115.00

99202 PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES 99202 $207.00

99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES 99203 $294.00

PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 99204 MINUTES 99204 $451.00

99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES 99205 $570.00

99211 PR OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) 99211 $62.00

99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN 99212 $123.00

99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN 99213 $204.00

99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN 99214 $297.00

99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN 99215 $400.00

99217 PR OBSERVATION CARE DISCHARGE MANAGEMENT 99217 $201.00 99218 PR INITIAL OBSERVATION CARE/DAY 30 MINUTES 99218 $276.00 99219 PR INITIAL OBSERVATION CARE/DAY 50 MINUTES 99219 $375.00 99220 PR INITIAL OBSERVATION CARE/DAY 70 MINUTES 99220 $511.00 99221 PR INITIAL HOSPITAL CARE/DAY 30 MINUTES 99221 $282.00 99222 PR INITIAL HOSPITAL CARE/DAY 50 MINUTES 99222 $381.00 99223 PR INITIAL HOSPITAL CARE/DAY 70 MINUTES 99223 $559.00 99224 PR SBSQ OBSERVATION CARE/DAY 15 MINUTES 99224 $110.00 99225 PR SBSQ OBSERVATION CARE/DAY 25 MINUTES 99225 $201.00 99226 PR SBSQ OBSERVATION CARE/DAY 35 MINUTES 99226 $289.00 99231 PR SBSQ HOSPITAL CARE/DAY 15 MINUTES 99231 $109.00 99232 PR SBSQ HOSPITAL CARE/DAY 25 MINUTES 99232 $200.00 99233 PR SBSQ HOSPITAL CARE/DAY 35 MINUTES 99233 $288.00

99234 PR OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES 99234 $369.00 99235 PR OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES 99235 $467.00

99236 PR OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES 99236 $601.00 99238 PR HOSPITAL DISCHARGE DAY,<30 MIN 99238 $202.00 99239 PR HOSPITAL DISCHARGE DAY,>30 MIN 99239 $296.00

99241 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN 99241 $124.00

99242 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN 99242 $224.00

99243 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN 99243 $307.00

99244 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN 99244 $458.00

99245 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN 99245 $877.00

99251 PR INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN 99251 $138.00

99252 PR INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN 99252 $209.00

99253 PR INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN 99253 $322.00

99254 PR INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN 99254 $469.00

99255 PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN 99255 $564.00

99281 PR EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB 99281 $63.00

99282 PR EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY 99282 $121.00

99283 PR EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY 99283 $181.00

99284 PR EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 99284 $331.00

99285 PR EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ 99285 $481.00

99288 PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS 99288 $331.00 99291 PR CRITICAL CARE, E/M 30-74 MINUTES 99291 $1,060.00 99292 PR CRITICAL CARE, ADDL 30 MIN 99292 $342.00

99304 PR INITIAL NURSING FACILITY CARE/DAY 25 MINUTES 99304 $250.00

99305 PR INITIAL NURSING FACILITY CARE/DAY 35 MINUTES 99305 $357.00

99306 PR INITIAL NURSING FACILITY CARE/DAY 45 MINUTES 99306 $461.00

99307 PR SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN 99307 $122.00

99308 PR SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN 99308 $191.00

99308 99308 PR SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN 26 26 $173.00

99309 PR SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN 99309 $252.00

99310 PR SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN 99310 $371.00 99315 PR NURSING FAC DISCHRGE DAY,1-30 MIN 99315 $203.00 99316 PR NURSING FAC DISCHRGE DAY,MORE 30 MIN 99316 $291.00

99318 PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN 99318 $265.00

99324 PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN 99324 $151.00

99325 PR DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN 99325 $220.00

99326 PR DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES 99326 $382.00

99327 PR DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN 99327 $513.00

PR DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 99328 MINUTES 99328 $607.00

99334 PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES 99334 $167.00

99335 PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES 99335 $264.00

99336 PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES 99336 $372.00

99337 PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES 99337 $536.00 99339 PR DOMICIL/REST-HOME CARE SUPERVISION, <30 MIN 99339 $215.00

99340 PR DOMICIL/REST-HOME CARE SUPERVISION, =>30 MIN 99340 $299.00

99341 PR HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES 99341 $151.00

99342 PR HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES 99342 $217.00

99343 PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES 99343 $355.00

99344 PR HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES 99344 $504.00

99345 PR HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN 99345 $614.00

99347 PR HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES 99347 $151.00

99348 PR HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES 99348 $232.00

99349 PR HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES 99349 $355.00

99350 PR HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS 99350 $495.00

99354 PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR 99354 $358.00

99355 PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN 99355 $272.00

99356 PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR 99356 $256.00

99357 PR PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN 99357 $258.00

99358 PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR 99358 $309.00

99359 PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MIN 99359 $151.00

99360 PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES 99360 $202.00 99363 PR ANTICOAG MGMT, INITIAL 90 DAYS 99363 $318.00 99364 PR ANTICOAG MGMT, EACH SUBSEQ 90 DAYS 99364 $109.00 99366 PR TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN 99366 $112.00

99367 PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN 99367 $158.00

99368 PR TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN 99368 $104.00

99374 PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES 99374 $194.00

PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 99375 MIN/> 99375 $290.00

99377 PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN 99377 $181.00

99378 PR SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/> 99378 $278.00

99379 PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN 99379 $194.00

99380 PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/> 99380 $290.00 99381 PR PREVENTIVE VISIT,NEW,INFANT < 1 YR 99381 $307.00 99382 PR PREVENTIVE VISIT,NEW,AGE 1-4 99382 $321.00 99383 PR PREVENTIVE VISIT,NEW,AGE5-11 99383 $335.00 99384 PR PREVENTIVE VISIT,NEW,12-17 99384 $379.00 99385 PR PREVENTIVE VISIT,NEW,18-39 99385 $367.00 99386 PR PREVENTIVE VISIT,NEW,40-64 99386 $425.00 99387 PR PREVENTIVE VISIT,NEW,65 & OVER 99387 $462.00 99391 PR PREVENTIVE VISIT,EST, INFANT < 1 YR 99391 $277.00 99392 PR PREVENTIVE VISIT,EST,AGE 1-4 99392 $295.00 99393 PR PREVENTIVE VISIT,EST,AGE5-11 99393 $294.00 99394 PR PREVENTIVE VISIT,EST,12-17 99394 $323.00 99395 PR PREVENTIVE VISIT,EST,18-39 99395 $331.00 99396 PR PREVENTIVE VISIT,EST,40-64 99396 $353.00 99397 PR PREVENTIVE VISIT,EST,65 & OVER 99397 $379.00 99401 PR PREVENT COUNSEL,INDIV,15 MIN 99401 $110.00 99402 PR PREVENT COUNSEL,INDIV,30 MIN 99402 $181.00 99403 PR PREVENT COUNSEL,INDIV,45 MIN 99403 $248.00 99404 PR PREVENT COUNSEL,INDIV,60 MIN 99404 $317.00

99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES 99406 $43.00 99407 PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES 99407 $81.00

99408 PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN 99408 $100.00

99409 PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN 99409 $194.00 99411 PR PREVENT COUNSEL,GROUP,30 MIN 99411 $55.00 99412 PR PREVENT COUNSEL,GROUP,60 MIN 99412 $70.00

99415 PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR 99415 $26.00

99416 PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL 99416 $20.00

99417 PR PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN 99417 $84.00

99421 PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES 99421 $43.00

99422 PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES 99422 $85.00

99423 PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES 99423 $136.00

99439 PR CHRONIC CARE MANAGEMENT SERVICES EA ADDL 20 MIN 99439 $108.00 99441 PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN 99441 $62.19

99442 PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN 99442 $101.42

99443 PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN 99443 $143.78

99444 PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE 99444 $84.00

99446 PR INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10 99446 $46.00

99447 PR INTERPROF PHONE/INTERNET ASSESS/MANAGE 11-20 99447 $93.00

99448 PR INTERPROF PHONE/INTERNET ASSESS/MANAGE 21-30 99448 $138.00

99449 PR INTERPROF PHONE/INTERNET ASSESS/MANAGE31/> 99449 $184.00 99450 PR LIFE/DISABILITY EVALUATION 99450 $334.00 99451 PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN 99451 $102.00

99452 PR NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30 MIN 99452 $102.00

99453 PR REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP 99453 $52.00

99454 PR REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D 99454 $171.00 99455 PR DISABILITY EXAM/TREATING DR 99455 $459.00 99456 PR DISABILITY EXAM/OTHER DR 99456 $528.00

99457 PR REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH 99457 $140.00

99458 PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO 99458 $106.00

PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH 99460 CENTER 99460 $265.00

PR INITIAL NORMAL NEWBORN CARE, EXCEPT HOSPITAL OR 99461 BIRTH CENTER 99461 $252.00

99462 PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN 99462 $114.00

99463 PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE 99463 $323.00

99464 PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN 99464 $207.00 99465 PR DELIVERY/BIRTHING ROOM RESUSCITATION 99465 $414.00

99466 PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN 99466 $660.00

99467 PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN 99467 $331.00

99468 PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL 99468 $3,808.00

PR SUBSEQUENT HOSP NEONATE 28 DAY OR LESS, CRITICALLY 99469 ILL 99469 $1,609.00

99471 PR INITIAL PED CRITICAL CARE 29 DAY THRU 24 MO 99471 $3,050.00

99472 PR SUBSEQUENT PED CRITICAL CARE 29 DAY THRU 24 MO 99472 $1,110.00

99473 PR SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION 99473 $31.00 99474 PR SELF-MEAS BP 2 READG 1 MIN APART BID 30 DAY PD 99474 $42.00 99475 PR INITIAL PED CRITICAL CARE 2 YR THRU 5 YR 99475 $2,027.00

99476 PR SUBSEQUENT PED CRITICAL CARE 2 YR THRU 5 YR 99476 $959.00

PR INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY 99477 ILL 99477 $969.00

99478 PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS 99478 $380.00

99479 PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS 99479 $345.00

99480 PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS 99480 $331.00

99483 PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT 99483 $703.00

99484 PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS 99484 $123.00

99485 PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN 99485 $215.00

99486 PR SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN 99486 $187.00

99487 PR COMPLEX CHRONIC CARE MANAGEMENT SVC 1ST 60 MIN 99487 $205.00

99489 PR COMPLEX CHRONIC CARE MGMT SERVICE EA ADDL 30 MIN 99489 $116.00

99490 PR CHRONIC CARE MANAGEMENT SERVICES 1ST 20 MIN 99490 $110.00

99491 PR CHRONIC CARE MGMT SVC AT LEAST 30 MIN PER MONTH 99491 $228.00

99492 PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS 99492 $430.00

99493 PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS 99493 $384.00

99494 PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS 99494 $178.00

99495 PR TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE 99495 $537.00

99496 PR TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE 99496 $701.00 99497 PR ADVANCE CARE PLANNING FIRST 30 MINS 99497 $236.00 99498 PR ADVANCE CARE PLANNING EA ADDL 30 MINS 99498 $207.00 99499 PR UNLISTED E/M SERVICE 99499 $0.00 99502 HOME VISIT,NEWBORN CARE,ASSESSMENT 99502 $121.00 A4351 PR STRAIGHT TIP URINE CATHETER A4351 $5.00 A4353 PR INTERMITTENT URINARY CATH A4353 $17.00 A4358 PR URINARY LEG OR ABDOMEN BAG A4358 $16.00 A4450 PR NON-WATERPROOF TAPE A4450 $1.00 A4495 PR THIGH LENGTH SURG STOCKING A4495 $22.00 A4500 PR BELOW KNEE SURGICAL STOCKING A4500 $20.00 A4550 PR SURGICAL TRAYS A4550 $55.00 A4556 PR ELECTRODES, PAIR A4556 $35.00 A4562 PR PESSARY, NON RUBBER,ANY TYPE A4562 $139.00 A4565 PR SLINGS A4565 $45.00 A4570 PR SPLINT A4570 $32.00 A4595 PR TENS SUPPL 2 LEAD PER MONTH A4595 $39.00 A4615 CANNULA NASAL A4615 $2.00 A4617 MOUTH PIECE A4617 $9.00 A4627 PR SPACER BAG/RESERVOIR A4627 $28.00 A5500 PR DIAB SHOE FOR DENSITY INSERT A5500 $89.00 A5501 PR DIABETIC CUSTOM MOLDED SHOE A5501 $268.00 A5503 PR DIABETIC SHOE W/ROLLER/ROCKR A5503 $44.00 A5504 PR DIABETIC SHOE WITH WEDGE A5504 $44.00 A5506 PR DIABETIC SHOE W/OFF SET HEEL A5506 $46.00 A5507 PR MODIFICATION DIABETIC SHOE A5507 $80.00 A5512 PR MULTI DEN INSERT DIRECT FORM A5512 $55.00 A5513 PR MULTI DEN INSERT CUSTOM MOLD A5513 $139.00 A6025 PR SILICONE GEL SHEET, EACH A6025 $44.00 A6453 PR SELF-ADHER BAND W <3/YD A6453 $2.00 A6504 PR CMPRSBURNGARMENT GLOVE-WRIST A6504 $315.00 A6505 PR CMPRSBURNGARMENT GLOVE-ELBOW A6505 $367.00 A6506 PR CMPRSBURNGRMNT GLOVE-AXILLA A6506 $383.00 A6507 PR CMPRS BURNGARMENT FOOT-KNEE A6507 $108.00 A6509 PR COMPRES BURN GARMENT JACKET A6509 $330.00 A6530 PR COMPRESSION STOCKING BK18-30 A6530 $38.00 A6531 PR COMPRESSION STOCKING BK30-40 A6531 $61.00 A6533 PR GC STOCKING THIGHLNGTH 18-30 A6533 $51.00 A6534 PR GC STOCKING THIGHLNGTH 30-40 A6534 $67.00 A6536 PR GC STOCKING FULL LNGTH 18-30 A6536 $57.00 A6537 PR GC STOCKING FULL LNGTH 30-40 A6537 $65.00 A6539 PR GC STOCKING WAISTLNGTH 18-30 A6539 $134.00 A6540 PR GC STOCKING WAISTLNGTH 30-40 A6540 $185.00 A6541 PR GC STOCKING WAISTLNGTH 40-50 A6541 $260.00 A6549 PR G COMPRESSION STOCKING A6549 $272.00 A7003 PR NEBULIZER ADMINISTRATION SET A7003 $5.00 A7015 PR AEROSOL MASK USED W NEBULIZE A7015 $4.00 A8000 PR SOFT PROTECT HELMET PREFAB A8000 $209.00 A8001 PR HARD PROTECT HELMET PREFAB A8001 $209.00 A8002 PR SOFT PROTECT HELMET CUSTOM A8002 $329.00 A8003 PR HARD PROTECT HELMET CUSTOM A8003 $2,492.00 A9270 PR NON-COVERED ITEM OR SERVICE A9270 $25.00 A9279 PR MONITORING FEATURE/DEVICENOC A9279 $250.00 A9300 PR EXERCISE EQUIPMENT A9300 $20.00 A9999 PR DME SUPPLY OR ACCESSORY, NOS A9999 $10.00 D0120 PR PERIODIC ORAL EVALUATION D0120 $60.00 D0140 PR LIMIT ORAL EVAL PROBLM FOCUS D0140 $75.00 D0145 PR ORAL EVALUATION, PT < 3YRS D0145 $60.00 D0150 PR COMPREHENSVE ORAL EVALUATION D0150 $90.00 D0160 PR EXTENSV ORAL EVAL PROB FOCUS D0160 $75.00 D0170 PR RE-EVAL,EST PT,PROBLEM FOCUS D0170 $75.00 D0171 PR RE-EVAL POST-OP VISIT D0171 $0.00 D0180 PR COMP PERIODONTAL EVALUATION D0180 $100.00 D0210 PR INTRAOR COMPLETE FILM SERIES D0210 $140.00 D0220 PR INTRAORAL PERIAPICAL FIRST F D0220 $32.00 D0230 PR INTRAORAL PERIAPICAL EA ADD D0230 $26.00 D0240 PR INTRAORAL OCCLUSAL FILM D0240 $48.00 D0250 PR EXTRAORAL FIRST FILM D0250 $50.00

D0251 EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE D0251 $75.00 D0270 PR DENTAL BITEWING SINGLE FILM D0270 $32.00 D0272 PR DENTAL BITEWINGS TWO FILMS D0272 $50.00 D0273 PR BITEWINGS - THREE FILMS D0273 $50.00 D0274 PR DENTAL BITEWINGS FOUR FILMS D0274 $70.00 D0277 PR VERT BITEWINGS-SEV TO EIGHT D0277 $100.00 D0330 PR DENTAL PANORAMIC FILM D0330 $125.00 D0340 PR DENTAL CEPHALOMETRIC FILM D0340 $140.00 D0350 PR ORAL/FACIAL PHOTO IMAGES D0350 $70.00 D0351 PR 3D PHOTOGRAPHIC IMAGE D0351 $0.00 D0363 PR CONE BEAM, THREE DIMENSIONAL D0363 $300.00 D0364 CONE BEAM CT CAPT & INTERP D0364 $400.00 D0365 CONE BEAM CT INTERPRETE MAN D0365 $400.00 D0366 CONE BEAM CT INTERPRETE MAX D0366 $400.00 D0367 CONE BEAM CT INTERP BOTH JAW D0367 $400.00 D0368 CONE BEAM CT INTERPRETE TMJ D0368 $400.00 D0380 PR CONE BEAM CT CAPTURE LIMITED D0380 $300.00 D0381 PR CONE BEAM CT CAPT MANDIBLE D0381 $300.00 D0382 PR CONE BEAM CT CAPT MAXILLA D0382 $300.00 D0383 PR CONE BEAM CT BOTH JAWS D0383 $300.00 D0384 PR CONE BEAM CT CAPTURE TMJ D0384 $300.00 D0391 PR INTERPRETE DIAGNOSTIC IMAGE D0391 $250.00 D0460 PR PULP VITALITY TEST D0460 $65.00 D0470 PR DIAGNOSTIC CASTS D0470 $90.00 D1110 PR DENTAL PROPHYLAXIS ADULT D1110 $95.00 D1120 PR DENTAL PROPHYLAXIS CHILD D1120 $75.00 D1206 PR TOPICAL FLUORIDE VARNISH D1206 $45.00 D1208 TOPICAL APPLICATION FLOURIDE D1208 $45.00 D1310 PR NUTRI COUNSEL-CONTROL CARIES D1310 $28.00 D1320 PR TOBACCO COUNSELING D1320 $0.00 D1330 PR ORAL HYGIENE INSTRUCTION D1330 $0.00 D1351 PR DENTAL SEALANT PER TOOTH D1351 $60.00 D1352 PREV RESIN REST, PERM TOOTH D1352 $75.00 D1353 PR SEALANT REPAIR PER TOOTH D1353 $60.00

INTERIM CARIES ARRESTING MEDICAMENT APPLICATION - PER D1354 TOOTH D1354 $50.00 D1510 PR SPACE MAINTAINER FXD UNILAT D1510 $300.00 D1515 PR FIXED BILAT SPACE MAINTAINER D1515 $400.00 D1516 SPACE MAINTAINER-FIXED-BILATERAL,MAXILLARY D1516 $350.00

D1517 SPACE MAINTAINER-FIXED-BILATERAL-MANDIBULAR D1517 $350.00 D1520 PR REMOVE UNILAT SPACE MAINTAIN D1520 $300.00 D1525 PR REMOVE BILAT SPACE MAINTAIN D1525 $400.00 D1550 PR RECEMENT SPACE MAINTAINER D1550 $70.00 D1555 PR REMOVE FIX SPACE MAINTAINER D1555 $75.00 D1575 PR DIST SPACE MAINT, FIXED UNIL D1575 $300.00 D2140 PR AMALGAM ONE SURFACE PERMANEN D2140 $150.00 D2150 PR AMALGAM TWO SURFACES PERMANE D2150 $200.00 D2160 PR AMALGAM THREE SURFACES PERMA D2160 $250.00 D2161 PR AMALGAM 4 OR > SURFACES PERM D2161 $300.00 D2330 PR RESIN ONE SURFACE-ANTERIOR D2330 $180.00 D2331 PR RESIN TWO SURFACES-ANTERIOR D2331 $220.00 D2332 PR RESIN THREE SURFACES-ANTERIO D2332 $290.00 D2335 PR RESIN 4/> SURF OR W INCIS AN D2335 $350.00 D2390 PR ANT RESIN-BASED CMPST CROWN D2390 $500.00 D2391 PR POST 1 SRFC RESINBASED CMPST D2391 $200.00 D2392 PR POST 2 SRFC RESINBASED CMPST D2392 $260.00 D2393 PR POST 3 SRFC RESINBASED CMPST D2393 $320.00 D2394 PR POST >=4SRFC RESINBASE CMPST D2394 $380.00 D2520 PR DENTAL INLAY METALLIC 2 SURF D2520 $1,000.00 D2530 PR DENTAL INLAY METL 3/MORE SUR D2530 $1,100.00 D2542 PR DENTAL ONLAY METALLIC 2 SURF D2542 $1,000.00 D2543 PR DENTAL ONLAY METALLIC 3 SURF D2543 $1,100.00 D2620 PR INLAY PORCELAIN/CERAMIC 2 SU D2620 $1,050.00 D2642 PR DENTAL ONLAY PORCELIN 2 SURF D2642 $1,100.00 D2643 PR DENTAL ONLAY PORCELIN 3 SURF D2643 $1,160.00 D2644 PR DENTAL ONLAY PORC 4/MORE SUR D2644 $1,200.00 D2651 PR INLAY COMPOSITE/RESIN TWO SU D2651 $950.00 D2652 PR DENTAL INLAY RESIN 3/MRE SUR D2652 $1,000.00 D2662 PR DENTAL ONLAY RESIN 2 SURFACE D2662 $1,100.00 D2663 PR DENTAL ONLAY RESIN 3 SURFACE D2663 $1,150.00 D2664 PR DENTAL ONLAY RESIN 4/MRE SUR D2664 $1,000.00 D2740 PR CROWN PORCELAIN/CERAMIC SUBS D2740 $1,200.00 D2750 PR CROWN PORCELAIN W/ H NOBLE M D2750 $1,200.00 D2751 PR CROWN PORCELAIN FUSED BASE M D2751 $1,200.00 D2752 PR CROWN PORCELAIN W/ NOBLE MET D2752 $1,200.00 D2780 PR CROWN 3/4 CAST HI NOBLE MET D2780 $1,200.00 D2781 PR CROWN 3/4 CAST BASE METAL D2781 $1,200.00 D2782 PR CROWN 3/4 CAST NOBLE METAL D2782 $1,200.00 D2783 PR CROWN 3/4 PORCELAIN/CERAMIC D2783 $1,200.00 D2790 PR CROWN FULL CAST HIGH NOBLE M D2790 $1,200.00 D2799 PR PROVISIONAL CROWN D2799 $350.00 D2910 PR RECEMENT INLAY ONLAY OR PART D2910 $120.00 D2920 PR DENTAL RECEMENT CROWN D2920 $120.00 D2921 PR REATTACH TOOTH FRAGMENT D2921 $180.00

PREFABRICATED PORCELAIN/CERAMIC CROWN, PRIMARY D2929 TOOTH D2929 $400.00 D2930 PR PREFAB STNLSS STEEL CRWN PRI D2930 $290.00 D2931 PR PREFAB STNLSS STEEL CROWN PE D2931 $300.00 D2940 PR DENTAL SEDATIVE FILLING D2940 $120.00 D2941 PR INT THERAPEUTIC RESTORATION D2941 $100.00 D2950 PR CORE BUILD-UP INCL ANY PINS D2950 $300.00 D2951 PR TOOTH PIN RETENTION D2951 $70.00 D2952 PR POST AND CORE CAST + CROWN D2952 $500.00 D2954 PR PREFAB POST/CORE + CROWN D2954 $380.00 D2960 PR LAMINATE LABIAL VENEER D2960 $700.00 D2962 PR LAB LABIAL VENEER PORCELAIN D2962 $1,200.00 D2975 PR COPING D2975 $200.00 D2980 PR CROWN REPAIR D2980 $225.00 D2983 VENEER REPAIR D2983 $225.00 D2990 RESIN INFILTRATION OF LESION D2990 $40.00 D2999 PR DENTAL UNSPEC RESTORATIVE PR D2999 $0.00 D3110 PR PULP CAP DIRECT D3110 $95.00 D3120 PR PULP CAP INDIRECT D3120 $95.00 D3220 PR THERAPEUTIC PULPOTOMY D3220 $200.00 D3221 PR GROSS PULPAL DEBRIDEMENT D3221 $250.00 D3222 PR PART PULP FOR APEXOGENESIS D3222 $200.00 D3230 PR PULPAL THERAPY ANTERIOR PRIM D3230 $300.00 D3240 PR PULPAL THERAPY POSTERIOR PRI D3240 $350.00 D3310 PR ANTERIOR D3310 $800.00 D3320 PR ROOT CANAL THERAPY 2 CANALS D3320 $900.00 D3330 PR ROOT CANAL THERAPY 3 CANALS D3330 $1,100.00 D3331 PR NON-SURG TX ROOT CANAL OBS D3331 $800.00 D3332 PR INCOMPLETE ENDODONTIC TX D3332 $500.00 D3333 PR INTERNAL ROOT REPAIR D3333 $300.00 D3346 PR RETREAT ROOT CANAL ANTERIOR D3346 $950.00 D3347 PR RETREAT ROOT CANAL BICUSPID D3347 $1,100.00 D3348 PR RETREAT ROOT CANAL MOLAR D3348 $1,200.00 D3351 PR APEXIFICATION/RECALC INITIAL D3351 $350.00 D3352 PR APEXIFICATION/RECALC INTERIM D3352 $300.00 D3353 PR APEXIFICATION/RECALC FINAL D3353 $800.00 D3355 PR PULPAL REGENERATION INITIAL D3355 $200.00 D3356 PR PULPAL REGENERATION INTERIM D3356 $150.00 D3410 PR APICOECT/PERIRAD SURG ANTER D3410 $800.00 D3421 PR ROOT SURGERY BICUSPID D3421 $900.00 D3425 PR ROOT SURGERY MOLAR D3425 $1,100.00 D3426 PR ROOT SURGERY EA ADD ROOT D3426 $300.00 D3427 PR PERIRADICULAR SURGERY D3427 $550.00 D3450 PR ROOT AMPUTATION D3450 $500.00 D3460 PR ENDODONTIC ENDOSSEOUS IMPLAN D3460 $2,000.00 D3470 PR INTENTIONAL REPLANTATION D3470 $1,000.00 D4210 PR GINGIVECTOMY/PLASTY PER QUAD D4210 $680.00 D4211 PR GINGIVECTOMY/PLASTY PER TOOT D4211 $400.00 D4212 GINGIVECTOMY/PLASTY REST D4212 $247.00 D4240 PR GINGIVAL FLAP PROC W/ PLANIN D4240 $680.00 D4241 PR GNGVL FLAP W ROOTPLAN 1-3 TH D4241 $500.00 D4245 PR APICALLY POSITIONED FLAP D4245 $550.00 D4249 PR CROWN LENGTHEN HARD TISSUE D4249 $900.00 D4260 PR OSSEOUS SURGERY PER QUADRANT D4260 $1,100.00 D4261 PR OSSEOUS SURGL-3TEETHPERQUAD D4261 $800.00 D4263 PR BONE REPLCE GRAFT FIRST SITE D4263 $650.00 D4264 PR BONE REPLCE GRAFT EACH ADD D4264 $450.00 D4265 PR BIO MTRLS TO AID SOFT/OS REG D4265 $527.00 D4266 PR GUIDED TISS REGEN RESORBLE D4266 $800.00 D4270 PR PEDICLE SOFT TISSUE GRAFT PR D4270 $1,000.00 D4273 PR SUBEPITHELIAL TISSUE GRAFT D4273 $1,100.00 D4274 PR DISTAL/PROXIMAL WEDGE PROC D4274 $350.00 D4277 SOFT TISSUE GRAFT 1ST TOOTH D4277 $1,000.00 D4278 SOFT TISSUE GRAFT ADDL TOOTH D4278 $500.00 D4283 AUTO TISSUE GRAFT ADDL TOOTH D4283 $550.00 D4320 PR PROVISION SPLNT INTRACORONAL D4320 $600.00 D4321 PR PROVISIONAL SPLINT EXTRACORO D4321 $500.00 D4341 PR PERIODONTAL SCALING & ROOT D4341 $275.00 D4342 PR PERIODONTAL SCALING 1-3TEETH D4342 $190.00 D4346 SCALING GINGIVAL INFLAMMATION D4346 $150.00 D4355 PR FULL MOUTH DEBRIDEMENT D4355 $190.00 D4381 PR LOCALIZED DELIVERY ANTIMICRO D4381 $125.00 D4910 PR PERIODONTAL MAINT PROCEDURES D4910 $160.00 D5110 PR DENTURES COMPLETE MAXILLARY D5110 $2,000.00 D5120 PR DENTURES COMPLETE MANDIBLE D5120 $2,000.00 D5130 PR DENTURES IMMEDIAT MAXILLARY D5130 $1,700.00 D5140 PR DENTURES IMMEDIAT MANDIBLE D5140 $1,300.00

MAXILLARY PARTIAL DENTURE-RESIN BASE (INCLUDING D5211 RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH) D5211 $1,500.00 MANDIBULAR PARTIAL DENTURE-RESIN BASE (INCLUDING D5212 RETENTIVE/CLASPING MATERIALS, RESTS AND TEETH) D5212 $1,500.00 D5213 PR DENTURES MAXILL PART METAL D5213 $2,000.00 D5214 PR DENTURES MANDIBL PART METAL D5214 $2,000.00 D5221 IMMED MAX PART DENTURE RESIN D5221 $1,250.00 D5222 IMMED MAN PART DENTURE RESIN D5222 $1,250.00 D5223 IMMED MAX PART DENT METAL D5223 $1,500.00 D5224 IMMED MAND PART DENT METAL D5224 $1,500.00 D5225 PR MAXILLARY PART DENTURE FLEX D5225 $1,800.00 D5226 PR MANDIBULAR PART DENTURE FLEX D5226 $1,800.00 D5281 PR REMOVABLE PARTIAL DENTURE D5281 $1,200.00

REMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAST D5282 METAL - MAXILLARY D5282 $800.00

REMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAST D5283 METAL -MANDIBULAR D5283 $800.00 D5410 PR DENTURES ADJUST CMPLT MAXIL D5410 $100.00 D5411 PR DENTURES ADJUST CMPLT MAND D5411 $100.00 D5421 PR DENTURES ADJUST PART MAXILL D5421 $100.00 D5422 PR DENTURES ADJUST PART MANDBL D5422 $100.00 D5510 PR DENTUR REPR BROKEN COMPL BAS D5510 $230.00

D5511 REPAIR BROKEN COMPLETE DENTURE BASE, MANDIBULAR D5511 $300.00

D5512 REPAIR BROKEN COMPLETE DENTURE BASE, MAXILLARY D5512 $250.00 D5520 PR REPLACE DENTURE TEETH COMPLT D5520 $200.00 D5610 PR DENTURES REPAIR RESIN BASE D5610 $230.00

D5611 REPAIR RESIN PARTIAL DENTURE BASE, MANDIBULAR D5611 $300.00

D5612 REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY D5612 $300.00

D5621 REPAIR CAST PARTIAL FRAMEWORK, MANDIBULAR D5621 $300.00 D5622 REPAIR CAST PARTIAL FRAMEWORK, MAXILLARY D5622 $300.00

REPAIR OR REPLACE BROKEN RETENTIVE/CLASPING D5630 MATERIALS-PER TOOTH D5630 $300.00 D5640 PR REPLACE PART DENTURE TEETH D5640 $200.00 D5650 PR ADD TOOTH TO PARTIAL DENTURE D5650 $230.00 D5660 PR ADD CLASP TO PARTIAL DENTURE D5660 $300.00 D5710 PR DENTURES REBASE CMPLT MAXIL D5710 $600.00 D5711 PR DENTURES REBASE CMPLT MAND D5711 $600.00 D5720 PR DENTURES REBASE PART MAXILL D5720 $600.00 D5721 PR DENTURES REBASE PART MANDBL D5721 $600.00 D5730 PR DENTURE RELN CMPLT MAXIL DIRECT D5730 $400.00 D5731 PR DENTURE RELN CMPLT MAND DIRECT D5731 $400.00 D5740 PR DENTURE RELN PART MAXIL DIRECT D5740 $400.00 D5741 PR DENTURE RELN PART MAND DIRECT D5741 $400.00 D5750 PR DENTURE RELN CMPLT MAX INDIRECT D5750 $500.00 D5751 PR DENTURE RELN CMPLT MAND INDIRECT D5751 $500.00 D5760 PR DENTURE RELN PART MAXIL INDIRECT D5760 $500.00 D5761 PR DENTURE RELN PART MAND INDIRECT D5761 $500.00 D5810 PR DENTURE INTERM CMPLT MAXILL D5810 $1,000.00 D5811 PR DENTURE INTERM CMPLT MANDBL D5811 $1,000.00 D5820 PR DENTURE INTERM PART MAXILL D5820 $800.00 D5821 PR DENTURE INTERM PART MANDBL D5821 $800.00 D5850 PR DENTURE TISS CONDITN MAXILL D5850 $250.00 D5851 PR DENTURE TISS CONDTIN MANDBL D5851 $250.00 D5862 PR PRECISION ATTACHMENT D5862 $700.00 D5863 OVERDENTURE COMPLETE MAXILLARY D5863 $2,000.00 D5864 OVERDENTURE PARTIAL MAXILLARY D5864 $2,000.00 D5865 OVERDENTURE COMPLETE MANDIBULAR D5865 $2,000.00 D5866 OVERDENTURE PARTIAL MANDIBULAR D5866 $2,000.00 D5875 PR PROSTHESIS MODIFICATION D5875 $800.00 D5933 PR REFITTING OF OBTURATOR D5933 $250.00 D5982 PR SURGICAL STENT D5982 $500.00 D5983 PR RADIATION APPLICATOR D5983 $450.00 D5986 PR FLUORIDE APPLICATOR D5986 $190.00 D5988 PR SURGICAL SPLINT D5988 $500.00 D6010 PR ODONTICS ENDOSTEAL IMPLANT D6010 $2,000.00 D6011 SECOND STAGE IMPLANT SURGERY D6011 $0.00 D6052 SEMI-PRECISION ATTACHMENT ABUTMENT D6052 $900.00 D6056 PR PREFABRICATED ABUTMENT D6056 $1,000.00 D6057 PR CUSTOM ABUTMENT D6057 $1,100.00 D6058 PR ABUTMENT SUPPORTED CROWN D6058 $1,400.00 D6059 PR ABUTMENT SUPPORTED MTL CROWN D6059 $1,400.00 D6065 PR IMPLANT SUPPORTED CROWN D6065 $1,336.00 D6066 PR IMPLANT SUPPORTED MTL CROWN D6066 $1,015.00 D6068 PR ABUTMENT SUPPORTED RETAINER D6068 $1,125.00 D6071 PR ABUTMENT SUPPORTED RETAINER D6071 $1,000.00 D6076 PR IMPLANT SUPPORTED RETAINER D6076 $1,100.00 D6080 PR IMPLANT MAINTENANCE D6080 $350.00 D6090 PR REPAIR IMPLANT D6090 $250.00 D6091 PR REPL SEMI/PRECISION ATTACH D6091 $150.00 D6092 PR RECEMENT SUPP CROWN D6092 $200.00 D6096 REMOVE BROKEN IMPLANT RETAINING SCREW D6096 $300.00 D6100 PR REMOVAL OF IMPLANT D6100 $1,000.00 D6102 DEBRIDEMENT AND CONTOURING D6102 $400.00 D6104 BONE GRAFT TIME OF IMPLANT D6104 $800.00 D6111 IMPLNT/ABUT REMOV DENT MAND D6111 $2,000.00

IMPLANT/ABUT SUPPORTED INTERIM FIXED DENTURE FOR D6118 EDENTULOUS ARCH-MAN D6118 $3,500.00

IMPLANT/ABUT SUPPORTED INTERIM FIXED DENTURE FOR D6119 EDENTULOUS ARCH - MAX D6119 $3,500.00 D6205 PR PONTIC-INDIRECT RESIN BASED D6205 $575.00 D6212 PR BRIDGE NOBLE METAL CAST D6212 $1,100.00 D6240 PR BRIDGE PORCELAIN HIGH NOBLE D6240 $1,100.00 D6242 PR BRIDGE PORCELAIN NOBEL METAL D6242 $1,100.00 D6245 PR BRIDGE PORCELAIN/CERAMIC D6245 $950.00 D6545 PR DENTAL RETAINR CAST METL D6545 $800.00

D6549 RETAINER - FOR RESIN BONDED FIXED PROSTHESIS D6549 $315.00 D6740 PR CROWN PORCELAIN/CERAMIC D6740 $975.00 D6750 PR CROWN PORCELAIN HIGH NOBLE D6750 $1,200.00 D6752 PR CROWN PORCELAIN NOBLE METAL D6752 $1,100.00 D6930 PR DENTAL RECEMENT BRIDGE D6930 $200.00 D6980 PR BRIDGE REPAIR D6980 $250.00 D7111 PR EXTRACTION CORONAL REMNANTS D7111 $100.00 D7140 PR EXTRACTION ERUPTED TOOTH/EXR D7140 $180.00 D7210 PR REM IMP TOOTH W MUCOPER FLP D7210 $300.00 D7220 PR IMPACT TOOTH REMOV SOFT TISS D7220 $375.00 D7230 PR IMPACT TOOTH REMOV PART BONY D7230 $450.00 D7240 PR IMPACT TOOTH REMOV COMP BONY D7240 $600.00 D7250 PR TOOTH ROOT REMOVAL D7250 $200.00 D7260 PR ORAL ANTRAL FISTULA CLOSURE D7260 $1,300.00 D7261 PR PRIMARY CLOSURE SINUS PERF D7261 $600.00 D7270 PR TOOTH REIMPLANTATION D7270 $700.00 D7280 PR EXPOSURE IMPACT TOOTH ORTHOD D7280 $400.00 PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF D7283 IMPACTED TOOTH D7283 $300.00 D7285 PR BIOPSY OF ORAL TISSUE HARD D7285 $500.00 D7286 PR BIOPSY OF ORAL TISSUE SOFT D7286 $400.00 D7310 PR ALVEOPLASTY W/ EXTRACTION D7310 $350.00 D7311 PR ALVEOLOPLASTY W/EXTRACT 1-3 D7311 $145.00 D7320 PR ALVEOPLASTY W/O EXTRACTION D7320 $600.00 D7321 PR ALVEOLOPLASTY NOT W/EXTRACTS D7321 $125.00 D7410 PR RAD EXC LESION UP TO 1.25 CM D7410 $750.00 D7411 PR EXCISION BENIGN LESION>1.25C D7411 $470.00 D7451 PR REM ODONTOGEN CYST > 1.25 CM D7451 $250.00 D7465 PR LESION DESTRUCTION D7465 $294.00 D7471 PR REM EXOSTOSIS ANY SITE D7471 $800.00 D7472 PR REMOVAL OF TORUS PALATINUS D7472 $625.00 D7473 PR REMOVE TORUS MANDIBULARIS D7473 $625.00 D7510 PR I&D ABSC INTRAORAL SOFT TISS D7510 $280.00 D7530 PR REMOVAL FB SKIN/AREOLAR TISS D7530 $408.00 D7540 PR REMOVAL OF FB REACTION D7540 $180.00 D7550 PR REMOVAL OF SLOUGHED OFF BONE D7550 $2,000.00 D7670 PR CLOSD RDUCTN SPLINT ALVEOLUS D7670 $2,000.00 D7910 PR DENT SUTUR RECENT WND TO 5CM D7910 $400.00 D7912 PR SUTURE COMPLICATE WND > 5 CM D7912 $600.00 D7951 PR SINUS AUG W BONE/BONE SUP D7951 $1,500.00 D7953 PR BONE REPLACEMENT GRAFT D7953 $800.00 D7960 PR FRENULECTOMY/FRENULOTOMY D7960 $500.00 D7970 PR EXCISION HYPERPLASTIC TISSUE D7970 $600.00 D7971 PR EXCISION PERICORONAL GINGIVA D7971 $450.00 D8030 PR LIMITED DENTAL TX ADOLESCENT D8030 $3,500.00 D8080 PR COMPRE DENTAL TX ADOLESCENT D8080 $6,500.00 D8210 PR ORTHODONTIC REM APPLIANCE TX D8210 $800.00 D8220 PR FIXED APPLIANCE THERAPY HABT D8220 $1,200.00 D8660 PR PREORTHODONTIC TX VISIT D8660 $600.00 D8670 PR PERIODIC ORTHODONTC TX VISIT D8670 $702.00 D8680 PR ORTHODONTIC RETENTION D8680 $190.00 D8690 PR ORTHODONTIC TREATMENT D8690 $184.00 D8692 PR REPLACEMENT RETAINER D8692 $500.00 D8693 PR REBOND/CEMENT/REPAIR RETAIN D8693 $45.00

REMOVAL OF FIXED ORTHO APPLIANCES FOR REASONS D8695 OTHER THAN COMPLETION D8695 $350.00 D8703 REPLACEMENT OF LOST OR BROKEN RETAINER - MAXILLARY D8703 $500.00

D8704 REPLACEMENT OF LOST OR BROKEN RETAINER - MANDIBULAR D8704 $500.00 D9110 PR TX DENTAL PAIN MINOR PROC D9110 $150.00 D9120 PR FIX PARTIAL DENTURE SECTION D9120 $225.00 D9230 PR ANALGESIA D9230 $100.00

INTRAVENOUS MODERATE (CONSCIOUS) D9239 SEDATION/ANALGESIA- FIRST 15 MINUTES D9239 $200.00 D9243 IV SEDATION EACH 15M D9243 $155.00 D9248 PR SEDATION (NON-IV) D9248 $300.00 D9310 PR DENTAL CONSULTATION D9310 $98.00 D9430 PR OFFICE VISIT DURING HOURS D9430 $90.00 D9450 PR CASE PRESENTATION TX PLAN D9450 $0.00 D9630 PR OTHER DRUGS/MEDICAMENTS D9630 $57.00 D9910 PR DENT APPL DESENSITIZING MED D9910 $50.00 D9911 PR APPL DESENSITIZING RESIN D9911 $64.00 D9940 PR DENTAL OCCLUSAL GUARD D9940 $550.00 D9941 PR FABRICATION ATHLETIC GUARD D9941 $250.00 D9943 OCCLUSAL GUARD ADJUSTMENT D9943 $44.00 D9944 OCCLUSAL GUARD-HARD APPLIANCE, FULL ARCH D9944 $500.00 D9945 OCCLUSAL GUARD-SOFT APPLIANCE, FULL ARCH D9945 $190.00 D9951 PR LIMITED OCCLUSAL ADJUSTMENT D9951 $225.00 D9970 PR ENAMEL MICROABRASION D9970 $35.00 D9971 PR ODONTOPLASTY - PER TOOTH D9971 $150.00 D9973 PR EXTRNL BLEACHING PER TOOTH D9973 $300.00 D9974 PR INTRNL BLEACHING PER TOOTH D9974 $350.00

EXTERNAL BLEACHING HOME ARCH TOOTH WHITENING D9975 FROM OUTSIDE THE TOOTH D9975 $200.00 E0191 PR PROTECTOR HEEL OR ELBOW E0191 $145.00 E0486 PR ORAL DEVICE/APPLIANCE CUSFAB E0486 $1,800.00 E0720 PR TENS TWO LEAD E0720 $510.00 E0731 PR CONDUCTIVE GARMENT FOR TENS/ E0731 $462.00 E0860 PR TRACT EQUIP CERVICAL TRACT E0860 $69.00 E0945 PR BELT/HARNESS EXTREMITY E0945 $107.00 G0008 PR ADMIN INFLUENZA VIRUS VAC G0008 $21.00 G0009 PR ADMIN PNEUMOCOCCAL VACCINE G0009 $21.00 G0010 PR ADMIN HEPATITIS B VACCINE G0010 $21.00 G0101 PR CA SCREEN;PELVIC/BREAST EXAM G0101 $95.00 G0103 PR PSA, TOTAL SCREENING G0103 $61.00 G0104 PR CA SCREEN;FLEXI SIGMOIDSCOPE G0104 $335.00 G0105 PR COLORECTAL SCRN; HI RISK IND G0105 $1,036.00 G0108 PR DIAB MANAGE TRN PER INDIV G0108 $132.00 G0117 PR GLAUCOMA SCRN HGH RISK DIREC G0117 $146.00

COLORECTAL CANCER SCREENING ALTERNATIVE TO G0105, G0120 SCREENING COLONOSCOPY BARIUM ENEMA G0120 $539.00

COLORECTAL CANCER SCREENING ALTERNATIVE TO G0105, G0120 G0120 SCREENING COLONOSCOPY BARIUM ENEMA 26 26 $133.00 G0121 PR COLON CA SCRN NOT HI RSK IND G0121 $961.00 G0124 PR SCREEN C/V THIN LAYER BY MD G0124 $82.00 G0127 PR TRIM NAIL(S) G0127 $63.00 G0168 PR WOUND CLOSURE BY ADHESIVE G0168 $257.00 G0179 PR MD RECERTIFICATION HHA PT G0179 $140.00 G0180 PR MD CERTIFICATION HHA PATIENT G0180 $150.00 G0181 PR HOME HEALTH CARE SUPERVISION G0181 $271.00 G0182 PR HOSPICE CARE SUPERVISION G0182 $273.00 G0202 PR SCR MAMMO BI INCL CAD G0202 $341.00

G0202 G0202 PR SCR MAMMO BI INCL CAD 26 26 $81.00

G0204 G0204 PR DX MAMMO INCL CAD BI 26 26 $101.00

G0206 G0206 PR DX MAMMO INCL CAD UNI 26 26 $81.00 G0270 PR MNT SUBS TX FOR CHANGE DX G0270 $76.00 G0271 PR GROUP MNT 2 OR MORE 30 MINS G0271 $40.00

G0279 G0279 PR TOMOSYNTHESIS, MAMMO SCREEN 26 26 $129.00 G0283 PR ELEC STIM OTHER THAN WOUND G0283 $39.00 G0289 PR ARTHRO, LOOSE BODY + CHONDRO G0289 $286.00 G0296 PR VISIT TO DETERM LDCT ELIG G0296 $136.00 G0297 PR LDCT FOR LUNG CA SCREEN G0297 $507.00

G0297 G0297 PR LDCT FOR LUNG CA SCREEN 26 26 $136.00 G0364 PR BONE MARROW ASPIRATE &BIOPSY G0364 $35.00 G0365 PR VESSEL MAPPING HEMO ACCESS G0365 $503.00 G0365 G0365 PR VESSEL MAPPING HEMO ACCESS 26 26 $31.00 G0372 PR MD SERVICE REQUIRED FOR PMD G0372 $52.00

G0389 G0389 PR ULTRASOUND EXAM AAA SCREEN 26 26 $68.00

G0399 G0399 PR HOME SLEEP TEST/TYPE 3 PORTA 26 26 $147.00 G0402 PR INITIAL PREVENTIVE EXAM G0402 $457.00 G0403 PR EKG FOR INITIAL PREVENT EXAM G0403 $50.00

G0403 G0403 PR EKG FOR INITIAL PREVENT EXAM 26 26 $50.00 G0405 PR EKG INTERPRET & REPORT PREVE G0405 $22.00 G0413 PR PELVIC RING FRACTURE UNI/BIL G0413 $3,357.00 G0414 PR PELVIC RING FX TREAT INT FIX G0414 $3,480.00 G0415 PR OPEN TX POST PELVIC FXCTURE G0415 $4,894.00

G0416 G0416 PR PROSTATE BIOPSY, ANY MTHD 26 26 $462.00 G0420 PR ED SVC CKD IND PER SESSION G0420 $272.00 G0425 INPT/ED TELECONSULT30 G0425 $245.00 G0426 INPT/ED TELECONSULT50 G0426 $350.00 G0427 INPT/ED TELECONSULT70 G0427 $521.00 G0432 PR EIA HIV-1/HIV-2 SCREEN G0432 $49.00 G0436 PR TOBACCO-USE COUNSEL 3-10 MIN G0436 $35.00 G0437 PR TOBACCO-USE COUNSEL>10MIN G0437 $70.00 G0438 PR PPPS, INITIAL VISIT G0438 $469.00 G0439 PR PPPS, SUBSEQ VISIT G0439 $318.00 G0442 PR ANNUAL ALCOHOL SCREEN 15 MIN G0442 $42.00 G0443 PR BRIEF ALCOHOL MISUSE COUNSEL G0443 $65.00 G0444 PR DEPRESSION SCREEN ANNUAL G0444 $43.00 G0446 PR INTENS BEHAVE THER CARDIO DX G0446 $59.00 G0447 PR BEHAVIOR COUNSEL OBESITY 15M G0447 $65.00 G0451 PR DEVLOPMENT TEST INTERPT&REP G0451 $26.00

G0452 G0452 PR MOLECULAR PATHOLOGY INTERPR 26 26 $100.00 G0455 PR FECAL MICROBIOTA PREP INSTIL G0455 $274.00 G0500 PR MOD SEDAT ENDO SERVICE >5YRS G0500 $149.00 G0502 PR INIT PSYCH CARE MANAG, 70MIN G0502 $358.00 G0503 PR SUBSEQ PSYCH CARE MAN,60MI G0503 $316.00 G0504 PR INIT/SUB PSYCH CARE ADD 30 M G0504 $166.00 G0505 PR COG/FUNC ASSESSMENT OUTPT G0505 $596.00 G0506 PR COMP ASSES CARE PLAN CCM SVC G0506 $160.00 G0508 PR CRIT CARE TELEHEA CONSULT 60 G0508 $504.00 G0509 PR CRIT CARE TELEHEA CONSULT 50 G0509 $486.00 G1004 PR CDSM NDSC G1004 $0.00 G2010 PR REMOT IMAGE SUBMIT BY PT G2010 $31.00 G2012 PR BRIEF CHECK IN BY MD/QHP G2012 $39.00 G2058 PR CCM ADD 20MIN G2058 $95.00 G2211 PR COMPLEX E/M VISIT ADD ON G2211 $45.00 G2212 PR PROLONG OUTPT/OFFICE VIS G2212 $88.00

G6002 G6002 PR STEREOSCOPIC X-RAY GUIDANCE 26 26 $50.00 G8600 PR TPA INITI W/IN 3 HRS G8600 $0.00 G8601 PR NO ELIG TPA INIT W/IN 3 HRS G8601 $0.00 G8602 PR NO TPA INIT W/IN 3 HRS G8602 $0.00 G9012 PR OTHER SPECIFIED CASE MGMT G9012 $243.00 H0004 PR ALCOHOL AND/OR DRUG SERVICES H0004 $24.00 H0005 PR ALCOHOL AND/OR DRUG SERVICES H0005 $8.00 H0014 PR ALCOHOL AND/OR DRUG SERVICES H0014 $140.00 H2036 PR A/D TX PROGRAM, PER DIEM H2036 $280.00 J0171 PR ADRENALIN EPINEPHRINE INJECT J0171 $19.00 J0558 PR PENG BENZATHINE/PROCAINE INJ J0558 $9.00 J0561 PR PENICILLIN G BENZATHINE INJ J0561 $20.00 J0585 PR INJECTION,ONABOTULINUMTOXINA J0585 $15.50 J0670 PR INJ MEPIVACAINE HCL/10 ML J0670 $10.00 J0696 PR CEFTRIAXONE SODIUM INJECTION J0696 $20.00 J1020 PR METHYLPREDNISOLONE 20 MG INJ J1020 $10.00 J1030 PR METHYLPREDNISOLONE 40 MG INJ J1030 $11.00 J1040 PR METHYLPREDNISOLONE 80 MG INJ J1040 $26.00 J1050 PR MEDROXYPROGESTERONE ACETATE J1050 $1.00 J1071 PR INJ TESTOSTERONE CYPIONATE 1MG J1071 $1.00 J1100 PR DEXAMETHASONE SODIUM PHOS J1100 $2.00 J1439 PR INJ FERRIC CARBOXYMALTOS 1MG J1439 $3.00 J1815 PR INSULIN INJECTION J1815 $2.00 J1885 PR KETOROLAC TROMETHAMINE INJ J1885 $10.00 J2001 PR LIDOCAINE INJECTION J2001 $0.00 J2357 PR OMALIZUMAB INJECTION J2357 $76.00 J2405 PR ONDANSETRON HCL INJECTION J2405 $3.00 J2790 PR RHO D IMMUNE GLOBULIN INJ J2790 $184.00 J2930 PR METHYLPREDNISOLONE INJECTION J2930 $12.00 J3301 PR TRIAMCINOLONE ACETONIDE INJ J3301 $5.00 J3420 PR VITAMIN B12 INJECTION J3420 $8.00 J7030 PR NORMAL SALINE SOLUTION INFUS J7030 $16.00 J7042 PR 5% DEXTROSE/NORMAL SALINE J7042 $11.00 J7296 PR KYLEENA, 19.5 MG J7296 $1,818.00 J7298 PR MIRENA, 52 MG J7298 $1,810.00 J7300 PR INTRAUT COPPER CONTRACEPTIVE J7300 $1,848.00 J7301 PR SKYLA, 13.5 MG J7301 $1,620.00 J7307 ETONOGESTREL IMPLANT SYSTEM J7307 $1,670.00 J7323 EUFLEXXA INJ PER DOSE J7323 $381.00 J7326 PR GEL-ONE J7326 $1,210.00 J7510 PR PREDNISOLONE ORAL PER 5 MG J7510 $1.00 J7613 PR ALBUTEROL NON-COMP UNIT J7613 $2.00 J7620 PR ALBUTEROL IPRATROP NON-COMP J7620 $3.00 J7644 PR IPRATROPIUM BROMIDE NON-COMP J7644 $5.00 J9267 PR PACLITAXEL INJECTION J9267 $1.00 J9306 PR INJECTION, PERTUZUMAB, 1 MG J9306 $92.00 L0112 PR CRANIAL CERVICAL ORTHOSIS L0112 $1,531.00 L0120 PR CERV FLEX N/ADJ FOAM PRE OTS L0120 $97.00 L0130 PR FLEX THERMOPLASTIC COLLAR MO L0130 $230.00 L0160 PR CERV SR WIRE OCC/MAN PRE OTS L0160 $178.00 L0172 PR CERV COL SR FOAM 2PC PRE OTS L0172 $159.00 L0174 PR CERV SR 2PC THOR EXT PRE OTS L0174 $312.00 L0180 PR CER POST COL OCC/MAN SUP ADJ L0180 $432.00 L0200 PR CERV COL SUPP ADJ BAR & THOR L0200 $586.00 L0220 PR THOR RIB BELT CUSTOM FABRICA L0220 $164.00 L0450 PR TLSO FLEX TRUNK/THOR PRE OTS L0450 $174.00 L0456 PR TLSO FLEX TRNK SJ-SS PRE CST L0456 $1,178.00 L0457 PR TLSO FLEX TRNK SJ-SS PRE OTS L0457 $1,157.00 L0462 PR TLSO 3MOD SACRO-SCAP PRE L0462 $1,529.00 L0464 PR TLSO 4MOD SACRO-SCAP PRE L0464 $1,760.00 L0472 PR TLSO RIGID FRAME HYPEREX PRE L0472 $459.00 L0480 PR TLSO RIGID PLASTIC CUSTOM FA L0480 $1,394.00 L0482 PR TLSO RIGID LINED CUSTOM FAB L0482 $1,876.00 L0486 PR TLSO RIGIDLINED CUST FAB TWO L0486 $2,139.00 L0488 PR TLSO RIGID LINED PRE ONE PIE L0488 $1,192.00 L0491 PR TLSO 2 PIECE RIGID SHELL L0491 $785.00 L0621 PR SIO FLEX PELVIC/SACR PRE OTS L0621 $108.00 L0626 PR LO SAG RIG PNL STAYS PRE CST L0626 $92.00 L0627 PR LO SAG RI AN/POS PNL PRE CST L0627 $487.00 L0628 PR LSO FLEX NO RI STAYS PRE OTS L0628 $109.00 L0630 PR LSO R POST PNL SJ-T9 PRE CST L0630 $192.00 L0631 PR LSO SAG R AN/POS PNL PRE CST L0631 $1,216.00 L0637 PR LSO SC R ANT/POS PNL PRE CST L0637 $1,272.00 L0638 PR LSO SAG-CORONAL PANEL CUSTOM L0638 $1,348.00 L0639 PR LSO S/C SHELL/PANEL PREFAB L0639 $1,272.00 L0640 PR LSO S/C SHELL/PANEL CUSTOM L0640 $1,239.00 L0641 PR LO RIG POS PNL L1-L5 PRE OTS L0641 $95.00 L0650 PR LSO SC R ANT/POS PNL PRE OTS L0650 $1,314.00 L0710 PR CTLSO A-P-L CONTROL W/ INTER L0710 $2,369.00 L0810 PR HALO CERVICAL INTO JCKT VEST L0810 $2,963.00 L0859 PR MRI COMPATIBLE SYSTEM L0859 $1,562.00 L0861 PR HALO REPL LINER/INTERFACE L0861 $255.00 L0974 PR TLSO FULL CORSET L0974 $176.00 L0984 PR PROTECT BODY SOCK EA PRE OTS L0984 $77.00 L1000 PR CTLSO MILWAUKE INITIAL MODEL L1000 $2,008.00 L1005 PR TENSION BASED SCOLIOSIS ORTH L1005 $3,588.00 L1020 PR KYPHOSIS PAD L1020 $98.00 L1040 PR LUMBAR OR LUMBAR RIB PAD L1040 $94.00 L1050 PR STERNAL PAD L1050 $117.00 L1060 PR THORACIC PAD L1060 $137.00 L1110 PR RING FLANGE PLAS/LEATHER MOL L1110 $290.00 L1210 PR LATERAL THORACIC EXTENSION L1210 $297.00 L1220 PR ANTERIOR THORACIC EXTENSION L1220 $284.00 L1270 PR ABDOMINAL PAD L1270 $105.00 L1290 PR LATERAL TROCHANTERIC PAD L1290 $93.00 L1300 PR BODY JACKET MOLD TO PATIENT L1300 $2,089.00 L1499 PR SPINAL ORTHOSIS NOS L1499 $525.00 L1620 PR HO FLEX PAVLIK HARNS PRE CST L1620 $183.00 L1650 PR HO ABDUCTION HIP ADJUSTABLE L1650 $256.00 L1686 PR HO POST-OP HIP ABDUCTION L1686 $1,302.00 L1690 PR COMBINATION BILATERAL HO L1690 $2,290.00 L1810 PR KO ELASTIC WITH JOINTS L1810 $112.00 L1812 PR KO ELASTIC W/JOINTS PRE OTS L1812 $112.00 L1820 PR KO ELAS W/ CONDYLE PADS & JO L1820 $173.00 L1830 PR KO IMMOB CANVAS LONG PRE OTS L1830 $105.00 L1831 PR KNEE ORTH POS LOCKING JOINT L1831 $349.00 L1832 PR KO ADJ JNT POS R SUP PRE CST L1832 $802.00 L1833 PR KO ADJ JNT POS R SUP PRE OTS L1833 $802.00 L1836 PR KO RIGID W/O JOINTS PRE OTS L1836 $159.00 L1843 PR KO SINGLE UPRIGHT PRE CST L1843 $1,062.00 L1844 PR KO W/ADJ JT ROT CNTRL MOLDED L1844 $1,589.00 L1845 PR KO DOUBLE UPRIGHT PRE CST L1845 $1,103.00 L1846 PR KO W ADJ FLEX/EXT ROTAT MOLD L1846 $1,352.00 L1850 PR KO SWEDISH TYPE PRE OTS L1850 $345.00 L1851 PR KO SINGLE UPRIGHT PREFAB OTS L1851 $1,063.00 L1902 PR AFO ANKLE GAUNTLET PRE OTS L1902 $106.00 L1904 PR AFO MOLDED ANKLE GAUNTLET L1904 $652.00 L1906 PR AFO MULTILIG ANK SUP PRE OTS L1906 $229.00 L1907 PR AFO SUPRAMALLEOLAR CUSTOM L1907 $666.00 L1930 PR AFO PLASTIC L1930 $268.00 L1932 PR AFO RIG ANT TIB PREFAB TCF/= L1932 $1,057.00 L1940 PR AFO MOLDED TO PATIENT PLASTI L1940 $561.00 L1945 PR AFO MOLDED PLAS RIG ANT TIB L1945 $1,341.00 L1950 PR AFO SPIRAL MOLDED TO PT PLAS L1950 $889.00 L1951 PR AFO SPIRAL PREFABRICATED L1951 $994.00 L1960 PR AFO POS SOLID ANK PLASTIC MO L1960 $671.00 L1970 PR AFO PLASTIC MOLDED W/ANKLE J L1970 $807.00 L1971 PR AFO W/ANKLE JOINT, PREFAB L1971 $555.00 L1990 PR AFO DOUB SOLID STIRRUP CALF L1990 $509.00 L2005 KAFO SNG/DBL MECHANICAL ACT L2005 $4,964.00 L2010 PR KAFO SNG SOLID STIRRUP W/O J L2010 $1,118.00 L2020 PR KAFO DBL SOLID STIRRUP BAND/ L2020 $1,407.00 L2030 PR KAFO DBL SOLID STIRRUP W/O J L2030 $1,102.00 L2034 PR KAFO PLA SIN UP W/WO K/A CUS L2034 $2,171.00 L2035 PR KAFO PLASTIC PEDIATRIC SIZE L2035 $179.00 L2036 PR KAFO PLAS DOUB FREE KNEE MOL L2036 $2,181.00 L2037 PR KAFO PLAS SING FREE KNEE MOL L2037 $2,035.00 L2038 PR KAFO W/O JOINT MULTI-AXIS AN L2038 $2,067.00 L2070 PR HKAFO TORSION UNILAT ROT STR L2070 $167.00 L2106 PR AFO TIB FX CAST PLASTER MOLD L2106 $771.00 L2108 PR AFO TIB FX CAST MOLDED TO PT L2108 $1,343.00 L2112 PR AFO TIBIAL FRACTURE SOFT L2112 $618.00 L2114 PR AFO TIB FX SEMI-RIGID L2114 $775.00 L2116 PR AFO TIBIAL FRACTURE RIGID L2116 $891.00 L2128 PR KAFO FEM FX CAST MOLDED TO P L2128 $2,112.00 L2180 PR PLAS SHOE INSERT W ANK JOINT L2180 $136.00 L2182 PR DROP LOCK KNEE L2182 $113.00 L2200 PR LIMITED ANKLE MOTION EA JNT L2200 $54.00 L2210 PR DORSIFLEXION ASSIST EACH JOI L2210 $78.00 L2220 PR DORSI & PLANTAR FLEX ASS/RES L2220 $93.00 L2230 PR SPLIT FLAT CALIPER STIRR & P L2230 $87.00 L2232 PR ROCKER BOTTOM, CONTACT AFO L2232 $118.00 L2250 PR FOOT PLATE MOLDED STIRRUP AT L2250 $437.00 L2260 PR REINFORCED SOLID STIRRUP L2260 $227.00 L2265 PR LONG TONGUE STIRRUP L2265 $134.00 L2270 PR VARUS/VALGUS STRAP PADDED/LI L2270 $63.00 L2275 PR PLASTIC MOD LOW EXT PAD/LINE L2275 $148.00 L2280 PR MOLDED INNER BOOT L2280 $516.00 L2300 PR ABDUCTION BAR JOINTED ADJUST L2300 $324.00 L2320 PR NON-MOLDED LACER L2320 $202.00 L2330 PR LACER MOLDED TO PATIENT MODE L2330 $489.00 L2340 PR PRE-TIBIAL SHELL MOLDED TO P L2340 $653.00 L2350 PR PROSTHETIC TYPE SOCKET MOLDE L2350 $1,128.00 L2360 PR EXTENDED STEEL SHANK L2360 $51.00 L2370 PR PATTEN BOTTOM L2370 $394.00 L2380 PR TORSION STRAIGHT KNEE JOINT L2380 $132.00 L2385 PR STRAIGHT KNEE JOINT HEAVY DU L2385 $152.00 L2390 PR OFFSET KNEE JOINT EACH L2390 $127.00 L2395 PR OFFSET KNEE JOINT HEAVY DUTY L2395 $177.00 L2405 PR KNEE JOINT DROP LOCK EA JNT L2405 $103.00 L2415 PR KNEE JOINT CAM LOCK EACH JOI L2415 $155.00 L2425 PR KNEE DISC/DIAL LOCK/ADJ FLEX L2425 $170.00 L2430 PR KNEE JNT RATCHET LOCK EA JNT L2430 $170.00 L2510 PR TH/WGHT BEAR QUAD-LAT BRIM M L2510 $714.00 L2525 PR TH/WGHT BEAR NAR M-L BRIM MO L2525 $1,452.00 L2526 PR TH/WGHT BEAR NAR M-L BRIM CU L2526 $840.00 L2540 PR THIGH/WGHT BEAR LACER MOLDED L2540 $414.00 L2550 PR THIGH/WGHT BEAR HIGH ROLL CU L2550 $338.00 L2610 PR HIP CLEVIS/THRUST BEARING LO L2610 $305.00 L2624 PR HIP ADJ FLEX EXT ABDUCT CONT L2624 $376.00 L2627 PR PLASTIC MOLD RECIPRO HIP & C L2627 $2,117.00 L2628 PR METAL FRAME RECIPRO HIP & CA L2628 $2,064.00 L2640 PR PELVIC CONTROL BAND & BELT B L2640 $381.00 L2660 PR THORACIC CONTROL THORACIC BA L2660 $183.00 L2680 PR THORAC CONT LAT SUPPORT UPRI L2680 $197.00 L2750 PR PLATING CHROME/NICKEL PR BAR L2750 $95.00 L2755 PR CARBON GRAPHITE LAMINATION L2755 $155.00 L2760 PR EXTENSION PER EXTENSION PER L2760 $69.00 L2768 PR ORTHO SIDEBAR DISCONNECT L2768 $154.00 L2780 PR NON-CORROSIVE FINISH L2780 $77.00 L2785 PR DROP LOCK RETAINER EACH L2785 $36.00 L2795 PR KNEE CONTROL FULL KNEECAP L2795 $98.00 L2800 PR KNEE CAP MEDIAL OR LATERAL P L2800 $150.00 L2810 PR KNEE CONTROL CONDYLAR PAD L2810 $118.00 L2820 PR SOFT INTERFACE BELOW KNEE SE L2820 $99.00 L2830 PR SOFT INTERFACE ABOVE KNEE SE L2830 $107.00 L2840 PR TIBIAL LENGTH SOCK FX OR EQU L2840 $63.00 L2861 PR TORSION MECHANISM KNEE/ANKLE L2861 $135.00 L3000 PR FT INSERT UCB BERKELEY SHELL L3000 $372.00 L3001 PR FOOT INSERT REMOV MOLDED SPE L3001 $161.00 L3002 PR FOOT INSERT PLASTAZOTE OR EQ L3002 $203.00 L3010 PR FOOT LONGITUDINAL ARCH SUPPO L3010 $212.00 L3020 PR FOOT LONGITUD/METATARSAL SUP L3020 $200.00 L3030 PR FOOT ARCH SUPPORT REMOV PREM L3030 $93.00 L3031 PR FOOT LAMIN/PREPREG COMPOSITE L3031 $145.00 L3040 PR FT ARCH SUPRT PREMOLD LONGIT L3040 $57.00 L3050 PR FOOT ARCH SUPP PREMOLD METAT L3050 $57.00 L3060 PR FOOT ARCH SUPP LONGITUD/META L3060 $87.00 L3090 PR ARCH SUPP ATT TO SHOE LONG/M L3090 $42.00 L3100 PR HALLUS-VALGUS NT DYN PRE OTS L3100 $52.00 L3150 PR ABDUCT ROTATION BAR W/O SHOE L3150 $116.00 L3160 PR SHOE STYLED POSITIONING DEV L3160 $157.00 L3201 PR OXFORD W SUPINAT/PRONAT INF L3201 $45.00 L3202 PR OXFORD W/ SUPINAT/PRONATOR C L3202 $45.00 L3203 PR OXFORD W/ SUPINATOR/PRONATOR L3203 $45.00 L3204 PR HIGHTOP W/ SUPP/PRONATOR INF L3204 $45.00 L3206 PR HIGHTOP W/ SUPP/PRONATOR CHI L3206 $58.00 L3207 PR HIGHTOP W/ SUPP/PRONATOR JUN L3207 $63.00 L3216 PR ORTHOPED LADIES SHOES DPTH I L3216 $82.50 L3221 PR ORTHOPEDIC MENS SHOES DPTH I L3221 $82.50 L3222 PR MENS SHOES HIGHTOP DEPTH INL L3222 $85.00 L3224 PR WOMAN'S SHOE OXFORD BRACE L3224 $100.00 L3225 PR MAN'S SHOE OXFORD BRACE L3225 $100.00 L3230 PR CUSTOM SHOES DEPTH INLAY L3230 $247.50 L3250 PR CUSTOM MOLD SHOE REMOV PROST L3250 $247.50 L3253 PR SHOE MOLDED PLASTAZOTE CUST L3253 $140.00 L3257 PR ORTH FOOT ADD CHARGE SPLIT S L3257 $192.00 L3260 PR AMBULATORY SURGICAL BOOT EAC L3260 $40.00 L3300 PR SHO LIFT TAPER TO METATARSAL L3300 $62.00 L3310 PR SHOE LIFT ELEV HEEL/SOLE NEO L3310 $96.00 L3330 PR LIFTS ELEVATION METAL EXTENS L3330 $670.00 L3332 PR SHOE LIFTS TAPERED TO ONE-HA L3332 $90.00 L3334 PR SHOE LIFTS ELEVATION HEEL /I L3334 $45.00 L3350 PR SHOE HEEL WEDGE L3350 $36.00 L3360 PR SHOE SOLE WEDGE OUTSIDE SOLE L3360 $42.00 L3370 PR SHOE SOLE WEDGE BETWEEN SOLE L3370 $59.00 L3390 PR SHOE OUTFLARE WEDGE L3390 $117.00 L3400 PR SHOE METATARSAL BAR WEDGE RO L3400 $96.00 L3410 PR SHOE METATARSAL BAR BETWEEN L3410 $112.00 L3440 PR HEEL LEATHER REINFORCED L3440 $78.00 L3450 PR SHOE HEEL SACH CUSHION TYPE L3450 $108.00 L3485 PR SHOE HEEL PAD REMOVABLE FOR L3485 $45.00 L3530 PR ORTHO SHOE ADD HALF SOLE L3530 $38.00 L3540 PR ORTHO SHOE ADD FULL SOLE L3540 $60.00 L3550 PR O SHOE ADD STANDARD TOE TAP L3550 $11.00 L3600 PR TRANS SHOE CALIP PLATE EXIST L3600 $90.00 L3610 PR TRANS SHOE CALIPER PLATE NEW L3610 $150.00 L3620 PR TRANS SHOE SOLID STIRRUP EXI L3620 $130.00 L3630 PR TRANS SHOE SOLID STIRRUP NEW L3630 $195.00 L3649 PR ORTHOPEDIC SHOE MODIFICA NOS L3649 $105.00 L3650 PR SO 8 ABD RESTRAINT PRE OTS L3650 $78.00 L3660 PR SO 8 AB RSTR CAN/WEB PRE OTS L3660 $114.00 L3670 PR SO ACRO/CLAV CAN WEB PRE OTS L3670 $151.00 L3674 PR SO AIRPLANE W/WO JOINT CF L3674 $1,274.00 L3675 PR SO VEST CANVAS/WEB PRE OTS L3675 $189.00 L3702 PR EO W/O JOINTS CF L3702 $318.34 L3710 PR EO ELAS W/METAL JNTS PRE OTS L3710 $178.00 L3740 PR CUFFS ADJ LOCK W/ ACTIVE CON L3740 $1,024.00 L3760 PR EO ADJ JT PREFAB CUSTOM FIT L3760 $552.00 L3762 PR EO RIGID W/O JOINTS PRE OTS L3762 $116.00 L3763 PR EWHO RIGID W/O JNTS CF L3763 $774.00 L3766 PR EWHFO W/JOINT(S) CF L3766 $1,512.00 L3806 WHFO W/JOINT(S) CUSTOM FAB L3806 $501.00 L3807 PR WHFO W/O JOINTS PRE CST L3807 $276.00 L3808 PR WHFO, RIGID W/O JOINTS L3808 $413.00 L3809 PR WHFO W/O JOINTS PRE OTS L3809 $276.00 L3900 PR HINGE EXTENSION/FLEX WRIST/F L3900 $1,608.00 L3906 PR WHO W/O JOINTS CF L3906 $486.00 L3908 PR WHO COCK-UP NONMOLDE PRE OTS L3908 $149.00 L3912 PR HFO FLEXION GLOVE PRE OTS L3912 $133.00 L3913 PR HFO W/O JOINTS CF L3913 $299.00 L3915 PR WHO NONTORSION JNTS PRE CST L3915 $573.00 L3916 PR WHO NONTORSION JNTS PRE OTS L3916 $587.00 L3919 PR HO W/O JOINTS CF L3919 $299.00 L3923 PR HFO WITHOUT JOINTS PRE CST L3923 $107.00 L3924 PR HFO WITHOUT JOINTS PRE OTS L3924 $107.00 L3925 PR FO PIP DIP JNT/SPRNG PRE OTS L3925 $58.00 L3927 PR FO PIP DIP NO JT SPR PRE OTS L3927 $39.00 L3929 PR HFO NONTORSION JNTS PRE CST L3929 $102.00 L3933 PR FO W/O JOINTS CF L3933 $236.00 L3960 PR SEWHO AIRPLAN DESIG ABDU POS L3960 $817.00 L3980 PR UP EXT FX ORTHOS HUMERAL NOS L3980 $355.00 L3981 PR UE FX ORTH SHOUL CAP FOREARM L3981 $1,120.00 L3982 PR UPPER EXT FX ORTHOSIS RAD/UL L3982 $414.00 L3984 PR UPPER EXT FX ORTHOSIS WRIST L3984 $382.00 L4002 PR REPLACE STRAP, ANY ORTHOSIS L4002 $12.00 L4100 PR REPL LEATH CUFF KAFO PROX TH L4100 $136.00 L4110 PR REPL LEATH CUFF KAFO-AFO CAL L4110 $102.00 L4205 PR ORTHO DVC REPAIR PER 15 MIN L4205 $20.00 L4210 PR ORTH DEV REPAIR/REPL MINOR P L4210 $12.00 L4350 PR ANKLE CONTROL ORTHO PRE OTS L4350 $114.00 L4360 PR PNEUMAT WALKING BOOT PRE CST L4360 $349.00 L4361 PR PNEUMA/VAC WALK BOOT PRE OTS L4361 $358.00 L4370 PR PNEUM FULL LEG SPLNT PRE OTS L4370 $231.00 L4386 PR NON-PNEUM WALK BOOT PRE CST L4386 $188.00 L4387 PR NON-PNEUM WALK BOOT PRE OTS L4387 $188.00 L4396 PR STATIC OR DYNAMI AFO PRE CST L4396 $199.00 L4398 PR FOOT DROP SPLINT PRE OTS L4398 $91.00 L4631 PR AFO, WALK BOOT TYPE, CUS FAB L4631 $1,888.00 L5000 PR SHO INSERT W ARCH TOE FILLER L5000 $674.00 L5010 PR MOLD SOCKET ANK HGT W/ TOE F L5010 $1,270.00 L5100 PR MOLDED SOCKET SHIN SACH FOOT L5100 $2,889.00 L5220 PR NO KNEE JOINT WITH ARTIC ALI L5220 $3,448.00 L5250 PR HIP CANAD SING AXI CONS FRIC L5250 $6,271.00 L5301 PR BK MOLD SOCKET SACH FT ENDO L5301 $2,775.00 L5321 PR AK OPEN END SACH L5321 $3,972.00 L5331 PR HIP DISART CANADIAN SACH FT L5331 $5,803.00 L5341 PR HEMIPELVECTOMY CANADIAN SACH L5341 $6,000.00 L5450 PR POSTOP APP NON-WGT BEAR DSG L5450 $519.00 L5460 PR POSTOP APP NON-WGT BEAR DSG L5460 $790.00 L5611 PR AK 4 BAR LINK W/FRIC SWING L5611 $1,947.00 L5618 PR TEST SOCKET SYMES L5618 $382.00 L5620 PR TEST SOCKET BELOW KNEE L5620 $336.00 L5622 PR TEST SOCKET KNEE DISARTICULA L5622 $443.00 L5624 PR TEST SOCKET ABOVE KNEE L5624 $490.00 L5626 PR TEST SOCKET HIP DISARTICULAT L5626 $688.00 L5628 PR TEST SOCKET HEMIPELVECTOMY L5628 $563.00 L5629 PR BELOW KNEE ACRYLIC SOCKET L5629 $498.00 L5631 PR AK/KNEE DISARTIC ACRYLIC SOC L5631 $649.00 L5632 PR SYMES TYPE PTB BRIM DESIGN S L5632 $275.00 L5637 PR BELOW KNEE TOTAL CONTACT L5637 $411.00 L5643 PR HIP FLEX INNER SOCKET EXT FR L5643 $1,881.00 L5645 PR BK FLEX INNER SOCKET EXT FRA L5645 $964.00 L5646 PR BELOW KNEE CUSHION SOCKET L5646 $662.00 L5647 PR BELOW KNEE SUCTION SOCKET L5647 $961.00 L5649 PR ISCH CONTAINMT/NARROW M-L SO L5649 $2,416.00 L5650 PR TOT CONTACT AK/KNEE DISART S L5650 $590.00 L5651 PR AK FLEX INNER SOCKET EXT FRA L5651 $1,451.00 L5652 PR SUCTION SUSP AK/KNEE DISART L5652 $527.00 L5653 PR KNEE DISART EXPAND WALL SOCK L5653 $720.00 L5654 PR SOCKET INSERT SYMES L5654 $401.00 L5655 PR SOCKET INSERT BELOW KNEE L5655 $339.00 L5656 PR SOCKET INSERT KNEE ARTICULAT L5656 $413.00 L5666 PR BELOW KNEE CUFF SUSPENSION L5666 $92.00 L5670 PR BK MOLDED SUPRACONDYLAR SUSP L5670 $374.00 L5671 PR BK/AK LOCKING MECHANISM L5671 $601.00 L5673 PR SOCKET INSERT W LOCK MECH L5673 $849.00 L5679 PR SOCKET INSERT W/O LOCK MECH L5679 $708.00 L5681 PR INTL CUSTM CONG/LATYP INSERT L5681 $1,561.00 L5683 PR INITIAL CUSTOM SOCKET INSERT L5683 $1,561.00 L5685 PR BELOW KNEE SUS/SEAL SLEEVE L5685 $152.00 L5694 PR AK PELVIC CONTROL BELT PAD/L L5694 $190.00 L5695 PR AK SLEEVE SUSP NEOPRENE/EQUA L5695 $230.00 L5698 PR AK/KNEE DISARTIC SILESIAN BA L5698 $127.00 L5700 PR REPLACE SOCKET BELOW KNEE L5700 $3,482.00 L5701 PR REPLACE SOCKET ABOVE KNEE L5701 $4,319.00 L5704 PR CUSTOM SHAPE COVER BK L5704 $710.00 L5705 PR CUSTOM SHAPE COVER AK L5705 $1,302.00 L5781 PR LOWER LIMB PROS VACUUM PUMP L5781 $4,747.00 L5782 PR HD LOW LIMB PROS VACUUM PUMP L5782 $5,005.00 L5811 PR ENDO KNEE-SHIN MNL LCK ULTRA L5811 $761.00 L5814 PR ENDO KNEE-SHIN HYDRAL SWG PH L5814 $4,406.00 L5828 PR ENDO KNEE-SHIN FLUID SWG/STA L5828 $3,533.00 L5845 PR KNEE-SHIN SYS STANCE FLEXION L5845 $2,127.00 L5848 PR KNEE-SHIN SYS HYDRAUL STANCE L5848 $1,276.00 L5850 PR ENDO AK/HIP KNEE EXTENS ASSI L5850 $161.00 L5855 PR MECH HIP EXTENSION ASSIST L5855 $373.00 $28,481.0 L5856 PR ELEC KNEE-SHIN SWING/STANCE L5856 0 L5910 PR ENDO BELOW KNEE ALIGNABLE SY L5910 $441.00 L5920 PR ENDO AK/HIP ALIGNABLE SYSTEM L5920 $641.00 L5925 PR ABOVE KNEE MANUAL LOCK L5925 $406.00 L5930 PR HIGH ACTIVITY KNEE FRAME L5930 $3,445.00 L5940 PR ENDO BK ULTRA-LIGHT MATERIAL L5940 $606.00 L5950 PR ENDO AK ULTRA-LIGHT MATERIAL L5950 $1,024.00 L5960 PR ENDO HIP ULTRA-LIGHT MATERIA L5960 $1,227.00 L5962 PR BELOW KNEE FLEX COVER SYSTEM L5962 $710.00 L5968 PR MULTIAXIAL ANKLE W DORSIFLEX L5968 $3,984.00 L5970 PR FOOT EXTERNAL KEEL SACH FOOT L5970 $265.00 L5972 PR FLEXIBLE KEEL FOOT L5972 $426.00 $21,249.0 L5973 PR ANK-FOOT SYS DORS-PLANT FLEX L5973 0 L5974 PR FOOT SINGLE AXIS ANKLE/FOOT L5974 $310.00 L5976 PR ENERGY STORING FOOT L5976 $677.00 L5979 PR MULTI-AXIAL ANKLE/FT PROSTH L5979 $2,830.00 L5980 PR FLEX FOOT SYSTEM L5980 $3,866.00 L5981 PR FLEX-WALK SYS LOW EXT PROSTH L5981 $3,873.00 L5984 PR ENDOSKELETAL AXIAL ROTATION L5984 $692.00 L5986 PR MULTI-AXIAL ROTATION UNIT L5986 $770.00 L5987 PR SHANK FT W VERT LOAD PYLON L5987 $8,535.00 L5988 PR VERTICAL SHOCK REDUCING PYLO L5988 $2,370.00 L5990 PR USER ADJUSTABLE HEEL HEIGHT L5990 $2,152.00 $15,600.0 L5999 PR LOWR EXTREMITY PROSTHES NOS L5999 0 L6020 PART HAND NO FINGERS L6020 $1,723.00 L6026 PR PART HAND MYO EXCLU TERM DEV L6026 $5,111.00 L6050 PR WRST MLD SCK FLX HNG TRI PAD L6050 $2,296.00 L6100 PR ELB MOLD SOCK FLEX HINGE PAD L6100 $2,326.00 L6110 PR ELBOW MOLD SOCK SUSPENSION T L6110 $2,129.00 L6250 PR ELBOW INTER LOC ELBOW FORARM L6250 $3,357.00 L6300 PR SHLDER DISART INT LOCK ELBOW L6300 $4,657.00 L6500 PR ABOVE ELBOW PROSTH TISS SHAP L6500 $3,217.00 L6611 PR ADDITIONAL SWITCH, EXT POWER L6611 $489.00 L6615 PR DISCONNECT LOCKING WRIST UNI L6615 $248.00 L6616 PR DISCONNECT INSERT LOCKING WR L6616 $105.00 L6620 PR FLEXION/EXTENSION WRIST UNIT L6620 $403.00 L6628 PR QUICK DISCONN HOOK ADAPTER O L6628 $685.00 L6629 PR LAMINATION COLLAR W/ COUPLIN L6629 $177.00 L6630 PR STAINLESS STEEL ANY WRIST L6630 $225.00 L6635 PR LIFT ASSIST FOR ELBOW L6635 $239.00 L6638 PR ELEC LOCK ON MANUAL PW ELBOW L6638 $2,967.00 L6655 PR STANDARD CONTROL CABLE EXTRA L6655 $91.00 L6660 PR HEAVY DUTY CONTROL CABLE L6660 $111.00 L6670 PR HOOK TO HAND CABLE ADAPTER L6670 $60.00 L6672 PR HARNESS CHEST/SHLDER SADDLE L6672 $209.00 L6675 PR HARNESS FIGURE OF 8 SING CON L6675 $145.00 L6676 PR HARNESS FIGURE OF 8 DUAL CON L6676 $127.00 L6680 PR TEST SOCK WRIST DISART/BEL E L6680 $280.00 L6682 PR TEST SOCK ELBW DISART/ABOVE L6682 $314.00 L6686 PR SUCTION SOCKET L6686 $783.00 L6687 PR FRAME TYP SOCKET BEL ELBOW/W L6687 $697.00 L6688 PR FRAME TYP SOCK ABOVE ELB/DIS L6688 $674.00 L6691 PR REMOVABLE INSERT EACH L6691 $540.00 L6692 PR SILICONE GEL INSERT OR EQUAL L6692 $699.00 L6693 PR LOCKINGELBOW FOREARM CNTRBAL L6693 $3,368.00 L6694 PR ELBOW SOCKET INS USE W/LOCK L6694 $849.00 L6695 PR ELBOW SOCKET INS USE W/O LCK L6695 $708.00 L6696 PR CUS ELBO SKT IN FOR CON/ATYP L6696 $1,561.00 L6697 PR CUS ELBO SKT IN NOT CON/ATYP L6697 $1,598.00 L6698 PR BELOW/ABOVE ELBOW LOCK MECH L6698 $459.00 L6703 PR TERM DEV, PASSIVE HAND MITT L6703 $385.00 L6704 PR TERM DEV, SPORT/REC/WORK ATT L6704 $637.00 L6706 PR TERM DEV MECH HOOK VOL OPEN L6706 $422.00 L6708 PR TERM DEV MECH HAND VOL OPEN L6708 $1,011.00 L6712 PR PED TERM DEV, HOOK, VOL CLOS L6712 $1,517.00 L6715 PR TERM DEVICE, MULTI ART DIGIT L6715 $3,746.00 L6721 PR HOOK/HAND, HVY DTY, VOL OPEN L6721 $2,882.00 L6722 PR HOOK/HAND, HVY DTY, VOL CLOS L6722 $2,406.00 L6881 PR TERM DEV AUTO GRASP FEATURE L6881 $4,850.00 L6882 PR MICROPROCESSOR CONTROL UPLMB L6882 $3,679.00 L6890 PR PREFAB GLOVE FOR TERM DEVICE L6890 $206.00 $14,809.0 L6955 PR ABOVE ELBOW MYOELECTRONIC CT L6955 0 L7007 PR ADULT ELECTRIC HAND L7007 $4,383.00 L7367 PR REPLACEMNT LITHIUM IONBATTER L7367 $444.00 L7368 LITHIUM ION BATTERY CHARGER L7368 $576.00 L7400 PR ADD UE PROST BE/WD, ULTLITE L7400 $364.00 L7401 PR ADD UE PROST A/E ULTLITE MAT L7401 $422.00 L7402 PR ADD UE PROST S/D ULTLITE MAT L7402 $427.00 L7403 PR ADD UE PROST B/E ACRYLIC L7403 $437.00 L7404 PR ADD UE PROST A/E ACRYLIC L7404 $659.00 L7499 PR UPPER EXTREMITY PROSTHES NOS L7499 $2,595.00 L7510 PR PROSTHETIC DEVICE REPAIR REP L7510 $62.00 L7520 PR REPAIR PROSTHESIS PER 15 MIN L7520 $16.00 L7600 PR PROSTHETIC DONNING SLEEVE L7600 $53.00 L7700 PR PROS SOC INSERT GASKET/SEAL L7700 $350.00 L8010 PR MASTECTOMY SLEEVE L8010 $187.00 L8300 PR TRUSS SINGLE W/ STANDARD PAD L8300 $102.00 L8400 PR SHEATH BELOW KNEE L8400 $21.00 L8417 PR PROS SHEATH/SOCK W GEL CUSHN L8417 $89.00 L8420 PR PROSTHETIC SOCK MULTI PLY BK L8420 $25.00 L8430 PR PROSTHETIC SOCK MULTI PLY AK L8430 $27.00 L8435 PR PROS SOCK MULTI PLY UPPER LM L8435 $25.00 L8440 PR SHRINKER BELOW KNEE L8440 $51.00 L8460 PR SHRINKER ABOVE KNEE L8460 $81.00 L8470 PR PROS SOCK SINGLE PLY BK L8470 $8.00 L8480 PR PROS SOCK SINGLE PLY AK L8480 $11.00 L8681 PR PT PRGRM FOR IMPLT NEUROSTIM L8681 $1,290.00 L8689 PR EXTERNAL RECHARG SYS INTERN L8689 $2,025.00 M0076 PR PROLOTHERAPY M0076 $250.00 M1145 PR MFN DRUG ADD-ON, PER DOSE M1145 $200.00 P3001 PR SCREENING PAP SMEAR BY PHYS P3001 $82.00 Q0091 PR OBTAINING SCREEN PAP SMEAR Q0091 $110.00 Q0111 PR WET MOUNTS/ W PREPARATIONS Q0111 $40.00 Q0112 PR POTASSIUM HYDROXIDE PREPS Q0112 $20.00 Q0138 PR FERUMOXYTOL, NON-ESRD Q0138 $1.80 Q2036 PR FLULAVAL VACC, 3 YRS & >, IM Q2036 $31.00 Q2038 PR FLUZONE VACC, 3 YRS & >, IM Q2038 $41.00 Q3014 PR TELEHEALTH FACILITY FEE Q3014 $43.00 Q4008 PR CAST SUP LONG ARM PED FBRGLS Q4008 $67.00 Q4010 PR CAST SUP SHT ARM ADULT FBRGL Q4010 $61.00 Q4012 PR CAST SUP SHT ARM PED FBRGLAS Q4012 $61.00 Q4022 PR CAST SUP SHT ARM SPLINT FBRG Q4022 $61.00 S0189 PR TESTOSTERONE PELLET 75 MG S0189 $204.00 S0610 PR ANNUAL GYNECOLOGICAL EXAMINA S0610 $107.00 S0620 PR ROUTINE OPHTHALMOLOGICAL EXA S0620 $100.00 S0621 PR ROUTINE OPHTHALMOLOGICAL EXA S0621 $100.00 S0630 PR REMOVAL OF SUTURES S0630 $183.00 S1040 PR CRANIAL REMOLDING ORTHOSIS S1040 $2,592.00 S2083 PR ADJUSTMENT GASTRIC BAND S2083 $500.00

S8032 S8032 PR LOW DOSE CT LUNG SCREENING 26 26 $200.00 S8421 PR READY GRADIENT SLEEV/GLOV S8421 $150.00 S8422 PR CUSTOM GRAD SLEEVE MED S8422 $198.00 S8423 PR CUSTOM GRAD SLEEVE HEAVY S8423 $401.00 S8424 PR READY GRADIENT SLEEVE S8424 $187.00 S8425 PR CUSTOM GRAD GLOVE MED S8425 $326.00 S8427 PR READY GRADIENT GLOVE S8427 $80.00 S8428 PR READY GRADIENT GAUNTLET S8428 $80.00 S8450 PR SPLINT DIGIT S8450 $10.00 S8451 PR SPLINT WRIST OR ANKLE S8451 $17.00 S9453 PR SMOKING CESSATION CLASS S9453 $31.00 S9470 PR NUTRITIONAL COUNSELING, DIET S9470 $51.00 V2520 PR CONTACT LENS HYDROPHILIC V2520 $190.00 V2627 PR SCLERAL COVER SHELL V2627 $3,115.00 V5008 PR HEARING SCREENING V5008 $101.00 V5010 PR ASSESSMENT FOR HEARING AID V5010 $0.00 V5011 PR HEARING AID FITTING/CHECKING V5011 $85.00 V5014 PR HEARING AID REPAIR/MODIFYING V5014 $125.00 V5020 PR CONFORMITY EVALUATION V5020 $115.00 V5160 PR DISPENSING FEE BINAURAL V5160 $660.00 V5200 PR CROS HEARING AID DISPENS FEE V5200 $330.00 V5210 PR IN EAR BICROS HEARING AID V5210 $51.00 V5240 PR DISPENSING FEE BICROS V5240 $660.00 V5241 PR DISPENSING FEE, MONAURAL V5241 $330.00 V5254 PR HEARING ID, DIGIT, MON, CIC V5254 $2,900.00 V5255 PR HEARING AID, DIGIT, MON, ITC V5255 $2,750.00 V5256 PR HEARING AID, DIGIT, MON, ITE V5256 $2,500.00 V5257 PR HEARING AID, DIGIT, MON, BTE V5257 $2,600.00 V5258 PR HEARING AID, DIGIT, BIN, CIC V5258 $5,800.00 V5260 PR HEARING AID, DIGIT, BIN, ITE V5260 $5,000.00 V5261 PR HEARING AID, DIGIT, BIN, BTE V5261 $5,200.00 V5264 PR EAR MOLD/INSERT V5264 $75.00 V5265 PR EAR MOLD/INSERT, DISP V5265 $5.00 V5266 PR BATTERY FOR HEARING DEVICE V5266 $6.00 V5267 PR HEARING AID SUP/ACCESS/DEV V5267 $53.00 V5274 PR ALD UNSPECIFIED V5274 $150.00 V5275 PR EAR IMPRESSION V5275 $25.00 01999A DUMMY ANES CODE FOR CRNA/MCR 01999A $0.00

17999A RECON OF PAROTIDECTOMY DEFECT W/ ACELLULAR DERMAL 17999A $566.00

17999M MUSCLE FLAP ELEVATION/CLOSURE 17999M $1,830.00

17999N RECTUS PLICATION 17999N $5,550.00 $11,264.0 19364A BREAST REDUCTION W/FREE FLAP (2 SURGEONS) 19364A 0 19499A TOMOSYNTHESIS GUIDED BREAST BIOPSY 19499A $1,664.00 20999B OSTEOARTICULAR ALLOGRAFT 20999B $2,684.00 21499A STYLOID PROCESS EXCISION PROCEDURE 21499A $2,965.00 22899H POSTERIOR ROD LENGTHENING 22899H $1,800.00

ARTHDSIS,POST/POSTENTROLATERAL/POSTINTERBODY:THORA 22899J CIC 22899J $9,544.00 24999B FASCIOTOMY, UPPER ARM 24999B $3,200.00 27299B OPEN GLUTEUS MEDIUS/MINIMUS REPAIR 27299B $2,036.00 27299C ANTERIOR CAPSULAR RECONSTRUCTION, HIP 27299C $5,988.00 27299O OPN FEM HIP DISLOC-ACTAB IMPIN 27299O $5,909.00 27599A CALYPSO EXTRA-CAPSULAR KNEE IMPLANT 27599A $4,467.00 27599B DENOVO ALLOGRAFT 27599B $8,480.00

ARTHROSCOPY, HIP, SURGICAL, ILIOTIBIAL BAND 29999A RELEASE/LENGTHENING 29999A $2,859.00

29999B ARTHROSCOPY, HIP,SURGICAL, TROCHANTERIC BURSECTOMY 29999B $1,267.00

ARTHROSCOPY,HIP,SURGICAL,ILIOPSOAS 29999C RELEASE/TENOTOMY 29999C $2,574.00

ARTHROSCOPY,HIP,SURGICAL,GLUTEUS MEDIUS/MINIMUS 29999D REPAIR 29999D $2,240.00

29999E ARTHROSCOPY,HIP,SURGICAL,LABRAL RECONSTRUCTION 29999E $3,908.00 29999F ARTHROSCOPIC ULNA WAFER RESECTION 29999F $1,602.00

ENDO ASSIST SKULL BASE SURGERY, ANTERIOR CRANIAL $17,162.0 31299A FOSSA 31299A 0

$15,062.0 31299B ENDO ASSIST SKULL BASE SURGERY, MIDDLE CRANIAL FOSSA 31299B 0 32850A DRY-RUN DONOR PNEUMONECTOMY 32850A $2,626.00 32999A INSERT GORE MESH (DURING THORACOTOMY) 32999A $670.00 33999E MV CLIP (1) REPAIR OF TRICUSPID VALVE 33999E $6,371.00

33999G CARDIOBAND REPAIR OF TRICUSPID VALVE 33999G $9,492.00

33999H INSERTION,AXILLARY SUBCLAVIAN BALLOON PUMP 33999H $1,866.00 33999I REMOVAL,AXILLARY SUBCLAVIAN BALLOON PUMP 33999I $2,534.00

33999J INSERT/REMOVE SAME DAY SUBCLAVIAN BALLOON PUMP 33999J $4,400.00 33999K TAVR TRANSCAROTID APPROACH 33999K $6,800.00

33999L TAKE DOWN OF VENTRICULAR SEPTAL DEFECT PATCH 33999L $7,186.00

33999M MV CLIPS (2 OR MORE) REPAIR OF TRICUSPID VALVE 33999M $7,715.00

33999N CARDIOPULMONARY BYPASS 33999N $1,046.00

BALLOON DILATION OF THE STAMES 33999P FENESTRATION/TRICUSPID 33999P $5,689.00 33999R TRANSCATHETER TRICUSPIC VALVE REPLACEMENT 33999R $5,554.00 33999S TRANSCAVAL AORTIC VALVE REPLACEMENT 33999S $5,554.00 33999T LEFT VENTRICULAR REPAIR 33999T $8,522.00 33999U INSERT ICD COIL, AZYGOUS VEIN 33999U $2,312.00

36299A ENDOSCOPIC PRESSURE GRADIENT MEASUREMENTS 36299A $4,963.00 36468A PR INJ SCLERO SOLN VEIN LIMB/TRUNK 36468A $300.00 36471A PR INJ SCLERO SOLN VEIN MULTI 36471A $350.00 37799C VENA CAVA RESECTION & REPAIR 37799C $5,061.00 37799E RELEASE MED ARCUATE LIGAMENT 37799E $1,700.00 37799F ATHERECTOMY OF VEIN 37799F $1,570.00

37799G STAB PHLEB OF VAR VEIN, LESS THAN 10 INCISIONS 37799G $1,108.00 37799I CATH/ANGIO OF VESSEL 37799I $2,225.00 37799J REMOVAL PORTO SPLENO-RENAL SHUNT 37799J $1,220.00 37799K RELEASE OF INGUINAL LIGAMENT 37799K $673.00 37799L OPEN AAA REPAIR USING BIFURCATED GRAFT 37799L $9,298.00

37799M VEIN BYPASS GRAFT; INTERNAL JUGULAR TO SUBCLAVIAN 37799M $3,624.00

37799N OPEN VENOUS THROMBECTOMY; RENAL VEIN 37799N $5,284.00

37799P CAROTID-BRACHIAL ARTERY BYPASS USING PTFE GRAFT 37799P $5,025.00

37799Q ENDOSCOPIC RADIAL ARTERY HARVEST 37799Q $620.00

37799R BYPASS GRAFT, W/VEIN ULNAR-SUPERFICIAL PALMER ARCH 37799R $5,227.00

37799S ENDOVASCULAR AORTIC FENESTRATION, ANY METHOD 37799S $5,143.00 37799T LIGATION EXPOSED PERFORATED VEIN 37799T $1,251.00 37799U WAVELINQ ENDOAVF 37799U $5,259.00 $11,464.0 37799V MESO-REX SHUNT PLACEMENT 37799V 0

37799W LASER FENESTRATION, ENDO REPAIR THORACIS AORTA 37799W $6,800.00 38129A LAP UNROOFING OF SPLENIC CYST 38129A $1,714.00 38999C BATS CELL INFUSION 38999C $304.00 38999D LYMPH NODE ABLATION 38999D $6,630.00 38999E SCLEROSANT INJ INTO LYMPHANGIOMA 38999E $2,692.00 38999F OTHER OPEN LYMPHADENECTOMY 38999F $1,300.00

38999G LYMPH NODE TRANSFER 38999G $9,419.00 38999H ALCOHOL ABLATION OF LYMPH NODE 38999H $2,989.00 39599A VATS DIAPHRAM PLICATION 39599A $3,191.00 40000A PR PSYC-UVA NO SHOW CHG 40000A $25.00 41899A PR TOOTH EXTRACT PRIOR TO RADIATION 41899A $180.00

41899B EXTRACTION,ERUPTED TOOTH OR EXPOSED ROOT 41899B $180.00

EXTRACTION,ERUPTED TOOTH REQUIRING REMOVAL OF 41899C BONE-SECTIONING OF TOOTH 41899C $300.00

41899D REMOVAL OF IMPACTED TOOTH-(COMPLETELY BONY) 41899D $600.00

REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING 41899E PROCEDURE) 41899E $200.00 43289A GASTRIC FUNDUS WEDGE EXCISION OF MASS 43289A $3,213.00

43289B LAP TAKEDOWN OF FUNDOPLICATION,ESOPHAGUS 43289B $5,921.00

IVOR-LEWIS ESOPHAGECTOMY, COMBINED OPEN AND– $14,972.0 43499A SCOPIC APPROAC 43499A 0

43499C PLACE/REPLACE ENDOLUMINAL WOUND VAC SPONGE 43499C $653.00

RETROGRADE ESOPHAGOGASTROSCOPY THRU EXIST 43499D GASTROSTOMY W/ PEG TUBE CHANGE 43499D $6,518.00 43659A PARTIAL LAP GASTRECTOMY 43659A $4,013.00 43659B LAP PYLOROPLASTY 43659B $4,019.00 43659C LAP EXCISION OF GIST 43659C $3,537.00 43659D LAP PYLOTOMYOTOMY 43659D $2,601.00 43659E LAP GASTROJEJUNOSTOMY 43659E $3,412.00

LAP BILLROTH I GASTROJEJUNOSTOMY W/ PROX DUODENAL 43659F RESECTION 43659F $6,727.00

LAPAROSCOPIC GASTROSTOMY TUBE PLACEMENT(OTHER 43659G THAN STAMM) 43659G $2,520.00

LAPAROSCOPIC TOTAL GASTRECTOMY W/ROUS-EN-Y $11,226.0 43659H ESOPHAGOJEJUNOSTOMY 43659H 0

43659I LAP REDUCTION OF GASTRIC VOLVULUS W/GASTROPEXY 43659I $3,365.00 43659J LAP GASTRORRHAPY 43659J $5,550.00 43659L LAP CLOSURE OF GASTROSTOMY 43659L $2,557.00 43659M LAP GASTRIC FISTULA TAKEDOWN 43659M $2,572.00

43659N HIGHLY SELECTIVE VAGOTOMY 43659N $3,332.00 43659P LAPAROSCOPIC DUODENAL SWITCH PROCEDURE 43659P $7,008.00

43659Q ENDOSCOPIC GASTRIC PLICATION 43659Q $6,727.00 43999B PARTIAL GASTRECTOMY ONLY 43999B $5,324.00 43999C PERORAL ENDOSCOPIC MYOTOMY 43999C $2,378.00 43999D ESM DISSECTION STOMACH 43999D $2,969.00 43999E POEM 43999E $4,157.00

RELOCATION,PORT,LAP ADJ BAND,BOTH LAP & EXTERNAL 43999F APPROACH 43999F $1,023.00

43999G ENDOSCOPIC SUTURING FISTULA CLOSURE 43999G $2,592.00 43999H OPEN PARTIAL GASTRECTOMY 43999H $4,559.00 43999I GASTROCUTANEOUS FISTULA TAKE DOWN. 43999I $5,768.00 43999J EMR BANDING STOMACH 43999J $4,042.00

43999K OPEN REMOVAL OF ADJ GASTRIC RESTRICTIVE DEVICE 43999K $2,566.00

43999M TAKEDOWN OF A GASTRO-PLEURAL FISTULA VIA ROBOTICS 43999M $7,052.00 44238A LAP REPAIR INTERNAL HERNIA/VOLVULUS 44238A $2,637.00

44238B LAPAROSCOPIC PARTIAL COLECTOMY WITH COLOSTOMY 44238B $7,195.00 44238C LAP GASTROJEJUNOSTOMY REVISION 44238C $5,294.00 44238D LADD'S PROCEDURE 44238D $3,850.00 44238E LAPAROSCOPIC LAR W/ J POUCH 44238E $8,930.00 44238F LAP ENTEROTOMY REPAIR LARGE INTESTINE 44238F $2,930.00

44238G LAP INTESTINAL BYPASS 44238G $6,804.00 44799B EXCISION AMPULLARY AND DUODENAL MASS 44799B $3,100.00 44799C CHANGE CECOSTOMY BUTTON 44799C $200.00 44799D PEXY (STITCHING) OF J POUCH 44799D $3,908.00 44799E EUS GUIDED ANTIGRADE BILIARY ERCP 44799E $2,466.00 44799F RETROGRADE SMALL BOWEL ENTEROSCOPY 44799F $797.00

44799G LAPAROSCOPIC APPENDICOSTOMY 44799G $3,033.00 44799H TAKEDOWN OF THE JEJUNOSTOMY 44799H $2,572.00 44799J DUODENAL STENT PLACEMENT 44799J $3,500.00 44899A LAP-ASSISTED MECKELS DIVERTICULECTOMY 44899A $3,976.00 45399A ESM DISSECTION COLON 45399A $2,969.00 45399B UNDERWATER EMR 45399B $1,218.00

45399C EXCISION OF POLYPS (2) AT END OF COLOSTOMY 45399C $1,342.00 45499A LAP, J POUCH EXCISION 45499A $5,040.00

45499B LAP ASSISTED POSTERIOR SAGITTAL ANORECTOPLASTY 45499B $8,913.00 45999C PEXY OF INTESTINE 45999C $3,908.00 45999D ABDOMINAL PERINEAL RESECTION OF RECTUM 45999D $7,198.00 46999A TE RECTAL TUMOR REMOVAL 46999A $2,648.00 46999B REPAIR OF ANAL TEAR (NON-PLASTIC) 46999B $2,153.00 46999C EXCISION OF INTERNAL HEMORRHOID 46999C $483.00 46999D EXCISION OF EXTERNAL HEMORRHOID 46999D $1,277.00

47379A LAP LIVER CYST EXCISION/FULGERATION/ABLATION 47379A $4,029.00 47379B LAPAROSCOPIC PART HEPATECTOMY 47379B $8,093.00 47379C LAPAROSCOPIC HEPATIC CYST FENESTRATION 47379C $4,029.00 47379D LAP LIVER BX 47379D $3,041.00 $11,481.0 47379E LAP HEPATIC TRISECEMYECTOMY 47379E 0 47379F LAP FENESTRATION LIVER 47379F $5,145.00

47379G LAP MICROWAVE ABLATION 47379G $5,145.00 $11,138.0 47379H LAP, TOTAL RIGHT HEPATECTOMY 47379H 0 47399C ETHANOL ABLATION OF HEPATIC LESION 47399C $2,989.00 47399D BACKBENCH, OPEN, LIVING DONOR 47399D $9,800.00 47579A LAP PROC BILIARY 47579A $3,751.00

FREY PROCEDURE W/ROUX-EN-Y 48999B PANCREATICOJEJUNOSTOMY 48999B $7,460.00 48999C LAP PANCREATECT W/WO SPLENECT 48999C $6,000.00

LAPAROSCOPIC ROBOTIC-ASSISTED PANCREAS $12,860.0 48999E TRANSPLANTATION 48999E 0 48999F PANCREATIC ESWL 48999F $2,000.00 48999H ENDO PANCREATIC NECROSECTOMY 48999H $9,750.00 48999I ROBOTIC ASSISTED LAP PANCREAS TRANSPLANT 48999I $6,838.00 48999J LAPAROSCOPIC, BACKBENCH PANCREAS 48999J $9,655.00 48999K DONOR PANCREATECTOMY 48999K $5,251.00 48999L LAP ENUCLEATION PANCREAS NE TUMOR 48999L $9,512.00

48999M EUS GUIDED ERCP DIRECT STNT, PAN 48999M $4,029.00

48999N ETHANOL ABLATION OF PANCREATIC MASS 48999N $2,989.00 49329A LAP REM VENTRICULOPERIT SHUNT 49329A $1,220.00 49329B LAP REMOVAL INTRAABDOMIN CYST 49329B $4,528.00 49329C LAP PART OMENTECTOMY 49329C $1,424.00

49329D LAPAROSCOPIC OMENTUM RESECTION OF TUMOR 49329D $2,848.00 49329E LAP OMENTUM FLAP 49329E $942.00 49329F LAP INTRA-ABDOMINAL TUMOR RESECTION 49329F $6,164.00 49659A TAPP,FEMORAL NERVE REPAIR 49659A $1,948.00 49659B LAP MORGAGNI HERNIA REPAIR 49659B $6,199.00 49659C LAPAROSCOPIC FLANK HERNIA REPAIR 49659C $2,423.00 49659D LAP FEMORAL HERNIA REPAIR 49659D $1,598.00 49999A FALCIFORM LIGAMENT FLAP 49999A $1,037.00 49999B REPAIR SPORTS HERNIA 49999B $1,320.00

49999C OPEN REVISION OF A PERITONEAL DIALYSIS CATHETER 49999C $833.00

GASTROSTOMY TUBE PLACEMENT PERFORMED UNDER CT 49999D GUIDANCE 49999D $2,041.00

49999E INSERT CECOSTOMY, PERC, UNDER CT GUIDANCE 49999E $2,644.00

49999G SUTURELESS CLOSURE OF GASTROSCHISIS 49999G $3,593.00 50549A LAPAROSCOPIC KIDNEY TRANSPLANT 50549A $7,189.00

LAPAROSCOPIC ROBOTIC-ASSISTED KIDNEY $11,669.0 50549B TRANSPLANTATION 50549B 0 50549D LAPAROSCOPIC KIDNEY BIOPSY 50549D $2,730.00 50549F LAP PYELOTOMY WITH REMOVAL OF CALCULUS 50549F $3,732.00 50949A LAPAROSCOPIC URETHROPLASTY 50949A $3,342.00 50949C LAPAROSCOPIC URETEROCALYCOSTOMY 50949C $4,759.00 50949D LAPAROSCOPIC URETEROURETEROSTOMY 50949D $4,661.00 50949E LAPAROSCOPIC URETEROLYSIS 50949E $3,508.00

51999A LAPAROSCOPIC EXCISION OF URACHAL REMNANT 51999A $2,299.00 51999B RECONSTRUCTION, BLADDER FROM URETHRA 51999B $3,740.00 ROBOTIC LAP REPAIR VESICOVAGINAL AND URETEROVAGINAL 51999C FISTULA 51999C $3,747.00

ROBOTIC ASSISTED PARTIAL CYSTECTOMY W/URETERAL 51999D IMPLANT 51999D $5,317.00

LAPAROSCOPIC PELVIC EXENTERATION WITH CREATION OF $11,955.0 51999E ILEAL CONDUIT 51999E 0 51999F LAP, PARTIAL CYSTECTOMY, COMPLICATED 51999F $5,181.00

51999G LAP BLADDER DIVERTICULECTOMY 51999G $3,074.00 51999H LAPAROSCOPIC RADIAL CYSTECTOMY 51999H $9,196.00 51999J LAP CYSTECTOMY 51999J $7,774.00

53899B REPLACEMENT OF CONTROL VALVES, BILATERAL NEPH TUBES 53899B $1,199.00

53899C CYSTOSTOMY W/REMOVAL OF FB FROM BLADDER 53899C $2,003.00

LAP BASKET EXTRACTION RENAL STONES W/STENT 53899D PLACEMENT 53899D $3,139.00 53899E CYSTOLITHALOPAXY ON MESH 53899E $2,146.00 53899F LASER INCISION, REMOVAL OF BLADDER MESH 53899F $3,545.00 54699A MICRO EPIDIDYMAL SPERM EXTRACTION 54699A $1,223.00

54699B LAP TESTICULAR BIOPSY (INCISIONAL APPROACH) 54699B $734.00 55559A LAP RESECTION, RIGHT CORD LIPOMA W/MESH 55559A $2,300.00 55899C CREMASTERIC RELEASE OF SPERMATIC CORD 55899C $1,157.00 55899D MICROSCOPIC EPIDIDYMAL SPERM ASPIRATION 55899D $2,000.00 55899E LAP SIMPLE PROSTATECTOMY 55899E $3,953.00 55899F REMOVAL FOREIGN BODY; PENIS,SCROTUM 55899F $1,812.00

55899G EXCISION OF SCROTAL SUTURE TRACTS 55899G $1,984.00 55899H EXAM UNDER ANESTHESIA, MALE PATIENT 55899H $564.00 55899J EXCISION OF FISTULA TRACT 55899J $2,858.00 60699A THYROID ABLATION 60699A $2,460.00 60699B ADRENAL MICROWAVE ABLATION 60699B $2,640.00 63746A REMOVAL PORTO SPLENO-RENAL SHUNT 63746A $1,220.00 64447P NERVE BLOCK, FEMORAL, PENG 64447P $0.00

TUMOR TREATMENT,TRANSNASAL OR TRANSPHENOIDAL ENDO 64999E APPROACH 64999E $6,243.00 64999F BOTOX INJECTION, PALMS 64999F $866.00 64999G BOTOX INJ, DIGITAL ARTERIES 64999G $286.00 64999H INJ NERVE BLOCK, FACIAL NERVE 64999H $345.00 64999J INJ NERVE BLOCK, PHRENIC NERVE 64999J $393.00 64999K INJ NERVE BLOCK, CERVICAL PLEXUS 64999K $335.00 64999L SPINAL DISC CORE BIOPSY 64999L $2,089.00

64999M IB - STIM PROCEDURE 64999M $1,830.00 67299A TRANSPUPILLARY THEMOTHERAPY 67299A $1,172.00 67999A ENDO REPAIR BROW PTOSIS W/IMPLANT 67999A $2,024.00

NASAL ENDO, SURG W/BALLOON DILATION OF EUSTACHIAN 69799A TUBE 69799A $5,166.00 71045A SPECIAL READ SMH, ONE VIEW 71045A $62.00 71045B SPECIAL READ SMH, TWO VIEWS 71045B $90.00 76498A LIMITED PROSTATE MRI/TREATMENT PLANNING 76498A $297.00

78999Z 78999Z CT FUSION FOR LOCALIZATION 26 26 $135.00 88036A CHEST CAVITY AND NECK ORGANS ONLY 88036A $848.00 88036B ABDOMINAL CAVITY AND PELVIC ORGANS ONLY 88036B $848.00 88037A BRAIN ONLY (REMOVED AT UVA) 88037A $848.00 88037B BRAIN ONLY (WITHOUT REMOVAL) 88037B $800.00

88037C BRAIN ONLY (DEGENERATIVE WORK-UP REMOVED AT UVA) 88037C $1,413.00

BRAIN ONLY (DEGENERATIVE WORK-UP, PREVIOUSLY 88037D REMOVED) 88037D $1,366.00 88037E BRAIN ONLY (CJD PREVAUTIONS) 88037E $1,696.00 88037F AUTOPSY, BRAIN ME 88037F $0.00

88305C 88305C CORE BIOP. PROSTATE 26 26 $178.00

88305M 88305M DERM TISSUE EXAM 13 26 26 $100.00 88321A CONSULT AND SLIDE REVIEW 88321A $130.00

CHG WINCHESTER CYTOLOGY/NEUROPATHOLOGY 88321B CONSULT 88321B $330.00 88321S DERM CONSULT UVA REFRL PATIENT 88321S $190.00 90899S DRIVING EVALUATIONS 90899S $150.00 92310A PR NEW CONTACT LENS FIT W TRAINING 92310A $100.00 92310B PR NEW CONTACT LENS FIT - TORIC LENS 92310B $90.00 92310C PR NEW CONTACT LENS FIT - PRESBYOPIA 92310C $105.00 92310D PR EST CONTACT LENS FIT 92310D $75.00 92310E PR DAVIS VISION LENS FIT 92310E $60.00 92310F PR CONTACT LENS FIT- IMAGE DISPARITY 92310F $130.00

TRANSCATHETER REPAIR OF DOUBLE CHAMBERED RIGHT 93799G VENTRICLE 93799G $4,943.00

93882A 93882A PR DUPLEX EXTRACRANIAL UNILAT 26 26 $22.00

93922A 93922A PR DOPPLER ARTERIAL EXT 26 26 $22.00 93979A PR DUPLEX AORTA/IVC/GRAFT/LTD 93979A $22.00

PERIPHERAL ARTERIAL VASCULAR DOPPLER UNLISTED (PROF 93998A COMP) 93998A $36.00

PR CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN >28 94799A DAYS 94799A $223.00

PR CAR SEAT/BED TESTING W/INTERP & REPORT +30MIN >28 94799B DAYS 94799B $49.00 97110A PR INDIVIDUAL YOGA 97110A $99.00 97139A NON BILLABLE THERAPY SERVICE 97139A $0.00 97150A PR GROUP YOGA 97150A $29.00 99024B PR POST-OP FOLLOW-UP VISIT 99024B $0.00 99199A TCOM NO ABI (PROF COMPONENT) 99199A $36.00 99211A PR PROSTHETICS/ORTHOTICS FITTING 99211A $0.00 99211B PR NURSE VISIT 99211B $58.30

99231A PR SUBSEQUENT HOSP CARE,LEVL I, CONCURRENT 99231A $109.00

99231B PR SUBSEQUENT HOSP CARE,LEVL I, CONCURRENT 99231B $109.00

99232A PR SUBSEQUENT HOSP CARE,LEVL II, CONCURRENT 99232A $200.00

99232B PR SUBSEQUENT HOSP CARE,LEVL II, CONCURRENT 99232B $200.00

99233A PR SUBSEQUENT HOSP CARE,LEVL III, CONCURRENT 99233A $288.00

99233B PR SUBSEQUENT HOSP CARE,LEVL III, CONCURRENT 99233B $288.00

99234A PR OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES 99234A $335.00

99235A PR OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES 99235A $435.00 99236A PR OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES 99236A $547.00 99238A PR HOSPITAL DISCHARGE DAY,<30 MIN 99238A $183.00 99239A PR HOSPITAL DISCHARGE DAY,>30 MIN 99239A $270.00 99291A PR CRITICAL CARE, E/M 30-74 MINUTES 99291A $1,060.00 99292A PR CRITICAL CARE, ADDL 30 MIN 99292A $333.00

99356A PR PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR 99356A $231.00

99357A PR PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN 99357A $231.00 99446A E-CONSULT REQUEST 99446A $0.00 99446B E-CONSULT 5-10 MIN. 99446B $0.00 99446C E-CONSULT REQUIRES FACE-TO-FACE 99446C $0.00 99446D E-CONSULT DECLINED 99446D $0.00 99447A E-CONSULT 11-20 MIN. 99447A $0.00 99448A E-CONSULT 21-30 MIN. 99448A $0.00 99449A E-CONSULT 31+ MIN. 99449A $0.00

99463A PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE 99463A $301.00

99464A PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN 99464A $194.00 99465A PR DELIVERY/BIRTHING ROOM RESUSCITATION 99465A $384.00 99499A PR INSUFFICIENT DOCUMENTATION 99499A $0.00 99499B PR PRE-OPERATIVE PHYSICAL EXAM 99499B $0.00 99499D PR BUS DRIVE/CDL (DOT) PHYSICAL 99499D $85.00 99499E PR MRO CALL 99499E $85.00

99499G PR SPORTS PHYSICAL 99499G $25.00 99499H PR AMBULATORY CARE RECONCILIATION 99499H $0.00 99499I PR WALK OUT/NOT SEEN 99499I $0.00 99499J PR NO CHARGE/LAB ONLY 99499J $0.00 99499L PR FU WITHIN 90 DAYS OF TREATMENT 99499L $0.00

99499N PR CLOSE ENCOUNTER - NO LOS 99499N $0.00

99499O PR FU WITHIN 90 DAYS OF TREATMENT 99499O $0.00 99499P PR CLOSE ENCOUNTER - NO LOS 99499P $0.00 99499R PR OB/GYN SERVICE 99499R $0.00 99499S PR OB/GYN SERVICE 99499S $0.00 99499U PR PRE-OPERATIVE PHYSICAL EXAM 99499U $0.00 99499V LIMITED PHYSICAL W/FORMS 99499V $50.00

99499W PEDS CARDIAC CLEARANCE 99499W $75.00 99499X INTRAOPERATIVE CONSULT 99499X $500.00 99499Y PB NON BILLABLE TELE ENCOUNTER 99499Y $0.00 99999C PR SUTURE LACERATION 99999C $0.00 99999E PR CPT CODE UNDETERMINED 99999E $0.00

A4466A KNEE ORTHOTIC, ELASTIC OR SIMILAR STRETCHABLE MATERIAL A4466A $75.00

A4466H ABDOMINAL BINDER, ELASTIC A4466H $40.00

A4467A KNEE ORTHOTIC, ELASTIC OR SIMILAR STRETCHABLE MATERIAL A4467A $75.00 A4467B HINGED KNEE BRACE A4467B $103.00

A4467C KNEE ORTHOTIC A4467C $66.00

A4467D ELBOW SLEEVE A4467D $67.00 A4467E PREFABRICATED SHOULDER ORTHOTIC A4467E $62.00 A4467F THORACIC,RIB BELT,CUSTOM FIT A4467F $47.00

A4467G HEEL PROTECTOR (HEELBO) A4467G $69.00

A4467H ABDOMINAL BINDER, ELASTIC A4467H $40.00 A4467J NEOPRENE ANKLE GAUNTLET A4467J $45.00

A6545A GRADIENT COMPRESSION WRAP-LOWER LEG A6545A $198.00

A6545B GRADIENT COMPRESSION WRAP-UPPER LEG WITH KNEE A6545B $220.00

GRADIENT COMPRESSION WRAP-SINGLE BAND ANKLE FOOT A6545C WRAP A6545C $44.00

A6545D GRADIENT COMPRESSION WRAP-HAND WRAP A6545D $60.00 A6545E GRADIENT COMPRESSION WRAP-ARM WRAP A6545E $224.00

A6549A COMPRESS STOCKING,CUSTOM MADE A6549A $759.00

A9900A FACE SHIELD A9900A $208.00 D1999A ADDITIONAL PPE D1999A $10.00

D2999A PR GOLD CROWN - CROWN PREP D2999A $0.00

D2999B PR CROWN PFM SEMI PRECIOUS METAL - CROWN PREP D2999B $0.00

D2999C PR PFM CROWN 2V - CROWN PREP D2999C $0.00

D2999D PR SEMI PRECIOUS METAL CROWN PREP D2999D $0.00 D2999E PR CROWN PORCELAIN - CROWN PREP D2999E $0.00

D5899A PR REMOVABLE DENTURE PRELIMINARY IMPRESSION D5899A $0.00 D5899B PR REMOVABLE DENTURE FINAL IMPRESSION D5899B $0.00

D5899C PR REMOVABLE DENTURE JAW RELATION D5899C $0.00

D5899D PR REMOVABLE DENTURE TRY IN D5899D $0.00

PR REMOVABLE IMM PART DENTURE RESIN - PRELIMINARY D5899E IMPRESSION D5899E $0.00

D5899F PR REMOVABLE IMM PART DENTURE RESIN - FINAL IMPRESSION D5899F $0.00

D5899G PR REMOVABLE IMM PART DENTURE RESIN - JAW RELATION D5899G $0.00

D5899H PR REMOVABLE IMM PART DENTURE RESIN - TRY IN D5899H $0.00

PR REMOVABLE IMM PART CAST METAL - PRELIMINARY D5899I IMPRESSION D5899I $0.00

D5899J PR REMOVABLE IMM PART CAST METAL - FINAL IMPRESSION D5899J $0.00

D5899K PR REMOVABLE IMM PART CAST METAL - JAW RELATION D5899K $0.00 D5899L PR REMOVABLE IMM PART CAST METAL - TRY IN D5899L $0.00

PR REMOVABLE PART DENTURE FLEXIBLE - PRELIMINARY D5899M IMPRESSION D5899M $0.00

D5899N PR REMOVABLE PART DENTURE - FINAL IMPRESSION D5899N $0.00

D5899O PR REMOVABLE PART DENTURE - JAW RELATION D5899O $0.00 D5899P PR REMOVABLE PART DENTURE - TRY IN D5899P $0.00

PR REMOVABLE IMM COMP DENTURE OTHER - PRELIMINARY D5899Q IMPRESSION D5899Q $0.00

PR REMOVABLE IMM COMP DENTURE OTHER - FINAL D5899R IMPRESSION D5899R $0.00

D5899S PR REMOVABLE IMM COMP DENTURE OTHER - JAW RELATION D5899S $0.00

D5899T PR REMOVABLE IMM COMP DENTURE OTHER - TRY IN D5899T $0.00

PR REMOVABLE COMP DENTURE OTHER - PRELIMINARY D5899U IMPRESSION D5899U $0.00

D5899V PR REMOVABLE COMP DENTURE OTHER - FINAL IMPRESSION D5899V $0.00

D5899W PR REMOVABLE COMP DENTURE OTHER - JAW RELATION D5899W $0.00 D5899X PR REMOVABLE COMP DENTURE OTHER - TRY IN D5899X $0.00

PR REMOVABLE PARTIAL DENTURE RESIN - PRELIMINARY D5899Y IMPRESSION D5899Y $0.00

D5899Z PR REMOVABLE PARTIAL DENTURE RESIN - FINAL IMPRESSION D5899Z $0.00

D9940A PR OCCLUSAL GUARD, IN OFFICE D9940A $190.00

D9999A DENTAL PREPARATION D9999A $0.00

G9012A ARTS CARE CO-ORDINATION G9012A $243.00 J3590A PR UNCLASSIFIED BIOLOGICS ASPIRATION ONLY J3590A $0.00 L1499C PECTUS CARINATUM COMPRESSION SYSTEM L1499C $4,000.00 L1499F NATL ORTHOSIS.. L1499F $550.00 L1499Z PECTUS THORACIC BRACE L1499Z $900.00 L2999J PR ADJUST-A-LIFT L2999J $11.00 L2999K PR HAMMERTOE SPL PR L2999K $15.00 L2999L PR HAPADS PAIR L2999L $12.00

L2999M TOE CAP/GUARD L2999M $13.00 L2999N PR TOE SEPARATOR PR L2999N $4.00 L2999O PR SHIPPING & HANDLING L2999O $1.00 L2999P PLASTIC ORTHOSIS CLR TRSFR L2999P $35.00 L2999Q KNEE BRACE SLEEVE L2999Q $45.00 L2999T NEURO SWING SYSTEM ANKLE JOINT L2999T $2,562.00 L2999Z REMOVABLE HEEL WEDGE L2999Z $18.00 L3999D SHLD IMMOBIL ELA L3999D $37.00 L3999G TENNIS ELBOW AOA L3999G $22.00 L3999N SHOULDER IMMOBILIZER L3999N $229.00 L5999B PR FOOT SHELL FOR PATH FINDER L5999B $150.00 L5999D PR REPLACE FLEX-FOOT SHELL L5999D $215.00

L5999E ADJUSTABLE CALIBRATED TENSIONING SOCKET SYSTEM L5999E $1,985.00

THERMOPLASTIC ELASTOMER SOCKET COMFORT AND L5999F ROTATION CONTROL L5999F $972.00

UNTENSIONED/OPEN SOCKET CIRCUMFERENCE DONNING L5999G FEATURE L5999G $2,214.00 L7499A PR ONE FINGER PROS L7499A $416.00 L7499C SURELOCK UPPER EXTREMITY CABLE LOCK L7499C $844.00 L7499D TOUGHWARE SELF-SUSPENDING HUMERAL CUFF L7499D $800.00 $17,775.0 L7499E PARTIAL FINGER PROSTHESIS L7499E 0 L7499R PARTIAL FINGER PROSTHESIS, CUSTON L7499R $2,508.00 L8499A PR PROTECTIVE STOCKING L8499A $30.00 S0620D PR DAVIS VISION EXAM NEW PT S0620D $51.50 S0621D PR DAVIS VISION EXAM RTRN PT S0621D $51.50 V2599D PR DAVIS VISION CONTACT LENS BENEFIT V2599D $110.50 V5011B FIT/CHECKING OF HA (ALL PLANS) V5011B $0.00 V5014B REPAIR/MODIFY HA (ALL PLANS) V5014B $0.00 V5014K HA REP (OTICON) ALL WARR 6 MO V5014K $220.00 V5014L HA REP (OTICON) ALL WARR 12 MO V5014L $260.00 V5014P HA REP (OTCON) W/AI WARR 12 MO V5014P $260.00 V5014U HA (WID) BTE&CUST REP WAR 6MO V5014U $230.00 V5014V HA (WID) BTE&CUST REP WAR 12MO V5014V $260.00 V5014Y HA WI CUS REM 6MO REM WAR ONL V5014Y $160.00 V5264A MICROMOLD (EACH) V5264A $60.00 V5264B ELAN SHELL V5264B $40.00 V5267B HEARING AID SUPPLY, WAX GUARDS V5267B $53.00 V5267D HEARING AID SUPPLY, DRI-AID KIT V5267D $15.00 V5267E HA REMOTE CONTROL/STREAMER V5267E $53.00 V5267H HA SUPPLY, TUBING V5267H $5.00 V5267I HA SUPPLY, RIC REC. (OTICON) V5267I $75.00 V5267K HA SUPPLY, RIC REC. (WIDEX) V5267K $100.00 V5299A HA FU UNLIM 2YRS PER AID W/PUR V5299A $200.00 V5299B HA FU UNLIM 5YRS PER AID W/PUR V5299B $350.00 V5299D HEARING AID DROP-OFF FEE V5299D $25.00 V5299E NEUROMONICS PROCESSOR(OASIS) V5299E $3,590.00

V5299F AUDIOLOGY, INITIAL TINNITUS VISIT, CASH & CARRY V5299F $150.00

V5299G NEUROMONIC PROCESS (SANCTUARY) V5299G $960.00 V5299H AUDIOLOGY, F/U TINNITUS VISIT,CASH & CARRY V5299H $100.00 V5299I NEUROMONIC PROCESS F/U PACKAGE. V5299I $105.00 V5299K HA REPLACEMENT FEE V5299K $300.00

V5299M HA FU 15 VIST OVR 5YRS PER AID V5299M $350.00

V5299N HA FU UNLIM 1 YR NON UVA PURCH V5299N $200.00

V5299O HA FU UNLIM 2 YR NON UVA PURCH V5299O $350.00

V5299Q HA ADD YR L&D (OTICON) V5299Q $40.00 V5299R HA ADD YR REP WARR (OTICON) V5299R $110.00 V5299S HA ADD YR EXT WARR (OTICON) V5299S $140.00

V5299W HA (WID) ALL OTHRE 3RD REP WARR V5299W $110.00 V5299X HA (WIDEX) ALL 2ND YEAR L&D V5299X $110.00

76499AU CONTRAST ENHANC SPECTRAL MAMMO 76499AU $100.00

93799ZA PR PULM ARTERY PRESS SENS IMPLANT 93799ZA $7,300.00

99499ZA NURSING HOME PE, ESTAB PAT 99499ZA $250.00

D5899A D5899A A PR REMOVABLE PARTIAL DENTURE RESIN - JAW RELATION A $0.00

D5899AB PR REMOVABLE PARTIAL DENTURE RESIN - TRY IN D5899AB $0.00

D5899A D5899A C PR RELINE UPPER DENTURE LAB - IMPRESSION C $0.00

D5899A D5899A D PR RELINE LOWER DENTURE LAB - IMPRESSION D $0.00

D5899AE PR NIGHTGUARD NIGHTGUARD FITTING D5899AE $0.00 D5899AF PR SPACE MAINTAINERS BILATERAL IMPRESSION D5899AF $0.00

L2999AD METATARSAL PAD L2999AD $6.00

L2999AE HAL-VALG SPLINT L2999AE $25.00

L2999AN HEEL CUP L2999AN $30.00

L2999BF ADD PPT TO FO L2999BF $12.00

L2999BY KNEE SLEEVE L2999BY $45.00

L7499AG PREM FUNCT AESTHETIC P. FING L7499AG $5,672.00

$21,375.0 L7499AI BIOMECHANICAL FUNCTION THUMB L7499AI 0

L7499AL PR TWO FINGER FUNCTION AESTH PROS L7499AL $8,835.00

V5014A V5014A A HA WI BTE&CUS REP WAR GT 5YR 6M A $305.00

V5014AE HA REP (PHON) CLAS SVC PLN 6MO V5014AE $210.00

V5014AF HA REP (PHO) CLAS SVC PLN 12MO V5014AF $240.00

V5014A V5014A G HA REP(PHO) DHC (REM) SPLN 6MO G $120.00

V5014AI REPAIR/MODIFICATION OF A HEARING AID V5014AI $220.00

V5014AJ HA REP (PHO) DIG SVC PLN 12 MO V5014AJ $250.00

V5014AR HA REP(PH)WLS CRS/BICRS 12 MO V5014AR $240.00

V5014BB HA REP(STAR)CIC/CANAL WAR 12MO V5014BB $250.00

V5014BF HA REP(STAR) CUST DIG 1YR WARR V5014BF $240.00

V5299AF HA WAR PHO EXT SVC CON DIG YR V5299AF $180.00