Delaware Valley Hospital REV SHORT DESCRIPTION CHARGE SELFPAY AVERAGE AVERAGE AVERAGE HCPCS COMMERCIAL MEDICARE MEDICAID 0001A Adm Sarscov2 30Mcg/0.3Ml 1St $6,606 $4,294 $5,129 $2,165 0001F Heart Failure Composite 0001U Rbc Dna Hea 35 Ag 11 Bld Grp $1,474 $958 $1,144 $512 0002A Adm Sarscov2 30Mcg/0.3Ml 2Nd $1,405 $913 $1,091 $460 0002M Liver Dis 10 Assays W/Ash $2,637 $1,714 $2,047 $822 0002U Onc Clrct 3 Ur Metab Alg Plp $413 $268 $321 $122 0003A Fee Covid-19 Vac 1 Booster $419 $272 $325 $137 0003M Liver Dis 10 Assays W/Nash $913 $593 $709 $324 0003U Onc Ovar 5 Prtn Ser Alg Scor $1,824 $1,186 $1,416 $640 0004A Fee Covid-19 Vac 1 Res $2,392 $1,555 $1,857 $784 0004M Scoliosis Dna Alys $5,112 $3,323 $3,969 $1,487 0005F Osteoarthritis Composite 0005U Onco Prst8 3 Gene Ur Alg 0006M Onc Hep Gene Risk Classifier 0006U Detc Ia Meds 120+ Analytes 0007M Onc Gastro 51 Gene Nomogram 0007U Rx Test Prsmv Ur W/Def Conf 0008U Hpylori Detcj Abx Rstnc Dna 0009U Onc Brst Ca Erbb2 Amp/Nonamp 00100 Anesth Salivary Gland $17 $11 $13 $6 00102 Anesth Repair Of Cleft Lip 00103 Anesth Blepharoplasty 00104 Anesth Electroshock $508 $331 $395 $167 $100 0010U Nfct Ds Strn Typ Whl Gen Seq 0011A Adm Sarscov2 100Mcg/0.5Ml1St 0011M Onc Prst8 Ca Mrna 12 Gen Alg 0011U Rx Mntr Lc-Ms/Ms Oral Fluid 00120 Anesth Ear Surgery $21 $14 $16 $7 00124 Anesth Ear Exam $142 $92 $110 $47 00126 Anesth Tympanotomy $653 $425 $507 $214 $73 0012A Adm Sarscov2 100Mcg/0.5Ml2Nd 0012F Cap Bacterial Assess 0012M Onc Mrna 5 Gen Rsk Urthl Ca 0012U Germln Do Gene Reargmt Detcj 0013A Fee Covid-19 Vac 2 Booster 0013M Onc Mrna 5 Gen Recr Urthl Ca 0013U Onc Sld Org Neo Gene Reargmt 00140 Anesth Procedures On Eye $800 $520 $621 $262 $35 00142 Anesth Lens Surgery $47 $31 $36 $15 00144 Anesth Corneal Transplant $60 $39 $47 $20 00145 Anesth Vitreoretinal Surg 00147 Anesth Iridectomy 00148 Anesth Eye Exam 0014A Fee Covid-19 Vac 2 Res 0014F Comp Preop Assess Cat Surg 0014M Liver Ds Alys 3 Bmrk Srm Alg 0014U Hem Hmtlmf Neo Gene Reargmt 0015F Melan Follow-Up Complete 0015M Adrnl Cortcl Tum Bchm Asy 25 00160 Anesth Nose/Sinus Surgery $1,327 $863 $1,030 $435 $160 00162 Anesth Nose/Sinus Surgery 00164 Anesth Biopsy Of Nose 0016M Onc Bladder Mrna 209 Gen Alg 0016U Onc Hmtlmf Neo Rna Bcr/Abl1 00170 Anesth Procedure On Mouth $1,112 $723 $864 $364 $117 00172 Anesth Cleft Palate Repair $900 $585 $699 $295 $117 00174 Anesth Pharyngeal Surgery 00176 Anesth Pharyngeal Surgery 0017M Onc Dlbcl Mrna 20 Genes Alg 0017U Onc Hmtlmf Neo Jak2 Mut Dna 0018U Onc Thyr 10 Microrna Seq Alg 00190 Anesth Face/Skull Bone Surg $1,350 $878 $1,048 $442 $175 00192 Anesth Facial Bone Surgery 0019U Onc Rna Tiss Predict Alg 00210 Anesth Cranial Surg Nos $182 $118 $141 $60 00211 Anesth Cran Surg Hemotoma $5,032 $3,271 $3,907 $1,649 00212 Anesth Skull Drainage $894 $581 $694 $293 00214 Anesth Skull Drainage $4,227 $2,748 $3,282 $1,385 00215 Anesth Skull Repair/Fract 00216 Anesth Head Vessel Surgery 00218 Anesth Special Head Surgery $4,599 $2,989 $3,570 $1,507 0021A Fee Covid-19 Vac 3 Dose 1 0021U Onc Prst8 Detcj 8 Autoantb 00220 Anesth Intrcrn Nerve $541 $352 $420 $177 00222 Anesth Head Nerve Surgery $1,134 $737 $880 $372 0022A Fee Covid-19 Vac 3 Dose 2 0022U Trgt Gen Seq Dna&Rna 23 Gene 0023A Fee Covid-19 Vac 3 Booster 0023U Onc Aml Dna Detcj/Nondetcj 0024A Fee Covid-19 Vac 3 Res 0024U Glyca Nuc Mr Spectrsc Quan 0025U Tenofovir Liq Chrom Ur Quan 0026U Onc Thyr Dna&Mrna 112 Genes 0027U Jak2 Gene Trgt Seq Alys 0029U Rx Metab Advrs Trgt Seq Alys 00300 Anesth Head/Neck/Ptrunk $1,055 $685 $819 $346 $107 0030U Rx Metab Warf Trgt Seq Alys 0031A Fee Covid-19 Vac 4 Dose 1 0031U Cyp1A2 Gene 00320 Anesth Neck Organ 1Yr/> $1,417 $921 $1,100 $464 $168 00322 Anesth Biopsy Of Thyroid 00326 Anesth Larynx/Trach < 1 Yr 0032A Fee Covid-19 Vac 4 Dose 2 0032U Comt Gene 0033A Fee Covid-19 Vac 4 Booster 0033U Htr2A Htr2C Genes 0034A Fee Covid-19 Vac 4 Res 0034U 301 Tpmt Nudt15 Genes $1,169 $760 $908 $393 00350 Anesth Neck Vessel Surgery 00352 Anesth Neck Vessel Surgery 0035U 301 Neuro Csf Prion Prtn Qual $1,420 $923 $1,102 $475 0036U Xome Tum & Nml Spec Seq Alys 0037U 301 Trgt Gen Seq Dna 324 Genes $12,250 $7,963 $9,510 $3,958 0038U Vitamin D Srm Microsamp Quan 0039U Dna Antb 2Strand Hi Avidity 00400 Anesth Skin Ext/Per/Atrunk $831 $540 $645 $272 $96 00402 Anesth Surgery Of Breast $2,022 $1,314 $1,570 $663 $287 00404 Anesth Surgery Of Breast 00406 Anesth Surgery Of Breast 0040U Bcr/Abl1 Gene Major Bp Quan 00410 Anesth Correct Heart Rhythm 0041A Fee Covid-19 Vac 5 Dose 1 0041U B Brgdrferi Antb 5 Prtn Igm 0042A Fee Covid-19 Vac 5 Dose 2 0042T 350 Ct Perfusion W/Contrast Cbf $1,879 $1,221 $1,459 $616 0042U B Brgdrferi Antb 12 Prtn Igg 0043A Fee Covid-19 Vac 5 Booster 0043U Tbrf B Grp Antb 4 Prtn Igm 0044A Fee Covid-19 Vac 5 Res 0044U Tbrf B Grp Antb 4 Prtn Igg 00450 Anesth Surgery Of Shoulder $1,600 $1,040 $1,242 $524 $91 00454 Anesth Collar Bone Biopsy 0045U Onc Brst Dux Carc Is 12 Gene 0046U Flt3 Gene Itd Variants Quan 00470 Anesth Removal Of Rib 00472 Anesth Chest Wall Repair 00474 Anesth Surgery Of Rib 0047U Onc Prst8 Mrna 17 Gene Alg 0048U Onc Sld Org Neo Dna 468 Gene 0049U Npm1 Gene Analysis Quan 00500 Anesth Esophageal Surgery 0050U Trgt Gen Seq Dna 194 Genes 0051A Fee Covid-19 Vac 6 Dose 1 0051U Rx Mntr Lc-Ms/Ms Ur 31 Pnl 00520 Anesth Chest Procedure 00522 Anesth Chest Lining Biopsy 00524 Anesth Chest Drainage 00528 Anes Mediascpy & Dx Thorscpy 00529 Anes Medscpy&Thorscpy 1 Lung 0052A Fee Covid-19 Vac 6 Dose 2 0052U Lpoprtn Bld W/5 Maj Classes 00530 Anesth Pacemaker Insertion 00532 Anesth Vascular Access $900 $585 $699 $295 $73 00534 Anesth Cardioverter/Defib $1,550 $1,008 $1,203 $508 $173 00537 Anesth Cardiac Electrophys $2,333 $1,517 $1,811 $765 $248 00539 Anesth Trach-Bronch Reconst 0053A Fee Covid-19 Vac 6 Booster 0053U Onc Prst8 Ca Fish Alys 4 Gen 00540 Anesth Chest Surgery 00541 Anesth One Lung Ventilation 00542 Anesthesia Removal Pleura 00546 Anesth Lung Chest Wall Surg 00548 Anesth Trachea Bronchi Surg 0054A Fee Covid-19 Vac 6 Res 0054T Bone Srgry Cmptr Fluor Image 0054U Rx Mntr 14+ Drugs & Sbsts 00550 Anesth Sternal Debridement 0055T Bone Srgry Cmptr Ct/Mri Imag 0055U Card Hrt Trnspl 96 Dna Seq 00560 Anesth Heart Surg W/O Pump 00561 Anesth Heart Surg <1 Yr 00562 Anesth Hrt Surg W/Pmp Age 1+ 00563 Anesth Heart Surg W/Arrest 00566 Anesth Cabg W/O Pump 00567 Anesth Cabg W/Pump 0056U Hem Aml Dna Gene Reargmt 00580 Anesth Heart/Lung Transplnt 0058T Cryopreservation Ovary Tiss 0058U Onc Merkel Cll Carc Srm Quan 0059U Onc Merkel Cll Carc Srm +/- 00600 Anesth Spine Cord Surgery $1,800 $1,170 $1,397 $590 $233 00604 Anesth Sitting Procedure 0060U Twn Zyg Gen Seq Alys Chrms2 0061A Fee Covid-19 Vac 7 Dose 1 0061U Tc Meas 5 Bmrk Sfdi M-S Alys 00620 Anesth Spine Cord Surgery 00625 Anes Spine Tranthor W/O Vent 00626 Anes Spine Transthor W/Vent 0062A Fee Covid-19 Vac 7 Dose 2 0062U Ai Sle Igg&Igm Alys 80 Bmrk 00630 Anesth Spine Cord Surgery $1,589 $1,033 $1,234 $521 $156 00632 Anesth Removal Of Nerves 00635 Anesth Lumbar Puncture 0063A Fee Covid-19 Vac 7 Booster 0063U Neuro Autism 32 Amines Alg 00640 Anesth Spine Manipulation 0064A Fee Covid-19 Vac 7 Res 0064U Antb Tp Total&Rpr Ia Qual 0065U Syfls Tst Nontreponemal Antb 0066U Pamg-1 Ia Cervico-Vag Fluid 00670 Anesth Spine Cord Surgery $2,125 $1,381 $1,650 $696 $233 0067U Onc Brst Imhchem Prfl 4 Bmrk 0068U Candida Species Pnl Amp Prb 0069U Onc Clrct Microrna Mir-31-3P 00700 Anesth Abdominal Wall Surg $800 $520 $621 $262 $18 00702 Anesth For Liver Biopsy 0070U 301 Cyp2D6 Gen Com&Slct Rar Vrnt $834 $542 $647 $321 0071A Fee Covid-19 Vac 8 Dose 1 0071T Us Leiomyomata Ablate <200 0071U 301 Cyp2D6 Full Gene Sequence $1,930 $1,255 $1,498 $594 0072A Fee Covid-19 Vac 8 Dose 2 0072T Us Leiomyomata Ablate >200 0072U 301 Cyp2D6 Gen Cyp2D6-2D7 Hybrid $2,619 $1,702 $2,033 $811 00730 Anesth Abdominal Wall Surg 00731 Anes Upr Gi Ndsc Px Nos $784 $509 $608 $257 $94 00732 Anes Upr Gi Ndsc Px Ercp 0073A Fee Covid-19 Vac 8 Booster 0073U 301 Cyp2D6 Gen Cyp2D7-2D6 Hybrid $2,895 $1,882 $2,248 $891 0074A Fee Covid-19 Vac 8 Res 0074U 301 Cyp2D6 Nonduplicated Gene $3,308 $2,150 $2,568 $1,010 00750 Anesth Repair Of Hernia $1,000 $650 $776 $328 $105 00752 Anesth Repair Of Hernia $1,267 $823 $983 $415 $119 00754 Anesth Repair Of Hernia 00756 Anesth Repair Of Hernia 0075T Perq Stent/Chest Vert Art 0075T Perq Stent/Chest Vert Art 0075T Perq Stent/Chest Vert Art 0075U 301 Cyp2D6 5' Gene Dup/Mlt $3,584 $2,330 $2,782 $1,090 0076T S&I Stent/Chest Vert Art 0076T S&I Stent/Chest Vert Art 0076T S&I Stent/Chest Vert Art 0076U 301 Cyp2D6 3' Gene Dup/Mlt $3,859 $2,508 $2,996 $1,169 00770 Anesth Blood Vessel Repair 0077U Ig Paraprotein Qual Bld/Ur 0078U Pain Mgt Opi Use Gnotyp Pnl 00790 Anesth Surg Upper Abdomen $1,401 $910 $1,087 $459 $160 00792 Anesth Hemorr/Excise Liver 00794 Anesth Pancreas Removal 00796 Anesth For Liver Transplant 00797 Anesth Surgery For Obesity 0079U Cmprtv Dna Alys Mlt Snps 00800 Anesth Abdominal Wall Surg $700 $455 $543 $229 $91 00802 Anesth Fat Layer Removal $2,533 $1,647 $1,967 $830 $342 0080U Onc Lng 5 Clin Rsk Factr Alg 00811 Anes Lwr Intst Ndsc Nos $775 $504 $602 $254 $103 00812 Anes Lwr Intst Scr Colsc $550 $358 $427 $180 $71 00813 Anes Upr Lwr Gi Ndsc Px $918 $597 $713 $301 $88 0081A Fee Covid-19 Vac 9 Dose 1 00820 Anesth Abdominal Wall Surg 0082A Fee Covid-19 Vac 9 Dose 2 0082U Rx Test Def 90+ Rx/Sbsts Ur 00830 Anesth Repair Of Hernia $971 $631 $754 $318 $99 00832 Anesth Repair Of Hernia $1,100 $715 $854 $360 $50 00834 Anesth Hernia Repair < 1 Yr 00836 Anesth Hernia Repair Preemie 0083A Fee Covid-19 Vac 9 Booster 0083U Onc Rspse Chemo Cntrst Tomog 00840 Anesth Surg Lower Abdomen $1,198 $779 $930 $393 $147 00842 Anesth Amniocentesis 00844 Anesth Pelvis Surgery 00846 Anesth Hysterectomy 00848 Anesth Pelvic Organ Surg 0084A Fee Covid-19 Vac 9 Res 0084U Rbc Dna Gnotyp 10 Bld Groups 00851 Anesth Tubal Ligation $1,027 $668 $797 $337 $119 0085T Breath Test Heart Reject 00860 Anesth Surgery Of Abdomen $1,718 $1,117 $1,334 $563 $198 00862 Anesth Kidney/Ureter Surg $2,200 $1,430 $1,708 $721 $55 00864 Anesth Removal Of Bladder 00865 Anesth Removal Of Prostate 00866 Anesth Removal Of Adrenal 00868 Anesth Kidney Transplant 0086U Nfct Ds Bact&Fng Org Id 6+ 00870 Anesth Bladder Stone Surg 00872 Anesth Kidney Stone Destruct $1,350 $878 $1,048 $442 $181 00873 Anesth Kidney Stone Destruct $1,100 $715 $854 $360 $143 0087U Crd Hrt Trnspl Mrna 1283 Gen 00880 Anesth Abdomen Vessel Surg 00882 Anesth Major Vein Ligation 0088U Trnsplj Kdn Algrft Rej 1494 0089U Onc Mlnma Prame & Linc00518 00902 Anesth Anorectal Surgery $810 $526 $628 $265 $98 00904 Anesth Perineal Surgery 00906 Anesth Removal Of Vulva 00908 Anesth Removal Of Prostate 0090U Onc Cutan Mlnma Mrna 23 Gene 00910 Anesth Bladder Surgery $703 $457 $546 $230 $79 00912 Anesth Bladder Tumor Surg $440 $286 $342 $144 $124 00914 Anesth Removal Of Prostate $1,000 $650 $776 $328 $130 00916 Anesth Bleeding Control 00918 Anesth Stone Removal $567 $368 $440 $186 $103 0091A Fee Covid-19 Vac 10 Dose 1 0091U Onc Clrct Scr Whl Bld Alg 00920 Anesth Genitalia Surgery $1,033 $672 $802 $339 $126 00921 Anesth Vasectomy $600 $390 $466 $197 $58 00922 Anesth Sperm Duct Surgery $1,200 $780 $932 $393 $156 00924 Anesth Testis Exploration 00926 Anesth Removal Of Testis 00928 Anesth Removal Of Testis 0092A Fee Covid-19 Vac 10 Dose 2 0092U Onc Lng 3 Prtn Bmrk Plsm Alg 00930 Anesth Testis Suspension 00932 Anesth Amputation Of Penis 00934 Anesth Penis Nodes Removal 00936 Anesth Penis Nodes Removal 00938 Anesth Insert Penis Device 0093A Fee Covid-19 Vac 10 Booster 0093U Rx Mntr 65 Com Drugs Urine 00940 Anesth Vaginal Procedures $636 $413 $494 $208 $69 00942 Anesth Surg On Vag/Urethral 00944 Anesth Vaginal Hysterectomy $1,479 $961 $1,148 $484 $144 00948 Anesth Repair Of Cervix $800 $520 $621 $262 $117 0094A Fee Covid-19 Vac 10 Res 0094U Genome Rapid Sequence Alys 00950 Anesth Vaginal Endoscopy 00952 Anesth Hysteroscope/Graph $718 $467 $557 $235 $81 0095T Rmvl Artific Disc Addl Crvcl 0095U Inflm Ee Elisa Alys Alg 0096U Hpv Hi Risk Types Male Urine 0097U Gi Pathogen 22 Targets $1,215 $790 $943 $398 $275 0098T Rev Artific Disc Addl 0098U Respir Pathogen 14 Targets 0099U Respir Pathogen 20 Targets 0100T Prosth Retina Receive&Gen 0100U 300 Respir Pathogen 21 Targets $1,319 $857 $1,024 $432 0101A Fee Covid-19 Vac 11 Dose 1 0101T Extracorp Shockwv Tx Hi Enrg 0101U Hered Colon Ca Do 15 Genes 0102A Fee Covid-19 Vac 11 Dose 2 0102T Extracorp Shockwv Tx Anesth 0102U Hered Brst Ca Rltd Do 17 Gen 0103A Fee Covid-19 Vac 11 Booster 0103U Hered Ova Ca Pnl 24 Genes 0104A Fee Covid-19 Vac 11 Res 0105U Neph Ckd Mult Eclia Tum Nec 0106T Touch Quant Sensory Test 0106U Gstr Emptg 7 Timed Brth Spec 0107T Vibrate Quant Sensory Test 0107U C Diff Tox Ag Detcj Ia Stool 0108T Cool Quant Sensory Test 0108U Gi Barrett Esoph 9 Prtn Bmrk 0109T Heat Quant Sensory Test 0109U Id Aspergillus Dna 4 Species 0110T Nos Quant Sensory Test 0110U Rx Mntr 1+Oral Onc Rx&Sbsts 01112 Anesth Bone Aspirate/Bx 0111T Rbc Membranes Fatty Acids 0111U Onc Colon Ca Kras&Nras Alys 01120 Anesth Pelvis Surgery 0112U Iadi 16S&18S Rrna Genes 01130 Anesth Body Cast Procedure 0113U Onc Prst8 Pca3&Tmprss2-Erg 01140 Anesth Amputation At Pelvis 0114U Gi Barretts Esoph Vim&Ccna1 01150 Anesth Pelvic Tumor Surgery 0115U Respir Iadna 18 Viral&2 Bact 01160 Anesth Pelvis Procedure 0116U Rx Mntr Nzm Ia 35+Oral Flu 01170 Anesth Pelvis Surgery 01173 Anesth Fx Repair Pelvis 0117U Pain Mgmt 11 Endogenous Anal 0118U Trnsplj Don-Drv Cll-Fr Dna 0119U Crd Ceramides Liq Chrom Plsm 01200 Anesth Hip Joint Procedure 01202 Anesth Arthroscopy Of Hip $1,700 $1,105 $1,320 $557 $125 0120U Onc B Cll Lymphm Mrna 58 Gen 01210 Anesth Hip Joint Surgery $1,200 $780 $932 $393 $156 01212 Anesth Hip Disarticulation 01214 Anesth Hip Arthroplasty $1,540 $1,001 $1,196 $505 $200 01215 Anesth Revise Hip Repair 0121U Sc Dis Vcam-1 Whole Blood 01220 Anesth Procedure On Femur 0122U Sc Dis P-Selectin Whl Blood 01230 Anesth Surgery Of Femur $1,300 $845 $1,009 $426 $168 01232 Anesth Amputation Of Femur 01234 Anesth Radical Femur Surg 0123U Mchnl Fragility Rbc Prflg 0124U Ftl Cgen Abnor 3 Analytes 01250 Anesth Upper Leg Surgery $960 $624 $745 $315 $127 0125U Ftl Cgen Abnor Prnt Comp 5 01260 Anesth Upper Leg Veins Surg $1,000 $650 $776 $328 $130 0126T Chd Risk Imt Study 0126U Ftl Cgen Abnor Prnt Comp 5 Y 01270 Anesth Thigh Arteries Surg 01272 Anesth Femoral Artery Surg 01274 Anesth Femoral Embolectomy 0127U Ob Pe 3 Analytes 0128U Ob Pe 3 Analytes Y Chrmsm 0129U Hered Brst Ca Rltd Do Panel 0130U Hered Colon Ca Do Mrna Pnl 0131U Hered Brst Ca Rltd Do Pnl 13 01320 Anesth Knee Area Surgery 0132U Hered Ova Ca Rltd Do Pnl 17 0133U Hered Prst8 Ca Rltd Do 11 01340 Anesth Knee Area Procedure 0134U Hered Pan Ca Mrna Pnl 18 Gen 0135U Hered Gyn Ca Mrna Pnl 12 Gen 01360 Anesth Knee Area Surgery 0136U Atm Mrna Seq Alys 0137U Palb2 Mrna Seq Alys 01380 Anesth Knee Joint Procedure 01382 Anesth Dx Knee Arthroscopy 0138U Brca1 Brca2 Mrna Seq Alys 01390 Anesth Knee Area Procedure $600 $390 $466 $197 $78 01392 Anesth Knee Area Surgery $1,200 $780 $932 $393 $156 0139U Neuro Austm Meas 6 C Metablt 01400 Anesth Knee Joint Surgery $1,182 $768 $918 $387 $113 01402 Anesth Knee Arthroplasty $1,513 $984 $1,175 $496 $163 01404 Anesth Amputation At Knee 0140U Nfct Ds Fungi Dna 15 Trgt 0141U Nfct Ds Bact&Fng Gram Pos 01420 Anesth Knee Joint Casting 0142U Nfct Ds Bact&Fng Gram Neg 01430 Anesth Knee Veins Surgery 01432 Anesth Knee Vessel Surg 0143U Drug Assay 120+ Rx/Metablt 01440 Anesth Knee Arteries Surg 01442 Anesth Knee Artery Surg 01444 Anesth Knee Artery Repair 0144U Drug Assay 160+ Rx/Metablt 0145U Drug Assay 65+ Rx/Metablt 01462 Anesth Lower Leg Procedure $600 $390 $466 $197 $78 01464 Anesth Ankle/Ft Arthroscopy $875 $569 $679 $287 $57 0146U Drug Assay 80+ Rx/Metablt 01470 Anesth Lower Leg Surgery $950 $618 $738 $311 $97 01472 Anesth Achilles Tendon Surg $1,300 $845 $1,009 $426 $128 01474 Anesth Lower Leg Surgery $800 $520 $621 $262 $50 0147U Drug Assay 85+ Rx/Metablt 01480 Anesth Lower Leg Bone Surg $1,088 $707 $845 $356 $129 01482 Anesth Radical Leg Surgery 01484 Anesth Lower Leg Revision 01486 Anesth Ankle Replacement 0148U Drug Assay 100+ Rx/Metablt 01490 Anesth Lower Leg Casting 0149U Drug Assay 60+ Rx/Metablt 01500 Anesth Leg Arteries Surg 01502 Anesth Lwr Leg Embolectomy 0150U Drug Assay 120+ Rx/Metablt 0151U Nfct Bct/Vir Resp Nfctj 33 01520 Anesth Lower Leg Vein Surg $700 $455 $543 $229 $18 01522 Anesth Lower Leg Vein Surg 0152U Nfct Ds Dna Untrgt Ngnrj Seq 0153U Onc Breast Mrna 101 Genes 0154U Fgfr3 Gene Analysis 0155U Pik3Ca Gene Analysis 0156U Copy Number Sequence Alys 0157U Apc Mrna Seq Alys 0158U Mlh1 Mrna Seq Alys 0159U Msh2 Mrna Seq Alys 0160U Msh6 Mrna Seq Alys 01610 Anesth Surgery Of Shoulder $1,400 $910 $1,087 $459 $143 0161U Pms2 Mrna Seq Alys 01620 Anesth Shoulder Procedure $600 $390 $466 $197 $78 01622 Anes Dx Shoulder Arthroscopy 0162U Hered Colon Ca Trgt Mrna Pnl 01630 Anesth Surgery Of Shoulder $1,325 $861 $1,028 $434 $179 01634 Anesth Shoulder Joint Amput 01636 Anesth Forequarter Amput 01638 Anesth Shoulder Replacement 0163T Lumb Artif Diskectomy Addl 0163U Onc Clrct Scr 3 Prtn Alg 0164T Remove Lumb Artif Disc Addl 0164U Gi Ibs Ia Anti-Cdtb&Vinculin 01650 Anesth Shoulder Artery Surg 01652 Anesth Shoulder Vessel Surg 01654 Anesth Shoulder Vessel Surg 01656 Anesth Arm-Leg Vessel Surg 0165T Revise Lumb Artif Disc Addl 0165U Peanut Allg Asmt Epi 0166U Liver Ds 10 Biochem Asy Srm 01670 Anesth Shoulder Vein Surg 0167U Chornc Gonadotropin Hcg Ia 01680 Anesth Shoulder Casting 0168U Ftl Aneuploidy Dna Seq Alys 0169U Nudt15&Tpmt Gene Com Vrnt 0170U Neuro Asd Rna Next Gen Seq 01710 Anesth Elbow Area Surgery $933 $607 $725 $306 $118 01712 Anesth Uppr Arm Tendon Surg 01714 Anesth Uppr Arm Tendon Surg 01716 Anesth Biceps Tendon Repair 0171U Trgt Gen Seq Alys Pnl Dna 23 0172U Onc Sld Tum Alys Brca1 Brca2 01730 Anesth Uppr Arm Procedure 01732 Anesth Dx Elbow Arthroscopy 0173U Psyc Gen Alys Panel 14 Genes 01740 Anesth Upper Arm Surgery 01742 Anesth Humerus Surgery 01744 Anesth Humerus Repair 0174T Cad Cxr With Interp 0174U Onc Solid Tumor 30 Prtn Trgt 01756 Anesth Radical Humerus Surg 01758 Anesth Humeral Lesion Surg 0175T Cad Cxr Remote 0175U Psyc Gen Alys Panel 15 Genes 01760 Anesth Elbow Replacement 0176U Cdtb&Vinculin Igg Antb Ia 01770 Anesth Uppr Arm Artery Surg 01772 Anesth Uppr Arm Embolectomy 0177U Onc Brst Ca Dna Pik3Ca 11 01780 Anesth Upper Arm Vein Surg 01782 Anesth Uppr Arm Vein Repair 0178U Peanut Allg Asmt Epi Clin Rx 0179U Onc Nonsm Cll Lng Ca Alys 23 0180U Abo Gnotyp Abo 7 Exons 01810 Anesth Lower Arm Surgery $695 $451 $539 $228 $85 0181U Co Gnotyp Aqp1 Exon 1 01820 Anesth Lower Arm Procedure $567 $368 $440 $186 $70 01829 Anesth Dx Wrist Arthroscopy 0182U Crom Gnotyp Cd55 Exons 1-10 01830 Anesth Lower Arm Surgery $885 $575 $687 $290 $125 01832 Anesth Wrist Replacement 0183U Di Gnotyp Slc4A1 Exon 19 01840 Anesth Lwr Arm Artery Surg 01842 Anesth Lwr Arm Embolectomy 01844 Anesth Vascular Shunt Surg 0184T Exc Rectal Tumor Endoscopic 0184U Do Gnotyp Art4 Exon 2 01850 Anesth Lower Arm Vein Surg 01852 Anesth Lwr Arm Vein Repair 0185U Fut1 Gnotyp Fut1 Exon 4 01860 Anesth Lower Arm Casting 0186U Fut2 Gnotyp Fut2 Exon 2 0187U Fy Gnotyp Ackr1 Exons 1-2 0188U Ge Gnotyp Gypc Exons 1-4 0189U Gypa Gnotyp Ntrns 1 5 Exon 2 0190U Gypb Gnotyp Ntrns 1 5 Seux 3 01916 Anesth Dx Arteriography $950 $618 $738 $311 $77 0191T Insert Ant Segment Drain Int 0191U In Gnotyp Cd44 Exons 2 3 6 01920 Anesth Catheterize Heart 01922 Anesth Cat Or Mri Scan 01924 Anes Ther Interven Rad Artrl $1,000 $650 $776 $328 $60 01925 Anes Ther Interven Rad Card 01926 Anes Tx Interv Rad Hrt/Cran 0192U Jk Gnotyp Slc14A1 Exon 9 01930 Anes Ther Interven Rad Vein $988 $642 $767 $324 $113 01931 Anes Ther Interven Rad Tips 01932 Anes Tx Interv Rad Th Vein 01933 Anes Tx Interv Rad Cran Vein 01935 Anesth Perc Img Dx Sp Proc $800 $520 $621 $262 $104 01936 Anesth Perc Img Tx Sp Proc $876 $570 $680 $287 $109 0193U Jr Gnotyp Abcg2 Exons 2-26 0194U Kel Gnotyp Kel Exon 8 01951 Anesth Burn Less 4 Percent 01952 Anesth Burn 4-9 Percent 01953 Anesth Burn Each 9 Percent 01958 Anesth Antepartum Manipul 0195U Klf1 Targeted Sequencing 01960 Anesth Vaginal Delivery 01961 Anesth Cs Delivery $1,050 $683 $815 $344 $249 01962 Anesth Emer Hysterectomy 01963 Anesth Cs Hysterectomy 01965 Anesth Inc/Missed Ab Proc $683 $444 $531 $224 $82 01966 Anesth Induced Ab Procedure 01967 Anesth/Analg Vag Delivery $4,750 $3,088 $3,688 $1,556 $337 01968 Anes/Analg Cs Deliver Add-On 01969 Anesth/Analg Cs Hyst Add-On 0196U Lu Gnotyp Bcam Exon 3 0197U Lw Gnotyp Icam4 Exon 1 0198T Ocular Blood Flow Measure 0198U Rhd&Rhce Gntyp Rhd1-10&Rhce5

01990 Support For Organ Donor $2,600 $1,690 $2,019 $852 $145 01991 Anesth Nerve Block/Inj 01992 Anesth N Block/Inj Prone $700 $455 $543 $229 $56 01996 Hosp Manage Cont Drug Admin 01999 Unlisted Anesth Procedure 0199U Sc Gnotyp Ermap Exons 4 12 0200T Perq Sacral Augmt Unilat Inj 0200U Xk Gnotyp Xk Exons 1-3 0201T Perq Sacral Augmt Bilat Inj 0201U Yt Gnotyp Ache Exon 2 0202T Post Vert Arthrplst 1 Lumbar 0202U Nfct Ds 22 Trgt Sars-Cov-2 0203U Ai Ibd Mrna Xprsn Prfl 17 0204U Onc Thyr Mrna Xprsn Alys 593 0205U Oph Amd Alys 3 Gene Variants 0206U Neuro Alzheimer Cell Aggregj 0207T Clear Eyelid Gland W/Heat 0207U Neuro Alzheimer Quan Imaging 0208T Audiometry Air Only 0208U Onc Mtc Mrna Xprsn Alys 108 0209T Audiometry Air & Bone 0209U Cytog Const Alys Interrog 0210T Speech Audiometry Threshold 0210U Syphilis Tst Antb Ia Quan 0211T Speech Audiom Thresh & Recog 0211U Onc Pan-Tum Dna&Rna Gnrj Seq 0212T Compre Audiometry Evaluation 0212U Rare Ds Gen Dna Alys Proband 0213T Njx Paravert W/Us Cer/Thor 0213U Rare Ds Gen Dna Alys Ea Comp 0214T Njx Paravert W/Us Cer/Thor 0214U Rare Ds Xom Dna Alys Proband 0215T Njx Paravert W/Us Cer/Thor 0215U Rare Ds Xom Dna Alys Ea Comp 0216T Njx Paravert W/Us Lumb/Sac 0216U Neuro Inh Ataxia Dna 12 Com 0217T Njx Paravert W/Us Lumb/Sac 0217U Neuro Inh Ataxia Dna 51 Gene 0218T Njx Paravert W/Us Lumb/Sac 0218U Neuro Musc Dys Dmd Seq Alys 0219T Plmt Post Facet Implt Cerv 0219U Nfct Agt Hiv Gnrj Seq Alys 0220T Plmt Post Facet Implt Thor 0220U Onc Brst Ca Ai Assmt 12 Feat 0221T Plmt Post Facet Implt Lumb 0221U Abo Gnotyp Next Gnrj Seq Abo 0222T Plmt Post Facet Implt Addl 0222U Rhd&Rhce Gntyp Next Gnrj Seq 0223U Nfct Ds 22 Trgt Sars-Cov-2 0224U Antibody Sars-Cov-2 Titer(S) 0225U Nfct Ds Dna&Rna 21 Sarscov2 0226U Svnt Sarscov2 Elisa Plsm Srm 0227U Rx Asy Prsmv 30+Rx/Metablt 0228T Njx Tfrml Eprl W/Us Cer/Thor 0228U Onc Prst8 Ma Molec Prfl Alg 0229T Njx Tfrml Eprl W/Us Cer/Thor 0229U Bcat1 Promoter Mthyltn Alys 0230T Njx Tfrml Eprl W/Us Lumb/Sac 0230U Ar Full Sequence Analysis 0231T Njx Tfrml Eprl W/Us Lumb/Sac 0231U Cacna1A Full Gene Analysis 0232T Njx Platelet Plasma 0232U Cstb Full Gene Analysis 0233U Fxn Gene Analysis 0234T Trluml Perip Athrc Renal Art 0234U Mecp2 Full Gene Analysis 0235T Trluml Perip Athrc Visceral 0235U Pten Full Gene Analysis 0236T Trluml Perip Athrc Abd Aorta 0236U Smn1&Smn2 Full Gene Analysis 0237T Trluml Perip Athrc Brchiocph 0237U Car Ion Chnlpthy Gen Seq Pnl 0238T Trluml Perip Athrc Iliac Art 0238U Onc Lnch Syn Gen Dna Seq Aly 0239U Trgt Gen Seq Alys Pnl 311+ 0240U Nfct Ds Vir Resp Rna 3 Trgt 0241U Nfct Ds Vir Resp Rna 4 Trgt 0253T Insert Aqueous Drain Device 0263T Im B1 Mrw Cel Ther Cmpl 0264T Im B1 Mrw Cel Ther Xcl Hrvst 0265T Im B1 Mrw Cel Ther Hrvst Onl 0266T Implt/Rpl Crtd Sns Dev Total 0267T Implt/Rpl Crtd Sns Dev Lead 0268T Implt/Rpl Crtd Sns Dev Gen 0269T Rev/Remvl Crtd Sns Dev Total 0270T Rev/Remvl Crtd Sns Dev Lead 0271T Rev/Remvl Crtd Sns Dev Gen 0272T Interrogate Crtd Sns Dev 0273T Interrogate Crtd Sns W/Pgrmg 0274T Perq Lamot/Lam Crv/Thrc 0275T Perq Lamot/Lam Lumbar 0278T Tempr 0290T Laser Inc For Pkp/Lkp Recip 0295T Ext Ecg Complete 0296T 731 Ext Ecg Recording $129 $84 $100 $42 0297T Ext Ecg Scan W/Report 0298T 731 Ext Ecg Review And Interp $129 $84 $100 $42 0308T Insj Ocular Telescope Prosth 0312T Laps Impltj Nstim Vagus 0313T Laps Rmvl Nstim Array Vagus 0314T Laps Rmvl Vgl Arry&Pls Gen 0315T Rmvl Vagus Nerve Pls Gen 0316T Replc Vagus Nerve Pls Gen 0317T Elec Alys Vagus Nrv Pls Gen 0329T Mntr Io Press 24Hrs/> Uni/Bi 0330T Tear Film Img Uni/Bi W/I&R 0331T Heart Symp Image Plnr 0332T Heart Symp Image Plnr Spect 0333T Visual Ep Scr Acuity Auto 0335T Insj Sinus Tarsi Implant 0338T Trnscth Renal Symp Denrv Unl 0339T Trnscth Renal Symp Denrv Bil 0342T Thxp Apheresis W/Hdl Delip 0345T Transcath Mtral Vlve Repair 0347T Ins Bone Device For Rsa 0348T Rsa Spine Exam 0349T Rsa Upper Extr Exam 0350T Rsa Lower Extr Exam 0351T Intraop Oct Brst/Node Spec 0352T Oct Brst/Node I&R Per Spec 0353T Intraop Oct Breast Cavity 0354T Oct Breast Surg Cavity I&R 0355T Gi Tract Capsule Endoscopy 0356T Insrt Drug Device For Iop 0358T Bia Whole Body 0362T Bhv Id Suprt Assmt Ea 15 Min 0373T Adapt Bhv Tx Ea 15 Min 0376T Insert Ant Segment Drain Int 0378T Visual Field Assmnt Rev/Rprt 0379T Vis Field Assmnt Tech Suppt 0381T Ext H Rate Epi Sz 14 Days 0382T Ext H Rate Sz 14 Day Ri Only 0383T Ext H Rate Sz Up To 30 Days 0384T Ex H Rate Sz 30 Day Ri Only 0385T Ex H Rate For Sz Ovr 30 Day 0386T Ex H Rate Sz 30+ Day Ri Only 0394T Hdr Elctrnc Skn Surf Brchytx 0395T Hdr Elctr Ntrst/Ntrcv Brchtx 0396T Intraop Kinetic Balnce Sensr 0397T Ercp W/Optical Endomicroscpy 0398T Mrgfus Strtctc Les Abltj 0400T Mltispectrl Digital Les Alys 0401T Mltispectrl Digital Les Alys 0402T Colgn Cross-Link Crn Med Sep 0403T Diabetes Prev Standard Curr 0404T Trnscrv Uterin Fibroid Abltj 0405T Ovrsght Xtrcorp Liv Asst Pat 0408T Insj/Rplc Cardiac Modulj Sys 0409T Insj/Rplc Car Modulj Pls Gn 0410T Insj/Rplc Car Modulj Atr Elt 0411T Insj/Rplc Car Modulj Vnt Elt 0412T Rmvl Cardiac Modulj Pls Gen 0413T Rmvl Car Modulj Tranvns Elt 0414T Rmvl & Rpl Car Modulj Pls Gn 0415T Repos Car Modulj Tranvns Elt 0416T Reloc Skin Pocket Pls Gen 0417T Prgrmg Eval Cardiac Modulj 0418T Interro Eval Cardiac Modulj 0419T Dstrj Neurofibroma Xtnsv 0420T Dstrj Neurofibroma Xtnsv 0421T Waterjet Prostate Abltj Cmpl 0422T Tactile Breast Img Uni/Bi 0423T Assay Secretory Type Ii Pla2 0424T Insj/Rplc Nstim Apnea Compl 0425T Insj/Rplc Nstim Apnea Sen Ld 0426T Insj/Rplc Nstim Apnea Stm Ld 0427T Insj/Rplc Nstim Apnea Pls Gn 0428T Rmvl Nstim Apnea Pls Gen 0429T Rmvl Nstim Apnea Sen Ld 0430T Rmvl Nstim Apnea Stimj Ld 0431T Rmvl/Rplc Nstim Apnea Pls Gn 0432T Repos Nstim Apnea Stimj Ld 0433T Repos Nstim Apnea Sensing Ld 0434T Interro Eval Npgs Apnea 0435T Prgrmg Eval Npgs Apnea 1 Ses 0436T Prgrmg Eval Npgs Apnea Study 0437T Impltj Synth Rnfcmt Abdl Wal 0439T Myocrd Contrast Prfuj Echo 0440T Abltj Perc Uxtr/Perph Nrv 0441T Abltj Perc Lxtr/Perph Nrv 0442T Abltj Perc Plex/Trncl Nrv 0443T R-T Spctrl Alys Prst8 Tiss 0444T 1St Plmt Drug Elut Oc Ins 0445T Sbsqt Plmt Drug Elut Oc Ins 0446T Insj Impltbl Glucose Sensor 0447T Rmvl Impltbl Glucose Sensor 0448T Remvl Insj Impltbl Gluc Sens 0449T Insj Aqueous Drain Dev 1St 0450T Insj Aqueous Drain Dev Each 0451T Insj/Rplcmt Aortic Ventr Sys 0452T Insj/Rplcmt Dev Vasc Seal 0453T Insj/Rplcmt Mech-Elec Ntrfce 0454T Insj/Rplcmt Subq Electrode 0455T Remvl Aortic Ventr Cmpl Sys 0456T Remvl Aortic Dev Vasc Seal 0457T Remvl Mech-Elec Skin Ntrfce 0458T Remvl Subq Electrode 0459T Relocaj Rplcmt Aortic Ventr 0460T Repos Aortic Ventr Dev Eltrd 0461T Repos Aortic Contrpulsj Dev 0462T Prgrmg Eval Aortic Ventr Sys 0463T Interrog Aortic Ventr Sys 0464T Visual Ep Test For Glaucoma 0465T Supchrdl Njx Rx W/O Supply 0466T Insj Ch Wal Respir Eltrd/Ra 0467T Revj/Rplmnt Ch Respir Eltrd 0468T Rmvl Ch Wal Respir Eltrd/Ra 0469T Rta Polarize Scan Oc Scr Bi 0470T Oct Skn Img Acquisj I&R 1St 0470T Oct Skn Img Acquisj I&R 1St 0470T Oct Skn Img Acquisj I&R 1St 0471T Oct Skn Img Acquisj I&R Addl 0471T Oct Skn Img Acquisj I&R Addl 0471T Oct Skn Img Acquisj I&R Addl 0472T Prgrmg Io Rta Eltrd Ra 0473T Reprgrmg Io Rta Eltrd Ra 0474T Insj Aqueous Drg Dev Io Rsvr 0475T Rec Ftl Car Sgl 3 Ch I&R 0476T Rec Ftl Car Sgl Elec Tr Data 0477T Rec Ftl Car Sgl Xrtj Alys 0478T Rec Ftl Car 3 Ch Rev I&R 0479T Fxjl Abl Lsr 1St 100 Sq Cm 0480T Fxjl Abl Lsr Ea Addl 100Sqcm 0481T Njx Autol Wbc Concentrate 0483T Tmvi Percutaneous Approach 0484T Tmvi Transthoracic Exposure 0485T Oct Mid Ear I&R Unilateral 0485T Oct Mid Ear I&R Unilateral 0485T Oct Mid Ear I&R Unilateral 0486T Oct Mid Ear I&R Bilateral 0486T Oct Mid Ear I&R Bilateral 0486T Oct Mid Ear I&R Bilateral 0487T Trvg Biomchn Mapg W/Reprt 0488T Diabetes Prev Online/Elec 0489T Regn Cell Tx Scldr Hands 0490T Regn Cell Tx Scldr H Mlt Inj 0491T Abl Lsr Opn Wnd 1St 20 Sqcm 0492T Abl Lsr Opn Wnd Addl 20 Sqcm 0493T Near Ifr Spectrsc Of Wounds 0494T Prep & Cannulj Cdvr Don Lung 0495T Mntr Cdvr Don Lng 1St 2 Hrs 0496T Mntr Cdvr Don Lng Ea Addl Hr 0497T Xtrnl Pt Act Ecg In-Off Conn 0498T Xtrnl Pt Act Ecg R&I Pr 30 D 0499T Cysto F/Urtl Strix/Stenosis 0500F 510 Initial Prenatal Care Visit $0 $0 $14 0500T Hpv 5+ Hi Risk Hpv Types 0501F Prenatal Flow Sheet 0501T Cor Ffr Derived Cor Cta Data 0502F 510 Subsequent Prenatal Care $0 $0 $17 0502T Cor Ffr Data Prep & Transmis 0503F 510 Postpartum Care Visit $0 $0 $10 0503T Cor Ffr Alys Gnrj Ffr Mdl 0504T Cor Ffr Data Review I&R 0505F Hemodialysis Plan Docd 0505T Ev Fempop Artl Revsc 0506T Mac Pgmt Opt Dns Meas Hfp 0506T Mac Pgmt Opt Dns Meas Hfp 0506T Mac Pgmt Opt Dns Meas Hfp 0507F Periton Dialysis Plan Docd 0507T Near Ifr 2Img Mibmn Glnd I&R 0507T Near Ifr 2Img Mibmn Glnd I&R 0507T Near Ifr 2Img Mibmn Glnd I&R 0508T Pls Echo Us B1 Dns Meas Tib 0508T Pls Echo Us B1 Dns Meas Tib 0508T Pls Echo Us B1 Dns Meas Tib 0509F Urine Incon Plan Docd 0509T Pattern Erg W/I&R 0509T Pattern Erg W/I&R 0509T Pattern Erg W/I&R 0510T Rmvl Sinus Tarsi Implant 0511T Rmvl&Rinsj Sinus Tarsi Implt 0512T Esw Integ Wnd Hlg 1St Wnd 0513F Elev Bp Plan Of Care Docd 0513T Esw Integ Wnd Hlg Ea Addl 0514F Care Plan Hgb Docd Esa Pt 0514T Intraop Vis Axis Id Pt Fixj 0515T Insj Wcs Lv Compl Sys 0516F Anemia Plan Of Care Docd 0516T Insj Wcs Lv Eltrd Only 0517F Glaucoma Plan Of Care Docd 0517T Insj Wcs Lv Pg Compnt 0518F Fall Plan Of Care Docd $0 $0 $0 $0 0518T Rmvl Pg Compnt Wcs 0519F Pland Chemo Docd B/4 Txmnt 0519T Rmvl & Rplcmt Pg Compnt Wcs 0520F Rad Dos Limts B/4 3D Rad 0520T Rmvl&Rplcmt Pg Wcs New Eltrd 0521F Plan Of Care 4 Pain Docd 0521T Interrog Dev Eval Wcs Ip 0521T Interrog Dev Eval Wcs Ip 0521T Interrog Dev Eval Wcs Ip 0522T Prgrmg Dev Eval Wcs Ip 0522T Prgrmg Dev Eval Wcs Ip 0522T Prgrmg Dev Eval Wcs Ip 0523T Ntrapx C Ffr W/3D Funcjl Map 0524T Ev Cath Dir Chem Abltj W/Img 0525F Initial Visit For Episode 0525T Insj/Rplcmt Compl Iims 0526F Subs Visit For Episode 0526T Insj/Rplcmt Iims Eltrd Only 0527T Insj/Rplcmt Iims Implt Mntr 0528F Rcmnd Flw-Up 10 Yrs Docd 0528T Prgrmg Dev Eval Iims Ip 0528T Prgrmg Dev Eval Iims Ip 0528T Prgrmg Dev Eval Iims Ip 0529F Intrvl 3/>Yr Pts Clnscp Docd 0529T Interrog Dev Eval Iims Ip 0529T Interrog Dev Eval Iims Ip 0529T Interrog Dev Eval Iims Ip 0530T Removal Complete Iims 0531T Removal Iims Electrode Only 0532T Removal Iims Implt Mntr Only 0533T Cont Rec Mvmt Do 6-10 Days 0533T Cont Rec Mvmt Do 6-10 Days 0533T Cont Rec Mvmt Do 6-10 Days 0534T Cont Rec Mvmt Do Setup&Train 0534T Cont Rec Mvmt Do Setup&Train 0534T Cont Rec Mvmt Do Setup&Train 0535F Dyspnea Mngmnt Plan Docd 0535T Cont Rec Mvmt Do Reprt Cnfig 0535T Cont Rec Mvmt Do Reprt Cnfig 0535T Cont Rec Mvmt Do Reprt Cnfig 0536T Cont Rec Mvmt Do Dl W/I&R 0536T Cont Rec Mvmt Do Dl W/I&R 0536T Cont Rec Mvmt Do Dl W/I&R 0537T Bld Drv T Lymphcyt Car-T Cll 0538T Bld Drv T Lymphcyt Prep Trns 0539T Receipt&Prep Car-T Cll Admn 0540F Gluco Mngmnt Plan Docd 0540T Car-T Cll Admn Autologous 0541T Myocardial Imaging Mcg 0542T Myocardial Imaging Mcg I&R 0543T Ta Mv Rpr W/Artif Chord Tend 0544T Tcat Mv Annulus Rcnstj 0545F Follow Up Care Plan Mdd Docd 0545T Tcat Tv Annulus Rcnstj 0546T Rf Spectrsc Ntraop Mrgn Asmt 0547T B1 Matrl Qual Tst Mcrind Tib 0548T Tprnl Balo Cntnc Dev Bi 0549T Tprnl Balo Cntnc Dev Uni 0550F Cytopath Report Nongyn Spcmn 0550T Tprnl Balo Cntnc Dev Rmvl Ea 0551F Cytopath Report Non Routine 0551T Tprnl Balo Cntnc Dev Adjmt 0552T Low-Level Laser Therapy 0553T Perq Tcat Iliac Anast Implt 0554T B1 Str & Fx Rsk Analysis 0555F Symptom Mgmnt Plan Care Docd 0555T B1 Str&Fx Rsk Transmis Data 0556F Plan Care Lipid Control Docd 0556T B1 Str & Fx Rsk Assessment 0557F Plan Caremng Angnl Symptdocd 0557T B1 Str & Fx Rsk I&R 0558T Ct Scan F/Biomchn Ct Alys 0559T Antmc Mdl 3D Print 1St Cmpnt 0560T Antmc Mdl 3D Print Ea Addl 0561T Antmc Guide 3D Print 1St Gd 0562T Antmc Guide 3D Print Ea Addl 0563T Evac Meibomian Glnd Heat Bi 0564T Onc Chemo Rx Cytotox Csc 14 0565T Autol Cell Implt Adps Hrvg 0566T Autol Cell Implt Adps Njx 0567T Perm Flp Tube Occls W/Implt 0568T Intro Mix Saline&Air F/Ssg 0569T Ttvr Perq Appr 1St Prosth 0570T Ttvr Perq Ea Addl Prosth 0571T Insj/Rplcmt Icds Ss Eltrd 0572T Insertion Ss Dfb Electrode 0573T Removal Ss Dfb Electrode 0574T Repos Prev Ss Impl Dfb Eltrd 0575F Hiv Rna Plan Care Docd 0575T Prgrmg Dev Eval Icds Ss Ip 0576T Interrog Dev Eval Icds Ss Ip 0577T Ephys Eval Icds Ss 0578T Rem Interrog Dev Icds Phys 0579T Rem Interrog Dev Icds Tech 0580F Multidisciplinary Care Plan 0580T Rmvl Ss Impl Dfb Pg Only 0581F Pt Trnsfrd From Anesth To Cc 0581T Abltj Mal Brst Tum Perq Crtx 0582F No Trnsfr From Anesth To Cc 0582T Trurl Abltj Mal Prst8 Tiss 0583F Transfer Care Checklist Used 0583T Tmpst Auto Tube Dlvr Sys 0584F No Transfercare Chklist Used 0584T Perq Islet Cell Transplant 0585T Laps Islet Cell Transplant 0586T Open Islet Cell Transplant 0587T Perq Impltj/Rplcmt Isdns Ptn 0588T Revision/Removal Isdns Ptn 0589T Elec Alys Smpl Prgrmg Iins 0590T Elec Alys Cplx Prgrmg Iins 0591T Hlth&Wb Coaching Indiv 1St 0592T Hlth&Wb Coaching Indiv F-Up 0593T Hlth&Wb Coaching Group 0594T Osteot Hum Xtrnl Lngth Dev 0596T Temp Fml Iu Vlv-Pmp 1St Insj 0597T Temp Fml Iu Valve-Pmp Rplcmt 0598T Ncntc R-T Fluor Wnd Img 1St 0599T Ncntc R-T Fluor Wnd Img Ea 0600T Ire Abltj 1+Tum Organ Perq 0601T Ire Abltj 1+Tumors Open 0602T Transdermal Gfr Measurements 0603T Transdermal Gfr Monitoring 0604T Rem Oct Rta Dev Setup&Educaj 0605T Rem Oct Rta Techl Sprt Min 8 0606T Rem Oct Rta Phys/Qhp Ea 30D 0607T Rem Mntr Pulm Flu Mntr Setup 0608T Rem Mntr Pulm Flu Mntr Alys 0609T Mrs Disc Pain Acquisj Data 0610T Mrs Disc Pain Transmis Data 0611T Mrs Disc Pain Alg Alys Data 0612T Mrs Discogenic Pain I&R 0613T Perq Tcat Intratrl Septl Sht 0614T Rmvl&Rplcmt Ss Impl Dfb Pg 0615T Eye Mvmt Alys W/O Calbrj I&R 0616T Insertion Of Iris Prosthesis 0617T Insj Iris Prosth W/Rmvl&Insj 0618T Insj Iris Prosth Sec Io Lens 0619T Cysto W/Prst8 Commissurotomy 0620T Evasc Ven Artlz Tibl/Prnl Vn 0621T Trabeculostomy Interno Laser 0622T Trabeculostomy Int Lsr W/Scp 0623T Auto Quantification C Plaque 0624T Auto Quan C Plaq Data Prep 0625T Auto Quan C Plaq Cptr Alys 0626T Auto Quan C Plaq I&R 0627T Perq Njx Algc Fluor Lmbr 1St 0628T Perq Njx Algc Fluor Lmbr Ea 0629T Perq Njx Algc Ct Lmbr 1St 0630T Perq Njx Algc Ct Lmbr Ea 0631T Tc Vis Lit Hyperspectral Img 0632T Perq Tcat Us Abltj Nrv P-Art 0633T Ct Breast W/3D Uni C- 0633T Ct Breast W/3D Uni C- 0633T Ct Breast W/3D Uni C- 0634T Ct Breast W/3D Uni C+ 0634T Ct Breast W/3D Uni C+ 0634T Ct Breast W/3D Uni C+ 0635T Ct Breast W/3D Uni C-/C+ 0635T Ct Breast W/3D Uni C-/C+ 0635T Ct Breast W/3D Uni C-/C+ 0636T Ct Breast W/3D Bi C- 0636T Ct Breast W/3D Bi C- 0636T Ct Breast W/3D Bi C- 0637T Ct Breast W/3D Bi C+ 0637T Ct Breast W/3D Bi C+ 0637T Ct Breast W/3D Bi C+ 0638T Ct Breast W/3D Bi C-/C+ 0638T Ct Breast W/3D Bi C-/C+ 0638T Ct Breast W/3D Bi C-/C+ 0639T Wrls Skn Snr Anisotropy Meas 10004 510 Fna Bx W/O Img Gdn Ea Addl $30 $19 $23 $10 10005 450 Fna Bx W/Us Gdn 1St Les $148 $96 $115 $49 10006 510 Fna Bx W/Us Gdn Ea Addl $36 $23 $28 $12 10007 Fna Bx W/Fluor Gdn 1St Les 10008 Fna Bx W/Fluor Gdn Ea Addl 10009 Fna Bx W/Ct Gdn 1St Les 1000F Tobacco Use Assessed 10010 Fna Bx W/Ct Gdn Ea Addl 10011 Fna Bx W/Mr Gdn 1St Les 10012 Fna Bx W/Mr Gdn Ea Addl 10021 510 Fna Bx W/O Img Gdn 1St Les $424 $276 $329 $139 1002F Assess Anginal Symptom/Level 10030 450 Guide Cathet Fluid Drainage $582 $378 $452 $191 10035 Perq Dev Soft Tiss 1St Imag $202 $131 $157 $66 10036 Perq Dev Soft Tiss Add Imag $101 $66 $78 $33 1003F Level Of Activity Assess 10040 510 Acne Surgery $344 $224 $267 $113 1004F Clin Symp Vol Ovrld Assess 1005F Asthma Symptoms Evaluate 10060 983 Drainage Of Skin Abscess $716 $465 $556 $234 10061 983 Drainage Of Skin Abscess $1,266 $823 $983 $414 1006F Osteoarthritis Assess 1007F Anti-Inflm/Anlgsc Otc Assess 10080 983 Drainage Of Pilonidal Cyst $461 $300 $358 $151 10081 983 Drainage Of Pilonidal Cyst $727 $473 $564 $238 1008F Gi/Renal Risk Assess 1010F Severity Angina By Actvty 1011F Angina Present 10120 983 Remove Foreign Body $519 $337 $403 $170 10121 983 Remove Foreign Body $932 $606 $724 $305 $220 1012F Angina Absent 10140 983 Drainage Of Hematoma/Fluid $444 $289 $345 $145 1015F Copd Symptoms Assess 10160 983 Puncture Drainage Of Lesion $357 $232 $277 $117 10180 510 Complex Drainage Wound $289 $188 $225 $95 1018F Assess Dyspnea Not Present 1019F Assess Dyspnea Present 1022F Pneumo Imm Status Assess 1026F Co-Morbid Condition Assess 1030F Influenza Imm Status Assess 1031F Smoking & 2Nd Hand Assessed 1032F Smoker/Exposed 2Nd Hnd Smoke

1033F Tobacco Nonsmoker Nor 2Ndhnd 1034F Current Tobacco Smoker 1035F Smokeless Tobacco User 1036F Tobacco Non-User $0 $0 $0 $0 1038F Persistent Asthma 1039F Intermittent Asthma 1040F Dsm-5 Info Mdd Docd 1050F History Of Mole Changes 1052F Type Location Activityassess 1055F Visual Funct Status Assess 1060F Doc Perm/Cont/Parox Atr Fib 1061F Doc Lack Perm+Cont+Parox Fib 1065F Ischm Stroke Symp Lt3 Hrsb/4 1066F Ischm Stroke Symp Ge3 Hrsb/4 1070F Alarm Symp Assessed-Absent 1071F Alarm Symp Assessed-1+ Prsnt 1090F Pres/Absn Urine Incon Assess 1091F Urine Incon Characterized 11000 510 Debride Infected Skin $398 $259 $309 $130 11001 Debride Infected Skin Add-On 11004 Debride Genitalia & Perineum 11005 Debride Abdom Wall 11006 Debride Genit/Per/Abdom Wall 11008 Remove Mesh From Abd Wall 1100F Ptfalls Assess-Docd Ge2>/Yr 11010 510 Debride Skin At Fx Site $2,016 $1,310 $1,565 $660 11011 Debride Skin Musc At Fx Site 11012 510 Deb Skin Bone At Fx Site $1,976 $1,284 $1,534 $647 1101F Pt Falls Assess-Docd Le1/Yr 11042 983 Deb Subq Tissue 20 Sq Cm/< $1,182 $768 $918 $387 $307 11043 510 Deb Musc/Fascia 20 Sq Cm/< $2,031 $1,320 $1,577 $665 $203 11044 510 Deb Bone 20 Sq Cm/< $1,207 $785 $937 $395 11045 510 Deb Subq Tissue Add-On $101 $66 $78 $33 11046 510 Deb Musc/Fascia Add-On $964 $627 $748 $316 11047 510 Deb Bone Add-On $450 $293 $349 $148 11055 510 Trim Skin Lesion $174 $113 $135 $57 11056 510 Trim Skin Lesions 2 To 4 $191 $124 $148 $63 11057 510 Trim Skin Lesions Over 4 $299 $194 $232 $98 11102 510 Tangntl Bx Skin Single Les $156 $101 $121 $51 11103 510 Tangntl Bx Skin Ea Sep/Addl $80 $52 $62 $26 11104 983 Punch Bx Skin Single Lesion $426 $277 $331 $140 11105 510 Punch Bx Skin Ea Sep/Addl $91 $59 $70 $30 11106 510 Incal Bx Skn Single Les $237 $154 $184 $78 11107 510 Incal Bx Skn Ea Sep/Addl $106 $69 $82 $35 1110F Pt Lft Inpt Fac W/In 60 Days 1111F Dschrg Med/Current Med Merge $0 $0 $0 $0 1116F Auric/Peri Pain Assessed 1118F Gerd Symps Assessed 12 Month 1119F Init Eval For Condition 11200 510 Removal Of Skin Tags 2.0 Cm $346 $225 $269 $113 11305 510 Shave Skin Lesion 0.5 Cm/< $187 $122 $145 $61 11306 510 Shave Skin Lesion 0.6-1.0 Cm $280 $182 $217 $92 11307 510 Shave Skin Lesion 1.1-2.0 Cm $319 $207 $248 $105 11308 510 Shave Skin Lesion >2.0 Cm $393 $255 $305 $129 1130F Bk Pain & Fxn Assessed 11310 510 Shave Skin Lesion 0.5 Cm/< $89 $58 $69 $29 11311 510 Shave Skin Lesion 0.6-1.0 Cm $468 $304 $363 $153 11312 510 Shave Skin Lesion 1.1-2.0 Cm $272 $176 $211 $89 11313 510 Shave Skin Lesion >2.0 Cm $561 $365 $436 $184 1134F Epsd Bk Pain For 6 Wks/< 1135F Epsd Bk Pain For >6 Wks 1136F Epsd Bk Pain For 12 Wks/< 1137F Epsd Bk Pain For >12 Wks 11400 983 Exc Tr-Ext B9+Marg 0.5 Cm< $524 $341 $407 $172 11401 510 Exc Tr-Ext B9+Marg 0.6-1 Cm $671 $436 $521 $220 11402 510 Exc Tr-Ext B9+Marg 1.1-2 Cm $916 $595 $711 $300 11403 510 Exc Tr-Ext B9+Marg 2.1-3Cm $1,162 $755 $902 $381 11404 510 Exc Tr-Ext B9+Marg 3.1-4 Cm $1,520 $988 $1,180 $497 11406 510 Exc Tr-Ext B9+Marg >4.0 Cm $2,031 $1,320 $1,577 $664 11420 510 Exc H-F-Nk-Sp B9+Marg 0.5/< $605 $393 $470 $198 11421 510 Exc H-F-Nk-Sp B9+Marg 0.6-1 $782 $508 $607 $256 11422 510 Exc H-F-Nk-Sp B9+Marg 1.1-2 $1,026 $667 $797 $336 11423 510 Exc H-F-Nk-Sp B9+Marg 2.1-3 $1,420 $923 $1,102 $465 11424 510 Exc H-F-Nk-Sp B9+Marg 3.1-4 $1,686 $1,096 $1,309 $552 11426 510 Exc H-F-Nk-Sp B9+Marg >4 Cm $2,203 $1,432 $1,710 $721 11440 510 Exc Face-Mm B9+Marg 0.5 Cm/< $357 $232 $277 $117 11441 510 Exc Face-Mm B9+Marg 0.6-1 Cm $1,246 $810 $967 $408 $363 11442 510 Exc Face-Mm B9+Marg 1.1-2 Cm $667 $434 $518 $218 11443 510 Exc Face-Mm B9+Marg 2.1-3 Cm $764 $497 $593 $250 11444 510 Exc Face-Mm B9+Marg 3.1-4 Cm $277 $180 $215 $91 11446 510 Exc Face-Mm B9+Marg >4 Cm $1,278 $831 $992 $418 11450 510 Removal Sweat Gland Lesion $489 $318 $379 $160 11451 Removal Sweat Gland Lesion 11462 Removal Sweat Gland Lesion 11463 Removal Sweat Gland Lesion 11470 Removal Sweat Gland Lesion 11471 Removal Sweat Gland Lesion 1150F Doc Pt Rsk Death W/In 1Yr 1151F Doc No Pt Rsk Death W/In 1Yr 1152F Doc Advncd Dis Comfort 1St 1153F Doc Advncd Dis Cmfrt Not 1St 1157F Advnc Care Plan In Rcrd $0 $0 $0 $0 1158F Advnc Care Plan Tlk Docd 1159F Med List Docd In Rcrd $0 $0 $0 $0 11600 510 Exc Tr-Ext Mal+Marg 0.5 Cm/< $869 $565 $675 $284 11601 510 Exc Tr-Ext Mal+Marg 0.6-1 Cm $981 $638 $762 $321 11602 510 Exc Tr-Ext Mal+Marg 1.1-2 Cm $1,051 $683 $816 $344 $215 11603 510 Exc Tr-Ext Mal+Marg 2.1-3 Cm $1,155 $751 $897 $378 11604 510 Exc Tr-Ext Mal+Marg 3.1-4 Cm $1,268 $824 $984 $415 11606 510 Exc Tr-Ext Mal+Marg >4 Cm $1,653 $1,074 $1,283 $542 1160F Rvw Meds By Rx/Dr In Rcrd $0 $0 $0 $0 11620 983 Exc H-F-Nk-Sp Mal+Marg 0.5/< $831 $540 $645 $272 11621 510 Exc S/N/H/F/G Mal+Mrg 0.6-1 $975 $634 $757 $319 11622 510 Exc S/N/H/F/G Mal+Mrg 1.1-2 $1,111 $722 $863 $363 11623 510 Exc S/N/H/F/G Mal+Mrg 2.1-3 $1,310 $852 $1,017 $429 11624 510 Exc S/N/H/F/G Mal+Mrg 3.1-4 $1,505 $978 $1,168 $492 11626 510 Exc S/N/H/F/G Mal+Mrg >4 Cm $1,972 $1,282 $1,531 $645 11640 510 Exc F/E/E/N/L Mal+Mrg 0.5Cm< $682 $443 $529 $223 11641 510 Exc F/E/E/N/L Mal+Mrg 0.6-1 $600 $390 $466 $196 11642 510 Exc F/E/E/N/L Mal+Mrg 1.1-2 $957 $622 $743 $314 11643 510 Exc F/E/E/N/L Mal+Mrg 2.1-3 $1,090 $709 $846 $357 11644 510 Exc F/E/E/N/L Mal+Mrg 3.1-4 $1,365 $887 $1,060 $447 11646 510 Exc F/E/E/N/L Mal+Mrg >4 Cm $626 $407 $486 $205 1170F Fxnl Status Assessed $0 $0 $0 $0 11719 510 Trim Nail(S) Any Number $92 $60 $71 $30 11720 510 Debride Nail 1-5 $143 $93 $111 $47 11721 510 Debride Nail 6 Or More $217 $141 $168 $71 11730 983 Removal Of Nail Plate $474 $308 $368 $155 $141 11732 510 Remove Nail Plate Add-On $224 $146 $174 $73 11740 983 Drain Blood From Under Nail $115 $75 $89 $38 11750 510 Removal Of Nail Bed $877 $570 $681 $287 $277 11755 510 Biopsy Nail Unit $285 $185 $221 $93 1175F Function Stat Assessed Rvwd 11760 983 Repair Of Nail Bed $762 $495 $592 $249 11762 Reconstruction Of Nail Bed 11765 510 Excision Of Nail Fold Toe $246 $160 $191 $80 11770 983 Remove Pilonidal Cyst Simple $954 $620 $741 $313 $286 11771 510 Remove Pilonidal Cyst Exten $2,740 $1,781 $2,127 $896 11772 510 Remove Pilonidal Cyst Compl $3,628 $2,358 $2,817 $1,187 $684 1180F Thromboemb Risk Assessed 1181F Neuropsychia Sympts Assessed 1182F Neuropsychi Sympt 1+Present 1183F Neuropsychiatric Symp Absent 11900 510 Inject Skin Lesions 7 $98 $64 $76 $32 11920 510 Correct Skin Color 6.0 Cm/< $249 $162 $193 $82 11921 510 Correct Skn Color 6.1-20.0Cm $285 $185 $221 $93 11922 510 Correct Skin Color Ea 20.0Cm $106 $69 $82 $35 11950 Tx Contour Defects 1 Cc/< 11951 Tx Contour Defects 1.1-5.0Cc 11952 Tx Contour Defects 5.1-10Cc 11954 510 Tx Contour Defects >10.0 Cc $184 $119 $143 $60 11960 Insert Tissue Expander(S) 11970 Rplcmt Tiss Xpndr Perm Implt $1,879 $1,222 $1,459 $616 11971 Rmvl Tis Xpndr Wo Insj Implt 11976 510 Remove Contraceptive Capsule $462 $300 $359 $151 11980 510 Implant Hormone Pellet(S) $152 $99 $118 $50 11981 510 Insert Drug Implant Device $294 $191 $228 $96 11982 510 Remove Drug Implant Device $349 $227 $271 $114 11983 510 Remove/Insert Drug Implant $606 $394 $470 $198 12001 983 Rpr S/N/Ax/Gen/Trnk 2.5Cm/< $509 $331 $395 $167 12002 983 Rpr S/N/Ax/Gen/Trnk2.6-7.5Cm $743 $483 $577 $243 12004 983 Rpr S/N/Ax/Gen/Trk7.6-12.5Cm $1,023 $665 $794 $335 12005 983 Rpr S/N/A/Gen/Trk12.6-20.0Cm $1,266 $823 $983 $414 12006 510 Rpr S/N/A/Gen/Trk20.1-30.0Cm $1,520 $988 $1,180 $497 12007 510 Rpr S/N/Ax/Gen/Trnk >30.0 Cm $2,067 $1,344 $1,605 $676 1200F Seizure Type& Frequ Docd 12011 983 Rpr F/E/E/N/L/M 2.5 Cm/< $676 $439 $525 $221 12013 983 Rpr F/E/E/N/L/M 2.6-5.0 Cm $932 $606 $724 $305 12014 983 Rpr F/E/E/N/L/M 5.1-7.5 Cm $1,152 $749 $894 $377 12015 983 Rpr F/E/E/N/L/M 7.6-12.5 Cm $1,584 $1,030 $1,230 $518 $453 12016 983 Rpr Fe/E/En/L/M 12.6-20.0 Cm $1,653 $1,074 $1,283 $541 12017 510 Rpr Fe/E/En/L/M 20.1-30.0 Cm $1,686 $1,096 $1,309 $552 12018 510 Rpr F/E/E/N/L/M >30.0 Cm $1,936 $1,258 $1,503 $633 12020 983 Closure Of Split Wound $700 $455 $543 $229 12021 450 Closure Of Split Wound $549 $357 $426 $180 12031 983 Intmd Rpr S/A/T/Ext 2.5 Cm/< $763 $496 $592 $250 12032 983 Intmd Rpr S/A/T/Ext 2.6-7.5 $997 $648 $774 $326 12034 983 Intmd Rpr S/Tr/Ext 7.6-12.5 $1,616 $1,050 $1,255 $529 12035 983 Intmd Rpr S/A/T/Ext 12.6-20 $1,692 $1,100 $1,314 $554 12036 510 Intmd Rpr S/A/T/Ext 20.1-30 $2,089 $1,358 $1,622 $683 12037 510 Intmd Rpr S/Tr/Ext >30.0 Cm $2,466 $1,603 $1,914 $807 12041 983 Intmd Rpr N-Hf/Genit 2.5Cm/< $1,059 $688 $822 $346 12042 983 Intmd Rpr N-Hf/Genit2.6-7.5 $1,155 $751 $897 $378 12044 510 Intmd Rpr N-Hf/Genit7.6-12.5 $1,387 $902 $1,077 $454 12045 510 Intmd Rpr N-Hf/Genit12.6-20 $1,616 $1,050 $1,255 $529 12046 510 Intmd Rpr N-Hf/Genit20.1-30 $2,388 $1,552 $1,854 $781 12047 510 Intmd Rpr N-Hf/Genit >30.0Cm $2,440 $1,586 $1,894 $798 12051 983 Intmd Rpr Face/Mm 2.5 Cm/< $613 $398 $476 $201 12052 983 Intmd Rpr Face/Mm 2.6-5.0 Cm $676 $439 $525 $221 12053 510 Intmd Rpr Face/Mm 5.1-7.5 Cm $721 $469 $560 $236 12054 510 Intmd Rpr Face/Mm 7.6-12.5Cm $877 $570 $681 $287 12055 450 Intmd Rpr Face/Mm 12.6-20 Cm $858 $558 $666 $281 12056 Intmd Rpr Face/Mm 20.1-30.0 12057 Intmd Rpr Face/Mm >30.0 Cm 1205F Epi Etiol Synd Rvwd And Docd 1220F Pt Screened For Depression 13100 510 Cmplx Rpr Trunk 1.1-2.5 Cm $906 $589 $703 $296 13101 510 Cmplx Rpr Trunk 2.6-7.5 Cm $1,089 $708 $845 $356 $157 13102 983 Cmplx Rpr Trunk Addl 5Cm/< $352 $229 $273 $116 13120 983 Cmplx Rpr S/A/L 1.1-2.5 Cm $1,543 $1,003 $1,198 $505 13121 510 Cmplx Rpr S/A/L 2.6-7.5 Cm $1,168 $759 $907 $382 13122 510 Cmplx Rpr S/A/L Addl 5 Cm/> $352 $229 $273 $115 13131 983 Cmplx Rpr F/C/C/M/N/Ax/G/H/F $1,067 $694 $828 $349 13132 983 Cmplx Rpr F/C/C/M/N/Ax/G/H/F $1,653 $1,074 $1,283 $541 13133 510 Cmplx Rpr F/C/C/M/N/Ax/G/H/F $802 $521 $623 $263 13151 510 Cmplx Rpr E/N/E/L 1.1-2.5 Cm $2,220 $1,443 $1,723 $726 $371 13152 450 Cmplx Rpr E/N/E/L 2.6-7.5 Cm $2,889 $1,878 $2,243 $945 13153 450 Cmplx Rpr E/N/E/L Addl 5Cm/< $536 $348 $416 $176 13160 510 Late Closure Of Wound $3,062 $1,990 $2,377 $1,002 $0 14000 510 Tis Trnfr Trunk 10 Sq Cm/< $2,218 $1,442 $1,722 $726 14001 510 Tis Trnfr Trunk 10.1-30Sqcm $2,841 $1,847 $2,206 $929 1400F Prkns Diag Rviewed 14020 510 Tis Trnfr S/A/L 10 Sq Cm/< $2,482 $1,613 $1,927 $812 14021 510 Tis Trnfr S/A/L 10.1-30 Sqcm $3,093 $2,010 $2,401 $1,012 14040 983 Tis Trnfr F/C/C/M/N/A/G/H/F $2,598 $1,689 $2,017 $851 14041 510 Tis Trnfr F/C/C/M/N/A/G/H/F $3,270 $2,126 $2,539 $1,070 14060 510 Tis Trnfr E/N/E/L 10 Sq Cm/< $2,533 $1,646 $1,966 $829 14061 510 Tis Trnfr E/N/E/L10.1-30Sqcm $1,114 $724 $865 $365 14301 510 Tis Trnfr Any 30.1-60 Sq Cm $3,413 $2,218 $2,650 $1,117 14302 510 Tis Trnfr Addl 30 Sq Cm $864 $562 $671 $283 14350 Filleted Finger/Toe Flap 1450F Symptoms Improved/Consist 1451F Sympt Show Clin Import Drop 1460F Qual Card Diag Prior 12 Mons 1461F No Qual Card Diag Prior12Mon 1490F Dem Severity Classified Mild 1491F Dem Severity Classified Mod 1493F Dem Severity Class Severe 1494F Cognit Assessed And Reviewed 15002 510 Wound Prep Trk/Arm/Leg $1,193 $775 $926 $390 15003 510 Wound Prep Addl 100 Cm $262 $170 $203 $86 15004 510 Wound Prep F/N/Hf/G $1,376 $894 $1,068 $450 15005 510 Wnd Prep F/N/Hf/G Addl Cm $431 $280 $335 $141 1500F Symptom+Sign Symm Polyneuro 1501F Not Initial Eval For Cond 1502F Pt Queried Pain Fxn W/ Instr 1503F Pt Queried Symp Resp Insuff 15040 Harvest Cultured Skin Graft 1504F Pt Has Resp Insufficiency 15050 Skin Pinch Graft 1505F Pt Has No Resp Insufficiency 15100 510 Skin Splt Grft Trnk/Arm/Leg $2,904 $1,888 $2,255 $950 $0 15101 Skin Splt Grft T/A/L Add-On 15110 Epidrm Autogrft Trnk/Arm/Leg 15111 Epidrm Autogrft T/A/L Add-On 15115 Epidrm A-Grft Face/Nck/Hf/G 15116 Epidrm A-Grft F/N/Hf/G Addl 15120 Skn Splt A-Grft Fac/Nck/Hf/G 15121 Skn Splt A-Grft F/N/Hf/G Add 15130 Derm Autograft Trnk/Arm/Leg 15131 Derm Autograft T/A/L Add-On 15135 Derm Autograft Face/Nck/Hf/G 15136 Derm Autograft F/N/Hf/G Add 15150 Cult Skin Grft T/Arm/Leg 15151 Cult Skin Grft T/A/L Addl 15152 Cult Skin Graft T/A/L +% 15155 Cult Skin Graft F/N/Hf/G 15156 Cult Skin Grft F/N/Hfg Add 15157 Cult Epiderm Grft F/N/Hfg +% 15200 Skin Full Graft Trunk 15201 Skin Full Graft Trunk Add-On 15220 510 Skin Full Graft Sclp/Arm/Leg $765 $497 $594 $251 15221 510 Skin Full Graft Add-On $243 $158 $189 $80 15240 510 Skin Full Grft Face/Genit/Hf $792 $514 $614 $259 15241 510 Skin Full Graft Add-On $258 $168 $201 $85 15260 510 Skin Full Graft Een & Lips $872 $567 $677 $286 15261 Skin Full Graft Add-On 15271 510 Skin Sub Graft Trnk/Arm/Leg $481 $313 $373 $158 15272 510 Skin Sub Graft T/A/L Add-On $93 $60 $72 $31 15273 510 Skin Sub Grft T/Arm/Lg Child $1,024 $666 $795 $335 15274 510 Skn Sub Grft T/A/L Child Add $245 $159 $190 $80 15275 510 Skin Sub Graft Face/Nk/Hf/G $507 $330 $394 $166 15276 510 Skin Sub Graft F/N/Hf/G Addl $115 $75 $89 $38 15277 510 Skn Sub Grft F/N/Hf/G Child $1,112 $723 $863 $364 15278 510 Skn Sub Grft F/N/Hf/G Ch Add $296 $192 $230 $97 15570 Skin Pedicle Flap Trunk 15572 Skin Pedicle Flap Arms/Legs 15574 510 Pedcle Fh/Ch/Ch/M/N/Ax/G/H/F $2,781 $1,808 $2,159 $910 15576 Pedicle E/N/E/L/Ntroral 15600 Delay Flap Trunk 15610 Delay Flap Arms/Legs 15620 Delay Flap F/C/C/N/Ax/G/H/F 15630 Delay Flap Eye/Nos/Ear/Lip 15650 Transfer Skin Pedicle Flap 15730 Mdfc Flap W/Prsrv Vasc Pedcl 15731 Forehead Flap W/Vasc Pedicle 15733 Musc Myoq/Fscq Flp H&N Pedcl 15734 Muscle-Skin Graft Trunk $3,503 $2,277 $2,720 $1,148 15736 Muscle-Skin Graft Arm 15738 Muscle-Skin Graft Leg 15740 Island Pedicle Flap Graft 15750 Neurovascular Pedicle Flap 15756 Free Myo/Skin Flap Microvasc 15757 Free Skin Flap Microvasc 15758 Free Fascial Flap Microvasc 15760 Composite Skin Graft 15769 Grfg Autol Soft Tiss Dir Exc 15770 Derma-Fat-Fascia Graft 15771 Grfg Autol Fat Lipo 50 Cc/< 15772 Grfg Autol Fat Lipo Ea Addl 15773 Grfg Autol Fat Lipo 25 Cc/< 15774 Gfrg Autol Fat Lipo Ea Addl 15775 Hair Trnspl 1-15 Punch Grfts 15776 Hair Trnspl >15 Punch Grafts 15777 Acellular Derm Matrix Implt $671 $436 $521 $220 $214 15780 Dermabrasion Total Face 15781 Dermabrasion Segmental Face 15782 Dermabrasion Other Than Face 15783 Dermabrasion Suprfl Any Site 15786 Abrasion Lesion Single 15787 Abrasion Lesions Add-On 15788 510 Chemical Peel Face Epiderm $490 $318 $380 $160 15789 Chemical Peel Face Dermal 15792 Chemical Peel Nonfacial 15793 Chemical Peel Nonfacial 15819 Plastic Surgery Neck 15820 Revision Of Lower Eyelid 15821 Revision Of Lower Eyelid 15822 Revision Of Upper Eyelid 15823 510 Revision Of Upper Eyelid $474 $308 $368 $155 15824 Removal Of Forehead Wrinkles 15825 Removal Of Neck Wrinkles 15826 Removal Of Brow Wrinkles 15828 Removal Of Face Wrinkles 15829 Removal Of Skin Wrinkles 15830 Exc Skin Abd $3,661 $2,380 $2,842 $1,200 $600 15832 Excise Excessive Skin Thigh 15833 Excise Excessive Skin Leg 15834 Excise Excessive Skin Hip 15835 Excise Excessive Skin Buttck 15836 Excise Excessive Skin Arm 15837 Excise Excess Skin Arm/Hand 15838 Excise Excess Skin Fat Pad 15839 Excise Excess Skin & Tissue 15840 Nerve Palsy Fascial Graft 15841 Nerve Palsy Muscle Graft 15842 Nerve Palsy Microsurg Graft 15845 Skin And Muscle Repair Face 15847 Exc Skin Abd Add-On $699 $454 $543 $229 15850 Remove Sutures Same Surgeon 15851 Remove Sutures Diff Surgeon 15852 Dressing Change Not For Burn 15860 Test For Blood Flow In Graft 15876 Suction Lipectomy Head&Neck 15877 Suction Lipectomy Trunk $3,328 $2,163 $2,583 $1,090 $568 15878 Suction Lipectomy Upr Extrem 15879 Suction Lipectomy Lwr Extrem 15920 Removal Of Tail Bone Ulcer 15922 Removal Of Tail Bone Ulcer 15931 Remove Sacrum Pressure Sore 15933 Remove Sacrum Pressure Sore 15934 Remove Sacrum Pressure Sore 15935 Remove Sacrum Pressure Sore 15936 Remove Sacrum Pressure Sore 15937 Remove Sacrum Pressure Sore 15940 510 Remove Hip Pressure Sore $2,443 $1,588 $1,897 $799 15941 Remove Hip Pressure Sore 15944 510 Remove Hip Pressure Sore $3,114 $2,024 $2,418 $1,019 15945 Remove Hip Pressure Sore 15946 Remove Hip Pressure Sore 15950 Remove Thigh Pressure Sore 15951 Remove Thigh Pressure Sore 15952 Remove Thigh Pressure Sore 15953 Remove Thigh Pressure Sore 15956 Remove Thigh Pressure Sore 15958 Remove Thigh Pressure Sore 15999 Removal Of Pressure Sore 16000 510 Initial Treatment Of Burn(S) $381 $248 $296 $125 16020 510 Dress/Debrid P-Thick Burn S $361 $235 $280 $118 16025 510 Dress/Debrid P-Thick Burn M $521 $339 $404 $170 16030 450 Dress/Debrid P-Thick Burn L $190 $124 $148 $62 16035 Incision Of Burn Scab Initi 16036 Escharotomy Addl Incision 17000 510 Destruct Premalg Lesion $363 $236 $282 $119 17003 510 Destruct Premalg Les 2-14 $93 $60 $72 $31 17004 510 Destroy Premal Lesions 15/> $906 $589 $703 $296 17106 510 Destruction Of Skin Lesions $1,107 $720 $859 $362 17107 510 Destruction Of Skin Lesions $440 $286 $341 $144 17108 Destruction Of Skin Lesions $904 $587 $702 $296 17110 510 Destruct B9 Lesion 1-14 $391 $254 $304 $128 17111 510 Destruct Lesion 15 Or More $494 $321 $384 $162 17250 510 Chem Caut Of Granltj Tissue $239 $155 $185 $78 17260 510 Destruction Of Skin Lesions $290 $189 $225 $95 17261 510 Destruction Of Skin Lesions $548 $356 $425 $179 17262 510 Destruction Of Skin Lesions $680 $442 $528 $222 17263 510 Destruction Of Skin Lesions $757 $492 $588 $248 17264 510 Destruction Of Skin Lesions $816 $530 $633 $267 17266 510 Destruction Of Skin Lesions $957 $622 $743 $313 17270 510 Destruction Of Skin Lesions $596 $387 $463 $195 17271 510 Destruction Of Skin Lesions $642 $417 $498 $210 17272 510 Destruction Of Skin Lesions $231 $150 $179 $76 17273 510 Destruction Of Skin Lesions $735 $478 $571 $240 17274 510 Destruction Of Skin Lesions $839 $545 $651 $274 17276 510 Destruction Of Skin Lesions $1,007 $655 $782 $329 17280 510 Destruction Of Skin Lesions $320 $208 $248 $105 17281 510 Destruction Of Skin Lesions $214 $139 $166 $70 17282 510 Destruction Of Skin Lesions $242 $158 $188 $79 17283 510 Destruction Of Skin Lesions $269 $175 $209 $88 17284 Destruction Of Skin Lesions 17286 510 Destruction Of Skin Lesions $374 $243 $291 $123 17311 Mohs 1 Stage H/N/Hf/G 17312 Mohs Addl Stage 17313 Mohs 1 Stage T/A/L 17314 Mohs Addl Stage T/A/L 17315 Mohs Surg Addl Block 17340 510 Cryotherapy Of Skin $35 $23 $27 $11 17360 Skin Peel Therapy 17380 Hair Removal By Electrolysis 17999 510 Skin Tissue Procedure 19000 510 Drainage Of Breast Lesion $158 $103 $123 $52 19001 Drain Breast Lesion Add-On 19020 510 Incision Of Breast Lesion $920 $598 $714 $301 19030 Injection For Breast X-Ray 19081 Bx Breast 1St Lesion Strtctc $530 $345 $412 $174 $142 19082 Bx Breast Add Lesion Strtctc 19083 Bx Breast 1St Lesion Us Imag $497 $323 $386 $163 $140 19084 Bx Breast Add Lesion Us Imag $243 $158 $189 $80 19085 Bx Breast 1St Lesion Mr Imag 19086 Bx Breast Add Lesion Mr Imag 19100 Bx Breast Percut W/O Image 19101 510 Biopsy Of Breast Open $494 $321 $384 $162 19105 Cryosurg Ablate Fa Each 19110 Nipple Exploration $801 $521 $622 $263 19112 Excise Breast Duct Fistula 19120 510 Removal Of Breast Lesion $1,429 $929 $1,109 $468 19125 Excision Breast Lesion $1,060 $689 $823 $347 19126 Excision Addl Breast Lesion $489 $318 $380 $160 19281 Perq Device Breast 1St Imag 19282 Perq Device Breast Ea Imag 19283 Perq Dev Breast 1St Strtctc 19284 Perq Dev Breast Add Strtctc 19285 Perq Dev Breast 1St Us Imag $250 $163 $194 $82 19286 Perq Dev Breast Add Us Imag $126 $82 $98 $41 19287 Perq Dev Breast 1St Mr Guide 19288 Perq Dev Breast Add Mr Guide 19294 Prep Tum Cav Iort Prtl Mast 19296 Place Po Breast Cath For Rad 19297 Place Breast Cath For Rad 19298 Place Breast Rad Tube/Caths 19300 Removal Of Breast Tissue $975 $634 $757 $319 19301 Partial Mastectomy $1,638 $1,064 $1,271 $537 19302 P-Mastectomy W/Ln Removal 19303 Mast Simple Complete $2,552 $1,658 $1,981 $836 $616 19305 Mast Radical 19306 Mast Rad Urban Type 19307 Mast Mod Rad 19316 Suspension Of Breast 19318 Breast Reduction $3,410 $2,217 $2,648 $1,117 $699 19324 Enlarge Breast 19325 Breast Augmentation W/Implt 19328 Rmvl Intact Breast Implant 19330 Rmvl Ruptured Breast Implant 19340 Insj Breast Implt Sm D Mast $2,520 $1,638 $1,957 $826 19342 Insj/Rplcmt Brst Implt Sep D 19350 Breast Reconstruction 19355 Correct Inverted Nipple(S) 19357 Tiss Xpndr Plmt Brst Rcnstj 19361 Brst Rcnstj Latsms Drsi Flap 19364 Brst Rcnstj Free Flap 19366 Breast Reconstruction 19367 Brst Rcnstj 1 Pdcl Tram Flap 19368 Brst Rcnstj 1Pdcl Tram Anast 19369 Brst Rcnstj 2 Pdcl Tram Flap 19370 Revj Peri-Implt Capsule Brst 19371 Peri-Implt Capslc Brst Compl $1,992 $1,295 $1,547 $653 $214 19380 Revj Reconstructed Breast $1,964 $1,277 $1,525 $644 19396 Design Custom Breast Implant 19499 Breast Surgery Procedure 2000F Blood Pressure Measure 2001F Weight Record 2002F Clin Sign Vol Ovrld Assess 2004F Initial Exam Involved Joints 20100 Explore Wound Neck 20101 Explore Wound Chest 20102 Explore Wound Abdomen 20103 510 Explore Wound Extremity $1,431 $930 $1,111 $468 2010F Vital Signs Recorded $0 $0 $0 $0 2014F Mental Status Assess 20150 Excise Epiphyseal Bar 2015F Asthma Impairment Assessed 2016F Asthma Risk Assessed 2018F Hydration Status Assess 2019F Dilated Macul Exam Done 20200 Muscle Biopsy 20205 Deep Muscle Biopsy 20206 Needle Biopsy Muscle 2020F Dilated Fundus Eval Done 2021F Dilat Macular Exam Done 20220 510 Bone Biopsy Trocar/Needle $428 $278 $332 $140 20225 Bone Biopsy Trocar/Needle 2022F Dilat Rta Xm Evc Rtnopthy 2023F Dilat Rta Xm W/O Rtnopthy 20240 510 Bone Biopsy Open Superficial $1,236 $803 $960 $404 20245 Bone Biopsy Open Deep 2024F 7 Fld Rta Photo Evc Rtnopthy 20250 Open Bone Biopsy 20251 Open Bone Biopsy 2025F 7 Fld Rta Photo W/O Rtnopthy 2026F Eye Img Valid Evc Rtnopthy 2027F Optic Nerve Head Eval Done 2028F Foot Exam Performed 2029F Complete Phys Skin Exam Done 2030F H2O Stat Docd Normal 2031F H2O Stat Docd Dehydrated 2033F Eye Img Valid W/O Rtnopthy 2035F Tymp Memb Motion Examd 2040F Bk Pn Xm On Init Visit Date 2044F Doc Mntl Tst B/4 Bk Trxmnt 20500 Injection Of Sinus Tract 20501 Inject Sinus Tract For X-Ray 2050F Wound Char Size Etc Docd 20520 510 Removal Of Foreign Body $255 $166 $198 $83 20525 510 Removal Of Foreign Body $2,651 $1,723 $2,058 $867 20526 510 Ther Injection Carp Tunnel $410 $267 $318 $134 20527 510 Inj Dupuytren Cord W/Enzyme $167 $109 $130 $55 20550 983 Inj Tendon Sheath/Ligament $269 $175 $209 $88 20551 510 Inj Tendon Origin/Insertion $303 $197 $235 $99 20552 983 Inj Trigger Point 1/2 Muscl $267 $174 $207 $87 20553 510 Inject Trigger Points 3/> $303 $197 $235 $99 20555 Place Ndl Musc/Tis For Rt 20560 Ndl Insj W/O Njx 1 Or 2 Musc 20561 Ndl Insj W/O Njx 3+ Musc 20600 510 Drain/Inj Joint/Bursa W/O Us $269 $175 $209 $88 20604 510 Drain/Inj Joint/Bursa W/Us $98 $64 $76 $32 20605 360 Drain/Inj Joint/Bursa W/O Us $299 $194 $232 $98 20606 450 Drain/Inj Joint/Bursa W/Us $2,096 $1,362 $1,627 $687 $270 2060F Pt Talk Eval Hlthwkr Re Mdd 20610 360 Drain/Inj Joint/Bursa W/O Us $347 $226 $269 $114 20611 510 Drain/Inj Joint/Bursa W/Us $216 $140 $168 $71 20612 510 Aspirate/Inj Ganglion Cyst $232 $151 $180 $76 20615 510 Treatment Of Bone Cyst $609 $396 $473 $200 20650 510 Insert And Remove Bone Pin $707 $460 $549 $231 20660 Apply Rem Fixation Device 20661 Application Of Head Brace 20662 Application Of Pelvis Brace 20663 Application Of Thigh Brace 20664 Application Of Halo 20665 Removal Of Fixation Device 20670 510 Removal Of Support Implant $662 $430 $514 $217 20680 510 Removal Of Support Implant $860 $559 $668 $282 20690 Apply Bone Fixation Device 20692 Apply Bone Fixation Device 20693 Adjust Bone Fixation Device 20694 Remove Bone Fixation Device $787 $512 $611 $258 20696 Comp Multiplane Ext Fixation 20697 Comp Ext Fixate Strut Change 20700 Mnl Prep&Insj Dp Rx Dlvr Dev 20701 Rmvl Deep Rx Delivery Device 20702 Mnl Prep&Insj Imed Rx Dev 20703 Rmvl Imed Rx Delivery Device 20704 Mnl Prep&Insj I-Artic Rx Dev 20705 Rmvl I-Artic Rx Delivery Dev 20802 Replantation Arm Complete 20805 Replant Forearm Complete 20808 Replantation Hand Complete 20816 Replantation Digit Complete 20822 Replantation Digit Complete 20824 Replantation Thumb Complete 20827 Replantation Thumb Complete 20838 Replantation Foot Complete 20900 Removal Of Bone For Graft 20902 Removal Of Bone For Graft 20910 Remove Cartilage For Graft 20912 Remove Cartilage For Graft $1,458 $947 $1,132 $478 20920 Removal Of Fascia For Graft 20922 Removal Of Fascia For Graft 20924 Removal Of Tendon For Graft 20930 Sp Bone Algrft Morsel Add-On $568 $369 $441 $186 $82 20931 Sp Bone Algrft Struct Add-On $309 $201 $240 $101 20932 Osteoart Algrft W/Surf & B1 20933 Hemicrt Intrclry Algrft Prtl 20934 Intercalary Algrft Compl 20936 Sp Bone Agrft Local Add-On $267 $173 $207 $87 20937 Sp Bone Agrft Morsel Add-On 20938 Sp Bone Agrft Struct Add-On 20939 Bone Marrow Aspir Bone Grfg $181 $117 $140 $59 $41 20950 510 Fluid Pressure Muscle $528 $343 $410 $173 20955 Fibula Bone Graft Microvasc 20956 Iliac Bone Graft Microvasc 20957 Mt Bone Graft Microvasc 20962 Other Bone Graft Microvasc 20969 Bone/Skin Graft Microvasc 20970 Bone/Skin Graft Iliac Crest 20972 Bone/Skin Graft Metatarsal 20973 Bone/Skin Graft Great Toe 20974 Electrical Bone Stimulation 20975 Electrical Bone Stimulation 20979 Us Bone Stimulation 20982 Ablate Bone Tumor(S) Perq 20983 Ablate Bone Tumor(S) Perq 20985 Cptr-Asst Dir Ms Px 20999 Musculoskeletal Surgery 21010 Incision Of Jaw Joint 21011 510 Exc Face Les Sc <2 Cm $399 $259 $310 $131 21012 510 Exc Face Les Sbq 2 Cm/> $1,261 $819 $979 $413 21013 510 Exc Face Tum Deep < 2 Cm $372 $242 $288 $122 21014 510 Exc Face Tum Deep 2 Cm/> $2,130 $1,384 $1,654 $698 21015 Resect Face/Scalp Tum < 2 Cm 21016 Resect Face/Scalp Tum 2 Cm/> 21025 Excision Of Bone Lower Jaw 21026 Excision Of Facial Bone(S) 21029 510 Contour Of Face Bone Lesion 21030 Excise Max/Zygoma B9 Tumor 21031 Remove Exostosis Mandible 21032 Remove Exostosis Maxilla 21034 Excise Max/Zygoma Mal Tumor 21040 Excise Mandible Lesion 21044 Removal Of Jaw Bone Lesion 21045 Extensive Jaw Surgery 21046 Remove Mandible Cyst Complex 21047 Excise Lwr Jaw Cyst W/Repair 21048 Remove Maxilla Cyst Complex 21049 Excis Uppr Jaw Cyst W/Repair 21050 Removal Of Jaw Joint 21060 Remove Jaw Joint Cartilage 21070 Remove Coronoid Process 21073 Mnpj Of Tmj W/Anesth 21076 Prepare Face/Oral Prosthesis 21077 Prepare Face/Oral Prosthesis 21079 Prepare Face/Oral Prosthesis 21080 Prepare Face/Oral Prosthesis 21081 Prepare Face/Oral Prosthesis 21082 Prepare Face/Oral Prosthesis 21083 Prepare Face/Oral Prosthesis 21084 Prepare Face/Oral Prosthesis 21085 Prepare Face/Oral Prosthesis 21086 Prepare Face/Oral Prosthesis 21087 Prepare Face/Oral Prosthesis 21088 Prepare Face/Oral Prosthesis 21089 Prepare Face/Oral Prosthesis 21100 Maxillofacial Fixation 21110 Interdental Fixation 21116 Injection Jaw Joint X-Ray 21120 Reconstruction Of Chin 21121 Reconstruction Of Chin 21122 Reconstruction Of Chin 21123 Reconstruction Of Chin 21125 Augmentation Lower Jaw Bone 21127 Augmentation Lower Jaw Bone 21137 Reduction Of Forehead 21138 Reduction Of Forehead 21139 Reduction Of Forehead 21141 Lefort I-1 Piece W/O Graft 21142 Lefort I-2 Piece W/O Graft 21143 Lefort I-3/> Piece W/O Graft 21145 Lefort I-1 Piece W/ Graft 21146 Lefort I-2 Piece W/ Graft 21147 Lefort I-3/> Piece W/ Graft 21150 Lefort Ii Anterior Intrusion 21151 Lefort Ii W/Bone Grafts 21154 Lefort Iii W/O Lefort I 21155 Lefort Iii W/ Lefort I 21159 Lefort Iii W/Fhdw/O Lefort I 21160 Lefort Iii W/Fhd W/ Lefort I 21172 Reconstruct Orbit/Forehead 21175 Reconstruct Orbit/Forehead 21179 Reconstruct Entire Forehead 21180 Reconstruct Entire Forehead 21181 Contour Cranial Bone Lesion 21182 Reconstruct Cranial Bone 21183 Reconstruct Cranial Bone 21184 Reconstruct Cranial Bone 21188 Reconstruction Of Midface 21193 Reconst Lwr Jaw W/O Graft 21194 Reconst Lwr Jaw W/Graft 21195 Reconst Lwr Jaw W/O Fixation 21196 Reconst Lwr Jaw W/Fixation 21198 Reconstr Lwr Jaw Segment 21199 Reconstr Lwr Jaw W/Advance 21206 Reconstruct Upper Jaw Bone 21208 Augmentation Of Facial Bones 21209 Reduction Of Facial Bones 21210 Face Bone Graft 21215 Lower Jaw Bone Graft 21230 Rib Cartilage Graft 21235 Ear Cartilage Graft 21240 Reconstruction Of Jaw Joint 21242 Reconstruction Of Jaw Joint 21243 Reconstruction Of Jaw Joint 21244 Reconstruction Of Lower Jaw 21245 Reconstruction Of Jaw 21246 Reconstruction Of Jaw 21247 Reconstruct Lower Jaw Bone 21248 Reconstruction Of Jaw 21249 Reconstruction Of Jaw 21255 Reconstruct Lower Jaw Bone 21256 Reconstruction Of Orbit 21260 Revise Eye Sockets 21261 Revise Eye Sockets 21263 Revise Eye Sockets 21267 Revise Eye Sockets 21268 Revise Eye Sockets 21270 Augmentation Cheek Bone 21275 Revision Orbitofacial Bones 21280 Revision Of Eyelid 21282 Revision Of Eyelid 21295 Revision Of Jaw Muscle/Bone 21296 Revision Of Jaw Muscle/Bone 21299 Cranio/Maxillofacial Surgery 21310 450 Closed Tx Nose Fx W/O Manj $338 $220 $262 $111 21315 Closed Tx Nose Fx W/O Stablj 21320 Closed Tx Nose Fx W/ Stablj $358 $233 $278 $117 21325 Open Tx Nose Fx Uncomplicatd 21330 Open Tx Nose Fx W/Skele Fixj 21335 Open Tx Nose & Septal Fx 21336 Open Tx Septal Fx W/Wo Stabj 21337 Closed Tx Septal&Nose Fx 21338 Open Nasoethmoid Fx W/O Fixj 21339 Open Nasoethmoid Fx W/ Fixj 21340 Perq Tx Nasoethmoid Fx 21343 Open Tx Dprsd Front Sinus Fx 21344 Open Tx Compl Front Sinus Fx 21345 Closed Tx Nose/Jaw Fx 21346 Opn Tx Nasomax Fx W/Fixj 21347 Opn Tx Nasomax Fx Multple 21348 Opn Tx Nasomax Fx W/Graft 21355 Perq Tx Malar Fracture 21356 Opn Tx Dprsd Zygomatic Arch 21360 Opn Tx Dprsd Malar Fracture 21365 Opn Tx Complx Malar Fx 21366 Opn Tx Complx Malar W/Grft 21385 Opn Tx Orbit Fx Transantral 21386 Opn Tx Orbit Fx Periorbital 21387 Opn Tx Orbit Fx Combined 21390 Opn Tx Orbit Periorbtl Implt 21395 Opn Tx Orbit Periorbt W/Grft 21400 Closed Tx Orbit W/O Manipulj 21401 Closed Tx Orbit W/Manipulj 21406 Opn Tx Orbit Fx W/O Implant 21407 Opn Tx Orbit Fx W/Implant 21408 Opn Tx Orbit Fx W/Bone Grft 21421 Treat Mouth Roof Fracture 21422 Treat Mouth Roof Fracture 21423 Treat Mouth Roof Fracture 21431 Treat Craniofacial Fracture 21432 Treat Craniofacial Fracture 21433 Treat Craniofacial Fracture 21435 Treat Craniofacial Fracture 21436 Treat Craniofacial Fracture 21440 Treat Dental Ridge Fracture 21445 Treat Dental Ridge Fracture 21450 450 Treat Lower Jaw Fracture $999 $649 $776 $327 21451 Treat Lower Jaw Fracture 21452 Treat Lower Jaw Fracture 21453 450 Treat Lower Jaw Fracture $11,577 $7,525 $8,988 $3,793 21454 Treat Lower Jaw Fracture 21461 Treat Lower Jaw Fracture 21462 Treat Lower Jaw Fracture 21465 Treat Lower Jaw Fracture 21470 Treat Lower Jaw Fracture 21480 510 Reset Dislocated Jaw $343 $223 $266 $112 21485 Reset Dislocated Jaw 21490 Repair Dislocated Jaw 21497 Interdental Wiring 21499 Head Surgery Procedure 21501 Drain Neck/Chest Lesion $754 $490 $586 $247 21502 Drain Chest Lesion 21510 Drainage Of Bone Lesion 21550 Biopsy Of Neck/Chest 21552 510 Exc Neck Les Sc 3 Cm/> $2,130 $1,384 $1,654 $698 $174 21554 Exc Neck Tum Deep 5 Cm/> 21555 510 Exc Neck Les Sc < 3 Cm $1,576 $1,024 $1,224 $516 21556 510 Exc Neck Tum Deep < 5 Cm $2,130 $1,384 $1,654 $698 $626 21557 Resect Neck Thorax Tumor<5Cm 21558 Resect Neck Tumor 5 Cm/> 21600 Partial Removal Of Rib 21601 Exc Chest Wall Tumor W/Ribs 21602 Exc Ch Wal Tum W/O Lymphadec 21603 Exc Ch Wal Tum W/Lymphadec 21610 Partial Removal Of Rib 21615 Removal Of Rib 21616 Removal Of Rib And Nerves 21620 Partial Removal Of Sternum 21627 Sternal Debridement 21630 Extensive Sternum Surgery 21632 Extensive Sternum Surgery 21685 Hyoid Myotomy & Suspension 21700 Revision Of Neck Muscle 21705 Revision Of Neck Muscle/Rib 21720 Revision Of Neck Muscle 21725 Revision Of Neck Muscle 21740 Reconstruction Of Sternum 21742 Repair Stern/Nuss W/O Scope 21743 Repair Sternum/Nuss W/Scope 21750 Repair Of Sternum Separation 21811 Optx Of Rib Fx W/Fixj Scope 21812 Treatment Of Rib Fracture 21813 Treatment Of Rib Fracture 21820 Treat Sternum Fracture 21825 Treat Sternum Fracture 21899 Neck/Chest Surgery Procedure 21920 Biopsy Soft Tissue Of Back 21925 Biopsy Soft Tissue Of Back 21930 510 Exc Back Les Sc < 3 Cm $1,822 $1,184 $1,415 $596 21931 510 Exc Back Les Sc 3 Cm/> $1,261 $819 $979 $413 21932 510 Exc Back Tum Deep < 5 Cm $2,130 $1,384 $1,654 $698 21933 510 Exc Back Tum Deep 5 Cm/> $2,130 $1,384 $1,654 $698 $215 21935 Resect Back Tum < 5 Cm 21936 Resect Back Tum 5 Cm/> 22010 510 I&D P-Spine C/T/Cerv-Thor $3,468 $2,254 $2,692 $1,135 22015 I&D Abscess P-Spine L/S/Ls 22100 Remove Part Of Neck Vertebra 22101 Remove Part Thorax Vertebra 22102 Remove Part Lumbar Vertebra 22103 Remove Extra Spine Segment 22110 Remove Part Of Neck Vertebra 22112 Remove Part Thorax Vertebra 22114 Remove Part Lumbar Vertebra 22116 Remove Extra Spine Segment 22206 Incis Spine 3 Column Thorac 22207 Incis Spine 3 Column Lumbar 22208 Incis Spine 3 Column Adl Seg 22210 Incis 1 Vertebral Seg Cerv 22212 Incis 1 Vertebral Seg Thorac 22214 Incis 1 Vertebral Seg Lumbar 22216 Incis Addl Spine Segment 22220 Incis W/Discectomy Cervical 22222 Incis W/Discectomy Thoracic 22224 Incis W/Discectomy Lumbar 22226 Revise Extra Spine Segment 22310 510 Closed Tx Vert Fx W/O Manj $279 $181 $216 $91 22315 Closed Tx Vert Fx W/Manj 22318 Treat Odontoid Fx W/O Graft 22319 Treat Odontoid Fx W/Graft 22325 Treat Spine Fracture 22326 Treat Neck Spine Fracture 22327 Treat Thorax Spine Fracture 22328 Treat Each Add Spine Fx 22505 Manipulation Of Spine 22510 Perq Cervicothoracic Inject 22511 Perq Lumbosacral Injection 22512 Vertebroplasty Addl Inject 22513 Perq Vertebral Augmentation 22514 510 Perq Vertebral Augmentation $24,013 $15,608 $18,642 $7,856 22515 Perq Vertebral Augmentation 22526 Idet Single Level 22527 Idet 1 Or More Levels 22532 Lat Thorax Spine Fusion 22533 Lat Lumbar Spine Fusion 22534 Lat Thor/Lumb Addl Seg 22548 Neck Spine Fusion 22551 Neck Spine Fuse&Remov Bel C2 $5,226 $3,397 $4,057 $1,712 $1,232 22552 Addl Neck Spine Fusion $1,615 $1,050 $1,254 $529 22554 Neck Spine Fusion 22556 Thorax Spine Fusion 22558 Lumbar Spine Fusion 22585 Additional Spinal Fusion 22586 Prescrl Fuse W/ Instr L5-S1 22590 Spine & Skull Spinal Fusion 22595 Neck Spinal Fusion 22600 Neck Spine Fusion 22610 510 Thorax Spine Fusion $4,963 $3,226 $3,853 $1,624 22612 Lumbar Spine Fusion 22614 Spine Fusion Extra Segment $1,212 $788 $941 $397 $41 22630 Lumbar Spine Fusion 22632 Spine Fusion Extra Segment 22633 Lumbar Spine Fusion Combined $6,010 $3,907 $4,666 $1,969 $41 22634 Spine Fusion Extra Segment 22800 Post Fusion Vert Seg 22808 Ant Fusion 2-3 Vert Seg 22810 Ant Fusion 4-7 Vert Seg 22812 Ant Fusion 8/> Vert Seg 22818 Kyphectomy 1-2 Segments 22819 Kyphectomy 3 Or More 22830 Exploration Of Spinal Fusion 22840 Insert Spine Fixation Device 22841 Insert Spine Fixation Device 22842 Insert Spine Fixation Device 22843 Insert Spine Fixation Device 22844 Insert Spine Fixation Device 22845 Insert Spine Fixation Device $2,183 $1,419 $1,695 $715 22846 Insert Spine Fixation Device 22847 Insert Spine Fixation Device 22848 Insert Pelv Fixation Device 22849 Reinsert Spinal Fixation 22850 Remove Spine Fixation Device 22852 Remove Spine Fixation Device 22853 Insj Biomechanical Device $696 $452 $540 $228 22854 Insj Biomechanical Device 22855 Remove Spine Fixation Device 22856 Cerv Artific Diskectomy $4,942 $3,212 $3,837 $1,619 $1,054 22857 Lumbar Artif Diskectomy 22858 Second Level Cer Diskectomy 22859 Insj Biomechanical Device 22861 Revise Cerv Artific Disc 22862 Revise Lumbar Artif Disc 22864 Remove Cerv Artif Disc 22865 Remove Lumb Artif Disc 22867 Insj Stablj Dev W/Dcmprn 22868 Insj Stablj Dev W/Dcmprn 22869 Insj Stablj Dev W/O Dcmprn 22870 Insj Stablj Dev W/O Dcmprn 22899 Spine Surgery Procedure 22900 Exc Abdl Tum Deep < 5 Cm 22901 Exc Abdl Tum Deep 5 Cm/> 22902 510 Exc Abd Les Sc < 3 Cm $524 $340 $406 $172 22903 510 Exc Abd Les Sc 3 Cm/> $1,745 $1,134 $1,355 $571 22904 Radical Resect Abd Tumor<5Cm 22905 Rad Resect Abd Tumor 5 Cm/> 22999 761 Abdomen Surgery Procedure $578 $376 $449 $189 23000 Removal Of Calcium Deposits 23020 Release Shoulder Joint 23030 510 Drain Shoulder Lesion $1,581 $1,028 $1,227 $517 23031 Drain Shoulder Bursa 23035 Drain Shoulder Bone Lesion 23040 Exploratory Shoulder Surgery 23044 Exploratory Shoulder Surgery 23065 510 Biopsy Shoulder Tissues $159 $103 $123 $52 23066 Biopsy Shoulder Tissues 23071 510 Exc Shoulder Les Sc 3 Cm/> $1,261 $819 $979 $413 23073 510 Exc Shoulder Tum Deep 5 Cm/> $2,130 $1,384 $1,654 $698 23075 510 Exc Shoulder Les Sc < 3 Cm $580 $377 $451 $190 23076 Exc Shoulder Tum Deep < 5 Cm $1,709 $1,111 $1,327 $560 23077 Resect Shoulder Tumor < 5 Cm 23078 Resect Shoulder Tumor 5 Cm/> 23100 Biopsy Of Shoulder Joint 23101 Shoulder Joint Surgery 23105 Remove Shoulder Joint Lining 23106 Incision Of Collarbone Joint 23107 Explore Treat Shoulder Joint 23120 Partial Removal Collar Bone 23125 Removal Of Collar Bone 23130 Remove Shoulder Bone Part $1,835 $1,193 $1,424 $601 23140 Removal Of Bone Lesion 23145 Removal Of Bone Lesion 23146 Removal Of Bone Lesion 23150 Removal Of Humerus Lesion 23155 Removal Of Humerus Lesion 23156 Removal Of Humerus Lesion 23170 Remove Collar Bone Lesion 23172 Remove Shoulder Blade Lesion 23174 Remove Humerus Lesion 23180 Remove Collar Bone Lesion 23182 Remove Shoulder Blade Lesion 23184 Remove Humerus Lesion 23190 Partial Removal Of Scapula 23195 Removal Of Head Of Humerus 23200 Resect Clavicle Tumor 23210 Resect Scapula Tumor 23220 Resect Prox Humerus Tumor 23330 Remove Shoulder Foreign Body 23333 Remove Shoulder Fb Deep 23334 Shoulder Prosthesis Removal 23335 Shoulder Prosthesis Removal 23350 Injection For Shoulder X-Ray 23395 Muscle Transfer Shoulder/Arm 23397 Muscle Transfers 23400 Fixation Of Shoulder Blade 23405 Incision Of Tendon & Muscle 23406 Incise Tendon(S) & Muscle(S) 23410 Repair Rotator Cuff Acute 23412 Repair Rotator Cuff Chronic $2,640 $1,716 $2,050 $865 $859 23415 Release Of Shoulder Ligament 23420 Repair Of Shoulder 23430 Repair Biceps Tendon $2,308 $1,500 $1,792 $756 23440 Remove/Transplant Tendon 23450 Repair Shoulder Capsule 23455 Repair Shoulder Capsule 23460 Repair Shoulder Capsule 23462 Repair Shoulder Capsule 23465 Repair Shoulder Capsule 23466 Repair Shoulder Capsule 23470 Reconstruct Shoulder Joint 23472 Reconstruct Shoulder Joint 23473 Revis Reconst Shoulder Joint 23474 Revis Reconst Shoulder Joint 23480 Revision Of Collar Bone $1,906 $1,239 $1,480 $625 $335 23485 Revision Of Collar Bone 23490 Reinforce Clavicle 23491 Reinforce Shoulder Bones 23500 510 Treat Clavicle Fracture $1,061 $690 $824 $347 $248 23505 Treat Clavicle Fracture 23515 Treat Clavicle Fracture $1,813 $1,179 $1,408 $594 $425 23520 Treat Clavicle Dislocation 23525 Treat Clavicle Dislocation 23530 Treat Clavicle Dislocation 23532 Treat Clavicle Dislocation 23540 510 Treat Clavicle Dislocation $124 $80 $96 $40 23545 Treat Clavicle Dislocation 23550 Treat Clavicle Dislocation $1,629 $1,059 $1,265 $534 $0 23552 Treat Clavicle Dislocation 23570 510 Treat Shoulder Blade Fx $138 $90 $107 $45 23575 Treat Shoulder Blade Fx 23585 Treat Scapula Fracture 23600 510 Treat Humerus Fracture $1,598 $1,039 $1,241 $523 $67 23605 510 Treat Humerus Fracture $1,976 $1,284 $1,534 $646 $590 23615 Treat Humerus Fracture 23616 Treat Humerus Fracture 23620 510 Treat Humerus Fracture $207 $134 $161 $68 23625 Treat Humerus Fracture 23630 Treat Humerus Fracture 23650 450 Treat Shoulder Dislocation $1,691 $1,099 $1,313 $554 23655 510 Treat Shoulder Dislocation $3,285 $2,135 $2,550 $1,075 $0 23660 Treat Shoulder Dislocation 23665 450 Treat Dislocation/Fracture $3,722 $2,419 $2,890 $1,220 23670 Treat Dislocation/Fracture 23675 450 Treat Dislocation/Fracture $440 $286 $342 $144 23680 Treat Dislocation/Fracture 23700 Fixation Of Shoulder $573 $373 $445 $188 23800 Fusion Of Shoulder Joint 23802 Fusion Of Shoulder Joint 23900 Amputation Of Arm & Girdle 23920 Amputation At Shoulder Joint 23921 Amputation Follow-Up Surgery 23929 Shoulder Surgery Procedure 23930 Drainage Of Arm Lesion 23931 510 Drainage Of Arm Bursa $793 $515 $616 $259 23935 Drain Arm/Elbow Bone Lesion 24000 Exploratory Elbow Surgery 24006 Release Elbow Joint 24065 Biopsy Arm/Elbow Soft Tissue 24066 510 Biopsy Arm/Elbow Soft Tissue $592 $385 $460 $194 24071 510 Exc Arm/Elbow Les Sc 3 Cm/> $1,316 $855 $1,022 $431 24073 Ex Arm/Elbow Tum Deep 5 Cm/> 24075 510 Exc Arm/Elbow Les Sc < 3 Cm $645 $419 $500 $211 24076 Ex Arm/Elbow Tum Deep < 5 Cm 24077 Resect Arm/Elbow Tum < 5 Cm 24079 Resect Arm/Elbow Tum 5 Cm/> 24100 Biopsy Elbow Joint Lining 24101 Explore/Treat Elbow Joint 24102 Remove Elbow Joint Lining 24105 Removal Of Elbow Bursa 24110 Remove Humerus Lesion 24115 Remove/Graft Bone Lesion 24116 Remove/Graft Bone Lesion 24120 Remove Elbow Lesion 24125 Remove/Graft Bone Lesion 24126 Remove/Graft Bone Lesion 24130 Removal Of Head Of Radius 24134 Removal Of Arm Bone Lesion 24136 Remove Radius Bone Lesion 24138 Remove Elbow Bone Lesion 24140 Partial Removal Of Arm Bone 24145 Partial Removal Of Radius 24147 Partial Removal Of Elbow 24149 Radical Resection Of Elbow 24150 Resect Distal Humerus Tumor 24152 Resect Radius Tumor 24155 Removal Of Elbow Joint 24160 Remove Elbow Joint Implant 24164 Remove Radius Head Implant 24200 510 Removal Of Arm Foreign Body $735 $478 $571 $240 24201 Removal Of Arm Foreign Body 24220 Injection For Elbow X-Ray 24300 Manipulate Elbow W/Anesth 24301 Muscle/Tendon Transfer 24305 Arm Tendon Lengthening 24310 Revision Of Arm Tendon 24320 Repair Of Arm Tendon 24330 Revision Of Arm Muscles 24331 Revision Of Arm Muscles 24332 Tenolysis Triceps 24340 Repair Of Biceps Tendon 24341 Repair Arm Tendon/Muscle $1,880 $1,222 $1,459 $616 24342 Repair Of Ruptured Tendon 24343 Repr Elbow Lat Ligmnt W/Tiss 24344 Reconstruct Elbow Lat Ligmnt 24345 Repr Elbw Med Ligmnt W/Tissu 24346 Reconstruct Elbow Med Ligmnt 24357 Repair Elbow Perc 24358 Repair Elbow W/Deb Open 24359 Repair Elbow Deb/Attch Open $2,050 $1,332 $1,591 $672 $304 24360 Reconstruct Elbow Joint 24361 Reconstruct Elbow Joint 24362 Reconstruct Elbow Joint 24363 Replace Elbow Joint 24365 Reconstruct Head Of Radius 24366 Reconstruct Head Of Radius 24370 Revise Reconst Elbow Joint 24371 Revise Reconst Elbow Joint 24400 Revision Of Humerus 24410 Revision Of Humerus 24420 Revision Of Humerus 24430 Repair Of Humerus 24435 Repair Humerus With Graft 24470 Revision Of Elbow Joint 24495 Decompression Of Forearm 24498 Reinforce Humerus 24500 510 Treat Humerus Fracture $1,479 $961 $1,148 $484 $136 24505 450 Treat Humerus Fracture $494 $321 $384 $162 24515 Treat Humerus Fracture 24516 Treat Humerus Fracture 24530 510 Treat Humerus Fracture $336 $218 $261 $110 24535 450 Treat Humerus Fracture $435 $283 $338 $143 24538 Treat Humerus Fracture 24545 510 Treat Humerus Fracture $3,261 $2,120 $2,532 $1,067 24546 Treat Humerus Fracture 24560 510 Treat Humerus Fracture $254 $165 $197 $83 24565 450 Treat Humerus Fracture $3,465 $2,252 $2,690 $1,135 24566 Treat Humerus Fracture 24575 Treat Humerus Fracture $2,139 $1,390 $1,660 $701 $434 24576 510 Treat Humerus Fracture $1,552 $1,009 $1,205 $508 24577 450 Treat Humerus Fracture $1,629 $1,059 $1,265 $534 24579 Treat Humerus Fracture 24582 Treat Humerus Fracture 24586 Treat Elbow Fracture 24587 Treat Elbow Fracture 24600 510 Treat Elbow Dislocation $1,354 $880 $1,051 $443 24605 510 Treat Elbow Dislocation $1,570 $1,021 $1,219 $514 24615 Treat Elbow Dislocation 24620 Treat Elbow Fracture 24635 Treat Elbow Fracture 24640 983 Treat Elbow Dislocation $893 $580 $693 $292 $154 24650 510 Treat Radius Fracture $847 $551 $658 $277 24655 510 Treat Radius Fracture $1,976 $1,284 $1,534 $646 24665 Treat Radius Fracture 24666 Treat Radius Fracture 24670 510 Treat Ulnar Fracture $1,152 $749 $894 $377 $358 24675 510 Treat Ulnar Fracture $1,685 $1,095 $1,308 $551 24685 Treat Ulnar Fracture 24800 Fusion Of Elbow Joint 24802 Fusion/Graft Of Elbow Joint 24900 Amputation Of Upper Arm 24920 Amputation Of Upper Arm 24925 Amputation Follow-Up Surgery 24930 Amputation Follow-Up Surgery 24931 Amputate Upper Arm & Implant 24935 Revision Of Amputation 24940 Revision Of Upper Arm 24999 Upper Arm/Elbow Surgery 25000 Incision Of Tendon Sheath $1,036 $674 $804 $340 25001 Incise Flexor Carpi Radialis 25020 Decompress Forearm 1 Space 25023 Decompress Forearm 1 Space 25024 Decompress Forearm 2 Spaces 25025 Decompress Forearm 2 Spaces 25028 Drainage Of Forearm Lesion 25031 Drainage Of Forearm Bursa 25035 Treat Forearm Bone Lesion 25040 Explore/Treat Wrist Joint 25065 Biopsy Forearm Soft Tissues 25066 Biopsy Forearm Soft Tissues 25071 510 Exc Forearm Les Sc 3 Cm/> $1,261 $819 $979 $413 25073 Exc Forearm Tum Deep 3 Cm/> $1,272 $827 $988 $417 25075 510 Exc Forearm Les Sc < 3 Cm $642 $418 $499 $210 25076 Exc Forearm Tum Deep < 3 Cm 25077 Resect Forearm/Wrist Tum<3Cm 25078 Resect Forarm/Wrist Tum 3Cm> 25085 Incision Of Wrist Capsule 25100 Biopsy Of Wrist Joint 25101 Explore/Treat Wrist Joint 25105 Remove Wrist Joint Lining 25107 Remove Wrist Joint Cartilage 25109 Excise Tendon Forearm/Wrist 25110 Remove Wrist Tendon Lesion 25111 Remove Wrist Tendon Lesion $982 $638 $762 $322 25112 Reremove Wrist Tendon Lesion 25115 Remove Wrist/Forearm Lesion 25116 Remove Wrist/Forearm Lesion 25118 Excise Wrist Tendon Sheath 25119 Partial Removal Of Ulna 25120 Removal Of Forearm Lesion 25125 Remove/Graft Forearm Lesion 25126 Remove/Graft Forearm Lesion 25130 Removal Of Wrist Lesion 25135 Remove & Graft Wrist Lesion 25136 Remove & Graft Wrist Lesion 25145 Remove Forearm Bone Lesion 25150 Partial Removal Of Ulna 25151 Partial Removal Of Radius 25170 Resect Radius/Ulnar Tumor 25210 Removal Of Wrist Bone 25215 Removal Of Wrist Bones 25230 Partial Removal Of Radius 25240 Partial Removal Of Ulna 25246 Injection For Wrist X-Ray 25248 450 Remove Forearm Foreign Body $5,762 $3,745 $4,473 $1,888 25250 Removal Of Wrist Prosthesis 25251 Removal Of Wrist Prosthesis 25259 Manipulate Wrist W/Anesthes 25260 Repair Forearm Tendon/Muscle 25263 Repair Forearm Tendon/Muscle 25265 Repair Forearm Tendon/Muscle 25270 510 Repair Forearm Tendon/Muscle $3,819 $2,482 $2,965 $1,249 25272 Repair Forearm Tendon/Muscle 25274 Repair Forearm Tendon/Muscle 25275 Repair Forearm Tendon Sheath 25280 Revise Wrist/Forearm Tendon 25290 Incise Wrist/Forearm Tendon 25295 Release Wrist/Forearm Tendon 25300 Fusion Of Tendons At Wrist 25301 Fusion Of Tendons At Wrist 25310 Transplant Forearm Tendon 25312 Transplant Forearm Tendon 25315 Revise Palsy Hand Tendon(S) 25316 Revise Palsy Hand Tendon(S) 25320 Repair/Revise Wrist Joint 25332 Revise Wrist Joint 25335 Realignment Of Hand 25337 Reconstruct Ulna/Radioulnar 25350 Revision Of Radius 25355 Revision Of Radius 25360 Revision Of Ulna 25365 Revise Radius & Ulna 25370 Revise Radius Or Ulna 25375 Revise Radius & Ulna 25390 Shorten Radius Or Ulna 25391 Lengthen Radius Or Ulna 25392 Shorten Radius & Ulna 25393 Lengthen Radius & Ulna 25394 Repair Carpal Bone Shorten 25400 Repair Radius Or Ulna 25405 Repair/Graft Radius Or Ulna 25415 Repair Radius & Ulna 25420 Repair/Graft Radius & Ulna 25425 Repair/Graft Radius Or Ulna 25426 Repair/Graft Radius & Ulna 25430 Vasc Graft Into Carpal Bone 25431 Repair Nonunion Carpal Bone 25440 Repair/Graft Wrist Bone 25441 Reconstruct Wrist Joint 25442 Reconstruct Wrist Joint 25443 Reconstruct Wrist Joint 25444 Reconstruct Wrist Joint 25445 Reconstruct Wrist Joint 25446 Wrist Replacement 25447 Repair Wrist Joints 25449 Remove Wrist Joint Implant 25450 Revision Of Wrist Joint 25455 Revision Of Wrist Joint 25490 Reinforce Radius 25491 Reinforce Ulna 25492 Reinforce Radius And Ulna 25500 510 Treat Fracture Of Radius $188 $123 $146 $62 25505 510 Treat Fracture Of Radius $3,023 $1,965 $2,347 $989 25515 Treat Fracture Of Radius 25520 Treat Fracture Of Radius 25525 Treat Fracture Of Radius 25526 Treat Fracture Of Radius 25530 510 Treat Fracture Of Ulna $850 $553 $660 $278 $0 25535 510 Treat Fracture Of Ulna $2,258 $1,468 $1,753 $739 25545 Treat Fracture Of Ulna 25560 510 Treat Fracture Radius & Ulna $955 $621 $741 $312 $235 25565 510 Treat Fracture Radius & Ulna $1,813 $1,178 $1,408 $593 $0 25574 Treat Fracture Radius & Ulna $1,694 $1,101 $1,315 $555 $399 25575 Treat Fracture Radius/Ulna 25600 510 Treat Fracture Radius/Ulna $1,770 $1,151 $1,374 $579 $306 25605 983 Treat Fracture Radius/Ulna $2,395 $1,557 $1,859 $784 $490 25606 510 Treat Fx Distal Radial $2,616 $1,700 $2,031 $856 25607 Treat Fx Rad Extra-Articul $2,280 $1,482 $1,770 $747 $535 25608 Treat Fx Rad Intra-Articul 25609 Treat Fx Radial 3+ Frag $3,232 $2,101 $2,509 $1,059 $747 25622 510 Treat Wrist Bone Fracture $1,185 $770 $920 $388 $284 25624 510 Treat Wrist Bone Fracture $1,531 $995 $1,189 $501 25628 Treat Wrist Bone Fracture $2,242 $1,457 $1,741 $735 25630 510 Treat Wrist Bone Fracture $1,206 $784 $936 $395 25635 450 Treat Wrist Bone Fracture $3,465 $2,252 $2,690 $1,135 25645 Treat Wrist Bone Fracture 25650 510 Treat Wrist Bone Fracture $1,152 $749 $894 $377 25651 Pin Ulnar Styloid Fracture $1,348 $876 $1,046 $442 25652 Treat Fracture Ulnar Styloid 25660 Treat Wrist Dislocation 25670 Treat Wrist Dislocation 25671 Pin Radioulnar Dislocation 25675 510 Treat Wrist Dislocation $1,912 $1,243 $1,484 $625 25676 Treat Wrist Dislocation 25680 510 Treat Wrist Fracture $1,616 $1,050 $1,255 $529 25685 Treat Wrist Fracture 25690 450 Treat Wrist Dislocation $2,494 $1,621 $1,936 $817 25695 Treat Wrist Dislocation 25800 Fusion Of Wrist Joint 25805 Fusion/Graft Of Wrist Joint 25810 Fusion/Graft Of Wrist Joint 25820 Fusion Of Hand Bones 25825 Fuse Hand Bones With Graft 25830 Fusion Radioulnar Jnt/Ulna 25900 Amputation Of Forearm 25905 Amputation Of Forearm 25907 Amputation Follow-Up Surgery 25909 Amputation Follow-Up Surgery 25915 Amputation Of Forearm 25920 Amputate Hand At Wrist 25922 Amputate Hand At Wrist 25924 Amputation Follow-Up Surgery 25927 Amputation Of Hand 25929 Amputation Follow-Up Surgery 25931 Amputation Follow-Up Surgery 25999 Forearm Or Wrist Surgery 26010 510 Drainage Of Finger Abscess $492 $320 $382 $161 26011 510 Drainage Of Finger Abscess $1,364 $887 $1,059 $446 26020 Drain Hand Tendon Sheath $1,348 $876 $1,047 $442 26025 Drainage Of Palm Bursa 26030 Drainage Of Palm Bursas 26034 Treat Hand Bone Lesion 26035 Decompress Fingers/Hand 26037 Decompress Fingers/Hand 26040 Release Palm Contracture 26045 Release Palm Contracture 26055 510 Incise Finger Tendon Sheath $939 $610 $729 $308 26060 Incision Of Finger Tendon 26070 Explore/Treat Hand Joint 26075 Explore/Treat Finger Joint $997 $648 $774 $327 26080 Explore/Treat Finger Joint $1,211 $787 $940 $397 $388 26100 Biopsy Hand Joint Lining 26105 Biopsy Finger Joint Lining 26110 Biopsy Finger Joint Lining 26111 510 Exc Hand Les Sc 1.5 Cm/> 26113 Exc Hand Tum Deep 1.5 Cm/> 26115 510 Exc Hand Les Sc < 1.5 Cm $734 $477 $570 $241 26116 Exc Hand Tum Deep < 1.5 Cm $1,641 $1,067 $1,274 $538 26117 Rad Resect Hand Tumor < 3 Cm 26118 Rad Resect Hand Tumor 3 Cm/> 26121 Release Palm Contracture $1,857 $1,207 $1,442 $609 26123 Release Palm Contracture 26125 Release Palm Contracture 26130 Remove Wrist Joint Lining 26135 Revise Finger Joint Each 26140 Revise Finger Joint Each 26145 Tendon Excision Palm/Finger 26160 510 Remove Tendon Sheath Lesion $996 $647 $773 $326 26170 Removal Of Palm Tendon Each 26180 Removal Of Finger Tendon 26185 Remove Finger Bone 26200 Remove Hand Bone Lesion 26205 Remove/Graft Bone Lesion 26210 Removal Of Finger Lesion $1,375 $894 $1,067 $451 $208 26215 Remove/Graft Finger Lesion 26230 Partial Removal Of Hand Bone 26235 510 Partial Removal Finger Bone $1,245 $809 $966 $408 26236 510 Partial Removal Finger Bone $1,257 $817 $976 $412 26250 Extensive Hand Surgery 26260 Resect Prox Finger Tumor 26262 Resect Distal Finger Tumor 26320 Removal Of Implant From Hand 26340 Manipulate Finger W/Anesth 26341 Manipulat Palm Cord Post Inj $279 $181 $217 $91 $90 26350 Repair Finger/Hand Tendon $2,057 $1,337 $1,597 $674 $368 26352 Repair/Graft Hand Tendon 26356 Repair Finger/Hand Tendon 26357 Repair Finger/Hand Tendon 26358 Repair/Graft Hand Tendon 26370 Repair Finger/Hand Tendon 26372 Repair/Graft Hand Tendon 26373 Repair Finger/Hand Tendon 26390 Revise Hand/Finger Tendon 26392 Repair/Graft Hand Tendon 26410 510 Repair Hand Tendon $1,210 $787 $940 $397 26412 Repair/Graft Hand Tendon 26415 Excision Hand/Finger Tendon 26416 Graft Hand Or Finger Tendon 26418 510 Repair Finger Tendon $2,794 $1,816 $2,169 $914 $719 26420 Repair/Graft Finger Tendon 26426 Repair Finger/Hand Tendon 26428 Repair/Graft Finger Tendon 26432 Repair Finger Tendon 26433 Repair Finger Tendon 26434 Repair/Graft Finger Tendon 26437 Realignment Of Tendons $1,826 $1,187 $1,418 $598 26440 Release Palm/Finger Tendon 26442 Release Palm & Finger Tendon 26445 Release Hand/Finger Tendon 26449 Release Forearm/Hand Tendon 26450 Incision Of Palm Tendon 26455 Incision Of Finger Tendon 26460 Incise Hand/Finger Tendon 26471 Fusion Of Finger Tendons 26474 Fusion Of Finger Tendons 26476 Tendon Lengthening 26477 Tendon Shortening 26478 Lengthening Of Hand Tendon 26479 Shortening Of Hand Tendon 26480 Transplant Hand Tendon 26483 Transplant/Graft Hand Tendon $2,262 $1,470 $1,756 $741 $516 26485 Transplant Palm Tendon 26489 Transplant/Graft Palm Tendon 26490 Revise Thumb Tendon 26492 Tendon Transfer With Graft 26494 Hand Tendon/Muscle Transfer 26496 Revise Thumb Tendon 26497 Finger Tendon Transfer 26498 Finger Tendon Transfer 26499 Revision Of Finger 26500 510 Hand Tendon Reconstruction $3,680 $2,392 $2,857 $1,204 26502 Hand Tendon Reconstruction 26508 Release Thumb Contracture 26510 Thumb Tendon Transfer 26516 Fusion Of Knuckle Joint 26517 Fusion Of Knuckle Joints 26518 Fusion Of Knuckle Joints 26520 Release Knuckle Contracture 26525 Release Finger Contracture 26530 Revise Knuckle Joint 26531 Revise Knuckle With Implant 26535 Revise Finger Joint 26536 Revise/Implant Finger Joint 26540 Repair Hand Joint 26541 Repair Hand Joint With Graft 26542 Repair Hand Joint With Graft $1,834 $1,192 $1,424 $601 26545 Reconstruct Finger Joint 26546 Repair Nonunion Hand 26548 Reconstruct Finger Joint 26550 Construct Thumb Replacement 26551 Great Toe-Hand Transfer 26553 Single Transfer Toe-Hand 26554 Double Transfer Toe-Hand 26555 Positional Change Of Finger 26556 Toe Joint Transfer 26560 Repair Of Web Finger 26561 Repair Of Web Finger 26562 Repair Of Web Finger 26565 Correct Metacarpal Flaw 26567 Correct Finger Deformity 26568 Lengthen Metacarpal/Finger 26580 Repair Hand Deformity 26587 Reconstruct Extra Finger 26590 Repair Finger Deformity 26591 Repair Muscles Of Hand 26593 Release Muscles Of Hand 26596 Excision Constricting Tissue 26600 510 Treat Metacarpal Fracture $1,112 $723 $863 $364 $248 26605 510 Treat Metacarpal Fracture $1,040 $676 $807 $340 26607 Treat Metacarpal Fracture 26608 450 Treat Metacarpal Fracture $6,731 $4,375 $5,226 $2,206 $639 26615 Treat Metacarpal Fracture $1,635 $1,063 $1,270 $536 26641 983 Treat Thumb Dislocation $1,543 $1,003 $1,198 $505 26645 Treat Thumb Fracture 26650 Treat Thumb Fracture 26665 Treat Thumb Fracture 26670 510 Treat Hand Dislocation $1,118 $727 $868 $366 $53 26675 Treat Hand Dislocation $419 $272 $325 $137 26676 Pin Hand Dislocation 26685 Treat Hand Dislocation 26686 Treat Hand Dislocation 26700 510 Treat Knuckle Dislocation $1,357 $882 $1,054 $444 26705 510 Treat Knuckle Dislocation $2,030 $1,320 $1,576 $664 26706 Pin Knuckle Dislocation 26715 Treat Knuckle Dislocation 26720 510 Treat Finger Fracture Each $871 $566 $676 $285 $281 26725 510 Treat Finger Fracture Each $1,174 $763 $911 $384 26727 Treat Finger Fracture Each $1,438 $935 $1,116 $471 26735 Treat Finger Fracture Each 26740 510 Treat Finger Fracture Each $998 $649 $775 $327 $212 26742 510 Treat Finger Fracture Each $1,420 $923 $1,102 $465 26746 Treat Finger Fracture Each $1,856 $1,206 $1,441 $608 $440 26750 510 Treat Finger Fracture Each $776 $504 $602 $254 $245 26755 510 Treat Finger Fracture Each $1,041 $677 $808 $341 26756 Pin Finger Fracture Each $1,295 $841 $1,005 $424 26765 Treat Finger Fracture Each 26770 510 Treat Finger Dislocation $1,130 $735 $877 $370 26775 450 Treat Finger Dislocation $599 $389 $465 $196 26776 Pin Finger Dislocation 26785 Treat Finger Dislocation 26820 Thumb Fusion With Graft 26841 Fusion Of Thumb 26842 Thumb Fusion With Graft 26843 Fusion Of Hand Joint 26844 Fusion/Graft Of Hand Joint 26850 Fusion Of Knuckle 26852 Fusion Of Knuckle With Graft 26860 510 Fusion Of Finger Joint $2,683 $1,744 $2,083 $878 26861 Fusion Of Finger Jnt Add-On 26862 Fusion/Graft Of Finger Joint 26863 Fuse/Graft Added Joint 26910 Amputate Metacarpal Bone 26951 510 Amputation Of Finger/Thumb $2,497 $1,623 $1,939 $817 26952 510 Amputation Of Finger/Thumb $4,689 $3,048 $3,640 $1,534 26989 Hand/Finger Surgery 26990 510 Drainage Of Pelvis Lesion $2,551 $1,658 $1,980 $835 26991 Drainage Of Pelvis Bursa 26992 Drainage Of Bone Lesion 27000 Incision Of Hip Tendon 27001 Incision Of Hip Tendon 27003 Incision Of Hip Tendon 27005 Incision Of Hip Tendon 27006 Incision Of Hip Tendons 27025 Incision Of Hip/Thigh Fascia 27027 Buttock Fasciotomy 27030 Drainage Of Hip Joint 27033 Exploration Of Hip Joint 27035 Denervation Of Hip Joint 27036 Excision Of Hip Joint/Muscle 27040 Biopsy Of Soft Tissues 27041 Biopsy Of Soft Tissues 27043 510 Exc Hip Pelvis Les Sc 3 Cm/> $2,130 $1,384 $1,654 $698 $453 27045 Exc Hip/Pelv Tum Deep 5 Cm/> 27047 Exc Hip/Pelvis Les Sc < 3 Cm 27048 Exc Hip/Pelv Tum Deep < 5 Cm 27049 Resect Hip/Pelv Tum < 5 Cm 27050 Biopsy Of Sacroiliac Joint 27052 Biopsy Of Hip Joint 27054 Removal Of Hip Joint Lining 27057 Buttock Fasciotomy W/Dbrdmt 27059 Resect Hip/Pelv Tum 5 Cm/> 27060 Removal Of Ischial Bursa 27062 Remove Femur Lesion/Bursa 27065 Remove Hip Bone Les Super 27066 Remove Hip Bone Les Deep 27067 Remove/Graft Hip Bone Lesion 27070 Part Remove Hip Bone Super 27071 Part Removal Hip Bone Deep 27075 Resect Hip Tumor 27076 Resect Hip Tum Incl Acetabul 27077 Resect Hip Tum W/Innom Bone 27078 Rsect Hip Tum Incl Femur 27080 Removal Of Tail Bone 27086 Remove Hip Foreign Body 27087 Remove Hip Foreign Body 27090 Removal Of Hip Prosthesis 27091 Removal Of Hip Prosthesis 27093 Injection For Hip X-Ray $164 $106 $127 $54 27095 Injection For Hip X-Ray 27096 510 Inject Sacroiliac Joint $524 $341 $407 $172 $112 27097 Revision Of Hip Tendon 27098 Transfer Tendon To Pelvis 27100 Transfer Of Abdominal Muscle 27105 Transfer Of Spinal Muscle 27110 Transfer Of Iliopsoas Muscle 27111 Transfer Of Iliopsoas Muscle 27120 Reconstruction Of Hip Socket 27122 Reconstruction Of Hip Socket 27125 Partial Hip Replacement 27130 Total Hip Arthroplasty $4,335 $2,818 $3,366 $1,421 $934 27132 Total Hip Arthroplasty 27134 Revise Hip Joint Replacement 27137 Revise Hip Joint Replacement 27138 Revise Hip Joint Replacement 27140 Transplant Femur Ridge 27146 Incision Of Hip Bone 27147 Revision Of Hip Bone 27151 Incision Of Hip Bones 27156 Revision Of Hip Bones 27158 Revision Of Pelvis 27161 Incision Of Neck Of Femur 27165 Incision/Fixation Of Femur 27170 Repair/Graft Femur Head/Neck 27175 Treat Slipped Epiphysis 27176 Treat Slipped Epiphysis $2,377 $1,545 $1,846 $779 $0 27177 Treat Slipped Epiphysis 27178 Treat Slipped Epiphysis 27179 Revise Head/Neck Of Femur 27181 Treat Slipped Epiphysis 27185 Revision Of Femur Epiphysis 27187 Reinforce Hip Bones 27197 Clsd Tx Pelvic Ring Fx 27198 Clsd Tx Pelvic Ring Fx 27200 Treat Tail Bone Fracture 27202 Treat Tail Bone Fracture 27215 Treat Pelvic Fracture(S) 27216 Treat Pelvic Ring Fracture 27217 Treat Pelvic Ring Fracture 27218 Treat Pelvic Ring Fracture 27220 510 Treat Hip Socket Fracture $389 $253 $302 $128 27222 Treat Hip Socket Fracture 27226 Treat Hip Wall Fracture 27227 Treat Hip Fracture(S) 27228 Treat Hip Fracture(S) 27230 Treat Thigh Fracture 27232 510 Treat Thigh Fracture $1,716 $1,115 $1,332 $561 27235 Treat Thigh Fracture 27236 Treat Thigh Fracture 27238 Treat Thigh Fracture 27240 510 Treat Thigh Fracture $2,766 $1,798 $2,147 $905 27244 Treat Thigh Fracture 27245 Treat Thigh Fracture 27246 Treat Thigh Fracture 27248 Treat Thigh Fracture 27250 450 Treat Hip Dislocation $425 $276 $330 $139 27252 510 Treat Hip Dislocation $2,206 $1,434 $1,713 $722 27253 Treat Hip Dislocation 27254 Treat Hip Dislocation 27256 Treat Hip Dislocation 27257 510 Treat Hip Dislocation $1,303 $847 $1,012 $426 27258 Treat Hip Dislocation 27259 Treat Hip Dislocation 27265 450 Treat Hip Dislocation $599 $389 $465 $196 27266 Treat Hip Dislocation 27267 Cltx Thigh Fx 27268 Cltx Thigh Fx W/Mnpj 27269 Optx Thigh Fx 27275 Manipulation Of Hip Joint 27279 Arthrodesis Sacroiliac Joint 27280 Fusion Of Sacroiliac Joint 27282 Fusion Of Pubic Bones 27284 Fusion Of Hip Joint 27286 Fusion Of Hip Joint 27290 Amputation Of Leg At Hip 27295 Amputation Of Leg At Hip 27299 510 Pelvis/Hip Joint Surgery $387 $252 $300 $127 27301 510 Drain Thigh/Knee Lesion $1,855 $1,206 $1,440 $607 27303 Drainage Of Bone Lesion 27305 Incise Thigh Tendon & Fascia 27306 Incision Of Thigh Tendon 27307 Incision Of Thigh Tendons 27310 Exploration Of Knee Joint 27323 Biopsy Thigh Soft Tissues 27324 Biopsy Thigh Soft Tissues 27325 Neurectomy Hamstring 27326 Neurectomy Popliteal 27327 510 Exc Thigh/Knee Les Sc < 3 Cm $636 $413 $494 $208 27328 510 Exc Thigh/Knee Tum Deep <5Cm $2,130 $1,384 $1,654 $698 27329 Resect Thigh/Knee Tum < 5 Cm 27330 Biopsy Knee Joint Lining 27331 Explore/Treat Knee Joint 27332 Removal Of Knee Cartilage 27333 Removal Of Knee Cartilage 27334 Remove Knee Joint Lining 27335 Remove Knee Joint Lining 27337 510 Exc Thigh/Knee Les Sc 3 Cm/> $2,130 $1,384 $1,654 $698 $496 27339 510 Exc Thigh/Knee Tum Dep 5Cm/> $2,130 $1,384 $1,654 $698 27340 Removal Of Kneecap Bursa 27345 Removal Of Knee Cyst 27347 Remove Knee Cyst 27350 Removal Of Kneecap 27355 Remove Femur Lesion 27356 Remove Femur Lesion/Graft 27357 Remove Femur Lesion/Graft 27358 Remove Femur Lesion/Fixation 27360 Partial Removal Leg Bone(S) 27364 Resect Thigh/Knee Tum 5 Cm/> 27365 Resect Femur/Knee Tumor 27369 Njx Cntrst Kne Arthg/Ct/Mri 27372 510 Removal Of Foreign Body $3,205 $2,083 $2,488 $1,048 27380 Repair Of Kneecap Tendon 27381 Repair/Graft Kneecap Tendon 27385 Repair Of Thigh Muscle $1,777 $1,155 $1,380 $582 $419 27386 Repair/Graft Of Thigh Muscle 27390 Incision Of Thigh Tendon 27391 Incision Of Thigh Tendons 27392 Incision Of Thigh Tendons 27393 Lengthening Of Thigh Tendon 27394 Lengthening Of Thigh Tendons 27395 Lengthening Of Thigh Tendons 27396 Transplant Of Thigh Tendon 27397 Transplants Of Thigh Tendons 27400 Revise Thigh Muscles/Tendons 27403 Repair Of Knee Cartilage $1,978 $1,286 $1,536 $648 27405 Repair Of Knee Ligament 27407 Repair Of Knee Ligament 27409 Repair Of Knee Ligaments $2,649 $1,722 $2,057 $868 27412 Autochondrocyte Implant Knee 27415 Osteochondral Knee Allograft 27416 Osteochondral Knee Autograft 27418 Repair Degenerated Kneecap 27420 Revision Of Unstable Kneecap 27422 Revision Of Unstable Kneecap $2,297 $1,493 $1,783 $753 $265 27424 Revision/Removal Of Kneecap 27425 Lat Retinacular Release Open 27427 Reconstruction Knee $2,205 $1,433 $1,712 $723 27428 Reconstruction Knee 27429 Reconstruction Knee 27430 Revision Of Thigh Muscles 27435 Incision Of Knee Joint 27437 Revise Kneecap 27438 Revise Kneecap With Implant 27440 Revision Of Knee Joint 27441 Revision Of Knee Joint 27442 Revision Of Knee Joint 27443 Revision Of Knee Joint 27445 Revision Of Knee Joint 27446 Revision Of Knee Joint 27447 Total Knee Arthroplasty $4,175 $2,714 $3,242 $1,368 $647 27448 Incision Of Thigh 27450 Incision Of Thigh 27454 Realignment Of Thigh Bone 27455 Realignment Of Knee 27457 Realignment Of Knee 27465 Shortening Of Thigh Bone 27466 Lengthening Of Thigh Bone 27468 Shorten/Lengthen Thighs 27470 Repair Of Thigh 27472 Repair/Graft Of Thigh 27475 Surgery To Stop Leg Growth 27477 Surgery To Stop Leg Growth 27479 Surgery To Stop Leg Growth 27485 Surgery To Stop Leg Growth 27486 Revise/Replace Knee Joint 27487 Revise/Replace Knee Joint 27488 Removal Of Knee Prosthesis 27495 Reinforce Thigh 27496 Decompression Of Thigh/Knee 27497 Decompression Of Thigh/Knee 27498 Decompression Of Thigh/Knee 27499 Decompression Of Thigh/Knee 27500 510 Treatment Of Thigh Fracture $401 $261 $311 $131 27501 Treatment Of Thigh Fracture 27502 510 Treatment Of Thigh Fracture $2,755 $1,791 $2,139 $901 27503 Treatment Of Thigh Fracture 27506 Treatment Of Thigh Fracture 27507 Treatment Of Thigh Fracture 27508 510 Treatment Of Thigh Fracture $429 $279 $333 $141 27509 Treatment Of Thigh Fracture 27510 510 Treatment Of Thigh Fracture $2,409 $1,566 $1,870 $788 27511 Treatment Of Thigh Fracture 27513 Treatment Of Thigh Fracture 27514 Treatment Of Thigh Fracture 27516 Treat Thigh Fx Growth Plate 27517 Treat Thigh Fx Growth Plate 27519 Treat Thigh Fx Growth Plate 27520 510 Treat Kneecap Fracture $1,577 $1,025 $1,224 $516 $377 27524 Treat Kneecap Fracture 27530 510 Treat Knee Fracture $1,045 $679 $811 $342 $213 27532 Treat Knee Fracture 27535 Treat Knee Fracture $2,793 $1,816 $2,169 $915 27536 Treat Knee Fracture $3,701 $2,406 $2,874 $1,213 $340 27538 510 Treat Knee Fracture(S) $324 $211 $252 $106 27540 Treat Knee Fracture $2,440 $1,586 $1,894 $799 $207 27550 510 Treat Knee Dislocation $1,826 $1,187 $1,418 $597 27552 Treat Knee Dislocation 27556 Treat Knee Dislocation 27557 Treat Knee Dislocation 27558 Treat Knee Dislocation 27560 510 Treat Kneecap Dislocation $1,093 $710 $849 $358 27562 Treat Kneecap Dislocation 27566 Treat Kneecap Dislocation 27570 Fixation Of Knee Joint 27580 Fusion Of Knee 27590 Amputate Leg At Thigh 27591 Amputate Leg At Thigh 27592 Amputate Leg At Thigh 27594 Amputation Follow-Up Surgery 27596 Amputation Follow-Up Surgery 27598 Amputate Lower Leg At Knee 27599 Leg Surgery Procedure $1,400 $910 $1,087 $459 27600 Decompression Of Lower Leg 27601 Decompression Of Lower Leg 27602 Decompression Of Lower Leg $1,554 $1,010 $1,206 $509 27603 510 Drain Lower Leg Lesion $1,840 $1,196 $1,428 $602 27604 Drain Lower Leg Bursa 27605 Incision Of Achilles Tendon 27606 Incision Of Achilles Tendon 27607 Treat Lower Leg Bone Lesion 27610 Explore/Treat Ankle Joint 27612 Exploration Of Ankle Joint 27613 Biopsy Lower Leg Soft Tissue 27614 510 Biopsy Lower Leg Soft Tissue $2,164 $1,407 $1,680 $708 27615 Resect Leg/Ankle Tum < 5 Cm 27616 Resect Leg/Ankle Tum 5 Cm/> 27618 510 Exc Leg/Ankle Tum < 3 Cm $672 $437 $522 $220 27619 Exc Leg/Ankle Tum Deep <5 Cm 27620 Explore/Treat Ankle Joint 27625 Remove Ankle Joint Lining 27626 Remove Ankle Joint Lining $1,726 $1,122 $1,340 $566 $0 27630 Removal Of Tendon Lesion $1,407 $915 $1,093 $461 27632 Exc Leg/Ankle Les Sc 3 Cm/> 27634 Exc Leg/Ankle Tum Dep 5 Cm/> 27635 Remove Lower Leg Bone Lesion 27637 Remove/Graft Leg Bone Lesion 27638 Remove/Graft Leg Bone Lesion 27640 Partial Removal Of Tibia 27641 Partial Removal Of Fibula 27645 Resect Tibia Tumor 27646 Resect Fibula Tumor 27647 Resect Talus/Calcaneus Tum 27648 Injection For Ankle X-Ray 27650 Repair Achilles Tendon $2,023 $1,315 $1,570 $663 $268 27652 Repair/Graft Achilles Tendon 27654 Repair Of Achilles Tendon $2,202 $1,431 $1,710 $722 $404 27656 Repair Leg Fascia Defect 27658 510 Repair Of Leg Tendon Each $1,349 $877 $1,047 $441 27659 Repair Of Leg Tendon Each 27664 Repair Of Leg Tendon Each 27665 Repair Of Leg Tendon Each 27675 Repair Lower Leg Tendons 27676 Repair Lower Leg Tendons 27680 Release Of Lower Leg Tendon $1,333 $867 $1,035 $437 27681 Release Of Lower Leg Tendons 27685 510 Revision Of Lower Leg Tendon $1,149 $747 $892 $377 27686 Revise Lower Leg Tendons 27687 Revision Of Calf Tendon $1,182 $769 $918 $387 $0 27690 Revise Lower Leg Tendon 27691 Revise Lower Leg Tendon 27692 Revise Additional Leg Tendon 27695 Repair Of Ankle Ligament $1,477 $960 $1,147 $484 27696 Repair Of Ankle Ligaments $1,735 $1,128 $1,347 $569 27698 Repair Of Ankle Ligament $1,991 $1,294 $1,545 $652 $549 27700 Revision Of Ankle Joint 27702 Reconstruct Ankle Joint 27703 Reconstruction Ankle Joint 27704 Removal Of Ankle Implant 27705 Incision Of Tibia 27707 Incision Of Fibula 27709 Incision Of Tibia & Fibula 27712 Realignment Of Lower Leg 27715 Revision Of Lower Leg 27720 Repair Of Tibia 27722 Repair/Graft Of Tibia 27724 Repair/Graft Of Tibia 27725 Repair Of Lower Leg 27726 Repair Fibula Nonunion 27727 Repair Of Lower Leg 27730 Repair Of Tibia Epiphysis 27732 Repair Of Fibula Epiphysis 27734 Repair Lower Leg Epiphyses 27740 Repair Of Leg Epiphyses 27742 Repair Of Leg Epiphyses 27745 Reinforce Tibia 27750 510 Treatment Of Tibia Fracture $1,444 $939 $1,121 $472 $266 27752 510 Treatment Of Tibia Fracture $1,781 $1,158 $1,383 $583 27756 Treatment Of Tibia Fracture 27758 Treatment Of Tibia Fracture $2,685 $1,745 $2,085 $880 $742 27759 Treatment Of Tibia Fracture $3,093 $2,010 $2,401 $1,013 $883 27760 510 Cltx Medial Ankle Fx $1,139 $740 $884 $373 $285 27762 510 Cltx Med Ankle Fx W/Mnpj $1,662 $1,080 $1,290 $544 27766 Optx Medial Ankle Fx $1,839 $1,195 $1,427 $602 $596 27767 510 Cltx Post Ankle Fx $198 $129 $154 $65 27768 Cltx Post Ankle Fx W/Mnpj 27769 Optx Post Ankle Fx 27780 510 Treatment Of Fibula Fracture $264 $171 $205 $86 27781 450 Treatment Of Fibula Fracture $3,465 $2,252 $2,690 $1,135 27784 Treatment Of Fibula Fracture $1,819 $1,183 $1,412 $596 27786 510 Treatment Of Ankle Fracture $1,552 $1,009 $1,205 $508 $259 27788 510 Treatment Of Ankle Fracture $1,457 $947 $1,131 $477 $0 27792 Treatment Of Ankle Fracture $2,020 $1,313 $1,569 $662 27808 510 Treatment Of Ankle Fracture $1,114 $724 $865 $364 $198 27810 510 Treatment Of Ankle Fracture $2,216 $1,440 $1,720 $725 27814 Treatment Of Ankle Fracture $2,389 $1,553 $1,854 $783 $476 27816 510 Treatment Of Ankle Fracture $1,085 $705 $842 $355 27818 510 Treatment Of Ankle Fracture $1,619 $1,052 $1,257 $530 $234 27822 Treatment Of Ankle Fracture $2,642 $1,717 $2,051 $866 $649 27823 Treatment Of Ankle Fracture 27824 510 Treat Lower Leg Fracture $1,333 $866 $1,035 $436 27825 510 Treat Lower Leg Fracture $1,476 $959 $1,146 $483 27826 Treat Lower Leg Fracture 27827 Treat Lower Leg Fracture 27828 Treat Lower Leg Fracture 27829 Treat Lower Leg Joint $1,769 $1,150 $1,374 $580 27830 510 Treat Lower Leg Dislocation $1,311 $852 $1,018 $429 27831 Treat Lower Leg Dislocation 27832 Treat Lower Leg Dislocation 27840 510 Treat Ankle Dislocation $1,751 $1,138 $1,359 $573 27842 510 Treat Ankle Dislocation $1,783 $1,159 $1,384 $583 27846 Treat Ankle Dislocation 27848 Treat Ankle Dislocation 27860 Fixation Of Ankle Joint 27870 Fusion Of Ankle Joint Open 27871 Fusion Of Tibiofibular Joint 27880 Amputation Of Lower Leg 27881 Amputation Of Lower Leg 27882 Amputation Of Lower Leg 27884 Amputation Follow-Up Surgery 27886 Amputation Follow-Up Surgery 27888 Amputation Of Foot At Ankle 27889 Amputation Of Foot At Ankle 27892 Decompression Of Leg 27893 Decompression Of Leg 27894 Decompression Of Leg 27899 Leg/Ankle Surgery Procedure 28001 Drainage Of Bursa Of Foot 28002 Treatment Of Foot Infection 28003 Treatment Of Foot Infection 28005 Treat Foot Bone Lesion 28008 Incision Of Foot Fascia $1,352 $879 $1,050 $443 $373 28010 510 Incision Of Toe Tendon $106 $69 $83 $35 28011 Incision Of Toe Tendons 28020 Exploration Of Foot Joint 28022 Exploration Of Foot Joint 28024 Exploration Of Toe Joint 28035 Decompression Of Tibia Nerve $1,012 $658 $786 $332 28039 Exc Foot/Toe Tum Sc 1.5 Cm/> 28041 510 Exc Foot/Toe Tum Dep 1.5Cm/> $1,499 $974 $1,164 $490 28043 Exc Foot/Toe Tum Sc < 1.5 Cm 28045 Exc Foot/Toe Tum Deep <1.5Cm 28046 Resect Foot/Toe Tumor < 3 Cm 28047 Resect Foot/Toe Tumor 3 Cm/> 28050 Biopsy Of Foot Joint Lining 28052 Biopsy Of Foot Joint Lining 28054 Biopsy Of Toe Joint Lining 28055 Neurectomy Foot 28060 Partial Removal Foot Fascia 28062 Removal Of Foot Fascia 28070 Removal Of Foot Joint Lining 28072 Removal Of Foot Joint Lining 28080 Removal Of Foot Lesion 28086 Excise Foot Tendon Sheath 28088 Excise Foot Tendon Sheath 28090 Removal Of Foot Lesion 28092 Removal Of Toe Lesions 28100 Removal Of Ankle/Heel Lesion 28102 Remove/Graft Foot Lesion 28103 Remove/Graft Foot Lesion 28104 Removal Of Foot Lesion 28106 Remove/Graft Foot Lesion 28107 Remove/Graft Foot Lesion 28108 Removal Of Toe Lesions $672 $437 $522 $220 28110 Part Removal Of Metatarsal 28111 Part Removal Of Metatarsal 28112 Part Removal Of Metatarsal 28113 Part Removal Of Metatarsal 28114 Removal Of Metatarsal Heads 28116 Revision Of Foot 28118 Removal Of Heel Bone 28119 Removal Of Heel Spur 28120 Part Removal Of Ankle/Heel $1,164 $757 $904 $381 28122 510 Partial Removal Of Foot Bone $2,076 $1,349 $1,612 $679 28124 510 Partial Removal Of Toe $1,485 $965 $1,153 $486 28126 Partial Removal Of Toe 28130 Removal Of Ankle Bone 28140 Removal Of Metatarsal 28150 Removal Of Toe 28153 Partial Removal Of Toe 28160 450 Partial Removal Of Toe $7,277 $4,730 $5,649 $2,384 28171 Resect Tarsal Tumor 28173 Resect Metatarsal Tumor 28175 Resect Phalanx Of Toe Tumor 28190 510 Removal Of Foot Foreign Body $1,118 $727 $868 $366 $287 28192 450 Removal Of Foot Foreign Body $3,716 $2,415 $2,885 $1,218 $424 28193 450 Removal Of Foot Foreign Body $2,082 $1,353 $1,616 $682 28200 Repair Of Foot Tendon $1,418 $921 $1,101 $464 28202 Repair/Graft Of Foot Tendon 28208 Repair Of Foot Tendon 28210 Repair/Graft Of Foot Tendon 28220 Release Of Foot Tendon $870 $566 $676 $285 28222 Release Of Foot Tendons 28225 Release Of Foot Tendon 28226 Release Of Foot Tendons 28230 Incision Of Foot Tendon(S) $1,107 $720 $860 $363 28232 Incision Of Toe Tendon 28234 Incision Of Foot Tendon 28238 Revision Of Foot Tendon 28240 Release Of Big Toe 28250 Revision Of Foot Fascia 28260 Release Of Midfoot Joint 28261 Revision Of Foot Tendon 28262 Revision Of Foot And Ankle 28264 Release Of Midfoot Joint 28270 Release Of Foot Contracture 28272 Release Of Toe Joint Each 28280 Fusion Of Toes 28285 Repair Of Hammertoe $1,533 $996 $1,190 $502 28286 Repair Of Hammertoe 28288 Partial Removal Of Foot Bone $1,750 $1,138 $1,359 $573 $519 28289 Corrj Halux Rigdus W/O Implt 28291 Corrj Halux Rigdus W/Implt 28292 Correction Hallux Valgus 28295 Correction Hallux Valgus 28296 Correction Hallux Valgus $2,315 $1,505 $1,797 $759 $671 28297 Correction Hallux Valgus $2,639 $1,716 $2,049 $865 $593 28298 Correction Hallux Valgus 28299 Correction Hallux Valgus $2,189 $1,423 $1,700 $717 28300 Incision Of Heel Bone $2,030 $1,320 $1,576 $665 28302 Incision Of Ankle Bone 28304 Incision Of Midfoot Bones 28305 Incise/Graft Midfoot Bones 28306 Incision Of Metatarsal $939 $610 $729 $308 28307 Incision Of Metatarsal 28308 Incision Of Metatarsal $893 $581 $694 $293 28309 Incision Of Metatarsals 28310 Revision Of Big Toe 28312 Revision Of Toe 28313 Repair Deformity Of Toe $1,582 $1,028 $1,228 $518 28315 Removal Of Sesamoid Bone $1,384 $900 $1,074 $454 28320 Repair Of Foot Bones 28322 Repair Of Metatarsals 28340 Resect Enlarged Toe Tissue 28341 Resect Enlarged Toe 28344 Repair Extra Toe(S) 28345 Repair Webbed Toe(S) 28360 Reconstruct Cleft Foot 28400 510 Treatment Of Heel Fracture $1,112 $723 $863 $364 28405 Treatment Of Heel Fracture 28406 Treatment Of Heel Fracture 28415 Treat Heel Fracture $3,472 $2,257 $2,695 $1,138 28420 Treat/Graft Heel Fracture 28430 510 Treatment Of Ankle Fracture $799 $519 $620 $261 28435 Treatment Of Ankle Fracture 28436 Treatment Of Ankle Fracture 28445 Treat Ankle Fracture 28446 Osteochondral Talus Autogrft 28450 510 Treat Midfoot Fracture Each $1,232 $801 $956 $403 28455 510 Treat Midfoot Fracture Each $131 $85 $102 $43 28456 Treat Midfoot Fracture 28465 Treat Midfoot Fracture Each 28470 510 Treat Metatarsal Fracture $922 $599 $716 $302 28475 450 Treat Metatarsal Fracture $380 $247 $295 $125 28476 Treat Metatarsal Fracture 28485 Treat Metatarsal Fracture $1,682 $1,093 $1,306 $551 28490 510 Treat Big Toe Fracture $816 $530 $633 $267 28495 450 Treat Big Toe Fracture $599 $389 $465 $196 28496 Treat Big Toe Fracture 28505 Treat Big Toe Fracture 28510 510 Treatment Of Toe Fracture $575 $374 $446 $188 28515 510 Treatment Of Toe Fracture $578 $376 $449 $189 28525 Treat Toe Fracture 28530 510 Treat Sesamoid Bone Fracture $97 $63 $75 $32 28531 Treat Sesamoid Bone Fracture 28540 510 Treat Foot Dislocation $679 $441 $527 $222 28545 Treat Foot Dislocation 28546 Treat Foot Dislocation 28555 Repair Foot Dislocation 28570 510 Treat Foot Dislocation $739 $480 $574 $242 28575 Treat Foot Dislocation 28576 Treat Foot Dislocation 28585 Repair Foot Dislocation 28600 Treat Foot Dislocation 28605 Treat Foot Dislocation 28606 Treat Foot Dislocation 28615 Repair Foot Dislocation 28630 450 Treat Toe Dislocation $599 $389 $465 $196 28635 Treat Toe Dislocation 28636 Treat Toe Dislocation 28645 Repair Toe Dislocation 28660 510 Treat Toe Dislocation $636 $413 $494 $208 28665 Treat Toe Dislocation 28666 Treat Toe Dislocation 28675 Repair Of Toe Dislocation 28705 Fusion Of Foot Bones 28715 Fusion Of Foot Bones 28725 Fusion Of Foot Bones $2,422 $1,574 $1,880 $794 28730 Fusion Of Foot Bones 28735 Fusion Of Foot Bones $2,444 $1,588 $1,897 $801 28737 Revision Of Foot Bones 28740 Fusion Of Foot Bones 28750 Fusion Of Big Toe Joint 28755 Fusion Of Big Toe Joint 28760 Fusion Of Big Toe Joint 28800 Amputation Of Midfoot 28805 Amputation Thru Metatarsal $2,305 $1,498 $1,789 $755 $721 28810 Amputation Toe & Metatarsal 28820 Amputation Of Toe $1,273 $827 $988 $417 28825 510 Partial Amputation Of Toe $1,882 $1,223 $1,461 $616 28890 Hi Enrgy Eswt Plantar Fascia 28899 Foot/Toes Surgery Procedure 29000 Application Of Body Cast 29010 Application Of Body Cast 29015 Application Of Body Cast 29035 Application Of Body Cast 29040 Application Of Body Cast 29044 Application Of Body Cast 29046 Application Of Body Cast 29049 Application Of Figure Eight 29055 Application Of Shoulder Cast 29058 Application Of Shoulder Cast 29065 510 Application Of Long Arm Cast $676 $439 $525 $221 29075 510 Application Of Forearm Cast $542 $352 $421 $177 29085 510 Apply Hand/Wrist Cast $435 $283 $338 $142 $119 29086 510 Apply Finger Cast $236 $153 $183 $77 29105 983 Apply Long Arm Splint $449 $292 $349 $147 29125 983 Apply Forearm Splint $323 $210 $251 $106 29126 510 Apply Forearm Splint $166 $108 $129 $54 29130 983 Application Of Finger Splint $259 $168 $201 $85 29131 510 Application Of Finger Splint $267 $174 $207 $87 29200 510 Strapping Of Chest $49 $32 $38 $16 29240 983 Strapping Of Shoulder $438 $285 $340 $143 29260 510 Strapping Of Elbow Or Wrist $141 $92 $109 $46 29280 510 Strapping Of Hand Or Finger $100 $65 $78 $33 29305 510 Application Of Hip Cast $820 $533 $637 $268 29325 Application Of Hip Casts 29345 510 Application Of Long Leg Cast $908 $590 $705 $297 $0 29355 510 Application Of Long Leg Cast $1,003 $652 $779 $328 29358 Apply Long Leg Cast Brace 29365 Application Of Long Leg Cast 29405 510 Apply Short Leg Cast $599 $389 $465 $196 29425 510 Apply Short Leg Cast $679 $441 $527 $222 29435 Apply Short Leg Cast 29440 Addition Of Walker To Cast 29445 Apply Rigid Leg Cast 29450 510 Application Of Leg Cast $108 $70 $84 $35 29505 983 Application Long Leg Splint $446 $290 $346 $146 29515 983 Application Lower Leg Splint $399 $259 $310 $131 29520 Strapping Of Hip 29530 510 Strapping Of Knee $101 $66 $78 $33 29540 983 Strapping Of Ankle And/Or Ft $129 $84 $100 $42 29550 510 Strapping Of Toes $29 $19 $23 $10 29580 510 Application Of Paste Boot $259 $168 $201 $85 29581 983 Apply Multlay Comprs Lwr Leg $240 $156 $186 $79 29584 510 Appl Multlay Comprs Arm/Hand $228 $148 $177 $75 29700 510 Removal/Revision Of Cast $221 $144 $172 $72 29705 510 Removal/Revision Of Cast $182 $118 $141 $60 29710 Removal/Revision Of Cast 29720 Repair Of Body Cast 29730 Windowing Of Cast 29740 Wedging Of Cast 29750 Wedging Of Clubfoot Cast 29799 510 Casting/Strapping Procedure $101 $66 $79 $33 29800 Jaw Arthroscopy/Surgery 29804 Jaw Arthroscopy/Surgery 29805 Sho Arthrs Dx +- Synovial Bx 29806 Sho Arthrs Srg Capsulorpaphy $3,260 $2,119 $2,531 $1,068 $1,036 29807 Sho Arthrs Srg Rpr Slap Les $3,295 $2,142 $2,558 $1,080 29819 Sho Arthrs Srg Rmvl Loose/Fb $1,716 $1,116 $1,333 $562 29820 Sho Arthrs Srg Prtl Synvct 29821 Sho Arthrs Srg Compl Synvct 29822 Sho Arthrs Srg Lmtd Dbrdmt $1,764 $1,147 $1,370 $578 29823 Sho Arthrs Srg Xtnsv Dbrdmt $1,908 $1,240 $1,481 $625 29824 Sho Arthrs Srg Dstl Claviclc $2,057 $1,337 $1,597 $674 29825 Sho Arthrs Srg Lss&Rescj Ads 29826 Sho Arthrs Srg Decompression $561 $365 $436 $184 29827 Sho Arthrs Srg Rt8Tr Cuf Rpr $3,265 $2,122 $2,534 $1,070 29828 Sho Arthrs Srg Bicp Tenodsis $2,789 $1,813 $2,165 $914 29830 Elbow Arthroscopy 29834 Elbow Arthroscopy/Surgery 29835 Elbow Arthroscopy/Surgery 29836 Elbow Arthroscopy/Surgery 29837 Elbow Arthroscopy/Surgery 29838 Elbow Arthroscopy/Surgery 29840 Wrist Arthroscopy 29843 Wrist Arthroscopy/Surgery 29844 Wrist Arthroscopy/Surgery 29845 Wrist Arthroscopy/Surgery 29846 Wrist Arthroscopy/Surgery 29847 Wrist Arthroscopy/Surgery 29848 Wrist Endoscopy/Surgery 29850 Knee Arthroscopy/Surgery 29851 Knee Arthroscopy/Surgery 29855 Tibial Arthroscopy/Surgery $1,974 $1,283 $1,532 $647 $597 29856 Tibial Arthroscopy/Surgery 29860 Hip Arthroscopy Dx 29861 Hip Arthro W/Fb Removal 29862 Hip Arthr0 W/Debridement 29863 Hip Arthr0 W/Synovectomy 29866 Autgrft Implnt Knee W/Scope 29867 Allgrft Implnt Knee W/Scope 29868 Meniscal Trnspl Knee W/Scpe $4,764 $3,097 $3,699 $1,561 $237 29870 Knee Arthroscopy Dx 29871 Knee Arthroscopy/Drainage 29873 Knee Arthroscopy/Surgery $1,290 $838 $1,001 $423 29874 Knee Arthroscopy/Surgery $1,671 $1,086 $1,297 $547 29875 Knee Arthroscopy/Surgery $1,533 $997 $1,190 $502 $485 29876 Knee Arthroscopy/Surgery $2,045 $1,329 $1,588 $670 29877 Knee Arthroscopy/Surgery 29879 Knee Arthroscopy/Surgery $2,052 $1,334 $1,593 $672 29880 Knee Arthroscopy/Surgery $1,791 $1,164 $1,390 $587 $502 29881 Knee Arthroscopy/Surgery $1,664 $1,082 $1,292 $545 29882 Knee Arthroscopy/Surgery $2,212 $1,438 $1,718 $725 29883 Knee Arthroscopy/Surgery 29884 Knee Arthroscopy/Surgery $1,761 $1,145 $1,367 $577 $367 29885 Knee Arthroscopy/Surgery 29886 Knee Arthroscopy/Surgery 29887 Knee Arthroscopy/Surgery 29888 Knee Arthroscopy/Surgery $3,120 $2,028 $2,422 $1,022 $877 29889 Knee Arthroscopy/Surgery $3,482 $2,263 $2,703 $1,141 29891 Ankle Arthroscopy/Surgery 29892 Ankle Arthroscopy/Surgery 29893 Scope Plantar Fasciotomy $1,530 $995 $1,188 $501 $500 29894 Ankle Arthroscopy/Surgery 29895 Ankle Arthroscopy/Surgery 29897 Ankle Arthroscopy/Surgery 29898 Ankle Arthroscopy/Surgery $1,763 $1,146 $1,368 $578 29899 Ankle Arthroscopy/Surgery 29900 Mcp Joint Arthroscopy Dx 29901 Mcp Joint Arthroscopy Surg 29902 Mcp Joint Arthroscopy Surg 29904 Subtalar Arthro W/Fb Rmvl 29905 Subtalar Arthro W/Exc 29906 Subtalar Arthro W/Deb 29907 Subtalar Arthro W/Fusion 29914 Hip Arthro W/Femoroplasty $2,822 $1,835 $2,191 $925 29915 Hip Arthro Acetabuloplasty 29916 Hip Arthro W/Labral Repair $2,876 $1,870 $2,233 $942 29999 Arthroscopy Of Joint $1,700 $1,105 $1,320 $557 30000 Drainage Of Nose Lesion 30020 Drainage Of Nose Lesion 3006F Cxr Doc Rev 3008F Body Mass Index Docd $0 $0 $0 $0 30100 510 Intranasal Biopsy $245 $159 $190 $80 30110 510 Removal Of Nose Polyp(S) $375 $244 $291 $123 30115 Removal Of Nose Polyp(S) 30117 Removal Of Intranasal Lesion 30118 Removal Of Intranasal Lesion 3011F Lipid Panel Doc Rev 30120 510 Revision Of Nose $319 $207 $248 $104 30124 Removal Of Nose Lesion 30125 Removal Of Nose Lesion 30130 Excise Inferior Turbinate 30140 Resect Inferior Turbinate $1,271 $826 $987 $416 3014F Screen Mammo Doc Rev $0 $0 $0 $0 30150 Partial Removal Of Nose 3015F Cerv Cancer Screen Docd $0 $0 $0 $0 30160 Removal Of Nose 3016F Pt Scrnd Unhlthy Oh Use 3017F Colorectal Ca Screen Doc Rev 3018F Pre-Prxd Rsk Et Al Docd 3019F Lvef Assess Planpost Dschrge 30200 Injection Treatment Of Nose 3020F Lvf Assess 30210 Nasal Sinus Therapy 3021F Lvef Mod/Sever Deprs Syst 30220 510 Insert Nasal Septal Button $458 $298 $355 $150 3022F Lvef >/=40% Systolic 3023F Spirom Doc Rev 3025F Spirom Fev/Fvc <70% W/Copd 3027F Spirom Fev/Fvc>/=70%/W/Ocopd 3028F O2 Saturation Doc Rev 30300 510 Remove Nasal Foreign Body $599 $389 $465 $196 30310 Remove Nasal Foreign Body 30320 Remove Nasal Foreign Body 3035F O2 Saturation88%/Pao>55 Hg 3038F Pulm Fx W/In 12 Mon B/4 Surg 30400 Reconstruction Of Nose 3040F Fev <40% Predicted Value 30410 Reconstruction Of Nose 30420 Reconstruction Of Nose 3042F Fev >/=40% Predicted Value 30430 Revision Of Nose 30435 Revision Of Nose 3044F Hg A1C Level Lt 7.0% $0 $0 $0 $0 30450 Revision Of Nose 30460 Revision Of Nose 30462 Revision Of Nose 30465 Repair Nasal Stenosis $2,952 $1,919 $2,292 $967 $690 30468 Rpr Nsl Vlv Collapse W/Implt 3046F Hemoglobin A1C Level >9.0% $0 $0 $0 $0 3048F Ldl-C <100 Mg/Dl 3049F Ldl-C 100-129 Mg/Dl 3050F Ldl-C >/= 130 Mg/Dl 3051F Hg A1C>Equal 7.0%<8.0% $0 $0 $0 $0 30520 Repair Of Nasal Septum $1,570 $1,021 $1,219 $515 3052F Hg A1C>Equal 8.0%/= 140 Mm Hg $0 $0 $0 $0 3078F Diast Bp <80 Mm Hg $0 $0 $0 $0 3079F Diast Bp 80-89 Mm Hg $0 $0 $0 $0 30801 Ablate Inf Turbinate Superf $332 $216 $258 $109 $71 30802 Ablate Inf Turbinate Submuc $449 $292 $348 $147 3080F Diast Bp >/= 90 Mm Hg $0 $0 $0 $0 3082F Kt/V <1.2 3083F Kt/V =/> 1.2 & <1.7 3084F Kt/V >= 1.7 3085F Suicide Risk Assessed 3088F Mdd Mild 3089F Mdd Moderate 30901 983 Control Of Nosebleed $311 $202 $241 $102 30903 510 Control Of Nosebleed $232 $151 $180 $76 30905 510 Control Of Nosebleed $248 $161 $192 $81 30906 450 Repeat Control Of Nosebleed $366 $238 $284 $120 3090F Mdd Severe W/O Psych 30915 Ligation Nasal Sinus Artery 3091F Mdd Severe W/Psych 30920 Ligation Upper Jaw Artery 3092F Mdd In Remission 30930 Ther Fx Nasal Inf Turbinate 3093F Doc New Diag 1St/Addl Mdd 3095F Central Dexa Results Docd 3096F Central Dexa Ordered 30999 450 Nasal Surgery Procedure $525 $341 $408 $172 31000 Irrigation Maxillary Sinus 31002 Irrigation Sphenoid Sinus 3100F Image Test Ref Carot Diam 31020 Exploration Maxillary Sinus 31030 Exploration Maxillary Sinus 31032 Explore Sinus Remove Polyps 31040 Exploration Behind Upper Jaw 31050 Exploration Sphenoid Sinus 31051 Sphenoid Sinus Surgery 31070 Exploration Of Frontal Sinus 31075 Exploration Of Frontal Sinus 31080 Removal Of Frontal Sinus 31081 Removal Of Frontal Sinus 31084 Removal Of Frontal Sinus 31085 Removal Of Frontal Sinus 31086 Removal Of Frontal Sinus 31087 Removal Of Frontal Sinus 31090 Exploration Of Sinuses 3110F Pres/Absn Hmrhg/Lesion Docd 3111F Ct/Mri Brain Done W/In 24Hrs 3112F Ct/Mri Brain Done 24 Hrs 3115F Quant Results Activity &Symp 3117F Hf Assessment Tool Completed 3118F Ny Heart Assoc Class Docd 3119F No Eval Activity Clin Symp 31200 Removal Of Ethmoid Sinus 31201 Removal Of Ethmoid Sinus 31205 Removal Of Ethmoid Sinus 3120F 12-Lead Ecg Performed $0 $0 $0 $0 31225 Removal Of Upper Jaw 31230 Removal Of Upper Jaw 31231 510 Nasal Endoscopy Dx $462 $300 $359 $151 31233 Nsl/Sins Ndsc Dx Max Sinusc 31235 Nsl/Sins Ndsc Dx Sphn Sinusc 31237 510 Nasal/Sinus Endoscopy Surg $406 $264 $315 $133 31238 510 Nasal/Sinus Endoscopy Surg $364 $237 $283 $119 31239 Nasal/Sinus Endoscopy Surg 31240 Nasal/Sinus Endoscopy Surg $504 $327 $391 $165 31241 Nsl/Sins Ndsc W/Artery Lig 31253 Nsl/Sins Ndsc Total 31254 Nsl/Sins Ndsc W/Prtl Ethmdct $966 $628 $750 $317 31255 Nsl/Sins Ndsc W/Tot Ethmdct $1,256 $816 $975 $411 31256 Exploration Maxillary Sinus $620 $403 $481 $203 31257 Nsl/Sins Ndsc Tot W/Sphendt 31259 Nsl/Sins Ndsc Sphn Tiss Rmvl 31267 Endoscopy Maxillary Sinus $995 $647 $773 $326 3126F Esoph Bx Rprt W/Dyspl Info 31276 Nsl/Sins Ndsc Frnt Tiss Rmvl 31287 Nasal/Sinus Endoscopy Surg 31288 Nasal/Sinus Endoscopy Surg 31290 Nasal/Sinus Endoscopy Surg 31291 Nasal/Sinus Endoscopy Surg 31292 Nsl/Sins Ndsc Med/Inf Dcmprn 31293 Nsl/Sins Ndsc Med&Inf Dcmprn 31294 Nsl/Sins Ndsc Surg On Dcmprn 31295 Nsl/Sins Ndsc Surg Max Sins 31296 510 Nsl/Sins Ndsc Surg Frnt Sins $5,702 $3,706 $4,427 $1,868 $576 31297 Nsl/Sins Ndsc Surg Sphn Sins 31298 Nsl/Sins Ndsc Surg Frnt&Sphn 31299 Sinus Surgery Procedure 31300 Removal Of Larynx Lesion 3130F Upper Gi Endoscopy Performed 3132F Doc Ref Upper Gi Endoscopy 31360 Removal Of Larynx 31365 Removal Of Larynx 31367 Partial Removal Of Larynx 31368 Partial Removal Of Larynx 31370 Partial Removal Of Larynx 31375 Partial Removal Of Larynx 31380 Partial Removal Of Larynx 31382 Partial Removal Of Larynx 31390 Removal Of Larynx & Pharynx 31395 Reconstruct Larynx & Pharynx 31400 Revision Of Larynx 3140F Upper Gi Endo Shows Barrtts 3141F Upper Gi Endo Not Barrtts 31420 Removal Of Epiglottis 3142F Barium Swallow Test Ordered 31500 983 Insert Emergency Airway $847 $551 $658 $277 31502 Change Of Windpipe Airway $110 $71 $85 $36 31505 Diagnostic Laryngoscopy 3150F Forceps Esoph Biopsy Done 31510 Laryngoscopy With Biopsy 31511 Remove Foreign Body Larynx 31512 Removal Of Larynx Lesion 31513 Injection Into Vocal Cord 31515 Laryngoscopy For Aspiration 31520 Dx Laryngoscopy Newborn 31525 Dx Laryngoscopy Excl Nb $710 $461 $551 $233 $158 31526 Dx Laryngoscopy W/Oper Scope 31527 Laryngoscopy For Treatment 31528 Laryngoscopy And Dilation 31529 Laryngoscopy And Dilation 31530 Laryngoscopy W/Fb Removal 31531 Laryngoscopy W/Fb & Op Scope 31535 Laryngoscopy W/Biopsy $598 $389 $464 $196 31536 Laryngoscopy W/Bx & Op Scope $666 $433 $517 $218 31540 Laryngoscopy W/Exc Of Tumor 31541 Larynscop W/Tumr Exc + Scope $832 $541 $646 $273 31545 Remove Vc Lesion W/Scope 31546 Remove Vc Lesion Scope/Graft 31551 Laryngoplasty Laryngeal Sten 31552 Laryngoplasty Laryngeal Sten 31553 Laryngoplasty Laryngeal Sten 31554 Laryngoplasty Laryngeal Sten 3155F Cytogen Test Marrow B/4 Tx 31560 Laryngoscop W/Arytenoidectom 31561 Larynscop Remve Cart + Scop 31570 Laryngoscope W/Vc Inj 31571 Laryngoscop W/Vc Inj + Scope $645 $419 $500 $211 31572 Largsc W/Laser Dstrj Les 31573 Largsc W/Ther Injection 31574 Largsc W/Njx Augmentation 31575 510 Diagnostic Laryngoscopy $187 $122 $146 $61 31576 510 Laryngoscopy With Biopsy $363 $236 $282 $119 31577 Largsc W/Rmvl Foreign Bdy(S) 31578 Largsc W/Removal Lesion 31579 Laryngoscopy Telescopic 31580 Laryngoplasty Laryngeal Web 31584 Laryngoplasty Fx Rdctj Fixj 31587 Laryngoplasty Cricoid Split 31590 Reinnervate Larynx 31591 Laryngoplasty Medialization 31592 Cricotracheal Resection 31599 Larynx Surgery Procedure 31600 Incision Of Windpipe 31601 Incision Of Windpipe 31603 Incision Of Windpipe 31605 450 Incision Of Windpipe $478 $311 $371 $157 3160F Doc Fe+ Stores B/4 Epo Thx 31610 Incision Of Windpipe 31611 Surgery/Speech Prosthesis 31612 Puncture/Clear Windpipe 31613 Repair Windpipe Opening 31614 Repair Windpipe Opening 31615 Visualization Of Windpipe 31622 Dx Bronchoscope/Wash 31623 Dx Bronchoscope/Brush 31624 Dx Bronchoscope/Lavage 31625 Bronchoscopy W/Biopsy(S) 31626 Bronchoscopy W/Markers 31627 360 Navigational Bronchoscopy $4,509 $2,931 $3,501 $1,477 31628 Bronchoscopy/Lung Bx Each 31629 Bronchoscopy/Needle Bx Each 31630 Bronchoscopy Dilate/Fx Repr 31631 Bronchoscopy Dilate W/Stent 31632 Bronchoscopy/Lung Bx Addl 31633 Bronchoscopy/Needle Bx Addl 31634 Bronch W/Balloon Occlusion 31635 Bronchoscopy W/Fb Removal 31636 Bronchoscopy Bronch Stents 31637 Bronchoscopy Stent Add-On 31638 Bronchoscopy Revise Stent 31640 Bronchoscopy W/Tumor Excise 31641 Bronchoscopy Treat Blockage 31643 Diag Bronchoscope/Catheter 31645 Brnchsc W/Ther Aspir 1St 31646 Brnchsc W/Ther Aspir Sbsq 31647 Bronchial Valve Init Insert 31648 Bronchial Valve Remov Init 31649 Bronchial Valve Remov Addl 31651 Bronchial Valve Addl Insert 31652 Bronch Ebus Samplng 1/2 Node 31653 Bronch Ebus Samplng 3/> Node 31654 Bronch Ebus Ivntj Perph Les 31660 Bronch Thermoplsty 1 Lobe 31661 Bronch Thermoplsty 2/> Lobes 3170F Baselin Flo Cytometry B/4 Tx 31717 Bronchial Brush Biopsy 31720 Clearance Of Airways 31725 Clearance Of Airways 31730 Intro Windpipe Wire/Tube 31750 Repair Of Windpipe 31755 Repair Of Windpipe 31760 Repair Of Windpipe 31766 Reconstruction Of Windpipe 31770 Repair/Graft Of Bronchus 31775 Reconstruct Bronchus 31780 Reconstruct Windpipe 31781 Reconstruct Windpipe 31785 Remove Windpipe Lesion 31786 Remove Windpipe Lesion 31800 Repair Of Windpipe Injury 31805 Repair Of Windpipe Injury 31820 Closure Of Windpipe Lesion 31825 Repair Of Windpipe Defect 31830 Revise Windpipe Scar 31899 Airways Surgical Procedure 3200F Barium Swallow Test Not Req 32035 Thoracostomy W/Rib Resection 32036 Thoracostomy W/Flap Drainage 32096 Open Wedge/Bx Lung Infiltr 32097 Open Wedge/Bx Lung Nodule 32098 Open Biopsy Of Lung Pleura 32100 Exploration Of Chest 3210F Grp A Strep Test Performed 32110 Explore/Repair Chest 32120 Re-Exploration Of Chest 32124 Explore Chest Free Adhesions 32140 Removal Of Lung Lesion(S) 32141 Remove/Treat Lung Lesions 32150 Removal Of Lung Lesion(S) 32151 Remove Lung Foreign Body 3215F Pt Immunity To Hep A Docd 32160 Open Chest Heart Massage 3216F Pt Immunity To Hep B Docd 3218F Rna Tstng Hep C Docd Done 32200 Drain Open Lung Lesion 3220F Hep C Quant Rna Tstng Docd 32215 Treat Chest Lining 32220 Release Of Lung 32225 Partial Release Of Lung 3230F Note Hring Tst W/In 6 Mon 32310 Removal Of Chest Lining 32320 Free/Remove Chest Lining 32400 Needle Biopsy Chest Lining 32405 Percut Bx Lung/Mediastinum 32408 Core Ndl Bx Lng/Med Perq 32440 Remove Lung Pneumonectomy 32442 Sleeve Pneumonectomy 32445 Removal Of Lung Extrapleural 32480 Partial Removal Of Lung 32482 Bilobectomy 32484 Segmentectomy 32486 Sleeve Lobectomy 32488 Completion Pneumonectomy 32491 Lung Volume Reduction 32501 Repair Bronchus Add-On 32503 Resect Apical Lung Tumor 32504 Resect Apical Lung Tum/Chest 32505 Wedge Resect Of Lung Initial 32506 Wedge Resect Of Lung Add-On 32507 Wedge Resect Of Lung Diag 3250F Nonprim Loc Anat Bx Site Tum 32540 Removal Of Lung Lesion 32550 Insert Pleural Cath 32551 983 Insertion Of Chest Tube $511 $332 $397 $167 32552 Remove Lung Catheter 32553 Ins Mark Thor For Rt Perq 32554 510 Aspirate Pleura W/O Imaging $2,101 $1,366 $1,631 $687 32555 450 Aspirate Pleura W/ Imaging $689 $448 $535 $226 32556 450 Insert Cath Pleura W/O Image $3,859 $2,508 $2,996 $1,264 32557 Insert Cath Pleura W/ Image 32560 Treat Pleurodesis W/Agent 32561 Lyse Chest Fibrin Init Day 32562 Lyse Chest Fibrin Subq Day 32601 Thoracoscopy Diagnostic 32604 Thoracoscopy Wbx Sac 32606 Thoracoscopy W/Bx Med Space 32607 Thoracoscopy W/Bx Infiltrate 32608 Thoracoscopy W/Bx Nodule 32609 Thoracoscopy W/Bx Pleura 3260F Pt Cat/Pn Cat/Hist Grd Docd 32650 Thoracoscopy W/Pleurodesis 32651 Thoracoscopy Remove Cortex 32652 Thoracoscopy Rem Totl Cortex 32653 Thoracoscopy Remov Fb/Fibrin 32654 Thoracoscopy Contrl Bleeding 32655 Thoracoscopy Resect Bullae 32656 Thoracoscopy W/Pleurectomy 32658 Thoracoscopy W/Sac Fb Remove

32659 Thoracoscopy W/Sac Drainage 3265F Rna Tstng Hepc Vir Ord/Docd 32661 Thoracoscopy W/Pericard Exc 32662 Thoracoscopy W/Mediast Exc 32663 Thoracoscopy W/Lobectomy 32664 Thoracoscopy W/ Th Nrv Exc 32665 Thoracoscop W/Esoph Musc Exc 32666 Thoracoscopy W/Wedge Resect 32667 Thoracoscopy W/W Resect Addl 32668 Thoracoscopy W/W Resect Diag 32669 Thoracoscopy Remove Segment 3266F Hepc Gn Tstng Docd B/4Txmnt 32670 Thoracoscopy Bilobectomy 32671 Thoracoscopy Pneumonectomy 32672 Thoracoscopy For Lvrs 32673 Thoracoscopy W/Thymus Resect 32674 Thoracoscopy Lymph Node Exc 3267F Path Rprt W/ Pt Pn Cat Et Al 3268F Psa/T/Glsc Docd B/4 Txmnt 3269F Bone Scn B/4 Txmnt/Aftr Dx 32701 Thorax Stereo Rad Targetw/Tx 3270F No Bone Scn B/4 Txmnt/Aftrdx 3271F Low Risk Prostate Cancer 3272F Med Risk Prostate Cancer 3273F High Risk Prostate Cancer 3274F Prost Cncr Rsk Not Lw/Md/Hgh 3278F Serum Lvls Ca/Ipth/Lpd Ord 3279F Hgb Lvl >/= 13 G/Dl 32800 Repair Lung Hernia 3280F Hgb Lvl 11-12.9 G/Dl 32810 Close Chest After Drainage 32815 Close Bronchial Fistula 3281F Hgb Lvl <11 G/Dl 32820 Reconstruct Injured Chest 3284F Iop Down >15% Of Pre-Svc Lvl 32850 Donor Pneumonectomy 32851 Lung Transplant Single 32852 Lung Transplant With Bypass 32853 Lung Transplant Double 32854 Lung Transplant With Bypass 32855 Prepare Donor Lung Single 32856 Prepare Donor Lung Double 3285F Iop Down <15% Of Pre-Svc Lvl 3288F Fall Risk Assessment Docd 32900 Removal Of Rib(S) 32905 Revise & Repair Chest Wall 32906 Revise & Repair Chest Wall 3290F Pt=D(Rh)- And Unsensitized 3291F Pt=D(Rh)+ Or Sensitized 3292F Hiv Tstng Asked/Docd/Revwd 3293F Abo Rh Blood Typing Docd 32940 Revision Of Lung 3294F Grp B Strep Screening Docd 32960 Therapeutic Pneumothorax 32994 Ablate Pulm Tumor Perq Crybl 32997 Total Lung Lavage 32998 Ablate Pulm Tumor Perq Rf 32999 Chest Surgery Procedure 3300F Ajcc Stage Docd B/4 Thxpy 33016 Pericardiocentesis W/Imaging 33017 Prcrd Drg 6Yr+ W/O Cgen Car 33018 Prcrd Drg 0-5Yr Or W/Anomly 33019 Perq Prcrd Drg Insj Cath Ct 3301F Cancer Stage Docd Metast 33020 Incision Of Heart Sac 33025 Incision Of Heart Sac 33030 Partial Removal Of Heart Sac 33031 Partial Removal Of Heart Sac 33050 Resect Heart Sac Lesion 33120 Removal Of Heart Lesion 33130 Removal Of Heart Lesion 33140 Heart Revascularize (Tmr) 33141 Heart Tmr W/Other Procedure 3315F Er+ Or Pr+ Breast Cancer 3316F Er- Or Pr- Breast Cancer 3317F Path Rpt Malig Cancer Docd 3318F Path Rpt Malig Cancer Docd 3319F X-Ray/Ct/Ultrsnd Et Al Ord 33202 Insert Epicard Eltrd Open 33203 Insert Epicard Eltrd Endo 33206 Insert Heart Pm Atrial 33207 Insert Heart Pm Ventricular 33208 Insrt Heart Pm Atrial & Vent $1,659 $1,078 $1,288 $543 $526 3320F No Xray/Ct/ Et Al Ordd 33210 450 Insert Electrd/Pm Cath Sngl $14,524 $9,441 $11,276 $4,759 33211 Insert Card Electrodes Dual 33212 Insert Pulse Gen Sngl Lead 33213 Insert Pulse Gen Dual Leads 33214 Upgrade Of Pacemaker System 33215 Reposition Pacing-Defib Lead 33216 Insert 1 Electrode Pm-Defib 33217 Insert 2 Electrode Pm-Defib 33218 Repair Lead Pace-Defib One 3321F Ajcc Cncr 0/Ia Melan Docd 33220 Repair Lead Pace-Defib Dual 33221 Insert Pulse Gen Mult Leads 33222 Relocation Pocket Pacemaker 33223 Relocate Pocket For Defib $1,257 $817 $976 $412 $405 33224 Insert Pacing Lead & Connect 33225 L Ventric Pacing Lead Add-On $1,459 $948 $1,133 $478 $386 33226 Reposition L Ventric Lead 33227 Remove&Replace Pm Gen Singl 33228 Remv&Replc Pm Gen Dual Lead 33229 Remv&Replc Pm Gen Mult Leads 3322F Melanomaajcc Stage 0 Or Ia 33230 Insrt Pulse Gen W/Dual Leads 33231 Insrt Pulse Gen W/Mult Leads 33233 Removal Of Pm Generator $752 $489 $584 $247 33234 Removal Of Pacemaker System 33235 Removal Pacemaker Electrode $1,911 $1,242 $1,483 $626 33236 Remove Electrode/Thoracotomy 33237 Remove Electrode/Thoracotomy 33238 Remove Electrode/Thoracotomy 3323F Clin Node Stgng Docdb/4 Surg 33240 Insrt Pulse Gen W/Singl Lead 33241 Remove Pulse Generator $687 $446 $533 $225 33243 Remove Eltrd/Thoracotomy 33244 Remove Elctrd Transvenously 33249 Insj/Rplcmt Defib W/Lead(S) $2,885 $1,875 $2,239 $945 $647 3324F Mri Ct Scan Ord Rvwd Rqstd 33250 Ablate Heart Dysrhythm Focus 33251 Ablate Heart Dysrhythm Focus 33254 Ablate Atria Lmtd 33255 Ablate Atria W/O Bypass Ext 33256 Ablate Atria W/Bypass Exten 33257 Ablate Atria Lmtd Add-On 33258 Ablate Atria X10Sv Add-On 33259 Ablate Atria W/Bypass Add-On 3325F Preop Asses 4 Cataract Surg 33261 Ablate Heart Dysrhythm Focus 33262 Rmvl& Replc Pulse Gen 1 Lead 33263 Rmvl & Rplcmt Dfb Gen 2 Lead 33264 Rmvl & Rplcmt Dfb Gen Mlt Ld 33265 Ablate Atria Lmtd Endo 33266 Ablate Atria X10Sv Endo 33270 Ins/Rep Subq Defibrillator $1,604 $1,042 $1,245 $525 $445 33271 Insj Subq Impltbl Dfb Elctrd 33272 Rmvl Of Subq Defibrillator 33273 Repos Prev Impltbl Subq Dfb 33274 Tcat Insj/Rpl Perm Ldls Pm 33275 Tcat Rmvl Perm Ldls Pm W/Img 33285 450 Insj Subq Car Rhythm Mntr $19,530 $12,695 $15,162 $6,399 $85 33286 Rmvl Subq Car Rhythm Mntr $327 $213 $254 $107 $93 33289 Tcat Impl Wrls P-Art Prs Snr 3328F Prfrmnc Docd 2 Wks B/4 Surg 33300 Repair Of Heart Wound 33305 Repair Of Heart Wound 3330F Imaging Study Ordered (Bkp) 33310 Exploratory Heart Surgery 33315 Exploratory Heart Surgery 3331F Bk Imaging Tst Not Ordered 33320 Repair Major Blood Vessel(S) 33321 Repair Major Vessel 33322 Repair Major Blood Vessel(S) 33330 Insert Major Vessel Graft 33335 Insert Major Vessel Graft 33340 Perq Clsr Tcat L Atr Apndge 33361 Replace Aortic Valve Perq $3,899 $2,535 $3,027 $1,278 $897 33362 Replace Aortic Valve Open 33363 Replace Aortic Valve Open 33364 Replace Aortic Valve Open 33365 Replace Aortic Valve Open 33366 Trcath Replace Aortic Valve 33367 Replace Aortic Valve W/Byp 33368 Replace Aortic Valve W/Byp 33369 Replace Aortic Valve W/Byp 33390 Valvuloplasty Aortic Valve 33391 Valvuloplasty Aortic Valve 33404 Prepare Heart-Aorta Conduit 33405 Replacement Aortic Valve Opn 33406 Replacement Aortic Valve Opn 3340F Mammo Assess Inc Xray Docd 33410 Replacement Aortic Valve Opn 33411 Replacement Of Aortic Valve 33412 Replacement Of Aortic Valve 33413 Replacement Of Aortic Valve 33414 Repair Of Aortic Valve 33415 Revision Subvalvular Tissue 33416 Revise Ventricle Muscle 33417 Repair Of Aortic Valve 33418 Repair Tcat Mitral Valve 33419 Repair Tcat Mitral Valve 3341F Mammo Assess Negative Docd 33420 Revision Of Mitral Valve 33422 Revision Of Mitral Valve 33425 Repair Of Mitral Valve 33426 Repair Of Mitral Valve 33427 Repair Of Mitral Valve 3342F Mammo Assess Bengn Docd 33430 Replacement Of Mitral Valve 3343F Mammo Probably Bengn Docd 33440 Rplcmt A-Valve Tlcj Autol Pv 3344F Mammo Assess Susp Docd 3345F Mammo Assess Hghlymalig Doc 33460 Revision Of Tricuspid Valve 33463 Valvuloplasty Tricuspid 33464 Valvuloplasty Tricuspid 33465 Replace Tricuspid Valve 33468 Revision Of Tricuspid Valve 33470 Revision Of Pulmonary Valve 33471 Valvotomy Pulmonary Valve 33474 Revision Of Pulmonary Valve 33475 Replacement Pulmonary Valve 33476 Revision Of Heart Chamber 33477 Implant Tcat Pulm Vlv Perq 33478 Revision Of Heart Chamber 33496 Repair Prosth Valve Clot 33500 Repair Heart Vessel Fistula 33501 Repair Heart Vessel Fistula 33502 Coronary Artery Correction 33503 Coronary Artery Graft 33504 Coronary Artery Graft 33505 Repair Artery W/Tunnel 33506 Repair Artery Translocation 33507 Repair Art Intramural 33508 Endoscopic Vein Harvest 3350F Mammo Bx Proven Malig Docd 33510 Cabg Vein Single 33511 Cabg Vein Two 33512 Cabg Vein Three 33513 Cabg Vein Four 33514 Cabg Vein Five 33516 Cabg Vein Six Or More 33517 Cabg Artery-Vein Single 33518 Cabg Artery-Vein Two 33519 Cabg Artery-Vein Three 3351F Neg Scrn Dep Symp By Deptool 33521 Cabg Artery-Vein Four 33522 Cabg Artery-Vein Five 33523 Cabg Art-Vein Six Or More 3352F No Sig Dep Symp By Dep Tool 33530 Coronary Artery Bypass/Reop 33533 Cabg Arterial Single 33534 Cabg Arterial Two 33535 Cabg Arterial Three 33536 Cabg Arterial Four Or More 3353F Mild-Mod Dep Symp By Deptool 33542 Removal Of Heart Lesion 33545 Repair Of Heart Damage 33548 Restore/Remodel Ventricle 3354F Clin Sig Dep Sym By Dep Tool 33572 Open Coronary Endarterectomy 33600 Closure Of Valve 33602 Closure Of Valve 33606 Anastomosis/Artery-Aorta 33608 Repair Anomaly W/Conduit 33610 Repair By Enlargement 33611 Repair Double Ventricle 33612 Repair Double Ventricle 33615 Repair Modified Fontan 33617 Repair Single Ventricle 33619 Repair Single Ventricle 33620 Apply R&L Pulm Art Bands 33621 Transthor Cath For Stent 33622 Redo Compl Cardiac Anomaly 33641 Repair Heart Septum Defect 33645 Revision Of Heart Veins 33647 Repair Heart Septum Defects 33660 Repair Of Heart Defects 33665 Repair Of Heart Defects 33670 Repair Of Heart Chambers 33675 Close Mult Vsd 33676 Close Mult Vsd W/Resection 33677 Cl Mult Vsd W/Rem Pul Band 33681 Repair Heart Septum Defect 33684 Repair Heart Septum Defect 33688 Repair Heart Septum Defect 33690 Reinforce Pulmonary Artery 33692 Repair Of Heart Defects 33694 Repair Of Heart Defects 33697 Repair Of Heart Defects 33702 Repair Of Heart Defects 3370F Ajcc Brst Cncr Stage 0 Docd 33710 Repair Of Heart Defects 33720 Repair Of Heart Defect 33722 Repair Of Heart Defect 33724 Repair Venous Anomaly 33726 Repair Pul Venous Stenosis 3372F Ajcc Brst Cncr Stage 1 Docd 33730 Repair Heart-Vein Defect(S) 33732 Repair Heart-Vein Defect 33735 Revision Of Heart Chamber 33736 Revision Of Heart Chamber 33737 Revision Of Heart Chamber 33741 Tas Congenital Car Anomal 33745 Tis Cgen Car Anomal 1St Shnt 33746 Tis Cgen Car Anomal Ea Addl 3374F Ajcc Brst Cncr Stage 1 Docd 33750 Major Vessel Shunt 33755 Major Vessel Shunt 33762 Major Vessel Shunt 33764 Major Vessel Shunt & Graft 33766 Major Vessel Shunt 33767 Major Vessel Shunt 33768 Cavopulmonary Shunting 3376F Ajcc Brstcncr Stage 2 Docd 33770 Repair Great Vessels Defect 33771 Repair Great Vessels Defect 33774 Repair Great Vessels Defect 33775 Repair Great Vessels Defect 33776 Repair Great Vessels Defect 33777 Repair Great Vessels Defect 33778 Repair Great Vessels Defect 33779 Repair Great Vessels Defect 33780 Repair Great Vessels Defect 33781 Repair Great Vessels Defect 33782 Nikaidoh Proc 33783 Nikaidoh Proc W/Ostia Implt 33786 Repair Arterial Trunk 33788 Revision Of Pulmonary Artery 3378F Ajcc Brstcncr Stage 3 Docd 33800 Aortic Suspension 33802 Repair Vessel Defect 33803 Repair Vessel Defect 3380F Ajcc Brstcncr Stage 4 Docd 33813 Repair Septal Defect 33814 Repair Septal Defect 33820 Revise Major Vessel 33822 Revise Major Vessel 33824 Revise Major Vessel 3382F Ajcc Cln Cncr Stage 0 Docd 33840 Remove Aorta Constriction 33845 Remove Aorta Constriction 3384F Ajcc Cln Cncr Stage 1 Docd 33851 Remove Aorta Constriction 33852 Repair Septal Defect 33853 Repair Septal Defect 33858 As-Aort Grf F/Aortic Dsj 33859 As-Aort Grf F/Ds Oth/Thn Dsj 33863 Ascending Aortic Graft 33864 Ascending Aortic Graft 33866 Aortic Hemiarch Graft 3386F Ajcc Cln Cncr Stage 2 Docd 33871 Transvrs A-Arch Grf Hypthrm 33875 Thoracic Aortic Graft 33877 Thoracoabdominal Graft 33880 Endovasc Taa Repr Incl Subcl 33881 Endovasc Taa Repr W/O Subcl 33883 Insert Endovasc Prosth Taa 33884 Endovasc Prosth Taa Add-On 33886 Endovasc Prosth Delayed 33889 Artery Transpose/Endovas Taa 3388F Ajcc Cln Cncr Stage 3 Docd 33891 Car-Car Bp Grft/Endovas Taa 3390F Ajcc Cln Cncr Stage 4 Docd 33910 Remove Lung Artery Emboli 33915 Remove Lung Artery Emboli 33916 Surgery Of Great Vessel 33917 Repair Pulmonary Artery 33920 Repair Pulmonary Atresia 33922 Transect Pulmonary Artery 33924 Remove Pulmonary Shunt 33925 Rpr Pul Art Unifocal W/O Cpb 33926 Repr Pul Art Unifocal W/Cpb 33927 Impltj Tot Rplcmt Hrt Sys 33928 Rmvl & Rplcmt Tot Hrt Sys 33929 Rmvl Rplcmt Hrt Sys F/Trnspl 33930 Removal Of Donor Heart/Lung 33933 Prepare Donor Heart/Lung 33935 Transplantation Heart/Lung 33940 Removal Of Donor Heart 33944 Prepare Donor Heart 33945 Transplantation Of Heart 33946 Ecmo/Ecls Initiation Venous 33947 Ecmo/Ecls Initiation Artery 33948 Ecmo/Ecls Daily Mgmt-Venous 33949 Ecmo/Ecls Daily Mgmt Artery 3394F Quant Her2 Ihc Eval Brst Cx 33951 Ecmo/Ecls Insj Prph Cannula 33952 Ecmo/Ecls Insj Prph Cannula 33953 Ecmo/Ecls Insj Prph Cannula 33954 Ecmo/Ecls Insj Prph Cannula 33955 Ecmo/Ecls Insj Ctr Cannula 33956 Ecmo/Ecls Insj Ctr Cannula 33957 Ecmo/Ecls Repos Perph Cnula 33958 Ecmo/Ecls Repos Perph Cnula 33959 Ecmo/Ecls Repos Perph Cnula 3395F Quant Nonher2 Ihc Brst Cx 33962 Ecmo/Ecls Repos Perph Cnula 33963 Ecmo/Ecls Repos Perph Cnula 33964 Ecmo/Ecls Repos Perph Cnula 33965 Ecmo/Ecls Rmvl Perph Cannula 33966 Ecmo/Ecls Rmvl Prph Cannula 33967 Insert I-Aort Percut Device 33968 Remove Aortic Assist Device 33969 Ecmo/Ecls Rmvl Perph Cannula 33970 Aortic Circulation Assist 33971 Aortic Circulation Assist 33973 Insert Balloon Device 33974 Remove Intra-Aortic Balloon 33975 Implant Ventricular Device 33976 Implant Ventricular Device 33977 Remove Ventricular Device 33978 Remove Ventricular Device 33979 Insert Intracorporeal Device 33980 Remove Intracorporeal Device 33981 Replace Vad Pump Ext 33982 Replace Vad Intra W/O Bp 33983 Replace Vad Intra W/Bp 33984 Ecmo/Ecls Rmvl Prph Cannula 33985 Ecmo/Ecls Rmvl Ctr Cannula 33986 Ecmo/Ecls Rmvl Ctr Cannula 33987 Artery Expos/Graft Artery 33988 Insertion Of Left Heart Vent 33989 Removal Of Left Heart Vent 33990 Insj Perq Vad L Hrt Arterial 33991 Insj Perq Vad L Hrt Artl&Ven 33992 Rmvl Perq Left Heart Vad 33993 Reposg Perq R/L Hrt Vad 33995 Insj Perq Vad R Hrt Venous 33997 Rmvl Perq Right Heart Vad 33999 Cardiac Surgery Procedure 34001 Removal Of Artery Clot 34051 Removal Of Artery Clot 34101 Removal Of Artery Clot 34111 Removal Of Arm Artery Clot 34151 Removal Of Artery Clot 34201 Removal Of Artery Clot 34203 Removal Of Leg Artery Clot 34401 Removal Of Vein Clot 34421 Removal Of Vein Clot 34451 Removal Of Vein Clot 34471 Removal Of Vein Clot 34490 Removal Of Vein Clot 34501 Repair Valve Femoral Vein 34502 Reconstruct Vena Cava $4,437 $2,884 $3,445 $1,454 3450F Dyspnea Scrnd No-Mild Dysp 34510 Transposition Of Vein Valve 3451F Dyspnea Scrnd Mod-High Dysp 34520 Cross-Over Vein Graft 3452F Dyspnea Not Screened 34530 Leg Vein Fusion 3455F Tb Scrng Done-Interpd 6Mon 34701 Evasc Rpr A-Ao Ndgft 34702 Evasc Rpr A-Ao Ndgft Rpt 34703 Evasc Rpr A-Unilac Ndgft 34704 Evasc Rpr A-Unilac Ndgft Rpt 34705 Evac Rpr A-Biiliac Ndgft 34706 Evasc Rpr A-Biiliac Rpt 34707 Evasc Rpr Ilio-Iliac Ndgft 34708 Evasc Rpr Ilio-Iliac Rpt 34709 Plmt Xtn Prosth Evasc Rpr 3470F Ra Disease Activity Low 34710 Dlyd Plmt Xtn Prosth 1St Vsl 34711 Dlyd Plmt Xtn Prosth Ea Addl 34712 Tcat Dlvr Enhncd Fixj Dev 34713 Perq Access & Clsr Fem Art 34714 Opn Fem Art Expos Cndt Crtj 34715 Opn Ax/Subcla Art Expos 34716 Opn Ax/Subcla Art Expos Cndt 34717 Evasc Rpr A-Iliac Ndgft 34718 Evasc Rpr N/A A-Iliac Ndgft 3471F Ra Disease Activity Mod 3472F Ra Disease Activity High 3475F Disease Progn Ra Poor Docd 3476F Disease Progn Ra Good Docd 34808 Endovas Iliac A Device Addon 34812 Opn Fem Art Expos 34813 Femoral Endovas Graft Add-On 34820 Opn Iliac Art Expos 34830 Open Aortic Tube Prosth Repr 34831 Open Aortoiliac Prosth Repr 34832 Open Aortofemor Prosth Repr 34833 Opn Ilac Art Expos Cndt Crtj 34834 Opn Brach Art Expos 34839 Plnning Pt Spec Fenest Graft 34841 Endovasc Visc Aorta 1 Graft 34842 Endovasc Visc Aorta 2 Graft 34843 Endovasc Visc Aorta 3 Graft 34844 Endovasc Visc Aorta 4 Graft 34845 Visc & Infraren Abd 1 Prosth 34846 Visc & Infraren Abd 2 Prosth 34847 Visc & Infraren Abd 3 Prosth 34848 Visc & Infraren Abd 4+ Prost 3490F History Aids-Defining Cond 3491F Hiv Unsure Baby Of Hiv+Moms 3492F History Cd4+ Cell Count <350 3493F No Hist Cd4+ Cell Count <350 3494F Cd4+Cell Count <200Cells/Mm3 3495F Cd4+Cell Cnt 200-499 Cells 3496F Cd4+ Cell Count >= 500 Cells 3497F Cd4+ Cell Percentage <15% 3498F Cd4+ Cell =15% (Hiv) 35001 Repair Defect Of Artery 35002 Repair Artery Rupture Neck 35005 Repair Defect Of Artery 3500F Cd4+Cell Cnt/% Docd As Done 35011 Repair Defect Of Artery 35013 Repair Artery Rupture Arm 35021 Repair Defect Of Artery 35022 Repair Artery Rupture Chest 3502F Hiv Rna Vrl Ld Segmt 35685 Bypass Graft Patency/Patch 35686 Bypass Graft/Av Fist Patency 35691 Art Trnsposj Vertbrl Carotid 35693 Art Trnsposj Subclavian 35694 Art Trnsposj Subclav Carotid 35695 Art Trnsposj Carotid Subclav 35697 Reimplant Artery Each 35700 Reoperation Bypass Graft 35701 Expl N/Flwd Surg Neck Art 35702 Expl N/Flwd Surg Uxtr Art 35703 Expl N/Flwd Surg Lxtr Art 3570F Rprt Bone Scint Xref W Xray 3572F Pt Consid Poss Risk Fx 3573F Pt Not Consid Poss Risk Fx 35800 Explore Neck Vessels 35820 Explore Chest Vessels 35840 Explore Abdominal Vessels 35860 Explore Limb Vessels 35870 Repair Vessel Graft Defect 35875 Removal Of Clot In Graft 35876 Removal Of Clot In Graft 35879 Revise Graft W/Vein 35881 Revise Graft W/Vein 35883 Revise Graft W/Nonauto Graft 35884 Revise Graft W/Vein 35901 Excision Graft Neck 35903 Excision Graft Extremity 35905 Excision Graft Thorax 35907 Excision Graft Abdomen 36000 460 Place Needle In Vein $133 $86 $103 $43 36002 Pseudoaneurysm Injection Trt 36005 Injection Ext Venography 36010 Place Catheter In Vein $381 $248 $296 $125 36011 Place Catheter In Vein 36012 Place Catheter In Vein 36013 Place Catheter In Artery 36014 Place Catheter In Artery 36015 Place Catheter In Artery 36100 Establish Access To Artery 36140 Intro Ndl Icath Upr/Lxtr Art $323 $210 $251 $106 36160 Establish Access To Aorta 36200 Place Catheter In Aorta 36215 Place Catheter In Artery 36216 Place Catheter In Artery 36217 Place Catheter In Artery 36218 Place Catheter In Artery 36221 Place Cath Thoracic Aorta 36222 Place Cath Carotid/Inom Art 36223 Place Cath Carotid/Inom Art $967 $629 $751 $317 36224 Place Cath Carotd Art 36225 Place Cath Subclavian Art 36226 Place Cath Vertebral Art $951 $618 $738 $312 36227 Place Cath Xtrnl Carotid 36228 Place Cath Intracranial Art 36245 Ins Cath Abd/L-Ext Art 1St $768 $499 $596 $252 $153 36246 Ins Cath Abd/L-Ext Art 2Nd $849 $552 $659 $278 $179 36247 Ins Cath Abd/L-Ext Art 3Rd 36248 Ins Cath Abd/L-Ext Art Addl 36251 Ins Cath Ren Art 1St Unilat 36252 Ins Cath Ren Art 1St Bilat 36253 Ins Cath Ren Art 2Nd+ Unilat 36254 Ins Cath Ren Art 2Nd+ Bilat 36260 Insertion Of Infusion Pump 36261 Revision Of Infusion Pump 36262 Removal Of Infusion Pump 36299 Vessel Injection Procedure 36400 Bl Draw < 3 Yrs Fem/Jugular 36405 Bl Draw <3 Yrs Scalp Vein 36406 Bl Draw <3 Yrs Other Vein 36410 Non-Routine Bl Draw 3/> Yrs 36415 301 Routine Venipuncture $21 $14 $16 $6 36416 983 Capillary Blood Draw $21 $14 $16 $7 36420 Vein Access Cutdown < 1 Yr 36425 Vein Access Cutdown > 1 Yr 36430 510 Blood Transfusion Service $731 $475 $568 $239 36440 Bl Push Transfuse 2 Yr/< 36450 Bl Exchange/Transfuse Nb 36455 Bl Exchange/Transfuse Non-Nb 36456 Prtl Exchange Transfuse Nb 36460 Transfusion Service Fetal 36465 Njx Noncmpnd Sclrsnt 1 Vein 36466 Njx Noncmpnd Sclrsnt Mlt Vn 36468 Njx Sclrsnt Spider Veins 36470 510 Njx Sclrsnt 1 Incmptnt Vein $268 $174 $208 $88 36471 510 Njx Sclrsnt Mlt Incmptnt Vn $361 $235 $280 $118 36473 Endovenous Mchnchem 1St Vein 36474 Endovenous Mchnchem Add-On 36475 Endovenous Rf 1St Vein $1,096 $713 $851 $359 36476 Endovenous Rf Vein Add-On $315 $204 $244 $103 36478 Endovenous Laser 1St Vein 36479 Endovenous Laser Vein Addon 36481 Insertion Of Catheter Vein 36482 Endoven Ther Chem Adhes 1St 36483 Endoven Ther Chem Adhes Sbsq 36500 Insertion Of Catheter Vein 3650F Eeg Ordered Rvwd Reqstd 36510 Insertion Of Catheter Vein 36511 Apheresis Wbc 36512 Apheresis Rbc 36513 Apheresis Platelets 36514 Apheresis Plasma 36516 Apheresis Immunoads Slctv 36522 Photopheresis 36555 450 Insert Non-Tunnel Cv Cath $2,928 $1,903 $2,273 $959 36556 510 Insert Non-Tunnel Cv Cath $1,338 $870 $1,039 $438 36557 Insert Tunneled Cv Cath 36558 761 Insert Tunneled Cv Cath $6,873 $4,467 $5,336 $2,252 36560 Insert Tunneled Cv Cath 36561 Insert Tunneled Cv Cath $1,108 $720 $860 $363 $225 36563 Insert Tunneled Cv Cath 36565 Insert Tunneled Cv Cath 36566 Insert Tunneled Cv Cath 36568 450 Insj Picc <5 Yr W/O Imaging $2,814 $1,829 $2,185 $922 36569 510 Insj Picc 5 Yr+ W/O Imaging $1,540 $1,001 $1,196 $504 36570 Insert Picvad Cath 36571 Insert Picvad Cath $981 $638 $762 $322 $204 36572 450 Insj Picc Rs&I <5 Yr $1,628 $1,058 $1,264 $533 36573 450 Insj Picc Rs&I 5 Yr+ $2,888 $1,877 $2,242 $946 36575 Repair Tunneled Cv Cath 36576 Repair Tunneled Cv Cath 36578 Replace Tunneled Cv Cath 36580 Replace Cvad Cath 36581 Replace Tunneled Cv Cath $602 $391 $467 $197 36582 Replace Tunneled Cv Cath 36583 Replace Tunneled Cv Cath 36584 Compl Rplcmt Picc Rs&I 36585 Replace Picvad Cath 36589 Removal Tunneled Cv Cath $497 $323 $385 $163 $0 36590 450 Removal Tunneled Cv Cath $458 $298 $356 $150 36591 309 Draw Blood Off Venous Device $72 $47 $56 $24 36592 301 Collect Blood From Picc $49 $32 $38 $16 36593 510 Declot Vascular Device $214 $139 $166 $70 36595 Mech Remov Tunneled Cv Cath 36596 510 Mech Remov Tunneled Cv Cath $236 $153 $183 $77 36597 Reposition Venous Catheter 36598 Inj W/Fluor Eval Cv Device 36600 300 Withdrawal Of Arterial Blood $216 $140 $168 $71 36620 450 Insertion Catheter Artery $174 $113 $135 $57 36625 Insertion Catheter Artery 36640 Insertion Catheter Artery 36660 Insertion Catheter Artery 36680 510 Insert Needle Bone Cavity $260 $169 $202 $85 36800 Insertion Of Cannula 36810 Insertion Of Cannula 36815 Insertion Of Cannula 36818 Av Fuse Uppr Arm Cephalic 36819 Av Fuse Uppr Arm Basilic 36820 Av Fusion/Forearm Vein 36821 Av Fusion Direct Any Site 36823 Insertion Of Cannula(S) 36825 Artery-Vein Autograft 36830 Artery-Vein Nonautograft 36831 Open Thrombect Av Fistula 36832 Av Fistula Revision Open 36833 Av Fistula Revision 36835 Artery To Vein Shunt 36838 Dist Revas Ligation Hemo 36860 External Cannula Declotting 36861 Cannula Declotting 36901 Intro Cath Dialysis Circuit $410 $267 $318 $134 36902 Intro Cath Dialysis Circuit $592 $385 $459 $194 36903 Intro Cath Dialysis Circuit 36904 Thrmbc/Nfs Dialysis Circuit 36905 Thrmbc/Nfs Dialysis Circuit 36906 Thrmbc/Nfs Dialysis Circuit 36907 Balo Angiop Ctr Dialysis Seg 36908 Stent Plmt Ctr Dialysis Seg 36909 Dialysis Circuit Embolj 3700F Psych Disorders Assessed 37140 Revision Of Circulation 37145 Revision Of Circulation 37160 Revision Of Circulation 37180 Revision Of Circulation 37181 Splice Spleen/Kidney Veins 37182 Insert Hepatic Shunt (Tips) 37183 Remove Hepatic Shunt (Tips) 37184 Prim Art M-Thrmbc 1St Vsl 37185 Prim Art M-Thrmbc Sbsq Vsl 37186 Sec Art Thrombectomy Add-On 37187 Venous Mech Thrombectomy 37188 Ven Mechnl Thrmbc Repeat Tx 37191 320 Ins Endovas Vena Cava Filtr $3,307 $2,150 $2,567 $1,084 37192 Redo Endovas Vena Cava Filtr 37193 Rem Endovas Vena Cava Filter $1,111 $722 $862 $364 37195 450 Thrombolytic Therapy Stroke $566 $368 $439 $185 37197 Remove Intrvas Foreign Body 37200 Transcatheter Biopsy 3720F Cognit Impairment Assessed 37211 Thrombolytic Art Therapy 37212 Thrombolytic Venous Therapy 37213 Thromblytic Art/Ven Therapy 37214 Cessj Therapy Cath Removal 37215 320 Transcath Stent Cca W/Eps $3,637 $2,364 $2,824 $1,192 37216 320 Transcath Stent Cca W/O Eps $3,637 $2,364 $2,824 $1,192 37217 320 Stent Placemt Retro Carotid $3,637 $2,364 $2,824 $1,192 37218 320 Stent Placemt Ante Carotid $3,637 $2,364 $2,824 $1,192 37220 Iliac Revasc 37221 320 Iliac Revasc W/Stent $3,637 $2,364 $2,824 $1,192 37222 Iliac Revasc Add-On 37223 320 Iliac Revasc W/Stent Add-On $3,637 $2,364 $2,824 $1,192 37224 Fem/Popl Revas W/Tla $1,450 $943 $1,126 $475 $219 37225 Fem/Popl Revas W/Ather 37226 320 Fem/Popl Revasc W/Stent $3,637 $2,364 $2,824 $1,192 37227 320 Fem/Popl Revasc Stnt & Ather $3,637 $2,364 $2,824 $1,192 37228 Tib/Per Revasc W/Tla 37229 Tib/Per Revasc W/Ather 37230 320 Tib/Per Revasc W/Stent $3,637 $2,364 $2,824 $1,192 37231 320 Tib/Per Revasc Stent & Ather $3,637 $2,364 $2,824 $1,192 37232 Tib/Per Revasc Add-On 37233 Tibper Revasc W/Ather Add-On 37234 320 Revsc Opn/Prq Tib/Pero Stent $3,637 $2,364 $2,824 $1,192 37235 Tib/Per Revasc Stnt & Ather 37236 320 Open/Perq Place Stent 1St $3,637 $2,364 $2,824 $1,192 $569 37237 320 Open/Perq Place Stent Ea Add $3,637 $2,364 $2,824 $1,192 37238 320 Open/Perq Place Stent Same $3,637 $2,364 $2,824 $1,192 37239 320 Open/Perq Place Stent Ea Add $3,637 $2,364 $2,824 $1,192 37241 Vasc Embolize/Occlude Venous 37242 Vasc Embolize/Occlude Artery 37243 Vasc Embolize/Occlude Organ 37244 Vasc Embolize/Occlude Bleed 37246 Trluml Balo Angiop 1St Art 37247 Trluml Balo Angiop Addl Art 37248 Trluml Balo Angiop 1St Vein 37249 Trluml Balo Angiop Addl Vein 37252 Intrvasc Us Noncoronary 1St $256 $167 $199 $84 37253 Intrvasc Us Noncoronary Addl $205 $133 $159 $67 3725F Screen Depression Performed 37500 Endoscopy Ligate Perf Veins 37501 Vascular Endoscopy Procedure 3750F Ptnotrcvngsteroid>/=10Mg/Day 3751F Electrodiag Polyneuro 6 Mn 3752F No Electrodiag Polyneuro 6Mn 3753F Pt Has Symp&Signs Neuropathy 3754F Screening Tests Dm Done 3755F Cog&Behav Imprmnt Scrng Done 37565 Ligation Of Neck Vein 3756F Pt W/Pseudobulb Affect/Als 3757F Pt W/O Pseudobulbaffect/Als 3758F Pt Ref Pulm Fx Test/Peakflow 3759F Pt Scrn Dysphag/Wt Loss/Nutr 37600 Ligation Of Neck Artery 37605 Ligation Of Neck Artery 37606 Ligation Of Neck Artery 37607 Ligation Of A-V Fistula 37609 Temporal Artery Procedure $955 $621 $742 $313 $244 3760F Pt W/ Dysphag/Wt Loss/Nutr 37615 Ligation Of Neck Artery 37616 Ligation Of Chest Artery 37617 Ligation Of Abdomen Artery 37618 Ligation Of Extremity Artery 37619 Ligation Of Inf Vena Cava 3761F Pt W/O Dysphag/Wt Loss/Nutr 3762F Patient Is Dysarthric 3763F Patient Is Not Dysarthric 37650 Revision Of Major Vein 37660 Revision Of Major Vein 37700 Revise Leg Vein $786 $511 $610 $258 37718 Ligate/Strip Short Leg Vein 37722 Ligate/Strip Long Leg Vein 37735 Removal Of Leg Veins/Lesion 3775F Adenoma Detected Screening 37760 Ligate Leg Veins Radical 37761 Ligate Leg Veins Open $1,748 $1,136 $1,357 $573 37765 Stab Phleb Veins Xtr 10-20 $1,844 $1,199 $1,432 $604 $574 37766 Phleb Veins - Extrem 20+ 3776F Adenoma Not Detect Screening 37780 Revision Of Leg Vein 37785 Ligate/Divide/Excise Vein 37788 Revascularization Penis 37790 Penile Venous Occlusion 37799 Vascular Surgery Procedure $1,808 $1,175 $1,404 $592 38100 Removal Of Spleen Total 38101 Removal Of Spleen Partial 38102 Removal Of Spleen Total 38115 Repair Of Ruptured Spleen 38120 Laparoscopy Splenectomy 38129 Laparoscope Proc Spleen 38200 Injection For Spleen X-Ray 38204 Bl Donor Search Management 38205 Harvest Allogeneic Stem Cell 38206 Harvest Auto Stem Cells 38207 Cryopreserve Stem Cells 38208 Thaw Preserved Stem Cells 38209 Wash Harvest Stem Cells 38210 T-Cell Depletion Of Harvest 38211 Tumor Cell Deplete Of Harvst 38212 Rbc Depletion Of Harvest 38213 Platelet Deplete Of Harvest 38214 Volume Deplete Of Harvest 38215 Harvest Stem Cell Concentrte 38220 Dx Bone Marrow Aspirations 38221 510 Dx Bone Marrow Biopsies $252 $164 $196 $83 38222 510 Dx Bone Marrow Bx & Aspir $257 $167 $199 $84 38230 Bone Marrow Harvest Allogen 38232 Bone Marrow Harvest Autolog 38240 Transplt Allo Hct/Donor 38241 Transplt Autol Hct/Donor 38242 Transplt Allo Lymphocytes 38243 Transplj Hematopoietic Boost 38300 Drainage Lymph Node Lesion 38305 Drainage Lymph Node Lesion 38308 Incision Of Lymph Channels 38380 Thoracic Duct Procedure 38381 Thoracic Duct Procedure 38382 Thoracic Duct Procedure 38500 510 Biopsy/Removal Lymph Nodes $348 $226 $270 $114 38505 510 Needle Biopsy Lymph Nodes $214 $139 $166 $70 38510 Biopsy/Removal Lymph Nodes $974 $633 $756 $319 $61 38520 Biopsy/Removal Lymph Nodes 38525 Biopsy/Removal Lymph Nodes $1,091 $709 $847 $357 38530 Biopsy/Removal Lymph Nodes 38531 Open Bx/Exc Inguinofem Nodes $1,090 $708 $846 $357 38542 Explore Deep Node(S) Neck 38550 Removal Neck/Armpit Lesion 38555 Removal Neck/Armpit Lesion 38562 Removal Pelvic Lymph Nodes 38564 Removal Abdomen Lymph Nodes 38570 Laparoscopy Lymph Node Biop 38571 Laparoscopy Lymphadenectomy 38572 Laparoscopy Lymphadenectomy 38573 Laps Pelvic Lymphadec 38589 Laparoscope Proc Lymphatic 38700 Removal Of Lymph Nodes Neck 38720 Removal Of Lymph Nodes Neck 38724 Removal Of Lymph Nodes Neck 38740 Remove Armpit Lymph Nodes 38745 Remove Armpit Lymph Nodes $2,567 $1,669 $1,993 $841 $234 38746 Remove Thoracic Lymph Nodes 38747 Remove Abdominal Lymph Nodes

38760 Remove Groin Lymph Nodes 38765 Remove Groin Lymph Nodes 38770 Remove Pelvis Lymph Nodes 38780 Remove Abdomen Lymph Nodes $2,965 $1,927 $2,302 $972 38790 Inject For Lymphatic X-Ray 38792 Ra Tracer Id Of Sentinl Node 38794 Access Thoracic Lymph Duct 38900 Io Map Of Sent Lymph Node $430 $280 $334 $141 38999 Blood/Lymph System Procedure 39000 Exploration Of Chest 39010 Exploration Of Chest 39200 Resect Mediastinal Cyst 39220 Resect Mediastinal Tumor 39401 Mediastinoscpy W/Medstnl Bx 39402 Mediastinoscpy W/Lmph Nod Bx 39499 Chest Procedure 39501 Repair Diaphragm Laceration 39503 Repair Of Diaphragm Hernia 39540 Repair Of Diaphragm Hernia 39541 Repair Of Diaphragm Hernia 39545 Revision Of Diaphragm 39560 Resect Diaphragm Simple 39561 Resect Diaphragm Complex 39599 Diaphragm Surgery Procedure 4000F Tobacco Use Txmnt Counseling $0 $0 $0 $0 4001F Tobacco Use Txmnt Pharmacol $0 $0 $0 $0 4003F Pt Ed Write/Oral Pts W/ Hf 4004F Pt Tobacco Screen Rcvd Tlk $0 $0 $0 $0 4005F Pharm Thx For Op Rxd 4008F Beta-Blocker Therapy Rxd/Tkn 4010F Ace/Arb Therapy Rxd/Taken 4011F Oral Antiplatelet Therapy Rx 4012F Warfarin Therapy Rx 4013F Statin Therapy/Currently Tkn 4014F Written Discharge Instr Prvd 4015F Persist Asthma Medicine Ctrl 4016F Anti-Inflm/Anlgsc Agent Rx 4017F Gi Prophylaxis For Nsaid Rx 4018F Therapy Exercise Joint Rx 4019F Doc Recpt Counsl Vit D/Calc+ 4025F Inhaled Bronchodilator Rx 4030F Oxygen Therapy Rx 4033F Pulmonary Rehab Rec 4035F Influenza Imm Rec 4037F Influenza Imm Order/Admin $0 $0 $0 $0 4040F Pneumoc Vac/Admin/Rcvd 4041F Doc Order Cefazolin/Cefurox 4042F Doc Antibio Not Given 4043F Doc Order Given Stop Antibio 4044F Doc Order Given Vte Prophylx 4045F Empiric Antibiotic Rx 4046F Doc Antibio Given B/4 Surg 4047F Doc Antibio Given B/4 Surg 4048F Doc Antibio Given B/4 Surg 40490 510 Biopsy Of Lip $219 $143 $170 $72 4049F Doc Order Given Stop Antibio 40500 Partial Excision Of Lip 4050F Ht Care Plan Doc 40510 Partial Excision Of Lip 4051F Referred For An Av Fistula 40520 Partial Excision Of Lip 40525 Reconstruct Lip With Flap 40527 Reconstruct Lip With Flap 4052F Hemodialysis Via Av Fistula 40530 Partial Removal Of Lip 4053F Hemodialysis Via Av Graft 4054F Hemodialysis Via Catheter 4055F Pt Rcvng Periton Dialysis 4056F Approp Oral Rehyd Recommd 4058F Ped Gastro Ed Given Caregvr 4060F Psych Svcs Provided 4062F Pt Referral Psych Docd 4063F Antidepres Rxthxpy Not Rxd 4064F Antidepressant Rx 40650 450 Repair Lip $1,489 $968 $1,156 $488 40652 Repair Lip $1,273 $827 $988 $417 $331 40654 Repair Lip $1,448 $941 $1,124 $475 4065F Antipsychotic Rx 4066F Ect Provided 4067F Pt Referral For Ect Docd 4069F Vte Prophylaxis Rcvd 40700 Repair Cleft Lip/Nasal 40701 Repair Cleft Lip/Nasal 40702 Repair Cleft Lip/Nasal 4070F Dvt Prophylx Recvd Day 2 40720 Repair Cleft Lip/Nasal 4073F Oral Antiplat Thx Rx Dischrg 4075F Anticoag Thx Rx At Dischrg 40761 Repair Cleft Lip/Nasal 4077F Doc T-Pa Admin Considered 40799 Lip Surgery Procedure 4079F Doc Rehab Svcs Considered 40800 510 Drainage Of Mouth Lesion $288 $187 $223 $94 40801 Drainage Of Mouth Lesion 40804 Removal Foreign Body Mouth 40805 Removal Foreign Body Mouth 40806 510 Incision Of Lip Fold $253 $165 $197 $83 40808 510 Biopsy Of Mouth Lesion $277 $180 $215 $91 40810 Excision Of Mouth Lesion 40812 510 Excise/Repair Mouth Lesion $378 $246 $294 $124 40814 Excise/Repair Mouth Lesion 40816 Excision Of Mouth Lesion 40818 Excise Oral Mucosa For Graft 40819 Excise Lip Or Cheek Fold 40820 510 Treatment Of Mouth Lesion $272 $177 $211 $89 40830 Repair Mouth Laceration 40831 Repair Mouth Laceration $536 $349 $416 $176 40840 Reconstruction Of Mouth 40842 Reconstruction Of Mouth 40843 Reconstruction Of Mouth 40844 Reconstruction Of Mouth 40845 Reconstruction Of Mouth 4084F Aspirin Recvd W/In 24 Hrs 4086F Aspirin/Clopidogrel Rxd 40899 Mouth Surgery Procedure 4090F Pt Rcvng Epo Thxpy 4095F Pt Not Rcvng Epo Thxpy 41000 Drainage Of Mouth Lesion 41005 Drainage Of Mouth Lesion 41006 Drainage Of Mouth Lesion 41007 Drainage Of Mouth Lesion 41008 Drainage Of Mouth Lesion 41009 Drainage Of Mouth Lesion 4100F Biphos Thxpy Vein Ord/Recvd 41010 960 Incision Of Tongue Fold $633 $412 $492 $207 $175 41015 Drainage Of Mouth Lesion 41016 Drainage Of Mouth Lesion 41017 Drainage Of Mouth Lesion 41018 Drainage Of Mouth Lesion 41019 Place Needles H&N For Rt 41100 510 Biopsy Of Tongue $185 $120 $144 $61 41105 Biopsy Of Tongue $264 $171 $205 $86 41108 510 Biopsy Of Floor Of Mouth $172 $112 $133 $56 4110F Int Mam Art Used For Cabg 41110 Excision Of Tongue Lesion 41112 Excision Of Tongue Lesion 41113 Excision Of Tongue Lesion 41114 Excision Of Tongue Lesion 41115 Excision Of Tongue Fold $719 $467 $558 $236 41116 Excision Of Mouth Lesion 41120 Partial Removal Of Tongue 41130 Partial Removal Of Tongue 41135 Tongue And Neck Surgery 41140 Removal Of Tongue 41145 Tongue Removal Neck Surgery 41150 Tongue Mouth Jaw Surgery 41153 Tongue Mouth Neck Surgery 41155 Tongue Jaw & Neck Surgery 4115F Beta Blckr Admin W/In 24 Hrs 4120F Antibiot Rxd/Given 4124F Antibiot Not Rxd/Given 41250 510 Repair Tongue Laceration $827 $538 $642 $271 41251 Repair Tongue Laceration 41252 450 Repair Tongue Laceration $2,208 $1,435 $1,714 $723 4130F Topical Prep Rx Aoe 4131F Syst Antimicrobial Thx Rx 4132F No Syst Antimicrobial Thx Rx 4133F Antihist/Decong Rx/Recom 4134F No Antihist/Decong Rx/Recom 4135F Systemic Corticosteroids Rx 4136F Syst Corticosteroids Not Rx 4140F Inhaled Corticosteroids Rxd 4142F Corticoster Sparng Thrpy Rxd 4144F Alt Long-Term Cntrl Med Rxd 4145F 2+ Anti-Hyprtnsv Agents Tkn 4148F Hep A Vac Injxn Admin/Recvd 4149F Hep B Vac Injxn Admin/Recvd 4150F Pt Recvng Antivir Txmnt Hepc 41510 Tongue To Lip Surgery 41512 Tongue Suspension 4151F Pt Not Recvng Antiv Hep C 41520 Reconstruction Tongue Fold 41530 Tongue Base Vol Reduction $1,059 $689 $822 $347 4153F Combo Pegintf/Rib Rx 4155F Hep A Vac Series Prev Recvd 4157F Hep B Vac Series Prev Recvd 4158F Pt Edu Re Alcoh Drnkng Done 41599 Tongue And Mouth Surgery 4159F Contrcp Talk B/4 Antiv Txmnt 4163F Pt Couns 4 Txmnt Opt Prost 4164F Adjv Hrmnl Thxpy Rxd 4165F 3D-Crt/Imrt Received 4167F Hd Bed Tilted 1St Day Vent 4168F Pt Care Icu&Vent W/In 24Hrs 4169F No Pt Care Icu/Vent In 24Hrs 4171F Pt Rcvng Esa Thxpy 4172F Pt Not Rcvng Esa Thxpy 4174F Couns Potent Glauc Impct 4175F Vis 20/40/> W/In 90 Days 4176F Talk Re Uv Light Pt/Crgvr 4177F Talk Pt/Crgvr Re Areds Prev 4178F Antid Glbln Rcvd W/In 26Wks 4179F Tamoxifen/Ai Prescribed 41800 510 Drainage Of Gum Lesion $580 $377 $450 $190 $45 41805 Removal Foreign Body Gum 41806 Removal Foreign Body Jawbone 4180F Adjv Thxpyrxd/Rcvd Colon Ca 4181F Conformal Radn Thxpy Rcvd 41820 Excision Gum Each Quadrant 41821 Excision Of Gum Flap 41822 Excision Of Gum Lesion 41823 Excision Of Gum Lesion 41825 450 Excision Of Gum Lesion $6,064 $3,942 $4,708 $1,987 41826 Excision Of Gum Lesion 41827 Excision Of Gum Lesion 41828 Excision Of Gum Lesion 4182F No Conformal Radn Thxpy 41830 Removal Of Gum Tissue 41850 Treatment Of Gum Lesion 4185F Continuous Ppi Or H2Ra Rcvd 4186F No Cont Ppi Or H2Ra Rcvd 41870 Gum Graft 41872 Repair Gum 41874 Repair Tooth Socket 4187F Anti Rheum Drugthxpyrxd/Gvn 4188F Approp Ace/Arb Tstng Done 41899 450 Dental Surgery Procedure $293 $190 $227 $96 4189F Approp Digoxin Tstng Done 4190F Approp Diuretic Tstng Done 4191F Approp Anticonvuls Tstng 4192F Pt Not Rcvng Glucoco Thxpy 4193F Pt Rcvng<10Mg Daily Predniso 4194F Pt Rcvng10Mg Daily Predniso 4195F Pt Rcvng Anti-Rheum Thxpy Ra 4196F Ptnot Rcvng Anti-Rhm Thxpyra 42000 Drainage Mouth Roof Lesion 4200F External Beam To Prost Only 4201F Extrnl Beam Other Than Prost 42100 510 Biopsy Roof Of Mouth $135 $88 $105 $44 42104 Excision Lesion Mouth Roof 42106 Excision Lesion Mouth Roof 42107 Excision Lesion Mouth Roof 4210F Ace/Arb Thxpy For Mos/> 42120 Remove Palate/Lesion 42140 Excision Of Uvula $361 $235 $281 $118 42145 Repair Palate Pharynx/Uvula $2,220 $1,443 $1,724 $728 $591 42160 510 Treatment Mouth Roof Lesion $259 $168 $201 $85 42180 Repair Palate 42182 Repair Palate 42200 Reconstruct Cleft Palate 42205 Reconstruct Cleft Palate 4220F Digoxin Thxpy For 6 Mos/> 42210 Reconstruct Cleft Palate 42215 Reconstruct Cleft Palate 4221F Diuretic Thxpy For 6 Mos/> 42220 Reconstruct Cleft Palate 42225 Reconstruct Cleft Palate 42226 Lengthening Of Palate 42227 Lengthening Of Palate 42235 Repair Palate 42260 Repair Nose To Lip Fistula 42280 Preparation Palate Mold 42281 Insertion Palate Prosthesis 42299 Palate/Uvula Surgery 42300 Drainage Of Salivary Gland 42305 Drainage Of Salivary Gland 4230F Anticonv Thxpy For 6 Mos/> 42310 Drainage Of Salivary Gland 42320 Drainage Of Salivary Gland 42330 Removal Of Salivary Stone 42335 Removal Of Salivary Stone 42340 Removal Of Salivary Stone 42400 510 Biopsy Of Salivary Gland $168 $109 $130 $55 42405 Biopsy Of Salivary Gland 42408 Excision Of Salivary Cyst $1,124 $731 $873 $368 42409 Drainage Of Salivary Cyst 4240F Instr Xrcz Back Pain 12 Wks 42410 Excise Parotid Gland/Lesion $1,900 $1,235 $1,475 $623 $371 42415 Excise Parotid Gland/Lesion $3,328 $2,163 $2,584 $1,091 42420 Excise Parotid Gland/Lesion 42425 Excise Parotid Gland/Lesion 42426 Excise Parotid Gland/Lesion 4242F Sprvsd Xrcz Back Pn >12 Wks 42440 Excise Submaxillary Gland 42450 Excise Sublingual Gland 4245F Pt Instr Nrml Lifest 4248F Pt Instr No Bd Rest 4 Days/> 42500 Repair Salivary Duct $975 $634 $757 $319 42505 Repair Salivary Duct 42507 Parotid Duct Diversion 42509 Parotid Duct Diversion 4250F Wrmng 4 Surg Normothermia 42510 Parotid Duct Diversion 42550 Injection For Salivary X-Ray 4255F Anesth 60 Min/> As Docd 4256F Anesthe <60 Min As Docd 42600 Closure Of Salivary Fistula 4260F Wound Srfc Culturetech Used 4261F Tech Other Than Surfc Cultr 42650 Dilation Of Salivary Duct 4265F Wet-Dry Dressings Rx Recmd 42660 Dilation Of Salivary Duct 42665 Ligation Of Salivary Duct 4266F No Wet-Dry Drssings Rx Recmd 4267F Comprssion Thxpy Prescribed 4268F Pt Ed Re Comp Thxpy Rcvd 42699 Salivary Surgery Procedure 4269F Appropos Mthd Offloading Rxd 42700 450 Drainage Of Tonsil Abscess $1,008 $655 $783 $330 4270F Pt Rcvng Anti R-Viral Thxpy 4271F Pt Rcvng Anti R-Viral Thxpy 42720 Drainage Of Throat Abscess 42725 Drainage Of Throat Abscess 4274F Flu Immuno Admind Rcvd 4276F Potent Antivir Thxpy Rxd 4279F Pcp Prophylaxis Rxd 42800 510 Biopsy Of Throat $183 $119 $142 $60 42804 Biopsy Of Upper Nose/Throat 42806 Biopsy Of Upper Nose/Throat 42808 Excise Pharynx Lesion 42809 450 Remove Pharynx Foreign Body $260 $169 $202 $85 4280F Pcp Prophylax Rxd 3Mon Low % 42810 Excision Of Neck Cyst 42815 Excision Of Neck Cyst 42820 Remove Tonsils And Adenoids $910 $591 $706 $298 42821 Remove Tonsils And Adenoids $948 $616 $736 $311 42825 Removal Of Tonsils $824 $536 $640 $270 $264 42826 Removal Of Tonsils $779 $507 $605 $255 42830 Removal Of Adenoids $651 $423 $505 $213 42831 Removal Of Adenoids $704 $457 $546 $231 42835 Removal Of Adenoids 42836 Removal Of Adenoids 42842 Extensive Surgery Of Throat 42844 Extensive Surgery Of Throat 42845 Extensive Surgery Of Throat 42860 Excision Of Tonsil Tags 42870 Excision Of Lingual Tonsil $1,542 $1,002 $1,197 $505 42890 Partial Removal Of Pharynx 42892 Revision Of Pharyngeal Walls 42894 Revision Of Pharyngeal Walls 42900 Repair Throat Wound 4290F Pt Scrned For Inj Drug Use 4293F Pt Scrnd Hgh-Risk Sex Behav 42950 Reconstruction Of Throat 42953 Repair Throat Esophagus 42955 Surgical Opening Of Throat 42960 Control Throat Bleeding 42961 Control Throat Bleeding 42962 Control Throat Bleeding 42970 Control Nose/Throat Bleeding 42971 Control Nose/Throat Bleeding 42972 Control Nose/Throat Bleeding 42999 Throat Surgery Procedure 4300F Pt Rcvng Warf Thxpy 4301F Pt Not Rcvng Warf Thxpy 43020 Incision Of Esophagus 43030 Throat Muscle Surgery 43045 Incision Of Esophagus 4305F Pt Ed Re Ft Care Inspct Rcvd 4306F Pt Tlk Psych & Rx Opd Addic 43100 Excision Of Esophagus Lesion 43101 Excision Of Esophagus Lesion 43107 Removal Of Esophagus 43108 Removal Of Esophagus 43112 Esphg Tot W/Thrcm 43113 Removal Of Esophagus 43116 Partial Removal Of Esophagus 43117 Partial Removal Of Esophagus 43118 Partial Removal Of Esophagus 43121 Partial Removal Of Esophagus 43122 Partial Removal Of Esophagus 43123 Partial Removal Of Esophagus 43124 Removal Of Esophagus 43130 Removal Of Esophagus Pouch 43135 Removal Of Esophagus Pouch 43180 982 Esophagoscopy Rigid Trnso $3,433 $2,232 $2,665 $1,125 43191 982 Esophagoscopy Rigid Trnso Dx $971 $631 $753 $318 43192 982 Esophagoscp Rig Trnso Inject $1,064 $692 $826 $349 43193 982 Esophagoscp Rig Trnso Biopsy $1,062 $690 $825 $348 43194 982 Esophagoscp Rig Trnso Rem Fb $1,226 $797 $952 $402 43195 982 Esophagoscopy Rigid Balloon $1,156 $752 $898 $379 43196 982 Esophagoscp Guide Wire Dilat $1,228 $798 $953 $402 43197 982 Esophagoscopy Flex Dx Brush $534 $347 $414 $175 43198 982 Esophagosc Flex Trnsn Biopsy $1,228 $798 $953 $402 43200 982 Esophagoscopy Flexible Brush $554 $360 $430 $182 43201 982 Esoph Scope W/Submucous Inj $653 $424 $507 $214 43202 982 Esophagoscopy Flex Biopsy $648 $421 $503 $212 43204 982 Esoph Scope W/Sclerosis Inj $840 $546 $652 $275 43205 982 Esophagus Endoscopy/Ligation $876 $569 $680 $287 43206 982 Esoph Optical Endomicroscopy $824 $536 $640 $270 4320F Pt Talk Psychsoc&Rx Oh Dpnd 43210 982 Egd Esophagogastrc Fndoplsty $2,778 $1,806 $2,157 $910 43211 982 Esophagoscop Mucosal Resect $1,450 $943 $1,126 $475 43212 982 Esophagoscop Stent Placement $1,219 $792 $946 $399 43213 982 Esophagoscopy Retro Balloon $1,636 $1,064 $1,270 $536 43214 982 Esophagosc Dilate Balloon 30 $1,203 $782 $934 $394 43215 982 Esophagoscopy Flex Remove Fb $895 $582 $695 $293 43216 982 Esophagoscopy Lesion Removal $834 $542 $648 $273 43217 982 Esophagoscopy Snare Les Remv $992 $645 $770 $325 43220 982 Esophagoscopy Balloon <30Mm $700 $455 $544 $229 43226 982 Esoph Endoscopy Dilation $823 $535 $639 $270 43227 982 Esophagoscopy Control Bleed $1,022 $664 $793 $335 43229 982 Esophagoscopy Lesion Ablate $1,233 $802 $958 $404 4322F Crgvr Prov W/ Ed Addl Rsrcs 43231 982 Esophagoscop Ultrasound Exam $981 $638 $761 $321 43232 982 Esophagoscopy W/Us Needle Bx $1,226 $797 $952 $402 43233 982 Egd Balloon Dil Esoph30 Mm/> $1,450 $942 $1,126 $475 43235 982 Egd Diagnostic Brush Wash $768 $499 $596 $252 $188 43236 982 Uppr Gi Scope W/Submuc Inj $860 $559 $667 $282 43237 982 Endoscopic Us Exam Esoph $1,210 $786 $939 $396 43238 982 Egd Us Fine Needle Bx/Aspir $1,436 $934 $1,115 $471 43239 982 Egd Biopsy Single/Multiple $862 $560 $669 $282 $231 43240 982 Egd W/Transmural Drain Cyst $2,433 $1,582 $1,889 $797 43241 982 Egd Tube/Cath Insertion $881 $572 $684 $289 43242 982 Egd Us Fine Needle Bx/Aspir $1,623 $1,055 $1,260 $532 $273 43243 982 Egd Injection Varices $1,475 $958 $1,145 $483 43244 982 Egd Varices Ligation $1,519 $987 $1,179 $498 43245 982 Egd Dilate Stricture $1,108 $720 $860 $363 43246 982 Egd Place Gastrostomy Tube $1,273 $827 $988 $417 $117 43247 982 Egd Remove Foreign Body $1,107 $720 $859 $363 43248 982 Egd Guide Wire Insertion $1,028 $668 $798 $337 $246 43249 982 Esoph Egd Dilation <30 Mm $954 $620 $741 $313 $211 4324F Pt Queried Prkns Complic 43250 982 Egd Cautery Tumor Polyp $1,087 $707 $844 $356 43251 982 Egd Remove Lesion Snare $1,221 $794 $948 $400 43252 982 Egd Optical Endomicroscopy $1,059 $688 $822 $347 43253 982 Egd Us Transmural Injxn/Mark $1,631 $1,060 $1,266 $535 43254 982 Egd Endo Mucosal Resection $1,673 $1,087 $1,299 $548 43255 982 Egd Control Bleeding Any $1,244 $809 $966 $408 43257 982 Egd W/Thrml Txmnt Gerd $1,465 $952 $1,137 $480 43259 982Egd Us Exam Duodenum/Jejunum $1,401 $910 $1,087 $459 $203

4325F Med Txmnt Options Rvwd W/Pt 43260 982 Ercp W/Specimen Collection $1,996 $1,297 $1,549 $654 43261 982 Endo Cholangiopancreatograph $2,089 $1,358 $1,622 $685 43262 982 Endo Cholangiopancreatograph $2,203 $1,432 $1,711 $722 43263 982 Ercp Sphincter Pressure Meas $2,203 $1,432 $1,711 $722 43264 982 Ercp Remove Duct Calculi $2,243 $1,458 $1,741 $735 $588 43265 982 Ercp Lithotripsy Calculi $2,681 $1,743 $2,081 $878 43266 982 Egd Endoscopic Stent Place $1,363 $886 $1,058 $446 4326F Pt Asked Re Symp Auto Dysfxn 43270 982 Egd Lesion Ablation $1,393 $905 $1,081 $456 43273 982 Endoscopic Pancreatoscopy $746 $485 $579 $244 43274 982 Ercp Duct Stent Placement $2,863 $1,861 $2,223 $938 $588 43275 982 Ercp Remove Forgn Body Duct $2,328 $1,513 $1,807 $763 $468 43276 982 Ercp Stent Exchange W/Dilate $2,975 $1,934 $2,310 $975 43277 982 Ercp Ea Duct/Ampulla Dilate $2,340 $1,521 $1,817 $767 43278 982 Ercp Lesion Ablate W/Dilate $2,683 $1,744 $2,083 $879 43279 Lap Myotomy Heller 43280 Laparoscopy Fundoplasty 43281 Lap Paraesophag Hern Repair 43282 Lap Paraesoph Her Rpr W/Mesh 43283 Lap Esoph Lengthening 43284 Laps Esophgl Sphnctr Agmntj 43285 Rmvl Esophgl Sphnctr Dev 43286 Esphg Tot W/Laps Moblj 43287 Esphg Dstl 2/3 W/Laps Moblj 43288 Esphg Thrsc Moblj 43289 Laparoscope Proc Esoph 4328F Pt Asked Re Sleep Disturb 43300 Repair Of Esophagus 43305 Repair Esophagus And Fistula 4330F Cnslng Epi Spec Sfty Issues 43310 Repair Of Esophagus 43312 Repair Esophagus And Fistula 43313 Esophagoplasty Congenital 43314 Tracheo-Esophagoplasty Cong 43320 Fuse Esophagus & Stomach 43325 Revise Esophagus & Stomach 43327 Esoph Fundoplasty Lap 43328 Esoph Fundoplasty Thor 43330 Esophagomyotomy Abdominal 43331 Esophagomyotomy Thoracic 43332 Transab Esoph Hiat Hern Rpr 43333 Transab Esoph Hiat Hern Rpr 43334 Transthor Diaphrag Hern Rpr 43335 Transthor Diaphrag Hern Rpr 43336 Thorabd Diaphr Hern Repair 43337 Thorabd Diaphr Hern Repair 43338 Esoph Lengthening 43340 Fuse Esophagus & Intestine 43341 Fuse Esophagus & Intestine 43351 Surgical Opening Esophagus 43352 Surgical Opening Esophagus 43360 Gastrointestinal Repair 43361 Gastrointestinal Repair 43400 Ligate Esophagus Veins 43405 Ligate/Staple Esophagus 4340F Cnslng Chldbrng Women Epi 43410 Repair Esophagus Wound 43415 Repair Esophagus Wound 43420 Repair Esophagus Opening 43425 Repair Esophagus Opening 43450 982 Dilate Esophagus 1/Mult Pass $1,154 $750 $896 $378 $296 43453 982 Dilate Esophagus $533 $346 $414 $175 43460 982 Pressure Treatment Esophagus $1,316 $856 $1,022 $431 43496 Free Jejunum Flap Microvasc 43499 Esophagus Surgery Procedure 43500 Surgical Opening Of Stomach 43501 Surgical Repair Of Stomach 43502 Surgical Repair Of Stomach 4350F Cnslng Provided Symp Mngmnt 43510 Surgical Opening Of Stomach 43520 Incision Of Pyloric Muscle 43605 Biopsy Of Stomach 43610 Excision Of Stomach Lesion 43611 Excision Of Stomach Lesion 43620 Removal Of Stomach 43621 Removal Of Stomach 43622 Removal Of Stomach 43631 Removal Of Stomach Partial 43632 Removal Of Stomach Partial 43633 Removal Of Stomach Partial 43634 Removal Of Stomach Partial 43635 Removal Of Stomach Partial 43640 Vagotomy & Pylorus Repair 43641 Vagotomy & Pylorus Repair 43644 Lap Gastric Bypass/Roux-En-Y 43645 Lap Gastr Bypass Incl Smll I 43647 Lap Impl Electrode Antrum 43648 Lap Revise/Remv Eltrd Antrum 43651 Laparoscopy Vagus Nerve 43652 Laparoscopy Vagus Nerve 43653 Laparoscopy Gastrostomy 43659 Laparoscope Proc Stom 43752 982 Nasal/Orogastric W/Tube Plmt $253 $165 $197 $83 43753 982 Tx Gastro Intub W/Asp $148 $96 $115 $49 43754 982 Dx Gastr Intub W/Asp Spec $232 $150 $180 $76 43755 Dx Gastr Intub W/Asp Specs 43756 Dx Duod Intub W/Asp Spec 43757 Dx Duod Intub W/Asp Specs 43761 982 Reposition Gastrostomy Tube $657 $427 $510 $215 43762 982 Rplc Gtube No Revj Trc $244 $159 $189 $80 43763 450 Rplc Gtube Revj Gstrst Trc $609 $396 $473 $200 43770 Lap Place Gastr Adj Device 43771 Lap Revise Gastr Adj Device 43772 Lap Rmvl Gastr Adj Device 43773 Lap Replace Gastr Adj Device 43774 Lap Rmvl Gastr Adj All Parts 43775 Lap Sleeve Gastrectomy 43800 Reconstruction Of Pylorus 43810 Fusion Of Stomach And Bowel 43820 Fusion Of Stomach And Bowel 43825 Fusion Of Stomach And Bowel 43830 Place Gastrostomy Tube 43831 Place Gastrostomy Tube 43832 Place Gastrostomy Tube 43840 Repair Of Stomach Lesion 43842 V-Band Gastroplasty 43843 Gastroplasty W/O V-Band 43845 Gastroplasty Duodenal Switch 43846 Gastric Bypass For Obesity 43847 Gastric Bypass Incl Small I 43848 Revision Gastroplasty 43850 Revise Stomach-Bowel Fusion 43855 Revise Stomach-Bowel Fusion 43860 Revise Stomach-Bowel Fusion 43865 Revise Stomach-Bowel Fusion 43870 Repair Stomach Opening 43880 Repair Stomach-Bowel Fistula 43881 Impl/Redo Electrd Antrum 43882 Revise/Remove Electrd Antrum 43886 Revise Gastric Port Open 43887 Remove Gastric Port Open 43888 Change Gastric Port Open 43999 982 Stomach Surgery Procedure 44005 Freeing Of Bowel Adhesion 4400F Rehab Thxpy Options W/Pt 44010 Incision Of Small Bowel 44015 Insert Needle Cath Bowel 44020 Explore Small Intestine 44021 Decompress Small Bowel 44025 Incision Of Large Bowel 44050 Reduce Bowel Obstruction 44055 Correct Malrotation Of Bowel 44100 Biopsy Of Bowel 44110 Excise Intestine Lesion(S) 44111 Excision Of Bowel Lesion(S) 44120 Removal Of Small Intestine 44121 Removal Of Small Intestine 44125 Removal Of Small Intestine 44126 Enterectomy W/O Taper Cong 44127 Enterectomy W/Taper Cong 44128 Enterectomy Cong Add-On 44130 Bowel To Bowel Fusion 44132 Enterectomy Cadaver Donor 44133 Enterectomy Live Donor 44135 Intestine Transplnt Cadaver 44136 Intestine Transplant Live 44137 Remove Intestinal Allograft 44139 Mobilization Of Colon 44140 Partial Removal Of Colon 44141 Partial Removal Of Colon 44143 Partial Removal Of Colon 44144 Partial Removal Of Colon 44145 Partial Removal Of Colon 44146 Partial Removal Of Colon 44147 Partial Removal Of Colon 44150 Removal Of Colon 44151 Removal Of Colon/Ileostomy 44155 Removal Of Colon/Ileostomy 44156 Removal Of Colon/Ileostomy 44157 Colectomy W/Ileoanal Anast 44158 Colectomy W/Neo-Rectum Pouch 44160 Removal Of Colon 44180 Lap Enterolysis 44186 Lap Jejunostomy 44187 Lap Ileo/Jejuno-Stomy 44188 Lap Colostomy 44202 Lap Enterectomy 44203 Lap Resect S/Intestine Addl 44204 Laparo Partial Colectomy 44205 Lap Colectomy Part W/Ileum 44206 Lap Part Colectomy W/Stoma 44207 L Colectomy/Coloproctostomy 44208 L Colectomy/Coloproctostomy 44210 Laparo Total Proctocolectomy 44211 Lap Colectomy W/Proctectomy 44212 Laparo Total Proctocolectomy 44213 Lap Mobil Splenic Fl Add-On 44227 Lap Close Enterostomy 44238 Laparoscope Proc Intestine 44300 982 Open Bowel To Skin $5,662 $3,680 $4,396 $1,855 44310 Ileostomy/Jejunostomy 44312 Revision Of Ileostomy 44314 Revision Of Ileostomy 44316 Devise Bowel Pouch 44320 Colostomy 44322 Colostomy With Biopsies 44340 Revision Of Colostomy 44345 Revision Of Colostomy 44346 Revision Of Colostomy 44360 982 Small Bowel Endoscopy $890 $578 $691 $291 44361 982 Small Bowel Endoscopy/Biopsy $982 $638 $762 $322 44363 982 Small Bowel Endoscopy $1,195 $777 $928 $392 44364 982 Small Bowel Endoscopy $1,266 $823 $983 $415 44365 982 Small Bowel Endoscopy $1,124 $730 $872 $368 44366 982 Small Bowel Endoscopy $1,487 $966 $1,154 $487 44369 982 Small Bowel Endoscopy $1,523 $990 $1,182 $499 44370 982 Small Bowel Endoscopy/Stent $1,652 $1,074 $1,283 $541 44372 982 Small Bowel Endoscopy $1,502 $976 $1,166 $492 44373 982 Small Bowel Endoscopy $1,206 $784 $936 $395 44376 982 Small Bowel Endoscopy $1,756 $1,142 $1,364 $575 44377 982 Small Bowel Endoscopy/Biopsy $1,851 $1,203 $1,437 $607 44378 982 Small Bowel Endoscopy $2,376 $1,544 $1,844 $778 44379 982 S Bowel Endoscope W/Stent $2,532 $1,646 $1,966 $830 44380 982 Small Bowel Endoscopy Br/Wa $346 $225 $268 $113 44381 982 Small Bowel Endoscopy Br/Wa $518 $337 $402 $170 44382 982 Small Bowel Endoscopy $453 $294 $351 $148 44384 982 Small Bowel Endoscopy $960 $624 $745 $314 44385 982 Endoscopy Of Bowel Pouch $452 $294 $351 $148 44386 982 Endoscopy Bowel Pouch/Biop $556 $362 $432 $182 44388 982 Colonoscopy Thru Stoma Spx $994 $646 $772 $326 44388 982 Colonoscopy Thru Stoma Spx $994 $646 $772 $326 44389 982 Colonoscopy With Biopsy $1,081 $703 $840 $354 44390 982 Colonoscopy For Foreign Body $1,302 $847 $1,011 $427 44391 982 Colonoscopy For Bleeding $1,431 $930 $1,111 $469 44392 982 Colonoscopy & Polypectomy $1,274 $828 $989 $417 44394 982 Colonoscopy W/Snare $1,416 $920 $1,099 $464 44401 982 Colonoscopy With Ablation $1,503 $977 $1,167 $492 44402 982 Colonoscopy W/Stent Plcmt $1,623 $1,055 $1,260 $532 44403 982 Colonoscopy W/Resection $1,879 $1,221 $1,459 $616 44404 982 Colonoscopy W/Injection $1,079 $701 $838 $354 44405 982 Colonoscopy W/Dilation $1,134 $737 $880 $372 44406 982 Colonoscopy W/Ultrasound $1,421 $923 $1,103 $465 44407 982 Colonoscopy W/Ndl Aspir/Bx $1,705 $1,108 $1,324 $559 44408 982 Colonoscopy W/Decompression $1,433 $931 $1,112 $469 44500 982 Intro Gastrointestinal Tube $117 $76 $91 $38 4450F Self-Care Ed Provided To Pt 44602 Suture Small Intestine 44603 Suture Small Intestine 44604 Suture Large Intestine 44605 Repair Of Bowel Lesion 44615 Intestinal Stricturoplasty 44620 Repair Bowel Opening 44625 Repair Bowel Opening 44626 Repair Bowel Opening 44640 Repair Bowel-Skin Fistula 44650 Repair Bowel Fistula 44660 Repair Bowel-Bladder Fistula 44661 Repair Bowel-Bladder Fistula 44680 Surgical Revision Intestine 44700 Suspend Bowel W/Prosthesis 44701 Intraop Colon Lavage Add-On 44705 982 Prepare Fecal Microbiota 4470F Icd Counseling Provided 44715 Prepare Donor Intestine 44720 Prep Donor Intestine/Venous 44721 Prep Donor Intestine/Artery 44799 982 Unlisted Px Small Intestine $2,424 $1,576 $1,882 $794 44800 Excision Of Bowel Pouch 4480F Pt Rcvng Ace/Arb B-Blockertx 4481F Pt Rcvng Ace/Arb Blker >3Mos 44820 Excision Of Mesentery Lesion 44850 Repair Of Mesentery 44899 Bowel Surgery Procedure 44900 Drain Appendix Abscess Open 44950 Appendectomy $2,000 $1,300 $1,553 $655 44955 Appendectomy Add-On 44960 Appendectomy 44970 Laparoscopy Appendectomy $1,858 $1,208 $1,442 $609 44979 Laparoscope Proc App 45000 Drainage Of Pelvic Abscess 45005 Drainage Of Rectal Abscess 4500F Ref To Outpt Card Rehab Prog 45020 Drainage Of Rectal Abscess 45100 Biopsy Of Rectum $918 $597 $712 $301 45108 Removal Of Anorectal Lesion 4510F Prev Cardrehab Qualcardevent 45110 Removal Of Rectum 45111 Partial Removal Of Rectum 45112 Removal Of Rectum 45113 Partial Proctectomy 45114 Partial Removal Of Rectum 45116 Partial Removal Of Rectum 45119 Remove Rectum W/Reservoir 45120 Removal Of Rectum 45121 Removal Of Rectum And Colon 45123 Partial Proctectomy 45126 Pelvic Exenteration 45130 Excision Of Rectal Prolapse 45135 Excision Of Rectal Prolapse 45136 Excise Ileoanal Reservior 45150 Excision Of Rectal Stricture 45160 Excision Of Rectal Lesion 45171 Exc Rect Tum Transanal Part 45172 Exc Rect Tum Transanal Full 45190 Destruction Rectal Tumor 4525F Neuropsychia Interven Order 4526F Neuropsychia Interven Rcvd 45300 510 Proctosigmoidoscopy Dx $212 $138 $164 $69 45303 Proctosigmoidoscopy Dilate 45305 Proctosigmoidoscopy W/Bx 45307 Proctosigmoidoscopy Fb 45308 Proctosigmoidoscopy Removal 45309 Proctosigmoidoscopy Removal 45315 Proctosigmoidoscopy Removal 45317 Proctosigmoidoscopy Bleed 45320 Proctosigmoidoscopy Ablate 45321 Proctosigmoidoscopy Volvul 45327 Proctosigmoidoscopy W/Stent 45330 982 Diagnostic Sigmoidoscopy $351 $228 $272 $115 45331 982 Sigmoidoscopy And Biopsy $445 $289 $345 $146 $89 45332 982 Sigmoidoscopy W/Fb Removal $664 $432 $516 $218 $59 45333 Sigmoidoscopy & Polypectomy 45334 982 Sigmoidoscopy For Bleeding $729 $474 $566 $239 45335 982 Sigmoidoscopy W/Submuc Inj $415 $270 $322 $136 45337 982 Sigmoidoscopy & Decompress $726 $472 $564 $238 45338 982 Sigmoidoscopy W/Tumr Remove $754 $490 $585 $247 $159 45340 982 Sig W/Tndsc Balloon Dilation $487 $317 $378 $160 45341 982 Sigmoidoscopy W/Ultrasound $769 $500 $597 $252 45342 982 Sigmoidoscopy W/Us Guide Bx $1,050 $682 $815 $344 45346 982 Sigmoidoscopy W/Ablation $996 $647 $773 $326 45347 982 Sigmoidoscopy W/Plcmt Stent $955 $621 $741 $313 45349 982 Sigmoidoscopy W/Resection $1,233 $801 $957 $404 45350 982 Sgmdsc W/Band Ligation $636 $414 $494 $208 45378 982 Diagnostic Colonoscopy $1,162 $755 $902 $381 $219 45378 982 Diagnostic Colonoscopy $1,162 $755 $902 $381 $219 45379 982 Colonoscopy W/Fb Removal $1,494 $971 $1,160 $490 45380 982 Colonoscopy And Biopsy $1,249 $812 $969 $409 $284 45381 982 Colonoscopy Submucous Njx $1,249 $812 $969 $409 $357 45382 982 Colonoscopy W/Control Bleed $1,607 $1,045 $1,248 $527 45384 982 Colonoscopy W/Lesion Removal $1,443 $938 $1,121 $473 45385 982 Colonoscopy W/Lesion Removal $1,584 $1,029 $1,229 $519 $303 45386 982 Colonoscopy W/Balloon Dilat $1,319 $857 $1,024 $432 45388 982 Colonoscopy W/Ablation $1,697 $1,103 $1,317 $556 45389 982 Colonoscopy W/Stent Plcmt $1,804 $1,173 $1,400 $591 45390 982 Colonoscopy W/Resection $2,053 $1,335 $1,594 $673 $359 45391 982 Colonoscopy W/Endoscope Us $1,592 $1,035 $1,236 $522 45392 982 Colonoscopy W/Endoscopic Fnb $1,886 $1,226 $1,464 $618 45393 982 Colonoscopy W/Decompression $1,585 $1,030 $1,230 $519 45395 Lap Removal Of Rectum 45397 Lap Remove Rectum W/Pouch 45398 982 Colonoscopy W/Band Ligation $1,503 $977 $1,167 $492 45399 Unlisted Procedure Colon 45400 Laparoscopic Proc 45402 Lap Proctopexy W/Sig Resect 4540F Disease Modif Pharmacothxpy 4541F Pt Offered Tx For Pseudobulb 45499 Laparoscope Proc Rectum 45500 Repair Of Rectum 45505 Repair Of Rectum 4550F Noninvas Resp Support Talk 4551F Nutritional Support Offered 45520 Treatment Of Rectal Prolapse 4552F Pt Ref For Speech Lang Path 4553F Pt Asst Re End Life Issues 45540 Correct Rectal Prolapse 45541 Correct Rectal Prolapse 4554F Pt Recvd Inhal Anesthetic 45550 Repair Rectum/Remove Sigmoid 4555F Pt Recvd No Inhal Anesthic 45560 Repair Of Rectocele 45562 Exploration/Repair Of Rectum 45563 Exploration/Repair Of Rectum 4556F Pt W/3+ Post-Op Nausea&Vom 4557F Pt W/O 3+ Post-Opnausea&Vom 4558F Pt Recvd 2 Rx Anti-Emet Agt 4559F 1 Bodytemp >=35.5Cw/In 30Min 4560F Anesth W/O Gen/Neurax Anesth 4561F Pt W/ Coronary Artery Stent 4562F Pt W/O Coronary Artery Stent 4563F Pt Recvd Aspirin W/In 24 Hrs 45800 Repair Rect/Bladder Fistula 45805 Repair Fistula W/Colostomy 45820 Repair Rectourethral Fistula 45825 Repair Fistula W/Colostomy 45900 Reduction Of Rectal Prolapse 45905 Dilation Of Anal Sphincter 45910 982 Dilation Of Rectal Narrowing $1,227 $797 $952 $402 45915 Remove Rectal Obstruction 45990 Surg Dx Exam Anorectal $337 $219 $262 $111 45999 Rectum Surgery Procedure 46020 Placement Of Seton 46030 Removal Of Rectal Marker 46040 510 Incision Of Rectal Abscess $2,158 $1,403 $1,675 $706 46045 Incision Of Rectal Abscess 46050 510 Incision Of Anal Abscess $697 $453 $541 $228 $71 46060 Incision Of Rectal Abscess 46070 Incision Of Anal Septum 46080 Incision Of Anal Sphincter $710 $462 $552 $233 $173 46083 510 Incise External Hemorrhoid $393 $255 $305 $129 46200 Removal Of Anal Fissure 46220 510 Excise Anal Ext Tag/Papilla $321 $209 $249 $105 46221 982 Ligation Of Hemorrhoid(S) $1,207 $784 $937 $395 46230 510 Removal Of Anal Tags $410 $266 $318 $134 46250 Remove Ext Hem Groups 2+ 46255 Remove Int/Ext Hem 1 Group 46257 Remove In/Ex Hem Grp & Fiss 46258 Remove In/Ex Hem Grp W/Fistu 46260 Remove In/Ex Hem Groups 2+ $1,478 $961 $1,147 $484 46261 Remove In/Ex Hem Grps & Fiss 46262 Remove In/Ex Hem Grps W/Fist 46270 Remove Anal Fist Subq $920 $598 $715 $302 46275 Remove Anal Fist Inter 46280 Remove Anal Fist Complex $1,357 $882 $1,054 $445 46285 Remove Anal Fist 2 Stage 46288 Repair Anal Fistula 46320 Removal Of Hemorrhoid Clot 46500 Injection Into Hemorrhoid(S) 46505 Chemodenervation Anal Musc 46600 510 Diagnostic Anoscopy Spx $424 $276 $329 $139 46601 Diagnostic Anoscopy 46604 Anoscopy And Dilation 46606 510 Anoscopy And Biopsy $389 $253 $302 $127 46607 Diagnostic Anoscopy & Biopsy 46608 Anoscopy Remove For Body 46610 Anoscopy Remove Lesion 46611 Anoscopy 46612 Anoscopy Remove Lesions 46614 Anoscopy Control Bleeding 46615 Anoscopy 46700 Repair Of Anal Stricture 46705 Repair Of Anal Stricture 46706 Repr Of Anal Fistula W/Glue 46707 Repair Anorectal Fist W/Plug 46710 Repr Per/Vag Pouch Sngl Proc 46712 Repr Per/Vag Pouch Dbl Proc 46715 Rep Perf Anoper Fistu 46716 Rep Perf Anoper/Vestib Fistu 46730 Construction Of Absent Anus 46735 Construction Of Absent Anus 46740 Construction Of Absent Anus 46742 Repair Of Imperforated Anus 46744 Repair Of Cloacal Anomaly 46746 Repair Of Cloacal Anomaly 46748 Repair Of Cloacal Anomaly 46750 Repair Of Anal Sphincter 46751 Repair Of Anal Sphincter 46753 Reconstruction Of Anus 46754 Removal Of Suture From Anus 46760 Repair Of Anal Sphincter 46761 Repair Of Anal Sphincter 46900 510 Destruction Anal Lesion(S) $406 $264 $315 $133 46910 Destruction Anal Lesion(S) $309 $201 $240 $101 46916 Cryosurgery Anal Lesion(S) 46917 Laser Surgery Anal Lesions 46922 510 Excision Of Anal Lesion(S) $459 $298 $356 $150 46924 510 Destruction Anal Lesion(S) $949 $617 $737 $311 46930 Destroy Internal Hemorrhoids 46940 Treatment Of Anal Fissure 46942 Treatment Of Anal Fissure 46945 Int Hrhc Lig 1 Hroid W/O Img 46946 Int Hrhc Lig 2+Hroid W/O Img 46947 Hemorrhoidopexy By Stapling 46948 Int Hrhc Tranal Dartlzj 2+ 46999 Anus Surgery Procedure 47000 982 Needle Biopsy Of Liver $539 $350 $418 $176 47001 982 Needle Biopsy Liver Add-On $708 $460 $550 $232 47010 Open Drainage Liver Lesion 47015 Inject/Aspirate Liver Cyst 47100 Wedge Biopsy Of Liver 47120 Partial Removal Of Liver 47122 Extensive Removal Of Liver 47125 Partial Removal Of Liver 47130 Partial Removal Of Liver 47133 Removal Of Donor Liver 47135 Transplantation Of Liver 47140 Partial Removal Donor Liver 47141 Partial Removal Donor Liver 47142 Partial Removal Donor Liver 47143 Prep Donor Liver Whole 47144 Prep Donor Liver 3-Segment 47145 Prep Donor Liver Lobe Split 47146 Prep Donor Liver/Venous 47147 Prep Donor Liver/Arterial 47300 Surgery For Liver Lesion 47350 Repair Liver Wound 47360 Repair Liver Wound 47361 Repair Liver Wound 47362 Repair Liver Wound 47370 Laparo Ablate Liver Tumor Rf 47371 Laparo Ablate Liver Cryosurg 47379 Laparoscope Procedure Liver 47380 Open Ablate Liver Tumor Rf 47381 Open Ablate Liver Tumor Cryo 47382 Percut Ablate Liver Rf 47383 Perq Abltj Lvr Cryoablation 47399 Liver Surgery Procedure 47400 Incision Of Liver Duct 47420 Incision Of Bile Duct 47425 Incision Of Bile Duct 47460 Incise Bile Duct Sphincter 47480 Incision Of Gallbladder 47490 Incision Of Gallbladder 47531 Injection For Cholangiogram 47532 Injection For Cholangiogram 47533 Plmt Biliary Drainage Cath 47534 Plmt Biliary Drainage Cath 47535 Conversion Ext Bil Drg Cath 47536 Exchange Biliary Drg Cath 47537 Removal Biliary Drg Cath 47538 Perq Plmt Bile Duct Stent 47539 Perq Plmt Bile Duct Stent 47540 Perq Plmt Bile Duct Stent 47541 Plmt Access Bil Tree Sm Bwl 47542 Dilate Biliary Duct/Ampulla 47543 Endoluminal Bx Biliary Tree 47544 Removal Duct Glbldr Calculi 47550 Bile Duct Endoscopy Add-On 47552 Biliary Endo Perq Dx W/Speci 47553 Biliary Endoscopy Thru Skin 47554 Biliary Endoscopy Thru Skin 47555 Biliary Endoscopy Thru Skin 47556 Biliary Endoscopy Thru Skin 47562 Laparoscopic Cholecystectomy $2,029 $1,319 $1,575 $665 $498 47563 Laparo Cholecystectomy/Graph $2,155 $1,401 $1,673 $706 $411 47564 Laparo Cholecystectomy/Explr 47570 Laparo Cholecystoenterostomy 47579 Laparoscope Proc Biliary 47600 Removal Of Gallbladder 47605 Removal Of Gallbladder 47610 Removal Of Gallbladder 47612 Removal Of Gallbladder 47620 Removal Of Gallbladder 47700 Exploration Of Bile Ducts 47701 Bile Duct Revision 47711 Excision Of Bile Duct Tumor 47712 Excision Of Bile Duct Tumor 47715 Excision Of Bile Duct Cyst 47720 Fuse Gallbladder & Bowel 47721 Fuse Upper Gi Structures 47740 Fuse Gallbladder & Bowel 47741 Fuse Gallbladder & Bowel 47760 Fuse Bile Ducts And Bowel 47765 Fuse Liver Ducts & Bowel 47780 Fuse Bile Ducts And Bowel 47785 Fuse Bile Ducts And Bowel 47800 Reconstruction Of Bile Ducts 47801 Placement Bile Duct Support 47802 Fuse Liver Duct & Intestine 47900 Suture Bile Duct Injury 47999 982 Bile Tract Surgery Procedure 48000 Drainage Of Abdomen 48001 Placement Of Drain Pancreas 48020 982 Removal Of Pancreatic Stone $7,958 $5,172 $6,178 $2,607 48100 982 Biopsy Of Pancreas Open $5,921 $3,848 $4,596 $1,940 48102 Needle Biopsy Pancreas 48105 982 Resect/Debride Pancreas $19,005 $12,353 $14,754 $6,227 48120 Removal Of Pancreas Lesion 48140 Partial Removal Of Pancreas 48145 Partial Removal Of Pancreas 48146 Pancreatectomy 48148 982 Removal Of Pancreatic Duct $8,441 $5,487 $6,553 $2,766 48150 Partial Removal Of Pancreas 48152 Pancreatectomy 48153 Pancreatectomy 48154 Pancreatectomy 48155 Removal Of Pancreas 48160 Pancreas Removal/Transplant 48400 Injection Intraop Add-On 48500 Surgery Of Pancreatic Cyst 48510 Drain Pancreatic Pseudocyst 48520 Fuse Pancreas Cyst And Bowel 48540 Fuse Pancreas Cyst And Bowel 48545 Pancreatorrhaphy 48547 Duodenal Exclusion 48548 982 Fuse Pancreas And Bowel $11,231 $7,300 $8,719 $3,680 48550 Donor Pancreatectomy 48551 Prep Donor Pancreas 48552 Prep Donor Pancreas/Venous 48554 Transpl Allograft Pancreas 48556 Removal Allograft Pancreas 48999 982 Pancreas Surgery Procedure 49000 Exploration Of Abdomen 49002 Reopening Of Abdomen 49010 Exploration Behind Abdomen 49013 Prpertl Pel Pack Hemrrg Trma 49014 Reexploration Pelvic Wound 49020 Drainage Abdom Abscess Open 49040 Drain Open Abdom Abscess 49060 Drain Open Retroperi Abscess 49062 Drain To Peritoneal Cavity 49082 982 Abd Paracentesis $1,394 $906 $1,082 $457 49083 761 Abd Paracentesis W/Imaging $1,882 $1,223 $1,461 $617 49084 Peritoneal Lavage 49180 Biopsy Abdominal Mass 49185 Sclerotx Fluid Collection 49203 Exc Abd Tum 5 Cm Or Less 49204 Exc Abd Tum Over 5 Cm $4,350 $2,828 $3,377 $1,425 49205 Exc Abd Tum Over 10 Cm 49215 Excise Sacral Spine Tumor 49220 Multiple Surgery Abdomen 49250 Excision Of Umbilicus 49255 Removal Of Omentum 49320 Diag Laparo Separate Proc $1,002 $651 $778 $328 $306 49321 Laparoscopy Biopsy $1,064 $692 $826 $349 $325 49322 Laparoscopy Aspiration $1,114 $724 $865 $365 49323 Laparo Drain Lymphocele 49324 Lap Insert Tunnel Ip Cath 49325 Lap Revision Perm Ip Cath 49326 Lap W/Omentopexy Add-On 49327 Lap Ins Device For Rt 49329 Laparo Proc Abdm/Per/Oment $1,943 $1,263 $1,508 $637 $25 49400 Air Injection Into Abdomen 49402 Remove Foreign Body Adbomen 49405 Image Cath Fluid Colxn Visc 49406 Image Cath Fluid Peri/Retro 49407 Image Cath Fluid Trns/Vgnl 49411 Ins Mark Abd/Pel For Rt Perq 49412 Ins Device For Rt Guide Open 49418 Insert Tun Ip Cath Perc 49419 Insert Tun Ip Cath W/Port 49421 Ins Tun Ip Cath For Dial Opn 49422 Remove Tunneled Ip Cath 49423 Exchange Drainage Catheter 49424 Assess Cyst Contrast Inject 49425 Insert Abdomen-Venous Drain 49426 Revise Abdomen-Venous Shunt 49427 Injection Abdominal Shunt 49428 Ligation Of Shunt 49429 Removal Of Shunt 49435 Insert Subq Exten To Ip Cath 49436 Embedded Ip Cath Exit-Site 49440 982 Place Gastrostomy Tube Perc $1,259 $819 $978 $413 49441 Place Duod/Jej Tube Perc 49442 Place Cecostomy Tube Perc 49446 982 Change G-Tube To G-J Perc $907 $590 $704 $297 49450 Replace G/C Tube Perc 49451 982 Replace Duod/Jej Tube Perc $555 $361 $431 $182 49452 Replace G-J Tube Perc 49460 Fix G/Colon Tube W/Device 49465 Fluoro Exam Of G/Colon Tube 49491 Rpr Hern Preemie Reduc 49492 Rpr Ing Hern Premie Blocked 49495 Rpr Ing Hernia Baby Reduc 49496 Rpr Ing Hernia Baby Blocked 49500 Rpr Ing Hernia Init Reduce 49501 Rpr Ing Hernia Init Blocked 49505 Prp I/Hern Init Reduc >5 Yr $1,615 $1,050 $1,254 $529 49507 Prp I/Hern Init Block >5 Yr $1,818 $1,182 $1,412 $596 $373 49520 Rerepair Ing Hernia Reduce 49521 Rerepair Ing Hernia Blocked 49525 Repair Ing Hernia Sliding 49540 Repair Lumbar Hernia 49550 Rpr Rem Hernia Init Reduce $1,685 $1,095 $1,308 $552 $507 49553 Rpr Fem Hernia Init Blocked 49555 Rerepair Fem Hernia Reduce 49557 Rerepair Fem Hernia Blocked 49560 Rpr Ventral Hern Init Reduc $2,258 $1,467 $1,753 $740 $229 49561 Rpr Ventral Hern Init Block $2,892 $1,880 $2,245 $948 $738 49565 Rerepair Ventrl Hern Reduce 49566 Rerepair Ventrl Hern Block 49568 Hernia Repair W/Mesh $830 $539 $644 $272 49570 Rpr Epigastric Hern Reduce 49572 Rpr Epigastric Hern Blocked 49580 Rpr Umbil Hern Reduc < 5 Yr 49582 Rpr Umbil Hern Block < 5 Yr 49585 Rpr Umbil Hern Reduc > 5 Yr $1,361 $884 $1,056 $446 $391 49587 Rpr Umbil Hern Block > 5 Yr 49590 Repair Spigelian Hernia 49600 Repair Umbilical Lesion 49605 Repair Umbilical Lesion 49606 Repair Umbilical Lesion 49610 Repair Umbilical Lesion 49611 Repair Umbilical Lesion 49650 Lap Ing Hernia Repair Init $1,327 $863 $1,030 $435 $285 49651 Lap Ing Hernia Repair Recur 49652 Lap Vent/Abd Hernia Repair 49653 Lap Vent/Abd Hern Proc Comp 49654 Lap Inc Hernia Repair 49655 Lap Inc Hern Repair Comp $3,206 $2,084 $2,489 $1,050 $669 49656 Lap Inc Hernia Repair Recur 49657 Lap Inc Hern Recur Comp $3,987 $2,591 $3,095 $1,306 $0 49659 Laparo Proc Hernia Repair 49900 Repair Of Abdominal Wall 49904 Omental Flap Extra-Abdom 49905 Omental Flap Intra-Abdom 49906 Free Omental Flap Microvasc 49999 Abdomen Surgery Procedure 50010 Exploration Of Kidney 50020 Renal Abscess Open Drain 50040 Drainage Of Kidney 50045 Exploration Of Kidney 5005F Pt Counsld On Exam For Moles 50060 Removal Of Kidney Stone 50065 Incision Of Kidney 50070 Incision Of Kidney 50075 Removal Of Kidney Stone 50080 Removal Of Kidney Stone $2,509 $1,631 $1,948 $822 $489 50081 Removal Of Kidney Stone 50100 Revise Kidney Blood Vessels 5010F Macul Result Phy/Qhp Mng Dm 50120 Exploration Of Kidney 50125 Explore And Drain Kidney 50130 Removal Of Kidney Stone 50135 Exploration Of Kidney 5015F Doc Fx & Test/Txmnt For Op 50200 Renal Biopsy Perq 50205 Renal Biopsy Open 5020F Txmnts 2 Phys/Qhp By 1 Mon 50220 Remove Kidney Open 50225 Removal Kidney Open Complex 50230 Removal Kidney Open Radical 50234 Removal Of Kidney & Ureter 50236 Removal Of Kidney & Ureter 50240 Partial Removal Of Kidney 50250 Cryoablate Renal Mass Open 50280 Removal Of Kidney Lesion 50290 Removal Of Kidney Lesion 50300 Remove Cadaver Donor Kidney 50320 Remove Kidney Living Donor 50323 Prep Cadaver Renal Allograft 50325 Prep Donor Renal Graft 50327 Prep Renal Graft/Venous 50328 Prep Renal Graft/Arterial 50329 Prep Renal Graft/Ureteral 50340 Removal Of Kidney 50360 Transplantation Of Kidney 50365 Transplantation Of Kidney 50370 Remove Transplanted Kidney 50380 Reimplantation Of Kidney 50382 Change Ureter Stent Percut 50384 Remove Ureter Stent Percut 50385 Change Stent Via Transureth 50386 Remove Stent Via Transureth 50387 Change Nephroureteral Cath 50389 Remove Renal Tube W/Fluoro 50390 Drainage Of Kidney Lesion 50391 Instll Rx Agnt Into Rnal Tub 50396 Measure Kidney Pressure 50400 Revision Of Kidney/Ureter 50405 Revision Of Kidney/Ureter 50430 Njx Px Nfrosgrm &/Urtrgrm 50431 Njx Px Nfrosgrm &/Urtrgrm 50432 Plmt Nephrostomy Catheter $566 $368 $440 $186 50433 Plmt Nephroureteral Catheter $698 $454 $542 $229 50434 Convert Nephrostomy Catheter 50435 Exchange Nephrostomy Cath $260 $169 $202 $85 50436 Dilat Xst Trc Ndurlgc Px 50437 Dilat Xst Trc New Access Rcs 50500 Repair Of Kidney Wound 5050F Plan 2 Main Dr By 1 Month 50520 Close Kidney-Skin Fistula 50525 Close Nephrovisceral Fistula 50526 Close Nephrovisceral Fistula 50540 Revision Of Horseshoe Kidney 50541 Laparo Ablate Renal Cyst 50542 Laparo Ablate Renal Mass 50543 Laparo Partial Nephrectomy 50544 Laparoscopy Pyeloplasty 50545 Laparo Radical Nephrectomy 50546 Laparoscopic Nephrectomy 50547 Laparo Removal Donor Kidney 50548 Laparo Remove W/Ureter 50549 Laparoscope Proc Renal 50551 Kidney Endoscopy 50553 Kidney Endoscopy 50555 Kidney Endoscopy & Biopsy 50557 Kidney Endoscopy & Treatment 50561 Kidney Endoscopy & Treatment 50562 Renal Scope W/Tumor Resect 50570 Kidney Endoscopy 50572 Kidney Endoscopy 50574 Kidney Endoscopy & Biopsy 50575 Kidney Endoscopy 50576 Kidney Endoscopy & Treatment 50580 Kidney Endoscopy & Treatment 50590 Fragmenting Of Kidney Stone $2,111 $1,372 $1,639 $692 50592 Perc Rf Ablate Renal Tumor 50593 Perc Cryo Ablate Renal Tum 50600 Exploration Of Ureter 50605 Insert Ureteral Support 50606 Endoluminal Bx Urtr Rnl Plvs 5060F Fndngs Mammo 2Pt W/In 3 Days 50610 Removal Of Ureter Stone 50620 Removal Of Ureter Stone 5062F Mammo Result Com To Pt 5 Day 50630 Removal Of Ureter Stone 50650 Removal Of Ureter 50660 Removal Of Ureter 50684 Injection For Ureter X-Ray 50686 Measure Ureter Pressure 50688 510 Change Of Ureter Tube/Stent $1,627 $1,058 $1,263 $533 50690 Injection For Ureter X-Ray 50693 Plmt Ureteral Stent Prq 50694 Plmt Ureteral Stent Prq 50695 Plmt Ureteral Stent Prq 50700 Revision Of Ureter 50705 Ureteral Embolization/Occl 50706 Balloon Dilate Urtrl Strix 50715 Release Of Ureter $3,446 $2,240 $2,675 $1,129 50722 Release Of Ureter 50725 Release/Revise Ureter 50727 Revise Ureter 50728 Revise Ureter 50740 Fusion Of Ureter & Kidney 50750 Fusion Of Ureter & Kidney 50760 Fusion Of Ureters 50770 Splicing Of Ureters 50780 Reimplant Ureter In Bladder 50782 Reimplant Ureter In Bladder 50783 Reimplant Ureter In Bladder 50785 Reimplant Ureter In Bladder 50800 Implant Ureter In Bowel 50810 Fusion Of Ureter & Bowel 50815 Urine Shunt To Intestine 50820 Construct Bowel Bladder 50825 Construct Bowel Bladder 50830 Revise Urine Flow 50840 Replace Ureter By Bowel 50845 Appendico-Vesicostomy $3,136 $2,038 $2,434 $1,027 $0 50860 Transplant Ureter To Skin 50900 Repair Of Ureter 50920 Closure Ureter/Skin Fistula 50930 Closure Ureter/Bowel Fistula 50940 Release Of Ureter 50945 Laparoscopy Ureterolithotomy 50947 Laparo New Ureter/Bladder 50948 Laparo New Ureter/Bladder 50949 Laparoscope Proc Ureter 50951 Endoscopy Of Ureter 50953 Endoscopy Of Ureter 50955 Ureter Endoscopy & Biopsy 50957 Ureter Endoscopy & Treatment 50961 Ureter Endoscopy & Treatment 50970 Ureter Endoscopy 50972 Ureter Endoscopy & Catheter 50974 Ureter Endoscopy & Biopsy 50976 Ureter Endoscopy & Treatment 50980 Ureter Endoscopy & Treatment 5100F Rsk Fx Ref W/N 24 Hrs Xray 51020 Incise & Treat Bladder 51030 Incise & Treat Bladder 51040 Incise & Drain Bladder 51045 510 Incise Bladder/Drain Ureter $1,627 $1,058 $1,263 $533 51050 Removal Of Bladder Stone 51060 Removal Of Ureter Stone 51065 Remove Ureter Calculus 51080 Drainage Of Bladder Abscess 51100 Drain Bladder By Needle 51101 Drain Bladder By Trocar/Cath 51102 510 Drain Bl W/Cath Insertion $331 $215 $257 $108 51500 Removal Of Bladder Cyst 51520 Removal Of Bladder Lesion 51525 Removal Of Bladder Lesion 51530 Removal Of Bladder Lesion 51535 Repair Of Ureter Lesion 51550 Partial Removal Of Bladder 51555 Partial Removal Of Bladder 51565 Revise Bladder & Ureter(S) 51570 Removal Of Bladder 51575 Removal Of Bladder & Nodes 51580 Remove Bladder/Revise Tract 51585 Removal Of Bladder & Nodes 51590 Remove Bladder/Revise Tract 51595 Remove Bladder/Revise Tract 51596 Remove Bladder/Create Pouch 51597 Removal Of Pelvic Structures 51600 Injection For Bladder X-Ray 51605 Preparation For Bladder Xray 51610 Injection For Bladder X-Ray 51700 510 Irrigation Of Bladder $266 $173 $207 $87 51701 510 Insert Bladder Catheter $276 $179 $214 $90 51702 510 Insert Temp Bladder Cath $435 $283 $338 $142 51703 510 Insert Bladder Cath Complex $430 $280 $334 $141 51705 510 Change Of Bladder Tube $305 $198 $237 $100 51710 510 Change Of Bladder Tube $1,561 $1,015 $1,212 $511 51715 Endoscopic Injection/Implant 51720 510 Treatment Of Bladder Lesion $199 $130 $155 $65 51725 510 Simple Cystometrogram $625 $406 $485 $205 51725 510 Simple Cystometrogram $625 $406 $485 $205 51725 510 Simple Cystometrogram $625 $406 $485 $205 51726 510 Complex Cystometrogram $810 $526 $628 $265 51726 510 Complex Cystometrogram $810 $526 $628 $265 51726 510 Complex Cystometrogram $810 $526 $628 $265 51727 Cystometrogram W/Up 51727 Cystometrogram W/Up 51727 Cystometrogram W/Up 51728 510 Cystometrogram W/Vp $704 $458 $546 $231 51728 510 Cystometrogram W/Vp $704 $458 $546 $231 51728 510 Cystometrogram W/Vp $704 $458 $546 $231 51729 510 Cystometrogram W/Vp&Up $721 $468 $559 $236 51729 510 Cystometrogram W/Vp&Up $721 $468 $559 $236 51729 510 Cystometrogram W/Vp&Up $721 $468 $559 $236 51736 510 Urine Flow Measurement $25 $16 $19 $8 51736 510 Urine Flow Measurement $25 $16 $19 $8 51736 510 Urine Flow Measurement $25 $16 $19 $8 51741 920 Electro-Uroflowmetry First $28 $18 $21 $9 51741 920 Electro-Uroflowmetry First $28 $18 $21 $9 51741 920 Electro-Uroflowmetry First $28 $18 $21 $9 51784 510 Anal/Urinary Muscle Study $495 $322 $384 $162 51784 510 Anal/Urinary Muscle Study $495 $322 $384 $162 51784 510 Anal/Urinary Muscle Study $495 $322 $384 $162 51785 510 Anal/Urinary Muscle Study $599 $390 $465 $196 51785 510 Anal/Urinary Muscle Study $599 $390 $465 $196 51785 510 Anal/Urinary Muscle Study $599 $390 $465 $196 51792 Urinary Reflex Study 51792 Urinary Reflex Study 51792 Urinary Reflex Study 51797 920 Intraabdominal Pressure Test $245 $159 $190 $80 51797 920 Intraabdominal Pressure Test $245 $159 $190 $80 51797 920 Intraabdominal Pressure Test $245 $159 $190 $80 51798 510 Us Urine Capacity Measure $140 $91 $109 $46 51800 Revision Of Bladder/Urethra 51820 Revision Of Urinary Tract 51840 Attach Bladder/Urethra 51841 Attach Bladder/Urethra 51845 Repair Bladder Neck 51860 Repair Of Bladder Wound 51865 Repair Of Bladder Wound 51880 Repair Of Bladder Opening 51900 Repair Bladder/Vagina Lesion 51920 Close Bladder-Uterus Fistula 51925 Hysterectomy/Bladder Repair 51940 Correction Of Bladder Defect 51960 Revision Of Bladder & Bowel 51980 Construct Bladder Opening 51990 Laparo Urethral Suspension 51992 Laparo Sling Operation 51999 Laparoscope Proc Bla 52000 510 Cystoscopy $427 $277 $331 $140 52001 Cystoscopy Removal Of Clots 52005 Cystoscopy & Ureter Catheter $311 $202 $241 $102 52007 Cystoscopy And Biopsy 5200F Eval Appros Surg Thxpy Epi 52010 Cystoscopy & Duct Catheter 52204 510 Cystoscopy W/Biopsy(S) $758 $492 $588 $248 52214 Cystoscopy And Treatment 52224 510 Cystoscopy And Treatment $1,605 $1,043 $1,246 $526 52234 Cystoscopy And Treatment $767 $499 $596 $251 52235 Cystoscopy And Treatment $895 $582 $695 $293 52240 Cystoscopy And Treatment 52250 Cystoscopy And Radiotracer 52260 Cystoscopy And Treatment $652 $424 $506 $214 52265 Cystoscopy And Treatment $382 $248 $297 $125 52270 Cystoscopy & Revise Urethra 52275 Cystoscopy & Revise Urethra 52276 Cystoscopy And Treatment $833 $542 $647 $273 52277 Cystoscopy And Treatment 52281 510 Cystoscopy And Treatment $464 $302 $360 $152 52282 Cystoscopy Implant Stent 52283 Cystoscopy And Treatment 52285 Cystoscopy And Treatment 52287 510 Cystoscopy Chemodenervation $510 $331 $396 $167 52290 Cystoscopy And Treatment 52300 Cystoscopy And Treatment 52301 Cystoscopy And Treatment 52305 Cystoscopy And Treatment 52310 510 Cystoscopy And Treatment $379 $246 $294 $124 52315 Cystoscopy And Treatment 52317 Remove Bladder Stone $2,423 $1,575 $1,881 $794 $281 52318 Remove Bladder Stone 52320 Cystoscopy And Treatment 52325 Cystoscopy Stone Removal 52327 Cystoscopy Inject Material 52330 Cystoscopy And Treatment 52332 Cystoscopy And Treatment $1,465 $952 $1,137 $480 52334 Create Passage To Kidney 52341 Cysto W/Ureter Stricture Tx $4,568 $2,969 $3,546 $1,497 52342 Cysto W/Up Stricture Tx $891 $579 $692 $292 52343 Cysto W/Renal Stricture Tx 52344 Cysto/Uretero Stricture Tx 52345 Cysto/Uretero W/Up Stricture 52346 Cystouretero W/Renal Strict 52351 Cystouretero & Or Pyeloscope $944 $614 $733 $309 52352 Cystouretero W/Stone Remove $1,115 $724 $865 $365 52353 Cystouretero W/Lithotripsy $1,210 $787 $939 $396 52354 Cystouretero W/Biopsy 52355 Cystouretero W/Excise Tumor 52356 Cysto/Uretero W/Lithotripsy $1,199 $779 $931 $393 52400 Cystouretero W/Congen Repr 52402 Cystourethro Cut Ejacul Duct 52441 Cystourethro W/Implant 52442 Cystourethro W/Addl Implant 52450 Incision Of Prostate 52500 Revision Of Bladder Neck 5250F Asthma Discharge Plan Presnt 52601 Prostatectomy (Turp) 52630 Remove Prostate Regrowth 52640 Relieve Bladder Contracture 52647 Laser Surgery Of Prostate 52648 Laser Surgery Of Prostate 52649 Prostate Laser Enucleation 52700 Drainage Of Prostate Abscess 53000 Incision Of Urethra 53010 Incision Of Urethra 53020 Incision Of Urethra 53025 Incision Of Urethra 53040 510 Drainage Of Urethra Abscess $1,627 $1,058 $1,263 $533 53060 510 Drainage Of Urethra Abscess $89 $58 $69 $29 53080 Drainage Of Urinary Leakage 53085 Drainage Of Urinary Leakage 53200 Biopsy Of Urethra 53210 Removal Of Urethra 53215 Removal Of Urethra 53220 Treatment Of Urethra Lesion 53230 Removal Of Urethra Lesion 53235 Removal Of Urethra Lesion 53240 Surgery For Urethra Pouch 53250 Removal Of Urethra Gland 53260 Treatment Of Urethra Lesion 53265 Treatment Of Urethra Lesion 53270 Removal Of Urethra Gland 53275 Repair Of Urethra Defect 53400 Revise Urethra Stage 1 53405 Revise Urethra Stage 2 53410 Reconstruction Of Urethra 53415 Reconstruction Of Urethra 53420 Reconstruct Urethra Stage 1 53425 Reconstruct Urethra Stage 2 53430 Reconstruction Of Urethra 53431 Reconstruct Urethra/Bladder 53440 Male Sling Procedure 53442 Remove/Revise Male Sling 53444 Insert Tandem Cuff 53445 Insert Uro/Ves Nck Sphincter 53446 Remove Uro Sphincter 53447 Remove/Replace Ur Sphincter 53448 Remov/Replc Ur Sphinctr Comp 53449 Repair Uro Sphincter 53450 Revision Of Urethra 53460 Revision Of Urethra 53500 Urethrlys Transvag W/ Scope 53502 Repair Of Urethra Injury 53505 Repair Of Urethra Injury 53510 Repair Of Urethra Injury 53515 Repair Of Urethra Injury 53520 Repair Of Urethra Defect 53600 510 Dilate Urethra Stricture $93 $61 $72 $31 53601 510 Dilate Urethra Stricture $118 $77 $92 $39 53605 Dilate Urethra Stricture 53620 510 Dilate Urethra Stricture $145 $94 $113 $48 53621 510 Dilate Urethra Stricture $160 $104 $124 $52 53660 510 Dilation Of Urethra $108 $70 $84 $35 53661 510 Dilation Of Urethra $106 $69 $83 $35 53665 Dilation Of Urethra 53850 Prostatic Microwave Thermotx 53852 Prostatic Rf Thermotx 53854 Trurl Dstrj Prst8 Tiss Rf Wv 53855 Insert Prost Urethral Stent 53860 Transurethral Rf Treatment 53899 Urology Surgery Procedure 54000 Slitting Of Prepuce 54001 Slitting Of Prepuce 54015 Drain Penis Lesion 54050 510 Destruction Penis Lesion(S) $390 $254 $303 $128 54055 Destruction Penis Lesion(S) 54056 510 Cryosurgery Penis Lesion(S) $388 $252 $301 $127 54057 Laser Surg Penis Lesion(S) $405 $263 $315 $133 54060 Excision Of Penis Lesion(S) $304 $198 $236 $100 54065 510 Destruction Penis Lesion(S) $226 $147 $175 $74 54100 Biopsy Of Penis 54105 Biopsy Of Penis 54110 Treatment Of Penis Lesion 54111 Treat Penis Lesion Graft 54112 Treat Penis Lesion Graft 54115 Treatment Of Penis Lesion 54120 Partial Removal Of Penis 54125 Removal Of Penis 54130 Remove Penis & Nodes 54135 Remove Penis & Nodes 54150 Circumcision W/Regionl Block $467 $303 $362 $153 $84 54160 Circumcision Neonate 54161 Circum 28 Days Or Older 54162 Lysis Penil Circumic Lesion 54163 Repair Of Circumcision 54164 Frenulotomy Of Penis 54200 Treatment Of Penis Lesion 54205 Treatment Of Penis Lesion 54220 450 Treatment Of Penis Lesion $587 $382 $456 $192 54230 Prepare Penis Study 54231 Dynamic Cavernosometry 54235 510 Penile Injection $81 $53 $63 $27 54240 Penis Study 54240 Penis Study 54240 Penis Study 54250 Penis Study 54250 Penis Study 54250 Penis Study 54300 Revision Of Penis 54304 Revision Of Penis 54308 Reconstruction Of Urethra 54312 Reconstruction Of Urethra 54316 Reconstruction Of Urethra 54318 Reconstruction Of Urethra 54322 Reconstruction Of Urethra 54324 Reconstruction Of Urethra 54326 Reconstruction Of Urethra 54328 Revise Penis/Urethra 54332 Revise Penis/Urethra 54336 Revise Penis/Urethra 54340 Secondary Urethral Surgery 54344 Secondary Urethral Surgery 54348 Secondary Urethral Surgery 54352 Reconstruct Urethra/Penis 54360 Penis Plastic Surgery 54380 Repair Penis 54385 Repair Penis 54390 Repair Penis And Bladder 54400 Insert Semi-Rigid Prosthesis 54401 Insert Self-Contd Prosthesis 54405 Insert Multi-Comp Penis Pros 54406 Remove Muti-Comp Penis Pros 54408 Repair Multi-Comp Penis Pros 54410 Remove/Replace Penis Prosth 54411 Remov/Replc Penis Pros Comp 54415 Remove Self-Contd Penis Pros 54416 Remv/Repl Penis Contain Pros 54417 Remv/Replc Penis Pros Compl 54420 Revision Of Penis 54430 Revision Of Penis 54435 Revision Of Penis 54437 Repair Corporeal Tear 54438 Replantation Of Penis 54440 Repair Of Penis 54450 450 Preputial Stretching $635 $413 $493 $208 54500 Biopsy Of Testis 54505 Biopsy Of Testis 54512 Excise Lesion Testis $1,523 $990 $1,182 $499 54520 Removal Of Testis $1,020 $663 $792 $334 54522 Orchiectomy Partial 54530 Removal Of Testis 54535 Extensive Testis Surgery $1,865 $1,212 $1,448 $611 54550 Exploration For Testis 54560 Exploration For Testis 54600 Reduce Testis Torsion 54620 Suspension Of Testis 54640 Orchiopexy Ingun/Scrot Appr 54650 Orchiopexy (Fowler-Stephens) 54660 Revision Of Testis 54670 Repair Testis Injury 54680 Relocation Of Testis(Es) 54690 Laparoscopy Orchiectomy 54692 Laparoscopy Orchiopexy 54699 Laparoscope Proc Testis 54700 Drainage Of Scrotum 54800 Biopsy Of Epididymis 54830 Remove Epididymis Lesion 54840 Remove Epididymis Lesion 54860 Removal Of Epididymis $1,274 $828 $989 $417 54861 Removal Of Epididymis 54865 Explore Epididymis 54900 Fusion Of Spermatic Ducts 54901 Fusion Of Spermatic Ducts 55000 450 Drainage Of Hydrocele $1,581 $1,028 $1,227 $518 55040 Removal Of Hydrocele $1,057 $687 $821 $346 55041 Removal Of Hydroceles 55060 Repair Of Hydrocele 55100 510 Drainage Of Scrotum Abscess $249 $162 $193 $82 55110 Explore Scrotum 55120 Removal Of Scrotum Lesion 55150 Removal Of Scrotum 55175 Revision Of Scrotum 55180 Revision Of Scrotum 55200 Incision Of Sperm Duct 55250 510 Removal Of Sperm Duct(S) $628 $408 $487 $206 55300 Prepare Sperm Duct X-Ray 55400 Repair Of Sperm Duct 55500 Removal Of Hydrocele 55520 Removal Of Sperm Cord Lesion $1,136 $738 $882 $372 55530 Revise Spermatic Cord Veins 55535 Revise Spermatic Cord Veins 55540 Revise Hernia & Sperm Veins 55550 Laparo Ligate Spermatic Vein 55559 Laparo Proc Spermatic Cord 55600 Incise Sperm Duct Pouch 55605 Incise Sperm Duct Pouch 55650 Remove Sperm Duct Pouch 55680 Remove Sperm Pouch Lesion 55700 510 Biopsy Of Prostate $387 $252 $301 $127 55705 Biopsy Of Prostate 55706 Prostate Saturation Sampling 55720 Drainage Of Prostate Abscess 55725 Drainage Of Prostate Abscess 55801 Removal Of Prostate 55810 Extensive Prostate Surgery 55812 Extensive Prostate Surgery 55815 Extensive Prostate Surgery 55821 Removal Of Prostate 55831 Removal Of Prostate 55840 Extensive Prostate Surgery 55842 Extensive Prostate Surgery 55845 Extensive Prostate Surgery 55860 Surgical Exposure Prostate 55862 Extensive Prostate Surgery 55865 Extensive Prostate Surgery 55866 Laparo Radical Prostatectomy 55870 Electroejaculation 55873 Cryoablate Prostate 55874 Tprnl Plmt Biodegrdabl Matrl 55875 Transperi Needle Place Pros 55876 510 Place Rt Device/Marker Pros $174 $113 $135 $57 55880 Abltj Mal Prst8 Tiss Hifu 55899 Genital Surgery Procedure $1,229 $799 $954 $403 $0 55920 Place Needles Pelvic For Rt 55970 Sex Transformation M To F 55980 Sex Transformation F To M 56405 510 I & D Of Vulva/Perineum $549 $357 $426 $180 $130 56420 510 Drainage Of Gland Abscess $768 $499 $596 $251 $225 56440 Surgery For Vulva Lesion $530 $345 $412 $174 $88 56441 510 Lysis Of Labial Lesion(S) $89 $58 $69 $29 56442 Hymenotomy $110 $71 $85 $36 56501 510 Destroy Vulva Lesions Sim $449 $292 $349 $147 56515 510 Destroy Vulva Lesion/S Compl $192 $125 $149 $63 56605 510 Biopsy Of Vulva/Perineum $299 $194 $232 $98 56606 510 Biopsy Of Vulva/Perineum $40 $26 $31 $13 56620 Partial Removal Of Vulva $1,562 $1,015 $1,213 $512 56625 Complete Removal Of Vulva 56630 Extensive Vulva Surgery 56631 Extensive Vulva Surgery 56632 Extensive Vulva Surgery 56633 Extensive Vulva Surgery 56634 Extensive Vulva Surgery 56637 Extensive Vulva Surgery 56640 Extensive Vulva Surgery 56700 Partial Removal Of Hymen $561 $364 $435 $184 56740 Remove Vagina Gland Lesion 56800 Repair Of Vagina 56805 Repair Clitoris 56810 Repair Of Perineum 56820 510 Exam Of Vulva W/Scope $127 $82 $98 $41 56821 Exam/Biopsy Of Vulva W/Scope 57000 Exploration Of Vagina 57010 Drainage Of Pelvic Abscess 57020 Drainage Of Pelvic Fluid 57022 I & D Vaginal Hematoma Pp 57023 I & D Vag Hematoma Non-Ob 57061 510 Destroy Vag Lesions Simple $89 $58 $69 $29 57065 510 Destroy Vag Lesions Complex $163 $106 $126 $53 57100 510 Biopsy Of Vagina $112 $73 $87 $37 57105 Biopsy Of Vagina 57106 Remove Vagina Wall Partial 57107 Remove Vagina Tissue Part 57109 Vaginectomy Partial W/Nodes 57110 Remove Vagina Wall Complete 57111 Remove Vagina Tissue Compl 57112 Vaginectomy W/Nodes Compl 57120 Closure Of Vagina 57130 Remove Vagina Lesion 57135 Remove Vagina Lesion $572 $372 $444 $188 57150 Treat Vagina Infection 57155 Insert Uteri Tandem/Ovoids 57156 Ins Vag Brachytx Device 57160 510 Insert Pessary/Other Device $173 $112 $134 $57 57170 Fitting Of Diaphragm/Cap 57180 510 Treat Vaginal Bleeding $92 $60 $71 $30 57200 Repair Of Vagina 57210 Repair Vagina/Perineum 57220 Revision Of Urethra 57230 510 Repair Of Urethral Lesion $2,294 $1,491 $1,781 $752 57240 Anterior Colporrhaphy $2,073 $1,347 $1,609 $679 57250 Repair Rectum & Vagina 57260 Cmbn Ant Pst Colprhy $2,222 $1,444 $1,725 $728 $576 57265 Cmbn Ap Colprhy W/Ntrcl Rpr 57267 Insert Mesh/Pelvic Flr Addon 57268 Repair Of Bowel Bulge 57270 Repair Of Bowel Pouch 57280 Suspension Of Vagina 57282 Colpopexy Extraperitoneal 57283 Colpopexy Intraperitoneal 57284 Repair Paravag Defect Open 57285 Repair Paravag Defect Vag 57287 Revise/Remove Sling Repair 57288 Repair Bladder Defect $2,278 $1,481 $1,769 $746 $736 57289 Repair Bladder & Vagina 57291 Construction Of Vagina 57292 Construct Vagina With Graft 57295 Revise Vag Graft Via Vagina 57296 Revise Vag Graft Open Abd 57300 Repair Rectum-Vagina Fistula 57305 Repair Rectum-Vagina Fistula 57307 Fistula Repair & Colostomy 57308 Fistula Repair Transperine 57310 Repair Urethrovaginal Lesion 57311 Repair Urethrovaginal Lesion 57320 Repair Bladder-Vagina Lesion 57330 Repair Bladder-Vagina Lesion 57335 Repair Vagina 57400 Dilation Of Vagina 57410 Pelvic Examination 57415 450 Remove Vaginal Foreign Body $6,267 $4,074 $4,865 $2,053 $169 57420 510 Exam Of Vagina W/Scope $140 $91 $109 $46 57421 510 Exam/Biopsy Of Vag W/Scope $181 $118 $141 $59 57423 Repair Paravag Defect Lap 57425 Laparoscopy Surg Colpopexy 57426 Revise Prosth Vag Graft Lap 57452 510 Exam Of Cervix W/Scope $112 $73 $87 $37 57454 510 Bx/Curett Of Cervix W/Scope $152 $99 $118 $50 57455 510 Biopsy Of Cervix W/Scope $168 $109 $131 $55 57456 510 Endocerv Curettage W/Scope $163 $106 $126 $53 57460 510 Bx Of Cervix W/Scope Leep $460 $299 $357 $151 57461 510 Conz Of Cervix W/Scope Leep $512 $333 $398 $168 57465 Cam Cervix Uteri Drg Colp 57500 510 Biopsy Of Cervix $459 $298 $356 $150 57505 510 Endocervical Curettage $69 $45 $54 $23 57510 Cauterization Of Cervix 57511 Cryocautery Of Cervix 57513 Laser Surgery Of Cervix 57520 Conization Of Cervix $925 $601 $718 $303 57522 510 Conization Of Cervix $201 $131 $156 $66 57530 Removal Of Cervix 57531 Removal Of Cervix Radical 57540 Removal Of Residual Cervix 57545 Remove Cervix/Repair Pelvis 57550 Removal Of Residual Cervix 57555 Remove Cervix/Repair Vagina 57556 Remove Cervix Repair Bowel 57558 D&C Of Cervical Stump 57700 Revision Of Cervix 57720 450 Revision Of Cervix 57800 510 Dilation Of Cervical Canal $218 $142 $169 $71 58100 510 Biopsy Of Uterus Lining $398 $259 $309 $130 58110 514 Bx Done W/Colposcopy Add-On $47 $31 $37 $15 58120 510 Dilation And Curettage $840 $546 $652 $275 $271 58140 Myomectomy Abdom Method 58145 Myomectomy Vag Method 58146 Myomectomy Abdom Complex 58150 Total Hysterectomy 58152 Total Hysterectomy 58180 Partial Hysterectomy $2,976 $1,934 $2,310 $975 $494 58200 Extensive Hysterectomy 58210 Extensive Hysterectomy 58240 Removal Of Pelvis Contents 58260 Vaginal Hysterectomy $2,533 $1,646 $1,966 $830 $400 58262 Vag Hyst Including T/O 58263 Vag Hyst W/T/O & Vag Repair 58267 Vag Hyst W/Urinary Repair 58270 Vag Hyst W/Enterocele Repair 58275 Hysterectomy/Revise Vagina 58280 Hysterectomy/Revise Vagina 58285 Extensive Hysterectomy 58290 Vag Hyst Complex 58291 Vag Hyst Incl T/O Complex 58292 Vag Hyst T/O & Repair Compl 58293 Vag Hyst W/Uro Repair Compl 58294 Vag Hyst W/Enterocele Compl 58300 514 Insert Intrauterine Device $347 $226 $269 $114 58301 510 Remove Intrauterine Device $347 $226 $269 $114 58321 Artificial Insemination 58322 Artificial Insemination 58323 Sperm Washing 58340 Catheter For Hysterography $134 $87 $104 $44 $42 58345 Reopen Fallopian Tube 58346 Insert Heyman Uteri Capsule 58350 Reopen Fallopian Tube 58353 Endometr Ablate Thermal 58356 Endometrial Cryoablation 58400 Suspension Of Uterus 58410 Suspension Of Uterus 58520 Repair Of Ruptured Uterus 58540 Revision Of Uterus 58541 Lsh Uterus 250 G Or Less 58542 Lsh W/T/O Ut 250 G Or Less 58543 Lsh Uterus Above 250 G 58544 Lsh W/T/O Uterus Above 250 G 58545 Laparoscopic Myomectomy 58546 Laparo-Myomectomy Complex 58548 Lap Radical Hyst 58550 Laparo-Asst Vag Hysterectomy $2,702 $1,756 $2,098 $885 $407 58552 Laparo-Vag Hyst Incl T/O $3,049 $1,982 $2,367 $999 $555 58553 Laparo-Vag Hyst Complex 58554 Laparo-Vag Hyst W/T/O Compl 58555 510 Hysteroscopy Dx Sep Proc $262 $170 $203 $86 58558 510 Hysteroscopy Biopsy $2,594 $1,686 $2,014 $850 $356 58559 Hysteroscopy Lysis 58560 Hysteroscopy Resect Septum 58561 Hysteroscopy Remove Myoma 58562 Hysteroscopy Remove Fb 58563 Hysteroscopy Ablation $1,052 $684 $817 $345 58565 Hysteroscopy Sterilization 58570 Tlh Uterus 250 G Or Less 58571 Tlh W/T/O 250 G Or Less 58572 Tlh Uterus Over 250 G 58573 Tlh W/T/O Uterus Over 250 G 58575 Laps Tot Hyst Resj Mal 58578 Laparo Proc Uterus 58579 Hysteroscope Procedure 58600 Division Of Fallopian Tube 58605 Division Of Fallopian Tube 58611 Ligate Oviduct(S) Add-On 58615 Occlude Fallopian Tube(S) 58660 Laparoscopy Lysis $2,081 $1,353 $1,615 $682 58661 Laparoscopy Remove Adnexa $2,002 $1,301 $1,554 $656 58662 Laparoscopy Excise Lesions 58670 Laparoscopy Tubal Cautery $1,113 $724 $864 $365 58671 Laparoscopy Tubal Block 58672 Laparoscopy Fimbrioplasty 58673 Laparoscopy Salpingostomy 58674 Laps Abltj Uterine Fibroids 58679 Laparo Proc Oviduct-Ovary 58700 Removal Of Fallopian Tube 58720 Removal Of Ovary/Tube(S) 58740 Adhesiolysis Tube Ovary 58750 Repair Oviduct 58752 Revise Ovarian Tube(S) 58760 Fimbrioplasty 58770 Create New Tubal Opening 58800 Drainage Of Ovarian Cyst(S) $722 $469 $560 $236 58805 Drainage Of Ovarian Cyst(S) 58820 Drain Ovary Abscess Open 58822 Drain Ovary Abscess Percut 58825 Transposition Ovary(S) 58900 Biopsy Of Ovary(S) 58920 Partial Removal Of Ovary(S) 58925 Removal Of Ovarian Cyst(S) $2,302 $1,497 $1,787 $754 $544 58940 Removal Of Ovary(S) 58943 Removal Of Ovary(S) 58950 Resect Ovarian Malignancy 58951 Resect Ovarian Malignancy 58952 Resect Ovarian Malignancy 58953 Tah Rad Dissect For Debulk 58954 Tah Rad Debulk/Lymph Remove 58956 Bso Omentectomy W/Tah 58957 Resect Recurrent Gyn Mal 58958 Resect Recur Gyn Mal W/Lym 58960 Exploration Of Abdomen 58970 Retrieval Of Oocyte 58974 Transfer Of Embryo 58976 Transfer Of Embryo 58999 Genital Surgery Procedure 59000 Amniocentesis Diagnostic 59001 729 Amniocentesis Therapeutic $722 $469 $561 $237 59012 Fetal Cord Puncture Prenatal 59015 Chorion Biopsy 59020 Fetal Contract Stress Test 59020 Fetal Contract Stress Test 59020 Fetal Contract Stress Test 59025 920 Fetal Non-Stress Test $153 $99 $118 $50 59025 920 Fetal Non-Stress Test $153 $99 $118 $50 59025 920 Fetal Non-Stress Test $153 $99 $118 $50 59030 Fetal Scalp Blood Sample 59050 Fetal Monitor W/Report 59051 Fetal Monitor/Interpret Only 59070 Transabdom Amnioinfus W/Us 59072 Umbilical Cord Occlud W/Us 59074 Fetal Fluid Drainage W/Us 59076 Fetal Shunt Placement W/Us 59100 Remove Uterus Lesion 59120 Treat Ectopic Pregnancy 59121 Treat Ectopic Pregnancy 59130 Treat Ectopic Pregnancy 59135 Treat Ectopic Pregnancy 59136 Treat Ectopic Pregnancy 59140 Treat Ectopic Pregnancy 59150 Treat Ectopic Pregnancy 59151 Treat Ectopic Pregnancy 59160 D & C After Delivery $421 $274 $327 $138 59200 720 Insert Cervical Dilator $629 $409 $488 $206 59300 Episiotomy Or Vaginal Repair 59320 Revision Of Cervix $460 $299 $357 $151 59325 Revision Of Cervix 59350 Repair Of Uterus 59400 Obstetrical Care 59409 Obstetrical Care 59410 Obstetrical Care 59412 720 Antepartum Manipulation $5,052 $3,284 $3,922 $1,655 59414 Deliver Placenta 59425 510 Antepartum Care Only $144 $94 $112 $47 59426 510 Antepartum Care Only $144 $94 $112 $47 59430 510 Care After Delivery $156 $101 $121 $51 59510 Cesarean Delivery 59514 Cesarean Delivery Only 59515 Cesarean Delivery 59525 Remove Uterus After Cesarean 59610 Vbac Delivery 59612 Vbac Delivery Only 59614 Vbac Care After Delivery 59618 Attempted Vbac Delivery 59620 Attempted Vbac Delivery Only 59622 Attempted Vbac After Care 59812 Treatment Of Miscarriage $1,411 $917 $1,095 $462 $403 59820 Care Of Miscarriage $1,124 $731 $873 $368 $330 59821 Treatment Of Miscarriage 59830 Treat Uterus Infection 59840 Abortion 59841 Abortion 59850 Abortion 59851 Abortion 59852 Abortion 59855 Abortion 59856 Abortion 59857 Abortion 59866 Abortion (Mpr) 59870 Evacuate Mole Of Uterus 59871 Remove Cerclage Suture 59897 Fetal Invas Px W/Us 59898 Laparo Proc Ob Care/Deliver 59899 Maternity Care Procedure 60000 Drain Thyroid/Tongue Cyst 6005F Care Level Rationale Doc 60100 Biopsy Of Thyroid 6010F Dysphag Test Done B/4 Eating 6015F Dysphag Test Done B/4 Eating 60200 Remove Thyroid Lesion 6020F Npo (Nothing-Mouth) Ordered 60210 Partial Thyroid Excision 60212 Partial Thyroid Excision 60220 Partial Removal Of Thyroid $2,207 $1,434 $1,713 $723 $206 60225 Partial Removal Of Thyroid 60240 Removal Of Thyroid $2,868 $1,864 $2,226 $940 $545 60252 Removal Of Thyroid $3,888 $2,527 $3,018 $1,274 $1,035 60254 Extensive Thyroid Surgery 60260 Repeat Thyroid Surgery 60270 Removal Of Thyroid 60271 Removal Of Thyroid 60280 Remove Thyroid Duct Lesion 60281 Remove Thyroid Duct Lesion 60300 Aspir/Inj Thyroid Cyst 6030F Max Sterile Barriers Follwd 6040F Appro Rad Ds Dvcs Techs Docd 6045F Radxps In End Rprt4Fluro Pxd 60500 Explore Parathyroid Glands $3,006 $1,954 $2,334 $985 60502 Re-Explore Parathyroids 60505 Explore Parathyroid Glands 60512 Autotransplant Parathyroid 60520 Removal Of Thymus Gland 60521 Removal Of Thymus Gland 60522 Removal Of Thymus Gland 60540 Explore Adrenal Gland 60545 Explore Adrenal Gland 60600 Remove Carotid Body Lesion 60605 Remove Carotid Body Lesion 60650 Laparoscopy Adrenalectomy 60659 Laparo Proc Endocrine 60699 Endocrine Surgery Procedure 6070F Pt Asked/Cnsld Aed Effects 6080F Pt/Caregiver Queried Falls 6090F Pt/Caregiver Counsel Safety 61000 Remove Cranial Cavity Fluid 61001 Remove Cranial Cavity Fluid 6100F Verify Pt Site Pxd Docd 6101F Safety Counseling Dementia 61020 Remove Brain Cavity Fluid 61026 Injection Into Brain Canal 6102F Safety Counseling Dem Order 61050 Remove Brain Canal Fluid 61055 Injection Into Brain Canal 61070 Brain Canal Shunt Procedure 61105 Twist Drill Hole 61107 Drill Skull For Implantation 61108 Drill Skull For Drainage 6110F Counsel Prov Driving Risks 61120 Burr Hole For Puncture 61140 Pierce Skull For Biopsy 61150 Pierce Skull For Drainage 61151 Pierce Skull For Drainage 61154 Pierce Skull & Remove Clot 61156 Pierce Skull For Drainage 61210 Pierce Skull Implant Device 61215 Insert Brain-Fluid Device 61250 Pierce Skull & Explore 61253 Pierce Skull & Explore 61304 Open Skull For Exploration 61305 Open Skull For Exploration 61312 Open Skull For Drainage 61313 Open Skull For Drainage 61314 Open Skull For Drainage 61315 Open Skull For Drainage 61316 Implt Cran Bone Flap To Abdo 61320 Open Skull For Drainage 61321 Open Skull For Drainage 61322 Decompressive Craniotomy 61323 Decompressive Lobectomy 61330 Decompress Eye Socket 61333 Explore Orbit/Remove Lesion 61340 Subtemporal Decompression 61343 Incise Skull (Press Relief) 61345 Relieve Cranial Pressure 61450 Incise Skull For Surgery 61458 Incise Skull For Brain Wound 61460 Incise Skull For Surgery 61500 Removal Of Skull Lesion 61501 Remove Infected Skull Bone 6150F Pt Notrcvng1St Antitnf Txmnt 61510 Removal Of Brain Lesion 61512 Remove Brain Lining Lesion 61514 Removal Of Brain Abscess 61516 Removal Of Brain Lesion 61517 Implt Brain Chemotx Add-On 61518 Removal Of Brain Lesion 61519 Remove Brain Lining Lesion 61520 Removal Of Brain Lesion 61521 Removal Of Brain Lesion 61522 Removal Of Brain Abscess 61524 Removal Of Brain Lesion 61526 Removal Of Brain Lesion 61530 Removal Of Brain Lesion 61531 Implant Brain Electrodes 61533 Implant Brain Electrodes 61534 Removal Of Brain Lesion 61535 Remove Brain Electrodes 61536 Removal Of Brain Lesion 61537 Removal Of Brain Tissue 61538 Removal Of Brain Tissue 61539 Removal Of Brain Tissue 61540 Removal Of Brain Tissue 61541 Incision Of Brain Tissue 61543 Removal Of Brain Tissue 61544 Remove & Treat Brain Lesion 61545 Excision Of Brain Tumor 61546 Removal Of Pituitary Gland 61548 Removal Of Pituitary Gland 61550 Release Of Skull Seams 61552 Release Of Skull Seams 61556 Incise Skull/Sutures 61557 Incise Skull/Sutures 61558 Excision Of Skull/Sutures 61559 Excision Of Skull/Sutures 61563 Excision Of Skull Tumor 61564 Excision Of Skull Tumor 61566 Removal Of Brain Tissue 61567 Incision Of Brain Tissue 61570 Remove Foreign Body Brain 61571 Incise Skull For Brain Wound 61575 Skull Base/Brainstem Surgery 61576 Skull Base/Brainstem Surgery 61580 Craniofacial Approach Skull 61581 Craniofacial Approach Skull 61582 Craniofacial Approach Skull 61583 Craniofacial Approach Skull 61584 Orbitocranial Approach/Skull 61585 Orbitocranial Approach/Skull 61586 Resect Nasopharynx Skull 61590 Infratemporal Approach/Skull 61591 Infratemporal Approach/Skull 61592 Orbitocranial Approach/Skull 61595 Transtemporal Approach/Skull 61596 Transcochlear Approach/Skull 61597 Transcondylar Approach/Skull 61598 Transpetrosal Approach/Skull 61600 Resect/Excise Cranial Lesion 61601 Resect/Excise Cranial Lesion 61605 Resect/Excise Cranial Lesion 61606 Resect/Excise Cranial Lesion 61607 Resect/Excise Cranial Lesion 61608 Resect/Excise Cranial Lesion 61611 Transect Artery Sinus 61613 Remove Aneurysm Sinus 61615 Resect/Excise Lesion Skull 61616 Resect/Excise Lesion Skull 61618 Repair Dura 61619 Repair Dura 61623 Endovasc Tempory Vessel Occl 61624 Transcath Occlusion Cns 61626 Transcath Occlusion Non-Cns 61630 Intracranial Angioplasty 61635 Intracran Angioplsty W/Stent 61640 Dilate Ic Vasospasm Init 61641 Dilat Ic Vspsm Ea Vsl Sm Ter 61642 Dilat Ic Vspsm Ea Diff Ter 61645 Perq Art M-Thrombect &/Nfs 61650 Evasc Prlng Admn Rx Agnt 1St 61651 Evasc Prlng Admn Rx Agnt Add 61680 Intracranial Vessel Surgery 61682 Intracranial Vessel Surgery 61684 Intracranial Vessel Surgery 61686 Intracranial Vessel Surgery 61690 Intracranial Vessel Surgery 61692 Intracranial Vessel Surgery 61697 Brain Aneurysm Repr Complx 61698 Brain Aneurysm Repr Complx 61700 Brain Aneurysm Repr Simple 61702 Inner Skull Vessel Surgery 61703 Clamp Neck Artery 61705 Revise Circulation To Head 61708 Revise Circulation To Head 61710 Revise Circulation To Head 61711 Fusion Of Skull Arteries 61720 Incise Skull/Brain Surgery 61735 Incise Skull/Brain Surgery 61750 Incise Skull/Brain Biopsy 61751 Brain Biopsy W/Ct/Mr Guide 61760 Implant Brain Electrodes 61770 Incise Skull For Treatment 61781 Scan Proc Cranial Intra 61782 Scan Proc Cranial Extra $554 $360 $430 $182 61783 Scan Proc Spinal 61790 Treat Trigeminal Nerve 61791 Treat Trigeminal Tract 61796 Srs Cranial Lesion Simple 61797 Srs Cran Les Simple Addl 61798 Srs Cranial Lesion Complex $4,244 $2,758 $3,295 $1,390 61799 Srs Cran Les Complex Addl 61800 Apply Srs Headframe Add-On $492 $320 $382 $161 61850 Implant Neuroelectrodes 61860 Implant Neuroelectrodes 61863 Implant Neuroelectrode 61864 Implant Neuroelectrde Addl 61867 Implant Neuroelectrode 61868 Implant Neuroelectrde Addl 61870 Implant Neuroelectrodes 61880 Revise/Remove Neuroelectrode 61885 Insrt/Redo Neurostim 1 Array 61886 Implant Neurostim Arrays 61888 Revise/Remove Neuroreceiver 62000 Treat Skull Fracture 62005 Treat Skull Fracture 62010 Treatment Of Head Injury 62100 Repair Brain Fluid Leakage 62115 Reduction Of Skull Defect 62117 Reduction Of Skull Defect 62120 Repair Skull Cavity Lesion 62121 Incise Skull Repair 62140 Repair Of Skull Defect 62141 Repair Of Skull Defect 62142 Remove Skull Plate/Flap 62143 Replace Skull Plate/Flap 62145 Repair Of Skull & Brain 62146 Repair Of Skull With Graft 62147 Repair Of Skull With Graft 62148 Retr Bone Flap To Fix Skull 62160 Neuroendoscopy Add-On 62161 Dissect Brain W/Scope 62162 Remove Colloid Cyst W/Scope 62163 Zneuroendoscopy W/Fb Removal 62164 Remove Brain Tumor W/Scope 62165 Remove Pituit Tumor W/Scope 62180 Establish Brain Cavity Shunt 62190 Establish Brain Cavity Shunt 62192 Establish Brain Cavity Shunt 62194 Replace/Irrigate Catheter 62200 Establish Brain Cavity Shunt 62201 Brain Cavity Shunt W/Scope 62220 Establish Brain Cavity Shunt 62223 Establish Brain Cavity Shunt 62225 Replace/Irrigate Catheter 62230 Replace/Revise Brain Shunt 62252 Csf Shunt Reprogram $328 $213 $255 $107 62252 Csf Shunt Reprogram $328 $213 $255 $107 62252 Csf Shunt Reprogram $328 $213 $255 $107 62256 Remove Brain Cavity Shunt 62258 Replace Brain Cavity Shunt 62263 Epidural Lysis Mult Sessions 62264 Epidural Lysis On Single Day 62267 Interdiscal Perq Aspir Dx 62268 Drain Spinal Cord Cyst 62269 Needle Biopsy Spinal Cord 62270 450 Dx Lmbr Spi Pnxr $922 $599 $716 $302 62272 Ther Spi Pnxr Drg Csf 62273 450 Inject Epidural Patch $1,364 $887 $1,059 $447 $137 62280 Treat Spinal Cord Lesion 62281 Treat Spinal Cord Lesion 62282 Treat Spinal Canal Lesion 62284 Injection For Myelogram 62287 Percutaneous Diskectomy 62290 Njx Px Discography Lumbar 62291 Njx Px Discography Crv/Thrc 62292 Njx Chemonucleolysis Lmbr 62294 Injection Into Spinal Artery 62302 Myelography Lumbar Injection 62303 Myelography Lumbar Injection 62304 Myelography Lumbar Injection 62305 Myelography Lumbar Injection 62320 Njx Interlaminar Crv/Thrc 62321 Njx Interlaminar Crv/Thrc $661 $430 $513 $217 $129 62322 Njx Interlaminar Lmbr/Sac 62323 Njx Interlaminar Lmbr/Sac $578 $376 $449 $189 $113 62324 Njx Interlaminar Crv/Thrc 62325 Njx Interlaminar Crv/Thrc 62326 Njx Interlaminar Lmbr/Sac 62327 Njx Interlaminar Lmbr/Sac 62328 Dx Lmbr Spi Pnxr W/Fluor/Ct 62329 Ther Spi Pnxr Csf Fluor/Ct 62350 Implant Spinal Canal Cath 62351 Implant Spinal Canal Cath 62355 Remove Spinal Canal Catheter 62360 Insert Spine Infusion Device 62361 Implant Spine Infusion Pump 62362 Implant Spine Infusion Pump 62365 Remove Spine Infusion Device 62367 Analyze Spine Infus Pump 62368 Analyze Sp Inf Pump W/Reprog 62369 Anal Sp Inf Pmp W/Reprg&Fill 62370 Anl Sp Inf Pmp W/Mdreprg&Fil $341 $222 $265 $112 $60 62380 Ndsc Dcmprn 1 Ntrspc Lumbar 63001 Remove Spine Lamina 1/2 Crvl 63003 Remove Spine Lamina 1/2 Thrc 63005 Remove Spine Lamina 1/2 Lmbr 63011 Remove Spine Lamina 1/2 Scrl 63012 Remove Lamina/Facets Lumbar 63015 Remove Spine Lamina >2 Crvcl 63016 Remove Spine Lamina >2 Thrc 63017 Remove Spine Lamina >2 Lmbr 63020 Neck Spine Disk Surgery 63030 Low Back Disk Surgery $2,449 $1,592 $1,901 $802 $548 63035 Spinal Disk Surgery Add-On $591 $384 $459 $194 63040 Laminotomy Single Cervical 63042 Laminotomy Single Lumbar 63043 Laminotomy Addl Cervical 63044 Laminotomy Addl Lumbar 63045 Remove Spine Lamina 1 Crvl $5,245 $3,409 $4,072 $1,719 $1,198 63046 Remove Spine Lamina 1 Thrc 63047 Remove Spine Lamina 1 Lmbr $2,841 $1,847 $2,206 $931 $697 63048 Remove Spinal Lamina Add-On $659 $428 $512 $216 63050 Cervical Laminoplsty 2/> Seg 63051 C-Laminoplasty W/Graft/Plate 63055 Decompress Spinal Cord Thrc 63056 Decompress Spinal Cord Lmbr 63057 Decompress Spine Cord Add-On 63064 Decompress Spinal Cord Thrc 63066 Decompress Spine Cord Add-On 63075 Neck Spine Disk Surgery 63076 Neck Spine Disk Surgery 63077 Spine Disk Surgery Thorax 63078 Spine Disk Surgery Thorax 63081 Remove Vert Body Dcmprn Crvl 63082 Remove Vertebral Body Add-On 63085 Remove Vert Body Dcmprn Thrc 63086 Remove Vertebral Body Add-On 63087 Remov Vertbr Dcmprn Thrclmbr 63088 Remove Vertebral Body Add-On 63090 Remove Vert Body Dcmprn Lmbr 63091 Remove Vertebral Body Add-On 63101 Remove Vert Body Dcmprn Thrc 63102 Remove Vert Body Dcmprn Lmbr 63103 Remove Vertebral Body Add-On 63170 Incise Spinal Cord Tract(S) 63172 Drainage Of Spinal Cyst 63173 Drainage Of Spinal Cyst 63180 Revise Spinal Cord Ligaments 63182 Revise Spinal Cord Ligaments 63185 Incise Spine Nrv Half Segmnt 63190 Incise Spine Nrv >2 Segmnts 63191 Incise Spine Accessory Nerve 63194 Incise Spine & Cord Cervical 63195 Incise Spine & Cord Thoracic 63196 Incise Spine&Cord 2 Trx Crvl 63197 Incise Spine&Cord 2 Trx Thrc 63198 Incise Spin&Cord 2 Stgs Crvl 63199 Incise Spin&Cord 2 Stgs Thrc 63200 Release Spinal Cord Lumbar 63250 Revise Spinal Cord Vsls Crvl 63251 Revise Spinal Cord Vsls Thrc 63252 Revise Spine Cord Vsl Thrlmb 63265 Excise Intraspinl Lesion Crv 63266 Excise Intrspinl Lesion Thrc 63267 Excise Intrspinl Lesion Lmbr 63268 Excise Intrspinl Lesion Scrl 63270 Excise Intrspinl Lesion Crvl 63271 Excise Intrspinl Lesion Thrc 63272 Excise Intrspinl Lesion Lmbr 63273 Excise Intrspinl Lesion Scrl 63275 Bx/Exc Xdrl Spine Lesn Crvl 63276 Bx/Exc Xdrl Spine Lesn Thrc 63277 Bx/Exc Xdrl Spine Lesn Lmbr 63278 Bx/Exc Xdrl Spine Lesn Scrl 63280 Bx/Exc Idrl Spine Lesn Crvl 63281 Bx/Exc Idrl Spine Lesn Thrc 63282 Bx/Exc Idrl Spine Lesn Lmbr 63283 Bx/Exc Idrl Spine Lesn Scrl 63285 Bx/Exc Idrl Imed Lesn Cervl 63286 Bx/Exc Idrl Imed Lesn Thrc 63287 Bx/Exc Idrl Imed Lesn Thrlmb 63290 Bx/Exc Xdrl/Idrl Lsn Any Lvl 63295 Repair Laminectomy Defect 63300 Remove Vert Xdrl Body Crvcl 63301 Remove Vert Xdrl Body Thrc 63302 Remove Vert Xdrl Body Thrlmb 63303 Remov Vert Xdrl Bdy Lmbr/Sac 63304 Remove Vert Idrl Body Crvcl 63305 Remove Vert Idrl Body Thrc 63306 Remov Vert Idrl Bdy Thrclmbr 63307 Remov Vert Idrl Bdy Lmbr/Sac 63308 Remove Vertebral Body Add-On 63600 Remove Spinal Cord Lesion 63610 Stimulation Of Spinal Cord 63620 Srs Spinal Lesion 63621 Srs Spinal Lesion Addl 63650 Implant Neuroelectrodes $3,310 $2,151 $2,569 $1,084 $620 63655 Implant Neuroelectrodes 63661 Remove Spine Eltrd Perq Aray $1,705 $1,108 $1,324 $559 $341 63662 Remove Spine Eltrd Plate 63663 Revise Spine Eltrd Perq Aray 63664 Revise Spine Eltrd Plate 63685 Insrt/Redo Spine N Generator $1,147 $746 $891 $376 63688 Revise/Remove Neuroreceiver $945 $614 $733 $310 63700 Repair Of Spinal Herniation 63702 Repair Of Spinal Herniation 63704 Repair Of Spinal Herniation 63706 Repair Of Spinal Herniation 63707 Repair Spinal Fluid Leakage 63709 Repair Spinal Fluid Leakage 63710 Graft Repair Of Spine Defect 63740 Install Spinal Shunt 63741 Install Spinal Shunt 63744 Revision Of Spinal Shunt 63746 Removal Of Spinal Shunt $1,679 $1,092 $1,304 $550 $350 64400 450 Njx Aa&/Strd Trigeminal Nrv $217 $141 $169 $71 64405 360 Njx Aa&/Strd Gr Ocpl Nrv $872 $567 $677 $285 $100 64408 Njx Aa&/Strd Vagus Nrv 64415 Njx Aa&/Strd Brach Plexus $300 $195 $233 $98 64416 Njx Aa&/Strd Brach Plex Nfs 64417 510 Njx Aa&/Strd Axillary Nrv $224 $146 $174 $73 64418 Njx Aa&/Strd Sprscap Nrv 64420 Njx Aa&/Strd Ntrcost Nrv 1 64421 Njx Aa&/Strd Ntrcost Nrv Ea 64425 360 Njx Aa&/Strd Ii Ih Nerves $905 $588 $703 $296 $179 64430 Njx Aa&/Strd Pudendal Nerve 64435 Njx Aa&/Strd Paracrv Nrv 64445 Njx Aa&/Strd Sciatic Nerve $174 $113 $135 $57 64446 Njx Aa&/Strd Sciatic Nrv Nfs 64447 Njx Aa&/Strd Femoral Nerve $154 $100 $119 $50 64448 Njx Aa&/Strd Fem Nerve Nfs 64449 Njx Aa&/Strd Lmbr Plex Nfs 64450 450 Njx Aa&/Strd Other Pn/Branch $134 $87 $104 $44 64451 Njx Aa&/Strd Nrv Nrvtg Si Jt $200 $130 $155 $65 64454 Njx Aa&/Strd Gnclr Nrv Brnch 64455 510 Njx Aa&/Strd Pltr Com Dg Nrv $136 $88 $106 $44 64461 Pvb Thoracic Single Inj Site $221 $143 $171 $72 64462 Pvb Thoracic 2Nd+ Inj Site $139 $90 $108 $46 64463 Pvb Thoracic Cont Infusion 64479 Njx Aa&/Strd Tfrm Epi C/T 1 64480 Njx Aa&/Strd Tfrm Epi C/T Ea 64483 Njx Aa&/Strd Tfrm Epi L/S 1 $548 $356 $426 $180 $145 64484 Njx Aa&/Strd Tfrm Epi L/S Ea $256 $166 $199 $84 64486 Tap Block Unil By Injection 64487 Tap Block Uni By Infusion 64488 Tap Block Bi Injection 64489 Tap Block Bi By Infusion 64490 Inj Paravert F Jnt C/T 1 Lev $533 $347 $414 $175 64491 Inj Paravert F Jnt C/T 2 Lev $269 $175 $209 $88 64492 Inj Paravert F Jnt C/T 3 Lev $271 $176 $210 $89 64493 Inj Paravert F Jnt L/S 1 Lev $432 $281 $336 $142 64494 Inj Paravert F Jnt L/S 2 Lev $237 $154 $184 $78 64495 360 Inj Paravert F Jnt L/S 3 Lev $496 $322 $385 $163 64505 N Block Spenopalatine Gangl 64510 N Block Stellate Ganglion 64517 N Block Inj Hypogas Plxs 64520 N Block Lumbar/Thoracic $528 $343 $410 $173 $83 64530 N Block Inj Celiac Pelus 64553 Implant Neuroelectrodes 64555 Implant Neuroelectrodes $862 $560 $669 $282 $0 64561 510 Implant Neuroelectrodes $1,759 $1,143 $1,365 $576 64566 510 Neuroeltrd Stim Post Tibial $312 $203 $242 $102 64568 Inc For Vagus N Elect Impl 64569 Revise/Repl Vagus N Eltrd 64570 Remove Vagus N Eltrd 64575 Implant Neuroelectrodes 64580 Implant Neuroelectrodes 64581 Implant Neuroelectrodes 64585 Revise/Remove Neuroelectrode $332 $216 $258 $109 64590 Insrt/Redo Pn/Gastr Stimul 64595 Revise/Rmv Pn/Gastr Stimul $291 $189 $226 $95 64600 Injection Treatment Of Nerve 64605 Injection Treatment Of Nerve 64610 Injection Treatment Of Nerve 64611 Chemodenerv Saliv Glands 64612 510 Destroy Nerve Face Muscle $107 $70 $83 $35 64615 510 Chemodenerv Musc Migraine $430 $279 $334 $141 64616 510 Chemodenerv Musc Neck Dyston $243 $158 $189 $80 64617 Chemodener Muscle Larynx Emg 64620 Injection Treatment Of Nerve 64624 Dstrj Nulyt Agt Gnclr Nrv 64625 Rf Abltj Nrv Nrvtg Si Jt $1,221 $794 $948 $400 $0 64630 Injection Treatment Of Nerve 64632 510 N Block Inj Common Digit $91 $59 $71 $30 64633 Destroy Cerv/Thor Facet Jnt $588 $382 $456 $193 64634 Destroy C/Th Facet Jnt Addl $178 $116 $139 $58 64635 Destroy Lumb/Sac Facet Jnt $574 $373 $446 $188 64636 Destroy L/S Facet Jnt Addl $155 $101 $121 $51 64640 Injection Treatment Of Nerve $218 $141 $169 $71 64642 510 Chemodenerv 1 Extremity 1-4 $283 $184 $219 $93 64643 510 Chemodenerv 1 Extrem 1-4 Ea $364 $237 $283 $119 64644 510 Chemodenerv 1 Extrem 5/> Mus $260 $169 $202 $85 64645 Chemodenerv 1 Extrem 5/> Ea 64646 510 Chemodenerv Trunk Musc 1-5 $265 $172 $206 $87 64647 Chemodenerv Trunk Musc 6/> 64650 Chemodenerv Eccrine Glands 64653 Chemodenerv Eccrine Glands 64680 Injection Treatment Of Nerve 64681 Injection Treatment Of Nerve 64702 Revise Finger/Toe Nerve 64704 Revise Hand/Foot Nerve 64708 Revise Arm/Leg Nerve 64712 Revision Of Sciatic Nerve 64713 Revision Of Arm Nerve(S) 64714 Revise Low Back Nerve(S) 64716 Revision Of Cranial Nerve 64718 Revise Ulnar Nerve At Elbow $1,806 $1,174 $1,402 $592 64719 Revise Ulnar Nerve At Wrist 64721 Carpal Tunnel Surgery $1,317 $856 $1,023 $432 64722 Relieve Pressure On Nerve(S) 64726 Release Foot/Toe Nerve 64727 Internal Nerve Revision 64732 Incision Of Brow Nerve 64734 Incision Of Cheek Nerve 64736 Incision Of Chin Nerve 64738 Incision Of Jaw Nerve 64740 Incision Of Tongue Nerve 64742 Incision Of Facial Nerve 64744 Incise Nerve Back Of Head 64746 Incise Diaphragm Nerve 64755 Incision Of Stomach Nerves 64760 Incision Of Vagus Nerve 64763 Incise Hip/Thigh Nerve 64766 Incise Hip/Thigh Nerve 64771 Sever Cranial Nerve 64772 Incision Of Spinal Nerve 64774 Remove Skin Nerve Lesion 64776 Remove Digit Nerve Lesion 64778 Digit Nerve Surgery Add-On 64782 Remove Limb Nerve Lesion 64783 Limb Nerve Surgery Add-On 64784 Remove Nerve Lesion $2,109 $1,371 $1,638 $691 $0 64786 Remove Sciatic Nerve Lesion 64787 Implant Nerve End 64788 Remove Skin Nerve Lesion $731 $475 $568 $240 64790 Removal Of Nerve Lesion 64792 Removal Of Nerve Lesion 64795 510 Biopsy Of Nerve $1,579 $1,026 $1,226 $517 64802 Sympathectomy Cervical 64804 Remove Sympathetic Nerves 64809 Remove Sympathetic Nerves 64818 Remove Sympathetic Nerves 64820 Sympathectomy Digital Artery 64821 Remove Sympathetic Nerves 64822 Remove Sympathetic Nerves 64823 Sympathectomy Supfc Palmar 64831 Repair Of Digit Nerve 64832 Repair Nerve Add-On 64834 Repair Of Hand Or Foot Nerve 64835 Repair Of Hand Or Foot Nerve 64836 Repair Of Hand Or Foot Nerve $2,325 $1,511 $1,805 $762 $736 64837 Repair Nerve Add-On 64840 Repair Of Leg Nerve 64856 Repair/Transpose Nerve 64857 Repair Arm/Leg Nerve 64858 Repair Sciatic Nerve 64859 Nerve Surgery 64861 Repair Of Arm Nerves 64862 Repair Of Low Back Nerves 64864 Repair Of Facial Nerve 64865 Repair Of Facial Nerve 64866 Fusion Of Facial/Other Nerve 64868 Fusion Of Facial/Other Nerve 64872 Subsequent Repair Of Nerve 64874 Repair & Revise Nerve Add-On 64876 Repair Nerve/Shorten Bone 64885 Nerve Graft Head/Neck 4 Cm 64890 Nerve Graft Hand/Foot 4 Cm 64892 Nerve Graft Arm/Leg <4 Cm 64893 Nerve Graft Arm/Leg >4 Cm 64895 Nerve Graft Hand/Foot 4 Cm 64897 Nerve Graft Arm/Leg 4 Cm 64901 Nerve Graft Add-On 64902 Nerve Graft Add-On 64905 Nerve Pedicle Transfer 64907 Nerve Pedicle Transfer 64910 Nerve Repair W/Allograft 64911 Neurorraphy W/Vein Autograft 64912 Nrv Rpr W/Nrv Algrft 1St 64913 Nrv Rpr W/Nrv Algrft Ea Addl 64999 Nervous System Surgery 65091 Revise Eye 65093 Revise Eye With Implant 65101 Removal Of Eye 65103 Remove Eye/Insert Implant 65105 Remove Eye/Attach Implant 65110 Removal Of Eye 65112 Remove Eye/Revise Socket 65114 Remove Eye/Revise Socket 65125 Revise Ocular Implant 65130 Insert Ocular Implant 65135 Insert Ocular Implant 65140 Attach Ocular Implant 65150 Revise Ocular Implant 65155 Reinsert Ocular Implant 65175 Removal Of Ocular Implant 65205 450 Remove Foreign Body From Eye $66 $43 $51 $22 65210 450 Remove Foreign Body From Eye $919 $597 $713 $301 65220 510 Remove Foreign Body From Eye $196 $127 $152 $64 65222 510 Remove Foreign Body From Eye $213 $138 $165 $70 65235 Remove Foreign Body From Eye 65260 Remove Foreign Body From Eye 65265 Remove Foreign Body From Eye 65270 Repair Of Eye Wound 65272 Repair Of Eye Wound 65273 Repair Of Eye Wound 65275 Repair Of Eye Wound 65280 Repair Of Eye Wound 65285 Repair Of Eye Wound 65286 Repair Of Eye Wound 65290 Repair Of Eye Socket Wound 65400 Removal Of Eye Lesion 65410 Biopsy Of Cornea 65420 Removal Of Eye Lesion 65426 Removal Of Eye Lesion 65430 Corneal Smear 65435 Curette/Treat Cornea 65436 Curette/Treat Cornea 65450 Treatment Of Corneal Lesion 65600 Revision Of Cornea 65710 Corneal Transplant 65730 Corneal Transplant 65750 Corneal Transplant 65755 Corneal Transplant 65756 Corneal Trnspl Endothelial 65757 Prep Corneal Endo Allograft 65760 Revision Of Cornea 65765 Revision Of Cornea 65767 Corneal Tissue Transplant 65770 Revise Cornea With Implant 65771 Radial Keratotomy 65772 Correction Of Astigmatism 65775 Correction Of Astigmatism 65778 Cover Eye W/Membrane 65779 Cover Eye W/Membrane Suture 65780 Ocular Reconst Transplant 65781 Ocular Reconst Transplant 65782 Ocular Reconst Transplant 65785 Impltj Ntrstrml Crnl Rng Seg 65800 Drainage Of Eye 65810 Drainage Of Eye 65815 Drainage Of Eye 65820 Relieve Inner Eye Pressure 65850 Incision Of Eye 65855 Trabeculoplasty Laser Surg 65860 Incise Inner Eye Adhesions 65865 Incise Inner Eye Adhesions 65870 Incise Inner Eye Adhesions 65875 Incise Inner Eye Adhesions 65880 Incise Inner Eye Adhesions 65900 Remove Eye Lesion 65920 Remove Implant Of Eye 65930 Remove Blood Clot From Eye 66020 Injection Treatment Of Eye 66030 Injection Treatment Of Eye 66130 Remove Eye Lesion 66150 Glaucoma Surgery 66155 Glaucoma Surgery 66160 Glaucoma Surgery 66170 Glaucoma Surgery 66172 Incision Of Eye 66174 Translum Dil Eye Canal 66175 Trnslum Dil Eye Canal W/Stnt 66179 Aqueous Shunt Eye W/O Graft 66180 Aqueous Shunt Eye W/Graft 66183 Insert Ant Drainage Device 66184 Revision Of Aqueous Shunt 66185 Revise Aqueous Shunt Eye 66225 Repair/Graft Eye Lesion 66250 Follow-Up Surgery Of Eye 66500 Incision Of Iris 66505 Incision Of Iris 66600 Remove Iris And Lesion 66605 Removal Of Iris 66625 Removal Of Iris 66630 Removal Of Iris 66635 Removal Of Iris 66680 Repair Iris & Ciliary Body 66682 Repair Iris & Ciliary Body 66700 Destruction Ciliary Body 66710 Ciliary Transsleral Therapy 66711 Ecp Ciliary Body Destruction 66720 Destruction Ciliary Body 66740 Destruction Ciliary Body 66761 Revision Of Iris 66762 Revision Of Iris 66770 Removal Of Inner Eye Lesion 66820 Incision Secondary Cataract 66821 After Cataract Laser Surgery 66825 Reposition Intraocular Lens 66830 Removal Of Lens Lesion 66840 Removal Of Lens Material 66850 Removal Of Lens Material 66852 Removal Of Lens Material 66920 Extraction Of Lens 66930 Extraction Of Lens 66940 Extraction Of Lens 66982 Xcapsl Ctrc Rmvl Cplx Wo Ecp 66983 Cataract Surg W/Iol 1 Stage 66984 Xcapsl Ctrc Rmvl W/O Ecp 66985 Insert Lens Prosthesis 66986 Exchange Lens Prosthesis 66987 Xcapsl Ctrc Rmvl Cplx W/Ecp 66988 Xcapsl Ctrc Rmvl W/Ecp 66990 Ophthalmic Endoscope Add-On 66999 Eye Surgery Procedure 67005 Partial Removal Of Eye Fluid 67010 Partial Removal Of Eye Fluid 67015 Release Of Eye Fluid 67025 Replace Eye Fluid 67027 Implant Eye Drug System 67028 Injection Eye Drug 67030 Incise Inner Eye Strands 67031 Laser Surgery Eye Strands 67036 Removal Of Inner Eye Fluid 67039 Laser Treatment Of Retina 67040 Laser Treatment Of Retina 67041 Vit For Macular Pucker 67042 Vit For Macular Hole 67043 Vit For Membrane Dissect 67101 Repair Detached Retina Crtx 67105 Repair Detached Retina Pc 67107 Repair Detached Retina 67108 Repair Detached Retina 67110 Repair Detached Retina 67113 Repair Retinal Detach Cplx 67115 Release Encircling Material 67120 Remove Eye Implant Material 67121 Remove Eye Implant Material 67141 Treatment Of Retina 67145 Treatment Of Retina 67208 Treatment Of Retinal Lesion 67210 Treatment Of Retinal Lesion 67218 Treatment Of Retinal Lesion 67220 Treatment Of Choroid Lesion 67221 Ocular Photodynamic Ther 67225 Eye Photodynamic Ther Add-On 67227 Dstrj Extensive Retinopathy 67228 Treatment X10Sv Retinopathy 67229 Tr Retinal Les Preterm Inf 67250 Reinforce Eye Wall 67255 Reinforce/Graft Eye Wall 67299 Eye Surgery Procedure 67311 Revise Eye Muscle 67312 Revise Two Eye Muscles 67314 Revise Eye Muscle 67316 Revise Two Eye Muscles 67318 Revise Eye Muscle(S) 67320 Revise Eye Muscle(S) Add-On 67331 Eye Surgery Follow-Up Add-On 67332 Rerevise Eye Muscles Add-On 67334 Revise Eye Muscle W/Suture 67335 Eye Suture During Surgery 67340 Revise Eye Muscle Add-On 67343 Release Eye Tissue 67345 Destroy Nerve Of Eye Muscle 67346 Biopsy Eye Muscle 67399 Unlisted Px Extraocular Musc 67400 Explore/Biopsy Eye Socket 67405 Explore/Drain Eye Socket 67412 Explore/Treat Eye Socket 67413 Explore/Treat Eye Socket 67414 Explr/Decompress Eye Socket 67415 Aspiration Orbital Contents 67420 Explore/Treat Eye Socket 67430 Explore/Treat Eye Socket 67440 Explore/Drain Eye Socket 67445 Explr/Decompress Eye Socket 67450 Explore/Biopsy Eye Socket 67500 Inject/Treat Eye Socket 67505 Inject/Treat Eye Socket 67515 Inject/Treat Eye Socket 67550 Insert Eye Socket Implant 67560 Revise Eye Socket Implant 67570 Decompress Optic Nerve 67599 Orbit Surgery Procedure 67700 510 Drainage Of Eyelid Abscess $355 $231 $276 $116 67710 Incision Of Eyelid 67715 Incision Of Eyelid Fold 67800 Remove Eyelid Lesion 67801 Remove Eyelid Lesions 67805 Remove Eyelid Lesions 67808 Remove Eyelid Lesion(S) 67810 510 Biopsy Eyelid & Lid Margin $344 $224 $267 $113 67820 Revise Eyelashes 67825 Revise Eyelashes 67830 Revise Eyelashes 67835 Revise Eyelashes 67840 510 Remove Eyelid Lesion $424 $275 $329 $139 67850 Treat Eyelid Lesion 67875 Closure Of Eyelid By Suture 67880 Revision Of Eyelid 67882 Revision Of Eyelid 67900 510 Repair Brow Defect $653 $424 $507 $214 67901 Repair Eyelid Defect 67902 Repair Eyelid Defect 67903 Repair Eyelid Defect 67904 Repair Eyelid Defect 67906 Repair Eyelid Defect 67908 Repair Eyelid Defect 67909 Revise Eyelid Defect 67911 Revise Eyelid Defect 67912 Correction Eyelid W/Implant 67914 510 Repair Eyelid Defect $410 $267 $319 $134 67915 Repair Eyelid Defect 67916 Repair Eyelid Defect 67917 Repair Eyelid Defect 67921 Repair Eyelid Defect 67922 Repair Eyelid Defect 67923 Repair Eyelid Defect 67924 Repair Eyelid Defect 67930 Repair Eyelid Wound 67935 Repair Eyelid Wound 67938 Remove Eyelid Foreign Body 67950 Revision Of Eyelid 67961 Revision Of Eyelid 67966 Revision Of Eyelid 67971 Reconstruction Of Eyelid 67973 Reconstruction Of Eyelid 67974 Reconstruction Of Eyelid 67975 Reconstruction Of Eyelid 67999 Revision Of Eyelid 68020 Incise/Drain Eyelid Lining 68040 Treatment Of Eyelid Lesions 68100 Biopsy Of Eyelid Lining 68110 Remove Eyelid Lining Lesion 68115 Remove Eyelid Lining Lesion 68130 Remove Eyelid Lining Lesion 68135 Remove Eyelid Lining Lesion 68200 Treat Eyelid By Injection 68320 Revise/Graft Eyelid Lining 68325 Revise/Graft Eyelid Lining 68326 Revise/Graft Eyelid Lining 68328 Revise/Graft Eyelid Lining 68330 Revise Eyelid Lining 68335 Revise/Graft Eyelid Lining 68340 Separate Eyelid Adhesions 68360 Revise Eyelid Lining 68362 Revise Eyelid Lining 68371 Harvest Eye Tissue Alograft 68399 Eyelid Lining Surgery 68400 Incise/Drain Tear Gland 68420 Incise/Drain Tear Sac 68440 Incise Tear Duct Opening 68500 Removal Of Tear Gland 68505 Partial Removal Tear Gland 68510 Biopsy Of Tear Gland 68520 Removal Of Tear Sac 68525 Biopsy Of Tear Sac 68530 Clearance Of Tear Duct 68540 Remove Tear Gland Lesion 68550 Remove Tear Gland Lesion 68700 Repair Tear Ducts 68705 Revise Tear Duct Opening 68720 Create Tear Sac Drain 68745 Create Tear Duct Drain 68750 510 Create Tear Duct Drain $289 $188 $225 $95 68760 Close Tear Duct Opening 68761 Close Tear Duct Opening 68770 Close Tear System Fistula 68801 Dilate Tear Duct Opening 68810 Probe Nasolacrimal Duct 68811 Probe Nasolacrimal Duct 68815 Probe Nasolacrimal Duct 68816 Probe Nl Duct W/Balloon 68840 Explore/Irrigate Tear Ducts 68850 Injection For Tear Sac X-Ray 68899 Tear Duct System Surgery 69000 450 Drain External Ear Lesion $248 $161 $193 $81 69005 510 Drain External Ear Lesion $249 $162 $193 $81 69020 Drain Outer Ear Canal Lesion 69090 Pierce Earlobes 69100 510 Biopsy Of External Ear $187 $122 $145 $61 69105 510 Biopsy Of External Ear Canal $208 $135 $161 $68 69110 Remove External Ear Partial 69120 Removal Of External Ear 69140 Remove Ear Canal Lesion(S) 69145 Remove Ear Canal Lesion(S) 69150 Extensive Ear Canal Surgery 69155 Extensive Ear/Neck Surgery 69200 510 Clear Outer Ear Canal $649 $422 $504 $212 $161 69205 Clear Outer Ear Canal $316 $205 $245 $104 69209 983 Remove Impacted Ear Wax Uni $44 $29 $34 $14 69210 983 Remove Impacted Ear Wax Uni $178 $116 $138 $58 69220 510 Clean Out Mastoid Cavity $239 $156 $186 $78 69222 Clean Out Mastoid Cavity 69300 Revise External Ear 69310 Rebuild Outer Ear Canal 69320 Rebuild Outer Ear Canal 69399 510 Outer Ear Surgery Procedure 69420 Incision Of Eardrum 69421 Incision Of Eardrum $465 $302 $361 $152 69424 Remove Ventilating Tube 69433 510 Create Eardrum Opening $294 $191 $228 $96 69436 Create Eardrum Opening $496 $323 $385 $163 69440 Exploration Of Middle Ear 69450 Eardrum Revision 69501 Mastoidectomy 69502 Mastoidectomy 69505 Remove Mastoid Structures 69511 Extensive Mastoid Surgery 69530 Extensive Mastoid Surgery 69535 Remove Part Of Temporal Bone 69540 Remove Ear Lesion 69550 Remove Ear Lesion 69552 Remove Ear Lesion 69554 Remove Ear Lesion 69601 Mastoid Surgery Revision 69602 Mastoid Surgery Revision 69603 Mastoid Surgery Revision 69604 Mastoid Surgery Revision 69605 Mastoid Surgery Revision 69610 Repair Of Eardrum $1,158 $753 $899 $379 $203 69620 Repair Of Eardrum 69631 Repair Eardrum Structures 69632 Rebuild Eardrum Structures 69633 Rebuild Eardrum Structures 69635 Repair Eardrum Structures 69636 Rebuild Eardrum Structures 69637 Rebuild Eardrum Structures 69641 Revise Middle Ear & Mastoid 69642 Revise Middle Ear & Mastoid 69643 Revise Middle Ear & Mastoid 69644 Revise Middle Ear & Mastoid 69645 Revise Middle Ear & Mastoid 69646 Revise Middle Ear & Mastoid 69650 Release Middle Ear Bone 69660 Revise Middle Ear Bone 69661 Revise Middle Ear Bone 69662 Revise Middle Ear Bone 69666 Repair Middle Ear Structures 69667 Repair Middle Ear Structures 69670 Remove Mastoid Air Cells 69676 Remove Middle Ear Nerve 69700 Close Mastoid Fistula 69705 Nps Surg Dilat Eust Tube Uni 69706 Nps Surg Dilat Eust Tube Bi 69710 Implant/Replace Hearing Aid 69711 Remove/Repair Hearing Aid 69714 Implant Temple Bone W/Stimul 69715 Temple Bne Implnt W/Stimulat 69717 Temple Bone Implant Revision 69718 Revise Temple Bone Implant 69720 Release Facial Nerve 69725 Release Facial Nerve 69740 Repair Facial Nerve 69745 Repair Facial Nerve 69799 Middle Ear Surgery Procedure 69801 510 Incise Inner Ear $431 $280 $334 $141 69805 Explore Inner Ear 69806 Explore Inner Ear 69905 Remove Inner Ear 69910 Remove Inner Ear & Mastoid 69915 Incise Inner Ear Nerve 69930 Implant Cochlear Device 69949 Inner Ear Surgery Procedure 69950 Incise Inner Ear Nerve 69955 Release Facial Nerve 69960 Release Inner Ear Canal 69970 Remove Inner Ear Lesion 69979 Temporal Bone Surgery 69990 Microsurgery Add-On $677 $440 $526 $222 $0 70010 Contrast X-Ray Of Brain 70015 Contrast X-Ray Of Brain 70015 Contrast X-Ray Of Brain 70015 Contrast X-Ray Of Brain 70030 320 X-Ray Eye For Foreign Body $701 $456 $544 $229 70030 320 X-Ray Eye For Foreign Body $701 $456 $544 $229 70030 320 X-Ray Eye For Foreign Body $701 $456 $544 $229 70100 320 X-Ray Exam Of Jaw <4Views $310 $202 $241 $101 70100 320 X-Ray Exam Of Jaw <4Views $310 $202 $241 $101 70100 320 X-Ray Exam Of Jaw <4Views $310 $202 $241 $101 7010F Pt Info Into Recall System 70110 320 X-Ray Exam Of Jaw 4/> Views $395 $257 $307 $129 70110 320 X-Ray Exam Of Jaw 4/> Views $395 $257 $307 $129 70110 320 X-Ray Exam Of Jaw 4/> Views $395 $257 $307 $129 70120 X-Ray Exam Of Mastoids 70120 X-Ray Exam Of Mastoids 70120 X-Ray Exam Of Mastoids 70130 320 X-Ray Exam Of Mastoids $470 $306 $365 $154 70130 320 X-Ray Exam Of Mastoids $470 $306 $365 $154 70130 320 X-Ray Exam Of Mastoids $470 $306 $365 $154 70134 X-Ray Exam Of Middle Ear 70134 X-Ray Exam Of Middle Ear 70134 X-Ray Exam Of Middle Ear 70140 320 X-Ray Exam Of Facial Bones $370 $241 $287 $121 $120 70140 320 X-Ray Exam Of Facial Bones $370 $241 $287 $121 $120 70140 320 X-Ray Exam Of Facial Bones $370 $241 $287 $121 $120 70150 320 X-Ray Exam Of Facial Bones $470 $306 $365 $154 $142 70150 320 X-Ray Exam Of Facial Bones $470 $306 $365 $154 $142 70150 320 X-Ray Exam Of Facial Bones $470 $306 $365 $154 $142 70160 320 X-Ray Exam Of Nasal Bones $373 $242 $290 $122 70160 320 X-Ray Exam Of Nasal Bones $373 $242 $290 $122 70160 320 X-Ray Exam Of Nasal Bones $373 $242 $290 $122 70170 X-Ray Exam Of Tear Duct 70170 X-Ray Exam Of Tear Duct 70170 X-Ray Exam Of Tear Duct 70190 X-Ray Exam Of Eye Sockets 70190 X-Ray Exam Of Eye Sockets 70190 X-Ray Exam Of Eye Sockets 70200 320 X-Ray Exam Of Eye Sockets $470 $306 $365 $154 $143 70200 320 X-Ray Exam Of Eye Sockets $470 $306 $365 $154 $143 70200 320 X-Ray Exam Of Eye Sockets $470 $306 $365 $154 $143 7020F Mammo Assess Cat In Dbase 70210 320 X-Ray Exam Of Sinuses $370 $241 $287 $121 $8 70210 320 X-Ray Exam Of Sinuses $370 $241 $287 $121 $8 70210 320 X-Ray Exam Of Sinuses $370 $241 $287 $121 $8 70220 320 X-Ray Exam Of Sinuses $468 $304 $363 $153 $95 70220 320 X-Ray Exam Of Sinuses $468 $304 $363 $153 $95 70220 320 X-Ray Exam Of Sinuses $468 $304 $363 $153 $95 70240 X-Ray Exam Pituitary Saddle 70240 X-Ray Exam Pituitary Saddle 70240 X-Ray Exam Pituitary Saddle 70250 320 X-Ray Exam Of Skull $370 $241 $287 $121 70250 320 X-Ray Exam Of Skull $370 $241 $287 $121 70250 320 X-Ray Exam Of Skull $370 $241 $287 $121 7025F Pt Infosys Alarm 4 Nxt Mammo 70260 320 X-Ray Exam Of Skull $548 $356 $425 $179 $101 70260 320 X-Ray Exam Of Skull $548 $356 $425 $179 $101 70260 320 X-Ray Exam Of Skull $548 $356 $425 $179 $101 70300 X-Ray Exam Of Teeth 70300 X-Ray Exam Of Teeth 70300 X-Ray Exam Of Teeth 70310 X-Ray Exam Of Teeth 70310 X-Ray Exam Of Teeth 70310 X-Ray Exam Of Teeth 70320 Full Mouth X-Ray Of Teeth 70320 Full Mouth X-Ray Of Teeth 70320 Full Mouth X-Ray Of Teeth 70328 X-Ray Exam Of Jaw Joint 70328 X-Ray Exam Of Jaw Joint 70328 X-Ray Exam Of Jaw Joint 70330 320 X-Ray Exam Of Jaw Joints $503 $327 $391 $165 $115 70330 320 X-Ray Exam Of Jaw Joints $503 $327 $391 $165 $115 70330 320 X-Ray Exam Of Jaw Joints $503 $327 $391 $165 $115 70332 X-Ray Exam Of Jaw Joint 70332 X-Ray Exam Of Jaw Joint 70332 X-Ray Exam Of Jaw Joint 70336 614 Magnetic Image Jaw Joint $2,720 $1,768 $2,112 $890 70336 614 Magnetic Image Jaw Joint $2,720 $1,768 $2,112 $890 70336 614 Magnetic Image Jaw Joint $2,720 $1,768 $2,112 $890 70350 X-Ray Head For Orthodontia 70350 X-Ray Head For Orthodontia 70350 X-Ray Head For Orthodontia 70355 Panoramic X-Ray Of Jaws 70355 Panoramic X-Ray Of Jaws 70355 Panoramic X-Ray Of Jaws 70360 320 X-Ray Exam Of Neck $252 $164 $196 $82 70360 320 X-Ray Exam Of Neck $252 $164 $196 $82 70360 320 X-Ray Exam Of Neck $252 $164 $196 $82 70370 Throat X-Ray & Fluoroscopy 70370 Throat X-Ray & Fluoroscopy 70370 Throat X-Ray & Fluoroscopy 70371 320 Speech Evaluation Complex $939 $610 $729 $308 70371 320 Speech Evaluation Complex $939 $610 $729 $308 70371 320 Speech Evaluation Complex $939 $610 $729 $308 70380 X-Ray Exam Of Salivary Gland 70380 X-Ray Exam Of Salivary Gland 70380 X-Ray Exam Of Salivary Gland 70390 X-Ray Exam Of Salivary Duct 70390 X-Ray Exam Of Salivary Duct 70390 X-Ray Exam Of Salivary Duct 70450 350 Ct Head/Brain W/O Dye $2,176 $1,414 $1,689 $712 70450 350 Ct Head/Brain W/O Dye $2,176 $1,414 $1,689 $712 70450 350 Ct Head/Brain W/O Dye $2,176 $1,414 $1,689 $712 70460 350 Ct Head/Brain W/Dye $2,610 $1,697 $2,026 $854 $207 70460 350 Ct Head/Brain W/Dye $2,610 $1,697 $2,026 $854 $207 70460 350 Ct Head/Brain W/Dye $2,610 $1,697 $2,026 $854 $207 70470 350 Ct Head/Brain W/O & W/Dye $3,570 $2,321 $2,772 $1,168 70470 350 Ct Head/Brain W/O & W/Dye $3,570 $2,321 $2,772 $1,168 70470 350 Ct Head/Brain W/O & W/Dye $3,570 $2,321 $2,772 $1,168 70480 351 Ct Orbit/Ear/Fossa W/O Dye $2,176 $1,414 $1,689 $712 70480 351 Ct Orbit/Ear/Fossa W/O Dye $2,176 $1,414 $1,689 $712 70480 351 Ct Orbit/Ear/Fossa W/O Dye $2,176 $1,414 $1,689 $712 70481 350 Ct Orbit/Ear/Fossa W/Dye $3,086 $2,006 $2,396 $1,010 $600 70481 350 Ct Orbit/Ear/Fossa W/Dye $3,086 $2,006 $2,396 $1,010 $600 70481 350 Ct Orbit/Ear/Fossa W/Dye $3,086 $2,006 $2,396 $1,010 $600 70482 350 Ct Orbit/Ear/Fossa W/O&W/Dye $5,262 $3,420 $4,085 $1,721 70482 350 Ct Orbit/Ear/Fossa W/O&W/Dye $5,262 $3,420 $4,085 $1,721 70482 350 Ct Orbit/Ear/Fossa W/O&W/Dye $5,262 $3,420 $4,085 $1,721 70486 350 Ct Maxillofacial W/O Dye $2,176 $1,414 $1,689 $712 70486 350 Ct Maxillofacial W/O Dye $2,176 $1,414 $1,689 $712 70486 350 Ct Maxillofacial W/O Dye $2,176 $1,414 $1,689 $712 70487 350 Ct Maxillofacial W/Dye $2,588 $1,682 $2,009 $847 70487 350 Ct Maxillofacial W/Dye $2,588 $1,682 $2,009 $847 70487 350 Ct Maxillofacial W/Dye $2,588 $1,682 $2,009 $847 70488 350 Ct Maxillofacial W/O & W/Dye $3,239 $2,105 $2,515 $1,060 70488 350 Ct Maxillofacial W/O & W/Dye $3,239 $2,105 $2,515 $1,060 70488 350 Ct Maxillofacial W/O & W/Dye $3,239 $2,105 $2,515 $1,060 70490 350 Ct Soft Tissue Neck W/O Dye $2,189 $1,423 $1,699 $716 70490 350 Ct Soft Tissue Neck W/O Dye $2,189 $1,423 $1,699 $716 70490 350 Ct Soft Tissue Neck W/O Dye $2,189 $1,423 $1,699 $716 70491 350 Ct Soft Tissue Neck W/Dye $2,608 $1,695 $2,025 $853 70491 350 Ct Soft Tissue Neck W/Dye $2,608 $1,695 $2,025 $853 70491 350 Ct Soft Tissue Neck W/Dye $2,608 $1,695 $2,025 $853 70492 350 Ct Sft Tsue Nck W/O & W/Dye $3,259 $2,118 $2,530 $1,066 70492 350 Ct Sft Tsue Nck W/O & W/Dye $3,259 $2,118 $2,530 $1,066 70492 350 Ct Sft Tsue Nck W/O & W/Dye $3,259 $2,118 $2,530 $1,066 70496 350 Ct Angiography Head $4,337 $2,819 $3,367 $1,419 70496 350 Ct Angiography Head $4,337 $2,819 $3,367 $1,419 70496 350 Ct Angiography Head $4,337 $2,819 $3,367 $1,419 70498 350 Ct Angiography Neck $3,670 $2,386 $2,849 $1,201 70498 350 Ct Angiography Neck $3,670 $2,386 $2,849 $1,201 70498 350 Ct Angiography Neck $3,670 $2,386 $2,849 $1,201 70540 614 Mri Orbit/Face/Neck W/O Dye $2,720 $1,768 $2,112 $890 70540 614 Mri Orbit/Face/Neck W/O Dye $2,720 $1,768 $2,112 $890 70540 614 Mri Orbit/Face/Neck W/O Dye $2,720 $1,768 $2,112 $890 70542 614 Mri Orbit/Face/Neck W/Dye $3,867 $2,514 $3,002 $1,265 70542 614 Mri Orbit/Face/Neck W/Dye $3,867 $2,514 $3,002 $1,265 70542 614 Mri Orbit/Face/Neck W/Dye $3,867 $2,514 $3,002 $1,265 70543 614 Mri Orbt/Fac/Nck W/O &W/Dye $4,547 $2,956 $3,530 $1,488 70543 614 Mri Orbt/Fac/Nck W/O &W/Dye $4,547 $2,956 $3,530 $1,488 70543 614 Mri Orbt/Fac/Nck W/O &W/Dye $4,547 $2,956 $3,530 $1,488 70544 615 Mr Angiography Head W/O Dye $2,814 $1,829 $2,185 $921 70544 615 Mr Angiography Head W/O Dye $2,814 $1,829 $2,185 $921 70544 615 Mr Angiography Head W/O Dye $2,814 $1,829 $2,185 $921 70545 615 Mr Angiography Head W/Dye $3,367 $2,189 $2,614 $1,101 70545 615 Mr Angiography Head W/Dye $3,367 $2,189 $2,614 $1,101 70545 615 Mr Angiography Head W/Dye $3,367 $2,189 $2,614 $1,101 70546 615Mr Angiograph Head W/O&W/Dye $4,835 $3,143 $3,754 $1,582 $850

70546 615Mr Angiograph Head W/O&W/Dye $4,835 $3,143 $3,754 $1,582 $850

70546 615Mr Angiograph Head W/O&W/Dye $4,835 $3,143 $3,754 $1,582 $850

70547 615 Mr Angiography Neck W/O Dye $2,702 $1,756 $2,098 $884 70547 615 Mr Angiography Neck W/O Dye $2,702 $1,756 $2,098 $884 70547 615 Mr Angiography Neck W/O Dye $2,702 $1,756 $2,098 $884 70548 615 Mr Angiography Neck W/Dye $3,867 $2,514 $3,002 $1,265 70548 615 Mr Angiography Neck W/Dye $3,867 $2,514 $3,002 $1,265 70548 615 Mr Angiography Neck W/Dye $3,867 $2,514 $3,002 $1,265 70549 615 Mr Angiograph Neck W/O&W/Dye $4,835 $3,143 $3,754 $1,582 70549 615 Mr Angiograph Neck W/O&W/Dye $4,835 $3,143 $3,754 $1,582 70549 615 Mr Angiograph Neck W/O&W/Dye $4,835 $3,143 $3,754 $1,582 70551 611 Mri Brain Stem W/O Dye $3,064 $1,992 $2,379 $1,002 $288 70551 611 Mri Brain Stem W/O Dye $3,064 $1,992 $2,379 $1,002 $288 70551 611 Mri Brain Stem W/O Dye $3,064 $1,992 $2,379 $1,002 $288 70552 611 Mri Brain Stem W/Dye $3,922 $2,549 $3,045 $1,283 70552 611 Mri Brain Stem W/Dye $3,922 $2,549 $3,045 $1,283 70552 611 Mri Brain Stem W/Dye $3,922 $2,549 $3,045 $1,283 70553 611 Mri Brain Stem W/O & W/Dye $4,634 $3,012 $3,598 $1,516 $422 70553 611 Mri Brain Stem W/O & W/Dye $4,634 $3,012 $3,598 $1,516 $422 70553 611 Mri Brain Stem W/O & W/Dye $4,634 $3,012 $3,598 $1,516 $422 70554 Fmri Brain By Tech 70554 Fmri Brain By Tech 70554 Fmri Brain By Tech 70555 Fmri Brain By Phys/Psych 70555 Fmri Brain By Phys/Psych 70555 Fmri Brain By Phys/Psych 70557 Mri Brain W/O Dye 70557 Mri Brain W/O Dye 70557 Mri Brain W/O Dye 70558 Mri Brain W/Dye 70558 Mri Brain W/Dye 70558 Mri Brain W/Dye 70559 Mri Brain W/O & W/Dye 70559 Mri Brain W/O & W/Dye 70559 Mri Brain W/O & W/Dye 71045 320 X-Ray Exam Chest 1 View $290 $189 $225 $95 71045 320 X-Ray Exam Chest 1 View $290 $189 $225 $95 71045 320 X-Ray Exam Chest 1 View $290 $189 $225 $95 71046 320 X-Ray Exam Chest 2 Views $370 $241 $287 $121 71046 320 X-Ray Exam Chest 2 Views $370 $241 $287 $121 71046 320 X-Ray Exam Chest 2 Views $370 $241 $287 $121 71047 324 X-Ray Exam Chest 3 Views $444 $289 $345 $145 71047 324 X-Ray Exam Chest 3 Views $444 $289 $345 $145 71047 324 X-Ray Exam Chest 3 Views $444 $289 $345 $145 71048 324 X-Ray Exam Chest 4+ Views $466 $303 $362 $152 $103 71048 324 X-Ray Exam Chest 4+ Views $466 $303 $362 $152 $103 71048 324 X-Ray Exam Chest 4+ Views $466 $303 $362 $152 $103 71100 320 X-Ray Exam Ribs Uni 2 Views $369 $240 $286 $121 71100 320 X-Ray Exam Ribs Uni 2 Views $369 $240 $286 $121 71100 320 X-Ray Exam Ribs Uni 2 Views $369 $240 $286 $121 71101 320 X-Ray Exam Unilat Ribs/Chest $595 $387 $462 $195 $113 71101 320 X-Ray Exam Unilat Ribs/Chest $595 $387 $462 $195 $113 71101 320 X-Ray Exam Unilat Ribs/Chest $595 $387 $462 $195 $113 71110 320 X-Ray Exam Ribs Bil 3 Views $470 $306 $365 $154 71110 320 X-Ray Exam Ribs Bil 3 Views $470 $306 $365 $154 71110 320 X-Ray Exam Ribs Bil 3 Views $470 $306 $365 $154 71111 320 X-Ray Exam Ribs/Chest4/> Vws $536 $348 $416 $175 71111 320 X-Ray Exam Ribs/Chest4/> Vws $536 $348 $416 $175 71111 320 X-Ray Exam Ribs/Chest4/> Vws $536 $348 $416 $175 71120 320 X-Ray Exam Breastbone 2/>Vws $392 $255 $304 $128 71120 320 X-Ray Exam Breastbone 2/>Vws $392 $255 $304 $128 71120 320 X-Ray Exam Breastbone 2/>Vws $392 $255 $304 $128 71130 320 X-Ray Strenoclavic Jt 3/>Vws $420 $273 $326 $137 71130 320 X-Ray Strenoclavic Jt 3/>Vws $420 $273 $326 $137 71130 320 X-Ray Strenoclavic Jt 3/>Vws $420 $273 $326 $137 71250 350 Ct Thorax Dx C- $2,725 $1,771 $2,116 $891 71250 350 Ct Thorax Dx C- $2,725 $1,771 $2,116 $891 71250 350 Ct Thorax Dx C- $2,725 $1,771 $2,116 $891 71260 350 Ct Thorax Dx C+ $3,259 $2,118 $2,530 $1,066 71260 350 Ct Thorax Dx C+ $3,259 $2,118 $2,530 $1,066 71260 350 Ct Thorax Dx C+ $3,259 $2,118 $2,530 $1,066 71270 350 Ct Thorax Dx C-/C+ $4,066 $2,643 $3,157 $1,330 71270 350 Ct Thorax Dx C-/C+ $4,066 $2,643 $3,157 $1,330 71270 350 Ct Thorax Dx C-/C+ $4,066 $2,643 $3,157 $1,330 71271 Ct Thorax Lung Cancer Scr C- 71271 Ct Thorax Lung Cancer Scr C- 71271 Ct Thorax Lung Cancer Scr C- 71275 350 Ct Angiography Chest $4,066 $2,643 $3,157 $1,330 71275 350 Ct Angiography Chest $4,066 $2,643 $3,157 $1,330 71275 350 Ct Angiography Chest $4,066 $2,643 $3,157 $1,330 71550 614 Mri Chest W/O Dye $3,157 $2,052 $2,451 $1,033 71550 614 Mri Chest W/O Dye $3,157 $2,052 $2,451 $1,033 71550 614 Mri Chest W/O Dye $3,157 $2,052 $2,451 $1,033 71551 614 Mri Chest W/Dye $3,867 $2,514 $3,002 $1,265 71551 614 Mri Chest W/Dye $3,867 $2,514 $3,002 $1,265 71551 614 Mri Chest W/Dye $3,867 $2,514 $3,002 $1,265 71552 614 Mri Chest W/O & W/Dye $4,799 $3,119 $3,726 $1,570 71552 614 Mri Chest W/O & W/Dye $4,799 $3,119 $3,726 $1,570 71552 614 Mri Chest W/O & W/Dye $4,799 $3,119 $3,726 $1,570 71555 320 Mri Angio Chest W Or W/O Dye $2,462 $1,600 $1,911 $807 71555 320 Mri Angio Chest W Or W/O Dye $2,462 $1,600 $1,911 $807 71555 320 Mri Angio Chest W Or W/O Dye $2,462 $1,600 $1,911 $807 72020 320 X-Ray Exam Of Spine 1 View $252 $164 $196 $82 72020 320 X-Ray Exam Of Spine 1 View $252 $164 $196 $82 72020 320 X-Ray Exam Of Spine 1 View $252 $164 $196 $82 72040 320 X-Ray Exam Neck Spine 2-3 Vw $362 $235 $281 $118 72040 320 X-Ray Exam Neck Spine 2-3 Vw $362 $235 $281 $118 72040 320 X-Ray Exam Neck Spine 2-3 Vw $362 $235 $281 $118 72050 320 X-Ray Exam Neck Spine 4/5Vws $579 $376 $450 $189 $133 72050 320 X-Ray Exam Neck Spine 4/5Vws $579 $376 $450 $189 $133 72050 320 X-Ray Exam Neck Spine 4/5Vws $579 $376 $450 $189 $133 72052 320 X-Ray Exam Neck Spine 6/>Vws $675 $439 $524 $221 $109 72052 320 X-Ray Exam Neck Spine 6/>Vws $675 $439 $524 $221 $109 72052 320 X-Ray Exam Neck Spine 6/>Vws $675 $439 $524 $221 $109 72070 320 X-Ray Exam Thorac Spine 2Vws $429 $279 $333 $140 72070 320 X-Ray Exam Thorac Spine 2Vws $429 $279 $333 $140 72070 320 X-Ray Exam Thorac Spine 2Vws $429 $279 $333 $140 72072 320 X-Ray Exam Thorac Spine 3Vws $444 $289 $345 $145 72072 320 X-Ray Exam Thorac Spine 3Vws $444 $289 $345 $145 72072 320 X-Ray Exam Thorac Spine 3Vws $444 $289 $345 $145 72074 320 X-Ray Exam Thorac Spine4/>Vw $550 $358 $427 $180 72074 320 X-Ray Exam Thorac Spine4/>Vw $550 $358 $427 $180 72074 320 X-Ray Exam Thorac Spine4/>Vw $550 $358 $427 $180 72080 320 X-Ray Exam Thoracolmb 2/> Vw $391 $254 $304 $128 72080 320 X-Ray Exam Thoracolmb 2/> Vw $391 $254 $304 $128 72080 320 X-Ray Exam Thoracolmb 2/> Vw $391 $254 $304 $128 72081 320 X-Ray Exam Entire Spi 1 Vw $402 $261 $312 $132 72081 320 X-Ray Exam Entire Spi 1 Vw $402 $261 $312 $132 72081 320 X-Ray Exam Entire Spi 1 Vw $402 $261 $312 $132 72082 320 X-Ray Exam Entire Spi 2/3 Vw $768 $499 $596 $251 $95 72082 320 X-Ray Exam Entire Spi 2/3 Vw $768 $499 $596 $251 $95 72082 320 X-Ray Exam Entire Spi 2/3 Vw $768 $499 $596 $251 $95 72083 X-Ray Exam Entire Spi 4/5 Vw 72083 X-Ray Exam Entire Spi 4/5 Vw 72083 X-Ray Exam Entire Spi 4/5 Vw 72084 X-Ray Exam Entire Spi 6/> Vw 72084 X-Ray Exam Entire Spi 6/> Vw 72084 X-Ray Exam Entire Spi 6/> Vw 72100 320 X-Ray Exam L-S Spine 2/3 Vws $402 $261 $312 $132 72100 320 X-Ray Exam L-S Spine 2/3 Vws $402 $261 $312 $132 72100 320 X-Ray Exam L-S Spine 2/3 Vws $402 $261 $312 $132 72110 320 X-Ray Exam L-2 Spine 4/>Vws $558 $363 $433 $183 72110 320 X-Ray Exam L-2 Spine 4/>Vws $558 $363 $433 $183 72110 320 X-Ray Exam L-2 Spine 4/>Vws $558 $363 $433 $183 72114 320 X-Ray Exam L-S Spine Bending $618 $402 $480 $202 $117 72114 320 X-Ray Exam L-S Spine Bending $618 $402 $480 $202 $117 72114 320 X-Ray Exam L-S Spine Bending $618 $402 $480 $202 $117 72120 320 X-Ray Bend Only L-S Spine $414 $269 $321 $135 $66 72120 320 X-Ray Bend Only L-S Spine $414 $269 $321 $135 $66 72120 320 X-Ray Bend Only L-S Spine $414 $269 $321 $135 $66 72125 350 Ct Neck Spine W/O Dye $2,725 $1,771 $2,116 $891 72125 350 Ct Neck Spine W/O Dye $2,725 $1,771 $2,116 $891 72125 350 Ct Neck Spine W/O Dye $2,725 $1,771 $2,116 $891 72126 350 Ct Neck Spine W/Dye $3,259 $2,118 $2,530 $1,066 $940 72126 350 Ct Neck Spine W/Dye $3,259 $2,118 $2,530 $1,066 $940 72126 350 Ct Neck Spine W/Dye $3,259 $2,118 $2,530 $1,066 $940 72127 Ct Neck Spine W/O & W/Dye 72127 Ct Neck Spine W/O & W/Dye 72127 Ct Neck Spine W/O & W/Dye 72128 350 Ct Chest Spine W/O Dye $2,725 $1,771 $2,116 $891 72128 350 Ct Chest Spine W/O Dye $2,725 $1,771 $2,116 $891 72128 350 Ct Chest Spine W/O Dye $2,725 $1,771 $2,116 $891 72129 350 Ct Chest Spine W/Dye $3,259 $2,118 $2,530 $1,066 $0 72129 350 Ct Chest Spine W/Dye $3,259 $2,118 $2,530 $1,066 $0 72129 350 Ct Chest Spine W/Dye $3,259 $2,118 $2,530 $1,066 $0 72130 350 Ct Chest Spine W/O & W/Dye $4,370 $2,841 $3,393 $1,432 72130 350 Ct Chest Spine W/O & W/Dye $4,370 $2,841 $3,393 $1,432 72130 350 Ct Chest Spine W/O & W/Dye $4,370 $2,841 $3,393 $1,432 72131 350 Ct Lumbar Spine W/O Dye $2,725 $1,771 $2,116 $891 72131 350 Ct Lumbar Spine W/O Dye $2,725 $1,771 $2,116 $891 72131 350 Ct Lumbar Spine W/O Dye $2,725 $1,771 $2,116 $891 72132 350 Ct Lumbar Spine W/Dye $3,259 $2,118 $2,530 $1,066 $40 72132 350 Ct Lumbar Spine W/Dye $3,259 $2,118 $2,530 $1,066 $40 72132 350 Ct Lumbar Spine W/Dye $3,259 $2,118 $2,530 $1,066 $40 72133 350 Ct Lumbar Spine W/O & W/Dye $4,370 $2,841 $3,393 $1,432 72133 350 Ct Lumbar Spine W/O & W/Dye $4,370 $2,841 $3,393 $1,432 72133 350 Ct Lumbar Spine W/O & W/Dye $4,370 $2,841 $3,393 $1,432 72141 612 Mri Neck Spine W/O Dye $3,694 $2,401 $2,868 $1,208 $320 72141 612 Mri Neck Spine W/O Dye $3,694 $2,401 $2,868 $1,208 $320 72141 612 Mri Neck Spine W/O Dye $3,694 $2,401 $2,868 $1,208 $320 72142 612 Mri Neck Spine W/Dye $4,086 $2,656 $3,172 $1,337 72142 612 Mri Neck Spine W/Dye $4,086 $2,656 $3,172 $1,337 72142 612 Mri Neck Spine W/Dye $4,086 $2,656 $3,172 $1,337 72146 612 Mri Chest Spine W/O Dye $3,758 $2,443 $2,918 $1,229 $286 72146 612 Mri Chest Spine W/O Dye $3,758 $2,443 $2,918 $1,229 $286 72146 612 Mri Chest Spine W/O Dye $3,758 $2,443 $2,918 $1,229 $286 72147 612 Mri Chest Spine W/Dye $3,367 $2,189 $2,614 $1,101 72147 612 Mri Chest Spine W/Dye $3,367 $2,189 $2,614 $1,101 72147 612 Mri Chest Spine W/Dye $3,367 $2,189 $2,614 $1,101 72148 612 Mri Lumbar Spine W/O Dye $4,001 $2,601 $3,106 $1,309 $266 72148 612 Mri Lumbar Spine W/O Dye $4,001 $2,601 $3,106 $1,309 $266 72148 612 Mri Lumbar Spine W/O Dye $4,001 $2,601 $3,106 $1,309 $266 72149 612 Mri Lumbar Spine W/Dye $4,182 $2,718 $3,247 $1,368 72149 612 Mri Lumbar Spine W/Dye $4,182 $2,718 $3,247 $1,368 72149 612 Mri Lumbar Spine W/Dye $4,182 $2,718 $3,247 $1,368 72156 612 Mri Neck Spine W/O & W/Dye $5,765 $3,747 $4,476 $1,886 $302 72156 612 Mri Neck Spine W/O & W/Dye $5,765 $3,747 $4,476 $1,886 $302 72156 612 Mri Neck Spine W/O & W/Dye $5,765 $3,747 $4,476 $1,886 $302 72157 612 Mri Chest Spine W/O & W/Dye $5,249 $3,412 $4,075 $1,717 $850 72157 612 Mri Chest Spine W/O & W/Dye $5,249 $3,412 $4,075 $1,717 $850 72157 612 Mri Chest Spine W/O & W/Dye $5,249 $3,412 $4,075 $1,717 $850 72158 612 Mri Lumbar Spine W/O & W/Dye $5,335 $3,468 $4,142 $1,745 $363 72158 612 Mri Lumbar Spine W/O & W/Dye $5,335 $3,468 $4,142 $1,745 $363 72158 612 Mri Lumbar Spine W/O & W/Dye $5,335 $3,468 $4,142 $1,745 $363 72159 Mr Angio Spine W/O&W/Dye 72159 Mr Angio Spine W/O&W/Dye 72159 Mr Angio Spine W/O&W/Dye 72170 320 X-Ray Exam Of Pelvis $310 $202 $241 $101 72170 320 X-Ray Exam Of Pelvis $310 $202 $241 $101 72170 320 X-Ray Exam Of Pelvis $310 $202 $241 $101 72190 320 X-Ray Exam Of Pelvis $421 $274 $327 $138 $113 72190 320 X-Ray Exam Of Pelvis $421 $274 $327 $138 $113 72190 320 X-Ray Exam Of Pelvis $421 $274 $327 $138 $113 72191 350 Ct Angiograph Pelv W/O&W/Dye $3,905 $2,538 $3,032 $1,277 72191 350 Ct Angiograph Pelv W/O&W/Dye $3,905 $2,538 $3,032 $1,277 72191 350 Ct Angiograph Pelv W/O&W/Dye $3,905 $2,538 $3,032 $1,277 72192 350 Ct Pelvis W/O Dye $2,725 $1,771 $2,116 $891 $796 72192 350 Ct Pelvis W/O Dye $2,725 $1,771 $2,116 $891 $796 72192 350 Ct Pelvis W/O Dye $2,725 $1,771 $2,116 $891 $796 72193 350 Ct Pelvis W/Dye $3,214 $2,089 $2,495 $1,051 72193 350 Ct Pelvis W/Dye $3,214 $2,089 $2,495 $1,051 72193 350 Ct Pelvis W/Dye $3,214 $2,089 $2,495 $1,051 72194 350 Ct Pelvis W/O & W/Dye $3,905 $2,538 $3,032 $1,277 72194 350 Ct Pelvis W/O & W/Dye $3,905 $2,538 $3,032 $1,277 72194 350 Ct Pelvis W/O & W/Dye $3,905 $2,538 $3,032 $1,277 72195 614 Mri Pelvis W/O Dye $3,123 $2,030 $2,425 $1,022 72195 614 Mri Pelvis W/O Dye $3,123 $2,030 $2,425 $1,022 72195 614 Mri Pelvis W/O Dye $3,123 $2,030 $2,425 $1,022 72196 614 Mri Pelvis W/Dye $3,867 $2,514 $3,002 $1,265 72196 614 Mri Pelvis W/Dye $3,867 $2,514 $3,002 $1,265 72196 614 Mri Pelvis W/Dye $3,867 $2,514 $3,002 $1,265 72197 614 Mri Pelvis W/O & W/Dye $4,835 $3,143 $3,754 $1,582 72197 614 Mri Pelvis W/O & W/Dye $4,835 $3,143 $3,754 $1,582 72197 614 Mri Pelvis W/O & W/Dye $4,835 $3,143 $3,754 $1,582 72198 618 Mr Angio Pelvis W/O & W/Dye $2,462 $1,600 $1,911 $807 72198 618 Mr Angio Pelvis W/O & W/Dye $2,462 $1,600 $1,911 $807 72198 618 Mr Angio Pelvis W/O & W/Dye $2,462 $1,600 $1,911 $807 72200 X-Ray Exam Si Joints 72200 X-Ray Exam Si Joints 72200 X-Ray Exam Si Joints 72202 320 X-Ray Exam Si Joints 3/> Vws $370 $241 $287 $121 72202 320 X-Ray Exam Si Joints 3/> Vws $370 $241 $287 $121 72202 320 X-Ray Exam Si Joints 3/> Vws $370 $241 $287 $121 72220 320 X-Ray Exam Sacrum Tailbone $349 $227 $271 $114 72220 320 X-Ray Exam Sacrum Tailbone $349 $227 $271 $114 72220 320 X-Ray Exam Sacrum Tailbone $349 $227 $271 $114 72240 Myelography Neck Spine 72240 Myelography Neck Spine 72240 Myelography Neck Spine 72255 320 Myelography Thoracic Spine $1,953 $1,269 $1,516 $640 $0 72255 320 Myelography Thoracic Spine $1,953 $1,269 $1,516 $640 $0 72255 320 Myelography Thoracic Spine $1,953 $1,269 $1,516 $640 $0 72265 Myelography L-S Spine 72265 Myelography L-S Spine 72265 Myelography L-S Spine 72270 Myelogphy 2/> Spine Regions 72270 Myelogphy 2/> Spine Regions 72270 Myelogphy 2/> Spine Regions 72275 Epidurography 72275 Epidurography 72275 Epidurography 72285 Discography Cerv/Thor Spine 72285 Discography Cerv/Thor Spine 72285 Discography Cerv/Thor Spine 72295 X-Ray Of Lower Spine Disk 72295 X-Ray Of Lower Spine Disk 72295 X-Ray Of Lower Spine Disk 73000 320 X-Ray Exam Of Collar Bone $622 $404 $483 $203 73000 320 X-Ray Exam Of Collar Bone $622 $404 $483 $203 73000 320 X-Ray Exam Of Collar Bone $622 $404 $483 $203 73010 320 X-Ray Exam Of Shoulder Blade $317 $206 $246 $104 73010 320 X-Ray Exam Of Shoulder Blade $317 $206 $246 $104 73010 320 X-Ray Exam Of Shoulder Blade $317 $206 $246 $104 73020 320 X-Ray Exam Of Shoulder $272 $177 $211 $89 73020 320 X-Ray Exam Of Shoulder $272 $177 $211 $89 73020 320 X-Ray Exam Of Shoulder $272 $177 $211 $89 73030 320 X-Ray Exam Of Shoulder $349 $227 $271 $114 73030 320 X-Ray Exam Of Shoulder $349 $227 $271 $114 73030 320 X-Ray Exam Of Shoulder $349 $227 $271 $114 73040 322 Contrast X-Ray Of Shoulder $1,745 $1,134 $1,355 $572 73040 322 Contrast X-Ray Of Shoulder $1,745 $1,134 $1,355 $572 73040 322 Contrast X-Ray Of Shoulder $1,745 $1,134 $1,355 $572 73050 320 X-Ray Exam Of Shoulders $402 $261 $312 $132 73050 320 X-Ray Exam Of Shoulders $402 $261 $312 $132 73050 320 X-Ray Exam Of Shoulders $402 $261 $312 $132 73060 320 X-Ray Exam Of Humerus $349 $227 $271 $114 73060 320 X-Ray Exam Of Humerus $349 $227 $271 $114 73060 320 X-Ray Exam Of Humerus $349 $227 $271 $114 73070 320 X-Ray Exam Of Elbow $310 $202 $241 $101 73070 320 X-Ray Exam Of Elbow $310 $202 $241 $101 73070 320 X-Ray Exam Of Elbow $310 $202 $241 $101 73080 320 X-Ray Exam Of Elbow $349 $227 $271 $114 73080 320 X-Ray Exam Of Elbow $349 $227 $271 $114 73080 320 X-Ray Exam Of Elbow $349 $227 $271 $114 73085 322 Contrast X-Ray Of Elbow $1,460 $949 $1,133 $478 73085 322 Contrast X-Ray Of Elbow $1,460 $949 $1,133 $478 73085 322 Contrast X-Ray Of Elbow $1,460 $949 $1,133 $478 73090 320 X-Ray Exam Of Forearm $310 $202 $241 $101 73090 320 X-Ray Exam Of Forearm $310 $202 $241 $101 73090 320 X-Ray Exam Of Forearm $310 $202 $241 $101 73092 320 X-Ray Exam Of Arm Infant $292 $190 $227 $96 73092 320 X-Ray Exam Of Arm Infant $292 $190 $227 $96 73092 320 X-Ray Exam Of Arm Infant $292 $190 $227 $96 73100 320 X-Ray Exam Of Wrist $292 $190 $227 $96 73100 320 X-Ray Exam Of Wrist $292 $190 $227 $96 73100 320 X-Ray Exam Of Wrist $292 $190 $227 $96 73110 320 X-Ray Exam Of Wrist $309 $201 $240 $101 73110 320 X-Ray Exam Of Wrist $309 $201 $240 $101 73110 320 X-Ray Exam Of Wrist $309 $201 $240 $101 73115 322 Contrast X-Ray Of Wrist $1,745 $1,134 $1,355 $572 73115 322 Contrast X-Ray Of Wrist $1,745 $1,134 $1,355 $572 73115 322 Contrast X-Ray Of Wrist $1,745 $1,134 $1,355 $572 73120 320 X-Ray Exam Of Hand $292 $190 $227 $96 73120 320 X-Ray Exam Of Hand $292 $190 $227 $96 73120 320 X-Ray Exam Of Hand $292 $190 $227 $96 73130 320 X-Ray Exam Of Hand $309 $201 $240 $101 73130 320 X-Ray Exam Of Hand $309 $201 $240 $101 73130 320 X-Ray Exam Of Hand $309 $201 $240 $101 73140 320 X-Ray Exam Of Finger(S) $252 $164 $196 $82 73140 320 X-Ray Exam Of Finger(S) $252 $164 $196 $82 73140 320 X-Ray Exam Of Finger(S) $252 $164 $196 $82 73200 350 Ct Upper Extremity W/O Dye $2,286 $1,486 $1,775 $748 73200 350 Ct Upper Extremity W/O Dye $2,286 $1,486 $1,775 $748 73200 350 Ct Upper Extremity W/O Dye $2,286 $1,486 $1,775 $748 73201 350 Ct Upper Extremity W/Dye $2,725 $1,771 $2,116 $891 73201 350 Ct Upper Extremity W/Dye $2,725 $1,771 $2,116 $891 73201 350 Ct Upper Extremity W/Dye $2,725 $1,771 $2,116 $891 73202 350 Ct Uppr Extremity W/O&W/Dye $3,713 $2,413 $2,883 $1,215 73202 350 Ct Uppr Extremity W/O&W/Dye $3,713 $2,413 $2,883 $1,215 73202 350 Ct Uppr Extremity W/O&W/Dye $3,713 $2,413 $2,883 $1,215 73206 350 Ct Angio Upr Extrm W/O&W/Dye $3,453 $2,244 $2,681 $1,131 73206 350 Ct Angio Upr Extrm W/O&W/Dye $3,453 $2,244 $2,681 $1,131 73206 350 Ct Angio Upr Extrm W/O&W/Dye $3,453 $2,244 $2,681 $1,131 73218 614 Mri Upper Extremity W/O Dye $1,728 $1,123 $1,342 $565 $229 73218 614 Mri Upper Extremity W/O Dye $1,728 $1,123 $1,342 $565 $229 73218 614 Mri Upper Extremity W/O Dye $1,728 $1,123 $1,342 $565 $229 73219 Mri Upper Extremity W/Dye 73219 Mri Upper Extremity W/Dye 73219 Mri Upper Extremity W/Dye 73220 614 Mri Uppr Extremity W/O&W/Dye $5,453 $3,544 $4,233 $1,784 $375 73220 614 Mri Uppr Extremity W/O&W/Dye $5,453 $3,544 $4,233 $1,784 $375 73220 614 Mri Uppr Extremity W/O&W/Dye $5,453 $3,544 $4,233 $1,784 $375 73221 614 Mri Joint Upr Extrem W/O Dye $1,728 $1,123 $1,342 $565 $324 73221 614 Mri Joint Upr Extrem W/O Dye $1,728 $1,123 $1,342 $565 $324 73221 614 Mri Joint Upr Extrem W/O Dye $1,728 $1,123 $1,342 $565 $324 73222 614 Mri Joint Upr Extrem W/Dye $1,710 $1,111 $1,327 $560 73222 614 Mri Joint Upr Extrem W/Dye $1,710 $1,111 $1,327 $560 73222 614 Mri Joint Upr Extrem W/Dye $1,710 $1,111 $1,327 $560 73223 614 Mri Joint Upr Extr W/O&W/Dye $4,680 $3,042 $3,633 $1,531 73223 614 Mri Joint Upr Extr W/O&W/Dye $4,680 $3,042 $3,633 $1,531 73223 614 Mri Joint Upr Extr W/O&W/Dye $4,680 $3,042 $3,633 $1,531 73225 Mr Angio Upr Extr W/O&W/Dye 73225 Mr Angio Upr Extr W/O&W/Dye 73225 Mr Angio Upr Extr W/O&W/Dye 73501 320 X-Ray Exam Hip Uni 1 View $273 $177 $212 $89 73501 320 X-Ray Exam Hip Uni 1 View $273 $177 $212 $89 73501 320 X-Ray Exam Hip Uni 1 View $273 $177 $212 $89 73502 320 X-Ray Exam Hip Uni 2-3 Views $402 $261 $312 $132 73502 320 X-Ray Exam Hip Uni 2-3 Views $402 $261 $312 $132 73502 320 X-Ray Exam Hip Uni 2-3 Views $402 $261 $312 $132 73503 X-Ray Exam Hip Uni 4/> Views $36 $23 $28 $12 73503 X-Ray Exam Hip Uni 4/> Views $36 $23 $28 $12 73503 X-Ray Exam Hip Uni 4/> Views $36 $23 $28 $12 73521 320 X-Ray Exam Hips Bi 2 Views $604 $393 $469 $198 73521 320 X-Ray Exam Hips Bi 2 Views $604 $393 $469 $198 73521 320 X-Ray Exam Hips Bi 2 Views $604 $393 $469 $198 73522 320 X-Ray Exam Hips Bi 3-4 Views $809 $526 $628 $265 $58 73522 320 X-Ray Exam Hips Bi 3-4 Views $809 $526 $628 $265 $58 73522 320 X-Ray Exam Hips Bi 3-4 Views $809 $526 $628 $265 $58 73523 X-Ray Exam Hips Bi 5/> Views 73523 X-Ray Exam Hips Bi 5/> Views 73523 X-Ray Exam Hips Bi 5/> Views 73525 322 Contrast X-Ray Of Hip $1,624 $1,056 $1,261 $532 73525 322 Contrast X-Ray Of Hip $1,624 $1,056 $1,261 $532 73525 322 Contrast X-Ray Of Hip $1,624 $1,056 $1,261 $532 73551 X-Ray Exam Of Femur 1 73551 X-Ray Exam Of Femur 1 73551 X-Ray Exam Of Femur 1 73552 320 X-Ray Exam Of Femur 2/> $349 $227 $271 $114 73552 320 X-Ray Exam Of Femur 2/> $349 $227 $271 $114 73552 320 X-Ray Exam Of Femur 2/> $349 $227 $271 $114 73560 320 X-Ray Exam Of Knee 1 Or 2 $310 $202 $241 $101 73560 320 X-Ray Exam Of Knee 1 Or 2 $310 $202 $241 $101 73560 320 X-Ray Exam Of Knee 1 Or 2 $310 $202 $241 $101 73562 320 X-Ray Exam Of Knee 3 $330 $215 $256 $108 $93 73562 320 X-Ray Exam Of Knee 3 $330 $215 $256 $108 $93 73562 320 X-Ray Exam Of Knee 3 $330 $215 $256 $108 $93 73564 320 X-Ray Exam Knee 4 Or More $382 $248 $297 $125 73564 320 X-Ray Exam Knee 4 Or More $382 $248 $297 $125 73564 320 X-Ray Exam Knee 4 Or More $382 $248 $297 $125 73565 320 X-Ray Exam Of Knees $825 $536 $640 $270 $98 73565 320 X-Ray Exam Of Knees $825 $536 $640 $270 $98 73565 320 X-Ray Exam Of Knees $825 $536 $640 $270 $98 73580 322 Contrast X-Ray Of Knee Joint $1,305 $848 $1,013 $428 73580 322 Contrast X-Ray Of Knee Joint $1,305 $848 $1,013 $428 73580 322 Contrast X-Ray Of Knee Joint $1,305 $848 $1,013 $428 73590 320 X-Ray Exam Of Lower Leg $310 $202 $241 $101 73590 320 X-Ray Exam Of Lower Leg $310 $202 $241 $101 73590 320 X-Ray Exam Of Lower Leg $310 $202 $241 $101 73592 320 X-Ray Exam Of Leg Infant $292 $190 $227 $96 73592 320 X-Ray Exam Of Leg Infant $292 $190 $227 $96 73592 320 X-Ray Exam Of Leg Infant $292 $190 $227 $96 73600 320 X-Ray Exam Of Ankle $292 $190 $227 $96 73600 320 X-Ray Exam Of Ankle $292 $190 $227 $96 73600 320 X-Ray Exam Of Ankle $292 $190 $227 $96 73610 320 X-Ray Exam Of Ankle $321 $209 $249 $105 73610 320 X-Ray Exam Of Ankle $321 $209 $249 $105 73610 320 X-Ray Exam Of Ankle $321 $209 $249 $105 73615 322 Contrast X-Ray Of Ankle $1,460 $949 $1,133 $478 73615 322 Contrast X-Ray Of Ankle $1,460 $949 $1,133 $478 73615 322 Contrast X-Ray Of Ankle $1,460 $949 $1,133 $478 73620 320 X-Ray Exam Of Foot $292 $190 $227 $96 73620 320 X-Ray Exam Of Foot $292 $190 $227 $96 73620 320 X-Ray Exam Of Foot $292 $190 $227 $96 73630 320 X-Ray Exam Of Foot $309 $201 $240 $101 73630 320 X-Ray Exam Of Foot $309 $201 $240 $101 73630 320 X-Ray Exam Of Foot $309 $201 $240 $101 73650 320 X-Ray Exam Of Heel $288 $187 $224 $94 73650 320 X-Ray Exam Of Heel $288 $187 $224 $94 73650 320 X-Ray Exam Of Heel $288 $187 $224 $94 73660 320 X-Ray Exam Of Toe(S) $252 $164 $196 $82 73660 320 X-Ray Exam Of Toe(S) $252 $164 $196 $82 73660 320 X-Ray Exam Of Toe(S) $252 $164 $196 $82 73700 350 Ct Lower Extremity W/O Dye $2,286 $1,486 $1,775 $748 73700 350 Ct Lower Extremity W/O Dye $2,286 $1,486 $1,775 $748 73700 350 Ct Lower Extremity W/O Dye $2,286 $1,486 $1,775 $748 73701 350 Ct Lower Extremity W/Dye $2,725 $1,771 $2,116 $891 73701 350 Ct Lower Extremity W/Dye $2,725 $1,771 $2,116 $891 73701 350 Ct Lower Extremity W/Dye $2,725 $1,771 $2,116 $891 73702 350 Ct Lwr Extremity W/O&W/Dye $2,434 $1,582 $1,890 $798 73702 350 Ct Lwr Extremity W/O&W/Dye $2,434 $1,582 $1,890 $798 73702 350 Ct Lwr Extremity W/O&W/Dye $2,434 $1,582 $1,890 $798 73706 350 Ct Angio Lwr Extr W/O&W/Dye $3,713 $2,413 $2,883 $1,215 73706 350 Ct Angio Lwr Extr W/O&W/Dye $3,713 $2,413 $2,883 $1,215 73706 350 Ct Angio Lwr Extr W/O&W/Dye $3,713 $2,413 $2,883 $1,215 73718 614 Mri Lower Extremity W/O Dye $3,247 $2,111 $2,521 $1,062 $240 73718 614 Mri Lower Extremity W/O Dye $3,247 $2,111 $2,521 $1,062 $240 73718 614 Mri Lower Extremity W/O Dye $3,247 $2,111 $2,521 $1,062 $240 73719 Mri Lower Extremity W/Dye 73719 Mri Lower Extremity W/Dye 73719 Mri Lower Extremity W/Dye 73720 614 Mri Lwr Extremity W/O&W/Dye $2,644 $1,719 $2,053 $865 $250 73720 614 Mri Lwr Extremity W/O&W/Dye $2,644 $1,719 $2,053 $865 $250 73720 614 Mri Lwr Extremity W/O&W/Dye $2,644 $1,719 $2,053 $865 $250 73721 614 Mri Jnt Of Lwr Extre W/O Dye $3,441 $2,237 $2,671 $1,126 $248 73721 614 Mri Jnt Of Lwr Extre W/O Dye $3,441 $2,237 $2,671 $1,126 $248 73721 614 Mri Jnt Of Lwr Extre W/O Dye $3,441 $2,237 $2,671 $1,126 $248 73722 614 Mri Joint Of Lwr Extr W/Dye 73722 614 Mri Joint Of Lwr Extr W/Dye 73722 614 Mri Joint Of Lwr Extr W/Dye 73723 614 Mri Joint Lwr Extr W/O&W/Dye $4,823 $3,135 $3,744 $1,578 $375 73723 614 Mri Joint Lwr Extr W/O&W/Dye $4,823 $3,135 $3,744 $1,578 $375 73723 614 Mri Joint Lwr Extr W/O&W/Dye $4,823 $3,135 $3,744 $1,578 $375 73725 Mr Ang Lwr Ext W Or W/O Dye 73725 Mr Ang Lwr Ext W Or W/O Dye 73725 Mr Ang Lwr Ext W Or W/O Dye 74018 320 X-Ray Exam Abdomen 1 View $310 $202 $241 $101 74018 320 X-Ray Exam Abdomen 1 View $310 $202 $241 $101 74018 320 X-Ray Exam Abdomen 1 View $310 $202 $241 $101 74019 320 X-Ray Exam Abdomen 2 Views $432 $281 $335 $141 74019 320 X-Ray Exam Abdomen 2 Views $432 $281 $335 $141 74019 320 X-Ray Exam Abdomen 2 Views $432 $281 $335 $141 74021 320 X-Ray Exam Abdomen 3+ Views $349 $227 $271 $114 74021 320 X-Ray Exam Abdomen 3+ Views $349 $227 $271 $114 74021 320 X-Ray Exam Abdomen 3+ Views $349 $227 $271 $114 74022 320 X-Ray Exam Complete Abdomen $595 $387 $462 $195 74022 320 X-Ray Exam Complete Abdomen $595 $387 $462 $195 74022 320 X-Ray Exam Complete Abdomen $595 $387 $462 $195 74150 350 Ct Abdomen W/O Dye $2,608 $1,695 $2,025 $853 74150 350 Ct Abdomen W/O Dye $2,608 $1,695 $2,025 $853 74150 350 Ct Abdomen W/O Dye $2,608 $1,695 $2,025 $853 74160 350 Ct Abdomen W/Dye $3,151 $2,048 $2,446 $1,031 $215 74160 350 Ct Abdomen W/Dye $3,151 $2,048 $2,446 $1,031 $215 74160 350 Ct Abdomen W/Dye $3,151 $2,048 $2,446 $1,031 $215 74170 350 Ct Abdomen W/O & W/Dye $3,984 $2,590 $3,093 $1,303 $349 74170 350 Ct Abdomen W/O & W/Dye $3,984 $2,590 $3,093 $1,303 $349 74170 350 Ct Abdomen W/O & W/Dye $3,984 $2,590 $3,093 $1,303 $349 74174 350 Ct Angio Abd&Pelv W/O&W/Dye $5,895 $3,832 $4,577 $1,928 $823 74174 350 Ct Angio Abd&Pelv W/O&W/Dye $5,895 $3,832 $4,577 $1,928 $823 74174 350 Ct Angio Abd&Pelv W/O&W/Dye $5,895 $3,832 $4,577 $1,928 $823 74175 350 Ct Angio Abdom W/O & W/Dye $3,930 $2,555 $3,051 $1,286 74175 350 Ct Angio Abdom W/O & W/Dye $3,930 $2,555 $3,051 $1,286 74175 350 Ct Angio Abdom W/O & W/Dye $3,930 $2,555 $3,051 $1,286 74176 350 Ct Abd & Pelvis W/O Contrast $3,462 $2,250 $2,688 $1,133 74176 350 Ct Abd & Pelvis W/O Contrast $3,462 $2,250 $2,688 $1,133 74176 350 Ct Abd & Pelvis W/O Contrast $3,462 $2,250 $2,688 $1,133 74177 350 Ct Abd & Pelv W/Contrast $4,265 $2,772 $3,311 $1,395 74177 350 Ct Abd & Pelv W/Contrast $4,265 $2,772 $3,311 $1,395 74177 350 Ct Abd & Pelv W/Contrast $4,265 $2,772 $3,311 $1,395 74178 350 Ct Abd & Pelv 1/> Regns $5,254 $3,415 $4,079 $1,719 $676 74178 350 Ct Abd & Pelv 1/> Regns $5,254 $3,415 $4,079 $1,719 $676 74178 350 Ct Abd & Pelv 1/> Regns $5,254 $3,415 $4,079 $1,719 $676 74181 614 Mri Abdomen W/O Dye $4,047 $2,631 $3,142 $1,324 74181 614 Mri Abdomen W/O Dye $4,047 $2,631 $3,142 $1,324 74181 614 Mri Abdomen W/O Dye $4,047 $2,631 $3,142 $1,324 74182 614 Mri Abdomen W/Dye $3,867 $2,514 $3,002 $1,265 74182 614 Mri Abdomen W/Dye $3,867 $2,514 $3,002 $1,265 74182 614 Mri Abdomen W/Dye $3,867 $2,514 $3,002 $1,265 74183 614 Mri Abdomen W/O & W/Dye $4,528 $2,943 $3,515 $1,481 $66 74183 614 Mri Abdomen W/O & W/Dye $4,528 $2,943 $3,515 $1,481 $66 74183 614 Mri Abdomen W/O & W/Dye $4,528 $2,943 $3,515 $1,481 $66 74185 618 Mri Angio Abdom W Orw/O Dye $2,462 $1,600 $1,911 $807 74185 618 Mri Angio Abdom W Orw/O Dye $2,462 $1,600 $1,911 $807 74185 618 Mri Angio Abdom W Orw/O Dye $2,462 $1,600 $1,911 $807 74190 X-Ray Exam Of Peritoneum 74190 X-Ray Exam Of Peritoneum 74190 X-Ray Exam Of Peritoneum 74210 X-Ray Xm Phrnx&/Crv Esoph C+ 74210 X-Ray Xm Phrnx&/Crv Esoph C+ 74210 X-Ray Xm Phrnx&/Crv Esoph C+ 74220 320 X-Ray Xm Esophagus 1Cntrst $708 $460 $550 $232 $93 74220 320 X-Ray Xm Esophagus 1Cntrst $708 $460 $550 $232 $93 74220 320 X-Ray Xm Esophagus 1Cntrst $708 $460 $550 $232 $93 74221 320 X-Ray Xm Esophagus 2Cntrst $460 $299 $357 $151 74221 320 X-Ray Xm Esophagus 2Cntrst $460 $299 $357 $151 74221 320 X-Ray Xm Esophagus 2Cntrst $460 $299 $357 $151 74230 320 X-Ray Xm Swlng Funcj C+ $877 $570 $681 $287 74230 320 X-Ray Xm Swlng Funcj C+ $877 $570 $681 $287 74230 320 X-Ray Xm Swlng Funcj C+ $877 $570 $681 $287 74235 Remove Esophagus Obstruction 74235 Remove Esophagus Obstruction 74235 Remove Esophagus Obstruction 74240 320 X-Ray Xm Upr Gi Trc 1Cntrst $1,171 $761 $909 $384 74240 320 X-Ray Xm Upr Gi Trc 1Cntrst $1,171 $761 $909 $384 74240 320 X-Ray Xm Upr Gi Trc 1Cntrst $1,171 $761 $909 $384 74246 320 X-Ray Xm Upr Gi Trc 2Cntrst $906 $589 $703 $296 $129 74246 320 X-Ray Xm Upr Gi Trc 2Cntrst $906 $589 $703 $296 $129 74246 320 X-Ray Xm Upr Gi Trc 2Cntrst $906 $589 $703 $296 $129 74248 320 X-Ray Sm Int F-Thru Std $250 $163 $194 $82 74248 320 X-Ray Sm Int F-Thru Std $250 $163 $194 $82 74248 320 X-Ray Sm Int F-Thru Std $250 $163 $194 $82 74250 320 X-Ray Xm Sm Int 1Cntrst Std $774 $503 $601 $253 74250 320 X-Ray Xm Sm Int 1Cntrst Std $774 $503 $601 $253 74250 320 X-Ray Xm Sm Int 1Cntrst Std $774 $503 $601 $253 74251 X-Ray Xm Sm Int 2Cntrst Std 74251 X-Ray Xm Sm Int 2Cntrst Std 74251 X-Ray Xm Sm Int 2Cntrst Std 74261 Ct Colonography Dx 74261 Ct Colonography Dx 74261 Ct Colonography Dx 74262 Ct Colonography Dx W/Dye 74262 Ct Colonography Dx W/Dye 74262 Ct Colonography Dx W/Dye 74263 Ct Colonography Screening 74263 Ct Colonography Screening 74263 Ct Colonography Screening 74270 320 X-Ray Xm Colon 1Cntrst Std $1,021 $664 $793 $334 $308 74270 320 X-Ray Xm Colon 1Cntrst Std $1,021 $664 $793 $334 $308 74270 320 X-Ray Xm Colon 1Cntrst Std $1,021 $664 $793 $334 $308 74280 320 X-Ray Xm Colon 2Cntrst Std $1,341 $872 $1,041 $439 74280 320 X-Ray Xm Colon 2Cntrst Std $1,341 $872 $1,041 $439 74280 320 X-Ray Xm Colon 2Cntrst Std $1,341 $872 $1,041 $439 74283 Ther Nma Rdctj Intus/Obstrcj 74283 Ther Nma Rdctj Intus/Obstrcj 74283 Ther Nma Rdctj Intus/Obstrcj 74290 Contrast X-Ray Gallbladder 74290 Contrast X-Ray Gallbladder 74290 Contrast X-Ray Gallbladder 74300 320 X-Ray Bile Ducts/Pancreas $326 $212 $253 $107 74300 320 X-Ray Bile Ducts/Pancreas $326 $212 $253 $107 74300 320 X-Ray Bile Ducts/Pancreas $326 $212 $253 $107 74301 X-Rays At Surgery Add-On 74301 X-Rays At Surgery Add-On 74301 X-Rays At Surgery Add-On 74328 X-Ray Bile Duct Endoscopy 74328 X-Ray Bile Duct Endoscopy 74328 X-Ray Bile Duct Endoscopy 74329 X-Ray For Pancreas Endoscopy 74329 X-Ray For Pancreas Endoscopy 74329 X-Ray For Pancreas Endoscopy 74330 982 X-Ray Bile/Panc Endoscopy $268 $174 $208 $88 74330 982 X-Ray Bile/Panc Endoscopy $268 $174 $208 $88 74330 982 X-Ray Bile/Panc Endoscopy $268 $174 $208 $88 74340 X-Ray Guide For Gi Tube 74340 X-Ray Guide For Gi Tube 74340 X-Ray Guide For Gi Tube 74355 X-Ray Guide Intestinal Tube 74355 X-Ray Guide Intestinal Tube 74355 X-Ray Guide Intestinal Tube 74360 982 X-Ray Guide Gi Dilation $170 $110 $132 $56 74360 982 X-Ray Guide Gi Dilation $170 $110 $132 $56 74360 982 X-Ray Guide Gi Dilation $170 $110 $132 $56 74363 X-Ray Bile Duct Dilation 74363 X-Ray Bile Duct Dilation 74363 X-Ray Bile Duct Dilation 74400 320 Urography Iv +-Kub Tomog $1,195 $777 $928 $391 74400 320 Urography Iv +-Kub Tomog $1,195 $777 $928 $391 74400 320 Urography Iv +-Kub Tomog $1,195 $777 $928 $391 74410 Urography Nfs Drip&/Bolus 74410 Urography Nfs Drip&/Bolus 74410 Urography Nfs Drip&/Bolus 74415 Urography Nfs Drip&/Bls W/Nf 74415 Urography Nfs Drip&/Bls W/Nf 74415 Urography Nfs Drip&/Bls W/Nf 74420 320 Urography Rtrgr +-Kub $1,196 $777 $929 $392 74420 320 Urography Rtrgr +-Kub $1,196 $777 $929 $392 74420 320 Urography Rtrgr +-Kub $1,196 $777 $929 $392 74425 320 Urography Antegrade Rs&I $889 $578 $690 $291 74425 320 Urography Antegrade Rs&I $889 $578 $690 $291 74425 320 Urography Antegrade Rs&I $889 $578 $690 $291 74430 320 Contrast X-Ray Bladder $926 $602 $719 $303 74430 320 Contrast X-Ray Bladder $926 $602 $719 $303 74430 320 Contrast X-Ray Bladder $926 $602 $719 $303 74440 X-Ray Male Genital Tract 74440 X-Ray Male Genital Tract 74440 X-Ray Male Genital Tract 74445 X-Ray Exam Of Penis 74445 X-Ray Exam Of Penis 74445 X-Ray Exam Of Penis 74450 320 X-Ray Urethra/Bladder $857 $557 $665 $280 74450 320 X-Ray Urethra/Bladder $857 $557 $665 $280 74450 320 X-Ray Urethra/Bladder $857 $557 $665 $280 74455 320 X-Ray Urethra/Bladder $925 $601 $718 $303 74455 320 X-Ray Urethra/Bladder $925 $601 $718 $303 74455 320 X-Ray Urethra/Bladder $925 $601 $718 $303 74470 X-Ray Exam Of Kidney Lesion 74470 X-Ray Exam Of Kidney Lesion 74470 X-Ray Exam Of Kidney Lesion 74485 Dilation Urtr/Urt Rs&I 74485 Dilation Urtr/Urt Rs&I 74485 Dilation Urtr/Urt Rs&I 74710 X-Ray Measurement Of Pelvis 74710 X-Ray Measurement Of Pelvis 74710 X-Ray Measurement Of Pelvis 74712 Mri Fetal Sngl/1St Gestation 74712 Mri Fetal Sngl/1St Gestation 74712 Mri Fetal Sngl/1St Gestation 74713 Mri Fetal Ea Addl Gestation 74713 Mri Fetal Ea Addl Gestation 74713 Mri Fetal Ea Addl Gestation 74740 320 X-Ray Female Genital Tract $762 $495 $592 $249 $115 74740 320 X-Ray Female Genital Tract $762 $495 $592 $249 $115 74740 320 X-Ray Female Genital Tract $762 $495 $592 $249 $115 74742 X-Ray Fallopian Tube 74742 X-Ray Fallopian Tube 74742 X-Ray Fallopian Tube 74775 X-Ray Exam Of Perineum 74775 X-Ray Exam Of Perineum 74775 X-Ray Exam Of Perineum 75557 614 Cardiac Mri For Morph $2,720 $1,768 $2,112 $890 75557 614 Cardiac Mri For Morph $2,720 $1,768 $2,112 $890 75557 614 Cardiac Mri For Morph $2,720 $1,768 $2,112 $890 75559 614 Cardiac Mri W/Stress Img $2,720 $1,768 $2,112 $890 75559 614 Cardiac Mri W/Stress Img $2,720 $1,768 $2,112 $890 75559 614 Cardiac Mri W/Stress Img $2,720 $1,768 $2,112 $890 75561 614 Cardiac Mri For Morph W/Dye $3,867 $2,514 $3,002 $1,265 75561 614 Cardiac Mri For Morph W/Dye $3,867 $2,514 $3,002 $1,265 75561 614 Cardiac Mri For Morph W/Dye $3,867 $2,514 $3,002 $1,265 75563 614 Card Mri W/Stress Img & Dye $5,249 $3,412 $4,075 $1,717 75563 614 Card Mri W/Stress Img & Dye $5,249 $3,412 $4,075 $1,717 75563 614 Card Mri W/Stress Img & Dye $5,249 $3,412 $4,075 $1,717 75565 Card Mri Veloc Flow Mapping 75565 Card Mri Veloc Flow Mapping 75565 Card Mri Veloc Flow Mapping 75571 350 Ct Hrt W/O Dye W/Ca Test $208 $135 $161 $68 75571 350 Ct Hrt W/O Dye W/Ca Test $208 $135 $161 $68 75571 350 Ct Hrt W/O Dye W/Ca Test $208 $135 $161 $68 75572 Ct Hrt W/3D Image 75572 Ct Hrt W/3D Image 75572 Ct Hrt W/3D Image 75573 Ct Hrt W/3D Image Congen 75573 Ct Hrt W/3D Image Congen 75573 Ct Hrt W/3D Image Congen 75574 350 Ct Angio Hrt W/3D Image $2,109 $1,371 $1,637 $691 $91 75574 350 Ct Angio Hrt W/3D Image $2,109 $1,371 $1,637 $691 $91 75574 350 Ct Angio Hrt W/3D Image $2,109 $1,371 $1,637 $691 $91 75600 Contrast Exam Thoracic Aorta 75600 Contrast Exam Thoracic Aorta 75600 Contrast Exam Thoracic Aorta 75605 Contrast Exam Thoracic Aorta 75605 Contrast Exam Thoracic Aorta 75605 Contrast Exam Thoracic Aorta 75625 320 Contrast Exam Abdominl Aorta $2,085 $1,355 $1,619 $683 75625 320 Contrast Exam Abdominl Aorta $2,085 $1,355 $1,619 $683 75625 320 Contrast Exam Abdominl Aorta $2,085 $1,355 $1,619 $683 75630 X-Ray Aorta Leg Arteries 75630 X-Ray Aorta Leg Arteries 75630 X-Ray Aorta Leg Arteries 75635 350 Ct Angio Abdominal Arteries $4,066 $2,643 $3,157 $1,330 $852 75635 350 Ct Angio Abdominal Arteries $4,066 $2,643 $3,157 $1,330 $852 75635 350 Ct Angio Abdominal Arteries $4,066 $2,643 $3,157 $1,330 $852 75705 320 Artery X-Rays Spine $1,658 $1,078 $1,287 $543 75705 320 Artery X-Rays Spine $1,658 $1,078 $1,287 $543 75705 320 Artery X-Rays Spine $1,658 $1,078 $1,287 $543 75710 320 Artery X-Rays Arm/Leg $1,024 $666 $795 $336 75710 320 Artery X-Rays Arm/Leg $1,024 $666 $795 $336 75710 320 Artery X-Rays Arm/Leg $1,024 $666 $795 $336 75716 320 Artery X-Rays Arms/Legs $1,879 $1,221 $1,459 $616 75716 320 Artery X-Rays Arms/Legs $1,879 $1,221 $1,459 $616 75716 320 Artery X-Rays Arms/Legs $1,879 $1,221 $1,459 $616 75726 321 Artery X-Rays Abdomen $2,631 $1,710 $2,043 $862 75726 321 Artery X-Rays Abdomen $2,631 $1,710 $2,043 $862 75726 321 Artery X-Rays Abdomen $2,631 $1,710 $2,043 $862 75731 Artery X-Rays Adrenal Gland 75731 Artery X-Rays Adrenal Gland 75731 Artery X-Rays Adrenal Gland 75733 Artery X-Rays Adrenals 75733 Artery X-Rays Adrenals 75733 Artery X-Rays Adrenals 75736 320 Artery X-Rays Pelvis $4,682 $3,043 $3,635 $1,534 75736 320 Artery X-Rays Pelvis $4,682 $3,043 $3,635 $1,534 75736 320 Artery X-Rays Pelvis $4,682 $3,043 $3,635 $1,534 75741 Artery X-Rays Lung 75741 Artery X-Rays Lung 75741 Artery X-Rays Lung 75743 320 Artery X-Rays Lungs $2,463 $1,601 $1,912 $807 75743 320 Artery X-Rays Lungs $2,463 $1,601 $1,912 $807 75743 320 Artery X-Rays Lungs $2,463 $1,601 $1,912 $807 75746 Artery X-Rays Lung 75746 Artery X-Rays Lung 75746 Artery X-Rays Lung 75756 Artery X-Rays Chest 75756 Artery X-Rays Chest 75756 Artery X-Rays Chest 75774 320 Artery X-Ray Each Vessel $524 $341 $407 $172 75774 320 Artery X-Ray Each Vessel $524 $341 $407 $172 75774 320 Artery X-Ray Each Vessel $524 $341 $407 $172 75801 Lymph Vessel X-Ray Arm/Leg 75801 Lymph Vessel X-Ray Arm/Leg 75801 Lymph Vessel X-Ray Arm/Leg 75803 Lymph Vessel X-Ray Arms/Legs 75803 Lymph Vessel X-Ray Arms/Legs 75803 Lymph Vessel X-Ray Arms/Legs 75805 Lymph Vessel X-Ray Trunk 75805 Lymph Vessel X-Ray Trunk 75805 Lymph Vessel X-Ray Trunk 75807 Lymph Vessel X-Ray Trunk 75807 Lymph Vessel X-Ray Trunk 75807 Lymph Vessel X-Ray Trunk 75809 Nonvascular Shunt X-Ray 75809 Nonvascular Shunt X-Ray 75809 Nonvascular Shunt X-Ray 75810 Vein X-Ray Spleen/Liver 75810 Vein X-Ray Spleen/Liver 75810 Vein X-Ray Spleen/Liver 75820 320 Vein X-Ray Arm/Leg $1,684 $1,095 $1,307 $552 75820 320 Vein X-Ray Arm/Leg $1,684 $1,095 $1,307 $552 75820 320 Vein X-Ray Arm/Leg $1,684 $1,095 $1,307 $552 75822 320 Vein X-Ray Arms/Legs $877 $570 $681 $287 75822 320 Vein X-Ray Arms/Legs $877 $570 $681 $287 75822 320 Vein X-Ray Arms/Legs $877 $570 $681 $287 75825 320 Vein X-Ray Trunk $2,125 $1,381 $1,650 $696 75825 320 Vein X-Ray Trunk $2,125 $1,381 $1,650 $696 75825 320 Vein X-Ray Trunk $2,125 $1,381 $1,650 $696 75827 320 Vein X-Ray Chest $2,219 $1,442 $1,723 $727 $372 75827 320 Vein X-Ray Chest $2,219 $1,442 $1,723 $727 $372 75827 320 Vein X-Ray Chest $2,219 $1,442 $1,723 $727 $372 75831 320 Vein X-Ray Kidney $2,360 $1,534 $1,832 $773 75831 320 Vein X-Ray Kidney $2,360 $1,534 $1,832 $773 75831 320 Vein X-Ray Kidney $2,360 $1,534 $1,832 $773 75833 Vein X-Ray Kidneys 75833 Vein X-Ray Kidneys 75833 Vein X-Ray Kidneys 75840 Vein X-Ray Adrenal Gland 75840 Vein X-Ray Adrenal Gland 75840 Vein X-Ray Adrenal Gland 75842 Vein X-Ray Adrenal Glands 75842 Vein X-Ray Adrenal Glands 75842 Vein X-Ray Adrenal Glands 75860 Vein X-Ray Neck 75860 Vein X-Ray Neck 75860 Vein X-Ray Neck 75870 Vein X-Ray Skull 75870 Vein X-Ray Skull 75870 Vein X-Ray Skull 75872 Vein X-Ray Skull Epidural 75872 Vein X-Ray Skull Epidural 75872 Vein X-Ray Skull Epidural 75880 Vein X-Ray Eye Socket 75880 Vein X-Ray Eye Socket 75880 Vein X-Ray Eye Socket 75885 Vein X-Ray Liver W/Hemodynam 75885 Vein X-Ray Liver W/Hemodynam 75885 Vein X-Ray Liver W/Hemodynam 75887 Vein X-Ray Liver W/O Hemodyn 75887 Vein X-Ray Liver W/O Hemodyn 75887 Vein X-Ray Liver W/O Hemodyn 75889 Vein X-Ray Liver W/Hemodynam 75889 Vein X-Ray Liver W/Hemodynam 75889 Vein X-Ray Liver W/Hemodynam 75891 Vein X-Ray Liver 75891 Vein X-Ray Liver 75891 Vein X-Ray Liver 75893 Venous Sampling By Catheter 75893 Venous Sampling By Catheter 75893 Venous Sampling By Catheter 75894 320 X-Rays Transcath Therapy $1,805 $1,173 $1,401 $591 75894 320 X-Rays Transcath Therapy $1,805 $1,173 $1,401 $591 75894 320 X-Rays Transcath Therapy $1,805 $1,173 $1,401 $591 75898 Follow-Up Angiography 75898 Follow-Up Angiography 75898 Follow-Up Angiography 75901 Remove Cva Device Obstruct 75901 Remove Cva Device Obstruct 75901 Remove Cva Device Obstruct 75902 Remove Cva Lumen Obstruct 75902 Remove Cva Lumen Obstruct 75902 Remove Cva Lumen Obstruct 75956 Xray Endovasc Thor Ao Repr 75956 Xray Endovasc Thor Ao Repr 75956 Xray Endovasc Thor Ao Repr 75957 Xray Endovasc Thor Ao Repr 75957 Xray Endovasc Thor Ao Repr 75957 Xray Endovasc Thor Ao Repr 75958 Xray Place Prox Ext Thor Ao 75958 Xray Place Prox Ext Thor Ao 75958 Xray Place Prox Ext Thor Ao 75959 Xray Place Dist Ext Thor Ao 75959 Xray Place Dist Ext Thor Ao 75959 Xray Place Dist Ext Thor Ao 75970 Vascular Biopsy 75970 Vascular Biopsy 75970 Vascular Biopsy 75984 Xray Control Catheter Change 75984 Xray Control Catheter Change 75984 Xray Control Catheter Change 75989 320 Abscess Drainage Under X-Ray $702 $456 $545 $230 75989 320 Abscess Drainage Under X-Ray $702 $456 $545 $230 75989 320 Abscess Drainage Under X-Ray $702 $456 $545 $230 76000 982 Fluoroscopy <1 Hr Phys/Qhp $258 $168 $200 $85 76000 982 Fluoroscopy <1 Hr Phys/Qhp $258 $168 $200 $85 76000 982 Fluoroscopy <1 Hr Phys/Qhp $258 $168 $200 $85 76010 320 X-Ray Nose To Rectum $87 $57 $68 $28 76010 320 X-Ray Nose To Rectum $87 $57 $68 $28 76010 320 X-Ray Nose To Rectum $87 $57 $68 $28 76080 320 X-Ray Exam Of Fistula $626 $407 $486 $205 76080 320 X-Ray Exam Of Fistula $626 $407 $486 $205 76080 320 X-Ray Exam Of Fistula $626 $407 $486 $205 76098 X-Ray Exam Surgical Specimen $26 $17 $20 $8 76098 X-Ray Exam Surgical Specimen $26 $17 $20 $8 76098 X-Ray Exam Surgical Specimen $26 $17 $20 $8 76100 X-Ray Exam Of Body Section 76100 X-Ray Exam Of Body Section 76100 X-Ray Exam Of Body Section 76101 Complex Body Section X-Ray 76101 Complex Body Section X-Ray 76101 Complex Body Section X-Ray 76102 Complex Body Section X-Rays 76102 Complex Body Section X-Rays 76102 Complex Body Section X-Rays 76120 Cine/Video X-Rays 76120 Cine/Video X-Rays 76120 Cine/Video X-Rays 76125 Cine/Video X-Rays Add-On 76125 Cine/Video X-Rays Add-On 76125 Cine/Video X-Rays Add-On 76140 X-Ray Consultation 76145 Med Physic Dos Eval Rad Exps 76376 402 3D Render W/Intrp Postproces $732 $476 $568 $240 76376 402 3D Render W/Intrp Postproces $732 $476 $568 $240 76376 402 3D Render W/Intrp Postproces $732 $476 $568 $240 76377 510 3D Render W/Intrp Postproces $86 $56 $66 $28 76377 510 3D Render W/Intrp Postproces $86 $56 $66 $28 76377 510 3D Render W/Intrp Postproces $86 $56 $66 $28 76380 350 Cat Scan Follow-Up Study $650 $423 $505 $213 76380 350 Cat Scan Follow-Up Study $650 $423 $505 $213 76380 350 Cat Scan Follow-Up Study $650 $423 $505 $213 76390 Mr Spectroscopy 76390 Mr Spectroscopy 76390 Mr Spectroscopy 76391 Mr Elastography 76391 Mr Elastography 76391 Mr Elastography 76496 320 Fluoroscopic Procedure 76496 320 Fluoroscopic Procedure 76496 320 Fluoroscopic Procedure 76497 Ct Procedure 76497 Ct Procedure 76497 Ct Procedure 76498 Mri Procedure 76498 Mri Procedure 76498 Mri Procedure 76499 320 Radiographic Procedure $577 $375 $448 $189 76499 320 Radiographic Procedure $577 $375 $448 $189 76499 320 Radiographic Procedure $577 $375 $448 $189 76506 402 Echo Exam Of Head $684 $445 $531 $224 $77 76506 402 Echo Exam Of Head $684 $445 $531 $224 $77 76506 402 Echo Exam Of Head $684 $445 $531 $224 $77 76510 Oph Us Dx B-Scan&Quan A-Scan 76510 Oph Us Dx B-Scan&Quan A-Scan 76510 Oph Us Dx B-Scan&Quan A-Scan 76511 Oph Us Dx Quan A-Scan Only 76511 Oph Us Dx Quan A-Scan Only 76511 Oph Us Dx Quan A-Scan Only 76512 Oph Us Dx B-Scan 76512 Oph Us Dx B-Scan 76512 Oph Us Dx B-Scan 76513 Oph Us Dx Ant Sgm Us Uni/Bi 76513 Oph Us Dx Ant Sgm Us Uni/Bi 76513 Oph Us Dx Ant Sgm Us Uni/Bi 76514 Echo Exam Of Eye Thickness 76514 Echo Exam Of Eye Thickness 76514 Echo Exam Of Eye Thickness 76516 Echo Exam Of Eye 76516 Echo Exam Of Eye 76516 Echo Exam Of Eye 76519 Echo Exam Of Eye 76519 Echo Exam Of Eye 76519 Echo Exam Of Eye 76529 Echo Exam Of Eye 76529 Echo Exam Of Eye 76529 Echo Exam Of Eye 76536 402 Us Exam Of Head And Neck $611 $397 $474 $200 $97 76536 402 Us Exam Of Head And Neck $611 $397 $474 $200 $97 76536 402 Us Exam Of Head And Neck $611 $397 $474 $200 $97 76604 402 Us Exam Chest $774 $503 $601 $253 76604 402 Us Exam Chest $774 $503 $601 $253 76604 402 Us Exam Chest $774 $503 $601 $253 76641 402 Ultrasound Breast Complete $778 $506 $604 $255 $218 76641 402 Ultrasound Breast Complete $778 $506 $604 $255 $218 76641 402 Ultrasound Breast Complete $778 $506 $604 $255 $218 76642 402 Ultrasound Breast Limited $778 $506 $604 $255 $160 76642 402 Ultrasound Breast Limited $778 $506 $604 $255 $160 76642 402 Ultrasound Breast Limited $778 $506 $604 $255 $160 76700 402 Us Exam Abdom Complete $1,174 $763 $911 $384 $279 76700 402 Us Exam Abdom Complete $1,174 $763 $911 $384 $279 76700 402 Us Exam Abdom Complete $1,174 $763 $911 $384 $279 76705 402 Echo Exam Of Abdomen $880 $572 $683 $288 76705 402 Echo Exam Of Abdomen $880 $572 $683 $288 76705 402 Echo Exam Of Abdomen $880 $572 $683 $288 76706 402 Us Abdl Aorta Screen Aaa $770 $501 $598 $252 $101 76706 402 Us Abdl Aorta Screen Aaa $770 $501 $598 $252 $101 76706 402 Us Abdl Aorta Screen Aaa $770 $501 $598 $252 $101 76770 402 Us Exam Abdo Back Wall Comp $883 $574 $686 $289 76770 402 Us Exam Abdo Back Wall Comp $883 $574 $686 $289 76770 402 Us Exam Abdo Back Wall Comp $883 $574 $686 $289 76775 402 Us Exam Abdo Back Wall Lim $630 $410 $489 $206 $138 76775 402 Us Exam Abdo Back Wall Lim $630 $410 $489 $206 $138 76775 402 Us Exam Abdo Back Wall Lim $630 $410 $489 $206 $138 76776 402 Us Exam K Transpl W/Doppler $3,333 $2,166 $2,588 $1,092 76776 402 Us Exam K Transpl W/Doppler $3,333 $2,166 $2,588 $1,092 76776 402 Us Exam K Transpl W/Doppler $3,333 $2,166 $2,588 $1,092 76800 402 Us Exam Spinal Canal $171 $111 $133 $56 $44 76800 402 Us Exam Spinal Canal $171 $111 $133 $56 $44 76800 402 Us Exam Spinal Canal $171 $111 $133 $56 $44 76801 402 Ob Us < 14 Wks Single Fetus $856 $556 $665 $280 $185 76801 402 Ob Us < 14 Wks Single Fetus $856 $556 $665 $280 $185 76801 402 Ob Us < 14 Wks Single Fetus $856 $556 $665 $280 $185 76802 402 Ob Us < 14 Wks Addl Fetus $386 $251 $300 $126 $103 76802 402 Ob Us < 14 Wks Addl Fetus $386 $251 $300 $126 $103 76802 402 Ob Us < 14 Wks Addl Fetus $386 $251 $300 $126 $103 76805 402 Ob Us >= 14 Wks Sngl Fetus $856 $556 $665 $280 $132 76805 402 Ob Us >= 14 Wks Sngl Fetus $856 $556 $665 $280 $132 76805 402 Ob Us >= 14 Wks Sngl Fetus $856 $556 $665 $280 $132 76810 402 Ob Us >= 14 Wks Addl Fetus $93 $60 $72 $30 76810 402 Ob Us >= 14 Wks Addl Fetus $93 $60 $72 $30 76810 402 Ob Us >= 14 Wks Addl Fetus $93 $60 $72 $30 76811 402 Ob Us Detailed Sngl Fetus $1,196 $777 $929 $391 $114 76811 402 Ob Us Detailed Sngl Fetus $1,196 $777 $929 $391 $114 76811 402 Ob Us Detailed Sngl Fetus $1,196 $777 $929 $391 $114 76812 402 Ob Us Detailed Addl Fetus $442 $287 $343 $145 76812 402 Ob Us Detailed Addl Fetus $442 $287 $343 $145 76812 402 Ob Us Detailed Addl Fetus $442 $287 $343 $145 76813 402 Ob Us Nuchal Meas 1 Gest $559 $363 $434 $183 76813 402 Ob Us Nuchal Meas 1 Gest $559 $363 $434 $183 76813 402 Ob Us Nuchal Meas 1 Gest $559 $363 $434 $183 76814 402 Ob Us Nuchal Meas Add-On $559 $363 $434 $183 76814 402 Ob Us Nuchal Meas Add-On $559 $363 $434 $183 76814 402 Ob Us Nuchal Meas Add-On $559 $363 $434 $183 76815 402 Ob Us Limited Fetus(S) $533 $346 $414 $175 76815 402 Ob Us Limited Fetus(S) $533 $346 $414 $175 76815 402 Ob Us Limited Fetus(S) $533 $346 $414 $175 76816 402 Ob Us Follow-Up Per Fetus $666 $433 $517 $218 76816 402 Ob Us Follow-Up Per Fetus $666 $433 $517 $218 76816 402 Ob Us Follow-Up Per Fetus $666 $433 $517 $218 76817 402 Transvaginal Us Obstetric $910 $592 $706 $298 76817 402 Transvaginal Us Obstetric $910 $592 $706 $298 76817 402 Transvaginal Us Obstetric $910 $592 $706 $298 76818 402 Fetal Biophys Profile W/Nst $282 $183 $219 $92 76818 402 Fetal Biophys Profile W/Nst $282 $183 $219 $92 76818 402 Fetal Biophys Profile W/Nst $282 $183 $219 $92 76819 402 Fetal Biophys Profil W/O Nst $1,107 $720 $859 $362 76819 402 Fetal Biophys Profil W/O Nst $1,107 $720 $859 $362 76819 402 Fetal Biophys Profil W/O Nst $1,107 $720 $859 $362 76820 402 Umbilical Artery Echo $826 $537 $641 $271 76820 402 Umbilical Artery Echo $826 $537 $641 $271 76820 402 Umbilical Artery Echo $826 $537 $641 $271 76821 402 Middle Cerebral Artery Echo $825 $536 $640 $270 $194 76821 402 Middle Cerebral Artery Echo $825 $536 $640 $270 $194 76821 402 Middle Cerebral Artery Echo $825 $536 $640 $270 $194 76825 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76825 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76825 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76826 402 Echo Exam Of Fetal Heart $334 $217 $259 $109 76826 402 Echo Exam Of Fetal Heart $334 $217 $259 $109 76826 402 Echo Exam Of Fetal Heart $334 $217 $259 $109 76827 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76827 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76827 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76828 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76828 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76828 402 Echo Exam Of Fetal Heart $315 $205 $245 $103 76830 402 Transvaginal Us Non-Ob $684 $445 $531 $224 76830 402 Transvaginal Us Non-Ob $684 $445 $531 $224 76830 402 Transvaginal Us Non-Ob $684 $445 $531 $224 76831 402 Echo Exam Uterus $617 $401 $479 $202 76831 402 Echo Exam Uterus $617 $401 $479 $202 76831 402 Echo Exam Uterus $617 $401 $479 $202 76856 402 Us Exam Pelvic Complete $953 $619 $740 $312 76856 402 Us Exam Pelvic Complete $953 $619 $740 $312 76856 402 Us Exam Pelvic Complete $953 $619 $740 $312 76857 402 Us Exam Pelvic Limited $681 $443 $529 $223 76857 402 Us Exam Pelvic Limited $681 $443 $529 $223 76857 402 Us Exam Pelvic Limited $681 $443 $529 $223 76870 402 Us Exam Scrotum $630 $410 $489 $206 76870 402 Us Exam Scrotum $630 $410 $489 $206 76870 402 Us Exam Scrotum $630 $410 $489 $206 76872 402 Us Transrectal $1,204 $783 $935 $394 76872 402 Us Transrectal $1,204 $783 $935 $394 76872 402 Us Transrectal $1,204 $783 $935 $394 76873 Echograp Trans R Pros Study 76873 Echograp Trans R Pros Study 76873 Echograp Trans R Pros Study 76881 402 Us Compl Joint R-T W/Img $856 $556 $665 $280 76881 402 Us Compl Joint R-T W/Img $856 $556 $665 $280 76881 402 Us Compl Joint R-T W/Img $856 $556 $665 $280 76882 402 Us Lmtd Jt/Nonvasc Xtr Strux $308 $200 $239 $101 76882 402 Us Lmtd Jt/Nonvasc Xtr Strux $308 $200 $239 $101 76882 402 Us Lmtd Jt/Nonvasc Xtr Strux $308 $200 $239 $101 76885 402 Us Exam Infant Hips Dynamic $655 $426 $509 $215 $50 76885 402 Us Exam Infant Hips Dynamic $655 $426 $509 $215 $50 76885 402 Us Exam Infant Hips Dynamic $655 $426 $509 $215 $50 76886 402 Us Exam Infant Hips Static $395 $257 $307 $129 $73 76886 402 Us Exam Infant Hips Static $395 $257 $307 $129 $73 76886 402 Us Exam Infant Hips Static $395 $257 $307 $129 $73 76932 Echo Guide For Heart Biopsy 76932 Echo Guide For Heart Biopsy 76932 Echo Guide For Heart Biopsy 76936 402 Echo Guide For Artery Repair $1,498 $974 $1,163 $491 76936 402 Echo Guide For Artery Repair $1,498 $974 $1,163 $491 76936 402 Echo Guide For Artery Repair $1,498 $974 $1,163 $491 76937 320 Us Guide Vascular Access $318 $207 $247 $104 76937 320 Us Guide Vascular Access $318 $207 $247 $104 76937 320 Us Guide Vascular Access $318 $207 $247 $104 76940 Us Guide Tissue Ablation 76940 Us Guide Tissue Ablation 76940 Us Guide Tissue Ablation 76941 Echo Guide For Transfusion 76941 Echo Guide For Transfusion 76941 Echo Guide For Transfusion 76942 402 Echo Guide For Biopsy $917 $596 $712 $300 76942 402 Echo Guide For Biopsy $917 $596 $712 $300 76942 402 Echo Guide For Biopsy $917 $596 $712 $300 76945 Echo Guide Villus Sampling 76945 Echo Guide Villus Sampling 76945 Echo Guide Villus Sampling 76946 402 Echo Guide For Amniocentesis $486 $316 $377 $159 76946 402 Echo Guide For Amniocentesis $486 $316 $377 $159 76946 402 Echo Guide For Amniocentesis $486 $316 $377 $159 76948 Echo Guide Ova Aspiration 76948 Echo Guide Ova Aspiration 76948 Echo Guide Ova Aspiration 76965 Echo Guidance Radiotherapy 76965 Echo Guidance Radiotherapy 76965 Echo Guidance Radiotherapy 76970 Ultrasound Exam Follow-Up 76975 Gi Endoscopic Ultrasound 76975 Gi Endoscopic Ultrasound 76975 Gi Endoscopic Ultrasound 76977 Us Bone Density Measure 76977 Us Bone Density Measure 76977 Us Bone Density Measure 76978 Us Trgt Dyn Mbubb 1St Les 76978 Us Trgt Dyn Mbubb 1St Les 76978 Us Trgt Dyn Mbubb 1St Les 76979 Us Trgt Dyn Mbubb Ea Addl 76979 Us Trgt Dyn Mbubb Ea Addl 76979 Us Trgt Dyn Mbubb Ea Addl 76981 Use Parenchyma 76981 Use Parenchyma 76981 Use Parenchyma 76982 Use 1St Target Lesion 76982 Use 1St Target Lesion 76982 Use 1St Target Lesion 76983 Use Ea Addl Target Lesion 76983 Use Ea Addl Target Lesion 76983 Use Ea Addl Target Lesion 76998 Us Guide Intraop 76998 Us Guide Intraop 76998 Us Guide Intraop 76999 402 Echo Examination Procedure $530 $345 $411 $173 76999 402 Echo Examination Procedure $530 $345 $411 $173 76999 402 Echo Examination Procedure $530 $345 $411 $173 77001 320 Fluoroguide For Vein Device $1,552 $1,009 $1,205 $509 77001 320 Fluoroguide For Vein Device $1,552 $1,009 $1,205 $509 77001 320 Fluoroguide For Vein Device $1,552 $1,009 $1,205 $509 77002 320 Needle Localization By Xray $395 $257 $307 $129 77002 320 Needle Localization By Xray $395 $257 $307 $129 77002 320 Needle Localization By Xray $395 $257 $307 $129 77003 320 Fluoroguide For Spine Inject $535 $348 $415 $175 77003 320 Fluoroguide For Spine Inject $535 $348 $415 $175 77003 320 Fluoroguide For Spine Inject $535 $348 $415 $175 77011 352 Ct Scan For Localization 77011 352 Ct Scan For Localization 77011 352 Ct Scan For Localization 77012 350 Ct Scan For Needle Biopsy $1,804 $1,173 $1,401 $591 77012 350 Ct Scan For Needle Biopsy $1,804 $1,173 $1,401 $591 77012 350 Ct Scan For Needle Biopsy $1,804 $1,173 $1,401 $591 77013 Ct Guide For Tissue Ablation 77013 Ct Guide For Tissue Ablation 77013 Ct Guide For Tissue Ablation 77014 Ct Scan For Therapy Guide $137 $89 $107 $45 77014 Ct Scan For Therapy Guide $137 $89 $107 $45 77014 Ct Scan For Therapy Guide $137 $89 $107 $45 77021 Mri Guidance Ndl Plmt Rs&I 77021 Mri Guidance Ndl Plmt Rs&I 77021 Mri Guidance Ndl Plmt Rs&I 77022 Mri Gdn Parnchyma Tiss Abltj 77022 Mri Gdn Parnchyma Tiss Abltj 77022 Mri Gdn Parnchyma Tiss Abltj 77046 Mri Breast C- Unilateral 77046 Mri Breast C- Unilateral 77046 Mri Breast C- Unilateral 77047 Mri Breast C- Bilateral 77047 Mri Breast C- Bilateral 77047 Mri Breast C- Bilateral 77048 614 Mri Breast C-+ W/Cad Uni $3,227 $2,098 $2,505 $1,057 77048 614 Mri Breast C-+ W/Cad Uni $3,227 $2,098 $2,505 $1,057 77048 614 Mri Breast C-+ W/Cad Uni $3,227 $2,098 $2,505 $1,057 77049 614 Mri Breast C-+ W/Cad Bi $3,422 $2,224 $2,657 $1,121 $218 77049 614 Mri Breast C-+ W/Cad Bi $3,422 $2,224 $2,657 $1,121 $218 77049 614 Mri Breast C-+ W/Cad Bi $3,422 $2,224 $2,657 $1,121 $218 77053 X-Ray Of Mammary Duct 77053 X-Ray Of Mammary Duct 77053 X-Ray Of Mammary Duct 77054 X-Ray Of Mammary Ducts 77054 X-Ray Of Mammary Ducts 77054 X-Ray Of Mammary Ducts 77061 Breast Tomosynthesis Uni 77061 Breast Tomosynthesis Uni 77061 Breast Tomosynthesis Uni 77062 Breast Tomosynthesis Bi 77062 Breast Tomosynthesis Bi 77062 Breast Tomosynthesis Bi 77063 403 Breast Tomosynthesis Bi $92 $60 $71 $32 77063 403 Breast Tomosynthesis Bi $92 $60 $71 $30 77063 403 Breast Tomosynthesis Bi $92 $60 $71 $29 77065 401 Dx Mammo Incl Cad Uni $655 $426 $509 $203 77065 401 Dx Mammo Incl Cad Uni $655 $426 $509 $194 77065 401 Dx Mammo Incl Cad Uni $655 $426 $509 $199 77066 401 Dx Mammo Incl Cad Bi $605 $393 $470 $193 77066 401 Dx Mammo Incl Cad Bi $605 $393 $470 $180 77066 401 Dx Mammo Incl Cad Bi $605 $393 $470 $187 77067 403 Scr Mammo Bi Incl Cad $524 $341 $407 $166 $115 77067 403 Scr Mammo Bi Incl Cad $524 $341 $407 $156 $115 77067 403 Scr Mammo Bi Incl Cad $524 $341 $407 $162 $115 77071 X-Ray Stress View $128 $83 $99 $42 $34 77072 320 X-Rays For Bone Age $310 $202 $241 $101 77072 320 X-Rays For Bone Age $310 $202 $241 $101 77072 320 X-Rays For Bone Age $310 $202 $241 $101 77073 320 X-Rays Bone Length Studies $134 $87 $104 $44 77073 320 X-Rays Bone Length Studies $134 $87 $104 $44 77073 320 X-Rays Bone Length Studies $134 $87 $104 $44 77074 X-Rays Bone Survey Limited 77074 X-Rays Bone Survey Limited 77074 X-Rays Bone Survey Limited 77075 320 X-Rays Bone Survey Complete $281 $183 $218 $92 77075 320 X-Rays Bone Survey Complete $281 $183 $218 $92 77075 320 X-Rays Bone Survey Complete $281 $183 $218 $92 77076 320 X-Rays Bone Survey Infant $585 $380 $454 $192 77076 320 X-Rays Bone Survey Infant $585 $380 $454 $192 77076 320 X-Rays Bone Survey Infant $585 $380 $454 $192 77077 Joint Survey Single View 77077 Joint Survey Single View 77077 Joint Survey Single View 77078 Ct Bone Density Axial 77078 Ct Bone Density Axial 77078 Ct Bone Density Axial 77080 320 Dxa Bone Density Axial $1,076 $699 $835 $352 $105 77080 320 Dxa Bone Density Axial $1,076 $699 $835 $352 $105 77080 320 Dxa Bone Density Axial $1,076 $699 $835 $352 $105 77081 320 Dxa Bone Density/Peripheral $1,023 $665 $794 $335 77081 320 Dxa Bone Density/Peripheral $1,023 $665 $794 $335 77081 320 Dxa Bone Density/Peripheral $1,023 $665 $794 $335 77084 614 Magnetic Image Bone Marrow $2,720 $1,768 $2,112 $890 77084 614 Magnetic Image Bone Marrow $2,720 $1,768 $2,112 $890 77084 614 Magnetic Image Bone Marrow $2,720 $1,768 $2,112 $890 77085 Dxa Bone Density Study 77085 Dxa Bone Density Study 77085 Dxa Bone Density Study 77086 Fracture Assessment Via Dxa 77086 Fracture Assessment Via Dxa 77086 Fracture Assessment Via Dxa 77261 Radiation Therapy Planning 77262 Radiation Therapy Planning 77263 Radiation Therapy Planning $515 $335 $400 $169 77280 333 Set Radiation Therapy Field $843 $548 $654 $276 $262 77280 333 Set Radiation Therapy Field $843 $548 $654 $276 $262 77280 333 Set Radiation Therapy Field $843 $548 $654 $276 $262 77285 Set Radiation Therapy Field 77285 Set Radiation Therapy Field 77285 Set Radiation Therapy Field 77290 333 Set Radiation Therapy Field $1,989 $1,293 $1,544 $652 $381 77290 333 Set Radiation Therapy Field $1,989 $1,293 $1,544 $652 $381 77290 333 Set Radiation Therapy Field $1,989 $1,293 $1,544 $652 $381 77293 333 Respirator Motion Mgmt Simul $1,532 $996 $1,189 $502 77293 333 Respirator Motion Mgmt Simul $1,532 $996 $1,189 $502 77293 333 Respirator Motion Mgmt Simul $1,532 $996 $1,189 $502 77295 333 3-D Radiotherapy Plan $4,947 $3,216 $3,841 $1,621 77295 333 3-D Radiotherapy Plan $4,947 $3,216 $3,841 $1,621 77295 333 3-D Radiotherapy Plan $4,947 $3,216 $3,841 $1,621 77299 Radiation Therapy Planning 77299 Radiation Therapy Planning 77299 Radiation Therapy Planning 77300 333 Radiation Therapy Dose Plan $569 $370 $442 $186 77300 333 Radiation Therapy Dose Plan $569 $370 $442 $186 77300 333 Radiation Therapy Dose Plan $569 $370 $442 $186 77301 333 Radiotherapy Dose Plan Imrt $3,804 $2,473 $2,953 $1,246 $856 77301 333 Radiotherapy Dose Plan Imrt $3,804 $2,473 $2,953 $1,246 $856 77301 333 Radiotherapy Dose Plan Imrt $3,804 $2,473 $2,953 $1,246 $856 77306 Telethx Isodose Plan Simple 77306 Telethx Isodose Plan Simple 77306 Telethx Isodose Plan Simple 77307 333 Telethx Isodose Plan Cplx $856 $556 $665 $280 77307 333 Telethx Isodose Plan Cplx $856 $556 $665 $280 77307 333 Telethx Isodose Plan Cplx $856 $556 $665 $280 77316 Brachytx Isodose Plan Simple 77316 Brachytx Isodose Plan Simple 77316 Brachytx Isodose Plan Simple 77317 Brachytx Isodose Intermed 77317 Brachytx Isodose Intermed 77317 Brachytx Isodose Intermed 77318 Brachytx Isodose Complex 77318 Brachytx Isodose Complex 77318 Brachytx Isodose Complex 77321 Special Teletx Port Plan 77321 Special Teletx Port Plan 77321 Special Teletx Port Plan 77331 Special Radiation Dosimetry 77331 Special Radiation Dosimetry 77331 Special Radiation Dosimetry 77332 333 Radiation Treatment Aid(S) $544 $354 $422 $178 77332 333 Radiation Treatment Aid(S) $544 $354 $422 $178 77332 333 Radiation Treatment Aid(S) $544 $354 $422 $178 77333 333 Radiation Treatment Aid(S) $617 $401 $479 $202 77333 333 Radiation Treatment Aid(S) $617 $401 $479 $202 77333 333 Radiation Treatment Aid(S) $617 $401 $479 $202 77334 333 Radiation Treatment Aid(S) $1,135 $738 $881 $372 $304 77334 333 Radiation Treatment Aid(S) $1,135 $738 $881 $372 $304 77334 333 Radiation Treatment Aid(S) $1,135 $738 $881 $372 $304 77336 333 Radiation Physics Consult $857 $557 $665 $281 77338 333 Design Mlc Device For Imrt $1,274 $828 $989 $417 77338 333 Design Mlc Device For Imrt $1,274 $828 $989 $417 77338 333 Design Mlc Device For Imrt $1,274 $828 $989 $417 77370 Radiation Physics Consult 77371 Srs Multisource 77372 333 Srs Linear Based $25,445 $16,539 $19,754 $8,337 77373 333 Sbrt Delivery $18,178 $11,816 $14,112 $5,956 77385 Ntsty Modul Rad Tx Dlvr Smpl 77386 333 Ntsty Modul Rad Tx Dlvr Cplx $2,159 $1,403 $1,676 $707 $300 77387 333 Guidance For Radj Tx Dlvr $508 $330 $394 $166 77399 External Radiation Dosimetry 77399 External Radiation Dosimetry 77399 External Radiation Dosimetry 77401 Radiation Treatment Delivery 77402 333 Radiation Treatment Delivery $374 $243 $290 $123 77407 Radiation Treatment Delivery 77412 333 Radiation Treatment Delivery $745 $484 $578 $244 77417 333 Radiology Port Images(S) $259 $168 $201 $85 $73 77423 Neutron Beam Tx Complex 77424 Io Rad Tx Delivery By X-Ray 77425 Io Rad Tx Deliver By Elctrns 77427 Radiation Tx Management X5 $574 $373 $445 $188 77431 Radiation Therapy Management 77432 Stereotactic Radiation Trmt 77435 Sbrt Management 77469 Io Radiation Tx Management 77470 333 Special Radiation Treatment $1,527 $993 $1,185 $500 77470 333 Special Radiation Treatment $1,527 $993 $1,185 $500 77470 333 Special Radiation Treatment $1,527 $993 $1,185 $500 77499 Radiation Therapy Management 77499 Radiation Therapy Management 77499 Radiation Therapy Management 77520 Proton Trmt Simple W/O Comp 77522 Proton Trmt Simple W/Comp 77523 Proton Trmt Intermediate 77525 Proton Treatment Complex 77600 Hyperthermia Treatment 77600 Hyperthermia Treatment 77600 Hyperthermia Treatment 77605 Hyperthermia Treatment 77605 Hyperthermia Treatment 77605 Hyperthermia Treatment 77610 Hyperthermia Treatment 77610 Hyperthermia Treatment 77610 Hyperthermia Treatment 77615 Hyperthermia Treatment 77615 Hyperthermia Treatment 77615 Hyperthermia Treatment 77620 Hyperthermia Treatment 77620 Hyperthermia Treatment 77620 Hyperthermia Treatment 77750 Infuse Radioactive Materials 77750 Infuse Radioactive Materials 77750 Infuse Radioactive Materials 77761 Apply Intrcav Radiat Simple 77761 Apply Intrcav Radiat Simple 77761 Apply Intrcav Radiat Simple 77762 Apply Intrcav Radiat Interm 77762 Apply Intrcav Radiat Interm 77762 Apply Intrcav Radiat Interm 77763 Apply Intrcav Radiat Compl 77763 Apply Intrcav Radiat Compl 77763 Apply Intrcav Radiat Compl 77767 Hdr Rdncl Skn Surf Brachytx 77767 Hdr Rdncl Skn Surf Brachytx 77767 Hdr Rdncl Skn Surf Brachytx 77768 Hdr Rdncl Skn Surf Brachytx 77768 Hdr Rdncl Skn Surf Brachytx 77768 Hdr Rdncl Skn Surf Brachytx 77770 Hdr Rdncl Ntrstl/Icav Brchtx 77770 Hdr Rdncl Ntrstl/Icav Brchtx 77770 Hdr Rdncl Ntrstl/Icav Brchtx 77771 Hdr Rdncl Ntrstl/Icav Brchtx 77771 Hdr Rdncl Ntrstl/Icav Brchtx 77771 Hdr Rdncl Ntrstl/Icav Brchtx 77772 Hdr Rdncl Ntrstl/Icav Brchtx 77772 Hdr Rdncl Ntrstl/Icav Brchtx 77772 Hdr Rdncl Ntrstl/Icav Brchtx 77778 Apply Interstit Radiat Compl 77778 Apply Interstit Radiat Compl 77778 Apply Interstit Radiat Compl 77789 Apply Surf Ldr Radionuclide 77789 Apply Surf Ldr Radionuclide 77789 Apply Surf Ldr Radionuclide 77790 Radiation Handling 77799 Radium/Radioisotope Therapy 77799 Radium/Radioisotope Therapy 77799 Radium/Radioisotope Therapy 78012 Thyroid Uptake Measurement 78012 Thyroid Uptake Measurement 78012 Thyroid Uptake Measurement 78013 340 Thyroid Imaging W/Blood Flow $1,754 $1,140 $1,362 $575 78013 340 Thyroid Imaging W/Blood Flow $1,754 $1,140 $1,362 $575 78013 340 Thyroid Imaging W/Blood Flow $1,754 $1,140 $1,362 $575 78014 340 Thyroid Imaging W/Blood Flow $1,208 $785 $938 $396 $162 78014 340 Thyroid Imaging W/Blood Flow $1,208 $785 $938 $396 $162 78014 340 Thyroid Imaging W/Blood Flow $1,208 $785 $938 $396 $162 78015 Thyroid Met Imaging 78015 Thyroid Met Imaging 78015 Thyroid Met Imaging 78016 Thyroid Met Imaging/Studies 78016 Thyroid Met Imaging/Studies 78016 Thyroid Met Imaging/Studies 78018 340 Thyroid Met Imaging Body $2,595 $1,687 $2,015 $850 78018 340 Thyroid Met Imaging Body $2,595 $1,687 $2,015 $850 78018 340 Thyroid Met Imaging Body $2,595 $1,687 $2,015 $850 78020 340 Thyroid Met Uptake $786 $511 $610 $258 78020 340 Thyroid Met Uptake $786 $511 $610 $258 78020 340 Thyroid Met Uptake $786 $511 $610 $258 78070 341 Parathyroid Planar Imaging $1,196 $777 $929 $392 $251 78070 341 Parathyroid Planar Imaging $1,196 $777 $929 $392 $251 78070 341 Parathyroid Planar Imaging $1,196 $777 $929 $392 $251 78071 340 Parathyrd Planar W/Wo Subtrj $1,779 $1,156 $1,381 $583 78071 340 Parathyrd Planar W/Wo Subtrj $1,779 $1,156 $1,381 $583 78071 340 Parathyrd Planar W/Wo Subtrj $1,779 $1,156 $1,381 $583 78072 340 Parathyrd Planar W/Spect&Ct $1,742 $1,132 $1,352 $571 78072 340 Parathyrd Planar W/Spect&Ct $1,742 $1,132 $1,352 $571 78072 340 Parathyrd Planar W/Spect&Ct $1,742 $1,132 $1,352 $571 78075 Adrenal Cortex & Medulla Img 78075 Adrenal Cortex & Medulla Img 78075 Adrenal Cortex & Medulla Img 78099 Endocrine Nuclear Procedure 78099 Endocrine Nuclear Procedure 78099 Endocrine Nuclear Procedure 78102 Bone Marrow Imaging Ltd 78102 Bone Marrow Imaging Ltd 78102 Bone Marrow Imaging Ltd 78103 Bone Marrow Imaging Mult 78103 Bone Marrow Imaging Mult 78103 Bone Marrow Imaging Mult 78104 Bone Marrow Imaging Body 78104 Bone Marrow Imaging Body 78104 Bone Marrow Imaging Body 78110 Plasma Volume Single 78110 Plasma Volume Single 78110 Plasma Volume Single 78111 Plasma Volume Multiple 78111 Plasma Volume Multiple 78111 Plasma Volume Multiple 78120 Red Cell Mass Single 78120 Red Cell Mass Single 78120 Red Cell Mass Single 78121 Red Cell Mass Multiple 78121 Red Cell Mass Multiple 78121 Red Cell Mass Multiple 78122 Blood Volume 78122 Blood Volume 78122 Blood Volume 78130 Red Cell Survival Study 78130 Red Cell Survival Study 78130 Red Cell Survival Study 78135 Red Cell Survival Kinetics 78140 Red Cell Sequestration 78140 Red Cell Sequestration 78140 Red Cell Sequestration 78185 Spleen Imaging 78185 Spleen Imaging 78185 Spleen Imaging 78191 Platelet Survival 78191 Platelet Survival 78191 Platelet Survival 78195 340 Lymph System Imaging $1,976 $1,284 $1,534 $647 $125 78195 340 Lymph System Imaging $1,976 $1,284 $1,534 $647 $125 78195 340 Lymph System Imaging $1,976 $1,284 $1,534 $647 $125 78199 Blood/Lymph Nuclear Exam 78199 Blood/Lymph Nuclear Exam 78199 Blood/Lymph Nuclear Exam 78201 Liver Imaging 78201 Liver Imaging 78201 Liver Imaging 78202 Liver Imaging With Flow 78202 Liver Imaging With Flow 78202 Liver Imaging With Flow 78215 340 Liver And Spleen Imaging $1,549 $1,007 $1,203 $508 78215 340 Liver And Spleen Imaging $1,549 $1,007 $1,203 $508 78215 340 Liver And Spleen Imaging $1,549 $1,007 $1,203 $508 78216 Liver & Spleen Image/Flow 78216 Liver & Spleen Image/Flow 78216 Liver & Spleen Image/Flow 78226 340 Hepatobiliary System Imaging $2,286 $1,486 $1,775 $749 78226 340 Hepatobiliary System Imaging $2,286 $1,486 $1,775 $749 78226 340 Hepatobiliary System Imaging $2,286 $1,486 $1,775 $749 78227 340 Hepatobil Syst Image W/Drug $2,272 $1,477 $1,764 $744 $708 78227 340 Hepatobil Syst Image W/Drug $2,272 $1,477 $1,764 $744 $708 78227 340 Hepatobil Syst Image W/Drug $2,272 $1,477 $1,764 $744 $708 78230 Salivary Gland Imaging 78230 Salivary Gland Imaging 78230 Salivary Gland Imaging 78231 Serial Salivary Imaging 78231 Serial Salivary Imaging 78231 Serial Salivary Imaging 78232 Salivary Gland Function Exam 78232 Salivary Gland Function Exam 78232 Salivary Gland Function Exam 78258 Esophageal Motility Study 78258 Esophageal Motility Study 78258 Esophageal Motility Study 78261 Gastric Mucosa Imaging 78261 Gastric Mucosa Imaging 78261 Gastric Mucosa Imaging 78262 340 Gastroesophageal Reflux Exam $2,230 $1,450 $1,731 $731 78262 340 Gastroesophageal Reflux Exam $2,230 $1,450 $1,731 $731 78262 340 Gastroesophageal Reflux Exam $2,230 $1,450 $1,731 $731 78264 340 Gastric Emptying Imag Study $2,276 $1,479 $1,767 $746 $197 78264 340 Gastric Emptying Imag Study $2,276 $1,479 $1,767 $746 $197 78264 340 Gastric Emptying Imag Study $2,276 $1,479 $1,767 $746 $197 78265 Gastric Emptying Imag Study 78265 Gastric Emptying Imag Study 78265 Gastric Emptying Imag Study 78266 Gastric Emptying Imag Study 78266 Gastric Emptying Imag Study 78266 Gastric Emptying Imag Study 78267 Breath Tst Attain/Anal C-14 78268 Breath Test Analysis C-14 78278 340 Acute Gi Blood Loss Imaging $1,704 $1,108 $1,323 $558 78278 340 Acute Gi Blood Loss Imaging $1,704 $1,108 $1,323 $558 78278 340 Acute Gi Blood Loss Imaging $1,704 $1,108 $1,323 $558 78282 Gi Protein Loss Exam 78282 Gi Protein Loss Exam 78282 Gi Protein Loss Exam 78290 340 Meckels Divert Exam $1,295 $842 $1,005 $424 78290 340 Meckels Divert Exam $1,295 $842 $1,005 $424 78290 340 Meckels Divert Exam $1,295 $842 $1,005 $424 78291 Leveen/Shunt Patency Exam 78291 Leveen/Shunt Patency Exam 78291 Leveen/Shunt Patency Exam 78299 Gi Nuclear Procedure 78299 Gi Nuclear Procedure 78299 Gi Nuclear Procedure 78300 340 Bone Imaging Limited Area $1,217 $791 $945 $399 78300 340 Bone Imaging Limited Area $1,217 $791 $945 $399 78300 340 Bone Imaging Limited Area $1,217 $791 $945 $399 78305 Bone Imaging Multiple Areas 78305 Bone Imaging Multiple Areas 78305 Bone Imaging Multiple Areas 78306 340 Bone Imaging Whole Body $1,979 $1,286 $1,536 $648 78306 340 Bone Imaging Whole Body $1,979 $1,286 $1,536 $648 78306 340 Bone Imaging Whole Body $1,979 $1,286 $1,536 $648 78315 340 Bone Imaging 3 Phase $2,608 $1,695 $2,025 $855 $338 78315 340 Bone Imaging 3 Phase $2,608 $1,695 $2,025 $855 $338 78315 340 Bone Imaging 3 Phase $2,608 $1,695 $2,025 $855 $338 78350 Bone Mineral Single Photon 78350 Bone Mineral Single Photon 78350 Bone Mineral Single Photon 78351 Bone Mineral Dual Photon 78399 Musculoskeletal Nuclear Exam 78399 Musculoskeletal Nuclear Exam 78399 Musculoskeletal Nuclear Exam 78414 Non-Imaging Heart Function 78414 Non-Imaging Heart Function 78414 Non-Imaging Heart Function 78428 Cardiac Shunt Imaging 78428 Cardiac Shunt Imaging 78428 Cardiac Shunt Imaging 78429 Myocrd Img Pet 1 Std W/Ct 78429 Myocrd Img Pet 1 Std W/Ct 78429 Myocrd Img Pet 1 Std W/Ct 78430 Myocrd Img Pet Rst/Strs W/Ct 78430 Myocrd Img Pet Rst/Strs W/Ct 78430 Myocrd Img Pet Rst/Strs W/Ct 78431 Myocrd Img Pet Rst&Strs Ct 78431 Myocrd Img Pet Rst&Strs Ct 78431 Myocrd Img Pet Rst&Strs Ct 78432 Myocrd Img Pet 2Rtracer 78432 Myocrd Img Pet 2Rtracer 78432 Myocrd Img Pet 2Rtracer 78433 Myocrd Img Pet 2Rtracer Ct 78433 Myocrd Img Pet 2Rtracer Ct 78433 Myocrd Img Pet 2Rtracer Ct 78434 Aqmbf Pet Rest & Rx Stress 78434 Aqmbf Pet Rest & Rx Stress 78434 Aqmbf Pet Rest & Rx Stress 78445 Vascular Flow Imaging 78445 Vascular Flow Imaging 78445 Vascular Flow Imaging 78451 340 Ht Muscle Image Spect Sing $2,833 $1,841 $2,199 $928 78451 340 Ht Muscle Image Spect Sing $2,833 $1,841 $2,199 $928 78451 340 Ht Muscle Image Spect Sing $2,833 $1,841 $2,199 $928 78452 340 Ht Muscle Image Spect Mult $2,155 $1,401 $1,673 $706 $675 78452 340 Ht Muscle Image Spect Mult $2,155 $1,401 $1,673 $706 $675 78452 340 Ht Muscle Image Spect Mult $2,155 $1,401 $1,673 $706 $675 78453 Ht Muscle Image Planar Sing 78453 Ht Muscle Image Planar Sing 78453 Ht Muscle Image Planar Sing 78454 Ht Musc Image Planar Mult 78454 Ht Musc Image Planar Mult 78454 Ht Musc Image Planar Mult 78456 Acute Venous Thrombus Image 78456 Acute Venous Thrombus Image 78456 Acute Venous Thrombus Image 78457 Venous Thrombosis Imaging 78457 Venous Thrombosis Imaging 78457 Venous Thrombosis Imaging 78458 Ven Thrombosis Images Bilat 78458 Ven Thrombosis Images Bilat 78458 Ven Thrombosis Images Bilat 78459 Myocrd Img Pet Single Study 78459 Myocrd Img Pet Single Study 78459 Myocrd Img Pet Single Study 78466 Heart Infarct Image 78466 Heart Infarct Image 78466 Heart Infarct Image 78468 Heart Infarct Image (Ef) 78468 Heart Infarct Image (Ef) 78468 Heart Infarct Image (Ef) 78469 Heart Infarct Image (3D) 78469 Heart Infarct Image (3D) 78469 Heart Infarct Image (3D) 78472 340 Gated Heart Planar Single $3,976 $2,584 $3,087 $1,303 $98 78472 340 Gated Heart Planar Single $3,976 $2,584 $3,087 $1,303 $98 78472 340 Gated Heart Planar Single $3,976 $2,584 $3,087 $1,303 $98 78473 Gated Heart Multiple 78473 Gated Heart Multiple 78473 Gated Heart Multiple 78481 Heart First Pass Single 78481 Heart First Pass Single 78481 Heart First Pass Single 78483 Heart First Pass Multiple 78483 Heart First Pass Multiple 78483 Heart First Pass Multiple 78491 Myocrd Img Pet 1Std Rst/Strs 78491 Myocrd Img Pet 1Std Rst/Strs 78491 Myocrd Img Pet 1Std Rst/Strs 78492 Myocrd Img Pet Mlt Rst&Strs 78492 Myocrd Img Pet Mlt Rst&Strs 78492 Myocrd Img Pet Mlt Rst&Strs 78494 Heart Image Spect 78494 Heart Image Spect 78494 Heart Image Spect 78496 Heart First Pass Add-On 78496 Heart First Pass Add-On 78496 Heart First Pass Add-On 78499 Cardiovascular Nuclear Exam 78499 Cardiovascular Nuclear Exam 78499 Cardiovascular Nuclear Exam 78579 340 Lung Ventilation Imaging $2,382 $1,548 $1,849 $781 78579 340 Lung Ventilation Imaging $2,382 $1,548 $1,849 $781 78579 340 Lung Ventilation Imaging $2,382 $1,548 $1,849 $781 78580 340 Lung Perfusion Imaging $1,733 $1,126 $1,345 $568 78580 340 Lung Perfusion Imaging $1,733 $1,126 $1,345 $568 78580 340 Lung Perfusion Imaging $1,733 $1,126 $1,345 $568 78582 340 Lung Ventilat&Perfus Imaging $4,113 $2,673 $3,193 $1,348 $1,108 78582 340 Lung Ventilat&Perfus Imaging $4,113 $2,673 $3,193 $1,348 $1,108 78582 340 Lung Ventilat&Perfus Imaging $4,113 $2,673 $3,193 $1,348 $1,108 78597 Lung Perfusion Differential 78597 Lung Perfusion Differential 78597 Lung Perfusion Differential 78598 340 Lung Perf&Ventilat Diferentl $4,378 $2,846 $3,399 $1,435 78598 340 Lung Perf&Ventilat Diferentl $4,378 $2,846 $3,399 $1,435 78598 340 Lung Perf&Ventilat Diferentl $4,378 $2,846 $3,399 $1,435 78599 Respiratory Nuclear Exam 78599 Respiratory Nuclear Exam 78599 Respiratory Nuclear Exam 78600 Brain Image < 4 Views 78600 Brain Image < 4 Views 78600 Brain Image < 4 Views 78601 Brain Image W/Flow < 4 Views 78601 Brain Image W/Flow < 4 Views 78601 Brain Image W/Flow < 4 Views 78605 Brain Image 4+ Views 78605 Brain Image 4+ Views 78605 Brain Image 4+ Views 78606 340 Brain Image W/Flow 4 + Views $1,742 $1,132 $1,352 $571 78606 340 Brain Image W/Flow 4 + Views $1,742 $1,132 $1,352 $571 78606 340 Brain Image W/Flow 4 + Views $1,742 $1,132 $1,352 $571 78608 Brain Imaging (Pet) 78608 Brain Imaging (Pet) 78608 Brain Imaging (Pet) 78609 Brain Imaging (Pet) 78609 Brain Imaging (Pet) 78609 Brain Imaging (Pet) 78610 Brain Flow Imaging Only 78610 Brain Flow Imaging Only 78610 Brain Flow Imaging Only 78630 340 Cerebrospinal Fluid Scan $3,342 $2,172 $2,595 $1,095 78630 340 Cerebrospinal Fluid Scan $3,342 $2,172 $2,595 $1,095 78630 340 Cerebrospinal Fluid Scan $3,342 $2,172 $2,595 $1,095 78635 Csf Ventriculography 78635 Csf Ventriculography 78635 Csf Ventriculography 78645 Csf Shunt Evaluation 78645 Csf Shunt Evaluation 78645 Csf Shunt Evaluation 78650 340 Csf Leakage Imaging $3,350 $2,178 $2,601 $1,098 78650 340 Csf Leakage Imaging $3,350 $2,178 $2,601 $1,098 78650 340 Csf Leakage Imaging $3,350 $2,178 $2,601 $1,098 78660 Nuclear Exam Of Tear Flow 78660 Nuclear Exam Of Tear Flow 78660 Nuclear Exam Of Tear Flow 78699 Nervous System Nuclear Exam 78699 Nervous System Nuclear Exam 78699 Nervous System Nuclear Exam 78700 Kidney Imaging Morphol 78700 Kidney Imaging Morphol 78700 Kidney Imaging Morphol 78701 Kidney Imaging With Flow 78701 Kidney Imaging With Flow 78701 Kidney Imaging With Flow 78707 340 K Flow/Funct Image W/O Drug $2,063 $1,341 $1,602 $676 $434 78707 340 K Flow/Funct Image W/O Drug $2,063 $1,341 $1,602 $676 $434 78707 340 K Flow/Funct Image W/O Drug $2,063 $1,341 $1,602 $676 $434 78708 340 K Flow/Funct Image W/Drug $3,020 $1,963 $2,345 $990 $274 78708 340 K Flow/Funct Image W/Drug $3,020 $1,963 $2,345 $990 $274 78708 340 K Flow/Funct Image W/Drug $3,020 $1,963 $2,345 $990 $274 78709 K Flow/Funct Image Multiple 78709 K Flow/Funct Image Multiple 78709 K Flow/Funct Image Multiple 78725 Kidney Function Study 78725 Kidney Function Study 78725 Kidney Function Study 78730 Urinary Bladder Retention 78730 Urinary Bladder Retention 78730 Urinary Bladder Retention 78740 Ureteral Reflux Study 78740 Ureteral Reflux Study 78740 Ureteral Reflux Study 78761 Testicular Imaging W/Flow 78761 Testicular Imaging W/Flow 78761 Testicular Imaging W/Flow 78799 Genitourinary Nuclear Exam 78799 Genitourinary Nuclear Exam 78799 Genitourinary Nuclear Exam 78800 Rp Loclzj Tum 1 Area 1 D Img 78800 Rp Loclzj Tum 1 Area 1 D Img 78800 Rp Loclzj Tum 1 Area 1 D Img 78801 Rp Loclzj Tum 2+Area 1+D Img 78801 Rp Loclzj Tum 2+Area 1+D Img 78801 Rp Loclzj Tum 2+Area 1+D Img 78802 340 Rp Loclzj Tum Whbdy 1 D Img $2,951 $1,918 $2,291 $967 78802 340 Rp Loclzj Tum Whbdy 1 D Img $2,951 $1,918 $2,291 $967 78802 340 Rp Loclzj Tum Whbdy 1 D Img $2,951 $1,918 $2,291 $967 78803 340 Rp Loclzj Tum Spect 1 Area $2,951 $1,918 $2,291 $967 78803 340 Rp Loclzj Tum Spect 1 Area $2,951 $1,918 $2,291 $967 78803 340 Rp Loclzj Tum Spect 1 Area $2,951 $1,918 $2,291 $967 78804 340 Rp Loclzj Tum Whbdy 2+D Img 78804 340 Rp Loclzj Tum Whbdy 2+D Img 78804 340 Rp Loclzj Tum Whbdy 2+D Img 78808 Iv Inj Ra Drug Dx Study 78811 Pet Image Ltd Area 78811 Pet Image Ltd Area 78811 Pet Image Ltd Area 78812 Pet Image Skull-Thigh 78812 Pet Image Skull-Thigh 78812 Pet Image Skull-Thigh 78813 Pet Image Full Body 78813 Pet Image Full Body 78813 Pet Image Full Body 78814 Pet Image W/Ct Lmtd 78814 Pet Image W/Ct Lmtd 78814 Pet Image W/Ct Lmtd 78815 Pet Image W/Ct Skull-Thigh 78815 Pet Image W/Ct Skull-Thigh 78815 Pet Image W/Ct Skull-Thigh 78816 Pet Image W/Ct Full Body 78816 Pet Image W/Ct Full Body 78816 Pet Image W/Ct Full Body 78830 Rp Loclzj Tum Spect W/Ct 1 78830 Rp Loclzj Tum Spect W/Ct 1 78830 Rp Loclzj Tum Spect W/Ct 1 78831 Rp Loclzj Tum Spect 2 Areas 78831 Rp Loclzj Tum Spect 2 Areas 78831 Rp Loclzj Tum Spect 2 Areas 78832 Rp Loclzj Tum Spect W/Ct 2 78832 Rp Loclzj Tum Spect W/Ct 2 78832 Rp Loclzj Tum Spect W/Ct 2 78835 Rp Quan Meas Single Area 78835 Rp Quan Meas Single Area 78835 Rp Quan Meas Single Area 78999 Nuclear Diagnostic Exam 78999 Nuclear Diagnostic Exam 78999 Nuclear Diagnostic Exam 79005 340 Nuclear Rx Oral Admin $193 $125 $150 $63 79005 340 Nuclear Rx Oral Admin $193 $125 $150 $63 79005 340 Nuclear Rx Oral Admin $193 $125 $150 $63 79101 340 Nuclear Rx Iv Admin $347 $226 $269 $114 79101 340 Nuclear Rx Iv Admin $347 $226 $269 $114 79101 340 Nuclear Rx Iv Admin $347 $226 $269 $114 79200 Nuclear Rx Intracav Admin 79200 Nuclear Rx Intracav Admin 79200 Nuclear Rx Intracav Admin 79300 Nuclr Rx Interstit Colloid 79300 Nuclr Rx Interstit Colloid 79300 Nuclr Rx Interstit Colloid 79403 Hematopoietic Nuclear Tx 79403 Hematopoietic Nuclear Tx 79403 Hematopoietic Nuclear Tx 79440 Nuclear Rx Intra-Articular 79440 Nuclear Rx Intra-Articular 79440 Nuclear Rx Intra-Articular 79445 Nuclear Rx Intra-Arterial 79445 Nuclear Rx Intra-Arterial 79445 Nuclear Rx Intra-Arterial 79999 Nuclear Medicine Therapy 79999 Nuclear Medicine Therapy 79999 Nuclear Medicine Therapy 80047 Metabolic Panel Ionized Ca 80047 Metabolic Panel Ionized Ca 80048 301 Metabolic Panel Total Ca $256 $166 $199 $75 80048 301 Metabolic Panel Total Ca $256 $166 $199 $75 80050 General Health Panel 80051 301 Electrolyte Panel $122 $79 $95 $36 80051 301 Electrolyte Panel $122 $79 $95 $36 80053 301 Comprehen Metabolic Panel $423 $275 $328 $124 80053 301 Comprehen Metabolic Panel $423 $275 $328 $124 80055 301 Obstetric Panel $328 $213 $255 $101 80061 301 Lipid Panel $229 $149 $178 $68 80061 301 Lipid Panel $229 $149 $178 $68 80069 301 Renal Function Panel $183 $119 $142 $54 80069 301 Renal Function Panel $183 $119 $142 $54 80074 Acute Hepatitis Panel $276 $179 $214 $85 80076 301 Hepatic Function Panel $213 $138 $165 $63 80081 Obstetric Panel 80143 Drug Assay Acetaminophen 80145 301 Drug Assay Adalimumab $429 $279 $333 $129 80150 301 Assay Of Amikacin $280 $182 $217 $83 80151 Drug Assay Amiodarone 80155 Drug Assay Caffeine 80156 301 Assay Carbamazepine Total $232 $151 $180 $69 80157 301 Assay Carbamazepine Free $63 $41 $49 $20 80158 301 Drug Assay Cyclosporine $131 $85 $102 $40 80159 301 Drug Assay Clozapine $86 $56 $67 $27 $24 80161 Asy Carbamazepin 10,11-Epxid 80162 301 Assay Of Digoxin Total $212 $138 $165 $63 80163 Assay Of Digoxin Free 80164 301 Assay Dipropylacetic Acd Tot $288 $187 $224 $85 80165 301 Dipropylacetic Acid Free $221 $144 $172 $66 80167 Drug Assay Felbamate 80168 301 Assay Of Ethosuximide $93 $60 $72 $29 80169 301 Drug Assay Everolimus $168 $109 $130 $50 80170 301 Assay Of Gentamicin $296 $192 $230 $88 80171 301 Drug Screen Quant Gabapentin $96 $62 $75 $30 80173 301 Assay Of Haloperidol $170 $111 $132 $51 80175 301 Drug Screen Quan Lamotrigine $249 $162 $193 $74 $56 80176 Assay Of Lidocaine 80177 301 Drug Scrn Quan Levetiracetam $309 $201 $240 $91 80178 301 Assay Of Lithium $119 $77 $92 $35 80178 301 Assay Of Lithium $119 $77 $92 $35 80179 Drug Assay Salicylate 80180 301 Drug Scrn Quan Mycophenolate $605 $393 $470 $177 80181 Drug Assay Flecainide 80183 301 Drug Scrn Quant Oxcarbazepin $76 $49 $59 $24 80184 301 Assay Of Phenobarbital $268 $174 $208 $79 80185 301 Assay Of Phenytoin Total $267 $174 $207 $79 80186 301 Assay Of Phenytoin Free $69 $45 $54 $22 $17 80187 301 Drug Assay Posaconazole $156 $101 $121 $48 80188 301 Assay Of Primidone $94 $61 $73 $29 80189 Drug Assay Itraconzaole 80190 Assay Of Procainamide 80192 Assay Of Procainamide 80193 Drug Assay Leflunomide 80194 Assay Of Quinidine 80195 301 Assay Of Sirolimus $249 $162 $193 $74 80197 301 Assay Of Tacrolimus $395 $257 $307 $116 $53 80198 301 Assay Of Theophylline $230 $150 $179 $68 80199 301 Drug Screen Quant Tiagabine $329 $214 $255 $98 80200 301 Assay Of Tobramycin $279 $181 $217 $83 80201 301 Assay Of Topiramate $123 $80 $95 $37 80202 301 Assay Of Vancomycin $279 $181 $217 $82 80203 301 Drug Screen Quant Zonisamide $604 $393 $469 $176 $58 80204 Drug Assay Methotrexate 80210 Drug Assay Rufinamide 80230 301 Drug Assay Infliximab $580 $377 $450 $172 80235 301 Drug Assay Lacosamide $131 $85 $102 $41 $23 80280 301 Drug Assay Vedolizumab $387 $252 $300 $116 80285 301 Drug Assay Voriconazole $113 $73 $88 $36 80299 301 Quantitative Assay Drug $106 $69 $82 $33 80305 301 Drug Test Prsmv Dir Opt Obs $332 $216 $258 $97 80305 301 Drug Test Prsmv Dir Opt Obs $332 $216 $258 $97 80306 301 Drug Test Prsmv Instrmnt $340 $221 $264 $100 80307 301 Drug Test Prsmv Chem Anlyzr $201 $131 $156 $65 80320 301 Drug Screen Quantalcohols $147 $96 $114 $48 80321 301 Alcohols Biomarkers 1Or 2 $50 $33 $39 $16 80322 301 Alcohols Biomarkers 3/More $0 $0 80323 301 Alkaloids Nos $121 $79 $94 $40 80324 301 Drug Screen Amphetamines 1/2 $98 $64 $76 $32 80325 301 Amphetamines 3Or 4 $49 $32 $38 $16 80326 301 Amphetamines 5 Or More $34 $22 $26 $11 80327 301 Anabolic Steroid 1 Or 2 $129 $84 $100 $42 80328 301 Anabolic Steroid 3 Or More $0 $0 80329 301 Analgesics Non-Opioid 1 Or 2 $237 $154 $184 $78 80330 301 Analgesics Non-Opioid 3-5 $0 $0 80331 301 Analgesics Non-Opioid 6/More $9 $6 $7 $3 80332 301 Antidepressants Class 1 Or 2 $104 $68 $81 $34 80333 301 Antidepressants Class 3-5 $55 $36 $43 $18 80334 301 Antidepressants Class 6/More $35 $23 $27 $11 80335 301 Antidepressant Tricyclic 1/2 $200 $130 $155 $66 80336 301 Antidepressant Tricyclic 3-5 $75 $49 $58 $25 80337 301 Tricyclic & Cyclicals 6/More $38 $25 $30 $12 80338 301 Antidepressant Not Specified $48 $31 $37 $16 80339 301 Antiepileptics Nos 1-3 $215 $140 $167 $70 $9 80340 301 Antiepileptics Nos 4-6 $0 $0 80341 301 Antiepileptics Nos 7/More $9 $6 $7 $3 80342 301 Antipsychotics Nos 1-3 $200 $130 $155 $66 80343 301 Antipsychotics Nos 4-6 $119 $77 $92 $39 80344 301 Antipsychotics Nos 7/More $31 $20 $24 $10 80345 301 Drug Screening Barbiturates $51 $33 $40 $17 80346 301 Benzodiazepines1-12 $71 $46 $55 $23 80347 301 Benzodiazepines 13 Or More $0 $0 80348 301 Drug Screening Buprenorphine $143 $93 $111 $47 80349 301 Cannabinoids Natural $160 $104 $124 $52 80350 301 Cannabinoids Synthetic 1-3 $48 $31 $37 $16 80351 301 Cannabinoids Synthetic 4-6 $0 $0 80352 301 Cannabinoid Synthetic 7/More $234 $152 $182 $77 80353 301 Drug Screening Cocaine $65 $42 $50 $21 80354 301 Drug Screening Fentanyl $75 $49 $58 $25 80355 301 Gabapentin Non-Blood $34 $22 $26 $11 80356 301 Heroin Metabolite $85 $55 $66 $28 80357 301 Ketamine And Norketamine $46 $30 $36 $15 80358 301 Drug Screening Methadone $88 $57 $68 $29 80359 301 Methylenedioxyamphetamines $76 $49 $59 $25 80360 301 Methylphenidate $40 $26 $31 $13 80361 301 Opiates 1 Or More $88 $57 $68 $29 80362 301 Opioids & Opiate Analogs 1/2 $105 $68 $82 $34 80363 301 Opioids & Opiate Analogs 3/4 $78 $51 $61 $26 80364 301 Opioid &Opiate Analog 5/More $59 $38 $46 $19 80365 301 Drug Screening Oxycodone $68 $44 $53 $22 80366 301 Drug Screening Pregabalin $32 $21 $25 $10 80367 301 Drug Screening Propoxyphene $113 $73 $88 $37 80368 301 Sedative Hypnotics $39 $25 $30 $13 80369 301 Skeletal Muscle Relaxant 1/2 $50 $33 $39 $16 80370 301 Skel Musc Relaxant 3 Or More $44 $29 $34 $14 80371 301 Stimulants Synthetic $52 $34 $40 $17 80372 301 Drug Screening Tapentadol $47 $31 $36 $15 80373 301 Drug Screening Tramadol $46 $30 $36 $15 80374 301 Stereoisomer Analysis $0 $0 80375 301 Drug/Substance Nos 1-3 $363 $236 $282 $119 80376 301 Drug/Substance Nos 4-6 $0 $0 80377 301 Drug/Substance Nos 7/More $456 $296 $354 $149 $101 80400 Acth Stimulation Panel 80402 Acth Stimulation Panel 80406 Acth Stimulation Panel 80408 Aldosterone Suppression Eval 80410 Calcitonin Stimul Panel 80412 Crh Stimulation Panel 80414 Testosterone Response Panel 80415 Tot Estradiol Response Panel 80416 Renin Stimulation Panel 80417 Renin Stimulation Panel 80418 Pituitary Evaluation Panel 80420 Dexamethasone Panel 80422 Glucagon Tolerance Panel 80424 Glucagon Tolerance Panel 80426 Gonadotropin Hormone Panel 80428 Growth Hormone Panel 80430 Growth Hormone Panel 80432 Insulin Suppression Panel 80434 Insulin Tolerance Panel 80435 Insulin Tolerance Panel 80436 Metyrapone Panel 80438 Trh Stimulation Panel 80439 Trh Stimulation Panel 80500 Lab Pathology Consultation 80502 Lab Pathology Consultation 81000 Urinalysis Nonauto W/Scope $14,250 $9,263 $11,063 $4,120 81001 Urinalysis Auto W/Scope $21 $14 $16 $6 81002 306 Urinalysis Nonauto W/O Scope $18 $12 $14 $6 81003 301 Urinalysis Auto W/O Scope $59 $38 $46 $17 81003 301 Urinalysis Auto W/O Scope $59 $38 $46 $17 81005 Urinalysis 81007 Urine Screen For Bacteria 81007 Urine Screen For Bacteria 81015 307 Microscopic Exam Of Urine $42 $27 $33 $13 81020 Urinalysis Glass Test 81025 307 Urine Pregnancy Test $166 $108 $129 $49 81050 Urinalysis Volume Measure 81099 Urinalysis Test Procedure 81105 Hpa-1 Genotyping 81106 Hpa-2 Genotyping 81107 Hpa-3 Genotyping 81108 Hpa-4 Genotyping 81109 Hpa-5 Genotyping 81110 Hpa-6 Genotyping 81111 Hpa-9 Genotyping 81112 Hpa-15 Genotyping 81120 Idh1 Common Variants 81121 Idh2 Common Variants 81161 Dmd Dup/Delet Analysis 81162 Brca1&2 Gen Full Seq Dup/Del 81163 Brca1&2 Gene Full Seq Alys 81164 Brca1&2 Gen Ful Dup/Del Alys 81165 Brca1 Gene Full Seq Alys 81166 Brca1 Gene Full Dup/Del Alys 81167 Brca2 Gene Full Dup/Del Alys 81168 Ccnd1/Igh Translocation Alys 81170 312 Abl1 Gene $1,517 $986 $1,178 $474 81171 Aff2 Gene Detc Abnor Alleles 81172 Aff2 Gene Charac Alleles 81173 Ar Gene Full Gene Sequence 81174 Ar Gene Known Famil Variant 81175 Asxl1 Full Gene Sequence 81176 Asxl1 Gene Target Seq Alys 81177 Atn1 Gene Detc Abnor Alleles 81178 Atxn1 Gene Detc Abnor Allele 81179 Atxn2 Gene Detc Abnor Allele 81180 Atxn3 Gene Detc Abnor Allele 81181 Atxn7 Gene Detc Abnor Allele 81182 Atxn8Os Gen Detc Abnor Allel 81183 Atxn10 Gene Detc Abnor Allel 81184 Cacna1A Gen Detc Abnor Allel 81185 Cacna1A Gene Full Gene Seq 81186 Cacna1A Gen Known Famil Vrnt 81187 Cnbp Gene Detc Abnor Allele 81188 Cstb Gene Detc Abnor Allele 81189 Cstb Gene Full Gene Sequence 81190 Cstb Gene Known Famil Vrnt 81191 Ntrk1 Translocation Analysis 81192 Ntrk2 Translocation Analysis 81193 Ntrk3 Translocation Analysis 81194 Ntrk Translocation Analysis 81200 301 Aspa Gene $201 $131 $156 $64 81201 Apc Gene Full Sequence 81202 Apc Gene Known Fam Variants 81203 Apc Gene Dup/Delet Variants 81204 Ar Gene Charac Alleles 81205 Bckdhb Gene 81206 312 Bcr/Abl1 Gene Major Bp $434 $282 $337 $145 $18 81207 312 Bcr/Abl1 Gene Minor Bp $592 $385 $460 $188 $18 81208 312 Bcr/Abl1 Gene Other Bp $789 $513 $613 $254 $18 81209 301 Blm Gene $168 $109 $130 $53 81210 312 Braf Gene $921 $599 $715 $287 81212 Brca1&2 185&5385&6174 Vrnt 81215 Brca1 Gene Known Famil Vrnt 81216 Brca2 Gene Full Seq Alys 81217 Brca2 Gene Known Famil Vrnt 81218 Cebpa Gene Full Sequence 81219 312 Calr Gene Com Variants $1,884 $1,225 $1,463 $559 $30 81220 301 Cftr Gene Com Variants $479 $311 $372 $205 81221 Cftr Gene Known Fam Variants 81222 Cftr Gene Dup/Delet Variants 81223 300 Cftr Gene Full Sequence $3,101 $2,016 $2,407 $956 81224 Cftr Gene Intron Poly T 81225 301 Cyp2C19 Gene Com Variants $1,737 $1,129 $1,349 $537 81226 Cyp2D6 Gene Com Variants 81227 312 Cyp2C9 Gene Com Variants $1,500 $975 $1,165 $454 81228 Cytogen Micrarray Copy Nmbr 81229 312 Cytogen M Array Copy No&Snp $3,096 $2,012 $2,404 $1,033 $399 81230 Cyp3A4 Gene Common Variants 81231 Cyp3A5 Gene Common Variants 81232 312 Dpyd Gene Common Variants $1,737 $1,129 $1,349 $523 81233 Btk Gene Common Variants 81234 312 Dmpk Gene Detc Abnor Allele $2,035 $1,323 $1,580 $605 81235 301 Egfr Gene Com Variants $2,826 $1,837 $2,194 $856 81236 Ezh2 Gene Full Gene Sequence 81237 Ezh2 Gene Common Variants 81238 F9 Full Gene Sequence 81239 Dmpk Gene Charac Alleles 81240 301 F2 Gene $386 $251 $300 $119 81241 301 F5 Gene $226 $147 $175 $74 81242 301 Fancc Gene $156 $101 $121 $49 81243 312 Fmr1 Gene Detection $435 $283 $338 $133 81244 312 Fmr1 Gene Charac Alleles $377 $245 $293 $114 81245 312 Flt3 Gene $277 $180 $215 $100 81246 302 Flt3 Gene Analysis $277 $180 $215 $90 81247 G6Pd Gene Alys Cmn Variant 81248 G6Pd Known Familial Variant 81249 G6Pd Full Gene Sequence 81250 G6Pc Gene 81251 301 Gba Gene $201 $131 $156 $64 81252 Gjb2 Gene Full Sequence 81253 Gjb2 Gene Known Fam Variants 81254 Gjb6 Gene Com Variants 81255 301 Hexa Gene $219 $142 $170 $69 81256 312 Hfe Gene $435 $283 $338 $134 81257 Hba1/Hba2 Gene 81258 Hba1/Hba2 Gene Fam Vrnt 81259 301 Hba1/Hba2 Full Gene Sequence $1,737 $1,129 $1,349 $573 81260 301 Ikbkap Gene $167 $109 $130 $53 81261 Igh Gene Rearrange Amp Meth 81262 Igh Gene Rearrang Dir Probe 81263 312 Igh Vari Regional Mutation $1,575 $1,024 $1,223 $490 81264 Igk Rearrangeabn Clonal Pop 81265 Str Markers Specimen Anal 81266 Str Markers Spec Anal Addl 81267 Chimerism Anal No Cell Selec 81268 Chimerism Anal W/Cell Select 81269 301 Hba1/Hba2 Gene Dup/Del Vrnts $1,124 $731 $873 $349 81270 312 Jak2 Gene $437 $284 $339 $137 $24 81271 312 Htt Gene Detc Abnor Alleles $656 $426 $509 $206 81272 312 Kit Gene Targeted Seq Analys $1,392 $905 $1,081 $442 81273 312 Kit Gene Analys D816 Variant $772 $502 $599 $238 81274 Htt Gene Charac Alleles 81275 301 Kras Gene Variants Exon 2 $724 $471 $562 $232 81276 Kras Gene Addl Variants 81277 Cytogenomic Neo Microra Alys 81278 Igh@/Bcl2 Translocation Alys 81279 Jak2 Gene Trgt Sequence Alys 81283 Ifnl3 Gene 81284 Fxn Gene Detc Abnor Alleles 81285 Fxn Gene Charac Alleles 81286 Fxn Gene Full Gene Sequence 81287 307 Mgmt Gene Prmtr Mthyltn Alys $1,217 $791 $945 $367 81288 Mlh1 Gene 81289 Fxn Gene Known Famil Variant 81290 301 Mcoln1 Gene $167 $109 $130 $53 81291 310 Mthfr Gene $445 $289 $345 $136 $125 81292 312 Mlh1 Gene Full Seq $2,483 $1,614 $1,928 $798 81293 Mlh1 Gene Known Variants 81294 Mlh1 Gene Dup/Delete Variant 81295 Msh2 Gene Full Seq 81296 Msh2 Gene Known Variants 81297 Msh2 Gene Dup/Delete Variant 81298 Msh6 Gene Full Seq 81299 Msh6 Gene Known Variants 81300 Msh6 Gene Dup/Delete Variant 81301 312 Microsatellite Instability $667 $434 $518 $234 81302 Mecp2 Gene Full Seq 81303 Mecp2 Gene Known Variant 81304 Mecp2 Gene Dup/Delet Variant 81305 Myd88 Gene P.Leu265Pro Vrnt 81306 Nudt15 Gene Common Variants 81307 Palb2 Gene Full Gene Seq 81308 Palb2 Gene Known Famil Vrnt 81309 Pik3Ca Gene Trgt Seq Alys 81310 Npm1 Gene 81311 Nras Gene Variants Exon 2&3 81312 Pabpn1 Gene Detc Abnor Allel 81313 301 Pca3/Klk3 Antigen $1,367 $889 $1,061 $426 81314 Pdgfra Gene 81315 312 Pml/Raralpha Com Breakpoints $522 $339 $405 $176 81316 Pml/Raralpha 1 Breakpoint 81317 Pms2 Gene Full Seq Analysis 81318 Pms2 Known Familial Variants 81319 Pms2 Gene Dup/Delet Variants 81320 Plcg2 Gene Common Variants 81321 Pten Gene Full Sequence 81322 Pten Gene Known Fam Variant 81323 Pten Gene Dup/Delet Variant 81324 Pmp22 Gene Dup/Delet 81325 Pmp22 Gene Full Sequence 81326 Pmp22 Gene Known Fam Variant 81327 Sept9 Gen Prmtr Mthyltn Alys 81328 Slco1B1 Gene Com Variants 81329 301 Smn1 Gene Dos/Deletion Alys $1,724 $1,121 $1,338 $515 81330 301 Smpd1 Gene Common Variants $200 $130 $155 $63 81331 312 Snrpn/Ube3A Gene $312 $203 $242 $96 81332 Serpina1 Gene 81333 Tgfbi Gene Common Variants 81334 Runx1 Gene Targeted Seq Alys 81335 Tpmt Gene Com Variants 81336 Smn1 Gene Full Gene Sequence 81337 Smn1 Gen Nown Famil Seq Vrnt 81338 Mpl Gene Common Variants 81339 Mpl Gene Seq Alys Exon 10 81340 312 Trb@ Gene Rearrange Amplify $471 $306 $366 $161 81341 Trb@ Gene Rearrange Dirprobe 81342 312 Trg Gene Rearrangement Anal $611 $397 $474 $201 81343 Ppp2R2B Gen Detc Abnor Allel 81344 Tbp Gene Detc Abnor Alleles 81345 Tert Gene Targeted Seq Alys 81346 Tyms Gene Com Variants 81347 Sf3B1 Gene Common Variants 81348 Srsf2 Gene Common Variants 81350 Ugt1A1 Gene Common Variants 81351 Tp53 Gene Full Gene Sequence 81352 Tp53 Gene Trgt Sequence Alys 81353 Tp53 Gene Known Famil Vrnt 81355 Vkorc1 Gene 81357 U2Af1 Gene Common Variants 81360 Zrsr2 Gene Common Variants 81361 Hbb Gene Com Variants 81362 Hbb Gene Known Fam Variant 81363 301 Hbb Gene Dup/Del Variants $1,376 $894 $1,068 $422 81364 301 Hbb Full Gene Sequence $1,835 $1,193 $1,425 $569 $34 81370 Hla I & Ii Typing Lr 81371 Hla I & Ii Type Verify Lr 81372 301 Hla I Typing Complete Lr $1,559 $1,013 $1,210 $499 81373 Hla I Typing 1 Locus Lr 81374 301 Hla I Typing 1 Antigen Lr $315 $205 $245 $100 81375 312 Hla Ii Typing Ag Equiv Lr $1,575 $1,024 $1,223 $482 81376 312 Hla Ii Typing 1 Locus Lr $428 $278 $332 $138 81377 Hla Ii Type 1 Ag Equiv Lr 81378 Hla I & Ii Typing Hr 81379 Hla I Typing Complete Hr 81380 Hla I Typing 1 Locus Hr 81381 301 Hla I Typing 1 Allele Hr $1,044 $679 $811 $322 $0 81382 Hla Ii Typing 1 Loc Hr 81383 Hla Ii Typing 1 Allele Hr 81400 301 Mopath Procedure Level 1 $620 $403 $481 $187 81401 301 Mopath Procedure Level 2 $921 $599 $715 $283 81402 Mopath Procedure Level 3 81403 302 Mopath Procedure Level 4 $829 $539 $644 $262 $30 81404 312 Mopath Procedure Level 5 $2,895 $1,882 $2,248 $870 81405 Mopath Procedure Level 6 81406 Mopath Procedure Level 7 $2,469 $1,605 $1,917 $747 $0 81407 Mopath Procedure Level 8 81408 Mopath Procedure Level 9 81410 Aortic Dysfunction/Dilation 81411 Aortic Dysfunction/Dilation 81412 Ashkenazi Jewish Assoc Dis 81413 Car Ion Chnnlpath Inc 10 Gns 81414 Car Ion Chnnlpath Inc 2 Gns 81415 Exome Sequence Analysis 81416 Exome Sequence Analysis 81417 Exome Re-Evaluation 81419 Epilepsy Gen Seq Alys Panel 81420 Fetal Chrmoml Aneuploidy 81422 Fetal Chrmoml Microdeltj 81425 Genome Sequence Analysis 81426 Genome Sequence Analysis 81427 Genome Re-Evaluation 81430 Hearing Loss Sequence Analys 81431 Hearing Loss Dup/Del Analys 81432 Hrdtry Brst Ca-Rlatd Dsordrs 81433 Hrdtry Brst Ca-Rlatd Dsordrs 81434 Hereditary Retinal Disorders 81435 Hereditary Colon Ca Dsordrs 81436 Hereditary Colon Ca Dsordrs 81437 Heredtry Nurondcrn Tum Dsrdr 81438 Heredtry Nurondcrn Tum Dsrdr 81439 Hrdtry Cardmypy Gene Panel 81440 Mitochondrial Gene 81442 Noonan Spectrum Disorders 81443 312 Genetic Tstg Severe Inh Cond $8,999 $5,849 $6,986 $2,893 81445 312 Targeted Genomic Seq Analys $5,238 $3,405 $4,067 $1,585 81448 Hrdtry Perph Neurphy Panel 81450 302 Targeted Genomic Seq Analys $2,326 $1,512 $1,806 $763 81455 302 Targeted Genomic Seq Analys $4,031 $2,620 $3,129 $1,512 81460 Whole Mitochondrial Genome 81465 Whole Mitochondrial Genome 81470 X-Linked Intellectual Dblt 81471 X-Linked Intellectual Dblt 81479 301 Unlisted Molecular Pathology $1,368 $889 $1,062 $448 81490 Autoimmune Rheumatoid Arthr 81493 Cor Artery Disease Mrna 81500 Onco (Ovar) Two Proteins 81503 Onco (Ovar) Five Proteins 81504 Oncology Tissue Of Origin 81506 Endo Assay Seven Anal 81507 Fetal Aneuploidy Trisom Risk 81508 312 Ftl Cgen Abnor Two Proteins $200 $130 $155 $64 81509 Ftl Cgen Abnor 3 Proteins 81510 Ftl Cgen Abnor Three Anal 81511 312 Ftl Cgen Abnor Four Anal $537 $349 $417 $173 $153 81512 Ftl Cgen Abnor Five Anal 81513 Nfct Ds Bv Rna Vag Flu Alg 81514 Nfct Ds Bv&Vaginitis Dna Alg 81518 Onc Brst Mrna 11 Genes 81519 Oncology Breast Mrna 81520 Onc Breast Mrna 58 Genes 81521 312 Onc Breast Mrna 70 Genes $4,200 $2,730 $3,261 $1,674 81522 Onc Breast Mrna 12 Genes 81525 Oncology Colon Mrna 81528 Oncology Colorectal Scr 81529 Onc Cutan Mlnma Mrna 31 Gene 81535 Oncology Gynecologic 81536 Oncology Gynecologic 81538 Oncology Lung 81539 Oncology Prostate Prob Score 81540 Oncology Tum Unknown Origin 81541 Onc Prostate Mrna 46 Genes 81542 Onc Prostate Mrna 22 Cnt Gen 81545 Oncology Thyroid 81546 Onc Thyr Mrna 10,196 Gen Alg 81551 Onc Prostate 3 Genes 81552 Onc Uveal Mlnma Mrna 15 Gene 81554 Pulm Ds Ipf Mrna 190 Gen Alg 81595 Cardiology Hrt Trnspl Mrna 81596 312 Nfct Ds Chrnc Hcv 6 Assays $911 $592 $707 $272 $264 81599 Unlisted Maaa 82009 301 Test For Acetone/Ketones $76 $49 $59 $23 82010 301 Acetone Assay $39 $25 $30 $12 82010 301 Acetone Assay $39 $25 $30 $12 82013 Acetylcholinesterase Assay 82016 Acylcarnitines Qual 82017 301 Acylcarnitines Quant $120 $78 $93 $37 82024 301 Assay Of Acth $215 $140 $167 $67 82030 Assay Of Adp & Amp 82040 301 Assay Of Serum Albumin $72 $47 $56 $21 82040 301 Assay Of Serum Albumin $72 $47 $56 $21 82042 301 Other Source Albumin Quan Ea $37 $24 $29 $12 82042 301 Other Source Albumin Quan Ea $37 $24 $29 $12 82043 301 Ur Albumin Quantitative $103 $67 $80 $30 82043 301 Ur Albumin Quantitative $103 $67 $80 $30 82044 Ur Albumin Semiquantitative 82044 Ur Albumin Semiquantitative 82045 Albumin Ischemia Modified 82075 300 Assay Of Breath Ethanol $30 $20 $23 $12 82077 Assay Spec Xcp Ur&Breath Ia 82085 301 Assay Of Aldolase $168 $109 $130 $50 82088 301 Assay Of Aldosterone $599 $389 $465 $178 82103 301 Alpha-1-Antitrypsin Total $169 $110 $131 $50 82104 301 Alpha-1-Antitrypsin Pheno $95 $62 $74 $29 82105 301 Alpha-Fetoprotein Serum $120 $78 $93 $37 82106 301 Alpha-Fetoprotein Amniotic $140 $91 $109 $42 82107 Alpha-Fetoprotein L3 82108 301 Assay Of Aluminum $374 $243 $290 $111 82120 Amines Vaginal Fluid Qual 82120 Amines Vaginal Fluid Qual 82127 Amino Acid Single Qual 82128 Amino Acids Mult Qual 82131 300 Amino Acids Single Quant $362 $235 $281 $107 82135 301 Assay Aminolevulinic Acid $373 $242 $290 $110 82136 301 Amino Acids Quant 2-5 $279 $181 $217 $83 82139 301 Amino Acids Quan 6 Or More $452 $294 $351 $133 82140 301 Assay Of Ammonia $198 $129 $154 $59 82143 Amniotic Fluid Scan 82150 301 Assay Of Amylase $137 $89 $106 $40 82150 301 Assay Of Amylase $137 $89 $106 $40 82154 Androstanediol Glucuronide 82157 301 Assay Of Androstenedione $210 $137 $163 $64 $0 82160 Assay Of Androsterone 82163 Assay Of Angiotensin Ii 82164 301 Angiotensin I Enzyme Test $205 $133 $159 $61 82172 301 Assay Of Apolipoprotein $72 $47 $56 $23 82175 301 Assay Of Arsenic $240 $156 $186 $72 82180 301 Assay Of Ascorbic Acid $88 $57 $68 $27 82190 Atomic Absorption 82232 301 Assay Of Beta-2 Protein $152 $99 $118 $46 82239 301 Bile Acids Total $122 $79 $95 $37 82240 Bile Acids Cholylglycine 82247 301 Bilirubin Total $132 $86 $102 $39 82247 301 Bilirubin Total $132 $86 $102 $39 82248 301 Bilirubin Direct $93 $60 $72 $27 82252 Fecal Bilirubin Test 82261 Assay Of Biotinidase 82270 301 Occult Blood Feces $62 $40 $48 $18 82271 307 Occult Blood Other Sources $91 $59 $71 $27 82271 307 Occult Blood Other Sources $91 $59 $71 $27 82272 300 Occult Bld Feces 1-3 Tests $62 $40 $48 $18 82274 Assay Test For Blood Fecal 82274 Assay Test For Blood Fecal 82286 Assay Of Bradykinin 82300 301 Assay Of Cadmium $263 $171 $204 $79 82306 301 Vitamin D 25 Hydroxy $375 $244 $291 $112 82308 301 Assay Of Calcitonin $129 $84 $100 $40 82310 301 Assay Of Calcium $175 $114 $136 $51 82310 301 Assay Of Calcium $175 $114 $136 $51 82330 301 Assay Of Calcium $247 $161 $192 $73 82330 301 Assay Of Calcium $247 $161 $192 $73 82331 Calcium Infusion Test 82340 301 Assay Of Calcium In Urine $111 $72 $86 $33 82355 Calculus Analysis Qual 82360 Calculus Assay Quant $53 $34 $41 $17 $13 82365 301 Calculus Spectroscopy $45 $29 $35 $15 82370 X-Ray Assay Calculus 82373 301 Assay C-D Transfer Measure $134 $87 $104 $41 82374 301 Assay Blood Carbon Dioxide $66 $43 $51 $20 82374 301 Assay Blood Carbon Dioxide $66 $43 $51 $20 82375 301 Assay Carboxyhb Quant $222 $144 $172 $66 82376 Assay Carboxyhb Qual 82378 301 Carcinoembryonic Antigen $193 $125 $150 $58 82379 301 Assay Of Carnitine $176 $114 $137 $53 82380 301 Assay Of Carotene $356 $231 $276 $104 82382 Assay Urine Catecholamines 82383 Assay Blood Catecholamines 82384 301 Assay Three Catecholamines $411 $267 $319 $122 $69 82387 Assay Of Cathepsin-D 82390 301 Assay Of Ceruloplasmin $168 $109 $130 $50 82397 301 Chemiluminescent Assay $196 $127 $152 $58 82415 Assay Of Chloramphenicol 82435 301 Assay Of Blood Chloride $61 $40 $47 $18 82435 301 Assay Of Blood Chloride $61 $40 $47 $18 82436 301 Assay Of Urine Chloride $101 $66 $78 $30 82438 301 Assay Other Fluid Chlorides $76 $49 $59 $23 82441 Test For Chlorohydrocarbons 82465 301 Assay Bld/Serum Cholesterol $86 $56 $67 $25 82465 301 Assay Bld/Serum Cholesterol $86 $56 $67 $25 82480 301 Assay Serum Cholinesterase $38 $25 $30 $12 82482 301 Assay Rbc Cholinesterase $218 $142 $169 $64 82485 Assay Chondroitin Sulfate 82495 301 Assay Of Chromium $83 $54 $64 $26 82507 301 Assay Of Citrate $368 $239 $286 $110 82523 301 Collagen Crosslinks $91 $59 $71 $29 82523 301 Collagen Crosslinks $91 $59 $71 $29 82525 301 Assay Of Copper $91 $59 $71 $28 82528 Assay Of Corticosterone 82530 301 Cortisol Free $251 $163 $195 $75 $22 82533 301 Total Cortisol $228 $148 $177 $68 82540 Assay Of Creatine 82542 301 Col Chromotography Qual/Quan $472 $307 $366 $139 $112 82550 301 Assay Of Ck (Cpk) $113 $73 $88 $33 82550 301 Assay Of Ck (Cpk) $113 $73 $88 $33 82552 301 Assay Of Cpk In Blood $613 $398 $476 $179 $98 82553 301 Creatine Mb Fraction $224 $146 $174 $66 82554 Creatine Isoforms 82565 301 Assay Of Creatinine $102 $66 $79 $30 82565 301 Assay Of Creatinine $102 $66 $79 $30 82570 301 Assay Of Urine Creatinine $86 $56 $67 $25 82570 301 Assay Of Urine Creatinine $86 $56 $67 $25 82575 301 Creatinine Clearance Test $216 $140 $168 $64 82585 301 Assay Of Cryofibrinogen $293 $190 $227 $86 82595 301 Assay Of Cryoglobulin $119 $77 $92 $35 82600 Assay Of Cyanide 82607 301 Vitamin B-12 $274 $178 $213 $81 82608 301 B-12 Binding Capacity $281 $183 $218 $83 82610 301 Cystatin C $120 $78 $93 $37 82615 Test For Urine Cystines 82626 301 Dehydroepiandrosterone $399 $259 $310 $118 82627 301 Dehydroepiandrosterone $377 $245 $293 $112 82633 Desoxycorticosterone 82634 301 Deoxycortisol $69 $45 $54 $23 82638 301 Assay Of Dibucaine Number $59 $38 $46 $19 82642 301 Dihydrotestosterone $129 $84 $100 $41 $0 82652 301 Vit D 1 25-Dihydroxy $277 $180 $215 $85 82656 301 Pancreatic Elastase Fecal $389 $253 $302 $114 82657 301 Enzyme Cell Activity $840 $546 $652 $245 $175 82658 Enzyme Cell Activity Ra 82664 301 Electrophoretic Test $192 $125 $149 $63 82668 301 Assay Of Erythropoietin $303 $197 $235 $90 82670 301 Assay Of Total Estradiol $406 $264 $315 $121 82671 301 Assay Of Estrogens $233 $151 $181 $71 82672 301 Assay Of Estrogen $382 $248 $297 $113 82677 301 Assay Of Estriol $418 $272 $325 $124 $72 82679 301 Assay Of Estrone $170 $111 $132 $52 82679 301 Assay Of Estrone $170 $111 $132 $52 82681 Assay Dir Meas Fr Estradiol 82693 301 Assay Of Ethylene Glycol $315 $205 $245 $93 82696 Assay Of Etiocholanolone 82705 Fats/Lipids Feces Qual 82710 301 Fats/Lipids Feces Quant $88 $57 $68 $27 $2 82715 Assay Of Fecal Fat 82725 301 Assay Of Blood Fatty Acids $118 $77 $92 $36 82726 301 Long Chain Fatty Acids $161 $105 $125 $49 82728 301 Assay Of Ferritin $216 $140 $168 $64 82731 301 Assay Of Fetal Fibronectin $608 $395 $472 $183 82735 301 Assay Of Fluoride $360 $234 $279 $106 82746 301 Assay Of Folic Acid Serum $310 $202 $241 $91 82747 301 Assay Of Folic Acid Rbc $333 $216 $259 $98 82757 Assay Of Semen Fructose 82759 Assay Of Rbc Galactokinase 82760 Assay Of Galactose 82775 Assay Galactose Transferase 82776 Galactose Transferase Test 82777 Galectin-3 82784 301 Assay Iga/Igd/Igg/Igm Each $107 $70 $83 $32 82785 301 Assay Of Ige $218 $142 $169 $65 82787 301 Igg 1 2 3 Or 4 Each $183 $119 $142 $54 $53 82800 301 Blood Ph $158 $103 $123 $47 82803 301 Blood Gases Any Combination $242 $157 $188 $73 82805 301 Blood Gases W/O2 Saturation $269 $175 $209 $87 82810 301 Blood Gases O2 Sat Only $83 $54 $64 $25 82820 Hemoglobin-Oxygen Affinity 82930 Gastric Analy W/Ph Ea Spec 82938 Gastrin Test 82941 301 Assay Of Gastrin $126 $82 $98 $39 $38 82943 301 Assay Of Glucagon $136 $88 $106 $41 82945 301 Glucose Other Fluid $10 $7 $8 $3 82946 Glucagon Tolerance Test 82947 301 Assay Glucose Blood Quant $96 $62 $75 $28 82947 301 Assay Glucose Blood Quant $96 $62 $75 $28 82948 Reagent Strip/Blood Glucose $27 $18 $21 $8 82950 301 Glucose Test $109 $71 $85 $32 82950 301 Glucose Test $109 $71 $85 $32 82951 301 Glucose Tolerance Test (Gtt) $164 $107 $127 $49 82951 301 Glucose Tolerance Test (Gtt) $164 $107 $127 $49 82952 301 Gtt-Added Samples $67 $44 $52 $20 82952 301 Gtt-Added Samples $67 $44 $52 $20 82955 301 Assay Of G6Pd Enzyme $228 $148 $177 $67 82960 Test For G6Pd Enzyme 82962 301 Glucose Blood Test $49 $32 $38 $15 82963 Assay Of Glucosidase 82965 Assay Of Gdh Enzyme 82977 301 Assay Of Ggt $111 $72 $86 $33 82977 301 Assay Of Ggt $111 $72 $86 $33 82978 Assay Of Glutathione 82979 Assay Rbc Glutathione 82985 301 Assay Of Glycated Protein $110 $72 $85 $34 82985 301 Assay Of Glycated Protein $110 $72 $85 $34 83001 301 Assay Of Gonadotropin (Fsh) $264 $172 $205 $79 83001 301 Assay Of Gonadotropin (Fsh) $264 $172 $205 $79 83002 301 Assay Of Gonadotropin (Lh) $279 $181 $217 $83 83002 301 Assay Of Gonadotropin (Lh) $279 $181 $217 $83 83003 301 Assay Growth Hormone (Hgh) $120 $78 $93 $37 83006 Growth Stimulation Gene 2 83009 H Pylori (C-13) Blood 83010 301 Assay Of Haptoglobin Quant $180 $117 $140 $54 83012 Assay Of Haptoglobins 83013 301 H Pylori (C-13) Breath $425 $276 $330 $131 $109 83014 H Pylori Drug Admin 83015 Heavy Metal Qual Any Anal 83018 301 Heavy Metal Quant Each Nes $317 $206 $246 $94 83020 301 Hemoglobin Electrophoresis $163 $106 $127 $49 83020 301 Hemoglobin Electrophoresis $163 $106 $127 $53 83021 301 Hemoglobin Chromotography $194 $126 $151 $58 83026 Hemoglobin Copper Sulfate 83030 Fetal Hemoglobin Chemical 83033 Fetal Hemoglobin Assay Qual 83036 301 Glycosylated Hemoglobin Test $146 $95 $113 $43 83036 301 Glycosylated Hemoglobin Test $146 $95 $113 $43 83037 Glycosylated Hb Home Device 83037 Glycosylated Hb Home Device 83045 Blood Methemoglobin Test 83050 Blood Methemoglobin Assay 83051 301 Assay Of Plasma Hemoglobin $99 $64 $77 $29 83060 Blood Sulfhemoglobin Assay 83065 Assay Of Hemoglobin Heat 83068 301 Hemoglobin Stability Screen $140 $91 $109 $42 83069 301 Assay Of Urine Hemoglobin $200 $130 $155 $58 83070 301 Assay Of Hemosiderin Qual $59 $38 $46 $18 83080 301 Assay Of B Hexosaminidase $306 $199 $238 $90 83088 301 Assay Of Histamine $485 $315 $377 $144 83090 301 Assay Of Homocystine $362 $235 $281 $107 83150 301 Assay Of Homovanillic Acid $94 $61 $73 $30 83491 Assay Of Corticosteroids 17 83497 301 Assay Of 5-Hiaa $305 $198 $237 $90 $54 83498 301 Assay Of Progesterone 17-D $152 $99 $118 $47 83500 Assay Free Hydroxyproline 83505 Assay Total Hydroxyproline 83516 301 Immunoassay Nonantibody $210 $137 $163 $62 83516 301 Immunoassay Nonantibody $210 $137 $163 $62 83518 Immunoassay Dipstick 83518 Immunoassay Dipstick 83519 301 Ria Nonantibody $142 $92 $110 $43 83520 301 Immunoassay Quant Nos Nonab $466 $303 $362 $137 83520 301 Immunoassay Quant Nos Nonab $466 $303 $362 $137 83525 301 Assay Of Insulin $201 $131 $156 $59 83527 301 Assay Of Insulin $228 $148 $177 $67 83528 Assay Of Intrinsic Factor 83540 301 Assay Of Iron $98 $64 $76 $29 83550 301 Iron Binding Test $138 $90 $107 $41 83570 Assay Of Idh Enzyme 83582 Assay Of Ketogenic Steroids 83586 Assay 17- Ketosteroids 83593 Fractionation Ketosteroids 83605 301 Assay Of Lactic Acid $145 $94 $113 $43 83605 301 Assay Of Lactic Acid $145 $94 $113 $43 83615 301 Lactate (Ld) (Ldh) Enzyme $101 $66 $78 $30 83625 301 Assay Of Ldh Enzymes $61 $40 $47 $19 83630 301 Lactoferrin Fecal (Qual) $268 $174 $208 $80 83631 Lactoferrin Fecal (Quant) 83632 Placental Lactogen 83633 Test Urine For Lactose 83655 301 Assay Of Lead $85 $55 $66 $26 83655 301 Assay Of Lead $85 $55 $66 $26 83661 L/S Ratio Fetal Lung 83662 Foam Stability Fetal Lung 83663 Fluoro Polarize Fetal Lung 83664 301 Lamellar Bdy Fetal Lung $92 $60 $71 $29 83670 Assay Of Lap Enzyme 83690 301 Assay Of Lipase $130 $85 $101 $38 83695 301 Assay Of Lipoprotein(A) $66 $43 $51 $21 83698 Assay Lipoprotein Pla2 83700 301 Lipopro Bld Electrophoretic $42 $27 $33 $13 83701 Lipoprotein Bld Hr Fraction 83704 301 Lipoprotein Bld Quan Part $158 $103 $123 $50 83718 301 Assay Of Lipoprotein $126 $82 $98 $37 83718 301 Assay Of Lipoprotein $126 $82 $98 $37 83719 Assay Of Blood Lipoprotein 83721 301 Assay Of Blood Lipoprotein $142 $92 $110 $42 83721 301 Assay Of Blood Lipoprotein $142 $92 $110 $42 83722 Lipoprtn Dir Meas Sd Ldl Chl 83727 Assay Of Lrh Hormone 83735 301 Assay Of Magnesium $107 $70 $83 $32 83775 Assay Malate Dehydrogenase 83785 301 Assay Of Manganese $294 $191 $228 $88 83789 301 Mass Spectrometry Qual/Quan $118 $77 $92 $37 83825 301 Assay Of Mercury $50 $33 $39 $16 83835 301 Assay Of Metanephrines $419 $272 $325 $123 $67 83857 Assay Of Methemalbumin 83861 Microfluid Analy Tears 83861 Microfluid Analy Tears 83864 301 Mucopolysaccharides $685 $445 $532 $201 83872 Assay Synovial Fluid Mucin 83873 301 Assay Of Csf Protein $82 $53 $64 $26 83874 301 Assay Of Myoglobin $67 $44 $52 $21 83876 Assay Myeloperoxidase 83880 301 Assay Of Natriuretic Peptide $643 $418 $499 $191 83880 301 Assay Of Natriuretic Peptide $643 $418 $499 $191 83883 301 Assay Nephelometry Not Spec $233 $151 $181 $69 83885 301 Assay Of Nickel $201 $131 $156 $61 83915 301 Assay Of Nucleotidase $201 $131 $156 $59 83916 301 Oligoclonal Bands $142 $92 $110 $44 83918 Organic Acids Total Quant 83919 301 Organic Acids Qual Each $79 $51 $61 $25 83921 301 Organic Acid Single Quant $471 $306 $366 $139 83930 301 Assay Of Blood Osmolality $109 $71 $85 $32 83935 301 Assay Of Urine Osmolality $119 $77 $92 $35 83937 301 Assay Of Osteocalcin $136 $88 $106 $43 83945 301 Assay Of Oxalate $205 $133 $159 $61 83950 Oncoprotein Her-2/Neu 83951 Oncoprotein Dcp 83970 301 Assay Of Parathormone $616 $400 $478 $183 83986 301 Assay Ph Body Fluid Nos $27 $18 $21 $8 83986 301 Assay Ph Body Fluid Nos $27 $18 $21 $8 83987 Exhaled Breath Condensate 83992 301 Assay For Phencyclidine $88 $57 $68 $29 83993 301 Assay For Calprotectin Fecal $840 $546 $652 $245 $155 84030 Assay Of Blood Pku 84035 Assay Of Phenylketones 84060 Assay Acid Phosphatase 84066 301 Assay Prostate Phosphatase $50 $33 $39 $16 84075 301 Assay Alkaline Phosphatase $93 $60 $72 $28 84075 301 Assay Alkaline Phosphatase $93 $60 $72 $28 84078 Assay Alkaline Phosphatase 84080 301 Assay Alkaline Phosphatases $238 $155 $185 $71 $36 84081 Assay Phosphatidylglycerol 84085 Assay Of Rbc Pg6D Enzyme 84087 Assay Phosphohexose Enzymes 84100 301 Assay Of Phosphorus $96 $62 $75 $28 84105 301 Assay Of Urine Phosphorus $101 $66 $78 $30 84106 Test For Porphobilinogen 84110 301 Assay Of Porphobilinogen $78 $51 $61 $24 84112 301 Eval Amniotic Fluid Protein $45 $29 $35 $25 84119 Test Urine For Porphyrins 84120 301 Assay Of Urine Porphyrins $72 $47 $56 $23 84126 Assay Of Feces Porphyrins 84132 301 Assay Of Serum Potassium $93 $60 $72 $27 84132 301 Assay Of Serum Potassium $93 $60 $72 $27 84133 301 Assay Of Urine Potassium $101 $66 $78 $30 84134 301 Assay Of Prealbumin $130 $85 $101 $39 84135 Assay Of Pregnanediol 84138 Assay Of Pregnanetriol 84140 301 Assay Of Pregnenolone $99 $64 $77 $31 84143 301 Assay Of 17-Hydroxypregneno $269 $175 $209 $80 84144 301 Assay Of Progesterone $240 $156 $186 $72 84145 301 Procalcitonin (Pct) $118 $77 $92 $37 84146 301 Assay Of Prolactin $359 $233 $279 $106 84150 Assay Of Prostaglandin 84152 Assay Of Psa Complexed 84153 301 Assay Of Psa Total $245 $159 $190 $73 84154 301 Assay Of Psa Free $327 $213 $254 $97 84155 301 Assay Of Protein Serum $28 $18 $22 $9 84155 301 Assay Of Protein Serum $28 $18 $22 $9 84156 301 Assay Of Protein Urine $28 $18 $22 $9 84157 301 Assay Of Protein Other $111 $72 $86 $33 84157 301 Assay Of Protein Other $111 $72 $86 $33 84160 Assay Of Protein Any Source 84163 301 Pappa Serum $105 $68 $82 $32 84165 301 Protein E-Phoresis Serum $251 $163 $195 $74 84165 301 Protein E-Phoresis Serum $251 $163 $195 $82 84166 301 Protein E-Phoresis/Urine/Csf $105 $68 $82 $32 84166 301 Protein E-Phoresis/Urine/Csf $105 $68 $82 $34 84181 301 Western Blot Test $310 $202 $241 $92 84181 301 Western Blot Test $310 $202 $241 $102 84182 301 Protein Western Blot Test $385 $250 $299 $115 84182 301 Protein Western Blot Test $385 $250 $299 $126 84202 301 Assay Rbc Protoporphyrin $80 $52 $62 $25 84203 Test Rbc Protoporphyrin 84206 301 Assay Of Proinsulin $103 $67 $80 $33 84207 301 Assay Of Vitamin B-6 $305 $198 $237 $92 84210 301 Assay Of Pyruvate $135 $88 $105 $41 84220 Assay Of Pyruvate Kinase 84228 Assay Of Quinine 84233 Assay Of Estrogen 84234 Assay Of Progesterone 84235 Assay Of Endocrine Hormone 84238 Assay Nonendocrine Receptor 84244 301 Assay Of Renin $338 $220 $262 $100 84252 301 Assay Of Vitamin B-2 $102 $66 $79 $32 84255 301 Assay Of Selenium $184 $120 $143 $56 84260 301 Assay Of Serotonin $224 $146 $174 $68 84270 301 Assay Of Sex Hormone Globul $158 $103 $123 $48 84275 Assay Of Sialic Acid 84285 Assay Of Silica 84295 301 Assay Of Serum Sodium $69 $45 $54 $21 84295 301 Assay Of Serum Sodium $69 $45 $54 $21 84300 301 Assay Of Urine Sodium $96 $62 $75 $28 84302 301 Assay Of Sweat Sodium $75 $49 $58 $22 84305 301 Assay Of Somatomedin $327 $213 $254 $97 84307 Assay Of Somatostatin 84311 301 Spectrophotometry $300 $195 $233 $88 84315 301 Body Fluid Specific Gravity $19 $12 $15 $6 84375 Chromatogram Assay Sugars 84376 301 Sugars Single Qual $132 $86 $102 $39 84377 Sugars Multiple Qual 84378 Sugars Single Quant 84379 Sugars Multiple Quant 84392 301 Assay Of Urine Sulfate $88 $57 $68 $26 84402 301 Assay Of Free Testosterone $468 $304 $363 $138 84403 301 Assay Of Total Testosterone $468 $304 $363 $138 $135 84410 301 Testosterone Bioavailable $246 $160 $191 $77 84425 301 Assay Of Vitamin B-1 $362 $235 $281 $107 84430 Assay Of Thiocyanate 84431 Thromboxane Urine 84432 301 Assay Of Thyroglobulin $288 $187 $224 $85 84436 301 Assay Of Total Thyroxine $101 $66 $78 $30 84437 Assay Of Neonatal Thyroxine 84439 301 Assay Of Free Thyroxine $176 $114 $137 $52 84442 301 Assay Of Thyroid Activity $81 $53 $63 $25 84443 301 Assay Thyroid Stim Hormone $229 $149 $178 $68 84443 301 Assay Thyroid Stim Hormone $229 $149 $178 $68 84445 301 Assay Of Tsi Globulin $608 $395 $472 $182 $168 84446 301 Assay Of Vitamin E $228 $148 $177 $68 84449 301 Assay Of Transcortin $102 $66 $79 $32 84450 301 Transferase (Ast) (Sgot) $107 $70 $83 $32 84450 301 Transferase (Ast) (Sgot) $107 $70 $83 $32 84460 301 Alanine Amino (Alt) (Sgpt) $101 $66 $78 $30 84460 301 Alanine Amino (Alt) (Sgpt) $101 $66 $78 $30 84466 301 Assay Of Transferrin $93 $60 $72 $28 84478 301 Assay Of Triglycerides $107 $70 $83 $32 84478 301 Assay Of Triglycerides $107 $70 $83 $32 84479 301 Assay Of Thyroid (T3 Or T4) $48 $31 $37 $15 84480 301 Assay Triiodothyronine (T3) $224 $146 $174 $66 84481 301 Free Assay (Ft-3) $309 $201 $240 $91 84482 301 T3 Reverse $91 $59 $71 $28 84484 301 Assay Of Troponin Quant $252 $164 $196 $74 84485 Assay Duodenal Fluid Trypsin 84488 Test Feces For Trypsin 84490 Assay Of Feces For Trypsin 84510 Assay Of Tyrosine 84512 Assay Of Troponin Qual 84520 301 Assay Of Urea Nitrogen $102 $66 $79 $30 84520 301 Assay Of Urea Nitrogen $102 $66 $79 $30 84525 Urea Nitrogen Semi-Quant 84540 301 Assay Of Urine/Urea-N $107 $70 $83 $32 84545 Urea-N Clearance Test 84550 301 Assay Of Blood/Uric Acid $93 $60 $72 $27 84550 301 Assay Of Blood/Uric Acid $93 $60 $72 $27 84560 301 Assay Of Urine/Uric Acid $111 $72 $86 $33 84577 Assay Of Feces/Urobilinogen 84578 Test Urine Urobilinogen 84580 Assay Of Urine Urobilinogen 84583 Assay Of Urine Urobilinogen 84585 301 Assay Of Urine Vma $75 $49 $58 $24 84586 301 Assay Of Vip $195 $127 $151 $61 84588 301 Assay Of Vasopressin $324 $211 $252 $98 $34 84590 301 Assay Of Vitamin A $218 $142 $169 $64 84591 301 Assay Of Nos Vitamin $247 $161 $192 $73 84597 301 Assay Of Vitamin K $247 $161 $192 $73 84600 Assay Of Volatiles 84620 Xylose Tolerance Test 84630 301 Assay Of Zinc $180 $117 $140 $53 84681 301 Assay Of C-Peptide $345 $224 $268 $102 84702 301 Chorionic Gonadotropin Test $198 $129 $154 $59 84703 302 Chorionic Gonadotropin Assay $107 $70 $83 $32 84703 302 Chorionic Gonadotropin Assay $107 $70 $83 $32 84704 Hcg Free Betachain Test 84830 Ovulation Tests 84999 301 Clinical Chemistry Test $93 $60 $72 $30 85002 Bleeding Time Test 85004 Automated Diff Wbc Count 85007 301 Bl Smear W/Diff Wbc Count $62 $40 $48 $18 85008 305 Bl Smear W/O Diff Wbc Count $48 $31 $37 $14 85009 Manual Diff Wbc Count B-Coat 85013 Spun Microhematocrit 85014 305 Hematocrit $66 $43 $51 $19 85014 305 Hematocrit $66 $43 $51 $19 85018 305 Hemoglobin $66 $43 $51 $19 85018 305 Hemoglobin $66 $43 $51 $19 85025 305 Complete Cbc W/Auto Diff Wbc $146 $95 $113 $43 85025 305 Complete Cbc W/Auto Diff Wbc $146 $95 $113 $43 85027 305 Complete Cbc Automated $111 $72 $86 $33 85032 Manual Cell Count Each 85041 Automated Rbc Count 85044 Manual Reticulocyte Count 85045 305 Automated Reticulocyte Count $90 $59 $70 $26 85046 Reticyte/Hgb Concentrate 85048 305 Automated Leukocyte Count $27 $18 $21 $8 85049 305 Automated Platelet Count $61 $40 $47 $18 85055 Reticulated Platelet Assay 85060 305 Blood Smear Interpretation $525 $341 $408 $172 85097 Bone Marrow Interpretation $272 $177 $211 $89 85130 Chromogenic Substrate Assay 85170 Blood Clot Retraction 85175 Blood Clot Lysis Time 85210 305 Clot Factor Ii Prothrom Spec $175 $114 $136 $52 85220 305 Blooc Clot Factor V Test $191 $124 $148 $57 85230 305 Clot Factor Vii Proconvertin $199 $129 $154 $60 $55 85240 305 Clot Factor Viii Ahg 1 Stage $536 $348 $416 $157 85244 Clot Factor Viii Reltd Antgn 85245 Clot Factor Viii Vw Ristoctn 85246 305 Clot Factor Viii Vw Antigen $629 $409 $488 $185 85247 305 Clot Factor Viii Multimetric $139 $90 $108 $43 85250 305 Clot Factor Ix Ptc/Chrstmas $405 $263 $314 $119 85260 305 Clot Factor X Stuart-Power $409 $266 $318 $120 85270 305 Clot Factor Xi Pta $405 $263 $314 $119 $84 85280 305 Clot Factor Xii Hageman $408 $265 $317 $120 85290 305 Clot Factor Xiii Fibrin Stab $196 $127 $152 $59 85291 Clot Factor Xiii Fibrin Scrn 85292 Clot Factor Fletcher Fact 85293 Clot Factor Wght Kininogen 85300 305 Antithrombin Iii Activity $191 $124 $148 $57 85301 305 Antithrombin Iii Antigen $191 $124 $148 $57 85302 305 Clot Inhibit Prot C Antigen $122 $79 $95 $37 85303 305 Clot Inhibit Prot C Activity $274 $178 $213 $81 85305 305 Clot Inhibit Prot S Total $67 $44 $52 $21 85306 305 Clot Inhibit Prot S Free $191 $124 $148 $57 85307 305 Assay Activated Protein C $395 $257 $307 $116 85335 305 Factor Inhibitor Test $607 $395 $471 $177 85337 Thrombomodulin 85345 Coagulation Time Lee & White 85347 305 Coagulation Time Activated $18 $12 $14 $6 85348 Coagulation Time Otr Method 85360 305 Euglobulin Lysis $244 $159 $189 $72 85362 Fibrin Degradation Products 85366 305 Fibrinogen Test $441 $287 $342 $137 85370 Fibrinogen Test 85378 Fibrin Degrade Semiquant 85379 305 Fibrin Degradation Quant $188 $122 $146 $56 85380 Fibrin Degradj D-Dimer 85384 305 Fibrinogen Activity $173 $112 $134 $51 85385 Fibrinogen Antigen 85390 301 Fibrinolysins Screen I&R $100 $65 $78 $31 85390 301 Fibrinolysins Screen I&R $100 $65 $78 $33 85396 305 Clotting Assay Whole Blood $111 $72 $86 $36 85397 305 Clotting Funct Activity $546 $355 $424 $162 85400 Fibrinolytic Plasmin 85410 305 Fibrinolytic Antiplasmin $200 $130 $155 $59 85415 305 Fibrinolytic Plasminogen $464 $302 $360 $136 85420 Fibrinolytic Plasminogen 85421 Fibrinolytic Plasminogen 85441 Heinz Bodies Direct 85445 Heinz Bodies Induced 85460 305 Hemoglobin Fetal $143 $93 $111 $42 85461 305 Hemoglobin Fetal $33 $21 $26 $11 85475 Hemolysin Acid 85520 305 Heparin Assay $166 $108 $129 $50 $17 85525 Heparin Neutralization 85530 305 Heparin-Protamine Tolerance $62 $40 $48 $19 85536 Iron Stain Peripheral Blood 85540 305 Wbc Alkaline Phosphatase $82 $53 $64 $25 85547 Rbc Mechanical Fragility 85549 305 Muramidase $136 $88 $106 $42 85555 Rbc Osmotic Fragility 85557 305 Rbc Osmotic Fragility $235 $153 $182 $70 85576 305 Blood Platelet Aggregation $111 $72 $86 $35 85576 305 Blood Platelet Aggregation $111 $72 $86 $36 85576 305 Blood Platelet Aggregation $111 $72 $86 $35 85597 305 Phospholipid Pltlt Neutraliz $224 $146 $174 $67 85598 305 Hexagnal Phosph Pltlt Neutrl $401 $261 $311 $118 85610 305 Prothrombin Time $68 $44 $53 $20 85610 305 Prothrombin Time $68 $44 $53 $20 85611 305 Prothrombin Test $191 $124 $148 $56 85612 Viper Venom Prothrombin Time 85613 305 Russell Viper Venom Diluted $162 $105 $126 $48 85635 305 Reptilase Test $140 $91 $109 $42 85651 Rbc Sed Rate Nonautomated $66 $43 $51 $20 85652 305 Rbc Sed Rate Automated $86 $56 $67 $25 85660 305 Rbc Sickle Cell Test $66 $43 $51 $20 85670 305 Thrombin Time Plasma $124 $81 $96 $37 85675 Thrombin Time Titer 85705 300 Thromboplastin Inhibition $30 $20 $23 $10 85730 305 Thromboplastin Time Partial $105 $68 $82 $31 85732 305 Thromboplastin Time Partial $126 $82 $98 $37 85810 305 Blood Viscosity Examination $102 $66 $79 $31 85999 301 Hematology Procedure $14 $9 $11 $5 86000 Agglutinins Febrile Antigen 86001 Allergen Specific Igg 86003 302 Allg Spec Ige Crude Xtrc Ea $38 $25 $30 $12 86005 302 Allg Spec Ige Multiallg Scr $45 $29 $35 $14 86008 302 Allg Spec Ige Recomb Ea $136 $88 $106 $41 $38 86021 Wbc Antibody Identification 86022 302 Platelet Antibodies $55 $36 $43 $18 86023 Immunoglobulin Assay 86038 302 Antinuclear Antibodies $197 $128 $153 $58 86039 302 Antinuclear Antibodies (Ana) $80 $52 $62 $24 86060 302 Antistreptolysin O Titer $146 $95 $113 $43 86063 Antistreptolysin O Screen 86077 Phys Blood Bank Serv Xmatch 86078 Phys Blood Bank Serv Reactj 86079 Phys Blood Bank Serv Authrj 86140 302 C-Reactive Protein $86 $56 $67 $25 86141 302 C-Reactive Protein Hs $101 $66 $78 $31 86146 302 Beta-2 Glycoprotein Antibody $99 $64 $77 $32 86147 302 Cardiolipin Antibody Ea Ig $418 $272 $325 $124 86148 302 Anti-Phospholipid Antibody $30 $20 $23 $11 86152 Cell Enumeration & Id 86153 Cell Enumeration Phys Interp 86155 Chemotaxis Assay 86156 Cold Agglutinin Screen 86157 302 Cold Agglutinin Titer $126 $82 $98 $37 86160 302 Complement Antigen $218 $142 $169 $64 86161 301 Complement/Function Activity $471 $306 $366 $138 86162 302 Complement Total (Ch50) $362 $235 $281 $107 86171 Complement Fixation Each 86200 302 Ccp Antibody $218 $142 $169 $65 86215 302 Deoxyribonuclease Antibody $63 $41 $49 $20 86225 302 Dna Antibody Native $238 $155 $185 $70 86226 302 Dna Antibody Single Strand $50 $33 $39 $16 86235 302 Nuclear Antigen Antibody $84 $55 $65 $26 86255 302 Fluorescent Antibody Screen $210 $137 $163 $62 86255 302 Fluorescent Antibody Screen $210 $137 $163 $69 86256 302 Fluorescent Antibody Titer $218 $142 $169 $64 86256 302 Fluorescent Antibody Titer $218 $142 $169 $71 86277 Growth Hormone Antibody 86280 Hemagglutination Inhibition 86294 Immunoassay Tumor Qual 86294 Immunoassay Tumor Qual 86300 302 Immunoassay Tumor Ca 15-3 $150 $98 $116 $46 86301 302 Immunoassay Tumor Ca 19-9 $247 $161 $192 $74 86304 302 Immunoassay Tumor Ca 125 $247 $161 $192 $74 86305 302 Human Epididymis Protein 4 $171 $111 $133 $52 86308 302 Heterophile Antibody Screen $132 $86 $102 $39 86308 302 Heterophile Antibody Screen $132 $86 $102 $39 86309 Heterophile Antibody Titer 86310 Heterophile Antibody Absrbj 86316 302 Immunoassay Tumor Other $208 $135 $161 $63 86317 302 Immunoassay Infectious Agent $39 $25 $30 $13 86318 Ia Infectious Agent Antibody 86318 Ia Infectious Agent Antibody 86320 Serum Immunoelectrophoresis 86320 Serum Immunoelectrophoresis 86325 Other Immunoelectrophoresis 86325 Other Immunoelectrophoresis 86327 Immunoelectrophoresis Assay 86327 Immunoelectrophoresis Assay 86328 Ia Nfct Ab Sarscov2 Covid19 86329 302 Immunodiffusion Nes $573 $372 $445 $167 86331 Immunodiffusion Ouchterlony 86332 Immune Complex Assay 86334 302 Immunofix E-Phoresis Serum $338 $220 $262 $100 86334 302 Immunofix E-Phoresis Serum $338 $220 $262 $111 86335 302 Immunfix E-Phorsis/Urine/Csf $300 $195 $233 $90 86335 302 Immunfix E-Phorsis/Urine/Csf $300 $195 $233 $98 86336 302 Inhibin A $624 $406 $484 $182 $107 86337 302 Insulin Antibodies $507 $330 $394 $149 $70 86340 302 Intrinsic Factor Antibody $73 $47 $57 $23 86341 302 Islet Cell Antibody $218 $142 $169 $66 86343 302 Leukocyte Histamine Release $464 $302 $360 $136 86344 Leukocyte Phagocytosis 86352 302 Cell Function Assay W/Stim 86353 302 Lymphocyte Transformation $765 $497 $594 $227 86355 302 B Cells Total Count $200 $130 $155 $62 86356 302 Mononuclear Cell Antigen $353 $229 $274 $105 86357 302 Nk Cells Total Count $267 $174 $207 $82 86359 302 T Cells Total Count $200 $130 $155 $62 86360 302 T Cell Absolute Count/Ratio $263 $171 $204 $82 86361 302 T Cell Absolute Count $101 $66 $78 $32 86367 Stem Cells Total Count 86376 302 Microsomal Antibody Each $228 $148 $177 $68 86382 302 Neutralization Test Viral $1,730 $1,125 $1,343 $502 $57 86384 Nitroblue Tetrazolium Dye 86386 Nuclear Matrix Protein 22 86386 Nuclear Matrix Protein 22 86403 Particle Agglut Antbdy Scrn 86406 Particle Agglut Antbdy Titr 86408 Neutrlzg Antb Sarscov2 Scr 86409 Neutrlzg Antb Sarscov2 Titer 86413 Sars-Cov-2 Antb Quantitative 86430 302 Rheumatoid Factor Test Qual $129 $84 $100 $38 86431 302 Rheumatoid Factor Quant $88 $57 $68 $26 86480 302 Tb Test Cell Immun Measure $342 $222 $266 $106 86481 Tb Ag Response T-Cell Susp 86485 Skin Test Candida 86486 Skin Test Nos Antigen 86490 Coccidioidomycosis Skin Test 86510 Histoplasmosis Skin Test 86580 302 Tb Intradermal Test $60 $39 $47 $20 86590 Streptokinase Antibody 86592 302 Syphilis Test Non-Trep Qual $72 $47 $56 $21 86593 Syphilis Test Non-Trep Quant 86602 Antinomyces Antibody 86603 302 Adenovirus Antibody $48 $31 $37 $15 86606 302 Aspergillus Antibody $30 $20 $23 $10 86609 302 Bacterium Antibody $61 $40 $47 $19 86611 302 Bartonella Antibody $201 $131 $156 $59 86612 302 Blastomyces Antibody $125 $81 $97 $38 $0 86615 302 Bordetella Antibody $328 $213 $255 $96 86617 302 Lyme Disease Antibody $194 $126 $151 $58 86618 302 Lyme Disease Antibody $274 $178 $213 $81 86618 302 Lyme Disease Antibody $274 $178 $213 $81 86619 Borrelia Antibody 86622 302 Brucella Antibody $60 $39 $47 $18 86625 Campylobacter Antibody 86628 Candida Antibody 86631 302 Chlamydia Antibody $61 $40 $47 $19 86632 302 Chlamydia Igm Antibody $72 $47 $56 $22 86635 302 Coccidioides Antibody $96 $62 $75 $29 86638 302 Q Fever Antibody $58 $38 $45 $18 86641 Cryptococcus Antibody 86644 302 Cmv Antibody $228 $148 $177 $68 86645 302 Cmv Antibody Igm $288 $187 $224 $85 86648 Diphtheria Antibody 86651 Encephalitis Californ Antbdy 86652 301 Encephaltis East Eqne Anbdy $63 $41 $49 $20 86653 301 Encephaltis St Louis Antbody $63 $41 $49 $20 86654 301 Encephaltis West Eqne Antbdy $63 $41 $49 $20 86658 302 Enterovirus Antibody $219 $142 $170 $65 86663 302 Epstein-Barr Antibody $54 $35 $42 $17 86664 302 Epstein-Barr Nuclear Antigen $258 $168 $200 $76 86665 302 Epstein-Barr Capsid Vca $75 $49 $58 $24 86666 302 Ehrlichia Antibody $98 $64 $76 $30 86668 302 Francisella Tularensis $329 $214 $255 $97 86671 302 Fungus Nes Antibody $185 $120 $144 $55 86674 Giardia Lamblia Antibody 86677 302 Helicobacter Pylori Antibody $247 $161 $192 $73 86682 302 Helminth Antibody $176 $114 $137 $52 86684 302 Hemophilus Influenza Antibdy $102 $66 $79 $31 86687 Htlv-I Antibody 86688 Htlv-Ii Antibody 86689 302 Htlv/Hiv Confirmj Antibody $372 $242 $289 $110 86692 302 Hepatitis Delta Agent Antbdy $196 $127 $152 $59 86694 302 Herpes Simplex Nes Antbdy $59 $38 $46 $19 86695 302 Herpes Simplex Type 1 Test $265 $172 $206 $78 86696 302 Herpes Simplex Type 2 Test $265 $172 $206 $79 86698 302 Histoplasma Antibody $138 $90 $107 $42 86701 302 Hiv-1Antibody $93 $60 $72 $28 86701 302 Hiv-1Antibody $93 $60 $72 $28 86702 302 Hiv-2 Antibody $140 $91 $109 $42 86703 302 Hiv-1/Hiv-2 1 Result Antbdy $233 $151 $181 $69 86704 302 Hep B Core Antibody Total $303 $197 $235 $89 86705 302 Hep B Core Antibody Igm $228 $148 $177 $67 86706 302 Hep B Surface Antibody $160 $104 $124 $48 86707 302 Hepatitis Be Antibody $180 $117 $140 $53 $52 86708 302 Hepatitis A Antibody $205 $133 $159 $61 86709 302 Hepatitis A Igm Antibody $232 $151 $180 $68 86710 302 Influenza Virus Antibody $56 $36 $43 $18 86711 John Cunningham Antibody 86713 302 Legionella Antibody $69 $45 $54 $22 86717 302 Leishmania Antibody $115 $75 $89 $35 86720 Leptospira Antibody 86723 Listeria Monocytogenes 86727 Lymph Choriomeningitis Ab 86732 Mucormycosis Antibody 86735 302 Mumps Antibody $183 $119 $142 $54 86738 302 Mycoplasma Antibody $218 $142 $169 $65 86741 Neisseria Meningitidis 86744 Nocardia Antibody 86747 302 Parvovirus Antibody $69 $45 $54 $22 86750 Malaria Antibody 86753 302 Protozoa Antibody Nos $205 $133 $159 $61 86756 Respiratory Virus Antibody 86757 302 Rickettsia Antibody $201 $131 $156 $60 86759 Rotavirus Antibody 86762 302 Rubella Antibody $228 $148 $177 $68 86765 302 Rubeola Antibody $201 $131 $156 $60 86768 302 Salmonella Antibody $67 $44 $52 $21 $6 86769 302 Sars-Cov-2 Covid-19 Antibody $248 $161 $193 $81 $75 86771 Shigella Antibody 86774 Tetanus Antibody 86777 302 Toxoplasma Antibody $70 $46 $54 $22 86778 302 Toxoplasma Antibody Igm $70 $46 $54 $22 86780 302 Treponema Pallidum $140 $91 $109 $42 86780 302 Treponema Pallidum $140 $91 $109 $42 86784 302 Trichinella Antibody $105 $68 $82 $32 86787 302 Varicella-Zoster Antibody $201 $131 $156 $60 86788 302 West Nile Virus Ab Igm $97 $63 $75 $30 86789 302 West Nile Virus Antibody $83 $54 $64 $26 86790 302 Virus Antibody Nos $125 $81 $97 $38 86793 Yersinia Antibody 86794 306 Zika Virus Igm Antibody $437 $284 $339 $128 86800 302 Thyroglobulin Antibody $222 $144 $172 $66 86803 302 Hepatitis C Ab Test $240 $156 $186 $71 86803 302 Hepatitis C Ab Test $240 $156 $186 $71 86804 Hep C Ab Test Confirm 86805 Lymphocytotoxicity Assay 86806 Lymphocytotoxicity Assay 86807 Cytotoxic Antibody Screening 86808 Cytotoxic Antibody Screening 86812 302 Hla Typing A B Or C $177 $115 $137 $54 86813 Hla Typing A B Or C 86816 Hla Typing Dr/Dq 86817 Hla Typing Dr/Dq 86821 Lymphocyte Culture Mixed 86825 Hla X-Math Non-Cytotoxic 86826 Hla X-Match Noncytotoxc Addl 86828 Hla Class I&Ii Antibody Qual 86829 Hla Class I/Ii Antibody Qual 86830 Hla Class I Phenotype Qual 86831 Hla Class Ii Phenotype Qual 86832 Hla Class I High Defin Qual 86833 Hla Class Ii High Defin Qual 86834 Hla Class I Semiquant Panel 86835 Hla Class Ii Semiquant Panel 86849 Immunology Procedure 86850 300 Rbc Antibody Screen $162 $105 $126 $48 86860 300 Rbc Antibody Elution $180 $117 $140 $59 86870 300 Rbc Antibody Identification $295 $192 $229 $97 86880 300 Coombs Test Direct $120 $78 $93 $35 86885 Coombs Test Indirect Qual 86886 300 Coombs Test Indirect Titer $150 $98 $116 $44 86890 Autologous Blood Process 86891 Autologous Blood Op Salvage 86900 300 Blood Typing Serologic Abo $100 $65 $78 $29 86901 300 Blood Typing Serologic Rh(D) $96 $62 $75 $28 86902 300 Blood Type Antigen Donor Ea $315 $205 $245 $92 86904 Blood Typing Patient Serum 86905 Blood Typing Rbc Antigens 86906 Bld Typing Serologic Rh Phnt 86910 Blood Typing Paternity Test 86911 Blood Typing Antigen System 86920 300 Compatibility Test Spin $54 $35 $42 $18 86921 Compatibility Test Incubate 86922 300 Compatibility Test Antiglob $179 $116 $139 $59 86923 Compatibility Test Electric 86927 Plasma Fresh Frozen 86930 Frozen Blood Prep 86931 Frozen Blood Thaw 86932 Frozen Blood Freeze/Thaw 86940 Hemolysins/Agglutinins Auto 86941 Hemolysins/Agglutinins 86945 Blood Product/Irradiation 86950 Leukacyte Transfusion 86960 Vol Reduction Of Blood/Prod 86965 Pooling Blood Platelets 86970 Rbc Pretx Incubatj W/Chemicl 86971 Rbc Pretx Incubatj W/Enzymes 86972 Rbc Pretx Incubatj W/Density 86975 Rbc Serum Pretx Incubj Drugs 86976 Rbc Serum Pretx Id Dilution 86977 Rbc Serum Pretx Incubj/Inhib 86978 Rbc Pretreatment Serum 86985 Split Blood Or Products 86999 Transfusion Procedure 87003 Small Animal Inoculation 87015 306 Specimen Infect Agnt Concntj $14 $9 $11 $5 87040 306 Blood Culture For Bacteria $131 $85 $102 $39 87045 306 Feces Culture Aerobic Bact $40 $26 $31 $13 87046 300 Stool Cultr Aerobic Bact Ea $72 $47 $56 $22 87070 306 Culture Othr Specimn Aerobic $142 $92 $110 $42 87071 Culture Aerobic Quant Other 87073 Culture Bacteria Anaerobic 87075 306 Cultr Bacteria Except Blood $147 $96 $114 $44 87076 306 Culture Anaerobe Ident Each $135 $88 $105 $40 87077 306 Culture Aerobic Identify $75 $49 $58 $23 87077 306 Culture Aerobic Identify $75 $49 $58 $23 87081 306 Culture Screen Only $72 $47 $56 $22 87084 Culture Of Specimen By Kit 87086 306 Urine Culture/Colony Count $123 $80 $95 $37 87088 Urine Bacteria Culture 87101 306 Skin Fungi Culture $196 $127 $152 $58 87102 306 Fungus Isolation Culture $65 $42 $50 $20 87103 Blood Fungus Culture 87106 306 Fungi Identification Yeast $158 $103 $123 $47 87107 306 Fungi Identification Mold $163 $106 $127 $48 87109 306 Mycoplasma $206 $134 $160 $61 87110 306 Chlamydia Culture $61 $40 $47 $20 87116 306 Mycobacteria Culture $111 $72 $86 $33 87118 306 Mycobacteric Identification $235 $153 $182 $70 87140 306 Culture Type Immunofluoresc $61 $40 $47 $18 87143 Culture Typing Glc/Hplc 87147 306 Culture Type Immunologic $39 $25 $30 $12 87149 306 Dna/Rna Direct Probe $71 $46 $55 $23 87150 306 Dna/Rna Amplified Probe $212 $138 $165 $65 87152 Culture Type Pulse Field Gel 87153 306 Dna/Rna Sequencing $642 $417 $498 $199 87158 Culture Typing Added Method 87164 Dark Field Examination 87164 Dark Field Examination 87166 Dark Field Examination 87168 306 Macroscopic Exam Arthropod $191 $124 $148 $56 $4 87169 306 Macroscopic Exam Parasite $191 $124 $148 $56 87172 306 Pinworm Exam $102 $66 $79 $30 $25 87176 306 Tissue Homogenization Cultr $66 $43 $51 $20 87177 306 Ova And Parasites Smears $158 $103 $123 $47 87181 306 Microbe Susceptible Diffuse $29 $19 $23 $9 87184 306 Microbe Susceptible Disk $105 $68 $82 $31 87185 306 Microbe Susceptible Enzyme $30 $20 $23 $9 87186 306 Microbe Susceptible Mic $338 $220 $262 $99 87187 Microbe Susceptible Mlc 87188 Microbe Suscept Macrobroth 87190 Microbe Suscept Mycobacteri 87197 Bactericidal Level Serum 87205 306 Smear Gram Stain $47 $31 $36 $14 87206 306 Smear Fluorescent/Acid Stai $120 $78 $93 $35 87207 306 Smear Special Stain $57 $37 $44 $17 87207 306 Smear Special Stain $57 $37 $44 $19 87209 306 Smear Complex Stain $158 $103 $123 $48 87210 306 Smear Wet Mount Saline/Ink $98 $64 $76 $29 87210 306 Smear Wet Mount Saline/Ink $98 $64 $76 $29 87220 306 Tissue Exam For Fungi $77 $50 $60 $23 87230 Assay Toxin Or Antitoxin 87250 Virus Inoculate Eggs/Animal 87252 306 Virus Inoculation Tissue $296 $192 $230 $89 87253 306 Virus Inoculate Tissue Addl $76 $49 $59 $24 87254 306 Virus Inoculation Shell Via $137 $89 $106 $42 87255 306 Genet Virus Isolate Hsv $162 $105 $126 $51 87260 Adenovirus Ag If 87265 Pertussis Ag If 87267 Enterovirus Antibody Dfa 87269 Giardia Ag If 87270 Chlamydia Trachomatis Ag If 87271 Cytomegalovirus Dfa 87272 Cryptosporidium Ag If 87273 Herpes Simplex 2 Ag If 87274 Herpes Simplex 1 Ag If 87275 Influenza B Ag If 87276 Influenza A Ag If 87278 Legion Pneumophilia Ag If 87279 Parainfluenza Ag If 87280 Respiratory Syncytial Ag If 87281 Pneumocystis Carinii Ag If 87283 Rubeola Ag If 87285 Treponema Pallidum Ag If 87290 Varicella Zoster Ag If 87299 Antibody Detection Nos If 87300 Ag Detection Polyval If 87301 Adenovirus Ag Ia 87305 306 Aspergillus Ag Ia $204 $133 $158 $60 87320 Chylmd Trach Ag Ia 87324 306 Clostridium Ag Ia $42 $27 $33 $14 87327 Cryptococcus Neoform Ag Ia 87328 306 Cryptosporidium Ag Ia $415 $270 $322 $122 87329 306 Giardia Ag Ia $218 $142 $169 $64 87332 Cytomegalovirus Ag Ia 87335 E Coli 0157 Ag Ia 87336 Entamoeb Hist Dispr Ag Ia 87337 306 Entamoeb Hist Group Ag Ia $330 $215 $256 $97 87338 306 Hpylori Stool Ag Ia $370 $241 $287 $109 $63 87338 306 Hpylori Stool Ia $370 $241 $287 $109 $63 87339 H Pylori Ag Ia 87340 306 Hepatitis B Surface Ag Ia $183 $119 $142 $54 87341 306 Hepatitis B Surface Ag Ia $155 $101 $120 $46 87350 306 Hepatitis Be Ag Ia $56 $36 $43 $18 87380 Hepatitis Delta Agent Ag Ia 87385 306 Histoplasma Capsul Ag Ia $345 $224 $268 $101 87389 306 Hiv-1 Ag W/Hiv-1&2 Ab Ag Ia $201 $131 $156 $61 87389 306 Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab $201 $131 $156 $61 87390 306 Hiv-1 Ag Ia $303 $197 $235 $90 87391 Hiv-2 Ag Ia 87400 306 Influenza A/B Each Ag Ia $193 $125 $150 $57 87420 306 Resp Syncytial Virus Ag Ia $41 $27 $32 $14 87425 306 Rotavirus Ag Ia $39 $25 $30 $13 87426 Sarscov Coronavirus Ag Ia 87427 Shiga-Like Toxin Ag Ia 87428 Sarscov & Inf Vir A&B Ag Ia 87430 Strep A Ag Ia 87449 306 Nos Each Organism Ag Ia $334 $217 $259 $98 87449 306 Ag Detect Nos Ia Mult $334 $217 $259 $98 87450 Ag Detect Nos Ia Single 87451 Polyvalent Mult Org Ea Ag Ia 87471 Bartonella Dna Amp Probe 87472 Bartonella Dna Quant 87475 Lyme Dis Dna Dir Probe 87476 306 Lyme Dis Dna Amp Probe $252 $164 $196 $77 87480 Candida Dna Dir Probe 87481 Candida Dna Amp Probe 87482 Candida Dna Quant 87483 306 Cns Dna Amp Probe Type 12-25 $1,987 $1,292 $1,543 $624 87485 Chylmd Pneum Dna Dir Probe 87486 306 Chylmd Pneum Dna Amp Probe $537 $349 $417 $159 87487 Chylmd Pneum Dna Quant 87490 Chylmd Trach Dna Dir Probe 87491 306 Chylmd Trach Dna Amp Probe $216 $140 $168 $67 87492 Chylmd Trach Dna Quant 87493 306 C Diff Amplified Probe $240 $156 $186 $74 87495 Cytomeg Dna Dir Probe 87496 306 Cytomeg Dna Amp Probe $195 $127 $151 $61 87497 306 Cytomeg Dna Quant $155 $101 $120 $50 87498 306 Enterovirus Probe&Revrs Trns $252 $164 $196 $77 87500 Vanomycin Dna Amp Probe 87501 Influenza Dna Amp Prob 1+ 87502 Influenza Dna Amp Probe 87502 Influenza Dna Amp Probe 87503 Influenza Dna Amp Prob Addl 87505 Nfct Agent Detection Gi 87506 306 Iadna-Dna/Rna Probe Tq 6-11 $692 $450 $537 $231 87507 Iadna-Dna/Rna Probe Tq 12-25 87510 Gardner Vag Dna Dir Probe 87511 Gardner Vag Dna Amp Probe 87512 Gardner Vag Dna Quant 87516 Hepatitis B Dna Amp Probe 87517 306 Hepatitis B Dna Quant $204 $133 $158 $64 87520 Hepatitis C Rna Dir Probe 87521 Hepatitis C Probe&Rvrs Trnsc 87522 306 Hepatitis C Revrs Trnscrpj $1,286 $836 $998 $377 87525 Hepatitis G Dna Dir Probe 87526 Hepatitis G Dna Amp Probe 87527 Hepatitis G Dna Quant 87528 Hsv Dna Dir Probe 87529 306 Hsv Dna Amp Probe $162 $105 $126 $51 87530 Hsv Dna Quant 87531 Hhv-6 Dna Dir Probe 87532 306 Hhv-6 Dna Amp Probe $198 $129 $154 $61 87533 Hhv-6 Dna Quant 87534 Hiv-1 Dna Dir Probe 87535 306 Hiv-1 Probe&Reverse Trnscrpj $137 $89 $106 $44 87536 306 Hiv-1 Quant&Revrse Trnscrpj $533 $346 $414 $164 87537 Hiv-2 Dna Dir Probe 87538 306 Hiv-2 Probe&Revrse Trnscripj $785 $510 $609 $231 87539 Hiv-2 Quant&Revrse Trnscripj 87540 Legion Pneumo Dna Dir Prob 87541 Legion Pneumo Dna Amp Prob 87542 Legion Pneumo Dna Quant 87550 Mycobacteria Dna Dir Probe 87551 Mycobacteria Dna Amp Probe 87552 Mycobacteria Dna Quant 87555 M.Tuberculo Dna Dir Probe 87556 306 M.Tuberculo Dna Amp Probe $418 $272 $325 $126 87557 M.Tuberculo Dna Quant 87560 M.Avium-Intra Dna Dir Prob 87561 M.Avium-Intra Dna Amp Prob 87562 M.Avium-Intra Dna Quant 87563 M. Genitalium Amp Probe 87580 M.Pneumon Dna Dir Probe 87581 306 M.Pneumon Dna Amp Probe $143 $93 $111 $46 87582 M.Pneumon Dna Quant 87590 N.Gonorrhoeae Dna Dir Prob 87591 306 N.Gonorrhoeae Dna Amp Prob $175 $114 $136 $55 87592 N.Gonorrhoeae Dna Quant 87623 Hpv Low-Risk Types 87624 306 Hpv High-Risk Types $119 $77 $92 $39 87625 306 Hpv Types 16 & 18 Only $162 $105 $126 $52 87631 306 Resp Virus 3-5 Targets $533 $346 $414 $171 87631 306 Resp Virus 3-5 Targets $533 $346 $414 $171 87632 306 Resp Virus 6-11 Targets $885 $575 $687 $282 87633 306 Resp Virus 12-25 Targets $2,333 $1,516 $1,811 $724 87633 306 Resp Virus 12-25 Targets $2,333 $1,516 $1,811 $724 87634 Rsv Dna/Rna Amp Probe 87634 Rsv Dna/Rna Amp Probe 87635 306 Sars-Cov-2 Covid-19 Amp Prb $248 $161 $193 $81 87636 Sarscov2 & Inf A&B Amp Prb 87637 Sarscov2&Inf A&B&Rsv Amp Prb 87640 Staph A Dna Amp Probe 87641 Mr-Staph Dna Amp Probe 87650 Strep A Dna Dir Probe 87650 Strep A Dna Dir Probe 87651 Strep A Dna Amp Probe 87651 Strep A Dna Amp Probe 87652 Strep A Dna Quant 87653 Strep B Dna Amp Probe 87660 Trichomonas Vagin Dir Probe 87661 306 Trichomonas Vaginalis Amplif $147 $96 $114 $47 87662 306 Zika Virus Dna/Rna Amp Probe $641 $417 $498 $191 87797 Detect Agent Nos Dna Dir 87798 300 Detect Agent Nos Dna Amp $563 $366 $437 $167 87799 306 Detect Agent Nos Dna Quant $171 $111 $133 $55 87800 Detect Agnt Mult Dna Direc 87801 306 Detect Agnt Mult Dna Ampli $417 $271 $324 $129 87801 306 Detect Agnt Mult Dna Ampli $417 $271 $324 $129 87802 Strep B Assay W/Optic 87803 Clostridium Toxin A W/Optic 87804 302 Influenza Assay W/Optic $43 $28 $33 $14 87804 302 Influenza Assay W/Optic $43 $28 $33 $14 87806 301 Hiv W/Hiv1&2 Antb W/Optic $92 $60 $72 $31 87806 301 Hiv Antigen W/Hiv Antibodies $92 $60 $72 $31 87807 300 Rsv Assay W/Optic $197 $128 $153 $59 87807 300 Rsv Assay W/Optic $197 $128 $153 $59 87808 Trichomonas Assay W/Optic 87808 Trichomonas Assay W/Optic 87809 Adenovirus Assay W/Optic 87809 Adenovirus Assay W/Optic 87810 Chylmd Trach Assay W/Optic 87811 Sars-Cov-2 Covid19 W/Optic 87850 N. Gonorrhoeae Assay W/Optic 87880 306 Strep A Assay W/Optic $141 $92 $109 $43 87880 306 Strep A Assay W/Optic $141 $92 $109 $43 87899 306 Agent Nos Assay W/Optic $177 $115 $137 $53 $0 87899 306 Agent Nos Assay W/Optic $177 $115 $137 $53 $0 87900 306 Phenotype Infect Agent Drug $456 $296 $354 $147 87901 306 Genotype Dna Hiv Reverse T $901 $586 $699 $291 87902 306 Genotype Dna/Rna Hep C $1,286 $836 $998 $402 87903 Phenotype Dna Hiv W/Culture 87904 Phenotype Dna Hiv W/Clt Add 87905 Sialidase Enzyme Assay 87905 Sialidase Enzyme Assay 87906 Genotype Dna/Rna Hiv 87910 Genotype Cytomegalovirus 87912 306 Genotype Dna Hepatitis B $1,052 $684 $817 $335 87999 306 Microbiology Procedure $87 $57 $68 $29 88000 Autopsy (Necropsy) Gross 88005 Autopsy (Necropsy) Gross 88007 Autopsy (Necropsy) Gross 88012 Autopsy (Necropsy) Gross 88014 Autopsy (Necropsy) Gross 88016 Autopsy (Necropsy) Gross 88020 Autopsy (Necropsy) Complete 88025 Autopsy (Necropsy) Complete 88027 Autopsy (Necropsy) Complete 88028 Autopsy (Necropsy) Complete 88029 Autopsy (Necropsy) Complete 88036 Limited Autopsy 88037 Limited Autopsy 88040 Forensic Autopsy (Necropsy) 88045 Coroners Autopsy (Necropsy) 88099 Necropsy (Autopsy) Procedure 88104 311 Cytopath Fl Nongyn Smears $172 $112 $134 $56 88104 311 Cytopath Fl Nongyn Smears $172 $112 $134 $56 88104 311 Cytopath Fl Nongyn Smears $172 $112 $134 $56 88106 Cytopath Fl Nongyn Filter 88106 Cytopath Fl Nongyn Filter 88106 Cytopath Fl Nongyn Filter 88108 311 Cytopath Concentrate Tech $180 $117 $140 $59 88108 311 Cytopath Concentrate Tech $180 $117 $140 $59 88108 311 Cytopath Concentrate Tech $180 $117 $140 $59 88112 Cytopath Cell Enhance Tech 88112 Cytopath Cell Enhance Tech 88112 Cytopath Cell Enhance Tech 88120 Cytp Urne 3-5 Probes Ea Spec 88120 Cytp Urne 3-5 Probes Ea Spec 88120 Cytp Urne 3-5 Probes Ea Spec 88121 Cytp Urine 3-5 Probes Cmptr 88121 Cytp Urine 3-5 Probes Cmptr 88121 Cytp Urine 3-5 Probes Cmptr 88125 Forensic Cytopathology 88125 Forensic Cytopathology 88125 Forensic Cytopathology 88130 Sex Chromatin Identification 88140 Sex Chromatin Identification 88141 Cytopath C/V Interpret $81 $53 $63 $27 $13 88142 Cytopath C/V Thin Layer 88143 Cytopath C/V Thin Layer Redo 88147 Cytopath C/V Automated 88148 Cytopath C/V Auto Rescreen 88150 Cytopath C/V Manual 88152 Cytopath C/V Auto Redo 88153 Cytopath C/V Redo 88155 Cytopath C/V Index Add-On 88160 311 Cytopath Smear Other Source $177 $115 $137 $58 88160 311 Cytopath Smear Other Source $177 $115 $137 $58 88160 311 Cytopath Smear Other Source $177 $115 $137 $58 88161 311 Cytopath Smear Other Source $137 $89 $106 $45 88161 311 Cytopath Smear Other Source $137 $89 $106 $45 88161 311 Cytopath Smear Other Source $137 $89 $106 $45 88162 Cytopath Smear Other Source 88162 Cytopath Smear Other Source 88162 Cytopath Smear Other Source 88164 311 Cytopath Tbs C/V Manual $138 $90 $107 $42 88165 Cytopath Tbs C/V Redo 88166 Cytopath Tbs C/V Auto Redo 88167 Cytopath Tbs C/V Select 88172 311 Cytp Dx Eval Fna 1St Ea Site $245 $159 $190 $80 88172 311 Cytp Dx Eval Fna 1St Ea Site $245 $159 $190 $80 88172 311 Cytp Dx Eval Fna 1St Ea Site $245 $159 $190 $80 88173 311 Cytopath Eval Fna Report $245 $159 $190 $80 88173 311 Cytopath Eval Fna Report $245 $159 $190 $80 88173 311 Cytopath Eval Fna Report $245 $159 $190 $80 88174 Cytopath C/V Auto In Fluid 88175 311 Cytopath C/V Auto Fluid Redo $168 $109 $130 $52 88177 311 Cytp Fna Eval Ea Addl $29 $19 $23 $10 88177 311 Cytp Fna Eval Ea Addl $29 $19 $23 $10 88177 311 Cytp Fna Eval Ea Addl $29 $19 $23 $10 88182 Cell Marker Study 88182 Cell Marker Study 88182 Cell Marker Study 88184 311 Flowcytometry/ Tc 1 Marker $259 $168 $201 $85 88185 311 Flowcytometry/Tc Add-On $53 $34 $41 $17 88187 311 Flowcytometry/Read 2-8 $205 $133 $159 $67 88188 Flowcytometry/Read 9-15 $285 $185 $221 $93 $34 88189 Flowcytometry/Read 16 & > $385 $250 $299 $126 $87 88199 Cytopathology Procedure 88199 Cytopathology Procedure 88199 Cytopathology Procedure 88230 311 Tissue Culture Lymphocyte $326 $212 $253 $108 $0 88233 Tissue Culture Skin/Biopsy 88235 312 Tissue Culture Placenta $294 $191 $228 $103 88237 311 Tissue Culture Bone Marrow $628 $408 $488 $199 88239 Tissue Culture Tumor 88240 Cell Cryopreserve/Storage 88241 Frozen Cell Preparation 88245 Chromosome Analysis 20-25 88248 Chromosome Analysis 50-100 88249 Chromosome Analysis 100 88261 Chromosome Analysis 5 88262 311 Chromosome Analysis 15-20 $439 $285 $341 $142 $0 88263 Chromosome Analysis 45 88264 311 Chromosome Analysis 20-25 $620 $403 $481 $196 88267 Chromosome Analys Placenta 88269 311 Chromosome Analys Amniotic $305 $198 $237 $109 88271 311 Cytogenetics Dna Probe $125 $81 $97 $39 88272 Cytogenetics 3-5 88273 311 Cytogenetics 10-30 $180 $117 $140 $56 88274 Cytogenetics 25-99 88275 312 Cytogenetics 100-300 $226 $147 $175 $71 88280 312 Chromosome Karyotype Study $126 $82 $98 $40 88283 Chromosome Banding Study 88285 312 Chromosome Count Additional $72 $47 $56 $24 88289 Chromosome Study Additional 88291 311 Cyto/Molecular Report $346 $225 $269 $113 88299 Cytogenetic Study 88300 312 Surgical Path Gross $88 $57 $68 $29 88300 312 Surgical Path Gross $88 $57 $68 $29 88300 312 Surgical Path Gross $88 $57 $68 $29 88302 312 Tissue Exam By Pathologist $235 $153 $182 $77 88302 312 Tissue Exam By Pathologist $235 $153 $182 $77 88302 312 Tissue Exam By Pathologist $235 $153 $182 $77 88304 312 Tissue Exam By Pathologist $286 $186 $222 $94 88304 312 Tissue Exam By Pathologist $286 $186 $222 $94 88304 312 Tissue Exam By Pathologist $286 $186 $222 $94 88305 312 Tissue Exam By Pathologist $448 $291 $348 $147 88305 312 Tissue Exam By Pathologist $448 $291 $348 $147 88305 312 Tissue Exam By Pathologist $448 $291 $348 $147 88307 312 Tissue Exam By Pathologist $623 $405 $484 $204 88307 312 Tissue Exam By Pathologist $623 $405 $484 $204 88307 312 Tissue Exam By Pathologist $623 $405 $484 $204 88309 312 Tissue Exam By Pathologist $701 $456 $544 $230 88309 312 Tissue Exam By Pathologist $701 $456 $544 $230 88309 312 Tissue Exam By Pathologist $701 $456 $544 $230 88311 312 Decalcify Tissue $45 $29 $35 $15 88311 312 Decalcify Tissue $45 $29 $35 $15 88311 312 Decalcify Tissue $45 $29 $35 $15 88312 312 Special Stains Group 1 $53 $34 $41 $17 88312 312 Special Stains Group 1 $53 $34 $41 $17 88312 312 Special Stains Group 1 $53 $34 $41 $17 88313 312 Special Stains Group 2 $65 $42 $50 $21 88313 312 Special Stains Group 2 $65 $42 $50 $21 88313 312 Special Stains Group 2 $65 $42 $50 $21 88314 Histochemical Stains Add-On 88314 Histochemical Stains Add-On 88314 Histochemical Stains Add-On 88319 312 Enzyme Histochemistry $180 $117 $140 $59 88319 312 Enzyme Histochemistry $180 $117 $140 $59 88319 312 Enzyme Histochemistry $180 $117 $140 $59 88321 Microslide Consultation 88323 Microslide Consultation 88323 Microslide Consultation 88323 Microslide Consultation 88325 Comprehensive Review Of Data 88329 312 Path Consult Introp $100 $65 $78 $33 88331 312 Path Consult Intraop 1 Bloc $215 $140 $167 $70 88331 312 Path Consult Intraop 1 Bloc $215 $140 $167 $70 88331 312 Path Consult Intraop 1 Bloc $215 $140 $167 $70 88332 312 Path Consult Intraop Addl $181 $118 $141 $59 88332 312 Path Consult Intraop Addl $181 $118 $141 $59 88332 312 Path Consult Intraop Addl $181 $118 $141 $59 88333 Intraop Cyto Path Consult 1 88333 Intraop Cyto Path Consult 1 88333 Intraop Cyto Path Consult 1 88334 Intraop Cyto Path Consult 2 88334 Intraop Cyto Path Consult 2 88334 Intraop Cyto Path Consult 2 88341 312 Immunohisto Antb Addl Slide $184 $120 $143 $60 88341 312 Immunohisto Antb Addl Slide $184 $120 $143 $60 88341 312 Immunohisto Antb Addl Slide $184 $120 $143 $60 88342 312 Immunohisto Antb 1St Stain $265 $172 $206 $87 88342 312 Immunohisto Antb 1St Stain $265 $172 $206 $87 88342 312 Immunohisto Antb 1St Stain $265 $172 $206 $87 88344 312 Immunohisto Antibody Slide $184 $120 $143 $60 88344 312 Immunohisto Antibody Slide $184 $120 $143 $60 88344 312 Immunohisto Antibody Slide $184 $120 $143 $60 88346 312 Immunofluor Antb 1St Stain $283 $184 $220 $93 88346 312 Immunofluor Antb 1St Stain $283 $184 $220 $93 88346 312 Immunofluor Antb 1St Stain $283 $184 $220 $93 88348 312 Electron Microscopy $874 $568 $679 $286 88348 312 Electron Microscopy $874 $568 $679 $286 88348 312 Electron Microscopy $874 $568 $679 $286 88350 312 Immunofluor Antb Addl Stain $175 $114 $136 $57 88350 312 Immunofluor Antb Addl Stain $175 $114 $136 $57 88350 312 Immunofluor Antb Addl Stain $175 $114 $136 $57 88355 Analysis Skeletal Muscle 88355 Analysis Skeletal Muscle 88355 Analysis Skeletal Muscle 88356 Analysis Nerve 88356 Analysis Nerve 88356 Analysis Nerve 88358 Analysis Tumor $447 $291 $347 $146 88358 Analysis Tumor $447 $291 $347 $146 88358 Analysis Tumor $447 $291 $347 $146 88360 310 Tumor Immunohistochem/Manual $642 $417 $498 $210 $185 88360 310 Tumor Immunohistochem/Manual $642 $417 $498 $210 $185 88360 310 Tumor Immunohistochem/Manual $642 $417 $498 $210 $185 88361 Tumor Immunohistochem/Comput 88361 Tumor Immunohistochem/Comput 88361 Tumor Immunohistochem/Comput 88362 Nerve Teasing Preparations 88362 Nerve Teasing Preparations 88362 Nerve Teasing Preparations 88363 Xm Archive Tissue Molec Anal 88364 310 Insitu Hybridization (Fish) $357 $232 $277 $117 88364 310 Insitu Hybridization (Fish) $357 $232 $277 $117 88364 310 Insitu Hybridization (Fish) $357 $232 $277 $117 88365 312 Insitu Hybridization (Fish) $721 $469 $560 $236 88365 312 Insitu Hybridization (Fish) $721 $469 $560 $236 88365 312 Insitu Hybridization (Fish) $721 $469 $560 $236 88366 Insitu Hybridization (Fish) 88366 Insitu Hybridization (Fish) 88366 Insitu Hybridization (Fish) 88367 312 Insitu Hybridization Auto $400 $260 $311 $131 88367 312 Insitu Hybridization Auto $400 $260 $311 $131 88367 312 Insitu Hybridization Auto $400 $260 $311 $131 88368 312 Insitu Hybridization Manual $188 $122 $146 $62 88368 312 Insitu Hybridization Manual $188 $122 $146 $62 88368 312 Insitu Hybridization Manual $188 $122 $146 $62 88369 312 M/Phmtrc Alysishquant/Semiq $188 $122 $146 $62 88369 312 M/Phmtrc Alysishquant/Semiq $188 $122 $146 $62 88369 312 M/Phmtrc Alysishquant/Semiq $188 $122 $146 $62 88371 Protein Western Blot Tissue 88371 Protein Western Blot Tissue 88372 Protein Analysis W/Probe 88372 Protein Analysis W/Probe 88373 M/Phmtrc Alys Ishquant/Semiq 88373 M/Phmtrc Alys Ishquant/Semiq 88373 M/Phmtrc Alys Ishquant/Semiq 88374 312 M/Phmtrc Alys Ishquant/Semiq $1,155 $751 $897 $378 88374 312 M/Phmtrc Alys Ishquant/Semiq $1,155 $751 $897 $378 88374 312 M/Phmtrc Alys Ishquant/Semiq $1,155 $751 $897 $378 88375 Optical Endomicroscpy Interp 88377 312 M/Phmtrc Alys Ishquant/Semiq $925 $601 $718 $303 88377 312 M/Phmtrc Alys Ishquant/Semiq $925 $601 $718 $303 88377 312 M/Phmtrc Alys Ishquant/Semiq $925 $601 $718 $303 88380 Microdissection Laser 88380 Microdissection Laser 88380 Microdissection Laser 88381 312 Microdissection Manual $297 $193 $231 $97 88381 312 Microdissection Manual $297 $193 $231 $97 88381 312 Microdissection Manual $297 $193 $231 $97 88387 Tiss Exam Molecular Study 88387 Tiss Exam Molecular Study 88387 Tiss Exam Molecular Study 88388 Tiss Ex Molecul Study Add-On 88388 Tiss Ex Molecul Study Add-On 88388 Tiss Ex Molecul Study Add-On 88399 Surgical Pathology Procedure 88399 Surgical Pathology Procedure 88399 Surgical Pathology Procedure 88720 301 Bilirubin Total Transcut $30 $20 $23 $9 88738 Hgb Quant Transcutaneous 88740 Transcutaneous Carboxyhb 88741 Transcutaneous Methb 88749 In Vivo Lab Service 89049 Chct For Mal Hyperthermia 89050 305 Body Fluid Cell Count $70 $46 $54 $21 89051 305 Body Fluid Cell Count $131 $85 $102 $39 89055 301 Leukocyte Assessment Fecal $68 $44 $53 $20 89060 301 Exam Synovial Fluid Crystals $221 $144 $172 $65 89060 301 Exam Synovial Fluid Crystals $221 $144 $172 $72 89125 Specimen Fat Stain 89160 Exam Feces For Meat Fibers 89190 Nasal Smear For Eosinophils 89220 Sputum Specimen Collection 89230 Collect Sweat For Test 89240 Pathology Lab Procedure 89250 Cultr Oocyte/Embryo <4 Days 89251 Cultr Oocyte/Embryo <4 Days 89253 Embryo Hatching 89254 Oocyte Identification 89255 Prepare Embryo For Transfer 89257 Sperm Identification 89258 Cryopreservation Embryo(S) 89259 Cryopreservation Sperm 89260 Sperm Isolation Simple 89261 Sperm Isolation Complex 89264 Identify Sperm Tissue 89268 Insemination Of Oocytes 89272 Extended Culture Of Oocytes 89280 Assist Oocyte Fertilization 89281 Assist Oocyte Fertilization 89290 Biopsy Oocyte Polar Body 89291 Biopsy Oocyte Polar Body 89300 Semen Analysis W/Huhner 89300 Semen Analysis W/Huhner 89310 Semen Analysis W/Count $117 $76 $91 $35 $9 89320 312 Semen Anal Vol/Count/Mot $259 $168 $201 $76 89321 312 Semen Anal Sperm Detection $117 $76 $91 $35 $0 89321 312 Semen Anal Sperm Detection $117 $76 $91 $35 $0 89322 Semen Anal Strict Criteria $259 $168 $201 $77 $15 89325 312 Sperm Antibody Test $62 $40 $48 $19 89329 Sperm Evaluation Test 89330 Evaluation Cervical Mucus 89331 Retrograde Ejaculation Anal 89335 Cryopreserve Testicular Tiss 89337 Cryopreservation Oocyte(S) 89342 Storage/Year Embryo(S) 89343 Storage/Year Sperm/Semen 89344 Storage/Year Reprod Tissue 89346 Storage/Year Oocyte(S) 89352 Thawing Cryopresrved Embryo 89353 Thawing Cryopresrved Sperm 89354 Thaw Cryoprsvrd Reprod Tiss 89356 Thawing Cryopresrved Oocyte 89398 Unlisted Reprod Med Lab Proc 9001F Aortic Aneurysm<5Cm Diam Ct 9002F Aortic Aneurysm 5-5.4Cm Diam 9003F Aortic Anrysm5.5-5.9Cm Diam 9004F Aortic Anrysm 6/> Cm Diam 9005F Asympt Carot/Vrtbrbas Sten 9006F Sympt Sten-Tia/Strk<120Days 9007F Other Carot Sten 120 Days/> 90281 Human Ig Im 90283 Human Ig Iv 90284 Human Ig Sc 90287 Botulinum Antitoxin 90288 Botulism Ig Iv 90291 Cmv Ig Iv 90296 Diphtheria Antitoxin 90371 Hep B Ig Im 90375 Rabies Ig Im/Sc $967 $629 $751 $317 90376 Rabies Ig Heat Treated 90377 Rabies Ig Ht&Sol Human Im/Sc 90378 636 Rsv Mab Im 50Mg $2,220 $1,443 $1,724 $728 90384 Rh Ig Full-Dose Im 90385 Rh Ig Minidose Im 90386 Rh Ig Iv 90389 Tetanus Ig Im 90393 Vaccina Ig Im 90396 Varicella-Zoster Ig Im 90399 Immune Globulin 90460 771 Im Admin 1St/Only Component $51 $33 $40 $17 90461 771 Im Admin Each Addl Component $46 $30 $36 $15 90471 771 Immunization Admin $51 $33 $40 $17 90472 771 Immunization Admin Each Add $46 $30 $36 $15 90473 771 Immune Admin Oral/Nasal $24 $16 $19 $8 90474 771 Immune Admin Oral/Nasal Addl $16 $10 $12 $5 90476 Adenovirus Vaccine Type 4 90477 Adenovirus Vaccine Type 7 90581 Anthrax Vaccine Sc Or Im 90585 Bcg Vaccine Percut 90586 Bcg Vaccine Intravesical 90587 Dengue Vacc Quad 3 Dose Subq 90619 Menacwy-Tt Vaccine Im 90620 636 Menb-4C Vacc 2 Dose Im $236 $153 $183 $77 90621 Menb-Fhbp Vacc 2/3 Dose Im 90625 Cholera Vaccine Live Oral 90630 Flu Vacc Iiv4 No Preserv Id 90632 636 Hepa Vaccine Adult Im $424 $276 $329 $139 $109 90633 636 Hepa Vacc Ped/Adol 2 Dose Im $475 $309 $369 $156 $137 90634 636 Hepa Vacc Ped/Adol 3 Dose $169 $110 $131 $55 90636 636 Hep A/Hep B Vacc Adult Im $152 $99 $118 $50 90644 Hib-Mency Vacc 6Wk-18M0 Im 90647 636 Hib Prp-Omp Vacc 3 Dose Im $117 $76 $91 $38 $0 90648 636 Hib Prp-T Vaccine 4 Dose Im $117 $76 $91 $38 90649 636 4Vhpv Vaccine 3 Dose Im $606 $394 $470 $199 90650 2Vhpv Vaccine 3 Dose Im 90651 636 9Vhpv Vaccine 2/3 Dose Im $509 $331 $395 $167 $106 90653 636 Iiv Adjuvant Vaccine Im $46 $30 $36 $15 90654 Flu Vacc Iiv3 No Preserv Id 90655 Iiv3 Vacc No Prsv 0.25 Ml Im 90656 Iiv3 Vacc No Prsv 0.5 Ml Im 90657 Iiv3 Vaccine Splt 0.25 Ml Im 90658 Iiv3 Vaccine Splt 0.5 Ml Im 90660 Laiv3 Vaccine Intranasal 90661 Cciiv3 Vac No Prsv 0.5 Ml Im 90662 636 Iiv No Prsv Increased Ag Im $40 $26 $31 $13 90664 Laiv Vacc Pandemic Intranasl 90666 Flu Vac Pandem Prsrv Free Im 90667 Iiv Vacc Pandemic Adjuvt Im 90668 Iiv Vaccine Pandemic Im 90670 636 Pcv13 Vaccine Im $396 $257 $307 $130 90672 636 Laiv4 Vaccine Intranasal $21 $14 $16 $7 90673 636 Riv3 Vaccine No Preserv Im $41 $27 $32 $13 90674 Cciiv4 Vac No Prsv 0.5 Ml Im 90675 636 Rabies Vaccine Im $935 $608 $726 $306 90676 Rabies Vaccine Id 90680 636 Rv5 Vacc 3 Dose Live Oral $317 $206 $246 $104 90681 Rv1 Vacc 2 Dose Live Oral 90682 636 Riv4 Vacc Recombinant Dna Im $49 $32 $38 $16 90685 636 Iiv4 Vacc No Prsv 0.25 Ml Im $23 $15 $18 $8 90686 636 Iiv4 Vacc No Prsv 0.5 Ml Im $22 $14 $17 $7 90687 Iiv4 Vaccine Splt 0.25 Ml Im 90688 Iiv4 Vaccine Splt 0.5 Ml Im 90689 Vacc Iiv4 No Prsrv 0.25Ml Im 90690 Typhoid Vaccine Oral 90691 636 Typhoid Vaccine Im $172 $112 $134 $56 90694 636 Vacc Aiiv4 No Prsrv 0.5Ml Im $45 $29 $35 $15 90696 636 Dtap-Ipv Vaccine 4-6 Yrs Im $259 $168 $201 $85 90697 Dtap-Ipv-Hib-Hepb Vaccine Im 90698 636 Dtap-Ipv/Hib Vaccine Im $315 $205 $245 $103 90700 636 Dtap Vaccine < 7 Yrs Im $124 $81 $96 $41 90702 636 Dt Vaccine Under 7 Yrs Im $35 $23 $27 $11 90707 636 Mmr Vaccine Sc $174 $113 $135 $57 90710 636 Mmrv Vaccine Sc $444 $289 $345 $145 $133 90713 636 Poliovirus Ipv Sc/Im $143 $93 $111 $47 90714 636 Td Vacc No Presv 7 Yrs+ Im $115 $75 $89 $38 90715 636 Tdap Vaccine 7 Yrs/> Im $124 $81 $96 $41 90716 636 Var Vaccine Live Subq $302 $196 $234 $99 90717 Yellow Fever Vaccine Subq 90723 636 Dtap-Hep B-Ipv Vaccine Im $355 $231 $276 $116 90732 636 Ppsv23 Vacc 2 Yrs+ Subq/Im $105 $68 $82 $34 90733 Mpsv4 Vaccine Subq 90734 636 Menacwyd/Menacwycrm Vacc Im $256 $166 $199 $84 90736 Hzv Vaccine Live Subq 90738 Inactivated Je Vacc Im 90739 Hepb Vacc 2 Dose Adult Im 90740 Hepb Vacc 3 Dose Immunsup Im 90743 Hepb Vacc 2 Dose Adolesc Im 90744 636 Hepb Vacc 3 Dose Ped/Adol Im $169 $110 $131 $55 90746 636 Hepb Vaccine 3 Dose Adult Im $391 $254 $304 $128 $103 90747 Hepb Vacc 4 Dose Immunsup Im 90748 Hib-Hepb Vaccine Im 90749 Vaccine Toxoid 90750 636 Hzv Vacc Recombinant Im $203 $132 $158 $67 90756 Cciiv4 Vacc Abx Free Im 90785 Psytx Complex Interactive 90791 900 Psych Diagnostic Evaluation $399 $259 $310 $131 $120 90792 914 Psych Diag Eval W/Med Srvcs $413 $268 $321 $135 90832 510 Psytx W Pt 30 Minutes $72 $47 $56 $24 90833 Psytx W Pt W E/M 30 Min 90834 510 Psytx W Pt 45 Minutes $239 $155 $186 $78 $74 90836 510 Psytx W Pt W E/M 45 Min $85 $55 $66 $28 90837 510 Psytx W Pt 60 Minutes $391 $254 $304 $128 $100 90838 Psytx W Pt W E/M 60 Min 90839 459 Psytx Crisis Initial 60 Min $1,298 $844 $1,008 $425 90840 Psytx Crisis Ea Addl 30 Min 90845 Psychoanalysis 90846 510 Family Psytx W/O Pt 50 Min $119 $77 $93 $39 $18 90847 510 Family Psytx W/Pt 50 Min $128 $83 $99 $42 $32 90849 916 Multiple Family Group Psytx $84 $55 $65 $28 90853 915 Group Psychotherapy $107 $69 $83 $35 90863 Pharmacologic Mgmt W/Psytx 90865 Narcosynthesis 90867 Tcranial Magn Stim Tx Plan 90868 Tcranial Magn Stim Tx Deli 90869 Tcran Magn Stim Redetemine 90870 901 Electroconvulsive Therapy $628 $408 $488 $206 90875 Psychophysiological Therapy 90876 Psychophysiological Therapy 90880 Hypnotherapy 90882 900 Environmental Manipulation $198 $128 $153 $65 $15 90885 Psy Evaluation Of Records 90887 Consultation With Family 90889 Preparation Of Report 90899 Psychiatric Service/Therapy 90901 430 Biofeedback Train Any Meth $105 $68 $82 $32 90912 Bfb Training 1St 15 Min 90913 Bfb Training Ea Addl 15 Min 90935 Hemodialysis One Evaluation $230 $150 $179 $76 90937 Hemodialysis Repeated Eval 90940 Hemodialysis Access Study 90945 Dialysis One Evaluation $266 $173 $207 $87 90947 Dialysis Repeated Eval 90951 Esrd Serv 4 Visits P Mo <2Yr 90952 Esrd Serv 2-3 Vsts P Mo <2Yr 90953 Esrd Serv 1 Visit P Mo <2Yrs 90954 Esrd Serv 4 Vsts P Mo 2-11 90955 Esrd Srv 2-3 Vsts P Mo 2-11 90956 Esrd Srv 1 Visit P Mo 2-11 90957 Esrd Srv 4 Vsts P Mo 12-19 90958 Esrd Srv 2-3 Vsts P Mo 12-19 90959 Esrd Serv 1 Vst P Mo 12-19 90960 Esrd Srv 4 Visits P Mo 20+ $901 $586 $699 $295 $262 90961 Esrd Srv 2-3 Vsts P Mo 20+ $754 $490 $586 $247 $231 90962 Esrd Serv 1 Visit P Mo 20+ 90963 Esrd Home Pt Serv P Mo <2Yrs 90964 Esrd Home Pt Serv P Mo 2-11 90965 Esrd Home Pt Serv P Mo 12-19 90966 Esrd Home Pt Serv P Mo 20+ $732 $476 $568 $240 $214 90967 Esrd Svc Pr Day Pt <2 90968 Esrd Svc Pr Day Pt 2-11 90969 Esrd Svc Pr Day Pt 12-19 90970 Esrd Svc Pr Day Pt 20+ 90989 Dialysis Training Complete 90993 Dialysis Training Incompl 90997 Hemoperfusion 90999 Dialysis Procedure 91010 750 Esophagus Motility Study $1,208 $785 $938 $396 91010 750 Esophagus Motility Study $1,208 $785 $938 $396 91010 750 Esophagus Motility Study $1,208 $785 $938 $396 91013 Esophgl Motil W/Stim/Perfus 91013 Esophgl Motil W/Stim/Perfus 91013 Esophgl Motil W/Stim/Perfus 91020 Gastric Motility Studies 91020 Gastric Motility Studies 91020 Gastric Motility Studies 91022 Duodenal Motility Study 91022 Duodenal Motility Study 91022 Duodenal Motility Study 91030 Acid Perfusion Of Esophagus 91030 Acid Perfusion Of Esophagus 91030 Acid Perfusion Of Esophagus 91034 Gastroesophageal Reflux Test 91034 Gastroesophageal Reflux Test 91034 Gastroesophageal Reflux Test 91035 G-Esoph Reflx Tst W/Electrod 91035 G-Esoph Reflx Tst W/Electrod 91035 G-Esoph Reflx Tst W/Electrod 91037 Esoph Imped Function Test 91037 Esoph Imped Function Test 91037 Esoph Imped Function Test 91038 750 Esoph Imped Funct Test > 1Hr $1,208 $785 $938 $396 91038 750 Esoph Imped Funct Test > 1Hr $1,208 $785 $938 $396 91038 750 Esoph Imped Funct Test > 1Hr $1,208 $785 $938 $396 91040 Esoph Balloon Distension Tst 91040 Esoph Balloon Distension Tst 91040 Esoph Balloon Distension Tst 91065 Breath Hydrogen/Methane Test 91065 Breath Hydrogen/Methane Test 91065 Breath Hydrogen/Methane Test 91110 510 Gi Tract Capsule Endoscopy $2,237 $1,454 $1,737 $733 $504 91110 510 Gi Tract Capsule Endoscopy $2,237 $1,454 $1,737 $733 $504 91110 510 Gi Tract Capsule Endoscopy $2,237 $1,454 $1,737 $733 $504 91111 Esophageal Capsule Endoscopy 91111 Esophageal Capsule Endoscopy 91111 Esophageal Capsule Endoscopy 91112 Gi Wireless Capsule Measure 91112 Gi Wireless Capsule Measure 91112 Gi Wireless Capsule Measure 91117 Colon Motility 6 Hr Study 91120 Rectal Sensation Test $264 $172 $205 $87 91120 Rectal Sensation Test $264 $172 $205 $87 91120 Rectal Sensation Test $264 $172 $205 $87 91122 Anal Pressure Record 91122 Anal Pressure Record 91122 Anal Pressure Record 91132 Electrogastrography 91132 Electrogastrography 91132 Electrogastrography 91133 Electrogastrography W/Test 91133 Electrogastrography W/Test 91133 Electrogastrography W/Test 91200 402 Liver Elastography $343 $223 $266 $112 $75 91200 402 Liver Elastography $343 $223 $266 $112 $75 91200 402 Liver Elastography $343 $223 $266 $112 $75 91299 Gastroenterology Procedure 91299 Gastroenterology Procedure 91299 Gastroenterology Procedure 91300 Sarscov2 Vac 30Mcg/0.3Ml Im 91301 Sarscov2 Vac 100Mcg/0.5Ml Im 91302 Coronavirus Vaccine 3 91303 Coronavirus Vaccine 4 91304 Coronavirus Vaccine 5 91305 Coronavirus Vaccine 6 91306 Coronavirus Vaccine 7 91307 Coronavirus Vaccine 8 91308 Coronavirus Vaccine 9 91309 Coronavirus Vaccine 10 91310 Coronavirus Vaccine 11 92002 Eye Exam New Patient 92004 Eye Exam New Patient 92012 Eye Exam Establish Patient 92014 Eye Exam&Tx Estab Pt 1/>Vst 92015 Determine Refractive State 92018 New Eye Exam & Treatment 92019 Eye Exam & Treatment 92020 Special Eye Evaluation 92025 Corneal Topography 92025 Corneal Topography 92025 Corneal Topography 92060 Special Eye Evaluation 92060 Special Eye Evaluation 92060 Special Eye Evaluation 92065 510 Orthoptic/Pleoptic Training $97 $63 $76 $32 92065 510 Orthoptic/Pleoptic Training $97 $63 $76 $32 92065 510 Orthoptic/Pleoptic Training $97 $63 $76 $32 92071 Contact Lens Fitting For Tx 92072 Fit Contac Lens For Managmnt 92081 Visual Field Examination(S) 92081 Visual Field Examination(S) 92081 Visual Field Examination(S) 92082 Visual Field Examination(S) 92082 Visual Field Examination(S) 92082 Visual Field Examination(S) 92083 Visual Field Examination(S) 92083 Visual Field Examination(S) 92083 Visual Field Examination(S) 92100 Serial Tonometry Exam(S) 92132 Cmptr Ophth Dx Img Ant Segmt 92132 Cmptr Ophth Dx Img Ant Segmt 92132 Cmptr Ophth Dx Img Ant Segmt 92133 Cmptr Ophth Img Optic Nerve 92133 Cmptr Ophth Img Optic Nerve 92133 Cmptr Ophth Img Optic Nerve 92134 Cptr Ophth Dx Img Post Segmt 92134 Cptr Ophth Dx Img Post Segmt 92134 Cptr Ophth Dx Img Post Segmt 92136 Ophthalmic Biometry 92136 Ophthalmic Biometry 92136 Ophthalmic Biometry 92145 Corneal Hysteresis Deter 92145 Corneal Hysteresis Deter 92145 Corneal Hysteresis Deter 92201 Opscpy Extnd Rta Draw Uni/Bi 92202 Opscpy Extnd On/Mac Draw 92227 Img Rta Detcj/Mntr Ds Staff 92228 Img Rta Detc/Mntr Ds Phy/Qhp 92228 Img Rta Detc/Mntr Ds Phy/Qhp 92228 Img Rta Detc/Mntr Ds Phy/Qhp 92229 Img Rta Detc/Mntr Ds Poc Aly 92230 Eye Exam With Photos 92235 Fluorescein Angrph Uni/Bi 92235 Fluorescein Angrph Uni/Bi 92235 Fluorescein Angrph Uni/Bi 92240 Icg Angiography Uni/Bi 92240 Icg Angiography Uni/Bi 92240 Icg Angiography Uni/Bi 92242 Fluorescein Icg Angiography 92242 Fluorescein Icg Angiography 92242 Fluorescein Icg Angiography 92250 Eye Exam With Photos 92250 Eye Exam With Photos 92250 Eye Exam With Photos 92260 Ophthalmoscopy/Dynamometry 92265 Eye Muscle Evaluation 92265 Eye Muscle Evaluation 92265 Eye Muscle Evaluation 92270 Electro-Oculography 92270 Electro-Oculography 92270 Electro-Oculography 92273 Full Field Erg W/I&R 92273 Full Field Erg W/I&R 92273 Full Field Erg W/I&R 92274 Multifocal Erg W/I&R 92274 Multifocal Erg W/I&R 92274 Multifocal Erg W/I&R 92283 Color Vision Examination 92283 Color Vision Examination 92283 Color Vision Examination 92284 Dark Adaptation Eye Exam 92284 Dark Adaptation Eye Exam 92284 Dark Adaptation Eye Exam 92285 Eye Photography 92285 Eye Photography 92285 Eye Photography 92286 Internal Eye Photography 92286 Internal Eye Photography 92286 Internal Eye Photography 92287 Internal Eye Photography 92287 Internal Eye Photography 92287 Internal Eye Photography 92310 Contact Lens Fitting 92311 Contact Lens Fitting 92312 Contact Lens Fitting 92313 Contact Lens Fitting 92314 Prescription Of Contact Lens 92315 Rx Cntact Lens Aphakia 1 Eye 92316 Rx Cntact Lens Aphakia 2 Eye 92317 Rx Corneoscleral Cntact Lens 92325 Modification Of Contact Lens 92326 Replacement Of Contact Lens 92340 Fit Spectacles Monofocal 92341 Fit Spectacles Bifocal 92342 Fit Spectacles Multifocal 92352 Fit Aphakia Spectcl Monofocl 92353 Fit Aphakia Spectcl Multifoc 92354 Fit Spectacles Single System 92355 Fit Spectacles Compound Lens 92358 Aphakia Prosth Service Temp 92370 Repair & Adjust Spectacles 92371 Repair & Adjust Spectacles 92499 Eye Service Or Procedure 92499 Eye Service Or Procedure 92499 Eye Service Or Procedure 92502 Ear And Throat Examination 92504 471 Ear Microscopy Examination $67 $43 $52 $22 92507 440 Speech/Hearing Therapy $399 $259 $310 $124 92508 440 Speech/Hearing Therapy $74 $48 $57 $24 92511 510 Nasopharyngoscopy $311 $202 $242 $102 92512 Nasal Function Studies 92516 Facial Nerve Function Test 92517 Vemp Test I&R Cervical 92518 Vemp Test I&R Ocular 92519 Vemp Tst I&R Cervical&Ocular 92520 Laryngeal Function Studies 92521 440 Evaluation Of Speech Fluency $403 $262 $313 $131 92522 440 Evaluate Speech Production $328 $213 $255 $107 92523 440 Speech Sound Lang Comprehen $681 $443 $529 $222 92524 440 Behavral Qualit Analys Voice $342 $222 $266 $111 92526 440 Oral Function Therapy $311 $202 $241 $99 $76 92531 Spontaneous Nystagmus Study 92532 Positional Nystagmus Test 92533 Caloric Vestibular Test 92534 Optokinetic Nystagmus Test 92537 471 Caloric Vstblr Test W/Rec $143 $93 $111 $47 92537 471 Caloric Vstblr Test W/Rec $143 $93 $111 $47 92537 471 Caloric Vstblr Test W/Rec $143 $93 $111 $47 92538 Caloric Vstblr Test W/Rec 92538 Caloric Vstblr Test W/Rec 92538 Caloric Vstblr Test W/Rec 92540 471 Basic Vestibular Evaluation $678 $441 $526 $222 $149 92540 471 Basic Vestibular Evaluation $678 $441 $526 $222 $149 92540 471 Basic Vestibular Evaluation $678 $441 $526 $222 $149 92541 Spontaneous Nystagmus Test 92541 Spontaneous Nystagmus Test 92541 Spontaneous Nystagmus Test 92542 Positional Nystagmus Test 92542 Positional Nystagmus Test 92542 Positional Nystagmus Test 92544 Optokinetic Nystagmus Test 92544 Optokinetic Nystagmus Test 92544 Optokinetic Nystagmus Test 92545 Oscillating Tracking Test 92545 Oscillating Tracking Test 92545 Oscillating Tracking Test 92546 Sinusoidal Rotational Test 92546 Sinusoidal Rotational Test 92546 Sinusoidal Rotational Test 92547 Supplemental Electrical Test 92548 Cdp-Sot 6 Cond W/I&R 92548 Cdp-Sot 6 Cond W/I&R 92548 Cdp-Sot 6 Cond W/I&R 92549 Cdp-Sot 6 Cond W/I&R Mct&Adt 92549 Cdp-Sot 6 Cond W/I&R Mct&Adt 92549 Cdp-Sot 6 Cond W/I&R Mct&Adt 92550 471 Tympanometry & Reflex Thresh $179 $116 $139 $59 92551 Pure Tone Hearing Test Air $112 $73 $87 $37 $27 92552 510 Pure Tone Audiometry Air $84 $55 $65 $28 92553 Audiometry Air & Bone 92555 471 Speech Threshold Audiometry $81 $53 $63 $27 92556 471 Speech Audiometry Complete $81 $53 $63 $27 92557 510 Comprehensive Hearing Test $32 $21 $25 $11 92558 Evoked Auditory Test Qual 92559 Group Audiometric Testing 92560 Bekesy Audiometry Screen 92561 Bekesy Audiometry Diagnosis 92562 Loudness Balance Test 92563 Tone Decay Hearing Test 92564 Sisi Hearing Test 92565 Stenger Test Pure Tone 92567 470 Tympanometry $18 $12 $14 $6 92568 Acoustic Refl Threshold Tst 92570 Acoustic Immitance Testing 92571 Filtered Speech Hearing Test 92572 Staggered Spondaic Word Test 92575 Sensorineural Acuity Test 92576 Synthetic Sentence Test 92577 Stenger Test Speech 92579 471 Visual Audiometry (Vra) $158 $103 $123 $52 92582 471 Conditioning Play Audiometry $158 $103 $123 $52 92583 Select Picture Audiometry 92584 Electrocochleography 92585 471 Auditor Evoke Potent Compre $1,352 $879 $1,050 $443 $69 92586 471 Auditor Evoke Potent Limit $242 $157 $188 $79 92587 471 Evoked Auditory Test Limited $71 $46 $55 $23 92587 471 Evoked Auditory Test Limited $71 $46 $55 $23 92587 471 Evoked Auditory Test Limited $71 $46 $55 $23 92588 Evoked Auditory Tst Complete 92588 Evoked Auditory Tst Complete 92588 Evoked Auditory Tst Complete 92590 470 Hearing Aid Exam One Ear $94 $61 $73 $31 92591 470 Hearing Aid Exam Both Ears $94 $61 $73 $31 92592 Hearing Aid Check One Ear 92593 Hearing Aid Check Both Ears 92594 470 Electro Hearng Aid Test One $94 $61 $73 $31 92595 470 Electro Hearng Aid Tst Both $94 $61 $73 $31 92596 Ear Protector Evaluation 92597 440 Oral Speech Device Eval $355 $231 $276 $111 92601 Cochlear Implt F/Up Exam <7 92602 Reprogram Cochlear Implt <7 92603 Cochlear Implt F/Up Exam 7/> 92604 Reprogram Cochlear Implt 7/> 92605 Ex For Nonspeech Device Rx 92606 Non-Speech Device Service 92607 440 Ex For Speech Device Rx 1Hr $336 $218 $261 $111 92608 440 Ex For Speech Device Rx Addl $99 $64 $77 $34 92609 440 Use Of Speech Device Service $314 $204 $244 $102 $77 92610 444 Evaluate Swallowing Function $495 $322 $384 $151 92611 440 Motion Fluoroscopy/Swallow $224 $146 $174 $75 92612 440 Endoscopy Swallow (Fees) Vid $427 $278 $331 $131 92613 Endoscopy Swallow (Fees) I&R 92614 Laryngoscopic Sensory Vid 92615 Laryngoscopic Sensory I&R 92616 Fees W/Laryngeal Sense Test 92617 Fees W/Laryngeal Sense I&R 92618 Ex For Nonspeech Dev Rx Add 92620 471 Auditory Function 60 Min $60 $39 $47 $20 92621 Auditory Function + 15 Min 92625 Tinnitus Assessment 92626 Eval Aud Funcj 1St Hour 92627 Eval Aud Funcj Ea Addl 15 92630 Aud Rehab Pre-Ling Hear Loss 92633 Aud Rehab Postling Hear Loss 92640 Aud Brainstem Implt Programg 92650 Aep Scr Auditory Potential 92651 Aep Hearing Status Deter I&R 92652 Aep Thrshld Est Mlt Freq I&R 92653 Aep Neurodiagnostic I&R 92700 Ent Procedure/Service 92920 481 Prq Cardiac Angioplast 1 Art $6,088 $3,957 $4,726 $1,995 92921 481 Prq Cardiac Angio Addl Art $1,463 $951 $1,136 $479 92924 481 Prq Card Angio/Athrect 1 Art $6,032 $3,921 $4,683 $1,976 92925 Prq Card Angio/Athrect Addl 92928 481 Prq Card Stent W/Angio 1 Vsl $6,060 $3,939 $4,705 $1,986 $960 92929 481 Prq Card Stent W/Angio Addl $1,474 $958 $1,144 $483 92933 Prq Card Stent/Ath/Angio 92934 Prq Card Stent/Ath/Angio 92937 481 Prq Revasc Byp Graft 1 Vsl $5,537 $3,599 $4,299 $1,814 92938 481 Prq Revasc Byp Graft Addl $1,320 $858 $1,025 $433 92941 481 Prq Card Revasc Mi 1 Vsl $5,485 $3,565 $4,258 $1,797 92943 481 Prq Card Revasc Chronic 1Vsl $5,485 $3,565 $4,258 $1,797 92944 Prq Card Revasc Chronic Addl 92950 480 Heart/Lung Resuscitation Cpr $1,501 $976 $1,165 $491 92953 985 Temporary External Pacing $39 $25 $30 $13 92960 480 Cardioversion Electric Ext $930 $605 $722 $305 92961 Cardioversion Electric Int 92970 Cardioassist Internal 92971 Cardioassist External 92973 481 Prq Coronary Mech Thrombect $960 $624 $745 $315 92974 Cath Place Cardio Brachytx 92975 Dissolve Clot Heart Vessel 92977 Dissolve Clot Heart Vessel 92978 481 Endoluminl Ivus Oct C 1St $698 $454 $542 $229 92978 481 Endoluminl Ivus Oct C 1St $698 $454 $542 $229 92978 481 Endoluminl Ivus Oct C 1St $698 $454 $542 $229 92979 481 Endoluminl Ivus Oct C Ea $390 $254 $303 $128 92979 481 Endoluminl Ivus Oct C Ea $390 $254 $303 $128 92979 481 Endoluminl Ivus Oct C Ea $390 $254 $303 $128 92986 481 Revision Of Aortic Valve $11,161 $7,255 $8,665 $3,657 92987 481 Revision Of Mitral Valve $11,006 $7,154 $8,544 $3,606 92990 Revision Of Pulmonary Valve 92992 Revision Of Heart Chamber 92993 Revision Of Heart Chamber 92997 Pul Art Balloon Repr Percut 92998 Pul Art Balloon Repr Percut 93000 730 Electrocardiogram Complete $643 $418 $499 $211 $66 93005 730 Electrocardiogram Tracing $488 $317 $379 $160 93010 985 Electrocardiogram Report $155 $101 $120 $51 $20 93015 482 Cardiovascular Stress Test $1,607 $1,045 $1,248 $527 $4 93016 Cardiovascular Stress Test $70 $45 $54 $23 93017 482 Cardiovascular Stress Test $119 $77 $92 $39 93018 482 Cardiovascular Stress Test $54 $35 $42 $18 93024 Cardiac Drug Stress Test 93024 Cardiac Drug Stress Test 93024 Cardiac Drug Stress Test 93025 Microvolt T-Wave Assess 93025 Microvolt T-Wave Assess 93025 Microvolt T-Wave Assess 93040 Rhythm Ecg With Report 93041 Rhythm Ecg Tracing 93042 Rhythm Ecg Report 93050 Art Pressure Waveform Analys 93050 Art Pressure Waveform Analys 93050 Art Pressure Waveform Analys 93224 731 Ecg Monit/Reprt Up To 48 Hrs $1,221 $794 $948 $400 $54 93225 731 Ecg Monit/Reprt Up To 48 Hrs $406 $264 $315 $133 93226 731 Ecg Monit/Reprt Up To 48 Hrs $815 $530 $633 $267 93227 731 Ecg Monit/Reprt Up To 48 Hrs $86 $56 $67 $28 93228 Remote 30 Day Ecg Rev/Report $76 $50 $59 $25 93229 Remote 30 Day Ecg Tech Supp 93241 Ext Ecg>48Hr<7D Rec Scan A/R 93242 Ext Ecg>48Hr<7D Recording 93243 Ext Ecg>48Hr<7D Scan A/R 93244 Ext Ecg>48Hr<7D Rev&Interpj 93245 Ext Ecg>7D<15D Rec Scan A/R 93246 Ext Ecg>7D<15D Recording 93247 Ext Ecg>7D<15D Scan A/R 93248 Ext Ecg>7D<15D Rev&Interpj 93260 Prgrmg Dev Eval Impltbl Sys 93260 Prgrmg Dev Eval Impltbl Sys 93260 Prgrmg Dev Eval Impltbl Sys 93261 Interrogate Subq Defib $177 $115 $137 $58 $39 93261 Interrogate Subq Defib $177 $115 $137 $58 $39 93261 Interrogate Subq Defib $177 $115 $137 $58 $39 93264 Rem Mntr Wrls P-Art Prs Snr 93268 Ecg Record/Review $610 $396 $473 $200 $89 93270 731 Remote 30 Day Ecg Rev/Report $1,161 $755 $901 $380 $66 93271 Ecg/Monitoring And Analysis 93272 Ecg/Review Interpret Only $79 $51 $61 $26 93278 Ecg/Signal-Averaged 93278 Ecg/Signal-Averaged 93278 Ecg/Signal-Averaged 93279 510 Prgrmg Dev Eval Pm/Ldls Pm $78 $51 $61 $26 93279 510 Prgrmg Dev Eval Pm/Ldls Pm $78 $51 $61 $26 93279 510 Prgrmg Dev Eval Pm/Ldls Pm $78 $51 $61 $26 93280 510 Pm Device Progr Eval Dual $84 $54 $65 $27 93280 510 Pm Device Progr Eval Dual $84 $54 $65 $27 93280 510 Pm Device Progr Eval Dual $84 $54 $65 $27 93281 921 Pm Device Progr Eval Multi $88 $57 $68 $29 93281 921 Pm Device Progr Eval Multi $88 $57 $68 $29 93281 921 Pm Device Progr Eval Multi $88 $57 $68 $29 93282 921 Prgrmg Eval Implantable Dfb $103 $67 $80 $34 93282 921 Prgrmg Eval Implantable Dfb $103 $67 $80 $34 93282 921 Prgrmg Eval Implantable Dfb $103 $67 $80 $34 93283 921 Prgrmg Eval Implantable Dfb $133 $86 $103 $44 93283 921 Prgrmg Eval Implantable Dfb $133 $86 $103 $44 93283 921 Prgrmg Eval Implantable Dfb $133 $86 $103 $44 93284 921 Prgrmg Eval Implantable Dfb $133 $86 $103 $44 93284 921 Prgrmg Eval Implantable Dfb $133 $86 $103 $44 93284 921 Prgrmg Eval Implantable Dfb $133 $86 $103 $44 93285 480 Prgrmg Dev Eval Scrms Ip $60 $39 $46 $20 93285 480 Prgrmg Dev Eval Scrms Ip $60 $39 $46 $20 93285 480 Prgrmg Dev Eval Scrms Ip $60 $39 $46 $20 93286 921 Peri-Px Eval Pm/Ldls Pm Ip $114 $74 $89 $37 93286 921 Peri-Px Eval Pm/Ldls Pm Ip $114 $74 $89 $37 93286 921 Peri-Px Eval Pm/Ldls Pm Ip $114 $74 $89 $37 93287 921 Peri-Px Device Eval & Prgr $114 $74 $89 $37 93287 921 Peri-Px Device Eval & Prgr $114 $74 $89 $37 93287 921 Peri-Px Device Eval & Prgr $114 $74 $89 $37 93288 921 Interrog Evl Pm/Ldls Pm Ip $65 $42 $50 $21 93288 921 Interrog Evl Pm/Ldls Pm Ip $65 $42 $50 $21 93288 921 Interrog Evl Pm/Ldls Pm Ip $65 $42 $50 $21 93289 510 Interrog Device Eval Heart $141 $92 $109 $46 93289 510 Interrog Device Eval Heart $141 $92 $109 $46 93289 510 Interrog Device Eval Heart $141 $92 $109 $46 93290 Interrog Dev Eval Icpms Ip $85 $56 $66 $28 93290 Interrog Dev Eval Icpms Ip $85 $56 $66 $28 93290 Interrog Dev Eval Icpms Ip $85 $56 $66 $28 93291 921 Interrog Dev Eval Scrms Ip $133 $86 $103 $44 93291 921 Interrog Dev Eval Scrms Ip $133 $86 $103 $44 93291 921 Interrog Dev Eval Scrms Ip $133 $86 $103 $44 93292 Wcd Device Interrogate 93292 Wcd Device Interrogate 93292 Wcd Device Interrogate 93293 921 Pm Phone R-Strip Device Eval $124 $80 $96 $40 93293 921 Pm Phone R-Strip Device Eval $124 $80 $96 $40 93293 921 Pm Phone R-Strip Device Eval $124 $80 $96 $40 93294 Rem Interrog Evl Pm/Ldls Pm $103 $67 $80 $34 93295 Dev Interrog Remote 1/2/Mlt $201 $130 $156 $66 $47 93296 921 Rem Interrog Evl Pm/Ids $71 $46 $55 $23 93297 Rem Interrog Dev Eval Icpms $72 $47 $56 $24 93298 Rem Interrog Dev Eval Scrms $78 $51 $61 $26 93303 Echo Transthoracic 93303 Echo Transthoracic 93303 Echo Transthoracic 93304 Echo Transthoracic 93304 Echo Transthoracic 93304 Echo Transthoracic 93306 480 Tte W/Doppler Complete $318 $207 $247 $104 93306 480 Tte W/Doppler Complete $318 $207 $247 $104 93306 480 Tte W/Doppler Complete $318 $207 $247 $104 93307 483 Tte W/O Doppler Complete $1,383 $899 $1,074 $452 93307 483 Tte W/O Doppler Complete $1,383 $899 $1,074 $452 93307 483 Tte W/O Doppler Complete $1,383 $899 $1,074 $452 93308 483 Tte F-Up Or Lmtd $657 $427 $510 $215 93308 483 Tte F-Up Or Lmtd $657 $427 $510 $215 93308 483 Tte F-Up Or Lmtd $657 $427 $510 $215 93312 Echo Transesophageal 93312 Echo Transesophageal 93312 Echo Transesophageal 93313 480 Echo Transesophageal $3,202 $2,081 $2,486 $1,049 $817 93314 Echo Transesophageal $380 $247 $295 $125 $82 93314 Echo Transesophageal $380 $247 $295 $125 $82 93314 Echo Transesophageal $380 $247 $295 $125 $82 93315 Echo Transesophageal 93315 Echo Transesophageal 93315 Echo Transesophageal 93316 Echo Transesophageal 93317 Echo Transesophageal 93317 Echo Transesophageal 93317 Echo Transesophageal 93318 Echo Transesophageal Intraop 93318 Echo Transesophageal Intraop 93318 Echo Transesophageal Intraop 93320 483 Doppler Echo Exam Heart $592 $385 $460 $194 93320 483 Doppler Echo Exam Heart $592 $385 $460 $194 93320 483 Doppler Echo Exam Heart $592 $385 $460 $194 93321 Doppler Echo Exam Heart 93321 Doppler Echo Exam Heart 93321 Doppler Echo Exam Heart 93325 480 Doppler Color Flow Add-On $1,040 $676 $807 $341 93325 480 Doppler Color Flow Add-On $1,040 $676 $807 $341 93325 480 Doppler Color Flow Add-On $1,040 $676 $807 $341 93350 480 Stress Tte Only $470 $306 $365 $154 93350 480 Stress Tte Only $470 $306 $365 $154 93350 480 Stress Tte Only $470 $306 $365 $154 93351 483 Stress Tte Complete $2,115 $1,375 $1,642 $693 $376 93351 483 Stress Tte Complete $2,115 $1,375 $1,642 $693 $376 93351 483 Stress Tte Complete $2,115 $1,375 $1,642 $693 $376 93352 Admin Ecg Contrast Agent 93355 480 Echo Transesophageal (Tee) $833 $541 $647 $273 93356 Myocrd Strain Img Spckl Trck 93451 481 Right Heart Cath $2,858 $1,858 $2,219 $936 93451 481 Right Heart Cath $2,858 $1,858 $2,219 $936 93451 481 Right Heart Cath $2,858 $1,858 $2,219 $936 93452 Left Hrt Cath W/Ventrclgrphy 93452 Left Hrt Cath W/Ventrclgrphy 93452 Left Hrt Cath W/Ventrclgrphy 93453 R&L Hrt Cath W/Ventriclgrphy 93453 R&L Hrt Cath W/Ventriclgrphy 93453 R&L Hrt Cath W/Ventriclgrphy 93454 481 Coronary Artery Angio S&I $3,985 $2,590 $3,094 $1,306 93454 481 Coronary Artery Angio S&I $3,985 $2,590 $3,094 $1,306 93454 481 Coronary Artery Angio S&I $3,985 $2,590 $3,094 $1,306 93455 481 Coronary Art/Grft Angio S&I $4,372 $2,842 $3,394 $1,433 93455 481 Coronary Art/Grft Angio S&I $4,372 $2,842 $3,394 $1,433 93455 481 Coronary Art/Grft Angio S&I $4,372 $2,842 $3,394 $1,433 93456 481 R Hrt Coronary Artery Angio $6,833 $4,441 $5,305 $2,239 93456 481 R Hrt Coronary Artery Angio $6,833 $4,441 $5,305 $2,239 93456 481 R Hrt Coronary Artery Angio $6,833 $4,441 $5,305 $2,239 93457 481 R Hrt Art/Grft Angio $4,954 $3,220 $3,846 $1,623 $319 93457 481 R Hrt Art/Grft Angio $4,954 $3,220 $3,846 $1,623 $319 93457 481 R Hrt Art/Grft Angio $4,954 $3,220 $3,846 $1,623 $319 93458 481 L Hrt Artery/Ventricle Angio $12,270 $7,976 $9,526 $4,020 93458 481 L Hrt Artery/Ventricle Angio $12,270 $7,976 $9,526 $4,020 93458 481 L Hrt Artery/Ventricle Angio $12,270 $7,976 $9,526 $4,020 93459 481 L Hrt Art/Grft Angio $12,270 $7,976 $9,526 $4,020 $3,264 93459 481 L Hrt Art/Grft Angio $12,270 $7,976 $9,526 $4,020 $3,264 93459 481 L Hrt Art/Grft Angio $12,270 $7,976 $9,526 $4,020 $3,264 93460 481 R&L Hrt Art/Ventricle Angio $12,500 $8,125 $9,704 $4,096 93460 481 R&L Hrt Art/Ventricle Angio $12,500 $8,125 $9,704 $4,096 93460 481 R&L Hrt Art/Ventricle Angio $12,500 $8,125 $9,704 $4,096 93461 481 R&L Hrt Art/Ventricle Angio $12,743 $8,283 $9,893 $4,175 93461 481 R&L Hrt Art/Ventricle Angio $12,743 $8,283 $9,893 $4,175 93461 481 R&L Hrt Art/Ventricle Angio $12,743 $8,283 $9,893 $4,175 93462 L Hrt Cath Trnsptl Puncture 93463 481 Drug Admin & Hemodynmic Meas $296 $192 $230 $97 93464 Exercise W/Hemodynamic Meas 93464 Exercise W/Hemodynamic Meas 93464 Exercise W/Hemodynamic Meas 93503 Insert/Place Heart Catheter 93505 Biopsy Of Heart Lining 93505 Biopsy Of Heart Lining 93505 Biopsy Of Heart Lining 93530 Rt Heart Cath Congenital 93530 Rt Heart Cath Congenital 93530 Rt Heart Cath Congenital 93531 R & L Heart Cath Congenital 93531 R & L Heart Cath Congenital 93531 R & L Heart Cath Congenital 93532 R & L Heart Cath Congenital 93532 R & L Heart Cath Congenital 93532 R & L Heart Cath Congenital 93533 R & L Heart Cath Congenital 93533 R & L Heart Cath Congenital 93533 R & L Heart Cath Congenital 93561 Cardiac Output Measurement 93561 Cardiac Output Measurement 93561 Cardiac Output Measurement 93562 Card Output Measure Subsq 93562 Card Output Measure Subsq 93562 Card Output Measure Subsq 93563 Inject Congenital Card Cath 93564 Inject Hrt Congntl Art/Grft 93565 Inject L Ventr/Atrial Angio 93566 Inject R Ventr/Atrial Angio 93567 481 Inject Suprvlv Aortography $298 $194 $231 $98 93568 Inject Pulm Art Hrt Cath 93571 480 Heart Flow Reserve Measure $4,535 $2,948 $3,521 $1,486 93571 480 Heart Flow Reserve Measure $4,535 $2,948 $3,521 $1,486 93571 480 Heart Flow Reserve Measure $4,535 $2,948 $3,521 $1,486 93572 480 Heart Flow Reserve Measure $2,589 $1,683 $2,010 $848 93572 480 Heart Flow Reserve Measure $2,589 $1,683 $2,010 $848 93572 480 Heart Flow Reserve Measure $2,589 $1,683 $2,010 $848 93580 481 Transcath Closure Of Asd $11,431 $7,430 $8,874 $3,746 93581 Transcath Closure Of Vsd 93582 Perq Transcath Closure Pda 93583 481 Perq Transcath Septal Reduxn $12,610 $8,197 $9,790 $4,132 93590 Perq Transcath Cls Mitral 93591 Perq Transcath Cls Aortic 93592 Perq Transcath Closure Each 93600 Bundle Of His Recording 93600 Bundle Of His Recording 93600 Bundle Of His Recording 93602 Intra-Atrial Recording 93602 Intra-Atrial Recording 93602 Intra-Atrial Recording 93603 Right Ventricular Recording 93603 Right Ventricular Recording 93603 Right Ventricular Recording 93609 480 Map Tachycardia Add-On $10,378 $6,746 $8,057 $3,401 93609 480 Map Tachycardia Add-On $10,378 $6,746 $8,057 $3,401 93609 480 Map Tachycardia Add-On $10,378 $6,746 $8,057 $3,401 93610 Intra-Atrial Pacing 93610 Intra-Atrial Pacing 93610 Intra-Atrial Pacing 93612 480 Intraventricular Pacing $2,042 $1,327 $1,585 $669 93612 480 Intraventricular Pacing $2,042 $1,327 $1,585 $669 93612 480 Intraventricular Pacing $2,042 $1,327 $1,585 $669 93613 480 Electrophys Map 3D Add-On $7,107 $4,620 $5,517 $2,329 $1,289 93615 Esophageal Recording 93615 Esophageal Recording 93615 Esophageal Recording 93616 Esophageal Recording 93616 Esophageal Recording 93616 Esophageal Recording 93618 480 Heart Rhythm Pacing $8,043 $5,228 $6,244 $2,635 93618 480 Heart Rhythm Pacing $8,043 $5,228 $6,244 $2,635 93618 480 Heart Rhythm Pacing $8,043 $5,228 $6,244 $2,635 93619 480 Electrophysiology Evaluation $3,016 $1,960 $2,341 $988 93619 480 Electrophysiology Evaluation $3,016 $1,960 $2,341 $988 93619 480 Electrophysiology Evaluation $3,016 $1,960 $2,341 $988 93620 480 Electrophysiology Evaluation $7,673 $4,987 $5,957 $2,514 93620 480 Electrophysiology Evaluation $7,673 $4,987 $5,957 $2,514 93620 480 Electrophysiology Evaluation $7,673 $4,987 $5,957 $2,514 93621 480 Electrophysiology Evaluation $3,240 $2,106 $2,515 $1,062 93621 480 Electrophysiology Evaluation $3,240 $2,106 $2,515 $1,062 93621 480 Electrophysiology Evaluation $3,240 $2,106 $2,515 $1,062 93622 480 Electrophysiology Evaluation $9,466 $6,153 $7,349 $3,102 93622 480 Electrophysiology Evaluation $9,466 $6,153 $7,349 $3,102 93622 480 Electrophysiology Evaluation $9,466 $6,153 $7,349 $3,102 93623 480 Stimulation Pacing Heart $2,569 $1,670 $1,994 $842 93623 480 Stimulation Pacing Heart $2,569 $1,670 $1,994 $842 93623 480 Stimulation Pacing Heart $2,569 $1,670 $1,994 $842 93624 Electrophysiologic Study 93624 Electrophysiologic Study 93624 Electrophysiologic Study 93631 Heart Pacing Mapping 93631 Heart Pacing Mapping 93631 Heart Pacing Mapping 93640 Evaluation Heart Device 93640 Evaluation Heart Device 93640 Evaluation Heart Device 93641 480 Electrophysiology Evaluation $847 $551 $658 $278 93641 480 Electrophysiology Evaluation $847 $551 $658 $278 93641 480 Electrophysiology Evaluation $847 $551 $658 $278 93642 480 Electrophysiology Evaluation $857 $557 $665 $281 93642 480 Electrophysiology Evaluation $857 $557 $665 $281 93642 480 Electrophysiology Evaluation $857 $557 $665 $281 93644 Electrophysiology Evaluation 93644 Electrophysiology Evaluation 93644 Electrophysiology Evaluation 93650 480 Ablate Heart Dysrhythm Focus $4,908 $3,190 $3,810 $1,608 93653 480 Ep & Ablate Supravent Arrhyt $8,266 $5,373 $6,417 $2,708 $1,016 93654 480 Ep & Ablate Ventric Tachy $8,266 $5,373 $6,417 $2,708 93655 480 Ablate Arrhythmia Add On $410 $267 $318 $134 93656 480 Tx Atrial Fib Pulm Vein Isol $6,992 $4,545 $5,428 $2,291 $1,347 93657 480 Tx L/R Atrial Fib Addl $410 $267 $318 $134 93660 480 Tilt Table Evaluation $355 $231 $276 $116 93660 480 Tilt Table Evaluation $355 $231 $276 $116 93660 480 Tilt Table Evaluation $355 $231 $276 $116 93662 480 Intracardiac Ecg (Ice) $1,787 $1,162 $1,387 $586 93662 480 Intracardiac Ecg (Ice) $1,787 $1,162 $1,387 $586 93662 480 Intracardiac Ecg (Ice) $1,787 $1,162 $1,387 $586 93668 943 Peripheral Vascular Rehab $140 $91 $109 $46 93701 Bioimpedance Cv Analysis 93702 Bis Xtracell Fluid Analysis 93724 Analyze Pacemaker System 93724 Analyze Pacemaker System 93724 Analyze Pacemaker System 93740 Temperature Gradient Studies 93745 Set-Up Cardiovert-Defibrill 93745 Set-Up Cardiovert-Defibrill 93745 Set-Up Cardiovert-Defibrill 93750 Interrogation Vad In Person 93770 Measure Venous Pressure 93784 Ambl Bp Mntr W/Software 93786 Ambl Bp Mntr W/Sw Rec Only 93788 Ambl Bp Mntr W/Sw A/R 93790 Ambl Bp Mntr W/Sw I&R 93792 Pt/Caregiver Traing Home Inr 93793 Anticoag Mgmt Pt Warfarin 93797 Cardiac Rehab 93798 943 Cardiac Rehab/Monitor $234 $152 $182 $77 93799 Cardiovascular Procedure 93799 Cardiovascular Procedure 93799 Cardiovascular Procedure 93880 921 Extracranial Bilat Study $2,332 $1,516 $1,810 $763 93880 921 Extracranial Bilat Study $2,332 $1,516 $1,810 $763 93880 921 Extracranial Bilat Study $2,332 $1,516 $1,810 $763 93882 921 Extracranial Uni/Ltd Study $952 $619 $739 $312 93882 921 Extracranial Uni/Ltd Study $952 $619 $739 $312 93882 921 Extracranial Uni/Ltd Study $952 $619 $739 $312 93886 Intracranial Complete Study 93886 Intracranial Complete Study 93886 Intracranial Complete Study 93888 Intracranial Limited Study 93888 Intracranial Limited Study 93888 Intracranial Limited Study 93890 Tcd Vasoreactivity Study 93890 Tcd Vasoreactivity Study 93890 Tcd Vasoreactivity Study 93892 Tcd Emboli Detect W/O Inj 93892 Tcd Emboli Detect W/O Inj 93892 Tcd Emboli Detect W/O Inj 93893 Tcd Emboli Detect W/Inj 93893 Tcd Emboli Detect W/Inj 93893 Tcd Emboli Detect W/Inj 93895 Carotid Intima Atheroma Eval 93895 Carotid Intima Atheroma Eval 93895 Carotid Intima Atheroma Eval 93922 402 Upr/L Xtremity Art 2 Levels $522 $339 $405 $171 93922 402 Upr/L Xtremity Art 2 Levels $522 $339 $405 $171 93922 402 Upr/L Xtremity Art 2 Levels $522 $339 $405 $171 93923 921 Upr/Lxtr Art Stdy 3+ Lvls $1,127 $733 $875 $369 $319 93923 921 Upr/Lxtr Art Stdy 3+ Lvls $1,127 $733 $875 $369 $319 93923 921 Upr/Lxtr Art Stdy 3+ Lvls $1,127 $733 $875 $369 $319 93924 921 Lwr Xtr Vasc Stdy Bilat $1,122 $729 $871 $368 $111 93924 921 Lwr Xtr Vasc Stdy Bilat $1,122 $729 $871 $368 $111 93924 921 Lwr Xtr Vasc Stdy Bilat $1,122 $729 $871 $368 $111 93925 921 Lower Extremity Study $1,484 $965 $1,152 $485 $280 93925 921 Lower Extremity Study $1,484 $965 $1,152 $485 $280 93925 921 Lower Extremity Study $1,484 $965 $1,152 $485 $280 93926 921 Lower Extremity Study $378 $246 $293 $124 93926 921 Lower Extremity Study $378 $246 $293 $124 93926 921 Lower Extremity Study $378 $246 $293 $124 93930 921 Upper Extremity Study $1,739 $1,130 $1,350 $569 $265 93930 921 Upper Extremity Study $1,739 $1,130 $1,350 $569 $265 93930 921 Upper Extremity Study $1,739 $1,130 $1,350 $569 $265 93931 921 Upper Extremity Study $1,390 $904 $1,079 $455 93931 921 Upper Extremity Study $1,390 $904 $1,079 $455 93931 921 Upper Extremity Study $1,390 $904 $1,079 $455 93970 402 Extremity Study $1,548 $1,006 $1,202 $506 93970 402 Extremity Study $1,548 $1,006 $1,202 $506 93970 402 Extremity Study $1,548 $1,006 $1,202 $506 93971 921 Extremity Study $714 $464 $554 $234 93971 921 Extremity Study $714 $464 $554 $234 93971 921 Extremity Study $714 $464 $554 $234 93975 921 Vascular Study $1,625 $1,056 $1,262 $532 93975 921 Vascular Study $1,625 $1,056 $1,262 $532 93975 921 Vascular Study $1,625 $1,056 $1,262 $532 93976 320 Vascular Study $762 $495 $592 $250 93976 320 Vascular Study $762 $495 $592 $250 93976 320 Vascular Study $762 $495 $592 $250 93978 921 Vascular Study $1,871 $1,216 $1,453 $613 $208 93978 921 Vascular Study $1,871 $1,216 $1,453 $613 $208 93978 921 Vascular Study $1,871 $1,216 $1,453 $613 $208 93979 Vascular Study 93979 Vascular Study 93979 Vascular Study 93980 921 Penile Vascular Study $1,109 $721 $861 $363 93980 921 Penile Vascular Study $1,109 $721 $861 $363 93980 921 Penile Vascular Study $1,109 $721 $861 $363 93981 Penile Vascular Study 93981 Penile Vascular Study 93981 Penile Vascular Study 93985 921 Dup-Scan Hemo Compl Bi Std $600 $390 $466 $197 93985 921 Dup-Scan Hemo Compl Bi Std $600 $390 $466 $197 93985 921 Dup-Scan Hemo Compl Bi Std $600 $390 $466 $197 93986 921 Dup-Scan Hemo Compl Uni Std $300 $195 $233 $98 93986 921 Dup-Scan Hemo Compl Uni Std $300 $195 $233 $98 93986 921 Dup-Scan Hemo Compl Uni Std $300 $195 $233 $98 93990 921 Doppler Flow Testing $1,004 $653 $779 $329 $71 93990 921 Doppler Flow Testing $1,004 $653 $779 $329 $71 93990 921 Doppler Flow Testing $1,004 $653 $779 $329 $71 93998 Noninvas Vasc Dx Study Proc 94002 410 Vent Mgmt Inpat Init Day $513 $333 $398 $168 94003 460 Vent Mgmt Inpat Subq Day $563 $366 $437 $184 94004 Vent Mgmt Nf Per Day 94005 Home Vent Mgmt Supervision 94010 510 Breathing Capacity Test $263 $171 $204 $86 94010 510 Breathing Capacity Test $263 $171 $204 $86 94010 510 Breathing Capacity Test $263 $171 $204 $86 94011 Spirometry Up To 2 Yrs Old 94012 Spirmtry W/Brnchdil Inf-2 Yr 94013 Meas Lung Vol Thru 2 Yrs 94014 Patient Recorded Spirometry 94015 Patient Recorded Spirometry 94016 Review Patient Spirometry 94060 510 Evaluation Of Wheezing $111 $72 $86 $36 94060 510 Evaluation Of Wheezing $111 $72 $86 $36 94060 510 Evaluation Of Wheezing $111 $72 $86 $36 94070 460 Evaluation Of Wheezing $113 $74 $88 $37 94070 460 Evaluation Of Wheezing $113 $74 $88 $37 94070 460 Evaluation Of Wheezing $113 $74 $88 $37 94150 460 Vital Capacity Test $66 $43 $51 $22 94150 460 Vital Capacity Test $66 $43 $51 $22 94150 460 Vital Capacity Test $66 $43 $51 $22 94200 460 Lung Function Test (Mbc/Mvv) $268 $174 $208 $88 94200 460 Lung Function Test (Mbc/Mvv) $268 $174 $208 $88 94200 460 Lung Function Test (Mbc/Mvv) $268 $174 $208 $88 94250 Expired Gas Collection 94375 Respiratory Flow Volume Loop 94375 Respiratory Flow Volume Loop 94375 Respiratory Flow Volume Loop 94400 Co2 Breathing Response Curve 94450 Hypoxia Response Curve 94450 Hypoxia Response Curve 94450 Hypoxia Response Curve 94452 Hast W/Report 94452 Hast W/Report 94452 Hast W/Report 94453 Hast W/Oxygen Titrate 94453 Hast W/Oxygen Titrate 94453 Hast W/Oxygen Titrate 94610 Surfactant Admin Thru Tube 94617 Exercise Tst Brncspsm W/Ecg 94617 Exercise Tst Brncspsm W/Ecg 94617 Exercise Tst Brncspsm W/Ecg 94618 510 Pulmonary Stress Testing $30 $20 $24 $10 94618 510 Pulmonary Stress Testing $30 $20 $24 $10 94618 510 Pulmonary Stress Testing $30 $20 $24 $10 94619 Exercise Tst Brncspsm Wo Ecg 94619 Exercise Tst Brncspsm Wo Ecg 94619 Exercise Tst Brncspsm Wo Ecg 94621 460 Cardiopulm Exercise Testing $1,140 $741 $885 $374 94621 460 Cardiopulm Exercise Testing $1,140 $741 $885 $374 94621 460 Cardiopulm Exercise Testing $1,140 $741 $885 $374 94640 510 Airway Inhalation Treatment $95 $62 $74 $31 94642 460 Aerosol Inhalation Treatment $196 $127 $152 $64 94644 410 Cbt 1St Hour $171 $111 $133 $56 94645 Cbt Each Addl Hour 94660 410 Pos Airway Pressure Cpap $763 $496 $592 $250 94662 Neg Press Ventilation Cnp 94664 510 Evaluate Pt Use Of Inhaler $92 $60 $71 $30 94667 410 Chest Wall Manipulation $91 $59 $71 $30 94668 410 Chest Wall Manipulation $106 $69 $82 $35 94669 410 Mechanical Chest Wall Oscill $103 $67 $80 $34 94680 Exhaled Air Analysis O2 94680 Exhaled Air Analysis O2 94680 Exhaled Air Analysis O2 94681 Exhaled Air Analysis O2/Co2 94681 Exhaled Air Analysis O2/Co2 94681 Exhaled Air Analysis O2/Co2 94690 Exhaled Air Analysis 94690 Exhaled Air Analysis 94690 Exhaled Air Analysis 94726 460 Pulm Funct Tst Plethysmograp $289 $188 $224 $95 94726 460 Pulm Funct Tst Plethysmograp $289 $188 $224 $95 94726 460 Pulm Funct Tst Plethysmograp $289 $188 $224 $95 94727 460 Pulm Function Test By Gas $443 $288 $344 $145 $129 94727 460 Pulm Function Test By Gas $443 $288 $344 $145 $129 94727 460 Pulm Function Test By Gas $443 $288 $344 $145 $129 94728 Airwy Resist By Oscillometry 94728 Airwy Resist By Oscillometry 94728 Airwy Resist By Oscillometry 94729 460 Co/Membane Diffuse Capacity $333 $216 $259 $109 94729 460 Co/Membane Diffuse Capacity $333 $216 $259 $109 94729 460 Co/Membane Diffuse Capacity $333 $216 $259 $109 94750 Pulmonary Compliance Study 94760 510 Measure Blood Oxygen Level $105 $68 $82 $34 94761 510 Measure Blood Oxygen Level $268 $174 $208 $88 94762 460 Measure Blood Oxygen Level $373 $242 $290 $122 94770 Exhaled Carbon Dioxide Test 94772 Breath Recording Infant 94772 Breath Recording Infant 94772 Breath Recording Infant 94774 Ped Home Apnea Rec Compl 94775 Ped Home Apnea Rec Hk-Up 94776 Ped Home Apnea Rec Downld 94777 Ped Home Apnea Rec Report 94780 Cars/Bd Tst Inft-12Mo 60 Min 94781 Cars/Bd Tst Inft-12Mo +30Min 94799 460 Pulmonary Service/Procedure $66 $43 $51 $22 94799 460 Pulmonary Service/Procedure $66 $43 $51 $22 94799 460 Pulmonary Service/Procedure $66 $43 $51 $22 95004 Percut Allergy Skin Tests 95012 Exhaled Nitric Oxide Meas $51 $33 $40 $17 95017 Perq & Icut Allg Test Venoms 95018 Perq&Ic Allg Test Drugs/Biol 95024 Icut Allergy Test Drug/Bug 95027 Icut Allergy Titrate-Airborn 95028 Icut Allergy Test-Delayed 95044 Allergy Patch Tests 95052 Photo Patch Test 95056 Photosensitivity Tests 95060 Eye Allergy Tests 95065 Nose Allergy Test 95070 Bronchial Allergy Tests 95071 Bronchial Allergy Tests 95076 Ingest Challenge Ini 120 Min 95079 Ingest Challenge Addl 60 Min 95115 510 Immunotherapy One Injection $84 $55 $65 $27 $25 95117 510 Immunotherapy Injections $105 $68 $82 $34 $24 95120 Immunotherapy One Injection 95125 Immunotherapy 2/> Injections 95130 Immntx 1 Sting Insect 95131 Immntx 2 Sting Insects 95132 Immntx 3 Sting Insects 95133 Immntx 4 Sting Insects 95134 Immntx 5 Sting Insects 95144 Antigen Therapy Services 95145 Antigen Therapy Services 95146 Antigen Therapy Services 95147 Antigen Therapy Services 95148 Antigen Therapy Services 95149 Antigen Therapy Services 95165 Antigen Therapy Services 95170 Antigen Therapy Services 95180 Rapid Desensitization 95199 Allergy Immunology Services 95249 510 Cont Gluc Mntr Pt Prov Eqp $51 $33 $39 $17 95250 510 Cont Gluc Mntr Phys/Qhp Eqp $452 $294 $351 $148 95251 510 Cont Gluc Mntr Analysis I&R $52 $34 $41 $17 95700 Eeg Cont Rec W/Vid Eeg Tech 95705 Eeg W/O Vid 2-12 Hr Unmntr 95706 Eeg Wo Vid 2-12Hr Intmt Mntr 95707 Eeg W/O Vid 2-12Hr Cont Mntr 95708 Eeg Wo Vid Ea 12-26Hr Unmntr 95709 Eeg W/O Vid Ea 12-26Hr Intmt 95710 Eeg W/O Vid Ea 12-26Hr Cont 95711 471 Veeg 2-12 Hr Unmonitored $630 $410 $489 $206 95712 Veeg 2-12 Hr Intmt Mntr 95713 Veeg 2-12 Hr Cont Mntr 95714 471 Veeg Ea 12-26 Hr Unmntr $1,215 $790 $943 $398 95715 Veeg Ea 12-26Hr Intmt Mntr 95716 Veeg Ea 12-26Hr Cont Mntr 95717 Eeg Phys/Qhp 2-12 Hr W/O Vid 95718 Eeg Phys/Qhp 2-12 Hr W/Veeg 95719 Eeg Phys/Qhp Ea Incr W/O Vid 95720 Eeg Phy/Qhp Ea Incr W/Veeg 95721 Eeg Phy/Qhp>36<60 Hr W/O Vid 95722 Eeg Phy/Qhp>36<60 Hr W/Veeg 95723 Eeg Phy/Qhp>60<84 Hr W/O Vid 95724 Eeg Phy/Qhp>60<84 Hr W/Veeg 95725 Eeg Phy/Qhp>84 Hr W/O Vid 95726 Eeg Phy/Qhp>84 Hr W/Veeg 95782 Polysom <6 Yrs 4/> Paramtrs 95782 Polysom <6 Yrs 4/> Paramtrs 95782 Polysom <6 Yrs 4/> Paramtrs 95783 Polysom <6 Yrs Cpap/Bilvl 95783 Polysom <6 Yrs Cpap/Bilvl 95783 Polysom <6 Yrs Cpap/Bilvl 95800 510 Slp Stdy Unattended $408 $265 $317 $134 $0 95800 510 Slp Stdy Unattended $408 $265 $317 $134 $0 95800 510 Slp Stdy Unattended $408 $265 $317 $134 $0 95801 Slp Stdy Unatnd W/Anal 95801 Slp Stdy Unatnd W/Anal 95801 Slp Stdy Unatnd W/Anal 95803 Actigraphy Testing 95803 Actigraphy Testing 95803 Actigraphy Testing 95805 510 Multiple Sleep Latency Test $1,137 $739 $883 $373 $256 95805 510 Multiple Sleep Latency Test $1,137 $739 $883 $373 $256 95805 510 Multiple Sleep Latency Test $1,137 $739 $883 $373 $256 95806 510 Sleep Study Unatt&Resp Efft $904 $588 $702 $296 $32 95806 510 Sleep Study Unatt&Resp Efft $904 $588 $702 $296 $32 95806 510 Sleep Study Unatt&Resp Efft $904 $588 $702 $296 $32 95807 510 Sleep Study Attended $1,216 $791 $944 $399 95807 510 Sleep Study Attended $1,216 $791 $944 $399 95807 510 Sleep Study Attended $1,216 $791 $944 $399 95808 Polysom Any Age 1-3> Param 95808 Polysom Any Age 1-3> Param 95808 Polysom Any Age 1-3> Param 95810 510 Polysom 6/> Yrs 4/> Param $1,565 $1,017 $1,215 $513 $401 95810 510 Polysom 6/> Yrs 4/> Param $1,565 $1,017 $1,215 $513 $401 95810 510 Polysom 6/> Yrs 4/> Param $1,565 $1,017 $1,215 $513 $401 95811 510 Polysom 6/>Yrs Cpap 4/> Parm $1,646 $1,070 $1,278 $539 $402 95811 510 Polysom 6/>Yrs Cpap 4/> Parm $1,646 $1,070 $1,278 $539 $402 95811 510 Polysom 6/>Yrs Cpap 4/> Parm $1,646 $1,070 $1,278 $539 $402 95812 Eeg 41-60 Minutes 95812 Eeg 41-60 Minutes 95812 Eeg 41-60 Minutes 95813 Eeg Extnd Mntr 61-119 Min 95813 Eeg Extnd Mntr 61-119 Min 95813 Eeg Extnd Mntr 61-119 Min 95816 740 Eeg Awake And Drowsy $1,294 $841 $1,005 $424 95816 740 Eeg Awake And Drowsy $1,294 $841 $1,005 $424 95816 740 Eeg Awake And Drowsy $1,294 $841 $1,005 $424 95819 740 Eeg Awake And Asleep $1,463 $951 $1,136 $479 95819 740 Eeg Awake And Asleep $1,463 $951 $1,136 $479 95819 740 Eeg Awake And Asleep $1,463 $951 $1,136 $479 95822 Eeg Coma Or Sleep Only 95822 Eeg Coma Or Sleep Only 95822 Eeg Coma Or Sleep Only 95824 Eeg Cerebral Death Only 95824 Eeg Cerebral Death Only 95824 Eeg Cerebral Death Only 95829 Surgery Electrocorticogram 95829 Surgery Electrocorticogram 95829 Surgery Electrocorticogram 95830 Insert Electrodes For Eeg 95836 Ecog Impltd Brn Npgt <30 D 95851 Range Of Motion Measurements 95852 Range Of Motion Measurements 95857 Cholinesterase Challenge 95860 Muscle Test One Limb 95860 Muscle Test One Limb 95860 Muscle Test One Limb 95861 Muscle Test 2 Limbs 95861 Muscle Test 2 Limbs 95861 Muscle Test 2 Limbs 95863 Muscle Test 3 Limbs 95863 Muscle Test 3 Limbs 95863 Muscle Test 3 Limbs 95864 Muscle Test 4 Limbs 95864 Muscle Test 4 Limbs 95864 Muscle Test 4 Limbs 95865 Muscle Test Larynx 95865 Muscle Test Larynx 95865 Muscle Test Larynx 95866 Muscle Test Hemidiaphragm 95866 Muscle Test Hemidiaphragm 95866 Muscle Test Hemidiaphragm 95867 510 Muscle Test Cran Nerv Unilat $136 $88 $106 $45 95867 510 Muscle Test Cran Nerv Unilat $136 $88 $106 $45 95867 510 Muscle Test Cran Nerv Unilat $136 $88 $106 $45 95868 Muscle Test Cran Nerve Bilat 95868 Muscle Test Cran Nerve Bilat 95868 Muscle Test Cran Nerve Bilat 95869 Muscle Test Thor Paraspinal 95869 Muscle Test Thor Paraspinal 95869 Muscle Test Thor Paraspinal 95870 Muscle Test Nonparaspinal 95870 Muscle Test Nonparaspinal 95870 Muscle Test Nonparaspinal 95872 Muscle Test One Fiber 95872 Muscle Test One Fiber 95872 Muscle Test One Fiber 95873 Guide Nerv Destr Elec Stim 95873 Guide Nerv Destr Elec Stim 95873 Guide Nerv Destr Elec Stim 95874 510 Guide Nerv Destr Needle Emg $151 $98 $117 $49 95874 510 Guide Nerv Destr Needle Emg $151 $98 $117 $49 95874 510 Guide Nerv Destr Needle Emg $151 $98 $117 $49 95875 Limb Exercise Test 95875 Limb Exercise Test 95875 Limb Exercise Test 95885 510 Musc Tst Done W/Nerv Tst Lim $168 $109 $131 $55 95885 510 Musc Tst Done W/Nerv Tst Lim $168 $109 $131 $55 95885 510 Musc Tst Done W/Nerv Tst Lim $168 $109 $131 $55 95886 510 Musc Test Done W/N Test Comp $165 $107 $128 $54 95886 510 Musc Test Done W/N Test Comp $165 $107 $128 $54 95886 510 Musc Test Done W/N Test Comp $165 $107 $128 $54 95887 Musc Tst Done W/N Tst Nonext 95887 Musc Tst Done W/N Tst Nonext 95887 Musc Tst Done W/N Tst Nonext 95905 Motor &/ Sens Nrve Cndj Test 95905 Motor &/ Sens Nrve Cndj Test 95905 Motor &/ Sens Nrve Cndj Test 95907 Nvr Cndj Tst 1-2 Studies 95907 Nvr Cndj Tst 1-2 Studies 95907 Nvr Cndj Tst 1-2 Studies 95908 510 Nrv Cndj Tst 3-4 Studies $154 $100 $119 $50 95908 510 Nrv Cndj Tst 3-4 Studies $154 $100 $119 $50 95908 510 Nrv Cndj Tst 3-4 Studies $154 $100 $119 $50 95909 510 Nrv Cndj Tst 5-6 Studies $180 $117 $140 $59 95909 510 Nrv Cndj Tst 5-6 Studies $180 $117 $140 $59 95909 510 Nrv Cndj Tst 5-6 Studies $180 $117 $140 $59 95910 510 Nrv Cndj Test 7-8 Studies $237 $154 $184 $78 95910 510 Nrv Cndj Test 7-8 Studies $237 $154 $184 $78 95910 510 Nrv Cndj Test 7-8 Studies $237 $154 $184 $78 95911 510 Nrv Cndj Test 9-10 Studies $270 $176 $210 $89 95911 510 Nrv Cndj Test 9-10 Studies $270 $176 $210 $89 95911 510 Nrv Cndj Test 9-10 Studies $270 $176 $210 $89 95912 510 Nrv Cndj Test 11-12 Studies $278 $181 $216 $91 95912 510 Nrv Cndj Test 11-12 Studies $278 $181 $216 $91 95912 510 Nrv Cndj Test 11-12 Studies $278 $181 $216 $91 95913 510 Nrv Cndj Test 13/> Studies $296 $192 $230 $97 95913 510 Nrv Cndj Test 13/> Studies $296 $192 $230 $97 95913 510 Nrv Cndj Test 13/> Studies $296 $192 $230 $97 95921 Autonomic Nrv Parasym Inervj 95921 Autonomic Nrv Parasym Inervj 95921 Autonomic Nrv Parasym Inervj 95922 Autonomic Nrv Adrenrg Inervj 95922 Autonomic Nrv Adrenrg Inervj 95922 Autonomic Nrv Adrenrg Inervj 95923 Autonomic Nrv Syst Funj Test 95923 Autonomic Nrv Syst Funj Test 95923 Autonomic Nrv Syst Funj Test 95924 Ans Parasymp & Symp W/Tilt 95924 Ans Parasymp & Symp W/Tilt 95924 Ans Parasymp & Symp W/Tilt 95925 Somatosensory Testing 95925 Somatosensory Testing 95925 Somatosensory Testing 95926 Somatosensory Testing 95926 Somatosensory Testing 95926 Somatosensory Testing 95927 Somatosensory Testing 95927 Somatosensory Testing 95927 Somatosensory Testing 95928 C Motor Evoked Uppr Limbs 95928 C Motor Evoked Uppr Limbs 95928 C Motor Evoked Uppr Limbs 95929 C Motor Evoked Lwr Limbs 95929 C Motor Evoked Lwr Limbs 95929 C Motor Evoked Lwr Limbs 95930 922 Visual Ep Test Cns W/I&R $1,362 $885 $1,057 $446 $127 95930 922 Visual Ep Test Cns W/I&R $1,362 $885 $1,057 $446 $127 95930 922 Visual Ep Test Cns W/I&R $1,362 $885 $1,057 $446 $127 95933 Blink Reflex Test 95933 Blink Reflex Test 95933 Blink Reflex Test 95937 Neuromuscular Junction Test 95937 Neuromuscular Junction Test 95937 Neuromuscular Junction Test 95938 Somatosensory Testing 95938 Somatosensory Testing 95938 Somatosensory Testing 95939 C Motor Evoked Upr&Lwr Limbs 95939 C Motor Evoked Upr&Lwr Limbs 95939 C Motor Evoked Upr&Lwr Limbs 95940 Ionm In Operatng Room 15 Min 95941 Ionm Remote/>1 Pt Or Per Hr 95943 Parasymp&Symp Hrt Rate Test 95943 Parasymp&Symp Hrt Rate Test 95943 Parasymp&Symp Hrt Rate Test 95954 Eeg Monitoring/Giving Drugs 95954 Eeg Monitoring/Giving Drugs 95954 Eeg Monitoring/Giving Drugs 95955 740 Eeg During Surgery $489 $318 $380 $160 95955 740 Eeg During Surgery $489 $318 $380 $160 95955 740 Eeg During Surgery $489 $318 $380 $160 95957 Eeg Digital Analysis 95957 Eeg Digital Analysis 95957 Eeg Digital Analysis 95958 Eeg Monitoring/Function Test 95958 Eeg Monitoring/Function Test 95958 Eeg Monitoring/Function Test 95961 Electrode Stimulation Brain 95961 Electrode Stimulation Brain 95961 Electrode Stimulation Brain 95962 Electrode Stim Brain Add-On 95962 Electrode Stim Brain Add-On 95962 Electrode Stim Brain Add-On 95965 Meg Spontaneous 95965 Meg Spontaneous 95965 Meg Spontaneous 95966 Meg Evoked Single 95966 Meg Evoked Single 95966 Meg Evoked Single 95967 Meg Evoked Each Addl 95967 Meg Evoked Each Addl 95967 Meg Evoked Each Addl 95970 510 Alys Npgt W/O Prgrmg $104 $67 $80 $34 95971 510 Alys Smpl Sp/Pn Npgt W/Prgrm $70 $46 $54 $23 95972 510 Alys Cplx Sp/Pn Npgt W/Prgrm $77 $50 $60 $25 95976 Alys Smpl Cn Npgt Prgrmg 95977 Alys Cplx Cn Npgt Prgrmg 95980 Io Anal Gast N-Stim Init 95981 Io Anal Gast N-Stim Subsq 95982 Io Ga N-Stim Subsq W/Reprog 95983 Alys Brn Npgt Prgrmg 15 Min 95984 Alys Brn Npgt Prgrmg Addl 15 95990 Spin/Brain Pump Refil & Main 95991 Spin/Brain Pump Refil & Main 95992 420 Canalith Repositioning Proc $103 $67 $80 $34 95999 Neurological Procedure 96000 Motion Analysis Video/3D 96001 Motion Test W/Ft Press Meas 96002 Dynamic Surface Emg 96003 Dynamic Fine Wire Emg 96004 Phys Review Of Motion Tests 96020 Functional Brain Mapping 96020 Functional Brain Mapping 96020 Functional Brain Mapping 96040 Genetic Counseling 30 Min 96105 440 Assessment Of Aphasia $294 $191 $228 $96 96110 510 Developmental Screen W/Score $31 $20 $24 $10 96112 430 Devel Tst Phys/Qhp 1St Hr $397 $258 $308 $130 96113 430 Devel Tst Phys/Qhp Ea Addl $0 $0 96116 918 Nubhvl Xm Phys/Qhp 1St Hr $454 $295 $352 $149 96121 Nubhvl Xm Phy/Qhp Ea Addl Hr 96125 430 Cognitive Test By Hc Pro $278 $181 $216 $92 96127 900 Brief Emotional/Behav Assmt $37 $24 $29 $12 96130 510 Psycl Tst Eval Phys/Qhp 1St $136 $88 $106 $45 96131 510 Psycl Tst Eval Phys/Qhp Ea $136 $88 $106 $45 96132 918 Nrpsyc Tst Eval Phys/Qhp 1St $143 $93 $111 $47 96133 918 Nrpsyc Tst Eval Phys/Qhp Ea $143 $93 $111 $47 96136 510 Psycl/Nrpsyc Tst Phy/Qhp 1St $17 $11 $13 $6 96137 510 Psycl/Nrpsyc Tst Phy/Qhp Ea $17 $11 $13 $6 96138 Psycl/Nrpsyc Tech 1St 96139 Psycl/Nrpsyc Tst Tech Ea 96146 Psycl/Nrpsyc Tst Auto Result 96156 918 Hlth Bhv Assmt/Reassessment $342 $222 $266 $112 96158 918 Hlth Bhv Ivntj Indiv 1St 30 $234 $152 $182 $77 $64 96159 918 Hlth Bhv Ivntj Indiv Ea Addl $82 $53 $64 $27 96160 Pt-Focused Hlth Risk Assmt $12 $8 $9 $4 96161 Caregiver Health Risk Assmt 96164 Hlth Bhv Ivntj Grp 1St 30 96165 Hlth Bhv Ivntj Grp Ea Addl 96167 Hlth Bhv Ivntj Fam 1St 30 96168 Hlth Bhv Ivntj Fam Ea Addl 96170 Hlth Bhv Ivntj Fam Wo Pt 1St 96171 Hlth Bhv Ivntj Fam W/O Pt Ea 96360 510 Hydration Iv Infusion Init $499 $324 $387 $163 96361 260 Hydrate Iv Infusion Add-On $208 $135 $161 $68 96365 510 Ther/Proph/Diag Iv Inf Init $472 $307 $366 $154 96366 260 Ther/Proph/Diag Iv Inf Addon $166 $108 $129 $54 96367 260 Tx/Proph/Dg Addl Seq Iv Inf $166 $108 $129 $54 96368 260 Ther/Diag Concurrent Inf $326 $212 $253 $107 96369 Sc Ther Infusion Up To 1 Hr 96370 Sc Ther Infusion Addl Hr 96371 Sc Ther Infusion Reset Pump 96372 510 Ther/Proph/Diag Inj Sc/Im $93 $60 $72 $30 96373 510 Ther/Proph/Diag Inj Ia $47 $31 $37 $15 96374 510 Ther/Proph/Diag Inj Iv Push $236 $153 $183 $77 96375 260 Tx/Pro/Dx Inj New Drug Addon $119 $77 $92 $39 96376 260 Tx/Pro/Dx Inj Same Drug Adon $97 $63 $75 $32 96377 Applicaton On-Body Injector 96379 Ther/Prop/Diag Inj/Inf Proc 96401 510 Chemo Anti-Neopl Sq/Im $254 $165 $197 $83 96402 331 Chemo Hormon Antineopl Sq/Im $92 $60 $71 $30 96405 Chemo Intralesional Up To 7 96406 Chemo Intralesional Over 7 96409 510 Chemo Iv Push Sngl Drug $332 $216 $258 $109 96411 335 Chemo Iv Push Addl Drug $142 $92 $110 $47 96413 335 Chemo Iv Infusion 1 Hr $378 $246 $294 $124 96415 335 Chemo Iv Infusion Addl Hr $85 $55 $66 $28 96416 335 Chemo Prolong Infuse W/Pump $1,288 $837 $1,000 $422 96417 335 Chemo Iv Infus Each Addl Seq $142 $92 $110 $47 96420 Chemo Ia Push Tecnique 96422 Chemo Ia Infusion Up To 1 Hr 96423 Chemo Ia Infuse Each Addl Hr 96425 Chemotherapy Infusion Method 96440 Chemotherapy Intracavitary 96446 Chemotx Admn Prtl Cavity 96450 Chemotherapy Into Cns 96521 339 Refill/Maint Portable Pump $346 $225 $269 $113 96522 Refill/Maint Pump/Resvr Syst 96523 510 Irrig Drug Delivery Device $121 $79 $94 $40 96542 Chemotherapy Injection 96549 Chemotherapy Unspecified 96567 Pdt Dstr Prmlg Les Skn 96570 Photodynmc Tx 30 Min Add-On 96571 Photodynamic Tx Addl 15 Min 96573 Pdt Dstr Prmlg Les Phys/Qhp 96574 Dbrdmt Prmlg Les W/Pdt 96900 Ultraviolet Light Therapy 96902 Trichogram 96904 Whole Body Photography 96910 Photochemotherapy With Uv-B 96912 Photochemotherapy With Uv-A 96913 Photochemotherapy Uv-A Or B 96920 Laser Tx Skin < 250 Sq Cm 96921 Laser Tx Skin 250-500 Sq Cm 96922 Laser Tx Skin >500 Sq Cm 96931 Rcm Celulr Subcelulr Img Skn 96932 Rcm Celulr Subcelulr Img Skn 96933 Rcm Celulr Subcelulr Img Skn 96934 Rcm Celulr Subcelulr Img Skn 96935 Rcm Celulr Subcelulr Img Skn 96936 Rcm Celulr Subcelulr Img Skn 96999 Dermatological Procedure 97010 430 Hot Or Cold Packs Therapy $62 $40 $48 $20 $17 97012 420 Mechanical Traction Therapy $138 $90 $107 $42 97014 420 Electric Stimulation Therapy $138 $90 $107 $45 97016 420 Vasopneumatic Device Therapy $125 $81 $97 $37 97018 420 Paraffin Bath Therapy $137 $89 $106 $40 97022 420 Whirlpool Therapy $153 $99 $119 $46 97024 Diathermy Eg Microwave 97026 430 Infrared Therapy $17 $11 $13 $6 97028 Ultraviolet Therapy 97032 430 Electrical Stimulation $71 $46 $55 $22 97033 430 Electric Current Therapy $160 $104 $124 $48 97034 430 Contrast Bath Therapy $102 $66 $79 $31 97035 430 Ultrasound Therapy $138 $90 $107 $41 97036 Hydrotherapy 97039 Physical Therapy Treatment 97110 430 Therapeutic Exercises $140 $91 $109 $44 97112 430 Neuromuscular Reeducation $197 $128 $153 $61 97113 Aquatic Therapy/Exercises 97116 420 Gait Training Therapy $138 $90 $107 $43 97124 430 Massage Therapy $158 $103 $123 $49 97129 430 Ther Ivntj 1St 15 Min $60 $39 $47 $20 97130 430 Ther Ivntj Ea Addl 15 Min $57 $37 $44 $19 97139 Physical Medicine Procedure $25 $16 $19 $8 $0 97140 430 Manual Therapy 1/> Regions $169 $110 $131 $52 97150 430 Group Therapeutic Procedures $83 $54 $64 $26 97151 Bhv Id Assmt By Phys/Qhp 97152 Bhv Id Suprt Assmt By 1 Tech 97153 Adaptive Behavior Tx By Tech 97154 Grp Adapt Bhv Tx By Tech 97155 Adapt Behavior Tx Phys/Qhp 97156 Fam Adapt Bhv Tx Gdn Phy/Qhp 97157 Mult Fam Adapt Bhv Tx Gdn 97158 Grp Adapt Bhv Tx By Phy/Qhp 97161 420 Pt Eval Low Complex 20 Min $327 $213 $254 $106 97162 420 Pt Eval Mod Complex 30 Min $327 $213 $254 $106 97163 420 Pt Eval High Complex 45 Min $327 $213 $254 $106 97164 420 Pt Re-Eval Est Plan Care $248 $161 $193 $79 $26 97165 430 Ot Eval Low Complex 30 Min $327 $213 $254 $105 97166 430 Ot Eval Mod Complex 45 Min $327 $213 $254 $105 97167 430 Ot Eval High Complex 60 Min $327 $213 $254 $105 97168 430 Ot Re-Eval Est Plan Care $248 $161 $193 $79 97169 Athletic Trn Eval Low Cmplx 97170 Athletic Trn Eval Mod Cmplx 97171 Athletic Trn Eval High Cmplx 97172 Athletic Trn Re-Eval Plan Cr 97530 430 Therapeutic Activities $210 $137 $163 $65 97533 430 Sensory Integration $150 $98 $116 $50 97535 430 Self Care Mngment Training $163 $106 $127 $51 97537 430 Community/Work Reintegration $161 $105 $125 $50 97542 430 Wheelchair Mngment Training $56 $36 $43 $20 97545 430 Work Hardening $458 $298 $356 $150 97546 Work Hardening Add-On 97597 510 Rmvl Devital Tis 20 Cm/< $275 $179 $213 $90 97598 510 Rmvl Devital Tis Addl 20Cm/< $41 $27 $32 $13 97602 960 Wound(S) Care Non-Selective $175 $114 $136 $57 97605 510 Neg Press Wound Tx <=50 Cm $93 $60 $72 $30 97606 510 Neg Press Wound Tx >50 Cm $80 $52 $62 $26 97607 Neg Press Wnd Tx <=50 Sq Cm 97608 Neg Press Wound Tx >50 Cm 97610 Low Frequency Non-Thermal Us 97750 430 Physical Performance Test $142 $92 $110 $45 97755 Assistive Technology Assess 97760 420 Orthotic Mgmt&Traing 1St Enc $197 $128 $153 $62 $50 97761 420 Prosthetic Traing 1St Enc $120 $78 $93 $39 97763 420 Orthc/Prostc Mgmt Sbsq Enc $255 $166 $198 $80 97799 420 Physical Medicine Procedure $30 $20 $23 $10 97802 942 Medical Nutrition Indiv In $122 $79 $95 $39 $6 97803 942 Med Nutrition Indiv Subseq $108 $70 $84 $34 $9 97804 942 Medical Nutrition Group $60 $39 $47 $19 97810 Acupunct W/O Stimul 15 Min $42 $27 $33 $14 $8 97811 Acupunct W/O Stimul Addl 15M 97813 Acupunct W/Stimul 15 Min 97814 Acupunct W/Stimul Addl 15M 98925 510 Osteopath Manj 1-2 Regions $134 $87 $104 $44 98926 510 Osteopath Manj 3-4 Regions $204 $133 $158 $67 98927 510 Osteopath Manj 5-6 Regions $228 $148 $177 $75 98928 510 Osteopath Manj 7-8 Regions $263 $171 $204 $86 $66 98929 510 Osteopath Manj 9-10 Regions $299 $194 $232 $98 98940 510 Chiropract Manj 1-2 Regions $63 $41 $49 $21 $18 98941 940 Chiropract Manj 3-4 Regions $39 $25 $30 $13 98942 940 Chiropractic Manj 5 Regions $39 $26 $31 $13 98943 Chiropract Manj Xtrspinl 1/> $59 $38 $45 $19 $0 98960 Self-Mgmt Educ & Train 1 Pt 98961 Self-Mgmt Educ/Train 2-4 Pt 98962 Self-Mgmt Educ/Train 5-8 Pt 98966 900 Hc Pro Phone Call 5-10 Min $53 $34 $41 $17 98967 900 Hc Pro Phone Call 11-20 Min $90 $59 $70 $29 98968 900 Hc Pro Phone Call 21-30 Min $135 $88 $105 $43 98970 430 Qnhp Ol Dig Assmt&Mgmt 5-10 $45 $29 $35 $15 98971 430 Qnhp Ol Dig Assmt&Mgmt 11-20 $79 $51 $61 $26 98972 430 Qnhp Ol Dig Assmt&Mgmt 21+ $124 $81 $96 $41 99000 Specimen Handling Office-Lab $47 $31 $36 $15 99001 Specimen Handling Pt-Lab $49 $32 $38 $16 99002 Device Handling Phys/Qhp 99024 510 Postop Follow-Up Visit $0 $0 $28 99026 In-Hospital On Call Service 99027 Out-Of-Hosp On Call Service 99050 900 Medical Services After Hrs $65 $42 $50 $21 99051 510 Med Serv Eve/Wkend/Holiday $61 $40 $47 $20 99053 320 Med Serv 10Pm-8Am 24 Hr Fac $117 $76 $91 $38 99056 Med Service Out Of Office 99058 Office Emergency Care 99060 Out Of Office Emerg Med Serv 99070 250 Special Supplies Phys/Qhp $0 $0 $0 $0 99071 Patient Education Materials 99072 Addl Supl Matrl&Staf Tm Phe 99075 Medical Testimony 99078 Group Health Education 99080 Special Reports Or Forms 99082 Unusual Physician Travel 99091 Collj & Interpj Data Ea 30 D 99100 Special Anesthesia Service $150 $98 $116 $49 99116 Anesthesia With Hypothermia 99135 Special Anesthesia Procedure 99140 Emergency Anesthesia $150 $98 $116 $49 99151 Mod Sed Same Phys/Qhp <5 Yrs $64 $42 $50 $21 99152 982 Mod Sed Same Phys/Qhp 5/>Yrs $73 $48 $57 $24 99153 982 Mod Sed Same Phys/Qhp Ea $68 $44 $53 $22 99155 Mod Sed Oth Phys/Qhp <5 Yrs $252 $164 $196 $83 99156 Mod Sed Oth Phys/Qhp 5/>Yrs $205 $134 $159 $67 99157 Mod Sed Other Phys/Qhp Ea $156 $102 $121 $51 99170 Anogenital Exam Child W Imag 99172 Ocular Function Screen 99173 Visual Acuity Screen $41 $27 $32 $13 99174 Ocular Instrumnt Screen Bil 99175 Induction Of Vomiting 99177 Ocular Instrumnt Screen Bil 99183 Hyperbaric Oxygen Therapy $500 $325 $388 $164 $89 99184 Hypothermia Ill Neonate 99188 App Topical Fluoride Varnish 99190 Special Pump Services 99191 Special Pump Services 99192 Special Pump Services 99195 940 Phlebotomy $510 $332 $396 $167 99199 Special Service/Proc/Report 99201 510 Office/Outpatient Visit New $184 $120 $143 $60 99202 510 Office O/P New Sf 15-29 Min $247 $161 $192 $81 99203 510 Office O/P New Low 30-44 Min $364 $237 $283 $119 $114 99204 510 Office O/P New Mod 45-59 Min $510 $332 $396 $167 99205 510 Office O/P New Hi 60-74 Min $727 $473 $564 $238 99211 510 Office O/P Est Minimal Prob $90 $59 $70 $29 99212 510 Office O/P Est Sf 10-19 Min $138 $90 $107 $45 99213 510 Office O/P Est Low 20-29 Min $206 $134 $160 $67 99214 510 Office O/P Est Mod 30-39 Min $302 $196 $234 $99 99215 510 Office O/P Est Hi 40-54 Min $461 $300 $358 $151 99217 982 Observation Care Discharge $297 $193 $231 $97 99218 982 Initial Observation Care $355 $231 $276 $117 99219 982 Initial Observation Care $462 $300 $359 $151 99220 Initial Observation Care $390 $253 $303 $128 99221 982 Initial Hospital Care $453 $294 $352 $148 99222 982 Initial Hospital Care $625 $406 $485 $205 $183 99223 982 Initial Hospital Care $806 $524 $626 $264 $215 99224 982 Subsequent Observation Care $111 $72 $86 $36 99225 982 Subsequent Observation Care $197 $128 $153 $65 99226 982 Subsequent Observation Care $221 $144 $172 $72 99231 982 Subsequent Hospital Care $234 $152 $182 $77 $71 99232 982 Subsequent Hospital Care $319 $207 $248 $105 $73 99233 982 Subsequent Hospital Care $470 $306 $365 $154 $67 99234 982 Observ/Hosp Same Date $671 $436 $521 $220 $114 99235 982 Observ/Hosp Same Date $929 $604 $721 $304 $150 99236 Observ/Hosp Same Date $459 $298 $356 $150 99238 982 Hospital Discharge Day $384 $250 $298 $126 99239 Hospital Discharge Day $226 $147 $175 $74 99241 Office Consultation 99242 Office Consultation $216 $141 $168 $71 $61 99243 510 Office Consultation $304 $198 $236 $100 99244 Office Consultation 99245 Office Consultation $559 $363 $434 $183 99251 Inpatient Consultation 99252 Inpatient Consultation 99253 Inpatient Consultation $283 $184 $219 $93 $46 99254 Inpatient Consultation $407 $264 $316 $133 $133 99255 Inpatient Consultation $502 $326 $390 $164 $91 99281 981 Emergency Dept Visit $270 $176 $210 $88 99282 981 Emergency Dept Visit $375 $244 $291 $123 99283 981 Emergency Dept Visit $510 $332 $396 $167 99284 981 Emergency Dept Visit $819 $532 $636 $268 99285 981 Emergency Dept Visit $1,336 $868 $1,037 $437 99288 Direct Advanced Life Support 99291 981 Critical Care First Hour $1,796 $1,167 $1,394 $588 99292 981 Critical Care Addl 30 Min $582 $378 $452 $191 99304 Nursing Facility Care Init $252 $164 $196 $83 $82 99305 Nursing Facility Care Init $265 $172 $206 $87 $57 99306 Nursing Facility Care Init $338 $220 $263 $111 $99 99307 Nursing Fac Care Subseq $91 $59 $71 $30 $12 99308 Nursing Fac Care Subseq $140 $91 $109 $46 $18 99309 Nursing Fac Care Subseq $185 $120 $144 $61 $19 99310 Nursing Fac Care Subseq $277 $180 $215 $91 99315 Nursing Fac Discharge Day 99316 Nursing Fac Discharge Day $215 $140 $167 $71 $16 99318 Annual Nursing Fac Assessmnt $194 $126 $151 $64 $0 99324 Domicil/R-Home Visit New Pat 99325 Domicil/R-Home Visit New Pat 99326 Domicil/R-Home Visit New Pat 99327 Domicil/R-Home Visit New Pat 99328 Domicil/R-Home Visit New Pat 99334 Domicil/R-Home Visit Est Pat 99335 Domicil/R-Home Visit Est Pat 99336 Domicil/R-Home Visit Est Pat 99337 Domicil/R-Home Visit Est Pat 99339 Domicil/R-Home Care Supervis 99340 Domicil/R-Home Care Supervis 99341 Home Visit New Patient 99342 Home Visit New Patient 99343 Home Visit New Patient 99344 Home Visit New Patient 99345 Home Visit New Patient 99347 Home Visit Est Patient 99348 Home Visit Est Patient 99349 982 Home Visit Est Patient $592 $385 $460 $194 99350 Home Visit Est Patient 99354 510 Prolng Svc O/P 1St Hour $457 $297 $355 $150 99355 510 Prolng Svc O/P Ea Addl 30 $452 $294 $351 $148 99356 Prolng Svc I/P/Obs 1St Hour $285 $185 $221 $93 $24 99357 Prolng Svc I/P/Obs Ea Addl $266 $173 $206 $87 $24 99358 Prolong Service W/O Contact 99359 Prolong Serv W/O Contact Add 99360 Physician Standby Services 99366 Team Conf W/Pat By Hc Prof 99367 420 Team Conf W/O Pat By Phys $91 $59 $71 $30 99368 Team Conf W/O Pat By Hc Pro 99374 Home Health Care Supervision 99375 Home Health Care Supervision 99377 Hospice Care Supervision 99378 Hospice Care Supervision 99379 Nursing Fac Care Supervision 99380 Nursing Fac Care Supervision 99381 510 Init Pm E/M New Pat Infant $221 $144 $172 $72 99382 510 Init Pm E/M New Pat 1-4 Yrs $247 $161 $192 $81 99383 510 Prev Visit New Age 5-11 $310 $202 $241 $102 $94 99384 510 Prev Visit New Age 12-17 $285 $185 $221 $93 99385 510 Prev Visit New Age 18-39 $366 $238 $284 $120 $112 99386 510 Prev Visit New Age 40-64 $420 $273 $326 $138 $125 99387 510 Init Pm E/M New Pat 65+ Yrs $468 $304 $363 $153 $128 99391 510 Per Pm Reeval Est Pat Infant $191 $124 $148 $63 99392 510 Prev Visit Est Age 1-4 $199 $129 $154 $65 99393 510 Prev Visit Est Age 5-11 $221 $144 $172 $73 99394 510 Prev Visit Est Age 12-17 $247 $161 $192 $81 99395 510 Prev Visit Est Age 18-39 $309 $201 $240 $101 99396 510 Prev Visit Est Age 40-64 $342 $222 $266 $112 99397 510 Per Pm Reeval Est Pat 65+ Yr $435 $283 $338 $143 $108 99401 900 Preventive Counseling Indiv $108 $70 $84 $35 99402 942 Preventive Counseling Indiv $161 $105 $125 $53 99403 942 Preventive Counseling Indiv $240 $156 $186 $79 99404 942 Preventive Counseling Indiv $321 $209 $249 $105 99406 942 Behav Chng Smoking 3-10 Min $53 $34 $41 $17 99407 983 Behav Chng Smoking > 10 Min $108 $70 $84 $35 99408 Audit/Dast 15-30 Min 99409 Audit/Dast Over 30 Min 99411 Preventive Counseling Group $56 $36 $43 $18 $0 99412 Preventive Counseling Group 99415 Prolng Clin Staff Svc 1St Hr 99416 Prolng Clin Staff Svc Ea Add 99417 Prolng Off/Op E/M Ea 15 Min 99421 Ol Dig E/M Svc 5-10 Min 99422 Ol Dig E/M Svc 11-20 Min 99423 Ol Dig E/M Svc 21+ Min 99429 Unlisted Preventive Service $100 $65 $78 $33 99439 Chrnc Care Mgmt Svc Ea Addl 99441 900 Phone E/M Phys/Qhp 5-10 Min $63 $41 $49 $21 $20 99442 900 Phone E/M Phys/Qhp 11-20 Min $117 $76 $91 $38 $36 99443 900 Phone E/M Phys/Qhp 21-30 Min $187 $122 $145 $61 $47 99446 Ntrprof Ph1/Ntrnet/Ehr 5-10 99447 Ntrprof Ph1/Ntrnet/Ehr 11-20 99448 Ntrprof Ph1/Ntrnet/Ehr 21-30 99449 Ntrprof Ph1/Ntrnet/Ehr 31/> 99450 Basic Life Disability Exam 99451 Ntrprof Ph1/Ntrnet/Ehr 5/> 99452 Ntrprof Ph1/Ntrnet/Ehr Rfrl 99453 Rem Mntr Physiol Param Setup 99454 Rem Mntr Physiol Param Dev 99455 Work Related Disability Exam 99456 Disability Examination 99457 Rem Physiol Mntr 1St 20 Min 99458 Rem Physiol Mntr Ea Addl 20 99460 Init Nb Em Per Day Hosp 99461 Init Nb Em Per Day Non-Fac 99462 Sbsq Nb Em Per Day Hosp 99463 Same Day Nb Discharge 99464 Attendance At Delivery 99465 Nb Resuscitation 99466 Ped Crit Care Transport 99467 Ped Crit Care Transport Addl 99468 Neonate Crit Care Initial 99469 Neonate Crit Care Subsq 99471 Ped Critical Care Initial 99472 Ped Critical Care Subsq 99473 Self-Meas Bp Pt Educaj/Train 99474 Self-Meas Bp 2 Readg Bid 30D 99475 Ped Crit Care Age 2-5 Init 99476 Ped Crit Care Age 2-5 Subsq 99477 Init Day Hosp Neonate Care 99478 Ic Lbw Inf < 1500 Gm Subsq 99479 Ic Lbw Inf 1500-2500 G Subsq 99480 Ic Inf Pbw 2501-5000 G Subsq 99483 510 Assmt & Care Pln Pt Cog Imp $281 $183 $218 $92 99484 Care Mgmt Svc Bhvl Hlth Cond 99485 Suprv Interfacilty Transport 99486 Suprv Interfac Trnsport Addl 99487 Cplx Chrnc Care 1St 60 Min 99489 Cplx Chrnc Care Ea Addl 30 99490 Chrnc Care Mgmt Svc 1St 20 99491 Chrnc Care Mgmt Svc 30 Min 99492 1St Psyc Collab Care Mgmt 99493 Sbsq Psyc Collab Care Mgmt 99494 1St/Sbsq Psyc Collab Care 99495 510 Trans Care Mgmt 14 Day Disch $570 $371 $443 $186 $54 99496 510 Trans Care Mgmt 7 Day Disch $802 $521 $623 $263 99497 510 Advncd Care Plan 30 Min $53 $35 $41 $17 99498 Advncd Care Plan Addl 30 Min 99499 Unlisted E&M Service 99500 Home Visit Prenatal 99501 Home Visit Postnatal 99502 Home Visit Nb Care 99503 Home Visit Resp Therapy 99504 Home Visit Mech Ventilator 99505 Home Visit Stoma Care 99506 Home Visit Im Injection 99507 Home Visit Cath Maintain 99509 Home Visit Day Life Activity 99510 Home Visit Sing/M/Fam Couns 99511 Home Visit Fecal/Enema Mgmt 99512 Home Visit For Hemodialysis 99600 Home Visit Nos 99601 Home Infusion/Visit 2 Hrs 99602 Home Infusion Each Addtl Hr 99605 Mtms By Pharm Np 15 Min 99606 Mtms By Pharm Est 15 Min 99607 Mtms By Pharm Addl 15 Min A0021 Outside State Ambulance Serv A0080 Noninterest Escort In Non Er A0090 Interest Escort In Non Er A0100 Nonemergency Transport Taxi A0110 Nonemergency Transport Bus A0120 Noner Transport Mini-Bus A0130 Noner Transport Wheelch Van A0140 Nonemergency Transport Air A0160 Noner Transport Case Worker A0170 Transport Parking Fees/Tolls A0180 Noner Transport Lodgng Recip A0190 Noner Transport Meals Recip A0200 Noner Transport Lodgng Escrt A0210 Noner Transport Meals Escort A0225 Neonatal Emergency Transport A0380 Basic Life Support Mileage A0382 Basic Support Routine Suppls A0384 Bls Defibrillation Supplies A0390 Advanced Life Support Mileag A0392 Als Defibrillation Supplies A0394 Als Iv Drug Therapy Supplies A0396 Als Esophageal Intub Suppls A0398 Als Routine Disposble Suppls A0420 Ambulance Waiting 1/2 Hr A0422 Ambulance 02 Life Sustaining A0424 Extra Ambulance Attendant A0425 Ground Mileage A0426 Als 1 A0427 Als1-Emergency A0428 Bls A0429 Bls-Emergency A0430 Fixed Wing Air Transport A0431 Rotary Wing Air Transport A0432 Pi Volunteer Ambulance Co A0433 Als 2 A0434 Specialty Care Transport A0435 Fixed Wing Air Mileage A0436 Rotary Wing Air Mileage A0888 Noncovered Ambulance Mileage A0998 Ambulance Response/Treatment A0999 Unlisted Ambulance Service A4206 1 Cc Sterile Syringe&Needle A4207 2 Cc Sterile Syringe&Needle A4208 3 Cc Sterile Syringe&Needle A4209 5+ Cc Sterile Syringe&Needle A4210 Nonneedle Injection Device A4211 Supp For Self-Adm Injections A4212 Non Coring Needle Or Stylet A4213 20+ Cc Syringe Only A4215 Sterile Needle A4216 Sterile Water/Saline, 10 Ml A4217 Sterile Water/Saline, 500 Ml A4218 Sterile Saline Or Water A4220 Infusion Pump Refill Kit A4221 Supp Non-Insulin Inf Cath/Wk A4222 Infusion Supplies With Pump A4223 Infusion Supplies W/O Pump A4224 Supply Insulin Inf Cath/Wk A4225 Sup/Ext Insulin Inf Pump Syr A4226 Weekly Supply Maint Cgs Pump A4230 Infus Insulin Pump Non Needl A4231 Infusion Insulin Pump Needle A4232 Syringe W/Needle Insulin 3Cc A4233 Alkalin Batt For Glucose Mon A4234 J-Cell Batt For Glucose Mon A4235 Lithium Batt For Glucose Mon A4236 Silvr Oxide Batt Glucose Mon A4244 Alcohol Or Peroxide Per Pint A4245 Alcohol Wipes Per Box A4246 Betadine/Phisohex Solution A4247 Betadine/Iodine Swabs/Wipes A4248 Chlorhexidine Antisept A4250 Urine Reagent Strips/Tablets A4252 Blood Ketone Test Or Strip A4253 Blood Glucose/Reagent Strips A4255 Glucose Monitor Platforms A4256 Calibrator Solution/Chips A4257 Replace Lensshield Cartridge A4258 Lancet Device Each A4259 Lancets Per Box A4261 Cervical Cap Contraceptive A4262 Temporary Tear Duct Plug A4263 Permanent Tear Duct Plug A4264 Intratubal Occlusion Device A4265 Paraffin A4266 Diaphragm A4267 Male Condom A4268 Female Condom A4269 Spermicide A4270 Disposable Endoscope Sheath A4280 Brst Prsths Adhsv Attchmnt A4281 Replacement Breastpump Tube A4282 Replacement Breastpump Adpt A4283 Replacement Breastpump Cap A4284 Replcmnt Breast Pump Shield A4285 Replcmnt Breast Pump Bottle A4286 Replcmnt Breastpump Lok Ring A4290 270 Sacral Nerve Stim Test Lead $716 $465 $556 $235 A4300 Cath Impl Vasc Access Portal A4301 Implantable Access Syst Perc A4305 Drug Delivery System >=50 Ml A4306 Drug Delivery System <=50 Ml A4310 Insert Tray W/O Bag/Cath A4311 Catheter W/O Bag 2-Way Latex A4312 Cath W/O Bag 2-Way Silicone A4313 Catheter W/Bag 3-Way A4314 Cath W/Drainage 2-Way Latex A4315 Cath W/Drainage 2-Way Silcne A4316 Cath W/Drainage 3-Way A4320 Irrigation Tray A4321 Cath Therapeutic Irrig Agent A4322 Irrigation Syringe A4326 Male External Catheter A4327 Fem Urinary Collect Dev Cup A4328 Fem Urinary Collect Pouch A4330 Stool Collection Pouch A4331 Extension Drainage Tubing A4332 Lube Sterile Packet A4333 Urinary Cath Anchor Device A4334 Urinary Cath Leg Strap A4335 Incontinence Supply A4336 Urethral Insert A4337 Incontinent Rectal Insert A4338 Indwelling Catheter Latex A4340 Indwelling Catheter Special A4344 Cath Indw Foley 2 Way Silicn A4346 Cath Indw Foley 3 Way A4349 Disposable Male External Cat A4351 Straight Tip Urine Catheter A4352 Coude Tip Urinary Catheter A4353 Intermittent Urinary Cath A4354 Cath Insertion Tray W/Bag A4355 Bladder Irrigation Tubing A4356 Ext Ureth Clmp Or Compr Dvc A4357 Bedside Drainage Bag A4358 Urinary Leg Or Abdomen Bag A4360 Disposable Ext Urethral Dev A4361 Ostomy Face Plate A4362 Solid Skin Barrier A4363 Ostomy Clamp, Replacement A4364 Adhesive, Liquid Or Equal A4366 Ostomy Vent A4367 Ostomy Belt A4368 Ostomy Filter A4369 Skin Barrier Liquid Per Oz A4371 Skin Barrier Powder Per Oz A4372 Skin Barrier Solid 4X4 Equiv A4373 Skin Barrier With Flange A4375 Drainable Plastic Pch W Fcpl A4376 Drainable Rubber Pch W Fcplt A4377 Drainable Plstic Pch W/O Fp A4378 Drainable Rubber Pch W/O Fp A4379 Urinary Plastic Pouch W Fcpl A4380 Urinary Rubber Pouch W Fcplt A4381 Urinary Plastic Pouch W/O Fp A4382 Urinary Hvy Plstc Pch W/O Fp A4383 Urinary Rubber Pouch W/O Fp A4384 Ostomy Faceplt/Silicone Ring A4385 Ost Skn Barrier Sld Ext Wear A4387 Ost Clsd Pouch W Att St Barr A4388 Drainable Pch W Ex Wear Barr A4389 Drainable Pch W St Wear Barr A4390 Drainable Pch Ex Wear Convex A4391 Urinary Pouch W Ex Wear Barr A4392 Urinary Pouch W St Wear Barr A4393 Urine Pch W Ex Wear Bar Conv A4394 Ostomy Pouch Liq Deodorant A4395 Ostomy Pouch Solid Deodorant A4396 Peristomal Hernia Supprt Blt A4397 Irrigation Supply Sleeve A4398 Ostomy Irrigation Bag A4399 Ostomy Irrig Cone/Cath W Brs A4400 Ostomy Irrigation Set A4402 Lubricant Per Ounce A4404 Ostomy Ring Each A4405 Nonpectin Based Ostomy Paste A4406 Pectin Based Ostomy Paste A4407 Ext Wear Ost Skn Barr <=4Sq A4408 Ext Wear Ost Skn Barr >4Sq A4409 Ost Skn Barr Convex <=4 Sq I A4410 Ost Skn Barr Extnd >4 Sq A4411 Ost Skn Barr Extnd =4Sq A4412 Ost Pouch Drain High Output A4413 2 Pc Drainable Ost Pouch A4414 Ost Sknbar W/O Conv<=4 Sq In A4415 Ost Skn Barr W/O Conv >4 Sqi A4416 Ost Pch Clsd W Barrier/Filtr A4417 Ost Pch W Bar/Bltinconv/Fltr A4418 Ost Pch Clsd W/O Bar W Filtr A4419 Ost Pch For Bar W Flange/Flt A4420 Ost Pch Clsd For Bar W Lk Fl A4421 Ostomy Supply Misc A4422 Ost Pouch Absorbent Material A4423 Ost Pch For Bar W Lk Fl/Fltr A4424 Ost Pch Drain W Bar & Filter A4425 Ost Pch Drain For Barrier Fl A4426 Ost Pch Drain 2 Piece System A4427 Ost Pch Drain/Barr Lk Flng/F A4428 Urine Ost Pouch W Faucet/Tap A4429 Urine Ost Pouch W Bltinconv A4430 Ost Urine Pch W B/Bltin Conv A4431 Ost Pch Urine W Barrier/Tapv A4432 Os Pch Urine W Bar/Fange/Tap A4433 Urine Ost Pch Bar W Lock Fln A4434 Ost Pch Urine W Lock Flng/Ft A4435 1Pc Ost Pch Drain Hgh Output A4450 Non-Waterproof Tape A4452 Waterproof Tape A4455 Adhesive Remover Per Ounce A4456 Adhesive Remover, Wipes A4458 Reusable Enema Bag A4459 Manual Pump Enema, Reusable A4461 Surgicl Dress Hold Non-Reuse A4463 Surgical Dress Holder Reuse A4465 Non-Elastic Extremity Binder A4467 Belt Strap Sleev Grmnt Cover A4470 Gravlee Jet Washer A4480 Vabra Aspirator A4481 Tracheostoma Filter A4483 Moisture Exchanger A4490 Above Knee Surgical Stocking A4495 Thigh Length Surg Stocking A4500 Below Knee Surgical Stocking A4510 Full Length Surg Stocking A4520 Incontinence Garment Anytype A4550 Surgical Trays A4553 Nondisp Underpads, All Sizes A4554 Disposable Underpads A4555 Ca Tx E-Stim Electr/Transduc A4556 Electrodes, Pair A4557 Lead Wires, Pair A4558 Conductive Gel Or Paste A4559 Coupling Gel Or Paste A4561 Pessary Rubber, Any Type A4562 274 Pessary, Non Rubber,Any Type $97 $63 $75 $32 A4563 Vag Inser Rectal Control Sys A4565 Slings A4566 Should Sling/Vest/Abrestrain A4570 Splint A4575 Hyperbaric O2 Chamber Disps A4580 Cast Supplies (Plaster) A4590 272 Special Casting Material $54 $35 $42 $18 A4595 Tens Suppl 2 Lead Per Month A4600 Sleeve, Inter Limb Comp Dev A4601 Lith Ion Non Prosth Recharge A4602 Replace Lithium Battery 1.5V A4604 Tubing With Heating Element A4605 Trach Suction Cath Close Sys A4606 Oxygen Probe Used W Oximeter A4608 Transtracheal Oxygen Cath A4611 Heavy Duty Battery A4612 Battery Cables A4613 Battery Charger A4614 Hand-Held Pefr Meter A4615 Cannula Nasal A4616 Tubing (Oxygen) Per Foot A4617 Mouth Piece A4618 Breathing Circuits A4619 Face Tent A4620 Variable Concentration Mask A4623 Tracheostomy Inner Cannula A4624 Tracheal Suction Tube A4625 Trach Care Kit For New Trach A4626 Tracheostomy Cleaning Brush A4627 Spacer Bag/Reservoir A4628 Oropharyngeal Suction Cath A4629 Tracheostomy Care Kit A4630 Repl Bat T.E.N.S. Own By Pt A4633 Uvl Replacement Bulb A4634 Replacement Bulb Th Lightbox A4635 Underarm Crutch Pad A4636 Handgrip For Cane Etc A4637 Repl Tip Cane/Crutch/Walker A4638 Repl Batt Pulse Gen Sys A4639 Infrared Ht Sys Replcmnt Pad A4640 Alternating Pressure Pad A4641 Radiopharm Dx Agent Noc $93 $60 $72 $30 A4642 In111 Satumomab A4648 278 Implantable Tissue Marker $494 $321 $384 $162 A4649 Surgical Supplies A4650 Implant Radiation Dosimeter A4651 Calibrated Microcap Tube A4652 Microcapillary Tube Sealant A4653 Pd Catheter Anchor Belt A4657 Syringe W/Wo Needle A4660 Sphyg/Bp App W Cuff And Stet A4663 Dialysis Blood Pressure Cuff A4670 Automatic Bp Monitor, Dial A4671 Disposable Cycler Set A4672 Drainage Ext Line, Dialysis A4673 Ext Line W Easy Lock Connect A4674 Chem/Antisept Solution, 8Oz A4680 Activated Carbon Filter, Ea A4690 Dialyzer, Each A4706 Bicarbonate Conc Sol Per Gal A4707 Bicarbonate Conc Pow Per Pac A4708 Acetate Conc Sol Per Gallon A4709 Acid Conc Sol Per Gallon A4714 Treated Water Per Gallon A4719 Y Set Tubing A4720 Dialysat Sol Fld Vol > 249Cc A4721 Dialysat Sol Fld Vol > 999Cc A4722 Dialys Sol Fld Vol > 1999Cc A4723 Dialys Sol Fld Vol > 2999Cc A4724 Dialys Sol Fld Vol > 3999Cc A4725 Dialys Sol Fld Vol > 4999Cc A4726 Dialys Sol Fld Vol > 5999Cc A4728 Dialysate Solution, Non-Dex A4730 Fistula Cannulation Set, Ea A4736 Topical Anesthetic, Per Gram A4737 Inj Anesthetic Per 10 Ml A4740 Shunt Accessory A4750 Art Or Venous Blood Tubing A4755 Comb Art/Venous Blood Tubing A4760 Dialysate Sol Test Kit, Each A4765 Dialysate Conc Pow Per Pack A4766 Dialysate Conc Sol Add 10 Ml A4770 Blood Collection Tube/Vacuum A4771 Serum Clotting Time Tube A4772 Blood Glucose Test Strips A4773 Occult Blood Test Strips A4774 Ammonia Test Strips A4802 Protamine Sulfate Per 50 Mg A4860 Disposable Catheter Tips A4870 Plumb/Elec Wk Hm Hemo Equip A4890 Repair/Maint Cont Hemo Equip A4911 Drain Bag/Bottle A4913 Misc Dialysis Supplies Noc A4918 Venous Pressure Clamp A4927 Non-Sterile Gloves A4928 Surgical Mask A4929 Tourniquet For Dialysis, Ea A4930 Sterile, Gloves Per Pair A4931 Reusable Oral Thermometer A4932 Reusable Rectal Thermometer A5051 Pouch Clsd W Barr Attached A5052 Clsd Ostomy Pouch W/O Barr A5053 Clsd Ostomy Pouch Faceplate A5054 Clsd Ostomy Pouch W/Flange A5055 Stoma Cap A5056 1 Pc Ost Pouch W Filter A5057 1 Pc Ost Pou W Built-In Conv A5061 Pouch Drainable W Barrier At A5062 Drnble Ostomy Pouch W/O Barr A5063 Drain Ostomy Pouch W/Flange A5071 Urinary Pouch W/Barrier A5072 Urinary Pouch W/O Barrier A5073 Urinary Pouch On Barr W/Flng A5081 Stoma Plug Or Seal, Any Type A5082 Continent Stoma Catheter A5083 Stoma Absorptive Cover A5093 Ostomy Accessory Convex Inse A5102 Bedside Drain Btl W/Wo Tube A5105 Urinary Suspensory A5112 Urinary Leg Bag A5113 Latex Leg Strap A5114 Foam/Fabric Leg Strap A5120 Skin Barrier, Wipe Or Swab A5121 Solid Skin Barrier 6X6 A5122 Solid Skin Barrier 8X8 A5126 Disk/Foam Pad +Or- Adhesive A5131 Appliance Cleaner A5200 Percutaneous Catheter Anchor A5500 Diab Shoe For Density Insert A5501 Diabetic Custom Molded Shoe A5503 Diabetic Shoe W/Roller/Rockr A5504 Diabetic Shoe With Wedge A5505 Diab Shoe W/Metatarsal Bar A5506 Diabetic Shoe W/Off Set Heel A5507 Modification Diabetic Shoe A5508 Diabetic Deluxe Shoe A5510 Compression Form Shoe Insert A5512 Multi Den Insert Direct Form A5513 Multi Den Insert Custom Mold A5514 Mult Den Insert Dir Carv/Cam A6000 Wound Warming Wound Cover A6010 Collagen Based Wound Filler A6011 Collagen Gel/Paste Wound Fil A6021 Collagen Dressing <=16 Sq In A6022 Collagen Drsg>16<=48 Sq In A6023 Collagen Dressing >48 Sq In A6024 Collagen Dsg Wound Filler A6025 Silicone Gel Sheet, Each A6154 Wound Pouch Each A6196 Alginate Dressing <=16 Sq In A6197 Alginate Drsg >16 <=48 Sq In A6198 Alginate Dressing > 48 Sq In A6199 Alginate Drsg Wound Filler A6203 Composite Drsg <= 16 Sq In A6204 Composite Drsg >16<=48 Sq In A6205 Composite Drsg > 48 Sq In A6206 Contact Layer <= 16 Sq In A6207 Contact Layer >16<= 48 Sq In A6208 Contact Layer > 48 Sq In A6209 Foam Drsg <=16 Sq In W/O Bdr A6210 Foam Drg >16<=48 Sq In W/O B A6211 Foam Drg > 48 Sq In W/O Brdr A6212 Foam Drg <=16 Sq In W/Border A6213 Foam Drg >16<=48 Sq In W/Bdr A6214 Foam Drg > 48 Sq In W/Border A6215 Foam Dressing Wound Filler A6216 Non-Sterile Gauze<=16 Sq In A6217 Non-Sterile Gauze>16<=48 Sq A6218 Non-Sterile Gauze > 48 Sq In A6219 Gauze <= 16 Sq In W/Border A6220 Gauze >16 <=48 Sq In W/Bordr A6221 Gauze > 48 Sq In W/Border A6222 Gauze <=16 In No W/Sal W/O B A6223 Gauze >16<=48 No W/Sal W/O B A6224 Gauze > 48 In No W/Sal W/O B A6228 Gauze <= 16 Sq In Water/Sal A6229 Gauze >16<=48 Sq In Watr/Sal A6230 Gauze > 48 Sq In Water/Salne A6231 Hydrogel Dsg<=16 Sq In A6232 Hydrogel Dsg>16<=48 Sq In A6233 Hydrogel Dressing >48 Sq In A6234 Hydrocolld Drg <=16 W/O Bdr A6235 Hydrocolld Drg >16<=48 W/O B A6236 Hydrocolld Drg > 48 In W/O B A6237 Hydrocolld Drg <=16 In W/Bdr A6238 Hydrocolld Drg >16<=48 W/Bdr A6239 Hydrocolld Drg > 48 In W/Bdr A6240 Hydrocolld Drg Filler Paste A6241 Hydrocolloid Drg Filler Dry A6242 Hydrogel Drg <=16 In W/O Bdr A6243 Hydrogel Drg >16<=48 W/O Bdr A6244 Hydrogel Drg >48 In W/O Bdr A6245 Hydrogel Drg <= 16 In W/Bdr A6246 Hydrogel Drg >16<=48 In W/B A6247 Hydrogel Drg > 48 Sq In W/B A6248 Hydrogel Drsg Gel Filler A6250 Skin Seal Protect Moisturizr A6251 Absorpt Drg <=16 Sq In W/O B A6252 Absorpt Drg >16 <=48 W/O Bdr A6253 Absorpt Drg > 48 Sq In W/O B A6254 Absorpt Drg <=16 Sq In W/Bdr A6255 Absorpt Drg >16<=48 In W/Bdr A6256 Absorpt Drg > 48 Sq In W/Bdr A6257 Transparent Film <= 16 Sq In A6258 Transparent Film >16<=48 In A6259 Transparent Film > 48 Sq In A6260 Wound Cleanser Any Type/Size A6261 Wound Filler Gel/Paste /Oz A6262 Wound Filler Dry Form / Gram A6266 Impreg Gauze No H20/Sal/Yard A6402 Sterile Gauze <= 16 Sq In A6403 Sterile Gauze>16 <= 48 Sq In A6404 Sterile Gauze > 48 Sq In A6407 Packing Strips, Non-Impreg A6410 Sterile Eye Pad A6411 Non-Sterile Eye Pad A6412 Occlusive Eye Patch A6413 Adhesive Bandage, First-Aid A6441 Pad Band W>=3 <5/Yd A6442 Conform Band N/S W<3/Yd A6443 Conform Band N/S W>=3<5/Yd A6444 Conform Band N/S W>=5/Yd A6445 Conform Band S W <3/Yd A6446 Conform Band S W>=3 <5/Yd A6447 Conform Band S W >=5/Yd A6448 Lt Compres Band <3/Yd A6449 Lt Compres Band >=3 <5/Yd A6450 Lt Compres Band >=5/Yd A6451 Mod Compres Band W>=3<5/Yd A6452 High Compres Band W>=3<5Yd A6453 Self-Adher Band W <3/Yd A6454 Self-Adher Band W>=3 <5/Yd A6455 Self-Adher Band >=5/Yd A6456 Zinc Paste Band W >=3<5/Yd A6457 Tubular Dressing A6460 Synthetic Drsg <= 16 Sq In A6461 Synthetic Drsg >16<=48 Sq In A6501 Compres Burngarment Bodysuit A6502 Compres Burngarment Chinstrp A6503 Compres Burngarment Facehood A6504 Cmprsburngarment Glove-Wrist A6505 Cmprsburngarment Glove-Elbow A6506 Cmprsburngrmnt Glove-Axilla A6507 Cmprs Burngarment Foot-Knee A6508 Cmprs Burngarment Foot-Thigh A6509 Compres Burn Garment Jacket A6510 Compres Burn Garment Leotard A6511 Compres Burn Garment Panty A6512 Compres Burn Garment, Noc A6513 Compress Burn Mask Face/Neck A6530 Compression Stocking Bk18-30 A6531 Compression Stocking Bk30-40 A6532 Compression Stocking Bk40-50 A6533 Gc Stocking Thighlngth 18-30 A6534 Gc Stocking Thighlngth 30-40 A6535 Gc Stocking Thighlngth 40-50 A6536 Gc Stocking Full Lngth 18-30 A6537 Gc Stocking Full Lngth 30-40 A6538 Gc Stocking Full Lngth 40-50 A6539 Gc Stocking Waistlngth 18-30 A6540 Gc Stocking Waistlngth 30-40 A6541 Gc Stocking Waistlngth 40-50 A6544 Gc Stocking Garter Belt A6545 Grad Comp Non-Elastic Bk A6549 G Compression Stocking A6550 Neg Pres Wound Ther Drsg Set A7000 Disposable Canister For Pump A7001 Nondisposable Pump Canister A7002 Tubing Used W Suction Pump A7003 Nebulizer Administration Set A7004 Disposable Nebulizer Sml Vol A7005 Nondisposable Nebulizer Set A7006 Filtered Nebulizer Admin Set A7007 Lg Vol Nebulizer Disposable A7008 Disposable Nebulizer Prefill A7009 Nebulizer Reservoir Bottle A7010 Disposable Corrugated Tubing A7012 Nebulizer Water Collec Devic A7013 Disposable Compressor Filter A7014 Compressor Nondispos Filter A7015 Aerosol Mask Used W Nebulize A7016 Nebulizer Dome & Mouthpiece A7017 Nebulizer Not Used W Oxygen A7018 Water Distilled W/Nebulizer A7020 Interface, Cough Stim Device A7025 Replace Chest Compress Vest A7026 Replace Chst Cmprss Sys Hose A7027 Combination Oral/Nasal Mask A7028 Repl Oral Cushion Combo Mask A7029 Repl Nasal Pillow Comb Mask A7030 Cpap Full Face Mask A7031 Replacement Facemask Interfa A7032 Replacement Nasal Cushion A7033 Replacement Nasal Pillows A7034 Nasal Application Device A7035 Pos Airway Press Headgear A7036 Pos Airway Press Chinstrap A7037 Pos Airway Pressure Tubing A7038 Pos Airway Pressure Filter A7039 Filter, Non Disposable W Pap A7040 One Way Chest Drain Valve A7041 Water Seal Drain Container A7044 Pap Oral Interface A7045 Repl Exhalation Port For Pap A7046 Repl Water Chamber, Pap Dev A7047 Resp Suction Oral Interface A7048 Vacuum Drain Bottle/Tube Kit A7501 Tracheostoma Valve W Diaphra A7502 Replacement Diaphragm/Fplate A7503 Hmes Filter Holder Or Cap A7504 Tracheostoma Hmes Filter A7505 Hmes Or Trach Valve Housing A7506 Hmes/Trachvalve Adhesivedisk A7507 Integrated Filter & Holder A7508 Housing & Integrated Adhesiv A7509 Heat & Moisture Exchange Sys A7520 Trach/Laryn Tube Non-Cuffed A7521 Trach/Laryn Tube Cuffed A7522 Trach/Laryn Tube Stainless A7523 Tracheostomy Shower Protect A7524 Tracheostoma Stent/Stud/Bttn A7525 Tracheostomy Mask A7526 Tracheostomy Tube Collar A7527 Trach/Laryn Tube Plug/Stop A8000 Soft Protect Helmet Prefab A8001 Hard Protect Helmet Prefab A8002 Soft Protect Helmet Custom A8003 Hard Protect Helmet Custom A8004 Repl Soft Interface, Helmet A9150 Misc/Exper Non-Prescript Dru A9152 Single Vitamin Nos A9153 Multi-Vitamin Nos A9155 Artificial Saliva A9180 Lice Treatment, Topical A9270 Non-Covered Item Or Service $83 $54 $64 $27 A9272 Disp Wound Suct, Drsg/Access A9273 Hot/Cold Botle/Cap/Col/Wrap A9274 Ext Amb Insulin Delivery Sys A9275 Disp Home Glucose Monitor A9276 Disposable Sensor, Cgm Sys A9277 External Transmitter, Cgm A9278 External Receiver, Cgm Sys A9279 Monitoring Feature/Devicenoc A9280 Alert Device, Noc A9281 Reaching/Grabbing Device A9282 Wig Any Type A9283 Foot Press Off Load Supp Dev A9284 Non-Electronic Spirometer A9285 Inversion Eversion Cor Devic A9286 Any Hygienic Item, Device A9300 Exercise Equipment A9500 Tc99M Sestamibi $582 $378 $452 $191 A9501 Technetium Tc-99M Teboroxime A9502 Tc99M Tetrofosmin $275 $179 $213 $90 A9503 Tc99M Medronate $42 $27 $33 $14 A9504 Tc99M Apcitide A9505 Tl201 Thallium $60 $39 $47 $20 A9507 In111 Capromab A9508 I131 Iodobenguate, Dx A9509 Iodine I-123 Sod Iodide Mil A9510 Tc99M Disofenin A9512 Tc99M Pertechnetate $2 $1 $2 $1 A9513 Lutetium Lu 177 Dotatat Ther A9515 Choline C-11 A9516 Iodine I-123 Sod Iodide Mic $82 $53 $64 $27 A9517 I131 Iodide Cap, Rx $59 $38 $46 $19 A9520 Tc99 Tilmanocept Diag 0.5Mci A9521 Tc99M Exametazime A9524 I131 Serum Albumin, Dx A9526 Nitrogen N-13 Ammonia A9527 Iodine I-125 Sodium Iodide A9528 Iodine I-131 Iodide Cap, Dx $97 $63 $75 $32 A9529 I131 Iodide Sol, Dx A9530 I131 Iodide Sol, Rx A9531 I131 Max 100Uci A9532 I125 Serum Albumin, Dx A9536 Tc99M Depreotide A9537 Tc99M Mebrofenin $95 $62 $74 $31 A9538 Tc99M Pyrophosphate A9539 Tc99M Pentetate $38 $25 $30 $12 A9540 Tc99M Maa $142 $92 $110 $47 A9541 Tc99M Sulfur Colloid $74 $48 $57 $24 A9542 In111 Ibritumomab, Dx A9543 Y90 Ibritumomab, Rx A9546 Co57/58 A9547 In111 Oxyquinoline $3,916 $2,545 $3,040 $1,283 A9548 In111 Pentetate $2,573 $1,672 $1,998 $843 $234 A9550 Tc99M Gluceptate A9551 Tc99M Succimer A9552 F18 Fdg A9553 Cr51 Chromate A9554 I125 Iothalamate, Dx A9555 Rb82 Rubidium A9556 Ga67 Gallium A9557 Tc99M Bicisate A9558 Xe133 Xenon 10Mci $170 $111 $132 $56 A9559 Co57 Cyano A9560 Tc99M Labeled Rbc $578 $376 $449 $189 $98 A9561 Tc99M Oxidronate A9562 Tc99M Mertiatide A9563 P32 Na Phosphate A9564 P32 Chromic Phosphate A9566 Tc99M Fanolesomab A9567 Technetium Tc-99M Aerosol A9568 Technetium Tc99M Arcitumomab A9569 Technetium Tc-99M Auto Wbc A9570 Indium In-111 Auto Wbc A9571 Indium In-111 Auto Platelet A9572 Indium In-111 Pentetreotide $12,323 $8,010 $9,567 $4,038 A9575 Inj Gadoterate Meglumi 0.1Ml A9576 Inj Prohance Multipack A9577 Inj Multihance A9578 Inj Multihance Multipack A9579 Gad-Base Mr Contrast Nos,1Ml A9580 Sodium Fluoride F-18 A9581 Gadoxetate Disodium Inj A9582 Iodine I-123 Iobenguane A9583 Gadofosveset Trisodium Inj A9584 Iodine I-123 Ioflupane A9585 Gadobutrol Injection A9586 Florbetapir F18 A9587 Gallium Ga-68 A9588 Fluciclovine F-18 A9589 Insti Hexaminolevulinate Hcl A9590 Iodine I-131 Iobenguane 1Mci A9591 Fluoroestradiol F 18 A9597 Pet, Dx, For Tumor Id, Noc A9598 Pet Dx For Non-Tumor Id, Noc A9600 Sr89 Strontium A9604 Sm 153 Lexidronam A9606 Radium Ra223 Dichloride Ther A9698 Non-Rad Contrast Materialnoc A9699 Radiopharm Rx Agent Noc A9700 Echocardiography Contrast A9900 Supply/Accessory/Service A9901 Delivery/Set Up/Dispensing A9999 Dme Supply Or Accessory, Nos B4034 Enter Feed Supkit Syr By Day B4035 Enteral Feed Supp Pump Per D B4036 Enteral Feed Sup Kit Grav By B4081 Enteral Ng Tubing W/ Stylet B4082 Enteral Ng Tubing W/O Stylet B4083 Enteral Stomach Tube Levine B4087 Gastro/Jejuno Tube, Std B4088 Gastro/Jejuno Tube, Low-Pro B4100 Food Thickener Oral B4102 Ef Adult Fluids And Electro B4103 Ef Ped Fluid And Electrolyte B4104 Additive For Enteral Formula B4105 Enzyme Cartridge Enteral Nut B4149 Ef Blenderized Foods B4150 Ef Complet W/Intact Nutrient B4152 Ef Calorie Dense>/=1.5Kcal B4153 Ef Hydrolyzed/Amino Acids B4154 Ef Spec Metabolic Noninherit B4155 Ef Incomplete/Modular B4157 Ef Special Metabolic Inherit B4158 Ef Ped Complete Intact Nut B4159 Ef Ped Complete Soy Based B4160 Ef Ped Caloric Dense>/=0.7Kc B4161 Ef Ped Hydrolyzed/Amino Acid B4162 Ef Ped Specmetabolic Inherit B4164 Parenteral 50% Dextrose Solu B4168 Parenteral Sol Amino Acid 3. B4172 Parenteral Sol Amino Acid 5. B4176 Parenteral Sol Amino Acid 7- B4178 Parenteral Sol Amino Acid > B4180 Parenteral Sol Carb > 50% B4185 Pn Soln Nos 10 Grams Lipids B4187 Omegaven, 10 Grams Lipids B4189 Parenteral Sol Amino Acid & B4193 Parenteral Sol 52-73 Gm Prot B4197 Parenteral Sol 74-100 Gm Pro B4199 Parenteral Sol > 100Gm Prote B4216 Parenteral Nutrition Additiv B4220 Parenteral Supply Kit Premix B4222 Parenteral Supply Kit Homemi B4224 Parenteral Administration Ki B5000 Parenteral Sol Renal-Amirosy B5100 Parenteral Solution Hepatic B5200 Parenteral Sol Hepatic Fream B9002 Enter Nutr Inf Pump Any Type B9004 Parenteral Infus Pump Portab B9006 Parenteral Infus Pump Statio B9998 Enteral Supp Not Otherwise C B9999 Parenteral Supp Not Othrws C C1052 Hemostatic Agent, Gi, Topic C1062 Intravertebral Fx Aug Impl C1713 Anchor/Screw Bn/Bn,Tis/Bn $2,317 $1,506 $1,799 $759 C1714 Cath, Trans Atherectomy, Dir C1715 Brachytherapy Needle $38 $25 $30 $13 C1716 Brachytx, Non-Str, Gold-198 C1717 Brachytx, Non-Str,Hdr Ir-192 C1719 Brachytx, Ns, Non-Hdrir-192 C1721 Aicd, Dual Chamber $38,475 $25,009 $29,870 $12,607 C1722 Aicd, Single Chamber $36,551 $23,758 $28,376 $11,977 C1724 Cath, Trans Atherec,Rotation $9,120 $5,928 $7,080 $2,988 C1725 Cath, Translumin Non-Laser $1,268 $824 $985 $416 C1726 Cath, Bal Dil, Non-Vascular $3,474 $2,258 $2,697 $1,138 C1727 Cath, Bal Tis Dis, Non-Vas $23 $15 $18 $7 C1728 Cath, Brachytx Seed Adm $3,511 $2,282 $2,726 $1,150 C1729 272 Cath, Drainage $633 $411 $491 $207 C1730 Cath, Ep, 19 Or Few Elect $1,639 $1,065 $1,272 $537 C1731 Cath, Ep, 20 Or More Elec C1732 Cath, Ep, Diag/Abl, 3D/Vect $9,092 $5,909 $7,058 $2,979 $1,134 C1733 Cath, Ep, Othr Than Cool-Tip $2,922 $1,899 $2,268 $957 C1734 Orth/Devic/Drug Bn/Bn,Tis/Bn $10,460 $6,799 $8,120 $3,427 C1748 Endoscope, Single, Ugi C1749 Endo, Colon, Retro Imaging C1750 Cath, Hemodialysis,Long-Term $1,055 $685 $819 $346 C1751 272 Cath, Inf, Per/Cent/Midline $1,174 $763 $912 $385 C1752 Cath,Hemodialysis,Short-Term $238 $155 $185 $78 C1753 Cath, Intravas Ultrasound $3,420 $2,223 $2,655 $1,121 C1754 Catheter, Intradiscal C1755 Catheter, Intraspinal $2,565 $1,667 $1,991 $840 C1756 Cath, Pacing, Transesoph C1757 Cath, Thrombectomy/Embolect $23 $15 $18 $7 C1758 Catheter, Ureteral $23 $15 $18 $7 C1759 Cath, Intra Echocardiography $7,553 $4,909 $5,863 $2,475 $1,103 C1760 Closure Dev, Vasc $527 $343 $409 $173 C1762 Conn Tiss, Human(Inc Fascia) $5,938 $3,859 $4,610 $1,946 C1763 Conn Tiss, Non-Human $1,075 $699 $834 $352 C1764 Event Recorder, Cardiac $10,830 $7,040 $8,408 $3,549 C1765 Adhesion Barrier $1,069 $695 $830 $350 C1766 Intro/Sheath,Strble,Non-Peel $1,354 $880 $1,051 $444 C1767 Generator, Neuro Non-Recharg $28,215 $18,340 $21,905 $9,245 C1768 Graft, Vascular $2,539 $1,651 $1,971 $832 C1769 Guide Wire $276 $179 $214 $90 C1770 Imaging Coil, Mr, Insertable C1771 Rep Dev, Urinary, W/Sling $3,342 $2,172 $2,595 $1,095 C1772 Infusion Pump, Programmable $1,568 $1,019 $1,217 $514 C1773 Ret Dev, Insertable $655 $426 $509 $215 C1776 Joint Device (Implantable) $1,744 $1,134 $1,354 $572 C1777 Lead, Aicd, Endo Single Coil $7,994 $5,196 $6,206 $2,619 C1778 Lead, Neurostimulator $16,815 $10,930 $13,054 $5,510 C1779 Lead, Pmkr, Transvenous Vdd $1,425 $926 $1,106 $467 C1780 Lens, Intraocular (New Tech) C1781 Mesh (Implantable) $828 $538 $643 $271 C1782 Morcellator $2,032 $1,321 $1,578 $666 C1783 Ocular Imp, Aqueous Drain De $4,703 $3,057 $3,651 $1,541 C1784 Ocular Dev, Intraop, Det Ret C1785 Pmkr, Dual, Rate-Resp $9,405 $6,113 $7,302 $3,082 C1786 Pmkr, Single, Rate-Resp $30,638 $19,914 $23,785 $10,039 C1787 Patient Progr, Neurostim $2,836 $1,843 $2,202 $929 C1788 Port, Indwelling, Imp $677 $440 $525 $222 C1789 Prosthesis, Breast, Imp $3,358 $2,183 $2,607 $1,100 C1813 Prosthesis, Penile, Inflatab C1814 Retinal Tamp, Silicone Oil C1815 Pros, Urinary Sph, Imp C1816 Receiver/Transmitter, Neuro C1817 Septal Defect Imp Sys $19,941 $12,962 $15,481 $6,534 C1818 Integrated Keratoprosthesis C1819 Tissue Localization-Excision C1820 Generator Neuro Rechg Bat Sy $46,538 $30,249 $36,129 $15,249 C1821 Interspinous Implant C1822 Gen, Neuro, Hf, Rechg Bat $47,529 $30,894 $36,899 $15,574 C1823 Gen, Neuro, Trans Sen/Stim C1824 Generator, Ccm, Implant C1825 Gen, Neuro, Carot Sinus Baro C1830 272 Power Bone Marrow Bx Needle $392 $255 $304 $128 C1839 Iris Prosthesis C1840 Telescopic Intraocular Lens C1841 Retinal Prosth Int/Ext Comp $156 $102 $121 $51 C1842 Retinal Prosth, Add-On C1849 Skin Substitute, Synthetic C1874 278 Stent, Coated/Cov W/Del Sys $3,500 $2,275 $2,717 $1,147 C1875 Stent, Coated/Cov W/O Del Sy C1876 Stent, Non-Coa/Non-Cov W/Del $7,695 $5,002 $5,974 $2,521 C1877 Stent, Non-Coat/Cov W/O Del $177 $115 $137 $58 C1878 Matrl For Vocal Cord $1,781 $1,158 $1,383 $584 C1880 Vena Cava Filter $2,802 $1,821 $2,176 $918 C1881 Dialysis Access System C1882 Aicd, Other Than Sing/Dual $72,607 $47,194 $56,368 $23,791 $13,605 C1883 Adapt/Ext, Pacing/Neuro Lead $89 $58 $69 $29 C1884 Embolization Protect Syst $3,634 $2,362 $2,821 $1,191 C1885 Cath, Translumin Angio Laser C1886 Catheter, Ablation $5,016 $3,260 $3,894 $1,644 C1887 Catheter, Guiding $298 $194 $231 $98 C1888 Endovas Non-Cardiac Abl Cath $1,710 $1,112 $1,328 $560 C1889 Implant/Insert Device, Noc $4,500 $2,925 $3,494 $1,475 C1890 No Device W/Dev-Intensive Px C1891 Infusion Pump,Non-Prog, Perm C1892 Intro/Sheath,Fixed,Peel-Away $906 $589 $704 $297 C1893 Intro/Sheath, Fixed,Non-Peel $442 $287 $343 $145 C1894 Intro/Sheath, Non-Laser $23 $15 $18 $7 C1895 Lead, Aicd, Endo Dual Coil $7,994 $5,196 $6,206 $2,619 C1896 Lead, Aicd, Non Sing/Dual $9,405 $6,113 $7,302 $3,082 C1897 Lead, Neurostim Test Kit $1,425 $926 $1,106 $467 C1898 Lead, Pmkr, Other Than Trans $0 $0 $10,120 C1899 Lead, Pmkr/Aicd Combination C1900 Lead, Coronary Venous $4,560 $2,964 $3,540 $1,494 C1982 Cath, Pressure,Valve-Occlu C2596 Probe, Robotic, Water-Jet C2613 Lung Bx Plug W/Del Sys C2614 Probe, Perc Lumb Disc C2615 Sealant, Pulmonary, Liquid C2616 Brachytx, Non-Str,Yttrium-90 C2617 Stent, Non-Cor, Tem W/O Del $309 $201 $240 $101 C2618 Probe/Needle, Cryo $7,624 $4,955 $5,919 $2,498 C2619 Pmkr, Dual, Non Rate-Resp C2620 Pmkr, Single, Non Rate-Resp C2621 Pmkr, Other Than Sing/Dual $17,442 $11,337 $13,541 $5,715 C2622 Prosthesis, Penile, Non-Inf $5,444 $3,538 $4,226 $1,784 C2623 Cath, Translumin, Drug-Coat $6,270 $4,076 $4,868 $2,054 C2624 Wireless Pressure Sensor C2625 Stent, Non-Cor, Tem W/Del Sy $336 $218 $261 $110 C2626 Infusion Pump, Non-Prog,Temp C2627 Cath, Suprapubic/Cystoscopic $177 $115 $138 $58 C2628 Catheter, Occlusion $442 $287 $343 $145 C2629 Intro/Sheath, Laser C2630 Cath, Ep, Cool-Tip C2631 Rep Dev, Urinary, W/O Sling C2634 Brachytx, Non-Str, Ha, I-125 C2635 Brachytx, Non-Str, Ha, P-103 C2636 Brachy Linear, Non-Str,P-103 C2637 Brachy,Non-Str,Ytterbium-169 C2638 Brachytx, Stranded, I-125 C2639 Brachytx, Non-Stranded,I-125 C2640 Brachytx, Stranded, P-103 C2641 Brachytx, Non-Stranded,P-103 C2642 Brachytx, Stranded, C-131 C2643 Brachytx, Non-Stranded,C-131 C2644 Brachytx Cesium-131 Chloride C2645 Brachytx Planar, P-103 C2698 Brachytx, Stranded, Nos C2699 Brachytx, Non-Stranded, Nos C5271 272 Low Cost Skin Substitute App $241 $157 $187 $79 C5272 Low Cost Skin Substitute App C5273 Low Cost Skin Substitute App C5274 Low Cost Skin Substitute App C5275 272 Low Cost Skin Substitute App $355 $231 $276 $116 C5276 Low Cost Skin Substitute App C5277 Low Cost Skin Substitute App C5278 Low Cost Skin Substitute App C8900 Mra W/Cont, Abd C8901 Mra W/O Cont, Abd C8902 Mra W/O Fol W/Cont, Abd C8903 Mri W/Cont, Breast, Uni C8905 Mri W/O Fol W/Cont, Brst, Un C8906 Mri W/Cont, Breast, Bi C8908 Mri W/O Fol W/Cont, Breast, C8909 Mra W/Cont, Chest C8910 Mra W/O Cont, Chest C8911 Mra W/O Fol W/Cont, Chest C8912 Mra W/Cont, Lwr Ext C8913 Mra W/O Cont, Lwr Ext C8914 Mra W/O Fol W/Cont, Lwr Ext C8918 Mra W/Cont, Pelvis C8919 Mra W/O Cont, Pelvis C8920 Mra W/O Fol W/Cont, Pelvis C8921 Tte W Or W/O Fol W/Cont, Com C8922 Tte W Or W/O Fol W/Cont, F/U C8923 2D Tte W Or W/O Fol W/Con,Co C8924 2D Tte W Or W/O Fol W/Con,Fu C8925 480 2D Tee W Or W/O Fol W/Con,In $3,451 $2,243 $2,679 $1,131 C8926 Tee W Or W/O Fol W/Cont,Cong C8927 Tee W Or W/O Fol W/Cont, Mon C8928 483 Tte W Or W/O Fol W/Con,Stres $1,728 $1,123 $1,342 $566 C8929 483 Tte W Or Wo Fol Wcon,Doppler $2,871 $1,866 $2,229 $939 C8930 Tte W Or W/O Contr, Cont Ecg C8931 Mra, W/Dye, Spinal Canal C8932 Mra, W/O Dye, Spinal Canal C8933 Mra, W/O&W/Dye, Spinal Canal C8934 Mra, W/Dye, Upper Extremity C8935 Mra, W/O Dye, Upper Extr C8936 Mra, W/O&W/Dye, Upper Extr C8937 Cad Breast Mri C8957 Prolonged Iv Inf, Req Pump C9046 Cocaine Hcl Nasal Solution C9047 Injection, Caplacizumab-Yhdp C9060 Fluoroestradiol F18 C9062 Daratumumab Hyaluronidase C9064 Mitomycin Pyelocalyceal Inst C9065 Romidepsin Non-Lyophilized C9066 Sacituzumab Govitecan-Hziy C9067 Gallium Ga-68 Dotatoc C9068 Copper Cu-64, Dotatate, Dx C9069 Belantamab Mafodontin-Blmf C9070 Injection, Tafasitamab-Cxix C9071 Injection, Viltolarsen C9072 Inj, Imm Glob Asceniv C9073 Brexucabtagene Autoleucel Ca C9113 Inj Pantoprazole Sodium, Via $35 $22 $27 $11 C9122 Mometasone Furoate (Sinuva) C9132 Kcentra, Per I.U. $3 $2 $2 $1 C9248 Inj, Clevidipine Butyrate $230 $150 $179 $75 C9250 Artiss Fibrin Sealant C9254 Injection, Lacosamide C9257 Bevacizumab Injection C9285 Patch, Lidocaine/Tetracaine C9290 Inj, Bupivacaine Liposome $640 $416 $496 $210 $19 C9293 Injection, Glucarpidase C9352 Neuragen Nerve Guide, Per Cm $6,031 $3,920 $4,682 $1,976 C9353 Neurawrap Nerve Protector,Cm C9354 Veritas Collagen Matrix, Cm2 $463 $301 $360 $152 C9355 Neuromatrix Nerve Cuff, Cm $2,633 $1,712 $2,044 $863 C9356 Tenoglide Tendon Prot, Cm2 $8,935 $5,808 $6,936 $2,928 C9358 Surgimend, Fetal C9359 Implnt,Bon Void Filler-Putty C9360 Surgimend, Neonatal C9361 Neuromend Nerve Wrap $3,210 $2,087 $2,492 $1,052 C9362 Implnt,Bon Void Filler-Strip $4,218 $2,742 $3,275 $1,382 C9363 Integra Meshed Bil Wound Mat C9364 Porcine Implant, Permacol $27,325 $17,761 $21,214 $8,954 C9399 Unclassified Drugs Or Biolog $6,299 $4,094 $4,890 $2,064 C9460 Injection, Cangrelor $1,415 $920 $1,099 $464 $176 C9462 Injection, Delafloxacin C9482 Sotalol Hydrochloride Iv C9488 Conivaptan Hcl C9600 481 Perc Drug-El Cor Stent Sing $8,958 $5,823 $6,955 $2,935 C9601 481 Perc Drug-El Cor Stent Bran $8,948 $5,816 $6,947 $2,932 C9602 481 Perc D-E Cor Stent Ather S $8,140 $5,291 $6,319 $2,667 C9603 Perc D-E Cor Stent Ather Br C9604 481 Perc D-E Cor Revasc T Cabg S $8,168 $5,309 $6,341 $2,676 C9605 481 Perc D-E Cor Revasc T Cabg B $8,081 $5,253 $6,274 $2,648 C9606 481 Perc D-E Cor Revasc W Ami S $8,197 $5,328 $6,364 $2,686 C9607 481 Perc D-E Cor Revasc Chro Sin $8,081 $5,253 $6,274 $2,648 C9608 481 Perc D-E Cor Revasc Chro Add $7,696 $5,002 $5,975 $2,522 C9725 Place Endorectal App C9726 Rxt Breast Appl Place/Remov C9727 Insert Palate Implants C9728 Place Device/Marker, Non Pro C9733 Non-Ophthalmic Fva C9734 U/S Trtmt, Not Leiomyomata C9738 Blue Light Cysto Imag Agent C9739 Cystoscopy Prostatic Imp 1-3 C9740 Cysto Impl 4 Or More C9745 Nasal Endo Eustachian Tube C9747 Ablation, Hifu, Prostate C9749 Repair Nasal Stenosis W/Imp C9751 Microwave Bronch, 3D, Ebus C9752 Intraosseous Des Lumb/Sacrum C9753 Intraosseous Destruct Add'L C9756 Fluorescence Lymph Map W/Icg C9757 Spine/Lumbar Disk Surgery C9758 Interatrial Shunt Ide C9759 Transcath Intraop Microinf C9760 Non-Blind Interatrial Shunt C9761 Cysto, Litho, Vacuum Kidney C9762 Cardiac Mri Seg Dys Strain C9763 Cardiac Mri Seg Dys Stress C9764 Revasc Intravasc Lithotripsy C9765 Revasc Intra Lithotrip-Stent C9766 Revasc Intra Lithotrip-Ather C9767 Revasc Lithotrip-Stent-Ather C9768 Endo Us-Guide Hep Porto Grad C9769 Cysto W/Temp Pros Implant C9770 Vitrec/Mech Pars, Subret Inj C9771 Nsl/Sins Cryo Post Nasal Tis C9772 Revasc Lithotrip Tibi/Perone C9773 Revasc Lithotr-Stent Tib/Per C9774 Revasc Lithotr-Ather Tib/Per C9775 Revasc Lith-Sten-Ath Tib/Per C9803 510 Hopd Covid-19 Spec Collect $58 $37 $45 $19 C9898 Inpnt Stay Radiolabeled Item C9899 Inpt Implant Pros Dev,No Cov D0120 Periodic Oral Evaluation $31 $20 $24 $10 D0140 Limit Oral Eval Problm Focus $47 $30 $36 $15 D0145 Oral Evaluation, Pt < 3Yrs D0150 Comprehensve Oral Evaluation $64 $42 $50 $21 D0160 Extensv Oral Eval Prob Focus D0170 Re-Eval,Est Pt,Problem Focus D0171 Re-Eval Post-Op Visit D0180 Comp Periodontal Evaluation D0190 Screening Of A Patient D0191 Assessment Of A Patient D0210 Intraor Complete Film Series $104 $68 $81 $34 D0220 Intraoral Periapical First $26 $17 $20 $8 D0230 Intraoral Periapical Ea Add $20 $13 $15 $6 D0240 Intraoral Occlusal Film D0250 Extraoral 2D Project Image D0251 Extraoral Posterior Image D0270 Dental Bitewing Single Image D0272 Dental Bitewings Two Images D0273 Bitewings - Three Images D0274 Bitewings Four Images $57 $37 $45 $19 D0277 Vert Bitewings 7 To 8 Images D0310 Dental Saliography D0320 Dental Tmj Arthrogram Incl I D0321 Other Tmj Images By Report D0322 Dental Tomographic Survey D0330 Panoramic Image $78 $51 $61 $26 D0340 2D Cephalometric Image D0350 Oral/Facial Photo Images D0351 3D Photographic Image D0364 Cone Beam Ct Capt & Interp D0365 Cone Beam Ct Interprete Man D0366 Cone Beam Ct Interprete Max D0367 Cone Beam Ct Interp Both Jaw D0368 Cone Beam Ct Interprete Tmj D0369 Max Mri Capture & Interprete D0370 Max Ultrasound Capt & Interp D0371 Sialoendoscopy Capt & Interp D0380 Cone Beam Ct Capture Limited D0381 Cone Beam Ct Capt Mandible D0382 Cone Beam Ct Capt Maxilla D0383 Cone Beam Ct Both Jaws D0384 Cone Beam Ct Capture Tmj D0385 Max Mri Image Capture D0386 Max Ultrasound Image Capture D0391 Imterprete Diagnostic Image D0393 Trtmnt Simulation 3D Image D0394 Digital Sub 2 Or More Images D0395 Fusion 2 Or More 3D Images D0411 Hba1C In Office Testing D0412 Blood Glucose Level Test D0414 Lab Process Microbial Spec D0415 Collection Of Microorganisms D0416 Viral Culture D0417 Collect & Prep Saliva Sample D0418 Analysis Of Saliva Sample D0419 Assess Of Salivary Flow D0422 Collect & Prep Genetic Samp D0423 Genetic Test Spec Analysis D0425 Caries Susceptibility Test D0431 Diag Tst Detect Mucos Abnorm D0460 Pulp Vitality Test D0470 Diagnostic Casts D0472 Gross Exam, Prep & Report D0473 Micro Exam, Prep & Report D0474 Micro W Exam Of Surg Margins D0475 Decalcification Procedure D0476 Spec Stains For Microorganis D0477 Spec Stains Not For Microorg D0478 Immunohistochemical Stains D0479 Tissue In-Situ Hybridization D0480 Cytopath Smear Prep & Report D0481 Electron Microscopy D0482 Direct Immunofluorescence D0483 Indirect Immunofluorescence D0484 Consult Slides Prep Elsewher D0485 Consult Inc Prep Of Slides D0486 Access Of Transep Cytol Samp D0502 Other Oral Pathology Procedu D0600 Non-Ionizing Diag Proc D0601 Caries Risk Assess Low Risk D0602 Caries Risk Assess Mod Risk D0603 Caries Risk Assess High Risk D0604 Antigen Test Pub Hlth Pathog D0605 Antibody Test Pub Hlth Path D0701 Pano Radio Image D0702 2D Cephal Radio Image D0703 2D Oral/Facial Photo Image D0704 3D Photo Image Capture Only D0705 Extra Oral Post Radio Image D0706 Intraoral Occlus Radio Image D0707 Intraoral Periap Radio Image D0708 Intraoral Bite Radio Image D0709 Intraoral Cmplt Radio Images D0999 Unspecified Diagnostic Proce D1110 Dental Prophylaxis Adult $76 $50 $59 $25 D1120 Dental Prophylaxis Child $56 $36 $43 $18 D1206 Topical Fluoride Varnish $33 $22 $26 $11 D1208 Topical App Fluorid Ex Vrnsh $32 $21 $25 $11 D1310 Nutri Counsel-Control Caries D1320 Tobacco Counseling D1321 Couns For High Risk Sub Use D1330 Oral Hygiene Instruction D1351 Dental Sealant Per Tooth D1352 Prev Resin Rest, Perm Tooth D1353 Sealant Repair Per Tooth D1354 Int Caries Med App Per Tooth D1355 Caries Med App Per Tooth D1510 Space Maintainer Fxd Unilat D1516 Fixed Bilat Space Maint, Max D1517 Fixed Bilat Space Maint, Man D1520 Remove Unilat Space Maintain D1526 Remove Bilat Space Main, Max D1527 Remove Bilat Space Main, Man D1551 Recement Space Maint - Max D1552 Recement Space Maint - Man D1553 Recement Unilat Space Maint D1556 Rem Fixed Unilat Space Maint D1557 Remove Fixed Bilat Maint Max D1558 Remove Fixed Bilat Man D1575 Dist Space Maint, Fixed Unil D1999 Unspecified Preventive Proc D2140 Amalgam One Surface Permanen D2150 Amalgam Two Surfaces Permane D2160 Amalgam Three Surfaces Perma D2161 Amalgam 4 Or > Surfaces Perm D2330 Resin One Surface-Anterior D2331 Resin Two Surfaces-Anterior D2332 Resin Three Surfaces-Anterio D2335 Resin 4/> Surf Or W Incis An $194 $126 $151 $64 D2390 Ant Resin-Based Cmpst Crown D2391 Post 1 Srfc Resinbased Cmpst $116 $76 $90 $38 D2392 Post 2 Srfc Resinbased Cmpst D2393 Post 3 Srfc Resinbased Cmpst D2394 Post >=4Srfc Resinbase Cmpst D2410 Dental Gold Foil One Surface D2420 Dental Gold Foil Two Surface D2430 Dental Gold Foil Three Surfa D2510 Dental Inlay Metalic 1 Surf D2520 Dental Inlay Metallic 2 Surf D2530 Dental Inlay Metl 3/More Sur D2542 Dental Onlay Metallic 2 Surf D2543 Dental Onlay Metallic 3 Surf D2544 Dental Onlay Metl 4/More Sur D2610 Inlay Porcelain/Ceramic 1 Su D2620 Inlay Porcelain/Ceramic 2 Su D2630 Dental Onlay Porc 3/More Sur D2642 Dental Onlay Porcelin 2 Surf D2643 Dental Onlay Porcelin 3 Surf D2644 Dental Onlay Porc 4/More Sur D2650 Inlay Composite/Resin One Su D2651 Inlay Composite/Resin Two Su D2652 Dental Inlay Resin 3/Mre Sur D2662 Dental Onlay Resin 2 Surface D2663 Dental Onlay Resin 3 Surface D2664 Dental Onlay Resin 4/Mre Sur D2710 Crown Resin-Based Indirect D2712 Crown 3/4 Resin-Based Compos D2720 Crown Resin W/ High Noble Me D2721 Crown Resin W/ Base Metal D2722 Crown Resin W/ Noble Metal D2740 Crown Porcelain/Ceramic D2750 Crown Porcelain W/ H Noble M D2751 Crown Porcelain Fused Base M D2752 Crown Porcelain W/ Noble Met D2753 Crown Porc Fused To Titanium D2780 Crown 3/4 Cast Hi Noble Met D2781 Crown 3/4 Cast Base Metal D2782 Crown 3/4 Cast Noble Metal D2783 Crown 3/4 Porcelain/Ceramic D2790 Crown Full Cast High Noble M D2791 Crown Full Cast Base Metal D2792 Crown Full Cast Noble Metal D2794 Crown-Titanium D2799 Provisional Crown D2910 Recement Inlay Onlay Or Part D2915 Recement Cast Or Prefab Post D2920 Re-Cement Or Re-Bond Crown D2921 Reattach Tooth Fragment D2928 Prefab Porc/Cer Crown Perm D2929 Prefab Porc/Ceram Crown Pri D2930 Prefab Stnlss Steel Crwn Pri D2931 Prefab Stnlss Steel Crown Pe D2932 Prefabricated Resin Crown D2933 Prefab Stainless Steel Crown D2934 Prefab Steel Crown Primary D2940 Protective Restoration D2941 Int Therapeutic Restoration D2949 Restorative Foundation D2950 Core Build-Up Incl Any Pins D2951 Tooth Pin Retention D2952 Post And Core Cast + Crown D2953 Each Addtnl Cast Post D2954 Prefab Post/Core + Crown D2955 Post Removal D2957 Each Addtnl Prefab Post D2960 Labial Veneer Resin Direct D2961 Labial Veneer Resin Indirect D2962 Labial Veneer Porc Indirect D2971 Add Proc Construct New Crown D2975 Coping D2980 Crown Repair D2981 Inlay Repair D2982 Onlay Repair D2983 Veneer Repair D2990 Resin Infiltration Of Lesion D2999 Dental Unspec Restorative Pr D3110 Pulp Cap Direct D3120 Pulp Cap Indirect D3220 Therapeutic Pulpotomy D3221 Gross Pulpal Debridement D3222 Part Pulp For Apexogenesis D3230 Pulpal Therapy Anterior Prim D3240 Pulpal Therapy Posterior Pri D3310 End Thxpy, Anterior Tooth D3320 End Thxpy, Premolar Tooth D3330 End Thxpy, Molar Tooth D3331 Non-Surg Tx Root Canal Obs D3332 Incomplete Endodontic Tx D3333 Internal Root Repair D3346 Retreat Root Canal Anterior D3347 Retreat Root Canal Premolar D3348 Retreat Root Canal Molar D3351 Apexification/Recalc Initial D3352 Apexification/Recalc Interim D3353 Apexification/Recalc Final D3355 Pulpal Regeneration Initial D3356 Pulpal Regeneration Interim D3357 Pulpal Regeneration Complete D3410 Apicoectomy - Anterior D3421 Root Surgery Premolar D3425 Root Surgery Molar D3426 Root Surgery Ea Add Root D3427 Periradicular Surgery D3428 Bone Graft Peri Per Tooth D3429 Bone Graft Peri Each Addl D3430 Retrograde Filling D3431 Biological Materials D3432 Guided Tissue Regeneration D3450 Root Amputation D3460 Endodontic Endosseous Implan D3470 Intentional Replantation D3471 Surg Rep Root Res Anterior D3472 Surg Rep Root Res Premolar D3473 Surg Rep Root Res Molar D3501 Surg Exp Root Surf Anterior D3502 Surg Exp Root Surf Premolar D3503 Surg Exp Root Surf Molar D3910 Isolation- Tooth W Rubb Dam D3920 Tooth Splitting D3950 Canal Prep/Fitting Of Dowel D3999 Endodontic Procedure D4210 Gingivectomy/Plasty 4 Or Mor D4211 Gingivectomy/Plasty 1 To 3 D4212 Gingivectomy/Plasty Rest D4230 Ana Crown Exp 4 Or> Per Quad D4231 Ana Crown Exp 1-3 Per Quad D4240 Gingival Flap Proc W/ Planin D4241 Gngvl Flap W Rootplan 1-3 Th D4245 Apically Positioned Flap D4249 Crown Lengthen Hard Tissue D4260 Osseous Surgery 4 Or More D4261 Osseous Surg 1 To 3 Teeth D4263 Bone Replce Graft First Site D4264 Bone Replce Graft Each Add D4265 Bio Mtrls To Aid Soft/Os Reg D4266 Guided Tiss Regen Resorble D4267 Guided Tiss Regen Nonresorb D4268 Surgical Revision Procedure D4270 Pedicle Soft Tissue Graft Pr D4273 Auto Tissue Graft 1St Tooth D4274 Mesial/Distal Wedge Proc D4275 Non-Auto Graft 1St Tooth D4276 Con Tissue W Dble Ped Graft D4277 Soft Tissue Graft Firsttooth D4278 Soft Tissue Graft Addl Tooth D4283 Auto Tissue Graft Addl Tooth D4285 Non-Auto Graft Addl Tooth D4320 Provision Splnt Intracoronal D4321 Provisional Splint Extracoro D4341 Periodontal Scaling & Root D4342 Periodontal Scaling 1-3Teeth D4346 Scaling Gingiv Inflammation D4355 Full Mouth Debridement D4381 Localized Delivery Antimicro D4910 Periodontal Maint Procedures D4920 Unscheduled Dressing Change D4921 Gingival Irrigation Per Quad D4999 Unspecified Periodontal Proc D5110 Dentures Complete Maxillary $832 $541 $646 $273 D5120 Dentures Complete Mandible D5130 Dentures Immediat Maxillary D5140 Dentures Immediat Mandible D5211 Dentures Maxill Part Resin $416 $270 $323 $136 D5212 Dentures Mand Part Resin D5213 Dentures Maxill Part Metal D5214 Dentures Mandibl Part Metal D5221 Immed Max Part Denture Resin D5222 Immed Man Part Denture Resin D5223 Immed Max Part Dent Metal D5224 Immed Mand Part Dent Metal D5225 Maxillary Part Denture Flex D5226 Mandibular Part Denture Flex D5282 Remove Unil Part Denture,Max D5283 Remove Unil Part Denture,Man D5284 Rem Unilat Dent Flex Base D5286 Rem Unilat Dent 1 Pc Resin D5410 Dentures Adjust Cmplt Maxil D5411 Dentures Adjust Cmplt Mand D5421 Dentures Adjust Part Maxill D5422 Dentures Adjust Part Mandbl D5511 Rep Broke Comp Dent Base Man D5512 Rep Broke Comp Dent Base Max D5520 Replace Denture Teeth Complt D5611 Rep Resin Part Dent Base Man D5612 Rep Resin Part Dent Base Max D5621 Rep Cast Part Frame Man D5622 Rep Cast Part Frame Max D5630 Rep Partial Denture Clasp D5640 Replace Part Denture Teeth D5650 Add Tooth To Partial Denture D5660 Add Clasp To Partial Denture D5670 Replc Tth&Acrlc On Mtl Frmwk D5671 Replc Tth&Acrlc Mandibular D5710 Dentures Rebase Cmplt Maxil D5711 Dentures Rebase Cmplt Mand D5720 Dentures Rebase Part Maxill D5721 Dentures Rebase Part Mandbl D5730 Denture Reln Cmplt Max Dir D5731 Denture Reln Cmplt Mand Dir D5740 Denture Reln Part Max Dir D5741 Denture Reln Part Mand Dir D5750 Denture Reln Cmplt Max Indir D5751 Denture Reln Cmplt Mand Ind D5760 Denture Reln Part Max Indir D5761 Denture Reln Part Mand Indir D5810 Denture Interm Cmplt Maxill D5811 Denture Interm Cmplt Mandbl D5820 Denture Interm Part Maxill D5821 Denture Interm Part Mandbl D5850 Denture Tiss Conditn Maxill D5851 Denture Tiss Condtin Mandbl D5862 Precision Attachment D5863 Overdenture Complete Max D5864 Overdenture Partial Max D5865 Overdenture Complete Mandib D5866 Overdenture Partial Mandib D5867 Replacement Of Precision Att D5875 Prosthesis Modification D5876 Add Metal Sub To Acrylc Dent D5899 Removable Prosthodontic Proc D5911 Facial Moulage Sectional D5912 Facial Moulage Complete D5913 Nasal Prosthesis D5914 Auricular Prosthesis D5915 Orbital Prosthesis D5916 Ocular Prosthesis D5919 Facial Prosthesis D5922 Nasal Septal Prosthesis D5923 Ocular Prosthesis Interim D5924 Cranial Prosthesis D5925 Facial Augmentation Implant D5926 Replacement Nasal Prosthesis D5927 Auricular Replacement D5928 Orbital Replacement D5929 Facial Replacement D5931 Surgical Obturator D5932 Postsurgical Obturator D5933 Refitting Of Obturator D5934 Mandibular Flange Prosthesis D5935 Mandibular Denture Prosth D5936 Temp Obturator Prosthesis D5937 Trismus Appliance D5951 Feeding Aid D5952 Pediatric Speech Aid D5953 Adult Speech Aid D5954 Superimposed Prosthesis D5955 Palatal Lift Prosthesis D5958 Intraoral Con Def Inter Plt D5959 Intraoral Con Def Mod Palat D5960 Modify Speech Aid Prosthesis D5982 Surgical Stent D5983 Radiation Applicator D5984 Radiation Shield D5985 Radiation Cone Locator D5986 Fluoride Applicator D5987 Commissure Splint D5988 Surgical Splint D5991 Vesiculobullous Disease Carr D5992 Adjust Max Prost Appliance D5993 Main/Clean Max Prosthesis D5994 Peridontal Medicament D5995 Peri Medicament W/Seal, Max D5996 Peri Medicament W/Seal, Mand D5999 Maxillofacial Prosthesis D6010 Odontics Endosteal Implant D6011 Second Stage Implant Surgery D6012 Endosteal Implant D6013 Surgical Place Mini Implant D6040 Odontics Eposteal Implant D6050 Odontics Transosteal Implnt D6051 Interim Abutment D6052 Semi Precision Attach Abut D6055 Implant Connecting Bar D6056 Prefabricated Abutment D6057 Custom Abutment D6058 Abutment Supported Crown D6059 Abutment Supported Mtl Crown D6060 Abutment Supported Mtl Crown D6061 Abutment Supported Mtl Crown D6062 Abutment Supported Mtl Crown D6063 Abutment Supported Mtl Crown D6064 Abutment Supported Mtl Crown D6065 Implant Supported Crown D6066 Implant Supported Mtl Crown D6067 Implant Supported Mtl Crown D6068 Abutment Supported Retainer D6069 Abutment Supported Retainer D6070 Abutment Supported Retainer D6071 Abutment Supported Retainer D6072 Abutment Supported Retainer D6073 Abutment Supported Retainer D6074 Abutment Supported Retainer D6075 Implant Supported Retainer D6076 Implant Supported Retainer D6077 Implant Supported Retainer D6080 Implant Maintenance D6081 Scale & Debride, Single Imp D6082 Imp Crown Porc To Base Alloy D6083 Imp Crown Porc To Noble Allo D6084 Imp Crown Porc To Titanium D6085 Provisional Implant Crown D6086 Imp Crown Base Alloys D6087 Implant Crown Noble Alloys D6088 Imp Crown Titanium Alloys D6090 Repair Implant D6091 Repl Semi/Precision Attach D6092 Recement Supp Crown D6093 Recement Supp Part Denture D6094 Abut Support Crown Titanium D6095 Odontics Repr Abutment D6096 Remove Broken Imp Ret Screw D6097 Abut Crown Porc To Titanium D6098 Imp Retain Porc To Base Allo D6099 Imp Retainer For Fpd D6100 Removal Of Implant D6101 Debridement Of A Periimplant D6102 Debridement & Contouring D6103 Bone Graft Repair Perimplant D6104 Bone Graft Time Of Implant D6110 Implnt/Abut Remov Dent Max D6111 Implnt/Abut Remov Dent Mand D6112 Imp/Abut Rem Dent Part Max D6113 Imp/Abut Rem Dent Part Mand D6114 Implnt/Abut Fixed Dent Max D6115 Implnt/Abut Fixed Dent Mand D6116 Imp/Abut Fixed Dent Part Max D6117 Imp/Abut Fixed Dent Part Man D6118 Imp/Abut Int Fixed Dent Man D6119 Int/Abut Int Fixed Dent Max D6120 Imp Retain Porc To Titanium D6121 Retain Metal Fpd Base Alloys D6122 Retain Metal Fpd Noble Alloy D6123 Retain Metal Fpd Titanium D6190 Radio/Surgical Implant Index D6191 Semi Precision Abutment D6192 Semi Precision Attachment D6194 Abut Support Retainer Titani D6195 Abut Retain Porc To Titanium D6199 Implant Procedure D6205 Pontic-Indirect Resin Based D6210 Prosthodont High Noble Metal D6211 Bridge Base Metal Cast D6212 Bridge Noble Metal Cast D6214 Pontic Titanium D6240 Bridge Porcelain High Noble D6241 Bridge Porcelain Base Metal D6242 Bridge Porcelain Nobel Metal D6243 Pontic Porcelain To Titanium D6245 Bridge Porcelain/Ceramic D6250 Bridge Resin W/High Noble D6251 Bridge Resin Base Metal D6252 Bridge Resin W/Noble Metal D6253 Provisional Pontic D6545 Dental Retainr Cast Metl D6548 Porcelain/Ceramic Retainer D6549 Resin Retainer D6600 Porcelain/Ceramic Inlay 2Srf D6601 Porc/Ceram Inlay >= 3 Surfac D6602 Cst Hgh Nble Mtl Inlay 2 Srf D6603 Cst Hgh Nble Mtl Inlay >=3Sr D6604 Cst Bse Mtl Inlay 2 Surfaces D6605 Cst Bse Mtl Inlay >= 3 Surfa D6606 Cast Noble Metal Inlay 2 Sur D6607 Cst Noble Mtl Inlay >=3 Surf D6608 Onlay Porc/Crmc 2 Surfaces D6609 Onlay Porc/Crmc >=3 Surfaces D6610 Onlay Cst Hgh Nbl Mtl 2 Srfc D6611 Onlay Cst Hgh Nbl Mtl >=3Srf D6612 Onlay Cst Base Mtl 2 Surface D6613 Onlay Cst Base Mtl >=3 Surfa D6614 Onlay Cst Nbl Mtl 2 Surfaces D6615 Onlay Cst Nbl Mtl >=3 Surfac D6624 Inlay Titanium D6634 Onlay Titanium D6710 Crown-Indirect Resin Based D6720 Retain Crown Resin W Hi Nble D6721 Crown Resin W/Base Metal D6722 Crown Resin W/Noble Metal D6740 Crown Porcelain/Ceramic D6750 Crown Porcelain High Noble D6751 Crown Porcelain Base Metal D6752 Crown Porcelain Noble Metal D6753 Retain Crown Porc To Titaniu D6780 Crown 3/4 High Noble Metal D6781 Crown 3/4 Cast Based Metal D6782 Crown 3/4 Cast Noble Metal D6783 Crown 3/4 Porcelain/Ceramic D6784 Retainer Crown 3/4 Titanium D6790 Crown Full High Noble Metal D6791 Crown Full Base Metal Cast D6792 Crown Full Noble Metal Cast D6793 Provisional Retainer Crown D6794 Crown Titanium D6920 Dental Connector Bar D6930 Recement/Bond Part Denture D6940 Stress Breaker D6950 Precision Attachment D6980 Fixed Partial Repair D6985 Pediatric Partial Denture Fx D6999 Fixed Prosthodontic Proc D7111 Extraction Coronal Remnants D7140 Extraction Erupted Tooth/Exr $147 $96 $114 $48 D7210 Rem Imp Tooth W Mucoper Flp $235 $153 $182 $77 D7220 Impact Tooth Remov Soft Tiss D7230 Impact Tooth Remov Part Bony D7240 Impact Tooth Remov Comp Bony D7241 Impact Tooth Rem Bony W/Comp D7250 Tooth Root Removal D7251 Coronectomy D7260 Oral Antral Fistula Closure D7261 Primary Closure Sinus Perf D7270 Tooth Reimplantation D7272 Tooth Transplantation D7280 Exposure Of Unerupted Tooth D7282 Mobilize Erupted/Malpos Toot D7283 Place Device Impacted Tooth D7285 Biopsy Of Oral Tissue Hard D7286 Biopsy Of Oral Tissue Soft D7287 Exfoliative Cytolog Collect D7288 Brush Biopsy D7290 Repositioning Of Teeth D7291 Transseptal Fiberotomy D7292 Screw Retained Plate D7293 Temp Anchorage Dev W Flap D7294 Temp Anchorage Dev W/O Flap D7295 Bone Harvest,Auto Graft Proc D7296 Corticotomy, 1-3 Teeth D7297 Corticotomy, 4 Or More Teeth D7310 Alveoplasty W/ Extraction D7311 Alveoloplasty W/Extract 1-3 D7320 Alveoplasty W/O Extraction D7321 Alveoloplasty Not W/Extracts D7340 Vestibuloplasty Ridge Extens D7350 Vestibuloplasty Exten Graft D7410 Rad Exc Lesion Up To 1.25 Cm D7411 Excision Benign Lesion>1.25C D7412 Excision Benign Lesion Compl D7413 Excision Malig Lesion<=1.25C D7414 Excision Malig Lesion>1.25Cm D7415 Excision Malig Les Complicat D7440 Malig Tumor Exc To 1.25 Cm D7441 Malig Tumor > 1.25 Cm D7450 Rem Odontogen Cyst To 1.25Cm D7451 Rem Odontogen Cyst > 1.25 Cm D7460 Rem Nonodonto Cyst To 1.25Cm D7461 Rem Nonodonto Cyst > 1.25 Cm D7465 Lesion Destruction D7471 Rem Exostosis Any Site D7472 Removal Of Torus Palatinus D7473 Remove Torus Mandibularis D7485 Surg Reduct Osseoustuberosit D7490 Maxilla Or Mandible Resectio D7510 I&D Absc Intraoral Soft Tiss $235 $153 $182 $77 D7511 Incision/Drain Abscess Intra D7520 I&D Abscess Extraoral D7521 Incision/Drain Abscess Extra D7530 Removal Fb Skin/Areolar Tiss D7540 Removal Of Fb Reaction D7550 Removal Of Sloughed Off Bone D7560 Maxillary Sinusotomy D7610 Maxilla Open Reduct Simple D7620 Clsd Reduct Simpl Maxilla Fx D7630 Open Red Simpl Mandible Fx D7640 Clsd Red Simpl Mandible Fx D7650 Open Red Simp Malar/Zygom Fx D7660 Clsd Red Simp Malar/Zygom Fx D7670 Closd Rductn Splint Alveolus D7671 Alveolus Open Reduction D7680 Reduct Simple Facial Bone Fx D7710 Maxilla Open Reduct Compound D7720 Clsd Reduct Compd Maxilla Fx D7730 Open Reduct Compd Mandble Fx D7740 Clsd Reduct Compd Mandble Fx D7750 Open Red Comp Malar/Zygma Fx D7760 Clsd Red Comp Malar/Zygma Fx D7770 Open Reduc Compd Alveolus Fx D7771 Alveolus Clsd Reduc Stblz Te D7780 Reduct Compnd Facial Bone Fx D7810 Tmj Open Reduct-Dislocation D7820 Closed Tmp Manipulation D7830 Tmj Manipulation Under Anest D7840 Removal Of Tmj Condyle D7850 Tmj Meniscectomy D7852 Tmj Repair Of Joint Disc D7854 Tmj Excisn Of Joint Membrane D7856 Tmj Cutting Of A Muscle D7858 Tmj Reconstruction D7860 Tmj Cutting Into Joint D7865 Tmj Reshaping Components D7870 Tmj Aspiration Joint Fluid D7871 Lysis + Lavage W Catheters D7872 Tmj Diagnostic Arthroscopy D7873 Tmj Arthroscopy Lysis Adhesn D7874 Tmj Arthroscopy Disc Reposit D7875 Tmj Arthroscopy Synovectomy D7876 Tmj Arthroscopy Discectomy D7877 Tmj Arthroscopy Debridement D7880 Occlusal Orthotic Appliance D7881 Occ Orthotic Device Adjust D7899 Tmj Unspecified Therapy D7910 Dent Sutur Recent Wnd To 5Cm D7911 Dental Suture Wound To 5 Cm D7912 Suture Complicate Wnd > 5 Cm D7920 Dental Skin Graft D7921 Collect & Appl Blood Product D7922 Place Intra-Socket Bio Dress D7940 Reshaping Bone Orthognathic D7941 Bone Cutting Ramus Closed D7943 Cutting Ramus Open W/Graft D7944 Bone Cutting Segmented D7945 Bone Cutting Body Mandible D7946 Reconstruction Maxilla Total D7947 Reconstruct Maxilla Segment D7948 Reconstruct Midface No Graft D7949 Reconstruct Midface W/Graft D7950 Mandible Graft D7951 Sinus Aug W Bone Or Bone Sub D7952 Sinus Augmentation Vertical D7953 Bone Replacement Graft D7955 Repair Maxillofacial Defects D7960 Frenulectomy/Frenectomy D7961 Buccal/Labial Frenectomy D7962 Lingual Frenectomy D7963 Frenuloplasty D7970 Excision Hyperplastic Tissue D7971 Excision Pericoronal Gingiva D7972 Surg Redct Fibrous Tuberosit D7979 Non-Surgical Sialolithotomy D7980 Surgical Sialolithotomy D7981 Excision Of Salivary Gland D7982 Sialodochoplasty D7983 Closure Of Salivary Fistula D7990 Emergency Tracheotomy D7991 Dental Coronoidectomy D7993 Surg Place Craniofacial Impl D7994 Surg Place Zygomatic Impl D7995 Synthetic Graft Facial Bones D7996 Implant Mandible For Augment D7997 Appliance Removal D7998 Intraoral Place Of Fix Dev D7999 Oral Surgery Procedure D8010 Limited Dental Tx Primary D8020 Limited Dental Tx Transition D8030 Limited Dental Tx Adolescent D8040 Limited Dental Tx Adult D8050 Intercep Dental Tx Primary D8060 Intercep Dental Tx Transitn D8070 Compre Dental Tx Transition D8080 Compre Dental Tx Adolescent D8090 Compre Dental Tx Adult D8210 Orthodontic Rem Appliance Tx D8220 Fixed Appliance Therapy Habt D8660 Preorthodontic Tx Visit D8670 Periodic Orthodontc Tx Visit D8680 Orthodontic Retention D8681 Removable Retainer Adjust D8690 Orthodontic Treatment D8695 Remove Fixed Ortho Appliance D8696 Rep Of Ortho Appliance Max D8697 Rep Of Ortho Appliance Man D8698 Recement Fixed Retainer Max D8699 Recement Fixed Retainer Man D8701 Repair Fixed Retainer Max D8702 Repair Of Fixed Retainer Man D8703 Replace Broken Retainer Max D8704 Replace Broken Retainer Man D8999 Orthodontic Procedure D9110 Tx Dental Pain Minor Proc $92 $59 $71 $30 D9120 Fix Partial Denture Section D9130 Temporomandibular Joint Dysf D9210 Dent Anesthesia W/O Surgery D9211 Regional Block Anesthesia D9212 Trigeminal Block Anesthesia D9215 Local Anesthesia D9219 Eval Mod/Deep Sed/Gen Anest D9222 Deep Anest, 1St 15 Min D9223 General Anesth Ea Addl 15 Mi D9230 Analgesia D9239 Iv Mod Sedation, 1St 15 Min D9243 Iv Sedation Ea Addl 15M D9248 Sedation (Non-Iv) D9310 Dental Consultation D9311 Consult W/Med Hlth Care Prof D9410 Dental House Call D9420 Hospital/Asc Call D9430 Office Visit During Hours D9440 Office Visit After Hours D9450 Case Presentation Tx Plan D9610 Dent Therapeutic Drug Inject D9612 Thera Par Drugs 2 Or > Admin D9613 Infiltration Thera Drug D9630 Drugs/Meds Disp For Home Use D9910 Dent Appl Desensitizing Med D9911 Appl Desensitizing Resin D9920 Behavior Management D9930 Treatment Of Complications D9932 Clean & Inspect Rem Dent Max D9933 Clean & Inspect Rem Dent Man D9934 Clean Rem Part Denture Max D9935 Clean Rem Part Denture Mand D9941 Fabrication Athletic Guard D9942 Repair/Reline Occlusal Guard D9943 Occlusal Guard Adjustment D9944 Occ Guard, Hard, Full Arch D9945 Occ Guard, Soft, Full Arch D9946 Occ Guard, Hard, Part Arch D9950 Occlusion Analysis D9951 Limited Occlusal Adjustment D9952 Complete Occlusal Adjustment D9961 Dup/Copy Patient'S Records D9970 Enamel Microabrasion D9971 Odontoplasty Per Tooth D9972 Extrnl Bleaching Per Arch D9973 Extrnl Bleaching Per Tooth D9974 Intrnl Bleaching Per Tooth D9975 External Bleaching Home App D9985 Sales Tax D9986 Missed Appointment D9987 Cancelled Appointment D9990 Trans Or Sign Language Svcs D9991 Case Mgmt, Appt Barriers D9992 Case Mgmt, Care Coordination D9993 Case Mgmt, Interviewing D9994 Case Mgmt, Pt Education D9995 Teledentistry Real-Time D9996 Teledentistry Dent Review D9997 Dent Case Mgmt Special Needs D9999 Adjunctive Procedure $0 $0 $0 E0100 Cane Adjust/Fixed With Tip E0105 Cane Adjust/Fixed Quad/3 Pro E0110 Crutch Forearm Pair E0111 Crutch Forearm Each E0112 273 Crutch Underarm Pair Wood $87 $57 $68 $29 E0113 Crutch Underarm Each Wood E0114 273 Crutch Underarm Pair No Wood $79 $51 $61 $26 E0116 Crutch Underarm Each No Wood E0117 Underarm Springassist Crutch E0118 Crutch Substitute E0130 Walker Rigid Adjust/Fixed Ht E0135 Walker Folding Adjust/Fixed E0140 Walker W Trunk Support E0141 Rigid Wheeled Walker Adj/Fix E0143 Walker Folding Wheeled W/O S E0144 Enclosed Walker W Rear Seat E0147 Walker Variable Wheel Resist E0148 Heavyduty Walker No Wheels E0149 Heavy Duty Wheeled Walker E0153 Forearm Crutch Platform Atta E0154 Walker Platform Attachment E0155 Walker Wheel Attachment,Pair E0156 Walker Seat Attachment E0157 Walker Crutch Attachment E0158 Walker Leg Extenders Set Of4 E0159 Brake For Wheeled Walker E0160 Sitz Type Bath Or Equipment E0161 Sitz Bath/Equipment W/Faucet E0162 Sitz Bath Chair E0163 Commode Chair With Fixed Arm E0165 Commode Chair With Detacharm E0167 Commode Chair Pail Or Pan E0168 Heavyduty/Wide Commode Chair E0170 Commode Chair Electric E0171 Commode Chair Non-Electric E0172 Seat Lift Mechanism Toilet E0175 Commode Chair Foot Rest E0181 Press Pad Alternating W/ Pum E0182 Replace Pump, Alt Press Pad E0184 Dry Pressure Mattress E0185 Gel Pressure Mattress Pad E0186 Air Pressure Mattress E0187 Water Pressure Mattress E0188 Synthetic Sheepskin Pad E0189 Lambswool Sheepskin Pad E0190 Positioning Cushion E0191 Protector Heel Or Elbow E0193 Powered Air Flotation Bed E0194 Air Fluidized Bed E0196 Gel Pressure Mattress E0197 Air Pressure Pad For Mattres E0198 Water Pressure Pad For Mattr E0199 Dry Pressure Pad For Mattres E0200 Heat Lamp Without Stand E0202 Phototherapy Light W/ Photom E0203 Therapeutic Lightbox Tabletp E0205 Heat Lamp With Stand E0210 Electric Heat Pad Standard E0215 Electric Heat Pad Moist E0217 Water Circ Heat Pad W Pump E0218 Fluid Circ Cold Pad W Pump E0221 Infrared Heating Pad System E0225 Hydrocollator Unit E0231 Wound Warming Device E0232 Warming Card For Nwt E0235 Paraffin Bath Unit Portable E0236 Pump For Water Circulating P E0239 Hydrocollator Unit Portable E0240 Bath/Shower Chair E0241 Bath Tub Wall Rail E0242 Bath Tub Rail Floor E0243 Toilet Rail E0244 Toilet Seat Raised E0245 Tub Stool Or Bench E0246 Transfer Tub Rail Attachment E0247 Trans Bench W/Wo Comm Open E0248 Hdtrans Bench W/Wo Comm Open

E0249 Pad Water Circulating Heat U E0250 Hosp Bed Fixed Ht W/ Mattres E0251 Hosp Bed Fixd Ht W/O Mattres E0255 Hospital Bed Var Ht W/ Mattr E0256 Hospital Bed Var Ht W/O Matt E0260 Hosp Bed Semi-Electr W/ Matt E0261 Hosp Bed Semi-Electr W/O Mat E0265 Hosp Bed Total Electr W/ Mat E0266 Hosp Bed Total Elec W/O Matt E0270 Hospital Bed Institutional T E0271 Mattress Innerspring E0272 Mattress Foam Rubber E0273 Bed Board E0274 Over-Bed Table E0275 Bed Pan Standard E0276 Bed Pan Fracture E0277 Powered Pres-Redu Air Mattrs E0280 Bed Cradle E0290 Hosp Bed Fx Ht W/O Rails W/M E0291 Hosp Bed Fx Ht W/O Rail W/O E0292 Hosp Bed Var Ht No Sr W/Matt E0293 Hosp Bed Var Ht No Sr No Mat E0294 Hosp Bed Semi-Elect W/ Mattr E0295 Hosp Bed Semi-Elect W/O Matt E0296 Hosp Bed Total Elect W/ Matt E0297 Hosp Bed Total Elect W/O Mat E0300 Enclosed Ped Crib Hosp Grade E0301 Hd Hosp Bed, 350-600 Lbs E0302 Ex Hd Hosp Bed > 600 Lbs E0303 Hosp Bed Hvy Dty Xtra Wide E0304 Hosp Bed Xtra Hvy Dty X Wide E0305 Rails Bed Side Half Length E0310 Rails Bed Side Full Length E0315 Bed Accessory Brd/Tbl/Supprt E0316 Bed Safety Enclosure E0325 Urinal Male Jug-Type E0326 Urinal Female Jug-Type E0328 Ped Hospital Bed, Manual E0329 Ped Hospital Bed Semi/Elect E0350 Control Unit Bowel System E0352 Disposable Pack W/Bowel Syst E0370 Air Elevator For Heel E0371 Nonpower Mattress Overlay E0372 Powered Air Mattress Overlay E0373 Nonpowered Pressure Mattress E0424 Stationary Compressed Gas 02 E0425 Gas System Stationary Compre E0430 Oxygen System Gas Portable E0431 Portable Gaseous 02 E0433 Portable Liquid Oxygen Sys E0434 Portable Liquid 02 E0435 Oxygen System Liquid Portabl E0439 Stationary Liquid 02 E0440 Oxygen System Liquid Station E0441 Stationary O2 Contents, Gas E0442 Stationary O2 Contents, Liq E0443 Portable 02 Contents, Gas E0444 Portable 02 Contents, Liquid E0445 Oximeter Non-Invasive E0446 Topical Ox Deliver Sys, Nos E0447 Port O2 Cont, Liq Over 4 Lpm E0455 Oxygen Tent Excl Croup/Ped T E0457 Chest Shell E0459 Chest Wrap E0462 Rocking Bed W/ Or W/O Side R E0465 Home Vent Invasive Interface E0466 Home Vent Non-Invasive Inter E0467 Home Vent Multi-Function E0470 Rad W/O Backup Non-Inv Intfc E0471 Rad W/Backup Non Inv Intrfc E0472 Rad W Backup Invasive Intrfc E0480 Percussor Elect/Pneum Home M E0481 Intrpulmnry Percuss Vent Sys E0482 Cough Stimulating Device E0483 Hi Freq Chest Wall Oscil Sys E0484 Non-Elec Oscillatory Pep Dvc E0485 Oral Device/Appliance Prefab E0486 Oral Device/Appliance Cusfab E0487 Electronic Spirometer E0500 Ippb All Types E0550 Humidif Extens Supple W Ippb E0555 Humidifier For Use W/ Regula E0560 Humidifier Supplemental W/ I E0561 Humidifier Nonheated W Pap E0562 Humidifier Heated Used W Pap E0565 Compressor Air Power Source E0570 Nebulizer With Compression E0572 Aerosol Compressor Adjust Pr E0574 Ultrasonic Generator W Svneb E0575 Nebulizer Ultrasonic E0580 Nebulizer For Use W/ Regulat E0585 Nebulizer W/ Compressor & He E0600 Suction Pump Portab Hom Modl E0601 Cont Airway Pressure Device E0602 Manual Breast Pump E0603 Electric Breast Pump E0604 Hosp Grade Elec Breast Pump E0605 Vaporizer Room Type E0606 Drainage Board Postural E0607 Blood Glucose Monitor Home E0610 Pacemaker Monitr Audible/Vis E0615 Pacemaker Monitr Digital/Vis E0616 Cardiac Event Recorder E0617 Automatic Ext Defibrillator E0618 Apnea Monitor E0619 Apnea Monitor W Recorder E0620 Cap Bld Skin Piercing Laser E0621 Patient Lift Sling Or Seat E0625 Patient Lift Bathroom Or Toi E0627 Seat Lift Mech, Electric Any E0629 Seat Lift Mech, Non-Electric E0630 Patient Lift Hydraulic E0635 Patient Lift Electric E0636 Pt Support & Positioning Sys E0637 Combination Sit To Stand Sys E0638 Standing Frame Sys E0639 Moveable Patient Lift System E0640 Fixed Patient Lift System E0641 Multi-Position Stnd Fram Sys E0642 Dynamic Standing Frame E0650 Pneuma Compresor Non-Segment

E0651 Pneum Compressor Segmental E0652 Pneum Compres W/Cal Pressure E0655 Pneumatic Appliance Half Arm E0656 Segmental Pneumatic Trunk E0657 Segmental Pneumatic Chest E0660 Pneumatic Appliance Full Leg E0665 Pneumatic Appliance Full Arm E0666 Pneumatic Appliance Half Leg E0667 Seg Pneumatic Appl Full Leg E0668 Seg Pneumatic Appl Full Arm E0669 Seg Pneumatic Appli Half Leg E0670 Seg Pneum Int Legs/Trunk E0671 Pressure Pneum Appl Full Leg E0672 Pressure Pneum Appl Full Arm E0673 Pressure Pneum Appl Half Leg E0675 Pneumatic Compression Device E0676 Inter Limb Compress Dev Nos E0691 Uvl Pnl 2 Sq Ft Or Less E0692 Uvl Sys Panel 4 Ft E0693 Uvl Sys Panel 6 Ft E0694 Uvl Md Cabinet Sys 6 Ft E0700 Safety Equipment E0705 Transfer Device E0710 Restraints Any Type E0720 Tens Two Lead E0730 Tens Four Lead E0731 Conductive Garment For Tens/ E0740 Non-Implant Pelv Flr E-Stim E0744 Neuromuscular Stim For Scoli E0745 Neuromuscular Stim For Shock E0746 Electromyograph Biofeedback E0747 Elec Osteogen Stim Not Spine E0748 Elec Osteogen Stim Spinal E0749 Elec Osteogen Stim Implanted E0755 Electronic Salivary Reflex S E0760 Osteogen Ultrasound Stimltor E0761 Nontherm Electromgntc Device E0762 Trans Elec Jt Stim Dev Sys E0764 Functional Neuromuscularstim E0765 Nerve Stimulator For Tx N&V E0766 Elec Stim Cancer Treatment E0769 Electric Wound Treatment Dev E0770 Functional Electric Stim Nos E0776 Iv Pole E0779 Amb Infusion Pump Mechanical E0780 Mech Amb Infusion Pump <8Hrs E0781 External Ambulatory Infus Pu E0782 Non-Programble Infusion Pump E0783 Programmable Infusion Pump E0784 Ext Amb Infusn Pump Insulin E0785 Replacement Impl Pump Cathet E0786 Implantable Pump Replacement E0787 Cgs Dose Adj Insulin Inf Pmp E0791 Parenteral Infusion Pump Sta E0830 Ambulatory Traction Device E0840 Tract Frame Attach Headboard E0849 Cervical Pneum Trac Equip E0850 Traction Stand Free Standing E0855 Cervical Traction Equipment E0856 Cervic Collar W Air Bladders E0860 Tract Equip Cervical Tract E0870 Tract Frame Attach Footboard E0880 Trac Stand Free Stand Extrem E0890 Traction Frame Attach Pelvic E0900 Trac Stand Free Stand Pelvic E0910 Trapeze Bar Attached To Bed E0911 Hd Trapeze Bar Attach To Bed E0912 Hd Trapeze Bar Free Standing E0920 Fracture Frame Attached To B E0930 Fracture Frame Free Standing E0935 Cont Pas Motion Exercise Dev E0936 Cpm Device, Other Than Knee E0940 Trapeze Bar Free Standing E0941 Gravity Assisted Traction De E0942 Cervical Head Harness/Halter E0944 Pelvic Belt/Harness/Boot E0945 Belt/Harness Extremity E0946 Fracture Frame Dual W Cross E0947 Fracture Frame Attachmnts Pe E0948 Fracture Frame Attachmnts Ce E0950 Tray E0951 Loop Heel E0952 Toe Loop/Holder, Each E0953 W/C Lateral Thigh/Knee Sup E0954 Foot Box, Any Type Each Foot E0955 Cushioned Headrest E0956 W/C Lateral Trunk/Hip Suppor E0957 W/C Medial Thigh Support E0958 Whlchr Att- Conv 1 Arm Drive E0959 Amputee Adapter E0960 W/C Shoulder Harness/Straps E0961 Wheelchair Brake Extension E0966 Wheelchair Head Rest Extensi E0967 Man Wc Rim/Projection Rep Ea E0968 Wheelchair Commode Seat E0969 Wheelchair Narrowing Device E0970 Wheelchair No. 2 Footplates E0971 Wheelchair Anti-Tipping Devi E0973 W/Ch Access Det Adj Armrest E0974 W/Ch Access Anti-Rollback E0978 W/C Acc,Saf Belt Pelv Strap E0980 Wheelchair Safety Vest E0981 Seat Upholstery, Replacement E0982 Back Upholstery, Replacement E0983 Add Pwr Joystick E0984 Add Pwr Tiller E0985 W/C Seat Lift Mechanism E0986 Man W/C Push-Rim Powr System E0988 Lever-Activated Wheel Drive E0990 Wheelchair Elevating Leg Res E0992 Wheelchair Solid Seat Insert E0994 Wheelchair Arm Rest E0995 Wc Calf Rest, Pad Replacemnt E1002 Pwr Seat Tilt E1003 Pwr Seat Recline E1004 Pwr Seat Recline Mech E1005 Pwr Seat Recline Pwr E1006 Pwr Seat Combo W/O Shear E1007 Pwr Seat Combo W/Shear E1008 Pwr Seat Combo Pwr Shear E1009 Add Mech Leg Elevation E1010 Add Pwr Leg Elevation E1011 Ped Wc Modify Width Adjustm E1012 Ctr Mount Pwr Elev Leg Rest E1014 Reclining Back Add Ped W/C E1015 Shock Absorber For Man W/C E1016 Shock Absorber For Power W/C E1017 Hd Shck Absrbr For Hd Man Wc E1018 Hd Shck Absrber For Hd Powwc E1020 Residual Limb Support System E1028 W/C Manual Swingaway E1029 W/C Vent Tray Fixed E1030 W/C Vent Tray Gimbaled E1031 Rollabout Chair With Casters E1035 Patient Transfer System <300 E1036 Patient Transfer System >300 E1037 Transport Chair, Ped Size E1038 Transport Chair Pt Wt<=300Lb E1039 Transport Chair Pt Wt >300Lb E1050 Whelchr Fxd Full Length Arms E1060 Wheelchair Detachable Arms E1070 Wheelchair Detachable Foot R E1083 Hemi-Wheelchair Fixed Arms E1084 Hemi-Wheelchair Detachable A E1085 Hemi-Wheelchair Fixed Arms E1086 Hemi-Wheelchair Detachable A E1087 Wheelchair Lightwt Fixed Arm E1088 Wheelchair Lightweight Det A E1089 Wheelchair Lightwt Fixed Arm E1090 Wheelchair Lightweight Det A E1092 Wheelchair Wide W/ Leg Rests E1093 Wheelchair Wide W/ Foot Rest E1100 Whchr S-Recl Fxd Arm Leg Res E1110 Wheelchair Semi-Recl Detach E1130 Whlchr Stand Fxd Arm Ft Rest E1140 Wheelchair Standard Detach A E1150 Wheelchair Standard W/ Leg R E1160 Wheelchair Fixed Arms E1161 Manual Adult Wc W Tiltinspac E1170 Whlchr Ampu Fxd Arm Leg Rest E1171 Wheelchair Amputee W/O Leg R E1172 Wheelchair Amputee Detach Ar E1180 Wheelchair Amputee W/ Foot R E1190 Wheelchair Amputee W/ Leg Re E1195 Wheelchair Amputee Heavy Dut E1200 Wheelchair Amputee Fixed Arm E1220 Whlchr Special Size/Constrc E1221 Wheelchair Spec Size W Foot E1222 Wheelchair Spec Size W/ Leg E1223 Wheelchair Spec Size W Foot E1224 Wheelchair Spec Size W/ Leg E1225 Manual Semi-Reclining Back E1226 Manual Fully Reclining Back E1227 Wheelchair Spec Sz Spec Ht A E1228 Wheelchair Spec Sz Spec Ht B E1229 Pediatric Wheelchair Nos E1230 Power Operated Vehicle E1231 Rigid Ped W/C Tilt-In-Space E1232 Folding Ped Wc Tilt-In-Space E1233 Rig Ped Wc Tltnspc W/O Seat E1234 Fld Ped Wc Tltnspc W/O Seat E1235 Rigid Ped Wc Adjustable E1236 Folding Ped Wc Adjustable E1237 Rgd Ped Wc Adjstabl W/O Seat E1238 Fld Ped Wc Adjstabl W/O Seat E1239 Ped Power Wheelchair Nos E1240 Whchr Litwt Det Arm Leg Rest E1250 Wheelchair Lightwt Fixed Arm E1260 Wheelchair Lightwt Foot Rest E1270 Wheelchair Lightweight Leg R E1280 Whchr H-Duty Det Arm Leg Res E1285 Wheelchair Heavy Duty Fixed E1290 Wheelchair Hvy Duty Detach A E1295 Wheelchair Heavy Duty Fixed E1296 Wheelchair Special Seat Heig E1297 Wheelchair Special Seat Dept E1298 Wheelchair Spec Seat Depth/W E1300 Whirlpool Portable E1310 Whirlpool Non-Portable E1352 O2 Flow Reg Pos Inspir Press E1353 Oxygen Supplies Regulator E1354 Wheeled Cart, Port Cyl/Conc E1355 Oxygen Supplies Stand/Rack E1356 Batt Pack/Cart, Port Conc E1357 Battery Charger, Port Conc E1358 Dc Power Adapter, Port Conc E1372 Oxy Suppl Heater For Nebuliz E1390 Oxygen Concentrator E1391 Oxygen Concentrator, Dual E1392 Portable Oxygen Concentrator E1399 Durable Medical Equipment Mi E1405 O2/Water Vapor Enrich W/Heat E1406 O2/Water Vapor Enrich W/O He E1500 Centrifuge E1510 Kidney Dialysate Delivry Sys E1520 Heparin Infusion Pump E1530 Replacement Air Bubble Detec E1540 Replacement Pressure Alarm E1550 Bath Conductivity Meter E1560 Replace Blood Leak Detector E1570 Adjustable Chair For Esrd Pt E1575 Transducer Protect/Fld Bar E1580 Unipuncture Control System E1590 Hemodialysis Machine E1592 Auto Interm Peritoneal Dialy E1594 Cycler Dialysis Machine E1600 Deli/Install Chrg Hemo Equip E1610 Reverse Osmosis H2O Puri Sys E1615 Deionizer H2O Puri System E1620 Replacement Blood Pump E1625 Water Softening System E1630 Reciprocating Peritoneal Dia E1632 Wearable Artificial Kidney E1634 Peritoneal Dialysis Clamp E1635 Compact Travel Hemodialyzer E1636 Sorbent Cartridges Per 10 E1637 Hemostats For Dialysis, Each E1639 Scale, Each E1699 Dialysis Equipment Noc E1700 Jaw Motion Rehab System E1701 Repl Cushions For Jaw Motion E1702 Repl Measr Scales Jaw Motion E1800 Adjust Elbow Ext/Flex Device E1801 Sps Elbow Device E1802 Adjst Forearm Pro/Sup Device E1805 Adjust Wrist Ext/Flex Device E1806 Sps Wrist Device E1810 Adjust Knee Ext/Flex Device E1811 Sps Knee Device E1812 Knee Ext/Flex W Act Res Ctrl E1815 Adjust Ankle Ext/Flex Device E1816 Sps Ankle Device E1818 Sps Forearm Device E1820 Soft Interface Material E1821 Replacement Interface Spsd E1825 Adjust Finger Ext/Flex Devc E1830 Adjust Toe Ext/Flex Device E1831 Static Str Toe Dev Ext/Flex E1840 Adj Shoulder Ext/Flex Device E1841 Static Str Shldr Dev Rom Adj E1902 Aac Non-Electronic Board E2000 Gastric Suction Pump Hme Mdl E2100 Bld Glucose Monitor W Voice E2101 Bld Glucose Monitor W Lance E2120 Pulse Gen Sys Tx Endolymp Fl E2201 Man W/Ch Acc Seat W>=20<24 E2202 Seat Width 24-27 In E2203 Frame Depth Less Than 22 In E2204 Frame Depth 22 To 25 In E2205 Manual Wc Accessory, Handrim E2206 Man Wc Whl Lock Comp Repl Ea E2207 Crutch And Cane Holder E2208 Cylinder Tank Carrier E2209 Arm Trough Each E2210 Wheelchair Bearings E2211 Pneumatic Propulsion Tire E2212 Pneumatic Prop Tire Tube E2213 Pneumatic Prop Tire Insert E2214 Pneumatic Caster Tire Each E2215 Pneumatic Caster Tire Tube E2216 Foam Filled Propulsion Tire E2217 Foam Filled Caster Tire Each E2218 Foam Propulsion Tire Each E2219 Foam Caster Tire Any Size Ea E2220 Solid Propuls Tire, Repl, Ea E2221 Solid Caster Tire Repl, Each E2222 Solid Caster Integ Whl, Repl E2224 Propulsion Whl Excl Tire Rep E2225 Caster Wheel Excludes Tire E2226 Caster Fork Replacement Only E2227 Gear Reduction Drive Wheel E2228 Mwc Acc, Wheelchair Brake E2230 Manual Standing System E2231 Solid Seat Support Base E2291 Planar Back For Ped Size Wc E2292 Planar Seat For Ped Size Wc E2293 Contour Back For Ped Size Wc E2294 Contour Seat For Ped Size Wc E2295 Ped Dynamic Seating Frame E2300 Pwr Seat Elevation Sys E2301 Pwr Standing E2310 Electro Connect Btw Control E2311 Electro Connect Btw 2 Sys E2312 Mini-Prop Remote Joystick E2313 Pwc Harness, Expand Control E2321 Hand Interface Joystick E2322 Mult Mech Switches E2323 Special Joystick Handle E2324 Chin Cup Interface E2325 Sip And Puff Interface E2326 Breath Tube Kit E2327 Head Control Interface Mech E2328 Head/Extremity Control Inter E2329 Head Control Nonproportional E2330 Head Control Proximity Switc E2331 Attendant Control E2340 W/C Wdth 20-23 In Seat Frame E2341 W/C Wdth 24-27 In Seat Frame E2342 W/C Dpth 20-21 In Seat Frame E2343 W/C Dpth 22-25 In Seat Frame E2351 Electronic Sgd Interface E2358 Gr 34 Nonsealed Leadacid E2359 Gr34 Sealed Leadacid Battery E2360 22Nf Nonsealed Leadacid E2361 22Nf Sealed Leadacid Battery E2362 Gr24 Nonsealed Leadacid E2363 Gr24 Sealed Leadacid Battery E2364 U1Nonsealed Leadacid Battery E2365 U1 Sealed Leadacid Battery E2366 Battery Charger, Single Mode E2367 Battery Charger, Dual Mode E2368 Pwr Wc Drivewheel Motor Repl E2369 Pwr Wc Drivewheel Gear Repl E2370 Pwr Wc Dr Wh Motor/Gear Comb E2371 Gr27 Sealed Leadacid Battery E2372 Gr27 Non-Sealed Leadacid E2373 Hand/Chin Ctrl Spec Joystick E2374 Hand/Chin Ctrl Std Joystick E2375 Non-Expandable Controller E2376 Expandable Controller, Repl E2377 Expandable Controller, Initl E2378 Pw Actuator Replacement E2381 Pneum Drive Wheel Tire E2382 Tube, Pneum Wheel Drive Tire E2383 Insert, Pneum Wheel Drive E2384 Pneumatic Caster Tire E2385 Tube, Pneumatic Caster Tire E2386 Foam Filled Drive Wheel Tire E2387 Foam Filled Caster Tire E2388 Foam Drive Wheel Tire E2389 Foam Caster Tire E2390 Solid Drive Wheel Tire E2391 Solid Caster Tire E2392 Solid Caster Tire, Integrate E2394 Drive Wheel Excludes Tire E2395 Caster Wheel Excludes Tire E2396 Caster Fork E2397 Pwc Acc, Lith-Based Battery E2398 Wc Dynamic Pos Back Hardware E2402 Neg Press Wound Therapy Pump E2500 Sgd Digitized Pre-Rec <=8Min E2502 Sgd Prerec Msg >8Min <=20Min E2504 Sgd Prerec Msg>20Min <=40Min E2506 Sgd Prerec Msg > 40 Min E2508 Sgd Spelling Phys Contact E2510 Sgd W Multi Methods Msg/Accs E2511 Sgd Sftwre Prgrm For Pc/Pda E2512 Sgd Accessory, Mounting Sys E2599 Sgd Accessory Noc E2601 Gen W/C Cushion Wdth < 22 In E2602 Gen W/C Cushion Wdth >=22 In E2603 Skin Protect Wc Cus Wd <22In E2604 Skin Protect Wc Cus Wd>=22In E2605 Position Wc Cush Wdth <22 In E2606 Position Wc Cush Wdth>=22 In E2607 Skin Pro/Pos Wc Cus Wd <22In E2608 Skin Pro/Pos Wc Cus Wd>=22In E2609 Custom Fabricate W/C Cushion E2610 Powered W/C Cushion E2611 Gen Use Back Cush Wdth <22In E2612 Gen Use Back Cush Wdth>=22In E2613 Position Back Cush Wd <22In E2614 Position Back Cush Wd>=22In E2615 Pos Back Post/Lat Wdth <22In E2616 Pos Back Post/Lat Wdth>=22In E2617 Custom Fab W/C Back Cushion E2619 Replace Cover W/C Seat Cush E2620 Wc Planar Back Cush Wd <22In E2621 Wc Planar Back Cush Wd>=22In E2622 Adj Skin Pro W/C Cus Wd<22In E2623 Adj Skin Pro Wc Cus Wd>=22In E2624 Adj Skin Pro/Pos Cus<22In E2625 Adj Skin Pro/Pos Wc Cus>=22 E2626 Seo Mobile Arm Sup Att To Wc E2627 Arm Supp Att To Wc Rancho Ty E2628 Mobile Arm Supports Reclinin E2629 Friction Dampening Arm Supp E2630 Monosuspension Arm/Hand Supp E2631 Elevat Proximal Arm Support E2632 Offset/Lat Rocker Arm W/Ela E2633 Mobile Arm Support Supinator E8000 Posterior Gait Trainer E8001 Upright Gait Trainer E8002 Anterior Gait Trainer G0008 771 Admin Influenza Virus Vac $51 $33 $40 $17 G0009 771 Admin Pneumococcal Vaccine $51 $33 $40 $17 G0010 771 Admin Hepatitis B Vaccine $51 $33 $40 $17 G0027 Semen Analysis G0068 Adm Iv Infusion Drug In Home G0069 Adm Sq Infusion Drug In Home G0070 Adm Of Chemo Drug In Home G0071 Comm Svcs By Rhc/Fqhc 5 Min G0076 Care Manag H Vst New Pt 20 M G0077 Care Manag H Vst New Pt 30 M G0078 Care Manag H Vst New Pt 45 M G0079 Care Manag H Vst New Pt 60 M G0080 Care Manag H Vst New Pt 75 M G0081 Care Man H V Ext Pt 20 Mi G0082 Care Man H V Ext Pt 30 M G0083 Care Man H V Ext Pt 45 M G0084 Care Man H V Ext Pt 60 M G0085 Care Man H V Ext Pt 75 M G0086 Care Man Home Care Plan 30 M G0087 Care Man Home Care Plan 60 M G0088 Adm Iv Drug 1St Home Visit G0089 Adm Subq Drug 1St Home Visit G0090 Adm Iv Chemo 1St Home Visit G0101 510 Ca Screen;Pelvic/Breast Exam $0 $0 G0102 Prostate Ca Screening; Dre G0103 Psa Screening G0104 Ca Screen;Flexi Sigmoidscope G0105 982 Colorectal Scrn; Hi Risk Ind $1,157 $752 $898 $379 $78 G0105 982 Colorectal Scrn; Hi Risk Ind $1,157 $752 $898 $379 $78 G0106 Colon Ca Screen;Barium Enema G0106 Colon Ca Screen;Barium Enema G0106 Colon Ca Screen;Barium Enema G0108 942 Diab Manage Trn Per Indiv $309 $201 $240 $95 G0109 942 Diab Manage Trn Ind/Group $47 $30 $36 $15 $11 G0117 Glaucoma Scrn Hgh Risk Direc G0118 Glaucoma Scrn Hgh Risk Direc G0120 Colon Ca Scrn; Barium Enema G0120 Colon Ca Scrn; Barium Enema G0120 Colon Ca Scrn; Barium Enema G0121 982 Colon Ca Scrn Not Hi Rsk Ind $1,166 $758 $905 $382 $187 G0121 982 Colon Ca Scrn Not Hi Rsk Ind $1,166 $758 $905 $382 $187 G0122 Colon Ca Scrn; Barium Enema G0122 Colon Ca Scrn; Barium Enema G0122 Colon Ca Scrn; Barium Enema G0123 Screen Cerv/Vag Thin Layer G0124 Screen C/V Thin Layer By Md G0127 510 Trim Nail(S) $48 $31 $37 $16 G0128 Corf Skilled Nursing Service G0129 Partial Hosp Prog Service G0130 Single Energy X-Ray Study G0130 Single Energy X-Ray Study G0130 Single Energy X-Ray Study G0141 Scr C/V Cyto,Autosys And Md G0143 Scr C/V Cyto,Thinlayer,Rescr G0144 Scr C/V Cyto,Thinlayer,Rescr G0145 Scr C/V Cyto,Thinlayer,Rescr G0147 Scr C/V Cyto, Automated Sys G0148 Scr C/V Cyto, Autosys, Rescr G0151 421 Hhcp-Serv Of Pt,Ea 15 Min $190 $124 $148 $62 G0152 431 Hhcp-Serv Of Ot,Ea 15 Min $190 $124 $148 $62 G0153 441 Hhcp-Svs Of S/L Path,Ea 15Mn $190 $124 $148 $62 G0155 561 Hhcp-Svs Of Csw,Ea 15 Min $190 $124 $148 $62 G0156 571 Hhcp-Svs Of Aide,Ea 15 Min $90 $59 $70 $29 G0157 421 Hhc Pt Assistant Ea 15 $190 $124 $148 $62 G0158 Hhc Ot Assistant Ea 15 G0159 421 Hhc Pt Maint Ea 15 Min $190 $124 $148 $62 G0160 431 Hhc Occup Therapy Ea 15 $190 $124 $148 $62 G0161 441 Hhc Slp Ea 15 Min $190 $124 $148 $62 G0162 Hhc Rn E&M Plan Svs, 15 Min G0166 Extrnl Counterpulse, Per Tx G0168 Wound Closure By Adhesive G0175 Opps Service,Sched Team Conf G0176 Opps/Php;Activity Therapy G0177 Opps/Php; Train & Educ Serv G0179 Md Recertification Hha Pt $123 $80 $96 $40 $7 G0180 Md Certification Hha Patient $164 $107 $128 $54 $4 G0181 Home Health Care Supervision G0182 Hospice Care Supervision G0186 Dstry Eye Lesn,Fdr Vssl Tech G0219 Pet Img Wholbod Melano Nonco G0219 Pet Img Wholbod Melano Nonco G0219 Pet Img Wholbod Melano Nonco G0235 Pet Not Otherwise Specified G0235 Pet Not Otherwise Specified G0235 Pet Not Otherwise Specified G0237 Therapeutic Procd Strg Endur G0238 Oth Resp Proc, Indiv G0239 412 Oth Resp Proc, Group $54 $35 $42 $18 G0245 Initial Foot Exam Pt Lops G0246 Followup Eval Of Foot Pt Lop G0247 Routine Footcare Pt W Lops G0248 Demonstrate Use Home Inr Mon G0249 Provide Inr Test Mater/Equip G0250 Md Inr Test Revie Inter Mgmt G0252 Pet Imaging Initial Dx G0252 Pet Imaging Initial Dx G0252 Pet Imaging Initial Dx G0255 Current Percep Threshold Tst G0255 Current Percep Threshold Tst G0255 Current Percep Threshold Tst G0257 761 Unsched Dialysis Esrd Pt Hos $1,599 $1,039 $1,241 $524 G0259 Inject For Sacroiliac Joint G0260 Inj For Sacroiliac Jt Anesth G0268 Removal Of Impacted Wax Md G0269 480 Occlusive Device In Vein Art $137 $89 $106 $45 G0270 581 Mnt Subs Tx For Change Dx $150 $98 $116 $46 G0271 Group Mnt 2 Or More 30 Mins G0276 Pild/Placebo Control Clin Tr G0277 413 Hbot, Full Body Chamber, 30M $433 $281 $336 $142 $86 G0278 Iliac Art Angio,Cardiac Cath G0279 401 Tomosynthesis, Mammo $807 $525 $627 $239 G0279 401 Tomosynthesis, Mammo $807 $525 $627 $236 G0279 401 Tomosynthesis, Mammo $807 $525 $627 $236 G0281 Elec Stim Unattend For Press G0282 Elect Stim Wound Care Not Pd G0283 420 Elec Stim Other Than Wound $138 $90 $107 $41 G0288 Recon, Cta For Surg Plan G0289 Arthro, Loose Body + Chondro $273 $177 $212 $89 G0293 Non-Cov Surg Proc,Clin Trial G0294 Non-Cov Proc, Clinical Trial G0295 Electromagnetic Therapy Onc G0296 Visit To Determ Ldct Elig G0297 352 Ldct For Lung Ca Screen $2,725 $1,771 $2,116 $893 $72 G0299 551 Hhs/Hospice Of Rn Ea 15 Min $200 $130 $155 $66 G0300 551 Hhs/Hospice Of Lpn Ea 15 Min $200 $130 $155 $66 G0302 Pre-Op Service Lvrs Complete G0303 Pre-Op Service Lvrs 10-15Dos G0304 Pre-Op Service Lvrs 1-9 Dos G0305 Post Op Service Lvrs Min 6 G0306 Cbc/Diffwbc W/O Platelet G0307 Cbc Without Platelet G0328 Fecal Blood Scrn Immunoassay G0328 Fecal Blood Scrn Immunoassay G0329 Electromagntic Tx For Ulcers G0333 Dispense Fee Initial 30 Day G0337 Hospice Evaluation Preelecti G0339 Robot Lin-Radsurg Com, First G0340 Robt Lin-Radsurg Fractx 2-5 G0341 Percutaneous Islet Celltrans G0342 Laparoscopy Islet Cell Trans G0343 Laparotomy Islet Cell Transp G0372 Md Service Required For Pmd G0378 762 Hospital Observation Per Hr $63 $41 $49 $21 G0379 762 Direct Refer Hospital Observ $194 $126 $151 $64 G0380 450 Lev 1 Hosp Type B Ed Visit $285 $185 $221 $93 G0381 450 Lev 2 Hosp Type B Ed Visit $252 $164 $196 $83 G0382 450 Lev 3 Hosp Type B Ed Visit $436 $283 $338 $143 G0383 450 Lev 4 Hosp Type B Ed Visit $578 $376 $449 $189 G0384 450 Lev 5 Hosp Type B Ed Visit $789 $513 $613 $259 G0390 682 Trauma Respons W/Hosp Criti $1,689 $1,098 $1,311 $553 G0396 Alcohol/Subs Interv 15-30Mn G0397 Alcohol/Subs Interv >30 Min G0398 510 Home Sleep Test/Type 2 Porta $353 $230 $274 $116 $21 G0398 510 Home Sleep Test/Type 2 Porta $353 $230 $274 $116 $21 G0398 510 Home Sleep Test/Type 2 Porta $353 $230 $274 $116 $21 G0399 740 Home Sleep Test/Type 3 Porta $505 $328 $392 $165 $45 G0399 740 Home Sleep Test/Type 3 Porta $505 $328 $392 $165 $45 G0399 740 Home Sleep Test/Type 3 Porta $505 $328 $392 $165 $45 G0400 510 Home Sleep Test/Type 4 Porta $123 $80 $95 $40 G0400 510 Home Sleep Test/Type 4 Porta $123 $80 $95 $40 G0400 510 Home Sleep Test/Type 4 Porta $123 $80 $95 $40 G0402 510 Initial Preventive Exam G0403 Ekg For Initial Prevent Exam G0404 Ekg Tracing For Initial Prev G0405 Ekg Interpret & Report Preve G0406 Inpt/Tele Follow Up 15 G0407 Inpt/Tele Follow Up 25 G0408 Inpt/Tele Follow Up 35 G0409 Corf Related Serv 15 Mins Ea G0410 Grp Psych Partial Hosp 45-50 G0411 Inter Active Grp Psych Parti G0412 Open Tx Iliac Spine Uni/Bil G0413 Pelvic Ring Fracture Uni/Bil G0414 Pelvic Ring Fx Treat Int Fix G0415 Open Tx Post Pelvic Fxcture G0416 Prostate Biopsy, Any Mthd G0416 Prostate Biopsy, Any Mthd G0416 Prostate Biopsy, Any Mthd G0420 Ed Svc Ckd Ind Per Session G0421 Ed Svc Ckd Grp Per Session G0422 Intens Cardiac Rehab W/Exerc G0423 Intens Cardiac Rehab No Exer G0424 948 Pulmonary Rehab W Exer $105 $68 $82 $34 G0425 Inpt/Ed Teleconsult30 G0426 Inpt/Ed Teleconsult50 G0427 Inpt/Ed Teleconsult70 G0428 Collagen Meniscus Implant G0429 Dermal Filler Injection(S) G0432 Eia Hiv-1/Hiv-2 Screen G0433 Elisa Hiv-1/Hiv-2 Screen G0433 Elisa Hiv-1/Hiv-2 Screen G0435 302 Oral Hiv-1/Hiv-2 Screen $89 $58 $69 $27 G0438 983 Ppps, Initial Visit $0 $0 $157 G0439 983 Ppps, Subseq Visit $0 $0 $123 G0442 Annual Alcohol Screen 15 Min G0443 Brief Alcohol Misuse Counsel G0444 Depression Screen Annual G0445 High Inten Beh Couns Std 30M G0446 510 Intens Behave Ther Cardio Dx $12 $8 $9 $4 G0447 Behavior Counsel Obesity 15M G0448 Place Perm Pacing Cardiovert G0451 Devlopment Test Interpt&Rep G0452 Molecular Pathology Interpr G0452 Molecular Pathology Interpr G0452 Molecular Pathology Interpr G0453 Cont Intraop Neuro Monitor G0454 Md Document Visit By Npp G0455 Fecal Microbiota Prep Instil G0458 Ldr Prostate Brachy Comp Rat G0459 Telehealth Inpt Pharm Mgmt G0460 Autologous Prp For Ulcers G0463 Hospital Outpt Clinic Visit $120 $78 $93 $39 G0466 Fqhc Visit New Patient G0467 Fqhc Visit, Estab Pt G0468 Fqhc Visit, Ippe Or Awv G0469 Fqhc Visit, Mh New Pt G0470 Fqhc Visit, Mh Estab Pt G0471 Ven Blood Coll Snf/Hha G0472 Hep C Screen High Risk/Other G0472 Hep C Screen High Risk/Other G0473 Group Behave Couns 2-10 G0475 Hiv Combination Assay G0475 Hiv Combination Assay G0476 Hpv Combo Assay Ca Screen G0480 301 Drug Test Def 1-7 Classes $300 $195 $233 $100 G0481 301 Drug Test Def 8-14 Classes $411 $267 $319 $137 G0482 301 Drug Test Def 15-21 Classes $522 $339 $405 $175 G0483 301 Drug Test Def 22+ Classes $648 $421 $503 $217 G0490 Home Visit Rn, Lpn By Rhc/Fq G0491 Dialysis Acu Kidney No Esrd G0492 Md/Oth Eval Acut Kid No Esrd G0493 551 Rn Care Ea 15 Min Hh/Hospice $200 $130 $155 $66 G0494 551 Lpn Care Ea 15Min Hh/Hospice $200 $130 $155 $66 G0495 551 Rn Care Train/Edu In Hh $200 $130 $155 $66 G0496 Lpn Care Train/Edu In Hh G0498 Chemo Extend Iv Infus W/Pump G0499 Hepb Screen High Risk Indiv G0500 Mod Sedat Endo Service >5Yrs G0501 Resource-Inten Svc During Ov G0506 Comp Asses Care Plan Ccm Svc G0508 Crit Care Telehea Consult 60 G0509 Crit Care Telehea Consult 50 G0511 Ccm/Bhi By Rhc/Fqhc 20Min Mo G0512 Cocm By Rhc/Fqhc 60 Min Mo G0513 Prolong Prev Svcs, First 30M G0514 Prolong Prev Svcs, Addl 30M G0516 Insert Drug Del Implant, >=4 G0517 Remove Drug Implant G0518 Remove W Insert Drug Implant G0659 Drug Test Def Simple All Cl G0913 Improve Visual Funct G0914 Survey Not Complete G0915 No Improve Visual Funct G0916 Satisfy With Care G0917 Satisfy Survey Not Complete G0918 No Satisfy With Care G1001 Cdsm Evicore G1002 Cdsm Medcurrent G1003 Cdsm Medicalis G1004 999 Cdsm Ndsc $0 $0 G1005 Cdsm Nia G1006 Cdsm Test Approp G1007 Cdsm Aim G1008 Cdsm Cranberry Pk G1009 Cdsm Sage Health G1010 Cdsm Stanson G1011 Cdsm Qualified Nos G1012 Cdsm Agilemd G1013 Cdsm Evidencecare G1014 Cdsm Inveniqa G1015 Cdsm Reliant G1016 Cdsm Speed Of Care G1017 Cdsm Healthhelp G1018 Cdsm Infinx G1019 Cdsm Logicnets G1020 Cdsm Curbside G1021 Cdsm Ehealthline G1022 Cdsm Intermountain G1023 Cdsm Persivia G2000 Blinded Conv. Tx Mdd Clin Tr G2001 Post D/C H Vst New Pt 20 M G2002 Post-D/C H Vst New Pt 30 M G2003 Post-D/C H Vst New Pt 45 M G2004 Post-D/C H Vst New Pt 60 M G2005 Post-D/C H Vst New Pt 75 M G2006 Post-D/C H Vst Ext Pt 20 M G2007 Post-D/C H Vst Ext Pt 30 M G2008 Post-D/C H Vst Ext Pt 45 M G2009 Post-D/C H Vst Ext Pt 60 M G2010 Remot Image Submit By Pt G2011 Alcohol/Sub Misuse Assess G2012 Brief Check In By Md/Qhp G2013 Post-D/C H Vst Ext Pt 75 M G2014 Post-D/C Care Plan Overs 30M G2015 Post-D/C Care Plan Overs 60M G2021 Hea Care Pract Tx In Place G2022 Benef Refuses Service, Mod G2023 Specimen Collect Covid-19 G2024 Spec Coll Snf/Lab Covid-19 G2025 Dis Site Tele Svcs Rhc/Fqhc G2058 Ccm Add 20Min G2061 Qual Nonmd Est Pt 5-10M G2062 Qual Nonmd Est Pt 11-20M G2063 Qual Nonmd Est Pt 21>Min G2064 Md Mang High Risk Dx 30 G2065 Clin Mang H Risk Dx 30 G2066 Inter Devc Remote 30D $518 $337 $402 $170 $49 G2067 Med Assist Tx Meth Wk G2068 Med Assist Tx Bupre Oral G2069 Med Assist Tx Inject G2070 Med Assist Tx Implant G2071 Med Tx Remove Implant G2072 Med Tx Insert/Remove Imp G2073 Med Tx Naltrexone G2074 Med Assist Tx No Drug G2075 Med Tx Meds Nos G2076 Intake Act W/Med Exam G2077 Periodic Assessment G2078 Take-Home Meth G2079 Take-Hom Buprenorphine G2080 Add 30 Mins Counsel G2081 Pt 66+ Snp Or Ltc Pos > 90D G2082 Visit Esketamine 56M Or Less G2083 Visit Esketamine, > 56M G2086 Off Base Opioid Tx 70Min G2087 Off Base Opioid Tx, 60 M G2088 Off Base Opioid Tx, Add30 G2089 A1C Level 7 To 9% G2090 Pt 66+ Frailty And Med Dem G2091 Pt 66+ Frailty And Adv Ill G2092 Ace Arb Arni G2093 Med Doc Rsn No Ace Arn Arni G2094 Pt Rsn No Ace Arn Arni G2095 Sys Rsn No Ace Arn Arni G2096 No Rsn Ace Arb Arni G2097 Dx Uri 3D After Other Dx G2098 Pt 66+ Frailty And Med Dem G2099 Pt 66+ Frailty And Adv Ill G2100 Pt 66+ Frailty And Med Dem G2101 Pt 66+ Frailty And Adv Ill G2102 Dil Retinal Eye Exam G2103 7 Stereo Photos Interpret G2104 Eye Img Valid W/7 Stereo G2105 Pt 66+ Snp Or Ltc Pos > 90D G2106 Pt 66+ Lt Ints > 90 G2107 Pt 66+ Frailty And Adv Ill G2108 Pt 66+ Snp Or Ltc Pos > 90D G2109 Pt 66+ Frailty And Med Dem G2110 Pt 66+ Frailty And Adv Ill G2112 Pred<=5 Mg Ra Glu <6M G2113 Pred>5 Mg >6M, No Chg Da G2114 Pt 66-80 Frailty And Med Dem G2115 Pt 66-80 Frailty And Med Dem G2116 Pt 66-80 Frailty And Adv Ill G2117 Pt 66-80 Frailty And Adv Ill G2118 Pt 81+ Frailty G2119 Calc Vitd Opt G2120 No Calc Vitd Opt G2121 Psy Dep Anx Ap And Icd Asse G2122 Psy/Dep/Anx/Apandicd Noasse G2123 Pt 66-80 Frailty Med Dem G2124 Pt 66-80 Frailty Adv Ill G2125 Pt 81+ Frailty G2126 Pt 66-80 Frailty And Adv Ill G2127 Pt 66-80 Frailty And Med Dem G2128 No Aspirin Med Rsn G2129 No Bp Outpt G2130 Pt 66+ Lt Inst > 90 G2131 Pt 81+ Frailty G2132 Pt 66-80 Frailty And Med Dem G2133 Pt 66-80 Frailty And Adv Ill G2134 Pt 66+ Frailty And Med Dem G2135 Pt 66+ Frailty And Adv Ill G2136 Bk Pain Vas 6-20Wk <= 3 G2137 Bk Pain Vas 6-20Wk > 3 G2138 Bk Pain Vas 9-15Mo <= 3 G2139 Bk Pain Vas 9-20Mo > 3 G2140 Leg Pain Vas 6-20Wk <= 3 G2141 Leg Pain Vas 6-20Wk > 3 G2142 Fs Odi 9-15Mo Postop<= 22 G2143 Fs Odi 9-15Mo > 22 G2144 Fs Odi 6-20Wk Postop <= 22 G2145 Fsodi 6-20Wk >22 Or Chg 30Pt G2146 Leg Pain Vas 9-15Mo <= 3 G2147 Leg Pain Vas 9-15Mo > 3 G2148 Mpm Used G2149 No Mpm Med Rsn G2150 No Mpm G2151 Dx Degen Neuro G2152 Res Change Sc >=0 G2153 Hosp Dur Meas Pd G2154 Td 9 Yrs Start End Meas G2155 Hist Contraindications G2156 No Prior Td Or Hx Contra G2157 Pneum Vacc 12 Mo 60+ G2158 Pneum Vacc Adv Rx G2159 No Pneum Vacc 12 Mo 60+ G2160 Herpzos 50+ G2161 Adv Rx Zos G2162 No Herpzos 50+ G2163 Infl Vacc 07/01 To 06/30 G2164 Adv Rx Infl Vacc G2165 No Infl Vacc 07/01 To 06/30 G2166 No Pt Adm Dx No Neck Fs Prom G2167 Res Change Sc < 0 G2168 Svs By Pt In Home Health $190 $124 $148 $62 G2169 Svs By Ot In Home Health $190 $124 $148 $62 G2170 Avf By Tissue W Thermal E G2171 Avf Use Magnetic/Art/Ven G2173 Uri W Comorb 12M Oth Dx G2174 Uri New Rx Antibiotic 30D G2175 Pt Comorb Dx 12M Of Epi G2176 Outpt Ed Obs W Inpt Admit G2177 Bronch W Rx Antibx 30D G2178 Pt Not Elig Low Neuro Ex G2179 Med Doc Rsn No Low Ex G2180 Inelig Footwr Eval G2181 Bmi Not Doc Medrsn Ptref G2182 Pt 1St Biolog Antirheum G2183 Doc Pt Unable Comm G2184 No Caregiver G2185 Caregiver Dem Trained G2186 Pt Ref App Rsrcs G2187 Clin Ind Img Hd Trauma G2188 Pt 50 Yrs W/Clin Ind Hd G2189 Img Hd Abnml Neuro Exam G2190 Ind Img Hd Rad Neck G2191 Ind Img Hd Pos Hd Ache G2192 >55 Yrs Temp Hd Ache G2193 <6Yr New Onset Hd Ache G2194 New Hdache Ped Pt Dis G2195 Occip Hdache Child G2196 Screen Unhlthy Etoh Use G2197 Screen Hlthy Etoh Use G2198 Med Rsn No Unhlthy Etoh G2199 Not Scrn Etoh No Rsn G2200 Unhlthy Etoh Rcvd Couns G2201 Med Rsn No Brief Couns G2202 No Rsn No Brief Couns G2203 Med Rsn No Etoh Couns G2204 Pt 50-85 W/ Scope G2205 Preg Drng Adjv Trtmt G2206 Adjv Trtmt Chemo Her2 G2207 Rsn No Trtmt Chem Her2 G2208 No Trtmt Chemo And Her2 G2209 Refused To Participate G2210 No Neck Fs Prom No Rsn G2211 Complex E/M Visit Add On G2212 Prolong Outpt/Office Vis G2213 Initiat Med Assist Tx In Er G2214 Init/Sub Psych Care M 1St 30 G2215 Home Supply Nasal Naloxone G2216 Home Supply Inject Naloxon G2250 Remot Img Sub By Pt, Non E/M G2251 Brief Chkin, 5-10, Non-E/M G2252 Brief Chkin By Md/Qhp, 11-20 G6001 Echo Guidance Radiotherapy G6001 Echo Guidance Radiotherapy G6001 Echo Guidance Radiotherapy G6002 Stereoscopic X-Ray Guidance $64 $41 $50 $21 G6002 Stereoscopic X-Ray Guidance $64 $41 $50 $21 G6002 Stereoscopic X-Ray Guidance $64 $41 $50 $21 G6003 Radiation Treatment Delivery G6004 Radiation Treatment Delivery G6005 Radiation Treatment Delivery G6006 Radiation Treatment Delivery G6007 Radiation Treatment Delivery G6008 Radiation Treatment Delivery G6009 Radiation Treatment Delivery G6010 Radiation Treatment Delivery G6011 Radiation Treatment Delivery G6012 Radiation Treatment Delivery G6013 Radiation Treatment Delivery G6014 Radiation Treatment Delivery G6015 Radiation Tx Delivery Imrt G6016 Delivery Comp Imrt G6017 Intrafraction Track Motion G8395 Lvef>=40% Doc Normal Or Mild G8396 Lvef Not Performed G8397 Dil Macula/Fundus Exam/W Doc G8398 Dil Macular/Fundus Not Perfo G8399 Pt W/Dxa Results Document G8400 Pt W/Dxa No Results Doc G8404 Low Extemity Neur Exam Docum G8405 Low Extemity Neur Not Perfor G8410 Eval On Foot Documented G8415 Eval On Foot Not Performed G8416 Pt Inelig Footwear Evaluatio G8417 Calc Bmi Abv Up Param F/U G8418 Calc Bmi Blw Low Param F/U G8419 Calc Bmi Out Nrm Param Nof/U G8420 Calc Bmi Norm Parameters G8421 Bmi Not Calculated G8422 Pt Inelig Bmi Calculation G8427 Docrev Cur Meds By Elig Clin G8428 Cur Meds Not Document G8430 Doc Med Rsn No Medrec G8431 Pos Clin Depres Scrn F/U Doc $38 $25 $29 $12 G8432 Dep Scr Not Doc, Rng G8433 Scr For Dep Not Cpt Doc Rsn G8442 Doc Pain As Nt Perf, Not Elg G8450 Beta-Bloc Rx Pt W/Abn Lvef G8451 Pt W/Abn Lvef Inelig B-Bloc G8452 Pt W/Abn Lvef B-Bloc No Rx G8465 High Risk Recurrence Pro Ca G8473 Ace/Arb Thxpy Rx'D G8474 Ace/Arb Not Rx'D; Doc Reas G8475 Ace/Arb Thxpy Not Rx'D G8476 Bp Sys <140 And Dias <90 G8477 Bp Sys>=140 And/Or Dias >=90 G8478 Bp Not Performed/Doc G8482 Flu Immunize Order/Admin G8483 Flu Imm No Admin Doc Rea G8484 Flu Immunize No Admin G8506 Pt Rec Ace/Arb G8509 Pos Pain Assess No F/U Doc G8510 Scr Dep Neg, No Plan Reqd $38 $24 $29 $12 $10 G8511 Scr Dep Pos, No Plan Doc Rng G8535 Eld Maltreatment Not Doc G8536 No Doc Elder Mal Scrn G8539 Doc Funct And Care Plan G8540 Foa Not Doc As Being Perf G8541 No Doc Cur Funct Assess G8542 Doc Funct No Deficiencies G8543 Cur Funct Asses; No Care Pln G8559 Pt Ref Doc Oto Eval G8560 Pt Hx Act Drain Prev 90 Days G8561 Pt Inelig For Ref Oto Eval G8562 Pt No Hx Act Drain 90 D G8563 Pt No Ref Oto Reas No Spec G8564 Pt Ref Oto Eval G8565 Ver Doc Hear Loss G8566 Pt Inelig Ref Oto Eval G8567 Pt No Doc Hear Loss G8568 Pt No Ref Otolo No Spec G8569 Prol Intubation Req G8570 No Prol Intub Req G8571 Ster Wd Ifx 30 D Postop G8572 No Ster Wd Ifx G8573 Stk Cabg G8574 No Strk Cabg G8575 Postop Ren Fail G8576 No Postop Ren Fail G8577 Reop Req Bld Grft Oth G8578 No Reop Req Bld Grft Oth G8598 Asa/Antiplat Ther Used G8599 No Asa/Antiplat Ther Use Rng G8600 Tpa Initi W/In 3 Hrs G8601 No Elig Tpa Init W/In 3 Hrs G8602 No Tpa Init W/In 3 Hrs G8627 Surg Proc W/In 30 Days G8628 No Surg Proc W/In 30 Days G8633 Pharm Ther Osteo Rx G8635 No Pharm Ther Osteo Rx G8647 Rafscrs Ki Scor >= 0 G8648 Rafscrs Ki Scor < 0 G8650 Rafs Crs Ki No Scor No Rsn G8651 Rafscrs Hi Scor >=0 G8652 Rafscrs Hi Scor < 0 G8654 Rafs Crs Hi No Scor No Surv G8655 Rafscrs Llfai Scor >= 0 G8656 Rafscrs Llfai Scor < 0 G8658 Rafscrs Llfai No Scor + Surv G8659 Rafscrs Lbi Scor >= 0 G8660 Rafscrs Lbi Scor < 0 G8661 Rafscrs Lbi No Scor G8662 Rafs Crs Lbi No Scor No Surv G8663 Rafscrs Si Scor >= 0 G8664 Rafscrs Si Scor < 0 G8666 Rafs Crs Si No Scor No Surv G8667 Rafscrs Ewh Scor >= 0 G8668 Rafscrs Ewh Scor < 0 G8670 Rafs Crs Ewh No Scor No Surv G8671 Rafscrs Goi Scor >= 0 G8672 Rafscrs Goi Scor < 0 G8674 Rafscrs Neck, No Msr/No Foto G8694 Lvef <40% G8708 Antibiotic Not Pres G8709 Uri Ep Compete Diag G8710 Pt Pres Antibiotic G8711 Pres Antibiotic G8712 Not Pres Antibiotic G8721 Pt, Pn, Hist Grade Doc G8722 Med Reas Pt, Pn, Not Doc G8723 Spec Sit Not Prim Tumor G8724 Pt, Pn, Hist Grade Not Doc G8730 Pain Doc Pos And Plan G8731 Pain Neg No Plan G8732 No Doc Of Pain G8733 Doc Pos Elder Mal Scrn Plan G8734 Doc Neg Elder Mal No Plan G8735 Eld Mal Scrn Pos No Plan G8749 No Signs Melanoma G8752 Sys Bp Less 140 G8753 Sys Bp > Or = 140 G8754 Dias Bp Less 90 G8755 Dias Bp > Or = 90 G8756 No Bp Measure Doc G8783 Bp Scrn Perf Rec Interval G8785 Bp Scrn No Perf At Interval G8797 Specimen Site Not Esophagus G8798 Specimen Site Not Prostate G8806 Perf Ultrsnd To Lct Preg Doc G8807 No Ta Tv Ultrasnd G8808 Ultrasound Not Perf, Rng G8809 Rh-Immunoglobulin Order G8810 Doc Reas No Rh-Immuno G8811 No Rh-Immunoglobulin Order G8815 Doc Reas No Statin Therapy G8816 Statin Med Pres At Disch G8817 Doc Reas No Statin Med Disch G8818 Pt Disch To Home By Day#7 G8825 Pt Not Disch To Home Day#7 G8826 Pt Disch Home Day #2 Evar G8833 Pt Not Disch Home Day#2 Evar G8834 Pt Disch Home Day #2 Cea G8838 Not Disch Home By Day #2 G8839 Sleep Apnea Assess G8840 Doc Reas No Sleep Apnea G8841 No Sleep Apnea Assess G8842 Ahi Or Rdi Initial Dx G8843 Doc Reas No Ahi Or Rdi G8844 No Ahi Or Rdi Initial Dx G8845 Pos Airway Press Prescribed G8846 Mod Or Severe Osa G8849 Doc Reas No Pos Air Press G8850 No Pap Prescribed G8851 Adhere Pos Air Press Therapy G8852 Pos Air Press Prescribe G8854 Reas No Adhere Pos Air Pres G8855 Pos Air Press Adhere No Perf G8856 Ref For Oto Eval G8857 No Elig Ref For Oto Eval G8858 Not Ref For Oto Eval G8863 No Assess Bone Loss G8864 Pneumococcal Vaccine Admin G8865 Doc Med Reas No Pneumococcal

G8866 Doc Pt Reas No Pneumococcal G8867 No Pneumococcal Admin G8869 Doc Immune Hep B Antitnf G8872 Intraop Image Confirm Excise G8873 Specimen Not Intraop Image G8874 Tissue Not Image Intraop G8875 Breast Cancer Dx Min Invsive G8876 Doc Reas No Min Inv Dx G8877 No Brst Cncr Dx Min Invasive G8878 Sent Lymph Node Biopsy G8880 Sen Lym P Node Biop Not Perf G8881 Brst Cncr Stage > T1N0M0 G8882 No Sent Lymph Node Biopsy G8883 Rev, Comm, Track, Doc Biopsy G8884 Doc Reas Biopsy Not Review G8885 No Rev, Comm, Track Biopsy G8907 Pt Doc No Events On Discharg G8908 Pt Doc W Burn Prior To D/C G8909 Pt Doc No Burn Prior To D/C G8910 Pt Doc To Have Fall In Asc G8911 Pt Doc No Fall In Asc G8912 Pt Doc With Wrong Event G8913 Pt Doc No Wrong Event G8914 Pt Trans To Hosp Post D/C G8915 Pt Not Trans To Hosp At D/C G8916 Pt W Iv Ab Given On Time G8917 Pt W Iv Ab Not Given On Time G8918 Pt W/O Preop Order Iv Ab Pro G8923 Lvef < 40% Or Lvsd G8924 Spir Fev1/Fvc<70%,Fev<60% G8925 Spir Fev1/Fvc>=60% & No Copd G8926 Spiro No Perf Or Doc G8934 Lvef <40% Or Dep Lv Sys Fcn G8935 Rx Ace Or Arb Therapy G8936 Pt Not Eligible Ace/Arb G8937 No Rx Ace/Arb Therapy G8938 Bmi Doc Onl Fup Nt Doc G8939 Pain As Doc Positive, No F/U G8941 Eld Maltreatment Doc As Pos G8942 Doc Fcn/Care Plan W/30 Days G8944 Ajcc Mel Cnr Stg 0 - Iic G8946 Mibm But No Dx Of Breast Ca G8950 Pre-Htn Or Htn Doc, F/U Indc G8952 Pre-Htn/Htn, No F/U, Not Gvn G8955 Most Recent Assess Vol Mgmt G8956 Pt Rcv Hedia Outpt Dyls Fac G8958 Assess Vol Mgmt Not Doc G8959 Clin Tx Mdd Comm To Tx Clin G8960 Clin Tx Mdd Not Comm G8961 Csit Lowrisk Surg Pts Preop G8962 Csit On Pt Any Reas 30 Days G8963 Csi Per Asx Pt W/Pci 2 Yrs G8964 Csi Any Other Than Pci 2 Yr G8965 Csit Perf On Low Chd Rsk G8966 Csit Perf Sx Or High Chd Rsk G8967 Warf Or Other Fda Drug Presc G8968 Doc Med Not Presb G8969 Doc Pt Rsn No Presc Warf/Fda G8970 No Rsk Fac Or 1 Mod Risk Te G8973 Mst Rcnt Hbb < 10G/Dl G8974 Hgb Not Doc Rns Not Gvn G8975 Hgb <10G/Dl, Med Rsn G8976 Hgb >= 10 G/Dl G9001 Mccd, Initial Rate G9002 Mccd,Maintenance Rate G9003 Mccd, Risk Adj Hi, Initial G9004 Mccd, Risk Adj Lo, Initial G9005 Mccd, Risk Adj, Maintenance G9006 Mccd, Home Monitoring G9007 Mccd, Sch Team Conf G9008 Mccd,Phys Coor-Care Ovrsght G9009 Mccd, Risk Adj, Level 3 G9010 Mccd, Risk Adj, Level 4 G9011 Mccd, Risk Adj, Level 5 G9012 Other Specified Case Mgmt G9013 Esrd Demo Bundle Level I G9014 Esrd Demo Bundle-Level Ii G9016 Demo-Smoking Cessation Coun G9050 Oncology Work-Up Evaluation G9051 Oncology Tx Decision-Mgmt G9052 Onc Surveillance For Disease G9053 Onc Expectant Management Pt G9054 Onc Supervision Palliative G9055 Onc Visit Unspecified Nos G9056 Onc Prac Mgmt Adheres Guide G9057 Onc Pract Mgmt Differs Trial G9058 Onc Prac Mgmt Disagree W/Gui G9059 Onc Prac Mgmt Pt Opt Alterna G9060 Onc Prac Mgmt Dif Pt Comorb G9061 Onc Prac Cond Noadd By Guide G9062 Onc Prac Guide Differs Nos G9063 Onc Dx Nsclc Stgi No Progres G9064 Onc Dx Nsclc Stg2 No Progres G9065 Onc Dx Nsclc Stg3A No Progre G9066 Onc Dx Nsclc Stg3B-4 Metasta G9067 Onc Dx Nsclc Dx Unknown Nos G9068 Onc Dx Sclc/Nsclc Limited G9069 Onc Dx Sclc/Nsclc Ext At Dx G9070 Onc Dx Sclc/Nsclc Ext Unknwn G9071 Onc Dx Brst Stg1-2B Hr,Nopro G9072 Onc Dx Brst Stg1-2 Noprogres G9073 Onc Dx Brst Stg3-Hr, No Pro G9074 Onc Dx Brst Stg3-Noprogress G9075 Onc Dx Brst Metastic/ Recur G9077 Onc Dx Prostate T1No Progres G9078 Onc Dx Prostate T2No Progres G9079 Onc Dx Prostate T3B-T4Noprog G9080 Onc Dx Prostate W/Rise Psa G9083 Onc Dx Prostate Unknwn Nos G9084 Onc Dx Colon T1-3,N1-2,No Pr G9085 Onc Dx Colon T4, N0 W/O Prog G9086 Onc Dx Colon T1-4 No Dx Prog G9087 Onc Dx Colon Metas Evid Dx G9088 Onc Dx Colon Metas Noevid Dx G9089 Onc Dx Colon Extent Unknown G9090 Onc Dx Rectal T1-2 No Progr G9091 Onc Dx Rectal T3 N0 No Prog G9092 Onc Dx Rectal T1-3,N1-2Noprg G9093 Onc Dx Rectal T4,N,M0 No Prg G9094 Onc Dx Rectal M1 W/Mets Prog G9095 Onc Dx Rectal Extent Unknwn G9096 Onc Dx Esophag T1-T3 Noprog G9097 Onc Dx Esophageal T4 No Prog G9098 Onc Dx Esophageal Mets Recur G9099 Onc Dx Esophageal Unknown G9100 Onc Dx Gastric No Recurrence G9101 Onc Dx Gastric P R1-R2Noprog G9102 Onc Dx Gastric Unresectable G9103 Onc Dx Gastric Recurrent G9104 Onc Dx Gastric Unknown Nos G9105 Onc Dx Pancreatc P R0 Res No G9106 Onc Dx Pancreatc P R1/R2 No G9107 Onc Dx Pancreatic Unresectab G9108 Onc Dx Pancreatic Unknwn Nos G9109 Onc Dx Head/Neck T1-T2No Prg G9110 Onc Dx Head/Neck T3-4 Noprog G9111 Onc Dx Head/Neck M1 Mets Rec G9112 Onc Dx Head/Neck Ext Unknown G9113 Onc Dx Ovarian Stg1A-B No Pr G9114 Onc Dx Ovarian Stg1A-B Or 2 G9115 Onc Dx Ovarian Stg3/4 Noprog G9116 Onc Dx Ovarian Recurrence G9117 Onc Dx Ovarian Unknown Nos G9123 Onc Dx Cml Chronic Phase G9124 Onc Dx Cml Acceler Phase G9125 Onc Dx Cml Blast Phase G9126 Onc Dx Cml Remission G9128 Onc Dx Multi Myeloma Stage I G9129 Onc Dx Mult Myeloma Stg2 Hig G9130 Onc Dx Multi Myeloma Unknown G9131 Onc Dx Brst Unknown Nos G9132 Onc Dx Prostate Mets No Cast G9133 Onc Dx Prostate Clinical Met G9134 Onc Nhlstg 1-2 No Relap No G9135 Onc Dx Nhl Stg 3-4 Not Relap G9136 Onc Dx Nhl Trans To Lg Bcell G9137 Onc Dx Nhl Relapse/Refractor G9138 Onc Dx Nhl Stg Unknown G9139 Onc Dx Cml Dx Status Unknown G9140 Frontier Extended Stay Demo G9143 Warfarin Respon Genetic Test G9147 Outpt Iv Insulin Tx Any Mea G9148 Medical Home Level 1 G9149 Medical Home Level Ii G9150 Medical Home Level Iii G9151 Mapcp Demo State G9152 Mapcp Demo Community G9153 Mapcp Demo Physician G9156 Evaluation For Wheelchair G9157 Transesoph Doppl Cardiac Mon G9187 Bpci Home Visit G9188 Beta Not Given No Reason G9189 Beta Pres Or Already Taking G9190 Medical Reason For No Beta G9191 Pt Reason For No Beta G9192 System Reason For No Beta G9196 Med Reason For No Ceph G9197 Order For Ceph G9198 No Order For Ceph No Reason G9212 Doc Of Dsm-Iv Init Eval G9213 No Doc Of Dsm-Iv G9223 Pjp Proph Ordered Cd4 Low G9225 Norsn No Foot Exam G9226 3 Comp Foot Exam Completed G9227 Foa Doc, Care Plan Not Doc G9228 Gc Chl Syp Documented G9229 Ptrsn No Gc Chl Syp Test G9230 Norsn For Gc Chl Syp Test G9231 Doc Esrd Dia Trans Preg G9232 Ptrsn No Comm Comorbid G9239 Doc Rsn Hemod & Cath Acc G9240 Doc Pt W Cath Maint Dia G9241 Doc Pt W Out Cath Maint Dia G9242 Doc Viral Load >=200 G9243 Doc Viral Load <200 G9246 No Med Visit In 24Mo G9247 1 Med Visit In 24Mo G9250 Doc Of Pain Comfort 48Hr G9251 Doc No Pain Comfort 48Hr G9254 Doc Pt Dischg >2D G9255 Doc Pt Dischg <=2D G9256 Doc Of Pat Death After Cas G9257 Doc Of Pat Stroke After Cas G9258 Doc Of Pat Stroke After Cea G9259 Survive/No Stroke Post Cas G9260 Doc Of Pat Death After Cea G9261 Survive/No Stroke Post Cea G9262 Doc Of Death Post-Aaa Repair G9263 Doc Of Disch Post-Aaa Repair G9264 Doc Rsn Hemod W/Cath >=90D G9265 Doc Cath >90D For Maint Dia G9266 Norsn Pt Cath >=90D G9267 Doc Comp Or Mort W In 30D G9268 Doc Comp Or Mort W In 90D G9269 Doc No Comp Or Mort W In 30D G9270 Doc No Comp Or Mort W In 90D G9273 Sys<140 And Dia<90 G9274 Bp Out Of Nrml Limits G9275 Doc Of Non Tobacco User G9276 Doc Of Tobacco User G9277 Doc Daily Aspirin Or Contra G9278 Doc No Daily Aspirin G9279 Pne Scrn Done Doc Vac Done G9280 Pne Not Given Norsn G9281 Pne Scrn Done Doc Not Ind G9282 Doc Medrsn No Histo Type G9283 Hist Type Doc On Report G9284 No Hist Type Doc On Report G9285 Site Not Small Cell Lung Ca G9286 Antibio Rx W In 10D Of Sympt G9287 No Antibio W In 10D Of Sympt G9288 Doc Medrsn No Hist Type Rpt G9289 Doc Type Nsm Lung Ca G9290 No Doc Type Nsm Lung Ca G9291 Not Nsm Lung Ca G9292 Medrsn No Pt Category G9293 No Pt Category On Report G9294 Pt Cat And Thck On Report G9295 Non Cutaneous Loc G9296 Doc Share Dec Prior Proc G9297 No Doc Share Dec Prior Proc G9298 Eval Risk Vte Card 30D Prior G9299 No Eval Risk Vte Card Prior G9300 Doc Medrsn No Compl Antibio G9301 Doc Compl Inf Antibio G9302 Norsn Incomp Inf Antibio G9303 Norsn No Pros Info Op Rpt G9304 Pros Info Op Rpt G9305 No Interv Req For Leak G9306 Interv Req For Leak G9307 No Ret For Surg W In 30D G9308 Unpl Ret Or W/Compl W/In 30D G9309 No Unplnd Hosp Readm In 30D G9310 Unplnd Hosp Readm In 30D G9311 No Surg Site Infection G9312 Surgical Site Infection G9313 Amoxic Not Presc As 1St Line G9314 Norsn Not First Line Amox G9315 Doc First Line Amox G9316 Doc Comm Risk Calc G9317 No Doc Comm Risk Calc G9318 Image Std Nomenclature G9319 Image Not Std Nomenclature G9321 Doc Count Of Ct In 12Mo G9322 No Doc Count Of Ct In 12Mo G9326 Ct Done No Rad Ds Index, Nrg G9327 Ct Done Rad Ds Index G9329 Norsn No Dicom Format Doc G9340 Dicom Format Doc On Rpt G9341 Srch For Ct W In 12 Mos G9342 No Srch For Ct In 12Mo Norsn G9344 Sysrsn No Dicom Srch G9345 Follow Up Pulm Nod G9347 No Follow Up Pulm Nod Norsn G9348 Doc Rsn For Ord Ct Scan G9349 Ct Within 28 Days G9350 No Doc Sinus Ct 28D Or Dx G9351 Doc >1 Sinus Ct W 90D Dx G9352 Not >1 Sinus Ct W 90D Dx G9353 Medrsn >1 Sinus Ct W 90D Dx G9354 1 Or No Ct Sinus W/In 90D Dx G9355 No Early Ind/Delivery G9356 Early Ind/Delivery G9357 Pp Eval/Edu Perf G9358 Pp Eval/Edu Not Perf G9359 Neg Mgd Pos Tb Notact G9360 No Doc Of Neg Or Man Pos Tb G9361 Doc Rsn Elect C-Sec/Induct G9364 Sinus Caus Bac Inx G9365 1High Risk Med Ord G9366 1High Risk No Ord G9367 >= 2 Same Hi-Rsk Med Ord G9368 >= 2 Same Hi-Rsk Med Not Ord G9380 Off Assis Eol Iss G9382 No Off Assis Eol G9383 Recd Scrn Hcv Infec G9384 Doc Med Rsn No Hcv Scrn G9385 Doc Pt Reas Not Rec Hcv Srn G9386 Scrn Hcv Infec Not Recd G9389 Unpln Rup Post Cap G9390 No Unpln Rup Post Cap G9393 Ini Phq9 >9 Remiss <5 G9394 Dx Bipol, Death, Nhres, Hosp G9395 Ini Phq9 >9 No Remiss >=5 G9396 Ini Phq9 >9 Not Assess G9399 Doc Disc Tx Choices G9400 Doc Reas No Disc Tx Opt G9401 No Disc Tx Choices G9402 Recd F/U W/In 30D Disch G9403 Doc Reas No 30 Day F/U G9404 No 30 Day F/U G9405 Recd F/U W/In 7D Dc G9406 Doc Reas No 7D F/U G9407 No 7D F/U G9408 Card Tamp W/In 30D G9409 No Card Tamp E/In 30D G9410 Admit W/In 180D Req Remov G9411 No Admit W/In 180D Req Remov G9412 Admit W/In 180D Req Surg Rev G9413 No Admit Req Surg Rev G9414 1Dose Menig Vac Btwn 11 & 13 G9415 No 1Dose Meni Vac Btwn 11&13 G9416 Pt 1 Tdap Betw 10-13 Yrs G9417 Pt Not 1 Tdap Betw 10-13 Yrs G9418 Lungcx Bx Rpt Docs Class G9419 Med Reas Not Incl Histo Type G9420 Spec Site No Lung G9421 Lung Cx Bx Rpt No Doc Class G9422 Rpt Doc Class Histo Type G9423 Med Reas Rpt No Histo Type G9424 Site No Lung Or Lung Cx G9425 Spec Rpt No Doc Class Histo G9426 Impr Med Time Edarr Pain Med G9427 No Impro Med Time Pain Med G9428 Patho Rpt Incl Pt Ctg G9429 Doc Med Rsn No Pt Cat G9430 Spec Site No Cutaneous G9431 Patho Rpt No Pt Ctg G9432 Asth Controlled G9434 Asth Not Controlled G9448 Born 1945-1965 G9449 Hx Bld Transf B/F 1992 G9450 Hx Injec Drug Use G9451 1X Scrn Hcv Infect G9452 Doc Med Reas No Scrn Hcv G9453 Pt Reas No Hcv Infect G9454 No Scr Hcv Inf 12 Mth Rp G9455 Abd Imag W/Us, Ct Or Mri G9456 Doc Med Pt Reas No Hcc Scrn G9457 Pt No Abd Img No Doc Rsn G9458 Tob User Recd Cess Interv G9459 Tob Non-User G9460 No Tob Assess Or Cess Inter G9468 No Recd Cortico>=10Mg/D >60D G9469 Rec Cortico>90D Or 1Rx 900Mg G9470 No Rec Cortico>60D 1Rx 600Mg G9471 W/In 2Yr Dxa Not Order G9473 Chap Services At Hospice G9474 Diet Counsel At Hospice G9475 Other Counselor At Hospice G9476 Volun Service At Hospice G9477 Care Coord At Hospice G9478 Othe Therapist At Hospice G9479 Pharmacist At Hospice G9480 Admission To Mccm G9481 Remote E/M New Pt 10Mins G9482 Remote E/M New Pt 20Mins G9483 Remote E/M New Pt 30Mins G9484 Remote E/M New Pt 45Mins G9485 Remote E/M New Pt 60Mins G9486 Remote E/M Est. Pt 10Mins G9487 Remote E/M Est. Pt 15Mins G9488 Remote E/M Est. Pt 25Mins G9489 Remote E/M Est. Pt 40Mins G9490 Cmmi Mod Home Visit G9497 Rec Inst No Smoke Day Surg G9498 Abx Reg Prescribed G9500 Rad Expos Ind/Exp Tm Doc G9501 Rad Expos Ind/Exp Tm No Doc G9502 Med Reas No Perf Foot Exam G9503 Pt Tk Tams Hcl G9504 Doc Rsn Hep B Stat Not Asses G9505 Abx Pres W/In 10 Dys Of Symp G9506 Bio Imm Resp Mod Presc G9507 Doc Reas On Statin Or Contra G9508 Doc Pt Not On Statin G9509 Adit Mdd Dys Rem 12 Mnths G9510 Remis12M Not Phq-9 Score <5 G9511 Idx Evt Dte Phq>9 Doc 12 Mo G9512 Indiv Pdc > 0.8 G9513 Indiv Pdc Not > 0.8 G9514 Req Ret Or W/In 90D Of Surg G9515 No Reas, No Ret Or W/In 90D G9516 Impr Vis Acuit W/In 90D G9517 No Impr Vis Acuit W/In 90D G9518 Doc Active Inj Drug Use G9519 Final Ref +/- 1.0 W/In 90D G9520 Refract Not +/- 1.0 W/In 90D G9521 Er And Ip Hosp <2 In 12 Mos G9522 Er/Ip Hosp =/>2 In 12 Mos G9523 D/C Hemo Or Perit Dialysis G9524 Refer To Hospice G9525 Doc Pt Reas No Hospice Refer G9526 No Reason, No Refer Hospice G9529 Minor Blunt Trauma W/Head Ct G9530 Pt Mbht Hd Ct Ord Ec Prov G9531 Pt Doc G9532 Pt Hd Ct Ord G9533 Indic For Head Ct Not Valid G9537 Img Hd Clin Trial G9539 Intent Pot Remv Time Placemt G9540 Pt Alive 3 Mos Post Proc G9541 Filter Rem 3 Mon Plmt G9542 Doc Reass Appr Remo Filt 3Ms G9543 Doc 2X Re-Assess Filt Remov G9544 No Filt Remov W/In 3Mos Plcm G9547 Cys Ren Les Or Adren G9548 No F/U Rec Image Study G9549 Doc Med Rsn For F/U Imag G9550 Imag Rec G9551 Imag No Les G9552 Inc Thyr Node <1.0 In Rpt G9553 Prior Thyroid Dise Dx G9554 Ct/Cta/Mri/A Chst Foll Rec G9555 Doc Med Rsn For Follup Image G9556 Ct/Cta/Mri/A No Follup Imag G9557 Ct/Cta/Mri/A No Thyr <1.0Cm G9558 Tx Beta-Lactam Abx Therapy G9559 Doc Med Reas No Abx Therapy G9560 No Beta-Lactam Abx Ther, Rng G9561 Presc Opiates >6 Wks G9562 Foll-Up Eval Q3Mo Opiod Tx G9563 No F/U Eval Q3Mo Opiod Tx G9573 Adl Pt Md Or Dys Rem 6 Mon G9574 Adl Pt Md Dys No Rem 6 Mon G9577 Presc Opiates >6 Wks G9578 Doc Opioid Tx 1X During Ther G9579 No Doc Opioid Tx 1X At Ther G9580 Door To Punc Time <2Hrs G9582 Door To Punc Time >2Hr, Nrg G9583 Presc Opiates >6 Wks G9584 Eval Opioid Use Instr/Pt Int G9585 No Eval Opi Use Instr/Intv G9593 Low Pecarn Ped Head Trauma G9594 Pt Mbht Hd Ct Ord Ec Prov G9595 Doc Shnt/Tum/Coag G9596 Ped Pt Hd Ct Ord G9597 No Low Pecarn Ped Head Traum G9598 Aor Ane 5.5-5.9 Cm Max Diam G9599 Aor Ane >=6.0 Cm Max Diam G9600 Symp Aaa Urgent Repair G9601 Pt Dchg Home Post Op Day 7 G9602 Pt No Dchg Home Postop Day 7 G9603 Pt Surv Improv Bsline Tx G9604 Pt Surv Results Not Avail G9605 Surv Score No Improv W/Tx G9606 Intraop Cyst Eval Trac Inj G9607 Doc Med Rsn Not Perf Cystosc G9608 Intraop Cyst Eval Not Done G9609 Doc Order Anti-Plat G9610 Doc Md Rsn No Antipla G9611 No Doc Order Anti-Plat Rng G9612 Phodoc 2 Mr Cec Lndmk G9613 Doc Post Surg Anatomy G9614 Photodoc < 2 Cec Lndmk G9615 Pre-Op Asst Doc G9616 Doc Rsn No Preop Assmt G9617 Pre-Op Asst Not Doc, Rng G9618 Doc Scr Uter Mal Or Us/Samp G9620 No Scr Utr Malig/Us/Samp Rng G9621 Scr Unheal Etoh W/Counsel G9622 No Unheal Etoh User G9623 Doc Med Rsn No Scr Etoh Use G9624 Pt Not Scrn Or No Counseling G9625 Pt Bl Srg 30 Day Pst Srg G9626 Med Rsn No Rpt Baldder Inj G9627 Pt No Bl Srg 30 Day Pst Srg G9628 Pt Bwli Srg 30 Day Pst Srg G9629 Med Rsn No Rpt Bowel Inj G9630 Pt No Bwli Srg 30 Day Srg G9631 Pt Ui Srg 30 Day Pst Srg G9632 Med Rsn For No Rpt Uret Inj G9633 Pt No Ui Srg 30 Day Pst Srg G9634 Qual Life Tool 2X Same/Impr G9635 No Doc Rsn Do Qual Life Assm G9636 No Life Asst 2X Same/Decr G9637 Doc >1 Dose Reduc Tech G9638 No Doc >1 Dose Reduc Tech G9639 Amp No Reqd In48H Ieler Proc G9640 Doc Plan Hybrid/Stage Proc G9641 Amp Reqd W/In 48H Ieler Proc G9642 Current Smoker G9643 Elective Surgery G9644 No Smok B/4 Anes Day Of Surg G9645 Had Smoke B/4 Anes Day Surg G9646 Pt W/90D Mrs 0-2 G9647 No Mrs Score In 90D Followup G9648 Pt W/90D Mrs >2 G9649 Psor As Doc Spc Bm G9651 Psor As Doc No Spc Bm G9654 Mon Anesth Care G9655 Toc Tool Incl Key Elem G9656 Pt Trans From Anest To Pacu G9658 Toc Tool Incl Elem Not Used G9659 >=86Y No Hx Colo Ca/Rsn Scop G9660 Doc Med Rsn Scope Pt >= 86Y G9661 Pt >= 86 W/ Hi Risk G9662 Prior Dx/Active Clin Ascvd G9663 Fast/Dir Ldl >= 190 Mg/Dl G9664 Taking Statin Or Rec'D Order G9665 No Statin/No Order Statin G9666 Fas/Dir Ldl 70-189Mg/Dl Mst G9674 Pt W/Clin Ascvd Dx G9675 Pt W/Fast/Dir Lab Ldl-C >190 G9676 40-75Y W/Type 1/2 W/Ldl-C Rs G9678 Oncology Care Model Service G9679 Acute Care Pneumonia G9680 Acute Care Congestive Heart G9681 Acute Care Chronic Obstruct G9682 Acute Care Skin Infection G9683 Acute Fluid/Electro Disorder G9684 Acute Care Urinary Tract Inf G9685 Acute Nursing Facility Care G9687 Hospice Anytime Msmt Per G9688 Pt W/Hosp Anytime Msmt Per G9689 Inpt Elect Carotid Intervent G9690 Pt In Hos G9691 Pt Hosp Dur Msmt Period G9692 Hosp Recd By Pt Dur Msmt Per G9693 Pt Use Hosp During Msmt Per G9694 Hosp Srv Used Pt In Msmt Per G9695 Long Act Inhal Bronchdil Pre G9696 Med Rsn No Presc Bronchdil G9697 Pt Rsn No Presc Bronchdil G9698 Sys Rsn No Presc Bronchdil G9699 Long Inhal Bronchdil No Pres G9700 Pt Is W/Hosp During Msmt Per G9701 Child Anbx 30 Prior Dx Estab G9702 Pt Use Hosp During Msmt Per G9703 Anbx 30 Prior To Episode G9704 Ajcc Br Ca Stg I: T1 Mic/T1A G9705 Ajcc Br Ca Stg Ib G9706 Low Recur Prost Ca G9707 Pt Had Hosp Dur Msmt Per G9708 Bilat Mast/Hx Bi /Unilat Mas G9709 Hosp Srv Used Pt In Msmt Per G9710 Pt Prov Hosp Srv Msmt Per G9711 Pt Hx Tot Col Or Colon Ca G9712 Doc Med Rsn Presc Anbx G9713 Pt Use Hosp During Msmt Per G9714 Pt Is W/Hosp During Msmt Per G9715 Pt W/Hosp Anytime Msmt Per G9716 Bmi Doc Onl Fup Not Cmpltd G9717 Doc Pt Dx Dep/Bipol G9718 Hospice Anytime Msmt Per G9719 Pt Not Ambul/Immob/Wc G9720 Hospice Anytime Msmt Per G9721 Pt Not Ambul/Immob/Wc G9722 Doc Hx Renal Fail Or Cr+ >=4 G9723 Hosp Recd By Pt Dur Msmt Per G9724 Pt W/Doc Use Anticoag Mst Yr G9725 Pt W/Hosp Anytime Msmt Per G9726 Refused To Participate G9727 Pt Unable Cmplt Lepf Prom G9728 Refused To Participate G9729 Pt Unbl Cmplt Lepf Prom G9730 Refused To Participate G9731 Pt Unbl Cmplt Lepf Prom G9732 Refused To Participate G9733 Pt Unbl Cmplt Lb Fs Prom G9734 Refused To Participate G9735 Pt Unbl Cmplt Shld Fs Prom G9736 Refused To Participate G9737 Pt Unbl Cmplt Ewh Fs Prom G9738 Refused To Participate G9739 Pt Unbl Cmplt Go Fs Prom G9740 Hosp Srv To Pt Dur Msmt Per G9741 Pt W/Hosp Anytime Msmt Per G9744 Pt Not Eli D/T Act Dig Htn G9745 Doc Rsn No Hbp Scrn Or F/U G9746 Mit Sten, Valve Or Trans Af G9747 Pall Dialysis With Catheter G9748 App Transpl Lvg Kidney Donor G9749 Pall Dialysis With Catheter G9750 App Transpl Lvg Kidney Donor G9751 Pt Died W/In 24 Mos Rpt Time G9752 Urgent Surgery G9753 Doc No Dicom, Ct Other Fac G9754 Incid Pulm Nodule G9755 Doc Med Rsn No Fllw Up G9756 Surg Proc W/Silicone Oil G9757 Surg Proc W/Silicone Oil G9758 Pt In Hos G9759 Hx Preop Post Cap Rup G9760 Pt W/Hosp Anytime Msmt Per G9761 Pt W/Hosp Anytime Msmt Per G9762 Pt Had >= 2-3 Hpv Vaccines G9763 Pt Not Have 2-3 Hpv Vaccines G9764 Pt Treatd W/Oral Syst Or Bio G9765 Doc Pat Declined Therapy G9766 Cva Stroke Dx Tx Transf Fac G9767 Hosp New Dx Cva Consid Evst G9768 Pt W/Hosp Anytime Msmt Per G9769 Bn Den 2Yr/Got Ost Med/Ther G9770 Perip Nerve Block G9771 Anes End, 1 Temp >35.5(95.9) G9772 Doc Med Rsn No Temp >= 35.5 G9773 1 Bod Temp >=35.5 G9774 Pt Had Hyst G9775 Recd 2 Anti-Emet Pre/Intraop G9776 Doc Med Rsn No Proph Antiem G9777 Pt No Antiemet Pre/Intraop G9778 Pts Dx W/Pregn G9779 Pts Breastfeeding G9780 Pts Dx W/Rhabdomyolysis G9781 Doc Rsn No Statin G9782 Hx Dx Fam/Pure Hypercholes G9783 Doc Dx Dm, Fast <70, No Stat G9784 Path/Derm Prov 2Nd Biop Opin G9785 Path Report Sent G9786 Path Report Not Sent G9787 Pt Alive G9788 Most Rct Bp /= 140/90 G9791 Most Rct Tob Stat Free G9792 Most Rct Tob Stat Not Free G9793 Pt On Daily Asa/Antiplat G9794 Doc Med Rsn No Daily Aspirin G9795 Pt No Daily Asa/Antiplat G9796 Pt Not Currently On Statin G9797 Pt Currently On Statin G9798 D/C Ami Btw 7/1-6/30 Meas Pd G9799 Med Disp Evt Indic Hx Asth G9800 Pt Id Intol/Alleg Beta-Block G9801 Nonacut Transf From Inpt G9802 Pt W/Hosp Anytime Msmt Per G9803 Pt Presc 135 Day Trmt G9804 Pt Not Presc 135 Day Trmt G9805 Pt W/Hosp Anytime Msmt Per G9806 Pt Recd Cerv Cyto/Hpv G9807 Pt No Recd Cerv Cyto/Hpv G9808 Pt No Asthm Cont Med Mst Per G9809 Pt W/Hosp Anytime Msmt Per G9810 Pdc 75% W/Asth Cont Med G9811 No Pdc 75% W/Asth Cont Med G9812 Pt Died During Inpt/30D Aft G9813 Pt Not Died W/In 30D Of Proc G9814 Death During Index Hosp G9815 Death Not During Index Hosp G9816 Death <30 Day Post Discharge G9817 No Death 30-Days Post-Disch G9818 Doc Sex Activity G9819 Pt W/Hosp Anytime Msmt Per G9820 Doc Chlam Scr Test W/Follow G9821 No Doc Chlam Scr Ts W/Follow G9822 Endo Abl Proc Yr Prev Ind Dt G9823 Endo Smpl/Hyst Bx Res Doc G9824 Endo Smpl/Hyst Bx Res No Doc G9825 Her-2 Neg,Undoc/Unkn G9826 Transf Pract Aft Init Chemo G9827 Her-2 Targ Ther No Init Tx G9828 Her-2 Targ Ther Dur Init Tx G9829 Breast Adj Chemo Admin G9830 Her-2 Pos G9831 Ajcc Stg Brt Ca Dx Ii Or Iii G9832 Brt Ca Dx I, No T1/T1A/T1B G9833 Transf Pract Aft Init Chemo G9834 Pt Met Dis At Dx G9835 Trastuz Given W/In 12 Mos Dx G9836 Rsn No Trast Given Doc G9837 Trastuz Not In 12 Mos Dx G9838 Pt Met Dis At Dx G9839 Anti-Egfr Mon Anti Ther G9840 Gene Testing Performed G9841 Gene Testing Not Performed G9842 Pt Met Dis At Dx G9843 Kras Or Nras Gene Mutation G9844 Pt No Recd Anti-Egfr Ther G9845 Pt Recd Anti-Egfr Ther G9846 Pt Died From Cancer G9847 Pt Recd Chemo Last 14D Life G9848 Pt No Chemo Last 14D Life G9849 Pt Died From Cancer G9850 1/More Ed Last 30D Life G9851 1/No Ed Visit Last 30D Life G9852 Pt Died From Cancer G9853 Icu Stay Last 30D Life G9854 No Icu Stay Last 30D Life G9855 Pt Died From Cancer G9856 Pt No Hospice G9857 Pt Admit Hospice G9858 Pt Enroll Hospice G9859 Pt Died From Cancer G9860 Pt Less 3D Hospice G9861 Pt More Than 3D Hospice G9862 Doc Rsn No 10 Yr Follow G9868 Next Gen Aco Model <10Min G9869 Next Gen Aco Model 10-20Min G9870 Next Gen Aco Model >20Min G9873 1 Em Core Session G9874 4 Em Core Sessions G9875 9 Em Core Sessions G9876 2 Em Core Ms Mo 7-9 No Wl G9877 2 Em Core Ms Mo 10-12 No Wl G9878 2 Em Core Ms Mo 7-9 Wl G9879 2 Em Core Ms Mo 10-12 Wl G9880 Em 5 Percent Wl G9881 Em 9 Percent Wl G9882 2 Em Ongoing Ms Mo 13-15 Wl G9883 2 Em Ongoing Ms Mo 16-18 Wl G9884 2 Em Ongoing Ms Mo 19-21 Wl G9885 2 Em Ongoing Ms Mo 22-24 Wl G9890 Em Bridge Payment G9891 Em Session Reporting G9892 Doc Pt Rsn No Dil Mac Exam G9893 No Mac Exam G9894 Adr Dep Thrpy Prescribed G9895 Doc Med Rsn No Adr Dep Thrpy G9896 Doc Pt Rsn No Adr Dep Thrpy G9897 Pt Nt Prsc Adr Dep Thrpy Rng G9898 Pt 66+ Snp Or Ltc Pos > 90D G9899 Scrn Mam Perf Rslts Doc G9900 Scrn Mam Perf Rslts Not Doc G9901 Pt 66+ Snp Or Ltc Pos > 90D G9902 Pt Scrn Tbco And Id As User G9903 Pt Scrn Tbco Id As Non User G9904 Doc Med Rsn No Tbco Scrn G9905 No Pt Tbco Scrn Rng G9906 Pt Recv Tbco Cess Interv G9907 Doc Med Rsn No Tbco Interv G9908 No Pt Tbco Cess Interv Rng G9909 Doc Med Rsn No Tbco Interv G9910 Pt 66+ Snp Or Ltc Pos > 90D G9911 Node Neg Pre/Post Syst Ther G9912 Hbv Status Assesed And Int G9913 No Hbv Status Assesd And Int G9914 Pt Receiving Anti-Tnf Agent G9915 No Documntd Hbv Results Rcd G9916 Funct Status Past 12 Months G9917 Adv Dem Crgvr Limited G9918 No Funct Stat Perf, Rsn Nos G9919 Scrn Nd Pos Nd Prov Of Rec G9920 Scrning Perf And Negative G9921 No Or Part Scrn Nd Rng Or Os G9922 Sfty Cncrns Scrn Nd Mit Recs G9923 Safty Cncrns Scrn And Neg G9924 Doc Med Rsn No Scrn Or Recs G9925 No Scrn Prov Rsn Nos G9926 Sfty Cncrns Scrn But No Recs G9927 Doc No Warf /Fda Pt Trial G9928 No Warf Or Fda Drug Presc G9929 Trs/Rev Af G9930 Com Care G9931 No Chad Or Chad Scr 0 Or 1 G9932 Doc Pt Rsn No Tb Scrn Recrds G9933 Canc Detectd During Col Scrn G9934 Doc Rsn Not Detecting Cancer G9935 Canc Not Detectd During Srcn G9936 Pmh Plyp/Neo Co/Rect/Jun/Ans G9937 Dig Or Surv Colsco G9938 Pt 66+ Snp Or Ltc Pos > 90D G9939 Same Path/Derm Perf Biopsy G9940 Doc Reas No Statin Therapy G9942 Adtl Spine Proc On Same Date G9943 Bk Pn Nt Msr Vas Scl Pre/Pst G9945 Pt W/Cancer Scoliosis G9946 Bk Pain No Vas G9948 Adtl Spine Proc On Same Date G9949 Leg Pain No Vas G9954 Pt >2 Rsk Fac Post-Op Vomit G9955 Inhlnt Anesth Only For Induc G9956 Combo Thrpy Of >= 2 Prophly G9957 Doc Med Rsn No Combo Thrpy G9958 No Combo Prohpyl Thrp For Pt G9959 Systemic Antimicro Not Presc G9960 Med Rsn Sys Antimi Nt Rx G9961 Systemic Antimicro Presc G9962 Embolization Doc Separatly G9963 Embolization Not Doc Separat G9964 Pt Recv >=1 Well-Chld Visit G9965 No Well-Chld Vist Recv By Pt G9966 Scrn, Inter, Report Child G9967 No Scrn, Inter, Reprt Child G9968 Pt Refrd 2 Pvdr/Spclst In Pp G9969 Pvdr Rfrd Pt Rprt Rcvd G9970 Pvdr Rfrd Pt No Rprt Rcvd G9974 Mac Exam Perf G9975 Doc Med Rsn No Dil Mac Exam G9978 Remote E/M New Pt 10Mins G9979 Remote E/M New Pt 20Mins G9980 Remote E/M New Pt 30 Mins G9981 Remote E/M New Pt 45Mins G9982 Remote E/M New Pt 60Mins G9983 Remote E/M Est. Pt 10Mins G9984 Remote E/M Est. Pt 15Mins G9985 Remote E/M Est. Pt 25Mins G9986 Remote E/M Est. Pt 40Mins G9987 Bpci Advanced In Home Visit H0001 900 Alcohol And/Or Drug Assess $324 $211 $252 $106 H0002 900 Alcohol And/Or Drug Screenin $428 $278 $332 $140 H0003 Alcohol And/Or Drug Screenin H0004 914 Alcohol And/Or Drug Services $66 $43 $51 $22 H0005 915 Alcohol And/Or Drug Services $261 $170 $203 $86 H0006 Alcohol And/Or Drug Services H0007 Alcohol And/Or Drug Services H0008 Alcohol And/Or Drug Services H0009 Alcohol And/Or Drug Services H0010 Alcohol And/Or Drug Services H0011 Alcohol And/Or Drug Services H0012 Alcohol And/Or Drug Services H0013 Alcohol And/Or Drug Services H0014 Alcohol And/Or Drug Services H0015 Alcohol And/Or Drug Services H0016 Alcohol And/Or Drug Services H0017 Alcohol And/Or Drug Services H0018 Alcohol And/Or Drug Services H0019 Alcohol And/Or Drug Services H0020 900 Alcohol And/Or Drug Services $150 $98 $116 $49 H0021 Alcohol And/Or Drug Training H0022 Alcohol And/Or Drug Interven H0023 Alcohol And/Or Drug Outreach H0024 Alcohol And/Or Drug Preventi H0025 Alcohol And/Or Drug Preventi H0026 Alcohol And/Or Drug Preventi H0027 Alcohol And/Or Drug Preventi H0028 Alcohol And/Or Drug Preventi H0029 Alcohol And/Or Drug Preventi H0030 Alcohol And/Or Drug Hotline H0031 Mh Health Assess By Non-Md H0032 Mh Svc Plan Dev By Non-Md H0033 944 Oral Med Adm Direct Observe $269 $175 $209 $88 H0034 Med Trng & Support Per 15Min H0035 Mh Partial Hosp Tx Under 24H H0036 Comm Psy Face-Face Per 15Min H0037 Comm Psy Sup Tx Pgm Per Diem H0038 914 Self-Help/Peer Svc Per 15Min $587 $382 $456 $192 H0039 Asser Com Tx Face-Face/15Min H0040 Assert Comm Tx Pgm Per Diem H0041 Fos C Chld Non-Ther Per Diem H0042 Fos C Chld Non-Ther Per Mon H0043 Supported Housing, Per Diem H0044 Supported Housing, Per Month H0045 Respite Not-In-Home Per Diem H0046 Mental Health Service, Nos H0047 Alcohol/Drug Abuse Svc Nos H0048 Spec Coll Non-Blood:A/D Test H0049 Alcohol/Drug Screening H0050 Alcohol/Drug Service 15 Min H1000 Prenatal Care Atrisk Assessm H1001 Antepartum Management H1002 Carecoordination Prenatal H1003 Prenatal At Risk Education H1004 Follow Up Home Visit/Prental H1005 Prenatalcare Enhanced Srv Pk H1010 Nonmed Family Planning Ed H1011 Family Assessment H2000 Comp Multidisipln Evaluation H2001 Rehabilitation Program 1/2 D H2010 Comprehensive Med Svc 15 Min H2011 900 Crisis Interven Svc, 15 Min $192 $125 $149 $63 H2012 Behav Hlth Day Treat, Per Hr H2013 Psych Hlth Fac Svc, Per Diem H2014 Skills Train And Dev, 15 Min H2015 Comp Comm Supp Svc, 15 Min H2016 Comp Comm Supp Svc, Per Diem H2017 Psysoc Rehab Svc, Per 15 Min H2018 Psysoc Rehab Svc, Per Diem H2019 Ther Behav Svc, Per 15 Min H2020 Ther Behav Svc, Per Diem H2021 Com Wrap-Around Sv, 15 Min H2022 Com Wrap-Around Sv, Per Diem H2023 Supported Employ, Per 15 Min H2024 Supported Employ, Per Diem H2025 Supp Maint Employ, 15 Min H2026 Supp Maint Employ, Per Diem H2027 Psychoed Svc, Per 15 Min H2028 Sex Offend Tx Svc, 15 Min H2029 Sex Offend Tx Svc, Per Diem H2030 Mh Clubhouse Svc, Per 15 Min H2031 Mh Clubhouse Svc, Per Diem H2032 Activity Therapy, Per 15 Min H2033 Multisys Ther/Juvenile 15Min H2034 A/D Halfway House, Per Diem H2035 A/D Tx Program, Per Hour H2036 A/D Tx Program, Per Diem H2037 Dev Delay Prev Dp Ch, 15 Min J0120 Tetracyclin Injection J0121 Inj., Omadacycline, 1 Mg J0122 Inj., Eravacycline, 1 Mg J0129 Abatacept Injection $1,982 $1,288 $1,539 $649 $41 J0130 Abciximab Injection J0131 Acetaminophen Injection $55 $35 $42 $18 J0132 Acetylcysteine Injection J0133 Acyclovir Injection $36 $23 $28 $12 J0135 Adalimumab Injection J0153 Adenosine Inj 1Mg $39 $26 $31 $13 J0171 Adrenalin Epinephrine Inject $59 $38 $45 $19 J0178 Aflibercept Injection J0179 Inj, Brolucizumab-Dbll, 1 Mg J0180 Agalsidase Beta Injection J0185 Inj., Aprepitant, 1 Mg $458 $298 $356 $150 $5 J0190 Inj Biperiden Lactate/5 Mg J0200 Alatrofloxacin Mesylate J0202 Injection, Alemtuzumab J0205 Alglucerase Injection J0207 Amifostine J0210 Methyldopate Hcl Injection J0215 Alefacept J0220 Alglucosidase Alfa Injection J0221 Lumizyme Injection J0222 Inj., Patisiran, 0.1 Mg J0223 Inj Givosiran 0.5 Mg J0256 Alpha 1 Proteinase Inhibitor J0257 Glassia Injection J0270 Alprostadil For Injection J0275 Alprostadil Urethral Suppos J0278 Amikacin Sulfate Injection J0280 Aminophyllin 250 Mg Inj $3 $2 $3 $1 J0282 Amiodarone Hcl $50 $33 $39 $17 J0285 Amphotericin B J0287 Amphotericin B Lipid Complex J0288 Ampho B Cholesteryl Sulfate J0289 Amphotericin B Liposome Inj $182 $118 $141 $60 J0290 Ampicillin 500 Mg Inj $32 $21 $25 $11 J0291 Inj., Plazomicin, 5 Mg J0295 Ampicillin Sulbactam 1.5 Gm $43 $28 $33 $14 J0300 Amobarbital 125 Mg Inj J0330 Succinycholine Chloride Inj $52 $34 $40 $17 J0348 Anidulafungin Injection J0350 Injection Anistreplase 30 U J0360 Hydralazine Hcl Injection $18 $11 $14 $6 J0364 Apomorphine Hydrochloride J0365 Aprotonin, 10,000 Kiu J0380 Inj Metaraminol Bitartrate J0390 Chloroquine Injection J0395 Arbutamine Hcl Injection J0400 Aripiprazole Injection J0401 Inj Aripiprazole Ext Rel 1Mg $3,909 $2,541 $3,035 $1,281 $1 J0456 Azithromycin $35 $23 $27 $12 J0461 Atropine Sulfate Injection $38 $24 $29 $12 J0470 Dimecaprol Injection J0475 Baclofen 10 Mg Injection $645 $419 $501 $211 $60 J0476 Baclofen Intrathecal Trial J0480 Basiliximab J0485 Belatacept Injection J0490 Belimumab Injection $2,324 $1,510 $1,804 $761 $69 J0500 Dicyclomine Injection $106 $69 $82 $35 J0515 Inj Benztropine Mesylate $136 $89 $106 $45 J0517 Inj., Benralizumab, 1 Mg $9,647 $6,270 $7,489 $3,161 $97 J0520 Bethanechol Chloride Inject J0558 Peng Benzathine/Procaine Inj J0561 Penicillin G Benzathine Inj $174 $113 $135 $57 $27 J0565 Inj, Bezlotoxumab, 10 Mg J0567 Inj., Cerliponase Alfa 1 Mg J0570 Buprenorphine Implant 74.2Mg J0571 Buprenorphine Oral 1Mg $16 $11 $13 $5 J0572 Bupren/Nal Up To 3Mg Bupreno $31 $20 $24 $10 J0573 Bupren/Nal 3.1 To 6Mg Bupren $34 $22 $26 $11 J0574 Bupren/Nal 6.1 To 10Mg Bupre $36 $23 $28 $12 J0575 Bupren/Nal Over 10Mg Bupreno J0583 Bivalirudin $251 $163 $195 $82 $58 J0584 Injection, Burosumab-Twza 1M J0585 Injection,Onabotulinumtoxina $15 $9 $11 $5 J0586 Abobotulinumtoxina J0587 Inj, Rimabotulinumtoxinb J0588 Incobotulinumtoxin A J0591 Inj Deoxycholic Acid, 1 Mg J0592 Buprenorphine Hydrochloride $11 $7 $9 $4 J0593 Inj., Lanadelumab-Flyo, 1 Mg J0594 Busulfan Injection J0595 Butorphanol Tartrate 1 Mg $35 $22 $27 $11 J0596 Injection, Ruconest J0597 C-1 Esterase, Berinert J0598 C-1 Esterase, Cinryze J0599 Inj., Haegarda 10 Units J0600 Edetate Calcium Disodium Inj J0604 Cinacalcet, Esrd On Dialysis $118 $77 $91 $39 J0606 Inj, Etelcalcetide, 0.1 Mg J0610 Calcium Gluconate Injection $33 $21 $25 $11 J0620 Calcium Glycer & Lact/10 Ml J0630 Calcitonin Salmon Injection J0636 Inj Calcitriol Per 0.1 Mcg J0637 Caspofungin Acetate J0638 Canakinumab Injection J0640 Leucovorin Calcium Injection $45 $29 $35 $15 $14 J0641 Inj Levoleucovorin Nos 0.5Mg J0642 Injection, Khapzory, 0.5 Mg J0670 Inj Mepivacaine Hcl/10 Ml $32 $21 $25 $11 J0690 Cefazolin Sodium Injection $17 $11 $13 $6 J0691 Inj Lefamulin 1 Mg J0692 Cefepime Hcl For Injection $45 $29 $35 $15 J0693 Inj., Cefiderocol, 5 Mg J0694 Cefoxitin Sodium Injection $43 $28 $33 $14 J0695 Inj Ceftolozane Tazobactam J0696 Ceftriaxone Sodium Injection $25 $16 $20 $8 J0697 Sterile Cefuroxime Injection J0698 Cefotaxime Sodium Injection J0702 Betamethasone Acet&Sod Phosp $65 $42 $50 $21 J0706 Caffeine Citrate Injection J0710 Cephapirin Sodium Injection J0712 Ceftaroline Fosamil Inj J0713 Inj Ceftazidime Per 500 Mg $27 $17 $21 $9 J0714 Ceftazidime And Avibactam J0715 Ceftizoxime Sodium / 500 Mg J0716 Centruroides Immune F(Ab) J0717 Certolizumab Pegol Inj 1Mg J0720 Chloramphenicol Sodium Injec J0725 Chorionic Gonadotropin/1000U J0735 Clonidine Hydrochloride J0740 Cidofovir Injection J0742 Inj Imip 4 Cilas 4 Releb 2Mg J0743 Cilastatin Sodium Injection J0744 Ciprofloxacin Iv $18 $12 $14 $6 J0745 Inj Codeine Phosphate /30 Mg J0770 Colistimethate Sodium Inj J0775 Collagenase, Clost Hist Inj $83 $54 $65 $27 J0780 Prochlorperazine Injection $51 $33 $39 $17 J0791 Inj Crizanlizumab-Tmca 5Mg J0795 Corticorelin Ovine Triflutal J0800 Corticotropin Injection J0834 Inj., Cosyntropin, 0.25 Mg J0840 Crotalidae Poly Immune Fab J0841 Inj Crotalidae Im F(Ab')2 Eq J0850 Cytomegalovirus Imm Iv /Vial J0875 Injection, Dalbavancin $6,202 $4,031 $4,815 $2,032 $14 J0878 Daptomycin Injection $132 $86 $103 $43 $18 J0881 Darbepoetin Alfa, Non-Esrd $14 $9 $11 $5 $4 J0882 Darbepoetin Alfa, Esrd Use J0883 Argatroban Nonesrd Use 1Mg J0884 Argatroban Esrd Dialysis 1Mg J0885 Epoetin Alfa, Non-Esrd J0887 Epoetin Beta Esrd Use J0888 Epoetin Beta Non Esrd J0890 Peginesatide Injection J0894 Decitabine Injection J0895 Deferoxamine Mesylate Inj J0896 Inj Luspatercept-Aamt 0.25Mg J0897 Denosumab Injection $521 $339 $405 $171 $15 J0945 Brompheniramine Maleate Inj J1000 Depo-Estradiol Cypionate Inj J1020 Methylprednisolone 20 Mg Inj $63 $41 $49 $21 J1030 Methylprednisolone 40 Mg Inj $64 $42 $50 $21 J1040 Methylprednisolone 80 Mg Inj $96 $62 $74 $31 J1050 Medroxyprogesterone Acetate $3 $2 $2 $1 $1 J1071 Inj Testosterone Cypionate J1094 Inj Dexamethasone Acetate J1095 Injection, Dexamethasone 9% J1096 Dexametha Opth Insert 0.1 Mg J1097 Phenylep Ketorolac Opth Soln J1100 Dexamethasone Sodium Phos $7 $4 $5 $2 J1110 Inj Dihydroergotamine Mesylt $224 $145 $174 $73 J1120 Acetazolamid Sodium Injectio $92 $60 $71 $30 J1130 Inj Diclofenac Sodium 0.5Mg J1160 Digoxin Injection $25 $16 $20 $8 J1162 Digoxin Immune Fab (Ovine) J1165 Phenytoin Sodium Injection $11 $7 $9 $4 J1170 Hydromorphone Injection $20 $13 $15 $6 J1180 Dyphylline Injection J1190 Dexrazoxane Hcl Injection J1200 Diphenhydramine Hcl Injectio $5 $3 $4 $2 J1201 Inj. Cetirizine Hcl 0.5Mg J1205 Chlorothiazide Sodium Inj J1212 Dimethyl Sulfoxide 50% 50 Ml $867 $563 $673 $284 J1230 Methadone Injection J1240 Dimenhydrinate Injection J1245 Dipyridamole Injection J1250 Inj Dobutamine Hcl/250 Mg J1260 Dolasetron Mesylate J1265 Dopamine Injection $31 $20 $24 $10 J1267 Doripenem Injection J1270 Injection, Doxercalciferol J1290 Ecallantide Injection J1300 Eculizumab Injection J1301 Injection, Edaravone, 1 Mg J1303 Inj., Ravulizumab-Cwvz 10 Mg J1320 Amitriptyline Injection J1322 Elosulfase Alfa, Injection J1324 Enfuvirtide Injection J1325 Epoprostenol Injection J1327 Eptifibatide Injection J1330 Ergonovine Maleate Injection J1335 Ertapenem Injection $244 $158 $189 $80 J1364 Erythro Lactobionate /500 Mg $128 $83 $100 $42 J1380 Estradiol Valerate 10 Mg Inj J1410 Inj Estrogen Conjugate 25 Mg $278 $180 $216 $91 J1428 Inj, Eteplirsen, 10 Mg J1429 Inj Golodirsen 10 Mg J1430 Ethanolamine Oleate 100 Mg J1435 Injection Estrone Per 1 Mg J1436 Etidronate Disodium Inj J1437 Inj. Fe Derisomaltose 10 Mg J1438 Etanercept Injection J1439 Inj Ferric Carboxymaltos 1Mg $3,420 $2,223 $2,655 $1,121 $1 J1442 Inj Filgrastim Excl Biosimil J1443 Inj Ferric Pyrophosphate Cit J1444 Fe Pyro Cit Pow 0.1 Mg Iron J1447 Inj Tbo Filgrastim 1 Microg J1450 Fluconazole $39 $25 $30 $13 J1451 Fomepizole, 15 Mg J1452 Intraocular Fomivirsen Na J1453 Fosaprepitant Injection J1454 Inj Fosnetupitant, Palonoset J1455 Foscarnet Sodium Injection J1457 Gallium Nitrate Injection J1458 Galsulfase Injection J1459 Inj Ivig Privigen 500 Mg $5,372 $3,492 $4,171 $1,760 $42 J1460 Gamma Globulin 1 Cc Inj J1555 Inj Cuvitru, 100 Mg J1556 Inj, Imm Glob Bivigam, 500Mg J1557 Gammaplex Injection J1558 Inj. Xembify, 100 Mg J1559 Hizentra Injection J1560 Gamma Globulin > 10 Cc Inj J1561 Gamunex-C/Gammaked J1562 Vivaglobin, Inj J1566 Immune Globulin, Powder J1568 Octagam Injection J1569 Gammagard Liquid Injection $3,057 $1,987 $2,373 $1,002 $46 J1570 Ganciclovir Sodium Injection J1571 Hepagam B Im Injection J1572 Flebogamma Injection J1573 Hepagam B Intravenous, Inj J1575 Hyqvia 100Mg Immuneglobulin J1580 Garamycin Gentamicin Inj $10 $7 $8 $3 J1595 Injection Glatiramer Acetate J1599 Ivig Non-Lyophilized, Nos J1600 Gold Sodium Thiomaleate Inj J1602 Golimumab For Iv Use 1Mg J1610 Glucagon Hydrochloride/1 Mg $214 $139 $166 $70 J1620 Gonadorelin Hydroch/ 100 Mcg J1626 Granisetron Hcl Injection J1627 Inj, Granisetron, Xr, 0.1 Mg J1628 Inj., Guselkumab, 1 Mg J1630 Haloperidol Injection $26 $17 $20 $9 J1631 Haloperidol Decanoate Inj $108 $70 $84 $35 $25 J1632 Inj., Brexanolone, 1 Mg J1640 Hemin, 1 Mg J1642 Inj Heparin Sodium Per 10 U $16 $10 $12 $5 J1644 Inj Heparin Sodium Per 1000U $7 $4 $5 $2 J1645 Dalteparin Sodium J1650 Inj Enoxaparin Sodium $29 $19 $23 $10 J1652 Fondaparinux Sodium J1655 Tinzaparin Sodium Injection J1670 Tetanus Immune Globulin Inj J1675 Histrelin Acetate J1700 Hydrocortisone Acetate Inj J1710 Hydrocortisone Sodium Ph Inj J1720 Hydrocortisone Sodium Succ I $59 $38 $46 $19 J1726 Makena, 10 Mg $54 $35 $42 $18 J1729 Inj Hydroxyprogst Capoat Nos J1730 Diazoxide Injection J1738 Inj. Meloxicam 1 Mg J1740 Ibandronate Sodium Injection J1741 Ibuprofen Injection J1742 Ibutilide Fumarate Injection J1743 Idursulfase Injection J1744 Icatibant Injection J1745 Infliximab Not Biosimil 10Mg $243 $158 $189 $80 $61 J1746 Inj., Ibalizumab-Uiyk, 10 Mg J1750 Inj Iron Dextran $50 $33 $39 $16 J1756 Iron Sucrose Injection $94 $61 $73 $31 $3 J1786 Imuglucerase Injection J1790 Droperidol Injection J1800 Propranolol Injection J1810 Droperidol/Fentanyl Inj J1815 Insulin Injection $6 $4 $5 $2 J1817 Insulin For Insulin Pump Use J1823 Inj. Inebilizumab-Cdon, 1 Mg J1826 Interferon Beta-1A Inj J1830 Interferon Beta-1B / .25 Mg J1833 Injection, Isavuconazonium J1835 Itraconazole Injection J1840 Kanamycin Sulfate 500 Mg Inj J1850 Kanamycin Sulfate 75 Mg Inj J1885 Ketorolac Tromethamine Inj $6 $4 $5 $2 J1890 Cephalothin Sodium Injection J1930 Lanreotide Injection J1931 Laronidase Injection J1940 Furosemide Injection $19 $13 $15 $6 J1943 Inj., Aristada Initio, 1 Mg J1944 Aripirazole Lauroxil 1 Mg $3,682 $2,393 $2,858 $1,206 $792 J1945 Lepirudin J1950 Leuprolide Acetate /3.75 Mg $10,706 $6,959 $8,312 $3,508 $672 J1953 Levetiracetam Injection $44 $28 $34 $14 J1955 Inj Levocarnitine Per 1 Gm J1956 Levofloxacin Injection $26 $17 $20 $8 J1960 Levorphanol Tartrate Inj J1980 Hyoscyamine Sulfate Inj J1990 Chlordiazepoxide Injection J2001 Lidocaine Injection $21 $14 $16 $7 J2010 Lincomycin Injection J2020 Linezolid Injection $68 $44 $53 $22 J2060 Lorazepam Injection $25 $16 $20 $8 J2062 Loxapine For Inhalation 1 Mg J2150 Mannitol Injection $15 $9 $11 $5 J2170 Mecasermin Injection J2175 Meperidine Hydrochl /100 Mg $10 $7 $8 $3 J2180 Meperidine/Promethazine Inj J2182 Injection, Mepolizumab, 1Mg J2185 Meropenem $67 $43 $52 $22 J2186 Inj., Meropenem, Vaborbactam J2210 Methylergonovin Maleate Inj $25 $16 $19 $8 J2212 Methylnaltrexone Injection $207 $134 $160 $68 $53 J2248 Micafungin Sodium Injection J2250 Inj Midazolam Hydrochloride $16 $10 $12 $5 J2260 Inj Milrinone Lactate / 5 Mg $69 $45 $54 $23 J2265 Minocycline Hydrochloride J2270 Morphine Sulfate Injection $12 $8 $9 $4 J2274 Inj Morphine Pf Epid Ithc J2278 Ziconotide Injection J2280 Inj, Moxifloxacin 100 Mg J2300 Inj Nalbuphine Hydrochloride $8 $5 $6 $3 J2310 Inj Naloxone Hydrochloride $102 $66 $79 $33 J2315 Naltrexone, Depot Form $7 $4 $5 $2 J2320 Nandrolone Decanoate 50 Mg J2323 Natalizumab Injection J2325 Nesiritide Injection J2326 Inj, Nusinersen, 0.1Mg J2350 Injection, Ocrelizumab, 1 Mg $32,988 $21,442 $25,610 $10,809 $57 J2353 Octreotide Injection, Depot $17,139 $11,140 $13,306 $5,616 $163 J2354 Octreotide Inj, Non-Depot $24 $16 $19 $8 J2355 Oprelvekin Injection J2357 Omalizumab Injection $1,927 $1,252 $1,496 $631 $27 J2358 Olanzapine Long-Acting Inj J2360 Orphenadrine Injection $28 $18 $22 $9 J2370 Phenylephrine Hcl Injection $35 $23 $27 $12 J2400 Chloroprocaine Hcl Injection $73 $48 $57 $24 J2405 Ondansetron Hcl Injection $4 $2 $3 $1 J2407 Injection, Oritavancin J2410 Oxymorphone Hcl Injection J2425 Palifermin Injection J2426 Paliperidone Palmitate Inj $3,946 $2,565 $3,063 $1,293 $9 J2430 Pamidronate Disodium /30 Mg $100 $65 $77 $33 J2440 Papaverin Hcl Injection $16 $11 $13 $5 J2460 Oxytetracycline Injection J2469 Palonosetron Hcl $193 $125 $150 $63 $48 J2501 Paricalcitol J2502 Inj, Pasireotide Long Acting J2503 Pegaptanib Sodium Injection J2504 Pegademase Bovine, 25 Iu J2505 Injection, Pegfilgrastim 6Mg $18,389 $11,953 $14,276 $6,025 $3,605 J2507 Pegloticase Injection $41,459 $26,948 $32,186 $13,585 $778 J2510 Penicillin G Procaine Inj $121 $79 $94 $40 J2513 Pentastarch 10% Solution J2515 Pentobarbital Sodium Inj J2540 Penicillin G Potassium Inj $27 $18 $21 $9 J2543 Piperacillin/Tazobactam $48 $31 $38 $16 J2545 Pentamidine Non-Comp Unit J2547 Injection, Peramivir J2550 Promethazine Hcl Injection J2560 Phenobarbital Sodium Inj J2562 Plerixafor Injection J2590 Oxytocin Injection $82 $53 $63 $27 J2597 Inj Desmopressin Acetate $750 $488 $582 $246 J2650 Prednisolone Acetate Inj $21 $14 $17 $7 J2670 Totazoline Hcl Injection J2675 Inj Progesterone Per 50 Mg J2680 Fluphenazine Decanoate 25 Mg J2690 Procainamide Hcl Injection J2700 Oxacillin Sodium Injeciton $42 $27 $33 $14 J2704 Inj, Propofol, 10 Mg $22 $14 $17 $7 J2710 Neostigmine Methylslfte Inj $79 $51 $61 $26 J2720 Inj Protamine Sulfate/10 Mg $37 $24 $29 $12 J2724 Protein C Concentrate J2725 Inj Protirelin Per 250 Mcg J2730 Pralidoxime Chloride Inj J2760 Phentolaine Mesylate Inj J2765 Metoclopramide Hcl Injection $26 $17 $20 $8 J2770 Quinupristin/Dalfopristin J2778 Ranibizumab Injection J2780 Ranitidine Hydrochloride Inj J2783 Rasburicase J2785 Regadenoson Injection $428 $278 $332 $140 J2786 Injection, Reslizumab, 1Mg J2787 Riboflavin 5'Phos Opth<=3Ml J2788 Rho D Immune Globulin 50 Mcg J2790 Rho D Immune Globulin Inj $247 $161 $192 $81 J2791 Rhophylac Injection J2792 Rho(D) Immune Globulin H, Sd J2793 Rilonacept Injection J2794 Inj Risperdal Consta, 0.5 Mg $1,062 $691 $825 $348 $4 J2795 Ropivacaine Hcl Injection $33 $21 $25 $11 J2796 Romiplostim Injection $7,062 $4,590 $5,483 $2,314 $40 J2797 Inj., Rolapitant, 0.5 Mg J2798 Inj., Perseris, 0.5 Mg J2800 Methocarbamol Injection J2805 Sincalide Injection $502 $326 $390 $164 J2810 Inj Theophylline Per 40 Mg J2820 Sargramostim Injection J2840 Inj Sebelipase Alfa 1 Mg J2850 Inj Secretin Synthetic Human J2860 Injection, Siltuximab J2910 Aurothioglucose Injeciton J2916 Na Ferric Gluconate Complex J2920 Methylprednisolone Injection $34 $22 $27 $11 J2930 Methylprednisolone Injection $36 $23 $28 $12 J2940 Somatrem Injection J2941 Somatropin Injection J2950 Promazine Hcl Injection J2993 Reteplase Injection J2995 Inj Streptokinase /250000 Iu J2997 Alteplase Recombinant $6,422 $4,174 $4,985 $2,104 $403 J3000 Streptomycin Injection J3010 Fentanyl Citrate Injection $7 $5 $6 $2 J3030 Sumatriptan Succinate / 6 Mg $100 $65 $78 $33 J3031 Inj., Fremanezumab-Vfrm 1 Mg J3032 Inj. Eptinezumab-Jjmr 1 Mg J3060 Inj, Taliglucerase Alfa 10 U J3070 Pentazocine Injection J3090 Inj Tedizolid Phosphate J3095 Telavancin Injection J3101 Tenecteplase Injection J3105 Terbutaline Sulfate Inj $12 $8 $9 $4 J3110 Teriparatide Injection J3111 Inj. Romosozumab-Aqqg 1 Mg J3121 Inj Testostero Enanthate 1Mg J3145 Testosterone Undecanoate 1Mg J3230 Chlorpromazine Hcl Injection $72 $47 $56 $24 J3240 Thyrotropin Injection J3241 Inj. Teprotumumab-Trbw 10 Mg J3243 Tigecycline Injection J3245 Inj., Tildrakizumab, 1 Mg J3246 Tirofiban Hcl $932 $606 $724 $305 $268 J3250 Trimethobenzamide Hcl Inj $50 $33 $39 $16 J3260 Tobramycin Sulfate Injection J3262 Tocilizumab Injection $1,429 $929 $1,110 $468 $2 J3265 Injection Torsemide 10 Mg/Ml J3280 Thiethylperazine Maleate Inj J3285 Treprostinil Injection J3300 Triamcinolone A Inj Prs-Free J3301 Triamcinolone Acet Inj Nos $22 $14 $17 $7 J3302 Triamcinolone Diacetate Inj J3303 Triamcinolone Hexacetonl Inj J3304 Inj Triamcinolone Ace Xr 1Mg J3305 Inj Trimetrexate Glucoronate J3310 Perphenazine Injeciton J3315 Triptorelin Pamoate J3316 Inj., Triptorelin Xr 3.75 Mg J3320 Spectinomycn Di-Hcl Inj J3350 Urea Injection J3355 Urofollitropin, 75 Iu J3357 Ustekinumab Sub Cu Inj, 1 Mg $16,688 $10,847 $12,955 $5,468 $45 J3358 Ustekinumab, Iv Inject, 1 Mg $3,248 $2,111 $2,522 $1,064 $11 J3360 Diazepam Injection $94 $61 $73 $31 J3364 Urokinase 5000 Iu Injection J3365 Urokinase 250,000 Iu Inj J3370 Vancomycin Hcl Injection $31 $20 $24 $10 J3380 Injection, Vedolizumab $24,725 $16,071 $19,195 $8,101 $9 J3385 Velaglucerase Alfa J3396 Verteporfin Injection J3397 Inj., Vestronidase Alfa-Vjbk J3398 Inj Luxturna 1 Billion Vec G J3399 Inj Onase Abepar-Xioi Treat J3400 Triflupromazine Hcl Inj J3410 Hydroxyzine Hcl Injection $22 $14 $17 $7 J3411 Thiamine Hcl 100 Mg $26 $17 $20 $9 J3415 Pyridoxine Hcl 100 Mg J3420 Vitamin B12 Injection $17 $11 $13 $6 J3430 Vitamin K Phytonadione Inj $131 $85 $102 $43 J3465 Injection, Voriconazole J3470 Hyaluronidase Injection J3471 Ovine, Up To 999 Usp Units J3472 Ovine, 1000 Usp Units J3473 Hyaluronidase Recombinant J3475 Inj Magnesium Sulfate $20 $13 $15 $6 J3480 Inj Potassium Chloride $34 $22 $27 $11 J3485 Zidovudine J3486 Ziprasidone Mesylate $108 $70 $83 $35 J3489 Zoledronic Acid 1Mg $209 $136 $162 $68 J3490 Drugs Unclassified Injection $54 $35 $42 $18 J3520 Edetate Disodium Per 150 Mg J3530 Nasal Vaccine Inhalation J3535 Metered Dose Inhaler Drug J3570 Laetrile Amygdalin Vit B17 J3590 Unclassified Biologics J3591 Esrd On Dialysi Drug/Bio Noc J7030 Normal Saline Solution Infus $52 $34 $40 $17 J7040 Normal Saline Solution Infus $55 $36 $42 $18 J7042 5% Dextrose/Normal Saline $43 $28 $33 $14 J7050 Normal Saline Solution Infus $33 $22 $26 $11 J7060 5% Dextrose/Water $37 $24 $28 $12 J7070 D5W Infusion $46 $30 $36 $15 J7100 Dextran 40 Infusion J7110 Dextran 75 Infusion J7120 Ringers Lactate Infusion $46 $30 $36 $15 J7121 5% Dextrose In Lac Ringers $49 $32 $38 $16 J7131 Hypertonic Saline Sol $25 $16 $20 $8 J7169 Inj Andexxa, 10 Mg J7170 Inj., Emicizumab-Kxwh 0.5 Mg J7175 Inj, Factor X, (Human), 1Iu J7177 Inj., Fibryga, 1 Mg J7178 Inj Human Fibrinogen Con Nos J7179 Vonvendi Inj 1 Iu Vwf:Rco J7180 Factor Xiii Anti-Hem Factor J7181 Factor Xiii Recomb A-Subunit J7182 Factor Viii Recomb Novoeight J7183 Wilate Injection J7185 Xyntha Inj J7186 Antihemophilic Viii/Vwf Comp J7187 Humate-P, Inj J7188 Factor Viii Recomb Obizur J7189 Factor Viia Recomb Novoseven J7190 Factor Viii J7191 Factor Viii (Porcine) J7192 Factor Viii Recombinant Nos $2 $1 $1 $1 $0 J7193 Factor Ix Non-Recombinant J7194 Factor Ix Complex J7195 Factor Ix Recombinant Nos J7196 Antithrombin Recombinant J7197 Antithrombin Iii Injection J7198 Anti-Inhibitor J7199 Hemophilia Clot Factor Noc J7200 Factor Ix Recombinan Rixubis J7201 Factor Ix Alprolix Recomb J7202 Factor Ix Idelvion Inj J7203 Factor Ix Recomb Gly Rebinyn J7204 Inj Recombin Esperoct Per Iu J7205 Factor Viii Fc Fusion Recomb J7207 Factor Viii Pegylated Recomb J7208 Inj. Jivi 1 Iu J7209 Factor Viii Nuwiq Recomb 1Iu J7210 Inj, Afstyla, 1 I.U. J7211 Inj, Kovaltry, 1 I.U. J7212 Factor Viia Recomb Sevenfact J7296 Kyleena, 19.5 Mg $1,430 $930 $1,110 $469 J7297 Liletta, 52 Mg $1,389 $903 $1,078 $455 J7298 Mirena, 52 Mg $1,510 $981 $1,172 $495 J7300 Intraut Copper Contraceptive $1,286 $836 $998 $421 J7301 Skyla, 13.5 Mg $1,173 $762 $911 $384 J7303 Contraceptive Vaginal Ring J7304 Contraceptive Hormone Patch J7306 Levonorgestrel Implant Sys J7307 Etonogestrel Implant System $1,337 $869 $1,038 $438 J7308 Aminolevulinic Acid Hcl Top J7309 Methyl Aminolevulinate, Top J7310 Ganciclovir Long Act Implant J7311 Inj., Retisert, 0.01 Mg J7312 Dexamethasone Intra Implant J7313 Inj., Iluvien, 0.01 Mg J7314 Inj., Yutiq, 0.01 Mg J7315 Ophthalmic Mitomycin J7316 Inj, Ocriplasmin, 0.125 Mg J7318 Inj, Durolane 1 Mg J7320 Genvisc 850, Inj, 1Mg J7321 Hyalgan Or Supartz Inj Dose J7322 Hymovis Injection 1 Mg J7323 Euflexxa Inj Per Dose $476 $309 $370 $156 $141 J7324 Orthovisc Inj Per Dose J7325 Synvisc Or Synvisc-One $74 $48 $58 $24 $1 J7326 Gel-One $929 $604 $721 $304 $96 J7327 Monovisc Inj Per Dose J7328 Gelsyn-3 Injection 0.1 Mg J7329 Inj, Trivisc 1 Mg J7330 Cultured Chondrocytes Implnt J7331 Synojoynt, Inj., 1 Mg J7332 Inj., Triluron, 1 Mg J7333 Visco-3 Inj Dose J7336 Capsaicin 8% Patch J7340 Carbidopa Levodopa Ent 100Ml J7342 Ciprofloxacin Otic Susp 6 Mg J7345 Aminolevulinic Acid, 10% Gel J7351 Inj Bimatoprost Itc Imp1Mcg J7352 Afamelanotide Implant, 1 Mg J7401 Mometasone Furoate Sinus Imp J7500 Azathioprine Oral 50Mg J7501 Azathioprine Parenteral J7502 Cyclosporine Oral 100 Mg J7503 Tacrol Envarsus Ex Rel Oral J7504 Lymphocyte Immune Globulin J7505 Monoclonal Antibodies J7507 Tacrolimus Imme Rel Oral 1Mg $9 $6 $7 $3 J7508 Tacrol Astagraf Ex Rel Oral J7509 Methylprednisolone Oral J7510 Prednisolone Oral Per 5 Mg J7511 Antithymocyte Globuln Rabbit J7512 Prednisone Ir Or Dr Oral 1Mg $1 $1 $1 $0 J7513 Daclizumab, Parenteral J7515 Cyclosporine Oral 25 Mg J7516 Cyclosporin Parenteral 250Mg J7517 Mycophenolate Mofetil Oral $3 $2 $3 $1 J7518 Mycophenolic Acid J7520 Sirolimus, Oral J7525 Tacrolimus Injection J7527 Oral Everolimus J7599 Immunosuppressive Drug Noc J7604 Acetylcysteine Comp Unit J7605 Arformoterol Non-Comp Unit J7606 Formoterol Fumarate, Inh $34 $22 $27 $11 J7607 Levalbuterol Comp Con J7608 Acetylcysteine Non-Comp Unit $233 $151 $181 $76 J7609 Albuterol Comp Unit J7610 Albuterol Comp Con J7611 Albuterol Non-Comp Con J7612 Levalbuterol Non-Comp Con J7613 Albuterol Non-Comp Unit $3 $2 $3 $1 J7614 Levalbuterol Non-Comp Unit $11 $7 $8 $4 J7615 Levalbuterol Comp Unit J7620 Albuterol Ipratrop Non-Comp $4 $3 $3 $1 J7622 Beclomethasone Comp Unit J7624 Betamethasone Comp Unit J7626 Budesonide Non-Comp Unit $15 $10 $12 $5 J7627 Budesonide Comp Unit J7628 Bitolterol Mesylate Comp Con J7629 Bitolterol Mesylate Comp Unt J7631 Cromolyn Sodium Noncomp Unit J7632 Cromolyn Sodium Comp Unit J7633 Budesonide Non-Comp Con J7634 Budesonide Comp Con J7635 Atropine Comp Con J7636 Atropine Comp Unit J7637 Dexamethasone Comp Con J7638 Dexamethasone Comp Unit J7639 Dornase Alfa Non-Comp Unit J7640 Formoterol Comp Unit J7641 Flunisolide Comp Unit J7642 Glycopyrrolate Comp Con J7643 Glycopyrrolate Comp Unit J7644 Ipratropium Bromide Non-Comp J7645 Ipratropium Bromide Comp J7647 Isoetharine Comp Con J7648 Isoetharine Non-Comp Con J7649 Isoetharine Non-Comp Unit J7650 Isoetharine Comp Unit J7657 Isoproterenol Comp Con J7658 Isoproterenol Non-Comp Con J7659 Isoproterenol Non-Comp Unit J7660 Isoproterenol Comp Unit J7665 Mannitol For Inhaler J7667 Metaproterenol Comp Con J7668 Metaproterenol Non-Comp Con J7669 Metaproterenol Non-Comp Unit J7670 Metaproterenol Comp Unit J7674 Methacholine Chloride, Neb $139 $90 $108 $46 $2 J7676 Pentamidine Comp Unit Dose J7677 Revefenacin Inh Non-Com 1Mcg J7680 Terbutaline Sulf Comp Con J7681 Terbutaline Sulf Comp Unit J7682 Tobramycin Non-Comp Unit J7683 Triamcinolone Comp Con J7684 Triamcinolone Comp Unit J7685 Tobramycin Comp Unit J7686 Treprostinil, Non-Comp Unit J7699 Inhalation Solution For Dme $53 $35 $41 $17 J7799 Non-Inhalation Drug For Dme J7999 Compounded Drug, Noc J8498 Antiemetic Rectal/Supp Nos J8499 Oral Prescrip Drug Non Chemo J8501 Oral Aprepitant $57 $37 $45 $19 $2 J8510 Oral Busulfan J8515 Cabergoline, Oral 0.25Mg J8520 Capecitabine, Oral, 150 Mg J8521 Capecitabine, Oral, 500 Mg J8530 Cyclophosphamide Oral 25 Mg J8540 Oral Dexamethasone $2 $1 $2 $1 J8560 Etoposide Oral 50 Mg J8562 Oral Fludarabine Phosphate J8565 Gefitinib Oral J8597 Antiemetic Drug Oral Nos J8600 Melphalan Oral 2 Mg J8610 Methotrexate Oral 2.5 Mg J8650 Nabilone Oral J8655 Oral Netupitant, Palonosetro J8670 Rolapitant, Oral, 1Mg J8700 Temozolomide J8705 Topotecan Oral J8999 Oral Prescription Drug Chemo J9000 Doxorubicin Hcl Injection $30 $20 $23 $10 J9015 Aldesleukin Injection J9017 Arsenic Trioxide Injection J9019 Erwinaze Injection J9020 Asparaginase, Nos J9022 Inj, Atezolizumab,10 Mg $38,339 $24,920 $29,764 $12,562 $76 J9023 Injection, Avelumab, 10 Mg J9025 Azacitidine Injection J9027 Clofarabine Injection J9030 Bcg Live Intravesical 1Mg $6 $4 $5 $2 J9032 Injection, Belinostat, 10Mg J9033 Inj., Treanda 1 Mg J9034 Inj., Bendeka 1 Mg $8,058 $5,238 $6,256 $2,640 $35 J9035 Bevacizumab Injection $6,456 $4,196 $5,012 $2,115 $159 J9036 Inj. Belrapzo/Bendamustine J9039 Injection, Blinatumomab J9040 Bleomycin Sulfate Injection $102 $66 $79 $33 $0 J9041 Inj., Velcade 0.1 Mg J9042 Brentuximab Vedotin Inj J9043 Cabazitaxel Injection J9044 Inj, Bortezomib, Nos, 0.1 Mg J9045 Carboplatin Injection $24 $16 $19 $8 J9047 Injection, Carfilzomib, 1 Mg J9050 Carmustine Injection J9055 Cetuximab Injection J9057 Inj., Copanlisib, 1 Mg J9060 Cisplatin 10 Mg Injection $6 $4 $5 $2 J9065 Inj Cladribine Per 1 Mg J9070 Cyclophosphamide 100 Mg Inj $708 $460 $550 $232 $82 J9098 Cytarabine Liposome Inj J9100 Cytarabine Hcl 100 Mg Inj J9118 Inj. Calaspargase Pegol-Mknl J9119 Inj., Cemiplimab-Rwlc, 1 Mg J9120 Dactinomycin Injection J9130 Dacarbazine 100 Mg Inj J9144 Daratumumab, Hyaluronidase J9145 Injection, Daratumumab 10 Mg $6,715 $4,365 $5,213 $2,200 $69 J9150 Daunorubicin Injection J9151 Daunorubicin Citrate Inj J9153 Inj Daunorubicin, Cytarabine J9155 Degarelix Injection J9160 Denileukin Diftitox Inj J9165 Diethylstilbestrol Injection J9171 Docetaxel Injection $243 $158 $189 $80 $19 J9173 Inj., Durvalumab, 10 Mg J9175 Elliotts B Solution Per Ml J9176 Injection, Elotuzumab, 1Mg J9177 Inj Enfort Vedo-Ejfv 0.25Mg J9178 Inj, Epirubicin Hcl, 2 Mg J9179 Eribulin Mesylate Injection J9181 Etoposide Injection $2 $1 $1 $1 J9185 Fludarabine Phosphate Inj J9190 Fluorouracil Injection $103 $67 $80 $34 $21 J9198 Inj. Infugem, 100 Mg J9200 Floxuridine Injection J9201 In Gemcitabine Hcl Nos 200Mg $36 $24 $28 $12 J9202 Goserelin Acetate Implant J9203 Gemtuzumab Ozogamicin 0.1 Mg J9204 Inj Mogamulizumab-Kpkc, 1 Mg J9205 Inj Irinotecan Liposome 1 Mg J9206 Irinotecan Injection $110 $71 $85 $36 $16 J9207 Ixabepilone Injection J9208 Ifosfamide Injection J9209 Mesna Injection J9210 Inj., Emapalumab-Lzsg, 1 Mg J9211 Idarubicin Hcl Injection J9212 Interferon Alfacon-1 Inj J9213 Interferon Alfa-2A Inj J9214 Interferon Alfa-2B Inj J9215 Interferon Alfa-N3 Inj J9216 Interferon Gamma 1-B Inj J9217 Leuprolide Acetate Suspnsion $2,043 $1,328 $1,586 $669 $138 J9218 Leuprolide Acetate Injeciton J9219 Leuprolide Acetate Implant J9223 Inj. Lurbinectedin, 0.1 Mg J9225 Vantas Implant J9226 Supprelin La Implant J9227 Inj. Isatuximab-Irfc 10 Mg J9228 Ipilimumab Injection $63,528 $41,293 $49,320 $20,816 $315 J9229 Inj Inotuzumab Ozogam 0.1 Mg J9230 Mechlorethamine Hcl Inj J9245 Inj Melpha Hydroch Nos 50 Mg J9246 Inj., Evomela, 1 Mg J9250 Methotrexate Sodium Inj $6 $4 $5 $2 $1 J9260 Methotrexate Sodium Inj J9261 Nelarabine Injection J9262 Inj, Omacetaxine Mep, 0.01Mg J9263 Oxaliplatin $35 $22 $27 $11 $0 J9264 Paclitaxel Protein Bound $2,767 $1,799 $2,148 $907 $26 J9266 Pegaspargase Injection J9267 Paclitaxel Injection $40 $26 $31 $13 $0 J9268 Pentostatin Injection J9269 Inj. Tagraxofusp-Erzs 10 Mcg J9270 Plicamycin (Mithramycin) Inj J9271 Inj Pembrolizumab $20,491 $13,319 $15,908 $6,714 $85 J9280 Mitomycin Injection $352 $229 $273 $115 $80 J9281 Mitomycin Instillation J9285 Inj, Olaratumab, 10 Mg J9293 Mitoxantrone Hydrochl / 5 Mg J9295 Injection, Necitumumab, 1 Mg J9299 Injection, Nivolumab $22,300 $14,495 $17,312 $7,307 $28 J9301 Obinutuzumab Inj J9302 Ofatumumab Injection J9303 Panitumumab Injection J9304 Inj. Pemetrexed, 10 Mg J9305 Inj. Pemetrexed Nos 10Mg $3,999 $2,600 $3,105 $1,310 $729 J9306 Injection, Pertuzumab, 1 Mg $21,410 $13,917 $16,622 $7,015 $12 J9307 Pralatrexate Injection J9308 Injection, Ramucirumab J9309 Inj, Polatuzumab Vedotin 1Mg J9311 Inj Rituximab, Hyaluronidase J9312 Inj., Rituximab, 10 Mg $6,546 $4,255 $5,082 $2,145 $40 J9313 Inj., Lumoxiti, 0.01 Mg J9315 Romidepsin Injection J9316 Pertuzu, Trastuzu, 10 Mg J9317 Sacituzumab Govitecan-Hziy J9320 Streptozocin Injection J9325 Inj Talimogene Laherparepvec J9328 Temozolomide Injection J9330 Temsirolimus Injection J9340 Thiotepa Injection J9351 Topotecan Injection J9352 Injection Trabectedin 0.1Mg J9354 Inj, Ado-Trastuzumab Emt 1Mg J9355 Inj Trastuzumab Excl Biosimi $3,454 $2,245 $2,681 $1,132 $220 J9356 Inj. Herceptin Hylecta, 10Mg J9357 Valrubicin Injection J9358 Inj Fam-Trastu Deru-Nxki 1Mg J9360 Vinblastine Sulfate Inj J9370 Vincristine Sulfate 1 Mg Inj J9371 Inj, Vincristine Sul Lip 1Mg J9390 Vinorelbine Tartrate Inj J9395 Injection, Fulvestrant J9400 Inj, Ziv-Aflibercept, 1Mg J9600 Porfimer Sodium Injection J9999 Chemotherapy Drug K0001 Standard Wheelchair K0002 Stnd Hemi (Low Seat) Whlchr K0003 Lightweight Wheelchair K0004 High Strength Ltwt Whlchr K0005 Ultralightweight Wheelchair K0006 Heavy Duty Wheelchair K0007 Extra Heavy Duty Wheelchair K0008 Cstm Manual Wheelchair/Base K0009 Other Manual Wheelchair/Base K0010 Stnd Wt Frame Power Whlchr K0011 Stnd Wt Pwr Whlchr W Control K0012 Ltwt Portbl Power Whlchr K0013 Custom Power Whlchr Base K0014 Other Power Whlchr Base K0015 Detach Non-Adj Ht Armrst Rep K0017 Detach Adjust Armrest Base K0018 Detach Adjust Armrst Upper K0019 Arm Pad Repl, Each K0020 Fixed Adjust Armrest Pair K0037 Hi Mount Flip-Up Footrest Ea K0038 Leg Strap Each K0039 Leg Strap H Style Each K0040 Adjustable Angle Footplate K0041 Large Size Footplate Each K0042 Standard Size Ftplate Rep Ea K0043 Ftrst Lowr Exten Tube Rep Ea K0044 Ftrst Upr Hanger Brac Rep Ea K0045 Ftrst Compl Assembly Repl Ea K0046 Elev Lgrst Lwr Exten Repl Ea K0047 Elev Legrst Upr Hangr Rep Ea K0050 Ratchet Assembly Replacement K0051 Cam Rel Asm Ft/Legrst Rep Ea K0052 Swingaway Detach Ftrest Repl K0053 Elevate Footrest Articulate K0056 Seat Ht <17 Or >=21 Ltwt Wc K0065 Spoke Protectors K0069 Rr Whl Compl Sol Tire Rep Ea K0070 Rr Whl Compl Pne Tire Rep Ea K0071 Fr Cstr Comp Pne Tire Rep Ea K0072 Fr Cstr Semi-Pne Tire Rep Ea K0073 Caster Pin Lock Each K0077 Fr Cstr Asmb Sol Tire Rep Ea K0098 Drive Belt For Pwc, Repl K0105 Iv Hanger K0108 W/C Component-Accessory Nos K0195 Elevating Whlchair Leg Rests K0455 Pump Uninterrupted Infusion K0462 Temporary Replacement Eqpmnt K0552 Sup/Ext Non-Ins Inf Pump Syr K0553 Ther Cgm Supply Allowance K0554 Ther Cgm Receiver/Monitor K0601 Repl Batt Silver Oxide 1.5 V K0602 Repl Batt Silver Oxide 3 V K0603 Repl Batt Alkaline 1.5 V K0604 Repl Batt Lithium 3.6 V K0605 Repl Batt Lithium 4.5 V K0606 Aed Garment W Elec Analysis K0607 Repl Batt For Aed K0608 Repl Garment For Aed K0609 Repl Electrode For Aed K0669 Seat/Back Cus No Dmepdac Ver K0672 Removable Soft Interface Le K0730 Ctrl Dose Inh Drug Deliv Sys K0733 12-24Hr Sealed Lead Acid K0738 Portable Gas Oxygen System K0739 Repair/Svc Dme Non-Oxygen Eq K0740 Repair/Svc Oxygen Equipment K0743 Portable Home Suction Pump K0744 Absorp Drg <= 16 Suc Pump K0745 Absorp Drg >16<=48 Suc Pump K0746 Absorp Drg >48 Suc Pump K0800 Pov Group 1 Std Up To 300Lbs K0801 Pov Group 1 Hd 301-450 Lbs K0802 Pov Group 1 Vhd 451-600 Lbs K0806 Pov Group 2 Std Up To 300Lbs K0807 Pov Group 2 Hd 301-450 Lbs K0808 Pov Group 2 Vhd 451-600 Lbs K0812 Power Operated Vehicle Noc K0813 Pwc Gp 1 Std Port Seat/Back K0814 Pwc Gp 1 Std Port Cap Chair K0815 Pwc Gp 1 Std Seat/Back K0816 Pwc Gp 1 Std Cap Chair K0820 Pwc Gp 2 Std Port Seat/Back K0821 Pwc Gp 2 Std Port Cap Chair K0822 Pwc Gp 2 Std Seat/Back K0823 Pwc Gp 2 Std Cap Chair K0824 Pwc Gp 2 Hd Seat/Back K0825 Pwc Gp 2 Hd Cap Chair K0826 Pwc Gp 2 Vhd Seat/Back K0827 Pwc Gp Vhd Cap Chair K0828 Pwc Gp 2 Xtra Hd Seat/Back K0829 Pwc Gp 2 Xtra Hd Cap Chair K0830 Pwc Gp2 Std Seat Elevate S/B K0831 Pwc Gp2 Std Seat Elevate Cap K0835 Pwc Gp2 Std Sing Pow Opt S/B K0836 Pwc Gp2 Std Sing Pow Opt Cap K0837 Pwc Gp 2 Hd Sing Pow Opt S/B K0838 Pwc Gp 2 Hd Sing Pow Opt Cap K0839 Pwc Gp2 Vhd Sing Pow Opt S/B K0840 Pwc Gp2 Xhd Sing Pow Opt S/B K0841 Pwc Gp2 Std Mult Pow Opt S/B K0842 Pwc Gp2 Std Mult Pow Opt Cap K0843 Pwc Gp2 Hd Mult Pow Opt S/B K0848 Pwc Gp 3 Std Seat/Back K0849 Pwc Gp 3 Std Cap Chair K0850 Pwc Gp 3 Hd Seat/Back K0851 Pwc Gp 3 Hd Cap Chair K0852 Pwc Gp 3 Vhd Seat/Back K0853 Pwc Gp 3 Vhd Cap Chair K0854 Pwc Gp 3 Xhd Seat/Back K0855 Pwc Gp 3 Xhd Cap Chair K0856 Pwc Gp3 Std Sing Pow Opt S/B K0857 Pwc Gp3 Std Sing Pow Opt Cap K0858 Pwc Gp3 Hd Sing Pow Opt S/B K0859 Pwc Gp3 Hd Sing Pow Opt Cap K0860 Pwc Gp3 Vhd Sing Pow Opt S/B K0861 Pwc Gp3 Std Mult Pow Opt S/B K0862 Pwc Gp3 Hd Mult Pow Opt S/B K0863 Pwc Gp3 Vhd Mult Pow Opt S/B K0864 Pwc Gp3 Xhd Mult Pow Opt S/B K0868 Pwc Gp 4 Std Seat/Back K0869 Pwc Gp 4 Std Cap Chair K0870 Pwc Gp 4 Hd Seat/Back K0871 Pwc Gp 4 Vhd Seat/Back K0877 Pwc Gp4 Std Sing Pow Opt S/B K0878 Pwc Gp4 Std Sing Pow Opt Cap K0879 Pwc Gp4 Hd Sing Pow Opt S/B K0880 Pwc Gp4 Vhd Sing Pow Opt S/B K0884 Pwc Gp4 Std Mult Pow Opt S/B K0885 Pwc Gp4 Std Mult Pow Opt Cap K0886 Pwc Gp4 Hd Mult Pow S/B K0890 Pwc Gp5 Ped Sing Pow Opt S/B K0891 Pwc Gp5 Ped Mult Pow Opt S/B K0898 Power Wheelchair Noc K0899 Pow Mobil Dev No Dmepdac K0900 Cstm Dme Other Than Wheelchr K1001 Electronic Posa Treatment K1002 Ces System W/Supplies Access K1003 Whirlpool Tub Walkin Portabl K1004 Lo Freq Us Diathermy Device K1005 Disp Col Sto Bag Breast Milk K1006 Suct Pum Ext Urine Mgmt Sys K1007 Bil Hkaf Pc S/D Micro Sensor K1009 Speech Volume Modulation Sys K1010 Intraurethral Drainag Device K1011 Acti Intraurethral Drainage K1012 Charger Base Station Intraur L0112 Cranial Cervical Orthosis L0113 Cranial Cervical Torticollis L0120 274 Cerv Flex N/Adj Foam Pre Ots $32 $21 $25 $10 L0130 Flex Thermoplastic Collar Mo L0140 Cervical Semi-Rigid Adjustab $221 $144 $172 $72 L0150 Cerv Semi-Rig Adj Molded Chn L0160 Cerv Sr Wire Occ/Man Pre Ots L0170 Cervical Collar Molded To Pt L0172 Cerv Col Sr Foam 2Pc Pre Ots L0174 Cerv Sr 2Pc Thor Ext Pre Ots L0180 Cer Post Col Occ/Man Sup Adj L0190 Cerv Collar Supp Adj Cerv Ba L0200 Cerv Col Supp Adj Bar & Thor L0220 Thor Rib Belt Custom Fabrica L0450 Tlso Flex Trunk/Thor Pre Ots L0452 Tlso Flex Custom Fab Thoraci L0454 Tlso Trnk Sj-T9 Pre Cst L0455 Tlso Flex Trnk Sj-T9 Pre Ots L0456 Tlso Flex Trnk Sj-Ss Pre Cst L0457 Tlso Flex Trnk Sj-Ss Pre Ots L0458 Tlso 2Mod Symphis-Xipho Pre L0460 Tlso 2 Shl Symphys-Stern Cst L0462 Tlso 3Mod Sacro-Scap Pre L0464 Tlso 4Mod Sacro-Scap Pre L0466 Tlso R Fram Soft Ant Pre Cst L0467 Tlso R Fram Soft Pre Ots L0468 Tlso Rig Fram Pelvic Pre Cst L0469 Tlso Rig Fram Pelvic Pre Ots L0470 Tlso Rigid Frame Pre Subclav L0472 Tlso Rigid Frame Hyperex Pre L0480 Tlso Rigid Plastic Custom Fa L0482 Tlso Rigid Lined Custom Fab L0484 Tlso Rigid Plastic Cust Fab L0486 Tlso Rigidlined Cust Fab Two L0488 Tlso Rigid Lined Pre One Pie L0490 Tlso Rigid Plastic Pre One L0491 Tlso 2 Piece Rigid Shell L0492 Tlso 3 Piece Rigid Shell L0621 Sio Flex Pelvic/Sacr Pre Ots $25 $16 $19 $8 $0 L0622 Sio Flex Pelvisacral Custom L0623 Sio Rig Pnl Pelv/Sac Pre Ots L0624 Sio Panel Custom L0625 Lo Flex L1-Below L5 Pre Ots L0626 Lo Sag Rig Pnl Stays Pre Cst L0627 Lo Sag Ri An/Pos Pnl Pre Cst L0628 Lso Flex No Ri Stays Pre Ots L0629 Lso Flex W/Rigid Stays Cust L0630 Lso R Post Pnl Sj-T9 Pre Cst L0631 Lso Sag R An/Pos Pnl Pre Cst L0632 Lso Sag Rigid Frame Cust L0633 Lso Sc R Pos/Lat Pnl Pre Cst L0634 Lso Flexion Control Custom L0635 Lso Sagit Rigid Panel Prefab L0636 Lso Sagittal Rigid Panel Cus L0637 Lso Sc R Ant/Pos Pnl Pre Cst L0638 Lso Sag-Coronal Panel Custom L0639 Lso S/C Shell/Panel Prefab L0640 Lso S/C Shell/Panel Custom L0641 Lo Rig Pos Pnl L1-L5 Pre Ots L0642 Lo Sag Ri An/Pos Pnl Pre Ots L0643 Lso Sag Ctr Rigi Pos Pre Ots L0648 Lso Sag R An/Pos Pnl Pre Ots L0649 Lso Sc R Pos/Lat Pnl Pre Ots L0650 Lso Sc R Ant/Pos Pnl Pre Ots L0651 Lso Sag-Co Shell Pnl Pre Ots L0700 Ctlso A-P-L Control Molded L0710 Ctlso A-P-L Control W/ Inter L0810 Halo Cervical Into Jckt Vest L0820 Halo Cervical Into Body Jack L0830 Halo Cerv Into Milwaukee Typ L0859 Mri Compatible System L0861 Halo Repl Liner/Interface $7,268 $4,724 $5,642 $2,381 L0970 Tlso Corset Front L0972 Lso Corset Front L0974 Tlso Full Corset L0976 Lso Full Corset L0978 Axillary Crutch Extension L0980 Peroneal Straps Pair Pre Ots L0982 Stocking Sup Grips 4 Pre Ots L0984 Protect Body Sock Ea Pre Ots L0999 Add To Spinal Orthosis Nos L1000 Ctlso Milwauke Initial Model L1001 Ctlso Infant Immobilizer L1005 Tension Based Scoliosis Orth L1010 Ctlso Axilla Sling L1020 Kyphosis Pad L1025 Kyphosis Pad Floating L1030 Lumbar Bolster Pad L1040 Lumbar Or Lumbar Rib Pad L1050 Sternal Pad L1060 Thoracic Pad L1070 Trapezius Sling L1080 Outrigger L1085 Outrigger Bil W/ Vert Extens L1090 Lumbar Sling L1100 Ring Flange Plastic/Leather L1110 Ring Flange Plas/Leather Mol L1120 Covers For Upright Each L1200 Furnsh Initial Orthosis Only L1210 Lateral Thoracic Extension L1220 Anterior Thoracic Extension L1230 Milwaukee Type Superstructur L1240 Lumbar Derotation Pad L1250 Anterior Asis Pad L1260 Anterior Thoracic Derotation L1270 Abdominal Pad L1280 Rib Gusset (Elastic) Each L1290 Lateral Trochanteric Pad L1300 Body Jacket Mold To Patient L1310 Post-Operative Body Jacket L1499 Spinal Orthosis Nos L1600 Ho Flex Frejka W/Cov Pre Cst L1610 Ho Frejka Cov Only Pre Cst L1620 Ho Flex Pavlik Harns Pre Cst L1630 Abduct Control Hip Semi-Flex L1640 Pelv Band/Spread Bar Thigh C L1650 Ho Abduction Hip Adjustable L1652 Ho Bi Thighcuffs W Sprdr Bar L1660 Ho Abduction Static Plastic L1680 Pelvic & Hip Control Thigh C L1685 Post-Op Hip Abduct Custom Fa L1686 Ho Post-Op Hip Abduction L1690 Combination Bilateral Ho L1700 Leg Perthes Orth Toronto Typ L1710 Legg Perthes Orth Newington L1720 Legg Perthes Orthosis Trilat L1730 Legg Perthes Orth Scottish R L1755 Legg Perthes Patten Bottom T L1810 274 Ko Elastic With Joints $125 $81 $97 $41 L1812 Ko Elastic W/Joints Pre Ots L1820 272 Ko Elas W/ Condyle Pads & Jo $213 $138 $165 $70 L1830 270 Ko Immob Canvas Long Pre Ots $121 $78 $94 $39 L1831 Knee Orth Pos Locking Joint L1832 Ko Adj Jnt Pos R Sup Pre Cst L1833 Ko Adj Jnt Pos R Sup Pre Ots L1834 Ko W/0 Joint Rigid Molded To L1836 Ko Rigid W/O Joints Pre Ots L1840 Ko Derot Ant Cruciate Custom L1843 Ko Single Upright Pre Cst L1844 Ko W/Adj Jt Rot Cntrl Molded L1845 Ko Double Upright Pre Cst L1846 Ko W Adj Flex/Ext Rotat Mold L1847 Ko Dbl Upright W/Air Pre Cst L1848 Ko Dbl Upright W/Air Pre Ots L1850 Ko Swedish Type Pre Ots L1851 Ko Single Upright Prefab Ots L1852 Ko Double Upright Prefab Ots L1860 Ko Supracondylar Socket Mold L1900 Afo Sprng Wir Drsflx Calf Bd L1902 274 Afo Ankle Gauntlet Pre Ots $155 $101 $121 $51 $8 L1904 Afo Molded Ankle Gauntlet L1906 274 Afo Multilig Ank Sup Pre Ots $141 $92 $110 $46 L1907 Afo Supramalleolar Custom L1910 Afo Sing Bar Clasp Attach Sh L1920 Afo Sing Upright W/ Adjust S L1930 Afo Plastic L1932 Afo Rig Ant Tib Prefab Tcf/= L1940 Afo Molded To Patient Plasti L1945 Afo Molded Plas Rig Ant Tib L1950 Afo Spiral Molded To Pt Plas L1951 Afo Spiral Prefabricated L1960 Afo Pos Solid Ank Plastic Mo L1970 273 Afo Plastic Molded W/Ankle J $1,403 $912 $1,089 $460 L1971 Afo W/Ankle Joint, Prefab L1980 Afo Sing Solid Stirrup Calf L1990 Afo Doub Solid Stirrup Calf L2000 Kafo Sing Fre Stirr Thi/Calf L2005 Kafo Sng/Dbl Mechanical Act L2006 Kaf Sng/Dbl Swg/Stn Mcpr Cus L2010 Kafo Sng Solid Stirrup W/O J L2020 Kafo Dbl Solid Stirrup Band/ L2030 Kafo Dbl Solid Stirrup W/O J L2034 Kafo Pla Sin Up W/Wo K/A Cus L2035 Kafo Plastic Pediatric Size L2036 Kafo Plas Doub Free Knee Mol L2037 Kafo Plas Sing Free Knee Mol L2038 Kafo W/O Joint Multi-Axis An L2040 Hkafo Torsion Bil Rot Straps L2050 Hkafo Torsion Cable Hip Pelv L2060 Hkafo Torsion Ball Bearing J L2070 Hkafo Torsion Unilat Rot Str L2080 Hkafo Unilat Torsion Cable L2090 Hkafo Unilat Torsion Ball Br L2106 Afo Tib Fx Cast Plaster Mold L2108 Afo Tib Fx Cast Molded To Pt L2112 Afo Tibial Fracture Soft L2114 Afo Tib Fx Semi-Rigid L2116 Afo Tibial Fracture Rigid L2126 Kafo Fem Fx Cast Thermoplas L2128 Kafo Fem Fx Cast Molded To P L2132 Kafo Femoral Fx Cast Soft L2134 Kafo Fem Fx Cast Semi-Rigid L2136 Kafo Femoral Fx Cast Rigid L2180 Plas Shoe Insert W Ank Joint L2182 Drop Lock Knee L2184 Limited Motion Knee Joint L2186 Adj Motion Knee Jnt Lerman T L2188 Quadrilateral Brim L2190 Waist Belt L2192 Pelvic Band & Belt Thigh Fla L2200 Limited Ankle Motion Ea Jnt L2210 Dorsiflexion Assist Each Joi L2220 Dorsi & Plantar Flex Ass/Res L2230 Split Flat Caliper Stirr & P L2232 Rocker Bottom, Contact Afo L2240 Round Caliper And Plate Atta L2250 Foot Plate Molded Stirrup At L2260 Reinforced Solid Stirrup L2265 Long Tongue Stirrup L2270 Varus/Valgus Strap Padded/Li L2275 Plastic Mod Low Ext Pad/Line L2280 Molded Inner Boot L2300 Abduction Bar Jointed Adjust L2310 Abduction Bar-Straight L2320 Non-Molded Lacer L2330 Lacer Molded To Patient Mode L2335 Anterior Swing Band L2340 Pre-Tibial Shell Molded To P L2350 Prosthetic Type Socket Molde L2360 Extended Steel Shank L2370 Patten Bottom L2375 Torsion Ank & Half Solid Sti L2380 Torsion Straight Knee Joint L2385 Straight Knee Joint Heavy Du L2387 Add Le Poly Knee Custom Kafo L2390 Offset Knee Joint Each L2395 Offset Knee Joint Heavy Duty L2397 Suspension Sleeve Lower Ext L2405 Knee Joint Drop Lock Ea Jnt L2415 Knee Joint Cam Lock Each Joi L2425 Knee Disc/Dial Lock/Adj Flex L2430 Knee Jnt Ratchet Lock Ea Jnt L2492 Knee Lift Loop Drop Lock Rin L2500 Thi/Glut/Ischia Wgt Bearing L2510 Th/Wght Bear Quad-Lat Brim M L2520 Th/Wght Bear Quad-Lat Brim C L2525 Th/Wght Bear Nar M-L Brim Mo L2526 Th/Wght Bear Nar M-L Brim Cu L2530 Thigh/Wght Bear Lacer Non-Mo L2540 Thigh/Wght Bear Lacer Molded L2550 Thigh/Wght Bear High Roll Cu L2570 Hip Clevis Type 2 Posit Jnt L2580 Pelvic Control Pelvic Sling L2600 Hip Clevis/Thrust Bearing Fr L2610 Hip Clevis/Thrust Bearing Lo L2620 Pelvic Control Hip Heavy Dut L2622 Hip Joint Adjustable Flexion L2624 Hip Adj Flex Ext Abduct Cont L2627 Plastic Mold Recipro Hip & C L2628 Metal Frame Recipro Hip & Ca L2630 Pelvic Control Band & Belt U L2640 Pelvic Control Band & Belt B L2650 Pelv & Thor Control Gluteal L2660 Thoracic Control Thoracic Ba L2670 Thorac Cont Paraspinal Uprig L2680 Thorac Cont Lat Support Upri L2750 Plating Chrome/Nickel Pr Bar L2755 Carbon Graphite Lamination L2760 Extension Per Extension Per L2768 Ortho Sidebar Disconnect L2780 Non-Corrosive Finish L2785 Drop Lock Retainer Each L2795 Knee Control Full Kneecap L2800 Knee Cap Medial Or Lateral P L2810 Knee Control Condylar Pad L2820 Soft Interface Below Knee Se L2830 Soft Interface Above Knee Se L2840 Tibial Length Sock Fx Or Equ L2850 Femoral Lgth Sock Fx Or Equa L2861 Torsion Mechanism Knee/Ankle L2999 Lower Extremity Orthosis Nos L3000 274 Ft Insert Ucb Berkeley Shell $381 $248 $296 $125 $87 L3001 Foot Insert Remov Molded Spe L3002 Foot Insert Plastazote Or Eq L3003 Foot Insert Silicone Gel Eac L3010 Foot Longitudinal Arch Suppo L3020 273 Foot Longitud/Metatarsal Sup $365 $237 $284 $120 L3030 274 Foot Arch Support Remov Prem $105 $68 $82 $34 L3031 Foot Lamin/Prepreg Composite L3040 274 Ft Arch Suprt Premold Longit $93 $61 $72 $31 L3050 Foot Arch Supp Premold Metat L3060 274 Foot Arch Supp Longitud/Meta $90 $58 $70 $29 L3070 274 Arch Suprt Att To Sho Longit $39 $25 $30 $13 L3080 Arch Supp Att To Shoe Metata L3090 Arch Supp Att To Shoe Long/M L3100 Hallus-Valgus Nt Dyn Pre Ots L3140 Abduction Rotation Bar Shoe L3150 Abduct Rotation Bar W/O Shoe L3160 Shoe Styled Positioning Dev L3170 Foot Plas Heel Stabi Pre Ots L3201 Oxford W Supinat/Pronat Inf L3202 Oxford W/ Supinat/Pronator C L3203 Oxford W/ Supinator/Pronator L3204 Hightop W/ Supp/Pronator Inf L3206 Hightop W/ Supp/Pronator Chi L3207 Hightop W/ Supp/Pronator Jun L3208 Surgical Boot Each Infant L3209 Surgical Boot Each Child L3211 Surgical Boot Each Junior L3212 Benesch Boot Pair Infant L3213 Benesch Boot Pair Child L3214 Benesch Boot Pair Junior L3215 Orthopedic Ftwear Ladies Oxf L3216 Orthoped Ladies Shoes Dpth I L3217 Ladies Shoes Hightop Depth I L3219 Orthopedic Mens Shoes Oxford L3221 Orthopedic Mens Shoes Dpth I L3222 Mens Shoes Hightop Depth Inl L3224 Woman'S Shoe Oxford Brace L3225 Man'S Shoe Oxford Brace L3230 Custom Shoes Depth Inlay L3250 Custom Mold Shoe Remov Prost L3251 Shoe Molded To Pt Silicone S L3252 Shoe Molded Plastazote Cust L3253 Shoe Molded Plastazote Cust L3254 Orth Foot Non-Stndard Size/W L3255 Orth Foot Non-Standard Size/ L3257 Orth Foot Add Charge Split S L3260 273 Ambulatory Surgical Boot Eac $76 $49 $59 $25 L3265 Plastazote Sandal Each L3300 Sho Lift Taper To Metatarsal L3310 274 Shoe Lift Elev Heel/Sole Neo $124 $81 $96 $41 L3320 Shoe Lift Elev Heel/Sole Cor L3330 Lifts Elevation Metal Extens L3332 Shoe Lifts Tapered To One-Ha L3334 Shoe Lifts Elevation Heel /I L3340 Shoe Wedge Sach L3350 Shoe Heel Wedge L3360 Shoe Sole Wedge Outside Sole L3370 Shoe Sole Wedge Between Sole L3380 Shoe Clubfoot Wedge L3390 Shoe Outflare Wedge L3400 Shoe Metatarsal Bar Wedge Ro L3410 Shoe Metatarsal Bar Between L3420 Full Sole/Heel Wedge Btween L3430 Sho Heel Count Plast Reinfor L3440 Heel Leather Reinforced L3450 Shoe Heel Sach Cushion Type L3455 Shoe Heel New Leather Standa L3460 Shoe Heel New Rubber Standar L3465 Shoe Heel Thomas With Wedge L3470 Shoe Heel Thomas Extend To B L3480 Shoe Heel Pad & Depress For L3485 Shoe Heel Pad Removable For L3500 Ortho Shoe Add Leather Insol L3510 Orthopedic Shoe Add Rub Insl L3520 O Shoe Add Felt W Leath Insl L3530 Ortho Shoe Add Half Sole L3540 Ortho Shoe Add Full Sole L3550 O Shoe Add Standard Toe Tap L3560 O Shoe Add Horseshoe Toe Tap L3570 O Shoe Add Instep Extension L3580 O Shoe Add Instep Velcro Clo L3590 O Shoe Convert To Sof Counte L3595 Ortho Shoe Add March Bar L3600 Trans Shoe Calip Plate Exist L3610 Trans Shoe Caliper Plate New L3620 Trans Shoe Solid Stirrup Exi L3630 Trans Shoe Solid Stirrup New L3640 Shoe Dennis Browne Splint Bo L3649 Orthopedic Shoe Modifica Nos L3650 274 So 8 Abd Restraint Pre Ots $104 $68 $81 $34 L3660 273 So 8 Ab Rstr Can/Web Pre Ots $120 $78 $93 $39 L3670 274 So Acro/Clav Can Web Pre Ots $153 $99 $119 $50 L3671 So Cap Design W/O Jnts Cf L3674 So Airplane W/Wo Joint Cf L3675 So Vest Canvas/Web Pre Ots L3677 So Hard Plas Stabili Pre Cst L3678 So Hard Plas Stabili Pre Ots L3702 274 Eo W/O Joints Cf $320 $208 $248 $105 L3710 Eo Elas W/Metal Jnts Pre Ots L3720 Forearm/Arm Cuffs Free Motio L3730 Forearm/Arm Cuffs Ext/Flex A L3740 Cuffs Adj Lock W/ Active Con L3760 Eo Adj Jt Prefab Custom Fit L3761 Eo, Adj Lock Joint Prefab Ot L3762 Eo Rigid W/O Joints Pre Ots L3763 Ewho Rigid W/O Jnts Cf L3764 Ewho W/Joint(S) Cf L3765 Ewhfo Rigid W/O Jnts Cf L3766 Ewhfo W/Joint(S) Cf L3806 Whfo W/Joint(S) Custom Fab L3807 274 Whfo W/O Joints Pre Cst $277 $180 $215 $91 L3808 Whfo, Rigid W/O Joints L3809 Whfo W/O Joints Pre Ots $350 $227 $271 $115 L3891 Torsion Mechanism Wrist/Elbo L3900 Hinge Extension/Flex Wrist/F L3901 Hinge Ext/Flex Wrist Finger L3904 Whfo Electric Custom Fitted L3905 Who W/Nontorsion Jnt(S) Cf L3906 Who W/O Joints Cf L3908 274 Who Cock-Up Nonmolde Pre Ots $81 $53 $63 $27 L3912 Hfo Flexion Glove Pre Ots L3913 Hfo W/O Joints Cf L3915 Who Nontorsion Jnts Pre Cst L3916 Who Nontorsion Jnts Pre Ots L3917 Metacarp Fx Orthosis Pre Cst L3918 Metacarp Fx Orthosis Pre Ots L3919 Ho W/O Joints Cf L3921 Hfo W/Joint(S) Cf L3923 274 Hfo Without Joints Pre Cst $132 $86 $103 $43 L3924 Hfo Without Joints Pre Ots L3925 Fo Pip Dip Jnt/Sprng Pre Ots L3927 Fo Pip Dip No Jt Spr Pre Ots L3929 Hfo Nontorsion Jnts Pre Cst L3930 Hfo Nontorsion Jnts Pre Ots L3931 Whfo Nontorsion Joint Prefab L3933 Fo W/O Joints Cf L3935 Fo Nontorsion Joint Cf L3956 Add Joint Upper Ext Orthosis L3960 Sewho Airplan Desig Abdu Pos L3961 Sewho Cap Design W/O Jnts Cf L3962 Sewho Erbs Palsey Design Abd L3967 Sewho Airplane W/O Jnts Cf L3971 Sewho Cap Design W/Jnt(S) Cf L3973 Sewho Airplane W/Jnt(S) Cf L3975 Sewhfo Cap Design W/O Jnt Cf L3976 Sewhfo Airplane W/O Jnts Cf L3977 Sewhfo Cap Desgn W/Jnt(S) Cf L3978 Sewhfo Airplane W/Jnt(S) Cf L3980 Up Ext Fx Orthos Humeral Nos L3981 Ue Fx Orth Shoul Cap Forearm L3982 Upper Ext Fx Orthosis Rad/Ul L3984 Upper Ext Fx Orthosis Wrist L3995 Sock Fracture Or Equal Each L3999 Upper Limb Orthosis Nos L4000 Repl Girdle Milwaukee Orth L4002 Replace Strap, Any Orthosis L4010 Replace Trilateral Socket Br L4020 Replace Quadlat Socket Brim L4030 Replace Socket Brim Cust Fit L4040 Replace Molded Thigh Lacer L4045 Replace Non-Molded Thigh Lac L4050 Replace Molded Calf Lacer L4055 Replace Non-Molded Calf Lace L4060 Replace High Roll Cuff L4070 Replace Prox & Dist Upright L4080 Repl Met Band Kafo-Afo Prox L4090 Repl Met Band Kafo-Afo Calf/ L4100 Repl Leath Cuff Kafo Prox Th L4110 Repl Leath Cuff Kafo-Afo Cal L4130 Replace Pretibial Shell L4205 Ortho Dvc Repair Per 15 Min L4210 Orth Dev Repair/Repl Minor P L4350 274 Ankle Control Ortho Pre Ots $104 $68 $81 $34 L4360 274 Pneumat Walking Boot Pre Cst $335 $218 $260 $110 L4361 274 Pneuma/Vac Walk Boot Pre Ots $423 $275 $328 $138 $44 L4370 Pneum Full Leg Splnt Pre Ots L4386 Non-Pneum Walk Boot Pre Cst L4387 Non-Pneum Walk Boot Pre Ots L4392 Replace Afo Soft Interface L4394 Replace Foot Drop Spint L4396 274 Static Or Dynami Afo Pre Cst $204 $133 $158 $67 L4397 Static Or Dynami Afo Pre Ots L4398 Foot Drop Splint Pre Ots L4631 Afo, Walk Boot Type, Cus Fab L5000 Sho Insert W Arch Toe Filler L5010 Mold Socket Ank Hgt W/ Toe F L5020 Tibial Tubercle Hgt W/ Toe F L5050 Ank Symes Mold Sckt Sach Ft L5060 Symes Met Fr Leath Socket Ar L5100 Molded Socket Shin Sach Foot L5105 Plast Socket Jts/Thgh Lacer L5150 Mold Sckt Ext Knee Shin Sach L5160 Mold Socket Bent Knee Shin S L5200 Kne Sing Axis Fric Shin Sach L5210 No Knee/Ankle Joints W/ Ft B L5220 No Knee Joint With Artic Ali L5230 Fem Focal Defic Constant Fri L5250 Hip Canad Sing Axi Cons Fric L5270 Tilt Table Locking Hip Sing L5280 Hemipelvect Canad Sing Axis L5301 Bk Mold Socket Sach Ft Endo L5312 Knee Disart, Sach Ft, Endo L5321 Ak Open End Sach L5331 Hip Disart Canadian Sach Ft L5341 Hemipelvectomy Canadian Sach L5400 Postop Dress & 1 Cast Chg Bk L5410 Postop Dsg Bk Ea Add Cast Ch L5420 Postop Dsg & 1 Cast Chg Ak/D L5430 Postop Dsg Ak Ea Add Cast Ch L5450 Postop App Non-Wgt Bear Dsg L5460 Postop App Non-Wgt Bear Dsg L5500 Init Bk Ptb Plaster Direct L5505 Init Ak Ischal Plstr Direct L5510 Prep Bk Ptb Plaster Molded L5520 Perp Bk Ptb Thermopls Direct L5530 Prep Bk Ptb Thermopls Molded L5535 Prep Bk Ptb Open End Socket L5540 Prep Bk Ptb Laminated Socket L5560 Prep Ak Ischial Plast Molded L5570 Prep Ak Ischial Direct Form L5580 Prep Ak Ischial Thermo Mold L5585 Prep Ak Ischial Open End L5590 Prep Ak Ischial Laminated L5595 Hip Disartic Sach Thermopls L5600 Hip Disart Sach Laminat Mold L5610 Above Knee Hydracadence L5611 Ak 4 Bar Link W/Fric Swing L5613 Ak 4 Bar Ling W/Hydraul Swig L5614 4-Bar Link Above Knee W/Swng L5616 Ak Univ Multiplex Sys Frict L5617 Ak/Bk Self-Aligning Unit Ea L5618 Test Socket Symes L5620 Test Socket Below Knee L5622 Test Socket Knee Disarticula L5624 Test Socket Above Knee L5626 Test Socket Hip Disarticulat L5628 Test Socket Hemipelvectomy L5629 Below Knee Acrylic Socket L5630 Syme Typ Expandabl Wall Sckt L5631 Ak/Knee Disartic Acrylic Soc L5632 Symes Type Ptb Brim Design S L5634 Symes Type Poster Opening So L5636 Symes Type Medial Opening So L5637 Below Knee Total Contact L5638 Below Knee Leather Socket L5639 Below Knee Wood Socket L5640 Knee Disarticulat Leather So L5642 Above Knee Leather Socket L5643 Hip Flex Inner Socket Ext Fr L5644 Above Knee Wood Socket L5645 Bk Flex Inner Socket Ext Fra L5646 Below Knee Cushion Socket L5647 Below Knee Suction Socket L5648 Above Knee Cushion Socket L5649 Isch Containmt/Narrow M-L So L5650 Tot Contact Ak/Knee Disart S L5651 Ak Flex Inner Socket Ext Fra L5652 Suction Susp Ak/Knee Disart L5653 Knee Disart Expand Wall Sock L5654 Socket Insert Symes L5655 Socket Insert Below Knee L5656 Socket Insert Knee Articulat L5658 Socket Insert Above Knee L5661 Multi-Durometer Symes L5665 Multi-Durometer Below Knee L5666 Below Knee Cuff Suspension L5668 Bk Molded Distal Cushion L5670 Bk Molded Supracondylar Susp L5671 Bk/Ak Locking Mechanism L5672 Bk Removable Medial Brim Sus L5673 Socket Insert W Lock Mech L5676 Bk Knee Joints Single Axis P L5677 Bk Knee Joints Polycentric P L5678 Bk Joint Covers Pair L5679 Socket Insert W/O Lock Mech L5680 Bk Thigh Lacer Non-Molded L5681 Intl Custm Cong/Latyp Insert L5682 Bk Thigh Lacer Glut/Ischia M L5683 Initial Custom Socket Insert L5684 Bk Fork Strap L5685 Below Knee Sus/Seal Sleeve L5686 Bk Back Check L5688 Bk Waist Belt Webbing L5690 Bk Waist Belt Padded And Lin L5692 Ak Pelvic Control Belt Light L5694 Ak Pelvic Control Belt Pad/L L5695 Ak Sleeve Susp Neoprene/Equa L5696 Ak/Knee Disartic Pelvic Join L5697 Ak/Knee Disartic Pelvic Band L5698 Ak/Knee Disartic Silesian Ba L5699 Shoulder Harness L5700 Replace Socket Below Knee L5701 Replace Socket Above Knee L5702 Replace Socket Hip L5703 Symes Ankle W/O (Sach) Foot L5704 Custom Shape Cover Bk L5705 Custom Shape Cover Ak L5706 Custom Shape Cvr Knee Disart L5707 Custom Shape Cvr Hip Disart L5710 Kne-Shin Exo Sng Axi Mnl Loc L5711 Knee-Shin Exo Mnl Lock Ultra L5712 Knee-Shin Exo Frict Swg & St L5714 Knee-Shin Exo Variable Frict L5716 Knee-Shin Exo Mech Stance Ph L5718 Knee-Shin Exo Frct Swg & Sta L5722 Knee-Shin Pneum Swg Frct Exo L5724 Knee-Shin Exo Fluid Swing Ph L5726 Knee-Shin Ext Jnts Fld Swg E L5728 Knee-Shin Fluid Swg & Stance L5780 Knee-Shin Pneum/Hydra Pneum L5781 Lower Limb Pros Vacuum Pump L5782 Hd Low Limb Pros Vacuum Pump L5785 Exoskeletal Bk Ultralt Mater L5790 Exoskeletal Ak Ultra-Light M L5795 Exoskel Hip Ultra-Light Mate L5810 Endoskel Knee-Shin Mnl Lock L5811 Endo Knee-Shin Mnl Lck Ultra L5812 Endo Knee-Shin Frct Swg & St L5814 Endo Knee-Shin Hydral Swg Ph L5816 Endo Knee-Shin Polyc Mch Sta L5818 Endo Knee-Shin Frct Swg & St L5822 Endo Knee-Shin Pneum Swg Frc L5824 Endo Knee-Shin Fluid Swing P L5826 Miniature Knee Joint L5828 Endo Knee-Shin Fluid Swg/Sta L5830 Endo Knee-Shin Pneum/Swg Pha L5840 Multi-Axial Knee/Shin System L5845 Knee-Shin Sys Stance Flexion L5848 Knee-Shin Sys Hydraul Stance L5850 Endo Ak/Hip Knee Extens Assi L5855 Mech Hip Extension Assist L5856 Elec Knee-Shin Swing/Stance L5857 Elec Knee-Shin Swing Only L5858 Stance Phase Only L5859 Knee-Shin Pro Flex/Ext Cont L5910 Endo Below Knee Alignable Sy L5920 Endo Ak/Hip Alignable System L5925 Above Knee Manual Lock L5930 High Activity Knee Frame L5940 Endo Bk Ultra-Light Material L5950 Endo Ak Ultra-Light Material L5960 Endo Hip Ultra-Light Materia L5961 Endo Poly Hip, Pneu/Hyd/Rot L5962 Below Knee Flex Cover System L5964 Above Knee Flex Cover System L5966 Hip Flexible Cover System L5968 Multiaxial Ankle W Dorsiflex L5969 Ak/Ft Power Asst Incl Motors L5970 Foot External Keel Sach Foot L5971 Sach Foot, Replacement L5972 Flexible Keel Foot L5973 Ank-Foot Sys Dors-Plant Flex L5974 Foot Single Axis Ankle/Foot L5975 Combo Ankle/Foot Prosthesis L5976 Energy Storing Foot L5978 Ft Prosth Multiaxial Ankl/Ft L5979 Multi-Axial Ankle/Ft Prosth L5980 Flex Foot System L5981 Flex-Walk Sys Low Ext Prosth L5982 Exoskeletal Axial Rotation U L5984 Endoskeletal Axial Rotation L5985 Lwr Ext Dynamic Prosth Pylon L5986 Multi-Axial Rotation Unit L5987 Shank Ft W Vert Load Pylon L5988 Vertical Shock Reducing Pylo L5990 User Adjustable Heel Height L5999 Lowr Extremity Prosthes Nos L6000 Part Hand Thumb Rem L6010 Part Hand Little/Ring L6020 Part Hand No Fingers L6026 Part Hand Myo Exclu Term Dev L6050 Wrst Mld Sck Flx Hng Tri Pad L6055 Wrst Mold Sock W/Exp Interfa L6100 Elb Mold Sock Flex Hinge Pad L6110 Elbow Mold Sock Suspension T L6120 Elbow Mold Doub Splt Soc Ste L6130 Elbow Stump Activated Lock H L6200 Elbow Mold Outsid Lock Hinge L6205 Elbow Molded W/ Expand Inter L6250 Elbow Inter Loc Elbow Forarm L6300 Shlder Disart Int Lock Elbow L6310 Shoulder Passive Restor Comp L6320 Shoulder Passive Restor Cap L6350 Thoracic Intern Lock Elbow L6360 Thoracic Passive Restor Comp L6370 Thoracic Passive Restor Cap L6380 Postop Dsg Cast Chg Wrst/Elb L6382 Postop Dsg Cast Chg Elb Dis/ L6384 Postop Dsg Cast Chg Shlder/T L6386 Postop Ea Cast Chg & Realign L6388 Postop Applicat Rigid Dsg On L6400 Below Elbow Prosth Tiss Shap L6450 Elb Disart Prosth Tiss Shap L6500 Above Elbow Prosth Tiss Shap L6550 Shldr Disar Prosth Tiss Shap L6570 Scap Thorac Prosth Tiss Shap L6580 Wrist/Elbow Bowden Cable Mol L6582 Wrist/Elbow Bowden Cbl Dir F L6584 Elbow Fair Lead Cable Molded L6586 Elbow Fair Lead Cable Dir Fo L6588 Shdr Fair Lead Cable Molded L6590 Shdr Fair Lead Cable Direct L6600 Polycentric Hinge Pair L6605 Single Pivot Hinge Pair L6610 Flexible Metal Hinge Pair L6611 Additional Switch, Ext Power L6615 Disconnect Locking Wrist Uni L6616 Disconnect Insert Locking Wr L6620 Flexion/Extension Wrist Unit L6621 Flex/Ext Wrist W/Wo Friction L6623 Spring-Ass Rot Wrst W/ Latch L6624 Flex/Ext/Rotation Wrist Unit L6625 Rotation Wrst W/ Cable Lock L6628 Quick Disconn Hook Adapter O L6629 Lamination Collar W/ Couplin L6630 Stainless Steel Any Wrist L6632 Latex Suspension Sleeve Each L6635 Lift Assist For Elbow L6637 Nudge Control Elbow Lock L6638 Elec Lock On Manual Pw Elbow L6640 Shoulder Abduction Joint Pai L6641 Excursion Amplifier Pulley T L6642 Excursion Amplifier Lever Ty L6645 Shoulder Flexion-Abduction J L6646 Multipo Locking Shoulder Jnt L6647 Shoulder Lock Actuator L6648 Ext Pwrd Shlder Lock/Unlock L6650 Shoulder Universal Joint L6655 Standard Control Cable Extra L6660 Heavy Duty Control Cable L6665 Teflon Or Equal Cable Lining L6670 Hook To Hand Cable Adapter L6672 Harness Chest/Shlder Saddle L6675 Harness Figure Of 8 Sing Con L6676 Harness Figure Of 8 Dual Con L6677 Ue Triple Control Harness L6680 Test Sock Wrist Disart/Bel E L6682 Test Sock Elbw Disart/Above L6684 Test Socket Shldr Disart/Tho L6686 Suction Socket L6687 Frame Typ Socket Bel Elbow/W L6688 Frame Typ Sock Above Elb/Dis L6689 Frame Typ Socket Shoulder Di L6690 Frame Typ Sock Interscap-Tho L6691 Removable Insert Each L6692 Silicone Gel Insert Or Equal L6693 Lockingelbow Forearm Cntrbal L6694 Elbow Socket Ins Use W/Lock L6695 Elbow Socket Ins Use W/O Lck L6696 Cus Elbo Skt In For Con/Atyp L6697 Cus Elbo Skt In Not Con/Atyp L6698 Below/Above Elbow Lock Mech L6703 Term Dev, Passive Hand Mitt L6704 Term Dev, Sport/Rec/Work Att L6706 Term Dev Mech Hook Vol Open L6707 Term Dev Mech Hook Vol Close L6708 Term Dev Mech Hand Vol Open L6709 Term Dev Mech Hand Vol Close L6711 Ped Term Dev, Hook, Vol Open L6712 Ped Term Dev, Hook, Vol Clos L6713 Ped Term Dev, Hand, Vol Open L6714 Ped Term Dev, Hand, Vol Clos L6715 Term Device, Multi Art Digit L6721 Hook/Hand, Hvy Dty, Vol Open L6722 Hook/Hand, Hvy Dty, Vol Clos L6805 Term Dev Modifier Wrist Unit L6810 Term Dev Precision Pinch Dev L6880 Elec Hand Ind Art Digits L6881 Term Dev Auto Grasp Feature L6882 Microprocessor Control Uplmb L6883 Replc Sockt Below E/W Disa L6884 Replc Sockt Above Elbow Disa L6885 Replc Sockt Shldr Dis/Interc L6890 Prefab Glove For Term Device L6895 Custom Glove For Term Device L6900 Hand Restorat Thumb/1 Finger L6905 Hand Restoration Multiple Fi L6910 Hand Restoration No Fingers L6915 Hand Restoration Replacmnt G L6920 Wrist Disarticul Switch Ctrl L6925 Wrist Disart Myoelectronic C L6930 Below Elbow Switch Control L6935 Below Elbow Myoelectronic Ct L6940 Elbow Disarticulation Switch L6945 Elbow Disart Myoelectronic C L6950 Above Elbow Switch Control L6955 Above Elbow Myoelectronic Ct L6960 Shldr Disartic Switch Contro L6965 Shldr Disartic Myoelectronic L6970 Interscapular-Thor Switch Ct L6975 Interscap-Thor Myoelectronic L7007 Adult Electric Hand L7008 Pediatric Electric Hand L7009 Adult Electric Hook L7040 Prehensile Actuator L7045 Pediatric Electric Hook L7170 Electronic Elbow Hosmer Swit L7180 Electronic Elbow Sequential L7181 Electronic Elbo Simultaneous L7185 Electron Elbow Adolescent Sw L7186 Electron Elbow Child Switch L7190 Elbow Adolescent Myoelectron L7191 Elbow Child Myoelectronic Ct L7259 Electronic Wrist Rotator Any L7360 Six Volt Bat Otto Bock/Eq Ea L7362 Battery Chrgr Six Volt Otto L7364 Twelve Volt Battery Utah/Equ L7366 Battery Chrgr 12 Volt Utah/E L7367 Replacemnt Lithium Ionbatter L7368 Lithium Ion Battery Charger L7400 Add Ue Prost Be/Wd, Ultlite L7401 Add Ue Prost A/E Ultlite Mat L7402 Add Ue Prost S/D Ultlite Mat L7403 Add Ue Prost B/E Acrylic L7404 Add Ue Prost A/E Acrylic L7405 Add Ue Prost S/D Acrylic L7499 Upper Extremity Prosthes Nos L7510 Prosthetic Device Repair Rep L7520 Repair Prosthesis Per 15 Min L7600 Prosthetic Donning Sleeve L7700 Pros Soc Insert Gasket/Seal L7900 Male Vacuum Erection System L7902 Tension Ring, Vac Erect Dev L8000 Mastectomy Bra L8001 Breast Prosthesis Bra & Form L8002 Brst Prsth Bra & Bilat Form L8010 Mastectomy Sleeve L8015 Ext Breastprosthesis Garment L8020 Mastectomy Form L8030 Breast Prosthes W/O Adhesive L8031 Breast Prosthesis W Adhesive L8032 Reusable Nipple Prosthesis L8033 Nipple Prosthesis Custom, Ea L8035 Custom Breast Prosthesis L8039 Breast Prosthesis Nos L8040 Nasal Prosthesis L8041 Midfacial Prosthesis L8042 Orbital Prosthesis L8043 Upper Facial Prosthesis L8044 Hemi-Facial Prosthesis L8045 Auricular Prosthesis L8046 Partial Facial Prosthesis L8047 Nasal Septal Prosthesis L8048 Unspec Maxillofacial Prosth L8049 Repair Maxillofacial Prosth L8300 Truss Single W/ Standard Pad L8310 Truss Double W/ Standard Pad L8320 Truss Addition To Std Pad Wa L8330 Truss Add To Std Pad Scrotal L8400 Sheath Below Knee L8410 Sheath Above Knee L8415 Sheath Upper Limb L8417 Pros Sheath/Sock W Gel Cushn L8420 Prosthetic Sock Multi Ply Bk L8430 Prosthetic Sock Multi Ply Ak L8435 Pros Sock Multi Ply Upper Lm L8440 Shrinker Below Knee L8460 Shrinker Above Knee L8465 Shrinker Upper Limb L8470 Pros Sock Single Ply Bk L8480 Pros Sock Single Ply Ak L8485 Pros Sock Single Ply Upper L L8499 Unlisted Misc Prosthetic Ser L8500 Artificial Larynx L8501 272 Tracheostomy Speaking Valve $205 $133 $159 $67 L8505 Artificial Larynx, Accessory L8507 Trach-Esoph Voice Pros Pt In L8509 Trach-Esoph Voice Pros Md In L8510 Voice Amplifier L8511 Indwelling Trach Insert L8512 Gel Cap For Trach Voice Pros L8513 Trach Pros Cleaning Device L8514 Repl Trach Puncture Dilator L8515 Gel Cap App Device For Trach L8600 Implant Breast Silicone/Eq $3,121 $2,028 $2,423 $1,023 L8603 Collagen Imp Urinary 2.5 Ml $997 $648 $774 $327 L8604 Dextranomer/Hyaluronic Acid L8605 Inj Bulking Agent Anal Canal L8606 Synthetic Implnt Urinary 1Ml $1,332 $866 $1,034 $437 L8607 Inj Vocal Cord Bulking Agent L8608 Arg Ii Ext Com/Sup/Acc Misc L8609 Artificial Cornea L8610 Ocular Implant $137 $89 $106 $45 L8612 Aqueous Shunt Prosthesis $1,710 $1,112 $1,328 $560 L8613 Ossicular Implant $89 $58 $69 $29 L8614 Cochlear Device L8615 Coch Implant Headset Replace L8616 Coch Implant Microphone Repl L8617 Coch Implant Trans Coil Repl L8618 Coch Implant Tran Cable Repl L8619 Coch Imp Ext Proc/Contr Rplc L8621 Repl Zinc Air Battery L8622 Repl Alkaline Battery L8623 Lith Ion Batt Cid,Non-Earlvl L8624 Lith Ion Batt Cid, Ear Level L8625 Charger Coch Impl/Aoi Battry L8627 Cid Ext Speech Process Repl L8628 Cid Ext Controller Repl L8629 Cid Transmit Coil And Cable L8630 Metacarpophalangeal Implant L8631 Mcp Joint Repl 2 Pc Or More L8641 Metatarsal Joint Implant $1,206 $784 $936 $395 L8642 Hallux Implant $2,903 $1,887 $2,254 $951 L8658 Interphalangeal Joint Spacer L8659 Interphalangeal Joint Repl $7,256 $4,716 $5,633 $2,378 L8670 Vascular Graft, Synthetic L8679 Imp Neurosti Pls Gn Any Type $40,461 $26,300 $31,412 $13,258 L8680 Implt Neurostim Elctr Each L8681 Pt Prgrm For Implt Neurostim L8682 Implt Neurostim Radiofq Rec L8683 Radiofq Trsmtr For Implt Neu L8684 Radiof Trsmtr Implt Scrl Neu L8685 Implt Nrostm Pls Gen Sng Rec L8686 Implt Nrostm Pls Gen Sng Non L8687 Implt Nrostm Pls Gen Dua Rec L8688 Implt Nrostm Pls Gen Dua Non L8689 External Recharg Sys Intern $2,138 $1,389 $1,659 $700 L8690 Aud Osseo Dev, Int/Ext Comp L8691 Aoi Snd Proc Repl Excl Actua L8692 Non-Osseointegrated Snd Proc L8693 Aud Osseo Dev, Abutment L8694 Aoi Transducer/Actuator Repl L8695 External Recharg Sys Extern L8696 Ext Antenna Phren Nerve Stim L8698 Misc Used With Tot Art Heart L8699 Prosthetic Implant Nos $13,110 $8,522 $10,178 $4,296 $2,016 L8701 Ewh S/D Uprt Micro Sensor L8702 Ewhf S/D Uprt Micro Sensor L9900 O&P Supply/Accessory/Service M0075 Cellular Therapy M0076 Prolotherapy M0100 Intragastric Hypothermia M0239 260 Bamlanivimab-Xxxx Infusion $1,085 $705 $842 $356 M0243 260 Casirivi And Imdevi Infusion $1,085 $705 $842 $356 M0300 Iv Chelationtherapy M0301 Fabric Wrapping Of Aneurysm M1003 Tb Scr 12 Mo Pri Fst Bio Dz M1004 Doc Med Rsn No Srn Tb M1005 Tb Scr No Perf M1006 Dz Not Ases, No Rsn M1007 >=50% Total Pt Outpt Ra Enct M1008 <50% Total Pt Outpt Ra Encts M1009 Dc Eoc Doc Med Rec M1010 Dc Eoc Doc Med Rec M1011 Dc Eoc Doc Med Rec M1012 Dc Eoc Doc Med Rec M1013 Dc Eoc Doc Med Rec M1014 Dc Epi Care Doc Medrec M1015 Dc Eoc Doc Med Rec M1016 Pt Dx Meop Or Sur Steri M1017 Pt Admt To Palitve Serv M1018 Pt Dx Hst Cr Pt Sk Lg Cr Scr M1019 Adl Pt Mj Dep Ds Rs 12 Phq<5 M1020 Adl Pt Mj Dep Ds No Rs 12 Mo M1021 Pt Uc In Pp M1022 Pt Hospice During Perf Pd M1023 Adl Pt Mj Dep Ds Rs 6 Phq<5 M1024 Adl Pt Mj Dep Ds No Rs 6 Mo M1025 Pt Hospice During Perf Pd M1026 Pt Hospice During Perf Pd M1027 Img Head (Ct Or Mri) Obtnd M1028 Doc Of Pt Prm Hda Dx And Otr M1029 Doc Sysm Rsn Img Hd M1031 Pt Clin Ind Img Hd M1032 Adt Tkng Pharmthry For Oud M1033 Pharmthry For Oud Afr 6.30 M1034 Adt 180 Dys Pharmthry Oud M1035 Adt Pd Out Mat Pr 180 Dys Tx M1036 Adt No 180 Dys Pharmthry Oud M1037 Pt Dx Lum Sp Reg Cacr M1038 Pt Dx Lum Sp Reg Fract M1039 Pt Dx Lum Sp Reg Inf M1040 Pt Dx Lum Idi Or Cong Scol M1041 Pt Cr Ft Inf Lm Or Pt Id Sl M1043 Fs No Odi 9-15Mo M1045 Fs Oks 9-15Mo >= 37 >= 71 M1046 Fs Oks 9-15Mo < 37 < 71 M1049 Fs Wth Scr No Odi Pre And P M1051 Pt W/Cancer Scoliosis M1052 Lg Pn Not Meas W/ Vas 1Yr Po M1054 Pt Uc In Pp M1055 Aspirin Used M1056 Presc Antico Med In Pp M1057 Aspirin Not Used, No Rsn M1058 Pt Prm Nurs Hm Res In Pp M1059 Pt No Prm Nurs Hm Res In Pp M1060 Pt Died In Pp M1061 Pt Preg M1062 Pt Imcomprmd M1063 Pt Rec Hg Dos Imsup Thpy M1064 Shing Vac Doc Adm Or Pv Rec M1065 Shing Vac No Adm Clinc Rsn M1066 Shing Vac No Doc No Rsn M1067 Hspc Pt Prv Time Meam Per M1068 Pt Not Ambulatory M1069 Pt Scr Ft Fall Rsk M1070 Pt Not Scrn Fut Fall No Rsn M1071 Pt Had Add'L Sp Pcr Perf M1106 Start Eoc Doc Med Rec M1107 Docu Dx Degen Neuro M1108 Oc Ni Pt Home Prog M1109 Oc Ni Pt Dc M1110 Oc Not P Pt Selfdc M1111 Start Eoc Doc Med Rec M1112 Docu Dx Degen Neuro M1113 Oc Ni Pt Home Prog M1114 Oc Ni Pt Dc M1115 Oc Ni Pt Selfdc M1116 Start Eoc Doc Med Rec M1117 Docu Dx Degen Neuro M1118 Oc Ni Pt Home Prog M1119 Oc Ni Pt Dc M1120 Oc Ni Pt Selfdc M1121 Start Eoc Doc Med Rec M1122 Docu Dx Degen Neuro M1123 Oc Ni Pt Home Prog M1124 Oc Ni Pt Dc 1-2 Vis M1125 Oc Ni Pt Selfdc 1-2 Vis M1126 Start Eoc Doc Med Rec M1127 Docu Dx Degen Neuro M1128 Oc Ni Pt Home Prog M1129 Oc Ni Pt Dc M1130 Oc Ni Pt Selfdc M1131 Docu Dx Degen Neuro M1132 Oc Ni Pt Home Prog M1133 Oc Ni Pt Dc M1134 Oc Ni Pt Selfdc M1135 Start Eoc Doc Med Rec M1136 Start Eoc Doc Med Rec M1137 Docu Dx Degen Neuro M1138 Oc Ni Pt 1-2 Vis M1139 Oc Ni Pt Self Dc 1-2 Vis M1140 Oc Ni Pt Dc 1-2 Vis M1141 Fs No Oks M1142 Emerge Cases M1143 Ni Rehab Med Chiro M1144 Oc No Ind Pt 1-2 Vis M1145 636 Mfn Drug Add-On, Per Dose $521 $339 $404 $171 M1146 Ongoing Care Not Ind M1147 Care Not Poss Med Rsn M1148 Pt Self Dschg M1149 No Neck Fs Prom Incap P2028 Cephalin Floculation Test P2029 Congo Red Blood Test P2031 Hair Analysis P2033 Blood Thymol Turbidity P2038 Blood Mucoprotein P3000 Screen Pap By Tech W Md Supv P3001 Screening Pap Smear By Phys P7001 Culture Bacterial Urine P9010 Whole Blood For Transfusion P9011 Blood Split Unit P9012 390 Cryoprecipitate Each Unit $462 $300 $359 $151 P9016 390 Rbc Leukocytes Reduced $770 $501 $598 $252 P9017 390 Plasma 1 Donor Frz W/In 8 Hr $270 $176 $210 $88 P9019 390 Platelets, Each Unit $198 $129 $154 $65 P9020 Plaelet Rich Plasma Unit P9021 390 Red Blood Cells Unit $462 $300 $359 $151 P9022 390 Washed Red Blood Cells Unit $1,219 $792 $946 $399 P9023 Frozen Plasma, Pooled, Sd P9031 Platelets Leukocytes Reduced P9032 Platelets, Irradiated P9033 Platelets Leukoreduced Irrad P9034 390 Platelets, Pheresis $1,219 $792 $946 $399 P9035 390 Platelet Pheres Leukoreduced $2,538 $1,650 $1,970 $830 P9036 390 Platelet Pheresis Irradiated $1,247 $811 $968 $408 P9037 390 Plate Pheres Leukoredu Irrad $2,218 $1,442 $1,722 $726 P9038 390 Rbc Irradiated $563 $366 $437 $184 P9039 390 Rbc Deglycerolized $1,313 $853 $1,019 $430 P9040 390 Rbc Leukoreduced Irradiated $830 $540 $644 $272 P9041 Albumin (Human),5%, 50Ml P9043 Plasma Protein Fract,5%,50Ml P9044 Cryoprecipitatereducedplasma P9045 Albumin (Human), 5%, 250 Ml $93 $60 $72 $30 P9046 Albumin (Human), 25%, 20 Ml P9047 Albumin (Human), 25%, 50Ml $143 $93 $111 $47 P9048 Plasmaprotein Fract,5%,250Ml P9050 390 Granulocytes, Pheresis Unit $6,169 $4,010 $4,789 $2,021 P9051 390 Blood, L/R, Cmv-Neg $793 $515 $616 $259 P9052 Platelets, Hla-M, L/R, Unit P9053 Plt, Pher, L/R Cmv-Neg, Irr P9054 Blood, L/R, Froz/Degly/Wash P9055 Plt, Aph/Pher, L/R, Cmv-Neg P9056 Blood, L/R, Irradiated P9057 Rbc, Frz/Deg/Wsh, L/R, Irrad P9058 Rbc, L/R, Cmv-Neg, Irrad P9059 390 Plasma, Frz Between 8-24Hour $290 $189 $225 $95 P9060 Fr Frz Plasma Donor Retested P9070 Pathogen Reduced Plasma Pool P9071 Pathogen Reduced Plasma Sing P9073 Platelets Pheresis Path Redu P9099 Blood Component/Product Noc P9100 Pathogen Test For Platelets P9603 One-Way Allow Prorated Miles P9604 310 One-Way Allow Prorated Trip $0 $0 $10 P9612 Catheterize For Urine Spec P9615 Urine Specimen Collect Mult Q0035 Cardiokymography Q0035 Cardiokymography Q0035 Cardiokymography Q0081 Infusion Ther Other Than Che Q0083 Chemo By Other Than Infusion Q0084 Chemotherapy By Infusion Q0085 Chemo By Both Infusion And O Q0091 510 Obtaining Screen Pap Smear $89 $58 $69 $29 Q0092 Set Up Port Xray Equipment Q0111 Wet Mounts/ W Preparations Q0112 Potassium Hydroxide Preps Q0113 Pinworm Examinations Q0114 300 Fern Test $28 $18 $22 $9 Q0115 Post-Coital Mucous Exam Q0138 Ferumoxytol, Non-Esrd Q0139 Ferumoxytol, Esrd Use Q0144 Azithromycin Dihydrate, Oral $75 $49 $58 $25 Q0161 Chlorpromazine Hcl 5Mg Oral $12 $8 $9 $4 Q0162 Ondansetron Oral Q0163 Diphenhydramine Hcl 50Mg $0 $0 $0 $0 Q0164 Prochlorperazine Maleate 5Mg $1 $0 $1 $0 Q0166 Granisetron Hcl 1 Mg Oral Q0167 Dronabinol 2.5Mg Oral Q0169 Promethazine Hcl 12.5Mg Oral $1 $1 $1 $0 Q0173 Trimethobenzamide Hcl 250Mg Q0174 Thiethylperazine Maleate10Mg Q0175 Perphenazine 4Mg Oral Q0177 Hydroxyzine Pamoate 25Mg Q0180 Dolasetron Mesylate Oral Q0181 Unspecified Oral Anti-Emetic Q0239 Bamlanivimab-Xxxx Q0243 Casirivimab And Imdevimab Q0477 Pwr Module Pt Cable Lvad Rpl Q0478 Power Adapter, Combo Vad Q0479 Power Module Combo Vad, Rep Q0480 Driver Pneumatic Vad, Rep Q0481 Microprcsr Cu Elec Vad, Rep Q0482 Microprcsr Cu Combo Vad, Rep Q0483 Monitor Elec Vad, Rep Q0484 Monitor Elec Or Comb Vad Rep Q0485 Monitor Cable Elec Vad, Rep Q0486 Mon Cable Elec/Pneum Vad Rep Q0487 Leads Any Type Vad, Rep Only Q0488 Pwr Pack Base Elec Vad, Rep Q0489 Pwr Pck Base Combo Vad, Rep Q0490 Emr Pwr Source Elec Vad, Rep Q0491 Emr Pwr Source Combo Vad Rep Q0492 Emr Pwr Cbl Elec Vad, Rep Q0493 Emr Pwr Cbl Combo Vad, Rep Q0494 Emr Hd Pmp Elec/Combo, Rep Q0495 Charger Elec/Combo Vad, Rep Q0496 Battery Elec/Combo Vad, Rep Q0497 Bat Clps Elec/Comb Vad, Rep Q0498 Holster Elec/Combo Vad, Rep Q0499 Belt/Vest Elec/Combo Vad Rep Q0500 Filters Elec/Combo Vad, Rep Q0501 Shwr Cov Elec/Combo Vad, Rep Q0502 Mobility Cart Pneum Vad, Rep Q0503 Battery Pneum Vad Replacemnt Q0504 Pwr Adpt Pneum Vad, Rep Veh Q0506 Lith-Ion Batt Elec/Pneum Vad Q0507 Misc Sup/Acc Ext Vad Q0508 Mis Sup/Acc Imp Vad Q0509 Mis Sup/Ac Imp Vad Nopay Med Q0510 Dispens Fee Immunosupressive Q0511 Sup Fee Antiem,Antica,Immuno Q0512 Px Sup Fee Anti-Can Sub Pres Q0513 Disp Fee Inhal Drugs/30 Days Q0514 Disp Fee Inhal Drugs/90 Days Q0515 Sermorelin Acetate Injection Q1004 Ntiol Category 4 Q1005 Ntiol Category 5 Q2004 Bladder Calculi Irrig Sol Q2009 Fosphenytoin Inj Pe Q2017 Teniposide, 50 Mg Q2026 Radiesse Injection Q2028 Inj, Sculptra, 0.5Mg Q2034 Agriflu Vaccine Q2035 Afluria Vacc, 3 Yrs & >, Im Q2036 Flulaval Vacc, 3 Yrs & >, Im Q2037 Fluvirin Vacc, 3 Yrs & >, Im Q2038 Fluzone Vacc, 3 Yrs & >, Im Q2039 Influenza Virus Vaccine, Nos Q2041 Axicabtagene Ciloleucel Car+ Q2042 Tisagenlecleucel Car-Pos T Q2043 Sipuleucel-T Auto Cd54+ Q2049 Imported Lipodox Inj Q2050 Doxorubicin Inj 10Mg Q2052 Ivig Demo, Services/Supplies Q3001 Brachytherapy Radioelements Q3014 510 Telehealth Facility Fee $58 $38 $45 $19 Q3027 Inj Beta Interferon Im 1 Mcg Q3028 Inj Beta Interferon Sq 1 Mcg Q3031 Collagen Skin Test Q4001 Cast Sup Body Cast Plaster Q4002 Cast Sup Body Cast Fiberglas Q4003 Cast Sup Shoulder Cast Plstr Q4004 Cast Sup Shoulder Cast Fbrgl Q4005 271 Cast Sup Long Arm Adult Plst $49 $32 $38 $16 Q4006 271 Cast Sup Long Arm Adult Fbrg $103 $67 $80 $34 Q4007 Cast Sup Long Arm Ped Plster Q4008 271 Cast Sup Long Arm Ped Fbrgls $77 $50 $60 $25 Q4009 Cast Sup Sht Arm Adult Plstr Q4010 271 Cast Sup Sht Arm Adult Fbrgl $80 $52 $62 $26 Q4011 271 Cast Sup Sht Arm Ped Plaster $16 $10 $12 $5 Q4012 271 Cast Sup Sht Arm Ped Fbrglas $72 $47 $56 $24 Q4013 Cast Sup Gauntlet Plaster Q4014 271 Cast Sup Gauntlet Fiberglass $34 $22 $27 $11 Q4015 Cast Sup Gauntlet Ped Plster Q4016 Cast Sup Gauntlet Ped Fbrgls Q4017 Cast Sup Lng Arm Splint Plst Q4018 Cast Sup Lng Arm Splint Fbrg Q4019 Cast Sup Lng Arm Splnt Ped P Q4020 Cast Sup Lng Arm Splnt Ped F Q4021 Cast Sup Sht Arm Splint Plst Q4022 270 Cast Sup Sht Arm Splint Fbrg $22 $14 $17 $7 Q4023 Cast Sup Sht Arm Splnt Ped P Q4024 Cast Sup Sht Arm Splnt Ped F Q4025 Cast Sup Hip Spica Plaster Q4026 Cast Sup Hip Spica Fiberglas Q4027 Cast Sup Hip Spica Ped Plstr Q4028 Cast Sup Hip Spica Ped Fbrgl Q4029 Cast Sup Long Leg Plaster Q4030 271 Cast Sup Long Leg Fiberglass $100 $65 $77 $33 Q4031 Cast Sup Lng Leg Ped Plaster Q4032 271 Cast Sup Lng Leg Ped Fbrgls $58 $38 $45 $19 Q4033 Cast Sup Lng Leg Cylinder Pl Q4034 Cast Sup Lng Leg Cylinder Fb Q4035 Cast Sup Lngleg Cylndr Ped P Q4036 Cast Sup Lngleg Cylndr Ped F Q4037 Cast Sup Shrt Leg Plaster Q4038 270 Cast Sup Shrt Leg Fiberglass $53 $35 $41 $17 Q4039 271 Cast Sup Shrt Leg Ped Plster $14 $9 $11 $5 Q4040 271 Cast Sup Shrt Leg Ped Fbrgls $37 $24 $29 $12 Q4041 Cast Sup Lng Leg Splnt Plstr Q4042 Cast Sup Lng Leg Splnt Fbrgl Q4043 Cast Sup Lng Leg Splnt Ped P Q4044 Cast Sup Lng Leg Splnt Ped F Q4045 Cast Sup Sht Leg Splnt Plstr Q4046 Cast Sup Sht Leg Splnt Fbrgl Q4047 Cast Sup Sht Leg Splnt Ped P Q4048 Cast Sup Sht Leg Splnt Ped F Q4049 270 Finger Splint, Static $15 $10 $12 $5 Q4050 Cast Supplies Unlisted $15 $9 $11 $5 Q4051 Splint Supplies Misc Q4074 Iloprost Non-Comp Unit Dose Q4081 Epoetin Alfa, 100 Units Esrd Q4082 Drug/Bio Noc Part B Drug Cap Q4100 Skin Substitute, Nos $89 $58 $69 $29 Q4101 636 Apligraf $174 $113 $135 $57 Q4102 636 Oasis Wound Matrix $74 $48 $57 $24 Q4103 Oasis Burn Matrix Q4104 Integra Bmwd $337 $219 $262 $111 Q4105 636 Integra Drt Or Omnigraft $263 $171 $204 $86 Q4106 Dermagraft Q4107 Graftjacket $96 $62 $75 $31 Q4108 Integra Matrix Q4110 636 Primatrix $79 $51 $61 $26 Q4111 Gammagraft Q4112 Cymetra Injectable Q4113 Graftjacket Xpress $4,606 $2,994 $3,576 $1,509 Q4114 Integra Flowable Wound Matri Q4115 Alloskin Q4116 Alloderm $88 $57 $68 $29 $21 Q4117 Hyalomatrix Q4118 Matristem Micromatrix Q4121 636 Theraskin $154 $100 $120 $50 Q4122 Dermacell, Awm, Porous Sq Cm Q4123 Alloskin Q4124 Oasis Tri-Layer Wound Matrix Q4125 Arthroflex $464 $301 $360 $152 Q4126 Memoderm/Derma/Tranz/Integup Q4127 Talymed Q4128 636 Flexhd/Allopatchhd/Matrixhd $82 $53 $64 $27 Q4130 Strattice Tm $76 $49 $59 $25 Q4132 636 Grafix Core, Grafixpl Core $510 $331 $396 $167 Q4133 636 Grafix Stravix Prime Pl Sqcm $543 $353 $421 $178 Q4134 Hmatrix Q4135 Mediskin Q4136 Ezderm Q4137 636 Amnioexcel Biodexcel 1Sq Cm $330 $215 $256 $108 Q4138 Biodfence Dryflex, 1Cm Q4139 Amnio Or Biodmatrix, Inj 1Cc Q4140 Biodfence 1Cm Q4141 Alloskin Ac, 1 Cm Q4142 Xcm Biologic Tiss Matrix 1Cm $93 $61 $72 $31 Q4143 Repriza, 1Cm Q4145 Epifix, Inj, 1Mg Q4146 Tensix, 1Cm Q4147 Architect Ecm Px Fx 1 Sq Cm Q4148 Neox Neox Rt Or Clarix Cord Q4149 Excellagen, 0.1 Cc Q4150 Allowrap Ds Or Dry 1 Sq Cm $379 $246 $294 $124 Q4151 Amnioband, Guardian 1 Sq Cm $2,788 $1,812 $2,164 $914 Q4152 Dermapure 1 Square Cm Q4153 Dermavest, Plurivest Sq Cm Q4154 Biovance 1 Square Cm Q4155 Neoxflo Or Clarixflo 1 Mg Q4156 Neox 100 Or Clarix 100 Q4157 Revitalon 1 Square Cm Q4158 Kerecis Omega3, Per Sq Cm Q4159 Affinity1 Square Cm $1,320 $858 $1,025 $433 Q4160 Nushield 1 Square Cm $1,481 $963 $1,150 $485 Q4161 Bio-Connekt Per Square Cm Q4162 Wndex Flw, Bioskn Flw, 0.5Cc Q4163 Woundex, Bioskin, Per Sq Cm Q4164 Helicoll, Per Square Cm Q4165 Keramatrix, Kerasorb Sq Cm Q4166 Cytal, Per Square Centimeter Q4167 Truskin, Per Sq Centimeter Q4168 Amnioband, 1 Mg $8,299 $5,394 $6,443 $2,719 Q4169 Artacent Wound, Per Sq Cm Q4170 Cygnus, Per Sq Cm Q4171 Interfyl, 1 Mg Q4173 Palingen Or Palingen Xplus Q4174 Palingen Or Promatrx Q4175 Miroderm $189 $123 $147 $62 Q4176 Neopatch Or Therion, 1 Sq Cm Q4177 Floweramnioflo, 0.1 Cc Q4178 Floweramniopatch, Per Sq Cm Q4179 Flowerderm, Per Sq Cm Q4180 Revita, Per Sq Cm Q4181 Amnio Wound, Per Square Cm Q4182 Transcyte, Per Sq Centimeter Q4183 Surgigraft, 1 Sq Cm Q4184 Cellesta Or Duo Per Sq Cm Q4185 Cellesta Flowab Amnion 0.5Cc Q4186 Epifix 1 Sq Cm Q4187 Epicord 1 Sq Cm Q4188 Amnioarmor 1 Sq Cm Q4189 Artacent Ac, 1 Mg Q4190 Artacent Ac 1 Sq Cm Q4191 Restorigin 1 Sq Cm Q4192 Restorigin, 1 Cc Q4193 Coll-E-Derm 1 Sq Cm Q4194 Novachor 1 Sq Cm Q4195 Puraply 1 Sq Cm Q4196 Puraply Am 1 Sq Cm Q4197 Puraply Xt 1 Sq Cm Q4198 Genesis Amnio Membrane 1Sqcm Q4200 Skin Te 1 Sq Cm Q4201 Matrion 1 Sq Cm Q4202 Keroxx (2.5G/Cc), 1Cc Q4203 Derma-Gide, 1 Sq Cm Q4204 Xwrap 1 Sq Cm Q4205 Membrane Graft Or Wrap Sq Cm Q4206 Fluid Flow Or Fluid Gf 1 Cc Q4208 Novafix Per Sq Cm Q4209 Surgraft Per Sq Cm Q4210 Axolotl Graf Dualgraf Sq Cm Q4211 Amnion Bio Or Axobio Sq Cm Q4212 Allogen, Per Cc Q4213 Ascent, 0.5 Mg Q4214 Cellesta Cord Per Sq Cm Q4215 Axolotl Ambient, Cryo 0.1 Mg Q4216 Artacent Cord Per Sq Cm Q4217 Woundfix Biowound Plus Xplus Q4218 Surgicord Per Sq Cm Q4219 Surgigraft Dual Per Sq Cm Q4220 Bellacell Hd, Surederm Sq Cm Q4221 Amniowrap2 Per Sq Cm Q4222 Progenamatrix, Per Sq Cm Q4226 Myown Harv Prep Proc Sq Cm Q4227 Amniocore Per Sq Cm Q4228 Bionextpatch, Per Sq Cm Q4229 Cogenex Amnio Memb Per Sq Cm Q4230 Cogenex Flow Amnion 0.5 Cc Q4231 Corplex P, Per Cc Q4232 Corplex, Per Sq Cm Q4233 Surfactor /Nudyn Per 0.5 Cc Q4234 Xcellerate, Per Sq Cm Q4235 Amniorepair Or Altiply Sq Cm Q4236 Carepatch Per Sq Cm Q4237 Cryo-Cord, Per Sq Cm Q4238 Derm-Maxx, Per Sq Cm Q4239 Amnio-Maxx Or Lite Per Sq Cm Q4240 Corecyte Topical Only 0.5 Cc Q4241 Polycyte, Topical Only 0.5Cc Q4242 Amniocyte Plus, Per 0.5 Cc Q4244 Procenta, Per 200 Mg Q4245 Amniotext, Per Cc Q4246 Coretext Or Protext, Per Cc Q4247 Amniotext Patch, Per Sq Cm Q4248 Dermacyte Amn Mem Allo Sq Cm Q4249 Amniply, Per Sq Cm Q4250 Amnioamp-Mp Per Sq Cm Q4254 Novafix Dl Per Sq Cm Q4255 Reguard, Topical Use Per Sq Q5001 Hospice Or Home Hlth In Home Q5002 Hospice/Home Hlth In Asst Lv Q5003 Hospice In Lt/Non-Skilled Nf Q5004 Hospice In Snf Q5005 Hospice, Inpatient Hospital Q5006 Hospice In Hospice Facility Q5007 Hospice In Ltch Q5008 Hospice In Inpatient Psych Q5009 Hospice/Home Hlth, Place Nos Q5010 Hospice Home Care In Hospice Q5101 Injection, Zarxio $832 $541 $646 $273 $1 Q5103 Injection, Inflectra $579 $376 $449 $190 $153 Q5104 Injection, Renflexis $1,079 $701 $837 $353 $59 Q5105 Inj Retacrit Esrd On Dialysi Q5106 Inj Retacrit Non-Esrd Use $485 $315 $377 $159 $12 Q5107 Inj Mvasi 10 Mg $5,713 $3,713 $4,435 $1,872 $28 Q5108 Injection, Fulphila Q5109 Injection, Ixifi, 10 Mg Q5110 Nivestym Q5111 Injection, Udenyca 0.5 Mg $17,278 $11,231 $13,413 $5,661 $201 Q5112 Inj Ontruzant 10 Mg Q5113 Inj Herzuma 10 Mg Q5114 Inj Ogivri 10 Mg $16,791 $10,914 $13,036 $5,502 $178 Q5115 Inj Truxima 10 Mg $4,389 $2,853 $3,407 $1,438 $340 Q5116 Inj., Trazimera, 10 Mg Q5117 Inj., Kanjinti, 10 Mg $17,643 $11,468 $13,697 $5,781 $171 Q5118 Inj., Zirabev, 10 Mg Q5119 Inj Ruxience, 10 Mg $20,814 $13,529 $16,159 $6,820 $45 Q5120 Inj Pegfilgrastim-Bmez 0.5Mg Q5121 Inj. Avsola, 10 Mg Q5122 Inj, Nyvepria Q9001 Va Chaplain Assessment Q9002 Va Chaplain Counsel Individu Q9003 Va Chaplain Counsel Group Q9950 Inj Sulf Hexa Lipid Microsph Q9951 Locm >= 400 Mg/Ml Iodine,1Ml Q9953 Inj Fe-Based Mr Contrast,1Ml Q9954 Oral Mr Contrast, 100 Ml Q9955 Inj Perflexane Lip Micros,Ml Q9956 Inj Octafluoropropane Mic,Ml Q9957 Inj Perflutren Lip Micros,Ml $195 $127 $151 $64 Q9958 Hocm <=149 Mg/Ml Iodine, 1Ml Q9959 Hocm 150-199Mg/Ml Iodine,1Ml Q9960 Hocm 200-249Mg/Ml Iodine,1Ml Q9961 Hocm 250-299Mg/Ml Iodine,1Ml Q9962 Hocm 300-349Mg/Ml Iodine,1Ml Q9963 Hocm 350-399Mg/Ml Iodine,1Ml Q9964 Hocm>= 400Mg/Ml Iodine, 1Ml Q9965 Locm 100-199Mg/Ml Iodine,1Ml Q9966 Locm 200-299Mg/Ml Iodine,1Ml Q9967 Locm 300-399Mg/Ml Iodine,1Ml Q9968 Visualization Adjunct $108 $70 $84 $35 Q9969 Non-Heu Tc-99M Add-On/Dose Q9982 Flutemetamol F18 Diagnostic Q9983 Florbetaben F18 Diagnostic Q9991 Buprenorph Xr 100 Mg Or Less Q9992 Buprenorphine Xr Over 100 Mg R0070 Transport Portable X-Ray R0075 Transport Port X-Ray Multipl R0076 Transport Portable Ekg S0012 Butorphanol Tartrate, Nasal S0013 Esketamine, Nasal Spray S0014 Tacrine Hydrochloride, 10 Mg S0017 Injection, Aminocaproic Acid S0020 Injection, Bupivicaine Hydro S0021 Injection, Cefoperazone Sod S0023 Injection, Cimetidine Hydroc S0028 Injection, Famotidine, 20 Mg S0030 Injection, Metronidazole $9 $6 $7 $3 S0032 Injection, Nafcillin Sodium S0034 Injection, Ofloxacin, 400 Mg S0039 Injection, Sulfamethoxazole $34 $22 $27 $11 S0040 Injection, Ticarcillin Disod S0073 Injection, Aztreonam, 500 Mg $156 $101 $121 $51 S0074 Injection, Cefotetan Disodiu S0077 Injection, Clindamycin Phosp $25 $16 $19 $8 S0078 Injection, Fosphenytoin Sodi S0080 Injection, Pentamidine Iseth S0081 Injection, Piperacillin Sodi S0088 Imatinib 100 Mg S0090 Sildenafil Citrate, 25 Mg S0091 Granisetron 1Mg S0092 Hydromorphone 250 Mg S0093 Morphine 500 Mg S0104 Zidovudine, Oral, 100 Mg S0106 Bupropion Hcl Sr 60 Tablets S0108 Mercaptopurine 50 Mg S0109 Methadone Oral 5Mg S0117 Tretinoin Topical 5 G S0119 Ondansetron 4 Mg $8 $5 $6 $3 S0122 Inj Menotropins 75 Iu S0126 Inj Follitropin Alfa 75 Iu S0128 Inj Follitropin Beta 75 Iu S0132 Inj Ganirelix Acetat 250 Mcg S0136 Clozapine, 25 Mg S0137 Didanosine, 25 Mg S0138 Finasteride, 5 Mg S0139 Minoxidil, 10 Mg S0140 Saquinavir, 200 Mg S0142 Colistimethate Inh Sol Mg S0145 Peg Interferon Alfa-2A/180 S0148 Peg Interferon Alfa-2B/10 S0155 Epoprostenol Dilutant S0156 Exemestane, 25 Mg S0157 Becaplermin Gel 1%, 0.5 Gm S0160 Dextroamphetamine S0164 Injection Pantroprazole S0166 Inj Olanzapine 2.5Mg $84 $55 $65 $28 S0169 Calcitrol S0170 Anastrozole 1 Mg S0171 Bumetanide 0.5 Mg $16 $10 $12 $5 S0172 Chlorambucil 2 Mg S0174 Dolasetron 50 Mg S0175 Flutamide 125 Mg S0176 Hydroxyurea 500 Mg S0177 Levamisole 50 Mg S0178 Lomustine 10 Mg S0179 Megestrol 20 Mg S0182 Procarbazine, Oral S0183 Prochlorperazine 5 Mg S0187 Tamoxifen 10 Mg S0189 Testosterone Pellet 75 Mg S0190 Mifepristone, Oral, 200 Mg S0191 Misoprostol, Oral, 200 Mcg S0194 Vitamin Suppl 100 Caps S0197 Prenatal Vitamins 30 Day S0199 Med Abortion Inc All Ex Drug S0201 Partial Hospitalization Serv S0207 Paramedicintercep Nonhospals S0208 Paramed Intrcept Nonvol S0209 Wc Van Mileage Per Mi S0215 Nonemerg Transp Mileage S0220 Medical Conference By Physic S0221 Medical Conference, 60 Min S0250 Comp Geriatr Assmt Team S0255 Hospice Refer Visit Nonmd S0257 End Of Life Counseling S0260 H&P For Surgery S0265 Genetic Counsel 15 Mins S0270 Home Std Case Rate 30 Days S0271 Home Hospice Case 30 Days S0272 Home Episodic Case 30 Days S0273 Md Home Visit Outside Cap S0274 Nurse Practr Visit Outs Cap S0280 Medical Home, Initial Plan S0281 Medical Home, Maintenance S0285 983 Cnslt Before Screen Colonosc $331 $215 $257 $109 $31 S0302 Completed Epsdt S0310 Hospitalist Visit S0311 Comp Mgmt Care Coord Adv Ill S0315 Disease Management Program S0316 Follow-Up/Reassessment S0317 Disease Mgmt Per Diem S0320 Rn Telephone Calls To Dmp S0340 Lifestyle Mod 1St Stage S0341 Lifestyle Mod 2 Or 3 Stage S0342 Lifestyle Mod 4Th Stage S0353 Cancer Treatmentplan Initial S0354 Cancer Treatment Plan Change S0390 Rout Foot Care Per Visit S0395 Impression Casting Ft S0400 Global Eswl Kidney S0500 Dispos Cont Lens S0504 Singl Prscrp Lens S0506 Bifoc Prscp Lens S0508 Trifoc Prscrp Lens S0510 Non-Prscrp Lens S0512 Daily Cont Lens S0514 Color Cont Lens S0515 Scleral Lens Liquid Bandage S0516 Safety Frames S0518 Sunglass Frames S0580 Polycarb Lens S0581 Nonstnd Lens S0590 Misc Integral Lens Serv S0592 Comp Cont Lens Eval S0595 New Lenses In Pts Old Frame S0596 Phakic Iol Refractive Error S0601 Screening Proctoscopy S0610 Annual Gynecological Examina S0612 Annual Gynecological Examina S0613 Ann Breast Exam S0618 Audiometry For Hearing Aid S0620 Routine Ophthalmological Exa S0621 Routine Ophthalmological Exa S0622 Phys Exam For College S0630 Removal Of Sutures S0800 Laser In Situ Keratomileusis S0810 Photorefractive Keratectomy S0812 Phototherap Keratect S1001 Deluxe Item S1002 Custom Item S1015 Iv Tubing Extension Set $31 $20 $24 $10 S1016 Non-Pvc Intravenous Administ S1030 Gluc Monitor Purchase S1031 Gluc Monitor Rental S1034 Art Pancreas System S1035 Art Pancreas Inv Disp Sensor S1036 Art Pancreas Ext Transmitter S1037 Art Pancreas Ext Receiver S1040 Cranial Remolding Orthosis S2053 Transplantation Of Small Int S2054 Transplantation Of Multivisc S2055 Harvesting Of Donor Multivis S2060 Lobar Lung Transplantation S2061 Donor Lobectomy (Lung) S2065 Simult Panc Kidn Trans S2066 Breast Gap Flap Reconst S2067 Breast Stacked Diep/Gap S2068 Breast Diep Or Siea Flap S2070 Cysto Laser Tx Ureteral Calc S2079 Lap Esophagomyotomy S2080 Laup S2083 361 Adjustment Gastric Band $245 $159 $190 $80 S2095 Transcath Emboliz Microspher S2102 Islet Cell Tissue Transplant S2103 Adrenal Tissue Transplant S2107 Adoptive Immunotherapy S2112 Knee Arthroscp Harv S2115 Periacetabular Osteotomy S2117 Arthroereisis, Subtalar S2118 Total Hip Resurfacing S2120 Low Density Lipoprotein(Ldl) S2140 Cord Blood Harvesting S2142 Cord Blood-Derived Stem-Cell S2150 Bmt Harv/Transpl 28D Pkg S2152 Solid Organ Transpl Pkg S2202 Echosclerotherapy S2205 Minimally Invasive Direct Co S2206 Minimally Invasive Direct Co S2207 Minimally Invasive Direct Co S2208 Minimally Invasive Direct Co S2209 Minimally Invasive Direct Co S2225 Myringotomy Laser-Assist S2230 Implant Semi-Imp Hear S2235 Implant Auditory Brain Imp S2260 Induced Abortion 17-24 Weeks S2265 Induced Abortion 25-28 Wks S2266 Induced Abortion 29-31 Wks S2267 Induced Abortion 32 Or More S2300 Arthroscopy, Shoulder, Surgi S2325 Hip Core Decompression S2340 Chemodenervation Of Abductor S2341 Chemodenerv Adduct Vocal S2342 Nasal Endoscop Po Debrid S2348 Decompress Disc Rf Lumbar S2350 Diskectomy, Anterior, With D S2351 Diskectomy, Anterior, With D S2400 Fetal Surg Congen Hernia S2401 Fetal Surg Urin Trac Obstr S2402 Fetal Surg Cong Cyst Malf S2403 Fetal Surg Pulmon Sequest S2404 Fetal Surg Myelomeningo S2405 Fetal Surg Sacrococ Teratoma S2409 Fetal Surg Noc S2411 Fetoscop Laser Ther Ttts S2900 Robotic Surgical System $0 $0 $0 $0 $0 S3000 Bilat Dil Retinal Exam S3005 Eval Self-Assess Depression S3600 Stat Lab S3601 Stat Lab Home/Nf S3620 Newborn Metabolic Screening S3630 Eosinophil Blood Count S3645 Hiv-1 Antibody Testing Of Or S3650 Saliva Test, Hormone Level; S3652 Saliva Test, Hormone Level; S3655 Antisperm Antibodies Test S3708 Gastrointestinal Fat Absorpt S3722 Dose Optimization Auc - 5Fu S3800 Genetic Testing Als S3840 Dna Analysis Ret-Oncogene S3841 Gene Test Retinoblastoma S3842 Gene Test Hippel-Lindau S3844 Dna Analysis Deafness S3845 Gene Test Alpha-Thalassemia S3846 Gene Test Beta-Thalassemia S3849 Gene Test Niemann-Pick S3850 Gene Test Sickle Cell S3852 Dna Analysis Apoe Alzheimer S3853 Gene Test Myo Musclr Dyst S3854 Gene Profile Panel Breast S3861 Genetic Test Brugada S3865 Comp Genet Test Hyp Cardiomy S3866 Spec Gene Test Hyp Cardiomy S3870 Cgh Test Developmental Delay S3900 Surface Emg S3902 Ballistocardiogram S3904 Masters Two Step S4005 Interim Labor Facility Globa S4011 Ivf Package S4013 Compl Gift Case Rate S4014 Compl Zift Case Rate S4015 Complete Ivf Nos Case Rate S4016 Frozen Ivf Case Rate S4017 Ivf Canc A Stim Case Rate S4018 F Emb Trns Canc Case Rate S4020 Ivf Canc A Aspir Case Rate S4021 Ivf Canc P Aspir Case Rate S4022 Asst Oocyte Fert Case Rate S4023 Incompl Donor Egg Case Rate S4025 Donor Serv Ivf Case Rate S4026 Procure Donor Sperm S4027 Store Prev Froz Embryos S4028 Microsurg Epi Sperm Asp S4030 Sperm Procure Init Visit S4031 Sperm Procure Subs Visit S4035 Stimulated Iui Case Rate S4037 Cryo Embryo Transf Case Rate S4040 Monit Store Cryo Embryo 30 D S4042 Ovulation Mgmt Per Cycle S4981 Insert Levonorgestrel Ius S4989 Contracept Iud S4990 Nicotine Patch Legend S4991 Nicotine Patch Nonlegend S4993 Contraceptive Pills For Bc S4995 Smoking Cessation Gum S5000 Prescription Drug, Generic S5001 Prescription Drug,Brand Name S5010 5% Dextrose And 0.45% Saline $42 $28 $33 $14 S5012 5% Dextrose With Potassium S5013 5%Dextrose/0.45%Saline1000Ml S5014 D5W/0.45Ns W Kcl And Mgs04 S5035 Hit Routine Device Maint S5036 Hit Device Repair S5100 Adult Daycare Services 15Min S5101 Adult Day Care Per Half Day S5102 Adult Day Care Per Diem S5105 Centerbased Day Care Perdiem S5108 Homecare Train Pt 15 Min S5109 Homecare Train Pt Session S5110 Family Homecare Training 15M S5111 Family Homecare Train/Sessio S5115 Nonfamily Homecare Train/15M S5116 Nonfamily Hc Train/Session S5120 Chore Services Per 15 Min S5121 Chore Services Per Diem S5125 Attendant Care Service /15M S5126 Attendant Care Service /Diem S5130 Homaker Service Nos Per 15M S5131 Homemaker Service Nos /Diem S5135 Adult Companioncare Per 15M S5136 Adult Companioncare Per Diem S5140 Adult Foster Care Per Diem S5141 Adult Foster Care Per Month S5145 Child Fostercare Th Per Diem S5146 Ther Fostercare Child /Month S5150 Unskilled Respite Care /15M S5151 Unskilled Respitecare /Diem S5160 580 Emer Response Sys Instal&Tst $40 $26 $31 $13 S5161 580 Emer Rspns Sys Serv Permonth $35 $23 $27 $11 S5162 Emer Rspns System Purchase S5165 Home Modifications Per Serv S5170 Homedelivered Prepared Meal S5175 Laundry Serv,Ext,Prof,/Order S5180 Hh Respiratory Thrpy In Eval S5181 Hh Respiratory Thrpy Nos/Day S5185 Med Reminder Serv Per Month S5190 Wellness Assessment By Nonph S5199 Personal Care Item Nos Each S5497 Hit Cath Care Noc S5498 Hit Simple Cath Care S5501 Hit Complex Cath Care S5502 Hit Interim Cath Care S5517 Hit Declotting Kit S5518 Hit Cath Repair Kit S5520 Hit Picc Insert Kit S5521 Hit Midline Cath Insert Kit S5522 Hit Picc Insert No Supp S5523 Hip Midline Cath Insert Kit S5550 Insulin Rapid 5 U S5551 Insulin Most Rapid 5 U S5552 Insulin Intermed 5 U S5553 Insulin Long Acting 5 U $225 $147 $175 $74 S5560 Insulin Reuse Pen 1.5 Ml S5561 Insulin Reuse Pen 3 Ml S5565 Insulin Cartridge 150 U S5566 Insulin Cartridge 300 U S5570 Insulin Dispos Pen 1.5 Ml S5571 Insulin Dispos Pen 3 Ml S8030 Tantalum Ring Application S8035 Magnetic Source Imaging S8037 Mrcp S8040 Topographic Brain Mapping S8042 Mri Low Field S8055 Us Guidance Fetal Reduct S8080 Scintimammography S8085 Fluorine-18 Fluorodeoxygluco S8092 Electron Beam Computed Tomog S8096 Portable Peak Flow Meter S8097 Asthma Kit S8100 Spacer Without Mask S8101 Spacer With Mask S8110 Peak Expiratory Flow Rate (P S8120 O2 Contents Gas Cubic Ft S8121 O2 Contents Liquid Lb S8130 Interferential Stim 2 Chan S8131 Interferential Stim 4 Chan S8185 Flutter Device S8186 Swivel Adaptor S8189 Trach Supply Noc S8210 Mucus Trap S8265 Haberman Feeder S8270 Enuresis Alarm S8301 Infect Control Supplies Nos S8415 Supplies For Home Delivery S8420 Custom Gradient Sleev/Glov S8421 Ready Gradient Sleev/Glov S8422 Custom Grad Sleeve Med S8423 Custom Grad Sleeve Heavy S8424 Ready Gradient Sleeve S8425 Custom Grad Glove Med S8426 Custom Grad Glove Heavy S8427 Ready Gradient Glove S8428 Ready Gradient Gauntlet S8429 Gradient Pressure Wrap S8430 Padding For Comprssn Bdg S8431 Compression Bandage S8450 Splint Digit S8451 271 Splint Wrist Or Ankle $54 $35 $42 $18 S8452 Splint Elbow S8460 Camisole Post-Mast S8490 100 Insulin Syringes S8930 Auricular Electrostimulation S8940 Hippotherapy Per Session S8948 Low-Level Laser Trmt 15 Min S8950 Complex Lymphedema Therapy, S8990 Pt Or Manip For Maint S8999 Resuscitation Bag S9001 Home Uterine Monitor With Or S9007 Ultrafiltration Monitor S9024 Paranasal Sinus Ultrasound S9025 Omnicardiogram/Cardiointegra S9034 Eswl For Gallstones S9055 Procuren Or Other Growth Fac S9056 Coma Stimulation Per Diem S9061 Medical Supplies And Equipme S9083 Urgent Care Center Global S9088 Services Provided In Urgent S9090 Vertebral Axial Decompressio S9097 Home Visit Wound Care S9098 Home Phototherapy Visit S9110 Telemonitoring/Home Per Mnth S9117 Back School Visit S9122 Home Health Aide Or Certifie S9123 Nursing Care In Home Rn S9124 Nursing Care, In The Home; B S9125 Respite Care, In The Home, P S9126 Hospice Care, In The Home, P S9127 Social Work Visit, In The Ho S9128 Speech Therapy, In The Home, S9129 Occupational Therapy, In The S9131 Pt In The Home Per Diem S9140 Diabetic Management Program, S9141 Diabetic Management Program, S9145 Insulin Pump Initiation S9150 Evaluation By Ocularist S9152 Speech Therapy, Re-Eval S9208 Home Mgmt Preterm Labor S9209 Home Mgmt Pprom S9211 Home Mgmt Gest Hypertension S9212 Hm Postpar Hyper Per Diem S9213 Hm Preeclamp Per Diem S9214 Hm Gest Dm Per Diem S9325 Hit Pain Mgmt Per Diem S9326 Hit Cont Pain Per Diem S9327 Hit Int Pain Per Diem S9328 Hit Pain Imp Pump Diem S9329 Hit Chemo Per Diem S9330 Hit Cont Chem Diem S9331 Hit Intermit Chemo Diem S9335 Ht Hemodialysis Diem S9336 Hit Cont Anticoag Diem S9338 Hit Immunotherapy Diem S9339 Hit Periton Dialysis Diem S9340 Hit Enteral Per Diem S9341 Hit Enteral Grav Diem S9342 Hit Enteral Pump Diem S9343 Hit Enteral Bolus Nurs S9345 Hit Anti-Hemophil Diem S9346 Hit Alpha-1-Proteinas Diem S9347 Hit Longterm Infusion Diem S9348 Hit Sympathomim Diem S9349 Hit Tocolysis Diem S9351 Hit Cont Antiemetic Diem S9353 Hit Cont Insulin Diem S9355 Hit Chelation Diem S9357 Hit Enzyme Replace Diem S9359 Hit Anti-Tnf Per Diem S9361 Hit Diuretic Infus Diem S9363 Hit Anti-Spasmotic Diem S9364 Hit Tpn Total Diem S9365 Hit Tpn 1 Liter Diem S9366 Hit Tpn 2 Liter Diem S9367 Hit Tpn 3 Liter Diem S9368 Hit Tpn Over 3L Diem S9370 Ht Inj Antiemetic Diem S9372 Ht Inj Anticoag Diem S9373 Hit Hydra Total Diem S9374 Hit Hydra 1 Liter Diem S9375 Hit Hydra 2 Liter Diem S9376 Hit Hydra 3 Liter Diem S9377 Hit Hydra Over 3L Diem S9379 Hit Noc Per Diem S9381 Hit High Risk/Escort S9401 Anticoag Clinic Per Session S9430 Pharmacy Comp/Disp Serv S9433 Medical Food Oral 100% Nutr S9434 Mod Solid Food Suppl S9435 Medical Foods For Inborn Err S9436 Lamaze Class S9437 Childbirth Refresher Class S9438 Cesarean Birth Class S9439 Vbac Class S9441 Asthma Education S9442 Birthing Class S9443 Lactation Class S9444 Parenting Class S9445 Pt Education Noc Individ S9446 Pt Education Noc Group S9447 Infant Safety Class S9449 Weight Mgmt Class S9451 Exercise Class S9452 Nutrition Class S9453 Smoking Cessation Class S9454 Stress Mgmt Class S9455 Diabetic Management Program, S9460 Diabetic Management Program, S9465 Diabetic Management Program, S9470 Nutritional Counseling, Diet S9472 Cardiac Rehabilitation Progr S9473 Pulmonary Rehabilitation Pro S9474 Enterostomal Therapy By A Re S9475 Ambulatory Setting Substance S9476 Vestibular Rehab Per Diem S9480 915 Intensive Outpatient Psychia $555 $361 $431 $182 $108 S9482 Family Stabilization 15 Min S9484 Crisis Intervention Per Hour S9485 Crisis Intervention Mental H S9490 Hit Corticosteroid/Diem S9494 Hit Antibiotic Total Diem S9497 Hit Antibiotic Q3H Diem S9500 Hit Antibiotic Q24H Diem S9501 Hit Antibiotic Q12H Diem S9502 Hit Antibiotic Q8H Diem S9503 Hit Antibiotic Q6H Diem S9504 Hit Antibiotic Q4H Diem S9529 Venipuncture Home/Snf S9537 Ht Hem Horm Inj Diem S9538 Hit Blood Products Diem S9542 Ht Inj Noc Per Diem S9558 Ht Inj Growth Horm Diem S9559 Hit Inj Interferon Diem S9560 Ht Inj Hormone Diem S9562 Ht Inj Palivizumab Diem S9590 Ht Irrigation Diem S9810 Ht Pharm Per Hour S9900 Christian Sci Pract Visit S9901 Christian Sci Nurse Visit S9960 Air Ambulanc Nonemerg Fixed S9961 Air Ambulan Nonemerg Rotary S9970 Health Club Membership Yr S9975 Transplant Related Per Diem S9976 Lodging Per Diem S9977 Meals Per Diem S9981 Med Record Copy Admin S9982 Med Record Copy Per Page S9986 Not Medically Necessary Svc S9988 Serv Part Of Phase I Trial S9989 Services Outside Us S9990 Services Provided As Part Of S9991 Services Provided As Part Of S9992 Transportation Costs To And S9994 Lodging Costs (E.G. Hotel Ch S9996 Meals For Clinical Trial Par S9999 Sales Tax T1000 Private Duty/Independent Nsg T1001 Nursing Assessment/Evaluatn T1002 Rn Services Up To 15 Minutes T1003 Lpn/Lvn Services Up To 15Min T1004 Nsg Aide Service Up To 15Min T1005 Respite Care Service 15 Min T1006 900 Family/Couple Counseling $417 $271 $324 $137 T1007 Treatment Plan Development T1009 Child Sitting Services T1010 Meals When Receive Services T1012 Alcohol/Substance Abuse Skil T1013 900 Sign Lang/Oral Interpreter $29 $19 $23 $10 T1014 Telehealth Transmit, Per Min T1015 Clinic Service T1016 Case Management T1017 Targeted Case Management T1018 School-Based Iep Ser Bundled T1019 Personal Care Ser Per 15 Min T1020 Personal Care Ser Per Diem T1021 Hh Aide Or Cn Aide Per Visit T1022 Contracted Services Per Day T1023 900 Program Intake Assessment $162 $105 $126 $53 $49 T1024 Team Evaluation & Management T1025 Ped Compr Care Pkg, Per Diem T1026 Ped Compr Care Pkg, Per Hour T1027 Family Training & Counseling T1028 Home Environment Assessment T1029 Dwelling Lead Investigation T1030 Rn Home Care Per Diem T1031 Lpn Home Care Per Diem T1040 Comm Bh Clinic Svc Per Diem T1041 Comm Bh Clinic Svc Per Month T1502 Medication Admin Visit T1503 Med Admin, Not Oral/Inject T1505 Elec Med Comp Dev, Noc T1999 Noc Retail Items Andsupplies T2001 N-Et; Patient Attend/Escort T2002 N-Et; Per Diem T2003 N-Et; Encounter/Trip T2004 N-Et; Commerc Carrier Pass T2005 N-Et; Stretcher Van T2007 Non-Emer Transport Wait Time T2010 Pasrr Level I T2011 Pasrr Level Ii T2012 Habil Ed Waiver, Per Diem T2013 Habil Ed Waiver Per Hour T2014 Habil Prevoc Waiver, Per D T2015 Habil Prevoc Waiver Per Hr T2016 Habil Res Waiver Per Diem T2017 Habil Res Waiver 15 Min T2018 Habil Sup Empl Waiver/Diem T2019 Habil Sup Empl Waiver 15Min T2020 Day Habil Waiver Per Diem T2021 Day Habil Waiver Per 15 Min T2022 Case Management, Per Month T2023 Targeted Case Mgmt Per Month T2024 Serv Asmnt/Care Plan Waiver T2025 Waiver Service, Nos T2026 Special Childcare Waiver/D T2027 Spec Childcare Waiver 15 Min T2028 Special Supply, Nos Waiver T2029 Special Med Equip, Noswaiver T2030 Assist Living Waiver/Month T2031 Assist Living Waiver/Diem T2032 Res Care, Nos Waiver/Month T2033 Res, Nos Waiver Per Diem T2034 Crisis Interven Waiver/Diem T2035 Utility Services Waiver T2036 Camp Overnite Waiver/Session T2037 Camp Day Waiver/Session T2038 Comm Trans Waiver/Service T2039 Vehicle Mod Waiver/Service T2040 Financial Mgt Waiver/15Min T2041 Support Broker Waiver/15 Min T2042 Hospice Routine Home Care T2043 Hospice Continuous Home Care T2044 Hospice Respite Care T2045 Hospice General Care T2046 Hospice Long Term Care, R&B T2047 Hab Prevo Waiver Per 15 T2048 Bh Ltc Res R&B, Per Diem T2049 N-Et; Stretcher Van, Mileage T2101 Breast Milk Proc/Store/Dist T4521 Adult Size Brief/Diaper Sm T4522 Adult Size Brief/Diaper Med T4523 Adult Size Brief/Diaper Lg T4524 Adult Size Brief/Diaper Xl T4525 Adult Size Pull-On Sm T4526 Adult Size Pull-On Med T4527 Adult Size Pull-On Lg T4528 Adult Size Pull-On Xl T4529 Ped Size Brief/Diaper Sm/Med T4530 Ped Size Brief/Diaper Lg T4531 Ped Size Pull-On Sm/Med T4532 Ped Size Pull-On Lg T4533 Youth Size Brief/Diaper T4534 Youth Size Pull-On T4535 Disposable Liner/Shield/Pad T4536 Reusable Pull-On Any Size T4537 Reusable Underpad Bed Size T4538 Diaper Serv Reusable Diaper T4539 Reuse Diaper/Brief Any Size T4540 Reusable Underpad Chair Size T4541 Large Disposable Underpad T4542 Small Disposable Underpad T4543 Adult Disp Brief/Diap Abv Xl T4544 Adlt Disp Und/Pull On Abv Xl T4545 Incon Disposable Penile Wrap T5001 Position Seat Spec Orth Need T5999 Supply, Nos U0001 2019-Ncov Diagnostic P U0002 Covid-19 Lab Test Non-Cdc U0003 Cov-19 Amp Prb Hgh Thruput U0004 Cov-19 Test Non-Cdc Hgh Thru U0005 Infec Agen Detec Ampli Probe V2020 Vision Svcs Frames Purchases V2025 Eyeglasses Delux Frames V2100 Lens Spher Single Plano 4.00 V2101 Single Visn Sphere 4.12-7.00 V2102 Singl Visn Sphere 7.12-20.00 V2103 Spherocylindr 4.00D/12-2.00D V2104 Spherocylindr 4.00D/2.12-4D V2105 Spherocylinder 4.00D/4.25-6D V2106 Spherocylinder 4.00D/>6.00D V2107 Spherocylinder 4.25D/12-2D V2108 Spherocylinder 4.25D/2.12-4D V2109 Spherocylinder 4.25D/4.25-6D V2110 Spherocylinder 4.25D/Over 6D V2111 Spherocylindr 7.25D/.25-2.25 V2112 Spherocylindr 7.25D/2.25-4D V2113 Spherocylindr 7.25D/4.25-6D V2114 Spherocylinder Over 12.00D V2115 Lens Lenticular Bifocal V2118 Lens Aniseikonic Single V2121 Lenticular Lens, Single V2199 Lens Single Vision Not Oth C V2200 Lens Spher Bifoc Plano 4.00D V2201 Lens Sphere Bifocal 4.12-7.0 V2202 Lens Sphere Bifocal 7.12-20. V2203 Lens Sphcyl Bifocal 4.00D/.1 V2204 Lens Sphcy Bifocal 4.00D/2.1 V2205 Lens Sphcy Bifocal 4.00D/4.2 V2206 Lens Sphcy Bifocal 4.00D/Ove V2207 Lens Sphcy Bifocal 4.25-7D/. V2208 Lens Sphcy Bifocal 4.25-7/2. V2209 Lens Sphcy Bifocal 4.25-7/4. V2210 Lens Sphcy Bifocal 4.25-7/Ov V2211 Lens Sphcy Bifo 7.25-12/.25- V2212 Lens Sphcyl Bifo 7.25-12/2.2 V2213 Lens Sphcyl Bifo 7.25-12/4.2 V2214 Lens Sphcyl Bifocal Over 12. V2215 Lens Lenticular Bifocal V2218 Lens Aniseikonic Bifocal V2219 Lens Bifocal Seg Width Over V2220 Lens Bifocal Add Over 3.25D V2221 Lenticular Lens, Bifocal V2299 Lens Bifocal Speciality V2300 Lens Sphere Trifocal 4.00D V2301 Lens Sphere Trifocal 4.12-7. V2302 Lens Sphere Trifocal 7.12-20 V2303 Lens Sphcy Trifocal 4.0/.12- V2304 Lens Sphcy Trifocal 4.0/2.25 V2305 Lens Sphcy Trifocal 4.0/4.25 V2306 Lens Sphcyl Trifocal 4.00/>6 V2307 Lens Sphcy Trifocal 4.25-7/. V2308 Lens Sphc Trifocal 4.25-7/2. V2309 Lens Sphc Trifocal 4.25-7/4. V2310 Lens Sphc Trifocal 4.25-7/>6 V2311 Lens Sphc Trifo 7.25-12/.25- V2312 Lens Sphc Trifo 7.25-12/2.25 V2313 Lens Sphc Trifo 7.25-12/4.25 V2314 Lens Sphcyl Trifocal Over 12 V2315 Lens Lenticular Trifocal V2318 Lens Aniseikonic Trifocal V2319 Lens Trifocal Seg Width > 28 V2320 Lens Trifocal Add Over 3.25D V2321 Lenticular Lens, Trifocal V2399 Lens Trifocal Speciality V2410 Lens Variab Asphericity Sing V2430 Lens Variable Asphericity Bi V2499 Variable Asphericity Lens V2500 Contact Lens Pmma Spherical V2501 Cntct Lens Pmma-Toric/Prism V2502 Contact Lens Pmma Bifocal V2503 Cntct Lens Pmma Color Vision V2510 Cntct Gas Permeable Sphericl V2511 Cntct Toric Prism Ballast V2512 Cntct Lens Gas Permbl Bifocl V2513 Contact Lens Extended Wear V2520 Contact Lens Hydrophilic V2521 Cntct Lens Hydrophilic Toric V2522 Cntct Lens Hydrophil Bifocl V2523 Cntct Lens Hydrophil Extend V2524 Cntct Lens Hydrophil Photoch V2530 Contact Lens Gas Impermeable V2531 Contact Lens Gas Permeable V2599 Contact Lens/Es Other Type V2600 Hand Held Low Vision Aids V2610 Single Lens Spectacle Mount V2615 Telescop/Othr Compound Lens V2623 Plastic Eye Prosth Custom V2624 Polishing Artifical Eye V2625 Enlargemnt Of Eye Prosthesis V2626 Reduction Of Eye Prosthesis V2627 Scleral Cover Shell V2628 Fabrication & Fitting V2629 Prosthetic Eye Other Type V2630 Anter Chamber Intraocul Lens $242 $157 $188 $79 V2631 Iris Support Intraoclr Lens V2632 Post Chmbr Intraocular Lens $385 $250 $299 $126 V2700 Balance Lens V2702 Deluxe Lens Feature V2710 Glass/Plastic Slab Off Prism V2715 Prism Lens/Es V2718 Fresnell Prism Press-On Lens V2730 Special Base Curve V2744 Tint Photochromatic Lens/Es V2745 Tint, Any Color/Solid/Grad V2750 Anti-Reflective Coating V2755 Uv Lens/Es V2756 Eye Glass Case V2760 Scratch Resistant Coating V2761 Mirror Coating V2762 Polarization, Any Lens V2770 Occluder Lens/Es V2780 Oversize Lens/Es V2781 Progressive Lens Per Lens V2782 Lens, 1.54-1.65 P/1.60-1.79G V2783 Lens, >= 1.66 P/>=1.80 G V2784 Lens Polycarb Or Equal V2785 Corneal Tissue Processing $12,811 $8,327 $9,946 $4,198 V2786 Occupational Multifocal Lens V2787 Astigmatism-Correct Function $895 $582 $695 $293 V2788 Presbyopia-Correct Function $984 $640 $764 $322 V2790 Amniotic Membrane $1,411 $917 $1,095 $462 V2797 Vis Item/Svc In Other Code V2799 Misc Vision Item Or Service V5008 470 Hearing Screening $247 $161 $192 $81 V5010 Assessment For Hearing Aid V5011 Hearing Aid Fitting/Checking V5014 470 Hearing Aid Repair/Modifying $17 $11 $13 $6 $2 V5020 470 Conformity Evaluation $97 $63 $75 $32 V5030 Body-Worn Hearing Aid Air V5040 Body-Worn Hearing Aid Bone V5050 Hearing Aid Monaural In Ear V5060 Behind Ear Hearing Aid V5070 Glasses Air Conduction V5080 Glasses Bone Conduction V5090 Hearing Aid Dispensing Fee V5095 Implant Mid Ear Hearing Pros V5100 Body-Worn Bilat Hearing Aid V5110 Hearing Aid Dispensing Fee V5120 Body-Worn Binaur Hearing Aid V5130 In Ear Binaural Hearing Aid V5140 Behind Ear Binaur Hearing Ai V5150 Glasses Binaural Hearing Aid V5160 470 Dispensing Fee Binaural $428 $278 $332 $140 V5171 Hearing Aid Monaural Ite V5172 Hearing Aid Monaural Itc V5181 Hearing Aid Monaural Bte V5190 Hearing Aid Monaural Glasses V5200 Disp Fee Contralateral Monau V5211 Hearing Aid Binaural Ite/Ite V5212 Hearing Aid Binaural Ite/Itc V5213 Hearing Aid Binaural Ite/Bte V5214 Hearing Aid Binaural Itc/Itc V5215 Hearing Aid Binaural Itc/Bte V5221 Hearing Aid Binaural Bte/Bte V5230 Hearing Aid Binaural Glasses V5240 Disp Fee Contralateral Binau V5241 470 Dispensing Fee, Monaural $289 $188 $224 $95 V5242 Hearing Aid, Monaural, Cic V5243 Hearing Aid, Monaural, Itc V5244 Hearing Aid, Prog, Mon, Cic V5245 Hearing Aid, Prog, Mon, Itc V5246 Hearing Aid, Prog, Mon, Ite V5247 Hearing Aid, Prog, Mon, Bte V5248 Hearing Aid, Binaural, Cic V5249 Hearing Aid, Binaural, Itc V5250 Hearing Aid, Prog, Bin, Cic V5251 Hearing Aid, Prog, Bin, Itc V5252 Hearing Aid, Prog, Bin, Ite V5253 Hearing Aid, Prog, Bin, Bte V5254 Hearing Id, Digit, Mon, Cic V5255 Hearing Aid, Digit, Mon, Itc V5256 470 Hearing Aid, Digit, Mon, Ite $792 $515 $615 $260 $147 V5257 470 Hearing Aid, Digit, Mon, Bte $1,108 $720 $860 $363 $337 V5258 Hearing Aid, Digit, Bin, Cic V5259 470 Hearing Aid, Digit, Bin, Itc $4,061 $2,640 $3,153 $1,331 V5260 470 Hearing Aid, Digit, Bin, Ite $2,221 $1,444 $1,724 $728 V5261 470 Hearing Aid, Digit, Bin, Bte $2,027 $1,318 $1,574 $664 V5262 Hearing Aid, Disp, Monaural V5263 Hearing Aid, Disp, Binaural V5264 470 Ear Mold/Insert $84 $55 $65 $28 $0 V5265 Ear Mold/Insert, Disp V5266 470 Battery For Hearing Device $1 $1 $1 $0 V5267 470 Hearing Aid Sup/Access/Dev $139 $90 $108 $46 V5268 Ald Telephone Amplifier V5269 Alerting Device, Any Type V5270 Ald, Tv Amplifier, Any Type V5271 Ald, Tv Caption Decoder V5272 Tdd V5273 Ald For Cochlear Implant V5274 Ald Unspecified V5275 470 Ear Impression $35 $23 $27 $11 $0 V5281 Ald Fm/Dm System, Monaural V5282 Ald Fm/Dm System Binaural V5283 Ald Neck, Loop Ind Receiver V5284 Ald Fm/Dm Ear Level Receiver V5285 Ald Fm/Dm Aud Input Receiver V5286 470 Ald Blu Tooth Fm/Dm Receiver $424 $276 $329 $139 V5287 Ald Fm/Dm Receiver, Nos V5288 Ald Fm/Dm Transmitter Ald V5289 Ald Fm/Dm Adapt/Boot Couplin V5290 Ald Transmitter Microphone V5298 Hearing Aid Noc V5299 470 Hearing Service $259 $168 $201 $85 V5336 Repair Communication Device V5362 Speech Screening V5363 Language Screening V5364 Dysphagia Screening