Service Code Service Description Charge 1100000 PRIVATE ROOM AND BOARD 3,339.00 1100001 ISOLATION ROOM 3,892.00 1200000 SEMI-PRIVATE ROOM AND BOARD 3,339.00 1200001 SWINGBED ROOM AND BOARD 2,593.00 1200002 ICU/MONITORED BED 4,048.00 1200005 SIU-ROOM AND BOARD 4,457.00 1700000 NURSERY ROOM AND BOARD 959.00 2000000 ICU ROOM AND BOARD 4,457.00 2500005 AHC MED CHARGE I 25.00 2500010 AHC MED CHARGE II 65.00 2500011 ACETAMINOPHEN 325MG TAB PO 9.00 2500020 PPD 33.00 2500100 ACTIDOSE/SORB 50GM/240ML SUSPO 107.00 2500110 ALBUTEROL 0.5% NEBSOL 20ML INH 97.00 2500135 BUDESONIDE 0.5/2ML NEB SOL INH 40.00 2500137 BUPIVACAINE 0.25% INJ 10 ML IV 66.00 2500138 BUPIVACAINE 0.5% INJ 10 ML IV 69.00 2500140 BUPIVACAINE MPF 0.75% INJ 10ML 52.00 2500141 BUPIVACAINE/EPI 0.25% INJ 10ML 75.00 2500142 BUPIVACAINE/EPI 0.5% INJ 10 ML - 2500143 BUPIVACAINE MPF 0.5% INJ 30ML 47.00 2500145 CALCIUM CARB 1000MG TABS PO 13.00 2500160 CEFUROXIME 250 MG TAB PO 34.00 2500165 CEPHALEXIN 500MG CAP PO 17.00 2500167 CHLORHEXIDINE 4% SOL 240ML TOP 47.00 2500169 CHLOROPROCAINE 3% 20 ML INJ 90.00 2500170 CHOLESTRYRAMINE 4GM LT POWD PO 18.00 2500173 CLOTRIMAZOLE 10MG TROCHE PO 17.00 2500180 CRASH CART ACCESS 330.00 2500185 D5/NACL 0.9% KCL20 MEQ 1000 ML 39.00 2500186 D5W 100 ML BAG IV 40.00 2500187 D5W 250 ML BAG IV 40.00 2500200 EPINEPHRINE 1MG/ML (1:1000)INJ 17.00 2500201 EPINEPHRINE 1MG/ML MDV 30M INJ 42.00 2500205 ETHYL CHLORIDE SPR 103.1ML TOP 79.00 2500215 FLUTIC/SALM 100/50 ADVAIR INH 340.00 2500216 FLUTIC/SALM 250/50 ADVAIR INH 430.00 2500221 FUROSEMIDE 10MG/ML INJ 10ML IV 17.00 2500222 FUROSEMIDE 10MG/ML INJ 2ML IV 17.00 2500230 GLIPIZIDE XL 5MG TAB PO 17.00 2500238 GUAIFENESIN DM SYRUP 10ML UDC 21.00 2500244 HUMULIN R U-100 INJ 3 ML 17.00 2500245 HYDRALAZINE 25MG TAB PO 17.00 2500250 IBUPROFEN 600 MG TAB PO 17.00 2500260 INSULIN LISPRO 100U/ML INJ 10M 17.00 2500267 LAMOTRIGINE 25 MG TAB PO 26.00 2500272 LEVALBUTEROL 0.63MG/3ML INH 21.00 2500273 LEVALBUTEROL 1.25MG/3ML INH 20.00 2500275 LEVETIRACETAM 250 TAB PO 18.00 2500276 LEVETIRACETAM 750 TAB PO 23.00 2500280 LIDOCAINE 2% GEL 5GM TOP 57.00 2500283 LIDOCAINE MPF 0.5% INJ 50ML IV 112.00 2500287 LORAZEPAM 2MG/ML INJ 10ML MDV 156.00 2500293 MANNITOL 20% 500ML BAG IV - 2500298 METHYLPRED 40 MG-SOLUMED INJ 19.00 2500300 MIRTAZAPINE 15 MG TAB PO 20.00 2500305 MUPIROCIN 2% OINT 22GM TOP 200.00 2500310 NACL 0.45%/KCL20MEQ 1000ML BAG 19.00 2500313 NAFCILLIN 2GM INJ IV 88.00 2500322 NOREPINEPHRNE 4MG/ML INJ4ML IV 69.00 2500335 PHYTONADIONE 10 MG/ML INJ SQ 41.00 2500338 POLYVINYL SOLN 15 ML OPTH 27.00 2500347 RHO(D) IMMUNE GLOB 300MCG INJ 537.00 2500352 SIMETHICONE 40MG/0.6ML ORAL 30 38.00 2500358 SOD CHLORIDE 4MEQ/ML 30ML IV 17.00 2500366 TIOTROPIUM INH (SPIRIVA) INH 156.00 2500368 TRIAMCINOLONE 0.1%CRM 15GM TOP 27.00 2500370 TRIAMTERENE/HCTZ 37.5/25MG TAB 17.00 2500376 ALCOHOL (GRAIN) PO 14.00 2500392 ISOSORBIDE MONO 30MG PO 17.00 2500393 LISINOPRIL 40MG TAB PO 17.00 2500394 LITHIUM 150MG CAP PO 17.00 2500396 MAG SULFATE 40 GRAM 500ML IV 40.00 2500398 OSELTAMIVIR 75MG CAP PO 47.00 2500399 PENICILLIN 250MG/5ML PO(ED) 38.00 2500402 SILVER SULFADIAZ 1%CRM 50G TOP 60.00 2500405 KCL 20MEQ/10ML VIAL IV 17.00 2500409 BRIMONIDINE 0.15% OPTH SOLN 219.00 2500410 CEFOXITIN 1 GM INJ IV 58.00 2500412 FLUOXETINE 10MG CAPS PO 19.00 2500413 FLUOXETINE 20 MG CAPS PO 20.00 2500414 ESCITALOPRAM 10 MG TABS PO 19.00 2500415 VENLAFAXINE XR 75MG CAPS PO 24.00 2500417 GABAPENTIN 100MG CAPS PO 23.00 2500421 EC ASA TABS PO 11.00 2500422 ACETAMINOPHEN 80MG DISSOLV TAB 11.00 2500426 VITAMIN B-6 TAB PO 17.00 2500429 STERILE WATER INJ 1L BAG IV 18.00 2500430 NIACIN 500MG TAB PO 17.00 2500431 GEMFIBROZIL 600MG TAB PO 17.00 2500432 CEPACOL LOZENGES PO 11.00 2500433 ACETYLCYSTEINE 30 ML IV 521.00 2500436 FLUDROCORTISONE 0.1MG TAB PO 17.00 2500437 FERROUS GLUCONATE 300MG PO 17.00 2500438 INSULIN GLARG 100U/ML 10ML INJ 271.00 2500440 ATORVASTATIN 40MG TAB PO 17.00 2500442 GLIPIZIDE XL 2.5MG TAB PO 17.00 2500443 ENOXAPARIN 100MG SYG INJ 286.00 2500444 D5 1/2 NS W/40mEq KCL 1L IV 17.00 2500446 OLANZAPINE 10MG IM INJ 103.00 2500447 TRIAMCINOLONE 200MG/5ML MDV IV 172.00 2500456 GUAIFENESIN AC 5ML UDC PO 17.00 2500457 PROMETHAZINE/CODIENE 5ML UD PO 17.00 2500458 DETROL LA 2MG CAP PO 17.00 2500460 CLARITHROMYCIN 250MG TAB PO 17.00 2500464 NA CITRATE/CITRC AC 3/2G UD PO 17.00 2500469 LINEZOLID (ZYVOX) 600MG TAB PO 262.00 2500470 LINEZOLID (ZYVOX) 600MG BAG IV 331.00 2500474 IOTHALAMATE MEGLUMINE VIAL IV 72.00 2500476 SOD BICARB 8.4% VIAL IV 17.00 2500477 SALINE NASAL SPRAY 17.00 2500480 ROCURONIUM (ZEMURON) 10 ML IV 152.00 2500483 PRAMIPEXOLE 0.125 TAB PO 17.00 2500492 CYCLOPENTOLATE 1% OPTH SOL 2ML 34.00 2500499 DONEPEZIL 10MG TAB 40.00 2500500 IRON SUCROSE 100MG/5ML INJ 267.00 2500501 RANITIDINE ELIXIR 150MG/10ML 46.00 2500503 PROPRANOLOL 10MG TAB 17.00 2500508 TERAZOSIN 5MG CAP 17.00 2500510 PED INFLUENZA VAC INJ 6-35 MO 67.00 2500512 ENALAPRIL IV - 2500513 EC ASA TAB - 2500514 RISPERIDONE 0.25MG TAB PO - 2500515 QUETIAPINE 25MG TAB - 2500516 OLANZAPINE 2.5MG TAB PO - 2500517 AMMONIA SALTS INH - 2500519 MAG CL TAB - 2500520 NICODERM 7MG PATCH TOP - 2500524 METHOTREXATE 200MG/8ML INJ - 2500526 LR 5000ML BAG IRRIG SOLUTION - 2500527 NACL 0.9%/KCL 20MEQ 1000ML IV - 2500528 PEN G BENZATHINE 2ML SYR INJ - 2500566 FOSPHENYTOIN 500MG VIAL IV - 2500567 WARFARIN 3MG TAB PO - 2500570 DUONEB 3ML AMPULE INH SOLN - 2500573 ACETAMINOPHEN 325MG/10ML PO - 2500574 IBUPROFEN SUSP 100MG/5ML PO - 2500575 DIPHENHYDRAMINE 12.5MG/5ML PO - 2500576 LEVAQUIN 750MG IV - 2500578 EZETIMIBE 10 MG PO TAB - 2500584 ESTRADIOL 1 MG TAB PO - 2500585 ACETAZOLAMIDE 250 MG PO TAB - 2500586 NS W/40MEQ KCL LVIV 1 L - 2500589 FINASTERIDE 5 MG TAB PO - 2500598 DILTIAZEM 125MG/25ML VIAL - 2500599 BOOSTRIX (Tdap) INJ >7YRS - 2500601 ENOXAPARIN 40MG/0.4ML SYR - 2500602 ADVAIR 500/50 INHALER - 2500613 HEPARIN 100 UNIT/ML 3ML SYR IV - 2500621 LIDOCAINE 2% 2ML AMP PRES FREE - 2500622 NS 3000 ML IRRIGATION - 2500626 MONTELUKAST 10MG TAB PO - 2500628 OXYBUTYNIN 5 MG IR TAB PO - 2500629 CHLORDIAZEPOXIDE 10MG TAB PO - 2500633 ALTEPLASE 2 MG INJ - 2500636 DULOXETINE DR 30MG CAPS PO - 2500639 MEMANTINE 10 MG TAB - 2500641 METHADONE 10 MG TAB - 2500645 BUSPIRONE 5 MG TABS - 2500648 ACETAMINOPHEN SUPP 650 MG - 2500649 MOXIFLOXACIN 0.5% 3ML OPTH - 2500650 THROMBIN 20000 UNITS/VIAL TOP - 2500651 MANNITOL 5% 1000ML IV BAG - 2500653 ACETAMINOPHEN 500 MG TAB PO - 2500654 TIMOLOL MALEATE 0.5% OPTH DROP - 2500655 SULFASALIZINE 500 MG TAB PO - 2500658 VANCOMYCIN 125 CAP PO - 2500660 LIDOCAINE 0.5%/EPIN 50ML MDV - 2500664 NEUTRA PHOS ORAL PACKET - 2500669 ONDANSETRON 4MG DISINT TAB - 2500671 LIDOCAINE 40MG/ML 5 ML AMP - 2500680 GELFOAM SIZE 100 SPONGE EA - 2500681 GELFOAM SIZE 50 SPONGE EA - 2500682 ADENOSINE 90MG/30ML INJ 848.00 2500687 GELFOAM POWDER 1 EA - 2500692 BACLOFEN 10MG TAB PO - 2500695 LACTATED RINGERS 500ML BAG IV - 2500697 PREDNISONE 5MG TAB PO - 2500700 CALCITRIOL 0.25 MCG TAB PO - 2500710 MEROPENEM 1 GM IV - 2500712 CEFEPIME HCL 1 GM INJ - 2500715 HYDROCORTISONE 10MG PO - 2500716 BUPROPION HCL 150MG PO - 2500718 LIDOCAINE HCL 4% TOP SOLN - 2500719 MIDAZOLAM HCL 5MG/ML IV - 2500721 NICOTINE TRANSDERM PATCH 14MG - 2500722 METOPROL TARTRATE 25MG TAB - 2500731 LEVOFLOXACIN 250MG TAB BLISTER - 2500732 ATENOLOL 50 MG TABS - 2500736 PREGABALIN 75 MG CAPSULE PO - 2500739 CELECOXIB 200MG CAPSULES PO - 2500740 NORTRIPTYLINE 25MG CAPS - 2500748 ZOLEDRONIC ACID 5MG INJ - 2500753 NADOLOL 40MG TAB PO - 2500756 PHENYLEPHRINE 10% OPH SOL 5ML - 2500760 LIDOCAINE 5% PATCH 54.00 2500767 CITALOPRAM 20MG TAB PO 27.00 2500772 ICODEXTRIN 4% 1500ML IP/IRR 691.00 2500780 BUPIVACAINE/EPI 0.5% INJ 30 ML - 2500784 POTASSIUM PHOS MONO 500MG PO - 2500786 DAPTOMYCIN 500MG INJ IV - 2500787 MAGNESIUM OXIDE 400MG TAB - 2500788 METHOCARBAMOL 1000MG/10ML INJ - 2500794 SITAGLIPTIN 100MG TAB PO - 2500795 LIDO/EPI 1% MPF 10ML IV - 2500798 VECURONIUM 10MG IV - 2500800 FLEETS OIL ENEMA RECTAL - 2500806 EMPTY EVAC CONT 1000ML GLS - 2500807 EMPTY FLEX CONT 250ML PLTC - 2500810 EPHEDRINE 25MG/5ML INJ SYR - 2500811 ONDANSETRON 4MG/5ML PO SOL - 2500812 ONDANSETRON 4MG/5ML UDC - 2500813 LIDOCAINE 2% GEL PF 5GM SYR - 2500821 PREVNAR-13 PEDS VACCINE - 2500823 LABETALOL 20MG/4ML INJ IV - 2500830 SYMBICORT 160/4.5 MCG INH - 2500832 RABIES VACCINE IM 2.5 IU VIAL - 2500836 DEXTROSE 50% INJ IV VIAL - 2500841 CELESTONE-BETAMETH 5ML VIAL - 2500849 IRON DEXTRAN 50MG/ML INJ 10CT - 2500864 WATER STRL IRRIG 250ML 24CT - 2500865 SOD CL 0.9% IRR 250ML 24CT - 2500887 OXYBUTYNIN 5MG ER TAB PO 17.00 2500890 IRON DEXTRAN 100MG/2ML VIAL - 2500891 HYDROMORPHONE 2MG TAB PO - 2501005 SUCCINYLCHOLINE 100MG/5ML SYR - 2501013 OXYMETAZOLINE 0.05% 15ML SPRY - 2501014 ROCURONIUM 50 MG/5 ML SYR - 2501019 DENOSUMAB INJ 60MG - 2501020 PROCAINAMIDE 1GM/10ML IV - 2501022 EPINEPHRINE 0.3 MG AUTO INJ TW - 2501029 QUETIAPINE 25MG TAB - 2501032 PERFLUTREN LIP MICROS 1.1MG/ML - 2501035 NALBUPHINE HCL 10MG AMP IV - 2501036 OXYCODONE 5 MG TAB IR PO - 2501041 KETOROLAC 0.5% OPHTH SOLN 5ML - 2501057 CASSETTE RESERVOIR 100 ML - 2501063 HYDROCODONE/APAP 5-325 TAB PO - 2501064 HYDROCODONE/APAP 5-325 6PK PO - 2501065 ALBUTEROL 1.25MG NEB SOLN INH - 2501067 BACITRACIN OINT 15G - 2501069 SULFAMETH/TRIM SUSP 30ML BTL - 2501070 PREDNISOLONE 1% OPTH SOLN 15ML - 2501071 ONDANSETRON 4MG DISINT TAB 4PK - 2501072 CHOLECALCIFEROL 1000 U TAB - 2501074 IOPAMIDOL 61%/50ML INJ VIAL - 2501078 METOPROLOL XL 25MG TAB PO - 2501081 NYSTATIN 100000U CRM 15 GM TOP - 2501083 FLU VACCINE 65 YRS & > IM - 2501085 LIDOCAINE 2% 5ML INJ PF 67.00 2501086 CLINDAMYCIN 600MG/50ML IVPB - 2501087 CLINDAMYCIN 900MG/50ML IVPB - 2501089 FENTANYL 100MCG/2ML SYR - 2501090 DEXAMETHASONE 4MG 5ML IV 17.00 2501092 ROPIVACAINE 0.5% 30ML VIAL - 2501094 NALOXONE 0.4MG/ML INJ - 2501097 MORPHINE 10MG/10ML PF VIAL - 2501098 ALBUMIN 5% 250ML - 2501099 HYDROXYCHLOROQUINE 200MG TAB 17.00 2501104 IBUPROFEN 100MG/5ML 120ML BTL - 2501107 ROPIVACAINE 0.2% /400ML PUMP 17.00 2501110 ALBUTEROL MDI 6.7GM INH - 2501111 ON-Q I-FLOW PUMP 400ML - 2501112 LIDOCAINE 1% 5ML MPF VIAL - 2501119 BENZOCAINE 20% SPRAY UD - 2501120 PREGABALIN 25MG CAPSULE PO - 2501123 NACL 10ML SDV IV - 2501124 INSULIN LISPRO 100U/ML INJ 3ML - 2501125 INSULIN GLARG 100U/ML 3ML INJ - 2501126 HUMULIN N U-100 INJ 3ML - 2501127 HUMULIN 70/30 U-100 INJ 3ML - 2501128 MAGNESIUM SULFATE 1GM BAG IV - 2501133 SOD. CHLORIDE IRR 250ML - 2501137 PHENYLEPHRINE 1000MCG/10ML INJ - 2501138 KETAMINE 200MG/20ML INJ - 2501139 LEVETIRACETAM 500MG/5ML INJ - 2501144 PROPRANOLOL 40MG TAB - 2501145 ENOXAPARIN SOD 120MG SYR INJ - 2501146 ROPINIROLE 2MG PO TAB - 2501147 PHENYTOIN 50 MG/ML 2ML INJ IV - 2501151 PNEUMOCOC VACC INJ ADULT 23VAL - 2501153 GLYBURIDE 2.5MG PO TAB - 2501154 PSYLLIUM (METAMUCIL) PO UD PK - 2501162 BETADINE 10% 15ML TOPICAL SOLN - 2501164 CEFAZOLIN/DW 2GM/50ML IV BAG - 2501166 CEFTRIAXONE/DW 1GM/50ML IV BAG - 2501167 CEFAZOLIN/DW 1GM/50ML IV BAG - 2501171 OFLOXACIN 0.3% OPHT SOL - 2501173 CEFOXITIN 2GM/50ML IV BAG - 2501178 TIMOLOL GFS 0.5% OPTH DROP 5ML - 2501179 STERILE WATER 10ML IV - 2501180 LEVOTHYROXINE 0.088MG PO - 2501182 ACETAMINOPHEN 1000MG/100ML INJ - 2501183 DEXAMETHASONE P/F 10MG/ML INJ - 2501185 IMMUNE GLOB 20G/200ML IV INJ - 2501191 ROPIVACAINE 0.2% 100ML INJ - 2501192 ERTAPENEM 1 GM IV - 2501196 OSELTAMIVIR 360MG/60ML PO(ED) - 2501198 OCTREOTIDE 200 MCG VIAL IV - 2501199 MISOPROSTOL 100MCG TABLET - 2501206 ALPRAZOLAM 1MG TAB PO - 2501207 OSELTAMIVIR 30MG CAP PO - 2501209 OXYCODONE IR 5MG 6 PK PO - 2501213 MORPHINE 30MG ER TAB PO - 2501221 ZOSYN 4.5 GRAM IV - 2501223 DOCUSATE 100MG/10ML UDC LIQ - 2501225 RIVAROXABAN 10MG TAB PO - 2501226 TRANEXAMIC ACID 1G/10ML INJ - 2501227 MIDAZOLAM 10MG/5ML PO UDC - 2501229 AMPICILLIN 2GM SDV IV - 2501230 RIVAROXABAN 15MG TAB PO - 2501232 REGADENOSON 0.4MG/5ML SYR - 2501240 LAMOTRIGINE 100 MG TAB PO - 2501241 RISPERIDONE 1MG TAB PO - 2501242 LISINOPRIL 10MG TAB PO - 2501247 AYR SALINE NASAL GEL - 2501249 CARBI/LEVODOPA 25/250MG PO - 2501250 HYDROMORPHONE 1MG/ML INJ SYR - 2501252 ESTRADIOL 0.1MG/DAY TD PATCH - 2501253 BUNNEL'S SOLUTION 100ML BTL - 2501258 CARVEDILOL 12.5 MG TAB PO - 2501259 CEFTRIAXONE/DW 2GM/50ML IV BAG - 2501269 ROPIVACAINE 0.2% 200ML INJ - 2501270 OMALIZUMAB 150MG INJ VIAL - 2501271 XIAFLEX 0.9MG INJ VIAL - 2501275 PHYTONADIONE 1MG/0.5ML SYR INJ - 2501277 IMMUNE GLOB 5G/50ML IV INJ - 2501278 INSULIN DETEMIR 100U/ML INJ - 2501281 LUGOL'S IODINE TOP SOLN 14 ML - 2501282 TRUVADA 200/300MG 4PK TAB PO - 2501285 NIFEDIPINE ER 30MG TAB PO - 2501286 NEBIVOLOL 10MG TAB PO - 2501288 CLINDAMYCIN 300MG/2ML SDV IV - 2501289 IMMUNE GLOB 10G/100ML IV INJ - 2501291 CIPRO HC 0.2% OTIC BTL (ED) - 2501293 KCENTRA 500 IU INJ KIT - 2501294 3% SODIUM CL 500ML IV BAG 105.00 2501296 ACETYLCYSTEINE 20% 4ML INH/PO - 2501298 LIDOCAINE 4% TOP CR 5GR TUBE - 2501299 IBUPROFEN 100MG CHEW TAB PO - 2501300 ACETAMIN 80MG/2.5ML SYR PO - 2501301 HYDROCOD/APAP 7.5-325/15ML UDC - 2501302 TOPIRAMATE 100MG TAB - 2501306 ARIPIPRAZOLE 10MG TAB PO - 2501309 CLOTRIMAZOLE 1% CR 15G TUBE - 2501314 AMOXIL 400MG/5ML 50ML PO - 2501315 AUGMENTIN ES 600MG/5ML PO(ED) - 2501316 CEFDINIR 250MG/5ML 60ML PO - 2501319 LANSOPRAZOLE 3MG/ML 3OZ KIT PO - 2501320 APREPITANT 40MG CAP PO - 2501321 MONSEL'S SOLUTION 1 EA BTL - 2501322 HALOPERIDOL DEC 50MG INJ IM - 2501323 PHENYLEPHRINE 2.5% OP SOL 15ML - 2501327 BUFFERED LIDOCAINE 1% SYR IV - 2501328 NICARDIPINE 25MG/10ML VIAL IV - 2501329 AUGMENTIN 875MG 4PK TAB PO - 2501330 AZITHROMYCIN 250MG 6PK TAB PO - 2501335 ALBUTEROL MDI 8GM INH - 2501338 AUGMENTIN ES 600MG/5ML PO - 2501339 AZITHROMYCIN 200MG/5ML PO - 2501341 AZITHROMYCIN 100MG/5ML PO - 2501344 AMOXIL 250MG/5ML 80ML PO - 2501346 MEGESTROL 40MG/ML SUSP PO - 2501349 OFLOXACIN OTIC SOLUTION (ED) - 2501351 CREON 6000 CAP - 2501353 DESMOPRESSIN 4MCG/ML INJ 1 ML - 2501355 VALPROATE 500MG/5ML VIAL IV - 2501357 POTASSIUM ACE 40MEQ/20ML IV - 2501358 LR 3000ML BAG IRRIG SOLUTION - 2501360 ATROPINE 1% OPHTH SOL - 2501361 LINACLOTIDE 145MG CAP PO - 2501362 DENOSUMAB 120MG SQ INJ - 2501365 MAGIC MOUTHWASH PO - 2501369 DABIGATRAN 75MG TAB PO - 2501373 LACTOBACILLUS CAP PO - 2501374 ARMOUR THYROID 60MG TAB PO - 2501375 FAMOTIDINE 20MG INJ IV VIAL - 2501376 SUMATRIPTAN 6MG SQ INJ SYR - 2501377 IOPAMIDOL-M 41%/10ML INJ VIAL - 2501380 FENTANYL 12MCG PATCH TOP - 2501384 HYDROCORTISONE 1% 30G TUBE - 2501386 BUFFERED LIDO 1% 10ML SYR IV - 2501387 CLINIMIX E 4.25%/10% BAG - 2501391 HEPARIN 30 UNIT/3 ML FLUSH INJ - 2501393 METRONIDAZOLE 500MG TAB PO - 2501394 BUT/APAP/CF 50/325/40MG TAB PO - 2501396 DIVALPROEX 250MG ER TAB PO - 2501399 CREON 36000 CAP PO - 2501400 LOSARTAN 50MG TAB PO - 2501401 LORAZEPAM 2MG/ML ORAL SUSP - 2501403 RITUXIMAB 500MG/50ML VIAL IV - 2501406 SUCRALFATE 1 GM TAB PO - 2501407 CEFTRIAXONE 2 GM SDV IV - 2501414 CLONIDINE 0.2MG/DAY TOP PATCH - 2501415 CEFDINIR 300MG CAP PO - 2501416 FLUORESCEIN 500MG/5ML VIAL IV - 2501417 SUGAMMADEX 200MG/2ML VIAL IV - 2501421 LINAGLIPTIN 5MG TAB PO - 2501422 METFORMIN ER 500MG TAB PO - 2501425 HYDROMORPHONE 0.2MG/ML INJ SYR - 2501426 DARBEPOETIN 200MCG INJ VIAL - 2501428 NATALIZUMAB 300MG/15ML VIAL IV - 2501429 CEFEPIME HCL 2 GM IV VIAL - 2501430 IOHEXOL 240MG 50ML VIAL IV - 2501433 LR 1000ML IV (PREOP WARMER) 105.00 2501434 CLINIMIX E 5%/15% BAG - 2501435 TRACE ELEMENTS 1ML SDV IV - 2501437 METHYLENE BLUE 0.5% AMP INJ - 2501438 FAT EMULSION 20% IV 250ML BAG - 2501440 CEFEPIME 2GM/50ML IV BAG - 2501441 DOXYLAMINE 25MG TAB PO - 2501443 NS/0.9% 250ML IV PVC free - 2501447 FOSAPREPITANT 150MG SDV IV - 2501448 GEMCITABINE 1GM VIAL IV - 2501449 CISPLATIN 200MG MDV IV - 2501450 PALONOSETRON 0.25MG SDV IV - 2501451 PEGFILGRASTIM 6MG/0.6ML KIT - 2501454 BETADINE 5% 30ML OPTH SOLN - 2501455 OCRELIZUMAB 300MG VIAL IV - 2501456 OLANZAPINE 10MG TAB PO - 2501457 INFLECTRA 100MG VIAL IV - 2501458 ROPIVACAINE 0.2% /500ML BAG - 2501459 SUMATRIPTAN 50 MG TAB PO - 2501460 GLIPIZIDE 5MG TAB PO - 2501461 FULVESTRANT 250MG/5ML SYR IM - 2501463 ROMIDEPSIN 10MG VIAL IV - 2501465 MORPHINE 30MG/30ML PF PCA VIAL - 2501466 POTASSIUM CIT 1100/334MG/5ML - 2501467 NEOSTIGMINE 10MG/10ML VIAL IV - 2501468 DOXEPIN HCL 10MG CAP PO - 2501469 OXALIPLATIN 100MG/20ML VIAL IV - 2501470 5-FU 2500MG/50ML VIAL IV - 2501471 BORTEZOMIDE 3.5MG/10ML IV/IM - 2501473 AMIKACIN SULF 1G/4ML VIAL IV - 2501474 DALBAVANCIN 500MG VIAL - 2501475 D5W 500 ML BAG IV - 2501476 FERRIC GLUCONATE 62.5MG MDV IV - 2501478 HEPARIN 1/2 NS 50U/ML 500ML IV - 2501479 SODIUM CL 1 GRAM PO TAB - 2501480 PRAMIPEXOLE 1MG TAB PO - 2501481 AZATHIOPRINE 50MG TAB PO - 2501482 HALOPERIDOL 5MG TAB PO - 2501483 ZOSYN 2.25 GRAM VIAL IV - 2501484 CHLORDIAZEPOXIDE 25MG CAP PO - 2501485 ZARXIO 300MCG PFS SC INJ - 2501487 VANCOMYCIN 125MG/5ML PO SYR - 2501488 ZARXIO 480MCG PFS SC INJ - 2501489 ROMIPLOSTIM 250MCG SDV SC INJ - 2501490 LORAZEPAM 1MG/0.5ML PO SOLN - 2501492 FERUMOXYTOL 510MG SDV IV - 2501494 ROMIPLOSTIM 500MCG SDV SC INJ - 2501495 PACLITAXEL 300MG VIAL IV - 2501496 CARBOPLATIN 600MG VIAL IV - 2501497 GAMUNEX-C 10% VIAL IV - 2501498 BENRALIZUMAB 30MG SC INJ - 2501499 PROPOFOL VIAL 100ML IV - 2501500 EDARAVONE 30MG/100ML IV BAG - 2501501 HYDROMOR 0.5MG/0.5ML INJ SYR - 2501502 GAMUNEX-C 10% 25G VIAL IV - 2501503 5-FU 1000MG/20ML VIAL IV - 2501507 LEUCOVORIN 500MG VIAL IV - 2501508 IRINOTECAN 100MG/5ML VIAL IV - 2501511 VEDOLIZUMAB 300MG VIAL IV - 2501513 GAMUNEX-C 10% 1G VIAL IV - 2501516 INJECTAFER 750MG/15ML SDV IV - 2501517 KETAMINE 50MG/5ML SYR IV - 2501518 ABATACEPT 250MG VIAL IV - 2501519 EPOETIN ALFA 10000U/ML INJ SQ - 2501522 BELATACEPT 250MG VIAL IV - 2506206 PERCOCET TABLETS PO 17.00 2506212 ACTIVASE 100MG IV 6,796.00 2506218 MORPHINE 10MG SYR IV 36.00 2506219 CEFTRIAXONE 1GM INJ IV 199.00 2506221 CEFAZOLIN 1 GRAM VIAL IV 45.00 2506223 CEFUROXIME 750MG INJ IV 47.00 2506224 TETANUSDIPTH TOXOID INJ >7YRS 95.00 2506225 D5/.45NS 1000ML IV 40.00 2506227 PROPARACAINE DROPS OPTH 60.00 2506233 NS/0.9 1000ML IV 105.00 2506234 LR 1000ML IV 105.00 2506235 SOD. CHLORIDE IRRIGATION 42.00 2506242 KETOROLAC 60MG INJ IV 49.00 2506245 DIPHENHYDRAMINE 50MG SDV IV 17.00 2506248 PROCHLORPERIZINE 10MG INJ IV 66.00 2506250 DEXAMETHASONE 4MG INJ IV 17.00 2506251 DIGOXIN 0.5MG/2ML AMP IV 17.00 2506255 FUROSEMIDE 10MG/ML INJ 4ML IV 17.00 2506256 FLUMAZENIL 5ML VIAL IV 381.00 2506257 NALOXONE 1MG INJ IV 40.00 2506258 OXYTOCIN 10U/ML AMP IV 23.00 2506260 METOCLOPRAMIDE 10MG INJ IV 17.00 2506261 SODIUM BICARBONATE 8.4% IV 24.00 2506262 METHYLPREDNISOLON 125MG SDV IV 27.00 2506264 DIAZEPAM 10MG INJ IV 26.00 2506266 MIDAZOLAM 2MG/2ML VIAL IV 21.00 2506267 PROMETHAZINE 25MG INJ IV 23.00 2506275 AMOXIL 125MG/5ML 80ML PO (ED) 38.00 2506277 ASPIRIN 325MG TAB PO 11.00 2506278 HYDROXYZINE 25MG TAB PO 17.00 2506282 CIPROFLOXACIN 500MG TAB PO 44.00 2506286 AMITRIPTYLINE 25MG PO 17.00 2506288 CYCLOBENZAPRINE 10MG TAB PO 17.00 2506289 INDOMETHACIN 25MG TAB PO 17.00 2506290 CEPHALEXIN 500MG 6PK PO - 2506291 LOMOTIL TAB PO 17.00 2506292 METPROLOL TART 50MG TAB PO 17.00 2506293 NITROFURANTOIN 100 MG CAP PO 18.00 2506294 POTASSIUM CL 20MEQ ER TAB PO 17.00 2506295 IBUPROFEN 200MG PO 13.00 2506297 DIAZEPAM 5MG TAB PO 17.00 2506300 PHENAZOPYRIDINE 200MG PO 17.00 2506304 ACETAMINOPHEN 325MG TAB 11.00 2506305 D5 1/2NS/KCL 20MEQ IV 45.00 2506307 FAMOTIDINE 20MG INJ IV 39.00 2506326 CALCIUM CHLORIDE 10% INJ 41.00 2506327 DEXTROSE 50% INJ IV SYR 38.00 2506329 DOBUTAMINE 500 MG INJ IV 52.00 2506330 EPINEPHRINE INJ 38.00 2506331 HEPARIN 5000 UNIT INJ 17.00 2506353 BISCODYL 10MG R/S RECTAL 17.00 2506354 GENTAMINCIN OINT OPTH (ED) 112.00 2506357 MAGNESIUM CITRATE 10OZ PO 17.00 2506358 MILK OF MAGNESIA PO 17.00 2506361 NITRO-BID OINT 2% 1GM TOP 17.00 2506362 NYSTATIN ORAL SUSP 5ML UDC PO 97.00 2506365 PENICILLIN 250MG TAB PO 17.00 2506368 GUAIFENESIN AC 30ML PO 38.00 2506369 FAMOTIDINE 20MG TAB PO 17.00 2506370 SILVER SULFADIAZ 1%CRM 20G TOP 60.00 2506371 SILVER NITRATE STICKS TOP 66.00 2506377 DICYCLOMINE 20MG CAP PO 17.00 2506383 BENZTROPINE 2MG/2ML INJ 52.00 2506385 ACYCLOVIR 400MG PO 17.00 2506393 ATROPINE S04 1MG/CC IV 47.00 2506396 SENNA CONC TAB PO 17.00 2506413 BACTRIM-DS TAB PO 17.00 2506416 BETADINE LIQUID TOP 21.00 2506417 SULFACETAMIDE 10% OPTH 50.00 2506420 DILTIAZEM 5MG/ML 5ML IV 68.00 2506421 DILTIAZEM 30MG TAB PO 17.00 2506422 CLONIDINE 1MG TAB PO 17.00 2506429 GI COCKTAIL PO 34.00 2506435 PROMETHAZINE 12.5 MG RS RECTAL 27.00 2506437 ALBUTEROL MDI 8GM INH (ED) 142.00 2506441 THIAMINE 200MG INJ SDV IV 23.00 2506444 KETOROLAC 30MG INJ IV 46.00 2506445 ACETAMINOPHEN 120MG RECTAL 17.00 2506446 ACET LIQ 160MG/5ML PO 19.00 2506447 ATROPINE 1MG SYRN IV 40.00 2506449 MAG SULFATE 50% SDV IV 17.00 2506450 ADENOSINE 6MG/2ML IV SYR 214.00 2506452 SUCCINYLCHOLIN 20MG/ML VIAL IV 23.00 2506456 LORAZEPAM 1MG TAB PO 17.00 2506457 PROMETHAZINE 25MG RS RECTAL 34.00 2506459 ALPRAZOLAM 0.25MG TAB PO 17.00 2506461 LORAZEPAM 2MG INJ IV 38.00 2506464 HEPARIN 50U/ML 500ML IV 38.00 2506465 NITRO 100MCG/ML 250ML IV 47.00 2506467 POTASSIUM CL 10 MEQ ER TAB 17.00 2506468 CEPHALEX 250MG/5ML SUSP PO(ED) 107.00 2506471 METOPROLOL 5MG/5ML VIAL 26.00 2506472 FUROSEMIDE 20MG TAB PO 17.00 2506475 HALOPERIDOL 5MG INJ IM 51.00 2506477 VANCOMYCIN 1GM SDV IV 44.00 2506478 LIDOCAINE 4GM/500ML IV 68.00 2506479 DOPAMINE 400/250ML IV 130.00 2506481 AMPICILLIN 1GM SDV IV 38.00 2506482 CIPROFLOXACIN 400MG/200ML IV 144.00 2506484 METRONIDAZOLE 500MG/100ML IV 156.00 2506487 PENICILLIN IMMU IV/IM 198.00 2506491 DOXYCYCLINE 100MG INJ IV 88.00 2506494 METOCLOPRAMIDE 10MG TAB PO 17.00 2506495 KCL 20MEQ/15ML ORAL SOL PO 17.00 2506497 LIDOCAINE VISC 2% 15ML PO 17.00 2506499 FENTANYL 100MCG/2ML VIAL 26.00 2506502 PROPOFOL 10MG/ML 20ML IV 76.00 2506507 GENTAMYCIN OPTH DROPS (ED) 67.00 2506511 CARBACMOL 0.01% OPTH 154.00 2506516 TROPICAMIDE 1% SOL OPTH 76.00 2506523 EPHEDRINE 50MG/ML INJ 17.00 2506525 GLYCOPYROLATE INJ IV 44.00 2506528 FOLIC ACID 1MG TAB PO 17.00 2506529 FOLIC ACID INJ 1MG IV 111.00 2506530 DIGOXIN 0.125MG PO 17.00 2506534 DOXYCYCLINE 100 CAP PO 17.00 2506536 PROPOFOL VIAL 50ML IV 178.00 2506540 PHENYTOIN 100MG CAP PO 17.00 2506541 CEFTRIAXONE 500MG SDV IV 142.00 2506542 CEFTRIAXONE 250MG SDV IV 95.00 2506544 THIAMINE 100MG TAB PO 17.00 2506545 FERROUS SULFATE 5 GR. PO 17.00 2506546 MULTIPLE VITAMIN TAB PO 13.00 2506547 MULTIPLE VITAMIN INJ IV 23.00 2506556 ASPIRIN 300MG R/S RECTAL 17.00 2506562 CALCIUM/VITAMIN D TAB PO 17.00 2506564 SUCRALFATE SUSP 10CC SUSP PO 17.00 2506567 LORATADINE 10MG TAB PO 17.00 2506568 DOCUSATE SODIUM 100MG PO 17.00 2506572 FLUCONAZOLE 100MG TAB PO 67.00 2506573 HEPAT B VAC 10MG/0.5 INJ PEDS 129.00 2506575 ERYTHROMYCIN OINT OPTH 42.00 2506578 FLU VACCINE 3 YRS & > IM 41.00 2506580 GLUCAGON 1MG SDVIV 291.00 2506583 HALOPERIDOL 1MG TAB PO 17.00 2506584 HCTZ 25MG TAB PO 17.00 2506591 KETAMINE 500MG MDV IV 67.00 2506592 ENOXAPARIN 30MG SYR SQ 112.00 2506593 METHYLERGONOVINE 0.2MG INJ IV 38.00 2506597 AZITHROMYCIN 250MG TAB PO 38.00 2506599 TUBERCULIN-PPD TEST INJ 45.00 2506607 CARBAMAZIPINE 200MG TAB PO 17.00 2506608 METFORMIN 500MG TAB PO 17.00 2506610 ZOLPIDEM 5MG PO 20.00 2506612 SERTRALINE 50MG TAB PO 21.00 2506613 ALLOPURINOL 100MG TAB PO 17.00 2506614 METHYLPREDNISOLONE 1 GRAM IV 112.00 2506621 LOPERAMIDE 2MG PO 17.00 2506625 PREDNISOLONE 15MG/5ML LIQ PO 97.00 2506627 FLUTICASONE 110 MCG MDI INH 371.00 2506629 FENTANYL 25MCG PATCH TOP 94.00 2506630 FENTANYL 50 MCG PATCH TOP 140.00 2506632 TRAMADOL 50MG PO 17.00 2506635 NAPROSYN 500MG TAB PO 17.00 2506637 PROMETHAZINE 25MG TAB PO 17.00 2506641 COMBIVENT MDI INH 309.00 2506643 LABETALOL 100MG/20ML INJ IV 44.00 2506649 BUMETANIDE 1MG TAB PO 17.00 2506651 METOLAZONE 2.5MG TAB PO 17.00 2506652 POTASSIUM PHOSPHATE SDV IV 17.00 2506656 CLINDAMYCIN 150MG CAP PO 17.00 2506657 NICODERM PATCH 21MG TOP 20.00 2506660 ACETAZOLAMIDE 500MG INJ IV 111.00 2506670 AMLODIPINE 5MG TAB PO 17.00 2506672 CALCITONIN (SALMON) 200U SPRY 417.00 2506674 AZITHROMYCIN 200MG/5ML PO(ED) 173.00 2506676 PHENYLEPHRINE 1% INJ IV 19.00 2506677 SIMETHACONE 80MG PO 17.00 2506679 TOBRADEX SOLN 5M OPTH 245.00 2506681 VITAMIN C 500MG TAB PO 17.00 2506684 BACITRACIN 50MU SDV INJ IV 119.00 2506685 AMANTADINE 100MG CAP PO 17.00 2506687 LACTULOSE 30ML PO 21.00 2506690 TRAZODONE 50MG TAB PO 17.00 2506698 CATAPRES-TTS 1 PATCH TOP 94.00 2506700 FLUTICASONE 0.05% NASAL SPRAY 286.00 2506701 METHOCARBAMOL 500MG TAB PO 17.00 2506705 LIDOCAINE 2% JELLY 30ML TOP 100.00 2506713 MS-CONTIN 15 MG TAB PO 17.00 2506714 ONDANSETRON 4MG/2ML SDV IV 129.00 2506716 PSEUDOEPHEDRINE 30MG TAB PO 17.00 2506720 COLCHICINE 0.6MG TAB PO 17.00 2506721 AUGMENTIN 875MG TAB PO 45.00 2506724 CHLORPROMAZINE 50MG INJ IV 36.00 2506729 NITROSTAT 0.4MG #25 PO 36.00 2506736 HYOSCYAMINE 0.125MG PO 17.00 2506738 NULYTELY LIQUID PO 124.00 2506749 GUAIFENESIN-LA 600MG TAB PO 17.00 2506757 GUAIFENESIN 10ML PO UDC 19.00 2506761 TRIAMCINOLONE 40MG SDV IV 47.00 2506768 SPIRONOLACTONE 25MG PO 17.00 2506769 ALBUMIN 25G 25% 100ML 285.00 2506776 PHYTONIDIONE 5MG TAB PO 17.00 2506779 PREMARIN VAG CRM 42.5GM PV 186.00 2506783 ACETAMINOPHEN W/COD 3 TAB 17.00 2506784 CLOPIDOGREL 75 MG TAB PO 36.00 2506794 LIDO/PRILOC 2.5% 5 GM TUBE TOP 52.00 2506801 WARFARIN 1MG TAB PO 17.00 2506804 WARFARIN 5MG TAB PO 17.00 2506806 FUROSEMIDE 40MG ORAL TAB 17.00 2506807 HYDRALAZINE 20MG/ML SDV IV 86.00 2506808 HYDROXYZINE 100MG INJECTION IV 17.00 2506810 LEVOTHYROXINE 0.1MG PO 17.00 2506811 LEVOTHYROXINE 0.075MG PO 17.00 2506812 LEVOTHYROXINE 0.05MG TAB PO 17.00 2506814 ASPIRIN 81MG TAB PO 11.00 2506815 ACETAMINOPHEN R/SUPP 325MG 17.00 2506818 AMOXICILLIN 500MG CAP PO 17.00 2506820 MECLIZINE 25MG TAB PO 17.00 2506822 MEPERIDINE 50MG CARPUJECT 26.00 2506827 D5/LR 1000ML IV 45.00 2506828 D5W 1000ML IV 40.00 2506829 D5/0.2NS 1000ML IV 40.00 2506830 D5/0.9NS 1000ML IV 40.00 2506831 NS/0.45 1000ML IV 39.00 2506832 NS/0.9 500ML IV 105.00 2506833 NS/0.9 250ML IV 105.00 2506834 NS/0.9% 100ML IV 62.00 2506835 NS/0.9 50ML IV 62.00 2506836 D10% W 500ML IV 39.00 2506841 PAROXETINE 20MG PO 23.00 2506843 PREDNISONE 20MG TAB PO 17.00 2506845 AZITHROMYCIN 100MG/5ML PO(ED) 165.00 2506851 VITAMIN B12 1000MCG SDV IM 17.00 2506852 CEPHALEXIN 250MG CAP PO 17.00 2506854 DEXAMETHASONE 4MG TAB PO 17.00 2506855 MANNTOL 12.5GM 50ML SDV IV 23.00 2506856 HYOROCORTISONE 100MG SDV IV 17.00 2506858 AMOXIL 250MG/5ML 80ML PO(ED) 52.00 2506870 DILTIAZEM 120MG CAP PO 17.00 2506871 DILTIAZEM 180MG CAP PO 17.00 2506873 GLYCERINE SUPP RECTAL 17.00 2506880 DIPHENHYDRAMINE 25MG CAP PO 13.00 2506890 NYSTATIN POWDER 50 TOP 133.00 2506891 CALCIUM GLUCONATE 10% IV 17.00 2506892 ATORVASTATIN 10MG TAB PO 26.00 2506895 IBUPROFEN 800MG TAB PO 17.00 2506896 BISACODYL 5MG TAB PO 17.00 2506910 DEXTROSE GEL 15GM TUBE PO 21.00 2506911 METOPROLOL XL 50MG TAB PO 17.00 2506926 LIDO/EPI 1% 20ML MDV IV 23.00 2506927 LIDOCAINE 1% 20ML MDV IV 17.00 2506928 LIDO/EPI 2% 20ML MDV IV 23.00 2506932 KCL 10MEQ 100CC WATER IV 39.00 2506938 ENOXAPARIN 60MG SYRINGE SQ 212.00 2506945 MAALOX 30ML PO 21.00 2506947 KAYEXALATE 15GM/60ML PO/PR 45.00 2506954 LEVOFLOXACIN 500MG PO 67.00 2507000 OXYCONTIN 10MG TAB PO 19.00 2507002 AMOXICILLIN 500 6PK PO - 2507005 BACTRIM DS 6PK PO - 2507009 DICYCLOMINE 20 MG 6PK PO - 2507012 CIPROFLOXACIN 500MG 6PK PO - 2507016 CYCLOBENZAPRINE 10MG 6PK PO - 2507029 PEN VK 250MG 6PK PO - 2507030 PROMETHAZINE 25MG 6PK - 2507032 PREDNISONE 20MG TAB PO 6PK - 2507040 TRAMADOL 50MG 6PK PO - 2507045 LORAZEPAM 1MG (6PAK) PO - 2507046 DIAZEPAM 5MG 6PK PO - 2507048 APAP/CODIENE #3 TAB 6PK PO - 2507049 PERCOCET 6PK PO - 2507054 LACRILUDE OINT OPTH 60.00 2507060 EYE WASH 4OZ OPTH 27.00 2507062 LEVOTHYROXINE .025MG TAB PO 17.00 2507066 POLYSPORIN OINTMENT OPTH (ED) 124.00 2507072 STERILE WATER IRRIGATION 42.00 2507073 BENZONATATE 100MG PO 17.00 2507074 ALBUTEROL 2.5MG NEB SOLN INH 17.00 2507076 MIDAZOLAM 5MG/5ML VIAL IV 97.00 2507077 ETOMIDATE 20MG/10ML VIAL 154.00 2507084 CLONAZEPAM 1MG TAB PO 17.00 2507087 AZIYHROMYCIN 500MG INJ IV 146.00 2507089 HYDROMORPHONE 2MG/ML INJ SYR 26.00 2507092 EPINEPHRINE RACEMIC NEB INH 86.00 2507097 FLURBIPROFEN SOLN OPTH 60.00 2507100 MORPHINE 2MG SYR IV 36.00 2507101 MORPHINE 4MG SYR IV 36.00 2507102 COSYNTROPIN 0.25MG IV 345.00 2507108 VASOPRESSIN 20U SDV INJ 50.00 2507111 PHENYTOIN SUSP.5ML PO 17.00 2507112 SEVOFLURANE 30 MINUTE INH 157.00 2507118 LET TOPICAL 3 ML 67.00 2507119 PANTOPRAZOLE 40 MG TAB PO 27.00 2507120 PANTOPRAZOLE 40MG IV 142.00 2507123 DESFLURANE 30 MINUTES INH 555.00 2507129 ALBUTEROL 2.5 MG NEB 6PK INH 77.00 2507133 ENOXAPARIN 80 MG INJ SQ 231.00 2507146 OCTREOTIDE 50 MCG VIAL IV 77.00 2507149 TAMSULOSIN 0.4 MG TAB PO 18.00 2507159 LABETALOL 100 MG TAB PO 17.00 2507160 ACYCLOVIR INJ 1000MG/20ML VIAL 112.00 2507165 AGGRENOX 25/200 CAP PO 17.00 2507166 BUDESONIDE/PULM 0.25MG/2ML NEB 38.00 2507170 FLEETS SALINE ENEMA RECTAL 17.00 2507171 MIRALAX PACKET PO 18.00 2507173 MORPHINE 20MG/ML ORAL SOLN PO 50.00 2507174 ZOSYN 3.375 GRAM IV 100.00 2507180 AMIODARONE 200 MG TAB PO 24.00 2507181 GABAPENTIN 300MG CAP PO 17.00 2507182 ESMOLOL 100 MG/10 ML IV 74.00 2507184 GENTAMYCIN 80 MG INJ IV 27.00 2507185 RIZATRIPTAN 5 MG PO 104.00 2507187 CARVEDILOL 6.25 MG TAB PO 17.00 2507193 SCOPOLAMINE 1.5 MG PATCH TOP 47.00 2508000 IPRATROPIUM NEB SOL INH 18.00 2508003 DOBUTAMINE 250 MG/250ML BAG IV 233.00 2508004 AMIODARONE 150MG VIAL IV 50.00 2508005 LEVOFLOXACIN 500M/100M IV 215.00 2550010 GAD-BASE MR CONTRAST NOS 1ML 34.00 2705270 HUMIDIFIER OXYGEN 45.00 2705388 VENTILATION CIRCUIT 132.00 2705770 MDI SPACER 122.00 2705837 CPM PADD KIT - 2708164 BAIR HUGGER FULL BODY - 2708193 BAIRHUGGER UPPERBODY - 2720008 BIOPSY FORCEP RAD JAW 3 CLD - 2720011 PROB GOLD PROBE BIOPSY - 2720012 NEEDLE SURESHOT INJECTION - 2720015 TUBING HYDROFLEX ARTHROSCOPY - 2721940 ENDO BALLOON DILATOR CATHETER - 2721946 FEMORAL CANAL BRUSH/TIP - 2721948 CEMENT MIXING BOWL - 2721963 ENDO INLET CLOSURE DEVICE - 2721964 INTRODUCER SYSTEM - 2721984 SUTURE 3-0 TICRON P-22 - 2721999 SUTURE 1 PDS CT-1 36inch - 2722011 GUIDE WIRE 1.6 THRD 4.5 CANN - 2722020 SHAVER TURBOWHISKER - 2722022 DRILL BIT CANNULATED - 2722023 GUIDE WIRE - 2722028 LONE STAR RETRACTOR RING - 2722029 LONE STAR ELASTIC STAYS - 2722030 DRILL BIT 2.8 165MM - 2722032 BLADE MYRINGOTOMY - 2722037 DRILL BIT CANNULATED - 2722044 GLIDEWIRE UROLOGY - 2722045 SAW BLADE - 2722050 HOTLINE WARMING SET - 2722051 TEMP PROBE ESOPHAGEAL - 2722057 SET EXTENSION - 2722076 CLAMPS LARGE EXTERNAL FIXATOR - 2722077 TUBES/CARBON RODS LARGE EX-FIX - 2722085 BURR STRYKER - 2722097 SUTURE ORTHOCORD - 2722105 SUTURE MONOCRYL - 2722111 A-LINE CATHETER SET - 2722114 CATHETER AIRWAY EXCHANGE - 2722119 ENDOLOOP SUTURE - 2722122 NASAL RAE ENDOTRACHEAL TUBE - 2722124 SUTURE 0 VICRYL CT-1 CR8 - 2722125 SUTURE 0 PDS CT-1 - 2722126 ARTHRO SHAVER 3.5 RESECTOR - 2722127 ARTHRO SHAVER 4.0 PLUS CUTTER - 2722128 ARTHRO SHAVER 4.0 TOMCAT - 2722134 ARTHRO BUR ROUND 6 FLUTE 4.0 - 2722146 DRILL BIT - 2722147 K WIRE .062 - 2722161 SUTURE 2-0 PDS CT-1 - 2722162 TAUT CHOLANGIOCATHETER - 2722166 SUTURE 2-0 MONOCRYL CT-1 - 2722170 RADIOLUCENT DRILL BIT - 2722176 ENDOSCOPIC MARKER - 2722185 ROTH NET RETRIEVAL DEVICE - 2722191 DISTRACTION SCREW - 2722193 TISSEEL HEMOSTASIS AGENT - 2722195 DRILL BIT AESCULAP - 2722196 SUTURE 4-0 PDS PS-2 - 2722198 SUTURE MISCELLANEOUS - 2722199 WAYNE PNEUMOTHORAX TRAY - 2722203 HELICAL BLADE SYNTHES - 2722205 IM REAMING ROD - 2722207 ANKLE DISTRACTOR FOOT STRAP - 2722211 ENDOTRAC DISPOSABLE BLADE - 2722213 LIGASURE DISSECTOR - 2722214 FORCE TRIVERSE ELECTROCAUTERY - 2722520 DRILL BIT QUICK COUPLING - 2722590 GUIDE WIRE 1.25 FOR 4.0 CANN - 2723008 ENDO-GIA - 2723009 ENDO-GIA RELOAD - 2723037 CANNISTER SUCTION 2000CC - 2723046 SUCTION TUBE/TRU-CUT Bx NEEDLE - 2723049 BOVIE TIP - 2723050 ELECTRODE EXTENDED BLADE - 2723099 BALL ELECT 5MM 57.00 2723134 DRAPE FLUOROSCAN - 2723136 FALOPE RING - 2723140 BLADE STERILE - 2723167 HEMOCLIP WECK MEDIUM - 2723206 SHOULDER SUSPENSION KIT - 2723209 MITEK VAPR W/301 - 2723217 ANCHORS/MITEX MINI - 2723294 INTRODUCER SET 9 FR - 2723309 SUTURE 4-0 PROLENE PS-2 - 2723456 DRILL BIT 2.5MM GOLD - 2723457 DRILL BIT 3.5MM SM FRAG - 2723458 DRILL BIT 1.1MM MINI - 2723461 DRILL BIT 1.8MM MINI - 2723466 DRILL BIT .76MM W/10MM STOP - 2723467 DRILL BIT .76MM W/8MM STOP - 2723471 DRILL BIT 2.0 MM LG FRAG - 2723472 DRILL BIT 3.2 MM LG FRAG - 2723473 DRILL BIT 4.5 MM LG FRAG - 2723475 DRILL BIT 2.7MM E-NAIL - 2723476 DRILL BIT 2.0 CANNULATED - 2723477 DRILL BIT 2.7 CANNULATED - 2724548 TROCAR 12MM - 2725291 BONE CEMENT - 2725292 FAST-FIX CVD MENISCAL REPAIR - 2725293 FAST-FIX KNOT PUSHER/CUTTER - 2725969 GUIDE WIRE NO-THR 150MM 1.1MM - 2726072 SUTURE LASSO 90 DEGREE - 2726076 CANNULA TWIST-IN 8.25 X 7 - 2726082 GUIDE WIRE 2.8MMTHRD 7.3 CANN - 2726085 SUTURE 0 PROLENE CT-1 - 2726093 SUTURE 4-0 PROLENE FS-2 - 2726098 SUTURE 3-0 PROLENE PS-1 - 2726101 SUTURE 2-0 PROLENE SH - 2726103 SUTURE 1 PROLENE CT-1 - 2726106 SUTURE 5-0 NYLON PS-3 - 2726108 SUTURE 8-0 NYLON BU 130-4 - 2726110 SUTURE 6-0 NYLON P-1 - 2726115 SUTURE 4-0 NYLON FS - 1 - 2726117 SUTURE 3-0 NYLON FS-1 - 2726118 SUTURE 3-0 NYLON PS -2 - 2726120 SUTURE 3-0 NYLON FSLX - 2726122 SUTURE 2-0 NYLON FS - 2726123 SUTURE 2-0 NYLON FSLX - 2726134 SUTURE 5-0 CHROMIC P-3 - 2726136 SUTURE 4-0 CHROMIC RB-1 - 2726140 SUTURE 3-0 CHROMIC SH - 2726144 SUTURE 2-0 CHROMIC SH - 2726150 SUTURE 0 CHROMIC CT-1 - 2726405 SUTURE 3-0 MONOCRYL PS-2 - 2726414 INSULSCAN WAND - 2726415 FLEXITIP APPLICATOR - 2726416 HEMOSTATIC AGENT - 2726417 DISPOSABLE INSTRUMENT - 2726422 ULTRASONIC DISSECTOR - 2726423 NEURO IRRIGATING BIPOLAR - 2727040 SUTURE 4-0 MONOCRYL PS-2 - 2727049 SUTURE 4-0 SILK TIES 18inch - 2727051 SUTURE 3-0 SILK SH - 2727055 SUTURE 2-0 SILK FS - 2727056 SUTURE 2-0 SILK SH - 2727057 SUTURE 2-0 SILK TIES 30inch - 2727058 SUTURE 2-0 SILK TIES 18inch - 2727059 SUTURE 0 SILK SUTUPAK - 2727065 SUTURE 4-0 VICRYL FS-2 - 2727066 SUTURE 4-0 VICRYL FS-1 - 2727067 SUTURE 4-0 VICRYL RB-1 - 2727068 SUTURE 3-0 VICRYL FS-2 - 2727069 SUTURE 3-0 VICRYL FS-1 - 2727071 SUTURE 3-0 VICRYL SH - 2727073 SUTURE 3-0 VICRYL TIES 18inch - 2727074 SUTURE 2-0 VICRYL FS-1 - 2727077 SUTURE 2-0 VICRYL SH - 2727078 SUTURE 2-0 VICRYL UR-6 - 2727079 SUTURE 2-0 VICRYL CT-1 - 2727080 SUTURE 2-0 VICRYL TIES 18inch - 2727081 SUTURE 0 VICRYL UR-6 - 2727082 SUTURE 0 VICRYL SUTUPAK - 2727083 SUTURE 0 VICRYL CT-2 - 2727084 SUTURE 0 VICRYL CT-1 - 2727086 SUTURE 1 VICRYL 36IN CT1 - 2727088 SUTURE 5 ETHIBAND EXCEL V-37 - 2727089 SUTURE 0 ETHBOND EXCEL MO-7 - 2727090 SUTURE 2 ETHIBOND EXCEL - 2727091 SUTURE 2-0 ETHIBOND EXTRA CT2 - 2727092 SUTURE 0 ETHIBOND EXCEL CT2 - 2727093 SUTURE 1 ETHIBOND EXCEL CT1 - 2727097 SUTURE 5-0 ETHILON P-3 - 2727099 SUTURE 2-0 PDS11 FS-1 - 2727100 SUTURE 3-0 PDS11 PS-1 - 2727105 SUTURE 3-0 PROLENE - 2727303 CATH WHISTLE TIP - 2727439 CURRETTE STERILE VAC 9MM - 2727443 FILTER PSI-TEC ABSOLUTE - 2727444 TUBING ASPIRATION-LIPOSUCTION - 2727450 SUTURE 2-0 VICRYL CT-2 - 2727460 SUTURE 3-0 SILK SH CR/9 - 2728136 SUTURE VICRYL 3.0 J497G - 2728145 SUTURE ETHILON 4.0 662H - 2728147 SUTURE ETHILON 5.0 661H - 2728166 TOURIQUET STERILE 18inch - 2728167 TOURNIQUET STERILE 12inch - 2728175 SAW BLADE 6.4 X 25.4 - 2728178 SUTURE 1 PDS CTX - 2728181 SUTURE RETRIEVER - 2728223 ARTHREX FIBERWIRE - 2728224 ARTHREX SUTUREPASS WIRE - 2728228 SUTURE BONE WAX - 2728230 SUTURE 6-0 PLAIN G-1 - 2728238 ARTHROCARE WAND TURBOAVAC 90 - 2782462 BONE MATRIX DBX 1CC - 2782463 BONE MATRIZ DBX 2.5CC - 2782511 TIBIAL NAIL - 2783102 MARLEX MESH 2X4 - 2783103 MARLEX MESH 3X6 - 2783421 SCREW 3.5MM CORTEX S-TAPP 28MM - 2783427 SCREW 3.5MM CORTEX S-TAPP 50MM - 2783437 SCREW 4.0 CANC F.T. 14MM - 2783439 SCREW 4.0 CANC F.T. 18MM - 2783440 SCREW 4.0 CANC F.T. 20MM - 2783451 K WIRE 1.6MM - 2783452 K WIRE 2.0MM - 2783491 SCREW 6.5 CAN BON 32TL 40MM - 2783504 SCREW NO PROFILE CORT 46MM - 2783518 PLATE 3.5 1/3 TUB 5 HOLE - 2783519 PLATE 3.5 1/3 TUB 6 HOLE - 2783521 PLATE 3.5 1/3 TUB 8 HOLE - 2783529 PLATE 3.5 LC-DCP 6 HOLE - 2783530 PLATE 3.5 DCP 7 HOLE - 2785052 PLATE DHS 135 STANDARD 4 HOLE - 2785091 SCREW DHS/DCS LAG 80MM - 2785771 SCREW 4.5 CORTEX SELF-TAP 44MM - 2785774 SCREW 4.5 CORTEX SELF-TAP 50MM - 2785775 SCREW 4.5 CORTEX SELF-TAP 52MM - 2785778 SCREW 4.5 CORTEX SELF-TAP 58MM - 2785779 SCREW 4.5 CORTEX SELF-TAP 60MM - 2785792 SCREW 4.0 CANNU SHRT THRD 24MM - 2785793 SCREW 4.0 CANNU SHRT THRD 26MM - 2785798 SCREW 4.0 CANNU SHRT THRD 36MM - 2785800 SCREW 4.0 CANNU SHRT THRD 40MM - 2785803 SCREW 4.0 CANNU SHRT THRD 46MM - 2785805 SCREW 4.0 CANNU SHRD THRD 50MM - 2785827 SCREW 4.0 CAN BON PT 18MM 7MM - 2785831 SCREW 4.0 CAN BON 26MM 12MM - 2785833 SCREW 4.0 CAN BON 30MM 14MM - 2785835 SCREW 4.0 CAN BON 40MM 14MM - 2785836 SCREW 4.0 CAN BON 45MM 15MM - 2785837 SCREW 4.0 CAN BON 50MM 15MM - 2785848 SCREW COR SF-TAP 8MM 2.0MM - 2785849 SCREW COR SF-TAP 9MM 2.0MM - 2785850 SCREW COR SF-TAP 10MM 2.0MM - 2785851 SCREW COR SF-TAP 11MM 2.0MM - 2785852 SCREW COR SF-TAP 12MM 2.0MM - 2785854 SCREW COR SF-TAP 14MM 2.0MM - 2785855 SCREW COR SF-TAP 16MM 2.0MM - 2785856 SCREW COR SF-TAP 18MM 2.0MM - 2785874 PLATE 1.5MM 6 HOLE - 2785889 SCREW COR SF-TAP 8MM 1.0MM - 2785933 SCREW CAN SHRT THR 25MM 3.0MM - 2785938 SCREW CAN SHRT THR 30MM 3.0MM - 2785970 SCREW COR SF-TAP 8MM 1.5MM - 2785971 SCREW COR SF-THR 9MM 1.5MM - 2785972 SCREW COR SF-THR 10MM 1.5MM - 2785973 SCREW COR SF-TAP 11MM 1.5MM - 2785974 SCREW COR SF-TAP 12MM 1.5MM - 2785976 SCREW COR SF-TAP 14MM 1.5MM - 2785977 SCREW COR SF-TAP 16MM 1.5MM - 2786013 WASHER 7.0 MM FOR SM SCREW - 2786023 SCREW COR SF-TAP 14MM 2.4MM - 2786026 PLATE LC-DCP 6H 36MM 2.0MM - 2786049 PLATE COND 7H 36MM LT 1.5MM - 2786099 SCREW 7.3 CANN 16THRD 75MM - 2786100 SCREW 7.3 CANN 16THRD 80MM - 2786122 WASHER 13.0 MM FOR 7.3 CANN - 2786209 SCREW CANN INTRFER FT 8X25 - 2786210 CANC BONE CHIPS 30CC - 2786218 SCREW TI CORTEX 2.7MM - 2786219 ANCHOR MITEK - 2786221 SCREW 4.0 CANN LG THRD - 2786222 STEINMAN PIN - 2786223 K WIRE 9inch - 2786227 SCREW BIOCRYL INTERFERENCE - 2786228 SCREW 4.5 CANNULATED - 2786235 SCREW CORTICAL 3.2MM - 2786241 SCREW 3.5 CORTICAL LOCKING - 2786242 PLATE 1/3 TUBE LCP W/COLLAR - 2786247 SEPRAFILM - 2786248 PLATE CLAVICLE - 2786249 WASHER - 2786251 WASHER FOR 4.5 CANN SCREW - 2786257 URETERAL STENT SET - 2786262 SCREW SCHANZ LARGE EXT-FIXATOR - 2786263 PLATE ACUMED - 2786264 SCREW ACUMED - 2786266 SCREW 6.5 CANNULATED - 2786269 ENDO FIXATION BUTTON - 2786278 PORT-A-CATH - 2786285 PLATE 3.5 MEDIAL DISTAL TIBIA - 2786290 CABLE WITH CRIMP - 2786306 PLATE 3.5 LCP RECONSTRUCTION - 2786311 MONARC/MINI SUBFASCIAL SLING - 2786314 LOCKING SCREW ACUMED - 2786318 PLATE WITH PEGS - 2786319 3.5 CORTICAL SCREWS - 2786320 2.0MM SMOOTH PEGS - 2786336 TIGHTROPE REPAIR KIT - 2786338 TISSUE EXPANDER - 2786343 MINI TIGHTROPE REPAIR KIT - 2786354 TRICORTICAL BONE WEDGE - 2786355 AMNIOGRAFT - 2786358 ANTERIOR CERVICAL PLATE - 2786359 ANTERIOR CERVICAL SCREW - 2786367 SCREW 3.0 HEADLESS COMPRESSION - 2786368 SCREW 3.0MM HEADLESS COMPRESSN - 2786369 DISTAL HUMERAL PLATE - 2786377 SCREW 5.0 LOCKING IM NAIL - 2786378 TROCHANTERIC NAIL - 2786385 HERNIA MESH SHEET - 2786394 REGULAR FIXATION STAPLE - 2786399 SEPRAMESH HERNIA MESH - 2786405 PLATE HAND INNOVATIONS - 2786410 GRACILIS TENDON GRAFT - 2786418 QUICKFIX SCREW - 2786421 TOTAL HIP COMPONENT - 2786423 TOTAL KNEE COMPONENT - 2786429 ANCHOR ORTHOPEDIC - 2787399 K WIRE .035 - 2787400 K WIRE .045 - 2787401 K WIRE .054 - 2787402 K WIRE .062 - 2788103 SCREW 3.5MM CORTEX S.TAP 10MM - 2788104 SCREW 3.5MM CORTEX S-TAP 12MM - 2788105 SCREW 3.5MM CORTEX S-TAP 14MM - 2788106 SCREW 3.5MM CORTEX S-TAP 16MM - 2788107 SCREW 3.5MM CORTEX S-TAP 18MM - 2788110 SCREW CORTEX S-TAP 22MM - 2788111 SCREW 3.5MM CORTEX S-TAP 24MM - 2788112 SCREW 3.5MM CORTEX S-TAP 26MM - 2788114 SCREW 3.5MM CORTEX S-TAP 34MM - 2788150 K SPACE WIRE .028 - 2788152 NAIL ELASTIC 2.0MM - 2788160 SCREW ACUTRAK MINI 24MM - 3200100 JAW< 4 VIEWS 540.00 3200110 JAW MINI 4 VIEWS 540.00 3200120 MASTOIDS < 3 VIEWS 392.00 3200130 MASTOIDSCOMP MINI 3 VIEWS 561.00 3200140 FACIAL BONES <2 VIEWS 392.00 3200150 FACIAL BONESCOMP MINI 3VIEWS 527.00 3200160 NASAL BONES COMP MINI 3 VIEWS 384.00 3200190 XR OPTIC FORAMINA 367.00 3200200 EYE COMP MINI 4 VIEWS 367.00 3200210 SINGLE VIEW SINUS 218.00 3200220 SINUSES PARANASAL COMP MINI 384.00 3200240 SELLA TURCICA 405.00 3200250 X-RAY EXAM OF SKULL 370.00 3200260 SKULLCOMP MINI 4V W/WO STEREO 682.00 3200320 TMJ'S UNILATERAL OP/CLOS MOUTH 450.00 3200330 TMJ BILATERAL OP/CLOS MOUTH 472.00 3200360 NECK SOFT TISSUE 384.00 3200370 PHARYNX-LARYNX INC FLUOR/MAGNI 392.00 3201100 RIBS-UNILATERAL 2 VIEW 444.00 3201101 RIBSUNILAT W/CHEST PA/LAT 3VI 574.00 3201110 RIBS-BILAT 3 VIEWS 583.00 3201111 RIBSBILAT W/PA CHST MINI 4VIE 624.00 3201120 STERNUM MINI 2 VIEWS 384.00 3201130 STERNOCLAVICULAR JNT COMP 3 VI 397.00 3202010 SPINE ENTIRE 1,243.00 3202020 SGL VW SPINE XR 303.00 3202040 CERVICAL SPINE 2-3 VIEWS 432.00 3202050 CERVICAL SPINE MINI 4 VIEW 575.00 3202052 CERVICAL SPINE COMP W/EX & FLX 750.00 3202070 THORACIC SPINE 2 VIEWS 542.00 3202072 THORACIC SPINE 3 VIEWS 558.00 3202090 SCOLIOSIS STUDY 585.00 3202100 LUMBAR SPINE 2-3 VIEWS 431.00 3202110 LUMBAR SPINE-COMPL MINI 4V 569.00 3202114 LS SPINE COMPL W BENDING VWS 643.00 3202170 PELVIS 1-2 VIEWS 399.00 3202190 PELVIS AND HIPS COMP MINI 3V 501.00 3202200 SACROILLIAC JOINTS < 3 VIEWS 400.00 3202202 SI JOINTS 3 OR MORE VIEWS 583.00 3202220 SACRUM AND COCCYX MINI 2 VIEWS 384.00 3203000 CLAVICLE COMPLETE LT 384.00 3203001 CLAVICLE COMPLETE RT 384.00 3203010 SCAPULA COMPLETE LT 400.00 3203011 SCAPULA COMPLETE RT 400.00 3203020 SHOULDER LEFT 1 VIEW 256.00 3203021 SHOULDER RIGHT 1 VIEW 256.00 3203030 SHOULDER LEFT 2+ VIEWS 384.00 3203031 SHOULDER RIGHT 2+ VIEWS 384.00 3203050 ACJ BILATERAL W/WO WEIGHTS 397.00 3203060 X-RAY EXAM OF HUMERUS 2 VW LT 341.00 3203061 X-RAY EXAM OF HUMERUS 2 VW RT 341.00 3203070 ELBOW LEFT 2 VIEW 270.00 3203071 ELBOW RIGHT 2 VIEW 270.00 3203080 ELBOW LEFT COMP MINI 3 VIEW 270.00 3203081 ELBOW RT COMP MINI 3 VIEW 303.00 3203090 X-RAY EXAM OF FOREARM LT 303.00 3203091 FOREARM RT 303.00 3203092 FULL ARM INFANT LEFT 2 VIEWS 276.00 3203093 FULL ARM INFANT RIGHT 2 VIEWS 276.00 3203100 WRIST LEFT 2 VIEWS 256.00 3203101 WRIST RIGHT 2 VIEWS 256.00 3203102 BILAT WRISTS 2 VIEWS. 276.00 3203110 WRIST LEFT COMP MINI 3 VIEWS 303.00 3203111 WRIST RIGHT COMP MINI 3 VIEWS 303.00 3203112 BILAT WRISTS MINI 3 VIEWS. 295.00 3203120 HAND LEFT 2 VIEWS 273.00 3203121 HAND RIGHT 2 VIEWS 273.00 3203130 HAND LEFT MINI 3 VIEWS 303.00 3203131 HAND RIGHT MINI 3 VIEWS 303.00 3203132 BILAT HANDS MINI 3 VIEWS. 295.00 3203140 X-RAY EXAM OF FINGER(S) LT THB 226.00 3203141 X-RAY EXAM OF FINGER(S) LT 2ND 258.00 3203142 X-RAY EXAM OF FINGER(S) LT 3RD 226.00 3203143 X-RAY EXAM OF FINGER(S) LT 4TH 226.00 3203144 X-RAY EXAM OF FINGER(S) LT 5TH 226.00 3203145 X-RAY EXAM OF FINGER(S) RT THB 226.00 3203146 X-RAY EXAM OF FINGER(S) RT 3RD 226.00 3203147 X-RAY EXAM OF FINGER(S) RT 2ND 226.00 3203148 X-RAY EXAM OF FINGER(S) RT 4TH 226.00 3203149 X-RAY EXAM OF FINGER(S) RT 5TH 226.00 3203500 HIP LEFT 1 VIEW 299.00 3203501 HIP RIGHT 1 VIEW 299.00 3203510 HIP LEFT COMPLETE MINI 2V 415.00 3203511 HIP RIGHT COMPL MINI 2V 415.00 3203540 X-RAY EXAM OF PELVIS&HIPS 3-4V 444.00 3203541 X-RAY EXAM OF PELVIS&HIPS 2V 373.00 3203550 X-RAY EXAM OF THIGH 2 VWS LT 382.00 3203551 X-RAY EXAM OF THIGH 2VWS RT 382.00 3203552 KNEE RIGHT COMP MINI 4 VIEWS 494.00 3203560 KNEE LEFT 1 - 2 VIEWS 299.00 3203561 KNEE RIGHT 1-2 VIEWS 299.00 3203562 KNEE LEFT 3 VIEWS 367.00 3203563 KNEE RIGHT 3 VIEWS 367.00 3203564 KNEE LEFT COMP MINI 4 VIEWS 494.00 3203565 KNEE; BOTH KNEES STANDING AP 240.00 3203569 KNEE BILATERAL 3 VIEWS 394.00 3203580 KNEE ARTHROGRAM 1,476.00 3203581 KNEE ARTHROGRAM 1,476.00 3203590 TIBIA AND FIBULA LEFT 411.00 3203591 TIBIA AND FIBULA RIGHT 411.00 3203592 LOWER LEGLEFT INFMINI 2 VIEW 299.00 3203593 LOWER LEG RIGHTINF.MINI 2 VIE 299.00 3203600 ANKLE LEFT 2 VIEWS 278.00 3203601 ANKLE RIGHT 2 VIEWS 278.00 3203610 ANKLE LEFT COMP MINI 3 VIEWS 316.00 3203611 ANKLE RIGHT COMP MINI 3 VIEWS 316.00 3203620 FOOT 2 V LEFT 278.00 3203621 FOOT 2 V RIGHT 278.00 3203630 FOOT LEFT COMP MINI 3 VIEWS 303.00 3203631 FOOT RIGHT COMP MINI 3 VIEWS 303.00 3203650 X-RAY EXAM OF HEEL LT 256.00 3203651 X-RAY EXAM OF HEEL RT 256.00 3203660 X-RAY EXAM OF TOE(S) 303.00 3204000 AP ABDOMEN 1 VIEW 384.00 3204020 COMPLETE ABDOMEN 427.00 3204022 COMPL ACUTE ABDOMEN 574.00 3204220 ESOPHOGRAM 795.00 3204230 MODIFIED BARIUM SWALLOW 936.00 3204240 UPPER GI-W/KUB 1,120.00 3204245 UGI W/SMALL BOWEL STUDY 1,581.00 3204246 UGI AIR CONTRAST 878.00 3204247 UGI W/AIR W/KUB 1,101.00 3204249 UGI AIR W/SM BOWEL 1,101.00 3204250 SMALL BOWEL STUDY 743.00 3204270 BARIUM ENEMA 999.00 3204280 BARIUM ENEMA WITH AIR CONTRAST 1,235.00 3204290 ORAL GALLBLADDER STUDY 518.00 3204300 CHOLANGIOGRAM INTRAOP 689.00 3204321 PTHC 1,119.00 3204400 IV PYELOGRAM 1,057.00 3204405 IVP W/WO TOMO/KUB 1,043.00 3204410 INFUSION IVP 1,382.00 3204415 IVP W TOMOGRAPHY 1,906.00 3204420 RETROGRADE PYELOGRAM 624.00 3204430 CONTRAST X-RAY BLADDER 600.00 3204450 URETHROGRAM RETROGRADE 334.00 3204455 VOIDING URETHROCYSTOGRAM 795.00 3204710 PELVIMETRY 574.00 3204741 HYSTEROSALPINGOGRAM 1,084.00 3205822 VENOGRAM BILATERAL 1,468.00 3205989 U/S ABCESS DRAINAGE 1,226.00 3206000 FLUOROSCOPY UP TO ONE HOUR 533.00 3206001 FLUOROSCOPE EXAM EXTENSIVE 860.00 3206010 RAD-FOR.BODY EXAM NOSE TO RECT 128.00 3206020 BONE AGE STUDIES 273.00 3206040 BONE LENGTH STUDIES 367.00 3206061 BONE SURVEY METAS LTD 1,285.00 3206062 BONE SURVEY METS COMPLETE 1,425.00 3206075 DEXA >1 SITE AXIAL SKELETON 357.00 3206076 DEXA APPENDICULAR SKELETON 115.00 3206077 DXA BONE DENSITY AXIAL 357.00 3206081 FISTULA/SINUS TRACT 757.00 3206096 MAM NEEDLE LOC EACH BREAST 685.00 3206098 SURGICAL SPECIMEN XR 341.00 3206100 TOMOGRAM 2,038.00 3206101 COMPLEX MOTION; UNILATERAL 587.00 3206102 COMPLEX MOTION; BILATERAL 587.00 3206815 U/S OB LIMITED-MULTI 500.00 3208341 URETHROCYSTOGRAPHY RETROGRADE 600.00 3208343 FLUOROSCOPIC NEEDLE GUIDANCE 1,570.00 3220001 ANKLE RT ARTHROGRAM 1,476.00 3220002 ANKLE LT ARTHROGRAM 1,476.00 3220003 KNEE ARTHROGRAM 1,476.00 3220004 KNEE LT ARTHROGRAM 1,476.00 3220005 WRIST RT ARTHROGRAM 1,476.00 3220006 WRIST LT. ARTHROGRAM 1,476.00 3220007 ELBOW RT ARTHROGRAM 1,476.00 3220008 ELBOW LT ARTHROGRAM 1,476.00 3220009 SHOULDER ARTHROGRAM INJ 1,476.00 3220010 SHOULDER ARTHROGRAM 1,476.00 3223041 SHOULDER ARTHROGRAM LEFT 1,476.00 3223042 SHOULDER ARTHROGRAM RIGHT 1,476.00 3223116 WRIST ARTHROGRAM LEFT 1,476.00 3223117 WRIST ARTHROGRAM RIGHT 1,476.00 3223616 ANKLE ARTHROGRAM LEFT 1,476.00 3223617 ANKLE ARTHROGRAM RIGHT 1,476.00 3241010 CHEST SINGLE VIEW 194.00 3241020 CHEST X-RAY/2-VIEW 245.00 3241021 CHEST-APICAL 435.00 3241022 CHEST-OBLIQUE VIEW 574.00 3241023 CHEST W/FLUOROSCOPY 1,164.00 3241030 CHESTMULTI FLM COMPMINI 4VIEW 706.00 3418596 NM LUNG SCAN PERFUSION/VENT 3,127.00 3500498 CT ANGIOGRAPHY NECK 2,341.00 3503206 CT UPPER EXTREMITY ANGIOGRAPHY 2,228.00 3506377 3D RENDERING W/POSTPROCESS 647.00 3506380 CT - LIMITED OR FOLLOW-UP STUD 921.00 3510450 CT HEAD WITHOUT CONTRAST 1,872.00 3510460 CT HEAD WITH CONTRAST 1,951.00 3510470 CT - HEAD/BRAIN W & WO CONTRAS 2,553.00 3510480 CT_ORBITSELLAMID/INNER EAR W 1,550.00 3510481 CT-ORBITSELLAMID/INNER EAR W 1,633.00 3510482 CT EAR WITH & WITHOUT CONTRAST 1,591.00 3510485 CT - MF WO CONTR 742.00 3510486 CT FACIAL WITHOUT CONTRAST 1,456.00 3510487 CT FACIAL WITH CONTRAST 2,083.00 3510488 CT SINUS WITH CONTRAST 1,550.00 3510490 CT SOFT TISSUE NECK WO CONTRAS 1,619.00 3510491 CT SOFT TISSUE NECK WITH CONTR 2,039.00 3510492 CT SOFT TISSUE NECK W/WO CONTR 2,172.00 3511482 CT - ORBIT SELLA MID/INNER E 1,729.00 3517048 CT FACIAL WITH/WITHOUT CONTRAS 1,936.00 3520496 CT HEAD ANGIOGRAPHY 2,496.00 3521250 CT THORAX; WO CONTRAST 1,756.00 3521260 CT THORAX; W CONTRAST 2,202.00 3521270 CT THORAX; W & WO CONTRAST 2,341.00 3521275 CT PE STUDY/CHEST W/IV CONTRAS 2,563.00 3522120 CT LOW DOSE CHEST W/O 239.00 3522125 CT CERVICAL SPINE WITHOUT CONT 1,951.00 3522126 CT CERVICAL SPINE WITH CONTRAS 2,285.00 3522127 CT CERVICAL SPINE W/WO CONTRAS 2,417.00 3522128 CT THORACIC SPINE WITHOUT CONT 1,659.00 3522129 CT THORACIC SPINE WITH CONTRAS 2,262.00 3522130 CT THORACIC SPINE W/WO CONTRAS 2,417.00 3522131 CT LUMBAR SPINE WITHOUT CONTRA 1,816.00 3522132 CT LUMBAR SPINE WITH CONTRAST 2,285.00 3522133 CT LUMBAR SPINE W/WO CONTRAST 2,417.00 3522191 CT PELVIS ANGIOGRAPHY 2,078.00 3522192 CT PELVIS; WO CONTR 1,619.00 3522193 CT PELVIS WITH CONTRAST 2,239.00 3522194 CT PELVIS W/WO CONTRAST 2,591.00 3523200 CT UPPER EXTREMITY W/O CONTRAS 1,728.00 3523201 CT UPPER EXTREMITY WITH CONTR 1,653.00 3523202 CT UPPER EXTREM W/WO CONTRAST 2,033.00 3523700 CT LOWER EXT WITHOUT CONTRAST 1,561.00 3523701 CT LOWER EXT W/ CONTRAST 1,735.00 3523702 CT LOWER EXT W/WO CONTRAST 2,228.00 3523706 CT LOWER EXTREMITY ANGIOGRAPHY 2,786.00 3524150 CT ABDOMEN WITHOUT CONTRAST 1,619.00 3524160 CT ABDOMEN WITH CONTRAST 2,174.00 3524170 CT ABD W AND WO CONTRAST 2,553.00 3524174 CT ABD/PEL ANGIO 5,044.00 3524175 CT ABDOMEN ANGIOGRAPHY 2,250.00 3525571 CT HRT W/O DYE W/CA TEST 160.00 3525635 CT-AORTA/ILIOFEMORAL RUN-OFF A 2,786.00 3526360 CT GUIDANCE NEEDLE BIOPSY 2,148.00 3600446 CATARACT 3,531.00 3600465 COLONOSCOPY 2,087.00 3600480 COLONOSCOPY/EGD 2,936.00 3600481 FLEXIBLE SIGMIODOSCOPY 1,944.00 3600550 PM-LEVEL 1 276.00 3600551 PM-LEVEL 2 461.00 3600552 PM-LEVEL 3 1,073.00 3600553 PM-LEVEL 4 1,409.00 3600560 PM-IMPLANT NEURO STIM ELECTRO 5,699.00 3600600 PLATELET RICH PLASMA INJ 1,325.00 3600610 PLATELET RICH PLASMA W/MARROW 2,550.00 3600620 AUTOLOG BLOOD COLLECTED 1,229.00 3600631 AUTOLOG BLOOD TRANSFUSION 1,013.00 3600632 AUTOLOG WHOLE BLOOD 945.00 3602042 EGD 1,984.00 3602500 CASE CART MINOR 237.00 3602501 CASE CART MAJOR 354.00 3602502 CASE CART D&C 124.00 3602503 CASE CART CYSTO 170.00 3602504 CASE CART TURBP/TURP 231.00 3602505 CASE CART LITHOTOMY 161.00 3602506 CASE CART UPPER EXTREMITY 391.00 3602507 CASE CART LOWER EXTREMITY 377.00 3602508 CASE CART BASIC HAND 239.00 3602509 CASE CART KNEE ARTHROSCOPY 467.00 3602510 CASE CART ACL 538.00 3602511 CASE CART SHOULDER ARTHROSCOPY 416.00 3602512 CASE CART LAP CHOLE 2,586.00 3602513 CASE CART LAP APPY 1,799.00 3602514 CASE CART LAP TUBAL 746.00 3602515 CASE CART DIAGNOSTIC LAP 1,633.00 3602516 CASE CART LAP HYSTERECTOMY 1,659.00 3602517 CASE CART T&A 84.00 3602518 CASE CART PE TUBES 395.00 3602519 CASE CART CONE BIOPSY 180.00 3602520 CASE CART NEURO BACK 1,322.00 3602521 CASE CART ANTERIOR CERVICAL 3,124.00 3602522 CASE CART TOTAL HIP 1,200.00 3602523 CASE CART-TOTAL KNEE 1,129.00 3603001 OP-LEVEL 1 TX/1ST 30 MIN 135.00 3603002 OP-LEVEL 1 TX/ADDITIONAL 15MIN 47.00 3603003 OP-LEVEL 2 TX/1ST 30 MIN 189.00 3603004 OP-LEVEL 2 TX/ADDITIONAL 15MIN 53.00 3603060 OP-GLUCOSE MONITOR/PER TEST 42.00 3609501 OR LEVEL 5 - EMERGENT CARE 174.00 3616610 ARTERIAL PUNCTURE 86.00 4016089 DIGITAL MAM/DIAG UNI LT 422.00 4016090 DIGITAL MAM/DIAG UNI RT 422.00 4016091 DIGITAL MAM/BILAT DIAG 523.00 4020389 U/S AAA SCREEN 290.00 4023926 DUPLEX LE ART/BPG; UNIL/LIMIT 1,208.00 4023932 DUPLEX UE ART/BPG; UNIL/LIMIT 665.00 4026536 U/S HEAD AND NECK 807.00 4026537 US THYROID 639.00 4026604 US EXAM CHEST 837.00 4026645 US EXAM BREAST(S) LT 500.00 4026646 US EXAM BREAST(S) RT 500.00 4026647 U/S BREAST BILATERAL 989.00 4026700 U/S ABDOMEN COMPLETE 822.00 4026705 U/S ABDOMEN LIMITED 666.00 4026710 US GUIDED NEEDLE PLACEMENT 666.00 4026770 US RENAL 704.00 4026775 US EXAM ABDO BACK WALL LIM 666.00 4026778 US RENAL W/DOPPLER 1,296.00 4026800 U/S SPINE AND CONTENTS 515.00 4026801 U/S OB <14 WEEKS 1ST TRIMESTER 592.00 4026805 U/S OB >14 WEEKS 592.00 4026816 U/S OB FOLLOW-UP 266.00 4026818 U/S BIOPHYSICAL PROFILE 742.00 4026830 NON-OB TRANSVAG US 540.00 4026840 OB US LIMITED FETUS(S) 540.00 4026856 U/S PELVIS COMPLETE 513.00 4026857 U/S PELVIS LIMITED 432.00 4026870 US SCROTUM AND CONTENTS 675.00 4026880 EXTREMITIES NON-VASCULAR 527.00 4026885 US EXAM INFANT HIPS DYNAMIC 470.00 4026930 U/S PERICARDIOCENTES 1,036.00 4026934 US GUIDED NEEDLE PLACEMENT 1,081.00 4026942 U/S NEEDLE BIOPSY GD 757.00 4026943 U/S NEEDLE BIOPSY GD ADDL 757.00 4036092 DIGITAL MAM/SCREENING 369.00 4036093 DIGITAL MAM/SCREEN UNI 326.00 4040529 ELBOW LEFT 2 VIEW 270.00 4040530 ELBOW LEFT COMP MINI 3 VIEW 270.00 4060942 PLETHYSMOGRAPHY COMPLETE 456.00 4090445 TOTAL CONTACT LEG CAST 546.00 4091445 TOTAL CONTACT LEG CAST 546.00 4092521 SPEECH EVAL FLUENCY 531.00 4092522 SPEECH EVAL PROD 505.00 4092523 SPEECH EVAL PROD/COMP 505.00 4092524 SPEECH EVAL BEHAV/QUAL 505.00 4104644 CONTINUOUS NEBULIZER 1ST HR 254.00 4104645 CONTINUOUS NEBULIZER EA ADD HR 161.00 4104664 NEB/MDI EVAL/DEMO 123.00 4105284 INCENTIVE SPIROMETRY 154.00 4105290 MDI TREATMENT INITIAL 168.00 4105291 MDI REPEAT SAME DAY 118.00 4105315 NEBULIZER INITIAL TREATMENT 168.00 4105317 NEBULIZER REPEAT SAME DAY 118.00 4105325 LOW FLOW OXYGEN/DAY 544.00 4105328 HIGH FLOW OXYGEN/DAY 1,088.00 4105338 CPT/PEP THERAPY INITIAL 131.00 4105339 CPT/PEP SUBSEQUENT 106.00 4105345 SPUTUM INDUCTION 113.00 4105350 SPUTUM COLLECTION 86.00 4105354 SUCTION NASA/TRACHIAL 163.00 4105356 SUCTION ENDOTRACHIAL 163.00 4105358 RSV/FLU NASAL WASH SUCTION 160.00 4105379 CPAP INITIATION 678.00 4105382 VENTILATOR VOL/PRESS 1ST DAY 1,373.00 4105384 VENTILATOR VOL/PRESS ADD DAY 1,160.00 4200000 EMPLOYEE MASSAGE 55.00 4200901 BIOFEEDBACK 170.00 4201114 UPPR LIMB ORTH 63.00 4205832 HAND MUSCLE TESTING 102.00 4205851 ROM MEASURE 88.00 4205852 ROM MEASURE-HAND 65.00 4207010 HOT/COLD PACK 23.00 4207011 DRY NEEDLING 32.00 4207013 TRACTION-MECHANICAL 66.00 4207014 E-STIMULATION/ATTENDED/15MIN 103.00 4207015 DRY NEEDLING 3+ MUSCLES 48.00 4207016 VASOPNEUMATIC DEVICE 65.00 4207018 PARAFFIN BATH 38.00 4207026 INFRARED 56.00 4207033 IONTOPHORESIS EA 15 103.00 4207034 CONTRAST BATH EA 15 MIN 62.00 4207111 DRY NEEDLING 32.00 4207112 NEUROMUSCULAR RE-EDU EA 15 MIN 117.00 4207115 DRY NEEDLING 3+ MUSCLES 48.00 4207116 GAIT TRAINING EA 15 MIN 101.00 4207124 MASSAGE EA 15 MIN 97.00 4207195 AQUATIC THERAPY/EXER EA 15 MIN 132.00 4207530 THERAPEUTIC ACTIVITY EA 15 MIN 129.00 4207532 COGNITIVE SKILLS DEVELOPMENT 113.00 4207533 SENSORY INTEGRATION 113.00 4207535 SELF-CARE MGMT TRNG EA 15 MIN 116.00 4207546 WORK HARD/CONDIT ADD-ON (1 HR) 184.00 4207597 WOUND MGMT 20 SQ CM OR LESS 446.00 4207598 WOUND MGMT > 20 SQ CM 247.00 4207602 NON-SELECTIVE DEBRIDEMENT 249.00 4207605 NEG PRESSURE WOUND THER <50 CM 143.00 4207606 NEG PRESSURE WOUND THER >50 CM 238.00 4207612 PRE-EMPLOYMENT SCREENING 179.00 4207703 ORTHOTIC/PROSTHETIC CHECK-OUT 129.00 4207750 PHYSICAL PERF TEST EA 15 MIN 134.00 4207751 FUNC CAPACITY EVAL- EA 15 MIN 108.00 4207755 ASSITIVE TECHNOLOGY ASSESS 147.00 4207760 ORTHOTICS MGMT TRNG EA 15 MIN 123.00 4207761 PROSTHETIC TRNG EA 15 MIN 121.00 4207762 ORTHOTIC/PROSTHET CK EA 15 MIN 137.00 4207862 MANUAL THERAPY EA 15 MIN 117.00 4209240 STRAPPING-SHOULDER 249.00 4209260 STRAPPING-ELBOW/WRIST 206.00 4209280 STRAPPING-HAND/FINGER 208.00 4209580 UNNA BOOT APPLICATION 324.00 4209998 PT DISCHARGE 6.00 4214550 TENS INSTRUCTION 76.00 4217022 WHIRLPOOL THERAPY 111.00 4217035 ULTRASOUND EA 15 MIN 59.00 4217110 THERAPEUTIC EXERCISE EA 15 MIN 115.00 4217150 GROUP THERAPY 84.00 4217504 ORTHOTIC TRAINING 110.00 4217542 WHEELCHAIR MGMT TRNG EA 15 MIN 121.00 4217545 WORK HARD/CONDIT (2 HOURS) 436.00 4247002 PT RE-EVAL 159.00 4247161 PT EVAL - LOW COMPLEX 291.00 4247162 PT EVAL - MOD COMPLEX 291.00 4247163 PT EVAL - HIGH COMPLEX 291.00 4249999 THERAPY FUNCTIONAL REPORTING 3.00 4300283 E-STIMULATION/ATTENDED/15MIN 103.00 4300901 BIOFEEDBACK 170.00 4301100 TLSO 488.00 4301101 FOOT ARCH SUPPORT PRE MLDED 56.00 4301102 CR CLR SMIRGD THMPLST FOAM 155.00 4301103 CR CLR SMIRGD W/THOR EXT 332.00 4301104 CUSTOM AFO 429.00 4301105 ELB ORTH W/ADJ LOCK JNT PRFAB 526.00 4301106 ELB ORTH W/O JNTS CSTM FAB 460.00 4301107 EWHFO RGD W/O JNTS CSTM FAB 1,343.00 4301108 FO NONTORSION JOINT CF 353.00 4301109 HEEL WEDGE 28.00 4301110 HFO INCL NONTORSN JNT CS FAB 512.00 4301111 PRE FAB AFO 287.00 4301112 SEWHO; ABD; W/O JNTS CSTM FAB 2,075.00 4301113 SHLD ORTH W/O JNTS 944.00 4301114 UPPR LIMB ORTH 63.00 4301115 WHFO CSTM FAB INC FIT/ADJ 724.00 4301116 WHFO DYN FLX HNG WRST/FNGR 1,525.00 4301117 WHO INCL NONTORSN JNT CS FAB 1,579.00 4301118 WHO WRST/HND ORTH COCK UP 74.00 4301120 TLSO FLEX TRUNK/THOR PRE OTS 357.00 4302525 OT-CLINICAL SWALLOW EVALUATION 527.00 4302526 OT-DYSPHAGIA TREATMENT 252.00 4302610 SLP-CLNCAL SWALLOW EVALUATION 534.00 4302611 OT-MOD BARIUM SWALLOW STUDY 590.00 4304550 TENS INSTRUCTION 76.00 4305831 EXTREMITY MUSCLE TESTING 122.00 4305832 HAND MUSCLE TESTING 102.00 4305851 ROM MEASURE 88.00 4305852 ROM MEASURE HAND 65.00 4307010 HOT/COLD PACK 24.00 4307014 E-STIMULATION/UNATTENDED 86.00 4307016 VASOPNEUMATIC DEVICE 62.00 4307018 PARAFFIN BATH 40.00 4307022 WHIRLPOOL 111.00 4307026 INFRARED 56.00 4307033 IONTOPHORESIS EA 15 103.00 4307034 CONTRAST BATH EA 15 MIN 60.00 4307035 ULTRASOUND EA 15 MIN 59.00 4307110 THERAPEUTIC EXERCISE EA 15 MIN 127.00 4307112 NEUROMUSCULAR RE-EDU EA 15 MIN 129.00 4307124 MASSAGE EA 15 MIN 97.00 4307150 GROUP THERAPY 81.00 4307530 THERAPEUTIC ACTIVITY EA 15 MIN 129.00 4307532 COGNITIVE SKILLS DEVELOPMENT 112.00 4307533 SENSORY INTEGRATION 113.00 4307535 SELF-CARE MGMT TRNG EA 15 MIN 129.00 4307537 COMMUNITY/WORK REINT EA 15 MIN 121.00 4307542 WHEELCHAIR MGMT TRNG EA 15 MIN 121.00 4307545 WORK HARD/CONDIT (2 HOURS) 436.00 4307546 WORK HARDENING ADD-ON (1 HR) 184.00 4307597 WOUND MGMT 20 SQ CM OR LESS 426.00 4307602 NON-SELECTIVE DEBRIDEMENT 251.00 4307605 NEG PRESSURE WOUND THER <50 CM 143.00 4307606 NEG PRESSURE WOUND THER >50 CM 238.00 4307612 PRE-EMPLOYMENT SCREENING 49.00 4307750 PHYSICAL PERF TEST EA 15 MIN 121.00 4307751 FUNC CAPACITY EVAL- EA 15 MIN 102.00 4307755 ASSISTIVE TECHNOLOGY ASSESS 147.00 4307760 ORTH MGT TRN INT ENC EA 15 MIN 128.00 4307761 PROST TRNG INT ENC EA 15 MIN 121.00 4307762 ORTHOTIC/PROSTH CKOUT EA 15MIN 113.00 4307862 MANUAL THERAPY EA 15 MIN 129.00 4309055 APPLY SH SPICA CAST/SPLINT 305.00 4309075 APPLY SHORT ARM CAST/SPLING 692.00 4309085 APPLY GNTLET CAST/SPLINT 692.00 4309105 LONG ARM SPLINT 340.00 4309125 SHORT ARM SPLINT-STATIC 257.00 4309126 SHORT ARM SPLINT-DYNAMIC 313.00 4309130 FINGER SPLINT-STATIC 161.00 4309131 FINGER SPLINT-DYNAMIC 205.00 4309240 STRAPPING-SHOULDER 249.00 4309260 STRAPPING-ELBOW/WRIST 206.00 4309280 STRAPPING-HAND/FINGER 208.00 4309580 UNA BOOT APPLICATION 199.00 4329065 APPLY LONG ARM CAST/SPLINT 692.00 4329086 APPLY WRST HAND CAST/SPLINT 671.00 4347004 OT RE-EVAL 191.00 4347165 OT EVAL - LOW COMPLEX 311.00 4347166 OT EVAL - MOD COMPLEX 311.00 4347167 OT EVAL - HIGH COMPLEX 311.00 4402507 SPEECH THERAPY TREATMENT 264.00 4402508 SPEECH THERAPY GROUP 120.00 4402526 DYSPHAGIA TREATMENT 324.00 4407530 THERAPEUTIC ACTIVITY EA 15 MIN 123.00 4407532 COGNITIVE SKILLS DEVELOPMENT 113.00 4407533 SENSORY INTEGRATION 113.00 4407535 SELF-CARE MGMT TRNG EA 15 MIN 116.00 4407537 COMMUNITY/WORK REINT EA 15 MIN 121.00 4442521 SPEECH EVAL FLUENCY 531.00 4442522 SPEECH EVAL PROD 505.00 4442523 SPEECH EVAL PROD/COMP 505.00 4442524 SPEECH EVAL BEHAV/QUAL 505.00 4442525 CLINICAL SWALLOW EVALUATION 508.00 4442526 VIDEO FLUORO SWALLOW EVAL 520.00 4442607 SPEECH DEVICE EVALUATION-1HR 374.00 4446105 AHPASIA ASSESSMENT 287.00 4500115 VENOUS BLOOD DRAW 30.00 4500700 IMMUNIZATION ADM; 1 VACCINE 60.00 4500701 IMMUNIZATION ADM; ADD'L VACC 44.00 4500702 IMMUNIZATION ADM AGE<8 60.00 4500703 IMMUNIZATION ADM; ADD'L AGE<8 44.00 4500760 IV HYDRATION INIT UP TO 1 HR 324.00 4500761 IV HYDRATION EA ADD HR UP TO 8 144.00 4500765 IV INFUSE THER/PROPH/DX-TO 1HR 497.00 4500766 IV INFUSE THER/PROPH/DX-TO 8HR 180.00 4500767 IV DRUG NEW SEQUENTIAL 221.00 4500768 IV DRUG NEW SAME LINE 221.00 4500771 VACCINE ADMIN FLU VIRUS 59.00 4500772 VACCINE ADMIN PNEUMONIA 59.00 4500774 IV PUSH INITIAL MED 183.00 4500775 IV PUSH ADD'L NEW MED 160.00 4500776 IV PUSH ADD'L SAME MED 159.00 4500782 ER INJECTION IM/SUB Q 244.00 4502950 CARDIOPULMONARY RESUSCITATION 420.00 4503060 GLUCOSE CHECK 43.00 4504762 PULSE OXIMETRY 86.00 4505318 NEBULIZER TREATMENT 164.00 4505335 OXYGEN-ER-LOW FLOW 153.00 4505336 OXYGEN-ER-HIGH FLOW 208.00 4509125 SPLINT FOREARM TO HAND/ SHORT 250.00 4509281 ER LEVEL 1 - FACILITY FEE 297.00 4509282 ER LEVEL 2 - FACILITY FEE 425.00 4509283 ER LEVEL 3 - FACILITY FEE 776.00 4509284 ER LEVEL 4 - FACILITY FEE 1,237.00 4509285 ER LEVEL 5 - FACILITY FEE 1,857.00 4509291 ER CRITICAL CARE 1ST HOUR 2,896.00 4509292 ER CRITICAL CARE ADD 30 MIN 656.00 4509430 CASTING ROLL 2 IN 163.00 4509431 CASTING ROLL 3 IN 182.00 4509432 CASTING ROLL 4 IN 198.00 4509433 CASTING ROLL 5 IN 279.00 4509434 CASTING ROLL 6 IN 407.00 4509815 ER TRAUMA RESPONSE - LEVEL I 3,819.00 4509816 ER TRAUMA RESPONSE - LEVEL II 3,819.00 4509910 AFTER HOURS CARE 156.00 4605247 PULSE OXIMETRY MULT DE 145.00 4605248 PULSE OXIMETRY CONT DAY 464.00 4605249 PULSE OXIMETRY SLEEP 285.00 4605250 PULSE OXIMETRY SINGLE 86.00 4605255 ABP MONITORING 24+ HRS; RECORD 242.00 4605400 SPIROMETRY 232.00 4605401 BRONCHOSPASM - PRE & POST BD 467.00 4605403 VITAL CAPACITY 107.00 4605405 FUNCTIONAL RESIDUAL CAPACITY 189.00 4605406 CARBON MONOXIDE DIFFUSION CAP 280.00 4605408 PULMONARY STRESS TEST 6 MIN 276.00 4803308 2-D ECHO LIMITED OR FOLLOW-UP 789.00 4825501 ECG STRESS TEST TRACING ONLY 804.00 4835219 TTE W/DOPPLER COMPLETE 2,030.00 4835221 ECHO DOPPLER COLOR FLOW 627.00 6100159 MRI BREAST CAD ADD ON 255.00 6100336 MRI OF TMJ(S) 3,120.00 6100540 MRI FACE W/O CONTRAST 2,674.00 6100542 MRI FACIAL W CONTRAST 2,508.00 6100543 MRI FACE W/WO CONTRAST 2,508.00 6100544 MRA BRAIN WO CONTRAST 2,954.00 6100545 MRA HEAD W/CONTRAST 2,285.00 6100546 MRA HEAD W/WO CONTRAST 2,508.00 6100547 MRA NECK W/O CONTRAST CAROTIDS 2,897.00 6100548 MRA NECK W/CONTRAST CAROTIDS 2,954.00 6100549 MRA NECK W/WO CONTRAST CAROTID 3,009.00 6100550 MRA BRAIN NONCON WITH MRI 2,954.00 6100551 MRI BRAIN W/O CONTRAST 2,731.00 6100552 MRI BRAIN W/CONTRAST 2,786.00 6100553 MRI BRAIN W/WO CONTRAST 3,733.00 6100554 MRI BRAIN VENOUS NON-CONTRAST 2,954.00 6100555 MRI BRAIN WO CONTRAST LIMITED 2,285.00 6100563 MRI BREAST BILAT W/WO CONT 3,065.00 6100574 MRI BREAST UNILAT W/O CONT 2,563.00 6100575 MRI BREAST UNILAT W/WO CONT 2,897.00 6100576 MRI BREAST BILAT WITH CONTRA 3,009.00 6100577 MRI BREAST BILAT W/O CONT 2,954.00 6100580 MRI IAC W/CONTRAST 2,620.00 6100581 MRI IAC W/O CONTRAST 2,285.00 6100582 MRI IAC W/WO CONTRAST 2,620.00 6101111 MRI NECK W/O CONTRAST 2,786.00 6101112 MRI NECK W CONTRAST 2,620.00 6101113 MRI NECK W/WO CONTRAST 2,620.00 6101114 MRI ORBITS W/O CONTRAST 2,508.00 6101115 MRI ORBIT W CONTRAST 2,508.00 6101116 MRI ORBITS W/WO CONTRAST 2,508.00 6101550 MRI CHEST WO CONTRAST 2,563.00 6101551 MRI CHEST W/CONTRAST 2,620.00 6101552 MRI CHEST W/WO CONTRAST 2,842.00 6101555 MRA CHEST WITH OR WO CONTRAST 2,620.00 6102141 MRI CERVICAL SPINE W/O CONTRAS 2,620.00 6102142 MRI CERVICAL-SPINE W/CONTRAST 2,674.00 6102146 MRI THORACIC-SPINE W/O CONTRAS 2,674.00 6102147 MRI THORACIC-SPINE W/CONTRAST 3,009.00 6102148 MRI LUMBAR-SPINE W/O CONTRAST 2,223.00 6102149 MRI LUMBAR-SPINE W/CONTRAST 3,009.00 6102156 MRI CERVICAL-SPINE W/WO CONTRA 3,956.00 6102157 MRI THORACIC-SPINE W/WO CONTRA 3,287.00 6102158 MRI LUMBAR-SPINE W/WO CONTRAST 3,287.00 6102175 MRI SACRUM/COCCYX W/O CONTRAST 3,677.00 6102176 MRI SACRUM/COCCYX W/CONTRAST 3,789.00 6102177 MRI SACRUM/COCCYX W/WO CONTRAS 3,789.00 6102195 MRI PELVIS W/O CONTRAST 3,677.00 6102196 MRI PELVIS W/CONTRAST 3,789.00 6102197 MRI PELVIS W/WO CONTRAST 3,789.00 6103218 MRI UPPER EXT NON-JT W/O CONTR 2,563.00 6103219 MRI UPPER EXT NON-JT W/CONTRAS 3,622.00 6103220 MRI UPPER EXT NON-JT W/WO CONT 3,454.00 6103221 MRI UPPER EXT JOINT W/O CONTRA 2,563.00 6103222 MRI UPPER EXT JOINT W/CONTRAST 3,232.00 6103223 MRI UPPER EXT JOINT W/WO CONTR 3,232.00 6103225 MRA UPPER EXT W OR WO CONTRAST 2,731.00 6103718 MRI LOWER EXT NON-JT W/O CONTR 2,731.00 6103719 MRI LOWER EXT NON-JT W/CONTRA 2,897.00 6103720 MRI LOWER EXT NON-JT W/WO CONT 3,622.00 6103721 MRI LOWER EXT JOINT W/O CONTRA 2,563.00 6103722 MRI LOWER EXT JOINT W/CONTRA 2,897.00 6103723 MRI LOWER EXT JOINT W/WO CONTR 3,232.00 6103725 MRA LOWER EXT W/WO CONTRAST 2,620.00 6104180 MRI ADRENALS W/O CONTRAST 2,897.00 6104181 MRI ABDOMEN W/O CONTRAST 2,897.00 6104182 MRI ABDOMEN W/CONTRAST 3,900.00 6104183 MRI ABDOMEN W/WO CONTRAST 3,844.00 6104185 MRI ABDOMEN ANGIO W/WO 3,844.00 6105552 MRI CARDIAC W/O CONTRAST 3,454.00 6105553 CARDIAC MRI FOR MORPH W/DYE 3,565.00 6105554 MRI CARDIAC W W/O CONTRAST 3,565.00 6367138 INFLIXIMAB 100 MG INJ IV 1,584.00 6369967 LOCM 300-399MG/ML IODINE1.0ML 10.00 7305509 ECG 12 LEAD MEDICARE INIT 99.00 7305510 ECG 12 LEAD TRACING ONLY 215.00 7305511 ECG SAME DAY WITH HOLTER 215.00 7305512 ECG RYTHM STRIP TRACING ONLY 146.00 7305514 ECG REPEAT PROC BY SAME PHY 215.00 7305515 ECG REPEAT PROC DIFFERENT PHY 215.00 7315569 HOLTER MONITOR RECORDING 508.00 7315570 REMOTE PT 30 DAY ECG REV/RPT 330.00 7319322 HOLTER MONITOR SCAN + ANAL 637.00 7405816 EEG AWAKE & DROWSY 990.00 7405824 EEG; CEREBRAL SILENCE 990.00 7611610 RETROGRADE URETHROCYSTOGRAPHY 552.00 7612240 MYELOGRAM CERVICAL 1,094.00 7612266 MYELOGRAM LUMBOSACRAL 1,094.00 7612284 MYELOGRAM INJECT PRO 1,091.00 7612648 ANKLE ARTHROGRAM INJECT LEFT 1,091.00 7612649 ANKLE ARTHROGRAM INJECT RIGHT 1,091.00 7613350 SHOULDER ARTHROGRAM-INJECT LFT 1,091.00 7613351 SHOULDER ARTHROGRAM-INJECT RT 1,091.00 7614221 ELBOW ARTHROGRAM INJ 1,091.00 7614222 ELBOW ARTHROGRAM INJ 1,091.00 7615246 WRIST ARTHROGRAM INJ 1,091.00 7615247 WRIST ARTHROGRAM INJECT RIGHT 1,091.00 7615700 BIOPSY PROSTATE 666.00 7616005 VENOGRAM INJECTION LT 1,542.00 7616006 VENOGRAM INJECTION RT 1,542.00 7617370 KNEE ARTHROGRAM INJECT LEFT 1,039.00 7617371 KNEE ARTHROGRAM INJECT RIGHT 1,039.00 7617500 TRANSHEPATIC INJECTION 1,091.00 7621000 OBSERVATION INITIAL HOUR 1,476.00 7621001 OBSERVATION EA ADDITIONAL HOUR 120.00 9205800 HOME SLEEP TEST 573.00 9209580 POLYSOMNOGRAPHY 4,060.00 9209581 POLYSOMNOGRAPHY W/CPAP 4,264.00 9213880 CAROTID DOPPLER-BILATERAL 1,296.00 9213970 US VENOUS BILATERAL EXTREMITIE 1,314.00 9213971 DUPLEX EXT VEINS UNIL/LIMIT RT 789.00 9213972 DUPLEX EXT VEINS UNIL/LIMIT LT 789.00 9216925 CAROTID DUPLEX SCAN UNIL/L 829.00 9216926 ARTERIAL UE UNILAT 829.00 9810060 I&D ABSCESS SIMPLE 266.00 9810061 DRAIN ABSCESS COMPLICATED 518.00 9810120 REMOVE FOREIGN BODY SIMPLE 325.00 9810121 REMOVE FOREIGN BODY COMPLX 747.00 9810140 DRAIN HEMATOMA 261.00 9810300 REMOVE F/B INTRANASAL 327.00 9810394 IVP DYE INJECTION 480.00 9810600 BURSA SMALL JOINT FINGER/TOE 204.00 9810605 BURSA MED JOINT WRIST/ANK/ELB 172.00 9810610 BURSA MAJOR JT HIP/KNEE/SHLDR 134.00 9810830 LAC SIMP <2.5CM MOUTH 339.00 9810831 LAC SIMP/COMPLX >2.5 MOUTH 620.00 9810901 NASAL HEM ANTERIOR SIMPLE 325.00 9810903 NASAL HEM ANTERIOR COMPLX 495.00 9810905 NASAL HEM POSTERIOR COMPLX 932.00 9811005 INSERTION SUPRAPUBIC CATHETER 1,353.00 9811040 DEBRIDE SKIN PART THICKNESS 329.00 9811042 DEBRIDE SKIN AND SUB-Q 319.00 9811044 DEBRIDE SKIN SUB-QMUSCLEBONE 1,127.00 9811100 BIOPSY OF SKIN SINGLE LESION 226.00 9811105 GASTRIC INTUBATION/ASPIR./LAVA 2,641.00 9811250 LAC SIMP <2.5 TONGUE ANTERIOR 364.00 9811251 LAC SIMP <2.5 TONGUE POSTERIOR 495.00 9811252 LAC SIMP/COMPLX >2.5 TONGUE 973.00 9811500 INTUBATION/ENDOTRAC.EMERENGCY 492.00 9811502 TRACHEOSTOMY TUBE CHANGE 319.00 9811605 TRACH-CRICOTHYROID MEMBRANE 2,099.00 9811740 EVACUATION SUBUNGUAL HEMATOMA 202.00 9811750 EXCISION OF NAIL-PERMANENT 800.00 9811765 WEDGE INCISION-INGROWN TOENAIL 393.00 9811810 ANES REG BLOCK WRIST 976.00 9812000 THORACENTESIS WITH IMAGING 649.00 9812001 LAC SIMPLE <2.5 348.00 9812002 LAC SIMPLE 2.6-7.5 455.00 9812004 LAC SIMPLE 7.6-12.5 580.00 9812005 LAC SIMPLE 12.6-20.0 707.00 9812011 LAC SIMPLE <2.5 FACE 359.00 9812013 LAC SIMPLE 2.5-5.0 FACE 489.00 9812014 LAC SIMPLE 5.1-7.5 FACE 586.00 9812020 TUBE THORACOSTOMY 812.00 9812031 LAC INTER <2.5 SCALP/TRUNK 453.00 9812032 LAC INTER 2.5-7.5 SCALP/TRUNK 652.00 9812034 LAC INTER 7.5-12.5 SCALP/TRUNK 820.00 9812041 LAC INTER <2.5 FOOT/HAND 550.00 9812042 LAC INTER 2.6-7.5 FOOT/HAND 702.00 9812044 LAC INTER 7.6-12.5 FOOT/HAND 877.00 9812051 LAC INTER <2.5 FACE/EAR 583.00 9812052 LAC INTER 2.6-5.0 FACE/EAR 779.00 9812053 LAC INTER 5.1-7.5 FACE/EAR 1,029.00 9812054 LAC INTER 7.6-12.5 FACE/EAR 1,197.00 9812270 SPINAL PUNCTURE LUMBAR-DIAGNOS 641.00 9812950 CARDIOPULMONARY RESUSCITATION 2,271.00 9812960 CARIODVERSON EXTERNAL ELECTIVE 1,078.00 9812977 THROMBOLYSIS CORONARY-IV 1,203.00 9813010 PERICARIOCENTESIS-INITIAL 1,437.00 9813100 LAC CMPLX 1.1-2.5 TRUNK 426.00 9813101 LAC CMPLX 2.6-7.5 TRUNK 973.00 9813120 LAC CMPLX 1.1-2.5 SCALP/EXTR 812.00 9813121 LAC CMPLX 2.6-7.5 SCALP/EXTR 1,293.00 9813131 LAC CMPLX 1.1-2.5 FACE/HAND/FT 1,036.00 9813132 LAC CMPLX 2.6-7.5 FACE/HAND/FT 1,667.00 9813151 LAC CMPLX 1.1-2.5 LIP/NOSE/LID 579.00 9813152 LAC CMPLX 2.6-7.5 LIP/NOSE/LIE 2,079.00 9813650 DISLOC SHOULDER 526.00 9813655 DISLOC SHOULDER W/ CON SED 1,259.00 9813676 FOLEY CATHETER-SIMPLE 415.00 9814400 ANES REG BLOCK TRIGEMINAL NERV 458.00 9814402 ANES REG BLOCK FACIAL NERVE 431.00 9814420 ANES INTERCOSTAL BLOCK 684.00 9814421 ANES INTERCOSTAL BLOCK 2 1,022.00 9814450 ANES DIGITAL BLOCK 291.00 9814600 DISLOC ELBOW 490.00 9814605 DISLOC ELBOW W/ CON SED 624.00 9814640 DISLOC RADIAL HEAD CHILD 643.00 9815205 REMOVE F/B EXTERNAL EYE 254.00 9815210 REMOVE F/B CONJUNCTIVAL EMBED 293.00 9815220 REMOVE F/B CORNEAL 292.00 9815222 REMOVE F/B CORNEAL/SLIT LAMP 428.00 9816000 BURN INITIAL TX. 1ST DEGREE 179.00 9816010 DRAIN FINGER ABSCESS/SIMPLE 267.00 9816020 BURN DEBRIDEMENT/SMALL 247.00 9816025 BURN DEBRIDEMENT/MEDIUM 483.00 9816030 BURN DEBRIDEMENT/LARGE 866.00 9816050 DRAIN PERIANAL ABSCESS 556.00 9816410 LAC CMPLX EXTENSOR TENDON/HAND 1,488.00 9816418 LAC CMPLX EXTENSOR TENDON/FING 1,611.00 9816601 ANOSCOPY 303.00 9816620 ARTERIAL LINE PLACEMENT 480.00 9816621 ARTERIAL BLOOD GAS DRAW 126.00 9816770 DISLOC FINGER JOINT 326.00 9816951 AMPUTATION FINGER/THUMB/CLOSUR 1,774.00 9817200 DISLOC COCCYGEAL FX. 319.00 9817250 DISLOC HIP 683.00 9817252 DISLOC HIP W/CON SEDATION 683.00 9817552 DISLOC KNEE W/CON SEDATION 293.00 9817842 DISLOC ANKLE W/CON SEDATION 872.00 9817938 REMOVAL F/B EMBEDDED EYELID 231.00 9818190 REMOVE F/B FOOT/SUBCUTANEOUS 463.00 9819002 THORACENTESIS W/O IMAGING 458.00 9819075 CAST ELBOW TO FINGER/SHORT ARM 204.00 9819105 SPLINT SHOULDER TO HAND/LONG A 203.00 9819125 SPLINT FOREARM TO HAND/SHORT 170.00 9819130 SPLINT FINGER 168.00 9819141 CONSCIOUS SED -IVIMINH <5Y/O 574.00 9819144 CONSC SED-IVIMINH >5 1st 30m 576.00 9819200 REMOVE F/B EXT.AUDITORY CANAL 277.00 9819202 EYE EXAM/EVALUATION NEW PT 404.00 9819210 REMOVE IMPACTED CERUMEN EAR 204.00 9819281 ER LEVEL 1- PHYS FEE 189.00 9819282 ER LEVEL 2- PHYS FEE 311.00 9819283 ER LEVEL 3- PHYS FEE 410.00 9819284 ER LEVEL 4- PHYS FEE 609.00 9819285 ER LEVEL 5- PHYS FEE 1,107.00 9819291 CRITICAL CARE 1ST HR SERVICE 1,327.00 9819292 CRITICAL CARE ADD'L 1/2 HOUR 452.00 9819505 SPLINT THIGH TO TOE/LONG LEG 233.00 9819515 SPLINT CALF TO FOOT/SHORT LEG 200.00 9819530 STRAPPING KNEE 136.00 9819700 CAST REMOVE/BIVALVE BOOT/SPICA 139.00 9819705 CAST REMOVE/BIVALVE ARM/ LEG 269.00 30200465 VACCINE ADMIN IM/SQ <8YR 57.00 30200466 VACCINE ADM EA ADD IM/SQ <8YR 44.00 30200467 VACCINE ADMIN PO/NASAL <8YR 44.00 30200468 VACCINE ADM EA ADD PO/NAS <8YR 44.00 30200471 VACCINE ADMIN IM/SQ SINGLE 60.00 30200472 VACCINE ADMIN EA ADD IM/SQ 46.00 30200473 VACCINE ADMIN PO/NASAL 44.00 30200474 VACCINE ADMIN EA ADD PO/NASAL 44.00 30200475 ADMIN FLU VIRUS VACCINE 62.00 30200476 ADMIN PNEUMONIA VACCINE 60.00 30200772 INJECTION IM/SQ 221.00 30201001 PICC PLACEMENT >=5YR 2,796.00 30201002 ULTRASOUND FOR PICC PLACEMENT 620.00 30201005 REPLACE PICC CATH 2,005.00 30201701 INSERT BLADDER CATH-STRAIGHT 90.00 30201702 INS TEMP BLADDER CATH-FOLEY 133.00 30201710 BLOOD DRAW FROM IMPLANT DEVICE 186.00 30201711 DRESSING CHANGE W/DEBRIDEMENT 168.00 30201798 BLADDER SCANNING 61.00 30202962 GLUCOSE MONITOR/TEST 43.00 32100765 IV INFUSE THER/PROPH/DX-TO 1HR 161.00 32108000 FEMTOSECOND LASER PROCEDURE 1,055.00 32108100 INTRAOP WAVEFRONT ABERROMETER 175.00 32109100 SURGERY LEVEL 1 PER MIN 90.00 32109200 SURGERY LEVEL 2 PER MIN 105.00 32109300 SURGERY LEVEL 3 PER MIN 121.00 32109400 SURGERY LEVEL 4 PER MIN 136.00 32109500 PROCEDURE ROOM PER MIN 38.00 32201000 RECOVERY ROOM PER MIN 30.00 32202000 RECOVERY STAGE 2 PER MIN 18.00 32250005 RAPID STREP GROUP A 84.00 40110010 ABG (ARTERIAL BLOOD GAS) 264.00 40110015 ACETAMINOPHEN 208.00 40110020 ACETONE SERUM QUAL 54.00 40110035 ALBUMIN SERUM OR PLASMA 97.00 40110040 ALKALINE PHOSPHATASE 97.00 40110045 ALT/SGPT 97.00 40110047 AMMONIA 218.00 40110050 AMYLASE BODY FLUID 133.00 40110055 AMYLASE SERUM OR PLASMA 133.00 40110060 AMYLASE URINE 133.00 40110065 ARTERIAL COLLECTION 99.00 40110070 AST/SGOT 97.00 40110080 BASIC METABOLIC PANEL 227.00 40110081 BMP-POC 212.00 40110090 BILIRUB DIRECT SERUM OR PLASMA 97.00 40110095 BILIRUB TOTAL SERUM OR PLASMA 97.00 40110105 BILIRUBIN TOTAL BODY FLUID 97.00 40110110 BILIRUB TOT NEON SER OR PLASMA 97.00 40110115 VENIPUNCTURE 30.00 40110125 BUNQUANT 97.00 40110130 CALCIUM TOTALBODY FLUID 97.00 40110135 CALCIUM TOTAL SERUM OR PLASMA 97.00 40110140 CALCIUM URINERANDOM 97.00 40110155 CAPILLARY COLLECTION 36.00 40110160 CARBAMAZEPINE TOTAL 191.00 40110165 CARBON DIOXIDE SERUM OR PLASMA 102.00 40110170 ASSAY OF BLOOD CARBON MONOXIDE 167.00 40110175 CHLORIDE OTHER SOURCE 97.00 40110180 CHLORIDE BLOOD 102.00 40110190 CHOLESTEROL SERUM OR PLASMA 97.00 40110195 CK MB 192.00 40110200 CK TOTAL 128.00 40110210 COMPREHENSIVE METABOLIC PANEL 324.00 40110215 CREATININE 24 HOUR URINE 98.00 40110220 CREATININE BODY FLUID/URINE 98.00 40110225 CREATININE CLEARANCE URINE 151.00 40110230 CREATININE RANDOM URINE 98.00 40110235 CREATININE SERUM OR PLASMA 98.00 40110236 CREATININE POC 42.00 40110240 CRP HIGH SENSITIVE 144.00 40110260 DIGOXIN/LANOXIN 191.00 40110265 DILANTIN (PHENYTOIN) 191.00 40110275 DRUG SCREEN-GRHD KIT. 136.00 40110280 DRUG SCREEN-OUR KIT 136.00 40110285 DRUG SCREEN-THEIR KIT 87.00 40110290 ELECTROLYTE PANEL 153.00 40110295 ETHANOL SERUM OR PLASMA MEDICA 236.00 40110300 FERRITIN 204.00 40110310 GENTAMICIN RANDOM LEVEL EXTEND 264.00 40110315 GENTAMICIN TROUGH LEVEL 264.00 40110320 GENTAMICIN TROUGH LEVEL EXTEND 264.00 40110325 GGT 109.00 40110330 GLUCOSE 2 HR POST PRANDIAL 105.00 40110335 GLUCOSE BODY FLUID 97.00 40110340 GLUCOSE CSF 97.00 40110345 GLUCOSE SCREEN PREGNANCY 105.00 40110350 GLUCOSE SERUM OR PLASMA 97.00 40110359 GLUCOSE TOLERANCE - 1HR2SPEC 129.00 40110360 GLUCOSE TOLERANCE TEST-3 SPEC 122.00 40110361 GLUCOSE TOLERANCE-1 ADD'L SPEC 44.00 40110362 GLUCOSE TOLERANCE-2 ADD'L SPEC 82.00 40110364 GLUCOSE TOLERANCE-4 ADD'L SPEC 160.00 40110365 GLUCOSE URINE 102.00 40110369 GLUCOSE TOLERANCE - 4HR6SPEC* 240.00 40110370 H PYLORI Ab IgG 163.00 40110375 HCG SERUM QUALITATIVE PREG 115.00 40110380 HCG SERUM QUANTITATIVE 227.00 40110385 URINE PREGNANCY VISUAL COLOR 115.00 40110390 HDL 97.00 40110395 GLYCOSYLATED (A1C) 187.00 40110400 HEPATIC FUNCTION PANEL 208.00 40110405 HETEROPHILE A/B(MONONUCLEOSIS) 94.00 40110410 IONIZED CALCIUM 153.00 40110420 IRON 97.00 40110425 LACTATE DEHYDROGENASE S/P 97.00 40110426 LDL DIRECT 82.00 40110430 LACTATE DEHYDROGENASE BDY FLD 105.00 40110431 LACTIC ACID 144.00 40110435 LIPASE SERUM OR PLASMA 136.00 40110440 LIPID PANEL 188.00 40110445 MAGNESIUM SERUM OR PLASMA 133.00 40110450 MYOGLOBIN PLASMA 141.00 40110465 POTASSIUM SERUM PLASMA 97.00 40110470 POTASSIUM URINE 97.00 40110475 PROTEIN TOTAL BODY FLUID 97.00 40110480 PROTEIN TOTAL CSF 97.00 40110490 PROTEIN TOTAL URINE 97.00 40110495 PSA SCREEN 208.00 40110496 PSA TOTAL 208.00 40110500 SALICYLATE 199.00 40110505 SODIUM URINE 97.00 40110510 SODIUM URINE 24 HOUR 97.00 40110515 SODIUM SERUM OR PLASMA 97.00 40110520 T4 FREE 195.00 40110525 THEOPHYLLINE 191.00 40110530 IRON BINDING CAPACITY 151.00 40110535 TIMED VOLUME MEASURE URINE 40.00 40110540 TOBRAMYCIN PEAK LEVEL 533.00 40110550 TOBRAMYCIN TROUGH LEVEL 533.00 40110555 TOTAL PROTEIN SERUM PLASMA 97.00 40110560 TOTAL PROTEIN URINE 97.00 40110570 TRIGLYCERIDE SERUM PLASMA 97.00 40110575 TROPONIN QUAN 142.00 40110580 TSH 200.00 40110582 TSH 3RD GEN 200.00 40110585 UREA NITROGEN FLUIDQUANT 97.00 40110590 UREA NITROGEN URINE 24 HR UR 97.00 40110595 URIC ACID BODY FLUID 97.00 40110600 URIC ACID SERUM PLASMA 97.00 40110605 URIC ACID URINE 97.00 40110610 URIC ACID URINE 24 HOUR 116.00 40110615 URINE CALCIUM 24 HOUR 116.00 40110620 URINE SODIUM 24 HOUR 116.00 40110625 URINE URIC ACID 24 HOUR 116.00 40110630 VALPROIC ACID 191.00 40110645 pH BODY FLUID 54.00 40110650 SPECIFIC GRAVITY BODY FLUID 38.00 40110655 PHOSPHORUS URINE 97.00 40110660 PHOSPHORUS SERUM 97.00 40110665 TOXICOLOGY SCREEN URINE 245.00 40110670 BRAIN NATURETIC PEPTIDE 245.00 40110675 BREATH ALCOHOL TEST 48.00 40110680 BLOOD GAS PH ONLY 77.00 40110690 TOBRAMYCIN PEAK LEVEL 278.00 40110700 ALBUMIN PERITONEAL FLUID 97.00 40110810 ABG (VENOUS BLOOD GAS) 240.00 40110815 RAPID HIV SCREEN 81.00 40120010 BLEED TIME 86.00 40120015 COMPL CBC W PLT W AUTOM DIFF 98.00 40120020 CELL COUNT BODY FLUID 104.00 40120025 CELL COUNT CSF 104.00 40120030 CRYSTAL ID FLUID 109.00 40120035 D-DIMER SEMI-QUANT 195.00 40120040 HEMATOCRIT 42.00 40120045 HEMOGLOBIN 42.00 40120050 COMPL AUTOM CBC W PLT 79.00 40120052 MALARIA SMEAR 161.00 40120055 MANUAL DIFFERENTIAL 57.00 40120060 PARTIAL THROMBOPLASTIN TIME 94.00 40120065 AUTOMATED PLATELET COUNT 73.00 40120070 POST VASECTOMY SPERM CHECK 99.00 40120075 PROTHROMBIN TIME W/INR 54.00 40120080 RED BLOOD CELL (RBC) AUTOMATED 53.00 40120085 SED RATE WESTERGREN (ESR) 70.00 40120090 SEMEN ANALYSIS 227.00 40120100 WBC COUNT AUTOMATED 77.00 40120105 AUTOMATED RETICULOCYTE COUNT 79.00 40120120 VON WILLEBRAND FACTOR 278.00 40120125 RISTOCETIN CO-FACTOR 260.00 40140010 MICRO ALBUMIN SEMI QUANT 73.00 40140015 MICROSCOPIC EXAM (URINE) 46.00 40140020 pH URINE 49.00 40140025 SPECIFIC GRAVITY URINE 36.00 40140030 URINALYSIS AUTO W/O MICRO 57.00 40140035 URINALYSIS COMPLETE W/MICRO 80.00 40140038 KETONE URINE 55.00 40140040 SPECIFIC GRAVITY PLEURAL FLUID 38.00 40150020 ANTIBODY SCREEN-RBC 121.00 40150030 COMPATIBILITY TEST ANTIGLOB 175.00 40150035 COMPATIBILITY TEST INCUBATE 183.00 40150040 COMPATIBILITY TEST SPIN 161.00 40150045 DIRECT COOMBS 97.00 40150055 FRESH FROZEN PLASMA - THAWING 115.00 40150060 ABO GROUP/RH BLOOD TYPING 105.00 40150065 PLATELET PHERESIS PACK 1,780.00 40150075 RED BLOOD CELLS - EACH UNIT 505.00 40150076 TRANSFUSE RBC'S 176.00 40150080 BLOOD TYPING RH D 98.00 40150095 THERAPEUTIC PHLEBOTOMY 216.00 40150100 FFP - EACH UNIT 278.00 40150105 ANTIBODY IDENTIFICATION 750.00 40150110 ANTIGEN TYPING PATIENT 250.00 40150115 ANTIGEN TYPING UNIT 250.00 40160002 TISSUE GROSS ONLY I 95.00 40160004 TISSUE GROSS ONLY I ADDTIONAL 91.00 40160007 BLOOD SMEAR-PATH 67.00 40160010 TISSUE G&M ID II 152.00 40160012 TISSUE G&M ID II ADDL 161.00 40160044 TISSUE INTERMEDIATE 1SP IV 264.00 40160046 TISSUE MULTIPLE 2-6 278.00 40160048 TISSUE INTERMEDIATE LEVEL IV 120.00 40160050 TISSUE INTERMTLEVEL IV ADDL 115.00 40160051 TISSUE COMPLEX V 623.00 40160069 TISSUE ROUTINE III 218.00 40160071 TISSUE ROUTINE IIIADDL 208.00 40160077 TISSUE COMPREHENSIVE VI 744.00 40160094 FROZEN SECTION 281.00 40160219 FROZEN SECTION ADDITIONAL BLK 180.00 40166560 DECALCIFICATION 56.00 40166578 SPEC STAINS I 171.00 40166580 SPEC STAINS I ADDL 171.00 40166586 SPEC STAINS II 178.00 40166588 SPEC STAINS II ADDL 178.00 40167253 IMMUNOPEROX STEA AB 404.00 40167255 IMMUNOPEROX STEA AB ADDL 404.00 40168070 ER/PR: HER2/NEU ANALYSIS 1,066.00 40168075 HER2/NEU IMMUNOHISTO CHEMISTRY 538.00 40168108 CYTO SPINSLIDE INTERP 201.00 40168184 FLOW CYTOMETRY-1ST METER 176.00 40168185 FLOW CYTOMETRY-EA ADDL MARKER 176.00 40168233 CYTOGENICSSOLID TISSUE 866.00 40168237 CYTOGENICSBONE MARROW 1,276.00 40168239 TISSUE CULTURESOLID TUMOR 1,066.00 40168264 CHROMOSOME ANALYSIS 959.00 40168271 MOLEC CYTOGEN DNA PROBE 119.00 40168272 MOLEC CYTOGEN DNA PROBE ADDL 119.00 40168273 MOLAR PROFILE-DNA PROBE 167.00 40168274 MOLAR PROFILE-DNA PROBE ADDL 167.00 40168275 INTERPHASE ANALYSIS 100-300 519.00 40168276 MOLAR PROFILE-INTERPHASE ISH 204.00 40168277 MOLAR PREGNANCY DNA PROBE ADDL 172.00 40168305 TISSUE INTERM LEVEL IV 50 429.00 40168313 SPECIAL STAIN GROUP II 208.00 40168314 HISTOCHEM STAIN W/FROZEN 320.00 40168315 HISTOCHEM STAIN W/FROZEN ADDL 320.00 40168316 SPEC STAIN GROUP II ADDL 208.00 40168317 MOLAR PROFILE-SPEC ST II 89.00 40168319 HISTOCHEM FOR ENZYME CONST. 294.00 40168320 HISTOCHEM ENZ CONST ADDL 294.00 40168321 CONSULTATION & REPORT 479.00 40168323 CONSULT BLOCKS 669.00 40168325 CONSULTREVIEW&REPT REF MATRL 210.00 40168326 CONSULTREVIEW & RPT REF MTR 815.00 40168340 IMMUNO HISTO CHEMISTRY ADDL 535.00 40168341 IMMUNO HISTO CHEMISTRY IHC AB 535.00 40168342 COLO PROFILE-IMMUNOPEROXIDASE 244.00 40168350 MICROMETASTESISIMMUNOHISTOCHM 742.00 40168365 IN SITU HYBRIDIZATION 354.00 40168366 IN SITU HYBRID ADDL 354.00 40168367 MOLAR PROFILE-INTERP & REPT 134.00 40168861 TOUCH PREP SCREEN & INTERP 134.00 40168862 CYTOPATH FLUID WASHING BRUSH 168.00 40168863 HER 2 QUANT 404.00 40168864 MICROSATELITE INSTAB. 834.00 40168865 MICRODISSECTION MANUAL 263.00 40168866 HPV DNA SUBTYPING PROBE T HIGH 139.00 40168867 SPECIAL STAIN GROUP III 299.00 40170010 ASCORBIC ACID (VIT C) 238.00 40170015 5-HIAA 24 HR URINE 128.00 40170020 ANGIOTENSIN CONVERTING ENZYME 191.00 40170025 ACET RECEP BIND ANTIBODY 303.00 40170030 ACET RECEP BLOCK ANTIBODY 631.00 40170035 ACET RECEP MOD ANTIBODY 655.00 40170040 ACTH 367.00 40170045 ADENOVIRUS Ab 294.00 40170050 ADRENAL ANTIBODY 126.00 40170055 ADVIL/IBUPROFEN 228.00 40170057 AEROBIC BACTERIA CULTURE 91.00 40170060 AFB CULTURE 211.00 40170065 AFB SUSCEPTIBILITY PANEL 554.00 40170070 AFP TUMOR MARKER 216.00 40170075 MATERNAL QUAD SCREEN PANEL 349.00 40170080 ALDOLASE 93.00 40170085 ALDOSTERONE SERUM 367.00 40170090 ALDOSTERONE URINE 367.00 40170096 ALKALINE PHOS ISOENZYMES 143.00 40170097 ALKALINE PHOSHASTASE 57.00 40170100 ALLERGENS ALLERGY PROFILE A/B 479.00 40170105 ALLERGENS ANIMAL PROFILE 166.00 40170110 ALLERGENS BASIC PROFILE/ADULT 909.00 40170115 ALLERGENS CEREAL PROFILE 220.00 40170120 ALLERGENS PIGEON DROPPINGS 53.00 40170125 ALLERGENS REGIONAL PROFILE F 479.00 40170130 ALLERGENS TREE PROFILE 190.00 40170135 ALLERGENS WEED PROFILE 244.00 40170140 ALPHA SUB UNIT 401.00 40170145 ALPHA-1-ACID GLYCOPROTEIN 288.00 40170150 ALPHA-1-ANTITRYPSIN 124.00 40170155 ALPHA-1-ANTITRYPSIN PHENOTYPE 179.00 40170160 ALPHA-1-ANTITRYPSIN FECES 223.00 40170165 ALPHA-2-MACROGLOBULIN 248.00 40170170 ALUMINUM SERUM 254.00 40170175 ALUMINUM URINE 254.00 40170185 AMIKACIN PEAK LEVEL 161.00 40170190 AMIKACIN TROUGH LEVEL 162.00 40170200 ANA REFLEX PANEL SCREEN 124.00 40170201 CYCLIC CITRULLINATED PEPTIDE 164.00 40170205 ANAEROBIC CULTURE ID 316.00 40170210 ANCA ANTIBODIES BY ELISA 392.00 40170215 ANDROSTANEDIOL GLUCURONIDE 204.00 40170220 ANDROSTENEDIONE 268.00 40170225 ANTI MITOCHONDRIAL 112.00 40170230 ANTIBODY TO PM-1 155.00 40170235 LYMPHOCYTE TRANSFORM MITOGEN 603.00 40170240 PLATELET ASSOCIATED IMMUNOGLOB 281.00 40170245 PLATELET ANTIBODY SCREEN 176.00 40170250 ANTI-SPERM ANTIBODIES 979.00 40170255 ANTITHROMBIN III ACTIVITY ASSA 166.00 40170257 ANTI 68KD (hsp-70) ANTIBODIES 291.00 40170260 APO E CARDIAC RISK 204.00 40170265 ARBOVIRUS ANTIBODIES PANEL 456.00 40170270 ARGININE VASOPRESSIN HORMONE 291.00 40170275 ARSENIC BLOOD 166.00 40170280 ARSENIC URINE 215.00 40170281 ARSENIC FRACTIONATED 24 UR 215.00 40170286 ASO AB 54.00 40170287 ANTI-DNAS B TITER 51.00 40170290 ASPERGILLUS AG EIA 179.00 40170300 BABESIA MICROTI AB IgG 176.00 40170305 BENEDRYL-DIPHENHYDRAMINE 316.00 40170310 BENZENE BLOOD 265.00 40170315 BETA hCG SERUM QUANT TUMOR MAR 155.00 40170320 BETA-2 GLYCOPROTEIN 1 ANTB IgA 475.00 40170325 BETA-2 MICROGLOBULIN CSF 164.00 40170330 BETA-2 MICROGLOBULIN SERUM 118.00 40170335 BETA-2 MICROGLOBULIN URINE 164.00 40170340 BETA-2 TRANSFERRIN 585.00 40170345 BETA-HYDROXYBUTYRIC ACID 388.00 40170350 BETA-THROMBOGLOBULIN 1,019.00 40170355 BILE ACIDS TOTAL 723.00 40170356 BILE ACID FRACTIONATED 317.00 40170360 BIOTINIDASE SERUM 239.00 40170365 BORDETELLA PERTUSSIS PCR 593.00 40170370 BORDETELLA PERTUSSIS ANTI IgG 416.00 40170383 MYOCARDIAL ANTIBODY IgG 243.00 40170385 BRAIN NATURETIC PEPTIDE 607.00 40170391 BRUCELLA AB IgG 112.00 40170392 BRUCELLA AB IgM 111.00 40170395 CA 125 186.00 40170400 CA 15-3 186.00 40170405 CA 19-9 186.00 40170410 CA 27-29 186.00 40170416 CALCITONIN 295.00 40170420 CANDIDA ANTIBODY (ID) 454.00 40170425 CANDIDA ANTIGEN 432.00 40170430 CARBAMAZEPINE FREE 235.00 40170435 CARDIOLIPIN ANTIBODIES IgG IgM 258.00 40170436 CARDIOLIPIN AB IgA 133.00 40170437 CARDIOLIPIN AB IgM 143.00 40170440 CARDIOQUIN (DURAQUIN)QUINIDINE 177.00 40170445 CARNITINE FREE & TOTAL 296.00 40170450 CAROTENE SERUM TOTAL 101.00 40170455 CAT SCRATCH FEVER ANTI IgGIgM 275.00 40170460 CATECHOLAMINES PLASMA FRACT 306.00 40170465 CATECHOLAMINES URINE FREE 306.00 40170470 CEA 186.00 40170475 CENTROMERE ANTIBODYIgG 131.00 40170480 CERULOPLASMIN 104.00 40170485 CHLAMYDIA ANTI PANEL IgG&IgM* 212.00 40170486 CHLAMYDIA IgM 52.00 40170487 CHLAMYDIA IgG 52.00 40170495 CHLAMYDIA TRACHOMATIS AMP DNA 322.00 40170501 CHLAMYDIA RNA PROBE 123.00 40170502 GC RNA PROBE 126.00 40170505 CHLORAMPHENICOL 136.00 40170515 CHOLINESTERASE SERUM-DIBUCAINE 152.00 40170520 CHROMIUM SERUM 229.00 40170525 CHROMIUM URINE 24 HOUR 186.00 40170530 CHROMOGRANIN A 297.00 40170535 CHROMOSOME ANALYS BONE MARROW 1,913.00 40170540 CHROMOSOME ANALYS-AMNIOTIC FLD 3,281.00 40170545 CHROMOSOME ANAL-CHORIONIC VILL 3,574.00 40170550 CITRATE 24 HR UR 249.00 40170554 CK W/ ISOENZYME REFLEX 128.00 40170555 CK ISOENZYMES 93.00 40170565 CMV ANTI IgG 169.00 40170566 CMV ANTI IGM 149.00 40170570 CMV BY PCR-QUAL 182.00 40170581 COCCI COMPLEMENT F 71.00 40170582 COCCI IMMUNODIFFUSION IgG 71.00 40170583 COCCI IMMUNODIFFUSION IgM 71.00 40170590 COLD AGGLUTININS 135.00 40170591 COLD AGGLUTININS SCREEN 68.00 40170592 COLD AGGLUTININS TITER 68.00 40170595 COLORADO TICK FEVER ANTIBODIES 416.00 40170600 COMPLEMENT 2 184.00 40170605 COMPLEMENT 1-ESTERASE INHIBIT 159.00 40170610 COMPLEMENT 3 117.00 40170615 COMPLEMENT 4 117.00 40170620 COMPLEMENT 5 256.00 40170625 COMPLEMENT CH 50 186.00 40170630 COPPER SERUM 175.00 40170635 COPPER URINE 226.00 40170640 COPROPORPHYRIN URINE 452.00 40170645 CORTISOL SERUM 186.00 40170650 CORTISOL URINARY FREE 24 HR 186.00 40170655 COUMADIN (WARFARIN) 313.00 40170660 COXSACKIE A VIRUS ANTIBODIES 370.00 40170665 COXSACKIE B VIRUS ANTIBODIES 186.00 40170670 C-PEPTIDE 186.00 40170675 CROSS LINKED N TELOPEPTIDE SER 200.00 40170680 CROSSLINK N-TELOPEPTIDE UR 24H 194.00 40170685 CRYPTOCOCCUS ANTIBODY 149.00 40170686 CRYPTOSPORIDIUM 139.00 40170687 C-TELOPEPTIDE 220.00 40170690 CYANIDE 175.00 40170695 CYCLIC AMP PLASMA 346.00 40170700 CYCLOSPORINE 318.00 40170710 CYSTINE URINE QUANTITATIVE 179.00 40170711 CYSTINE 24 HR URINE 370.00 40170715 CYTOMEGALOVIRUS ANTI IgG-IgM 223.00 40170716 CYTOPATH CONTECH SMEAR & INTP 119.00 40170725 DHEA-S 191.00 40170730 DEHYDROEPIANDROSTERONE (DHEA) 216.00 40170735 DENGUE FEVER Ab IgG & IgM 458.00 40170750 DESIPRAMINE 157.00 40170755 DIHYDROTESTOSTERONE (DHT) 298.00 40170760 DILANTIN (PTN) FREE 237.00 40170765 DILUTE RUSSELL VIPER VENOM 144.00 40170770 DIPTHERIA Ab IgG 367.00 40170775 DNA DOUBLE STRANDED Ab IgG 186.00 40170780 DNA SINGLE STRANDED Ab IgG 141.00 40170785 DNASE-B ANTIBODY IgG 124.00 40170790 ECHOVIRUS ANTIBODIES 364.00 40170795 EHLICH CHAFF ANTI IgG & IgM 645.00 40170800 ELECTROPHORESIS PROTEIN CSF 188.00 40170802 ELASTASE FECAL 276.00 40170810 ENTAMOEBA ANTIGEN ELISA 323.00 40170815 ENTAMOEBA HISTOLYTICA ANTIBODY 198.00 40170816 ENTAMOEBA 282.00 40170820 ENTEROVIRUS DETECTION B/PCR 236.00 40170835 EOSINOPHILS NASAL SMEAR 47.00 40170840 EPSTEIN BARR Ab PANEL 405.00 40170841 EPSTEIN BARR VIRUS CSF 394.00 40170845 ERYTHROPOIETIN 216.00 40170850 ESTRADIOL SERUM 245.00 40170855 ESTRIOL SERUM 210.00 40170865 ESTRONE SERUM 216.00 40170870 ETHOSUXIMIDE/ZARONTIN 113.00 40170875 ETHYLENE GLYCOL 157.00 40170876 EVAL NEEDLE ASP 250.00 40170880 FACTOR II (PROTHROMBIN) 294.00 40170885 FACTOR II (PT)20210 MUTATION 452.00 40170890 FACTOR IX 309.00 40170895 FACTOR V LEIDEN MUTATION 512.00 40170905 FACTOR VII 309.00 40170915 FACTOR VIII ACTIVITY 294.00 40170920 FACTOR X 294.00 40170925 FACTOR XI 309.00 40170930 FACTOR XII 309.00 40170935 FACTOR XIII 199.00 40170940 FARMERS LUNG PANEL-HYERS PNEUM 326.00 40170945 FAT FECAL QUANTITATIVE 239.00 40170950 FATTY ACIDS FREE 143.00 40170955 ELECTROLYTES FECAL 24 HR 153.00 40170960 FECAL FAT QUALITATIVE 194.00 40170965 FECAL MAGNESIUM 194.00 40170966 FECAL REDUCING SUBSTANCE 153.00 40170967 FECAL PH 59.00 40170970 HGB F RBC DISTRIBUTION 193.00 40170975 FIBRINOGEN 133.00 40170980 FLETCHER FACTOR 606.00 40170985 FLUORIDE 467.00 40170995 FOLATE RBC 226.00 40171000 FOLIC ACID SERUM 190.00 40171005 FRAGILE X SYNDROME 732.00 40171010 FRUCTOSAMINE 134.00 40171015 FSH SERUM 186.00 40171026 FUNGAL CULTURE ROUTINE 123.00 40171027 FUNGAL STAIN (NOCARDIA) 80.00 40171030 GABAPENTIN 131.00 40171032 GLUTAMIC ACID DECARBOXYLASE AB 286.00 40171033 GLOMERULAR BASEMENT MEMBRAN AB 301.00 40171035 GANGLIOSIDE MONOSIALIC ACID AN 270.00 40171040 GASTRIN 155.00 40171045 GIARDIA ANTIGEN BY EIA-STOOL 212.00 40171048 GLIADIN IgA S 153.00 40171049 GLIADIN IgG S 153.00 40171051 GLUCAGON PLASMA 264.00 40171054 GRAM STAIN MAYO 68.00 40171055 GROWTH HORMONE RANDOM 155.00 40171060 HALDOL 157.00 40171065 HAM TEST 416.00 40171070 HEAVY METAL PANEL 6 URINE 293.00 40171075 HEAVY METAL PANEL BLOOD 156.00 40171076 ARSENIC 41.00 40171077 LEAD 41.00 40171078 MERCURY 41.00 40171079 CADMIUM 41.00 40171085 HEMOCHROMOTOSIS GENE ANALYSIS 817.00 40171091 HGB A2 AND F 84.00 40171092 HGB ELECTROPHORESIS 105.00 40171093 IEF CONFIRMS (REFLEX) 82.00 40171094 HB VARIANT BY MASS SPEC 184.00 40171095 HEMOGLOBIN PLASMA 252.00 40171096 UNSTABLE HGB 57.00 40171100 HAPTOGLOBIN SERUM 137.00 40171105 HEMOGLOBIN URINE 132.00 40171110 HEMOSIDERIN URINE 117.00 40171115 HEP A Ab IgM 170.00 40171120 HEP A ANTIBODIES (TOTAL) 124.00 40171125 HEP B CORE Ab 124.00 40171130 HEP B CORE ANTI IgM 179.00 40171135 HEP B SURFACE Ab 120.00 40171140 HEP B SURFACE Ag 118.00 40171145 HEP B VIRAL DNA QUANTITATIVE 520.00 40171150 HEP Be ANTIBODY 126.00 40171155 HEP Be ANTIGEN 126.00 40171160 HEP C Ab 88.00 40171165 HEP C ab (RIBA) 312.00 40171167 HEP C GENOTYPE 1,218.00 40171170 HEP C PCR QUAL 503.00 40171175 HEP C VIRUS (HCV) RNAQUANT PC 706.00 40171176 HCV GENOTYPE RESOLUTION 403.00 40171180 HEP DELTA VITUS ANTI 183.00 40171185 HEP E IgG 365.00 40171190 HEP E IgM 365.00 40171195 HEP PANEL ACUTE 216.00 40171200 HEP PANEL CHRONIC HBV 141.00 40171205 HEPARIN ANTI-XA LOW MOLE/WEI 270.00 40171220 HERPES SIMPLEX VIRUS DFA 168.00 40171221 HERPES SIMPLEX VIRUS CSF 394.00 40171225 HEXAGONAL PHOSPHOLIPID NEUTRAL 261.00 40171230 HISTAMINE 24HR URINE 266.00 40171235 HISTAMINE WHOLE BLOOD 309.00 40171240 HISTOPLASMA ANTIBODY SCREEN 217.00 40171255 HIV 1 ANTIBODY 163.00 40171256 HIV-1/2 AB CONFIRM EVAL 317.00 40171258 HIV-1 AB DIFFERENTIATION 154.00 40171259 HIV-2 AB DIFFERENTIATION 235.00 40171260 HIV WESTERN BLOT 319.00 40171265 HLA B27 221.00 40171270 HOMOCYSTINE TOTAL-CARDIO 90.00 40171280 HOMOVANILLIC ACID (HVA) 284.00 40171285 HSV I II DNA PCR 337.00 40171287 HTLV I/II AB S 347.00 40171290 HYDROXYPROLINE TOTAL URINE 319.00 40171295 IgA CSF 65.00 40171300 IgA SERUM 87.00 40171306 IgA 196.00 40171307 IgA 1 196.00 40171308 IgA 2 196.00 40171310 IgD SERUM 303.00 40171315 IgE 186.00 40171320 IgF BINDING PROTEIN 237.00 40171325 IgG CSF 147.00 40171330 IgG SERUM 85.00 40171335 IgM CSF 65.00 40171340 IgM SERUM 87.00 40171350 IMMUNE COMPLEX ASSAY 1,042.00 40171355 IMMFIX ELECPHORESIS 204.00 40171360 IMMUFIXA ELECTRPHORESIS URINE 268.00 40171365 COMPLEMENT C1q 125.00 40171370 IMMUNOGLOBULINS IgG AM 123.00 40171375 INFLUENZA A VIRUS Ab 167.00 40171380 INFLUENZA A&B VIRUS Ab 179.00 40171385 INFLUENZA B VIRUS Ab 324.00 40171389 INHIBIN-A 86.00 40171390 INHIBIN-B 151.00 40171395 INSULIN ANTIBODIES HUMAN 217.00 40171396 INSULIN LIKE GROWTH FACTOR 1 248.00 40171400 INSULIN TOTAL 129.00 40171402 INSULIN FREE 44.00 40171403 INSULIN TOTAL 79.00 40171405 INTERLUKIN 2 346.00 40171410 INTRINSIC FACT BLOCK ANTIBODY 171.00 40171415 ISLET CELL ANTIBODY IgG 140.00 40171420 ISOENZYMES AMYLASE 136.00 40171425 JO 1 ANTIBODY IgG 136.00 40171430 LAMICTAL LAMOTRIGONE 144.00 40171435 LD ISOENZYMES 243.00 40171440 LEAD URINE 153.00 40171445 LEAD WHOLE BLOOD 126.00 40171450 LEAD PEDIATRIC 59.00 40171451 LEAD-PEDIATRIC 56.00 40171455 LEGIONELLA PNEUMOPHILIA Ab IgM 153.00 40171460 LEGIONELLA PNEUMOPHILIA Ab IgG 133.00 40171465 LEISHMANIA Ab IgG IgM 322.00 40171470 LEPTOSPIRIA Ab 139.00 40171475 LH 186.00 40171480 LIPOPROTEIN (A) 134.00 40171490 LISTERIA Ab SERUM 291.00 40171495 LITHIUM 102.00 40171500 LIVER/KIDNEY MICROSOME Ab 199.00 40171505 LUPUS ANTICOAGULANT PANEL 578.00 40171510 LYME ANTIBODIES IgG IgM 159.00 40171515 MAG ANTIBODY DUAL ELISA 454.00 40171521 RUBEOLA (MEASLES) AB IgM 69.00 40171522 RUBEOLA (MEASLES) AB IgG 69.00 40171525 RUBEOLA (MEASLES) IgG 118.00 40171555 MERCURY BLOOD 193.00 40171560 MERCURY URINE 24 HOUR 212.00 40171565 METANEPHRINES URINE 24 HR 194.00 40171570 METHANOL 208.00 40171575 METHEMOGLOBIN 256.00 40171580 METHOTREXATE 150.00 40171585 METHYLMALONIC ACID (MMA) SERUM 178.00 40171590 METHYLMALONIC ACID (MMA) URINE 170.00 40171600 MICROALBUMIN 24 HR URINE 155.00 40171605 MTHFR 2 MUTATION ANALYSIS 1,121.00 40171606 MTHFR C677T 562.00 40171607 MTHFR A1298C 562.00 40171611 MSP- ALBUMIN SERUM 67.00 40171612 MSP-ALBUMIN CSF 67.00 40171613 MSP- IgG CSF 67.00 40171614 MSP- IgG SERUM 67.00 40171615 MUMPS VIRUS ANTIBODY IgG 155.00 40171616 MSP- CSF BANDS 67.00 40171617 MSP- SERUM BANDS 67.00 40171620 MUMPS VIRUS ANTIBODY IgM 249.00 40171625 MYASTHENIA GRAVIS PANEL 800.00 40171628 MYCOPHENOLIC ACID 290.00 40171630 MYCOPLASMA PNEU Ab IgG IgM 204.00 40171631 MYCOPLASMA PNEU Ab IgM REFLEX 266.00 40171640 MYELOPEROXIDASE Ab 306.00 40171650 MYOGLOBIN URINE 120.00 40171655 NEURON SPECIFIC ENOLASE 168.00 40171660 NEUTR/CYTOPLASMIC ANTI IgG 155.00 40171665 NORTRIPTYLINE 93.00 40171667 NORWALK-LIKE VIRUS 188.00 40171670 OBSTETRIC PANEL 270.00 40171675 ORGANIC ACIDS PLASMA 572.00 40171680 ORGANIC ACIDS URINE 275.00 40171685 OSMOLALITY SERUM OR PLASMA 101.00 40171690 OSMOLALITY URINE 108.00 40171695 OVA & PARASITE EXAM 159.00 40171700 OXALATE URINE 167.00 40171705 OXALATE SERUM 579.00 40171710 PANCREATIC POLYPEPTIDE 349.00 40171715 PARAINFLUENZA Ab TYPE 12 & 3 307.00 40171720 PARVOVIRUS B19 Ab IgG & IgM 157.00 40171725 PHENOBARBITAL 164.00 40171730 PHOSPHATIDYLSERINE Ab 1,075.00 40171735 PHOSPHOLIPIDS SERUM 78.00 40171740 PLASMINOGEN 241.00 40171741 PLAC-LIPOPROTEIN-PLAC2 227.00 40171745 PM 1 ANTIBODY 128.00 40171750 PNEUMOCOCCAL ANTIBODIES IgG 798.00 40171755 PNEUMOCYSTIS CARINII DFA 332.00 40171760 POLIOVIRUS Ab 328.00 40171765 PORPHYRINS FECAL 266.00 40171767 PORPHOBILINOGEN URINE 163.00 40171770 PREALBUMIN 86.00 40171775 PREGNENOLONE 169.00 40171785 PROGESTERONE 186.00 40171790 PROINSULIN 569.00 40171795 PROLACTIN 186.00 40171800 PROTEIN C ACTIVITY 243.00 40171805 PROTEIN C ANTIGEN 187.00 40171810 PROTEIN ELECTROPHORESIS URINE 341.00 40171815 PROTEIN S ACTIVITY 261.00 40171820 PROTEINASE-3Ab 239.00 40171826 PSA FREE (PSA F&T PANEL) 124.00 40171827 PSA TOT (PSA F&T PANEL) 208.00 40171830 PTH INTACT MOLECULE 303.00 40171831 PTH RELATED PEPTIDE 326.00 40171835 PURKINJE CELL CYTOPLASMIC ANT 414.00 40171840 Q-FEVER Ab.IgG PHASE 1&2 217.00 40171842 RABIES AB 172.00 40171845 RA-RHEUMATOID FACTOR 81.00 40171855 RENIN 216.00 40171860 RETICULIN ANTIBODY IgA 175.00 40171865 RETINOL BINDING PROTEIN 418.00 40171870 ROCK MTN SPOT FEV ANTI IgMIgG 206.00 40171875 RPR 116.00 40171877 SYPHILIS AB IgG W/REFLEX 87.00 40171878 SYPHILIS AB IgM 83.00 40171879 RPR TITER (REFLEX) 39.00 40171880 RSV ANTIBODY 290.00 40171885 RSV ANTIGEN 132.00 40171890 RUBELLA ANTIBODIES IgG&IgM 155.00 40171895 RUBELLA ANTIBODY IgG 161.00 40171900 RUBELLA ANTIBODY IgM 273.00 40171905 SCLERODERMA ANTIBODY SCL-70 136.00 40171910 SELENIUM URINE 218.00 40171915 SELENIUM SERUM OR PLASMA 216.00 40171920 SEROTONIN WHOLE BLOOD 279.00 40171925 SEROTONIN SERUM 279.00 40171927 SEROQUEL - SERUM 170.00 40171930 SEX HORMONE BINDING GLOBULIN 216.00 40171935 SJOREN'S ANTIBODY SERUM 186.00 40171940 SKIN ANTIBODY 329.00 40171945 SMOOTH MUSCLE ANTIBODY 111.00 40171948 SOLUBLE TRANSFERRIN RECEPTOR 337.00 40171950 SOMATOMEDIN C 237.00 40171955 SOMATOSTATIN 558.00 40171970 STRIATED MUSCLE ANTIBODY 121.00 40171975 T3 FREE 156.00 40171980 T3 TOTAL 186.00 40171985 T3 UPTAKE 144.00 40171990 T4 BINDING GLOBULIN 198.00 40171995 T4 TOTAL 161.00 40172000 TACROLIMUS (FK506) 206.00 40172005 TEICHOIC ACID ANTIBODIES 130.00 40172010 TESTOSTERONE 245.00 40172020 TETANUS ANTIBODY IgG 132.00 40172030 THYROID ANTIBODIES 149.00 40172035 THYROID PEROXIDASE Ab (TPO) 124.00 40172037 THYROTROPIN RECEPTOR AB 203.00 40172045 TORCH ANTIBODIES IgM 585.00 40172050 TOXOCARA ANTIBODIES 304.00 40172055 TOXOPLASMA ANTIBODY IgG 131.00 40172060 TOXOPLASMA ANTIBODY IgM 131.00 40172065 TRANSFERRIN SERUM 155.00 40172066 THYROGLOBULIN AB SCR 122.00 40172067 THYROGLOBULIN TUMOR MARKER 135.00 40172070 TRANSGLUTAMINASE Ab (IgA) 159.00 40172071 TISSUE TRANSGLUTAMINASE ABIgG 156.00 40172075 TRICINELLA ANTIBODY 298.00 40172085 TRYPSIN SERUM 279.00 40172090 TRYPTASE 167.00 40172095 TSI 306.00 40172100 TULAREMIA ANTIBODY-FRACISELLA 228.00 40172105 TYPHUS FEVER ANTIBODIES 422.00 40172106 UREA BREATH TEST OUR KIT 337.00 40172110 VANCOMYCIN RANDOM LEVEL 264.00 40172115 VANCOMYCIN TROUGH LEVEL 264.00 40172120 VANCOMYCIN PEAK LEVEL 264.00 40172126 VARICELLA-ZOSTER IgM 112.00 40172127 VARICELLA ZOSTER IgG 112.00 40172130 VDRL CSF 57.00 40172135 VIRAL CULTURE 372.00 40172140 VISOCITY SERUM 133.00 40172145 VIT A RETINOL SERUM OR PLASMA 137.00 40172150 VIT B1-THIAMINE WHOLE BLOOD 212.00 40172155 VIT B6(PYRIDOXINE)TOTAL PLASMA 294.00 40172160 VITAMIN B1(THIAMINE) PLASMA 226.00 40172165 VITAMIN B12 190.00 40172175 VITAMIN B2 153.00 40172180 VITAMIN D 1 25-DIHYDROXY 227.00 40172185 VITAMIN D 25-DIHYDROXY 272.00 40172186 VITAMIN E 145.00 40172190 VMA URINE 131.00 40172193 WEST NILE VIRUS IgM 47.00 40172194 WEST NILE VIRUS IgG 47.00 40172196 WEST NILE IGM CSF 129.00 40172197 WEST NILE IGG CSF 129.00 40172199 WEST NILE VIRUS CSF 239.00 40172200 YERSINIA ANTIBODIES 311.00 40172205 ZINC PROTOPOR(ZPP)WHOLE BLOOD 131.00 40172210 ZINC SERUM 145.00 40172215 ZINC URINE 256.00 40172225 STONE ANALYSIS 123.00 40172235 17-0H PROGESTERONE 233.00 40172240 ALAURINE 340.00 40172250 ENDOMYSIAL AB IgA 256.00 40172252 ENDOMYSIAL AB IgG SCREEN 134.00 40172253 ENDOMYSIAL AB IgG TITER 134.00 40172255 VON WILLEBRAND PANEL 1,597.00 40172261 HSV IGM BY EIA 112.00 40172262 HSV TYPE 1 117.00 40172263 HSV TYPE 2 117.00 40172265 KEPPRA 216.00 40172270 SIROLIMUS 254.00 40172275 THYROGLOBULIN ANTIBODY 160.00 40172280 H PYLORI ANTIGEN 261.00 40172285 METABOLIC SCREEN 814.00 40172290 LEGIONELLA AG URINE 118.00 40172295 XYLOSE BLOOD 304.00 40172300 B-CELL TOTAL COUNT 140.00 40172301 NATURAL KILLER (NK) CELL TOT 140.00 40172302 T CELL TOTAL COUNT 140.00 40172303 ABSOLUTE CD4/CD8 COUNT W/RATIO 147.00 40172305 RNP ANTIBODIES IgG 145.00 40172310 SSB (LA)(ENA) ANTIBODYIGG 82.00 40172315 SSA (RO)(ENA) ANTIBODYIGG 82.00 40172320 IMMUNOGLOBUL.FREE LIGHT CHAINS 374.00 40172325 CRYOGLOGULIN S AND P 190.00 40172330 BCR/ABL p210 712.00 40172350 BETA 2 GLYCOPROTEIN I - 3 AB'S 359.00 40172355 BETA 2 GLYCOPROTEIN I AB IgA 128.00 40172360 BETA 2 GLYCOPROTIEN 1 AB IgG 128.00 40172365 BETA 2 GLYCOPROTEIN I AB IgM 128.00 40172370 FUNGAL AB SURVEYSERUM 545.00 40172375 ERYTHROCYTE ENZYME EVAL 1,091.00 40172380 PORPHOBILINOGEN DEAMINASERBC 279.00 40172385 ORTHOSPCO PROTEIN UR 137.00 40172390 VARICELLA-ZOSTER VIRUS BY PCR 133.00 40172396 CRYOGLOBULIN - QUAL/SEMI QUAN 101.00 40172397 CRYOFIBRINOGEN 98.00 40172400 METANEPHRINES FRAC FREE 301.00 40172410 RIBOSOME P AB IgG 161.00 40172420 ALA DEHYDRATASE RBC 301.00 40172430 PSEUDOCHOLINESTERASE TOTALS 91.00 40172441 ANTI-NEURONAL NUCLEAR ABTYPE1 98.00 40172442 ANTI-NEURONAL NUCLEAR ABTYPE2 72.00 40172443 ANTI-NEURONAL NUCLEAR ABTYPE3 72.00 40172444 ANTI-GLIAL NUCLEAR AB TYPE1 72.00 40172445 PURKINJE CELL CYTOPLASMIC ABI 72.00 40172446 PURKINJE CELL CYTOPLASMIC AB2 72.00 40172447 PURKINJE CELL CYTOPLASM. ABTR 53.00 40172448 AMPHIPHYSIN ABS 54.00 40172449 CRMP-5-IgG S 72.00 40172450 STRIATIONAL(STRIATED MUSCLE)AB 183.00 40172451 P/Q-TYPE CALCIUM CHANNEL AB 108.00 40172452 P/Q-TYPE CALCIUM CHANNEL AB 108.00 40172453 ACh RECEPTOR(MUSCLE)BINDING AB 339.00 40172454 AChR GANGLIONIC NEURONAL AB 108.00 40172455 NEURONAL (V-G) K+ CHANNEL AB 108.00 40172460 T3; REVERSE 112.00 40172466 LYME'S IgG WESTERN BLOT 143.00 40172467 LYME'S IgM WESTERN BLOT 143.00 40172470 STREPTOZYME 109.00 40172480 ZONISIMIDE S 190.00 40172486 ANAPLASMA PHAGOCYTOPHIL ABIgG 176.00 40172487 EHRLICHIA CHAFFEENSIS AB IgG 167.00 40172490 CAT EPITHELIUM (DANDER) IgE 45.00 40172495 COW EPITHELIUM (DANDER) IgE 45.00 40172500 HORSE DANDER IgE 45.00 40172505 DOG EPITHELIUM (DANDER) IgE 45.00 40172510 SM AB IgG (ANTI-SMITH) 153.00 40172515 HISTONE AUTOANTIBODIESS 183.00 40172525 AMINO ACID QN PLASMA 386.00 40172530 VASOACTIVE INTEST. POLYPEPTIDE 411.00 40172540 ADENOSINE DEAMINASEFLUID 162.00 40172545 UROVYSION 541.00 40172550 MILK IgE (allergy testing) 42.00 40172561 HEP A ANTIBD (TOTAL) W/REFLEX 114.00 40172562 HEP A Ab IgM 88.00 40172563 HEP A Ab IgG 97.00 40172565 HHV-6 BY PCR 355.00 40172570 H PYLORI AB IgG SERUM 131.00 40172571 H PYLORI AB IgM SERUM 131.00 40172572 H PYLORI AB IgA SERUM 131.00 40172573 H PYLORI AB PANEL IgGIgMIgA 386.00 40172579 PROTHROMBIN TIME 56.00 40172580 PROTIME PLASMA FRACTIONS EA 68.00 40172584 PTT; PLASMA OR WHOLE BLOOD 109.00 40172585 PTT; SUBSTITUTION PLASMA FRAC 79.00 40172590 CHLAMYDIA AB IgG IgA IgM 170.00 40172610 ADENOSINE DEAMINASE BLOOD 190.00 40172620 LEUKEMIA/LYMPHOMA PHENOTYPE 523.00 40172625 LEUKEMIA PHENOTYPING TRIAGE 671.00 40172630 DIURETIC SCREEN URINE 188.00 40172635 FLOW CYTOM. INTERP. 2-8 MARKER 122.00 40172645 CHILDHOOD ALLERGY PROFILE 270.00 40172655 NICOTINE & METABOLITES SERUM 210.00 40172658 NICOTINE & METABOLITES URINE 214.00 40172668 HSV AB IgM By IFA 153.00 40172678 CARDIAC CRP 144.00 40172680 CONFIRMED DRUG ABUSE SURVEY 181.00 40172685 OPIATES URINE (QUANTIFY & SPE 183.00 40172686 OXYCODONE BY GC/MS 89.00 40172687 CODEINE BY GC/MS 89.00 40172690 BENZODIAZEPINEURINE (QUAN & S 170.00 40172695 PARIETAL CELL AB 145.00 40172700 IODINE URINE RANDOM 192.00 40172710 CYSTIC FIBROSIS MUTATION ANALY 716.00 40172715 MuSK ANTIBODY 522.00 40172716 POTASSIUM WHOLE BLOOD 97.00 40172721 MIRCOSPORIDIA CONCENTRATION 79.00 40172722 MIRCOSPORIDIA STAIN 71.00 40172732 FLOW CYTOM. INTERP. 2-8 MARKER 154.00 40172741 LEUKEMIA PHENOTYPE CYTOMETRY 227.00 40172742 LEUKEMIA PHENOTYPE ADD'L MARKR 427.00 40172750 MAGNESIUM TOTAL RBCs 96.00 40172755 JAK2 EXON 12 MUTATION DETECTIO 409.00 40172770 BABESIA MICROTI IgG ANTIBODY 176.00 40172780 CYSTATIN CSERUM 210.00 40172790 JAK2 V617F MUTATION PANEL 692.00 40172800 CALCIUM RANDOM URINE 88.00 40172801 HOMOCYSTEINE URINE 286.00 40172830 CRMP-5-IgG WESTERN BLOT 370.00 40172840 OXCARBAZEPINE METABOLITE (MHC) 182.00 40172841 ETOH CONFIRMATION-UR 82.00 40172850 SYNOVIAL FLUID CRYSTAL ID 145.00 40172860 LACTOFERRIN FECAL 143.00 40172881 MDA BY GC/MS 78.00 40172882 AMPHETAMINES BY GC / MS 78.00 40172890 EGG IgE (allergy testing) 42.00 40172891 SOY IgE (allergy testing) 42.00 40172892 WHEAT IgE (allergy testing) 42.00 40172896 PRIMIDONE 94.00 40172897 CMV PCR QN PLASMA 499.00 40172910 PNEUMONIAE AB (23 SEROTYPES) 216.00 40172920 PNEUMONIAE 23 SEROTYPES IgG 265.00 40172950 ALBUMIN PERITONEAL FLUID 97.00 40172955 CELIAC DISEASE CASCADE 87.00 40172961 XYLENE ORGAINIC ACID 150.00 40172962 CREATININE 98.00 40172965 TOLUENE 153.00 40172970 AChR(MUSCLE)MODULATING AB 286.00 40172975 CORTISOL FREE RANDOM URINE 216.00 40172980 NICOTINE EMPLOYEE 17.00 40172982 ANTI MULLERIAN HORMONE (AMH) 150.00 40172985 IODINE 24 HR URINE 192.00 40172990 NMR LIPOPROFILE 291.00 40173000 TB BY QUANTIFERON 306.00 40173001 CORTISOL SALIVA 252.00 40173002 VITAMIN K 143.00 40173016 PROTEIN ANTIGEN 168.00 40173017 ACTIVATED PROTEIN RESIST V 312.00 40173018 SOLUBLE FIBRIN MONOMER 203.00 40173019 SPECIAL COAG INTER 214.00 40173020 THROMBIN TIME 78.00 40173025 HIV -2 AB EVAL 179.00 40173040 MAGNESIUM 24 HR URINE 97.00 40173041 MAGNESIUM RANDOM URINE 97.00 40173042 PEANUT IgE (allergy testing) 42.00 40173043 G-6-PD 137.00 40173045 PSA ULTRASENSITIVE 258.00 40173051 OSMOLALITY F 93.00 40173052 SODIUM OTHER SOURCE 84.00 40173053 POTASSIUM OTHER SOURCE 93.00 40173054 CHLORIDE OTHER SOURCE 84.00 40173055 MAGNESIUM OTHER SOURCE 84.00 40173060 H. INFLU B IgG 144.00 40173061 WHIPPLE DISEASE PCR 540.00 40173063 SODIUM URINE 11.00 40173064 POTASSIUM URINE 11.00 40173065 CALCIUM URINE 16.00 40173066 MAGNESIUM URINE 16.00 40173067 CHLORIDEURINE 11.00 40173068 PHOSPHORUSURINE 11.00 40173069 SULFATEURINE 11.00 40173070 CITRATE EXCRETIONURINE 48.00 40173071 OXALATE URINE 27.00 40173072 pH URINE 11.00 40173073 URIC ACID URINE 11.00 40173074 CREATININE URINE 11.00 40173075 OSMOLALITYURINE 16.00 40173076 AMMONIUM 24 HR URINE 32.00 40173077 UREA NITROGEN URINE 11.00 40173085 MANGANESE S 221.00 40173096 HEXAGONAL PHOSPHOLIPID NEUTRAL 188.00 40173097 STACLOT LA 272.00 40173100 APTT MIX 1:1 103.00 40173101 PT MIX 1:1 108.00 40173102 DRVVT CONFIRMATION 111.00 40173103 DRVVT MIX 111.00 40173104 SPECIAL COAG INTERPRETATION 44.00 40173116 BENZENE CREATININE URINE 54.00 40173117 BENZENE VOLATILES URINE 177.00 40173118 TYSABRI ANTIBODIES 420.00 40173123 PORPHYRINS QUAN URINE 137.00 40173124 PORPHYRINS FRAC URINE 144.00 40173126 MUMPS AB IgG AND IgM 269.00 40173130 CRP (NON HI -SENSITIVE) 103.00 40173133 FREE T4 BY DIRECT DIALYSIS 260.00 40173135 CONNECTIVE TISSUE CASCADE 265.00 40173136 CALCIUM/CREAT RATIO URINE 124.00 40173138 ARYLSULFATASE A LEUKOCYTES 405.00 40173140 ALPHA-LACTOALBUMIN IgE 64.00 40173141 CASEIN IgE 45.00 40173142 EPSTEIN-BARR VIRUS PCR (FLD) 386.00 40173143 WEST NILE VIRUS PCR CSF 305.00 40173144 LYME DISEASE PCR (FLD/TISS) 506.00 40173145 LYME DIS. WESTERN BLOT CSF 272.00 40173147 B.BURGDORFERI IgG IgM 369.00 40173148 ACE CSF 253.00 40173151 PANEL B CELL TOTAL 68.00 40173152 PANEL NATERAL KILLER CELLS 68.00 40173153 PANEL T-CELL TOTAL 68.00 40173154 PANEL ABSOLUTE CD4/CD8 74.00 40173155 PANEL FLOW CYTO FIRST MARKER 100.00 40173156 PANEL FLOW CYTO ADDL MARKERS 712.00 40173157 PANEL FLOW CYTO XLINK 100.00 40173158 PANEL CD45 100.00 40173159 PANEL CD40 BY FLOW QL 51.00 40173160 M. PNEU Ab IgM BY IFA 188.00 40173170 LISTERIA Ab CSF 291.00 40173175 CODFISH IgE (allergy testing) 45.00 40173176 HALIBUT IgE (allergy testing) 64.00 40173177 TUNA IgE (allergy testing) 64.00 40173178 CATFISH IgE (allergy testing) 45.00 40173179 HIV-1 RNA QUANTIFICATION 260.00 40173180 HIV-1 GENOTYPIC DRUG RESIST 2,191.00 40173181 OVA 1 955.00 40173190 PARASITES-RAPID (VVH) 200.00 40173195 AFB STAIN 71.00 40173200 HONEYBEE VENOM IgE 45.00 40173201 YELLOW JACKET VENOM IgE 45.00 40173202 WASP VENOM IgE 45.00 40173203 YELLOW FACED HORNET VENOM IgE 45.00 40173204 WHITE FACED HORNET VENOM IgE 45.00 40173205 LATEX IgE 45.00 40173206 VON WILLEBRAND FACTOR AG 293.00 40173210 TIMOTHY GRASS IgE 45.00 40173211 GONADOTROPIN RELEASING HORMONE 341.00 40173212 MALT IgE 45.00 40173213 GLYCYPHAGUS DOMESTICUS IgE 64.00 40173214 LEPIDOGLYPHUS DESTRUCTOR IgE 64.00 40173215 COBALT 199.00 40173216 HSV SCR IgM By EIA 130.00 40173217 CRAB IgE 45.00 40173218 LOBSTER IgE 45.00 40173219 SHRIMP IgG 45.00 40173220 FIRE ANT IgE 45.00 40173221 HYMENOPTRA IgE (CHG ONLY) 196.00 40173222 CINNAMON IgE 45.00 40173223 EASTERN SYCAMORE IgE 45.00 40173224 GOOSE FEATHERS IgE 45.00 40173225 COTTONWOOD IgE 42.00 40173226 JALAPENO/CHIPOLTE IgE 45.00 40173227 JOHNSON GRASS IgE 45.00 40173228 JUNIPER WESTERN IgE 45.00 40173229 LOCUST BLACK IgE 45.00 40173230 FOOD PANEL 6 98.00 40173231 SUSCEPTIBILITY (MAYO) 98.00 40173235 BCR/ABL FISH 775.00 40173241 CYTOGENETIC INT & REP (CMS) 58.00 40173242 CHROMOSOME ANALYSIS (CMS) 703.00 40173243 TISSUE CULTURE (CMS) 558.00 40173250 REPTILASE TIME 99.00 40173251 ANTITHROMBIN ANTIGEN 258.00 40173252 CREATININE 24 HR UR TO MAYO 133.00 40173253 TOTAL PROTEIN 24 HR UR TO MAYO 133.00 40173260 TB PCR 419.00 40173265 HEMOGLOBIN S SCRN 103.00 40173266 DDIMER PLASMA (REFLEX) 174.00 40173267 COCNUT IgE 45.00 40173268 RISTOCETIN COFACTOR P 227.00 40173269 VON WILLEBRAND FACTOR MULTIMER 363.00 40173270 COAG FACTOR VIII INH SCR 93.00 40173271 BETHESDA UNITS 183.00 40173272 PAS STAIN 199.00 40173274 AUTOIMMUNE DYSAUTONOMIA EVAL 1,344.00 40173275 PARANEOPLASTIC AUTOAB W BLOT 338.00 40173276 AMPHIPHYSIN WESTERN BLOT 349.00 40173277 MANGO IgE 45.00 40173278 IMMUNOFIX. CRYOGLOBULIN/REFLX 191.00 40173279 WATERMELON IgE 45.00 40173280 PEACH IgE 45.00 40173281 MELONS IgE 45.00 40173282 AVOCADO IgE 45.00 40173283 FREE T4 (MAYO) 195.00 40173284 KIWI IgE 45.00 40173285 MAG (IgM) AB W/ REFLEX 202.00 40173286 SULFATIDE AUTOANTIBODY TEST 512.00 40173290 21-HYDROXYLASE AB 290.00 40173294 WEST NILE VIRUS PCR PLASMA 324.00 40173295 ALPHA-SUBUNIT PITUITARY TM 208.00 40173296 CARDIOLIPIN AB IgG 150.00 40173297 CARDIOLIPIN AB EVAL(IgAMG) 352.00 40173301 AFP ON PERITONEAL FLD 227.00 40173304 NMO(obsolete) 675.00 40173305 METANNEPHERINES RAND UR 227.00 40173306 PORPHYRINS UR QUANTATIVE 163.00 40173307 PORPHYRINS QN AND FRAC 133.00 40173308 OVA 1 942.00 40173310 EBV IgG AB EARLY ANTIGEN 150.00 40173311 EPSTEIN-BARR VIRUS PCR FLD 337.00 40173313 BCR/ABL MUTATION ASPE 702.00 40173315 HSV 1 IGM TITER (REFLEX ) 99.00 40173316 HSV 2 IGM TITER (REFLEX ) 99.00 40173317 FLOW CYO INTER >=16 MARKERS 227.00 40173318 CALPROTECTIN FECAL 288.00 40173319 PROM. THIOPURINE METAB 367.00 40173320 CHRONIC HEPAT PANEL (HepB)* 291.00 40173321 HEP Bs AG (HBP PANEL) 99.00 40173322 HEP Be AG (HBP PANEL) 99.00 40173323 HEP Be AB (HBP PANEL) 94.00 40173324 HBsAG CONFIRM (REFLEX) 124.00 40173325 1ST TRIMESTER MATERNAL SCR 244.00 40173326 SYPHILIS AB TP-PA (REFLEX) 155.00 40173327 ALCOHOL BIOMK UR (ETG) 175.00 40173328 BCR/ABL RNA QUAL 769.00 40173340 TESTOSTERONE TOT 170.00 40173341 TESTOSTERONE FREE 158.00 40173342 TESTOSTERONE BIOAVAIL 158.00 40173343 HSV 1 IgM SCR 115.00 40173344 HSV 2 IgM SCR 115.00 40173346 LEGIONELLA PNEUMO (SERO 1) 143.00 40173347 LEGIONELLA PNEUMO (SERO 2-68) 143.00 40173348 HEPARIN-PF4 AB (HIT) 290.00 40173349 SEROTONIN RELEASE ASSAY (SRA) 488.00 40173350 EBV IgA 150.00 40173351 IODINE/CREAT RATIO UR RANDOM 291.00 40173353 ESTRADIOL (MENO PANEL) 81.00 40173354 PROGESTERONE (MENO PANEL) 81.00 40173355 TSH (MENO PANEL) 73.00 40173356 FT3 (MENO PANEL) 81.00 40173357 FT4 (MENO PANEL) 81.00 40173358 DHEA-S (MENO PANEL) 81.00 40173359 PREGNENOLONE (MENO PANEL) 76.00 40173361 TESTOSTERONE FREE (MENO PANEL) 42.00 40173362 TESTOSTERONETOT (MENO PANEL) 42.00 40173363 DIPTHERIAE CULTURE 216.00 40173365 ALPHA GLOBIN GENE SEQ 206.00 40173366 BETA GLOBIN GENE SEQ 206.00 40173367 MANUAL DNA EXTRACTION 206.00 40173368 MICROALBUMIN RANDOM URINE 155.00 40173369 CULTURE REFER FOR ID MYCOBACT 240.00 40173370 RUBEOLA (MEASLES) AB IgM 163.00 40173371 GRAPEFRUIT IgE 45.00 40173372 BLUEBERRY IgE 45.00 40173373 WHEY IgE 45.00 40173375 MMRV IMMUNE PROFILE* 249.00 40173376 RUBEOLA (MEASLES) IgG 66.00 40173377 MUMPS VIRUS ANTIBODY IgG 66.00 40173378 RUBELLA ANTIBODY IgG 66.00 40173379 VARICELLA ZOSTER IgG 70.00 40173380 IgG4 SUB CLASS 264.00 40173382 ASPERGILLUS FLAVUS AB 104.00 40173383 ASPERGILLUS NIGER AB 104.00 40173384 ASPERGILLUS FUMIGATUS 104.00 40173385 PROCALCITONIN 337.00 40173386 BARLEY IgE 42.00 40173387 RICE IgE 45.00 40173388 CORN-FOOD IgE 45.00 40173389 ORANGE IgE 45.00 40173390 OAT IgE 45.00 40173391 POTATO WHITE IgE 45.00 40173392 POTATO SWEET IgE 45.00 40173393 SCALLOP IgE 45.00 40173394 STRAWBERRY IgE 45.00 40173395 TOMATO IgE 45.00 40173396 WALNUT IgE 45.00 40173397 FOOD 5 IgE (FOOD-MEAT PANEL) 94.00 40173398 EGG YOLK IgE 45.00 40173399 WHITEFISH IgE 45.00 40173401 EGG WHITE IgE 40.00 40173402 MILK IgE 40.00 40173403 WHEAT IgE 40.00 40173404 SOYBEAN IgE 40.00 40173405 OAT IgE 40.00 40173406 FUNGAL STAIN DERMAL 87.00 40173407 FUNGUS CULTURE ID 131.00 40173408 CHICKEN IgE 42.00 40173409 BANANA IgE 45.00 40173410 CARROT IgE 45.00 40173411 CELIAC DISEASE CASCADE 502.00 40173412 HEPATITIS D AB. TOTAL 210.00 40173413 HEPATITIS D AB. IgM 210.00 40173415 FUNGAL ID PANEL A (CHG ONLY) 90.00 40173417 TRIGLYCERIDES 112.00 40173418 HIGH RES FRAC/QUANT 118.00 40173419 TOPIRAMATE 147.00 40173421 RICKETTSIAL AB (R.TYPHI) 83.00 40173423 RICKETTSIAL AB (RMSF) 83.00 40173425 Q FEVER AB IgG/IgM 76.00 40173430 R.TYPHI IgG TITER 112.00 40173431 R.TYPHI Igm TITER 112.00 40173432 RMSF IgG TITER 112.00 40173433 RMSF IgM TITER 112.00 40173434 Q FEVER IgG PHASE I TITER 93.00 40173435 Q FEVER IgG PHASE II TITER 93.00 40173436 Q FEVER IgM PHASE I TITER 93.00 40173437 Q FEVER IgM PHASE II TITER 93.00 40173439 CAT SCRATCH (BARTONELLA) AB 212.00 40173440 IMMUNOGLOB. TOTAL LITE CH UR 204.00 40173441 CRYPTOCOCCUS AG SCR S 74.00 40173442 CRYPTOCOCCUS AG (REFLEX) 74.00 40173443 CRYPTOCOCCUS AG CSF 129.00 40173444 HHV-6 BY PCRCSF 345.00 40173445 FSHD DNA (CHG ONLY) 1,505.00 40173447 SACCHAROMYCES CEREVISIAE IgA 134.00 40173448 SACCHAROMYCES CEREVISIAE IgG 134.00 40173449 NEUTROPHIL SPECIFIC ANTIBODIES 134.00 40173450 AEROBIC ID REFERRAL (MAYO) 90.00 40173451 METHOTREXATE 168.00 40173452 ANA REFLEX TO CTD PANEL 175.00 40173453 ANA HEp-2 Substrate 175.00 40173454 ANA (MULTIPLE) REFLEX 47.00 40173455 DNA DBLE STRNDED IgG (REFLEX) 33.00 40173456 AB TO ENA EVAL 116.00 40173457 SS-A/RO AB IgG (REFLEX) 20.00 40173458 SS-B/RO AB IgG (REFLEX) 20.00 40173459 Sm AB IgG (ANTI-Sm) (REFLEX) 20.00 40173460 RNP AB IgG (REFLEX) 20.00 40173461 SCL-70 AB IgG (REFLEX) 20.00 40173462 JO 1 AB IgG (REFLEX) 20.00 40173463 RIBOSOME P AB 124.00 40173464 FOOD 4 PANEL (ALLERGY TESTING) 64.00 40173465 CLOMIPRAMINE 186.00 40173466 LYME PCR (B.BURGDORFERI) 446.00 40173467 ALPHA-GALACTOSIDASE 253.00 40173468 THC CONFIRMATION UR 154.00 40173470 GAD65 98.00 40173471 INSULIN ABS 98.00 40173472 IA-2 AB 98.00 40173473 WELLBUTRIN (BUPROPIONZYBAN) 201.00 40173475 RNA POLYMERASE III AB 160.00 40173476 STREPTOZYME 87.00 40173477 TAY-SACHS CARRIER SCREEN 383.00 40173478 PYRUVIC ACID (BLOOD) 143.00 40173480 Q-FEVER Ab.IgG (phase I & II) 60.00 40173481 Q-FEVER Ab.IgM (phase I&II) 60.00 40173482 COXIELLA BURNETII PCR 669.00 40173483 CHROMOSOME ANALYSIS (CMAC) 2,272.00 40173484 NMO 307.00 40173485 VORICONAZOLE 216.00 40173487 HANTAVIRUS IgG 140.00 40173488 HANTAVIRUS IgM 140.00 40173491 IgG TOTAL 35.00 40173492 IgG I 34.00 40173493 IgG 2 34.00 40173494 IgG 3 34.00 40173495 IgG 4 34.00 40173501 ALPHA 2 MACROGLOBULINS QN 180.00 40173502 HAPTOGLOBIN 157.00 40173503 APOLIPOPROTEIN A-1 180.00 40173504 BILIRUBIN TOTAL 38.00 40173505 GGT 38.00 40173506 ALT 38.00 40173510 COAG FACTOR VIII ASSAY 177.00 40173511 PROTEIN S AG 79.00 40173512 PROTEIN S AG FREE 160.00 40173513 GRAINS & NUTS PANEL 493.00 40173514 THYROTROPIN RELEASING HORMONE 253.00 40173515 PEPPER CAYENE IgE 45.00 40173516 ROSEMARY IgE 45.00 40173517 CORIANDER IgE 45.00 40173518 SHRIMP IgE 45.00 40173519 PRADER-WILLE 879.00 40173520 5' NUCLEOTIDASE 71.00 40173521 FACTOR XIIIQL W/REFX 186.00 40173525 VEGTABLES PANEL 494.00 40173528 SALMON IgE 42.00 40173530 FRUIT PANEL 493.00 40173531 IODINE SERUM 150.00 40173532 ISLET CELL CYTOPLASMIC AB 235.00 40173533 FUNGITELL 224.00 40173534 HLA-DR 3/4 (CHG ONLY) 529.00 40173536 B-CELL TOTAL COUNT 587.00 40173537 CD20 TOTAL COUNT 392.00 40173540 ZINC TRANSPORTER 8 AB 475.00 40173542 HEPATITIS B SURFACE AB 49.00 40173543 HEPATITIS B SURFACE AG 49.00 40173544 HBc TOTAL 49.00 40173545 HCV Ab W/ REFLEX 49.00 40173546 FORMALDEHYDE IgE 64.00 40173547 URTICARIA INDEX 208.00 40173548 BK VIRUS DNA by PCR 246.00 40173549 METHOTREXATE 168.00 40173550 MI-2 149.00 40173551 SRP 149.00 40173552 AFP SINGLE MATERNAL SCR 129.00 40173554 VITAMIN A 85.00 40173555 VITAMIN E 85.00 40173556 BLASTOMYCES AB 129.00 40173557 PGD2 376.00 40173560 MA ANTIBODY 1,049.00 40173562 MICROSPORIDIA STOOL PCR 446.00 40173563 ADENOVIRUS PCR 224.00 40173564 YEAST ID PANEL C (CHG ONLY) 119.00 40173565 MICRBIAL PROBE ID (CHG ONLY) 168.00 40173566 D2 FUNG SEQUENC. ID (CHG ONLY) 196.00 40173567 FUNGAL ID PANEL B (CHG ONLY) 113.00 40173568 YEAST ID PANEL A (CHG ONLY) 79.00 40173569 ID PCR COCCIDIOIDES (CHG ONLY) 141.00 40173570 ID HISTO/BLASTO PCR (CHG ONLY) 168.00 40173571 YEAST ID PANEL B (CHG ONLY) 90.00 40173572 ID MALDI-TOF FUNGI (CHG ONLY) 113.00 40173573 YEAST ID PANEL D (CHG ONLY) 60.00 40173574 ID MALDI-TOF YEAST(CHG ONLY) 141.00 40173576 IGF-1 142.00 40173577 IGFBP-3 134.00 40173578 SOLUBLE LIVER AG AUTOAB 224.00 40173579 CA 125 (VVH) 347.00 40173580 COFFEE GREEN BEAN IgG 45.00 40173581 COFFEE IgE 45.00 40173582 COFFEE GREEN BEAN IgE 45.00 40173583 BCR/ABL p190 1,449.00 40173584 PENICILLIN G IgE 42.00 40173585 PENICILLIN V IgE 45.00 40173586 ASPERGILLUS AG 168.00 40173587 HISTOPLASMA AG UR 253.00 40173588 MVISTA HISTOPLASMA AG U (RFX) 224.00 40173589 HANTAVIRUS IgM 90.00 40173590 HANTAVIRUS IgG 90.00 40173592 THYROXINE BINDING CAPACITY 85.00 40173593 THYROXINE (T4) TOTAL 85.00 40173595 PTH INTACT 271.00 40173596 CALCIUM 51.00 40173597 PROSTATIC ACID PHOS. (PAP) 102.00 40173598 HUNTINGTON DISEASE 440.00 40173599 PEA IgE (allergy testing) 45.00 40173600 PHOSPHORUS 24 HR URINE 97.00 40173602 FOOD 1 42.00 40173604 CATHARTIC LAXATIVE PANEL* 238.00 40173605 MAGNESIUM 119.00 40173606 PHOSPHORUS (INORGANIC) 113.00 40173607 GLUTEN IgG 67.00 40173608 ALS ANALYSIS 1,165.00 40173609 ETHANOL UR 95.00 40173610 GREEN STRING BEAN IgE 64.00 40173611 TCA CONFIRMATION UR 212.00 40173612 ANTIDEPRESSANTS CLASS 3-5 71.00 40173613 TRICYCLIC & CYCLICALS 6/MORE 71.00 40173614 SKELETAL MUSCLE RELAXANT1/2 71.00 40173615 PEAR 45.00 40173616 PROCALCITONIN 214.00 40173617 CYP2D6 GENOTYPE 791.00 40173618 LACOSAMIDE (VIMPAT) 216.00 40173619 EPSTEIN-BARR VIRUS PCR BLD 313.00 40173620 FEBRILE AGGLUTININS (BRUCELLA) 364.00 40173621 BK VIRUS DNA by PCR 246.00 40173623 TOXOPLASMA IgM 119.00 40173624 CMV IgM 119.00 40173625 HSV IgM 119.00 40173627 TOXOPLASMA IgG 36.00 40173628 RUBELLA IgG 36.00 40173629 CMV IgG 36.00 40173630 HSV TYPE 1 IgG 36.00 40173631 HSV TYPE 2 IgG 36.00 40173632 METHADONE CONFIRMATIONU 107.00 40173633 APT TEST 171.00 40173635 GLUTEN IgE 44.00 40173636 STRONGYLOIDES AB IgG 141.00 40173637 CHROMOSOMES CONGENITAL BLD 447.00 40173638 THIOPURINE METHYLTRANSFERASE 319.00 40173639 PGD2 24 HR UR 569.00 40173640 HISTAMINE PLASMA 222.00 40173641 HISTAMINE WHOLE BLOOD 202.00 40173642 NUTS ALLERGEN PANEL 81.00 40173650 ASO TITER 133.00 40173652 CA 125 425.00 40173653 HE4 440.00 40173657 PGD2 388.00 40173659 CYP2C9 GENE 669.00 40173660 VKORC1 GENE 251.00 40173661 URTICARIA (CU) INDEX PANEL 425.00 40173662 ANTI-THROID PEROXIDASE IgG 57.00 40173663 ANTI-THYROGLOBULIN IgG 57.00 40173664 TSH (THYROTROPIN) 57.00 40173665 CU INDEX 266.00 40173666 ID MALDI-TOF MS AFB (CHG) 97.00 40173667 CULTURE 01 (CHG ONLY) 140.00 40173668 METAPHASES 15-19 (chg only) 140.00 40173669 CA 19-9 PERITONEAL FLD 186.00 40173670 URIC ACID BODY FLD -SYNOVIAL 97.00 40173671 GLUCOSE BODY FLD -SYNOVIAL 97.00 40173672 T PROTEIN BODY FLD -SYNOVIAL 97.00 40173673 SUSCEPTIBILITY YEAST PANEL 123.00 40173674 ID BY MALD-TOF MASS SPEC CHG 52.00 40173675 SUSCEPTIBILITY AEROBIC CHG 24.00 40173676 H.PYLORI C&S 86.00 40173677 BACTERIA ID CHG 60.00 40173678 TISSUE PROCESSING CHG 24.00 40173679 SUSCEPTIBILITY 47.00 40173680 CYSTIC FIBROSIS PANEL 220.00 40173682 CFTR GENE DUP/DELET VARIANTS 1,449.00 40173683 CFTR GENE FULL SEQUENCE 1,449.00 40173684 SMA EVAL 797.00 40173685 ADALIMUMAB QN W/REFLEX TO AB 524.00 40173687 ANTI-ADALIMUMAB AB (reflex) 266.00 40173688 ACETYLCHOLINESTERASE RBC 74.00 40173689 HYPEROXALURIA PANEL 24UR 168.00 40173690 ARIXTRA (FONDAPARINUX) 207.00 40173691 HOMOCYSTINE TOT-CARDIO SERUM 86.00 40173692 HCV RNA NS3 DRUG RESISTANCE 1,167.00 40173693 HCV RNA NS5a DRUG RESISTANCE 949.00 40173695 FLOW CYTOMETRY (PNH) 185.00 40173696 FLOW CYTOMETRY (PNH) 185.00 40173700 CHLAMYDIA TRACHAMATIS MISC 130.00 40173701 NEISSERIA GONORRHOEA MISC 130.00 40173705 23BPGURINE 198.00 40173710 COLOVANTAGE 585.00 40173713 MOPATH PROCEDURE LEV 4 823.00 40173714 MOPATH PROCEDURE LEV 6 823.00 40173715 HV-6 AB IgGIgM 192.00 40173716 HHV-7 DNA QN PCR 558.00 40173717 HV-7 AB IgGIgM 531.00 40173720 TRICHOMONAS VAGINALIS RNA 313.00 40173725 SULFONYLUREA SCREENUR 391.00 40173730 METFORMIN 280.00 40173735 URINE POTASSIUM 24 HOUR 135.00 40173740 NMDA-R AB. CBA 160.00 40173741 NEURONAL (V-G) K+CHANNEL AB 152.00 40173742 GAD65 AB ASSAY 152.00 40173743 GABA-B-R AB 152.00 40173744 AMPA-RB. CBA 152.00 40173745 ANTI-NEURONAL NUCLEAR ABTYPE1 152.00 40173746 ANTI-NEURONAL NUCLEAR ABTYPE2 152.00 40173747 ANTI-NEURONAL NUCLEAR ABTYPE3 152.00 40173748 ANTI-GLIAL NUCLEAR AB TYPE 1 152.00 40173749 PCA AB TYPE 2 152.00 40173750 PCA AB TYPE TR 152.00 40173751 AMPHIPHYSIN 152.00 40173752 N-TYPE CALCIUM CHANNEL AB 160.00 40173753 P/Q-TYPE CALCIUM CHANNEL AB 160.00 40173754 ACh RECEPTOR (MUSCLE) BIND. AB 160.00 40173755 AChR GANGLIONIC NEURONAL AB 160.00 40173756 CRMP-5-IgG 152.00 40173760 NT PRO BNP 206.00 40173765 ZIKA VIRUS RT-PCRS 490.00 40173766 FLOW C CELL SUR ADD(chg only) 24.00 40173767 FLOW CYTO2-8 MKERS (chg only) 57.00 40173768 FLOW CCELL SUR 1st (chg only) 57.00 40173770 C1 ESTERASE INHIBFUNCTIONAL 134.00 40173775 LEUKOTRIENE E4UR 367.00 40173778 AMINOLEVULINIC ACID R UR 174.00 40173780 BIOTINIDASESER 124.00 40173782 HEXOSAMINIDASE TOTAL & A 130.00 40173783 HEXOSAMINIDASE TOTAL 66.00 40173784 HEXOSAMINIDASE % A 66.00 40173786 TISSUE (DIR IMM STUDY) 139.00 40173787 INTERP (IMMFLU AB ADD ST) 133.00 40173790 HSV PCR CSF 140.00 40173792 ANAEROBIC ID(MAYO) 91.00 40173794 MACROPROLACTIN 163.00 40173798 STREP PNEUMO AG UR 118.00 40173800 RAJI CELL IMMUNE COMPLEX 682.00 40173801 CIRCULATING IMMUNE COMPLEXES 228.00 40173802 OXYCODONE SERUM 191.00 40173803 MORPHINE 244.00 40173804 CYP2C19 GENOTYPE 1,245.00 40173810 LYSOZYME 163.00 40173811 NMOFS 361.00 40173812 NMOTS (REFLEX) 93.00 40173815 HEROIN (CHG ONLY) 258.00 40173816 FLOW CYTOM. INT 9-15 MK CHG 163.00 40173817 ID MALDI-TOF ANAER (CHG ONLY) 50.00 40173818 FLOW CYTOM. INT 9-15 MK CHG 773.00 40173819 BETA LACTAMASE (CHG ONLY) 33.00 40173820 ANAEROBE ID-SEQUENCING CHG 140.00 40173825 ASPERGILLUS FUMIGATUS IgE 42.00 40173826 MG EVAL ADULT 325.00 40173827 AChRECEPTOR (MUS) BINDING AB 112.00 40173828 AChRECEPTOR (MUS) MODUAL AB 112.00 40173829 STRIATIONAL (STRIAT MUSCLE)AB 112.00 40173831 STACHYBOTRYS CHART IgE 73.00 40173832 STACHYBOTRYS CHART IgG 77.00 40173833 STACHYBOTRYS PANEL IgA 176.00 40173835 PTH 98.00 40173836 CALCIUM 71.00 40173837 PHOPHORUS (INORGANIC) 71.00 40173838 CREATININE 67.00 40173840 XARELTO (CHG ONLY) 244.00 40173845 HLA-B 5701 GENOTYPE 920.00 40173850 PLATELET NEUTRALIZATION 93.00 40173855 STOOL CULTURE (MAYO) 78.00 40173860 AEROBE ID BY SEQUENCING 140.00 40173861 ADDITIONAL ID PROCEDURE 60.00 40173862 SEROLOGIC AGGLU 1 ID 39.00 40173863 SEROLOGIC AGGLU 3 ID 39.00 40173864 KPC & NDM PCR 505.00 40173865 CARBAPENAMASE-MODIFIED HODG 181.00 40173866 CARBAPENAMASE-CARBA NP TEST 217.00 40173870 RIBOSOME P AB IgG 86.00 40173876 IMMUNOASSAY NON-AB 181.00 40173877 NUCLEAR AG AB 181.00 40173878 IMMUNOASSAY QUANT NON-AB 181.00 40173881 EXTRACTABLE NUCLEAR AG 145.00 40173882 IMMUNASSAY FOR ANANLYTE MULT 351.00 40173886 IMMUNOGLOBULIN E 33.00 40173887 COCKROACH IgE(ALLERGIN) 309.00 40173890 PARVOVIRUS B19 PCR 232.00 40173891 CRYPTOCICCUS AG SCR 82.00 40173892 COCCIDIODES AB SCR 82.00 40173893 HISTOPLASMA AB 115.00 40173895 POULTRY & MEAT PANEL 208.00 40173898 GRANULOCYTE ANTIBODIES 185.00 40173899 FLUNITRAZEPAN (ROOFIE) 257.00 40173905 INFLIXIMAB QN W/ REFLEX 361.00 40173906 INFLIXIMAB AB (REFLEX) 175.00 40173910 ACYLCARNITINES QN 136.00 40173915 SPECIAL COAG INTERPRETATION 45.00 40173916 RSV ANTIBODIES IgG IgM 125.00 40173917 CREATINE (CHG ONLY) 45.00 40173918 CREATININE (CHG ONLY) 45.00 40173919 GUANIDINOACTATE(CHG ONLY) 143.00 40173920 AMINO ACIDS QN URINE 423.00 40173921 NE REGIONAL ALLERGY PANEL 206.00 40173923 FLOW CYTOMETRY/TC 1 MARKER 212.00 40173924 FLOW CYTOMETRY/TC ADD-ON 201.00 40173925 CHROMOSOMAL MICROARRAY HEM 5,047.00 40173926 TICK -BORNE AB PANEL 268.00 40173927 E. CHAFFEENSIS IgG 71.00 40173928 A.PHAGOCYTOPHILUM IgG 71.00 40173929 B.MICROTI IgG 71.00 40173930 LYME DISEASE SEROLOGY IgG 71.00 40173931 BK VIRUS PCR QUANT URINE 309.00 40173935 FRAG. X F/U ANALYSIS 268.00 40173940 ZIKA VIRUS IgM 387.00 40173941 ZIKA VIRUS IgM (PRENATAL) 387.00 40173942 ZIKA VIRUS PCR UR 490.00 40173945 FATTY ACID COMPEHENSIVE 289.00 40173951 C.TRICH MISC 66.00 40173952 N. GONORRHOEA MISC 66.00 40173955 PORPHYRINS TOTAL 155.00 40173956 PORPHYRINS FRAC 141.00 40173960 CELL-FREE DNA PRENATAL SCR 2,651.00 40173962 HEP C HI RESOLU GENOTYPE (CHG) 693.00 40173965 URIC ACID RANDOM UR 78.00 40173968 OSTEOCALCIN 407.00 40173969 PROCOLLAGEN I INTACT N-TERMINA 515.00 40173970 N-METHYLHISTAMINE 24 HR UR 125.00 40173972 BORON 168.00 40173975 CHYMOTRYPSINSTOOL 268.00 40173976 TRYPSIN SERUM (CHG ONLY) 184.00 40173980 ANA AB HEp-2 SUNSTRATE 50.00 40173985 TPMT3CO (CHG ONLY) 407.00 40173986 TBTCO (CHG ONLY) 63.00 40173987 FACTIN AB IGG 289.00 40173995 ZnT8 AB 98.00 40173998 FISH/SHELLFISH PANEL 321.00 40174000 MUMPS VIRUS RNA QUAL PCR 666.00 40174005 N-METHYLHISTAMINE 24 HR UR 131.00 40174008 COCOA IgG 45.00 40174011 IMMUNOGLOBULIN E 33.00 40174012 MUGWORTIgE 340.00 40174015 MUMPS AB IgM BY IFA 132.00 40174018 LIVER CYTOSOL (CHG ONLY) 176.00 40174020 HYPOGLYCEMIC AGENT SCREEN 227.00 40174022 DRVVT W/REFLEX 58.00 40174025 CHEMILUMINESCENT (CHG) 93.00 40174026 IMMUNOASSAY QN NOS NONAB(CHG) 291.00 40174027 CRP (CHG ONLY) 18.00 40174028 UNLISTED MOLECULAR PATH (CHG) 4.00 40174029 IMMUNOFLUOR AB 1ST STAIN(CHG) 208.00 40174030 IMMUNOFLUOR AB ADD STAIN(CHG) 162.00 40174035 PEANUT COMPONENTS(REFLEX) 284.00 40174036 C3a LEVEL 289.00 40174037 C4a LEVEL 289.00 40174038 ALMOND IgE 42.00 40174040 TBPBCO (CHG ONLY) 79.00 40174045 SHIGA TOXIN PCRFECAL 876.00 40174046 MOLD 1 PANEL 42.00 40174048 CULTURE 01 (CHRCB) 477.00 40174049 CYTO/MOLECULAR REPORT(CHRCB) 93.00 40174050 STINGING INSECT ALLERGY PANEL 103.00 40174051 ASPERGILLUS PRECIP. ID 237.00 40174052 TROPONIN T 142.00 40174053 CHIKUNGUNYA IgG IgM PANEL 458.00 40174055 TOTAL CHOLESTEROL CDC 18.00 40174056 TOTAL TRIGLYCERIDES CDC 18.00 40174057 APOLIPOPROTEIN B 78.00 40174058 HDL CHOLESTEROL CDC 32.00 40174059 LIPOPROTEIN METABOLISM PROF 1 42.00 40174060 LEFLUNOMIDE(TERIFLUNIDE) 209.00 40174061 UREAPLASMA SPECIES PCR BLD 225.00 40174063 MOPATH PROC. LEV 2 429.00 40174064 UNLISTED MOPATH 390.00 40174065 B.PERTUSSIS AB IgG 225.00 40174067 THYROPEROXIDASE AB 105.00 40174068 THYROGLOBULIN AB 105.00 40174069 PROMETHEUS IBD sgi DIAGNOSTIC* 777.00 40174070 IMMUNOFLOR AB 1ST STAIN 198.00 40174071 IMMUNOFLO AB ADDL. STAIN 158.00 40174072 CHEMILUMENESCENT ASSAY (CHG) 80.00 40174073 IMMUNOASSAY QN NOS NONAB (CHG) 255.00 40174074 C-REACTIVE PROTEIN (CHG) 77.00 40174075 UNLISTED MOLECULAR PATH (CHG) 6.00 40174077 TRG GENE REARRANGE ANAL 330.00 40174078 TRB@GENE REARRANGE AMPLIFY 315.00 40174079 MYCOBACT ID BY SEQ. (CHG ONLY) 203.00 40174080 AFB SENSITIVITY (CHG ONLY) 90.00 40174081 THYROGLOBULIN REFLEX TO MS 88.00 40174082 THYROGLOBULIN TM IA 88.00 40174083 THYROGLOBULIN MASS SPEC. 265.00 40174084 HTLVL CONFIRMATION 331.00 40174085 APPLE IgE 42.00 40174086 BP 180 230 IgG ANTIBODIES 250.00 40174087 DRUG SCREEN MAYO(9) 315.00 40174088 FBN1B FULL GENE SEQUENCE 2,070.00 40174089 dsDNA AB BY CRITHDIA- RFLX 200.00 40174090 DESMOGLEIN 1&3 116.00 40174091 CHOLESTEROL BODY FLD 225.00 40174092 TRIGLYCERIDES BODY FLD 85.00 40174093 LDH BODY FLD 120.00 40174094 ALBUMIN BODY FLD 75.00 40174095 ETHYL GLUCURIDE SCREEN UR 175.00 40174096 ANTI-IgE 240.00 40174097 PML/RARA QUANTPCR 998.00 40174098 ECHINCOCCUS AB IgG 125.00 40174099 BIRD FANCIER'SPRECIPITIN (CHG) 295.00 40174169 GENE PMS2_MLPA (CHG ONLY) 499.00 40174170 GADOLINIUM 24 HR UR 250.00 40174201 SERUM BANDS 67.00 40174202 CSF BANDS 67.00 40174203 FOOD 3 PANEL (ALLERGY TESTING) 64.00 40174204 VORICONAZOLE 210.00 40174205 POSACONAZOLE 210.00 40174206 BERMUDA GRASS IgE 45.00 40174207 WORMWOOD IgE 45.00 40174208 MOUNTAIN CEDAR IgE 45.00 40174209 GIARDIA LAMBLIA ABS (IgG/A/M) 189.00 40174210 FRATAXIN QN WB 815.00 40174212 EOSINOPHILS URINE 195.00 40174215 POLIOVIRUS 1&3 AB. 420.00 40174218 BKV PCRQUANT PLASMA 259.00 40174220 RYE, IgE (ALLERGEN) 45.00 40174224 NICKEL, SERUM 179.00 40174226 PLATINUM, SERUM 485.00 40180010 ABSCESS CULTURE 163.00 40180015 AEROBIC ORGANISM IDENT 334.00 40180035 BLOOD CULTURE BOTTLE SYS 231.00 40180040 BLOOD CULTURE FUNGAL 167.00 40180045 BODY FLUID CULTURE 167.00 40180050 C.DIFFICLE ANTIGEN & TOXIN A/B 157.00 40180060 CATHETER TIP CULTURE 167.00 40180065 CSF BACTERIAL CULTURE 167.00 40180070 CULTURE MISC 167.00 40180075 CYSTIC RESPIRATORY CULTURE 167.00 40180080 EAR CULTURE 167.00 40180085 EYE CULTURE 167.00 40180090 FECAL LEUKOCYTE COUNT 67.00 40180095 FECAL OCCBLD CONSECUTIVE SAMP 53.00 40180098 iFOB 140.00 40180100 FUNGAL CULTURE 167.00 40180105 GRAM STAIN 74.00 40180110 INDIA INK EXAM 78.00 40180115 INFLUENZA A/B ANTIGEN DETECT 130.00 40180120 KOH PREP 76.00 40180123 MRSA SCREEN 167.00 40180125 MIC/MBC 301.00 40180135 GASTRIC OCCULT BLOOD 54.00 40180145 RAPID STREP - GROUP A 116.00 40180155 ROTAVIRUS ANTIGEN 142.00 40180160 SINUS CULTURE 167.00 40180165 SKIN CULTURE 167.00 40180170 SPUTUM CULTURE 167.00 40180185 STOOL CULTURE 186.00 40180190 STREP CULT GRP B GENITAL 167.00 40180205 THROAT CULTURE 167.00 40180210 TRACHEAL ASPIRATE CULTURE 167.00 40180215 URINE CULTURE 167.00 40180220 GENITAL CULTURE 167.00 40180225 WET PREP 74.00 40180230 WOUND CULTURE 167.00 40180235 YEAST CULTURE 167.00 40180240 YEAST IDENTIFICATION 130.00 40180242 INFLUENZA A H1 (RP) 736.00 40180243 BORDETELLA PERTUSSIS (RP) 63.00 40180244 CHLAMYDOPHILA PNEUMONIAE (RP) 63.00 40180245 MYCOPLASMA PNEUMONIAE (RP) 63.00 40180246 GI PANEL 465.00 40180251 ECOLI K1 (BACTERIA GP) 544.00 40180252 STREP. AGALACTIAE 75.00 40180253 CMV 75.00 40180254 ENTEROVIRUS 75.00 40180255 HHV-6 71.00 40180256 HSV 150.00 40180260 CLOTEST 58.00 40200010 DIG MAM/SCRN 3D TOMOSNYTHESIS 61.00 40200011 DIG MAM/SCRN UNI 3D TOMOSYNTH 61.00 40200020 DIG MAM/DIAGNOSTIC TOMO ONLY 61.00 40200021 DIG MAM/DIAG UNI LT 3D TOMO 61.00 40200022 DIG MAM/DIAG UNI RT 3D TOMO 61.00 40200040 DIG MAM/ADD'L VIEWS BILAT 523.00 40200041 DIG MAM/ADD'L VIEWS UNI LT 422.00 40200042 DIG MAM/ADD'L VIEWS UNI RT 422.00 40200050 DIG MAM/ADD'L VWS BL TOMO ONLY 61.00 40200051 DIG MAM/ADD'L VWS LT TOMO ONLY 61.00 40200052 DIG MAM/ADD'L VWS RT TOMO ONLY 61.00 40200060 STEREO/VAC/SPEC/CLIP EA ADDL 2,216.00 40201060 STEREO/VAC/SPEC/CLIP PROCEDURE 4,423.00 40232555 US GUIDED THORACENTESIS 666.00 40249083 US FOR ABD PARACENTESIS 666.00 40250010 INFUSE RADIOACTIVE MATERIALS 269.00 40250045 MUGA WITH RV EF 995.00 40250105 CARDIAC REST/STRESS SINGLE 2,591.00 40250110 HT MUSCLE IMAGE SPECT MULT 3,975.00 40250130 SENTINEL NODE IDENTIFICATION 570.00 40250155 THYROID UPTAKE 1,657.00 40250160 THYROID IMAGING; ONLY 1,648.00 40250180 THYROID METS; WHOLE BODY 1,848.00 40250290 LIVER VASCULAR SPECT 2,019.00 40250299 LIVER/SPLEEN STATICS 1,763.00 40250300 LIVER/SPLEEN FLOW 2,019.00 40250305 LIVER FUNCTION W HB AGENT 2,034.00 40250310 HIDA WITHOUT GBEF 2,115.00 40250330 ESOPHAGEAL MOTILITY 1,224.00 40250340 GASTRIC REFLUX 1,224.00 40250345 GASTRIC EMPTYING 1,839.00 40250370 ACUTE GI BLEED STUDY 1,875.00 40250380 MECKELS DIVERT EXAM 1,224.00 40250405 TOTAL BODY BONE SCAN 1,952.00 40250410 BONE SCAN 3 PHASE 2,110.00 40250415 BONE SPECT 1,580.00 40250440 VENOGRAM UNILATERAL LEG 829.00 40250445 VENOGRAM BILATERAL LEGS 1,166.00 40250465 MUGA; SGL W WM & EF 2,331.00 40250500 PARATHYROID NUCLEAR IMAGING 1,712.00 40250505 TUMOR LOC WB WITH SPECT 2 DAY 3,962.00 40251001 NM THYROID SCAN AND UPTAKE 3,223.00 40251015 TC99M SULFUR COLL UP TO 20 MCI 319.00 40251380 TCM99M SESTAMIBI 749.00 40251385 TC99M LABELED RBC UP TO 30 MCI 675.00 40251395 TC99M MAA UP TO 10 MCI 437.00 40251405 TC99M PENTETATE 201.00 40251410 TC99M PERTECHNETATE 177.00 40251411 TC99M PERTECHNETATE - STAT 345.00 40251420 URETER REFLUX STUDY 1,094.00 40251425 BLADDER RETENTION 244.00 40251430 KIDNEY IMAGING WITH FLOW 1,094.00 40251435 TC99M MERTIATIDE UP TO 15 MCI 777.00 40251440 K FLOW/FUNCT IMAGE W/DRUG 1,915.00 40251450 TC99M MEBROFENIN UP TO 15 mci 290.00 40251455 TC99M MEDRONATE UP TO 30mci 257.00 40251460 BRAIN FLOW 1,887.00 40251470 TESTICULAR FLOW 1,887.00 40251475 TUMOR LOCALIZ; SPECT 1,778.00 40251480 IODINE I-123 SOD IODIDE MIC 527.00 40251485 IODINE I-131 IODIDE CAP DX 332.00 40251490 GALLIUM 67 PER 1 MCI 71.00 40251500 I131 IODIDE CAP RX 332.00 40251535 INDIUM IN-111 PENTETREOTIDE 4,027.00 40251540 TL201 THALLIUM PER 1 MCI 279.00 40251560 I-123 SOD IOD PER 1 MCI 360.00 40251600 MAG-3 775.00 40258300 LIMITED BONE SCAN 1,866.00 40301000 CT ABD/PEL WITHOUT CONTRAST 2,563.00 40301001 CT AB/PEL W/WITHOUT CONTRAST 4,011.00 40301002 CT ABD/PEL WITH CONTRAST 3,454.00 40359103 MRI VACUUM ASSISTED BIOPSY 1ST 2,808.00 40401010 OH - CHEST 1 VIEW 153.00 40401011 OH - CHEST 1 VIEW INTERP 57.00 40401020 OH - CHEST 2 VIEWS 161.00 40401021 OH - CHEST 2 VIEWS INTERP 76.00 40402100 OH-LUMBAR SPINE 2-3 VIEWS 431.00 40402101 OH-LUMBAR SPINE 2-3 V INTERP 76.00 40402110 OH-LUMBAR SPINE MINI 4 VIEWS 661.00 40402111 OH-LUMBAR SPINE MINI 4V INTERP 98.00 40405000 AP ABDOMEN 1 VIEW 384.00 40405001 COMPLETE ABDOMEN 427.00 40405002 COMPL ACUTE ABDOMEN 574.00 40405003 RAD-FOR.BODY EXAM NOSE TO RECT 128.00 40405004 ACJ BILATERAL W/WO WEIGHTS 397.00 40405005 ANKLE LEFT COMP MINI 3 VIEWS 316.00 40405006 ANKLE LEFT 2 VIEWS 278.00 40405007 ANKLE RIGHT COMP MINI 3 VIEWS 316.00 40405008 ANKLE RIGHT 2 VIEWS 278.00 40405009 BONE LENGTH STUDIES 367.00 40405010 BONE AGE STUDIES 273.00 40405011 BONE SURVEY METS COMPLETE 1,425.00 40405012 BONE SURVEY METAS LTD 1,285.00 40405013 X-RAY EXAM OF HEEL LT MIN 2 VW 256.00 40405014 X-RAY EXAM OF HEEL RT MIN 2 VW 256.00 40405015 OH - CHEST 2 VIEWS 161.00 40405016 OH - CHEST 1 VIEW 153.00 40405017 CLAVICLE COMPLETE LT 384.00 40405018 OH-LUMBAR SPINE 2-3 VIEWS 574.00 40405019 OH-LUMBAR SPINE MINI 4 VIEWS 661.00 40405020 CLAVICLE COMPLETE RT 384.00 40405021 CERVICAL SPINE COMP W/EX & FLX 750.00 40405022 CERVICAL SPINE 2-3 VIEWS 432.00 40405023 CERVICAL SPINE MINI 4 VIEW 575.00 40405024 CHEST-APICAL 435.00 40405025 CHESTMULTI FLM COMPMINI 4VIEW 706.00 40405026 CHEST-OBLIQUE VIEW 574.00 40405027 OH - CHEST 2 VIEWS 161.00 40405028 CHEST SINGLE VIEW 194.00 40405031 ELBOW RIGHT 2 VIEW 270.00 40405032 ELBOW RIGHT COMP MINI 3 VW 303.00 40405033 FACIAL BONESCOMP MINI 3VIEWS 527.00 40405034 FACIAL BONES <2 VIEWS 392.00 40405035 X-RAY EXAM OF THIGH LT 382.00 40405036 X-RAY EXAM OF THIGH RT 382.00 40405037 X-RAY EXAM OF FINGER(S) LT 226.00 40405038 X-RAY EXAM OF FINGER(S) RT 258.00 40405039 X-RAY EXAM OF FOREARM LT 303.00 40405040 FOREARM RIGHT 303.00 40405041 FOOT LEFT COMP MINI 3 VIEWS 303.00 40405042 FOOT 2 V LT 278.00 40405043 FOOT RT COMP MINI 3 VIEWS 303.00 40405044 FOOT 2 V RIGHT 278.00 40405045 X-RAY EXAM OF PELVIS&HIPS 3-4V 444.00 40405046 HAND LT MINI 3 VIEWS 303.00 40405047 HAND LEFT 2 VIEWS 273.00 40405048 HAND RIGHT MINI 3 VIEWS 303.00 40405049 HAND RT 2 VIEWS 273.00 40405050 HIP LEFT COMPLETE MINI 2V 415.00 40405051 HIP LEFT 1 VIEW 299.00 40405052 HIP LEFT DURING OR PROCEDURE 798.00 40405053 HIP RIGHT COMPL MINI 2V 415.00 40405054 HIP RIGHT 1 VIEW 299.00 40405055 X-RAY EXAM OF HUMERUS LT 341.00 40405056 X-RAY EXAM OF HUMERUS RT 341.00 40405057 KNEE LEFT 3 VIEWS 367.00 40405058 KNEE LEFT COMP MINI 4 VIEWS 494.00 40405059 KNEE LEFT 1 - 2 VIEWS 299.00 40405060 KNEE RIGHT 1-2 VIEWS 299.00 40405061 KNEE RIGHT 3 VIEWS 367.00 40405062 KNEE RIGHT COMP MINI 4 VIEWS 494.00 40405063 KNEE; BOTH KNEES STANDING AP 240.00 40405064 LOWER LEG LT INF.MINI 2 VIE 411.00 40405065 LOWER LEG RIGHTINF.MINI 2 VIE 299.00 40405066 LUMBAR SPINE 2-3 VIEWS 431.00 40405068 LUMBAR SPINE-COMPL MINI 4V 569.00 40405069 LS SPINE COMPL W BENDING VWS 643.00 40405070 JAW MINI 4 VIEWS 540.00 40405071 JAW< 4 VIEWS 540.00 40405072 MASTOIDS < 3 VIEWS 392.00 40405073 MASTOIDSCOMP MINI 3 VIEWS 561.00 40405074 NECK SOFT TISSUE 384.00 40405075 NASAL BONES COMP MINI 3 VIEWS 384.00 40405076 ORBITS COMP MINI 4 VIEWS 367.00 40405077 PELVIS 1-2 VIEWS 399.00 40405078 RIBS-BILAT 3 VIEWS 583.00 40405079 RIBSBILAT W/PA CHST MINI 4VIE 624.00 40405080 RIBS-UNILATERAL 2 VIEW 444.00 40405081 RIBSUNILAT W/CHEST PA/LAT 3VI 574.00 40405082 SACRUM AND COCCYX MINI 2 VIEWS 384.00 40405083 SACROILLIAC JOINTS < 3 VIEWS 400.00 40405084 SCAPULA COMPLETE LT 400.00 40405085 SCAPULA COMPLETE RT 400.00 40405086 STERNOCLAVICULAR JNT COMP 3 VI 397.00 40405087 SCOLIOSIS STUDY 585.00 40405088 SHOULDER LEFT 2+ VIEWS 384.00 40405089 SHOULDER LEFT 1 VIEW 256.00 40405090 SHOULDER RIGHT 2+ VIEWS 384.00 40405091 SHOULDER RIGHT 1 VIEW 256.00 40405092 SINUSES PARANASAL COMP MINI 384.00 40405093 SINGLE VIEW SINUS 218.00 40405094 SKULLCOMP MINI 4V W/WO STEREO 682.00 40405095 X-RAY EXAM OF SKULL 370.00 40405096 SGL VW SPINE XR 303.00 40405097 SPINE ENTIRE 1,243.00 40405098 STERNUM MINI 2 VIEWS 384.00 40405099 TIBIA AND FIBULA LT 411.00 40405100 TIBIA AND FIBULA RIGHT 411.00 40405101 TMJ BILATERAL OP/CLOS MOUTH 472.00 40405102 TMJ'S UNILATERAL OP/CLOS MOUTH 450.00 40405103 X-RAY EXAM OF TOE(S) LT 303.00 40405104 X-RAY EXAM OF TOE(S) RT 303.00 40405105 THORACIC SPINE 2 VIEWS 542.00 40405106 THORACIC SPINE 558.00 40405107 FULL ARM INFANT LEFT 2 VIEWS 276.00 40405108 FULL ARM INFANT RIGHT 2 VIEWS 276.00 40405109 WRIST LEFT 2 VIEWS 256.00 40405110 WRIST RIGHT 2 VIEWS 256.00 40405111 WRIST LEFT COMP MINI 3 VIEWS 303.00 40405112 WRIST RIGHT COMP MINI 3 VIEWS 303.00 40405300 DEXA >1 SITE AXIAL SKELETON 357.00 40455400 U/S ABDOMEN COMPLETE 822.00 40455401 U/S ABDOMEN LIMITED 666.00 40455402 U/S AAA SCREEN 290.00 40455403 DUPLEX LE ART/BPG UNIL/LIM LT 1,208.00 40455404 DUPLEX LE ART/BPG UNIL/LIM RT 1,208.00 40455405 DUPLEX UE ART/BPG UNIL/LIM LT 665.00 40455406 DUPLEX UE ART/BPG UNIL/LIM RT 665.00 40455407 U/S BIOPHYSICAL PROFILE 742.00 40455408 US EXAM ABDO BACK WALL LIM 666.00 40455409 US EXAM BREAST(S) LT 500.00 40455410 US EXAM BREAST(S) RT 500.00 40455411 CAROTID DOPPLER-BILATERAL 1,296.00 40455412 US EXAM CHEST 837.00 40455413 US GUIDED NEEDLE PLACEMENT 666.00 40455414 EXTREMITIES NON-VASCULAR 527.00 40455415 U/S NEEDLE BIOPSY GD 757.00 40455416 U/S HEAD AND NECK 807.00 40455417 U/S OB <14 WEEKS 1ST TRIMESTER 615.00 40455418 U/S OB >14 WEEKS 998.00 40455419 U/S OB FOLLOW-UP 266.00 40455420 OB US LIMITED FETUS(S) 540.00 40455422 U/S PELVIS COMPLETE 513.00 40455423 U/S PELVIS LIMITED 429.00 40455424 U/S PERICARDIOCENTES 1,036.00 40455425 US RENAL W/DOPPLER 1,296.00 40455426 US RENAL 704.00 40455427 US SCROTUM AND CONTENTS 675.00 40455428 US THYROID 639.00 40455429 NON-OB TRANSVAG US 541.00 40455430 DUPLEX EXT VEINS; BILAT 1,314.00 40455431 US VENOUS BILATERAL EXTREMITIE 1,314.00 40455432 DUPLEX EXT VEINS UNIL/LIM LT 789.00 40455433 DUPLEX EXT VEINS UNIL/LIM RT 789.00 40455434 DUPLEX EXT VEINS UNIL/LIM LT 789.00 40455435 DUPLEX EXT VEINS UNIL/LIM RT 829.00 40601006 SMOKING CESSATION 3-10 MIN 44.00 40601007 SMOKING CESSATION >10 MIN 70.00 40601009 SPHB 38.00 40608738 SPCO 79.00 40801000 ANESTHESIA LEVEL 1 PER MIN 18.00 40802000 ANESTHESIA LEVEL 2 PER MIN 20.00 40803000 ANESTHESIA LEVEL 3 PER MIN 27.00 40804000 U/S GUIDANCE NERVE BLOCK 624.00 40900901 BIOFEEDBACK 164.00 40904550 TENS INSTRUCTION 76.00 40905831 EXTREMITY MUSCLE TESTING 122.00 40905832 HAND MUSCLE TESTING 102.00 40905851 ROM MEASURE 88.00 40905852 ROM MEASURE-HAND 65.00 40906115 E-STIMULATION/ATTENDED/15MIN 103.00 40907002 PT RE-EVAL 159.00 40907010 HOT/COLD PACK 24.00 40907013 TRACTION-MECHANICAL 66.00 40907016 VASOPNEUMATIC DEVICE 62.00 40907018 PARAFFIN BATH 38.00 40907022 WHIRLPOOL 111.00 40907026 INFRARED THERAPY 56.00 40907033 IONTOPHORESIS EA 15 103.00 40907034 CONTRAST BATH EA 15 MIN 62.00 40907035 ULTRASOUND EA 15 MIN 59.00 40907110 THERAPEUTIC EXERCISE EA 15 MIN 115.00 40907112 NEUROMUSCULAR RE-EDU EA 15 MIN 117.00 40907116 GAIT TRAINING EA 15 MIN 101.00 40907124 MASSAGE EA 15 MIN 97.00 40907139 COMPRESSION GARMENT FITTING 84.00 40907150 GROUP THERAPY 84.00 40907161 PT EVAL - LOW COMPLEX 291.00 40907162 PT EVAL - MOD COMPLEX 291.00 40907163 PT EVAL - HIGH COMPLEX 291.00 40907195 AQUATIC THERAPY/EXER EA 15 MIN 134.00 40907504 OTHOTIC FIT/TRAIN EA 15 MIN 92.00 40907520 PROSTHETIC TRAINING 93.00 40907530 THERAPEUTIC ACTIVITY EA 15 MIN 129.00 40907532 COGNITIVE SKILLS DEVELOPMENT 113.00 40907533 SENSORY INTEGRATION 113.00 40907535 SELF-CARE MGMT TRNG EA 15 MIN 116.00 40907537 COMMUNITY/WORK REINT EA 15 MIN 121.00 40907542 WHEELCHAIR MGMT TRNG EA 15 MIN 121.00 40907545 WORK HARD/CONDIT (2 HOURS) 436.00 40907546 WORK HARD/CONDIT ADD-ON (1 HR) 184.00 40907597 WOUND MGMT 20 SQ CM OR LESS 199.00 40907598 WOUND MGMT > 20 SQ CM 251.00 40907602 DEBRIDEMENT/DRESSING 56.00 40907605 NEG PRESSURE WOUND THER <50CM 143.00 40907606 NEG PRESSURE WOUND THER >50CM 230.00 40907610 LOW FREQUENCY NON-THERMAL US 303.00 40907703 CHKOUT OTHOTIC/PROSTHETIC USE 129.00 40907750 PHYSICAL PERF TEST EA 15 MIN 128.00 40907751 FUNC CAPACITY EVAL - EA 15 MIN 113.00 40907755 ASSISTIVE TECHNOLOGY ASSESS 147.00 40907760 ORTHOTICS MGMT TRNG EA 15 MIN 123.00 40907761 PROSTHETIC TRNG EA 15 MIN 121.00 40907762 ORTHOTIC/PROSTHET CK EA 15 MIN 113.00 40907862 MANUAL THERAPY EA 15 MIN 117.00 40908925 OSTEO MANIPULATION 1-2 REGION 123.00 40908926 OSTEO MANIPULATION 3-4 REGION 123.00 40909105 LONG ARM SPLINT 340.00 40909130 FINGER SPLINT-STATIC 161.00 40909131 FINGER SPLINT-DYNAMIC 205.00 40909240 STRAPPING-SHOULDER 249.00 40909260 STRAPPING-ELBOW/WRIST 206.00 40909280 STRAPPING-HAND/FINGER 208.00 40909580 UNNA BOOT APPLICATION 193.00 40909998 PT DISCHARGE 6.00 40917610 LOW FREQUENCY NON-THERMAL US 306.00 40942507 SPEECH THERAPY TREATMENT 264.00 40942508 SPEECH THERAPY GROUP 120.00 40942525 CLINICAL SWALLOW EVALUATION 508.00 40942526 DYSPHAGIA TREATMENT 324.00 40942597 EVAL TO USE/FIT VOICE PROSTH 374.00 40942605 EX FOR NONSPEECH DEVICE RX 502.00 40942606 NON-SPEECH DEVICE TX 224.00 40942607 SPEECH DEVICE EVALUATION-1HR 374.00 40942609 THERAPEUTIC SP DEVICE SERVICE 266.00 40946105 AHPASIA ASSESSMENT 297.00 40946125 COGNITIVE TEST PER HOUR 582.00 40947530 THERAPEUTIC ACTIVITY EA 15 MIN 123.00 40947532 COGNITIVE SKILLS DEVELOPMENT 113.00 40947533 SENSORY INTEGRATION 113.00 40947535 SELF-CARE MGMT TRNG EA 15 MIN 116.00 40947537 COMMUNITY/WORK REINT EA 15 MIN 121.00 40949998 SLP DISCHAGE 4.00 40952597 EVAL TO USE/FIT VOICE PROSTH 374.00 40952605 EX FOR NONSPEECH DEVICE RX 502.00 40952606 NON-SPEECH DEVICE TX 224.00 40952609 THERAPEUTIC SP DEVICE SERVICE 266.00 40956125 COGNITIVE TEST PER HR 596.00 40959998 SLP DISCHAGE 4.00 40963763 EWHO RIGID W/O JNTS CF 1,070.00 40963808 WHFO RIGID W/O JOINTS 578.00 40963906 WHO W/O JOINTS CF 648.00 40963913 HFO W/O JOINTS CF 432.00 40963919 HO W/O JOINTS CF 432.00 40963923 HFO WITHOUT JOINTS PRE CST 237.00 40963933 FO W/O JOINTS CF 340.00 40969998 OT DISCHARGE 4.00 40970901 BIOFEEDBACK 170.00 40972525 OT-CLINICAL SWALLOW EVALUATION 531.00 40972526 OT-DYSPHAGIA TREATMENT 252.00 40972610 SLP-CLNCAL SWALLOW EVALUATION 534.00 40973702 ELB ORTH W/O JNTS CSTM FAB 460.00 40973763 EWHO RIGID W/O JNTS CF 1,070.00 40973806 WHFO CSTM FAB INC FIT/ADJ 724.00 40973808 WHFO RIGID W/O JOINTS 578.00 40973905 WHO INCL NONTORSN JNT CS FAB 1,579.00 40973906 WHO W/O JOINTS CF 648.00 40973913 HFO W/O JOINTS CF 432.00 40973919 HO W/O JOINTS CF 432.00 40973921 HFO INCL NONTORSN JNT CS FAB 512.00 40973923 HFO WITHOUT JOINTS PRE CST 237.00 40973933 FO W/O JOINTS CF 340.00 40973935 FO NONTORSION JOINT CF 353.00 40974550 TENS INSTRUCTION 76.00 40975831 EXTREMITY MUSCLE TESTING 122.00 40975832 HAND MUSCLE TESTING 102.00 40975851 ROM MEASURE 88.00 40975852 ROM MEASURE-HAND 65.00 40977004 OT RE-EVAL 191.00 40977010 HOT/COLD PACK 24.00 40977014 E-STIMULATION/UNATTENDED 86.00 40977016 VASOPNEUMATIC DEVICE 62.00 40977018 PARAFFIN BATH 38.00 40977022 WHIRLPOOL 111.00 40977026 INFRARED 56.00 40977033 IONTPHORESIS EA 15 103.00 40977034 CONTRAST BATH EA 15 MIN 62.00 40977035 ULTRASOUND EA 15 MIN 59.00 40977110 THERAPEUTIC EXERCISE EA 15 MIN 127.00 40977112 NEUROMUSCULAR RE-EDU EA 15 MIN 123.00 40977116 GAIT TRAINING 102.00 40977124 MASSAGE EA 15 MIN 97.00 40977140 MANUAL THERAPY EA 15 MIN 123.00 40977141 MYOFASCIAL RELEASE EA 15 MIN 123.00 40977150 GROUP THERAPY 84.00 40977165 OT EVAL - LOW COMPLEX 311.00 40977166 OT EVAL - MOD COMPLEX 311.00 40977167 OT EVAL - HIGH COMPLEX 327.00 40977530 THERAPEUTIC ACTIVITY EA 15 MIN 129.00 40977532 COGNITIVE SKILLS DEVELOPMENT 113.00 40977533 SENSORY INTEGRATION 113.00 40977535 SELF CARE MGMT TRNG EA 15 MIN 121.00 40977537 COMMUNITY/WORK REINT EA 15MIN 121.00 40977542 WHEELCHAIR MGMT TRNG EA 15 MIN 121.00 40977545 WORK HARD/CONDIT (2 HOURS) 436.00 40977546 WORK HARDENING ADD-ON (1 HR) 184.00 40977550 PHYSICAL PERF TEST EA 15 MIN 102.00 40977612 PRE-EMPLOYMENT SCREENING 49.00 40977750 PHYSICAL PERF TEST EA 15 MIN 121.00 40977755 ASSISTIVE TECHNOLOGY ASSESS 147.00 40977760 ORTH MGT TRN INT ENC EA 15 MIN 130.00 40977761 PROST TRNG INT ENC EA 15 MIN 121.00 40977762 ORTHOTIC/PROSTH CHCKOUT EA 15M 113.00 40977862 MANUAL THERAPY; EA 15 MIN 129.00 40979240 STRAPPING-SHOULDER 249.00 40979260 STAPPING-ELBOW/WRIST 206.00 40979280 STRAPPING-HAND/FINGER 208.00 40979990 OT CONSULTING PER HOUR 70.00 40979998 OT DISCHAGE 6.00 40980002 AUDIOGRAM 33.00 40980005 NURSE VISIT 41.00 40980006 BPHEIGHTWEIGHT ABD CIRCUM 21.00 40980010 POST OFFER/PRE-EMPLOYMENT 205.00 40980015 POST OFFER/PRE-EMPLOY PARTIAL 54.00 40980018 POST OFFER/PREEMP W/UPPER EXT 216.00 40980020 POST OFFER/PRE-EMPLOY HALF 107.00 40980021 POST OFFER/PRE-EMP UPPER QUADR 166.00 40980026 POST OFFER BASIC NONWKSTEPS 144.00 40980027 POST OFFER HALF NONWKSTEPS 79.00 40980040 FIT FOR DUTY/RETURN TO WORK 176.00 40980046 GRIP TESTING 32.00 40980048 ADMINISTRATION FEE 29.00 40980051 MEDICAL PHYSICAL 100.00 40980052 MEDICAL PHYSICAL W/UA 105.00 40980053 MEDICAL PHYSICAL-COMPREHENSIVE 175.00 40980054 DOT PHYSICAL 105.00 40980057 DOT PE 3 MONTH REVIEW 34.00 40980060 PPD 21.00 40980061 INFLUENZA VACCINE 0.5ML 27.00 40980062 TDAP VACCINE >7 IM 74.00 40980063 HEPATITIS B VACCINE 20MCG/ML 104.00 40980065 HEPATITIS A VACCINE >18YRS 115.00 40980066 SQ MMR VACCINE 72.00 40980075 ON SITE SERVICES - 40980102 BENZENE/SILICA QUESTIONAIRE 37.00 40980103 MED QUESTIONNAIRE RESPIRATOR 32.00 40980104 SPIROMETRY 39.00 40980110 RESPIRATOR FIT - QUANTITATIVE 61.00 40980119 INJECTION FEES 18.00 40980199 RAPID DRUG SCREEN-THEIR KIT 23.00 40980200 DRUG SCREEN-DOT-THEIR KIT 21.00 40980201 DRUG SCREEN-OUR KIT-DOT 56.00 40980202 BREATH ALCOHOL-DOT 30.00 40980203 HAIR FOLLICLE COLLECT/SUBMIT 92.00 40980204 HAIR FOLLICLE COLLECTION ONLY 14.00 40980206 EKG 83.00 40980208 BA-NON-DOT 29.00 40980209 DRUG SCREEN-THEIR KIT-NON-DOT 20.00 40980210 SPECIMEN HANDLING PT-LAB 56.00 40980211 QUICK/RAPID DRUG SCREEN - OH 53.00 40980212 BLOOD COLLECTION 20.00 40980213 BREATH ALCOHOL CONFIRMATION 24.00 40980241 RESPIRATOR CLEARANCE EXAM 34.00 40980246 SHAVING SUPPLIES 6.00 40980252 DRUG SCREEN OBSERVED COLLECT 13.00 40982000 LEVEL 3-INITIAL 157.00 40982001 LEVEL 4-INITIAL 220.00 40982002 LEVEL 5-INITIAL 281.00 40982010 LEVEL 2-EST 62.00 40982011 LEVEL 3-EST 84.00 40982012 LEVEL 4-EST 133.00 40982013 LEVEL 5-EST 194.00 40982016 LEVEL III - INTERMEDIATE 262.00 40982017 LEVEL IV - EXTENDED 392.00 40982018 LEVEL V - EXTENDED 717.00 40982020 CONS-PROB FOCUSED 100.00 40982021 CONS-EXPANDED PROBLEM 138.00 40982022 CONS-LOW COMPLEX 182.00 40982023 CONS-MOD COMPLEX 259.00 40982024 CONS-HIGH COMPLEX 338.00 40982025 FACE TO FACE 1ST HOUR 252.00 40982026 FACE TO FACE EA ADD HOUR 278.00 40982030 SIMP LAC REPAIR 0.0-2.5 CM 216.00 40982031 SIMP LAC REPAIR 2.6-7.5 CM 249.00 40982032 SIMP LAC REPAIR 7.6-12.5 CM 375.00 40982040 INTM LAC REPAIR 0.0-2.5 CM 292.00 40982041 INTM LAC REPAIR 2.6-7.5 CM 419.00 40982042 INTM LAC REPAIR 7.6-12.5 CM 527.00 40982050 COMP LAC REPAIR 1.1-2.5 CM 630.00 40982051 COMP LAC REPAIR 2.6-7.5 CM 829.00 40982064 I&D ABCESS-SIMPLE 170.00 40982065 I&D ABSCESS-COMPLEX 334.00 40982066 PUNCT ASP OF ABSCESS 219.00 40982067 I&D HEMATOMA 249.00 40982068 I&D FINGER ABSCESS SIMPLE 170.00 40982069 I&D FINGER ABSCESS COMPLEX 623.00 40982075 REMOVAL FB-SKIN-SIMPLE 304.00 40982076 REMOVAL FB SKIN-COMPLEX 552.00 40982077 REMOVAL FB MUSCLE-SIMPLE 441.00 40982088 REMOVAL FB FOOT-SIMPLE 297.00 40982089 REMOVAL FB FOOT-DEEP 686.00 40982090 REMOVAL FB FOOT-COMPLEX 1,027.00 40982095 BURN -INIT TX 1ST DEGREE BURN 151.00 40982096 BURN-DRESS/DEBRIDE SMALL BURN 177.00 40982097 BURN-DRESS/DEBRIDE MED BURN 308.00 40982100 DEBRIDE-SKIN PARTIAL THICKNESS 209.00 40982101 DEBRIDEMENT-SKIN AND SUB-Q 201.00 40982105 NAIL-FINGER SUBUNGAL HEMA EVAC 128.00 40982106 NAIL EXCISION 569.00 40982107 REPAIR OF NAIL BED 726.00 40982115 DRESSING CHANGE 114.00 40982128 ARTH/ASP TENDON/LET/CYST 135.00 40982133 SPLINT-ARM-SHORT 122.00 40982134 SPLINT-ARM-LONG 195.00 40982135 SPLINT-LET=SHORT 161.00 40982136 SPLINT-LEG-LONG 149.00 40982137 SPLINT-FINGERS 107.00 40982149 BIVALV/REMOV SPICA OR BOOT CAS 86.00 40982150 BIVALV/REMOV FULL ARM/LEG CAST 170.00 40982161 ELBOW DISLOC W/O MANIP ANESTH 348.00 40982164 CARPAL MC THUMB DISLOCATION 250.00 40982165 CARPAL MC FINGER DISLOCATION 189.00 40982166 MC/PHALANGEAL DISLOCATION 396.00 40982167 IP JOINT FINGER DISLOCATION 209.00 40982168 MT/PHALANGEAL DISLOCATION 226.00 40982169 IP JOINT TOE DISLOCATION 290.00 40982175 DIGITAL BLOCK 185.00 40982180 LAC-SIMPLE BODY <2.5CM 277.00 40982181 LAC-SIMPLE BODY 2.6-7.5CM 292.00 40982182 LAC-SIMPLE BODY 7.6-12.5CM 375.00 40982185 LAC-SIMPLE FACE <2.5CM 277.00 40982186 LAC-SIMPLE FACE 2.6-5.0CM 314.00 40982187 LAC-SIMPLE FACE 5.1-7.5CM 375.00 40982188 LAC-SIMPLE FACE 7.6-12.5CM 477.00 40982190 LAC-SCALP/TRUNK INTER <2.5CM 327.00 40982191 LAC-SCALP/TRK INTERMED 2.6-7.5 419.00 40982192 LAC-SCALP/TRNK INTRMED 7.6-12. 545.00 40982195 LAC-NK/HNDS/FT INTERMED<=2.5CM 355.00 40982196 LAC-NK/HNDS/FT INTRMED 2.6-7.5 545.00 40982197 LAC-NK/HNDS/FT INTRMED 7.6-12. 561.00 40982198 LAC-NK/HNDS/FT INTRMED 12.6-20 664.00 40982199 LAC-NK/HND/FT INTRMED 20.1-30 768.00 40982204 LAC-NK/HND/FT INTRMED >30.1CM 871.00 40982225 URINALYSIS (DIP) 14.00 40982238 HAIR FOLLICLE COLLECTION ONLY 14.00 40982239 HAIR FOLLICLE COLLECT/SUBMIT 92.00 40982243 PULSE OXIMETRY 18.00 40982244 GLUCOSE FINGER STICK 18.00 40982303 KETOROLAC 30MG/1 ML 20.00 40982304 TDAP VACCINE >7 IM 74.00 40982310 HEPATITIS B VACCINE 20MCG/ML 104.00 40982329 SILVADENE 1% 50G 17.00 40982345 EYE - EXAM IMTERMEDIATE 194.00 40982346 EYE - EXAM COMPREHENSIVE 315.00 40982347 EYE-REMOVE FB CONJUCTIVA SIMPL 246.00 40982348 EYE-REMOVE FB CONJUCTIVA EMBED 246.00 40982349 EYE-REMOVE FB CORNEA W/O SLIT 246.00 40982350 EYE-REMOVE FB LID EMBEDDED 271.00 40982355 EAR-REMOVE FB EXTERNAL AUD CAN 177.00 40982356 EAR-REMOVE IMPACTED CERUMEN 150.00 40982360 NOSE-EPISTAXIS ANT LIM TX PACK 209.00 40982361 NOSE-EPISTAXIS ANT COMPLX PACK 314.00 40982362 NOSE-REMOVE FB 209.00 40982370 AUDIOGRAM 33.00 40982390 MTG EMP ATTY CLAIMS/15 MIN 83.00 40982395 COPYING FEE FIRST 14 PAGES 16.00 40982399 RAPID DRUG SCREEN-THEIR KIT 23.00 40982400 COPYING FEE PGS 11-40/PER PG 2.00 40982405 DEPOSITON PREP TIME/HR 360.00 40982410 APPLICATION OF HOT/COLD PACKS 18.00 40982415 ORTHOCLASS PER INCH 1.00 40982425 GAIT TRAINING PER 15 MIN 92.00 40982435 TELEPHONE CONSULT HCP 15 MIN 73.00 40982450 SUPPLIES/WOUND CARE 11.00 40982950 NO SHOW FEE 83.00 40982953 EYE-REMOVE FB CORNEA W/ SLIT 315.00 40985851 ROM MEASURE 70.00 40989173 VISUAL ACUITY 21.00 40989955 IMPAIRMENT RATING 1.5 HRS 342.00 40989956 IMPAIRMENT RATING REFER 2.5HRS 657.00 40989960 WC 164 FORM-INITIAL REPORT 50.00 40989961 WC 164 FORM-PROGRESS REPORT 50.00 40989962 WC 164 FORM-CLOSING REPORT 50.00 40989963 WC164 FORM-INIT&CLOSE SAME DAY 50.00 40989964 FORMS COMPLETION BY PROVIDER 50.00 40989965 DEPOSITION FEE 360.00 40989966 TESTIMONY FEE 497.00 40989971 TELE/FTF W/EMPATTYWKCP/15MIN 83.00 41210001 COUM CLINIC-PROTHROMBIN TIME 53.00 41210002 CAPILLARY BLOOD SPEC-FINGER 33.00 41219211 E&M LEVEL 1 69.00 41219212 E&M LEVEL 2 123.00 41219213 E&M LEVEL 3 161.00 41219214 E&M LEVEL 4 244.00 41219215 E&M LEVEL 5 280.00 41239211 PM CONSULT 1-5 MIN 103.00 41239212 PM CONSULT 6-10 MIN 122.00 41239213 PM CONSULT 11-15 MIN 239.00 41239214 PM CONSULT 16-24 MIN 271.00 41239215 PM CONSULT 25+ MIN 341.00 41250115 BLOOD DRAW 32.00 41250465 VACCINE ADMIN IM/SQ <8YRS 57.00 41250466 VACCINE ADM EA ADD IM/SQ <8YRS 44.00 41250467 VACCINE ADMIN PO/NASAL <8YRS 44.00 41250468 VACCINE ADM EA ADD PO/NAS <8YR 44.00 41250471 VACCINE ADMIN IM/SQ SINGLE 60.00 41250472 VACCINE ADMIN EA ADD IM/SQ 46.00 41250473 VACCINE ADMIN PO/NASAL 44.00 41250474 VACCINE ADMIN EA ADD PO/NASAL 44.00 41250475 ADMIN FLU VIRUS VACCINE 62.00 41250476 ADMIN PNEUMONIA VACCINE 60.00 41250523 IV FLUSH NON-INFUSION DAY 112.00 41250760 IV HYDRATION INIT UP TO 1 HR 324.00 41250761 IV HYDRATION EA ADD HR UP TO 8 144.00 41250765 IV INFUSE THER/PROPH/DX-TO 1HR 497.00 41250766 IV INFUSE THER/PROPH/DX-TO 8HR 180.00 41250767 IV DRUG NEW SEQUENTIAL 221.00 41250768 IV DRUG NEW SAME LINE 221.00 41250772 INJECTION IM/SQ 221.00 41250774 IV PUSH INITIAL MED 183.00 41250775 IV PUSH ADD'L NEW MED 160.00 41250776 IV PUSH ADD'L SAME MED 159.00 41251001 PICC PLACEMENT 2,702.00 41251002 ULTRASOUND FOR PICC PLACEMENT 624.00 41251005 REPLACE PICC CATH 1,965.00 41251701 INSERT BLADDER CATH-STRAIGHT 91.00 41251702 INSERT BLADDER CATH-FOLEY 133.00 41251705 BLOOD DRAW FROM PICC 169.00 41251710 BLOOD DRAW FROM PORT 186.00 41251711 NON-SELECT DEBRIDE/DRESSING 170.00 41251798 BLADDER SCANNING 61.00 41252962 GLUCOSE MONITOR/TEST 43.00 41256360 IV HYDRATION INIT 2ND SITE 309.00 41256365 IV INFUSE THER/PRO/DX-2ND SITE 497.00 41256374 IV PUSH INITIAL MED 2ND SITE 175.00 41256430 TRANSFUSION BLOOD/BLOOD COMPON 993.00 41259211 E&M LEVEL 1 87.00 41259212 E&M LEVEL 2 193.00 41259213 E&M LEVEL 3 223.00 41259214 E&M LEVEL 4 309.00 41259215 E&M LEVEL 5 409.00 43075998 WOUND MGMT > 20 SQ CM 251.00 70110545 TOBRAMYCIN RANDOM LEVEL 533.00 404050571 KNEE BILATERAL 3 VIEWS 394.00 404576641 3D US EXAM BREAST (S) 224.00 409097014 E-STIMULATION/UNATTENDED 86.00 409197014 E-STIMULATION/UNATTENDED 86.00 409797110 THERAPEUTIC EXERCISE/15 MIN 121.00 412596401 CHEMO NON-HORMONAL ANTI-NEO IM 293.00 412596402 CHEMO HORMONAL ANTI-NEO IM 133.00 412596405 CHEMO INTRALESIONAL <=7 LESION 133.00 412596406 CHEMO INTRALESIONAL >7 LESIONS 558.00 412596409 CHEMO IV PUSH INITIAL DRUG 558.00 412596411 CHEMO IV PUSH ADDITIONAL DRUG 319.00 412596413 CHEMO IV INFUSION 1ST HOUR 903.00 412596415 CHEMO IV INFUSION EA ADDL HOUR 160.00 412596416 CHEMO IV INFUSION 8+ HOURS 903.00 412596417 CHEMO IV INFUSION SEQ 1ST HOUR 160.00 412596440 CHEMO PLEURAL CAVITY 903.00 412596446 CHEMO PERITONEAL CAVITY PORT 903.00 412596521 CHEMO REFILL PORTABLE PUMP 558.00 412596522 CHEMO REFILL IMPLANTED PUMP 133.00 412596549 CHEMO PROCEDURE 133.00 2100010061 I&D Abscess; Complicated or Mu 670.00 2100010120 Inc & Rem FB SubQ; Simple 495.00 2100010140 Drainage Of Hematoma/Fluid 531.00 2100011301 Shave Lesion T/A/L; 0.6-1.0 cm 392.00 2100011310 Shave Lesion F/E/N/L; 0.5 cm/< 371.00 2100011312 Shave Lesion F/E/N/L; 1.1-2.0 523.00 2100011401 Exc Ben Les T/A/L; 0.6-1.0 Cm 485.00 2100011402 Exc Ben Les T/A/L; 1.1-2.0 cm 540.00 2100011406 Exc Ben Les T/A/L; >4.0 Cm 1,022.00 2100011420 Exc Ben Les S/N/Ex/G; 0.5 Cm/< 397.00 2100011421 Exc Ben Les S/N/Ex/G; 0.6-1.0 509.00 2100011422 Exc Ben Les S/N/Ex/G; 1.1-2.0 571.00 2100011423 Exc Ben Les S/N/Ex/G; 2.1-3.0 656.00 2100011426 Exc Ben Les S/N/Ex/G; >4 Cm 1,087.00 2100011440 Exc Face-Mm B9+Marg 0.5 Cm/< 436.00 2100011442 Exc Face-Mm B9+Marg 1.1-2 Cm 611.00 2100011443 Exc Face-Mm B9+marg 2.1-3 Cm 728.00 2100011444 Exc Face-Mm B9+marg 3.1-4 Cm 916.00 2100011603 Exc Tr-Ext Mlg+marg 2.1-3 Cm 923.00 2100011620 Exc H-F-Nk-Sp Mlg+marg 0.5 < 630.00 2100011623 Exc H-F-Nk-Sp Mlg+marg 2.1-3 979.00 2100011642 Exc Face-Mm Malig+marg 1.1-2 885.00 2100011643 Exc Face-Mm Malig+marg 2.1-3 1,042.00 2100011644 Exc Face-Mm Malig+marg 3.1-4 1,284.00 2100011646 Exc Face-Mm Mlg+marg > 4 Cm 1,678.00 2100011976 Rem Impl Contraceptive Cap 464.00 2100011982 Remove Drug Implant 521.00 2100012011 S Rep F/E/N/L/MM; 2.5 Cm/< 355.00 2100012031 Intmd Wnd Repr S/A/T/Ext <2.5 772.00 2100012032 Intmd Wnd Repr S/A/T/Ext 2.6-7 986.00 2100012041 Intmd Wnd Rep N-HF/Genit =<2.5 771.00 2100012042 Intmd Wnd Rep N-HF/Genit =2.6- 940.00 2100012051 Intmd Wnd Rep Face/MM =<2.5 CM 838.00 2100012052 Intmd Wnd Rep Face/MM 2.6-5.0 956.00 2100012053 Intmd Wnd Rep Face/MM 5.1-7.5 1,122.00 2100013120 Cmplx Rep S/A/L; 1.1-2.5 Cm 1,139.00 2100013131 Cmplx Rep F/G/H/F; 1.0-2.5 Cm 1,254.00 2100013132 Cmplx Rep F/G/H/F; 2.6-7.5 Cm 1,549.00 2100013151 Cmplx Repr E/N/E/L; 1.1-2.5 Cm 1,374.00 2100013152 Cmplx Repr E/N/E/L; 2.6-7.5 Cm 1,648.00 2100013153 Cmplx Repr E/N/E/L; Ea Addl 5 634.00 2100014040 ATT F/C/M/N/A/G/H/F;10 Sq Cm/< 2,482.00 2100014060 ATT E/N/E/L; D 10 Sq Cm/< 2,532.00 2100015115 Epidrm A-Grft Face/Nck/Hf/G 10 2,614.00 2100015760 Graft; Composite 2,782.00 2100015839 Excise Excess Skin Tissue; Oth 2,879.00 2100021011 Exc Face Lesion Subcu <2.0 Cm 1,138.00 2100021315 Closed Tx Nasal Bone Fx; WO St 900.00 2100021320 Closed Tx Nasal Bone Fx; W Sta 835.00 2100021337 Closed Tx Nasal Septal Fractur 1,322.00 2100027447 Total Knee Arthroplasty 4,473.00 2100027650 Primary Repair Ruptured Achill 2,161.00 2100030110 Excision Nasal Polyp(s) Simple 746.00 2100030115 Excise Nasal Polyp(s) Extensiv 1,400.00 2100030117 Remove Intranasal Lesion; Inte 2,835.00 2100030140 Resect Inferior Turbinate 1,427.00 2100030220 Insert Nasal Septal Prosth (Bu 980.00 2100030310 Remove FB Intranasal; W Anesth 670.00 2100030520 Septoplasty Or Submucous Resec 2,020.00 2100030630 Repair Nasal Septal Perforatio 2,018.00 2100030901 Control Nasal Hemorrhag Anteri 309.00 2100030903 Control Nasal Hemorrhage Ant; 718.00 2100031051 Sinusotomy Sphenoid; W Polype 2,093.00 2100031200 Ethmoidectomy; Intranasal Ant 1,858.00 2100031201 Ethmoidectomy; Intranasal Tota 2,401.00 2100031237 Nasal Endo; W Bx Polypectomy/D 838.00 2100031238 Nasal Endo W Hemorrhage Contro 837.00 2100031254 Nasal Endoscopy Ethmoidectomy; 894.00 2100031255 Nasal Endoscopy W Ethmoidectom 1,308.00 2100031256 Nasal Endoscopy W Maxillary An 647.00 2100031267 Nasal Endo W Max Ant; W Rem Ti 1,038.00 2100031276 Nasal/Sinus Endo W Frontal Sin 1,650.00 2100031287 Nasal/Sinus Endoscopy W Spleno 759.00 2100031288 Nasal Endo; W Rem Tiss Sphenoi 880.00 2100031525 Diagnostic Laryngoscopy Except 825.00 2100031535 Laryngoscopy W/Biopsy 624.00 2100031536 Laryngoscopy W/Biopsy & Op Sco 696.00 2100031540 Laryngoscopy W/Exc Of Tumor 797.00 2100031575 Diagnostic Flex Laryngoscopy 370.00 2100035840 Explore PostOp Hemor/Thromb/In 3,971.00 2100040510 Excise Lip; Transverse Wedge E 1,591.00 2100040650 Repair Lip Front; Vermilion On 1,441.00 2100040812 Exc Les Mouth Vestibule W Simp 960.00 2100040814 Exc Les Mouth Vestibule W Comp 1,285.00 2100041000 I&D Absc/Cyst Tongue FOM; Ling 538.00 2100041010 Incision Of Lingual Frenum (Fr 662.00 2100041100 Biopsy Of Tongue; Anterior 2/3 556.00 2100041112 Exc Tongue Lesion W Close; Ant 1,112.00 2100042104 Excise Lesion Palate Uvula; WO 714.00 2100042408 Excise Sublingual Salivary Cys 1,495.00 2100042804 Bx; Nasopharynx Visible Lesion 840.00 2100042808 Excise Or Destroy Pharynx Lesi 747.00 2100042820 Remove Tonsils And Adenoids <1 952.00 2100042825 Removal Of Tonsils <12 Years O 864.00 2100042826 Tonsillectomy; Age 12 Or Older 829.00 2100042830 Removal Of Adenoids 1' <12 Yea 683.00 2100042831 Adenoidectomy; Age 12 And Over 739.00 2100042860 Excision Of Tonsil Tags 620.00 2100042960 Control Oropharyngeal Hemorrha 562.00 2100042961 Control Oropharyng Hemorrh; Co 1,393.00 2100042962 Control Oropharyngeal Hemorrh; 1,715.00 2100044005 Enterolysis 3,635.00 2100044180 Laparoscopy Enterolysis 3,050.00 2100044950 Appendectomy 2,130.00 2100044955 Appy; Done For Indicated Purpo 280.00 2100044970 Laparoscopy; Appendectomy 1,991.00 2100046750 Repair Of Anal Sphincter 2,488.00 2100047001 Needle Biopsy Liver At Major O 348.00 2100049010 Explore Retroperitoneal Area W 3,098.00 2100049084 Peritoneal Lavage 361.00 2100049255 Omentectomy Epiploectomy 2,621.00 2100049320 Lap; Dx Abdomen/Peritoneum/Ome 1,078.00 2100049321 Lap; Abdomen/Peritoneum/Omentu 1,142.00 2100049322 Lap; Abd/Peritoneum/Omentum W 1,222.00 2100049402 Remove Foreign Body Adbomen 2,838.00 2100049419 Insrt Abdom Cath For Chemotx 1,473.00 2100049900 Abdominl Wall 2' Suture For Ev 2,698.00 2100051860 Suture Bladder Wound Injury; S 2,462.00 2100051992 Lap; Sling Op For Stress Incon 2,766.00 2100052000 Cystourethroscopy 536.00 2100052332 CYST W INS OF URETER STENT 515.00 2100056405 I & D Of Vulva Or Perineal Abs 355.00 2100056440 Marsupialization Bartholin's G 593.00 2100056441 Lysis Of Labial Lesion(s) 468.00 2100056620 Vulvectomy Simple; Partial 1,708.00 2100056700 PARTIAL HYMENECTOMY OR REV 611.00 2100056740 Excise Bartholin's Gland Or Cy 981.00 2100057010 Drainage Of Pelvic Abscess 1,412.00 2100057065 Destroy Vaginal Lesions; Compl 637.00 2100057120 COLPOCLEISIS (LE FORT TYPE) 1,651.00 2100057130 Remove Vagina Lesion 574.00 2100057135 Excise Vaginal Cyst Or Tumor 624.00 2100057200 Colporrhaphy 985.00 2100057240 Anterior Colporrhaphy Repair C 2,181.00 2100057250 Posterior Colporrhaphy Repair 2,194.00 2100057260 Combined Anteroposterior Colpo 2,702.00 2100057265 Comb Ant/Post Colporrhaphy; W 2,960.00 2100057268 Repair Of Bowel Bulge 1,573.00 2100057282 Sacrospinous Ligament Fix For 1,626.00 2100057285 Repair Paravaginal Defect Vag 2,186.00 2100057287 Revise/Repair Stress Incontine 2,219.00 2100057288 Sling Operation For Stress Inc 2,333.00 2100057461 CONZ OF CERVIX W/SCOPE LEEP 613.00 2100057500 Biopsy Of Cervix 414.00 2100057520 Conization Of Cervix Cold Knif 1,001.00 2100057522 Conization Of Cervix Leep 855.00 2100057530 Removal Of Cervix 1,131.00 2100057720 Revision Of Cervix 999.00 2100058120 D&C Diagnostic Or Therapeutic; 839.00 2100058150 Total Abdominal Hysterectomy 3,315.00 2100058180 SUBTOTAL ABD HYSTERECTOMY 3,133.00 2100058200 Extensive Hysterectomy 4,513.00 2100058260 Vaginal Hysterectomy = <250 Gm 2,678.00 2100058262 Vag Hyst Including T/O = <250 2,989.00 2100058267 Vag Hyst W/Urinary Repair = <2 3,399.00 2100058270 Vag Hyst W/Enterocele Repair = 2,860.00 2100058290 Vaginal Hysterectomy Complex = 3,730.00 2100058291 Vag Hyst Incl T/O Complex >25 4,023.00 2100058300 Insert Intrauterine Device 308.00 2100058301 Remove Intrauterine Device 308.00 2100058350 Chromotubation of Oviduct 313.00 2100058353 Thermal Endometrial Tumor Abla 3,257.00 2100058356 Endometrial Cryoablation W Ult 6,099.00 2100058541 Lsh Uterus 250 G Or Less 2,325.00 2100058545 Laparoscopic Myomectomy =<250 2,938.00 2100058550 Laparo-Asst Vag Hysterectomy = 2,860.00 2100058552 Laparo-Vag Hyst Including T/O 3,210.00 2100058553 Laparo-Vag Hyst Complex 3,691.00 2100058554 Laparo-Vag Hyst W/T/O Compl > 4,315.00 2100058555 Hysteroscopy Diagnostic 870.00 2100058558 Hysteroscopy W Bx Endom Or Pol 4,416.00 2100058559 Hysteroscopy; W Lysis Intraut 945.00 2100058561 Hysteroscopy Remove Myoma 1,431.00 2100058562 Hysteroscopy; W Removal Impact 1,103.00 2100058563 Hysteroscopy; W Endometrial Ab 5,156.00 2100058573 TLH W/T/O Uterus Over 250 Gm 3,974.00 2100058615 Occlude Fallopian Tube(s) By D 808.00 2100058660 Laparoscopy; W Lysis Of Adhesi 2,191.00 2100058661 Lap; W Removal Adnexal Structu 2,115.00 2100058662 Lap W Exc/Destr Ovary Pelvic V 2,310.00 2100058670 Lap W Destruction Of Oviducts 1,182.00 2100058671 Lap W Occlusion Of Oviducts W 1,179.00 2100058720 Salpingo-Oophor Compl/Part Uni 2,410.00 2100058740 Adhesiolysis Tube Ovary 2,880.00 2100058800 DRAIN OVARIAN CYST VAGINAL 963.00 2100058805 Drainage Of Ovarian Cyst(s) 1,315.00 2100058925 Ovarian Cystectomy Unilat Or B 2,434.00 2100058940 Oophorectomy Partial Or Total 1,720.00 2100058957 Resect Recurrent Gyn Mal 5,243.00 2100059120 Surg Tx Ectopic Preg; Tub/Ovar 2,619.00 2100059150 Lap Tx Ect Preg; WO Salpingect 2,541.00 2100059151 Lap Tx Ect Preg; W Salpingect/ 2,478.00 2100059160 D & C After Delivery 671.00 2100059812 Surgical Tx Incomplete Abortio 1,052.00 2100059820 Surg Tx Missed Abortion; 1st T 1,251.00 2100069145 Exc Soft Tiss Lesion Ext Audit 1,288.00 2100069205 Remove FB Ext Auditory Canal; 332.00 2100069210 Remove Impacted Ear Wax Unilat 159.00 2100069421 Incision Of Eardrum 487.00 2100069424 Remove Ventilating Tube Under 414.00 2100069436 Tympanostomy Under General Ane 524.00 2100069990 Operating Microscope Add-On 741.00 2100093010 12 Lead EKG; Interpret And Rep 14.00 2100093018 Cardiovascular Strss Test Int 25.00 2100094010 Spirometry 58.00 2100097597 Selective Wound Debridem 20 Cm 122.00 2100099217 Observation Care Discharge 118.00 2100099218 Initial Observation Care 30min 161.00 2100099219 Initial Observation Care 50min 219.00 2100099220 Initial Observation Care 70min 300.00 2100099221 Initial Hospital Care 30 Min 164.00 2100099222 Initial Hospital Care 50 Min 221.00 2100099223 Initial Hospital Care 70 Min 327.00 2100099231 Subsequent Hospital Care 15min 63.00 2100099232 Subsequent Hospital Care 25min 117.00 2100099233 Subsequent Hospital Care 35min 168.00 2100099234 Observ/Hosp Same Date 40min 215.00 2100099235 OBSERV/HOSP SAME DATE 272.00 2100099236 Observ/Hosp Same Date 55min 351.00 2100099238 Hospital DC Day < 30 min 117.00 2100099239 Hospital DC Day 31+ min 174.00 2100099241 Office Consultation 15 Min 33.00 2100099242 Office Consultation 30 Min 71.00 2100099243 Office Consultation 40 Min 118.00 2100099244 Office Consultation 60 Min 174.00 2100099245 Office Consultation 80 Min 234.00 2100099251 Inpatient Consultation 20 Min 164.00 2100099252 Inpatient Consultation 40 Min 164.00 2100099253 Inpatient Consultation 55 Min 221.00 2100099254 Inpatient Consultation 80 Min 326.00 2100099255 Inpatient Consultation 110 Min 326.00 2100099281 Emergency Dept Visit Level I 35.00 2100099282 Emergency Dept Visit Level II 67.00 2100099283 Emergency Dept Visit Level III 100.00 2100099284 Emergency Dept Visit Level IV 189.00 2100099285 Emergency Dept Visit Level V 280.00 2100099291 Critical Care First Hour 443.00 2100099292 Critical Care Addl 30 Min 198.00 2100099356 Prolonged Svc Inp First Hour 149.00 2100099357 Prolonged Svc Inp Addl 30 min 149.00 2100211301 Shave Lesion T/A/L; 0.6-1.0 -A 98.00 2100211310 Shave Lesion F/E/N/L; 0.5 cm-A 93.00 2100211312 Shave Lesion F/E/N/L; 1.1-2.-A 132.00 2100211976 Rem Impl Contraceptive Cap-A 116.00 2100211982 Remove Drug Implant-A 131.00 2100215839 Excise Excess Skin Tissue; O-A 720.00 2100221011 Exc Face Lesion Subcu <2.0 C-A 285.00 2100221337 Closed Tx Nasal Septal Fract-A 331.00 2100227447 Total Knee Arthroplasty-A 1,119.00 2100227650 Primary Repair Ruptured Achi-A 541.00 2100230310 Remove FB Intranasal; W Anes-A 168.00 2100230630 Repair Nasal Septal Perforat-A 504.00 2100231238 Nasal Endo W Hemorrhage Cont-A 209.00 2100231287 Nasal/Sinus Endoscopy W Sple-A 191.00 2100231288 Nasal Endo; W Rem Tiss Sphen-A 221.00 2100235840 Explore PostOp Hemor/Thromb/-A 993.00 2100240650 Repair Lip Front; Vermilion -A 361.00 2100241010 Incision Of Lingual Frenum (-A 166.00 2100242408 Excise Sublingual Salivary C-A 374.00 2100242820 Remove Tonsils And Adenoids -A 239.00 2100242825 Removal Of Tonsils <12 Years-A 217.00 2100242830 Removal Of Adenoids 1' <12 Y-A 172.00 2100242831 Adenoidectomy; Age 12 And Ov-A 185.00 2100242860 Excision Of Tonsil Tags-A 156.00 2100242960 Control Oropharyngeal Hemorr-A 141.00 2100242961 Control Oropharyng Hemorrh; -A 349.00 2100244005 Enterolysis-A 909.00 2100244180 Laparoscopy Enterolysis-A 763.00 2100244950 Appendectomy-A 533.00 2100244955 Appy; Done For Indicated Pur-A 71.00 2100244970 Laparoscopy; Appendectomy-A 498.00 2100246750 Repair Of Anal Sphincter-A 622.00 2100249010 Explore Retroperitoneal Area-A 775.00 2100249255 Omentectomy Epiploectomy-A 656.00 2100249320 Lap; Dx Abdomen/Peritoneum/O-A 270.00 2100249321 Lap; Abdomen/Peritoneum/Omen-A 286.00 2100249322 Lap; Abd/Peritoneum/Omentum -A 306.00 2100249900 Abdominl Wall 2' Suture For -A 675.00 2100251860 Suture Bladder Wound Injury;-A 616.00 2100251992 Lap; Sling Op For Stress Inc-A 692.00 2100252332 CYST W INS OF URETER STENT-A 258.00 2100256441 Lysis Of Labial Lesion(s)-A 117.00 2100256620 Vulvectomy Simple; Partial-A 428.00 2100256700 Partial Hymen Removal-A 153.00 2100257010 Drainage Of Pelvic Abscess-A 353.00 2100257120 COLPOCLEISIS (LE FORT TYPE)-A 413.00 2100257130 Remove Vagina Lesion-A 144.00 2100257200 Colporrhaphy-A 247.00 2100257240 Anterior Colporrhaphy Repair-A 545.00 2100257250 Posterior Colporrhaphy Repai-A 549.00 2100257260 Combined Anteroposterior Col-A 676.00 2100257265 Comb Ant/Post Colporrhaphy; -A 741.00 2100257268 Repair Of Bowel Bulge-A 394.00 2100257282 Sacrospinous Ligament Fix Fo-A 407.00 2100257285 Repair Paravaginal Defect V-A 546.00 2100257287 Revise/Repair Stress Inconti-A 555.00 2100257288 Sling Operation For Stress I-A 583.00 2100257530 Removal Of Cervix-A 283.00 2100257720 Revision Of Cervix-A 250.00 2100258150 Total Abdominal Hysterectomy-A 829.00 2100258180 SUBTOTAL ABD HYSTERECTOMY-A 1,567.00 2100258200 Extensive Hysterectomy-A 1,129.00 2100258260 Vaginal Hysterectomy = <250 -A 670.00 2100258262 Vag Hyst Including T/O = <25-A 748.00 2100258267 Vag Hyst W/Urinary Repair = -A 850.00 2100258270 Vag Hyst W/Enterocele Repair-A 716.00 2100258290 Vaginal Hysterectomy Complex-A 933.00 2100258291 Vag Hyst Incl T/O Complex >-A 1,006.00 2100258301 Remove Intrauterine Device-A 77.00 2100258356 Endometrial Cryoablation W U-A 1,525.00 2100258541 Lsh Uterus 250 G Or Less-A 582.00 2100258545 Laparoscopic Myomectomy =<25-A 735.00 2100258550 Laparo-Asst Vag Hysterectomy-A 716.00 2100258552 Laparo-Vag Hyst Including T/-A 803.00 2100258553 Laparo-Vag Hyst Complex-A 923.00 2100258554 Laparo-Vag Hyst W/T/O Compl-A 1,079.00 2100258555 Hysteroscopy Diagnostic-A 218.00 2100258561 Hysteroscopy Remove Myoma-A 359.00 2100258563 Hysteroscopy; W Endometrial -A 1,290.00 2100258573 TLH W/T/O Uterus Over 250 Gm-A 994.00 2100258615 Occlude Fallopian Tube(s) By-A 202.00 2100258660 Laparoscopy; W Lysis Of Adhe-A 549.00 2100258661 Lap; W Removal Adnexal Struc-A 530.00 2100258662 Lap W Exc/Destr Ovary Pelvic-A 578.00 2100258720 Salpingo-Oophor Compl/Part U-A 603.00 2100258740 Adhesiolysis Tube Ovary-A 721.00 2100258805 Drainage Of Ovarian Cyst(s)-A 329.00 2100258925 Ovarian Cystectomy Unilat Or-A 609.00 2100258940 Oophorectomy Partial Or Tota-A 431.00 2100258957 Resect Recurrent Gyn Mal-A 1,311.00 2100259120 Surg Tx Ectopic Preg; Tub/Ov-A 656.00 2100259150 Lap Tx Ect Preg; WO Salpinge-A 636.00 2100259151 Lap Tx Ect Preg; W Salpingec-A 620.00 2100259160 D & C After Delivery-A 168.00 2100269990 Operating Microscope Add-On-A 185.00 2160206817 GYN TRANSVAG US OB<14 WEEKS 378.00 2160206830 GYN NON-OB TRANSVAG US 378.00 2160206831 GYN SONOHYSTEROGRAM 525.00 2160206856 GYN U/S PELVIS COMPLETE 378.00 2160206857 GYN U/S PELVIS LIMITED 252.00 2200093010 12 Lead EKG; Interpret And Rep 14.00 2200093018 Cardiovascular Strss Test Int 25.00 2200093227 ECG Monitor/Report Up To 48 Hr 44.00 2200094010 Spirometry 58.00 2200097597 Selective Wound Debridem 20 Cm 122.00 2200099217 Observation Care Discharge 118.00 2200099218 Initial Observation Care 30min 161.00 2200099219 Initial Observation Care 50min 219.00 2200099220 Initial Observation Care 70min 300.00 2200099221 Initial Hospital Care 30 Min 164.00 2200099222 Initial Hospital Care 50 Min 221.00 2200099223 Initial Hospital Care 70 Min 327.00 2200099231 Subsequent Hospital Care 15min 63.00 2200099232 Subsequent Hospital Care 25min 117.00 2200099233 Subsequent Hospital Care 35min 168.00 2200099234 Observ/Hosp Same Date 40min 215.00 2200099235 Observ/Hosp Same Date 50min 272.00 2200099236 Observ/Hosp Same Date 55min 351.00 2200099238 Hospital DC Day < 30 min 117.00 2200099239 Hospital DC Day 31+ min 174.00 2200099241 Office Consultation 15 Min 33.00 2200099242 Office Consultation 30 Min 71.00 2200099243 Office Consultation 40 Min 118.00 2200099244 Office Consultation 60 Min 174.00 2200099245 Office Consultation 80 Min 234.00 2200099251 Inpatient Consultation 20 Min 164.00 2200099252 Inpatient Consultation 40 Min 164.00 2200099253 Inpatient Consultation 55 Min 221.00 2200099254 Inpatient Consultation 80 Min 326.00 2200099255 Inpatient Consultation 110 Min 326.00 2200099281 Emergency Dept Visit Level I 35.00 2200099282 Emergency Dept Visit Level II 67.00 2200099283 Emergency Dept Visit Level III 100.00 2200099284 Emergency Dept Visit Level IV 189.00 2200099285 Emergency Dept Visit Level V 280.00 2200099291 Critical Care First Hour 443.00 2200099292 Critical Care Addl 30 Min 198.00 2200099356 Prolonged Svc Inp First Hour 149.00 2200099357 Prolonged Svc Inp Addl 30 min 149.00 2300000104 CA SCREEN;FLEXI SIGMOIDSCOPE 543.00 2300000105 COLORECTAL SCREEN HI RISK PAT 1,026.00 2300000121 SCREEN COLONOSCOPY NOT HI RISK 1,029.00 2300000232 NJX PLATELET PLASMA 105.00 2300010021 FNA W/O IMAGE 397.00 2300010060 I&D ABSCESS; SIMPLE OR SINGLE 382.00 2300010061 I&D ABSCESS; COMPLICATED OR MU 670.00 2300010080 I&D PILONID CYS; SMPL 338.00 2300010081 I&D PILONID CYST; COMPLEX 874.00 2300010120 INC & REM FB SUBQ; SIMPLE 495.00 2300010121 INCISE & REM FB SUBQ; COMPLEX 890.00 2300010140 DRAINAGE OF HEMATOMA/FLUID 531.00 2300010160 PUNCT ASP - ABSC HEMAT CYST 313.00 2300010180 I&D CPLX POSTOP WND INF 587.00 2300011000 DEBRIDE EXZ/INF SKIN; 10% BS 177.00 2300011004 DEBRIDE NECRO ST- GENITALS & P 1,917.00 2300011010 DEBRIDE SKIN AT FRACTURE SITE 1,647.00 2300011011 DEBRIDE SKIN MUSCLE AT FX SITE 1,750.00 2300011012 DEBRIDE SKIN/MUSCLE/BONE AT FX 2,318.00 2300011042 DEBRIDE SUBQ TISSUE 20 SQ CM/< 378.00 2300011043 DEBRIDE MUSC/FASCIA 20 SQ CM/< 742.00 2300011044 DEBRIDE BONE 20 SQ CM/< 1,023.00 2300011046 DEB MUSC/FASCIA ADD-ON=<20SQCM 186.00 2300011100 BIOPSY SKIN SQ/MM; SINGLE 320.00 2300011200 REMOVE SKIN TAGS; <=15 LESIONS 288.00 2300011301 SHAVE LESION T/A/L; 0.6-1.0 CM 392.00 2300011310 SHAVE LESION F/E/N/L; 0.5 CM/< 371.00 2300011312 SHAVE LESION F/E/N/L; 1.1-2.0 523.00 2300011400 EXC TR-EXT B9+MARG 0.5 < CM 404.00 2300011401 EXC BEN LES T/A/L; 0.6-1.0 CM 485.00 2300011402 EXC BEN LES T/A/L; 1.1-2.0 CM 540.00 2300011403 EXC BEN LES T/A/L; 2.1-3.0 CM 624.00 2300011404 EXC BEN LES T/A/L; 3.1-4.0 CM 709.00 2300011406 EXC BEN LES T/A/L; >4.0 CM 1,022.00 2300011420 EXC BEN LES S/N/EX/G; 0.5 CM/< 397.00 2300011421 EXC BEN LES S/N/EX/G; 0.6-1.0 509.00 2300011422 EXC BEN LES S/N/EX/G; 1.1-2.0 571.00 2300011423 EXC BEN LES S/N/EX/G; 2.1-3.0 656.00 2300011424 EXC BEN LES S/N/EX/G; 3.1-4.0 761.00 2300011426 EXC BEN LES S/N/EX/G; >4 CM 1,087.00 2300011440 EXC FACE-MM B9+MARG 0.5 CM/< 436.00 2300011441 EXC FACE-MM B9+MARG 0.6-1 CM 545.00 2300011442 EXC FACE-MM B9+MARG 1.1-2 CM 611.00 2300011443 EXC FACE-MM B9+MARG 2.1-3 CM 728.00 2300011444 EXC FACE-MM B9+MARG 3.1-4 CM 916.00 2300011446 EXC FACE-MM B9+MARG > 4 CM 1,272.00 2300011450 EXC HIDRAD AXIL; S/I REP 830.00 2300011600 EXC TR-EXT MAL+MARG 0.5 < CM 392.00 2300011601 EXC TR-EXT MLG+MARG 0.6-1 CM 745.00 2300011602 EXC TR-EXT MLG+MARG 1.1-2 CM 808.00 2300011603 EXC TR-EXT MLG+MARG 2.1-3 CM 923.00 2300011604 EXC TR-EXT MLG+MARG 3.1-4 CM 1,026.00 2300011606 EXC TR-EXT MLG+MARG > 4 CM 1,468.00 2300011623 EXC H-F-NK-SP MLG+MARG 2.1-3 979.00 2300011624 EXC H-F-NK-SP MLG+MARG 3.1-4 1,105.00 2300011626 EXC H-F-NK-SP MLG+MAR > 4 CM 1,330.00 2300011641 EXC F/E/E/N/L MAL+MRG 0.6-1 514.00 2300011642 EXC FACE-MM MALIG+MARG 1.1-2 885.00 2300011643 EXC FACE-MM MALIG+MARG 2.1-3 1,042.00 2300011644 EXC FACE-MM MALIG+MARG 3.1-4 1,284.00 2300011646 EXC FACE-MM MLG+MARG > 4 CM 1,678.00 2300011730 SPL AVULSE NP; SINGLE 340.00 2300011732 SPL AVULSE NP; EACH ADDTL 103.00 2300011750 REMOVE NAIL BED 496.00 2300011755 BIOPSY NAIL UNIT 431.00 2300011762 RECONSTRUCT NAIL BED W GRAFT 903.00 2300011770 EXCISE PILONIDAL CYST; SIMPLE 902.00 2300011771 EXC PILONIDAL CYST; EXTENSIVE 1,868.00 2300011772 EXC PILONIDAL CYST; COMPLEX 2,263.00 2300011976 REM IMPL CONTRACEPTIVE CAP 464.00 2300011982 REMOVE DRUG IMPLANT 521.00 2300012001 SMPL REPAIR S/N/G/TR/E; 2.5 CM 291.00 2300012002 SREPS/N/A/G/TR/E; 2.6-7.5CM 192.00 2300012011 S REP F/E/N/L/MM; 2.5 CM/< 355.00 2300012020 TX S WND DEHISC; SMPL 621.00 2300012031 INTMD WND REPR S/A/T/EXT <2.5 772.00 2300012032 INTMD WND REPR S/A/T/EXT 2.6-7 986.00 2300012034 INTMD WND REPR S/TR/EXT 7.6-12 1,015.00 2300012035 INTMD WND REPR S/A/T/EXT 12.6- 1,238.00 2300012036 INTMD WND REPR S/A/T/EXT 20.1- 1,370.00 2300012037 INTMD WND REPR S/TR/EXT 30+ CM 1,085.00 2300012041 INTMD WND REP N-HF/GENIT =<2.5 771.00 2300012042 INTMD WND REP N-HF/GENIT =2.6- 940.00 2300012051 INTMD WND REP FACE/MM =<2.5 CM 838.00 2300012052 INTMD WND REP FACE/MM 2.6-5.0 956.00 2300012053 INTMD WND REP FACE/MM 5.1-7.5 1,122.00 2300013101 CMPLX REP TRUNK 2.6-7.5 CM 1,288.00 2300013102 CMPLX REP TRUNK; EA ADDL 5 CM< 395.00 2300013120 CMPLX REP S/A/L; 1.1-2.5 CM 1,139.00 2300013121 CMPLX REP S/A/L; 2.6-7.5 CM 1,389.00 2300013122 C REP S/A/L; EA ADD 5 CM/< 284.00 2300013131 CMPLX REP F/G/H/F; 1.0-2.5 CM 1,254.00 2300013132 CMPLX REP F/G/H/F; 2.6-7.5 CM 1,549.00 2300013151 CMPLX REPR E/N/E/L; 1.1-2.5 CM 1,374.00 2300013152 CMPLX REPR E/N/E/L; 2.6-7.5 CM 1,648.00 2300013153 CMPLX REPR E/N/E/L; EA ADDL 5 634.00 2300013160 LATE CL SURG WOUND/DEH EXTENSI 2,641.00 2300014040 ATT F/C/M/N/A/G/H/F;10 SQ CM/< 2,482.00 2300014060 ATT E/N/E/L; D 10 SQ CM/< 2,532.00 2300015002 WND PREP T/A/L; 100 SQ CM/1% B 1,131.00 2300015100 SKIN SPLT GRFT TK/A/L 100 SQ 2,800.00 2300015115 EPIDRM A-GRFT FACE/NCK/HF/G 10 2,614.00 2300015271 SKIN SUB GRFT T/A/L; 25 SQ CM/ 456.00 2300015275 SKIN SUBSTITUTE FOR OTHER THAN 483.00 2300015760 GRAFT; COMPOSITE 2,782.00 2300015839 EXCISE EXCESS SKIN TISSUE; OTH 2,879.00 2300015852 DRESSING CHANGE NOT FOR BURN 155.00 2300017110 DESTRUCT B9 LESION; 1-14 361.00 2300017999 UNLISTED PROC SKIN MM & SQ TIS 105.00 2300019020 MASTOTOMY W EXPLORATION DEEP 1,541.00 2300019100 BX BREAST 1ST LESION STEREOTAC 491.00 2300019101 OPEN INCISION BREAST BIOPSY 1,112.00 2300019110 NIPPLE EXPL W/WO EXC DUCT 1,584.00 2300019120 REMOVAL OF BREAST LESION 1+ 1,615.00 2300019125 EXC BREAST LES BY N LOC; SINGL 1,791.00 2300019260 EXCISION CHEST WALL TUMOR 3,966.00 2300019281 PERQ DEVICE BREAST 1ST IMAG 334.00 2300019300 REMOVAL OF BREAST TISSUE 1,710.00 2300019301 PARTIAL MASTECTOMY 2,151.00 2300019302 PARTIAL MASTECTOMY W/LN REMOVA 2,968.00 2300019303 MASTECTOMY SIMPLE COMPLETE 3,333.00 2300019307 MASTECTOMY MODIFIED RADICAL 3,946.00 2300019357 BREAST RECONST W TISSUE EXPANS 4,952.00 2300019380 REVISION OF RECONSTRUCTED BREA 2,545.00 2300020005 INC ST ABSC; DEEP 734.00 2300020103 EXPL PENETRATING WOUND; EXTREM 1,902.00 2300020205 MUSCLE BX; DEEP 518.00 2300020220 BONE BX TROCAR/NEEDLE; SUPERFI 546.00 2300020240 OPEN SUPERFICIAL BONE BIOPSY 504.00 2300020245 EXCISIONAL BONE BIOPSY; DEEP 1,168.00 2300020520 REMOVE FB MUSCLE; SIMPLE 664.00 2300020525 REMOVE FB MUSCLE; DEEP 1,560.00 2300020526 CARPAL TUNNEL TX INJ 191.00 2300020527 INJECTION DUPUYTREN CORD W ENZ 276.00 2300020552 INJ TRIGGER POINT 1/2 MUSCL 124.00 2300020553 INJECT TRIGGER POINTS >=3 MUSC 142.00 2300020600 DRAIN/INJ SMALL JOINT/BURSA W/ 156.00 2300020604 DRAIN/INJ SMALL JOINT/BURSA W/ 154.00 2300020605 DRAIN/INJ INTER JOINT/BURSA W/ 154.00 2300020606 DRAIN/INJ INTER JOINT/BURSA W/ 154.00 2300020610 DRAIN MAJOR JOINT/BURSA NO US 153.00 2300020611 DRAIN/INJ MAJOR JOINT/BURSA W/ 202.00 2300020670 REMOVAL OF SUPPORT IMPLANT SUP 1,236.00 2300020680 REMOVAL IMPLANT; DEEP 2,018.00 2300020690 APPLY BONE FIXATION DEVICE 1 P 1,960.00 2300020694 REMOVE EXTERNAL FIX SYSTEM W A 1,389.00 2300020900 BONE GRAFT; MINOR/SMALL 1,359.00 2300020926 TISSUE GRAFTS OTHER 1,391.00 2300020931 SPINAL BONE ALLOGRAFT STRUCT A 378.00 2300020938 SPINAL BONE AUTOGRAFT STRUCT A 623.00 2300020999 UNLISTED MUSCULOSKELETAL SYS 105.00 2300021011 EXC FACE LESION SUBCU <2.0 CM 1,138.00 2300021012 EXC FACE LESION SUBQ 2.1 CM/> 1,117.00 2300021026 EXC BONE; FACIAL BONE(S) 1,654.00 2300021315 CLOSED TX NASAL BONE FX; WO ST 900.00 2300021320 CLOSED TX NASAL BONE FX; W STA 835.00 2300021337 CLOSED TX NASAL SEPTAL FRACTUR 1,322.00 2300021552 EXC NECK LES SC 3 CM/> 1,477.00 2300021554 EXCISE NECK TUMOR DEEP 5 CM> 2,412.00 2300021555 EXCISE NECK LESION SUBQ <3 CM 1,358.00 2300021930 EXC BACK LES SC < 3 CM 1,204.00 2300021931 EXCISION BACK LESION SUBQ 3 CM 1,552.00 2300021933 EXC BACK TUMOR DEEP 5 CM> 2,439.00 2300022100 PEXC PVC BONE LES 1 SEGM; CERV 3,062.00 2300022102 PEXC PVC B LES 1 SEGM; LUMB 2,632.00 2300022551 NECK SPINE FUSE & REMOVE BELOW 5,727.00 2300022552 SPINE FUSE&REMV CERV BELOW C2 1,341.00 2300022554 SPINE FUSION WO DECOMPRS CERV 4,188.00 2300022845 INSERT SPINE FIXATION DEVICE A 2,460.00 2300022846 INSERT SPINE FIXATION DEVICE A 2,554.00 2300022853 INSJ BIOMECHANICAL DEVICE 878.00 2300022855 REM ANTERIOR SEGMENTAL INSTRUM 3,694.00 2300022900 EXC ABDOMINAL TUMOR DEEP <5 CM 1,864.00 2300022902 EXC ABDOMINAL LESION 3 CM> 1,437.00 2300022903 EXC ABDOMINAL LESION SUBQ 3 CM 1,449.00 2300023030 I & D SHLDR; DEEP ABSC 844.00 2300023071 EXC SHOULDER LESION SUBCU 3 CM 1,384.00 2300023075 EXC SHOULDER LESION SUBCU < 3 1,535.00 2300023120 CLAVICULECTOMY; PARTIAL 1,920.00 2300023130 ACROMIOPLASTY/ACROMIONECTOMY P 2,003.00 2300023405 TENOMYOTOMY SHOULDER; SINGLE 2,048.00 2300023406 TENOMYOTOMY SHOULDER; MULTIPLE 2,531.00 2300023410 OPEN REPAIR ROTATOR CUFF 2,704.00 2300023412 REPAIR ROTATOR CUFF; CHRONIC 2,803.00 2300023415 CORACOACROMIAL LIGAMENT RELEAS 2,294.00 2300023420 RECONSTRUCT RC AVULSION CHRONI 3,189.00 2300023430 TENODESIS LARGE TENDON OF BICE 2,451.00 2300023455 CAPSULORRHAPHY; BANKART 3,278.00 2300023462 CAPSULORRHAPHY ANT; W CPT 3,478.00 2300023466 CAPSULORRHAPHY GHJ MULTIDIR 3,722.00 2300023472 ARTHROPLASTY GHJ TOTAL SHOULDE 4,804.00 2300023474 REVIS RECONST SHOULDER JOINT 5,805.00 2300023485 OSTEOTOMY CLAVICLE; W BONE GRA 3,137.00 2300023515 OPEN TX CLAVICLE FRACTURE 2,369.00 2300023552 OP TX ACLAV DISLOC W GRAFT 2,153.00 2300023615 OPEN TX PROXIMAL HUMERAL FRACT 2,910.00 2300023630 OPEN TX GREATER HUMERAL TUBERO 2,565.00 2300023650 CL TX SHLDR DISL W MAN 939.00 2300023655 CL TX SHLDR DISL W MANIP 1,313.00 2300023665 CL TX SHLDR DISLOC&FX G; W MAN 1,297.00 2300023670 OPEN TX SHLDER DISLC W HUM TUB 2,881.00 2300023700 MANIP SHOULDER JOINT UNDER ANE 645.00 2300024066 DEEP SFT TISS BX - UPPER ARM/E 2,044.00 2300024075 EXC ARM/ELBOW LESION SUBCU <3 1,605.00 2300024105 EXCISE OLECRANON BURSA 1,148.00 2300024120 EXC CYST/TUMOR - RADIUS 1,736.00 2300024300 MANIPULATE ELBOW W/ANESTH 1,361.00 2300024341 REPAIR UPPER ARM/ELBOW TENDON/ 2,451.00 2300024342 REINSERT RUPTURED BICEPS/TRICE 2,549.00 2300024358 REINSERT RUPTURED BICEPS/TRICE 1,714.00 2300024359 REPAIR ELBOW DEB/ATTCH OPEN 2,166.00 2300024515 OPEN TX HUMERUS SFT FX W PLATE 2,884.00 2300024538 PERCUTANEOUS FIX SC/TC HUMERUS 2,450.00 2300024575 OPEN TX HUMERUS EPICONDYLAR FX 2,412.00 2300024579 TREAT HUMERUS CONDYLAR FRACT 2,760.00 2300024605 CLOSED TX ELBOW DISLOCATION W 1,538.00 2300024635 OPEN TX MONTEGGIA ELBOW FRACTU 2,211.00 2300024665 OPEN TX RADIAL HEAD/NECK FRACT 2,144.00 2300024666 OPEN TX RADIAL HEAD/NECK FX 2,414.00 2300024685 OPEN TX ULNAR FX PROXIMAL END 2,147.00 2300025000 TENDON SH INCISION; RAD STYL 1,278.00 2300025075 EXC FOREARM LESION SUBCUTANEOU 1,560.00 2300025107 REPAIR WRIST JOINT CARTILAGE 2,021.00 2300025111 EXCISE 1 WRIST GANGLION 1,049.00 2300025112 EXCISE RECURRENT WRIST GANGLIO 1,268.00 2300025210 REMOVAL OF WRIST BONE; 1 BONE 1,596.00 2300025240 EXCISION OF DISTAL ULNA 1,402.00 2300025248 DEEP FB REMOVAL - FOREARM/WRIS 1,351.00 2300025259 MANIPULATE WRIST W ANESTHESIA 1,359.00 2300025260 REP TENDON/MUSCLE - FOREARM/WR 2,064.00 2300025270 REP T/M EXTENSOR FOREARM/WRIST 1,605.00 2300025275 REP TS FA/WR W FGRAFT 2,199.00 2300025310 TRANSPLANT FOREARM TENDON 2,032.00 2300025312 TRANSF TEND FLEX/EXT FA/W W GR 2,356.00 2300025320 OPEN REPAIR WRIST JOINT 3,240.00 2300025332 WRIST ARTHROPLASTY 2,765.00 2300025360 OSTEOTOMY; ULNA 2,145.00 2300025390 SHORTENING OF RADIUS OR ULNA 2,531.00 2300025420 REPAIR NONUNION RADIUS/ULNA 3,827.00 2300025425 REPAIR RAD OR ULNA AUTOGRAFT 3,170.00 2300025440 REPAIR CARPAL NAVICULAR BONE 2,527.00 2300025445 PROSTH REPLACEMENT TRAPEZIUM B 2,373.00 2300025447 REPAIR WRIST JOINTS 2,721.00 2300025505 CLOSED TX RADIAL SHAFT FX W MA 1,629.00 2300025515 OPEN TX RADIAL SHAFT FRACTURE 2,196.00 2300025526 OPEN RDL SHAFT FX RAD/ULN JT 3,128.00 2300025545 TREAT FRACTURE OF ULNA SHAFT 2,051.00 2300025565 CLOSED TX RADIAL & ULNA FX W M 1,687.00 2300025575 OPEN TX RADIAL & ULNAR SHFT FX 2,964.00 2300025605 CLSD TX DSTL RDL FX/EPIPHYSL S 1,773.00 2300025606 PERC TX DISTAL RADIAL FX W FIX 2,176.00 2300025607 OPEN TX DIST RADIUS EXTRA-ARTI 2,413.00 2300025608 OPEN TX RADIAL INTRA-ARTIC FX; 2,707.00 2300025609 OPEN TX DSTL RADIAL INTRA-ART 3,443.00 2300025628 OPEN TX CARPAL SCAP NAVI FRACT 2,367.00 2300025635 CLSD TX CARPL BONE FX W MANIP 1,369.00 2300025651 PIN ULNAR STYLOID FRACTURE 1,582.00 2300025652 OPEN TX ULNAR STYLOID FRACTURE 2,048.00 2300025695 OPEN TX OF LUNATE DISLOCATION 2,079.00 2300025805 FUSION WRIST JNT W SLIDE GRAFT 2,780.00 2300025810 FUSION WRIST JOINT W AUTOGRAFT 2,853.00 2300025820 INTERCARPAL FUSION; WO BONE GR 2,016.00 2300025830 RADIOULNAR JNT FUS/ULNA RESECT 3,145.00 2300025931 TRANSMETACARPAL; RE-AMPUTATE 2,378.00 2300026011 DRAIN FINGER ABSC; COMPLICATED 606.00 2300026034 DEEP INCISION OF HAND/FINGER 1,769.00 2300026040 PERC RELEASE - DUPUYTREN'S CON 1,021.00 2300026055 TENDON SHEATH INCISION FINGER 1,817.00 2300026060 PERC INCISION FINGER TENDON EA 852.00 2300026075 EXPLORE/REMOVE FB MCP JOINT 1,090.00 2300026080 EXPLORE/REMOVE FB IP JOINT EA 1,277.00 2300026111 EXC HAND LESION SUBCU 1.5 CM> 1,372.00 2300026115 EXC HAND LESION SUBCU < 1.5 CM 1,644.00 2300026123 PALM W SINGLE DIGIT RELEASE 2,740.00 2300026125 PALM RELEASE W EA ADDITIONAL D 907.00 2300026160 EXC TENDON SHEATH LESION HAND/ 1,868.00 2300026200 EXC CYST/TUMOR MCP 1,470.00 2300026210 EXC CYST/TUMOR FINGER PHALANX 1,449.00 2300026320 REMOVE IMPLANT FROM FINGER OR 1,134.00 2300026340 MANIPULATE FINGER JOINT W ANES 1,090.00 2300026350 REP FLEXOR TENDON NOT ZONE 2 W 2,299.00 2300026356 REPAIR FLEXOR TENDON ZONE 2 EA 2,601.00 2300026357 2NDRY TENDON REP NO MAN'S EACH 2,911.00 2300026370 1 PROFUNDUS TENDON REPAIR 2,449.00 2300026372 PROFUNDUS TENDON REP/ADV; 2 W 2,785.00 2300026410 REP EXTENDON HAND; WO FREE GRF 1,823.00 2300026418 EXTENSOR TENDON REPAIR EACH 1,863.00 2300026432 CLOSED TREATMENT MALLET FINGER 1,609.00 2300026433 REPAIR MALLET FINGER WO GRAFT 1,709.00 2300026440 RELEASE FLEXOR TENDON PALM/FIN 1,997.00 2300026460 OPEN INCIS HAND/FINGER EXTENSO 1,272.00 2300026480 CMC TENDON TRANSFER/TRANSPLANT 2,426.00 2300026483 CMP TENDON TRANSPL W GRAFT 2,717.00 2300026490 SUBLIMIS TENDON TRANSFER 2,581.00 2300026492 OPPONENSPLASTY; TENDON TRNSFER 2,864.00 2300026497 RING AND SMALL FINGER TENDON T 2,809.00 2300026520 RELEASE MCP JOINT CONTRACTURE 2,099.00 2300026530 ARTHROPLASTY MCP JOINT; EA JOI 1,763.00 2300026535 IP JNT ARTHROPLASTY - EA 1,403.00 2300026540 REPAIR MCP/IP JOINT COLLATERAL 2,123.00 2300026548 REP & RECONST FINGER VPLATE IP 2,449.00 2300026567 OSTEOTOMY TO CORRECT DEFORMITY 2,192.00 2300026605 CLOSED TX MC FX SINGLE; W MANI 1,045.00 2300026607 CLOSED TX MC FX W MANIP & FIXA 1,488.00 2300026608 PERC SKEL FIXATION MC FX; EA B 1,558.00 2300026615 OPEN TX METACARPAL FX W FIXATI 1,888.00 2300026641 CLOSED TX CMC DISLOC THUMB W M 1,221.00 2300026665 OPEN TX CARPOMETACARPAL FX/DIS 2,057.00 2300026676 PIN CMC DISLOCATION EA JOINT 1,634.00 2300026725 CL TX PHALANG SHFT FX; W MANIP 989.00 2300026727 PERC SKL FIX UNST PHAL SHFT FX 1,536.00 2300026735 OPEN TX PHALANG SHAFT FX PROX/ 1,956.00 2300026746 OPEN TX ARTICULAR FX MCP/IP JO 2,436.00 2300026750 CLOSED TX DIST PHAL FX FNGR/TH 597.00 2300026755 CLOSED TX DIST PHAL FX FGR/THM 1,019.00 2300026756 PERC SKTL FIX DIST PHAL FX FIN 1,363.00 2300026765 OPEN TX DISTAL PHALANGE FX EA 1,640.00 2300026775 CL TX IP JT D W MANIP; W ANES 1,129.00 2300026776 PERC SKL FIX IP JOINT DISL SNG 1,447.00 2300026842 ARTHRODESIS CMC JOINT THUMB W 2,533.00 2300026850 ARTHROD MCP JOINT W/WO FIX 2,233.00 2300026860 ARTHRODESIS IP JOINT W/WO FIXA 1,822.00 2300026910 AMPUTATION METACARPAL W FINGER 2,334.00 2300026951 AMPUTATE FING/THMB SNGL; W DIR 2,108.00 2300026952 AMPUTATE FINGER/THMB SGL; W LO 2,082.00 2300026990 I&D PELV/HIP JOINT ABSCESS; DE 2,060.00 2300027030 ARTHROTOMY HIP W DRAINAGE 3,083.00 2300027041 ST BX; HIP/PELVIS; DEEP 2,293.00 2300027047 EXC HIP/PELVIS LES SC < 3 CM 1,194.00 2300027052 ARTHROTOMY W BIOPSY; HIP JOINT 1,907.00 2300027062 EXC TROCHANTERIC BURSA/CALCIFI 1,497.00 2300027125 PARTIAL HIP REPL PROSTHESIS 3,741.00 2300027130 TOTAL HIP ARTHROPLASTY 4,477.00 2300027132 CONVERT TO TOTAL HIP ARTHROPLA 5,530.00 2300027170 BONE GRAFT FEMORAL HEAD NECK I 3,879.00 2300027235 PERC FIX FEMUR PROXIMAL NECK F 2,999.00 2300027236 BIPOLAR HIP REPLACEMENT 3,947.00 2300027238 CL TX INTER/PERI/SUBTROCH FEM 1,510.00 2300027240 CLSD TX INTR/PERI/SBTROCH FEM 3,156.00 2300027244 TX INTER/PR/SUBTROCH FEM FX SC 4,063.00 2300027245 TX INTER/PR/SUBTROCH FEM FX IM 4,063.00 2300027248 OPEN TX GREATER TROCHANTERIC F 2,447.00 2300027257 TX SPONTAN HIP DISLOC W ANES 1,124.00 2300027266 CLOSED TX POSTOP HIP DISLOC W 1,910.00 2300027299 UNL PROC PELVIS/HIP JOINT 105.00 2300027301 DEEP I&D THIGH/KNEE 2,199.00 2300027328 EXC THIGH/KNEE TUM DEEP <5CM 2,057.00 2300027332 ARTHROTOMY KNEE W MENISC; MED 2,109.00 2300027337 EXCIS THIGH/KNEE LESION SUBCU 1,378.00 2300027340 EXCISION PREPATELLAR BURSA 1,220.00 2300027355 EXC FEMUR BONE CYST/TUMOR 1,991.00 2300027372 REM DEEP FB THIGH OR KNEE 1,320.00 2300027380 REPAIR KNEECAP TENDON 1,947.00 2300027403 ARTHROTOMY W MENISCUS REPAIR 2,103.00 2300027418 ANTERIOR TIBIAL TUBERCLEPLASTY 2,711.00 2300027422 RECONSTRUCT DISLOC PATELLA W M 2,442.00 2300027427 LIGAMENT AUGMENT KNEE; EXTRA-A 2,338.00 2300027428 LIGAMENT AUGMENT KNEE; INTRA-A 3,659.00 2300027438 ARTHROPLASTY PATELLA; W PROSTH 2,763.00 2300027442 ARTHROPLASTY KNEE FC/TP 2,863.00 2300027447 TOTAL KNEE ARTHROPLASTY 4,473.00 2300027506 OPEN TX FEMORAL SHFT FX W INS 4,413.00 2300027514 OPEN TX FEMORAL FX DIST MED/LA 3,189.00 2300027524 OPEN TX PATELLA FX W INT FIX & 2,474.00 2300027535 OPEN TX TIBIAL FX PROX UNICOND 2,959.00 2300027540 OPEN TX INTERCOND SPINE/TUBRST 2,671.00 2300027570 MANIPULATE KNEE JOINT UNDER AN 496.00 2300027598 DISARTICULATION AT KNEE 2,373.00 2300027603 I&D LEG/ANKLE DEEP ABSCESS/HEM 1,730.00 2300027610 INC ANKLE W EXPL; INFECTION/RE 2,135.00 2300027613 SUPERF SOFT TISS BIOPSY LEG/AN 826.00 2300027618 EXC LEG/ANKLE TUM < 3 CM 1,016.00 2300027620 EXPLORE/TREAT ANKLE JOINT 1,494.00 2300027630 EXC TENDON SHTH LESION LEG/ANK 1,203.00 2300027635 EXCISE TIB/FIB BONE CYST/TUMOR 1,924.00 2300027650 PRIMARY REPAIR RUPTURED ACHILL 2,161.00 2300027654 SECONDRY REPR RUPT ACHILLES TE 2,325.00 2300027695 SUTURE LIGAMENT ANKLE; COLLATE 1,567.00 2300027696 1' SUTR BOTH RUPTR ANKLE COLLA 1,813.00 2300027726 REPAIR FIBULA NONUN/MALUN W IN 3,173.00 2300027752 CLOSED TX TIBIA SHAFT FX W MAN 1,755.00 2300027758 TREATMENT OF TIBIA FRACTURE 2,945.00 2300027759 OPEN/PERC TX TIBIA SHAFT FX BY 3,291.00 2300027766 OPEN TX MEDIAL ANKLE FRACTURE 2,002.00 2300027769 OPEN TX POSTERIOR ANKLE FRACTU 2,378.00 2300027784 OPEN TREATMENT FIBULA FRACTURE 2,351.00 2300027786 CLOSED TX DISTAL FIBULA FX WO 1,029.00 2300027788 CL TX DISTL FIB FX W MANIP 1,260.00 2300027792 OPEN TX DISTAL FIBULAR FX LAT 2,146.00 2300027814 OPEN TX BIMALLEOLAR ANKLE FRAC 2,538.00 2300027822 OPEN TX TRIMALL ANKLE FX WO FI 2,825.00 2300027823 OPEN TX TRIMALL ANKLE FX W FIX 3,203.00 2300027827 OPEN TX FRACTURE DISTAL TIBIA 3,619.00 2300027829 OPEN TX TIBIA/FIBULA JOINT 2,287.00 2300028002 DEEP DISSECT FOOT INFECT; SGL 1,452.00 2300028010 TENOTOMY PERCUTANEOUS TOE; SIN 761.00 2300028024 EXPL W DR/REM FB - IP FOOT JOI 1,516.00 2300028039 EXCISE FOOT/TOE TUMOR SUBCU 1. 1,675.00 2300028043 EXCISE FOOT/TOE TUMOR DEEP 1.5 1,325.00 2300028060 PARTIAL REMOVAL FOOT PLANTAR F 1,708.00 2300028080 EXCISE INTERDIGIT MORTON NEURO 1,737.00 2300028090 EXCISE FOOT CYST/GANGLION 1,553.00 2300028108 EXC BONE CYST/BENIGN TUMOR FOO 1,454.00 2300028110 PARTIAL EXCISION 5TH METATARSA 1,532.00 2300028111 COMPLEX EXCISION 1ST METATARSA 1,629.00 2300028116 EXCISION OF TARSAL COALITION 2,507.00 2300028119 REMOVE HEEL SPUR 1,735.00 2300028120 PARTIAL EXCISION ANKLE OR HEEL 2,231.00 2300028122 PARTIAL EXCISION TARSAL/METATA 1,978.00 2300028124 PARTIAL EXCISION PHALANX OR TO 1,577.00 2300028126 RESECT PHALANGEAL BASE SINGLE 1,309.00 2300028140 REMOVEL METATARSAL (METATARSEC 1,967.00 2300028153 RESECT HEAD OF TOE PHALANX 1,358.00 2300028190 REM FB FOOT; SQ 443.00 2300028192 REMOVE DEEP FB OF FOOT 1,548.00 2300028200 REPR FOOT FLEXOR TENDON EA 1,065.00 2300028208 REPR FOOT EXTENSOR TENDON EA 1,032.00 2300028232 TENOTOMY OPEN FLEXOR; TOE SIN 1,281.00 2300028234 OPEN INCISION FOOT/TOE EXTENSO 1,351.00 2300028238 ADV POST TIBIAL TENDN W EXC NA 2,212.00 2300028270 MTP JOINT CAPSULOTOMY EACH SI 1,628.00 2300028285 HAMERTOE OP ONE TOE 1,768.00 2300028288 PRTL REM FOOT BONE MTRSL HEAD 1,995.00 2300028289 REPAIR HALLUX RIGIDUS 2,469.00 2300028291 CORRJ HALUX RIGDUS W/IMPLT 1,580.00 2300028292 KELLER/MCBRIDE/MAYO BUNION COR 2,468.00 2300028296 BUNION CORRECT W METATARSAL BO 3,012.00 2300028297 CORRECTION OF BUNION W/WO SESM 3,462.00 2300028298 CORRECTION HALLUX VALGUS 1,629.00 2300028299 DOUBLE OSTEOTOMY BUNION CORREC 3,309.00 2300028306 METATARSAL SHORTEN; 1ST METATA 2,032.00 2300028308 METATARSAL SHORTEN NOT 1ST MT 1,875.00 2300028313 RECONSTR ANGLE TOE DEFORMITY 1,170.00 2300028315 SESAMOIDECTOMY FIRST TOE 1,076.00 2300028322 REPAIR NU/MU; METATARSAL 2,598.00 2300028420 TREAT/GRAFT HEEL FRACTURE; OPE 4,192.00 2300028445 TREAT ANKLE FRACTURE; OPEN 3,500.00 2300028476 PERC SKEL FEX METATARSAL FX W 1,157.00 2300028485 OPEN TX METATARSAL FRACTURE 1,778.00 2300028505 TREAT BIG TOE FRACTURE 2,560.00 2300028515 CLOSED TX PHALANX/PHALANG FX W 530.00 2300028525 TREAT TOE FRACTURE 1,304.00 2300028531 OPEN TX SESAMOID FRACTURE 1,133.00 2300028645 REPAIR TOE DISLOCATION 1,593.00 2300028740 ARTHRODESIS MT/TME;SGL JOINT 2,049.00 2300028750 ARTHRODESIS GREAT TOE; MTP JOI 2,677.00 2300028810 AMPUTATE METATARSAL W TOE SING 1,424.00 2300028820 AMPUTATE TOE; MTP JOINT 1,863.00 2300028825 AMPUTATE TOE; IP JOINT 1,780.00 2300029805 SHOULDER ARTHROSCOPY DIAGNOST 1,553.00 2300029806 SHOULDER CAPSULOR ARTHROSCOPY 3,501.00 2300029807 REPAIR SHOULDER SLAP LESION 3,414.00 2300029819 ARTHROSCOPY SHOULDER; W REMOVA 1,928.00 2300029822 ARTHROSCOPY SHOULDER; DEBRIDE 1,864.00 2300029823 ARTHROSCPY SHLDR; DEBRID EXT 2,042.00 2300029824 SHOULDER MUMFORD PROCEDURE 2,191.00 2300029825 ARTHROSCOPY SHOULDER; W LYSIS 1,897.00 2300029826 SHOULDER ARTHROSCOPY/SURGERY 584.00 2300029827 ROTATOR CUFF REPAIR ARTHROSCOP 3,473.00 2300029828 ARTHROSCOPY BICEPS TENODESIS 2,997.00 2300029830 ARTHROSCOPY ELBOW DIAGNOSTIC 1,509.00 2300029837 ARTHROSCOPY ELBOW; LIM DEBRID 1,718.00 2300029846 ARTHROSCOPY WRIST; EXC/REP CAR 1,709.00 2300029851 ARTHROSCOPE TX IC KNEE;W FIX 3,089.00 2300029862 ARTHROSCOPY HIP; W REM FB W CH 2,652.00 2300029863 ARTHROSC HIP; W REM FB W SYN 2,652.00 2300029866 AUTGRAFT IMPLANT KNEE W SCOPE 3,417.00 2300029870 KNEE ARTHROSCOPY DIAGNOSTIC 1,910.00 2300029874 ARTHROSCOPY KNEE; REMOVE LOOSE 1,769.00 2300029875 ARTHROSCOPY KNEE; LIMITED SYNO 1,630.00 2300029877 ARTHROSCOPY KNEE; DEBRIDE/SHAV 2,046.00 2300029879 ARTHROSCOPY KNEE; ABRASION ART 2,181.00 2300029880 ARTHROSCOPY KNEE; W MENISC MED 1,852.00 2300029881 ARTHROSCOPY KNEE; W MENISC MED 1,782.00 2300029882 ARTHROSCOPY KNEE; W MENISC REP 2,313.00 2300029883 ARTHROSC KNEE;W MEN RPR M/L 2,790.00 2300029887 ARTHROSC KNEE;DRILL OD LES W 2,485.00 2300029888 ARTHROSCOPY; ANT CRUCIATE LIG 3,249.00 2300029891 ARTHROSCOPY ANKLE;EXC OSCHON D 2,210.00 2300029892 ARTHROSC REPAIR O.D. LESION/FX 2,127.00 2300029893 ENDOSCOPIC PLANTAR FASCIOTOMY 2,014.00 2300029899 ANKLE ARTHROSCOPY WITH FUSION 3,421.00 2300029914 ARTHROSCOPY HIP W FEMOROPLASTY 3,270.00 2300029916 ARTHROSCOPY HIP W LABRAL REPAI 3,334.00 2300029999 UNLISTED JNT ARTHROSC 105.00 2300030110 EXCISION NASAL POLYP(S) SIMPLE 746.00 2300030115 EXCISE NASAL POLYP(S) EXTENSIV 1,400.00 2300030117 REMOVE INTRANASAL LESION; INTE 2,835.00 2300030140 RESECT INFERIOR TURBINATE 1,427.00 2300030220 INSERT NASAL SEPTAL PROSTH (BU 980.00 2300030310 REMOVE FB INTRANASAL; W ANESTH 670.00 2300030520 SEPTOPLASTY OR SUBMUCOUS RESEC 2,020.00 2300030630 REPAIR NASAL SEPTAL PERFORATIO 2,018.00 2300030901 CONTROL NASAL HEMORRHAG ANTERI 309.00 2300030903 CONTROL NASAL HEMORRHAGE ANT; 718.00 2300031051 SINUSOTOMY SPHENOID; W POLYPE 2,093.00 2300031200 ETHMOIDECTOMY; INTRANASAL ANT 1,858.00 2300031201 ETHMOIDECTOMY; INTRANASAL TOTA 2,401.00 2300031237 NASAL ENDO; W BX POLYPECTOMY/D 838.00 2300031238 NASAL ENDO W HEMORRHAGE CONTRO 837.00 2300031254 NASAL ENDOSCOPY ETHMOIDECTOMY; 894.00 2300031255 NASAL ENDOSCOPY W ETHMOIDECTOM 1,308.00 2300031256 NASAL ENDOSCOPY W MAXILLARY AN 647.00 2300031267 NASAL ENDO W MAX ANT; W REM TI 1,038.00 2300031276 NASAL/SINUS ENDO W FRONTAL SIN 1,650.00 2300031287 NASAL/SINUS ENDOSCOPY W SPLENO 759.00 2300031288 NASAL ENDO; W REM TISS SPHENOI 880.00 2300031296 SINUS ENDO W/BALLOON DIL FR 588.00 2300031525 DIAGNOSTIC LARYNGOSCOPY EXCEPT 825.00 2300031535 LARYNGOSCOPY W/BIOPSY 624.00 2300031536 LARYNGOSCOPY W/BIOPSY & OP SCO 696.00 2300031540 LARYNGOSCOPY W/EXC OF TUMOR 797.00 2300031541 LARYNSCOP W/TUMR EXC + SCOPE 870.00 2300031575 DIAGNOSTIC FLEX LARYNGOSCOPY 370.00 2300031600 TRACHEOSTOMY PLANNED 1,063.00 2300032550 INSERT PLEURAL CATH 686.00 2300032551 INSERTION OF CHEST TUBE 521.00 2300032555 ASPIRATE PLEURA W IMAGING 943.00 2300035840 EXPLORE POSTOP HEMOR/THROMB/IN 3,971.00 2300036556 INSERT NON-TUNNEL CV CATH 5 YE 760.00 2300036561 INSERT TUNNELED CVAD W PORT AG 3,545.00 2300036571 INSERT PICC DEVICE W PORT 5 YR 3,955.00 2300036582 REPLACE TUNNELED VAD W PORT 3,283.00 2300036589 REMOVE TUNNELED CV CATHETER 537.00 2300036590 REMOVE TUNNELED CVAD W PORT/PU 727.00 2300036591 DRAW BLOOD OFF VENOUS DEVICE 77.00 2300037609 LIGATION OR BIOPSY TEMPORAL AR 1,014.00 2300038300 DRAIN LYMPH ND ABSCESS/INFECTI 888.00 2300038500 OPEN BIOPSY OR EXCISE LYM NODE 1,088.00 2300038510 OPEN BX/EXC LYM NODE; DEEP CER 1,703.00 2300038520 OPEN BIOPSE/EXC LN; DEEP CERV 1,532.00 2300038525 OPEN BX/EXC LYM NODE; CERV W S 1,446.00 2300038530 OPEN BX/EXC LN; INT MAMM NODE( 1,832.00 2300038570 LAP; W RETROP LN BX SINGLE/MUL 1,667.00 2300038760 INGUINOFEM LYMPPHADENECTOMY SU 2,792.00 2300038765 INGUINOFEM W PELVIC LYMPHADECT 4,290.00 2300038792 RA TRACER ID OF SENTINL NODE 132.00 2300040510 EXCISE LIP; TRANSVERSE WEDGE E 1,591.00 2300040650 REPAIR LIP FRONT; VERMILION ON 1,441.00 2300040812 EXC LES MOUTH VESTIBULE W SIMP 960.00 2300040814 EXC LES MOUTH VESTIBULE W COMP 1,285.00 2300041000 I&D ABSC/CYST TONGUE FOM; LING 538.00 2300041010 INCISION OF LINGUAL FRENUM (FR 662.00 2300041100 BIOPSY OF TONGUE; ANTERIOR 2/3 556.00 2300041112 EXC TONGUE LESION W CLOSE; ANT 1,112.00 2300042000 DRAINAGE ABCESS PALATE UVULA 558.00 2300042104 EXCISE LESION PALATE UVULA; WO 714.00 2300042140 UVULECTOMY EXCISION OF UVULA 515.00 2300042408 EXCISE SUBLINGUAL SALIVARY CYS 1,495.00 2300042440 EXCISION SUBMANDIBULARGLAND 1,357.00 2300042808 EXCISE OR DESTROY PHARYNX LESI 747.00 2300042820 REMOVE TONSILS AND ADENOIDS <1 952.00 2300042825 REMOVAL OF TONSILS <12 YEARS O 864.00 2300042826 TONSILLECTOMY; AGE 12 OR OLDER 829.00 2300042830 REMOVAL OF ADENOIDS 1' <12 YEA 683.00 2300042831 ADENOIDECTOMY; AGE 12 AND OVER 739.00 2300042860 EXCISION OF TONSIL TAGS 620.00 2300042960 CONTROL OROPHARYNGEAL HEMORRHA 562.00 2300042961 CONTROL OROPHARYNG HEMORRH; CO 1,393.00 2300042962 CONTROL OROPHARYNGEAL HEMORRH; 1,715.00 2300043194 ESOPHAGOSCP RIG TRNSO REM FB 638.00 2300043202 ESOPHAGOSCOPY FLEX W/BIOPSY 1,000.00 2300043235 EGD DIAGNOSTIC BRUSH WASH 834.00 2300043239 EGD BIOPSY SINGLE/MULTIPLE 1,115.00 2300043245 EGD DILATE STRICTURE 1,796.00 2300043246 EGD PLACE GASTROSTOMY TUBE 672.00 2300043247 EGD REMOVE FOREIGN BODY 1,139.00 2300043249 ESOPHAGEAL EGD DILATION < 30 M 3,305.00 2300043280 LAP ESOPHAGOGASTRIC FUNDOPLSTY 3,589.00 2300043282 LAP PARAESOPH HER RPR W/MESH 5,770.00 2300043450 DILATE ESOPH UNGUIDED SOUND/BO 511.00 2300043830 GASTROSTOMY OP; WO GASTIC TUBE 2,317.00 2300043840 GASTRORRHAPHY SUTURE PERF DUOD 4,510.00 2300044005 ENTEROLYSIS 3,635.00 2300044020 BIOPSY FB OR EXPLORE SMALL INT 3,229.00 2300044050 RED VOLVULUS INTUSSUSCEPTION 3,101.00 2300044055 CORRECT MALROTATION BY LYSIS 4,938.00 2300044120 RESECT SM INTESTINE; SGL RESEC 4,062.00 2300044130 ENTEROENTEROSTOMY ANASTOM OF I 4,359.00 2300044140 COLECTOMY PARTIAL; W ANASTOMOS 4,452.00 2300044141 COLECTOMY PART; W SM LN CECOST 6,063.00 2300044143 COLECTOMY PARTIAL; (HARTMANN T 5,529.00 2300044147 COLECTOMY P; ABD TRANSANAL 6,451.00 2300044160 P COLECTOMY W REM ILIUM 4,122.00 2300044180 LAPAROSCOPY ENTEROLYSIS 3,050.00 2300044202 LAP ENTERECTOMY 4,601.00 2300044204 LAP PARTIAL COLECTOMY 5,108.00 2300044205 LAP P COLECTOMY W REM ILEUM 4,443.00 2300044207 L COLECTOMY/COLOPROCTOSTPART 6,043.00 2300044213 LAP MOBIL SPLENIC FL ADD-ON 209.00 2300044310 ILEOSTOMY/JEJUNOSTOMY 3,464.00 2300044320 COLOSTOMY 3,987.00 2300044388 COLONOSCOPY THRU STOMA SPX 528.00 2300044602 SUTURE SM IN FOR ULCER WND INJ 4,689.00 2300044604 SUTURE LG IN FOR WND INJ; WO C 3,514.00 2300044620 CLOSED ENTEROSTOMY LG/SM INTES 2,881.00 2300044626 CLOSED ENTEROSTOMY; W RESECT & 5,324.00 2300044800 EXC MECKEL'S DIVERTICULUM OR O 2,537.00 2300044950 APPENDECTOMY 2,130.00 2300044955 APPY; DONE FOR INDICATED PURPO 280.00 2300044960 APPY; FOR RUPTURED APPENDX W P 2,901.00 2300044970 LAPAROSCOPY; APPENDECTOMY 1,991.00 2300045005 I&D OF SUBMUCOSAL ABSCESS; REC 901.00 2300045020 I&D SUPRALEVATOR PELVIRECTAL 1,896.00 2300045100 BIOPSY OF ANORECTAL WALL ANAL 990.00 2300045190 DESTRUCTION RECTAL TUMOR 2,306.00 2300045330 DIAGNOSTIC SIGMOIDOSCOPY 543.00 2300045331 SIGMOIDOSCOPY FLEX WITH BIOPSY 833.00 2300045338 SIGMOIDOSCOPY W REM T/P/LES BY 874.00 2300045378 DIAGNOSTIC COLONOSCOPY 1,029.00 2300045379 COLONOSCOPY W/FB REMOVAL 1,328.00 2300045380 COLONOSCOPY AND BIOPSY 1,317.00 2300045381 COLONOSCOPY SUBMUCOUS NJX 677.00 2300045384 COLONOSCOPY W/LESION REMOVAL 1,461.00 2300045385 COLONOSCOPY W/LESION REMOVAL 1,383.00 2300045388 COLONOSCOPY W/ABLATION 910.00 2300045393 COLONOSCOPY W/DECOMPRESSION 850.00 2300045399 UNLISTED PROCEDURE COLON 105.00 2300045915 REMOVE FECAL IMPACTION OR FB 748.00 2300045990 SURGICAL DIAGNOSTIC EXAM ANORE 357.00 2300046020 PLACEMENT OF SETON 908.00 2300046040 I & D; PERIRECTAL OR ISCHIAL A 1,757.00 2300046045 I & D; SUPERFICIAL ABSCESS PER 1,437.00 2300046050 I & D; PERIANAL ABSCESS 660.00 2300046080 SPHINCTEROTOMY ANAL DIV OF SPH 814.00 2300046200 REMOVAL OF ANAL FISSURE 1,075.00 2300046220 EXCISE ANAL EXTERNAL TAG/PAPIL 675.00 2300046221 LIGATION OF HEMORRHOID(S) 877.00 2300046230 REMOVAL OF ANAL TAGS 571.00 2300046250 REMOVE EXTERNAL HEMORRHOID GRO 1,518.00 2300046255 REMOVE INT/EXT HEM 1 GROUP 1,168.00 2300046260 REMOVE IN/EX HEMORRHOID GROUPS 1,570.00 2300046270 REMOVE ANAL FISTULA SUBQ 1,667.00 2300046275 REMOVAL OF ANAL FISTULA 1,766.00 2300046280 REMOVE ANAL FISTULA; COMPLEX 1,547.00 2300046285 REMOVE ANAL FIST 2 STAGE 1,363.00 2300046320 REMOVAL OF HEMORRHOID CLOT EX 602.00 2300046606 ANOSCOPY AND BIOPSY 739.00 2300046750 REPAIR OF ANAL SPHINCTER 2,488.00 2300046910 DEST ANAL LESION; ELECTRODES 445.00 2300046922 DESTROY ANAL LESION SMPLE; SUR 874.00 2300046924 DESTRUCTION ANAL LESION(S) 1,741.00 2300046946 REMOVE BY LIGAT INT HEM 2+ GRP 747.00 2300046947 HEMORRHOIDOPEXY BY STAPLING 1,263.00 2300047001 NEEDLE BIOPSY LIVER AT MAJOR O 348.00 2300047100 BX OF LIVER WEDGE 2,798.00 2300047379 LAPAROSCOPE PROCEDURE LIVER 105.00 2300047562 LAPAROSCOPIC CHOLECYSTECTOMY 2,180.00 2300047563 LAP; CHOLECYSTECTOMY W CHOLANG 2,368.00 2300047600 CHOLECYSTECTOMY 3,540.00 2300049000 EXPLORE LAPAROTOMY EXPLORE CEL 2,553.00 2300049010 EXPLORE RETROPERITONEAL AREA W 3,098.00 2300049020 DRAINAGE ABDOM ABSCESS OPEN 5,276.00 2300049082 ABDOMINAL PARACENTESIS 628.00 2300049083 ABD PARACENTESIS WITH IMAGING 957.00 2300049084 PERITONEAL LAVAGE 361.00 2300049250 EXCISION OF UMBILICUS 1,950.00 2300049255 OMENTECTOMY EPIPLOECTOMY 2,621.00 2300049320 LAP; DX ABDOMEN/PERITONEUM/OME 1,078.00 2300049321 LAP; ABDOMEN/PERITONEUM/OMENTU 1,142.00 2300049322 LAP; ABD/PERITONEUM/OMENTUM W 1,222.00 2300049329 UNLISTED LAP ABD PERIT OMENT 105.00 2300049402 REMOVE FOREIGN BODY ADBOMEN 2,838.00 2300049419 INSRT ABDOM CATH FOR CHEMOTX 1,473.00 2300049500 RPR ING HERNIA INIT REDUCE 0.5 1,302.00 2300049505 REP INGUINAL HERNIA INIT REDUC 1,724.00 2300049507 REP INGUINAL HERNIA INIT BLOCK 1,938.00 2300049520 REPAIR RECURRENT INGUINAL HERN 2,093.00 2300049550 RPR REM HERNIA INIT REDUCE 1,905.00 2300049553 REPAIR INIT FEM HERNIA REDUCIB 2,089.00 2300049560 REPAIR INIT INCI/VENT HERNIA; 2,445.00 2300049561 REPAIR INITIAL INCISIONAL HERN 3,083.00 2300049564 LAP INC HERNIA REPAIR 2,804.00 2300049565 REPAIR RECURRENT INC HERNIA; R 2,546.00 2300049568 HERNIA REPAIR WITH MESH 889.00 2300049570 REPAIR EPIGASTRIC HERNIA; REDU 1,379.00 2300049585 REPAIR UMBILICAL HERNIA REDUCI 1,473.00 2300049587 REPAIR UMBILICAL HERNIA BLOCKE 1,572.00 2300049605 REPAIR UMBILICAL LESION 16,429.00 2300049650 LAP INGUINAL HERNIA REPAIR INI 1,418.00 2300049652 LAP VENTRAL/ABDOMINAL HERNIA R 2,465.00 2300049654 LAP INC HERNIA REPAIR 2,804.00 2300049656 LAP INC HERNIA REPAIR RECUR 3,043.00 2300049900 ABDOMINL WALL 2' SUTURE FOR EV 2,698.00 2300049905 OMENTAL FLAP INTRA-ABDOMINAL 1,174.00 2300049999 UNLISTED PROC ABD PERITONEUM 105.00 2300050760 URETEROURETEROSTOMY 3,714.00 2300051860 SUTURE BLADDER WOUND INJURY; S 2,462.00 2300051992 LAP; SLING OP FOR STRESS INCON 2,766.00 2300052000 CYSTOURETHROSCOPY 536.00 2300052005 CYSTOURETHROSCOPY W CATH 440.00 2300054150 CIRCUMCISION W REGIONAL BLOCK 506.00 2300054161 CIRCUM 28 DAYS OR OLDER 648.00 2300054520 REMOVAL OF TESTIS 1,077.00 2300055040 REMOVAL OF HYDROCELE 1,115.00 2300055100 DRAINAGE OF SCROTAL WALL ABSCE 705.00 2300055250 VASECTOMY UNILATERAL OR BILATE 1,262.00 2300055500 EXCISE HYDROCELE OF SPERM CRD 1,306.00 2300055520 EXCISE LESION OF SPERMATIC COR 1,499.00 2300056405 I & D OF VULVA OR PERINEAL ABS 355.00 2300056440 MARSUPIALIZATION BARTHOLIN'S G 593.00 2300056441 LYSIS OF LABIAL LESION(S) 468.00 2300056515 DESTROY LESION(S) VULVA; EXT 658.00 2300056620 VULVECTOMY SIMPLE; PARTIAL 1,708.00 2300056700 PARTIAL HYMENECTOMY OR REV 611.00 2300056740 EXCISE BARTHOLIN'S GLAND OR CY 981.00 2300056810 PERINEOPLASTY REPAIR PERINEUM 847.00 2300057061 DESTROY VAGINAL LESION(S) SIM 320.00 2300057065 DESTROY VAGINAL LESIONS; COMPL 637.00 2300057120 COLPOCLEISIS (LE FORT TYPE) 1,651.00 2300057130 REMOVE VAGINA LESION 574.00 2300057135 EXCISE VAGINAL CYST OR TUMOR 624.00 2300057200 COLPORRHAPHY 985.00 2300057240 ANTERIOR COLPORRHAPHY REPAIR C 2,181.00 2300057250 POSTERIOR COLPORRHAPHY REPAIR 2,194.00 2300057260 COMBINED ANTEROPOSTERIOR COLPO 2,702.00 2300057265 COMB ANT/POST COLPORRHAPHY; W 2,960.00 2300057268 REPAIR OF BOWEL BULGE 1,573.00 2300057282 SACROSPINOUS LIGAMENT FIX FOR 1,626.00 2300057285 REPAIR PARAVAGINAL DEFECT VAG 2,186.00 2300057287 REV/REP STRESS INCONT SLING 2,219.00 2300057288 SLING OPERATION FOR STRESS INC 2,333.00 2300057410 PELVIC EXAMINATION W/ANESTH 352.00 2300057415 REMOVE VAGINAL FOREIGN BODY 521.00 2300057500 BIOPSY OF CERVIX 414.00 2300057520 CONIZATION OF CERVIX COLD KNIF 1,001.00 2300057522 CONIZATION OF CERVIX LEEP 855.00 2300057530 REMOVAL OF CERVIX 1,131.00 2300057720 REVISION OF CERVIX 999.00 2300058120 D&C DIAGNOSTIC OR THERAPEUTIC; 713.00 2300058150 TOTAL ABDOMINAL HYSTERECTOMY 3,315.00 2300058200 EXTENSIVE HYSTERECTOMY 4,513.00 2300058260 VAGINAL HYSTERECTOMY = <250 GM 2,678.00 2300058262 VAG HYST INCLUDING T/O = <250 2,989.00 2300058263 VAG HYST W/T/O & REPR =<250 GM 3,191.00 2300058267 VAG HYST W/URINARY REPAIR = <2 3,399.00 2300058270 VAG HYST W/ENTEROCELE REPAIR = 2,860.00 2300058290 VAGINAL HYSTERECTOMY COMPLEX = 3,730.00 2300058291 VAG HYST INCL T/O COMPLEX >25 4,023.00 2300058300 INSERT IUD 315.00 2300058301 REMOVE INTRAUTERINE DEVICE 308.00 2300058350 CHROMOTUBATION OF OVIDUCT 313.00 2300058353 THERMAL ENDOMETRIAL TUMOR ABLA 3,257.00 2300058356 ENDOMETRIAL CRYOABLATION W ULT 6,099.00 2300058541 LSH UTERUS 250 G OR LESS 2,325.00 2300058545 LAPAROSCOPIC MYOMECTOMY =<250 2,938.00 2300058550 LAPARO-ASST VAG HYSTERECTOMY = 2,860.00 2300058552 LAPARO-VAG HYST INCLUDING T/O 3,210.00 2300058553 LAPARO-VAG HYST COMPLEX 3,691.00 2300058554 LAPARO-VAG HYST W/T/O COMPL > 4,315.00 2300058555 HYSTEROSCOPY DIAGNOSTIC 870.00 2300058558 HYSTEROSCOPY W BX ENDOM OR POL 4,416.00 2300058559 HYSTEROSCOPY; W LYSIS INTRAUT 945.00 2300058561 HYSTEROSCOPY REMOVE MYOMA 1,431.00 2300058562 HYSTEROSCOPY; W REMOVAL IMPACT 1,103.00 2300058563 HYSTEROSCOPY; W ENDOMETRIAL AB 5,156.00 2300058573 TLH W/T/O UTERUS OVER 250 GM 3,974.00 2300058615 OCCLUDE FALLOPIAN TUBE(S) BY D 808.00 2300058660 LAPAROSCOPY; W LYSIS OF ADHESI 2,191.00 2300058661 LAP; W REMOVAL ADNEXAL STRUCTU 2,115.00 2300058662 LAP W EXC/DESTR OVARY PELVIC V 2,310.00 2300058670 LAP W DESTRUCTION OF OVIDUCTS 1,182.00 2300058671 LAP W OCCLUSION OF OVIDUCTS W 1,179.00 2300058700 SALPINGECTOMY COMPL/PARTBI/UNI 2,539.00 2300058720 SALPINGO-OOPHOR COMPL/PART UNI 2,410.00 2300058740 ADHESIOLYSIS TUBE OVARY 2,880.00 2300058805 DRAINAGE OF OVARIAN CYST(S) 1,315.00 2300058925 OVARIAN CYSTECTOMY UNILAT OR B 2,434.00 2300058940 OOPHORECTOMY PARTIAL OR TOTAL 1,720.00 2300058957 RESECT RECURRENT GYN MAL 5,243.00 2300058999 UNLIST PROC FEMALE GENITAL SYS 105.00 2300059120 SURG TX ECTOPIC PREG; TUB/OVAR 2,619.00 2300059150 LAP TX ECT PREG; WO SALPINGECT 2,541.00 2300059151 LAP TX ECT PREG; W SALPINGECT/ 2,478.00 2300059160 D & C AFTER DELIVERY 671.00 2300059812 SURGICAL TX INCOMPLETE ABORTIO 1,052.00 2300059820 SURG TX MISSED ABORTION; 1ST T 1,251.00 2300060210 PARTIAL THYROID LOBECTOMY UNIL 2,331.00 2300060220 TOTAL THYROID LOBECTOMY UNI 2,325.00 2300060240 REMOVAL OF THYROID 3,031.00 2300060252 REMOVAL OF THYROID 4,357.00 2300060500 PARATHYROIDECTOMY 3,186.00 2300062323 NJX INTERLAMINAR LMBR/SAC 326.00 2300063030 LOW BACK DISK SURGERY 3,238.00 2300063035 SPINAL DISK SURGERY ADD-ON 644.00 2300063042 LAMINOTOMY SINGLE LUMBAR 4,322.00 2300063045 REMOVAL OF SPINAL LAMINA SGL C 4,318.00 2300063046 REMOVE SPINAL LAMINA SGL THORA 4,087.00 2300063047 REMOVAL OF SPINAL LAMINA SINGL 3,681.00 2300063048 REMOVE SPINAL LAMINA ADD-ON 711.00 2300063055 DECOMPR SPINAL CORD THORACIC 5,471.00 2300063056 DECOMPRESS SPINAL CORD LUMBAR 4,961.00 2300063075 NECK DISCECTOMY ANTERIOR 4,528.00 2300063076 NECK DISCECTOMY ADDL INTERSP 834.00 2300063081 REMOVAL OF VERTEBRAL BODY 5,876.00 2300063082 REMOVE VERTEBRAL BODY ADD-ON 896.00 2300063267 LAMINECTOMY W EXC INTRASPINOUS 4,586.00 2300063707 REP DURAL/CSF LEAK WO LAMINECT 3,080.00 2300063709 REP DURAL OR CSF LEAK; W LAMIN 3,675.00 2300064418 INJECT ANESTH; SUPRASCAPULAR N 472.00 2300064421 INJECT ANESTH; INTERCOS NERVE 487.00 2300064447 FEMORAL NERVE BLOCK SINGLE 387.00 2300064448 N BLOCK INJ FEMORAL CONTINUOUS 233.00 2300064450 INJECT ANESTH; OTHER PERIPH NE 260.00 2300064493 INJ PARAVERT F JNT L/S 1 LEV 298.00 2300064494 INJ PARAVERT F JNT L/S 2 LEV 171.00 2300064702 REVISE FINGER/TOE NERVE 1-2 1,642.00 2300064718 NEUROPLASTY; ULNAR NERVE AT EL 1,945.00 2300064721 NEUROPLASTY; MEDIAN NRV AT CAR 1,410.00 2300064727 INTERN NEUROLYSIS W USE OF OP 613.00 2300064776 RMV NERVE LESION 1-2 DIGIT 1,289.00 2300064831 REPAIR OF DIGIT NERVE 1 2,258.00 2300064832 SUT DIGIT NERVE HAND/FOOT; EA 1,119.00 2300064834 SUTURE 1 NERVE HAND/FOOT COMM 2,455.00 2300064835 SUTURE 1 NERVE; MEDIAN MOTOR T 2,655.00 2300064836 SUTURE 1 NERVE; ULNAR MOTOR 2,699.00 2300064861 SUTURE; BRACHIAL PLEXUS 4,123.00 2300064999 PROCEDURE NERVOUS SYSTEM 259.00 2300067810 BIOPSY EYELID & LID MARGIN 558.00 2300069005 DR EXT EAR ABS/HEMATOMA; COMP 510.00 2300069110 EXC EXT EAR; PART SIMPLE REP 1,058.00 2300069145 EXC SOFT TISS LESION EXT AUDIT 1,288.00 2300069205 REMOVE FB EXT AUDITORY CANAL; 332.00 2300069210 REMOVE IMPACTED EAR WAX UNILAT 159.00 2300069421 INCISION OF EARDRUM 487.00 2300069424 REMOVE VENTILATING TUBE UNDER 414.00 2300069436 TYMPANOSTOMY UNDER GENERAL ANE 524.00 2300069990 OPERATING MICROSCOPE ADD-ON 741.00 2300077002 NEEDLE LOCALIZATION BY XRAY 92.00 2300092950 HEART/LUNG RESUSCITATION CPR 983.00 2300093010 12 Lead EKG; Interpret And Rep 32.00 2300093018 Cardiovascular Strss Test Int 58.00 2300093227 ECG Monitor/Report Up To 48 Hr 99.00 2300094010 Spirometry 116.00 2300097597 SELECTIVE WOUND DEBRIDEM 20 CM 244.00 2300099217 OBSERVATION CARE DISCHARGE 236.00 2300099218 INITIAL OBSERVATION CARE 30 MI 322.00 2300099219 INITIAL OBSERVATION CARE 50 MI 437.00 2300099220 INITIAL OBSERVATION CARE 70 MI 598.00 2300099221 INITIAL HOSPITAL CARE 30 MIN 328.00 2300099222 INITIAL HOSPITAL CARE 50 MIN 441.00 2300099223 INITIAL HOSPITAL CARE 70 MIN 654.00 2300099231 SUBSEQUENT HOSPITAL CARE 15 MI 126.00 2300099232 SUBSEQUENT HOSPITAL CARE 25 MI 233.00 2300099233 SUBSEQUENT HOSPITAL CARE 35 MI 336.00 2300099234 OBSERV/HOSP SAME DATE 40 MIN 430.00 2300099235 OBSERV/HOSP SAME DATE 50 MIN 544.00 2300099236 OBSERV/HOSP SAME DATE 55 MIN 702.00 2300099238 HOSPITAL DC DAY MNGMT <= 30MIN 234.00 2300099239 HOSPITAL DC DAY MANAGEMENT; > 347.00 2300099241 Office Consultation 15 Min 66.00 2300099242 Office Consultation 30 Min 141.00 2300099243 Office Consultation 40 Min 236.00 2300099244 Office Consultation 60 Min 347.00 2300099245 Office Consultation 80 Min 467.00 2300099251 Inpatient Consultation 20 Min 219.00 2300099252 Inpatient Consultation 40 Min 219.00 2300099253 Inpatient Consultation 55 Min 294.00 2300099254 Inpatient Consultation 80 Min 436.00 2300099255 Inpatient Consultation 110 Min 436.00 2300099281 EMERGENCY DEPT VISIT LEVEL 1 179.00 2300099282 EMERGENCY DEPT VISIT LEVEL 2 294.00 2300099283 EMERGENCY DEPT VISIT LEVEL 3 389.00 2300099284 EMERGENCY DEPT VISIT LEVEL 4 578.00 2300099285 EMERGENCY DEPT VISIT LEVEL 5 1,053.00 2300099291 ER CRITICAL CARE INITIAL HR 1,263.00 2300099292 ER CRITICAL CARE ADDL .5HR 431.00 2300099356 Prolonged Svc Inp First Hour 297.00 2300210021 FNA W/O IMAGE-A 100.00 2300210140 DRAINAGE OF HEMATOMA/FLUID-A 133.00 2300211012 DEBRIDE SKIN/MUSCLE/BONE AT -A 580.00 2300211042 DEBRIDE SUBQ TISSUE 20 SQ CM-A 95.00 2300211043 DEBRIDE MUSC/FASCIA 20 SQ CM-A 186.00 2300211044 DEBRIDE BONE 20 SQ CM/<-A 256.00 2300211301 SHAVE LESION T/A/L; 0.6-1.0 -A 98.00 2300211310 SHAVE LESION F/E/N/L; 0.5 CM-A 93.00 2300211312 SHAVE LESION F/E/N/L; 1.1-2.-A 131.00 2300211420 EXC BEN LES S/N/EX/G; 0.5 CM-A 100.00 2300211421 EXC BEN LES S/N/EX/G; 0.6-1.-A 128.00 2300211755 BIOPSY NAIL UNIT-A 108.00 2300211976 REM IMPL CONTRACEPTIVE CAP-A 116.00 2300211982 REMOVE DRUG IMPLANT-A 131.00 2300212031 INTMD WND REPR S/A/T/EXT <2.-A 193.00 2300213121 CMPLX REP S/A/L; 2.6-7.5 CM-A 348.00 2300213122 C REP S/A/L; EA ADD 5 CM/< -A 142.00 2300213131 CMPLX REP F/G/H/F; 1.0-2.5 C-A 314.00 2300215002 WND PREP T/A/L; 100 SQ CM/1%-A 283.00 2300215100 SKIN SPLT GRFT TK/A/L 100 S-A 700.00 2300215839 EXCISE EXCESS SKIN TISSUE; O-A 720.00 2300219110 NIPPLE EXPL W/WO EXC DUCT-A 396.00 2300219260 EXCISION CHEST WALL TUMOR-A 992.00 2300219281 PERQ DEVICE BREAST 1ST IMAG-A 84.00 2300219301 PARTIAL MASTECTOMY-A 538.00 2300219302 PARTIAL MASTECTOMY W/LN REMO-A 742.00 2300219303 MASTECTOMY SIMPLE COMPLETE-A 834.00 2300219307 MASTECTOMY MODIFIED RADICAL-A 987.00 2300219357 BREAST RECONST W TISSUE EXPA-A 1,238.00 2300220103 EXPL PENETRATING WOUND; EXTR-A 476.00 2300220610 DRAIN SMALL JOINT/BURS NO US-A 79.00 2300220670 REMOVAL OF SUPPORT IMPLANT S-A 309.00 2300220680 REMOVAL IMPLANT; DEEP-A 505.00 2300220900 BONE GRAFT; MINOR/SMALL-A 340.00 2300220931 SPINAL BONE ALLOGRAFT STRUCT-A 95.00 2300220938 SPINAL BONE AUTOGRAFT STRUCT-A 156.00 2300220999 UNLIST MUSCULOSKELETAL SYS-A 27.00 2300221011 EXC FACE LESION SUBCU <2.0 C-A 285.00 2300221012 EXC FACE LESION SUBQ 2.1 CM/-A 280.00 2300221337 CLOSED TX NASAL SEPTAL FRACT-A 331.00 2300221554 EXCISE NECK TUMOR DEEP 5 CM>-A 603.00 2300221931 EXCISION BACK LESION SUBQ 3 -A 388.00 2300221933 EXC BACK TUMOR DEEP 5 CM>-A 610.00 2300222100 PEXC PVC BONE LES 1 SEGM; CE-A 766.00 2300222551 NECK SPINE FUSE & REMOVE BEL-A 1,432.00 2300222552 SPINE FUSE&REMV CERV BELOW C-A 336.00 2300222554 SPINE FUSION WO DECOMPRS CER-A 1,047.00 2300222845 INSERT SPINE FIXATION DEV-A 615.00 2300222846 INSERT SPINE FIXATION DEVICE-A 639.00 2300222853 INSJ BIOMECHANICAL DEVICE-A 439.00 2300222855 REM ANTERIOR SEGMENTAL INSTR-A 924.00 2300222900 EXC ABDOMINAL TUMOR DEEP <5 -A 466.00 2300222902 EXC ABDOMINAL LESION 3 CM>-A 360.00 2300222903 EXC ABDOMINAL LESION SUBQ 3 -A 363.00 2300223071 EXC SHOULDER LESION SUBCU 3 -A 346.00 2300223075 EXC SHOULDER LESION SUBCU < -A 384.00 2300223120 CLAVICULECTOMY; PARTIAL-A 480.00 2300223130 ACROMIOPLASTY/ACROMIONECTOMY-A 501.00 2300223405 TENOMYOTOMY SHOULDER; SINGLE-A 513.00 2300223406 TENOMYOTOMY SHOULDER; MULTIP-A 633.00 2300223410 OPEN REPAIR ROTATOR CUFF-A 676.00 2300223412 REPAIR ROTATOR CUFF; CHRONIC-A 701.00 2300223420 RECONSTRUCT RC AVULSION CHRO-A 798.00 2300223430 TENODESIS LARGE TENDON OF BI-A 613.00 2300223455 CAPSULORRHAPHY; BANKART-A 820.00 2300223462 CAPSULORRHAPHY ANT; W CPT-A 870.00 2300223466 CAPSULORRHAPHY GHJ MULTIDIR-A 931.00 2300223472 ARTHROPLASTY GHJ TOTAL SHOUL-A 1,201.00 2300223474 REVIS RECONST SHOULDER JOINT-A 1,452.00 2300223485 OSTEOTOMY CLAVICLE; W BONE G-A 785.00 2300223515 OPEN TX CLAVICLE FRACTURE-A 593.00 2300223552 OP TX ACLAV DISLOC W GRAFT-A 539.00 2300223615 OPEN TX PROXIMAL HUMERAL FRA-A 728.00 2300223630 OPEN TX GREATER HUMERAL TUBE-A 642.00 2300223670 OPEN TX SHLDER DISLC W HUM T-A 721.00 2300224105 EXCISE OLECRANON BURSA-A 287.00 2300224120 EXC CYST/TUMOR - RADIUS-A 434.00 2300224341 REPAIR UPPER ARM/ELBOW TENDO-A 613.00 2300224342 REINSERT RUPTURED BICEPS/TRI-A 638.00 2300224358 REINSERT RUPTURED BICEPS/TRI-A 429.00 2300224359 REPAIR ELBOW DEB/ATTCH OPEN-A 542.00 2300224515 OPEN TX HUMERUS SFT FX W PLA-A 721.00 2300224575 OPEN TX HUMERUS EPICONDYLAR -A 603.00 2300224579 TREAT HUMERUS CONDYLAR FRACT-A 690.00 2300224635 OPEN TX MONTEGGIA ELBOW FRAC-A 553.00 2300224665 OPEN TX RADIAL HEAD/NECK FRA-A 536.00 2300224666 OPEN TX RADIAL HEAD/NECK FX -A 604.00 2300224685 OPEN TX ULNAR FX PROXIMAL EN-A 537.00 2300225000 TENDON SH INCISION; RAD STYL-A 321.00 2300225107 REPAIR WRIST JOINT CARTILAGE-A 506.00 2300225111 EXCISE 1 WRIST GANGLION-A 263.00 2300225112 EXCISE RECURRENT WRIST GANGL-A 317.00 2300225210 REMOVAL OF WRIST BONE; 1 BON-A 399.00 2300225240 EXCISION OF DISTAL ULNA-A 351.00 2300225260 REP TENDON/MUSCLE - FOREARM/-A 516.00 2300225270 REP T/M EXTENSOR FOREARM/WRI-A 402.00 2300225275 REP TS FA/WR W FGRAFT-A 2,199.00 2300225310 TRANSPLANT FOREARM TENDON-A 508.00 2300225312 TRANSF TEND FLEX/EXT FA/W W -A 589.00 2300225320 OPEN REPAIR WRIST JOINT-A 810.00 2300225332 WRIST ARTHROPLASTY-A 692.00 2300225360 OSTEOTOMY; ULNA - A 536.00 2300225390 SHORTENING OF RADIUS OR ULN-A 633.00 2300225420 REPAIR NONUNION RADIUS/ULNA-A 957.00 2300225425 REPAIR RAD OR ULN AUTOGRAFT-A 793.00 2300225440 REPAIR CARPAL NAVICULAR BONE-A 632.00 2300225445 PROSTH REPLACEMENT TRAPEZIUM-A 594.00 2300225447 REPAIR WRIST JOINTS-A 681.00 2300225515 OPEN TX RADIAL SHAFT FRACTUR-A 549.00 2300225526 OPEN RDL SHAFT FX RAD/ULN JT-A 783.00 2300225545 TREAT FRACTURE OF ULNA SHAFT-A 513.00 2300225565 CLOSED TX RADIAL & ULNA FX W-A 422.00 2300225575 OPEN TX RADIAL & ULNAR SHFT -A 741.00 2300225605 CLSD TX DSTL RDL FX/EPIPHYSL-A 444.00 2300225607 OPEN TX DIST RADIUS EXTRA-AR-A 604.00 2300225608 OPEN TX RADIAL INTRA-ARTIC F-A 677.00 2300225609 OPEN TX DSTL RADIAL INTRA-AR-A 861.00 2300225628 OPEN TX CARPAL SCAP NAVI FRA-A 593.00 2300225635 CLSD TX CARPL BONE FX W MANI-A 343.00 2300225651 PIN ULNAR STYLOID FRACTURE-A 396.00 2300225652 OPEN TX ULNAR STYLOID FRACTU-A 512.00 2300225695 OPEN TX OF LUNATE DISLOCATIO-A 520.00 2300225805 FUSION WRIST JNT W SL GRAFT-A 696.00 2300225810 FUSION WRIST JOINT W AUTOGRA-A 714.00 2300225820 INTERCARPAL FUSION; WO BONE -A 504.00 2300226011 DRAIN FINGER ABSC; COMP-A 152.00 2300226055 TENDON SHEATH INCISION FINGE-A 455.00 2300226060 PERC INCISION FINGER TENDON -A 213.00 2300226111 EXC HAND LESION SUBCU 1.5 CM-A 343.00 2300226123 PALM W SINGLE DIGIT RELEASE-A 685.00 2300226125 PALM RELEASE W EA ADDITIONAL-A 227.00 2300226160 EXC TENDON SHEATH LESION HAN-A 467.00 2300226350 REP FLEXOR TENDON NOT ZONE 2-A 575.00 2300226356 REPAIR FLEXOR TENDON ZONE 2 -A 651.00 2300226357 2NDRY TENDON REP NO MAN'S -A 728.00 2300226370 1 PROFUNDUS TENDON REPAIR-A 613.00 2300226372 PROFUNDUS TENDON REP/ADV; 2 -A 697.00 2300226410 REP EXTENDON HAND; WO FREE G-A 456.00 2300226418 EXTENSOR TENDON REPAIR EACH-A 466.00 2300226480 CMC TENDON TRANSFER/TRANSPLA-A 607.00 2300226483 CMP TENDON TRANSPL W GRAFT-A 680.00 2300226490 SUBLIMIS TENDON TRANSFER-A 646.00 2300226492 OPPONENSPLASTY; TENDON TRNSF-A 716.00 2300226497 RING AND SMALL FINGER TENDON-A 703.00 2300226530 ARTHROPLASTY MCP JOINT; EA J-A 441.00 2300226540 REPAIR MCP/IP JOINT COLLATER-A 531.00 2300226548 REP & RECONST FINGER VPLATE -A 613.00 2300226567 OSTEOTOMY TO CORRECT DEFORMI-A 548.00 2300226607 CLOSED TX MC FX W MANIP & FI-A 372.00 2300226608 PERC SKEL FIXATION MC FX; EA-A 390.00 2300226615 OPEN TX METACARPAL FX W FIXA-A 472.00 2300226641 CLOSED TX CMC DISLOC THUMB W-A 306.00 2300226727 PERC SKL FIX UNST PHAL SHFT -A 384.00 2300226735 OPEN TX PHALANG SHAFT FX PRO-A 489.00 2300226746 OPEN TX ARTICULAR FX MCP/IP -A 609.00 2300226756 PERC SKTL FIX DIST PHAL FX F-A 341.00 2300226765 OPEN TX DISTAL PHALANGE FX E-A 410.00 2300226842 ARTHRODESIS CMC JOINT THUMB -A 634.00 2300226850 ARTHROD MCP JOINT W/WO FIX-A 559.00 2300226860 ARTHRODESIS IP JOINT W/WO FI-A 456.00 2300226951 AMPUTATE FING/THMB SNGL; W D-A 527.00 2300227030 ARTHROTOMY HIP W DRAINAGE-A 1,542.00 2300227052 ARTHROTOMY W BIOPSY; HIP -A 954.00 2300227125 PARTIAL HIP REPL PROSTHESIS-A 936.00 2300227130 TOTAL HIP ARTHROPLASTY-A 1,120.00 2300227132 CONVERT TO TOTAL HIP ARTHROP-A 1,383.00 2300227170 BONE GRAFT FEMORAL HEAD NECK-A 970.00 2300227235 PERC FIX FEMUR PROXIMAL NECK-A 750.00 2300227236 BIPOLAR HIP REPLACEMENT-A 987.00 2300227240 CLSD TX INTR/PERI/SBTROCH FE-A 789.00 2300227244 TX INTER/PR/SBTROCH FEM FX -A 1,016.00 2300227245 TX INTER/PR/SUBTROCH FEM FX -A 1,016.00 2300227248 OPEN TX GREATER TROCHANTERIC-A 612.00 2300227257 TX SPONTAN HIP DISLOC W ANES-A 281.00 2300227299 UNL PROC PELVIS/HIP JOINT-A 27.00 2300227301 DEEP I&D THIGH/KNEE-A 550.00 2300227328 EXC THIGH/KNEE TUM DEEP <5CM-A 515.00 2300227332 ARTHROTOMY KNEE W MENISC; ME-A 528.00 2300227337 EXCIS THIGH/KNEE LESION SUBC-A 345.00 2300227340 EXCISION PREPATELLAR BURSA-A 305.00 2300227372 REM DEEP FB THIGH OR KNEE-A 330.00 2300227380 REPAIR KNEECAP TENDON-A 487.00 2300227403 ARTHROTOMY W MENISCUS REPAIR-A 525.00 2300227418 ANTERIOR TIBIAL TUBERCLEPLAS-A 678.00 2300227422 RECONSTRUCT DISLOC PATELLA W-A 611.00 2300227427 LIGAMENT AUGMENT KNEE; EXTRA-A 585.00 2300227428 LIGAMENT AUGMENT KNEE; INTRA-A 915.00 2300227438 ARTHROPLASTY PATELLA; W PROS-A 691.00 2300227442 ARTHROPLASTY KNEE FC/TP-A 716.00 2300227447 TOTAL KNEE ARTHROPLASTY-A 1,119.00 2300227506 OPEN TX FEMORAL SHFT FX W IN-A 1,104.00 2300227514 OPEN TX FEMORAL FX DIST MED/-A 798.00 2300227524 OPEN TX PATELLA FX W INT FIX-A 619.00 2300227535 OPEN TX TIBIAL FX PROX UNICO-A 740.00 2300227540 OPEN TX INTERCOND SPINE/TUBR-A 668.00 2300227598 DISARTICULATION AT KNEE-A 594.00 2300227620 EXPLORE/TREAT ANKLE JOINT-A 374.00 2300227635 EXCISE TIB/FIB BONE CYST/TUM-A 481.00 2300227650 PRIMARY REPAIR RUPTURED ACHI-A 541.00 2300227654 SECONDRY REPR RUPT ACHILLES -A 582.00 2300227696 1' SUTR BOTH RUPTR ANKLE COL-A 454.00 2300227758 TREATMENT OF TIBIA FRACTURE-A 737.00 2300227759 OPEN/PERC TX TIBIA SHAFT FX -A 823.00 2300227766 OPEN TX MEDIAL ANKLE FRACTUR-A 501.00 2300227788 CL TX DISTL FIB FX W MANIP-A 315.00 2300227792 OPEN TX DISTAL FIBULAR FX LA-A 537.00 2300227814 OPEN TX BIMALLEOLAR ANKLE FR-A 635.00 2300227822 OPEN TX TRIMALL ANKLE FX WO -A 707.00 2300227823 OPEN TX TRIMALL ANKLE FX W F-A 801.00 2300227827 OPEN TX FRACTURE DISTAL TIBI-A 905.00 2300227829 OPEN TX TIBIA/FIBULA JOINT-A 572.00 2300228039 EXCISE FOOT/TOE TUMOR SUBCU -A 419.00 2300228080 EXCISE INTERDIGIT MORTON NEU-A 435.00 2300228122 PARTIAL EXCISION TARSAL/META-A 495.00 2300228208 REPR FOOT EXTENSOR TENDON EA-A 259.00 2300228238 ADV POST TIBIAL TENDN W EXC -A 553.00 2300228289 REPAIR HALLUX RIGIDUS-A 618.00 2300228291 CORRJ HALUX RIGDUS W/IMPLT-A 395.00 2300228292 KELLER/MCBRIDE/MAYO BUNION C-A 617.00 2300228296 BUNION CORRECT W METATARSAL -A 753.00 2300228297 CORRECTION OF BUNION W/WO SE-A 866.00 2300228298 CORRECTION HALLUX VALGUS-A 408.00 2300228299 DOUBLE OSTEOTOMY BUNION CORR-A 828.00 2300228306 METATARSAL SHORTEN; 1ST META-A 508.00 2300228308 METATARSAL SHORTEN NOT 1ST -A 469.00 2300228322 REPAIR NU/MU; METATARSAL-A 650.00 2300228420 TREAT/GRAFT HEEL FRACTURE; O-A 1,048.00 2300228445 TREAT ANKLE FRACTURE; OPEN-A 875.00 2300228476 PERC SKEL FEX METATARSAL FX -A 290.00 2300228485 OPEN TX METATARSAL FRACTURE-A 445.00 2300228505 TREAT BIG TOE FRACTURE 641.00 2300228525 TREAT TOE FRACTURE - A 326.00 2300228740 ARTHRODESIS MT/TME;SGL JOINT-A 513.00 2300228750 ARTHRODESIS GREAT TOE; MTP J-A 670.00 2300228810 AMPUTATE METATARSAL W TOE SI-A 356.00 2300229805 SHOULDER ARTHROSCOPY DIAGNO-A 389.00 2300229806 SHOULDER CAPSULOR ARTHROSCOP-A 876.00 2300229807 REPAIR SHOULDER SLAP LESION-A 854.00 2300229819 ARTHROSCOPY SHOULDER; W REMO-A 482.00 2300229822 ARTHROSCOPY SHOULDER; DEBRID-A 466.00 2300229823 ARTHROSCPY SHLDR; DEBRID EXT-A 511.00 2300229824 SHOULDER MUMFORD PROCEDURE-A 548.00 2300229825 ARTHROSCOPY SHOULDER; W LYSI-A 475.00 2300229826 SHOULDER ARTHROSCOPY/SURGERY-A 146.00 2300229827 ROTATOR CUFF REPAIR ARTHROSC-A 869.00 2300229828 ARTHROSCOPY BICEPS TENODESIS-A 750.00 2300229830 ARTHROSCOPY ELBOW DIAGNOSTIC-A 377.00 2300229837 ARTHROSCOPY ELBOW; LIM DEBR-A 430.00 2300229846 ARTHROSCOPY WRIST; EXC/REP C-A 428.00 2300229851 ARTHROSCOPE TX IC KNEE;W FIX 772.00 2300229862 ARTHROSCOPY HIP; W REM FB W -A 663.00 2300229863 ARTHROSC HIP; W REM FB W SYN-A 663.00 2300229866 AUTGRAFT IMPLANT KNEE W SCO-A 855.00 2300229870 KNEE ARTHROSCOPY DIAGNOSTIC-A 478.00 2300229874 ARTHROSCOPY KNEE; REMOVE LOO-A 443.00 2300229875 ARTHROSCOPY KNEE; LIMITED SY-A 408.00 2300229877 ARTHROSCOPY KNEE; DEBRIDE/SH-A 512.00 2300229879 ARTHROSCOPY KNEE; ABRASION A-A 546.00 2300229880 ARTHROSCOPY KNEE; W MENIS M-A 463.00 2300229881 ARTHROSCOPY KNEE; W MENISC M-A 446.00 2300229882 ARTHROSCOPY KNEE; W MENISC R-A 579.00 2300229883 ARTHROSC KNEE;W MEN RPR M/L-A 698.00 2300229887 ARTHROSC KNEE;DRILL OD LES W-A 622.00 2300229888 ARTHROSCOPY; ANT CRUCIATE LI-A 813.00 2300229891 ARTHROSCOPY ANKLE;EXC OSCHON-A 553.00 2300229892 ARTHROSC REPAIR O.D. LES/FX-A 532.00 2300229899 ANKLE ARTHROSCOPY WITH FUSIO-A 856.00 2300229914 ARTHROSCOPY HIP W FEMOROPLAS-A 818.00 2300229916 ARTHROSCOPY HIP W LABRAL REP-A 834.00 2300229999 UNLISTED JNT ARTHROSC-A 27.00 2300230310 REMOVE FB INTRANASAL; W ANES-A 168.00 2300230630 REPAIR NASAL SEPTAL PERFORAT-A 505.00 2300231238 NASAL ENDO W HEMORRHAGE CONT-A 210.00 2300231287 NASAL/SINUS ENDOSCOPY W SPLE-A 190.00 2300231288 NASAL ENDO; W REM TISS SPHEN-A 220.00 2300235840 EXPLORE POSTOP HEMOR/THROMB/-A 993.00 2300236561 INSERT TUNNELED CVAD W PORT -A 887.00 2300236571 INSERT PICC DEVICE W PORT 5 -A 989.00 2300236582 REPLACE TUNNELED VAD W PORT-A 821.00 2300236589 REMOVE TUNNELED CV CATHETER-A 135.00 2300236590 REMOVE TUNNELED CVAD W PORT/-A 182.00 2300236591 DRAW BLOOD OFF VENOUS DEVICE-A 20.00 2300238530 OPEN BX/EXC LN; INT MAMM NOD-A 458.00 2300238570 LAP; W RETROP LN BX SINGLE/M-A 417.00 2300238760 INGUINOFEM LYMPPHADENECTOMY -A 698.00 2300238765 INGUINOFEM W PELVIC LYMPHADE-A 1,073.00 2300240650 REPAIR LIP FRONT; VERMILION -A 361.00 2300241010 INCISION OF LINGUAL FRENUM (-A 166.00 2300242000 DRAINAGE ABCESS PALATE UVULA-A 138.00 2300242408 EXCISE SUBLINGUAL SALIVARY C-A 374.00 2300242440 EXCISION SUBMANDIBULARGLAND-A 340.00 2300242820 REMOVE TONSILS AND ADENOIDS -A 238.00 2300242825 REMOVAL OF TONSILS <12 YEARS-A 216.00 2300242830 REMOVAL OF ADENOIDS 1' <12 Y-A 171.00 2300242831 ADENOIDECTOMY; AGE 12 AND OV-A 185.00 2300242860 EXCISION OF TONSIL TAGS-A 155.00 2300242960 CONTROL OROPHARYNGEAL HEMORR-A 141.00 2300242961 CONTROL OROPHARYNG HEMORRH; -A 349.00 2300243280 LAP ESOPHAGOGASTRIC FUNDOPLS-A 898.00 2300243282 LAP PARAESOPH HER RPR W/MESH-A 1,444.00 2300243830 GASTROSTOMY OP; WO GASTIC TU-A 580.00 2300243840 GASTRORRHAPHY SUTURE PERF DU-A 1,128.00 2300244005 ENTEROLYSIS-A 909.00 2300244020 BIOPSY FB OR EXPLORE SMALL I-A 808.00 2300244050 RED VOLVULUS INTUSSUSCEPTION-A 775.00 2300244055 CORRECT MALROTATION BY LYSIS-A 1,234.00 2300244120 RESECT SM INTESTINE; SGL RES-A 1,016.00 2300244130 ENTEROENTEROSTOMY ANASTOM OF-A 1,090.00 2300244140 COLECTOMY PARTIAL; W ANASTOM-A 1,113.00 2300244141 COLECTOMY PART; W SM LN CECO-A 1,516.00 2300244143 COLECTOMY PARTIAL; (HARTMANN-A 1,383.00 2300244147 COLECTOMY P; ABD TRANSANAL-A 1,612.00 2300244160 P COLECTOMY W REM ILIUM-A 1,031.00 2300244180 LAPAROSCOPY ENTEROLYSIS-A 763.00 2300244202 LAP ENTERECTOMY - A 1,150.00 2300244204 LAP PARTIAL COLECTOMY - A 1,277.00 2300244205 LAP P COLECTOMY W REM ILEUM-A 1,111.00 2300244207 L COLECTOMY/COLOPROCTOSPART-A 1,511.00 2300244213 LAP MOBIL SPLENIC FL ADD-ON-A 53.00 2300244310 ILEOSTOMY/JEJUNOSTOMY-A 866.00 2300244320 COLOSTOMY-A 997.00 2300244602 SUTURE SM IN FOR ULCER WND I-A 1,173.00 2300244604 SUTURE LG IN FOR WND INJ; WO-A 879.00 2300244620 CLOSED ENTEROSTOMY LG/SM INT-A 721.00 2300244626 CLOSED ENTEROSTOMY; W RESECT-A 1,331.00 2300244800 EXC MECKEL'S DIVERTICULUM OR-A 635.00 2300244950 APPENDECTOMY-A 533.00 2300244955 APPY; DONE FOR INDICATED PUR-A 70.00 2300244960 APPY; FOR RUPTURED APPENDX W-A 726.00 2300244970 LAPAROSCOPY; APPENDECTOMY-A 498.00 2300245990 SURGICAL DIAGNOSTIC EXAM ANO-A 90.00 2300246230 REMOVAL OF ANAL TAGS-A 143.00 2300246270 REMOVE ANAL FISTULA SUBQ-A 417.00 2300246750 REPAIR OF ANAL SPHINCTER-A 622.00 2300247100 BX OF LIVER WEDGE-A 699.00 2300247562 LAPAROSCOPIC CHOLECYSTECTOMY-A 545.00 2300247563 LAP; CHOLECYSTECTOMY W CHOLA-A 592.00 2300247600 CHOLECYSTECTOMY-A 885.00 2300249000 EXPLORE LAPAROTOMY EXPLORE C-A 639.00 2300249010 EXPLORE RETROPERITONEAL AREA-A 775.00 2300249020 DRAINAGE ABDOM ABSCESS OPEN-A 1,319.00 2300249255 OMENTECTOMY EPIPLOECTOMY-A 656.00 2300249320 LAP; DX ABDOMEN/PERITONEUM/O-A 270.00 2300249321 LAP; ABDOMEN/PERITONEUM/OMEN-A 286.00 2300249322 LAP; ABD/PERITONEUM/OMENTUM -A 306.00 2300249500 RPR ING HERNIA INIT REDUCE 0-A 326.00 2300249505 REP INGUINAL HERNIA INIT RED-A 431.00 2300249507 REP INGUINAL HERNIA INIT BLO-A 485.00 2300249520 REPAIR RECURRENT INGUINAL HE-A 524.00 2300249550 RPR REM HERNIA INIT REDUCE-A 477.00 2300249553 REPAIR INIT FEM HERNIA REDUC-A 523.00 2300249560 REPAIR INIT INCI/VENT HERNIA-A 612.00 2300249561 REPAIR INITIAL INCISIONAL HE-A 771.00 2300249564 LAP INC HERNIA REPAIR -A 702.00 2300249565 REPAIR RECURRENT INC HERNIA;-A 637.00 2300249568 HERNIA REPAIR WITH MESH-A 223.00 2300249570 REPAIR EPIGASTRIC HERNIA; RE-A 345.00 2300249585 REPAIR UMBILICAL HERNIA REDU-A 369.00 2300249587 REPAIR UMBILICAL HERNIA BLOC-A 393.00 2300249605 REPAIR UMBILICAL LESION-A 4,108.00 2300249650 LAP INGUINAL HERNIA REPAIR I-A 355.00 2300249652 LAP VENTRAL/ABDOMINAL HERNIA-A 617.00 2300249654 LAP INC HERNIA REPAIR -A 702.00 2300249900 ABDOMINL WALL 2' SUTURE FOR -A 675.00 2300249905 OMENTAL FLAP INTRA-ABDOMINA-A 294.00 2300249999 UNLISTED PROC ABD PERITONEUM-A 27.00 2300250760 URETEROURETEROSTOMY-A 929.00 2300251860 SUTURE BLADDER WOUND INJURY;-A 616.00 2300251992 LAP; SLING OP FOR STRESS INC-A 692.00 2300254150 CIRCUMCISION W REGIONAL BLOC-A 127.00 2300255500 EXCISE HYDROCELE OF SPERM CR-A 327.00 2300255520 EXCISE LESION OF SPERMATIC C-A 375.00 2300256441 LYSIS OF LABIAL LESION(S)-A 117.00 2300256620 VULVECTOMY SIMPLE; PARTIAL-A 427.00 2300256700 EXCISE BARTHOLIN'S GLAND OR -A 153.00 2300256740 EXCISE BARTHOLIN'S GLAND OR -A 246.00 2300256810 PERINEOPLASTY REPAIR PERINEU-A 212.00 2300257120 COLPOCLEISIS (LE FORT TYPE)-A 413.00 2300257130 REMOVE VAGINA LESION-A 144.00 2300257200 COLPORRHAPHY-A 247.00 2300257240 ANTERIOR COLPORRHAPHY REPAIR-A 546.00 2300257250 POSTERIOR COLPORRHAPHY REPAI-A 549.00 2300257260 COMBINED ANTEROPOSTERIOR COL-A 676.00 2300257265 COMB ANT/POST COLPORRHAPHY; -A 740.00 2300257268 REPAIR OF BOWEL BULGE-A 394.00 2300257282 SACROSPINOUS LIGAMENT FIX FO-A 407.00 2300257285 REPAIR PARAVAGINAL DEFECT V-A 547.00 2300257287 REV/REP STRESS INCONT SLING-A 555.00 2300257288 SLING OPERATION FOR STRESS I-A 584.00 2300257415 REMOVE VAGINAL FOREIGN BODY-A 131.00 2300257530 REMOVAL OF CERVIX-A 283.00 2300257720 REVISION OF CERVIX-A 250.00 2300258150 TOTAL ABDOMINAL HYSTERECTOMY-A 829.00 2300258200 EXTENSIVE HYSTERECTOMY-A 1,129.00 2300258260 VAGINAL HYSTERECTOMY = <250 -A 670.00 2300258262 VAG HYST INCLUDING T/O = <25-A 748.00 2300258263 VAG HYST W/T/O& RPR =<250 GM-A 798.00 2300258267 VAG HYST W/URINARY REPAIR = -A 850.00 2300258270 VAG HYST W/ENTEROCELE REPAIR-A 715.00 2300258290 VAGINAL HYSTERECTOMY COMPLEX-A 933.00 2300258291 VAG HYST INCL T/O COMPLEX >-A 1,006.00 2300258301 REMOVE INTRAUTERINE DEVICE-A 77.00 2300258350 CHROMOTUBATION OF OVIDUCT-A 79.00 2300258356 ENDOMETRIAL CRYOABLATION W U-A 1,525.00 2300258541 LSH UTERUS 250 G OR LESS-A 582.00 2300258545 LAPAROSCOPIC MYOMECTOMY =<25-A 735.00 2300258550 LAPARO-ASST VAG HYSTERECTOMY-A 715.00 2300258552 LAPARO-VAG HYST INCLUDING T/-A 803.00 2300258553 LAPARO-VAG HYST COMPLEX-A 923.00 2300258554 LAPARO-VAG HYST W/T/O COMPL-A 1,079.00 2300258555 HYSTEROSCOPY DIAGNOSTIC-A 218.00 2300258558 HYSTEROSCOPY W BX ENDOM OR P-A 1,104.00 2300258561 HYSTEROSCOPY REMOVE MYOMA-A 358.00 2300258563 HYSTEROSCOPY; W ENDOMETRIAL -A 1,289.00 2300258573 TLH W/T/O UTERUS OVER 250 GM-A 994.00 2300258615 OCCLUDE FALLOPIAN TUBE(S) BY-A 202.00 2300258660 LAPAROSCOPY; W LYSIS OF ADHE-A 548.00 2300258661 LAP; W REMOVAL ADNEXAL STRUC-A 529.00 2300258662 LAP W EXC/DESTR OVARY PELVIC-A 578.00 2300258700 SALPINGECTOMY COMPL/PARTBI/U-A 636.00 2300258720 SALPINGO-OOPHOR COMPL/PART U-A 603.00 2300258740 ADHESIOLYSIS TUBE OVARY-A 720.00 2300258805 DRAINAGE OF OVARIAN CYST(S)-A 329.00 2300258925 OVARIAN CYSTECTOMY UNILAT OR-A 609.00 2300258940 OOPHORECTOMY PARTIAL OR TOTA-A 430.00 2300258957 RESECT RECURRENT GYN MAL-A 1,311.00 2300259120 SURG TX ECTOPIC PREG; TUB/OV-A 655.00 2300259150 LAP TX ECT PREG; WO SALPINGE-A 636.00 2300259151 LAP TX ECT PREG; W SALPINGEC-A 620.00 2300259160 D & C AFTER DELIVERY-A 168.00 2300260210 PARTIAL THYROID LOBECTOMY UN-A 583.00 2300260220 TOTAL THYROID LOBECTOMY UNI-A 581.00 2300260240 REMOVAL OF THYROID-A 758.00 2300260252 REMOVAL OF THYROID2-A 1,090.00 2300260500 PARATHYROIDECTOMY- A 797.00 2300263030 LOW BACK DISK SURGERY-A 810.00 2300263035 SPINAL DISK SURGERY ADD-ON-A 161.00 2300263042 LAMINOTOMY SINGLE LUMBAR-A 1,081.00 2300263045 REMOVAL OF SPINAL LAMINA SGL-A 1,080.00 2300263047 REMOVAL OF SPINAL LAMINA SIN-A 921.00 2300263048 REMOVE SPINAL LAMINA ADD-ON-A 178.00 2300263055 DECOMPR SPINAL CORD THORACIC-A 2,736.00 2300263056 DECOMPRESS SPINAL CORD LUMBA-A 1,241.00 2300263075 NECK DISCECTOMY ANTERIOR-A 1,132.00 2300263076 NECK DISCECTOMY ADDL INTERSP-A 209.00 2300263081 REMOVAL OF VERTEBRAL BODY-A 1,469.00 2300263082 REMOVE VERTEBRAL BODY ADD-ON-A 224.00 2300263267 LAMINECTOMY W EXC INTRASPINO-A 1,147.00 2300263709 REP DURAL OR CSF LEAK; W LAM-A 919.00 2300264718 NEUROPLASTY; ULNAR NERVE AT -A 487.00 2300264721 NEUROPLASTY; MEDIAN NRV AT C-A 353.00 2300264831 REPAIR OF DIGIT NERVE 1-A 565.00 2300264832 SUT DIGIT NERVE HAND/FOOT; E-A 280.00 2300264834 SUTURE 1 NERVE HAND/FOOT COM-A 614.00 2300264835 SUTURE 1 NERVE; MEDIAN MOTOR-A 664.00 2300264861 SUTURE; BRACHIAL PLEXUS-A 2,062.00 2300264999 PROCEDURE NERVOUS SYSTEM-A 65.00 2300269990 OPERATING MICROSCOPE ADD-ON-A 186.00 2300920610 ER-DRAIN MAJ JOINT/BURSA 153.00 2300993010 ER - 12 LEAD EKG INTERPRET 32.00 3201008763 NON-LOCK SCREW 3.5 HEX 18MM - 3210000811 LINEAR TLC 75 - 3210000812 LINEAR RELOAD TCR-75 - 3210001649 CURRETTE STERILE VAC 8MM - 3210001936 GLASSMAN VISCERA RETRACTOR - 3210004042 DRILL BIT 3.5 LG EX-FIX - 3210004043 DRILL BIT 4.5 LG EX-FIX - 3210004083 CORTICAL SCREW 3.5 - 3210004619 VENTRALEX HAERNIA PATCH SM CRC - 3210004665 ALEXIS WOUND RETRACTOR SMALL - 3210005166 GUIDE WIRE - 3210005293 INTRAOCULAR MONOFOCAL LENS - 3210005567 DRILL BIT 2.0MM W/DEPTHMARK - 3210005874 VENTRALEX HAERNIA PATCH MEDIUM - 3210005947 ENDO CLIP APPLIER 5MM EL5ML - 3210006053 DRILL BIT 4.2 X 145 NEEDLE PT - 3210006640 HERNIA SORBAFIX TACK 30 - 3210006812 DRILL BIT STRYKER J-LATCH 1.5 - 3210006813 DRILL BIT STRYKER J-LATCH 2.0 - 3210006956 STOCKING TED KNEE REG XXL - 3210007193 DRILL BIT 2.4 MINI - 3210007524 VENTRALEX HAERNIA PATCH LARGE - 3210008500 DRILL BIT 4.2 X 330 CAL QC - 3210008746 TUOHY NERVE BLOCK SET 18GX4IN - 3210008762 NON-LOCK SCREW 3.5 HEX 16MM - 3210008873 DRILL 2.8 X 165MM MOD HAND - 3210009130 INTRAOCULAR TECNIS LENS - 3210009156 CAPIO SLIM SUTURE DEVICE - 3210009157 TUOHY NERVE BLOCK SET 18GX4IN - 3210009160 SUTURE PROLENE 2-0 CT-2 BL - 3210009169 VAGINAL CERVICAL RETRACTOR MED - 3210009386 PACK PROCEDURE TREN GUARD 450 - 3210009397 GRAFIX PRIME GRAFT 2X3 - 3210009422 GRAFIX PRIME GRAFT 1.5 X 2 - 3210009423 GRAFIX PRIME GRAFT 3 X 4 - 3210009731 VAPOR - CLEAN FILTER - 3210009806 TUOHY NERVE BLOCK SET 18GX4IN - 3210009808 RADIOLUCENT DRILL BIT 3.2 - 3210009843 BUTTON-BICEPS TENODESIS KIT - 3210009854 5.5MM X 72MM THREADED CANNULA - 3210009855 7.0MM X 72MM THREADED CANNULA - 3210009862 NANOPASS CRESENT - 3210009864 NANOPASS RIGHT - 3210009868 CANNULA PASSPORT BUTTON 2CM - 3210009873 DIEGO DISSECTOR BLADE 4.8 ENT - 3210009874 NEEDLE MULTIFIRE SCORPION - 3210009876 SUTURE 3-0 VICRYL FS-2 J423H - 3210009889 MENISCAL STITCH W/DBLE NEEDLE - 3210009897 SUTURE 3-0 MONOCRYL PS-1 - 3210009915 ENDO ARGON PROBE CONNECTOR - 3210009916 ENDO STRAIGHT FIRE PROBE 2.3MM - 3210009917 ENDO MONOPOLAR PROBE - 3210009973 SNARE POLYPECTOMY - 3210009974 RADIAL JAW 4 LG CAP W/NDL - 3210009975 SINGLE USE HEXAGONAL SNARE SM - 3210010097 DRILLBIT 8.5 FLIPCUTTER II - 3210010188 SHAVER HIP CURVED 4.5MM - 3210010189 BURR OPHTHALMIC - 3210010204 DERMAGRAFT SKIN GRAFT 37.5 CM - 3210010221 EPIFIX MESH 3.5 CM X 3.5 CM - 3210010253 PLATE 2.4 DISTAL RADIUS LOCK - 3210010262 RESOLUTION 360 CLIP 235CM - 3210010323 ELECTROSURGICAL SUCTION/COAG - 3210010348 RETRACTOR LONESTAR 14CM - 3210010352 ENDOCUT SCISSOR TIP 19.3MM - 3210010357 CLIP HEMOLOK POLYMER MED/LG - 3210010358 ROUND BLAKE DRAIN 15FR - 3210010385 SUTURE ORTHOCORD VIOLET/BLUE - 3210010437 MESH BIO A - 3210010438 ENDOSTITCH DEVICE - 3210010439 SURGIDAC 0 - 3210010440 SURGIDAC 2-0 - 3210010458 COMP VENTRAL HERNIA PATCH 4.6 - 3210010459 COMP VENTRAL HERNIA PATCH 6.6 - 3210010466 EZCLIP OSTEO STAPLE 12X15X13 - 3210010500 DRILL BIT 10.0 FLIPCUTTER II - 3210010504 LARGE PHS HERNIA MESH - 3210010509 T-SCOPE PREMIER KNEE BRACE - 3210010510 T-SCOPE PREMIER KNEE BRACE XL - 3210010540 SCREW 6.5MM CAN SET 45MM - 3210010541 SCREW 6.5MM CAN SET 50MM - 3210010542 SCREW 6.5MM CAN SET 55MM - 3210010546 EPIFIX MESH GRAFT 4CM X 4.5CM - 3210010551 ENDO GIA 60MM PURPLE THICK - 3210010552 ENDO GIA 60MM TAN MED RELOAD - 3210010555 SCREW 6.5MM CAN SET 35MM - 3210010627 MINI SCORPION DX IMPLANT SYS - 3210010629 PLANTAR PLATE INST SET - 3210010632 SUTURE PDS II 3-0 SH Z316H - 3210010688 INFLATION DEVICE BIG60 BALLOON - 3210010699 EPIFIX MESH GRAFT 2CM X 3CM - 3210010724 HEMOSTAT SURGICEL SNOW ABS 2X4 - 3210010728 7.0MM X 72MM THREADED CANNULA - 3210010816 EPIFIX SKIN GRAFT 3CM X 3CM - 3210010893 ALLODERM THICK 16 X 20 CM - 3210010894 EPIFIX MESH GRAFT 14MM - 3210010903 SUTURE SLINGSHOT 70 DEG UP - 3210010911 ULNA SHORTENING PLATE 6 HOLE - 3210010912 OSTEOTOMY SAW BLADE HUB STY S - 3210010918 MPFL BIOCOMPOSITE IMPLANT SYS - 3210010931 TI TROCH FIXATION NSCREW 11MM - 3210010932 CLEAR-TRAC 7.0MMX110MM - 3210010953 GRAFT JACKET RTM 5X5CM - 3210010960 EPIFIX MESH GRAFT 5CMX5.5CM - 3210011043 CAPITAL PROSTHETIC HEAD - 3210011044 PROSTHESIS STEM CAPITELLO RAD - 3210011104 PARIMATRIX GRAPH 6X6 CM - 3210011111 PASSPORT BUTTON CANNULA 8MM - 3210011117 PRIMATRIX AG FENESTRATED 6X6 - 3210011129 PRIMATRIX AG FENESTRATED 4X4 - 3210011135 RELLIEVA SPINPLUS BALLOON 6X16 - 3210011136 ACCLARENT INFLATION DE DEVICE - 3210011153 ENDO EIA ART XTRA THICK 60MM - 3210011194 EPICORD GRAFT 3CM X 5CM - 3210011250 TFNA FENESTRATED SCREW 110MM - 3210011251 TFNA TI CANN SCREW 11MM - 3210011264 PRIMATRIX AG MESH 8X8 CM - 3210011265 PRIMATRIX AG MESH 5X5 CM - 3210011266 PURSTRING DEVICE 65MM - 3210011391 EPIFIX SOLID SKIN GRAFT 4X4 - 3210011400 PRIMATRIX AG FENS 8X8 CM - 3210011417 MENISCAL ROOT TEPAIR SYSTEM - 3210011418 ULTRABRAID/COBRIAD SUTURE&NDL - 3210011419 FIRSTPASS MINI SUTURE PASSER - 3210011432 PRIMATRIX FENESTRATED 6 X 6 CM - 3210011462 MENISCAL ROOT REPAIR PACK - 3210011464 DISPOSABLE KIT - 3210011465 Q-FIX SUTURE ANCHOR 2.8MM - 3210011466 Q-FIX IMPLANT 1.8MM - 3210950071 SKIN SUB GRAFT TRNK/ARM/LEG 3,150.00 3210950072 SKIN SUB GRAFT T/A/L ADD-ON 525.00 3210950073 SKIN SUB GRAFT FACE/NK/HF/G 3,150.00 3210950074 SKIN SUB GRAFT F/N/HF/G ADDL 525.00 3250000388 DRAIN J.P. 1.5FR/10MM ROUND - 3250000794 ENDO PEANUT - 3250000821 DRAIN J.P. 100cc RESERVOIR - 3250000869 PERFIX MESH PLUG SMALL - 3250000870 PERFIX MESH PLUG MEDIUM - 3250000871 PERFIX MESH PLUG LARGE - 3250000887 CRYO CUFF - 3250001396 BLAKE DRAIN 10MM - 3250001398 BLAKE DRAIN 7MM - 3250001858 TUBE TRACH ORAL RAE 6.0 CU - 3250001859 TUBE TRACH ORAL RAE 7.0 CU - 3250001860 TUBE TRACH ORAL RAE 7.5 CU - 3250001861 TUBE TRACH ORAL RAE 8.0 CU - 3250002045 DRAIN JACKSON PRATT FLAT 10MM - 3250002067 STAPLER SKIN 35 WIDE - 3250003051 DRAPE ISOLATION 3M - 3250003453 BIS SENSOR - 3250003821 TUBE TRACH ORAL RAE 6.5 CU - 3250003853 DRAPE INCISE IOBAN - 3250003857 TUBE TRACH ORAL RAE 5.5 CU - 3250003921 TEMP PROBE ESOPHAGEAL - 3250004344 TUBE TRACH ORAL RAE 4.5 UC - 3250004451 LMA #4 - 3250004687 ARTHRO BUR BARREL 6 FLUTE 4.0 - 3250004854 TUBE TRACH ORAL RAE 5.0 CU - 3250004965 CRYO CUFF KNEE LARGE - 3250005049 CRYO CUFF SHOULDER XL - 3250005111 ENDO TROCAR 5MM - 3250005188 CRYO CUFF COOLER - 3250006740 LENS INTRAOCULAR MULTIFOCAL - 3250006741 LENS INTRAOCULAR TORIC - 3250007317 ENDO SUCT/IRRIG STRYKER - 3250007516 ELECTROSURGICAL PENCIL - 3250007522 HERNIA VENTRIO-ST PATCH - 3250007802 NEEDLE VERRES - 3250007805 STAPLER SKIN INSORB - 3250008024 CANNULA ARTHROSCOPIC CLEARVIEW - 3250008025 CANNULA RFK 10CM 10MM TIP 20GA - 3250008026 CANNULA RFK 15CM 10MM TIP 20GA - 3250008046 HARMONIC DISSECTING HOOK - 3250008047 NOVASURE/SURESOUND DEVICE - 3250008049 TUBE TRACH ORAL RAE 4.0 CU - 3250008053 MYOSURE TISSUE REMOVAL DEVICE - 3250008063 RICHARDS MODIFIED PE TUBE - 3250008068 MYOSURE LITE FIBROID REMOVAL - 3250008072 PE TUBE COLLAR BUTTON ULTRASIL - 3250008129 MEROGEL NASAL INJECTABLE FOAM - 3250008131 CAPIO SUTURE TI-CRON - 3250008351 TOURNIQUET 24IN STERILE - 3250008352 TOURNIQUET 34IN STERILE - 3250008353 TOURNIQUET 8IN STERILE - 3250008354 POSTERIOR FEMORAL PRESSURIZER - 3250008360 KIT CONCISE CEMENT SCULPS - 3250008389 SHAVER DIEGO 2.9MM - 3250008396 BONE VOID FILLER VITOSS - 3250008523 FALOPE-RING APPLICATOR DISP - 3250008850 NASAL SEPTAL BUTTON 3CM - 3250008949 KNOTLESS TIGHTROPE REPAIR KIT - 3250009580 LMA CHILD DISP 2 1/2 - 3250009581 LMA CHILD DISP 1 1/2 - 4085000001 ESOPHAGUS PROCEDURES 30.00 4085000002 RAD MOD BREAST W NODE DISSECT 30.00 4085000003 CLOSED CHEST 1 LUNG VENT 30.00 4085000004 CERVICAL SPINE & CORD PROC 30.00 4085000005 THORACIC SPINE & CORD PROC 30.00 4085000006 REVISION HIP ARTROPLASTY 30.00 4085000007 TOTAL SHOULDER ARTHOPLASTY 30.00 4085000008 CLOSED CHEST PROC NO LUNG VENT 30.00 4085000009 INTRAPERITONEAL LOWER ABDOMEN 30.00 4085000010 HIP ARTHROPLASTY 30.00 4085000011 TRANSABDOMINAL HERNIA REPAIR 30.00 4085000012 UPPER ABDOMEN LAPAROSCOPY 30.00 4085000013 LOW ABD LAP ABDOMINOPERITONEAL 30.00 4085000014 RADICAL PERINEAL PROCEDURE 30.00 4085000015 KNEE ARTHROPLASTY 30.00 4085000016 SYSTEM OF NECK PROCEDURE 30.00 4085000017 CLOSED CHEST INC BRONCHOSCOPE 30.00 4085000018 VENTRAL AND LUMBAR HERNIA 30.00 4085000019 VENTRAL & INCISIONAL HERNIAS 30.00 4085000020 LOWER ABDOMEN LAPAROSCOPY 30.00 4085000021 LOW ABD LAP TUBAL LIGATION 30.00 4085000022 SEMINAL VESCICLE 30.00 4085000023 RADICAL ABDOMINAL ORCHIECTOMY 30.00 4085000024 VAG HYST 30.00 4085000025 OPEN PROC OF UPPER 2/3 FEMUR 30.00 4085000026 RADICAL PROCEDURE OF ELBOW 30.00 4085000027 RECONSTRUCTIVE PROC OF EYELID 30.00 4085000028 EXT MID & INNER EAR BIOPSY 30.00 4085000029 NOSE AND ACCESSORY SINUS PROC 30.00 4085000030 INTRAORAL PROC INCL BIOPSY 30.00 4085000031 INVIEG MSCL NRV H N POS TRUNK 30.00 4085000032 INT EXT ANT TR N PERI RECON BR 30.00 4085000033 INT EXT ANT TR N P RAD MRAD BR 30.00 4085000034 CLAVICAL AND SCAPULA 30.00 4085000035 UPPER POSTERIOR ABDOMINAL WALL 30.00 4085000036 ANES UPR GI NDSC PX NOS 30.00 4085000037 ANES LWR INTST NDSC NOS 30.00 4085000038 LOWER POSTERIOR ABDOMINAL WALL 30.00 4085000039 ANORECTAL PROCEDURES 30.00 4085000040 TURBT 30.00 4085000041 TURP 30.00 4085000042 POST TURP BLEEDING 30.00 4085000043 W/ FRAG MANPL N/OR REM UTRL CA 30.00 4085000044 OPEN PROCEDURE LOWER 1/3 FEMUR 30.00 4085000045 RUPTURED ACHILLES TENDON 30.00 4085000046 GASTRICNEMIUS RECESSION 30.00 4085000047 NMTFB SHOULDER N AXILLIA 30.00 4085000048 OOS ARTH HUM HD N NK SCVLR SJ 30.00 4085000049 TENODESIS 30.00 4085000050 O OR ARTH OSTEOTOMY OF HUMERUS 30.00 4085000051 REP NONUNION OR MALUNION HUMER 30.00 4085000052 EXCISION CYST TUMOR HUMERUS 30.00 4085000053 TYMPANOTOMY 30.00 4085000054 LENS SURGERY 30.00 4085000055 PROCON NOSE AND SINUSE 30.00 4085000056 CLOSED CHEST PROC 30.00 4085000057 PNEUMOCENTESIS 30.00 4085000058 ACCESS TO CENTRAL VENOUS 30.00 4085000059 PROC IN LUMBAR REGION 30.00 4085000060 PROC UPPER ANTERIOR ABDOMEN 30.00 4085000061 PERCUTANEOUS LIVER BIOPSY 30.00 4085000062 PROC UPPER ABDOMEN 30.00 4085000063 PROC LOWER ANT ABDOMINAL WALL 30.00 4085000064 LOWER ABDOMEN REPAIR NOT SPEC 30.00 4085000065 UNDESCENDED TESTIS 30.00 4085000066 RADICAL ORCHIECTOMY 30.00 4085000067 ORCHIOPEXY UNI OR BILATERAL 30.00 4085000068 PENILE PROSTHESIS 30.00 4085000069 OPEN URETHRAL PROC 30.00 4085000070 HYSTEROSCOPY 30.00 4085000071 CLOSED PROC HIP JOINT 30.00 4085000072 PROC OF NERVE MUSCLE TENDON 30.00 4085000073 FASCIA AND BURSA OF KNEE 30.00 4085000074 OPEN PROC TIBIA FIBULA PATELLA 30.00 4085000075 SURGICAL ARTHROSCOPY JOINT 30.00 4085000076 BKA 30.00 4085000077 OSTEOTOMY OF TIBIA FIBULA 30.00 4085000078 CLOSED PROC SHOULDER 30.00 4085000079 DIAG ARTHORSCOPIC PROC SHOULDE 30.00 4085000080 ARTHROSCOPIC PROC ELBOW 30.00 4085000081 INC OR MISSED ABORTION 30.00 4085000083 LYMPHATIC SYSTEM OF NECK 30.00 4085000084 INTEGUMENTARY SYST EXTREMITIES 30.00 4085000085 TRANSURETHRAL PROCEDURES 30.00 4085000086 PROC ON MALE GENITALIA 30.00 4085000087 VASSECTOMY UNILAT OR BILAT 30.00 4085000088 VAGINAL PROCEDURES 30.00 4085000089 UPPER LEG VEINS 30.00 4085000090 CLOSED PROC OF KNEE 30.00 4085000091 DIAG KNEE ARTHROSCOPY 30.00 4085000092 CLOSED PROC TIBIA FIB/PATELLA 30.00 4085000093 CAST APP REMOVAL OR REPR KNEE 30.00 4085000094 VEINS OF KNEE POPLITEAL AREA 30.00 4085000095 ALL CLOSED PROC LOWER LEG 30.00 4085000096 ARTHROSCOPIC PROC ANKLE/FOOT 30.00 4085000097 TENDON AND FASCIA OF LOWER LEG 30.00 4085000098 OPEN PROC ON BONE LOWER LEG 30.00 4085000099 LOWER LEG CAST REMOVE OR REP 30.00 4085000100 VEINS OF LOWER LEG 30.00 4085000101 FASCIA AND BURSAE UPPER ARM 30.00 4085000102 CLOSED PROC HUMERUS/ELBOW 30.00 4085000103 DIAG PROC OF ELBOW 30.00 4085000104 ANES FASCIA & BURSAE FOREARM 30.00 4085000105 ANEST DIAG ARTHROSCOPY WRIST 30.00 4085000106 ANES WRIST AND HAND 30.00 4085000107 ANEST FOR CAST APPLICATION 30.00 4085000108 ANESTH OTOSCOPY 30.00 4085000109 ANES PROC EYE;NOS 30.00 4085000110 PRT HEPTCMY F LIVER HEMR EX BX 30.00 4085000111 PROC ARTHROSCPIC HIP JOINT 30.00 4085000112 CL PROC UPPER 2/3 OF FEMUR 30.00 4085000113 ANES CL PROC LOWR 1/3 OF FEMUR 30.00 4085000114 ANES SHOULDER CAST APREMREP 30.00 4085000116 TENOTOMYELBOW TO SHOULDER OPN 30.00 4085000117 ANESTH TENOPLASTY ELBOW2SHOULD 30.00 4085000118 ANES CL RADULNAWRST OR HAND 30.00 4085000119 ANESTH CESAREAN DEL ONLY 30.00 4085000120 ANESTH VAGINAL DELIVERY ONLY 30.00 4085000122 ANESTH EXTREME AGE <1 OR >70 341.00 4085000123 ANESTH CMPLCD CONTROL HYPOTENS 30.00 4085000124 ANES CMPLCD BY EMERGENCY 333.00 4085000125 ANESTH CS FOLLOW LABOR ANESTH 30.00 4085000126 ANESTH CSHYST FOLLOW LABOR ANE 30.00 4085000127 ANES PLN VAG DEL W LABOR ANEST 30.00 4085000134 EXTRAPERITONEAL LOWER ABDOMEN 30.00 4085000136 PROCEDURE IN LUMBAR REGION 30.00 4085000137 BRACHIAL PLEXIS BLOCK 990.00 4085000138 BRACHIAL PLEXIS CATHETER PLACE 1,020.00 4085000139 AXILLARY BLOCK 1,020.00 4085000140 FEMORAL NERVE BLOCK 1,000.00 4085000141 FEMORAL NERVE CATH PLACEMENT 1,020.00 4085000142 OTHER PERIPHERAL BLOCK 1,012.00 4085000143 TAPINTERCOSTAL NERVE MULT REG 1,020.00 4085000144 EPIDURAL LUMBAR CATHETER 1,020.00 4085000145 SCIATIC NERVE BLOCK-SINGLE 1,020.00 4085000146 SCIATIC NERVE BLOCK-CATHETER 990.00 4085000147 EMERGENCY INTUBATION 942.00 4085000148 BLOOD PATCH 341.00 4085000149 DIFFICULT IV PLACEMENT 341.00 4085000150 ARTERIAL LINE PLACEMENT 1,685.00 4085000151 CENTRAL LINE PLACEMENT 30.00 4085000152 LUMBAR PUNCTURE DIAGNOSTIC 193.00 4085000153 EPIDURAL PER DAY 193.00 4085000155 EXTENSIVE SPINE AND CORD PROC 30.00 4085000156 MOD SED NONSURG >5 FIRST 30MIN 538.00 4085000157 ILIOINGUINAL/GASTRIC BLOCK 1,020.00 4085000158 CARDIOVERSION OF ARRHYTHMIA 30.00 4085000159 ANES NON-INVASIVE RAD IMAGING 30.00 4085000160 VENIPUNCTURE YOUNGER THAN 3 341.00 4085000161 MOD SED NONSURG>5 ADDL 15MIN 271.00 4085000162 EPIDURAL THORACIC CATHETER 1,020.00 4085000163 ACCESS CENTRAL VENOUS CIRC 30.00 4085000164 ANESTHESIA FOR SIMPLE LIGATION 30.00 4085000165 ANES PROC FACIAL BONE&SKULL 30.00 4085000166 THORACOTOMY PROCEDURE 30.00 4085000732 ANES UPR GI NDSC PX ERCP 30.00 4085000812 ANES LWR INTST SCR COLSC 30.00 4085000813 ANES UPR LWR GI NDSC PX 30.00 4085001210 OPEN HIP JOINT NOS 30.00 4085200103 CRNA-RECONSTRUCTIVE PROC OF EY 30.00 4085200120 CRNA-EXT MID & INNER EAR BIOPS 30.00 4085200124 CRNA-ANESTH OTOSCOPY 30.00 4085200126 CRNA-TYMPANOTOMY 30.00 4085200140 CRNA-ANES PROC EYE;NOS 30.00 4085200142 CRNA-LENS SURGERY 30.00 4085200160 CRNA-NOSE AND ACCESSORY SINUS 30.00 4085200164 CRNA-PROCON NOSE AND SINUSE 30.00 4085200170 CRNA-INTRAORAL PROC INCL BIOPS 30.00 4085200190 CRNA-ANES PROC FACIAL BONE&SKU 30.00 4085200300 CRNA-INVIEG MSCL NRV H N POS T 30.00 4085200320 CRNA-SYSTEM OF NECK PROCEDURE 30.00 4085200322 CRNA-LYMPHATIC SYSTEM OF NECK 30.00 4085200352 CRNA-ANESTHESIA FOR SIMPLE LIG 30.00 4085200400 CRNA-INTEGUMENTARY SYST EXTREM 30.00 4085200402 CRNA-INT EXT ANT TR N PERI REC 30.00 4085200404 CRNA-INT EXT ANT TR N P RAD MR 30.00 4085200406 CRNA-RAD MOD BREAST W NODE DIS 30.00 4085200410 CRNA-CARDIOVERSION OF ARRHYTHM 30.00 4085200450 CRNA-CLAVICAL AND SCAPULA 30.00 4085200500 CRNA-ESOPHAGUS PROCEDURES 30.00 4085200520 CRNA-CLOSED CHEST INC BRONCHOS 30.00 4085200522 CRNA-CLOSED CHEST PROC 30.00 4085200524 CRNA-PNEUMOCENTESIS 30.00 4085200528 CRNA-CLOSED CHEST PROC NO LUNG 30.00 4085200529 CRNA-CLOSED CHEST 1 LUNG VENT 30.00 4085200532 CRNA-ACCESS TO CENTRAL VENOUS 30.00 4085200540 CRNA-THORACOTOMY PROCEDURE 30.00 4085200600 CRNA-CERVICAL SPINE & CORD PRO 30.00 4085200620 CRNA-THORACIC SPINE & CORD PRO 30.00 4085200630 CRNA-PROCEDURE IN LUMBAR REGIO 30.00 4085200635 CRNA-PROC IN LUMBAR REGION 30.00 4085200670 CRNA-EXTENSIVE SPINE AND CORD 30.00 4085200700 CRNA-PROC UPPER ANTERIOR ABDOM 30.00 4085200702 CRNA-PERCUTANEOUS LIVER BIOPSY 30.00 4085200730 CRNA-UPPER POSTERIOR ABDOMINAL 30.00 4085200732 CRNA -ANES UPR GI NDSC PX ERCP 30.00 4085200740 CRNA -ANES UPR GI NDSC PX NOS 30.00 4085200750 CRNA-PROC UPPER ABDOMEN 30.00 4085200752 CRNA-VENTRAL AND LUMBAR HERNIA 30.00 4085200756 CRNA-TRANSABDOMINAL HERNIA REP 30.00 4085200790 CRNA-UPPER ABDOMEN LAPAROSCOPY 30.00 4085200792 CRNA-PRT HEPTCMY F LIVER HEMR 30.00 4085200800 CRNA-PROC LOWER ANT ABDOMINAL 30.00 4085200810 CRNA -ANES LWR INTST NDSC NOS 30.00 4085200812 CRNA -ANES LWR INTST SCR COLSC 30.00 4085200813 CRNA -ANES UPR LWR GI NDSC PX 30.00 4085200820 CRNA-LOWER POSTERIOR ABDOMINAL 30.00 4085200830 CRNA-LOWER ABDOMEN REPAIR NOT 30.00 4085200832 CRNA-VENTRAL & INCISIONAL HERN 30.00 4085200840 CRNA-LOWER ABDOMEN LAPAROSCOPY 30.00 4085200844 CRNA-LOW ABD LAP ABDOMINOPERIT 30.00 4085200846 CRNA-INTRAPERITONEAL LOWER ABD 30.00 4085200851 CRNA-LOW ABD LAP TUBAL LIGATIO 30.00 4085200860 CRNA-EXTRAPERITONEAL LOWER ABD 30.00 4085200902 CRNA-ANORECTAL PROCEDURES 30.00 4085200904 CRNA-RADICAL PERINEAL PROCEDUR 30.00 4085200910 CRNA-TRANSURETHRAL PROCEDURES 30.00 4085200912 CRNA-TURBT 30.00 4085200914 CRNA-TURP 30.00 4085200916 CRNA-POST TURP BLEEDING 30.00 4085200918 CRNA-W/ FRAG MANPL N/OR REM UT 30.00 4085200920 CRNA-PROC ON MALE GENITALIA 30.00 4085200921 CRNA-VASSECTOMY UNILAT OR BILA 30.00 4085200922 CRNA-SEMINAL VESCICLE 30.00 4085200924 CRNA-UNDESCENDED TESTIS 30.00 4085200926 CRNA-RADICAL ORCHIECTOMY 30.00 4085200928 CRNA-RADICAL ABDOMINAL ORCHIEC 30.00 4085200930 CRNA-ORCHIOPEXY UNI OR BILATER 30.00 4085200938 CRNA-PENILE PROSTHESIS 30.00 4085200940 CRNA-VAGINAL PROCEDURES 30.00 4085200942 CRNA-OPEN URETHRAL PROC 30.00 4085200944 CRNA-VAG HYST 30.00 4085200952 CRNA-HYSTEROSCOPY 30.00 4085201200 CRNA-CLOSED PROC HIP JOINT 30.00 4085201202 CRNA-PROC ARTHROSCPIC HIP JOIN 30.00 4085201210 CRNA-OPEN HIP JOINT NOS 30.00 4085201214 CRNA-HIP ARTHROPLASTY 30.00 4085201215 CRNA-REVISION HIP ARTROPLASTY 30.00 4085201220 CRNA-CL PROC UPPER 2/3 OF FEMU 30.00 4085201230 CRNA-OPEN PROC OF UPPER 2/3 FE 30.00 4085201250 CRNA-PROC OF NERVE MUSCLE TEND 30.00 4085201260 CRNA-UPPER LEG VEINS 30.00 4085201320 CRNA-FASCIA AND BURSA OF KNEE 30.00 4085201340 CRNA-ANES CL PROC LOWR 1/3 OF 30.00 4085201360 CRNA-OPEN PROCEDURE LOWER 1/3 30.00 4085201380 CRNA-CLOSED PROC OF KNEE 30.00 4085201382 CRNA-DIAG KNEE ARTHROSCOPY 30.00 4085201390 CRNA-CLOSED PROC TIBIA FIB/PAT 30.00 4085201392 CRNA-OPEN PROC TIBIA FIBULA PA 30.00 4085201400 CRNA-SURGICAL ARTHROSCOPY JOIN 30.00 4085201402 CRNA-KNEE ARTHROPLASTY 30.00 4085201420 CRNA-CAST APP REMOVAL OR REPR 30.00 4085201430 CRNA-VEINS OF KNEE POPLITEAL A 30.00 4085201462 CRNA-ALL CLOSED PROC LOWER LEG 30.00 4085201464 CRNA-ARTHROSCOPIC PROC ANKLE/F 30.00 4085201470 CRNA-TENDON AND FASCIA OF LOWE 30.00 4085201472 CRNA-RUPTURED ACHILLES TENDON 30.00 4085201474 CRNA-GASTRICNEMIUS RECESSION 30.00 4085201480 CRNA-OPEN PROC ON BONE LOWER L 30.00 4085201482 CRNA-BKA 30.00 4085201484 CRNA-OSTEOTOMY OF TIBIA FIBULA 30.00 4085201490 CRNA-LOWER LEG CAST REMOVE OR 30.00 4085201520 CRNA-VEINS OF LOWER LEG 30.00 4085201610 CRNA-NMTFB SHOULDER N AXILLIA 30.00 4085201620 CRNA-CLOSED PROC SHOULDER 30.00 4085201622 CRNA-DIAG ARTHORSCOPIC PROC SH 30.00 4085201630 CRNA-OOS ARTH HUM HD N NK SCVL 30.00 4085201638 CRNA-TOTAL SHOULDER ARTHOPLAST 30.00 4085201680 CRNA-ANES SHOULDER CAST APREMR 30.00 4085201710 CRNA-FASCIA AND BURSAE UPPER A 30.00 4085201712 CRNA-TENOTOMYELBOW TO SHOULDER 30.00 4085201714 CRNA-ANESTH TENOPLASTY ELBOW2S 30.00 4085201716 CRNA-TENODESIS 30.00 4085201730 CRNA-CLOSED PROC HUMERUS/ELBOW 30.00 4085201732 CRNA-DIAG PROC OF ELBOW 30.00 4085201740 CRNA-ARTHROSCOPIC PROC ELBOW 30.00 4085201742 CRNA-O OR ARTH OSTEOTOMY OF HU 30.00 4085201744 CRNA-REP NONUNION OR MALUNION 30.00 4085201756 CRNA-RADICAL PROCEDURE OF ELBO 30.00 4085201758 CRNA-EXCISION CYST TUMOR HUMER 30.00 4085201810 CRNA-ANES FASCIA & BURSAE FORE 30.00 4085201820 CRNA-ANES CL RADULNAWRST OR HA 30.00 4085201829 CRNA-ANEST DIAG ARTHROSCOPY WR 30.00 4085201830 CRNA-ANES WRIST AND HAND 30.00 4085201860 CRNA-ANEST FOR CAST APPLICATIO 30.00 4085201922 CRNA-ANES NON-INVASIVE RAD IMA 30.00 4085201960 CRNA-ANESTH VAGINAL DELIVERY O 30.00 4085201961 CRNA-ANESTH CESAREAN DEL ONLY 30.00 4085201965 CRNA-INC OR MISSED ABORTION 30.00 4085201967 CRNA-ANES PLN VAG DEL W LABOR 30.00 4085201968 CRNA-ANESTH CS FOLLOW LABOR AN 30.00 4085201969 CRNA-ANESTH CSHYST FOLLOW LABO 30.00 4085201996 CRNA-EPIDURAL PER DAY 193.00 4085231500 CRNA-EMERGENCY INTUBATION 942.00 4085236400 CRNA-VENIPUNCTURE YOUNGER THAN 341.00 4085236410 CRNA-DIFFICULT IV PLACEMENT 341.00 4085236620 CRNA-ARTERIAL LINE PLACEMENT 1,685.00 4085262270 CRNA-LUMBAR PUNCTURE DIAGNOSTI 193.00 4085262273 CRNA-BLOOD PATCH 341.00 4085262324 CRNA-EPIDURAL THORACIC CATHETE 1,020.00 4085262326 CRNA-EPIDURAL LUMBAR CATHETER 1,020.00 4085264415 CRNA-BRACHIAL PLEXIS BLOCK 1,020.00 4085264416 CRNA-BRACHIAL PLEXIS CATHETER 1,020.00 4085264417 CRNA-AXILLARY BLOCK 1,020.00 4085264421 CRNA-TAPINTERCOSTAL NERVE MULT 1,020.00 4085264425 CRNA-ILIOINGUINAL/GASTRIC BLOC 1,020.00 4085264445 CRNA-SCIATIC NERVE BLOCK-SINGL 1,020.00 4085264446 CRNA-SCIATIC NERVE BLOCK-CATHE 1,020.00 4085264447 CRNA-FEMORAL NERVE BLOCK 1,020.00 4085264448 CRNA-FEMORAL NERVE CATH PLACEM 1,020.00 4085264450 CRNA-OTHER PERIPHERAL BLOCK 1,009.00 4085299100 CRNA-ANESTH EXTREME AGE <1 OR 341.00 4085299135 CRNA-ANESTH CMPLCD CONTROL HYP 30.00 4085299140 CRNA-ANES CMPLCD BY EMERGENCY 336.00 4085299156 CRNA-MOD SED NONSURG >5 FIRST 538.00 4085299157 CRNA-MOD SED NONSURG>5 ADDL 15 271.00 4310000010 STOCKING TED THIGH HI MD REG - 4310000011 STOCKING TED THIGH HI LG REG - 4310000024 TRAY FOLEY WITH CATH 16 FR - 4310000050 SLING ARM XLG - 4310000051 SLING ARM LG - 4310000052 SLING ARM MED - 4310000053 SLING ARM SM - 4310000054 SLING ARM - PED - 4310000059 IMMOBILIZER KNEE UNIV 20 IN - 4310000063 KIT FEMALE CATH - 4310000065 BRACE ANKLE RIGHT MEDIUM - 4310000075 STOCKING TED THIGH HI XL REG - 4310000079 TRIPLE LUMEN CATH TRAY - 4310000082 DRAPE INCISE IOBAN - 4310000098 STOCKING TED THIGH HI SM REG - 4310000140 LITHOTOMY PACK IV - 4310000159 BINDER ABDOMINAL 46-62 - 4310000164 SUTURE 5-0 PROLENE P-3 8698G - 4310000167 SCD SLEEVE MED - 4310000169 NU-GAUZE PACK STRIP PL 1 IN - 4310000176 TUBE TRACH LOPRO 5.5 CUFF - 4310000177 TUBE TRACH LOPRO 6.0 CUFF - 4310000181 TUBE TRACH LOPRO 6.5 CUFF - 4310000183 TUBE TRACH LOPRO 7.5 CUFF - 4310000184 TUBE TRACH LOPRO 8.0 CUFF - 4310000185 TUBE TRACH LOPRO 7.0 CUFF - 4310000194 URINE DRAIN LEG BAG - 4310000210 CAUTERY CORDLESS SINGLE USE - 4310000228 SUTURE 6-0 PROLENE P-3 8695G - 4310000230 BRACE ANKLE LEFT MEDIUM - 4310000231 BRACE ANKLE RIGHT SMALL - 4310000232 BRACE ANKLE LEFT SMALL - 4310000233 BRACE ANKLE RIGHT LARGE - 4310000234 BRACE ANKLE LEFT LARGE - 4310000240 SUTURE 5-0 ETHILON FS-2 661H - 4310000253 SALEM SUMP TUBE 18 FR - 4310000254 TUBE LEVIN 14 FR - 4310000264 TUBE TRACH LOPRO 4.0 CUFF - 4310000265 TUBE TRACH LOPRO 4.5 CUFF - 4310000276 LUMBAR PUNCTURE TRAY ADULT - 4310000277 LUMBAR PUNCTURE TRAY PED - 4310000280 TROCAR CATHETER 8 FR - 4310000284 THORACIC CATHETER 28 FR - 4310000305 TRAY EPIDURAL 17GA - 4310000306 CATH-N-GLOVE SET - 4310000316 URINE METER WITH DRAIN BAG - 4310000325 NUGAUZE PACK STRIP PL 1/4 IN - 4310000326 NUGAUZE PACK STRIP PL 1/2 IN - 4310000327 NUGAUZE PACK STRIP IO 1/4 IN - 4310000328 NUGAUZE PACK STRIP IO 1 IN - 4310000349 SPLINT WRIST RIGHT MED - 4310000350 SPLINT WRIST LEFT MED - 4310000351 SPLINT WRIST RIGHT LG - 4310000352 SPLINT WRIST LEFT LG - 4310000373 PACK ORTHO I MAJOR - 4310000374 UNIVERSAL TIBURON PACK - 4310000437 DERMA BOND - 4310000449 TEGADERM 4X4 DRESSING - 4310000450 TEGADERM 2X2 DRESSING - 4310000458 XEROFROM 1X8 DRESSING - 4310000459 XEROFORM 5X9 DRESSING - 4310000469 SPIROMETER - 4310000472 TUBING VENTED NITRO BAXTER - 4310000481 CATH FOLEY 8 FR 3CC - 4310000482 CATH FOLEY 10 FR 3CC - 4310000484 CATH FOLEY 12 FR 5CC - 4310000485 CATH FOLEY 14 FR 5CC - 4310000486 CATH RED RUBBER 14 FR - 4310000487 CATH FOLEY 16 FR 5CC - 4310000488 CATH FOLEY 16 FR 30CC - 4310000490 CATH FOLEY 18 FR 5CC - 4310000493 CATH FOLEY 20 FR 30CC - 4310000499 CATH FOLEY 26 FR 30CC - 4310000505 SUTURE 7-0 PROLENE P-6 8648G - 4310000509 SUTURE 4-0 PROLENE P-3 8699G - 4310000510 SUTURE 4-0 PROLENE FS-2 8683G - 4310000527 SUTURE 6-0 ETHILON P-1 697G - 4310000531 SUTURE 4-0 NYLON FS-2 662G - 4310000532 SUTURE 4-0 ETHILON FS - 1 1629 - 4310000534 SUTURE 3-0 NYLON FS-1 699H - 4310000535 SUTURE 3-0 ETHILON PS -2 1669H - 4310000551 SUTURE 5-0 CHROMIC P-3 687G - 4310000571 SUTURE 6-0 PROLENE P-1 8697G - 4310000766 SNARE POLYPECTOMY - 4310000796 EPIX LAPAROSC SCISSORS 5MM - 4310000807 INSUFFLATION NEEDLE 120MM - 4310000851 DRESSING DUODERM 4X4 - 4310000860 TRAY CATH WITH RED RUBBER 15FR - 4310000862 TRAY FOLEY WITHOUT CATH - 4310000921 SALEM SUMP TUBE 12 FR - 4310001045 COMBINED PACK ARTHROSCOPY - 4310001113 SUTURE 6-0 VICRYL P-1 J489G - 4310001116 SUTURE 5-0 VICYL PS-5 J593G - 4310001117 SUTURE 4-0 VICRYL P-3 J494G - 4310001118 SUTURE 4-0 VICRYL FS-2 J422H - 4310001121 SUTURE 3-0 VICRYL FS-2 J423H - 4310001146 SUTURE 1-0 ETHIBOND CT1 X425H - 4310001150 SUTURE 5-0 ETHILON P-3 698H - 4310001171 ENDOCLIP APPLIER LIGACLIP 10MM - 4310001182 INZII RETRIEVAL SYSTEM 10MM - 4310001188 SHOE POSTOP MALE MED - 4310001189 SHOE POSTOP FEMALE SM - 4310001190 SHOE POSTOP MALE SM - 4310001191 SHOE POSE OP MALE XLG - 4310001201 SHOE POSTOP FEMALE MED - 4310001202 SHOE POSTOP FEMALE LG - 4310001203 SHOE POSTOP MALE LG - 4310001277 DRESSING MEPILEX 4X4 - 4310001304 LENS MORGAN THERAPY - 4310001595 DRESSING PRIMAPORE 4 X 3 - 4310001630 CATH FOLEY COUDE TIP 14FR - 4310001631 CATH FOLEY COUDE TIP 16FR - 4310001632 CATH FOLEY COUDE TIP 18FR - 4310001644 SUTURE 5-0 VICRYL FS-2 J421H - 4310001666 STAPLER SKIN 35R - 4310001704 IMMOBILIZER SHOULDER UNIV - 4310001705 BELT RIB MALE - 4310001707 COLLAR CERVICAL UNIV ADJ 3 IN - 4310001743 FEEDING TUBE ENTRIFLEX 8 FR - 4310001766 AMBUBAG ADULT - 4310001767 AMBUBAG CHILD - 4310001777 SUTURE SILK 680H - 4310001873 AIRWAY NASOPHAR 26 FR - 4310001877 SUTURE 6-0 ETHILON P-3 1698G - 4310001886 ETHICON 5-0 PROLENE FS-2 8661G - 4310001891 SUTURE 0 SILK FSL 680H - 4310001896 IMMOBILIZER KNEE UNIV 24 IN - 4310001901 RAPID RHINO AAC 4.5 CM - 4310001902 RAPID RHINO AAC 5.5 CM - 4310001903 RAPID RHINO PAC 7.5 CM - 4310001964 DRESSING MEPILEX 3X3 - 4310001965 DRESSING MEPILEX 5X5 - 4310001966 DRESSING MEPILEX SACRUM - 4310001967 CLEANSER DERMAL WOUND - 4310001971 SECURA PERSONAL CLEANSER - 4310001972 OINTMENT CLOVE OIL PROTECTIVE - 4310001973 OINTMENT ANTIFUNGAL - 4310001974 CREAM DIMETHICONE PROTECTANT - 4310001984 SUTURE UMB TAPE U12T - 4310002002 KIT CATH INFANT PEDIATRIC - 4310002079 DRESSING PRIMAPORE 8 X 4 - 4310002115 SUTURE 7-0 NYLON P-6 1647G - 4310002190 COLLAR TRAUMA - 4310002411 SUTURE 4-0 ETHILON P-3 699G - 4310002412 SET FLUID WARMER STANDARD FLOW - 4310002413 SET FLUID WARMING HIGH FLOW - 4310002492 NUGAUZE PACK STRIP IO 1/2 IN - 4310002751 SPLINT WRIST RIGHT SM - 4310002752 SPLINT WRIST LEFT SM - 4310002826 ENDO BALLOON DILATOR 60CC SYR - 4310002938 BRACE NEOPRENE HINGED KNEE MED - 4310002939 BRACE NEOPRENE HINGED KNEE LG - 4310002940 BRACE NEOPRENE HINGED KNEE XL - 4310002944 BRACE ANKLE ASO SM - 4310002945 BRACE ANKLE ASO MED - 4310002946 BRACE ANKLE ASO LG - 4310002947 BRACE ANKLE ASO XL - 4310002951 SPLINT WRIST LEFT XSM - 4310002952 SPLINT WRIST RIGHT XSM - 4310002953 SPLINT WRIST RIGHT XLG - 4310002994 ATHLETIC SUPPORTER LG - 4310002995 ATHLETIC SUPPORTER MED - 4310003028 IMMOBILIZER SHOULDER MED - 4310003042 INTERPULSE HANDPIECE - 4310003066 IMMOBILIZER KNEE UNIV 22 IN - 4310003133 UNNA BOOT DRESSING W/CALAMINE - 4310003136 BOOT TRACTION UNIVERSAL - 4310003212 BRACE-FAST FIT TROM LG - 4310003227 SUTURE 5-0 VICRYL P-3 J493H - 4310003263 FORCEPS BIOPSY COATED - 4310003340 SUTURE 4-0 PROLENE PS-2 8682G - 4310003376 SPLINT THUMB SPICA LEFT SM - 4310003377 SPLINT THUMB SPICA RIGHT SM - 4310003378 SPLINT THUMB SPICA LEFT MED - 4310003379 SPLINT THUMB SPICA RIGHT MED - 4310003380 SPLINT THUMB SPICA RIGHT LG - 4310003381 SPLINT THUMB SPICA LEFT LG - 4310003382 SPLINT THUMB SPICA LEFT XL - 4310003383 SPLINT THUMB SPICA RIGHT XL - 4310003427 IMMOBILIZER SHOULDER FEM LG - 4310003429 IMMOBILIZER SHOULDER FEM XLG - 4310003452 HEELZUP ELEVATING CUSHION - 4310003468 BINDER ABDOMINAL XL - 4310003487 IMMOBILIZER KNEE SM 16IN - 4310003586 TRAY EPIDURAL PAIN CLINIC - 4310003754 KIT PNEUMOTHORAX - 4310003762 ENDOSCOPIC CURVED STAPLER 29MM - 4310003763 CURVED STAPLER INTRA 33MM - 4310003889 RAPID RHINO PAC 5.5 CM - 4310003954 LARYNGEAL MASK AIRWAY SZ 3 - 4310003955 LARYNGEAL MASK AIRWAY SZ 4 - 4310003956 LARYNGEAL MASK AIRWAY SZ 5 - 4310003977 DRESSING CHANGE KIT - 4310003995 COLLAR CERVICAL 3.5 X 24 - 4310004035 SURGICEL - 4310004039 BURR OPHTHALMIC - 4310004112 SALEM SUMP TUBE 16 FR - 4310004113 SALEM SUMP TUBE 14 FR - 4310004144 ENDOPATH LINEAR RELOAD 45MM - 4310004241 AIRWAY NASOPHAR 28 FR - 4310004242 AIRWAY NASOPHAR 32 FR - 4310004252 PLEUR-EVAC PLUS CHEST BTL - 4310004290 IV SET BURETROL SOLUTION - 4310004299 TUBE LEVIN 12 FR - 4310004325 TRAY SPINAL BUIVACAINE 25GA - 4310004394 CANNULA NASAL O2 CO2 LP12 - 4310004395 CIRCUIT ETCO2 LIFEPAK 12 - 4310004406 SLEEVE SCD KNEE HIGH LARGE - 4310004613 CATHETER FOLEY COUDE TIP - 4310004615 A-LINE RADIAL CATHETER SET - 4310004627 TRANSDUCER CABLE - 4310004661 KII FIOS TROCAR 5X100MM - 4310004662 KII FIOS TROCAR 11X100MM - 4310004685 SHAVER INCISOR CUTTER 5.5 - 4310004688 BUR BARREL 6 FLUTE 5.5 - 4310004692 BURR BARREL STONECUTTER 5.5 - 4310004888 VASYLI ORTHOTIC FULL FIRM SM - 4310004889 VASYLI ORTHOTIC FULL FIRM MED - 4310004890 VASYLI ORTHOTIC FULL FIRM LG - 4310004891 VASYLI ORTHOTIC FULL MED SM - 4310004892 VASYLI ORTHOTIC FULL MED MED - 4310004893 VASYLI ORTHOTIC FULL MED LG - 4310004894 VASYLI REARFOOT WEDGE 2 DEGREE - 4310004895 VASYLI REARFOOT WEDGE 4 DEGREE - 4310004896 VASYLI FOREFOOT WEDGE 2 DEGREE - 4310004897 VASYLI FOREFOOT WEDGE 4 DEGREE - 4310004898 VASYLI FOREFOOT WEDGE 6 DEGREE - 4310004908 OSTOMY POUCH DRAINABLE 2 3/4 - 4310004910 OSTOMY BARRIER 2 PC 8723 - 4310004911 OSTOMY CLAMP DRAIN POUCH 8770 - 4310004912 OSTOMY POUCH DRAIN 18103 - 4310004913 OSTOMY BARRIER 2 2PC 87711 - 4310004914 OSTOMY PASTE SKIN BARRIER EZ - 4310004939 SUTURE 6-0 VICRYL P-3 J492G - 4310004987 TRAUMA KIT - 4310005026 SUTURE 3-0 PROLENE PS-2 8687H - 4310005075 SUTURE 3-0 PROLENE FS-2 8665G - 4310005076 SUTURE 6-0 ETHILON PS-2 1667G - 4310005078 SUTURE 5-0 PROLENE PS-2 8686G - 4310005082 SUTURE 4-0 ETHILON PS-2 1666G - 4310005085 VASYLI ORTHOTIC FULL MED XLG - 4310005101 KII FIOS TROCAR 12X100MM - 4310005105 COLLAR TRAUMA PED - 4310005185 STOCKING TED THIGH HI MD SHORT - 4310005214 TRAY FOLEY 16FR W/URINE METER - 4310005335 HEEL LIFT ADJUSTABLE SMALL - 4310005336 HEEL LIFT ADJUSTABLE MEDIUM - 4310005337 HEEL LIFT ADJUSTABLE LARGE - 4310005364 COLLAR CERVICAL 3.5 X 18 - 4310005421 CENTRAL LINE KIT PED FEMORAL - 4310005431 OVERDOOR PULLEY AND ROPE - 4310005453 CERVICAL COLLAR MIAMI J SM - 4310005454 CERVICAL COLLAR MIAMI J MED - 4310005455 CERVICAL COLLAR MIAMI J LG - 4310005456 CERVICAL COLLAR MIAMI J SHORT - 4310005457 CERVICAL COLLAR MIAMI J XSM - 4310005458 CERVICAL COLLAR MIAMI J STOUT - 4310005574 STOCKING TED KNEEHIGH LG REG - 4310005575 STOCKING TED KNEE HI MD REG - 4310005576 STOCKING TED KNEE HI SM REG - 4310005577 STOCKING TED KNEE HIGH XLG REG - 4310005642 HIP SURGERY PATIENT CARE KIT - 4310005647 KII SHLDD BLDD TROCAR 5X100M - 4310005648 KII SHLDD BLDD TROCR 11X100MM - 4310005878 ENDOPATH LINEAR CUTTER 45 - 4310005885 DRESSING ACTICOAT ABSORB 4X5 - 4310005896 DRESSING MEPILEX THIN 2X2 - 4310005921 BRACE FASTFIT TROM SM - 4310005980 TRAY PARACENTESIS - 4310006000 SECURA PROTECTIVE OINTMENT - 4310006001 CREAM EXTRA PROTECTIVE - 4310006003 CREAM ANTIFUNGAL S&N - 4310006008 DRESSING ACTICOAT POSTOP 4X4 - 4310006009 DRESSING ACTICOAT POSTOP 4X10 - 4310006010 DRESSING ALLEVYN AG SILVER 5X5 - 4310006012 IODOSORB GEL 10 GM TUBE - 4310006129 CATH PICC SOLO DL POWER 5FR - 4310006172 FORCEP WOUND CLOSURE FINE BLUE - 4310006179 IMMOBILIZER KNEE 12IN SM - 4310006180 IMMOBILIZER KNEE 12IN MED - 4310006181 IMMOBILIZER KNEE 12IN LG - 4310006182 IMMOBILIZER KNEE 12IN XLG - 4310006183 IMMOBILIZER KNEE 16IN MED - 4310006184 IMMOBILIZER KNEE 16IN LG - 4310006185 IMMOBILIZER KNEE 16IN XLG - 4310006217 BELT SI-LOC SACROILIAC S/M - 4310006449 BRACE-FAST FIT TROM XLG - 4310006465 CLEANSER TOTAL BODY FOAM - 4310006554 MEDIHONEY TUBE 1.5 OZ - 4310006588 SLEEVE KNEE NEOPRENE - 4310006742 BLADE 2.5 SM JOINT FULL RAD - 4310006760 TOTAL JOINT PACK - 4310006883 BENIK WRIST WRAP W-200 - 4310006961 PACK HOT/COLD REUSE GEL 10X12 - 4310007069 MEPILEX BORDER 6X6 DRESSING - 4310007096 STOCKING TED THIGH HI XL SHORT - 4310007161 SYSTAGENIX PRISMA MATRIX DRSG - 4310007174 BURR ABRADER POWERMINI 2.9MM - 4310007330 SET ANI-SIPHON PCA - 4310007331 EPIDURAL PUMP TUBING CADD - 4310007372 BOOT WALKER FX PRO SMALL - 4310007373 BOOT WALKER FX PRO MEDIUM - 4310007374 BOOT WALKER FX PRO LARGE - 4310007427 SHAVER 4MM STRAIGHT ENT - 4310007454 DRESSING ACTICOAT FLEX 7 4X5 - 4310007519 WOUND VAC KIT SHORT TERM - 4310007582 DRESSING OPTIFOAM AG 3.5X6 - 4310007618 SCD SLEEVE KNEE LENGTH MED - 4310007690 TRACH GLIDESCOPE SIZE 3 - 4310007691 TRACH GLIDESCOPE SIZE 4 - 4310007692 TRACH GLIDESCOPE SIZE 0 - 4310007693 TRACH GLIDESCOPE SIZE 2.5 - 4310007786 COLLAR CERVICAL SOFT SMALL - 4310007795 HEALICOIL ANCHOR 4.5 - 4310008020 TUBING HIGH FLOW W/RTP PNEUMO - 4310008021 TUBING HEATED W/RTP PNEUMO - 4310008043 NASAL SPLINT DOYLE II - 4310008173 BRACE LACING WRIST RIGHT LG - 4310008178 GLOVE JOBST EDEMA REG LG - 4310008179 GLOVE EDEMA LEFT SMALL - 4310008184 GLOVE EDEMA RIGHT SMALL - 4310008294 TRACH INTRODUCER BOUGIE 15FR - 4310008305 INTRODUCER PEDIATRIC BOUGIE - 4310008314 LMA FLEXIBLE AIRWAY SZ 2.5 - 4310008316 LMA FLEXIBLE AIRWAY SZ 4 - 4310008317 LMA FLEXIBLE AIRWAY SZ 5 - 4310008326 AQUACEL RIBBON AG 2 IN - 4310008333 SUTURE TICRON 2-0 - 4310008335 SUTURE ETHILON 9-0 BLK 2819G - 4310008337 TEGADERM DRESSING 6 X 8 - 4310008376 LEG LIFTER W/FOOT GRIP 40IN - 4310008405 MEPILEX AG ANTIMICROBIAL 4X4 - 4310008410 ULTRASLING 15DEG LEFT LG - 4310008411 ULTRASLING 15DEG RIGHT MED - 4310008433 FOREFOOT WEDGE 4 DEGREE VALGUS - 4310008455 DUODERM XTHIN STERILE 4X4 - 4310008473 ABSORBA TACK FIXATION DEVICE - 4310008504 TRAY EPIDURAL COMBINATION - 4310008545 AQUACEL AG HYDROFIBER BURN 5X4 - 4310008546 AQUACEL AG HYDROFIBER BURN 4 - 4310008547 AQUACEL AG HYDROFIBER BURN 3 - 4310008587 DERMABOND SKIN ADHESIVE MINI - 4310008592 VASYLI ORTHOTIC FULL RED XXL - 4310008685 LIGASURE MARYLAND JAW 5MM - 4310008707 AQUACEL HYDROFIBER RIBBON 1X45 - 4310008708 AQUACEL AG HYDRO RIBBON 1X45 - 4310008710 MEPITEL ONE 2X3 - 4310008783 JUXTA-LITE XL LEGGING LONG - 4310008830 AQUACEL EXTRA HYDROFBR 4X5 - 4310008831 AQUACEL AG EXTRA HYDROFBR 4X5 - 4310008927 MEPILEX 6X6 DRESSING - 4310008928 MEPILEX AG 6X6 FOAM DRESSING - 4310008933 SMART CAPNOLINE O2 PEDIATRIC - 4310008938 WAFFLE MATTRESS PAD - 4310008939 WAFFLE CUSHION - 4310008969 SLING PELVIC STABILIZER STD - 4310009018 JUXTA-LITE XL FC LONG - 4310009022 QUIKCLOT X RAY 2X2 - 4310009023 QUIKCLOT X RAY 4X4 - 4310009100 INSUFFLATION NEEDLE 150MM - 4310009101 COMPRILAN 8CM - 4310009102 COMPRILAN 10CM - 4310009103 COMPRILAN 6CM - 4310009105 TUBE NASOGASTRIC SUMP 10FR - 4310009166 INFANT PROBE SENSOR - 4310009167 NEO-ADULT PROBE SENSOR - 4310009189 HYPERGEL WOUND .17OZ TUBE - 4310009192 SET DISP ADMIN BLOOD WARMER - 4310009328 NEEDLE STIMUQUIK 22GA X 2IN - 4310009338 SHORT CAM WALKER BOOT MED - 4310009339 SHORT CAM WALKER BOOT LRG - 4310009340 SHORT CAM WALKER BOOT XLRG - 4310009362 STOCKING JOBST SMALL - 4310009363 STOCKING JOBST MEDIUM - 4310009364 STOCKING JOBST LARGE - 4310009365 STOCKING JOBST X-LARGE - 4310009411 THUMB CMC LEFT MEDIUM - 4310009431 LG CIRCAID COMPRESSION ANKLET - 4310009432 STD CIRCAID COMPRESSION ANKLET - 4310009506 AMBU aSCOPE 3 SLIM 37FR - 4310009507 AMBU aASCOPE 3 41FR - 4310009597 MEPILEX FOAM AG DRESSING 8X8 - 4310009604 PROFORE LF COMPRESSION WRAP - 4310009621 NEO-PED PROBE SENSOR - 4310009628 MULTIFIX ANCHOR 5.5MM PEEK - 4310009639 POWERGLIDE MIDLINE CATH 18G - 4310009648 RIGHT SM/MED THUMB SPICA - 4310009651 LEFT SM/MD WRIST/THUMB SPICA - 4310009653 LEFT MD/LG WRIST/THUMB SPICA - 4310009737 SOLARIS READY WRAP KNEE MED - 4310009738 SOLARIS READY WRAP CALF LRG - 4310009739 SOLARIS READY WRAP THIGH MED - 4310009839 ACCUPASS 45 DEG LEFT - 4310009840 DRILL BIT 1.7MM SUTUREFIX - 4310009841 PACK DISPOSABLE HIP - 4310009867 LUMBAR ROLL SOFT - 4310009869 CANNULA PASSPORT BUTTON 3CM - 4310009881 SPLINT 3PT STEP DOWN MEDIUM - 4310009890 ULTRA SLING SMALL - 4310009891 ULTRA SLING MEDIUM - 4310009892 ULTRA SLING LARGE - 4310009895 PACK BOOT INSERT ORTHO - 4310009896 PACK PERINEAL PAD ORTHO - 4310009994 DRSG ALLEVYN LIFE 15.4 X 15.4 - 4310010059 MIDLINE CATH DRESSING CHNG KIT - 4310010070 COMFORTPRENE WRIST WRP LNG MD - 4310010213 DVT CALF SLEEVE SMALL - 4310010228 PPT METATARSAL BAR PADS SMALL - 4310010279 JOBST OPAQUE NAT KNEE HIGH SM - 4310010280 JOBST OPAQUE NAT KNEE HIGH MED - 4310010281 JOBST OPAQUE NAT KNEE HIGH LRG - 4310010289 BRACE ANKLE LEFT XLARGE - 4310010290 BRACE ANKLE RIGHT XLARGE - 4310010292 TLSO BRACE MEDIUM - 4310010312 KIT SYMPHONY DBL BREAST PUMP - 4310010353 SUTURE SILK 2-0 BLK BR KS 30IN - 4310010553 GIA UNIVERSAL STAPLER - 4310010554 ENDO KIT - 4310010582 TEGADERM 6X6 DRESSING - 4310010605 SOLARIS READY WRAP CALF SMALL - 4310010606 SOLARIS READY WRAP CALF MED - 4310010607 SOLARIS READY WRAP CALF LG TL - 4310010608 SOLARIS READY WRAP CALF XL - 4310010631 SUTURE PDS II 3-0 SH Z316H - 4310010671 UNIVERSAL HEAD RESTRAINT - 4310010729 SUTURE 2-0 VICRYL SH CR-8 - 4310010755 HIBICLENS BOTTLE 4OZ - 4310010781 BETADINE SOLUTION - 4310010782 WRIST WIDGET - 4310010896 HARMONY BREAST PUMP MANUAL - 4310010928 FOLEY CATH 6FR 1.5CC 2-WAY - 4310010946 KII ADV FIXA SLEEVE 11X100MM - 4310010962 T AND A PACK - 4310010964 LAPAROSCOPY PACK - 4310010965 SLECTIVE NERVE ROOT BLK KIT - 4310010973 HEADREST PILLOW 7 IN - 4310010996 PERFIX PLUG LARG 1.6 X 1.90 - 4310010997 KII BLADED AF TROCHAR 5MM - 4310010998 KII AF SLEEVE TROCHAR 5MM - 4310011003 VASYLI-ARMSTRONG SENSITIVE LG - 4310011057 CMC SPLINT TODDLER THUMB LEFT - 4310011141 JOBST OPAQUE NAT KNEE HIGH LG - 4310011161 TK TI KNOT DEVICE - 4310011162 TK QUICK LOAD - 4310011180 FULL RADIUS ELITE BUR 3.5MM - 4310011237 JOBST BELLA LT ARM SLEEVE LRG - 4310011240 JOBST BELLA GAUNTLET 20-30 LG - 4310011252 UNIVERSAL PROCEDURE PACK - G8978 PT MOBILITY CURRENT STATUS 2.00 G8978GO OT MOBILITY CURRENT STATUS 2.00 G8979 PT MOBILITY GOAL STATUS 2.00 G8979GO OT MOBILITY GOAL STATUS 2.00 G8980 PT MOBILITY D/C STATUS 2.00 G8980GO OT MOBILITY D/C STATUS 2.00 G8981 PT BODY POS CURRENT STATUS 2.00 G8981GO OT BODY POS CURRENT STATUS 2.00 G8982 PT BODY POS GOAL STATUS 2.00 G8982GO OT BODY POS GOAL STATUS 2.00 G8983 PT BODY POS D/C STATUS 2.00 G8983GO OT BODY POS D/C STATUS 2.00 G8984 PT CARRY CURRENT STATUS 2.00 G8984GO OT CARRY CURRENT STATUS 2.00 G8985 PT CARRY GOAL STATUS 2.00 G8985GO OT CARRY GOAL STATUS 2.00 G8986 PT CARRY D/C STATUS 2.00 G8986GO OT CARRY D/C STATUS 2.00 G8987 PT SELF CARE CURRENT STATUS 2.00 G8987GO OT SELF CARE CURRENT STATUS 2.00 G8988 PT SELF CARE GOAL STATUS 2.00 G8988GO OT SELF CARE GOAL STATUS 2.00 G8989 PT SELF CARE D/C STATUS 2.00 G8989GO OT SELF CARE D/C STATUS 2.00 G8990 PT OTHER CURRENT STATUS 2.00 G8990GO OT OTHER CURRENT STATUS 2.00 G8991 PT OTHER GOAL STATUS 2.00 G8991GO OT OTHER GOAL STATUS 2.00 G8992 PT OTHER D/C STATUS 2.00 G8992GO OT OTHER D/C STATUS 2.00 G8993 PT SUBSEQUENT CURRENT STATUS 2.00 G8993GO OT SUBSEQUENT CURRENT STATUS 2.00 G8994 PT SUBSEQUENT GOAL STATUS 2.00 G8994GO OT SUBSEQUENT GOAL STATUS 2.00 G8995 PT SUBSEQUENT D/C STATUS 2.00 G8995GO OT SUBSEQUENT D/C STATUS 2.00 G8996 SWALLOW CURRENT STATUS 2.00 G8997 SWALLOW GOAL STATUS 2.00 G8998 SWALLOW D/C STATUS 2.00 G8999 MOTOR SPEECH CURRENT STATUS 2.00 G9158 MOTOR SPEECH D/C STATUS 2.00 G9159 LANG COMP CURRENT STATUS 2.00 G9160 LANG COMP GOAL STATUS 2.00 G9161 LANG COMP D/C STATUS 2.00 G9162 LANG EXPRESS CURRENT STATUS 2.00 G9163 LANG EXPRESS GOAL STATUS 2.00 G9164 LANG EXPRESS D/C STATUS 2.00 G9165 ATTEN CURRENT STATUS 2.00 G9166 ATTEN GOAL STATUS 2.00 G9167 ATTEN D/C STATUS 2.00 G9168 MEMORY CURRENT STATUS 2.00 G9169 MEMORY GOAL STATUS 2.00 G9170 MEMORY D/C STATUS 2.00 G9171 VOICE CURRENT STATUS 2.00 G9172 VOICE GOAL STATUS 2.00 G9173 VOICE D/C STATUS 2.00 G9174 SPEECH LANG CURRENT STATUS 2.00 G9175 SPEECH LANG GOAL STATUS 2.00 G9176 SPEECH LANG D/C STATUS 2.00 G9186 MOTOR SPEECH GOAL STATUS 2.00 20938 Spinal Bone Autograft Struct Add-On Specialty $591.00 20938 Spinal Bone Autograft Struct Add-On Standard Fee $295.00 49082 Abdominal Paracentesis Specialty $593.00 49082 Abdominal Paracentesis Standard Fee $296.00 99201 Office/Outpatient Visit, New Specialty $131.00 99202 Office/Outpatient Visit, New Specialty $227.00 99203 Office/Outpatient Visit, New Specialty $328.00 99204 Office/Outpatient Visit, New Specialty $498.00 99205 Office/Outpatient Visit, New Specialty $627.00 99211 Office/Outpatient Visit, Est Specialty $62.00 99212 Office/Outpatient Visit, Est Specialty $133.00 99213 Office/Outpatient Visit, Est Specialty $221.00 99214 Office/Outpatient Visit, Est Specialty $326.00 99215 Office/Outpatient Visit, Est Specialty $439.00 99217 Observation Care Discharge Standard Fee $111.00 99218 Initial Observation Care 30 Min Specialty $304.00 99219 Initial Observation Care 50 Min Specialty $413.00 99220 Initial Observation Care 70 Min Standard Fee $282.00 99221 Initial Hospital Care 30 Min Specialty $310.00 99222 Initial Hospital Care 50 Min Specialty $418.00 99223 Initial Hospital Care 70 Min Specialty $618.00 99231 Subsequent Hospital Care 15 Min Specialty $120.00 99232 Subsequent Hospital Care 25 Min Specialty $220.00 99233 Subsequent Hospital Care 35 Min Specialty $317.00 99234 Observ/Hosp Same Date 40 Min Specialty $408.00 99235 Observ/Hosp Same Date 50 Min Specialty $515.00 99236 Observ/Hosp Same Date 55 Min Specialty $663.00 99238 Hospital DC Day Management; 30 Min/< Standard Fee $110.00 99239 Hospital DC Day Management; > 30 Min Standard Fee $163.00 99242 Office Consultation 30 Min Standard Fee $139.00 99243 Office Consultation 40 Min Specialty $259.00 99244 Office Consultation 60 Min Standard Fee $280.00 99245 Office Consultation 80 Min Standard Fee $347.00 99281 Emergency Dept Visit Minor Severity Standard Fee $64.00 99282 Emergency Dept Visit Low To Mod Severity Specialty $127.00 99283 Emergency Dept Visit Moderate Severity Specialty $189.00 99284 Emergency Dept Visit High Severity Standard Fee $180.00 99285 Emergency Dept Visit Sev; Threat to Life Specialty $531.00 99291 Critical Care, First Hour (30-74 Min) Specialty $840.00 99292 Critical Care, Add'l 30 Min Specialty $375.00 99354 Prolonged E&M/Psyc Tx Serv O/P Specialty $305.00 99355 Prolong E&M/Psyc Tx Serv O/P Ea Addl 30M Specialty $296.00 99356 Prolonged Service, Inpatient 1st Hour Specialty $280.00 99357 Prolonged Service, Inpat Ea Addl 30 Min Specialty $278.00 99384 Prev Visit, New, Age 12-17 Standard Fee $202.00 99385 Prev Visit, New, Age 18-39 Standard Fee $196.00 99386 Prev Visit, New, Age 40-64 Specialty $259.00 99387 Init Pm E/M, New Pat 65+ Yrs Standard Fee $246.00 99394 Prev Visit, Est, Age 12-17 Standard Fee $172.00 99395 Prev Visit, Est, Age 18-39 Standard Fee $176.00 99396 Prev Visit, Est, Age 40-64 Standard Fee $188.00 99397 Per Pm Reeval Est Pat 65+ Yr Specialty $229.00 99401 Preventive Counseling, Indiv 15 Min Specialty $79.00 99406 Behavioral Change; Smoking 3-10 Min Specialty $0.00 99407 Behavioral Change Smoking > 10 Min Specialty $0.00 10021 FNA W/O Image Standard Fee $189.00 10021 FNA W/O Image Specialty $379.00 10022 FNA W/Image Specialty $434.00 10022 FNA W/Image Standard Fee $217.00 10040 Acne Surgery (Milia Cysts) Specialty $313.00 10040 Acne Surgery (Milia Cysts) Standard Fee $156.00 10060 I&D Abscess; Simple or Single Specialty $360.00 10060 I&D Abscess; Simple or Single Standard Fee $180.00 10061 I&D Abscess; Complicated or Multi Standard Fee $317.00 10061 I&D Abscess; Complicated or Multi Specialty $635.00 10080 I&D Pilonidal Cyst; Simple Standard Fee $276.00 10080 I&D Pilonidal Cyst; Simple Specialty $552.00 10081 I&D Pilonid Cyst; Complex Standard Fee $413.00 10081 I&D Pilonid Cyst; Complex Specialty $826.00 10120 Inc & Rem FB SubQ; Simple Standard Fee $233.00 10120 Inc & Rem FB SubQ; Simple Specialty $467.00 10121 Incise & Rem FB SubQ; Complex Specialty $844.00 10121 Incise & Rem FB SubQ; Complex Standard Fee $422.00 10140 Drainage Of Hematoma/Fluid Standard Fee $251.00 10140 Drainage Of Hematoma/Fluid Specialty $502.00 1015F COPD Symptoms Assess Standard Fee $132.00 10160 Puncture Aspiration - Abscess/Hemat/Cyst Standard Fee $200.00 10160 Puncture Aspiration - Abscess/Hemat/Cyst Specialty $401.00 10180 I&D Cplx Postop Wound Infected Specialty $763.00 10180 I&D Cplx Postop Wound Infected Standard Fee $381.00 11000 Debride Exz/Inf Skin; 10% BS Standard Fee $83.00 11000 Debride Exz/Inf Skin; 10% BS Specialty $167.00 11001 11001 Debride Infected Skin Add-On <10% BS Specialty $66.00 11001 Debride Infected Skin Add-On <10% BS Standard Fee $33.00 11004 Debride Necro ST- Genitals & Perineum Specialty $1,825.00 11005 Debride Necrotiz STISS - Abdominal Wall Specialty $2,475.00 11006 Debr Necrotiz STISS - Genit Perin & Abd Specialty $2,215.00 11008 Remove Mesh From Abdominal Wall Specialty $870.00 11010 Debride Skin At Fracture Site Standard Fee $760.00 11010 Debride Skin At Fracture Site Specialty $1,521.00 11011 Debride Skin Muscle At Fx Site Standard Fee $827.00 11011 Debride Skin Muscle At Fx Site Specialty $1,654.00 11012 Debride Skin/Muscle/Bone At Fx Site Specialty $2,210.00 11042 Debride SubQ Tissue 20 Sq CM/< Standard Fee $179.00 11042 Debride SubQ Tissue 20 Sq CM/< Specialty $387.00 11043 Debride Musc/Fascia 20 Sq Cm/< Specialty $705.00 11044 Debride Bone 20 Sq CM/< Specialty $724.00 11044 Debride Bone 20 Sq CM/< Standard Fee $362.00 11045 Debride SubQ Tissue Ea Addtl 20 Sq Cm Specialty $126.00 11045 Debride SubQ Tissue Ea Addtl 20 Sq Cm Standard Fee $63.00 11046 Debr Musc/Fascia Add-on =<20 SQ cm Standard Fee $114.00 11046 Debr Musc/Fascia Add-on =<20 SQ cm Specialty $227.00 11047 Debride Bone Add-On =<20 Sq Cm Specialty $385.00 11055 Pare Benign Lesion; Single Standard Fee $73.00 11055 Pare Benign Lesion; Single Specialty $145.00 11056 Pare Benign Lesions; 2 To 4 Standard Fee $89.00 11056 Pare Benign Lesions; 2 To 4 Specialty $178.00 11057 Trim Skin Lesions, Over 4 Standard Fee $100.00 11057 Trim Skin Lesions, Over 4 Specialty $200.00 11100 Biopsy Skin SQ/MM; Single Specialty $317.00 11100 Biopsy Skin SQ/MM; Single Standard Fee $159.00 11101 Bx Skin SQ/MM; Ea Additional Standard Fee $51.00 11101 Bx Skin SQ/MM; Ea Additional Specialty $101.00 11200 Remove Skin Tags; <=15 Lesions Standard Fee $135.00 11200 Remove Skin Tags; <=15 Lesions Specialty $270.00 11201 Rem Skin Tags Add-On =<10 Lesions Standard Fee $29.00 11201 Rem Skin Tags Add-On =<10 Lesions Specialty $59.00 11300 Shave Lesion T/A/L; 0.5 cm/< Standard Fee $149.00 11300 Shave Lesion T/A/L; 0.5 cm/< Specialty $298.00 11301 Shave Lesion T/A/L; 0.6-1.0 cm Specialty $367.00 11301 Shave Lesion T/A/L; 0.6-1.0 cm Standard Fee $184.00 11302 Shave Lesion T/A/L; 1.1-2.0 cm Specialty $432.00 11302 Shave Lesion T/A/L; 1.1-2.0 cm Standard Fee $216.00 11303 Shave Lesion T/A/L; >2.0 cm Specialty $478.00 11303 Shave Lesion T/A/L; >2.0 cm Standard Fee $239.00 11305 Shave Lesion S/N/H/F/G; 0.5 cm/< Specialty $307.00 11305 Shave Lesion S/N/H/F/G; 0.5 cm/< Standard Fee $152.00 11306 Shave Lesion S/N/H/F/G; 0.6-1.0 cm Specialty $373.00 11306 Shave Lesion S/N/H/F/G; 0.6-1.0 cm Standard Fee $187.00 11307 Shave Lesion S/N/H/F/G; 1.1-2.0 cm Specialty $441.00 11307 Shave Lesion S/N/H/F/G; 1.1-2.0 cm Standard Fee $220.00 11308 Shave Lesion S/N/H/F/G; >2.0 cm Specialty $462.00 11308 Shave Lesion S/N/H/F/G; >2.0 cm Standard Fee $231.00 11310 Shave Lesion F/E/N/L; 0.5 cm/< Specialty $347.00 11310 Shave Lesion F/E/N/L; 0.5 cm/< Standard Fee $174.00 11311 Shave Lesion F/E/N/L; 0.6-1.0 cm Standard Fee $171.00 11311 Shave Lesion F/E/N/L; 0.6-1.0 cm Specialty $342.00 11312 Shave Lesion F/E/N/L; 1.1-2.0 cm Standard Fee $246.00 11312 Shave Lesion F/E/N/L; 1.1-2.0 cm Specialty $492.00 11313 Shave Lesion F/E/N/L; >2.0 cm Specialty $570.00 11313 Shave Lesion F/E/N/L; >2.0 cm Standard Fee $285.00 11400 Exc Tr-Ext B9+Marg 0.5 < Cm Specialty $380.00 11400 Exc Tr-Ext B9+Marg 0.5 < Cm Standard Fee $190.00 11401 Exc Ben Les T/A/L; 0.6-1.0 Cm Standard Fee $229.00 11401 Exc Ben Les T/A/L; 0.6-1.0 Cm Specialty $457.00 11402 Exc Ben Les T/A/L; 1.1-2.0 cm Standard Fee $254.00 11402 Exc Ben Les T/A/L; 1.1-2.0 cm Specialty $508.00 11403 Exc Ben Les T/A/L; 2.1-3.0 cm Standard Fee $295.00 11403 Exc Ben Les T/A/L; 2.1-3.0 cm Specialty $590.00 11404 Exc Ben Les T/A/L; 3.1-4.0 cm Standard Fee $335.00 11404 Exc Ben Les T/A/L; 3.1-4.0 cm Specialty $680.00 11406 Exc Ben Les T/A/L; >4.0 Cm Specialty $968.00 11420 Exc Ben Les S/N/Ex/G; 0.5 Cm/< Specialty $376.00 11420 Exc Ben Les S/N/Ex/G; 0.5 Cm/< Standard Fee $188.00 11421 Exc Ben Les S/N/Ex/G; 0.6-1.0 Cm Standard Fee $241.00 11421 Exc Ben Les S/N/Ex/G; 0.6-1.0 Cm Specialty $481.00 11422 Exc Ben Les S/N/Ex/G; 1.1-2.0 Cm Standard Fee $269.00 11422 Exc Ben Les S/N/Ex/G; 1.1-2.0 Cm Specialty $539.00 11423 Exc Ben Les S/N/Ex/G; 2.1-3.0 Cm Standard Fee $311.00 11423 Exc Ben Les S/N/Ex/G; 2.1-3.0 Cm Specialty $622.00 11424 Exc Ben Les S/N/Ex/G; 3.1-4.0 Cm Specialty $720.00 11426 Exc Ben Les S/N/Ex/G; >4 Cm Specialty $1,030.00 11440 Exc Face-Mm B9+Marg 0.5 Cm/< Standard Fee $207.00 11440 Exc Face-Mm B9+Marg 0.5 Cm/< Specialty $414.00 11441 Exc Face-Mm B9+marg 0.6-1 Cm Standard Fee $258.00 11441 Exc Face-Mm B9+marg 0.6-1 Cm Specialty $516.00 11442 Exc Face-Mm B9+Marg 1.1-2 Cm Standard Fee $289.00 11442 Exc Face-Mm B9+Marg 1.1-2 Cm Specialty $578.00 11443 Exc Face-Mm B9+marg 2.1-3 Cm Standard Fee $345.00 11443 Exc Face-Mm B9+marg 2.1-3 Cm Specialty $690.00 11444 Exc Face-Mm B9+marg 3.1-4 Cm Specialty $867.00 11444 Exc Face-Mm B9+marg 3.1-4 Cm Standard Fee $434.00 11446 Exc Face-Mm B9+marg > 4 Cm Specialty $1,205.00 11450 Exc Hidrad Axilla; S/I Repair Specialty $1,176.00 11451 Exc Hidrad Axilla; Complex Repair Specialty $1,499.00 11462 Exc Hidrad Inguinal; S/I Repair Specialty $1,147.00 11463 Exc Hidrad Inguinal; Complex Repair Specialty $1,516.00 11470 Exc Hidrad Umbilical; S/I Repair Specialty $1,276.00 11471 Exc Hidrad Umbil; Complex Repair Specialty $1,574.00 11600 Exc Tr-Ext Mlg+marg 0.5 < Cm Specialty $591.00 11600 Exc Tr-Ext Mlg+marg 0.5 < Cm Standard Fee $295.00 11601 Exc Tr-Ext Mlg+marg 0.6-1 Cm Standard Fee $351.00 11601 Exc Tr-Ext Mlg+marg 0.6-1 Cm Specialty $703.00 11602 Exc Tr-Ext Mlg+marg 1.1-2 Cm Standard Fee $381.00 11602 Exc Tr-Ext Mlg+marg 1.1-2 Cm Specialty $763.00 11603 Exc Tr-Ext Mlg+marg 2.1-3 Cm Standard Fee $436.00 11603 Exc Tr-Ext Mlg+marg 2.1-3 Cm Specialty $872.00 11604 Exc Tr-Ext Mlg+marg 3.1-4 Cm Standard Fee $485.00 11604 Exc Tr-Ext Mlg+marg 3.1-4 Cm Specialty $970.00 11606 Exc Tr-Ext Mlg+marg > 4 Cm Specialty $1,392.00 11620 Exc H-F-Nk-Sp Mlg+marg 0.5 < Standard Fee $299.00 11620 Exc H-F-Nk-Sp Mlg+marg 0.5 < Specialty $597.00 11621 Exc H-F-Nk-Sp Mlg+marg 0.6-1 Standard Fee $354.00 11621 Exc H-F-Nk-Sp Mlg+marg 0.6-1 Specialty $707.00 11622 Exc H-F-Nk-Sp Mlg+marg 1.1-2 Standard Fee $394.00 11622 Exc H-F-Nk-Sp Mlg+marg 1.1-2 Specialty $789.00 11623 Exc H-F-Nk-Sp Mlg+marg 2.1-3 Standard Fee $463.00 11623 Exc H-F-Nk-Sp Mlg+marg 2.1-3 Specialty $927.00 11624 Exc H-F-Nk-Sp Mlg+marg 3.1-4 Specialty $1,046.00 11626 Exc H-F-Nk-Sp Mlg+mar > 4 Cm Specialty $1,261.00 11640 Exc Face-Mm Malig+marg 0.5 < Standard Fee $308.00 11640 Exc Face-Mm Malig+marg 0.5 < Specialty $616.00 11641 Exc Face-Mm Malig+marg 0.6-1 Standard Fee $366.00 11641 Exc Face-Mm Malig+marg 0.6-1 Specialty $732.00 11642 Exc Face-Mm Malig+marg 1.1-2 Standard Fee $418.00 11642 Exc Face-Mm Malig+marg 1.1-2 Specialty $837.00 11643 Exc Face-Mm Malig+marg 2.1-3 Standard Fee $493.00 11643 Exc Face-Mm Malig+marg 2.1-3 Specialty $987.00 11644 Exc Face-Mm Malig+marg 3.1-4 Specialty $1,217.00 11646 Exc Face-Mm Mlg+marg > 4 Cm Specialty $1,592.00 11719 Trim ND Nails Any Number Standard Fee $21.00 11719 Trim ND Nails Any Number Specialty $42.00 11720 Debride Nail, 1-5 Standard Fee $49.00 11720 Debride Nail, 1-5 Specialty $99.00 11721 Debride Nail, 6 Or More Standard Fee $69.00 11721 Debride Nail, 6 Or More Specialty $138.00 11730 SPL Avulse NP; Single Standard Fee $152.00 11730 SPL Avulse NP; Single Specialty $319.00 11732 SPL Avulse NP; Each Addtl Standard Fee $55.00 11732 SPL Avulse NP; Each Addtl Specialty $109.00 11740 Evac SubUng Hematoma Standard Fee $76.00 11740 Evac SubUng Hematoma Specialty $152.00 11750 Remove Nail Bed Standard Fee $277.00 11750 Remove Nail Bed Specialty $467.00 11752 Remove Nail Bed/Tip Standard Fee $499.00 11752 Remove Nail Bed/Tip Specialty $998.00 11755 Biopsy, Nail Unit Standard Fee $205.00 11755 Biopsy, Nail Unit Specialty $410.00 11760 Repair Nail Bed Specialty $597.00 11762 Reconstruct Nail Bed W Graft Specialty $861.00 11765 Wedge Excision Nail Fold Specialty $513.00 11770 Excise Pilonidal Cyst; Simple Standard Fee $429.00 11770 Excise Pilonidal Cyst; Simple Specialty $859.00 11771 Exc Pilonidal Cyst; Extensive Specialty $1,776.00 11772 Exc Pilonidal Cyst; Complex Specialty $2,153.00 11900 Injection Into Skin Lesions =<7 Standard Fee $85.00 11901 Added Skin Lesions Inj >7 Specialty $215.00 11901 Added Skin Lesions Inj >7 Standard Fee $108.00 11920 Tattoo <=6.0 Sq Cm Specialty $523.00 11921 Correct Skin Color 6.1-20.0 Cm Specialty $610.00 11922 Correct Skin Color Defct Addl =<20 Sq Cm Specialty $189.00 11922 Correct Skin Color Defct Addl =<20 Sq Cm Standard Fee $95.00 11950 Subcutaneous Collagen; <=1 cc Specialty $225.00 11950 Subcutaneous Collagen; <=1 cc Standard Fee $113.00 11951 Subcutaneous Collagen; 1.1-5.0 CC Specialty $300.00 11952 Subcutaneous Collagen; 5.1-10.0 CC Specialty $403.00 11954 Subcutaneous Collagen; 10+ CC Specialty $486.00 11960 Insert Tissue Expander Not Breast Specialty $2,940.00 11970 Repl Tiss Exp W Perm Prosthesis Specialty $1,896.00 11971 Rem Tissue Exp WO Ins Perm Prosth Specialty $1,445.00 11976 Rem Impl Contraceptive Cap Standard Fee $219.00 11976 Rem Impl Contraceptive Cap Specialty $438.00 11980 Subcu Hormone Pellet Implant Specialty $289.00 11980 Subcu Hormone Pellet Implant Standard Fee $144.00 11981 Insert Drug Implant (NOT Device) Specialty $433.00 11981 Insert Drug Implant (NOT Device) Standard Fee $216.00 11982 Remove Drug Implant Specialty $491.00 11982 Remove Drug Implant Standard Fee $246.00 11983 Remove W Insert Drug Implant Specialty $685.00 12001 Smpl Repair S/N/G/Tr/E; 2.5 Cm/< Standard Fee $137.00 12001 Smpl Repair S/N/G/Tr/E; 2.5 Cm/< Specialty $274.00 12002 Smpl Repair S/N/A/F/Tr/E; 2.6-7.5 Cm Standard Fee $167.00 12002 Smpl Repair S/N/A/F/Tr/E; 2.6-7.5 Cm Specialty $333.00 12004 S Rep S/N/A/G/Tr/E; 7.6-12.5 Cm Standard Fee $197.00 12004 S Rep S/N/A/G/Tr/E; 7.6-12.5 Cm Specialty $393.00 12005 S Rep S/N/A/G/Tr/E; 12.6-20.0 Cm Specialty $496.00 12005 S Rep S/N/A/G/Tr/E; 12.6-20.0 Cm Standard Fee $248.00 12006 S Rep S/N/A/G/Tr/E; 20.1-30.0 Cm Specialty $589.00 12007 S Rep S/N/A/G/Tr/E; >30.0 Cm Specialty $688.00 12011 S Rep F/E/N/L/MM; 2.5 Cm/< Standard Fee $168.00 12011 S Rep F/E/N/L/MM; 2.5 Cm/< Specialty $336.00 12013 S Rep F/E/N/L/MM; 2.6-5.0 Cm Specialty $351.00 12014 S Rep F/E/N/L/MM; 5.1-7.5 Cm Standard Fee $205.00 12014 S Rep F/E/N/L/MM; 5.1-7.5 Cm Specialty $410.00 12015 S Rep F/E/N/L/MM; 7.6-12.5 Cm Standard Fee $249.00 12015 S Rep F/E/N/L/MM; 7.6-12.5 Cm Specialty $497.00 12016 S Rep F/E/N/L/MM; 12.6-20 Cm Specialty $632.00 12017 S Rep F/E/N/L/MM; 20.1-30.0 Cm Specialty $479.00 12018 S Rep F/E/N/L/MM; >30.0 Cm Specialty $544.00 12020 Tx S Wound Dehisc; Simple Specialty $895.00 12021 Tx S Wound Dehisc; W Packing Standard Fee $448.00 12021 Tx S Wound Dehisc; W Packing Specialty $895.00 12031 Intmd Wnd Repr S/A/T/Ext <2.5 cm Standard Fee $364.00 12031 Intmd Wnd Repr S/A/T/Ext <2.5 cm Specialty $728.00 12032 Intmd Wnd Repr S/A/T/Ext 2.6-7.5 cm Specialty $932.00 12032 Intmd Wnd Repr S/A/T/Ext 2.6-7.5 cm Standard Fee $466.00 12034 Intmd Wnd Repr S/Tr/Ext 7.6-12.5 Cm Specialty $958.00 12035 Intmd Wnd Repr S/A/T/Ext 12.6-20.0 Cm Specialty $1,178.00 12036 Intmd Wnd Repr S/A/T/Ext 20.1-30.0 Cm Specialty $1,299.00 12037 Intmd Wnd Repr S/Tr/Ext 30.0+ Cm Specialty $1,473.00 12041 Intmd Wnd Rep N-HF/Genit =<2.5 Cm Specialty $728.00 12042 Intmd Wnd Rep N-HF/Genit =2.6-7.5 Cm Specialty $889.00 12044 Intmd Wnd Rep N-HF/Genit =7.6-12.5 Cm Specialty $1,104.00 12045 Intmd Wnd Rep N-HF/Genit 12.6-20.0 Cm Specialty $1,241.00 12046 Intmd Wnd Rep N-HF/Genit 20.1-30.0 Cm Specialty $1,477.00 12047 Intmd Wnd Rep N-HF/Genit >30.0 Cm Specialty $1,601.00 12051 Intmd Wnd Rep Face/MM =<2.5 CM Standard Fee $397.00 12051 Intmd Wnd Rep Face/MM =<2.5 CM Specialty $794.00 12052 Intmd Wnd Rep Face/MM 2.6-5.0 CM Standard Fee $452.00 12052 Intmd Wnd Rep Face/MM 2.6-5.0 CM Specialty $905.00 12053 Intmd Wnd Rep Face/MM 5.1-7.5 CM Specialty $1,061.00 12054 Intmd Wnd Rep Face/MM 7.6-12.5 CM Specialty $1,109.00 12055 Intmd Wnd Rep Face/MM 12.6-20.0 CM Specialty $1,441.00 12056 Intmd Wnd Rep Face/MM 20.1-30.0 CM Specialty $1,683.00 12057 Intmd Wnd Rep Face/MM 30.1+ CM Specialty $1,738.00 13100 Cmplx Rep Trunk 1.1-2.5 Cm Standard Fee $514.00 13101 Cmplx Rep Trunk 2.6-7.5 Cm Specialty $1,218.00 13102 Cmplx Rep Trunk; Ea Addl 5 CM< Standard Fee $188.00 13102 Cmplx Rep Trunk; Ea Addl 5 CM< Specialty $375.00 13120 Cmplx Rep S/A/L; 1.1-2.5 Cm Specialty $1,077.00 13120 Cmplx Rep S/A/L; 1.1-2.5 Cm Standard Fee $538.00 13121 Cmplx Rep S/A/L; 2.6-7.5 Cm Standard Fee $657.00 13121 Cmplx Rep S/A/L; 2.6-7.5 Cm Specialty $1,314.00 13122 Cmplx Rep S/A/L; Ea Addl 5 Cm< Standard Fee $205.00 13122 Cmplx Rep S/A/L; Ea Addl 5 Cm< Specialty $411.00 13131 Cmplx Rep F/G/H/F; 1.0-2.5 Cm Standard Fee $593.00 13131 Cmplx Rep F/G/H/F; 1.0-2.5 Cm Specialty $1,185.00 13132 Cmplx Rep F/G/H/F; 2.6-7.5 Cm Specialty $1,466.00 13133 Cmplx Rep H/A/G/Ext; Ea Addl 5.0 Cm< Specialty $552.00 13151 Cmplx Repr E/N/E/L; 1.1-2.5 Cm Specialty $1,299.00 13152 Cmplx Repr E/N/E/L; 2.6-7.5 Cm Specialty $1,562.00 13153 Cmplx Repr E/N/E/L; Ea Addl 5 Cm/< Specialty $599.00 13160 Late Cl Surg Wound/Deh Extensive Specialty $2,522.00 14000 Adjac Tiss Trnsf Trunk; D 10 Sq Cm Specialty $1,620.00 14001 Adjac Tiss Trnsf Trunk; D 10.1-30 Sq Cm Specialty $2,471.00 14020 Adjac Tiss Trnsf S/A/L; D 10 Sq Cm/< Specialty $2,148.00 14021 Adjac Tiss Trnsf S/A/L; D 10.1-30 Sq Cm Specialty $2,689.00 14040 ATT F/C/M/N/A/G/H/F;10 Sq Cm/< Specialty $2,352.00 14041 ATT F/C/M/N/A/G/H/F;10.1-30 Sq Cm Specialty $2,913.00 14060 ATT E/N/E/L; D 10 Sq Cm/< Specialty $2,400.00 14061 ATT E/N/E/L; D 10.1-30 Sq Cm Specialty $3,133.00 14301 Skin Tiss Rearr 30.41-60.0 Sq Cm Specialty $3,332.00 14302 Skin Tiss Rearr Addl 30.0 Sq Cm Specialty $696.00 14350 Filleted Finger/Toe Flap Specialty $2,164.00 15002 Wnd Prep T/A/L; 100 Sq Cm/1% BA Specialty $1,073.00 15003 Wound Prep Addl 100 Cm Specialty $234.00 15004 Wnd Prep F/N/HF/G 100 Sq Cm/1% BA Specialty $1,238.00 15005 Wnd Prep F/N/Hf/G Addl 100 Sq Cm/1% BA Specialty $386.00 15040 Harvest Cultured Skin Graft=<100 Sq Cm Specialty $792.00 15050 Pinch Graft Small; Defect to 2 Cm Specialty $1,739.00 15100 Skin Splt Grft, Tk/A/L 100 Sq Cm/1% BA Specialty $2,659.00 15101 Skin Splt Grft T/A/L Addl 100 Sq Cm/1%BA Specialty $575.00 15110 Epidrm Autogrft Tk/A/L 100 Sq Cm/1% BA Specialty $2,487.00 15111 Epidrm Autogrft T/A/L Add-On 100 Sq Cm Specialty $362.00 15111 Epidrm Autogrft T/A/L Add-On 100 Sq Cm Standard Fee $181.00 15115 Epidrm A-Grft Face/Nck/Hf/G 100 Sq Cm Specialty $2,550.00 15116 Epidrm A-Grft F/N/Hf/G Addl Sq Cm/1% BA Specialty $480.00 15116 Epidrm A-Grft F/N/Hf/G Addl Sq Cm/1% BA Standard Fee $240.00 15120 Skn Splt A-Grft Fac/Nck/Hf/G Sq Cm/1% BA Specialty $2,636.00 15121 Skn Splt A-Grft F/N/Hf/G Addl 100 Sq Cm Specialty $645.00 15130 Derm Autograft, Trnk/Arm/Leg 100 SqCm Specialty $2,084.00 15131 Derm Autogrft T/A/L Addl 100 Sq Cm/1% BA Specialty $310.00 15135 Derm Autogrft F/Nk/Hf/G 100 Sq Cm/1% BA Specialty $2,613.00 15136 Derm Autograft, F/N/Hf/G Addl 100 Sq Cm Specialty $295.00 15136 Derm Autograft, F/N/Hf/G Addl 100 Sq Cm Standard Fee $148.00 15150 Cult Epiderm Grft Tnk/Arm/Leg Specialty $2,174.00 15151 Cult Epiderm Graft T/A/L Addl Specialty $383.00 15152 Cult Epiderm Graft T/A/L +% Specialty $470.00 15156 Cult Epidrm Grft F/N/Hfg Addl Specialty $495.00 15157 Cult Epiderm Graft F/N/Hfg +% Specialty $542.00 15200 Skin Full Graft Trnk =<20 Sq Cm Specialty $2,568.00 15201 Skin Full Graft Trnk Addl =<20 Sq Cm Specialty $457.00 15220 Skin Full Graft Sclp/Arm/Leg =<20 Sq Cm Specialty $2,379.00 15221 Skin Full Grft S/A/L Addl =<20 Sq Cm Specialty $422.00 15240 Skin Full Grft Face/Genit/Hf =<20 Sq Cm Specialty $2,885.00 15241 Skn Full Grft F/C/C/M/N/Ax/H/F Addl 20Cm Specialty $571.00 15260 Skin Full Graft Een & Lips=<20 Sq Cm Specialty $3,128.00 15261 Skin Full Graft N/E/E/L Addl =<20 Sq Cm Specialty $667.00 15271 Skin Sub Grft T/A/L; 25 Sq Cm/< Specialty $433.00 15272 Skin Sub Grft TAL Add-on 25 to 100 Sq Cm Specialty $84.00 15273 Skin Sub Grft T/A/L Child Specialty $920.00 15274 Skn Sub Grft T/A/L Child Addl to 100SqCm Specialty $221.00 15275 Skin substitute for other than trunk Specialty $411.00 15276 Skin Sub Grft F/N/HF/G Addl 25 Sq Cm Specialty $106.00 15277 Skin Sub Grft F/N/HF/G Child to 100 SqCm Specialty $997.00 15278 Skn Sub Grft F/N/HF/G Child Add 100 SqCm Specialty $263.00 15570 Pedicle Flap; Trunk Specialty $2,826.00 15572 Pedicle Flap; Scalp/Arm/Leg Specialty $2,743.00 15574 Pedicle Flap; FC/Cheek/Mouth Specialty $2,827.00 15576 Pedicle Flap; El/Ns/Er/Lip Specialty $2,492.00 15600 Delay Flap; Trunk Specialty $992.00 15610 Delay Flap; Scalp/Arm/Leg Specialty $1,093.00 15620 Delay Flap; Fh/Ck/Ch/N/A/Hd Specialty $1,355.00 15630 Delay Flap; El/Ns/Er/Lip Specialty $1,416.00 15650 Intermediate Transfer Pedicle Flap Specialty $1,553.00 15731 Forehead Flap W/Vasc Pedicle Specialty $3,495.00 15732 Muscle Flap; Head/Neck Specialty $3,981.00 15734 Muscle Flap; Trunk Specialty $4,678.00 15736 Muscle Flap; Upper Extremity Specialty $4,100.00 15738 Muscle Flap; Lower Extremity Specialty $4,360.00 15740 Island Pedicle Flap Graft Specialty $3,151.00 15750 Flap; Neurovascular Pedicle Specialty $2,869.00 15756 Free Muscle Flap W Anastomosis Specialty $7,287.00 15757 Free Skin Flap W Anastomosis Specialty $7,197.00 15758 Free Fascial Flap W Anastomosis Specialty $7,209.00 15760 Graft; Composite Specialty $2,640.00 15770 Graft; Derma-Fat-Fascia Specialty $2,096.00 15775 Punch Graft Hair; 1-15 Punch Specialty $929.00 15776 Punch Graft Hair; >15 Punch Specialty $1,532.00 15780 Dermabrasion; Total Face Specialty $2,597.00 15781 Dermabrasion; Segment Face Specialty $1,714.00 15782 Dermabrasion; Regional Face Specialty $1,960.00 15783 Dermabrasion; Superficial, Any site Specialty $1,438.00 15786 Abrasion; Single Lesion Specialty $752.00 15787 Abrasion; Lesions Addl =<4 Specialty $151.00 15788 Chem Face Peel; Epidermal Specialty $1,418.00 15788 Chem Face Peel; Epidermal Standard Fee $709.00 15789 Chemical Face Peel; Dermal Specialty $1,694.00 15789 Chemical Face Peel; Dermal Standard Fee $847.00 15792 Chem Peel; Nonfacial Epidermis Specialty $1,366.00 15792 Chem Peel; Nonfacial Epidermis Standard Fee $683.00 15793 Chemical Peel, Nonfacial Dermal Specialty $1,520.00 15793 Chemical Peel, Nonfacial Dermal Standard Fee $760.00 15819 Cervicoplasty Specialty $2,294.00 15820 Blepharoplasty Lower Eyelid Specialty $1,729.00 15821 Blepharopl Lower Lid; W Ext Fat Pad Specialty $1,864.00 15822 Blepharoplasty Upper Eyelid Specialty $1,369.00 15823 Blepharopl Upper Lid; W Exc Skin Specialty $1,863.00 15830 Exc Skin Abdomen Specialty $3,663.00 15832 Excise Excess Skin Tissue; Thigh Specialty $2,863.00 15833 Excise Excess Skin Tissue; Leg Specialty $2,685.00 15834 Excise Excess Skin Tissue; Hip Specialty $2,766.00 15835 Excise Excess Skin Tiss; Buttock Specialty $2,896.00 15836 Excise Excess Skin Tissue; Arm Specialty $2,896.00 15837 Excise Excess Skin Tissue; FA/Hand Specialty $2,501.00 15838 Excise Excess Skin Tissue; Fat Pad Specialty $1,786.00 15839 Excise Excess Skin Tissue; Other Specialty $2,739.00 15840 Graft For Face Nerve Paralysis Specialty $3,150.00 15841 FMG Grft Face Nerve Paralysis Specialty $5,062.00 15842 M MG - Face Nerve Paralysis Specialty $8,235.00 15845 Region MT - Face Nerve Paralysis Specialty $3,118.00 15850 Rem Suture W Anesth, Same Surgery Standard Fee $50.00 15850 Rem Suture W Anesth, Same Surgery Specialty $253.00 15851 Rem Suture W Anesth, Other Surgery Specialty $304.00 15851 Rem Suture W Anesth, Other Surgery Standard Fee $152.00 15852 Dressing Change Not For Burn Specialty $147.00 15852 Dressing Change Not For Burn Standard Fee $74.00 15860 Graft Blood Flow Test Specialty $347.00 15860 Graft Blood Flow Test Standard Fee $174.00 15920 Exc Coc Pressure Ulcer; W 1" Suture Specialty $1,888.00 15922 Exc Coc Presure Ulcer; W Flap Specialty $2,431.00 15931 Exc Sacral Pressure Ulcer; W 1" Suture Specialty $2,150.00 15933 Exc Sacral Pressure Ulcer W Ostectomy Specialty $2,650.00 15934 Exc Sacr Press Ulcer W Skin Flap Specialty $2,901.00 15935 Exc Sacr Press Ulcer W SF Ostectomy Specialty $3,417.00 15936 Exc Sacr Press Ulcer; Prep for Flap Specialty $2,786.00 15937 Exc Sacr Press Ulcer; Prep for Flap/Grft Specialty $3,229.00 15940 Exc Hip Pressure Ulcer W 1" Suture Specialty $2,191.00 15941 Exc Hip Pres Ulcer W 1" Sut/Ostectomy Specialty $2,805.00 15944 Exc Hip Pressure Ulcer W Skin Flap Specialty $2,764.00 15945 Exc Hip Press Ulcer W Sk Flp & Ostectomy Specialty $3,045.00 15946 Exc Hip Pres Ulcer W Ostectomy & Flap Specialty $5,109.00 15950 Exc Troch Pr Ulcer W 1" Suture Specialty $1,848.00 15951 Exc Troch Pr Ulcer W Ostectomy Specialty $2,734.00 15952 Exc Troch Pr Ulcer W Flap Specialty $2,792.00 15953 Exc Troch Pr Ulcer W SF & Ostect Specialty $3,096.00 15956 Exc Troch Pr Ulcer W Flap Specialty $3,601.00 15958 Exc Troch Pr Ulcer W Ostectomy Specialty $3,660.00 16000 Initial Tx 1st Degree Burn Standard Fee $106.00 16000 Initial Tx 1st Degree Burn Specialty $212.00 16020 Dress/Debrid P-Thick Burn, Small Standard Fee $125.00 16020 Dress/Debrid P-Thick Burn, Small Specialty $251.00 16025 Dress/Debrid P-Thick Burn, Med Specialty $454.00 16025 Dress/Debrid P-Thick Burn, Med Standard Fee $227.00 16030 Dress/Debrid P-Thick Burn, Large Specialty $573.00 16030 Dress/Debrid P-Thick Burn, Large Standard Fee $286.00 16035 Escharotomy; Initial Incision Specialty $609.00 16035 Escharotomy; Initial Incision Standard Fee $305.00 16036 Escharotomy; Add'l Incision Specialty $253.00 16036 Escharotomy; Add'l Incision Standard Fee $127.00 17000 Destroy Premalignant Lesion Standard Fee $103.00 17000 Destroy Premalignant Lesion Specialty $205.00 17003 Destroy Premalignant Lesions 2-14 Standard Fee $8.00 17003 Destroy Premalignant Lesions 2-14 Specialty $17.00 17004 Destroy Premalignant Lesions 15/> Standard Fee $231.00 17004 Destroy Premalignant Lesions 15/> Specialty $462.00 17106 Destroy Cut Vasc Lesion; 10 Sq Cm Specialty $462.00 17106 Destroy Cut Vasc Lesion; 10 Sq Cm Standard Fee $231.00 17107 Destr Cut Vasc Lesion; 10-50 Sq Cm Specialty $1,337.00 17108 Destroy Cut Vasc Lesion; >50 Sq Cm Specialty $1,972.00 17110 Destruct B9 Lesion; 1-14 Standard Fee $170.00 17110 Destruct B9 Lesion; 1-14 Specialty $340.00 17111 Destruct Lesion; 15 Or More Standard Fee $201.00 17111 Destruct Lesion; 15 Or More Specialty $403.00 17250 Chem Cautery Granulation Tiss Standard Fee $122.00 17250 Chem Cautery Granulation Tiss Specialty $243.00 17260 Destr Malg Lesion T/A/L; 0.5 Cm/< Specialty $291.00 17260 Destr Malg Lesion T/A/L; 0.5 Cm/< Standard Fee $146.00 17261 Destr Malg Lesion T/A/L; 0.6-1.0 Cm Specialty $441.00 17261 Destr Malg Lesion T/A/L; 0.6-1.0 Cm Standard Fee $220.00 17262 Destr Malg Lesion T/A/L; 1.1-2.0 Cm Specialty $538.00 17262 Destr Malg Lesion T/A/L; 1.1-2.0 Cm Standard Fee $269.00 17263 Destr Malg Lesion T/A/L; 2.1-3.0 Cm Specialty $588.00 17263 Destr Malg Lesion T/A/L; 2.1-3.0 Cm Standard Fee $294.00 17264 Destr Malg Lesion T/A/L; 3.1-4.0 Cm Specialty $630.00 17266 Destr Malg Lesion S/N/H/F/G; 0.5 Cm/< Specialty $715.00 17270 Destr Malg Lesion S/N/H/F/G; 0.5 Cm/< Specialty $463.00 17270 Destr Malg Lesion S/N/H/F/G; 0.5 Cm/< Standard Fee $231.00 17271 Destr Malg Lesion S/N/H/F/G; 0.6-1.0 Cm Specialty $501.00 17271 Destr Malg Lesion S/N/H/F/G; 0.6-1.0 Cm Standard Fee $250.00 17272 Destr Malg Lesion S/N/H/F/G; 1.1-2.0 Cm Specialty $572.00 17272 Destr Malg Lesion S/N/H/F/G; 1.1-2.0 Cm Standard Fee $286.00 17273 Destr Malg Lesion S/N/H/F/G; 2.1-3.0 Cm Specialty $639.00 17273 Destr Malg Lesion S/N/H/F/G; 2.1-3.0 Cm Standard Fee $319.00 17274 Destr Malg Lesion S/N/H/F/G; 3.1-4.0 Cm Specialty $755.00 17276 Destr Malg Lesion S/N/H/F/G; >4.1 Cm Specialty $874.00 17280 Destr Malg Lesion F/E/E/N/L/MM; 0.5 cm/< Specialty $432.00 17280 Destr Malg Lesion F/E/E/N/L/MM; 0.5 cm/< Standard Fee $216.00 17281 Destr Malg Les F/E/E/N/L/MM; 0.6-1.0 Cm Specialty $546.00 17281 Destr Malg Les F/E/E/N/L/MM; 0.6-1.0 Cm Standard Fee $273.00 17282 Destr Malg Les F/E/E/N/L/MM; 1.1-2.0 Cm Specialty $629.00 17282 Destr Malg Les F/E/E/N/L/MM; 1.1-2.0 Cm Standard Fee $314.00 17283 Destr Malg Les F/E/E/N/L/MM; 2.1-3.0 Cm Specialty $753.00 17283 Destr Malg Les F/E/E/N/L/MM; 2.1-3.0 Cm Standard Fee $376.00 17284 Destr Malg Les F/E/E/N/L/MM; 3.1-4.0 Cm Specialty $890.00 17286 Destr Malg Les F/E/E/N/L/MM; >4.1 Cm Specialty $1,105.00 17311 MOHS, 1 Stage, H/N/Hf/G Specialty $2,034.00 17312 MOHS Additional Stage Specialty $1,195.00 17313 MOHS, 1 Stage, T/A/L Specialty $1,901.00 17314 MOHS, Additional Stage, T/A/L Specialty $1,146.00 17315 MOHS Surgery, Additional Block Specialty $245.00 17340 Acne Cryotherapy Specialty $158.00 17340 Acne Cryotherapy Standard Fee $79.00 17360 Chemical Exfoliation - Acne Specialty $396.00 17360 Chemical Exfoliation - Acne Standard Fee $198.00 19000 Puncture Aspirate Breast Cyst - Initial Standard Fee $175.00 19000 Puncture Aspirate Breast Cyst - Initial Specialty $349.00 19001 Punct Asp Breast Cyst - Ea Addtl Specialty $84.00 19020 Mastotomy W Exploration, Deep Specialty $1,460.00 19030 Mammary Duct Injection Specialty $509.00 19081 Bx Breast 1st Lesion; Stereotactic Specialty $2,139.00 19082 Bx Breast Addl Lesion Stereotactic Specialty $1,768.00 19083 Bx Breast 1st Lesion US Imaging Specialty $2,068.00 19084 Bx Breast Add Lesion US Imaging Specialty $1,700.00 19085 Bx Breast 1st Lesion MR Imaging Specialty $3,177.00 19086 Bx Breast Add Lesion MR Imaging Specialty $2,517.00 19100 Bx Breast 1st Lesion Stereotactic Specialty $2,139.00 19101 Open Incision Breast Biopsy Specialty $1,057.00 19105 Cryosurg Ablate Fibroadenoma Each Specialty $6,595.00 19110 Nipple Expl W/WO Exc Duct Specialty $1,502.00 19112 Exc Lactiferous Duct Fistula Specialty $1,412.00 19120 Removal Of Breast Lesion 1+ Specialty $1,537.00 19125 Exc Breast Les By N Loc; Single Specialty $1,705.00 19126 Exc Breast Les By N Loc; Ea Addl Specialty $511.00 19260 Excision Chest Wall Tumor Specialty $3,782.00 19271 Exc Chest Wall Tumor; WO ML Specialty $5,117.00 19272 Exc Chest Wall Tumor; W ML Specialty $5,594.00 19281 Perq Device Breast 1st Image Specialty $738.00 19282 Perq Device Breast Each Image Specialty $517.00 19283 Perq Device Breast 1st Stereotactic Specialty $830.00 19284 Perq Device Breast Addtl Stereotactic Specialty $626.00 19285 Perq Device Breast 1st US Image Specialty $1,587.00 19286 Perq Device Breast Addtl US Image Specialty $1,394.00 19287 Perq Device Breast 1st MR Guide Specialty $2,653.00 19288 Perq Device Breast Add MR Guide Specialty $2,140.00 19296 Place PO Breast Cath For Rad Specialty $12,185.00 19297 Place Breast Cath For Rad Specialty $300.00 19298 Plc Brst Cath for Radthh Subs P Mastect Specialty $3,245.00 19300 Removal Of Breast Tissue Specialty $1,623.00 19301 Partial Mastectomy Specialty $2,051.00 19302 Partial Mastectomy W/Ln Removal Specialty $2,827.00 19303 Mastectomy Simple Complete Specialty $3,177.00 19304 Mastectomy Subcutaneous Specialty $1,799.00 19305 Mastectomy Radical Specialty $3,545.00 19306 Mastectomy Radical Urban Type Specialty $3,771.00 19307 Mastectomy Modified Radical Specialty $3,761.00 19316 Mastopexy Specialty $2,403.00 19318 Reduction Mammoplasty Specialty $3,439.00 19324 Mammaplasty; WO Prosthetic Implant Specialty $1,535.00 19325 Mammaplasty; W Prosth Implant Specialty $1,995.00 19328 Remove Mammary Implant Specialty $1,544.00 19330 Remove Mammary Implant Material Specialty $1,978.00 19340 Immed Insert Breast Prosth S/P M Specialty $3,130.00 19342 Delay Insert Breast Prosth S/P M Specialty $2,875.00 19350 Nipple/Areola Reconstruction Specialty $2,550.00 19355 Correct Inverted Nipples Specialty $2,191.00 19357 Breast Reconst W Tissue Expansion Specialty $4,691.00 19361 Breast Reconstruction W/Lateral Flap Specialty $4,919.00 19364 Breast Reconstruction W Free Flap Specialty $8,617.00 19366 Breast Reconstruction W Other Technique Specialty $4,405.00 19367 Breast Reconstruct W Tram Single Pedicle Specialty $5,593.00 19368 Breast Rcst W Tram Sp W Anastomosis Specialty $6,884.00 19369 Breast Rcst W Tram Double Pedicle Specialty $6,396.00 19370 Open Breast Capsulotomy Specialty $2,138.00 19371 Periprosth Capsulectomy Breast Specialty $2,444.00 19380 Revision of Reconstructed Breast Specialty $2,409.00 19396 Prep Moulage Cust Breast Implant Specialty $856.00 20005 I&D Soft Tissue Abscess; Deep Specialty $959.00 20100 Expl Penetrating Wound; Neck Specialty $1,912.00 20101 Expl Penetrating Wound; Chest Specialty $1,392.00 20102 Expl Penetrating Wound; Abdomen/Flank Specialty $1,523.00 20103 Expl Penetrating Wound; Extremity Specialty $1,802.00 20150 Excise Epiphyseal Bar Specialty $2,822.00 20200 Muscle Biopsy; Superficial Specialty $642.00 20205 Muscle Biopsy; Deep Specialty $899.00 20206 Muscle Biopsy; Perc Needle Specialty $729.00 20220 Bone Bx Trocar/Needle; Superficial Specialty $521.00 20225 Deep Bone Bx Trocar/Needle Specialty $1,625.00 20240 Open Superficial Bone Biopsy Specialty $483.00 20245 Excisional Bone Biopsy; Deep Specialty $1,624.00 20250 Open Vertebral Biopsy; Thoracic Specialty $1,230.00 20251 Open Vertebral Bx; Lumbar/Cervical Specialty $1,335.00 20500 Sinus Tract Injection; Therapeutic Specialty $321.00 20501 Sinus Tract Injection; Diagnostic Specialty $365.00 20520 Remove FB Muscle; Simple Specialty $629.00 20525 Remove FB Muscle; Deep Specialty $1,484.00 20526 Carpal Tunnel Tx Injection Standard Fee $119.00 20526 Carpal Tunnel Tx Injection Specialty $238.00 20527 Injection Dupuytren Cord W Enzyme Standard Fee $130.00 20527 Injection Dupuytren Cord W Enzyme Specialty $259.00 20550 Inj Sgl Tendon Sheath Or Ligament Specialty $181.00 20550 Inj Sgl Tendon Sheath Or Ligament Standard Fee $91.00 20551 Inj Tendon Origin/Insertion Standard Fee $93.00 20551 Inj Tendon Origin/Insertion Specialty $185.00 20552 Injection Trigger Point, 1/2 Muscle Specialty $170.00 20552 Injection Trigger Point, 1/2 Muscle Standard Fee $85.00 20553 Inject Trigger Points, =/> 3 Specialty $196.00 20553 Inject Trigger Points, =/> 3 Standard Fee $98.00 20555 Place Needle Muscle/Tissue For Rt Specialty $1,024.00 20555 Place Needle Muscle/Tissue For Rt Standard Fee $512.00 20600 Drain/Inj Small Joint/Bursa W/O US Standard Fee $73.00 20600 Drain/Inj Small Joint/Bursa W/O US Specialty $146.00 20604 Drain/Inj Small Joint/Bursa W US Standard Fee $111.00 20604 Drain/Inj Small Joint/Bursa W US Specialty $222.00 20605 Drain/Inj Inter Joint/Bursa W/O US Specialty $154.00 20605 Drain/Inj Inter Joint/Bursa W/O US Standard Fee $77.00 20606 Drain/Inj Inter Joint/Bursa W US Specialty $246.00 20606 Drain/Inj Inter Joint/Bursa W US Standard Fee $123.00 20610 Drain/Inj Major Joint/Bursa W/O US Specialty $186.00 20610 Drain/Inj Major Joint/Bursa W/O US Standard Fee $93.00 20611 Drain/Inj Major Joint/Bursa W Ultrasound Specialty $282.00 20611 Drain/Inj Major Joint/Bursa W Ultrasound Standard Fee $141.00 20612 Aspirate/Inject Ganglion Cyst Standard Fee $93.00 20612 Aspirate/Inject Ganglion Cyst Specialty $187.00 20615 Aspirate & Injection Tx Of Bone Cyst Specialty $756.00 20615 Aspirate & Injection Tx Of Bone Cyst Standard Fee $378.00 20650 Insert Wire/Pin W Skeletal Traction Specialty $641.00 20660 Cranial Tongs/Ster Frame Specialty $780.00 20661 Apply Halo; Cranial Specialty $1,594.00 20662 Apply Halo; Pelvic Specialty $1,344.00 20663 Apply Halo; Femoral Specialty $1,465.00 20664 Apply Halo; Cranial 6/> Pins Specialty $2,783.00 20665 Removal Of Tongs or Halo Specialty $325.00 20670 Removal Of Support Implant Superficial Specialty $1,171.00 20680 Removal Implant; Deep Specialty $1,918.00 20690 Apply Bone Fixation Device 1 Plane Specialty $1,861.00 20692 Apply Bone Fixation Device >1 Plane Specialty $3,499.00 20693 Adjust Bone Fixation Device W Anesth Specialty $1,393.00 20694 Remove External Fix System W Anesth Specialty $1,321.00 20802 Repl Arm Complete Amputation Specialty $7,521.00 20805 Repl Forearm Complete Amputation Specialty $10,366.00 20808 Repl Hand Complete Amputation Specialty $12,616.00 20816 Repl MCP to Flex Tend; Amputation Specialty $6,502.00 20822 Repl Digit Tip to Sub Ten; Amputat Specialty $5,606.00 20824 Repl Thmb CMC to MP Amputate Specialty $6,390.00 20827 Repl Thumb Distal to MP; Amputate Specialty $5,734.00 20838 Repl Foot Complete Amputation Specialty $7,599.00 20900 Bone Graft; Minor/Small Specialty $1,297.00 20902 Bone Graft; Major/Large Specialty $899.00 20910 Cartilage Graft; Costochondral Specialty $1,283.00 20912 Cartilage Graft; Nasal Septum Specialty $1,502.00 20920 Fascia lata Graft; Stripper Specialty $1,231.00 20922 Fascia lata Graft; Incision Complex Specialty $1,897.00 20924 Distance Tendon Graft Specialty $1,581.00 20926 Tissue Grafts Other Specialty $1,345.00 20930 Spinal Bone Allograft Morsel Add-On Standard Fee $369.00 20930 Spinal Bone Allograft Morsel Add-On Specialty $369.00 20931 Spinal Bone Allograft Struct Add-On Specialty $360.00 20937 Spinal Bone Autograft Morsel Add-On Specialty $534.00 20950 Monitor Interstit Fluid Pressure Specialty $780.00 20955 Bone Graft W Anastomosis; Fibula Specialty $7,872.00 20956 Bone Graft W Anastomosis; Iliac Crest Specialty $8,352.00 20957 Bone Graft W Anastomosis; Metatarsal Specialty $7,684.00 20962 Bone Graft W Anastomosis; Other Specialty $6,615.00 20969 Free O Flap W Anastomosis; Other Specialty $8,694.00 20970 Free O Flap; Iliac Crest Specialty $9,220.00 20972 Free O Flap; Metatarsal Specialty $7,397.00 20973 Free O Flap; Great Toe Specialty $8,270.00 20974 Elect Bone Stimulation; Noninvasive Specialty $237.00 20974 Elect Bone Stimulation; Noninvasive Standard Fee $119.00 20975 Elect Bone Stimulation; Invasive Specialty $562.00 20979 US Stimulation For Bone Healing Specialty $162.00 20979 US Stimulation For Bone Healing Standard Fee $81.00 20982 Ablate Bone Tumor(s) Percutaneous Specialty $9,332.00 20983 Ablate Bone Tumor(s) Percutaneous Specialty $22,427.00 20985 Computer-Assist Dir Ms Px Specialty $464.00 20985 Computer-Assist Dir Ms Px Standard Fee $232.00 21010 TMJ Arthrotomy Specialty $2,325.00 21011 Exc Face Lesion Subcu <2.0 Cm Specialty $1,081.00 21012 Exc Face Lesion Subq 2.1 Cm/> Specialty $1,061.00 21013 Exc Face Tumor Deep <2.0 cm Specialty $1,611.00 21014 Exc Face Tumor Deep 2.1 cm/> Specialty $1,632.00 21015 Resect Face/Scalp Tumor <2.0 Cm Specialty $2,223.00 21016 Resect Face/Scalp Tumor 2.1 Cm> Specialty $3,209.00 21025 Excision Bone; Mandible Specialty $2,805.00 21026 Exc Bone; Facial Bone(s) Specialty $1,936.00 21029 Contour Bone Tumor Face Specialty $2,395.00 21030 Exc Max/Zygoma Tumor Specialty $1,631.00 21031 Excise Torus Mandibularis Specialty $1,242.00 21032 Exc Maxillary Torus Palatinus Specialty $1,263.00 21034 Excise Max/Zygoma Malignant Tumor Specialty $4,127.00 21040 Excise Mandible Tumor/Cyst Specialty $1,643.00 21044 Exc Malignant Tumor Mandible Specialty $2,758.00 21045 Exc Malig Tumor Mandible; Radical Specialty $3,866.00 21046 Exc Mandible Tumor W Osteotomy Specialty $3,534.00 21047 Excise Mandible Tumor W EOO Specialty $4,169.00 21048 Excise Maxilla Tumor Complex Specialty $3,623.00 21049 Exc Maxilla Tumor W EOO Specialty $3,816.00 21050 Condylectomy TMJ Specialty $2,643.00 21060 Meniscectomy TMJ Specialty $2,503.00 21070 Coronoidectomy Specialty $1,918.00 21073 Manipulation TMJ W/Anesth Specialty $1,213.00 21076 Prep; Surg Obturator Prosth Specialty $3,164.00 21077 Prep; Orbital Prosthesis Specialty $7,935.00 21079 Prep; Interim Obturator Prosth Specialty $5,340.00 21080 Prep; Defin Obturator Prosth Specialty $5,993.00 21081 Prep; Mandibular Resec Prosth Specialty $5,536.00 21082 Prep; Palatal Augment Prosth Specialty $5,232.00 21083 Prep; Palatal Lift Prosth Specialty $4,985.00 21084 Prep; Speech Aid Prosth Specialty $5,731.00 21085 Prep; Oral Surgical Splint Specialty $2,397.00 21086 Prep; Auricular Prosthesis Specialty $5,902.00 21087 Prep; Nasal Prosthesis Specialty $5,892.00 21100 Apply Halo Maxillofacial Specialty $3,219.00 21110 Apply Interdental Fixation Device Specialty $2,531.00 21116 TMJ Arthrography Injection Specialty $452.00 21116 TMJ Arthrography Injection Standard Fee $226.00 21120 Genioplasty; Augmentation Specialty $2,061.00 21121 Genioplasty; SO Single Specialty $2,543.00 21122 Reconstr Chin 2+ Osteotomies Specialty $2,064.00 21123 Genioplasty; Sliding W Bone Graft Specialty $2,939.00 21125 Augmentation Mandible; Prosthetic Specialty $9,517.00 21127 Augmentation Mandible; Bone Graft Specialty $13,766.00 21137 Reduce Forehead; Contour Only Specialty $2,376.00 21138 Reduce Forehead; Prosthetic Specialty $2,778.00 21139 Reduce Forehead; Setback ASWL Specialty $2,978.00 21141 Lefort I; Single W/O Bone Graft Specialty $4,223.00 21142 Reconstruct Midface, Lefort 2 Pcs Specialty $4,429.00 21143 Reconstruct Midface, Lefort 3+ Pcs Specialty $4,455.00 21145 Lefort I; Single W Bone Graft Specialty $4,976.00 21146 Reconstr Midface Lefort 2 Pcs W Bn Grft Specialty $4,865.00 21147 Reconstr Midface Lefort 3+ Pcs W Bn Grft Specialty $5,504.00 21150 Lefort II; Anterior Intrusion Specialty $5,283.00 21151 Lefort II; Any Direction W Bone Grft Specialty $6,360.00 21154 Lefort III W Bone Grft; WO Lefort I Specialty $6,568.00 21155 Lefort III W Bone Grft; WO Lefort I Specialty $6,783.00 21159 Lefort III W FH Adv; WO Lefort I Specialty $7,857.00 21160 Lefort III W FH Adv; W Lefort I Specialty $9,987.00 21172 Reconstr SL Orbit Rim & Low Forehead Specialty $5,658.00 21175 Reconstr BSL Orbit Rim & Low Forehead Specialty $6,730.00 21179 Reconst FH/Orb Rim; W Grft/Prosth Specialty $4,536.00 21180 Reconstr FH/Orb Rim; WO Grft/Prosth Specialty $4,844.00 21181 Contour B Cranial Bones Tumor Specialty $2,313.00 21182 Reconstruct Cranial Bone < 40 cm Specialty $6,102.00 21183 Reconstruct Cranial Bone > 40 < 80 cm Specialty $7,255.00 21184 Reconstruct Cranial Bone > 80 cm Specialty $6,697.00 21188 Reconstruct Midface Not Lefort Specialty $5,077.00 21193 Reconstr Mand Rami; WO Bone Graft Specialty $3,821.00 21194 Reconstruct Mand Rami; W Bone Graft Specialty $4,522.00 21195 Reconstr Mand Rami; WO Int Fixation Specialty $4,213.00 21196 Reconstruct Mand Rami; W Internal Fix Specialty $4,674.00 21198 Osteotomy Mandible Segmental Specialty $3,684.00 21199 Osteotomy Mandible Seg W Advance Specialty $3,373.00 21206 Osteotomy Maxilla Segmental Specialty $3,704.00 21208 Osteoplasty FB; AAGMENT Specialty $5,915.00 21209 Osteoplasty Face Bone; Reduction Specialty $2,539.00 21210 Graft Bone; Nose/Maxilla/Malar Specialty $7,177.00 21215 Graft Bone; Mandible Specialty $12,740.00 21230 Graft; Rib Cartilage Specialty $2,236.00 21235 Graft; Ear Cartilage Specialty $2,265.00 21240 TMJ Arthroplasty Specialty $3,540.00 21242 Arthroplasty TMJ W Allograft Specialty $3,242.00 21243 Arthroplasty TMJ W Prosthetic Joint Specialty $5,364.00 21244 Reconstr Mandible W TT Bone Pl Specialty $3,358.00 21245 Reconstruct Mand/Maxilla; Partial Specialty $3,477.00 21246 Reconstruct Mandible/Maxilla; Complete Specialty $2,741.00 21247 Reconstruct Mandible Comp W Autograft Specialty $4,881.00 21248 Reconstruct Mand/Maxilla; Partial Specialty $3,500.00 21249 Reconstruct Mand/Maxilla; Complete Specialty $4,796.00 21255 Reconstruct ZA W Bone & Cartilage Specialty $4,371.00 21256 Reconstruct Orbit W Osteot & Bone Grft Specialty $3,754.00 21260 Periorbital Osteot W Bn Gft; Excranial Specialty $4,365.00 21261 Periorbital Osteot W BG; Complete Specialty $6,606.00 21263 Periorbital Osteot W BG; W FH Advance Specialty $6,101.00 21267 Orbital Reposition; Extracranial Specialty $4,887.00 21268 Orbital Reposition; Int & Extracranial Specialty $5,451.00 21270 MMalr Augment W Prosthetic Material Specialty $2,987.00 21275 2" Revision Orbitocranial Reconstruction Specialty $2,616.00 21280 Medial Canthopexy Specialty $1,758.00 21282 Lateral Canthopexy Specialty $1,180.00 21295 Reduce Masseter M&B; Extraoral Specialty $563.00 21296 Reduce Masseter M&B; Intraoral Specialty $1,350.00 21310 Closed Tx Nasal Bone Fx WO Manipulation Specialty $408.00 21310 Closed Tx Nasal Bone Fx WO Manipulation Standard Fee $204.00 21315 Closed Tx Nasal Bone Fx; WO Stabiliz Specialty $862.00 21315 Closed Tx Nasal Bone Fx; WO Stabiliz Standard Fee $431.00 21320 Closed Tx Nasal Bone Fx; W Stabiliz Specialty $799.00 21325 Open Tx Nasal Fx; Uncomplicated Specialty $1,480.00 21330 Open Tx Nasal Fx; Compl W Fixation Specialty $1,773.00 21335 Open Tx Nasal Fx; W Open Tx Septal Fx Specialty $2,277.00 21336 Open Tx Nasal Septal Fracture Specialty $2,015.00 21337 Closed Tx Nasal Septal Fracture Specialty $1,260.00 21338 Open Tx Nasoethmoid Fx; WO Ext Fix Specialty $2,259.00 21339 Open Tx Nasoethmoid Fx; W Extern Fix Specialty $2,408.00 21340 Perc Tx Nasoethmoid Cplx Fx W Fix Specialty $2,360.00 21343 Open Tx Depressed Frontal Sinus Fx Specialty $3,770.00 21344 Open Tx Complx Frontal Sinus Fx Specialty $4,375.00 21345 Closed Tx Lefort II Fx; W Fixation Specialty $2,532.00 21346 Open Tx Lefort II Fx; W Fixation Specialty $2,850.00 21347 Open Tx Lefort II Fx; W Open Approach Specialty $3,559.00 21348 Open Tx Lefort II Fx; W Bone Grafts Specialty $3,781.00 21355 Perc Tx Malar Fx Not Zygomatic Arch Specialty $1,340.00 21356 Open Tx Depressed Zygomatic Arch Fx Specialty $1,565.00 21360 Open Tx Depr Malar Fx Includ Zyg Arch Specialty $1,689.00 21365 Open Tx Compl Cran Nerve Fx; W Int Fix Specialty $3,491.00 21366 Opn Tx Compl Cranl Nrv Fx; W Bone Grft Specialty $3,628.00 21385 Open Tx Orbit Floor Fx; Transantral Specialty $2,134.00 21386 Open Tx Orbit Floor Fx; Periorbital Specialty $2,172.00 21387 Open Tx Orbit Floor Fx; Comb Apprch Specialty $2,231.00 21390 Open Tx Orbit Floor Fx; Periorbit W Impl Specialty $2,481.00 21395 Opn Tx Orbit Floor Fx; Periorb W Bn Grft Specialty $3,138.00 21400 Clsd Tx Orbit Fx No Blowout; WO Manip Specialty $600.00 21401 Clsd Tx Orbit Fx No Blowout; W Manip Specialty $1,379.00 21406 Open Tx Orbit Fx No Blowout; WO Implant Specialty $1,625.00 21407 Open Tx Orbit Fx No Blowout; W Implant Specialty $2,018.00 21408 Open Tx Orbit Fx No Blowout; W Bn Grft Specialty $2,740.00 21421 Closed Tx Lefort I Fx; W ID Wire Fix Specialty $2,370.00 21422 Open Tx Palate Or Maxillary Fx Specialty $2,115.00 21423 Open Tx Palate/Maxillary Fx; Complicated Specialty $2,565.00 21431 Closed Tx CranioFace Sep; W ID Wire Specialty $2,321.00 21432 Open Tx CranioFace Sep; W Wire/NT Fix Specialty $2,057.00 21433 Op Tx LeFort III Sep; Complic W Multi Op Specialty $5,435.00 21435 Op Tx LeFort III Sep; Compl W Fixation Specialty $3,960.00 21436 Op Tx LeFort III Sep; Compl W Bn Grft Specialty $6,566.00 21440 Op Tx Mand/Maxill Alveolar Ridge Fx Specialty $1,818.00 21445 Op Tx Mandib/Maxill Alv Ridge Fx Specialty $2,426.00 21450 Closed Tx Mandibular Fx; W O Manip Specialty $1,949.00 21451 Closed Tx Mandibular Fx; W Manip Specialty $2,399.00 21452 Perc Tx of Mand Fx W External Fix Specialty $1,876.00 21453 Closed Tx of Mandibular Fx W ID Fix Specialty $2,874.00 21454 Closed Tx of Mand Fx W External Fix Specialty $1,865.00 21461 Open Tx Mandibular Fx; WO ID Fix Specialty $6,716.00 21462 Open Tx Mandibular Fx; W ID Fix Specialty $7,127.00 21465 Open Tx Mandibular Condylar Fx Specialty $3,017.00 21470 Open Tx Mandib Fx W Multi Ops & Fix Specialty $3,796.00 21480 Closed Tx TMJ Dislocation; Initial Specialty $307.00 21480 Closed Tx TMJ Dislocation; Initial Standard Fee $154.00 21485 Closed Tx TMJ Dislocation; Complicated Specialty $2,210.00 21490 Open Tx TMJ Dislocation Specialty $2,881.00 21495 Open Tx Hyoid Bone Fracture Specialty $2,215.00 21497 Interdental Wiring For Other Than Fx Specialty $2,313.00 21501 I&D Deep Absc Soft Tiss Neck/Thorax Specialty $1,414.00 21502 I&D Deep Absc Sft Tiss Nk/Thor W Rib O Specialty $1,674.00 21510 Deep Inc W BC; Thorax Specialty $1,409.00 21550 Soft Tissue Biopsy - Neck/Thorax Specialty $817.00 21552 Excision Neck Lesion SC 3cm > Specialty $1,405.00 21554 Excise Neck Tumor Deep 5 cm> Specialty $2,303.00 21555 Excise Neck Lesion SubQ <3 Cm Standard Fee $647.00 21555 Excise Neck Lesion SubQ <3 Cm Specialty $1,293.00 21556 Excise Neck Tumor Deep <5 Cm Specialty $1,664.00 21557 Resect Neck/Thorax Tumor <5 Cm Specialty $3,013.00 21558 Resect Neck Tumor 5 Cm> Specialty $4,242.00 21600 Partial Excision Rib Specialty $1,752.00 21610 Costotransversectomy Specialty $3,804.00 21615 Excise 1st And/Or Cervical Rib Specialty $1,955.00 21616 Exc 1st And/Or Cerv Rib; W Sympath Specialty $2,372.00 21620 Ostectomy of Sternum Partial Specialty $1,586.00 21627 Sternal Debridement Specialty $1,698.00 21630 Radical Resection of Sternum Specialty $3,812.00 21632 Radical Resect Sternum; W ML Specialty $3,816.00 21685 Hyoid Myotomy & Suspension Specialty $3,145.00 21700 Div S Anticus; WO Cervical Rib Resect Specialty $1,172.00 21705 Div S Anticus; W Cervical Rib Resection Specialty $1,747.00 21720 Divide SCM; WO Cast Specialty $1,422.00 21725 Divide SCM; With Cast Specialty $1,668.00 21740 Reconstruct P Excavatum/Carinatum Specialty $3,227.00 21750 Close Sternum Separation Specialty $2,161.00 21811 Open Tx Rib Fx W FixJ Scope Specialty $1,933.00 21812 Open Tx of Rib Fx 4-6 Ribs Specialty $2,318.00 21813 Open Tx of Rib Fx 7 > Ribs Specialty $3,021.00 21820 Closed Tx Sternum Fx Standard Fee $218.00 21820 Closed Tx Sternum Fx Specialty $437.00 21825 Open Tx Sternum Fx W/WO Fixation Specialty $1,703.00 21920 Soft Tiss Bx Back/Flank; Superficial Specialty $798.00 21920 Soft Tiss Bx Back/Flank; Superficial Standard Fee $399.00 21925 Soft Tissue Bx Back/Flank; Deep Specialty $1,390.00 21930 Excision Back Lesion SubQ <3 Cm Standard Fee $736.00 21930 Excision Back Lesion SubQ <3 Cm Specialty $1,472.00 21931 Excision Back Lesion SubQ 3 Cm> Specialty $1,478.00 21932 Excision Back Tumor Deep < 5 Cm Specialty $2,083.00 21933 Exc Back Tumor Deep 5 Cm> Specialty $2,319.00 21935 Resect Back Tumor <5 Cm Specialty $3,226.00 21936 Resect Back Tumor 5 Cm> Specialty $4,443.00 22010 I&D P-Spine; C/T/Cerv-Thor Specialty $3,009.00 22015 I&D P-Spine; L/S/Ls Specialty $2,911.00 22100 Pexc Pvc Bone Les 1 Segm; Cervical Specialty $2,761.00 22101 Pexc Pvc Bone Les 1 Segm; Thorax Specialty $2,687.00 22102 Pexc Pvc Bone Les 1 Segm; Lumbar Specialty $2,482.00 22103 Pexc Pvc Bone Les; Ea Addtl Segment Specialty $444.00 22110 Pexc VB Bone Lesion 1 Segm; Cervical Specialty $3,319.00 22112 Pexc VB Bone Lesion 1 Segm; Thorax Specialty $3,111.00 22114 Pexc VB Bone Lesion 1 Segm; Lumbar Specialty $3,124.00 22116 Pexc VB Bone Les 1 Segm; Ea Addtl Segm Specialty $453.00 22206 Osteotomy Spine 3 Columns; Thorax Specialty $7,754.00 22207 Osteotomy Spine 3 Columns; Lumbar Specialty $7,594.00 22208 Osteotomy Spine 3 Columns; Addtl Seg Specialty $1,857.00 22210 Revision of Neck Spine Post Appr 1 V Seg Specialty $5,670.00 22212 Revisn of Thorax Spine Post Appr 1 V Seg Specialty $4,685.00 22214 Revisn Of Lumbar Spine Post Appr 1 V Seg Specialty $4,703.00 22216 Revise Extra Spine Segment Post 1 V Seg Specialty $1,158.00 22220 Revise Neck Spine Anterior Appr Specialty $5,060.00 22222 Revise Thorax Spine Anterior Appr Specialty $4,898.00 22224 Revise Lumbar Spine Anterior Appr Specialty $4,999.00 22226 Revise Extra Spine Segment Anterior Specialty $1,156.00 22305 Closed Tx Of Vert Process Fx(s) Standard Fee $297.00 22305 Closed Tx Of Vert Process Fx(s) Specialty $594.00 22310 Closed Tx Vert Body Fx WO Manip Specialty $960.00 22310 Closed Tx Vert Body Fx WO Manip Standard Fee $480.00 22315 Closed Tx Vert Fx/Disloc W Cast/Brace Specialty $2,773.00 22318 Opn Tx&Rep Odont Fx/Disl Ant WO Graft Specialty $5,255.00 22319 Opn Tx&Rep Odont Fx/Disl Ant W Graft Specialty $5,843.00 22325 Treat Spine Fracture 1 Fx Vert Specialty $4,564.00 22326 Treat Spine Fracture 1 Fx Vert Specialty $4,564.00 22327 Treat Thorax Spine Fracture 1 Fx Vert Specialty $4,776.00 22328 Tx Ea Addl Spine Fx 1 Fx Vert/Dslc Seg Specialty $905.00 22505 Manipulate Spine Req Anesth Specialty $401.00 22510 Perc Cervicothoracic Injection Specialty $5,471.00 22511 Perq Lumbosacral Injection Specialty $5,415.00 22512 Vertebroplasty Addl Injection Specialty $3,035.00 22513 Perq Vertebral Augment Thoracic Specialty $22,663.00 22514 Perq Vertebral Augment Lumbar Specialty $22,635.00 22515 Perq Vertebral Augment Ea Addtl Specialty $13,706.00 22532 Lateral Thorax Spine Fusion Specialty $5,661.00 22533 Lateral Lumbar Spine Fusion Specialty $5,229.00 22534 Lat Thor/Lumb, Addtll Seg Specialty $1,150.00 22548 Arthrodesis Anterior C1-C2 Specialty $6,343.00 22551 Neck Spine Fuse & Remove Below C2 Specialty $5,470.00 22552 Spine Fuse&Remv Cerv Below C2, Ea Addl Specialty $1,283.00 22554 Spine Fusion WO Decomprs Cerv Below C2 Specialty $3,996.00 22556 Thorax Spine Fusion Specialty $5,299.00 22558 Lumbar Spine Fusion Anterior Specialty $4,884.00 22585 Additional Spinal Fusion Specialty $1,053.00 22586 Pre-Sacral Fuse W Instrumentation L5/S1 Specialty $5,740.00 22590 Arthrodesis PT Occiput - C2 Specialty $5,051.00 22595 Arthrodesis Posterior C1-C2 Specialty $4,817.00 22600 Arthrodesis P/PL; 1 L Below C2 Specialty $4,105.00 22610 Thorax Spine Fusion Specialty $4,016.00 22612 Lumbar Spine Fusion Specialty $5,047.00 22614 Arthrodesis Posterior; Ea Addl Level Specialty $1,254.00 22630 Lumbar Spine Fusion Posterior Specialty $4,999.00 22632 Spine Fusion, Extra Segment Specialty $1,031.00 22633 Lumbar Spine Fusion Combined Specialty $5,900.00 22634 Spine Fusion Extra Segment Specialty $1,592.00 22800 Arthrodesis Posterior Spine; To 6 Vert Specialty $4,279.00 22802 Arthrodesis Posterior Spine; 7-12 Vert Specialty $6,644.00 22804 Arthrodesis Posterior Spine; 13+ Vertebr Specialty $7,687.00 22808 Arthrodesis Anterior Spine; 2-3 Vert Specialty $5,835.00 22810 Arthrodesis Anterior Spine; 4-7 Vert Specialty $6,439.00 22812 Arthrodesis Anterior Spine; 8+ Vertebr Specialty $7,680.00 22818 Kyphectomy 1 Or 2 Segments Specialty $6,853.00 22819 Kyphectomy 3+ Segments Specialty $8,891.00 22830 Explore Spinal Fusion Specialty $2,575.00 22840 Insert Spine Fixation Device Posterior Specialty $2,437.00 22842 Insrt Spine Fixation Device Post 3-6 Seg Specialty $2,445.00 22843 Insrt Spine Fixation Dev Post 7-12 Seg Specialty $2,612.00 22844 Insrt Spine Fixation Dev Post 13+ Seg Specialty $3,140.00 22845 Insert Spine Fixation Device Ant 2-3 Seg Specialty $2,349.00 22846 Insert Spine Fixation Device Ant 4-7 Seg Specialty $2,439.00 22847 Insert Spine Fixation Device Ant 8+ Seg Specialty $2,643.00 22848 Insert Pelv Fixation Device Specialty $1,148.00 22849 Reinsert Spinal Fixation Device Specialty $4,131.00 22850 Remove Harrington Rod Specialty $2,292.00 22851 Apply Spine Prosth Device Specialty $1,307.00 22852 Rem Posterior Segmental Instrument Specialty $2,196.00 22855 Rem Anterior Segmental Instrument Specialty $3,526.00 22856 Cervical Artificial Diskectomy Specialty $5,164.00 22857 Lumbar Artificial Diskectomy Specialty $6,268.00 22858 2nd Level Cervical Diskectomy Specialty $1,611.00 22861 Revise Cervical Artifical Disc Specialty $6,371.00 22862 Revise Lumbar Artificial Disc Specialty $6,340.00 22864 Remove Cervical Artificial Disc Specialty $6,607.00 22865 Remove Lumb Artificial Disc Specialty $6,461.00 22900 Exc Abdominal Tumor Deep <5 Cm Specialty $1,775.00 22901 Exc Abdominal Tumor Deep 5 Cm> Specialty $2,092.00 22902 Exc Abdominal Lesion 3 Cm> Specialty $1,367.00 22903 Exc Abdominal Lesion SubQ 3 Cm> Specialty $1,380.00 22904 Rad Resect Abdominal Tumor <5 Cm Specialty $3,301.00 22905 Rad Resect Abdominal Tumor 5 Cm> Specialty $4,188.00 23000 Open Removal SD Calcium Deposits Specialty $1,815.00 23020 Capsular Contracture Release Specialty $2,153.00 23030 I&D Shoulder; Deep Abscess Specialty $1,369.00 23031 I&D Shoulder; Infected Bursa Specialty $1,320.00 23035 Incise Bone Cortex Shoulder Specialty $2,116.00 23040 Arthrotomy GH Joint For Infection Specialty $2,250.00 23044 Arthrotomy ACL SCL Infected Joint Specialty $1,779.00 23065 Soft Tissue Biopsy Shoulder; Superficial Specialty $674.00 23065 Soft Tissue Biopsy Shoulder; Superficial Standard Fee $337.00 23066 Soft Tissue Biopsy Shoulder; Deep Specialty $1,726.00 23071 Exc Shoulder Lesion Subcu 3 Cm> Specialty $1,318.00 23073 Excise Shoulder Tumor Deep 5 Cm> Specialty $2,178.00 23075 Exc Shoulder Lesion Subcu < 3 Cm Standard Fee $728.00 23075 Exc Shoulder Lesion Subcu < 3 Cm Specialty $1,457.00 23076 Exc Shoulder Tumor Deep < 5 Cm Specialty $1,694.00 23077 Resect Shoulder Tumor < 5 Cm Specialty $3,601.00 23078 Resect Shoulder Tumor 5 Cm> Specialty $4,513.00 23100 Arthrotomy W Biopsy GH Joint Specialty $1,555.00 23101 Arthrotomy W Biopsy/Exc; ACJ/SCJ Specialty $1,419.00 23105 Arthrotomy W Synov; GH Joint Specialty $1,993.00 23106 Arthrotomy W Synov; SC Joint Specialty $1,536.00 23107 Arthrotomy; GHJ W Joint Exploration Specialty $2,059.00 23120 Claviculectomy; Partial Specialty $1,824.00 23125 Claviculectomy; Total Specialty $2,219.00 23130 Acromioplasty/Acromionectomy Partial Specialty $1,906.00 23140 Exc Bn Core/Bone Tumor Clav/Scapula Specialty $1,669.00 23145 Exc Bn Cr/Bn Tum Clav/Scap W Autogft Specialty $2,174.00 23146 Exc Bn Cr/Bn Tum Clav/Scap W Allogrft Specialty $1,937.00 23150 Exc Bn Cr/Bn Tum Proximal Humerus Specialty $2,051.00 23155 Exc Bn Cr/Bn Tum Prox Humerus W Autogft Specialty $2,482.00 23156 Exc Bn Cr/Bn Tum Prox Humerus W Allogrft Specialty $2,112.00 23170 Sequestrectomy; Clavicle Specialty $1,734.00 23172 Sequestrectomy; Scapula Specialty $1,767.00 23174 Sequestrectomy; Hum Head To Surg Neck Specialty $2,344.00 23180 Partial Excision Bone; Clavicle Specialty $2,085.00 23182 Partial Excision Bone; Scapula Specialty $2,035.00 23184 Partial Excision Bone; Proximal Humerus Specialty $2,296.00 23190 Ostectomy Of Scapula Partial Specialty $1,775.00 23195 Resect Humeral Head Specialty $2,353.00 23200 Resect Clavicle Tumor Specialty $4,674.00 23210 Resect Scapula Tumor Specialty $5,570.00 23220 Partial Removal Of Humerus Specialty $6,095.00 23330 Remove FB Shoulder; Subcutaneous Specialty $739.00 23330 Remove FB Shoulder; Subcutaneous Standard Fee $369.00 23333 Remove Shoulder FB Deep Specialty $1,413.00 23334 Shoulder Prosthesis Rem (Hum Or Glen) Specialty $3,375.00 23335 Shoulder (Total) Prosthesis Removal Specialty $4,016.00 23350 Shoulder Arthrogram Injection Specialty $402.00 23350 Shoulder Arthrogram Injection Standard Fee $201.00 23395 Muscle Transfer UArm/Shldr; Single Specialty $4,027.00 23397 Muscle Transfer UArmShldr; Multi Specialty $3,575.00 23400 Scapulopexy Specialty $3,043.00 23405 Tenomyotomy Shoulder; Single Specialty $1,952.00 23406 Tenomyotomy Shoulder; Multiple Specialty $2,402.00 23410 Open Repair Rotator Cuff Specialty $2,572.00 23412 Repair Rotator Cuff; Chronic Specialty $2,668.00 23415 Coracoacromial Ligament Release Specialty $2,178.00 23420 Reconstruct RC Avulsion Chronic Specialty $3,033.00 23430 Tenodesis Large Tendon Of Biceps Specialty $2,332.00 23440 Resect/Transplant Biceps Large Tendon Specialty $2,363.00 23450 Capsulorrhaphy; Putti-Platt/Magnus Specialty $2,958.00 23455 Capsulorrhaphy; Bankart Specialty $3,130.00 23460 Capsulorrhaphy; Anterior W BB Specialty $3,419.00 23462 Capsulorrhaphy Anterior; W CPT Specialty $3,321.00 23465 Capsulorrhaphy GH Joint Posterior Specialty $3,483.00 23466 Capsulorrhaphy GH Jnt MultiDir Unstable Specialty $3,502.00 23470 Arthroplasty GH Joint Hemiarthroplasty Specialty $3,773.00 23472 Arthroplasty GHJ Total Shoulder Replace Specialty $4,571.00 23473 Revise Reconstructed Shoulder Joint Specialty $5,106.00 23474 Revise Reconstructed Shoulder Joint Specialty $5,516.00 23480 Osteotomy Clavicle W/WO Internal Fix Specialty $2,570.00 23485 Osteotomy Clavicle; W Bone Graft Specialty $2,989.00 23490 Nail/Pin/Plate/Wire; Clavicle Specialty $2,634.00 23491 Nail/Pin/Plate/Wire; Proximal Humerus Specialty $3,173.00 23500 Closed Tx Clavicular Fx; WO Manip Standard Fee $338.00 23500 Closed Tx Clavicular Fx; WO Manip Specialty $676.00 23505 Closed Tx Clavicular Fx; W Manip Specialty $1,095.00 23515 Open Tx Clavicle Fracture Specialty $2,252.00 23520 Closed Tx SternClav Disloc WO Manip Specialty $695.00 23520 Closed Tx SternClav Disloc WO Manip Standard Fee $347.00 23525 Closed Tx SternClav Disloc W Manip Specialty $1,166.00 23530 Open Tx SternClav Disl Acute/Chronic Specialty $1,720.00 23532 Open Tx SternClav Disloc W Fasc Graft Specialty $1,935.00 23540 Closed Tx Acromioclav Disloc; WO Manip Standard Fee $347.00 23540 Closed Tx Acromioclav Disloc; WO Manip Specialty $695.00 23545 Closed Tx Acromioclav Disloc; W Manip Specialty $1,051.00 23550 Open Tx AcromClav Disloc Acute/Chronic Specialty $1,760.00 23552 Open Tx AcromioClav Disloc W Graft Specialty $2,046.00 23570 Closed Tx Scapular Fx; WO Manip Standard Fee $359.00 23570 Closed Tx Scapular Fx; WO Manip Specialty $719.00 23575 Closed Tx Scapular Fx; W Manip Specialty $1,239.00 23585 Open Tx Scapula Fracture Specialty $3,071.00 23600 Closed Tx Prox Humeral Fx; WO Manip Standard Fee $505.00 23600 Closed Tx Prox Humeral Fx; WO Manip Specialty $1,010.00 23605 Closed Tx Prox Humeral Fx; W Manip Specialty $1,438.00 23615 Open Tx Proximal Humeral Fx Specialty $2,768.00 23616 Open Prox Hum Fx Prosth Replacemnt Specialty $3,894.00 23620 Closed Tx Gr Tuberosity Fx; WO Manip Standard Fee $417.00 23620 Closed Tx Gr Tuberosity Fx; WO Manip Specialty $834.00 23625 Closed Tx Gr Tuberosity Fx: W Manip Specialty $1,175.00 23630 Open Tx Greater Humeral Tuberosity Fx Specialty $2,443.00 23650 Closed Tx Shldr Disloc W Manip; WO Anes Specialty $968.00 23650 Closed Tx Shldr Disloc W Manip; WO Anes Standard Fee $484.00 23655 Closed Tx Shldr Disl W Manip; W Anesth Specialty $1,248.00 23660 Open Tx Acute Shoulder Disloc Specialty $1,815.00 23665 Closed Tx Shldr Disloc & Fx GT; W Manip Specialty $1,317.00 23670 Open Tx Shlder Dislc W Hum Tuber Fx Specialty $2,741.00 23675 Closed Tx Shldr Disloc W Neck Fx W Manip Specialty $1,710.00 23680 Open Tx Shoulder W Neck Fx Specialty $2,905.00 23700 Manip Shoulder Joint Under Anesth Specialty $614.00 23800 Arthrodesis Shoulder Joint Specialty $3,216.00 23802 Arthrodesis Shoulder Joint; W AG Specialty $3,957.00 23900 Interthoracoscapular Amputation Specialty $4,357.00 23920 Disarticulation of Shoulder Specialty $3,523.00 23921 Amputation 2 Follow-Up Shoulder Specialty $1,462.00 23930 Deep I&D - Upper Arm/Elbow Specialty $1,095.00 23931 Infec Bursa I&D - Upper Arm/Elbow Specialty $889.00 23935 Deep Incision W OBC - Elbow Specialty $1,579.00 24000 Explore Infec/Rem FB - Elbow Specialty $1,486.00 24006 Capsular Release - Elbow Specialty $2,205.00 24065 Sft Tiss Bx Upper Arm/Elbow; Superficial Specialty $794.00 24065 Sft Tiss Bx Upper Arm/Elbow; Superficial Standard Fee $397.00 24066 Deep Sft Tiss Bx - Upper Arm/Elbow Specialty $1,301.00 24071 Exc Arm/Elbow Lesion Subcu 3 Cm> Specialty $1,275.00 24073 Exc Arm/Elbow Tumor Deep 5 Cm> Specialty $2,172.00 24075 Exc Arm/Elbow Lesion Subcu <3 Cm Standard Fee $762.00 24075 Exc Arm/Elbow Lesion Subcu <3 Cm Specialty $1,524.00 24076 Exc Arm/Elbow Tumor Deep < 5 Cm Specialty $1,701.00 24077 Resect Arm/Elbow Tumor < 5 Cm Specialty $3,253.00 24079 Resect Arm/Elbow Tumor 5 Cm> Specialty $4,157.00 24100 Synovial Biopsy Of Elbow Specialty $1,304.00 24101 Elbow Joint Exploration Specialty $1,560.00 24102 Synovectomy Of Elbow Specialty $1,924.00 24105 Excise Olecranon Bursa Specialty $1,091.00 24110 Excise Cyst/Tumor Humerus Specialty $1,811.00 24115 Exc Humerus Cyst/Tumor W Autograft Specialty $2,308.00 24116 Exc Humerus Cyst/Tumor W Allograft Specialty $2,701.00 24120 Excise Cyst/Tumor Radius Specialty $1,649.00 24125 Exc Cyst/Tumor Radius Head W Autogrft Specialty $1,914.00 24126 Exc Cyst/Tumor Radius Head W Allogrft Specialty $2,030.00 24130 Excision Radial Head Specialty $1,584.00 24134 Sequestrectomy Shaft/Distal Humerus Specialty $2,335.00 24136 Sequestrectomy Radial Head or Neck Specialty $1,951.00 24138 Sequestrectomy Olecranon Process Specialty $2,100.00 24140 Partial Excision - Humerus Bone Specialty $2,187.00 24145 Partial Exc Bone - Radial Head/Neck Specialty $1,851.00 24147 Partial Exc Olecranon Proc Bone Specialty $1,939.00 24149 Rad Resect Elbow Caps/SR Bone W Rels Specialty $3,673.00 24150 Resect Distal Humerus Tumor Specialty $4,894.00 24152 Resect Radius Tumor Specialty $4,144.00 24155 Remove Elbow Joint Specialty $2,642.00 24160 Remove Elbow Joint Implant Specialty $3,963.00 24164 Remove Radius Head Implant Specialty $2,286.00 24200 Remove FB Upper Arm or Elbow; Subcu Standard Fee $320.00 24200 Remove FB Upper Arm or Elbow; Subcu Specialty $641.00 24201 Remove Deep FB from Upper Arm/Elbow Specialty $1,694.00 24220 Elbow Arthrogram Injection Specialty $495.00 24220 Elbow Arthrogram Injection Standard Fee $247.00 24300 Manipulate Elbow W/Anesth Specialty $1,298.00 24301 Single Muscle Transf - Upper Arm/Elbow Specialty $2,342.00 24305 Lengthen Ea Tendon - Upper Arm/Elbow Specialty $1,797.00 24310 Open Revision Tendon - Elbow to Shoulder Specialty $1,469.00 24320 Rpr Tendon W Mscl Transf-Elbow to Shldr Specialty $2,445.00 24330 Elbow Flexor-Plasty Specialty $2,246.00 24331 Elbow Flexor-Plasty W Ext Advancement Specialty $2,462.00 24332 Tenolysis Triceps Specialty $1,911.00 24340 Tenodesis Of Biceps Tendon At Elbow Specialty $1,912.00 24341 Repair Upper Arm/Elbow Tendon/Muscle Specialty $2,331.00 24342 Reinsert Ruptured Biceps/Triceps Tendon Specialty $2,424.00 24343 Repair Elbow Lateral Ligament W/Tiss Specialty $2,203.00 24344 Reconstruct Elbow W Tendon Graft Specialty $3,431.00 24345 Repair Elbow Med Ligament W Local Tiss Specialty $2,196.00 24346 Reconstruct Elbow Med Ligament W Graft Specialty $3,424.00 24357 Repair Elbow, Percutaneous Specialty $1,336.00 24358 Repair Elbow W Debridement, Open Specialty $1,627.00 24359 Repair Elbow Debride/Attach Open Specialty $2,057.00 24360 Elbow Arthroplasty W Membrane Specialty $2,771.00 24361 Elbow Arthroplasty W D Hum Prosth Repl Specialty $3,125.00 24362 Elbow Arthroplasty W Impl and Reconstr Specialty $3,324.00 24363 Elbow Arthroplasty W Prosth Replacement Specialty $4,562.00 24365 Radial Head Arthroplasty Specialty $1,989.00 24366 Radial Head Arthroplasty W Implant Specialty $2,123.00 24370 Revise/Reconstruct Elbow Joint Specialty $4,877.00 24371 Revise/Reconstruct Elbow Joint Specialty $5,591.00 24400 Humerus Osteotomy Specialty $2,553.00 24410 Multi Humeral Shft Osteotomy W Realignm Specialty $3,314.00 24420 Shorten or Lengthen Humerus Specialty $3,066.00 24430 Repair Humerus Malunion WO Graft Specialty $3,307.00 24435 Repair Humerus Malunion W Autograft Specialty $3,371.00 24470 Hemipiphyseal Arrest Distal Humerus Specialty $1,766.00 24495 Forearm Decompression Fasciotomy Specialty $2,039.00 24498 Nail Pin Or Wire Humerus Specialty $2,710.00 24500 Closed Treatment Humerus Fx WO Manip Specialty $1,108.00 24505 Closed Tx Humerus Fracture W Manip Specialty $1,548.00 24515 Open Tx Humerus Sft Fx W Plate/Screws Specialty $2,740.00 24516 Treat Humerus Shaft Fx W Implant Specialty $2,693.00 24530 Closed Tx SC/TC Humerus Fx WO Manip Standard Fee $589.00 24530 Closed Tx SC/TC Humerus Fx WO Manip Specialty $1,178.00 24535 Closed Tx SC/TC Humerus Shft Fx W Manip Specialty $1,907.00 24538 Percutaneous Fix SC/TC Humerus Fx Specialty $2,323.00 24545 Open Tx Humerus Fx WO Extension Specialty $2,908.00 24546 Open Tx Humerus Fx W Extension Specialty $3,253.00 24560 Closed Tx EC Humerus Fx WO Manip Specialty $989.00 24560 Closed Tx EC Humerus Fx WO Manip Standard Fee $495.00 24565 Closed Tx EC Humerus Fx W Manip Specialty $1,645.00 24566 Perc Tx EC Humerus Fx W Manip Specialty $2,241.00 24575 Open Tx Humerus Epicondylar Fx Specialty $2,281.00 24576 Closed Tx Condyl Humerus Fx WO Manip Specialty $1,050.00 24576 Closed Tx Condyl Humerus Fx WO Manip Standard Fee $525.00 24577 Closed Tx Condylar Humerus Fx W Manip Specialty $1,688.00 24579 Open Tx Condylar Humerus Fx Specialty $2,613.00 24582 Perc Skel Fix Humeral Cond Fx; W Manip Specialty $2,515.00 24586 Open Tx Elbow PA Fracture/Dislocation Specialty $3,391.00 24587 Open Tx PA Elbow Fx/Disloc W Impl Specialty $3,383.00 24600 Closed Tx Elbow Disloc WO Anesth Specialty $1,125.00 24600 Closed Tx Elbow Disloc WO Anesth Standard Fee $562.00 24605 Closed Tx Elbow Dislocation W Anesthesia Specialty $1,463.00 24615 Open Tx Acute/Chronic Elbow Dislocation Specialty $2,225.00 24620 Closed Tx Monteggia Elbow Fx W Manip Specialty $1,710.00 24635 Open Tx Monteggia Elbow Fracture Specialty $2,101.00 24640 Closed Tx "Nursemaid Elbow" W Manip Specialty $416.00 24640 Closed Tx "Nursemaid Elbow" W Manip Standard Fee $288.00 24650 Closed Tx Radial Head/Neck Fx; WO Manip Standard Fee $404.00 24650 Closed Tx Radial Head/Neck Fx; WO Manip Specialty $808.00 24655 Closed Tx Radial Head/Neck Fx; W Manip Specialty $1,346.00 24665 Open Tx Radial Head/Neck Fracture Specialty $2,033.00 24666 Open Tx Radial Head/Neck Fx W Prosth Specialty $2,289.00 24670 Closed Tx Ulnar Fx Prox End WO Manip Specialty $899.00 24670 Closed Tx Ulnar Fx Prox End WO Manip Standard Fee $450.00 24675 Closed Tx Ulnar Fx Proximal End W Manip Specialty $1,406.00 24685 Open Tx Ulnar Fx Proximal End Specialty $2,041.00 24800 Elbow Joint Arthrodesis Specialty $2,596.00 24802 Elbow Joint Arthrodesis W Autograft Specialty $3,063.00 24900 Amputate Arm-Humerus; 1" Close Specialty $2,288.00 24920 Amputate Arm-Humerus; Open Circular Specialty $2,287.00 24925 Amputate Arm/Hum 2" Close/Scar Revision Specialty $1,715.00 24930 Amp Arm-Humerus; Re-Amputate Specialty $2,406.00 24931 Amputate Arm-Humerus; W Implant Specialty $2,502.00 24935 Stump Elongation Upper Extremity Specialty $3,483.00 25000 Tendon Sheath Incision; Radial Styloid Specialty $1,046.00 25001 Incise Flexor Carpi Radialis Specialty $1,062.00 25020 Decompress Forearm/Wrist; 1 Comp Specialty $1,784.00 25023 Decompress Forearm/Wrist W Debridement Specialty $3,430.00 25024 Decompr Forearm/Wrist Flexor & Extensor Specialty $2,415.00 25025 Decompr Forearm/Wrist Flex & Ext W Debr Specialty $3,773.00 25028 I&D Deep Abscess - Forearm/Wrist Specialty $1,626.00 25031 I&D Infected Bursa - Forearm/Wrist Specialty $1,117.00 25035 Deep Incision To Bone Forearm/Wrist Specialty $1,804.00 25040 Expl/Tx Radiocarpal/Midcarpal Joint Specialty $1,752.00 25065 Sft Tiss Biopsy Forearm/Wrist; Superfic Specialty $786.00 25065 Sft Tiss Biopsy Forearm/Wrist; Superfic Standard Fee $393.00 25066 Deep Soft Tissue Biopsy Forearm/Wrist Specialty $1,119.00 25071 Exc Forearm Tumor Deep Subcu 3 Cm> Specialty $1,334.00 25073 Exc Forearm Tumor Deep Subfascial 3 Cm> Specialty $1,662.00 25075 Exc Forearm Lesion Subcutaneous < 3 Cm Specialty $1,484.00 25076 Exc Forearm Tumor Deep < 3 Cm Specialty $1,611.00 25077 Resect Forearm/Wrist Tumor < 3 Cm Specialty $2,774.00 25078 Resect Forearm/Wrist Tumor 3 Cm> Specialty $3,650.00 25085 Capsulotomy Wrist Specialty $1,399.00 25100 Biopsy Wrist Joint Specialty $1,074.00 25101 Wrist Joint Exploration Specialty $1,253.00 25105 Synovectomy Wrist Joint Specialty $1,500.00 25107 Repair Wrist Joint Cartilage Specialty $1,915.00 25109 Excise Tendon Forearm/Wrist Specialty $1,672.00 25110 Exc Tendon Sheath Lesion Forearm/Wrist Specialty $1,065.00 25111 Excise 1" Wrist Ganglion Specialty $995.00 25112 Excise Recurrent Wrist Ganglion Specialty $1,202.00 25115 Rad Exc Wrist Bursa/Forearm Tend Shth Specialty $2,362.00 25116 Rad Exc Wrist Forearm Extensors Specialty $1,865.00 25118 Wrist Synovectomy - 1 Compartment Specialty $1,185.00 25119 Resection Of Distal Ulna Specialty $1,538.00 25120 Excision Bone Cyst/Tumor - Radius/Ulna Specialty $1,547.00 25125 Exc Cyst/Tumor Radius/Ulna W Autograft Specialty $1,811.00 25126 Exc Cyst/Tumor Radius/Ulna W Allograft Specialty $1,854.00 25130 Exc Bone Cyst/Tumor - Carpal Bones Specialty $1,386.00 25135 Exc Cyst/Tumor Carpal Bones W Autograft Specialty $1,725.00 25136 Exc Cyst/Tumor Carpal Bones W Allograft Specialty $1,526.00 25145 Rem Bone Absc/Osteomy - Forearm/Wrist Specialty $1,613.00 25150 Partial Excision of Ulna Bone Specialty $1,765.00 25151 Partial Excision Of Radius Bone Specialty $1,820.00 25170 Resect Radius/Ulnar Tumor Specialty $4,647.00 25210 Removal Of Wrist Bone; 1 Bone Specialty $1,515.00 25215 Carpectomy; All Bones Proximal Row Specialty $1,922.00 25230 Radial Styloidectomy Specialty $1,345.00 25240 Excision Of Distal Ulna Specialty $1,329.00 25246 Wrist Arthrography Injection Specialty $500.00 25246 Wrist Arthrography Injection Standard Fee $250.00 25248 Deep FB Removal - Forearm/Wrist Specialty $1,296.00 25250 Remove Wrist Prosthesis Specialty $1,628.00 25251 Complicated Removal Wrist Prosthesis Specialty $2,242.00 25259 Manipulate Wrist W Anesthesia Specialty $1,289.00 25260 Rep Tendon/Muscle - Forearm/Wrist Specialty $1,961.00 25263 Rep T/M Flexor Forearm/Wrist; 2" Ea Specialty $1,934.00 25265 Rep T/M Flexor Forearm/Wrist; 2" W Graft Specialty $2,335.00 25270 Rep T/M Extensor Forearm/Wrist; 1" Ea Specialty $1,521.00 25272 Rep T/M Extensor Forearm/Wrist; 2" Ea Specialty $1,721.00 25274 Rep Tend/Mscl Forearm/Wrist W Free Grft Specialty $2,068.00 25275 Rep Tend Shth Forearm/Wrist W Free Grft Specialty $2,093.00 25280 Length/Short Flex/Ext Tend FA/Wst; Ea Specialty $1,752.00 25290 Open Tenotomy Flex/Ext Tend FA/Wst Ea Specialty $1,357.00 25295 Tenolysis Fl/Ex Tend FA/W Ea Tendon Specialty $1,628.00 25300 Tenodesis Wrist; Flexors Of Fingers Specialty $2,123.00 25301 Wrist Tenodesis - Finger Extensors Specialty $2,004.00 25310 Transplant Forearm Tendon Specialty $1,929.00 25312 Transf Tend Flex/Ext FA/W W Grafts Specialty $2,229.00 25315 Flexor Orig Slide Forearm and/Or Wrist Specialty $2,409.00 25316 Flexor Orig Slide Forearm/Wrist; W TTrsf Specialty $2,861.00 25320 Open Repair Wrist Joint Specialty $3,075.00 25332 Wrist Arthroplasty Specialty $2,625.00 25335 Centralization Of Wrist On Ulna Specialty $2,517.00 25337 Reconstruct Ulna/Radioulnar Joint Specialty $2,770.00 25350 Osteotomy Radius; Distal Third Specialty $2,099.00 25355 Osteotomy Radius; Mid Or Proximal Third Specialty $2,350.00 25360 Osteotomy; Ulna Specialty $2,038.00 25365 Osteotomy; Radius And Ulna Specialty $2,852.00 25370 Multi Osteot W Realign; Radius/Ulna Specialty $3,147.00 25375 Multi Osteot W Realign; Radius And Ulna Specialty $2,983.00 25390 Shortening Of Radius Or Ulna Specialty $2,400.00 25391 Lengthen Radius Or Ulna W Autograft Specialty $3,119.00 25392 Shorten Radius And Ulna Specialty $2,712.00 25393 Lengthen Radius And Ulna W Autograft Specialty $3,537.00 25394 Shorten Carpal Bone Specialty $2,436.00 25400 Repair Nonunion Of Radius Or Ulna Specialty $2,509.00 25405 Repair Nonunion Radius/Ulna W Autograft Specialty $3,240.00 25415 Repair Nonunion Radius And Ulna Specialty $3,012.00 25420 Repair Nonunion Radius & Ulna W Autogrft Specialty $3,653.00 25425 Repr Nonunion Radius Or Ulna W Autogrft Specialty $3,016.00 25426 Repair Defect Radius & Ulna W Autograft Specialty $3,523.00 25430 Vascular Graft Into Carpal Bone Specialty $2,286.00 25431 Repair Nonunion Carpal Bone Ea Specialty $2,456.00 25440 Repair Nonunion Carpal Navicular Bone Specialty $2,390.00 25441 Prosth Replacement Distal Radius Specialty $2,912.00 25442 Prosth Replacement Distal Ulna Specialty $2,512.00 25443 Prosth Replacement Scaphoid Specialty $2,444.00 25444 Prosth Replacement Lunate Bone Specialty $2,584.00 25445 Prosth Replacement Trapezium Bone Specialty $2,252.00 25446 Prosth Replacement - Total Wrist Specialty $3,656.00 25447 Repair Wrist Joints Specialty $2,579.00 25449 Revise Wrist Jnt Arthropl Incl Impl Remv Specialty $3,225.00 25450 Epiphyseal Arrest; Distal Radius/Ulna Specialty $1,614.00 25455 Epiphyseal Arrest; Distal Radius W Ulna Specialty $1,911.00 25490 Prophylactic Tx; Radius Specialty $2,248.00 25491 Prophylactic Tx; Ulna Specialty $2,313.00 25492 Prophylactic Tx; Radius And Ulna Specialty $2,831.00 25500 Closed Tx Of Radial Shaft Fx; WO Manip Standard Fee $422.00 25500 Closed Tx Of Radial Shaft Fx; WO Manip Specialty $845.00 25505 Closed Tx Radial Shaft Fx W Manip Specialty $1,558.00 25515 Open Tx Radial Shaft Fracture Specialty $2,088.00 25520 Galeazzi Fracture/Dislocation Specialty $1,736.00 25525 Open Radl Shft Fx Closed Rad/Uln Jt Disl Specialty $2,449.00 25526 Open Radl Shft Fx Open Rad/Uln Jnt Disl Specialty $2,973.00 25530 Closed Tx Ulnar Shaft Fx; WO Manip Standard Fee $405.00 25530 Closed Tx Ulnar Shaft Fx; WO Manip Specialty $810.00 25535 Closed Tx Ulnar Shaft Fx W Manip Specialty $1,516.00 25545 Open Treatment Of Ulnar Fracture Specialty $1,942.00 25560 Closed Tx Radial & Ulnar Shft Fx; WO Man Standard Fee $429.00 25560 Closed Tx Radial & Ulnar Shft Fx; WO Man Specialty $857.00 25565 Closed Tx Radial & Ulna Fx W Manip Specialty $1,609.00 25574 Open Tx Fracture Radius And Ulna Specialty $2,098.00 25575 Open Tx Radial & Ulnar Shft Fx Fixj R/U Specialty $2,815.00 25600 Clsd Tx Dis Rad Fx/Epiphysl Sep WO Manip Standard Fee $507.00 25600 Clsd Tx Dis Rad Fx/Epiphysl Sep WO Manip Specialty $1,013.00 25605 Clsd Tx Dstl Rdl Fx/Epiphysl Sep W Manip Specialty $1,692.00 25606 Perc Tx Distal Radial Fx W Fixation Specialty $2,068.00 25607 Open Tx Dist Radius Extra-Articular Fx Specialty $2,293.00 25608 Open Tx Radial Intra-Artic Fx; 2 Frags Specialty $2,571.00 25609 Open Tx Dstl Radial Intra-Art Fx 3+ Frag Specialty $3,270.00 25622 Closed Tx Carpal Scaphoid Fx; WO Manip Standard Fee $470.00 25622 Closed Tx Carpal Scaphoid Fx; WO Manip Specialty $939.00 25624 Closed Tx Carpal Scaphoid Fx W Manip Specialty $1,473.00 25628 Open Tx Carpal Scaphoid(Navicular) Fx Specialty $2,247.00 25630 Clsd Tx Carpl Bone Fx WO Manip Ea Bone Standard Fee $471.00 25630 Clsd Tx Carpl Bone Fx WO Manip Ea Bone Specialty $942.00 25635 Clsd Tx Carpl Bone Fx W Manip Ea Bone Specialty $1,318.00 25645 Open Tx Carpal Bone Fx Oth/Thn Scaph Ea Specialty $1,770.00 25650 Closed Tx Of Ulnar Styloid Fracture Specialty $989.00 25650 Closed Tx Of Ulnar Styloid Fracture Standard Fee $495.00 25651 Pin Ulnar Styloid Fracture Specialty $1,506.00 25652 Open Tx Ulnar Styloid Fracture Specialty $1,945.00 25660 Clsd Tx RdCrpl/Intrcrpl Disl 1+ Bn W Man Specialty $1,265.00 25670 Opn Tx Radiocarpal/Intracarpl Disl 1+ Bn Specialty $1,890.00 25671 Pin Radioulnar Dislocation Specialty $1,652.00 25675 Closed Tx Distal Radioulnar Disl W Manip Specialty $1,341.00 25676 Open Tx Distal Radioulnar Dislocation Specialty $1,954.00 25680 Closed Tx Trans-Scapl Fx Disloc; W Manip Specialty $1,468.00 25685 Open Tx Trans-Scaphoperil Fx Dislocation Specialty $2,289.00 25690 Closed Tx Lunate Dislocation W Manip Specialty $1,481.00 25695 Open Tx Of Lunate Dislocation Specialty $1,979.00 25800 Fusion Of Wrist Joint WO Graft Specialty $2,282.00 25805 Fusion Wrist Joint W Sliding Graft Specialty $2,666.00 25810 Fusion Wrist Joint W Autograft Specialty $2,705.00 25820 Intercarpal Fusion; WO Bone Graft Specialty $1,913.00 25825 Intercarpal Fusion; W Autograft Specialty $2,357.00 25830 Radioulnar Joint Fusion W Ulna Resect Specialty $2,940.00 25900 Amputate Forearm Radius Thru Ulna Specialty $2,211.00 25905 Amputate Forearm Rad-Ulna; Open Circular Specialty $2,029.00 25907 Forearm Amputation 2" Closure Specialty $1,817.00 25909 Amputate Forearm Rad-Uln; Re-Amputate Specialty $2,141.00 25915 Krukenberg Procedure Specialty $3,691.00 25920 Disarticulation Through Wrist Specialty $2,167.00 25922 Wrist Amputation W 2" Closure Specialty $1,790.00 25924 Disarticulation To Wrist; Re-Amputate Specialty $1,900.00 25927 Transmetacarpal Amputation Specialty $2,531.00 25929 Transmetacarpal Amputate 2" Closure Specialty $1,845.00 25931 Transmetacarpal; Re-Amputate Specialty $2,071.00 26010 Drain Finger Abscess; Simple Specialty $812.00 26010 Drain Finger Abscess; Simple Standard Fee $406.00 26011 Drain Finger Abscess; Complicated Specialty $1,201.00 26020 Drain Tendon Sheath 1 Digit &/Or Palm Ea Specialty $1,349.00 26025 Drain Palmar Bursa Single Specialty $1,314.00 26030 Drainage Of Palmar Bursa(s) Specialty $1,530.00 26034 Deep Incision of Hand/Finger Specialty $1,672.00 26035 Decompress Fingers/Hand Inj Injury Specialty $2,660.00 26037 Decompress Fasciotomy Hand Specialty $1,767.00 26040 Perc Release - Dupuytren's Contracture Specialty $967.00 26045 Partial Open Rel Dupuytren's Contracture Specialty $1,459.00 26055 Tendon Sheath Incision Finger Specialty $1,720.00 26060 Perc Incision Finger Tendon Ea Digit Specialty $822.00 26070 Explore/Remove FB CMC Joint Specialty $974.00 26070 Explore/Remove FB CMC Joint Standard Fee $487.00 26075 Explore/Remove FB MCP Joint Specialty $1,033.00 26075 Explore/Remove FB MCP Joint Standard Fee $517.00 26080 Explore/Remove FB IP Joint Ea Specialty $1,213.00 26100 Synovial Biopsy CMC Joint Specialty $1,037.00 26105 Synovial Biopsy MCP Joint Specialty $1,034.00 26110 Synovial Biopsy IP Joint Specialty $997.00 26111 Exc Hand Lesion Subcu 1.5 Cm> Specialty $1,302.00 26113 Exc Hand Tumor Deep 1.5 Cm> Specialty $1,708.00 26115 Exc Hand Lesion Subcu < 1.5 Cm Specialty $1,558.00 26116 Exc Hand Tumor Deep < 1.5 Cm Specialty $1,641.00 26117 Rad Resection Hand Tumor < 3 Cm Specialty $2,337.00 26118 Rad Resection Hand Tumor 3 Cm> Specialty $3,284.00 26121 Fasciectomy Palm Only Specialty $1,859.00 26123 Palm W Single Digit Release Specialty $2,598.00 26125 Palm Release W Ea Additional Digit Specialty $861.00 26130 Synovectomy CMC Joint Specialty $1,441.00 26135 Synovectomy MCP Joint; Ea Digit Specialty $1,708.00 26140 Synovectomy PIP Joint; Ea IP Joint Specialty $1,567.00 26145 Synovectomy Tendon Sheath Radical Specialty $1,591.00 26160 Exc Tendon Sheath Lesion Hand/Finger Specialty $1,770.00 26170 Removal Of Palm Tendon Each Specialty $1,257.00 26180 Removal Of Finger Tendon Each Specialty $1,374.00 26185 Sesamoidectomy Thumb Or Finger Specialty $1,688.00 26200 Excise Cyst/Tumor MCP Specialty $1,400.00 26205 Exc MCP Cyst/Tumor W Autograft Specialty $1,882.00 26210 Excise Cyst/Tumor Finger Phalanx Specialty $1,374.00 26215 Exc Cyst/Tumor Finger Phalanx W Autogrft Specialty $1,758.00 26230 Partial Excision MCP Bone Specialty $1,551.00 26235 Partial Excision MDL Phalanx Bone Specialty $1,534.00 26236 Partial Excision Bone; Distal Phalanx Specialty $1,373.00 26250 Radical Resection Metacarpal Tumor Specialty $3,363.00 26260 Resect Proximal Finger Tumor Specialty $2,497.00 26262 Radical Resection Distal Finger Tumor Specialty $1,946.00 26320 Remove Implant From Finger Or Hand Specialty $1,078.00 26340 Manipulate Finger Joint W Anesthesia Ea Specialty $1,034.00 26341 Manipulate Palm Cord Post Injection Standard Fee $153.00 26341 Manipulate Palm Cord Post Injection Specialty $306.00 26350 Rep Flexor Tendon Not Zone 2 WO Grft Ea Specialty $2,176.00 26352 Rep Flexor Tendon Not Zone 2 W Graft Ea Specialty $2,513.00 26356 Repair Flexor Tendon Zone 2 Each Specialty $2,720.00 26357 Secondary Tendon Repair "No Man's" Each Specialty $2,677.00 26358 Rep Flexr Tendon Zone 2 Scndry W Grft Ea Specialty $2,976.00 26370 1" Profundus Tendon Repair Specialty $2,317.00 26372 Profundus Tendon Rep/Adv; 2" W Free Grft Specialty $2,700.00 26373 Profundus Tend Rep/Adv; 2" WO FG Ea Tnd Specialty $2,593.00 26390 Exc Tendon Hand/Finger W Rod Each Specialty $2,578.00 26392 Remove Rod W Inser Grft Hand/Finger Specialty $2,974.00 26410 Rep ExTendon Hand; WO Free Grft Ea Tend Specialty $1,730.00 26412 Rep ExTend Hand; W Free Grft Ea Tendon Specialty $2,085.00 26415 Exc ExTendon W Rod Hand/Finger Each Specialty $2,359.00 26416 Remove Rod W Tendon Grft Hand/Fing Ea Specialty $2,223.00 26418 Extensor Tendon Repair Each Specialty $1,764.00 26420 Extensor Tendon Rep W FreeGrft Ea Tendon Specialty $2,165.00 26426 Extensor Tendon Repair 2" Specialty $1,558.00 26428 Extensor Tendon Rep W FreeGrft Ea Fing Specialty $2,312.00 26432 Closed Treatment "Mallet Finger" Specialty $1,524.00 26433 Repair "Mallet Finger" WO Graft Specialty $1,624.00 26434 Repair "Mallet Finger" W Free Graft Specialty $1,983.00 26437 Extensor Tendon Realignment Specialty $1,905.00 26440 Release Flexor Tendon Palm/Finger Specialty $1,890.00 26442 Release Flexor Tendon Palm And Finger Specialty $2,954.00 26445 Release Extensor Tendon Hand/Finger Specialty $1,760.00 26449 Complex Rel Extensor Finger Tendon Ea Specialty $2,158.00 26450 Open Incision Palm Flexor Tendon Ea Specialty $1,249.00 26455 Open Incision Finger Flexor Tendon Ea Specialty $1,229.00 26460 Open Incis Hand/Finger Extensor Tend Ea Specialty $1,206.00 26471 Tenodesis Prox IP Joint, Ea Joint Specialty $1,876.00 26474 Tenodesis Distal Joint Each Joint Specialty $1,843.00 26476 Lengthen Extensor Tendon Specialty $1,767.00 26477 Shorten Extensor Tendon Specialty $1,774.00 26478 Lengthen Flexor Tendon Specialty $1,897.00 26479 Shorten Flexor Tendon Specialty $1,871.00 26480 CMC Tendon Transfer/Transplant Specialty $2,295.00 26483 CMP Tendon Transfer/Transplant W Grft Specialty $2,582.00 26485 Palm Tendon Transfer/Transplant Specialty $2,471.00 26489 Palm Tendon Transfer/Transplant W Graft Specialty $2,789.00 26490 Sublimis Tendon Transfer Specialty $2,409.00 26492 Opponensplasty; Tendon Trnsfer W Graft Specialty $2,672.00 26494 Hypothenar Muscle Transfer Specialty $2,420.00 26496 Opponensplasty; Other Methods Specialty $2,630.00 26497 Ring And Small Finger Tendon Transfer Specialty $2,668.00 26498 Finger Tendon Transfer; 4 Fingers Specialty $3,532.00 26499 Correct Claw Finger Other Methods Specialty $2,556.00 26500 Tendon Pulley Reconstruction Specialty $1,905.00 26502 Tendon Pulley Reconstruction; W Graft Specialty $2,130.00 26508 Release Thenar Muscle Thumb Contracture Specialty $1,969.00 26510 Cross Intrinsic Transfer Ea Tendon Specialty $1,814.00 26516 Capsulodesis MCP Joint; 1 Digit Specialty $2,140.00 26517 Capsulodesis MCP Joints; 2 Digits Specialty $2,533.00 26518 Capsulodesis MCP Joints; 3 Or 4 Digits Specialty $2,525.00 26520 Release MCP Joint Contracture Ea Joint Specialty $1,987.00 26525 Release IP Joint Contracture Ea Joint Specialty $1,989.00 26530 Arthroplasty MCP Joint; Ea Joint Specialty $1,668.00 26531 MCP Arthroplasty W Implant Ea Specialty $1,941.00 26535 IP Joint Arthroplasty Ea Joint Specialty $1,307.00 26536 IP Joint Arthroplasty W Impl Ea Joint Specialty $2,178.00 26540 Repair MCP/IP Joint Collateral Ligament Specialty $2,009.00 26541 Reconstr MCP Jnt Collat Ligament W Grft Specialty $2,455.00 26542 Reconst MCP Jnt Collat Ligmt W LTis Grft Specialty $2,072.00 26545 Reconstr IP Joint Collateral Ligament Ea Specialty $2,110.00 26546 Repair Nonunion Hand Specialty $3,046.00 26548 Rep & Reconst Finger VPlate IP Joint Specialty $2,327.00 26550 Construct Thumb Replacement Specialty $4,774.00 26551 T-To-H Trsf W Microvasc Anast; GToe Grft Specialty $8,852.00 26553 T-To-H Trsf W MVS; Not Gr Toe, Single Specialty $10,235.00 26554 T-To-H Trsf W MVS; Not Gr Toe, Double Specialty $10,296.00 26555 Positional Change Of Other Finger Specialty $4,146.00 26556 Free Toe Joint Transf W MVLR Anast Specialty $10,635.00 26560 Repair Web Finger W Skin Flaps Specialty $1,714.00 26561 Repair Web Finger W Flaps & Grafts Specialty $2,858.00 26562 Complex Repair Of Web Finger Specialty $4,157.00 26565 Osteotomy To Correct Deformity; MCP Specialty $2,071.00 26567 Osteotomy To Correct Deformity; Phalanx Specialty $2,083.00 26568 Lengthen Metacarpal Or Phalanx Specialty $2,766.00 26580 Repair Cleft Hand Specialty $4,527.00 26587 Reconstruct Extra Finger Specialty $2,838.00 26590 Repair Macrodactylia Specialty $4,188.00 26591 Repair Intrinsic Muscles Of Hand Specialty $1,329.00 26593 Release Intrinsic Muscles Of Hand Ea Specialty $1,832.00 26596 Exc Constricting Ring Finger W Z-Plasty Specialty $2,312.00 26600 Closed Tx MC Fx Single; WO Manip Ea Bone Standard Fee $454.00 26605 Closed Tx MC Fx Single; W Manip Specialty $994.00 26607 Closed Tx MC Fx W Manip & Fixation Ea Specialty $1,413.00 26608 Perc Skel Fixation MC Fx; Ea Bone Specialty $1,480.00 26615 Open Tx MetaCarpal Fx W Fixation Ea Specialty $1,794.00 26641 Closed Tx CMC Disloc Thumb W Manip Specialty $1,135.00 26645 Closed Tx CMC Fx/Disloc Thumb W Manip Specialty $1,306.00 26650 Perc Skel Fix Carp/MCarp Fx/Dislc Thumb Standard Fee $742.00 26650 Perc Skel Fix Carp/MCarp Fx/Dislc Thumb Specialty $1,484.00 26665 Open Tx Carpometacarpal Fx/Disloc Thmb Specialty $1,972.00 26670 Closed Tx CMC Dislocation W Manip Ea Specialty $1,046.00 26675 Closed Tx CMC Disloc W Manip & Anesth Specialty $1,399.00 26676 Pin CMC Dislocation Ea Joint Specialty $1,554.00 26685 Open Tx Carpometacarpal Disloc Not Thumb Specialty $1,794.00 26686 Open Tx Carpometacrpl Disl Thmb Cmplx Specialty $1,947.00 26700 Closed Tx MCP Disloc Single W Manip Specialty $994.00 26705 Closed Tx MCP Disloc Sngl W Man & Anesth Specialty $1,290.00 26706 Perc Skeletal Fix MCP Disloc W Manip Specialty $1,367.00 26715 Open Trtmt Knuckle Dislocation Specialty $1,779.00 26720 Closed Tx Phalan Shft Fx; WO Manip Specialty $611.00 26720 Closed Tx Phalan Shft Fx; WO Manip Standard Fee $305.00 26725 Closed Tx Phalangeal Shaft Fx; W Manip Specialty $1,040.00 26727 Perc Skl Fix Unst Phal Shft Fx Pr/Mid Ea Specialty $1,456.00 26735 Open Tx Phalang Shaft Fx Prox/Mid Ea Specialty $1,857.00 26740 Closed Tx Art Fx MCP/IP Jnt; WO Manip Specialty $710.00 26742 Closed Tx Art Fx MCP/IP Joint; W Manip Specialty $1,138.00 26746 Open Tx Articular Fx MCP/IP Joint Ea Specialty $2,310.00 26750 Closed Tx Dist Phal Fx Fngr/Thmb; WO Man Standard Fee $284.00 26750 Closed Tx Dist Phal Fx Fngr/Thmb; WO Man Specialty $567.00 26755 Closed TX Dist Phal Fx Fgr/Thmb; W Manip Specialty $967.00 26756 Perc Sktl Fix Dist Phal Fx Finger/Thumb Specialty $1,295.00 26765 Open Tx Distal Phalange Fx Ea Specialty $1,557.00 26770 Closed Tx IP Joint Dist W Manip; WO Anes Specialty $847.00 26775 Closed Tx IP Joint Distl W Manip; W Anes Specialty $1,182.00 26776 Perc Skl Fix IP Joint Disl Sngl; W Manip Specialty $1,374.00 26785 Open Tx Finger Dislocation, Single Specialty $1,703.00 26820 Fuse In Opposition Thumb W Autog Graft Specialty $2,417.00 26841 Arthrodesis CMC Joint Thumb W/WO Fix Specialty $2,223.00 26842 Arthrodesis CMC Joint Thumb W Graft Specialty $2,408.00 26843 Carpometacarpal Joint Fusion, Ea Specialty $2,271.00 26844 Arthrodesis CMC Joint Not Thumb W Graft Specialty $2,485.00 26850 Arthrodesis MCP Joint W/WO Fixation Specialty $2,116.00 26852 Arthrodesis MCP Joint W Autograft Specialty $2,435.00 26860 Arthrodesis IP Joint W/WO Fixationl Specialty $1,725.00 26861 Arthrodesis IP Joint; Ea Addtl IP Joint Specialty $324.00 26862 Arthrodesis IP Joint W Autograft Specialty $2,222.00 26863 Arthrodesis IP Joint W A-Graft; Ea Addtl Specialty $724.00 26910 Amputation Metacarpal W Finger/Thumb Specialty $2,209.00 26951 Amputate Fing/Thmb Sngl; W Dir Close Specialty $2,002.00 26952 Amputate Finger/Thmb Sgl; W Loc Adv Flap Specialty $1,974.00 26990 I&D Pelv/Hip Joint Abscess; Deep Specialty $1,951.00 26991 I&D Pelv/Hip Joint; Infected Bursa Specialty $2,182.00 26992 Inc Deep W Op Bone Cortex Pelvis Specialty $2,998.00 27000 Perc Incision Hip Adductor Specialty $1,298.00 27001 Open Incision Hip Adductor Specialty $1,675.00 27003 Tenotomy Adduct SQ Op W Neurect Specialty $1,860.00 27005 Tenotomy Hip Flexor(s) Open Specialty $2,261.00 27006 Tenotomy Hip Abd/Ext Open Specialty $2,297.00 27025 Fasciotomy Hip Or Thigh Any Type Specialty $2,862.00 27030 Arthrotomy Hip W Drainage Specialty $2,931.00 27033 Explore/Remove FB From Hip Specialty $3,045.00 27035 Denerv Hip Joint; Sciatic Femoral Obtura Specialty $3,597.00 27036 Capsulectomy W Release Hip Flex Muscle Specialty $3,161.00 27040 Soft Tissue Bx: Hip/Pelvis; Superficial Specialty $1,066.00 27041 Soft Tissue Bx; Hip/Pelvis Deep Specialty $2,156.00 27043 Exc Hip/Pelvis Lesion Subcu 3 Cm> Specialty $1,478.00 27045 Exc Hip/Pelv Tumor Deep 5 Cm> Specialty $2,353.00 27047 Exc Hip Pelvis Les Subcu <3 Cm Specialty $1,453.00 27048 Exc Hip/Pelvis Tumor Deep <5 Cm Specialty $1,918.00 27049 Resect Hip/Pelvic Tumor <5 Cm Specialty $4,240.00 27050 Arthrotomy W Biopsy; Sacroiliac Joint Specialty $1,196.00 27052 Arthrotomy W Biopsy; Hip Joint Specialty $1,801.00 27054 Arthrotomy W Synovectomy Hip Joint Specialty $2,139.00 27057 Buttock Fasciotomy W Debridement Specialty $3,180.00 27059 Resect Hip/Pelvic Tumor 5 Cm> Specialty $5,723.00 27060 Excision; Ischial Bursa Specialty $1,445.00 27062 Exc Trochanteric Bursa/Calcification Specialty $1,426.00 27065 Exc Bone Cyst/Benign Tumor; Superficial Specialty $1,596.00 27066 Excision Bone Cyst/Tumor; Deep Specialty $2,535.00 27067 Exc Bone Cyst/Tumor; W Autograft Specialty $3,207.00 27070 Partial Exc for Osteomyelitis; Superfic Specialty $2,649.00 27071 Partial Exc For Osteomyelitis; Deep Specialty $2,867.00 27075 Resect Hip Tumor; 1 Ischium/Pubis Specialty $6,590.00 27076 Resect Hip Tumor Including Acetabulum Specialty $7,953.00 27077 Resect Hip Tumor W Innominate Bone Specialty $8,944.00 27078 Resect Hip Tumor Including Femur Specialty $6,489.00 27080 Coccygectomy, Primary Specialty $1,607.00 27086 Remove FB Pelvis Or Hip; Subcu Specialty $898.00 27087 Remove FB Pelvis Or Hip; Deep Specialty $1,959.00 27090 Remove Hip Prosthesis Specialty $2,598.00 27091 Remove Hip Prosthesis; Complicated Specialty $5,017.00 27093 Hip Arthrography Inj WO Anesthesia Specialty $580.00 27093 Hip Arthrography Inj WO Anesthesia Standard Fee $290.00 27095 Hip Arthrography Injection W Anesthesia Specialty $746.00 27096 Inject Sacroiliac Joint Specialty $498.00 27096 Inject Sacroiliac Joint Standard Fee $249.00 27097 Revision Of Proximal Hip Tendon Specialty $2,104.00 27098 Adductor Transfer to Ischium Specialty $2,088.00 27100 Transfer Extern Obliq To Grtr Trochanter Specialty $2,558.00 27105 Transfer Paraspinal Muscle To Hip Specialty $2,714.00 27110 Transfer Iliopsoas Muscle To Femur Specialty $3,029.00 27111 Transfer Iliopsoas To Femoral Neck Specialty $2,819.00 27120 Acetabuloplasty Specialty $4,082.00 27122 Acetabuloplasty; Resect Femoral Head Specialty $3,446.00 27125 Partial Hip Replacement W Prosthesis Specialty $3,556.00 27130 Total Hip Arthroplasty Specialty $4,258.00 27132 Convert To Total Hip Arthroplasty Specialty $5,260.00 27134 Revise Total Hip Arthroplasty; Both Comp Specialty $6,024.00 27137 Revise Hip Arthroplasty; Acetabular Specialty $4,627.00 27138 Revise Total Hip Arthroplasty; Femoral Specialty $4,808.00 27140 Transplant Femur Ridge Specialty $2,799.00 27146 Osteotomy Iliac Acetabular/Innom Bone Specialty $4,040.00 27147 Osteotomy Iliac Acet/Innom W OpRed Hip Specialty $4,623.00 27151 Osteotomy Iliac Acet/Innom W Fem Osteot Specialty $4,989.00 27156 Osteotomy Iliac Acet/Innom; W FO & OR Specialty $5,398.00 27158 Osteotomy Pelvis Bilateral Specialty $4,480.00 27161 Osteotomy Femoral Neck Specialty $3,810.00 27165 Osteotomy IT Or ST Incl Fixation Specialty $4,311.00 27170 Bone Graft Femoral Head Neck IT Or ST Specialty $3,689.00 27175 Slipped Femoral Epiphysis; Traction Specialty $2,090.00 27176 Slipped Femoral Epiphysis; Sgl/Multi Pin Specialty $2,818.00 27177 Open Tx SF Epiphysis; W Pins/Grafts Specialty $3,496.00 27178 Open Tx SF Epiphysis; Cl Manip W Pin Specialty $2,877.00 27179 Open Tx S Fem Epiphysis; Osteoplasty Specialty $3,061.00 27181 Open Tx S Fem Epiphysis; Osteotomy Specialty $3,012.00 27185 Revise Femur Epiphysis Specialty $1,899.00 27187 Prophyl Tx; Fem Neck And Prox Femur Specialty $3,107.00 27193 Closed Tx Pelvic Ring Fx WO Manip Specialty $1,468.00 27194 Closed Tx Pelvic Ring Fx W Manip Specialty $2,210.00 27200 Closed Tx Coccygeal Fracture Specialty $560.00 27200 Closed Tx Coccygeal Fracture Standard Fee $280.00 27202 Open Tx Coccygeal Fracture Specialty $1,656.00 27220 Closed Tx Acetabulum Fx(s); WO Manip Specialty $1,655.00 27222 Closed Tx Acetabulum Fx(s); W Manip Specialty $3,059.00 27226 Open Tx Acetab Wall Fx W Internal Fix Specialty $3,313.00 27227 Open Tx Acet Fx A/P 1 Col/Fx Run Trans Specialty $5,213.00 27228 Open Tx Acet Fx A/P 2 Col W Ace Fx W I Specialty $5,945.00 27230 Closed Tx Proximal Femur Fx WO Manip Specialty $1,477.00 27232 Closed Tx Femoral Fx Prx Neck; W Manip Specialty $2,356.00 27235 Perc Fix Femur Proximal Neck Fx Specialty $2,851.00 27236 Bipolar Hip Replacement Specialty $3,754.00 27238 Cl Tx Inter/Peri/Subtroch Fem Fx WO Man Specialty $1,434.00 27240 Clsd Tx Intr/Peri/SbTroch Fem Fx W Manip Specialty $2,998.00 27244 Tx Inter/Pr/SubTroch Fem Fx Screw Implt Specialty $3,864.00 27245 Tx Inter/Pr/Subtroch Fem Fx Immed Implt Specialty $3,863.00 27246 Closed Tx Grtr Trochntrc Fx WO Manip Specialty $1,200.00 27248 Open Tx Greater Trochanteric Fracture Specialty $2,327.00 27250 Closed Tx Trauma Hip Disloc WO Anesth Standard Fee $283.00 27250 Closed Tx Trauma Hip Disloc WO Anesth Specialty $566.00 27252 Closed Tx Trauma Hip Disloc W Anesth Specialty $2,375.00 27253 Open Tx Hip Disloc Traum WO Intern Fix Specialty $2,947.00 27254 Open Tx Hip Disloc Trauma W Wall Fx Specialty $3,976.00 27256 TX Sp Hip Disloc Abd Splnt/Traction; WO Specialty $928.00 27256 TX Sp Hip Disloc Abd Splnt/Traction; WO Standard Fee $464.00 27257 TX Spontan Hip Dislocation W Anesthesia Specialty $1,140.00 27258 Open Tx Spontaneous Hip Dislocation Specialty $3,484.00 27259 Open Tx Spont Hip Disloc; W Fem Shorten Specialty $4,483.00 27265 Closed Tx Post Hip Disloc WO Anesth Specialty $1,238.00 27266 Closed Tx Postop Hip Disloc W Anesth Specialty $1,818.00 27267 Closed Tx Thigh Fracture Specialty $1,356.00 27268 Closed Tx Thigh Fx W/ManipJ Specialty $1,663.00 27269 Open Tx Thigh Fracture Specialty $3,895.00 27275 Manipulate Hip Joint W Anesthesia Specialty $567.00 27279 Arthrodesis Sacroiliac Joint Specialty $2,187.00 27280 Fusion Sacroiliac Joint Specialty $4,308.00 27282 Arthrodesis Symphysis Pubis Specialty $2,581.00 27284 Arthrodesis Hip Joint Specialty $4,893.00 27286 Arthrodesis Hip Joint; W St Osteotomy Specialty $5,132.00 27290 Interpelviabdominal Amputation Specialty $5,058.00 27295 Disarticulation of Hip Specialty $3,959.00 27301 Deep I&D Thigh/Knee Specialty $2,088.00 27303 Deep Inc W Op Bone; Knee/Femur Specialty $1,992.00 27305 Fasciotomy Iliotibial Open Specialty $1,501.00 27306 Perc Incis Adductor/Hamstring Tendon Specialty $1,105.00 27307 Perc Incis Adductor/Hamstring Tend Multi Specialty $1,439.00 27310 Explore Knee W Drain/Remove FB Specialty $2,287.00 27323 Superficial Soft Tiss Biopsy Thigh/Knee Specialty $840.00 27324 Deep Soft Tissue Biopsy Thigh/Knee Specialty $1,247.00 27325 Neurectomy Hamstring Specialty $1,707.00 27326 Neurectomy Popliteal Specialty $1,620.00 27327 Excis Thigh/Knee Lesion SC < 3 Cm Standard Fee $714.00 27327 Excis Thigh/Knee Lesion SC < 3 Cm Specialty $1,427.00 27328 Excise Thigh/Knee Tumor Deep < 5 Cm Specialty $1,946.00 27329 Resect Thigh/Knee Tumor < 5 Cm Specialty $3,255.00 27330 Arthrotomy Knee; W Synovial Biopsy Specialty $1,306.00 27331 Arthrotomy Knee; W Expl/Bx/Remove FB Specialty $1,482.00 27332 Arthrotomy Knee W Menisc; Med or Lat Specialty $2,001.00 27333 Arthrotomy Knee W Menisc; Med & Lat Specialty $1,831.00 27334 Arthrotomy Knee W Synov; Anter/Post Specialty $2,135.00 27335 Arthrotomy Knee W Synov; Anter & Post Specialty $2,387.00 27337 Excis Thigh/Knee Lesion Subcu 3 Cm > Specialty $1,314.00 27339 Exc Thigh/Knee Tumor Deep 5 Cm > Specialty $2,367.00 27340 Excision Prepatellar Bursa Specialty $1,160.00 27345 Excise Synovial Cyst Popliteal Space Specialty $1,501.00 27347 Excise Lesion Meniscus/Capsule Specialty $1,654.00 27350 Patellectomy or Hemipatellectomy Specialty $2,034.00 27355 Excise Femur Bone Cyst/Tumor Specialty $1,879.00 27356 Excise Femur Bone Cyst/Tumor W Allogrft Specialty $2,302.00 27357 Excise Femur Bone Cyst/Tumor W Autogrft Specialty $2,546.00 27358 Excise Femur Bone Cyst/Tumor W Int Fix Specialty $875.00 27360 Partial Excise Bone Femur Prox Tibia Specialty $2,666.00 27364 Resect Thigh/Knee Tumor 5 Cm > Specialty $4,915.00 27365 Resect Femur/Knee Tumor Specialty $6,510.00 27370 Injection For Knee X-Ray Specialty $479.00 27370 Injection For Knee X-Ray Standard Fee $239.00 27372 Remove Deep FB Thigh or Knee Specialty $1,881.00 27380 Repair Kneecap Tendon Specialty $1,853.00 27381 Reconstruct Infrapatellar Tendon Specialty $2,489.00 27385 Suture Quad/Hamstring Muscle Rupture Specialty $1,793.00 27386 Reconstruct Quad/Hamstring Mscl Rupture Specialty $2,591.00 27390 Open Incis Hamstring Knee to Hip Single Specialty $1,397.00 27391 Incision of Thigh Tendons 1 Leg Specialty $1,803.00 27392 Open Incis Hamstring Multi Bilateral Specialty $2,218.00 27393 Lengthen Hamstring Tendon; Single Specialty $1,581.00 27394 Lengthening Of Thigh Tendons 1 Leg Specialty $1,985.00 27395 Lengthen Hamstring Tendon; Multi Bilat Specialty $2,751.00 27396 Transplant Of Thigh Tendon Specialty $1,926.00 27397 Transplants Of Thigh Tendons Specialty $2,828.00 27400 Tend/Muscle Transfer Hamstring to Femur Specialty $2,172.00 27403 Arthrotomy W Open Meniscus Repair Specialty $2,000.00 27405 Repair Torn Collateral Knee Ligament Specialty $2,107.00 27407 Repair Torn Cruciate Knee Ligament Specialty $2,430.00 27409 Repair Torn Collat & Cruc Knee Ligaments Specialty $2,984.00 27412 Autochondrocyte Implant Knee Specialty $5,193.00 27415 Open Osteochondral Knee Allograft Specialty $4,301.00 27416 Open Osteochondral Knee Autograft Specialty $3,066.00 27418 Anterior Tibial Tubercleplasty Specialty $2,592.00 27420 Reconstruct Dislocating Patella Specialty $2,327.00 27422 Reconstruct Disloc Patella W Mscl Adv Specialty $2,319.00 27424 Reconst Rec Disl Patella; W Patellectomy Specialty $2,342.00 27425 Open Lateral Retinacular Release Specialty $1,398.00 27427 Ligament Augment Knee; Extra-Articular Specialty $2,225.00 27428 Ligament Augment Knee; Intra-Articular Specialty $3,488.00 27429 Ligament Augment Knee; IA & EA Specialty $3,900.00 27430 Quadricepsplasty Specialty $2,311.00 27435 Post Capsular Release Knee Specialty $2,521.00 27437 Arthroplasty Patella; WO Prosthesis Specialty $2,066.00 27438 Arthroplasty Patella; W Prosth Specialty $2,630.00 27440 Arthroplasty Knee Tibial Plateau Specialty $2,500.00 27441 Arthroplasty Knee TP; W Debridement Specialty $2,577.00 27442 Arthroplasty Knee FC/TP Specialty $2,721.00 27443 Arthroplasty Knee FC/TP; W Debridement Specialty $2,525.00 27445 Arthroplasty Knee Constrained Prosth Specialty $3,915.00 27446 Arthroplasty Knee C&P; Medial Lateral Specialty $3,639.00 27447 Total Knee Arthroplasty Specialty $4,257.00 27448 Osteot Femur Shaft/SCondy WO Fixation Specialty $2,425.00 27450 Osteot Femur Shaft/SCondy W Fixation Specialty $3,165.00 27454 Osteot Mult Femur Shaft W Realignment Specialty $4,083.00 27455 Realignment Knee Before Epiphyseal Close Specialty $2,949.00 27457 Realignment Knee After Epiphyseal Close Specialty $2,964.00 27465 Osteoplasty Femur; Shorten Specialty $3,876.00 27466 Osteoplasty Femur; Lengthen Specialty $3,694.00 27468 Osteoplasty Femur; Lengthen & Shorten Specialty $3,858.00 27470 Rep Nonun/Malun Femur WO Fixation Specialty $3,686.00 27472 Rep Nonun/Malun Femur D H&N; W Grfts Specialty $3,961.00 27475 Epiphyseal Arrest; Distal Femur Specialty $2,071.00 27477 Epiphyseal Arrest; Tib-Fibula Proximal Specialty $2,288.00 27479 Epiphyseal Arrest; Comb D Fem & Tib-Fib Specialty $2,464.00 27485 Hemieph Arrest D Fem/Prox Leg Specialty $2,098.00 27486 Revise/Replace Knee Joint 1 Component Specialty $4,416.00 27487 Rev Tot Knee Arthropl; Fem & Tib Compon Specialty $5,523.00 27488 Rem Tot Knee Prosth Methylmeth Specialty $3,766.00 27495 Reinforce Thigh Specialty $3,537.00 27496 Decomp Thigh/Knee 1 Compartment Specialty $1,691.00 27497 Decomp Thigh/Knee W Debride 1 Comp Specialty $1,808.00 27498 Decompress Thigh/Knee Multi Comp Specialty $2,019.00 27499 Decompress Thigh/Knee Multi Comp W Debr Specialty $2,181.00 27500 Closed Tx Femoral Shaft Fx WO Manip Specialty $1,616.00 27501 Closed Tx SC/TC Femur Fx WO Manip Specialty $1,570.00 27502 Closed Tx Femoral Shaft Fx W Manip Specialty $2,393.00 27503 Closed Tx SC/TC Femur Fx W Manip Specialty $2,512.00 27506 Open Tx Femoral Shft Fx W Ins IM Implt Specialty $4,198.00 27507 Open Tx Fem Shaft Fx W Plates/Screws Specialty $3,051.00 27508 Closed Tx Distal Femur Fx WO Manip Specialty $1,634.00 27509 Perc SK Fix Femoral Fx or Epiphys Sep Specialty $2,004.00 27510 Closed Tx Femur Fx or Ephiphys Sep Specialty $2,134.00 27511 Open Tx Femoral Supracondylar Fx W Xtn Specialty $3,129.00 27513 Open Tx Femoral Supracondylar Fx W Xtn Specialty $3,898.00 27514 Open Tx Femoral Fx Dist Med/Lat Condyle Specialty $3,034.00 27516 Closed Tx Dist Fem Epiphys Sep; WO Manip Specialty $1,582.00 27517 Closed Tx Dist Fem Epiphys Sep; W Manip Specialty $2,111.00 27519 Treat Thigh Fx Growth Plate Specialty $2,798.00 27520 Closed Tx Patellar Fx WO Manipulation Standard Fee $500.00 27520 Closed Tx Patellar Fx WO Manipulation Specialty $1,000.00 27524 Open Tx Patella Fx W Int Fix &/ Repair Specialty $2,354.00 27530 Closed Tx Proximal Tibial Fx WO Manip Specialty $935.00 27530 Closed Tx Proximal Tibial Fx WO Manip Standard Fee $468.00 27532 Closed Tx Prox Tbial Fx W Skel Traction Specialty $1,916.00 27535 Open Tx Tibial Fx Prox Unicondylar Specialty $2,815.00 27536 Open Tx Tibial Fx Proximal; Bicondylar Specialty $3,734.00 27538 Closed Tx IC SP &/Or Tuberosity Specialty $1,467.00 27540 Open Tx Intercond Spine/Tubrst Fx Knee Specialty $2,534.00 27550 Closed Tx Knee Dislocation; WO Anesth Specialty $1,568.00 27552 Closed Tx Knee Dislocation; W Anesth Specialty $1,953.00 27556 Open Tx Knee Dislc WO Ligamentous Rpr Specialty $2,743.00 27557 Open Tx Knee Dislc W Ligamentous Rpr Specialty $3,293.00 27558 Open Tx Knee Dislc W Rpr/Reconstr Specialty $3,737.00 27560 Closed Tx Patellar Disloc; WO Anesth Specialty $1,119.00 27560 Closed Tx Patellar Disloc; WO Anesth Standard Fee $560.00 27562 Closed Tx Patellar Dislocation; W Anesth Specialty $1,461.00 27566 Open Tx Patellar Dislocation Specialty $2,793.00 27570 Manipulate Knee Joint Under Anesthesia Specialty $472.00 27580 Fusion Of Knee Any Technique Specialty $4,506.00 27590 Amputate Thigh-Femur Any Level Specialty $2,552.00 27591 Amputate Thigh-Femur; Imm Fitting Technq Specialty $3,023.00 27592 Open Amputate Thigh-Femur Circular Specialty $2,165.00 27594 Amputate Thigh-Femur; 2" Closure Specialty $1,604.00 27596 Thigh-Femur Re-Amputation Specialty $2,294.00 27598 Disarticulation At Knee Specialty $2,289.00 27600 Leg Decompressn Ant/Lat Compartm Specialty $1,295.00 27601 Leg Decompression Lower Compartment Specialty $1,390.00 27602 DF Leg; Ant/Lat & P Compartment Specialty $1,557.00 27603 I&D Leg/Ankle Deep Abscess/Hematoma Specialty $1,652.00 27604 I&D Leg or Ankle; Infected Bursa Specialty $1,541.00 27605 SubCu Inc Achilles Tendon W Lcl Anesth Specialty $1,060.00 27605 SubCu Inc Achilles Tendon W Lcl Anesth Standard Fee $530.00 27606 Inc Ankle W Expl; Infection/Remove FB Specialty $886.00 27607 Deep Incision Leg/Ankle Specialty $1,900.00 27610 Inc Ankle W Expl; Infection/Remove FB Specialty $2,037.00 27612 Incision Ankle; Post Capsule Release Specialty $1,737.00 27613 Superf Soft Tiss Biopsy Leg/Ankle Specialty $782.00 27613 Superf Soft Tiss Biopsy Leg/Ankle Standard Fee $391.00 27614 Deep Soft Tissue Biopsy Leg/Ankle Specialty $1,799.00 27615 Resect Leg/Ankle Tumor < 5 Cm Specialty $3,213.00 27616 Resect Leg/Ankle Tumor 5 Cm/> Specialty $3,995.00 27618 Excise Leg/Ankle Tumor < 3 Cm Standard Fee $698.00 27618 Excise Leg/Ankle Tumor < 3 Cm Specialty $1,396.00 27619 Excise Leg/Ankle Tumor Deep < 5 Cm Specialty $1,466.00 27620 Explore/Treat Ankle Joint Specialty $1,418.00 27625 Arthrotomy Ankle W Synovectomy Specialty $1,830.00 27626 Arthrotomy Ankle W Synovect & Tenosyn Specialty $1,931.00 27630 Excise Tendon Shth Lesion Leg/Ankle Specialty $1,746.00 27635 Excise Tib/Fib Bone Cyst/Tumor Specialty $1,837.00 27637 Exc Tib/Fib Cyst/Tumor W Autograft Specialty $2,343.00 27638 Exc Tib/Fib Cyst/Tumor W Allograft Specialty $2,389.00 27640 Partial Removal Of Tibia Specialty $2,612.00 27641 Partial Removal Of Fibula Specialty $2,092.00 27645 Resect Tibia Tumor Specialty $2,092.00 27646 Resect Fibula Tumor Specialty $4,834.00 27647 Resect Talus/Calcaneus Tumor Specialty $3,185.00 27648 Ankle Arthrography Injection Specialty $507.00 27648 Ankle Arthrography Injection Standard Fee $254.00 27650 Primary Repair Ruptured Achilles Tendon Specialty $2,058.00 27652 Prim Repair Rupt Achilles Tendon W Graft Specialty $2,134.00 27654 Secondry Repr Rupt Achilles Tendon Specialty $2,210.00 27656 Repair Leg Fascia Defect Specialty $1,975.00 27658 1' Repair/Suture Leg Flexor Tendon Specialty $1,164.00 27659 2' Repair/Suture Leg Flexor Tendon Specialty $1,504.00 27664 1' Repair/Suture Leg Extensor Tendon Specialty $1,127.00 27665 2' Repair/Suture Leg Extensor Tendon Specialty $1,285.00 27675 Repair Dislocated Peroneal Tendons Specialty $1,519.00 27676 Repr Dist Peroneal Tendon W Fib Incision Specialty $1,885.00 27680 Release Single Tib/Fib/Ankle Flexor Specialty $1,342.00 27681 Release Multipl Tib/Fib/Ankle Flexors Specialty $1,702.00 27685 Length/Short Tendon Leg/Ankle; Single Specialty $2,068.00 27686 Lngthn/Shortn Multi Leg/Ankle Tendons Ea Specialty $1,744.00 27687 Gastrocnemius Recession Specialty $1,417.00 27690 Superf Transf/Transpl Single Tendon Specialty $1,965.00 27691 Deep Transf/Transpl Sgl Lowr Leg Tendon Specialty $2,342.00 27692 Transf/Transpl Single Tendon Ea Addtl Specialty $330.00 27695 Suture Ligament Ankle; Collateral Specialty $1,484.00 27696 1' Sutr Both Ruptr Ankle Collat Ligamnts Specialty $1,736.00 27698 2' Repr Torn Collat Ankle Ligament Specialty $2,005.00 27700 Arthroplasty Ankle Specialty $1,855.00 27702 Arthroplasty Ankle; W Implant Specialty $3,027.00 27703 Arthroplasty Ankle; 2' Reconstruct Specialty $3,476.00 27704 Removal Of Ankle Implant Specialty $1,803.00 27705 Incision Of Tibia Specialty $2,377.00 27707 Incision Of Fibula Specialty $1,261.00 27709 Incision Of Tibia & Fibula Specialty $3,661.00 27712 Osteotomy; Mult W Realign IM Rod Specialty $3,452.00 27715 Osteoplasty Tib & Fib Lengthen Specialty $3,359.00 27720 Repair Nonun/Malun Tibia; WO Graft Specialty $2,740.00 27722 Repair Nonun/Malun Tibia; W Slide Graft Specialty $2,753.00 27724 Repair Nonun/Malun Tibia; W Autograft Specialty $3,970.00 27725 Repair Nonun/Malun Tibia; Synostosis Specialty $3,783.00 27726 Repair Fibula Nonun/Malun W Int Fix Specialty $3,034.00 27727 Repair Congenital Pseudarthrosis Tibia Specialty $3,252.00 27730 Open Epiphyseal Arrest Distal Tibia Specialty $1,784.00 27732 Open Epiphyseal Arrest Distal Fibula Specialty $1,267.00 27734 Open Epiphysieal Arrest; Dist Tib&Fib Specialty $2,053.00 27740 Tib-Fib Epiphyseal Arrest By Stapling Specialty $2,415.00 27742 Tib-Fib&Fem Epiphyseal Arrest By Staplng Specialty $2,415.00 27745 Pin/Plate/Wire Tibia Specialty $2,364.00 27750 Closed Tx Tibia Shaft Fx WO Manip Standard Fee $537.00 27750 Closed Tx Tibia Shaft Fx WO Manip Specialty $1,073.00 27752 Closed Tx Tibia Shaft Fx W Manipulation Specialty $1,672.00 27756 Perc Skeletal Fixation Tibial Shaft Fx Specialty $1,789.00 27758 Open Treatment of Tibia Fracture Specialty $2,790.00 27759 Open/Perc Tx Tibia Shaft Fx By IM Impl Specialty $3,132.00 27760 Closed Tx Medial Ankle Fracture Standard Fee $516.00 27760 Closed Tx Medial Ankle Fracture Specialty $1,032.00 27762 Closed Tx Medial Ankle Fx W ManipJ Specialty $1,474.00 27766 Open Tx Medial Ankle Fracture Specialty $1,910.00 27767 Closed Tx Posterior Ankle Fracture Specialty $870.00 27767 Closed Tx Posterior Ankle Fracture Standard Fee $435.00 27768 Closed Tx Posterior Ankle Fx W ManipJ Specialty $1,371.00 27769 Open Tx Posterior Ankle Fracture Specialty $2,286.00 27780 Closed Tx Prox Fib Shaft Fx WO Manip Specialty $949.00 27780 Closed Tx Prox Fib Shaft Fx WO Manip Standard Fee $475.00 27781 Closed Tx Prox Fibula Shft Fx W Manip Specialty $1,310.00 27784 Open Treatment Fibula Fracture Specialty $2,241.00 27786 Closed Tx Distal Fibula Fx WO Manip Standard Fee $490.00 27786 Closed Tx Distal Fibula Fx WO Manip Specialty $979.00 27788 Closed Tx Distal Fibula Fx W Manip Specialty $1,306.00 27792 Open Tx Distal Fibular Fx Lat Malleolus Specialty $2,042.00 27808 Closed Tx Bimalleolar Ankle Fx WO Manip Standard Fee $517.00 27808 Closed Tx Bimalleolar Ankle Fx WO Manip Specialty $1,035.00 27810 Closed Tx Bimalleolar Ankle Fx W Manip Specialty $1,448.00 27814 Open Tx Bimalleolar Ankle Fracture Specialty $2,417.00 27816 Closed Tx Trimall Ankle Fx WO Manip Specialty $991.00 27816 Closed Tx Trimall Ankle Fx WO Manip Standard Fee $496.00 27818 Closed Tx Trimall Ankle Fx W Manip Specialty $1,501.00 27822 Open Tx Trimall Ankle Fx WO Fix Pst Lip Specialty $2,631.00 27823 Open Tx Trimall Ankle Fx W Fix Pst Lip Specialty $2,989.00 27824 Closed Tx WB Distal Tibia Fx WO Manip Specialty $973.00 27824 Closed Tx WB Distal Tibia Fx WO Manip Standard Fee $487.00 27825 Closed Tx WB Distal Tibia Fx W Manip Specialty $1,695.00 27826 Open Tx Fracture Distal Tibia Fibula Specialty $2,601.00 27827 Open Tx Fracture Distal Tibia Only Specialty $3,383.00 27828 Open Tx Fracture Distal Tibia & Fibula Specialty $4,058.00 27829 Open Tx Tibia/Fibula Joint Specialty $2,138.00 27831 Closed Tx Prox Tib-Fib Jnt Disl; W Anes Specialty $1,222.00 27832 Open Treatment Lower Leg Dislocation Specialty $2,369.00 27840 Closed Tx Ankle Dislocation WO Anesth Specialty $1,143.00 27842 Closed Tx Ankle Dislocation W Anesth Specialty $1,547.00 27846 Open Tx Ankle Dislocation WO Repair Specialty $2,271.00 27848 Open Tx Ankle Disloc W Repair/Ext Fix Specialty $2,540.00 27860 Manipulate Ankle Under General Anesth Specialty $547.00 27870 Open Ankle Joint Fusion Specialty $3,229.00 27871 Arthrod Tib-Fib Joint Proximal Or Distal Specialty $2,140.00 27880 Amputate Leg Thru Tibia and Fibula Specialty $2,920.00 27881 Amputate Leg Tib-Fib; W IF Technique Specialty $2,759.00 27882 Amputate Leg Tib-Fib; Open Circular Specialty $1,914.00 27884 2' Close Tib-Fib Amputation Specialty $1,832.00 27886 Leg Tibia-Fibula; Reamputate Specialty $2,092.00 27888 Amput Ankle to Tib-Fib M W Pl Repair Specialty $2,155.00 27889 Amputate Foot at Ankle Specialty $2,070.00 27892 Decompress Ant/Lat Cmprt Leg W Debr Specialty $1,735.00 27893 Decompress Post Cmprtm Leg W Debride Specialty $1,891.00 27894 Decompress Ant/Lat Cmprtm Leg W Debride Specialty $2,685.00 28001 I & D Infected Bursa; Foot Specialty $863.00 28001 I & D Infected Bursa; Foot Standard Fee $431.00 28002 Deep Dissect Foot Infect; Sgl Bursa SP Specialty $1,381.00 28003 Deep Dissect Foot Infect; Multi Areas Specialty $2,214.00 28005 Deep Incis Foot W Open Bone Cortex Specialty $1,804.00 28005 Deep Incis Foot W Open Bone Cortex Standard Fee $0.00 28008 Incision Foot/Toe Fascia Specialty $1,349.00 28010 Tenotomy Percutaneous Toe; Single Specialty $722.00 28011 Tenotomy, Perc Toe; Multi Tendons Specialty $1,004.00 28020 Expl W Drain/Rem FB - IT/MT Foot Joint Specialty $1,695.00 28022 Expl W Dr/Rem FB - MTP Foot Joint Specialty $1,529.00 28024 Expl W Dr/Rem FB - IP Foot Joint Specialty $1,444.00 28035 Tarsal Tunnel Release Tibial Nerve Specialty $1,646.00 28039 Excise Foot/Toe Tumor SubCu 1.5cm> Specialty $1,598.00 28043 Excise Foot/Toe Tumor Deep 1.5 Cm/> Specialty $1,442.00 28045 Excise Foot/Toe Tumor SubC < 1.5 Cm Specialty $1,250.00 28046 Resect Foot/Toe Tumor < 3 Cm Specialty $3,358.00 28047 Resect Foot/Toe Tumor 3 Cm/> Specialty $3,358.00 28050 Synovial Biopsy Tarsal Joint Specialty $1,328.00 28052 Synovial MTP Joint Biopsy Specialty $1,403.00 28054 Synovial IP Joint Biopsy Specialty $1,225.00 28055 Neurectomy Foot Specialty $1,168.00 28060 Partial Removal Foot Plantar Fascia Specialty $1,623.00 28062 Radical Removal Foot Plantar Fascia Specialty $1,833.00 28070 Remove IT/MT Foot Joint Lining, Each Specialty $1,670.00 28072 Remove MTP Foot Joint Lining, Each Specialty $1,586.00 28080 Excise Interdigit Morton Neuroma Ea Sgl Specialty $1,639.00 28086 Excise Foot Flexor Tendon Sheath Specialty $1,719.00 28088 Excise Foot Extensor Tendon Sheath Specialty $1,403.00 28090 Excise Foot Cyst/Ganglion Specialty $1,474.00 28092 Excise Cyst/Ganglion - Toes Specialty $1,325.00 28100 Exc Heel Talus/Calcaneus Cyst/Tumor Specialty $1,902.00 28102 Exc Talus/Calcans Cyst/Tumor W Autogrft Specialty $1,893.00 28103 Exc Talus/Calcans Cyst/Tumor W Allogrft Specialty $1,750.00 28104 Excise Tarsal/Metatarsal Cyst/Tumor Specialty $1,653.00 28106 Exc Tarsl/Metrsl Cyst/Tumor W Autogrft Specialty $1,446.00 28107 Exc Tarsal/Metrsal Cyst/Tumor W Allogrft Specialty $1,750.00 28108 Exc Bone Cyst/Benign Tumor Foot Phalange Specialty $1,379.00 28110 Partial Excision 5th Metatarsal Head Specialty $1,450.00 28111 Complex Excision 1st Metatarsal Head Specialty $1,545.00 28112 Complex Excision Other Metatarsal Head Specialty $1,533.00 28113 Complex Excision 5th Metatarsal Head Specialty $1,851.00 28114 Complex Excision All Metatarsal Heads Specialty $3,365.00 28116 Excision of Tarsal Coalition Specialty $2,363.00 28118 Calcaneus Removal Specialty $1,860.00 28119 Remove Heel Spur Specialty $1,645.00 28120 Partial Excision Ankle or Heel Bone Specialty $2,125.00 28122 Partial Excision Tarsal/Metatarsal Bone Specialty $1,874.00 28124 Partial Excision Phalanx or Toe Bone Specialty $1,492.00 28126 Resect Phalangeal Base Single Toe Ea Specialty $1,240.00 28130 Remove Ankle Bone (Talectomy) Specialty $2,003.00 28140 Removel Metatarsal (Metatarsectomy) Specialty $1,875.00 28150 Remove Single Toe Phalange Each Specialty $1,340.00 28153 Resect Head of Toe Phalanx Specialty $1,288.00 28160 Interphalangeal Toe Joint Exc Each Sngl Specialty $1,320.00 28171 Resect Tarsal Tumor Specialty $2,639.00 28173 Resect Metatarsal Tumor Specialty $2,379.00 28175 Resect Phalanx of Toe Tumor Specialty $1,524.00 28190 Remove FB Foot; Subcutaneous Specialty $803.00 28190 Remove FB Foot; Subcutaneous Standard Fee $401.00 28192 Remove Deep FB Of Foot Specialty $1,476.00 28193 Complicated Removal FB From Foot Specialty $1,659.00 28200 Repair Foot Flexor Tendon, Each Specialty $1,534.00 28202 2' Repair Foot Flexor Tendon W Free Grft Specialty $1,868.00 28208 Repair Foot Extensor Tendon, Each Specialty $1,484.00 28210 2' Repair Foot Extensor Tend W Free Grft Specialty $1,793.00 28220 Tenolysis Foot Flexor; Single Specialty $1,408.00 28222 Release Foot Flexors, Multiple Specialty $1,583.00 28225 Release Foot Extensor Tendon, Single Specialty $1,283.00 28226 Release Foot Extensor Tendon, Multiple Specialty $1,905.00 28230 Tenotomy Open Flexor; Foot, Sgl/Multi Specialty $1,362.00 28232 Tenotomy Open Flexor; Toe, Single Specialty $1,214.00 28234 Open Incision Foot/Toe Extensor Tendon Specialty $1,280.00 28238 Adv Post Tibial Tendn W Exc Naviclr Bone Specialty $2,100.00 28240 Lengthen/Release Abd Hallucis Muscle Specialty $1,384.00 28250 Divide Plantar Fascia & Muscle Specialty $1,824.00 28260 Capsulotomy Midfoot; Med Release Specialty $2,149.00 28261 Capsulotomy Midfoot; Tendon Lengthen Specialty $3,066.00 28262 Extensive Midfoot Capsulotomy Specialty $4,614.00 28264 Capsulotomy MidTarsal Specialty $3,140.00 28270 MTP Joint Capsulotomy, Each Single Joint Specialty $1,539.00 28272 Capsulotomy; IP Joint Single, Ea Joint Specialty $1,236.00 28280 Toe Webbing Op Specialty $1,623.00 28285 Hamertoe Op, One Toe Specialty $1,673.00 28286 Cock-Up 5th Toe W Plastic Close Specialty $1,416.00 28288 Prtl Rem Foot Bone Mtrsl Head 1-5, Each Specialty $1,894.00 28289 Repair Hallux Rigidus Specialty $2,293.00 28290 Simple Bunion Correction Specialty $1,846.00 28292 Keller/McBride/Mayo Bunion Correction Specialty $2,467.00 28293 Bunion Correct W Joint Resect W Implant Specialty $3,276.00 28294 Bunion Correct W Tendon Transplant Specialty $2,407.00 28296 Bunion Correct W Metatarsal Bone Inc Specialty $2,229.00 28297 Correction of Bunion W/WO Sesmoidectomy Specialty $2,542.00 28298 Bunion; By Phalanx Osteotomy Specialty $2,260.00 28299 Double Osteotomy Bunion Correction Specialty $2,803.00 28300 Osteotomy; Calcaneus Specialty $2,041.00 28302 Osteotomy; Talus Specialty $2,240.00 28304 Osteotomy Midfoot Bone Specialty $2,588.00 28305 Osteotomy Midfoot Bones; W Autograft Specialty $2,081.00 28306 Metatarsal Shorten; 1st Metatarsal Specialty $1,925.00 28307 Metatarsal Shorten; 1st MT W Allograft Specialty $2,136.00 28308 Metatarsal Shorten, Not 1st MT Specialty $1,772.00 28309 Metatarsal Multiple for Cavus Foot Specialty $2,835.00 28310 Shorten; Proximal Phalanx 1st Toe Specialty $1,715.00 28312 Shorten Phalange, Any Toe Specialty $1,596.00 28313 Reconstruct Angle Toe Deformity Sft Tiss Specialty $1,659.00 28315 Sesamoidectomy First Toe Specialty $1,509.00 28320 Repair NU/MU; Tarsal Bones Specialty $1,908.00 28322 Repair NU/MU; Metatarsal Specialty $2,478.00 28340 Reconstruct Toe Macrodactyly; Sft Tiss Specialty $1,809.00 28341 Reconstuct Toe Macrodactyly; W Bone Res Specialty $2,098.00 28344 Reconstruct Toe(s); Polydactyly Specialty $1,470.00 28345 Reconstruct Toe(s); Syndactyly Specialty $1,634.00 28360 Reconstruction Cleft Foot Specialty $2,879.00 28400 Closed Tx Calcaneal Fx; WO Manipulation Specialty $774.00 28405 Closed Tx Calcaneal Fx; W Manipulation Specialty $1,226.00 28406 Perc Skeletal Fixation Calcaneal Fx Specialty $1,633.00 28415 Open Tx Calcaneal Fracture Specialty $3,463.00 28420 Treat/Graft Heel Fracture; Open Specialty $3,937.00 28430 Closed Tx Talus Fx; WO Manipulation Standard Fee $369.00 28430 Closed Tx Talus Fx; WO Manipulation Specialty $738.00 28435 Closed Tx Talus Fx; W Manipulation Specialty $990.00 28436 Perc Skeletal Fixation of Talus Fx Specialty $1,402.00 28445 Treat Ankle Fracture; Open Specialty $3,328.00 28446 Open Osteochondral Talus Autograft Specialty $3,798.00 28450 Tx Tarsal Bone Fx; WO Manipulation Specialty $672.00 28450 Tx Tarsal Bone Fx; WO Manipulation Standard Fee $336.00 28455 Tx Tarsal Bone Fx; W Manipulation Specialty $901.00 28456 Perc Skel Fix Tarsal Bone Fx; W Manip Specialty $996.00 28465 Open Tx Midfoot Fracture, Each Specialty $1,948.00 28470 Closed Tx Metatarsal Fx; WO Manipulation Standard Fee $341.00 28470 Closed Tx Metatarsal Fx; WO Manipulation Specialty $682.00 28475 Closed Tx Metatarsal Fx; W Manipulation Specialty $800.00 28476 Perc Skel Fex Metatarsal Fx W Manip Specialty $1,099.00 28485 Open Tx Metatarsal Fracture Specialty $1,639.00 28490 Closed Tx Great Phalanx(s) Fx; WO Manip Standard Fee $226.00 28490 Closed Tx Great Phalanx(s) Fx; WO Manip Specialty $453.00 28495 Closed Tx Great Phalanx(s) Fx; W Manip Specialty $553.00 28496 Perc Skel Fix Great Toe Fx; W Manip Specialty $1,373.00 28505 Open Treatment Great Toe Fracture Specialty $2,088.00 28510 Closed Tx Phalanx/Phalang Fx WO Manip Standard Fee $193.00 28510 Closed Tx Phalanx/Phalang Fx WO Manip Specialty $385.00 28515 Closed Tx Phalanx/Phalang Fx W Manip Standard Fee $251.00 28515 Closed Tx Phalanx/Phalang Fx W Manip Specialty $502.00 28525 Open Tx Phalx/Phalg Fx Othr Than Gr Toe Specialty $1,773.00 28530 Closed Tx Sesamoid Fracture Specialty $359.00 28530 Closed Tx Sesamoid Fracture Standard Fee $180.00 28531 Open Tx Sesamoid Fracture Specialty $1,082.00 28540 Closed Tx Tarsal Bone Disloc; WO Anesth Specialty $644.00 28540 Closed Tx Tarsal Bone Disloc; WO Anesth Standard Fee $322.00 28545 Closed Tx Tarsal Bone Disloc; W Anesth Specialty $910.00 28546 Perc Skel Fix Tarsal Bone Disloc; W Manp Specialty $1,749.00 28555 Repair Tarsal Bone Dislocation Specialty $2,760.00 28570 Closed Tx Talotarsal Jnt Disl; WO Manip Specialty $694.00 28570 Closed Tx Talotarsal Jnt Disl; WO Manip Standard Fee $347.00 28575 Closed Tx Talotarsal Jnt Disl; W Anesth Specialty $1,139.00 28576 Perc Sk Fix Talotarsal Jnt Disl W Reduc Specialty $1,219.00 28585 Open Repair Talotarsal Joint Dislocation Specialty $2,671.00 28600 Closed Tx TMT Joint Disloc; WO Anesth Specialty $680.00 28600 Closed Tx TMT Joint Disloc; WO Anesth Standard Fee $340.00 28605 Closed Tx TMT Joint Disloc; W Anesth Specialty $2,470.00 28606 Perc Skel Fix TMT Joint Disloc; W Manip Specialty $1,235.00 28615 Repair Tarsometatarsal Joint Dislocation Specialty $2,470.00 28630 Closed Tx MTP Joint Disloc; WO Anesth Specialty $488.00 28630 Closed Tx MTP Joint Disloc; WO Anesth Standard Fee $244.00 28635 Closed Tx MTP Joint Disloc; W Anesth Specialty $543.00 28635 Closed Tx MTP Joint Disloc; W Anesth Standard Fee $272.00 28636 Perc Skel Fix MTP Joint Disloc; W Manip Specialty $887.00 28645 Open Repair Toe Dislocation Specialty $2,057.00 28660 Closed Tx IP Joint Disloc; WO Anesth Specialty $363.00 28660 Closed Tx IP Joint Disloc; WO Anesth Standard Fee $181.00 28665 Closed Tx IP Joint Disloc; W Anesthesia Specialty $478.00 28665 Closed Tx IP Joint Disloc; W Anesthesia Standard Fee $239.00 28666 Perc Skel Fix IP Joint Disloc; W Manip Specialty $585.00 28675 Open Repair Of Toe Dislocation Specialty $1,829.00 28705 Pantalar Arthrodesis Specialty $3,926.00 28715 Triple Arthrodesis Specialty $2,937.00 28725 Subtalar Arthrodesis Specialty $2,435.00 28730 Arthrodesis MT Or TMT Multiple Or Transv Specialty $2,292.00 28735 Arthrodesis MT/TMT; W Osteot For Flat Ft Specialty $2,444.00 28737 Arthrodesis Miller Type Foot Revision Specialty $2,155.00 28740 Arthrodesis MT Or TMT; Single Joint Specialty $2,652.00 28750 Arthrodesis Great Toe; MTP Joint Specialty $2,550.00 28755 Arthrodesis Great Toe; IP Joint Specialty $1,594.00 28760 Arthrodesis Great Toe IP Jnt W EHL Trans Specialty $2,472.00 28800 Amputate Foot; Midtarsal Specialty $1,701.00 28805 Amputate Foot; Transmetatarsal Specialty $2,304.00 28810 Amputate Metatarsal W Toe Single Specialty $1,360.00 28820 Amputate Toe; MTP Joint Specialty $1,777.00 28825 Amputate Toe; IP Joint Specialty $1,695.00 28890 Hi Energy ESWT, Plantar Fascia Specialty $1,006.00 29000 Apply Halo Type Body Cast Specialty $899.00 29000 Apply Halo Type Body Cast Standard Fee $450.00 29010 Apply Risser Jacket Body; Only Specialty $739.00 29010 Apply Risser Jacket Body; Only Standard Fee $370.00 29015 Apply Risser Jacket Body; W Head Specialty $886.00 29015 Apply Risser Jacket Body; W Head Standard Fee $443.00 29035 Apply Body Cast Shoulder to Hips Specialty $605.00 29035 Apply Body Cast Shoulder to Hips Standard Fee $302.00 29040 Apply Body Cast Shldr To Hips; W Head Specialty $701.00 29040 Apply Body Cast Shldr To Hips; W Head Standard Fee $351.00 29044 Application Of Body Cast 1 Thigh Specialty $878.00 29044 Application Of Body Cast 1 Thigh Standard Fee $439.00 29046 Apply Body Cast Shldr To Hips; 2 Thighs Specialty $755.00 29046 Apply Body Cast Shldr To Hips; 2 Thighs Standard Fee $377.00 29049 Apply Figure 8 Cast Specialty $261.00 29049 Apply Figure 8 Cast Standard Fee $130.00 29055 Apply Shoulder Spica Specialty $694.00 29055 Apply Shoulder Spica Standard Fee $347.00 29058 Apply Plaster Velpeau Specialty $380.00 29058 Apply Plaster Velpeau Standard Fee $190.00 29065 Apply Long Arm Cast Standard Fee $149.00 29065 Apply Long Arm Cast Specialty $299.00 29075 Apply Short Arm Cast Standard Fee $135.00 29075 Apply Short Arm Cast Specialty $270.00 29085 Apply Gauntlet Cast Standard Fee $148.00 29085 Apply Gauntlet Cast Specialty $297.00 29086 Apply Finger Cast Standard Fee $122.00 29086 Apply Finger Cast Specialty $243.00 29105 Apply Long Arm Splint Standard Fee $136.00 29105 Apply Long Arm Splint Specialty $273.00 29125 Apply Short Arm Splint; Static Standard Fee $100.00 29125 Apply Short Arm Splint; Static Specialty $200.00 29126 Apply Short Arm Splint; Dynamic Specialty $238.00 29126 Apply Short Arm Splint; Dynamic Standard Fee $119.00 29130 Apply Finger Splint; Static Standard Fee $64.00 29130 Apply Finger Splint; Static Specialty $127.00 29131 Apply Finger Splint; Dynamic Specialty $157.00 29131 Apply Finger Splint; Dynamic Standard Fee $79.00 29200 Strapping; Thorax Specialty $91.00 29200 Strapping; Thorax Standard Fee $45.00 29240 Strapping; Shoulder Specialty $89.00 29240 Strapping; Shoulder Standard Fee $44.00 29260 Strapping; Elbow Or Wrist Specialty $90.00 29260 Strapping; Elbow Or Wrist Standard Fee $45.00 29280 Strapping; Hand Or Finger Specialty $91.00 29280 Strapping; Hand Or Finger Standard Fee $46.00 29305 Application Of Hip Cast 1 Leg Specialty $770.00 29305 Application Of Hip Cast 1 Leg Standard Fee $385.00 29325 Application Of Hip Casts 1.5 Spica/2 Leg Specialty $847.00 29325 Application Of Hip Casts 1.5 Spica/2 Leg Standard Fee $424.00 29345 Apply Long Leg Cast Standard Fee $212.00 29345 Apply Long Leg Cast Specialty $424.00 29355 Apply Walker Long Leg Cast Specialty $438.00 29355 Apply Walker Long Leg Cast Standard Fee $219.00 29358 Apply Long Leg Cast Brace Specialty $500.00 29358 Apply Long Leg Cast Brace Standard Fee $250.00 29365 Apply Cylinder Cast Specialty $382.00 29365 Apply Cylinder Cast Standard Fee $191.00 29405 Apply Short Leg Cast Standard Fee $127.00 29405 Apply Short Leg Cast Specialty $254.00 29425 Apply Walker Short Leg Cast Specialty $244.00 29425 Apply Walker Short Leg Cast Standard Fee $122.00 29435 Apply Patellar Tendon Bearing Cast Specialty $362.00 29435 Apply Patellar Tendon Bearing Cast Standard Fee $181.00 29440 Add Walker To Old Cast Standard Fee $68.00 29440 Add Walker To Old Cast Specialty $135.00 29445 Apply Rigid Total Contact Leg Cast Specialty $418.00 29445 Apply Rigid Total Contact Leg Cast Standard Fee $209.00 29450 Apply Clubfoot Cast Long Or Short Leg Standard Fee $222.00 29450 Apply Clubfoot Cast Long Or Short Leg Specialty $444.00 29505 Apply Long Leg Splint Specialty $258.00 29505 Apply Long Leg Splint Standard Fee $129.00 29515 Apply Short Leg Splint Standard Fee $111.00 29515 Apply Short Leg Splint Specialty $223.00 29520 Hip Strapping Standard Fee $48.00 29520 Hip Strapping Specialty $96.00 29530 Knee Strapping Specialty $89.00 29530 Knee Strapping Standard Fee $44.00 29540 Strap Ankle Or Foot Standard Fee $40.00 29540 Strap Ankle Or Foot Specialty $80.00 29550 Strapping Of Toes Specialty $59.00 29550 Strapping Of Toes Standard Fee $29.00 29580 Unna Boot Strapping Standard Fee $81.00 29580 Unna Boot Strapping Specialty $163.00 29581 Apply Multi-Layer Compress Syst; Lwr Leg Specialty $190.00 29581 Apply Multi-Layer Compress Syst; Lwr Leg Standard Fee $95.00 29582 Apply Multi-Layer Compress Syst; Upp Leg Standard Fee $108.00 29582 Apply Multi-Layer Compress Syst; Upp Leg Specialty $216.00 29583 Apply Multi-Layer Compress Syst; Upp Arm Standard Fee $67.00 29583 Apply Multi-Layer Compress Syst; Upp Arm Specialty $134.00 29584 Apply Multi-Layer Compres Syst; Arm/Hand Specialty $216.00 29584 Apply Multi-Layer Compres Syst; Arm/Hand Standard Fee $108.00 29700 Remove Gauntlet Boot Or Body Cast Standard Fee $97.00 29700 Remove Gauntlet Boot Or Body Cast Specialty $194.00 29705 Remove Full Arm Or Leg Cast Standard Fee $104.00 29705 Remove Full Arm Or Leg Cast Specialty $208.00 29710 Remove Shoulder Or Hip Spica Specialty $380.00 29710 Remove Shoulder Or Hip Spica Standard Fee $190.00 29720 Repair Spica Body Cast Or Jacket Specialty $264.00 29720 Repair Spica Body Cast Or Jacket Standard Fee $132.00 29730 Windowing Of Cast Specialty $201.00 29730 Windowing Of Cast Standard Fee $101.00 29740 Wedging Of Cast Not Clubfoot Cast Specialty $310.00 29740 Wedging Of Cast Not Clubfoot Cast Standard Fee $155.00 29750 Wedging Of Clubfoot Cast Specialty $277.00 29750 Wedging Of Clubfoot Cast Standard Fee $138.00 29800 TMJ Diagnostic Arthroscopy Specialty $1,595.00 29804 Arthroscopy TMJ Surgical Specialty $2,022.00 29805 Shoulder Arthroscopy, Diagnostic Specialty $1,478.00 29806 Shoulder Capsulor Arthroscopy Specialty $3,330.00 29807 Repair Shoulder Slap Lesion Specialty $3,250.00 29819 Arthroscopy Shoulder; W Removal FB/LB Specialty $1,835.00 29820 Arthroscopy Shoulder; Synovectmy Partial Specialty $1,670.00 29821 Shoulder Arthroscopy; Synovectomy Compl Specialty $1,825.00 29822 Arthroscopy Shoulder; Debride Limited Specialty $1,772.00 29823 Arthroscopy Shoulder; Debride Extensive Specialty $1,934.00 29824 Shoulder Mumford Procedure Specialty $2,085.00 29825 Arthroscopy Shoulder; W Lysis Of Adhes Specialty $1,806.00 29826 Shoulder Arthroscopy/Surgery Specialty $1,806.00 29827 Rotator Cuff Repair Arthroscopy Specialty $3,306.00 29828 Arthroscopy Biceps Tenodesis Specialty $2,853.00 29830 Arthroscopy Elbow Diagnostic Specialty $1,416.00 29834 Arthroscopy Elbow; Remove Loose Bodies Specialty $1,518.00 29835 Arthroscopy Elbow; Parthal Synovectomy Specialty $1,583.00 29836 Arthroscopy Elbow; Complete Synovectomy Specialty $1,777.00 29837 Arthroscopy Elbow; Limited Debrid Specialty $1,634.00 29838 Arthroscopy Elbow; Extensive Debrid Specialty $1,834.00 29840 Arthroscopy Wrist Diagnostic Specialty $1,834.00 29843 Arthroscopy Wrist; For Inf/Lavage/Drain Specialty $1,515.00 29844 Arthroscopy Wrist; Partial Synovectomy Specialty $1,546.00 29845 Arthroscopy Wrist; Complete Synovectomy Specialty $1,796.00 29846 Arthroscopy Wrist; Exc/Rep Cartilage Specialty $1,622.00 29847 Arthroscopy Wrist; Int Fix - Fx/Instabil Specialty $1,664.00 29848 Arthroscopy Wrist; W Rel TMSV Carp Lig Specialty $1,595.00 29850 Arthroscopy Tx Intercondylar Knee Fx Specialty $1,932.00 29851 Arthroscopy Tx IC Fx; With Fixation Specialty $2,770.00 29855 Arthroscopy Aid Tibial Fx Prox Unicondyl Specialty $2,450.00 29856 Arthroscopy Aid Tibial Fx Prox Uni/Bicon Specialty $3,128.00 29860 Hip Arthroscopy Dx W/WO Synov Biopsy Specialty $2,069.00 29861 Arthroscopy Hip; Remove Loose Or FB Specialty $2,251.00 29862 Arthroscopy Hip; W Rem FB W Chondropl Specialty $2,525.00 29863 Arthroscopy Hip; W Rem FB W Chondplsty Specialty $2,525.00 29866 Autgraft Implant Knee W Scope Specialty $3,269.00 29867 Osteochondral Allograft Knee W Scope Specialty $3,966.00 29868 Meniscal Transplant Knee W Scope Specialty $5,040.00 29870 Knee Arthroscopy Diagnostic Specialty $1,818.00 29871 Arthroscopy Knee; For Inf/Lavage/Drain Specialty $1,612.00 29873 Knee Arthroscopy W Lateral Release Specialty $1,642.00 29874 Arthroscopy Knee; Remove Loose Or FB Specialty $1,682.00 29875 Arthroscopy Knee; Limited Synovectomy Specialty $1,551.00 29876 Arthroscopy Knee 2+ Compartments Specialty $2,063.00 29877 Arthroscopy Knee; Debride/Shave AC Specialty $1,949.00 29879 Arthroscopy Knee; Abrasion Arthroplasty Specialty $2,075.00 29880 Arthroscopy Knee; W Menisc Med Or Lat Specialty $1,761.00 29881 Arthroscopy Knee; W Menisc Med & Lat Specialty $1,696.00 29882 Arthroscopy Knee; W Menisc Rep Med & Lat Specialty $2,197.00 29883 Arthroscopy Knee; W Menis Rep-Med&Lat Specialty $2,638.00 29884 Arthroscopy Knee; W Lysis Of Adhesions Specialty $1,924.00 29885 Arthroscopy Knee; Drill For Osteochondr Specialty $2,355.00 29886 Arthroscopy Knee; Drill For OD Lesion Specialty $1,998.00 29887 Arthroscopy Knee; Drill For OD Les W Fix Specialty $2,340.00 29888 Arthroscopy; Ant Cruciate Lig Rep/Augm Specialty $3,093.00 29889 Arthroscopy; Post Cruciate Lig Rep/Aug Specialty $3,834.00 29891 Arthroscopy Ankle;Exc Oschon Defect Specialty $2,117.00 29892 Arthroscopy Repair OD Lesion Or Fx Specialty $1,814.00 29893 Endoscopic Plantar Fasciotomy Specialty $1,908.00 29894 Arthroscopy Ankle; W FB Removal Specialty $1,567.00 29895 Arthroscopy Ankle; Partial Synovectomy Specialty $1,491.00 29897 Arthroscopy Ankle; Simple Debride Specialty $1,586.00 29898 Arthroscopy Ankle; Extensive Debride Specialty $1,770.00 29899 Ankle Arthroscopy With Fusion Specialty $3,246.00 29900 MCP Joint Diagnostic Arthroscopy Specialty $1,416.00 29901 MCP Joint Arthroscopy W Debrid Specialty $1,667.00 29902 MCP Joint Arthroscopy W Ligament Reduc Specialty $1,751.00 29904 Subtalar Arthroscopy W FB Removal Specialty $2,001.00 29905 Subtalar Arthroscopy W Synovectomy Specialty $2,149.00 29906 Subtalar Arthroscopy W Debridement Specialty $2,258.00 29907 Subtalar Arthroscopy With Fusion Specialty $2,750.00 29914 Arthroscopy Hip w Femoroplasty Specialty $3,117.00 29915 Hip Arthroscopy Acetabuloplasty Specialty $3,174.00 29916 Arthroscopy Hip W Labral Repair Specialty $3,174.00 30000 Drain Abscess/Hematoma Nasal Internal Specialty $715.00 30020 Drain Abscess/Hematoma Nasal Septum Specialty $643.00 30100 Intranasal Biopsy Specialty $439.00 30110 Excision Nasal Polyp(s) Simple Specialty $717.00 30115 Excise Nasal Polyp(s) Extensive Specialty $1,346.00 30117 Remove Intranasal Lesion; Internal Aprch Specialty $2,727.00 30118 Exc/Destroy Intranasal Lesion; Extensive Specialty $2,394.00 30120 Excise/Plane Nose For Rhinophyma Specialty $1,613.00 30124 Excise Dermoid Cyst Nose; Simple Specialty $890.00 30125 Excise Dermoid Cyst Nose; Complex Specialty $1,892.00 30130 Excise Inferior Turbinate Specialty $1,184.00 30140 Resect Inferior Turbinate Specialty $1,371.00 30150 Rhinectomy; Partial Specialty $2,397.00 30160 Rhinectomy; Total Specialty $2,403.00 30200 Inject Turbinate(s) Therapeutic Specialty $354.00 30210 Displacement Therapy (Proetz Type) Specialty $466.00 30220 Insert Nasal Septal Prosth (Button) Specialty $943.00 30300 Remove FB Intranasal; Office Standard Fee $289.00 30300 Remove FB Intranasal; Office Specialty $578.00 30310 Remove FB Intranasal; W Anesth Specialty $578.00 30320 Remove FB Intranasal; By Lat Rhinect Specialty $1,380.00 30400 Rhinoplasty 1'; Cartil & Elevte Nose Tip Specialty $3,143.00 30410 Rhinoplasty 1'; Complete Ext Parts Specialty $3,678.00 30420 Rhinoplasty 1'; W Major Septal Repair Specialty $4,264.00 30430 Rhinoplasty 2'; Minor Revision Specialty $2,988.00 30435 Rhinoplasty 2'; Intermediate Revision Specialty $3,453.00 30450 Rhinoplasty 2'; Major Revision Specialty $4,652.00 30460 Rhinoplasty 2'; To CCL Or CCP; Tip Only Specialty $2,216.00 30462 Rhinoplasty 2'; To CCL Or CCP; Tip & Sep Specialty $4,851.00 30465 Repair Nasal Stenosis Specialty $3,050.00 30520 Septoplasty Or Submucous Resection Specialty $1,939.00 30540 Repair Choanal Atresia; Intranasal Aprch Specialty $2,156.00 30545 Repair Choanal Atresia; Transpalatine Ap Specialty $2,735.00 30560 Lysis Intranasal Synechia Specialty $835.00 30580 Repair Fistula; Oromaxillary Specialty $2,039.00 30600 Repair Fistula; Oronasal Specialty $1,835.00 30620 Septal Or Other in Dermatoplasty Specialty $1,941.00 30630 Repair Nasal Septal Perforations Specialty $1,936.00 30801 Ablate Inferior Turbinate, Superficial Specialty $712.00 30802 Ablate Inferior Turbinate Submucosal Specialty $904.00 30901 Control Nasal Hemorrhag Anterior; Simple Standard Fee $148.00 30901 Control Nasal Hemorrhag Anterior; Simple Specialty $295.00 30903 Control Nasal Hemorrhage Ant; Complex Specialty $685.00 30905 Control Posterior Epistaxis Initial Specialty $841.00 30906 Control Posterior Epistaxis Subcutaneous Specialty $1,082.00 30915 Ligation Arteries; Ethmoidal Specialty $1,792.00 30920 Ligate Arteries; Initial Maxill T-Antral Specialty $2,600.00 30930 Ther Fx, Nasal Inf Turbinate Specialty $383.00 30930 Ther Fx, Nasal Inf Turbinate Standard Fee $192.00 31000 Lavage By Cannula; Maxillary Sinus Specialty $571.00 31002 Cannula Lavage; Sphenoid Sinus Specialty $601.00 31020 Sinusotomy Maxillary; Intranasal Specialty $1,506.00 31030 Caldwell-Luc WO Rem Antroch Polyps Specialty $2,153.00 31032 Sinosotomy, Maxill W Rem Antroch Polyps Specialty $1,789.00 31040 Pterygomaxillary Fossa Surgery Specialty $2,372.00 31050 Sinusotomy Sphenoid; W/WO Biopsy Specialty $1,515.00 31051 Sinusotomy, Sphenoid; W Polypectomy Specialty $2,007.00 31070 Sinusotomy Frontal; External Simple Specialty $1,367.00 31075 Sinusotomy Frontal; Lynch Type Specialty $2,446.00 31080 Sinusotomy Front; Oblit WO Brow Included Specialty $3,224.00 31081 Sinusotomy Front; Oblit Coronal Incision Specialty $4,632.00 31084 Sinusotomy Front; Oblit W Flap; Brow Inc Specialty $3,603.00 31085 Sinusotomy Front; Oblit W Flap; Cor Inc Specialty $4,942.00 31086 Sinsotomy Frnt; NonOblit W Flap Brow Inc Specialty $3,508.00 31087 Sinusotomy Frnt; NonOblit W Flp; Cor Inc Specialty $3,373.00 31200 Ethmoidectomy; Intranasal Ant Approach Specialty $1,759.00 31201 Ethmoidectomy; Intranasal Total Specialty $2,301.00 31205 Ethmoidectomy; Extranasal Total Specialty $2,766.00 31225 Maxillectomy; WO Orbital Exenteration Specialty $5,847.00 31230 Maxillectomy; W Orbital Exenteration Specialty $6,493.00 31231 Nasal Endoscopy, Diagnostic Specialty $652.00 31233 Nasal Endoscopy Dx W Maxil Sinusotomy Specialty $817.00 31235 Nasal Endo Dx W Sphenoid Sinusotomy Specialty $931.00 31237 Nasal Endo; W Bx Polypectomy/Debride Specialty $805.00 31238 Nasal Endo W Hemorrhage Control Specialty $804.00 31239 Nasal Endo; W Dacryocystorhinostomy Specialty $1,911.00 31240 Nasal Endo; W Choncha Bullosa Resect Specialty $505.00 31254 Nasal Endoscopy Ethmoidectomy; Partial Specialty $856.00 31255 Nasal Endoscopy W Ethmoidectomy; Total Specialty $1,255.00 31256 Nasal Endoscopy W Maxillary Antrostomy Specialty $620.00 31267 Nasal Endo W Max Ant; W Rem Tiss Max Sin Specialty $996.00 31276 Nasal/Sinus Endo W Frontal Sinus Explore Specialty $1,584.00 31287 Nasal/Sinus Endoscopy W Splenoidotomy Specialty $728.00 31288 Nasal Endo; W Rem Tiss Sphenoid Sinus Specialty $843.00 31290 Nasal Endo W Rep CSF Leak; Ethmoid Specialty $3,621.00 31291 Nasal Endo W Rep CSF Leak; Sphenoid Specialty $3,867.00 31292 Nasal Endo W M/I Orb Wall Decompression Specialty $3,132.00 31293 Nasal Endo W M&I Orb Wal Decompression Specialty $3,398.00 31294 Nasal Endo W Optic Nerve Decompression Specialty $3,883.00 31295 Sinus Endo W Balloon Dilation Max Sinus Specialty $6,347.00 31296 Sinus Endo W Balloon Diltion Front Sinus Specialty $6,463.00 31297 Sinus Endo W Balloon Dil Sphenoid Sinus Specialty $6,347.00 31300 Laryngotomy; W Rem Tumor/Corectomy Specialty $4,088.00 31320 Laryngotomy; Diagnostic Specialty $2,159.00 31360 Laryngectomy; Total WO Rad Nec Dissect Specialty $6,628.00 31365 Laryngectomy; Total W Rad Neck Dissect Specialty $8,179.00 31367 Laryngectomy; Subtot Supragl WO RND Specialty $7,023.00 31368 Laryngectomy; Subtot Supragl W RND Specialty $7,837.00 31370 Partial Laryngectomy; Horizontal Specialty $6,618.00 31375 Partial Laryngectomy; Laterovertical Specialty $6,247.00 31380 Partial Laryngectomy; Anteriovertical Specialty $6,182.00 31382 Partial Laryngectomy; Antero-Latero-Vert Specialty $6,809.00 31390 Pharyngolaryng W RND WO Reconst Specialty $9,122.00 31395 Pharyngolaryng W RND W Reconstruction Specialty $9,641.00 31400 Arytenoidectomy/Arytenoidopexy External Specialty $3,072.00 31420 Epiglottidectomy Specialty $2,606.00 31500 Intubation ET Emergency Standard Fee $171.00 31500 Intubation ET Emergency Specialty $343.00 31502 Trach Tube Chg Before Fistula Tract Specialty $110.00 31502 Trach Tube Chg Before Fistula Tract Standard Fee $55.00 31505 Laryngoscopy Indirect; Diagnostic Specialty $258.00 31505 Laryngoscopy Indirect; Diagnostic Standard Fee $129.00 31510 Laryngoscopy Indirect W Biopsy Specialty $656.00 31511 Laryngoscopy Indirect; W Rem Of FB Specialty $659.00 31512 Laryngoscopy Indirect; W Rem Of Lesion Specialty $637.00 31513 Laryngoscopy Indirect; W VC Injection Specialty $415.00 31513 Laryngoscopy Indirect; W VC Injection Standard Fee $207.00 31515 Laryngoscopy Direct; For Aspiration Specialty $575.00 31515 Laryngoscopy Direct; For Aspiration Standard Fee $288.00 31520 Diagnostic Laryngoscopy Newborn Specialty $492.00 31520 Diagnostic Laryngoscopy Newborn Standard Fee $246.00 31525 Diagnostic Laryngoscopy Except Newborn Specialty $790.00 31526 Dx Laryngoscopy W/Oper Scope Specialty $496.00 31526 Dx Laryngoscopy W/Oper Scope Standard Fee $248.00 31527 Laryngoscopy Direct; W Ins Obturator Specialty $613.00 31528 Initial Direct Laryngoscopy W Dilation Specialty $456.00 31529 Direct Laryngoscopy W Dil Subsequent Specialty $511.00 31530 Laryngoscopy W/FB Removal Specialty $625.00 31531 Laryngoscopy W/FB & Op Scope Specialty $671.00 31535 Laryngoscopy W/Biopsy Specialty $599.00 31536 Laryngoscopy W/Biopsy & Op Scope Specialty $666.00 31540 Laryngoscopy W/Exc Of Tumor Specialty $764.00 31541 Larynscopy W/Tumor Excision + Scope Specialty $834.00 31545 Remove VC Lesion W/Scope Specialty $1,145.00 31546 Remove VC Lesion Scope/Graft Specialty $1,773.00 31560 Laryngoscope W/Arytenoidectomy Specialty $989.00 31561 Larynscopy, Remove Cart + Scope Specialty $1,084.00 31570 Laryngoscope W/VC Injection Specialty $1,060.00 31571 Laryngoscopy W/VC Inj + Scope Specialty $790.00 31575 Diagnostic Flex Laryngoscopy Specialty $355.00 31576 Laryngoscopy Flex; With Biopsy Specialty $355.00 31577 Laryngoscopy Flex; W Removal Of FB Specialty $754.00 31578 Laryngoscopy Flex; W Rem Of Lesion Specialty $870.00 31579 Laryngoscopy Flex/Rigis; W Stroboscopy Specialty $656.00 31580 Revision of Larynx 2 Stage Specialty $3,816.00 31582 Laryngoplasty; For Laryngeal Stenosis Specialty $5,922.00 31584 Laryngoplasty W Or WO Fx Specialty $4,730.00 31587 Laryngoplasty Cricoid Split Specialty $3,132.00 31588 Laryngoplasty NOS Specialty $3,560.00 31590 Laryngeal Reinnervate Neuromusc Pedicle Specialty $2,795.00 31595 Section Recur Laryng Nerve Therapy Unlis Specialty $2,388.00 31600 Tracheostomy Planned Specialty $1,253.00 31601 Incision Of Windpipe < 2 Years Specialty $793.00 31603 Tracheostomy Emergency; Transtracheal Specialty $705.00 31605 Tracheostomy Emergency; Cricothyroid Specialty $579.00 31605 Tracheostomy Emergency; Cricothyroid Standard Fee $290.00 31610 Tracheostomy Fenestr W Skin Flaps Specialty $2,237.00 31611 TE Fistula W Insert Speech Prosthesis Specialty $1,687.00 31612 Tracheal Punct Perc W TT Asp Or Inj Specialty $262.00 31612 Tracheal Punct Perc W TT Asp Or Inj Standard Fee $131.00 31613 Tracheostoma Rev; Simple WO FL Rotate Specialty $1,421.00 31614 Tracheostoma Rev; Complex W FL Rotate Specialty $2,361.00 31615 Tracheobronch Thru Old Incision Specialty $567.00 31615 Tracheobronch Thru Old Incision Standard Fee $284.00 31620 Diagnostic Bronchoscope/Wash Specialty $941.00 31622 Diagnostic Bronchoscopy W Wash Specialty $941.00 31623 Diagnostic Bronchoscopy W Brush Specialty $1,023.00 31624 Dx Bronchoscope/Lavage Specialty $968.00 31625 Bronchoscopy W/Biopsy(s) Specialty $1,224.00 31628 Bronchoscopy/Lung Biopsy, Each Specialty $1,288.00 31629 Bronchoscopy/Needle Bx, Each Specialty $1,537.00 31630 Bronchoscopy Dilate/Fx Repair Specialty $627.00 31631 Bronchoscopy Dilate W/Stent Specialty $722.00 31632 Bronchoscopy/Lung Biopsy Addl Standard Fee $115.00 31632 Bronchoscopy/Lung Biopsy Addl Specialty $231.00 31633 Bronchoscopy/Needle Biopsy Addl Specialty $285.00 31633 Bronchoscopy/Needle Biopsy Addl Standard Fee $142.00 31634 Bronchoscopy W/Balloon Occlusion Specialty $5,745.00 31635 Bronchoscopy W/FB Removal Specialty $1,079.00 31636 Bronchoscopy Bronchial Stents Specialty $694.00 31637 Bronchoscopy Stent Add-On Specialty $232.00 31638 Bronchoscopy Revise Stent Specialty $793.00 31640 Bronchoscopy W/Tumor Excise Specialty $797.00 31641 Bronchoscopy Treat Blockage Specialty $808.00 31643 Diagnostic Bronchoscope/Catheter Specialty $552.00 31645 Bronchoscopy Clear Airways Specialty $1,000.00 31646 Bronchoscopy ReClear Airway Specialty $897.00 31647 Bronchial Valve Initial Insert Specialty $692.00 31648 Bronchial Valve Removal Initial Specialty $640.00 31649 Bronchial Valve Removal Addl Specialty $218.00 31651 Bronchial Valve Addl Insert Specialty $249.00 31652 Bronchoscopy EBUS Sampling 1/2 Node Specialty $2,790.00 31653 Bronchoscopy EBUS Sampling 3/> Node Specialty $2,966.00 31654 Bronchoscopy EBUS IVNTJ Perph Lesion Specialty $445.00 31717 Catheterization W Bronchial Brush Biopsy Specialty $805.00 31720 Catheter Aspiration Specialty $160.00 31720 Catheter Aspiration Standard Fee $80.00 31725 TB Catheterization Asp W Scope, Bedside Specialty $279.00 31725 TB Catheterization Asp W Scope, Bedside Standard Fee $140.00 31730 TT NDL Wire/Dilator/Stent For O2 Tx Standard Fee $0.00 31730 TT NDL Wire/Dilator/Stent For O2 Tx Specialty $3,805.00 31750 Tracheoplasty; Cervical Specialty $4,421.00 31755 Tracheoplasty; TP Fistulization Specialty $5,535.00 31760 Tracheoplasty; Intrathoracic Specialty $4,409.00 31766 Carinal Reconstruction Specialty $5,658.00 31770 Bronchoplasty; Graft Repair Specialty $4,245.00 31775 Bronchoplasty; Exc Stenosis & Anastomos Specialty $4,066.00 31780 Excise T Stenosis & Anast; Cervical Specialty $3,720.00 31781 Exc T Stenosis & Anast; Cervicothoracic Specialty $4,549.00 31785 Exc T Tumor Or Carcinoma; Cervical Specialty $3,417.00 31786 Exc T Tumor Or Carcinoma; Thoracic Specialty $4,552.00 31800 Suture Trach Wound Or Injury; Cervical Specialty $2,303.00 31805 Suture Trach Wound Or Injury; Intrathor Specialty $2,613.00 31820 Surg Close Tracheost/Fistula; WO P Rep Specialty $1,356.00 31825 Surg Close Tracheostomy/Fistula; W P Rep Specialty $1,874.00 31830 Revision of Tracheostomy Scar Specialty $1,386.00 32035 Thoracostomy W/Rib Resection Specialty $2,271.00 32036 Thoracostomy W Flap Drainage Specialty $2,453.00 32096 Open Wedge/Biopsy Lung Infiltrate Specialty $2,550.00 32097 Open Wedge/Biopsy Lung Nodule Specialty $2,548.00 32098 Open Biopsy Of Lung Pleura Specialty $2,418.00 32100 Exploration Of Chest Specialty $2,561.00 32110 Explore/Repair Chest Specialty $4,627.00 32120 Re-Exploration Of Chest Specialty $2,754.00 32124 Explore Chest Free Adhesions Specialty $2,930.00 32140 Removal Of Lung Lesion(s) Specialty $3,157.00 32141 Remove/Treat Lung Lesions Specialty $4,832.00 32150 Removal Of Lung Lesion(s) Specialty $3,180.00 32151 Remove Lung Foreign Body Specialty $3,173.00 32160 Open Chest Heart Massage Specialty $2,494.00 32200 Drain Open Lung Lesion Specialty $3,594.00 32215 Pleural Scarification Repeat Pneumothor Specialty $2,519.00 32220 Decortication Pulmonary; Total Specialty $5,013.00 32225 Decortication Pulmonary; Partial Specialty $3,148.00 32310 Pleurectomy Parietal Specialty $2,881.00 32320 Decortication & Parietal Pleurectomy Specialty $5,057.00 32400 Needle Biopsy Chest Lining Specialty $468.00 32405 Percutaneous Biopsy Lung/Mediastinum Specialty $1,389.00 32440 Remove Lung Pneumonectomy Specialty $4,960.00 32442 Sleeve Pneumonectomy Specialty $10,163.00 32445 Removal Of Lung Extrapleural Specialty $11,239.00 32480 Partial Removal Of Lung Specialty $4,681.00 32482 Bilobectomy Specialty $5,008.00 32484 Segmentectomy Specialty $4,554.00 32486 Sleeve Lobectomy Specialty $7,462.00 32488 Completion Pneumonectomy Specialty $7,584.00 32491 Lung Volume Reduction Specialty $4,670.00 32501 Bronchoplasty W Lobectomy/Segment Specialty $779.00 32503 Resect Apical Lung Tumor Specialty $5,730.00 32504 Resect Apical Lung Tumor/Chest Specialty $6,538.00 32505 Wedge Resection Of Lung Initial Specialty $2,952.00 32506 Wedge Resection Of Lung Add-On Specialty $499.00 32507 Wedge Resection Of Lung Diagnostic Specialty $497.00 32540 Extrapleural Enucleation of Empyema Specialty $5,502.00 32550 Insert Pleural Cath Specialty $2,418.00 32551 Insertion Of Chest Tube Specialty $535.00 32551 Insertion Of Chest Tube Standard Fee $267.00 32552 Remove Lung Catheter Specialty $578.00 32553 Insert Marker Intra-Thor For RT Perq Specialty $1,828.00 32554 Aspirate Pleura W/O Imaging Specialty $618.00 32555 Aspirate Pleura W Imaging Specialty $895.00 32556 Insert Catheter Pleura WO Imaging Specialty $1,668.00 32557 32557 Insert Catheter Pleura W/Imaging Specialty $1,593.00 32560 Treat Pleurodesis W Agent Specialty $756.00 32561 Lyse Chest Fibrin Initial Day Specialty $287.00 32562 Lyse Chest Fibrin Subsequent Day Specialty $260.00 32601 Thoracoscopy Diagnostic Specialty $978.00 32604 Thoracoscopy Diag; Pericardial Sac W Bx Specialty $1,531.00 32606 Thoracoscopy Dx; W Bx Medial Space Specialty $1,467.00 32607 Thoracoscopy W Bx Infiltrate Specialty $979.00 32608 Thoracoscopy W Biopsy Nodule Specialty $1,201.00 32609 Thoracoscopy W Biopsy Pleura Specialty $821.00 32650 Thoracoscopy W Pleurodesis Specialty $2,106.00 32651 Thoracoscopy Remove Cortex Specialty $3,473.00 32652 Thoracoscopy Remove Total Cortex Specialty $5,269.00 32653 Thoracoscopy Remove FB/Fibrin Specialty $3,354.00 32654 Thoracoscopy To Control Bleeding Specialty $3,755.00 32655 Thoracoscopy Resect Bullae Specialty $3,028.00 32656 Thoracoscopy With Pleurectomy Specialty $2,543.00 32658 Thoracoscopy W/Sac, FB Removal Specialty $2,261.00 32659 Thoracoscopy W Sac Drainage Specialty $2,316.00 32661 Thoracoscopy W Excision Pericardial Cyst Specialty $2,538.00 32662 Thoracoscopy W/Excision Mediastinal Cyst Specialty $2,827.00 32663 Thoracoscopy With Lobectomy Specialty $4,442.00 32664 Thoracoscopy W Th Nrv Exc Specialty $2,699.00 32665 Thoracoscopy W Esophageal Musc Excision Specialty $3,881.00 32667 Thorascopy W/W Resection Addl Specialty $500.00 32668 Thoracoscopy W/W Resection Diagnostic Specialty $499.00 32669 Thoracoscopy Remove Segment Specialty $4,270.00 32670 Thoracoscopy Bilobectomy Specialty $5,077.00 32671 Thoracoscopy Pneumonectomy Specialty $5,617.00 32672 Thoracoscopy For LVRS Specialty $4,830.00 32673 Thoracoscopy W Thymus Resection Specialty $3,863.00 32674 Thoracoscopy Lymph Node Excision Specialty $686.00 32701 Thorax Stereo Rad Target W/Tx Specialty $689.00 32800 Repair Lung Hernia Through Chest Wall Specialty $2,995.00 32810 Close Chest After Flap Dr For Empyema Specialty $2,857.00 32815 Open Close Of Major Bronchial Fistula Specialty $8,872.00 32820 Major Reconstr Chest Wall - Post Trauma Specialty $4,230.00 32851 Lung Transplant Single; WO Bypass Specialty $10,463.00 32852 Lung Transplant Single; With Bypass Specialty $11,448.00 32853 Lung Transplant Double; WO Bypass Specialty $14,578.00 32854 Lung Transplant Double; With Bypass Specialty $15,498.00 32900 Resection Of Ribs Extrapleura All Stages Specialty $4,443.00 32905 Thoracoplasty Schede Type Or Extrapleur Specialty $4,253.00 32906 Thoracoplasty W Close Of Bronchop Fistul Specialty $5,256.00 32940 Pneumonolysis Extraperiosteal Specialty $3,913.00 32960 Pneumothorax Therapy Intrapleural Inj Specialty $441.00 32997 Total Lung Lavage (Unilateral) Specialty $1,072.00 32998 Perq RF Ablate Tx Pulmonary Tumor(s) Specialty $7,385.00 33010 Pericardiocentesis; Initial Specialty $381.00 33010 Pericardiocentesis; Initial Standard Fee $191.00 33011 Pericardiocentesis; Subsequent Specialty $383.00 33011 Pericardiocentesis; Subsequent Standard Fee $191.00 33015 Tube Pericariostomy Specialty $383.00 33020 Pericardiotomy To Remove Clot Or FB Specialty $2,785.00 33025 Create Pericardial Window/Partial Resect Specialty $2,529.00 33030 Pericardiectomy; WO CP Bypass Specialty $6,354.00 33031 Paricardiectomy; W CP Bypass Specialty $7,842.00 33050 Resect Heart Sac Lesion Specialty $3,162.00 33120 Excise Intracardial Tumor Resect W CPB Specialty $6,658.00 33130 Resect External Cardiac Tumor Specialty $4,373.00 33140 TMLR By Thoracotomy Specialty $4,991.00 33141 Open TMR W Cardiac Other Procedure Specialty $419.00 33202 Insert Epicardial Electrode Open Specialty $2,460.00 33203 Insert Epicardial Electrode Endo Apprch Specialty $2,556.00 33206 Insert Heart Pacemaker Atrial Specialty $1,459.00 33207 Insert Heart Pacemaker Ventricular Specialty $1,557.00 33208 Insert Heart Pacemaker Atrial & Vent Specialty $1,686.00 33210 Insert Electrd/PM Catheter Single Specialty $567.00 33211 Insert Cardiac Electrodes Dual Specialty $580.00 33212 Insert Pulse Generator Single Lead Specialty $1,054.00 33213 Insert Pulse Generator Dual Leads Specialty $1,099.00 33214 Upgrade Impl Pacemaker; SC To DC Specialty $1,547.00 33215 Reposition Pacing-Defib Lead Specialty $979.00 33216 Insert 1 Electrode Pacemaker/Defib Specialty $1,209.00 33217 Insert 2 Electrode Pacemaker-Defib Specialty $1,186.00 33218 Repair Lead Pacemaker-Defib One Specialty $1,266.00 33220 Repair Lead Pacemaker-Defib Dual Specialty $1,268.00 33222 Relocation Pocket Pacemaker Specialty $1,101.00 33223 Relocate Pocket For Defib Specialty $1,327.00 33224 Insert Pacing Lead & Connect Specialty $1,632.00 33225 Left Ventrical Pacing Lead Add-On Specialty $1,482.00 33226 Reposition Left Ventrical Lead Specialty $1,564.00 33227 Remove&Replace Pacemaker Gen Single Specialty $1,108.00 33228 Remove&Replace Pacemaker Gen Dual Lead Specialty $1,156.00 33229 Remove&Replace Pacemaker Gen Mult Leads Specialty $1,218.00 33230 Insert Pulse Generator W Dual Leads Specialty $1,254.00 33231 Insert Pulse Generator W Multiple Leads Specialty $1,305.00 33233 Removal Of Pacemaker Generator Specialty $765.00 33234 Remove 1 Pacer Lead Only Specialty $1,569.00 33235 Remove 2-Pacer Lead Only Specialty $2,045.00 33236 Rem Perm Epic Pmkr&Electrode; Sngl Lead Specialty $2,480.00 33237 Rem Perm Epic Pmkr & Electr; Dual Lead Specialty $2,665.00 33238 Rem Perm Transven Electr By Thoracotomy Specialty $2,952.00 33240 Insert Pulse Generator W Single Lead Specialty $1,195.00 33241 Remove Pulse Generator Specialty $720.00 33243 Remove ElectrodeThoracotomy Specialty $4,334.00 33244 Remove Electrode Transvenously Specialty $2,748.00 33249 Insert/Replace Defibrilator W Lead(s) Specialty $2,931.00 33250 Ablate SV Arrhythm Focus; WO CPB Specialty $4,650.00 33251 Ablate SV Arrhythm Focus; W CPB Specialty $5,149.00 33254 Ablate Atria Limited Specialty $4,351.00 33255 Ablate Atria W/O Bypass Extensive Specialty $5,131.00 33256 Ablate Atria W/Bypass Extensive Specialty $6,202.00 33257 Ablate Atria Limited Add-On Specialty $1,845.00 33258 Ablate Atria X10SV Add-On Specialty $2,070.00 33259 Ablate Atria W/Bypass Add-On Specialty $2,674.00 33261 Ablate Ventrical Arrhythmia Focus; W CPB Specialty $5,202.00 33262 Remove&Replace Pulse Generator 1 Lead Specialty $1,217.00 33263 Remove & Replace Defib Gen 2 Lead Specialty $1,265.00 33264 Remove & Replace Defib Gen Multi Leads Specialty $1,318.00 33265 Ablate Atria Limited Endoscopic Apprch Specialty $4,311.00 33266 Ablate Atria X10SV Endoscopic Apprch Specialty $5,860.00 33270 Insert/Replace SubQ Defibrillator Specialty $1,869.00 33271 Insert SubQ Implantable Defibr Electrode Specialty $1,573.00 33272 Removal Of SubQ Defibrillator Specialty $1,110.00 33273 Reposition Prev Impltbl SubQ Defibr Specialty $1,269.00 33282 Implant Pt-Activated Card Event Recorder Specialty $753.00 33284 Remove Pt-Activated Card Event Recorder Specialty $666.00 33300 Repair Cardiac Wound; WO CPB Specialty $7,778.00 33305 Repair Cardiac Wound; W CPB Specialty $13,027.00 33310 Cardiotomy Exploratory; WO CPB Specialty $3,730.00 33315 Cardiotomy Exploratory; W CPB Specialty $6,066.00 33320 Suture Aorta/Great Vessels; WO Shunt/CPB Specialty $3,370.00 33321 Suture Aorta/Great Vessels; W Shunt/CPB Specialty $3,905.00 33322 Suture Aorta/Grt Vessels; W Shunt Bypass Specialty $4,407.00 33330 Insrt Graft Aorta/Grt Vess; WO Shunt/CPB Specialty $4,520.00 33335 Insert Graft Aorta/Grt Vess; W CP Bypass Specialty $5,932.00 33361 Replace Aortic Valve Percutaneous Specialty $4,316.00 33362 Replace Aortic Valve Open Specialty $4,718.00 33363 Replace Aortic Valve Open Specialty $4,900.00 33364 Replace Aortic Valve Open Specialty $5,138.00 33365 Replace Aortic Valve Open Specialty $5,657.00 33366 Transcatheter Aortic Valve Replacement Specialty $6,122.00 33367 Replace Aortic Valve W Bypass Specialty $1,986.00 33368 Replace Aortic Valve W Bypass Specialty $2,378.00 33369 Replace Aortic Valve W Bypass Specialty $3,143.00 33400 Valvuloplasty Aortic V Open W Bypass Specialty $7,226.00 33401 Valvuloplsty Aortic Valve; Open W Inflow Specialty $4,583.00 33403 Valvuloplasty Aortic; W Transv Dil W CPB Specialty $4,706.00 33404 Construction Of Apical-Aortic Conduit Specialty $5,588.00 33405 Replace Aortic Valve W CPB; W Prosth Vlv Specialty $7,204.00 33406 Replace Aortic Valve W CPB; W AGValve Specialty $9,135.00 33410 Repl Aortic Valve W Stentls Tiss Valve Specialty $8,043.00 33411 Repl Aortic Valve; W Aortic Annulus Enl Specialty $10,666.00 33412 Replace Aortic Valve; Konno Procedure Specialty $10,084.00 33413 Replace Aortic Valve; Ross Procedure Specialty $10,333.00 33414 Repair Left Ventricle Outlow Tract Obstr Specialty $6,874.00 33415 Resect/Incise Subvalve Tiss for Stenosis Specialty $6,423.00 33416 Ventriculomyotomy For Stenosis Specialty $6,452.00 33417 Aortoplasty (Gusset) For SV Stenosis Specialty $5,323.00 33418 Repair Transcatheter Mitral Valve Specialty $5,696.00 33419 Repair Transcatheter Mitral Valve Specialty $1,340.00 33420 Valvotomy Mitral Valve; Closed Heart Specialty $4,632.00 33422 Valvotomy Mitral Valve; Opn Heart W CPB Specialty $5,308.00 33425 Valvuloplasty Mitral Valve W CPB Specialty $8,681.00 33426 Valvuloplasty Mitral W CPB; Prosth Ring Specialty $7,560.00 33427 Valvuloplasty Mitral W CPB; Rad Reconstr Specialty $7,759.00 33430 Replace Mitral Valve W CPB Specialty $8,881.00 33460 Valvectomy Tricuspid Valve W CPB Specialty $7,758.00 33463 Valvuloplasty Tricuspid; WO Ring Insert Specialty $9,812.00 33464 Valvuloplasty Tricuspid; W Ring Insert Specialty $7,749.00 33465 Replace Tricuspid Valve W CPB Specialty $8,752.00 33468 Reposition Tricuspid Valve For Anomaly Specialty $7,837.00 33470 Valvotomy Pulmon Cl Heart; Transventr Specialty $4,115.00 33471 Valvotomy Pulmonary; Cl Heart; Pulm Art Specialty $4,399.00 33474 Revision Of Pulmonary Valve Specialty $6,961.00 33475 Replace Pulmonary Valve Specialty $7,396.00 33476 Right Ventricle Resect For Stenosis Specialty $4,859.00 33477 Implant Trancatheter Pulm Valve PerQ Specialty $4,082.00 33478 Outflow Tract Augmentation Specialty $5,021.00 33496 Rep Prosth Valve Dysfunction W CPB Specialty $5,306.00 33500 Rep Coronary AV/AC Fistula; W CPB Specialty $4,970.00 33501 Rep Coronary AV/AC Fistula; WO CPB Specialty $3,597.00 33502 Coronary Artery Correction Specialty $4,072.00 33503 Coronary Artery Graft WO CP Bypass Specialty $4,232.00 33504 Coronary Artery Graft W CP Bypass Specialty $4,679.00 33505 Repair Artery W/Tunnel Specialty $6,598.00 33506 Repair Artery Translocation Specialty $6,569.00 33507 Repair Artery Intramural Specialty $5,511.00 33508 Endoscopic Vein Harvest For CABG Specialty $51.00 33510 CABG Vein Only; Single Coronary Vein Specialty $6,132.00 33511 CABG Vein Only; 2 Coronary Venous Grafts Specialty $6,740.00 33512 CABG Vein Only; 3 Coronary Venous Grafts Specialty $7,662.00 33513 CABG Vein Only; 4 Coronary Venous Grafts Specialty $7,883.00 33514 CABG Vein Only; 5 Coronary Venous Grafts Specialty $8,296.00 33516 CABG Vein Only; 6+ Coronary Venous Grfts Specialty $8,669.00 33517 CABG Artery-Vein Single Specialty $596.00 33518 CABG Artery-Vein Two Specialty $1,309.00 33519 CABG Artery-Vein Three Specialty $1,731.00 33521 CABG Artery-Vein Four Specialty $2,076.00 33522 CABG Artery-Vein Five Specialty $2,329.00 33523 CABG Artery-Vein 6+ Specialty $2,648.00 33530 Coronary Artery Bypass Reoperate Specialty $1,674.00 33533 CABG Arterial Graft(s); 1 Artery Specialty $5,930.00 33534 CABG Arterial 2 Specialty $6,979.00 33535 CABG Arterial 3 Specialty $7,781.00 33536 CABG Arterial 4+ Specialty $8,388.00 33542 Myocardial Resection Specialty $8,342.00 33545 Repair Postinfarct Ventric Septal Defect Specialty $9,845.00 33548 Restore/Remodel Ventricle Specialty $9,403.00 33572 Cartoid Endarterectomy Open W CABG Specialty $733.00 33600 Close AV Valve (Mitral Or Tricuspid) Specialty $5,488.00 33602 Close Semilunar Valve-Suture/Patch Specialty $5,326.00 33606 Anastomosis Pulmonary Artery To Aorta Specialty $5,937.00 33608 Rep Cplx Cardio Anomal Constr/Repl Cond Specialty $5,750.00 33610 Repair Heart By Enlargement Specialty $5,670.00 33611 Repair Rt Ventricle W Tunnel Repair Specialty $6,557.00 33612 Rep Rt Ventricle W Repair Of Outfl Tract Specialty $6,406.00 33615 Fontan Procedure Specialty $6,380.00 33617 Modified Fontan Procedure Specialty $6,914.00 33619 Norwood Procedure Specialty $8,710.00 33620 Apply R&L Pulmonary Artery Bands Specialty $5,275.00 33621 Transthoracic Catheter For Stent Specialty $2,974.00 33622 Redo Complicated Cardiac Anomaly Specialty $11,587.00 33641 Rep Atrial Septal Defect Secund W CPB Specialty $5,241.00 33645 Direct/Patch Close Sinus Venosus Specialty $5,531.00 33647 Repair A & V Septal Defect W Patch Specialty $5,813.00 33660 Repair Partial Atrioventricular Canal Specialty $5,617.00 33665 Rep Interm/Transit Atrioventr Canal Specialty $6,120.00 33670 Repair Complete Atrioventricular Canal Specialty $6,312.00 33675 Close Multipl Ventricular Septal Defects Specialty $6,307.00 33676 Close Mult Ventricular Sept Dfct W Resec Specialty $6,804.00 33677 Close Mult VSD W/Removal Of Pul Band Specialty $7,069.00 33681 Repair Heart Septum Defect Specialty $5,874.00 33684 Rep Heart Septum Defect W Pulm Valvotomy Specialty $6,345.00 33688 Rep Heart Septum Def W Rem Of Pulm Band Specialty $6,027.00 33690 Banding Of Pulmonary Artery Specialty $3,829.00 33692 Compl Rep Tetralogy Of Fallot WO PA Specialty $6,594.00 33694 C Rep Tetralogy Of Fallot WO PA; W Patch Specialty $6,557.00 33697 Compl Rep Tetralogy Of Fallot; W PA Specialty $6,573.00 33702 Repair Valsalva Fistula With CPB Specialty $4,938.00 33710 Rep Vals Fistula W CPV; W Rep VSD Specialty $6,898.00 33720 Rep Sinus Of Valsalva Aneurysm W CPB Specialty $4,940.00 33722 Close Aortico-Left Ventricular Tunnel Specialty $5,195.00 33724 Repair Venous Anomaly Specialty $4,920.00 33726 Repair Pul Venous Stenosis Specialty $6,502.00 33730 Repair Heart-Vein Defect(s) Specialty $6,408.00 33732 Rep Mitral Ring W Resect Lt Atrial Membr Specialty $5,263.00 33735 Atrial Septectomy/Septostomy; Closed Specialty $4,135.00 33736 Atrial Septectomy; Open W CPB Specialty $4,489.00 33737 Atrial Septectomy; Open W Inflow Specialty $4,313.00 33750 Shunt; Blalock-Taussig Type Specialty $4,030.00 33755 Shunt; Waterston Type Specialty $4,202.00 33762 Shunt; Potts-Smith Type Specialty $4,275.00 33764 Shunt; Central With Prosthetic Graft Specialty $4,202.00 33766 Major Vessel Shunt 1 Lung Specialty $4,254.00 33767 Shunt; SVC To Pulm Art (Bidirect Glenn) Specialty $4,542.00 33768 Cavopulmonary Shunting Specialty $1,334.00 33770 Rep Transs Grt Arter; WO Ventr Enlarg Specialty $7,132.00 33771 Rep Tranp Grt Artery; W Ventr Enlargm Specialty $7,354.00 33774 rep Transp Grt Artery Atrial Baffle Op Specialty $5,748.00 33775 Rep Transp Grt Art; W Rem Pulm Band Specialty $6,195.00 33776 Rep Transp Grt Art; W Close Vs Defect Specialty $6,545.00 33777 Rep Transp Grt Art; W Rep Subpulm Obstr Specialty $6,341.00 33778 Rep Transp Grt Art; Aortic Pulm A Recons Specialty $7,887.00 33779 Rep Transp Grt Artery; W Rem Pulm Band Specialty $7,846.00 33780 Rep Transp grt Artery; W Cl VS Defect Specialty $7,577.00 33781 Rep Transp Grt Artery; W Rep So Obstr Specialty $7,810.00 33782 Nikaidoh Procedure Specialty $10,329.00 33783 Nikaidoh Procedure W 1-2 Ostia Implt Specialty $11,778.00 33786 Rastelli Repair of Truncus Arteriosus Specialty $7,276.00 33788 Reimplant Anomalous Pulmonary Artery Specialty $5,127.00 33800 Aortopexy For Trach Decompression Specialty $3,154.00 33802 Divide Aberrant Vessel (Vascular Ring) Specialty $3,459.00 33803 Divide Aberrant Vessel; W Reanastamosis Specialty $3,673.00 33813 Obliterate AP Septal Defect; WO CPB Specialty $4,115.00 33814 Obliterate AP Septal Defect; W CPB Specialty $4,865.00 33820 Repair PDA By Ligation Specialty $3,094.00 33822 Revise Major Vessel <18 Years Specialty $3,397.00 33824 Rep PDA; By Division 18 Or > Yrs Old Specialty $3,764.00 33840 Exc Coarctation Of Aorta; W Anastom Specialty $3,955.00 33845 Excise Coarctation Of Aorta; W Graft Specialty $4,258.00 33851 Excise Coarctation Of Aorta; Repair Specialty $4,090.00 33852 Repair AA W Autog/Prosth; WO CAB Specialty $4,465.00 33853 Rep AA W Autog/Prosthetic; W CAB Specialty $5,855.00 33860 Ascending Aortic Graft W CPB Specialty $10,205.00 33863 Ascending Aorta Graft; W Aortic Root Rep Specialty $10,010.00 33864 Ascending Aortic Graft Specialty $10,238.00 33870 Transverse Aortic Arch Graft W CPB Specialty $7,997.00 33875 Descending Thoracic Aorta Graft Specialty $8,743.00 33877 Rep Thoracoabd Aortic Aneurysm W Graft Specialty $11,607.00 33880 Endovascular TAA Repair Incl Subclavian Specialty $5,775.00 33881 Endovascular TAA Repair W/O Subclavian Specialty $4,960.00 33883 Insert Endovascular Prosthesis TAA Specialty $3,589.00 33884 Endovascular Prosthesis TAA Add-On Specialty $1,313.00 33886 Endovascular Prosthesis Delayed Specialty $3,099.00 33889 Artery Transpose/Endovascular TAA Specialty $2,534.00 33891 Cart-Cart Bypass Graft/Endovascular TAA Specialty $3,120.00 33910 Pulmonary Artery Embolectomy; W CPB Specialty $8,353.00 33915 Pulmonary Artery Embolectomy; WO CPB Specialty $4,049.00 33916 Pulmonary Endarterectomy W CPB Specialty $13,398.00 33917 Repair Pulm Art Stenosis W Patch/Graft Specialty $4,652.00 33920 Repair Pulm Atresia; Repair Conduit Specialty $6,069.00 33924 Takedown Syst-To-Pulmary Artery Shunt Specialty $915.00 33925 Repair Pulm Artery Unifocal W/O CPB Specialty $5,492.00 33926 Repair Pulmonary Artery Unifocal W CPB Specialty $8,147.00 33935 Heart-Lung Transpl W Cecip Card-Pneum Specialty $15,898.00 33945 Heart Transplant W/WO Rec Cardiectomy Specialty $15,442.00 33946 ECMO/ECLS Initiation Venous Specialty $970.00 33947 ECMO/ECLS Initiation Artery Specialty $1,072.00 33948 ECMO/ECLS Daily Management-Venous Specialty $765.00 33949 ECMO/ECLS Daily Management-Artery Specialty $744.00 33951 ECMO/ECLS InsJ Proph Cannula 0-5 Yrs Specialty $1,321.00 33952 ECMO/ECLS InsJ Proph Cannula 6 > Yrs Specialty $1,367.00 33953 ECMO/ECLS InsJ Prph Cannula Opn 0-5 Yrs Specialty $1,476.00 33954 ECMO/ECLS InsJ Prph Cannula Opn 6 > Yrs Specialty $1,529.00 33955 ECMO/ECLS InsJ Center Cannula 0-5 Yrs Specialty $2,648.00 33956 ECMO/ECLS InsJ Center Cannula 6 Yrs > Specialty $2,667.00 33957 ECMO/ECLS Repos Perph Cannula 0-5 Yrs Specialty $589.00 33958 ECMO/ECLS Repos Perph Cannula 6 Yrs > Specialty $580.00 33959 ECMO/ECLS Repos Perph Cnula, Opn 0-5 Yr Specialty $747.00 33962 ECMO/ECLS Repos Perph Cnula, Op 6 > Yrs Specialty $759.00 33963 ECMO/ECLS Rpos Perph Cannula 0-5 Yrs Specialty $1,494.00 33964 ECMO/ECLS Repos Perph Cnula 6 Yrs > Specialty $1,557.00 33965 ECMO/ECLS Rmvl Perph Cannula 0-5 Yrs Specialty $589.00 33966 ECMO/ECLS Rmvl Prph Cannula 6 Yrs > Specialty $749.00 33967 Insert IA Percutaneous Balloon Specialty $825.00 33968 Remove IAB Assist Device Percutaneous Specialty $107.00 33968 Remove IAB Assist Device Percutaneous Standard Fee $53.00 33969 ECMO/ECLS Rmvl Perph Cannula 0-5 Yrs Specialty $870.00 33970 Ins IAB Assist Device Thru Fem Art Open Specialty $1,129.00 33971 Aortic Circulation Assist Specialty $2,253.00 33973 Insert IAB Assist Device Thru ASC Aorta Specialty $1,636.00 33974 Rem IAB Assist Device From ASC Aorta Specialty $2,820.00 33975 Insert Ventr Assist Device; EC Sngl Vent Specialty $4,193.00 33976 Insert Ventr Assist Device EC; Biventr Specialty $5,106.00 33977 Remove Ventr Assist Device EC; Sgl Vent Specialty $3,597.00 33978 Remove Ventr Assist Device EC; Biventr Specialty $4,255.00 33979 Insert VAD Intracorporeal, Sgl Ventricle Specialty $6,225.00 33980 Remove VAD EC Single Ventricle Specialty $5,693.00 33981 Replace VAD Pump Extracorporeal Specialty $2,665.00 33982 Replace VAD Intracorporeal W/O Bypass Specialty $6,311.00 33983 Replace VAD Intracorporeal W Bypass Specialty $7,385.00 33984 ECMO/ECLS Rmv Prph Cannula, Op, 6 Yr > Specialty $909.00 33985 ECMO/ECLS Rmvl Center Cannula 0-5 Yrs Specialty $1,641.00 33986 ECMO/ECLS Rmvl Center Cannula 6 Yr > Specialty $1,686.00 33987 Artery Expos/Graft Artery Specialty $663.00 33988 Insertion Of Left Heart Vent Specialty $2,474.00 33989 Removal Of Left Heart Vent Specialty $1,600.00 33990 Insert VAD Artery Access Specialty $1,399.00 33991 Insert VAD Artery & Vein Access Specialty $2,037.00 33992 Remove VAD Different Session Specialty $660.00 33993 Reposition VAD Different Session Specialty $579.00 34001 Embolectomy; Carotid By Neck Incision Specialty $3,132.00 34051 Embolectomy; Innom SClav By Thor Incis Specialty $3,152.00 34101 Embolectomy; Ax/Br/In/Scl By Arm Incis Specialty $1,939.00 34111 Embolectomy; Radial/Ulnar ARE By Arm Inc Specialty $1,933.00 34151 Embolectomy; Ren/Cel/Mes/Ai By Abd Incis Specialty $4,512.00 34201 Embolectomy; FemPop Aortoil By Leg Incis Specialty $3,327.00 34203 Embolectomy; Pl-Tib-Peron Art By Leg Inc Specialty $3,084.00 34401 Thrombectomy; VC Iliac Vein By Abd Incis Specialty $4,648.00 34421 Thrombectomy; VC Iliac Femp V Leg Incis Specialty $2,352.00 34451 Thrombec; VC Iliac FemPop V AbdLeg Inc Specialty $4,655.00 34471 Thrombectomy; Subclavian Vein Neck Inc Specialty $3,484.00 34490 Thrombectomy; Axill & Sclav V Arm Inc Specialty $1,962.00 34501 Valvuloplasty Femoral Vein Specialty $3,138.00 34502 Reconstruction Of Vena Cava Any Method Specialty $4,908.00 34510 Venous Valve Transposition Any Vein Donr Specialty $3,811.00 34520 Cross-Over Vein Graft To Venous System Specialty $3,233.00 34530 Saphenopopliteal Vein Anastomosis Specialty $3,501.00 34800 AA Repair W AA Prosthesis Specialty $3,613.00 34802 Endovascular AAA Repair W/2-P Part Specialty $4,019.00 34803 Endovascular AAA Repair W/3-P Part Specialty $4,153.00 34804 AAA Rep W Unibody Bifurcation Prosth Specialty $4,013.00 34805 Endovascular AAA Repair W Prosthesis Specialty $3,847.00 34806 Aneurysm Press Sensor Add-On Specialty $323.00 34808 Place Iliac Artery Occlusion Device Specialty $668.00 34812 Unilat Femoral Artery Exp For Prosth Specialty $1,088.00 34813 Place Fem-Fem Graft at AA Repair Specialty $764.00 34820 Open Iliac Prosthesis - Abd/RP; Unilat Specialty $1,586.00 34825 Place Prosth Aort A Repair; Init Vessel Specialty $2,240.00 34826 Endovascular Extension Prosthesis Addl Specialty $662.00 34830 Open Aortic Tube Prosthetic Repair Specialty $5,693.00 34831 Open Aortoiliac Prosthesis Repair Specialty $6,136.00 34832 Open AortoFemoral Prosthesis Repair Specialty $6,091.00 34833 Open Expose For Endoprosthesis Iliac Specialty $1,963.00 34834 Open Expose Endoprosthesis Brachial Specialty $879.00 34900 Endovascular Iliac Repair W/Graft Specialty $2,888.00 35001 Neck Incision To Repair Aneurysm Specialty $3,613.00 35002 Repair Aneurysm; Carotid For Rupture Specialty $3,667.00 35005 Repair Aneurysm; Vertebral Artery Specialty $3,473.00 35011 Repair Aneurysm; Axilla-Brachial Art OD Specialty $3,235.00 35013 Repair Artery Rupture Aorta Specialty $4,044.00 35021 Repair Aneurysm - Thoracic Incision Specialty $4,011.00 35022 Repair Aneurysm; Innom Sclav For Rupture Specialty $4,459.00 35045 Repair Aneurysm - Radial/Ulnar Artery Specialty $3,199.00 35081 Repair Aneurysm Abdominal Aorta Specialty $5,640.00 35082 Repair Aneurysm; Abdominal Aorta Rupture Specialty $7,086.00 35091 Repair Visceral Aneurysm Specialty $5,793.00 35092 Rep Aneurysm; Abd Aorta W Visc Rupture Specialty $8,391.00 35102 Repair Aneurysm - Iliac Vessel Specialty $6,107.00 35103 Rep Aneurysm; Abd Aorta W Iliac Rupture Specialty $7,255.00 35111 Repair Aneurysm Splenic Artery Specialty $4,899.00 35112 Repair Aneurysm; Splenic Artery Rupture Specialty $5,907.00 35121 Repair Aneurysm Renal Artery Specialty $5,304.00 35122 Repair Aneurysm; Hepatic/Renal Rupture Specialty $6,892.00 35131 Repair Aneurysm Iliac Artery Specialty $4,482.00 35132 Repair Aneurysm; Iliac Artery Rupture Specialty $5,265.00 35141 Repair Aneurysm; C Femoral Artery For OD Specialty $3,574.00 35142 Repar Aneurysm; C Femoral Artery Rupture Specialty $4,272.00 35151 Repair Aneurysm; Popliteal Artery Specialty $4,013.00 35152 Repar Aneurysm; Popliteal Artery Rupture Specialty $4,523.00 35180 Repair Congenital AV Fistula; Head&Neck Specialty $2,972.00 35182 Repair Congenital AV Fistula; Thorax&Abd Specialty $5,706.00 35184 Repar Congenital AV Fistula; Extremities Specialty $3,359.00 35188 Repair Acq/Traum AV Fistula; Head&Neck Specialty $3,677.00 35189 Repair Acq/Traum AV Fistula; Thorax&Abd Specialty $4,943.00 35190 Repair Acq/Traum AV Fistula; Extremities Specialty $2,449.00 35201 Repair Blood Vessel Direct; Neck Specialty $3,049.00 35206 Repair Blood Vessel Direct; Upper Extrem Specialty $2,493.00 35207 Repair Blood Vessel Direct; Hand Finger Specialty $2,378.00 35211 Repr Bld Vess Dir; Intrathorax W BP Specialty $4,390.00 35216 Rep Bld Vess Dir; Intrathorax WO BP Specialty $6,536.00 35221 Repair Blood Vessel Direct; Intra-Abdom Specialty $4,665.00 35226 Rep Blood Vess Direct; Lower Extremity Specialty $2,682.00 35231 Repair Blood Vessel W Vein Graft; Neck Specialty $3,887.00 35236 Rep Blood Vessel W Vein Graft; Upr Extr Specialty $3,153.00 35241 Rep Bld Vess W Vein Grft; Intrathor W BP Specialty $4,383.00 35246 Rep Bld Ves W Vein Grft; Intrathor WO BP Specialty $5,025.00 35251 Rep Bld Ves W Vein Grft; Intra-Abdominal Specialty $5,462.00 35256 Rep Bld Ves W Vein Grft; Lower Extremity Specialty $3,284.00 35261 Rep Blood Ves W Graft Not Vein; Neck Specialty $3,409.00 35266 Rep Bld Ves W Graft Not Vein; Upr Extrem Specialty $2,807.00 35271 Rep Bld Ves W Grft Not V; Intrathor W BP Specialty $4,372.00 35276 Rep Bld Ves W Grft Not V; Int-Thor WO BP Specialty $4,644.00 35281 Rep Bld Vess W Graft Not V; Intra-Abdom Specialty $5,206.00 35286 Rep Bld Ves W Grft Not V; Lowr Extremity Specialty $3,017.00 35301 Rechannel Of Artery Carotid/Verteb/Subcl Specialty $3,655.00 35302 Rechannel Of Artery Super Femoral Specialty $3,636.00 35303 Rechannel Of Artery Popliteal Specialty $4,024.00 35304 Rechannel Of Artery Tibioperoneal Trunk Specialty $4,149.00 35305 Rechannel Of Artery Tibial Or Peroneal Specialty $3,973.00 35306 Rechannel Of Artery Addl Tib Or Peroneal Specialty $1,479.00 35311 Rechannel Of Artery Subclav Innominate Specialty $4,701.00 35321 Rechannel Of Artery Axillary-Brachial Specialty $2,873.00 35331 Rechannel Of Artery Abdominal - Aorta Specialty $4,681.00 35341 Rechannel Of Artery Mesen/Celiac/Renal Specialty $4,415.00 35351 Rechannel Of Artery; Iliac Specialty $4,137.00 35355 Rechannel Of Artery; Iliofemoral Specialty $3,348.00 35361 Rechannel Of Artery; CMB Aortoiliac Specialty $4,967.00 35363 Rechanel Of Artery; CMB AortoIlioFemoral Specialty $5,641.00 35371 Rechannel Of Artery; Common Femoral Specialty $2,648.00 35372 Rechannel Of Artery; Deep Femoral Specialty $3,172.00 35390 Reoperation Carotid Add-On Specialty $514.00 35400 Angioscopy Specialty $481.00 35400 Angioscopy Standard Fee $241.00 35450 TBA Open; Renal Or Other Visceral Artery Specialty $1,631.00 35452 TBA Open; Aortic Specialty $1,100.00 35458 TBA Open; Brachiocephalic Trunk/Branch Specialty $1,589.00 35460 TBA Open; Venous Specialty $1,011.00 35471 PTA Renal Or Visceral Artery Specialty $7,918.00 35472 Percutan Transluminal Angioplasty; Aorta Specialty $5,703.00 35473 PTA Brachiocephalic Arteries Specialty $4,825.00 35475 PTA Brachiocephalic Arteries Specialty $4,825.00 35476 PTA Venous Specialty $4,423.00 35500 Harvest Vein For Bypass 1 Segment Specialty $1,029.00 35501 Artery Bypass Graft Common Car-Ipsi Specialty $4,824.00 35506 Artery Bypass Graft Cartoid-Subclavian Specialty $4,122.00 35508 Bypass Graft W Vein; Carotid-Vertebral Specialty $4,383.00 35509 Artery Bypass Graft Carot-Contralateral Specialty $4,557.00 35510 Carotid-Brachial Bypass Graft; Vein Specialty $3,979.00 35511 Bypass Graft W Vein; Subclav-Subclav Specialty $3,624.00 35512 Subclavian-Brachial Bypass Graft; Vein Specialty $3,943.00 35515 Bypass Graft W Vein; Subclav-Vertebral Specialty $4,605.00 35516 Bypass Graft W Vein; Subclavian-Axillary Specialty $3,947.00 35518 Bypass Graft W Vein; Axillary-Axillary Specialty $3,749.00 35521 Bypass Graft W Vein; Axillary-Femoral Specialty $3,994.00 35522 Axillary-Brachial Bypass Graft Vein Specialty $3,904.00 35523 Artery Bypass Graft Brachial-Ulna/Radius Specialty $4,142.00 35525 Brachial-Brachial Bypass Graft Vein Specialty $3,696.00 35526 Bypass Graft W Vein; AortoSubclavian Specialty $5,471.00 35531 Bypass Graft W Vein; AortoCeliac/Mesent Specialty $6,534.00 35533 Bypass Graft W Vein; Axillary-Fem-Fem Specialty $4,838.00 35535 Artery Bypass Graft HepatoRenal Specialty $6,193.00 35536 Bypass Graft With Vein; SplenoRenal Specialty $5,464.00 35537 Artery Bypass Graft AortoIliac Specialty $7,080.00 35538 Artery Bypass Graft AortoBi-Iliac Specialty $7,585.00 35539 Artery Bypass Graft AortoFemoral Specialty $7,090.00 35540 Artery Bypass Graft AortoBiFemoral Specialty $7,931.00 35556 Bypass Graft W Vein; Femoral-Popliteal Specialty $4,533.00 35558 Bypass Graft With Vein; Femoral-Femoral Specialty $3,985.00 35560 Bypass Graft With Vein; AortoRenal Specialty $5,549.00 35563 Bypass Graft With Vein; IlioIliac Specialty $4,298.00 35565 Bypass Graft With Vein; IlioFemoral Specialty $4,282.00 35566 Byp Grft With Vein; Fem-Ant Tib Post Tib Specialty $5,410.00 35570 Artery Bypass Graft Tibia Specialty $4,919.00 35571 Byp Graft W Vein; Popl-Tib Peroneal Art Specialty $4,305.00 35572 Harvest FemoroPopliteal Vein 1 Segment Specialty $1,115.00 35583 In-Situ Vein Bypass; Femoral-Popliteal Specialty $4,684.00 35585 In-Situ Vein Bypas; Fem-Ant Tib Post Tib Specialty $5,437.00 35587 In-Situ Vein Bypass; Popl-Tib Peroneal Specialty $4,418.00 35600 Harvest Artery For CABG Add-On 1 Segment Specialty $812.00 35601 Artery Bypass Grft WO V Common CAR-IPSI Specialty $4,536.00 35606 Bypass Graft Not Vein; Carotid-Subclav Specialty $3,796.00 35612 Bypass Graft Not Vein; Subcl-Subclavian Specialty $3,470.00 35616 Bypass Graft Not Vein; Subclavian-Axill Specialty $3,567.00 35621 Bypass Graft Not Vein; Axillary-Femoral Specialty $3,555.00 35623 Bypass Graft Not Vein; Axilary-Popliteal Specialty $4,251.00 35626 Byp Graft Not Vein; AortoSubcl/Carotid Specialty $5,067.00 35631 Bypass Graft Not Vein; AortoCeliac/Mesen Specialty $5,986.00 35632 Artery Bypass Graft WO Vein; Ilio-Celiac Specialty $5,831.00 35633 Artery Bypass Grft WO Vein; Ilio-Mesentr Specialty $6,482.00 35634 Artery Bypass Graft WO Vein IlioRenal Specialty $5,713.00 35636 Bypass Graft Not Vein; SplenoRenal Specialty $5,182.00 35637 Artery Bypass Grft WO Vein; AortoIliac Specialty $5,579.00 35638 Artery Byps Grft WO Vein; AortoBi-Iliac Specialty $5,702.00 35642 Bypass Graft Not Vein; Carotid-Vertebral Specialty $3,188.00 35645 Bypass Graft Not Vein; Subclav-Vertebral Specialty $3,284.00 35646 Bypass Graft Not Vein; AortoBiFemoral Specialty $5,555.00 35647 Bypass Graft Not Vein; AortoFemoral Specialty $5,036.00 35650 Bypass Graft Not Vein; Axillary-Axillary Specialty $3,491.00 35654 Bypass Graft Not Vein; Axill-Femor-Femor Specialty $4,434.00 35656 Bypass Graft Not Vein; Femoral-Popliteal Specialty $3,510.00 35661 Bypass Graft Not Vein; Femoral-Femoral Specialty $3,511.00 35663 Bypass Graft Not Vein; IlioIliac Specialty $4,060.00 35665 Bypass Graft Not Vein; IlioFemoral Specialty $3,796.00 35666 Bypass Graft Not Vein; Femoral/Peron Art Specialty $4,101.00 35671 Bypass Graft Not Vein; Pop-Tib/Peron Art Specialty $3,616.00 35681 Composite Bypass Graft; Prosth & Vein Specialty $259.00 35682 Composite Bypass Graft; 2 Segments Specialty $1,142.00 35683 Composite Bypass Graft; 3+ Segments Specialty $1,333.00 35685 Place Vein Patch Or Cuff Specialty $643.00 35686 Create Distal AVF At Extrem Bypass Surg Specialty $522.00 35691 Transpose/Reimplant; Vertebr to Car Art Specialty $3,100.00 35693 Transpose/Reimpl; Vertebr To Subclav Art Specialty $2,629.00 35694 Transpose/Reimpl; Subclav To Carotid Art Specialty $3,198.00 35695 Transpose/Reimpl; Carotid To Subclav Art Specialty $3,392.00 35697 Reimplant Visc-InfraRenal Each Artery Specialty $477.00 35700 Reoperation Bypass Graft Specialty $494.00 35701 Explore; Carotid Artery Specialty $1,812.00 35721 Explore; Femoral Artery Specialty $1,468.00 35741 Explore; Popliteall Artery Specialty $1,658.00 35761 Explore; Other Vessels Specialty $1,247.00 35800 Explore Postop Hemor/Thromb/Inf; Neck Specialty $2,280.00 35820 Explore Postop Hemor/Thromb/Inf; Chest Specialty $6,393.00 35840 Explore PostOp Hemor/Thromb/Inf; Abdomen Specialty $3,788.00 35860 Explore Postop Hemor/Thromb/Inf; Extrem Specialty $2,709.00 35870 Repair Of Graft-Enteric Fistula Specialty $4,018.00 35875 Thrombectomy Of Arterial Or Venous Graft Specialty $1,922.00 35876 Thrombectomy Art/Vein Graft; W Revision Specialty $3,055.00 35879 Revise LE Art Byp; Op W Vein Ptch Angiop Specialty $2,986.00 35881 Revise Le Art Byp; Op W Segm Vein Interp Specialty $3,301.00 35883 Revise Graft W/Nonauto Graft Specialty $3,911.00 35884 Revise Graft W/Vein Specialty $4,004.00 35901 Excision Of Infected Graft; Neck Specialty $1,526.00 35903 Excision Of Infected Graft; Extremity Specialty $1,822.00 35905 Excision Of Infected Graft; Thorax Specialty $5,442.00 35907 Excision Of Infected Graft; Abdomen Specialty $6,184.00 36002 Inject Percutaneous Extremity Aneurysm Specialty $504.00 36005 Extremity Venogram Injection Specialty $1,002.00 36010 Nonselective Cath Superior/Inf Vena Cava Specialty $1,553.00 36011 Selective Cath Vein; 1st Order Family Specialty $2,580.00 36012 Selective Cath Vein; 2nd Order Family Specialty $2,665.00 36013 Nonselect Cath Rt Heart/Main Pulmon Art Specialty $2,429.00 36014 Selective Cath - Lt/Rt Pulmonary Artery Specialty $2,508.00 36015 Selective Cath - Segmental Artery Specialty $2,688.00 36100 Nonselect Cath - Carotid/Vertebral Art Specialty $1,553.00 36120 Nonsel Cath - Retrograde Brachial Artery Specialty $1,312.00 36140 Nonselective Cath - Extremity Artery Specialty $1,356.00 36145 Access AV Dial Graft For Evaluation Specialty $2,595.00 36148 Access AV Dial Graft For Procedure Specialty $811.00 36160 Nonselect Cath - Translumbar Aorta Specialty $1,527.00 36200 Nonselective Cath - Aorta Specialty $1,933.00 36215 Select Cath Art - Brach-Ceph; 1st Order Specialty $3,481.00 36216 Select Cath Art - Brach-Ceph; 2nd Order Specialty $3,694.00 36217 Select Cath Art - Brach-Ceph; 3rd Order Specialty $6,078.00 36218 Select Cath Art - Brach-Ceph; Ea Addtl Specialty $597.00 36221 Place Catheter Thoracic Aorta Specialty $3,399.00 36222 Place Catheter Carotid/Innominate Artery Specialty $4,077.00 36224 Place Catheter Carotid Artery Specialty $5,618.00 36225 Place Catheter Subclavian Artery Specialty $4,660.00 36226 Place Catheter Vertebral Artery Specialty $5,703.00 36227 Place Catheter External Carotid Specialty $782.00 36228 Place Catheter Intracranial Artery Specialty $3,768.00 36245 Insert Cath Abd/L-Ext Artery 1st Specialty $4,241.00 36246 Insert Catheter Abd/L-Ext Artery 2nd Specialty $2,763.00 36247 Insert Catheter Abd/L-Ext Artery 3rd Specialty $4,889.00 36248 Insert Catheter Abd/L-Ext Artery Addtl Specialty $474.00 36251 Insert Catheter Renal Artery 1st Unilat Specialty $4,414.00 36252 Insert Catheter Renal Artery 1st Bilat Specialty $4,791.00 36253 Insert Catheter Renal Artery 2nd+ Unilat Specialty $7,015.00 36254 Insert Catheter Renal Artery 2nd+ Bilat Specialty $6,826.00 36260 Insert Impl Intra-Arterial Infusion Pump Specialty $1,987.00 36261 Revise Impl Intra-Arterial Infusion Pump Specialty $1,265.00 36262 Remove Impl Intra-Arterial Infusion Pump Specialty $966.00 36400 Blood Draw < 3 Yrs Femoral/Jugular Specialty $92.00 36400 Blood Draw < 3 Yrs Femoral/Jugular Standard Fee $46.00 36405 Blood Draw < 3 Yrs Scalp Vein Specialty $81.00 36405 Blood Draw < 3 Yrs Scalp Vein Standard Fee $41.00 36406 Blood Draw < 3 Yrs Other Vein Specialty $51.00 36406 Blood Draw < 3 Yrs Other Vein Standard Fee $26.00 36410 Non-Routine Blood Draw > 3 Yrs Specialty $52.00 36410 Non-Routine Blood Draw > 3 Yrs Standard Fee $26.00 36416 Capillary Blood Draw Standard Fee $17.00 36420 Vein Access Cutdown < 1 Yr Specialty $164.00 36420 Vein Access Cutdown < 1 Yr Standard Fee $82.00 36425 Venipuncture Cutdown; Age 1 Or Over Specialty $125.00 36425 Venipuncture Cutdown; Age 1 Or Over Standard Fee $62.00 36430 Transfusion Blood Or Blood Components Standard Fee $53.00 36430 Transfusion Blood Or Blood Components Specialty $107.00 36440 Blood Push Transfuse, 2 Yr Or < Specialty $179.00 36440 Blood Push Transfuse, 2 Yr Or < Standard Fee $89.00 36450 Exchange Transfusion Blood; Newborn Specialty $366.00 36450 Exchange Transfusion Blood; Newborn Standard Fee $183.00 36455 Exchange Transfusion Blood; Not Newborn Specialty $398.00 36455 Exchange Transfusion Blood; Not Newborn Standard Fee $199.00 36460 Transfusion Intrauterine Fetal Specialty $1,080.00 36470 Inject Sclerosing Solution - Single Vein Specialty $464.00 36471 Inj Sclerosing Solution; Multi Same Leg Specialty $542.00 36475 Endovenous Radiofrequency; 1st Vein Specialty $4,760.00 36476 Endovenous Radiofrequency Vein Add-On Specialty $926.00 36478 Laser Ablation Extremity Vein 1st Vein Specialty $3,737.00 36479 Laser Ablation Extremity Vein 2nd & > Specialty $960.00 36481 Percutaneous Portal Vein Catheterizaion Specialty $6,301.00 36500 Venous Selective Organ Blood Sampling Specialty $576.00 36510 Catheterization Of Umbilical Vein For Dx Specialty $280.00 36510 Catheterization Of Umbilical Vein For Dx Standard Fee $140.00 36511 Apheresis For White Blood Cells Specialty $291.00 36511 Apheresis For White Blood Cells Standard Fee $146.00 36512 Apheresis for Red Blood Cells Specialty $293.00 36512 Apheresis for Red Blood Cells Standard Fee $147.00 36513 Apheresis Platelets Specialty $304.00 36513 Apheresis Platelets Standard Fee $152.00 36514 Apheresis Plasma Specialty $1,663.00 36515 Apheresis Adsorption/Reinfuse Specialty $6,378.00 36516 Apheresis Selective Specialty $6,427.00 36522 Photopheresis Extracorporeal Specialty $4,319.00 36555 Insert Non-Tunnel Cv Cath < 5 Yrs Specialty $795.00 36556 Insert Non-Tunnel Cv Cath 5 Years/> Standard Fee $361.00 36556 Insert Non-Tunnel Cv Cath 5 Years/> Specialty $723.00 36557 Insert Tunneled Cv Cath WO SQ Port <5 Yr Specialty $3,126.00 36558 Insert Tunneled Cv Catheter Age 5/> Specialty $2,424.00 36560 Insert Tunneled Cv Cath W SQ Port <5 Yrs Specialty $4,170.00 36561 Insert Tunneled CVAD W Port Age 5 Yrs/> Specialty $3,643.00 36563 Insert Tunnel CVAD Cath W SQ Pump Specialty $4,122.00 36565 Insert Tunneled CV 2X Cath WO SQ Port Specialty $3,022.00 36566 Insert Tunneled CV 2X Cath W SQ Port Specialty $16,849.00 36568 Insert PICC Cath WO SQ Port < 5 Yrs Specialty $931.00 36569 Insert PICC Cath 5 Yrs > Specialty $773.00 36570 Insert PICVAD Cath < 5 Yrs Specialty $3,582.00 36571 Insert PICC Device W Port 5 Yrs/> Specialty $4,040.00 36575 Repair CVA Catheter Specialty $516.00 36575 Repair CVA Catheter Standard Fee $258.00 36576 Repair CVA Device W Port/Pump Specialty $1,208.00 36578 Replace Catheter Only Of VAD Specialty $1,611.00 36580 Replace Non-Tunneled CV Catheter Specialty $665.00 36581 Replace Tunneled CV Catheter Specialty $2,381.00 36582 Replace Tunneled VAD W Port Specialty $3,412.00 36583 Replace Tunneled CVAD Cath W Pump Specialty $4,237.00 36584 Replace PICC Catheter Specialty $634.00 36585 Replace Periph VAD W Port Specialty $3,566.00 36589 Remove Tunneled CV Catheter Specialty $514.00 36589 Remove Tunneled CV Catheter Standard Fee $257.00 36590 Remove Tunneled CVAD W Port/Pump Specialty $915.00 36591 Draw Blood Off Venous Device Standard Fee $36.00 36591 Draw Blood Off Venous Device Specialty $72.00 36592 Collect Blood From PICC Standard Fee $40.00 36592 Collect Blood From PICC Specialty $80.00 36593 Declot Vascular Device Standard Fee $48.00 36593 Declot Vascular Device Specialty $96.00 36595 SA Mechanical Rem Obstructed CVAD Specialty $1,813.00 36596 Luminal Mech Removal Of Obstr CVAD Specialty $413.00 36597 Reposition CVC W Fluoroscope Specialty $394.00 36598 Inj W/Fluor Evaluate CV Device Specialty $342.00 36600 Arterial Puncture Blood For Diagnosis Specialty $98.00 36600 Arterial Puncture Blood For Diagnosis Standard Fee $49.00 36620 Arterial Cath - Sample/Monitor/Transfuse Standard Fee $80.00 36620 Arterial Cath - Sample/Monitor/Transfuse Specialty $159.00 36625 Arterial Cath - Sampling Monitor-Cutdown Specialty $328.00 36625 Arterial Cath - Sampling Monitor-Cutdown Standard Fee $164.00 36640 Arterial Cath - Prolngd Infusion (Chemo) Specialty $370.00 36640 Arterial Cath - Prolngd Infusion (Chemo) Standard Fee $185.00 36660 Umbilical Cath Newborn For Dx Or Tx Specialty $200.00 36660 Umbilical Cath Newborn For Dx Or Tx Standard Fee $100.00 36680 Place Needle Intraosseous Infusion Specialty $184.00 36680 Place Needle Intraosseous Infusion Standard Fee $92.00 36800 Ins Cannula For Hemodialysis; V To V Specialty $390.00 36800 Ins Cannula For Hemodialysis; V To V Standard Fee $195.00 36810 Ins Cannula Hemodialysis; AV Specialty $686.00 36815 Ins Cannula-Hemodialysis; AV Revision Specialty $466.00 36818 Op AV Fuse Upper Arm Cephalic Specialty $2,236.00 36819 AV Fuse Upper Arm Basilic Specialty $2,364.00 36820 Operative AV Anastomosis Forearm Vein Specialty $2,357.00 36821 AV Anastomosis Open; Direct Any Site Specialty $2,142.00 36823 Insert Artery + Vein Cannula(s) Specialty $4,274.00 36825 Create AV Fistula; Autogenous Graft Specialty $2,583.00 36830 Create AV Fistula; Not Autogenous Graft Specialty $2,155.00 36831 Thrombectomy AVF Dialysis Graft Specialty $1,992.00 36832 Revise AV Fistula - Graft Specialty $2,444.00 36833 Open Revision AV Fistula W Thrombectomy Specialty $2,621.00 36835 Insert Thomas Shunt Specialty $1,575.00 36838 Dist Revascularization Ligation Hemody Specialty $3,692.00 36860 Cannula Declotting; WO Balloon Catheter Specialty $644.00 36861 Cannula Declotting; W Balloon Cath Specialty $420.00 36870 Percutaneous AVF Thrombectomy - Graft Specialty $5,682.00 37140 Open Portacaval Venous Anastomosis Specialty $7,287.00 37145 Venous Anastomosis; Renoportal Specialty $6,822.00 37160 Venous Anastomosis; Caval-Mesenteric Specialty $7,008.00 37180 Venous Anastomosis; Splenorenal Prox Specialty $6,445.00 37181 Vein Anastomosis; Splenorenal Distal Specialty $7,379.00 37182 Insert Hepatic Shunt (Tips) Specialty $2,626.00 37183 Remove Hepatic Shunt (Tips) Specialty $18,302.00 37184 Prim Artery Mech Thrombectomy 1st Vessel Specialty $7,060.00 37185 Prim Artery M-Thrombect Subsequ Vessel Specialty $2,241.00 37186 Secondary Artery M-Thrombect Add-On Specialty $4,276.00 37187 Venous Mechanical Thrombectomy Specialty $6,395.00 37188 Venous Mechanical Thrombectomy Add-On Specialty $5,506.00 37191 Insert Endovascular Vena Cava Filter Specialty $8,150.00 37192 Redo Endovascular Vena Cava Filter Specialty $4,804.00 37193 Remove Endovascular Vena Cava Filter Specialty $4,960.00 37197 Remove Intravascular Foreign Body Specialty $4,712.00 37200 Transcatheter Biopsy Specialty $693.00 37211 Thrombolytic Artery Therapy Specialty $1,272.00 37212 Thrombolytic Venous Therapy Specialty $1,118.00 37213 Thrombolytic Artery/Vein Therapy Specialty $784.00 37214 CESSJ Therapy Catheter Removal Specialty $430.00 37215 Transcatheter Stent CCA W/EPS Specialty $3,209.00 37217 Stent Placement Retro Carotid Specialty $3,511.00 37218 Stent Placement Antegrade Carotid Specialty $2,621.00 37220 Iliac Revascularization Specialty $9,789.00 37221 Iliac Revascularization W/Stent Specialty $14,431.00 37222 Iliac Revascularization Add-On Specialty $2,751.00 37223 Iliac Revascularization W/Stent Add-On Specialty $8,025.00 37224 Femoral/Popliteal Revascularizatn W/TLA Specialty $11,877.00 37225 Femoral/Popliteal Revasc W/Ather Specialty $34,112.00 37226 Femoral/Popliteal Revascularizn W/Stent Specialty $28,054.00 37227 Femoral/Popliteal Revasc W Stent & Ather Specialty $46,070.00 37228 Tibia/Peroneal Revascularization W/TLA Specialty $16,875.00 37229 Tibial/Peroneal Revasc W/Atherectomy Specialty $33,629.00 37230 Tibial/Peroneal Revascularizatio W/Stent Specialty $25,709.00 37231 Tibial/Peroneal Revasc W Stent & Ather Specialty $41,376.00 37232 Tibial/Peroneal Revascularization Add-On Specialty $3,759.00 37233 Tibial/Peroneal Revasc W/Ather Add-On Specialty $4,542.00 37234 Revasc Open/Percut Tibial/Peroneal Stent Specialty $12,010.00 37235 Tibial/Peroneal Revasc W Stent & Ather Specialty $12,649.00 37236 Open/Percutaneous Place Stent 1st Specialty $12,748.00 37237 Open/Percutaneous Place Stent Ea Addtl Specialty $7,622.00 37238 Open/Percutaneous Place Stent Same Specialty $12,999.00 37239 Open/Percutaneous Place Stent Ea Addtl Specialty $6,290.00 37500 Endoscopy Ligate Perf Veins Specialty $2,426.00 37565 Ligation Internal Jugular Vein Specialty $2,303.00 37600 Ligation; External Carotid Artery Specialty $2,258.00 37605 Ligate Internal Or Common Carotid Artery Specialty $2,553.00 37606 Ligate Int/Com Carotid Artery W Occl Specialty $1,845.00 37607 Ligation/Band AngioAccess AV Fistula Specialty $1,207.00 37609 Ligation Or Biopsy Temporal Artery Specialty $970.00 37615 Ligation Major Artery; Neck Specialty $1,615.00 37616 Ligation Major Artery; Chest Specialty $3,502.00 37617 Ligation Major Artery; Abdomen Specialty $4,255.00 37618 Ligation Major Artery; Extremity Specialty $1,224.00 37619 Ligation Of Inferior Vena Cava Specialty $5,224.00 37650 Ligation Of Femoral Vein Specialty $3,716.00 37660 Ligation Of Common Iliac Vein Specialty $3,716.00 37700 Lig & Div Lg Saph Vein At Saph-Fem Junct Specialty $700.00 37718 Ligate/Strip Short Leg Vein Specialty $1,401.00 37718 Ligate/Strip Short Leg Vein Standard Fee $0.00 37722 Ligate/Strip Long Leg Vein Standard Fee $0.00 37722 Ligate/Strip Long Leg Vein Specialty $1,540.00 37735 Lig & Strip Saph Vn W Rad Exc Ulcr/Grft Specialty $2,200.00 37760 Ligate Leg Veins Radical - 1 Leg Specialty $1,977.00 37761 Ligate Leg Veins Open - 1 Leg Specialty $1,768.00 37765 Stab Phlebectomy Veins Extremity 10-20 Specialty $2,056.00 37766 Phlebectomy Veins - 1 Extremity 20+ Inc Specialty $2,446.00 37780 Lig & Div Sh Saph Vein At Saph-Pop Jnct Specialty $814.00 37785 Ligate/Divide/Excise Vein - 1 Leg Specialty $1,121.00 37788 Penile Revascul Artery W/WO Vein Graft Specialty $4,040.00 37790 Penile Venous Occlusive Procedure Specialty $1,575.00 38100 Splenectomy; Total Specialty $3,653.00 38101 Splenectomy; Partial Specialty $3,662.00 38102 Splenectomy; Tot En Bloc For Extnsv Dis Specialty $831.00 38115 38115 Repr Ruptured Spleen W/WO Partl Splenec Specialty $4,006.00 38120 Laparoscopy Surgical Splenectomy Specialty $3,332.00 38200 Splenoportography Injection Specialty $365.00 38200 Splenoportography Injection Standard Fee $182.00 38205 Harvest Allogenic Stem Cell Specialty $258.00 38206 Harvest Auto Stem Cells Specialty $259.00 38220 Bone Marrow Aspiration Specialty $508.00 38221 Bone Marrow Biopsy Specialty $516.00 38230 Bone Marrow Harvest Allogen Specialty $621.00 38232 Bone Marrow Harvest Autolog Specialty $619.00 38240 Transplant Allogenic HCT/Donor Specialty $696.00 38241 Transplant Autologous HCT/Donor Specialty $521.00 38242 Transplant Allogeneic Lymphocytes Specialty $366.00 38243 TransplJ Hematopoietic Boost Specialty $365.00 38300 Drain Lymph Nd Abscess/Infection; Simple Specialty $860.00 38305 Drain LN Abscess/Infection; Extensive Specialty $1,499.00 38308 Lymphangiotomy/Other OP Lymph Chann Specialty $1,406.00 38380 Suture/Ligate Thoracic Duct; Cervical Specialty $1,788.00 38381 Suture/Ligate Thoracic Duct; Thoracic Specialty $2,539.00 38382 Suture/Ligate Thoracic Duct; Abdominal Specialty $1,947.00 38500 Open Biopsy Or Excise Lym Node; Superfic Standard Fee $0.00 38500 Open Biopsy Or Excise Lym Node; Superfic Specialty $1,037.00 38505 Perc Biopsy Or Exc Lymph Nd; Superficial Specialty $393.00 38505 Perc Biopsy Or Exc Lymph Nd; Superficial Standard Fee $196.00 38510 Open Bx/Exc Lym Node; Deep Cerv Node(s) Standard Fee $0.00 38510 Open Bx/Exc Lym Node; Deep Cerv Node(s) Specialty $1,628.00 38520 Open Biopse/Exc LN; Deep Cerv Node(s) Specialty $1,628.00 38525 Open Bx/Exc Lym Node; Cerv W SFP Exc Specialty $1,377.00 38530 Open Bx/Exc LN; Int Mamm Node(s) Specialty $1,731.00 38542 Excise Sentinel Node Specialty $1,631.00 38550 Exc Cyst Hygroma; WO D Neurovasc Disect Specialty $1,595.00 38555 Exc Cys Hygroma; W D Neurovasc Disect Specialty $3,169.00 38562 Stage Lymphadenect; Pelv & Para-Aortic Specialty $2,205.00 38564 Stage Lymphadenectomy; Retroperitoneal Specialty $2,219.00 38570 Lap; W Retrop LN Bx Single/Multiple Specialty $1,581.00 38571 Lap; W Bil Total Pelvic Lymphadecectomy Specialty $2,089.00 38572 Lap; W BTPL & LN Biopsy Single/Multi Specialty $2,927.00 38700 Suprahyoid Lymphadenectomy Specialty $2,536.00 38720 Cervical Lymphadenectomy - Complete Specialty $4,240.00 38724 Cervical Lymphadenectomy - Mod Rad Specialty $4,579.00 38740 Axillary Lymphadenectomy; Superficial Specialty $2,191.00 38745 Axillary Lymphadenectomy; Complete Specialty $2,765.00 38746 Remove Thoracic Lymph Nodes Specialty $684.00 38747 Abdominal Lymphadenectomy; Regional Specialty $847.00 38760 Inguinofem Lympphadenectomy Superficial Specialty $2,654.00 38765 Inguinofem W Pelvic Lymphadectomy Specialty $4,071.00 38770 Pelvic Lymphadenectomy Specialty $2,531.00 38780 Retroperit Transabd Lymphadenectomy Specialty $3,209.00 38790 Injection For Lymphangiography Specialty $261.00 38790 Injection For Lymphangiography Standard Fee $130.00 38792 RA Tracer ID Of Sentinel Node Standard Fee $62.00 38792 RA Tracer ID Of Sentinel Node Specialty $125.00 38794 Cannulation Thoracic Duct Specialty $936.00 38900 IO Map Of Sentinel Lymph Node Specialty $438.00 39000 Mediastinotomy; Cervical Approach Specialty $1,572.00 39010 Mediastinotomy; Transthoracic Specialty $2,494.00 39200 Resect Mediastinal Cyst Specialty $2,793.00 39220 Resect Mediastinal Tumor Specialty $3,605.00 39401 Mediastinoscopy W Mediastinal Biopsy Specialty $987.00 39402 Mediastinoscopy W Lymph Node Biopsy Specialty $1,290.00 39501 Repair Laceration Of Diaphragm Any App Specialty $2,681.00 39503 Repair Neonatal Diaphragmatic Hernia Specialty $19,458.00 39540 Repair Diaphr Hernia (Not NN); Acute Specialty $2,737.00 39541 Repair Diaphr Hernia (Not NN); Chronic Specialty $2,986.00 39545 Imbrication Of Diaphragm Specialty $2,830.00 39560 Resect Diaphragm; W Simple Repair Specialty $2,516.00 39561 Resect Diaphragm; W Complex Repair Specialty $3,915.00 40490 Biopsy Of Lip Specialty $400.00 40500 Lip Shave W Mucosal Advancement Specialty $1,584.00 40510 Excise Lip; Transverse Wedge Exc 1' Clos Specialty $1,519.00 40520 Excise Lip; V-Excision W 1' Direct Close Specialty $1,534.00 40525 Excise Lip; Ft Reconstruction W Loc Flap Specialty $1,739.00 40527 Excise Lip; Ft Reconstr W Cross-Lip Flap Specialty $1,949.00 40530 Resect Lip > 1/4 WO Reconstruction Specialty $1,692.00 40650 Repair Lip Front; Vermilion Only Specialty $1,381.00 40652 Repair Lip Ft; Up To Half Vertical Hight Specialty $1,524.00 40654 Repair Lip Ft; > 1/2 Vert Hgt Or Complex Specialty $1,782.00 40700 Plastic Repair Cleft Lip; Unilateral Specialty $2,849.00 40701 Repair Cleft Lip/Nasal 1 Stage Procedure Specialty $3,195.00 40702 Repair Cleft Lip/Nasal 1 Of 2 Stages Specialty $2,676.00 40720 Pl Repair Cleft Lip; 2' Recr Defect Recl Specialty $3,214.00 40761 Pl Repair Cleft Lip; Abbe-Eslander Type Specialty $3,400.00 40800 Drain Abscess/Cyst/Hematom Mouth; Simple Specialty $674.00 40801 Drain Absc/Cyst/Hemat Mouth; Complicated Specialty $1,002.00 40804 Rem Embedded FB Mouth Vestibule; Simple Specialty $603.00 40805 Rem Embedded FB Mouth Vestib; Compl Specialty $1,161.00 40806 Incision Of Labial Frenum (Frenotomy) Specialty $357.00 40808 Biopsy Vestibule Of Mouth Specialty $592.00 40810 Exc Lesion Mouth Vestibule WO Repair Specialty $655.00 40812 Exc Les Mouth Vestibule W Simple Repair Specialty $917.00 40814 Exc Les Mouth Vestibule W Complex Repair Specialty $1,226.00 40816 Exc Les Mouth Vestibule; Cplx W Excl Specialty $1,280.00 40818 Exc Mucosa Mouth Vestibule - Donor Graft Specialty $1,133.00 40819 Excision Of Frenum Labial Or Buccal Specialty $1,006.00 40820 Destr Les/Scar Mouth Vestibule Physical Specialty $842.00 40830 Close Laceration Mouth Vestib; 2.5 Cm/< Specialty $841.00 40831 Close Laceration Mouth Vestib; >2.5 Cm Specialty $1,068.00 40840 Vestibuloplasty; Anterior Specialty $2,565.00 40842 Vestibuloplasty; Posterior Unilateral Specialty $2,466.00 40843 Vestibuloplasty; Posterior Bilateral Specialty $3,424.00 40844 Vestibuloplasty; Entire Arch Specialty $4,103.00 40845 Vestibuloplasty; Complex Specialty $4,610.00 40980199 Rapid Drug Screen - Their Kit Standard Fee $20.00 41000 I&D Absc/Cyst Tongue FOM; Lingual Specialty $515.00 41005 I&D Absc/Cyst Tongue FOM; Superficial Specialty $720.00 41006 I&D Absc/Cyst FOM; Sublingual Specialty $1,135.00 41007 I&D Absc/Cyst FOM; Submental Specialty $1,110.00 41008 I&D Absc/Cyst FOM; Submandibular Specialty $1,204.00 41009 I&D Absc/Cyst FOM; Mastic Space Specialty $1,278.00 41010 Incision Of Lingual Frenum (Frenotomy) Standard Fee $315.00 41010 Incision Of Lingual Frenum (Frenotomy) Specialty $642.00 41015 EO I&D Absc/Cyst FOM; Sublingual Specialty $1,437.00 41016 EO I&D Absc/Cyst FOM; Submental Specialty $1,403.00 41017 EO I&D Absc/Cyst FOM; Submandibular Specialty $1,416.00 41018 EO I&D Absc/Cyst FOM; Mastic Space Specialty $1,610.00 41019 Place Needles Head & Neck For RT Specialty $1,465.00 41100 Biopsy Of Tongue; Anterior 2/3 Specialty $532.00 41105 Biopsy Of Tongue; Posterior 1/3 Specialty $541.00 41108 Biopsy Of Floor Of Mouth Specialty $469.00 41110 Excise Tongue Lesion WO Closure Specialty $672.00 41112 Exc Tongue Lesion W Close; Anterior 2/3 Specialty $1,064.00 41113 Exc Tongue Lesion W Close; Posterior 1/3 Specialty $1,164.00 41114 Exc Tongue Lesion W Close; W Local Flap Specialty $2,021.00 41115 Excision Of Lingual Frenum (Frenectomy) Specialty $786.00 41116 Excision Lesion Of Floor Of Mouth Specialty $1,053.00 41120 Glossectomy; < 1/2 Of Tongue Specialty $3,450.00 41130 Glossectomy; Hemiglossectomy Specialty $4,243.00 41135 Glossectomy; Part W Unil Rad Neck Dissec Specialty $6,954.00 41140 Glossectomy; Total WO Rad Neck Dissect Specialty $7,018.00 41145 Glossectomy; Total W Rad Neck Dissect Specialty $8,914.00 41150 Glossectomy; Composite WO Rad Neck Dis Specialty $7,062.00 41153 Glossectomy; Composite W Sh Neck Dissect Specialty $7,688.00 41155 Glossectomy; Composite W Resection Specialty $9,637.00 41250 Rep Lacerat 2.5 Cm/<; Flr-Mouth/Ant 2/3 Specialty $845.00 41251 Rep Lacerat 2.5 Cm/<; Post 1/3 Tongue Specialty $921.00 41252 Rep Lacerat-Tongue Flr-Mouth >2.6/Cmplx Specialty $995.00 41500 Mechanical Fixation Of Tongue Not Suture Specialty $1,314.00 41510 Suture Tongue To Lip For Micrognathia Specialty $1,343.00 41512 Tongue Suspension Specialty $2,114.00 41520 Frenoplasty Specialty $1,126.00 41530 Tongue Base Volume Reduction 1+ Sites Specialty $3,110.00 41800 Dr Absc/Cyst/Hematoma-Dentoalveolar Specialty $858.00 41805 Rem Emb FB From Dentoalv; Sft Tissue Specialty $819.00 41806 Rem Emb FB From Dentoalveolar; Bone Specialty $1,128.00 41822 Excise Fibrous Tuberosities Dentoalveol Specialty $932.00 41823 Excise Osseous Tuberosities Dentoalveol Specialty $1,364.00 41825 Exc Les/Tumor Dentoalveolar WO Repair Specialty $672.00 41826 Exc Les/Tumor Dentoalveolar W Simpl Rep Specialty $1,004.00 41827 Exc Les/Tumor Dentoalveolar W Cplx Rep Specialty $1,403.00 41828 Exc Hyperplasia Alveolar Mucosa Ea Quadr Specialty $985.00 41830 Alveolectomy Incl Curettage Of Osteitis Specialty $1,256.00 41872 Gingivoplasty Each Quadrant Specialty $1,166.00 41874 Alveolopllasty Each Quadrant Specialty $1,200.00 42000 Drainage Of Abscess Of Palate Uvula Specialty $503.00 42100 Biopsy Of Palate Uvula Specialty $476.00 42104 Excise Lesion Palate Uvula; WO Closure Specialty $684.00 42106 Exc Lesion Palate Uvula; W Simple Close Specialty $870.00 42107 Excise Lesion Palate Uvula; W Local Flap Specialty $1,467.00 42120 Resection Of Palate Or Extensive Resect Specialty $3,249.00 42140 Uvulectomy Excision Of Uvula Specialty $802.00 42145 Palatopharyngoplasty Specialty $2,228.00 42160 Destroy Lesion Palate Or Uvula Specialty $735.00 42180 Repair Palate Laceration; Up To 2 Cm Specialty $772.00 42182 Repair Palate Laceration; Over 2 Cm Specialty $1,012.00 42200 Palatoplasty Cleft Palate; Soft And Hard Specialty $2,690.00 42205 Palatoplasty-Clft Palate; Soft Tiss Only Specialty $2,803.00 42210 Palatoplasty-Cleft Palate; W Bond Graft Specialty $3,131.00 42215 Palatoplasty-Cleft Palate; Major Revise Specialty $2,077.00 42220 Palatoplasty-Cleft Palate; 2' Lengthen Specialty $1,572.00 42225 Palatoplasty-Cleft Palate; W Pharyn Flap Specialty $2,780.00 42226 Lengthen Palate & Pharyngeal Flap Specialty $2,844.00 42227 Lengthen Palate W Island Flap Specialty $2,698.00 42235 Repair Ant Palate Including Vomer Flap Specialty $2,325.00 42260 Repair Of Nasolabial Fistula Specialty $2,573.00 42280 Maxillary Impression For Palatal Prosth Standard Fee $262.00 42280 Maxillary Impression For Palatal Prosth Specialty $525.00 42281 Insertion Of Pin-Retained Palatal Prosth Specialty $648.00 42300 Drainage Of Abscess; Parotid Simple Specialty $663.00 42305 Drainage Of Abscess; Parotid Complicated Specialty $1,366.00 42310 Drain Abscess;Submax/Sublin; Intraoral Standard Fee $254.00 42310 Drain Abscess;Submax/Sublin; Intraoral Specialty $508.00 42320 Drain Abscess; Submaxillary External Specialty $790.00 42330 Sialolithotomy; Small Uncomplicated Specialty $734.00 42335 Sialolithotomy; Small Complicated Specialty $1,186.00 42340 Sialolithotomy; Parotid ExtraOr/Complic Specialty $1,466.00 42400 Biopsy Salivary Gland; Needle Specialty $333.00 42400 Biopsy Salivary Gland; Needle Standard Fee $167.00 42405 Biopsy Salivary Gland; Incisional Specialty $942.00 42408 Excise Sublingual Salivary Cyst Specialty $1,427.00 42409 Marsupialize Sublingual Salivary Cyst Specialty $1,050.00 42410 Exc Parotid Tum/Gland; LL WO Nrv Disect Specialty $1,966.00 42415 Excise Parotid Tumor/Gland; LL W Dissect Specialty $3,334.00 42420 Exc Parotid Tumor/Gland; Total W Dissect Specialty $3,745.00 42425 Exc Parotid Tumor/Gland; Total En Bloc Specialty $2,639.00 42426 Exc Parotid Tum/Glnd; Tot W Unil Rad Dis Specialty $4,258.00 42440 Excision Of Submandibular Gland Specialty $1,303.00 42450 Excision Of Sublingual Gland Specialty $1,427.00 42500 Plastic Repair Salivary Duct; Simple Specialty $1,371.00 42505 Plastic Repair Salivary Duct;Complicated Specialty $1,755.00 42507 Parotid Duct Diversion Bilateral Specialty $1,632.00 42509 Parotid Duct Div Bilat; Exc 2 Sm Glands Specialty $2,671.00 42510 Parotid Duct Div Bil; W Lig 2 Sm Glands Specialty $2,034.00 42550 Injection For Sialography Standard Fee $210.00 42550 Injection For Sialography Specialty $420.00 42650 Dilate Salivary Duct Specialty $264.00 42650 Dilate Salivary Duct Standard Fee $132.00 42660 Dilate & Catheterize Salivary Duct Specialty $406.00 42665 Ligate Salivary Duct; Intraoral Specialty $975.00 42700 I&D Abscess; Peritonsillar Specialty $598.00 42720 I&D Abscess; Retropharyngeal; Internal Specialty $1,434.00 42725 I&D Abscess; Retropharyngeal; External Specialty $2,588.00 42800 Biopsy; Oropharynx Specialty $501.00 42804 Bx; Nasopharynx Visible Lesion Simple Specialty $617.00 42806 Bx; Nasopharynx For Unknown 1' Lesion Specialty $693.00 42808 Excise Or Destroy Pharynx Lesion Specialty $717.00 42809 Remove Foreign Body Pharynx Specialty $638.00 42810 Exc Branchial Cleft Cyst/Vestige; To SQ Specialty $1,223.00 42815 Exc Branch Cleft Cyst Vestig; > SQ Specialty $1,769.00 42820 Remove Tonsils And Adenoids <12 Yrs Old Specialty $918.00 42821 Remove Tonsils And Adenoids; Age 12+ Specialty $953.00 42825 Removal Of Tonsils <12 Years Old Specialty $829.00 42826 Tonsillectomy; Age 12 Or Older Specialty $795.00 42830 Removal Of Adenoids 1' <12 Years Specialty $655.00 42831 Adenoidectomy; Age 12 And Over Specialty $708.00 42835 Removal Of Adenoids 2' < 12 Yrs Old Specialty $608.00 42836 Adenoidectomy 2'; Age 12 Or Over Specialty $761.00 42842 Radical Resection Of Tonsil; WO Closure Specialty $3,243.00 42844 Rad Resect Of Tonsil; W Local Flap Close Specialty $4,444.00 42845 Rad Resect Of Tonsil; W Other Flap Close Specialty $7,158.00 42860 Excision Of Tonsil Tags Specialty $595.00 42870 Excise Or Destroy Lingual Tonsil Specialty $1,913.00 42890 Limited Pharyngectomy Specialty $4,586.00 42892 Resect Pharyng Wall W Cl - Advance Walls Specialty $6,058.00 42894 Revision Of Pharyngeal Walls Specialty $7,608.00 42900 Suture Pharynx For Wound Or Injury Specialty $1,067.00 42950 Pharyngoplasty Specialty $2,615.00 42953 Pharyngoesophageal Repair Specialty $3,149.00 42955 Pharyngostomy Specialty $2,471.00 42960 Control Oropharyngeal Hemorrhage; Simple Specialty $538.00 42961 Control Oropharyng Hemorrh; Complicated Specialty $1,341.00 42962 Control Oropharyngeal Hemorrh; Req Surg Specialty $1,639.00 42970 Simple Control Nose Bleed Specialty $1,273.00 42971 Control Nasophar Hemorrh; Complicated Specialty $1,444.00 42972 Control Nasophar Hemorrh; W 2' Surg Specialty $1,616.00 43020 Esophagotomy Cervical W Removal FB Specialty $1,672.00 43030 Cricopharyngeal Myotomy Specialty $1,640.00 43045 Esophagotomy Thoracic W Removal FB Specialty $4,143.00 43100 Exc Lesion Esophagus W 1' Repair; Cerv Specialty $1,971.00 43101 Exc Lesion Esophagus W 1' Rep; Thoracic Specialty $3,226.00 43107 Tot/N Tot Esophagectomy WO Thoracot Specialty $8,111.00 43108 Esophagectomy W Int Reconstruction Specialty $14,547.00 43112 Tot/NT Esophagect W Thor; W Ph/Gastr/CE Specialty $8,564.00 43113 Esophag W Thoracot W Int Reconst Specialty $14,403.00 43116 Partial Esophagectomy Cervical With FR Specialty $15,952.00 43117 Part Esophagect D 2/3 W Th&Sep Abd I Specialty $7,845.00 43118 Part Esophagectomy W Int Reconstruct Specialty $11,729.00 43121 Part Esophagectomy Distal 2/3rd Specialty $9,133.00 43122 Part Esophagectomy ThoracoAbd Or Abd Specialty $8,149.00 43123 Part Esophagectomy Ta/Abd W Int Recon Specialty $15,018.00 43124 Esophagectomy WO Reconstr W Cerv Specialty $12,166.00 43130 Diverticulectomy; Cervical Specialty $2,488.00 43135 Diverticulectomy; Thoracic Specialty $4,716.00 43180 Esophagoscopy Rigid Transoral Specialty $1,737.00 43191 Esophagoscopy Rigid Transoral Dx Specialty $487.00 43191 Esophagoscopy Rigid Transoral Dx Standard Fee $243.00 43192 Esophagoscopy Rigid Transoral Injection Specialty $538.00 43192 Esophagoscopy Rigid Transoral Injection Standard Fee $269.00 43193 Esophagoscopy Rigid Transoral Biopsy Specialty $536.00 43193 Esophagoscopy Rigid Transoral Biopsy Standard Fee $268.00 43194 Esophagoscopy Rigid Transoral Remove FB Specialty $611.00 43195 Esophagoscopy Rigid Balloon Specialty $582.00 43195 Esophagoscopy Rigid Balloon Standard Fee $291.00 43196 Esophyagoscopy Guide Wire Dilatation Specialty $624.00 43196 Esophyagoscopy Guide Wire Dilatation Standard Fee $312.00 43197 Esophagoscopy Flex Dx Brush Specialty $588.00 43197 Esophagoscopy Flex Dx Brush Standard Fee $294.00 43198 Esophagoscopy Flex TransNasal Biopsy Specialty $653.00 43198 Esophagoscopy Flex TransNasal Biopsy Standard Fee $326.00 43200 Esophagoscopy Flexible Brush Standard Fee $420.00 43200 Esophagoscopy Flexible Brush Specialty $841.00 43201 Esophagoscopy W/Submucous Inj Specialty $854.00 43201 Esophagoscopy W/Submucous Inj Standard Fee $427.00 43202 Esophagoscopy Flex W/Biopsy Specialty $1,120.00 43204 Esophagoscopy W/Sclerosis Inj Specialty $447.00 43204 Esophagoscopy W/Sclerosis Inj Standard Fee $224.00 43205 Esophagus Endoscopy/Ligation Specialty $466.00 43205 Esophagus Endoscopy/Ligation Standard Fee $233.00 43206 Esophatgoscopy Flex TO Endomicroscopy Specialty $1,021.00 43210 EGD Esophagogastric Fundoplasty Specialty $1,346.00 43211 Esophagoscopy Mucosal Resection Specialty $767.00 43212 Esophagoscopy W Stent Placement Specialty $623.00 43213 Esophagoscopy Retro Balloon Specialty $3,773.00 43214 Esophagoscopy Dilate Balloon 30mm> Specialty $628.00 43214 Esophagoscopy Dilate Balloon 30mm> Standard Fee $314.00 43215 Esophagoscopy Flex To Remove FB Specialty $1,294.00 43216 Esophagoscopy Lesion Removal Specialty $1,277.00 43217 Esophagoscopy Snare Lesion Removal Specialty $1,379.00 43220 Esophagoscopy Balloon <30mm Specialty $3,491.00 43226 Esophagoscopy W Dilation Specialty $1,175.00 43227 Esophagoscopy To Control Bleed Specialty $2,143.00 43229 Esophagoscopy Lesion Ablate Specialty $2,226.00 43231 Esophagoscopy Ultrasound Exam Specialty $1,237.00 43232 Esophagoscopy W/US Needle Biopsy Specialty $1,475.00 43233 EGD Balloon Dilation Esoph 30 mm> Specialty $743.00 43233 EGD Balloon Dilation Esoph 30 mm> Standard Fee $371.00 43235 EGD Diagnostic Brush Wash Standard Fee $480.00 43235 EGD Diagnostic Brush Wash Specialty $960.00 43236 Upper GI Scope W/Submucosal Injection Specialty $1,194.00 43237 Endoscopic US Exam Esophagus Specialty $640.00 43237 Endoscopic US Exam Esophagus Standard Fee $320.00 43238 EGD US Fine Needle Biopsy/Aspiration Specialty $759.00 43238 EGD US Fine Needle Biopsy/Aspiration Standard Fee $379.00 43239 EGD Biopsy Single/Multiple Standard Fee $613.00 43239 EGD Biopsy Single/Multiple Specialty $1,225.00 43240 EGD W/Transmural Drain Cyst Specialty $1,269.00 43241 EGD Tube/Catheter Insertion Specialty $471.00 43241 EGD Tube/Catheter Insertion Standard Fee $236.00 43242 EGD US Fine Needle Biopsy/Aspiration Specialty $856.00 43242 EGD US Fine Needle Biopsy/Aspiration Standard Fee $428.00 43243 EGD Injection Varices Specialty $773.00 43243 EGD Injection Varices Standard Fee $386.00 43244 EGD Varices Ligation Specialty $800.00 43244 EGD Varices Ligation Standard Fee $400.00 43245 EGD Dilate Stricture Specialty $1,892.00 43246 EGD Place Gastrostomy Tube Standard Fee $328.00 43246 EGD Place Gastrostomy Tube Specialty $655.00 43247 EGD Remove Foreign Body Specialty $1,284.00 43248 EGD Guide Wire Insertion Standard Fee $630.00 43248 EGD Guide Wire Insertion Specialty $1,259.00 43249 Esophageal EGD Dilation < 30 mm Specialty $3,308.00 43250 EGD Cautery Tumor Polyp Standard Fee $703.00 43250 EGD Cautery Tumor Polyp Specialty $1,406.00 43251 EGD Remove Lesion W Snare Specialty $1,538.00 43251 EGD Remove Lesion W Snare Standard Fee $769.00 43252 EGD Optical Endomicroscopy Specialty $1,133.00 43252 EGD Optical Endomicroscopy Standard Fee $566.00 43253 EGD US Transmural Inj/Mark Specialty $854.00 43253 EGD US Transmural Inj/Mark Standard Fee $427.00 43254 EGD Endoscopic Mucosal Resection Specialty $880.00 43254 EGD Endoscopic Mucosal Resection Standard Fee $440.00 43255 EGD Control Bleeding Any Standard Fee $1,125.00 43255 EGD Control Bleeding Any Specialty $2,249.00 43257 EGD W Thermal Treatment GERD Specialty $760.00 43257 EGD W Thermal Treatment GERD Standard Fee $380.00 43259 EGD US Exam Duodenum/Jejunum Specialty $738.00 43259 EGD US Exam Duodenum/Jejunum Standard Fee $369.00 43260 ERCP W/Specimen Collection Specialty $1,045.00 43260 ERCP W/Specimen Collection Standard Fee $523.00 43261 ERCP W/Biopsy Single/Multiple Specialty $1,097.00 43261 ERCP W/Biopsy Single/Multiple Standard Fee $549.00 43262 ERCP W Sphincter/Papillotomy Specialty $1,157.00 43262 ERCP W Sphincter/Papillotomy Standard Fee $578.00 43263 ERCP Sphincter Pressure Measure Specialty $1,158.00 43263 ERCP Sphincter Pressure Measure Standard Fee $579.00 43264 ERCP Remove Duct Calculi Specialty $1,179.00 43264 ERCP Remove Duct Calculi Standard Fee $589.00 43265 ERCP Lithotripsy Calculi Specialty $1,399.00 43266 EGD Endoscopic Stent Placement Standard Fee $369.00 43266 EGD Endoscopic Stent Placement Specialty $739.00 43270 EGD Lesion Ablation Specialty $2,316.00 43273 Endoscopic Pancreatoscopy Specialty $381.00 43273 Endoscopic Pancreatoscopy Standard Fee $190.00 43274 ERCP Duct Stent Placement Specialty $1,493.00 43275 ERCP Remove Foreign Body In Duct Specialty $1,219.00 43276 ERCP Stent Exchange W/Dilation Specialty $1,555.00 43277 ERCP Each Duct/Ampulla Dilation Specialty $1,225.00 43278 ERCP Lesion Ablate W/Dilation Standard Fee $699.00 43278 ERCP Lesion Ablate W/Dilation Specialty $1,398.00 43279 Lap Esophagomyotomy (Heller Type) Specialty $4,097.00 43280 Lap Esophagogastric Fundoplasty Specialty $3,425.00 43281 Lap Paraesophageal Hernia Repair Specialty $4,896.00 43282 Lap Paraesophageal Hernia Repr W/Mesh Specialty $5,503.00 43283 Laparoscopy, Esophageal Lengthening Specialty $504.00 43283 Laparoscopy, Esophageal Lengthening Standard Fee $252.00 43300 Esophagoplasty Cerv Aprch; WO Rep-Trach Specialty $1,946.00 43305 Esophagoplasty Cerv Aprch; W Rep-Trach Specialty $3,466.00 43310 Esophagoplasty Thor Appr; WO Rep-Trach Specialty $4,725.00 43312 Esophagoplasty Thor Aprch; W Rep-Trach Specialty $5,136.00 43313 Esophagoplasty Congenital Defect Specialty $8,535.00 43314 Repair Congenital Trachesophagl Fistula Specialty $9,780.00 43320 Esophagogastrostom TransAbd Or TransThor Specialty $4,411.00 43325 Revise Esophagus & Stomach Specialty $4,242.00 43327 Esophagogastric Fundoplasty Lap Specialty $2,598.00 43328 Esophagogastric Fundoplasty, Thoracotomy Specialty $3,603.00 43330 Esophagomyotomy abdominal Specialty $4,208.00 43331 Esophagomyotomy Thoracic Specialty $4,268.00 43332 Transab Esoph Hiat Hernia Rpr WO Mesh Specialty $3,679.00 43333 Transab Esoph Hiat Hern Repair W Mesh Specialty $4,010.00 43334 Transthor Diaphrag Hern Rpr WO Mesh Specialty $3,978.00 43335 Transthor Diaphrag Hern Rpr W Mesh Specialty $4,265.00 43336 Thorabd Diaphr Hernia Repair WO Mesh Specialty $4,798.00 43337 Thorabd Diaphr Hernia Repair W Mesh Specialty $5,173.00 43338 Esophageal Lengthening Procedure Specialty $370.00 43338 Esophageal Lengthening Procedure Standard Fee $185.00 43340 Esophagojejunostomy; Abd Approach Specialty $4,319.00 43341 Esophagojejunostomy; Thoracic Approach Specialty $4,465.00 43351 Fistulization-Esoph External; Thor Appr Specialty $4,082.00 43352 Fstulization Esoph Estern; Cervical Appr Specialty $3,395.00 43360 Gastrointestinal Reconstruct; W Stomach Specialty $7,504.00 43361 Gastrointestinal Reconstruction Specialty $8,113.00 43400 Ligation Direct Esophageal Varices Specialty $4,678.00 43401 Transect Esoph W Rep For Esoph Varices Specialty $4,940.00 43405 Ligate GEJ Pre-Existing Esoph Perforat Specialty $4,636.00 43410 Suture Esoph Wound/Injury; Cervical Specialty $3,330.00 43415 Suture Esoph Wound/Injury; TT/TAbdom Specialty $8,172.00 43420 Close Esophagostomy/Fistula; Cervical Specialty $3,207.00 43425 Close Esophagost/Fistula; TT/TAbdom Specialty $4,567.00 43450 Dilate Esoph Unguided Sound/Bougie Specialty $653.00 43450 Dilate Esoph Unguided Sound/Bougie Standard Fee $327.00 43453 Dilate Esophagus Over Guide Wire Specialty $2,982.00 43460 Pressure Treatment Esophagus Specialty $678.00 43460 Pressure Treatment Esophagus Standard Fee $339.00 43500 Gastrotomy; W Explore Or FB Removal Specialty $2,477.00 43501 Gastrotomy; W Suture Rep Bleeding Ulcer Specialty $4,255.00 43502 Gastrotomy; W Suture Rep Pre Egg Lacer Specialty $4,819.00 43510 Gastrotomy; W Esoph Dil & Ins Perm Tube Standard Fee $0.00 43510 Gastrotomy; W Esoph Dil & Ins Perm Tube Specialty $2,982.00 43520 Pyloromyotomy Cut Pyloric Muscle Specialty $2,174.00 43605 Biopsy Stomach; By Laparotomy Specialty $2,643.00 43610 Excision Local; Ulcer/B Tumor Stomach Specialty $3,099.00 43611 Excision Local; Malignant Tumor Stomach Specialty $3,870.00 43620 Gastrectomy Total; W Esophagoenterostomy Specialty $6,193.00 43621 Gastrectomy Total; W Roux-En-Y Reconst Specialty $7,195.00 43622 Gastrectomy Tot; W Form Intestinal Pouch Specialty $7,342.00 43631 Gastrectomy Part Dist; W Gastroduodenost Specialty $4,588.00 43632 Gastrectomy P Dist; W Gastrojejunostomy Specialty $6,437.00 43633 Gastrectomy P Dist; W Roux-En-Y Reconst Specialty $6,082.00 43634 Gastrectomy P Dist; W/Form Intest Pouch Specialty $6,701.00 43635 Removal Of Stomach Partial Specialty $357.00 43640 Vagotomy; Truncal Or Selective Specialty $3,730.00 43641 Vagotomy; Parietal Cell Specialty $3,756.00 43644 Lap Gastric Bypass/Roux-En-Y Specialty $5,486.00 43645 Lap Gastric Bypass Incl Small Intestine Specialty $5,865.00 43651 Lap; Transect Vagus Nerves Truncal Specialty $2,060.00 43652 Lap; Transect Vagus Nerves Selective Specialty $2,422.00 43653 Lap; Gastrostomy WI Gastric Tube Specialty $1,809.00 43752 Nasal/Orogastric W/Tube Placement Standard Fee $64.00 43752 Nasal/Orogastric W/Tube Placement Specialty $128.00 43754 Dx Gastr Intubation W/Aspiration Spec Specialty $328.00 43754 Dx Gastr Intubation W/Aspiration Spec Standard Fee $164.00 43755 Dx Gastric Intubation W/Aspiration Specs Specialty $435.00 43755 Dx Gastric Intubation W/Aspiration Specs Standard Fee $217.00 43756 Dx Duodenal Intubation W/Aspir Spec Specialty $634.00 43756 Dx Duodenal Intubation W/Aspir Spec Standard Fee $317.00 43757 Dx Duodenal Intub W/Asp Specimens Specialty $896.00 43757 Dx Duodenal Intub W/Asp Specimens Standard Fee $448.00 43760 Change Gastrostomy Tube Standard Fee $752.00 43760 Change Gastrostomy Tube Specialty $1,503.00 43761 Reposition Gastrostomy Tube Specialty $363.00 43761 Reposition Gastrostomy Tube Standard Fee $182.00 43770 Laparosc; Place Gastric Adjustable Band Specialty $3,540.00 43771 Laparos, Revise Adjustable Gastric Band Specialty $4,029.00 43772 Lap, Removal Of Adjustable Gastric Band Specialty $3,001.00 43773 Laparosc Replace Gastric Adj Device Specialty $4,014.00 43774 Lap Removal Gastric Adjustable All Parts Specialty $3,035.00 43775 Laparoscopic Sleeve Gastrectomy Specialty $3,489.00 43800 Pyloroplasty Specialty $2,939.00 43810 Gastroduodenostomy Specialty $3,219.00 43820 Gastrojejunostomy; WO Vagotomy Specialty $4,244.00 43825 Gastrojejunostomy; W Vagotomy Specialty $4,132.00 43830 Gastrostomy OP; WO Gastic Tube Create Specialty $2,210.00 43831 Temporary Gastrostomy Tube Neonatal Specialty $1,841.00 43832 Gastrostomy Op; W Gastric Tube Create Specialty $3,290.00 43840 Gastrorrhaphy Suture Perf Duod/Gastric Standard Fee $0.00 43840 Gastrorrhaphy Suture Perf Duod/Gastric Specialty $4,299.00 43843 Gastric Restrict WO ByPass; WO V-Band Specialty $4,044.00 43845 Gastric Restrict W Partial Gastrectomy Specialty $6,218.00 43846 Gastric Bypass For Obesity 150 Cm/< Specialty $5,104.00 43847 Gastric Bypass For Obesity > 150 Cm Specialty $5,613.00 43848 Revision Gastroplasty Specialty $6,094.00 43850 Revise Gastroduod Anastom; WO Vagotomy Specialty $5,132.00 43855 Revise Gastroduod Anastom; W Vagotomy Specialty $5,198.00 43860 Revise Gastrojej Anastom WO Vagotomy Specialty $5,176.00 43865 Revise Gastrojejun Anastom; W Vagotomy Specialty $5,391.00 43870 Closure Of Gastrostomy Surgical Specialty $2,249.00 43880 Closure Of Gastrocolic Fistula Specialty $5,058.00 43886 Revise Gastric Port Open Specialty $1,140.00 43887 Remove Gastric Port Open Specialty $1,020.00 43888 Change Gastric Port Open Specialty $1,445.00 44005 Enterolysis Standard Fee $0.00 44005 Enterolysis Specialty $3,460.00 44010 Duodenotomy - Explore/Biopsy/FB Removal Specialty $2,726.00 44015 Percutan Placement Of Enteroclysis Tube Specialty $452.00 44020 Biopsy FB Or Explore Small Intestine Specialty $3,083.00 44021 Enterotomy Small Bowel; Decompress Specialty $3,081.00 44025 Colotomy- Explore/Biopsy/FB Removal Specialty $3,117.00 44050 Reduce Volvulus Intussesception Specialty $2,961.00 44055 Correct Malrotation Of Bowel By Lysis Specialty $4,720.00 44100 Biopsy Of Bowel 1+ Specimens Specialty $343.00 44110 Excise Intestine 1+ Lesion(s) Specialty $2,694.00 44111 Excision Of Bowel 1+ Lesion(s) Specialty $3,113.00 44120 Resect Sm Intestine; Sgl Resect & Anast Specialty $3,871.00 44121 Resect Sm Intest; Each Addtl Resection Specialty $769.00 44125 Resect Small Intestine; W Enterostomy Specialty $3,737.00 44126 Resect Sm Int Congen Atresia WO Taper Specialty $7,812.00 44127 Resect Sm Intes Congen Atresia W Taper Specialty $8,967.00 44128 Resect Sm Intes Congen Atresia Ea Addtl Specialty $777.00 44130 Enteroenterostomy Anastom Of Intestine Specialty $4,153.00 44139 Take-Dwn Splen Flexure W Part Colectomy Specialty $385.00 44140 Colectomy Partial; W Anastomosis Standard Fee $0.00 44140 Colectomy Partial; W Anastomosis Specialty $4,244.00 44141 Colectomy Part; W Sm ln Cecostom/Ostomy Specialty $5,777.00 44143 Colectomy Partial; (Hartmann Type) Specialty $5,268.00 44144 Colectomy Part; W Resect Or Mucofistula Specialty $5,606.00 44145 Colectomy Partial; W Coloproctostomy Standard Fee $0.00 44145 Colectomy Partial; W Coloproctostomy Specialty $5,244.00 44146 Colectomy Part; W Coloproctost & Colonos Specialty $6,698.00 44147 Colectomy Part; Abdominal And Transanal Specialty $6,155.00 44150 Colectomy Total Abd; W Ileost/Ileoproct Specialty $5,913.00 44151 Colectomy Tot Abd; W Continent Ileostomy Specialty $6,768.00 44155 Colectomy Tot Abd; W Proct/W Iliostom Specialty $6,580.00 44156 Colectomy Tot Abd W Proct; W Cont Ilio Specialty $7,270.00 44157 Colectomy W/Ileoanal Anastomosis Specialty $6,808.00 44158 Colectomy W/Neo-Rectum Pouch Specialty $6,704.00 44160 Partial Colectomy W Removal Of Ilium Standard Fee $0.00 44160 Partial Colectomy W Removal Of Ilium Specialty $3,928.00 44180 Laparoscopy Enterolysis Specialty $2,904.00 44186 Laparoscopy Jejunostomy Specialty $2,063.00 44187 Laparoscopy Ileo/Jejuno-Stomy Specialty $3,490.00 44188 Laparoscopy Colostomy Specialty $3,873.00 44202 Laparoscopy Enterectomy Specialty $4,390.00 44202 Laparoscopy Enterectomy Standard Fee $0.00 44203 Lap Resect Small Intestine Addl Specialty $765.00 44204 Laparoscopy Partial Colectomy Specialty $4,866.00 44205 Lap Partial Colectomy W Removal Ileum Specialty $4,231.00 44206 Laparoscopy Partial Colectomy W/Stoma Specialty $5,549.00 44207 Laparoscopic Colectomy/Coloproctostomy Specialty $5,756.00 44208 Lap Colectomy/Coloproctostomy W Colostom Specialty $6,280.00 44210 Laparo Total Proctocolectomy WO Protect Specialty $5,625.00 44211 Laparoscopy Colectomy W/Proctectomy Specialty $6,888.00 44212 Laparo Total Proctocolectomy W Protectom Specialty $6,460.00 44213 Lap Mobilization Of Splenic Flex Add-On Specialty $596.00 44227 Laparoscopy Close Enterostomy Specialty $5,277.00 44300 Open Bowel To Skin Specialty $2,663.00 44310 Ileostomy/Jejunostomy Specialty $3,300.00 44312 Revise Ileostomy; Simple Specialty $1,858.00 44314 Revise Ileostomy; Complicated Specialty $3,165.00 44316 Continent Ileostomy (Kock Procedure) Specialty $4,484.00 44320 Colostomy Specialty $3,798.00 44322 Colostomy W Multiple Biopsies Specialty $3,155.00 44340 Revise Colostomy; Simple Specialty $1,973.00 44345 Revise Colostomy; Complicated Specialty $3,322.00 44346 Revise Colostomy; W Rep PC Hernia Specialty $3,737.00 44360 Small Bowel Endoscopy Specialty $474.00 44360 Small Bowel Endoscopy Standard Fee $237.00 44361 Small Intestine Endo W Bx; Single/Multi Standard Fee $262.00 44361 Small Intestine Endo W Bx; Single/Multi Specialty $523.00 44363 Small Bowel Endoscopy Specialty $628.00 44363 Small Bowel Endoscopy Standard Fee $314.00 44364 Sm Intestine Endo W Rem T/P/L W Snare Standard Fee $334.00 44364 Sm Intestine Endo W Rem T/P/L W Snare Specialty $667.00 44365 Sm Int Endo W Rem By Hot Bx/Bp Cautery Specialty $586.00 44366 Small Intestine Endo W Bleed Control Specialty $784.00 44369 Sm Intestine Endo W Ablation Of T/P/Les Specialty $801.00 44370 Small Bowel Endoscopy/Stent Specialty $869.00 44372 Sm Intestine Endo W Perc Plac Jejun Tube Specialty $783.00 44373 Sm Intest Endo; Convert Perc GT To JT Specialty $630.00 44376 Sm Intestinal Endo W Ileum; Diagnostic Specialty $923.00 44377 Sm Int Endo W Ileum W Bx; Single/Multi Specialty $974.00 44378 Sm Intest Endo To Ileum W Bleed Control Specialty $1,245.00 44379 Small Intestinal Endoscopy W Stent Specialty $1,324.00 44380 Small Bowel Endoscopy Brush/Wash Specialty $680.00 44381 Small Bowel Endoscopy Brush/Wash/Dilate Specialty $3,081.00 44382 Ileoscopy Thru Stoma; W Bx Sgl/Multi Specialty $985.00 44384 Small Bowel Endoscopy Thru Stoma Specialty $498.00 44384 Small Bowel Endoscopy Thru Stoma Standard Fee $249.00 44385 Endoscopy Of Bowel Pouch Specialty $749.00 44385 Endoscopy Of Bowel Pouch Standard Fee $375.00 44386 Endoscopy Bowel Pouch/Biopsy Specialty $1,054.00 44388 Colonoscopy Thru Stoma SPX Specialty $1,090.00 44389 Colonoscopy Thru Stoma W Biopsy Specialty $1,373.00 44390 Colonoscopy For Foreign Body Specialty $1,370.00 44391 Colonoscopy For Bleeding Specialty $2,364.00 44392 Colonoscopy & Polypectomy Specialty $1,292.00 44392 Colonoscopy & Polypectomy Standard Fee $646.00 44394 Colonoscopy Stoma; W Removal By Snare Standard Fee $726.00 44394 Colonoscopy Stoma; W Removal By Snare Specialty $1,452.00 44401 Colonoscopy Stoma W Ablation Specialty $10,035.00 44402 Colonoscopy W/Stent Placement Specialty $855.00 44403 Colonoscopy W/Resection Specialty $982.00 44404 Colonoscopy Thru Stoma W/Injection Specialty $1,315.00 44405 Colonoscopy Stoma W Balloon Dilation Specialty $1,887.00 44406 Colonoscopy Thru Stoma W/Ultrasound Specialty $750.00 44406 Colonoscopy Thru Stoma W/Ultrasound Standard Fee $375.00 44407 Colonoscopy W/Needle Aspiration/Biopsy Standard Fee $449.00 44407 Colonoscopy W/Needle Aspiration/Biopsy Specialty $898.00 44408 Colonoscopy W/Decompression Standard Fee $379.00 44408 Colonoscopy W/Decompression Specialty $757.00 44500 Introduce Long GI Tube Specialty $77.00 44500 Introduce Long GI Tube Standard Fee $38.00 44602 Suture Sm In For Ulcer Wnd Inj; Sgl Perf Standard Fee $0.00 44602 Suture Sm In For Ulcer Wnd Inj; Sgl Perf Specialty $4,472.00 44603 Suture Sm In For Ulcer Wnd Inj; Mul Perf Specialty $5,126.00 44604 Suture Lg In For Wnd Inj; WO Colostomy Specialty $3,345.00 44605 Suture Lg In For Wnd Inj; W Colostomy Specialty $4,130.00 44615 Intestinal Stricturoplasty For Obstruct Specialty $3,405.00 44620 Closed Enterostomy Lg/Sm Intestine Specialty $2,744.00 44625 Closed Enterostomy; W Resect & Anastom Specialty $3,212.00 44626 Closed Enterostomy; W Resect & CR Anast Specialty $5,075.00 44640 Closed Intestinal Cutaneous Fistula Specialty $4,436.00 44650 Closed Enteroenteric/Enterocolic Fistula Specialty $4,586.00 44660 Closd Enteroves Fist; WO Int/Bldr Resect Specialty $4,192.00 44661 Closed Ev Fistula W Int/Blad Resection Specialty $4,902.00 44680 Intestinal Plication Specialty $3,372.00 44700 Excl SB From Pelvis By Mesh/Othr Prosth Specialty $3,219.00 44701 Intraoperative Colon Lavage Add-On Specialty $534.00 44800 Exc Meckel's Diverticulum Or Opm Duct Specialty $2,744.00 44800 Exc Meckel's Diverticulum Or Opm Duct Standard Fee $0.00 44820 Excision Of Mesentery Lesion Specialty $2,652.00 44850 Suture Of Mesentery Specialty $2,376.00 44900 Drain Appendix Abscess Open Specialty $2,441.00 44950 Appendectomy Standard Fee $0.00 44950 Appendectomy Specialty $2,033.00 44955 Appy; Done For Indicated Purpose At Time Standard Fee $0.00 44955 Appy; Done For Indicated Purpose At Time Specialty $266.00 44960 Appy; For Ruptured Appendx W Peritonitis Specialty $2,766.00 44960 Appy; For Ruptured Appendx W Peritonitis Standard Fee $0.00 44970 Laparoscopy; Appendectomy Specialty $1,900.00 45000 Transrectal Drainage Of Pelvic Abscess Specialty $1,330.00 45005 I&D Of Submucosal Abscess; Rectum Specialty $854.00 45020 I&D Deep Supralevator Pelvirectal Absc Specialty $1,799.00 45100 Biopsy Of Anorectal Wall Anal Approach Specialty $940.00 45108 Anorectal Myomectomy Specialty $1,154.00 45110 Proctectomy; Complete Abdominoperineal Specialty $5,830.00 45111 Proctectomy; Part Resect Rectum Transabd Specialty $3,428.00 45112 Proctectomy Abdominoperineal Pull-Thru Specialty $5,926.00 45113 Proctectomy With Ileal Reservoir Specialty $5,958.00 45114 Proctectomy W Anast; Abd & Transacral Specialty $5,753.00 45116 Proctectomy Part W Anastom; Transacral Specialty $5,205.00 45119 Remove Rectum W/Reservoir Specialty $6,139.00 45120 Proctectomy Abd-Perineal; W Pull-Thru Specialty $4,729.00 45121 Proctectomy Tot/Subtot W Multiple Bx Specialty $5,497.00 45123 Proctectomy Partial WO Anast Perineal Specialty $3,528.00 45126 Pelvic Exenteration For Malig W Proctect Specialty $8,808.00 45130 Excision Rectal Procidentia; Perineal Specialty $3,425.00 45135 Exc Rectal Procidentia; Abd And Perineal Specialty $4,329.00 45136 Excise Ileoanal Reservior Specialty $5,695.00 45150 Division Of Stricture Of Rectum Specialty $1,224.00 45160 Excise Rectal Tumor TS/TC Proctotomy Specialty $3,229.00 45170 Excise Rectal Tumor TS/TC Proctotomy Specialty $3,229.00 45172 Excise Rectal Tumor Transanal Full Specialty $2,545.00 45190 Destruction Rectal Tumor Specialty $2,181.00 45300 Proctosigmoidoscopy Rigid; Diagnostic Specialty $380.00 45300 Proctosigmoidoscopy Rigid; Diagnostic Standard Fee $190.00 45303 Rigid Proctosigmoidoscopy W Dilation Specialty $2,963.00 45305 Proctosigmoidoscopy Rigid; W Bx Sgl/Mult Specialty $604.00 45305 Proctosigmoidoscopy Rigid; W Bx Sgl/Mult Standard Fee $302.00 45307 Proctosigmoidoscopy Rigid; W FB Removal Specialty $725.00 45307 Proctosigmoidoscopy Rigid; W FB Removal Standard Fee $362.00 45308 Proctosig Rigid; W Rem Sgl T/P/L-Hot Bx Specialty $669.00 45309 Proctosig Rigid; W Rem Sgl Tum Pol/Other Specialty $701.00 45315 Proctosig Rig; W Rem Mult T/P/L Hot Bx Specialty $698.00 45317 Proctosigmoidoscopy W Bleed Control Specialty $753.00 45320 Proctosig Rig; W Abl Tum/Pol/Les Not Hot Specialty $755.00 45321 Proctosig Rigid; W Decompr Volvulus Specialty $339.00 45321 Proctosig Rigid; W Decompr Volvulus Standard Fee $169.00 45327 Proctosigmoidoscopy W Stent Specialty $386.00 45330 Diagnostic Sigmoidoscopy Standard Fee $257.00 45330 Diagnostic Sigmoidoscopy Specialty $515.00 45331 Sigmoidoscopy Flex With Biopsy Specialty $789.00 45332 Sigmoidoscopy Flexible W/Fb Removal Specialty $958.00 45333 Sigmoidoscopy & Polypectomy Specialty $1,075.00 45334 Sigmoidoscopy For Bleeding Specialty $1,877.00 45335 Sigmoidoscopy W/Submucosal Injection Specialty $890.00 45337 Sigmoidoscopy Flex & Decompression Specialty $383.00 45338 Sigmoidoscopy W Rem T/P/Les By Snare Specialty $1,000.00 45340 Sigmoidoscopy W/Trnsdsc Balloon Dilation Specialty $1,510.00 45341 Sigmoidoscopy W/Ultrasound Specialty $411.00 45341 Sigmoidoscopy W/Ultrasound Standard Fee $206.00 45342 Sigmoidoscopy W/US Guided Biopsy Specialty $558.00 45342 Sigmoidoscopy W/US Guided Biopsy Standard Fee $279.00 45346 Sigmoidoscopy With Ablation Specialty $9,605.00 45347 Sigmoidoscopy With Stent Placement Specialty $509.00 45349 Sigmoidoscopy With Resection Specialty $649.00 45350 Sigmoidoscopy With Band Ligation Specialty $1,798.00 45378 Diagnostic Colonoscopy Standard Fee $585.00 45378 Diagnostic Colonoscopy Specialty $1,170.00 45379 Colonoscopy W/FB Removal Standard Fee $738.00 45379 Colonoscopy W/FB Removal Specialty $1,475.00 45380 Colonoscopy And Biopsy Specialty $1,445.00 45380 Colonoscopy And Biopsy Standard Fee $1,445.00 45381 Colonoscopy Submucous NJX Standard Fee $695.00 45381 Colonoscopy Submucous NJX Specialty $1,390.00 45382 Colonoscopy W/Control Bleed Standard Fee $0.00 45382 Colonoscopy W/Control Bleed Specialty $2,445.00 45384 Colonoscopy W/Lesion Removal Standard Fee $0.00 45384 Colonoscopy W/Lesion Removal Specialty $1,587.00 45385 Colonoscopy W/Lesion Removal Standard Fee $0.00 45385 Colonoscopy W/Lesion Removal Specialty $1,516.00 45386 Colonoscopy W/Balloon Dilation Specialty $2,020.00 45388 Colonoscopy With Ablation Specialty $10,092.00 45389 Coloonoscopy With Stent Placement Specialty $943.00 45390 Colonoscopy With Resection Specialty $1,077.00 45391 Colonoscopy W/Endoscope US Standard Fee $420.00 45391 Colonoscopy W/Endoscope US Specialty $839.00 45392 Colonoscopy W/Endoscopic FNB Specialty $988.00 45393 Colonoscopy With Decompression Specialty $823.00 45393 Colonoscopy With Decompression Standard Fee $412.00 45395 Laparoscopy Removal Of Rectum Specialty $6,239.00 45397 Laparoscopy Remove Rectum W/Pouch Specialty $6,792.00 45398 Colonoscopy With Band Ligation Specialty $2,258.00 45400 Laparoscopic Proctopexy Specialty $3,591.00 45402 Lap Proctopexy W/Sigmoid Resection Specialty $4,790.00 45500 Proctoplasty; For Stenosis Specialty $1,634.00 45505 Proctoplasty For Prolapse Of Mucous Specialty $1,864.00 45520 Perirectal Inj Scleros SLN For Prolapse Specialty $485.00 45520 Perirectal Inj Scleros SLN For Prolapse Standard Fee $243.00 45540 Correct Rectal Prolapse Abdominal Specialty $3,335.00 45541 Correct Rectal Prolapse Perineal Standard Fee $0.00 45541 Correct Rectal Prolapse Perineal Specialty $2,973.00 45550 Repair Rectum/Remove Sigmoid Specialty $4,598.00 45560 Repair Of Rectocele Specialty $2,150.00 45562 Expl Repair & PS Drain For Injury Specialty $3,531.00 45563 Expl Repair & PS Dr Rectal Inj W Colost Specialty $5,216.00 45800 Closure Of Rectovesical Fistula Specialty $3,788.00 45805 Close Rectovesical Fistula; W/Colostomy Specialty $4,628.00 45820 Closure Of Rectourethral Fistula Specialty $3,743.00 45825 Close Rectourethral Fistula; W Colostomy Specialty $4,346.00 45900 Reduction Of Procidentia Under Anesth Specialty $638.00 45905 Dilate Anal Sphincter Under Anesthesia Specialty $532.00 45910 Dilate Rectal Stricture Under Anesthesia Specialty $610.00 45915 Remove Fecal Impaction Or FB Specialty $1,030.00 45990 Surgical Diagnostic Exam Anorectal Specialty $338.00 46020 Placement Of Seton Specialty $861.00 46040 I & D; Perirectal Or Ischial Abscess Specialty $1,668.00 46045 I & D; Superficial Abscess Peri/Ischeal Specialty $1,362.00 46050 I & D; Perianal Abscess Specialty $624.00 46080 Sphincterotomy Anal Div Of Sphincter Specialty $771.00 46083 Incise Thrombosed Hemorrhoid External Standard Fee $273.00 46083 Incise Thrombosed Hemorrhoid External Specialty $545.00 46220 Excise Anal External Tag/Papilla Specialty $639.00 46220 Excise Anal External Tag/Papilla Standard Fee $320.00 46230 Removal Of Multiple External Anal Tags Specialty $848.00 46250 Remove External Hemorrhoid Groups 2+ Standard Fee $0.00 46250 Remove External Hemorrhoid Groups 2+ Specialty $1,443.00 46260 Remove In/Ex Hemorrhoid Groups 2+ Specialty $1,494.00 46261 Remove In/Ex Hemorrhoid 2+ Grps & Fiss Specialty $1,638.00 46270 Remove Anal Fistula SubQ Standard Fee $0.00 46270 Remove Anal Fistula SubQ Specialty $1,583.00 46280 Remove Anal Fistula; Complex Specialty $1,470.00 46320 Removal Of Hemorrhoid Clot, External Standard Fee $285.00 46320 Removal Of Hemorrhoid Clot, External Specialty $570.00 46600 Diagnostic Anoscopy SPX Specialty $274.00 46600 Diagnostic Anoscopy SPX Standard Fee $137.00 46707 Repair Anorectal Fist W/Plug Specialty $1,399.00 46922 Destroy Anal Lesion Smple; Surg Excision Specialty $827.00 46934 Destruction Of Hemorrhoids, Internal Standard Fee $0.00 46934 Destruction Of Hemorrhoids, Internal Specialty $507.00 46946 Remove By Ligat Int Hemorrhoids 2+ Grps Specialty $974.00 46947 Hemorrhoidopexy By Stapling Specialty $1,108.00 47000 Needle Biopsy Liver; Percutaneous Specialty $1,121.00 47001 Needle Biopsy Liver At Major OP Standard Fee $0.00 47001 Needle Biopsy Liver At Major OP Specialty $330.00 47490 Percutaneous Cholecystostomy Specialty $1,040.00 47562 Laparoscopic Cholecystectomy Specialty $2,078.00 47563 Lap; Cholecystectomy W Cholangiography Specialty $2,259.00 47564 Lap Chole W Exploration Of CD Specialty $3,521.00 47600 Cholecystectomy Specialty $3,375.00 47605 Cholecystectomy With Cholangiography Specialty $3,555.00 47780 Anastom Reny EH Bile Ducts & GI Tract Specialty $7,823.00 4900 Optifast Program Fee - Regular Standard Fee $400.00 49000 Explore Laparotomy Explore Celiotomy Specialty $2,435.00 49002 Reopen Recent Laparotomy Specialty $3,307.00 4901 Optifast Program Fee - Mini Standard Fee $150.00 49010 Explore Retroperitoneal Area W/WO Biopsy Specialty $2,950.00 4902 Optifast No Charge Standard Fee $0.00 49080 Puncture, Peritoneal Cavity Standard Fee $313.00 49083 Abd Paracentesis With Imaging Specialty $907.00 49083 Abd Paracentesis With Imaging Standard Fee $454.00 49084 Peritoneal Lavage Standard Fee $172.00 49084 Peritoneal Lavage Specialty $343.00 49203 Excise Abdominal Tumor 5 Cm Or Less Specialty $3,780.00 49205 Excise Abdominal Tumor Over 10 Cm Specialty $5,555.00 49255 Omentectomy Epiploectomy Specialty $2,495.00 49320 Lap; Dx Abdomen/Peritoneum/Omentum Specialty $1,025.00 49321 Lap; Abdomen/Peritoneum/Omentum W Bx Specialty $1,088.00 49322 Lap; Abd/Peritoneum/Omentum W Asp Cyst Specialty $1,157.00 49429 Remove Peritoneal-Venous Shunt Specialty $1,450.00 49500 Rpr Ing Hernia Init Reduce 0.5-5 Yrs Specialty $1,128.00 49505 Rep Inguinal Hernia Init Reducible 5+ Yr Specialty $1,643.00 49507 Rep Inguinal Hernia Init Blocked 5+ Yr Specialty $1,847.00 49520 Repair Recurrent Inguinal Hernia Any AG Specialty $1,996.00 49553 Repair Init Fem Hernia Reducible; Incarc Specialty $1,992.00 49560 Repair Init Inci/Vent Hernia; Reducible Specialty $2,329.00 49561 Repair Initial Incisional Hernia; Incarc Specialty $2,939.00 49565 Repair Recurrent Inc Hernia; Reducible Specialty $2,425.00 49566 Rep Recurrent Incis Hernia; Incarcerated Specialty $2,966.00 49568 Hernia Repair With Mesh Specialty $878.00 49570 Repair Epigastric Hernia; Reducible Specialty $1,312.00 49580 Repair Umbilical Hernia, Reducible <5 Yr Specialty $1,048.00 49585 Repair Umbilical Hernia Reducible Age 5+ Specialty $1,402.00 49587 Repair Umbilical Hernia Blocked Age 5+ Specialty $1,500.00 49590 Repair Spigelian Hernia Specialty $1,807.00 49650 Lap Inguinal Hernia Repair Initial Specialty $1,351.00 49651 Lap Inguinal Hernia Repair Recurrent Specialty $1,755.00 49652 Lap Ventral/Abdominal Hernia Repair Specialty $2,351.00 49653 Lap Vent/Abd Hernia Proc Complicated Specialty $2,932.00 49900 Abdominl Wall 2' Suture For Evisceration Specialty $2,569.00 49905 Omental Flap, Intra-Abdominal Specialty $1,118.00 51701 Insert Bladder Catheter Standard Fee $84.00 51701 Insert Bladder Catheter Specialty $168.00 51702 Insert Temporary Bladder Catheter Standard Fee $108.00 51702 Insert Temporary Bladder Catheter Specialty $216.00 51840 Anterior Vesicourethropexy; Simple Specialty $2,045.00 51860 Suture Bladder Wound Injury; Simple Specialty $2,330.00 51992 Lap; Sling Op For Stress Incontinence Specialty $2,620.00 52000 Cystourethroscopy Specialty $629.00 52351 Dx Cystourethroscopy W Ureter Pyeloscope Standard Fee $473.00 52351 Dx Cystourethroscopy W Ureter Pyeloscope Specialty $947.00 54060 Destroy Lesion(s) Penis Simple; Surg Exc Standard Fee $277.00 54060 Destroy Lesion(s) Penis Simple; Surg Exc Specialty $553.00 54100 Biopsy Of Penis Specialty $612.00 54150 Circumcision W Regional Block Standard Fee $238.00 54150 Circumcision W Regional Block Specialty $612.00 54160 Circumcision; Neonate <=28 Days Specialty $688.00 54160 Circumcision; Neonate <=28 Days Standard Fee $344.00 54161 Circumcision; 28 Days Or Older Specialty $613.00 54161 Circumcision; 28 Days Or Older Standard Fee $306.00 55100 Drainage Of Scrotal Wall Abscess Specialty $669.00 55250 Vasectomy Unilateral Or Bilateral Standard Fee $0.00 55250 Vasectomy Unilateral Or Bilateral Specialty $1,184.00 55500 Excise Hydrocele of Sperm Crd Unilateral Standard Fee $0.00 55500 Excise Hydrocele of Sperm Crd Unilateral Specialty $1,240.00 55520 Excise Lesion of Spermatic Cord Specialty $1,425.00 56405 I & D Of Vulva Or Perineal Abscess Specialty $335.00 56420 Drainage Of Gland Abscess Specialty $375.00 56420 Drainage Of Gland Abscess Standard Fee $188.00 56440 Marsupialization Bartholin's Gland Cyst Standard Fee $281.00 56440 Marsupialization Bartholin's Gland Cyst Specialty $561.00 56605 Biopsy Of Vulva/Perineum 1 Lesion Standard Fee $126.00 56605 Biopsy Of Vulva/Perineum 1 Lesion Specialty $253.00 56620 Vulvectomy Simple; Partial Specialty $1,618.00 56740 Excise Bartholin's Gland Or Cyst Specialty $930.00 56810 Perineoplasty Repair Perineum Nonobstet Specialty $802.00 56820 Colposcopy Of Vulva Standard Fee $173.00 56820 Colposcopy Of Vulva Specialty $347.00 57020 Colpocentesis Standard Fee $143.00 57020 Colpocentesis Specialty $285.00 57061 Destroy Vaginal Lesion(s), Simple Specialty $350.00 57061 Destroy Vaginal Lesion(s), Simple Standard Fee $175.00 57065 Destroy Vaginal Lesions; Complex Specialty $601.00 57100 Biopsy Vaginal Mucosa; Simple Specialty $275.00 57100 Biopsy Vaginal Mucosa; Simple Standard Fee $137.00 57135 Excise Vaginal Cyst Or Tumor Specialty $591.00 57135 Excise Vaginal Cyst Or Tumor Standard Fee $295.00 57150 Irrigate Vagina With Meds Standard Fee $69.00 57150 Irrigate Vagina With Meds Specialty $138.00 57160 Fit Or Insert Pessary Standard Fee $117.00 57160 Fit Or Insert Pessary Specialty $233.00 57170 Diaphragm Or Cervical Cap Fitting Standard Fee $93.00 57170 Diaphragm Or Cervical Cap Fitting Specialty $187.00 57200 Colporrhaphy Specialty $933.00 57210 Colpoperineorrhaphy Specialty $1,131.00 57240 Anterior Colporrhaphy Repair Cystocele Specialty $2,067.00 57250 Posterior Colporrhaphy Repair Rectocele Specialty $2,079.00 57260 Combined Anteroposterior Colporrhaphy Specialty $2,561.00 57265 Comb Ant/Post Colporrhaphy; W Entero Rep Specialty $2,804.00 57267 Insert Mesh/Pelvic Floor Add-On Specialty $791.00 57280 Colpopexy Abdominal Approach Specialty $2,937.00 57282 Sacrospinous Ligament Fix For Prolapse Specialty $1,541.00 57283 Colpopexy; Intraperitoneal Specialty $2,119.00 57284 Repair Paravaginal Defect, Open Specialty $2,511.00 57285 Repair Paravaginal Defect, Vaginal Appr Specialty $2,070.00 57287 Revise/Repair Stress Incontinence Sling Specialty $2,098.00 57288 Sling Operation For Stress Incontinence Specialty $2,206.00 57295 Revise Vaginal Graft Via Vagina Specialty $1,470.00 57420 Colposcopy Of Vagina Standard Fee $181.00 57420 Colposcopy Of Vagina Specialty $363.00 57421 Exam/Biopsy Of Vagina W/Scope Standard Fee $243.00 57421 Exam/Biopsy Of Vagina W/Scope Specialty $487.00 57452 Colposcopy Of Cervix Specialty $335.00 57452 Colposcopy Of Cervix Standard Fee $168.00 57454 Colposcopy Cervix W Biopsy & Currettage Standard Fee $235.00 57454 Colposcopy Cervix W Biopsy & Currettage Specialty $470.00 57455 Cervical Colposcopy W Cervix Biopsy Specialty $438.00 57455 Cervical Colposcopy W Cervix Biopsy Standard Fee $219.00 57456 Cervical Colposcopy W EndoCerv Currettag Standard Fee $207.00 57456 Cervical Colposcopy W EndoCerv Currettag Specialty $414.00 57460 Cervical Colposcopy Leep W Biopsy Specialty $867.00 57460 Cervical Colposcopy Leep W Biopsy Standard Fee $434.00 57461 Conization Of Cervix W Scope Leep Specialty $1,880.00 57500 Biopsy Of Cervix Specialty $392.00 57500 Biopsy Of Cervix Standard Fee $196.00 57505 Endocervical Curettage Specialty $314.00 57505 Endocervical Curettage Standard Fee $157.00 57510 Cautery Of Cervix; Electro/Thermal Specialty $403.00 57510 Cautery Of Cervix; Electro/Thermal Standard Fee $201.00 57511 Cautery Of Cervix; Cryocautery Standard Fee $222.00 57511 Cautery Of Cervix; Cryocautery Specialty $445.00 57520 Conization Of Cervix Cold Knife Laser Standard Fee $473.00 57520 Conization Of Cervix Cold Knife Laser Specialty $946.00 57522 Conization Of Cervix Leep Standard Fee $404.00 57522 Conization Of Cervix Leep Specialty $809.00 57720 Revision Of Cervix Specialty $943.00 57800 Dilate Cervical Canal Instrumental Standard Fee $93.00 57800 Dilate Cervical Canal Instrumental Specialty $186.00 58100 Endometrial Biopsy WO Cervical Dilation Standard Fee $168.00 58100 Endometrial Biopsy WO Cervical Dilation Specialty $335.00 58110 Bx Done W/Colposcopy Add-On Specialty $148.00 58120 D&C Diagnostic Or Therapeutic; Not OB Standard Fee $339.00 58120 D&C Diagnostic Or Therapeutic; Not OB Specialty $679.00 58140 Myomectomy Abdom Method 1-4 Myomas Specialty $2,847.00 58145 Myomectomy Vag Method 1-4 Myomas Specialty $1,691.00 58150 Total Abdominal Hysterectomy Specialty $3,136.00 58152 Tot Abd Hysterectomy; Marshall-Marchetti Specialty $3,847.00 58260 Vaginal Hysterectomy = <250 Gm Specialty $2,538.00 58262 Vag Hyst Including T/O = <250 Gm Specialty $2,834.00 58263 Vag Hyst W/T/O & Vag Repair = <250 Gm Specialty $3,039.00 58267 Vag Hyst W/Urinary Repair = <250 Gm Specialty $3,240.00 58270 Vag Hyst W/Enterocele Repair = <250 Gm Specialty $2,708.00 58290 Vaginal Hysterectomy Complex = <250 Gm Specialty $3,535.00 58291 Vag Hyst Incl T/O, Complex >250 Gm Specialty $3,815.00 58292 Vag Hyst T/O & Repair, Compl >250 Gm Specialty $4,028.00 58300 Insert Intrauterine Device Standard Fee $124.00 58300 Insert Intrauterine Device Specialty $247.00 58301 Remove Intrauterine Device Specialty $291.00 58301 Remove Intrauterine Device Standard Fee $145.00 58321 Artificial Insemination; Intra-Cervical Standard Fee $118.00 58321 Artificial Insemination; Intra-Cervical Specialty $236.00 58322 Artificial Insemination; Intra-Uterine Specialty $263.00 58322 Artificial Insemination; Intra-Uterine Standard Fee $131.00 58323 Sperm Washing - Artifical Insemination Specialty $47.00 58323 Sperm Washing - Artifical Insemination Standard Fee $23.00 58345 Reopen Fallopian Tube Specialty $853.00 58350 Chromotubation of Oviduct Specialty $294.00 58353 Thermal Endometrial Tumor Ablation Specialty $3,078.00 58356 Endometrial Cryoablation W Ultrasound Specialty $5,759.00 58542 LSH W/T/O Uterus 250 Gm Or Less Specialty $2,520.00 58545 Laparoscopic Myomectomy =<250 Gm Specialty $2,786.00 58550 Laparo-Asst Vag Hysterectomy =<250 Gm Specialty $5,947.00 58552 Laparo-Vag Hyst Including T/O =<250 Gm Specialty $3,047.00 58554 Laparo-Vag Hyst W/T/O, Compl >250 Gm Specialty $4,101.00 58555 Hysteroscopy Diagnostic Specialty $462.00 58558 Hysteroscopy W Bx Endom Or Polypectomy Specialty $600.00 58559 Hysteroscopy; W Lysis Intraut Adhesions Specialty $508.00 58560 Hysteroscopy, Resect Septum Standard Fee $573.00 58561 Hysteroscopy, Remove Myoma Standard Fee $812.00 58562 Hysteroscopy; W Removal Impacted FB Specialty $621.00 58563 Hysteroscopy; W Endometrial Ablation Specialty $2,467.00 58565 Hysteroscopy, Sterilization Standard Fee $2,745.00 58571 TLH W/T/O 250 Gm Or Less Specialty $2,782.00 58573 TLH W/T/O Uterus Over 250 Gm Specialty $3,765.00 58605 Ligate Fallop Tube Agd/Vag; Postpartum Specialty $1,011.00 58615 Occlude Fallopian Tube(s) By Device Specialty $746.00 58660 Laparoscopy; W Lysis Of Adhesions Specialty $2,077.00 58661 Lap; W Removal Adnexal Structures Specialty $2,006.00 58662 Lap W Exc/Destr Ovary Pelvic Viscera Les Specialty $2,187.00 58670 Lap W Destruction Of Oviducts Specialty $1,122.00 58671 Lap W Occlusion Of Oviducts W Device Specialty $1,120.00 58672 Laparoscopy W Fimbrioplasty Specialty $2,252.00 58720 Salpingo-Oophor Compl/Part Unilat/Bilat Specialty $2,282.00 58740 Adhesiolysis Tube Ovary Specialty $2,729.00 58800 Drainage Of Ovarian Cyst(s) Vaginal Specialty $973.00 58823 Drain Pelv Absc Transvag/Transrect Perc Specialty $2,782.00 58825 Transposition Ovary(s) Specialty $2,142.00 58925 Ovarian Cystectomy Unilat Or Bilat Specialty $2,309.00 58940 Oophorectomy Partial Or Total Unilateral Specialty $1,632.00 59120 Surg Tx Ectopic Preg; Tub/Ovar Req S/O Specialty $2,499.00 59150 Lap Tx Ect Preg; WO Salpingect Or Oophor Specialty $2,428.00 59151 Lap Tx Ect Preg; W Salpingect/Oophor Specialty $2,354.00 59409 Obstetrical Care - Vaginal Delivery Only Specialty $2,570.00 59410 Obstetrical Care-Vag Del Only; Includ PP Specialty $3,278.00 59425 Antepartum Care Only; 4-6 Visits Specialty $1,422.00 59426 Antepartum Care Only; 7 Or > Visits Specialty $2,542.00 59430 Postpartum Care Only Standard Fee $288.00 59430 Postpartum Care Only Specialty $576.00 59812 Surgical Tx Incomplete Abortion Specialty $998.00 59820 Surg Tx Missed Abortion; 1st Trimester Specialty $1,187.00 60210 Partial Thyroid Lobectomy Unilateral Specialty $2,227.00 60500 Parathyroidectomy Or Expl Parathyroid(s) Specialty $3,041.00 60540 Adrealectomy Transabd Lumbar Or Dorsal Specialty $3,335.00 61107 Drill Skull For Implantation Specialty $1,023.00 61312 Craniectomy; Evac Hematoma St Ed Sd Specialty $6,716.00 61343 Craniectomy SO W Lamin For Decompression Specialty $7,082.00 61501 Craniectomy; For Osteomyelitis Specialty $3,680.00 61885 Ins/Repl Cranl Nstim TG/RCVR W 1 Elc Arr Specialty $1,648.00 61886 Implant Neurostimulator 2+ Arrays Specialty $2,705.00 62141 Cranioplasty For Skull Defect; >5 Cm Specialty $3,649.00 62223 Create Shunt; Ventriculo-Periton Pleural Specialty $3,366.00 62270 Spinal Puncture Lumbar Diagnostic Standard Fee $247.00 62270 Spinal Puncture Lumbar Diagnostic Specialty $493.00 62290 Inject For Spine Disk X-Ray Specialty $1,034.00 62319 Inject Spine W/Cath L/S (CD) Standard Fee $260.00 62319 Inject Spine W/Cath L/S (CD) Specialty $519.00 63015 Remove Spinal Lamina 2+ Segm Cervical Specialty $4,760.00 63016 Remove Spinal Lamina 2+ Segm Thoracic Specialty $4,859.00 63017 Remove Spinal Lamina 2+ Segments Lumbar Specialty $4,010.00 63030 Low Back Disk Surgery Specialty $3,080.00 63035 Spinal Disk Surgery Add-On Specialty $613.00 63042 Laminotomy Single Lumbar Specialty $4,119.00 63043 Laminotomy Addl Cervical Specialty $0.00 63044 Laminotomy Addl Lumbar Specialty $1,845.00 63045 Removal Of Spinal Lamina Sgl Cervical Specialty $4,123.00 63045 Removal Of Spinal Lamina Sgl Cervical Standard Fee $2,061.50 63047 Removal Of Spinal Lamina Single Lumbar Specialty $3,511.00 63048 Remove Spinal Lamina Add-On Specialty $678.00 63055 Decompress Spinal Cord Thoracic Specialty $5,219.00 63056 Decompress Spinal Cord Lumbar Specialty $4,727.00 63075 Neck Spine Disk Surgery Discectomy Specialty $4,326.00 63076 Neck Spine Disk Surgery Discectomy Addl Specialty $792.00 63172 Laminectomy W Dr IM Cyst; Subarach SP Specialty $4,453.00 63265 Laminectomy W Exc Intraspinous Les; Cerv Specialty $5,363.00 63266 Laminectomy W Exc Intraspinous Les; Thor Specialty $5,513.00 63267 Laminectomy W Exc Intraspinous Les; Lumb Specialty $4,379.00 63271 Laminectomy W Exc Intradural Les; Thorac Specialty $6,652.00 63707 Repair Spinal Fluid Leakage Specialty $2,933.00 63709 Rep Dural Or CSF Leak; W Laminectomy Specialty $3,506.00 64405 Inject Anesth; Greater Occipital Nerve Specialty $313.00 64405 Inject Anesth; Greater Occipital Nerve Standard Fee $157.00 64415 Single NBI Brachial Plexus Specialty $364.00 64417 Inject Anesthesia; Axillary Nerve Specialty $399.00 64418 Inject Anesth; Suprascapular Nerve Specialty $449.00 64420 Inject Anesth; Intercostal Nerve Single Specialty $347.00 64421 Inject Anesth; Intercos Nerve Multi Reg Specialty $465.00 64447 Femoral Nerve Block Single Specialty $370.00 64448 N Block Inj Femoral Continuous Infusion Specialty $221.00 64450 Inject Anesth; Other Periph Nerve/Brnch Specialty $246.00 64455 Nerve Block Injection Plantar Digit Standard Fee $74.00 64455 Nerve Block Injection Plantar Digit Specialty $147.00 64550 Apply TENS Unit Specialty $49.00 64550 Apply TENS Unit Standard Fee $24.00 64600 Destr W Neurolyt Trigem Nrv; Inf Alv Br Specialty $1,211.00 64702 Revise Finger/Toe Nerve 1-2 Specialty $1,556.00 64718 Neuroplasty; Ulnar Nerve At Elbow Specialty $1,848.00 64719 Neuroplasty; Ulnar Nerve At Wrist Specialty $1,249.00 64721 Neuroplasty; Median Nrv At Carpal Tunnel Specialty $1,340.00 64727 Intern Neurolysis W Use of Op Microscope Specialty $581.00 64774 Excise Neuroma Surgically; Cutaneous Nrv Specialty $1,303.00 64831 Repair Of Digit Nerve 1 Specialty $2,141.00 64832 Sut Digit Nerve Hand/Foot; Ea Addl Nrv Specialty $1,062.00 64834 Suture 1 Nerve Hand/Foot Comm Sensory Specialty $2,318.00 64835 Suture 1 Nerve; Median Motor Thenar Specialty $2,531.00 65205 Remove FB Conjunctiva; Superficial Standard Fee $86.00 65205 Remove FB Conjunctiva; Superficial Specialty $171.00 67810 Biopsy Eyelid & Lid Margin Specialty $528.00 69000 Drain Ext Ear Abscess/Hematoma; Simple Specialty $581.00 69000 Drain Ext Ear Abscess/Hematoma; Simple Standard Fee $290.00 69145 Exc Soft Tiss Lesion Ext Auditory Canal Specialty $1,238.00 69200 Remove FB Ext Auditory Canal; WO Anesth Standard Fee $154.00 69200 Remove FB Ext Auditory Canal; WO Anesth Specialty $307.00 69205 Remove FB Ext Auditory Canal; W Anesth Specialty $318.00 69209 Remove Impacted Ear Wax Unil-Lavage Standard Fee $20.00 69209 Remove Impacted Ear Wax Unil-Lavage Specialty $39.00 69210 Remove Impacted Ear Wax Unilat W Instr Specialty $152.00 69210 Remove Impacted Ear Wax Unilat W Instr Standard Fee $76.00 69420 Incision Of Eardrum Specialty $585.00 69424 Remove Ventilating Tube Under Anesth Specialty $397.00 69436 Tympanostomy Under General Anesthesia Specialty $503.00 69990 Operating Microscope Add-On Specialty $708.00 8029 Cosmetic Consult Standard Fee $0.00 8030 Glabellar Area Inj - Botox Standard Fee $190.00 8031 Glabellar Area Inj - Dusport Standard Fee $190.00 8032 Forehead Area Inj - Botox Standard Fee $190.00 8033 Forehead Area Inj - Dysport Standard Fee $190.00 8034 Crows Feet Inj - Botox Standard Fee $190.00 8035 Crows Feet Inj - Dysport Standard Fee $190.00 8036 Bunny Lines Inj - Botox Standard Fee $70.00 8037 Bunny Lines Inj - Dysport Standard Fee $70.00 8038 Perioral Area Inj - Botox Standard Fee $90.00 8039 Perioral Area Inj - Dysport Standard Fee $90.00 8040 Mentalis Area Inj - Botox Standard Fee $90.00 8041 Mentalis Area Inj - Dysport Standard Fee $90.00 8042 Derma Filler - Restylane Standard Fee $600.00 8043 Restylane Refyne Standard Fee $600.00 8044 Sclerotherapy per area Standard Fee $125.00 8045 Restylane Defyne Standard Fee $600.00 8046 Gummy Smile - Botoxc Standard Fee $150.00 8047 Gummy Smile - Dysport Standard Fee $150.00 8048 Marionette Lines - Botox Standard Fee $150.00 8049 Marionette Lines - Dysport Standard Fee $150.00 8050 Lower Eyelids - Botox Standard Fee $70.00 8051 Lower Eyelid - Dysport Standard Fee $70.00 8052 Eyebrow Lift - Botox Standard Fee $175.00 8053 Eyebrow Lift - Dysport Standard Fee $175.00 8054 Neck Bands - Botox Standard Fee $650.00 8055 Neck Bands - Dysport Standard Fee $650.00 8056 Touch Up - Botox Standard Fee $0.00 8057 Touch Up - Dysport Standard Fee $0.00 8058 Chemical Peel Standard Fee $90.00 8059 Chemical Peel with Dermaplaning Standard Fee $125.00 8060 Voluma XC Inj per syringe/unit Standard Fee $800.00 8061 Trinity Treatment Botox Standard Fee $530.00 8062 Trinity Treatment Dysport Standard Fee $530.00 8101 Laser Hair Removal 1/2 Leg Standard Fee $250.00 8102 Laser Hair Removal Full Leg Standard Fee $375.00 8103 Laser Hair Removal Bikini Standard Fee $200.00 8104 Laser Hair Removal Brazilian Standard Fee $300.00 8105 Laser Hair Removal Back A Standard Fee $200.00 8106 Laser Hair Removal Back B Standard Fee $250.00 8107 Laser Hair Removal Back C Standard Fee $300.00 8108 Laser Hair Removal Neckline Standard Fee $150.00 8109 Laser Hair Removal Face A Standard Fee $150.00 8110 Laser Hair Removal Face B Standard Fee $200.00 8111 Laser Hair Removal Face C Standard Fee $250.00 8112 Laser Hair Removal Buttocks Standard Fee $225.00 8113 Laser Hair Removal Under Arms Standard Fee $125.00 8114 Laser Hair Removal 1/2 Arm Standard Fee $200.00 8115 Laser Hair Removal Full Arm Standard Fee $300.00 8120 Laser Resurfacing Veins A Standard Fee $150.00 8121 Laser Resurfacing Veins B Standard Fee $300.00 8122 Laser Resurfacing Veins C Standard Fee $650.00 8123 Laser Resurfacing Spot A Standard Fee $150.00 8124 Laser Resurfacing Spot B Standard Fee $300.00 8125 Laser Resurfacing Acne Standard Fee $400.00 8126 IPL Facial Standard Fee $300.00 8174 Podiatry Laser Toe Fungus Standard Fee $500.00 8176 Dermatology Cosmetic 1 Standard Fee $50.00 8177 Dermatology Cosmetic 2 Standard Fee $100.00 8178 Dermatology Cosmetic 3 Standard Fee $150.00 8179 Dermatology Cosmetic 4 Standard Fee $200.00 8180 Dermatology Cosmetic 5 Standard Fee $250.00 8181 Dermatology Cosmetic 6 Standard Fee $300.00 8182 Dermatology Cosmetic 7 Standard Fee $350.00 8183 Dermatology Cosmetic 8 Standard Fee $400.00 8184 Dermatology Cosmetic 9 Standard Fee $450.00 8185 Dermatology Cosmetic 10 Standard Fee $500.00 8192 Aviation Medical Exam-Class 2 Standard Fee $225.00 8193 Aviation Medical Exam- Class 3 Standard Fee $225.00 8194 Air Traffic Controller Exam Standard Fee $225.00 9014 Specialty Space Rental Standard Fee $0.00 90384 Rh Ig, Full-Dose, Im Standard Fee $143.00 90460 Admin Peds vaccine 1st toxiod Standard Fee $30.00 90461 Admin Peds Vaccine additional Toxoid(s) Standard Fee $15.00 90470 H1N1 Immunization Administration Standard Fee $14.00 90471 Immunization Admin 1 Vaccine Standard Fee $18.00 90472 Immunization Admin, Ea Addl Vaccine Standard Fee $15.00 90473 Immune Admin Oral/Nasal 1 Vaccine Standard Fee $38.00 90473 Immune Admin Oral/Nasal 1 Vaccine Specialty $77.00 90474 Immune Admin Oral/Nasal Ea Addl Standard Fee $19.00 90474 Immune Admin Oral/Nasal Ea Addl Specialty $38.00 9060 No Show Fee Standard Fee $25.00 90620 Meningococcal B 2 dose Specialty $197.00 90620 Meningococcal B 2 dose Standard Fee $197.00 90620 VFC Meningococcal B 2 VFC Specialty $0.01 90620 VFC Meningococcal B 2 VFC Standard Fee $0.01 90621 VFC Meningococcal B 3 dose VFC Specialty $0.00 90621 VFC Meningococcal B 3 dose VFC Standard Fee $0.00 90632 Hep A Vaccine, Adult Im Standard Fee $100.00 90633 Hep A Vacc, Ped/Adol, 2 Dose Standard Fee $65.00 90634 Hep A Vacc, Ped/Adol, 3 Dose Standard Fee $44.00 90636 Hep A/Hep B Vacc, Adult Im Standard Fee $140.00 90645 Hib Vaccine, Hboc, Im Standard Fee $41.00 90647 HIB PRP-OMP Vacc 3 Dose IM Specialty $43.00 90647 HIB PRP-OMP Vacc 3 Dose IM Standard Fee $43.00 90647 VFC HIB PRP-OMP Vacc 3 Dose IM VFC Standard Fee $0.01 90647 VFC HIB PRP-OMP Vacc 3 Dose IM VFC Specialty $0.01 90648 HIB PRP-T Vaccine 4 Dose IM Standard Fee $43.00 90649 4VHPV Vaccine 3 Dose IM Standard Fee $280.00 9065 Non Sufficient Fee Standard Fee $25.00 90651 9VHPV Vaccine 3 Dose IM Specialty $266.00 90651 9VHPV Vaccine 3 Dose IM Standard Fee $266.00 90653 FluAd Vaccine (High Dose) Standard Fee $50.00 90654 Flu Vaccine IIV3 No Preserv ID Standard Fee $20.00 90657 Flu Vaccine IIV3 6-35 Months IM Standard Fee $25.00 90658 Flu Vaccine IIV3 3 Yrs + IM Standard Fee $25.00 90660 Flu Vaccine LAIV3 Intranasal Standard Fee $33.00 90662 Flu Vacc high dose Standard Fee $35.00 90662 Flu Vacc high dose Specialty $35.00 90669 Pneumococcal Vacc, Ped <5 Standard Fee $226.00 90670 Pneumococcal Vaccine 13 valent IM Standard Fee $239.00 90680 Rotavirus RV5 Vacc 3 Dose Live Oral Standard Fee $127.00 90681 Rotavirus RV1 Vacc 2 Dose Live Oral Standard Fee $160.00 90685 IIV4 Vaccine 6-35 Months IM Standard Fee $25.00 90686 Fluarix Vaccine No Prsv 3 Yrs+ IM Standard Fee $25.00 90686 Fluarix Vaccine No Prsv 3 Yrs+ IM Specialty $25.00 90696 DTAP-IPV Vacc 4-6 Yr IM Standard Fee $88.00 90698 DTAP-IPV/HIB Vaccine IM Standard Fee $135.00 90700 DTAP Vaccine < 7 Yrs IM Standard Fee $42.00 90701 Dtp Vaccine, Im Specialty $27.00 90701 Dtp Vaccine, Im Standard Fee $27.00 90702 DT Vaccine Under 7 Yrs IM Standard Fee $18.00 90707 MMR Vaccine SQ Standard Fee $86.00 90710 MMRV Live Vaccine SQ Standard Fee $241.00 90713 Poliovirus IPV Vaccine SQ Or IM Standard Fee $43.00 90714 TD Vacc No Preserv 7+ Yrs IM Standard Fee $39.00 90715 TDAP Vaccine >7 Yrs IM Standard Fee $70.00 90716 Varicella Vaccine Live SubQ Standard Fee $153.00 90718 Td Vaccine > 7, Im Specialty $34.00 90718 Td Vaccine > 7, Im Standard Fee $34.00 90721 Dtap/Hib Vaccine, Im Standard Fee $104.00 90723 DTAP-HEP B-IPV Vaccine IM Standard Fee $130.00 90732 Pneumococcal PPSV23 Vacc 2+ Yrs SQ/IM Standard Fee $110.00 90733 Meningococcal MPSV4 Vaccine SubQ Standard Fee $162.00 90734 Meningococcal MENACWY Vaccine IM Standard Fee $136.00 90736 Zoster (Shingles) HZV Live Vacc SubQ Standard Fee $381.00 90744 HEPB Vacc 3 Dose Ped/Adol IM Standard Fee $40.00 90746 HEPB Vaccine 3 Dose Adult IM Standard Fee $96.00 90748 HIB-HEPB Vaccine IM Standard Fee $80.00 90750 Zoster shingels vacc, recombinant IM NJX Specialty $191.00 90750 Zoster shingels vacc, recombinant IM NJX Standard Fee $191.00 90785 PSY Tx Complex Interactive Therapy Standard Fee $21.00 90791 PSYCH Diagnostic Evaluation Standard Fee $188.00 90792 PSYCH Diag Eval W Med Services Standard Fee $188.00 90832 PSY Tx Pt & Family 30 Minutes Standard Fee $105.00 90833 PSY Tx Pt & Family W E&M 30 Minutes Standard Fee $99.00 90834 PSY Tx Pt And/Or Family 45 Minutes Standard Fee $188.00 90836 Psytx pt&/fam w/e&m 45 min Standard Fee $126.00 90837 PSY Tx Pt And/Or Family 60 Minutes Standard Fee $188.00 90838 Psytx pt&/fam w/e&m 60 min Standard Fee $167.00 90839 Psytx crisis initial 60 min Standard Fee $188.00 90840 Psytx crisis ea addl 30 min Standard Fee $96.00 90845 Psychoanalysis Standard Fee $188.00 90846 Family Therapy WO Patient Standard Fee $188.00 90847 Family Therapy W Patient Standard Fee $188.00 90847 Family Therapy W Patient Specialty $323.00 90849 Multi-Family Group Therapy Standard Fee $70.00 90853 Group Therapy Not Multi-Family Standard Fee $39.00 90863 Pharmacologic mgmt w/psytx Standard Fee $50.00 90899 Psychiatric Service/Therapy Standard Fee $188.00 9100 Sports Physical Standard Fee $35.00 9101 DOT Physical Standard Fee $125.00 91105 Gastric Intubation & Asp For Poisons Standard Fee $274.00 92014 Eye Exam & Treatment 1+ Visits Specialty $377.00 92014 Eye Exam & Treatment 1+ Visits Standard Fee $188.00 92511 Nasopharyngoscopy W Endoscope Specialty $345.00 92552 Pure Tone Audiometry Air Only Standard Fee $48.00 92567 Tympanometry Standard Fee $37.00 92950 Heart/Lung Resuscitation CPR Standard Fee $467.00 92950 Heart/Lung Resuscitation CPR Specialty $933.00 92960 Cardioversion Electric External Specialty $632.00 92960 Cardioversion Electric External Standard Fee $316.00 93000 Electrocardiogram, Complete Specialty $26.00 93000 Electrocardiogram, Complete Standard Fee $26.00 93005 12 Lead EKG, Tracing Only Standard Fee $13.00 93010 12 Lead EKG; Interpret And Report Standard Fee $13.00 93018 Cardiovascular Strss Test Int & Rep Only Standard Fee $22.00 93042 Rhythm ECG 1-3 Leads Report Standard Fee $11.00 93227 ECG Monitor/Report Up To 48 Hrs Standard Fee $41.00 93272 ECG/Review Interpret Only Standard Fee $39.00 93555 S&I For Inj; VT Or AT Angiography Standard Fee $153.00 93784 93784 Ambulatory BP Monitor 24+ Hrs; Global Standard Fee $82.00 94010 Spirometry Standard Fee $42.00 94060 Bronchospasm - Pre & Post BD Standard Fee $73.00 94150 Total Vital Capacity Standard Fee $18.00 94200 Maximum Breathing Capacity (MVV) Standard Fee $30.00 94620 Pulmonary Stress Test/Simple Standard Fee $39.00 94640 Airway Inhalation Treatment Standard Fee $29.00 94664 Pos Airway Pressure CPAP Init & Mgmt Standard Fee $97.00 94720 Monoxide Diffusing Capacity Standard Fee $30.00 94760 Pulse Oximetry Single Standard Fee $5.00 94761 Pulse Oximetry Multiple Standard Fee $8.00 94762 Continuous Pulse Oximetry Measure Standard Fee $38.00 95004 Percutaneous Allergy Skin Tests Standard Fee $10.00 95012 Exhaled Nitric Oxide Measure Specialty $59.00 95012 Exhaled Nitric Oxide Measure Standard Fee $29.00 95024 ICUT Allergy Test Drug/Bug Specialty $24.00 95024 ICUT Allergy Test Drug/Bug Standard Fee $12.00 95115 One Injection Pro Allergy Immunotherapy Specialty $27.00 95115 One Injection Pro Allergy Immunotherapy Standard Fee $27.00 95117 Immunotherapy 2+ Injections Standard Fee $20.00 95165 Antigens-Allergen Immun; Single/Multiple Standard Fee $20.00 95165 Antigens-Allergen Immun; Single/Multiple Specialty $39.00 95974 Cranial Neurostim Complex Specialty $639.00 96040 Genetic Counseling, 30 Min Standard Fee $76.00 96101 Psycho Testing By Psych/Phys Standard Fee $150.00 96110 Developmental Screen W Score Standard Fee $9.00 96111 Developmental Test Extended Standard Fee $197.00 96127 Brief Emotional/Behavioral Assessment Specialty $8.00 96360 Hydration IV Infusion Init 31-60 Minutes Standard Fee $87.00 96360 Hydration IV Infusion Init 31-60 Minutes Specialty $175.00 96361 Hydrate IV Infusion Add-On Specialty $47.00 96361 Hydrate IV Infusion Add-On Standard Fee $23.00 96365 Ther/Proph/Diag IV INF INIT to 1 hr Standard Fee $270.00 96366 96366 Ther/Proph/Diag IV INF Addon Standard Fee $53.00 96367 TX/PROPH/DG ADDL SEQ IV INF Standard Fee $81.00 96372 Ther/Proph/Diag Injection SQ/IM Standard Fee $38.00 96374 Ther/Proph/Diag Injection IV Push Standard Fee $30.00 96523 Irrigation Of Drug Delivery Device Specialty $76.00 96523 Irrigation Of Drug Delivery Device Standard Fee $38.00 97001 Physical Therapy Evaluation Standard Fee $115.00 97002 Physical Therapy Re-Evaluation Standard Fee $64.00 97012 Mechanical Traction Therapy 1+ Areas Standard Fee $24.00 97014 Electric Stimulation Therapy 1+ Areas Standard Fee $37.00 97022 Whirlpool Therapy 1+ Areas Standard Fee $36.00 97033 Electric Current Therapy Each 15 Minutes Standard Fee $40.00 97035 Ultrasound Therapy Each 15 Minutes Standard Fee $19.00 97110 Therapeutic Exercises Each 15 Minutes Standard Fee $49.00 97112 Neuromuscular Reeducation Ea 15 Minutes Standard Fee $51.00 97116 Gait Training Therapy Each 15 Minutes Standard Fee $43.00 97124 Massage Therapy Each 15 Minutes Standard Fee $40.00 97140 Manual Therapy Each 15 Minutes Standard Fee $37.00 97537 Community/Work Reintegration Standard Fee $46.00 97597 Selective Wound Debridem 20 Cm Or < Standard Fee $115.00 97597 Selective Wound Debridem 20 Cm Or < Specialty $230.00 97598 Selective Wound Debridem Addl 20 Cm/< Specialty $75.00 97598 Selective Wound Debridem Addl 20 Cm/< Standard Fee $37.00 97602 NSW Debridem WO A/Session Standard Fee $55.00 97605 Neg Press Wound Tx, <=50 Cm Specialty $125.00 97605 Neg Press Wound Tx, <=50 Cm Standard Fee $63.00 97606 Neg Pressure Wound Tx, > 50 Cm Specialty $148.00 97606 Neg Pressure Wound Tx, > 50 Cm Standard Fee $74.00 97610 Low Freq Non-Thermal Ultrasound Standard Fee $183.00 97610 Low Freq Non-Thermal Ultrasound Specialty $366.00 97804 Group Nutrition Therapy; Ea 30 Min Specialty $49.00 97804 Group Nutrition Therapy; Ea 30 Min Standard Fee $24.00 97810 Acupuncture WO Stimul 15 Min Standard Fee $50.00 97811 Acupuncture WO Stimul Addl 15 Min Standard Fee $45.00 97813 Acupuncture W Stimul 15 Min Standard Fee $75.00 97814 Acupuncture W Stimul Addl 15 Min Standard Fee $55.00 98925 Osteopathic Manip 1-2 Body Regions Specialty $96.00 98925 Osteopathic Manip 1-2 Body Regions Standard Fee $48.00 98926 Osteopathic Manip 3-4 Body Regions Specialty $140.00 98926 Osteopathic Manip 3-4 Body Regions Standard Fee $70.00 98927 Osteopathic Manip 5-6 Body Regions Specialty $181.00 98927 Osteopathic Manip 5-6 Body Regions Standard Fee $91.00 98928 Osteopathic Manip 7-8 Body Regions Standard Fee $111.00 98928 Osteopathic Manip 7-8 Body Regions Specialty $222.00 98929 Osteopathic Manipulation Standard Fee $111.00 99000 Specimen Handling Office-Lab Standard Fee $29.00 99001 Specimen Handling Pt-Lab Standard Fee $36.00 99002 Device Handling Phys/Qhp Specialty $204.00 99058 Office Emergency Care Standard Fee $44.00 99070 Special Supplies Phys/Qhp Standard Fee $119.00 99080 Special Reports Standard Fee $30.00 99143 Mod Sedat Phy/Qhp <5 Yrs Standard Fee $120.00 99144 Mod Sedat Phys/Qhp 5 Yrs/> Standard Fee $120.00 99174 Ocular Instrument Screen Bilateral Standard Fee $11.00 99188 Apply Topical Fluoride Varnish Standard Fee $20.00 9920 Immigration Physical Standard Fee $250.00 99201 Office/Outpatient Visit, New Standard Fee $66.00 99202 Office/Outpatient Visit, New Standard Fee $112.00 99203 Office/Outpatient Visit, New Standard Fee $162.00 99204 Office/Outpatient Visit, New Standard Fee $250.00 99205 Office/Outpatient Visit, New Standard Fee $311.00 9921 Immigration Physical Followup Standard Fee $0.00 99211 Office/Outpatient Visit, Est Standard Fee $30.00 99212 Office/Outpatient Visit, Est Standard Fee $77.00 99213 Office/Outpatient Visit, Est Standard Fee $109.00 99213I Office/Outpatient Visit, Est Specialty $126.00 99213I Office/Outpatient Visit, Est Standard Fee $93.00 99214 Office/Outpatient Visit, Est Standard Fee $160.00 99215 Office/Outpatient Visit, Est Standard Fee $214.00 99217 Observation Care Discharge Specialty $222.00 99218 Initial Observation Care 30 Min Standard Fee $152.00 99219 Initial Observation Care 50 Min Standard Fee $207.00 99220 Initial Observation Care 70 Min Specialty $565.00 99221 Initial Hospital Care 30 Min Standard Fee $155.00 99222 Initial Hospital Care 50 Min Standard Fee $209.00 99223 Initial Hospital Care 70 Min Standard Fee $309.00 99231 Subsequent Hospital Care 15 Min Standard Fee $60.00 99232 Subsequent Hospital Care 25 Min Standard Fee $110.00 99233 Subsequent Hospital Care 35 Min Standard Fee $159.00 99234 Observ/Hosp Same Date 40 Min Standard Fee $204.00 99235 Observ/Hosp Same Date 50 Min Standard Fee $258.00 99236 Observ/Hosp Same Date 55 Min Standard Fee $332.00 99238 Hospital DC Day Management; 30 Min/< Specialty $221.00 99239 Hospital DC Day Management; > 30 Min Specialty $327.00 99241 Office Consultation 15 Min Specialty $161.00 99241 Office Consultation 15 Min Standard Fee $153.00 99242 Office Consultation 30 Min Specialty $189.00 99243 Office Consultation 40 Min Standard Fee $190.00 99244 Office Consultation 60 Min Specialty $382.00 99245 Office Consultation 80 Min Specialty $474.00 99251 Inpatient Consultation 20 Min Standard Fee $74.00 99252 Inpatient Consultation 40 Min Standard Fee $239.00 99253 Inpatient Consultation 55 Min Standard Fee $356.00 99254 Inpatient Consultation 80 Min Standard Fee $250.00 99255 Inpatient Consultation 110 Min Standard Fee $317.00 99281 99282 Emergency Dept Visit Low To Mod Severity Standard Fee $63.00 99283 Emergency Dept Visit Moderate Severity Standard Fee $95.00 99284 Emergency Dept Visit High Severity Specialty $359.00 99285 Emergency Dept Visit Sev; Threat to Life Standard Fee $265.00 99291 Critical Care, First Hour (30-74 Min) Standard Fee $420.00 99292 Critical Care, Add'l 30 Min Standard Fee $187.00 99304 Nursing Facility Care, Init Low Severity Standard Fee $140.00 99305 Nursing Facility Care, Init Mod Severity Standard Fee $199.00 99306 Nursng Facility Care, Init High Severity Standard Fee $253.00 99307 Nursing Fac Care, Subseq Recovering Standard Fee $136.00 99308 Nursing Fac Care, Subseq Resp Inadeq Standard Fee $106.00 99309 Nursing Fac Care Subseq, Sig Problem Standard Fee $139.00 99310 Nursing Fac Care, Subseq Unstable Standard Fee $207.00 99315 Nursing Fac Discharge Day 30 Min Or Less Standard Fee $111.00 99316 Nursing Fac Discharge Day > 30 Min Standard Fee $161.00 99318 Annual Nursing Facility Assessment Standard Fee $146.00 99324 Domicil/R-Home Visit New Pat Low Severit Standard Fee $84.00 99325 Domicil/R-Home Visit New Pat Mod Severit Standard Fee $246.00 99326 Dom/R-Hm Visit New Pat High Sev 45 Min Standard Fee $212.00 99327 Dom/R-Hm Visit New Pat High Sev, 60 Min Standard Fee $283.00 99328 Dom/R-Hm Visit New Pat High Sev, 75 Min Standard Fee $330.00 99334 Dom/R-Hm Visit Est Pat Low Sev, 15 Min Standard Fee $92.00 99335 Dom/R-Hm Visit Est Pat Low To Mod Sev Standard Fee $145.00 99336 Dom/R-Hm Visit Est Pat Mod To High Sev Standard Fee $205.00 99337 Dom/R-Hm Visit Est Pat High Sev, 60 Min Standard Fee $294.00 99339 Dom/R-Home Care Supervis 15-29 Min/Mo Standard Fee $115.00 99341 Home Visit, New Pat Low Sev, 20 Min Standard Fee $84.00 99342 Home Visit, New Pat Mod Sev, 30 Min Standard Fee $121.00 99343 Home Visit, New Pat High Sev, 45 Min Standard Fee $198.00 99344 Home Visit, New Pat High Sev, 60 Min Standard Fee $278.00 99345 Home Visit, New Pat Severe, 75 Min Standard Fee $337.00 99347 Home Visit, Est Pat Low Sev, 15 Min Standard Fee $84.00 99348 Home Visit, Est Pat Low To Mod, 25 Min Standard Fee $128.00 99349 Home Visit, Est Pat Mod To High, 40 Min Standard Fee $391.00 99350 Home Visit, Est Pat Mod To High, 60 Min Standard Fee $271.00 99354 Prolonged E&M/Psyc Tx Serv O/P Standard Fee $153.00 99355 Prolong E&M/Psyc Tx Serv O/P Ea Addl 30M Standard Fee $148.00 99356 Prolonged Service, Inpatient 1st Hour Standard Fee $140.00 99357 Prolonged Service, Inpat Ea Addl 30 Min Standard Fee $19.00 99358 Prolonged Serv, W/O Contact 1st Hr Standard Fee $160.00 99359 Prolong Serv, W/O Contact Ea Addl 30 Min Standard Fee $78.00 99360 Physician Standby Services Each 30 Min Standard Fee $90.00 99366 Team Conf W/Pat By Hc Pro 30+ Min Standard Fee $62.00 99374 Home Health Care Supervision 15-29 Min Standard Fee $132.00 99379 Nursing Fac Care Supervision Standard Fee $0.00 99381 Init Pm E/M, New Pat, Infant < 1 Yr Standard Fee $165.00 99382 Prev Visit, New, Age 1-4 Yr Standard Fee $171.00 99383 Prev Visit, New, Age 5-11 Standard Fee $179.00 99384 Prev Visit, New, Age 12-17 Specialty $331.00 99385 Prev Visit, New, Age 18-39 Specialty $221.00 99386 Prev Visit, New, Age 40-64 Standard Fee $227.00 99387 Init Pm E/M, New Pat 65+ Yrs Specialty $283.00 99391 Per Pm Reeval, Est Pat, Infant < 1 Yr Standard Fee $148.00 99392 Prev Visit, Est, Age 1-4 Standard Fee $158.00 99393 Prev Visit, Est, Age 5-11 Standard Fee $158.00 99394 Prev Visit, Est, Age 12-17 Specialty $279.00 99395 Prev Visit, Est, Age 18-39 Specialty $187.00 99396 Prev Visit, Est, Age 40-64 Specialty $206.00 99397 Per Pm Reeval Est Pat 65+ Yr Standard Fee $202.00 99401 Preventive Counseling, Indiv 15 Min Standard Fee $40.00 99402 Preventive Counseling, Indiv 30 Min Standard Fee $102.00 99403 Preventive Counseling, Indiv 45 Min Standard Fee $95.00 99406 Behavioral Change; Smoking 3-10 Min Standard Fee $0.00 99407 Behavioral Change Smoking > 10 Min Standard Fee $0.00 99415 Prolonged Clinical Staff Svcs 1st Hour Specialty $27.00 99415 Prolonged Clinical Staff Svcs 1st Hour Standard Fee $14.00 99416 Prolonged Clinical Svc; Ea Addl 30 min Specialty $15.00 99416 Prolonged Clinical Svc; Ea Addl 30 min Standard Fee $8.00 99460 Initial Care, Normal Newborn Standard Fee $143.00 99477 Init Day Hosp Neonate Care <=28 Days Standard Fee $545.00 99490 Chronic Care Management 1 per month Standard Fee $50.00 99497 Advance Care Planning 1st 30 min Specialty $260.00 99497 Advance Care Planning 1st 30 min Standard Fee $130.00 99498 Advance Care Planning Ea Addl 30 min Specialty $226.00 99498 Advance Care Planning Ea Addl 30 min Standard Fee $113.00 99499 Unlisted E&M Service Standard Fee $77.00 A4264 Intratubal Occlusion Device Standard Fee $2,775.00 A4266 Diaphragm Standard Fee $86.00 A4351 Intermitt Urinary Catheter, Strt Tip Ea Standard Fee $11.00 A4358 Urinary Drainage Bag; Leg Or Abdomen Standard Fee $12.00 A4466 Stabilizing brace (arm or knee) Standard Fee $20.00 A4467 Belt, strap, sleeve, covering any type Standard Fee $20.00 A4561 Rubber Pessary Any Type Standard Fee $77.00 A4565 Slings Standard Fee $28.00 A4590 Special Casting Material Standard Fee $1.00 A4649 Foam Dressing Standard Fee $27.00 A5121 Solid Skin Barrier 6X6 Standard Fee $20.00 A6021 Collagen Dressing <=16 Sq In Standard Fee $15.00 A6196 Alginate Dressing <=16 Sq In Standard Fee $20.00 A6199 Alginate Dressing Wound Filler Standard Fee $10.00 A6203 Composite Dressing <= 16 Sq In Standard Fee $10.00 A6209 Foam Dressing <=16 Sq In W/O Bdr Standard Fee $5.00 A6210 Foam Drg >16<=48 Sq In W/O B Standard Fee $5.00 A6212 Foam Drg <=16 Sq In W/Border Standard Fee $244.00 A6215 Foam Dressing Wound Filler Standard Fee $5.00 A6254 Absorpt Drg <=16 Sq In W/Bdr Standard Fee $5.00 A6261 Wound Filler Standard Fee $20.00 A6449 Lt Compres Band >=3 In <5 In/Yd Standard Fee $9.00 A6535 Gc Stocking Thighlngth 40-50 Standard Fee $48.00 A6545 Gradient Compression Wrap Standard Fee $20.00 A9270 Non-Covered Item Or Service Standard Fee $25.00 C9003 Palivizumab Per 50 mg Standard Fee $1,119.00 D0140 Limit Oral Eval Problm Focus Standard Fee $10.00 D0145 Oral Evaluation < 3 Yrs Standard Fee $30.00 D0190 Screening of Patient Standard Fee $25.00 D1206 Topical Fluoride Varnish Standard Fee $16.00 D1330 Oral Hygiene Instruction Standard Fee $25.00 E0110 Crutch Forearm Pair Specialty $250.00 E0114 Crutch Underarm Pair No Wood Standard Fee $30.00 E0191 Protector Heel Or Elbow Standard Fee $63.00 E0272 Mattress Foam Rubber Standard Fee $60.00 E0740 Incontinence Treatment Systm Standard Fee $650.00 G0008 Admin Influenza Virus Vac Standard Fee $15.00 G0009 Admin Pneumococcal Vaccine Standard Fee $15.00 G0010 Admin Hepatitis B Vaccine Standard Fee $15.00 G0101 CA Screening Pelvic & Breast Exam Standard Fee $59.00 G0105 Colorectal Screen On Hi Risk Patient Standard Fee $584.00 G0121 Screen Colonoscopy Patient Not Hi Risk Standard Fee $585.00 G0121 Screen Colonoscopy Patient Not Hi Risk Specialty $1,170.00 G0179 Physician Recertification HHA Patient Standard Fee $63.00 G0179 Physician Recertification HHA Patient Specialty $126.00 G0180 Physician Certification HHA Patient Standard Fee $82.00 G0180 Physician Certification HHA Patient Specialty $164.00 G0181 Home Health Care Supervision 30+ Min/Mo Standard Fee $165.00 G0245 Initial Foot Exam Pt LOPS Standard Fee $101.00 G0245 Initial Foot Exam Pt LOPS Specialty $201.00 G0246 Followup Eval Of Foot Pt LOP Standard Fee $59.00 G0246 Followup Eval Of Foot Pt LOP Specialty $117.00 G0247 Routine Footcare Pt W LOPS Standard Fee $111.00 G0247 Routine Footcare Pt W LOPS Specialty $222.00 G0268 Removal Of Impacted Wax Md Specialty $165.00 G0268 Removal Of Impacted Wax Md Standard Fee $83.00 G0296 Visit To Determine LDCT Eligibility Standard Fee $43.00 G0296 Visit To Determine LDCT Eligibility Specialty $87.00 G0328 Occult Blood Immunoassay Screen Standard Fee $17.00 G0344 Initial Preventive Exam New Beneficiary Standard Fee $145.00 G0368 Init Prevent Exam Scrn EKG, Interp Only Standard Fee $30.00 G0372 MD Service Required For PMD Standard Fee $14.00 G0372 MD Service Required For PMD Specialty $27.00 G0378 Hospital Observation Service Per Hr Specialty $304.00 G0378 Hospital Observation Service Per Hr Standard Fee $152.00 G0379 Direct Admit Refer Hospital Observ Care Standard Fee $207.00 G0379 Direct Admit Refer Hospital Observ Care Specialty $413.00 G0402 Initial Preventive Exam; New Beneficiary Standard Fee $253.00 G0402 Initial Preventive Exam; New Beneficiary Specialty $507.00 G0403 Init Prevnt Exam Screen EKG W Intr & Rpt Standard Fee $26.00 G0403 Init Prevnt Exam Screen EKG W Intr & Rpt Specialty $52.00 G0404 Init Prevnt Exam Scren EKG, Tracing Only Standard Fee $13.00 G0404 Init Prevnt Exam Scren EKG, Tracing Only Specialty $26.00 G0436 Tobacco Use Counseling 3-10 Min Standard Fee $22.00 G0436 Tobacco Use Counseling 3-10 Min Specialty $44.00 G0437 Tobacco Use Counseling > 10 Min Standard Fee $42.00 G0437 Tobacco Use Counseling > 10 Min Specialty $84.00 G0438 Annual Wellness Initial Visit Standard Fee $261.00 G0438 Annual Wellness Initial Visit Specialty $522.00 G0439 Annual Wellness Visit Subsequent Standard Fee $177.00 G0439 Annual Wellness Visit Subsequent Specialty $354.00 G0442 Annual Alcohol Missuse Screening 15 Min Specialty $55.00 G0442 Annual Alcohol Missuse Screening 15 Min Standard Fee $28.00 G0444 Annual depression screening 15 min MCR Standard Fee $0.00 G0447 Behavior Counsel Obesity 15 Min Standard Fee $40.00 G0447 Behavior Counsel Obesity 15 Min Specialty $79.00 G0511 Chronic Care Management 1 per month Standard Fee $50.00 G8431 Clin Depression Screen Doc Standard Fee $20.00 G8510 Negative Depression Screen Standard Fee $20.00 G9141 Influenza A H1N1, Admin Fee Standard Fee $14.00 G9142 Influenza A H1N1 Vaccine Standard Fee $0.00 J0171 Adrenalin Epinephrin 0.1 mg Standard Fee $20.00 J0500 Dicyclomine Inj To 20 mg Standard Fee $55.00 J0530 Penicillin G Benzathine Inj Standard Fee $31.00 J0560 Penicillin G Benzathine Inj Standard Fee $14.00 J0561 Penicillin G Benzathine Inj 100000 Units Standard Fee $5.00 J0690 Cefazolin Sodium Inj 500 Mg Standard Fee $55.00 J0696 Ceftriaxone Sodium Inj Per 250 mg Standard Fee $25.00 J0702 Betamethasone Acet&Sod Phosp 3 Mg Standard Fee $50.00 J0704 Betamethasone Sod Phosp/4 Mg Standard Fee $45.00 J0725 Chorionic Gonadotropin 1mL=1 unit Standard Fee $24.50 J0775 Xiaflex Inj 0.01 Mg Standard Fee $0.00 J0780 Compazine Inj Up To 10 Mg Standard Fee $15.00 J0881 Darbepoetin Alfa Non-ESRD 1 Mcg Standard Fee $1,335.00 J0885 Epoetin Alfa Non-ESRD 1000 Units Standard Fee $24.00 J0897 Denosumab Inj 1 Mg Standard Fee $25.00 J1000 Depo-Estradiol Cypionate Inj To 5 Mg Standard Fee $48.00 J1020 Depo-Medrol Inj 20 Mg Specialty $8.00 J1030 Depo-Medrol Inj 40 Mg Standard Fee $16.00 J1040 Depo-Medrol Inj 80 Mg Standard Fee $32.00 J1050 Medroxyprogesterone Acetate Inj 1mg Standard Fee $1.00 J1051 Medroxyprogesterone Inj Standard Fee $40.00 J1055 Medrxyprogester Acetate Inj Standard Fee $68.00 J1060 Testosterone Cypionate 1 Ml Standard Fee $0.00 J1070 Testosterone Cypionat 100 Mg Standard Fee $0.00 J1071 Testosterone Cypionate Inj 1 Mg Standard Fee $0.18 J1080 Testosterone Cypionat 200 Mg Standard Fee $30.00 J1100 Dexameth Sod Inj To 1 Mg Standard Fee $5.00 J1110 Dehydroergotamine Inj To 1 Mg Standard Fee $90.00 J1200 Benadryl Inj Up To 50 mg Standard Fee $11.00 J1380 Estradiol Valerate Inj Up To 10 Mg Standard Fee $18.00 J1390 Estradiol Valerate 20 Mg Inj Standard Fee $0.00 J1470 Gamma Globulin 2 Cc Inj Standard Fee $0.00 J1631 Haloperidol Decanoate Inj Per 50 mg Standard Fee $78.00 J1650 Lovenox Inj 10 mg Standard Fee $63.00 J1750 Iron Dextran Inj 50 mg Standard Fee $35.00 J1751 Iron Dextran 165 Injection Standard Fee $0.00 J1815 Insulin Inj Per 5 Units Standard Fee $10.00 J1825 Interferon Beta-1A Standard Fee $0.00 J1885 Toradol Inj Per 15 mg Standard Fee $17.00 J1950 Lupron Depot Inj Per 3.75 mg Standard Fee $1,368.00 J1956 Levofloxacin Inj 250 mg Standard Fee $34.00 J2001 Lidocaine HCL Inj For IV 10 mg Standard Fee $2.00 J2175 Meperidine (Demerol) HCL Inj Per 100 mg Standard Fee $12.00 J2270 Morphine Sulfate Inj Up To 10 mg Standard Fee $3.00 J2300 Nalbuphine HCL (Nubain) Inj Per 10 mg Standard Fee $6.00 J2353 Octreotide Depot Inj 1 mg IM Standard Fee $2,327.00 J2405 Ondansetron (Zofran) HCL Inj Per 1 mg Standard Fee $2.00 J2505 Pegfilgrastim (Neulasta) Inj 6 mg Standard Fee $4,500.00 J2550 Promethazine HCL(Phenergan) 25 mg Standard Fee $12.00 J2680 Prolixin Decanoate Inj To 25 Mg Standard Fee $27.00 J2765 Metoclopramide Hcl Injection Standard Fee $2.00 J2790 Rho D Immune Globulin Inj Standard Fee $125.00 J2930 Methylprednisolone Injection Standard Fee $30.00 J2997 Alteplase Recombinant Inj Standard Fee $215.00 J3030 Sumatriptan Succinate / 6 Mg Standard Fee $165.00 J3301 Triamcinolone Inj 10mg Standard Fee $3.50 J3302 Triamcinolone Diacetate Inj Standard Fee $2.00 J3303 Triamcinolone Hexacetonl Inj Standard Fee $21.00 J3360 Diazepam Injection Standard Fee $11.00 J3410 Hydroxyzine Hcl Injection Standard Fee $11.00 J3420 Vitamin B12 Injection Standard Fee $13.00 J3430 Vitamin K Phytonadione Inj Standard Fee $16.00 J3475 Inj Magnesium Sulfate Standard Fee $19.00 J3490 Drugs Unclassified Standard Fee $25.00 J7030 Normal Saline Solution Infus Standard Fee $22.00 J7040 Normal Saline Solution Infus Standard Fee $1.00 J7042 5% Dextrose/Normal Saline Standard Fee $34.00 J7050 Normal Saline Solution Infus Standard Fee $1.00 J7060 5% Dextrose/Water Standard Fee $30.00 J7070 D5W Infusion Standard Fee $34.00 J7120 Ringers Lactate Infusion Standard Fee $34.00 J7296 Kyleena Standard Fee $864.00 J7298 Levonorgestrel Iu Contracept Standard Fee $495.00 J7300 Intraut Copper Contraceptive Standard Fee $1,154.00 J7301 Skyla IUD Standard Fee $748.00 J7302 Levonorgestrel Iu Contracept Standard Fee $1,055.00 J7307 Etonogestrel Implant System Standard Fee $1,158.00 J7322 Synvisc Inj Per Dose Standard Fee $1,797.00 J7324 Orthovisc Inj Per Dose Standard Fee $636.00 J7325 Synvisc or Synvisc One per 1mL Standard Fee $19.00 J7327 Monovisc Inj Per Dose Standard Fee $1,895.00 J7506 Prednisone Oral Standard Fee $1.00 J7510 Prednisolone Oral Per 5 Mg Standard Fee $2.00 J7512 Prednisone Oral(1mg) 20mg Tab Standard Fee $8.00 J7609 Albuterol Comp Unit Standard Fee $6.00 J7611 Albuterol,concentrated, 1mg Standard Fee $6.00 J7613 Albuterol, noncompounded, 1mg Standard Fee $6.00 J7614 Xopenex Standard Fee $9.00 J7620 Albuterol Ipratrop Non-Comp Standard Fee $6.00 J7626 Budesonide Non-Comp Unit Standard Fee $11.00 J7627 Budesonide Comp Unit Standard Fee $6.00 J7633 Budesonide Non-Comp Con Standard Fee $10.00 J7644 Ipratropium Bromide Non-Comp Standard Fee $10.00 J7645 Ipratropium Bromide Comp Standard Fee $5.00 J7670 Metaproterenol Comp Unit Standard Fee $27.00 J7699 Inhalation Solution For Dme Standard Fee $3.00 J8540 Oral Dexamethasone Standard Fee $5.00 J9202 Goserelin Acetate Implant Standard Fee $504.00 J9217 Leuprolide Acetate Suspnsion Standard Fee $1,000.00 J9250 Methotrexate Sodium Inj Standard Fee $11.00 L0120 Cerv Flexible Non-Adjustable Standard Fee $19.00 L0140 Cervical Semi-Rigid Adjustab Standard Fee $17.00 L0210 Thoracic Rib Belt Standard Fee $82.00 L0625 Lo Flexibl L1-Below L5 Pre Standard Fee $23.00 L1800 Knee Orthoses Elas W Stays Standard Fee $11.00 L1812 Patella Stabilizer Standard Fee $25.00 L1815 Elastic With Condylar Pads Standard Fee $50.00 L1820 Ko Elas W/ Condyle Pads & Jo Standard Fee $50.00 L1825 Ko Elastic Knee Cap Standard Fee $11.00 L1902 Afo Ankle Gauntlet Standard Fee $45.00 L1930 Afo Plastic Standard Fee $125.00 L3020 Foot Longitud/Metatarsal Sup Standard Fee $20.00 L3030 Foot Arch Support Remov Prem Standard Fee $52.50 L3050 Foot pad Standard Fee $20.00 L3170 Foot Plastic Heel Stabilizer Standard Fee $23.00 L3215 Orthopedic Ftwear Ladies Oxf Standard Fee $27.00 L3260 Ambulatory Surgical Boot Eac Standard Fee $58.00 L3310 Shoe Lift Elev Heel/Sole Neo Standard Fee $9.00 L3420 Full Sole/Heel Wedge Btween Standard Fee $17.50 L3450 Shoe Heel Sach Cushion Type Standard Fee $44.00 L3670 Acromio/Clavicular Canvas&we Standard Fee $150.00 L3700 Elbow Orthoses Elas W Stays Specialty $15.00 L3701 Prefab Elbow Orthosis Specialty $24.00 L3702 Eo W/O Joints Cf Standard Fee $265.00 L3710 Elbow Elastic With Metal Joi Specialty $63.00 L3760 Eo Withjoint Standard Fee $188.00 L3807 Whfo Standard Fee $266.00 L3908 Wrist Cock-Up Non-Molded Standard Fee $17.00 L3909 Prefab Wrist Orthosis Standard Fee $40.00 L3911 Prefab Hand Finger Orthosis Standard Fee $20.00 L3917 Galveston Metacarpal Brace Standard Fee $86.00 L4360 Pneumati Walking Boot Prefab Standard Fee $138.00 L4386 Non-Pneum Walk Boot Prefab Standard Fee $183.00 L4387 Short Walking Boot Standard Fee $53.00 L4396 Static Afo Standard Fee $54.00 Q0091 Obtaining Screen Pap Smear Standard Fee $31.00 Q4132 Grafix Core-Skin graft Standard Fee $1,400.00 Q4133 Grafix Prime-skin graft Standard Fee $1,400.00 Q4154 Biologic Dressing Standard Fee $218.00 Q9984 KYLEENA IUD Standard Fee $857.00 S0020 Injection Standard Fee $3.00 S0610 Annual Gynecological Examina Standard Fee $227.00 S0612 Annual Gynecological Examina Standard Fee $176.00 S0613 Ann Breast Exam Specialty $196.00 S0613 Ann Breast Exam Standard Fee $109.00 S2083 Adjustment Gastric Band Standard Fee $50.00 S8096 Portable Peak Flow Meter Standard Fee $34.00 S8429 Gradient Pressure Wrap Standard Fee $135.00